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Medicai  Times  and  Gazette. 


Dec.  29,  1813. 


THE 


Mica!  ©junta  aiul  dagutt*. 


JOURNAL  OF  MEDICAL  SCIENCE, 


LITERATURE,  CRITICISM,  AND  NEWS. 


VOLUME  II.  FOP,  18S3. 


PUBLISHED 


LOXDOX : 

BY  J.  &  A.  CHURCHILL,  11,  NEW  BURLINGTON  STREET 


AND  SOLD  BY  ALL  BOOKSELLERS. 


MDCCCLXXXIII. 


Meiical  Times  aoa  Ua:e  te. 


Dec.  29,  TS83. 


LONDON: 

F ADDON  AND  SONS,  PDINTEDS, 
PATERNOSTDD  DOW. 


THORNTON  ox  fibro-myoma  of  the  uterus. 


July  7,  1883.  1 


'V 


CLINICAL  LECTURE 

ON  THE  SURGICAL  TREATMENT  OF  FIBRO- 
MYOMA  OF  THE  UTERUS. 

Delivered  at  the  Samaritan  Hospital,  Jan.  24,  1883. 

By  J.  KNOWSLEY  THORNTON,  M.B.,  C.M., 

Surgeon  to  the  Hospital. 


The  case  upon  which  I  am  going  to  operate  to-day  is,  in 
many  respects,  typical  of  the  kind  of  fibroid  or  fibro-myoma 
of  the  uterus  which  requires  surgical  treatment.  I  therefore 
take  the  opportunity  of  making  some  remarks  upon  the 
nature  of  the  operations  which  we  may  perform.  In  all 
these  cases  the  first  point  for  decision  is — Does  this  enlarge¬ 
ment  of  the  uterus  so  endanger  the  life  of  the  patient,  or 
so  completely  render  her  unfit  for  her  ordinary  avocations, 
that  we  are  justified  in  performing  an  operation,  attended 
with  more  or  less  risk  to  her  life,  for  its  cure  ?  In  the  case 
I  bring  before  you  to-day  I  am  convinced  that  some  opera¬ 
tion  is  necessary  and  justifiable.  The  patient  is  a  poor 
woman  (a  domestic  servant),  and  is  quite  unable  to  follow 
her  calling.  She  is  single,  and  forty-five  years  of  age  ;  has 
never  had  any  serious  illness  before.  Menstruation  came 
on  late  in  life,  and  was  perfectly  regular  till  her  thirty-ninth 
year,  when  it  suddenly  became  excessive,  and  has  continued 
so  ever  since,  with  the  exception  of  two  months,  when  she 
was  at  death’s  door  from  constant  flooding,  and  it  ceased 
•altogether.  She  has  now  been  an  inmate  of  a  provincial 
hospital  for  some  months,  and  the  perfect  rest  and  regular 
diet  have  much  improved  her  condition,  but  not  sufficiently 
to  enable  her  to  return  to  work ;  and  for  eight  or  nine  days 
in  each  month  she  is  obliged  to  be  laid  up  entirely.  Her 
menstruation  began  late,  and  she  may  still  have  five  years 
or  more  to  wait  for  any  chance  of  natural  cure  by  the  meno¬ 
pause.  The  abdomen  is  distended  by  a  round,  soft,  elastic, 
and  non- fluctuant  tumour,  which  is  found  on  vaginal  exa¬ 
mination  to  involve  the  whole  uterus,  almost  obliterating  its 
•cervical  portion.  Clearly  it  is  a  case  calling  for  aid,  if  such 
be  possible.  The  only  thing  in  her  condition  to  which  I 
specially  direct  your  attention  is  that  with  perfect  rest  and 
regular  diet  she  has  much  improved  in  general  health, 
though  the  haemorrhages  continue  severe.  Now,  if  she 
were  a  lady  in  easy  circumstances,  I  think  this  would,  or 
•should,  have  much  weight  in  deciding  against  operative 
Interference.  The  tumour  is  only  growing  slowly,  and  there 
are  but  five  or  six  years  to  run  before  the  menopause.  If, 
with  care,  life  can  be  passed  in  tolerable  comfort  up  to  that 
time,  I  do  not  think  we  are  justified  in  recommending  any 
operation  which  may  cut  it  suddenly  short.  But  our  patient 
must  work  or  starve ;  and  if  she  works,  her  disease  is  very 
likely  to  kill  her,  and  will  certainly  soon  again  render  her 
unfit  for  work. 

Having,  then,  decided  that  operation  is  justifiable,  the 
next  question  is — What  operation  shall  we  perform  P  In 
these  cases  we  can  choose  between  an  operation  which 
brings  on  an  artificial  menopause,  and  so  gradually  removes 
the  tumour —I  refer  to  the  removal  of  the  uterine  appendages 
— or  we  can  remove  the  whole  of  the  supra- vaginal  portion 
of  the  uterus,  together  with  the  ovaries  and  fallopian  tubes. 
There  are,  of  course,  cases  of  pediculate  outgrowth  (fibro- 
myoma)  which  can  be  treated  by  simple  removal  of  the 
.growth,  without  interfering  either  with  the  uterus  or  its 
appendages,  but  these  cases  are  comparatively  rare,  and  are 
much  less  dangerous  than  the  two  kinds  of  operation  that 
we  are  now  considering.  »They  are,  moreover,  nearly  always 
mere  operations  of  expediency,  and  we  will  not  stop  to 
discuss  them  now. 

I  have  already  said  that  in  cases  like  the  one  now  before 
us  we  can  select  one  of  two  operations.  I  must,  however, 
qualify  this  statement  to  some  extent,  because  we  may  in 
any  case  open  the  abdomen  intending  merely  to  remove  the 
uterine  appendages,  and  may  after  all  be  induced  to  per¬ 
form  complete  supra- vaginal  hysterectomy  ;  or  we  may  even 
be  compelled  to  perform  the  latter  operation  by  some  accident 
occurring  in  the  performance  of  the  former.  So  also  we 
may  decide  beforehand  to  perform  hysterectomy,  and  when 

Yol.  II.  1883.  No.  1723. 


the  abdomen  is  opened  may  decide  merely  to  remove  the 
uterine  appendages.  In  commencing  an  operation  for  the 
cure  of  uterine  tumour  the  surgeon  should,  therefore,  be 
fully  prepared  for  either  operation.  The  patient  should 
also  be  told  beforehand  that  though  it  is  the  intention  of 
the  surgeon  to  perform  one  or  other  of  the  two  operations, 
it  cannot  be  a  matter  of  absolute  certainty  until  the  abdo¬ 
men  is  opened,  so  that  she  must  leave  something  to  the 
judgment  of  the  operator. 

Keeping  in  mind  this  uncertainty,  we  still,  of  course,  in 
every  case  endeavour  to  decide  beforehand  which  operation 
will  be  the  safest  and  the  best  for  the  patient.  In  our  present 
case  it  is  my  intention  to  remove  the  uterine  appendages, 
and  I  select  this  operation  for  the  following  reasons : — 

1.  It  is  a  soft  vascular  enlargement  of  the  whole  or  nearly 
the  whole  uterine  wall ;  and  experience  has  shown  me  that 
these  are  the  cases  which  give  the  most  rapidly  satisfactory 
results  after  this  operation. 

2.  It  involves  the  cervical  portion  of  the  uterus  so  deeply 
that  the  vaginal  portion  is  almost  obliterated ;  and  such  cases 
are  not  at  all  favourable  for  complete  hysterectomy,  because 
the  stump  is  too  thick  and  large,  and  is  very  difficult  to 
bring  up  into  the  abdominal  incision. 

It  is  worthy  of  note  that  this  patient  is  stout  rather  than 
thin,  and  has  a  good  deal  of  colour.  Both  these  conditions 
are  common  with  uterine  fibro-myoma.  If  a  patient  comes 
to  me  with  an  abdominal  tumour,  and  is  stout  and  of  full 
colour,  especially  this  general  colouring  of  face,  I  usually 
suspect  uterine  disease,  rather  than  ovarian.  Patients  are 
often  fat,  even  when  perfectly  blanched  with  prolonged 
htemorrhage,  and  it  is  surprising  how  quickly  they  regain 
this  colouring  of  the  face  when  the  period  is  over,  even 
though  their  mucous  membranes  and  half-filled  arteries 
distinctly  tell  the  history  of  severe  haemorrhage. 

Another  point  of  interest  is  that  she  herself  had  never 
noticed  the  abdominal  enlargement  till  it  was  pointed  out  to 
her  by  her  medical  attendant,  nine  months  back,  though  it 
was  then  reaching  nearly  to  the  navel.  I  have  seen  a  patient 
with  an  enormous  solid  tumour  filling  the  whole  abdomen, 
and  pressing  up  the  tip  of  the  ensiform  cartilage,  happily 
unconscious  of  its  presence,  and  merely  thinking  herself  a 
little  large  owing  to  her  time  of  life. 

It  is  now  a  fortnight  since  the  last  menstruation,  and  the 
patient  tells  me  that  she  is  always  at  her  best  about  this 
time  ;  partly  on  this  account  I  select  this  time  for  operation, 
but  also  because  I  have  found  by  experience  that  the  old 
plan  of  operating  soon  after  the  period  is  over  is  a  mistake. 
In  the  operations  for  removal  of  the  uterine  appendages  a 
more  or  less  free  metrostaxis  comes  on  within  twenty-four 
to  seventy-two  hours ;  if  the  proper  time  for  this  is  near  it 
comes  better  and  with  less  constitutional  disturbance.  The 
same,  of  course,  applies  to  many  cases  of  ovariotomy,  but 
the  metrostaxis  is  not  after  this  latter  operation  so  common, 
though  it  is  sufficiently  so  to  make  this  period  of  operation 
a  matter  worthy  of  consideration.  I  now  proceed  to  incise 
the  abdominal  parietes  to  an  extent  of  four  inches,  begin¬ 
ning  a  little  below  the  navel,  and  carrying  the  knife  boldly 
through  the  skin  and  subcutaneous  fat  down  to  the  muscular 
layer.  The  haemorrhage  from  small  vessels  is  free,  requiring 
many  pairs  of  compression  forceps  to  be  applied  before  the 
incision  is  carried  through  the  deeper  structures,  and,  as 
you  see,  it  continues  free  from  small  vessels  in  the  deeper 
structures.  This  free  haemorrhage  in  cutting  through  the 
parietes  is  in  itself  a  strong  evidence  that  the  case  is  one 
of  uterine  tumour ;  the  only  other  conditions  in  which  it  is 
met  with  are  those  in  which  the  parietes  have  been  long 
and  closely  adherent  to  an  ovarian  tumour,  or  in  which  the 
peritoneum  is  thickened  by  malignant  disease.  I  now  open 
the  peritoneum  to  the  extent  of  my  external  incision,  and 
find  it  necessary  to  prolong  the  incision  upwards  to  an  inch 
above  and  to  the  left  of  the  navel,  making  it  fully  six  inches. 
It  is  important  in  prolonging  the  incision  above  the  navel  to 
cut  to  its  left  side ;  on  the  right  the  ligament  of  the  liver  may 
very  likely  be  wounded,  and  with  it,  in  some  cases,  a  large 
vessel  (the  remains  of  the  umbilical  vein).  We  now  see  that 
the  tumour  is  very  vascular,  and  that  it  is  a  symmetrical 
enlargement  of  the  whole  uterus.  Passing  my  hand  into 
the  pelvis,  I  find  the  broad  base,  which  I  had  made  out 
by  vaginal  examination,  and  this  renders  it  a  very  un¬ 
favourable  case  for  hysterectomy.  Now  you  see  on  this  left 
side  a  small  ovary,  with  normal  fallopian  tube,  but  an  enor¬ 
mous  enlargement  of  the  ovarian  vessels  and  pampiniform 


Medical  Times  and  Gazette. 


THORNTON  ON  FIBRO- MYOMA  OF  THE  UTERUS. 


JaJy  7, 1883- 


plexus.  I  transfix  with.  No.  3  Chinese  twist,  so  as  to  include 
all  these  vessels  in  my  two  loops,  and,  taking  care  that  the 
loops  interlock,  I  tie  first  the  inner  one,  which  contains  most 
of  the  arteries,  and  then  the  outer  one,  which  holds  this 
pampiniform  plexus.  I  do  not  at  present  remove  the  ovary 
and  tube,  but  push  them  back  into  the  peritoneum  with  a 
pair  of  forceps  on,  while  I  deal  with  this  right  side.  My 
reason  for  this  is  that  the  strain  on  the  ligatures  is  very 
great  in  these  cases  while  one  is  twisting  round  the  large 
uterus  and  drawing  up  the  other  ovary  and  tube,  and  the 
risk  of  slipping  of  the  ligature,  and  consequent  haemorrhage, 
proportionately  great :  hence  I  leave  the  cutting  away  of  the 
ovaries  and  tubes  till  both  are  secured,  and  the  peritoneum 
sponged  out  behind  the  uterus ;  then,  when  the  stumps  are 
dropped,  they  are  left  at  rest.  The  importance  of  this  is  well 
seen  in  this  case,  for  you  see  how  difficult  it  is  to  drag  this 
right  ovary  and  tube  into  view,  and  how  much  strain  there 
must  be  upon  the  other  ligament,  shortened  as  it  is  by  my 
transfixing  ligatures.  This  right  ovary  is  rather  larger  than 
the  left,  but  both  it  and  its  tube  appear  healthy ;  the  vessels 
are  even  larger  on  this  side  than  on  the  other.  Now  I  have 
transfixed  a  little  too  near  the  uterus,  and  the  needle 
has  pricked  a  large  vein  or  sinus,  and  see  what  a  large 
and  continuous  spurt  of  blood  comes  from  it;  the  tying 
of  the  interlocking  ligatures  does  not  fully  check  it,  so 
I  pass  a  separate  one  on  to  the  pedicle  a  little  behind 
the  puncture ;  this  stops  the  haemorrhage,  and  the  ovary 
and  tube  are  cut  away.  The  left  ovary  and  tube  are  now 
carefully  drawn  into  view  again,  and  after  cutting  them 
away  I  apply  a  separate  ligature  round  the  whole  stump 
over  the  transfixing  ligatures.  This  I  do  in  every  case, 
both  in  this  operation  and  in  ovariotomy.  I  now  pass  a 
small  soft  sponge  carefully  down  into  the  pouch  of  Douglas 
Avith  this  pair  of  smooth,  straight  uterine  polypus  forceps. 
I  much  prefer  these  to  any  form  of  sponge-holder,  as  they 
are  much  smoother,  and  therefore  more  certain  to  be  clean. 
Everything  is  quite  dry,  and  I  therefore  arrange  the  flat 
sponge  over  the  intestines  and  introduce  the  sutures.  I 
use  for  this  purpose  No.  1  Chinese  twist  simply  soaked  in 
one-to-twenty  watery  solution  of  carbolic  acid;  oil  or  Avax 
only  makes  it  irritate  and  cause  suppuration.  You  see 
that  I  begin  with  a  silk  threaded  with  two  needles,  and 
pass  them  from  the  inside,  taking  up  merely  the  edge  of 
the  peritoneum,  going  a  little  deeper  into  the  fascia  and 
subcutaneous  tissues,  and  bringing  the  needle  out  about  a 
quarter  of  an  inch  from  the  skin  edge.  I  take  great  care  to 
include  all  the  tissues  of  the  abdominal  wall,  but  avoid  the 
muscle,  taking  up  both  layers  of  the  sheath  on  the  side 
on  which  it  is  divided.  I  avoid  the  muscle  because  if  it  is 
included  it  adds  much  to  the  suffering  of  the  patient,  and 
interferes  with  the  healing  from  its  constant  spasmodic 
twitching.  I  attach  much  importance  to  the  method  of 
closing  the  incision,  and  am  careful  not  to  pull  the  sutures 
too  tight  or  they  Avill  cut.  In  an  abdominal  wall  of  this 
thickness  the  loop  of  the  suture,  when  removed  at  the  end 
of  eight  or  nine  days,  should  measure  a  full  inch  and  a  half 
from  the  knot ;  then,  with  careful  strapping  for  some  weeks 
until  the  cicatrix  is  firm,  there  need  be  no  fear  of  that  far 
too  common  accident  after  abdominal  section — ventral 
hernia.  The  sutures  being  all  introduced,  the  flat  sponge 
is  pressed  back,  and  a  small  soft  sponge  again  carefully 
introduced  with  the  forceps  into  the  pouch  of  Douglas 
and  the  anterior  cul-de-sac.  Both  are  found  dry,  and  the  flat 
sponge  is  removed  and  the  sutures  tied  ;  after  they  are  cut 
short  a  flat  sponge  is  placed  over  the  incision  while  the 
apron  is  removed,  so  that  no  particle  from  it  or  its  plaster 
should  drop  on  to  the  wound,  which  is  then  dressed  with 
carbolic  gauze.  A  small  pad  of  six  or  eight  layers  is  first 
applied,  just  to  overlap  the  ends  and  sides  of  the  incision, 
the  surface  of  it,  Avhich  goes  next  to  the  wound,  being  wetted 
with  the  lotion  in  the  instrument- tray.  This  pad  is  soon 
soaked  with  the  blood  and  serum  from  the  wound,  and  thus, 
deprived  of  much  of  its  dressing,  it  becomes  an  efficient  pro¬ 
tective  to  the  wound  from  the  stronger  carbolic  acid  in  the 
dry  layers  of  gauze  which  are  afterwards  applied ;  in  all, 
the  wound  is  covered  with  about  twenty- four  layers  of  gauze. 
You  see  that  I  now  use  a  very  small  dressing,  which  only 
overlaps  the  wound  about  two  inches  and  a  half  on  all  sides. 
This  plan  I  have  adopted  from  a  consideration  of  the 
narrow  space  over  which,  from  the  lower  angle  of  the  wound 
to  the  pubes,  it  is  possible  to  apply  an  antiseptic  dressing  ; 
this  space  is  also  the  most  dependent,  and  it  is  there,  if  any¬ 


where,  that  discharge  is  likely  to  run  doAvn  ;  there  is,  then, 
no  object  in  having  wider  margins  of  antiseptic-  dressing 
round  other  parts  of  the  wound,  and  there  is  the  disadvan- 
.  tage  that  a  larger  dressing  prevents  the  full  grip  of  the 
plaster  and  deprives  the  wound  of  much  support,  especially 
when  there  are  straining  and  sickness.  Between  the  two- 
outer  layers  of  the  dressing  there  is  a  piece  of  pink  mackin¬ 
tosh  slightly  smaller  than  the  gauze,  and  the  dressing  is 
now  fixed  in  place  Avith  straps  of  adhesive  plaster,  each 
about  three  inches  wide,  and  applied  so  as  to  overlap  about 
half  an  inch,  while  they  are  long  enough  to  get  a  firm  grip 
of  the  loins.  Outside  the  plaster  and  over  the  wound  is 
now  placed  this  folded  towel,  which  comes  a  little  below 
the  lower  margin  of  the  plaster,  so  that  if  a  little  blood 
or  serum  runs  down  during  the  first  few  hours  it  is  quickly 
dried  up  ;  the  towel  also  serves  as  a  firm  pad,  over  which 
this  flannel  bandage,  lined  with  calico,  is  firmly  pinned  Avith 
three  safety-pins.  The  patient  is  now  placed  in  bed  with, 
the  head  and  shoulders  well  supported  by  an  inclined  plan 
of  pillows,  the  knees  being  raised  and  a  pillow  placed  under- 
them.  She  is  kept  in  this  position  for  at  least  ten  days,  and 
usually  till  she  gets  up  at  the  end  of  a  fortnight.  The  dress¬ 
ing  I  have  now  applied  will  not  be  removed  till  the  eighth 
or  ninth  day,  by  which  time  I  can  confidently  predict  com¬ 
plete  union  of  the  wound  Avithout  redness  or  irritation,  and 
of  course  without  suppuration.  I  have  not  seen  a  suppu¬ 
rating  wound  in  my  own  practice  after  abdominal  section, 
for  several  years.  The  sutures  will  all  be  removed  at  this- 
first  dressing  without  the  spray,  the  wound  being  moistened 
as  I  remove  the  old  dressing,  with  some  warm  one-to-forty 
carbolic  lotion.  A  still  smaller  gauze  dressing  than  the  one 
I  have  now  applied  will  then  be  used,  so  that  the  straps  come 
almost  to  the  edges  of  the  incision.  In  a  few  mo-re  days  this 
gauze  is  removed,  the  straps  are  firmly  applied  right  across 
the  dry  linear  wound,  and  the  patient  is  dismissed  from  the 
nineteenth  to  the  twenty-first  day  after  operation,  with  orders 
to  change  the  strapping  every  week  or  ten  days  for  the  first 
two  months,  so  that  the  cicatrix  is  quite  strong  before 
it  is  left  merely  to  the  support  of  the  elastic  abdominal 
belt,  which  is  worn  for  some  years  after  the  operation,, 
or  permanently  if  the  incision  has  been  a  very  long  one. 
The  patient’s  pulse  and  vaginal  temperature  are  noted 
directly  she  is  placed  in  bed,  and  the  latter  is  recorded 
by  the  nurse  every  two  hours  for  the  next  few  days» 
Twenty  drops  of  laudanum  in  an  ounce  of  water  are 
injected  into  the  rectum  directly  the  patient  has  sufficiently 
recovered  from  the  anaesthetic  to  be  conscious  of  pain,  and 
this  injection  is  repeated  once  or  twice  during  the  first  few 
hours,  and  then  every  six  or  eight  hours  for  the  first  three 
or  four  days,  or  until  all  pain  has  entirely  gone,  and  the 
flatus  passes  freely  without  the  use  of  the  tube.  Nothing 
but  a  little  ice,  warm  water  sipped,  or  plain  soda-water  is 
given  for  the  first  twelve  or  twenty-four  hours  by  the  mouth,, 
or  for  a  longer  period  if  there  is  any  sickness  or  difficulty  in 
getting  the  flatus  to  pass  down;  injections  of  two  or  three 
ounces  of  strong  beef -tea  made  without  salt,  and  with  or 
without  half  an  ounce  of  port  wine,  being  given  every  tAVO 
or  three  hours  if  required  by  the  condition  of  the  patient. 
Should  the  state  of  the  kidneys  or  other  organs  indicate  any 
medicinal  treatment,  the  medicine  is  given  in  these  enemata, 
and  never  by  the  mouth.  Milk  and  soda-water,  small 
quantities  of  bread-and-milk,  or  Brand’s  essence  with  bread, 
or  clear  beef-tea,  are  given  after  all  chance  of  sickness  is 
over,  every  two  or  three  hours  by  the  mouth,  and  then  about 
the  third  day  a  little  tea  and  toast  morning  and  evening,, 
with  boiled  sole  for  dinner,  are  added  to  the  diet. 

With  regard  to  this  special  operation  which  I  have  just 
completed,  I  much  regret  the  puncture  of  the  vessel  or  sinus 
on  the  right  side  of  the  uterus,  and  though  the  ligature  has 
checked  the  hsemorrhage  for  the  time,  I  much  fear  that  it 
may  recur  when  the  tissues  relax  from  the  shrinking  of  the 
tumour,  or  later  when  they  are  strained  upon  by  the  con¬ 
gestion  of  the  organs  Avhich  precedes  the  metrostaxis.  In 
a  similar  case  some  years  ago,  a  like  accident,  and  a  com¬ 
plete  failure  to  stop  the  hsemorrhage  which  followed, 
compelled  me  to  go  on  and  perform  complete  hysterec¬ 
tomy,  and  fortunately  the  patient  made  a  good  recovery. 
More  recently,  at  the  close  of  last  year,  I  was  compelled, 
through  severe  hsemorrhage  from  a  tear  in  uterine  tissue, 
to  perform  complete  hysterectomy,  when  I  had  hoped  that, 
the  milder  operation  would  be  possible.  It  was  a  most  un¬ 
favourable  case  for  either  operation,  the  ovaries  and  tubes- 


Medical  Times  and  Gazette. 


July  7, 1883.  3 


BUCHANAN'S  MEMORANDA  CONCERNING  CHOLERA. 


being  much  diseased  and  universally  adherent,  and  a  large 
mass  of  fibroid  so  situated  in  the  cellular  tissue  behind  the 
cervix  that  I  was  obliged  to  leave  it,  even  when  I  amputated 
the  uterus  at  the  level  of  the  internal  os.  It  was  impossible 
to  bring  the  stump  well  into  the  incision,  and  I  attempted, 
by  sewing  the  peritoneum  round  it,  to  make  a  sort  of  half 
intra-  and  half  extra-peritoneal  operation  of  it.  The  patient, 
however,  died  of  septicaemia  in  a  few  days. 

This  is  the  eleventh  case  in  which  I  have  removed  the  ap¬ 
pendages  for  the  cure  of  fibro-myoma.  All  the  patients  have 
made  good  recoveries  from  the  operation.  In  all  but  two  the 
disappearance  of  the  tumour  has  been  rapid,  and  in  these  two 
a  very  marked  diminution  in  the  size  has  occurred :  but  in 
one  the  haemorrhage  has  recurred  ;  it  is,  however,  only  a 
few  months  since  I  operated,  and  I  have  little  doubt  that 
before  the  year  is  over  this  one  also  will  be  among  the  per¬ 
fectly  successful  cases.  I  would  recommend  anyone  who 
performs  this  operation  to  tell  the  patient  that  she  must  not 
expect  too  rapid  a  cure,  but  must  remember  that,  in  the 
natural  order  of  things,  the  menopause  is  much  slower  and 
more  difficult  in  some  women  than  in  others,  and  that  this 
is  equally,  or  perhaps  more  likely  to  be,  the  case  when  we 
bring  it  about  in  a  sudden  manner  by  operation. 

March,  1883. — The  patient,  whose  case  was  made  the  text 
for  the  above  lecture,  had  internal  haemorrhage  which  re¬ 
curred  from  time  to  time,  and  she  was  very  ill  for  some  weeks 
after  the  operation,  but  went  home  on  the  thirty-third  day 
quite  well ;  the  tumour  soft  and  boggy,  quite  gone  from 
the  pelvis,  and  less  than  a  third  its  former  size  in  the 
abdomen. 


MEMORANDA  CONCERNING  CHOLERA. 

Delivered  before  the  Epidemiological  Society  on  July  4,  as  an 
Introduction  to  a  Paper  on  the  “  Sanitary  Lessons  of 
Indian  Epidemics.” 

By  Dr.  GEORGE  BUCHANAN,  F  R.S., 

President  of  the  Society;  Medical  Officer  to  H.M.  Local  Government  Board 

I.  Narrative. — Cholera  reached  Europe  by  way  of  Egypt 
for  the  first  time  in  1865.  Before  that  date,  its  course  from 
Asia  had  been  through  the  Russian  Empire. 

At  the  first  appearance  of  cholera  in  Europe,  over  forty 
years  ago,  it  began  in  Great  Britain  fifteen  months  after  its 
introduction  to  Europe.  At  its  second  appearance,  it  began 
with  us  in  England  after  about  the  same  interval.  Its  third 
appearance  does  not  admit  of  comparison  with  the  others. 

At  the  fourth  appearance  of  cholera  in  Europe,  when  it 
came  by  way  of  Egypt,  it  was  epidemic  in  the  Hedjaz  in 
May;  it  appeared  at  Alexandria  on  June  2  ;  was  at  Malta, 
Smyrna,  and  Constantinople  before  the  end  of  that  month ; 
and  appeared  in  Spain  and  Italy  and  at  Marseilles  during 
July.  Spreading  somewhat  widely  in  Europe  during  the 
next  two  months,  it  was  at  Southampton  on  September  17, 
and  on  November  3  it  was  witnessed  at  New  Tork.  In 
the  spring  of  1866,  cholera  acquired  an  increased  diffusive¬ 
ness  ;  and  by  June  had  attacked  many  places  in  the  United 
Kingdom,  but  hardly  any  cases  occurred  in  London  until  July. 
[The  Suez  Canal  was  opened  in  November,  1869.] 
Extension  of  cholera  from  Northern  Arabia  was  next 
threatened  in  1871 ;  and  the  disease  prevailed  to  a  small 
extent  in  Europe  during  1872  and  1873.  Since  that  date,  it 
has  occurred  several  times  among  the  pilgrims  to  the  Holy 
places,  but  has  not  established  itself  in  Egypt,  nor  has  it 
prevailed  in  Europe.  » 

Cholera  is  now  at  Damietta,  a  place  with  some  30,000  in¬ 
habitants,  about  six  miles  from  the  mouth  of  one  of  the 
branches  of  the  Nile.  The  way  of  its  arrival  thither  cannot 
be  stated.  Damietta  is  not  on  any  high  road  from  Asia  ;  and 
the  towns  above  Damietta,  on  the  Nile,  are  not  known  to 
have  been  affected  before  this  town.  No  cholera  is  known 
of  at  Suez,  nor  in  the  course  of  the  Canal,  though  from  Port 
Said  an  occasional  death  is  now  being  reported.  In  the  ten 
days  ending  last  Saturday,  about  500  deaths  from  cholera 
occurred  at  Damietta ;  on  July  1  there  were  140,  on  the  2nd 
130,  and  on  the  3rd  there  were  110  deaths.  The  disease  now 
exists  at  Mansonrah,  higher  up  the  same  branch  of  the  Nile, 
and  cases  are  appearing  in  other  towns  situated  on  the 
.railways  of  the  Delta. 


II.  Expectations. — When — Ihavebeen  asked — may  cholera 
be  expected  to  travel  through  Europe  to  England?  how 
long  after  its  present  manifestations  in  Egypt  ? 

Evidently  no  medical  data  exist  for  an  answer  to  the 
question.  We  do  not  understand  all  the  conditions  for  the 
diffusion  of  the  disease. 

But  we  in  England  do  firmly  believe,  what  many  of  our 
Indian  friends  would  deny,  that  cholera  is  influenced  in  its 
spread  by  human  intercourse.  We  do  not  affirm  that  it 
passes  from  person  to  person,  as  small-pox  or  typhus  does ; 
but  we  believe  that  it  extends,  much  after  the  fashion  with 
which  we  are  familiar  in  the  case  of  enteric  fever,  by  means 
of  the  discharges  from  the  sick,  particularly  if  those  dis¬ 
charges  are  received  into  foul  cesspools  and  drains,  or  if  they 
obtain  admission  into  drinking-water ;  and  human  inter¬ 
course  is  one  of  the  conditions  for  the  spread  of  cholera  in 
such  fashion  as  this. 

If  we  now,  for  the  sake  of  hypothesis,  suppose  other  condi¬ 
tions  for  diffusion  of  cholera  to  be  to-day  what  they  were  in 
1865,  we  may  inquire  how  far  the  conditions  of  human  inter¬ 
course  have  altered  in  such  wise  as  to  affect  the  probable 
dissemination  and  rate  of  transmission  of  cholera  in  and 
about  Europe.  In  reply,  let  it  be  remembered  that,  though 
Egypt  has  doubtless  incurred  repeated  risk  from  her  cum- 
munications  with  the  Hedjaz,  there  is  no  evidence  that  even 
Egypt  has  been  subjected  to  danger  from  cholera,  at  any 
time,  through  her  direct  maritime  communications  with 
more  Eastern  countries;  let  it  be  remembered  that  the  Suez 
Canal  has  now  been  open  for  more  than  thirteen  years  ;  and 
let  it  further  be  noted  that  the  present  outbreak  of  cholera 
in  Egypt  is  not  on  the  line  of  traffic  between  Asia  and 
Europe  ;  and  it  will  appear  improbable,  I  think,  that  the  use 
of  the  new  highway  will  affect  the  course  of  cholera  towards 
France  and  England.  Still,  it  is  not  to  be  supposed  that 
1883  will  find  us  in  every  respect  under  the  same  conditions 
of  human  intercourse  as  1865 ;  and  it  is  possible  that  some 
of  the  changed  conditions  may  be  such  as  to  affect  the  oppor¬ 
tunities  for  the  migration  of  cholera.  But,  plainly,  they  are 
not  worth  speculating  about,  in  view  of  our  complete  uncer¬ 
tainty  whether  those  conditions  for  the  diffusion  of  cholera 
which  are  independent  of  human  intercourse  are  or  are  not 
to  be  the  same  in  1883  as  in  1865. 

ni.  Precautions. — “  Quarantine,”  meaning  by  the  word  a 
system  which  professes  to  prevent  the  entry  into  a  country 
of  persons  coming  from  another  country  until  assurance  is 
attained  that  no  infection  can  be  introduced  by  those  persons, 
is  not  now  regarded  as  capable  of  fulfilling  its  pretensions  : 
and  its  least  failure  to  exclude  infection  is  seen  to  make  the 
whole  system  irrational ;  its  cost  and  its  vexations  unjustifi¬ 
able.  Accordingly,  England,  which  long  ago  abandoned  the 
system  as  of  any  avail  against  cholera,  has  now  the  consent 
of  most  European  nations  (as  expressed  by  their  delegates  to 
the  Vienna  Conference  of  1874)  in  preferring  for  the  defence 
of  her  ports  another  system  which,  under  the  name  of 
“  Medical  Inspection,”  aims  at  obtaining  the  seclusion  of 
actually  infected  persons,  and  the  disinfection  of  ships  and 
of  articles  that  may  have  received  infection  from  the  sick. 

The  details  of  this  system,  as  formulated  for  practical 
application  in  the  ports  and  waters  of  England,  are  set  forth 
in  an  Order  of  the  Local  Government  Board  of  July  17, 
1873.  Provision  is  there  made  for  the  detention  of  ships  at 
appointed  places  ;  for  the  visiting  and  medical  examination 
of  ships  and  passengers ;  for  the  removal  to  hospital  of 
persons  suffering  from  cholera  or  suspected  cholera,  and  for 
their  detention  there ;  for  the  speedy  burial  of  the  dead; 
for  the  disinfection  or  destruction  of  clothing  and  bedding  ; 
and  for  the  purification  of  the  ship  and  of  articles  therein. 

This  Order  is  at  present  operative.  From  a  statement 
by  Earl  Granville,  I  learn  that  it  is  proposed  to  re-issue  the 
Order,  though  without  change  in  essentials.  It  represents 
the  system  upon  which  we  rely,  in  preference  to  quarantine, 
for  the  protection  of  our  shores.  For  the  last  ten  years  the 
country  has  been  thus  prepared  for  the  invasion  of  cholera, 
and  the  fact  of  this  preparedness  should  be  known. 

We  have  reason  to  hope  that,  if  cholera  should  enter 
England,  it  will  find  fewer  opportunities  for  doing  mischief 
than  at  previous  invasions.  We  are  generally  better  pro¬ 
vided  with  defences  against  a  disease  which  spreads  as 
cholera  can  spread.  Some  further  precautions  for  use  at 
the  moment  will  doubtless  be  requisite ;  but  it  will  be  on 
our  permanent  sanitary  works  and  procedure  that  we  shall 
with  most  confidence  rely. 


4 


Medical  Times  and  Gazette. 


RAWLINSON  OK  THE  HYGIENE  OF  ARMIES  IN  THE  FIELD. 


July  7,  188J. 


AN  ADDRESS 

ON 

THE  HYGIENE  OF  ARMIES  IN  THE  FIELD. 

Delivered  at  the  Parties  Museum,  June  21,  1883. (a) 

By  ROBERT  RAWLINSON,  C.B., 

Chief  Engineering  Inspector  to  the  Local  Government  Board. 


This  subject  is  so  vast,  special,  and  complicated,  tbat  I  can 
only  promise  to  touch  the  fringe  of  it,  and  this  in  a  round¬ 
about  way.  I  will  not  presume  to  lay  down  bard  and  fast 
rules  by  which  armies  in  the  field  shall  be  regulated  in 
sanitary  matters  in  the  future,  but  rather  describe,  in 
narrative  form,  some  of  my  own  experience,  gained 
during  the  time  I  acted  as  the  engineer  member  of  a  Sani¬ 
tary  Commission  sent  out  to  the  army  in  the  Crimea  in 
the  spring  of  1855. 

After  reading  the  instructions  issued  to  this  Commission, 
Mr.  Rawlinson  said  :  If  General  Orders  could  in  all  cases  have 
been  made  applicable,  and  could  have  been  obeyed,  outside 
comment  might  cease,  and  the  aid  of  a  specially  appointed 
Sanitary  Commission  during  the  Crimean  War  might  not 
have  been  needed.  It  may,  however,  from  experience,  be 
assumed  that  there  never  will  be  General  Orders  framed 
sufficient  to  cover  all  contingencies  ;  and  we  may  also  assume 
that  there  will  be  neglect  now  and  then,  from  various  causes. 
Some  of  the  links  in  the  chain  of  regulations  will  break,  and 
confusion  will  follow.  The  General  Orders  for  the  army 
under  the  command  of  the  Duke  of  Wellington  in  the 
Peninsula,  in  the  Low  Countries,  and  in  France,  1809  to 
1815,  cannot  probably  be  improved  upon.  Lord  Raglan  was 
secretary  to  the  Duke,  and  he  must  consequently  have  been 
acquainted  with  the  Duke’s  General  Orders ;  and  yet  we  see 
the  utter  confusion  into  which  affairs  drifted  in  the  Crimea. 
The  siege  of  Sebastopol  became,  however,  exceptional. 

To  whom  the  failure  in  the  Crimea  was  due,  it  is  impos¬ 
sible  now  to  say.  It  was  not,  however,  to  any  individual,  but 
rather  to  the  absence  of  an  independent  sanitary  department 
with  the  army,  and  to  the  want  of  one  home  department  to 
direct  and  control,  having  also  power  to  order  all  stores,  and 
to  inspect  their  shipment,  and  to  see  that  the  several  stores 
were  so  arranged  in  the  transports  that  they  should  be 
available  in  the  order  of  their  necessity,  and  not  to  have 
surgical  appliances  and  medicines  placed  beneath  a  massive 
bulk  of  ammunition.  Blunders  of  this  class  do  not  appear 
to  have  been  avoided  even  in  the  recent  Egyptian  campaign. 
The  Royal  Commission,  which,  under  the  Presidency  of  Lord 
Herbert  of  Lea,  inquired  into  the  sanitary  state  of  the  army 
after  the  Crimean  War,  resulted  in  Lord  Herbert’s  regula¬ 
tions.  One  of  these  regulations  provided  that  a  sanitary 
officer  should  be  attached  to  the  quartermaster-general’s 
staff.  To  this  officer  was  to  be  committed  the  duty  of  exa¬ 
mining  into  the  sanitary  condition  of  buildings  selected  for 
occupation  by  troops,  and  into  the  sanitary  condition  of  towns 
or  villages  about  to  be  occupied ;  he  was  also  to  make  recom¬ 
mendations  for  organising  a  proper  sanitary  police,  to  preserve 
cleanliness,  and  for  the  removal  of  nuisances.  But  it  will 
be  seen  that  practical  lessons,  however  well  taught,  and  also 
that  subsequent  official  inquiries,  however  ably  conducted, 
have  led  up  to  very  little  that  has  proved  to  be  really  useful 
when  the  country  again  enters  upon  war.  The  army  medical 
arrangements  had  drifted  back  into  the  old  groove,  the  old 
forms  of  blunders  and  the  old  stories  are  repeated — namely, 
that  the  existing  regulations  are  supposed  to  be,  if  not  per¬ 
fection,  all  that  is  requisite.  In  Government  departments, 
I  am  sorry  to  say  that  there  is  not,  on  all  occasions,  due 
respect  shown  to  the  feelings  of  permanent  officials ;  and,  in 
our  case,  we  were  not  put  into  communication  with  the  heads 
of  the  permanent  Medical  Department  before  leaving  London, 
which,  no  doubt,  gave  offence,  but  for  which  the  members  of 
the  Commission  were  in  no  sort  of  way  answerable. 

When  the  Sanitary  Commission  arrived  at  the  seat  of 
their  labours,  they  found  the  buildings  used  as  hospitals  in 
an  unsanitary  condition ;  the  sewers  of  the  great  hospital 
were  foul,  and  required  frequent  and  thorough  flushing,  and 


their  lower  ends  were  covered  to  prevent  the  wind  blowing- 
up  them  into  the  building  ;  the  carcases  of  a  certain  number 
of  animals  which  lay  in  the  neighbourhood  of  the  hospital 
were  removed  and  buried,  and  many  handcart-loads  of  filth 
were  also  removed.  The  work  of  scavenging  was  carried  on 
systematically  until  the  hospital  ceased  to  be  needed,  owing 
to  the  departure  of  the  troops. 

Mr.  Rawlinson  then  continued  as  follows  : — The  Blue- 
book  Report  (1883)  on  the  organisation  of  the  Army  Hospital 
Corps  in  Egypt  reveals  many  blunders  of  a  type  as  old  as- 
the  service,  such  as  confusion  in  transmitting  materials 
for  use ;  and  something  worse  than  confusion  in  contract, 
supplies,  both  of  materials  and  of  provisions.  Can  there 
be  no  better  service  in  future  ?  War  is  a  blundering,  extra¬ 
vagant,  and  destructive  business  under  any  aspect ;  and  the 
best-framed  regulations  come  to  be  disregarded,  and  even 
where  adhered  to,  they  may  at  times  be  the  worst  possible 
extravagance.  The  Egyptian  Report  (1883)  most  fully  sets 
forth  the  confusion  into  which  the  regulations  fell,  and  the 
suffering  which  resulted.  Detachments  of  the  army  had, 
however,  to  be  removed  suddenly,  and  the  impedimenta* 
necessary  for  use  could  not  follow  as  rapidly.  Then  pro¬ 
vision  was  made  for  contingencies  which  never  happened, 
and,  most  fortunately  for  the  men,  the  war  came  to  an 
abrupt  and  unexpected  termination. 

Men  in  war  are  loaded  like  beasts  of  burthen.  They  have, 
to  march  under  their  impedimenta  ;  the  whole  body  may  be 
bathed  in  perspiration  ;  feeding  must  be  irregular,  and 
water  may  be  absent  or  may  be  polluted,  and  in  one  night’s 
bivouac  the  body  may  be  chilled,  so  that  fever  to  a  large 
proportion  of  the  men  must  be  the  result;  and  that  there 
must  necessarily  be  great  loss  of  human  life  in  actual  war 
will  be  self-evident  to  anyone  who  knows  the  least  possible 
about  the  subject.  No  forethought  can  fully  guard  against 
excessive  changes  in  weather.  The  fighting  portion  of  a 
soldier’s  life  is  of  short  duration.  It  is  not  in  battle  that 
armies  are  destroyed,  but  on  the  field,  in  camp,  and  in 
hospital. 

Any  buildings  to  be  used  by  sick,  or  by  broken-down  and 
wounded  men  may,  as  taught  by  Sir  John  Pringle,  have 
the  windows  removed  to  prevent  injury  by  polluted  air, 
and  any  improved  apparatus  provided  for  water-supply  be 
brought  into  use.  Food  in  a  concentrated  and  portable 
form  may  also  be  served  out,  and  the  horrible  salt  junk 
and  ration-pork  be  in  future  dispensed  with.  A  spirit- 
ration  is  liable  to  be  most  injurious  in  several  ways,  and 
should  not  be  used  except  as  a  medicine. 

For  water-supply,  light  carts  of  steel,  similar  in  form  to 
watering-carts  in  towns,  may  be  of  great  utility,  as  one, 
horse  or  one  mule  would  easily  draw  to  a  distance  of  one  or 
two  miles  from  100  to  200  gallons  of  water,  to  be  served  out 
to  the  men  in  the  positions  occupied.  Portable  water-filters 
can  also  be  easily  arranged,  to  be  similar  in  form  to  the 
light  steel  water-carts  ;  so  that  water  for  hospital  purposes 
may  be  filtered  even  in  its  transmission. 

Where  an  army  for  a  time  becomes  stationary,  a  sanitary 
corps  will  find  ample  work  to  do  in  improving  roads,  in 
surface-draining,  in  scavenging,  and  in  ventilating  any 
permanent  buildings  used  as  hospitals ;  and  if  the  service 
will  permit  of  a  use  of  working  parties,  enormous  benefits 
may  be  secured  to  the  entire  force  in  the  field.  A  skilled 
sanitary  officer  will  be  a  man  of  many  expedients  springing 
from  close  and  intelligent  observations ;  and  in  his  works 
he  will  strive  to  save  labour.  Every  country  has  its  cha¬ 
racter  impressed  on  its  surface  contours,  and  these  the 
geologist  and  engineer  will  read  at  a  glance.  Wide  and  flat 
areas  will  indicate,  as  a  rule,  a  soft  subsoil ;  a  steep  gradient 
will  indicate  a  subsoil  of  some  hard  material,  such  as  gravel; 
rock  will  generally  show  above  the  surface ;  where  there  are 
mountains,  there  will  usually  be  at  the  base  mounds  of 
material,  particles  weathered  from  the  rock  and  admirably 
suited  for  road-forming,  as  it  may  be  excavated  and  sorted 
so  as  to  save  the  labour  of  quarrying  and  breaking  for  road¬ 
making.  In  future  wars  it  is  admitted  that  picks  and  spades 
may  require  to  be  used  as  much,  if  not  even  more,  than 
rifles.  All  officers  will,  therefore,  have  to  learn  something 
of  engineering.  If  soldiers  can  use  pick  and  spade  to- 
provide  earthwork  shelter  from  rifle-bullets,  they  may  also 
use  these  implements  for  sanitary  purposes.  A  working 
army  will  be  more  contented  if  they  find  that  their  labour 
tends  to  their  safety  and  comfort.  Idleness  is  an  incentive 
to  vice,  and  leads  to  insubordination.  A  modern  army  will 


(a)  The  Address  has  beea  somewhat  condensed. 


Medical  Times  and  Gazette. 


CHADWICK  OK  ARMY  SANITATION. 


July  7,  1883. 


lie  a  very  different  body  of  men  to  those  forming  the 
Peninsular  army  under  Wellington,  and  must  be  treated 
very  differently.  Flogging  is  for  ever  done  with,  and  it  is 
most  disgraceful  to  have  any  attempt  at  its  renewal. 

The  General  Orders  of  the  Duke  of  Wellington  are  con¬ 
sidered  good  examples  ;  but  the  Duke  in  the  Peninsula  ever 
did  something  more  than  unceasingly  refer  to  even  his  own 
General  Orders.  His  personal  observation  was  incessant, 
Pis  perception  rapid  ;  and  consequently  his  instructions, 
outside  any  order-book,  were  practical,  being  suited  to  the 
-conditions  and  requirements  of  place  and  time.  The  sug¬ 
gestions  of  the  Great  Duke  point  to  something  to  be  done  by 
commanders  of  regiments  outside  of  cut-and-dried  formal 
regulations. 

I  think  it  may  be  gathered  from  my  remarks,  that  I  do 
not  set  myself  up  as  a  practical  teacher  of  army  hygiene  in 
the  field.  The  purport  of  this  paper  is  rather  to  show  that, 
to  preserve  an  army  in  health,  either  in  barracks  or  in  the 
field,  will,  as  in  the  past,  so  in  the  future,  require  active 
intervention  on  the  part  of  the  commander- in-chief,  of  the 
generals,  and  of  the  colonels  and  officers,  outside  any  printed 
regulations,  however  full  and  ample.  As  the  Duke  of 
Wellington  explained  on  one  occasion  to  the  House  of  Lords, 
that  martial  law  was  no  law  other  than  the  will  of  the 
commander-in-chief ;  so,  in  future,  the  commander-in-chief, 
during  a  state  of  war,  must  have  the  power  to  relax  any 
^published  general  order  or  regulation  if  necessary,  to  make 
better  provisions  for  the  army.  A  sanitary  staff,  as  provided 
for  by  the  late  Lord  Herbert,  distinct  and  separate  from  both 
Commissariat  and  Army  Medical  Departments,  should  be 
with  and  part  of  the  army,  under  the  direct  control  of  the 
commander-in-chief,  who  shall  have  power  to  order  and 
expend  in  this  service  as  he  may  think  necessary,  that  is, 
that  any  amount  of  extraneous  labour  may  be  provided  and 
paid  for  which  he  deems  necessary,  and  the  country  in  which 
he  is  can  supply. 

The  army  in  the  Crimea  was  saved  in  a  great  measure  by 
voluntary  efforts  from  home,  by  relations,  and  the  general 
public  shipping  out  warm  clothing,  by  Florence  Nightingale 
and  her  lady  nursing,  by  distribution  of  food  suited  to  sick 
men  in  hospital,  and  by  extra  voluntary  furnishing  of 
medical  comforts,  and  also  by  the  labours  of  the  Army 
Sanitary  Commission.  The  expenditures  by  all  these  parties 
were,  however,  mere  fractions  in  the  gross  cost  of  the  war ; 
if  these  entire  extras  had  been  provided  for,  it  would  only 
have  amounted  to  about  half  a  week’s  expenditure  of  the 
■cost  of  the  war. 

In  touching  on  this  question  of  army  hygiene,  even  at 
this  day,  I  know  that  I  am  venturing  on  disputed  ground. 
But  that  enormous  improvement  took  place  in  the  British 
.army  in  the  Crimea  from  some  cause  or  causes,  after  the 
advent  of  the  Sanitary  Commission,  cannot  be  disputed; 
but,  officially,  the  credit  has  never  been  accorded  to  that 
Commission.  The  one  great  fact  was,  however,  made  un¬ 
mistakable,  namely,  that  from  the  spring  of  1855  the  health 
and  condition  of  the  British  army  began  to  improve,  until, 
by  the  autumn  of  that  year,  the  entire  force  in  the  field  was 
in  a  state  of  health,  and  was  under  a  less  rate  of  mortality 
than  when  in  barracks  at  home,  and  this  continued  until  the 
close  of  the  war.  The  French,  the  Sardinians,  and  the 
Eussian  soldiers,  however,  knew  of  no  such  abatement  of 
camp  and  hospital  sickness,  the  destruction  of  life  having 
gone  on  up  to  the  close  of  the  war.  Full  details  may  be 
found  in  the  Army  Eeturns  of  the  several  nations,  and  in  a 
pamphlet  by  Surgeon-General  T.  Longmore,  entitled  "  The 
Sanitary  Contrasts  of  the  British  and  French  Armies  during 
Lhe  Crimean  War.”  1883. 

Without  giving  the  details  furnished  by  Surgeon-General 
Longmore,  I  may  state,  from  pp.  17,  18,  the  British  army  in 
the  first  winter  had  2286  deaths  from  fevers  of  all  kinds ; 
second  winter,  reduced  to  129;  under  typhus,  from  164  to 
16.  Amongst  the  French  troops,  90  the  first  winter,  10,278 
■the  second  winter.  The  French  had  no  sanitary  commission, 
the  hospitals  remained  unscavenged,  un ventilated,  and  their 
hospital  drains  unimproved — the  result  being  excessive  over¬ 
crowding,  until  men  and  doctors  alike  perished ;  the  British 
hospitals  being  absolutely  free  from  typhus  cases.  Taking 
these  results  into  account.  Surgeon- General  Longmore  states  : 
“  It  is  well  that  the  practical  lessons  in  sanitary  science 
afforded  by  the  events  of  the  Crimean  W ar  should  not  be 
allowed  to  pass  out  of  mind.”  In  this  remark  I  cordially 
agree. 


ARMY  SANITATION. 

By  EDWIN  CHADWICK,  C.B.(a) 

Mi  action  in  Army  Sanitation,  I  beg  to  state,  has  not  been 
on  my  own  mere  intuition,  but  on  the  careful  consideration 
of  such  experiences  as  those  of  Sir  John  Pringle  (the  greatest 
sanitarian  of  the  last  century)  with  the  army  in  Flanders, 
and  also  of  Sir  J.  McGrigor  with  the  army  in  Spain,  together 
with  the  experiences  of  other  officers  in  the  tropics — experi¬ 
ences  which  do  not  enter  into  the  studies  of  the  curative 
science.  There  has  been  a  continued  neglect  of  sanitary 
experience  in  the  Army  down  to  the  present  day,  entailing 
a  continuity  of  losses  greater  than  by  the  sword,  if  it  be  not 
arrested.  If  the  experience  of  Sir  John  Pringle  had  been 
regarded  and  acted  upon,  the  disaster  that  occurred  from 
insanitary  conditions  at  Walcheren  would  have  been  averted. 
If  the  lesson  given  by  the  repeated  disaster  at  Walcheren 
had  been  properly  attended  to,  two-thirds  of  the  losses 
sustained  during  the  first  Peninsular  campaign  might  have 
been  prevented.  If  the  experiences  of  the  working  of  the 
rudimentary  principles  of  sanitation  during  the  last  part  of 
the  Peninsular  campaign  had  been  properly  attended  to,  of 
which  clear  warning  was  offered  by  himself,  the  first  army 
in  the  Crimea  would  have  been  saved  from  the  disaster 
which  befell  it,  and  from  the  repetition  of  which  the  second 
army  was  saved  by  the  work  of  our  sanitary  lieutenants  of 
the  first  General  Board  of  Health,  and  sent  back,  as  the 
Minister  of  War  declared,  in  a  better  state  of  health  than 
the  army  at  home — that  is  to  say,  the  deaths  were  reduced, 
as  shown  in  Mr.  Eawlinson’s  paper,  by  sanitation  from 
thousands  to  hundreds.  But  the  lesson  then  given,  it 
now  appears,  has  been  again  set  aside ;  there  has  been, 
as  declared  on  strong  testimony  (which  has  yet  to  be 
examined),  another  break-down  of  the  curative  service  and 
another  neglect  of  the  preventive  service  displayed  in  the 
army  in  Egypt.  Again,  the  losses  in  the  old  ratio  of  the 
loss  of  one  from  the  sword,  but  of  three  and  more  from  dis¬ 
eases  which  all  sanitarians  know  to  be  preventable— diarrhoea, 
dysentery,  and  entericfever — from  bad  camping  groundsfore- 
warned  to  be  bad,  and  which  if  held  for  strategical  reasons 
(which  are  denied)  were  capable  of  being  amended;  foul 
quarters,  which  proper  provision  would  have  cleansed  ;  bad 
food;  and  then  for  the  sick  in  the  hospitals,  bad  food,  failure 
in  medicines,  and  inferior  treatment.  And  then,  too,  the 
inquiry  into  the  defaults  has  been  committed  chiefly  to  the 
heads  of  the  defaulting  departments,  without  a  single  sani¬ 
tary  officer  in  authority,  and  with  the  excuse  for  the  failure 
that  it  has  not  been  worse  than  it  has  been  before  in  the 
time  of  Abercrombie,  that  it  has  been  no  worse  than  what 
has  been  usual,  omitting  all  notice  of  the  work  done  by  our 
sanitary  officers  with  the  second  army  in  the  Crimea.  No 
notice  was  taken  by  the  Committee  of  that  great  preventive 
work  described  by  Mr.  Eawlinson,  as  was  to  be  expected 
from  lay  members  who  knew  nothing  of  it.  But  this  defence, 
that  the  losses  have  been  no  greater  than  before,  lias  the 
pregnant  import  that,  under  the  existing  conditions,  in  any 
future  wars,  the  losses  to  be  sustained  will  be  as  great  as 
they  have  been  heretofore,  of  one  from  the  sword,  and  three 
from  disease;  and  there  can  be  little  doubt,  when  examined, 
that  in  the  existing  conditions  of  administration  of  the  work 
and  neglectful  position  of  the  preventive  service,  it  must 
continue,  as  it  has  been,  of  tremendous  preventable  loss  in 
future  wars  and  of  weak  and  tardy  sanitation  at  home.  The 
course  taken  on  the  return  of  the  army  from  the  Crimea 
will  be  found  to  have  been  little  creditable  to  the  legislative 
intelligence  and  administrative  capacity  of  that  time.  The 
very  defaulters  with  the  first  army,  some  of  whom  might 
fairly  have  been  put  on  their  trial,  were  all  decorated, 
whilst  every  sanitary  officer  who  had  contributed  to  the 
really  great  achievement  was  dismissed  without  any  recog¬ 
nition  whatever.  IVe  have,  in  fact,  all  been  treated  as  if 
our  principles  had  been  set  aside  (as  indeed  much  of  them 
have  been) ;  as  if  we  had  been  doing  something  bad  which 
ought  not  to  be  repeated.  Lord  Palmerston  saw  clearly  the 
position,  as  shown  in  his  letter  read  by  Mr .  Eawlinson,  and  Lord 

(a)  An  abstract  of  the  remarks  made  in  the  debate  on  Mr.  Eawlinson’s 
address  at  the  Parkes  Museum,  June  21. 


6 


.Medical  Times  and  Gazette. 


LORD  WOLSELEY’S  ADDRESS  AT  CHARING- CROSS  HOSPITAL. 


July  7.  1883. 


Palmerston  directed  the  organisation  of  a  preventive  service, 
distinct  from  the  curative  service,  and  also  from  the  com¬ 
bative  service,  and  yet  amenable  to  superior  command.  He 
had  clear  experience  of  the  great  success  of  that  intermediate 
service.  Why,  then,  was  the  sanitary  service  abandoned  to 
those  jealousies  of  both  which  he  foresaw  and  expressed  ? 
Some  time  afterwards  I  represented  to  Lord  Stanley,  now 
Lord  Derby,  and  by  a  paper  read  at  the  Congress  held  at 
Liverpool,  that  the  experience  gained  by  the  Sanitary  Com¬ 
mission  in  the  Crimea  should  be  applied  for  the  service  in 
India.  On  the  consideration  of  the  facts  presented  to  him 
in  that  respect,  his  lordship  advised  Her  Majesty  to  appoint 
a  commission  of  inquiry  into  the  condition  of  the  Indian 
Army  in  that  respect.  Hence  the  appointment  of  the  Army 
Sanitary  Commission  presided  over  by  Mr.  Sidney  Herbert. 
I  cannot  go  into  the  details  of  sanitary  service  rendered  to 
the  home  army  by  the  Barrack  and  Hospital  Commission, 
nor  the  service  of  the  same  sanitary  officers  on  the  Indian 
Army  Sanitary  Commission.  It  suffices  to  state  that  for  the 
last  decade  the  saving  of  force  has  been  of  forty  thousand 
men  from  death  and  a  proportion  of  sickness,  and  five 
millions  of  money  ;  and  yet  this  saving  is  far  from  complete, 
owing  to  the  imperfect  attributions  of  the  Sanitary  Com¬ 
missioners,  and  this  saving  is  threatened  by  the  neglect  of 
the  sanitary  service  and  the  threat  of  its  impending  ex¬ 
tinction  by  being  merged  in  the  curative  service,  of  which 
some  of  the  consequences  have  been  displayed  in  Egypt. 
The  testimony  of  the  combative  service  goes  to  this,  that 
the  curative  service  should  be  confined  exclusively  to  the 
exercise  of  its  own  high  service  in  the  hospitals ;  and  the 
testimony  of  the  officers  of  the  service  is  that  the  work  of 
sanitation  will  fail  if  it  is  left  to  the  combative  service.  The 
question  is  one  which  needs  the  intervention  of  a  superior 
independent  authority,  for  which  the  arrangements  of  the 
second  army  in  the  Crimea  may  be  submitted  as  a  safe  pre¬ 
cedent.  It  may  be  commended  to  the  consideration  of  the 
Government,  and  will  undoubtedly  meet  with  the  appro¬ 
bation  of  the  public  and  of  Parliament,  that  active  support 
is  due  to  the  preventive  or  sanitary  service,  which  is  only 
midway  in  the  civil  work  as  well  as  the  military  service  at 
home.  The  strengthening  of  the  sanitary  service  is  espe¬ 
cially  needed  for  civil  work  in  India,  where  it  may  be  shown 
that  having  succession  there  and  holding  that  great  Empire, 
as  well  as  the  well-being  of  the  population,  is  dependent  on 
effective  sanitation.  But,  as  has  been  discussed  by  impartial 
authorities,  independently  of  myself,  at  sanitary  congresses, 
it  may  be  claimed  as  a  first  step  that  the  service  should  be 
put  in  a  position  due  to  its  increasing  importance,  and  that 
recognition,  not  to  say  reparation  for  injurious  neglect, 
should  be  given  for  the  elaboration  of  sanitary  principles 
and  for  their  successful  administrative  application,  which,  be 
it  remembered,  have  during  the  last  decade  saved  forty 
thousand  of  military  force  and  five  millions  of  money,  and 
in  England  and  Wales  a  quarter  of  a  million  of  lives,  and, 
moreover,  according  to  the  last  census,  has  given  an  exten¬ 
sion  of  two  years  of  life  to  the  whole  population.  It  is  to  be 
seen  what  the  judgment  will  be  on  the  question,  at  least  for 
the  past. 


Evonymin. — In  a  these  just  published,  Dr.  Cornil  states 
that  this  substance  is  a  resin,  or  rather  a  mixture  of  various 
resins,  exacted  from  Evonymus  atro-purpureus  by  pre¬ 
cipitating  it  from  an  alcoholic  tincture  of  the  bark.  Its 
action  is  that  of  a  stimulant  of  the  biliary  apparatus.  It 
does  not  act  on  the  intestine  in  most  cases  as  a  hydrogogue, 
but  by  inducing  contraction  of  the  muscles  of  the  bowel.  It 
is  laxative  and  chologogic,  and  does  not  operate  as  a  violent 
purgative,  producing  only  one  or  two  stools  some  hours 
after  its  administration.  It  often  gives  rise  to  colicky  pain, 
which  might  be  prevented  by  combining  it  with  an  opiate. 
Its  efficacious  dose  varies  from  ten  to  forty  centigrammes. 
Its  action  is  temporary,  being  scarcely  prolonged  beyond 
twelve  days ;  and  when  this  becomes  exhausted,  it  cannot 
be  aroused  by  increase  of  dose. — Jour,  de  Thdrap.,  June  10. 

The  United  States  Epidemic  Fund. — The  Epidemic 
Fund  of  $100,000,  to  be  used  at  the  discretion  of  the 
President,  will  be  employed  only  in  case  of  actual  or 
threatened  epidemic,  in  which  event  the  Secretary  of  the 
Treasury  is  empowered  by  the  President  to  disburse  the 
fund  in  aid  of  State  and  local  boards  of  health  to  prevent  the 
introduction  or  spread  of  disease. — New  York  Med.  Record. 


AN  ADDRESS 

DELIVERED  TO  THE  STUDENTS  OE  THE 

CHAR IHG-CROSS  HOSPITAL  MEDICAL. 

SCHOOL. 

By  GENERAL  LORD  WOLSELEY,  G.C.R, 

On  Thursday,  July  5. 


After  distributing  the  prizes  gained  in  the  examinations,. 
Lord  Wolseley  said : — 

When  I  came  here  I  was  not  aware  I  was  to  have  the 
pleasure  of  addressing  ladies  as  well  as  gentlemen,  and  the 
few  remarks  I  have  to  make  will  be  addressed,  not  to  the 
ladies,  but  to  the  gentlemen,  especially  those  whom  I  have- 
had  the  pleasure  of  seeing  on  parade,  and  those  whom  I  had 
the  satisfaction  of  giving  prizes  to.  I  need  scarcely  tell 
you  that  it  is  a  great  pleasure  to  a  man  in  my  position  to 
come  here  to-day,  for  very  many  reasons.  First,  I  have  the 
opportunity  afforded  me  of  being  brought  into  contact  with 
a  number  of  young  men  who  are  now  about  to  begin  life-, 
and  launch  their  ships  to  go  on  the  stormy  sea,  and  who 
have  a  great  number  of  storms,  difficulties,  and  trials  to  en¬ 
counter.  It  is  always  a  pleasure,  therefore,  to  feel  once  more 
brought  into  contact  with  young  men.  It  reminds  one  of 
what  I  had  to  do  many  years  ago,  and  I  cannot  look  back  to 
that  time  and  the  various  occurrences  which  have  taken 
place  in  my  career  without  warning  those  who  are  about  to 
follow  my  example,  and  others  also  who  have  embarked  on 
the  difficult  and  thorny  path  of  life,  above  all  things  never 
to  be  discouraged.  If  you  find  difficulties  in  your  way,  as 
every  man  does,  you  must  remember  that  difficulties  are 
only  made  for  brave  men  to  encounter  and  overcome. 
It  is  the  weak-hearted  and  poor-hearted  who,  when  they 
have  had  a  bad  fall  in  their  race,  get  disheartened  and 
do  nothing.  The  brave  men  and  the  sturdy  men  look  on 
the  fall  or  misadventure  as  something  to  be  laughed  at, 
and  something  in  the  way  of  an  instructive  lesson  with 
regard  to  their  future  conduct  in  life.  It  has  been 
my  good  fortune  to  be  brought  into  contact  with  this  noble 
profession  in  which  you  are  all  about  to  embark,  but  more 
especially  that  branch  of  the  profession  which  belongs  to 
the  Army.  I  have  had  a  great  deal  to  do  with  them,  and  I 
may  say  they  have  had  a  good  deal  to  do  with  me.  Like 
most  men  who  have  been  in  the  Army,  I  have  had  my  own. 
share  of  the  knocks  and  blows,  and  I  owe  a  great  deal  to 
the  medical  profession, — I  do  not  think  any  man  in  the- 
Army  owes  more  to  them;  and  looking  back,  as  I  can,  over  a 
great  number  of  campaigns,  I  can  confidently  say  I  have 
never  been  brought  into  contact  with  any  body  of  men,  n» 
matter  what  the  department  of  life  or  branch  of  the  service, 
who  have  done  their  duty  with  greater  devotion  to  the 
service  and  humanity  than  the  medical  officers  of  the  Army. 

I  have  had  a  paper  handed  to  me  before  I  came  here,  on  the 
Volunteer  Medical  Organisation,  and  my  eye  fell  on  one- 
paragraph  of  it,  and  it  is  this— “  We  may  say  in  passings 
that  probably  no  battlefield  since  the  world  began  was  so- 
promptly  and  efficiently  cleared  of  its  wounded  as  was. 
the  recent  field  at  Tel-el-Kebir.  The  wounded  were 
all  off  the  ground  and  within  the  hospital  a  very  short 
time  after  "the  fight.”  Now  -that,  of  course,  attracted 
my  attention  particularly,  as  it  refers  to  an  event  with 
which  I  had  to  do  last  year,  and  I  can  bear  out  the. 
truth  of  the  statements  made  there.  On  no  previous 
occasion  that  I  am  aware  of  have  the  wounded  in  the  en¬ 
gagement  been  better  looked  after  than  they  were  then.. 
In  the  medical  profession,  which  is  a  very  great  one,  like- 
all  other  professions,  it  is  absurd  to  imagine  that  there 
should  not  be  some  failures.  There  are  failures  among- 
the  doctors  ;  there  are  plenty  of  failures  among  the  generals 
in  the  Army,  and  in  all  branches  of  the  Army  there  are  a 
number  of  failures.  Therefore  I  should  not  make  out  to- 
you  that  every  medical  man  who  took  part  in  every  war  in. 


Ileal  TIdpi  and  Gaastte. 


MEDICAL  AND  SURGICAL  PRACTICE. 


which  I  have  been  engaged  was  a  perfect  man  ;  but,  looking 
at  them  as  a  body  of  men,  I  say,  no  body  of  men  have 
wer  done  their  work  better  than  they.  I  am  aware  that 
in  the  medical  branch  of  the  Army  there  are  changes 
•-and  reforms  to  be  made.  So  there  are  in  every  other 
-department  of  the  Army.  No  army  is  ever  a  perfect  one  ; 
an  army  must  change  constantly  if  it  wishes  to  be  effi¬ 
cient,  and  the  Medical  Department  is  no  exception  to  the 
rule.  What  could  be  more  ridiculous  than  if  we  were  to 
;attempt  to  carry  on  the  medical  affairs  of  the  Army  on  the 
-same  system  as  they  were  carried  on  during  the  Peninsular 
•or  Crimean  War  ?  The  Medical  Service  requires  to  change, 
as  we  change  our  arms  and  munitions  of  war.  Every  branch 
of  science  and  invention  in  all  the  scientific  arrangements 
react  on  the  Army,  and  there  is  no  department  in  which 
invention  reacts  moi’e  forcibly  than  the  Medical  Depart¬ 
ment.  But  although  I  may  find  fault  with  the  Medical 
Department  of  the  Army  there  is  no  reason  that  we 
-should  find  fault  with  the  medical  officers,  and  I  have 
never  done  so,  and  I  have  never  seen  any  reason 
'to  do  so  during  my  long  career.  I  have  always  found 
■them  thoroughly  and  jealously  anxious  to  carry  out  the 
•duties  to  be  performed.  Now,  with  regard  to  your  own 
School,  it  is  unnecessary  for  me,  after  the  very  able  address 
which  you  have  heard  read,  to  go  into  the  particulars  as  to 
the  number  of  students.  The  results  which  have  been 
explained  to  you  in  the  address  speak  for  themselves. 
That  tells  you  the  number  of  men  who  have  been 
successful  in  the  various  examinations  last  year,  and  the 
number  who  have  successfully  competed  to  enter  the  Army 
and  Navy.  Those  results  are  most  creditable  to  this 
School,  and,  in  common  with  everyone,  I  am  sure  we  all 
wish  this  School  success  most  cordially  and  most  sincerely. 
This  paper  which  I  have  referred  to  reminds  me  of  the 
drill  that  I  have  seen  in  the  barrack-square,  which  has 
Been  remarkably  well  done.  I  may  say  very  well  done 
indeed,  considering  the  amount  of  time  you  have  had 
at  your  disposal.  I  only  wish  that  the  system  which 
now  holds  good  in  this  School  could  be  extended  to  all 
the  medical  schools  in  the  country.  Every  man  who  really 
takes  a  certificate,  every  man  who  becomes  a  medical  officer 
or  obtains  a  surgical  certificate,  should  not  only  acquire  the 
ordinary  certificate,  but  he  should  in  case  of  emergency  be 
able  to  carry  out  the  duties  of  a  military  surgeon  as  well  as 
of  a  civil  surgeon.  I  would  express  a  still  further  opinion,  and 
itisthis  :  I  cannot  see  why  there  should  not  be  in  London,  and 
also  in  the  other  towns,  but  especially  in  London,  a  Volunteer 
Medical  Corps.  I  think  that  would  be  a  popular  corps,  and 
if  the  other  medical  schools  contributed  as  many  well-drilled 
gentlemen  as  those  whom  I  have  inspected  to-day,  it  would 
be  a  corps  of  the  greatest  possible  service  to  the  country, 
and  especially  the  Army.  I  hope  that  those  whom  I  have 
addressed  will  think  of  this,  especially  those  who  have  the 
-direction  of  this  and  other  medical  schools.  It  would  be  an 
immense  boon  to  the  Army  and  the  country.  Remember, 
that  although  we  have  a  large  Medical  Department,  it  is 
only  just  sufficiently  large  for  our  own  medical  department 
in  peace,  and  in  the  event  of  war  or  invasion,  or  any  other 
difficulty  overtaking  us,  which  would  require  a  large  force 
-of  men  to  be  put  in  the  field,  we  have  not  now  the  medical 
officers  in  this  country  to  supply  the  wants  of  that  force,  If 
Si  volunteer  medical  battalion  or  corps  were  started,  and 
worked  as  it  would  be  worked  by  these  men,  that  would 
supply  the  very  great  want  which  all  military  men  who  have 
studied  this  question  deeply  deplore.  Gentlemen,  I  hope 
you  will  think  of  this,  and  if  ever  I  have  the  pleasure  to 
-come  here  again,  I  hope  I  may  have  the  pleasure  to  be 
able  to  congratulate  such  a  corps  on  its  formation  and 
success.  I  shall  not  say  more  than  to  say  it  has  been  a 
great  pleasure  to  me  to  give  away  these  prizes,  especially 
to  those  whose  names  I  see  repeated  several  times,  like  Mr. 
Morgan,  to  whom  I  have  given  four  or  five  prizes,  and  I 
congratulate  them  on  their  success,  and  I  wish  them  in 
future  life  all  success  that  their  profession  could  give  them  ; 
and,  in  congratulating  them,  I  would  also  say  that  I  hope 
“those  who  have  not  succeeded  in  getting  prizes  will  not  be 
•disheartened.  We  can  all  start  in  a  race,  but  we  cannot  all 
<win  ;  but  there  is  no  reason,  if  we  do  not  win  one  year,  why 
we  should  not  next  year.  I  hope  those  who  have  been 
unsuccessful  this  year  may  be  fortunate  enough  to  win 
medals  next  year.  I  wish  you  good  luck  in  the  profession 
do  which  you  are  about  to  aspire. 


July  7,  16S3.  7 


REPORTS  OF 

HOSPITAL  PRACTICE  IN  MEDICINE 
AND  SURGERY. 


MELBOURNE  HOSPITAL. 

TWO  CASES  OF  NEURO-FIBROMATA. 

(trader  the  care  of  JAMES  W.  BARRETT,  M.B.  Ch.B.  Sydney.) 

Case  1. — Diffused  Neuro-Fibromata. 

Thomas  E.,  aged  twenty-one,  single,  native  of  Lancashire, 
left  England  when  twelve  years  of  age,  and  has  since 
followed  the  occupation  of  sailor. 

Previous  History. — The  patient  came  to  Victoria  eighteen 
months  since,  and  at  that  time  he  first  noticed  a  few  small 
lumps  situated  beneath  the  skin  on  the  right  side  of  the 
chest.  They  were  hard,  and  only  painful  when  injured. 
Their  size  was  about  that  of  a  pea,  and  their  subsequent 
growth  has  been  very  slow  indeed,  but  similar  lumps  have 
rapidly  made  their  appearance  on  all  the  other  parts  of  the 
body  except  the  hands,  feet,  head,  and  genitals.  None  of 
them  have  grown  to  any  great  size.  Two  years  ago  he  had 
a  fit,  during  which  he  lost  consciousness  ;  six  weeks  ago  he 
had  a  second  similar  fit';  and  two  days  ago  a  third.  The 
only  previous  illness  with  which  he  has  been  troubled  was  a 
liver  complaint,  which  prostrated  him  for  seven  weeks  when 
he  was  eleven  years  of  age.  He  was  then  jaundiced.  His 
paternal  grandfather  and  his  father  both  died  of  consump¬ 
tion.  His  maternal  grandfather,  his  mother,  sisters,  and 
uncles  are  all  living,  and  in  good  health,  with  the  exception 
of  a  maternal  uncle  who  suffers  from  “  fits.” 

Present  Condition. — On  examination,  the  patient  is  seen 
to  be  of  small  stature,  but  of  fairly  well  developed  frame, 
with  moderate  muscular  development.  Face  pale.  All  the 
organs  seem  healthy  except  the  heart,  which  is  excitable, 
the  patient  suffering  from  palpitation  very  frequently. 
Almost  all  the  nerves  of  the  body  which  can  be  examined 
by  the  finger  are  affected,  with  firm  oval  or  round  growths 
situated  on  them,  and  interrupting  their  continuity.  In  the 
case  of  the  oval  ones  the  nerves  are  attached  to  each  end 
of  the  oval.  They  can  be  moved  freely  in  a  direction  at 
right  angles  to  that  of  the  nerve  on  which  they  are 
placed,  and  but  slightly  in  its  direction,  and  then  only 
with  pain.  The  size  varies  from  that  of  a  walnut  to  that 
of  a  pin’s  head  or  smaller  still,  but  the  average  size  is  about 
that  of  a  small  marble.  They  are  all  hard  and  firm.  Their 
number  was  not  ascertainable  definitely,  being  many  thou¬ 
sands.  Some,  if  not  most,  of  the  nerves  have  become  mere 
chains  of  these  growths,  and  where  there  are  no  apparent 
nodules  still  the  nerve  is  enlarged  and  hard,  probably  owing 
to  a  multitude  of  infinitely  small  ones  being  situate  on  it. 
The  internal  cutaneous  nerve  in  the  forearm  is  affected  from 
its  origin  to  its  terminal  branches  of  distribution,  and  can  be 
lifted  with  the  fingers  from  the  deep  fascia,  and  when  pulled 
on  far  down  in  the  forearm  can  be  felt  to  move  in  the  arm. 

Details  of  Distribution.—  Right  upper  limb  :  The  posterior 
interosseous  nerve  and  its  branches,  the  radial  nerve,  the 
cutaneous  nerves  of  the  forearm,  the  median  nerve  in  the 
arm  and  as  far  as  it  can  be  traced  in  the  forearm,  and  part 
of  the  musculo-spiral,  have  become  mere  chains  of  these 
Growths.  The  ulnar  nerve  is  also  affected  just  where  it 
passes  between  the  olecranon  and  internal  condyle.  All 
the  nerves  running  along  the  axillary  artery  are  in  a  similar 
condition.  With  the  exception  of  the  musculo-spiral,  the 
same  description  applies  exactly  to  the  left  upper  limb. 
Both  the  hands  are  apparently  free  from  disease.  The 
head  is  not  affected.  Neck  :  A  few  branches  of  the  super¬ 
ficial  cervical  plexus  are  affected,  and  both  spinal  accessories 
are  extensively  involved.  Trunk  :  Most  of  the  superficial 
branches  of  the  posterior  spinal  nerves  are  similarly  diseased, 
and  all  the  anterior  cutaneous  branches  of  the  intercostal  and 
abdominal  nerves  are  in  the  same  state,  the  growths  on  the 
right  side  of  the  thorax  being  the  larger.  Lower  limbs  :  Both 
equally  affected,  nearly  all  the  cutaneous  nerves  being  chains 
of  fibromata — the  musculo-cutaneous  at  their  emergence, 
the  long  saphenous,  the  external  saphenous,  the  internal, 
middle,  and  external  cutaneous  nerves,  the  internal  and 
external  popliteal,  and,  in  fact,  every  nerve  that  can  be  felt 
in  the  leg  or  thigh,  are  in  this  condition.  The  feet  are  not 
involved?  From  the  sensation  caused  by  pressure  over  the 


8 


Medical  Times  and  Gazette. 


ARMY  DOCTORS— PAST,  PRESENT,  AND  FUTURE. 


July  7, 1883. 


sciatics,  which,  is  similar  to  that  caused  by  pressure  on 
some  of  the  other  tumours,  the  patient  believes  that  they 
are  affected  also. 

Remarks. — The  patient  would  not  consent  to  the  removal 
of  a  superficial  tumour  for  microscopical  examination,  so  that 
their  nature  was  not  definitely  determined,  still  there  is  no 
doubt  that  they  are  fibromata.  None  of  the  tumours  were 
painful  or  caused  the  slightest  inconvenience  except  they 
were  pressed,  rubbed,  or  rolled. 

Case  2. — Localised  Neuro-Fibromata. 

The  patient  who  forms  the  subject  of  this  report  was  under 
the  private  care  of  Mr.  T.  N.  Fitzgerald,  Senior  Surgeon  to 
the  Melbourne  Hospital,  who,  after  removing  the  tumours, 
forwarded  them  to  me  for  general  and  microscopical  exami¬ 
nation,  and  gave  the  subjoined  notes  : — The  patient  had 
four  tumours,  three  of  which  were  situate  on  his  right  arm, 
and  one  on  his  leg.  Two  situated  near  the  elbow  were  of 
the  size  of  a  goose-egg,  another  (on  the  shoulder)  was  about 
that  of  a  marble,  whilst  the  fourth  (on  the  leg)  was  about 
as  large  as  a  walnut.  They  had  been  growing  a  very  long 
while,  but  had  only  caused  trouble  of  late,  having  in 
January,  1882,  produced  paralysis  of  the  right  arm,  which 
hung  down  useless,  whilst  the  leg  was  useless  on  account  of 
the  pain  caused  by  movement.  They  caused  no  incon¬ 
venience  except  on  movement  or  pressure.  In  January, 
1882,  Mr.  Fitzgerald  excised  them  all  at  one  sitting,  and 
then  found  that  the  large  ones  were  situated  on  the  ulnar 
and  median  nerves.  That  on  the  ulnar  was  placed  just 
at  the  elbow-joint,  and  the  nerve  was  divided  in  removal. 
That  on  the  median  was  just  below  the  elbow  in  the  fore¬ 
arm,  and  by  great  care  Mr.  Fitzgerald  contrived  to  save  a 
few  fibres  of  this  nerve.  The  small  one  at  the  shoulder  was 
removed  from  a  branch  of  the  circumflex  nerve.  The  fourth, 
in  the  leg,  was  situate  on  the  posterior  tibial  nerve,  at  the 
ankle-joint.  Mr.  Fitzgerald  opened  the  capsule  and  enucle¬ 
ated  this  tumour,  thus  leaving  the  nerve  almost  uninjured. 
He  would  have  enucleated  the  large  ones,  but  found  it  im¬ 
possible  to  do  so  from  the  nature  of  their  growth  and 
attachments.  The  patient  made  a  rapid  recovery,  as  far 
as  the  operation-wounds  were  concerned,  and  regained  a 
limited  amount  of  movement  in  his  arm,  and  perfect  power 
of  movement  in  his  leg,  and  up  to  the  present  (May  16, 
1883)  has  had  no  return  of  the  tumours.  The  tumours  were 
oval  in  shape  and  firm  in  consistence,  but  were  not  hard. 
They  had  a  sheath  of  connective  tissue  continuous  with 
that  of  the  nerves  on  which  they  were  placed,  which  were 
attached  to  each  end  of  them.  Many,  if  not  all,  of  the 
bands  of  nerve-fibres  ran  through  the  tumour  in  and  beneath 
this  sheath,  being,  however,  separated  widely  from  one 
another.  This  accounts  for  the  success  which  attended 
the  enucleation  of  the  one  situate  on  the  posterior  tibial 
nerve.  Microscopically,  the  section  showed  a  great  pre¬ 
dominance  of  white  fibrous  tissue  over  every  other  structure. 
The  bands  of  this  tissue  interlaced  in  every  direction,  and 
were  in  many  places  arranged  concentrically.  The  cells 
were  badly  defined ;  they  were  diffused  through  the  speci¬ 
men,  and  were  exceedingly  numerous  for  such  growths, 
which  could  fairly  be  called  soft  fibromata. 

Remarks. — The  contrast  in  these  two  cases  is  very  marked. 
In  the  first,  the  morbid  developmental  energy  seems  to 
have  been  expended  in  the  production  of  an  immense  number 
of  minute  tumours  and  in  a  general  fibroid  infiltration  of 
the  nerves.  In  the  latter  the  same  energy,  perhaps  less 
intense,  seems  to  have  been  expended  in  the  production  of 
much  larger  and;  infinitely  fewer  growths,  which,  however, 
were  more  destructive  as  regards  their  immediate  con¬ 
sequences.  The  first  patient  still  goes  about  his  business 
and  does  not  trouble  himself  about  these  tumours,  and  tells 
me  that  he  can  notice  the  increase  in  numbers  almost  weekly. 
With  the  exception  of  the  fits  and  the  palpitation  he  is 
absolutely  free  from  disease  in  the  popular  sense.  From 
what  I  have  seen  of  these  growths  I  am  convinced  that  the 
boundary -line  between  them  and  some  forms  of  sarcomata  is 
exceedingly  difficult  to  draw. 


Athletes. — In  view  of  what  is  sometimes  said  regard¬ 
ing  the  mutual  antagonism  of  brawn  and  brain,  it  is  worthy 
of  note  that  four  out  of  the  five  men  who  won  prizes  in  the 
Boylston  prize-speaking  at  Harvard  College  this  spring 
had  been  prominent  in  athletics  throughout  their  college 
courses. — Boston  Med.  Journal,  June  7. 


TERMS  OF  SUBSCRIPTION. 


(Free  by  post.) 
British  Islands  .....  Twelve 
,3  „  .....  Six 

The  Colonies  and  the  United  \  T  7 
States  of  America  .  .  ,)lwave 


,,  ,,  ,,  .  Six 

India  (vid  Brindisi)  .  .  .  Twelve 

,,  ...  i Six 


Months 

>> 

>> 

99 

99 

99 


.^180 

0  14  0 

.  1  10  0 

0  15  O 

.  112  6 

0  16  6. 


Foreign  Subscribers  are  requested  to  inform  the  Publishers  of 
any  remittance  made  through  the  agency  of  the  Post-office. 
Single  Copies  of  the  Journal  can  be  obtained  of  all  Bo  ok  seller  s 
and  Newsmen,  price  Sixpence. 

Cheques  or  Post-office  Orders  should  be  made  payable  to  Mr.. 
James  Lucas,  11,  New  Burlingt on-street,  W. 


TERMS  FOR  ADVERTISEMENTS. 


Seven  lines  (70  words)  .  .  .  .  ,£0  4 

Each  additional  line  (10  words)  .  ..00 
Half-column,  or  quarter-page  .  .  .15 
Whole  column,  or  half -page  .  .  .  2  10 
Whole  page . 5  0 


6" 

6 

0 

0 


For  the  future.  Births  and  Marriages  must  be  paid  for . 
Deaths  of  Medical  Men  are  inserted  Free  of  Charge. 


The  Medical  Times  and  Gazette  is  published  on  Friday 
morning :  Advertisements  must  therefore  reach  the  Pub¬ 
lishing  Office  not  later  than  One  o’clock  on  Thursday. 


eincal  Crates  aitit 


SATURDAY,  JULY  7,  1883. 


ARMY  DOCTORS— PAST,  PRESENT,  AND  FUTURE, 
Amidst  the  pages  of  abuse  lavished  upon  the  doctors,  which 
form  such  unpleasant  reading  in  the  Report  of  the  War 
Office  Committee,  it  is  pleasant  every  now  and  again  to  come 
across  acknowledgments  of  the  merits  and  grand  qualities- 
of  the  doctors  in  the  £f  good  old  times.”  The  puzzling  part  of 
the  conflicting  evidence  lies  in  the  reflection  that  the  “  good, 
old  times  ”  were  almost  the  times  of  yesterday,  and  that  the 
very  Medicos  who  are  now  looked  upon  with  dislike  are  the 
same  men  whose  former  merits  were  lauded  to  the  skies.. 
The  men  are  the  same — grown  indeed  a  little  older,  and- 
perhaps  a  little  wiser, — and  we  ask  ourselves  what  faults 
have  they  in  a  few  short  years  developed  to  rouse  such 
hosts  of  enemies  ?  We  believe  the  change  of  feeling  is  due 
simply  to  the  fact  that  the  doctors  have  ceased  to  be- 
regimental.  We  can  understand  how  deeply  the  old  system 
must  be  regretted.  The  colonels  were  happier  by  far  in 
those  days.  Each  possessed  a  confidential  friend  in 
his  medical  officer — a  man  who  could  give  advice  without 
being  necessarily  considered  insubordinate,  and  yet  suffi¬ 
ciently  under  control  to  be  influenced  to  hold  his  tongue' 
when  a  judicious  reserve  was  considered  best  for  regimental 
interests.  The  younger  officers  then  possessed  “  a  mess¬ 
mate,”  who  could  be  trusted  to  tell  no  tales  “  out  of  school.” 
The  women  of  the  regiment  had  a  patient  listener,  who  had 
no  choice  but  to  bear  the  infliction  of  their  tongues  if  he 
wished  for  a  quiet  life ;  and  the  old  soldier  was  sure  of  a 
helping  hand  in  any  little  difficulty  connected  with  an  occa¬ 
sional  “  drink.”  In  fact,  there  was  no  one  who  did  not  love 
the  regimental  doctor,  excepting  the  very  bad  characters 
and  the  malingerers.  Take  the  following  piece  of  evidence 
in  proof  of  how  much  was  thought  of  the  doctor.  The  question 
asked  (14,022)  was,  “  And  the  doctor  is  generally  the  most 
popular  man  in  the  regiment,  is  he  not  ?  ”  It  should  be,  was- 
he  not  ?  The  answer  is  certainly  flattering  to  medical  officers 
of  the  past :  “  Always  ;  and  very  often  the  most  useful  man. 
I  know  that  in  my  old  regiment  one  good  old  doctor  was  our 


-Medical  Times  and  Gazette- 


ARMY  DOCTORS— PAST,  PRESENT,  AND  FUTURE. 


July  7,  1883.  9 


mess  president,  and  -whenever  anything  was  wanted  we 
always  went  to  the  doctor,  and  he  was  always  ready  to  do 
anything ;  he  was  a  clever,  good  fellow.”  But  the  regi¬ 
mental  system  has  passed  away,  and  its  full  restoration  has 
become  an  impossibility.  The  British  public  has  to  be  con¬ 
sidered,  and  the  taxpayers  are  becoming  more  inquisitive 
ucvery  day.  There  is  no  doubt  that  “station  hospitals” 
^afford  as  good  or  better  treatment  for  serious  cases,  and 
can  be  more  economically  worked,  than  the  innumerable 
regimental  hospitals  of  the  olden  time.  Never  more  shall 
rthe  “  good  old  doctor  ”  be  part  and  parcel  of  a  regiment,  as 
irremovable  as  the  colonel  himself,  and  to  a  great  degree 
independent  of  the  authorities  of  the  Army  Medical  Depart¬ 
ment  ;  no  more  shall  he  pass  hours  of  dignified  ease,  after 
visiting  his  ten  or  twelve  patients,  of  whom  three,  perhaps, 
were  serious  cases  ;  never  again  shall  the  genial  medico  be 
the  beloved  mess  president ;  and  gone  are  the  days  when  the 
knowing  and  well-to-do  doctor  could  purchase  immunity 
from  foreign  disease  by  negotiating  a  judicious  exchange 
with  the  doetor  of  a  regiment  just  ‘'come  home,”  when  his 
own  regiment  was  unluckily  ordered  out,  let  us  say,  to  the 
West  Indies.  But  although  the  old  system  cannot  be 
fully  restored,  there  is  a  cry  for  a  partial  restoration; 
and  there  is  a  certain  amount  of  reason  for  it.  It  is  pro¬ 
posed  to  attach  a  medical  officer  for  duty  with  a  regi¬ 
ment  at  home.  Colonel  after  colonel  expresses  a  desire  for 
such  a  change.  What  they  object  to  is  the  constant  change 
of  medical  attendants  which  often  exists.  It  is  mentioned 
(14,069)  that  in  one  instance  “in  fourteen  months  the 
return  showed  that  thirteen  medical  officers  had  been 
in  charge  of  the  battalion.”  It  is  almost  ludicrous  to  read 
(13,960)  how  long  an  officer  at  Chatham  was  in  pursuit  of  a 
doctor  before  he  caught  him.  No  wonder  this  combatant 
officer  would  reverse  the  existing  system.  We  must  here 
observe  that  at  present  a  medical  officer  attached  to  a  station 
hospital  does  extra  duty  by  visiting  a  regiment  daily ;  and 
what  is  proposed  is  that  a  doctor  should  be  attached  to  a 
regiment  and  do  extra  duty  daily  at  the  nearest  station 
hospital.  The  difference  is  greater  than  it  seems.  Consider¬ 
ing  that  all  serious  cases  are  removed  to  the  station  hospi¬ 
tal,  there  seems  little  reason  for  lessening  the  ties  which 
bind  medical  officers  to  their  most  severe  professional  work 
in  order  to  satisfy  the  requirements  of  the  officers  and  women 
of  a  regiment.  Combatant  officers  acknowledge  that  there 
would  be  very  little  for  a  regimental  medical  officer  to  do  in 
time  of  peace,  and  mostly  are  of  opinion  that  he  might  fill 
up  his  time  at  a  station  hospital :  but  two  things  seem 
pretty  evident — the  change  is  not  required  in  the  interest  of 
the  men,  who  are  never  now  treated  regimentally ;  and  if  it 
were  made  in  the  interest  of  the  officers  and  women  of  a 
regiment,  the  medical  service  would  suffer.  “  No  man  can 
Serve  two  masters.”  There  is  an  amount  of  independence 
in  the  position  of  a  regimental  doctor  which  would  not 
fit  him  for  due  subordination  to  the  superior  of  his  own 
•department.  The  opinion  expressed  by  the  Committee  on 
this  point  (page  xxxi.,  par.  184)  gives  very  little  encou¬ 
ragement  to  any  medical  officers  who  may  still  wish  for 
such  comparative  independence.  It  runs  thus  : — “  We  are 
also  of  opinion  that  the  medical  service  of  the  House¬ 
hold  Troops  should  be  assimilated  to  that  of  the  Army 
at  large.”  “  Moreover,  the  evidence  which  we  have  re¬ 
ceived  proves  conclusively  that  it  is  unadvisable  that  the 
.Household  Troops  and  the  rest  of  the  Army  should  be  worked 
mnder  different,  and  to  some  extent  independent,  systems.” 
®till  it  is  very  evident  that  greater  consideration  should  be 
.shown  to  undoubted  regimental  requirements.  It  is  not 
right  that  the  medical  officer  detailed  to  visit  a  regiment 
should  reside  far  away  from  it.  Accidents  may  happen  at 
any  moment,  and  cases  of  childbirth  will  occur  before  the 


expected  time.  It  would  be  impossible  to  detail  a  medical 
officer  from  all  other  duty  to  provide  against  such  occa¬ 
sional  emergencies,  and  soldiers,  like  civilians,  must  take 
their  chance  of  the  doctor  being  sometimes  “out  of  the 
way,”  yet  every  care  should  be  taken  to  take  them 
as  little  “out  of  the  way”  as  possible.  We  find  the 
Committee  recognising  this  at  page  xxxi.,  par.  183.  They 
say,  “We  believe  the  inconvenience  now  justly  com¬ 
plained  of  can  be  remedied  without  departing  from  the 
present  system.  The  medical  officers  appointed  to  attend 
the  officers  and  families  of  any  body  of  troops  should  have 
quarters  in  barracks,  or  should  reside  as  near  to  the  barracks 
as  possible.”  We  certainly  hold  that  a  doctor  should  always 
be  available,  but  that  it  would  not  be  right  to  detail  a 
medical  officer  for  an  indefinite  period  for  regimental  work 
only.  There  is  another  danger  which  might  arise  from  such 
an  attempt  to  return  to  the  regimental  system.  It  is  ex¬ 
pressed  at  page  xxx.,  par.  180  (Objections  [5]),  “It  would  in 
some  cases  involve  a  probable  deterioration  in  the  professional 
competence  of  the  medical  officer  so  detached.”  The  Com¬ 
mittee  have  a  real  desire  to  maintain  the  efficiency  of  the 
Army  Medical  Department,  and  they  speak  out  very  much 
to  the  purpose  in  their  recommendations.  They  observe 
that  “  under  the  present  system,  the  public  has  less  gua¬ 
rantee  for  the  efficiency  of  the  army  medical  officers  than 
formerly.  After  the  Crimean  War  a  system  of  examination 
for  promotion  was  introduced,  but  it  was  abolished  in  1874 
as  regards  the  army  medical  officer  ;  and,  although  in  the 
Army  such  examinations  have  become  more  and  more  ex¬ 
tended,  in  the  Medical  Department  every  test  of  such  a 
nature  has  been  discarded.”  This,  in  the  opinion  of  the 
Committee,  was  a  great  mistake ;  they  argue — “  B>egi- 
mental  officers  are  subject  to  periodical  examinations  up 
to  the  rank  of  field  officer;  whereas  medical  officers, 
whose  training  should  be  of  the  most  scientific  nature, 
are  deprived  of  any  such  test,  and  are  promoted  by 
seniority  or  selection,  without  the  protective  and  stimulative 
influence  of  examinations.”  And  in  conclusion  they  say— 
“  We  recommend  that  the  system  of  examinations  for  pro¬ 
motion  should  be  restored.  That  between  three  and  seven 
years’  service  every  medical  officer  should  pass  through  an 
examination,  more  especially  in  practical  subjects,  such  as 
operative  surgery,  on  which  should  depend  his  promotion 
to  the  rank  of  surgeon-major;  and  that  greater  facilities 
should  be  given  for  special  courses  of  study  in  civil  or  mili¬ 
tary  hospitals  in  London  or  in  foreign  capitals.  They 
further  recommend  that  “the  proposed  examinations  should 
include,  in  addition  to  the  strictly  professional  subjects  con¬ 
nected  with  medicine  and  surgery,  theoretical  and  practical, 
all  matters  relating  to  army  hospital  administration,  under 
which  head  are  included  nursing,  ward  management,  pur¬ 
veying,  cooking,  and  sanitary  matters.’  There  is  unques- 
tionablv  much  to  be  said  in  favour  of  this  recommenda¬ 
tion.  It  may  be  somewhat  difficult  to  carry  out.  Good 
and  thoroughly  just  examiners  are  always  scarce ;  and  it 
certainly  will  not  be  easy  to  select  and  keep  up  a  tho¬ 
roughly  fair  and  reliable  body  of  men  to  test  practically, 
in  the  range  of  subjects  mentioned,  the  fitness  or  unfit¬ 
ness  of  army  medical  officers  for  promotion.  The  Com¬ 
mittee  do  not  say  why  army  medical  officers  were  “de¬ 
prived  ” — the  word  is  a  happy  one — of  the  examination 
for  promotion ;  but  the  simple  fact  is  that  the  Army 
Medical  Service  had,  through  the  blundering  mismanage¬ 
ment  and  bad  faith  of  successive  Secretaries  of  State  for 
War,  become  so  unpopular  that  till  1879  every  device  but 
the  simple  one  of  good  pay,  with  good  treatment,  and 
honesty  in  fulfilling  engagements,  was  tried  to  tempt  men 
into  the  Service ;  and  the  examination  as  then  conducted 
was  decidedly  unpopular.  Some  of  the  officers  then  in  the 


10 


Medical  Times  and  Gazette. 


THE  USE  OF  SECLUSION  OF  THE  INSANE. 


July  T,  1863, 


Service  may  have  been  pleased  to  escape  a  test  looming  in 
the  near  distance,  and  have  been  led  to  stay  in  the  Service 
by  the  abolition  of  the  examination ;  but  we  are  not  aware 
that  it  was  ever  asked  for  by  the  Medical  Department,  and 
the  main  cause  of  its  abolition  was  the  introduction  of  the 
“  ten  years’  service  system.”  It  would,  we  think,  be  well 
that  it  should  be  restored.  The  evidence  given  on  this 
point  by  Surgeon-General  Longmore  and  Brigade  Surgeon 
H.  B.  L.  Yeale  points  very  strongly  and  clearly  in  this 
direction ;  and  it  certainly  appears  to  us  that,  if  well  done, 
it  will  be  wisely  done.  Every  step  that  tends  to  keep 
a  medical  officer  in  the  front  rank  of  his  profession  is 
a  step  in  the  right  direction.  The  higher  the  scientific 
knowledge,  so  much  greater  will  the  probabilities  be  that 
all  friction  between  combatant  and  non-combatant  officers 
will  cease.  Both  may  learn  to  acknowledge  the  proper 
limits  of  their  separate  empires.  It  may  be  that  under  the 
regimental  system  some  not  too  wise  doctors  made  the 
mistake  of  over-valuing  dress,  feathers,  and  gold  lace.  But 
all  that  is  desirable  in  hospital  discipline  can  be  easily 
acquired  by  men  of  full  education  without  a  preliminary 
training  as  “  regimental  doctors.” 


THE  USE  OF  SECLUSION  OF  THE  INSANE. 
The  Commissioners  in  Lunacy  are  by  law  invested  with  the 
duty  of  inquiring  at  every  visit  to  an  asylum  as  to  the  use 
of  seclusion  in  the  treatment  of  the  patients  therein;  and 
the  results  of  their  inquiries  are  nearly  always  embodied  in 
the  Beports  that  are  annually  published  and  circulated 
throughout  the  country.  This  very  wholesome  enactment 
was  made  at  a  time  (in  1845)  when  the  treatment  of  insanity 
was  very  different  from  what  it  is  now,  and  when  the  em¬ 
ployment  of  restraint  and  seclusion  was  very  commonly, 
and  sometimes  very  grossly,  abused  ;  and  it  is  no  doubt 
mainly  owing  to  the  Beports  and  comments  that  have  been 
made  under  this  regulation  that  their  use  has  been  reduced 
to  its  present  inconsiderable  amount.  Meanwhile,  thorough 
exposure  to  the  light  and  air  of  free  publicity  has  so  puri¬ 
fied  the  administration  of  our  asylums,  and  the  humane 
treatment  of  lunatics  has  become  so  ingrained  into  our 
modern  habits,  that  the  regulation  in  question  is  but  little 
needed  as  a  safeguard,  and  it  has  come  at  length  to  have 
an  effect  not  wholly  beneficial.  The  publication  of  the 
Beports  of  the  Commissioners  has  brought  about  a  spirit 
of  emulation  among  the  superintendents  of  asylums,  each 
trying  to  obtain  as  favourable  a  record  as  possible,  and  the 
constant  enumeration  of  the  number  of  patients  secluded, 
and  the  number  of  hours  that  they  were  in  durance,  has  con¬ 
tributed  to  keep  up,  in  reference  to  the  use  of  seclusion,  the 
stigma  that  formerly  and  justly  adhered  to  its  abuse.  So 
that  we  now  have  the  not  infrequent  boast  by  medical  super¬ 
intendents  of  the  number  of  years  that  have  elapsed  with¬ 
out  any  resort  to  seclusion,  the  implied  doctrine  being  that 
under  all  circumstances  and  in  all  cases  seclusion  is  bad. 
Against  this  doctrine  it  is  necessary  to  protest.  Among  the 
many  improvements  that  have  been  introduced  into  the 
practice  of  surgery  is  that  of  securing  immobility  of  a  frac¬ 
tured  leg  by  means  of  a  fixed  bandage  of  gum  and  chalk  or 
some  such  material,  and  allowing  the  patient  with  this  ap¬ 
pliance  to  get  up  and  go  about  his  business  days  and  even 
weeks  earlier  than  he  could  otherwise  have  done.  Now,  sup¬ 
pose  that  general  hospitals  were  visited  periodically  by  Com¬ 
missioners  in  Surgery,  who  should  record  and  publish  the 
number  of  cases  in  which  this  bandage  was  not  used,  and 
the  number  of  days  that  cases  of  fractured  leg  were  kept  in 
bed :  the  inevitable  consequence  would  be  that,  in  anxiety 
to  obtain  a  good  record,  the  fixed  bandage  would  be  applied 
earlier  and  earlier,  and  with  less  and  less  careful  discrimina¬ 


tion  of  the  cases  to  which  it  was  appropriate,  until  in  a  few 
years  treatment  of  a  fractured  tibia  by  rest  in  bed  would  be- 
as  much  an  exploded  superstition  as  treatment  of  mania  by 
seclusion  is  now,  and  we  should  have  surgeons  complacently 
recording  the  length  of  time  that  had  elapsed  since  such  a 
treatment  had  been  adopted.  In  such  a  case  the  ill  con¬ 
sequences  would  be  so  direct,  so  apparent  and  unmistakable, 
that  a  reaction  would  soon  restore  the  present  state  of  things, 
or  more  probably  banish  fixed  bandages  altogether  from, 
surgical  practice ;  but  the  phenomena  of  insanity  are  sc 
immensely  complex,  involved,  and  obscure,  that  the  effect  of 
any  one  factor  in  alleviating  or  aggravating  their  gravity  is 
traceable  with  great  difficulty.  It  is  doubtless  for  this 
reason  that  the  abolition  of  seclusion  has  raised  no  protest  mT 
for  although  the  advantages  that  it  offers  in  appropriate- 
cases  are  patent  enough,  the  ill  effects  that  may  arise  from, 
its  disuse  are  so  interspersed  among  other  phenomena,  so. 
little  evident  on  the  surface,  that  they  may  easily  be  over¬ 
looked.  That  a  patient  in  acute  delirious  mania  is  not 
favourably  conditioned  for  recovery  if  allowed  to  mingle- 
freely  among  other  patients,  and  to  suffer  the  inevitable- 
retaliations  that  his  delirious  actions  bring  upon  him,  does- 
not  appear  to  need  demonstration;  and  that  the  other 
patients  are  less  likely  to  become  excited  if  this  source  off 
disturbance  is  absent,  is  also  tolerably  manifest ;  and  that 
in  minor  degrees  of  excitement  the  quietude,  the  solitude, 
and  the  freedom  from  disturbance  that  seclusion  affords 
are  not  only  beneficial  but  grateful  to  the  patients,  is 
seen  in  the  fact  that  they  occasionally  beg  to  be  secluded. 
While  it  is  unquestionably  wrong  to  seclude  a  patient 
merely  to  save  the  trouble  of  looking  after  him,  it  is  none 
the  less  wrong  to  deny  him  the  influence  of  seclusion  as  a 
therapeutic  agent,  if  there  is  reason  to  believe  that  he  would 
benefit  by  it.  That  its  use  has  been  withheld  when  it® 
appropriateness  has  been  recognised,  we  neither  say  nor 
believe ;  but  there  is  great  reason  to  believe  that  in  cases  in 
which  it  would  be  beneficial  it  is  never  thought  of,  because 
its  use  has  become  discredited.  As  well  might  we  abolish 
the  use  of  opium  because  it  is  poisonous  in  large  doses, 
regardless  of  the  enormous  benefit  that  it  affords  in  moderate 
doses  and  in  appropriate  cases,  as  abolish  the  use  of  seclu¬ 
sion  because  it  has  been  abused.  There  is  another  aspect 
to  the  question,  in  which,  though  it  is  not  medical,  medical 
men  are  interested  as  citizens.  When  we  hear  of  a  patient 
engrossing  the  entire  services  of  an  attendant,  or  two- 
attendants,  by  night  as  well  as  by  day  (that  is  to  say,  of 
four  people  in  all),  at  a  cost  of  some  £200  or  £250  a  year,  the 
question  forces  itself  upon  us,  whether  the  self-denial  and 
privation  of  the  ratepayers  that  this  sum  represents  are  not 
a  greater  evil  than  the  discomfort  that  the  patient  would 
suffer  in  seclusion.  We  are  far  from  advocating  the  indis¬ 
criminate  use  of  seclusion,  but  we  think  its  indiscriminate 
rejection  is  unwise  and  even  unjust. 


CHOLEBA  AND  QUABANTINE. 

The  present  outbreak  of  cholera  in  Egypt — a  country  where, 
though  we  are  in  actual  possession,  other  nations  claim  to 
have  interests  scarcely  less  than  ours — cannot  fail  to  bring 
to  the  front  once  more  the  long-vexed  question  of  quaran¬ 
tine,  to  the  neglect  of  which  by  British  officials  the  French 
papers  unanimously  attribute  the  extension  of  the  disease 
to  Damietta  and  Alexandria.  All  previous  epidemics  had 
entered  Europe  from  Persia  by  way  of  the  Caspian  Sea,  but 
that  of  1865-66  was  an  outcome  of  the  Mecca  pilgrimage, 
and  was  carried  to  the  Mediterranean  ports  by  returning 
pilgrims  and  other  intercourse  with  Egypt.  It  could  hardly 
be  expected  that  tens  of  thousands  of  wretched  pilgrims — 

|  ill-clad,  ill-fed,  and  devoid  of  all  sense  of  decency, — gathered 


Medical  Times  and  Gazette. 


THE  WEEK. 


July  7,  1883.  11 


from  every  part  of  Africa  and  Asia,  could  camp  out  for 
weeks  on  a  soil  sodden  with  excreta  without  a  certain 
number  of  cholera  cases  occurring  among  them;  but  the 
danger  is  intensified  when  the  great  Indian  three  and 
twelve  year  festivals  of  Juggernaut  and  Hurdwar  have 
shortly  preceded  it,  and  already  diffused  the  cholera-poison 
throughout  Hindostan. 

On  more  than  one  subsequent  occasion — e.g.,  in  1872  and 
1878 — has  Europe  been  thus  threatened  from  Mecca,  but 
the  detention  and  isolation  of  the  sufferers,  destruction  or 
disinfection  of  their  clothes,  etc.,  and  strict  inspection  of  all 
shipping  entering  or  leaving  the  port  of  Jeddah,  have  pre¬ 
vented  the  further  dissemination  of  the  disease.  But  the 
opening  of  the  Suez  Canal  in  1869,  and  with  it  of  direct 
communication  between  European  ports  and  those  of  the 
East,  renders  the  importation  of  cholera  at  any  moment 
more  probable  than  ever.  Only  recently  a  case  occurred  off 
Havre  on  board  a  ship  just  arrived  from  Bombay.  And  the 
problem  is,  how  to  avoid  such  accidents ;  for  it  may  safely 
be  asserted  that,  whether  thanks  to  the  better  sanitary  sur¬ 
roundings  of  the  people,  or  more  probably  also  to  meteoro¬ 
logical  and  climatic  conditions,  cholera  never  arises  in  Europe 
or  America  de  novo,  but  invariably  follows  the  lines  of 
traffic  and  human  intercourse,  whether  by  land  or  sea. 
Once  imported,  the  subsequent  development  and  fatality 
is  determined  by  the  sanitary  condition  of  the  people,  more 
especially,  often  solely,  by  the  facilities  presented — by  geo¬ 
logical  features  or  by  human  perversity — for  the  pollution  of 
the  ground,  air,  and  water,  or  of  the  drinking-water,  whence 
ever  it  may  be  obtained,  by  faecal  and  specific  matter. 
Attempts  to  cut  off  all  communication  between  affected  and, 
as  yet,  healthy  countries  are  on  land  a  physical,  and  by 
sea  a  social,  impossibility.  Commercial  interests  are  not 
those  of  wealthy  merchants  only,  but  their  violation  affects 
the  prosperity  of  all  classes  alike.  The  experience  of  the 
cattle  plague  showed  that  nothing  short  of  the  destruction 
of  all  suspected,  as  well  as  infected  animals,  and  of  every¬ 
thing  with  which  they  had  come  in  contact,  was  really 
effective.  Yet,  if  systematically,  firmly,  and  intelligently 
carried  out,  quarantine  in  a  modified  form  may  do  much  ; 
but  inquiries  must  not  be  limited  to  the  port  whence  a  ship 
has  sailed,  if  one  would  avoid  such  errors  as  the  introduc¬ 
tion  of  cholera  into  America  in  1872  by  Polish  emigrants, 
the  ports  whence  they  sailed  from  Germany  being  free  ;  or 
the  infection  of  many  German  ships  with  yellow  fever,  in 
1876-77,  in  Brazil,  the  reports  from  Eio  being  some  months 
in  arrear. 

A  clean  bill  of  health  must  never  be  accepted  without 
investigation,  for  ships  may  have  called  at  infected  ports,  or 
there  may  have  been  deliberate  concealment  of  facts,  as 
when  the  French  troopship  Correze  entered  Suez  with  a 
clean  bill,  although  cholera  was  raging  at  Saigon  when  she 
left  on  July  18,  1877,  and  before  her  arrival  at  Suez  on 
August  24,  sixty  cases,  with  thirty  deaths,  had  occurred  on 
board.  Indeed,  owners,  officers,  and  passengers  are  all 
interested  in  such  concealment.  But  no  good  purpose  can 
be  served  by  quarantine  of  longer  duration  than  the  incu¬ 
bation  period  of  the  disease  in  question,  although  the 
detention  should  be  reckoned  afresh  when  any  new  case 
appears.  If  the  voyage  have  taken  a  longer  time,  and  no 
case  have  occurred  on  board,  the  crew  and  passengers  may 
be  passed  at  once,  though  the  cargo  should  be  viewed  with 
suspicion  in  certain  circumstances  ;  as  an  example  of  which 
we  may  refer  to  the  Anne  Maria,  which  sailed  from  America 
to  St.  Nazaire,  no  case  of  yellow  fever  occurring  in  her 
passage  of  thirteen  days.  The  crew  who  went  on  shore  re¬ 
mained  in  health,  but  immediately  on  opening  the  hold 
almost  all  the  men  employed  in  landing  the  cargo  were 
attacked.  An  actually  infected  ship  should  be  purified-by 


pumping  out  the  bilge,  flushing  the  hold  with  a  strong 
solution  of  chloride  of  zinc,  removal  of  partitions  and  of 
planks  in  numerous  places,  and  fumigation  with  sulphur, 
nitrous  fumes,  or  chlorine,  as  in  the  case  of  infected  rooms. 
If  none  of  the  men  employed  in  the  work  sicken  within  the 
incubation  period,  she  may  be  considered  safe. 

In  the  present  alarm  of  cholera,  which  we  cannot  treat  as 
a  groundless  scare,  we  consider  that  the  strictest  inquiry 
should  be  made  into  the  health,  as  regards  tendency  to 
diarrhoea,  etc.,  of  all  crews  arriving  from  infected  ports  ; 
and  followed,  if  the  result  be  unsatisfactory,  by  detention . 
For  each  of  the  past  epidemics  sprang  from  such  directly 
imported  cases.  At  the  same  time,  every  precaution  should 
be  taken  that  the  disease,  if  it  elude  the  vigilance  of  our 
port  sanitary  authorities,  shall  not  find  favouring  conditions 
in  our  towns,  especially  as  regards  the  risk  of  contamination 
of  the  water-supply  and  soakage  of  the  subsoil  around 
dwellings  with  faecal  fluid.  The  germ  of  the  disease  must 
be  first  imported ;  next  it  must  find  a  favourable  soil.  An 
ineffective,  however  obtrusive,  quarantine  system  is  a  de¬ 
lusion,  as  tending  to  a  false  security,  but  it  behoves  us  to 
look  alike  to  the  best  means  for  preventing  the  introduction 
of  the  disease,  and  for  preventing  its  spread  if  introduced. 


THE  WEEK. 

TOPICS  OF  THE  DAT. 

In  a  case  which  recently  came  on  for  hearing  in  the  Queen’s 
Bench  Division  of  the  High  Court  of  Justice,  Mr.  Justice 
Manisty  is  reported  to  have  made  some  remarks  which  can¬ 
not  be  too  extensively  circulated.  The  action  in  question — 
Godard  and  Wife  v.  North  Metropolitan  Tramways  Company 
— was  recently  tried  before  the  Lord  Chief  Justice,  and  was 
to  recover  damages  for  personal  injuries  to  Mrs.  Godard.  In 
March,  1882,  whilst  on  a  visit  to  some  friends  in  London, 
she  met  with  an  accident  whilst  travelling  by  one  of  the  de¬ 
fendants’  cars.  She  was  so  much  hurt  that  the  assistance 
of  a  medical  man  was  obtained,  but  he  did  not  treat 
the  case  as  being  very  serious.  On  her  return  to  Brighton, 
where  she  resided.  Dr.  Arthur,  a  local  practitioner,  was 
called  in,  and  he  pronounced  the  lady  to  be  suffering 
from  two  broken  ribs.  The  defendants  admitted  their  lia¬ 
bility,  and  paid  =£60  into  court ;  but  the  jury  awarded 
an  additional  =£100.  A  rule  for  a  new  trial,  on  the  grounds 
that  the  damages  were  excessive,  was  obtained,  and  now 
came  on  for  argument.  In  delivering  judgment,  Mr.  J ustiee 
Manisty  said  he  was  of  opinion  that  the  rule  should  be  dis¬ 
charged.  The  substantial  ground  on  which  the  rule  was 
moved  was  that  the  jury  should  have  come  to  the  conclu¬ 
sion  that  this  was  a  concocted  fraud,  and  great  stress  was 
laid  on  a  letter  written  by  Dr.  Arthur  to  the  Company,  in 
which  he  invited  them  to  send  some  one  to  examine  the 
plaintiff  as  to  the  broken  ribs,  as  he  did  not  wish  it  to  be 
said  that  this  was  a  “  hole-and-corner  business.”  If  that 
letter  was  the  letter  of  a  man  who  had  conceived  a  gross 
fraud,  and  intended  that  it  should  be  supported  by  false 
evidence,  it  was  the  stupidest  way  he  could  have  gone  about 
the  matter,  since  the  Company  had  it  in  their  power  to 
ascertain  whether  fraud  was  contemplated  or  not.  Some¬ 
thing  was  raked  up  by  counsel  at  the  trial  against  Dr. 
Arthur’s  character.  This  practice  was  every  day  becoming 
worse  and  worse,  and  he,  for  one,  should  do  his  best  to  stop 
it.  The  question  of  damages  being  one  entirely  for  the 
jury,  he  should  not  be  a  party  to  disturbing  the  verdict. 
Mr.  Justice  Denman  concurred,  and  although  the  Lord 
Chief  Justice  dissented,  the  majority  of  the  Court  being  in 
favour  of  discharging  the  rule,  a  new  trial  was  refused. 

Much  comment  has  been  excited  in  France  by  the  pro- 
-mulgation  of  the  recent  order  of  the  Prefect  of  the  Seine 


Medical  Times  and  Gazette. 


THE  WEEK. 


July  7, 1883. 


abolishing  hospital  chaplaincies  from  the  1st  inst.,  except 
in  the  case  of  hospitals  the  statutes  of  which  require 
chaplains,  and  the  Berck  Hospital,  where  the  distance  from 
the  parish  church  and  the  peculiar  position  of  the  infant 
inmates  call  for  exceptional  treatment.  The  alternative 
provided  is,  that  if  patients  ask  for  religious  ministrations 
the  hospital  authorities  are  to  apply  immediately  at  the 
parish  church.  This  proceeding  has  rightly  called  forth  a 
rebuke  and  a  protest  from  Archbishop  Guibert.  He  lays 
the  proceeding  to  the  influence  of  the  Paris  Municipality,  a 
body  which,  he  affirms,  makes  a  parade  of  its  hostility  to 
religion ;  and  he  shows  that  although  hospitals  in  small 
towns  may  be  attended  to  by  the  parish  priest,  such  a 
course  will  be  impracticable  in  Paris,  where  hospitals  will  be 
found  in  parishes  containing  from  fifty  to  sixty  thousand 
inhabitants.  He  further  points  out  that  neither  in  France 
nor  in  any  other  Catholic  country  has  the  necessity  for 
hospital  chaplains  been  hitherto  disputed. 

At  a  recent  meeting  of  the  Paddington  Board  of  Guardians, 
the  Dispensary  Committee  reported  that  in  the  course  of  an 
investigation  into  the  number  of  cases  not  finally  accounted 
for  in  the  vaccination  returns  of  the  Union,  the  vaccination 
officer  had  informed  them  that  during  the  year  1882  he  was 
unable  to  trace  thirty-two  cases  of  children  born  at  certain 
houses  in  Tichborne-row.  On  making  inquiries  the  vaccina¬ 
tion  officer  found  that  the  children  were  born  of  young 
women,  sent  for  confinement  to  those  houses  from  all  parts 
(twelve  of  them  having  been  sent  from  one  particular 
home)  ;  that  both  mothers  and  children  were  removed  at  the 
end  of  a  fortnight’s  stay,  the  children  being  placed  out  to 
nurse ;  and  inquiries  by  the  vaccination  officer,  both  at 
Tichborne-row  and  at  the  home  in  question,  had  failed  to 
elicit  any  information  as  to  the  destination  of  the  children. 
The  Committee  recommended  that  these  facts  be  brought  to 
the  notice  of  the  Local  Government  Board,  as  showing  one 
of  the  difficulties  encountered  in  obtaining  complete  returns 
of  successful  vaccination.  The  report  was  unanimously 
adopted,  and  the  clerk  was  instructed  to  make  further 
inquiries  at  the  home  referred  to. 

A  deputation  of  representatives  from  about  forty  metro¬ 
politan  vestries  and  boards,  including  the  Commissioners  of 
Sewers  for  the  City  of  London,  recently  had  an  interview 
with  the  President  of  the  Local  Government  Board,  with 
reference  to  the  revival  of  the  practice  of  extending  tele¬ 
graphic  and  telephonic  wires  over  the  London  streets.  Sir 
Arthur  Hobhouse,  in  opening  the  subject,  stated  that  the 
object  of  the  vestries  in  seeking  the  interview  was  twofold. 
First,  they  contended  that  they  were  the  only  organised 
bodies  representing  the  inhabitants  of  the  metropolis,  and 
they  saw  all  around  this  new  practice  of  stretching  wires 
over  the  streets,  which  must  eventually  lead  to  accidents 
and  inconvenience.  They  therefore  felt  it  their  duty  to 
call  the  attention  of  the  Government  to  the  matter.  In 
the  second  place,  there  was  a  prevailing  opinion  that  the 
vestries  possessed  the  power  of  interfering,  though  after 
taking  legal  advice  they  were  informed  that  they  had  no 
control  in  these  cases,  their  only  remedy  being  to  seek 
an  interdict  from  a  court  of  law.  They  therefore  asked 
the  Government  to  provide  a  remedy,  either  by  intro¬ 
ducing  a  Bill  to  vest  in  some  local  authority  the  right  of 
control  over  the  erection  of  these  wires,  or,  if  it  were  dis¬ 
covered  that  the  authorities  had  power  under  the  existing 
law,  to  take  steps  in  order  that  such  power  might  be 
declared  by  Parliament  to  be  vested  in  the  local  governing 
body.  In  reply.  Sir  Charles  Dilke  said  the  Government 
were  of  opinion  that  the  owners  of  wires  had  no  special 
rig  hts  ;  the  question  to  be  considered  was  whether,  in  view 
of  the  great  risks  attending  the  wires,  the  local  authorities 


had  power  to  interfere,  and,  if  there  were  no  such  power, 
he  agreed  with  the  deputation  that  control  should  be  vested 
in  them.  But  the  Government  thought  the  authorities  had 
this  power,  and  until  it  was  proved  that  they  had  not,  he 
would  not  care  to  undertake  legislation  in  face  of  the 
opposition  which  such  a  scheme  would  provoke. 

The  British  public  is  a  long-suffering  body,  but  it  is  hardly 
wise  of  the  water  companies  to  strain  their  powers  to  the 
uttermost,  in  the  face  of  the  opposition  which  has  of  late 
been  so  freely  expressed  to  their  crushing  monopolies.  At 
a  meeting  of  the  Newington  Yestry,  held  last  week,  it  was 
resolved  to  direct  the  attention  of  the  Board  of  Trade  to  a 
new  regulation  of  the  Southwark  and  Yauxhall  Water 
Company,  by  which,  after  a  few  days’  notice,  the  water- 
supply  to  houses  might  be  cut  off,  and  the  tenants  left 
without  water  for  twenty-eight  days,  in  consequence  of  non¬ 
payment  of  water-rates.  Several  members  of  the  Vestry 
characterised  the  new  regulation  as  “  cruel  and  heartless,” 
and  the  medical  officer  intimated  that  it  was  calculated  to 
prove  highly  prejudicial  to  the  health  of  the  public  gene¬ 
rally.  Several  instances  had  come  under  his  notice  in  which 
the  Company  had  acted  in  a  most  arbitrary  manner. 

The  twenty-eighth  annual  festival  of  the  Poplar  Hospital 
was  recently  held  in  the  shape  of  a  dinner  at  Limmer’s 
Hotel,  the  chair  being  taken  by  Mr.  James  Duncan.  The 
report  called  attention  to  the  fact  that  this  Hospital  is  situ¬ 
ated  in  the  midst  of  laborious  and  dangerous  industries,  and 
is  therefore  located  in  a  position  where  it  is  most  needed, 
being  an  ever-ready  refuge  in  all  cases  of  sudden  and  dis¬ 
tressing  accidents.  During  the  past  year  no  less  than  seven 
cases  of  fractured  spine  were  received  in  the  space  of  a  fort¬ 
night,  while  the  total  number  of  patients  (all  under  treat¬ 
ment  for  accidents)  was  618,  or  twenty-five  in  excess  of  the 
previous  year.  Nevertheless,  the  total  cost  of  maintenance 
was  rather  less  than  that  for  the  year  1881 ;  and  this  eco¬ 
nomy  had  been  secured  without  any  sacrifice  of  efficiency. 
The  Hospital  had  succeeded  in  gaining  the  cordial  support  of 
the  great  shipowners,  engineers,  and  employers  of  labour  in 
the  immediate  neighbourhood,  and  many  of  these  attended 
upon  the  present  occasion  to  testify  their  estimation  of  the 
institution.  Before  the  close  of  the  evening,  subscriptions 
amounting  to  .£1700  were  announced. 

A  conference  on  the  administration  of  hospitals  was  this 
week  opened  in  the  rooms  of  the  Society  of  Arts.  Sir  T. 
Fowell  Buxton  presided,  and,  in  opening  the  proceedings, 
referred  to  the  manner  in  which  the  various  hospitals  were 
distributed  throughout  London,  observing  that  the  greater 
number  of  beds  were  concentrated  in  the  West  and  West- 
Central  Districts.  In  view  of  the  increased  demand  for 
hospital  accommodation,  it  was  a  question  whether  there 
ought  not  to  be  some  central  body  to  determine  in  what 
way  the  demand  should  be  met.  He  was  in  favour  of  a 
proposition  of  which  we  have  heard  before,  viz.,  that  a 
Loyal  Commission  should  be  appointed  to  inquire  into  the 
whole  question.  At  the  close  of  the  address,  papers  were 
read  on  hospital  administration  and  other  cognate  subjects. 

Eecent  published  returns  from  Surgeon-General  Irvine, 
principal  medical  officer  to  the  army  of  occupation  in  Egypt, 
state  that  out  of  a  total  force  at  Cairo  of  5135  men,  386 
were  on  the  sick  list;  of  the  1578  troops  stationed  at 
Alexandria,  112  men  were  sick ;  while  of  the  98  men  at  Port 
Said,  5  only  were  under  medical  treatment.  Of  the  various 
corps,  the  return  of  the  Eoyal  Engineers  is  the  most  favour¬ 
able — only  10  out  of  a  total  strength  of  181,  or  about  6  per 
cent.,  being  on  the  sick  list ;  while  the  regiment  that  is 
suffering  most  from  disease  is  the  Gordon  Highlanders,  with 
96  men,  out  of  a  total  strength  of  702,  in  hospital.  Tele¬ 
graphic  instructions  have  been  sent  out  to  Surgeon- General 


Medical  Times  and  Gazette. 


THE  WEEK. 


July  r,  1883.  13 


Irvine  to  take  every  precaution  for  the  health  of  the  troops,, 
in  view  of  the  outbreak  of  cholera  in  Egypt ;  and  a  draft  of 
officers  of  the  Army  Medical  Department  and  Army  Hospital 
Corps  is  under  orders  to  proceed  to  Egypt  to  strengthen  the 
medical  staff  already  there. 

A  recent  statement  issued  from  the  Mansion  House  shows 
that  the  total  sum  received  on  account  of  the  late  Hospital 
Sunday  Fund  collection  amounts  to  a  little  over  ,£30,000. 


THE  COUNCIL  OF  THE  BOYAL  COLLEGE  OF  SUBGEONS. 

The  annual  election  of  Fellows  of  the  Eoyal  College  of 
Surgeons  into  the  Council  of  that  institution  took  place  on 
Thursday,  the  5th  inst.,  and  caused,  as  was  expected,  great 
interest,  as  there  were  no  less  than  nine  candidates  for  the 
three  vacant  seats — all  well-known  and  good  men ;  and  as 
there  were  two  provincial  candidates,  an  unusully  large 
number  of  Fellows  attended  from  distant  provincial  towns. 
The  candidates,  taking  them  in  seniority,  were — Messrs.  J. 
Cooper  Forster,  of  Guy’s  Hospital ;  Sydney  Jones,  of  St. 
Thomas’s  Hospital ;  George  Lawson,  of  the  Middlesex  Hos¬ 
pital  ;  Arthur  E.  Durham,  of  Guy’s  Hospital ;  E.  Brudenell 
Carter,  of  St.  George’s  Hospital;  Eeginald  Harrison,  of  the 
Liverpool  Eoyal  Infirmary ;  Sir  William  Mac  Cormac,  of  St. 
Thomas’s  Hospital;  N.  Charles  Macnamara,  of  the  West¬ 
minster  Hospital ;  and  Oliver  Pemberton,  of  the  Birming¬ 
ham  General  Hospital.  The  President,  Sir  T.  Spencer  Wells, 
Bart.,  declared  the  ballot  open  at  two  o’clock,  and  the  voting 
was  not  brought  to  a  close  until  five  o’clock,  soon  after 
which  hour  the  President  announced  that  the  choice  of  the 
Fellows  had  fallen  on  Messrs.  Cooper  Forster,  Sydney  Jones, 
and  Sir  William  Mac  Cormac.  The  numbers  polled  by  these 
candidates  were  as  follows  : — Mr  .Cooper  Forster,  181,  in¬ 
cluding  2  plumpers ;  Mr.  Sydney  Jones,  125,  including  21 
plumpers  ;  Sir  William  Mac  Cormac,  119,  including  8 
plumpers.  In  the  evening  the  Fellows  dined  together 
at  the  Albion  Tavern,  under  the  presidency  of  Mr.  Luther 
Holden,  late  President  of  the  College. 


PBIZE  DISTBIBUTION  AT  CHABING-CBOSS  HOSPITAL. 

The  annual  prize-giving  of  the  School  attached  to  this 
Hospital  took  place  on  Thursday  last,  when  Lord  Wolseley 
presided.  Our  readers  will  find  in  another  column  the 
address  delivered  by  him. 


BOYAL  COLLEGE  OF  PHYSICIANS  OF  LONDON. 

At  an  extraordinary  meeting  of  the  Eoyal  College  of  Phy¬ 
sicians,  held  on  Thursday,  June  28,  it  was  ordered — “That 
no  present  or  gratuity  be  accepted  from  any  candidate, 
or  Fellow,  Member,  or  Licentiate  of  the  College  on  exami¬ 
nation  or  admission,  by  anyone  in  the  service  of  the  College  ”; 
and  it  was  directed  that  this  order  be  suspended  in  a  con¬ 
spicuous  part  of  the  College.  Dr.  Herbert  Watney  was  ad¬ 
mitted  a  Fellow.  On  the  motion  of  Dr.  Andrew  Clark, 
seconded  by  Sir  Eisdon  Bennett,  a  special  honorarium  of 
two  hundred  guineas  was  voted  to  the  Eegistrar,  Dr.  Pitman, 
in  recognition  of  his  long,  valuable,  and  increasingly 
arduous  services,  and  their  inadequate  remuneration.  A 
Finance  Committee  was  nominated,  to  consider  and  report  on 
the  salaries  of  the  officers  of  the  College.  A  communication 
was  received  from  the  Pharmacopceia  Committee  of  the 
General  Medical  Council,  and  the  following  Fellows  of  the 
College  were  appointed  a  committee  to  consider  and  report 
what  alterations,  additions,  or  omissions,  if  any,  it  is  de¬ 
sirable  should  be  made  in  the  proposed  new  edition  of 
the  British  Pharmacopoeia: — Drs.  Munk,  Garrod,  Einger, 
Brunton,  Baxter,  and  Thudichum.  Programmes  of  a  pro¬ 
posed  conference  on  the  administration  of  hospitals,  to  be 
held  at  the  House  of  the  Society  of  Arts,  were  laid  before 


the  Fellows.  A  committee,  consisting  of  the  following 
F ellows,  was  appointed  to  prepare  a  scheme  for  the  proposed 
examination  in  Hygiene  or  State  Medicine  Drs.  Corfield, 
Buchanan,  Barclay,  Bristowe,  Barnes,  Pavy,  Thorne,  and 
Gover.  A  by-law  was  passed  to  admit  Dr.  Osier,  of  Montreal, 
a  Fellow  in  abseniid.  It  was  resolved,  on  the  motion  of 
Dr.  Pitman,  seconded  by  Dr.  Acland — “  That  this  College 
withdraw  from  the  scheme,  dated  May  1,  1877,  for  a  Con¬ 
joint  Examining  Board  for  England,  at  the  expiration  of 
one  year  from  the  1st  day  of  October,  1883  ;  and  that  notice 
to  that  effect  be  given  to  all  the  medical  authorities  in 
England.”  A  report  from  the  Committee  on  the  Protection 
of  the  College  from  Fire  was  adopted. 


THE  TELEPHONE  FOB  THE  DUBLIN  HOSPITALS. 

We  understand  that  the  Public  Health  Committee  of  the 
Corporation  of  Dublin  have  unanimously  passed  the  following 
resolution: — “  That  the  Secretary  be  instructed  to  inform 
the  managing  committees  of  the  various  hospitals  subscribed 
to  by  the  Corporation  that  this  Committee  considers  it  desir¬ 
able  that  they  should  be  placed  in  telephonic  communication 
with  their  medical  staffs  after  the  manner  of  continental 
hospitals.”  This  step  on  the  part  of  the  Sanitary  Authority 
of  Dublin  cannot  fail  to  commend  itself  alike  to  the  medical 
profession  and  to  the  public. 


THE  METBOPOLITAN  WATEE-SUPPLY  FOB  MAY  LAST. 

The  report  of  the  Metropolitan  W at  er  Examiners  for  the  month 
of  May  last  records  a  slight,  though  not  important,  falling  off 
in  the  quality  of  the  supply  delivered  during  the  previous 
month.  In  dealing  with  the  condition  of  the  water  previous 
to  filtration.  Colonel  Bolton  says  the  state  of  the  water  in 
the  Thames  at  Hampton,  Molesey,  and  Sunbury  was  good 
in  quality  from  the  1st  to  the  11th  of  the  month,  when  it 
became  bad.  On  the  17th  it  again  became  good,  and  re¬ 
mained  in  that  condition  until  the  end  of  May.  He  again 
calls  attention  to  the  fact  [that  the  Southwark  and 
Yauxhall  Water  Company,  being  totally  unprovided  with 
reservoirs  for  subsidence,  have  to  draw  from  the  river 
at  all  times  ;  and  consequently  their  filter-beds  soon 
become  choked  up.  It  is  to  be  presumed  that  since 
their  revenue  is  substantially  increasing,  this  Company 
will,  before  long,  take  steps  to  remedy  a  defect  which 
has  now  existed  for  a  considerable  period.  As  regards 
the  condition  of  the  water  after  filtration.  Dr.  Frankland 
says  the  Thames  water  sent  out  by  the  Chelsea,  West 
Middlesex,  Southwark,  Grand  Junction,  and  Lambeth  Com¬ 
panies,  was,  for  river- water,  unusually  free  from  organic, 
matter,  though  not  quite  so  much  so  as  in  the  previous  month. 
With  the  exception  of  the  sample  of  the  Southwark  Com¬ 
pany’s  supply,  which  was  very  slightly  turbid,  and  con-,, 
tained  minute  moving  organisms,  all  the  water  was  efficiently, 
filtered  before  delivery.  The  water  drawn  from  the  river 
Lea  by  the  New  Eiver  and  East  London  Companies  was 
delivered  in  an  efficiently  filtered  condition,  and  contained 
also  an  exceptionally  small  proportion  of  organic  matter. 


THE  PABIS  WEEKLY  BETUBN. 

The  number  of  deaths  for  the  twenty-fifth  week  of  1883, 
terminating  June  21,  was  1074  (568  males  and  506  females), 
and  of  these  there  were  from  typhoid  fever  36,  small-pox 
14,  measles  29,  scarlatina  5,  pertussis  19,  diphtheria  and 
croup  33,  dysentery  1,  erysipelas  2,  and  puerperal  infections 
5.  There  were  also  58  deaths  from  acute  and  tubercular 
meningitis,  212  from  phthisis,  26  from  acute  bronchitis,  62 
from  pneumonia,  110  from  infantile  athrepsia  (41  of  the 
infants  having  been  wholly  or  partially  suckled),  and  33 
violent  deaths  (28  males  and  5  females).  The  mortality 


34 


Medical  Times  and  Gazette. 


THE  WEEK. 


July  7,  1883. 


continues  to  be  very  slight,  nothing  special  being  observ¬ 
able  concerning  the  epidemic  diseases.  The  births  for  the 
week  amounted  to  1104,  viz.,  583  males  (422  legitimate  and 
161  illegitimate)  and  521  females  (378  legitimate  and  143 
illegitimate)  :  95  infants  were  either  born  dead  or  died 

within  twenty-four  hours,  viz.,  60  males  (41  legitimate 
and  19  illegitimate)  and  35  females  (24  legitimate  and  11 
illegitimate). 

OPENING  OP  THE  PRINCESS  ALICE  MEMORIAL  HOSPITAL  AT 

EASTBOURNE. 

On  Saturday  last  the  Princess  Alice  Memorial  Hospital  at 
Eastbourne  was  opened  by  His  Royal  Highness  the  Prince 
of  Wales,  who  was  accompanied  by  the  Princess  of  Wales 
and  the  Princess  Elizabeth  of  Hesse,  daughter  of  the  late 
lamented  Princess  Alice.  The  inhabitants  of  Eastbourne 
had  done  everything  possible  to  provide  a  Royal  welcome  for 
the  distinguished  visitors,  who  on  their  arrival  were  con¬ 
ducted  to  the  entrance  of  the  Hospital,  where  the  Prince  of 
Wales  unlocked  the  front  door  with  a  ceremonial  key.  An 
inspection  of  the  wards  was  then  made ;  Dr.  Gream,  Physician 
to  the  Princess  of  Wales,  a  member  of  the  Grand  Committee, 
explaining  the  details  of  the  building.  The  Hospital  consists 
of  a  group  of  half-timbered  Elizabethan  buildings,  highly 
picturesque  in  appearance,  and  fitted  up  internally  with  all 
the  modern  requirements  of  a  sanitary  nature.  The  town  of 
Eastbourne  may  be  fairly  congratulated  upon  having  de¬ 
signed  a  very  handsome  and  very  useful  memorial,  and  on 
having  carried  out  their  project  to  its  termination  in  a 
thoroughly  scientific  and  efficient  manner. 


BERLIN  HOSPITAL  RETURNS  FOR  1882. 

It  is  stated  in  the  Deutsche  Med.  Wocli.  for  June  6,  that 
there  were  admitted  during  1882  into  the  nine  Berlin 
hospitals  (Charite,  Friedrichshain,  Hedwig,  Bethanien, 
Moabit,  Elisabeth,  Lazarus,  Augusta,  and  Jiidisches)  37,681 
new  patients,  or  3'22  per  1000  inhabitants.  The  number 
admitted  in  1879  was  34,613,  or  325  ;  in  1880, 38,189,  or  3'45  ; 
and  in  1881,  37,381,  or  3 ’28 — so  that  the  proportionate  num¬ 
bers  received  remain  much  the  same.  The  following  are  the 
distribution  of  diseases  observed,  and  the  percentages  com¬ 
pared  with  the  other  diseases  in  1882,  viz.  Small-pox  10 
(0-02),  varicella  9  (0'01),  measles  98  (0'26),  scarlatina  369 
11-00),  diphtheria  1515  (4  02),  croup  37  (O’ 10),  pertussis  22 
(0-06),  typhoid  fever  1138  (3  02),  relapsing  fever  6  (0-02)> 
typhus  fever  11  (0'03),  epidemic  trismus  7  (0'02),  dysentery 
134  (0'36),  cholera  90  (0'24),  puerperal  fevers  90  (0-24), 
intermittent  fever  117  (0-31),  erysipelas  200  (0'53),  syphilis 
and  gonorrhoea  4800  (12-13),  pneumonia  and  pleurisy 
1089  (2-88),  acute  bronchial  catarrh  167  (0'44),  phthisis 
pulmonalis  2195  (6'73),  other  diseases  of  the  respiratory 
organs  1395  (3'70),  acute  intestinal  catarrh  263  (0'6S), 
apoplexy  96  (0  26),  chronic  alcoholism  614  (l-63),  articular 
rheumatism  721  (l-90),  other  rheumatic  affections  1119 
(2'70),  injuries  2764  (7‘33),  all  other  unspecified  diseases 
18,605  (49 '37).  [Tables  of  this  kind,  in  which  nearly  50  per 
cent,  of  the  diseases  admitted  are  left  unspecified,  can  be 
only  of  a  limited  utility,  beyond  showing  the  relative 
prevalence  of  the  diseases  named  in  the  different  years.] 


THE  PROPOSED  SCOTCH  LOCAL  GOVERNMENT  BOARD. 

The  Local  Government  Board  for  Scotland,  which  the 
Government  Bill  proposes  to  create,  is  to  consist  of  a 
President,  with  a  salary  of  ,£2000  a  year,  and  as  ex  offi,cio 
members  the  Lord  President  of  the  Council,  all  the  principal 
Secretaries  of  State,  the  Chancellor  of  the  Exchequer,  and 
the  Lord  Advocate.  The  President  of  the  Board,  if  not  a 
member  of  the  House  of  Lords  or  a  peer  of  Scotland,  is  to 


be  capable  of  being  elected  a  member  of  the  House  of 
Commons,  and  the  Presidency  of  the  Board  is  to  be  one  of 
those  offices  of  profit,  the  acceptance  of  which  in  succession 
to  another  is  not  to  vacate  a  seat  in  Parliament.  As  to 
the  powers  and  duties  of  the  President  of  the  new  Board, 
they  are  to  be  those  now  vested  in  the  Home  Secretary,  the 
Privy  Council,  and  the  English  Local  Government  Board, 
with  respect  to  certain  Scotch  subjects.  These  matters 
relate  to  the  Poor-law,  lunacy,  fishery  boards,  registration  of 
births,  marriages,  and  deaths,  vaccination,  marriage  notices, 
general  police,  borough  police,  division  of  burghs  into  wards, 
markets  and  fairs,  prisons,  public  parks,  county  general 
assessment,  turnpike  accounts,  roads  and  bridges,  loco¬ 
motives,  police,  court-houses,  rivers-pollution,  burial-grounds, 
food  and  drugs  adulteration,  contagious  diseases  (animals)* 
artisans’  and  labourers’  dwellings,  local  taxation  returns, 
vivisection,  supervision  of  alkali  works,  factories  and  work¬ 
shops,  industrial  schools,  reformatories,  mines,  public  health, 
loans  by  the  Public  Works  Commissioners,  etc.  One  clause 
expressly  declares  that  the  Bill  is  not  to  prejudice  or  inter¬ 
fere  with  any  rights,  powers,  privileges,  or  duties  of  the 
Lord  Advocate. 


THE  SUNDERLAND  DISASTER. 

In  the  House  of  Commons,  on  Friday  last  week,  the  Vice- 
President  of  the  Council  was  asked  whether  any  steps  would 
be  taken  by  the  Education  Department  to  instruct  school 
managers  to  insure  the  due  supervision  of  school  children 
brought  together  in  large  numbers  for  the  purpose  of  enter¬ 
tainment  in  theatres  or  other  like  places  of  popular  public 
amusement.  Mr.  Mundella  replied  that  if  the  managers  of 
schools  would  not  of  themselves  recognise  the  lessons  taught 
by  the  terrible  disaster  at  Sunderland,  he  feared  no  circular 
from  the  Department  would  be  of  any  avail.  But  in  fact,  he 
said,  the  matter  was  not  within  the  jurisdiction  of  the 
Department;  and  he  did  not  understand  that  in  the  case 
referred  to  the  children  attended  collectively  as  scholars 
of  public  elementary  schools.  If  they  had  done  so,  the 
managers  and  teachers  would  have  been  responsible,  not  only 
for  their  good  conduct,  but  also  for  their  safety.  But  the 
objectionable  feature  of  the  case  was  that  the  giver  of  the 
entertainment  had  been  permitted  to  go  the  round  of  the 
schools  of  the  town  to  tout  for  the  sale  of  tickets  to  individual 
scholars;  and  ought  in  no  circumstances  to  have  been 
allowed. 


THE  WIRRAL  HOSPITAL  FOR  SICK  CHILDREN. 

On  the  28th  ult.  the  Duke  of  Westminster  presided  at 
the  ceremony  of  opening  the  Wirral  Children’s  Hospital, 
situated  in  Woodchurch-road,  Oxton,  near  Birkenhead.  The 
institution  in  question  was  initiated  by  a  few  gentlemen  of 
that  vicinity  in  1869,  and  proceedings  were  shortly  after¬ 
wards  commenced  in  a  house  containing  six  beds,  which 
was  the  means  of  affording  relief  to  sixty-two  children 
during  the  first  year.  The  first  stone  of  the  new  building 
was  laid  on  July  1  last  year.  It  consists  of  a  central  block 
and  one  wing,  calculated  to  afford  accommodation  for  forty- 
two  in-patients,  and  it  is  intended,  when  funds  permit,  to 
complete  the  design  by  erecting  a  second  wing.  The  style 
of  the  building  is  domestic  Gothic,  and,  without  entering 
into  details,  it  may  be  stated  generally  that  every  care  has 
been  taken  in  its  erection  to  secure  all  the  advantages  re¬ 
quired  by  modern  sanitary  science.  The  patients  admitted 
are  not,  strictly  speaking,  of  the  pauper  class,  a  fee  of  six¬ 
pence  being  exacted  on  the  first  application  for  the  benefits 
of  the  dispensary,  and  one  penny  for  every  form  of  medicine 
supplied.  It  is  stated  that  the  purchase  fund  has  been  fully 
subscribed,  and  that  the  new  building  will  start  entirely 
free  from  debt;  but,  with  a  view  of  securing  ample  funds. 


Medical  Times  and  Gazette. 


THE  WEEK. 


July  7,  1683.  1 5 


a  bazaar  and  a  variety  of  entertainments  were  held  in  the 
building  on  the  28th  and  two  following  days.  The  sum 
realised  on  the  opening  day  amounted  to  .£750. 


THE  VOLUNTEER  AMBULANCE  SERVICE. 

On  Thursday  afternoon  Lord  Wolseley  inspected  the 
■Charing- cross  Hospital  Ambulance  Company  at  St.  George’s 
Barracks.  The  Company  consists  solely  of  medical  students 
connected  with  the  Charing-cross  Hospital,  numbering 
about  forty.  Mr.  James  Cantlie  (Senior  Assistant-Surgeon  to 
tlie  Hospital),  who  has  throughout  played  a  most  prominent 
part  in  the  movement,  put  the  Company  through  the  bearer 
and  stretcher  drill  of  the  Army  Hospital  Corps.  We  believe 
that  this  is  the  first  occasion  on  which  this  movement  has 
received  official  recognition  on  the  part  of  the  War  Office 
authorities ;  and,  considering  the  short  time  it  has  been 
in  existence,  the  proficiency  of  the  Company  is  certainly 
creditable. 


PROFESSOR  GUSTAV  VALENTIN. 

By  an  oversight  we  omitted  to  notice  at  the  time  the  death 
•of  this  distinguished  physiologist  (May  23),  in  the  seventy- 
third  year  of  his  age.  Born  of  a  Jewish  family  in  Breslau, 
after  a  most  successful  academical  education  he  devoted 
himself  to  medicine,  and  even  prior  to  his  twenty-third 
year  he  took  his  doctor’s  degree,  and  published  a  treatise 
upon  the  Development  of  Plants  and  Animals,  which  at  once 
became  famous  and  obtained  the  prize  of  3000  fr.  from  the 
French  Institute.  Important  works  followed  this  one  after 
another,  and  three  universities — Luttich,  Bern,  and  Dorpat 
— offered  him  the  chair  of  physiology.  As  the  Russian 
Government  insisted  on  a  change  of  confession  as  a  condi¬ 
tion,  he  chose  the  chair  of  Bern,  and  continued  as  Professor 
of  Physiology  and  the  chief  ornament  of  that  University 
during  thirty-five  years.  In  1881  he  was  seized  with  apo¬ 
plexy,  which  left  him  hemiplegic.  He  was,  however, 
enabled  in  that  year  to  celebrate  his  jubilee  of  fifty  years’ 
■doctorate,  at  which  the  high  appreciation  entertained  of 
him  by  the  scientific  world  was  amply  exhibited.  We  need 
Rot  enumerate  his  numerous  contributions  to  physiology 
and  development,  many  of  which  were  of  a  most  distin¬ 
guished  character,  and  will  form  a  portion  of  the  history 
of  science  for  all  time.  His  treatise  on  Physiology,  so 
famous  in  its  days,  was  translated  by  the  late  Dr.  Brin  ton. 


WOOD  PAVEMENTS  AS  EXCITANTS  OF  DISEASE. 

W e  should  like  to  know  who,  or  what,  prompted  Viscount 
Newport  to  accuse  the  extension  of  wood  pavement  in  the 
metropolis  of  having  caused  a  serious  increase  of  affections 
of  the  eyes  and  lungs.  It  is  of  course  highly  desirable  that 
our  streets  should  be  carefully,  constantly,  and  thoroughly 
cleansed ;  and  it  must  be  admitted  that  there  is  room  for 
improvement  in  that  respect.  It  is  satisfactory,  therefore, 
to  learn  from  the  Chairman  of  the  Metropolitan  Board  of 
Works  that  the  cleansing  and  sweeping  of  the  streets  by 
boys  employed  for  the  purpose  in  the  City  and  in  some 
districts  has  appeared  to  be  efficient ;  and  that  the  same 
means  are  adopted  by  the  Board  of  Works  with  regard  to 
the  Thames  Embankment.  But  we  have  not  received  any 
reports  from  medical  men  of  any  notable  increase  of 
ophthalmic  or  pulmonary  diseases. 


THE  MEDICAL  SOCIETY  OF  LONDON. 

The  annual  oration  of  the  Medical  Society  of  London  was 
delivered  at  the  House  of  the  Society  on  Monday  evening, 
the  2nd  inst.,  by  Professor  Edward  Lund,  Professor  of 
Surgery,  and  Member  of  the  Senate,  Owens  College,  Man¬ 


chester.  His  very  able  and  suggestive  address  was  given 
in  the  new  and  admirably  proportioned  meeting-room,  the 
excellent  acoustic  properties  and  good  ventilation  of  which 
were  very  satisfactorily  proved.  The  oration  was  followed 
by  a  conversazione,  which  was  honoured  by  the  presence  of 
H.R.H.  the  Prince  of  Wales.  Some  five  hundred  guests 
and  Fellows  of  the  Society  were  present  in  the  course 
of  the  evening.  Among  the  former  were  Prince  Lucien 
Bonaparte,  the  Earl  of  Selkirk,  Sir  Bartle  Frere,  Sir  Richard 
Temple,  Sir  James  Hanbury,  the  Director-General  of  the 
Medical  Department  of  the  Navy,  and  other  old  friends  of 
the  President,  Sir  Joseph  Fayrer. 


THE  summer  commencements  in  the  university  of 

DUBLIN. 

The  Comitia  JEstiva  in  the  University  of  Dublin  this  year 
possessed  a  special  interest  from  the  circumstance  that 
honorary  degrees  were  conferred  on  His  Excellency  Earl 
Spencer,  Lord  Lieutenant  of  Ireland ;  General  Lord 
Wolseley  of  Cairo ;  Professor  Crawford,  the  head  of  the 
Engineering  School  of  Trinity  College ;  and  Dr.  George 
Hugh  Kidd,  the  Master  of  the  Coombe  Lying-in  Hospital 
and  ex-President  of  the  Royal  College  of  Surgeons  in 
Ireland.  Not  the  least  interesting  feature  in  the  academi¬ 
cal  proceedings  was  the  delivery  by  Professor  Webb,  the 
learned  and  eloquent  Public  Orator  of  the  University,  of  a 
series  of  speeches,  couched  in  elegant  Latin,  setting  forth 
the  claims  of  the  several  candidates  for  honorary  degrees. 
In  presenting  Dr.  Kidd  for  the  degree  of  Magister  in  Arte 
Obstetricia,  honoris  causa.  Dr.  Webb  spoke  as  follows :  — 
“  Et  nunc  mihi,  Juno  Lucina,  fer  opem  !  Ingenio  partu- 
rienti  meo  adsis,  precor  ;  nam  celebrandus  adest  castus  ille 
sacerdos  qui  caerimoniis  ac  sacris  tuis  summa  cum  religione 
praeesse  solet.  An  me  ludit  insania  poetae  ? 

“  Continuo  auditae  voces,  vagitus  et  ingens 
Infantum — 

non  infantum,  ut  in  inferis, 

“  Quos  dulcis  vitae  exsort  es,  et  ab  utere  raptos 
Abstulit  atra  dies — 

sed  quos  favente  Junone  sua,  ad  auras  produxit  Artis 
Obstetriciae  Magister  ille  noster.  Illius  natalibus  afful- 
sit  signum  synonymum  Haedorum — splendor,  ut  ferunt, 
pluvialis,  sed  quod  de  Danae  refertur,  pluvialis  auro.  Artis 
Obstetriciae  aliquid  debemus  omnes.  Artis  praecipuae 
magistrum  praecipuum  salutemus  universi.”  Nothing  can 
be  happier  than  the  play  upon  the  words  “  signum  synony¬ 
mum  Haedorum ,”  the  allusion  to  Dr.  Kidd’s  professional 
success  in  “pluvialis  auro,”  and  the  truism  “  Arti  Obste¬ 
triciae  aliquid  debemus  omnes.”  We  may  be  permitted  to 
add  our  congratulations  to  Dr.  Kidd,  the  worthy  recipient 
of  an  honorary  degree  from  the  University  of  Dublin. 


ST.  ANDREWS  GRADUATES’  ASSOCIATION. 

The  fifteenth  annual  session  of  the  St.  Andrews  Graduates’ 
Association  was  held  at  the  House  of  the  Medical  Society  of 
London,  on  June  30.  The  Treasurer’s  report  showed  a  very 
flourishing  condition  of  the  funds.  The  Council’s  report  con¬ 
gratulated  the  members  on  the  avowed  intention  of  the 
Government  to  withdraw  the  clause  in  the  Universities 
(Scotland)  Bill  by  which  power  was  given  to  Commissioners 
to  dissolve  the  University  of  St.  Andrews  ;  and  also  on  their 
purpose  to  retain  a  representative  of  St.  Andrews  on  the 
Medical  Board  for  Scotland.  Stress  was  laid  on  the  need  of 
close  union,  so  that  every  effort  might  be  made  to  retain  and  to 
extend  the  Medical  Faculty  of  the  University  ;  and  promise 
was  given  of  an  early  meeting  to  consider  the  best  means  of 
aiding  the  University  and  the  chairs  of  the  Medical  Faculty 


16 


Medical  Times  and  Gazette. 


THE  WEEK. 


July  7,  1883. 


by  a  money  contribution  from  the  graduates  and  their  friends. 
The  anniversary  dinner  was  held  in  a  beautiful  and  pleasant 
room  of  the  Holborn  Restaurant.  Dr.  Richardson,  the 
President,  was  in  the  chair ;  and  among  the  visitors  were  Lord 
Balfour  of  Burleigh,  Sir  Joseph  Fayrer,  K.C.S.I.,  Dr.  Hassall, 
and  Dr.  Hayward.  The  following  officers  were  elected  for 
the  ensuing  year  :• — • President  of  Council :  Dr.  Richardson, 
F.R.S.  Treasurer  :  Dr.  Paul.  Secretary  :  Dr.  Leonard  W. 
Sedgwick.  Council :  Drs.  Archibald,  Alderson,  Byars, 
Cholmeley,  Christie,  Cleveland,  Corner,  Crosby,  Dale,  A.  G. 
Davey,  J.  G.  Davey,  Davies,  Gillespie,  Gordon,  C.B., 
Griffiths,  Henty,  Hicks,  Hill,  Hood,  Kesteven,  Murray, 
Lindsay,  Lipscombe,  Longhurst,  Mr.  Menzies,  Professor 
Pettigrew,  F.R.S.,  Drs.  Pocock,  Royston,  Seaton,  J. 
Sedgwick,  Semple,  Smith,  Stamper,  Tibbits,  Wilkinson, 
Willett,  Rhys  Williams,  and  Wyman. 


AN  EXTRAORDINARY  ERRATUM. 

The  Gazette  Hebdomadaire  (June  29)  inserts  a  communica¬ 
tion  from  an  anonymous  London  correspondent,  giving  some 
account  of  the  recent  debate  in  the  House  of  Commons  on 
compulsory  vaccination,  and  thus  introduces  Sir  Lyon 
Playfair’s  masterly  speech : — “  Sir  Lyon  Playfair  demanded 
that  persons  who  did  not  believe  in  vaccination  should  no 
longer,  under  pain  of  a  fine,  be  compelled  to  have  their 
children  vaccinated.  From  this  he  went  on  to  make  a 
fundamental  charge  against  vaccination  and  vaccinators, 
attributing  to  them  all  the  ills  which  humanity  suffers 
from.”  It  is  true  that  in  the  next  paragraph  the  narrator 
goes  on  to  give  Sir  Lyon’s  arguments  and  figures  in  favour 
of  vaccination,  and  to  thus  mystify  his  readers. 


ICHTHYOSIS  IN  TABES. 

In  the  Progres  Medical  (No.  20),  MM.  Ballet  and  Dutil  give 
a  short  description  of  an  ichthyotic  condition  of  the  skin 
which  they  have  had  occasion  to  observe  in  tabes,  and  which 
they  regard  as  an  essential  part  of  the  disease,  and  not  as  a 
mere  coincidence.  Compared  with  this,  the  lesions  hitherto 
described — e.g.,  herpetic  eruptions,  ecchymoses,  perforating 
ulcer,  etc. — are  to  be  regarded  as  mere  transitory  occurrences. 
The  ichthyosis  is  slowly  developed,  probably  progressive,  and 
seems  to  be  analogous  to  the  now  well-known  osseous  lesions. 
The  lesion,  when  present,  is  always  found  at  those  situations 
in  which  there  has  been  previously  some  marked  disturb¬ 
ance  of  sensation,  either  anaesthesia  or  hypersesthesia  or 
lightning  pains.  The  limbs,  and  especially  the  arms,  would 
seem  to  be  the  parts  most  frequently  affected.  The  falling 
off  of  or  alteration  of  the  nails,  which  have  already  been 
described,  would  seem  to  be  merely  a  particular  example  of 
this  same  lesion.  Disorders  of  nutrition  such  as  the  one 
under  consideration  accord  very  well  with  the  idea  of  a 
peripheral  lesion  which  Pierret  was  the  first  to  recognise. 


All  who  have  the  pleasure  of  being  personally  acquainted 
with  Dr.  Pitman,  the  Registrar  of  the  Royal  College  of 
Physicians  of  London,  and  who  know  how  efficiently  and 
how  courteously  he  has  served  the  public,  the  profession, 
and  the  College  for  now  not  far  short  of  five-and-twenty 
years,  will  be  glad  to  hear  that  the  Queen  has  been  pleased 
to  intimate  to  him  her  gracious  intention  to  confer  upon  him 
the  honour  of  knighthood,  in  recognition  of  his  services  in 
the  cause  of  medicine. 


We  understand  that  the  Dean  of  Llandaff  (Dr.  Yaughan, 
Master  of  the  Temple)  will  take  the  chair  at  Dr.  Ralfe’s 
lecture  on  “  The  Hygiene  of  Schools,”  at  the  Parkes 
Museum,  on  Thursday,  July  12,  at  8  p.m. 


On  Wednesday  evening  the  President  and  Fellows  of  the 
Royal  College  of  Physicians  entertained  a  large  and  distin¬ 
guished  company  at  a  conversazione  held  at  the  house  of 
the  College  in  Pall-mall.  Among  the  guests  were  H.R.H. 
the  Duke  of  Albany,  Lord  Chelmsford,  Lord  Denman, 
Bishop  McDougall  (who  is  a  Fellow  of  the  Royal  College  of 
Surgeons),  the  President  of  the  Royal  College  of  Surgeons, 
and  Sir  James  Paget,  as  well  as  many  other  well-known 
members  of  the  profession. 


The  Gold  Medal  of  the  Apothecaries’  Society,  given  after 
examination  to  the  best  candidate  in  Botany,  has  this  year 
been  awarded  to  Mr.  G.  B.  Hoffmeister,  B.A.  Cantab.,  of  St. 
Bartholomew’s  Hospital.  The  Silver  Medal  in  the  same  sub¬ 
ject  has  been  won  by  Mr.  F.  W.  Green,  of  St.  Bartholomew’s 
Hospital. 

The  Queen  has  contributed  .£100  towards  the  fund  for 
clearing  off  the  debt  on  the  Aberdeen  Royal  Infirmary. 


The  Duke  and  Duchess  of  Albany  have  consented  to  be 
present  at  the  flower  show  of  the  Society  for  Promoting- 
Window  Gardening  among  the  Working  Classes  in  the 
Parishes  of  St.  Margaret  and  St.  John,  Westminster.  The 
show  will  be  held  in  Dean’s-yard  on  Tuesday,  July  10,  at 
2  p.m.  The  prizes  will  be  distributed  by  Lord  Shaftesbury 
in  the  evening. 

It  is  reported  that  the  Council  of  the  Firth  College, 
Sheffield,  have  just  adopted  a  scheme  by  which  the  College 
is  to  be  known  as  the  Hallamshire  University  College,  and  to- 
be  incorporated  by  royal  charter.  It  is  to  consist  of  three 
faculties — Arts,  pure  and  applied  Science,  and  Medicine. 


The  building  in  course  of  erection  for  the  Cottage  Hospital, 
St.  Paul’s  Cray,  Kent,  is  on  a  site  consisting  of  an  acre  and 
a  quarter,  fronting  the  main  road  from  St.  Mary  Cray  to 
Bexley ;  is  situation  is  elevated  and  dry.  The  building  is 
being  erected  by  voluntary  contributions,  for  the  benefit  of 
Chislehurst,  Sidcup,  Orpington,  the  Crays,  and  adjacent 
parishes,  and  the  estimated  cost  is  <£2162. 


The  Town  Council  of  Stratford-on-Avon  have  just  sanc¬ 
tioned  a  combined  scheme  of  water-supply  and  sewage  dis¬ 
posal,  at  an  estimated  cost  of  <£23,500.  The  whole  of  the 
town  sewage  is  at  the  present  time  discharged  into  the  river 
Avon,  and  the  Corporation  have  been  threatened  with 
injunctions. 

The  anniversary  meeting  of  the  Sanitary  Institute  of 
Great  Britain  will  be  held  in  the  theatre  of  the  Royal 
Institution  on  Thursday,  July  12,  at  3  p.m.  Professor 
Humphry,  M.D.,  F.R.S.,  will  preside,  and  an  address  will  be 
delivered  by  W.  Eassie,  C.E.,  on  “  The  Relationship  between 
Geology  and  Sanitation.”  The  medals  and  certificates- 
awarded  to  the  successful  exhibitors  at  the  Exhibition  at 
Newcastle  in  1882  will  be  presented. 


Diphtheritic  Paralysis. — The  Revue  Medicate  for 
May  26  quotes  from  the  Eira  a  case  of  paralysis  in  which 
there  was  difficulty  of  speech  and  paresis  of  the  lower 
limbs  that  supervened  on  an  attack  of  diphtheria  occurring 
a  fortnight  previously.  Quinine  and  iron  produced  no  ame¬ 
lioration,  the  paralysis  getting  worse,  so  that  the  lad  could 
take  neither  food  nor  medicine.  Dr.  Bom  an  then  prescribed 
five  milligrammes  per  diem  of  nitrate  of  strychnia,  made  up 
into  suppositories,  and  in  three  or  four  days  the  condition  of 
the  patient  (aged  fifteen)  was  improved,  and  his  recovery 
rapidly  ensued. 


Medical  Times  and  Gazette. 


MEDICAL  MATTERS  IN  PARLIAMENT. 


July  7, 1883.  17 


MEDICAL  MATTERS  IN  PARLIAMENT. 


House  op  Commons — Thursday,  June  28. 

Imprisonment  under  the  Vaccination  Acts. — Mr.  P.  Taylor 
asked  a  question  as  to  the  imprisonment  of  William  Henry 
Kennard,  of  Shoreham,  Sussex,  for  the  non-payment  of  a 
fine  under  the  Vaccination  Acts,  he  having  already  paid  35s. 
on  account  of  the  same  child,  and  the  said  W.  H.  Kennard 
having  been  compelled  to  pick  oakum  and  to  lie  upon  a 
plank  bed. — Mr.  George  Russell,  in  reply,  said :  The  Local 
Government  Board  have  made  inquiry,  and  find  that,  after 
repeated  warnings,  proceedings  were  instituted  against 
W.  H.  Kennard  in  May,  1882,  for  not  complying  with  an 
order  of  the  justices  for  the  vaccination  of  his  child.  The 
fine  imposed,  with  all  the  costs,  amounted  to  35s.,  and  this 
sum  was  paid.  Proceedings  were  again  instituted  in  May 
last.  The  man  pleaded  guilty,  and  was  fined  20s.,  inclusive 
of  costs,  and,  in  default  of  distress,  was  sentenced  to  fourteen 
•days’  imprisonment.  He  was  supposed  to  leave  Shoreham 
for  Brighton,  and  gave  at  the  police-station  an  address 
which  proved  to  be  false,  and  he  was  subsequently  arrested 
at  Shoreham.  The  warrant  of  commitment  did  not  impose 
hard  labour,  and  the  superintendent  of  police  states  that 
Kennard,  on  the  day  he  left  the  gaol,  informed  him  that  he 
had  been  treated  by  everyone  in  the  prison  with  a  great  deal 
of  kindness.  The  views  of  the  Board  on  the  subject  of  re¬ 
peated  prosecutions  are  set  forth  in  a  letter  which  has  been 
published  as  a  Parliamentary  paper,  and  are  generally  well 
known.  When  it  had  appeared  desirable,  a  copy  of  that 
paper  had  been  sent  to  a  board  of  guardians. 

The  Evil  Effects  of  Wood  Pavements  on  Health. — Viscount 
Newport  asked  the  Chairman  of  the  Metropolitan  Board  of 
Works  whether  it  is  not  the  fact  that,  since  the  recent 
extension  of  wood  pavements  in  the  metropolis,  serious 
affections  of  the  eyes  and  of  the  lungs  had  been  largely  on 
the  increase;  and  whether  it  would  not  be  possible  to  mitigate 
this  growing  evil  by  a  more  careful  and  thorough  system  of 
cleansing  the  streets. — Sir  J.  MGarel  Hogg  replied  that 
the  Board  had  not  control  over  the  streets,  and  that  he  had 
no  information  as  to  the  evils  referred  to. 

Army  Medical  Arrangements. — Lord  Hartington,  in  reply 
to  a  question  by  Colonel  Stanley,  agreed  that  it  would  be 
convenient  that  all  questions  arising  out  of  the  report  of 
Lord  Morley’s  Committee  on  the  Medical  Arrangements  in 
Egypt  should  be  discussed  together.  He  could  not  say  what 
the  Chairman  of  Committees  might  rule  to  be  in  or  out  of 
■order,  but  the  Government  would  not  interpose  any  obstacle 
to  the  discussion  of  any  point  whatever  that  arose  out  of 
that  report. 

Friday,  June  29. 

The  Cholera  in  Egypt. — The  Marquis  of  Hartington,  in 
reply  to  Lord  Folkestone,  said :  The  staff  of  medical  officers 
in  Egypt  is  sufficient  to  meet  all  probable  requirements,  and 
a  reserve  of  medical  officers  is  in  readiness  to  proceed  there 
if  necessary.  The  supply  of  medicines  is  ample,  and  any 
.article  that  it  may  be  thought  likely  to  be  of  use  in  case 
cholera  attacks  the  troops  will  be  added  to  the  supply  now 
in  course  of  shipment.  Instructions  have  been  sent  to  the 
general  officer  in  command  to  take  every  possible  precaution 
to  avert  an  outbreak  of  cholera,  calling  special  attention  to 
the  Indian  regulations  on  the  subject;  and  information  has 
been  received  that  these  instructions  had  been  anticipated. 

Monday,  July  2. 

The  Indian  Medical  Service. — In  answer  to  a  question  by 
Mr.  Gibson  as  to  great  stagnation  of  promotion,  and  conse¬ 
quent  dissatisfaction,  in  the  Indian  Medical  Service,  Mr. 
•Cross  said :  The  disbandment  of  native  regiments,  though  it 
reduced  the  number  of  “  independent  charges,”  and  thus 
added  to  the  number  of  “  unemployed  ”  officers,  could  not 
affect  their  promotion,  which,  in  the  executive  branches,  is 
governed  solely  by  length  of  service.  As  I  have  explained 
•on  a  former  occasion,  a  considerable  reduction  made  in  the 
number  of  appointments  in  the  Service  during  the  past  and 
present  years  will  shortly  remove  the  difficulty  temporarily 
•experienced  through  the  disproportion  of  officers  to  the 
number  of  independent  charges.  It  is  therefore  not  con-  I 


sidered  expedient  to  have  recourse  to  an  offer  of  higher 
rates  of  pension  as  an  inducement  to  the  senior  officers  to 
retire.  The  total  loss  of  administr  ative  appointments  for 
the  whole  of  the  Indian  Medical  Service  consequent  on  the 
reorganisation  of  the  medical  administration  was  only  one. 
The  injury  to  the  Service  is  therefore  nominal,  though 
doubtless  the  arrangements  consequent  on  the  reorganisa¬ 
tion  have  retarded  the  possible  selection  of  a  few  officers. 
Such,  chances,  however,  are  to  be  looked  for  in  all  branches 
of  the  public  service,  and  are  not  in  this  case  considered  to 
justify  the  grant  of  any  special  compensation.  The  question 
of  the  future  organisation  of  the  Medical  Service  for  India 
is  now  the  subject  of  discussion  with  the  War  Office,  but  has 
no  reference  to  any  grievance  of  the  Indian  or  British 
Medical  Service,  and  it  has  not  yet  reached  a  stage  at  which 
any  statement  could  be  usefully  made  to  the  House. 

Artisans’  Dwellings. — Mr.  Broadhurst  asked  the  First 
Lord  of  the  Treasury  whether  he  would  appoint  a  Royal 
Commission  to  inquire  into  the  dwelling  accommodation 
of  the  labouring  classes,  and  into  the  evils  consequent  on 
overcrowding  in  the  metropolis  and  other  large  towns, 
with  a  view  to  legislation  on  the  subject. — Mr.  Gladstone 
said  that  he  believed  the  subject  was  ripe  for  discussion 
and  legislation ;  but  that  discussion  and  legislation  could 
hardly  take  place  in  the  present  session  of  Parliament. 
Her  Majesty’s  Government  were  not,  therefore,  inclined  to 
appoint  a  Commission  under  present  circumstances,  and 
it  was  too  soon  to  forecast  the  business  of  next  session. 
— In  answer  to  Sir  R.  Cross,  who  asked  whether  Govern¬ 
ment  would  consent  to  issue  a  small  Commission  to  report 
as  to  the  state  of  parts  of  the  metropolis  which  really  ought 
to  be  subject  to  the  alterations  required  by  the  Artisans’ 
Dwellings  Act,  Sir  W.  Harcourt  said  he  would  consider  the 
suggestion  if  the  matter  had  not  already  been  sufficiently 
inquired  into. 

Tuesday,  July  3. 

Hospitals  for  Infectious  Disease  in  Ireland. — Mr.  Moore 
asked  the  Chief  Secretary  for  Ireland  whether  he  knew  that 
the  workhouse  hospitals  are  in  many  districts  the  only  similar 
institutions  available  for  paying  patients,  and  for  people  in 
well-to-do  circumstances,  when  suffering  from  infectious  dis¬ 
eases  ;  whether  there  were  powers  of  compulsory  removal  of 
such  persons  from  their  homes ;  whether  all  persons  were 
compelled  to  wear  the  workhouse  uniform  while  in  hospital, 
and  that  great  exception  was  taken  to  this  by  paying 
patients  ;  and  whether  he  would  urge  the  Local  Government 
Board  to  modify  their  rules  in  this  respect.— Mr.  Trevelyan 
said  :  The  facts  are  as  stated  in  the  first  two  paragraphs  of 
the  question.  The  present  practice  with  regard  to  the  dress 
has  been  in  force  since  1862.  Boards  of  guardians  were  then 
advised  by  the  Local  Government  Board  that  persons  in  fever 
hospitals  ought  not  to  be  allowed  to  wear  their  own  clothing, 
but  that  a  simple  form  of  hospital  dress,  having  nothing  in 
common  with  the  ordinary  workhouse  dress,  should  be  pro¬ 
vided.  The  Board  believe  that  in  some  instances  this  rule 
has  been  relaxed  in  the  case  of  the  Royal  Irish  Constabulary 
and  of  other  paying  patients ;  but  they  regard  this  as  very 
objectionable.  They  think  that  persons  returning  to  their 
own  homes  in  the  dress  they  have  worn  in  hospital  would  be 
likely  to  spread  infection. 


Increase  oe  Physicians  in  New  York. — In  the  list 
of  registered  physicians  published  in  1881  the  total  number 
given  was  about  2400.  The  number  now  is  over  2800,  show¬ 
ing  an  increase  of  about  400  in  two  years.  During  this  time 
the  population  is  estimated  to  have  increased  from  1,230,000 
to  1,295,000,  or  about  65,000.  In  other  words,  there  has  been 
a  new  doctor  for  every  162  inhabitants.  This  does  not  take 
into  account  all  the  deaths  and  removals,  which  in  the  two 
years  amount  probably  to  above  80 ;  still,  even  allowing  for 
this,  it  shows  how  densely  New  York  is  becoming  crowded 
with  physicians,  and  that  medical  men  are  coming  in,  pro¬ 
portionally,  much  faster  than  the  rest  of  the  population. 
In  1881  the  ratio  of  doctors  to  population  was  1  to  514 ;  now 
it  is  1  to  463.  The  above  figures  relate  to  registered  or  legal 
practitioners.  Of  the  2800  now  in  the  city,  about  1800  are 
entitled  to  be  termed  regular  by  virtue  of  their  names  ap¬ 
pearing  in  the  Medical  Register.  There  are  therefore  a 
thousand  irregulars  amongst  us. — New  York  Med.  Record , 
June  2. 


18 


Medical  Times  and  Gazette . 


MEDICAL  REPOETS  TO  THE  LOCAL  GOVERNMENT  BOAKD. 


July  7,  1883- 


MEDICAL  EEPOETS  TO  THE  LOCAL 
GOVERNMENT  BOAED. 


Mr.  John  Spear  on  Enteric  Fever  at  Southborough. 
In  the  month  of  September  last,  Mr.  John  Spear  was  de¬ 
puted  by  the  Local  Government  Board  to  institute  an  inquiry 
as  to  the  origin  of  an  outbreak  of  enteric  fever  in  the 
Urban  Sanitary  District  of  Southborough.  This  latter 
place  is  situated  midway  between  Tunbridge  and  Tunbridge 
Wells ;  it  has  a  population  estimated  at  3870  persons,  and, 
as  it  possesses  all  the  advantages  of  scenery,  clear  air,  and 
dry  soil,  it  is  likely  to  increase  quickly.  Mr.  Spear  reports 
that,  although  the  sewerage  of  the  district  is  all  but  com¬ 
pleted,  there  are  no  special  means  provided  for  flushing. 
Moreover,  the  sewers  are  carried  for  the  most  part  down  the 
front  streets,  and  as  the  greater  number  of  houses  stand 
somewhat  back  from  the  road,  and  are  built  in  detached 
blocks,  a  considerable  length  of  private  drain  is  required. 
In  the  construction  of  these  private  drains,  Mr.  Spear 
observes,  the  most  unfortunate  mismanagement  has  been 
shown ;  a  large  proportion  of  them  allow  of  the  deposition 
and  retention  of  much  of  the  sewage  matter,  the  joints  are 
defective  and  leaky,  and  right-angle  junctions  are  generally 
provided,  the  result  being  that  when  the  excrement  reaches 
the  sewer  it  is  a  highly  putrid  mass,  resembling  the  ooze  of 
a  cesspool.  As  a  consequence,  the  sewers  are  highly  charged 
with  offensive  gases,  and  their  surface  ventilators  are  much, 
and  justly,  complained  of.  This  condition  of  the  drainage, 
leading  as  it  does  to  the  deposit  of  sewage  and  its  leakage  into 
the  surrounding  soil,  is  all  the  more  hazardous  since  the  water- 
supply  of  the  whole  district  is  solely  derived  from  local  wells. 
These  wells,  Mr.  Spear  adds,  are  rarely  protected  from  imme¬ 
diate  surface-pollution,  and  the  majority  of  them  are  liable 
to  most  dangerous  contamination.  Between  June  1  and  the 
commencement  of  September,  1882,  twenty-four  houses  in 
the  district  were  known  to  have  been  invaded  by  the  fever, 
thirty- three  persons  were  attacked,  and  four  died.  The 
majority  of  the  cases,  Mr.  Spear  remarks,  appear  to  have 
been  typical  attacks  of  enteric  fever  (four  such  cases  he 
himself  saw),  and  the  nature  of  the  whole  series  was  suffi¬ 
ciently  determined.  The  infected  houses  were,  with  one 
exception,  situated  in  the  district  to  the  west  of  the  main 
street — a  district  composed  for  the  most  part  of  cottage,  or 
smaller  house  property, — and  in  several  of  these,  notably  in 
certain  of  those  invaded  by  fever,  the  sewage  stench  was 
found  to  be  almost  intolerable.  The  Medical  Officer  of 
Health,  reporting  upon  this  outbreak  to  the  Sanitary  Autho¬ 
rity  just  before  Mr.  Spear's  visit,  had  given  it  as  his  opinion 
that  “  the  improper  and  insufficient  water-supply,  and  the 
direct  access  of  sewer- gas  into  the  dwellings,"  were  the 
cause  of  the  fever ;  and  the  facts  elicited  by  Mr.  Spear  in 
the  course  of  his  investigations  inclined  him  to  the  same 
opinion.  Many  of  the  harmful  conditions  noticed  in  his 
report  may,  he  thinks,  be  readily  dealt  with  by  proper 
application  of  those  provisions  of  the  Public  Health  Act 
which  deal  with  ordinary  nuisances;  and  the  judicious 
enforcement  of  by-laws — a  duty  which  in  the  past  has  been 
so  much  neglected — will  obviate  any  danger  of  the  recurrence 
of  such  conditions  in  property  hereafter  erected.  The  im¬ 
provement  of  the  water-supply — the  district’s  most  urgent 
need — can,  on  the  other  hand,  the  report  says,  only  be 
attained  by  the  direct  efforts  of  the  Authority  itself.  For 
some  time,  it  would  appear,'  the  provision  of  a  public  supply 
has  been  under  consideration,  and  Mr.  Spear  is  of  opinion 
that  the  sooner  such  a  provision  is  made,  the  better  it  will 
be  for  the  health  of  the  locality. 


Mr.  John  Spear  on  Fever  in  the  Borough 
of  St.  Helen’s. 

The  continued  prevalence  of  fever  in  the  Urban  Sanitary 
District  of  St.  Helen’s  induced  the  Local  Government 
Board  to  despatch  Mr.  John  Spear  in  the  middle  of  1882  to 
institute  inquiries  as  to  its  cause.  It  may  briefly  be  ex¬ 
plained  that  this  district  is  situated  on  the  south-western 
limits  of  the  Lancashire  coal-field,  covering  an  area  of  6586 
acres,  and  having  a  population  of  57,234.  Its  industries  are 


well  known — coal  mines,  chemical  works,  alkali  and  copper- 
extracting  works,  and  glass  works, — and  the  pollution  of  the 
atmosphere  by  chemical  fumes  and  coal-smoke  has  repeatedly 
been  brought  to  public  notice.  With  only  few  exceptions 
the  deaths  from  fever  have  always  been  recorded  under 
one  or  other  of  the  synonyms  of  enteric  or  typhoid  fever, 
and  this  form  of  fever  has  undoubtedly,  the  report  re¬ 
marks,  been  the  prevailing  disease.  A  close  examination 
cf  the  health-returns  of  the  district  for  the  past  ten 
years  shows  that  in  only  six  of  the  120  months  (these 
six  widely  separated  from  each  other)  have  the  bills  of 
mortality  been  free  from  the  record  of  “fever,”  while  the 
loss  of  life  from  this  disease  has  been  considerable.  Further, 
throughout  these  ten  years  there  has  been  in  the  behaviour 
of  the  disease  a  very  close  observance  of  that  tendency 
which  it  possesses  to  assume  a  wider  prevalence  at  certain 
seasonal  periods — a  characteristic,  Mr.  Spear  observes,  that 
is  apt  to  be  obscured  in  accidental  outbreaks,  and  one,  the. 
continued  exhibition  of  which  might  suggest  that  the  in¬ 
fection,  obeying  from  year  to  year  the  natural  laws  of  its 
development  and  progress,  is  running  a  course  little  influ¬ 
enced  by  any  but  the  permanent  conditions  of  the  locality. 
Dr.  McNicoll,  the  Medical  Officer  of  Health  for  St.  Helen’s, 
has  frequently  expressed  his  opinion  that  the  sulphu¬ 
retted  hydrogen  emitted  from  the  heaps  of  alkali  waste, 
and  especially  from  the  liquid  which  drains  from  these 
deposits  when  it  meets  the  waste  acid  in  the  brook  that 
runs  through  the  centre  of  the  town,  is  prejudicial  to  the 
health  of  the  localities  along  the  course  of  the  brook,  and 
wherever  else  this  nuisance  specially  arises.  But  mortality 
statistics  do  not  show  this.  In  the  six  wards  of  the  borough, 
three  of  which  are  mainly  urban  and  the  others  extra-urban 
in  character,  and  certain  of  which,  are  distinctly  more  ex¬ 
posed  than  others  to  the  nuisance  of  sulphuretted  hydrogen, 
the  fever-rate  for  the  ten  years  previously  mentioned  was 
remarkably  even.  On  the  other  hand,  the  result  of  his 
inquiries  impressed  Mr.  Spear  with  the  conviction  that  inves¬ 
tigation  of  the  cause  of  fever  in  St.  Helen’s  resolved  itself 
into  a  consideration  of  the  general  sanitary  condition  of  the 
town.  As  regards  water-supply,  but  few  alterations  were 
called  for.  The  district  is  almost  entirely  supplied  from  the 
public  mains,  the  water  being  obtained  from  deep  wells  in 
the  sandstone  rock,  and  nothing  was  found  tending  to 
implicate  the  public  water-supply  in  the  production  of  fever.. 
The  weak  spots  in  the  sanitary  administration  of  the  dis¬ 
trict  are,  in  Mr.  Spear’s  opinion,  the  drainage  arrange¬ 
ments  and  the  unsatisfactory  system  of  refuse  removal. 
The  main  sewer  of  St.  Helen’s  is  at  the  present  time  the 
town’s  brook ;  it  possesses  only  its  natural  bed,  and  in  most 
places  its  natural  clayey  or  sandy  sides;  and  its  generally 
sluggish  stream,  reduced  sometimes  in  dry  weather  to  little 
more  than  crude  sewage,  is  left  to  pursue  its  tortuous  course 
through  the  district,  only  hastened  here  and  there  by  very 
slight  and  inconsiderable  works.  The  refuse  removal  is 
generally  undertaken  on  the  midden  system,  and,  as  Mr. 
Spear  convinced  himself  by  observation,  is  performed  in  a 
very  slovenly  manner.  The  recommendations  attached  to* 
the  report  deal  chiefly  with  these  points,  and  with  certain 
administrative  changes  in  the  present  sanitary  arrange¬ 
ments  of  the  district ;  and,  if  these  are  actively  carried  out, 
Mr.  Spear  is  of  opinion  that  an  improvement  in  the  health 
of  the  town  may  confidently  be  expected. 


Dr.  Parsons  on  Diphtheria  in  the  Holbeach  Rural 
Sanitary  District. 

Application  having  been  made  to  the  Local  Government 
Board  by  the  Guardians  of  the  Holbeach  Union  for  its 
sanction  to  the  postponement  of  the  October  vaccination 
attendances  in  the  Gedney  vaccination  district  on  account 
of  an  outbreak  of  diphtheria  therein,  and  a  report  of  the- 
Medical  Officer  of  Health,  dated  October  last,  having  shown 
the  outbreak  to  have  been  one  of  some  severity.  Dr.  Parsons 
was  despatched  to  make  inquiries  respecting  it.  On  his 
arrival  on  November  1,  the  disease  appeared  to  be  dying 
out,  the  last  known  case  being  convalescent.  Up  to  that 
time,  however,  from  the  commencement  of  the  outbreak  in 
the  previous  February,  some  twenty  or  thirty  cases  had  come- 
to  the  knowledge  of  the  Medical  Officer  of  Health,  with  seven, 
deaths ;  but  as  several  instances  were  met  with,  during  the 
inquiry,  in  which  families  had  been  attacked  with  sore-throat 
without  resorting  to  medical  aid,  there  is  little  doubt  that,. 


Medical  Times  and  Gazette.  MEDICAL  REPOETS  TO  THE  LOCAL  GOVERNMENT  BOARD.  Jobless.  19 


numerous  cases  never  came  under  his  notice  at  all.  The 
outbreak  would  appear  to  have  been  almost  wholly  confined 
to  two  adjacent  places  called  Bawsmere  and  Gedney  Drove 
End,  adjoining  the  present  coast  of  the  Wash,  and  situate  in 
a  perfectly  level  district,  one  portion  of  which  is  called  the 
Fen,  and  the  other  the  Marshes.  The  Holbeach  Rural  Dis¬ 
trict  has  been,  so  far  as  is  known,  free  from  diphtheria  for 
some  years  until  the  February  of  1882,  when  the  first  cases 
occurred  at  Gedney  Drove  End.  There  had,  however,  been 
an  epidemic  of  diphtheria  at  King’s  Lynn,  eleven  miles  as 
the  crow  flies  south-east  of  Gedney  Drove  End.  This  epi¬ 
demic  commenced  in  September,  1881,  and  was  the  subject 
of  a  report  to  the  Board  by  Dr.  Airy.  One,  at  least,  of  the 
Gedney  cases.  Dr.  Parsons  observes,  was  connected  with 
that  epidemic,  namely,  a  boy  at  the  Lynn  Grammar  School, 
of  which  two  or  three  pupils  had  had  diphtheria  shortly 
before;  he  came  home  unwell  on  February  17  to  Leamlands, 
an  isolated  house  two  or  three  miles  from  Gedney  Drove 
End,  and  died  of  diphtheria  on  February  25.  With  the 
exception  of  another  member  of  the  family,  who  subse¬ 
quently  suffered  from  diphtheria,  no  connexion  is  traceable 
between  this  case  and  any  other  in  the  district.  Moreover, 
this  was  not  the  first  case  which  occurred  in  the  district, 
since,  on  February  12,  the  daughter  of  a  coastguardsman 
had  been  taken  ill  of  it,  and  two  members  of  the  same  family 
followed  at  successive  intervals  of  a  week.  On  a  review  of 
the  whole  circumstances  of  the  case.  Dr.  Parsons  is  unable 
to  say  in  what  manner  diphtheria  was  introduced  into  Gedney 
Drove  End.  He  finds  it  difficult  to  account  for  the  out¬ 
break  on  defective  sanitary  conditions,  since  these  have 
existed  at  Gedney  Drove  End  for  a  number  of  years  past, 
during  which  the  place  has,  nevertheless,  been  free  from 
diphtheria.  Again,  any  meteorological  or  other  conditions 
of  a  general  nature  would  affect  equally  the  adjoining 
villages,  which  have,  nevertheless,  escaped  diphtheria, 
although  local  conditions  similar  to  those  mentioned  are 
to  be  met  with  in  them  also.  In  view  of  the  suggestion 
that  the  infectious  matter  of  diphtheria  may  be  conveyed 
long  distances  by  the  wind.  Dr.  Parsons  procured  from 
the  coastguard  at  Gedney  Drove  End  a  table  of  the  wind 
and  weather  from  January  to  October,  1882,  as  recorded 
in  their  log-book.  From  this  he  found  that,  if  it  be  conceded 
that  infectious  particles  may  be  transmitted  through  the  air 
for  distances  so  great  as  that  from  Lynn  to  Gedney  Drove 
End  without  losing  their  activity,  the  meteorological  condi¬ 
tions  in  the  latter  part  of  January  and  beginning  of  February 
were  favourable  to  such  transmission.  It  may  also  be 
noticed.  Dr.  Parsons  remarks,  that  when  cases  of  diphtheria 
occurred  at  Lutton  Marsh,  the  wind,  which  through  March 
had  been  strong  and  westerly,  veered  to  E.  and  N.E.,  i.e.,  it 
blew  to  Lutton  Marsh  from  the  direction  of  the  places  where 
diphtheria  had  previously  existed.  The  prevailing  winds, 
however,  are  from  the  W.  and  S.W.,  and  these,  after  passing 
Dawsmere  and  Gedney  Drove  End,  would  blow  over  the 
Wash. 


Dr.  Parsons  on  Enteric  Fever  in  the  Holbeach 
Rural  Sanitary  District. 

Whilst  inspecting  the  Holbeach  Rural  Sanitary  District 
in  the  November  of  last  year.  Dr.  Parsons  ascertained  that 
enteric  fever  had  been  endemic  for  the  past  two  years  at  a 
place  in  that  neighbourhood  called  Whaplode  Drove,  and 
that  scarlet  fever  had  also  been  prevalent  there,  and  accord¬ 
ingly,  accompanied  by  the  Medical  Officer  of  Health  for  the 
district  and  Dr.  Crowden,  Poor-law  Medical  Officer,  he  pro¬ 
ceeded  to  investigate  the  circumstances.  Whaplode  Drove 
is  situated  nine  miles  south  of  Holbeach,  in  the  low-lying 
fen  country,  with  a  clay  soil ;  the  village  is  scattered, 
the  houses  standing  in  clusters  of  two  or  three  along  the 
course  of  two  parallel  roads  and  a  connecting  cross-road  ; 
many  of  them  were  found  to  be  old  and  ill-built,  and 
overcrowding  was  not  infrequent.  Although  Dr.  Parsons 
did  not  trace  the  cause  of  the  outbreak  of  fever,  he  dis¬ 
covered  ample  reasons  why,  being  once  established  in 
the  locality,  it  would  be  difficult  of  removal.  The  only 
drainage  existing  was  into  ditches  or  cesspits,  and  in  some 
places  accumulations  of  stagnant  dirty  water  were  seen 
standing  in  the  immediate  neighbourhood  of  the  houses. 
The  privies  were  of  the  roughest  description,  standing  over 
holes  dug  out  in  the  earth.  The  water-supply  was  very  bad. 
Some  houses  had  proper  cisterns,  but  at  others  rain  had  to 


be  caught  in  tub3  or  pails.  When  this  supply  failed,  the 
nearest  ponds  and  ditches  had  to  be  resorted  to.  At  other 
houses,  again,  there  were  wells ;  but  the  subsoil  being  im¬ 
pervious  clay,  the  water  consisted  merely  of  the  soakage  from 
the  superficial  soil,  and  was  liable  to  be  fouled  by  surface 
runnings  and  by  soakage  from  neighbouring  privies,  pig- 
styes,  etc.,  had  commonly  a  yellowish  or  brownish  hue,  and 
contained  floating  impurities.  Dr.  Crowden  informed  Dr. 
Parsons  that  duringthe  past  two  years  he  had  had  some  thirty 
cases  of  enteric  fever  under  his  care  at  Whaplode  Drove, 
some  of  which  had  been  severe  and  well  marked,  although, 
with  one  exception,  no  deaths  had  occurred.  The  earliest 
case  appeared  to  be  that  of  a  woman  who  had  recently  come 
to  the  neighbourhood  to  reside,  and  who  died  on  December  2, 
1880,  of  an  illness  which,  although  not  so  certified,  was 
subsequently  recognised  to  have  been  enteric  fever.  Close- 
to  the  house  where  she  died  a  small  school  was  kept,  the 
children  attending  which  were  taken  in  to  see  the  corpse, 
and  allowed  to  kiss  it ;  some  of  them  afterwards  suffered 
from  fever.  In  one  household  in  Whaplode  Drove  in  which 
enteric  fever  occurred,  the  disease  appeared  to  have  been 
imported,  the  parties  having  only  arrived  from  Spalding  a 
few  days  before.  Scarlet  fever  was  prevalent  in  the  locality 
in  the  winter  of  1881-82,  and  it  would  appear  to  have  been 
spread  through  unrestricted  intercourse  between  the  chil¬ 
dren  of  different  households.  The  want  of  wholesome  water 
in  parts  of  the  Holbeach  division,  among  which  Whaplode 
Drove  is  conspicuous,  was  laid  stress  on  by  the  Medical 
Officer  of  Health  in  his  annual  report  to  the  Holbeach 
Rural  Sanitary  Authority  for  1881,  and  formed  the  subject 
of  a  subsequent  correspondence  between  the  Board  and  the 
Sanitary  Authority.  The  action  of  the  Authority,  however, 
seemed  to  have  been  limited  to  the  serving  of  “threatening 
notices,”  with  which  some  owners  have  complied  by  con¬ 
structing  rain-water  cisterns,  while  others  have  disregarded 
them  with  impunity. 


Dr.  Parsons  on  an  Outbreak  of  Diphtheria 
at  Devonport. 

On  January  1,  1883,  the  Town  Council  of  Devonport  ad¬ 
dressed  a  communication  to  the  Local  Government  Board, 
requesting  that  an  immediate  inquiry  might  be  made  into 
an  outbreak  of  diphtheria  which  had  recently  occurred  in 
that  borough.  The  matter  was  placed  in  the  hands  of  Dr. 
Parsons,  who  spent  from  the  5th  to  the  8th  of  that  month, 
in  making  local  investigations.  Up  to  the  date  of  this  in¬ 
spection  the  number  of  known  recent  cases  of  the  disease 
was  thirty-one,  in  eighteen  households,  of  which  five  had 
proved  fatal.  The  outbreak,  however,  had  attracted  atten¬ 
tion  less,  perhaps,  by  the  number  of  its  victims  than  by  their 
social  position,  the  persons  attacked  having  been  members  of' 
the  families  and  servants  of  professional  men,  and  more  espe¬ 
cially  of  officers  of  the  Army  and  Navy,  including  those  in  the 
highest  positions  of  command  in  both  services.  In  only  one. 
instance  was  a  tradesman’s  family  attacked,  and  no  case 
is  known  to  have  occurred  among  the  large  working-class 
population.  After  a  considerable  amount  of  inquiry  it  was 
found  that  the  greater  number  of  the  persons  attacked  had 
obtained  their  milk-supply  from  a  particular  dairy,  although 
it  is  but  right  to  add  that  these  formed  but  a  small  per¬ 
centage  of  the  whole  of  the  customers  supplied  from  the- 
6ame  source.  Nevertheless,  the  report  remarks,  the  parts 
of  the  borough  not  supplied  by  this  dairy  escaped  the 
disease,  as  did  also  the  adjacent  towns  of  Stonehouse  and 
Plymouth.  Dr.  Parsons  inspected  the  farm  where  the  cows, 
supplying  the  dairy  were  kept,  but  failed  to  discover  any¬ 
thing  suspicious.  He  next  tried  the  shop  where  the  milk  was 
retailed  ;  the  residents  were  stated  to  have  all  been  in  good 
health,  but  next  door  a  case  of  diphtheria  had  occurred  early 
in  December.  The  two  houses  had  each  abackyard  surrounded^ 
by  high  buildings  on  all  sides,  forming  a  well  of  stagnant  air 
common  to  the  backs  of  the  two  premises.  In  the  backyard  of 
the  milk-shop  it  was  the  custom  to  wash  the  milk-cans,  and 
these, instead  of  being  drained,  were  wiped  inside  with  cloths, 
the  latter  being  frequently  washed  and  hung  up  to  dry  on  a 
line  in  the  yard.  It  should  be  stated  that  the  milk  in 
question  bore  a  good  reputation,  and  some  samples  analysed 
had  been  found  to  be  of  superior  quality.  The  facts,  Dr. 
Parsons  adds,  which  he  was  able  to  collect,  appeared  to 
point  to  the  following  conclusions  : — 1.  Although  it  cannot 
•  be  affirmed  with  any  degree  of  certainty  that  there  was  any/ 


20 


Medical  Times  and  Gazette. 


FROM  ABROAD. 


July  7,  1883. 


causal  connexion  between  the  outbreak  of  diphtheria  and 
the  particular  dairy,  yet  the  limitation  of  the  disease  to  the 
consumers  of  the  milk  indicates  that  this  was  probably  the 
case.  2.  The  small  proportion  of  the  customers  attacked 
shows  that  any  contamination  of  the  milk  by  infective 
material  could  have  been  only  partial  and  occasional  in  its 
occurrence.  3.  The  cause  of  diphtheria — if  the  infection 
was  conveyed  by  milk — may  have  been  some  condition 
existing  at  the  milk-shop  premises  or  at  the  farm.  4.  On 
the  milk  hypothesis,  the  milk  must  have  first  received 
infection  about  the  beginning  of  December.  The  child  in  the 
adjoining  house  may  have  received  infection  from  the  same 
source,  or  from  the  milk  itself,  which  she  was  in  the  habit  of 
■drinking.  5.  The  increased  prevalence  of  the  disease  in  the 
latter  part  of  December— eighteen  out  of  thirty-two  cases 
having  commenced  between  December  21  and  30  inclusive — 
may  be  due  to  infective  matter  reaching  the  milk  in  larger 
quantity  from  the  case  of  diphtheria  in  the  house  adjoining 
the  milk-shop.  6.  It  may  be  suggested  whether  the  infec¬ 
tive  matter  may  have  gained  access  to  the  milk  by  the  wiping 
out  of  the  cans  with  cloths  which  had  been  hung  up  in  the 
narrow  close  backyard,  and  had  contracted  impurities  from  the 
atmosphere.  In  concluding  his  report.  Dr.  Parsons  says  that 
the  observation  was  made  that  many  of  the  persons  attacked 
•by  diphtheria  were  constitutionally  liable  to  sore-throat,  and 
at  seems  reasonable  to  suppose  that  a  chronic  ulceration  of 
the  throat,  a  ragged  tonsil,  or  an  enlarged  mucous  follicle, 
would  afford  easier  lodgment  to  infective  material,  and  a 
fitter  soil  for  its  development,  than  a  healthy  and  unbroken 
mucous  membrane. 


Dr.  Charles  Kelly  on  the  Combined  Sanitary 
District  oe  West  Sussex. 

The  Combined  Sanitary  District  of  West  Sussex  is  formed 
by  the  union  of  seven  rural  and  three  urban  districts,  and 
its  extent  may  be  imagined  when  it  is  stated  that  it  com¬ 
prises,  with  one  exception,  all  the  unions  of  the  western 
division  of  the  county.  This  must  prove  an  anxious  charge 
for  one  medical  officer,  yet  the  annual  report  of  Dr.  C.  Kelly 
for  the  year  1881  shows  that  he  is  thoroughly  capable  of 
supervising  in  sanitary  matters  this  large  district.  The 
population,  which  in  1874  was  estimated  at  74,797,  has 
increased,  as  shown  by  the  census  of  1881,  to  94,511.  In 
bwo  districts — Petworth  and  Thakeham — the  number  of  in¬ 
habitants  has  slightly  declined  ;  but  Worthing,  on  the  other 
hand,  has  increased  its  population  to  a  greater  extent  than 
was  ever  anticipated.  The  vital  statistics  of  the  district  show 
•favourable  results :  the  general  death-rate  of  13  9  per  1000 
was  lower  than  in  any  previous  year,  and  Dr.  Kelly  remarks 
that  old  age  is  probably  the  most  frequent  cause  of  death  in 
the  locality ;  thus  out  of  a  total  mortality  for  the  year  1881  of 
1323  persons,  no  less  than  543  were  aged  sixty  years  and 
upwards,  and  he  shows  that  out  of  7819  deaths  in  1876-81, 
2039  were  those  of  persons  aged  seventy  and  upwards,  at 
which  period  of  life  all  deaths,  except  perhaps  those  from 
accident,  may  properly  be  put  down  to  the  degenerative 
changes  resulting  from  old  age.  Alluding  to  the  improve¬ 
ments  visible  in  the  sanitary  education  of  the  population 
of  this  part  of  the  country,  the  report  says  that  more  care 
is  now  bestowed  by  people  on  the  sources  of  drinking- 
water,  and  each  year  an  increased  quantity  is  submitted  for 
analysis;  while,  in  the  present  day,  all  direct  connexion  of 
the  house-drains  with  the  sewers  is  avoided,  ventilation  is 
better  carried  out,  and  the  chance  of  sewer-gas  entering 
houses  is  considerably  lessened. 


The  Formidad  of  Mercury. — Prof.  Zeissl,  of  the 
“Vienna  Hospital,  reports  that  in  a  trial  which  he  has  made 
of  Liebreich’s  formidad  of  mercury  in  fifteen  cases  of 
syphilis  he  has  been  well  satisfied  with  the  results.  The 
pain  produced  was  of  shorter  duration  and  less  severity 
than  with  the  sublimate,  the  regions  of  the  buttocks  or  the 
spine  being  best  suited  for  the  injections.  In  three  of  the 
cases  salivation  was  produced.  In  the  obstinate  forms  of 
the  disease — e.g.,  psoriasis  palmaris — many  more  injections 
were  required  than  in  the  lighter  forms ;  but  Prof.  Zeissl 
has  never  had  to  make  more  than  twenty  in  order  to  disperse 
the  various  secondary  symptoms. — Centralblatt  fiir  Med. 
Wiss.,  June  9. 


FROM  ABROAD. 


Action  of  Quinine  upon  the  Ear. 

At  a  meeting  of  the  Boston  Medical  Improvement  Society, 
Dr.  Orme  Green  read  a  paper  on  the  above  subject  ( Boston 
Med.  Journal,  March  3),  in  which  he  observed  that  the  effect 
of  quinine  in  inducing  tinnitus  aurium  is  so  well  known 
that  it  is  apt  to  be  considered  as  of  no  consequence  and  lead 
to  the  neglect  of  an  important  subject.  Cases  have  come 
under  his  observation  which  have  convinced  him  of  the  great 
injury  often  done  ;  and  as  these  observations  agree  with  the 
known  pathological  tendencies  of  the  ear  and  with  the  more 
recent  physiological  experiments  on  the  action  of  quinine, 
he  wishes  to  direct  attention  to  the  subject — especially  as 
writers  upon  materia  medica  say  very  little  about  it.  It 
was  formerly  believed  that  quinine  produced  contraction  of 
the  bloodvessels  and  antemia  of  the  ear ;  but  von  Graefe, 
Hammond,  and  Koosa  have  since  shown  that  congestion  of 
the  visible  vessels  of  the  organ  is  the  result  produced.  “  Prom 
the  very  close  relations  of  the  vascular  system  of  these  three 
parts — the  membrana  tympani,  the  tympanum,  and  the 
labyrinth, — and  from  the  appearance  of  congestion  as  the 
direct  result  of  the  administration  of  ten  and  fifteen  grain 
doses  in  the  carefully  conducted  experiments  of  Koosa,  we 
have  strong  evidence  that  the  effect  of  the  drug  upon  the  ear 
is  congestive  rather  than  anaemic;  but,  inasmuch  as  the 
amount  of  congestion  visible  in  the  manubrial  vessels  was 
slight,  and  disproportionate  to  the  intensity  of  the  tinnitus,  it 
seemed  reasonable  to  conclude  even  from  these  few  experi¬ 
ments  that  the  congestion  of  the  deeper  cavities  was  greater 
than  that  seen  on  the  periphery,  so  to  speak,  of  the  vascular 
system ;  and  as  the'nervous  structures  within  the  labyrinth 
are  the  undoubted  seat  of  subjective  noises,  it  was  probable 
that  theflabyrinth  was  the  chief  point  of  congestion.”  Decent 
observations  of  Kirchner  (Berliner  Klin.  Woch.,  1882,  Ho.  49) 
confirm  this  view,  showing  that  not  only  congestion,  but 
active  inflammation  and  even  haemorrhage  maybe  produced. 
Speaking  of  the  results  of  his  experiments  on  rabbits,  cats, 
and  dogs,  Kirchner  says  :  — 

“  ‘  Prom  these  observations  it  is  certainly  evident  that 
quinine  and  salicylic  acid  (which  produces  clinically  the 
same  symptoms  as  quinine)  may  produce  changes  in  the 
important  parts  of  the  ear  which  may  not  only  injure  but 
even  wholly  destroy  the  hearing.  The  involvement  of  the 
labyrinth  in  the  hypersemic  condition  could  not  exist  for  any 
length  of  time  without  serious  injury  to  the  ultimate  fibres  of 
the  acusticus.  The  clinical  appearances  of  deafness  pro¬ 
duced  by  quinine  point  to  the  same  thing  :  usually  pain  in 
the  depth  of  the  ear  is  complained  of,  as  was  also  observed 
by  Koosa — often  intermittent,  often  very  severe ;  and  some¬ 
times  otitis  externa  is  seen  as  a  complication.  In  the  exa¬ 
mination  of  trustworthy  persons  who  have  declared  that 
their  deafness  was  due  to  large  doses  of  quinine,  I  have 
repeatedly  seen  a  marked  opacity  of  the  drum-membrane,  a 
condition  which,  as  a  rule,  is  to  be  regarded  as  the  residuum 
of  a  chronic  inflammatory  process,  and  due  to  thickening  of 
the  mucous  membrane  lining  the  inner  side  of  the  drum- 
membrane.  The  symptoms  in  the  labyrinth  are  also  charac¬ 
teristic,  and  point  to  an  organic  change  in  the  ultimate  fibres 
of  the  acusticus.  Just  as  in  syphilis,  so  in  quinine-deafness 
we  find  diminution  in  the  perception  of  a  vibrating  tuning- 
fork  placed  on  the  bones  of  the  head,  and  a  defective  per¬ 
ception  of  the  higher  tones.  In  quinine-deafness  we  are, 
then,  dealing  not  alone  with  a  simple  irritation,  a  simple 
nervous  excitement  of  the  organ,  which  will  pass  off  with¬ 
out  leaving  injury,  but  with  an  inflammatory  process,  and 
(possible)  permanent  pathological  changes.” 

The  researches  of  Toynbee,  von  Troltsch,  Schwartze, 
Gruber,  Wendt,  and  others  have  proved  that  the  mucous 
membrane  of  the  tympanum  is  especially  liable  to  inflam¬ 
mation  ;  while  those  of  Politzer  exhibit  most  completely  the 
microscopical  changes  which  ensue,  showing  that  the  con¬ 
nective  tissue  is  the  portion  of  the  structure  in  which  the 
alterations  producing  permanent  impairmentof  thefunctions 
of  the  conducting  apparatus  are  most  common.  “  These 
changes  consist  in  an  infiltration  of  round  cells,  which  be¬ 
come  organised  with  new  fibrous  connective  tissue,  by  which 


Medical  Times  and  Gazette. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


July  7,  1883.  21 


the  delicate  and  movable  mucous  membrane  is  converted 
into  a  hard,  stiff,  and  adherent  membrane,  liable  with  time 
to  a  sort  of  cicatricial  contraction,  and  producing  immo¬ 
bility  of  the  parts  of  the  conducting  apparatus  covered  with 
the  affected  mucous  membrane.  This  connective  tissue  is 
subject  also  to  still  further  alteration,  such  as  calcification 
and  ossification.”  The  labyrinthine  structures,  being  so 
delicate  and  lying  so  deep,  have  been  much  less  thoroughly 
examined ;  but  clinical  experience  shows  us  the  frequent 
loss  or  diminution  of  perception  by  bone  conduction,  which 
there  is  every  reason  to  regard  as  due  to  the  extension  of 
the  congestion  of  the  tympanum  to  the  labyrinth — showing 
that  a  marked  and  long-continued  congestion  of  the  nervous 
apparatus  is  liable  to  produce  serious  injury.  Too  much 
stress,  however,  must  not  be  laid  upon  the  thickening  of  the 
mucous  membrane  observed  by  Kirchner  in  cases  of  quinine- 
deafness,  as  such  may  be  the  result  of  some  old  inflammatory 
process.  No  one  as  yet  has  watched  a  membrana  tympani 
normally  translucent  become  gradually  opaque  as  the  result 
of  quinine  treatment. 

After  referring  to  the  analogous  affection,  quinine- 
amaurosis,  and  suggesting  that  the  two  affections  are 
probably  due  to  the  action  on  the  vaso-motor  nerve-centres. 
Dr.  Green  goes  on  to  observe  that  the  congestion  thus  pro¬ 
duced  explains  the  fact  observed  clinically,  that  quinine 
may  increase  any  existing  inflammation  in  the  tympanum, 
leading  to  a  greater  degree  of  deafness  at  the  time  and  to 
still  further  tissue-changes.  In  the  view  of  these  facts,  and 
of  the  constantly  recurring  experience  that  patients  refer 
their  new  aural  symptoms,  or  the  aggravation  of  the  old 
ones,  to  the  quinine  given,  ought  we  not,  he  asks,  pay  more 
attention  than  is  usually  done  to  these  effects  ?  Of  the  great 
value  or  even  absolute  necessity  of  the  drug  no  doubt  can 
be  entertained ;  but  there  are  many  cases  in  which  it  is 
given  in  larger  and  longer-continued  doses  than  are  required 
— tinnitus  aurium  being  the  signal  of  congestion  of  the 
labyrinth  having  taken  place.  And  even  when  a  case  requires 
the  quinine  to  be  persisted  in,  in  spite  of  the  congestion  pro¬ 
duced,  its  administration  might  be  suspended  for  one  or  more 
days,  converting  the  continuous  congestion  into  the  less  dan¬ 
gerous  form  of  an  intermittent  congestion.  Dr.  Green  thus 
sums  up  his  paper  : — 1.  Clinical  experience  the  world  over 
is  that  quinine  occasionally  produces  serious  injury  to  the 
ears.  2.  From  our  present  knowledge,  both  clinical  and 
experimental,  we  are  justified  in  asserting  that  the  action 
of  quinine  on  the  ears  is  to  produce  congestion  of  the 
labyrinth  and  tympanum,  and  sometimes  distinct  inflam¬ 
mation  with  permanent  tissue-changes.  3.  That  the  action 
of  the  drug  upon  the  ears  should  always  be  considered  in 
prescribing  it ;  and  changes  in  the  ears  due  to  existing  or 
previous  inflammation  constitute  a  contra-indication  to  the 
medicine  in  large  doses  or  for  a  long  time,  except  under 
urgent  circumstances.  4.  That  when  large  and  continuous 
doses  are  absolutely  necessary,  an  occasional  intermission  is 
desirable,  in  order  to  diminish  the  risk  to  the  ears. 

In  the  discussion  which  followed.  Dr.  Fifield  observed  that 
he  felt  alarmed  at  the  enormous  doses  of  quinine  and  sali¬ 
cylic  acid  given  by  men  fresh  from  the  schools,  as  if  reduc¬ 
tion  of  abnormal  temperature  and  pulse  were  the  only 
ends  in  view. — Dr.  H.  W.  Williams  remarked  that  it  seemed 
an  enigma  that  the  ear  should  be  congested  while  the  eye  is 
rendered  anaemic  from  quinine.  He  has  seen  this  form  of 
blindness  only  after  long  courses  of  large  doses,  and  in  these 
there  has  been  slow  recovery. — Dr.  Lyman  also  deprecated 
the  large  doses  of  quinine  now  given,  and  he  found  that 
abatement  of  high  temperature  may  be  accomplished  by 
giving  one  large  dose  (ten  to  fifteen  grains),  and  repeating 
it,  if  required,  for  several  days.  He  had  rarely,  if  ever, 
seen  this  followed  by  tinnitus.  When  there  is  any  ten¬ 
dency  to  congestion,  he  combines  the  quinine  with  bromide 
of  potash.  He  had  seen  more  disturbance  produced  by 
small  doses  repeated  for  a  long  time  than  by  the  occasional 
use  of  a  large  dose. — Dr.  Hodges  said  that,  apart  from  its 
use  in  intermittent  fever,  he  was  not  aware  that  quinine 
produces  any  beneficial  and  well-established  effects,  while  it 
gives  rise  to  many  discomforts  and  dangers.  The  transient 
fall  ’of  temperature  which  is  sometimes  induced  by  large 
doses  attracts  attention  and  fixes  itself  upon  the  memory ; 
but  the  numberless  cases  in  which  the  drug  fails  are  probably 
more  familiarly  known  to  physicians  than  its  successes. — 
Dr.  Edes  has  been  familiar  with  moderate  quinine-deafness, 
but  he  believes  that  permanent  deafness  is  a  rare  though  per¬ 


fectly  well  recognised  accident.  Facts  of  this  kind,  as  well 
as  of  amaurosis,  are  reported  in  the  elaborate  work  of 
Briquet — all  occurring  after  large  and  continuous  doses. 
Briquet  refers  to  physicians  who  employed  quinine  on  a  large 
scale,  and  who  found  that  the  deafness  which  ensued  always 
disappeared  in  a  few  days ;  and  from  inquiries  which  Dr. 
Edes  has  made  among  New  York  aurists  he  arrives  at  the 
same  conclusion. — Dr.  Baker  had  very  often  given  thirty  to 
thirty-six  grains  daily  for  many  days,  and,  although  his 
cases  have  remained  under  long  observation  and  often  return, 
he  knew  of  no  bad  effects  that  resulted.  He  had  seen  deaf¬ 
ness  and  blindness  from  thirty-eight  grains  in  an  hour,  but 
these  passed  off  in  a  few  days. — Dr.  Green  observed  that  his 
paper  was  meant  as  a  caution  against  the  abuse  of  the  drug. 
Most  of  the  cases  get  well,  but  some  do  not. 


REVIEWS  AND  NOTICES  OP  BOOKS. 

■ - — - • - 

A  Manual  of  Nursing,  Medical  and  Surgical.  By  Charles: 

J.  Cullingworth,  M.D.,  M.R.C.P.  Bond.,  Physician  to  St. 

Mary’s  Hospital,  Manchester.  AVith  eighteen  illustrations. 

London:  J.  and  A.  Churchill.  Small  8vo, pp.  172.  1883. 
Dr.  Cullingworth’s  little  book  on  Nursing  is  one  of  the 
best  and  most  trustworthy  manuals  published  on  the  subject 
with  which  it  deals.  It  is  written  in  an  easy  and  pleasant 
style,  and,  without  in  any  way  unduly  magnifying  the  office 
and  position  of  a  nurse,  teaches  really  all  that  a  good  prac¬ 
tical  nurse  ought  to  be  acquainted  with  in  order  to  make  her 
a  safe  and  efficient  handmaid  to  the  physician  and  surgeon. 
It  treats  of  the  arrangement  and  management  of  the  sick¬ 
room,  of  the  management  of  the  patient,  of  sick-diet,  of  the  ad¬ 
ministration  of  medicines,  of  fomentations,  poultices,  lotions, 
irrigation,  etc.,  of  baths,  and  of  bandaging.  One  chapter  is 
devoted  to  “  The  Immediate  Treatment  of  Certain  Cases  of 
Emergency,”  as  fainting  fits,  epilepsy,  apoplexy,  sunstroke, 
delirium,  haemorrhage,  and  like  cases ;  and  another  teaches 
how  to  observe  and  report  all  important  and  significant 
conditions  and  symptoms.  The  local  treatment  of  in¬ 
flammation  is  briefly  described,  and  the  management, 
of  abscess;  the  various  modes  of  cleansing  and  dressing 
wounds,  and  the  preparations  of  the  operation-room  and  the 
operation-table.  Some  pages  are  devoted  to  the  antiseptic 
method  of  treatment,  so  far  as  concerns  the  work  of  the 
nurse,  giving  clear  and  minute  descriptions  of  the  various 
substances  employed,  and  the  reasons  for  their  employment. 
And  the  last  chapter  deals  with  “  Disinfection,  and  the 
Nursing  of  Infectious  Fevers.”  In  this  chapter  Dr. 
Cullingworth  speaks  of  the  nature  of  contagion,  and  of  the 
differences  in  the  mode  of  propagation  of  the  infectious 
fevers.  He  describes  the  precautions  necessary  to  prevent 
the  spread  of  infection,  and  the  modes  of  disinfection, 
giving  the  rules  that  ought  to  be  observed  in  all  cases.  He 
gives  directions  also  as  to  how  a  nurse  is  to  protect  and  dis¬ 
infect  herself  in  such  cases ;  and  finally  dwells,  very  use¬ 
fully,  on  some  “  special  points  in  the  nursing  of  some  of 
the  infectious  fevers  :  as  measles  and  whooping-cough, 
typhoid,  typhus,  diphtheria,  scarlet  fever,  and  small-pox. 
The  Manual  may  be  strongly  recommended  to  all  nurses, 
amateur  or  professional. 


On  the  Treatment  of  Wounds  and  Fractures.  Clinical 
Lectures  by  Sampson  Gamgee,  F.R.S.E.,  Consulting 
Surgeon  to  the  Queen’s  Hospital,  Birmingham  ;  Foreign 
Corresponding  Member  of  the  Academy  of  Medicine  of 
Rome,  and  of  the  Society  of  Surgery  of  Paris ;  Honorary 
Member  of  the  Massachusetts  Medical  Society,  and  of 
the  Medical  Society  of  Christiania,  etc.  With  forty-four 
engravings  on  wood.  Second  Edition.  London  :  J .  and  A. 
Churchill.  1883.  Pp.  364. 

This  volume  is  a  consolidated  second  edition  of  the  author’s 
clinical  lectures  on  the  “  Treatment  of  Fractures”  (1871), 
and  on  the  “  Treatment  of  Wounds  ”  (1878).  Well-reported 
histories  of  cases  are  always  instructive,  and  the  author  has 
made  for  this  work  an  excellent  selection  from  the  cases: 
which  have  occurred  in  his  practice.  The  lectures  are 
what,  in  our  opinion,  clinical  lectures  ought  to  be.  The 
author  does  not  aim  at  novelty  or  originality,  but,  to  quote 
his  own  words,  has  chiefly  endeavoured  “  to  demonstrate  the 


REVIEWS  AND  NOTICES  OF  BOOKS. 


July  7,  1£83. 


22 


Medical  Timos  and  Gazette. 


identity  and  continuity  of  the  principles  of  surgical  thera¬ 
peutics,  irrespective  of  the  tissues  affected.”  The  cardinal 
principles  of  the  treatment  of  surgical  in  juries — immobility, 
•position,  pressure,  drainage,  and  antiseptics — are  carefully 
explained  and  abundantly  illustrated  by  typical  cases.  The 
directions  for  the  manufacture  of  splints  of  millboard, 
gutta-percha,  and  plaster  of  Paris  for  special  fractures  are 
very  good,  and  may  be  consulted  with  advantage  by  prac¬ 
titioners  as  well  as  by  students. 


A  Synoptical  Guide  to  the  Study  of  Obstetrics.  Being  an 
Aid  to  the  Student  in  the  Class-room,  in  Private  Study, 
and  in  Preparing  for  Examinations.  By  Robert  Barnes, 
M.D.  Bond.,  Obstetric  Physician  and  Lecturer  in  Obstetrics 
to  St.  George’s  Hospital.  London  :  Smith.  Elder,  and  Co. 
1883.  Pp.  122. 

It  is  not  often  the  case  that  one  who  has  attained  the  posi¬ 
tion  which  Dr.  Robert  Barnes  occupies  in  our  profession 
nnd  in  his  own  department,  can  find  the  time,  or  has  the 
inclination,  to  write  an  aide-mdmoire  for  the  student ;  and 
that  Dr.  Barnes  has  so  occupied  himself,  shows  the  interest 
which  he  still  takes  in  the  progress  of  obstetric  science,  and 
in  the  prevalence  of  sound  obstetric  practice. 

The  work  itself  calls  for  little  detailed  comment.  Were 
It  not  that  we  learn  in  the  preface  that  it  is  a  sort  of  index 
to  a  “  Systematic  Handbook  of  Obstetrics  ”  shortly  to  be 
published,  we  should  have  guessed  it  to  be  the  author’s 
lecture  notes.  It  contains  a  brief  syllabus  of  the  points 
chiefly  to  be  remembered  in  relation  to  the  different  subjects 
which  are  described  in  obstetric  lectures  and  treatises.  It 
is  a  book  to  be  read  in  con j  unction  with  a  larger  one  :  not  a 
treatise  on  midwifery,  but  a  help  towards  mastering  such  a 
treatise.  We  have  no  doubt  that  many  will  find  it  useful. 


A  Compend  of  Obstetrics,  especially  adapted  to  the  use  of 
Medical  Students  and  Physicians.  By  Henry  G.  Landis, 
A.M.,  M.D.,  Professor  of  Obstetrics  and  Diseases  of 
Women  in  Starling  College,  etc. ;  author  of  “  How  to  Use 
the  Forceps,”  etc.  With  illustrations.  (Test  Series, 
Ho.  8.)  London:  Henry  Kimpton.  1883.  Pp.  107. 
This  little  work  is  commended  to  us  by  the  name  of  its 
author,  whose  able  work  on  the  forceps,  containing  an 
excellent  account  of  the  mechanism  of  labour,  we  reviewed 
ut  the  time  of  its  appearance.  It  is  what  our  American 
friends  call  a  “  quiz-book.”  The  information  it  gives  is 
conveyed  in  the  form  of  question  and  answer,  after  the 
manner  of  “Mangnall’s  Questions”  of  our  childhood's 
Hays.  It  is  a  small  book,  and  the  plan  of  its  construction  is 
not  one  by  which  a  great  amount  of  material  can  be  com¬ 
pressed  into  a  small  space.  The  instruction  given  is  there¬ 
fore  elementary,  but  it  appears  to  be  sound  and  accurate  so 
far  as  it  goes. 


The  Causation  of  Sleep.  By  James  Cappie,  M.D.  Second 
Edition.  Edinburgh  :  James  Thin.  1882.  8vo,  pp.  207. 
The  general  public  would  probably  be  surprised  to  learn 
that  physicians  and  physiologists  have  not  yet  been  able  to 
•determine  the  exact  nature  and  sequence  of  the  changes 
which  result  in  sleep.  The  phenomena  of  digestion,  of 
respiration,  and  circulation  have  in  great  measure  ceased  to 
be  debateable  ground,  but  the  intimate  changes  which  take 
place  in  the  brain  during  the  exercise  of  memory,  during 
sleep,  or  during  a  convulsion,  still  elude  our  vigilance.  The 
present  work  is  an  attempt  to  set  at  rest  one  of  these  ques¬ 
tions — that  relating  to  sleep, — with  what  success  will  appear 
hereafter.  The  author  starts  with  the  general  principle 
that  during  the  functional  activity  of  a  part  its  blood-supply 
is  increased,  and  that  therefore  the  brain  must  have  a  larger 
-supply  of  blood  in  the  waking  state  than  during  sleep.  It 
follows,  therefore,  that  during  sleep  there  is  a  diminished 
amount  of  blood  circulating  in  the  brain,  and  the  question 
is,  what  takes  its  place  ?  As  the  brain  is  enclosed  in  an  un¬ 
yielding  case,  the  extra  space  must  needs  be  filled  up  either 
by  cerebro-spinal  fluid  or  by  an  increase  in  the  amount 
of  blood  contained  in  the  veins.  The  latter  is  the  view 
adopted  by  Dr.  Cappie.  After  discussing  the  circula¬ 
tion  in  the  cranium,  and  pointing  out  the  relation  of  the 
.atmospheric  pressure  to  the  cranial  contents.  Dr.  Cappie 
-sums  up  his  views  as  follows  ,f  The  first  change  is  a  modi¬ 


fied  movement  in  the  molecules  in  the  brain-tissue ;  the  last 
is  compression  of  the  whole  organ.  From  lessened  activity 
of  the  molecules  spring  a  less  active  state  of  the  capillary 
circulation  and  diminished  stress  through  the  cranial  cavity. 
Next  we  have  a  change  in  the  balance  of  the  circulation,  in 
producing  which  the  weight  of  the  atmosphere,  causing 
backward  pressure  in  the  cerebral  veins,  is  an  essential 
agent.  With  the  altered  balance  of  the  circulation  there  is 
a  change  in  the  balance  of  active  pressure ;  it  is  less  from 
within  and  more  on  the  surface,  it  is  less  expansive  and 
more  compressing.  With  a  certain  amount  of  compression 
consciousness  is  suspended.”  The  keystone  of  this  theory 
is  the  altered  balance  of  the  circulation  within  the  cranium. 
According  to  the  author,  during  sleep  the  amount  of  blood 
in  the  arteries  is  greatly  diminished,  and  that  in  the  veins 
increased — this  being  especially  the  case  in  the  pia  mater, 
which  forms  a  soft  pad  and  compresses  the  cortex  of  the 
brain,  thus  producing  insensibility, — but  we  do  not  feel 
quite  clear  as  to  the  amount  of  compression  thus  produced, 
for  we  are  told  elsewhere  that  the  amount  of  blood  circu¬ 
lating  in  the  cranium  is  practically  a  constant  quantity, 
and,  that  being  the  case,  it  is  difficult  to  see  why  the  blood 
should  exercise  more  compression  at  one  time  than  another. 
There  is  no  evidence  before  us  that  compression  of  the 
brain  from  within  is  not  just  as  effectual  in  arresting  the 
cerebral  function  as  compression  from  without.  It  might 
be  said  that  the  lessened  activity  of  the  molecules  of  the 
brain,  of  which  the  author  speaks  as  the  first  change,  is  the 
cause  of  sleep,  and  the  altered  balance  of  the  circula¬ 
tion  the  effect.  Even  if  we  admit  the  correctness  of  the 
author’s  view  that  the  veins  of  the  pia  mater  are  turgid 
during  sleep,  still  it  does  not  follow  that  this  is  the  cause 
of  sleep  ;  there  is  no  proof  that  it  is  not  merely  the  effect. 
If  the  exact  causes  which  lead  up  to  sleep  are  ever  made 
known,  we  expect  that  the  medulla  oblongata  will  be  found 
to  play  a  more  important  part  in  bringing  this  about  than 
Dr.  Cappie  would  admit,  for  he  never  alludes  to  it  at  all. 
But  although  we  do  not  agree  that  the  author  has  proved 
the  reality  of  his  views,  we  must  acknowledge  that  he  has 
made  an  honest  attempt  to  throw  light  upon  an  obscure 
point.  The  ophthalmoscopic  drawings  of  the  fundus  oculi 
at  the  commencement  of  the  book  are  too  diagramatic  to 
be  relied  upon  as  of  much  value. 


Powdered  Ox-Blood  in  Artificial  Alimentation. 
— Dr.  Guerder,  after  testifying  to  the  great  utility  of  the 
artificial  feeding  by  large  quantities  of  powdered  meat  in 
phthisis,  pursued  by  Drs.  Debove  and  Dujardin-Beaumetz, 
observes  that  the  same  procedure  is  indicated  in  many  other 
affections,  such  as  chlorosis,  anaemia, eon  valescence  from  severe 
diseases,  organic  disease  accompanied  by  anorexia  and  dis¬ 
gust  with  food.  But  he  has  always  found  in  all  the  various 
preparations  of  this  dried  meat  a  slightly  nauseous  and 
sickly  taste  which  prevents  patients  continuing  its  employ¬ 
ment.  It  therefore  occurred  to  him  to  try  powdered  dried 
blood,  which  is  much  cheaper,  of  higher  nutritive  value,  and 
stimulates  the  digestive  organs  more  effectually.  He  has 
administered  it  to  fifty-one  persons,  forty-four  of  whom  have 
found  it  so  palatable  as  to  be  able  to  continue  it  for  several 
weeks.  In  three  it  produced  vomiting,  while  in  four  cases 
of  chlorosis  it  was  only  digested  with  difficulty.  Its  dose 
must  not  be  too  large,  a  teaspoonful  (seven  or  eight  grammes) 
three  times  a  day  sufficing  for  a  child,  and  from  twenty  to 
twenty-five  grammes  for  an  adult —from  seventy  to  seventy- 
five  grammes  being  equivalent  to  500  grammes  of  fresh 
blood.  If  there  is  any  difficulty  in  digesting  it  a  little 
powder  of  pepsine  may  be  added.  Directions  are  given  for 
the  preparation  of  the  blood  (which  is  a  long  process),  and  it 
may  be  obtained  ready  prepared  of  M.  Daimon,  pharmacien, 
80,  Faubourg  St.  Denis,  Paris.  Dr.  Guerder  relates  a  few 
cases  exemplifying  its  utility  in  convalesence  and  in  anaemia 
and  chlorosis.  It  is  also  useful  in  the  early  stage  of  phthisis 
and  other  organic  diseases. — Bulletin  de  Therap.,  May  30. 

The  Youngest  Grandmother. — Dr.  Stanley,  writing 
to  the  Louisville  Med.  News,  June  9,  says  : — “  I  expect  I  can 
report  the  case  of  the  youngest  grandmother  in  this  country. 
Mrs.  C.  was  born  in  1854,  and  married  in  1867,  a  daughter 
being  born  ten  months  afterwards.  The  daughter  married 
in  1882,  and  in  March  of  this  year  I  was  with  her  at  the 
birth  of  her  nine-pound  boy.  The  youthful  grandmother, 
not  quite  twenty-nine  years  of  age,  was  also  present.” 


Medical  Times  and  Gazette. 


ACADEMY  OF  MEDICINE  IN  IRELAND. 


July  7,  1883.  2  3 


REPORTS  OF  SOCIETIES. 


ACADEMY  OF  MEDICINE  IN  IRELAND. 


SURGICAL  SECTION. 

At  the  closing  meeting  of  the  Surgical  Section  in  the 
Albert  Hall,  Royal  College  of  Surgeons,  Mr.  J.  K.  Barton, 
President,  occupied  the  chair. 

The  President  read  a  paper  on  “  Excision  of  the  Hip.” 
He  pointed  out  that  surgeons  are  much  divided  in  opinion 
as  to  the  benefits  derived  from  this  operation — some,  seeing 
the  results  so  often  unfortunate,  holding  that  amputation 
of  the  hip  is  in  extreme  cases  better  than  excision ;  others, 
including  those  who  have  had  most  experience  of  the  opera¬ 
tion,  clinging  to  the  belief  that  in  excision  we  possess  the 
means  of  saving  those  cases  of  hip  disease  which  will  not 
yield  to  expectant  treatment.  In  two  cases  he  had  obtained 
an  encouraging  amount  of  success,  a  year  having  elapsed 
since  the  first  operation,  and  six:  months  since  the  second. 
Case  1. — L.  M.,  aged  fourteen,  a  delicate,  strumous  girl,  with 
sinuses  round  the  diseased  hip,  from  which  there  was  copious 
suppuration,  was  evidently  sinking  from  the  effects  of  the 
disease  when  the  operation  was  performed  in  May,  1882. 
A  marked  improvement  in  her  general  condition  followed 
the  operation.  She  was  able  to  leave  hospital  in  three 
months  for  the  country,  where  she  has  remained  since.  She 
is  able  to  walk  with  crutches,  but  there  are  still  open  sinuses 
as  evidence  of  the  existence  of  carious  bone  ;  but  the  union 
between  the  cut  end  of  the  femur  and  the  acetabulum  is 
firm,  and  capable  of  bearing  the  patient’s  weight  without 
pain.  Case  2. — M.  R.,  a  healthy-looking  girl,  aged  twelve, 
the  subject  of  recurrent  disease  in  the  trochanter  major. 
The  hip  was  anchylosed  when  she  was  seven  years  old,  in 
the  semi-flexed  position.  Disease  had  lately  been  set  up  in 
the  trochanter  by  a  fall.  The  operation  was  undertaken  to 
remove  the  progressive  caries  of  the  trochanter,  and  to  rectify 
the  anchylosis,  which  rendered  her  a  cripple.  It  was  per¬ 
formed  in  October,  1882,  and  has  been  successful  in  accom¬ 
plishing  both  objects,  as  the  girl  is  now  able  to  walk  and  the 
limb  is  straight,  though  four  inches  shorter  than  the  other. 
The  author  insisted  on  the  importance,  in  the  after  treat¬ 
ment  of  these  cases,  of  maintaining  a  free  drain  from  the 
wound,  submitting  that  the  accomplishment  of  this  must  be 
the  first  care  of  the  surgeon. 

Dr.  R.  McDonnell  said  his  own  experience  of  excision  of 
the  hip-joint  was  not  altogether  favourable.  At  the  same 
time,  the  operation  should  not  be  set  aside;  he  believed  it 
was  legitimate  in  suitable  cases. 

Mr.  Stokes  remarked  that  in  the  Richmond  Hospital  their 
experience  of  excision  of  the  hip-joint  had  neither  been  very 
great  nor  very  favourable.  In  one  case  in  which  he  had 
performed  the  operation  the  result  was  the  reverse  of  satis¬ 
factory;  but  it  was  in  every  respect  an  unfavourable  case. 
Had  he  had  his  own  will  at  the  time,  he  should,  on  perform¬ 
ing  the  excision  and  finding  the  large  amount  of  disease 
that  was  present,have  proceeded  to  amputate  atthehip-joint;  I 
but  he  was  precluded  by  the  express  directions  of  the 
patient.  He  mentioned  this  to  show  how  difficult  it  was 
beforehand  to  form  a  just  estimate  of  the  amount  of  disease 
that  might  be  present.  In  dealing  with  caries  of  other 
articulations  this  was  not  altogether  the  case.  He  asked 
the  President’s  opinion  with  regard  to  Thomas’s  splint, 
which  he  used  in  one  of  the  cases.  Having  tested  the  splint 
himself,  according  to  the  inventor’s  directions,  in  the  case 
alluded  to,  he  was  obliged,  after  a  few  days,  to  remove  it, 
owing  to  the  great  pain  caused  by  the  pressure  of  the  splint 
against  the  spine.  He  substituted  Liston’s  long  splint  with 
a  weight  attached.  The  President  being  a  warm  advocate 
of  antiseptic  treatment,  Mr.  Stokes  asked  why  he  abandoned 
it  in  favour  of  the  so-called  open  treatment  of  wounds. 

Mr.  Bennett  said  the  same  question  struck  him  as  that 
which  Mr.  Stokes  had  just  asked,  and  the  answer  might 
be  almost  anticipated — that  the  conditions  under  which  the 
President  operated  were  not  those  in  which  the  Listerian 
treatment  could  be  adopted,  being  cases  in  which  there 
was  already  an  open  suppurating  wound  existing  for 
some  time.  But  a  more  important  question  than  that  of 
the  immediate  detail  of  treatment  was  one  on  which  he 
desired  explanation.  The  difficulty  in  those  cases  was  to 
determine  the  conditions  under  which  the  operation  was 
likely  to  succeed.  He  heard  it  laid  down  in  the  debate  at 


the  International  Medical  Congress,  that,  as  a  rule,  the 
operation  should  not  be  undertaken  except  under  conditions 
where  the  alternative  was  amputation  of  the  hip.  He 
thought  amputation  should  take  precedence.  He  asked 
the  President,  however,  what  he  regarded  as  the  indications 
for  the  operation— whether  it  was  a  mere  alternative  to  am¬ 
putation  of  the  hip,  or  whether  it  should  be  adopted  under 
such  grave  conditions. 

Mr.  Corley,  referring  to  the  question  of  age  in  determin¬ 
ing  the  operation,  mentioned  the  case  of  a  patient,  aged 
thirty-six.  in  whom  all  the  conditions  for  a  favourable 
result  existed— a  limited  amount  of  bone  disease,  while  the 
operation  itself  was  not  attended  with  considerable  difficul¬ 
ties.  It  was  impossible,  however,  to  secure  anything  like 
immobility.  He  did  not  use  the  wire  apparatus  recom¬ 
mended  in  Sayre’s  work,  but  put  up  the  patient  in  Bryant’s 
double  splint,  and  endeavoured  to  carry  out  antiseptic  treat¬ 
ment.  The  difficulty  was  great,  as  a  large  abscess  sur¬ 
rounded  the  joint.  But  the  unfortunate  result,  depended  on- 
the  complete  impossibility  of  securing  anything  like  rest  to- 
the  fragments  in  position.  Modern  success  depended  more, 
on  securing  perfect  immobility  than  on  antiseptics,  and 
until  some  means  were  had  to  secure  this  desideratum  the- 
operation  must  be  looked  upon  as  a  serious  one. 

Mr.  Wheeler  asked  what  was  the  condition  of  the  aceta¬ 
bulum  ?  His  own  experience  in  five  cases  was  that  the 
operation  was  favourable  to  life.  In  three  the  results: 
were  very  favourable ;  but  two  still  had  sinuses.  The  splint 
he  used  was  Bryant’s,  with  a  posterior  splint  running  up 
behind  on  the  nates.  The  treatment  he  adopted  was  open 
dressing,  with  plenty  of  drainage.  He  believed  in  antisep¬ 
tic  treatment,  but  not  in  Listerism.  With  the  observation 
of  Mr.  Stokes,  that  it  was  more  difficult  to  determine  the- 
amount  of  disease  in  the  hip-joint  than  in  any  other,  he  dis¬ 
agreed.  In  the  knee  it  was  equally  difficult.  It  was  a  great 
point  that  the  sinus  did  not  open  posteriorly.  In  those- 
cases  that  turned  out  well  he  made  an  opening  below,  and 
drew  the  drainage-tube  through,  to  be  able  to  syringe  from 
the  top  and  prevent  any  collection  of  matter. 

Mr.  Thomson  said  the  discussion  showed  that  the  expe¬ 
rience  of  surgeons  in  and  out  of  Dublin  was  very  disastrous 
in  connexion  with  the  operation  of  excision  of  the  hip.  Even 
Mr.  Barton,  who  had  the  largest  experience  of  the  opera¬ 
tion  of  any  surgeon  in  Ireland,  had  only  been  able  to  bring 
forward  one  case  out  of  nine  that  he  would  claim  as  a 
success,  and  in  that  case  the  patient  was  unable  to  progress 
without  the  aid  of  crutches,  and  unable  to  bear  the  weight 
of  the  body.  He  had  done  the  operation  himself  in  one  case 
which  he  was  looking  after  for  Mr.  Stokes  during  his  illness,, 
and  in  that  case,  after  a  long  period  of  illness,  the  patient 
gradually  sank  and  died.  He  thought  the  great  practical 
point  to  be  decided  in  the  discussion  was  the  proper  time  at 
which  the  operation  should  be  commenced,  if  it  was  to  be 
undertaken  at  all.  There  was  no  doubt  the  operation  of 
excision  of  the  hip- joint  was  very  little  more  fatal  than 
leaving  those  cases  alone — that  is,  as  regards  those  that  had 
a  fatal  result.  A  considerable  proportion  recovered.  In  the- 
medical  press  he  saw  that  the  percentage  of  fatal  eases  that 
were  not  treated  at  all-  was  something  like  forty,  while  the 
fatal  results  from  excision  numbered  something  more.  So 
that  practically  there  was  very  little  difference  between 
interfering  by  excision  and  leaving  the  patient  alone.  He 
had  an  opportunity  of  seeing  a  case  treated  by  the  Lis¬ 
terian  method  in  St.  Thomas’s  Hospital,  London.  An  abscess 
had  formed,  and  the  disease  was  very  rapid  in  its  progress. 
The  case  came  under  the  care  of  Sir  William  Mac  Cormac, 
who  at  once  determined  to  excise ;  and,  cutting  down  upon 
the  part,  he  found  the  bone  was  diseased,  but  that  the  disease  • 
had  not  proceeded  to  such  an  extent  as  was  usually  the  case 
before  the  operation  was  undertaken.  In  that  case  the  wound 
remained  perfectly  aseptic  throughout.  The  patient  had 
been  operated  on  six  weeks  before  he  (Mr.  Thomson)  saw  the 
case.  The  wound  was  perfectly  healed  at  that  time,  while 
the  patient  was  able  to  get  out  of  bed  and  stand  on  both 
limbs  without  the  aid  of  a  crutch.  That  was  a  point  which 
went  to  prove  two  things — the  great  importance  of  early 
operation  in  those  cases,  if  there  was  to  be  any  hope  of 
success  at  all ;  and  the  great  advantage  which  must  always 
follow  the  adoption  of  the  true  Listerian  method. 

The  President  replied.  He  agreed  with  Mr.  Stokes’s 
experience  that  Thomas’s  splint  was  singularly  unsuited  for 
cases  of  excision,  the  pressure  of  the  rigid  bar  down  the  back 


Medical  Times  and  Gazette. 


July  7,  1883. 


24 


ACADEMY  OF  MEDICINE  IN  IRELAND. 


of  the  hip  not  being  at  all  comfortable.  In  the  cases  in 
which  he  used  it  he  had  to  lay  it  aside.  Thomas’s  splint 
was,  however,  useful  for  recovering  hip  disease  where  the 
patient  could  be  allowed  to  move  about.  Replying  to  Mr. 
Stokes’s  question,  he  adopted  the  open  treatment,  having 
first  tried  various  other  methods,  including  the  Listerian, 
but  he  did  not  find  it  to  answer  well.  Indeed,  the  condi¬ 
tions  were  such  as  should  have  enabled  him  beforehand 
to  say  it  would  not  answer  well.  Why  ?  Because  the  exci¬ 
sions  were  only  partial  ones,  unlike  the  excision  of  joints 
where  all  the  diseased  portions  were  removed,  as  in  the 
elbow  or  knee,  and  where  the  healthy  cut  parts  could 
be  closed  against  one  another.  But  where  there  was 
partial  resection,  the  result  was  bone  remaining  in  a 
partly  diseased  state  behind,  and  the  soft  parts  in  a 
very  unhealthy  state.  Thus  there  was  a  large  cavity 
through  which  there  must  be  the  products  of  inflammatory 
action  discharged.  His  experience  fortified  him  in  saying, 
what  all  would  agree  was  reasonable  in  theory,  that  free 
drainage  from  the  wound  was  the  first  thing  to  be 
gained.  He  therefore  thought  the  open  treatment  neces¬ 
sary  to  gain  that  desideratum.  Having  reported  one  of 
those  cases  some  years  ago,  it  was  remarked  on  that  occa¬ 
sion  that  the  constant  syringing  with  antiseptic  solution, 
•chloride  of  lime,  carbolic  acid,  etc.,  the  constant  washing 
away  of  the  discharge,  was  in  itself  antiseptic  treatment. 
While  the  method  of  closing  wounds  in  which  the  flesh 
might  unite  by  primary  union  was  inapplicable  here,  yet 
the  great  principle  of  removing  putrefactive  material  re¬ 
mained  the  same,  though  carried  out  in  another  way. 
Therefore  he  was  not  casting  the  slightest  slur  on  the  anti¬ 
septic  method,  but  adopting  the  suitable  way  of  applying  it 
to  cases  of  partial  excision.  It  appeared  from  the  discussion 
that  they  ought  to  aim  at  osseous  union  in  excision  of  the 
hip.  That  was  not  his  experience  ;  they  should  simply  aim 
at  fibrous  union,  as  supplying  in  successful  cases  all  the 
results  they  could  possibly  wish — complete  firmness  with 
mobility.  Bor  this  purpose  it  was  not  so  necessary  that 
absolute  rest  of  the  parts  should  be  maintained,  and  the 
apparatus  he  applied  had  to  be  laid  aside,  and  he  fell  back 
on  the  simplest  possible  method  of  keeping  the  limb  straight. 
Sir  William  Mac  Cormac’s  case  was  an  exceptional  one; 
but  ordinary  cases  of  a  strumous  type,  commencing  in  the 
trochanter  towards  the  head,  involving  the  joint  in  the 
secondary  degree,  were  not  suitable  for  excision  in  a  very 
early  stage,  for  the  simple  reason  that  a  great  number  of 
them  would  recover  by  expectant  or  ordinary  treatment. 
Therefore  the  surgeon  must  wait  until  such  time  as  the 
abscess  had  formed  or  the  disease  had  entered  into  what 
was  called  the  secondary  stage.  In  this  case  the  question 
might  arise  whether  amputation  or  excision  ought  to  be 
preferred.  Amputation  at  the  hip-joint  was  open  to  this 
■objection,  that  it  was  a  greater  shock  to  the  patient 
than  the  operation  of  excision.  Ho  doubt  it  was  difficult 
to  say  how  far  the  disease  had  progressed,  but  he  would  not 
perform  that  operation  when  he  could  by  any  reasonable 
section  of  it  gain  recovery  and  a  tolerably  useful  limb.  It 
was  better  for  a  child  to  have  one  limb  some  inches  shorter 
than  the  other,  and  useful,  rather  than  have  none  at  all.  Mr. 
Corley  had  asked  what  age  was  favourable.  He  agreed  with 
Mr.  Corley  that  as  age  advanced  the  risk  increased,  but  his 
own  cases  were  all  of  young  children.  Replying  to  Mr. 
Wheeler’s  inquiry  as  to  the  condition  of  the  acetabulum,  in 
most  cases,  he  said,  it  was  not  very  bad — there  was  no  necrosis 
of  the  bone.  The  cartilage  was  destroyed,  but  the  bone 
itself  or  the  ilium  was  not  extensively  diseased.  He  looked 
on  the  femur  as  more  of  a  difficulty  than  the  acetabulum. 

•  Mr.  Thomson  had  taken  a  gloomier  view  of  the  results  of  ex¬ 
cision  than  was  compulsory;  for,  damaging  as  the  results  had 
"been,  they  were  not  so  gloomy  as  he  had  pictured.  The 
young  man,  for  instance,  was  able  to  hop  on  the  diseased  limb, 
bend  it,  abduct  it,  flex  it,  and  rotate  it.  That  was  a  rarely 
■successful  case.  The  second  was  also  successful,  as  there 
was  fibrous  union  established.  The  time  for  operation  must 
be  when  the  case  had  progressedpast  recovery  from  expectant 
'treatment,  and  before  degenerate  changes  had  begun.  As 
pointed  out  by  the  Clinical  Society  in  London,  the  percentage 
of  recoveries  was  considerably  above  that  of  recoveries 
without  operation. 

Dr.  Theodore  Stack  read  apaper  “  On  the  Replantation  and 
Transplantation  of  Teeth.”  This  subject, he  stated,  was  first 
worthily  introduced  into  surgical  literature  by  John  Hunter, 


in  whose  museum  there  is  to  be  seen  an  immature  canine  trans¬ 
planted  into  the  comb  of  a  cock  with  perfect  success.  Having 
fallen  into  disuse  soon  after  Hunter’s  time,  this  method 
of  treatment  received  a  fresh  stimulus  from  the  practice  at 
St.  Bartholomew’s  of  Mr.  Coleman ;  and  more  recently  Pro¬ 
fessor  Magitot,  of  Paris,  had  made  a  valuable  communication 
on  the  subject  to  the  International  Medical  Congress.  Re¬ 
plantation  may  be  found  a  useful  therapeutic  measure  in — 
first,  pulp  exposed,  or  nearly  exposed,  with  carious  cavity 
extending  under  the  gum ;  secondly,  external  violence, 
knocking  the  teeth  out ;  thirdly,  accidental  extraction ; 
fourthly,  obscure  cases  of  neuralgia  referred  to  sound  teeth ; 
fifthly,  alveolar  abscess,  complicated  or  uncomplicated.  It 
will  be  undertaken  most  frequently  in  cases  of  alveolar 
abscess.  The  primary  cause  of  alveolar  abscess  is  in  nearly 
every  caseaputrefyingpulp.  A  secondary  cause  maybe  a  small 
portion  of  the  tip  of  the  root  becoming  necrosed,  by  the 
abscess,  after  it  has  lasted  a  little  while,  dissecting  off  from 
the  part  the  periodontal  membrane.  Magitot  proposed  ex¬ 
traction  of  the  tooth,  resection  of  any  necrosed  part,  and 
replantation;  and  claimed  a  success  of  92  per  cent.  Mr. 
Finlay  Thompson  proposed,  after  resection,  to  cap  the  end 
of  the  root  with  gold,  and  to  introduce  a  gold  tube  into  the 
root  for  drainage.  This  method  seems  equally  elaborate  and 
useless.  Mr.  Coleman  proposed  to  fill  the  root  antiseptically. 
This  method  appeared  to  fulfil  the  indications  most  fully, 
and  some  of  Mr.  Coleman’s  failures  must  be  attributed  to 
his  dipping  the  tooth  in  too  strong  carbolic  acid  before  re¬ 
placement.  Out  of  a  table  of  some  thirty  cases  made  out  by 
Mr.  A.  W.  W.  Baker  and  Dr.  Stack  from  their  private  and 
hospital  practice,  all  of  which  were  successful,  a  large  num¬ 
ber  had  been  treated  by  resection  of  the  root,  filling  the  root 
with  creasote  and  iodoform,  and  free  incision  into  alveolar 
abscess.  Referring  to  the  liability  of  these  teeth  to  absorp¬ 
tion — a  danger  mentioned  by  Tomes,  Coleman,  and  others, 
— Dr.  Stack  stated  that  he  believed  this  danger  only 
applied  to  teeth  which  had  been  so  treated  when  out 
of  the  mouth  as  to  cause  death  of  the  periodontal  mem¬ 
brane,  either  by  too  long  delay  or  by  the  use  of  some 
too  strong  chemical  agent.  It  was  not  due  to  rend¬ 
ing  of  the  alveolar  connexions,  for,  admittedly,  teeth  vio¬ 
lently  knocked  out  and  quickly  replanted  nearly  always 
succeeded.  Nor  was  it  due  to  placing  foreign  material  in 
the  pulp  chambers  and  canals ;  for  Dr.  Stack  was  proud  to 
say  that  in  cases  of  teeth  pivoted  by  two  of  their  oldest 
dental  surgeons — Mr.  Robert  Moore  and  Mr.  Daniel  Corbett 
• — it  was  no  uncommon  occurrence  for  the  roots  to  last  twenty 
or  thirty  years.  In  the  museum  of  the  Dental  Hospital  of 
Ireland  there  was  a  specimen  of  a  pivot  tooth  presented  by 
Mr.  Corbett  which  had  lasted  thirty-seven  years.  In  the 
allied  operation  of  transplantation  when  the  scion  tooth  was 
always  perfect,  it  is  still  undecided  whether  the  pulp  should 
be  exterminated  or  not.  Mr.  A.  W.  Baker,  Mr.  Abraham, 
and  Dr.  Stack  were,  he  believed,  the  first  who  had  esta¬ 
blished  by  actual  microscopical  examination  in  the  human 
subject  that  the  pulp  chamber  in  the  scion  tooth  could  after 
replantation  again  enclose  living  contents.  This  was  a 
possible,  perhaps  a  probable,  result,  but  by  no  means  a 
universal  one.  Dr.  Stack  believed  that  the  operation  of 
transplantation  was  likely  to  grow  in  favour,  especially  in 
hospital  practice,  where  the  patients  were  unable  to  pay 
for  good  artificial  dentures.  Dr.  Stack  said  he  was  much 
indebted  to  Mr.  Abraham  and  Dr.  Richard  Hayes  for  the 
assistance  they  had  given  himself  and  Mr.  Arthur  Baker. 

Mr.  Abraham  read  a  short  treatise  on  the  subject. 

Dr.  R.  McDonnell  said  the  paper  was  one  of  extra¬ 
ordinary  interest  not  only  to  the  dental  surgeon,  but  also  to 
the  surgeon  occupied  in  the  careful  study  of  the  processes 
engaged  in  the  absorption  of  bone  and  diseased  tissues. 
Savory,  referring  to  Gulliver’s  paper  on  the  absorption  of 
bone,  had  asked,  was  dead  bone  absorbed.  He  came  to  the 
conclusion  that,  according  to  Gulliver’s  experiment,  if  dead 
bone  was  lying  in  the  midst  of  surrounding  tissues  it  was 
not  absorbed.  But  his  experiments  extended  only  for  a 
short  time,  while  absorption  was  a  very  slow  process  of 
years.  Pressure  was  of  importance.  For  instance,  when 
allowed  to  make  experiments  in  this  country,  an  ivory  peg 
put  loosely  through  a  bone,  and  taken  out  after  a  few  weeks, 
was  just  as  smooth  as  when  hammered  in;  but  when  taken 
out  after  being  there  for  months  it  was  deeply  eroded,  and 
it  was  evident  that  some  process  was  going  on.  Ollier 
pointed  out  that  bone,  when  engaged  with  a  foreign  body. 


Medical  Times  and  Gazette. 


MEDICAL  NEWS, 


July  7,  1883.  25 


was  able  to  regenerate  new  bone,  or  attack  structures  that 
came  in  the  neighbourhood  of  it,  and  he  demonstrated  the 
rapid  development  of  new  bone  by  transplantation  into  the 
bone  of  a  chicken.  From  the  cases  in  question,  however,  he 
(Dr.  McDonnell)  would  be  most  cautious  in  drawing  the 
conclusion  that  it  was  revived  pulp.  It  might  be  that 
granulations  had  sprung  up  and  filled  the  cavity,  that  the 
tooth  was  acting  like  a  sponge  graft,  and  therefore  would 
be  in  the  happy  position  of  bearing  a  pulp  without  any 
nerve  in  it.  He  did  not  think  anyone  who  had  heard  the 
paper  could  scout  the  idea  of  antiseptics. 

Mr.  Wheeler  said  he  had  brought  forward  a  paper  in 
which  he  had  strongly  advocated  antiseptics,  laying  down, 
however,  the  difference  between  antiseptic  surgery  and 
Listerism.  Anything  that  fell  short  of  the  gauze  and  the 
spray,  as  Mac  Cormac  had  stated,  was  not  Listerism.  But 
he  believed  in  drainage,  in  rest,  in  cleanliness,  what  they  all 
aimed  at.  As  to  ivory  pegs  being  absorbed,  he  had  seen 
them  five  or  six  times  pegged  into  the  tibia.  It  was  not 
the  experience  of  many  surgeons  that  ivory  pegs  were 
absorbed. 

Closing  Remarks. 

The  President,  in  closing  the  meeting,  thought  they 
might  congratulate  themselves  on  the  work  of  the  past 
session.  The  papers  read  showed  an  amount  of  preparation 
that  was  in  the  highest  degree  encouraging,  while  the 
remarks  made  in  discussing  those  papers  evidenced  know¬ 
ledge  and  depth  of  thought  that  equally  augured  well  for 
the  future.  A  suggestion  made  in  the  Council  might  per¬ 
haps  be  carried  out  next  session — to  group  subjects  so  as  to 
have  two  or  three  papers  on  the  same  subject  read  at  the 
same  meeting,  and  let  these  be  discussed  together.  That 
course  had  been  found  to  work  well  elsewhere,  and  to 
add  very  much  to  the  interest  of  the  meetings.  The  exhibi¬ 
tion  of  living  specimens  during  the  session  had  proved  a  most 
successful  feature.  To  the  General  and  Sectional  Secretaries 
thanks  were  due  for  their  admirable  arrangements. 


Observations  aeter  Decapitation. — Dr.  F.  Holm¬ 
gren  communicated  to  the  TTpsala  Medical  Society  an  account 
of  some  observations  he  had  made  on  the  occasion  of  the 
decapitation  of  two  criminals.  Three  seconds  after  the 
decollation  of  the  first  of  these  the  eyes  were  widely  open 
and  the  pupils  contracted  ;  twenty  seconds  after,  they  com¬ 
menced  dilating,  the  dilatation  being  completed  in  about 
two  minutes,  after  which  they  remained  in  a  state  of  medium 
contraction.  Twenty- five  seconds  after  decapitation  the 
eyes  turned  upwards  and  to  the  right.  Reflex  movements 
commenced  after  forty-four  seconds  in  little  twitchings  of 
the  muscles  of  the  neck,  after  which  violent  contraction 
supervened  :  the  mouth  was  drawn  downwards  and  to  the 
left,  the  tongue  also  seeming  deviated  to  the  left.  Some 
seconds  later,  the  mouth,  which  had  been  widely  open,  closed 
slowly.  And  then,  after  some  slightly  rhythmic  movements  of 
the  muscles  of  the  face,  at  one  minute  and  forty- four 
seconds  after  the  execution,  complete  repose  ensued.  From 
the  surface  of  the  section  of  the  neck  blood  escaped  with  a 
hissing  sound,  and  in  a  jet  one  metre  in  length ;  and  thirty- 
five  seconds  later  there  was  still  an  intermittent,  jerking 
discharge  of  blood.  No  movement  was  observed  in  the  body 
after  decapitation.  At  the  second  execution  Dr.  Holmgren 
was  placed  so  as  to  observe  the  eyes  during  the  decapitation. 

At  the  blow  of  the  axe  there  was  no  winking  of  the  eyelids, 
and  the  culprit  had  kept  his  eyes  wide  open  the  whole  time 
his  head  was  on  the  block.  After  the  head  had  fallen  the 
same  phenomena  were  observed  as  in  thejfirst  case,  the  jet 
of  blood  extending  to  133  metre.  The  author  concludes 
from  his  observations  that  sensation  disappears  instantly, 
and  that  decapitation  is  consequently  not  apainful  operation. 

— Rev.  Med.,  May  26. 

A  Modern  Miracle. — The  New  Orleans  Picayune 
says  that  a  medical  man  of  New  Orleans,  who  is  fond  of 
his  little  joke,  began  to  catechise  a  coloured  minister,  “  Why 
is  it  that  you  are  not  able  to  do  the  miracles  that  the  Apostles 
did  ?  They  were  protected  against  all  poisons  and  all  kinds 
of  perils.  How  is  it  that  you  are  not  protected  in  the  same 
way  ?  ”  The  coloured  preacher  promptly  replied,  “  Don’t 
know  ’bout  that,  doctor ;  I  ’spect  I  is  ,•  I’ve  taken  a  mighty 
sight  of  strong  medicine  from  you,  and  I’s  alive.-JeJJrbF — _ 

New  York  Med.  Record,  June  2.  /.  " 

/&/RADFOF.U 


MEDICAL  NEWS. 

- • - 

University  of  Dublin. — At  the  Summer  Commence¬ 
ments,  held  on  Friday  and  Saturday,  July  29  and  30,  the 
following  degrees,  among  others,  were  conferred,  in  the 
presence  of  the  Senate,  in  the  Examination  Hall  of  Trinity 
College,  by  the  University  Caput,  consisting  of  the  Right 
Hon.  J .  T.  Ball,  LL.D.,  Vice-Chancellor ;  the  Very  Rev.  the 
Provost  of  Trinity  College;  and  the  Rev.  J.  W.  Barlow, 
M.A.,  Senior  Master  non-regent,  viz. : — 

Baccalaurei  in  GMrurgid.  —  Edmundus  Franciscus  Beveridge,  Monckton 
O’Dell  Braddell,  Georgius  Cowen,  Cecil  Arturus  Digby,  Franciscus 
Jacobus  Drury,  Frederieus  Conway  Dwyer,  Carolus  Joseph  Fagan,  Carolua 
Wolfe  Hamilton,  Thomaa  Wilfredus  Haughton,  Hugo  Falconer  Oldham, 
Carolus  Thomas  Poland,  Johannes  Harrison  Scott,  Henricus  Neville 
Thompson,  Almroth  Edvardus  Wright. 

Baccalaurei  in  Medicind.  —Edmundus  Franciscus  Beveridge.  Henricus 
Edmundus  Blandford,  Carolus  Holcroft  Blood,  Monckton  O’Dell  Braddell, 
Johannes  Jacobus  Cochrane,  Georgius  Cowen,  Cecil  Arturus  Digby, 
Georgius  Magill  Dobson,  Franciscus  Jacobus  Drury,  Frederieus  Conway 
Dwyer,  Carolus  Joseph  Fagan,  Gulielmus  Gualterus  Fenton,  Thomas 
Wilfredus  Haughton,  Henricus M'Quade,  Hugo  Falconer  Oldham,  Carolus 
Thomas  Poland,  Johannes  Harrison  Scott,  Robertus  Edvardus  Sproule, 
Henricus  Neville  Thompson,  Almroth  Edvardus  Wright,  Frederieus 
Johannes  Driver  (Cantab,  ad  eundem,  gradum). 

Magistri  in  Chirurgid. — Isidore  M‘Wm.  Bourke,  Ephraim  MacDowell 
Cosgrave  (stip.  cond.),  Jacobus  Gloster. 

Doctoresin  Medicind.  — Isidore M‘ Wm.  Bourke,  Robertus  Nickle  Denning, 
Frederieus  Johannes  Driver,  Edvardus  Fawcett,  Johannes  Rutherford 
Kirkpatrick,  Samuel  Robertus  Mason,  Travers  Robertus  Montgomery 
Smith,  Montgomery  Albertus  Ward,  Bertramus  Coghill  Alan  Windle. 

Licentiatus  in  Medicind.— Green  Jacobus  Sullivan. 

Gkadus  Honoeis  Causa. 

Magister  in  Arte  Obstetricid.  —  Georgius  Hugo  Kidd. 

Magister  in  Arte  Ingeniarid. — Robertus  Crawford. 

Doctores  in  JJtroque  Jure. — Preehonorabilis  Johannes  Poyntz,  Comes 
Spencer,  Eg.  Periscel.  Prorex  Eibernice;  Preehonorabilis  Garnet  Joseph, 
Baro  Wolseley,  G.C.B. 


Royal  College  of  Physicians  of  London. — The  fol¬ 
lowing  gentleman  was  duly  admitted  Fellow  of  the  College 
on  June  28  : — 

Watney,  Herbert,  M.D.  Cantab.,  1,  Wilton-crescent,  S.W. 


Royal  College  of  Surgeons  of  England. — The 
following  gentlemen  passed  their  Primary  examinations 
in  Anatomy  and  Physiology  at  a  meeting  of  the  Board  of 
Examiners  on  the  2nd  inst.,  and  when  eligible  will  be 
admitted  to  the  pass  examination,  viz..: — ■ 

Adami,  J.  G.,  student  of  the  University  of  Cambridge. 

Brown,  F.  J.,  of  the  Manchester  School. 

Cameron,  C.  Ernest,  of  McGill  College. 

Churcher,  T.  G.,  of  the  Edinburgh  School. 

Edwards,  J.  F.  H.,  of  the  Birmingham  School. 

Erulkar,  S.  A.,  of  the  Bombay  School. 

Gemmell,  J.  E.,  of  the  Edinburgh  School. 

Griswold,  Gaspar,  of  the  New  York  School. 

Pearson,  Richard,  of  St.  George’s  Hospital. 

Purchas,  A.  C.,  of  the  Edinburgh  School. 

Shackleton,  Henry,  of  the  Dublin  School. 

Winter,  J.  T.,  of  the  Manchester  School. 

Nine  candidates  were  referred  for  three  months  and  three 
for  six  months.  The  following  gentlemen  passed  their 
primary  examinations  on  the  3rd  inst.,  viz. : — 

Barker.  Jphn,  student  of  the  Newcastle  School. 

Bird,  F.  D.,  of  the  Melbourne  School. 

Bowden,  E.  E.,  of  the  Manchester  School. 

Briant,  A.  J.,  of  the  Liverpool  School. 

Davis,  A.  E.,  of  the  Liverpool  School. 

Dudfield,  S.  R.  O.,  of  the  Cambridge  School. 

Evans,  Evan,  of  St.  Mary’s  Hospital. 

Glasson,  C.  J.,  of  the  Bristol  School. 

Greig,  D.  McB.,  of  University  College  Hospital. 

Hay,  R.  M.,  of  theNewcastle  School. 

Martin,  C.  L.,  of  the  Liverpool  School. 

Mirza,  J.  F.,  of  the  Bombay  School. 

Oakley,  W.  D.,  of  M‘Gill  College. 

Sumner,  Benjamin,  of  the  Liverpool  School. 

Ten  candidates  were  referred  for  three  months.  The  fol¬ 
lowing  gentlemen  passed  on  the  4th  inst.,  viz. : — 

Baxter,  C.  E.,  student  of  the  Sheffield  School. 

Blackburn,  Herbert,  of  the  Manchester  School. 

Burns,  R.  J.,  of  the  Newcastle  School. 

Clayton,  W.  K.,  of  the  Leeds  School. 

Collymore,  J.  H.,  Guy’s  Hospital. 

Corbett,  H.  H.,  of  the  Manchester  School. 

Crickitt,  H.  H.,  of  St.  George’s  Hospital. 

Heaton,  T.  S.,  of  the  Manchester  School. 

Jeeves,  John,  of  the  Sheffield  School. 

Laing,  J.  G.,  of  the  Liverpool  School. 

Meldrum,  P.  G.,  of  the  Toronto  School. 

~ Paul,  G.  W.  F.,  of  University  College  Hospital, 
y  Richards,  Thomas,  of  the  Bristol  School. 

Simpson,  B.  C.,  of  the  Newcastle  School. 


26 


Medical  Times  and  Gazette 


MEDICAL  NEWS, 


July  7,  1883, 


Nine  candidates  were  referred  for  three  months  and  two  for 
■six  months. 

Primary  Examinations. — At  the  Anatomical  and  Physio¬ 
logical  Examination  for  the  diploma  of  Membership  of  the 
Royal  College  of  Surgeons  on  the  29th  ult.,  when  222  can¬ 
didates  presented  themselves,  the  following  were  the  ques¬ 
tions  on  Anatomy  submitted  to  them,  when  they  were  re¬ 
quired  to  answer  four  (and  not  more  than  that  number)  of  the 
questions,  from  one  to  three  o’clock  p.m.,  viz. : — 1.  Enume¬ 
rate  in  their  relative  position  the  muscles  attached  to  the 
temporal  bone;  give  their  nerve-supply.  2.  Describe  the 
cartilages  of  the  larynx.  3.  Mention  in  their  relative  posi¬ 
tion  the  structures  exposed  upon  removal  of  the  pectoralis 
major  muscle.  4.  Describe  the  diaphragm  :  its  attachments, 
relations  on  both  surfaces,  structure,  and  openings.  5.  De¬ 
scribe,  in  the  order  in  which  they  occur,  the  anastomoses  of 
the  arteries  on  the  walls  of  the  alimentary  canal  from  the 
cardiac  orifice  of  the  stomach  to  the  anus.  6.  Describe  the 
fascia  lata.  The  following  were  the  questions  on  Physiology, 
to  be  answered  from  four  to  six  o’clock  p.m.  on  the  same  day, 
viz. : — 1.  Describe  the  act  of  vomiting.  By  what  nervous  chan¬ 
nels  may  this  act  be  excited?  2.  What  varieties  of  cartilage 
are  found  in  the  adult  ?  Where  are  they  found  ?  Describe 
their  structure  and  functions.  3.  What  are  the  more  im¬ 
portant  constituents  of  urine?  State  and  explain  how 
they  are  affected  by  starvation,  digestion,  exercise,  and 
temperature.  4.  Describe  the  structure  of  the  olfactory 
mucous  membrane.  Explain  the  manner  in  which  the  sense 
of  smell  is  exercised.  5.  State  the  functions  of  the  pneumo- 
gastric  nerve.  Give  the  experimental  and  other  evidence 
on  which  your  statements  rest.  6.  What  is  the  chemical 
constitution  of  the  neutral  fats  ?  How  are  they  prepared 
for  absorption  in  the  alimentary  canal  ? — There  was  no  oral 
examination  on  Thursday,  owing  to  the  annual  election  of 
Eel  lows  into  the  Council  of  the  College. 


Apothecaries’  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday, 
June  28  : — 

Brown,  William  Henry,  Parkhurst-road,  Bexley,  Kent. 

Cox,  John  Henry,  Doddington-grove,  Kennington. 

Hill,  Thomas  James  Cooke,  Bonython,  Grampound,  Cornwall. 
Fletcher,  Wilfred  W.  Ernest,  Malvern-cottages,  Thornhill-road,  N. 
Maling,  William  Haygarth,  Sunderland. 

Mills,  Robert,  Edward-street,  Hampstead-road,  N.W. 

Scott,  Bernard  Charles,  Derwent-road,  Anerley. 

Strugnell,  Walter  Thomas,  Portsdown-road,  Maida-vale,  W. 


APPOINTMENTS. 

The  Editor  will  thank  gentlemen  to  forward  to  the  Publishing-office, 
as  early  as  possible,  information  as  to  all  new  Appointments  that  take 
place.  - 

Uewetson,  H.  Bendelack,  M.R.C.S.— Honorary  Surgeon  to  the  Oph¬ 
thalmic  and  Aural  Department  of  the  Leeds  General  Infirmary,  in  the 
place  of  the  late  Mr.  Robert  Parr  Oglesby,  M.R.C.S. 


DEATHS. 

"Cotiss,  Francis  P.,  M.R.C.S.,  of  St.  Servan,  France,  on  June  30,  aged  56. 
Scriven,  Samuel  Swain,  M.D.,  on  June  28,  at  11,  Erederick-place, 
Weymouth,  aged  80. 


VACANCIES. 

In  the  following  list  the  nature  of  the  office  vacant,  the  qualifications  re¬ 
quired  in  the  candidate,  the  person  to  whom  application  should  be  made 
and  the  day  of  election  (as  far  as  known)  are  stated  in  succession. 

Borough  of  Sheffield. — Resident  Medical  Officer.  (For  'particulars  see 
Advertisement.) 

Bournemouth  Cottage  Hospital  and  Dispensary.— Resident  Medical 
Officer  and  Secretary.  Salary  £120  per  annum,  with  rooms,  attendance, 
coals,  and  gas.  Candidates  must  hold  both  a  medical  and  surgical 
diploma.  Applications,  with  testimonials,  to  he  addressed  to  the 
Secretary  (from  whom  further  particulars  may  be  obtained),  on  or 
before  July  10. 

Hospital  for  Consumption,  Brompton,  S.W.— Assistant-Physician.  Candi¬ 
dates  must  be  Doctors  or  Bachelors  of  Medicine  and  Fellows  or  Members 
of  the  College  of  Physicians.  Applications  and  testimonials  to  be  sent, 
on  or  before  the  11th  inst.,  to  Henry  Dobbin,  Secretary. 

Joint  Counties  Asylum,  Carmarthen.— Junior  Assistant  Medical  Officer. 
Salary  to  begin  at  £100  per  annum,  with  board  and  attendance.  Appli¬ 
cations,  with  testimonials,  to  he  forwarded  to  Dr.  Hearder,  on  or  before 
July  7. 

Torbay  Hospital  and  Provident  Dispensary,  Torquay.— Junior  House- 
Surgeon  and  Dispenser.  Candidates,  qualified  in  medicine  and  surgery, 
and  registered,  must  be  single  and  without  the  care  of  a  family.  Board, 
lodging,  and  attendance,  together  with  fees  from  such  pupils  in  dis¬ 
pensing  as  the  Board  may  approve.  Testimonials  to  the  Hon.  Secretary, 
W.  H.  Kitson,  Esq.,  Hemsworth,  Torquay,  not  later  than  July  16. 


Stookton-upon-Tees  Hospital  and  Dispensary. — House-Surgeon  (non¬ 
resident).  Salary  £200  per  annum.  Candidates  must  be  doubly  quali¬ 
fied.  Applications,  in  writing,  stating  age,  with  recent  testimonials  (or 
copies),  to  be  sent  to  the  Secretary," not  later  than  July  14. 


UNION  AND  PAEOCHIAL  MEDICAL  SERVICE. 

***  The  area  of  each  district  is  stated  in  acres.  The  population  is 
computed  according  to  the  census  of  1881. 

RESIGNATIONS. 

Orediton  Union. — Mr.  John  Deans  has  resigned  the  Coldridge  District : 
area  5160  ;  population  651  ;  salary  £16  per  annum. 

Stoke  Damerel  Parish. — Mr.  F.  E.  Row  has  resigned  the  Clowance  and 
St.  John’s  District :  population  10,654  ;  salary  £60  per  annum. 

APPOINTMENTS. 

Bridgwater  Union. — Thomas  Unicume,  M.R.C.S.  Eng.,  L.R.C.P.  Lond., 
to  the  Middlezoy  District. 

Depwade  Union. — Job  N.  L.  Paulley,  M.R.C.S.  Eng.,  L.R.C.P.  Edin.,  to 
the  Fourth  District. 

Fast  Preston  Union.— Eraucis  C.  Bryan,  M.R.C.S.  Eng.,  L.S. A.,  to  the 
Third  District  and  the  Workhouse. 

Frome  Union.— William  H.  Wood,  M.R.C.S.  Eng.,  L.S. A.,  to  the 
Nunney  District. 

Huddersfield  Union.— Thomas  L.  Laxton,  M.R.C.S.  Eng.,  L.R.C.P. 
Edin.,  to  the  Fulstone  District. 

Machynlleth  Union. — Thomas  Davies,  L.R.C.P.  Edin.,  M.R.C.S.  Eng., 
to  the  Machynlleth  District. 


Effects  of  Napelline. — From  an  experimental  and 
clinical  examination  of  the  effects  of  napelline,  which  is  a 
soluble  amorphous  alkaloid  of  the  root  of  aconite.  Dr. 
Laborde  concludes — 1.  That  it  possesses  physiological  pro¬ 
perties  which,  while  approaching  in  their  fundamental 
characteristics  to  those  of  crystallised  aconitia,  sensibly 
differ  from  this,  both  in  their  much  less  activity,  and  by 
hypnotic  and  somniferous  effects  which  do  not  belong  to  it. 
2.  That  this  new  product  is  consequently  more  manageable 
in  practice,  without  giving  rise  to  alarming  accidents.  3.  It 
may  therefore  he  employed  in  subcutaneous  injections  in  doses 
of  one,  two,  three,  or  four  centigrammes,  whether  given  at 
once,  in  divided  doses,  or  at  very  short  intervals,  producing 
real  therapeutical  effects  without  causing  any  appreciable 
physiological  or  toxica  1  effects.  4.  Its  effects  are  chiefly 
manifested  in  local  painful  affections— especially  in  neu¬ 
ralgias — and  in  excessive  excitability  of  the  nervous  system, 
with  persistent  insomnia. — Jour,  de  ThSrap.,  June  10. 


APPOINTMENTS  FOR  THE  WEEK. 


July  7.  Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  1J  p.m. ;  King’s  College,  1|  p.m. ;  Royal 
Free,  2  p.m.;  Royal  London  Ophthalmic,  11  a.ra. ;  Royal  Westminster 
Ophthalmic,  ljp.ni.;  St.  Thomas’s,  ljp.m.;  London,  2  p.m. 


9.  Monday. 

Operations  at  the  Metropolitan  Free,  2  p.m. ;  St.  Mark’s  Hospital  for 
Diseases  of  the  Rectum.  2  p.m.;  Royal  London  Ophthalmic,  11  a.m.; 
Royal  Westminster  Ophthalmic,  1J  p.m. ;  Hospital  for  Women,  2  p.m. 


10.  Tuesday. 

Operations  at  Guy’s,  1J  p.m. ;  Westminster,  2  p.m. ;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  lj  p.m.;  West 
London,  3  p.m. 

Royal  College  of  Surgeons  of  England,  4  p.m.  Dr.  Garson,  “  On 
the  Comparative  Anatomy  of  the  Integumentary,  Respiratory,  and  Cir¬ 
culatory  Systems  of  the  Vertebrata.” 


11.  Wednesday. 

Operations  at  University  College,  2  p.m.;  St.  Mary’s,  If  p.m. ;  Middlesex  * 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew's,  1J  p.m.  ;  Great  Northern! 

2  p.m.  ;  Samaritan,  2J  p.m. ;  Royal  London  Ophthalmic,  11  a.m.  ; 
Royal  Westminster  Ophthalmic,  1  j  p.m. ;  St.  Thomas’s,  1&  p.m.;  St. 
Peter’s  Hospital  for  Stone,  2  p.m. ;  National  Orthopaedic,  Great 
Portland-street,  10  a.m. 


12.  Thursday. 

Operations  at  St.  George’s,  1  p.m.  ;  Central  London  Ophthalmic,  1  p.m. ; 
Royal  Orthopaedic,  2  p.m.;  University  College,  2  p.m.;  Royal  London 
Ophthalmic, 11  a.m. ;  Royal  Westminster  Ophthalmic,  lj  p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m. ;  Hospital  for  Women,  2  p.m. ; 
Charing-cross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  2J  p.m. 
Parkes  Museum  of  Hygiene,  8  p.m.  Dr.  Charles  Henry  Ralfe,  “  On  tha 
Hygiene  of  Schools.” 


13.  Friday. 

O  perations  at  Central  London  Ophthalmic,  2  p.m.;  Royal  London  Ophthal¬ 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminster 
Ophthalmic,  ljp.m.;  St.  George’s  (ophthalmic  operations),  1  \  p.m.; 
Guy’s,  1J  p.m. ;  St.  Thomas’s  (ophthalmic  operations),  2  p.m. ;  King’s 
College  (by  Mr.  Lister),  2  p.m. 


Medical  Times  and  Ga*ette. 


NOTES,  QUERIES,  AND  REPLIES. 


July  7,1883.  27 


VITAL  STATISTICS  OF  LONDON. 


NOTES,  QUERIES,  AND  REPLIES. 


Week  ending  Saturday,  June  30,  1883. 


RTHS. 

Births  of  Boys,  1263;  Girls,  1326;  Total,  2689. 

Corrected  weekly  average  in  the  10  years  1873-82,  2540'0. 

DEATHS. 


Males. 

Females. 

Total. 

Deaths  during  the  week . 

753 

679 

1432 

Weekly  average  of  the  ten  years  1873-82,  i 

751-8 

685-1 

1436-9 

41 

corrected  to  increased  population  ...  ) 

Deaths  of  peopleaged  80  and  upwards 

DEATHS  IN  SUB-DISTRICTS  FROM  EPIDEMICS. 


Enumeratei 

Population, 

1881 

(unrevised) 

Small-pox. 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

Whooping- 

cough. 

Typhus. 

Enteric  (or 
Typhoid) 
Fever. 

Simple 

continued 

Fever. 

Diarrhoea. 

West . 

669633 

6 

3 

4 

3 

3 

1 

13 

North 

905947 

4 

15 

2 

4 

5 

•  •• 

4 

18 

Central 

282238 1  ... 

9 

1 

4 

3 

•  •• 

... 

7 

East . 

692738  ... 

23 

9 

1 

4 

... 

3 

1 

19 

South . 

1265927 

23 

14 

2 

14 

... 

2 

... 

15 

Total . 

3816483 

4 

76 

29 

15 

29 

12 

2 

72 

METEOROLOGY. 


From  Observations  at  the  Cb'eenwich  Observatory. 


Mean  height  of  barometer 

Mean  temperature  . 

Highest  point  of  thermometer 
Lowest  point  of  thermometer 
Mean  dew-pointtemperature 
General  direction  of  wind 
Whole  amount  of  rain  in  the  week  . 


29741  in. 
63-2° 

84-8° 

49-3° 

67-0° 
S.S.W. 
0'86  in. 


BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  the 
Week  ending  Saturday,  June  30,  in  the  following  large  Towns : — 


Cities 

and 

Boroughs. 

Estimated  Population  to 
middle  of  the  year  1883. 

j  Births  Registered  during 
the  week  ending  J une  30. 

Deaths  Registered  during 
the  week  ending  June  30. 

Annual  Rate  of 
Mortality  per  1000  living, 
from  all  causes. 

Temperature 
of  Air  (Fahr.) 

Temp, 
of  Air 
(Cent.) 

Rain 

Fall. 

Highest  during 
the  Week. 

Lowest  during 
the  Week. 

Weekly  Mean  of 
Daily  MeanV  alues 

Weekly  Mean  of 
Daily  Mean 
Values. 

In  Inches. 

In  Centimetres. 

London 

3955814 

258d 

1432 

189 

84-8 

49-3 

63-2 

17-33 

0-86 

2-18 

Brighton  ... 

111262 

73 

29 

136 

780 

52-0 

620 

16-67 

0-40 

1-02 

Portsmouth 

... 

131478 

83 

34 

13-5 

... 

... 

... 

... 

... 

Norwich 

89612 

54 

26 

15-1 

... 

... 

... 

... 

... 

... 

Plymouth  ... 

... 

74977 

48 

24 

16-7 

67-7 

51-5 

56-5 

1361 

1-93 

4-90 

Bristol . 

212779 

141 

58 

14-2 

73-8 

49-2 

58-7 

14-83 

1-15 

2-92 

Wolverhampton  . 

77557 

41 

32 

2C5 

74-2 

427 

58-4 

14-66 

1-34 

3-40 

Birmingham 

... 

414846 

300 

173 

21-8 

... 

... 

... 

... 

Leicester  ... 

129483 

77 

40 

16-1 

80-2 

48-0 

63-2 

17-33 

1-76 

4-47 

Nottingham 

... 

199349 

150 

66 

173 

87-7 

45-0 

62-7 

17-06 

1-92 

4-88 

Derby . 

85574 

48 

29 

17-7 

... 

... 

... 

... 

... 

Birkenhead 

88700 

56 

23 

135 

... 

...  , 

... 

.  .  , 

Liverpool  ... 

666753 

359 

251 

23-1 

74-9 

50-3 

58-6 

14-78 

131 

3  33 

Bolton . 

107862 

78 

38 

18-4 

74-2 

46-1 

57-6 

14-28 

2-96 

7-52 

Manchester 

339252 

240 

176 

27-1 

... 

... 

... 

... 

r  -  * 

Salford 

190465 

131 

76 

20’8 

... 

... 

Oldham 

... 

119071 

65 

39 

171 

... 

... 

... 

... 

Blackburn  ... 

108460 

87 

47 

22-6 

... 

... 

... 

... 

Preston 

98564 

71 

36 

191 

... 

Huddersfield 

84701 

37 

39 

240 

... 

... 

... 

Halifax 

75591 

49 

27 

18'6 

.  .  . 

... 

... 

Bradford  ... 

204807 

117 

67 

17  T 

750 

49-7 

60  1 

15  62 

2-68 

6-55 

Leeds  . 

321611 

193 

109 

177 

76  0 

50-0 

61-3 

16-28 

258 

6-55 

Sheffield  ... 

295497 

187 

116 

205 

75-0 

46-5 

60-5 

15-84 

1-47 

3-73 

Hull  . 

176296 

116 

52 

16-4 

79'0 

32-0 

61-2 

1622 

2-27 

5-77 

Sunderland 

121117 

103 

47 

20-2 

... 

... 

... 

.  .  . 

Newcastle  ... 

... 

149464 

92 

76 

265 

... 

... 

... 

... 

... 

Cardiff . 

90033 

72 

29 

16'8 

... 

... 

... 

... 

... 

... 

For  28  towns 

5620975 

6657 

3191 

19-3 

87-7 

32-0 

60-3 

15-73 

1-73 

4-39 

Edinburgh ... 

235946 

142 

91 

20- 1 

66-6 

48-5  66-8 

1378 

1-36 

3-45 

Glasgow 

515589 

368 

280 

283 

72-0 

49-0 

58-3 

14-61 

2-60 

4-06 

Dublin . 

349^85 

209 

176 

26-1 

70-0 

44-1 

56'5 

13-61 

0-66 

1-68 

At  the  Royal  Observatory,  Greenwich,  the  mean  reading 
of  the  barometer  last  week  was  29'74  in.  The  lowest  read¬ 
ing  was  29'58  in.  on  Tuesday  morning,  and  the  highest 
29-90  in.  at  the  end  of  the  week. 


- • - 

1*  tfcat  q»*8ti0!ul|j  s^all  Itara  mncfc.— Bacon. 

Erratum.— In  the  pass  list  of  candidates  for  the  degrees  of  M.B.  and  B.C’h. 
in  the  University  of  Dublin  {Medical  Times  and  Gazette,  June  30,  page 
743),  for  “  Alworth  E.  Wright  ”  read  “  Almroth  Edward  Wright.”  Also 
in  the  paragraph  headed  “  University  of  Dublin- School  of  Physic  in 
Ireland,”  on  page  783,  the  words  “Mr.  Alworth  Wright”  should  read 
“  Mr.  Almroth  Wright.” 

Locdm  Tenens. 

TO  THE  EDITOR  OP  THE  MEDICAL  TIMES  AND  GAZETTE. 

Sir.,— In  reply  to  the  letter  of  “  Medicus  ”  in  your  issue  of  30th  ult.,  I 
beg  to  inform  him  that  there  is  no  medical  agency  in  Ireland  through, 
which  locum  tenens,  assistants,  etc.,  could  be  secured  ;  but  I  shall  be  glad 
to  furnish  him  with  the  names,  etc., of  several  highly  qualified  gentlemen, 
who,  while  awaiting  appointments,  are  constantly  reading  in  the  library 
of  this  College.  I  am,  &c., 

G.  F.  Blake,  Assistant-Librarian  R.C.S. 
Royal  College  of  Surgeons,  Dublin,  July  4. 

An  Old  Member—  The  following  is  the  form  of  bequest  to  which  you  refer,, 
viz..: — “  I  bequeath  to  the  Royal  College  of  Surgeons  of  England  the 

sum  of  £ -  (free  of  legacy  duty),  and  I  direct  the  same  to  be  paid 

out  of  such  part  of  my  personal  estate  as  is  by  law  applicable  to  that 
purpose.”  You  can  add — “To  be  expended  for  Museumadditions  only.”' 

Cheapened  Fish.— The  recent  agitation  and  general  discussion  of  the  fish 
question  is  bearing  a  practical  result.  A  few  days  ago  might  be  wit¬ 
nessed  in  the  shops  of  retail  fishmongers  of  the  metropolis— chiefly  in. 
the  southern  district— prime  salmon  offered  for  sale  at  tenpence  a  pound- 
Mackerel  of  good  size  were  selling  at  twopence  each,  and  other  fish  at 
equally  reduced  prices.  The  necessity  of  reduction  in  price  in  fish  trade 
circles,  it  is  stated,  is  being  tardily  recognised  both  by  the  wholesale 
and  the  retail  vendors. 

Cosmo.— No  fewer  than  14,200  persons  in  the  London  milk  trade  are 
registered  under  the  law.  Previous  to  the  institution  of  registration, 
the  whole  of  the  London  cowsheds  and  other  premises  connected  with, 
the  milk  trade  were,  with  few  exceptions,  unsuitable  in  construction 
and  in  sanitary  arrangements,  which  have  been  entirely  superseded  by 
the  enforcing  the  legal  obligations  now  required. 

Medical  Portraits. — We  have  received  photographic  portraits  of  Sir  T. 
Spencer  Wells,  Sir  James  Paget,  Professor  Owen,  Mr.  Holden,  and 
Mr.  Marshall,  from  Mr.  G.  Jerrard,  of  Regent-street.  They  are  not- 
only  admirable  likenesses  of  the  distinguished  originals,  but  excellent 
as  works  of  photographic  skill. 

Bakehouses. — Lord  Dalhousie’s  Bill,  introduced  into  the  House  of  Lords, 
deals  with  a  pressing  evil.  The  Bill  takes  the  form  of  an  amendment 
of  the  Factories  and  Workshops  Acts,  and  provides  that  no  room  or 
place  shall,  in  future,  be  occupied  as  a  bakery  unless  at  least  one-half  of 
its  height  be  above  the  level  of  the  street  or  the  adjoining  ground;  that 
no  water-closet,  earth-closet,  or  ashpit  shall  be  within  or  communicate- 
directly  with  a  bakehouse ;  that  any  cistern  for  supplying  water  to  a 
bakehouse  shall  be  separate  and  distinct  from  any  cistern  for  supplying 
water  to  a  closet ;  and  that  no  drain  or  pipe  for  carrying  off  sewage 
matter  shall  have  an  opening  within  the  bakehouse.  The  Bill  contains 
also  provisions  to  facilitate  its  enforcement.  Penalties  are  proposed’ 
for  letting  or  occupying  an  underground  bakery  and  for  contravening 
the  other  regulations,  and  especially  for  using  as  a  bakehouse  any  place 
which  is  in  such  a  state  as  to  be,  on  sanitary  grounds,  unfit  for  use  or 
occupation  for  that  purpose. 

Boards  of  Guardians  and  Repeated  Vaccination  Prosecutions. — With  respect 
to  a  resolution  of  the  Guardians  of  St.  George’s,  Hanover-square,  an 
to  repeated  protecutions  for  neglect  to  comply  with  the  provisions  of  the 
Vaccination  Act,  the  Local  Government  Board  informs  the  Guardians 
that  the  principles  on  which  the  Board  act  are  contained  in  a  letter 
of  theirs,  dated  in  1875,  to  the  effect  that  it  is  in  the  discretion  of  the 
Guardians  to  take  proceedings  more  than  once  in  the  case  of  people  who 
fail  to  comply  with  the  Vaccination  Act. 

A  “  Slink  Butcher  The  Law  Vindicated.— The  Brighton  magistrates  have- 

threatened  on  several  occasions  to  commit  to  prison,  without  the  option 
of  a  fine,  persons  exposing  for  sale  unwholesome  meat.  They  have  just 
sentenced  a  butcher,  living  in  the  country,  but  having  a  stall  in  the 
Brighton  Market,  on  which  the  carcase  of  a  pig  affected  with  disease  was 
found,  to  a  fortnight’s  imprisonment,  without  the  alternative  of  a  fine. 
The  defendant  pleaded  that  he  was  not  aware  that  the  meat  was  bad,, 
but,  as  the  magistrate  remarked,  it  was  a  professional  butcher’s  duty  to 
know  the  state(of  the  meat  in  which  he  dealt.  The  poor  are  the  “  slink 
butchers’  ”  customers.  Cheap  meat  attracts  them,  and  they  think 
inferior  quality  meat  is  better  than  “  no  meat  at  all.” 

Dr.  Fogarty.— You  will  find  an  interesting  “  Discourse  on  the  Life  and 
Works  of  Dr.  Robert  James  Graves,  F.R.S.,”  from  the  pen  of  his  friend 
Dr,  Stokes,  Regius  Professor  of  Physic  in  the  University  of  Dublin,  in 
which  the  anecdote  you  refer  to  is  given.  It  appeared  in  the  Medical 
Times  and  Gazette,  vol.  xxix.,  January  7,  1854,  page  1. 


28 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES 


July  7, 1883. 


Dr.  Miller. — In  the  Gentlemen’s  Magazine  for  October,  1829,  page  292, 
are  some  observations  on  the  Chelsea  Gardens,  signed  Robert  Sweet, 
who  dates  from  Pomona  Place.  Mr.  Field’s  “  Historical  Account  of  the 
Gardens  of  the  Apothecaries’  Society  at  Chelsea”  was  published  in  1820. 

Decent  Events  on  the  West  Coast  of  South  America. — An  account  pub. 
lished  by  Admiral  Aurelio  Garcia  y  Garcia,  late  General  Secretary  to 
■the  Peruvian  Government,  though  probably  in  its  entirety  somewhat 
ex  parte,  may  be  worthy  of  passing  notice  to  our  readers.  According  to 
the  Admiral,  the  conquerors  invaded  even  the  literary  repositories  of 
the  capital,  and  despoiled  them  of  their  precious  contents.  The 
National  Library,  the  best  in  South  America,  containing  300,000 
volumes,  and  that  of  the  University  of  St.  Mark,  in  its  different 
branches  of  jurisprudence,  medicine,  political  economy,  mineralogy, 
chemistry,  etc.,  have  all  been  pillaged  to  such  an  extent  that  not  a 
single  book  remains,  while  the  book-cases  have  been  broken  up  for 
packing-cases.  The  victors  also  took  and  shipped  off  to  Chili  the  in¬ 
struments  belonging  to  the  astronomical  observatory ;  the  machinery, 
laboratories,  and  apparatus  of  the  Medical  College,  and  those  for  teach¬ 
ing  arts  and  industries ;  and  in  the  course  of  the  contingencies  of  the 
campaign  the  buildings  of  the  University,  the  Library,  and  the  Colleges 
were  used  as  military  barracks  and  stables. 

Metropolitan  Drinking  Fountain  and  Cattle  Trough  Association. — There  have 
been  erected  during  the  past  year  in  various  districts  forty-eight  new 
troughs  for  animals,  and  forty  new  fountains  for  human  beings,  making 
a  total  in  London  of  520  fountains  and  627  troughs,  the  value  of  which 
may  be  taken  at  not  less  than  £60,000.  The  total  expenditure  of  the 
year  amounted  to  £7087,  leaving  a  small  balance  in  hand. 

The  Pauper’s  '‘Consoling  Whiff.”—  The  Lambeth  Board  of  Guardians  have 
lately  discussed  the  question  of  the  paupers  smoking  tobacco.  It  appears 
the  Visiting  Committee  observed  on  a  recent  visit  to  the  workhouse 
that  several  of  the  inmates  were  smoking.  The  Chairman  expressed 
the  opinion  that  unless  the  paupers  were  invalids  tobacco-smoking  was 
;a  direct  infraction  of  the  Act  of  Parliament,  which  forbids  paupers  to 
smoke  unless  by  direction  of  the  medical  officer.  A  guardian  thereupon 
moved  that  tobacco  be  altogether  prohibited,  except  under  medical 
orders.  Ultimately  the  Board,  by  a  majority  of  nine  to  five,  decided 
that  tobacco  be  allowed  to  inmates  over  sixty  years  of  age  out  of  doors. 
That  the  paupers  under  the  specified  age  should  be  deprived  of  the 
comfort  of  an  occasional  pipe  seems  a  somewhat  arbitrary  restriction. 

Mr.  Jenkins. — There  are  11S6  Fellows  of  the  Royal  College  of  Surgeons,  of 
which  number  621  obtained  the  distinction  by  examination. 

The  Kyrle  Society.—  Miss  F.  R.  Wilkinson,  a  lady  student  in  the  landscape 
division  of  the  Crystal  Palace  Company’s  School,  has  j  ust  been  appointed 
a  member  of  the  Council  of  this  Society,  with  a  view  to  her  specially 
advising  in  matters  connected  with  the  laying-out  and  improvement  of 
churchyards,  gardens,  squares,  etc. 

A  Working  Men's  Social  Club,  Stalybridge. — This  Club  (which  has  been 
before  noticed  in  these  pages)  has  obtained  some  notoriety.  The 
“steward”  has  been  summoned  for  selling  liquor  without  a  licence. 
There  was  no  business  done  on  the  premises  during  six  days  of  the 
week,  but  its  doors  were  opened  on  Sundays,  when  licensed  houses  were 
closed,  and  a  thriving  business  was  done  at  these  times.  The  magistrates 
held  the  offence  proved,  and  fined  the  defendant  40s.,  who  they  thought 
only  kept  a  “  colourable  club,”  the  object  being  to  evade  the  law;  and 
they  refused  to  grant  an  appeal. 

Potted  Meat. — A  dealer  in  potted  meat  at  Bradford  has  been  committed  to 
prison  for  two  months,  for  preparing  for  food  thirty-six  pounds  of 
horseflesh.  He  purchased  a  quantity  of  cat’s  meat  at  a  penny  per 
pound,  and  an  inspector  found  it  stewing  in  a  pan  with  a  few  pounds  of 
pigs’  heads. 

An  Official  Reprimand—  A  letter  was  read  at  a  recent  meeting  of  the 
Paddington  Board  of  Guardians  from  the  Local  Government  Board 
with  reference  to  the  unsatisfactory  nature  of  the  returns  made  from 
time  to  time  by  the  vaccination  officer  of  that  parish.  The  Board  ob¬ 
served  that  the  guardians  attributed  the  arrears  shown  in  these  returns 
to  the  frequent  migrations  of  the  artisans  and  poorer  classes  in  the 
parish,  and  to  those  giving,  as  the  guardians  believed,  false  addresses 
to  the  registrar  with  intent  to  evade  the  Vaccination  Laws.  They, 
however,  desired  to  state  that  in  other  districts  of  the  metropolis  and  in 
other  large  towns  in  England,  where  the  circumstances  of  the  popula¬ 
tion  were  not  more  favourable  to  the  enforcement  of  vaccination  than 
"those  of  Paddington,  the  Board’s  experience  showed  them  that  diffi¬ 
culties  like  those  referred  to  by  the  Guardians  of  Paddington  could  to 
a  very  large  extent  be  overcome.  The  Board  could  not  but  think  that 
the  defective  administration  of  the  Vaccination  Acts  in  Paddington  was 
chiefly  due  to  the  imperfect  manner  in  which  the  duties  of  the  vaccina¬ 
tion  officer  had  been  carried  out.  After  some  discussion  the  matter 
was  referred  to  the  Dispensary  and  Vaccination  Committee  to  report  on 
the  subject. 

Mr.  Williams  .—The  annual  election  of  the  President  of  the  Royal  College 
of  Surgeons  will  take  place  next  Thursday,  the  12th  inst.,  when  no 
doubt  the  senior  Vice-President  will  be  installed.  A  few  years  ago 
there  was  an  exception  to  this  rule,  when  the  senior  Vice-President  was 
passed  over— in  favour,  we  think,  of  Sir  W.  Fergusson— 


The  National  Health  Society’s  Exhibition. — This  exhibition,  after  a  very 
successful  run,  has  closed.  The  lectures,  given  sometimes  twice  daily, 
have  been  well  attended.  The  MS  3.  of  most  of  the  lectures  are  in  the 
hands  of  the  Society,  and  are  to  be  printed  for  distribution.  An 
arrangement  is  nearly  completed  by  which  the  Society  will  supervise  a 
similar  exhibition  to  be  opened  in  Manchester  about  August. 

Hampstead  Hospital  Case. — 'The  Hampstead  Vestry  have  received  a  number 
of  letters  approving  of  the  Vestry’s  protest  against  the  further  expendi¬ 
ture  of  the  ratepayers’  money  by  the  Metropolitan  Asylums  Board  in 
litigation  on  this  case.  Lord  George  Hamilton,  M.P.,  writes  that  he 
thoroughly  agrees  with  the  Vestry’s  protest ;  and  Mr.  O.  E.  Coope,  M.P., 
declares  it  is  “  perfectly  outrageous  that  the  Metropolitan  Asylums 
Board  seek  to  impose  further  expenditure  on  the  long-suffering  rate¬ 
payers,  the  case  having  been  so  well  threshed  out  in  Parliament  and  in 
the  courts  of  law.” 

The  Commons  Preservation  Society. — This  Society  has  done  so  much  in  the 
preservation  of  public  land  from  spoliation,  that  it  deserves  the  generous 
pecuniary  aid  for  which  it  is  now  making  an  urgent  appeal.  The  need 
of  open  spaces  for  recreation  purposes  can  be  at  once  realised,  when  it 
is  known  that  in  our  London  School  Board  82  per  cent,  of  the  children 
belong  to  families  which  live  in  a  single  room,  and  that  in  others  of  the 
Board  Schools  the  proportion  of  children  from  such  families  is  over 
50  per  cent.  The  Society  has  rendered  its  services  to  maintain  the  pre¬ 
scriptive  privileges  for  open-air  recreation  of  land  in  many  parts  of  the 
kingdom,  and  is  at  all  times  ready  to  advise  and  assist  local  efforts  in 
resisting  proposals  to  enclose  public  land. 

A  New  Malady. — It  is  stated  that  the  “  lawn-tennis  elbow  ”  is  the  latest 
malady  the  doctors  have  found  out. 

Hydraulic  Street  Service. — The  enterprise,  for  which  Parliamentary  powers 
were  obtained  last  session,  to  supply  some  of  the  principal  streets  in 
London  with  hydraulic  service  for  business  and  household  purposes, 
has  been  so  well  carried  forward,  that  we  understand  the  opening  of 
the  service  is  likely  to  take  place  in  August. 

The  Sewerage  of  Brighton.— The  Borough  Surveyor  has  reported  to  the 
Works  Committee  of  the  Town  Council  with  reference  to  the  recom¬ 
mendations  of  Sir  Joseph  Bazalgette  as  to  the  sewerage  of  the  borough, 
that  the  recommendations,  so  far  as  they  relate  to  matters  under  the 
control  of  the  Town  Council,  have  been  carried  out,  and  that  some  other 
alterations  to  the  sewers  in  points  of  detail  have  also  been  effected.  A 
town  councillor  has  given  notice  that  he  will  move — “  That  the  Sewers 
Board  be  required  to  inform  the  Town  Council  whether  they  have  carried 
out  any,  and  if  so,  which,  of  the  recommendations  contained  in  the 
report  of  Sir  Joseph  Bazalgette  relating  to  matters  under  their  control; 
and  whether  the  Board  propose  to  take  any  measures  with  respect  to 
such  of  those  recommendations  as  have  not  yet  been  acted  upon.” 

Preponderance  in  Sexes.— According  to  Mr.  Gosselin,  Secretary  to  the 
British  Embassy,  Berlin,  in  an  official  report  he  shows  that  London,  in 
comparison  with  other  cities,  stands  pre-eminent  in  the  preponderance 
of  females,  the  proportion  being  as  113‘7  to  100.  On  the  other  hand, 
in  Paris,  in  1876,  there  were  only  88 '5  females  to  100  males,  in  St. 
Petersburgh  (1881)  80'8,  and  in  Rome  (same  year)  79'5. 

COMMUNICATIONS  have  been  received  from— 

Thu  Registrar  op  the  Royah  College  op  Physicians  op  London  ;  The 
Registrar  op  the  Apothecaries’  Hall,  London  ;  The  Secretary 
op  the  Local  Government  Board,  London ;  Dr.  J.  W.  Barrett, 
Melbourne;  Dr.  Leonard  Sedgwick,  London;  The  Sanitary"  Com¬ 
missioner  por  the  Pctnjaub,  Lahore  ;  The  Registrar-General  por 
Scotland,  Edinburgh;  Dr.  Braidwood,  Birkenhead;  The  Secretary 
op  the  Native  Guano  Company,  London ;  The  Secretary  op  the 
Chelsea  Hospital,  London;  Mr.  T.  M.  Stone,  Wimbledon;  Dr. 
Charles  West,  Nice;  The  Honorary  Secretary  op  the  Epidemio¬ 
logical  Society  op  London  ;  Mr.  J.  Chatto,  London ;  The  Secretary 
op  the  Sanitary  Institute  of  Great  Britain,  London;  Mr.  G.  F. 
Blake,  Dublin. 

BOOKS,  ETC.,  RECEIVED  - 

The  Life  and  Work  of  St.  Paul,  part  18 — Forty-fourth  Annual  Report  of 
the  Registrar-General  of  Births,  etc.,  in  England — Fish,  How  Caught, 
etc. — The  Electro-Magnet,  by  Simeon  Snell— Vichy,  by  Prosser  James, 
M.D. — The  “  Blood  Accusation,”  its  Origin  and  Occurrence  in  the 
Middle  Ages— The  Cultivation  and  Life-History  of  the  Ringworm 
Fungus,  by  Malcolm  Morris,  F.R.C.S.  Ed.,  and  G.  C.  Henderson,  M.D. 
— Report  on  the  Health  of  Liverpool  during  1882,  by  J.  Stopford 
Taylor,  M.D. 

PERIODICALS  AND  NEWSPAPERS  RECEIVED— 

Lancet— British  Medical  Journal— Medical  Press  and  Circular — Ber¬ 
liner  Klinische  Wochenschrift — Centralblatt  fiir  Chirurgie — Gazette 
des  Hopitaux— Gazette  Medicale— Revista  de  Medicina— Bulletin  de 
1’ Acaddmie  de  Medecine  — Pharmaceutical  J ournal — W iener  Medicinische 
Wochenschrift — Revue  Medicale— Gazette  Hebdomadaire— Nature — 
Boston  Medical  and  Surgical  Journal— Louisville  Medical  News— 
Centralblatt  fiir  Gynakologie — Le  Concours  Medical— Centralblatt  fiir 
die  Medicinischen  Wissenschaften — Centralblatt  fiir  Klinische  Medicin 
— Philadelphia  Medical  News— Le  Progres  Mddieal — Ophthalmic  Review 
— Revue  Mensuelle  de  Laryngologie,  etc.  —  Archives  Gendrales  de  Mede¬ 
cine — Monthly  Homoeopathic  Review,  July— Times  of  India— Indian 
Medical  Gazette— Edinburgh  Medical  Journal,  July— Veterinarian, 
July— Medical  Temperance  Journal,  July— Morningside  Mirror— Bristol 
Medico-Chirurgical  Journal,  No.  1,  July— Glasgow  Medical  Journal, 
July— Birmingham  Medical  Review,  July — Philadelphia  Medical  Times 
—Practitioner,  July— L’Impartialite  Medicale. 


M«  ileal  Times  and  Gazette 


HOLMES  OH  URETHROTOMY. 


July  14,  1883.  29 


TWO 

CLIHICAL  LECTURES  OH  URETHROTOMY. 

By  T.  HOLMES,  F.R.C.S. 

Lecture  II. — Internal  Urethrotomy. 

I  know  hardly  any  subject  in  surgery  on  which  the  doctrines 
and  practice  of  different  schools  varies  more  than  internal 
urethrotomy.  In  France  it  seems  of  daily  occurrence  ;  some 
English  surgeons  speak  of  hundreds  of  cases  in  their  own 
practice.  At  this  hospital  (St.  George’s)  it  is  the  rarest 
possible  operation.  The  case  I  speak  of  at  present  is  only 
the  second  in  which  I  can  remember  to  have  performed  it 
myself,  and  I  cannot  recall  any  instance  which  I  have  seen 
an  the  practice  of  my  colleagues.  In  cases  where  we  cannot 
pass  an  instrument,  we  regard  the  attempt  to  incise  the 
■stricture  from  before  backwards  a3  more  dangerous  and 
uncertain  than  perinseal  section ;  while,  in  cases  where  an 
instrument  can  be  passed,  we  generally  prefer  the  operation 
by  rupture  or  forced  dilatation,  which  is  called  Holt’s  or 
Perreve’s  operation. 

But  there  is  one  exception  to  the  latter  rule — at  least,  in 
my  opinion, — I  mean  in  the  case  of  traumatic  stricture, 
of  which  the  following  is  a  very  striking  example.  The 
patient,  David  R.,  aged  forty-six,  about  two  years  ago  suf¬ 
fered  rupture  of  the  urethra  (partial  or  complete),  and  has 
still  the  scar  of  an  incision  in  the  middle  line  of  the  peri- 
nseum.  If  we  can  trust  his  history,  it  seems  that  this  incision 
was  not  made  till  about  a  week  after  the  accident.  During 
the  interval  the  urine  had  been  drawn  off  by  the  aspirator. 
Then  the  incision  in  the  perinseum  was  made,  but  it  does 
not  seem  that  any  instrument  was  ever  tied  into  the  bladder. 
He  remained  under  treatment  for  two  months  in  a  country 
hospital,  and  then  was  discharged,  able  to  pass  water  freely. 
Three  months  afterwards,  he  was  on  one  occasion  troubled 
■with  retention ;  but  a  catheter  was  easily  passed,  and  he 
had  no  further  treatment  till  a  short  time  before  his  appli¬ 
cation  here,  when  increasing  dysuria  compelled  him  to 
apply  again  at  the  same  hospital  for  treatment,  but  now  no 
instrument  could  be  passed. 

On  his  admission  here,  however  (May  12),  a  Ho.  1  silver 
catheter  was  got  into  the  bladder,  though  with  difficulty 
-and  with  much  pain  to  the  patient.  This  instrument  was 
now  passed  daily.  Attempts  to  pass  a  flexible  French  cath¬ 
eter  or  a  gum  catheter  failed.  With  still  greater  difficulty 
:a  Ho.  2  silver  catheter  was  passed,  and  it  was  tied  in  ;  but 
the  pain  was  intolerable,  and  the  patient  was  obliged  to  pull 
it  out  again  after  a  few  hours.  All  this  time  he  was  making 
water  with  great  difficulty,  and  the  urine  dribbled  away  a 
good  deal.  The  stricture,  though  very  tight,  seemed  of 
no  great  extent,  for  after  surmounting  the  obstacle  the 
catheter  went  at  once  into  the  bladder. 

It  was  now  clear  that  the  patient’s  sufferings  could  only 
be  relieved  by  rupturing  or  dividing  the  stricture,  and  all 
that  remained  was  to  select  the  method  of  procedure.  Three 
courses  were  open — to  perform  Syme’s  operation,  to  rupture 
the  stricture  after  Mr.  Holt’s  method,  or  to  perform  internal 
urethrotomy.  The  first  operation,  though  it  was  at  one 
time  freely  employed,  has  now,  I  think,  almost  ceased  to  be 
practised.  The  great  authority  of  Mr.  Syme  recommended 
it  to  his  pupils,  and  through  them  to  others.  But  the  other 
two  methods,  more  recently  introduced,  are  so  much  milder 
and  easier,  that  it  is  only  in  very  exceptional  cases  that  one 
hears  of  Syme’s  method  being  followed,  those  being,  I 
believe,  mainly  such  cases  of  obstinate  non-dilatable  stric¬ 
ture  as  are  complicated  with  much  thickening  and  numerous 
•old  sinuses  in  the  perinseum.  In  such  cases  it  is  thought 
that  the  free  division  of  the  soft  parts  is  advantageous. 
Holt’s  method  is  more  frequently  used,  but  my  own  ex¬ 
perience  of  it  is  not  very  favourable  in  traumatic  stricture. 
I  have  seen  rapid  recurrence  in  such  a  case,  with  increased 
obstinacy  and  apparently  closer  cicatrisation. 

I  decided,  therefore,  in  this  case  to  perform  internal 
urethrotomy,  and  I  must  say  that  the  result  not  only 
equalled,  but  surpassed,  my  expectations.  The  operation 
was  done  on  June  1.  The  instrument  that  I  used  was 

Yol.  II.  1883.  Ho.  1724. 


Trelat’s,  which  is  a  modification  of  Civiale’s  urethrotome. 
You  will  see  that  it  consists,  like  Syme’s  staff,  of  two  parts 
— a  terminal  more  slender  portion  about  the  size  of  a  Ho.  1 
catheter,  and  a  stouter  part  joining  the  other  at  a  shoulder 
or  projection.  When  the  slender  part  is  passed  through 
the  constriction,  the  projection  is  of  course  stopped  by  the 
mouth  of  the  stricture.  Pressure  on  a  spring  in  the  handle 
then  causes  a  knife-blade  to  start  out  of  the  slender  part  of 
the  stem,  and  this  knife-blade  is  jointed  so  as  to  assume  an 
angular  form.  The  size  of  the  angle  ( i.e .,  the  depth  of  the 
incision)  is  regulated  by  a  series  of  notches,  into  which 
the  pressure  on  the  spring  causes  the  stem  of  the  concealed 
blade  to  fit;  and  when  the  last  notch  is  selected,  the  pro¬ 
jection  of  the  knife-blade  will  measure  about  a  quarter  of 
an  inch.  '  I  thought  it  better  in  this  case  to  make  as  deep 
an  incision  as  possible,  so  as  more  certainly  to  divide  the 
whole  depth  of  the  cicatrix.  The  instrument  being  passed 
as  far  as  it  would  go,  the  knife-blade  was  protruded,  and 
lay,  of  course,  on  the  vesical  side  of  the  stricture — the 
position  of  the  instrument  directing  it  towards  the  floor  of 
the  urethra.  It  was  then  drawn  outwards  till  there  was  a 
complete  cessation  of  all  resistance,  and  I  was  confident 
that  the  stricture  had  been  entirely  divided.  The  blade 
was  then  returned  into  its  sheath,  and  the  urethrotome 
removed.  There  was  only  slight  bleeding.  A  Ho.  12  gum 
catheter  was  then  passed  without  any  difficutly,  and  tied  in, 
an  india-rubber  tube  being  adapted  to  it,  and  the  water 
allowed  to  flow  constantly,  so  as  to  avoid  any  risk  of  its 
percolating  alongside  the  catheter  and  getting  into  the 
wound.  Ho  symptoms  whatever  followed  the  operation — no 
bleeding,  no  rise  of  temperature,  and  only  slight  pain  in 
passing  water  for  a  few  days  after  the  withdrawal  of  the 
catheter,  which  was  left  in  for  four  days.  A  Ho.  10  or  Ho.  12 
silver  catheter  was  then  passed  daily  without  the  slightest 
trouble  or  feeling  of  resistance ;  but  the  passage  of  a  gum 
catheter  was  found  impossible,  at  least  without  anaesthesia, 
on  account  of  the  pain  it  caused.  He  was  accordingly  provided 
with  a  metal  bougie  which  he  could  pass  for  himself  with 
ease,  and  recommended  to  pass  it  every  few  days.  He  was 
discharged  on  June  30. 

A  few  points  only  require  further  notice.  How  far  the 
operation  may  be  a  safe  and  trustworthy  one,  we  have,  as  I 
have  previously  hinted,  far  too  limited  an  experience  of  our 
own  to  enable  us  to  judge.  Sir  H.  Thompson,  who  uses  it 
freely,  speaks  very  favourably  of  it.  He  even  goes  so 
far  as  to  say  that  there  is  “  absolutely  no  danger”  (a)  in  it. 
But  as  to  its  definite  results,  his  statement  is  wisely  cautious. 
He  says  that  it  gives  more  lasting  results  than  any  other 
operation  ;  and  warmly  recommends  it  in  cases  where  the 
stricture  has  recurred  after  all  other  known  forms  of  treat¬ 
ment  ;  but  he  does  not  claim  for  it  the  power  of  removing 
organic  contraction — in  fact,  he  says  (and  truly,  as  far  as  our 
present  experience  goes)  that  such  a  result  is  impossible. 
You  are  probably  aware  that  some  surgeons  have  claimed 
for  internal  urethrotomy  the  power  of  conferring  an  immu¬ 
nity  from  recurrence  of  stricture  if  only  the  urethra  be 
dilated  to  what  they  consider  its  normal  calibre ;  but  I 
think  I  am  right  in  saying  that  this  claim  has  not  as  yet 
been  admitted  by  the  surgical  profession. 

You  will  see,  however,  by  perusing  Sir  H.  Thompson’s 
Lectures,  which  I  strongly  recommend  you  to  do,  that  he  uses 
this  operation  in  cases  where  we  should  perform  rupture  of 
the  stricture.  What  the  proportion  of  relapses  may  have 
been  in  his  practice,  he  has  not  had  the  opportunity  of 
ascertaining — in  fact,  it  is  well-nigh  impossible  to  do  so  in 
hospital  or  even  in  private  practice ;  but  he  speaks  of 
having  had  occasion  to  repeat  it,  and  even  to  perform  it 
occasionally  for  the  third  time.  In  cases  of  traumatic 
origin  the  recurrence  of  the  stricture  is,  of  course,  even 
more  probable,  and  this  made  me  particular  in  giving  this 
man  a  full-sized  instrument  and  instructing  him  to  use  it 
at  intervals  during  the  rest  of  his  life. 

The  after-treatment  which  I  pursued  is  in  principle  the 
same  as  Sir  H.  Thompson  recommends  ;  only  that  I  kept  the 
catheter  tied  in  somewhat  longer,  and  left  it  open.  The 
latter  is,  I  think,  a  useful  precaution  against  the  percolation 
of  urine  by  the  side  of  the  instrument  into  the  wound. 

The  perfect  success  of  this  little  operation  will,  no  doubt, 
encourage  me  to  make  more  extensive  trial  of  it  in  suitable 
cases. _ _____ _ _ 

(a)  “  Clinical  Lectures  on  Diseases  of  the  Urinary  Organs.”  Sixth 
edition,  page  42. 


30 


Medical  Times  and  Gazette. 


HABERSHON’S  HARVEIAN  ORATION. 


July  14,  1883, 


THE  HARVEIAN  ORATION,  (a) 

DELIVERED  AT  THE  ROYAL  COLLEGE  OF  PHYSICIANS, 

Wednesday,  June  27,  1883. 

By  S.  O.  HABERSHON,  H.D.,  F.R.C.P., 

Late  Senior  Physician  to,  and  Lecturer  on  Medicine  at,  Guy’s  Hospital. 


Mr.  President  and  Gentlemen, — Wlien  I  received  the 
request  that  I  would,  during  the  present  year,  deliver  the 
Oration  which  is  associated  with  the  name  of  the  illustrious 
Harvey,  I  felt  great  distrust  in  my  own  capabilities  of 
rightly  performing  the  duty  allotted  to  me ;  and  that  feeling 
has  become  more  intense  as  the  work  has  gradually  opened 
before  me.  I  must  ask  your  indulgence  whilst  I  seek  to 
fulfil  the  object  of  Harvey  in  establishing  this  annual  oration 
— namely,  to  commemorate  those  who  have  shown  themselves 
benefactors  to  the  College,  and  to  exhort  the  members  to 
search  out  and  study  the  secrets  of  nature  by  way  of 
experiment. 

Harvey  was  a  lover  of  scientific  truth,  and  he  sought  to 
advance  science  by  observation  and  by  direct  experiment. 
Like  others  who  had  preceded,  and  still  more  those  who  have 
followed  in  the  same  pursuit,  the  mind  not  only  became 
absorbed  but  enraptured  in  the  work ;  and  as  any  fragment 
of  truth  was  unfolded,  the  desire  to  discover  more  became 
intensified.  The  eye  was  not  satisfied  by  seeing,  the  intel¬ 
lectual  thirst  could  not  be  quenched  nor  the  hunger 
assuaged ;  and  such  is  always  the  character  of  true  scientific 
research.  There  is  a  dignity  in  science,  and  the  mind  that 
seeks  to  find  out  its  mysteries  is  ennobled  in  the  search ;  it 
expands  with  the  effort,  even  although  one  branch  of  science 
alone  be  studied,  and  one  line  of  thought  be  pursued.  There 
is  a  reward  even  in  the  mental  exercise,  for  it  gives  intel¬ 
lectual  strength  and  constant  pleasurable  excitement.  Each 
truth  really  gained  is  a  standpoint  for  further  advance. 
An  Alpine  traveller  experiences  intense  satisfaction  when 
the  summit  of  his  mountain  climb  is  attained— when,  after 
hours  of  labour,  and  it  may  be  of  danger  and  fatigue,  he  feels 
that  his  object  is  reached,  not  to  speak  of  the  wonderful 
beauties  then  unfolded  before  him ;  but  his  delight  is  not  to 
be  compared  with  the  joy  of  the  philosopher  when  the  dis¬ 
covery  of  some  new  fact  in  science  has  rewarded  his  toil,  and 
a  higher  standpoint  of  truth  has  been  arrived  at. 

Like  the  very  mountains  themselves,  truth  is  stable  ;  not 
as  the  vague  hypothesis  which  too  often  surrounds  it  like 
dense  vapour  or  fog,  truth  is  unchangeable,  even  as  is  its 
Author.  The  works  of  God  reveal  Himself,  for  He  is  the 
Author  of  that  which  science  searches  out. 

Every  object  in  nature  bears  the  impress  of  the  Divine 
hand,  and  the  book  of  nature  reveals  His  wisdom.  His  bene¬ 
ficence,  His  creative  power,  and  His  superintending  provi¬ 
dence.  I  have  no  sympathy  with  those  who,  whilst  they 
seek  to  open  the  book  of  nature,  would  close  the  more 
precious  volume  of  Divine  revelation ;  both  emanate  from 
the  same  source,  and,  when  rightly  understood,  will  never 
contradict  each  other.  The  Scriptures  were  not  intended  to 
teach  science,  but  they  never  contradict  it,  however  they 
may  seem  to  be  opposed  to  the  false  teaching  of  imperfect 
investigation.  The  unfolding  of  scientific  truth  is  truly  an 
evolution ;  it  is  a  gradual  process  like  the  expansion  of  the 
beautiful  leaf -bud;  wonderfully  wrapped  together,  but 
spread  open  under  the  silent  powers  of  light  and  heat 
and  growth;  so  is  truth  gradually  revealed  under  the 
sunlight  of  advanced  science.  It  would  be  unwise  to 
guess  the  form  and  the  delineations  of  the  expanded  leaf 
or  flower  from  the  mere  outline  of  the  bud,  and  guesses 
in  science  too  often  mislead  and  hinder  the  advance  of 
truth.  Direct  experiments  have  led  to  the  establishment 
of  scientific  facts ;  but  mere  reasoning  on  hypothetical 
data  has  been  the  greatest  hindrance  to  the  progress  of 
science.  The  history  of  physiological  science  illustrates 
these  statements,  and  in  no  branch  of  physiology  is  it  more 
remarkable  than  in  that  of  the  circulation.  In  the  dis¬ 
covery  of  the  circulation  of  the  blood  the  process  was  a 


gradual  one;  the  steps  were  often  uncertain,  and  too 
frequently  were  retrograde  in  character. 

Fragments  of  truth  as  to  the  function  of  the  heart  and 
the  nature  of  the  circulation  are  found  in  the  writings  of 
Plato,  of  Aristotle,  and  of  Hippocrates ;  and  the  term  that. 
Plato  gave  to  the  large  vessel — the  aorta — is  still  retained, 
by  us  ;  but  the  knowledge  was  very  confused.  The  lungs- 
were  regarded  as  an  apparatus  to  cool  the  heated  blood,, 
and  to  reduce  the  natural  warmth,  both  emanating  from1 
the  heart  as  their  source  ;  it  was  believed  that  the  arteries 
contained  spirit,  and  that  the  veins  distributed  the  nourish¬ 
ment  collected  from  the  stomach  and  intestines  to  the  rest 
of  the  body.  Aristotle  declared  that  the  pulsation  of  the 
heart  arose  from  its  sudden  inflation  from  new  material  sup¬ 
plied  by  the  food  for  fresh  formation  of  the  blood.  It  ia 
difficult  for  us  so  to  divest  ourselves  of  facts  now  esta¬ 
blished,  as  to  realise  the  state  of  medical  knowledge  in  those- 
early  times. 

But  let  us  turn  to  another  great  physician,  one  who  was- 
almost  regarded  as  divine  in  his  unfoldings  of  the  truth  off 
medical  science.  I  refer  to  Galen  ;  he  was  born  a.d.  131,. 
when  the  Roman  Empire  had  become  aroused  by  the  power 
of  Christianity.  Galen  lived  in  a  time  of  persecution 
although  he  was  regarded  by  some  as  an  enemy  to  Chris¬ 
tianity,  I  cannot  perceive  of  a  pagan  giving  utterance  to 
the  sentiments  which  Galen  wrote,  and  he  was  evidently 
acquainted  with  the  writings  of  the  Old  Testament. 
Galen,  though  the  friend  of  the  Emperors  Hadrian  and 
Marcus  Antonius,  held  views  which  were  inconsistent  with- 
pagan  worship.  He  says  that  “  true  piety  is  not  shown  in 
the  sacrifice  of  hecatombs  of  bulls  or  in  causing  clouds  off 
fragrant  incense,  but  in  studying  myself  to  know,  and  in 
making  known  to  others,  the  wisdom,  the  power,  and  the 
goodness  of  the  Creator.”  It  would  be  well  if  many  mem 
of  high  attainment  in  our  own  day  would  copy  such  an 
example.  Galen  held  correctly  that  the  heart,  though  unlike- 
other  muscles,  was  still  muscular  in  its  action ;  he  knew  the 
structure  of  the  valves  of  the  heart,  but  he  affirmed  that 
there  were  pores  in  the  septum  between  the  ventricles 
which  allowed  some  of  the  blood  to  pass  from  the  right  to- 
the  left  side  of  the  heart.  Here  he  asserted  what  reason- 
fancied  rather  than  what  he  learnt  by  direct  observation — 
a  lesson  to  us,  even  at  the  present  day,  of  the  danger  off 
forming  our  opinions  on  hypotheses  rather  than  on  esta¬ 
blished  facts.  How  slow  we  are  to  learn  this  lesson,  but 
how  disastrous  has  been  the  result,  when  the  statements  off 
reason  are  received  as  facts,  and  are  regarded  as  solid  bases- 
upon  which  scientific  truths  may  be  built !  Like  buildings- 
upon  unstable  foundations,  they  crumble  and  decay  when 
really  tested.  It  is  a  slow  process  to  get  rid  of  these  phan¬ 
toms  ;  the  authority  of  great  names,  and  the  attraction  of 
beautiful  theories  nicely  accommodated  and  smoothly  glossed 
over,  give  these  emanations  of  thought  the  semblance  of 
truth ;  and  those  who  will  not  receive  them  are  regarded 
as  far  behind  in  that  which  constitutes  mental  vigour  and 
attainment.  The  vague  notions  of  Galen  had  immense 
power,  and  held  the  minds  of  men  in  bondage  for  nearly 
1200  years  ;  and  it  was  only  when  direct  observations  were 
made,  and  dissections  were  carefully  studied  by  Vesalius: 
and  Servetus,  that  those  shackles  upon  thought  were  un¬ 
loosed.  Galen  regarded  one  ventricle  of  the  heart  as  con¬ 
nected  with  nutrition  and  nourishment ;  the  other,  the  left, 
had  to  do  with  vital  spirit.  He  believed  that  the  blood  sent 
to  the  lung  was  especially  for  the  nourishment  of  the  lung 
itself,  though  he  was  quite  ignorant  of  the  circulation  of 
the  blood  through  the  lungs.  Yague  notions  of  emanations 
and  interchange  of  blood  and  air  between  the  arteries  and 
veins  were  held,  but  nothing  like  the  true  circulation  of  the- 
blood  was  dreamt  of ;  the  blood  was  said  to  flow  backward 
and  forward,  the  vessels  having  different  offices ;  and,  instead 
of  the  blood  being  propelled  by  the  contraction  of  the  mus¬ 
cular  structure  of  the  heart,  the  expansion  of  the  heart,  the 
diastole,  was  regarded  as  the  most  important  movement,, 
and  it  was  attributed  to  an  imaginary  innate  heat.  How 
different  from  the  simple  truth  brought  to  light  by  the  im¬ 
mortal  Harvey  !  When  direct  experiment  was  made  by 
Galen,  truth  was  elicited,  and  one  link  was  formed  in  the 
chain  of  facts  connected  with  the  circulation ;  he  showed 
that,  when  an  artery  was  ligatured  and  afterwards  opened, 
blood  was  poured  out,  proving  the  nature  of  its  contents  to 
be  blood,  and  not  spirit ;  and  he  also  ascertained  by  experi¬ 
ment  that  bleeding  from  the  arteries  emptied  the  veins. 


(a)  The  Oration  has  been  slightly  abridged. 


Medica1  Times  and  Gazette. 


HABERSHON’S  HARVEIAN  ORATION. 


July  14,  1S83.  31 


These  ohservations  led  to  results  of  a  very  different  cha¬ 
racter  from  his  deductions  from  reasoning.  One  careful 
observation  as  to  the  nature  of  the  ventricular  septum  would 
have  disproved  his  hypothesis  of  perforations  through  which 
blood  could  mis  between  the  two  sides  of  the  heart.  The 
experiment  led  to  the  truth ;  the  reasoning  without  fact  led 
to  error.  The  fallacies  engendered  by  the  fertile  imagina¬ 
tion  of  a  learned  philosopher  were  only  dispelled  by  the  direct 
observations  of  those  who  followed,  and  especially  by  the 
untiring  labours  of  Harvey.  The  opponents  of  research  by 
experiment  on  living  animals  would  have  left  us  in  the 
darkness  and  ignorance  of  Galenic  times,  for  the  dawn  of 
light  and  scientific  truth  were  due  to  experiment,  and  not 
to  mere  reasoning. 

Vesalius,  in  1512,  rebelled  against  the  assertions  of  the 
older  fathers  in  physic,  and  he  set  at  nought  the  mere 
authority  of  Galen.  He  first  showed  that  the  blood  passed 
through  the  vessels  of  the  lungs  from  the  right  to  the  left  side 
of  the  heart,  and  that  the  blood  was  modified  in  its  transit. 
Servetus,  about  the  same  time,  published  the  same  truth  of 
a  pulmonary  circulation,  but  he  still  held  that  the  venous 
blood  derived  from  the  liver  was  for  nourishment,  and  that 
the  blood  in  the  arteries  was  spirituous  and  adapted  for 
the  heat  and  vital  endowment  of  the  body. 

Other  anatomists  followed,  and  prepared  the  way  for 
the  fuller  investigations  of  Harvey,  Columbus  Eealdus, 
Eustachius,  Fallopius,  and  Arantius.  Fabricius  of  Aqua- 
pendente  was  Professor  of  Anatomy  at  Padua  when  Harvey 
was  a  student  there  in  1598.  Fabricius  had  no  correct  idea 
of  the  circulation,  although  he  rediscovered  the  valves  in 
the  veins.  Caesalpinus,  born  in  1519,  had  been  professor  at 
Pome  ;  he  died  in  1603 ;  and  a  remarkable  circumstance  con¬ 
nected  with  his  history  is  that  his  countrymen  have,  after  his 
death,  attempted  t6  prove  that  he  knew  more  than  he  ever 
dreamt  of  during  his  life.  He  knew  of  the  pulmonary  circu¬ 
lation,  but  adhered  to  the  doctrines  of  Galen,  and  believed 
that  the  blood  had  a  to-and-fro  motion  in  the  vessels.  It 
is  considered  by  those  who  have  given  him  the  honour  to 
which  he  was  never  entitled,  that  Caesalpinus  knew  of  the 
■circulation,  because  he  found  that  the  veins  swelled  beyond 
the  ligature,  but  he  explained  the  phenomenon  by  stating 
that  the  blood  sought  to  return  to  the  heart  in  its  wonted 
direction. 

My  predecessor.  Dr.  Johnson,  has,  I  believe,  fully  shown 
that  the  claims  of  Caesalpinus  are  without  adequate  founda¬ 
tion  ;  and,  whilst  we  would  give  all  the  credit  that  is  due 
to  the  talents  and  researches  of  Caesalpinus,  we  cannot  find 
any  warrant  for  the  statement  that  Harvey  obtained  from 
him  the  knowledge  of  the  circulation.  The  truths  that  had 
been  ascertained  were  the  result  of  direct  experiment  and 
exact  research  ;  the  vague  hypotheses  that  had  been  handed 
down  from  century  to  century  had  been  the  result  of 
reasoning  on  insufficient  data. 

The  times  of  Harvey  were  among  the  most  eventful  of 
English  history :  the  liberty  of  religious  thought  was  being 
felt,  and  exercised  its  influence ;  the  demand  for  civil  and 
religious  freedom  was  co-existent  with  scientific  research, 
with  literary  advancement,  and  with  extension  of  commerce. 
It  is  surprising  that  the  tumultuous  years  of  civil  strife  did 
not  check  the  ardour  of  the  student  of  nature.  Harvey 
was  borne  at  Folkestone  in  1578,  during  the  closing  years 
of  Elizabeth’s  reign ;  and  it  is  probable  that,  when  a  boy 
of  ten,  he  saw  from  the  cliffs  of  his  home  something  of  the 
Spanish  Armada,  which  was  intended  to  stop  the  freedom 
of  thought  and  of  spiritual  life  in  our  favoured  land.  The 
facts  of  Harvey’s  life  are  well  known :  how  at  sixteen  years 
of  age  he  went  to  Caius  College,  Cambridge,  took  his 
bachelor’s  degree  in  medicine,  and  then  spent  four  years 
at  Padua,  where  all  that  was  known  in  anatomical  science 
was  taught,  and  where  the  germs  of  his  future  discoveries 
were  probably  formed.  In  1602  he  graduated  in  medi¬ 
cine,  and  soon  after  came  to  London,  and  began  the 
active  duties  of  his  professional  life,  but  we  have  very 
slight  records  of  these  years.  In  1604  he  joined  the  Eoyal 
College  of  Physicians,  and  became  Fellow  of  the  College  in 
1607.  Two  years  later  we  find  that  he  obtained  the  office  of 
Physician  to  St.  Bartholomew’s  Hospital,  and  had  received 
Eoyal  support  in  his  application.  In  1615,  Harvey  was 
appointed  Lecturer  on  Anatomy  and  Surgery  at  the  College  ; 
but  it  was  not  till  1628  that  his  great  work  was  published, 
his  “  Anatomical  Disquisition  on  the  Motion  of  the  Heart 
and  Bloodvessels  in  Animals.”  Harvey  was  a  lover  of 


peace  and  a  student  of  science,  but  he  could  not  have 
remained  unmoved  by  the  political  events  that  were  passing 
before  him.  In  the  same  year  that  his  great  work  was 
published  (1628)  was  the  Petition  of  Eights  ;  in  1629  Sir 
John  Eliot  was  condemned  to  the  Tower,  and  the  King  began 
that  system  of  defiance  to  the  Parliament  which  led  to  the 
civil  war  and  to  his  death.  Harvey  had  been  appointed  one 
of  the  physicians  extraordinary  to  James  I.,  but  it  was  not 
until  Charles  had  been  on  the  throne  for  five  or  six  years 
that  Harvey  was  appointed  physician  in  ordinary  to  the 
King. 

Harvey  was  then  in  the  height  of  his  professional  career ; 
his  discoveries  were  becoming  generally  known,  and  he  had 
established  the  great  truths  connected  with  the  action  of  the 
heart,  and  the  course  of  the  circulation.  For  hundreds  of 
years  it  had  been  supposed  that  the  diastole  of  the  heart,  its 
expansion,  was  the  most  important  movement ;  but  Harvey 
saw  the  heart  contract,  and  proved  that  the  contraction,  the 
systole  of  the  heart,  was  that  which  was  pre-eminently  the 
propelling  power,  forcing  the  blood  into  the  lungs  and  into 
the  arteries,  whose  walls,  more  dense  than  the  veins,  yielded 
to  the  pressure.  If  he  had  been  content  to  reason  only,  he 
could  never  have  shown  the  error  of  the  Galenic  doctrine. 
It  was  by  experiments  on  living  animals  that  the  truth  was 
made  clear  to  the  mind  of  Harvey.  Let  us  quote  his  words, 
and  I  use  the  translation  of  Willis,  published  by  the 
Sydenham  Society :  “  In  the  first  place,  then,  when  the 
chest  of  a  living  animal  is  laid  open,  and  the  capsule  that 
immediately  surrounds  the  heart  is  slit  up  or  removed,  the 
organ  is  seen  now  to  move,  now  to  be  at  rest.  There  is  a 
time  when  it  moves,  and  a  time  when  it  is  motionless. 
These  things  are  more  obvious  in  the  colder  animals,  such 
as  toads,  frogs,  serpents,  small  fishes,  crabs,  shrimps,  snails, 
and  shell-fish.  They  also  become  more  distinct  in  warm¬ 
blooded  animals,  such  as  the  dog  and  hog,  if  they  be  atten¬ 
tively  noticed,  when  the  heart  begins  to  flag,  to  move  more 
slowly,  and,  as  it  were,  to  die ;  the  movements  then  become 
slower  and  rarer,  the  pauses  longer,  by  which  it  is  made 
more  easy  to  perceive  and  unravel  what  the  motions  really 
are,  and  how  they  are  performed.” 

Again  he  writes :  “  The  very  opposite  of  the  opinions 
commonly  received  appears  to  be  true ;  inasmuch  as  it  is 
generally  believed  that  when  the  heart  strikes  the  breast 
and  the  pulse  is  felt  without,  the  heart  is  dilated  in  its 
ventricles  and  is  filled  with  blood ;  but  the  contrary  of  this 
is  the  fact,  and  the  heart  when  it  contracts  is  emptied. 
Whence  the  motion  which  is  generally  regarded  as  the 
diastole  of  the  heart,  is  in  truth  its  systole ;  and  in  like 
manner  the  intrinsic  motion  is  not  the  diastole,  but  the 
systole ;  neither  is  it  in  the  diastole  that  the  heart  grows 
firm  and  tense,  but  in  the  systole,  for  then  only,  when  tense, 
is  it  moved  and  made  vigorous.” 

One  quotation  further  from  the  works  of  Harvey.  He 
writes  :  “  What  remains  to  be  said  upon  the  quantity  and 
source  of  the  blood  which  thus  passes,  is  of  so  novel  and 
unheard-of  a  character,  that  I  not  only  fear  injury  to  myself 
from  the  envy  of  a  few,  but  I  tremble  lest  I  have  mankind 
at  large  for  my  enemies,  so  much  doth  wont  and  custom, 
that  become  as  another  nature,  and  doctrine  once  sown  and 
that  hath  struck  deep  root,  and  respect  for  antiquity, 
influence  all  men.  Still  the  die  is  cast,  and  my  trust  is  in 
the  love  of  truth,  and  the  candour  that  inheres  in  cultivated 
minds.  And  sooth  to  say,  when  I  surveyed  my  mass  of 
evidence,  whether  derived  from  vivisections  and  my  various 
reflections  on  them,  or  from  the  ventricles  of  the  heart  and 
the  vessels  that  enter  into  and  issue  from  them,  the  symmetry 
and  size  of  these  conduits — for  nature,  doing  nothing  in 
vain,  would  never  have  given  them  so  large  a  relative  size 
without  a  purpose — or  from  the  arrangement  and  intimate 
structure  of  the  valves  in  particular,  and  of  the  other  parts 
of  the  heart  in  general,  with  many  things  beside,  I  fre¬ 
quently  seriously  bethought  me,  and  long  revolved  in  my 
mind,  what  might  be  the  quantity  of  blood  which  was 
transmitted,  in  how  short  a  time  its  passage  might  be 
effected,  and  the  like  ;  and  not  finding  it  possible  that 
this  could  be  supplied  by  the  juices  of  the  ingested  aliment, 
without  the  veins  on  the  one  hand  becoming  drained,  and 
the  arteries  on  the  other  getting  ruptured  through  the 
excessive  charge  of  blood,  unless  the  blood  should  somehow 
find  its  way  from  the  arteries  into  the  veins,  and  so  return 
to  the  other  side  of  the  heart,  I  began  to  think  whether  there 
might  not  be  a  motion  as  it  were  in  a  circle.  Now,  this  I 


HABERSHON’S  HARVEIAN  ORATION. 


July  14. 1883.. 


32 


MedicBl  Times  and  Gazette. 


afterwards  found  to  be  true ;  and  I  finally  saw  that  the 
blood,  forced  by  the  action  of  the  left  ventricle  into  the 
arteries,  was  distributed  to  the  body  at  large,  and  its  several 
parts,  in  the  same  manner  that  it  is  sent  through  the  lungs, 
impelled  by  the  right  ventricle  into  the  pulmonary  artery, 
and  that  then  it  passed  through  the  veins  and  along  the 
vena  cava,  and  so  round  to  the  left  ventricle,  which  motion 
we  may  be  allowed  to  call  circular.”  Thus  Harvey  made 
known  to  the  world  the  discovery  which  has  been  of  the 
greatest  value  in  physiological  science ;  it  has  revealed  many 
things  in  the  pathology  of  disease  which  could  not  otherwise 
have  been  understood,  and  has  conferred  the  greatest  benefit 
on  the  human  race.. 

Never  was  the  value  of  experimental  research  more  clearly 
demonstrated.  The  links  in  the  chain  of  truth  on  this  all- 
important  physiological  question  had  been  obtained  by 
experiment ;  Harvey  united  those  links,  to  which  he  had 
made  such  important  additions,  and  proved  beyond  doubt 
the  circulation  of  the  blood.  He  showed  how  the  blood 
passed  in  a  continuous  stream,  and  although  the  valves  of 
the  veins  had  been  previously  described  by  several  older 
anatomists,  as  by  Sylvius,  Eustachius,  and  especially  by 
Eabricius  of  Aquapendente,  Harvey  explained  their  true 
value  and  demonstrated  their  action.  His  work  absorbed 
his  mind  and  his  energies,  even  whilst  in  his  strange  duties 
on  the  field  of  battle  at  Edge  Hill,  in  October,  1642  ;  whilst 
in  charge  of  the  young  Prince  and  of  the  Duke  of  York  he 
was  engaged  in  reading,  till  warned  by  cannon-shot  that 
he  was  in  dangerous  proximity  to  the  scene  of  carnage. 

Soon  afterwards,  in  the  same  year,  we  hear  of  him  at 
Oxford,  with  Dr.  George  Bathurst,  watching  the  development 
of  the  chick — more  congenial  to  his  peace-loving  soul  than 
war  and  bloodshed.  The  victories  of  Cromwell  and  the 
Parliamentary  armies  at  Marston  Moor  and  at  Naseby 
indicated  the  waning  fortunes  of  the  King  ;  and  after  1646, 
Harvey,  who  had  attained  to  sixty-eight  years  of  age,  ceased 
to  follow  the  King,  to  whom  he  seemed  to  have  been  greatly 
attached,  and  he  went  to  reside  with  his  brother.  His 
interest  in  science  did  not  cease ;  the  same  industry  in  the 
study  of  physiology  was  characteristic  of  his  latter  as  well 
as  of  his  earlier  years,  and  in  1651  his  work  on  Generation 
was  published ;  it  was  imperfect  in  many  respects,  but  it 
was  an  indication  of  the  character  of  the  great  philosopher. 
His  manuscript  medical  observations  had  been  destroyed  in 
the  earlier  part  of  the  civil  war  by  a  senseless  mob,  and 
he  never  ceased  to  deplore  the  loss  he  sustained. 

Harvey  retained  his  mental  faculties  till  an  advanced  age, 
and  died  in  1657,  aged  eighty  years,  a  year  before  one  who 
had  taken  the  most  active  part  in  the  civil  contest  of  the  time, 
and  had  placed  himself  on  the  pinnacle  of  power — I  refer 
to  Oliver  Cromwell.  The  views  of  Harvey  were  regarded  as 
extravagant ;  and  truly  they  might  well  be  so  esteemed,  for 
they  were  in  direct  opposition  to  many  views  that  had  been 
regarded  as  established  truths.  It  had  been  supposed  that 
the  blood  flowed  from  the  larger  veins  into  the  smaller ; 
Harvey  proved  that  the  reverse  was  the  case,  and  that  the 
blood  reaching  the  smaller  vessels  from  the  arteries,  returned 
from  smaller  venous  branches  to  the  larger  trunks  till  the 
heart  was  reached.  He  did  not  know  of  the  true  anas¬ 
tomoses  of  the  vessels ;  that  remained  for  Malpighi,  who 
was  born  in  the  year  that  Harvey’s  work  was  published,  and 
who,  in  1661,  saw  the  capillary  circulation  in  the  frog. 
What  Harvey  had  attained  was  gained  by  direct  observation  ; 
where  he  failed,  was  in  leaving  this  safe  path  for  one  of 
hypothesis.  But  it  is  pleasant  to  regard  him  as  a  man  of 
earnest  religious  thought. 

I  delight  to  read  from  Willis’s  translation  of  Harvey’s 
works  the  following  words  of  truth  from  a  student  of  nature : 
“We  acknowledge  God,  the  supreme  and  omnipotent  Creator, 
to  be  present  in  the  production  of  all  animals,  and  to  point, 
as  it  were,  .with  a  finger,  to  His  existence  in  His  works,  the 
parents  being  in  every  case  but  as  instruments  in  His  hands. 
In  the  generation  of  the  pullet  from  the  egg,  all  things  are 
indeed  contrived  and  ordered  with  singular  providence. 
Divine  wisdom,  and  most  admirable  and  incomprehensible 
skill ;  and  to  none  can  these  attributes  be  referred  save  to 
the  Almighty  First  Cause  of  all  things,  by  whatever  name 
this  has  been  designated— the  Divine  Mind  by  Aristotle,  the 
Soul  of  the  Universe  by  Plato,  the  Natura  Naturans  by 
others,  Saturn  and  Jove  by  the  ancient  Greeks  and  Romans; 
by  ourselves,  and  as  is  seeming  in  these  days,  the  Creator 
and  Father  of  all  that  is  in  heaven  or  earth,  on  whom 


animals  depend  for  their  being,  and  at  whose  will  and  plea¬ 
sure  all  things  are  and  were  engendered.” — (“  On  Genera¬ 
tion,”  page  462.) 

Such  was  the  immortal  Harvey;  a  mind  endowed  with  the- 
highest  gifts.  The  attainment  of  the  knowledge  of  the- 
circulation  was  a  gradual  evolution  of  the  truth,  as  one 
portion  after  another  was  observed,  till  the  whole  was  clearly 
seen  in  the  beauty  of  its  simplicity ;  it  was  the  reward  of 
patient  research,  and  often  by  experiment  on  the  living 
animal.  I  cannot  find  a  better  answer  to  those  who,  in  their 
mistaken  kindness  of  heart  to  lower  animals,  would  per¬ 
petuate  ignorance,  than  by  reference  to  the  inestimable 
benefit  of  the  researches  of  Harvey.  To  stop  the  advance- 
of  science  is  to  encourage  the  darkness  of  ignorance.  If  the 
laws  of  the  present  day  had  existed  in  the  time  of  Harvey, 
we  might  have  remained  for  long  years  ignorant  of  the 
action  of  the  heart  and  of  the  circulation ;  and  the  knowledge 
of  disease  and  the  best  curative  measures  would  have  re¬ 
mained  unknown ;  or  Harvey  might  have  returned  to  Padua 
to  make  his  experiments.  If  it  were  possible,  it  might  be 
well  for  those  who  raise  such  a  vehement  outcry  against  the 
means  often  best  fitted  for  physiological  research— namely,, 
experiment  on  living  animals — if  they  ceased  to  partake  of 
the  advantages  which  humanity  has  received  from  these 
researches. 

Time  would  fail  me  to  describe  the  advances  made  in  phy¬ 
siological  science  since  the  time  of  Harvey.  It  was  a  hundred 
years  after  Harvey's  work  that  Stephen  Hales  used  a  mano¬ 
meter  to  estimate  the  pressure  of  the  blood,  and  afterwards 
Poiseuille  introduced  a  mercurial  one.  More  recently, 
Yolkmann  and  Ludwig  have  advanced  our  knowledge  of  the 
subject ;  but  perhaps  the  most  interesting  investigations 
of  later  times  in  connexion  with  the  circulation  have  been 
those  of  Claude  Bernard,  who  has  shown  that  section  of  the 
central  sympathetic  on  one  side  of  the  neck  was  followed 
by  a  rise  in  the  temperature  and  dilatation  of  the  blood¬ 
vessels  on  the  same  side.  On  these  experiments  followed  the 
discovery  of  the  inhibitory  action  of  the  pneumogastric 
nerve  of  the  heart  itself. 

Leaving  these  facts  connected  with  the  circulation,  let  us 
turn  for  a  few  moments  to  one  of  the  most  ardent  students 
of  nature  of  recent  times,  most  patient  in  observation, 
diligent  in  research,  an  investigator  of  those  minute  circum¬ 
stances  which  are  often  the  guide  to  clearer  truth,  a  profound 
philosopher,  on  whom  this  College  delighted  to  confer  the 
highest  honour  as  a  physiologist — I  refer  to  Darwin.  Hi3 
facts  are  wonderful  and  entrancing ;  his  deductions  are  not 
proven.  What  is  more  pleasant  than  to  study  his  observa¬ 
tions  on  plants  and  on  animals  ?  and  perhaps  none  of  his 
works  are  more  attractive  than  his  investigations  on  earth¬ 
worms,  in  which  he  shows  that  animals  hitherto  regarded 
as  of  but  little  interest  and  service  in  the  economy  of  nature 
are  of  the  greatest  value,  and  designed  to  be  of  incalculable 
benefit  to  man.  Darwin  proves  that  animals  undergo 
changes  greater  or  less  in  degree  from  modifying  circum¬ 
stances,  and  in  this  way  that  varieties  are  formed,  and 
wonderfully  adapted  to  the  circumstances  in  which  they  are 
placed;  that  these  variations  are  transmitted  to  the  off¬ 
spring  ;  that  many  changes  in  plants  and  in  animals  can  be 
produced  at  the  will  of  man  by  altering  the  conditions  of 
life ;  that  some  varieties  are  more  permanent  than  others, 
and  the  surroundings  of  particular  animals  or  plants  may 
be  so  altered  that  they  fail  to  comply  with  the  necessities  of 
life,  and  the  animals  or  plants  then  cease  to  exist.  There 
may,  indeed,  be  a  struggle  for  existence,  and  a  survival  of 
those  which  can  live  under  existing  conditions  ;  but  all  these 
modifications  do  not  prove  that  animals  in  their  varied 
forms  and  characters  are  derived  from  a  few  forms,  or  from 
mere  living  protoplasm,  without  Divine  interposition,  or  even 
that  species  are  thus  produced.  Some  of  the  lower  forms  of 
life,  the  infusoria  and  rhizopoda,  have  existed  unchanged 
for  enormous  periods  of  time,  whilst  others  have  by  some 
means  or  other  attained  to  wonderful  instinct  and  to  mar¬ 
vellous  adaptations  to  life.  How  full  of  interest  are  the 
minute  changes  in  ants,  their  peculiar  habits,  their  sterile 
members,  their  slave-holding  propensities !  There  are 
alterations  in  different  varieties,  but  they  are  ants  still,  and 
they  show  throughout,  we  think,  the  wonderful  design  of  a 
superior  mind,  the  mind  of  God.  The  instinctive  skill  of 
the  bee  may  lead  to  the  construction  of  the  perfect  cells  of 
the  hive-bee,  and  the  less  perfect  one  of  the  humble  bee, 
but  they  are  bees  still ;  and  it  is  difficult  to  believe  that,  by 


Medical  Times  and  Gazette. 


HABERSHOjSTS  harveian  oration. 


July  14, 1883.  33 


tracing  backward,  however  remotely,  to  primitive  germs,  we 
should  find  the  ant  and  the  bee  produced  from  a  similar 
origin,  without  Divine  interference,  although  belonging  to 
the  same  division  of  the  animal  kingdom.  To  what  but 
direct  design  could  we  trace  the  electric  organs  of  the  torpedo 
and  electric  eel,  or  the  remarkable  arrangement  for  the 
fertilisation  of  orchids  ?  The  manifold  peculiarities  of 
animals  and  their  adaptations  require,  we  think,  more  than 
mere  natural  selection  and  the  forces  of  the  living  structures 
of  the  animals  themselves  to  produce  structural  changes. 
The  exquisite  beauty  of  the  eye  in  the  different  classes  of 
animals,  according  to  their  conditions  of  life,  is,  we  consider, 
due  to  the  direct  power  of  a  beneficent  Creator ;  and  so  with 
every  other  sense,  and  the  instincts  of  every  species — the 
tribes  of  insect-life  and  their  wonderful  habits,  the  adaptations 
of  birds  and  animals  to  their  food-requirements  and  mode 
of  life,  the  carnivorous  to  its  need  and  the  herbivorous  to  its 
wants,  the  migratory  birds  and  the  aquatic  diver, — each  indi¬ 
cates  more  than  mere  progressive  development  by  insensible 
■steps.  ■  ssggBJ 

According  to  some  theories  the  swallow  would  at  first,  we 
presume,  be  satisfied  with  short  journeys,  but  the  next  and 
succeeding  generations  would  take  more  extended  flight  to 
warmer  climes .  The  poison-bag  of  the  cobra  or  of  the  rattle¬ 
snake  would,  according  to  the  same  theory,  by  slow  degrees 
.attain  its  deadly  venom  ;  but  whence  the  first  beginning  ? 

Whilst  allowing  all  the  facts  that  Darwin  discloses,  let  us 
keep  to  the  facts  themselves,  and  not  be  led  into  hypotheses 
which  are  not  proven.  Science  has  been  advanced  by  facts 
observed  and  proved,  but  where  deductions  are  brought 
forward  and  received  as  truth,  when  the  basis  is  only  hypo¬ 
thetical,  science  has  not  been  helped,  neither  by  Galen  nor 
by  Harvey,  nor  by  any  student  of  nature.  The  wonderful 
;and  beautiful  truths  elucidated  in  embryology  do  not  prove 
the  statements^  evolutionists,  but  rather  show  that  a  higher 
Power  controls  the  development.  Darwin  says,  “  I  believe 
that  animals  are  descended  from  at  most  four  or  five  pro¬ 
genitors,  and  plants  from  an  equal  or  lesser  number  ” 
(“  Origin  of  Species  ”) ;  but  is  number  anything  with  the 
"Creator,  or  does  He  descend  to  our  standard  ? 

-  The  development  of  higher  animals  is  a  gradual  process 
and  by  successive  stages;  but  the  presence  of  branchial 
fissures  in  the  embryonic  neck  does  not  necessarily  show 
that  the  animal  is  at  that  stage  a  fish ;  neither  does  the 
imperfect  septum  in  the  heart  of  the  mammal  during  em¬ 
bryonic  life  show  that  at  that  time  it  was  a  reptile.  These 
gradations  are  doubtless  the  steps  by  which  the  end  can  be 
best  attained  :  just  as,  in  the  formation  of  a  sheet  of  glass,  the 
workman  takes  a  portion  of  molten  glass,  but  he  does  not 
roll  it  into  a  plate  as  one  might  suppose ;  on  the  contrary, 
he  blows  it  into  a  sphere ;  then  by  gentle  pressure,  whilst 
he  rotates  the  globe  of  glass,  he  moulds  it  into  that  which  is 
well  known  as  a  glass  shade  ;  then,  whilst  still  revolving,  he 
nuts  off  the  upper  part,  and  leaves  a  cylinder  of  glass.  At 
last,  by  dividing  the  cylinder  longitudinally,  and  placing  it 
in  the  furnace,  it  gradually  unfolds  and  becomes  a  plane 
surface.  The  process  is  that  best  adapted  to  carry  out  the 
■design  of  the  workman ;  and  so  in  higher  development  and 
with  a  nobler  Artificer. 

There  is  constant  change  on  every  hand,  gradual  develop¬ 
ment  in  every  part  of  the  natural  kingdom  ;  one  variety  by 
•almost  imperceptible  steps  is  linked  on  to  another, — and 
withal  the  hand  of  God  is  seen  in  every  gradation.  Just  as 
in  the  unfolding  of  His  character  and  purpose  towards  man — 
at  first  only  by  type  and  shadow,  until  we  see  the  full  un¬ 
veiling  of  Himself  in  the  incarnation  of  his  own  Son ;  ever 
and  anon  by  fresh  direct  manifestation  adding  to  that  already 
given,— so  in  nature,  we  have  indications  that  there  has  been 
direct  interference  with  the  chain  of  events  ;  often  gradual, 
sometimes  changes  of  overwhelming  force,  but  all  carrying 
out  the  scheme  of  Infinite  Wisdom. 

Whilst  speaking  of  these  changes  in  animals  I  would  advert 
to  those  of  even  greater  interest  in  man.  On  him  more 
than  in  any  other  form  of  animal  life  has  the  influence  of 
modifying  circumstances  been  manifested  in  altering  his 
■character,  in  raising  or  lowering  his  mental  endowments,  and 
even  in  changing  his  physical  structure.  Slowly  have  these 
changes  been  brought  about,  and  at  our  own  day  they  are 
seen  to  be  in  operation.  The  climate  in  which  man  resides 
wonderfully  reacts  upon  his  physical  state  :  the  heat  of  the 
torrid  zone  demands  that  the  system  should  beooine  accus¬ 
tomed  to  it ;  the  requirements  for  the  maintenance  of 


animal  heat  are  altered;  the  normal  functions  are  easily 
disturbed ;  the  activity  of  the  cutaneous  transpiration  is 
necessarily  increased ;  the  mind  during  the  intensity  of  the 
heat  often  becomes  less  able  to  perform  its  function ;  and 
unless  by  degrees  the  system  becomes  acclimatised,  the 
health  utterly  fails  and  the  life  may  be  forfeited.  The 
Hindoo  and  the  Negro  have  become  accustomed  by  many 
generations  of  life  to  a  state  that  a  European  cannot  bear ; 
the  organism  is  changed,  and  the  alteration  is  not  only 
represented  by  the  pigmental  colouring  of  the  skin,  but  by 
an  adaptation  in  the  whole  economy.  An  opposite  state  is 
observed  amongst  those  whose  lot  is  cast  in  the  colder  regions 
near  the  Arctic  Circle ;  the  Greenlander  and  the  Esquimaux, 
by  many  years  of  change  through  succeeding  generations, 
can  bear,  with  impunity  and  with  enjoyment,  a  temperature 
which  would  soon  be  fatal  to  the  inhabitants  of  Central 
Africa.  The  food-requirements  of  man  are  different,  and 
whilst  the  Hindoo  can  live  and  thrive  on  rice,  the  Icelander 
needs  his  more  oleaginous  sustenance,  the  oil  and  the  blubber 
become  his  life-supply;  and  every  intermediate  condition 
is  found  in  the  varied  countries  and  localities  of  the  world. 
An  insufficient  supply  of  nourishment  soon  tells  not  only 
upon  the  growth  and  nutrition  of  the  body,  but  upon  the 
energy  and  power  of  the  mind.  The  poor  half-starved 
peasant  in  the  Connemara  bog  and  desolate  land  deteriorates 
not  only  in  his  physical  organism,  but  in  that  which  is  man’s 
proudest  endowment — his  faculties  of  thought  and  his  power 
of  reason.  The  struggle  to  obtain  a  meagre  existence  drags 
the  man  down  to  a  lower  level ;  and  the  same  painful  fact  is 
demonstrated  among  the  tribes  of  Africa,  the  degraded 
inhabitants  of  Terra  del  Fuego,  or  the  famine-stricken 
inhabitants  of  India  or  China.  The  condition  of  man  may 
change  in  a  descending  scale  instead  of  advancing  to  the 
civilisation  of  more  privileged  races.  The  circumstances  of 
social  life  add  other  modifying  conditions  to  man  in  his 
national  existence.  Compare  the  lithe  athletic  Indian  with 
the  phlegmatic  Turk  ;  the  Bedouin  Arab,  in  his  wild  noma¬ 
dic  life,  with  the  quiet  cultivator  of  the  soil ;  the  hardy 
fisherman  and  sailor,  exposed  to  the  vicissitudes  of  weather 
and  to  the  storm  and  tempest,  with  the  man  whose  life  is 
spent  in  one  close  room  or  for  long  hours  in  a  poisoned 
atmosphere.  The  life  is  changed,  and  the  consequences  are 
seen  in  succeeding  generations,  till  the  whole  race  is  affected, 
and  the  impress  is  witnessed  in  the  most  marked  divergence 
of  character,  thought,  and  action. 

But  there  is  another  evolution  in  man.  Morbific  changes 
take  place  from  the  result  of  modifying  conditions  ;  an  evo¬ 
lution  which  is  the  direct  result  of  pathological  states.  The 
parent  may  be  affected  with  syphilis,  and  the  offspring- 
become  altered  in  its  whole  development  and  growth ;  and 
if,  beside,  one  or  both  parents  have  a  strumous  or  scrofulous 
diathesis,  or  have  shown  a  proneness  to  cancerous  disease, 
the  state  of  the  offspring  is  modified  still  further ;  or  with 
a  tendency  to  gout  another  force  is  presented,  and  the 
resultant  is  an  altered  phase  of  life.  Still  further,  the  parent 
may  have  a  nervous  system  that  is  extremely  sensitive  and 
easily  disturbed ;  it  may  be  that  there  have  been  epileptic 
attacks,  or  a  tendency  to  mental  affection  and  insanity;  a 
superadded  source  of  disturbance  is  given,  and  the  resultant 
of  combined  forces  is  manifested.  All  these  causes  of  change 
may  be  yet  more  diverted  from  healthy  action  by  the  cir¬ 
cumstances  in  which  life  is  placed;  not  only  as  regards 
good  food,  pure  air,  and  the  surroundings  of  civilised  life 
and  education,  as  contrasted  with  the  wretched  state  induced 
by  poverty  and  starvation,  imperfect  clothing,  dark  and 
offensive  dwellings,  but  to  these  may  be  added  an  aguish 
locality,  producing  miasmatic  disease,  and  having  a  baneful 
influence  upon  the  whole  being.  The  clinical  observer  wit¬ 
nesses  the  result  of  these  combined  morbific  forces  in  a 
hundred  forms,  and  they  produce  results  which  are  most 
embarrassing  unless  understood. 

Almost  every  advance  in  science  has  been  made  by  the 
direct  questioning  of  nature,  whether  we  go  to  Lavoisier  and 
trace  the  wonderful  steps  in  chemical  science,  or  from  Bichat 
we  note  the  progress  in  biology.  It  has  been  by  experimental 
researches,  and  especially  on  living  animals,  that  the  impor¬ 
tant  discoveries  on  the  nervous  system  have  been  fully  esta¬ 
blished.  I  need  not  refer  to  Sir  Charles  Bell,  to  Marshall  Hall, 
to  Duchenne,  to  Brown-Sequard,  to  Hughlings-Jackson,  and 
to  many  others ;  but  the  more  recent  investigations  of  Dr. 
Ferrier,  also  connected  with  the  nervous  system  and  the 
localisation  of  cerebral  function,  have  been  and  will  be  of 


34 


Medical  Times  and  Gazette. 


HABERSHON’S  HARVEIAN  ORATION.’ 


July  14,  1883. 


increasing  value  in  rendering  the  knowledge  of  disease 
more  accurate,  and  in  leading  to  correct  diagnosis  and 
treatment. 

An  illustration  of  the  value  of  study  of  the  kind  just 
mentioned  is  well  shown  in  the  pathological  investigations 
connected  with  tubercle.  The  subject  is  one  replete  with 
interest,  and  especially  in  connexion  with  a  disease  of  so 
frequent  occurrence  as  phthisis.  The  phenomena  of  tubercle, 
since  the  time  of  Laennec  and  Carswell,  have  been  wonder¬ 
fully  cleared  up.  There  was  truth  in  the  views  of  Dr. 
Williams,  who  referred  tubercle  “  to  a  degraded  condition 
of  the  nutritive  material,”  and  said  that  in  its  origin  it 
differs  not  in  kind,  but  in  degree  of  vitality  and  capacity 
of  organisation.  The  clinical  observations  of  Dr.  Addison 
rested  on  a  sound  basis,  when  he  declared  that  inflammatory 
changes  were  of  the  greatest  importance  in  the  pathology 
of  the  disease.  The. microscopical  observations  of  Gulliver 
have  been  advanced  by  W.  Addison,  Yirchow,  Langhans, 
Rindfleisch,  and  many  others;  but  perhaps  the  most  in¬ 
teresting  observations  have  been  those  of  Villemin. 

He  shows  that  animals  inoculated  with  fresh  tubercle 
become  tuberculous.  Tubercles  were  found  in  the  spleen, 
in  the  lungs,  and  in  other  viscera.  From  his  experiments, 
it  was  supposed  that  there  was  a  special  virus  which  would 
reproduce  the  same  morbid  change  when  introduced  into 
the  system.  If  these  experiments  had  been  made  twenty 
years  later,  the  original  statements  might  have  gone  forth 
as  established  truths ;  but  science  was  then  less  trammeled. 
Burdon  Sanderson,  Wilson  Fox,  and  others,  tested  the 
theories  that  had  been  broached.  It  was  found  that, 
although  the  experiments  were  true  that  tubercle  could  be 
artificially  produced,  it  did  not  require  tubercle  to  be  used ; 
that  other  animal  substances,  that  vegetable  irritants,  and 
still  more,  that  a  mere  wound,  would  suflice  under  certain 
conditions ;  that  these  irritants,  when  placed  within  the 
tissue,  became  surrounded  byproduct  of  a  cheesy  and  inflam¬ 
matory  character ;  and  that  the  subsequent  changes  in  these 
products,  in  a  diathesis  of  a  tubercular  type,  led  to  secondary 
deposit  of  an  advanced  character  in  connexion  with  the 
lymphatic  system.  It  is  true  that  some  guinea-pigs  were 
used  to  establish  these  most  interesting  and  important 
pathological  truths ;  mere  reasoning  would  have  misled. 
The  advance  of  science  was  due  to  direct  experiment ;  and, 
happily,  the  barriers  were  not  then  existing,  and  the 
obstacles  to  research  had  not  been  devised.  With  all  these 
observers,  from  the  commencement,  the  unfolding  of  medical 
science  has  been  a  gradual  one,  as  step  by  step  the  darkness 
of  ignorance  was  dispersed  by  increasing  knowledge. 

It  is  the  object  of  science  to  attain  to  exactness  in 
knowledge,  and  the  advance  of  one  line  of  truth  reacts 
upon  others  in  close  relation  with  it.  During  later  years, 
how  much  has  been  ascertained  as  to  the  character  of  the 
blood  itself,  its  more  precise  composition  in  various  periods 
and  states  of  health,  not  only  as  to  its  white  corpuscles  and 
the  red  corpuscles,  and  perhaps  other  forms,  but  as  to  the 
migratory  character  of  the  leucocytes.  Chemical  science 
has  unfolded  much,  and  will  do  still  more  ;  but  the  micro¬ 
scope  and  the  spectroscope  have  added  immensely  to  our 
knowledge  in  relation  to  the  pathological  as  well  as  the 
physiological  changes  of  the  blood  itself.  With  a  better 
knowledge  of  the  heart  and  its  valves,  and  the  altered  states 
of  its  muscular  fibre,  we  have  learnt  not  only  the  true  nature 
of  the  sounds  of  the  heart,  but  the  import  of  their  morbid 
changes;  the  sphygmograph  and  cardiograph  have  led  to 
as  much  accuracy  in  clinical  observation  as  the  use  of  the 
thermometer  has  done  in  the  study  of  febrile  conditions. 
The  discoveries  in  the  physiology  of  the  brain  and  the 
whole  nervous  system  have  explained  the  facts  of  patho¬ 
logical  science;  but  it  has  been  a  gradual  evolution  of 
truth.  In  no  branch  of  medical  science  have  greater 
advances  been  made  than  in  the  knowledge  of  the  diseases 
of  the  spinal  cord  and  of  the  whole  nervous  system. 

During  the  last  few  years  a  comparatively  unexplored 
field(  of  research  has  been  laid  open,  which  is  now  being 
pushed  forward  with  determined  zeal :  the  study  of  the 
morbid  germs,  and  their  connexion  with  the  etiology  of 
disease.  The  bacteria  are  now  regarded  as  the  actual  or 
the  proximate  causes  of  many  maladies ;  they  are  the 
simplest  forms  of  vegetable  life,  and  are  classified  according 
to  their  several  characters.  To  the  presence  of  some  of 
these  forms  of  the  microccocci  are  attributed  many  terrible 
varieties  of  disease,  as  pyaemia,  erysipelas,  and  internal 


suppurations.  Some  of  these  bacteria  are  found  in  the 
blood ;  they  undergo  stages  of  development  and  decay,  and 
induce  secondary  changes  in  the  tissues  with  which  they 
come  into  contact. 

Pasteur,  in  his  observations  on  splenic  fever  in  animals', 
and  the  manner  in  which  the  bacilli  may  be  modified  by 
successive  germinations  in  proper  fluids,  has  unfolded  fact3 
which  will  probably  prove  of  immense  value ;  but  the  in¬ 
terest  has  been  eclipsed  by  the  observations  of  Koch  in 
reference  to  the  bacilli  of  phthisis.  That  these  bacilli  are 
found  in  the  expectoration  of  true  phthisis  has  been  esta¬ 
blished,  and  their  presence  has  also  been  observed  in  the 
tubercle  in  the  lung  itself ;  while  it  is  stated  very  posi¬ 
tively  that  they  do  not  exist  in  other  forms  of  pulmonary 
disease,  as  chronic  pneumonia  and  chronic  bronchitis ;  that, 
in  consequence,  phthisis  is  a  disease  directly  communicable 
from  one  person  to  another.  Whilst  there  is  much  to  warrant 
this  opinion,  let  us  bear  in  mind  that  it  is  not  as  yet  esta¬ 
blished  ;  fuller  facts  will  doubtless  be  brought  forth  by 
other  observers,  and  it  is  wiser  to  wait  for  clearer  knowledge 
before  we  at  once  accept  the  opinions  of  these  observers 
upon  the  data  already  made  out.  We  desire  to  know  more 
of  the  natural  history  of  these  bacilli ;  whether  they  are 
really  animal  structures  possessing  individual  life  and 
advancing  to  fuller  development,  or  mere  fragments  of 
living  organism  about  to  pass  into  inorganic  forms.  They 
increase  in  size,  spores  appear  to  be  produced  and  set  free, 
or  they  propagate  by  simple  division.  But  whence  do  these 
bacilli  come  to  be  found  in  the  cells  of  tubercle,  and  not  to 
leave  traces  behind  them  of  their  mode  of  entrance  P  Or 
are  these  the  commencement  of  degenerative  change  in 
ill- developed  tissue  ? 

The  munificent  grant  of  the  Grocers’  Company  in  the  City 
of  London,  for  the  establishment  of  a  Quadrennial  Dis¬ 
covery  Prize,  may,  we  trust,  lead  to  advancement  in  the 
knowledge  of  these  organisms,  which  are  placed  at  the  very 
threshold  of  animal  life,  but  capable,  it  would  seem,  of 
stopping  the  course  of  life  itself  in  the  highest  forms  of 
development. 

The  science  of  pathology  is  advancing  with  rapid  strides, 
but  the  fear  is  lest,  by  hasty  generalisation,  its  progress  be 
retarded,  and  that  hypotheses  imperfectly  established  be 
used  as  the  solid  bases  upon  which  to  build  explanations  of 
disease  and  modes  of  treatment.  The  safeguard  against 
these  disastrous  results  lies  in  the  plan  adopted  by  Harvey 
in  the  study  of  the  circulation  of  the  blood — patient  re¬ 
search,  direct  experiment,  and  exact  observation.  Everyone 
interested  in  the  advancement  of  medical  science  must,  we 
think,  desire  that  those  hindrances  which  have  been  formed1 
by  mistaken  sentimentalism  may  be  laid  aside,  and  that  true 
knowledge  may  be  promoted  in  all  its  beneficent  purposes. 
The  advancement  of  science  is  the  pride  of  a  nation,  and  a 
benefit  to  the  whole  human  race. 

The  science  of  medicine  is  unselfish  in  its  character ;  the 
members  of  its  profession  give  their  knowledge  for  the  gene¬ 
ral  good,  and  the  influence  is  spread  for  the  service  of  man 
wherever  he  may  be  found.  The  advances  made  in  Germany, 
in  France,  in  the  United  States,  and  elsewhere,  are  soon 
known  and  reflected  back,  with  additions  obtained  by  our 
own  investigators.  The  International  Medical  Congress 
two  years  ago  was  an  illustration  of  the  commonwealth  of 
science,  and  of  the  brotherhood  of  medical  men.  Medical 
science,  like  a  stream,  flows  on  quietly  and  noiselessly  as- 
regards  the  external  world.  Its  source  is  far  back  in  ages 
that  are  gone  by,  but  it  diffuses  on  the  right  hand  and  on 
the  left  a  thousand  benefits  to  those  who  avail  themselves 
of  it.  It  derives  strength  and  power  from  other  sciences 
as  they  join  in,  as  streams  flowing  on  in  like  direction,  and 
thus  the  power  for  good  is  enhanced. 

According  to  the  published  accounts,  we  have  no  record 
of  a  campaign  where  the  wounded  suffered  less  from  blood- 
poisoning  and  sloughing  sores  than  in  the  recent  war  in 
Egypt.  Sir  W.  Mac  Oormac  states :  “  During  this  campaign 
there  was  never  any  outbreak  of  those  infective  diseases 
that  have  hitherto  decimated  the  wounded  in  time  of 
war.  There  was  no  pyaemia,  no  erysipelas,  and  no  hospital 
gangrene  as  the  result  of  wounds.  Hot  a  single  man  lost 
his  eyesight,  though  there  were  1494  cases  of  inflammatory 
diseases  of  the  eyes  admitted  to  hospital.”  But  the  doctors 
were  expected  to  take  the  onus  of  the  failure  of  other  parts 
of  the  service  to  secure  pure  and  wholesome  bread,  supplies  of 
beds  and  sheets,  pure  water,  and  to  contend  with  the  plague 


Medical  Times  and  Gazette. 


CTJNINGHAM  ON-  INDIAN"  EPIDEMICS. 


July  14,  1683.  35 


of  Egyptian  flies ;  they  have,  however,  the  consciousness  of 
having  rightly  performed  their  duty,  and  when  the  facts  are 
fully  known  we  believe  they  will  be  honoured. 

It  has  been  the  common  experience  of  medical  men,  that 
oftentimes  when  the  praise  was  most  deserved  they  have 
received  the  least;  and  it  may  require  years  and  even  a  life¬ 
time  to  show  the  true  value  of  work,  and  to  remove  the 
mistakes  of  insufficient  knowledge  and  of  prejudice.  It 
was  so  in  the  great  work  of  Harvey  himself;  some  of  the 
practitioners  of  his  own  time  thought  lightly  of  his  views 
and  of  his  practice,  for  they  did  not  understand  the  impor¬ 
tance  of  his  discovery.  The  mountain-peak  may  shine 
brightly  in  the  morning  sunlight,  but  a  deep  shade  may  be 
cast  from  the  mountain-side  till  a  brighter  light  and  noon¬ 
day  sun  dissipate  the  shade.  In  like  manner  some  great 
truth  may  stand  forth  in  all  its  brightness,  but  a  dark 
shadow  may  be  cast  beyond,  till  ignorance  is  lost  in  the 
sunlight  of  completer  knowledge. 

The  pages  of  nature  lie  open  before  us  all ;  and  the 
lessons  we  have  sought  to  establish  from  the  works  of  Galen, 
from  Harvey,  and  from  Darwin  are,  that  we  must  seek  to 
unfold  the  mysteries  of  science  by  patient  research  and  ex¬ 
periment,  and  that  we  must  not  accept  as  truth  any  theory 
which  is  the  result  of  our  own  reasoning  unless  it  can  be 
proved  by  observation.  To  every  humble-minded  investi¬ 
gator  there  is  an  ample  reward,  and  the  fault  is  not  in  nature 
if  we  do  not  enrich  ourselves  from  the  stores  laid  before  us. 


Extirpation  of  the  Larynx. — We  learn  from  the 
May  number  of  the  Indian  Medical  Gazette  that  the  Hindoo, 
whose  larynx  Surgeon-Major  Dr.  Macleod  extirpated  in 
December  on  account  of  a  growth  which  filled  up  the  rima 
glottidis,  is  progressing  very  favourably.  The  power  of 
swallowing  has  been  restored  by  winding  a  narrow  rubber 
bandage  round  the  neck,  which  supplements  the  deficient 
wall,  aids  by  its  elasticity  the  transmission  of  the  food,  and 
prevents  the  escape  of  this  by  pressing  firmly  on  the  edges 
of  the  aperture.  Another  apparatus  constructed  of  vul¬ 
canite  plugs  the  aperture,  the  food  being  passed  through  a 
hollow  scooped  out  of  the  inner  aspect  of  the  plug.  Feed¬ 
ing  is  accomplished  partly  by  these  apparatus,  and  partly 
by  a  soft  catheter  passed  into  the  oesophagus  and  connected 
with  a  tin  funnel  and  india-rubber  valve.  The  restoration 
of  the  voice  was  a  less  easy  matter,  but  after  various  methods 
had  been  tried,  a  pipe  containing  a  reed  was  inserted  into 
the  roof  of  the  tracheotomy-tube,  and  with  this  the  voice 
and  vocal  articulation  were  restored ;  Mr.  Woods  adapted  this 
to  a  vulcanite  shield,  which  prevented  the  escape  of  air.  The 
tracheotomy-tube  served  when  unclosed  for  breathing  and 
discharge  of  phlegm ;  and  when  its  outer  surface  was  stopped, 
the  air  passed  through  the  vertical  tube  into  the  oral  cavity, 
and  voice  was  easily  produced.  The  advantages  of  this  arrange  - 
ment  are  : — 1.  That  sound  is  produced  without  much  effort. 
2.  Its  great  simplicity  and  the  ease  with  which  it  can  be 
placed  in  position.  3.  That  breathing  can  be  accomplished 
with  great  ease.  4.  That  the  reed  is  not  apt  to  become 
clogged  with  mucus.  5.  Different  sizes  of  reed  producing 
■different  pitches  of  voice  can  easily  be  placed  in  the  tube. 

Double  Excision  of  the  Hip-Joint.— Dr.  Byrd,  of 
Quincy,  Illinois,  related  at  the  American  Medical  Associa¬ 
tion  a  case  of  double  excision  of  the  hip-joint,  and  records  of 
the  only  two  other  instances  he  has  been  able  to  find.  The 
patient,  a  girl  ten  years  old,  is  now  able  to  go  up  and  down 
stairs  without  crutches,  and  over  smooth  ground,  but  em¬ 
ploys  them  over  rough  ground.  The  incision  for  the  removal 
of  the  head  and  upper  portion  of  the  right  femur  commenced 
two  inches  above  the  great  trochanter,  and  was  continued 
curving  downwards  so  as  to  pass  behind  the  great  trochanter 
and  ending  five  inches  below  its  origin.  The  soft  parts  were 
pulled  aside  and  detached  carefully  with  the  periosteum  from 
the  bone  with  a  dental  scraper,  the  softened  bone  being 
divided  by  pliers  just  below  the  trochanter.  An  abscess 
existing  on  the  left  side  over  the  great  trochanter,  this  was 
freely  laid  open  and  the  trochanter  removed  with  the  pliers. 
Both  wounds  were  dressed  with  balsam  of  Peru  and  oakum, 
and  the  child  was  placed  in  one  of  Dr.  Yerity’s  splints.  Dr. 
Verity,  of  Chicago,  exhibited  his  splints  and  derrick,  which 
were  much  admired  in  the  Section. — Phil.  Med.  Neivs, 
June  16. 


THE  SANITARY  LESSONS  OF  INDIAN 
EPIDEMICS.(a) 

By  Surgeon- General  J.  M.  CUNINGHAM, 
Sanitary  Commissioner  with  the  Government  of  India. 

The  author  commenced  the  discussion  of  this  subject  by  re¬ 
ferring  to  the  views  he  had  expressed  regarding  cholera  and 
other  Indian  diseases  at  a  meeting  held  by  the  Society  ten 
years  ago,  and  proposed  to  inquire  how  far  those  views  had 
been  altered  or  confirmed  by  further  experience.  The  field 
of  observation  in  India,  he  observed,  is  very  large,  and 
specially  fitted  by  its  extent,  the  variations  of  race,  and  local 
conditions  for  the  study  of  epidemics.  The  large  bodies  of 
troops  and  prisoners  scattered  over  this  enormous  area  give 
exact  data,  which  are  supplemented  by  the  statistics  obtained 
regarding  the  general  population.  These  data  deserve  much 
more  attention  than  they  have  hitherto  received.  India 
has  contributed  largely  to  our  knowledge  in  other  fields, 
both  of  peace  and  war,  and  in  sanitary  matters  also 
much  may  be  learned  from  Indian  experience.  But  in 
order  to  benefit  by  this  experience  it  is  essential  that  the 
history  of  disease  should  be  considered  not  only  from  a 
local,  but  also  from  a  general  point  of  view.  The  facts 
must  be  most  carefully  collected  ;  mere  opinions  must  not  be 
confounded  with  facts.  All  the  facts  must  be  collected,  and 
not  only  those  on  one  side.  Solitary  cases  of  epidemic  dis¬ 
ease  must  be  studied  with  as  much  care  as  the  many  cases 
of  the  epidemic  itself.  Mere  relation  of  time,  a  mere  coinci¬ 
dence,  must  not  be  regarded  as  proof  that  the  two  events  con¬ 
cerned  stand  to  each  other  in  the  relation  of  cause  and  effect. 
It  is  essential  that  all  evidence  should  be  carefully  weighed, 
and  that  undue  value  should  not  be  attached  to  one  class 
of  facts  on  the  plea  that  they  embody  positive  evidence,  to 
the  entire  exclusion  of  another  set  of  facts  which  are  con¬ 
sidered  as  embodying  only  negative  evidence.  The  theory 
which  attributes  epidemic  or  other  diseases  to  importation 
is  no  explanation,  but  merely  refers  the  question  back  to  an 
anterior  state  of  things — in  other  words,  to  the  place  from 
which  the  disease  is  said  to  have  been  imported.  In  in¬ 
quiring  into  the  causation  of  disease,  nothing  must  be 
assumed,  neither  the  existence  of  germs  nor  anything  else, 
but  each  step  must  be  taken  as  the  result  of  strict  logical 
induction  based  on  well-ascertained  facts.  These  general 
principles  are  of  vast  importance  in  dealing  with  the  diffi¬ 
cult  questions  concerning  disease,  and  especially  concerning 
epidemic  disease  in  India.  The  propositions  that  cholera 
is  due  to  a  germ  originated  in  the  delta  of  the  Ganges, 
and  that  it  is  thence  carried  by  human  beings,  rest  on  no 
such  evidence.  They  are,  on  the  contrary,  opposed  to  the 
great  facts  now  known  regarding  the  disease  in  India — the 
general  direction  taken  by  cholera  epidemics,  the  proved 
immunity  of  attendants  on  the  sick,  the  small  proportion 
of  villages  attacked  even  within  the  epidemic  area,  and 
others  that  might  be  mentioned.  The  only  means  of  pre¬ 
vention  of  cholera  is  to  be  found  in  sanitary  improvements, 
and  in  removal  from  the  locality  when  attacked,  for  its 
localisation  is  one  of  the  most  peculiar  characteristics  of 
the  disease.  Experience  tells  much  the  same  general 
truths  regarding  enteric  fever,  though  this  in  India  is, 
in  the  main,  a  disease  of  young  Europeans  new  to  the 
country.  The  importation  and  germ  theory  will  not 
account  for  it.  Enteric  fever  in  India  is  the  result  of  climate 
telling  on  constitutions  unaccustomed  to  the  strain,  and 
favoured,  as  all  diseases  are,  by  insanitary  local  conditions  ; 
it  is  to  be  classed  with  other  forms  of  what  is  known  as 
malarial  fever.  It  is  not  necessary  to  find  an  entity  to 
account  for  disease.  The  most  ^powerful  forces  we  know 
in  the  world,  such  as  the  wind,  electricity,  and  steam,  do  not 
owe  their  powers  to  any  entity  that  can  be  seen  under  the 
highest  magnifying  power.  These  are  not  mere  theoretical 
views ;  they  have  a  very  practical  bearing ;  they  lie  at 
the  root  of  all  real  sanitary  progress.  The  commonly 
and  too  hastily  accepted  theories  of  germs  and  contagia 
have  had  the  most  disastrous  consequences,  causing  much 


(a)  Read  before  the  Epidemiological  Society  on  Wednesday,  July  4. 


36 


Medical  Times  and  Gazette. 


FRANCIS'S  REMINISCENCES  ABOUT  CHLOROFORM. 


July  14, 1883. 


domestic  misery  by  needlessly  separating  members  of  the 
same  family  at  a  time  when  their  duty  clearly  lies  in  attend¬ 
ing  on  their  sick  relatives  and  friends.  They  have  also 
engendered  needless  alarm,  which  is  most  favourable  to 
disease.  They  have  caused  the  imposition  of  quarantines, 
which  are  but  the  natural  outcome  of  them,  which  are  most 
harassing  and  annoying  and  hurtful,  and  can  be  productive 
of  no  benefit.  And  they  have  caused  the  neglect  of  sanitary 
improvements,  which  are  the  only  real  preventives  of  disease. 
All  this  is  very  forcibly  illustrated  by  what  is  going  on  in 
Egypt,  where  soldiers  with  fixed  bayonets  are  attempting  to 
stay  cholera.  They  might  just  as  well  attempt  with  fixed 
bayonets  to  stay  the  wind,  or  the  rain-cloud,  or  the  thunder¬ 
storm.  Now  is  the  time  to  put  our  town-houses  in  order, 
and  to  see  that  our  sanitary  condition  is  good. 


REMINISCENCES  ABOUT  CHLOROFORM. 

By  CHARLES  R.  FRANCIS,  M.B. 

Case  1. — The  ward  of  a  large  mixed  European  and  native 
hospital  in  India  was  one  day  suddenly  thrown  into  a  state 
of  great  excitement  owing  to  the  death  of  a  patient,  behind 
the  screen,  under  chloroform.  He  was  a  fine  young  man — an 
Englishman — of  twenty,  and  had  been  admitted  for  stricture 
of  the  urethra.  He  was  keenly  sensitive  to  pain,  and  begged 
to  be  made  insensible  when  the  catheter  was  introduced. 
The  surgeon — a  very  able  man — kindly  acquiesced ;  and  the 
anaesthetic  was  administered  daily.  He  was  eminently  a 
favourable  subject  for  its  exhibition.  It  was  customary  at 
the  time  when  the  accident  occurred — some  twenty  years  ago 
— to  give  chloroform  by  means  of  a  handkerchief  formed  into 
a  hollow  cone.  The  plan  is  simple,  and  answers  well  enough 
if  care  be  taken  to  dilute  the  gas  with  air.  But  this  was 
just  what  the  native  assistant  did  not  do.  His  attention 
being  drawn  to  something  else,  he  allowed  the  cone  to  com¬ 
pletely  cover  both  mouth  and  nostrils ;  and  so  he  kept  it, 
looking  another  way.  The  surgeon  was  engaged  with  the 
operation,  and  was  of  course  horrified  beyond  measure  to 
find,  on  turning  to  speak  to  the  patient,  that  he  was  dead. 
Death  had  been  very  sudden,  without  any  preliminary  con¬ 
vulsion.  The  poor  fellow  was  completely  overpowered  by 
the  anesthetic. 

Case  2. — A  similar  accident  very  nearly  occurred  in  my 
own  practice  a  few  years  previously.  My  assistant  was  an 
elderly  gaol  native  doctor,  to  whom  the  administration  of 
chloroform  was  new.  He  too  from  ignorance,  the  extent  of 
which  I  did  not  at  the  time  appreciate,  covered  both  nostrils 
and  mouth  with  a  handkerchief  formed  into  a  cone.  The 
patient  was  a  young  civilian,  whose  right  middle  finger  had 
been  shattered  up  to  the  joint  by  the  bursting  in  his  hand  of 
a  gun,  so  that  it  became  necessary  to  remove  it  at  the  centre 
of  the  metacarpal  bone.  No  blood  flowed  from  the  wound  made 
with  the  knife,  and  on  looking  at  the  young  man’s  face  I  was 
shocked  to  notice  its  death-like  expression.  The  pulse  at 
the  wrist  was  barely  perceptible,  and  he  had  almost  ceased 
to  breathe.  Strong  friction  with  turpentine  on  the  limbs 
and  trunk  towards  the  heart  after  a  time  restored  animation ; 
and  I  was  very  thankful  to  hear  him  inquire  when  we  were 
going  to  begin !  He  had  dreamt,  when  under  the  influence  of 
the  chloroform,  that  he  was  being  surrounded  by  a  host  of  dry 
bones,  which  were  hemming  him  in  so  as  to  cut  off  all  chance 
of  escape. 

Case  3. — In  another  case  the  patient,  also  a  young  civilian, 
had  allowed  a  whitlow  on  his  hand  to  assume  very  large  pro¬ 
portions.  He  so  flinched  from  the  knife  that  we  were  fain 
to  be  content  with  poulticing.  At  length  the  suppuration 
became  so  great  that  he  consented  to  have  the  abscess  lanced, 
stipulating,  however,  for  chloroform.  This  was  given  him, 
the  patient  evidently  knowing  when  he  had  had  enough.  Be¬ 
lieving  him  at  one  time  to  be  sufficiently  insensible,  I  opened 
the  abscess-knife  (Syme’s),  and  prepared  to  operate  ;  but  he 
waved  me  off.  This  occurred  twice.  The  third  time,  how¬ 
ever,  he  held  out  his  hand,  intimating  that  he  was  now 
ready ;  and,  as  I  introduced  the  knife,  he  looked  composedly 
on,  without,  he  told  me  afterwards,  in  the  least  feeling  it. 
The?  patient  had  been  cognisant  of  every  step  of  the 
operation. 


Case  4. — The  chloroform  imported  in  former  days  into  India 
was  often  very  impure,  the  effect  of  inhalation  being  frequently 
most  distressing ;  the  more  so  as  large  quantities  would  be- 
required  to  produce  insensibility.  Constant  nausea,  with 
vomiting  and  loathing  of  food,  were,  with  extreme  prostra¬ 
tion  of  the  nervous  system,  the  prominent  symptoms.  Major 

M - ,  a  military  officer  recently  returned  from  furlough 

to  Europe,  when  it  was  decided  that  a  tooth  was  to  come 
out,  strongly  objected  to  take  chloroform.  The  dentist, 
however,  an  Eldorado-seeking’adventurer,  glibly  assured  him 
that  all  would  be  well,  and  administered  it.  Under  its  in 
fluence  the  major  became  like  a  maniac,  pulling  about  the 
tables,  overturning  the  chairs,  and  successfully  baffling  the 
operator  in  his  efforts  to  remove  the  tooth.  He  never 
forgave  the  dentist,  who,  he  asserted,  had  at  one  stroke 
destroyed  his  nervous  system,  which  he  had  expended  three 
years  at  home  in  endeavouring  to  build  up. 

Case  5. — A  married  lady,  without  children,  consulted  me- 
for  persistent  headache  affecting  the  whole  of  the  head. 
Her  habits  were  not  conducive  to  health.  Late  hours,, 
unsuitable  food,  and  indulgence  in  worldly  pleasures  had 
brought  about  a  state  of  nervous  exhaustion  that  made  her  life 
miserable.  An  American  doctor  had  advised  her,  whenever 
she  felt  headache  coming  on,  to  take  a  whiff  of  chloroform 
and  she  systematically  did  so.  The  pain  was  relieved  for 
the  moment,  but  returned  afterwards  with  still  greater 
intensity ;  and  her  general  health  was  greatly  undermined. 
I  of  course  at  once  withdrew  the  treacherous  auxiliary ;  and,, 
under  totally  opposite  management,  she  soon  got  well.  But 
the  case,  alas  !  is  one  of  many  of  a  like  nature,  where  the 
patient  (usually  of  the  fair  sex)  takes  to  chloroform  in  the 
first  instance  for  the  removal  of  pain,  and  eventually  for  the 
sake  of  the  dreamy  condition  which  this  anaesthetic  some¬ 
times  produces.  It  is  not  often  recommended,  I  imagine 
(as  in  this  case),  by  a  medical  practitioner  ! 


Sweeping  the  Pharynx  by  the  Tongue. — In  the- 
New  York  Med.  Record,  June  9,  Dr.  Roe,  alluding  to  a  similar- 
case  published  in  a  former  number  by  Dr.  Whiting,  narrates 
the  case  of  a  man,  aged  twenty-five,  who  applied  to  him  for- 
an  affection  of  the  nose  and  throat.  On  examination,  chronic- 
rhinitis  was  found  to  be  present,  accompanied  by  some 
adenoid  hypertrophy  of  the  vault  of  the  pharynx.  This  he 
could  plainly  perceive  himself  with  his  tongue,  as  also 
several  holes  or  depressions  in  it,  which  were  plainly  visible 
to  the  rhinoscopic  mirror.  As  his  nostrils  were  narrowed, 
by  thickening  of  the  inferior  turbinated  bone,  the  tip  of  his- 
tongue  could  not  be  seen  through  the  nostrils  when  in  the 
vault-  of  the  pharynx,  as  it  was  in  Dr.  Whiting’s  case;  but 
the  patient  was  able  to  move  with  his  tongue  a  probe  when, 
inserted  through  the  nostril  as  far  as  its  posterior  aper¬ 
ture,  and  if  it  were  pushed  further  back  he  could  throw  it 
forwards  nearly  out  of  the  nostril.  By  looking  into  his 
mouth  while  he  performed  this  feat,  his  tongue  was  seen  to- 
pass  up  behind  the  palate,  burying  itself  almost  out  of  sight 
behind  the  velum.  There  was  nothing  abnormal  about  the- 
tongue  or  fauces,  and  the  frsenum  was  well  marked,  though 
a  little  longer  and  more  lax  than  usual.  The  only  peculiarity 
observable  in  the  tongue  was  the  great  voluntary  muscular 
control  which  the  man  had  over  its  movements,  enabling- 
him  to  place  it  in  any  conceivable  position  in  the  mouth,, 
fauces,  and  naso-pharynx. 

Deafness  and  Tinnitus  in  Bright’s  Disease. — In  a 
paper  read  at  the  American  Medical  Association  by  Dr.  L» 
Turnbull,  “  On  Tinnitus  and  the  Deafness  which  accompany 
different  forms  of  Bright’s  Disease,”  he  reported  several 
cases,  and  concluded  that  the  symptoms  of  disturbance  of 
hearing  may  be  an  assistance  in  the  diagnosis  of  the  early 
and  obscure  stages  of  Bright’s  disease.  At  times,  all  other- 
symptoms  being  absent,  only  cardiac  hypertrophy  and 
auditory  symptoms  are  noticed  in  insterstitial  nephritis,  and. 
the  diagnosis  may  be  confirmed  by  examination  of  the  urine. 
— Dr.  Connor  observed  that  these  aural  symptoms  would  be- 
very  valuable  if  they  were  pathognomonic,  but  he  had  met 
with  similar  symptoms  which  had  no  connexion  with  sys¬ 
temic  disease. — Dr.  Turnbull  replied  that  the  subject  was 
too  new  for  him  to  state  whether  the  symptoms  of  serous 
effusion  and  injection  of  the  tympanic  membrane,  which  he 
had  noticed  in  all  his  cases,  were  pathognomonic  or  not. — 
Phil.  Med.  News,  June  16. 


Medical  Times  and  Gazette. 


MEDICAL  AND  SUEG1CAL  PEACTICE. 


July  14,  1883.  37 


REPORTS  OF 

SOSPITAL  PRACTICE  IN  MEDICINE 
AND  SURGERY. 

- « - 

LIYEEPOOL  EOYAL  INFIEMAEY. 


'SERIES  OP  BONE  AND  JOINT  CASES. 

(Under  the  care  of  Mr.  RUSHTON  PARKER.) 

Continued  from  page  727  of  last  volume. 

Case 2. — Synovitis  of  the  Knee-joint — Aspiration  of  the  Effused 
Fluid — Linear  Fixation  of  the  Limb  without  Confinement 
of  the  Patient— Cure  in  about  a  Month. 

John  M.,  aged  thirty- nine,  a  dock  labourer,  applied  on  March 
22,  1878,  having  had  his  right  knee  weakened  and  partly 
-disabled  during  the  previous  two  months,  in  consequence,  it 
was  supposed,  of  the  strain  of  his  work .  The  case  was  one  of 
-simple  fluid  effusion,  with  the  associated  encumbrances  above 
alluded  to,  but  without  any  acute  features.  Two  ounces  of 
.yellow  liquid  were  drawn  off  at  once  by  aspiration  through 
a  needle  about  the  size  of  a  No.  2  catheter ;  the  limb  was 
put  up  perfectly  straight,  supported  behind  the  knee  by  a 
.sheet  of  perforated  zinc  plate  reaching  from  the  middle  of 
the  thigh  to  the  middle  of  the  leg  in  the  form  of  a  half¬ 
cylinder,  fixed  with  strips  of  thick  plaster,  and  surrounded 
with  a  bandage.  The  front  of  the  joint  was  left  uncovered 
for  inspection,  and  the  patient  walked  home,  having  instruc¬ 
tions  to  call  and  show  himself  once  or  twice  a  week.  No 
re-accumulation  took  place.  The  splint  and  plasters  were 
removed  at  the  end  of  a  month,  being  replaced  by  a  band¬ 
age  alone,  to  limit  the  movements  now  resumed.  Complete 
recovery  of  the  joint  followed  shortly  after. 

•Case  3. — Acute  Sprain  of  the  Knee-joint — Aspiration  of 
Effused  Blood — Treatment  partly  in  Bed  and  partly  on 
Foot — Cure  in  about  a  Month. 

Harris  W.,  aged  twenty-seven,  a  Polish  Jew  glazier,  applied 
-on  August  9,  1879,  having  four  days  previously  fallen  in  the 
street  and  severely  hurt  his  right  knee,  which  had  shortly 
niter  swollen,  an'd  had  been  extremely  painful  in  the  interval. 
The  joint  was  distended,  very  tender,  and  apparently  con¬ 
stantly  painful.  Besides  the  unequivocal  signs  of  disable¬ 
ment  he  exhibited  the  timidity  and  extreme  sensitiveness 
that  seem  to  be  usual  in  his  race.  He  was  put  to  bed,  and 
the  limb  was  placed  at  once  perfectly  straight  in  a  Thomas’s 
knee-splint.  Aspiration  was  then  performed  at  the  outer 
-upper  corner,  and  about  two  ounces  of  bloody  fluid,  that  soon 
coagulated,  were  drawn  off,  with  admitted  comfort  to  the 
patient.  Three  days  later  the  splint  was  removed,  the  joint 
was  enveloped  in  many  layers  of  plaster  (pitch  and  resin 
spread  upon  brown  paper)  from  the  middle  of  the  thigh  to 
the  middle  of  the  leg — not  tightly,  but  so  as  to  maintain  the 
straight  position, — and  the  patient  sent  on  foot  to  his  home 
in  the  immediate  neighbourhood,  whence  he  returned  twice 
a  week  for  inspection.  The  plasters  were  removed  each 
time,  the  joint  examined,  and  fresh  plasters  put  on,  making 
a  stiff  case  as  clean  and  neat  as  a  grocer’s  parcel,  as  firm  as 
a  starched  bandage,  at  a  cost  to  the  hospital  of  about  two¬ 
pence,  and  to  the  surgeon  of  about  two  minutes  on  each 
■occasion.  A  little  re-accumulation  of  fluid  was  noticed 
•during  the  convalescence,  but  this  gradually  disappeared 
•under  the  fixed  position  of  the  joint,  that  still  did  not  debar 
the  patient  from  the  painless  support  and  moderate  use  of 
the  limb  in  progression. 

Case  4. — Chronic  Synovitis  of  the  Knee-joint — Repeated 
Aspiration — Treatment  in  the  Fixed  Straight  Position, 
without  Confinement  of  the  Patient — Cure  in  about  Three 
.  Months. 

Peter  D.,  aged  forty-three,  a  seafaring  man,  applied  on 
March  15,  1878,  having  effusion  of  fluid  in  his  right  knee  of 
two  years’  standing,  supposed  to  be  due  to  rheumatism. 
The  joint  was  plainly  distended,  but  there  were  no  acute 
symptoms,  the  only  inconvenience  being  weakness  as  com¬ 
pared  with  the  opposite  limb.  Aspiration  was  done,  and  the 
limb  fixed  with  plasters  and  bandage  over  a  wooden  back- 
splint.  The  joint  filled  again,  and  was  again  aspirated  on 
the  fourth,  seventh,  eleventh,  fourteenth,  and  eighteenth 
days  after  his  first  application.  It  now  became  obvious  that 


the  movements  of  the  joint  were  hardly,  if  at  all,  controlled, 
owing  to  the  shortness,  stoutness,  and  abruptly  tapering 
shape  of  the  patient’s  limb,  to  which  a  clumsy  wooden 
splint  is  not  easily  made  to  cling.  He  was  accordingly 
persuaded  to  get  a  Thomas’s  knee-splint  of  the  calliper 
variety,  fitted  below  into  the  heel  of  his  boot.  This  he 
wore  day  and  night,  the  limb  being  bandaged  straight 
between  the  iron  stems,  and  the  knee-joint  maintained 
immovable,  while  yet  progression  and  the  support  of  the 
body  were  permitted.  The  _  slight  effusion  that  still  re¬ 
turned  after  the  last  aspiration  gradually  disappeared,  the 
joint  resumed  its  normal  size  and  shape,  the  patient  gradu¬ 
ally  found  by  temporarily  dispensing  with  the  splint  that  he 
was  recovering  the  efficient  use  of  the  member,  and  even¬ 
tually  went  to  sea  again,  quite  recovered,  at  the  end  of 
three  months. 

Case  5. — Chronic  Synovitis  of  Knee — Aspiration  at  Intervals 

during  Four  Years,  with  Apparent  Cures  and  Subsequent 

Remissions — Periarticular  Exudations,  Free  Incisions,  and 

Eventual  Complete  Success. 

Richard  P.,  a  sailor,  aged  thirty-two,  was  admitted  in 
November,  1878,  under  the  care  of  Mr.  Bickersteth,  on 
account  of  an  extensive  hydrarthrosis  of  the  left  knee. 
The  affection  had  existed  for  four  years,  had  never  been 
acute,  and  the  patient  had  done  his  best  to  work,  but  at 
last  had  to  give  in.  Aspiration  was  performed  once,  and  as 
the  joint  filled  again  the  patient  was  shortly  after  discharged. 
From  December,  1879,  to  February,  1880,  he  was  underthe 
care  of  Mr.  H.  O.  Thomas,  who  aspirated  the  joint  three 
times,  and  applied  plasters  to  it  in  the  intervals.  Effusion 
having  disappeared  and  the  use  of  the  limb  been  restored, 
he  was  discharged  cured,  or  apparently  cured  as  it  turned 
out,  for  three  months  later  a  fresh  accumulation  had  taken 
place,  and  with  it  the  consequent  weakness  of  the  knee. 
He  entered  the  Infirmary  in  June,  1880,  under  the  care  of 
Mr.  Parker,  who  aspirated  the  joint  on  four  consecutive 
days,  ending  July  1,  the  patient  being  in  bed  and  having 
the  limb  previously  fixed  in  a  Thomas’s  knee-splint  of  the 
ordinary  long  pattern  used  for  bed  purposes. 

On  July  12,  1880,  he  was  fitted  with  Thomas’s  calliper 
walking  knee-splint,  and,  as  Mr.  Parker  was  going  from  home, 
placed  himself  again  under  the  care  of  Mr.  Thomas,  who 
continued  the  observation  of  the  case.  Nothing  more  was 
heard  of  him  till  September,  1882,  when  he  stated  that  the 
knee  had  remained  painless  since  last  note  until  a  few 
months  previously,  when  a  subcutaneous  swelling  was  found 
on  the  upper  outer  corner  of  the  affected  knee.  This  had 
increased  in  size,  had,  he  said,  been  incised  by  Mr.  Thomas, 
and  was  now  a  sinus  from  which  sweet  serous  fluid  escaped 
in  small  quantity  daily.  Another  indurated  spot  was  felt  on 
the  inner  lower  aspect  of  the  front  of  the  joint.  There  was 
a  constant  pain  complained  of  by  the  patient,  and  some 
tenderness,  but  his  health  was  good,  and  the  joint  entirely 
free  from  distension.  His  calliper  splint  was  kept  on,  and 
the  man  allowed  to  walk  about  the  hospital,  the  sinus  being 
covered  with  boracic  lint,  and  regularly  squeezed  by  him. 

On  October  6,  18S2,  under  ether,  the  sinus  was  enlarged, 
and  found  to  extend  upwards  into  the  vastus  externus, 
while  downwards  it  was  immediately  outside  the  capsule  of 
the  knee-joint.  The  lining  of  lymph  and  granulations  was 
scraped  away  with  Yolkmann’s  spoon,  and  the  exposed  fresh 
tissues  carbolised  with  one-in-twenty  lotion.  The  indurated 
and  partly  liquefied  spot  at  the  inner  lower  corner  of  the 
joint  was  now  cut  into,  found  to  consist  of  lymph  and  dark 
yellow  serum,  all  of  which  was  turned  out,  and  the  lining 
(in  which  no  granulations  had  formed)  scraped  away. 
Careful  examination  showed  this  cavity  to  be  subcutaneous, 
and  entirely  outside  the  capsule  of  the  joint,  the  outer 
surface  of  which,  however,  was  thus  exposed.  Both  inci¬ 
sions  were  dressed  with  eucalyptus  ointment  inside  a 
Listerian  gauze  dressing.  The  operation  was  done  under 
the  carbolic  spray,  and  due  precaution  taken  in  case  either 
incision  might  have  been  found  to  expose  the  interior  of  the 
joint.  The  calliper  splint  was  worn  throughout,  during  the 
operation  as  well,  and  after  a  week  or  so  the  patient  was 
allowed  to  get  up.  Granulation  took  place  and  perfect 
healing,  without  inconvenience,  and  the  pain  previously 
complained  of  disappeared. 

On  December  20  he  was  well,  and  discharged  for  Christ¬ 
mas.  During  the  healing  of  the  skin-cuts  he  complained  of 
swelling  of  the  left  testicle,  and  fancied  he  had  squeezed  it 


38 


Medical  Times  and  Gazette. 


LOED  MOELEY’S  COMMITTEE. 


July  14,  1853. 


against  the  adjacent  ring  of  the  splint.  This  was  kept  under 
observation  for  many  weeks,  slung  in  a  suspensory  bandage, 
and  treated  by  the  administration  of  grey  powder  inter¬ 
nally,  but  without  good  effect.  There  was  no  history  ot 
syphilis,  and  not  a  clear  one  of  injury,  but  it  became  unmis¬ 
takable  that  a  hard  nodule  of  some  kind,  probably  cheesy, 
remained,  and  the  patient  was  advised  to  have  the  organ 
removed.  This  he  has  not  yet  consented  to. 

Remarks. — The  course  followed  in  the  case  of  this  knee  is 
peculiar.  Such  cases  are  generally  easily  cured  by  the 
treatment  of  fixation  here  employed,  with  or  even  without 
aspiration.  It  cannot  be  decided  to  what  precise  circum¬ 
stance  the  periarticular  collections  are  due,  but  the  fact  of 
repeated  aspiration  naturally  suggests  the  bare  possibility 
of  some  association  between  them  as  cause  and  effect.  The 
affection  of  the  testicle  also,  in  which  there  is  still  an  exuda¬ 
tion,  suggests,  by  its  resemblance  to  tubercular  formations, 
that  this  or  an  allied  form  of  infection  may  have  also 
complicated  the  inflammation  at  the  knee. 

TEEMS  OF  SUBSCEIPTION. 

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But  they  ne’er  pardon  who  have  done  the  wrong.” 

Six 

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Twelve 

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At  any  rate,  the  Medical  Department  bears  no  malice,  and 

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TEEMS  FOE  ADVEETISEMENTS. 

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For  the  future,  Births  and  Marriages  must  be  paid  for. 
Deaths  of  Medical  Men  are  inserted  Free  of  Charge. 

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epical  Cimes  mO  da  A 


SATUEDAY,  JULY  14,  18S3. 


SOME  OF  THE  EECOMMENDATIONS  OF  LOED 
MOELEY’S  COMMITTEE. 

Thebe  are  a  few  suggestions  and  recommendations  for  the 
improvement  of  the  Army  Medical  Service  which  have  to 
be  regarded  before  we  bring  our  review  of  the  proceedings 
of  Lord  Morley’s  Committee  to  a  close.  And  before  noticing 
them  in  detail,  we  wish  particularly  to  remark  that  all  such 
suggestions  have  for  their  end  and  purpose  the  intention  to 
improve  the  present  system  of  medical  administration,  but 
not  to  reconstruct  it.  It  is  desirable  to  state  this  plainly, 
because  Lord  Wolseley,  when  he  addressed  the  students 
of  Charing- cross  Hospital  last  week,  implied  that  the 
Medical  Department  was  antiquated,  out  of  date,  and 
unfitted  for  modern  scientific  warfare.  He  asked,  “What 
could  be  more  ridiculous  than  if  we  were  to  attempt  to 
carry  on  the  medical  affairs  of  the  Army  on  the  same  system 
as  they  were  carried  on  during  the  Peninsular  or  Crimean 
War?  The  Medical  Service  requires  to  change,  as  we  change 


our  arms  and  munitions  of  war.”  And  again  he  says,  “But 
although  I  may  find  fault  with  the  Medical  Department  of 
the  Army,  there  is  no  reason  that  we  should  find  fault 
with  the  medical  officers.”  Now,  with  all  respect  to  Lord 
Wolseley,  we  must  say  that  his  remarks  upon  the  “  Depart¬ 
ment”  are  unjust  and  without  foundation,  for  no  system  of' 
administration  in  the  Army  has  changed  more  or  advanced1 
more  than  that  of  the  Medical  Department  since  the  Crimean. 
War.  No  one  knows  this  better  than  Lord  Wolseley,  and 
the  only  real  complaint  to  be  found  in  his  evidence  before' 
the  War  Office  Committee  amounted  simply  to  this — that 
the  Medical  Department  would  not  assume  the  power  of 
purchasing  indiscriminately,  on  their  own  authority,  in  de¬ 
fiance  of  all  War  Office  regulations.  Lord  Wolseley  thinks 
such  an  assumption  of  power  would  have  been  condoned, 
and  probably  he  feels  that  it  was  his  own  action  that  made 
such  an  assumption  desirable.  The  tone  in  which  he  in¬ 
dulges  when  he  speaks  of  the  Medical  Department  makes 
us  wonder  whether  he  is  himself  not  conscious  of  having 
unnecessarily  contributed  to  medical  embarrassments.  We 


to  the  suggestions  for  the  improvement  of  medical  service 
in  the  field.  One  of  the  recommendations  of  the  Committee 
(No.  15)  runs  thus: — “Provision  to  be  made  for  mounted 
bearer  companies  and  good  reason  for  this  is  found  in  the 
report  of  Colonel  Stewart  (Appendix  No.  39) :  “  It  seems 
to  me  that  in  the  future  not  only  must  cavalry  be  called 
upon  constantly  to  fight  on  foot,  but  this  at  considerable 
distances  from  the  main  body  of  the  army,  and  that  often 
they  must  move  rapidly  to  these  distances.  A  bearer  com¬ 
pany  can,  under  present  circumstances,  make  no  pretence 
of  keeping  near  cavalry.  ...  I  think  that  a  mounted  bearer 
company  should  take  the  place  of  the  present  bearer  com¬ 
pany,  so  far  as  cavalry  is  concerned.”  It  may  be  taken  for 
granted  that  the  Medical  Department  would  raise  no  diffi¬ 
culties  in  the  way  of  this,  but  would  readily  adapt  itself 
to  the  wants  of  cavalry  employed  under  any  conditions.. 
Another  recommendation  (No.  40)  is  to  the  effect  that  non¬ 
professional  clerical  work  shall  be  transferred  to  Army 
staff  clerks.  According  to  the  evidence  given  by  Major 
Terry,  “  there  is  generally,  throughout  the  Army,  a  want  of 
confidence  in  the  medical  skill  of  the  medical  officers,  so  much 
so,  that  it  has  become  a  great  cry  against  them.”  He  declares 
“  it  is  a  common  expression  among  the  medical  officers  in. 
charge  that  patients  may  die  to  any  extent  so  far  as  the 
regulations  are  concerned.  I  would  not  wish  to  imply  that 
they  would  neglect  their  patients,  but  they  say  c  the  prac¬ 
tical  effect  of  the  regulations  is  that  patients  may  die,  and  it 
is  of  no  importance  to  us  :  but  if  the  returns  go  wrong,  we 
should  come  to  grief.’  ”  He  was  asked,  very  naturally,. 
“  Do  you  not  think  those  medical  officers  were  joking  with 
you?”  but  his  reply  was,  “  No ;  I  think  they  were  speak¬ 
ing  in  sober  earnest.”  This  witness  accompanied  the  ex¬ 
pedition  in  the  capacity  of  correspondent  to  the  United ■ 
Service  Gazette,  and  it  may  be  supposed  that  he  was  in  the 
habit  of  putting  things  in  a  forcible  and  graphic  way ;  and 
he  wished  to  emphasise  his  objections  to  the  medical  regu¬ 
lations.  “  If  these  are  looked  at,”  he  states,  “  it  will  be  found, 
that  a  strict  and  direct  responsibility  in  respect  of  adminis¬ 
tration  and  clerical  work  is  thrown  upon  the  senior  officers, 
but  the  direct  responsibility  for  the  treatment  of  the  patient© 
by  the  junior  officers  is  thrown  on  those  junior  officers  ” 
(5653) ;  and  he  goes  on  to  say,  “As  even  in  civil  life  the 
older  medical  men  are  preferred  to  the  younger  ones, it  is 


Medical  Times  and  Gazette. 


TESTAMENTARY  CAPACITY. 


July  14,  1883.  39 


only  natural  that  officers  and  soldiers  should  prefer  men 
of  greater  experience.”  It  is,  in  the  circumstances,  satis¬ 
factory  to  find  he  owns,  “  As  far  as  my  own  experience  of 
the  medical  officers  as  a  body  is  concerned,  I  consider  that 
they  are  everything  that  could  be  desired — there  is  no  want 
of  skill  or  of  zeal  on  their  part ;  but,  as  I  say,  it  seems  to 
me  that  the  regulations  are  open  to  objection  in  throw¬ 
ing  the  whole  responsibility  of  the  medical  treatment 
practically  on  the  juniors,  and  everything  else  practi¬ 
cally  on  the  seniors.”  He  appears  to  have  really  given 
much  thought  and  attention  to  the  matter,  however,  and 
his  opinions  deserve  consideration.  It  is  clear  that  the 
seniors  of  the  Medical  Department  on  a  campaign  must  be 
answerable  for  administrative  duties,  and  much  of  their  time 
must  be  taken  up  in  organising  and  superintending  medical 
arrangements  generally.  These  are  duties  which  do  not 
fall  to  the  same  extent  upon  civilian  practitioners,  who  are 
more  immediately  occupied  in  the  treatment,  than  in  the 
prevention  of  disease  ;  still  it  is  certainly  desirable  that  the 
presence  of  senior  medical  officers  should  make  itself  felt  in 
the  wards,  if  for  no  other  reason  than  to  dissipate,  or  still 
better  to  prevent,  the  idea  that  the  heads  of  departments 
are  indifferent  to  the  welfare  of  individuals.  We  know  that 
such  indifference  does  not  really  exist,  and  that  the  doctors 
themselves  are  the  first  to  groan  under  the  burthen  of  lengthy 
returns,  hitherto  considered  indispensable ;  and  we  feel  sure 
that  senior  medical  officers  will  be  the  first  to  welcome  the 
recommendation  that  they  should  be  provided  with  army 
clerks. 

We  pass  on  now  to  what  seems  a  minor  matter,  but  still 
it  has  great  importance.  It  is  the  question  of  diet  for  the 
sick  and  wounded.  If  our  readers  will  look  at  the  diet 
table  for  hospitals  they  will  find  them  ranging  from  “  tea,” 
“  milk,”  “  low,”  “  chicken,”  “  half,”  “  roast,”  “  entire,”  up 
to  “  varied.”  Now,  in  the  field  these  diets  cannot  be  adhered 
to,  and,  of  course,  every  patient  who  does  not  get  all  the 
articles  enumerated  in  a  particular  diet  considers  himself  ill- 
used  and  starved.  And  there  are  times  when  he  has  really 
cause  to  complain.  The  evidence  given  by  Brigade- Surgeon 
Clarke  on  this  matter  is  of  great  practical  value.  He  says 
(9617)  :  “  I  think  the  question  of  the  diet  in  the  field 
hospitals  might  be  improved.  At  present  the  movable 
field  hospitals  draw  only  *  soldiers’  rations,’  and  I  think 
we  might  have  two  diets— a  full  diet  for  men  who  can  eat, 
and  a  beef-tea  or  soup  diet  for  men  who  cannot  manage 
solid  food.  I  think  every  movable  hospital  should  have 
that.  A  man  who  is  shot  in  the  mouth  cannot  eat  solid  beef, 
and  it  is  no  use  giving  it  him ;  and,  vice  versa,  a  man  who 
is  shot  in  the  foot  can  eat  a  gbod  solid  meal.  I  would  not 
have  more  than  two  complete  diets.  I  think  they  would 
be  ample.”  Turning  for  a  moment  to  the  recommenda¬ 
tion  with  regard  to  medical  organisation  in  time  of  peace, 
page  xli.  of  the  Deport,  No.  10,  says  : — “  Opportunity  of 
practice  with  war  equipment  during  peace  should  be 
afforded  both  as  regards  field  hospitals  and  bearer  com¬ 
panies.”  It  seems  strange  that  such  a  suggestion  should 
be  required,  and  we  can  only  wonder  at  the  evidence  given 
by  a  medical  officer  of  experience,  when  asked  (9206),  “Have 
you  ever  seen  a  field  hospital  mobilised  in  time  of  peace  ?  ” 
The  answer  was,  “  Never.”  It  seems  clear  that  the  training 
of  the  Army  Hospital  Corps  has  been  of  too  military  a 
nature,  and  we  agree  with  the  opinion  of  the  Committee, 
expressed  at  page  xxxvi.,  par.  216 — “  We  consider  the 
military  training  of  the  Army  Hospital  Corps  should  be 
limited  to  the  ordinary  drill  of  a  recruit  without  arms.” 

The  last  recommendation  of  the  Committee  is  most 
important.  It  is  No.  48,  page  xliii.,  and  runs :  “  Voluntary 
aid  in  war  to  be  taken  into  consideration,  and  a  system 
organised  for  its  proper  utilisation.”  It  is  impossible 


here  to  discuss  the  various  plans  for  organising  such  a 
force  as  that  alluded  to  by  the  Committee,  but  we  may 
concede  at  once  the  value  of  the  suggestion.  We  can 
agree  with  Lord  Wolseley’s  remarks  when  addressing 
the  students  at  the  Charing-cross  Hospital.  “I  cannot 
see,”  he  said,  “  why  there  should  not  be  in  London, 
and  also  in  the  other  towns,  but  especially  in  London,  a 

Volunteer  Medical  Corps . Remember,  that  though  we 

have  a  large  Medical  Department,  it  is  only  just  sufficiently 
large  for  our  own  Medical  Department  in  peace,  and  in  the 
event  of  war,  or  invasion,  or  any  other  difficulty  overtaking 
us,  which  would  require  a  large  force  of  men  to  be  put  in 
the  field,  we  have  not  now  the  medical  officers  in  this 
country  to  supply  the  wants  of  that  force.” 

In  conclusion,  we  must  say  we  are  glad  that  Lord 
Morley’s  Committee  met,  and  we  congratulate  them  upon 
the  result  of  their  patient  inquiries.  We  fully  expect  that 
improvements  will  follow  the  recommendations  they  have 
made,  and  that  in  future  wars  the  medical  officers  will  find 
their  work  more  easy  under  improved  arrangements  in 
matters  of  detail.  Still  we  must  not  expect  too  much.  The 
Committee  have  vetoed  one  step  which  some  consider  a 
necessity  for  the  due  development  of  medical  service  in  the 
field.  The  doctors  are  to  have  no  separate  transport,  and 
we  know  that  they  have  no  separate  commissariat.  The 
Medical  Department  must  be  content  to  suffer  in  many 
ways.  During  war  it  will  ever  be  the  primary  object  to 
destroy  men’s  lives,  and  not  to  save  them  ;  and  the  “  art  of 
healing  ”  gets  small  chance  of  fair  play  until  all  the  blows 
are  struck,  and  the  fight  is  over. 


TESTAMENTARY  CAPACITY. 

“  There  is  something  both  contemptible  and  frightful,” 
wrote  John  Stuart  Mill  not  many  years  ago,  “in  the  sort  of 
evidence  on  which,  of  late  years,  any  person  can  be  judi¬ 
cially  declared  unfit  for  the  management  of  his  affairs  ;  and 
after  his  death  his  disposal  of  his  property  can  be  set  aside 
if  there  is  enough  of  it  to  pay  the  expenses  of  litigation — 
which  are  charged  on  the  property  itself.”  Had  the  dis¬ 
tinguished  moralist  lived  to  witness  the  result  of  the  action 

o 

“  Lindsey  and  another  v.  Carr  and  another,”  which  was 
reported  in  the  Times  of  the  6th  inst.,  he  would  have  seen 
reason  to  modify  his  opinion.  “  The  testator,”  as  the 
learned  judge  said  in  his  summing  up,  “had  been  a  man 
steeped  in  drink.  He  had  had,  as  a  result  of  his  intem¬ 
perance,  fits  of  epilepsy  some  time  before  his  death,  and  he 
had  had  delirium  tremens  in  its  worst  form,  it  having 
reduced  him  to  such  a  state  of  terror  that  he  supposed 
imaginary  beings  to  be  pursuing  him,  and  rushed  at  night 
out  of  his  house  to  avoid  them.”  How  long  this  debauchery 
had  been  going  on  does  not  appear,  but  it  is  evident  that  to 
produce  these  symptoms,  and  to  cause  death,  as  it  eventually 
did,  it  must  have  been  pursued  for  months,  and  probably 
for  years.  The  will  was  executed  on  January  30  last.  On 
the  following  day  the  testator  became  violent,  and  had  more 
fits.  On  February  2  he  died.  The  will  was  executed  under 
the  following  circumstances  :  —At  seven  o’clock  in  the  even¬ 
ing  of  January  30,  Mrs.  Lindsey,  an  aunt  of  the  testator, 
and  one  of  the  two  chief  legatees  under  the  contested  will, 
went  out  and  bought  a  form  of  will.  According  to  her  evi¬ 
dence,  she  drew  the  will  in  question  about  midnight  the 
same  night  at  the  testator’s  direction,  he  repeating,  word 
by  word,  the  phraseology  of  the  form,  and  dictating  the 
amounts  and  names  that  he  wished  to  have  set  down. 
When  the  will  was  drawn  three  people  entered  the  room, 
two  of  whom — the  barmaid  and  potman  of  the  testator — 
received  small  legacies  under  the  will.  According  to  Mrs. 
Lindsey,  they  happened  to  be  passing  at  that  moment,  and 


40 


Medical  Times  and  Gazette . 


PRODUCTION  AND  PREVENTION  OF  CHOLERA. 


July  14,  1883. 


looked  in  casually ;  but  they  themselves  state  that  she  sent 
for  them.  All  four  agree  that  the  testator  was  in  a  per¬ 
fectly  collected  frame  of  mind,  and  Mrs.  Lindsey  fur¬ 
ther  represents  that  he  signed  the  will  in  his  usual 
manner.  One  of  the  others— the  only  person  present  who 
did  not  profit  under  the  will — states,  however,  that  he 
propped  the  testator  up  in  bed  by  putting  one  arm  and  his 
knee  behind  him,  and,  moreover,  that  he  “  steadied  his 
(testator’s)  wrist  ”  while  the  signature  was  written.  Mr. 
Shepherd,  the  testator’s  medical  attendant,  stated  that  he 
had  seen  him  in  the  afternoon  and  evening  of  the  day  on 
which  the  will  was  made,  that  the  testator  was  “  not  in  a 
condition  to  originate  and  sustain  a  connected  train  of 
thought,  but  that  he  might  have  been  capable  of  a  short 
mental  effort  he  could  not  say  that  the  testator  gave  him 
any  irrational  answers.  The  summing  up  of  the  learned 
judge  was  on  the  whole  adverse  to  the  will;  but  he  concluded 
by  saying,  as  of  course  he  was  bound  to  do,  that  the  question 
of  the  man’s  testamentary  capacity  was  entirely  one  for  the 
jury.  The  jury  found  that  the  will  was  duly  executed;  that 
the  testator  was  of  sound  mind,  memory,  and  understanding 
at  the  time  the  will  was  executed ;  and  that  he  knew  and 
approved  of  the  contents.  Upon  this  the  judge  pronounced 
judgment  for  the  will,  but  allowed  costs  out  of  the  estate. 

Of  the  execution  of  the  will  thus  legally  validated,  it 
must  be  said  that  had  it  been  the  plaintiff’s  earnest  en¬ 
deavour  to  surround  it  with  circumstances  of  suspicion,  she 
could  scarcely  have  been  more  successful  in  doing  so.  With 
the  first  portion  of  the  finding  of  the  jury  we  are  not  much 
concerned,  but  that  the  testator  was  found  fit  to  make  a 
will,  shows  that  there  is  little  ground  now  for  the  fear  ex¬ 
pressed  by  Mr.  Mill.  Here  is  a  man  within  three  days  of 
a  death  which  he  has  brought  upon  himself  by  excessive 
drinking,  at  the  early  age  of  twenty-eight.  He  is  dying  of 
the  effects  which  this  drink  has  wrought,  not  on  kidneys, 
or  liver,  or  stomach,  but  on  his  nervous  system ;  and  not 
on  the  subordinate  portions  of  his  nervous  system,  but,  as 
his  delirium  and  his  epileptic  fits  show,  upon  that  por¬ 
tion  of  his  brain  which  is  most  intimately  concerned  with 
the  intellectual  faculties.  On  the  evening  before  the  will 
is  made  he  is  excited  and  wandering,  and  not  in  a 
condition  to  originate  and  sustain  a  connected  train  of 
thought.  On  the  day  after  the  execution  of  the  will  he 
is  acutely  maniacal  and  has  several  fits.  The  will  is 
drawn  up  and  executed  at  midnight— at  that  hour  of  the 
twenty-four  when  delirium  &  potu  is  commonly  worst.  Yet 
this  man,  who  was  wandering  in  the  evening,  and  maniacal 
on  the  following  day,  is  able  at  midnight  to  dictate  the  terms 
of  his  will  in  the  legal  phraseology  of  the  form,  and  to  ap¬ 
portion  his  wealth  accurately  among  seven  legatees,  although 
at  the  same  time  his  physical  prostration  is  so  great  that  he 
has  to  be  held  up  in  bed,  and  to  have  his  “  wrist  steadied  ” 
while  he  signs  his  name !  Such  an  intellectual  feat  is  cer¬ 
tainly  surprising,  but  it  sinks  into  insignificance  beside  that 
performed  by  the  jury  in  coming  to  the  conclusion  that  the 
testator  was  “of  sound  mind,  memory,  and  understanding.” 
But,  after  all,  no  doubt  he  was  so — according  to  the  standard 
of  the  jui-y. 


PRODUCTION  AND  PREVENTION  OF  CHOLERA. 

Earl  Granville  stated  in  the  House  of  Lords,  last  week, 
that  he  had  received  a  letter  from  Sir  William  Gull,  in  which 
that  gentleman  assured  him  that  the  outbreak  of  cholera 
in  Egypt  was  of  a  purely  local  character,  and  that  there 
having  been  no  epidemic  in  India,  we  had  no  reason  to  fear 
its  importation  into  this  country.  We  hope  that  it  may 
not  reach  our  shores,  and  we  are  far  from  wishing  to 
create  a  panic,  for  such  a  state  of  mind  is  most  unfavour¬ 


able  to  calm  and  efficient  action.  But  Sir  William’s  opinion 
is  no  more  than  that  of  a  physician  who  has  had  no  better 
opportunities  for  forming  a  judgment  than  any  other  of 
his  professional  brethren.  The  Egyptian  epidemic  is  local 
only  in  the  sense  that,  having  been  imported  from  some 
country  (perhaps  from  India)  where  it  is  endemic,  it  has 
found  a  state  of  things  consequent  on  a  recent  campaign, 
unusually  favourable  to  its  development — we  mean  land 
and  water  polluted  by  unburied  corpses  of  man  and  beast, 
together  with  want,  and  other  evils  consecutive  on  war. 
There  may  have  been  no  extraordinary  epidemic  of  late 
depopulating  the  plains  and  cities  of  Hindostan,  but  cholera 
is  never  absent  from  India ;  and  the  pilgrimages,  which  far 
exceed  in  their  magnitude  and  their  horrors  anything  that 
ever  was  witnessed  at  Mecca,  are  invariably  attended  by  an 
amount  of  cholera  which  in  any  other  country  would  be 
deemed  an  epidemic.  These  pilgrimages  are  confined  to  no 
part  of  the  land  or  season  of  the  year ;  they  are  everywhere 
in  constant  operation,  until  scenes  and  consequences  that 
would  excite  consternation  elsewhere,  cease  by  familiarity 
to  be  even  noticed.  It  is  thus  only  that  we  can  account  for 
the  fact  that  many  Indian  surgeons  question  the  propagation 
of  cholera  by  human  intercourse,  and  are  inclined  to  seek 
the  cause  of  its  outbreaks  on  an  unusual  scale  in  aerial, 
terrene,  or  other  meteorological  conditions.  The  fact  is, 
that  they  do  not  enjoy  the  advantages  that  we  in  Europe 
possess  of  tracing  its  progress  under  conditions  analogous 
to  those  of  an  experiment  admitting  of  exact  scientific 
observation,  but  are  in  the  same  position  that  we  are  in 
with  regard  to  measles,  which  we  believe  to  be  always 
propagated  by  infection,  but  the  source  of  which  we  too 
often  cannot  trace.  Cholera  is  contagious  in  the  same 
sense  as  is  enteric  fever ;  i.e.,  the  poison — bacterial,  pos¬ 
sibly — resides  in  the  evacuations,  and  is  occasionally  in¬ 
haled,  but  more  often  imbibed  through  contaminated  water. 
In  India  we  have  every  condition  requisite  for  its  perpetual 
maintenance — a  high  temperature ;  a  soil  saturated  with 
organic,  and  especially  faecal  matter,  and  a  water-supply 
almost  invariably  of  the  foulest  kind ;  a  hundred  million 
persons  daily  defsecating  on  the  open  ground,  and  often  by 
preference  in  temporarily  dry  water-courses ;  heavy  rainfalls 
from  time  to  time  sweeping  the  excreta  into  rivers,  into 
which  the  carcases  of  men  and  animals  are  thrown  by 
thousands,  the  water  of  these  or  of  tanks  used  for  bathing 
constituting  the  drink  of  the  whole  population.  Improved 
water-supplies,  such  as  that  now  provided  at  Bombay, 
would  do  much  to  limit  the  ravages  of  cholera  in  the  great 
cities,  and  among  the  European  residents ;  but  many  gene¬ 
rations  must  elapse  before,  if  ever,  the  habits  of  the  Hindoo 
population  are  changed.  Besides  pilgrimages,  the  count¬ 
less  fairs  serve  to  maintain  local  foci  of  infection,  whence 
the  disease  is  carried  in  various  directions  ;  and  the  annual 
caravan  of  Afghan  merchants,  or  Provindahs,  slowly  travel¬ 
ling  from  fair  to  fair  through  the  cities  of  Northern  India, 
easily  convey  it  to  Persia  and  to  Central  Asia,  whence, 
as  we  have  seen,  it  has  so  often  entered  Russia.  Once 
imported  into  Europe,  it  depends  on  the  sanitary  surround¬ 
ing's  whether  it  establish  itself  or  no.  The  actual  carriers 
are  usually  pilgrims,  the  lower  class  of  seamen,  and 
steerage  passengers,  dirty  in  their  persons  and  them  habits, 
their  clothes  and  baggage  also  serving  as  fomites.  If,  as 
in  the  smaller  towns  and  villages  of  Europe,  the  old  system 
of  cesspool  and  well  is  still  in  favour,  nothing  more  is 
wanted  than  the  arrival  of  an  individual  suffering  from  the 
initial  symptoms  to  set  up  an  epidemic  like  that  of  Alten- 
burg  in  1865.  A  supply  of  pure  water  removed  from  all 
possible  means  of  pollution  is  the  first  requisite  for  preven¬ 
tion,  and  a  well-constructed  and  arranged  sewerage  provides 
an  additional  guarantee. 


Medical  Times  and  Gazette. 


THE  WEEK. 


July  14,  1883.  41 


In  the  immediate  prospect  of  an  invasion,  the  duty  of  the 
local  sanitary  authorities  is  to  remove  promptly  and  fre¬ 
quently  all  deposits  and  accumulations  of  organic  matter  from 
dustbins,  yards,  markets,  and  streets ;  to  inspect  and  order 
the  cleansing  of  all  closets  and  water-butts  or  cisterns,  pro¬ 
viding  for  the  decent  maintenance  of  the  same;  to  flush,  say 
weekly,  not  merely  the  sewers,  but  the  drains  of  courts* 
small  streets,  and  tenement  dwellings,  the  gutters  and 
surface  of  streets,  courts,  and  yards  in  crowded  quarters  ; 
to  rigidly  inspect  markets,  shops,  and  especially  coster  stalls 
for  the  sale  of  food ;  to  look  up  all  overcrowding  and  occupa¬ 
tion  of  cellars ;  to  offer  facilities  for  the  speedy  and  gratui¬ 
tous  treatment  of  diarrhoea;  and  generally  to  give  greater 
discretionary  powers  and  liberty  of  action  to  the  parish 
surgeons,  medical  officers  of  health,  and  sanitary  inspectors, 
such  as,  with  frequent  meetings  of  the  sanitary  authority, 
should  minimise  the  friction  and  delay.  Whether  disin¬ 
fectants  are  supplied  to  the  public  or  not,  they  should  be 
encouraged  rather  to  complain  of  offensive  emanations  and 
seek  the  removal  of  their  causes,  than  to  trust  to  mask¬ 
ing  them  by  carbolic  acid  and  like  substances.  In  seaport 
towns  the  port  medical  officer  should,  personally  or  by 
deputy,  board  and  inspect  every  vessel  arriving  from 
abroad,  and,  regardless  of  clean  bills  of  health,  satisfy 
himself  that  the  crew  and  passengers  are  free  from  sus¬ 
picion  of  being  already  attacked.  Whether  they  shall  be 
passed  at  once  or  detained  for  a  few  days  must  depend 
on  the  time  that  has  elapsed  since  the  vessel  left,  or 
called  at,  an  infected  port.  Ships  on  board  of  which 
cases  have  actually  occurred  should  on  no  account  be 
allowed  to  enter  the  port,  but  be  ordered  to  land  their 
human  freight,  and  to  undergo  purification  at  some 
isolated  part  of  the  coast  that  shall  have  been  selected 
as  a  temporary  quarantine  station.  In  every  town  where 
cholera  has  made  its  appearance,  or  which  is  specially  ex¬ 
posed  to  risk,  a  building,  or  buildings  if  necessary,  should 
be  secured  in  central  situations  as  a  hospital.  The  instant 
a  case  is  detected,  whether  by  day  or  by  night,  it  should 
be  removed  thither,  the  other  male  members  of  the  family 
receiving  (if  of  the  indigent  class)  orders  for  admission  to 
a  common  lodging-house,  and  the  women  and  children  to  a 
refuge  temporarily  provided.  The  key  of  the  room  being 
taken  by  the  sanitary  inspector,  it  and  its  furniture  should 
be  thoroughly  disinfected  and  cleansed;  all  bedding,  cloth¬ 
ing,  and  other  articles  which  may  have  come  in  contact  with 
vomit  or  excreta  being  inventoried,  destroyed,  and  replaced 
by  the  local  authority ;  after  which  the  family  may  be 
allowed  to  return. 

The  success  attending  such  measures  was  well  illustrated 
under  the  direction  of  Dr.  W.  Budd  and  Mr.  D.  Davies 
in  Bristol,  and  in  St.  Giles,  London,  under  Dr.  George 
Buchanan.  Into  the  former  town  a  number  of  cases 
were  introduced  from  abroad  and  from  London,  and  the 
disease  raged  at  the  village  of  Pill  (practically  a  part 
of  the  port  of  Bristol,  about  six  miles  lower  down  the 
river),  but  not  a  single  inhabitant  of  the  town  fell  a 
victim.  In  St.  Giles  no  fewer  than  eighty  genuine  cases  of 
algide  cholera  appeared  in  as  many  distinct  houses,  and 
would  naturally  have  acted  as  so  many  foci  of  infection, 
but,  being  instantly  isolated,  were  not  followed  by  others. 
On  three  occasions  only,  if  we  remember  rightly,  were  the 
patients,  being  in  more  easy  circumstances  than  the  others, 
left  to  the  care  of  their  relatives  ;  and  in  each  of  these 
the  disease  spread  to  other  persons  in  the  house,  and 
in  one  to  the  laundrywomen  who  washed  the  soiled  linen. 
The  question  of  treatment  we  shall  not  attempt  to  discuss 
at  present.  In  no  disease  is  it  more  true  that  prevention  is 
better  than  cure,  since  in  few  is  the  former  more  practicable 
or  the  latter  more  hopeless. 


THE  WEEK. 

TOPICS  OP  THE  DAT. 

W e  last  week  briefly  noticed  the  opening  of  the  Conference 
on  Hospital  Administration,  held  at  the  Society  of  Arts, 
under  the  presidency  of  Sir  T.  Powell  Buxton.  The  papers 
read  during  the  two  days  the  Conference  lasted  were  as 
follows.  The  first  general  heading  under  which  the  special 
topics  were  grouped  was  Hospital  Administration — the 
Governors  and  the  Management  of  Hospitals.  On  these, 
Mr.  B.  Rawlings,  Secretary  of  the  National  Hospital  for  the 
Paralysed  and  Epileptic,  read  a  paper,  the  main  proposition 
contained  in  which  was  the  desirability  of  obtaining  for 
hospitals  a  management  stable  in  character  and  impressed 
with  a  sense  of  responsibility  not  as  yet  attained.  Dr. 
J.  Syer  Bristowe,  M.D.,  F.R.S.,  Senior  Physician  to  St. 
Thomas’s  Hospital,  contributed  a  paper  on  The  Best 
Form  of  Executive  Government,  i.e.,  by  Treasurer,  House- 
Governor,  or  Medical  S  uperintendent :  Medical  Represen¬ 
tation  in  the  Management.”  He  explained  the  different 
systems  which  had  been  adopted  at  St.  Thomas’s,  and  main¬ 
tained  that  the  present  one  was  the  most  satisfactory.  The 
Conference  next  considered  the  question,  “  Can  the  system 
of  free  and  pay  beds  be  successfully  applied  to  existing 
hospitals  ?”  Papers  pro  and  con.  were  read  by  Mr.  Timothy 
Holmes,  Surgeon  to  St.  George’s  Hospital;  Mr.  J.  S.  Wood, 
Hon.  Secretary  to  the  Bolingbroke  House  Pay  Hospital ;  and 
Dr.  Fairlie  Clarke.  On  the  second  day,  Mr.  H.  C.  Burdett 
read  an  exhaustive  paper  on  “  The  Financial  Difficulties  of 
the  Metropolitan  Hospitals ;  their  Causes  and  Probable 
Results,”  which  gave  rise  to  a  lively  discussion.  Mr.  Blair, 
Manager  of  the  Leeds  General  Infirmary,  read  a  paper  con¬ 
tributed  by  himself  and  Mr.  Howley,  Secretary  of  the  North 
Staffordshire  Infirmary,  on  “  The  Differences  between  the 
Systems  for  Raising  Income  and  Controlling  Expenditure  at 
the  Metropolitan  and  Provincial  General.'and  Special  Hospi¬ 
tals.”  Dr.  J.  B.  Massiah  and  Mr.  Leveson  Scarth  contributed 
papers  on  “  The  Relation  of  Convalescent  Institutions  to 
Hospitals”;  and  Sir  Rutherford  Alcock,  K.C.B.,  and  Mr. 
Nelson  Hardy,  each  an  important  paper  on  “  The  Necessity 
for  a  Royal  Commission  of  Inquiry,” — the  latter  gentle¬ 
man  urging  that  the  largeness  of  the  interests  involved 
(1,000,000  patients  annually,  and  ,£10,000,000  invested  in 
London  hospitals  alone),  and  the  corresponding  magnitude 
of  the  evils  of  defective  hospital  administration,  seemed  to 
demand  such  an  inquiry  as  would  only  be  satisfactorily 
conducted  by  a  Commission  acting  under  the  authority  of 
the  Crown.  Before  the  close  of  the  Conference  the  follow¬ 
ing  resolution  was  adopted : — “  That  the  Council  of  the 
Social  Science  Association  be  requested  to  invite  the  follow¬ 
ing  attendants  at  this  Conference  to  form  themselves  into  a 
committee  to  consider  what  steps,  if  any,  should  be  taken 
to  secure  combined  action  among  hospitals,  and  to  decide  as 
to  future  conferences  ;  and  to  take  such  other  steps  as  may 
appear  desirable.”  The  names  given  comprised  most  of  those 
who  had  read  papers  or  taken  part  in  the  discussions,  with 
power  to  add  to  their  number. 

The  Times’  correspondent  in  Egypt  brings  serious  charges 
of  neglect  of  sanitary  precautions  against  the  Government 
there.  Travellers,  he  says,  reported  some  weeks  ago  that 
the  stench  of  Damietta  was  observable  ten  miles  away; 
whilst  the  English  residents  at  Mansourah  months  ago 
stated  that  the  passage  of  dead  animals  down  the  river,  five 
or  six  at  a  time,  was  evident  to  both  eyes  and  nose.  Until 
a  few  days  ago  Damietta  was  without  doctors,  medicine,  or 
disinfectants.  Prior  to  putting  a  cordon  around  the  place, 
10,000  people  attending  the  fair  there  were  allowed  to  dis¬ 
perse  throughout  the  interior.  Dr.  Mackie  is  stated  to  have 
applied,  through  the  Consulate,  to  the  Principal  Medical 


42 


Medical  Times  and  Gazette. 


THE  WEEK. 


July  14.  1883. 


Officer  for  information  of  the  simplest  description,  and 
received  a  reply  to  the  effect  that  that  officer  had  no  informa¬ 
tion.  The  same  correspondent  suggests  that  England  should 
insist  upon  an  efficient  supply  of  doctors  and  medicines 
being  sent  to  Damietta ;  the  inhabitants  should  be  removed 
and  camped  out  in  the  desert,  and  kept  within  a  strict 
cordon  until  the  town  has  been  purified — if  necessary,  by 
burning  the  infected  houses. 

The  first  installation  of  the  new  Order  of  the  Royal  Red 
Cross,  founded  by  Her  Majesty  for  ladies  and  nurses  who 
have  done  distinguished  service  in  tending  sick  and  wounded 
soldiers  and  sailors,  recently  took  place  at  Windsor.  The 
party,  which  included  Viscountess  Strangford,  Lady  Loyd- 
Lindsay,  and  Mrs.  Deeble,  the  head  nurse  at  Netley  Hos¬ 
pital,  were  presented  to  the  Queen,  who  affixed  the  decora- 
ti®ns,  consisting  of  enamelled  crosses  attached  to  blue  and 
red  ribbons,  upon  the  dresses  of  the  recipients.  Her  Majesty 
appeared  to  take  great  interest  in  the  accounts  which  she 
received  from  Lady  Strangford  as  to  the  work  done  by  the 
nurses.  Under  Class  4  of  the  Order,  Viscountess  Strangford 
and  Lady  Loyd-Lindsay  received  the  decoration  ;  and  under 
Class  5,  Mrs.  Deeble,  Mrs.  Fellows,  and  Misses  Caulfield, 
Stewart,  Norman,  Story,  Wheldon,  and  Gray. 

The  monthly  report  of  the  Registrar-General  for  Scotland 
for  May  last  shows  that  during  that  period  there  were  regis¬ 
tered  in  the  eight  principal  towns  of  North  Britain  the 
births  of  3956  children,  and  the  deaths  of  2780  persons. 
Allowing  for  increase  of  population,  this  latter  number 
is  112  above  the  average  for  the  corresponding  month 
during  the  last  ten  years.  A  comparison  of  the  deaths 
in  the  eight  towns  shows  that  the  mortality  was  at  the 
annual  rate  of  19  deaths  per  1000  persons  in  Edinburgh  and 
Aberdeen,  22  in  Perth,  24  in  Leith,  27  in  Greenock  and  in 
Paisley,  29  in  Dundee,  and  32  in  Glasgow.  The  miasmatic 
order  of  the  zymotic  class  of  diseases  proved  fatal  to  545 
persons,  and  constituted  19  6  per  cent,  of  the  whole  morta¬ 
lity  ;  this  rate  was,  however,  exceeded  in  Glasgow  and  Leith. 
Measles  was  the  most  fatal  epidemic,  having  caused  211 
deaths,  or  7'6  per  cent,  of  the  whole  mortality.  Fever 
caused  23  deaths,  of  which  5  were  tabulated  as  typhus  (all 
in  Glasgow),  17  as  enteric,  and  1  as  simple  continued 
fever.  The  deaths  from  inflammatory  affections  of  the  re¬ 
spiratory  organs  (not  including  consumption,  whooping- 
cough,  or  croup)  amounted  to  575,  or  207  per  cent.  Those 
from  consumption  alone  numbered  274,  or  9'9  per  cent. 
Two  males  and  seven  females  were  aged  ninety  years  and 
upwards,  the  eldest  of  whom  wasta  widow  103  years  of  age. 

On  Tuesday  last  Her  Royal  Highness  the  Duchess  of 
Albany,  accompanied  by  the  Duke,  officiated  at  the  cere¬ 
monial  opening  of  the  Chelsea  Hospital  for  Women.  The 
building,  which  is  on  the  south  side  of  the  Fulham-road, 
will  provide  accommodation  for  sixty-five  in-patients,  and  is 
also  possessed  of  an  extensive  and  well-arranged  out-patient 
department.  It  is  built  of  red  Mansfield  stone,  and  the  areas 
and  mortuary  are  lined  with  glazed  bricks.  The  Hospital 
is  six  storeys  high,  with  store-rooms  in  the  roof.  It  is  of 
“fireproof”  construction  throughout,  and  is  warmed  by  a 
system  of  hot-water  pipes,  though  fireplaces  are  supplied  in 
every  room,  because  of  their  importance  as  ventilators. 
There  is  a  corridor  eight  feet  wide  on  each  floor  extending 
from  north  to  south,  communicating  with  balconies  five  feet 
wide  which  run  the  length  of  the  building  on  the  south 
front.  The  total  cost  of  the  Hospital  is  said  to  have  been 
.£18,082. 

At  the  usual  fortnightly  meeting  of  the  Managers  of  the 
Metropolitan  Asylums  Eoard,  held  on  Saturday  last,  it  was 
reported  that  since  the  last  meeting  20  fever  patients  had 
been  admitted  into  the  Board’s  hospitals,  3  had  died,  15  had 


been  discharged,  and  68  were  still  under  treatment.  In  the 
small-pox  hospitals  79  patients  had  been  admitted,  7  had 
died,  and  46  had  been  discharged.  A  letter  from  the  soli¬ 
citors  of  the  plaintiff  in  the  case  against  the  Board  regarding 
the  Hampstead  Hospital,  offering  a  compromise,  was  ordered 
to  be  referred  to  a  committee. 


THE  ROYAL  COLLEGE  OF  SURGEONS  OF  ENGLAND. 

At  a  meeting  of  the  Council  of  the  Royal  College  of 
Surgeons,  held  on  the  12th  inst.,  Mr.  John  Marshall,  F.R.S., 
of  University  College  Hospital,  was  elected  President  of  the 
College,  in  the  vacancy  occasioned  by  the  retirement  of  Sir 
Thomas  Spencer  Wells,  Bart.;  and  Messrs.  John  Cooper 
Forster  (of  Guy’s  Hospital)  and  William  Scovell  Savory, 
F.R.S.  (of  St.  Bartholomew’s),  were  elected  Vice-Presidents. 
The  recently  elected  new  members  of  the  Council,  namely, 
Mr.  Sydney  Jones  and  Sir  William  Mac  Cormac  (both  of  St. 
Thomas’s  Hospital),  were  introduced,  and  took  their  seats. 
Mr.  Edward  Lund,  Consulting  Surgeon  to  the  Manchester 
Royal  Infirmary,  was  elected  a  member  of  the  Court  of 
Examiners,  in  the  vacancy  occasioned  by  the  expiration  of 
Mr.  Timothy  Holmes’s  term  of  office. 


THE  MEDICAL  ACT  AMENDMENT  BILL. 

On  Monday  last  the  first,  during  the  present  session  of 
Parliament,  of  those  annual  sacrifices  on  the  altar  of  legis¬ 
lative  necessity  that  are  commonly  known  as  “  Massacres  of 
the  Innocents,”  took  place  in  the  House  of  Commons. 
Many  Bills  were  ruthlessly  sacrificed  by  the  Prime  Minister, 
some  of  which,  as  the  Floods  Prevention  Bill  and  the  Burghs 
Police  and  Health  (Scotland)  Bill,  are  sorely  needed;  and 
the  fate  of  three  or  four  other  measures  of  importance  was 
left  undecided  for  the  present.  The  Medical  Acts  Amend¬ 
ment  Bill  was  included  in  the  second  rank  of  the  measures 
■which  the  Government  still  mean  to  proceed  with,  and  still 
hope  to  pass.  It  cannot  be  said,  however,  that  the  prospect 
of  the  Bill  becoming  law  is  a  good  one.  We  fully  believe 
that  Lord  Carlingford  and  Mr.  Mundella  earnestly  desire 
that  all  the  thought,  time,  and  labour  that  have  been 
bestowed  on  the  measure  shall  not  have  been  given  in 
vain;  and  that  the  Prime  Minister  is  alive  to  the  im¬ 
portance  of  passing  it.  But  August  looms  in  the  near 
distance,  and  there  is  a  very  considerable  amount  of  busi¬ 
ness  of  primary  necessity  or  importance  to  be  got  through 
before  the  House  of  Commons  can  arrive  at  the  considera¬ 
tion  of  the  Medical  Acts  Amendment  Bill.  Mr.  Gladstone 
warned  the  House  on  Monday  that,  under  the  most  favour¬ 
able  circumstances,  the  session  could  “not  reach  any  but 
a  late  termination”;  and  on  Wednesday  he  said  that  before 
Easter  a  whole  month  had  been  lost  to  the  House  through 
opposition  offered  to  the  Government,  and  now  the  House 
must  pay  the  penalty — that  is,  must  make  up  for  its 
behaviour  before  Easter  by  sitting  on  through  August  if 
necessary.  These  things  do  not  improve  the  temper  of  the 
House,  and  do  not  make  members  more  likely  to  look  with 
friendly  eyes  on  measures  of  secondary  importance. 


TETANY. 

At  the  meeting  of  the  Medical  Society  of  Vienna  on  May  25, 
Dr.  N.  Weiss  communicated  some  interesting  facts  bearing 
on  the  nature  of  tetany  (Wiener  Med.  Woch.,  No.  22).  He 
had  collected  from  German  literature  thirteen  cases  of  tetany 
which  had  followed  the  operation  for  extirpation  of  a  broncho- 
cele.  From  the  table  which  had  been  drawn  up  it  appeared 
that  tetany  had  only  been  met  with  in  cases  of  young  women 
on  whom  total  extirpation  of  the  enlarged  thyroid  had  been 
practised ;  that  the  nervous  affection  came  on  in  the  course 
of  not  later  than  ten  days  after  the  operation ;  that  only 


Medical  Times  and  Gazette. 


THE  WEEK. 


July  14, 1883.  43 


eight  of  the  cases  showed  signs  of  damage  to  the  recurrent 
laryngeal  nerve ;  and  finally,  that  five  cases  got  well,  seven 
died  (two  as  a  certain  result  of  the  tetany),  and  the  re¬ 
maining  one  still  suffered  from  tetany  three  years  after 
the  operation.  In  three  cases  in  which  Dr.  Weiss  had 
the  opportunity  of  performing  a  post-mortem  examination, 
changes  of  a  recognisable  nature  were  detected  in  the  grey 
matter  of  the  anterior  cornua  of  the  cervical  enlargement 
of  the  cord,  and  chiefly  at  the  level  of  the  fifth  and  sixth 
cervical  nerves.  The  alterations  observed  were,  briefly, 
swelling  of  the  ganglion  cells,  with  lateral  displacement  of 
the  nuclei,  vacuolation  of  the  cells,  atrophy  and  shrinking 
of  the  protoplasm  and  cell  processes.  In  the  discussion 
which  followed.  Professor  Billroth  contrasted  and  compared 
the  characters  of  tetanus  with  those  of  tetany  :  he  regarded 
the  anatomical  changes  found  microscopically  in  the  grey 
matter  of  the  cervical  region  of  the  spinal  cord  in  tetany  as 
probably  of  the  nature  of  a  direct  continuation  of  the  nutri¬ 
tive  disturbance  from  the  site  of  the  operation.  The  proxi¬ 
mity  of  the  brain  and  spinal  cord  was  an  important  factor, 
and  it  was  not  improbable  that  the  neural  changes  occurred 
in  all  cases  of  removal  of  goitre,  but  it  was  suggested  that 
they  had  to  reach  a  certain  degree  of  intensity  before  they 
could  give  rise  to  tetany.  Professor  Rosenthal  remarked 
that  vacuolation  could  be  by  no  means  characteristic  of 
tetany,  seeing  that  vacuoles  were  described  in  connexion 
with  many  nervous  diseases. 


THE  EPIDEMIOLOGICAL  SOCIETY  AND  CHOLERA. 
Elsewhere  in  our  pages  our  readers  will  find  an  abstract 
of  a  paper  read  at  the  last  meeting  of  the  above  Society  by 
Surgeon- General  J.  M.  Cuningham  on  “The  Sanitary  Lessons 
of  Indian  Epidemics.”  The  paper  was  prefaced  by  the 
reading  of  Dr.  George  Buchanan’s  “  Memoranda  concerning 
Cholera,”  which  we  published  last  week.  In  the  discussion 
which  followed,  the  President,  Dr.  Murray,  Dr.  Scriven, 
Mr.  Edwin  Chadwick,  Dr.  De  Renzy,  Sir  Joseph  Fayrer, 
and  others  took  part. 


THE  NORTH-WEST  LONDON  HOSPITAL. 

In  her  capacity  as  patroness  of  the  North-West  London 
Hospital,  in  the  Kentish  Town-road,  Princess  Christian  last 
week  opened  the  new  wing  which  has  been  recently  built. 
This  Hospital  was  started  as  a  public  institution  in  July, 
1878,  at  first  only  out-patients  being  dealt  with,  but  in 
the  following  September  a  ward  for  sick  children  was 
opened  with  ten  cots,  and,  to  meet  the  increasing  de¬ 
mands  for  admission,  wards  for  women  and  children  were 
arranged  in  the  adjoining  house  in  1879.  The  latest  addi¬ 
tion,  which  will  raise  the  number  of  beds  from  twenty-four 
to  fifty,  is  called  the  “Helena  Wing,”  at  the  request  of  Her 
Royal  Highness.  A  well-arranged  out-patients’  department 
and  dispensary  is  provided  on  the  ground-floor,  the  upper 
part  of  the  building  being  occupied  by  two  new  wards, 
one  for  women  and  children,  and  the  other  for  men  and 
boys.  The  treatment  of  sick  children  will,  it  is  announced, 
remain  the  chief  characteristic  of  the  Hospital.  Towards 
the  total  cost  of  the  new  wing  .£1300  has  been  collected, 
leaving  a  balance  of  =£700  still  to  be  obtained ;  and  the 
reliable  income  of  the  institution  appears  not  to  exceed  £150, 
while  the  annual  expenditure  has  been  hitherto  £1200.  The 
financial  position  of  the  charity  c  annot  at  present,  there¬ 
fore,  be  considered  very  satisfactory.  Whilst  fully  recog¬ 
nising  the  good  intentions  and  the  labours  of  those  who 
have  established  and  enlarged  this  Hospital,  it  may  occur 
to  people  who  study  the  subject  that  something  like  a  crisis 
is  approaching  in  the  monetary  affairs  of  the  London 
hospitals  in  general.  Up  to  the  present  it  has  been  the 


custom  to  devise  and  carry  out  enlargements  and  improve¬ 
ments,  trusting  that  the  funds  to  cover  the  increased  ex¬ 
penditure  would  be  sure  to  be  forthcoming.  But  the 
financial  position  of  nearly  every  hospital  in  the  metropolis 
is  just  now  the  reverse  of  satisfactory,  and  it  is  much  to  be 
feared  that,  unless  the  flow  of  charity  in  this  direction  is 
largely  increased,  the  powers  of  relief  at  the  disposal  of 
many  of  these  institutions  will  have  to  be  seriously  curtailed  ; 
whilst  the  idea  of  levying  a  “  hospital  rate  ”  on  householders 
cannot  be  considered  as  having  yet  come  within  the  range 
of  practical  politics. 

ARBDTIN. 

Aebutin  is  obtained  from  bearberry  leaves — Uvoeursi  folia. 
The  therapeutics  of  the  infusion  of  bearberry  have  long  been 
known,  and  Dr.  H.  Menche  has  now  given  his  experience 
of  arbutin  as  a  remedial  agent  ( Centralblatt  fur  Klin.  Med., 
No.  27).  He  finds  that  it  acts  in  many  cases  as  a  valuable 
diuretic.  Large  doses  may  be  administered  without  any  ill 
effects.  It  passes  out  in  the  urine  partly  in  the  form  of 
hydrochinon,  which  is  closely  allied  chemically  to  phenol. 
Urine  containing  hydrochinon  becomes,  by  standing,  of  an 
olive-green  colour,  just  as  happens  in  carboluria.  Arbutin 
is  of  service  in  urethritis  even  of  a  specific  nature.  Brieger 
has  employed  a  solution  of  hydrochinon  as  an  injection  in 
gonorrhoea,  but  the  internal  administration  would  seem  to 
answer  the  same  purpose.  Arbutin  is  a  glucosate  (a  com¬ 
pound  of  glucose  with  an  acid — e.g.,  tannin),  and  occurs  as 
fine  white  stable  acicular  crystals  soluble  in  water,  of  neutral 
reaction,  odourless,  and  of  slightly  bitter  taste.  The  best 
mode  of  administration  is  in  the  form  of  powder  dissolved 
in  a  tablespoonful  of  water.  Patients  did  not  complain  of  its 
taste. 


THE  METROPOLITAN  BOARD  OP  WORKS1  REPORT  FOR  1882. 
In  presenting  the  annual  report  of  their  proceedings  for  the 
year  1882,  the  Metropolitan  Board  of  Works  consider  it 
appropriate  to  call  attention  to  the  remarkable  growth  and 
extension  of  their  functions,  as  indicated  by  the  number 
and  variety  of  the  statutes  under  which  they  act.  In  the 
year  1856  (the  first  of  the  Board’s  existence)  there  were 
only  two  Acts  of  Parliament  conferring  jurisdiction  on  the 
Board — the  Metropolis  Local  Management  Act,  and  the 
Metropolitan  Building  Act,  both  passed  in  the  year  1855. 
The  duties  of  the  Board  under  the  first  of  these  statutes 
consisted  mainly  of  making  and  maintaining  main  sewers, 
as  distinguished  from  local  sewers,  which  were  placed  under 
the  control  of  the  vestries  and  district  boards ;  regulating 
the  formation,  width,  and  numbering  of  new  streets ;  and 
acting  as  an  appellate  and  controlling  authority  over  the 
vestries  and  district  boards.  Under  the  second  statute  the 
Board  was  entrusted  with  the  function  of  seeing  that  the 
rules  laid  down  by  Parliament  to  govern  the  erection  of 
buildings  throughout  the  metropolis  were  carried  out.  In 
the  course  of  two  or  three  years  other  Acts  of  Parliament 
were  passed,  extending  the  operation  of  the  original  statutes, 
and  conferring  new  powers  upon  the  Board ;  and  as,  with 
the  progress  of  time,  the  range  of  questions  brought  within 
the  province  of  municipal  administration  has  been  enlarged, 
the  Board’s  powers  and  responsibilities  have  been  increased, 
until  they  now  embrace — in  addition  to  what  is  provided  for 
in  the  original  statutes,  and  to  great  urban  improvements, 
such  as  the  river  embankments  and  new  streets,  for  which 
special  Acts  of  Parliament  have  been  passed — such  various 
matters  as  the  formation  and  maintenance  of  bridges  over 
the  Thames  ;  the  clearing  of  unhealthy  and  densely  crowded 
areas ;  the  acquisition  and  maintenance  of  parks,  gardens, 
and  suburban  commons  ;  the  supervision  of  the  gas  and 
water  supply,  and  of  the  construction  of  theatres  and  places 


44 


Medical  Times  an  d  Gazette. 


THE  WEEK. 


July  14,  1883. 


of  public  amusement ;  the  extinction  of  fires  and  saving  of  life 
and  property  in  case  of  fire  ;  the  regulation  of  tramways,  of 
slaughterhouses,  cowhouses,  and  dairies,  and  of  places  where 
offensive  businesses  are  carried  on ;  the  prevention  of  con¬ 
tagious  diseases  among  animals ;  and  the  regulation  of  the 
storage  and  sale  of  inflammable  and  explosive  substances. 
It  will,  therefore,  excite  but  little  surprise  when  it  is  stated 
that  the  report  under  notice  forms  a  small  volume  of  nearly 
two  hundred  pages,  since  it  has  to  record  under  each  of  the 
foregoing  heads  the  transactions  which  have  taken  place 
during  the  previous  twelve  months.  The  Board,  it  should 
be  stated,  consists  of  a  chairman  and  forty-five  representa¬ 
tive  members  elected  by. the  authorities  of  the  City  of  London, 
and  the  various  parishes  and  districts  of  the  metropolis,  and, 
taking  into  consideration  the  number  and  diversity  of  the 
duties  imposed  upon  it,  it  may  be  said  to  have  performed  its 
work  fairly  well.  But  it  is  constantly  being  suggested  in 
Parliament  that  new  powers  be  given  to  it,  or  fresh  depart¬ 
ments  handed  over  to  its  jurisdiction,  and  it  would  certainly 
be  wise  to  recognise  at  once  that  it  has  already  quite  as  much 
to  do  as  can  be  well  done,  however  willing  its  members  may 
be  to  accept  additional  control ;  and,  if  anybody  doubts  this, 
we  would  recommend  them  to  go  carefully  through  the 
report  which  is  the  subject  of  the  present  notice. 


IS  LUPTJS  TUBERCULOSIS  ? 

At  page  531  of  our  last  volume  we  noticed  some  experiments 
performed  by  Pagenstecher  and  Pfeiffer  on  rabbits,  which 
went  to  prove  that  lupus  was  practically  a  local  tuberculosis. 
The  only  link  in  the  chain  which  was  then  wanting,  accord¬ 
ing  to  Pfeiffer,  was  the  demonstration  of  bacilli  in  the 
growth  of  the  human  patient.  H  e  has  recently  finished  up 
this  point  by  finding  the  characteristic  bacilli  in  two  sections 
out  of  eight  preparations  made  by  freezing  a  portion  of  the 
new  growth  removed  from  the  girl’s  conjunctiva,  and  cutting 
thin  sections  with  the  microtome.  Only  six  to  eight  bacilli 
were  found  in  one,  and  but  two  in  the  other  preparation. 


THE  INFLUENCE  OF  SOCIAL  POSITION  ON  THE  DEATH-RATE. 
Since  the  commencement  of  the  present  year  the  Registrar- 
General  for  Ireland  has  included  in  his  weekly  return  a 
table  showing,  in  five  general  classes  and  eighteen  groups, 
the  occupations  or  social  position  of  the  persons  whose 
deaths  are  registered  week  by  week  in  the  Dublin  Registra¬ 
tion  District,  the  annual  death-rate  represented  by  the 
deaths  registered,  the  number  of  deaths  at  each  of  six 
periods  of  life,  and  the  number  from  each  of  the  principal 
causes  of  death.  This  table  has  already  supplied  some  sug¬ 
gestive  and  instructive  information.  Thus,  the  second 
quarterly  return  for  1883  shows  that  in  the  thirteen  weeks 
ending  June  30,  1883,  the  number  of  deaths  registered  in 
the  Dublin  Registration  District  (the  total  area  of  which  is 
24,710  statute  acres,  and  the  population  of  which,  estimated 
to  the  middle  of  this  year,  is  349,685)  amounted  to  2674 — 
1294  males  and  1380  females, — affording  an  annual  ratio  of 
1  in  32-7,  or  30-6  in  every  1000  of  the  estimated  population. 
The  deaths  in  families  of  the  “  professional  and  indepen¬ 
dent  class  ”  were  equal  to  an  annual  rate  of  24\3  per  1000 
of  the  persons  in  that  class ;  in  the  “  middle  class  ”  the 
death-rate  was  26’8  per  1000;  among  the  “  artisan  class 
and  petty  shopkeepers  ”  it  was  23'6 ;  and  in  the  “  general 
service  class  ”  and  the  “  inmates  of  workhouses  ”  com¬ 
bined  it  was  38 '6.  Among  the  last  division — “  inmates  of 
workhouses  ” — taken  separately,  the  rate  was  as  high  as 
43'6  per  1000  per  annum  ;  whereas  among  the  subdivision 
of  the  professional  and  independent  class  entitled  “persons 
of  rank  and  property,  not  otherwise  described”  (numbering 
19,030),  the  death-rate  was  only  18’ 5. 


THE  PARIS  WEEKLY  RETURN. 

The  number  of  deaths  for  the  twenty-sixth  week  of  1883, 
terminating  June  28,  was  1042  (589  males  and  473  females), 
and  of  these  there  were  from  typhoid  fever  44,  small-pox 
10,  measles  31,  scarlatina  none,  pertussis  22,  diphtheria 
and  croup  42,  erysipelas  7,  and  puerperal  infections  3. 
There  were  also  39  deaths  from  tubercular  and  acute 
meningitis,  187  from  phthisis,  31  from  acute  bronchitis,  66 
from  pneumonia,  98  from  infantile  athrepsia  (45  of  the 
infants  having  been  wholly  or  partially  suckled),  and  36 
violent  deaths  (29  males  and  7  females).  The  mortality 
continues  to  diminish,  and  is  now  at  about  its  normal  mean- 
Such  diminution  has  occurred  in  all  ages,  even  infants 
of  less  than  a  year  old,  who  are  generally  much  tried  by  the 
heat  of  the  season,  having  participated  in  it.  There  is  some 
fear,  however,  that  typhoid  fever  is  about  to  increase  its 
ravages,  for  not  only  have  there  been  41  deaths  registered  in 
place  of  36  of  last  week,  but  the  admissions  to  the  hospitals 
for  it  have  risen  from  99,  96,  and  72  in  the  three  preceding 
weeks  to  122,  while  the  reports  of  private  practitioners  show 
a  similar  increase  of  cases.  Infantile  athrepsia  is  more 
rare  than  is  usual  at  this  time  of  the  year.  The  births  for 
the  week  amounted  to  1213,  viz.,  610  males  (435  legitimate 
and  175  illegitimate)  and  603  females  (440  legitimate  and 
163  illegitimate)  :  91  infants  were  either  born  dead  or  died 
within  twenty-four  hours,  viz.,  44  males  (34  legitimate 
and  10  illegitimate)  and  47  females  (31  legitimate  and  16 
illegitimate). 


THE  DETENTION  IN  HOSPITALS  ACT. 

The  text  of  the  Government  Bill  for  the  detention  in  hospital 
of  women  affected  with  contagious  diseases  has  now  been 
made  public.  The  preamble  sets  forth  the  desirability  of 
making  a  provision  similar  to  that  which  already  exists  for 
workhouses,  under  the  Poor-Law  Amendment  Act  of  1867. 
The  Bill  then  proposes  to  authorise  the  chief  medical  officer 
of  a  certified  hospital  within  the  specified  limits  to  detain 
there  any  woman  who  is  therein,  and  is  suffering  from  a 
contagious  disease,  until  he  certifies  that  she  is  in  a  condi¬ 
tion  to  be  discharged.  The  patient  is,  however,  to  have 
a  right  of  appeal  to  a  justice,  and  he  will  order  her  dis¬ 
charge  if  he  be  satisfied  upon  reasonable  evidence  that 
she  is  free  from  a  contagious  disease.  If  a  woman  leaves 
a  hospital  without  authority  she  may  be  apprehended 
without  warrant,  and  taken  back  to  the  hospital  by  any 
person  authorised  by  the  chief  medical  officer.  When  a> 
woman  has  been  under  medical  treatment  in  a  certified 
hospital,  she  will,  on  her  discharge,  be  entitled  to  be  sent, 
without  expense  to  herself,  to  her  ordinary  place  of  resi¬ 
dence,  if  that  be  situate  in  any  of  the  scheduled  places,  or 
within  ten  miles  of  them.  Efficient  inspection  of  the  certi¬ 
fied  hospitals  is  to  be  provided  by  the  Admiralty  and  the 
Secretary  for  War,  and  the  same  authorities  are  to  make 
regulations  for  the  preservation  of  order  in  them.  Finally, 
the  Bill  proposes  to  repeal  the  Contagious  Diseases  Acts, 
1866-69.  The  places  brought  within  the  scope  of  the 
measure  are — Aldershot,  Canterbury,  Chatham,  Colchester, 
Dover,  Gravesend,  Maidstone,  Plymouth,  Devonport,  Ports¬ 
mouth,  Sheerness,  Shorncliffe,  Southampton,  Winchester, 
Windsor,  Woolwich,  the  Curragh,  Cork,  and  Queenstown. 


THE  NAVAL  MEDICAL  SUPPLEMENTAL  FUND. 

At  the  quarterly  meeting  of  the  directors  of  the  Naval 
Medical  Supplemental  Fund,  held  on  the  10th  inst..  Sir 
W.  R.  E.  Smart,  K.C.B.,  M.D.,  Inspector- General,  in  the 
chair,  the  sum  of  <£90  was  distributed  among  the  several 
applicants. 


Medical  Times  and  Gazette. 


THE  WEEK. 


July  14, 1883.  45 


ON  WORD-BLINDNESS. 

Of  the  many  varieties  of  aphasia  there  is  none,  perhaps, 
which  admits  of  being  studied  so  completely  as  the  condi¬ 
tion  known  as  word-blindness.  In  the  ordinary  forms  of 
aphasia  the  difficulty,  or  sometimes  impossibility,  of  com¬ 
prehending  what  the  patient  wishes  to  make  known,  con¬ 
stitutes  a  souroe  of  error  which  cannot  be  altogether 
•excluded.  In  the  case  of  word-blindness,  however,  this 
difficulty  does  not  arise,  and  a  scientific  investigation  of  the 
nature  of  this  symptom  is  in  consequence  possible.  In  the 
Progres  Medical,  Nos.  23  and  24,  there  is  a  lecture  by  M. 
Charcot  on  this  somewhat  rare  symptom.  The  patient 
whose  case  formed  the  basis  of  the  lecture  was  a  man, 
aged  thirty-five,  with  no  known  tendency,  hereditary  or 
acquired,  to  nervous  disease.'  The  commencement  of  his 
illness  had  been  sudden — loss  of  power  on  the  right  side 
of  the  body  being  the  first  thing  noticed,  followed  in  a 
few  minutes  by  loss  of  consciousness.  On  coming  to 
himself  again  he  found  that  he  had  right  hemiplegia  and 
aphasia.  When  he  came  under  M.  Charcot’s  observation, 
some  months  later,  these  symptoms  had  mainly  passed  off; 
he  had,  however,  right  lateral  hemiopia,  and  he  could  not 
read ;  he  could  write  well,  and  seldom  made  a  mistake,  but 
could  not  read  what  he  had  written  even  just  before.  In 
order  to  make  out  the  writing  he  was  obliged  to  form  each 
letter  separately  with  his  finger  on  a  piece  of  paper,  and 
pronounce  it  to  himself  as  he  went  along,  and  in  this  manner 
he  could  spell  out  words ;  if  his  hands  were  placed  behind 
his  back  he  still  traced  out  the  letters  with  his  finger  in  the 
air.  He  experienced  much  greater  difficulty  in  decipher¬ 
ing  printed  letters  than  ordinary  handwriting.  Thus  this 
patient  had  no  loss  of  memory  for  words,  no  loss  of 
understanding — he  understood  what  was  said  to  him  and 
what  he  said  to  others,  and  what  he  wrote,  perfectly, 
only  he  could  not  interpret  the  words  which  he  could 
nevertheless  see  quite  distinctly.  After  alluding  to  the 
previously  recorded  cases  in  which  the  symptom  had  been 
noted,  M.  Charcot  pointed  out  that  the  inferior  parietal 
lobule  was  most  probably  the  seat  of  the  lesion  in  such  cases, 
and  that  the  theory  of  such  a  localisation  received  confir¬ 
mation  rather  than  otherwise  from  the  coexistence  of  the 
hemiopia,  for  when  this  had  been  present  as  a  result  of 
cortical  cerebral  lesion,  such  lesion  had  usually  been  found 
to  occupy  very  much  the  same  area.  As  regarded  the  exact 
pathological  change  in  this  instance,  he  thought  the  pro¬ 
bable  sequence  of  events  had  been  plugging  of  the  Sylvian 
artery  and  its  branches  from  some  cause  which  could  not 
be  determined,  and  that  the  first  three  branches  had  re¬ 
covered,  the  fourth  or  parietal  remaining  impervious.  We 
ought  to  add,  in  conclusion,  that  the  patient  improved  very 
much  under  treatment,  so  that  at  the  end  of  a  month  he 
was  able  to  read  just  twice  as  fast  as  he  had  been  able  to  at 
the  commencement. 


THE  NIGHTINGALE  FUND. 

The  report  of  the  Nightingale  Fund  for  the  year  1882 
shows  that  there  were  32  probationer-nurses  in  the  school 
at  St.  Thomas’s  Hospital  on  January  1,  and  that  36  were 
admitted  during  the  year,  making  a  total  of  68.  Of  these, 
9  resigned  or  were  discharged  as  unsuitable  for  the  work, 
and  32  completed  their  year’s  training  and  received  appoint¬ 
ments.  There  remained  in  the  school  on  December  31  last 
year  27,  of  whom  10  were  special  or  lady-probationers,  and 
17  nurse-probationers.  Two  of  the  probationers  were  dis¬ 
missed  after  nearly  completing  their  year  of  training  in 
consequence  of  their  refusing  to  accept  the  situations  pro¬ 
vided  for  them  by  the  Committee.  The  Fund  possesses 
invested  capital  to  the  amount  of  =£51,200,  yielding  an  in¬ 


come  of  <£1591 ;  payments  by  special  probationers  amounted 
during  the  year  to  <£456,  and  the  balance  from  the  previous 
year  was  £1350.  The  total  of  the  expenses  was  £2047,  in¬ 
cluding  £114  paid  in  gratuities  to  certified  nurses;  and  thus 
a  balance  of  £1556  was  left  at  the  end  of  the  year.  The 
number  of  probationers  (viz.,  32)  who  completed  their  course 
of  training  and  became  certified  nurses  was  larger  than  in 
any  previous  year.  From  the  opening  of  the  school  in  June, 
1860,  to  the  end  of  1882,  a  total  of  686  candidates  have  been 
admitted  ;  and  414  have  left  the  school,  after  completing  a 
year’s  training,  as  certified  nurses. 


THE  AMERICAN  MEDICAL  ASSOCIATION. 

This  body  held  its  thirty-fourth  meeting  at  Cleveland,  Ohio, 
under  the  presidency  of  Dr.  John  Atlee,  June  5  to  8,  which 
seems  to  have  been  fairly  successful  without  being  in  any 
wise  remarkable.  The  President,  regarding  himself  as  a 
“  rare  specialty,  namely,  in  being  a  graduate  of  sixty -three 
years’  standing,”  made  his  address  consist  of  an  interesting 
reminiscence  of  the  American  medical  celebrities  whom  he 
had  known  during  that  period.  Washington  has  been  chosen 
as  the  place  of  meeting  for  1884,  and  Professor  Austin  Flint 
was  chosen  President-elect  with  enthusiasm.  The  Trans¬ 
actions  of  the  Association  are  to  be  discontinued — their  place 
to  be  supplied  by  a  weekly  Journal  of  the  American  Medical 
Association,  to  be  published  at  Chicago,  under  the  editorship 
of  Dr.  Davis. 


ON  THE  QUESTION  OF  OPERATIVE  PROCEEDINGS  IN  DISEASES 

OF  THE  LUNGS. 

In  continuation  of  a  former  contribution  on  this  subject  in 
the  Nordisld  Medicinskt  Arlciv,  Dr.  Bull,  of  Christiania,  com¬ 
municates,  in  a  recent  number  of  the  same  journal,  an 
interesting  case  bearing  upon  the  above  question.  He  also 
gives  a  brief  review  of  the  literature  relating  to  the  opera¬ 
tions  hitherto  performed  in  diseases  of  the  lungs,  together 
with  some  observations  on  the  indications  connected  with  the 
opening  of  tuberculous  cavities,  and  he  draws  attention  to 
some  new  possibilities  of  limited  expiratory  expansion  of  the 
pectoral  wall.  The  case  was  that  of  a  man,  twenty-nine 
years  old,  who  entered  the  State  Hospital  of  Christiania, 
exhibiting  all  the  signs  of  advanced  pulmonary  tuberculosis, 
such  as  hectic  fever,  violent  cough,  abundant  muco-purulent 
expectoration,  emaciation,  and  anaemia.  In  the  first,  and 
partly  in  the  second  left  intercostal  space,  external  to  the 
left  sternal  border,  there  was  observed  during  the  fits  of 
coughing  a  considerable  and  clearly  limited  expansion  of  the 
pectoral  coverings,  which  circumstance  was  not  observed  in 
tranquil  breathing.  This  limited  expiratory  expansion  was 
considered  due  to  a  superficial  cavity  adherent  to  the  thorax 
and,  perhaps,  ulcerated  by  the  pleural  adhesion.  Viewing 
the  possibility  of  the  suspected  cavity  offering  an  advanced 
process  of  ulceration ;  of  the  secretion,  incompletely  expec¬ 
torated,  flowing  into  the  neighbouring  bronchi ;  considering 
that  the  fever  and  the  cough  were  partly  relieved  by  the 
opening  of  the  cavity  externally  by  means  of  drainage  and 
disinfection,  and  that  the  expiratory  expansion  in  front 
might  perhaps  indicate  a  commencing  perforation  of  the 
thoracic  wall ; — taking  all  these  matters  into  consideration  it 
was  determined,  with  the  consent  of  the  patient,  to  try  the 
operation.  This  was  accordingly  performed,  and  after  the 
perforation  of  the  thoracic  wall  the  finger  could  be  intro¬ 
duced  into  a  small  empty  cavity,  limited  on  all  sides  by 
smooth  walls,  and  the  base  of  which  was  formed  by  a  solid 
elastic  tissue.  There  was  no  sound  of  air  entering  or 
going  out.  The  day  after  the  operation,  during  a  fit  of 
coughing,  there  was  a  sudden  discharge  by  the  wound  of 
a  liquid  like  that  of  expectoration,  and  this  discharge 


46 


Medical  Times  and  Gazette. 


THE  WEEK. 


July  14, 18 S3. 


continued  abundant,  but  without  relief  to  the  patient.,  and 
death  ensued  in  six  days.  On  post-mortem  examination 
the  left  lung  was  found  to  be  separated  almost  entirely 
from  three  to  four  centimetres  from  the  thoracic  wall,  and 
there  were  only  a  few  filiform  adhesions  with  the  upper  parts. 
There  was  fibrinous  pleurisy  and  a  little  pus  in  the  pleural 
cavity.  At  the  apex  of  the  lung  there  was  a  large  super¬ 
ficial  cavity.  In  other  respects  in  both  the  lungs  there 
were  the  usual  indications  of  phthisis.  The  differential 
diagnosis  between  a  cavity  and  a  pneumothorax  in  cases  such 
as  the  above  cannot  be  made  with  certainty,  and  consider¬ 
ing  the  possibility  of  mistake.  Dr.  Bull  advises  that  pul¬ 
monary  operations  should  always  be  performed  with  the 
aid  of  antiseptics,  so  that  if  the  incision  reveals  a  pneumo¬ 
thorax  the  wound  may  then  be  closed  and  the  operation 
be  regarded  only  as  “  diagnostic.”  Dr.  Bull  has  found  in 
medical  literature  the  records  of  nineteen  cases  in  which 
the  opening  of  pulmonary  cavities  has  been  undertaken. 
Five  of  these,  however,  are  imperfectly  reported  or  the 
diagnosis  was  too  doubtful  to  be  of  any  service.  Of  the 
rest  of  the  cases,  two  were  instances  of  bronchiectatic 
cavities,  one  was  a  case  of  bronchiectatic  cavity  and  a 
cavity  consecutive  to  pneumonia,  five  'were  cases  of  pul¬ 
monary  abscess,  three  of  pulmonary  gangrene,  two  of  tuber¬ 
culosis,  and  one  of  echinococcus  of  the  lung.  The  results 
of  the  operations  were  as  follows,  viz.  Cases  perfectly 
cured,  two;  very  marked  improvement,  two;  more  or  less 
relief,  seven ;  no  ill  consequences,  one ;  cases  made  worse, 
two.  As  to  the  tuberculous  cavities,  experience  is  almost 
entirely  wanting  as  to  the  effect  of  artificial  pulmonary  fis¬ 
tula;,  and  it  belongs  to  the  future  to  demonstrate  whether 
an  operation  of  that  kind  is  more  dangerous  in  phthisical 
patients,  but  even  when  this  proceeding  might  appear  to 
be  without  danger,  it  should  not  be  performed  at  a  too 
advanced  period  of  the  disease. 


The  Queen  has  been  graciously  pleased  to  confer  the 
honour  of  knighthood  upon  Mr.  Edwin  Saunders,  F.B.C.S. 
Eng.,  who  has  held  the  office  of  Surgeon-Dentist  to  Her 
Majesty  for  thirty-seven  years. 


If  we  are  not  misinformed.  Her  Majesty  the  Queen  is 
shortly  about  to  confer  a  mark  of  her  Royal  favour  on  a  dis¬ 
tinguished  member  of  the  medical  profession  who  has  been 
for  several  years  one  of  her  household  in  Ireland. 


The  French  Government  have  just  appointed  Madame 
Frary  Gross  to  be  a  "  Chevalier”  of  the  Legion  of  Honour,  in 
recognition  of  the  great  devotion  she  showed  as  director  of 
the  Hotel-de-Ville  Ambulance  during  the  siege  of  Paris, 
twelve  years  ago. _ 

The  Home  Secretary  has  consented  to  receive  a  joint 
deputation  from  the  Canterbury,  Dover,  Maidstone,  Eltham, 
Sheerness,  and  other  Boards  of  Guardians  on  the  subject  of 
the  Contagious  Diseases  Acts.  The  deputation  will  include 
also  representatives  appointed  by  the  municipal  authorities 
of  the  various  Kentish  towns  affected  by  the  withdrawal  of 
the  Acts. 


It  is  understood  that  the  orders  of  the  Local  Government 
Board  on  the  steps  to  be  taken  to  prevent  the  spread  of 
cholera  will  be  considered  at  a  meeting  soon  to  be  held  at 
Whitehall,  at  which  Sir  William  Jenner,  Sir  Joseph  Fayrer, 
Sir  Lyon  Playfair,  and  Sir  Edmund  Currie  have  been 
invited  to  meet  representatives  of  the  Medical  Department 
of  the  Local  Government  Board,  and  of  the  Home  Office, 
the  Foreign  Office,  and  the  Customs. 


The  Hospital  Sunday  Fund  for  this  year  now  amounts  to 
about  ,£32,600.  Among  the  contributions  lately  received, 
are — From  the  Chief  Rabbi,  ,£664  (including  collections  from 
the  Great  Synagogue,  £247 ;  Central  Synagogue,  £104;  North. 
London  Synagogue,  £33;  Bayswater  Synagogue,  £74;  New 
West-end  Synagogue,  £69;  St.  John’s-wood  Synagogue* 
£33;  and  New  St.  Helen’s  Synagogue,  £21).  From  the 
West  London  Synagogue  (Rev.  Professor  Marks)  the  sum. 
of  £197  has  been  received;  and  the  Corporation  of  the  City 
of  London  have  sent  in  £105. 


We  learn  from  Paris  that  M.  Pasteur  has  offered  to> 
organise  a  mission  for  investigating  the  cholera  in  Egypt  ; 
and  that  the  Hygiene  Commission  approved  and  recom¬ 
mended  his  plan.  The  mission  will  consist  of  MM.  Roux 
and  Thuillier,  of  Pasteur’s  laboratory ;  M.  Strauss,  of  the 
Faculty  of  Medicine;  and  M.  Nolaco.  M.  Pasteur  has 
written  to  Lord  Granville  to  ask  the  good  offices  of  the 
English  in  facilitating  the  work  of  the  mission  in  Egypt. 


A  considerable  increase  of  the  cases  of  typhoid  fever  in 
Paris  is  reported.  There  were  122  admissions  to  the  hos¬ 
pital  in  the  week  ending  the  30th  ult.,  against  72  the 
previous  week ;  and  the  deaths  were  41,  against  36. 


It  is  stated  that  as  many  as  270  candidates  have  entered 
their  names  for  the  final  examination  for  the  diploma  of 
membership  of  the  Royal  College  of  Surgeons. 


The  Industrial  Dwellings  Company,  of  which  Sir  Sydney 
Waterlow,  M.P.,  is  chairman,  have  obtained  more  than  an 
acre  of  land  in  Soho,  having  frontages  to  the  new  street 
that  is  to  run  from  Charing-cross  to  Oxford-street.  On 
this  space  the  Company  propose  to  erect  nearly  1000  rooms. 


The  London  Sanitary  Protection  Association  will  hold  a. 
meeting  in  the  Kensington  Town  Hall  on  Tuesday,  the  17th 
inst.,  at  8.30  p.m.,  when  the  newly  elected  President  (the 
Duke  of  Argyll)  will  take  the  chair,  and  will  deliver  an 
address  on  House  Sanitation. 


At  a  meeting  of  the  managers  of  the  Royal  Infirmary  of 
Edinburgh,  held  on  Monday  last,  Mr.  J.  M.  Cotterill,  M.B.y 
C.M.  Edin.,  F.R.C.S.  Edin.,  University  Clinical  Surgery 
Tutor,  was  elected  to  the  post  of  Assistant-Surgeon  to  that 
charity.  _ 

Mr.  Jonathan  Hutchinson  has  retired  from  active  duty 
as  Surgeon  to  the  London  Hospital,  his  term  of  office  having 
expired,  and  has  been  appointed  Consulting  Surgeon.  We 
believe  that  arrangements  are  contemplated  by  which  the 
services  of  this  distinguished  surgeon  as  a  teacher  will  not. 
be  entirely  discontinued.  Mr.  Hutchinson  will  be  succeeded 
in  the  care  of  in-patients  by  Mr.  McCarthy,  at  present 
surgeon  in  charge  of  out-patients. 


We  are  informed  that  Dr.  Hilton  Fagge  has  been 
appointed  Physician  to  the  Deaf  and  Dumb  Asylum. 


We  understand  that  a  vacancy  will  shortly  occur  on  the 
medical  staff  of  St.  Bartholomew’s  Hospital,  owing  to  the 
acceptance  by  Dr.  Reginald  Southey  of  a  Commissionership- 
in  Lunacy,  in  place  of  Dr.  Robert  Nairne,  resigned. 


The  Library  of  the  Royal  College  of  Surgeons  will  be 
closed  for  the  purposes  of  the  examinations  on  Friday,  the 
13th,  and  Saturday,  the  14th  inst. 


Medical  Times  and  Gazette. 


MEDICAL  MATTERS  IN'  PARLIAMENT. 


July  14, 1883.  47 


MEDICAL  MATTERS  IN'  PARLIAMENT. 


House  of  Lords — Thursday,  July  5. 

The  Medical  Act  (1858)  Amendment  Bill  was  read  a  third 
time. 

House  of  Commons — Friday,  July  6. 

The  German  Vaccination  Laws. — Dr.  Cameron  asked  the 
Secretary  to  the  Local  Government  Board  whether  his  atten¬ 
tion  had  been  called  to  a  statement  in  the  Konigliche  Privi- 
legirta  Berlinische  Zeitung  regarding  certain  tables  recently 
issued  by  the  German  State  Health  Office,  illustrating  the 
working  of  the  Vaccination  Laws  in  Germany;  and  whether 
he  would  have  the  goodness  to  procure  a  copy  of  the  tables 
for  the  library  of  the  House  ?— Mr.  G.  Russell  replied  that 
the  attention  of  the  Board  had  not  previously  been  called  to 
the  tables  referred  to,  but  they  had  communicated  with  the 
Secretary  of  State  for  Foreign  Affairs,  with  the  object 
of  obtaining  a  copy  for  the  library  of  the  House. 

The  Dwellings  of  the  Poor. — Mr.  Ashmead-Bartlett  asked 
whether  the  Government  would  give  an  opportunity  during 
the  present  session  for  a  discussion  upon  the  dwellings  of 
the  poor,  and  especially  for  the  consideration  of  a  scheme 
for  the  provision  of  houses  with  land  and  recreation-ground 
in  the  rural  suburbs  of  the  large  towns. — Mr.  Gladstone  said, 
in  reply :  I  am  bound  to  say  that  the  Government  could  not 
engage,  in  the  present  state  of  public  business,  to  set  aside 
any  other  business  for  the  purpose  of  such  a  discussion, 
or,  I  may  say  generally,  of  any  discussion,  except  it  has 
reference  to  legislation  of  the  present  session. 

The  Cholera  in  Egypt. — Lord  E.  Fitzmaurice,  in  reply  to 
questions  by  Sir  H.  Wolff  and  Sir  W.  Barttelot,  said  if  the 
House  desired  information  as  to  the  measures  taken  for  the 
suppression  of  the  cholera  in  Egypt,  he  would  give  a  short 
statement  on  the  subject  on  Monday.  The  Government 
had  not  heard  of  any  deaths  from  cholera  in  either  the 
Egyptian  or  the  English  army. 

Monday,  July  9. 

Surgeons  of  the  Irish  Prisons. — Mr.  Gibson  asked  the 
Chief  Secretary  to  the  Lord  Lieutenant  of  Ireland  whether 
the  Government  had  arrived  at  any  decision  respecting  the 
claim  of  the  surgeons  of  Irish  prisons  for  additional  remunera¬ 
tion  for  the  extra  work  thrown  upon  them  under  the  Peace 
Preservation  Acts  ;  whether  the  Irish  prison  surgeons  were 
not  promised  by  the  Executive  that  they  should  be  suitably 
remunerated  for  this  extra  work ;  and  whether  any  other 
offer  had  been  made  to  them  on  the  subject. — Mr.  Trevelyan 
replied :  The  Government  have  decided  that  claims  of  this 
character,  merely  on  the  ground  of  a  temporary  increase  of 
work,  cannot  be  entertained ;  but  the  cases  of  any  prison 
officers  who  can  show  that  they  were  put  to  any  expense 
will  be  specially  considered.  I  am  not  aware  that  any 
promise  of  extra  pay  was  made  to  the  prison  surgeons,  or 
that  any  special  offer  has  been  made  to  them . 

Cholera  in  Indian  Ports. — In  reply  to  Mr.  O’Donnell,  Mr. 
Cross  said  cholera  had  been  little,  if  at  all,  more  prevalent 
in  Indian  ports  during  the  last  six  months  than  it  usually 
is.  In  Calcutta  the  deaths  in  April  were  459  against  318  in 
April,  1882  ;  in  May  they  were  383  against  380  in  May  last 
year;  and  in  June  150  against  254.  The  health-statement 
of  Indian  ports  is  regularly  telegraphed  fortnightly  for  com¬ 
munication  to  the  Sanitary  Boards  in  the  Levant;  and  the 
cholera  deaths  in  Bombay  are  telegraphed  weekly  to  the 
Consul-General  at  Cairo.  Her  Majesty’s  Government  had 
objected  to  the  imposition  of  special  measures  of  quarantine 
against  arrivals  from  India  with  clean  bills  of  health,  and 
having  no  suspicious  cases  on  board  after  a  voyage  of  ten 
days. 

The  Cholera  in  Egypt. — Lord  E.  Fitzmaurice,  replying  to 
a  question  from  Sir  H.  Wolff,  said  :  The  measures  taken  for 
preventing  the  spread  of  cholera  in  Egypt  are  under  the 
control  of  the  Central  Government  in  Cairo.  Sir  E.  Malet 
states  that  the  Sanitary  Board  at  Cairo  is  composed  of 
native  and  foreign  doctors,  among  whom  is  Dr.  Grant,  the 
medical  adviser  of  Her  Majesty’s  Consular  Court.  The 
Board  have  from  the  beginning  of  the  outbreak  met  every 
evening,  in  conjunction  with  the  Minister  of  the  Interior 
and  General  Baker ;  and  Sir  E.  Malet  states  that  doctors, 
medicines,  and  food  have  been  supplied  to  the  infected 
places,  and  he  expresses  the  opinion  that  the  Government 


have  done  all  in  their  power  to  stamp  out  the  disease.  As 
regards  Alexandria,  Consul  Cookson  states  that  a  Commis¬ 
sion  has  been  hard  at  work  inspecting  nuisances  and  sug¬ 
gesting  sanitary  measures,  and  he  trusts  that  good  results 
will  follow  the  appointment  of  sub-committees,  to  whom  the 
Government  have  left,  on  Mr.  Cookson’s  advice,  great  lati¬ 
tude  of  action.  An  independent  British  Committee  has, 
moreover,  been  formed  to  visit  the  houses  of  British  and 
Maltese  residents.  The  infected  houses  have  been  iso¬ 
lated  by  cordons  of  police.  With  regard  to  the  steps 
taken  by  Her  Majesty’s  Government,  a  Departmental 
Committee  has  been  appointed  by  the  President  of  the 
Local  Government  Board  on  cholera  precautions  generally, 
and  a  competent  medical  authority  is  about  to  be  des¬ 
patched  to  Egypt.  The  Egyptian  Government  has  been 
informed  of  the  desire  of  Her  Majesty’s  Government 
to  afford  them  every  assistance. — Mr.  O’Donnell  inquired 
whether  the  late  decrease  in  the  number  of  deaths  at 
Damietta  was  not  due  to  the  fact  that  many  thousands 
of  persons  had  taken  refuge  in  the  surrounding  villages,  and 
whether  unregistered  deaths  were  not  now  occurring  every¬ 
where  over  a  large  space  of  country  in  small  villages :  to- 
which  Lord  E.  Fitzmaurice  replied  that  he  could  not  give 
detailed  information  as  to  the  latter  point ;  but  that  as  to  the 
former,  it  appeared  that  the  cholera  cordon  had  been  in 
some  places  so  strictly  kept  that  painful  scenes  had  resulted. 
In  Damietta  the  daily  number  of  deaths  had  slowly  but 
steadily  diminished  from  141  on  July  1  to  eighty-eight  on 
the  8th.  In  the  Mansourah  district  the  daily  number  of 
deaths  from  cholera  had  decreased  from  sixty- eight  on 
July  5  to  forty-eight  on  July  8.  In  three  other  districts, 
there  had  been  a  slight  increase  of  mortality. 

Tuesday,  July  10. 

Precautions  against  Cholera. — Viscount  Folkestone  asked 
the  President  of  the  Local  Government  Board  what  precau¬ 
tions  were  proposed  to  be  taken  to  prevent  the  importation 
of  cholera  by  the  ships  carrying  the  Indian  mails  and  other 
ships  arriving  in  England  through  the  Suez  Canal  or  from 
any  Egyptian  port. — In  reply.  Sir  Charles  Dilke  referred  to 
the  opinions  of  Mr.  Simon  on  the  subject  of  quarantine.  He 
said  :  In  the  eighth  annual  report  of  the  Medical  Officer  of 
the  Privy  Council  (Mr.  Simon),  laid  before'Parliament  at  the 
time,  and  again  in  1879,  will  be  found  a  full  examination  of 
the  value  of  quarantine  as  against  cholera.  Mr.  Simon 
pointed  out  that  “  a  quarantine  which  is  ineffective  is  a  mere 
irrational  derangement  of  commerce,  and  a  quarantine  of 
the  kind  which  insures  success  is  more  easily  imagined  than 
realised.  .  .  .  Quarantine  purporting  to  be  effectual  cannot 
rest  satisfied  with  excluding  from  entry  such  persons 
as  are  obviously  sick,  but  indispensably  for  its  purpose 
must  also  refuse  to  admit  the  healthy  till  they  have 
passed  in  perfectly  non-infectious  circumstances  at  least  as 
many  days  of  probation  as  the  disease  can  have  days  of 
incubation  or  latency.  ...  In  1832-33,  when  some  sort  of 
quarantine  was  adopted  here,  the  results  gave  no  encour¬ 
agement  to  a  repetition.  .  .  .  The  thought  of  quarantine  in 
England  became  more  and  more  obsolete,  and  the  possi¬ 
bility  of  enforcing  it,  if  ever  so  much  desired,  fell  more  and 
more  towards  nothingness.  ...  I  daresay  that  quarantine  in 
England  was  never  otherwise  than  very  lax.  At  all  events,  for 
many  years  past  it  has,  in  a  medical  sense,  been  abolished.” 
Quarantine,  meaning  by  the  word  a  system  which  professes 
to  prevent  the  entry  into  a  country  of  persons  coming  from 
another  country  until  assurance  is  attained  that  no  infection 
can  be  introduced  by  those  persons,  is  not  now  regarded  by 
the  English  Medical  Department  as  capable  of  fulfilling  its 
intentions,  and  its  least  failure  to  exclude  infection  is  seen  to 
make  the  whole  system  irrational.  Accordingly,  England, 
which  long  ago  abandoned  the  system  as  of  any  avail 
against  cholera,  has  now  the  consent  of  most  European 
nations  (as  expressed  by  their  delegates  to  the  Vienna  Con¬ 
ference  of  1874)  in  preferring  for  the  defence  of  her  ports 
another  system,  which,  under  the  name  of  “  medical  inspec¬ 
tion,”  aims  at  obtaining  the  seclusion  of  actually  infected 
persons,  and  the  disinfection  of  ships,  and  of  articles  that 
may  have  received  infection  from  the  sick.  The  details  of 
this  system  are  set  out  in  an  order  of  the  Local  Government 
Board,  in  which  provision  is  made  for  the  detention  of  ships 
at  appointed  places,  for  the  visiting  and  medical  examination 
of  ships  and  passengers,  for  the  removal  to  hospital  of  persons 
suffering  from  suspected  cholera  and  for  their  detention. 


48 


Medicfcl  Times  and  Gazette. 


MUSEUM  OF  THE  EOYAL  COLLEGE  OF  SUEGEONS. 


July  14,  1883. 


for  the  destruction  of  clothing  or  bedding,  and  for  the  puri¬ 
fication  of  the  ship.  Ever  since  1873  this  country  has  been 
thoroughly  prepared  for  the  invasion  of  cholera.  Mail 
steamers  coming  from  India  through  the  Canal  in  quaran¬ 
tine,  and  not  touching  at  any  infected  port,  would  not  be 
suspected  by  us.  Steamers  coming  direct  from  Alexandria, 
where  there  has  been  one  reported  case,  would,  owing  to 
the  length  of  the  voyage,  also  seem  safe  enough  should 
no  sickness  have  shown  itself  during  the  voyage. — Lord 
E.  Eitzmaurice,  in  reply  to  Mr.  O’Donnell,  said  :  It 
does  not  appear  whether  or  not  the  outbreak  of  cholera  at 
Menzaleh  and  other  localities  has  been  occasioned  by  fugi¬ 
tives  from  Damietta;  but  a  report  on  the  outbreak  of 
•cholera  in  Egypt,  from  a  Mr.  Mieville,  British  Delegate  to 
the  Egyptian  Marine,  Sanitary,  and  Quarantine  Board,  is 
•on  its  way  to  this  country,  and  will  be  presented  to  Parlia¬ 
ment  as  soon  as  it  is  received.  Her  Majesty’s  Government 
have  not  directed  the  employment  of  the  British  army  of 
■occupation  for  the  purpose  of  restraining  the  spread  of  the 
^disease.  They  attach  more  importance  to  sanitary  pre¬ 
cautions  than  to  cordons  of  soldiers  and  police. 


MUSEUM  OF  THE  EOYAL  COLLEGE  OF 
SUEGEONS. 


In  the  interesting  annual  report  of  the  Conservator  of  the 
•collection,  just  read  to  the  Council  of  the  Boyal  College  of 
Surgeons,  a  valuable  suggestion  has  been  made  by  Sir  James 
Paget  for  extending  still  more  the  usefulness  of  the  Museum. 
The  following  is  an  extract  from  his  letter  on  the  subject : — 

“  It  has  often  seemed  to  me  that  the  value  of  the  patho¬ 
logical  collection  of  the  College  would  be  increased  if, 
together  with  the  specimens  displaying  the  chief  facts  of 
morbid  anatomy,  there  were  also  a  collection  of  drawings, 
photographs,  and  other  such  illustrations  of  the  same  or 
•similar  facts.  However  well  any  morbid  changes  of  struc¬ 
ture  may  be  shown  in  specimens  long  preserved,  some  of 
the  characters  which  they  presented  in  their  recent  state  are 
lost.  Many  or  all  of  these  may  be  shown  in  well-executed 
■coloured  drawings,or  even  in  photographs.  Such  illustrations 
cannot  indeed  take  the  place  of  specimens  or  be  substituted 
for  them  in  the  study  or  teaching  of  morbid  anatomy,  but 
they  may  be  very  usefully  supplemental.  In  the  hope  that 
the  Museum  Committee  will  approve  the  formation  of  a 
•collection  of  original  drawings  and  other  illustrations  of 
morbid  anatomy  to  be  kept  in  the  Museum,  I  have  presented 
a  set  of  thirty-six  boxes,  of  appropriate  size  and  construc¬ 
tion,  in  which  such  a  collection  may  be  safely  kept.  I  would 
■suggest  that  the  collection  should  consist  of  original  draw¬ 
ings,  plain  or  coloured,  and  of  photographs,  whether  of 
specimens  in  the  Museum  or  of  any  other  rare  or  interesting 
illustrations  of  pathology,  but  not  of  published  plates,  such 
as  may  be  found  in  the  Library,  unless  it  be  in  instances 
in  which  such  plates  represent  specimens  in  the  Museum. 
There  are  already  in  the  Museum  numerous  original  draw¬ 
ings,  chiefly  collected  by  Sir  Astley  Cooper,  with  which  the 
.  proposed  collection  may  be  commenced ;  and  it  may  fairly 
be  hoped  that,  if  the  Committee  should  approve  the  design 
of  thus  increasing  the  value  of  the  Museum,  and  should 
make  it  known,  there  are  many  Fellows  and  Members  of 
the  College  who  will  gladly  become  contributors  to  it.” 

It  cannot  be  doubted  that  the  Fellows  and  Members  of 
the  College  will  respond  liberally  to  this  suggestion.  It  may 
he  added  that  the  unwillingness  of  Sir  James  Paget  to  accept 
the  honorarium  accorded  to  him  for  the  delivery  of  the  first 
Bradshawe  Lecture  in  December  last  was  the  occasion  of  his 
seeking  some  means  by  which  the  Museum  might  be  bene¬ 
fited  by  the  amount ;  and,  after  some  consideration,  he  finally 
■determined  upon  this  excellent  way  of  carrying  out  his  views. 
The  inauguration  of  this  collection  of  drawings  will  therefore 
always  be  associated  with  that  eloquent  exposition  of  the 
•value  of  pathological  museums. 

Amongst  the  additions  to  the  Physiological  Series  are  a 
very  interesting  series  of  dissections  made  by  Mr.  William 
Pearson,  illustrating  Mr.  Power’s  course  of  lectures  on  “  The 
Xacrimal  Apparatus  and  Accessory  Organs  of  the  Eye,” 
prepared  mostly  from  animals  procured  for  the  purpose  by 
Mr.  Power,  and  which  form  a  permanent  addition  to  the 
Museum  of  considerable  value  and  interest. 


EEECAUTIONS  IN  DUBLIN  IN  VIEW  OF  A 
THEEATENED  INVASION  OF  CHOLEEA. 


An  adjourned  meeting  of  the  Public  Health  Committee  of 
the  Corporation  of  Dublin  was  held  on  Saturday,  the  7th 
inst.,  for  the  consideration  of  the  duties  which  would  de¬ 
volve  upon  the  Committee  in  the  event  of  the 'epidemic  of 
cholera  spreading  to  this  country  from  Egypt.  The  chair 
was  occupied  by  Mr.  E.  D.  Gray,  M.P. ;  and  Dr.  F.  Xavier 
MacCabe,  Inspector  of  the  Local  Government  Board  for 
Ireland,  was  in  attendance. 

The  following  resolutions  were  adopted  : — 

That  the  Superintendent  of  Cleansing  be  requested  to 
supply  to  this  Committee  a  list  of  the  houses  with  ashpits 
attached,  of  which  he  complains,  and  that  proceedings  be 
taken  forthwith  to  have  them  structurally  altered,  and  that 
a  report  be  weekly  presented  to  the  Committee  of  the  steps 
taken  to  have  this  order  carried  out.” 

“  That  the  Cleansing  Committee  be  requested  to  consider 
whether  by  any  means  it  would  be  practicable  to  undertake 
the  cleaning  of  all  the  yards  attached  to  tenement-houses  : 
that  the  loan  of  <£3000  for  reconstruction  of  ashpits  be 
taken  up  at  once,  and  lists  be  submitted  on  Tuesday  next 
of  the  houses  to  be  dealt  with  thereunder.  That  Dr. 
Cameron  specially  instruct  the  inspectors  to  watch  carefully 
the  sale  of  fish,  vegetables,  and  fruit,  with  a  view  to  prevent 
the  sale  of  such  when  unsound  and  liable  to  give  rise  to 
diarrhoea.’ 

“  That  the  Cleansing  Committee  be  informed  that  if  the 
daily  cleansing  of  the  yards  not  now  dealt  with  cannot  be 
carried  out  by  any  other  means,  this  Committee  would  en¬ 
deavour,  under  the  circumstances,  to  advance  £500  for  that 
purpose  out  of  some  of  the  funds  at  its  disposal,  to  be  repaid 
by  them  hereafter.” 

“  That  the  question  of  the  condition  of  the  Disinfecting 
Chamber,  and  of  the  means  of  conveyance  of  the  sick  to 
hospital,  be  brought  before  the  Committee  on  Tuesday.” 

“  That  the  attention  of  the  Boards  of  Guardians  of  the 
North  and  South  Dublin  Unions  be  directed  to  Section  149 
of  the  Public  Health  (Ireland)  Act,  1878,  under  which,  in 
the  event  of  an  outbreak  of  any  dangerous  infectious  disease, 
the  duty  of  dealing  with  same  would  probably  be  transferred 
from  this  Committee  to  them,  and  that  they  be  requested 
to  take  the  subject  into  consideration,  and  be  informed  that 
this  Committee  will  be  ready  to  consult  with  them  at  any 
time  they  may  think  it  desirable,  with  a  view  to  securing 
joint  and  effective  action.” 

“  That  their  special  attention  be  directed  to  the  desira¬ 
bility  of  providing  for  hospital  accommodation  in  the  event 
of  an  outbreak.” 

The  Committee  then  adjourned. 

In  response  to  an  invitation  from  the  Sanitary  Authority 
of  the  city  of  Dublin,  the  King  and  Queen’s  College  of 
Physicians  in  Ireland  have  appointed  a  committee  to  report 
on  the  preventive  and  curative  measures  to  be  taken  in 
connexion  with  the  threatened  approach  of  cholera. 


Operation  in  Peritonitis. — In  the  number  for 
May  26,  the  Revue  Medicale  relates  a  case  which  it  desig¬ 
nates  “  as  an  example  of  how,  in  the  domain  of  affections 
of  the  abdomen,  surgery,  for  the  great  benefit  of  mankind, 
is  making  daily  encroachments  on  the  territory  of  its  old 
sister,  medicine.”  A  delicate  child  of  eight  years  of  age, 
who  had  not  had  any  serious  illness  before,  came  under 
the  care  of  Dr.  Beibel,  who  reported  the  case  to  the  Stras- 
burg  Medical  Society.  It  was  the  subject  of  a  generalised 
peritonitis,  which  by  the  tenth  day  exhibited  a  great 
amelioration.  On  that  day  a  relapse  ensued,  and  the 
disease  assumed  a  more  and  more  menacing  character,  so 
that  the  child’s  death  seemed  to  be  imminent.  Dr.  Keibel 
resolved  to  evacuate  the  effused  liquid  from  the  cavity  of 
the  peritoneum,  and  wash  it  outjwith  a  carbolic  acid  solution. 
The  abdomen  having  been  opened,  no  liquid  was  found  in 
the  peritoneum,  but  this  was  washed  out  with  tepid  carbolic 
acid,  and  the  child  eventually  recovered.  An  example  of 
peritoneal  tolerance,  at  all  events  ! 


Medical  Times  and  Gazette. 


FROM  ABROAD. 


July  14,  1883.  4$ 


THE  WORK  OE  THE  ARSENICAL  COMMITTEE 
OE  THE  NATIONAL  HEALTH  SOCIETY. 

Some  time  since  we  referred  to  the  fact  that  the  National 
Health  Society  had  appointed  a  Committee  of  medical  men 
and  chemists  to  carry  on  the  inquiry  into  the  effects  on 
health  of  arsenical  pigments  in  wall-papers  and  articles  of 
domestic  use,  which  had  been  begun  by  the  Society  of  Arts 
and  by  the  Medical  Society  of  London,  but  allowed  to  drop. 
The  whole  of  the  evidence  collected  by  those  committees 
was  placed  in  the  hands  of  that  of  the  National  Health 
Society,  and  they  have  added  and  are  still  adding  thereto. 

But  the  chief  aim  they  have  set  before  them  is  to  obtain 
some  legislative  regulation  of  the  use  of  poisonous  colours 
in  the  arts,  on  the  lines  of  that  which  already  exists  in 
Germany,  Sweden,  and  some  other  countries.  Since,  how¬ 
ever,  a  correspondence  which  passed  between  the  British 
and  Swedish  Governments  two  years  ago  showed  the  impera¬ 
tive  necessity  of  having  some  recognised  and  authorised 
test,  not  only  of  sufficient  delicacy,  but  certain  to  give  the 
same  indications  in  different  hands  and  in  all  circumstances, 
the  Committee,  after  many  hundred  trials  of  arsenic  in  dif¬ 
ferent  combinations,  and  in  the  presence  of  anilin,  etc., 
determined  on  adopting  that  of  Marsh  with  slight  modifica¬ 
tions,  as  the  use  of  a  chimney  of  non-conducting  material, 
to  concentrate  the  heat  on  one  part  of  the  tube,  and  irriga¬ 
tion  of  the  outer  portion  to  insure  complete  deposition  of 
the  arsenic.  The  chimney  and  its  cover  are  made  out  of 
the  ordinary  Daniell's  cell.  Another  modification  is  em¬ 
ployed  when  sulphur  is  found  to  be  present,  consisting  in 
the  interposition  of  a  tube  containing  charcoal  and  sodic 
carbonate,  with  an  asbestos  plug  to  retain  the  sulphur,  which 
would  interfere  with  the  reaction.  This  is  the  only  test  on 
the  evidence  of  which  they  would  allow  proceedings  at  law 
to  be  instituted  ;  but  for  use  in  ordinary  business  transac¬ 
tions  they  approve  of  Beinsch's,  conducted  in  the  manner 
they  prescribe.  Their  reports,  with  full  instructions  for  the 
conduct  of  both  tests,  have  recently  been  published  in  the 
British  Medical  Journal.  Of  course  it  is  absolutely  essen¬ 
tial  that  the  zinc  should  be  chemically  pure,  and  they  recom¬ 
mend  the  use  of  the  bars,  made  and  guaranteed  free  from 
arsenic  by  Messrs.  Johnson  and  Mathey,  of  Hatton-garden. 

Following  the  suggestion  of  the  Swedish  law,  they  specify 
the  superficies  of  papers  or  weight  of  other  objects  to  be 
subjected  to  analysis,  and  draw  the  line  between  per¬ 
missible  and  dangerous  impurity  in  these  words :  “No  paper 
should  be  passed  as  ‘  non-arsenical  ’  unless  when  treated  as 
hereafter  described  it  fail  to  yield  a  mirror,  in  a  tube  one- 
eighth  of  an  inch  internal  diameter,  sufficient  to  cut  off  at 
any  point  a  black  line  on  a  white  ground  technically  known 
as  thick  rule  (eight  to  pica) ." 

Meanwhile,  through  the  courtesy  of  Earl  Granville,  the 
Committee  have  ascertained  the  extent  and  nature  of  the 
existing  laws  on  the  use  of  poisons  in  every  European 
country,  an  abstract  of  which  by  the  Secretary  forms  one  of 
the  reports  of  the  Committee.  In  some  there  are  no  laws 
whatever;  in  others,  laws  corresponding  to  our  Sale  of 
Poisons  Act.  In  several  their  use  is  forbidden  in  connexion 
with  articles  of  food  only.  In  Holland,  anything,  however 
dangerous,  may  be  sold,  provided  the  buyer  is  fully  informed 
of  the  nature  of  the  article,  though  heavy  penalties  are  in¬ 
curred  by  neglect  to  give  such  notification .  The  Imperial  law 
of  Germany  and  that  of  Sweden  appear  most  complete  and  judi¬ 
cious,  the  former  being  almost  identical  with  that  which  has 
been  in  force  in  Prussia  for  many  years.  The  Imperial  law 
of  May  14,  1879,  deals  with  the  adulteration  or  falsification 
of  food  and  drink,  the  sale  of  diseased  or  unwholesome  meat, 
and  of  dangerous  petroleum ;  and  regulates  also  the  manu¬ 
facture  and  sale  of  all  articles  of  domestic  use,  of  whatever 
kind,  likely  to  affect  injuriously  the  health  of  individuals. 
Section  5  leaves  it  to  the  Emperor  in  Council  to  issue  orders 
from  time  to  time,  prohibiting  the  use  for  any  particular  pur¬ 
poses  of  such  colours,  substances,  etc.,  in  the  preparation  or 
packing  of  the  articles  in  question  as  may  be  deemed  injurious 
to  health,  and  to  forbid  the  employment  of  any  process  or 
mode  of  manufacture  calculated  to  produce  such  effect.  In 
accordance  with  this  section  the  Emperor  and  Council  issued 
last  year  an  order  which,  as  subsequently  amended,  came 


into  force  on  April  1  last,  specifying  the  colours  to  be  con¬ 
sidered  poisonous,  and  forbidding  the  use,  not  only  of  arseni¬ 
cal  colours,  but  of  “  colours  prepared  with  arsenic/'  or  of 
anilin  colours  if  so  prepared,  in  paper-hangings  and  all 
articles  of  dress.  Only  the  fear  of  injury  to  the  German, 
trade  in  toys  led  to  the  suspension  for  the  present  of  the 
clause  prohibiting  the  use  of  any  poisonous  pigment  in  their 
ornamentation.  Some  of  the  largest  German  anilin  works 
have  already  abandoned  the  use  of  arsenic  as  a  reducing-' 
agent,  and  where  it  is  still  employed  the  most  stringent — 
we  might  almost  say  vexatious — enactments  regulate  its  use,, 
and  have  indirectly  led  to  the  substitution  of  other  reagents. . 

Unfortunately  for  the  German  manufacturers  and  the. 
purchasers  in  other  countries,  no  such  restrictions  exist  in 
France,  where  the  wall-paper  manufacture  has  during 
recent  years  attained  enormous  proportions. 

The  Committee  having  become  possessed  of  so  much  in¬ 
formation,  purpose  the  drafting  of  a  Bill  on  the  subject,  but- 
are  at  present  undetermined  as  to  the  form  it  shall  assume, 
some  members  being  inclined  to  limit  its  scope  to  arsenical 
fabrics,  papers,  and  toys,  while  others  are  in  favour  of  a 
more  comprehensive  measure  on  the  German  plan  ;  for  the- 
difficulties  in  the  way  of  the  latter  course  are  not  so  great 
as  might  at  first  sight  appear.  Pigments  highly  dangerous-- 
when  in  the  form  of  water-colour  may  be  harmless  enough 
in  oil  paints,  and  insoluble  bodies  (non-volatile)  in  ordinary 
circumstances  may  be  volatilised  by  heat,  as,  for  example,, 
vermilion  or  cinnabar  in  candles.  A  little  study,  guided  by 
the  existing  laws  of  other  countries,  would  soon  decide  such, 
details,  and  we  have  already  had  too  much  of  piecemeal 
legislation  to  risk  adding  more. 


FROM  ABROAD. 


Management  op  Eingwoem  op  the  Scalp. 

In  an  article  on  “  Management  of  Ringworm  of  the  Scalp 
(Phil.  Med.  News,  March  17  and  24),  Dr.  Yan  Harlingen,, 
the  Chief  of  the  Skin  Clinic  of  the  Hospital  of  the  Univer¬ 
sity,  Philadelphia,  especially  dwells  upon  the  mode  of  appli¬ 
cation  of  remedies  to  this  disease.  There  is  no  want  of  good 
remedies  for  it,  and  the  failures  in  their  use  arise  for  the 
most  part  in  their  unintelligent  application.  It  must  be 
borne  in  mind  that  we  have  to  do  with  a  subtle  and  pene¬ 
trating  fungus,  which  invades  the  hair-follicles  in  their 
lowest  recesses,  grows  with  persistent  luxuriance,  and  refuses 
to  yield  to  any  remedy  with  which  it  is  not  brought  into 
intimate  contact.  This  may  destroy  any  of  the  fungus- 
existing  on  the  surface,  but  exerts  no  influence  on  the  germs 
which  have  penetrated  into  the  follicles.  It  is  to  be  re¬ 
marked  that  while  the  hair-follicles  of  the  scalp  are  often 
three-eighths  of  an  inch  in  length,  they  are  only  about  one- 
fiftieth  of  an  inch  in  diameter ;  in  other  words,  they  are 
little  wells,  nearly  twenty  times  deeper  than  they  are  wide. 
When  it  is  considered  that  the  greater  part  of  this  narrow 
calibre  is  usually  filled  by  the  growing  hair-shafts,  the  at¬ 
tempt  to  cure  an  old  case,  when  the  fungus  has  penetrated 
to  the  very  bottom  of  the  follicle,  by  smearing  an  ointment 
or  swabbing  a  wash  over  the  surface,  is  seen  at  once  to  be  a. 
vain  effort. 

Depilation,  indeed,  is  usually  the  first  procedure  to  which 
attention  must  be  paid — not  the  indiscriminate  pulling  out 
of  all  hairs  in  the  vicinity  of  the  diseased  patch,  but  the 
extraction  only  of  those  which  appear  to  the  naked  eye,  or 
aided  by  a  small  lens,  to  be  diseased.  The  difference  in 
appearance  between  a  healthy  hair  and  one  which  has  been 
attacked  by  the  ringworm-fungus  may  usually  be  easily 
recognised  by  the  naked  eye.  In  the  first  place,  the  diseased 
hair  is  broken  off  short,  with  a  length  of  from  one- eighth  to- 
a  quarter  of  an  inch.  The  spores,  by  their  multiplication,, 
have  separated  its  fibres,  and  the  texture  of  the  hair  has 
been  rendered  brittle.  The  broken  end  is  split  so  as  to- 
look  like  an  old  birch-broom.  It  is  enlarged  to  three  or 
four  times  the  diameter  of  the  healthy  hair,  and  its  lustre 
is  so  diminished  that  it  can  be  singled  out  of  a  group  of 
hairs  cut  to  the  same  length.  The  colour  is  usually  lighter, 
and  it  has  a  dry,  lifeless  look.  Depilation  should  be  executed 
systematically,  a  certain  limited  area  being  selected  for  each 


Medical  Times  and  Gazette. 


FKOM  ABBOAD. 


July  14,  18£3. 


50 


operation,  and  not  a  few  hairs  plucked  here  and  there  over 
a  large  surface.  Immediately  after  depilation  the  para¬ 
siticide  is  to  be  applied,  with  the  hope  of  penetrating  the 
still  yawning  follicles. 

It  is  to  he  remembered  that  the  fungus  tends  to  spread 
from  being  carried  about  from  one  part  of  the  head  to 
another  by  brushing,  rubbing,  or  scratching  the  scalp,  etc. 
I1  or  this  reason  it  may  be  found  at  various  points ;  and  in 
examining  the  scalp  in  a  case  in  which  a  single  characteristic 
patch  has  been  found,  care  should  be  taken  to  go  over  the 
whole  head  with  a  view  of  learning  whether  some  incipient 
and  superficial  patches  may  not  be  found,  the  timely  applica¬ 
tion  to  which  of  a  parasiticide  may  nip  the  disease  in  the 
bud.  The  patient’s  head  should  be  firmly  held  while  the  hair 
is  turned  back  in' successive  rows  from  front  to  back,  so  that 
no  point  should  remain  unexamined.  Every  diseased  patch 
should  of  course  be  made  the  subject  of  active  treatment ; 
but  some  parasiticide  should  also  be  kept  in  contact  with  all 
parts  of  the  scalp,  in  order  that  the  floating  fungus  may 
have  no  opportunity  to  alight  on  an  unprotected  spot.  It  is 
too  often  supposed  that  treatment  need  be  applied  only  to 
the  characteristic  ashen-grey,  slightly  raised  patches,  with 
their  goose-skin-like  arrangement  of  broken  stumps,  which 
go  to  make  up  the  typical  picture  of  ringworm  of  the  scalp. 
But  the  fungus  must  be  looked  for  in  all  parts  of  the  scalp, 
where  its  presence  may  be  indicated  by  a  few  scales  like  a 
small  round  patch  of  dandruff,  with  perhaps  a  single  stump 
of  a  diseased  hair,  or  even  one  or  two  of  those  black  dots 
in  the  scalp,  which  are  the  stumps  broken  off  even  with 
the  surface,  and  which  form  the  most  troublesome  points 
to  reach  with  parasiticides.  Now  and  then  an  isolated 
diseased  stump  may  be  found  among  healthy  hairs,  and 
this,  unless  looked  for,  may  become  a  focus  of  disease. 
One  of  the  mistakes  made  is  having  the  scalp  washed  too 
often,  as  the  parasiticide  should  be  left  undisturbed.  The 
longer  it  remains  on  the  skin,  the  more  it  is  likely  to  pene¬ 
trate  to  where  it  is  needed.  Once  in  two  weeks  is  often 
enough  to  wash  the  scalp  in  an  average  case. 

“  In  order  that  the  remedies  may  be  properly  applied,  the 
hair  must  be  shaven,  or  at  least  cut  very  short.  My  own 
custom  is  that  the  head  be  kept  closely  shaven  for  a  week 
or  so,  the  remedy  being  regularly  applied  during  that  time, 
and  that  the  hair  be  then  permitted  to  grow  for  a  day  or 
two,  in  order  to  take  account  of  progress,  and  to  see  what 
proportion  of  diseased  hairs  still  remain.  Of  course,  the 
limited  locality  where  depilation  is  being  practised  must  be 
left  unshaven,  so  that  the  hairs  may  grow  long  enough  to 
admit  of  their  being  readily  plucked.  It  is  generally  best 
to  apply  remedies  with  a  mop  or  sponge  tied  to  the  end  of  a 
stick,  because  the  finger  is  scarcely  firm  enough  to  be  of 
service.  The  scalp,  it  must  be  remembered,  is  not  so  sensi¬ 
tive  as  other  parts  of  the  body,  and  will  bear  with  impunity 
an  amount  of  rough  handling  which  would  prove  injurious 
elsewhere.  Ointments,  as  well  as  washes,  may  thus  be 
applied  with  advantage.  I  am  accustomed  to  use  mops 
made  of  old-fashioned  candle-wick  tied  to  the  end  of  a 
stick  the  size  of  a  crow-quill,  and  five  inches  in  length. 
These  are  made  for  me  in  quantity,  and,  as  they  cost 
next  to  nothing,  may  be  thrown  away  as  used.  Of 
■course,  the  scalp  must  not  be  made  sore,  and  when  this 
occurs,  treatment  must  be  suspended,  and  valuable  time  is 
lost.  There  is  a  great  deal  of  difference  in  individuals  as  to 
the  sensitiveness  of  the  scalp.  An  application  which  will 
agree  with  one  child,  and  which  may  be  rubbed  in  most 
vigorously  with  entire  impunity,  will  in  another,  by  its  mere 
application  in  the  gentlest  manner,  give  rise  to  violent  in¬ 
flammation.  In  some  the  scalp  is  so  sensitive,  especially 
when  the  ringworm  has  lasted  some  time  and  has  been  much 
treated,  that  none  but  the  mildest  remedies  can  be  tolerated. 
It  is  always  well  to  begin  a  little  cautiously  in  severe  cases, 
or  in  those  of  long  standing,  and  it  is  never  safe  to  send  a 
patient  away  for  some  days  or  weeks  with  a  new  remedy 
the  effect  of  which  on  the  case  has  not  been  tested. 

“  Ringworm  of  the  body  is  very  apt  to  go  along  with  ring¬ 
worm  of  the  scalp,  and,  on  examining  a  patient  for  the  first 
time,  the  body  should  be  carefully  looked  over  as  well  as 
the  head.  Also,  the  body  should  be  searched  with  care  from 
time  to  time  while  the  patient  is  under  treatment.  There 
is  a  good  deal  of  difference  in  individuals  as  to  the  aptitude 
of  catching  ringworm.  One  may  be  in  the  midst  of  floating 
spores  in  the  air  of  a  schoolroom  where  the  disease  is  rife 
without  coming  to  harm  from  it,  while  another  seems  to 


offer  the  conditions  needed  for  the  growth  of  the  fungus,  which 
is  continually  springing  up  on  some  new  part  of  the  skin  at 
the  same  time  that,  under  treatment,  it  is  being  stamped  out 
in  another.  In  my  experience,  children  with  light,  thin 
hair  are  more  apt  to  show  this  susceptibility,  while  dark¬ 
haired  children  seem,  as  a  rule,  less  prone  to  contract  ring¬ 
worm,  and  more  easily  get  rid  of  it.  Weakly  and  scrofulous 
children  are  also  much  more  prone  to  contract  it  in  a  stubborn 
form  ;  and  this  lends  an  indication  for  internal  treatment, 
which  experience  shows  to  be  useful.  I  refer  to  the  employ¬ 
ment  of  cod-liver  oil,  which  is  often  brought  into  use  with 
advantage  in  the  treatment  of  chronic  and  inveterate  ring¬ 
worm.  A  course  of  oil  seems  often  to  aid  external  treatment 
to  a  marked  degree.  Arsenic  I  do  not  think  is  so  useful— at 
least  it  has  not  proved  of  much  benefit  in  my  hands,  though 
others  speak  of  its  advantages.” 

Prominent  among  the  applications  is  carbolic  acid,  which 
Dr.  Yan  Harlingen  not  only  uses  for  the  destruction  of  the 
parasite  in  the  diseased  patches,  but  also  as  a  preventive  in 
checking  the  spread  of  the  fungus  to  healthy  parts.  He 
rubs  a  mixture  of  one  part  of  carbolic  acid  with  from  three 
to  six  parts  of  glycerine  into  the  whole  scalp  (excepting  the 
affected  patches)  every  day,  this  not  only  tending  to  destroy 
the  fungus,  but  also  to  prevent  its  spreading  to  other  persons. 
For  a  carefully  cleansed  scalp  becomes  covered  with  fine 
epidermic  scales  as  soon  as  it  is  dry,  and  these  branny  scales 
float  about  in  the  atmosphere,  transporting  the  contagion  to 
others.  The  patient  should  therefore  not  only  wear  a  linen 
cap  always,  but  should  also  have  the  scalp  constantly  saturated 
with  carbolised  glycerine.  A  stronger  carbolised  glycerine  is 
applied  to  the  patches  themselves  by  means  of  a  swab  or  with 
a  bit  of  flannel  on  the  end  of  the  finger.  Glycerine  has  much 
penetrative  power,  carrying  the  carbolic  acid  with  it,  and  with 
it  alone  Dr.  Van  Harlingen  has  sometimes  cured  very  severe 
cases.  Occasionally  he  uses  a  blisteringfluid,  especially  when 
the  disease  is  recent  and  tolerably  extensive,  but  superficial, 
and  when  the  fungus  has  only  penetrated  the  follicles  to  a 
short  distance.  Several  coats  of  a  rather  strong  cantharidal 
collodion  are  painted  over  the  diseased  patches  on  the 
freshly  shaven  scalp,  not  extending  over  more  than  from 
three  to  four  square  inches  at  one  sitting.  On  removing 
the  crusts,  after  the  collapse  and  drying  of  the  blister,  a 
large  number  of  diseased  stumps  come  away,  the  roof  of 
the  dried  blister  serving  as  a  depilatory  to  a  certain  extent. 
The  milder  carbolic  wash  may  usually  be  immediately 
applied  after  the  removal  of  the  blister.  In  more  inveterate 
cases  the  oleate  of  mercury  (6  per  cent.)  may  be  mixed, 
seven  parts  to  one  of  acetic  ether.  This  gets  down  to  the 
roots  of  the  hair  more  quickly  than  any  other  application. 
There  are  many  other  parasiticides —as  thymol,  boracic  acid, 
picrotoxin,  iodine  (alone,  or  combined  with  tar  or  sulphur), 
mercurial  preparations,  chrysarobin,  etc. — which  may  prove 
very  useful ;  and  when  one  that  has  been  thoroughly  used 
fails,  another  can  be  used.  In  order  to  prevent  the  passage 
of  the  disease  to  other  children,  isolation  should  be  ob¬ 
served;  but  it  is  not  communicable  to  adults,  or  only  in 
the  form  of  ringworm  of  the  body,  which  is  readily  curable. 
The  best  preventive  of  extension  is  to  keep  the  child’s 
scalp  saturated  with  weak  carbolised  glycerine;  and  when 
other  children  are  unavoidably  exposed  to  the  chances 
of  contagion  their  hair  should  be  kept  cut  short,  their 
scalps  thoroughly  washed  daily,  and  an  application  of  car¬ 
bolised  glycerine  in  the  proportion  of  one  part  to  ten 
made  immediately  afterwards.  The  patient  should  con¬ 
stantly  wear  a  linen  cap,  and  the  greatest  care  be  taken 
to  disinfect  by  dry  heat  the  various  articles  of  clothing  that 
cannot  be  boiled,  or  which  it  might  be  inconvenient  to  throw 
away.  When  the  coat-collar  (which  is  a  very  frequent  nidus 
for  scales  dropping  from  the  head)  is  of  cloth  it  should  be 
temporarily  covered  with  some  linen  or  cotton  fabric  which 
can  be  washed.  It  must  be  borne  in  mind  that  ringworm 
not  infrequently  arises  from  children  playing  with  mangy 
dogs. 

“Tt  may  be  thought,”  Dr.  Yan  Harlingen  observes  in 
conclusion,  “  that  in  the  foregoing  remarks  on  the  manage¬ 
ment  of  ringworm  of  the  scalp  I  have  gone  too  much  into 
what  appears  to  be  trivial  detail ;  but  I  am  convinced  that 
this  is  necessary,  inasmuch  as  we  constantly  see  failure  to 
cure  cases  where  suitable  and  efficient  remedies  have  indeed 
been  prescribed,  but  where  sufficient  care  has  not  been  taken 
to  have  them  properly  applied.  The  affection  is  a  stubborn 
one,  as  from  four  to  six  months  at  least  are  required  to 


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REVIEWS  AND  NOTICES  OF  BOOKS. 


July  14,  1883.  51 


effect  a  cure.  In  well-marked  cases  the  friends  of  patients 
should  he  told  this  beforehand  to  prevent  misapprehension. 
A  more  favourable  prognosis  is  almost  sure  to  lead  to  dis¬ 
appointment.  When  an  apparent  cure  has  been  reached 
the  patient  should  still  remain  under  the  oversight  of  the 
physician  for  some  months,  and  a  very  careful  search  should 
be  made  from  time  to  time  with  the  view  to  discover  the 
presence  of  scurfy  patches  with  broken-off  hairs  or  the  black 
dots  marking  diseased  stumps.  A  spontaneous  cure  some¬ 
times  occurs  after  the  lapse  of  years,  as  the  patient  reaches 
adult  life.  The  disease  is  rarely  encountered  in  persons 
over  twenty- one  years  of  age.” 


REVIEWS  AND  NOTICES  OF  BOOKS. 

- «. - 

On  Curvatures  and  Disease  of  the  Spine.  By  Bernard  E. 
Brodhtjrst,  F.R.C.S.,  Surgeon  to  the  Royal  Orthopaedic 
Hospital  and  to  the  Royal  Hospital  for  Incurables ;  Con¬ 
sulting  Surgeon  to  the  Belgrave  Hospital  for  Children. 
Third  Edition.  London :  J.  and  A.  Churchill,  1883 . 
Pp.  120. 

Nineteen  years  have  elapsed  since  the  second  edition  of  this 
work  appeared,  but  the  author  has  not  added  much  to  what 
he  then  published.  In  this,  as  in  the  last  edition,  the  greater 
part  of  the  book  is  occupied  with  a  description  of  lateral 
curvature,  its  causes  and  treatment.  The  views  of  Judson 
andMeyer  are  discussed  and  rejected,  and  the  author  adheres 
to  the  opinion  that  the  majority  of  cases  of  lateral  curva¬ 
ture  result  from  obliquity  of  the  pelvis  produced  by  in¬ 
equality  of  the  lower  extremities  from  flat  foot,  genu  val¬ 
gum,  rickets,  etc.  The  use  of  Sayre’s  plaster  of  Paris 
jacket  for  this  deformity  is  emphatically  condemned,  and 
most  surgeons  will  cordially  agree  with  this.  Mr.  Barwell’s 
sloping  seat  is  also  rejected,  consistently  with  the  author’s 
views  of  the  causation  of  lateral  curvature.  Removal  of  the 
exciting  cause,  well-adjusted  spinal  supports,  and  suitable 
gymnastic  exercises  are  the  inodes  of  treatment  that  are 
recommended. 

In  this  edition  three  short  chapters  have  been  added,  on 
spinal  disease,  including  sacro-iliac  and  coccygeal  disease ; 
diagnosis ;  prognosis  and  treatment.  The  author  disapproves 
of  Sayre’s  jacket  for  angular  curvature.  He  regards  the 
preliminary  suspension  as  a  recurrence  to  Glisson’s  barbarous 
practice  in  the  seventeenth  century ;  and  insists  that  the 
jacket  not  only  harbours  vermin,  but  also  seriously  inter¬ 
feres  with  respiration.  Dr.  Sayre  admits  that  when  the 
thorax  is  thus  firmly  secured,  manual  pressure  on  the  peri¬ 
neum  will  produce  a  feeling  of  suffocation,  and  “  therefore 
in  some  cases  it  will  be  necessary  for  the  patient  to  sit  on 
a  chair  with  a  hole  in  the  seat,  like  a  close-stool.”  The 
practical  inconvenience  of  this  jacket  is  certainly  not  exag¬ 
gerated,  and  many  surgeons  will  share  the  author’s  prefer¬ 
ence  for  treating  spinal  disease  by  rest  in  the  recumbent 
posture,  and  by  suitable  spinal  supports  which  can  be 
changed  and  readjusted  from  time  to  time.  This  book  is  a 
very  well  written  expression  of  the  author’s  opinions  about 
spinal  curvatures  and  their  treatment,  but  does  not  add 
anything  to  what  is  known  upon  the  subject. 


On  the  Pathology  of  Bronchitis,  Catarrhal  Pneumonia, 
Tubercle,  and  Allied  Lesions  of  the  Human  Lung.  By  D. 
J.  Hamilton,  M.B.,  E.R.C.S.  Eng.,  F.R.S.  Eng.  London: 
Macmillan  and  Co.  1883.  Pp.  240. 

Dr.  Hamilton  has  long  been  known  as  an  industrious  and 
trustworthy  observer  in  the  field  of  pathology,  and  any¬ 
thing  that  he  brings  forward  would  be  sure  to  command  and 
deserve  attention.  The  volume  before  us  is  in  great  measure 
composed  of  papers  that  appeared  a  few  years  ago  in  the 
Practitioner.  The  subject  treated  of  is  one  of  extreme  im¬ 
portance,  owing  to  the  very  great  frequency  of  pulmonary 
affections  in  this  country ;  and,  so  far  as  we  know,  it  has 
not  hitherto  been  described  in  so  exhaustive  and  masterly  a 
manner  as  in  the  present  work.  It  is  a  book  that  should  be 
read  by  all  who  take  any  interest  in  lung  affections,  and  the 
great  question  of  the  essential  nature  of  tubercle. 

One  of  the  earliest  changes  in  acute  bronchitis  is  the 
desquamation  of  the  columnar  epithelium,  which  is  not 
replaced  so  long  as  the  bronchitis  lasts  ;  not  that  the  repro¬ 
duction  of  epithelium  is  altogether  stopped,  but  the  cells 


are  formed  and  thrown  off  so  rapidly  that  there  is  no  time 
for  the  formation  of  the  complete  columnar  epithelial  cell. 
These  catarrhal  cells  when  set  free  are  more  or  less  rounded, 
and  are  apt  to  undergo  fatty  degeneration.  Dr.  Hamilton 
lays  especial  stress  on  the  fact  that  they  are  of  epithelial 
origin,  and  are  not  proliferated  connective-tissue  corpuscles 
escaped  on  to  the  surface,  for  the  very  good  reason  that  the 
basement  membrane  forms  an  impenetrable  barrier  through 
which  nothing  can  pass.  This  membrane  is  found  at  this 
stage  of  the  disease  to  be  greatly  swollen  and  cedematous, 
and  if  these  catarrhal  cells  really  passed  through  it,  they 
ought  sometimes  to  be  found  embedded  in  its  substance  in 
transit,  which  Dr.  Hamilton  assures  us  he  has  never  succeeded 
in  doing. 

On  examining  the  deeper  layers  of  the  mucous  membrane 
it  is  seen  that  the  bloodvessels  are  dilated,  and  that  the 
inner  fibrous  coat  is  infiltrated  with  cellular  structures,  the 
smaller  of  which  may  have  been  derived  from  the  blood,, 
but  the  larger  ones  are  derived  from  fissiparous  division  of 
the  flat  endothelial  cells  which  line  the  lymphatic  vessels 
and  plasma  spaces  normally  existing  in  this  area.  These 
cells  are  found  in  rows,  making  their  way  outwards  along 
the  peribronchial  lymphatic  vessels  between  the  cartilages- 
and  glands  to  join  the  outer  fibrous  coat. 

In  chronic  bronchitis  the  basement  membrane  plays  quite 
as  important  a  part  as  in  the  acute  disease.  Dr.  Hamilton 
says,  “  I  believe  that  in  this,  as  in  acute  bronchitis,  nothing' 
of  acellular  nature  ever  gets  from  below  on  to  the  free  surface. 
It  seems  to  form  an  impenetrable  barrier  to  the  exit  of  leu¬ 
cocytes  or  other  cellular  structures.  ...  It  maintains  its 
invariably  homogeneous  aspect,  without  there  being  a  single 
break  in  its  continuity.”  He  likens  the  basement  membrane 
to  a  fascia  which  determines  the  direction  that  pus  shall 
pursue. 

The  changes  that  take  place  in  the  muscular  wall  of  the* 
bronchus  in  chronic  bronchitis  are  compared  to  the  changes 
which  take  place  in  the  arterial  system  when  there  is  some 
impediment  to  the  flow  of  blood.  During  the  prolonged 
expiratory  effort  made  by  a  patient  with  chronic  bronchitis 
in  a  fit  of  coughing,  a  great  strain  is  put  on  the  bronchi  and 
air-vesicles.  The  latter,  as  we  know,  give  way  and  become 
dilated,  as  also  do  some  of  the  minute  bronchi,  but  in  others- 
of  these  the  lumen  is  contracted  instead  of  being  dilated, 
owing  to  the  hypertrophy  of  the  walls  (and  especially  of  the 
muscular  walls)  of  the  bronchus — a  good  instance  of  in¬ 
creased  development  to  meet  the  needs  of  increase  of 
function.  In  cases  of  chronic  bronchitis  associated  with 
chronic  interstitial  pneumonia,  this  hypertrophy  does  not 
occur,  the  wall  of  the  bronchus  being  much  thickened 
by  a  cellular  effusion,  which  by  pressure  has  caused 
atrophy  of  the  muscular  fibres.  As  regards  chronic- 
bronchitis  (so-called)  dependent  upon  valvular  disease  of  the 
heart,  the  author  does  not  admit  that  the  lesion  is  an  in¬ 
flammatory  one  at  all,  the  bronchial  irritation  being  purely 
mechanical,  and  due  to  the  great  capillary  congestion  in  the 
mucous  and  submucous  layers.  As  regards  the  deposits 
of  pigment  which  take  place  in  the  lungs  of  miners,  and  the 
mode  in  which  they  produce  bronchial  catarrh,  the  author- 
has  something  to  say.  In  the  first  place  the  pigment  is  most 
abundant  round  the  branches  of  the  pulmonary  artery,  but 
it  may  be  found  round  some  of  the  most  minute  bronchi.  The 
course  taken  by  the  pigment  particles  is  that  they  penetrate 
the  infundibula,  air  vesicles,  and  minute  bronchi,  and  thence 
pass  into  the  lymphatics,  more  especially  the  larger  peri¬ 
vascular  branches ;  thence  they  reach  the  lobular  septa,  the 
deep  layer  of  the  pleura,  and  finally  the  bronchial  glands. 
Since,  then,  the  bronchial  mucous  membrane  is  notpigmented, 
what  is  the  cause.  Dr.  Hamilton  asks,  of  the  great  frequency 
of  chronic  bronchitis  amongst  those  subject  to  this  condition  ? 
The  answer  is  simple.  The  branches  of  the  pulmonary- 
artery  become  plugged  by  the  development  of  the  pigment 
in  their  walls  ;  hence^a  difficulty  in  the  circulation  :  but  at  the 
same  time  the  lymphatics  are  also  more  or  less  obstructed,  so 
that  two  potent  causes  are  at  work  to  bring  about  and  keep 
up  an  cedematous  condition  of  those  structures  which  will 
most  readily  yield,  i.e.,  the  mucous  membrane.  The  subse¬ 
quent  stages  of  the  desquamation  and  proliferation  of 
epithelial  cells  will  take  place  precisely  as  in  simple  bron¬ 
chitis.  The  causes  of  bronchiectasis  are  stated  to  be  the 
traction  of  cicatricial  tissue  on  the  walls  of  the  bronchi, 
forced  expiratory  efforts,  atmospheric  pressure  when  there 
is  extensive  collapse  els&where,  and  the  accumulation: 


52 


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July  14, 1883. 


of  catarrhal  products  within  a  terminal  bronchus.  We 
cannot  do  more  than  call  attention  to  the  excellent 
chapter  on  interstitial  pneumonia  as  a  complication  of 
bronchitis ;  even  those  who  are  not  prepared  to  accept  the 
author’s  views  in  their  entirety  will  find  it  well  worth  read¬ 
ing.  In  speaking  of  vesicular  emphysema,  the  author  notes 
that  during  a  prolonged  expiratory  movement  the  blood 
contained  in  the  heart  and  large  vessels  is  driven  out,  leav¬ 
ing  the  portions  of  lung  in  the  neighbourhood  less  supported 
than  usual,  and  these  portions  accordingly  become  over¬ 
distended. 

The  second  part  of  the  book  is  devoted  to  the  subject 
■of  catarrhal  pneumonia  and  tubercle.  The  former  Dr. 
Hamilton  describes  at  great  length,  dividing  it  into  three 
stages — 'the  first,  or  commencement,  where  the  alveoli  be¬ 
come  filled  with  catarrhal  products ;  the  second,  where  these 
products  undergo  caseation ;  and  the  third,  where  breaking 
down  of  the  lung  tissue  occurs,  i.e.,  actual  phthisis,  this  not 
being  of  necessity  associated  with  any  deposit  of  tubercle. 
It  is  not  very  easy  to  understand  the  exact  position  which 
Dr.  Hamilton  takes  with  regard  to  the  tubercle-bacillus. 
He  accepts  in  a  general  way  Koch’s  experiments— i.e.,  that 
he  has  been  able  to  isolate  a  bacterium,  which,  when  intro¬ 
duced  in  the  living  body,  is  capable  of  producing  a  tuber¬ 
cular  eruption.  The  objection  on  this  head  that  other  foreign 
bodies  have  been  shown  to  be  capable  of  doing  the  same 
thing,  has  been  conclusively  answered  by  Mr.  Watson 
•Cheyne  since  Dr.  Hamilton’s  book  appeared.  But  in  his 
summary  of  conclusions  in  regard  to  tubercle  we  read, 
<r  the  tubercle  poison  is  generated  de  novo  in  a  necrotic 
•caseous  tissue.”  If  this  stood  alone  it  would  be  as  de¬ 
cided  an  expression  of  opinion  as  it  would  be  possible  to 
imagine,  but  a  few  lines  further  on  we  are  told,  “  the  reason 
of  certain  caseous  tissues  throughout  the  body  not  pro¬ 
pagating  a  tubercular  eruption,  is  that  by  their  position 
they  are  protected  from  external  contamination.”  Con¬ 
tamination  from  what  F  we  would  ask.  If  from  the  tubercle- 
bacillus,  then  it  can  hardly  be  correct  to  say  that  tubercle  is 
generated  de  novo,  as  he  does  just  previously.  Although  we 
are  much  pleased  with  his  chapter  on  the  supposed  con¬ 
tagiosity  of  phthisis,  and  admit  that  there  is  a  good  deal 
•of  truth  in  what  he  says,  still  we  do  not  find  anything 
to  justify  us  in  believing  that  a  special  organism  like  the 
tubercle-bacillus  was  not  introduced  into  the  body  from 
without. 


^Principles  of  Health  in  Childhood,  Manhood,  and  Old  Age. 

By  Louis  King,  M.R.C.S.  London :  Hamilton  and 

Adams.  Bath :  W.  Lewis  and  Son.  1883.  8vo.,  pp.  185. 
Notwithstanding  the  title  of  this  book,  the  greater  part 
of  it  is  occupied  with  a  multitude  of  quasi  medical  subjects 
treated  in  a  popular  manner,  though  the  author  assures  us 
in  his  preface  that  he  has  carefully  avoided  making  the 
volume  one  of  domestic  medicine — a  class  of  work  which, 
as  he  justly  observes,  “in  the  hands  of  most  does  more 
harm  than  good.”  Certainly  no  harm  can  result  from  a 
study  of  Mr.  King’s  boob,  but  we  think  that  it  might  have 
been  made  at  once  more  scientifically  accurate  and  more 
instructive  without  detracting  from  its  popular  character. 
After  about  twenty  pages  of  very  elementary  physiology, 
illustrated  by  several  indifferent  figures,  he  gives  two  sec¬ 
tions  on  the  sanitary  arrangements  of  the  house.  We  have 
no  fault  to  find  with  the  recommendations  made,  but  the 
absence  of  all  reference  to  the  objectionable  character  not 
•only  of  the  common  servants’  hopper  w.c.’s,  but  of  the  pan 
closet  and  its  appurtenances,  as  well  as  to  the  possible  un¬ 
syphoning  of  the  traps  of  waste-pipes  connected  with  a 
common  stack,  is  a  serious  defect.  We  are  surprised  also 
to  find  Mr.  King  implicitly  sanctioning  the  popular  mistake 
that  the  dangers  of  arsenical  poisoning  are  peculiar  to  green 
papers,  and  ignoring  the  possibility  of  the  tinted  lime- 
washes  or  distempers,  that  he  proposes  as  substitutes,  being 
as  arsenical  as  the  papers  themselves.  Good  figures  of  the 
best  forms  of  traps,  closets,  etc.,  such  as  could  be  borrowed 
from  any  illustrated  trade  catalogue,  would  have  added 
greatly  to  the  practical  usefulness  of  this  part  of  the  work. 

On  the  management  of  infancy  and  childhood  our  author’s 
remarks  are  sound  and  sensible,  but  it  is  a  great  mistake  to 
mention  thrush  as  a  disease  per  se  to  be  cured  by  borax  and 
honey (P)  instead  of  insisting  on  its  being  a  symptom  or 
consequence  of  gastro-intestinal  derangement,  the  cause  of 


which  must  be  found  and  removed.  He  seems  to  be  unac¬ 
quainted  with  the  recent  investigations  into  the  pathology 
of  rickets,  which  he  describes  as  due  to  a  deficiency  of  mineral 
matter  in  the  bone,  to  be  treated  by  phosphate  of  lime  alone ; 
and  of  the  value  of  cod-liver  oil  in  rickets  he  seems  unaware. 

So,  too,  throughout  the  chapters  on  food  and  digestion,  as 
well  as  in  those  on  the  prevention  of  disease,  we  look  in  vain 
for  reference  to  recent  authorities.  The  observations  of  Dr. 
Beaumont  on  digestion,  as  seen  in  Alexis  St.  Martin,  are 
quoted  as  if  they  represented  all  that  is  known  on  the  sub¬ 
ject.  To  the  labours  of  Bischoff,  Pettenkofer,  Yoit,  Hoppe- 
Seyler,  etc.,  there  is  not  a  single  reference ;  and  Parkes  is 
quoted  only  once/and  then  as  Dr.  Park  !  In  the  chapter  on 
brain  stimulants,  intoxicating  and  non-intoxicating,  we  find 
the  same  ignorance  or  ignoring  of  the  most  recent  research 
— Parkes,  Anstie,  and  even  Binz,  are  not  mentioned ;  but 
several  pages  are  filled  with  a  historical  account  of  tobacco, 
which  might  well  serve  as  the  introduction  to  a  monograph, 
but  is  at  best  but  useless  padding  here.  In  the  conduct  of 
the  sick-room  and  his  instructions  to  nurses,  Mr.  King  is 
thoroughly  at  home,  and  we  would  like  to  see  the  latter  re¬ 
printed  in  handbill  form.  The  only  exceptions  we  have  to 
take  are  that  he  advises  the  treatment  of  burns  and  scalds 
with  the  old  carron  oil,  as  if  he  were  unacquainted  with  the 
more  elegant  and  sweeter  alkaline  boric  lotions ;  and  also 
that  he  gives  sanction  to  the  popular  notion  that  the  air  of 
the  sick-room  may  be  advantageously  “  impregnated  with 
some  disinfectant.”  Such  “  disinfection  ”  of  an  occupied 
room  is  a  delusion  and  snare.  The  chapter  on  accidents 
and  emergencies,  with  its  illustrations,  is  compiled  from  the 
manuals  rendered  popular  by  the  ambulance  movement. 
We  notice  two  extraordinary  misprints,  “carrion  oil”  and 
“  embrasions.”  There  is  much,  however,  in  this  unpretend¬ 
ing  little  book  of  sound  advice  which  it  would  be  well  were 
more  generally  known  and  acted  on. 


Insanity  :  its  Causes  and  Prevention.  By  Henby  Putnam 
Stearns,  M.D.  New  York :  Putnam  Sons.  1883.  Crown 
8vo.,  pp.  248. 

It  is  difficult  to  know  from  what  point  of  view  this 
book  should  be  regarded,  or  by  what  standard  it  should 
be  judged.  But  for  the  author’s  statement  that  it  has 
not  been  written  for  specialists  exclusively — a  statement 
implying  that  it  has  been  written  mainly  for  them — we 
should  regard  it  as  one  of  the  large  family  of  books  of 
popular  science  which  clamour  for  the  attention  of  the 
intelligent  but  ill-informed  layman.  Regarded  from  this 
point  of  view  it  has  some  merits.  It  is  pleasantly 
written,  readable,  and  calculated  to  do  good  service 
among  the  laity  by  reiterated  insistence  on  the  plain  prin¬ 
ciples  of  mental  hygiene.  The  author  deals  with  the  evils 
of  the  forcing  system  of  education,  and  the  desirability  of 
some  more  definite  systems  of  industrial  and  moral  educa¬ 
tion  than  exist  at  present ;  he  considers  the  influence  of 
heredity,  of  consanguineous  marriages,  of  alcohol,  tobacco 
poverty,  religion,  sleep,  etc.,  on  the  production  of  insanity, 
and  in  each  case  he  arrives  at  a  definite  conclusion,  which 
is  expressed  in  plain  terms,  and  is  in  accordance  with  the 
best  knowledge  that  we  have  upon  the  subject.  So  long  as 
these  conclusions  are  sound,  and  are  expressed  without  hesi¬ 
tation,  and  with  that  air  of  authority  which  carries  such 
conviction  to  the  mind  of  the  inquiring  layman  aforesaid, 
they  will  doubtless  answer  a  very  useful  purpose,  and  it  does 
not  perhaps  greatly  matter  how  they  have  been  arrived  at. 
But  if  we  alter  our  standpoint,  and  estimate  the  work  from 
the  point  of  view  of  the  specialist,  either  as  a  new  contribu¬ 
tion  to  our  knowledge  of  the  subject  of  insanity,  or  even  as 
a  summary  of  the  knowledge  already  attained,  it  is  im¬ 
possible  to  attribute  to  it  any  merit.  The  conclusions 
reached  are  indeed  sound,  but  they  are  reached  through  bad 
reasoning  from  false  premisses,  and  the  conviction  is  forced 
upon  the  reader  that  the  author  started  with  his  conclusions 
ready  made  and  foregone,  and  has  unconsciously  wrenched 
his  facts  and  warped  his  arguments  until  they  point  as 
he  desires.  To  take  one  instance  out  of  many.  “  There 
can  be  little  doubt,”  says  Dr.  Stearns,  “  that  statistics 
would  confirm  the  statement,  that  a  large  majority  of  those 
men  who  attain  to  success  in  any  mechanical  occupation 
are  those  who  began  their  education  in  this  way  while  young  ; 
the  large  majority  of  inventors  of  any  kind  of  machinery 
are  those  who  have  thoroughly  mastered  the  details  of  the 


Medical  Times  and  Gazette. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


July  14, 1883.  53 


kind  of  work  to  be  done  in  early  life.”  This  may  be  so ; 
but  it  is  surely  worth  while  to  show  some  basis  of  fact  for 
a  statement  so  sweeping,  however  little  doubt  there  may  be 
that,  d  priori,  it  ought  to  be  true ;  and  that  some  such  basis 
is  required  is  sufficiently  indicated  by  the  facts  that 
Arkwright  began  life  as  a  barber,  Telford  as  a  shepherd, 
the  elder  Brunei  as  a  sailor,  and  that  Palissy  was  thirty 
years  old  before  he  turned  his  attention  to  pottery. 
Statistics  are  proverbially  untrustworthy,  even  when  col¬ 
lected  with  the  most  anxious  care:  what  reliance,  then,  can 
be  placed  upon  conclusions  drawn  from  statistics  that  are 
wholly  imaginative  ? 

Dr.  Stearns  starts  with  the  assumption  that  insanity  is 
much  more  prevalent  among  civilised  than  among  savage 
communities  ;  and  then  finds  reasons  for  this  state  of  things 
that  are  far  from  satisfactory  to  the  civilised  man.  But  in 
support  of  his  initial  assumption  he  does  not  adduce  one 
authority  or  state  one  fact.  It  may  or  may  not  be  true,  but 
it  is  unwarranted,  and  we  venture  to  say  that  it  is  at  pre¬ 
sent  unwarrantable  ;  and  rules  of  conduct  founded  upon  a 
gratuitous  assumption  are  untrustworthy  in  the  highest 
degree.  That  the  number  of  insane  persons  that  exist 
among  savage  communities  is  extremely  small,  is,  though 
not  proved,  yet  extremely  probable ;  but  it  does  not,  on  that 
account,  follow  that  the  number  of  persons  that  become 
insane  are  any  fewer,  proportionately,  than  among  the  civi¬ 
lised.  Not  only  would  persons  born  with  a  defective  organi¬ 
sation  be,  as  Dr.  Stearns  points  out,  less  likely  to  attain 
adult  age  in  a  savage  community,  but  those  adults  who 
become  insane,  and  who  prove  noxious  (as  insane  people 
must  do,  either  actively  by  theft,  violence,  or  destructive¬ 
ness,  or  passively  by  failing  to  support  themselves,  and  so 
becoming  a  burden  on  the  community),  are  likely  to  be  dis¬ 
posed  of  by  a  very  summary  process ;  and  thus,  however 
large  a  proportion  of  the  community  become  insane,  year  by 
year,  they  would  never  be  suffered  to  accumulate  so  as  to 
form  an  appreciable  element  in  the  life  of  the  race.  Grant¬ 
ing,  however,  that  insanity  is  of  less  common  occurrence 
among  savage  than  among  civilised  communities,  what  is  to 
be  said  of  Dr.  Stearns’s  explanation  P  “  One  of  the  condi¬ 
tions  of  savage  life  is  that  of  a  community  of  interests  and 
supplies,  to  a  large  extent  [italics  in  original].  Families 
and  tribes  seek  for,  and  possess,  supplies  in  common ;  the 
weaker  depend  upon  the  strong,  and  the  strong  aid  the 
weak,  so  that  when  privations  ....  may,come,  they  affect 
all  together,  and  generally  in  like  degree.  The  passion  of 
avarice  is  in  a  latent  state ;  those  who  are  strong  do  not 
thrive  at  the  expense  of  those  who  are  less  so.”  In  civi¬ 
lised  life,  on  the  contrary,  “  community  of  interests,  except 
in  some  very  indefinite  and  limited  measure,  is  lost  sight 
of,  and  swallowed  up  in  those  of  the  individual.”  A 
more  unfortunate  statement,  or  one  more  completely  at 
variance  with  fact,  could  scarcely  be  made.  Of  all  the 
traits  that  mark  the  advance  of  civilisation,  not  one, 
it  may  be  confidently  stated,  is  more  thoroughly  cha¬ 
racteristic  than  the  progressive  blending  of  the  separate 
individual  antagonistic  interests  into  a  common  and  har¬ 
monious  interest — an  interweaving  that  becomes  ever  more 
intricate  and  far-reaching  as  civilisation  rises  to  higher 
levels.  Savages  who  hunt  over  the  same  district  compete 
with  one  another  for  their  shares  in  the  common  stock  of 
food,  and  each  success  of  one  diminishes  by  so  much  the 
chances  of  the  others.  The  lucky  or  skilful  hunter  who 
secures  a  copious  supply  of  food  may,  it  is  true,  distribute 
among  his  fellow-tribesmen  the  surplus  beyond  what  is 
required  to  satisfy  his  own  immediate  wants,  but  his  interest 
is  strongly  opposed  to  his  doing  so,  since  the  more  he  buries 
for  future  use  the  more  secure  he  is  against  future  privation  ; 
unless,  indeed,  he  secures  a  quid  pro  quo,  in  which  case  the 
rudiment  of  a  community  of  interests  may  fairly  be  said  to 
be  established ;  but  by  what  means  ?  Why,  by  barter — that 
is,  by  introducing  the  rudiment  of  civilisation.  The  state¬ 
ment  that  in  savage  communities  “  those  who  are  strong  do 
not  thrive  at  the  expense  of  those  who  are  less  so,”  is  a  little 
startling  in  the  face  of  the  custom  that  these  stronger 
members  have,  in  many  tribes,  of  devouring  the  weaker  ones 
when  other  provisions  run  short.  Doubtless,  these  un¬ 
tutored  savages  ought  to  behave  in  the  way  that  Dr.  Stearns 
describes,  and  in  a  properly  conducted  universe  no  doubt 
they  would  do  so,  but  in  the  meantime  we  have  to  deal  with 
a  world  of  actual  facts,  whose  savages  are  no  more  like  the 
ideal  barbarians  of  Dr.  Stearns  than  our  boors  and  clod¬ 


hoppers  are  like  the  shepherds  of  Watteau.  Compare  this 
very  moderate  degree  of  community  of  interests  with  that 
which  obtains  in  a  state  of  civilisation.  The  prosperity  of  a 
shopkeeper  at  the  Cape  is  dependent  upon  that  of  his 
customers — the  neighbouring  diamond-diggers.  Their  pros¬ 
perity  again  depends  on  that  of  the  merchant  who  buys 
their  diamonds,  since  if  he  becomes  bankrupt  their  gains  are 
diminished.  The  prosperity  of  the  merchant  depends  on 
the  demand  for  his  goods  — that  is,  upon  the  prosperity 
of  the  moneyed  classes  in  England  and  other  civilised 
countries ;  and  these  again  depend  largely  upon  the  rents 
they  receive,  and  therefore  upon  the  prosperity  of  the 
farmers  who  are  their  tenants,  or  of  the  miners  who  work  on 
their  lands.  Here  we  have  an  indefinitely  large  number 
of  people,  differing  in  race  and  language,  living  in  distant 
parts  of  the  earth,  separated  by  thousands  of  miles, 
unaware  of  each  other’s  existence,  but  all  united  by  a 
“  community  of  interests  and  supplies  ”  such  as  has  no 
parallel  among  savage  races.  It  may  be  said  that  such  a 
question  as  this  has  little  bearing  upon  the  subject  of  insanity, 
and  that  to  object  to  errors  of  this  nature  is  hypercritical, 
but  the  instance  is  selected  not  only  because  it  is  a  very  fair 
sample  of  the  kind  of  reasoning  in  which  the  book  abounds, 
but  also  to  bring  into  prominence  the  fact,  that  to  look  upon 
insanity  merely  as  a  bodily  disease  to  be  treated,  is  to  take  a 
very  imperfect  view  of  its  nature  and  associations.  It  has 
also  a  very  important  sociological  aspect ;  and  no  one  can 
hope  to  treat  it  adequately  or  satisfactorily  who  has  not  first 
acquired  a  competent  knowledge  of  social  science.  Fortu¬ 
nately,  the  validity  of  Dr.  Stearns’s  conclusions  does  not  rest 
in  the  least  either  upon  his  facts  or  his  reasonings.  They 
are,  for  the  most  part,  the  common  property  and  the  common 
product  of  the  whole  body  of  men  who  are  or  have  been 
engaged  in  the  study  of  insanity  and  in  the  care  of  the 
insane.  Their  validity  rests,  not  upon  the  truth  of  this  or 
that  set  of  facts,  or  upon  the  accuracy  or  this  or  that 
line  of  argument,  but  on  the  general  bearing  of  a  vast 
but  vague  body  of  evidence  which  has,  half  unconsciously, 
shaped  the  thoughts  of  men.  If  we  take  this  fact  or  that, 
and  examine  it  separately,  its  influence  in  shaping  our 
beliefs  is  as  inappreciable  as  the  part  taken  by  this  wave  or 
that  in  undermining  a  cliff ;  yet  by  the  repeated  impact  of 
multitudinous  waves  the  cliff  at  length  falls,  and  by  the 
accumulated  stress  of  multitudinous  facts  belief  is  at  length 
guided.  To  express  these  beliefs  plainly,  and  put  them 
before  the  general  public  in  an  attractive  manner,  is  an  un¬ 
questionable  service,  and  this  Dr.  Stearns  has  done ;  but 
his  dicta  would  have  inspired  far  more  confidence  had  he 
not,  unfortunately,  given  his  reasons  for  them. 


The  Analysis  and  Adulteration  of  Foods.  By  James  Bell, 

Ph.Doc.,  Principal  of  the  Somerset  House  Laboratory. 

Part  II.  London :  Chapman  and  Hall.  1883.  8vo.,  pp.  179. 
It  is  now  a  year  since  the  first  of  these  small  volumes  ap¬ 
peared,  treating  of  the  analysis  and  adulteration  of  tea, 
coffee,  cocoa,  sugar,  and  honey.  The  second,  now  before  us, 
deals  with  milk,  butter,  cheese,  cereal  foods,  and  prepared 
starches.  Although  public  analysts  generally  entertain  a 
not  unnatural  jealousy  and  distrust  of  Somerset  House, 
there  is  no  doubt  that  the  great  experience  enjoyed  by  the 
Principal  of  the  Laboratory  of  that  establishment  gives  a 
value  to  anything  from  his  pen.  The  feeling  we  refer  to  is 
founded  on  the  fact  that  the  Adulteration  Acts  have  con¬ 
stituted  Somerset  House  a  final  court  of  appeal ;  although, 
skilful  and  honourable  as  the  gentlemen  employed  there 
may  be,  it  cannot  be  maintained  that  they  are  abler  than 
many  analysts  outside.  There  is  no  analogy  between  their 
position  and  that  of  the  judges  in  the  superior  courts,  who 
are  appointed  in  recognition  of  their  eminent  merit.  Dr. 
Bell’s  work,  however,  is  cautious  and  careful,  and  at  once 
free  from  undue  reliance  on  “ready  methods,”  and  from 
impracticable  refinements  in  analysis.  On  page  6  we  find 
two  analyses  of  woman’s  milk,  and  a  remark  which  throws 
some  light  on  the  readiness  with  which  infants  digest 
asses’  milk,  viz.,  that  the  casein  in  human  and  equine  (he 
might  have  added  asses’)  milk  is  not  thrown  down  by 
acetic  acid,  but  remains  in  a  suspended  and  partly  soluble 
state,  which  has  led  M.  Husson  to  estimate  the  albumen  in 
these  milks  higher  than  the  casein.  It  is  more  probable 
that  the  casein  is  in  a  transitional  and  ill-defined  condition. 

Dr.  Bell  does  not  find  Soxhlet’s  apparatus  so  satisfactory 


Medical  Times  and  Gazette. 


KEVIEWS  AND  NOTICES  OF  BOOKS. 


July  14,  1S93. 


54 


in  milk  analysis  as  in  the  extraction  of  fat  from  seeds,  etc. 
He  always  finds  it  give  from  3  to  -5  per  cent,  less  than 
the  usual  process,  though  very  convenient  where  great  accu¬ 
racy  is  not  required.  The  same  opinion  he  holds  as  regards 
Hehner’s  formulae,  which  give  too  low  an  estimate  of  the 
fats,  and  one  proportionately  too  high  of  the  other  solids. 
Sugar  he  determines  by  the  polariscope,  or  volumetrically 
by  a  copper  test.  He  gives  some  valuable  instructions  for 
the  analysis  of  sour  milk — a  matter  of  great  importance,  since 
the  public  analyst  may  have  to  meet  the  objections  brought 
against  his  results  on  the  ground  of  the  milk  having  altered 
by  keeping.  Some  of  the  sugar  is  transformed  into  lactic 
acid,  which,  being  soluble  in  ether,  would  be  reckoned  as 
fat  unless  previously  estimated  by  neutralisation  with  soda. 
The  sugar  which  has  been  converted  into  alcohol  and  car¬ 
bonic  acid  is  entirely  lost,  but  this  depreciation  may  be 
roughly  allowed  for.  He  does  not  believe  in  the  increase  of 
the  fat  at  the  expense  of  the  casein,  either  in  stale  milk 
or  in  cheese,  but  attributes  the  apparent  increase  to  the 
changes  in  the  non-fatty  solids,  and  to  the  greater  ease 
with  which  the  fat  separates  from  sour  milk.  Some 
of  the  disputes  between  him  and  other  analysts  have, 
if  we  mistake  not,  arisen  out  of  this  question  of  sour 
milks.  A  table  showing  the  composition  of  240  genuine 
samples  from  single  cows  and  24  dairy  samples  gives  in  the 
former  a  range  of  fat  from  T92  to  6 '87,  of  solids  not  fat  from 
8'00  to  11-27,  and  of  ash  -62  to  -87  percent.,  and  in  the  latter 
of  fats  2-95  to  5T4,  other  solids  8"  50  to  9-91,  and  ash  -63  to 
•78.  In  the  face  of  these  facts  the  difficulty  of  fixing  a 
standard  which  shall  be  just  alike  to  dealer  and  consumer  is 
evident,  unless  milk  far  below  the  average  quality  is  to  be 
condemned  on  that  ground,  apart  from  proof  of  fraudulent 
watering — a  solution  of  the  question  which  does  not  seem  to 
Iiave  occurred  to  him.  A  curious  suggestion  is  put  forward 
here,  viz.,  that  the  addition  of  1  per  cent,  of  cane  sugar  to 
milk  would  render  its  dilution  to  the  extent  of  10  per  cent, 
practicable  without  detection  by  the  usual  processes  of 
analysis. 

In  the  chapter  on  butter  we  find  a  full  description  of  the 
methods  employed  in  the  past  and  present  for  its  prepara¬ 
tion,  the  several  fatty  acids  and  other  constituents  of  butter, 
and  the  processes  for  its  analysis.  This,  he  maintains,  has 
been  recently  brought  to  at  least  as  high  a  degree  of  cer¬ 
tainty,  as  regards  adulteration,  as  has  been  attained  with 
any  other  article  of  food.  The  specific  gravity  test,  he 
asserts,  is  perfectly  reliable,  since  while  that  of  other  animal 
fats  varies  from  902-8  to  903'S,  in  genuine  butter  it  rarely 
falls  below  910,  and  is  generally  between  911  and  913. 
This  is  the  more  important,  for  while  formerly  foreign 
fats  were  believed  to  betray  their  presence  by  a  crystalline 
structure,  precautions  are  now  taken  in  the  manufacture  of 
butterine  to  prevent  the  fats  assuming  that  form,  but  five 
samples  of  good  butterine  indistinguishable  from  ordinary 
butter  had  specific  gravity  of  from  901-36  to  903-34  at 
100°  Falir.  When  a  more  minute  examination  is  demanded, 
the  relative  proportions  of  the  soluble  and  insoluble  fatty 
acids  are  equally  characteristic.  One  fat  only,  cocoa-nut 
oil,  would  present  any  difficulty  as  regards  composition  and 
specific  gravity,  but  even  if  the  objectionable  flavour  it 
would  impart  could  be  got  over,  its  low  melting  point  (73° 
Falir.)  would  distinguish  it.  The  ratio  of  the  soluble  to  the 
insoluble  fatty  acids  serves  also  to.  distinguish  the  margarine 
cheeses  from  others,  but,  if  sold  under  a  correct  description. 
Dr.  Bell  sees  even  less  objection  to  them  than  to  the 
factitious  butters. 

For  the  detection  of  alum  in  flour  or  bread  our  author 
recommends  the  logwood  test,  with  this  proviso  :  that  though 
dhe  absence  of  a  permanent  violet  proves  the  absence  of 
alum,  other  salts,  as  those  of  magnesia,  may  give  a  reaction 
not  easily  distinguished  from  that  of  alum  itself.  In  the 
case  of  flour  the  previous  separation  of  free  mineral  matters, 
by  shaking  with  chloroform,  is  a  useful  preliminary  measure. 
For  the  estimation  of  alum  he  adopts  Dr.  Dupre’s  method, 
but  prefers  precipitating  the  aluminium  phosphate  in  hot 
water.  For  experimenting  on  known  admixtures  of  alum 
he  found  that  the  whole  was  not  thrown  down  in  the  cold. 
Wanklyn’s  “  easy  ”  process  he  condemns  as  giving  results 
much  above  the  truth. 

Among, the  various  modes  of  raising  bread  he  omits  that 
of  Neville  consisting  in  the  addition  of  carbonate  of  ammonia, 
which  is  volatilised  and  entirely  dissipated  by  the  heat  of  the 
oven.  The  dark  colour  of  brown  bread  is  due,  he  states,  to 


the  action  of  the  cerealine  on  the  starchy  constituents,  and 
may  be  prevented  by  previous  heating  of  the  flour.  The 
so-called  wheat-meal  bread  has,  he  admits,  the  advantage  of 
being  less  irritating  than  common  brown  bread,  from  the 
grain  being  ground  between  steel  rollers ;  but  he  disputes 
the  higher  nutritive  value  claimed  for  it,  since  he  has  found 
good  household  flour  richer  in  nitrogenous  matter  than  the 
entire  grain. 

The  addition  of  rice  flour  he  believes  to  be  usually  practised 
in  poor  quarters,  to  enable  the  bread  to  be  sold  at  a  lower 
price,  and  thereby  to  draw  custom ;  he  does  not  allude  to  its 
greater  power  of  taking  up  water  and  increasing  the  weight 
of  the  loaf,  or,  as  bakers  say,  the  “  yield”  of  a  given  quantity 
of  flour,  which  is  a  fraud  precisely  like  that  of  diluting  milk. 
But  the  use  of  alum,  even  if  proved  to  be  not  hurtful,  he 
considers  a  clear  case  of  adulteration,  for,  as  he  says,  it  is 
intended  £f  simply  to  lead  the  public  to  infer  from  its  white¬ 
ness  and  general  appearance  that  the  bread  has  been  made 
from  a  better  description  of  flour  than  has  really  been  the 
case.” 

Under  the  title  of  “  Prepared  Starches,”  he  treats  of 
arrowroot,  cornflour,  sago,  and  tapioca,  with  full  but  not 
tedious  accounts  of  their  sources,  history,  and  preparation. 
These  chapters,  as  well  as  those  on  the  cereals  which  precede 
them,  are  illustrated  by  admirable  drawings  of  their  micro¬ 
scopical  appearances,  at  least  as  good  as  those  of  Hassall, 
and  far  superior  to  any  in  Wynter  Blyth’s  work. 


Bericht  der  K.K.  Kranlcenansialt  Rudolph- Stiftung  in  Wien 
vom  Jahre  1881.  Wien,  1882.  Pp.  467. 

Report  of  the  Rudolph- Stiftung  Hospital  in  Vienna  for 
1881,  etc. 

This  Report  is  compiled  upon  much  the  same  lines  as  those 
furnished  of  some  of  our  metropolitan  hospitals  by  their 
medical  and  surgical  registrars.  There  is  first  a  general 
tabular  statement  of  all  the  cases  treated  in  the  hospital, 
classified  under  the  headings  of  the  disease  from  which 
they  suffered,  and  stating  the  numbers  which  were  cured, 
relieved,  were  transferred  elsewhere,  or  died.  There  is  also 
a  statement  of  the  mortality  per  month  from  the  different 
diseases.  After  this  come  more  detailed  statements  of  the 
numbers,  ages,  and  such  other  general  facts  as  can  be  briefly 
stated  of  the  cases  of  each  kind  of  disease.  Finally  come 
full  accounts  of  selected  cases  of  special  interest. 

The  Report,  like  others  of  its  kind,  is  a  valuable  source  of 
reference  for  facts  to  illustrate  the  history  of  disease.  It  is 
suitable  for  this  purpose  rather  than  for  continuous  reading. 
It  is  well  done,  and  a  good  type  of  this  class  of  literature. 


The  Alienist  and  Neurologist,  April,  1883. 

A  paper  on  some  New  Experiments  in  Muscle-Reading  by 
the  late  Dr.  Beard,  reminds  us  of  the  great  loss  that  science 
has  sustained  in  his  death,  and  of  the  suddenness  of  its 
occurrence.  The  paper  itself  is  short,  but  is  fully  up  to  the 
standard  of  Dr.  Beard’s  best  efforts,  and  is  most  interesting. 
Guiteau  is  again  the  subject  of  two  articles,  neither  of  which 
will  interest  English  readers.  Dr.  Hammond  publishes 
here  a  chapter  out  of  his  new  work  on  “  Insanity,”  on  the 
Influence  of  Age  in  Mental  Derangement,  which  does  not 
contain  any  important  novelty.  Studies  on  the  Minute 
Anatomy  of  the  Central  Nervous  System  is  the  title  of  a 
long  and  very  important  article  by  Professor  Golgi,  of  Pavia, 
translated  by  Dr.  J.  Workman,  of  Toronto.  Professor  Golgi 
claims  to  have  discovered  a  method  of  staining  by  the 
combined  action  of  bichromate  [P  of  potash]  and  nitrate  of 
silver,  which  enables  the  processes  of  the  nerve-cells  to 
be  traced  to  a  far  greater  distance  than  any  method 
heretofore  devised.  The  conclusions  at  which  he  arrives 
are  too  numerous  to  be  detailed  here,  but  generally 
it  may  be  said  that  they  confirm  in  a  very  striking  manner 
those  of  the  late  G.  H.  Lewes,  who  is  not,  however,  among 
the  numerous  authorities  quoted  by  Professor  Golgi.  The 
translation  is  very  imperfectly  done.  In  his  anxiety  to  pro¬ 
duce  a  literal  transcript  of  the  author’s  words,  the  translator 
has  allowed  himself  to  ignore  the  structure  of  the  English 
language,  and  often  becomes  almost  unintelligible.  Such 
an  expression  as  "  complicate  nervous  anastomose  ”  is  cer¬ 
tainly  neither  English  nor  Italian,  and  we  are  reluctant  to 
believe  that  it  would  be  considered  good  American.  We 
must  protest  also  against  the  slovenly  proof-reading  of  our 


Medical  Times  and  Gazette. 


MEDICAL  NEWS, 


July  14, 1883.  55 


otherwise  excellent  contemporary.  On  the  same  page  fibrils 
become  first  fabrils  and  then  febrils.  A  division  which  pro¬ 
ceeds  dichotomously  is  said  in  one  place  to  proceed  discoto- 
mically,  in  another  dicotomically.  “  Eeflections  on  Mind,” 
by  Cecilia  Dean,  M.D.,  is  a  most  curious  production,  which 
may  be  described,  after  the  author’s  own  style,  as  a  blazing 
coruscation  of  simile  and  metaphor  sewn  together  by  an 
attenuated  stream  of  reasoning.  The  remainder  of  the 
number  is  well  up  to  the  usual  standard. 


MEDICAL  NEWS. 

- « - 

Boyal  University  of  Ireland. — Medical  Degree 
Examinations. — The  Examiners  have  recommended  the 
Senate  to  admit  the  following  candidates  to  the  under¬ 
mentioned  degrees : — 

The  Degree  of  M.  D.— John  Andrews,  John  Bolster,  George  Clarke, 
Horace  Elliott,  Thomas  Farrelly,  8.  Forster  Freyer,  Thomas  G.  Garry, 
John  B.  Graham,  James  Herron,  James  C.  Hood,  A.  M.  Johnson,  Isaac 

R.  Lane,  Bartholomew  Mangan,  C.  M.  Mitchell,  W.  J.  Mitchell,  John  A. 
Nealon,  Peter  O’Connell,  W.  C.  D.  Prendergast,  Richard  J.  Purdon, 
Stephen  Seanlan,  Michael  J.  Sexton,  R.  G.  Thompson,  Francis  G.  Tooker, 
James  Torrens,  George  W.  Weir. 

The  Degree  of  M.B. — Charles  W.  R.  Wynne. 

The  Degree  of  M.Ch.- F.  E.  Adams,  M.D.  ;  C.  W.  Allport,  M.D. ;  John 
Andrews,  John  Bolster,  George  Clarke,  David  S.  Dunn,  M.D. ;  Horace 
Elliott,  Thomas  Farrelly,  S.  F.  Freyer,  Thomas  G.  Garry,  William  Gibson, 
M.D. ;  John  B.  Graham,  Michael  Kelly,  M.D. ;  Isaac  R.  Lane,  Beattie 
M'Farland,  M.D. ;  Bartholomew  Mangan:  W.  G.  Mitchell,  Peter 
O’Connell,  Patrick  O’Gorman,  M.D. ;  W.  C.  D.  Prendergast,  Richard  J. 
Purdon,  Stephen  Seanlan,  Michael  J.  Sexton,  Simson  Stuart,  M.D. ; 

S.  A.  L.  Swan,  M.D.  ;  Charles  W.  R.  Wynne. 

The  Diploma  in  Obstetrics. — John  Bolster.  Thomas  G.  Garry,  William 
Good,  M.D. ;  John  B.  Graham,  Michael  Kelly.  M.D. ;  Isaac  R.  Lane, 
Bartholomew  Mangan,  W.  J.  Mitchell,  W.  C.  D.  Prendergast,  Stephen 
Seanlan. 


Boyal  College  of  Surgeons  of  England. — The 
following  gentlemen  passed  their  Primary  examinations 
in  Anatomy  and  Physiology  at  a  meeting  of  the  Board  of 
Examiners  on  the  6th  inst.,  and  when  eligible  will  be 
admitted  to  the  pass  examination,  viz.: — 

Archbutt,  H.  D.,  student  of  the  London  Hospital. 

Brown,  W.  H.,  of  the  University  of  Cambridge. 

Cunliffe,  W.  S.,  of  St.  Bartholomew’s  Hospital. 

Evans,  G.  E.  A.,  of  St.  Bartholomew’s  Hospital. 

Fitzgerald,  G.  C.,  of  St.  Thomas’s  Hospital. 

Kauffmann,  O.  J.,  of  the  Manchester  School. 

Lang,  G.  H.,  of  University  College  Hospital. 

Marshall,  A.  L.,  of  the  University  of  Cambridge. 

Pagden,  T.  C.,  of  St.  Bartholomew’s  Hospital. 

Simpson,  C.  S.,  of  Guy’s  Hospital. 

Spear,  George,  of  St.  Mary’s  Hospital. 

Thomas,  J.  L.,  of  St.  Bartholomew’s  Hospital. 

Ward,  J.  A.,  of  Guy’s  Hospital. 

Weaver,  J.  J.,  of  University  College  Hospital. 

Webster,  P.  S.,  of  the  London  Hospital. 

Winter,  H.  E.,  of  St.  Bartholomew’s  Hospital. 

Eight  candidates  were  referred.  The  following  gentlemen 
passed  on  the  7th  inst.,  viz. : —  • 

Anstie,  W.  C.,  student  of  University  College  Hospital. 
Bonnefin,  F.  H.,  of  University  College  Hospital. 

Chamberlain,  E,  B.,  of  the  London  Hospital. 

Christmas,  C.  D.,  of  the  Charing-cross  Hospital. 

Christopherson,  Cecil,  of  St.  Bartholomew’s  Hospital. 

Cox,  A.  H.  L.,  of  King’s  College  Hospital. 

Cressy,  C.  J.,  of  Guy’s  Hospital. 

Davis,  William,  of  the  London  Hospital. 

Farr,  E.  A.,  of  Guy’s  Hospital. 

Harris,  E.  B.,  of  Guy’s  Hospital. 

Jones,  A.  M.,  of  Guy’s  Hospital. 

Richardson,  W.  J.,  of  King’s  College  Hospital. 

Robinson,  B.  T.  A.,  of  University  College  Hospital. 

Smith,  L.  H.,  of  the  London  Hospital. 

Smith,  R.  G.,  of  St.  Bartholomew’s  Hospital. 

Spear,  Robert,  of  St.  Bartholomew’s  Hospital. 

Steman,  R.  S.,  of  St.  Mary’s  Hospital. 

Thompson,  S.  W.,  of  the  Charing-cross  Hospital. 

Four  candidates  were  referred  for  three  months,  and  two  for 
six  months.  The  following  gentlemen  passed  on  the  9th 
inst.,  viz. : — 

Blake,  E.  S.,  student  of  Guy’s  Hospital. 

Blaxford,  E.  G.,  of  University  College  Hospital. 

Capes,  Robert,  of  Guy’s  Hospital. 

Cheale,  Montague,  of  St.  Bartholomew’s  Hospital, 

Cockerill,  J.  W.,  of  St.  Bartholomew’s  Hospital. 

Gee,  F.  W.,  of  University  College  Hospital. 

Harries,  W.,  of  University  College  Hospital. 

Lewis,  B.  A.,  of  the  London  Hospital. 

Lyons,  Thomas,  of  St.  Thomas’s  Hospital. 

Mellor,  Sanderson,  of  the  London  Hospital. 

Parson,  C.  J.,  of  University  College  Hospital. 

Pearson,  G.  K.,  of  University  College  Hospital, 

Pool,  W.  F.,  of  the  London  Hospital. 


Reed,  H.  A.,  student  of  Guy’s  Hospital. 

Reynolds,  G.  H.,  of  Guy’s  Hospital. 

White,  J.  H.,  of  St.  Bartholomew’s  Hospital. 

Eight  candidates  were  referred  for  three  months.  The  fol¬ 
lowing  gentlemen  passed  on  the  10th  inst.,  viz. : — 

Bathurst,  Lancelot,  student  of  St.  Thomas’s  Hospital. 
Biddlecombe.  E.  H.,  of  St.  Bartholomew’s  Hospital. 

Buncombe,  W.  D.,  of  the  London  Hospital. 

Crouch,  C.  P.,  of  St.  Bartholomew’s  Hospital. 

Fraser,  P.  W.,  of  University  College  Hospital. 

Freeman,  C.  D.,  of  the  Charing-cross  Hospital. 

Joly,  J.  E.  N.,  of  University  College  Hospital. 

Matthey,  Arthur,  of  St.  Bartholomew’s  Hospital. 

Preston,  H.  O.,  of  St.  George’s  Hospital. 

Rawlinson,  G.  E.,  of  St.  Thomas’s  Hospital. 

Seccombe,  S.  H.,  of  Guy’s  Hospital. 

Speedy,  R.  G.  D.,  of  St  George’s  Hospital. 

Spoor,  W.  J.,  of  the  Middlesex  Hospital. 

Whicher,  A.  H.,  of  the  Charing-cross  Hospital. 

Williams,  G.  H.,  of  St.  George’s  Hospital. 

Wood,  H.  M.,  of  St.  Mary’s  Hospital. 

Six  candidates  were  referred  for  three  months,  and  one  for 
six  months.  The  following  gentlemen  passed  on  the  11th 
inst.,  viz.  : — 

Buckland,  S.  C.,  student  of  the  Middlesex  Hospital. 

Coryn,  H.  A.  W.,  of  the  Charing-cross  Hospital. 

Davies,  D.  T.,  of  St.  Bartholomew’s  Hospital. 

Davis,  Ifor,  of  the  Middlesex  Hospital. 

Dill,  R.  C.  G.,  of  St.  George’s  Hospital. 

Finueane,  M.  I.,  of  St.  Thomas’s  Hospital. 

Pearman,  T.  E.  A.,  of  the  London  Hospital. 

Pickthorn,  A.  J.,  of  St.  George’s  Hospital. 

Raven,  F.  H.  S.,  of  St.  Bartholomew’s  Hospital. 

Rusher,  J.  G.,  of  the  London  Hospital. 

Sealy,  F.  M.,  of  the  Middlesex  Hospital. 

West,  W.  P.,  of  Guy’s  Hospital. 

Wreford,  John,  of  the  London  Hospital. 

Twelve  candidates  were  referred  for  three  months. 


Apothecaries’  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday, 
July  5  : — 

Beardmore,  George  Russell,  Upper-street,  Islington,  N. 

Bennett,  Frederick  Thomas,  Instow,  North  Devon. 

Burrows,  Walter  Horncastle,  Cobden-road,  Chesterfield. 

D’ Aguiar,  Joao  Gomes,  Demerara. 

Gostling,  Thomas  Preston,  Lady  Margaret-road,  N.W. 

Hentsch,  George  Frederick,  Richmond-road,  Barnsbury,  N. 
Kitching,  John  Lea  Walton,  The  Infirmary,  Derby. 

Pauli,  William  Kirman,  Luton,  Bedfordshire. 

Power,  Henry  d’Arcy,  Charlwood-street,  W. 

Sutton,  Henry  Martyn,  Lambeth  Palace-road,  S.E. 

Whicher,  James  Charles  Francis,  Westcombe  Park,  Blackheath. 
Willett,  Edgar  William,  Great  Ormond-street,  W.C. 

Wingrave,  Thomas,  Hemel  Hempstead,  Herts. 

The  following  gentleman  also  on  the  same  day  passed  the 
Primary  Professional  Examination  : — 

Bradshaw,  William  Lucknow,  Belfast  Royal  Hospital. 


NAVAL,  MILITARY,  Etc.,  APPOINTMENTS. 

Army  Medical  Department. — To  be  Surgeon-General — Deputy  Surgeon- 
General  Annesley  Charles  Castriot  de  Renzy,  C.B.,  of  the  Bengal  Army. 
To  be  Deputy  Surgeon-General — Brigade  Surgeon  John  Picthall,  M.B., 
the  Bengal  Army.  To  be  Brigade  Surgeons — Surgeon-Major  George 
William  Jameson,  of  the  Bengal  Army;  Surgeon-Major  Lindsay 
Frederick  Dickson,  M.D.,  of  the  Bengal  Army;  Surgeon-Major  John. 
Bilderbeck,  of  the  Madras  Army. 


DEATHS. 

Jewesbury,  Charles  Frederick,  M.R.C.S.,  etc.,  late  of  Ceylon,  at  St.. 
Ives,  Cornwall,  on  July  3,  aged  33. 

Pratt,  Charles,  M.D.,  at  Appledore,  North  Devon,  on  July  9,  in  his  61st 
year. 

Pratt,  Edward,  M.R.C.S.E.,  etc.,  formerly  Assistant-Surgeon  R.N.,  at 
Swansea,  on  June  12. 


VACANCIES. 

In  the  following  list  the  nature  of  the  office  vacant,  the  qualifications  re¬ 
quired  in  the  candidate,  the  person  to  whom  application  should  be  made 
and  the  day  of  election  (as  far  as  known)  are  stated  in  succession. 

Leeds  Public  Dispensary. — Resident  Medical  Officer.  _  Candidates  must 
be  qualified  and  unmarried.  Applications  and  testimonials  must  be- 
sent  in  before  July  22,  to  Mr.  H.  Bendelack  Hewetson,  11,  Hanover- 
square,  Leeds. 

Middlesex  County  Lunatic  Asylum,  Colney  Hatch.— Assistant  Medical 
Officer.  ( For  particulars  see  Advertisement.) 

Royal  Free  Hospital,  Gray’s-inn-road,  W.C.  -  Junior  Resident  Medical 
Officer.  [For  particulars  see  Advertisement.) 

Royal  London  Ophthalmic  Hospital,  Mooreields,  E.C. — Refraction 
Assistant.  [For  particulars  see  Advertisement.) 

Stockton-upon-Tees  Hospital  and  Dispensary. — House-Surgeon  (non¬ 
resident).  Salary  £200  per  annum.  Candidates  must  be  doubly  quali¬ 
fied.  Applications,  in  writing,  stating  age,  with  recent  testimonials  (or 
copies),  to  be  sent  to  the  Secretary,  not  later  than  July  14. 


56 


Medical  Times  and  Gazette. 


VITAL  STATISTICS. 


July  14,  1883. 


Torbay  Hospital  and  Provident  Dispensary,  Torquay. — Junior  House- 
Surgeon  and  Dispenser.  Candidates,  qualified  in  medicine  and  surgery, 
and  registered,  must  be  single  and  without  the  care  of  a  family.  Board, 
lodging,  and  attendance,  together  with  fees  from  such  pupils  in  dis¬ 
pensing  as  the  Board  may  approve.  Testimonials  to  the  Hon.  Secretary, 
W.  H.  Kitson,  Esq.,  Hemsworth,  Torquay,  not  later  than  July  16. 

Township  op  Manchester. — Resident  Assistant  Medical  Officer.  Salary 
£140  per  annum,  with  furnished  apartments,  fire,  light,  washing,  and 
attendance.  Candidates  must  reside  in  workhouse,  be  unmarried, 
registered,  and  possess  medical  and  surgical  qualifications.  Applica¬ 
tions,  endorsed  “  Medical  Appointment,”  to  be  sent  not  later  than  18th 
inst.,  to  George  Macdonald,  Clerk  to  the  Guardians,  Poor-Law  Offices, 
iNew  Bridge-street,  Manchester. 


UNION  AND  PAROCHIAL  MEDICAL  SERVICE. 

***  The  area  of  each  district  is  stated  in  acres.  The  population  is 
'computed  according  to  the  census  of  1881. 

RESIGNATIONS. 

Dewsbury  Union. — The  office  of  Medical  Officer  for  the  Thornhill  District 
is  vacant  by  the  death  of  Mr.  W.  H.  Hatfield :  area  3497  ;  population 
£843 ;  salary  £20  per  annum. 

Downham  Union. — Mr.  W.  L.  King  has  resigned  the  Wiggenhall  Dis¬ 
trict  :  area  18,691 ;  population  3644 ;  salary  £46  per  annum. 

Tiverton  Union.— Mr.  Samuel  Burrows  has  resigned  the  Cruwys  Morchard 
District :  area  7661 ;  population  766  ;  salary  £18  per  annum. 

Township  of  Mancheser. — Mr.  Clement  B.  Voisey  has  resigned  the 
Resident  Assistant  Medical  Officership  of  the  Workhouse  :  salary  £140. 

APPOINTMENTS. 

Lichfield  Union. — James  Clark,  M.D.  Aber.,  F.R.C.S.  Edin.,  to  the  St. 
Chad  District. 

Romford  Union. — Alfred  Wright,  M.R.C.S.  Eng.,  L.S.A.,  to  the  Pirst 
District. 


New  Magistrate. — Edward  Lister,  L.R.C.P.  Edin., 
M.R.C.S.  Eng.,  L.S.A.  (retired),  Swarthdale,  Ulverston,  has 
been  placed  on  the  Commission  of  the  Peace  for  the  county 
of  Lancaster. 

Curious  Action  eor  Libel. — A  novel  and  important 
suit  for  libel  has  recently  been  tried  in  the  New  Jersey 
courts.  The  indictment  was  brought  against  the  editor  of 
the  Red  Bank  Register  for  libelling  the  people  of  Red  Bank. 
The  charge  was  that  in  August  last  the  defendant  sent 
communications  to  the  New  York  papers  concerning  the 
prevalence  of  typhoid  and  malarial  fevers  at  Red  Bank,  and 
had  also  published  similar  articles  in  his  own  paper.  These 
articles,  it  was  claimed,  caused  a  serious  depreciation  in  the 
value  of  real  estate.  After  a  protracted  trial  the  Court 
instructed  the  jury  to  acquit,  on  the  ground  that  the  State 
failed  to  prove  the  falsity  of  the  articles,  and  the  defendant 
was  discharged. — Boston  Med.  Jour.,  June  14. 


APPOINTMENTS  FOR  THE  WEEK. 


July  14.  Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  1 J  p.m. ;  King’s  College,  1J  p.m. ;  Royal 
Free,  2  p.m.;  Royal  London  Ophthalmic,  11  a.m. ;  Royal  Westminster 
Ophthalmic,  1J  p.m. ;  St.  Thomas’s,  ljp.m.;  London,  2  p.m. 


16.  Monday. 

Operations  at  the  Metropolitan  Free,  2  p.m.;  St.  Mark’s  Hospital  for 
Diseases  of  the  Rectum.  2  p.m.;  Royal  London  Ophthalmic,  11  a.m.; 
Royal  Westminster  Ophthalmic,  1£  p.m. ;  Hospital  for  Women,  2  p.m. 

17.  Tuesday. 

Operations  at  Guy’s,  li  p.m. ;  Westminster,  2  p.m. ;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  li  p.m.;  West 
London,  3  p.m. 

Royal  Colleqe  of  Surgeons  of  England,  4  p.m.  Dr.  Garson,  “  On 
the  Comparative  Anatomy  of  the  Integumentary,  Respiratory,  and  Cir¬ 
culatory  Systems  of  the  Vertebrata.” 


18.  Wednesday. 

Operations  at  University  College,  2  p.m. ;  St.  Mary’s,  11  p.m. ;  Middlesex, 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew’s,  li  p.m.  ;  Great  Northern, 

2  p.m.  ;  Samaritan,  2i  p.m. ;  Royal  London  Ophthalmic,  11  a.m. ; 
Royal  Westminster  Ophthalmic,  li  p.m. ;  St.  Thomas’s,  li  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m. ;  National  Orthopaedic,  Great 
Portland-street.  10  a.m. 


19.  Thursday. 

Operations  at  St.  George’s,  1  p.m.  ;  Central  London  Ophthalmic,  1  p.m. ; 
Royal  Orthopaedic,  2  p.m. ;  University  College,  2  p.m. ;  Royal  London 
Ophthalmic,  11  a.m. ;  Royal  Westminster  Ophthalmic,  li  p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m.;  Hospital  for  Women,  2  p.m.; 
Charing-cross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  2i  p.m. 

20.  Friday. 

Operations  at  Central  London  Ophthalmic,  2  p.m.;  Royal  London  Ophthal¬ 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminster 
Ophthalmic,  lip.m.;  St.  George’s  (ophthalmic  operations),  If  p.m.; 
Guy’s,  14  o.m. ;  St. Thomas’s  (ophthalmic  operations),  2  p.m. ;  King’s 
College  (by  Mr.  Lister),  2  p.m. 


VITAL  STATISTICS  OF  LONDON. 


Week  ending  Saturday,  July  7,  1883. 


BIRTHS. 

Births  of  Boys,  1284;  Girls,  1194;  Total,  2478. 
Corrected  weekly  average  in  the  10  years  1873-82,  2550  0. 


DEATHS. 


Males. 

Females. 

Total. 

Deaths  during  the  week . 

774 

747 

1521 

Weekly  average  of  the  ten  years  1873-82,  i 
corrected  to  increased  population  ...  ) 

767’6 

700-4 

1468 -0 

Deaths  of  people  aged  80  and  upwards 

... 

... 

57 

DEATHS  IN  SUB-DISTRICTS  FROM  EPIDEMICS. 


Enumerated 

Population, 

1881 

(unrevised). 

Small-pox. 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

f 

hn 

.9x5 

P.  to 
o  3 

O  o 
^  o 

Typhus. 

Enteric  (or 

Typhoid) 

Fever. 

Simple 

continued 

Fever. 

ce 

8 

A 

§ 

3 

West . 

669833 

6 

4 

4 

8 

•  •• 

1 

37 

North 

906947;  ... 

9 

5 

6 

9 

... 

5 

... 

19 

Central 

282238 

8 

•  •• 

1 

2 

... 

... 

12 

East . 

692738 

-  »  . 

24 

15 

... 

4 

... 

2 

... 

49 

South . 

1265927 

1 

18 

11 

1 

7 

... 

3 

... 

50 

Total . 

3816483 

1 

65 

35 

12 

30 

... 

11 

... 

167 

METEOROLOGY. 

From  Observations  at  the  Greenwich  Observatory. 


Mean  height  of  barometer  . 

... 

... 

.  29-745  in. 

Mean  temperature  . 

... 

... 

.  64-3° 

Highest  point  of  thermometer  ... 

... 

... 

.  83-3“ 

Lowest  point  of  thermometer  ... 

... 

... 

...  496° 

Mean  dew-point  temperature 

... 

... 

.  55-2’ 

General  direction  of  wind 

... 

.  S.S.W. 

Whole  amount  of  rain  in  the  week  ... 

... 

... 

.  012  in. 

BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  the 
Week  ending  Saturday,  July  7,  in  the  following  large  Towns: — 


Cities 

and 

Boroughs. 

Estimated  Population  to 
middle  of  the  year  1883. 

|  Births  Registered  during 
the  week  ending  July  7. 

Deaths  Registered  during 
;  the  week  ending  July  7. 

Annual  Rate  of 
Mortality  per  1000  living, 
from  all  causes. 

Temperature 
of  Air  (Fahr.) 

Temp, 
of  Air 
(Cent.) 

Rain 

Fall. 

Highestduring 
the  Week. 

1  Lowest  during 
the  Week. 

Weekly  Mean  of 
Daily  MeanVaiues 

Weekly  Mean  of 
Daily  Mean 
Values. 

In  Inches. 

In  Centimetres. 

London 

3955814 

2478 

1521 

20-1 

83-3 

49-6 

64-3 

17  95 

012 

030 

Brighton  ... 

... 

111262 

60 

23 

10-8 

75  3 

48-7 

61-7 

16-50 

037 

0-94 

Portsmouth 

... 

131478 

95 

47 

18-7 

... 

... 

... 

... 

... 

Norwich  ... 

89612 

37 

29 

16-9 

... 

... 

... 

Plymouth  ... 

74977 

39 

25 

17  4 

68-1 

55-0 

59-7 

15-39 

0-60 

1-52 

Bristol . 

212779 

103 

57 

14-0 

76-6 

49-0 

59-3 

1517 

0-54 

1-37 

Wolverhampton  . 

77557 

57 

24 

162 

76  7 

48-2 

60-0 

15  56 

0-39 

0-99 

Birmingham 

414846 

265 

155 

19-5 

... 

... 

... 

... 

Leicester  ... 

.  . " 

129483 

99 

38 

15'3 

77-8 

51 -5 

62’7 

17-06 

1-20 

305 

Nottingham 

... 

199349 

138 

66 

17-3 

84-2 

494 

631 

17-28 

1-00 

254 

Derby . 

... 

85574 

78 

22 

13-4 

... 

... 

... 

... 

.  .  . 

Birkenhead 

ft 

88700 

66 

30 

17-6 

... 

... 

... 

... 

... 

Liverpool  ... 

•  *. 

566763 

377 

252 

23-2 

... 

... 

... 

... 

... 

... 

Bolton . 

107862 

66 

32 

155 

... 

... 

... 

... 

... 

Manchester 

339262 

203 

124 

19-1 

... 

... 

... 

... 

... 

Salford  ... 

... 

190465 

141 

60 

10  4 

... 

... 

... 

... 

... 

... 

Oldham 

119071 

80 

47 

20-6 

... 

... 

... 

... 

... 

... 

Blackburn  ... 

... 

108460 

72 

37 

17-8 

... 

... 

... 

... 

... 

... 

Preston 

98564 

85 

40 

212 

... 

... 

... 

... 

... 

... 

Huddersfield 

84701 

53 

32 

19-7 

... 

... 

... 

... 

... 

... 

Halifax 

75591 

47 

20 

138 

... 

... 

... 

... 

... 

Bradford  ... 

204807 

107 

68 

17-3 

762 

53-3 

62-0 

16  67 

0  93 

2-36 

Leeds  . 

321611 

229 

137 

222 

76  0 

52-0 

61-3 

16-28 

1-31 

333 

Sheffield 

295497 

208 

110 

19-4 

... 

... 

... 

... 

... 

Hull  . 

176296 

112 

58 

17-2 

75-0 

50-0 

618 

1656 

1-25 

3  17 

Sunderland 

121117 

87 

38 

16-4 

... 

... 

... 

... 

... 

.  .  . 

Newcastle  ... 

149464 

107 

65 

22-7 

... 

... 

... 

... 

... 

... 

Cardiff . 

... 

90033 

57 

28 

16-2 

... 

... 

... 

... 

... 

... 

For  28  towns 

... 

6620975 

5546 

3185 

19  3 

84-2 

48-2 

61-6 

1645 

0-77 

1-96 

Edinburgh  ... 

235946 

138 

73 

16-1 

75-0 

48-6 

693 

15-17 

1-10 

2-79 

Glasgow 

515589 

359 

279 

28-1 

71-0 

50-0 

605 

15-84 

0-59 

1-50 

Dublin . 

... 

349:85 

... 

... 

... 

... 

... 

... 

... 

... 

... 

At  tbe  Royal  Observatory,  Greenwich,  the  mean  reading 
of  the  barometer  last  week  was  29’75  in.  The  highest  read¬ 
ing  was  29’94  in.  on  Sunday  morning,  and  the  lowest  29’63  in. 
on  Friday  afternoon. 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES. 


July  14,  1883.  57 


NOTES,  QUERIES,  AND  REPLIES. 

- ♦— - 

He  tjjat  qutsthmttfr  mnc|}  s^all  learn  mncfe. — Bacon. 

A  Provincial  Fellow.— The  annual  festival  of  the  Fellows  of  the  College  of 
Surgeons  took  place,  as  usual,  at  the  Albion  Tavern  ;  Mr.  Holden  in  the 
chair,  supported  by  seventy-three  guests.  Dr.  Crawford  replied  for  the 
Army,  Sir  J.  Reed  for  the  Navy,  Sir  Wm.  Mac  Cormae  and  Mr.  Alfred 
Cooper  for  the  Reserved  Forces.  “  The  Medical  Schools,”  proposed  by 
Mr.  B.  Carter,  was  responded  to  by  Mr.  O.  Pemberton  (who  made  some 
pertinent  and  well-received  observations  on  voting  by  proxy) ,  and  by  Mr . 
Durham  for  the  metropolitan  schools.  Sir  James  Paget  proposed  the 
Chairman,  eulogising  Mr.  Holden’s  conduct  and  career,  from  his  entrance 
at,  to  his  retirement  from  8t.  Bartholomew’s. 

An  Advocate  for  Clean  Streets.—  The  sweeping  of  the  Paris  streets,  accord¬ 
ing  to  the  last  official  return,  costs  5,243,<X  0  francs.  The  number  of 
persons  employed  in  the  work  is  3016,  including  820  sweepers,  2010 
auxiliary  sweepers,  and  166  foremen. 

Infant  Mortality  and  the  “ Baby’s  Bottle .” — Dr.  R.  Dacre  Fox,  Manchester, 
writing  on  the  subject  of  infant  mortality,  speaks  of  his  experience  as 
an  old  resident  medical  officer  at  the  workhouse,  and  as  surgeon  to  a 
children’s  hospital,  which  has  taught  him  to  regard  as  a  very  fruitful 
source  of  milk-poisoning  the  decomposition  from  the  vessel  which  is 
used  to  feed  the  child.  He  feels  sure  all  of  his  confreres  who  have  to 
treat  the  children  of  the  poor  will  agree  with  him  that  99  per  cent,  of 
the  bottles  out  of  which  children  are  fed  are  offensive  from  the  odour 
of  the  decomposed  milk,  which  adheres  about  the  cork,  tube,  or  teat, 
through  which  the  children  suck;  and  in  the  bottle  itself  rings  of 
adherent  putrefying  milk  mark,  as  tide  lines,  how  much  the  child  has 
taken  at  a  meal.  He  adds,  “  The  use  and  abuse  of  the  ‘  baby’s  bottle  ’ 
would  be  a  fit  subject  for  inquiry  by  our  local  8anitary  Association  ;  and 
assisted  by  its  lady  members,  might  it  not  devote  some  of  its  energy 
to  a  teaching  crusade  among  the  women  in  the  poorer  districts  of  the 
town  ?  ” 

Donations  to  Charitable  Institutions. — The  Corporation  of  London  has  just 
made  the  following  grants  City  Orthopaedic  Hospital,  £52  10s. ;  St. 
Mary’s  Hospital,  £105 ;  North-West  London  Hospital,  £52  lCs. ; 
Samaritan  Free  Hospital,  £105. 

Dr.  Harris. — At  the  recent  election  into  the  Council  of  the  Royal  College 
of  Surgeons,  it  is  stated  that  372  Fellows  recorded  their  votes— the  largest 
number  known  :  135  were  from  the  provinces;  but  twelve  were  invalid 
by  leaving  on  the  voting-papers  the  names  of  more  candidates  than 
there  were  vacancies.  It  is  curious  how  little  attention  is  paid  to  the 
directions  for  voting,  as  (in  red  ink,  in  order  to  make  it  more  conspicu¬ 
ous)  the  Fellows  are  told  to  strike  out  the  names  of  those  candidates  for 
whom  they  do  not  wish  to  vote.  No  less  than  fifty-one  plumpers  were 
distributed  amongst  eight  of  the  nine  candidates. 

A  Convalescent  Home  for  Working  Men. — An  establishment  managed  by 
working  men  for  working  men  has  just  been  opened  at  St.  Margaret’s 
Bay,  near  Dover.  It  is  the  outcome  of  the  Hospital  Saturday  movement, 
but  will  have  no  connexion  whatever  with  its  funds.  It  is  designed  to 
be  self-supporting,  and  for  convalescent  working  men  on  leaving  hos¬ 
pital,  where,  for  a  small  weekly  sum,  or,  if  need  be,  without  charge,  they 
should  be  able  to  take  rest  necessary  for  complete  restoration.  For 
the  purchase  and  furnishing  of  the  “retreat  ”  £2500  was  required,  which 
has  been  lent  by  Messrs.  Hoare.  Subsequently,  subscriptions,  including 
fifty  guineas  from  the  Corporation  of  London,  and  £200  from  Mr.  S. 
Morley,  M.P.,  have  been  received;  but  £1200  remains  to  be  paid  off. 
The  home  will  receive  thirty  men,  whose  payments,  though  small,  will, 
it  is  expected,  render  it  almost  self-supporting. 

A  Fee  of  Fourpence  per  Case  of  Successful  V accination  ! — A  letter  was  read 
at  the  last  meeting  of  the  Mile  End  Old  Town  Board  of  Guardians  from 
the  Local  Government  Board,  declining  to  assent  to  the  proposal  of  the 
guardians  to  allow  the  present  arrangement  with  the  vaccination  officer 
to  stand  over  for  twelve  months.  The  Board  did  not  think  that  four- 
pence  per  case  of  successful  vaccination  was  sufficient  remuneration- 
A  motion  that  the  letter  be  considered  that  day  six  months  was  adopted. 

A  Metropolitan  Teacher.— This  journal  was  the  first  to  publish  the  names 
■of  successful  candidates  for  the  diploma  of  Membership  of  the  Royal 
College  of  Surgeons— a  plan  now  become  general  for  all  kindred  insti. 
tutions.  It  was  an  innovation  much  resented  for  a  short  time,  but 
reflection  showed  the  authorities  the  wisdom  of  non-intervention. 

The  Metropolitan  Main  Drainage  System.— A  French  paper,  remarking 
upon  the  recent  visit  of  experts  to  this  country  for  the  purpose  of  exa¬ 
mining  our  main  drainage  system,  says — “  The  bad  sanitary  condition 
of  Paris,  the  recent  and  serious  epidemic  of  typhoid  fever,  and  the 
bad  smell  at  the  present  day  still  the  characteristic  of  the  capital  of 
France,  have  provoked  the  nomination  of  a  special  technical  commission 
to  report  upon  the  ameliorations  that  might  be  possible  to  apply  to  this 

state  of  things . It  is  absolutely  evident  to  all  who  have  studied 

the  question,  that  energetic  measures  ought  to  be  adopted  to  preserve 
the  health  of  the  inhabitants  of,  and  visitors  to,  Paris.” 


J .  Chadwick  S'.— The  Manchester  Royal  Eye  Hospital  has  been  in  existence 
for  nearly  seventy  years,  but  it  would  appear  to  be  only  within  the  last 
ten  years  that  the  building  erected  in  St.  John-street  sixteen  years  ago 
has  become  quite  insufficient  for  the  increasing  demands  upon  it.  A  new 
hospital  is  therefore  proposed,  capable  of  holding  100  beds,  with  proper 
accommodation  for  out-patients.  The  estimated  cost,  inclusive  of  the 
site,  is  £20,000. 

A  Necessary  Sanitary  Provision  at  last! — For  several  years  the  Hampstead 
Vestry  have  been  considering  the  adoption  of  the  Baths  and  Washhouses 
Act  for  the  parish.  At  length  they  have  resolved  to  adopt  it.  It  is 
thought  that  two  sets  of  baths  will  be  necessary— one  for  Hampstead 
proper,  and  one  for  the  Kilbum  portion  of  the  parish,— and  the  estimated 
cost,  including  site,  will  be  for  each  about  £16,000.  Each  building  will 
include  first-  and  second-class  baths,  swimming-baths,  and  washhouses. 
Heloman,  Egypt. — During  the  last  visitation  of  cholera  which  raged 
severely  at  Cairo,  there  were  hardly  any  cases  at  this  little  town.  It  is 
situated  on  a  plateau  some  two  hundred  feet  above  the  valley  of  the 
Nile,  nearly  opposite  the  Pyramids,  and  about  ten  miles  from  Cairo- 
It  is  connected  with  the  capital  by  a  railroad,  and  lies  on  the  borders  of 
the  desert.  There  is,  in  consequence,  no  moisture  there,  while  the 
extreme  heat  of  the  day  is  mitigated  by  cool  breezes,  which  always 
spring  up  in  the  desert  at  night.  It_is  a  bathing-place  famous  for  its 
sulphur  springs. 

Over-educating  in  School  Boards. — This  subject  has  obtained  much  public 
discussion,  but  it  may  be  incidentally  asked  whether  the  strain  of  the 
children’s  lessons  and  their  home  work  may  not  be  attended  with  an 
amount  of  harass  sufficient  to  produce  bad  health  and  mental  debility. 
Are  not  the  lessons  which  are  learnt  out  of  school,  in  crowded  and  noisy 
homes,  probable  factors  of  more  bodily  and  mental  disturbance  than  an 
increase  of  work  in  this  respect  in  school,  with  the  quiet  and  order  of  its 
superintendence  and  discipline  ? 

Ralph.  —  The  area  now  occupied  by  the  buildings  and  land  of  the  Caterham 
Asylum  for  Imbeciles  extends  over  150  acres.  The  land  is  cultivated  by 
the  inmates,  who  now  number  2C00,  of  whom  500  are  epileptic  patients. 
Mortality,  Logos. — If  the  report  of  the  Registrar  at  Lagos  for  1882  may  be 
accepted  as  correct,  the  death-rate  last  year  was  only  18-23  per  1000. 
Considering  the  unhealthiness  of  the  West  Coast  of  Africa,  to  which 
Lagos  has  hitherto  been  no  exception,  these  figures  are  somewhat 
astounding,  even  to  the  inhabitants.  How  was  it  that  death  should 
appear  to  be  so  busy  amongst  them  when,  from  a  statistical  point  of 
view,  they  had  little  to  complain  of  ?  Explanation  is  simple  enough  : 
the  discrepancy  is  due  to  absence  of  all  compulsory  regulation  for  the 
registration  of  deaths,  and  to  the  custom  of  burying  the  dead  under 
the  floors  of  the  houses.  The  natives  are  very  tenacious  of  this 
barbarous  practice.  To  them  it  is  an  outrage  to  bury  their  deceased 
relatives  under  ground  which  may  be  trodden  by  strangers,  and  conse¬ 
quently  the  interior  of  every  hut  is  converted  into  a  family  cemetery. 
The  Lagos  Observer  aptly  says  — “  This  noxious  and  offensive  custom  is 
a  fertile  source  of  disease  and  mortality,  and  steps  ought  to  be  taken 
to  compel  the  people  to  pay  some  regard  to  the  laws  of  health.” 

Juvenile  Temperance  “Badges.” — Mr.  F.  T.  Palgrave,  writing  to  the 
Wiveliscombe  School  Board,  Somerset,  on  behalf  of  the  Education 
Department,  states  that  refusing  admission  to  school  to  children  wearing 
the  “  blue  ribbon  ”  is  inadmissible  under  Article  89  of  the  Code,  and,  if 
persisted  in,  will  entail  the  loss  of  grants,  as  the  schools  of  the  Board 
thus  cease  to  be  public  elementary  schools. 

A  Grievance. — Dr.  Porter,  Medical  Officer  of  the  Bow  District,  draws  the 
attention  of  the  Poplar  Board  of  Guardians  to  the  subject  of  fees  for 
certifying  for  lunatics.  He  points  out  that  by  his.  agreement  with  the 
Guardians  he  was  entitled  to  a  guinea  fee  for  lunacy  certificates,  but  by 
a  change  in  the  arrangements  the  lunatics  go  to  the  workhouse,  and 
the  fees  to  the  «vorkhouse  medical  officer,  and  Dr.  Porter  is  “left.” 
The  Chairman  of  the  Board  states  that  although  the  Guardians  might 
see  that  there  was  a  little  loss  to  the  district  medical  officers,  they  had 
no  power  to  interfere,  as  the  arrangements  are  practically  controlled 
by  the  magistrates. 

Contagious  Diseases  Acts. — A  Parliamentary  return  has  been  issued,  con¬ 
taining  a  copy  of  all  orders  given  as  to  the  operation  of  these  Acts  since 
the  vote  of  the  House  of  Commons  in  reference  to  compulsory 
examination. 

Women  as  Poor-law  Guardians. — From  the  annual  report  of  the  Society 
for  Promoting  the  Return  of  Women  as  Poor-law  Guardians,  it  appears 
two  ladies  had  been  elected  for  the  first  time  in  the  Poor-law  history  of 
Scotland,  whilst  in  Bradford,  Eastbourne,  Birmingham,  and  Bristol 
ladies  had  also  obtained  a  majority  of  votes.  In  London,  thirteen 
ladies  had  been  elected  this  year,  against  eleven  last  year  It  is  stated 
that  the  Local  Government  Board  are  desirous  of  securing  the  admission 
of  women  as  guardians,  apparently  recognising  the  useful  work  which 
might  be  carried  out  by  them.  We  understand  it  is  in  contemplation  to 
bring  a  Bill  in  the  House  of  Commons  for  this  purpose. 

The  Tower  of  London  Improvements . — It  would  be  a  great  boon  to  the 
inhabitants  of  the  district  if  the  Tower  Embankment  were  thrown  open 
to  the  public.  Thirty  years  ago  it  was  accessible  by  the  people,  and  was 
closed  on  the  alleged  necessity  of  extra  room  for  Government  stores. 
That  necessity  no  longer  exists. 


58 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES 


July  14,  1883. 


Pickles  Artificially  Coloured  Green.— The  Court  of  Appeal  in  Brussels  has 
decided  that  the  objection  to  pickles  artificially  coloured  green  by 
the  contact  of  the  vinegar  with  copper  utensils  is  a  mere  prejudice. 
Some  manufacturers  of  pickled  gherkins  in  that  city  having  been  con¬ 
demned  in  December  last  to  a  fine  for  having,  in  the  technical  language 
of  the  judgment,  “  sold  or  exposed  for  sale  certain  substitutes  affected 
by  copper  verdigris  of  a  nature  to  cause  the  death  of  the  consumer,  or 
at  least  to  produce  effects  injurious  to  health,”  one  of  the  condemned 
appealed,  and  the  case  necessitated  the  examination  of  scientific  wit¬ 
nesses.  Professors  in  chemistry  gave  evidence  on  both  sides,  but  it  was 
of  such  a  conflicting  character  that  finally  judgment,  free  of  costs,  was 
given  for  the  appellant. 

A  Boon.— The  need  of  the  adaptation  of  the  burial-ground  of  St.  George’s, 
Bloomsbury,  which  is  situate  in  the  parish  of  St.  Pancras,  and  in  close 
proximity  to  a  dense  population  of  poor  people,  is  exhibited  by  the 
fact  that  many  of  the  children  who  frequent  the  Temple  Gardens  in  the 
evening  come  from  this  neighbourhood.  A  faculty  to  lay  out  the  ground 
in  question  as  a  public  garden  has  just  been  granted.  TheKyrle  Society 
has  laudably  agreed  to  find  £237,  which  is  required  for  the  necessary 
alterations,  and  the  parish  of  St.  Pancras  has  undertaken  to  keep  the 
garden  in  proper  order. 

The  County  Analyst,  Cambridge.— On  condition  that  the  county  analyst 
would  consent  to  a  reduction  of  the  fees  payable  to  him  for  analysing 
water,  which,  it  was  contended,  was  much  more  important  than 
other  articles  of  consumption,  the  county  magistrates  have  agreed  to 
advance  the  salary  by  £10  for  one  year. 

G.  G.,  Southwark. — The  existing  regulations  of  the  London  Corporation 
Sanitary  Committee  for  resisting  the  importation  of  cholera  into  the 
metropolis  are,  that  if  a  vessel  be  suspected  of  being  affected  it  be 
handed  over  to  the  medical  officers,  and  if  they  find  any  person  on 
board  who  is  affected  he  is  to  be  immediately  removed  to  the  hospital 
ship.  The  medical  officers  have  full  power  to  inspect  any  ship. 

Diseased  Meat  outside  the  City  of  London  Meat  Market. — With  respect  to  a 
complaint  by  Dr.  Sedgwick  Saunders,  the  Medical  Officer  of  Health,  of 
the  sale  of  unsound  and  diseased  meat  consigned  to  salesmen  in 
Charterhouse-street,  outside  the  Meat  Market,  and  beyond  the  jurisdic¬ 
tion  of  the  market  authorities  (previously  referred  to  in  these  columns), 
the  Sanitary  Committee  of  the  City  Commission  of  Sewers  report  that 
there  appeared  sufficient  evidence  to  warrant  legal  proceedings,  and 
they  recommended  that  the  matter  be  referred  to  the  Solicitor  to  take 
one  case  in  the  first  instance,  and  proceed  by  special  indictment.  This 
was  agreed  to. 

Norse. — The  Fulham  Board  of  Guardians,  in  reference  to  the  mortuary 
question,  are  about  to  make  an  application  for  inquests  to  be  held  in 
the  board-room  as  hitherto. 

Dr.  Mitchell. — Yes.  Sir  Henry  Alfred  Pitman  graduated  M.D.  Cantab,  in 
1841 ;  he  is  Consulting  Physician  to  St.  George’s  Hospital,  where  he 
formerly  lectured  on  the  Principles  and  Practice  of  Medicine.  He  has 
for  more  than  twenty  years  been  the  Registrar  of  the  Royal  College  of 
Physicians,  and  he  is  the  representative  of  that  Corporation  in  the 
General  Medical  Council. 

The  “  Nazareth  Souse ”  Charges. — At  the  Fulham  District  Board  of  Works, 
last  week,  the  General  and  Sanitary  Committee  reported  to  the  Board 
on  this  matter  a  recommendation  that  no  further  action  be  taken  on 
it.  A  member,  referring  to  the  Government  report,  thought  the  subject 
should  not  be  shelved,  out  of  justice  to  their  medical  officer.  Dr.  Collier, 
the  Medical  Officer  of  Health,  in  reply  to  a  question,  said  he  was  not 
called  at  the  inquiry.  H  the  inspector  had  been  called  who  removed 
the  case  of  typhus  fever  the  evidence  would  have  been  most  valuable. 
It  was  ultimately  resolved— “From  an  official  inquiry  into  the  Nazareth 
House  charges,  made  by  the  medical  officer,  the  B^ard  feel  altogether 
dissatisfied  with  the  private  investigation  made  by  Mr.  Spear,  and  that 
without  a  further  official  inquiry  on  oath  be  granted  the  Board  are 
still  disposed  to  abide  by  the  opinion  expressed  by  their  medical  officer.” 

Alleged  Immunity  from  Consumption. — At  a  German  ultramarine  manu¬ 
factory  the  director  has  observed  that  for  forty-four  years  none  of  his 
workmen  have  ever  suffered  from  consumption.  He  attributes  their 
immunity  to  the  fact  that  the  process  of  manufacture  involves  the 
constant  production  of  sulphurous  acid  by  the  burning  of  sulphur. 
Young  Women’s  Help  Society. — This  Society  has  now  thirty-one  branches  ; 
twenty-seven  of  these  are  working  among  shop  and  factory  girls,  and 
four  are  at  work  in  agricultural  districts,  and  are  for  the  benefit  of 
domestic  servants  and  of  young  women  dwelling  in  their  own  homes. 
Thirteen  club-rooms,  five  lodging-houses,  and  four  refreshment-bars 
have  been  provided  specially  for  the  use  of  factory  girls.  The  Society 
has  extended  its  benefits  to  women  both  married  and  single,  and  a  new 
feature  in  its  work  has  been  the  establishment  of  central  homes  for  lady 
workers  in  crowded  districts.  During  the  past  year  about  3003  girls  and 
women  had  been  benefited,  and  the  Branch  and  East  London  Central 
Home  balance-sheet  showed  a  local  expenditure  of  upwards  of  £1633. 
Citizen.— A  copy  of  the  correspondence  between  the  Secretary  of  State  and 
the  Commissioners  of  Sewers  relative  to  schemes  under  the  Artisans’ 
and  Labourers’  Dwellings  Acts,  1875-82,  has  been  issued  as  a  Parlia¬ 
mentary  paper. 


Vaccination  by  Authorised  Medical  Men  only. — The  Guardians  of  St.. 
George’s, 'Hanover-square,  have  resolved  that  students  should  not  be 
permitted  to  vaccinate  any  children  at  the  vaccination  station, 
2,  Regent-street,  Horseferry-road,  and  that  the  number  of  students- 
attending  on  any  one  day  should  not  exceed  three.  It  was  of  the 
highest  consequence  that  vaccination  should  be  performed  by  a  medical 
man  properly  authorised.  The  limit  of  the  students  to  three  was  from 
want  of  room. 

Keeping  Flowers  in  a  Bedroom. — Dr.  Reklam,  of  Berlin,  has  expressed  the 
opinion  that  the  indispositions,  in  the  shape  of  uneasy  sleep,  headache, 
etc.,  which  are  sometimes  found  to  result  from  keeping  flowers  all  night 
in  a  bedroom,  do  not  arise  from  any  special  properties  of  the  flowers. 
The  effect  is  analogous  to  that  produced  on  the  eyes  and  ears  by  exces¬ 
sive  light  and  by  loud  sounds,  being,  in  fact,  caused  by  a  continual 
strain  on  the  olfactory  nerves  !  More  or  less,  similar  consequences  arise, 
it  is  remarked,  from  a  bright  light  being  kept  burning  in  a  bedroom,  or 
from  the  noise  of  the  wind  or  of  vehicles  passing  by,  the  brain  being  dis¬ 
turbed  from  its  wonted  rest  by  these  external  influences.  The  moderate- 
use  of  perfumes,  it  is  argued,  cannot  be  regarded  as  injurious. 

Decrease  of  Sophistication. — Mr.  W.  C.  Young,  the  public  analyst,  Poplar,, 
reports  that  during  the  past  quarter  he  had  examined  seventy-two 
samples  of  food,  and  it  had  been  found  necessary  to  caution  the  vendors 
of  a  few  of  the  articles,  but  no  prosecution  had  been  instituted.  Dr. 
Swete,  the  county  analyst,  Worcestershire,  in  his  quarterly  report  to  the 
Midsummer  Quarter  Sessions,  states  that  he  had  received  twenty-four 
samples  of  food  for  analysis  during  the  quarter,  and  that  they  were  all 
genuine. 

“  Genuine  Polish  CheeseN — Our  metropolitan  sanitary  authorities  are  ever 
and  anon  discovering  some  noisome  odd  trade.  The  inhabitants  of 
Backchurch-lane  complained  of  a  nuisance,  and  when  the  inspectors 
paid  a  visit  they  found  a  large  storage  of  sour  milk  used  for  the 
manufacture  of  “  Genuine  Polish  Cheese.”  The  premises  were  in  an 
abominable  state  of  filth,  and  the  cheese  in  an  odious  condition.  The 
turning  out  of  cans  of  large  quantities  of  the  sour  milk  was  most 
offensive,  and  the  proprietor  has  been  warned  to  conduct  his  business  so 
as  to  be  neither  offensive  to  his  neighbours  nor  dangerous  to  the  health 
of  the  locality. 

The  Sale  of  Condemned  Meat,  London.— Dr.  S.  Gibbon,  Medical  Officer  of 
Health  of  the  Holborn  District  Board  of  Works,  reports,  from  inquiries 
he  has  made  of  the  Clerk  of  the  City  Commission  of  Sewers  as  to  the 
practice  of  that  Commission  in  the  disposal  of  condemned  meat,  that 
the  Commission  provides  vans  for  its  removal  by  the  contractors,  and 
that  at  the  present  time  the  latter  pay  at  the  rate  of  twopence  per  stone 
for  it.  That  during  the  past  four  years  the  amount  received  from  such 
sales  was  £2897  15s.  lid.,  or  an  average  of  £724  8s.  lid.  for  each  year. 
It  is  to  be  hoped  the  utilisation  of  this  meat  is  subject  to  such  regula¬ 
tions  as  to  leave  no  doubt  of  the  harmless  and  innocuous  purposes  to 
which  it  is  applied. 

A  Novel  Bequest :  A  Disbeliever  in  Physic.— A  French  lady  recently  died  at 
the  advanced  age  of  ninety.  Her  -will  contained  this  provision  “  X 
leave  to  my  physician,  whose  enlightened  care  and  wise  prescriptions 
have  made  me  live  so  long,  all  that  is  contained  in  the  old  oak  chest  of 
my  boudoir.  The  key  of  the  chest  will  be  found  under  the  mattress  of 
my  bed.”  The  family  were  somewhat  anxious.  The  fortunate  physician 
arrived.  The  chest  was  opened,  and  found  to  contain  solely  all  the 
drugs  and  potions  still  intact  which  the  doctor  had  given  his  patient  for 
years  back. 

COMMUNICATIONS  have  been  received  from— 

Mr.  Rushton  Parker,  Liverpool ;  The  Registrar,  op  the  Apothecaries’ 
Hall,  London  ;  The  Secretary  op  the  Sanitary  Institute  of  Great 
Britain,  London ;  Dr.  Sutherland,  London ;  Dr.  Hilton  Fagge, 
London;  Dr.  Willoughby,  London;  The  Registrar-General  for 
Scotland,  Edinburgh;  Mr.  J.  Chatto,  London;  The  Secretary  of 
the  London  Sanitary  Protection  Association  ;  Dr.  Norman  Kerr, 
London ;  Mr.  Edward  Lister,  Ulverstone  ;  Mr.  Shirley  F.  Murphy, 
London ;  The  Director-General  op  the  Medical  Department  op  the 
Navy',  London;  Mr.  W.  ;H.  Stickland,  London ;  Mr.  T.  M.  Stone, 
London. 

BOOKS,  ETC.,  RECEIVED  - 

Cookery  for  the  Household,  by  H.  Simpson,  M.D.— Traite  Clinique  de 
l’lnversion  Uterine,  par  P.  Denuce— Body  and  Will,  by  Henry 
Maudsley,  M.D.— On  a  Prolonged  Case  of  Enteric  Fever,  by  Robert 
Park,  M.D.— Narcotics,  Medical  Treatment,  Nursing— Sunspottery,  by 
J.  A.  Westwood  Oliver— Medical  Guide  to  the  Mineral  Waters  of  France 
and  its  Wintering  Stations,  by  A.  Vintras,  M.D.—  Ansesthetics,  by  R. 
T.  Freeman,  L.R.C.P.,  etc. 

PERIODICALS  AND  NEWSPAPERS  RECEIVED— 

Lancet— British  Medical  Journal— Medical  Press  and  Circular — Ber¬ 
liner  Klinische  Wochenschrift— Centralblatt  fur  Chirurgie— Gazette 
des  Hopitaux— Gazette  Medieale— Revista  de  Medicina— Bulletin  de 
l’AcadSmiedeMSdecine— Pharmaceutical  Journal — Wiener  Medicinische 
Wochenschrift— Revue  MtVlicale— Gazette  Hebdomadaire— Nature- 
Boston  Medical  and  Surgical  Journal— Louisville  Medical  News— 
Centralblatt  fur  Gynakologie — Le  Concours  Medical — Centralblatt  fur 
die  Medicinischen  Wissenschaf ten— Centralblatt  fur  Klinische  Medicin 
—Philadelphia  Medical  News— Le  Prog-res  Medical— Denver  Medical 
Times— Health— Weekblad  vanjhet  Nederlandsch-  Students’  Journal- 
Analyst  —  Ciencias  Medicas — Western  Medical  Reporter — New  York 
Medical  Journal— Popular  Science  News— British  Quarterly  Review, 
July— Builder— Sanitary  Journal,  Toronto— Club  and  Institute  Journal 
—  Quarterly  Therapeutic  Review— Westminster  Review,  July. 


CUNINGHAM  ON  INDIAN  EPIDEMICS. 


July  21,  1683.  59 


Metical  Times  and  Gazette.  % 


THE  SANITARY  LESSONS  OF  INDIAN 
EPIDEMICS,  (a) 

By  Surgeon  -  General  J.  M.  CUNIUGHAM,  M.D ., 
Sanitary  Commissioner  with  the  Government  of  India. 

It  was  in  the  early  part  of  1874,  if  I  remember  aright,  that 
a  paper  on  Cholera  in  India  was  read  by  your  late  President 
(Dr.  John  Murray),  and  that  in  the  course  of  the  discussion 
which  followed  I  had  the  opportunity  of  stating  some  of 
the  views  which  I  entertained  in  regard  to  cholera  and 
other  Indian  diseases.  I  ventured  to  say  that  I  considered 
the  opinions  ordinarily  held  about  cholera  were  opposed  to 
Indian  experience ;  that  there  was  no  evidence  that  cholera 
is  a  special  product,  raised  only  in  the  delta  of  the  Ganges, 
and  thence  disseminated  over  the  world;  and,  moreover, 
that  there  was  no  evidence  to  prove  that  it  is  caused  by 
any  special  contagium  developed  in  the  bodies  of  the  sick, 
and  communicated  either  directly  or  indirectly  by  human 
intercourse.  After  a  lapse  of  ten  years  it  seems  not  out  of 
place  that  I  should  recur  to  this  subject,  and  endeavour 
very  shortly  to  set  forth  how  far  the  views  I  then  expressed 
Lave  been  affected  by  further  experience.  How  far  have 
they  been  modified,  and  how  far  have  they  been  confirmed  P 
How  far,  again,  are  the  general  principles  which  seem  to  hold 
good  in  regard  to  cholera  applicable  to  other  diseases,  and 
■especially  to  some  of  the  other  epidemic  diseases  of  India  ? 
I  esteem  myself  fortunate  in  being  permitted  to  bring  these 
matters  under  your  special  notice  by  the  reading  of  this 
paper,  which  I  have  designated  “  The  Sanitary  Lessons  of 
Indian  Epidemics/’  and  which  I  shall  endeavour  to  make  as 
brief  and  practical  as  possible. 

It  can  hardly  be  questioned  that  India  presents  a  grand 
Held  for  the  study  of  sanitary  questions.  Its  vast  extent ; 
the  differences  in  its  soil  and  geological  formation  ;  the  well- 
marked  and  varied  features  in  its  physical  geography ;  the 
variety  of  climate  which  it  presents,  as  regards  temperature, 
rainfall,  humidity,  barometric  pressure,  and  other  points ; 
the  differences  of  race,  as  respects  not  only  nationality,  but 
also  food,  clothing,  and  other  habits;  the  differences  of 
local  conditions,  and  among  them  the  differences  in  the 
means  of  communication  over  so  vast  an  area,  which  in 
some  parts  are  as  good  as  they  are  in  England,  and  in  other 
parts  are  no  better  than  they  were  one  hundred  years  ago ; 
—all  these  render  India  a  country  the  facts  regarding  which 
are  well  worth  attentive  observation  from  a  sanitary  point 
■of  view. 

India  has  taught  us  many  lessons  in  other  departments 
both  of  peace  and  of  war,  and  I  believe  that  it  is  well  fitted 
to  teach  us  most  valuable  lessons  in  sanitary  matters  also. 
All  this  will  be  readily  granted.  This  statement  will  in  all 
probability  be  readily  accepted  in  the  abstract ;  but  it  may 
be  thought  that,  grand  as  is  the  field  of  observation,  the 
means  of  observing  are  very  small.  It  may  be  said  that 
the  facts  are  very  difficult  to  ascertain,  that  error  is  very  apt 
to  creep  into  all  regarding  them,  and  that  the  whole  record 
is  one  on  which  no  great  reliance  can  be  placed.  For  this 
reason  it  would  appear  that  the  data  which  have  been 
collected  year  by  year  in  India  have  hitherto  not  received 
the  attention  which  they  deserve.  It  may  be  granted  that 
the  means  of  observation  in  India  are  not  so  good  as  they 
are  in  some  other  countries ;  but,  at  the  same  time,  they  are 
■on  no  account  to  be  despised.  The  minute  particulars  which 
are  obtained  regarding  our  European  army,  numbering  60,000 
men,  our  native  army,  numbering  120,000  men,  and  our  prison 
population,  which  is  never  less  than  100,000,  are  all  of  ex¬ 
treme  value,  and  may  fairly  take  their  place  for  exactness 
.and  for  minute  detail  with  any  sanitary  statistics  which  can 
be  procured  elsewhere  ;  and,  although  the  statistics  of  the 
births  and  deaths  among  the  general  population  are  still  in 
a  very  imperfect  condition,  they  yet  afford  very  valuable 
information — information  which  is  yearly  becoming  more 
-exact  and  more  valuable  in  its  bearing  on  the  general  his¬ 
tory  of  disease  in  India.  But  even  in  its  imperfect  con¬ 
dition  it  is  remarkable  how  completely  the  great  facts 
embodied  in  these  statistics  concerning  the  general  popula¬ 
te)  Read  before  tbe  Epidemiological  Society  on  Wednesday,  July  4. 

Vol.  II.  1883.  No.  1725. 


tion  accord  with  the  details  furnished  by  the  bodies  of 
troops  and  prisoners,  the  exactness  of  which  cannot  be 
disputed. 

It  may  be  thought,  and  I  have  both  read  and  heard  this 
opinion  expressed  again  and  again,  that  the  truth  regard¬ 
ing  disease  is  to  be  learnt  rather  by  an  exhaustive  inquiry 
into  particular  outbreaks  than  by  a  consideration  of  the 
facts  extending  over  a  large  area.  But  it  seems  to  me,  as 
the  result  of  large  experience,  that  in  epidemiology  undue 
importance  has  been  attached  to  local  inquiries.  Inquiry 
into  particular  outbreaks  is,  no  doubt,  very  excellent  in  its 
way,  and  more  especially  into  the  local  insanitary  condi¬ 
tions  which  favour  epidemics,  the  examination  of  which  can 
never  be  too  searching,  but  from  an  epidemiological  point 
of  view  such  inquiry  cannot  be  accepted  by  itself,  indepen¬ 
dently  of  the  general  history  of  disease.  No  man  of  sense 
or  science  set  down  in  a  village  to  form  an  opinion  on  the 
causes  of  the  peculiarities  in  the  season — of  the  excessive 
rainfall  it  may  be,  or  of  the  unusual  dryness,  or  of  the 
potato  blight  or  any  other  abnormal  conditions  of  the  crops — 
would  ignore  everything  except  what  came  under  his  ob¬ 
servation  in  that  particular  village.  And  yet  this  is  very 
much  what  men  do  who  make  a  purely  local  inquiry  into 
epidemic  disease,  and  take  no  thought  of  what  has  been 
going  on,  or,  it  may  be,  is  going  on  at  that  very  time,  in 
other  parts  of  the  country. 

The  facts  regarding  the  general  history  of  disease  must  be 
considered  as  well  as  the  results  of  local  inquiry,  and  in  this 
way  these  great  facts  will  often  prevent  wrong  conclusions 
being  drawn  from  the  little  facts.  It  is,  in  truth,  essential, 
if  we  are  to  arrive  at  any  sound  conclusions,  that  we  should 
look  at  all  the  facts  so  far  as  they  can  possibly  be  collected. 
But  there  is  nothing  more  difficult  than  to  get  at  the  facts. 
In  the  course  of  a  long  experience  there  is  nothing  which 
has  struck  me  more  forcibly  than  this.  The  reporters  are 
so  apt  to  confuse  between  fact  and  mere  opinion :  in  the 
minds  of  some  it  seems  impossible  to  separate  the  two. 
Again,  there  is  nothing  more  common  than  forming  an 
opinion  without  any  (or  with  insufficient)  facts.  Then, 
again,  there  are  other  fallacies  which  are  extremely  common. 
There  is  the  common  fallacy  of  recording  the  facts  all  on  the 
one  side,  and  omitting  all  the  facts  on  the  other  side.  I  have 
known  a  man  write  a  report  on  a  local  outbreak  of  disease, 
which  seemed  to  be  very  plausible  and  even  convincing,  who 
left  out  of  consideration  the  whole  history  of  disease  among 
the  general  population  in  the  neighbourhood,  the  slightest 
acquaintance  with  which  would  have  shown  him  that  his 
ideas  were  altogether  wrong  and  would  not  stand  a  moment’s 
investigation.  I  have  known  another  man  write  a  goodly 
volume  to  prove  his  own  particular  theory,  and  leave  out  of 
it  all  mention  of  one  little  fact  which  might  have  been 
stated  in  a  single  line ;  and  yet  that  little  fact  was  sufficient 
to  show  that  his  whole  book  was  little  better  than  a  dream. 
I  do  not  mention  these  instances  to  hint  in  the  smallest 
possible  way  that  such  men  are  dishonest,  but  when  men 
become  possessed  of  a  theory,  they  seem  incapable  of  look¬ 
ing  at  anything  except  the  facts  which  fit  in  with  that 
particular  theory.  Another  common  fallacy  is  to  neglect, 
or  attach  no  importance  to,  solitary  cases  of  epidemic  dis¬ 
ease.  The  diseases  which  sweep  over  India,  and  more 
particularly  “cholera,”  are  diseases  which  are  common 
enough  without  any  epidemic  being  present.  Solitary  in¬ 
stances  of  cholera  occur  ever  and  again  far  beyond  the 
endemic  area,  but  they  are  too  often  passed  by  as  if  they 
were  of  no  consequence.  One  is  attributed  to  some  error  of 
diet,  another  to  exposure,  a  third  to  some  other  cause,  and 
no  doubt  these  causes  are  not  without  their  influence ;  but 
when  solitary  cases  of  this  kind  occur  here  and  there  over  a 
large  area — although  they  may  appear  to  be  of  little  conse¬ 
quence  to  the  individual  observers  concerned  with  each  case, 
— they  have  to  the  epidemiologist  who  views  them  all  a  sig¬ 
nificance  which  is  not  to  be  ignored.  Epidemiologists,  who 
propose  to  deal  with  epidemics,  and  to  show  the  causes  to 
which  they  are  due,  must  at  the  same  time  be  prepared  to 
deal  with  these  solitary  cases ;  and  I  venture  to  think  that 
even  in  temperate  climates,  where  such  cases,  even  of 
cholera,  are  not  unknown,  much  too  little  has  been  made  of 
them.  To  call  such  cases  “  cholera  nostras,”  as  distinguished 
from  “  cholera  Indica,”  is  to  make  the  nomenclature  of  disease 
depend  on  a  preconceived  theory.  They  are  indistinguish¬ 
able  at  the  bedside,  and  the  only  difference  is  that  while  the 
one  occurs  in  solitary  instances,  the  other  occurs  in  out- 


60 


Medical  Times  ami  Gazette. 


CUNINGrHAM  ON  INDIAN  EPIDEMICS. 


breaks  of  epidemic  violence ;  but  there  is  no  reason  to  sup¬ 
pose  that  the  cause  or  causes  which  produce  one  case  of  so- 
called  “  cholera  nostras  ”  may  not  produce  a  hundred  or  a 
thousand.  No  one  attempts  to  make  any  such  theoretical 
distinction  between  cases  of  small-pox — to  call  isolated 
cases  small-pox  nostras,  and  the  cases  of  an  epidemic  by 
some  other  name.  But,  in  dealing  with  epidemiological 
questions,  there  is  yet  another  evil,  which  is  perhaps 
even  greater  than  any  of  those  I  have  already  mentioned. 
It  is  the  evil  which  arises  from  taking  mere  coincidences 
as  evidences  of  cause  and  effect.  A  person  suffering  from 
disease,  or  coming  from  a  place  in  which  disease  is  prevalent, 
is  attacked,  and  soon  after  one  or  other  of  those  of  his  own 
house,  or  of  those  living  in  the  neighbourhood,  is  attacked 
also.  The  conclusion  is  immediately  arrived  at,  that  the 
first  person  has  been  the  cause  of  the  others  being  attacked ; 
but  this  is  exactly  one  of  those  cases  to  which  I  have  already 
referred,  in  which  all  the  instances  of  one  kind  are  cited, 
and  all  the  instances  of  the  opposite  kind  are  ignored.  It 
is  quite  true  that  there  are  numerous  instances  on  record, 
in  which  persons  travelling  from  an  affected  locality  have 
been  seized  with  disease  on  arrival  in  their  own  homes,  and 
their  neighbours  have  suffered  soon  afterwards ;  but  there 
are  innumerable  instances  in  which  such  travellers  have 
been  attacked,  and  yet  others  have  not  suffered.  These 
are  all  left  out  of  account.  It  is  argued  that  in  the 
one  case  the  evidence  is  positive,  and  that  in  the  other 
it  is  negative;  but  this  is  altogether  a  fallacious  view 
of  the  question.  There  is  no  positive  evidence  either 
on  the  one  side  or  on  the  other.  The  only  facts  we  have  are 
facts  relating  to  time  :  the  traveller  suffers  first,  his  neigh¬ 
bours  suffer  afterwards ;  therefore  the  neighbours  have  been 
affected  by  the  traveller.  This  subject  is  one  of  very  great 
importance,  because  a  clear  understanding  of  it  lies  at  the 
bottom  of  all  medical  evidence.  If  it  had  been  proved  that 
a  person  suffering  from  cholera,  or  other  epidemic  disease, 
really  propagates  a  specific  poison,  then  the  cases  in  which 
the  neighbours  were  affected  might  be  regarded  as  positive 
evidence;  but,  in  the  absence  of  such  proof,  no  conclusion 
can  be  arrived  at  unless  the  facts  on  both  sides  are  carefully 
collated.  If  the  facts  on  one  side  only  are  considered  to  be 
evidence,  it  would  be  possible  to  prove  almost  anything.  I 
remember  when  I  was  a  boy  it  was  a  common  remark  that 
the  frost  came  down  with  the  mail-coach ;  and,  no  doubt, 
there  were  numerous  instances  in  which  the  arrival  of  the 
mail-coach  and  the  setting  in  of  the  frost  were  contem¬ 
poraneous.  Had  I  been  anxious  to  prove  that  the  mail 
coach  really  did  bring  the  frost,  all  that  would  have  been 
necessary,  according  to  the  ordinary  mode  of  medical 
evidence,  would  have  been  to  cite  the  number  of  instances 
in  which  the  two  things  were  contemporaneous,  and  leave 
out  all  the  other  instances  in  which  they  were  not  contem¬ 
poraneous.  It  may  be  said  that  nobody  would  do  anything 
so  foolish  as  this,  but  this  is  exactly  what  is  done  in  regard 
to  many  epidemic  diseases,  and  to  none  more  than  in  regard 
to  cholera,  and  the  supposed  spread  of  cholera  by  means  of 
pilgrims. 

All  the  instances  in  which  pilgrims  are  first  attacked 
and  the  general  population  suffer  afterwards  are  cited,  but 
nothing  is  said  of  the  many  instances  in  which  either  the 
general  population  is  attacked  first,  or  in  which  the  pilgrims 
are  attacked,  and  no  cases  follow  in  the  localities  through 
which  they  pass.  Yet  without  these  cases  the  evidence  is 
altogether  incomplete  and  one-sided,  and  therefore  no  sound 
conclusion  can  be  based  on  it.  The  reasoning  now  is  all 
carried  on  in  a  vicious  circle.  The  supposed  spread  of 
cholera  by  human  beings  is  asserted  on  the  strength  of  facts 
selected  all  on  the  one  side,  and  which  are  dignified  by  the 
name  of  positive  evidence  on  the  ground  that  these  human 
beings  have  conveyed  the  “  germ  ”  or  “  contagium,”  the 
results  of  which  are  manifest  in  the  persons  of  those  among 
whom  the  travellers  have  come.  But  if  evidence  be  asked 
of  the  existence  of  this  supposed  germ  or  contagium,  the 
cases  of  these  same  pilgrims  and  other  travellers  are  cited  ! 
And  so,  as  I  have  already  said,  the  argument  proceeds  in 
the  same  vicious  circle.  If  the  existence  of  the  germ  or 
contagium  had  been  demonstrated,  the  case  would  be  very 
different.  Until  it  has  been  demonstrated  the  evidence  on 
the  one  side  is  just  as  important  and  just  as  positive  in  its 
character  as  the  evidence  on  the  other  side. 

But,  having  got  all  the  facts,  so  far  as  they  can  be 
collected,  it  is  essential  that  the  deductions  drawn  from 


July  21,  1883, 


them  should  be  strictly  logical.  If  the  question  were  asked 
of  a  hundred  people,  What  is  the  cause  of  epidemic  disease  ?' 
ninety-nine  of  them  would  probably  reply  that  epidemics 
were  due  to  contagion,  that  a  sick  person  coming  from  some 
place  or  other  brought  with  him  the  germs  of  the  disease,, 
and  that  those  germs  found  a  fitting  place  for  development 
in  the  persons  of  other  people.  But  such  an  explanation,, 
however  plausible  it  may  appear  at  first  sight,  is  really  no 
explanation  at  all;  for,  if  we  follow  back  and  trace  the- 
individual  who  is  supposed  to  have  brought  the  disease,, 
and  ask  where  he  got  it,  and  then  trace  the  third  person 
back  and  ask  where  he  got  it,  and  so  on,  we  have  still  the 
same  question  to  answer— How  did  this  disease  arise?' 
The  doctrine  of  importation  merely  puts  the  question  off. 
If  a  community  whom  we  may  call  “Z”  is  suffering  from 
an  epidemic,  there  is  little  satisfaction  in  being  told  that  this 
epidemic  was  imported  from  “  Y,”  and  that  the  epidemic 
in  “  Y”  was  imported  from  for  if  we  trace  back  and 

back  we  must  eventually  come  to  “A,”  and  the  question 
then  arises,  exactly  as  it  arose  with  regard  to  “  Z  ” — What 
was  the  cause  of  this  disease  ? 

In  dealing  with  epidemics,  and  in  fact  with  the  causa¬ 
tion  of  all  diseases,  we  must  assume  nothing.  In  the 
present  day  the  germ  theory  is  in  great  favour.  Germs 
are  supposed  to  account  not  only  for  cholera,  small-pox,, 
and  enteric  fever,  but  also  for  tubercle  and  ordinary 
malarial  fever.  There  seems  to  be  no  limit  to  the  germ 
theory  of  disease ;  but,  as  a  matter  of  fact,  do  these  germs 
really  exist  ?  Have  they  been  found  in  diseases  such  as 
small-pox  or  syphilis,  which  are  usually  cited  as  the  most 
striking  examples  of  contagious  disease  ?  Is  there  a  single- 
so-called  germ  which  can  be  shown  under  the  microscope 
and  recognised  as  the  germ  of  any  particular  disease  ?  Is- 
there  a  single  organism  derived  from  a  person  suffering  from 
a  particular  disease  which  can  be  said  to  be  the  cause,  and. 
not  a  consequence,  of  that  disease  ?  Is  there  a  single  organ¬ 
ism  found  in  disease  which  alone  is  capable  of  producing 
that  disease  ?  Every  now  and  again  the  medical  world  is- 
startled  with  the  announcement  that  one  of  these  specific 
germs  has  been  discovered,  and  the  announcement  is  far  too- 
readily  credited,  for,  as  time  goes  on,  grave  doubts  are 
thrown  on  the  accuracy  of  the  supposed  discovery.  A  year 
or  two  ago  we  were  told  that  malarial  fever  was  no 
longer  a  difficult  problem  to  solve — a  bacillus  had  been 
found  to  account  for  everything, — but  now  we  have  two- 
organisms  in  the  field,  which  both  claim  the  supposed- 
honour  :  one  the  bacillus  of  Tommasi  and  Klebs,  and  the 
other  of  Laverac,  which  I  believe  is  not  a  bacillus  at  all- 
Again,  we  had  the  bacillus  of  tubercle  announced  by 
Professor  Koch,  but,  according  to  the  latest  intelligence. 
Spina,  and  other  of  Strieker’s  pupils,  have  found  in  typhoid 
fever  stools,  in  the  sputum  of  pneumonia,  asthma,  and  bron¬ 
chitis,  and  in  the  lochial  secretions,  a  bacillus  which  in 
form,  size,  arrangement,  and  reaction  is  indistinguishable- 
from  the  tubercular  bacillus  of  Koch.  I  have  no  intention, 
of  entering  on  the  germ  question  in  general,  but  the  ques¬ 
tions  I  have  suggested  are  very  pertinent  in  the  history  of 
Indian  diseases,  and  more  especially  in  the  history  of  cholera 
and  enteric  fever,  in  regard  to  which  I  would  venture  to-- 
offer  a  few  special  remarks.  What  do  we  know,  or  what  do- 
we  not  know,  about  these  diseases  ?  Cholera  is  said  to  be 
due  to  a  germ  or  poison  spread  by  the  skin — a  poison  which 
is  bred  in  the  delta  of  the  Ganges,  and  thence  carried 
over  the  world.  These  were  propositions  which  were  formu¬ 
lated  by  the  Sanitary  Conference  of  Constantinople  and 
Vienna,  and  are  generally  accepted  as  embodying  the  truth,, 
but  I  venture  to  think  that  they  both  rest  on  a  most  imper¬ 
fect  foundation.  They  are  based  chiefly  on  a  series  of  one¬ 
sided  anecdotes,  which  are  not  only  one-sided,  but  which  are, 
moreover,  opposed  to  all  that  is  known  of  the  great  facts 
regarding  cholera.  Human  intercourse  is  free  and  uninter¬ 
rupted  all  over  India,  and  yet  for  years  together  great  parts 
of  this  large  continent  remain  unattacked  by  cholera.  Even 
in  those  instances  where  great  fairs  have  been  succeeded  by 
a  prevalence  of  cholera,  this  prevalence  has  never  been 
general  in  all  directions.  The  pilgrims  going  in  particular 
directions  no  doubt  have  suffered,  but  the  pilgrims  going  in 
other  directions  have,  after  the  first  day  or  two,  when  they 
seemed  to  be  suffering  from  the  influence  of  the  place  from 
which  they  had  come,  entirely  escaped.  The  real  explana¬ 
tion  of  the  pilgrims’  sufferings  is  to  be  found  in  the  fact- 
that  they  have  traversed  a  “  cholera  area  ”  at  a  time  when. 


Medical  Times  and  Gazette. 


CUNIKCHAM  OK  INDIAN"  EPIDEMICS. 


July  21, 1883.  61 


ill-fed  and  filthy,  exposed  to  hardship  and  fatigue,  they 
have  been  in  a  condition  most  favourable  to  be  attacked. 

The  history  of  attendants  on  cholera  cases  is  in  itself  a 
sufficient  answer  to  all  that  has  been  said  in  regard  to 
pilgrims  spreading  cholera,  for  the  evidence  is  complete  that 
the  attendants  on  cholera  cases  suffer  no  more  than  other 
people.  I  have  now  the  details  of  nearly  8000  attendants 
on  cholera  cases,  and  of  these  only  150  were  attacked.  Such 
a  result  cannot  be  accepted  as  evidence  of  contagion,  espe¬ 
cially  when  it  is  remembered  that  they  were  subject  to  the 
same  conditions  as  the  ordinary  inhabitants  of  the  place. 
On  the  contrary,  it  shows  an  absence  of  contagion  under 
circumstances  most  favourable  to  contagion  if  any  con¬ 
tagion  had  really  existed.  If  attendance  on  the  sick  for 
many  days  and  nights  is  not  a  service  of  danger — and  the 
whole  experience  of  India  shows  that  it  is  not — what  is  to 
be  said  of  the  innumerable  instances  of  supposed  contagion 
•where  the  persons  attacked  were  only  residents  of  the  same 
place,  and  never  came  into  communication  with  the  sick 
■at  all  ? 

There  is  another  great  fact  regarding  cholera  which  is  too 
often  ignored — that,  even  over  an  epidemic  area,  the  propor¬ 
tion  of  villages  attacked  is  comparatively  small.  If  cholera  be 
■due  to  human  intercourse,  how  is  it  that  even  in  times  of 
aevere  epidemics  the  proportion  of  villages  that  escape  is 
much  larger  than  the  proportion  that  suffers  ?  The  general 
direction  of  a  cholera  epidemic,  moreover,  is  opposed  to  the 
idea  that  it  is  governed  by  human  intercourse,  or  any  other 
•chance ;  and  if  the  believers  in  the  water-theory,  as  it  is 
called,  will  examine  the  facts  regarding  the  great  rivers  of 
India,  they  will  find  that  the  advance  of  cholera  is  in 
directly  the  opposite  direction  to  that  in  which,  according 
to  their  theory,  it  ought  to  be.  They  will  find,  moreover, 
that  the  children,  who  drink  more  water  than  any  other 
portion  of  the  community,  are  especially  exempt.  The 
Teal  truth,  so  far  as  we  have  yet  ascertained  it,  in  regard  to 
•cholera  is  its  remarkable  localisation  ;  and  the  real  remedy 
is  to  be  found,  not  in  any  endeavour  to  prevent  human 
intercourse — which  is  impossible, — or  to  destroy  the  germ, 
the  very  existence  of  which  remains  to  be  proved,  but  to 
carry  out  sanitary  improvements,  and  if,  in  spite  of  them, 
■cholera  should  still  prevail,  to  move  away  from  the  affected 
locality.  The  advantage  of  movement  has  been  exemplified 
over  and  over  again,  and  never  more  strikingly  than  in  the 
outbreak  at  Meanmeer  in  1881,  when  the  troops,  on  three 
occasions,  shook  off  the  disease  by  moving  into  camp  about 
a  hundred  miles  away,  and  were  attacked  again  immediately 
they  returned. 

Experience  in  regard  to  enteric  fever  teaches  very  much 
the  same  lesson  as  experience  in  regard  to  cholera.  When 
this  disease  was  first  returned  in  India  under  its  new  name, 
medical  officers  commonly  attributed  it  to  importation. 
Someone  had  brought  the  disease ;  where  it  originally 
came  from,  no  one  could  say.  The  explanation,  such  as  it 
was,  was  very  simple,  and,  at  the  same  time,  very  unsatis¬ 
factory.  And  more  accurate  and  extended  observation  has 
shown  that  it  is  not  only  unsatisfactory,  but  also  altogether 
inconsistent  with  facts.  We  now  know  that  enteric  fever  is 
a  disease  peculiarly  common  among  young  European  soldiers 
recently  arrived  in  India.  We  know  that  it  occurs  over  a 
large  extent  of  country  in  isolated  cases ;  that  it  does  not 
spread  from  the  sick  to  the  healthy ;  that  the  attendants  are 
no  more  exposed  to  danger  than  other  people  ;  and  that  the 
common  source  to  which  it  has  been  attributed  so  often  in 
England,  namely,  the  milk-supply,  cannot  hold  good  in 
India,  for  this  simple  reason — that  the  children,  who  consume 
most  milk,  are,  with  rare  exceptions,  exempt.  What  is  the  real 
nature  of  this  fever  it  is  not  for  me  to  say ;  but,  considering 
that  it  presents  itself  under  a  variety  of  phases,  that  in  its 
early  stages  it  is  almost  always  indistinguishable  from  the 
intermittent  or  remittent,  it  does  not  appear  unreasonable 
to  class  it  as  one  form  of  malarial  fever  due  to  climate  aided 
by  local  conditions  or  the  other  causes  to  which  malarial 
fever  is  due.  There  is  certainly  no  evidence  that  it  is  due 
to  [any  specific  germ.  Undue  importance  seems  to  have 
been  attached  to  a  name.  There  can  be  no  question  that 
the  fever  which  is  now  returned  so  commonly  in  India  as 
enteric  fever  is  simply  the  same  fever  which  used  to  be  re¬ 
turned  in  former  years  as  remittent  fever ;  and  whatever 
advance  may  have  been  made  in  pathology  by  the  change 
of  name,  the  tendency  in  the  treatment  has  been  decidedly 
hurtful — for  there  has  been  a  hesitation  in  the  administra-  1 


tion  of  quinine,  or  a  withholding  of  it  altogether  when  its 
use  might  have  been  attended  with  decided  benefit. 

Mere  fashion  has,  I  regret  to  say,  a  good  deal  to  do  with 
even  the  statistics  of  disease.  Although  the  mortality 
from  fevers  as  a  whole  has  certainly  declined  in  India  com¬ 
pared  with  what  it  used  to  be,  the  proportion  of  that  mor¬ 
tality  ascribed  to  enteric  fever  has  been  gradually  increasing, 
while  the  proportion  ascribed  to  remittents  and  other  more 
generally  recognised  forms  of  malarial  fever  have  been 
gradually  decreasing.  The  general  results  of  1881 — the  last 
year  for  which  I  have  the  records  with  me — merely  repeat 
the  experience  of  former  years.  The  percentage  of  liability 
to  enteric  among  men  under  twenty -five  years  of  age  was 
60  ;  between  twenty-five  and  twenty-nine  years  only  20 ;  and 
between  thirty  and  thirty-four  years  of  age  only  10.  In 
respect  of  Indian  residence  the  figures  are  even  more  striking, 
for  during  the  first  and  second  years  of  residence  the  per¬ 
centage  of  liability  to  enteric  was  60,  while  from  the  third 
to  the  sixth  year  it  was  only  27,  and  between  the  seventh 
and  tenth  years  it  fell  to  7.  It  is  difficult,  and  indeed  I 
believe  it  is  impossible,  to  reconcile  these  great  facts  with 
any  theory  which  ascribes  the  disease  to  a  specific  germ  or 
specific  contagium  com  municated  from  the  sick  to  the  healthy. 
It  has  been  argued  that  the  disease  described  as  such  in 
India  is  not  really  enteric,  because  in  Europe  enteric  arises 
under  conditions  which  do  not  exist  in  India.  But,  if  clinical 
observation  and  post-mortem  appearances  are  to  go  for  any¬ 
thing,  there  can  be  no  question  that  the  enteric  of  India  as 
seen  among  European  soldiers  is  one  and  the  same  as  the 
enteric  seen  in  England,  though  in  India  the  degrees  of 
severity  are  very  various,  and  it  is  often  impossible  to  say 
whether  the  fever  should  be  called  enteric  or  remittent,  or 
even  intermittent.  May  not  the  true  explanation  of  the 
facts  be  this — that  disease,  instead  of  being  caused  by  one 
specific  germ  is  really  the  product  of  many  causes,  some  of 
which  operate  most  strongly  under  certain  conditions,  and 
others  operate  most  strongly  under  other  conditions  ? 

When  the  evidence  is  carefully  sifted,  I  venture  to  think 
that  there  is  very  little  to  support  the  theory  that  either 
cholera  or  enteric  fever  is  due  to  a  specific  poison.  It  is 
important  to  make  this  point  very  clear,  because  until  it  is 
made  clear  the  practical  action  to  be  taken  is  apt  to  be 
misunderstood. 

You  will  ask,  then,  what  can  be  the  cause  or  causes  of  this 
and  other  diseases  ?  I  can  only  answer,  that  in  the  present 
state  of  our  knowledge  we  cannot  speak  with  any  exact¬ 
ness.  The  explanation  will,  no  doubt,  be  found  in  climatic 
and  other  conditions  affecting  certain  localities,  and  mate¬ 
rially  aided  by  the  insanitary  condition  of  those  localities. 
I  have  heard  it  argued  that  it  is  impossible  to  deny  the 
existence  of  an  entity  as  the  cause  of  disease ;  the  mere 
presence  of  the  disease  is  in  itself  sufficient  proof  that  this 
entity  exists.  But  such  reasoning  is  altogether  fallacious. 
Disease  may  be  due,  as  many  other  things  are  due,  to  a  force 
or  forces.  The  greatest  powers  we  know  of  in  the  world  are 
not  entities  at  all — such,  for  example,  as  wind,  and  steam, 
and  electricity.  No  one  doubts  their  power,  and  yet  we 
know  that  in  neither  one  nor  the  other  are  the  tremendous 
results  to  be  ascribed  to  the  existence  of  any  entity,  to  any¬ 
thing  which  can  be  seen  by  the  naked  eye  or  demonstrated 
under  the  most  powerful  microscope.  Amu  may  think  that 
these  are  merely  theoretical  views  which  have  little  or  no  prac¬ 
tical  application,  but  I  believe  that  they  are  really  of  very 
great  practical  importance,  and  that  they  in  fact  lie  at  the  root 
of  all  sanitary  progress.  The  doctrines  which  have  been  so 
commonly  preached  of  late  years  regarding  germs  and  the 
danger  arising  from  the  sick  have  been  attended  with  most 
disastrous  consequences,  and  there  seems  every  reason  to 
fear  that  these  disastrous  consequences  may  increase  rather 
than  diminish.  Much  domestic  misery  is  caused  by  the 
removal  of  a  sick  person  from  the  midst  of  his  family.  I 
have  known  wives  separated  from  their  husbands,  and  chil¬ 
dren  from  their  parents,  to  die  in  a  hospital  unattended  by 
those  whose  duty  under  any  circumstances  was  to  have 
nursed  them  in  their  extremity.  I  have  known  the  greatest 
fear  and  alarm  pervade  a  community  on  the  first  mention 
of  disease  supposed  to  be  contagious — a  fear  which  was  so 
general  and  so  great  that  it  was  a  matter  of  difficulty  to 
obtain  attendants  for  the  sick,  and  when  attendants  were 
found  they  entered  on  their  duties  in  a  state  of  alarm 
which  was  little  calculated  to  aid  in  their  discharge, 
but  rather  fitted  them  to  become  easy  victims  to  the 


62 


Medical  Times  and  Gazette. 


CTJNINGHAM  ON  INDIAN  EPIDEMICS. 


July  21,  1883V 


prevailing  disease.  The  consequences  have  -been  mis¬ 
chievous  not  only  in  regard  to  domestic  arrangements, 
but  in  regard  also  to  national  arrangements.  The  quaran¬ 
tines  which  have  been  set  up  at  Suez  of  late  years,  and 
which  are  again  and  again  imposed  without  the  smallest 
necessity,  are  the  natural  outcome  of  the  views  which  have 
been  so  loudly  proclaimed.  True,  English  authorities,  al¬ 
though  they  have  supported  the  germ  theory  very  warmly, 
have  at  the  same  time  expressed  their  decided  opinion  that 
quarantine  is  useless.  But  people  cannot  be  blamed  if, 
believing  in  germs,  they  should  take  every  possible  precau¬ 
tion  to  keep  them  out.  They  may  say,  “  You  yourselves 
have  expressed  your  opinion  that  cholera,  for  example,  is 
due  to  a  specific  poison  which  is  carried  from  the  delta  of 
the  Ganges  by  human  beings  all  over  the  civilised  world. 
You  object  to  quarantine,  it  is  true ;  you  say  it  is  useless, 
but  here  your  views  are  distorted  by  your  self-interest.  You 
do  not  wish  your  trade  to  be  interfered  with,  and  therefore 
you  tell  ns  that  quarantine  is  of  no  use.  At  all  events,  we 
will  try  ;  if  we  fail  to  keep  out  all  the  germs  which  are  so 
destructive  to  mankind,  we  may  yet  be  successful  in  keeping 
out  some  of  these  germs,  and  surely,  according  to  your  own 
showing,  every  germ  kept  out  must  be  a  decided  gain.” 
N’T®®  quarantine  restrictions  are  imposed  at  the  will  of 
international  boards  sitting  at  Constantinople  and  Alexandria. 
They  are  one  'of  the  consequences  of  the  Constantinople  and 
Yienria  Conferences,  and,  so  far  as  their  action  has  hitherto 
been  seen,  it  spems  to  me  to  be  one  of  nnmixed  evil.  They 
proceed  on  tjie  principle  that  there  is  a  great  danger  arising 
■  ffom  IndijM'f  ships,  and  that  this  danger  can  be  averted  by 
the  measures  which  are  taken  under  their  orders.  But  the 
danger  of  which  they  speak  is  a  purely  theoretical  danger. 
There  is  no  evidence  whatever  that  Indian  ships  have  ever 
brought  cholera.  The  Bed  Sea  route,  along  which  this 
constant  source  of  danger  is  supposed  to  exist,  has  been 
singularly  free  from  cholera,  and  that,  too,  over  a  period 
during  many  years  of  which  cholera  was  prevalent  in  Europe. 

During  the  seventeen  years  from  1865  to  1881,  so  far  as 
is  known,  there  is  no  ground  for  supposing  that  Indian 
ships  have  imported  cholera  either  into  Egypt  or  into 
Europe.  What  is  perhaps  even  more  striking  is  the  further 
fact  that  although  Egypt  has  been  in  direct  and  never- 
ceasing  communication  with  India  throughout  this  time,  it 
has  preserved  a  remarkable  immunity  from  cholera.  The 
general  distribution  of  the  disease  in  Europe  and  Asia 
during  a  series  of  years  is  clearly  shown  on  the  maps 
attached  to  Mr.  Badcliffe’s  “Papers  concerning  the  Euro¬ 
pean  Belations  of  Asiatic  Cholera,”  published  in  the  “  Be- 
port  of  the  Medical  Officer  of  the  Privy  Council  and  Local 
Government  Board,”  new  series.  No.  V.,  and  which  is  all 
the  more  valuable  for  any  purpose  because  Mr.  Badcliffe  is 
well  known  as  a  warm  supporter  of  the  doctrine  that  cholera 
is  spread  by  human  intercourse.  From  these  maps  and  the 
Beport  itself  it  appears  that  there  was  cholera  in  Egypt  in 
1865,  but  it  is  admitted  that  this  was  not  imported  by  ship 
from  India.  In  1866  there  was  a  slight  reappearance  of 
the  disease,  but  there  has  apparently  been  no  cholera  in 
Egypt  from  that  time  up  to  the  present  year.  During  the 
ten  years  1865  to  1874,  to  which  the  report  of  Mr.  Badcliffe 
refers,  there  is  not  a  single  year  in  which  Europe  was  abso¬ 
lutely  free  from  cholera,  and  in  some  of  them  after  1866,  as 
in  1867,  1869,  1870,  1871,  1872,  and  1873,  there  was  consider¬ 
able  prevalence.  In  other  words,  notwithstanding  the  sup¬ 
posed  danger  from  Indian  ships,  Egypt  for  fifteen  years  has 
been  altogether  free  from  the  disease,  and  yet  during  many  of 
these  years  India  has  suffered  from  most  serious  epidemics 
of  cholera.  The  experience  of  Aden  is  even  more  striking. 
It  suffered  from  cholera  in  1865,  and  again  to  a  slight  extent 
in  1867 ;  but  although  it  lies  within  a  few  days  of  Bombay, 
and  although  it  has  been  in  daily  communication  with  that 
and  other  Indian  ports,  it  did  not  once  suffer  from  cholera 
during  the  thirteen  years  1868  to  1880.  I  do  not  refer  to 
the  outbreak  at  Aden  in  1881,  because  it  does  not  affect  the 
general  truth  that  over  a  long  series  of  years  this  place  has 
been  singularly  free  from  cholera.  It  is  not  necessary  to  go 
further  back  than  1865,  and  it  would  be  difficult  to  ascertain 
the  facts  for  the  earlier  years  with  any  accuracy ;  so  far  as 
they  are  known,  they  confirm  the  experience  of  more  recent 
times.  It  must  be  borne  in  mind,  moreover,  that  the  whole 
period  above  referred  to — from  1865  onwards — is  a  period 
during  which  there  was  practically  no  quarantine  along 
the  Bed  Sea  line.  The  fear  of  the  importation  of  cholera 


from  India  into  Egypt  and  Europe  by  means  of  ships  is 
based,  not  on  facts,  but  on  the  theories  of  the  conferences 
as  to  what  ought  in  their  fopinion  to  have  taken  place,  but 
what,  so  far  as  the  evidence  goes,  never  actually  has  taken 
place.  It  is  impossible,  in  the  face  of  these  facts,  to  maintain 
that  Indian  ports  and  Indian  ships  have  proved  a  source  of 
danger  to  Egypt,  and  through  Egypt  to  other  countries. 

The  boards  proceed  on  the  assumption  that  prevalence  of 
cholera  in  India  means  increased  danger  to  Europe ;  but 
this  is  an  assumption  which  is  altogether  negatived  by  past 
experience,  and  it  would  appear  rather  that  when  cholera  is 
in  comparative  abeyance  in  India  is  the  time  of  danger  to 
other  countries. 

Again,  it  is  admitted  that  the  land  traffic  cannot  be 
brought  under  quarantine  restrictions  ;  and  so  we  have  this 
very  remarkable  state  of  things,  that  while  traffic  of  the 
land  along  which  cholera  does  appear  is  practically  left  to 
itself,  the  traffic  along  the  sea  route,  which  is  so  singularly 
free  from  cholera,  is  subject  to  a  never-ending  interference. 

If  all  this  be  the  truth — as  I  believe  it  is— it  is  abun¬ 
dantly  clear  that  these  boards  have  really  no  basis  whatever 
on  which  to  form  an  opinion,  and  that  their  action — haras¬ 
sing  and  annoying  as  it  is  to  trade,  and  the  cause  of  serious 
loss  to  shipowners — can  be  of  no  practical  benefit  to  anyone. 
It  would  be  much  better  if  the  time  and  money  expended 
in  quarantine  arrangements  were  devoted  to  cleansing  the 
towns  of  Egypt  and  other  countries  where  the  conditions 
are  so  favourable  for  disease.  The  maritime  nations  of 
Southern  Europe  are  no  doubt  fully  impressed  with  the 
belief  that  quarantine  can  protect  them — especially  from 
cholera.  There  can  be  no  objection  to  give  in  to  their 
prejudices  in  any  reasonable  way.  The  Constantinople  and 
Vienna  Conferences  both  expressed  a  decided  opinion  that 
the  period  of  incubation  of  cholera  did  not  exceed  eight  on 
ten  days  ;  and  if  this  statement  were  acted  on  in  practice 
the  prejudices  of  all  who  believe  in  quarantine  would  be 
respected,  while  trade  would  suffer  no  injury ;  for  the  in¬ 
stances  in  which  cholera  has  appeared  on  board  ships  going 
from  Indian  ports  to  the  Bed  Sea  are  so  extremely  rare  that 
they  need  hardly  be  taken  into  account. 

There  is  yet  another,  and,  if  possible,  greater  evil  still 
which  results  from  the  views  regarding  the  causation  of  dis¬ 
ease  so  common  in  the  present  day,  and  that  is  that  the 
importance  of  sanitary  improvement  does  not  receive  that 
attention  which  it  ought  to  do.  If  disease  be  due  to  a  specific 
germ,  then  there  is  no  danger  to  the  community  so  long  as 
that  specific  germ  is  not  introduced.  The  place  may  be  in 
the  most  unsatisfactory  condition,  both  as  to  its  conservancy, 
its  drainage,  or  its  water-supply ;  but,  if  the  specific  germ 
does  not  find  entrance,  these  conditions  are  of  little  or  no 
importance.  But  if,  on  the  other  hand,  it  is  believed  that 
disease  is  in  the  main  the  product  of  insanitary  conditions, 
the  community  will  be  much  more  likely  to  bestir  itself  to 
improve  them.  They  will  feel  that  it  is  not  sufficient  to  put 
their  water-supply,  or  their  drainage,  or  their  conservancy 
in  a  proper  state,  lest  some  germ  should  be  introduced ;  but 
that  it  is  absolutely  necessary,  if  they  are  to  maintain  a  good 
standard  of  health,  that  they  should  have  these  requisites  at 
all  times.  There  is  no  doubt  something  which  is  acceptable 
to  the  human  mind  in  the  theory  which  ascribes  disease  to 
somebody  else  ;  which  is  satisfied  with  the  explanation  that 
the  mysterious  “it”  was  brought  by  some  one  else;  which  is 
willing  to  blame  others,  instead. of  blaming  oneself,  for  the 
neglect  of  sanitary  arrangements.  The  one  idea  that  seems  in 
the  present  day  to  pervade  the  minds  of  many  men  in  regard  to 
sanitary  matters,  is  that  if  a  person  is  suffering  from  a  so- 
called  contagious  disease  he  should  be  immediately  isolated!, 
or,  in  other  words,  put  in  a  sort  of  medical  prison.  The  im¬ 
provement  of  sanitary  conditions  is  to  them  a  matter  of 
singularly  little  moment :  and  yet  the  only  safe  and  practical 
sanitary  creed  is  that  disease  is  not  to  be  prevented  by  any 
such  means  ;  that  it  is  due  to  causes  existing  chiefly  in  the 
locality  where  it  occurs ;  and  that  it  will  continue  to  exist 
until  these  causes  have  been  removed. 

In  regard  to  small-pox,  no  doubt,  we  have  a  special  means 
of  precaution  in  vaccination,  but  even  with  regard  to  small¬ 
pox  it  seems  extraordinary  how  the  danger  arising  from  the 
sick  person  seems  to  overshadow  everything  else.  In  India, 
more  especially,  such  procedure  is  attended  with  very 
lamentable  results.  We  endeavour  to  persuade  the  natives 
of  India  that  vaccination  is  an  admirable  protection  against 
small-pox,  and  yet  the  moment  a  case  of  small-pox  is  heard 


Medical  Times  and  Gazette. 


CHEVERS  ON  THE  ORDINARY  DISEASES  OE  INDIA. 


July  21,  1883.  63 


•of  there  is  the  greatest  alarm,  just  as  if  vaccination  were  no 
protection  whatever.  The  natives  are  not  slow  to  reason 
from  the  facts  which  come  under  their  observation,  and  are 
little  likely  to  place  reliance  in  vaccination  when  they  see 
that  those  who  applaud  it  so  loudly  believe  in  it  so  little 
themselves. 

People  seem  to  think  that  if  a  germ  could  be  discovered 
as  a  cause  of  every  disease  a  great  advance  would  be  made 
not  only  in  our  knowledge,  but  in  our  means  of  preventing 
•disease.  Knowledge  on  all  points  is  much  to  be  desired, 
and  if  it  should  appear  hereafter  that  diseases  are  really 
due  to  germs,  the  question  will  then  arise.  What  action  can 
be  taken  in  regard  to  them  ?  But  it  seems  to  me  that  the 
discovery  of  disease  germs,  which  people  hail  with  so 
much  satisfaction,  would  be  very  far  from  a  gain  to  the 
luman  race.  For,  if  a  germ  can  only  be  distinguished  and 
discovered  by  a  high-power  microscope,  it  seems  hardly 
probable  that  it  can  ever  be  dealt  with  in  practice  by  a 
sanitary  police.  Cleanliness  in  every  form,  cleanliness  of 
the  air,  of  the  water,  and  of  the  soil,  are  the  great  ends  to 
be  aimed  at.  The  great  lessons  I  would  draw  from  the 
experience  of  India  in  such  matters  are — 

1st. — The  importance  of  ascertaining  the  facts,  both  those 
respecting  the  localities  immediately  concerned  and  the 
general  history  of  disease  at  the  time,  and  of  recording 
them  all  fully,  instead  of  recording  only  those  which  tell 
either  on  the  one  side  or  on  the  other. 

2nd. — Having  collected  all  the  facts,  we  must  assume 
nothing,  and  draw  from  them  no  conclusions  except  such  as 
are  strictly  logical. 

3rd. — That,  however  the  questions  may  be  affected  by 
further  research,  the  doctrines  of  germs  or  contagia  com¬ 
municated  from  the  sick  to  the  healthy  will  not  account 
for  Indian  epidemics,  and  especially  not  for  epidemics  of 
cholera  and  prevalence  of  enteric  fever  among  European 
soldiers  serving  in  India. 

4th. — That  to  diminish  fevers  of  all  kinds,  to  diminish 
cholera,  and  to  diminish  small-pox — the  three  greatest 
forms  of  Indian  disease— the  real  and  only  practical  remedy 
is  the  improvement  of  local  sanitary  conditions,  largely 
aided  in  the  case  of  small-pox  by  vaccination. 

In  illustration  of  what  I  have  said  I  might  give  many 
examples  derived  from  an  experience  of  nearly  twenty  years 
in  the  Sanitary  Department  of  India,  but  I  have  already 
detained  you  long  enough.  I  am  well  aware  that  the  views 
which  I  have  expressed  are  not  those  which  are  generally 
accepted  or  which  are  generally  acceptable  to  the  medical 
profession,  but  I  can  say  that  they  are  the  result  of  an 
honest  endeavour  made  over  many  years  to  arrive  at  the 
truth.  I  advance  them  in  no  spirit  of  dogmatism,  for  I 
feel  that  the  subjects  to  which  they  refer  are  beset  with 
difficulty,  and  that  it  is  only  by  a  patient  and  persevering 
analysis  of  the  facts  that  we  can  ever  hope  to  frame  those 
wise  measures  which  are  best  calculated  to  prevent  disease. 

Postscript. — Here  my  paper,  as  I  wrote  it  some  days  ago, 
ended,  but  since  then  news  has  arrived  that  cholera  has 
broken  out  in  Damietta  and  in  other  parts  of  Egypt,  and 
all  that  I  have  said  acquires  an  immediate  importance 
which  I  had  not  anticipated.  I  prefer  to  leave  what  I  have 
written  untouched,  but  there  are  two  questions  which  the 
cholera  in  Egypt  suggests,  and  to  which  I  would  ask  your 
attention  for  a  very  few  minutes.  How  did  the  cholera 
appear  in  Egypt  ?  and  secondly.  What  can  be  done  to  arrest 
it  ?  In  reply  to  the  first  question,  the  believers  in  the 
cholera  germs  will  no  doubt  say  that  it  must  have  been 
brought  from  India  somehow  or  other.  We  shall  see  here¬ 
after  what  proof  can  be  advanced  in  favour  of  this  idea. 
Certainly  there  is  nothing  very  tangible,  or  we  should  have 
heard  of  it  long  ere  this,  and  the  British  Government  would 
have  been  upbraided,  as  it  has  already  been,  for  allowing 
the  cholera  to  get  out  of  India.  If  the  Sanitary  Boards  are 
to  justify  their  very  existence,  they  must  prove  that  cholera 
was  brought  from  India,  either  directly  or  indirectly,  and 
that  their  quarantine  failed  only  because  it  was  not  suffi¬ 
ciently  stringent.  It  will  be  time  enough  to  examine  the 
supposed  facts  when  they  are  announced,  but  there  is  one 
important  fact  which  is  worth  all  the  theory  in  the  world, 
and  that  is,  that  the  cholera  broke  out  not  at  Suez  or  along 
the  Suez  Canal,  or  at  any  port  of  the  country  through  which 
the  Indian  traffic  passes,  but  at  the  remote  and  decayed  port 
of  Damietta,  where  there  is  no  Indian  traffic  at  all.  And 
there  is  another  fact,  that  all  along  the  line  of  Indian  traffic 


from  Suez  upwards,  so  far  as  we  yet  know,  there  has  been 
no  cholera  at  all.  But  the  second  is  the  more  important 
question,  and  that  is — What  ought  to  be  done  ?  Results 
have  already  shown  this,  as  I  knew  they  would,  that  quaran¬ 
tine  cannot  keep  out  cholera,  and  that  sanitary  cordons,  as 
they  are  miscalled,  are  perfectly  powerless  to  isolate  it.  The 
misery,  and  alarm,  and  mischief  in  every  form  that  must  be 
caused  by  all  that  is  being  done  in  Egypt  under  the  mis¬ 
nomer  of  sanitation  is  sad  to  think  of.  It  is  indeed 
lamentable,  in  this  nineteenth  century,  to  read  of  soldiers 
with  fixed  bayonets  attempting  to  stay  the  cholera ;  they 
might  just  as  well  attempt  with  fixed  bayonets  to  stay  the 
wind,  or  the  rain- cloud,  or  the  thunderstorm.  These  Sani¬ 
tary  Boards  are  indeed,  I  firmly  believe,  doing  more  harm 
than  the  cholera  itself.  The  only  real  preventive  of 
cholera,  as  I  have  already  said,  is  sanitary  improvement  of 
every  kind,  and  I  trust  that  the  lesson  which  this  epidemic, 
if  it  go  no  further,  so  forcibly  teaches  may  not  be  lost- 
Every  effort  should  be  made  to  put  our  house  in  order 
in  case  the  storm  comes,  and  to  collect  information  to  guide 
us  in  future  epidemics.  If  the  cholera  should  come  it  will 
come  first  in  isolated  cases,  and  it  is  of  the  highest  im¬ 
portance  that  the  most  complete  account  of  these  cases 

should  be  recorded.  /Y 

— 


PEACTICAL  NOTES  ON 


foff  h  A  D  ^  G  R ! 
A  library 


-  v  c  \  u'oMArcY 

THE  ORDINARY  DISEASES  OFvJNDIA, 

Chi  s  ■  i 

ESPECIALLY  THOSE  PREVALENT  IN  BENGAL 


By  NORMAN  CHEYEES,  O.I.E.,  M.D. 


( Continued  from  page  640  of  last  volume.) 

TREATMENT  OF  TEEAI  FEVER  AND  OF  OTHER 
PERNICIOUS  FORMS  OF  REMITTENT. 

Oe  late.  Quinine  has  been  regarded  as  the  chief  remedy  in 
these  Pernicious  Fevers,  travellers  generally  taking  a  supply 
with  them ;  as  Macdonald,  writing  in  1843,  tells  us,  “  Those 
of  some  experience  in  these  fevers  never  omit  carrying 
a  supply  of  calomel,  which  they  use  in  large  doses,  often 
with  the  effect  of  checking  the  disorder/5  A  military 
surgeon  of  great  experience,  who  mentioned  that  he  had 
treated  about  two  thousand  cases  of  bad  Remittent  Fever 
writing  in  1839,  (a)  stated  that  he  had  lost  only  about 
twelve  patients.  He  appears  to  have  been  attached  to  the 
force  of  Sir  David  Ochterloney  in  their  progress  through  the 
Nepaul  Terai.  He  remarks,  "  My  opinion  is  not  singular 
that  mercury  in  the  treatment  of  Remittent  Fever  approaches 
as  nearly  as  possible  to  a  specific 55  ....  “  when  ptyalism  is 
produced.55  He  says,  Cf  I  was  informed  by  an  eminent 
medical  gentleman,  who  observed  sixteen  cases  of  the  Terai 
Fever  at  the  verge  of  the  forest  as  it  runs  along  the  range  of 
hills  near  Almora.  These  cases  were  in  the  second  stage 
and  of  a  deep  yellow  colour ;  the  first  stage  came  on  in  the 
forest,  so  that  they  had  taken  no  medicine.  He  considered 
these  patients  on  the  very  verge  of  death ;  but  yet,  convinced, 
from  what  he  had  previously  observed  of  the  disease,  that  a 
bold  measure  was  now  the  only  means  of  saving  them,  he  at 
once  gave  each  sixty  grains  of  calomel,  and  followed  it  up 
till  ptyalism  took  place.  Strange  to  say,  he  did  not  lose  a 
man.55  .  ..  .“I  was  informed  by  a  young  medical  friend 
at  Cawnpore  that  he  had  tried  scruple  doses  of  calomel  five 
times  a  day  with  the  most  eminent  success  in  Remittent 
Fever,  both  with  Europeans  and  natives.55 

Dr.  Sullivan  gives  Quinine  and  calomel  freely  in  the  algide 
pernicious  state,  as  I  did  in  the  convulsive  form.  In  the 
comatose  form,  when  there  is  spasm  of  the  pharynx  or  oeso¬ 
phagus  preventing  swallowing.  Dr.  Sullivan  administers 
quinine  by  the  rectum  and  hypodermically,  as  well  as  by 
rubbing  in  an  alcoholic  solution  of  the  alkaloid,  so  as  to  cause 
absorption. 

Webb’s  plan  of  treating  the  algide  form,  principally  by 
calomel  and  opium,  bleeding,  and  turpentine  enemata  and 

(a)  In  the  Treatment  of  Jungle  or  Remittent  Fever,  of  Hindoostan,  Ptyalism 
is  a  Sign  of  Cure  which  is  rendered  Permanent  by  change  of  air. — Indian 
Journal  of  Medical  and  Physical  Science,  vol.  vi.,  page  773. 


64  „««„».  CHEVEKS  ON  THE  ORDINAKY  DISEASES  OF  INDIA. 


draughts,  preceded  by  a  hot  bath  (a  very  dangerous  item 
of  treatment  in  the  collapse  stage  of  cholera)  for  twenty 
minutes,  was  found  so  effectual  that  he  eould  confidently 
trust  it  in  the  hands  of  the  native  doctor. 

I  was  struck  by  noticing,  three  years  ago,  that  Professor 
Fordyce  Barker,  of  New  Tork,(b)  considers  that  Warburg’s 
Tincture  is  a  far  more  effectual  and  speedy  remedy  in 
malarious  fever  than  the  largest  doses  of  quinia.  When  I 
first  went  to  India  more  than  one  leading  authority  highly 
valued  “Warburg”  in  Terai  Fever.  Some  considered,  as 
Dr.  W.  S.  Stiven  did,  that  this  agent  owed  its  febrifuge 
power  to  Berberis  Lycium,  the  famed  Avkiov  of  the  ancients, 
represented  by  the  Rusot  of  Indian  Bazars  and  its  alkaloid 
Berberite.  Sir  William  O’Shaughnessy  Brooke  found  the 
rusot  useful  in  intermittent  fever.  In  Dr.  Morehead’s 
hands  it  “proved  unequal  to  preventing  the  paroxysm  of 
ordinary  inter mittents.  Of  late  years  I  heard  little  or 
nothing  about  it  or  Warburg’s  Tincture  (which  was  con¬ 
sidered  an  unpleasant  agent).  Indeed,  to  use  the  euphuistic 
phrase  of  one  of  my  native  students,  it  does  not  “  come 
within  the  chancery  of  my  imagination  ”  to  rely  upon 
any  drug  but  quinia  in  this  class  of  fevers  when  life  is 
endangered,  (c) 

It  was  not  until  after  I  had  sent  the  final  proof  of  the  above 
paragraph  to  press  that  I  noticed(d)  that  Dr.  Warburg  com¬ 
municated  the  formula  of  his  tincture  to  Inspector-General 
Maclean  in  1875.  He  states  that  Quinine,  in  combination 
with  a  number  of  aromatics,  is  the  active  ingredient.  Dr. 
Maclean  adds  his  own  high  authority  to  the  evidence  of 
those  who  have  found  this  tincture  “  a  remedy  of  great  power 
in  all  malarial  fevers.” 

I  need  scarcely  add  that,  if  Dr.  Warburg  had  not  held  the 
composition  of  his  tincture  a  secret  from  the  profession 
throughout  my  Indian  career,  I  should  probably  have  now 
been  able  to  state  that  I  had  fully  tested  its  efficacy  in  the 
treatment  of  grave  Indian  fevers. 

MALARIAL  CACHEXIA. 

It  is  certain  that  many  of  the  gravest  diseases  of  India, 
not  generally  classified  with  those  which  are  directly  pro¬ 
duced  by  malaria,  are  largely  due  to  this  cause.  Among 
these  may  be  numbered  Asiatic  Cholera.,  Dysentery,  Sup¬ 
purative  Hepatitis,  Land  Scurvy,  Sloughing  of  the  Cornea, 
Menorrhagia,  a  tendency  to  Abort,  Post-partum  Haemor¬ 
rhage,  Puerperal  Fever,  Tetanus,  Chronic  Muscular  and 
Articular  Rheumatism,  Pneumonia,  and  certain  prevalent 
forms  of  Diarrhoea.  Moreheadsays  :(e) — “  There  can  be  no 
question  that  much  of  the  mortality  attributable  in  India  to 
‘bowel  complaints ’  is,  though  indirectly,  yet  chargeable  to 
the  account  of  malarious  fever.”  This  just  remark  has,  I  am 
satisfied, ’application  to  that  very  prevalent  form  of  deadly 
chronic  intestinal  flux  which  is  so  destructive  to  the  lives 
of  ill-fed  Bengalees  that  I  have  termed  it  Morbus  Bengalensis. 
Hence  much  of  the  inclination  of  some  of  our  first  autho¬ 
rities  to  conclude  that,  in  India,  True  Enteric  and  Relapsing 
Fever  are  wholly  due  (as  they  probably  are  in  part)  to 
“climatic  causes” — i.e.,  to  Malaria.  It  would  scarcely  be 
an  exaggeration  to  affirm  that  this  malarious  cachexia  is, 
more  or  less,  the  acquired  constitutional  state  of  everyone 
who  has  resided  long  in  India.  Everywhere  in  that  country, 
and  in  the  persons  of  all  old  Indians  there  and  at  home,  the 
malarious  taint  is  detectable  in  almost  every  kind  of  disease. 
In  this  chapter,  however,  I  shall  confine  my  remarks  as 
much  as  possible  to  those  conditions  of  disease  which  either 
follow  Malarious  Fevers  in  India  or  are  more  or  less  directly 
traceable  to  the  operation  of  Malaria  in  that  country. 

(b)  Medical  Times  and  Gazette,  vol.  i.  for  1880,  page  327. 

(c)  For  information  regarding  Berberis  Lycium,  vide  Sir  James  Simpson 
on  some  Ancient  Greek  Medicinal  Vases  for  containing  Lykion,  and  the 
Modem  Use  of  the  same  Drug  in  India ;  O’Shaughnessy’s  “  Bengal 
Dispensatory,”  page  203 ;  Dr.  Kenneth  Mackinnon,  Indian  Annals  of 
Medical  Science,  No.  v.,  page  161.  A  friend  of  Dr.  Mackinnon’s  wrote  from 
the  Neilgherries,  “  I  find  that  the  medicine  [Warburg’s]  is  a  favourite  one 
with  the  Madras  Medical  Officers,  who  use  it  in  all  desperate  cases,  and 

with  a  success  that  is  very  surprising.  - ,  who  is  travelling  to  join  one 

of  the  regiments  of  the  Hyderabad  Contingent,  had  to  pass  through  a  j  ungly 
country,  and  caught  a  bad  fever.  He  was  for  two  days  comatose  and  in  a 
hopeless  state,  when  the  Warburg’s  Drops  were  given  as  a  last  resource. 
The  effect  was  powerful  and  almost  immediate,  and  he  has  continued  to  get 
on  very  well.”  Dr.  Stiven,  Indian  Annals,  No.  vi.,  page  416 ;  Dr.  Francis, 
ibid.,  page  452. 

(d)  Dr.  Maclean’s  article,  Intermittent  Fever,  “  Quain’s  Dictionary  of 
Medicine,”  page  735. 

(e)  Ibid.,  page  26. 


Splenic  Hypertrophy, 

so  well  known  to  those  practising  in  the  malarious  districts- 
of  England  as  “  ague  cake,”  is  of  great  but  exceedingly 
unequal  prevalence  throughout  the  larger  portion  of  the 
plains  of  India.  The  occurrence  of  splenic  hypertrophy,  as  a. 
result  of  paludal  fever,  is  ruled  by  laws  of  which  we  have 
no  knowledge.  It  appears  to  depend  not  upon  the  type  or 
severity  of  fever,  but  upon  peculiarities  of  locality  .and 
race.  Thus,  as  we  shall  presently  see  that  Elephantiasis 
prevails  only  in  marshy  districts  within  the  range  of  the  sea 
breeze,  and  that,  where  it  is  most  prevalent  among  natives, 
it  very  rarely  attacks  Europeans, — so  Splenic  Hypertrophy, 
while  it  is  not  generally  prevalent  among  Europeans,  is 
most  common  among  natives  in  the  plain  country  of  Bengal 
and  Bombay,  but  is  comparatively  rare  in  the  Madras  Presi¬ 
dency.  Thus,  in  Bombay,  Morehead  found  that,  out  of  243- 
clinical  cases  of  Intermittent  Fever,  enlargement  of  the 
spleen  was  present  in  ninety-one.  The  infrequency  of  this 
lesion  in  the  Madras  Presidency  was  noticed  by  Annesley- 
In  the  Deccan,  during  five  years  ending  June,  1855,  in  an 
average  strength  of  10,500  men,  there  were  15,684  admis¬ 
sions  for  fever,  which  were  generally  amenable  to  quinine. 
Out  of  these,  there  were  only  thirty- nine  for  splenic  disease, 
with  two  deaths.  Dr.  Francis  Day  adds  that  in  none  “of 
his  own  cases  of  fever  in  the  3rd  Regiment  of  Infantry, 
Hyderabad  Contingent,  at  Bolarum,  could  enlargement .  of 
the  spleen  be  detected.”  Doubtless  the  general  immunity 
from  this  lesion  enjoyed  by  the  European  inhabitants  of 
malarious  districts  is,  in  a  large  measure,  due  to  the  prompti¬ 
tude  with  which  their  attacks  of  fever  are  encountered  and 
to  the  superiority  of  their  hygienic  surroundings.  Still,  this 
is  far  from  affording  a  full  explanation  of  the  difficulty, 
seeing  how  great  has  been  the  prevalence  of  “  spleen 
among  Europeans  in  certain  localities.  It  has  been  the 
leading  characteristic  of  Peshawar  fever  among  our  Euro¬ 
pean  troops.  This  condition  was  almost  inseparable  from 
Chittagong  Fever  in  natives;  but,  during  a  residence  of 
more  than  three  years,  I  never  saw  it  there  in  a  European. 
Although,  as  I  have  said,  I  believe  that  I  had  splenic, 
enlargement  when  a  child  in  the  Kentish  marshes,  I  have 
never,  in  thirty-three  years’  suffering  from  Chittagong  and 
Calcutta  fever  and  their  sequelae,  experienced  the  very 
slightest  evidence  of  splenic  uneasiness  or  enlargement. 
Splenic  hypertrophy  is  very  common  among  natives  in  and 
around  Calcutta,  but  I  do  not  recollect  ever  to  have  seen  a 
European  who  got  “spleen”  there;  whereas,  at  Mutlah  or 
Port  Canning,  forty  miles  from  Calcutta,  some  five  days 
fever  brought  the  spleen  down  in  robust  European  sailors- 
just  come  in  from  sea.  I  should  recognise  a  recent  Mutlah 
spleen  now.  It  appeared  like  a  goose-egg  below  the  ribs  in 
front.  One  of  my  patients,  a  magnificently  developed  gigantic- 
young  northern  sailor,  died  from  rupture  of  such  an  acutely 
enlarged  spleen,  this  lesion  being,  apparently,  quite  spon¬ 
taneous,  (f)  When  Peshawar  Fever  and  Spleen  were  most 
prevalent  thirty  years  ago  among  our  European  soldiers, 
the  native  inhabitants  of  the  Valley  were  not  at  all  remark¬ 
ably  liable  to  these  diseases.  Otherwise,  my  own  personal 
experience  of  “  Spleen,”  in  well-to-do  Europeans,  is  very 
small  indeed.  I  can  only  recall  two  cases.  One  of  these, 
occurred  in  Bengal,  the  other  in  the  N.W.  Provinces.  Both 
the  sufferers  were  officers  enthusiastically  devoted  to  the 
pursuit  of  game  in  malarious  localities. 

I  need  scarcely  add  that,  whether  our  patient  be  a  native 
or  a  European,  we  neglect  his  case  if  we  do  not  examine  the 
spleen  at  every  stage  of  malarious  fever. 

In  1845,  Government  received  so  many  reports  of  the 
prevalence  of  fever  along  the  line  of  the  Delhi  Canal,  that 
they  appointed  two  engineers  and  a  medical  officer  to  report 
upon  the  health  of  the  inhabitants  of  that  large  portion  of 
the  N.W.  Provinces  which  was  under  irrigation.  It  was 
suggested  by  the  medical  member,  the  late  Dr.  T.  E~ 
Dempster,  that  the  condition  of  the  spleen  in  any  given, 
number  of  individuals  would  be  a  fair  test  of  the  frequency 
and  degree  in  which  they  had  suffered  from  malarious  in¬ 
fluence.  This  test  was  applied  as  follows.  At  each  place, 
twenty  children  (it  being  believed  that  young  persons  are 
more  liable  to  enlargement  of  the  spleen  than  adults)  and 
twenty  adults  were  selected,  the  chief  care  being  to  take  a 

(f)  This  poor  fellow  suffered  from  a  very  noteworthy  symptom-an  un¬ 
ceasing  call  to  empty  the  bladder.  I  also  saw  this  in  the  case  of  Chief 
Justice  Norman,  ■who  died  from  stabs  in  the  belly,  the  cause  being  pressure 
by  blood  collected  in  the  pelvis. 


Medical  Timei  and  Gazette. 


MEDICAL  AND  SURGICAL  PRACTICE. 


July  21.  1883.  65 


fair  sample,  not  of  the  sick,  but  of  the  “  going  about  ” 
population.  The  Committee  travelled  about  1400  miles, 
visited  more  than  300  inhabited  localities,  and  examined 
upwards  of  12,000  individuals  of  all  ages  in  both  irrigated 
and  unirrigated  districts.  It  was  found  that,  in  places 
irrigated  from  the  Western  and  Eastern  Jumna  Canals,  the 
percentage  of  enlarged  spleens  ranged  from  16  to  59  among 
adults  and  children  of  all  classes,  the  proportion  of  instances 
in  which  the  percentage  was  25  and  upwards  being  as  8  to 
•5  of  those  in  which  it  was  below  that  rate.  In  lands  irri¬ 
gated  from  wells,  in  the  high  land  of  the  Dooab,  only  8 
per  cent,  of  enlarged  spleens  were  found  ;  in  unirrigated 
countries  the  percentage  ranged  from  3  to  44 ;  in  naturally 
malarious  localities,  from  34  to  44.  (g) 

Thus  originated  what  has  ever  since  been  known  as 

Dempster’s  Spleen  Test,”  which  can  never  be  neglected 
without  danger  when  new  ground  has  to  be  taken  up  for 
cantonments,  etc. 

The  association  of  Splenic  Disease  and  Scorbutus  has  been 
often  observed  in  India  and  elsewhere,  and  in  both  sea  and 
land  scurvy,  (h)  As  I  have  already  stated,  the  latter  disease 
is  of  great  prevalence  in  India  generally,  and  especially  in 
certain  districts,  as  in  Behar  and  Scinde.  It  would  be  very 
interesting  if  officers  on  tour  through  such  districts  would 
observe  and  report  how  far  Scorbutus  and  Spleen  are  asso¬ 
ciated  in  their  inhabitants. 

So  common  among  the  poor  in  India  is  splenic  disease, 
and  so  fragile  is  the  organ  in  many  cases  of  men  quite 
capable  of  performing  their  daily  work,  that  it  might  almost 
be  laid  down  as  a  rule  that  to  beat  or  kick  a  native  is  to 
endanger  his  life  (vide  my  “  Medical  Jurisprudence  for 
India,”  pages  457-67). 

Immense  spleens  are  daily  met  with  in  most  of  the  native 
hospitals  in  the  plains  of  Bengal  and  Bombay.  The  extreme 
limits  of  enlargement  are  from  about  the  level  of  the  sixth 
rib,  when  the  lung  and  heart  are  pressed  upwards  (i)  from  the 
spine  to  the  right  of  the  umbilicus,  and  down  to  Poupart’s 
ligament  or  below  it.  In  examination,  we  percuss  the  left 
chest,  and  then,  the  patient  lying  down,  we  place  the  open 
hand,  in  front,  over  the  left  hypochondrium,  where  the  mass 
of  the  enlarged  organ  is  felt.  If  there  be  ascites,  we  give 
the  spleen  sudden  but  gentle  pressure  backwards  with  the 
forefinger.  It  generally  sinks  in  the  fluid,  touches  the  spinal 
column,  and  immediately  rises  again,  striking  the  finger 
sharply  as  in  ballottement .  We  then  run  the  finger  across 
the  tumour  at  its  broadest  part  until  we  feel  an  abrupt 
rounded  edge,  when  we  easily  trace  its  very  defined  inner 
margin  often  from  the  scrobiculus  cordis  to  the  pubes.  We 
must  be  careful  to  do  all  this  with  a  perfectly  light  touch  ; 
these  spleens  are  often  too  tender  to  bear  any  “  punching  ” 
and  rough  handling. 

The  following  is  a  description  of  the  condition  of  an 
hypertrophied  spleen  in  the  museum  of  the  Calcutta  Medi¬ 
cal  College,  given  by  Dr.  Joseph  Ewart  in  his  admirable 
Catalogue : — 

“  Specimen  547.  Enlargement  of  the  Spleen  from  Mala¬ 
rious  Fever. — The  peritoneal  covering  and  capsule  are  much 
thickened  and  puckered  from  organised  inflammatory  exuda¬ 
tion.  In  the  depressions  caused  by  this  contraction  the 
adventitious  tissue  exists  in  greatest  abundance.  The  cap¬ 
sule  and  peritoneum,  as  they  are  seen  on  section  inseparably 
united,  measure  about  a  line  in  thickness.  The  trabeculae 
are  thickened  and  very  distinct,  the  interspaces  large,  and 
filled  with  the  spleen-pulp.  The  density  and  compactness  of 
the  organ  is  greater  as  we  examine  it  from  centre  to  circum¬ 
ference.  About  an  inch  of  the  periphery  is  so  compact  that 
the  trabecular  spaces  do  not  exceed  the  diameter  of  a 
pin’s  head,  whilst  many  of  those  towards  the  central  region 
of  the  spleen  are  large  enough  to  contain  a  pea.” 

Where  the  spleen  slowly  enlarges  under  repeated  attacks 
of  fever,  inflammation  probably  has  little  or  nothing  to  do 

(g)  “  Notes  on  the  Application  of  the  Test  of  Organic  Disease  of  the 
Spleen  as  an  Easy  and  Certain  Method  of  detecting  Malarious  Localities 
in  Hot  Climates”  (1848) ;  and  an  additional  communication,  Indian  Annals 
of  Medical  Science,  for  January,  1858,  page  293.  It  was  found  that  the 
prevailing  sickness  was  not  due  to  irrigation,  but  to  the  canal  works  or 
the  watercourses  of  private  individuals  having  intercepted  the  natural 
drainage  of  the  country ;  and  having  thus  led  to  the  formation  of  swampy 
tracts,  diffusing  malarious  influence  around  them. 

(h)  See  a  valuable  paper  by  Surgeon- General  W.  A.  Green,  “  Cases  of 
Sea  Scurvy,  of  Scorbutic  or  Putro-adynamic  Fever,  and  of  Fever  com¬ 
plicated  with  severe  Spleen  Disease ;  with  Remarks  to  point  out  severally 
a  similarity  in  their  probable  causes,  in  their  nature,  and  in  some  of  their 
symptoms.”— Trans.  Med.  and  Phys.  Society  of  Bengal,  1839, 

(i)  Morehead,  page  36. 


with  originating  the  process ;  such  inflammation  as  occurs 
is  intercurrent.  But  many  enlarged  spleens  present  such 
marked  traces  of  inflammation  externally,  peritoneal  opacity, 
contraction  and  thickening,  adhesion  to  the  diaphragm,  etc., 
and  inflammatory  sub-capsular  deposit,  that  we  cannot  doubt 
that  “  splenitis  ”  has  been  present.  The  spleen  may  be 
very  tender  under  pressure  when  its  enlargement  has  been 
sudden,  and  in  many  cases  there  has  been  local  peritonitis. 
Probably  this  inflammation  of  the  splenic  peritoneum  oc¬ 
curred  in  some  at  least  of  the  splenic  cases  at  Peshawar 
mentioned  above,  and  gave  a  colouring  of  reason  to  the 
practice  of  leeching  which  I  have  described. 

{To  he  continued.) 


REPORTS  OF 

HOSPITAL  PRACTICE  IN  MEDICINE 
AND  SURGERY. 

- ♦ - 

THE  MIDDLESEX  HOSPITAL. 


ABDOMINAL  ANEURISM— RUPTURE  INTO 
DUODENUM. 

(Under  the  care  of  Dr.  COUPLAND.) 

Christopher  B.,  aged  seventy-two,  a  labourer,  was  admitted 
into  Founder  Ward  on  March  16,  1883,  in  a  marked  con¬ 
dition  of  collapse.  His  features  were  pinched,  lips  pale  and 
livid,  surface  of  body  and  extremities  cold,  voice  feeble, 
pulse  thready. 

He  had  suffered  from  gout  for  several  years,  and  had  con¬ 
stantly  been  subject  to  a  cough  for  the  last  eight  or  nine 
years  ;  always  worse  in  the  winter.  He  dated  his  present 
illness  from  last  Christmas,  when  he  was  laid  up  with  gout. 
Since  then  he  had  lost  flesh  and  become  very  weak ;  had 
suffered  from  pains  all  over  the  body,  and  especially  in  the 
abdomen,  and  from  cough.  He  had  had  no  vomiting  ;  but 
his  appetite  was  bad,  and  bowels  very  constipated.  For  a 
few  days  before  admission  he  had  become  much  weaker  and 
unable  to  walk. 

On  examination  of  the  abdomen  the  walls  were  seen  to  be 
flaccid,  and  there  was  marked  tenderness  in  the  right 
hypochondrium.  A  firm  tumour  of  an  irregularly  oval 
shape  could  be  felt  in  the  epigastric  region  on  the  right  of 
the  middle  line,  projecting  apparently  from  below  the 
margin  of  the  liver.  The  tumour  reached  to  within  half 
an  inch  of  the  umbilicus,  and  measured  transversely  three 
inches  and  a  half,  vertically  two  inches  ;  it  was  very  tender 
on  manipulation,  and  pulsated  with  the  aorta.  Pulsation 
appeared  to  be  transmitted ;  it  was  not  expansile.  No 
bruit.  There  were  marked  signs  of  pulmonary  emphysema, 
and  a  few  subcrepitant  rales  at  Jthe  base  of  the  lungs.  The 
prsecordial  dulness  was  obscured ;  cardiac  sounds  very  faint. 

Under  stimulants  and  warmth  he  rallied  from  the  state  of 
collapse,  but  during  the  first  few  hours  the  bowels  were 
twice  opened,  and  on  each  occasion  some  black  tarry  blood 
was  passed.  There  was  no  recurrence  of  this  haemorrhage 
until  just  before  his  death,  twelve  days  later ;  and  no  change 
was  observed  in  the  tumour,  which  throughout  remained 
very  tender.  He  suffered  at  times  with  abdominal  pain, 
particularly  on  the  22nd.  requiring  hypodermic  injections 
of  morphia  for  its  relief.  There  was  also  throughout  a 
certain  amount  of  bronchitis,  but  otherwise  no  further 
special  features  in  the  case.  The  urine  was  free  from 
albumen  (specific  gravity  1018  to  1020),  and  frequently 
deposited  uric  acid  crystals. 

On  March  27  he  again  became  somewhat  collapsed,  and 
on  the  28th,  after  having  complained  during  the  morning 
of  more  pain  than  usual,  he  died  somewhat  suddenly.  A 
motion  passed  just  before  death  contained  tarry  blood. 

Post-mortem  Examination  by  Dr.  Fowler,  sixteen  hours 
after  Death. — Emaciated  ;  integuments  pallid  ;  marked  post¬ 
mortem  lividity.  The  peritoneal  cavity  contained  a  few 
ounces  of  clear  serum  ;  the  peritoneum  was  normal.  There 
were  a  few  old  fibrous  adhesions  over  both  pleurae.  No  fluid 
in  the  pleural  sacs.  The  bronchi  contained  frothy  mucus ; 
the  mucous  membrane  was  congested.  The  lungs  were 
crepitant  throughout,  but  engorged  and  cedematous,  especially 
the  lower  lobe  of  the  right  lung.  There  were  large  emphy¬ 
sematous  bullae  along  the  anterior  edges  and  base  of  both 


66 


Medical  Times  and  Gazette. 


THE  ELECTION  TO  THE  COUNCIL. 


July  21,  1883. 


lungs.  The  right  cavities  of  the  heart  contained  mixed 
clots;  the  left  contained  some  post-mortem  clots.  The 
valves  were  all  competent ;  the  aortic  valves  being  athero¬ 
matous.  There  were  numerous  patches  of  calcified  athe¬ 
roma  in  the  aorta.  The  muscular  tissue  was  firm  and  of 
good  colour.  The  liver  was  markedly  contracted,  with 
granular  surface ;  on  section,  the  tissue  was  found  to  be 
very  dense,  and  there  was  well-marked  interstitial  fibrosis. 
Gall-bladder  normal.  Spleen  small  and  fibrous.  Kidneys 
(each  three  ounces  and  a  half)  were  extremely  wasted,  the 
capsules  adherent,  the  surfaces  coai’sely  granular,  the 
cortical  portions  atrophied,  the  tissue  dense,  and  in  the 
straight  tubes  were  series  of  deposited  urates.  The  stomach 
contained  some  ounces  of  a  dark  brownish-black  fluid ;  the 
mucous  membrane  was  intact.  The  duodenum  contained 
some  similar  fluid,  but  it  was  distinctly  blood-stained. 
Thrusting  forward  the  duodenum  and  head  of  the  pancreas, 
a  globular  tumour  could  be  felt ;  it  was  about  the  size  of  an 
orange.  On  laying  open  the  duodenum  four  small  openings 
were  seen  in  its  inner  wall ;  two  in  the  middle  portion  and 
two  in  the  lowest  portion.  A  probe  passed  through  these 
foramina  could  be  felt  to  enter  the  substance  of  the  globu¬ 
lar  tumour.  Blood  was  issuing  from  these  openings.  The 
tumour  and  aorta  were  removed  together  with  the  duo¬ 
denum  in  situ.  On  laying  open  the  aorta  from  behind,  the 
orifice  of  the  sac  of  an  aneurism  was  found  immediately 
below  the  origin  of  the  renal  arteries.  The  opening  mea¬ 
sured  two  inches  and  a  quarter  in  diameter  in  each  direction, 
and  the  sac  was  almost  filled  with  laminated  clot. 

Remarks. — Apart  from  the  fact  of  the  intestinal  hemor¬ 
rhage,  the  amount  of  which,  as  evidenced  during  life,  hardly 
appeared  to  account  for  the  man’s  extremely  prostrate  con¬ 
dition,  the  diagnosis  between  aneurism  and  tumour  of  the 
pancreas  was  difficult  to  establish.  The  age  of  the  patient, 
the  solid  character  of  the  tumour,  the  fact  that  it  lay  entirely 
to  the  right  of  the  middle  line,  and  that  it  had  no  expan¬ 
sile  pulsation,  seemed  points  in  favour  of  the  second  alter¬ 
native.  The  pulsation  was  evidently  transmitted  to  the 
solid  mass,  but,  although  so  nearly  filled  with  laminated 
clot,  the  wall  had  given  way  on  the  side  of  the  duodenum, 
where  the  aneurism  had  caused  ulceration  in  the  charac¬ 
teristic  manner.  No  doubt  for  some  time  past  there  had 
been  leakage  of  blood  into  the  duodenum,  but  no  satisfactory 
history  of  this  could  be  obtained. 


Heifer-Vaccination. — Dr.  H.  A.  Martin,  of  Massa¬ 
chusetts,  in  a  paper  read  at  the  American  Medical  Asso¬ 
ciation,  observed  that  the  proper  sources  of  vaccine  are 
young  heifers  which  have  not  dropped  a  calf.  The  young 
animal  is  perfectly  exempt  from  diseases  to  which  the  older 
animals  are  subject — tuberculosis,  for  instance,  which  in  the 
bovine  species  is  extremely  difficult  to  check,  is  a  disease  of 
old  animals,  and  recent  discoveries  make  it  appear  that 
virus  from  a  tuberculous  animal  is  unsafe.  Young  animals, 
then,  from  four  to  eight  months  old,  are  to  be  preferred. 
After  vaccination  they  are  ready  to  yield  the  virus  in  from 
six  to  eight  days.  A  physician  must  then  determine  when 
the  vesicle  is  in  a  right  state  to  yield  lymph,  and  when 
pressure  is  to  be  applied.  The  epidermis  of  the  heifer  is 
very  tough  and  resistant,  and  does  not  yield  the  virus  so 
readily  as  the  human  arm.  At  each  point  where  a  puncture 
is  made  a  drop  of  perfectly  pellucid  lymph  appears,  and 
upon  the  application  of  pressure  it  pours  forth  in  a  quantity 
that  is  surprising.  The  first  points  covered  are  so  bloody 
that  we  do  not  use  them,  yet  a  large  proportion  of  the 
points  collected  are  bloody.  The  number  of  points  collected 
from  a  single  animal  varies  from  2000  to  6000.  If  you 
vaccinate  an  animal  once,  it  can  never  be  vaccinated  again. 
— Phil.  Med.  News,  June  16. 

Poisoning  by  Carbolic  Acid. — The  Indian  Med.  Gaz. 
for  May  contains  an  elaborate  article  on  a  criminal  trial — 
The  Empress  of  India  v.  U.  K.  Dutt,  L.F.P.&S.  Glasg.,  and 
L.R.C.P.  Edin.  The  accused  was  arraigned  for  having 
caused  the  death  of  a  child  five  years  of  age,  suffering  from 
ascarides,  by  administering  an  enema  containing  eighteen 
ounces  of  a  one-in-sixty  solution  of  carbolic  acid,  representing 
144  grains  of  the  acid.  The  jury  found  the  prisoner  guilty 
under  the  count  which  charged  him  with  causing  death  by 
a  rash  and  negligent  act,  but  strongly  recommended  him 
to  mercy.  He  was  sentenced  to  a  fine  of  Rs.  500. 


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epical  Cintes  ani)  (Laidfe 


SATURDAY,  JULY  21,  1883. 

- ♦ - 

THE  ELECTION  TO  THE  COUNCIL  OF  THE  ROYAL 
COLLEGE  OF  SURGEONS. 

The  recent  election  to  the  Council  of  the  Royal  College  of 
Surgeons  has  aroused  so  much  feeling,  which  has  been  so 
strongly  expressed,  that  we  have  postponed  its  considera¬ 
tion  until  a  short  time  has  given  opportunity  for  the  feeling 
to  subside,  and  for  a  calm  and  temperate  treatment  of  the 
subject  to  have  a  chance  of  a  fair  hearing.  It  must  first 
be  understood  that  there  are  two  totally  distinct  and  dif¬ 
ferent  questions  at  issue,  and  that  the  repugnance  that  has 
been  felt  for  the  one  has  been,  as  so  often  happens  in  similar 
cases,  illogically  transferred  to  the  other.  It  has  been 
for  years  past  felt  by  the  provincial  Fellows  that  they  were 
placed  at  a  disadvantage  in  this  election  in  comparison  with 
their  London  brethren.  The  latter  could  exercise  their 
franchise  at  a  merely  nominal  expenditure  of  money  and 
.  time ;  to  the  former  the  time  and  expense  involved  in  a 
personal  attendance  at  Lincoln’s-inn-fields  were  so  great  as 
virtually  to  amount  to  disfranchisement.  Why,  they  said, 
should  we  be  put  to  the  fatigue  of  a  journey,  the  loss  of  a 
day’s  work,  the  expense,  perhaps,  of  a  night’s  lodging  in 
addition  to  our  railway  fares,  when  our  purpose  could  be 
served  equally  well,  as  is  shown  by  the  practice  at  uni¬ 
versities  and  other  public  bodies,  by  merely  putting  a 
letter  in  the  post  ?  The  reality  of  the  grievance  is  seen  in 
the  fact  that  provincial  Fellows  have  always  formed  an. 
insignificant  minority  in  the  Council.  The  consciousness  of 
suffering  under  a  disability  and  a  grievance  has  grown  and 
strengthened  year  by  year,  until  at  length  an  Association 
of  Fellows  has  been  formed  for  the  purpose  of  forwarding 
the  election  of  those  candidates  who  are  in  favour  of  a  more 
convenient  method  of  voting.  To  this  end  the  Association 
sent  inquiries  to  the  several  candidates  who  appeared  in  the 
field  at  the  last  election,  as  to  whether  they  were  prepared 
to  support  a  scheme  by  which  provincial  Fellows  could  exer¬ 
cise  their  right  of  voting  without  being  put  to  the  trouble 
and  expense  and  loss  of  time  involved  in  a  personal  visit  to 


M«iical  Times  and  Gaiett  . 


“PREVIOUS”  SEWAGE  CONTAMINATION. 


July  21,  1883.  67 


Lincoln’s-inn-fields.  Some  other  inquiry  was  made  at  the 
same  time,  hut  virtually  it  was  understood  that  the  votes  re¬ 
presented  by  the  Association  would  be  determined  by  the  way 
in  which  this  question  was  answered.  So  far,  the  only  question 
at  issue  has  been  the  desirability  or  not  of  altering  the  method 
<of  election ;  but  now  an  entirely  different  question  starts 
into  sudden  prominence.  The  circular  of  the  President  of  the 
Association,  in  which  these  inquiries  were  put,  aroused,  on  the 
part  of  a  few  of  the  candidates  to  whom  they  were  addressed, 
such  a  burst  of  angry  feeling  as  is,  happily,  but  seldom 
witnessed  between  members  of  our  profession.  Although 
it  merely  inquired  whether  the  candidate  was  “  prepared, 
if  elected  upon  the  Council  of  the  Eoyal  College  of  Surgeons, 
to  support  measures  to  obtain  ”  such  and  such  alterations  in 
'the  charter,  and  although  it  was,  as  need  hardly  be  said, 
■couched  in  the  most  courteous  terms,  it  was  denounced  as 
.an  “  impertinent  interference  and  the  epithets,  “  brass,” 
“Brummagem,”  “caucus,”  and  still  stronger  expressions 
were  flung  at  the  President  and  members  of  the  Associa¬ 
tion.  However  much  these  candidates  might  have  resented 
the  inquiry  of  the  circular,  it  would  have  been  more  seemly 
to  treat  with  ordinary  courtesy  a  request  coming  from  more 
than  two  hundred  of  their  professional  brethren  and  signed 
Iby  a  distinguished  name.  After  all,  what  is  the  gravamen 
of  the  charges  brought  against  Bellows  belonging  to  the 
Association  ?  It  is  this :  that  being  entrusted  by  Eoyal 
■Charter  with  the  privilege  and  the  duty  of  controlling  the 
management  of  one  of  the  most  important  scientific  in¬ 
stitutions  in  existence,  they  have  endeavoured  to  perform 
this  duty  in  the  ordinary  constitutional  manner.  They 
look  upon  a  seat  on  the  Council  of  the  Eoyal  College 
of  Surgeons  not  as  an  empty  dignity  which  a  metro¬ 
politan  surgeon  can  secure  by  the  assent  and  help  of 
colleagues,  neighbours,  and  former  pupils,  but  as  an  im¬ 
portant  trust  which  ought  not  to  be  bestowed  save  by  the 
suffrages  of  all  those  who  are  placed  by  the  State  in  the 
position  of  electors.  The  position  of  the  protesting  candi¬ 
dates  cannot  be  deemed  dignified.  They  come  forward  of 
their  own  free  will  and  motion,  and  ask  to  be  elected  as 
representatives  of  their  brother  Fellows  ;  and  yet  when  the 
■electors  venture  to  put  a  single  question  as  to  whether  the 
■opinions  of  their  would-be  representatives  are  in  accordance 
with  their  own,  some  of  the  candidates  are  utterly  shocked 
by  the  “ impertinent  interference”!  This  point — i.e.,  to 
say  whether  a  representative  is  one  who  represents  those 
who  elect  him,  and  who  have  therefore  a  right  to  know  his 
•opinions  on  particular  subjects — is  not  one  that  needs  dis¬ 
cussion  in  these  days  ;  and  to  scold  at  electors  for  asking  a 
candidate’s  views  is  too  absurd  a  mistake  to  call  for  much 
notice.  As  to  the  main  matter  in  question,  the  method  of 
voting,  it  has  been  referred  by  the  Council  of  the  College 
to  an  excellent  committee  for  consideration  and  report. 
'This  committee  consists  of  Sir  James  Paget,  Sir  Spencer 
"Wells,  Mr.  Erichsen,  Mr.  Holmes,  and  the  three  provincial 
members.  Dr.  Humphry,  Mr.  Cadge,  and  Mr.  Lund;  together 
with  the  President  and  Vice-Presidents,  ex  officio.  Such  a 
■committee  cannot  fail  to  give  a  full  and  impartial  considera¬ 
tion  to  every  point  involved  in  the  inquiry  entrusted  to  them . 


“PEEVIOUS”  SEWAGE  CONTAMINATION. 
That  the  presence  of  nitrates  and  nitrites  in  water  is  an 
indication  of  sewage  contamination  is  one  of  the  best  esta¬ 
blished  facts  in  this  department  of  chemistry,  these  bodies 
being  produced  by  the  oxidation  of  organic  nitrogenous 
matter;  and  accordingly,  waters  containing  any  appre¬ 
ciable  amount  of  nitrites  and  nitrates  have  justly  been 
condemned.  But  it  would  seem  from  recent  observations 
made  by  Dr.  Ashby  and  Mr.  Hehner  that  the  time  required 


for  the  change  in  question  has  been  much  over-estimated. 
It  has  recently  been  shown  that  the  process  is  not  a  purely 
chemical  one,  but  that  the  transformation  is  brought  about 
by  organisms  of  a  low  type,  though  much  obscurity  still 
surrounds  their  precise  nature  and  their  relations  to  other 
bacteria.  To  Professor  Frankland  we  owe  the  phrase  “pre¬ 
vious  sewage  contamination,”  now  very  generally  accepted 
in  the  belief  that  the  process  of  “  nitrification  ”  demands  a 
considerable  lapse  of  time  for  its  completion.  It  is,  however, 
not  easy  to  reconcile  such  a  belief  with  the  highly  dan¬ 
gerous  character  of  some  waters,  the  pollution  of  which  must, 
consistently  with  it,  have  occurred  at  comparatively  remote 
date,  and  which  should  have  undergone  a  long  process  of  self- 
purification.  The  analyses  and  observations  of  Messrs.  Ashby 
and  Hehner  on  the  wells  of  Derby  and  Newark  show  that  in 
numerous  cases  where  the  wells  were  shallow  (i.e.,  from  eight 
to  twenty  feet),  and  the  sources  of  pollution,  cesspools,  broken 
drains,  etc.,  in  close  proximity  (viz.,  from  two  to  fifty  yards), 
there  was,  along  with  much  nitric  acid,  little  free  and  small 
or  moderate  quantities  of  organic  ammonia.  The  nitrates, 
though  approximately  measuring  the  amount  of  sewage  con¬ 
tamination,  certainly  did  not  indicate  previous,  in  the  sense 
of  remote,  contamination,  for  the  pollution  was  manifestly 
direct  and  very  recent.  Nay  more,  in  newly  made  wells  in 
quarters  but  lately  built  on,  the  oxidation  was  often  less 
complete,  while  in  places  where  the  soil  was  saturated  with 
sewage,  nitrification  proceeded  with  amazing  rapidity.  In 
the  Newark  wells  the  nitrogen  of  the  albuminoid  ammonia 
(which,  by  the  way,  does  not  represent  the  whole,  or  even  a 
constant  proportion,  of  the  unchanged  organic  matter)  was 
to  that  of  the  nitric  acid  as  1  to  7000.  It  must  therefore 
represent  some  very  different  and  more  permanent  form  of 
organic  matter,  and  may  represent  the  bacteria  or  germs  by 
which  the  rest  was  nitrified,  and  those  which,  whether  the 
same  or  others,  are  the  actual  agents  in  the  propagation  of 
disease.  Since  it  must  require  myriads  of  bacteria  to 
yield  a  ponderable  amount  of  albuminoid  ammonia  (the 
more  so  since  only  a  part  of  their  nitrogen  is  represented 
as  such  by  the  ordinary  process),  it  follows  that  the  very 
smallest  quantity  may  indicate  a  highly  dangerous  cha¬ 
racter  ;  and  also  that,  contrary  to  the  opinion  of  Dr.  Tidy, 
who  asserts  that  the  more  readily  oxidisable  matter  is  the 
more  injurious  as  being  the'  more  putrescent,  that  which 
longest  resists  oxidation,  as  being  living,  active,  and  disease¬ 
bearing,  may  be  the  worst.  Certainly  greater  importance 
must  in  future  be  attached  to  minute  quantities  of  organic 
matter  if  accompanied  by  a  larger  proportion  of  nitrates, 
chlorides,  phosphates,  and  sulphates  than  in  unpolluted 
waters  of  the  same  geological  formation.  But,  to  our  mind, 
the  lesson  most  clearly  taught  by  these  analyses  is  the  duty 
of  having  more  recourse  to  the  microscope  in  the  examina¬ 
tion  of  water,  as  Dr.  Hassall  long  since  taught  us  to  do 
in  that  of  foods.  Of  course,  higher  powers  will  be  needed 
for  the  detection  of  minute  bodies  like  bacilli,  micrococci, 
and  spores,  but  the  chief  difficulty  to  be  overcome  lies  in 
the  concentration  of  large  volumes  of  water  in  order  to 
obtain  any  number  of  organisms  too  light  for  collection  by 
mere  subsidence.  The  researches  of  Professors  Mallet  and 
Martin,  carried  on  under  the  direction  of  the  National 
Board  of  Health  of  the  United  States,  and  published  in 
abstract  in  its  last  Bulletin,  pointed  in  this  direction ;  but 
they  were  unfortunately  broken  off  by  the  dissolution  of  the 
Board  before  any  very  definite  results  had  been  achieved. 


CEEDULITY,  SCEPTICISM,  AND  AGNOSTICISM  IN 

SCIENCE. 

Last  week  we  were  able  to  publish  a  brief  abstract  of  the 
Address  on  Cholera  delivered  by  Surgeon-General  J.  M. 


Medical  Times  and  Gazette. 


THE  WEEK. 


July  21, 188&- 


68 

Cuningham  before  the  Epidemiological  Society ;  but  since 
then  we  have  unexpectedly  received  the  address  in  full. 
The  subject  treated  of  is  so  important,  and  it  is  so  ably 
dealt  with,  that  we  gladly  risk  the  appearance  of  repetition, 
and  place  the  paper  in  extenso  before  the  profession;  and  all 
the  more  willingly  because  we  cannot  altogether  accept  Dr. 
Cuningham’s  views.- 

Since  the  time  when  Chauveau  demonstrated  that  the 
energy  of  vaccine-lymph  resided  neither  in  the  albuminous 
fluid  nor  in  the  leucocytes,  but  solely  in  certain  minute 
bodies  which  he  called  microzymes,  the  search  for  material 
living  agents  as  the  essential  and  efficient  causes  of  disease 
— at  least  of  those  commonly  described  as  infectious  and 
infective — has  been  pursued  with  untiring  zeal,  and  not 
without  considerable  success.  The  pure  cultivation  in¬ 
troduced  by  Koch  has  eliminated  many  of  the  sources 
of  error  inseparable  from  the  reckless  and  slovenly 
methods  of  the  French  school,  and  has  led  its  originator 
to  reject  as  unproven,  if  not  actually  erroneous,  the  hasty 
conclusions  of  men  like  Buchner  on  the  life-history  of  bac¬ 
teria.  But  we  must  admit  that  the  fascination  of  this 
line  of  research  has  allured  other  less  careful  observers  into 
a  veritable  bacteriolatry ;  and,  unmindful  that  bacteria  are 
everywhere  present  in  earth,  air,  and  water,  into  raising  to 
the  rank  of  a  specific  pathological  agent  any  bacillus  they 
may  find  in  the  fluids  or  solids  of  a  diseased  organism. 
Under  such  circumstances  we  welcome  any  assertion  of  a 
healthy  scepticism ;  and  any  protests  against  generalisations 
drawn  from  few  and  undigested  facts,  from  observations  not 
subjected  to  the  most  rigorous  and  exact  scientific  examina¬ 
tion,  and  founded  on  instances  of  mere  accidental  coincidence 
or  sequence.  So  far  as  Dr.  Cuningham,  in  his  paper  on 
Cholera,  proceeds  on  these  lines,  we  heartily  agree  with  him . 
He  insisted  on  the  danger  of  mistaking  the  post  for  the 
propter,  of  founding  a  theory  on  facts,  however  numerous, 
all  favourable  thereto,  while  ignoring  even  one  opposite 
fact  which  might  be  sufficient  to  upset  the  whole  fabric  of 
hypotheses ;  or,  coming  to  particular  cases,  he  deprecated 
the  assumption  of  a  material  cause  while  ignoring  sanitary, 
climatic,  and  meteorological  conditions,  as  referring  the 
outbreak  of  a  disease  to  importation  when  human  inter¬ 
course  had  not  been  previously  followed  by  any  such  occur¬ 
rence.  But  we  may  be  sceptics  without  being  agnostics ; 
and  it  is  indeed  a  severe  reflection  on  the  acuteness  of  those 
who,  as  he  maintains,  have  enjoyed  unrivalled  opportunities 
of  watching  and  studying  cholera  in  its  home,  to  assert  that 
as  yet  we  know  nothing  whatever  as  to  its  cause  or  nature. 
And  we  venture  to  protest  against  his  statement  “that 
there  was  no  evidence  to  prove  that  it  is  caused  by  any 
special  contagium  developed  in  the  bodies  of  the  sick,  and 
communicated,  either  directly  or  indirectly,  by  human  inter¬ 
course”  !  If  so,  why  has  it  in  Europe,  and  from  Europe  to 
America,  invariably  followed  the  great  routes  of  trade  ?  why 
has  it,  in  countries  which, have  direct  communication  by  sea 
only  with  others  where  it  is  endemic  or  epidemic,  invariably 
made  its  first  appearance  in  those  seaport  towns  which  lie 
in  the  routes  of  such  intercourse,  and  as  constantly  among 
persons  just  arrived  from  infected  ports  abroad?  It  appears 
at  Marseilles  and  Havre  before  Paris,  at  Southampton, 
Liverpool,  and  Hull  before  Manchester  and  the  Yorkshire 
manufacturing  towns,  whose  sanitary  condition  is  in  nowise 
better ;  and  though  the  vast  and  ill-managed  armies  of  the 
American  Civil  War  were  decimated  by  disease  of  every 
kind,  they  escaped  cholera,  which  appeared  in  New  York, 
and  spread  thence  after,  and  only  after,  each  of  the 
five  several  epidemics  in  Germany  and  England.  The 
argument  of  Dr.  Cuningham,  that  the  attendants  on  the 
sick  rarely  take  the  disease,  is  beside  the  mark.  No  one  now 
asserts  the  contagiousness  of  cholera ;  the  same  degree  of 


immunity  is  observed  in  enteric  fever,  though  not  in; 
typhus  or  other  strictly  contagious  fevers.  Dr.  Cuningham. 
goes  so  far  as  to  deprecate  the  isolation  and  removal  to 
hospital  of  fever  patients  generally  as  cruel  and  compara¬ 
tively  useless,  and  would  trust  to  improved  sanitation  alone. 
In  this,  we  fancy,  few  will  be  willing  to  follow  him.  He, 
denies  that  any  “  germ  ”  has  yet  been  proved  to  be  of 
itself  and  alone  capable  of  producing  a  disease,  and  trium¬ 
phantly  points  to  the  recent  observation  of  Spina  that  other 
bacilli  are  totally  indistinguishable  from  the  alleged  tubercle 
bacillus  of  Koch.  Yery  well;  the  ova  of  man, ox,  and  dog 
are  indistinguishable,  but  no  one  doubts  their  specific  cha¬ 
racter;  and  if,  as  Watson  Cheyne  has  proved,  the  tubercle- 
bacillus  after  hundreds  of  successive  cultivations  in  gela¬ 
tinised  broth  never  fails  to  induce  tuberculosis  when  inocu¬ 
lated  into  the  anterior  chamber  of  the  eye,  whence  it  spreads 
to  the  organs  generally,  what  matters  it  if  it  be  micro¬ 
scopically  and  chemically  indistinguishable  from  others 
which  show  their  specific  difference  by  their  inertness  ?  It 
is  perfectly  true  that,  as  Dr.  Cuningham  insists,  diseases, 
may  be  induced  by  “forces”  without  the  intervention  of 
“  entities,”  but  herein  consists  the  difference  between  such, 
diseases  as  pleurisy  and  sunstroke,  and  such  as  hydrophobia, 
small-pox,  and  syphilis.  Nor  would  the  strongest  advocate 
of  sanitary  measures  as  preventives  deny  that  in  vaccina¬ 
tion  and  in  anthrax  (whether  of  beast  or  man)  there  is  a 
material  something,  whether  organised  or  not,  essentially 
involved.  Even  as  regards  cholera,  we  doubt  whether  Dr. 
Cuningham  would  consent  to  drink  water  containing, 
cholera  stools,  though  he  might  be  resident  in  Hygieopolis- 
itself. 

We  entirely  agree  with  him  as  to  the  uselessness  of 
quarantine  as  practised,  especially  by  land,  but  only  be¬ 
cause  an  efficient  quarantine  is  practically  impossible ;  we 
would,  however,  point  to  the  Moravian  settlements  on  the 
Volga,  which,  though  in  the  line  of  each  epidemic,  have 
always  escaped  by  maintaining  an  absolute  isolation  from 
the  outer  world,  such  as  would  be  impossible  for  any  com¬ 
mercial  community.  Space  forbids  our  discussing  Dr, 
Cuningham’s  paper  in  detail,  but  we  must  say  that,  with 
the  exception  of  a  few  assertions  which  he  does  not  attempt 
to  substantiate,  his  facts  are,  it  seems  to  us,  entirely  com¬ 
patible  with  the  views  received  in  this  country,  and  his 
conclusions  do  not  appear  convincing.  We  are  well  aware 
that  several  eminent  Indian  authorities  agree  with  him,  but 
others  of  equal  weight,  as  Dr.  Parkes,  do  not.  As  to  the  in¬ 
fluence  of  sanitary  conditions  on  cholera,  we  have  expressed 
our  opinions  in  a  recent  number  of  this  journal. 


THE  WEEK. 

TOPICS  OF  THE  DAY. 

A  meeting  of  representatives  interested  in  the  extramural 
medical  schools  in  Scotland  was  held  on  the  12th  inst.,  in 
Edinburgh  (Dr.  Littlejohn,  of  that  city,  presiding),  for 
the  purpose  of  considering  the  Medical  Act  Amendment 
Bill  so  far  as  it  affected  the  schools  in  question.  After 
some  discussion  the  following  resolutions  were  adopted 

1.  “That  in  the  opinion  of  this  meeting,  the  position  and 
interests  of  the  extramural  medical  schools  of  Scotland  were 
entirely  overlooked  by  the  late  Royal  Commission,  and  have 
been  equally  ignored  by  the  Government  in  framing  the  Medi¬ 
cal  Act  Amendment  Bill,  now  in  the  House  of  Commons.” 

2.  “That,  should  the  Bill  pass  in  its  present  form,  the 
universities  of  Scotland,  while  retaining  intact  their  mono¬ 
poly  in  granting  degrees,  will,  by  their  enormous  majority 
on  the  Board,  become  also  possessed  of  all  examination  and 
licensing  power,  and  thus  in  Scotland  will  be  the  absolute 
masters  of  the  portals  of  the  profession ;  and  that,  in  the 


Medical  Times  and  Gazette. 


THE  WEEK. 


July  21, 1883.  6® 


opinion  of  this  meeting,  a  monopoly  so  complete  will  lead 
not  only  to  the  destruction  of  the  extramural  schools,  but  in 
the  end  will  prove  disastrous  to  the  universities  them¬ 
selves,  and  to  the  cause  of  medical  education  in  Scotland.” 
3.  “  That  this  meeting  desires  to  impress  upon  the  Govern¬ 
ment  the  fact  that  the  origin  and  progress  of  extramural 
teaching  in  Scotland  have  been  chiefly  owing  to  its  free 
and  full  recognition  by  the  corporations,  and  that,  there 
being  no  arrangements  under  the  proposed  Bill  by  which 
the  extramural  teachers  can  be  directly  represented  on  the 
proposed  Medical  Board  for  Scotland,  the  meeting  is  of 
opinion  that  each  of  the  Scotch  corporations  should  return 
at  least  two  representatives  to  the  Board,  in  order  that  the 
interests  of  the  extramural  schools  may  be  preserved.”  It 
was  agreed  to  forward  a  copy  of  these  resolutions  to  the 
Government. 

As  we  last  week  intimated  would  take  place,  a  meeting 
has  been  held  at  the  offices  of  the  Local  Government  Board 
to  consider  the  precautions  against  cholera.  Sir  Charles 
Dilke  was  in  the  chair  ;  and  there  were  also  present — Lord 
Edmund  Fitzmaurice,  Sir  W.  Vernon  Harcourt,  Sir  William 
Jenner,  K.C.B.,  Sir  Lyon  Playfair,  K.C.B.,  Sir  Joseph 
Fayrer,  K.C.S.I.,  Surgeon-General  J.  M.  Cuningham  (Sani¬ 
tary  Commissioner  with  the  Government  of  India),  Sir 
Charles  Du  Cane,  Sir  E.  Currie,  Dr.  Buchanan,  F.B.S.,  and 
some  others.  It  was  reported  that  the  following  private 
telegram  had  been  received  from  Egypt : — “  The  cholera  is 
diminishing.  Most  of  the  fatal  cases  have  arisen  from  the 
fact  of  the  victims  having  refused  medical  assistance,  either 
because  they  imagine  the  epidemic  to  be  the  will  of  God  or 
from  other  causes.  There  is  little  or  no  medical  assistance. 
One  Italian  doctor  at  Damietta  has  over  a  hundred  cases 
under  his  charge.” 

The  supporters  of  the  Westminster  Sanitary  Aid  Associa¬ 
tion,  and  others  interested  in  the  health  of  that  part  of  our 
huge  metropolis,  met  lately,  at  the  residence  of  Mr.  W.  H. 
Smith,  M.P.,  with  the  object  of  extending  the  work  com¬ 
menced  by  the  Association  in  preventing  the  spread  of 
typhus,  typhoid,  and  scarlet  fever,  and  such  like  diseases. 
The  Chairman,  Archdeacon  Farrar,  explained  that  since  the 
formation  of  the  Association  visitors  had  been  appointed, 
who  had  worked  by  three  methods — they  had  taught  the 
practice  of  disinfection,  the  necessity  of  removing  the 
patients  and  isolating  them,  and  they  had  assisted  the  poor 
to  carry  out  the  necessary  precautions.  He  showed  that, 
with  very  small  means,  the  Association  in  the  course  of  the 
year  had  done  much  towards  lessening  the  ever-flowing 
stream  of  human  misery.  He  gave  facts,  from  his  own  per¬ 
sonal  knowledge,  of  the  great  practical  value  of  the  Associa¬ 
tion,  and  expressed  his  deep  regret  that  so  small  a  sum  as 
<£250  had  not  yet  been  raised.  Mrs.  Johnstone,  of  Hastings, 
gave  a  resume  of  her  successful  experiences  in  lessening  the 
spread  of  infectious  diseases,  and  urged  the  necessity  of  pro¬ 
viding  against  infection,  instead  of  waiting,  as  some  unwise 
people  would  do,  until  an  epidemic  broke  out.  Mr.  Barnard 
Holt,  as  medical  officer  of  health  for  the  district,  warmly 
urged  the  need  for  voluntary  help  in  preventing  the  spread 
of  zymotic  diseases,  and  further  practical  suggestions  were 
made  by  other  speakers.  The  Association  deserves  much 
more  hearty  support  than  appears  to  be  given  to  it. 

Although  the  evil  effects  of  the  present  method  of  con¬ 
ducting  work  in  the  white-lead  factories  are  continually 
being  brought  to  notice  through  the  deaths  of  those  em¬ 
ployed  in  them,  little  seems  to  be  done  by  the  Government 
to  bring  about  a  better  state  of  affairs.  Dr.  Danford 
Thomas  recently  held  an  inquest  at  the  Clerkenwell 
Coroner’s  Court,  on  the  body  of  a  woman  aged  twenty-four. 
The  evidence  given  was  that  she  had  been  engaged  at 


J ones’s  white-lead  factory.  Love- lane,  Southwark ;  that  she 
had  latterly  complained  of  pains  in  her  head  and  stomach, 
and  could  not  eat  any  anything.  On  the  5th  inst.  she 
had  a  fit,  gradually  grew  worse,  and  died  five  days  after¬ 
wards.  The  jury  returned  a  verdict  that  the  deceased  died 
from  epileptic  convulsions,  accelerated  by  debility  and  effects 
following  white-lead  poisoning.  They  desired  the  Coroner  to 
communicate  with  the  Home  Secretary,  and  suggested  that, 
pending  legislation  on  the  subject,  there  should  be  a  printed 
code  of  instructions  drawn  up  for  the  guidance  of  workers 
at  white-lead  factories,  and  that  inspections  of  such  factories 
by  the  Government  inspector  should  be  more  frequent.  It 
was  stated  that  the  factory  had  been  visited  by  the  Govern¬ 
ment  inspector  every  six  or  nine  months,  and  that  the  pro¬ 
prietor  had  been  complimented  upon  the  precautions  taken 
to  prevent  lead-poisoning. 

A  festival  dinner  in  aid  of  the  funds  of  St.  Mary’s 
Hospital  was  recently  held  at  Willis’s  Booms,  the  Lord 
Mayor  presiding.  In  proposing  the  toast  of  the  evening, 
his  Lordship  observed  that  the  late  Prince  Consort  laid  the 
foundation-stone  of  the  Hospital  in  1845,  and  in  1865  the 
Prince  of  Wales  lent  his  assistance  towards  the  extension  of 
the  building ;  and  it  was  even  now  being  added  to,  although 
it  already  contained  200  beds.  The  universal  cry  at  the 
present  time,  he  said,  was  that  the  demand  upon  our  hos¬ 
pitals  and  dispensaries  was  increasing  year  by  year.  On  the 
other  hand,  he  did  not  find  that  the  donations  were  on  the 
increase  ;  and  in  this  respect  St.  Mary’s  Hospital  was  not 
different  from  the  other  similar  institutions.  The  proposed 
extension  of  the  Hospital,  for  which  a  legacy  had  been  left, 
would  require  an  increase  in  the  income  of  nearly  £3000. 
The  total  income  required  was  <£15,000,  but  the  sum  at  the 
disposal  of  the  Hospital  from ‘investments  was  only  <£1190. 
The  Corporation  of  London  had  that  day  voted  the  charity 
a  hundred  guineas,  and  the  City  Guilds  had  also  given 
handsome  support  to  the  institution.  The  result  of  the 
festival  was  a  sum  amounting  to  <£2367,  and  promises  of 
new  annual  subscriptions  to  the  amount  of  <£81. 

We  last  week  published  the  text  of  the  Detention  in 
Hospital  Act,  which  the  Government  propose  to  bring 
forward  as  a  substitute  for  the  mutilated  Contagious  Dis¬ 
eases  Acts,  and  the  briefest  consideration  of  the  proposed 
measure  will  be  sufficient  to  show  that  it  will  be  perfectly 
inadequate  to  deal  with  such  an  important  question.  It 
would,  of  course,  be  of  vital  importance  to  have  the  power 
of  detaining  the  women  when  once  in  hospital,  but  it  is 
not  explained  in  what  manner  they  are  to  be  got  there. 
Meanwhile,  as  Lord  Hartington  stated  in  answer  to  a  ques¬ 
tion  in  the  House  a  few  nights  ago,  since  Mr.  Stansfeld’g 
resolution  was  carried  the  percentage  of  disease  amongst 
the  troops  in  the  formerly  protected  districts  has  risen,  even 
in  such  a  short  time,  from  11-89  to  17 AO  per  1000.  There 
is  not  much  to  be  hoped  for  from  the  present  Government, 
but  it  might  fairly  be  asked  whether  the  authorities  of  the 
protected  districts  are  not  in  a  better  position  to  know  the 
beneficial  operations  of  the  old  Acts  than  their  sensational 
opponents,  who,  for  the  most  part,  reside  in  towns  which  the 
legislation  in  question  did  not  touch.  Some  weight  ought 
certainly  to  attach  to  the  fact  that  the  protected  districts 
are  unanimous  in  their  desire  to  maintain  the  old  Acts,  and 
it  is  to  be  hoped  that,  before  it  is  too  late,  the  projected 
legislation  in  this  direction  may  be  enlarged  sufficiently  to 
restore  the  threatened  efficiency  of  our  Army  in  the  large 
towns  where  they  are  principally  quartered.  But  if  the 
present  Government  can  be  brought  for  once  to  abandon, 
its  policy  of  expediency  we  shall  be  agreeably  surprised. 

Becent  advices  from  Cairo  cannot  be  said  to  be  satis¬ 
factory  from  a  sanitary  point  of  view.  Out  of  6825  men  in 


70 


Medical  Times  and  Gazette. 


THE  WEEK. 


July  21, 1883. 


the  army  of  occupation,  no  less  than  588  were  in  hospital. 
The  Duke  of  Cornwall’s  regiment  alone  had  124  men  sick 
out  of  a  strength  of  800.  Sir  Evelyn  Wood  had  started  for 
England,  but,  on  receiving  information  of  the  appearance  of 
cholera  in  Cairo,  he  at  once  returned  to  his  post.  The  large 
Medical  Commission  which  assembled  at  Cairo  to  examine 
into  the  outbreak  have  expressed  an  opinion  that  the  disease  is 
epidemic  cholera,  and  they  expressly  wish  that  the  word  “epi¬ 
demic”  should  be  noted  in  contradistinction  to  “Asiatic.” 
Extraordinary  efforts  are  being  made  by  the  Commission  to 
disinfect  the  city  as  much  as  possible,  and  to  isolate  houses 
and  quarters  where  deaths  have  occurred.  Meanwhile,  the 
Commander-in-Chief  has  declared  all  the  native  bazaars  in 
Cairo  “  out  of  bounds  ”  for  British  troops,  and  preparations 
are  being  made  for  camping  out  at  Helouan  in  case  matters 
become  urgent.  Orders  have  also  been  given  at  Alexandria 
to  remove  the  camp  to  the  desert  of  Aboukir  on  the  first 
symptoms  of  choleraic  disease  amongst  the  English  soldiers. 
The  medical  staff  in  Egypt  has  been  immediately  increased, 
and  those  members  of  it  who  were  on  leave  have  been 
ordered  to  rejoin  at  once.  The  report  from  Alexandria, 
July  18,  of  the  deaths  from  cholera  during  the  previous 
twenty-four  hours,  is — at  Damietta,  18;  at  Mansourah,  45  ; 
at  Samannoud,  22 ;  at  Shiben-el-Kum,  2  ;  at  Sherbin,  6  ;  at 
Cairo,  12  ;  at  Menzaleh,  42  ;  and  at  four  other  places,  24. 


A  FRENCH  CHOLERA  COMMISSION. 

“We  learn,”  the  Gazette  Hebdomadaire  states,  “'that  at  the 
request  of  M.  Pasteur  a  scientific  commission  is  about  to  be 
sent  to  Egypt  in  order  to  study  the  cholera.  It  will  be  com¬ 
posed  of  MM.  Roux  and  Thuillier  (two  of  the  assistants  in 
M.  Pasteur’s  laboratory).  Dr,  Strauss  (agr eg  e-pro  fesseur  of 
the  Paris  Faculty  of  Medicine),  and  M.  Nocard,  Professor  of 
the  Veterinary  School  at  Alfort.  We  can  only  applaud  the 
zeal  of  these  courageous  savants ,  and  hope  that  the  dis¬ 
ciples  of  the  illustrious  master  who  has  realised  so  great 
a  progress  in  the  study  of  parasitic  diseases  may  succeed  in 
discovering  and  cultivating  the  cholera  microbe,  and  in 
finding  out  the  conditions  under  which  the  arrest  of  its 
development  may  be  accomplished.” 


THE  MEDICAL  ACT  AMENDMENT  BILL. 

At  the  beginning  of  the  present  week  a  deputation  from  the 
Medical  Alliance  Association  had  an  interview  with  Mr. 
Mundella,  M.P.,  at  the  Privy  Council  Office,  with  reference 
to  the  Medical  Act  Amendment  Bill.  The  deputation  was 
introduced  by  Mr.  Hopwood,  M.P. ;  and  Dr.  James  Rogers, 
as  spokesman,  urged  that  practitioners  throughout  the 
country  should  have  direct  representation  on  all  the  divi¬ 
sional  boards ;  that  unregistered  persons  should  not  be 
admitted  to  practice  ;  and  that  the  restrictions  and  penal¬ 
ties  for  disobedience  should  be  perpetuated,  if  not  made 
more  stringent ;  that  there  should  be  some  common  title  for 
medical  practitioners ;  and  that  power  should  be  given  to 
any  person  to  prosecute  offenders  against  the  law.  The 
Association  has  a  very  poor  opinion  of  the  Bill,  and  con¬ 
siders,  indeed,  that  it  is  the  worst  of  all  the  Medical  Act 
Amendment  Bills  that  have  been  manufactured.  Mr. 
Mundella  pointed  out  that  this  Bill  was  not  introduced  for 
the  purpose  of  inflicting  pains  and  penalties,  but  to  raise 
the  status  of  the  profession,  and  to  improve  medical  educa¬ 
tion  throughout  the  country.  He  denied  that  the  Bill  would 
act  to  the  detriment  of  the  public  by  admitting  incompetent 
practitioners,  and,  as  a  proof  of  that,  called  the  attention  of 
the  deputation  to  the  numerous  petitions  signed  by  in¬ 
fluential  medical  men  in  favour  of  the  Bill.  He  promised, 
however,  that  if  the  views  of  the  Association  were  sub¬ 
mitted  to  him  in  a  written  form,  their  objections  should 


receive  the  greatest  consideration.  A  deputation  from  the 
Brussels  Medical  Graduates’  Association  also  waited  upon 
Mr.  Mundella  to  bring  before  the  notice  of  the  Government 
their  opinion  that  the  effect  of  the  Bill,  as  regarded  quali¬ 
fications,  would  be  prejudicially  to  alter  their  status  quo. 
Mr.  Mundella  did  not  think  the  Bill  would  so  operate,  and 
said  that  at  any  rate  it  was  no  object  of  the  Government  in 
any  way  to  injure  them.  He  promised  to  consider  their 
representations  with  the  view  of  amending  the  clauses  they 
had  referred  to,  should  it  seem  necessary. 


INTESTINAL  ABSORPTION. 

A  novel  account  of  the  process  of  intestinal  absorption  has 
just  been  offered  by  Dr.  Zawarykin,  a  Russian  observer — 
so  novel  indeed  and  curious,  that  it  can  hardly  be  seriously 
discussed.  Everyone  knows  of  the  attempts  that  have  been 
made  to  account  for  the  entrance  of  fat  into  the  lymphatics 
of  the  villus ;  and  will  remember  the  descriptions  that  have 
been  given  of  the  epithelial  cells  covering  the  mucous 
membrane,  which  are  supposed  to  be  specially  provided  with 
pores  for  absorbent  purposes.  Dr.  Zawarykin’s  process  of 
absorption,  as  evolved  by  him  from  the  study  of  histological 
specimens  from  different  periods  of  digestion,  is  much  more 
beautiful,  and  indeed  more  simple,  than  this.  He  draws  a 
picture  of  the  leucocytes  of  the  mucous  membrane  making 
their  way  “  up  ”  to  the  epithelium,  pushing  an  arm-like 
process  out  between  these  cells,  taking  up  a  little  load  of 
fat,  and  then  hastening  “  down  ”  with  it,  to  fall  into  the 
central  lymphatic  of  the  villus.  If  anything  can  add  to 
this  picturesque  description,  it  is  the  account  of  the  brisk¬ 
ness,  the  activity,  of  the  leucocytes  on  their  outward  and 
return  journeys  ( Centralblatt  fur  die  Med.  fPIss.,  1883,  page 
485).  Protoplasm  is  becoming  more  than  powerful — it  is 
getting  positively  clever. 


MR.  JONATHAN  HUTCHINSON,  F.R.S. 

On  Friday,  last  week,  a  meeting  of  past  and  present  students 
of  the  London  Hospital  was  held  in  the  Anatomical  Theatre 
of  the  Medical  School,  under  the  presidency  of  Mr.  Walter 
Rivington,  F.R.C.S.,  when  it  was  resolved  to  raise  some  fit¬ 
ting  “  Hutchinson  Testimonial  its  exact  shape,  however, 
being  left  for  further  consideration.  Although  but  a  few 
hours’  notice  of  the  meeting  had  been  given,  between  sixty 
and  seventy  gentlemen  responded  to  the  summons,  among 
them  being  several  older  and  eminent  past  students  of  the 
School.  A  committee  was  elected  to  discuss  the  best 
method  of  carrying  out  the  views  of  the  meeting,  and  to 
receive  subscriptions,  which  may  be  paid  either  to  Dr. 
Andrew  Clark,  treasurer,  or  to  any  member  of  the  com¬ 
mittee,  the  secretaries  of  which  are  Dr.  J.  A.  Williams  and 
Mr.  Charles  H.  Wade.  It  is  understood  that,  whatever  form 
the  testimonial  may  take,  it  will  be  presented  to  Mr. 
Hutchinson  at  a  dinner  which  will  be  given  in  his  honour 
early  in  the  ensuing  winter  session. 


HONOURS  TO  THE  PROFESSION  IN  IRELAND. 

The  announcement  that  Her  Majesty  the  Queen  had  been 
advised  to  confer  the  honour  of  knighthood  on  Mr.  George 
H.  Porter,  Surgeon  to  Her  Majesty  in  Ireland,  has  raised  a 
storm  of  indignation  in  Dublin.  All  the  daily  papers  have 
published  strong  leading  articles,  not  so  much  against  the 
proffered  dignity  to  Mr.  Porter  as  against  the  studied 
neglect  of  years  to  confer  any  hereditary  honour  upon 
either  the  medical  or  the  surgical  branch  of  the  profession 
in  Ireland.  The  profession  have  taken  action  in  the  matter, 
and  a  largely  attended  and  highly  representative  deputa¬ 
tion  waited  upon  Mr.  R.  G.  Hamilton,  Under  Secretary  to 
the  Lord  Lieutenant,  at  Dublin  Castle,  on  Tuesday  last,  to 


Medical  Times  and  Gazette. 


THE  WEEK. 


July  21,  1883.  71 


request  him  to  submit  the  following  memorial  to  his  Excel¬ 
lency  without  delay: — “To  His  Excellency  Earl  Spencer, 
K.G.,  Lord  Lieutenant  of  Ireland. — Your  Excellency, — We, 
the  undersigned  members  of  the  medical  profession  in  Ireland, 
desire  respectfully  to  approach  and  confer  with  your  Excel¬ 
lency  on  the  subject  of  State  recognition  of  our  profession. 
We  are  induced  to  do  this  in  consequence  of  the  honour  of 
knighthood  having  recently  been  offered  by  Her  Majesty  to 
one  of  the  most  eminent  members  of  the  surgical  branch  of 
the  profession  in  Ireland.  We  feel  assured  that  your  Ex¬ 
cellency  and  the  Prime  Minister,  in  advising  Her  Majesty 
to  confer  this  mark  of  distinction,  were  actuated  by  the 
sincerest  desire  not  only  to  honour  the  recipient,  but  also 
the  profession  to  which  he  belongs.  Under  these  circum¬ 
stances  we  venture  with  all  respect  to  remind  your  Excellency 
that  until  recently  both  branches  of  our  profession — the 
medical  and  surgical — have  received  a  higher  form  of  recog¬ 
nition  than  that  now  proposed,  and  that  the  Medical  School 
of  Dublin,  of  which  we  are  so  justly  proud,  occupies  as  high 
a  position  as  it  ever  did  among  the  great  centres  of  medi¬ 
cal  science  in  Europe.  We  fail,  therefore,  to  see  why  Her 
Majesty’s  Government  do  not  apparently  consider  our  pro¬ 
fession  as  worthy  of  State  recognition  in  the  present  as  it 
has  been  considered  in  the  past ;  and  we  would  also  point 
out  that  the  absence  of  that  higher  recognition  places  us  in 
a  position  of  inferiority  as  regards  the  profession  in  England, 
where,  most  deservedly,  so  many,  both  in  medicine  and  sur¬ 
gery,  have  been  awarded  hereditary  distinctions.  We  feel 
confident  that  nothing  could  be  further  from  your  Excel¬ 
lency’s  wishes  than  to  see  the  status  of  a  profession,  in 
whose  welfare  you  have  ever  evinced  so  much  interest, 
placed  in  a  lower  position  in  Ireland  than  elsewhere.  We 
venture  to  hope,  therefore,  that  your  Excellency  and  Her 
Majesty’s  other  advisers  will  reconsider  the  subject  of  State 
honours  to  our  profession,  and  grant  an  hereditary  titular 
distinction  to  both  branches  of  it,  and  thus  place  the  profes¬ 
sion  in  this  respect  on  terms  of  equality  with  other  parts  of 
the  United  Kingdom. — Your  Excellency’s  most  obedient 
servants.”  Mr.  Hamilton  assured  the  deputation  that  the 
Viceroy  would  give  the  most  careful  consideration  to  their 
views. 


THE  LATE  DE.  FARE,  F.R.S. 

At  the  late  meeting  of  the  American  Medical  Association 
at  Cleveland,  the  Section  on  State  Medicine  paid  the  follow¬ 
ing  tribute  to  the  memory  of  Dr.  Farr,  and  referredit  to  the 
general  meeting  of  the  Association  for  its  adoption,  which 
was  accorded.  "  Resolved — That  the  labours  of  the  late  Dr. 
William  Farr,  of  England,  in  the  organisation,  classification, 
and  compilation  of  vital  statistics — labours  begun  in  1838, 
and  afterwards  perseveringly,  wisely,  and  ably  continued 
by  him  for  nearly  half  a  century — are  recognised  by  the 
profession  in  the  United  States  as  an  enduring  monument 
to  his  ability  and  learning  as  a  physician ;  as  the  real  ini¬ 
tiation  and  foundation  of  our  own  sanitary  work ;  and  as  a 
perpetual  blessing  to  present  and  future  generations  of  our 
universal  humanity,  entitling  his  name  and  fame  to  stand 
with  those  of  the  great  men  whose  genius  and  labours  have 
resulted  in  beneficial  revolutions  of  the  medical,  surgical, 
and  sanitary  activities  of  the  civilised  world.” 


SOCIETY  EOR  RELIEF  OF  WIDOWS  AND  ORPHANS  OF  MEDICAL 

MEN. 

On  Wednesday,  July  11,  the  quarterly  court  of  directors  of 
this  Society  was  held  in  the  rooms  of  the  Royal  Medical  and 
Chirurgical  Society ;  Sir  George  Burrows,  Bart.,  President, 
in  the  chair.  Four  new  members  were  elected,  the  deaths  of 
four  were  reported,  and  two  other  gentlemen  had  ceased  to 
be  members.  A  sum  of  <£1207  was  distributed  among  fifty- 


seven  widows  and  eight  orphans.  The  death  of  one  widow 
receiving  a  grant  of  <£50  per  annum  was  reported.  There 
were  no  fresh  applications  for  grants.  The  expenses  of  the 
quarter  amounted  to  <£71  13s.,  including  an  honorarium  of 
twenty-five  guineas  to  Mr.  Blackett,  in  recognition  of  his 
great  additional  services  rendered  to  the  Society,  of  which 
he  was  re-elected  Secretary. 


SURGERY  AND  DIFFERENT  RACES. 

Von  Brinton  has  contributed  to  the  Wiener  Med.  Woch. 
(No.  28)  an  article  on  the  behaviour  of  different  races  towards 
surgical  interference.  The  black  races  and  Oriental  nations 
bear  operation  the  best ;  next  comes  the  Anglo-Saxon  family, 
and  then  the  Latin  race.  The  small  mortality  of  the  Chinese 
and  Japanese  after  operations  is  well  known.  Pyaemia  is  of 
very  rare  occurrence  in  China.  Only  eight  died  out  of  138 
operated  on  for  lithotomy.  Similarly,  the  Japanese  enjoy 
immunity  from  pyaemia,  septicaemia,  tetanus,  and  erysipelas. 
Of  the  Americans  the  negro  stands  surgical  interference 
best.  Even  in  overcrowded  and  ill-ventilated  hospitals  the 
negroes  did  better  than  the  white-faces.  Germans  do  well 
because  of  their  phlegmatic  constitution ;  and  Irishmen 
also,  but  on  account  of  their  elasticity  of  spirits. 


THE  OPHTHALMOLOGICAL  SOCIETY  OF  THE  UNITED  KINGDOM. 
At  the  annual  general  meeting  of  this  Society  on  July  6, 
the  following  officers  and  Council  were  elected  for  the  session 
1883-84  : — President :  ^Jonathan  Hutchinson,  F.R.S.  Vice- 
Presidents  :  #William  Bowman,  F.R.S. ,  C.  E.  Fitzgerald, 
M.D.  (Dublin),  Henry  Power,  Frederick  Mason  (Bath), 
Augustin  Prichard  (Clifton), *J.  C.  Wordsworth.  Treasurer : 
J.  F.  Streatfeild.  Secretaries :  John  Abercrombie,  M.D., 
*W.  A.  Brailey,  M.D.  Other  Members  of  Council :  Edwyn 
Andrew,  M.D.  (Shrewsbury),  *  George  Cowell,  *  George  A. 
Critchett,  Robt.  Marcus  Gunn,  *George  Johnson,  M.D., 
F.R.S.,  George  Lawson,  Stephen  Mackenzie,  M.D.,  Charles 
Macnamara,  #E.  Nettleship,*Priestley  Smith  (Birmingham), 
T.  Shadford  Walker  (Liverpool),  *W.  Spencer  Watson. 
The  gentlemen  whose  names  are  marked  with  an  asterisk 
(*)  were  not  in  the  Council,  or  did  not  hold  the  same  office 
during  the  preceding  year.  At  the  conclusion  of  the  meet¬ 
ing  the  retiring  President  (Mr.  Bowman)  said,  in  response  to 
a  unanimous  vote  of  thanks  accorded  him  by  acclamation 
on  the  motion  of  Mr.  Carter,  that  his  mind  had  been  led 
back  to  the  time  when  he  had  first  begun  to  turn  his  atten¬ 
tion  to  the  subjects  which  now  interested  the  Ophthalmo- 
logical  Society ;  the  knowledge  of  the  structures  and  of  the 
functions  of  the  eye  was  then  imperfect  and  elementary,  and 
the  treatment  most  inadequate.  The  subject  had  then 
hardly  ceased  to  he  in  the  stage  in  which  it  was  dealt  with 
on  the  most  general  lines,  or  as  a  narrow  specialty.  Now, 
the  condition  of  things  was  widely  different ;  no  department 
of  medicine  had  known  more  splendid  progress.  It  had  been 
a  great  pleasure  to  him,  through  many  past  years,  to  follow 
the  advance,  and  perhaps,  in  some  small  part,  to  promote  it ; 
particularly  pleasant  it  had  been,  as  their  first  President,  to 
share  with  the  members  of  their  Society  in  the  happily  con¬ 
ceived  idea  of  bringing  together  all  or  most  of  those  engaged 
in  ophthalmic  practice,  and  the  kindred  side  of  the  medical 
art,  throughout  the  United  Kingdom,  its  great  colonies  and 
dependencies.  The  result  had,  he  thought,  been  very  suc¬ 
cessful.  For  himself  he  could  claim  but  a  very  small  share 
in  the  work  of  the  Society ;  the  credit  rather  belonged  to 
those  who  first  initiated  it,  and  they  were  particularly  in¬ 
debted  to  the  two  first  Secretaries  (Dr.  Stephen  Mackenzie 
and  Mr.  Nettleship)  and  Dr.  Brailey,  as  well  as  to  all  those 
gentlemen,  especially  on  the  medical  side,  who  had  co¬ 
operated  with  them.  It  was  one  of  the  great  advantages 


72 


Medical  Times  and  Gazette. 


THE  WEEK. 


July  21, 1883. 


of  the  Society  that  it  had  brought  into  union  those  who 
studied  eye-disease  as  physicians,  and  those  engaged  in  the 
special  practice  of  ophthalmology.  Such  union  explained 
the  necessity  for  studying  the  eye  always  in  the  light  of  its 
relation  to  the  whole  organism,  as  well  as  in  view  of  that 
wider  relationship  which  it  bears  to  all  organic  life  upon  the 
globe.  He  trusted  that  the  Society  would  always  continue, 
in  the  interest  of  medicine  at  large,  to  hold  up  ophthal¬ 
mology  as  that  department  of  the  medical  art  in  which  exact 
knowledge  was  most  attainable,  and  its  application  for  the 
prevention  and  alleviation  of  disease  best  exemplified. 


DEATH  OF  DR.  A.  PATRICK  STEWART. 

We  regret  to  have  to  record  that  Dr.  Alexander  Patrick 
Stewart  died  at  his  residence  in  Grosvenor-street  on  ,  Tues¬ 
day  last,  the  17th  inst.,  in  the  seventy-first  year  of  his  age. 
Dr.  Stewart  had  long  suffered  from  an  affection  of  the  heart, 
and  from  other  pains  and  penalties  inflicted  by  gout,  but 
had  been  fairly  well  lately,  so  as  to  have  been  about  till  two 
days  before  his  death,  when  he  began  to  suffer  severely  from 
cardiac  embarrassment,  and  though  some  degree  of  relief 
was  obtained  for  a  while,  the  improvement  did  not  last. 
Few  metropolitan  physicians  were  better  known  or  regarded 
with  more  kindly  esteem  and  respect  than  was  Dr.  Patrick 
Stewart ;  but  of  his  work  and  life  we  will  now  say  no  more 
than  that  his  name  will  ever  be  linked  with  the  differentia¬ 
tion  of  typhoid  fever  from  typhus,  he  having  contributed 
to  the  Parisian  Medical  Society,  in  1840,  a  paper  clearly 
setting  forth  the  main  points  of  distinction  between  the 
two  fevers. 


THE  PARIS  WEEKLY  RETURN. 

The  number  of  deaths  for  the  twenty -seventh  week  of  1883, 
terminating  July  4,  was  1024  (519  males  and  505  females), 
and  of  these  there  were  from  typhoid  fever  64,  small-pox 
10,  measles  33,  scarlatina  4,  pertussis  22,  diphtheria  and 
croup  26,  dysentery  1,  erysipelas  6,  and  puerperal  infec¬ 
tions  4.  There  were  also  50  deaths  from  tubercular  and 
acute  meningitis,  169  from  phthisis,  20  from  acute  bron¬ 
chitis,  63  from  pneumonia,  94  from  infantile  athrepsia 
(29  of  the  infants  having  been  wholly  or  partially  suckled), 
and  23  violent  deaths  (20  males  and  3  females).  The 
number  of  deaths  continues  to  diminish,  being  now  only 
1042,  in  place  of  1247  six  weeks  ago.  The  deaths  from 
typhoid  fever  have,  however,  increased  from  41  to  64,  while 
the  admissions  have  increased  from  122  to  135.  The  same 
increase  is  observable  in  private  practice,  so  that  there  is 
reason  to  fear  that  this  disease,  which  had  undergone  its 
usual  seasonary  diminution  in  April,  May,  and  June,  is 
about  to  cause  the  increased  mortality  again  which  it  has 
produced  since  1880.  Diphtheria  and  croup  have  notably 
decreased,  and  for  this  season  of  the  year  athrepsia  is  rare. 
The  births  for  the  week  amounted  to  1188,  viz.,  633  males 
(488  legitimate  and  145  illegitimate)  and  555  females  (406 
legitimate  and  149  illegitimate)  :  92  infants  were  either 
born  dead  or  died  within  twenty-four  hours,  viz.,  55  males 
(38  legitimate  and  17  illegitimate)  and  37  females  (25 
legitimate  and  12  illegitimate). 


THE  VARIETIES  OP  ANGINA  PECTORIS. 

Under  the  name  angina  pectoris  many  writers  have  grouped 
together  symptoms  differing  from  one  another  as  widely  in 
their  causation  as  they  do  in  gravity.  It  is  of  great  import¬ 
ance  to  have  clear  views  as  to  the  different  forms  of  angina 
pectoris.  According  to  M.  Henri  Huchard  ( Revue  de  Mede- 
cine,  Nos.  4  and  6),  there  is  but  one  form  of  true  angina 
pectoris,  viz.,  that  dependent  upon  cardiac  ischaemia.  This 
may  be  organic  or  functional.  The  former  is  produced  by 


narrowing  or  obliteration  of  the  coronary  arteries ;  and  the 
author  quotes  thirty  fatal  cases  of  this  disease  in  which  one 
or  other  of  these  conditions  was  found  on  autopsy.  This 
form  of  the  disease  is  of  grave  prognosis,  and,  indeed,  gene¬ 
rally  proves  fatal,  in  this  respect  forming  a  striking  con¬ 
trast  to  all  the  other  varieties.  The  existence  of  functional 
ischiemia  of  the  heart  is  not,  of  course,  susceptible  of  such 
definite  proof  as  in  the  case  of  the  organic  variety,  but  there 
is  [ample  evidence,  both  clinical  and  physiological,  that 
tobacco  is  capable  of  inducing  this  state  of  the  heart.  The 
symptoms  which  it  may  give  rise  to  are  so  well  known  that 
it  is  unnecessary  for  us  to  do  more  than  enumerate  them. 
They  are — diminished  frequency  of  the  pulse,  palpitations, 
irregularity  of  the  heart’s  action,  fainting,  and  a  feeling  of 
prsecordial  distress  which  may  go  on  to  a  typical  attack  of 
angina  pectoris.  Spurious  angina  pectoris  is  also  of  two 
kinds,  the  one  including  all  cases  of  nervous  or  arthritic 
origin,  the  other  cases  of  gastric  origin  associated  with 
dilatation  of  the  heart.  The  points  which  distinguish  these 
spurious  casesTrom  the  true  forms  are — that  the  attacks  do 
not  supervene  with  certainty  on  any  one  given  cause,  such, 
for  instance,  as  any  form  of  violent  exercise ;  that  the  attacks 
when  they  do  occur  are  not  so  severe  and  do  not  last  so  long 
as  in  the  true  disease ;  and  that  in  this  last  or  gastric  form 
the  attacks  are  especially  prone  to  come  on  after  a  meal. 
The  spurious  cases  never  prove  fatal. 


THE  REGISTRAR-GENERAL  FOR  SCOTLAND  ON  THE  MARCH 
QUARTER  OF  1883. 

In  his  quarterly  return  for  the  first  three  months  of  the 
present  year,  the  Registrar- General  for  Scotland  calls  atten¬ 
tion  to  the  circumstance  that,  owing  to  the  increase  of 
population  between  1871  and  1881,  it  has  been  considered 
desirable  to  re-arrange  the  groups  of  districts.  Several 
districts  formerly  included  among  the  small  towns  are 
now  placed  among  the  large  towns,  while  some  large  towns 
have  been  transferred  to  the  group  of  principal  towns  ;  and 
this  new  arrangement,  introduced  into  the  report  under 
notice,  will  be  adhered  to  for  the  future.  During  this  first 
quarter  of  the  year  the  births  in  Scotland  numbered  31,342, 
giving  an  annual  birth-rate  of  3-32  per  cent. ;  as  the 
average  rate  during  the  corresponding  quarter  of  the  ten 
preceding  years  was  3'443  per  cent.,  it  will  be  seen  that 
the  birth-rate  was  slightly  under  the  average.  For  every 
10,000  inhabitants  there  were  registered  362  births  in  the 
principal  towns,  358  in  the  large  towns,  330  in  the  small 
towns,  293  in  the  mainland-rural,  and  236  in  the  insular- 
rural  districts.  For  every  10,000  of  estimated  population  in 
the  eight  principal  towns  the  birth-rate  ranged  from  413 
in  Greenock  to  289  in  Edinburgh.  The  proportion  of  male 
to  female  children  was  as  105-4  of  the  former  to  100  of  the 
latter.  On  turning  to  the  records  of  the  mortality  of  this 
quarter,  it  will  be  found  that  the  number  of  deaths  registered 
was  22,012,  being  at  the  annual  rate  of  233  deaths  in  every 
10,000  inhabitants.  This  rate  is  higher  than  that  recorded 
in  the  first  quarter  of  any  year  since  1879.  In  England, 
during  the  same  period,  the  death-rate  was  223  for  every 
10,000  inhabitants ;  while  in  the  principal  towns  of  Scotland 
it  was  276,  in  the  large  towns  230,  in  the  small  towns  222, 
in  the  mainland-rural  districts  188,  and  in  the  insular-rural 
187.  As  regards  the  eight  principal  towns,  in  Glasgow  the 
death-rate  was  320  per  10,000  of  population ;  in  Dundee,  306  ; 
in  Greenock,  279 ;  in  Paisley,  268 ;  in  Perth,  246 ;  in  Leith, 
242  ;  in  Aberdeen,  224 ;  and  in  Edinburgh,  213.  The  mortality 
during  the  quarter  attributed  to  the  zymotic  class  of  diseases 
is  returned  as  1619,  or  18-7  per  cent,  of  all  deaths  referred 
to  specified  causes;  whooping-cough  proved  by  far  the 
most  fatal,  having  claimed  232  victims  in  January,  217  in 


M«  ileal  Times  and  Gazette. 


MEDICAL  MATTEES  IN  PAELIAMENT. 


July  21,  1883.  73 


February,  and  218  in  March.  The’eomputed  increase  of  popu¬ 
lation  during  this  March  quarter  is  set  down  at  4424,  which 
ds  arrived  at  as  follows : — Deducting  the  number  of  deaths 
from  the  number  of  births,  the  natural  increase  is  found  to 
be  9330;  but,  according  to  the  Government  Emigration 
Officer’s  return,  4906  persons  leaving  the  country  for  places 
■out  of  Europe  were  Scotch,  which  reduces  the  figures  to 
the  number  given.  The  chief  characteristics  of  the  weather 
in  J anuary  were  (but  none  of  them  attained  a  very  marked 
■degree)  a  high  mean  temperature  ;  a  dryness  or  small 
humidity  in  the  air ;  extra  depth  of  rain ;  extra  force 
of  wind,  but  an  extra  amount  of  southerly  direction  in  it. 
February  was  warmer  than  the  average  by  2‘5°,  and  though 
the  rainfall  was  rather  greater,  also  the  mean  pressure  of 
the  wind,  yet  the  humidity  of  the  air  was  less.  The  chief 
feature  of  March  was  its  extraordinary  coldness,  and  the 
manner  of  its  interposition  between  a  warm  February  and 
a  very  warm  April,  so  far  as  that  month  had  extended 
at  the  time  of  making  out  the  report.  The  mean  tem¬ 
perature  was  lower  than  in  any  of  the  Registrar- General’s 
registered  years.  The  month  was  also  very  dry,  or  with 
small  humidity,  small  depth  of  snow  or  rainfall,  and  few 
wet  days. 


THE  ACTION  OF  ALKALIES  ON  BILE. 

Some  researches  have  been  made  recently  by  Lewaschew 
and  Klikowitsch  on  the  subject  of  the  influence  of  alkaline 
agencies  on  the  composition  of  the  bile  ( Centralblatt  fur 
Klin.  Med.,  No.  27).  The  experiments  were  made  on  dogs 
with  permanent  fistulae  leading  to  the  gall-bladder.  No 
canula  was  used,  however.  For  twenty-four  hours  previous 
to  the  beginning  of  the  experiment  neither  food  nor  drink 
was  administered.  It  was  found  that  artificial  and  natural 
mineral  waters  had  a  similar  action  on  the  secretion  of  bile. 
For  some  time  after  the  administration  of  the  alkaline  waters 
the  quantity  of  bile  flowing  from  the  fistula  was  diminished. 
This  effect  was  probably  due  to  the  increased  flow  of  bile 
into  the  intestines.  After  this  initial  period  the  flow  from 
the  gall-bladder  became  more  than  the  normal.  The  normal 
amount  had  been  previously  measured.  Artificial  waters 
exercised  the  same  influence  on  the  quality  of  the  bile  as 
the  natural  waters ;  but  different  results  were  obtained  with 
waters  of  different  degrees  of  concentration.  Thus,  carbonate 
•of  soda  had  a  more  rapid,  powerful,  and  lasting  influence 
on  the  composition  of  the  bile  than  sulphate  of  sodium 
(Glauber’s  salts).  Solutions  of  weak  strength  were  more 
powerful  than  those  of  higher  concentration.  Hence,  those 
mineral  waters  whose  principal  constituent  was  carbonate  of 
sodium  had  the  greatest  influence  on  the  composition  of  the 
bile,  especially  when  the  carbonate  was  not  present  in  a 
high  degree  of  concentration.  The  higher  the  temperature 
of  the  fluids  ingested,  the  earlier  and  more  marked  were  the 
effects. 


We  have  been  requested  to  state  that  Dr.  Stewart’s 
funeral  will  be  at  Highgate  Cemetery,  on  Monday,  the  23rd 
inst.,  at  four  o’clock,  starting  from  Grosvenor-street  at 
three  o’clock. 


The  Treasurer  of  the  British  Medical  Benevolent  Fund 
acknowledges  a  donation  of  <£50  from  Sir  William  Jenner, 
Bart. 


On  Tuesday  evening  next,  at  the  ordinary  meeting  of  the 
"Sanitary  Institute,  to  be  held  at  9,  Conduit-street,  W.,  a 
paper  will  be  read  by  Professor  W.  H.  Corfield,  M.D.,  on 
“The  Compulsory  Notification  of  Infectious  Diseases.”  The 
chair  will  be  taken  at  a  quarter  to  eight  o’clock. 


Mb.  Jonathan  Hutchinson  has  been  appointed  Emeritus 
Professor  of  Surgery  in  the  London  Hospital  Medical  School, 
and  will  give  each  winter  and  summer  session  a  course  of 
lectures  on  Clinical  Surgery,  consisting  of  six  lectures  each 
course. 


MEDICAL  MATTEES  IN  PAELIAMENT. 

House  of  Commons — Thursday,  July  12. 

Contagious  Diseases  among  Soldiers. — The  Marquis  of 
Hartington,  in  reply  to  Captain  Price,  said  that  the  preva¬ 
lence  of  these  diseases  among  the  troops  in  the  districts  pro¬ 
tected  by  the  Contagious  Diseases  Acts  had  risen  from  11-89 
per  1000  in  the  four  weeks  prior  to  the  abolition  of  com¬ 
pulsory  examination  of  women,  to  17'40  per  1000  in  the  four 
weeks  since  the  abolition. 

The  Cholera  in  Egypt. — In  reply  to  Viscount  Folkestone, 
Lord  Edward  Fitzmaurice  stated  that  Her  Majesty’s  Go¬ 
vernment  had  made  offers  of  assistance  to  the  Egyptian 
Government  with  respect  to  the  outbreak  of  cholera,  but 
that  the  Egyptian  Government  had  courteously  intimated 
that  they  could  manage  matters  very  well  themselves.  But 
our  Government  intended,  nevertheless,  to  renew  their 
offer,  and  they  had  determined  on  sending  out,  without 
delay,  a  medical  officer  of  the  rank  of  surgeon-general,  who 
would  report  on  the  character  of  the  disease  and  on  all 
material  circumstances  to  the  Local  Government  Board, 
and  to  the  Parliamentary  Committee  on  Cholera  pre¬ 
sided  over  by  the  President  of  the  Board.  He  would 
also  support  Sir  E.  Malet  as  regards  the  proper  measures  to 
be  taken  in  the  present  grave  circumstances;  and  SirE. 
Malet  would  be  instructed  to  inform  Cherif  Pasha  that  the 
Surgeon-General’s  services  would  be  at  the  disposal  of  the 
Egyptian  Government. — In  reply  to  Sir  W.  Barttelot,  the 
Marquis  of  Hartington  stated  that  the  general  officer  com¬ 
manding  our  troops  in  Egypt  had  telegraphed  that  there 
was  not  any  sickness  among  the  troops  at  Alexandria  and 
Ramleh  to  cause  alarm,  but  that  much  fever  must  be  ex¬ 
pected  at  Alexandria  at  this  season ;  that  no  danger  was  to 
be  apprehended  from  the  state  of  the  slaughter-houses, 
which  are  two  miles  to  the  leeward  of  Ramleh. 

Friday,  July  13. 

The  Cholera  in  Egypt. — Lord  E.  Fitzmaurice  stated  that, 
acting  on  the  advice  of  Sir  Joseph  Fayrer,  Her  Majesty’s 
Government  had  been  able  to  obtain  the  services  of  Surgeon- 
General  William  Hunter,  Fellow  of  the  Royal  College  of  Phy¬ 
sicians  of  London,  and  Honorary  Surgeon  to  Her  Majesty.  He 
had  been  in  the  Indian  Medical  Service,  Bombay  Presidency, 
but  had  now  retired  The  Government  had  been  fortunate 
in  securing  the  advice  and  assistance  of  a  medical  officer 
of  his  knowledge  and  experience.  The  latest  telegram  from 
Alexandria,  dated  July  12,  Lord  E.  Fitzmaurice  said,  stated 
that  the  number  of  deaths  from  cholera  at  Damietta  was 
forty,  at  Mansourah  seventy-three,  at  Samanoud  eleven, 
and  at  Tantah  three.  There  had  been  no  account  of  any 
deaths  at  the  other  places.  Two  telegrams  had  been 
received  from  Sir  E.  Malet  with  regard  to  theories  and 
reports  about  the  state  of  things  in  Egypt.  The  first 
telegram,  dated  Cairo,  July  11,  gave  the  following  informa¬ 
tion  from  our  Consular  agent  at  Damietta  with  reference 
to  the  alleged  importation  of  cholera  from  Bombay  by 
Muhammed  Halifa:—  Muhammed  Halifa,  for  some  years  an 
inhabitant  of  Port  Said,  shipped  as  fireman  on  board  the 
steamer  Timor,  made  the  voyage  to  Bombay,  returning  18th 
ult.,  all  on  board  in  perfect  health.  Obtained  discharge  at 
Port  Said,  and  commenced  course  of  drunkenness  and  excess. 
This  continued  four  days,  when  he  was  imprisoned  by  the 
Governor  of  Port  Said,  and  finally  exiled  by  that  official  on 
the  23rd  ult. ;  arrived  at  Damietta  on  the  24th,  when  he 
recommenced  the  same  course  of  excess,  and  was  imprisoned 
on  the  25th.  He  is  now  at  liberty,  and  in  perfect 
health.  The  cholera  broke  out  at  Damietta  on  the  22nd. 
With  regard  to  the  state  of  things  at  Mansourah,  Sir  E. 
Malet  telegraphs  : — “  President  of  the  Board  of  Health 
informs  me  that  the  Governor  of  that  place  has  not  resigned ; 
that  he  declares  there  to  be  sufficient  food,  and  that  he  had 
punished  vendors  who  had  taken  advantage  of  the  circum¬ 
stances  to  sell  food  at  advanced  rates.  Orders  had  been 
given  by  the  Minister  of  the  Interior  and  General  Baker  to 


Medical  Times  and  Gazette. 


MEDICAL  MATTERS  IN  PARLIAMENT. 


July  21, 1883. 


74 


facilitate  the  entrance  of  doctors,  provisions,  and  medicines 
to  all  places  affected.  The  President  adds,  that  when  pas¬ 
senger  traffic  was  interrupted  with  affected  places  a  special 
service  was  organised  by  the  railway  administration  for 
Government  use. 

St.  Pancras  Workhouse. — Mr.  G.  Russell,  in  reply  to  Mr. 
Hopwood,  said :  The  Local  Government  Board  have  com¬ 
municated  with  Dr.  Dunlop,  the  Resident  Medical  Officer 
of  the  St.  Pancras  workhouse,  and  he  acknowledges  that  at 
a  recent  inquest  he  did  state  that  sometimes  in  winter  the 
inmates  of  the  workhouse  numbered  nearly  2000,  that  he 
had  to  see  every  person  admitted  into  the  receiving  wards, 
and  that  he  was  medically  responsible  for  about  1000 
inmates,  viz.,  those  in  the  sick,  infirm,  insane,  lying-in,  and 
nursery  wards,  which  wards,  with  the  exception  of  the 
lying-in  wards,  he  visited  daily.  He  stated  that  he  had 
vaccinated  1500  mothers  at  early  periods  after  confinement; 
the  usual  time  having  been  from  the  seventh  to  the  four¬ 
teenth  day  after.  As  to  the  amount  of  Dr.  Dunlop’s  work, 
the  severe  cases  of  sickness  are  taken  into  the  infirmary  at 
Highgate, — not  into  the  workhouse.  And  although  there 
may  be  1000  inmates  in  the  workhouse  wards,  only  com¬ 
paratively  a  small  proportion  of  the  number  require  to  be 
seen  by  Dr.  Dunlop  each  day.  The  duties  of  the  Medical 
Officer  are,  no  doubt,  arduous ;  but,  having  regard  to 
the  number  and  character  of  the  cases  visited  by  him, 
the  Board  at  present  possess  no  evidence  that  those 
duties  are  not  performed  with  sufficient  care.  As  to  the 
vaccination  of  women  within  a  few  hours  after  delivery,  he 
had  stated  to  the  House  a  month  ago  that  the  Board  would 
be  glad  to  see  the  risk  of  vaccination  dissociated,  as  far  as 
possible,  from  the  necessary  risk  of  delivery. 

Monday,  July  16. 

The  Indian  Medical  Service. — Sir  Trevor  Lawrence  asked 
the  Under  Secretary  of  State  for  India  whether  the  re¬ 
sult  of  the  reorganisation  of  the  Indian  Medical  Service 
was  not  to  the  medical  officers  senior  to  the  Sanitary 
Commissioners  a  loss  of  at  least  two  administrative  ap¬ 
pointments  in  Bengal  alone;  whether  the  block  of  pro¬ 
motion  in  the  Bengal  Medical  Service  was  largely  due 
to  the  deferred  promotion  of  the  senior  officers,  consequent 
on  this  reduction  in  the  number  of  administrative  appoint¬ 
ments  available;  whether  Section  56  of  21  and  22  Vie., 
cap.  106,  did  not  secure  to  all  branches  of  Her  Majesty’s 
Indian  Army  all  advantages  as  to  promotion  and  otherwise 
to  which  they  were  severally  entitled  at  the  time  it  was 
passed ;  and  whether  each  presidency  had  its  own  separate 
medical  list,  wherein  and  whereby  promotions  were  regu¬ 
lated  ? — Mr.  J.  K.  Cross,  in  reply,  said  :  Each  presidency  has 
its  own  separate  medical  list.  The  result  of  the  reorganisa¬ 
tion  of  the  Service,  to  the  medical  officers  senior  to  the 
Sanitary  Commissioners,  is  an  immediate  loss  of  two  ad¬ 
ministrative  appointments  in  Bengal.  But  to  the  Bengal 
Department,  taken  as  a  whole,  there  is  a  gain  of  one  ad¬ 
ministrative  appointment,  by  the  substitution  for  eleven 
deputy  surgeons-general  of  nine  deputy  surgeons-general 
and  three  Sanitary  Commissioners  who  rank  as  deputy 
surgeons-general  after  twenty-six  years’  service.  The  fact 
that,  when  the  change  was  carried  out,  two  of  the  Sanitary 
Commissioners  were  comparatively  junior  men  has  un¬ 
doubtedly  retarded  the  possible  selection  of  a  few  officers 
senior  to  them.  But  there  is  no  block  of  promotion.  The 
Act  of  Parliament  referred  to  did  not  provide  against  a 
change  in  the  number  of  deputy  surgeons-general ;  and  no 
alteration  has  been  made  in  the  system  of  selection  for  that 
grade. 

House  of  Lords — Monday,  July  16. 

Overwork  in  Elementary  Schools. —  Lord  Stanley  of 
Alderley  called  the  attention  of  the  House  to  the  increase  of 
insanity,  and  asked  the  Lord  President  if  the  Education 
Office  had  inquired  into  the  effects  of  overwork  in  elementary 
schools,  alleged  to  have  occurred  by  various  letters  in  the 
daily  press.  He  asserted  that  the  Lunacy  Commissioners 
had  now  admitted  that  lunacy  had  increased.  He  said  that 
this  increase  must  be  principally  attributed  to  intemper¬ 
ance  ;  but  it  was  nothing  as  compared  with  the  increase  of 
brain  disease  which  might  shortly  be  expected,  unless  the 
warnings  given  by  some  of  the  highest  authorities  in  the 
medical  profession  were  to  be  disregarded.  He  quoted  state¬ 
ments  made  by  Dr.  Hack  Tuke,  Dr.  Andrew  Clark,  Dr. 
Crichton  Browne,  and  other  authorities,  speaking  of  the  in¬ 


jurious  effects  of  overwork  on  children  ;  and  spoke  atlengtk 
of  the  evil  results  in  children  and  teachers  of  the  in¬ 
creased  severity  of  the  requirements  of  the  Revised  Code, 
of  overwork,  and  of  overtime  work  in  learning  and  in 
teaching. — Lord  Carlingford  said  that,  with  regard  to  thu 
alleged  increase  of  insanity,  he  was  unable  to  give  any 
information,  and  must  leave  that  question  to  be  dealt 
with  by  the  Home  Office,  for  it  was  not  part  of  the  duty 
of  the  Education  Department  to  deal  with  insanity.  The- 
Education  Department  were,  however,  making  very  careful 
inquiries  into  the  truth  of  the  statement  made  as  to  over¬ 
work  in  elementary  schools.  They  had  also  consulted  the 
most  experienced  of  their  inspectors  on  the  subject ;  not 
only  the  most  experienced,  but  those  who  had  the  greatest 
sympathy  with  children,  and  who  would,  therefore,  not  be 
likely  to  sanction  any  regulation  from  the  Education  De¬ 
partment  which  might  result  in  causing  overwork.  The 
result  had  been,  that  while  there  were  here  and  there  cases 
of  overwork  on  the  part  of  children  and  pupil  teachers  who 
were  anxious  to  distinguish  themselves,  upon  the  whole 
there  was  very  little  ground  for  the  wide  and  highly 
coloured  statements  that  had  appeared  in  some  of  the  news¬ 
papers.  The  Code  could  not,  however,  be  the  cause  of  the 
overwork,  if  there  were  any.  The  requirements  of  the  Code 
had  been  relaxed  and  made  less  severe  than  formerly,  and  eases 
of  overwork  were  due  to  overzeal  on  the  part  of  the  managers 
of  schools.  There  was  no  reason  why  school  managers 
should  go  beyond  their  powers.  Any  school  might  earn  a 
very  fair  grant  by  confining  itself  to  the  ordinary  subjects 
of  instruction.  It  was  a  mistake  to  suppose  that  the  Depart¬ 
ment  intended  to  lay  down  any  compulsory  rules  as  to- 
lessons  to  be  learnt  at  home.  They  had  not  done  anything; 
to  stimulate  the  practice  of  enforcing  such  lessons  :  in  many 
cases  they  were,  in  the  opinion  of  the  inspectors  and  the 
best  teachers,  extremely  useful  and  desirable;  but  they 
were  by  no  means  desirable  in  all  cases.  He  assured  his 
noble  friend  that  the  Department  would  impress  on  the- 
managers  of  schools  the  absolute  necessity  of  guarding 
against  overwork  on  the  part  of  children  and  of  pupil 
teachers. — The  Earl  of  Shaftesbury  said  that  the  increase- 
of  insanity  in  recent  times  had  not  exceeded  in  proportion 
the  increase  of  the  population.  If  the  figures  appeared 
larger  than  formerly,  it  was  due  to  the  numbers  of 
all  the  chronic  cases  being  gathered  throughout  the 
country  into  the  asylums  and  the  workhouses.  The  tem¬ 
perance  movement  was  beginning  to  produce  a  great 
effect  in  lessening  insanity.  But  if  Lord  Stanley  meant 
to  allude  only  to  a  special  kind  of  insanity  (that  pro¬ 
duced  by  the  overstraining  of  the  intellectual  powers, 
especially  among  those  just  rising  into  adult  life),  he  was 
right;  but  the  number  of  persons' by  that  means  afflicted 
was  not  large  enough  to  affect  the  statistical  tables  of  in¬ 
sanity  in  general,  and  this  matter  was  really  serious.  In 
1871  there  were,  according  to  the  census  of  that  year,  32,901 
males  and  94,239  females  employed  in  this  country  as 
teachers,  schoolmasters,  schoolmistresses,  governesses,  pro¬ 
fessors,  and  lecturers.  In  1882,  183  persons  belonging-  te 
the  teaching  class — 38  males  and  145  females — were  ad¬ 
mitted  into  the  asylums  of  England  and  Wales.  We  had 
not  as  yet  the  aggregate  number  of  that  class  existing  in 
1882,  but,  supposing  it  had  risen  to  200,000,  the  proportion  of 
lunatics  would  be  very  large ;  and  it  was  to  be  remembered 
that  there  were  much  larger  numbers  more  or  less  affected, 
but  falling  short  of  insanity.  This  state  of  things  was  well 
worthy  of  consideration  by  Her  Majesty’s  Government. 


Atropia  in  Earache. — The  Boston  Journal  of  Che¬ 
mistry  says  that  Dr.  A.  D.  Williams  orders  a  solution  of 
atropia  to  be  dropped  into  the  painful  ear,  allowing  it  to- 
remain  there  from  ten  to  fifteen  minutes.  It  is  then  made 
to  run  out  by  turning  the  head  over,  and  wiped  away  with  a. 
dry  rag.  From  three  to  five  drops  should  be  used  of  the  solu¬ 
tion,  which  may  be  warmed  to  prevent  shock.  Under  three 
years  old  it  should  consist  of  one  grain  to  the  ounce,  and 
over  ten  years  of  four  grains  to  the  ounce  of  water.  In 
adults  almost  any  strength  may  be  used ;  and  all  ages  will 
bear  stronger  solutions  in  the  ear  than  in  the  eye.  A  few 
applications  will  usually  stop  the  pain.  In  acute  suppura¬ 
tive  inflammation  of  the  middle  ear  and  acute  inflammation 
of  the  meatus,  atropia  will  only  slightly  palliate  the  suffer¬ 
ing  ;  but  in  the  recurring  nocturnal  earache  of  children  it 
is  practically  a  specific. — Phil.  Med.  Reporter,  May  5. 


Medical  Times  and  Gazette. 


FROM  ABROAD. 


July  21, 1883.  75 


FROM  ABROAD. 


The  Treatment  oe  Epilepsy. 

Prop.  Hammond,  in  a  clinical  lecture  on  epilepsy  (New 
York  Medical  Journal,  March  31),  thus  expresses  himself  on 
the  treatment  of  this  disease  : — 

“  This  child  has  never  taken  any  medicine.  It  is  not 
•often  that  we  meet  with  a  case  of  epilepsy  in  which  the 
bromides  have  not  been  tried,  and-  tried  very  properly. 
There  are  a  good  many  different  kinds  of  treatment,  which 
have  been  resorted  to  within  recent  years,  that  are  of  con¬ 
siderable  importance.  Whenever  a  patient  has  an  aura,  as 
this  child  has,  you  may  do  a  great  deal  of  good  by  giving 
something  which  will  prevent  the  development  of  the 
paroxysm.  It  is  a  remarkable  fact  that  epileptic  fits  may 
be  kept  up  by  the  force  of  habit,  even  after  the  original 
cause  has  been  removed.  Eor  instance,  a  child  may  swallow 
an  apple-core,  and  that  night  have  an  epileptic  fit.  Now, 
although  you  may  get  rid  of  the  core  by  purgatives,  another 
fit  may  occur  within  a  short  time,  merely  from  the  force  of 
habit,  which  has  been  so  readily  established.  I  know  of  no 
other  disease  that  becomes  habitual  so  readily  as  epilepsy. 
Hence  the  first  thing  to  be  done  in  all  cases  is  to  break  up  the 
habit.  There  are  two  important  ways  of  doing  this  :  First, 
when  the  patient  feels  an  aura,  if  three  or  four  drops  of  the 
nitrite  of  amyl  be  put  upon  a  handkerchief  and  inhaled,  the 
paroxysm  will  almost  certainly  be  aborted.  I  have  cured 
several  cases  of  epilepsy  by  that  method  alone,  without  any 
internal  remedy.  The  drug  should  be  put  to  the  mouth  so 
that  it  may  be  thoroughly  inhaled.  When  so  inhaled  it 
produces  a  sensation  of  fulness  of  the  head,  tingling  of 
the  surface  of  the  body,  and  redness  of  the  face.  Nitro¬ 
glycerine  or  glonoin  may  be  used  for  the  same  purpose ;  it 
takes  a  longer  time  to  act,  but  its  effect  is  more  permanent. 
The  strength  required  is  one  drop  of  glonoin  to  one  hundred 
of  alcohol,  and  it  may  be  administered  in  pill  form,  the  best 
preparation  being  that  of  Metcalf,  of  Boston .  Two  drops  of 
the  one-per-hundred  solution  may  be  given  to  an  adult,  or  it 
may  be  given  on  a  little  sugar.  It  is  also  one  of  the  remedies 
used  for  the  permanent  treatment  of  the  disease.  In  epi¬ 
lepsy  there  is  at  first  a  general  anaemia  of  the  brain ;  and  so 
long  as  this  organ  is  in  a  hypersemic  condition  it  is  impossible 
for  a  paroxysm  to  occur.  It  is  on  the  principle  of  producing 
this  hyper  acinic  condition  that  the  nitrite  of  amyl  and  nitro¬ 
glycerine  abort  the  epileptic  attack.  The  same  result  may 
be  obtained  by  putting  an  elastic  band  around  the  neck,  pre¬ 
venting  free  venous  return,  and  causing  a  fulness  of  the  cere¬ 
bral  vessels.  I  know  of  two  cases  of  epilepsy  which  were  cured 
in  this  way.  In  another  case  the  patient  applied  the  band 
at  the  time  she  felt  the  aura,  and  it  prevented  the  paroxysm. 
Afterwards  she  wore  it  constantly,  and  had  but  three  attacks 
within  four  months,  whereas  previously  she  had  been  having 
as  many  attacks  in  the  twenty-four  hours. 

For  a  permanent  cure  of  a  case  like  the  present  one,  I 
think  it  is  always  best  to  begin  with  the  bromides  in  some 
form  or  other.  There  is  no  use  in  trying  the  old  remedies — 
such  as  the  nitrate  of  silver,  or  the  salts  of  copper  or  zinc, 
etc.  Some  of  the  salts  of  zinc  are,  however,  sometimes 
beneficial;  but  they  are  more  efficient  in  conjunction  with 
the  bromides  than  when  administered  alone.  But,  in  gene¬ 
ral,  to  use  those  old  remedies  will  be  to  throw  precious 
time  away,  for  they  will  not  reduce  the  frequency  of  the 
paroxysms  oftener  than  in  one  case  in  one  or  two  hundred, 
whereas  the  bromides  will  do  so  almost  invariably,  and  if  the 
•case  be  not  an  old  one  they  may  effect  a  permanent  cure.  I 
usually  begin  treatment  in  an  adult  with  a  mixture  consist¬ 
ing  of  four  ounces  of  bromide  of  sodium  to  a  pint  of  water,  a 
teaspoonful  (which  contains  fifteen  grains  of  the  bromide)  to 
be  taken  three  times  daily.  The  efficacy  of  the  solution  will 
be  increased  by  adding  half  an  ounce  of  the  iodide  of  potas¬ 
sium.  It  will  take  several  days  for  the  drug  to  produce  any 
effect,  for  it  acts  slowly.  When  a  physician  tells  me  that 
he  has  induced  sleep  in  a  patient  by  a  single  ordinary  dose, 
I  do  not  believe  it,  for  it  requires  more  than  one  dose  of 
fifteen  grains  several  times  daily,  given  from  two  to  four 
days,  to  produce  any  decided  effect.  Perhaps  a  single 
■dose  of  one  hundred  grains  would  put  the  patient  to  sleep, 
but  it  is  not  usually  administered  in  such  large  quantities. 
A  teaspoonful  of  the  mixture  should  be  given  diluted  with 


water,  for  the  effect  of  these  salts  is  greatly  increased  when 
they  are  largely  diluted  with  water.  I  increase  the  dose 
one-fourth  every  three  months  for  a  year,  and  continue  it  at 
that  for  another  year.  It  is  then  reduced  in  the  same 
manner,  and  during  the  fourth  year  the  patient  takes 
fifteen  grains  of  the  bromide  three  times  a  day.  If  the 
quantity  is  not  increased  during  the  first  year,  the  attacks 
will  probably  recur,  and  you  will  then  find  it  very  difficult 
indeed  to  check  them.  I  used  to  teach  that  it  was  not 
necessary  to  give  the  bromide  longer  than  two  years,  but  I 
found  afterwards  that  in  a  few  cases  there  was  a  relapse, 
and  it  is  safer,  therefore,  to  continue  the  treatment  for  four 
years.  Indeed,  if  I  were  the  subject  of  epilepsy  myself,  I 
should  continue  to  take  the  bromide  all  my  life,  thus  avoid¬ 
ing  the  probability  of  the  recurrence  of  the  paroxysms.  If, 
after  a  time,  the  bromide  does  not  produce  as  marked  results 
as  are  desired,  I  would  advise  you  to  stop  for  a  month  or 
longer,  until  the  system  has  had  time  to  become  perfectly 
free  from  the  drug,  and  then  begin  the  treatment  anew.  In 
the  meantime,  something  should  be  given  to  quiet  nervous 
irritability,  such  as  cod-liver  oil  and  tonics.  The  patient 
must,  however,  remember  this  fact,  that  unless  a  certain 
degree  of  bromism  is  produced  the  disease  cannot  be  cured. 
The  bromide  treatment  is  not  altogether  unattended  with 
danger.  I  have  lost  three  cases  from  it.  In  one  case 
the  patient  wrote  to  me,  complaining  of  the  ill  effects  of 
the  drug.  Patients,  however,  are  likely  to  magnify  their 
troubles,  and  I  replied  that  she  had  better  see  her  local 
physician,  and  follow  his  advice.  She  did  so,  but  he  did 
not  like  to  take  the  responsibility  of  stopping  the  treat¬ 
ment.  It  was  continued,  and  she  died  soon  afterwards  from 
bromism.  In  another  case,  that  of  a  young  lady,  pneumonia 
supervened  on  bromide-poisoning,  and  caused  death.  I  have 
observed  that  bromism  predisposes  to  lung-trouble.  In  a 
third  case,  a  young  lady  exposed  herself,  took  pneumonia, 
and  died.  If,  however,  your  cases  are  under  your  own  im¬ 
mediate  supervision,  you  can  watch  them,  and  when  the 
effects  of  the  drug  are  becoming  too  marked,  decrease  the 
dose,  and  it  will  not  he  likely  to  produce  any  serious  results. 
It  is  necessary  to  affect  the  constitution  pretty  strongly,  else 
a  cure  cannot  be  obtained.  Weakness  (short  of  ability  to 
stand  up),  and  an  acne  eruption  on  the  face  and  chest,  are 
not  contra-indications  to  a  continuance  of  treatment.  But  I 
have  had  to  stop  the  bromide  frequently  on  account  of  indo¬ 
lent  ulcers  which  it  had  produced.  These  can  usually  be 
easily  cured  by  galvanism.  Another  useful  measure  in  the 
treatment  of  epilepsy  is  counter-irritation  applied  to  the 
back  of  the  neck  by  the  platinum  disc  or  other  instrument 
heated  to  a  white  heat.  It  is  necessary  only  just  to  touch 
the  skin,  and  then  remove  the  cautery  immediately.  The 
pain  produced  is  so  slight  that  the  patient  scarcely  feels  it. 
I  have  known  the  number  of  paroxysms  to  be  reduced  after 
a  single  application  of  the  cautery/’ 


Infantile  Leucorrhcea. — In  a  clinical  lecture,  Dr. 
Gaillard  Thomas  observes  (Phil.  Med.  Reporter,  March  31) 
that  this  should  properly  be  called  vaginitis,  characterised 
as  it  is  by  the  intense  redness  of  the  mucous  membrane 
and  the  copious  purulent  discharge.  It  may  be  due  to 
deficient  hygienic  precautions  in  ablution,  to  a  deteriorated 
state  of  the  child’s  health,  or  to  the  presence  of  ascarides  in 
the  rectum.  In  endeavouring  to  improve  the  child’s  health, 
vegetable  tonics  and  the  hypophosphates  may  be  resorted 
to,  but  most  reliance  is  to  be  placed  in  nutritious  diet.  The 
vagina  should  be  well  washed  out  with  a  syringe  provided 
with  a  small  nozzle,  which  should  be  well  oiled ;  and  in  some 
cases  the  thorough  washing  out  of  the  vagina,  with  the 
child  on  its  back,  will  effect  a  cure ;  but  when  the  affection 
has  lasted  some  time,  one  of  the  best  applications  is  black- 
wash  in  the  proportion  of  one  ounce  to  a  pint  of  water,  used 
twice  a  day,  the  vagina  being  injected  with  warm  water 
before  using  the  wash.  This  never  fails,  and  prevents  the 
necessity  of  resorting  to  astringents  and  nitrate  of  silver, 
which  may  do  harm.  A  much  longer  time  is  often  occupied 
in  treating  these  cases  than  is  necessary,  by  omitting  to 
show  the  mother  or  nurse  howto  introduce  the  nozzle  of  the 
syringe  properly.  Unless  taught,  they  never  carry  this 
higher  than  the  eighth  of  an  inch,  and  the  injections  fail  to 
reach  the  diseased  parts.  We  should  watch  the  mother 
using  the  syringe,  and  see  that  the  upper  part  of  the  vagina 
is  reached. 


76 


Medical  Times  and  Gazette. 


CLINICAL  CHARACTEKS  OF  “  WOOLSORTERS’  DISEASE.” 


July  21,  1883- 


MEMORANDUM  ON  THE 

CLINICAL  CHARACTERS  OF  “WOOLSORTERS’ 
DISEASE”  (ANTHRAX). 


The  subjoined  memorandum  has  been  prepared  for  use  in 
an  inquiry  now  being  conducted  by  Mr.  Spear  on  behalf  of 
the  Local  Government  Board,  into  the  occurrence  of  anthrax 
amongst  men  employed  in  hide  warehouses,  tanneries,  etc. 
Mr.  Spear  wishes  it  to  be  known  that  gentlemen  who  have 
had  opportunities  of  observing  the  disease  will  be  conferring 
a  useful  service  by  communicating  with  the  inspector. 

The  “  Internal  Form”  of  the  Infection,  or  Anthrax  Fever. — 
Premonitory  symptoms  (of  variable  duration)  :  Chilliness, 
aching  or  stiffness  of  limbs,  and  mental  depression ;  rest¬ 
lessness,  sense  of  constriction  of  chest,  and  oppression  of 
breathing ;  headache,  dizziness,  nausea,  or,  less  frequently, 
vomiting.  Stage  of  full  development :  Notwithstanding  the 
indefinite  premonitory  symptoms,  the  stage  of  full  develop¬ 
ment  is  generally  somewhat  sudden  and  unexpected  in  its 
onset,  so  as  to  cause  much  alarm'.  The  prostration  and  rest¬ 
lessness  become  extreme ;  there  are  prsecordial  anxiety  and 
dyspnoea  ;  blueness  of  the  face  and  extremities  (cyanosis)  is 
conspicuous  ;  and  the  patient  may  die  within  twenty- four  or 
thirty-six  hours  with  all  the  appearances  of  collapse  or  of 
asphyxia.  A  fatal  termination  is,  however,  more  often 
postponed  until  from  two  to  five  days  after  the  commence¬ 
ment  of  this  stage.  Other  nervous  phenomena — muscular 
paralyses,  convulsions,  or  tetanic  spasms— are  then  apt  to 
develope  themselves  ;  and  evidences  of  various  acute  local 
congestions  (especially  of  the  lungs,  less  frequently  of  the 
gastrointestinal  tract)  are  rarely  wanting.  Delirium  is 
often  absent ;  and  the  temperature  is  irregular.  Exacerba¬ 
tions,  alternating  with  more  or  less  complete  remissions,  of 
the  more  urgent  symptoms  constitute  usually  a  striking 
feature  of  the  disease.  Recovery  is  not  so  rare  as  has  been 
supposed,  even  in  fully  developed  attacks  ;  but  death  may 
occur  from  a  relapse,  or  from  secondary  septic  processes. 
The  body  after  death  usually  undergoes  rapid  decomposition, 
with  blue  discolouration  and  swelling,  especially  about  the 
neck. 

[Before  the  disease  was  identified  amongst  the  woolsorters, 
deaths  were  usually  referred  to  one  of  the  more  prominent 
local  symptoms  of  anthrax,  and  were  registered  as  from 
“  pneumonia,”  "  enteritis,”  “  peritonitis,”  “  meningitis.”] 

The  “External  Form ”  of  the  Infection,  or  Malignant  Pus¬ 
tule. — The  malignant  pustule  attacks  almost  always  parts  of 
the  body  habitually  uncovered,  and  most  frequently  the 
face.  It  commences  as  a  small  papule,  which  quickly 
developes  into  a  vesicle,  and  this,  being  broken,  pours  out  a 
little  watery  exudation.  The  base  of  the  vesicle,  and  the 
surface  immediately  adjacent,  dies ;  so  that  in  about  three 
days  after  its  appearance  the  lesion  consists  of  a  small 
central  black  eschar,  with  a  raised  border  of  inflamed  and 
tumid  skin  upon  which  vesicles  are  apt  to  be  developed  ;  a 
crop  of  secondary  vesicles  surrounding  thus  the  central 
eschar  like  a  wreath.  The  neighbouring  lymphatics  and 
glands  are  speedily  implicated ;  and  the  patient  may  soon 
lapse  into  the  condition,  described  above,  of  constitutional 
infection.  The  pustule  does  not  apparently  always  present 
this  typical  appearance ;  when  occurring  upon  the  bands 
such  appearance  is  uncommon.  It  has  then  no  central  black 
eschar,  no  raised  vesiculated  border.  It  is  described  as  “  a 
Small,  slightly  inflamed  tumour,  exuding  only  serosity  ; 
giving  rise  to  comparatively  little  pain  or  even  increased 
sensibility,  but  showing  a  tendency  to  set  up  a  diffuse 
cellulitis.”  Constitutional  infection  may  follow. 


Dead-Drunk. — This  is  defined  by  the  savants  of  the 
Paris  Biological  Society  to  be  a  condition  in  which  there  is  a 
proportion  of  one  part  of  alcohol  to  195  parts  of  blood  in  the 
circulation.  Should  the  proportion  ever  come  to  one  part  of 
alcohol  to  100  of  blood,  death  would  ensue.  This  might 
happen,  and  in  fact  has  happened  repeatedly,  when  a  very 
large  quantity  of  alcoholic  liquor  is  swallowed  at  one  time 
and  quickly.  In  ordinary  drinking,  consciousness  is  lost, 
and  with  it  the  power  to  drink  more,  before  the  proportion 
of  alcohol  in  the  blood  becomes  fatal. — Phil.  Med.  Reporter, 
No.  13. 


ANNUAL  MEETING  OF  THE  BRITISH 
MEDICAL  ASSOCIATION. 


The  following  are  the  arrangements  for  the  Fifty-first 
Annual  Meeting  of  the  British  Medical  Association,  to  be 
held  at  Liverpool,  on  Tuesday,  Wednesday,  Thursday,  and 
Friday,  July  31,  August  1,  2,  and  3,  1883  : — 

President,  William  Strange,  M.D.,  Senior  Physician  to 
the  General  Infirmary,  Worcester. 

President-elect,  A.  T.  H.  Waters,  M.D.,  F.R.C.P.,  Senior 
Physician  to  the  Royal  Infirmary,  and  Professor  of 
Medicine  in  University  College,  Liverpool. 

An  Address  in  Surgery  will  be  delivered  by  Reginald* 
Harrison,  F.R.C.S.,  Surgeon  to  the  Royal  Infirmary* 
Liverpool. 

An  Address  in  Pathology  will  be  delivered  by  C. 
Creighton,  M.D.,  formerly  Demonstrator  of  Anatomy* 
University  of  Cambridge. 

The  business  of  the  Annual  Meeting  will  be  conducted  in 
Ten  Sections,  viz. :  — 

Section  A.  Medicine. — President,  John  Cameron,  M.D. 
Vice-Presidents,  Thomas  R.  Glynn,  M.D.  ;  Frederick 
T.  Roberts,  M.D.  Secretaries,  Richard  Caton,  M.D.* 
18a,  Abercromby-square,  Liverpool;  Byrom  B  ram  well, 
M.D.,  23,  Drumsheugh-gardens,  Edinburgh. 

Section  B.  Surgery. — President,  Edward  R.  Bickersteth, 
F.R.C.S.  Vice-Presidents,  W.  Hargreaves  Manifold, 
M.R.C.S.  ;  W.  Mitchell  Banks,  F.R.C.S.  Secretaries , 
Rushton  Parker,  M.B.,  F.R.C.S.,  61,  Rodney-street,  Liver¬ 
pool;  Edmund  Owen,  M.B.,  F.R.C.S.,  49,  Seymour-street 
Portman-square,  W. 

Section  C.  Obstetric  Medicine. — President,  W.  M.  Graily 
Hewitt,  M.D.  Vice-Presidents,  John  Wallace,  M.D.  ; 
David  Lloyd  Roberts,  M.D.  Secretaries,  John  E.  Burton, 

L. R.C.P.,  64,  Rodney-street,  Liverpool;  W.  C.  Grigg, 

M. D.,  6,  Curzon-street,  Mayfair,  W. 

Section  D.  Public  Medicine. — President,  T.  P.  Teale, 
M.B.,  F.R.C.S.  Vice-Presidents,  William  Carter,  M.D.  ; 
W.  Honner  Fitz-Pa trick,  M.D.  Secretaries,  F.  Pollard, 
M.D.,  52,  Rodney-street,  Liverpool;  George  Goldie,  M.D.* 
123,  Hyde  Park-road,  Leeds. 

Section  E.  Anatomy  and  Physiology. — President,  Pro¬ 
fessor  E.  A.  Schafer,  F.R.S.  Vice-Presidents,  William 
Stirling,  M.D. ;  Richard  Norris,  M.D.  Secretaries,  James. 
Barr,  M.D.,  1,  St.  Domingo-grove,  Everton,  Liverpool;* 
A.  W.  Mayo  Robson,  F.R.C.S.,  Hillary-place,  Leeds. 
Section  F.  Pathology. — President,  T.  H.  Green,  M.D. 
Vice-Presidents,  E.  H.  Dickinson,  M.D. ;  Joseph  Coats, 
M.D.  Secretaries,  Frank  Thomas  Paul,  F.R.C.S.,  44* 
Rodney-street,  Liverpool  ;  James  F.  Goodharfc,  M.D., 
27,  Weymouth-street,  W. 

Section  G.  Psychology. — President,  T.  L.  Rogers,  M.D-.. 
Vice-Presidents,  G.  H.  Savage,  M.D.;  D.  Yellowlees,  M.D. 
Secretaries,  G.  Shuttleworth,  M.D.,  Royal  Albert  Asylum, 
Lancaster;  W.  Julius  Mickle,  M.D.,  Grove  Hall  Asylum*. 
Bow,  E. 

Section  H.  Ophthalmology. — President,  Thos.  Shadford 
Walker,  M.R.C.S.  Vice-Presidents,  E.Nettleship, F.R.C.S.* 
C.  E.  Fitzgerald,  M.D.  Secretaries,  E.  A.  Browne* 
F.R.C.S.,  86,  Bedford-street,  Liverpool;  C.  E.  Glascott, 
M.D.,  23,  St.  John-street,  Manchester. 

Section  I.  Diseases  oe  Children. — President,  Samuel  Jones 
Gee,  M.D.  Vice-Presidents,  M.  G.  B.  Oxley,  M.D.;  T.  R. 
Jessop,  F.R.C.S.  Secretaries,  H.  G.  Rawdon,  M.D.,  42; 
Rodney-street,  Liverpool;  H.  Ashby,  M.D.,  13,  St.  John- 
street,  Manchester. 

Section  J.  Otology. — President,  G.  P.  Field,  M.R.C.S. 
Vice-Presidents,  Edward  Woake3,  M.D.;  C.  Warden,  M.D. 
Secretaries,  Thos.  Barr,  M.D.,  10,  Albany-place,  Sauchie- 
hall-street,  Glasgow;  R.  Williams,  L.R.C.P.,  82,  Rodney- 
street,  Liverpool. 

Honorary  Local  Secretary,  Alexander  Davidson,  M.D.,  2, 
Gambier-terrace,  Liverpool. 

Honorary  Treasurer ,  W.  Mitchell  Banks,  F.R.C.S.,  28*  Rod¬ 
ney-street,  Liverpool. 


Medical  Times  and  Gazette. 


THE  BRITISH  MEDICAL  ASSOCIATION, 


July  21, 1883.  77 


Tuesday,  July  31,  1883. 

10.30  a. m.— Church  Service  at  Pro-Cathedral :  Sermon  by  Bishop  of 

Liverpool. 

12.0. — Meeting  of  Committee  of  Council. 

12.30  p  m. — Meeting  of  the  Council,  1882-83. 

3  p.m.— First  General  Meeting :  Report  of  Council  and  other 
business.  Adjourn  at  5  p.m. 

8.15  p.m.— Adjourned  General  Meeting:  President’s  Address,  and 
any  business  adjourned  from  meeting  at  3  o’clock. 

Wednesday,  August  1,  1683. 

9.30  a.m.— Meeting  of  Council,  1883-84. 

11  a.m. — Second  General  Meeting  :  Address  in  Surgery. 

1.30  to  5  p.m.— Sectional  Meetings. 

8.30  p.m.— Soiree  in  the  suite  of  rooms  forming  the  Arts  Gallery,  the 

Picton  Reading  Room,  and  the  Free  Library,  by  the 
President  and  Local  Committee.  ( To  this  ladies  will  be 
invited.) 

Thursday,  August  2,  1883. 

9  a.m. — Meeting  of  Committee  of  Council. 

10  a.m.— Third  General  Meeting  :  Sectional  Meetings.  Adjourn 
at  1  p.m. 

2  to  5  p.m. — Sectional  Meetings. 

6.30  p.m, — Public  Dinner  in  the  Philharmonic  Hall. 

Friday,  August  3,  1883. 

10  a.m.— Fourth  General  Meeting:  Address  in  Pathology.  Sec¬ 
tional  Meetings. 

2  p.m.— Concluding  General  Meeting. 

8.30  p.m. — Soiree  by  the  Mayor  of  Liverpool,  at  the  Town  Hall.  (To 

this  ladies  will  be  invited.) 

Saturday,  August  4,  1883. 

Excursions. 

Annual  Museum. 

The  Museum  will  he  in  the  same  building  as  the  recep¬ 
tion-room,  the  general  meetings,  and  the  sectional  meetings. 
In  fact,  all  the  business  of  the  annual  meeting  will  be 
carried  on  in  one  building,  viz. — the  College,  Shaw-street, 
Liverpool.  The  room  which  is  specially  devoted  to  Museum 
purposes  is  a  gallery,  300  feet  in  length,  in  the  upper  storey, 
lighted  from  the  roof.  On  the  same  floor  are  several  addi¬ 
tional  rooms,  so  that  the  accommodation  for  exhibiting 
drugs  and  instruments  is  ample.  On  the  second  floor, 
adjoining  the  room  where  the  Pathological  Section  meets, 
are  two  class-rooms,  one  of  which  will  be  used  for  the 
exhibition  of  pathological  drawings  and  specimens,  the 
latter  for  microscopes.  A  large  hall  on  the  ground  floor 
has  been  set  apart  for  sanitary  appliances,  among  which  it 
is  expected  there  will  be  a  good  exhibition  of  ambulances. 

The  Museum  will  comprise — 1.  Latest  inventions  in 
medical  and  surgical  instruments,  and  appliances  of  all 
kinds,  including  No.  4.  2.  New  chemicals  and  apparatus  ; 

new  drugs  and  their  preparations  ;  and  new  articles  of  diet 
for  invalids.  3.  Drawings,  diagrams,  or  models,  or  appa¬ 
ratus  connected  with  sanitary  appliances.  4.  Microscopes, 
thermometers,  and  other  instruments  of  investigation.  5. 
Pathological  specimens,  etc. 

Dinner. 

The  annual  dinner  will  be  held  as  a  banquet  in  the  Phil¬ 
harmonic  Hall  on  Thursday,  August  2,  at  6.30  p.m.  The 
number  of  tickets  is  limited  to  500,  and  none  will  be  sold 
after  Wednesday  night,  August  1.  Application  must  be 
sent  to  Dr.  Dickinson,  162,  Bedford-street,  Liverpool  (secre¬ 
tary  to  Dinner  Committee),  accompanied  by  a  remittance 
of  21s. 


The  following  papers,  etc.,  have  been  promised  in  the 
various  Sections. 

Section  A. — Medicine. 

1 .  A  discussion  on  Aphasia  will  be  opened  by  Professor 
Gairdner,  of  Glasgow.  Dr.  Hughlings-Jackson,  Dr.  Broad- 
bent,  Dr.  Ferrier,  Dr.  Antoine  Cros  (Paris),  Dr.  Thudichum, 
Dr.  W.  W.  Ireland,  Dr.  Drummond,  Dr.  Boss,  Dr.  G.  A. 
Woods,  Dr.  A.  Cameron,  and  Dr.  Wahltuch,  are  expected 
to  take  part  in  it. 

2.  A  discussion  on  the  Causes  and  Consequences  of 
Abnormal  Tension  in  the  Arteries  will  be  opened  by  Dr. 
Broadbent.  Dr.  Milner  Fothergill,  Dr.  B.  Foster,  Dr.  W.  F. 
Wade,  Dr.  Mahomed,  Dr.  Glynn,  Dr.  Eddison,  and  Dr. 
Carter,  are  expected  to  take  part. 

3.  A  discussion  on  the  Nature  of  Purpura  will  be  opened 
by  Dr.  Stephen  Mackenzie.  Dr.  Finny  (Dublin),  Dr.  B. 
Foster,  Dr.  McCall  Anderson,  Dr.  Stainthorpe,  Dr.  W. 
Bussell,  and  Mr.  Cauty,  will  take  part. 

The  following  papers  are  also  promised  : — 

Atkins,  R.,  M.D.  Hysterical  Hemiansesthesia. 

Bennett,  A.  Hughes,  M.D.  1.  Spastic  Paralysis.  2.  Hysterical  Malingering. 
Bramwell,  Byrom,  M.D.  Note  on  the  Mechanism  of  Cheyne-Stokes 
Respiration. 


Brunton,  T.  Lauder,  M.D.,  F.R.S.  Headache. 

Carter,  William,  M.D. 

Caton,  Bichard,  M.D.  On  Brain  Tumours. 

Cauty,  H.  E.,  Esq.  On  Roseola. 

Ceos,  A.,  M.D.  (Paris).  1.  Sur  la  PleximStrie.  2.  La  Theorie  Physiolo— 
gique  de  l’Hallucination. 

Davidson,  Alexander,  M.D. 

Drummond,  David,  M.D.  1.  Perforating  Tumour  of  the  Dura  Mater. 
2.  An  Unusual  Case  of  Locomotor  Ataxy. 

Drysdale,  C.R.,  M.D.  Recent  Innovations  in  the  Doctrine  of  Phthisis. 
Pulmonalis. 

Eddison,  J.  E.,  M.D.  1.  On  the  Cause  of  Cardiac  Murmurs  in  Anaemia. 
2.  A  Series  of  Forty  Consecutive  Cases  of  Empyema  treated  by  the- 
Physicians  of  the  Leeds  Infirmary  (Drs.  Allbutt,  Eddison,  and  Churton) . 

Finny,  J.  Magee,  M.D  A  Peculiar  and  hitherto  Undescribed  Condition 
of  the  Hairs  of  the  Human  Axilla. 

Flint,  Austin,  M.D.  (New  York).  Early  Tapping  in  Cases  of  Ascites. 

Gabbbtt,  H.  S.,  M.D.  The  Diagnostic  Value  of  the  Discovery  of  Koch’s 
Bacilli  in  Sputum. 

Glynn,  T.  R.,  M.D. 

Greves,  E.  H.,  M.B.  Notes  on  Cases  illustrating  Nerve-Diseases. 

Hassall,  A.  H.,  M.D.  1.  Further  Observations  and  Experiments  orv 
Inhalation  in  Affections  of  the  Lungs.  2.  On  the  Principles  of  the  Con¬ 
struction  of  Inhalation  Chambers  for  Diseases  of  the  Throat  and  Lungs. 

Leech,  D.  J.,  M.D.  Duration  of  Action  of  Medicines. 

Little,  J.  F.,  Esq.  Rheumatic  Arthritis  or  Neurotic  Arthritis. 

Mackenzie,  J.  A.,  M.D.  Rupture  of  the  Heart. 

Moore,  W.  W..  M.D.  Source  of  Heat  in  Fever. 

Morris,  Malcolm,  Eaq.  The  Use  of  Antimony  in  certain  Skin  Diseases. 

Myrtle,  A.  S.,  M.D.  Sweating  to  Death. 

Oliver,  George,  M.D.  Bedside  Urinary  Testing. 

Oxley,  M.  G.  B.,  M.D.  The  Position  of  Syphilis  as  regards  Classification, 
and  Treatment  in  this  Country. 

Ridge,  J.  J.,  M.D.  The  Use  of  Non-Alcoholic  Tinctures  as  Remedies. 

Robertson,  R.,  M.D.  Modern  Uses  of  Blood-letting. 

Ross,  James,  M.D.  1.  Rupture  of  the  Brachial  Plexus.  2.  On  Early 
Posterior  Sclerosis. 

Russell,  W.,  M.D.  Three  Fatal  Cases  of  Purpura  Hsemorrhagica. 

Sansom,  A.  E.,  M.D.  Note  on  Percussion  as  a  means  of  Diagnosis. 

Smith,  Solomon  C.,  M.D.  Antiseptic  Inhalations. 

Strange,  William,  M.D.  Sporadic  Septicaemia,  chiefly  Puerperal,  espe¬ 
cially  as  to  its  relations  with  the  Infectious  Zymotic  Diseases. 

Thomas,  W.  R.,  M.D.  On  the  Varieties  of  Phthisis,  and  the  Curability  of 
some  in  certain  Stages. 

Thomson,  G.,  M.D.  Rupture  of  the  Brachial  Plexus. 

Thudichum,  J.  L.  W.,  M.D.  On  Hay-Fever  or  Hay- Asthma,  and  its  fre¬ 
quent  Connexion  with  Structural  Disease  of  the  Nasal  Cavity. 

Wahltuch,  A.,  M.D.  On  Electro-therapeutics. 

Wise,  Alfred,  M.D.  Climatological  Studies  at  High  Altitudes. 

Woods,  G.  A.,  Esq.  Cerebellar  Tumour. 

Dr.  Byrom  Bramwell  will  give  a  demonstration  on  the. 
Microscopic  Pathology  of  the  Spinal  Cord. 


Section  B.— Surgery. 

1.  Mr.  Clement  Lucas  will  open  a  discussion  on  Surgical 
Diseases  of  the  Kidney,  and  the  Operations  for  their  Belief, 
in  which  Dr.  G.  Elder  and  Mr.  Bennett  May  will  take  part, 

2.  A  discussion  on  the  Treatment  of  Intestinal  Obstruc¬ 
tion  by  or  without  Operative  Interference  will  take  place, 
in  which  Sir  William  Mac  Cormac,  Mr.  Bellamy,  Dr.. 
Norman  Kerr,  and  others,  will  take  part. 

The  following  papers  have  been  promised :  — 

Atkinson.  E.,  Esq.  Drainage  of  Joints. 

Baker,  Morrant,  Esq.  Removal  of  the  Tongue  by  Median  Division. 
Bartleet,  T.  H.,  Esq.  Roux’s  Amputation  at  the  Ankle  :  its  Superiority 
to  Syme’s. 

Bernard,  Armand,  Esq.  Observations  on  Primary  Venereal  Sores. 
Berry,  William,  Esq.  Strangulated  Hernia  and  its  Complications. 
Browne,  H.  Langley,  Esq.  Treatment  of  Enlarged  Prostate  by  Continu¬ 
ous  Elastic  Pressure. 

Browne,  J.  W.,  M.D.  Cases  of  Hernia. 

Cousins,  J.  Ward,  M.D.  1.  Photograph  of  a  Dorsal  Tumour  which  was? 
removed  to  relieve  Pulmonary  and  Cardiac  Distress.  2.  Explanatory 
Remarks  on  a  New  Needle  for  Closing  Surgical  Wounds. 

Cross,  F.  Richardson,  Esq.  The  Treatment  of  Arthritis  by  Incision. 
Drysdale,  C.  R.,  M.D.  Recent  Experiments  on  the  Treatment  of  Syphilis. 
Eagan,  John,  L.K.Cl.C.P.  The  Nature,  Diagnosis,  and  Treatment  of 
Heemarthrosis  of  the  Knee-Joint. 

Hardie,  James,  Esq.  Amputation  by  Oblique  Circular  Incision. 

Heath,  Christopher,  Esq.  The  Use  of  Plaster-of-Paris  Bandages  in  the 
Treatment  of  Recent  Fractures. 

Jbssop,  T.  R.,  Esq.  Some  Results  derived  from  Experience  in  Colotomy. 
Jones,  Thomas,  Esq.  Cases  of  Resection  of  the  Ankle-Joint  for  Disease 
and  Injury. 

Keetley,  C.  B.,  Esq.  An  Analysis  of  Eight  Cases  of  Osteotomy  of  the  Hip?. 
Le  Page,  J.  F. ,  Esq.  The  Evacuation  of  Deep  Abscesses ;  with  Exhibition 
of  Deep  Abscess  Evacuator. 

Lowndes,  F.  W..  Esq.  Venereal  and  Sexual  Hypochondriasis. 

March,  H.  C.,  M.D.  A  Case  of  Resection  of  the  Ankle-Joint  by  an  Arti¬ 
ficial  Pott’s  Operation. 

Morgan,  J.  H.,  Esq.  The  Operative  Proceedings  in  Cases  of  Intestinal1 
Obstruction. 

Morris,  Malcolm,  Esq.  The  Comparative  Advantages  of  Scarification  and 
Scraping  in  the  Treatment  of  Lupus  Vulgaris. 

Norton,  A.  T.,  Esq.  A  Case  of  Excision  of  the  Superior  Maxilla  fog 
Melanotic  Sarcoma  of  the  Antrum. 

Owen,  Edmund,  Esq.  The  Treatment  of  Large  Neeyi. 

Pemberton,  Oliver.  Esq.  Gastro-Enterotomy. 

Rab»gliati,  A.,  M.D.  Cases  of  Osteotomy. 

Roth,  Bernard,  Esq.  The  Treatment  of  Non-Spasmodic  Torticollis. 
Smith,  E.  Noble,  Esq.  The  Treatment  of  Lateral  Curvature  of  the  Spine. 


Medical  Times  and  Gazette. 


THE  BRITISH  MEDICAL  ASSOCIATION. 


July  21,  1883. 


South am,  F.  A.,  Esq.  A  Case  of  Femoral  Aneurysm,  treated  by  Injection 
of  Fibrin  Ferment,  and  subsequently  by  Ligature  of  the  External  Iliac 
Artery. 

Stokes,  William,  Esq.  Excision  of  the  Shoulder- Joint. 

Stowep.s,  J.  H.,  M.D.  1.  The  Nature  and  Treatment  of  Paget’s  Disease 
of  the  Nipple  (with  Microscopic  Specimens) .  2.  The  Treatment  of  Vas¬ 
cular  Hypertrophy  of  the  Nose. 

Thomas,  William,  M.B.  1.  On  the  Accurate  Measurement  and  Comparison 
of  the  Lower  Limbs.  2.  The  Application  of  India-rubber  Bands  in  the 
Treatment  of  Talipes. 

Thompson,  James,  M.D.  Artificial  Limbs. 

Walter,  Wm.,  M.D.  A  Case  of  Nephrectomy  for  Cystic  Tumour  of  a 
Floating  Kidney. 

Warden,  Charles,  M.D.  On  Osteotomy  in  Genua  Vara  and  Valga. 
Warren,  J.  W.,  M.D.  1.  Cure  of  Hernia  by  Subcutaneous  Injection. 
2.  The  Use  of  the  Aspirating  Needle  in  Strangulated  Hernia  and 
Obstruction  of  the  Bowels. 

Whitehead,  Walter,  Esq.  1.  A  Further  Series  of  Twenty-five  Cases  of 
Excision  of  the  Tongue  with  Scissors.  2.  The  Surgical  Treatment  of 
Haemorrhoids. 

Patients  for  exhibition  will  attend  from  1.30  to  2.30  p.m. 
bn  Wednesday  and  Thursday,  August  1  and  2,  in  a  room 
adjacent  to  that  of  the  Section. 

Mr.  John  Croft  will  give  a  demonstration  of  the  appli¬ 
cation  of  Plaster-of-Paris  Splints  for  the  Treatment  of 
(Fractures. 


Section  C. — Obstetric  Medicine. 

Special  discussions  are  expected  to  take  place  in  this 
Section  on  the  following  subjects  :  — 

1.  Total  or  Partial  Extirpation  of  the  TJterus  for  Malig¬ 
nant  Disease.  Introduced  by  papers  by  Professor  Schroeder 
(Berlin)  and  Dr.  Wallace. 

2.  On  Operative  Treatment  of  Uterine  Fibromata.  Intro¬ 
duced  by  papers  by  Dr.  Keith,  Mr.  Knowsley  Thornton,  and 
Mr.  Lawson  Tait.  Dr.  Wallace  has  promised  to  take  part. 

3.  On  Metria  (so-called  Puerperal  Fever).  Introduced  by 
papers  by  Dr.  Atthill  and  Dr.  Thorburn.  Drs.  Grigg,  T. 
More  Madden,  Alderson,  and  Fancourt  Barnes,  and  Messrs. 
Donovan  and  Burton,  have  promised  to  take  part. 

4.  Porro’s  Operation.  Introduced  by  a  paper  by  Dr. 
Element  Godson. 

The  following  papers  are  promised  : — 

Alderson,  F.  H.,  M.D.  A  Case  of  Extra-Uterine  Pregnancy. 
Alexander,  William,  M.D.  On  Shortening  the  Round  Ligaments  for 
the  Cure  of  some  Forms  of  Uterine  Displacement. 

Barnes,  Fancourt,  M.D. 

Burton,  J.  E.,Esq.  A  Plea  for  the  more  Persevering  Treatment  of  Uterine 
Cancer  in  Cases  in  which  Operation  by  Removal  is  Impracticable. 
■Groom,  J.  Halliday,  M.D.  1.  Basilysis.  2.  On  some  Relations  of  the 
Bladder  and  Uterus  during  Labour. 

Dolan,  T.  M.,  Esq.  Defective  Lactation  in  Modem  Times :  its  Causes, 
and  how  far  it  may  be  Influenced  by  Drugs. 

Duke,  Alexander,  M.D.  On  the  Use  of  Additional  Traction  in  Difficult 
Cases  as  an  Alternative  to  Craniotomy. 

3Edis,  Arthur  W.,  M.D.  The  Treatment  of  Chronic  Metritis  associated 
with  Retroflexion. 

Lediard,  A.  H.,  M.D.  Alexander’s  Operation  on  the  Round  Ligaments  ; 
with  Cases  and  Remarks. 

ILe  Page,  John  F.,  Esq.  On  Axis-Traction  in  Delivery  with  Obstetric 
,  Forceps.  Mr.  Le  Page  will  also  exhibit  Le  Page’s  Axis-Traction 
Forceps. 

McDonald,  A.  Drummond,  M.B.  Position  in  Labour. 

Madden,  T.  More,  M.D.  Further  Observations  on  certain  Mental  and 
Nervous  Disorders  peculiar  to  Women. 

Meadows,  A.,  M.D.  On  the  Diagnosis  of  the  various  Forms  of  Uterine 
Fibromata. 

Murphy,  James,  M.D.  Short  Notes  of  Fifteen  Cases  of  Placenta  Preevia, 
with  Remarks  on  its  Treatment. 

Roberts,  D.  Lloyd,  M.D.  Inversion  of  the  Uterus. 

Smith,  Heywood,  M.D.  On  a  Case  of  Porro’s  Operation. 

Spanton,  W.  D.,  Esq.  A  Case  of  Extra-Uterine  Foetation. 

"Tait,  Lawson,  Esq.  Are  Diseases  of  the  Ovary  (specially  Cystoma)  on 
the  Increase  1 

Walter,  William,  M.D.  A  Case  of  Hysterectomy  for  Uterine  Fibromata. 
Williams,  A.  Wynn,  M.D.  1.  On  Displacements  of  the  Uterus  and  their 
Treatment.  2.  On  Cancer  of  the  Neck  of  the  Uterus  and  its  Treatment. 


Section  D. — Public  Medicine. 

Four  topics  have  been  selected  for  discussion  in  this 
Section — 

1.  Directions  in  which  Public  Health  Law  might  be  ad¬ 
vantageously  Amended  or  Extended.  Mr.  Charles  Wills 
will  read  a  paper  on  this  subject.  Mr.  Ernest  Hart  will 
read  one  on  the  Advisability  of  an  Extension  of  the  Law 
for  the  Regulation  and  Registration  of  Plumbing  in  Houses. 
Dr.  William  Carter  will  open  a  discussion  on  these  papers. 

2.  Quarantine.  Dr.  Imlach  will  read  a  paper  on  Quaran¬ 
tine  ;  and  Dr.  Stocker,  lately  Government  Emigration 
Inspector  at  Queenstown,  will  read  one  on  a  cognate  subject. 

3.  Disposal  of  Town-Refuse.  Dr.  Goldie  and  Dr.  E. 
Whittle  will  read  papers  on  this  subject. 

4.  Etiology  of  Diphtheria  and  Autumnal  Diarrhoea.  Drs. 


Alfred  Carpenter,  H.  J.  Alford,  and  E.  F.  Willoughby,  will 
read  papers  on  Diphtheria;  and  Mr.  M.  D.  Makuna  one 
on  Autumnal  Diarrhoea. 

Captain  Douglas  Galton,  C.B.,  F.R.S.,  has  promised  to 
read  a  paper  on  Hospital  Construction. 

The  following  papers  are  promised :  — 

Drummond,  Edward,  M.D.  On  the  Climate  of  Rome. 

Drysdale,  C.  R.,  M.D.  The  Mortality  of  the  Rich  and  the  Poor. 

Hill,  J.  Higham,  M.D.  Suggestions  for  the  Better  Police  Treatment  of 
Persons  found  Insensible  in  the  Streets,  and  supposed  to  be  under  the 
Influence  of  Alcohol. 

James,  J.  Brindley,  Esq.  On  Cremation. 

Kerr,  Norman,  M.D.  The  Present  Position  of  the  Habitual  Drunkards 
Movement. 

Lowndes,  F.  W.,  Esq.  How  to  Make  our  own  Houses  Sanitary ;  with 
Personal  Experiences. 

Makuna,  M.  D.,  Esq.  Small-pox  and  Vaccination  Statistics ;  Diseases 
and  Injuries  to  Health  attributed  to  Vaccination. 

Martin,  Johnson,  Esq.  On  the  Injury  done  to  the  Health  of  the  Young 
by  the  Present  System  of  Education. 

Millican,  K.  W.,  Esq.  Evolution  in  Disease. 

Shearer,  George,  M.D.  On  the  Opium-Habit. 


Section  E. — Anatomy  and  Physiology. 

The  following  papers  have  been  promised  : — 

Anderson,  Edward  C.,  M.D.  Koumiss :  its  Modes  of  Preparation, 
Varieties,  Physiological  Uses,  etc. 

Anderson,  R.  J.,  M.D.  Human  Ribs. 

Archer,  R.  S.,  M.B.  Note  on  Congenital  Aortic  Bands. 

Barr,  James,  M.D.  The  Causes  and  Mechanism  of  the  Cardiac  Impulse. 
Hadden,  W.  B.,  M.D.  Westphal’s  Phenomenon,  or  the  so-called  Para¬ 
doxical  Contraction  of  Muscles. 

Thudichum,  J.  L.  W.,  M.D.  On  the  Chemical  Constitution  of  the  Brain. 
Woods,  G.  A.,  Esq.  The  Anatomy  and  Physiology  of  the  Sixth  Nerve. 

Mr.  Lennox  Browne  will  exhibit  on  the  magic-lantern 
screen,  by  means  of  oxyhydrogen  light,  a  series  of  Photo¬ 
graphs  of  the  Larynx  and  Soft  Palate  in  the  production  of 
various  Musical  Tones. 

Afterwards,  Mr.  Emil  Behnke,  from  whom  the  pictures 
have  been  taken,  will  exhibit  his  Larynx  to  the  members 
present,  so  as  to  demonstrate  practically  the  physiological 
facts  illustrated  by  the  photographs. 

Mr.  C.  B.  Lockwood  will  show  an  anatomical  specimen 
illustrating  the  use  of  the  Fossa  at  the  Lower  End  of  the 
Fibula. 

Dr.  E.  H.  Jacob  will  show  (1)  Photographs  of  Chick 
Embryos  ;  (2)  a  Portable  Polygraph. 

Dr.  Francis  Warner  will  give  a  demonstration  of  an 
Apparatus  for  obtaining  Graphic  Records  of  the  Movements 
of  Fingers,  Hands,  Head,  etc.,  and  enumerating  them  and 
their  combinations. 

Dr.  John  Harker  will  show  a  sketch  of  Abnormal  Hands 
and  Feet  in  the  case  of  an  Infant. 

Mr.  Sibley  Hicks  will  exhibit  a  series  of  Embryos  to  illus¬ 
trate  the  Development  of  the  Chick. 


Section  F. — Pathology. 

The  following  discussions  will  take  place  : — 

1.  On  Micro-organisms  in  Disease.  To  be  opened  by  Dr. 
Dreschfeld.  Dr.  Shingleton  Smith  will  take  part  in  the 
discussion. 

2.  On  the  Micro-organism  of  Typhus.  To  be  opened  by 
Drs.  Mott  and  Blore.  Drs.  Davidson  and  Barrow  will  take 
part. 

3.  On  the  Pathology  of  Dropsy.  To  be  opened  by  Dr. 
Lauder  Brunton.  Drs.  Saundby  and  Churton  will  take  part. 

4.  On  Chronic  Inflammations  of  Bone.  To  be  opened  by 
Mr.  Charters  J.  Symonds. 

5.  On  Primary  Growths  of  the  Urinary  Tract.  To  be 
opened  by  Mr.  Frank  T.  Paul.  Mr.  Roger  Williams  will 
take  part  in  the  discussion. 

Cirrhosis  and  allied  conditions  of  the  Liver  will  be  brought 
forward,  should  time  allow. 

The  following  papers  have  been  promised 

Hadden,  W.  B.,  M.D.  On  Lardaceous  Disease  of  the  Suprarenal  Capsule. 
Le  Page,  John  F.,  Esq.  On  Neuropathic  Plica  . 

Mansell-Moullin,  C.,  M.B.  On  some  Forms  of  Osteitis  m  Hereditary 

Roeokkl^'w.  J.,  M.B.  The  Pathology  of  Internal  Haemorrhoids. 
Silcock  A.  Q,.,  M.D.  Some  points  connected  with  the  Repair  of  Fractures. 
Smith,  R.  Shingleton,  M.D.  1.  Tubercular  Bacilli  in  the  Urine.  2.  Cir¬ 
rhosis  of  Liver  simulating  Acute  Yellow  Atrophy. 

Stowers,  J.  Herbert,  M.D.  1.  Paget’s  Disease  of  the  Nipple.  2.  Various 
Affections  of  the  Skin.  _  «.  1 

Windlb,  B.  C.  A.,  M.B.,  and  Barling,  H.  G.,  M.B.  The  Pathology 
and  Relations  of  Lupus. 

It  is  desired  to  illustrate  in  as  complete  a  manner  as 


Medical  Times  and  Gazette. 


THE  BRITISH  MEDICAL  ASSOCIATION. 


July  21,  1883  .  79 


possible,  by  means  of  preparations  and  microscopical  speci¬ 
mens,  the  Primary  Growths  of  the  Urinary  Tract,  especially 
of  the  Kidney,  Bladder,  and  Prostate.  The  object  of  this 
investigation  is  to  collect  all  the  information  that  is  to  be 
obtained  in  this  country,  with  the  view  of  deciding  what  are 
the  primary  growths  that  have  been  met  with  in  this  region. 
The  specimens  lent  will  be  arranged  in  the  Museum,  and  a 
report  of  the  investigation  will  be  brought  forward  in  the 
Pathological  Section  by  Mr.  Paul.  The  Sub-committee  will 
be  very  glad  to  receive  (1)  recent  specimens;  (2)  mounted 
specimens  of  rare  growths ;  (3)  microscopical  sections  (these 
are  specially  requested).  The  specimens  and  sections  will 
be  returned  to  their  owners  after  the  meeting. 


Section  G. — Psychology. 

In  this  Section,  the  following  special  subjects  have  been 
selected  for  discussion  : — 

1.  The  Employment  of  the  Insane.  Introduced  by  Dr. 
Yellowlees.  Dr.  David  Bower,  Dr.  William  W.  Ireland,  Dr. 
John  A.  Wallis,  and  others,  are  expected  to  take  part  in  this 
discussion. 

2.  Bone-Degeneration  in  the  Insane.  Introduced  by  Dr. 
Wiglesworth.  Dr.  William  W.  Ireland  and  others  are 
expected  to  take  part. 

3.  Cerebral  Localisation  in  relation  to  Psychological 
Medicine.  Introduced  by  Mr.  W.  Bevan  Lewis.  Dr.  James 
Koss,  Dr.  David  Eerrier,  Dr.  W.  W.  Ireland,  Dr.  Fletcher 
Beach,  Dr.  Alexander  Robertson,  and  others,  are  expected  to 
take  part. 

4.  General  Paralysis.  Introduced  (if  time  permit)  by  Dr. 
W.  J.  Mickle.  Several  members  are  expected  to  take  part. 

The  following  papers  are  also  promised: — 

Baker,  John  Henry,  Esq.,  and  Mickle,  W.  J.,  M.D.  Some  Acts  during 
Temporary  Epileptic  Mental  Disorder. 

Hickson,  Albert  Thomas,  M.D.  Locomotor  Ataxy  and  General  Paralysis. 
Huggard,  William  Bichard,  M.D.  Definitions  of  Insanity. 

Meecieb,  Charles  A.,  M.B.  An  Epidemic  of  Delirium. 

Mickle,  William  Julius,  M.D.  Visceral  and  other  Syphilitic  Lesions  in 
Insane  Patients,  without  Cerebral  Syphilitic  Lesions. 

Sankey,  William  H.  O.,  M.D.  What  Phenomena  are  included  in  the 
name  of  General  Paralysis  or  General  Paresis  ? 

Savage,  George  H.,  M.D.  Some  Cases  of  General  Paralysis  with  Lateral 
Sclerosis  of  the  Cord. 

Shuttlbworth,  George  E.,  M.D.  Is  Legal  Responsibility  acquired  by 
Educated  Imbeciles  ? 

Wiglesworth,  Joseph,  M.D.  The  Pathology  of  Mania. 

Several  members  will  also  exhibit  Microscopical  Sections 
of  the  Brain  and  Spinal  Cord. 


Section  H. — Ophthalmology. 

Three  subjects  have  been  selected  for  discussion  in  this 
Section — 

1.  On  Tests  for  Colour-Sense  and  for  Acuteness  of  Vision, 
with  special  reference  to  Schools  and  Sailors.  Opened  by 
Dr.  W.  A.  Brailey,  followed  by  Dr.  Snellen  (Utrecht). 
Messrs.  Nettleship,  Fitzgerald,  and  Higgens  have  promised 
to  take  part. 

2.  On  the  Use  of  the  Magnet  in  Ophthalmic  Surgery. 
Opened  by  Mr.  Simeon  Snell,  followed  by  Dr.  W.  A. 
McKeown. 

3.  On  the  various  methods  of  Treatment  for  Sloughing 
Ulcer  of  the  Cornea,  with  especial  reference  to  Incision 
and  Scraping.  Opened  by  Mr.  T.  Pridgin  Teale,  followed 
by  Dr.  Little. 

The  following  papers  have  been  promised  : — 

Abbott,  George,  Esq.  Obstruction  of  the  Nasal  Duct,  and  its  Treatment 
by  Styles. 

Andrew,  Edwyn,  M.D.  Treatment  of  Lachrymal  Obstruction. 

Cbitchett,  G.  Anderson,  Esq.  Ulcers  of  the  Cornea  :  their  Varieties  and 
Treatment. 

Forbes,  Litton,  Esq.  1.  On  the  Relations  existing  between  certain  states 
of  the  Sexual  Organs  and  Visual  Disturbance.  2.  The  Doctrine  of 
Enucleation. 

Higgens,  Charles,  Esq.  On  the  Treatment  of  Painful  Corneal  Ulcers  by 
Warmth  and  Eserine. 

Jones,  A.  Emrys,  M.D.  1.  A  Case  of  Orbital  Abscess  communicating 
with  the  Brain.  2.  A  Case  of  Embolism  (?)  of  the  Central  Artery  of  the 
Retina  connected  with  Pacial  Erysipelas. 

Juler,  Henry,  Esq.  On  the  Relative  Merits  of  the  Various  Methods  of 
Testing  the  Refraction  of  the  Eye. 

Lee,  Charles  George,  Esq.  Notes  on  the  Ophthalmic  Conditions  of  Deaf- 
Mutes. 

McKeown,  W.  A.,  M.D.  The  Treatment  of  Accidental  Dislocation  of  the 
Lens. 

Macnamara,  Charles,  Esq.  On  the  Pathology  and  Treatment  of  Zonular 
Cataract. 

Mules,  P.  H.,  M.D.  An  Electric  Movement  for  Carter’s  Astigmatic  Clock.  | 
Shears,  Charles,  Esq.  Tobacco  Amblyopia.  • 


Taylor,  Charles  Bell,  M.D.  l.,On  the  Operative  Treatment  of  Sympa¬ 
thetic  Ophthalmia,  with  Cases.  2.  On  Transplantation  of  Skin  with 
Temporary  Pedicle  without  Scar.  3.  Notes  on  the  Operation  for 
Cataract,  with  and  without  Iridectomy. 

Watson,  W.  Spencer,  Esq.  Shot-Silk  Appearance  of  the  Retina. 

Wolfe,  John  R.,  M.D.  1.  On  the  Transference  of  Conjunctiva  from  the 
Rabbit  to  the  Human  Subject  for  the  Cure  of  Symblepharon.  2.  On 
the  Treatment  of  Suppuration  of  the  Tear-Passages. 


Section  I. — Diseases  op  Children. 

Three  special  subjects  have  been  selected  for  discussion — 

1.  Dr.  T.  Barlow  will  open  a  discussion  on  Rheumatism 
and  its  Allies  in  Children.  The  following  gentlemen  have 
promised  to  take  part  in  the  discussion : — Dr.  O.  Sturges,  Dr. 
Richards,  Dr.  Finlayson,  Dr.  Sansoih,  Dr.  Mahomed,  Dr.  J.  S. 
Bury,  Dr.  Donkin,  and  Dr.  Byers. 

2.  Dr.  Ballard  :  On  the  Etiology  and  Pathology  of  Sum¬ 
mer  Diarrhoea.  The  following  gentlemen  have  promised  to^ 
take  part  : — Dr.  Borchardt,  Dr/  Seaton,  Mr.  W.  Hugh 
Hughes,  Dr.  Bruce  Low,  Dr.  Strange,  Dr.  A.  Ransome,  and 
Dr.  Maccall. 

3.  Mr.  Morrant  Baker  :  On  Acute  Epiphyseal  Necrosis  and 
its  Consequences.  The  following  gentlemen-',  are  likely  to 
take  part: — Mr.  J.  H.  Morgan,  Mr.  R.  W.  Parker, Mr.  G.  A. 
Wright,  Mr.  G.  Cowell,  Mr.  E.  Owen,  and  Mr.  A.  Csesar. 

The  following  papers  are  promised : — 

Ashby,  H.,  M.D.  On  Scarlatinal  Rheumatism. 

Bury-,  J.  S.,  M.D.  A  Case  of  Osteomalacia  in  a  Child. 

Day,  W.  H.,  M.D.  A  Case  of  Croupous  Pneumonia  in  a  Child  treated 
successfully  by  the  Cold  Bath. 

Gee,  Samuel  J.,  M.D.  Some  kinds  of  Albuminous  and  Purulent  Urine 
in  Children. 

Morgan,  J.  H.,  Esq.  A  Case  of  Epiphyseal  Necrosis  of  the  Humerus,. 

followed  by  considerable  Shortening  of  the  Arm. 

Moribon,  B.  G.,  M.B.  Infantile  Diarrhoea  and  its  Treatment. 

Oxley,  M.  G.  B.,  M.D.  Fatal  Case  of  Chorea  in  a  Child  aged  ten  years. 
Pughe,  R.  N.,  Esq.  Operations  for  the  Radical  Cure  of  Hernia  in. 
Childhood. 

Rawdon,  H.  G.,  M.D.  On  the  Operation  for  Hare-lip. 

Steavenson,  W.  E.,  M.D.  On  Electricity  in  the  Treatment  of  Infantile 
Paralysis. 

Sturges,  O.,  M.D.  On  the  Alliance  of  Rheumatism  and  Chorea. 

Thomas,  W.  R.,  M.D.  On  Intermittent  Fever  among  Children  in  Low- 
lying  Districts :  its  Frequency,  and  the  importance  of  recognising  it,, 
owing  to  its  Curability. 

Tomkins,  H.,  M.D.  On  the  Clinical  Features  of  Typhus  Fever  in  Children. 
Wright,  G.  A.,  Esq.  On  the  Value  of  Localising  the  Primary  Lesion  in. 
Joint-Disease  as  an  Indication  for  Treatment. 


Section  J.— Otology. 

Discussions  will  take  place  on  the  following  subjects  : — 

1.  A  discussion  on  the  more  serious  aspects  of  Chronic 
Purulent  Inflammation  of  the  Middle  Ear  will  be  introduced 
by  Dr.  W.  Laidlaw  Purves. 

2.  A  discussion  on  the  various  forms  of  Artificial  Tympanic 
Membrane,  and  their  Comparative  Value,  will  be  introduced 
by  Dr.  F.  M.  Pierce. 

The  following  gentlemen  have  expressed  their  intention  of' 
taking  part  in  the  discussions : — Dr.  Edward  Woakes,  Dr. 
Thomas  Barr,  Dr.  Urban  Pritchard,  Dr.  William  A. 
McKeown,  Dr.  J.  W.  Browne,  Dr.  Richard  Ellis,  Dr.  H.  J. 
Hardwicke. 

The  following  papers  have  been  promised : — 

Barr,  Thomas,  M.D.  Practical  Observations  on  the  Use  of  the  Cotton- 
Pellet  (Yearsley’s  Artificial  Tympanic  Membrane)  as  an  Aid  to  Hearing. 
Cassells,  James  P.,  M.D.  An  Analysis  of  Ten  Years’  Aural  Surgery. 
Forbes,  Litton,  Esq.  The  Indications  for,  and  Therapeutic  Value  of„ 
Myringeetomy. 

McBride,  P.,  M.D.  The  Prognosis  of  Chronic  Non-Suppurative  Inflam¬ 
mation  of  the  Middle  Ear. 

Torrance,  Robert,  Esq.  Deafness  in  Cerebro-Spinal  Meningitis. 
Williams,  Richard,  Esq.  A  Fatal  Case  of  Chronic  Purulent  Inflamma¬ 
tion  of  the  Middle  Ear,  from  Extension  to  the  Intracranial  Cavity. 


The  Fear  oe  Premature  Interment. — In  the  will 
of  the  late  Major  Andrew  Gammell,  which  has  just  been 
proved  as  amounting  to  ,£107,000,  be  desires  that  immediately 
after  his  supposed  death  a  surgical  examination  be  made  by 
Mr.  Barnard  Holt,  or  some  other  eminent  surgeon,  to  see  if 
he  be  really  dead,  and  that  a  fee  of  one  hundred  guineas  be 
paid  for  such  examination,  free  of  legacy  duty. 

The  Odour  oe  Iodoform. — This,  Dr.  Andrews  (New 
York  Med.  Record,  June  30)  states,  may  be  effectually  re¬ 
moved  by  adding  (as  a  minimum)  three  grains  of  cumarin 
to  a  drachm  of  iodoform.  Cumarin,  a  derivative  of  the  Tonka 
bean,  is  ananhydrate  of  cumuric  acid.  The  Tonka  bean  itself 
placed  in  the  bottle  containing  the  iodoform  is  not  effectual. 


Medical  Times  and  Gazette. 


NOTICES  OF  BOOKS. 


July  21, 1883. 


•80 


NOTICES  OP  BOOKS. 


Gout  in  its  Protean  Aspects.  By  J.  Milner  Fothergill’ 

M.D.,  M.R.C.P.,  Hon.  M.D.  Rush  College,  Chicago,  etc. 

London :  H.  K.  Lewis.  1883.  Pp.  300. 

To  readers  of  previous  works  by  the  same  author  it  will  be 
sufficient  for  us  to  record  the  fact  that  in  the  work  before  us 
Dr.  Fothergill  has  adopted  the  same  system  of  treating  his 
subject  as  in  the  numerous  volumes  with  which  they  are 
already  familiar.  To  those  who  read  his  books  for  the  first 
time  a  description  of  the  present  work  and  the  methods 
•adopted  in  its  production  may  be  of  service.  The  treatise 
•bears  an  attractive  title,  which  is  designed  to  prepare  the 
reader  to  give  his  attention  to  those  forms  and  manifesta¬ 
tions  of  gout  which  have  not  the  same  well-defined  symp¬ 
toms  and  pathology  as  the  forms  of  regular  articular  gout. 
The  work  is  divided  into  chapters  dealing  respectively  with 
the  conditions  of  the  blood  and  the  urine  in  gout,  with  the 
diagnosis,  prognosis,  and  treatment  of  the  disease,  and 
with  the  conditions  described  as  “  rheumatic  gout  ”  and 
■“  chronic  rheumatism.”  The  whole  book  bears  the  name 
-of  Dr.  Fothergill  as  its  author,  but  after  careful  perusal 
we  are  obliged  to  notice  the  fact  that  only  very  small 
portions  of  the  text,  and  those  for  the  most  part  in  the 
chapters  relating  to  “  treatment,”  bear  upon  them  any 
evidence  of  being  the  original  work  of  the  writer.  In  the 
•opening  of  his  chapter  on  Prognosis,  and  in  a  footnote 
affixed  thereto,  he  states  clearly  his  preference  for  the  use 
of  the  language  of  other  authorities  on  the  subject,  to  his 
■own,  and  maintains  that  by  so  doing  he  is  acting  in  the 
true  interests  of  the  reader.  The  reader  may  or  may  not 
be  prepared  to  agree  with  him  in  this,  but  it  is  clearly  “  in 
the  true  interests  of  the  reader  ”  that  the  reviewer  should 
make  known  to  him  that  “  Gout  in  its  Protean  Aspects  ” 
-consists  for  the  most  part  of  a  series  of  quotations  from  the 
works  of  previous  writers  on  the  same  subject,  blended 
together  under  the  various  headings  alluded  to,  by  writing 
of  the  kind  known  as  “readable.”  In  some  branches  of 
literature — as,  for  instance,  in  the  dramatising  of  novels, 
where  the  bulk  of  the  play  is  written  in  the  very  words  of 
the  novelist — the  title  of  “  author  ”  has  been  long  since 
disallowed,  and  the  adapting  playwright  is  no  longer 
permitted  to  pose  as  an  original  dramatist. 

To  what  extent  Dr.  Fothergill  himself  agrees  with  the 
opinions  which  he  quotes  it  is  difficult  in  places  to  discover. 
Thus,  we  find  him  teaching  on  page  39  (by  quotation)  that 
the  gouty  forms  of  certain  skin  affections  are  characterised 
by  intense  itching.  On  page  124  we  find  him  expressing 
his  own  conviction  that  “  these  affections  when  gouty  have 
mo  special  characteristics.”  The  repetition  of  his  own  and 
other  writers’  views  as  to  the  connexion  of  gout  with  good 
living  adds  to  the  size  of  the  book,  but  not  to  its  interest. 
The  chapter  on  Treatment  of  Chronic  Gout,  however,  de- 
.serves  perusal,  not  only  as  being  a  useful  resume  of  all  the 
well-known  rules,  but  also  as  containing  views,  especially 
as  to  the  use  of  fruits  with  alkalies,  which  merit  more  than 
passing  consideration. 

As  an  addition  to  the  stock  of  our  knowledge  with  respect 
to  the  nature  of  gout  the  work  is  of  no  great  value,  nor  is  it 
comprehensive  of  all  the  information  which  we  possess  with 
respect  to  the  part  played  by  the  lymphatic  and  haemato¬ 
poietic  tissues  as  lately  enunciated  by  Ebstein  and  others. 
As  a  very  readable,  popular  summary  of  all  the  best-known 
ducts  on  the  subject  as  found  in  the  larger  text-books,  the 
work  will  be  found  acceptable  by  those  who  have  the  leisure 
to  indulge  in  this  species  of  literature. 


The  Daily  Clinical  Charts. 

We  have  received  from  Messrs.  Salt  and  Sons,  of  Birming¬ 
ham,  a  packet  of  these  charts,  which  have  been  designed 
by  Dr.  Sawyer.  They  are  arranged  to  record,  and  show  at 
a  glance,  in  a  tabular  form,  a  patient’s  daily  progress  as 
■regards  medicines,  stimulants,  food,  sleep,  excreta,  and  so 
on,  leaving  a  wide  margin  for  remarks.  No  column  is  set 
apart  for  a  statement  of  the  patient’s  temperature,  but  this 
can  doubtless  most  usefully  and  graphically  be  recorded  on 
a  special  and  separate  form.  The  charts  are  supplied  stitched 
in  paper-covered  bundles,  are  very  comprehensive,  and,  if 
■the  nurse  be  trustworthy,  will  be  found  very  useful  in 
practice,  whether  private  or  in  hospital. 


Sick-Room  Charts. 

Mr.  Strickland,  pharmacutical  chemist,  of  South  Ken¬ 
sington,  has  also  sent  us  a  set  of  charts  which  he  has  devised 
for  the  sick-room.  Separate  columns  are  marked  for  infor¬ 
mation  as  to  nutriment,  stimulants,  medicine,  sleep,  the 
excreta,  the  pulse,  and  the  temperature.  Distinct  sheets 
are  provided  for  the  twelve  hours  from  8  a.m.  to  8  p.m.,  and 
from  8  p.m.  to  8  a.m.,  and  each  hour  is  divided  into  quarters; 
a  space  is  provided  at  the  bottom  of  each  form  for  the 
nurse’s  signature,  and  one  for  “  remarks.”  A  form  is  also 
provided  for  a  weekly  return,  giving  for  each  day  the  totals 
as  respects  duration  of  sleep,  the  quantity  of  stimulant,  and 
the  amount  of  urine  passed.  Mr.  Strickland’s  sick-room 
charts,  or  “Nurses’  Returns,”  would  certainly  be  found 
very  useful  in  recording  the  progress  of  a  case  with  ideal 
perfection  as  to  minuteness  and  fulness,  but  we  fear  he 
will  learn  that  they  are  too  minutely  comprehensive  and 
exacting  for  any  but  exceptional  cases. 

The  History  of  the  Tear  :  a  Narrative  of  the  Chief  Events 
and  Topics  of  Interest  from  Oct.  1,  1881,  to  Sept.  30,  1882. 
London :  Cassell,  Petter,  Galpin,  and  Co.  8vo,  pp.  568. 
The  pressure  on  our  columns  has  alone  prevented  our 
giving  an  earlier  notice  of  this  volume,  which  contains  a 
summary  of  all  the  leading  public  events  of  the  twelvemonth 
preceding  its  publication,  and  notes  the  progress  made  in  the 
various  departments  of  human  activity.  In  the  different 
chapters  of  the  work  the  history  of  the  year  is  given — 
clearly,  though  of  course  in  a  very  condensed  form — as 
regards  home  and  foreign  politics,  events  in  the  colonies 
and  India,  and  in  foreign  states,  financial  and  commercial 
matters,  literature,  art,  music,  scientific  progress,  religion, 
athletics,  and  even  fashion.  An  obituary  of  eminent  persons 
is  also  given.  An  appendix  contains  many  useful  statistical 
tables,  of  public  revenue  and  expenditure,  population,  taxa¬ 
tion,  import  and  export  trade,  etc. ;  and  there  is  a  copious 
index.  All  the  work  seems  to  have  been  well  and  carefully 
done  ;  and  the  book  will  unquestionably  be  found  very 
useful  as  a  handy  means  of  reference  to  all  events  of  note 
in  the  period  dealt  with. 

History  of  Rome  and  of  the  Roman  People,  from  its  Origin 
to  the  Establishment  of  the  Christian  Empire.  By  Victor 
Durtjy.  Edited  by  the  Rev.  J.  P.  Mahaffy.  London : 
Kelly  and  Co.,  Great  Queen-street,  W.C.  To  be  completed 
in  38  Parts. 

This  valuable  work,  the  first  part  of  which  we  noticed  in 
our  issue  of  March  10,  has  been  brought  out  regularly,  and 
as  perfectly  in  all  points  as  at  first.  In  consequence  of  the 
numerous  representations  made  to  them  as  to  the  length  of 
time  that  would  elapse  before  the  completion  of  the  work, 
the  publishers  have  decided  to  double  the  size  of  the  monthly 
parts,  thus  completing  the  work  in  three  years  instead  of 
six ;  but  the  price  of  each  part  is  only  increased  from  four 
shillings  to  five,  making  the  cost  of  the  whole  only  £0  6s., 
instead  of  ,£14  8s.  Parts  5  and  6,  which  belong  to  the  en¬ 
larged  series  of  parts,  are  now  before  us,  and  are  as  admirably 
produced  as  to  paper,  typography,  and  illustrations  as  were 
the  four  preceding  parts.  The  work  is,  in  every  particular, 
deserving  of  the  highest  praise. 


Iodoform  in  Fissure  of  the  Anus. — Dr.  Hay,  of 
Philadelphia  (Phil.  Med.  Reporter,  April  14),  states  that  the 
value  and  efficacy  of  iodoform  are  very  great,  so  that  it  will  in 
most  cases  supersede  the  use  of  the  knife  or  forcible  rupture. 
While  using  it  the  bowels  must  never  be  allowed  to  become 
constipated  or  relaxed,  and  the  parts  around  must  be  kept 
constantly  clean,  so  that  there  may  be  no  deposit  of  dry 
incrustations.  With  one  or  two  evacuations  a  day,  the  fissure 
may  be-  speedily  cured  by  the  iodoform,  which  should  be 
dusted  in  very  fine  powder,  three  or  four  times  a  day,  upon 
and  into  the  fissured  parts,  or  applied  as  ointment  or  sup¬ 
pository.  In  some  cases  the  powder,  however  fine,  causes 
some  pain,  and  then  should  be  mixed  with  pulv.  acacise,  or 
it  may  be  made  into  an  ointment  with  vaseline,  or  supposi¬ 
tory  with  oil  of  theobroma.  Balsam  of  Peru,  carbolic  acid, 
or  peppermint  oil  will  moderate  the  odour  of  the  iodoform. 
There  may  be  a  little  smarting  after  the  application,  but  the 
parts  soon  become  insensible  to  this,  and  defsecation  can  now 
be  performed  without  the  previous  pain.  It  is  asserted  that 
the  powder  should  be  very  fine,  not  the  smallest  crystal 
remaining  unpowdered,  or  great  suffering  may  be  produced. 


Medical  Times  and  Gazette. 


THE  OBSTETRICAL  SOCIETY  OF  LONDON. 


July  21, 1883.  81 


REPORTS  OF  SOCIETIES. 

- + - 

r  OBSTETRICAL  SOCIETY  OF  LONDON. 

Wednesday,  July  4. 


Dr.  Gervis,  President,  in  the  Chair. 

Hemorrhage  into  an  Ovarian  Cyst. 

Dr.  Robert  Barnes  exhibited  a  specimen  of  haemorrhagic 
effusion  into  an  ovarian  cyst  and  the  corresponding  Fallopian 
tube. 

Modes  of  Separation  and  Expulsion  of  Placenta. 

Dr.  Champneys  showed  two  experimental  demonstrations 
which  he  had  used  in  lecturing  since  1882,  to  illustrate — 
1.  The  mode  of  separation  of  placenta  (a)  by  contraction  of 
placental  site,  as  in  ordinary  labour,  and  ( b )  by  expansion  of 
placental  site,  as  in  placenta  praevia ;  and,  2.  To  illustrate 
the  mechanical  advantage  of  the  edgewise  presentation  of 
the  placenta. 

Ovarian  and  Uterine  Tumours. 

Dr.  Meadows  showed  a  large  ovarian  tumour,  together 
with  the  other  ovary,  the  uterus,  and  a  fibroid  weighing  six 
pounds  and  a  half,  which  he  had  removed  from  a  patient 
aged  sixty-five. 

Sloughing  Uterine  Fibroid. 

The  President  showed  a  large  submucous  fibroid,  which 
had  sloughed  suddenly  and  completely  without  any  obvious 
cause  or  premonitory  symptoms.  There  was  also  double 
pyosalpinx,  and  one  tube  had  ruptured,  causing  fatal 
peritonitis. 

Pseudo-hermaphroditism. 

Dr.  Chalmers  exhibited  the  genito-urinary  organs  of  a 
female  child  whose  sex  during  life  had  been  matter  of 
doubt.  The  child  had  been  shown  at  a  former  meeting  of 
the  Society. 

Hydatiform  Mole. 

Dr.  W.  A.  Duncan  exhibited  a  hydatiform  mole  which  he 
had  removed  from  a  patient  aged  fifty-one.  The  patient 
had  suffered  from  hsemorrhage  for  three  months  previously, 
but  had  had  no  symptoms  of  pregnancy. 

The  specimen  was  referred  to  a  committee  for  further 
examination  and  report. 

Ovarian  and  Uterine  Tumours. 

Mr.  Knowsley  Thornton  showed  a  soft  uterine  growth 
and  an  ovarian  tumour  removed  from  a  patient  aged  fifty- 
six.  The  nature  of  the  growth  he  hoped  to  report  on  at  a 
subsequent  meeting.  He  also  showed  an  ovarian  cyst 
highly  congested  from  twisting  of  the  pedicle,  which  had 
been  removed  during  acute  peritonitis.  He  thought  that 
in  the  specimen  shown  by  Dr.  Robert  Barnes  the  haemor¬ 
rhage  was  probably  the  effect  of  twisting  of  the  pedicle. 

Mr.  Lawson  Tait  agreed  with  Mr.  Thornton  as  to  Dr. 
Barnes’s  specimen.  Such  twisting  mostly  occurred  in 
tumours  growing  from  the  right  side,  and  depended  on  the 
action  of  the  rectum. 

Fibrinous  Polypus. 

Mr.  W.  S.  A.  Griffith  showed  a  uterus  containing  a 
fibrinous  polypus,  four  inches  long,  formed  of  organised 
adherent  blood-clot.  There  was  no  reason  to  think  that 
recent  pregnancy  had  occurred.  The  patient  died  from  the 
bursting  of  a  perinephritic  abscess. 

Hypertrophied  Nympha. 

Dr.  Fancourt  Barnes  showed  a  hypertrophied  nympha 
which  he  had  removed. 

The  Obstetrics  of  the  Kyphotic  Pelvis. 

This  paper,  by  Dr.  Champneys,  was  then  read.  An 
analysis  was  given  of  thirty-two  labours  in  twenty  women, 
including  three  labours  in  a  patient  of  the  author’s,  the 
last  labour  having  been  carefully  observed.  An  analysis 
and  a  table  were  given,  stating  the  presentation,  change 
during  labour,  measurements  of  foetal  skull  and  pelvis, 
operative  measures,  moulding  of  foetal  skull,  result  to  child 
and  mother.  The  general  remarks  of  other  writers  on  the 
subject  were  summarised.  The  general  conclusions  at  which 
the  author  arrived  were  the  following : — That  vertex  pre¬ 
sentations,  and  especially  right  occipito-iliae  positions,  are 


unusually  frequent ;  deep  transverse  position  is  common  ? 
posterior  rotation  not  uncommon.  The  comparative  fre¬ 
quency  of  occipito-posterior  positions  is  probably  due  (as- 
explained  by  Hoening)  to  the  obstacle  to  forward  rotation 
in  third  positions,  which  are  very  common.  The  head 
sometimes  emerges  from  the  ligamentous  pelvis  transverse- 
or  nearly  so,  and  entirely  posterior  to  the  tubera  ischii. 
The  analogy  to  the  “  extra-median  ”  position  was  pointed 
out.  The  well-known  looseness  of  the  pelvic  joints  in  this 
pelvis  probably  assisted  this  by  the  nutation  of  the  sacrum. 
Spontaneous  premature  labour  is  not  uncommon.  The  im¬ 
mediate  foetal  mortality  in  the  published  cases  was  40 '6  per 
cent.,  the  maternal  28T  per  cent.,  but  the  author  thought  this 
estimate  probably  too  high,  as  slight  cases  were  not  recorded. 
The  conclusions  as  to  treatment  and  prognosis  were  : — 1.  In 
a  first  labour,  if  the  head  present,  wait,  and  act  according  to 
circumstances.  This  implies  forceps,  craniotomy,  or  Caesarian 
section,  which  should  always  be  considered  in  the  above 
order.  2.  If  the  head  present,  never  turn.  3.  In  subsequent- 
labours,  where  the  history  of  the  first  labour  seems  to  indi 
cate  it,  premature  labour  may  be  induced  with  good  hope. 
4.  No  known  measurements  give  us  any  sure  indication  for 
forceps,  turning,  Caesarian  section,  or  the  date  for  induction 
of  premature  labour.  5.  The  mobility  of  the  pelvic  joints 
implies  a  prognosis  always  more  favourable  than  measure¬ 
ments  would  lead  us  to  suppose.  6.  Probably  in  many  cases 
the  head  entirely  neglects  the  anterior  half  of  the  pelvic 
outlet,  and  emerges  from  it  transverse,  or  at  most  oblique, 
antero-posterior  emergence  being  the  exception.  7.  Each 
succeeding  difficult  labour  increases  the  liability  of  the- 
uterus  to  rupture,  as  in  other  forms  of  pelvic  distortion. 

Dr.  Roper  remarked  that  the  mechanism  described  by 
Dr.  Champneys  resembled  that  of  labour  in  the  lower 
animals,  in  which  there  was  no  pelvic  arch,  and  the  foetus 
always  passed  behind  the  ischial  tuberosities.  This  diminu¬ 
tion  of  curve  in  the  pelvic  axis  somewhat  lessened  the  diffi¬ 
culty  of  labour.  In  cases  of  kyphosis  the  vertical  capacity 
of  the  abdomen  was  diminished,  hence  the  uterus  was  thrust 
forward  and  pendulous  belly  was  common,  and  led  to  diffi¬ 
culty  in  the  entry  of  the  foetus  into  the  brim.  He  described 
a  case  which  he  had  seen.  In  these  cases  the  deformity  of 
the  outlet  obstructed  delivery  more  than  that  at  the  brim. 

Dr.  Herman  agreed  with  the  author  that  the  published 
cases  probably  contained  an  undue  proportion  of  difficult 
cases.  / 

Dr.  Champneys  thought  that  pendulous  belly  was  pro¬ 
duced  by  anything  which  shortened  the  abdominal  cavity. 

A  Note  on  Uterine  Myoma  :  its  Pathology  and 
Treatment. 

This, paper,  by  Mr.  Lawson  Tait,  was  then  read.  The 
author  thought  that  the  word  “  myoma  ”  should  entirely 
supersede  the  incorrect  term,  “  uterine  fibroid.”  The  growth 
of  ordinary  myoma  was  limited  to  the  period  of  sexual 
activity,  was  influenced  by  the  menstrual  function,  and 
probably  its  ultimate  cause  would  be  found  in  some  dis¬ 
turbance  of  the  nervous  body  which  governed  that  function. 
The  presence  of  a  myoma  indefinitely  delayed  the  meno¬ 
pause.  Menstruation  and  ovulation,  he  thought,  were  com¬ 
pletely  independent  functions,  having  perhaps  a  community 
of  purpose.  Removal  of  the  ovaries  often  did  not  affect 
menstruation,  but  removal  of  the  tubes  nearly  always  did  so. 
Butin  one  case  in  which  he  had  removed  both  ovaries,  tubes, 
and  part  of  the  fundus  uteri,  menstruation  continued  for 
more  than  a  year.  He  deprecated  the  triple  subdivision  of 
myomata  into  submucous,  intramural,  and  subperitoneal. 
For  pathological  and  surgical  purposes  he  proposed  a  new 
subdivision  into  the  nodular  and  the  concentric.  The  latter 
consisted  of  a  uniform  hypertrophy  of  the  muscular  tissue 
of  the  uterus,  in  the  midst  of  which  the  canal  lay  cen¬ 
trally;  the  tissue  of  this  form  was  loose,  and  usually  very 
oedematous.  Of  the  nodular  myoma  he  proposed  two  sub- 
varieties,  the  simple  and  the  multi-nodular.  He  believed 
that  each  nodule  was  seated  on  a  central  arterial  twig,  and 
that  its  growth  was  endogenous,  the  older  tissue  being  on  the 
outside.  The  dependence  of  such  growth  on  menstruation 
was  proved  by  the  fact  that  arrest  of  menstruation  arrested 
the  growth,  or  even  caused  the  complete  disappearance  of 
such  tumours.  This  had  been  in  several  cases  brought  about 
by  the  removal  of  the  tubes  only.  He  had  treated  fifty-four 
cases  of  uterine  myoma  by  removal  of  the  uterine  appen¬ 
dages,  with  three  deaths — a  mortality  of  5-5  per  cent., — a 


82 


Medical  Times  and  Gazette. 


NEW  INVENTIONS  AND  IMPROVEMENTS. 


July  21, 1883. 


striking  contrast  to  the  results  of  hysterectomy.  Of  these 
fifty-one,  in  thirty-eight  the  results  had  been  carefully  fol¬ 
lowed,  and  were  everything  that  was  to  he  desired.  In 
three  the  tumours  were,  or  became,  malignant.  In  three 
others  the  tumours  continued  to  grow,  although  menstrua¬ 
tion  had  been  arrested.  The  author  suspected  that  these 
were  either  fibro-cystic,  or  myoma  of  the  concentric  variety, 
in  neither  of  which  forms  was  the  removal  of  the  uterine 
appendages  useful. 

The  President  was  hardly  prepared  to  accept  Mr.  Tait’s 
classification ;  but  it  was  not  necessarily  antagonistic  to  the 
one  in  common  use.  He  agreed  with  Mr.  Tait  as  to  the 
delay  in  the  menopause  in  these  cases.  He  would  like 
further  evidence  as  to  the  sole  or  even  large  influence  of  the 
tubes  in  the  phenomena  of  menstruation. 

Dr.  Herman  had  published  a  case  in  which  the  symptoms 
of  a  fibroid  polypus  first  appeared  sixteen  years  after  the 
menopause.  The  history  of  patients  after  operations  like 
those  of  Mr.  Tait  was  of  great  importance,  for  patients  not 
benefited  often  did  not  return  to  the  operator,  and  he  there¬ 
fore  was  apt  to  get  a  too  favourable  impression  of  the  results. 

Dr.  Dewar  asked  if  Mr.  Tait  was  careful  to  tie  the  uterine 
artery,  and  whether  removal  of  the  tubes,  leaving  behind 
the  ovaries,  was  not  dangerous.  He  had  seen  one  case  in 
which  the  uterine  appendages  had  been  removed,  and 
hysterectomy  was  subsequently  required  on  account  of 
haemorrhage. 

Dr.  Meadows  preferred  the  present  classification  of  fibroid 
growths  to  that  suggested  by  Mr.  Tait,  as  being  founded  on 
clinical  characters,  and  of  great  practical  value  for  diagnosis 
and  treatment.  He  believed  that  the  ovaries,  and  not  the 
tubes,  were  the  prime  movers  in  menstruation.  In  one  case 
he  had  removed  the  ovaries  and  left  the  tubes,  and  menstrua¬ 
tion  ceased.  He  thought  there  were  many  exceptions  to  the 
rule  that  uterine  fibromata  ceased  to  grow  after  the  meno¬ 
pause.  Notwithstanding  the  high  rate  of  mortality  which 
attended  hysterectomy,  he  preferred  it  to  removal  of  the 
ovaries. 

Mr.  Lawson  Tait  said  that  cases  of  growth  of  apparent 
uterine  myomata  after  the  menopause  needed  most  careful 
examination.  Occasionally  removal  of  the  ovaries  arrested 
menstruation,  but  this  was  the  exception.  He  had  never 
knowingly  tied  the  uterine  artery,  and  it  would  be  very 
difficult  to  do  so. 


Health  of  the  City  oe  Glasgow. — The  medical 
officer’s  report  for  the  fortnight  ending  July  7,  1883,  states 
that  during  that  period  552  deaths  were  registered,  as  com¬ 
pared  with  602  for  the  previous  fortnight — a  decrease  of  50, 
representing  a  death-rate  of  28  (28*2),  in  place  of  30,  per  1000 
living.  There  had  been  101  deaths  below  one  year  of  age, 
instead  of  123,  and  71,  instead  of  83,  of  those  of  sixty  years 
and  upwards.  The  number  of  deaths  from  fever  was  9,  in 
place  of  7,  viz.,  5  from  typhus  and  4  from  enteric  fever. 
There  had  not  been  so  many  deaths  from  typhus  registered 
in  any  fortnight  since  November,  1880,  and  not  in  July  for 
at  least  ten  years.  The  number  of  deaths  from  infectious 
diseases  of  children  was  78,  in  place  of  108,  viz.,  measles  42, 
whooping-cough  25,  and  scarlet  fever  11.  The  death-rate 
for  the  past  fortnight  was  the  lowest  that  had  been  re¬ 
ported  since  November  last,  and  the  improvement  was  due 
chiefly  to  the  abatement  of  epidemic  measles.  The  number 
of  deaths  registered  last  week  from  measles  was  only  12, 
which  was  the  smallest  number  in  any  week  since  March. 
No  cases  of  small-pox  were  registered  during  the  fortnight. 
During  the  fortnight  122  cases  had  been  admitted  into  the 
fever  hospital,  107  were  dismissed  cured,  and  15  died;  6  cases 
were  dismissed  from  the  small-pox  hospital,  and  none  ad¬ 
mitted.  There  were  258  cases  of  measles  registered,  73  of 
scarlet  fever,  57  of  whooping-cough,  and  12  of  diphtheria. 
There  are  at  present  in  hospital  111  cases  of  scarlet  fever, 
63  of  measles,  38  of  enteric  fever,  28  of  typhus  fever,  24  of 
whooping-cough,  2  of  erysipelas,  1  of  diphtheria,  and  1  of 
small-pox,  giving  a  total  of  268  cases. 

Formula  for  Corns. — Dr.  Barbier,  writing  in  the 
Abeille  Medicale,  recommends  as  a  most  useful  application, 
which  he  has  repeatedly  tried,  equal  parts  of  acetic  acid 
and  tincture  of  iodine.  A  few  drops  are  applied  night 
and  morning,  which  gradually  use  up  the  pachydermatous 
covering  to  its  very  root. 


NEW  INVENTIONS  AND  IMPROVEMENTS. 

- • - 


NUSS  BAUM’S  BRACELET  FOR  WRITER’S  CRAMP. 
We  have  received  from  Messrs.  Krohne  and  Sesemann,  of 
Duke-street,  Manchester-square,  a  specimen  of  the  bracelet 
invented  by  Professor  von  Nussbaum,  of  Munich,  for  the 
treatment  of  the  spasmodic  disease  called  writer’s  cramp. 

This  is  in  fact  a  penholder, 
which  Nussbaum  calls  a  brace¬ 
let,  to  be  guided  by  the  exten¬ 
sors  and  abductors,  instead  of 
by  the  flexors  and  adductors. 
It  consists,  as  shown  in  the 
illustration,  of  a  band  of  vul¬ 
canite  of  oval  shape,  about 
an  eighth  of  an  inch  thick, 
and  one  inch  and  a  quarter 
broad,  with  an  oval  diameter 
of  about  three  inches  and  a 
quarter,  and  a  short  one  of 
an  inch  and  a  quarter.  All 
the  five  fingers  of  the  hand 
can  be  slipped  into  it.  In 
using  it,  however,  the  thumb 
only  just  enters,  the  little 
finger  is  left  free  outside,  and 
the  first,  second,  and  third 
fingers  are  passed  in  fully. 

The  instrument  can 
only  be  held  firmly 
by  expanding  the 
fingers  strongly, 
bringing  into  play 
the  abductors  of  the 
thumb  and  the  ex¬ 
tensors  of  the  first 
and  fourth  fingers. 
The  pen  is  screwed 
to  the  bracelet  so  as 
to  be  in  contact  with 
the  paper  when  the 
hand  lies  on  a 
table.  Professor  von 
Nussbaum  has  tried  the  treatment  of  the  instrument  in  a 
large  number  of  well-marked  cases  of  the  disease;  and 
states  that  all  the  patients  wrote  easily  and  well  with  it, 
and  all  of  them  said  they  felt  comfortable  and  confident  in 
employing  it,  writing  without  any  fear  of  spasm  being 
excited.  The  instrument  is  very  simple ;  and  any  patient 
employing  it  should  be  encouraged  to  write  as  much  as 
possible  with  it,  in  order  to  strengthen  thereby  the  anta¬ 
gonists  of  the  muscles  liable  to  the  spasmodic  contraction. 


POCKET  MEDICAL  EMERGENCY  CASE. 

Bi  T.  Frederick  Pearse,  M.D. 

This  case,  which  is  made  of  ebony,  resembles  in  form  a 
large  drawing-pencil.  It  contains  at  one  end  a  special 
hypodermic  syringe,  and  at  the  other  end  is  a  series  of  com¬ 
partments  which  contain  discs  and  perles  of  such  drugs  as 
are  most  likely  to  be  required  on  emergencies.  The  chief 


of  these  are — Morphia,  to  relieve  sudden  and  acute  pain ;  Apo- 
morphia,  to  excite  vomiting  quickly;  Nitrite  of  Amyl,  in 
perles,  for  employment  in  angina,  etc. ;  and  Ether,  in\perles, 
to  be  used  as  a  rapid  stimulant  in  cases  of  syncope,  etc. 
Each  compartment  is  labelled  with  the  name  and  strength 
of  the  drug  contained.  The  case,  which  is  made  by  Messrs. 
Arnold  and  Sons,  of  London,  is  very  compact  and  handy, 
and  will  be  found  very  useful  in  most  emergencies. 


PURE  AERATED  WATERS. 

We  have  received  from  Messrs.  Packham  and  Co.,  of 
Croydon,  samples  of  various  aerated  beverages  of  their 
manufacture,  which  deserve  high  commendation.  The 


Medical  Times  and  Gazette. 


MEDICAL  NEWS. 


July  21, 1883.  83 


water  employed  by  tbe  firm  is  from  the  deep  Croydon  wells, 
and  though  this  is  naturally  very  pure,  it  is  distilled  and 
filtered  through  charcoal  before  being  aerated.  The  excel¬ 
lence  of  the  processes  employed,  and  the  care  taken  to 
secure  the  purity  and  safety  of  the  beverages  manufactured, 
appear  to  be  perfectly  trustworthy,  and  are  certified  by 
Professors  Attfield  and  Wanklyn.  Among  the  samples 
sent  to  us  were  Orange  Champagne,  Lemon  Champagne, 
Sparkling  Lime  Wine,  Ginger  Ale,  an  excellent  Artificial 
Seltzer  Water  (containing  a  little  carbonate  of  magnesia  in 
the  place  of  carbonate  of  lime),  and  Hedozone,  an  already 
well-known  “  phosphated  tonic  ”  drink.  All  are  very  good, 
and  less  sweet  than  are  most  of  the  non-alcoholic  beverages 
provided  for  the  consumer  of  such  drinks ;  but  the  best  are, 
we  think,  the  Artificial  Seltzer  Water,  the  Ginger  Ale,  and 
the  Hedozone.  All  are  non-alcoholic. 


SAYOEY  AND  MOOEE’S  PREPARATIONS  OF 
CONVALLARIA. 

The  common  lily  of  the  valley,  the  Convallaria  majalis,  has 
lately,  as  our  readers  are  aware,  received  much  attention  as 
a  drug  of  marked  value  in  the  treatment  of  certain  cases  of 
disease  of  the  heart.  It  was  noticed  by  Dr.  Sansom  in  his 
Lettsomian  Lectures,  which  were  placed  before  the  profes¬ 
sion  in  our  pages;  and  we  have  received  from  Messrs. 
Savory  and  Moore,  143,  New  Bond-street,  London,  samples 
of  the  preparation  of  the  drug  prepared  by  them  for  his 
use.  These  preparations  consist  of  an  extract,  the  dose  of 
which  is  from  five  to  eight  grains  ;  a  fluid  extract,  to  be 
given  in  doses  of  from  five  to  twenty  minims ;  and  a  yellowish- 
white  amorphous  powder,  called  Convallamarin,  the  dose  of 
which  is  from  one-eighth  of  a  grain  to  two  grains.  The 
name  of  the  manufacturing  firm  is  a  sufficient  guarantee 
for  the  purity  and  excellence  of  the  preparations.  A 
summary  of  the  investigations  made  into  the  properties 
and  therapeutical  uses  of  the  drug  by  Botkin  and  Troitzky, 
by  Germain  See,  and  by  Stiller,  was  given  in  the  Medical 
Times  and  Gazette  of  January  6  last. 


MEDICAL  NEWS. 

- » - 

Royal  College  of  Surgeons  of  England. — The 
following  gentlemen  passed  their  Primary  Examinations 
in  Anatomy  and  Physiology  at  a  meeting  of  the  Board  of 
Examiners  on  the  12th  inst.,  and  when  eligible  will  be 
admitted  to  the  pass  examination,  viz.: — 

Blarney,  J.  H.,  student  of  University  College  Hospital. 

Farr,  Ernest,  of  the  Charing-cross  Hospital. 

Fenner,  Algernon,  of  King’s  College  Hospital. 

Gilkes,  E.  O.,  of  the  London  Hospital. 

Hinde,  A.  B.,  of  the  Middlesex  Hospital. 

Ives,  W.  R.  Y.,  of  the  Charing-eross  Hospital. 

Jaques,  J.  W.,  of  St.  Bartholomew’s  Hospital. 

Jarvis,  W.  C.,  of  the  London  Hospital. 

Lester,  Edward,  of  Guy’s  Hospital. 

Lipscomb,  E.  H.,  of  Guy’s  Hospital. 

Mallet,  T.  C.,  of  St.  George’s  Hospital. 

Palmer,  H.  G.,  of  St.  Thomas’s  Hospital. 

Parsons,  F.  G.,  of  St.  Thomas’s  Hospital. 

Pettigrew,  H.  T.  D,  of  St.  George’s  Hospital. 

Rigden,  Allen,  of  St.  George’s  Hospital. 

Ware,  G.  S.,  of  the  Middlesex  Hospital. 

Woodhouse,  F.  D.,  of  St.  George’s  Hospital. 

Eight  candidates  were  referred  for  three  months,  and  three 
for  six  months.  With  this  meeting  of  the  Board  the  Primary 
examinations  for  the  Membership  of  the  College  for  the 
present  session  were  brought  to  a  close,  and  out  of  the  222 
candidates  examined,  seventy-one,  having  failed  to  acquit 
themselves  to  the  satisfaction  of  the  Board  of  Examiners, 
were  referred  to  their  anatomical  and  physiological  studies 
for  three  months,  and  twelve  for  six  months,  making  a  total 
of  eighty-three.  At  the  corresponding  period  last  year  there 
were  252  candidates  examined. 

At  the  last  meeting  of  the  Council  of  the  College,  Mr. 
John  Edward  Smyth,  L.R.C.P.  Edin.,  of  Sugden-road, 
Clapham,  was  admitted  a  Fellow,  his  diploma  of  member¬ 
ship  bearing  date  June  3,  1842. 

The  following  gentlemen,  having  undergone  the  necessary 
examinations,  were  admitted  Members  of  the  College  at  a 
meeting  of  the  Court  of  Examiners  on  the  16th  inst.  : — 

Beck,  G.  S.,  M.B.  Toronto,  Peterborough,  Canada,  student  of  tbe  Toronto 
School. 

Bird,  F.  D.,  M.B.  Melb.,  Melbourne,  of  the  Melbourne  School. 


Cameron,  C.  E.,  M.B.  McGill,  Montreal,  of  the  McGill  School. 

Ford,  G.  W.,  L.R.C.P.  Edin.,  Upper  Kennington-lane,  of  St:  Thomas'* 
Hospital. 

Fraser,  T.  A.,  M.B.  Edin.,  Edinburgh,  of  the  Edinburgh  School. 
Gandevia,  N.  B„  L.R.C.P.  Lond.,  Bombay,  of  the  Grant  Medical  College. 
Gardner,  T.  F.,  L.S.A.,  Watford,  of  University  College  Hospital. 

Hunter,  William,  M.B.  Edin.,  Birkenhead,  of  the  Edinburgh  School. 
Jones,  J .  E.  E.,  L.R.C.P.  Lond.,  New  Swindon,  of  the  Middlesex  Hospital. 
Khan,  M.  I.,  L.R.C.P.  Lond.,  Chesterton-road,  W.,  of  the  Madras  School’.. 
Macdonald,  W.  H.,  M.B.  Toronto,  Toronto,  of  the  Toronto  School. 
McKenzie,  Archibald,  M.B.  Edin.,  Natal,  of  the  Edinburgh  School. 
Mackinnon,  F.  J.,  M.B.  Edin.,  Edinburgh,  of  the  Edinburgh  School. 
Nattress,  William,  M.B.  Toronto,  Toronto,  of  the  Toronto  School. 

Nicolet,  G.  P.,  M.B.  Edin.,  Edinburgh,  of  the  Edinburgh  School. 

Priestley,  Joseph,  M.B.  Edin.,  Manchester,  of  the  Edinburgh  School. 
Reckitt,  J.  D.  T.,  L.R.C.P.  Edin.,  A.M.D.,  of  the  Leeds  School. 

Rodman,  G.  H.,  M.B.  Durh.,  Selhurst-road,  S.E.,  of  the  Newcastle  School.. 
Rudge,  H.  T.,  L.R.C.P.  Edin.,  Bristol,  of  the  Bristol  School. 

Shuter,  C.  Y.,  L.8.A.,  Putney,  of  Guy’s  Hospital. 

Vincent,  George,  M.B.  Aber.,  Bedfont,  Middlesex,  of  the  Aberdeen  School. 
Ward,  A.  0.,  M.  B.  Edin.,  Eastbourne,  of  the  Edinburgh  School. 

Willett,  E.  W.,  L.S.A.,  Brighton,  of  St,  Bartholomew’s  Hospital. 
Woodbury,  J.  McG.,  M.D.  New  York,  New  York,  of  the  University  of 
New  York. 

One  gentleman  was  approved  in  Surgery,  and,  when  qualified 
in  Medicine,  will  be  admitted  a  Member  of  the  College,  and 
four  candidates,  having  failed  to  acquit  themselves  to  the 
satisfaction  of  the  Court  of  Examiners,  were  referred  to 
their  professional  studies — two  for  six  months,  and  two  for 
three  months.  At  this  meeting  of  the  Court,  Mr.  Edward 
Lund,  of  Manchester,  the  recently  elected  member  of  the 
Court  of  Examiners,  took  his  seat.  The  following  gentle¬ 
men  were  admitted  Members  of  the  College  on  the  17th 
inst.,  viz. : — 

Baxter,  W.  W. ,  L.R.C.P.  Edin.,  Pontardawe,  student  of  University  College 
Hospital. 

Beebe,  C.  E.,  L.8.A.,  Cambridge-street,  S.W.,  of  Guy’s  Hospital. 

Cox,  J.  H.,  L.S.A.,  Doddington-grove,  S.E.,  of  Guy’s  Hospital. 

Craig,  James,  M.B.  Edin.,  Castle  Douglas,  N.B.,  of  the  Edinburgh  School. 
Donald,  Archibald,  M.B.  Edin.,  Edinburgh,  of  the  Edinburgh  School. 
Ellis,  J.  L.,  L.K.&Q.C.P.  Ire.,  Dinas  Mawddwy,  Merionethshire,  of  the- 
Dublin  School. 

Holyoake,  J.  P.,  L.R.C.P.  Edin.,  Kinver,  Staffordshire,  of  University 
College  Hospital. 

Jones,  J.  H.,  L.S.A.,  Manchester,  of  the  Manchester  School. 

Lawrv,  T.  S.,  M.B.  Edin.,  Auckland,  of  the  Edinburgh  School. 

Lloyd,  H.  S.,  M.B.  Edin.,  Adelaide,  of  the  Edinburgh  School. 

Mackay,  George,  M.B.  Edin.,  Inverness,  of  the  Edinburgh  School. 
Nieuwoudt,  Gerrit,  M.B.  Edin.,  Cape  of  Good  Hope,  of  the  Edinburgh 
School. 

Parsloe,  H.  H.,  L.R.C.P.  Edin.,  Chippenham,  of  University  College 
Hospital. 

Paterson,  A.  M.,  M.B  Edin.,  Manchester,  of  the  Manchester  School. 
Phillpott,  G.  F.,  L.R.C.P.  Edin.,  Norton,  near  Stourbridge,  of  University 
College  Hospital. 

Shillito,  W.  A  ,  L.S.A.,  Sheffield,  of  the  Sheffield  School. 

Sutcliffe,  V.  Eugene,  L.R.C.P.  Edin.,  Scarborough,  of  the  Leeds  School. 
Welchman,  E.  W.,  L.R.C.P.  Edin.,  Lichfield,  of  the  Birmingham  School. 
Wilson,  T.  S.,  M.B.  Edin.,  Birmingham,  of  the  Edinburgh  School. 

Eleven  candidates  were  referred — viz.,  six  for  six  months, 
and  five  for  three  months.  The  following  gentlemen  were 
admitted  Members  of  the  College  on  the  18th  inst.,  viz. : — 

Gostling,  W.  A.,  Diss,  Norfolk,  student  of  University  College  Hospital. 
Jackson,  A.  M.,  Great  Grimsby,  of  St.  Bartholomew’s  Hospital. 

Overton,  Arthur,  Horncastle,  of  the  Liverpool  School. 

Pedley,  R.  D.,  Stockwell,  of  St.  Thomas’s  Hospital. 

Southcoinbe,  A.  G.,  Bath,  of  St.  Bartholomew’s  Hospital. 

Stericker,  G.  F.,  Pickering,  of  the  Leeds  School. 

Travis,  W.  O.,  Liverpool,  of  the  Liverpool  School. 

Six  candidates  who  passed  in  Surgery  at  previous  meetings 
of  the  Court,  having  subsequently  obtained  medical  qualifi¬ 
cations,  were  admitted  Members,  viz. : — 

Dunn,  J.  E.,  L.R.C.P.  Edin.,  Preston,  student  of  St.  Thomas’s  Hospital. 
Gordon,  A.  H.,  L.R  C.P.  Edin.,  Belsize-park,  of  King’s  College  Hospital. 
Kitching,  J.  S.  W.,  L.S.A.,  Derby,  of  St.  Thomas’s  Hospital. 

Morgan,  L.  A.,  M.B.  Durh.,  Myddelton-square,  of  St.  Thomas’s  Hospital. 
Papillon,  J.  W.,  L.S.A.,  Reading,  of  St.  Thomas’s  Hospital. 

Roberts,  A.  H.,  L.R.C.P.  Lond.,  Hampstead,  of  St.  Bartholomew’s 
Hospital. 

One  candidate  who  had  previously  qualified  in  Surgery  and 
Midwifery,  having  passed  in  Medicine,  was  also  admitted  a 
Member,  viz. :  — 

Foster,  A.  E.,  Bradford,  student  of  the  Leeds  School. 

Seven  candidates  passed  in  Surgery,  and  when  qualified  in 
Medicine  and  Midwifery  will  be  admitted  Members.  Five 
candidates  were  referred  for  six  months,  four  for  three 
months,  and  one  for  twelve  months. 

Pass  Examinations. — The  following  were  the  questions  on 
Surgical  Anatomy  and  the  Principles  and  Practice  of  Sur¬ 
gery  submitted  to  the  252  candidates  for  the  diploma  of 
Membership  of  the  Royal  College  of  Surgeons  of  England 
at  the  written  examination  on  the  13th  inst.,  when  they 
were  required  to  answer  at  least  four  (including  one  of  the- 
first  two)  out  of  the  six  questions,  from  1.30  to  4.30  p.m., 


84 


Medical  Times  and  Gazette. 


MEDICAL  HEWS, 


July  21,  1883. 


viz.  : — 1.  Describe  the  operation  of  enucleation  of  the  eye¬ 
ball;  enumerate  all  the  structures  divided  in  its  perform¬ 
ance.  2.  Describe  an  amputation  a  hand’s  breadth  below  the 
knee-joint,  and  give  the  relative  position  of  the  structures 
•seen  on  the  face  of  the  stump.  3.  Mention  the  causes  and 
describe  the  treatment  of  purulent  discharge  from  the  ear. 
4.  Give  the  various  positions  in  the  air-passages  in  which  a 
foreign  body  may  lodge  ;  describe  the  symptoms  and  treat¬ 
ment  in  each  case.  5.  Define  briefly  the  following  terms : — 
(a)  ranula;  (l)  epulis;  (c)  melanosis  ;  (d)  Pott’s  disease; 
(e)  paraplegia ;  (/)  renal  colic ;  (g)  staphyloma.  6.  What  are 
the  causes,  symptoms,  and  results  of  acute  suppuration  in  the 
knee-joint?  Give  the  treatment  appropriate  to  its  various 
stages. — On  the  following  day,  from  half-past  twelve  to  two 
o’clock,  candidates  were  required  to  answer  three  of  the  four 
following  questions  on  Midwifery  and  Diseases  of  Women, 
viz. : — 1.  How  would  you  treat  a  case  of  labour  rendered 
difficult  by  impaction  of  the  breech?  2.  What  are  the 
causes  of  rigidity  of  the  os  uteri  during  labour  ?  How  would 
you  treat  this  condition  ?  3.  What  is  the  lochial  discharge  ? 
What  are  its  characters  in  a  natural  lying-in  ?  What  altera¬ 
tions  in  it  would  you  regard  as  indications  of  a  morbid  pro¬ 
cess  ?  How  would  you  treat  the  conditions  in  question  ? 
4.  What  symptoms  are  commonly  associated  with  retroflexion 
of  the  unimpregnated  uterus  ?  How  would  you  treat  this  con¬ 
dition  ? — On  the  same  day,  from  half-past  two  to  half-past  four 
o’clock,  candidates  were  required  to  answer  three  out  of  the 
following  four  questions  on  the  Principles  and  Practice  of 
Medicine,  including  question  No.  4,  viz. : — 1.  Describe  the 
signs  and  symptoms  of  hydrothorax,  and  the  points  of  dis¬ 
tinction  between  it  and  conditions  which  may  be  mistaken 
for  it.  Mention  the  causes  that  give  rise  to  it,  and  the  treat¬ 
ment  required  in  different  circumstances.  2.  Describe  the 
symptoms  and  course  of  tubercular  meningitis,  and  the 
pathological  changes  as  observed  after  death.  3.  Describe 
a  fit  of  ague.  What  varieties  of  this  disease  are  found  in 
England  ?  What  is  known  as  to  the  conditions  in  which  it 
arises  ?  What  treatment  is  required  ?  4.  Indicate  the  effects 
and  uses  of  calomel,  tartarated  antimony,  iodide  of  potas¬ 
sium,  digitalis,  colchicum,  and  ipecacuanha.  Name  the 
preparations  of  each,  and  their  doses. 


Apothecaries’  Hale,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday, 
July  12  : — 

Beebe,  Charles  Edward,  Cambridge- street. 

Column,  Henry,  Cumberland  House,  Kew. 

Donovan,  Denis  William,  Keppel-street,  Russell-square. 

Felix,  Edward,  Bedford-square. 

Green,  Edwin  Collier,  Telford-avenue,  Streatham. 

MacLeroy,  Arthur  Lloyd,  The  Hyde,  Hendon,  N.W. 

Parry-Jones,  Maurice,  Trinity-square,  S.E. 

Robertson,  James  Sprent,  Netherwood-road,  Kensington. 

Rook,  Albert  Edward,  London-road,  Forest  Hill. 

Shuter,  Charles  Yaldwyn,  Lower  Richmond-road,  Putney. 

The  following  gentlemen  also  on  the  same  day  passed  their 
Primary  Professional  Examination  : — 

Gimblett,  William  Henry,  Middlesex  Hospital. 

Praeger,  Emil  Arnold,  Bristol  General  Hospital. 


APPOINTMENTS. 

•***  The  Editor  will  thank  gentlemen  to  forward  to  the  Publishing-office, 
as  early  as  possible,  information  as  to  all  new  Appointments  that  take 

place.  - 

Ackland,  J.  McKno,  L.D.S.Eng. — Dental  Surgeon  to  the  Exeter  Dental 
Hospital,  vice  Augustus  King,  L.D.S.  (resigned). 


NAYAL,  MILITARY,  Etc.,  APPOINTMENTS. 

Army  Medical  Department.— Surgeon-General  John  Andrew  Woolfryes, 
M.D.,  C.B.,  C.M.G.,  has  been  granted  retired  pay;  Surgeon -General 
James  Edmund  Clutterbuck,  M.D.,  has  been  granted  retired  pay. 
Whitehall.— The  Lord  Chancellor  has  appointed  Reginald  Southey, 
M.D.,  to  be  a  Commissioner  in  Lunacy,  on  the  resignation  of  Robert 
Nairne,  M.D. 


DEATHS. 

Croker,  John  Rees,  M.R.C.S.,  etc.,  at  Malvern  Link,  Worcestershire,  on 
July  12. 

Houston,  Patrick  Cruikshank,  M.D.,  at  Kirkcaldy,  on  July  16. 

Mein,  Archibald,  M.D.,  formerly  of  94,  George-street,  at  12,  Glencairn- 
crescent,  Edinburgh,  on  July  12. 

Stewart,  Alexander  Patrick,  M.D.,  at  76,  Grosvenor-street,  on  July  17> 
in  his  71st  year. 

Thurston,  George  J ames,  M.R.C.S.,  L.R.C.P.  Edin.,  at  Sandown,  Isle  of 
Wight,  on  July  10,  aged  56. 


VACANCIES. 

In  the  following  list  the  nature  of  the  office  vacant,  the  qualifications  re¬ 
quired  in  the  candidate,  the  person  to  whom  application  should  be  made 
and  the  day  of  election  (as  far  as  known)  are  stated  in  succession. 

Brighton,  Hove,  and  Sussex  Throat  and  Ear  Dispensary,  23,  Queen’s- 
road,  Brighton. — Honorary  Assistant-Surgeon.  Applications,  together 
with  copies  of  testimonials,  to  be  sent  to  Christopher  Challis,  Hon.  Sec., 
60,  King’s-road,  Brighton  (of  whom  all  further  particulars  may  be  had), 
on  or  before  July  29. 

Evelina  Hospital  for  Sick  Children,  Southwark-bridge-road,  S.E.— 
Dental  Surgeon.  Candidates  must  be  Licentiates  in  Dental  Surgery  and 
Members  of  the  Royal  College  of  Surgeons.  Applications  and  testi¬ 
monials  to  be  addressed  to  the  Committee  of  Management  at  the  Hospi¬ 
tal,  not  later  than  July  24. 

Gateshead  Dispensary.— Assistant-Surgeon.  Salary  £120  per  annum, 
without  board  or  apartments.  Candidates  must  be  doubly  qualified. 
Copies  of  testimonials  to  be  sent  to  Mr.  Joseph  Jordon,  2,  Side,  New- 
castle-on-Tyne,  on  or  before  July  20. 

Leeds  Public  Dispensary.— Resident  Medical  Officer.  Candidates  must 
he  qualified  and  unmarried.  Applications  and  testimonials  must  be 
sent  in  before  July  23,  to  Mr.  H.  Bendelack  Hewetson,  11,  Hanover- 
square,  Leeds. 

Middlesex  County  Lunatic  Asylum,  Colney  Hatch. — Assistant  Medical 
Officer.  ( For  particulars  see  Advertisement.) 

Royal  Free  Hospital,  Gray’s-inn-road,  W.C. — Junior  Resident 
Medical  Officer.  ( For  particulars  see  Advertisement.) 

Salop  Infirmary,  Shrewsbury.  —  House-Surgeon.  Salary  £100  per 
annum,  with  hoard  and  residence.  Candidates  must  be  Fellows  or 
Members  of  the  Royal  College  of  Surgeons  of  England,  Edinburgh,  or 
Dublin,  and  hold  also  qualifications  to  practise  medicine.  Testimonials, 
with  certificates  of  qualifications,  to  be  addressed  to  the  Board  of 
Directors,  not  later  than  July  27. 


UNION  AND  PAROCHIAL  MEDICAL  SERVICE, 

***  The  area  of  each  district  is  stated  in  acres.  The  population  is 
computed  according  to  the  census  of  1881. 

RESIGNATIONS. 

Bolton  Union. — Mr.  T.  B.  White  has  resigned  the  office  of  Resident 
Assistant  Medical  Officer  to  the  Workhouse  :  salary  £150  per  annum. 

Township  of  Manchester . — Mr.  W.  E.  Bailey  has  resigned  the  office  of 
Resident  Assistant  Medical  Officer  at  the  Crumpsall  Workhouse :  salary 
£140  per  annum. 

Reigate  Union.— Mr.  T.  C.  Lawson  has  resigned  the  No.  4  District :  area 
7162  ;  population  2302  ;  salary  £40  per  annum. 

Skirlaugh  Union.—  Mr.  Francis  Calvert  has  resigned  the  Brandes  Burton 
District :  area  10,430  ;  population  1582 ;  salary  £24  per  annum. 

APPOINTMENTS. 

Skipton  Union.— John  Anthony,  L.R.C.P.  Edin.,  L.F.P.& S.  Glasg.,  to 
the  Grassington  District. 

Stourbridge  Union. — Henry  Walker,  M.D.  Edin.,  L.R.C.S.  Edin.,  L.S.A., 
to  the  Kingswinford  District. 

Tisbury  Union. — Henry  H.  Bate,  L.R.C.P.  Edin.,  L.R.C.S.  Edin., 
L.S.A.  Lond.,  to  the  Hindon  District. 

Wilton  Union.—  Daniel  M.  Jones,  B.M.  and  M.C.  Edin.,  to  the  Bishop- 
stone  District. 


Plea  of  Insanity. — At  the  New  York  Medico-Legal 
Society,  the  District  Attorney,  Colonel  Corkhill,  read  a  paper 
on  “  Insanity  as  a  Defence  of  Crime,”  in  which  he  referred 
to  the  great  extent  to  which  insanity  has  been  used  as  an 
excuse  for  crime.  Speaking  of  the  cases  in  which  men  who 
avenge  the  ruin  of  their  domestic  bliss  by  killing  the  de¬ 
stroyer,  and  are  acquitted  on  the  ground  of  emotional 
insanity,  he  said,  “Would  it  not  be  more  creditable  to  our 
juries  and  more  honourable  to  the  administration  of  justice 
to  let  the  jury  say  by  their  verdict  that  the  justification  of 
the  crime  was  in  the  character  of  the  act  which  provoked  it, 
and  not  encourage  and  countenance  this  plea  of  insanity  by 
a  verdict  as  contrary  to  their  oaths  and  to  law  as  would  be 
the  former?  If  they  must  apologise,  let  it  be  the  more 
manly  apology  of  open  refusal  to  find  a  prisoner  guilty  under 
such  serious  provocation  than  to  shield  themselves  behind  a 
defence  which  neither  they  nor  the  community  which  they  re¬ 
present  believe.”  Colonel  Corkhill  does  not  think  that  in¬ 
sanity  should  ever  be  allowed  as  a  plea  of  defence  for  crime  in 
the  trial  of  a  prisoner  under  the  indictment.  When  a  pri¬ 
soner  proposes  to  defend  his  crime  on  the  ground  of  insanity, 
a  jury  should  be  specially  chosen  for  their  fitness  to  try 
the  special  plea  ;  and  if  the  prisoner,  after  trial,  is  found  to 
be  insane,  then  he  should  be  confined  in  an  insane-prison  a 
certain  time,  commensurate  with  the  character  of  bis  crime. 
If,  however,  the  verdict  of  the  jury  declare  him  to  be  sane, 
the  plea  of  insanity  should  not  be  allowed  on  the  trial  of  the 
cause.  It  is  not  a  question  whether  the  plea  of  insanity 
should  be  allowed  as  a  defence  for  crime,  but  whether  some 
means  cannot  be  devised  under  the  law  by  which  its  exist¬ 
ence  can  be  rationally  and  honestly  determined. — New  York 
Med.  Record,  June  23. 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES. 


July  21,1883.  85 


VITAL  STATISTICS  OF  LONDON. 


Week  ending  Saturday,  July  14,  1883. 

BIRTHS. 

Births  of  Boys,  1275 ;  Girls,  1259 ;  Total,  2534. 

Corrected  weekly  average  in  the  10  years  1873-82,  2595-6. 


DEATHS. 


Males. 

Females. 

Total. 

Deaths  during  the  week . 

873 

863 

1736 

Weekly  average  of  the  ten  years  1873-82,  / 

834-7 

746-0 

1580-7 

49 

corrected  to  increased  population  ...  j 

Deaths  of  people  aged  80  and  upwards 

DEATHS  IN  SUB-DISTRICTS  FROM  EPIDEMICS. 


Enumerated 

Population, 

1881 

(unrevised). 

Small-pox. 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

.9  J 

ft  to 
©  P 

O  o 

rP  O 

Typhus. 

Enteric  (or 
Typhoid) 
Fever. 

Simple 

continued 

Fever. 

Diarrhoea.  1 

West . 

669633 

1 

2 

2 

3 

3 

2 

58 

North 

905947 

... 

6 

7 

12 

7 

•  •• 

2 

61 

Central 

282238 

.  .  • 

9 

1 

3 

1 

... 

1 

... 

41 

East . 

692738 

22 

14 

4 

5 

... 

3 

1 

71 

South . 

1265927 

... 

32 

6 

5 

15 

1 

4 

1 

94 

Total . 

3816483 

... 

70 

30 

26 

31 

1 

13 

4 

325 

METEOROLOGY. 

From  Observations  at  the  Greenwich  Observatory. 


Mean  height  of  barometer  . 

... 

... 

...  29’581  in. 

Mean  temperature  . 

... 

... 

...  61-4° 

Highest  point  of  thermometer 

.*• 

...  78-1° 

Lowest  point  of  thermometer  ... 

... 

...  51-0° 

Mean  dew-point  temperature 

... 

... 

...  55-6° 

General  direction  of  wind  . 

•*? 

...  S.W. 

Whole  amount  of  rain  in  the  week  ... 

... 

... 

... 

...  0’87  in. 

BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  the 
Week  ending  Saturday,  July  14,  in  the  following  large  Towns : — 


Cities 

and 

Boroughs. 

Estimated  Population  to 
middle  of  the  year  1883. 

Births  Registered  during 
the  week  ending  July  14. 

|  Deaths  Registered  during 
j  the  week  ending  July  14. 

Annual  Rate  of 
Mortality  per  1000  living, 
from  all  causes. 

Temperature 
of  Air  (Fahr.) 

Temp, 
of  Air 
(Cent.) 

Rain 

Fall. 

Highest  during 
the  Week. 

1  Lowest  during 
theWeek. 

Weekly  Mean  of 
Daily  MeanValues 

Weekly  Mean  of 
Daily  Mean 
Values. 

In  Inches. 

In  Centimetres. 

London 

3955814 

2534 

1736 

22-9 

78-1 

51-0 

61-4 

16-33 

0-87 

221 

Brighton  ... 

111262 

69 

39 

18-3 

723 

53-2 

60-9 

16-06 

071 

1-80 

Portsmouth 

131478 

86 

45 

17-9 

... 

... 

... 

... 

... 

.  . . 

Norwich 

89612 

48 

26 

15-1 

... 

... 

... 

.  .  • 

Plymouth  ... 

74977 

44 

20 

139 

67-7 

529 

59-1 

15-06 

0-45 

1-14 

Bristol . 

212779 

132 

69 

16'9 

69-0 

51-6 

58-3 

14-61 

0-48 

1-22 

Wolverhampton  . 

77557 

61 

32 

21-5 

75  3 

46-4 

58-0 

14-44 

0-61 

1-55 

Birmingham 

414846 

259 

155 

195 

... 

... 

... 

... 

Leicester  ... 

129483 

93 

40 

16-1 

74-0 

50-5 

60-2 

15-67 

1-09 

2-77 

Nottingham 

199349 

139 

73 

191 

77-8 

48-3 

61-6 

16-45 

0-26 

0-66 

Derby . 

85574 

63 

27 

16-5 

... 

... 

... 

... 

... 

Birkenhead 

88700 

63 

23 

135 

.  .  . 

... 

... 

... 

Liverpool  ... 

566763 

352 

253 

233 

69-4 

49-3 

57  6 

14-23 

0-65 

1-40 

Bolton . 

107862 

74 

37 

17-9 

696 

45-8 

66-2 

13-44 

0-83 

2  11 

Manchester 

339262 

239 

168 

25-8 

•  •• 

... 

... 

c. 

... 

Salford 

190466 

100 

65 

17-8 

•  .  • 

.  .  . 

... 

... 

... 

... 

Oldham 

119071 

72 

41 

18-0 

... 

... 

... 

... 

... 

Blackburn  ... 

108460 

85 

35 

16-8 

... 

... 

Preston 

98564 

74 

47 

24-9 

715 

54-0 

69-9 

15-50 

0-71 

1-80 

Huddersfield 

84701 

47 

42 

259 

... 

... 

... 

... 

... 

Halifax 

75591 

37 

19 

131 

... 

... 

Bradford  ... 

204807 

120 

60 

153 

72-8 

50-0 

60-1 

15-62 

0-33 

O' 84 

Leeds  . 

321611 

257 

108 

175 

75-0 

50-0 

61-4 

16-33 

0-45 

1-14 

Sheffield  ... 

295497 

214 

113 

20-0 

73-0 

49-0 

59-3 

15-17 

0-19 

0-48 

Hull  . 

176296 

138 

67 

19-8 

75-0 

46-0 

600 

15-56 

0-52 

1-32 

Sunderland 

121117 

71 

225 

96-9* 

... 

... 

... 

Newcastle  ... 

149464 

117 

78 

27-2 

... 

... 

•  •• 

... 

... 

Cardiff . 

90033 

59 

17 

98 

... 

... 

... 

... 

... 

For  28  towns 

862C975 

5647 

3660 

222 

78-1 

45-8 

59- e 

15-34 

0-58 

1-47 

Edinburgh  ... 

235946 

128 

63 

13-9 

70-8 

47-2 

59-0 

15-00 

0-85 

216 

Glasgow 

... 

515589 

35) 

234 

237 

68-5 

45-0 

58-4 

14-66 

1-45 

3-68 

Dublin . 

... 

349685 

174 

138 

206 

67-6 

47'3158-i 

14-50 

103 

2.62 

*  This  high  death-rate  is  due  to  the  registration  of  177  deaths  of  children, 
resulting  from  the  disaster  at  the  Victoria  Theatre  in  that  town. 

At  the  Royal  Observatory,  Greenwich,  the  mean  reading 
of  the  barometer  last  week  was  29-58  in.  The  highest  read¬ 
ing  was  29-74  in.  both  on  Sunday  morning  and  Monday 
evening,  and  the  lowest  29-34  in.  on  Thursday  evening. 


NOTES,  QUERIES,  AND  REPLIES. 

- ♦— - 

It  tfcat  questiondljr  s(jh1I  Itarn  mtufr. — Bacon. 

Professor  Babington  has  prepared  two  pages  of  additions  and  corrections 
for  the  eighth  edition  of  his  “  Manual  of  British  Botany.”  Anyone 
having  the  book  may  obtain  these  pages  gratis  on  application  to  the 
publisher,  Mr.  Van  Voorst,  1,  Paternoster-row,  E.C. 

A  Provincial  Teacher. — Mr.  Edward  Lund,  of  Manchester,  the  recently 
elected  member  of  the  Court  of  Examiners  of  the  Royal  College  of 
Surgeons,  who  took  his  seat  at  a  meeting  of  the  Court  on  the  16th  inst., 
is  not  the  first  provincial  surgeon  so  elected.  Professor  George  Murray 
Humphry,  of  Cambridge,  still  a  member  of  it,  was  elected  in  1877.  Mr. 
Lund  was  admitted  a  Member  of  the  College,  April  9,  1847,  and  a  Fellow 
by  examination,  June  12, 1863. 

The  Thoughtless  Use  of  Firearms.— Mr.  CharlesM.  Leakey,  medical  student, 
was  tried  at  the  Leicester  Assizes  last  week,  charged  with  shooting  a 
boy  on  April  30,  and  was  found  by  the  jury  not  guilty,  and  discharged. 
It  will  be  remembered  that  the  boy  climbed  the  wall  of  the  vicarage 
garden  at  Blaby  to  watch  a  lawn-tennis  match.  He  refused  to  get 
down,  and  Mr.  Leaky  went  and  got  his  gun,  into  which  he  put,  as  he 
thought,  a  blank  cartridge,  but  some  shot  had  been  left  in  it.  He  pointed 
the  gun  at  the  boy,  merely  intending  to  frighten  him,  and  fired,  when 
the  lad  sustained  a  wound  in  the  chest  and  a  severe  shock.  The  boy’s 
family  will  be  awarded  adequate  compensation. 

A  Student.— The  examinations  will  be  continued  through  this  and  the- 
succeeding  week. 

A  Fatal  Case  of  Sea-Sickness. — An  inquest  has  been  held  at  Wapping  on 
the  body  of  a  young  woman,  aged  thirty-one,  a  lady’s  maid.  The 
deceased  had  been  a  passenger  on  board  a  steamer  from  Copenhagen. 
She  suffered  greatly  from  sea-sickness,  and  continued  to  do  so  during 
the  whole  passage.  There  was  no  doctor  on  board.  When  the  steamer- 
arrived  at  Gravesend  she  was  insensible,  and  was  afterwards  found  dead 
in  her  cabin.  She  appeared  quite  well  when  she  went  on  board.  The 
medical  evidence,  after  a  post-mortem  examination,  was  to  the  effect 
that  the  body  exhibited  no  marks  of  violence ;  the  cause  of  death  was- 
sudden  failure  of  the  heart’s  action  from  prolonged  sickness.  A  verdict 
in  accordance  with  the  medical  testimony  was  returned. 

Fish  Dinners  for  Paupers.—  The  Bristol  Board  of  Guardians  propose  to  try 
the  experiment  for  one  month  of  giving  a  fish  dinner,  once  a  week,  to 
the  inmates  of  the  workhouse.  Codfish  and  haddocks  will  be  supplied 
from  Grimsby  at  2d.  per  lb. 

Ambulance  Field  Day. — The  ambulance  department  of  the  Birmingham 
Volunteers,  accompanied  by  a  section  of  G  company,  under  the  com¬ 
mand  of  Surgeon-Major  Thompson  and  Surgeon  Freer,  have  had  a 
field  day  for  the  purpose  of  practising  the  duties  of  a  bearer  company. 
The  officers  present  expressed  their  entire  satisfaction  with  the  admirable 
skill  shown  by  the  detachment. 

Adequate  Legal  Powers. — The  Law  and  Parliamentary  Committee  of  the 
Kensington  Vestry  report,  with  reference  to  the  letter  from  the  Fulham 
District  Board  of  Works,  forwarding  a  copy  of  a  report  of  the  Medical 
Officer  of  Health  upon  the  recent  outbreak  of  typhus  fever  at  Nazareth 
House,  Hammersmith,  and  the  necessity  of  seeking  Parliamentary 
powers  for  the  sanitary  regulation  of  public  institutions  of  a  character 
similar  to  that  of  Nazareth  House,  that  the  Committee  were  of  opinion 
that  the  powers  given  by  the  Nuisances  Removal  Acts  for  the  inspection 
of  public  institutions  were  sufficient,  and  that  it  was  therefore  unneces¬ 
sary  to  seek  for  further  legislation  on  the  subject. 

Sarcina  Vomiting—  You  will  find  the  interesting  lecture  on  “ Disease  of 
the  Stomach  and  Vomiting  of  Sarcinse,”  by  the  late  Dr.  Todd,  in  the 
Medical  Times  and  Gazette  for  July  1,  1854.  Several  cases  of  sarcina- 
vomiting  were  recorded  by  Dr.  Ransom,  of  Norwich,  also,  in  a  paper 
published  in  this  journal,  November  12  and  19,  1853. 

Collapse  of  the  Grangemouth  Public-house  Cases. — Lord  Zetland’s  agents 
have  intimated  to  the  agent  for  the  Grangemouth  publicans  that  his 
lordship  does  not  intend  to  proceed  further  with  these  cases,  and  that 
if  the  defenders  allow  the  actions  to  drop  he  will  not  claim  payment  of 
the  portion  of  the  expenses  in  the  Court  of  Session  to  which  he  was 
found  entitled  by  the  House  of  Lords.  To  this  the  defenders  have 
agreed.  The  cases  are  consequently  now  at  an  end. 

A  Disinfecting  Mishap.— A.  contemporary  is  responsible  for  the  following 
story  : — A  doctor  attended  a  small-pox  patient  on  board  the  South 
Dublin  Port  Hospital  Ship,  which  appears  to  be  under  the  authority  of 
the  South  Dublin  Guardians.  His  duty  performed,  the  question  of 

.  disinfecting  the  doctor  as  well  as  his  clothes  was  considered.  It 
happened  that  not  far  from  the  Port  Hospital  Ship  there  was  a  small 
island ;  thither  the  doctor  was  conveyed.  The  disinfecting  his  apparel 
was  easily  disposed  of,  for  it  was  completely  destroyed  by  fire.  The 
doctor’s  personal  disinfection  remained ;  and,  being  left  in  the  nude 
state,  he  plunged  into  the  sea  and  soon  succeeded  in  reaching  the  shore. 
Whether  he  met  on  landing  with  any  sympathy,  and  how  he  reached  his 
home,  are  left  to  conjecture. 


86 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES 


July  21,  1883. 


Dr.  Thompson. — The  new  Calendar  of  the  College  of  Surgeons  does  not  go 
to  press  until  after  the  annual  election  of  President  and  Vice-Presidents, 
and  therefore  will  not  be  published  for  several  weeks.  It  will  give  you 
the  desired  information  on  both  subjects  of  your  inquiry. 

The  National  Sanitary  Corporation. — This  scheme  is  comprehensive.  It 
comprises  the  rendering  of  homes  and  public  buildings  perfect  in 
drainage,  ventilation,  light,  and  temperature — objects  which  are  to  be 
accomplished  by  the  employment  of  professional  specialists  in  reporting, 
■detecting,  and  remedying  defects.  After  the  completion  of  the  works 
recommended,  the  directors  will  be  prepared  to  give  certificates,  under 
their  seal,  that  the  sanitary  condition  of  the  home  or  building  has  been 
perfected. 

Coventry. — Small-pox  having  been  discovered  to  have  broken  out  in  one 
of  the  chief  hotels  of  the  city,  the  sanitary  authority  immediately  took 
the  necessary  steps  to  isolate  the  disease  and  prevent  its  spreading. 

Vaccination.— It  is  understood  that  the  late  discussion  in  the  House  of 
Commons  on  this  question  has  stimulated  the  Brighton  Board  of 
Guardians  to  enforce  the  Acts  even  more  energetically.  The  seizures, 
a  few  days  since,  of  goods  of  anti-vaccinators,  which  had  been  distrained 
upon  by  the  Board  for  non-payment  of  fines,  were  valued  at  upwards  of 
£200.  The  total  number  of  warrants  was  between  fifty  and  sixty.  On 
the  occasion  of  the  public  sale  there  was  an  anti-vaccination  demon¬ 
stration,  but  it  was  deprived  of  much  of  its  intended  effect  by  the  active 
interposition  of  the  police. 

Fines  for  Milk  Adulteration. — That  the  fines  for  milk  adulteration  are  paid 
by  an  association,  and  that  the  fact  should  be  widely  known,  was  the 
subject  of  some  remarks  at  the  last  meeting  of  the  District  Board  of 
Work  for  St.  Saviour’s,  Borough. 

The  Judge's  Lodgings  during  the  Assizes,  Northampton. — Baron  Huddleston 
at  the  recent  assizes  strongly  complained  of  the  bad  accommodation 
provided  for  Mr.  Justice  Smith  and  himself.  The  sanitary  arrange¬ 
ments  of  their  lodgings  he  denounced  as  execrable.  The  drainage  was 
so  pestiferous  he  could  scarcely  remain  in  his  room.  He  had  given  in¬ 
struction  to  engage  other  lodgings  unless  this  state  of  things  were 
remedied,  as  it  was  not  safe  to  remain  in  the  present  apartments. 

A  Sanitary  Precaution. — In  view  of  a  small-pox  epidemic  in  Birmingham, 
the  Board  of  Guardians  have  resolved  to  restrict  the  visits  to  inmates  of 
the  workhouse  to  one  day  a  month. 

New  Baths  for  North  London. — A  building  called  the  Finsbury-park  Baths 
has  just  been  opened.  It  is  situated  in  Fonthill-road,  near  Finsbury- 
park  railway-station,  and  covers  more  than  a  quarter  of  an  acre  of 
ground.  There  is  a  large  gentlemen’s  swimming  bath,  besides  twenty-two 
gentlemen’s  first-class  and  fourteen  second-class  private  baths.  The 
population  of  the  parish  in  1881  was  282,628,  and  the  institution  will, 
no  doubt,  be  considered  a  great  boon  by  North  London  residents. 

. Recalcitrant . — The  Medway  Board  of  Guardians  have  refused  to  accept 
the  suggestion  of  the  Local  Government  Board  that  they  should  erect  a 
new  hospital  at  a  cost  of  £25,OCO,  and  the  architect  of  the  central 
authority  has  declined  to  sanction  the  plans  of  the  Guardians  for 
enlarging  the  present  hospital. 

Sewerage  of  Hendon. — A  Local  Government  Board  inspector  has  held  an 
inquiry  in  reference  to  an  application  of  the  Hendon  Local  Board  for 
•sanction  to  borrow  £62,000  for  sewerage  works  and  for  sewage  disposal. 
The  area  which  will  be  drained  by  the  scheme  is  8382  acres,  and  includes 
the  whole  of  the  parish  of  Hendon,  which  is  almost  the  largest  in 
Middlesex. 

Sarcastic.— “  Well,”  remarked  a  young  M.D.,  “I  suppose  the  next  thing 
will  be  to  hunt  out  a  good  situation,  and  then  wait  for  something  to  do, 
like  Patience  on  a  monument.”  “Yes,”  said  a  bystander,  “  and  it 
won’t  be  long  after  you  do  begin  before  the  monument  will  be  on  the 
patients.” 

J Vest  Hartlepool. — A  public  park,  comprising  seventeen  acres,  subscribed 
for  by  the  inhabitants  of  the  town  and  others,  has  just  been  opened. 
It  is  dedicated  to  the  memory  of  the  late  Mr.  Ralph  Ward  Jackson, 
founder  of  the  town  and  port.  Mr.  Jackson  was  its  first  member  of 
Parliament,  elected  in  1868. 

Puhlic-house  Property,  Oldham. — The  remarkable  depreciation  in  the  value 
of  public-houses  in  this  town — mainly  caused,  it  is  stated,  by  the  spread 
of  clubs — has  led  the  Local  Assessment  Committee  to  re-value  the  whole 
of  this  property.  The  publicans  themselves  initiated  the  necessary  steps 
for  this  re-valuation. 

Constantinople.— In  consequence  of  the  unusually  crowded  state  of  the 
hospitals  at  Smyrna  and  Beyrout,  the  Sanitary  Council  has  resolved 
that  the  Porte  should  request  the  Egyptian  Government  to  prevent 
further  departures  from  Egypt  for  the  Ottoman  littoral,  as  persons 
arriving  at  Turkish  ports  from  that  country  would  not  be  allowed  to 
land.  The  Council  also  decided  to  despatch  an  extraordinary  commission 
to  Beyrout  and  Smyrna  with  hospital  appliances,  tents,  and  medicines, 
in  order  to  complete  the  temporary  buildings,  and  to  select  an  island 
upon  which  a  third  hospital  might  be  established. 

Panic. — The  Home  Secretary  has  stated  that  he  has  a  draft  Bill  prepared 
to  extend  the  scope  of  the  Buildings  Act  (now  applicable  only  to  the 
metropolis)  to  the  provinces,  with  amendments  requisite  for  diminishing 
the  dangers  of  panic  in  crowded  assemblies. 


Diseased  Meat. — A  veterinary  surgeon,  a  licensed  victualler,  and  a  butcher, 
have  been  committed  for  trial,  by  the  magistrates  at  Stratford-on-Avon, 
on  a  charge  of  perjury.  The  defendants  were  witnesses  in  a  case  (noticed 
in  these  pages)  against  a  Town  Councillor,  charged  with  being  in  posses¬ 
sion  of  diseased  meat,  and  upon  their  evidence,  which  is  alleged  to  have 
been  false,  the  latter  was  convicted. 

Juvenile  Smoking,  United  States.— In  New  Jersey  the  State  Senate,  with 
only  two  dissentients,  have  passed  a  Bill  which  forbids  the  sale  of 
cigarettes,  and  of  tobacco — even  for  the  purpose  of  chewing— to  all 
minors  under  the  age  of  sixteen  years. 

The  Sandgate  Convalescent  Home.— Subscribers  of  a  guinea  annually  have 
the  privilege  of  recommending  one  patient  yearly,  and  a  donor  of  ten 
guineas,  paid  in  one  sum,  has  the  advantage  of  recommending  one  patient 
a  year.  An  ordinary  applicant,  or  patient,  will  be  accommodated  with 
three  weeks’  residence  in  the  Home  at  the  small  cost  of  £2  Is.,  this  sum 
also  including  the  railway  fare  to  and  fro.  The  Home  is  well  conducted. 

COMMUNICATIONS  have  been  received  from — 

Mr.  T.  M.  Stone,  London;  Mr.  John  Speak,  Local  Government  Board, 
London;  Tiie  Registrar  of  the  Apothecaries’  Hall,  London;  The 
Secretary  of  the  Native  Guano  Company,  London  ;  Mr.  Shirley  F. 
Murphy,  London  ;  Mr.  J.  Chatto,  London;  Mr.  Blackett,  London; 
The  Secretary  of  the  Quekett  Microscopical  Club,  London ;  Mr. 
Munro  Scott,  London ;  Mr.  Charles  H.  Wade.  London ;  The 
Secretary  of  the  Sanitary  Institute  of  Great  Britain,  London ; 
The  Registrar-General  for  Scotland.  Edinburgh ;  Dr.  J.  W. 
Moore.  Dublin ;  Mr.  T.  M.  Stone,  Wimbledon ;  Sir  Joseph  Fayrer, 
M.D.,  London;  Dr.  Wolfe,  Glasgow;  Dr.  Elliston,  Ipswich;  The 
Treasurer  of  the  British  Medical  Benevolent  Fund,  London  ;  Mr. 
Edmund  Owen,  London. 

BOOKS,  ETC.,  RECEIVED  - 

London  Water-Supply,  1882,  by  W.  Crookes,  F.R.S.,  W.  Odling,  F.R.S., 
and  C.  Meymott  Tidy,  M.D. — Reports  of  Trials  for  Murder  by  Poisoning, 
by  G.  Lathom  Browne  and  C.  G.  Stewart— Enteric  Fever,  by  Francis  H. 
Welch,  F.R.C.S.— Note  sur  Vingt-deux  Operations  de  Goitre,  par 
J aques-Louis  Reverdin  et  Auguste  Reverdin— History  of  Rome,  by  Victor 
Duruy  — 2Esthetical  Sanitation,  by  W.  White,  F.S.A.— Knapsack  Hand¬ 
book,  etc.,  by  William  White,  A.C.,  F.S.A.,  etc.— Report  on  the  Sani¬ 
tary  Condition  of  the  Hackney  District  for  the  Year  1882,  by  John  W. 
Tripe,  M.D.— Balneologische  Studien  fiber  Wiesbaden,  von  Dr.  Emil 
Pfeiffer  und  von  Dr.  E.  Seitz— The  Filaria  Sanguinis  Hominis,  by 
Patrick  Manson,  M.D. 

PERIODICALS  AND  NEWSPAPERS  RECEIVED— 

Lancet— British  Medical  Journal— Medical  Press  and  Circular — Ber¬ 
liner  Klinische  Woehenschrift— Centralblatt  ffir  Chirurgie— Gazette 
des  Hopitaux— Gazette  Medicale— Revista  de  Medicina— Bulletin  de 
1’  AcadOnie  de  Medecine— Pharmaceutical  J ournal— Wiener  Medicinische 
Woehenschrift— Revue  Medicale— Gazette  Hebdomadaire  —  Nature- 
Boston  Medical  and  Surgical  Journal— Louisville  Medical  News— 
Centralblatt  ffir  Gynakologie— Le  Concours  Medical— Centralblatt  ffir 
die  Medicinischen  Wissenschaf ten— Centralblatt  fur  Klinische  Medicin 
—Philadelphia  Medical  News— Le  Progres  Medical— Physician  and 
Surgeon— Philadelphia  Medical  Times— American  Journal  of  Medical 
Sciences— Archives  de  Neurologie— Revue  des  Sciences  MMicales — 
Journal  of  the  Vigilance  Association— Canada  Lancet— North  Carolina 
Medical  Journal— Scotsman,  July  17— Journal  of  the  British  Dental 
Association— Ciencias  Medicas — New  York  Medical  Journal— Canadian 
Practitioner. 


APPOINTMENTS  FOE  THE  WEEK. 

July  21.  Saturday  (this  day). 

Operations  at  St.  Bartholomew’s,  1£  p.m. ;  King’s  College,  1J  p.m. ;  Royal 
Free,  2  p.m.;  Royal  London  Ophthalmic,  11  a.ra. ;  Royal  Westminster 
Ophthalmic,  ljp.m.;  St.  Thomas’s,  ljp.m.;  London,  2  p.m. 

23.  Monday. 

Operations  at  the  Metropolitan  Free,  2  p.m. ;  St.  Mark’s  Hospital  for 
Diseases  of  the  Rectum,  2  p.m.;  Royal  London  Ophthalmic,  11  a.m.; 
Royal  Westminster  Ophthalmic,  1J  p.m. ;  Hospital  for  Women,  2  p.m. 

24.  Tuesday. 

Operations  at  Guy’s,  1£  p.m. ;  Westminster,  2  p.m. ;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  1J  p.m.;  West 
London,  3  p.m. 

Royal  College  of  Surgeons  of  England,  4  p.m.  Dr.  Garson,  “  On 
the  Comparative  Anatomy  of  the  Integumentary,  Respiratory,  and  Cir¬ 
culatory  Systems  of  the  Vertebrata.” 

25.  Wednesday. 

Operations  at  University  College,  2  p.m. ;  St.  Mary’s,  1  j  p.m. ;  Middlesex, 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew’s,  1£  p.m.  ;  Great  Northern, 

2  p.m. ;  Samaritan,  2J  p.m. ;  Royal  London  Ophthalmic,  11  a.m. ; 

Royal  Westminster  Ophthalmic,  l£  p.m. ;  St.  Thomas’s,  li  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m.;  National  Orthopaedic,  Great 
Portland-street.  10  a.m. _ 

26.  Thursday. 

Operations  at  St.  George’s,  1  p.m. ;  Central  London  Ophthalmic,  1  p.m.; 
Royal  Orthopaedic,  2  p.m.;  University  College,  2  p.m.;  Royal  London 
Ophthalmic, 11  a.m. ;  Royal  Westminster  Ophthalmic,  li  p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m. ;  Hospital  for  Women,  2  p.m. ; 
Charing-cross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  2i  p.m. 

27.  Friday. 

Operations  at  CentralLondonOphthalmic,  2  p.m.;  Royal  London  Ophthal¬ 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminster 
Ophthalmic,  l£p.m.;  St.  George’s  (ophthalmic  operations),  If  p.m.; 
Guy’s,  li  o.m.  ;  St. Thomas’s  (ophthalmic  operations),  2  p.m. ;  Fling’s 
College  (by  Mr.  Lister),  2  p.m. 

Quekett  Microscopical  Club  (University  College,  Gower-street),  8  p.m. 
Annual  General  Meeting. 


Medical  Times  and  Gazette. 


BRISTOWE  ON  PURPURA. 


July  28, 1883.  87 


CLINICAL  REMARKS 

ON  PURPURA:  DEATH  FROM  CEREBRAL 
HAEMORRHAGE. 

By  J.  S.  BRISTOWE,  M.D.,  F.R.S. 

It  is  not  often  that  purpura  proves  fatal  by  htemorrhage 
into  the  substance  of  the  brain ;  and  my  main  object  in 
the  present  lecture  is  to  call  attention  to  two  such  cases 
which  have  happened  within  my  own  experience.  Before 
narrating  them,  however,  I  propose  making  a  few  observa¬ 
tions  with  regard  to  this  disease. 

Disseminated  extravasations  beneath  the  skin,  in  the  solid 
organs  and  tissues,  and  at  the  serous  and  mucous  surfaces, 
attended,  maybe,  with  more  or  less  abundant  loss  of  blood, 
are  not  infrequent  in  many  different  maladies  in  which 
either  there  is  profound  constitutional  disorder,  or  some 
serious  hindrance  exists  to  the  passage  of  blood  along  the 
veins.  Among  such  maladies  may  be  enumerated  certain  of 
the  specific  fevers  (as  small-pox  and  typhus),  rheumatism, 
scurvy,  leucocyth.se  mia,  so-called  “  pernicious  antemia,”  ob¬ 
structive  diseases  of  the  heart,  and  affections  of  the  liver. 
But  in  all  these  cases,  even  though  occasionally  in  some  of 
them  the  haemorrhagic  phenomena  may  exactly  resemble 
those  of  purpura,  the  fact  that  the  haemorrhage  constitutes 
only  a  subordinate  symptom  of  some  well-recognised  grave 
disorder  separates  them  absolutely  from  the  disease  to  which 
the  name  of  purpura  by  general  consent  is  given. 

True  purpura  is  a  so-called  “  idiopathic  ”  disease,  the 
/cause  of  which  is  as  obscure  as  are  the  causes  of  leucocy- 
thsemia  and  “  pernicious  ”  anaemia.  It  attacks  persons  of 
all  ages,  from  early  childhood  to  the  decline  of  life,  males 
and  females  in  equal  proportion,  those  who  are  apparently 
in  good  health,  as  well  as  such  as  are  already  ailing  ;  and,  so 
far  as  I  know,  its  appearance  is  independent  of  local  sanitary 
conditions  and  dietetic  errors.  It  has,  moreover,  a  tendency 
to  recur,  and  I  have  notes  of  several  case  in  which  children 
have  been  brought  to  me  at  intervals  of  some  months, 
suffering  from  two  or  even  three  recurrences. 

Purpura  is  commonly  divided  into  two  varieties,  namely, 
.purpura  simplex,  and  purpura  hsemorrhagica :  the  former 
•being  characterised  by  the  appearance,  in  successive  crops, 
of  numerous  petechial  spots  in  the  skin  and  visible  mucous 
surfaces,  and  attended  with  little  or  no  manifest  constitu¬ 
tional  disturbance  ;  the  latter  being  characterised  by  the 
occurrence  not  only  of  petechise  in  these  situations,  but  by 
more  abundant  extravasations  of  blood  into  the  connec¬ 
tive  tissue,  and  substance  of  solid  organs,  by  more  or  less 
copious  haemorrhage  from  the  mucous  membranes,  and, 
further,  by  progressive  anaemia  and  debility.  It  must  be 
.admitted  that  typical  cases  of  simple  purpura,  which  are 
common,  are  for  the  most  part  unattended  with  danger, 
and  run  a  favourable  course  j  and  that  typical  cases  of 
the  haemorrhagic  form,  which  are  comparatively  rare,  are 
attended  with  grave  symptoms  and  are  apt  to  prove  fatal ; 
and  that  there  is  some  clinical  justification,  therefore,  for 
placing  them  in  separate  groups.  But  it  should  never  be 
forgotten,  that  the  distinction  is  a  purely  artificial  one  ;  that 
true  purpura  in  all  its  forms  is  (so  far  as  we  know)  the  same 
disease;  that  the  simple  and  haemorrhagic  varieties  are 
linked  together  by  the  frequent  occurrence  of  cases  of  inter¬ 
mediate  severity ;  and  that  although  the  prognosis  of  a  case 
of  purpura  simplex  is  generally  favourable,  there  is  always 
the  possibility  that  it  may  assume  grave  proportions,  that  it 
may  be  attended  with  anaemia  and  debility,  and  prove  fatal 
by  haemorrhage.  An  attack  of  purpura,  therefore,  however 
mild  it  may  seem  to  be,  can  never  be  regarded  as  wholly  free 
from  risk. 

Apart  from  the  haemorrhages  beneath  the  skin  and  visible 
mucous  membranes,  and  the  more  or  less  abundant  bleedings 
that  take  place  from  time  to  time  from  the  nose,  mouth, 
lungs,  stomach,  bowels,  or  genito-urinary  organs,  the  symp¬ 
toms  of  purpura  haemorrhagia  are  not  specific,  and  to  a  large 
.extent  are  referable  to  the  losses  of  blood  which  the  patient 
experiences.  They  are,  mainly,  progressive  debility  and 

Vol.  II.  1883.  No.  1726. 


anaemia,  associated  with  irritability  of  temper,  headache, 
pains  in  the  limbs,  shortness  of  breath,  feebleness  of  the 
heart’s  action,  loss  of  appetite,  and  occasional  slight  febrile 
temperature  :  notwithstanding  which,  however,  patients  will 
often  continue  to  perform  their  ordinary  duties  throughout 
the  greater  part  or  even  the  whole  course  of  their  illness.  The 
duration  of  purpura  haemorrhagica  is  generally  some  weeks, 
and  its  event  is  for  the  most  part  favourable;  but  death, 
which  is  generally  due  directly  to  haemorrhage,  or  to  the 
debility  which  repeated  haemorrhages  induce,  may  occur  at 
any  time  in  the  course  of  the  disease. 

Of  the  pathology  of  purpura  as  little,  I  believe,  is  known 
as  of  its  causation.  Neither  the  blood  nor  the  bloodvessels  give 
distinct  evidences  of  either  chemical  or  structural  change ; 
yet  it  is  impossible  that  numerous  and  abundant  haemor¬ 
rhages  should  take  place  unless  there  be  something  abnormal 
in  one  or  other  or  both  of  these  constituents  of  the  organism. 
That  the  extravasations  depend  on  laceration  of  vessels 
there  can  be  no  reasonable  doubt ;  and,  indeed,  the  situation 
and  character  of  the  haemorrhages  into  the  brain  seem  to 
accord  exactly  with  those  of  cerebral  haemorrhage  in  ordi¬ 
nary  apoplexy  or  from  injury.  Such  laceration  must  depend 
either  on  weakening  of  the  parietes  of  the  vessels,  making 
them  apt  to  rupture,  or  on  undue  pressure  from  within. 
There  is  no  obstruction,  however,  in  the  right  side  of  the 
heart,  and  no  increased  arterial  tension,  to  justify  the  latter 
explanation.  The  former,  therefore,  is  probably  the  correct 
one ;  and  it  may  be  surmised  that  the  enfeebl'ement,  lacera¬ 
tion,  and  resulting  haemorrhages  are  the  consequences  of 
the  ordinary  causes  of  these  conditions,  namely,  obstruction 
of  the  smaller  arteries  of  the  districts  in  which  bleeding 
occurs.  Thrombosis  or  embolism  might  explain  this  obstruc¬ 
tion;  but  as  there  is  no  obvious  source  of  embolism,  it  seems 
probable  that  the  proximate  cause  of  obstruction  is  throm¬ 
bosis  due  to  some  morbid  condition  of  the  blood  which 
renders  it  liable  to  coagulate. 

The  treatment  of  purpura  is  as  unsatisfactory  as  are  its 
causation  and  pathology.  Antiscorbutic  remedies  have  been 
largely  employed  in  consequence  of  a  belief  that  prevails 
(but  seems  unfounded)  that  the  disease  has  a  close  causal 
relation  to  scurvy.  Other  remedies  are  tonics  and  astrin¬ 
gents  ;  and,  though  I  acknowledge  some  scepticism  as  to 
their  special  efficacy,  it  is  in  such  medicines  that,  in  the 
present  state  of  our  knowledge,  we  are  compelled  to  trust 
mainly.  Good  and  wholesome  diet  and  healthy  surround¬ 
ings  are,  of  course,  important  aids. 

The  two  cases  which  I  subjoin  are  typical  examples  of 
purpura  hsemorrhagica,  with  the  additional  important  fea¬ 
ture  to  which  I  have  adverted,  namely,  that  death  was  due 
to  haemorrhage  into  the  substance  of  the  cerebrum.  In  the 
latter  of  the  two  cases  the  haemorrhage  was  sudden,  and 
caused  death  in  the  course  of  a  few  hours ;  in  the  former 
the  symptoms  were  comparatively  slowly  developed,  and  the 
bleeding  therefore  was  probably  gradual.  The  symptoms  of 
the  cerebral  lesion  were  well  marked.  It  is  noteworthy  that 
in  one  of  the  cases  the  patient  became  blind  of  one  eye  from 
extravasation  into  it  a  few  days  before  death.  I  may  here 
mention  that  Sir  Thomas  Watson,  in  his  Lectures,  records  a 
case  of  purpura  in  which  also  death  was  due  to  cerebral 
haemorrhage. 

Case  1. — Purpura — Effusion  of  Blood  into  the  Brain — Death. 

J.  S.,  a  fitter,  thirty-three  years  of  age,  admitted  under  my 
care  on  November  9,  1S73.  He  had  an  attack  of  acute 
rheumatism  nine  years  previously,  and  a  second  attack  five 
years  later  ;  since  which  he  has  suffered  from  short  breath. 

About  four  months  previous  to  admission  he  began  to  ail, 
and  he  has  been  out  of  health  ever  since  ;  but  he  did  his 
work  as  usual  up  to  the  morning  of  the  day  on  which  he 
came  to  the  hospital.  He  suffered  during  the  whole  of  this 
period  from  weakness,  rheumatic  pains  in  the  limbs,  and 
shooting  pains  in  the  head,  dimness  of  sight  and  giddiness, 
morning  sickness,  and  irritability  of  temper.  Also  he  had 
frequent  attacks  of  epistaxis ;  on  one  occasion  he  vomited  a 
large  quantity  of  blood  ;  and  dark  purplish  spots  came  out 
from  time  to  time  in  more  or  less  abundance.  He  had  a  fit 
of  shivering  the  night  before  admission ;  and  the  next 
morning,  after  breakfast,  while  standing  at  work,  he  was 
suddenly  attacked  with  giddiness,  loss  of  sight,  and  faint¬ 
ness,  and  had  to  sit  down.  Not  recovering,  he  was  brought 
to  the  hospital. 

When  first  seen  he  was  pale  and  faint,  with  surface  cold 


Medical  Times  and  Gazette. 


BRISTOWE  ON  PURPURA. 


July  28,  1883" 


88 


and  teeth  chattering,  nnable  to  stand,  and  complaining  of 
giddiness  and  pain  in  the  head ;  pulse  small  and  weak. 
Half  an  hour  later  he  vomited,  and  became  partially  uncon¬ 
scious,  but  when  roused  he  answered  sensibly;  the  pain  in 
his  head  also  was  more  severe,  and  from  time  to  time  he 
struggled  and  threw  his  arms  about.  Pupils  equal,  acting 
readily  to  light ;  no  paralysis.  Limbs  and  trunk  covered 
with  purpuric  spots  of  different  ages,  and  varying  from  the 
size  of  a  pin’s  head  to  that  of  a  threepenny-piece.  Tongue 
moist,  and  thinly  coated  with  a  white  fur.  Teeth  black 
and  decayed;  gums  bleeding  slightly.  Temperature  99°. 
The  heart  was  somewhat  enlarged,  with  a  feeble  impulse  ; 
its  action  was  irregular,  and  a  faint  systolic  murmur  was 
audilbe  at  the  apes.  Pulse  72.  No  discoverable  affection  of 
the  lungs  or  abdominal  viscera.  Bowels  have  been  regular. 
Urine,  specific  gravity  1015 ;  no  albumen. 

At  9  p.m.  he  was  still  in  a  semi-comatose  condition,  and 
breathing  noisily ;  but  he  could  be  roused,  when  he 
answered  questions  irritably.  He  tossed  about  in  bed,  and 
occasionally  cried  out  as  if  in  pain.  There  was  distinct  loss 
of  power  in  left  arm  and  leg,  lower  part  of  left  side  of 
face,  and  left  side  of  tongue.  Pulse  66,  full,  irregular. 
Temperature  100°.  Head  to  be  shaved,  and  an  ice-bag  to  be 
applied.  A  black  draught  to  be  given  at  once. 

November  10. — He  remained  in  the  same  condition  all 
through  the  night.  One  loose  motion.  Tongue  dry  and 
brown.  Pulse  84,  full  and  strong ;  temperature  9S'2\ 
Several  large  bruise-like  patches  have  appeared  on  arms 
and  legs.  At  2  p.m.  I  made  the  following  note  : — “  Is  drowsy, 
but  can  be  roused.  Complains  of  pain  across  forehead  and 
eyes.  Rambles ;  wants  to  know  if  I  am  going  to  the  night- 
school  ;  and  also  says  that  he  is  in  a  consumption,  adding, 

‘  The  kippers  are— the  fishes  are.’  Left  arm  and  leg  para¬ 
lysed  and  limp.  No  reflex  movements  obtainable  in  left 
leg,  but  right  leg  drawn  up  when  left  foot  is  tickled.  Eyes 
closed ;  pupils  small,  equal ;  no  squint.  Tongue  coated. 
Respirations  tranquil.”  Temperature  98°.  At  9  p.m.  he 
was  very  noisy,  throwing  the  bedclothes  off,  and  trying  to 
get  out  of  bed.  He  still  complained  of  his  head.  Pupils 
contracted  ;  right  rather  smaller  than  left.  Pulse  60,  full ; 
temperature  98°.  A  third  of  a  grain  of  hydrochlorate  of 
morphia  was  administered  subcutaneously. 

11th. — After  the  injection  he  sank  into  a  deep  sleep,  which 
gradually  passed  into  coma.  This  morning  he  is  quite 
unconscious  and  still.  Pupils  small ;  conjunctive  insensible. 
Breathing  stertorous.  Pulse  132.  At  3.15  he  was  quite 
insensible,  lying  on  left  side.  Pace  flushed;  skin  moist; 
pupils  (especially  right)  much  dilated;  subsultus  tendi- 
num.  Respirations  60;  pulse  152.  9  p.m. :  Lying  on  back, 
wholly  unconscious  ;  perspiring.  Respirations  60,  very 
noisy ;  pulse  164.  Twitchings  of  left  arm  and  leg.  He 
passed  water  into  the  bed. 

He  died  a  little  after  one  on  the  morning  of  the  12th .  The 
temperature  rose  gradually  in  the  course  of  the  last  sixteen 
hours  of  his  life.  It  was  100’  at  8.40  a.m.,  102-1°  at  1  p.m., 
103-4°  at  4  p.m.,  103-6°  at  6  p.m.,  and  also  103-6°  about  half 
an  hour  after  death. 

Autopsy. — On  opening  the  skull,  the  dura  mater  appeared 
somewhat  congested,  and  many  patches  of  extravasated 
blood  were  found  on  the  surface  of  the  pia  mater,  especially 
on  the  left  side.  On  examining  the  brain,  the  greater  part  of 
the  right  occipital  and  temporo-sphenoidal  lobes  was  found 
to  be  broken  down  into  a  large  irregular  cavity,  filled  with 
coagulated  blood  and  brain  debris.  This  cavity  communi¬ 
cated  with  the  posterior  cornu  of  the  lateral  ventricle,  which 
also  contained  dark  coagula.  Numerous  punctiform  haemor¬ 
rhages  were  found  studding  the  surface  of  the  left  optic 
thalamus  and  the  surface  of  the  posterior  cornu.  The  brain 
was  otherwise  normal.  There  was  no  atheroma  or  plugging 
of  the  arteries.  Lungs  congested  and  oedematous.  Heart 
enlarged,  especially  left  ventricle ;  decolourised  clots  on  right 
side ;  aortic  valve  competent,  but  presenting  a  few  small 
vegetations  on  ventricular  aspect;  mitral  valve  healthy; 
small  ecchymoses  on  auricular  surface.  Liver  enlarged, 
congested,  somewhat  fatty.  Numerous  punctiform  extrava¬ 
sations  on  surface  of  kidneys,  which  were  otherwise  healthy. 
Patches  of  ecchymosis  also  in  walls  of  small  intestine. 

Case  2. — Purpura — Effusion  of  Blood  into  the  Brain — Death. 

M.  J.  B.,  a  single  woman,  a  cook,  aged  fifty-seven,  was 
admitted  under  my  care  on  November  27,  1882. 

About  thirty  years  ago  she  had  an  attack  of  hsematemesis. 


and  ten  years  later  experienced  a  slight  recurrence.  The 
catamenia  have  always  been  scanty  and  irregular. 

Her  present  illness  began  on  the  14th,  when  she  brought 
up  a  large  quantity  of  black  clotted  blood.  She  has  con¬ 
tinued  to  vomit  blood  from  time  to  time  ever  since.  Before 
long  she  observed  that  she  was  passing  blood  with  her 
water,  and  that  she  had  pain  in  micturition.  She  has  also- 
had  considerable  menorrhagia  during  the  same  period,  and 
large  bruise-like  patches  have  appeared  over  her  trunk  and 
extremities. 

The  patient  was  brought  to  the  hospital  in  the  evening, 
from  Enfield,  and  on  admission  was  much  exhausted.  She- 
was  a  pallid,  anxious-looking  woman,  and  complained  of  pain 
and  tenderness  in  the  abdomen  and  throat.  Tongue  clean,, 
but  fissured ;  gums  not  spongy.  Bowels  regular ;  pulse  108, 
small  and  weak.  Subcutaneous  extravasations  of  blood,  of 
largish  size,  irregular  form,  and  varying  in  colour  from 
dark-red  to  yellowish  or  greenish  stains,  were  observed  in 
the  arms  and  legs ;  few  or  none  were  present  in  the  trunk,  and 
there  were  no  extravasations  about  the  mucous  membrane 
of  the  mouth.  The  heart  and  lungs  presented  nothing 
abnormal ;  and,  beyond  the  presence  of  pain  and  tenderness,, 
the  abdomen  also  and  its  contents  seemed  free  from  disease. 
The  urine  contained  blood,  but  it  was  not  clearly  ascertained 
if  the  blood  came  from  the  bladder  or  vagina.  Temperature- 
100-20. 

The  next  day,  the  28th,  there  was  no  particular  change. 
Indeed,  though  weak,  she  seemed  to  be  going  on  well.  In 
the  morning  the  temperature  was  99-6°,  in  the  evening  it 
was  101-8°. 

Between  3  and  4  a.m.  on  the  29th  she  started  up  in 
bed  and  cried  out.  When  the  nurse  went  to  her,  she  was 
sensible  but  speechless,  and  waving  her  right  arm  round  and 
round.  She  made  noises  in  the  throat  as  though  she  were- 
trying  to  speak.  She  soon  became  comatose,  and  died  in 
this  condition  at  9  a.m. 

It  was  subsequently  ascertained  that  she  had  suddenly 
lost  the  sight  of  the  left  eye  a  few  days  before  admission. 
She  did  not,  however,  draw  attention  to  the  state  of  her 
eye  while  in  the  hospital. 

The  Autopsy  was  made  next  day.  Rigor  mortis  well1 
marked;  bruise-like  markings  on  trunk  and  limbs  well 
shown.  Chest.:  Heart  and  pericardium  healthy,  except 
that  there  were  numerous  petechial  spots  beneath  the 
visceral  pericardium.  The  lungs  were  oedematous,  but  there 
were  no  extravasations  of  blood  either  in  them  or  in  the* 
pleurae.  Abdomen  :  Peritoneum  healthy.  Liver  healthy  and 
pale.  Spleen  large,  with  thickened  adherent  capsule.  A  few 
small  haemorrhages  into  and  beneath  mucous  membrane  of 
stomach.  Intestines  healthy.  The  kidneys  (especially  the 
right)  were  freely  movable  beneath  the  parietal  peritoneum  ; 
their  substance  was  healthy;  in  the  pelves  and  calyces  of 
both  organs  the  mucous  membrane  was  abundantly  infil¬ 
trated  with  blood.  In  the  bladder  also  (which  was  otherwise* 
healthy)  there  were  two  large  patches  in  which  blood  had 
been  extravasated  into  the  substance  of  the  mucous  mem¬ 
brane,  and  there  were  numerous  petechial  spots.  Uterine 
organs  and  ovaries  healthy.  Head :  Over  left  hemisphere* 
of  brain,  in  front  of  the  fissure  of  Rolando,  there  was  con¬ 
siderable  presence  of  blood  in  the  subarachnoid  tissue.  On 
dissecting  the  brain  a  large  quantity  of  dark,  imperfectly 
clotted  blood  was  found  extravasated  into  the  left  centrum 
ovale.  This  reached  to  the  convex  surface  of  the  brain 
above,  and  opened  into  the  lateral  ventricle  below.  On  the* 
confines  of  the  main  extravasation  numerous  small  haemor¬ 
rhages  were  visible,  seeming  to  show  that  the  blood  had 
escaped  from  a  number  of  small  vessels  rather  than  from  one 
of  large  size.  There  was  also  a  large  effusion  of  blood  into 
the  left  retina. 


The  Paris  Night- Service.— In  M.  Passant’s  report 
on  the  night-service  for  the  quarter  ending  June  30,  he* 
states  that  the  total  number  of  visits  paid  was  1598,  being 
80  more  than  those  for  the  same  quarter  of  1882.  Of  these 
1598  visits,  540  (34  per  cent.)  were  paid  to  men,  840  (52  per¬ 
cent.)  to  women,  and  218  (14  per  cent.)  to  children  under- 
three  years  of  age.  The  mean  number  of  visits  per  night 
was  17'55  per  cent.  In  59  instances  the  patient  was  dead 
before  the  arrival  of  the  medical  visitor.  About  a  fifth  of 
the  whole  number  of  visits  (307)  were  paid  to  women  in 
labour,  or  suffering  from  uterine  haemorrhage  or  metritis. 


Medical  Times  and  Gazette. 


MORRIS  ON  MEDIAN  URETHROTOMY. 


July  28,  1883.  89 


REMARKS 

ON  EXPLORATION  OF  THE  BLADDER, 
AND  THE  TREATMENT  OF  CYSTITIS 
BY  MEDIAN  URETHROTOMY. 

By  HENRY  MORRIS,  M.A.,  F.R.C.S., 

Surgeon  to,  and  Lecturer  on  Surgery  at,  the  Middlesex  Hospital. 


The  subject  of  the  removal  of  bladder  tumours  and  the 
treatment  of  some  obstinate  forms  of  bladder  disease  in  the 
male  by  means  of  a  median  perineal  incision  of  the  urethra 
has  of  late  been  brought  prominently  before  the  profession 
by  the  discussions  at  the  Royal  Medical  and  Chirurgical 
•Society. 

There  can  be  little  doubt  that  this  mode  of  treatment  has 
•often  previously  been  in  the  minds  of  surgeons,  but,  owing 
to  the  want  of  any  authoritative  sanction,  it  either  has  not 
been  recommended  to,  or  not  accepted  by,  patients. 

No  doubt  too  on  this  account,  not  only  physicians  but 
surgeons  also  have  hesitated  to  act  upon  the  suggestion  when 
the  operation  has  been  proposed  either  to  discover  the  cause 
of  lisematuria  or  to  relieve  the  symptoms  of  intense  bladder- 
irritation  and  spasm. 

Sir  Henry  Thompson  has  therefore,  I  venture  to  think, 
done  a  great  service  by  his  recent  advocacy  and  successful 
employment  of  this  operation ;  for  it  is  to  be  expected  that 
in  future  there  will  be  less  difficulty  than  heretofore  in 
carrying  it  into  practice  in  suitable  cases. 

I  have  on  several  occasions  during  the  last  six  or  seven 
years  proposed  to  explore  the  bladder  .for  the  purpose  of 
diagnosis  as  well  as  of  relief,  but  always,  until  lately,  with¬ 
out  having  my  advice  adopted. 

I  will  refer  to  two  instances.  In  1876  a  man  was  under 
my  care,  suffering  from  intense  vesical  irritation,  enlarged 
prostate,  and  a  deposit  of  phosphates  near  the  neck  of  his 
bladder.  The  diagnosis  was  that  a  tumour  near  the  neck 
of  the  bladder  was  coated  with  phosphatic  concretion];  and 
I  wished  to  make  an  exploratory  incision,  which  I  thought 
would  relieve  his  bladder-symptoms,  if  it  did  not  permit  of 
the  removal  of  their  cause.  My  proposal  was  rejected;  and, 
having  no  experience  of  its  effects,  I  could  not  guarantee 
that  the  operation  would  for  certain  give  relief.  The  man 
■died,  and  at  the  post-mortem  examination  there  was  found 
cancer  of  the  prostate,  which  had  ulcerated  into  the  bladder, 
and  caused  the  deposition  of  calculous  matter  in  its  neigh¬ 
bourhood.  I  made  a  note  at  the  time  on  this  case  to  this 
effect :  “  Query. — Though  the  disease  could  not  have  been 
removed,  ought  not  a  median  incision  to  have  been  made  for 
the  sake  of  relieving  his  sufferings  ?” 

More  recently,  viz.,  in  June,  1S81,  Edward  B.,  a  butler, 
aged  thirty-five,  was  an  in-patient  at  the  Middlesex  Hospital, 
suffering  from  intermittent  liasmaturia,  with  great  irritation 
at  the  neck  of  the  bladder.  He  micturated  every  one  and  a 
half  or  two  hours,  day  and  night,  and  for  eleven  months  had 
been  passing  blood  and  clots  with  his  water — chiefly  at  the 
•end  of  micturition,  and  especially  on  going  to  stool.  When 
first  attacked,  he  saw  a  surgeon,  who  sounded  him,  and  said 
he  had  no  stone,  but  was  suffering  from  “  catarrh  of  the 
neck  of  the  bladder  ”;  after  this  he  consulted  a  physician. 
At  the  end  of  1880,  as  he  informed  us,  he  was  under  the 
care  of  Sir  Henry  Thompson  for  two  months,  whose  treat¬ 
ment  stayed  the  hsematuria,  though  the  frequent  desire  to 
micturate  continued.  Sir  Henry  sounded  him,  but  found  no 
stone,  and  recommended  him  to  go  into  a  hospital  for  the  pur¬ 
pose  of  obtaining  complete  rest.  He  came  under  my  care,  and 
I  concluded  that  he  had  villous  growth  in  the  bladder,  some 
fringe  of  which  I  thought  was  probably  floated  on  in  the 
stream  of  urine  towards  the  urethra,  and  becoming  nipped 
by  the  sphincter,  caused  the  irritation  from  which  he 
suffered.  As  long  as  he  remained  quiet  in  bed  the  hsema- 
turia  ceased,  but  after  being  up  for  a  few  days  it  returned. 

He  left  the  hospital  on  July  28,  1881,  and  for  some  months 
continued  as  an  out-patient.  Finding  remedies  of  no  per¬ 
manent  use,  I  proposed  to  explore  his  bladder  through  an 
incision  of  his  urethra  in  the  raphe  of  the  perineum.  This 
he  refused  to  allow,  and  forthwith  discontinued  his  visits. 
Here  again  I  had,  of  course,  to  tell  the  patient  that  I  could 
not  guarantee  to  cure  his  hsematuria  by  the  operation,  and 


as  he  was  at  this  time  experiencing  little  or  no  pain  the 
operation  was  not  indicated  as  a  measure  of  relief  from 
suffering. 

The  next  I  heard  of  him  was  on  April  11,  1882,  the  occa¬ 
sion  of  the  discussion  on  Sir  Henry  Thompson’s  paper  at 
the  Medical  and  Chirurgical  Society  on  the  successful  removal 
of  a  tumour  of  the  male  bladder  through  a  perineal  section 
of  the  urethra.  I  was  then  told  by  one  of  the  surgeons 
of  a  neighbouring  hospital  that  E.  B.  was  under  his  care,  I 
having  frightened  him  away  by  my  proposal  to  operate — a 
proposal  for  an  exploratory  operation,  which,  if  I  inferred 
rightly,  did  not  recommend  itself  to  my  informant.  Yet 
I  do  not  doubt  that  the  operation  was  the  best  thing  for 
this  patient,  as  it  afforded  a  possibility,  not  to  say  a  pro¬ 
bability,  that  the  cause  of  the  hsematuria  might  have  been 
satisfactorily  removed. 

In  a  short  communication,  which  I  sent  in  to  the  Secre¬ 
tary  of  the  Medical  and  Chirurgical  Society  in  May,  1882, 
on  a  case  in  which  I  removed  a  prostatic  calculus  by 
median  urethrotomy,  I  made  some  remarks  on  the  opera¬ 
tion  as  a  means  of  relieving  painful  and  frequent  mictu¬ 
rition  in  tubercular  and  other  chronic  forms  of  cystitis. 
Want  of  time,  I  believe,  did  not  permit  of  my  paper  being 
read,  and  it  was  returned  to  me  with  a  very  courteous  sug¬ 
gestion  that  I  should  enlarge  my  remarks  upon  the  latter 
subject  so  as  to  bring  the  question  definitely  forward  for 
discussion  on  another  occasion.  But,  instead,  my  case  was 
published  in  the  Medical  Times  and  Gazette  of  August  26, 
1882  (page  245),  and  the  method  of  treating  and  ex¬ 
ploring  bladder  diseases  by  perineal  section  of  the  urethra 
has  been  since  fully  brought  before  the  Society  by  Sir 
Henry  Thompson. 

I  propose  now,  however,  to  relate  the  particulars  of  four 
other  cases(a)  in  which  I  have  done  the  operation  with  great 
benefit,  and  in  two  of  the  cases  with  the  effect  of  saving  life. 
My  method  of  operating  has  been  to  make  an  incision  a  little 
over  an  inch  long,  about  an  inch  or  less  in  front  of  the  anus, 
upon  a  staff  with  a  median  grove.  Until  the  knife  has 
reached  the  staff  and  divided  the  membranous  urethra,  my 
left  index-finger  is  kept  upon  the  apex  of  the  prostate  felt 
through  the  rectum,  as  in  Cock’s  operation:  the  rectum 
having  been  well  cleared  out  previously  by  an  aperient 
followed  by  an  enema.  Then,  having  withdrawn  the  finger 
from  the  rectum  and  washed  it  in  carbolised  water,  I  in¬ 
troduce  into  the  bladder  a  long  director  or  probe  upon  the 
groove  of  the  staff.  The  staff  is  next  withdrawn,  and  the 
left  index-finger,  guided  by  the  director,  finds  its  way  into 
the  bladder ;  or  attempts  to  do  so,  for  unless  the  prostate  is 
partly  divided,  or  great  force  is  nsed  so  as  to  tear  it,  it  is  not 
always  possible  to  make  the  finger  enter  the  bladder. 

In  Cases  3  and  4  I  met  with  the  difficulty  I  referred  to  in 
the  discussion  at  the  Medical  and  Chirurgical  Society  on 
January  23,  1883 — namely,  I  could  not  reach  even  the  neck 
of  the  bladder  with  my  finger,  much  less  explore  the  whole 
surface  of  the  bladder  mucous  membrane.  In  Case  4  it  was 
subsequently  needful  to  divide  part  of  the  prostate  in  order 
to  extract  the  calculus,  and  after  doing  so  I  was  able  with 
some  stretching  of  the  parts  to  get  my  finger  well  into  the 
cavity  of  the  bladder. 

It  would  seem  to  me,  therefore,  that  in  a  certain  propor¬ 
tion  of  cases  where  the  prostate  is  enlarged,  or  the  person  is 
fat  and  the  perineum  deep,  it  will  be  found  absolutely  neces¬ 
sary  to  divide  more  or  less  of  the  prostatic  as  well  as  the 
membranous  urethra  in  order  to  make  a  digital  examination 
of  the  interior  surface  of  the  bladder.  I  am  also  led  to 
think  that  the  partial  division  of  the  prostatic  urethra, 
whilst  it  adds  but  little  to  the  danger,  is  very  desirable 
when  the  operation  is  done  with  the  object  of  putting  the 
bladder  into  a  state  of  rest.  In  those  cases  in  which  I 
have  divided  it  the  patient  remained  for  a  much  longer 
time  without  requiring  the  catheter  or  tube  to  keep  the 
wound  from  closing,  than  is  the  case  when  the  membranous 
urethra  alone  is  cut.  The  same  thing  was  illustrated  by 
the  first  of  the  cases  now  recorded;  for  though  the  incision 
was  limited,  yet  the  prostate  was  in  great  part  destroyed  by 
suppuration,  and  the  urine  continued  to  flow  through  the 
wound  for  six  weeks  without  the  wound  showing  any 
tendency  to  heal.  This  was  a  great  advantage,  as  I  feared 
closure  of  the  wound  might  be  attended  with  the  return 
of  the  symptoms. _ 

(a)  Two  of  the  cases  appear  this  week  under  Hospital  Practice  at  page 
92  ;  the  other  two  will  appear  next  week. 


Medical  Times  and  Gazette. 


CHEVERS  ON  THE  ORDINARY  DISEASES  OF  INDIA. 


July  23,  183?. 


90 


It  certainly  appears  that  in  some  cases,  even  without 
dividing  the  prostatic  urethra  along  a  part  of  its  extent,  the 
same  beneficial  and  curative  effects  can  be  obtained  in  obsti¬ 
nate  cystitis  and  irritable  bladder  by  median  urethrotomy  as 
were  obtained  by  Sir  William  Fergusson  and  Mr.  McCraith 
of  Smyrna.  Each  of  these  gentlemen,  as  Mr.  Royes  Bell 
has  recently  reminded  us,  divided  in  the  median  line  not  only 
the  membranous  urethra,  but  the  prostate,  and  the  neck  of 
the  bladder  freely,  as  well.  In  Mr.  McCraith’s  case(b)  the 
incision  was  free  enough  to  allow  of  two  fingers  entering 
the  bladder  for  the  purpose  of  exploring  its  interior. 

Sir  William  Eergusson(c)  considered  that  the  modus 
operandi  of  the  operation,  in  his  case,  was  through  the 
division  of  the  nerve  plexus  at  the  neck  of  the  bladder  ;  but 
it  seems  more  probable  that  the  good  which  the  opera¬ 
tion  effects  in  cystitis  is  by  inducing  a  state  of  rest 
to  the  bladder  by  the  free  draining  away  from  it  of  the 
decomposing  urine  which  is  the  source  of  irritation ;  and  if 
this  end  can  be  gained  by  a  milder  operation  than  the 
division  of  the  neck  of  the  bladder,  and  therefore  without 
trespassing  upon  the  pelvic  cellular  tissue,  so  much  the 
better  for  the  patients.  Experience  now  says  it  can,  and 
therefore  it  is  to  be  expected  that  the  operation  of  median 
urethrotomy — which,  so  far  as  the  parts  actually  cut  are 
concerned,  is  a  more  fitting  name  than  median  cystotomy — 
will  be  more  frequently  practised.  Mr.  Teevan,  I  believe, 
has  advocated  the  median  operation ;  but  it  is  a  matter  of 
surprise  that,  with  the  experience  of  Sir  William  Fergusson’s 
and  Mr.  McCraith’s  cases  before  the  profession,  and  the 
reputed  success  of  M.  Bouchardat  in  the  beginning  of  the 
century,  surgeons  have  been  so  long  before  recognising  and 
adopting  what  gives  promise  of  being — indeed,  is  amply 
proved  to  be — such  a  very  valuable  mode  of  treatment,  and 
means  of  diagnosis. 


Medical  Practitioners  in  New  York. — Some  special 
inquiries  having  been  made  of  us  regarding  the  num¬ 
ber  of  these,  we  would  say  that  the  total  number  of 
physicians  in  New  York  State  in  1880,  according  to  the 
census,  was  9272.  This  number  has  now  undoubtedly 
swollen  to  10,000.  In  what,  for  distinction’s  sake,  may  be 
called  the  “  Physician’s  Medical  Register  ”  for  1882-83,  a  list 
of  only  2684  names  is  given,  which  represents  the  regu¬ 
larly  educated  physician  in  affiliation  with  regular  medical 
societies.  The  remainder  are  composed  of  homoeopathies 
(probably  500  or  600),  eclectics,  and  nondescripts. — New 
York  Med.  Record,  July  7. 

Heart-Failure  in  Acute  Infectious  Disease. — 
Dr.  Beverley  Johnson  read  a  paper  to  the  Practitioners’ 
Society,  New  York,  upon  this  subject,  to  which  he  said  that 
he  had  long  paid  attention.  Its  title  is,  “  On  Rapid  or 
Sudden  Heart-Failure  in  Acute  Infectious  Disease,  notably 
in  Diphtheria  and  Typhoid  Fever.”  The  following  are  the 
therapeutic  indications  : — “1.  All  unnecessary  fatigue  should 
be  absolutely  avoided  during  the  duration  of  even  mild  cases 
of  diphtheria  and  typhoid  fever.  Patients  should  not  be 
permitted  to  raise  themselves  in  bed,  to  sit  up  but  for  a  very 
short  while  on  any  particular  occasion,  and  then  only  when 
convalescence  is  well  advanced.  They  should  not  be  allowed 
to  feed  themselves,  or  to  perform  any  act  which  causes  outlay 
of  physical  energy,  and  which  can  be  avoided  by  judicious 
nursing.  2.  Cardiac  tonics  should  be  employed  in  very 
moderate  doses  from  a  relatively  early  stage  of  the  disease, 
and  particularly  if  there  be  even  slight  manifestation  of 
cardiac  failure,  as  shown  by  inequality  or  irregularity  in 
force  or  rhythm  of  cardiac  beats,  or  of  the  radial  pulse,  or, 
indeed,  by  attacks  in  any  manner  resembling  those  to  which 
I  have  referred.  3.  I  look  upon  black  coffee  as  a  very 
valuable  stimulant,  and  particularly  urge  its  employment 
early  in  the  disease ;  and  I  incline  strongly  to  the  use  of 
liquid  nutriment  in  very  concentrated  forms.  In  regard  to 
one  drug  so  largely  used  in  the  treatment  of  asthenic  forms 
of  acute  disease,  I  am  disposed  to  enter  a  word  of  warning, 
and  it  is  about  the  use  of  large  doses  of  the  tincture  of 
chloride  of  iron.  This  is  one  of  the  most  powerful  styptics 
and  astringents,  and  it  is  presumed  to  exercise  these  pro¬ 
perties  on  the  blood  if  it  be  absorbed.  Now,  to  what 
extent  is  it  responsible  for  the  formation  of  intra-cardiac 
fibrinous  coagula,  particularly  in  diphtheria?” — New  York 
Med.  Record,  May  5. 

(b)  Medical  Times  and  Gazette,  1867,  vol.  i.,  page  653.  (e)  Lancet,  1655. 


PRACTICAL  NOTES  ON 

THE  ORDINARY  DISEASES  OF  INDIA, 

ESPECIALLY  THOSE  PREVALENT  IN  BENGAL. 

By  NORMAN  CHEVERS,  C.I.E.,  M.D. 

( Continued  from  page  65.) 

MALARIAL  CACHEXIA — Continued. 

Splenic  Abscess. 

Suppuration  leading  to  the  formation  of  distinct  abscess' 
of  the  spleen,  apart  from  pyeemic  infarction,  is  a  rare 
condition  in  India.  Preparations  Nos.  554  and  557  in 
the  Calcutta  Medical  College  Museum  appear  to  illustrate 
this  lesion.  Dr.  A.  A.  Mantell  narrates(a)  a  case  in  which 
a  very  large  splenic  abscess  was  evacuated  through  the  left 
lung ;  the  man,  a  European,  aged  sixty-two,  had  been  long 
employed  in  India  as  a  pilot  and  as  the  superintendent  of  a 
lighthouse  on  the  Cuttack  coast.  A  history  of  fever  is  not 
clearly  made  out ;  but,  as  there  was  an  abscess  in  the  throat, 
and  another  in  the  right  kidney  as  large  as  a  hen’s  egg,  it 
is  not  improbable  that  the  disease  was  tubercular.  Dr, 
Verchere  reported  (b)  the  case  of  a  man  who  had  been  ill  for 
a  considerable  time  at  Loodiana  with  fever.  He  complained 
of  great  pain  in  the  left  side,  and  the  spleen  was  acutely 
tender  and  “  enlarged  to  the  size  of  a  large  fish.”  It  was 
leeched  and  blistered.  A  few  days  later  fluctuation  could 
be  felt  in  the  spleen,  and  the  pain  was  intense ;  poultices 
were  applied,  and,  as  soon  as  an  indistinct  pointing  appeared, 
the  abscess  was  tapped  with  a  hydrocele  trocar,  the  canula 
being  left  in  for  some  days.  He  made  a  perfect  recovery, 
and  went  to  duty  without  being  ill  or  inconvenienced.  The 
general  health  improved  much,  and  the  man,  who  had  been 
emaciated,  feeble,  and  livid-grey-complexioned,  soon  made 
flesh  and  assumed  a  healthy  appearance.  At  nearly  the 
same  time  the  Civil  Surgeon,  Bhawulpore  State,  recorded (c) 
the  very  important  case  of  a  young  native  man  who  had 
suffered  from  fever  and  enlarged  spleen  about  ten  months 
previously.  The  spleen  was  acutely  tender;  it  extended 
beyond  the  mesial  line  of  the  abdomen  and  downwards 
nearly  to  the  crest  of  the  ilium.  The  entire  left  chest  was 
evidently  full  of  fluid.  An  opening  was  made  in  the  left 
iliac  region ;  only  two  ounces  and  a  half  of  clear  pus  escaped, 
and  the  distressing  symptoms  were  not  relieved.  There 
being  pointing  above  the  seventh  rib,  a  trocar  was  intro¬ 
duced,  and  one  pound  thirteen  ounces  of  healthy  pus  were 
drawn  off,  with  marked  relief  to  the  distended  chest.  Next 
day,  one  pound  four  ounces  more  were  removed  through  this 
aperture,  which  made  a  decided  impression  on  the  bulk  of 
the  spleen.  The  thoracic  and  abdominal  cavities  were, 
therefore,  in  communication.  Inoffensive  pus  continued  to 
flow,  to  the  amount  of  six  pounds  fifteen  ounces,  during  the 
following  fourteen  days,  when  the  patient  was  taken  away 
by  his  friends — a  most  common  termination  (as  far  as  we  are 
concerned)  to  our  most  interesting  cases  in  India.  The 
compressed  lung  rapidly  expanded,  and  the  heart’s  sounds 
were  heard  to  the  left  of  the  sternum.  When  the  patient 
was  last  seen  he  was  free  from  suffering,  respiration  was 
tranquil,  air  was  heard  all  over  the  left  lung,  the  spleen  was 
much  reduced,  there  was  no  hectic,  and  he  was  making  flesh. 

Dr.  Chandra  has  given(d)  a  case  of  abscess  of  the  spleen 
which  was  successfully  treated  by  free  drainage. 

Dr.  W.  H.  Bull  has  reported  in  the  Lancet(e )  the  very 
interesting  case  of  a  groom,  aged  forty-two,  who  had  served 
for  nine  years  as  a  soldier  in  India,  and  had  suffered  there 
from  hepatitis  and  from  several  attacks  of  fever.  Twelve 
years  after  his  return  home  he  died  from  repeated  attacks 
of  haematemesis,  caused  by  perforation  of  the  stomach  involv¬ 
ing  a  medium-sized  branch  of  the  splenic  artery.  This 
mischief  was  caused  by  an  abscess,  apparently  splenic,  not 
larger  than  a  small  orange.  The  lower  part  of  the  spleen 
was  “  entirely  disintegrated  and  in  a  state  of  ulceration* 
forming  the  outer  boundary  of  the  abscess  wall.” 

Specimen  No.  556  in  the  Medical  College  Museum  is  one 
of  Gangrene  of  the  Spleen  in  a  European  who  had  been 
suffering  from  intermittent  fever. 

(a)  Indian  Annals  of  Medical  Science,  No.  xviii.  for  1865. 

(b)  Indian  Medical  Gazette,  June,  1839.  (e)  Ibid.,  October  1,  1S3SL 

(d)  Ibid,  January  1 ,  U80.  (e)  For  August  ly,  1832,  page  261. 


Sledical  Times  and  Gazette- 


CHEVERS  ON  THE  ORDINARY  DISEASES  OF  INDIA. 


July  28,  1883.  91 


I  never  saw  gangrene  of  the  spleen  in  practice,  but  we 
read  of  a  disease  which,  in  1831,  was  called  the  Siberian 
Epidemic,  or  “  Splenitis  Gangrenosa,”  which  appears  to  have 
been  a  pernicious  fever,  often  ending  in  “  Symptoms  of 
putridity,  severe  pain  in  the  side,  meteorismus,  excessive 
thirst,  constant  vomiting,  yellowness  of  the  skin,  weak  pulse, 
cramps,  and  coldness  of  the  extremities.”  No  bowel  disorder. 
In  a  patient  who  died  on  the  third  day,  there  were  evidences 
of  low  peritonitis.  The  spleen  was  much  enlarged  and 
softened,  was  full  of  dark  blood,  and  presented,  on  its  under 
■surface,  a  large  gangrenous  spot.(f) 

We  have  few  older  or  more  general  observations  in 
medicine  than  that  blood  dyscrasis  and  spleen  disease  have 
always  been  present  in  all  severe  types  of  fever  :  the  more 
malignant  the  fever,  the  greater  the  dycrasis  and  the  more 
affected  the  spleen.  It  was  shown,  long  ago,  by  Thomas 
Wilkinson  King,  that  where,  from  any  cause,  blood  is  pre¬ 
vented  from  passing  readily  out  of  the  abdominal  veins, 
the  spleen  acts  as  a  reservoir,  moderating  the  venous  con¬ 
gestion.  In  Twining’s  time,  and  subsequently,  much  was 
said  about  internal  congestion  leading  to  inflammation 
and  interstitial  deposits,  especially  abdominal,  in  grave 
Indian  fevers :■ — congestion  of  the  veins  of  the  mesentery 
causing  inflammatory  effusion  between  its  layers  and  in¬ 
testinal  haemorrhage,  and  again  congestion,  eventually 
tending  to  inflammation  of  the  spleen  and  liver  and  to 
permanent  dilatation  of  the  portal  vessels.  It  was  the 
■existence  of  such  states,  or  the  belief  that  they  existed, 
which  sent  fever-broken,  anaemic,  sallow,  emaciated  old 
Indians,  who  had  just  escaped  death  by  bleeding  and 
calomel  abroad,  to  go  through  a  still  more  trying  ordeal  of 
drastic  purgative  treatment  in  the  chilly,  foggy  climate  of 
Cheltenham,  and  which  led  a  great  Indian  physician,  ten 
years  ago,  to  say  to  me,  in  speaking  of  our  means  of  obviat¬ 
ing  the  congestive  effects  of  English  cold  upon  the  damaged 
organs  of  old  Indians — ‘‘  Emulge  !  Emulge  !  Emulge !  ”  I  do 
not  deny  that,  as  Indian  fevers  now  are,  and  as  Indian 
treatment  now  stands,  something  of  such  congestion  of  the 
viscera  thus  resulting  is  observable,  but  there  is  not  much 
of  it.  Splenic  disease  is,  as  we  have  seen,  common,  espe¬ 
cially  among  the  native  poor,  and  there  is  some  hepatic 
disease,  demonstrably  of  malarious  origin ;  but  I  am  rather 
content  to  remain  ignorant  of  the  precise  causation  of  these 
lesions  of  the  solid  abdominal  viscera  than  to  cling  to  the 
old  plausible  but  unproved  theory  that  they  resulted  from 
congestion  due  to  arrest  of  faulty  blood  in  the  portal  veins, 
which  congestion  led  to  inflammation  and  enlargement  of 
the  spleen  and  liver.  Doubtless  Twining  was  right  in  con¬ 
sidering  that,  in  the  grave  Remittent  Fever  of  his  day, 
unchecked  congestion  gave  rise  to  low  inflammation  and 
interstitial  effusions ;  but  let  us  ask.  What  share  had  the 
bleeding  and  salivation  in  bringing  about  this  stasis  of  im¬ 
poverished  blood  P  It  must  be  repeated  that,  when  quinine 
has  fair  play,  we  do  not  expect  to  find  this  congestion. 

We  see  something,  but  not  much,  of  such  passive  con¬ 
gestion  in  neglected  cases  of  Remittent  among  natives.  I 
think  that  we  have  two  plain  facts  before  us. 

1.  Faulty  blood  causes  splenic  lesions,  as  in  Scurvy,  and 
as  shown  by  the  cases  of  Mutlah  Fever  which  I  have  given, 
where  about  five  days*  fever,  in  strong  mariners  just  arrived 
in  port,  brought  the  spleen  down. 

2.  Disease  of  the  Spleen  produces  various  lesions  in  the 
corpuscles,  fibrin,  and  albumen  of  the  blood,  in  the  causation 
of  which  lesions  coincident  disease  of  the  Liver  and  Kidneys 
probably  has  a  great  deal  to  do.  I  have  italicised  these 
words  because  it  is  certain  that,  whenever  one  of  the  three 
great  solid  viscera  of  the  abdomen — Spleen,  Liver,  Kidneys 
— is  organically  diseased,  the  other  two  are  more  or  less 
unhealthy — a  fact  never  to  be  lost  sight  of  in  treatment. 

If  it  were  needful  to  theorise,  in  the  present  state  of  our 
knowledge,  upon  the  causation  of  splenic  hypertrophy,  I 
would,  putting  aside  the  idea  of  congestive  tumefaction 
and  effusion  due  to  ague  and  blood  dyscrasis,  insist  upon 
the  close  resemblance  in  many  leading  points  between  the 
process  of  hypertrophic  increment  in  a  splen  ingens  or  a 
leucocythsemic  spleen,  and  the  lymphatic  mischief  which 
results  in  scrotal  tumour  or  Cochin  leg. 

I  think  we  may  reasonably  look  to  the  helminthologists 
who  have  given  us  an  insight  into  the  natural  history  of 
Filaria  sanguinis  hominis,  and  to  the  demonstrators  of 

(f)  Dr.  Magaziner  Kelinert’s  Report,  from  Russian  Military  Medical 
Gazette,  No.  3, 1833. 


Bacillus  anthracis  and  B.  malarial,  for  inquiries  as  to  whether 
malarious  splenic  disease  is  not  characterised  by  the  presence 
in  the  affected  organ  of  some  animal  or  vegetable  parasite. 

It  is  to  be  apprehended  that  those  who  maintain  that  paludal 
fever  dependsuponthepresenceof  a  microphyte  in  the  system 
assume  the  existence  of  that  organism  wherever  such  fever 
prevails.  Again,  it  has  not  been  proved  that  Filaria  sanguinis 
is  a  native  of  temperate  climates ;  still,  even  in  England, 
the  host  of  that  parasite,  the  mosquito,  makes  its  appear¬ 
ance  in  exceptionally  hot  weather,  and  its  congener,  the 
gnat,  is  always  with  us  in  due  season,  especially  in  marshy 
places.  Cats  which  feed  upon  cockchafers  and  black  beetles 
are  always  ill-conditioned  and  short-lived.  In  a  part  of  what 
was  formerly  Lambeth  Marsh,  where  my  father  and  I  suf¬ 
fered  from  acute  dysentery,  we  had  a  bZatta-devouring  cat 
which  died  suddenly.  I  found  the  bronchial  tubes  so  crammed 
with  Filarice  bronchiales  as  to  cause  surprise  that  the  process 
of  suffocation  only  occupied  a  single  night. 

Sir  Joseph  Fayrer  gives  a  most  important  case,  in  which 
a  young  Englishman,  returned  from  India  in  a  state  of 
extreme  splenic  cachexia  and  most  advanced  anaemia,  with 
a  spleen  descending  almost  to  the  pelvis,  was  becoming 
much  improved  under  quinine,  iron,  and  good  nourishment. 
“  One  day,  in  spite  of  earnest  warnings  to  the  contrary,  he 
got  up,  walked  to  the  window,  and  tried  to  raise  or  shut  it. 
He  got  back  to  bed  exhausted  and  breathless,  and  died  in  a 
few  hours.”  Did  this  death  occur  from  pulmonary  embolism, 
from  upward  pressure  by  the  enlarged  spleen  upon  the 
heart,  from  cardiac  weakness,  or  from  inadequate  supply  of 
faulty  blood  to  the  brain  ? 

[To  be  continued .1 


Bromide  of  Sodium. — Dr.  Field,  Professor  of  Thera¬ 
peutics  at  Dartmouth  College,  writes  to  the  Boston  Medical 
Journal,  May  10,  stating  that,  although  the  employment  of 
bromide  of  sodium  has  of  late  increased,  he  does  not  believe 
the  profession  sufficiently  appreciates  its  superiority  over  the 
bromides.  Long  and  attentive  observation  has  convinced 
him — 1.  That  bromide  of  sodium,  being  a  soda  compound, 
is  less  disturbing  to  the  system,  rendering  bromism  less 
probable  and  less  persistent.  2.  It  is  less  depressing  from 
continuous  use  on  the  heart’s  action.  3.  It  is  less  offensive 
to  the  taste,  and  much  less  irritating  to  the  stomach.  Foul 
tongue,  foetid  breath,  and  deranged  digestion  are  less  common 
and  less  extreme  under  its  continued  use.  4.  It  possesses 
equal  therapeutical  power,  or  rather  superior  power,  from 
the  greater  mildness  of  its  action,  and  because  it  can  be 
employed  when  the  potash  salt  would  be  inconvenient  or 
impossible.  It  is  pre-eminently  the  child’s  bromide,  owing 
to  its  less  disagreeable  taste  ;  and  for  children  two  years  old 
the  food  may  be  seasoned  with  it  instead  of  with  salt — a 
few  grains  being  added  to  the  bottle  of  milk  several  times  a 
day  or  at  bedtime ;  or,  again,  from  two  or  four  grains  may 
be  given  in  a  teaspoonful  of  water,  sweetened  or  not,  which 
with  the  potash  salt  would  be  impossible.  For  nausea  and 
vomiting  in  the  adult,  and  especially  in  nervous  females, 
whether  occasioned  by  derangement  of  the  stomach  or  re¬ 
flected  disturbance,  one  of  the  most  effective  remedies  is 
half  a  drachm  of  the  bromide  to  half  a  tumbler  of  iced  water. 
This  must  be  drunk  slowly  as  the  stomach  will  bear  it,  and 
a  little  ice  must  be  kept  in  the  solution  until  it  is  all  taken. 
The  bromide  of  potassium  could  not  be  taken  in  this  way 
any  more  than  it  could  in  sea-sickness,  in  which  the  soda  is  so 
useful.  Dr.  Field  cannot  state  from  his  own  experience 
whether  the  bromide  of  sodium  has  equal  power  with  the 
potassium  in  grave  neuroses,  as  epilepsy.  There  is,  how¬ 
ever,  much  affirmative  evidence.  But  for  the  many  condi¬ 
tions  met  with  in  general  practice  there  can  be  no  doubt  as  to 
its  superiority — for  example,  as  a  simple  hypnotic  and  general 
sedative  in  various  nervous  conditions,  as  an  antispasmodic 
in  mild  chorea,  etc. 

Action  to  Recover  the  Price  of  Blood  furnished. 
— Banks,  a  coloured  man,  has  begun  a  suit  against  Dr. 
Garrigues  and  Mr.  Okerberg  for  $250  as  the  value  of  eight 
ounces  of  blood  taken  from  him  and  injected  into  the  veins 
of  Mr.  Okerberg.  It  appears  that  this  gentleman  went  to 
bed  in  a  small,  close  room,  blowing  out  the  gas.  In  the 
morning  he  was  found  insensible,  and  Dr.  Garrigues  per¬ 
formed  transfusion.  The  patient  recovered,  and  now  Banks, 
who  furnished  the  blood,  claims  what  he  considers  a  fair 
compensation. — New  York  Med.  Record,  July  7. 


92 


Medical  Timei  and  Gazette. 


MEDICAL  AND  SURGICAL  PRACTICE. 


July  28,  1883:- 


REPORTS  OF 

HOSPITAL  PRACTICE  IN  MEDICINE 
AND  SURGERY. 

- «■ - 

THE  MIDDLESEX  HOSPITAL. 

CASES  OF  EXTERNAL  MEDIAN  URETHROTOMY 
UNDER  THE  CARE  OF  MR.  H.  MORRIS. 

Case  1. — Abscess  of  Prostate — Cystitis — Median  Urethrotomy 

— Death  from  Inflammation  of  Ureters,  Pyonephrosis ,  and 

Diffuse  Suppurative  Nephritis. 

[For  notes  we  are  indebted  to  Mr.  D.  Stephenson,  the  Dresser.] 
William  N.,  aged  forty-eight,  a  warder  at  a  convict  prison, 
was  admitted  into  Forbes  ward  on  January  12,  1882. 

History. —  Seven  months  ago  he  first  had  pain  and  fre¬ 
quency  in  micturition,  and  after  these  symptoms  had  con¬ 
tinued  for  a  few  weeks,  he  one  day  passed  a  quantity  of 
pus  by  the  penis.  A  urethral  discharge  continued  for  some 
time  afterwards.  [Urine  was  often  high-coloured,  with  a 
sediment  like  red  sand.  Never  passed  a  stone.  No  history 
of  gout  or  rheumatism. 

On  Admission. — Complains  of  a  constant  desire  to  pass 
water  night  and  day  :  last  night  he  had  to  get  out  of  bed 
six  times ;  during  the  day  he  has  to  make  water  about 
every  fifteen  minutes.  Has  to  strain  a  good  deal,  and  suffers 
great  pain,  which  lasts  for  some  minutes  after  micturition. 
Has  passed  small  drops  of  blood  after  passing  water.  Urine 
contains  a  quantity  of  pus. 

January  12. — No  stone  or  growth  in  the  bladder.  No 
stricture.  Per  rectum  there  was  not  the  usual  fulness  or 
resistance  of  the  prostate. 

The  symptoms  continuing  to  increase  in  their  severity 
in  spite  of  all  ordinary  treatment,  injections  of  hot  water 
into  the  bladder  were  tried,  but  without  any  sign  of  benefit. 
Mr.  Morris  therefore,  on  January  29,  made  an  incision  into 
the  membranous  urethra  through  the  middle  line  of  the 
perineum,  cutting  on  a  staff  with  a  median  groove. 

February  2. — Since  operation  has  passed  all  his  urine 
through  the  wound.  He  has  lost  the  dysuria,  but  still  has 
a  little  pain  at  the  end  of  the  penis.  Pulse  80,  full  and 
large ;  tongue  brown  and  dry ;  bowels  loose  ;  very  thirsty  ; 
skin  cool.  Says  he  has  been  much  comforted  by  the  operation. 

There  is  no  need  to  record  the  subsequent  daily  notes  of 
this  patient.  It  is  sufficient  to  say  that  he  continued  free 
of  the  spasms  and  frequent  efforts  at  micturition ;  that  he 
took  his  food  and  slept  well  for  over  a  month,  and  that  then 
the  evidence  of  rapidly  extending  renal  disease  became  more 
marked,  and  death  occurred  on  March  13,  nearly  six  weeks 
after  the  operation.  During  the  whole  of  this  time  mictu¬ 
rition  was  performed  through  the  wound]  a  catheter  was 
retained  for  several  days,  and  after  its  removal  the  wound 
showed  no  tendency  to  heal,  much  to  the  patient’s  satisfac¬ 
tion,  who  repeatedly  expressed  his  gratefulness  for  the 
operation,  and  would  have  on  no  account  returned  to  the 
normal  mode  of  urinating. 

Dr.  Fowler  made  the  post-mortem  examination  fifteen 
hours  after  death,  and  Mr.  Sutton  examined  the  bladder  and 
urethra  after  their  removal  from  the  body.  From  their  re¬ 
port  we  learn  that  the  ureters  were  much '  distended,  and 
their  mucous  membrane  blackened  and  ulcerated.  Near  the 
orifice  in  the  right  ureter  there  were  a  number  of  small 
tubercular-looking  nodules ;  similar  nodules  were  present  in 
the  left  ureter.  The  pelvis  of  each  kidney  was  distended,  the 
mucous  membrane  eroded  and  acutely  inflamed,  and,  as  seen 
post-mortem,  of  a  blackish -green  tint.  There  were  several 
caseous  nodules  on  the  surface  of  their  lining  membrane. 
The  pyramids  were  extensively  destroyed,  and  several 
large  sloughs  were  on  the  point  of  separating;  in  other 
parts  but  little  of  the  pyramids  remained.  Scattered 
through  the  substance  of  the  kidney  were  a  vast  number 
of  caseous  and  suppurating  foci ;  and  there  were  seen 
also  upon  the  surface  of  the  kidneys,  after  removing  their 
capsules,  a  number  of  suppurating  spots.  The  bladder 
was  contracted ;  its  mucous  membrane  was  (post  mortem) 
of  a  blackish  tint  and  eroded  in  many  places.  Small  ulcers 
and  tubercular-looking  bodies  were  seen  scattered  over  the 
surface,  a  few  in  the  trigone,  but  chiefly  situated  at  the 
fundus.  The  orifices  of  the  ureters  were  much  dilated  and 
thickened.  On  laying  open  the  urethra  from  above,  the 


posterior  half  of  the  prostatic  portion  was  seen  to  be 
distended  on  the  right  side  of  the  median  line.  On  the 
floor  of  this  part,  about  one- third  of  an  inch  in  front  of  the 
sinus  pocularis,  was  a  small  opening,  partly  ulcerating, 
partly  contracted  by  cicatricial  tissue.  This  opening  led 
into  a  large  abscess-cavity  two  inches  by  half  an  inch  in 
diameter,  which  had  approached  very  near  to  the  mucou3 
lining  of  the  rectum  just  above  the  anus,  and  had  destroyed 
the  whole  of  the  middle  lobe  and  part  of  the  right  lobe  of 
the  prostate,  as  well,  as  a  part  of  the  right  wall  of  the 
membranous  urethra.  The  left  lobe  and  a  small  part  of 
the  right  lobe  of  the  prostate  were  not  destroyed;  but  the 
normal  rounded  outline  and  the  resistance  of  the  prostate 
were  almost  wanting.  In  the  membranous  portion  of  the 
urethra  was  the  incision  about  half  an  inch  long,  made  at 
the  operation  ;  this  was  still  patent.  There  was  no  stricture 
of  any  part  of  the  urethra. 

Remarks. — The  diagnosis  formed  in  this  case  was  cystitis 
secondary  to  suppuration  in  the  prostate,  and  that  the 
prostatic  abscess  had  discharged  per  urethram.  The  post¬ 
mortem  showed  that  the  nature  of  the  disease  was  tuber¬ 
cular,  and  that  the  prostate  was  the  original  seat  of  the 
deposit.  The  operation  was  performed  simply  to  relieve 
symptoms,  not  with  a  hope  of  cure,  as  it  was  evident  from 
the  first  that  the  kidneys  had  become  already  affected.  The 
beneficial  results  of  the  operation  were  very  obvious  to  those- 
who  witnessed  the  course  of  the  case,  and  were  constantly 
testified  to  by  the  patient  himself. 

Case  2.  —  Stricture  of  Urethra — Cystitis  —  Sloughing  of 
Bladder — Median  Urethrotomy — Relief  of  Bladder  Sympr 
toms — Death  from  Peritonitis  due  to  Ulceration  of  Bladder. 

[From  notes  by  the  Dresser,  F.  J.  Jaynes  1 
John  A.,  aged  seventy-two,  admitted  into  Forbes  ward  on: 
the  morning  of  December  19,  1882. 

History. — Had  gonorrhoea  some  years  ago.  First  had  re¬ 
tention  of  urine  five  years  ago.  Since  that  time  he  says  he 
has  been  subject  to  slight  attacks  of  this  kind ;  but  he  has 
always  been  able  to  overcome  them  until  within  the  last 
seven  or  eight  weeks,  during  which  he  has  required  to  have 
the  catheter  passed  very  frequently,  and  has  had  constant 
pain  and  spasm  in  his  penis  and  about  his  bladder.  For  a 
fortnight  past  his  doctor  has  wanted  him  to  go  to  a  hospital, 
as  there  was  nothing  to  be  done  for  his  relief  but  an  operation. 
On  Admission.- — Has  not  passed  water  since  11.30  last 
night.  Bladder  appears  to  be  distended.  There  is  a  large 
area  of  dulness,  hardness,  and  tenderness  in  the  hypo 
gastrium.  Has  a  stricture  at  the  meatus,  and  about  three 
inches  down  the  penis.  A  No.  4  catheter  was  passed  by 
the  House-Surgeon  with  difficulty;  but  no  urine  could  be 
drawn  off.  On  withdrawing  the  catheter,  the  eye  was 
stopped  up  with  long  threads  of  sloughing  mucous  mem¬ 
brane.  About  2.30,  Mr.  Morris  saw  the  patient,  and,  after 
incising  a  contracted  meatus,  passed  a  No.  6  catheter  with¬ 
out  difficulty;  but  only  about  three  ounces  of  dark,  very 
offensive  urine  were  drawn  off.  There  still  remained  the 
dulness  in  the  hypogastrium,  with  great  tenderness  in  this 
region.  In  the  evening  only  about  three  ounces  of  urine 
were  drawn  off,  and  none  passed  voluntarily.  He  went 
through  a  most  distressing  night,  constantly  straining  to 
pass  water,  but  without  effect. 

December  20. — He  is  in  great  pain  over  the  abdomen.  Has 
a  constant  desire  to  pass  water,  which  he  is  unable  to  do.  Has 
vomited  a  good  deal,  the  vomit  being  of  the  colour  and  con¬ 
sistence  of  “coffee-grounds.”  At  1.30,  Mr.  Morris,  with  a- 
view  to  give  relief  to  the  frequent  spasmodic  efforts  to  mic¬ 
turate,  decided  on  performing  median  urethrotomy.  The 
patient  having  been  put  under  the  influence  of  an  anaes¬ 
thetic,  an  incision  was  made  down  on  to  the  membranous 
portion  of  the  urethra  through  the  middle  line  of  the 
perineum.  A  piece  of  india-rubber  tubing  of  large  calibre 
was  introduced  through  the  wound  into  the  bladder.  Only 
a  small  quantity  of  very  offensive  urine  escaped,  but  a  large 
piece  of  black,  sloughy  mucous  membrane,  like  an  imper¬ 
fect  cast  of  the  bladder,  came  down  through  the  tube,  and 
was, withdrawn.  The  bladder  was  well  washed  out  with  a 
weak  solution  of  Condy’s  fluid,  and  the  patient  put  to  bed, 
21st. — Had  some  quiet  sleep,  and  has  been  quite  relieved 
of  the  spasmodic  efforts  at  micturition.  He  said  it  was  the- 
first  real  sleep  he  had  had  for  six  or  seven  weeks.  Bladder 
again  washed  out.  Quite  free  from  pain,  but  weaker.. 
Quantity  of  urine  which  has  been  voided  is  small ;  it  has  all 


Medical  Times  and  Gazette. 


THE  HOUSE  OF  LORDS  ON  ARMY  HOSPITAL  SERVICES. 


July  28, 1883.  93 


come  through  the  tube.  At  4  p.m.  he  became  collapsed,  and 
died  at  4.20. 

The  post-mortem  was  made  by  Dr.  Fowler,  twenty-two 
hours  after  death.  On  opening  the  abdomen,  the  peri¬ 
toneum  was  seen  to  be  acutely  inflamed,  the  intestines  glued 
together  by  effused  lymph;  some  coils  of  small  intestine 
were  adherent  to  the  bladder  and  parietal  layer  of  the  peri¬ 
toneum  in  the  hypogastric  region.  These  coils,  and  also 
the  rectum  and  sigmoid  flexure,  to  which  they  were  adhe¬ 
rent,  contained  a  quantity  of  semi-fluid  faeces,  the  whole 
forming  a  mass  which  almost  filled  the  pelvis,  and  extended 
•to  within  two  inches  of  the  umbilicus.  About  the  base  of 
the  bladder  the  lymph  gluing  the  adjacent  coils  of  intestine 
was  of  older  date  than  elsewhere.  On  carefully  separating 
these  parts,  a  small  perforation  with  necrotic  edges  was 
seen  in  the  serous  coat  of  the  bladder,  and  close  to  it  was 
another  necrotic  patch  which  had  not  perforated.  On 
depressing  a  catheter  passed  into  the  bladder,  the  point 
approached  close  to  the  perforation  in  the  peritoneum  just 
mentioned.  The  penis  and  bladder  were  then  removed 
entire  and  laid  open.  Two  inches  from  the  orifice,  the 
mucous  membrane  of  the  lower  wall  showed  a  rent  nearly 
an  inch  long ;  beyond  it  there  were  several  other  less 
extensive  rents  in  the  mucous  membrane,  which  was 
rough  from  this  point  onwards  to  the  bladder.  In  the 
membranous  portion  the  lower  wall  had  been  divided 
for  a  distance  of  one  inch.  This  incision  communicated 
with  a  wound  in  the  perineum,  also  about  one  inch  long. 
The  mucous  membrane  here  showed  signs  of  injury  inde¬ 
pendent  of  the  incision,  there  being  several  small  rents. 
The  prostate  was  not  enlarged,  and  there  was  no  “  third 
lobe.”  At  the  orifice  of  the  bladder,  immediately  behind 
the  uvula  vesica;,  there  was  a  tunnel  through  the  mucous 
and  submucous  coats  on  the  left  of  the  middle  line ;  this 
would  admit  of  a  No.  12  catheter.  The  bladder  was 
contracted;  the  walls  extremely  thick,  measuring  three- 
quarters  to  half  an  inch ;  the  mucous  membrane  was  rugose 
and  intensely  inflamed,  and  here  and  there  pigmented. 
The  orifices  of  very  small  sacculi  could  be  seen  between  the 
rugae.  There  were  several  necrotic  spots  and  larger  sloughs, 
especially  about  the  base  of  the  bladder,  in  which  there 
was  also  a  rounded  opening  that  admitted  the  little  finger. 
The  edges  of  this  opening  were  steep  and  smooth,  but  the 
mucous  membrane  around  it  was  sloughy.  Through  this 
channel  a  communication  existed  between  the  bladder  and 
an  irregular  sac  lying  beneath  the  peritoneum  at  the  place 
where  it  was  perforated,  as  previously  mentioned.  To  the 
left  of  the  middle  line  the  sac  was  found  to  contain  a  quan¬ 
tity  of  brownish  fluid,  evidently  altered  blood,  which  had 
been  effused  into  the  cellular  tissue  around  the  bladder.  The 
ureters  were  normal.  The  kidneys  were  small  and  granular ; 
capsules  adherent ;  cortices  wasted ;  the  medullary  portion 
pale,  and  in  right  kidney  swollen  from  recent  inflammation  ; 
lining  of  pelvis  of  each  injected. 

Remarks. — This  old  man  was  admitted  in  almost  a  mori¬ 
bund  condition.  There  was  the  history  of  stricture  for  years, 
and  of  cystitis  for  weeks.  Frequent  catheterism  had  been 
employed,  but  without  relief  to,  probably  even  aggravating, 
his  distress,  which  steadily  increased  in  severity.  The  quan¬ 
tity  of  urine  secreted  by  his  diseased  kidneys  was  very  small, 
and  although  there  had  been  fifteen  hours’  complete  reten¬ 
tion  when  first  seen  by  me,  only  three  ounces  of  urine  were 
drawn  off.  Some  other  condition  than  a  distended  bladder 
had  therefore  to  be  sought  for  as  the  cause  of  the  hypo¬ 
gastric  dulness  and  tenderness ;  and  though  from  the  general 
symptoms  and  abdominal  pain  it  was  concluded  that  peri¬ 
tonitis  with  intestinal  adhesions  existed,  there  did  not 
appear  sufficient  reasons  for  supposing  the  inflammation 
of  the  bladder  had  run  on  to  actual  perforation ;  and  even 
when,  at  the  time  of  the  operation,  the  large  slough  escaped 
from  within  the  bladder,  we  had  no  proof  that  its  walls 
had  been  quite  perforated  by  the  necrotic  process.  On 
examination  of  the  perforated  spot,  which  was  old,  dis¬ 
coloured,  and  sloughy,  it  appeared  that  the  frequent  con¬ 
tact  of  the  catheter  against  the  same  part  of  an  already 
inflamed  bladder  had  determined  the  point  of  perforation. 
The  danger  from  catheterism  is  a  real  one  in  the  case  of  the 
bladders  of  old  people,  when  ulcerated  or  softened  by  in¬ 
flammation,  and  it  furnishes  another  argument  in  favour  of 
giving  relief  to  the  restless  and  painful  organ  by  perineal 
incision,  instead  of  constantly  harassing  it  by  unavailing 
and  harmful  use  of  instruments.  That  in  this  case  there  < 


had  been  many  hitches  with  the  catheter  was  proved  by  the 
torn  and  tunnelled  condition  of  the  urethra.  How  much 
suffering  the  patient  would  have  been  spared  had  he  taken 
his  doctor’s  advice,  and  come  earlier  to  the  hospital,  was 
shown  by  the  relief  the  operation  afforded  him ;  but  though 
I  performed  the  operation  on  the  day  after  his  admission 
(and  would  have  done  it  at  the  time  of  my  first  seeing  him 
had  I  had  the  sanction  of  his  relatives),  it  was  all  too  late  to 
save  his  life.  Incidentally,  this  case  also  shows  that  the 
bladder  may  be  perforated  at  a  part  covered  by  peritoneum, 
and  that,  provided  the  process  be  a  slow  one,  extravasation 
of  urine  into  the  peritoneal  cavity  may  be  prevented  by 
adhesion  of  the  bowels  to  the  bladder. 

C  To  be  continued .) 


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it 

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6 

it  ... 

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♦ 


SATURDAY,  JULY  28,  1883. 

- « - 

THE  HOUSE  OF  LORDS  ON  ARMY  HOSPITAL 
SERVICES. 

The  debate  in  the  House  of  Lords,  on  Friday  last  week,  on 
the  Army  Hospital  Services  in  Egypt,  and  on  the  organisa¬ 
tion  of  the  Army  Medical  Department,  added  nothing  to  our 
knowledge  of  the  hospital  management  during  the  campaign, 
and  threw  very  little  light  on  the  vexed  question  of  whether 
medical  officers  shall,  or  shall  not,  again  be  attached  to  regi¬ 
ments.  Lord  Bury  asked  the  House  to  resolve,  that  while 
the  individual  officers  in  Egypt  behaved  admirably  well,  the 
system  under  which  they  worked  did  not  successfully  stand 
the  strain  put  upon  it ;  that  the  military  authority  exercised 
by  the  medical  officers  was  inconvenient,  and  that  discipline 
in  hospitals  ought  to  be  administered  by  combatant  officers, 
leaving  to  the  medical  officers  medical  duties  only ;  and  that 
medical  officers  ought  to  be  attached  to  regiments  instead 
of  being  detached  for  duty  day  by  day  from  station  and 
other  hospitals.  In  his  speech,  as  in  his  resolution,  he  was 
studiously  courteous  to  the  medical  officers,  as  medical  men ;  it 
was  only  as  officers  entrusted  with  the  command  of  men  that 
they  failed.  His  great  object  was  to  show  that  every  mili 
tary  hospital,  station  as  well  as  general,  must,  if  things 
are  to  go  on  well,  be  governed  by  a  military  commandant 
and  the  absolute  necessity  of  a  return  to  the  regimental 
system  :  and  to  prove  this  he  contended  that  "  the  some- 


mefoical  Cunts  anir 


94 


Medical  Times  and  Gazette. 


STATE -MADE  LUNACY. 


July  28,  1863. 


what  of  a  break-down  ”  that  happened  in  the  Egyptian 
campaign  was  due  to  the  fact  that  although  the  medical 
officers  individually  were  unexceptionable  from  a  medical 
point  of  view,  they  were  unable,  owing  to  defective  training, 
to  enforce  discipline  in  the  hospitals ;  this  defect,  again, 
being  due  to  their  not  being  attached,  when  they  entered  the 
Service,  to  regiments.  Under  the  present  system,  his  lord- 
ship  said,  "  medical  officers,  not  being  attached  to  regiments, 
had  no  means  of  becoming  disciplinary  officers ;  and  conse¬ 
quently  they  had  entirely  failed  in  the  attempt  to  carry  out 
this  branch  of  their  functions.”  But  even  were  the  old 
system  restored.  Lord  Bury  still  would  not  trust  the  medical 
officers,  though  they  had  learned  discipline  through  having 
been  regimental  officers,  with  the  command  of  their  hospitals; 
but  insisted  that  in  all  cases  that  must  be  entrusted  to 
combatant  officers.  He  appears  to  hold  that  there  is  only 
one  kind  of  discipline — the  kind  that  can  be  learned  in 
an  orderly-room,  and  imparted  by  an  adjutant !  We  must 
ask,  is  there  really  no  other  kind  of  discipline  ?  Does  not 
a  young  medical  man  learn  discipline  when  he  attends 
practice  in  a  civil  hospital  ?  Does  he  not  see  by  every  bed¬ 
side  that  orders  must  be  implicitly  carried  out  ?  Does  he 
not  learn  to  subordinate  his  own  opinions  to  those  of  his 
superiors  in  age  and  position  ?  Surely  he  is  taught  the 
value  of  time,  and  the  need  of  punctual  performance  of 
duty !  Lord  Bury  quoted,  from  the  evidence  given  before 
Lord  Morley’ s  Committee,  cases  to  show  what,  in  a  com¬ 
batant  officer’s  opinion,  "  discipline  ”  means.  Colonel 
Maurice  stated  that  a  friend  of  his,  a  combatant  officer,  had 
sent  his  servant  to  ask  the  cook  for  some  food,  and  the  cook 
had,  in  very  uncivil  terms,  refused.  The  medical  officer  in 
charge,  when  spoken  to  about  it,  regretted  the  incivility  of 
the  cook’s  reply,  but  added,  “  You  must  remember  that 
though  you  are  an  officer  here,  you  are  a  patient  in  the 
hospital,  and  you  must  conform  to  the  orders  of  the  hospi¬ 
tal.”  This  was  thought  unsatisfactory;  but  let  anyone 
fancy  what  a  state  of  confusion  and  mischief  would  speedily 
be  brought  about,  could  every  officer  m  hospital  send  to  the 
cook  for  food  whenever  he  liked  ! 

Some  other  instances  of  complaints  were  referred  to  by 
Lord  Bury  in  support  of  his  argument,  but  they  were  all 
petty  or  absurd.  These  subjects  have,  however,  been  fully 
noticed  by  us  in  former  articles.  There  is  hio  doubt  that 
the  hospital  attendants  were  not  all  of  them,  by  any  means, 
all  that  could  be  desired ;  but  they  were  at  first  very  much 
overworked,  and  no  man,  even  if  well  trained  and  disci¬ 
plined,  can  for  any  length  of  time  do  at  all  well  the  work  of 
two  or  three.  Lord  Morley,  in  replying  to  Lord  Bury,  pointed 
out  that,  in  fact,  there  had  not  been  any  “  break-down”;  that 
the  difficulties  with  which  the  medical  officers  had  for  a  short 
while  to  contend  were  due  entirely  to  the  extreme  rapidity 
of  the  campaign  when  it  had  begun  in  earnest ;  and  that, 
notwithstanding  those  difficulties,  the  medical  results  were 
very  remarkable,  and  gave  ample  proof  that  the  sick  and 
wounded  had  not  seriously  suffered.  No  conceivably  possible 
organisation  of  the  Army  Medical  Department  can  secure 
that  every  arrangement  shall  always  work  without  hitch  or 
disturbance  in  the  stress  of  war,  or  that  all  the  field  or 
base  hospitals  shall  at  once  and  always  be  as  well  supplied 
and  as  free  from  discomfort  or  hardships  as  is  a  civil 
hospital  in  the  English  metropolis ;  nor,  pace  Lord  Bury, 
will  the  dictum  of  a  Gfeneral  Commanding-in-Chief  con¬ 
vert  a  field  hospital  into  a  fully  equipped  base  hospital. 
Lord  Morley  also  pointed  to  the  difficulty  of  recruiting  the 
Army  Hospital  Corps.  All  civil  hospitals  are  nursed  by 
women,  and  the  whole  supply  of  male  nurses  and  hospital 
orderlies  must  be  maintained  by  the  Army  authorities.  But 
some  system  might  unquestionably  be  adopted  for  training 
men  in  the  general  and  station  hospitals.  In  England  and 


Ireland  there  are  182  station  hospitals,  and  we-  do  not  see- 
why  in  every  one  of  them  some  men  might  not  always  be 
attending  as  Hospital  Corps  recruits.  This  matter,  like- 
the  question  of  a  partial  return  to  the  regimental  system  for 
medical  officers,  is  a  question  of  expense.  The  Duke  of' 
Cambridge  suggests  that  a  medical  officer  should  be  attached 
absolutely  to  a  regiment  for  two  or  three  years,  during  which 
he  should  be  a  regimental  officer,  as  was  the  doctor  under 
the  old  system;  but  at  the  same  time  he  might  attend  at  a 
station  hospital,  if  such  attendance  did  not  interfere  with  his- 
duties  to  his  regiment.  The  Duke  of  Richmond  and  some 
other  members  of  the  House  also  spoke  strongly  in  favour  of 
the  regimental  system.  Lord  Wolseley,  it  maybe  observed, 
was  conspicuous  by  his  absence  from  the  debate.  Lord 
Morley  acknowledged  the  importance  and  weight  of  the 
opinions  in  favour  of  regimental  medical  officers,  and  ad¬ 
mitted  that  the  Committee  had  not  been  unanimously 
against  any  return  to  that  system.  He  was  himself 
opposed  to  it,  because  medical  officers  would  deteriorate 
if  prevented  from  attending  hospitals ;  but  it  cannot  be 
supposed  that  they  would  seriously  lose  in  skill  and 
knowledge  if  the  Duke  of  Cambridge’s  modified  system 
were  adopted,  even  should  the  period  of  regimental  service  be 
extended  to  three  or  four  years.  The  Committee  acknow¬ 
ledged  that  “  the  comfort  and  convenience  of  the  Army 
generally  have  not  been  sufficiently  considered  in  arranging- 
the  details  of  medical  attendance  of  a  regiment  ”;  and  this 
modified,  short  regimental-service  system  would  probably 
supply  fairly  well  the  shortcomings  of  the  present  system. 
The  great  difficulty  in  the  way  of  any  such  change  is  that  it 
would  cause  extra  expense.  Is  the  nation  really  so  poor  that 
it  cannot  afford,  or  is  the  Ministry  so  timid  that  they  dare  not 
suggest,  an  increase  of  a  few  thousands  a  year  to  the  Army- 
estimates  in  order  to  render  the  Army  Medical  Service 
thoroughly  efficient  ?  No  one  can  believe  that  the  fault  in. 
this  case  lies  with  the  people  of  England. 


STATE-MADE  LUNACY. 

An  important  conversation  took  place  in  the  House  of  Lords-, 
last  week  on  the  question  of  overwork  in  elementary  schools 
and  its  connexion  with  insanity.  The  gravity  of  the  evil 
was,  of  course,  officially  minimised  by  the  Lord  President 
of  the  Council,  but  he  virtually  admitted  its  existence. 
Lord  Shaftesbury,  whose  position  as  President  of  the 
Commission  of  Lunacy  redoubles  the  weight  which  his  per¬ 
sonal  opinion  carries  with  it,  concluded  an  ominous  speech 
by  saying  that  “  the  state  of  things  that  existed  was- 
well  worthy  of  the  consideration  of  Her  Majesty’s  Govern¬ 
ment.”  Lord  Carlingford  deprecated  the  allusion  to  the 
increase  of  insanity  that  was  made  by  Lord  Stanley  of 
Alderley,  who  introduced  the  subject  to  the  notice  of  the- 
House,  but  he  admitted  formally  the  existence,  and  by  im¬ 
plication  the  prevalence,  of  overwork  in  elementary  schools  j 
and  when  this  is  admitted  the  defence  is  virtually  aban¬ 
doned,  for  no  one  who  has  mastered  the  rudiments  of  physi¬ 
ology  and  psychology  can  doubt  that  excessive  mental  strain,, 
at  the  period  of  time  when  the  brain  is  undergoing  its  most 
active  development,  must  impair  the  process  and  cause  it  to 
result  in  an  imperfect  structure.  Let  us  see  what  is  meant  by 
overwork.  The  Educational  Code  requires  a  school  attend¬ 
ance  of  twenty-five  hours  per  week.  At  the  same  time  the- 
Government  holds  out  inducements,  in  the  shape  of  grants  of 
money  to  the  teachers,  to  attain  the  best  possible  results  at  the 
periodical  examinations  by  the  inspectors.  In  order  to  gain  a 
good  report  from  these  officials  (a  report  on  which,  of  course,, 
the  reputation  and  career  of  the  teacher  largely  depend) 
the  children  are — it  is  admitted  as  to  some  schools,  and  it  is 
implied  and  appears  morally  certain  as  to,  many  schools— 


Medical  Times  and  Gazette. 


KNIGHT  OH  BABONET 1 


July  28,  1883.  95 


urged  and  driven  to  work  more  than  double  the  stated 
number  of  hours,  and  to  learn  a  very  large  variety  of 
subjects.  In  one  school  the  hours  of  work  all  the  year 
iround  were  seven  and  three-quarters  per  day,  and  for  three 
months  before  the  examinations  the  dunces  or  less  forward 
•children  had  an  additional  hour,  making  eight  hours  and 
three-quarters  per  day  of  brain  work  for  children  under  the 
age  of  thirteen  years  !  A  child  of  this  age  requires  at  least 
ten  hours  of  sleep  out  of  the  twenty-four,  and  if  this 
requirement  is  satisfied  there  remain  five  and  a  quarter 
hours  for  meals,  for  getting  to  and  from  school,  for  dressing 
and  undressing,  etc.  Out  of  these  five  hours  and  a  quarter 
how  many  are  spent  by  the  jaded  children  in  outdoor 
exercise  and  play  P  When  we  know  these  facts  it  is  un¬ 
necessary  to  ask  for  figures  in  order  to  determine  whether 
insanity  is  increasing  or  no.  We  may  require  figures  to  tell 
us  whether  small-pox  increases  with  the  decrease  of  vaccina¬ 
tion,  or  whether  crime  increases  with  the  increase  of  drunken¬ 
ness,  or  whether  fevers  increase  with  the  neglect  of  drain¬ 
age  ;  but  when  the  brains  of  young  children  are  exercised 
to  a  degree  out  of  all  proportion  to  the  exercise  of  their 
bodies, — when  at  the  most  active  period  of  life  they  are  kept 
at  sedentary  work  for  two-thirds  of  their  working-hours,  or 
of  what  ought  to  be  their  working-hours, — when,  after  work¬ 
ing  an  excessive  number  of  hours  at  school,  they  have  tasks 
to  take  home,  for  neglect  of  which  they  are  whipped, — we  do 
not  need  statistics  to  assure  us  of  the  result.  A  sound  and 
stable  brain  can  no  more  grow  from  thin  and  poorly  oxy¬ 
genated  blood,  supplied  under  feeble  pressure  by  a  heart 
that  is  not  duly  stimulated  by  general  muscular  exercise, 
than  a  substantial  house  can  be  built  of  rotten  mate¬ 
rials.  And  when  the  expanding  brain,  which  is  struggling 
to  grow  under  an  insufficient  supply  of  inferior  materials,  is 
at  the  same  time  suffering  daily  an  excessive  waste  which 
lias  to  be  repaired  from  the  same  source,  it  is  abundantly 
manifest  that  either  the  repair  must  be  incomplete,  or  the 
growth  must  be  scamped,  or  both  must  be  badly  done.  No 
truth  in  biology  is  better  established  than  this,  that  the 
more  development  is  hurried,  the  more  fragile,  unstable 
.and  ephemeral  is  the  result.  As  well  might  we  expect  the 
fungus  that  grows  up  in  a  night  to  attain  the  toughness  of 
an  oaken  sapling,  as  expect  the  brains  that  develope  under 
this  system  of  forcing  to  withstand  successfully  the  wear 
and  tear  of  after-life.  Children  do,  of  course,  break  down 
■actually  during  the  process,  and  there  are  few  physicians 
in  considerable  practice  who  could  not  speak  to  such  cases 
from  their  own  experience,  but  the  graver  effects  are  com¬ 
monly  more  remote.  It  is  when  the  stern  realities  of  adult 
life  begin  to  be  experienced,  when  the  struggle  for  existence 
is  in  full  progress,  that  the  inherent  weakness  of  a  struc¬ 
ture  built  up  under  such  unfavourable  conditions  becomes 
■manifest,  and  under  a  moderate  strain  it  breaks  down. 

When  we  ask  who  is  responsible  for  the  overwork,  we  are 
answered  by  a  ehorus  of  excuses.  Lord  Stanley  of  Alderley 
lays  the  blame  upon  the  Department.  “  Why,”  he  asks, 
“  should  the  Education  Department  dangle  ‘'excellent'’ 
before  every  master  and  mistress,  and,  having  with  every 
new  edition  of  the  Revised  Code  raised  the  standard  of 
learning,  make  it  really  wrong  for  those  teachers  to  attempt 
ito  get  excellent  and  to  secure  the  grant  ?  ”  The  Lord 
President  says  that  overwork  is  entirely  due  to  “overzeal  on 
the  part  of  the  managers  of  schools.5’  “  The  real  cause  of 
overwork  is  to  be  found  in  the  despotic  requirements  of  the 
local  educational  authorities.”  The  school  managers,  on 
the  other  hand,  are  in  some  cases  “  obliged  to  issue  circulars 
to  the  masters  and  mistresses,”  forbidding  them  to  woi'k  the 
children  overtime. 

In  spite  of  all  this  shifting  and  denial  of  responsibility,  it 
is  very  easy  to  see  where  the  fault  actually  lies.  “  There  is 


no  reason,”  says  Lord  Carlingford,  “  why  school-managers 
should  go  beyond  their  powers.  Any  school  may  earn  a  very 
fair  grant  by  confining  itself  to  the  ordinary  subjects  of 
instruction.”  Very  likely ;  but  can  it  be  supposed  that 
school  managers  or  school  masters  will  remain  content  with 
a  “  very  fair  ”  grant  when  a  still  better  grant  is  to  be  got  ? 
The  plain  truth  is  that  the  Government  grants  are  so 
arranged  as  to  place  a  direct  and  substantial  premium  on 
the  practice  of  overworking  the  children.  Whether  this 
result  could  be  avoided  by  a  redistribution  of  the  grants,  or 
whether  it  is  one  of  the  necessary  and  inherent  vices  of 
“  State-tamperings  ”  with  the  duties  of  parents  and  citizens, 
it  is  not  in  our  province  to  inquire,  but  there  can  be  no 
doubt  that  the  Education  Department  is  in  danger  of 
becoming  a  powerful  factor  in  the  production  of  lunacy  in 
this  country,  and  the  sooner  this  danger  is  recognised  the 
better. 


KNIGHT  OR  BARONET? 

The  medical  profession  in  Dublin  is  greatly  disturbed. 
Another  insult  has  been  offered  to  the  long-suffering  sister 
isle,  and  the  doctors  have  risen  to  resent  it.  The  incident 
is  a  grave  one,  and  amounts  to  no  less  than  this — that  a 
distinguished  Dublin  surgeon  has  been  offered  the  honour 
of  knighthood.  So  soon  as  the  tidings  became  known  to 
the  profession  it  aroused  a  storm  of  indignation,  which  an 
unconcerned  spectator  might  have  imagined  to  have  been 
the  expression  of  an  outraged  Spartan  simplicity  and  an 
offended  republican  sternness.  Such  was  not  the  case. 
The  offer  was  scouted,  but  not  as  an  offer  of  distinction 
from  an  alien  Government.  The  ground  of  its  rejection 
was  that  it  was  not  enough.  The  title  ought  not  to  have 
been  a  mere  knighthood,  but  a  full-blown  baronetcy.  Now, 
as  to  the  question  between  the  Government  and  the  pro¬ 
fession  in  Dublin,  let  us  say  at  once  that  our  sympathies 
are  entirely  with  the  latter.  According  to  the  unwritten 
law  which  regulates  such  matters,  the  title  offered  ought 
unquestionably  to  have  been  a  baronetcy,  and  the  Govern¬ 
ment  have  been  guilty  of  a  violation  of  custom  and  a  gra¬ 
tuitous  blundering  which  were  certain  to  arouse  resent¬ 
ment,  where  the  intention  presumably  was  to  confer  an 
honour  and  to  do  a  kindness.  The  action  was  so  plainly 
and  manifestly  a  wrong  one,  and  the  grievance  thus  put 
into  the  hands  of  the  profession  in  Ireland  was  so  un¬ 
answerable,  that  it  seemed  out  of.  the  question  that  any 
turn  of  affairs  could  put  the  latter  in  the  wrong.  What 
no  one  could  possibly  have  done  for  them,  they,  however 
succeeded  in  accomplishing  for  themselves.  A  deputation 
of  Irish  medical  men  waited  on  the  Under  Secretary  to 
present  a  memorial  to  the  Lord  Lieutenant  of  Ireland,  in 
which  they  actually  asked  for  “  an  hereditary  titular  dis¬ 
tinction”  to  be  granted  to  both  branches  of  the  profession. 
This  was  done  in  sober  seriousness ;  and  it  appears  to  us  a 
grievous  mistake.  Taste  is,  however,  proverbially  a  matter 
for  individual  decision ;  and  that  particular  form  of  it  which 
is  known  as  “good  taste”  is  perhaps  especially  so,  and  we 
therefore  leave  this  aspect  of  the  matter  for  our  readers 
to  form  their  own  opinions  upon, — only  observing  that  the 
movement  has  drawn  from  Earl  Spencer  the  rebuke  that  he 
is  “  unable  to  consider  that  the  bestowal  of  honours  by  the 
Crown  can  be  made  the  subject  of  discussion  between  him 
and  any  public  body.”  What  we  wish  to  direct  the  attention 
of  our  readers  to  is  a  wider  and  more  fundamental  ques¬ 
tion,  touching  more  permanently  the  honour  and  dignity 
of  the  profession.  We  ask  them  to  remember  that  we 
are  nearing  the  end  of  the  nineteenth  century ;  that  we  have 
almost  wholly  emerged  from  barbarism,  and  that  we  have 
begun  to  leave  behind  even  that  militarism  which  is  the 
tedious  stage  that  intervenes  between  barbarism  and  civilisa- 


96 


Medical  Time*  and  Gaz*>tf  . 


FLEXION  OF  THE  UTERUS  AND  DYSMENORRHCEA. 


July  28,  188SL 


tion.  To  this  semi-barbarous  militarism  belong,  in  great 
measure,  titles,  orders,  badges,  medals,  and,  in  general,  the 
paraphernalia  of  titular  distinction.  They  are  characteristic 
of  a  state  of  things  that  seems  to  be  gradually  passing  away. 
Is  it  the  part  of  a  profession  that  proudly  claims  a  place  as 
one  of  the  foremost  representatives  of  civilisation  to  concern 
itself  with  the  trappings  of  an  inferior  order  of  things  P 
The  only  distinction  that  a  medical  man  need  desire  is  the 
admiration  of  his  character,  his  abilities,  and  his  achieve¬ 
ments  that  he"! may  obtain  from  his  professional  brethren 
and  from  the  world  at  large.  This  is  a  distinction  that  no 
Government  can  give,  and  none  can  take  away.  It  depends 
not  on  Court  favour  or  the  chance  of  nationality,  but  on  a 
man’s  own  merits  and  exertions,  and  it  is  the  only  distinc¬ 
tion  that  will  endure.  If  the  “Fountain  of  Honour  ”  in  the 
kingdom  offer  a  knighthood  or  any  other  honour,  a  medical 
man  may  accept  it  as  a  well-intended  grace,  or  quietly  and 
courteously  decline  it.  But  anything  like  craving  for  adven¬ 
titious  distinctions  should  cease  ;  and  a  medical  man  should 
feel  and  be,  as  well  as  appear,  indifferent  whether  he  is 
addressed  as  Sir  T.jWeedledum,  Kt.,oras  Sir  T.  Weedledee, 
Bart. 


THE  RELATION  BETWEEN  FLEXION  OF  THE 
UTERES  AND  DYSMENORRHCEA. 

We  noticed(a)  at  thejtime  of  its  publication  an  able  paper  by 
Dr.  Yedeler,  of  Christiania  (published  in  the  Archiv  fur 
Gynukologie)  upon  flexions  of  the  uterus.  In  that  com¬ 
munication  Dr.  Yedeler  gave  the  result  of  examination  of 
some  thousands  of  women,  divided  broadly  into  two  classes 
— the  sick  and  the  healthy, — undertaken  with  the  object  of 
ascertaining  the  frequency  with  which  uterine  flexions 
occur.  The  “  sick,”  from  this  point  of  view,  were  those  suffer¬ 
ing  from  symptoms  referable  to  their  reproductive  organs  ; 
the  “healthy,” thosethat  had  no  suchsymptoms.  Dr.  Vedeler 
found  that  flexion  of  the  uterus  was  just  as  common  in 
healthy  women  as  in  those  who  suffered  from  uterine  symp¬ 
toms.  From  this  the  conclusion  would  obviously  follow  that 
flexion  of  the  uterus  is  seldom,  if  ever,  a  morbid  condition. 

But  there  was  one  defect  in  that  investigation— viz.,  that 
Dr.  Vedeler  designedly  left  out  of  consideration  the  symp. 
tom  dysmenorrhoea.  He  did  so  only  because  he  purposed  to 
consider  it  more  thoroughly  by  itself.  It  of  course  might 
be  said  that  dysmenorrhoea  is  the  chief  symptom  which 
flexion  of  the  uterus  produces ;  and  that  had  th  at  s  ymptom 
been  included,  the  results  would  have  been  quite  different. 

The  last  published  number  of  the  Archiv  fur  Gynalcologie 
is  now  before  us,  and  it  contains  Dr.  Yedeler’s  promised 
inquiry  into  the  subject  of  dysmenorrhoea.  At  present  we 
can  only  notice  that  part  of  the  investigation  which  deals 
with  the  relation  between  dysmenorrhoea  and  flexion  of  the 
uterus. 

Dr.  Vedeler  begins  by  relating  some  individual  cases 
which  shook  his  faith  in  the  mechanical  theory  of  dys¬ 
menorrhoea — cases  in  which  menstrual  pain  came  and  went 
in  a  manner  quite  inconsistent  with  its  dependence  upon 
organic  narrowing  of  the  canal.  We  need  not  quote  them, 
and  will  pass  at  once  to  the  main  subject.  Our  author  gives 
first  a  table  of  252  women,  all  of  whom  sought  advice  for 
some  disease  quite  unconnected  with  the  genital  organs,  and 
none  of  whom  suffered  from  menstrual  pain.  Of  these, 
59  were  virgins,  and  in  only  12  of  them  was  flexion 
of  the  uterus  quite  absent.  In  47  that  organ  was  more 
or  less  bent.  In  describing  flexion.  Dr.  Vedeler  divides 
the  cases  into  three  classes  :  flexion  of  the  first  degree,  in 
which  there  is  either  mere  curvature  or  an  angle  greater 
than  a  right  angle  ;  of  the  second  degree,  meaning  flexion 


at  about  a  right  angle  ;  and  of  the  third  degree,  in  which 
cervix  and  body  are  nearly  parallel.  Of  the  59  virgins,  in 
15  flexion  of  the  second  or  third  degree  was  found  present ; 
101  other  patients  were  unmarried,  and  most  of  them  (88 
out  of  101)  had  not  had  children.  In  36  the  uterus  was 
straight,  and  in  28  there  was  considerable  flexion.  There 
were  92  married,  82  of  them  having  had  children.  In  44 
of  these  the  uterus  was  straight,  and  in  13  a  flexion  of 
the  higher  degree  was  present.  Putting  them  altogether, 
out  of  252  women  menstruating  without  the  slightest  pain, 
acute  flexion  of  the  uterus  was  present  in  56,  or  22  per  cent. 
Dr.  Vedeler  says  that  to  him  it  seems  clear  that  dysmenor¬ 
rhoea  cannot  be  dependent  upon  flexion  of  the  uterus.  This 
evidence,  however,  is  merely  negative,  and  therefore  our 
author  goes  further.  He  gives  a  table  of  100  patients 
suffering  from  dysmenorrhoea.  In  all  of  these  there  was 
not  merely  pain,  but  severe  pain.  Out  of  the  100,  82  were 
nulliparae,  13  of  them  being  virgins,  and  18  had  had  one 
or  more  children.  In  71  of  the  100  there  was  anteflexion, 
in  4  retroflexion.  In  Dr.  Vedeler’s  former  investigation  he' 
found  that,  taking  all  women  together,  anteflexion  occurred 
in  about  54  per  cent.  Here,  then,  would  seem  an  excessive 
frequency  of  anteflexion  among  the  dysmenorrhoea  cases. 
But  this  is  only  apparent,  and  results  from  the  frequent 
association  of  dysmenorrhoea  and  sterility,  and  the  conse¬ 
quent  undue  proportion  of  nulliparae  among  those  suffering 
from  dysmenorrhoea.  When  the  nulliparae  suffering  from 
dysmenorrhoea  are  compared  with  nulliparae  in  general., 
Vedeler  gets  this  result : — 


Anteflexion  .. 
Retroflexion  . . 
Anteversion  . . 
Retroversion.. 
“Normal”  .. 


Nulliparae. 


71  per  cent. 


3 

7 

9 

9 


yy 

yy 

yy 


Nulliparae  suffering 
from  dysmenorrhoea. 

71  per  cent. 


4 

6 

11 

8 


yy 

S'* 

yy 

y» 


But,  it  may  be  said,  there  are  degrees  of  anteflexion.  This 
Vedeler  has  thought  of.  Among  his  100  cases  of  dys¬ 
menorrhoea,  anteflexion  of  the  second  or  third  degree  was 
present  in  26.  Of  those  not  suffering  any  pain  at  the 
menstrual  period,  these  degrees  of  anteflexion  were  present 
in  20  per  cent,  of  virgins,  27  per  cent,  of  nulliparae,  and 
13  per  cent,  of  those  who  had  had  children.  Consequently, 
says  Vedeler,  “the  simplest  reasoning  forbids  me  to  recog¬ 
nise  any  influence  of  flexion  of  the  uterus  upon  dys¬ 
menorrhoea.” 

These  researches  of  Vedeler  do  not  stand  alone.  In  a 
paper  read  before  the  Obstetrical  Society  of  London  in  1881, 
Dr.  Herman  communicated  the  result  of  an  inquiry  into  the 
same  subject,  and  on  the  same  plan,  as  Vedeler.  The  two 
investigations  differ  only  in  the  way  in  which  the  subject 
was  approached,  and  they  lead  to  an  identical  result. 
Vedeler  took  patients  suffering  from  dysmenorrhoea,  and 
those  not  so  suffering;  and  he  found  anteflexion  to  be  as 
common  in  the  one  group  as  in  the  other.  Herman  divided 
his  patients  into  those  in  whom  the  uterus  was  anteflexed 
and  those  in  whom  it  was  not  anteflexed ;  and  he  found  that 
dysmenorrhoea  was  equally  prevalent  in  each  class.  It  is, 
moreover,  interesting  to  observe  that  Vedeler’s  paper  con¬ 
tains  no  mention  of  Herman’s  work ;  from  which  we  may 
infer  that  he  had  not  seen  it,  and  that  therefore  these  two 
papers  may  be  regai'ded  as  the  testimony  of  two  independent 
witnesses.  Each  supports  the  other,  and  they  conclusively 
show,  unless  their  accuracy  can  be  impugned,  that  ante¬ 
flexion  of  the  uterus  has  nothing  whatever  to  do  with  the 
production  of  painful  menstruation ;  that  it  is  frequently 
met  with  in  cases  of  dysmenorrhoea  only  because  it  is  a 
very  common  condition.  These  researches  derive  increased 
importance  from  the  fact  that  they  are  uncontradicted. 
Herman  and  Vedeler  are,  so  far  as  we  know,  the  only 


(a)  Medical  Times  and  Gazette ,  vol.  ii.  1882,  page  100. 


Medical  Times  and  Gazette. 


THE  WEEK. 


July  28, 1883.  97 


writers  who  have  sought  to  test  the  supposed  relation¬ 
ship  between  anteflexion  and  dysmenorrhoea  by  a  simple 
and  scientific  numerical  method.  Two  conditions,  each 
of  them  very  common,  of  course  must  often  coincide ;  and 
because  anteflexion  and  dysmenorrhoea  often  are  found 
together,  it  has  been  assumed,  without  any  proof,  that 
the  one  was  the  cause  of  the  other,  and  theories  have  been 
constructed  to  explain  the  mode  of  causation.  These  are 
now  all  brushed  away  by  the  simple  explanation  that  ante¬ 
flexion  in  women  who  suffer  from  dysmenorrhoea  is  as 
frequent  as,  and  no  more  frequent  than,  in  other  women 
of  the  same  age,  and  condition  as  to  sexual  function.  This 
explanation  rests  on  the  authority  of  the  only  persons  \tfho 
have  investigated  the  relative  frequency  of  these  conditions 
in  the  healthy  as  well  as  in  the  suffering.  Their  facts  stand 
on  one  side,  and  theory  on  the  other.  Unless  very  much 
more  substantial  grounds  than  exist  at  present  can  be 
brought  forward  to  support  belief  in  the  mechanical  theory 
of  the  diseases  of  women,  we  cannot  doubt  that  it  is 
doomed  to  rejection,  if  not  to  oblivion. 


THE  WEEK. 

TOPICS  OF  THE  DAT. 

Db.  Sedgwick  Sadndebs,  the  Medical  Officer  of  Health 
for  the  City,  at  the  last  meeting  of  the  City  Commissioners 
of  Sewers,  referred  to  the  alarm  which  had  been  created  by 
premature  speculations  on  the  probability  of  cholera  reach¬ 
ing  this  country  during  the  autumn.  In  order,  however,  to 
minimise  the  danger  of  a  visitation  from  this  disease,  he  stated 
the  precautions  which  he  recommended  should  be  taken 
(and  which,  it  may  be  said,  are  applicable  to  every  district) 
to  eliminate  those  elements  which  acted  as  factors  in  its 
production,  spread,  and  virulence.  The  sewers  should  be 
flushed  oftener  than  at  present,  and  deodorants  used  occa¬ 
sionally.  Foul  gases  from  the  sewers  should  be  inter¬ 
cepted  by  providing  a  filtering  medium  of  freshly  pre¬ 
pared  charcoal  at  the  junction  of  the  ventilating  shaft 
with  the  roadway,  and  by  closing  the  gratings  in  the  road¬ 
way  altogether,  and  carrying  a  six-inch  pipe  from  the  top  of 
the  ventilating  shaft  to  the  roof  of  an  adjoining  house. 
The  catchpits  in  connexion  with  the  street  gullies  should 
be  emptied  and  deodorised  every  twenty-four  hours.  The 
roadways  should  be  daily  sprinkled  with  water  containing 
some  germicide.  The  courts  and  alleys  should  be  flushed 
and  deodorised  daily,  and  the  entrances  and  side-walls  of 
the  narrower  courts  lime- whitened  occasionally.  All  house 
refuse  should  be  removed  daily,  and  the  public  dustbins 
emptied  twice  a  day.  The  regulations  for  the  removal  of 
hog-wash,  and  all  kinds  of  animal  and  vegetable  refuse,  from 
taverns  and  restaurants  should  be  stringently  enforced. 
Stables  and  cowsheds  should  be  frequently  inspected,  and 
persons  conveying  offensive  material  through  the  City  during 
prohibited  hours  should  be  prosecuted.  Special  examinations 
should  be  made  into  the  condition,  location,  and  water-supply 
of  cisterns  in  houses  and  public  buildings.  The  superinten¬ 
dent  of  scavenging  should  be  placed  in  direct  communication 
with  the  medical  officer  of  health,  and  be  subject  to  his 
orders.  The  common  lodging-houses  should  be  put  under 
more  direct  control,  and  each  one  properly  registered. 
Prosecutions  should  be  systematically  instituted  against 
offenders  under  the  Smoke  Nuisance  Act.  The  food  in¬ 
spectors  should  be  enjoined  to  increased  vigilance  in  detect¬ 
ing  and  seizing  every  description  of  unsound  food,  including 
meat,  fish,  fruit,  and  vegetables.  On  the  appearance  of  the 
first  well-authenticated  case  of  cholera  of  the  true  Asiatic 
type,  a  house-to-house  visitation  by  competent  medical  men 
should  be  at  once  commenced.  Further,  close  attention  to 
the  condition  of  the  water-supply  was  of  paramount  im¬ 


portance  ;  the  general  consensus  being  that  water  was  the 
great  carrier  of  all  poisons  which  emanated  from  the  dejecta 
of  enteric  diseases.  The  water  should  be  analysed  from 
time  to  time,  and  the  position  and  cleanliness  of  the 
cisterns  carefully  considered.  Dr.  Saunders’s  report  was 
ordered  to  be  printed  and  circulated,  and  referred  to  the 
Sanitary  Committee. 

A  numerous  and  influential  meeting  of  medical  men  and 
students  was  held  last  week  at  St.  Bartholomew’s  Hospital, 
to  consider  a  proposal  to  establish  a  volunteer  ambulance 
corps  for  the  metropolis.  Surgeon- Major  Evatt,  of  the 
Army  Medical  Department,  delivered  an  address  on  volun¬ 
teer  medical  organisation,  and  urged  the  formation  of  a 
trained  volunteer  service  to  assist  in  the  various  surgical 
operations  in  the  field,  and  in  the  regimental  stretcher- 
bearers’  duties.  He  urged  the  necessity  for  one  thousand 
volunteer  medical  staff-surgeons,  and  probably  ten  thousand 
volunteer  medical  rank  and  file,  the  whole  body  to  be 
organised  into  bearer-companies  and  field-hospitals,  by 
counties  and  cities,  and  serving  quite  free  from  regimental 
organisation,  as  organised  units  under  medical  control. 
Resolutiqns  were  passed  that  a  volunteer  ambulance  corps 
be  formed  of  members  of  the  staff,  and  of  past  and  present 
members  of  the  Medical  School,  and  that  a  provisional  com¬ 
mittee  be  appointed  for  the  enrolment  of  such  corps  in 
October  next. 

A  sentence  which  is  likely  to  have  a  deterrent  effect  was 
passed  upon  a  pork-butcher  at  Canning  Town  by  the  magis¬ 
trates  at  West  Ham  Police-court  recently.  The  sanitary 
inspector  of  the  district  visited  this  man’s  premises  on  the 
13th  inst.  On  going  into  a  small  spare  room  behind  the 
shop  he  found  a  large  pickling- cask  and  several  tanks  in 
which  were  meat,  several  pieces,  at  least,  of  which  were 
tainted.  In  an  upstairs  room  a  cask  apparently  full  of  salt 
only  was  found  ;  careful  examination  of  which,  however, 
discovered  pieces  of  beef,  mutton,  and  pork,  every  piece 
being  tainted,  and  some  of  the  larger  ones  quite  green. 
Over  two  cwt.  of  such  meat  was  removed  to  the  Town  Hall, 
Stratford,  where  it  was  subsequently  condemned.  The 
magistrate  observed  on  the  grossness  of  the  case,  and  sen¬ 
tenced  the  defendant  to  pay  a  fine  of  iAOO  and  the  costs,  or, 
in  default  of  payment,  to  imprisonment  for  three  months 
with  hard  labour. 

It  is  a  scandalous  but  nevertheless  indisputable  fact  that 
even  in  these  days  it  generally  needs  the  sacrifice  of  a  life 
to  insure  the  abatement  of  even  the  most  patent  nuisance ; 
and  yet  every  parish  keeps  a  sanitary  inspector,  who  is  sup¬ 
posed  to  do  his  duty.  Recently,  Dr.  Danford  Thomas  held 
an  inquest  at  the  Holborn  Town  Hall  respecting  the  death 
of  a  child  aged  seven  and  a  half  months,  the  son  of  a  horse- 
keeper  named  Hoy,  living  in  Long-yard,  Lamb’s  Conduit- 
street.  It  appeared  from  the  evidence  that  in  the  mews  in 
which  the  child’s  parents  lived  there  was  a  bin,  in  which  the 
refuse  from  the  stables  was  kept,  and  not  cleaned  out  till 
the  whole  mass  was  in  a  putrid  condition.  The  medical 
evidence  said  that  death  was  the  result  of  blood-poisoning, 
caused  by  the  effluvia  from  decomposing  animal  matter. 
The  sanitary  inspector  stated  that  the  mews  were  visited 
every  week.  A  coffee-house  keeper  used  to  throw  all  the 
offal  into  this  bin,  and  he  was  told  that  a  poulterer  had 
been  in  the  habit  of  putting  his  trade  offal  in  the 
same  place.  The  consequence  was  that  the  odour  from  it 
was  very  bad  indeed,  and  he  had  great  trouble  to  get 
the  people  to  desist  from  doing  this.  In  future,  he  should 
take  precautions  to  have  the  place  cleared  out  at  least  three 
times  a  week,  and  to  use  disinfecting-powder.  The  jury 
added  a  rider  to  their  verdict,  calling  the  attention  of  the 
sanitary  authorities  to  the  dustbin  in  question.  It  does  not 


98 


Medicnl  Times  and  Gazette. 


THE  WEEK. 


July  28, 1883. 


appear  that  anyone  ashed  why  the  precautions  which  the 
sanitary  inspector  has  sketched  out  for  the  future  were  not 
resorted  to  in  the  past,  in  which  case  there  might  have  been 
no  necessity  for  a  coroner’s  inquiry. 

On  the  14th  of  the  present  month,  the  members  of  the 
Metropolitan  Asylums  Board  paid  their  annual  visit  to  the 
Leavesden  Asylum,  which  contains  about  2000  of  the  chronic 
imbecile  patients  who  used  formerly  to  be  located  in  the 
London  workhouse  wards.  The  asylum,  including  its  own 
farm,  stands  on  upwards  of  eighty-five  acres,  and  is  situated 
near  Watford,  in  Hertfordshire,  being  one  of  the  four 
asylums  for  imbeciles  under  the  management  of  the  Asylums 
Board.  The  visitors  were  conducted  over  the  building  and 
round  the  wards  by  Dr.  Case,  the  medical  superintendent, 
and  the  Rev.  Mr.  Watson,  the  chaplain.  Though  all  the 
patients  are  classed  as  chronic  cases,  it  is  found  that  many 
recover  sufficiently  to  undertake  different  employments,  and 
work  on  the  farm.  The  cost  for  maintenance  and  clothing 
is  kept  down  to  less  than  tenpence  per  diem  for  each  patient, 
a  sum  which  is  paid  by  the  several  metropolitan  parishes. 
Before  leaving,  the  visitors — amongst  whom  were  Sir  W. 
Wyatt,  the  first  chairman  of  the  Asylum,  and  Sir  T.  Tilly 
— warmly  congratulated  the  Committee  and  the  officers  upon 
the  manner  in  which  the  work  of  the  Asylum  was  carried 
out. 

It  is  satisfactory  to  know  that  the  Government  have  taken 
active  steps  in  reference  to  the  epidemic  of  cholera  which 
has  broken  out  in  Egypt.  The  Khedive’s  Government  has 
been  requested  to  associate  Generals  Stephenson,  Wood, 
and  Baker  with  the  Sanitary  Commission,  with  full  power  to 
order  and  execute  such  measures  as  may  be  deemed  neces¬ 
sary.  Further,  before  these  pages  are  printed,  twelve 
English  medical  men  will  have  left  this  country  for  Egypt, 
taking  with  them  a  large  supply  of  medicines  and  medical 
stores.  The  medical  officers  for  this  service  have  been 
selected  with  the  assistance  of  Sir  Joseph  Fayrer,  and  most, 
if  not  all  of  them,  have  had  extensive  Indian  experience. 
The  Viceroy  of  India  has  also  been  instructed  to  send  to 
Egypt,  if  the  Government  of  that  country  requires  their 
aid,  forty  experienced  Mohammedan  hospital  assistants. 
These  active  steps  have  not  been  taken  one  instant  too  soon, 
and  it  may  be  readily  conjectured  that  the  news  that  cholera 
had  attacked  our  troops  had  something  to  do  with  the 
promptitude  of  the  action  taken. 

The  Bethnal  Green  Vestry  recently  had  before  them  an 
application  for  permission  to  build  a  considerable  number 
of  houses  upon,  and  form  a  new  street  across,  the  disused 
burial-ground  known  as  Peel-grove,  in  that  parish.  In  the 
course  of  the  discussion  which  ensued,  it  was  stated  by  Mr. 
A.  Irwin,  the  Metropolitan  Board  of  Works  member  for 
Bethnal  Green,  that  it  was  estimated  there  were  not  less 
than  20,000  human  bodies  in  the  ground  referred  to,  and 
that  numbers  of  these  had  not  entirely  decomposed ;  also 
that  when  the  subject  was  first  broached,  it  was  urged  that 
the  foundations  of  any  buildings  or  roads  that  might  be 
constructed  might  subside  as  the  coffins  decayed  and  the 
graves  fell  in.  The  Metropolitan  Board  of  Works  were 
usually  desirous  of  giving  facilities  for  building  operations  ; 
but  this  was  a  new  application,  for  which,  perhaps,  there  was 
scarcely  a  precedent,  and  it  must  be  dealt  with  in  a  cautious 
manner.  After  some  further  discussion,  the  Vestry  resolved 
to  forward  to  the  Metropolitan  Board  of  Works  the  following 
resolution  “  That,  in  the  opinion  of  this  Vestry,  it  is  ex¬ 
tremely  objectionable  that  any  houses  should  be  erected  on 
the  disused  burial-ground  in  ^  Peel-grove,  unless  the  bodies 
therein  interred  have  been  previously  properly  removed.” 

A  deputation  from  the  British  Medical  Association,  con¬ 
sisting  of  Mr.  Ernest  Hart,  Dr.  Carter  (of  Liverpool),  Mr. 


Alfred  Carpenter  (of  Croydon),  and  Mr.  Kelson  Hardy, 
recently  had  a  private  interview  with  Sir  Charles  Dilke,  at 
the  Local  Government  Board,  to  protest  against  the  pro¬ 
posal  to  make  it  obligatory  on  medical  men  to  notify  cases 
of  infectious  disease  occurring  in  their  practice.  This, 
they  contended,  was  part  of  the  duty  of  the  householder  as 
a  citizen,  and  should  not  be  imposed,  by  penalty  or  otherwise, 
on  the  medical  attendant. 


THE  CHOLERA  IN  EGYPT. 

According  to  the  last  reports,  the  total  number  of  cases  of 
cholera  among  the  British  troops  has  been  seven,  of  which 
four  were  fatal — in  the  Black  Watch  at  Suez,  two,  both 
fatal ;  in  the  Black  Watch  at  Cairo,  one,  not  fatal ;  in  the 
Cameron  Highlanders  at  Cairo,  one,  fatal ;  in  the  Hospital 
Corps  at  Cairo,  two,  one  fatal ;  and  in  the  Artillery  at  Cairo, 
one,  not  fatal.  The  number  of  deaths  amongst  the  Egyptians 
in  the  twenty-four  hours  preceding  July  25  were — at  Man- 
sourah,  13 ;  at  Samannoud,  8 ;  at  Menzaleh,  3  ;  at  Chibin-el- 
Kum,  113  ;  at  Zefteh,  23  ;  at  Mehallet,  43  ;  at  Ghizeh,  95  ; 
at  Tantah,  16;  at  seven  other  villages,  23.  At  Cairo  within 
twelve  hours  284  deaths  had  occurred,  of  which  139  were  at 
Boulak  ;  and  it  is  reported  that  two  fatal  cases  occurred  in 
Alexandria  on  the  25th  inst.  Surgeon-General  W.  Hunter, 
M.D.,  Honorary  Surgeon  to  Her  Majesty,  had  arrived  at 
Alexandria,  and  proceeded  to  Cairo  on  the  26th  inst. 
Earl  Granville  has  appointed  the  following  medical  gen¬ 
tlemen  to  proceed  to  Egypt,  for  the  purpose  of  giving 
assistance  to  the  Egyptian  Government  in  dealing  with  the 
epidemic  of  cholera : — Dr.  Gulliver  and  Dr.  Acland,  of  St. 
Thomas’s  Hospital;  Mr.  H.  M.  Crookshank,  University 
College;  Dr.  MtNalty,  Indian  Medical  Service ;  Dr.  A.  F. 
Wilkins,  Edinburgh ;  Dr.  Armand  Leslie,  Middlesex  Hos¬ 
pital  and  Paris ;  Dr.  F.  E.  Taylor  and  Dr.  A.  Honman, 
Charing-cross  School;  Dr.  F.  G.  Thrapp ;  Dr.  C.  F.  Parker, 
Dublin  and  Manchester ;  Mr.  S.  Wyborn,  Charing-cross 
School;  and  Mr.  J.  Cantlie,  one  of  the  surgical  staff  of  the 
Charing-cross  Hospital.  Most  of  these  gentlemen  left  for 
Egypt  on  Wednesday  evening,  and  some  on  Thursday. 


THE  ARMY  HOSPITAL  CORPS. 

The  reply  made  by  the  Secretary  of  State  for  War  to  a 
question  put  in  the  House  of  Commons  on  Monday  by  Baron 
H.  de  Worms,  gives  a  good  reason  why  men  may  not  be 
very  willing  to  enter  that  service.  The  Baron  asked  whether 
it  was  the  fact  that  when  a  man  of  the  Hospital  Army 
Corps  contracted  an  infectious  disease,  in  consequence  of  his 
nursing  patients  suffering  from  such  disease,  he  was  deprived 
of  his  extra  pay,  and  was  made  subject  to  hospital  stoppages 
while  he  was  being  treated  in  hospital,  though  the  disease 
had  been  contracted  in  the  execution  of  his  duty.  And  the 
Marquis  of  Hartington  replied :  cf  Men  of  that  corps  are 
liable  to  stoppages  in  the  circumstances  named,  on  the  gene¬ 
ral  principles  that  special  pay  for  duty  cannot  be  issued 
except  for  the  performance  of  the  duty ;  and  that  all 
soldiers  are  liable  to  hospital  stoppages  unless  in  hospital 
on  account  of  wounds  received  in  action,  or  of  illness  con¬ 
tracted  on  a  service  with  an  army  in  the  field.  The  question 
of  relieving  men  of  the  Army  Hospital  Corps  from  these 
stoppages  in  the  case  of  illness  contracted  in  the  discharge 
of  duty  has  been  frequently  considered  ;  but  a  difficulty  has 
hitherto  been  felt  in  treating  them  differently  from  other 
corps  in  receipt  of  departmental  pay.  I  will,  however,”  he 
said,  “  undertake  to  look  further  into  the  matter.”  It  does 
seem  hard,  to  say  the  very  least,  that  the  men  of  the  Hos¬ 
pital  Army  Corps  should  not  only  lose  their  extra  pay  when 
laid  aside  by  disease  contracted  from  the  patients  they 
nurse,  but  also  have  to  be  mulcted  in  hospital  stoppages ; 


Medical  Times  and  Gazette. 


THE  WEEK. 


July  28,  1883.  99 


and  we  trust  that  the  further  inquiry  promised  by  the 
Secretary  of  State  will  result  in  these  men-nurses  being  dealt 
with  more  justly  and  considerately. 


THE  TREATMENT  OF  DILATATION  OF  THE  STOMACH. 
Under  the  title  of  gastritis,  atrophy,  and  dilatation  of  the 
stomach.  Dr.  James  Russell  records  ( Birmingham  Medical 
Review,  Nos.  58,  59)  the  case  of  a  man,  aged  twenty-six, 
whose  symptoms  extended  over  a  period  of  ten  years, 
dating  from  an  acute  attack  of  ill-defined  nature,  probably 
gastritis.  “  This  attack  permanently  changed  the  digestive 
power  of  the  stomach ;  from  that  time  the  patient  lost  the 
ability  to  assimilate  animal  food,  with  the  important  excep  - 
tion,  however,  of  milk.  Ten  years  afterwards  we  found 
that  meat,  finely  comminuted,  and  given  in  small  quantity, 
remained  for  two  days  in  the  stomach,  and  was  then  rejected, 
unchanged.”  The  patient  was  thin,  but  not  cachectic,  and 
there  was  considerable  dilatation  of  the  stomach.  It  was 
found  that,  even  when  tried  most  carefully,  all  kinds  of 
solid  albuminoid  food  were  rejected  after  a  more  or  less  brief 
stay  in  the  stomach.  Milk  alone  could  be  retained.  Of  some 
substances  ( e.g .,  cod-liver  oil)  the  stomach  was  exceedingly 
intolerant,  and  immediately  rejected  them.  Washing  the 
stomach  out  by  means  of  the  syphon-tube  was  tried,  but 
it  produced  considerable  distress,  and  did  no  good.  In 
the  ordinary  forms  of  atrophy  of  the  stomach,  the  peptic 
glands  are  the  chief  sufferers,  and  the  patient  is  able  to 
assimilate  the  hydrocarbons.  In  this  case,  however,  the 
patient  was  very  thin,  and  unable  to  digest  anything  but 
milk ;  a  condition  of  subacute  or  chronic  gastritis  was  con¬ 
stantly  kept  up,  and  as  a  result  of  these  changes  and  the 
impaired  general  nutrition  which  necessarily  followed,  a 
state  of  dilatation  of  the  stomach  was  induced.  This,  of 
course,  tended  to  keep  up  the  mischief  by  permitting  of  the 
accumulation  of  food  in  the  stomach,  and  favouring  its  de¬ 
composition.  The  remedy  for  this  state  of  things  employed 
by  nature  is  vomiting,  and  cleansing  the  stomach  by  means 
of  the  syphon-tube  is  therefore  the  proper  line  of  treatment 
to  adopt.  In  the  case  above  alluded  to  it  failed,  probably 
in  great  measure  owing  to  the  organic  changes  that  had 
taken  place  in  its  structures.  The  value  of  washing  out  the 
stomach  in  cases  of  dilatation  of  that  body  is  well  shown  by 
the  three  cases  given  at  the  conclusion  of  the  paper,  in  one 
of  which  the  patient  found  such  relief  from  it  that  he 
sometimes  resorted  to  it  twice  a  day. 


SIR  GEORGE  HORNIDGE  PORTER,  M.D.,  SURGEON  TO  HER 
MAJESTY  THE  QUEEN  IN  IRELAND. 

Sir  George  Porter  is  the  only  surviving  son  of  the  late 
William  Henry  Porter,  M.D.,  Professor  of  Surgery  in  the 
School  of  Surgery  of  the  Royal  College  of  Surgeons  in 
Ireland,  and  for  some  time  the  representative  of  that  body 
on  the  General  Medical  Council.  Born  on  November  24, 
1822,  Sir  George  in  due  course  graduated  in  Arts  and  Medi¬ 
cine  in  the  University  of  Dublin,  receiving  in  1876  the 
additional  degree  of  Master  of  Surgery,  honoris  causd.  In 
1849,  Sir  George  was  elected  Surgeon  to  the  Meath  Hospital 
and  County  Dublin  Infirmary,  of  the  staff  of  which  institution 
he  has  been  for  some  years  the  senior  member.  Probably  no 
other  living  surgeon  in  Dublin  has  received  so  many  marks 
of  recognition  of  his  reputation  at  the  hands  of  his  pro¬ 
fessional  brethren.  In  1861  he  was  appointed  Consulting 
Surgeon  to  the  Coombe  Lying-in  Hospital;  in  1866  he 
was  elected  Surgeon  to  Simpson’s  Hospital.  He  filled 
the  chair  as  President  of  the  Royal  College  of  Surgeons  in 
Ireland  in  1868,  and  the  following  year  was  chosen  President 
of  the  Pathological  Society  of  Dublin.  In  this  year  (1869) 
also  he  became  Surgeon  to  Her  Majesty  the  Queen  in 


Ireland.  In  1876  he  was  elected  Consulting  Surgeon  to 
Saint  Mai'k’s  Ophthalmic  Hospital,  Dublin  ;  and  in  1878  he 
presided  over  the  Dublin  Branch  of  the  British  Medical 
Association.  In  1880,  Sir  George  was  elected  a  corresponding 
member  of  the  Edinburgh  Medico-Chirurgical  Society  ;  and 
in  1881  he  was  appointed  Consulting  Surgeon  to  Steevens’s 
Hospital,  Dublin.  His  contributions  to  surgical  literature 
are  many  and  varied,  and  may  be  found  quoted  in  all 
modern  systems  of  surgery,  both  in  Great  Britain  and  in 
America. 


ACADI3MIE  DE  MlJDECINE. 

The  vacancy  in  the  Section  of  External  Pathology,  caused 
by  the  death  of  Baron  Cloquet,  has  been  filled  up  by  the 
election  of  M.  Lannelongue  by  the  votes  of  fifty-four  of 
the  eighty-four  academicians  present.  The  Section  had 
presented  the  list  of  candidates  in  the  following  order : — 
MM.  Lannelongue,  Le  Dentu,  Terrier,  St.  Germain,  and 
Pean.  The  Academy,  however,  raised  M.  Pean  from  the 
last  place  on  the  list  to  the  second,  giving  him  twenty- 
six  votes. 


HONOURS  TO  METROPOLITAN  MEDICAL  MEN. 

Her  Majesty  has  graciously  conferred  the  honour  of 
baronetcies  upon  Mr.  Prescott  Hewett  and  Dr.  Andrew 
Clark.  The  fitness  of  the  distinctions  thus  granted  will  be 
acknowledged  with  much  satisfaction  by  the  profession  at 
large.  Mr.  Prescott  Hewett  is  one  of  our  most  distinguished 
and  popular  surgeons.  He  is  a  Foreign  Correspondent  of 
the  Academy  of  Medicine  and  of  the  Society  of  Surgeons,  of 
Paris ;  Sergeant- Surgeon  Extraordinary  to  Her  Majesty,  and 
Surgeon-in- Ordinary  to  H.R.H.  the  Prince  of  Wales;  and 
a  past  President  and  Professor  of  Anatomy  and  Surgery  of 
the  Royal  College  of  Surgeons  of  England.  Dr.  Andrew 
Clark,  the  senior  Physician  to  the  London  Hospital,  is  not 
connected  in  any  way  with  the  Court,  and  has  not  any  high 
official  position ;  and  the  honour  conferred  on  him  is  a 
recognition  purely  of  his  eminence  as  a  physician.  It  is 
therefore  a  new  departure  in  the  bestowal  of  honours  by 
the  Crown,  and  will  be  for  that  reason  especially  grateful  to 
the  profession.  _ 


NEW  DENTAL  HOSPITAL  IN  MANCHESTER. 

A  Dental  Hospital  was  opened  inManchester  on  Saturday, 
the  21st  inst.,  being  the  first  institution  of  the  kind  that 
has  been  established  in  that  city.  A  number  of  gentlemen 
interested  in  the  movement  formed  themselves  into  a  com¬ 
mittee  a  few  weeks  ago,  and,  having  raised  the  requisite 
funds,  obtained  a  house  in  Grosvenor-street  at  a  very  mode¬ 
rate  rental,  which  they  have  fitted  up  and  adapted  to  the 
purposes  of  a  hospital.  The  rooms  on  the  ground  floor  are 
set  apart  for  ordinary  cases  of  extraction,  while  on  the 
first  and  second  floors  are  an  operating-room  containing 
three  of  Morrison’s  dental  chairs,  a  comfortable  waiting- 
room,  and  a  committee-room  which  can  also  be  used  as  a 
lecture-room.  Hitherto,  Manchester  candidates  for  the 
dental  diploma  have  been  unable  to  obtain  the  necessary 
instruction  in  their  own  town,  and  have  been  compelled  to 
go  either  to  Liverpool  or  to  London  for  the  purpose.  It  is 
intended  by  the  promoters  of  this  Hospital  to  keep  steadily 
in  view  the  desirability  of  removing  this  anomaly,  and,  with 
this  object,  to  aim  at  establishing,  as  soon  as  possible, 
courses  of  lectures  and  practical  instruction  in  dentistry  at 
the  Hospital.  There  can  be  little  doubt  that,  before  long,  the 
authorities  of  the  Owens  College  will  be  asked  to  take  up 
the  question  of  the  education  of  dentists,  and  to  include 
dentistry  amongst  the  special  subjects  taught  within  its 
walls.  Any  move  in  this  direction  has  hitherto  been  im¬ 
possible,  owing  to  there  being  no  facilities  for  demonstrating 


Medicn1  Times  ntirt  Gazette. 


THE  WEEK. 


July  28,  1883. 


ieo 


practically  the  various  manipulations  and  operations  of 
dental  surgery.  This  difficulty  it  is  one  of  the  objects  of 
the  new  Hospital  to  remove.  In  the  list  of  office-bearers 
may  be  noticed  the  names  of  the  Earl  of  Crawford  and 
Balcarres,  LL.D.,  F.R.S.,  President;  Mr.  John  Tomes  and 
Sir  Edwin  Saunders,  Patrons ;  and  Dr.  Lloyd  Roberts  and 
Mr.  Hardie,  F.R.C.S.,  who  have  been  appointed  Consulting 
Physician  and  Consulting  Surgeon  respectively. 


TROPHIC  TROUBLES  IN  PRIMARY  JOINT-DISEASE. 

This  important  question  in  surgical  pathology  has  been 
treated  of  by  Julius  Wolff  in  the  last  numbers  of  the  Berliner 
Klin.  Woch.,  Nos.  27-30.  Stated  as  facts,  we  may  say  that 
lesions  of  the  skin,  muscle,  and  bone  have  been  found  in 
association  with  inflammatory  disease  of  the  joint.  What 
the  exact  relation  between  these  facts  is,  must  be  regarded 
as  a  difficult  pathological  problem.  We  know  from  the  ob¬ 
servations  of  Weir  Mitchell  and  others  that  gunshot  wounds 
and  other  traumatic  influences  of  nerve-trunks  are  capable 
of  inducing  many  lesions  of  nutrition.  It  is  reasonable  to 
urge,  therefore,  that  such  affections  might  be  explained  by 
the  aid  of  the  spread  of  inflammatory  action  from  a  joint 
to  the  neighbouring  nerves.  But  Paget  and  Yulpian  have 
argued,  and  Yaltat  and  Charcot  have  endeavoured  to  prove, 
that  such  lesions  are  caused  through  the  intermediation  of 
a  reflex  mechanism.  Gurlt  and  other  German  authorities 
have  considered  that  the  mere  inactivity  of  the  affected 
limb  would  account  for  the  various  lesions  of  the  different 
tissues  which  have  been  described.  Quoting  some  statistics 
from  Gurlt’s  inquiries,  Wolff,  who  denies  the  above  tenet 
of  Gurlt’s,  comes  to  the  conclusion  that  the  unsatisfactory 
final  issue  of  the  majority  of  cases  of  resection  of  joints, 
especially  those  done  during  campaigns,  may  be  set  down 
to  the  occurrence  of  the  various  trophic  wastings,  etc. 
Gurlt  seems  to  have  shown  that  out  of  652  final  results  of 
resections  of  the  joints,  only  240  were  of  a  very  satisfactory 
nature. 


THE  WEST  MALLING  POISONING  CASE. 

At  the  recent  Maidstone  Assizes,  before  Mr.  Justice  Day, 
the  Rev.  John  Henry  Timins,  yicar  of  West  Mailing,  was 
placed  at  the  bar  to  stand  his  trial  on  a  charge  of  man¬ 
slaughter,  in  feloniously  killing  and  slaying  one  Sarah  Anne 
Wright.  It  is  not  impossible  that  our  readers  may  have 
forgotten  the  circumstances  which  led  to  the  committal  of 
the  Rev.  Mr.  Timins,  since  they  occurred  so  far  back  as 
December  14  last.  This  gentleman,  who  is  about  seventy 
years  of  age,  and  has  for  nearly  forty  years  been  vicar  of 
West  Mailing,  was  in  the  habit  of  doctoring  his  parishioners, 
on  the  strength  of  having  attended  some  lectures  at  St. 
Thomas’s  Hospital  in  early  life.  In  the  present  case 
he  appears  to  have  blundered  between  “essential”  and 
f  expressed  ”  oil  of  almonds  ;  and  although  warned  by  the 
chemist  who  supplied  the  article,  he  administered  a  fatal  dose 
of  the  first,  which  took  effect  in  less  than  two  hours.  Mr. 
Justice  Day,  in  summing  up  the  case  to  the  jury,  said  this 
was  a  case  of  homicide  by  negligence,  and  it  was  clear  that 
the  prisoner  had  caused  the  death  of  the  deceased  by  the 
administration  of  a  poison.  The  question  for  them  was 
whether  he  had  done  so  under  circumstances  which  made 
him  criminally  liable.  Unless  gross  negligence  was  esta¬ 
blished  against  the  accused,  it  would  be  their  duty  to  acquit 
him.  The  first  question  was,  what  did  the  prisoner  send 
for  ?  That  was  shown  by  the  written  correspondence  be¬ 
tween  him  and  the  chemist,  from  which  it  appeared  that  he 
knew  he  was  to  receive  poison,  and  the  chemist  put  upon  the 
bottle  the  label essential  oil  of  almonds”;  it  was  also  marked 
,c  poison.”  The  question  was  whether  the  administration 


of  poison  under  such  circumstances  was  or  was  not  criminal 
negligence.  A  person  who  took  upon  himself  to  administer 
such  a  drug  was  bound  to  be  careful,  and  in  this  case  it  was 
clear  that  there  had  been  a  want  of  care.  The  jury  at  once 
returned  a  verdict  of  “Not  guilty,”  which  was  received  with 
some  applause. 


THE  PARIS  WEEKLY  RETURN. 

The  number  of  deaths  for  the  twenty-eighth  week  of  1883, 
terminating  July  11,  was  1030  (577  males  and  453  females), 
and  of  these  there  were  from  typhoid  fever  39,  small-pox 
14,  measles  28,  scarlatina  2,  pertussis  18,  diphtheria  and 
croup  23,  dysentery  1,  erysipelas  7,  and  puerperal  infec¬ 
tions  7.  There  were  also  50  deaths  from  tubercular  and 
acute  meningitis,  182  from  phthisis,  27  from  acute  bron¬ 
chitis,  59  from  pneumonia,  129  from  infantile  athrepsia 
(39  of  the  infants  having  been  wholly  or  partially  suckled), 
and  51  violent  deaths  (42  males  and  9  females).  The 
low  mortality  of  the  preceding  week  also  prevailed  during 
the  present,  and  the  great  increase  of  deaths  from  typhoid 
fever  has  not  continued,  there  having  been  only  39  instead 
of  64.  The  frequent  admissions,  however,  continued,  having 
been  127.  Infantile  athrepsia,  as  usual  in  hot  weather, 
proved  very  fatal,  the  129  deaths  being  the  highest  number 
registered  this  year.  The  births  for  the  week  amounted  to 
1220,  viz.,  641  males  (499  legitimate  and  142  illegitimate) 
and  579  females  (421  legitimate  and  158  illegitimate)  : 
95  infants  were  either  born  dead  or  died  within  twenty-four 
hours,  viz.,  55  males  (35  legitimate  and  20  illegitimate)  and 
40  females  (21  legitimate  and  19  illegitimate). 


THE  METROPOLITAN  ASYLUMS  BOARD. 

At  the  usual  fortnightly  meeting  of  the  Managers  of  the 
Metropolitan  Asylums  Board,  held  on  Saturday  last,  amongst 
the  business  transacted  it  was  decided,  on  the  motion  of  Sir 
Edmund  Currie,  to  accept  the  charges  of  the  Thames  Con¬ 
servators  for  the  mooring  of  the  Castalia  at  Long  Reach ; 
other  work  in  connexion  with  preparing  the  ship  to  receive 
patients  suffering  from  infectious  diseases  was  also  sanc¬ 
tioned.  A  letter  was  read  from  the  Wandsworth  District 
Board  of  Guardians  in  reference  to  a  refusal  on  the  part  of 
the  Superintendent  of  the  South-West  Asylum  to  admit  a 
case  of  diphtheria,  and  expressing  the  opinion  of  that  Board 
that  the  asylum  managers  should  make  provision  for  such 
cases.  The  returns  submitted  from  the  several  fever 
asylums  showed  that  during  the  fortnight  there  had  been 
75  patients  admitted,  9  had  died,  and  62  had  been  dis¬ 
charged,  leaving  313  under  treatment,  or  4  more  than  in 
the  last  report.  Of  these  264  are  scarlet  fever  patients,  3 
are  typhus  cases,  and  46  are  cases  of  enteric  fever.  As 
regards  small-pox,  only  9  cases  had  been  admitted  during 
the  fortnight,  as  against  20  in  the  previous  fortnight ; 
the  patients  discharged  numbered  19,  and  5  had  died, 
leaving  53  under  treatment,  as  against  68  a  fortnight  ago. 


INTERNATIONAL  MEDICAL  CONGRESS. 

We  have  received  the  following  communication  from  Pro¬ 
fessors  P.  L.  Panum  and  C.  Lange:— The  eighth  Inter¬ 
national  Medical  Congress  will  be  held  in  Copenhagen  from 
August  10  to  16, 1884.  The  General  Organising  Committee, 
formed  for  the  preparatory  work,  is  composed  of  the  follow¬ 
ing  members,  living  either  in  or  near  Copenhagen : — 
President :  Professor  Dr.  P.L.  Panum.  Secretary-General : 
Professor  C.  Lange.  Secretaries  :  Dr.  O.  Bloch,  Dr.  C.  J. 
Salomonsen,  and  Surgeon-General  Joh.  Moller.  Honorary 
Treasurer :  Professor  Dr.  E.  Hansen  Grut,  besides  the 
Presidents  of  the  special  committees  of  the  Sections,  viz. : — 
Anatomy  :  Professor  Chievitz.  Physiology :  Professor  Dr. 


Mevilcal  Times  and  Gaxstte. 


THE  WEEK. 


July  58.  1883.  101 


Pc  L.  Panum.  General  Pathology  and  Pathological  Ana¬ 
tomy  :  Professor  Dr.  C.  Reisz.  Medicine :  Professor  Dr.  F. 
Trier.  Surgery :  Professor  Dr.  Holmer.  Hygiene  and 
.State  Medicine:  Dr.  E.  Hornemann.  Military  Surgery  and 
Medicine :  Director-General  of  the  Medical  Department  of 
the  Army,  Salomon.  Mental  and  Nervous  Diseases:  Pro¬ 
fessor  Dr.  Steenberg.  Obstetric  Medicine  and  Surgery, 
nnd  Gynaecology  :  Professor  Dr.  Stadfeldt  and  Professor 
Dr.  Howitz.  Diseases  of  Children :  Professor  Dr.  Hirsch¬ 
sprung.  Ophthalmology :  Professor  Dr.  E.  Hansen  Grut. 
Diseases  of  the  Skin  and  Syphilis  :  Professor  Dr.  Haslund. 
Diseases  of  the  Ear :  Dr.  W.  Meyer.  Diseases  of  the 
Throat :  Dr.  W.  Meyer.  In  order  that  the  meeting  of  so 
many  distinguished  medical  men,  who,  it  is  hoped,  will 
attend  on  this  occasion,  may  be  as  advantageous  as  possible, 
the  Organising  Committee,  following  the  example  of  the 
later  Congresses,  will  communicate  with  distinguished  men 
of  different  branches  and  of  different  countries,  in  order  to 
prepare  a  programme.  “  This  programme,  as  well  as  the 
rules,  will  be  forwarded  to  those  of  our  colleagues  who 
we  suppose  take  an  interest  in  the  work  of  the  Congress, 
and  who  might  be  inclined  to  participate  in  it.  In  order 
that  the  programme  may  be  ready  as  soon  as  possible,  we 
shall  be  pleased  if  communications,  referring  to  the  work  of 
the  Congress,  are  sent  to  the  Secretary-General  before 
October  1  next,  so  that  it  may  be  possible  for  us  to  have 
regard  to  them  in  arranging  the  definite  programme.  The 
programme  and  rules  will  be  forwarded,  as  soon  as  possible, 
to  everyone  qualified  to  participate  in  the  Congress,  who 
within  the  limited  time  has  announced  to  the  Secretary- 
General  his  interest  in  the  Congress,  and  his  intention  of 
participating  in  it ;  and,  if  possible,  which  section  he 
intends  chiefly  joining.” 


DEATH  OF  DE.  ABCHAMBATJLT. 

De.  Abchahbatjlt,  Physician  to  the  Hospital  des  Enfants, 
has  just  died,  after  a  long  and  painful  illness.  One  of  the 
most  distinguished  pupils  of  Trousseau,  he  particularly 
distinguished  himself,  like  his  eminent  master,  in  the  opera¬ 
tion  of  tracheotomy;  not  so  much  for  his  manual  skill, 
however,  in  its  performance,  as  for  his  great  discrimina¬ 
tion  in  the  selection  of  appropriate  cases  and  their  able 
management.  _ 


EHABDOMTOMA  OF  THE  OEBIT. 

Ehabdomtoma,  or  a  tumour  containing  striated  muscular 
fibres,  is  a  very  rare  affection,  and  Dr.  S.  Bayer,  of 
Stockholm,  who  describes  a  case  of  the  kind  in  a  recent 
number  of  the  Nor  disk  t  Medicinskt  Arkiv,  has  met  with  only 
twelve  instances  of  it  in  the  course  of  his  reading.  His 
own  case  was  that  of  a  tumour  extirpated  from  a  little  boy 
three  years  old,  and  which  had  been  observed  two  months 
before  the  operation,  penetrating  between  the  globe  of  the 
eye  and  the  lower  eyelid,  and  pushing  the  former  from 
below  upwards.  The  tumour  was  of  an  oval  form,  re¬ 
sembling  a  fibrous  tumour  in  its  consistence  and  in  the 
appearance  of  the  cut  surface.  On  microscopical  exami¬ 
nation  it  was  found  that  the  neoplasm  was  chiefly  composed 
of  muscular  fibres  with  transverse  strise,  but  that  the 
greater  part  of  these  fibres  had  at  the  same  time  longitu¬ 
dinal  strise.  These  striae  were  either  pressed  against  one 
another,  forming  fasciculi  arranged  in  different  ways,  or 
diffused  in  an  intermediate  substance  rich  in  nuclei.  At 
the  points  where  the  fibres  are  pressed  against  one  another 
they  interpenetrate  by  points.  Caustic  potash  immediately 
dissolves  the  nuclei  of  the  fibres,  but  causes  the  distinct 
appearance  of  the  transverse  striae,  while  acetic  acid  causes 
the  nuclei  to  appear  clearly,  but  dissolves,  although  slowly. 


the  transverse  strise.  A  longer  treatment  with  caustic  potash 
or  acetic  acid  causes  the  dissolution  of  the  whole,  as  happens 
in  striated  muscular  fibres,  which  the  striated  elements  of  the 
tumours  resemble,  moreover,  in  this  respect — that  they  pre¬ 
sent  the  same  double  refraction  when  examined  by  polarised 
light.  An  identical  method  of  examination  demonstrated 
the  same  property  of  refraction  in  the  fibres  of  a  tumour  of  a 
rhabdomyomatous  nature  preserved  in  the  Pathological  Insti¬ 
tution  of  Stockholm.  The  mass  which  combines  the  muscular 
elements  in  the  tumour  now  described  by  Dr.  Bayer  is  a 
delicate  granular  substance  with  round  nuclei,  which,  with 
preparations  of  osmium,  are  dissolved  in  cellules  provided 
with  broad  or  slender  prolongations,  anastomosing  with 
those  of  the  adjacent  cellules.  As  to  the  question  of  the 
origin  of  the  tumour,  the  author  can  give  no  other  expla¬ 
nation  than  by  admitting  the  presence  of  foetal  muscular 
elements,  which  probably  remained  at  the  base  of  the  orbit, 
and  to  the  subsequent  development  of  which  the  neoplasm 
now  described  was  probably  due. 


SCHOOL  HYGIENE. 

The  eighth  lecture  of  the  series  at  present  in  course  of  de¬ 
livery  at  the  Parkes  Museum  of  Hygiene  was  given  by  Dr. 
C.  H.  Ralfe,  of  the  London  Hospital,  on  Thursday  evening, 
July  12,  the  subject  being  “Hygiene  in  Schools.”  The 
lecturer,  after  dwelling  on  the  importance  of  the  subject, 
pointed  out  that  great  improvements  had  taken  place  of 
recent  years  in  the  general  management  of  schools,  but 
hand-in-hand  with  these  improvements  other  conditions 
had  arisen  which  had  a  tendency  to  lower  the  average 
standard  of  health  at  our  chief  centres  of  education.  Among 
these  the  competitive  system  must  be  reckoned  as  the 
chief,  which,  by  introducing  an  element  of  strain,  anxiety, 
and  excitement  at  a  period  when  growth  and  development 
were  most  active,  proved  highly  prejudicial.  But  this  sys¬ 
tem,  as  well  as  other  conditions,  had  to  be  accepted,  and 
the  evils  resulting  from  them  combated  by  an  increased 
care  and  attention  to  hygienic  details.  The  ill  effects  of  defec¬ 
tive  drainage  and  a  dangerous  water-supply  were  dealt  with, 
and  the  construction  of  the  school  buildings,  and  the  arrange¬ 
ment  of  studies  and  dormitories  were  fully  considered, 
together  with  the  question  of  ventilation  and  lighting. 
The  channels  by  which  epidemic  disorders  were  introduced 
into  a  school,  and  the  best  means  of  dealing  with  an  out¬ 
break  when  it  occurred,  were  next  discussed.  A  considerable 
portion  of  the  lecture  was  devoted  to  a  consideration  of  the 
vexed  question  of  schoolboy  food.  The  lecturer  insisted  it 
should  be  plain  and  simple  in  character,  sufficient  in 
quantity,  excellent  in  quality,  and  adapted  to  the  special 
requirements  of  growth  and  development,  according  to  the 
age  of  the  boys,  whilst  the  most  minute  attention  should  be 
paid  to  its  cooking,  and  that  it  should  be  served  hot  and  in 
a  palatable  and  relishing  form.  The  influence  of  school 
work  and  play  on  the  boy’s  health  and  development  was 
discussed.  Sound,  honest,  hard  work,  the  lecturer  was 
convinced,  never  did  a  healthy  boy  any  harm,  but  it  was 
the  system  of  forcing  minds  at  high  pressure  which  was 
accountable  for  many  lamentable  breakdowns.  For  a 
similar  reason,  athletic  sports,  which  required  previous 
training  and  often  a  severe  strain,  were  not  advisable  till 
the  frame  was  set,  the  ordinary  pastimes  of  cricket  and 
football  being  most  suitable  for  the  growing  lad.  In  con¬ 
clusion,  the  lecturer  insisted  on  the  necessity  of  adequate 
medical  supervision  in  order  to  carry  out  effectually  the 
details  requisite  for  the  maintenance  of  perfect  sanitary 
and  hygienic  conditions,  and  alluded  to  the  excellent  results 
that  had  followed  on  the  appointment  of  medical  officers 
at  Rugby  and  Marlborough  to  attend  to  these  details,  and 


MEDICAL  MATTERS  IlST  PARLIAMENT. 


July  28,  1883. 


Medical  Times  and  Gazette. 

who,  by  constantly  mixing  with  the  boys,  obtained  an  inti¬ 
mate  acquaintance  with  their  physical  conditions ;  whilst 
the  great  advantage  of  medical  supervision  lay  in  the  power 
of  being  beforehand  with  epidemics.  In  schools  where  it 
was  thoroughly  adopted,  the  necessity  for  breaking  up  a 
school  on  account  of  scarlet  fever,  etc.,  was  found  to  be  of 
extremely  rare  occurrence. 


THE  HEALTH  OP  KENSINGTON  FOR  THE  MONTH  OP  JUNE 

LAST. 

In  his  report  on  the  health  and  sanitary  condition  of  the 
parish  of  Kensington  for  the  four  weeks  ended  June  16  last. 
Dr.  Orme  Dudfield,  the  Medical  Officer  of  Health  for  the 
district,  remarks  that  the  state  of  the  public  health  in 
that  locality  continues  favourable,  so  far  as  can  be  judged 
from  the  returns  of  mortality,  which  show  a  death-rate  of 
only  14-7  per  1000,  as  against  16'6,  the  decennial  average. 
The  death-rate  in  the  metropolis  during  the  same  period 
(1S‘5  per  1000)  was  09  per  1000  below  the  decennial  average, 
and  3'8  above  the  rate  in  Kensington.  The  deaths  from  the 
principal  diseases  of  the  zymotic  class  were  13,  or  19  below 
the  decennial  average,  corrected  for  increase  of  population. 
Dour  deaths  were  attributed  to  diphtheria,  and  26  cases  of 
scarlet  fever  were  recorded — viz.,  11  in  the  district  north  of  the 
Uxbridge-road,  and  15  in  the  remainder  of  the  parish  south 
of  that  road.  Of  the  cases  in  the  south  district,  5  were  back 
cases  which  should  have  been  recorded  in  January ;  of  the 
cases  in  the  north  district,  4  (concealed)  belong  to  April. 
All  the  sufferers  in  both  districts  were  children  thirteen 
years  of  age  and  under.  In  the  north  district  6  cases  were 
removed  to  hospital,  there  was  refusal  to  go  in  1  case,  and 
in  4  cases  (concealed)  removal  was  unnecessary.  Of  the 
cases  in  the  south  district,  6  were  removed,  1  was  concealed, 
there  vras  refusal  to  go  to  hospital  in  2  cases,  and  removal 
was  unnecessary  in  6.  Nine  of  the  children  had  been  in 
attendance  at  different  schools,  but  only  one  death  was 
registered  from  the  fever  in  the  four  weeks  under  notice. 


H.R.H.  the  Prince  op  Wales  has  accepted  the  position 
of  Vice- Patron  of  the  Royal  Hospital  for  Diseases  of  the 
Chest,  City-road,  which  was  founded  by  H.R.H.  the  Duke  of 
Kent,  a.d.  1S14. 

A  meeting  of  Volunteer  medical  officers  will  be  held  at 
Liverpool,  in  one  of  the  section  rooms,  on  Wednesday, 
August  1,  at  9.30  a.m.,  to  hear  an  address  from  Surgeon- 
Major  Evatt,  A.M.D.,  on  “Volunteer  Medical  Organisa¬ 
tion.55  Several  resolutions  will  be  proposed.  All  Volunteer 
medical  officers  are  invited  to  attend. 


It  is  understood  that  Dr.  Banks,  Physician-in-Ordinary 
to  Her  Majesty  the  Queen  in  Ireland,  and  Regius  Professor 
of  Physic  in  the  University  of  Dublin,  has  been  offered 
the  honour  of  knighthood,  which  he  has  gratefully  and 
courteously  begged  to  be  allowed,  to  decline. 


At  a  meeting  of  the  trustees  of  the  Astley  Cooper  Prize 
Fund,  held  at  Guy’s  Hospital  on  July  20,  the  Triennial  Prize 
of  A300  was  awarded  to  Dr.  William  Alexander,  of  Liver¬ 
pool.  The  subject  of  the  essay  was  “  The  Pathology  and 
Pathological  Relations  of  the  Disease  known  as  Osteo¬ 
arthritis  or  Chronic  Rheumatic  Arthritis.55 


The  Court  of  Common  Council,  London,  has  referred  to 
the  Coal,  Corn,  and  Finance  Committee,  for  consideration 
and  report,  two  petitions  praying  the  Court  to  take  such 
steps  as  may  be  necessary  to  secure  the  Alexandra  Park  as 
an  open  space  for  the  use,  recreation,  and  enjoyment  of  the 
public. 


We  learn  that,  with  the  view  of  preventing  the  imports*- 
tion  of  cholera  into  the  United  States,  telegraphic  instruc¬ 
tions  have  been  received  at  the  American  Consulate- General, 
London,  to  appoint  a  medical  inspector  to  examine  all 
vessels  clearing  for  the  United  States  from  London  and 
Liverpool ;  and  Dr.  J.  Higham  Hill  has  been  appointed  to 
that  office  in  London. 


MEDICAL  MATTERS  IN  PARLIAMENT. 

House  of  Lords — Friday,  July  20. 

Army  Hospital  Services. — Viscount  Bury  called  the  atten¬ 
tion  of  the  House  to  the  report  of  the  Army  Hospital 
Services  Inquiry  Committee,  and  moved  a  resolution  that, 
while  the  individual  medical  officers  in  Egypt  behaved, 
admirably  well,  the  system  under  which  they  worked  did 
not  successfully  stand  the  strain  put  upon  it;  that  the 
military  authority  exercised  by  medical  officers  was  incon¬ 
venient  ;  and  that  discipline  in  hospitals  ought  to  be  ad¬ 
ministered  by  combatant  officers,  leaving  the  medical  officers 
medical  duties  only  ;  also  that  medical  officers  ought  to  be 
attached  to  regiments  instead  of  being  detailed  for  duty 
day  by  day  from  station  and  other  hospitals.  He  con¬ 
tended  that  the  evidence  before  Lord  Morley’s  Committee 
amply  justified  the  resolution.  He  described  the  change 
made  in  the  Army  Medical  Administration  in  1873,  and 
maintained  that  to  the  alteration  then  made  was  due  the 
fact  that  the  Army  Hospital  Service  had  somewhat  broken 
down  in  the  Egyptian  campaign.  He  was  careful  to  say 
that  the  conduct  of  the  medical  officers  was  beyond  all  praise, 
that  the  individual  officers  did  well,  and  there  was  nothing 
whatever  to  be  said  against  them.  Everything  they  could  do 
was  done ;  and  it  was  the  system  that  was  to  blame.  He  said, 
however,  that  Lord  Wolseley  had  stated,  before  the  Com¬ 
mittee,  that  he  found  in  the  hospitals  at  Ismailia  and  Cairo 
a  great  many  things  deserving  disapproval,  and  that  there 
was  no  excuse  for  them.  After  the  third  day  the  hospitals 
should  have  been  as  well  supplied  as  a  hospital  in  London, 
there  being  no  difficulty  in  obtaining  any  amount  of  servants, 
food,  and  necessary  materials.  Lord  Wolseley  and  other 
officers  had  stated  that  the  surgeons  had  not  the  power  of 
maintaining  discipline  among  their  subordinates ;  and  their 
evidence  went  to  support  his  contention  that  combatant 
officers  ought  to  be  placed  in  the  hospitals  to  maintain  disci¬ 
pline.  Colonel  Maurice,  who  was  on  the  staff  of  the  General 
Commanding-in-Chief,  had  been  woke  up,  while  lying 
wounded  in  the  tent,  three  or  four  times  in  the  course  of 
a  night ;  and  once  he  told  a  servant  to  get  him  some  food, 
but  the  cook  in  a  very  uncivil  way  refused  it,  and  the  medi¬ 
cal  officer,  while  admitting  that  an.  incivility  had  occurred, 
said  that  Colonel  Maurice  must  remember  not  only  that  he 
was  an  officer,  but  that  he  was  his  patient.  Colonel  Maurice 
was  entirely  of  opinion  that  the  discipline  of  the  hospitals 
ought  to  be  carried  out  by  combatant  officers,  not  by  medical 
men,  on  account  of  the  want  of  knowledge  on  the  part  of  the 
latter.  Lord  Bury  dwelt  also  on  the  evils  arising  from  the 
frequent  change  of  medical  men  under  the  present  system. 
— Lord  Morley  said  it  was  admitted  that  there  were  un¬ 
doubtedly  some  defects  in  the  administration  and  general 
management  of  the  hospitals  during  the  campaign  in  Egypt ; 
but  the  remarkable  nature  of  the  service  must  be  borne  in. 
mind.  The  peculiarity  of  the  campaign  was  its  extreme 
rapidity.  On  landing  at  Ismailia  the  army  had  to  move  into 
the  desert  at  once,  before  the  hospital  equipment  had 
been  landed.  The  hospital  at  Ismailia  had  not  been  in¬ 
tended  to  be  a  base  hospital,  and  was  fitted  as  a  field 
hospital  only.  He  quoted  the  medical  statistics  of  the 
campaign  as  proving  in  a  very  remarkable  degree  that 
even  if  there  had  been,  in  some  instances,  undue  delay 
in  getting  the  hospitals  into  perfect  order,  it  had  not 
been  productive  of  any  serious  consequences  to  the  sick. 
The  Army  Hospital  Corps  was  not  in  a  satisfactory  state; 
that  must  be  admitted:  there  were  admirable  nurses  in 
it,  but  there  were  also  some  who  were  indifferent.  The 
difficulty  was  how  to  recruit  the  Corps.  All  our  civil  hos¬ 
pitals  were  nursed  by  women ;  and  there  was  no  large  body 
of  men  from  whom  nurses  could  be  chosen  in  cases  of 


Medical  Times  and  Gazette. 


MEDICAL  MATTERS  IN'  PARLIAMENT. 


July  28, 1883.  103 


emergency.  He  hoped  when  the  Secretary  of  State  for  War 
had  had  time  and  opportunity  to  consider  the  recommenda¬ 
tions  of  the  Committee  there  would  be  improvements  in 
the  pay  and  position  of  the  nurses,  and  in  the  co-ordination 
of  the  different  branches  of  the  Corps.  The  Committee  had 
arrived  at  the  conclusion  opposed  to  Lord  Bury’s  proposi¬ 
tion  that  every  military  hospital  should  be  presided  over  by 
a  military  commandant.  Such  a  system  was  hardly  possible, 
seeing  that  there  were  182  station  hospitals  in  England 
and  Ireland  alone,  and  it  had  never  been  proposed  that 
these  should  have  military  governors  like  Netley  and  Wool¬ 
wich.  The  Committee  felt  the  great  importance  of  unity  of 
control,  and  that  it  should  be  vested  in  a  medical  and  not 
in  a  military  officer.  The  hospital  which  had  a  medical 
commandant  was  as  well  managed  as  a  hospital  could 
be;  and  the  military  hospital  at  Netley  had  duties  in  con¬ 
nexion  with  the  discharge  depot  which  rendered  the  presence 
•of  an  officer  of  high  position  necessary.  The  majority  of  the 
Committee  were  not  in  favour  of  reverting  to  the  old  system 
of  attaching  medical  officers  to  every  battalion  and  every 
corps  of  troops.  He  admitted  the  importance  of  the  wit¬ 
nesses  in  favour  of  such  a  system.  But  it  would  be  imprac¬ 
ticable,  he  thought,  in  war,  and  therefore  ought  not  to  be 
adopted  in  peace.  And,  moreover,  a  medical  officer  would 
deteriorate  if  his  only  duty  was  to  look  after  healthy  troops, 
and  he  was  debarred  attending  hospitals.  The  advantages 
that  might  be  derived  from  the  change  would  not  be  commen¬ 
surate  with  the  cost  of  the  experiment.  A  notion  prevailed, 
and  had  been  given  expression  to  that  day,  that  a  gallant 
colonel  had  been  reprimanded  for  visiting  some  of  his  men 
in  hospital.  That  visit  had  been  paid  when  the  medical 
•officers  were  engaged  in  the  wards  ;  and  it  would  be  very 
inconvenient  if  officers  visited  their  men  at  such  a  time ; 
but  it  must  not  be  supposed  that  regimental  officers  were 
prohibited  from  visiting  station  hospitals.  Any  such  pro¬ 
hibition  would  be  directly  contrary  to  the  wishes  of  the 
medical  officers.— The  Duke  of  Richmond  thought  the 
alteration  in  our  army  medical  system  had  been  the 
worst  of  the  many  changes  introduced  into  the  Army 
•during  recent  years. — The  Duke  of  Cambridge  wished 
to  improve  on  the  present  system.  He  did  not  think 
that  there  was  any  other  army  in  which  there  was  not 
a  medical  officer  attached  to  the  regiments.  The  old  system 
was  a  very  good  one,  but,  as  it  had  been  so  much  altered, 
we  could  not  go  back  to  anything  that  had  been  so  tho¬ 
roughly  altered.  But  if  any  one  of  their  lordships  wanted 
medical  advice,  he  would  not  like  to  put  himself  into  the 
hands  of  different  doctors ;  and  men  were  now  sent  about  so 
much  that  they  had  five  or  six  different  surgeons  to  deal 
with  them.  It  was  all  matter  of  arrangement.  He  desired 
that  a  medical  officer  should  be  attached  absolutely  to  a 
regiment  for  two  or  three  years,  and  should  perform  all 
the  medical  duties  connected  with  that  regiment.  He 
•could  not  see  why  they  should  not  attend  to  all  the  ordi¬ 
nary  medical  requirements  of  a  regiment,  and,  having 
done  that,  attend  also  at  a  station  hospital.  He  had  no 
•objection  to  station  hospitals ;  on  the  contrary,  he  thought 
they  were  better  organised  and  less  extravagantly  carried 
on  than  their  military  hospitals.  But  he  could  not  see 
why  the  station  hospital  system  as  it  existed  should 
not  be  combined  with  the  moderate  regimental  system 
which  he  had  suggested.  He  did  not  think,  however,  that 
medical  men  were  the  proper  persons  to  carry  out  discipline 
in  hospitals.  He  was  himself  President  of  the  London 
Hospital,  and  a  civilian  lived  on  the  spot  who  conducted  the 
supervision  of  that  establishment,  and  it  appeared  to  him 
that  they  ought  to  have  a  military  man  to  look  after  the 
wants  and  requirements  of  a  military  hospital,  quite  inde¬ 
pendent  of  the  medical  officer  who  might  be  in  charge  of 
the  sick.— Some  other  peers  spoke  strongly  against  the 
present  system,  but  the  result  of  the  discussion  was  that 
Lord  Bury’s  motion  was  withdrawn. 

House  oe  Commons — Friday,  July  20. 

The  Cholera  in  Egypt. — Lord  E.  Fitzmaurice,  in  reply  to 
■questions  from  Lord  H.  Lennox  and  other  members,  said 
that  Dr.  Hunter  had  started  for  Egypt ;  and  that  Mr. 
Mieville,  English  delegate  to  the  Quarantine  Board,  and 
Dr.  Mackie,  Consulting  Physician  to  the  Board,  were  also 
attached  to  the  mission ;  that  it  was  true  that  in  Eastern 
cities  funerals  and  burials  were  conducted  with  great  care¬ 
lessness,  but  he  should  make  it  a  special  and  immediate 


duty  to  call  Sir  E.  Malet’s  attention  to  the  accounts  of  the 
way  in  which  the  funerals  of  persons  who  had  died  from 
cholera  were  managed  ,•  that  this  was  among  the  subjects 
that  would  receive  Dr.  Hunter’s  earliest  attention;  and 
that,  as  everything  possible  was  being  done  to  assist  the 
Egyptian  Government,  it  would  be  highly  dangerous  to  do 
anything  that  might  tempt  that  Government  to  throw  the 
responsibility  of  repressing  the  disease  on  Her  Majesty’s 
Government,  which  had  not,  at  present  at  any  rate,  the 
necessary  staff  or  means  to  deal  with  the  disease  on  the  spot. 

Monday,  July  23. 

The  Cholera  in  Egypt. — Lord  E.  Fitzmaurice,  in  reply  to 
questions  from  Mr.  Onslow  and  Lord  E.  Cecil,  said:  I  have 
to  state  that  Sir  Edward  Malet  has  requested  the  Egyptian 
Ministers  at  Cairo  to  associate  with  them  Generals 
Stephenson,  Wood,  and  Baker,  to  form  together  a  commis¬ 
sion  with  full  powers  to  order  and  execute  measures  to  be 
taken  against  cholera.  Twelve  English  medical  officers  are 
being  selected  for  service  in  Egypt,  and  will  proceed  this 
week  to  Cairo.  The  Viceroy  of  India  has  also  been  asked  to 
despatch — if  the  Egyptian  Government  require  them — forty 
experienced  Mohammedan  hospital  assistants  for  general 
cholera  duty.  I  may  add  that  the  deaths  from  cholera 
reported  to  have  taken  place  at  Cairo  during  the  twenty  - 
four  hours  ending  at  8  a.m.  on  the  22nd  amount  to  381. — 
The  Marquis  of  Hartington  said :  I  have  received  a  tele¬ 
gram,  dated  the  23rd  inst.,  from  the  General  Officer  com¬ 
manding  at  Cairo,  in  which  he  states:  “Black  Watch 
moved  to  camp  near  Suez,  20th.  One  fatal  case  of 
cholera  eighteen  hours  after  arrival ;  a  second  case  just 
reported,  doing  well.  General  health  of  troops  as  last 
telegram.”  An  additional  number  of  doctors  have  been 
sent  out,  and  more  are  under  orders  to  go. — Mr.  Onslow 
asked  if  all  the  doctors  who  were  being  sent  out  had  had 
practical  experience  of  cholera  in  the  East. — Lord  E.  Fitz¬ 
maurice  replied :  The  advice  of  Sir  Joseph  Fayrer  has 
been  taken,  and  no  appointment  will  be  made  without  his 
approval.  He  has  had  great  experience  in  India,  and  I 
believe  I  may  say  that  all,  or  nearly  all,  the  doctors  who  are 
being  sent  out  have  also  had  extensive  Indian  experience. 

Emigrants  at  Queenstown. — Mr.  Moore  having  asked  the 
President  of  the  Board  of  Trade  whether  his  attention  had 
been  called  to  the  absence  of  proper  shelter  or  accommoda¬ 
tion  for  emigrants  at  Queenstown  while  undergoing  medical 
inspection,- — Mr.  Chamberlain  replied,  that  he  had  communi¬ 
cated  with  the  Board  of  Trade  officials  at  Queenstown,  and 
had  been  told  that  the  representatives  of  the  White  Star, 
Guion,  and  Allan  lines  have  well-sheltered  accommodation 
for  over  1000  persons,  with  good  sanitary  arrangements,  the 
distance  from  the  place  where  they  are  medically  inspected 
to  the  tender  being  but  a  few  yards.  The  Inman  Company’s 
premises  are  also  commodious,  sheltered,  and  provided  with 
all  necessary  appliances;  and  he  was  further  told  that  the 
same  remarks  apply  in  all  respects  to  the  accommodation 
provided  by  the  other  shipping  companies  at  Queenstown. 


Damages  for  the  Destruction  of  Examination 
Papers. — The  plaintiff  was  a  lady  medical  student,  who 
graduated  at  Pulte  Medical  College  in  1883.  The  examina¬ 
tions  at  the  close  of  the  term  were  conducted  in  writing, 
and  Dr.  Hartshorn,  the  Professor  of  Surgery,  wrote  a  list 
of  twenty-three  questions  on  the  blackboard,  requiring  the 
students,  in  his  presence',  to  write  the  answers.  The 
plaintiff  wrote  about  seventeen  pages  of  MS.  in  answer  to 
those  questions,  and  handed  it  to  the  Professor.  Having 
determined  to  publish  the  results  of  her  examination  in 
pamphlet  form,  as  an  aid  on  starting  in  practice,  she  went 
round  to  the  Professors  of  the  Faculty,  requesting  a  return 
of  her  answers  or  copies  of  them.  All  the  professors 
returned  them  except  Dr.  Hartshorn,  who,  instead  of  giving 
her  the  papers  or  copies  of  them,  threw  them  into  the  fire. 
This  strange  conduct  could  not  be  explained  satisfactorily, 
and,  upon  the  facts  and  testimony  as  to  the  value  of  the 
papers,  the  Court  assessed  the  damages  at  $300. — New  York 
Med.  Record,  July  7. 

Litmus  Paper. — Dr.  Squibb  has  substituted  for  the 
ordinary  blue  and  red  litmus  paper  a  single  colour,  viz., 
purple.  This  purple  litmus  paper  turns  red  with  acids,  and 
blue  with  alkalies.  It  is  claimed  to  be  much  more  delicate 
and  convenient. — Louisville  Med.  News,  June  23. 


104 


Medical  Times  and  Gazette. 


FROM  ABROAD. 


July  28,  1883. 


FROM  ABROAD. 

Treatment  of  Syphilis  at  Vienna. 

A  correspondent  of  the  May  number  of  the  Canada 
Medical  Journal,  writing  from  Vienna,  gives  an  account  of 
the  mode  of  treatment  of  syphilis  at  the  General  Hospital 
of  that  city.  This  Hospital  contains  400  beds  for  the  dis¬ 
ease,  and  there  are  three  professors — Zeissl,  Neumann,  and 
Auspitz, — six  Privat-docenten,  and  six  assistants.  Prof. 
Neumann  has  recently  succeeded  the  late  Prof.  Sigmund, 
whose  efforts  did  so  much  to  give  this  branch  of  the  medical 
school  its  celebrity.  The  treatment  still  pursued  is  essentially 
that  of  Prof.  Sigmund. 

1.  Treatment  of  the  Local  Sore. — The  term  hard  chancre 
is  now  never  used,  as  an  infecting  sore  may  be  either  hard 
or  soft.  The  mineral  acids  or  the  thermo-cautery  are  never 
used  for  its  destruction,  it  being  considered  that  treatment  of 
the  sore  by  escharotics,  after  forty-eight  hours,  is  useless  in 
preventing  infection.  The  removal  of  infecting  sores  by  the 
knife  or  scissors  has  been  given  up,  for  it  was  never  found 
effectual  in  preventing  infection.  The  treatment  of  the 
chancre  is  always  mild.  When  there  is  an  ulcerating  surface, 
iodoform  is  invariably  used  in  the  form  of  spray  (one  part 
being  dissolved  in  six  of  sulphuric  ether).  This  leaves  on 
the  surface  a  fine  coating  of  iodoform,  which  is  much  better 
than  dusting  it  on,  as  it  adheres  well  to  the  surface.  After  a 
few  days’  use  of  this,  the  sore  takes  on  an  healthy  action,  and 
when  the  granulations  are  healthy  a  2  per  cent,  solution  of 
carbolic  acid  is  substituted.  When  the  chancre  has  healed, 
leaving  a  nodule,  the  best  application  is  one  part  of  corro¬ 
sive  sublimate  to  fifty  of  water,  or  a  diluted  mercurial 
plaster. 

2.  Secondary  Symptoms. — It  is  considered  that  there  are 
no  known  means  of  preventing  these ;  but  Sigmund  found 
from  the  observation  of  many  thousand  cases  left  untreated 
that  in  40  per  cent,  they  are  so  slight  that  in  a  great 
number  of  instances  they  might  be  overlooked  by  the 
patient.  The  treatment  of  the  secondary  stage  is  not  com¬ 
menced  until  the  particular  form  that  it  assumes  is  evident. 
If  the  patient  has  an  excellent  constitution  and  good  appe¬ 
tite  it  is  not  considered  necessary  to  give  him  iodine  or 
mercury,  good  health  and  appetite  with  strict  attention  to 
cleanliness  being  regarded  as  sufficing.  During  the  two  or 
three  years  that  this  stage  is  supposed  to  last  the  patient 
has  two  or  more  relapses,  and  as  a  relapse  is  always  more 
difficult  to  get  rid  of,  it  is  recommended  when  the  first 
attack  of  secondary  symptoms  is  slight  not  to  give  iodine  or 
mercury,  but  to  reserve  these  agents  for  a  later  period  ;  for 
if  they  are  used  for  the  first  crop  of  secondary  symptoms 
they  will  be  found  to  have  much  less  effect  on  the  second 
or  third  crops  than  if  they  had  not  been  used  for  the  first. 
So  also  is  this  true  of  the  third  stage  of  the  disease.  More¬ 
over,  if  iodine  is  used  for  the  treatment  of  the  second  stage 
of  syphilis,  it  will  be  found  to  have  much  less  effect  than 
mercury  over  the  tertiary  symptoms  ;  and  if  mercury  is  used 
in  the  secondary  stage  it  will  have  less  influence  over  the 
third  stage  than  iodine.  As  a  rule  the  practice  is  to  give 
iodine  during  the  secondary  stage,  when  the  symptoms  are 
of  a  pronounced  character.  If  they  do  not  yield,  or  the 
iodine  is  ill  borne,  then  mercury  is  given.  Mercury  is  also 
given  if  the  case  is  a  particularly  severe  one.  Iodine  is  con¬ 
sidered  to  be  as  useful  during  the  secondary  as  it  is  during 
the  tertiary  stage.  In  either  stage  it  is  not,  like  mercury,  a 
direct  antidote  of  the  poison,  but  acts  indirectly  by  favour¬ 
ing  tissue-changes  and  increasing  the  patient’s  power  of 
resistance.  Whatever  preparation  of  iodine  or  mercury  is 
used,  it  only  does  harm  if  digestion  is  materially  interfered 
with.  This  is  a  point  of  great  practical  importance,  and  one 
too  often  neglected.  In  scrofulous  and  tuberculous  patients 
it  often  happens  that  neither  treatment  has  good  effect  until 
iron  or  cod-liver  oil  has  been  taken  for  some  time.  The 
rule  generally  followed  is  to  give  the  iodides  in  the  moist, 
and  mercury  in  the  dry  secondaries.  This  division  into  dry 
and  moist  secondaries  is  regarded  as  of  great  importance,  as 
it  is  always  found  that  dry  eruptions  occur  in  the  weak  and 
badly  nourished,  while  the  moist  occur  in  the  strong  and 
well-nourished. 

3.  Administration  of  Mercury. — Inunction  is  the  method 


most  commonly  employed,  and  for  the  great  majority  of 
cases  is  the  most  trustworthy,  as  by  no  other  means  can  the 
system  be  so  quickly  influenced.  In  gummata  of  the  nasal 
septum,  roof  of  the  mouth,  etc.,  when  hours  are  precious  in 
order  to  save  the  hard  tissues  from  destruction,  it  should 
always  be'  used ;  and  in  syphilitic  lesions  of  the  nervous 
system  (whether  a  circumscribed  gumma,  or  the  blocking 
of  an  artery  by  cellular  infiltration),  where  irretrievable 
damage  will  happen  in  a  very  short  time,  the  inunction  should 
always  form  part  of  the  treatment.  Mercury  should  always 
be  given  ;  and  to  treat  such  cases  by  the  iodide  alone  is  re¬ 
garded  by  Neumann  as  only  half  treatment.  After  the 
third  inunction  mercury  can  generally  be  found  in  the  urine, 
and  after  the  fifth  there  are  distinct  signs  of  stomatitis. 
The  preparation  generally  used  is  a  finely  divided  ointment, 
made  up  of  one  part  of  mercury  to  two  of  lard.  A  piece  net 
larger  than  a  pea  is  rubbed  slowly  in  until  the  parts  are 
dry,  and  the  desired  quantity  has  been  used  ;  half  an  hour 
being  always  required  (and  often  an  hour)  before  a  drachm 
can  be  rubbed  in.  On  the  sixth  day  the  patient  gets  a  warm 
bath,  and  on  the  seventh  day  begins  rubbing  in  again. 
The  process  is  continued  until  the  symptoms  disappear,  and 
from  thirty  to  fifty  rubbings  may  be  required;  and  it  is 
extremely  rare  to  find  a  case  in  the  second  stage  resist¬ 
ing  sixty  rubbings.  A  very  important  point  is  to  insist  upon 
keeping  the  mouth  and  gums  clean,  or  stomatitis,  which 
will  interrupt  the  treatment,  sets  in.  The  remedy  above  all 
others  which  is  best  for  preventing  too  severe  or  too  early 
stomatitis  is  tar,  and  this  forms  also  the  best  remedy  when 
stomatitis  has  occurred.  It  is  surprising  how  soon  it  effects  a 
cure  even  in  very  severe  cases.  Slight  stomatitis  is  produced 
after  the  fifth  rubbing ;  and  when  the  patient  after  ten  or 
twelve  rubbings  has  not  slight  salivation,  with  coppery  taste 
and  swelling  of  the  gums,  it  is  a  certain  proof  that  he  has 
rubbed  in  badly.  In  some  people  the  rubbing  produces 
eczema,  and  this,  with  the  time  required,  are  the  only  objec¬ 
tions  to  the  method.  The  time  may  be  diminished  by  em¬ 
ploying  one  part  of  mercury  with  two  of  green  soap,  the 
mercury  being  so  finely  divided  that  it  cannot  be  seen  with 
a  lens,  the  addition  of  a  very  small  quantity  of  glycerine 
assisting  to  divide  the  mercury.  From  one  to  one  and  a 
half  drachms  of  this  may  be  rubbed  in  in  ten  minutes. 

4.  Internal  Administration  of  Mercury. — Whatever  pre.- 
paration  is  used  it  is  apt  to  cause  catarrh  of  the  stomach. 
It  is  also  a  very  inexact  method,  as  we  can  never  be  sure 
what  amount  is  absorbed.  Calomel  is  used  for  children  and 
weak  persons,  and  is  especially  good  in  hereditary  syphilis. 
It  is  usually  given  in  powder  with  sugar — from  one- quarter 
to  three-quarters  of  a  grain  three  times  a  day  to  an  adult. 
Corrosive  sublimate  is  only  used  for  adults. 

5.  Subcutaneous  Injection. — This  is  extensively  used  in 
Neumann’s  wards,  but  only  in  the  secondary  stage  and  the- 
slight  forms  of  the  tertiary.  For  the  severer  forms  of  the 
latter  its  action  is  too  slow.  Liebreich’s  formidate  of  mer¬ 
cury  is  the  preparation  now  used ;  and  in  more  than  two 
hundred  cases  it  has  always  succeeded,  only  twice  having 
been  followed  by  abscess.  In  every  hundred  grains  there  is 
one  grain  of  mercury.  Until  latterly  corrosive  sublimate  was 
much  used  in  hypodermic  injections,  but  it  is  apt  to  cause  a 
burning  sensation  which  lasts  for  two  or  three  hours,  although 
it  is  rare  for  it  to  be  followed  by  abscess.  Bamberger’s  pep- 
tonate  and  albuminate  of  mercury  are  also  used,  and  give 
rise  to  no  irritation ;  but  having  to  be  prepared  daily,  they 
are  not  likely  to  be  widely  used.  In  using  any  pre  para- 
tion  of  mercury  hypodermically,  care  should  be  taken  to 
inject  the  subcutaneous  cellular  tissue,  and  not  the  skin 
or  muscles.  The  back,  three  or  four  inches  from  the  spine, 
is  the  best  situation.  It  must  always  be  recollected  that 
mercury  is  excreted  very  slowly,  so  that  considerable 
quantities  can  be  found  in  the  urine  three  weeks  after  any 
has  been  used.  After  a  month’s  inunction  it  can  be  de¬ 
tected  eight  months  afterwards,  and  Prof.  Ludwig  has 
several  times  found  it  in  the  urine  of  some  of  Sigmund’s 
cases  three,  four,  and  five  years  after  they  had  stopped 
using  it. 

6.  Iodine. — Three  preparations  of  this  are  used,  the  iodide 
of  sodium  containing  60  per  cent.,  iodide  of  potassium  80 
per  cent.,  and  iodoform  93  or  94  per  cent.  The  first  of 
these  is  best  for  children  and  weak  persons.  Iodoform  is  only 
employed  hypodermically,  one  part  dissolved  in  six  parts  of 
ether  being  the  formula  used.  It  gives  rise  to  no  irritation, 
and  its  injection  is  not  painful.  In  mild  cases  twenty  in- 


Medical  Times  and  Gazette. 


COLLEGIATE  STATISTICS. 


July  28, 1883.  105 


jections  will  suffice;  in  the  severer  forms  fifty  are  often 
required.  Iodoform  is  considered  as  useful  as  iodide  of 
potassium  in  either  the  secondary  or  tertiary  stage. 


COLLEGIATE  STATISTICS. 

At  the  last  meeting  of  the  Council  of  the  Royal  College  of 
Surgeons  of  England,  the  following  report  from  the  Board 
and  Court  of  Examiners— showing  the  number  of  candidates 
who  have  presented  themselves  for  the  Primary  and  Pass 
Examinations  for  the  diploma  of  Member  of  the  College 
during  the  collegiate  year  1882-83,  with  the  numbers  who 
have  passed  and  have  been  rejected,  from  each  medical 
school,  during  that  period— was  received,  and  ordered  to  be 
published,  viz. : — 


Primary  Examinations 

Medical  School.  Totals. 

1882-83. 

Number 

Number 

St.  Bartholomew’s 

196 

passed. 

123 

rejected. 

73 

Guy’s 

97 

79 

18 

University  College 

82 

57 

25 

London 

71 

56 

15 

St.  Thomas’s 

64 

44 

20 

King’s  College  . 

54 

39 

15 

St.  George’s 

50 

31 

19 

Charing-cross  . 

43 

26 

17 

Middlesex  . 

36 

20 

16 

St.  Marv’s  . 

28 

19 

9 

Westminster 

19 

16 

3 

Manchester 

78 

53 

25 

Leeds 

34 

26 

8 

Cambridge 

33 

27 

6 

Bristol 

24 

10 

8 

Birmingham 

21 

18 

3 

Liverpool 

19 

16 

3 

N  ewcastle-on-Tyne 

17 

12 

5 

Sheffield 

6 

2 

4 

Dublin 

9 

8 

1 

Belfast 

1 

1 

Galway 

1 

1 

_ 

Edinburgh 

57 

43 

14 

Glasgow 

20 

14 

6 

Aberdeen  . 

5 

3 

2 

'Toronto 

6 

6 

__ _ 

McGill  Coll.,  Montreal  2 

2 

- 

Ontario 

1 

1 

_ 

New  York  . 

2 

2 

- 

Cincinnati  . 

1 

1 

_ 

Harvard 

1 

1 

_ 

Calcutta 

2 

1 

1 

Madras 

1 

1 

Bombay 

2 

2 

_ 

Hanover 

1 

— 

1 

Miscellaneous  . 

35 

28 

7 

Totals 

.  1119 

795 

324 

Under  the  head  of  “  Miscellaneous  ”  are  counted  all  students 
who  have  pursued  their  studies  at  more  than  one  medical 
school.  The  following  statement  shows  the  schools  to  which 
such  students  belong,  viz. : — 

Passed,  28  =  Calcutta  and  Glasgow,  1  ;  Belfast  and  Guy’s, 
1  ;  Edinburgh  and  University  College,  3 ;  Calcutta  and 
Edinburgh,  1  ;  Cambridge  and  Charing-cross,  1 ;  Toronto 
and  Middlesex,  1 ;  Cambridge  and  St.  Bartholomew’s,  1 ; 
Liverpool  and  St.  Thomas’s,  1 ;  St.  George’s  and  St. 
Thomas’s,  1 ;  Cambridge  and  London,  2 ;  Liverpool  and 
Guy’s,  2  ;  Cambridge  and  University  College,  1 ;  Edinburgh 
and  St.  Bartholomew’s,  1;  University  College  and  King’s 
College,  1 ;  Newcastle  and  London,  1 ;  Glasgow  and  West¬ 
minster,  I ;  Cambridge  and  Guy’s,  1  ;  McGill  College  (Mon¬ 
treal)  and  Manchester,  1 ;  Cambridge  and  St.  Thomas’s,  3  ; 
Madras  and  University  College,  1 ;  New  York  and  Guy’s,  1  ; 
Manchester  and  Guy’s,  1. 

Referred,  7  =  Cambridge  and  University  College,  1 ;  Cam¬ 
bridge  and  St.  Thomas’s,  1 ;  New  York  and  Middlesex,  1  ; 
St.  Thomas’s  and  Charing-cross,  1  ;  Manchester  and  Edin¬ 
burgh,  1  ;  Madras  and  University  College,  1  ;  Westminster 
and  Charing-cross,  1. 


Pass  Examinations, 

1882-83. 

Medical  School. 

Totals. 

Number 

passed. 

Number 

rejected. 

St.  Bartholomew’s 

107 

67 

40 

Guy’s 

106 

71 

35 

University  College 

86 

54 

32 

London 

46 

27 

19 

St.  Thomas’s 

44 

33 

11 

King’s  College  . 

52 

25 

27 

St.  George’s 

17 

11 

6 

St.  Mary’s 

27 

16 

11 

Charing-cross 

14 

10 

4 

Middlesex  . 

24 

17 

7 

Westminster 

15 

10 

5 

Leeds 

14 

8 

6- 

Manchester 

34 

25 

9 

Liverpool  . 

9 

3 

6 

Birmingham 

15 

11 

4 

N  ewcastle-on-Tyne 

12 

6 

0 

Sheffield  . 

5 

3 

2 

Bristol 

6 

3 

3 

Dublin 

6 

5 

1 

Galway 

1 

1 

— 

Belfast 

1 

- 

1 

Edinburgh 

28 

20 

8 

Glasgow 

6 

2 

4 

Aberdeen  . 

1 

_ 

1 

Bombay 

1 

1 

— 

Calcutta 

2 

2 

_ 

Toronto 

2 

1 

1 

McGill  Coll . ,  Montreal  1 

_ 

1 

Kingston  . 

1 

— 

1 

New  York  . 

2 

_ 

2 

Cincinnati . 

1 

1 

-  - 

Miscellaneous  . 

83 

55 

28 

Totals 

.  769 

488 

281 

Under  the  head  of  “  Miscellaneous”  are  counted  all  students- 

who  have  pursued  their  studies  at  more  than  one  medical 
school.  The  following  statement  shows  the  schools  to  which; 
such  students  belong,  viz.  : — 

Passed,  55  =  Birmingham  and  Edinburgh,  1 ;  Cambridge 
and  Leeds,  1 ;  Cambridge  and  St.  Bartholomew’s,  2 ;  Cam¬ 
bridge  and  St.Thomas’s,  3 ;  Cambridge  and  King’s  College,  2 ; 
Cambridge  and  St.  George’s,  4;  Newcastle  and  St.  George’s,. 
1  ;  Birmingham  and  Charing-cross,  1  ;  Liverpool  and  Uni¬ 
versity  College,  5  ;  Calcutta  and  London,  1 ;  Aberdeen  and 
London,  1  ;  McGill  College  (Montreal)  and  London,  1 ; 
Melbourne  and  Guy’s,  1  ;  Cambridge  and  London,  1 
Manchester  and  Edinburgh,  1 ;  St.  Bartholomew’s  and  Edin¬ 
burgh,  1 ;  Sheffield  and  St.  Thomas’s,  2  ;  Charing-cross  and 
Newcastle,  1 ;  Manchester  and  Guy’s,  1 ;  University  College, 
Westminster,  and  Edinburgh,  1  ;  Cambridge,  Manchester, 
and  St.  Bartholomew’s,  1 ;  Newcastle  and  Guy’s,  1  ;  Cam¬ 
bridge  and  Guy’s,  3  ;  Toronto  and  University  College,  1 ; 
Liverpool  and  Guy’s,  1 ;  Madras  and  University  College,  2  ; 
Newcastle  and  University  College,  1  ;  Kingston  and  Birming¬ 
ham,  1 ;  Bristol  and  University  College,  1 ;  Dublin  and  St. 
Thomas’s,  1 ;  Newcastle  and  St.  Bartholomew’s,  1 ;  Bristol 
and  Middlesex,  1 ;  Calcutta  and  St.  Thomas’s,  1  ;  Edinburgh 
and  Guy’s,  1 ;  Middlesex,  Edinburgh,  and  St.  George’s,  1 ; 
Cambridge  and  St.  Mary’s,  1 ;  Newcastle  and  King’s  College,, 
1 ;  McGill  College  (Montreal)  and  St.  Mary’s,  1 ;  Toronto 
and  St.  Bartholomew’s,  1 ;  Manchester  and  St.  Thomas’s,  1. 

Rejected,  28  =  Madras  and  University  College,  1;  Dublin 
and  St.  Thomas’s,  2  ;  Hobart  Town,  University  College,  and 
London,  1 ;  Cambridge  and  St.  George’s,  1 ;  Liverpool  and 
Guy’s,  2 ;  Cambridge  and  St.  Mary’s,  2 ;  Madras  and  Uni¬ 
versity  College,  2 ;  Glasgow  and  Guy’s,  2 ;  Cambridge  and 
London,  1 ;  Calcutta  and  Edinburgh,  1 ;  Toronto  and  St. 
Bartholomew’s,  1 ;  Calcutta  and  Middlesex,  1 ;  Leeds  and 
Sheffield,  1 ;  New  York  and  St.  Mary’s,  1 ;  Calcutta  and  St. 
Thomas’s,  1 ;  Cambridge  and  St.  Bartholomew’s,  1 ;  Edin¬ 
burgh  and  Charing-cross,  1 ;  Dublin  and  London,  1 ;  St. 
Mary’s  and  University  College,  1 ;  Dublin,  Edinburgh,  Uni¬ 
versity  College,  and  London,  1;  University  College  and 
Leeds,  1  ;  Toronto  and  Middlesex,  1 ;  Harvard  and  Vienna,  1. 


The  Egyptian  Census. — These  returns  have  just  been 
completed,  and  show  that  the  population  of  the  country 
comprises  3,393,918  males  and  3,404,312  females. 


106 


Medical  Times  and  Gazette. 


THE  THREATENED  EPIDEMIC  OF  CHOLERA. 


July  28,  1883. 


THE  ROYAL  COLLEGE  OF  SURGEONS  IN 
IRELAND. 


'On  Thursday,  the  19th  inst.,  a  special  meeting  of  the 
•Council  and  Fellows  of  the  College  was  held,  for  the  pur¬ 
pose  of  conferring  the  Honorary  Fellowship  upon  Surgeon- 
■General  Crawford,  the  Director-General  of  the  Army  Medical 
Department,  and  Surgeon-General  Sir  James  Hanbury, 
K.C.B.  Dr.  William  Ireland  Wheeler,  President  of  the 
•College,  occupied  the  chair. 

In  presenting  the  certificate  of  Honorary  Fellowship  to 
Surgeon- General  Crawford,  the  President  recounted  the 
history  of  his  career,  and  concluded  in  these  words  : — “  And 
lastly,  sir,  we  are  all  aware  of  the  admirable  arrangements 
.you  made  for  the  sick  and  wounded  in  the  Egyptian  cam¬ 
paign.  Sir,  I  cannot  allude  to  them  without  expressing  great 
•admiration  for  the  perfection  of  your  arrangements  and  for 
the  astuteness  and  sagacity  in  your  selection  of  those  who  were 
to  carry  out  such  arrangements  and  organisation  as  you  con¬ 
ceived  to  be  necessary ;  and  although  it  may  be  an  experiment 
to  modify  in  minor  details  the  departmental  system  which  the 
Director-General  has  advocated,  yet  this  system  could  not 
have  worked  better  than  it  did  in  Egypt.  The  wounded 
were  never  so  quickly  carried  off  the  field  ;  never  so  promptly 
attended ;  never  was  there  a  war  in  which  men  were  better 
medically  attended  to;  never  was  the  mortality  so  small 
in  any  campaign  of  comparative  magnitude.  Gentlemen, 
I  could  recount  example  after  example  where  the  adminis¬ 
trative  powers  of  the  Director-General,  and  his  scientific 
knowledge  of  surgery  and  its  auxiliary  branches,  have  pre¬ 
vented  the  spread  of  disease,  have  saved  life,  have  lessened 
■■suffering,  have  mitigated  misery.  But  I  feel  that  this  is 
already  better  known  than  I  could  express  it,  and  I  will 
conclude  by  saying  that  the  Royal  College  of  Surgeons  in 
Ireland,  anxious  to  confer  honour  where  honour  is  due,  has 
awarded  to  the  Director-General  of  the  Army  Medical 
Department  its  highest  degree— its  Honorary  Fellowship.” 

The  President  then  conferred  the  Honorary  Fellowship  on 
■•Sir  James  Hanbury,  saying — “  As  Principal  Medical  Officer 
of  the  Egyptian  campaign,  we  congratulate  you  warmly  for 
the  manner  in  which  you  carried  out  the  hospital  organisa¬ 
tion.  We  are  fully  alive  to  the  difficulties  that  beset  you. 
The  way  in  which  you  conducted  your  comprehensive 
medical  work  cannot  be  spoken  of  too  highly.  Knowing 
Egypt  as  I  do,  where  sanitary  arrangements  are  not  con¬ 
sidered  necessary,  the  celerity  with  which  you  established 
the  police  hospital  at  Ismailia  cannot  but  be  a  matter  for 
■universal  admiration.  You  established  your  hospitals  at 
Alexandria,  Ramleh,  and  Ismailia,  and  also  the  Citadel 
Hospital  at  Cairo.  The  preparations  made  for  the  sick  in 
The  various  actions  fought  or  anticipated  are  an  additional 
proof,  if  such  were  required,  of  the  wisdom  of  the  Director- 
•General  in  selecting  you  for  that  duty.” 


Administration  of  Hospitals. — The  first  meeting  of 
the  representative  Committee  of  Hospital  Managers,  ap¬ 
pointed  at  the  recent  conference  organised  by  the  Social 
•Science  Association,  will  be  held  at  their  offices,  1,  Adam- 
street,  Adelphi,  on  Monday  next,  the  30th  inst.,  at  4.30  p.m. 
'The  following  is  the  constitution  of  the  Committee  (with 
power  to  add  to  their  number)  : — The  Earl  of  Cork  and 
Orrery,  K.P. ;  Viscount  Powerscourt,  K.P. ;  Sir  Thomas 
Fowell  Buxton,  Bart. ;  H.  W.  D.  Acland,  Esq.,  M.D., 
D.C.L.,  F.R.S. ;  J.  S.  Bristowe,  Esq.,  M.D.,  F.R.S. ;  Henry 
C.  Burdett,  Esq.;  the  Rev.’ Canon  Erskine  Clarke,  M.A. ; 
W.  Farquharson,  Esq.,  M.D.,  M.P. ;  S.  Leigh  Gregson,  Esq. 
•■(Southern  Hospital,  Liverpool);  J.  J.  Gurney, Esq.  (Newcastle 
Infirmary) ;  Timothy  Holmes,  Esq.,  F.R.C.S. ;  G.  B.  Lloyd, 
Esq.,  J.P.  (General  Hospital,  Birmingham) ;  Francis  S. 
Powell,  Esq.;  Joseph  White, Esq.,  F.R.C.S.  (General  Hospital, 
Nottingham). 

Castor  Oil  and  Glycerine. — The  following  may  be 
found  in  the  Pharmacopoeia  of  the  Hospital  of  the  Univer¬ 
sity  of  Pennsylvania,  and  is,  we  believe.  Prof.  H.  C.  Wood’s 
formula: — ft.  01.  ricini,  glycerin®,  aa  §j.;  ol.  menth.  pip. 
gtt.  iij. — Phil.  Med.  Reporter,  April  28. 


THE  THREATENED  EPIDEMIC  OF  CHOLERA. 

At  the  usual  weekly  meeting  of  the  Board  of  Guardians  of 
the  South  Dublin  Union,  held  on  Thursday,  July  19,  a 
circular  letter  from  the  Local  Government  Board  for  Ireland 
was  read,  calling  the  attention  of  the  Guardians  to  the 
precautions  necessary  to  be  adopted  for  the  prevention  of 
cholera.  The  circular  urged  the  propriety  of  appointing  a 
properly  qualified  medical  practitioner  as  special  medical 
officer  of  health  for  the  port. 

The  following  report  on  the  circular  was  subsequently 
adopted  : — 

“  1.  That  Halpin’s  Pool  shall  be  the  anchoring  station  for 
suspected  vessels,  under  Articles  6  and  10,  and  shall  be 
notified  as  such  to  the  Customs. 

“2.  That  Dr.  J.  K.  Denham  be  appointed  medical  officer 
under  the  order  for  port  inspection,  at  a  salary  of  £1  Is.  per 
day,  or  portion  of  day,  that  he  may  be  employed,  and  that 
his  name  and  address  be  communicated  to  the  Customs  and 
Coastguard  authorities. 

,f3.  That  the  hospital  ship  be  furnished  with  the  necessary 
supplies. 

“4.  That  a  medical  attendant  on  the  hospital  ship  be 
designated,  the  name  of  a  qualified  practitioner  to  be  sub¬ 
mitted  to  the  Visiting  Committee  next  Wednesday,  and  his 
salary  arranged  at  £1  Is.  per  day  while  employed,  and  also 
a  nurse  to  be  selected  by  the  Master. 

“  5.  To  arrange  with  Sir  Patrick  Dun’s  Hospital  to  receive 
patients,  if  necessary,  under  Articles  13  and  14.” 

The  “  Articles”  referred  to  are  those  of  the  Quarantine 
Order  of  the  Irish  Local  Government  Board,  issued  on 
July  16.  It  is,  mutatis  mutandis,  almost  identical  with  the 
similar  “  Order  ”  of  the  Local  Government  Board  for  Ireland. 

It  will  be  observed  that  the  South  Dublin  Board  of  Guar¬ 
dians  contemplate  using  Sir  Patrick  Dun’s  Hospital  as  a 
“port  hospital.”  This  appears  to  be  very  objectionable, 
and  for  two  good  reasons.  The  Hospital  is  a  considerable 
distance  from  "  Halpin’s  Pool,”  the  anchoring  station  for 
suspected  vessels,  and  is  situated  in  the  midst  of  a  thickly 
populated  district  of  the  city  of  Dublin.  It  will  be  an  error 
to  carry  cholera  patients  from  a  quarantine  station  in  the 
port  into  the  very  heart  of  the  city,  instead  of  treating  them 
in  an  isolated  intercepting  hospital  near  the  port,  and  apart 
from  other  human  habitations. 


Jeqtjirity  in  Granular  Lids. — In  the  Boston  Med. 
Journal,  June  28,  Dr.  Standish  gives  an  account  of  thirteen 
cases  of  granular  ophthalmia  which  have  been  treated  in 
Dr.  Derby’s  wards  of  the  Massachusetts  Eye  Infirmary  by 
means  of  this  new  remedy.  It  consists  of  the  seeds  of  the 
Abrus  precatorius,  which  has  long  been  used  as  a  popular 
remedy  for  ophthalmia  in  Brazil,  and  which  has  lately  re¬ 
ceived  the  strong  recommendation  of  Dr.  De  Wecker,  of 
Paris.  A  lotion  is  prepared  with  a  strong  infusion  of  the 
seeds,  and  the  outside  of  the  lid  is  washed  with  this  three 
times  daily,  a  camel’s-hair  brush  being  also  carried  two  or 
three  times  rapidly  across  the  everted  lower  lid.  Active 
inflammation  is  set  up  with  purulent  discharge,  which  in 
the  course  of  a  few  days  abates,  leaving  the  disease  greatly 
amended,  the  granulations  of  the  lids  gradually  disappearing. 

Gaultheria  in  Rheumatism. — At  the  New  York 
Medical  and  Surgical  Society,  Dr.  Flint  stated  that  the 
results  of  the  trial  made  of  this  substance  in  thirteen  cases 
at  Bellevue  Hospital  served  to  show  rather  better  results 
from  gaultheria  than  those  which  are  ordinarily  obtained 
from  salicylic  acid.  The  oil  of  wintergreen  was  the  pre¬ 
paration  used,  and  it  was  administered  several  times  a  day 
in  ten-drop  doses  in  flax-seed  tea,  which  renders  it  less  dis¬ 
agreeable  to  the  taste  and  to  the  stomach.  In  some  of  the 
cases  the  alkaline  treatment  was  employed  at  the  same  time. 
— Dr.  Ball  stated  that  Dr.  Kinnicutt  had  used  the  oil  of 
gaultheria  in  a  number  of  cases  of  acute  rheumatism  with 
even  better  results  then  those  mentioned  by  Dr.  Flint.  It 
was  administered  in  milk,  and  was  less  disagreeable  when  so 
taken  than  salicylic  acid  or  salicylate  of  soda. — New  York 
Med.  Jour.,  June  30. 


Medical  Times  and  Gazette. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


July  28,  1883.  107 


REVIEWS  AND  NOTICES  OP  BOOKS. 


A  Practical  Treatise  on  Diseases  of  the  Shin ,  for  the  Use  of 
Students  and  Practitioners.  By  Jambs  NevinHyde,  A.M., 
M.D.,  Professor  of  Skin  and  Venereal  Diseases,  Push 
Medical  College,  Chicago.  London  :  J.  and  A.  Churchill. 
1883.  Royal  Svo,  pp.  572. 

[First  Notice.] 

Vert  great  activity  is  being  displayed  by  the  American 
School  of  Dermatology.  Quite  recently  some  three  or  four 
text-books  on  this  subject  have  issued  from  the  American 
press,  and,  in  addition,  there  is  the  monthly  New  York 
publication,  the  Journal  of  Cutaneous  and  Venereal  Disease. 
This  richness  of  production  is  probably  to  be  accounted  for 
in  some  measure  by  the  increasing  appreciation  for  books 
which  are  founded  on  skilled  observation,  and  the  oppor¬ 
tunities  for  such  observation  which  are  largely  accorded 
to  the  American  dermatologists  at  the  general  hospitals. 
In  the  book  now  before  us,  the  preliminary  chapter  on 
the  Anatomy  and  Physiology  of  the  Skin  contains  the 
newest  views;  especially  may  be  mentioned  those  of  the 
formation  of  the  prickle  cells  of  the  epidermis  and  their 
relation  to  the  surrounding  cement-substance.  The  author 
adopts  Heitzman’s  views  as  to  the  structure  of  the  corium  : 
— “The  bundles  (connective-tissue  bundles)  are  bounded 
in  many  instances  by  a  very  dense  basis-substance,  repre¬ 
senting  the  elastic  fibres  and  separated  from  each  other 
by  narrow  layers  of  a  cement-substance,  which  in  its 
chemical  features  is  kindred  to  the  glue-giving  basis- 
substance  of  the  fibrous  connective  tissue  in  general.” — 
(Thomsa.)  The  so-called  connective-tissue  cells  are  em¬ 
bedded  in  this  substance ;  and  in  this  connexion  we  are  told 
that  the  formerly  described  lymph-spaces,  with  which  it  was 
thought  the  lymphatics  were  in  open  communication,  are 
now  known  to  have  no  existence.  Trophic  nerves,  which 
hitherto  have  enjoyed  but  an  inferential  existence,  are 
spoken  of  as  supplying  all  the  secretory  organs  of  the  skin 
and  all  protoplasmic  formations.  The  formation  of  the  hair 
and  root-sheath  is  admirably  given.  The  hair,  although 
nourished  by  the  papilla,  is  said  not  to  be  formed  from  it, 
but  is  produced  by  the  inner  root-sheath  exclusively.  The 
columnse  adiposse  of  Dr.  Collins  Warren  are  figured:  these 
are  the  columnar-shaped  prolongations  extending  from  the 
bases  of  the  hair  follicles  to  the  panniculus  adiposus  below ; 
they  conduct  the  bloodvessels  to  the  deeper  tissues  of  the 
skin.  In  this  chapter  there  are  many  new  well-executed 
figures  and  diagrams,  mostly  after  Heitzman. 

In  the  preliminary  chapter  on  Symptomatology,  the  defini¬ 
tion  of  lesions  and  lesion  relics  (secondary  lesions)  are  some¬ 
what  modified  from  those  we  usually  meet  with  in  derma¬ 
tological  works.  Dr.  Hyde  declares  himself  a  true  follower 
of  the  Vienna  School  in  the  chapter  on  Etiology,  admitting 
the  internal  causes  of  skin- disease  in  the  most  restricted 
sense.  Physiological  processes,  “  dentition,  menstruation, 
pregnancy,  and  the  menopause  disturb  the  physiological 
equilibrium,  and  at  times  render  the  access  of  other  dis¬ 
turbing  forces  exceptionally  facile.”  Heredity  is  declared 
to  be  of  less  importance  than  is  generally  supposed.  After 
discussing  hereditary  syphilis.  Dr.  Hyde  says :  "  Many  of 
the  examples  cited  of  hereditary  transmission  of  cutaneous 
disease  are  without  doubt  cases  of  coincidence  which,  con¬ 
sidering  the  number  of  patients  affected  annually  with 
eczema  and  psoriasis,  for  example,  should  not  be  regarded 
as  of  very  rare  occurrence.”  Lastly,  constitutional  diseases 
are  said  only  to  affect  the  skin  indirectly,  inasmuch  as  they 
tend  to  arrest  repair,  to  lower  nutrition,  etc.  It  is  needless 
to  say  that  no  mention  is  made  of  the  herpetic  or  dartrous 
diatheses.  In  treating  of  general  diagnosis,  the  systematic 
method  of  inquiry  as  to  medical  history,  the  information  to 
be  gathered  from  the  physician’s  own  observation  of  facts  as 
to  the  patient’s  mode  of  dress,  appearance,  expression,  etc., 
the  directions  for  the  thorough  investigation  of  the  particular 
ailment  for  which  the  patient  seeks  relief,  are  all  given  with  a 
force  which  is  most  impressive.  To  give  an  example.  Dr. 
Hyde  says  :  “  The  assurances  of  the  patient  are  always  to  be 
accepted  with  reserve.  Thus,  ona  who  exposes  his  leg  merely, 
stating  that  this  is  the  only  part  of  his  body  affected,  may 
have  concealed  beneath  his  clothing  extensive  varicosities 
of  the  thigh,  a  typical  syphilitic  exanthem  over  the  belly. 


a  significant  scar  on  his  elbow,  an  extensive  patch  of  tinea 
versicolor  on  the  surface  of  his  chest,  or  a  blennorrhagic 
discharge  from  the  urethra,  the  medication  of  which  has 
induced  the  rash  for  which  he  seeks  relief.” 

The  classification  adopted  is  modified  from  Hebra.  Pro¬ 
ceeding  now  to  the  special  chapters,  that  on  Erythema 
Multiforme  seems  somewhat  scant.  Erythema  Nodosum  is 
included  as  a  form  of  E.  Multiforme.  Only  eight  lines  are 
devoted  to  this  remarkable  disease.  Herpes  Iris,  which 
is  pretty  generally  recognised  as  a  variety  of  Erythema. 
Multiforme,  the  author  places  provisionally  under  the 
heading  Herpes,  taking  care  to  explain  its  alliances  with  E. 
Multiforme.  Guarded  mention  is  made  of  the  existence  of 
those  curious  but  rare  cases  of  what  has  been  called  in  this 
country  Factitious  Urticaria.  The  peculiar  measly  rash  of 
Urticaria  Pigmentosa  would  perhaps  bear  fuller  description  ^ 
its  likeness  to  measles  and  syphilitic  roseola,  and  its  almost 
exclusive  occurrence  in  infancy,  are  points  worthy  of  mention. 

The  chapter  on  Eczema  is  most  complete,  upwards  of 
sixty  pages  being  devoted  to  it.  The  four  types  are 
first  described — Erythematous  Eczema,  Vesicular  Eczema, 
Pustular  Eczema,  and  Papular  Eczema ;  afterwards  special 
varieties  are  discussed.  In  treating  of  the  etiology  of  the- 
affection,  the  author  speaks  strongly  in  favour  of  the  skin- 
organ  itself  being  at  fault,  adducing  arguments.  “  The- 
autonomy  of  the  integument  must  be  conceded  to  an 
extent  recognised  in  other  organs  of  the  body.  There  are 
diseases  of  the  liver  which  are  neither  referred  to  the  blood, 
the  nerves,  or  the  action  of  poisons,  etc.”  As  regards  the 
relationship  of  eczema  to  gout  and  rheumatism,  the  author 
looks  on  the  association  as  coincidence.  “  If  figures,”  he 
says,  “  alone  were  to  decide  the  question,  these,  and  a  larger 
list  of  maladies  which  have  been  named  in  similar  con¬ 
nexion,  would  be  included  in  the  study  of  the  etiology  of  the 
disease.”  Heitzman’s  researches  as  to  the  pathology  of 
eczema  show  that  the  initial  step  of  the  inflammation  is 
declared  in  the  epidermis  by  an  increase  of  the  living  matter 
both  within  and  between  the  protoplasmic  bodies,  leading 
to  an  enlargement  of  the  points  of  intersection  of  the  proto¬ 
plasmic  network — the  formerly  so-called  granules, — and  by 
the  shining  and  solid  condition  of  that  part  of  the  network 
called  the  nucleus.  Especially  to  be  praised  are  the  prac¬ 
tical  suggestions  as  to  what  may  be  called  the  common- 
sense  treatment  of  eczema,  the  avoidance  of  sources  of 
irritation,  the  importance  of  putting  the  part  at  rest,  etc. 
It  is  quite  impossible  to  exaggerate  the  judiciousness  with 
which  the  formulae  for  the  external  treatment  of  eczema  are- 
selected,  and,  what  is  of  equal  importance,  the  full  and  clear 
instructions  for  their  use. 

■  As  might  have  been  expected,  the  constitutional  treat¬ 
ment  of  eczema  receives  but  scant  attention  beyond  the 
recognition  of  general  conditions  of  ill-health  and  their 
appropriate  management.  “  Sunlight,  fresh  air,  a  properly 
selected  diet,  suitable  clothing,  and  due  rSgime  as  to  pleasure 
and  business,  may  do  much  to  aid  the  management  of  eczema: 
they  may  do  more,  if  neglected,  to  furnish  sources  of  its. 
aggravation.”  As  to  the  internal  administration  of  arsenic, 
the  author  states  that  it  has  unquestionably  aggravated 
more  cases  than  it  has  relieved.  Again,  “  If  arsenic,  which 
certainly  does  possess  an  influence  over  the  skin,  cannot  to¬ 
day  be  demonstrated  to  have  any  therapeutic  value  in  the- 
large  proportion  of  all  cases  of  eczema,  what  can  be  said  of 
other  drugs  too  commonly  employed  for  a  similar  purpose, 
which  are  inferior  to  arsenic  in  their  cutaneous  effects  ?  ” 
The  chapter  concludes  with  separate  descriptions  of  local 
eczemas,  with  abundant  hints  for  their  treatment. 

There  is  a  chapter  devoted  to  MedicinalRashes,  now  neces¬ 
sary  in  all  books  on  skin  diseases.  The  author  departs  from 
Vienna  in  describing  Impetigo  as  a  disease  “ sui  generis .” 
When  mention  is  made  of  its  striking  individuality,  most 
English  dermatologists  will  wonder  why  it  is  not  recognised 
in  English  clinics ;  of  course  the  difficulty  is  to  distinguish 
it  from  pustular  eczema.  The  points  in  diagnosis  are  given 
as  follows : — “  The  absence  of  infiltration  of  the  tissues 
affected ;  second,  the  absence  of  itching ;  third,  the  failure 
of  the  lesions  to  form  patches ;  fourth,  the  isolation  and 
wide  separation  each  from  the  other  of  lesions  distinctly 
pustular;  fifth,  the  large  development  and  rather  persistent 
character  of  individual  pustules;  sixth,  after  involution  of 
the  latter,  the  evident  termination  of  the  disease,  which 
does  not,  as  does  eczema  in  many  cases,  progress  to  form  a 
freely  discharging  and  crusting  surface,  the  pustular  being 


Medical  Times  and  Gazette. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


July  28,  1S83. 


TO  8 


but  the  initial  stage  of  a  distinct  disease-process.”  The  dis¬ 
ease  is  considered  to  be  connected  mainly  with  local  irritation. 
Impetigo  Contagiosa  is  not  looked  upon  as  an  indepen¬ 
dent  affection.  Stress  is  laid  on  the  fact  that  it  frequently 
follows  a  more  or  less  actively  contagious  affection  (varicella, 
variola,  vaccinia).  It  is  therefore  considered  as  an  Impetigo 
which  occurs  in  an  individual  who  has  lately  suffered  with  a 
contagious  disease,  and  in  whom  the  living  matter  of  the 
pus  still  shows  a  feeble  activity  capable  of  exciting  the  pro¬ 
toplasm  of  another  part  of  the  body,  or  of  another  individual 
not  convalescent  from  a  contagious  disease,  to  a  similar 
activity.  Ecthyma  is  described  as  a  distinct  disease — con¬ 
trary  again  to  the  teaching  of  the  Vienna  School;  but  it  is 
a  little  difficult  to  extract  from  the  author’s  description  an 
account  of  a  true  idiopathic  affection. 

There  is  much  original  matter  in  the  chapter  on  Psoriasis. 
'The  statements  that  the  efflorescence  does  not  usually 
give  rise  to  any  subjective  sensation,  aud  that  the  dis¬ 
ease  is  not  hereditary,  will  perhaps  be  challenged  by  some. 
I)r.  Hyde  raises  the  question  as  to  whether  psoriasis  is  a 
disease  or  a  deformity.  The  suggestions  for  the  treatment 
of  the  disease  are  most  complete.  Concerning  the  use  of 
internal  administration  of  arsenic,  the  author’s  remarks  are 
so  original  and  outspoken  that  they  may  be  given  at  length. 
“  Personally,”  the  author  says,  “I  may  say  that,  with  enlarg¬ 
ing  experience,  I  view  with  greater  distrust  eachyear  the  bene¬ 
fits  to  be  derived  from  arsenic  in  any  untried  case  of  psoriasis. 
The  large  possibilities  of  its  failure,  the  repeated  recurrence 
of  the  eruption,  of  the  necessity  for  continuing  the  medica¬ 
tion  for  one  or  two  years,  and  even  after  that  period  of  time, 
of  witnessing  a  generalised  development  of  the  eruption  to 
an  extent  quite  equal  to  that  exhibited  at  the  outset :  all 
these  considerations  should  certainly  have  some  weight  in 
the  mind  of  an  ordinarily  prudent  man.  Is  the  ultimate 
result  in  such  cases  worth  the  cost  by  which  it  is  obtained  ? 
In  such  cases,  certainly,  it  would  seem  not.  In  the  others, 
where,  under  a  judiciously  directed  arsenical  course,  the 
eruption  slowly  disappears,  and  fails  to  recur,  the  value  of 
the  treatment  is  incontestable.  Personal  observation  and 
experience  lead  me  to  believe  that  the  patients  in  the  last- 
named  category  decidedly  outnumber  the  others.”  Later 
on,  again — “  In  many  cases,  I  am  fully  persuaded,  hetero- 
doxical  though  the  belief  may  be,  that  psoriasis  calls  for  no 
treatment.  Such  are  the  extremely  indolent  cases  where 
the  patches  exist  in  middle-aged  adults  on  parts  of  the  body 
entirely  covered  with  clothing.” 

With  Duhring  the  author  admits  Pityriasis  Maculata  et 
Circinata.  As  yet  the  disease  has  not  found  a  settled  place 
In  our  systems. 

Pemphigus  Poliaceus  is  dissociated  from  the  disease  Pem¬ 
phigus,  and  classed  with  Pityriasis  Eubra  under  the  title 
of  Dermatitis  Exfoliativa  generalis,  to  which  category  the 
generalised  stage  of  Lichen  Euber  is  also  referred.  The 
latter  disease  is  divided,  according  to  Vienna  teaching,  into 
Lichen  Euber  acuminatus  and  Lichen  Euber  planus.  The 
former  variety,  which  is  characterised  by  pinhead,  conical, 
reddish  papules,  the  author  has  not  seen  in  America :  it 
certainly  is  hardly  recognised  in  this  country. 

Duhring’s  name,  Molluscum  Epitheliale,  is  adopted  for 
the  disease  known  in  this  country  as  Molluscum  Conta- 
giosum.  Its  contagiousness  is  hardly  believed  in  by  the 
author.  The  very  striking  cases  in  which  the  disease  occurs 
simultaneously  on  the  maternal  breast  and  infant’s  face,  and 
those  in  which  different  members  of  the  same  family  are 
simultaneously  affected,  are  stated  by  the  author  to  be  gene¬ 
rally  explicable  as  coincidences.  The  non-glandular  theory 
of  origin  of  the  disease  is  supported.  With  other  American 
dermatologists,  the  author  maintains  the  identity  of  Mor- 
phoea  as  distinct  from  Scleroderma,  Duhring’s  points  in 
their  differential  diagnosis  being  given. 

The  term  Xeroderma  is  retained  for  the  disease  originally 
described  under  that  name  by  Hebra — the  mild  form  of 
Ichthyosis  usually  known  as  Xeroderma  in  this  country 
being  styled  Ichthyosis  Simplex.  Lupus  is  said  to  be  as 
widely  separated  in  its  clinical  features  from  Scrofula  as  is 
Lupus  Erythematosus.  English  readers  will  be  surprised 
at  the  statement  that  ordinary  Lupus  is  as  rare  in  America 
as  Lupus  Erythematosus.  Preference  is  given  to  the 
treatment  by  mechanical  means. 

As  regards  the  etiology  of  Keloid,  the  author  says  it  occurs 
both  spontaneously  and  as  a  hypertrophic  development  from 
a  simple  scar. 


On,  the  Sea-Bathing  and  Mineral  Waters  of  Scarborough.  By 
William  Alexander,  M.D.,  F.E.C.P.  Lond.,  Senior 
Physician  to  the  Halifax  Infirmary.  London  :  Longman 
and  Co.  1882. 

The  caustic  remarks  so  often  made  on  publications  of  this 
description,  to  the  effect  that  their  scarcely- veiled  intention 
is  to  puff  the  places  of  which  they  treat,  is  not  applicable  in 
the  present  instance ;  in  fact,  the  first  half  of  the  treatise, 
which  treats  of  sea-bathing,  does  so  entirely  without  refer¬ 
ence  to  Scarborough,  and  would  be  useful  to  bathers  at  any 
seaside  place — that  is  to  say,  if  such  people  ever  troubled 
themselves  to  read  about  “  the  bad  effects  ”  or  “  the  best 
time  and  season  ”  for  bathing.  The  second  part— or,  more 
correctly  speaking,  the  second  treatise,  for  the  two  parts  are 
paged  as  distinct  works — does  indeed  treat  of  the  medicinal 
and  physical  effects  of  the  Scarborough  waters,  but  these 
are  not  unduly  praised  at  the  expense  of  the  mineral 
springs  of  other  localities.  Dr.  Alexander  may,  therefore, 
be  acquitted  of  any  marked  prejudice  in  favour  of  the 
mineral  waters  of  Scarborough  ;  and  his  object,  it  may  be 
supposed,  in  publishing  the  work  under  notice  was  to  afford 
a  little  semi-professional  reading  for  the  maturer  ladies  of 
both  sexes  who  drink  the  various  “waters”  one  after 
another  for  the  express  purpose  of  curing  nothing  in 
particular. 


The  Mineral  Waters  of  Aix-les-Bains  aad  Marlioz  :  Practical 
Considerations  on  their  Action  and  Application.  By  LfioN 
Blanc,  M.D.  Paris,  Medical  Inspector  of  the  Baths  of 
Aix,  Physician  of  the  Thermal  Hospital.  London:  J.  and 
A.  Churchill.  1883.  Small  8vo,  pp.  60. 

The  baths  of  Aix  have  long  been  known  for  their  remedial 
powers  in  several  maladies,  and  the  present  extensive  build¬ 
ings  which  constitute  the  thermal  establishment  in  the 
town  were  commenced  in  1772,  and  were  enlarged  at  succes¬ 
sive  periods  until  last  year.  Dr.  Blanc’s  little  book  describes 
in  detail  the  different  departments  of  the  thermal  establish¬ 
ment,  consisting  of  douches,  bath-rooms,  swimming-baths, 
vapour-baths,  halls  of  inhalation,  halls  of  pulverisation, 
and  drinking-fountains ;  and  there  are  some  illustrative 
woodcuts,  showing  the  construction  of  the  various  kinds  of 
apparatus  employed,  and  their  modes  of  application.  The 
waters  of  Aix  appear  to  owe  but  little  to  the  presence  of 
their  mineral  constituents,  for,  like  those  of  Malvern  and 
Gastein,  they  have  hardly  any  solid  matters  in  solution. 
They  contain,  however,  a  considerable  amount  of  sulphu¬ 
retted  hydrogen,  hyposulphite  of  sulphur,  carbonic  acid  gas, 
and  nitrogen.  The  temperature  of  the  waters  is  warm  (on 
the  average  about  100°  Fahr.),  but  it  may  be  varied  accord¬ 
ing  to  circumstances.  Whether  it  be  from  their  gaseous 
constituents,  or  their  temperature,  or  the  mode  of  their 
application,  or  the  regimen  prescribed  during  their  use,  or 
the  salubrity  of  the  climate,  or  all  these  conditions  combined, 
it  is  certain  that  a  course  of  treatment  at  Aix  is  found  of 
great  service  in  many  deranged  conditions  of  the  human 
system,  and  Dr.  Blanc  points  out  the  special  circumstances 
in  which  such  treatment  is  beneficial.  To  those  invalids 
who  are  contemplating  a  sojourn  at  Aix-les-Bains,  this  little 
manual  will  be  of  much  service  ;  and  to  the  medical  profes¬ 
sion  it  may  offer  some  useful  hints  when  recommending  the 
locality  to  their  patients. 


Descriptive  Catalogue  of  the  Pathological  Museum  of  Univer¬ 
sity  College,  Liverpool.  Printed  for  the  Medical  Faculty 
of  the  College.  1883.  Pp.  268. 

This  Catalogue  is  not  intended  merely  as  a  guide  to  the 
Museum,  but  also,  and  perhaps  more,  as  a  means  of  teach¬ 
ing  pathology  to  students,  using  the  Museum  specimens  in 
illustration  whenever  possible.  Accordingly,  in  each  section 
the  description  of  the  specimens  is  preceded  by  some  general 
remarks  on  the  pathology  of  the  diseases  about  to  be  referred 
to.  This  plan  is  one  that  commends  itself  to  us  very 
strongly.  Students  often  find  it  very  dull  work  going 
through  the  specimens  in  a  museum,  even  with  the  help  of  a 
good  catalogue ;  but  when  that  catalogue  is  made  a  sort  of 
handbook  of  pathology,  illustrated  by  mounted  specimens 
instead  of  by  drawings,  we„  believe  that  a  new  interest  will 
be  given  to  the  study  of  museum  specimens.  Of  course  it 
must  not  be  forgotttn  that  there  are  many  diseases  that 
cannot  be  studied  except  in  a  recent  specimen ;  foremost 


Medical  Times  and  Gazette. 


THE  OPHTHALMOLOGICAL  SOCIETY. 


July  58, 1883.  100 


among  these  is  pneumonia,  and  therefore  when  we  read — 
“  C.  40.  This  is  said  to  be  a  piece  of  pneumonic  lung  in  the 
stage  of  grey  hepatisation,  but  nothing  is  to  be  learnt  from 
it,” — we  are  tempted  to  ask  why  the  specimen  was  preserved : 
perhaps  because  it  is  the  only  specimen  of  acute  pneumonia 
in  the  Museum.  The  Dean  and  his  colleagues  have  acted 
wisely  in  getting  their  Museum  put  in  order  and  their  cata¬ 
logue  printed  in  time  for  the  meeting  of  the  British  Medical 
Association. 


The  Latin  Grammar  of  Pharmacy .  By  Joseph  Ince,  F.C.S., 
F.L.S.  Second  Edition.  London:  Bailliere,  Tindall,  and 
Cox.  1883.  Pp.  160. 

This  little  work  is  intended  for  the  use  of  medical  and 
pharmaceutical  students.  We  should  like  to  think  that  the 
former  had  received  a  sufficiently  good  education  at  school 
to  be  able  to  dispense  with  any  instruction  in  this  line. 
Such,  we  fear,  is  not,  and  never  will  be,  the  case.  The  last 
half  of  the  book  is  devoted  to  the  subject  of  Latin  prescrip¬ 
tions,  from  which  we  suspect  that  not  a  few  physicians 
might  glean  something  they  did  not  know  before.  The 
book  seems  well  adapted  to  meet  the  requirements  of  those 
for  whom  it  is  intended,  and  the  author  has  evidently  done 
his  best  to  make  everything  he  has  to  say  intelligible. 


Knapsack  Handbook ;  or,  Pedestrian’s  Guide.  By  William 

White,  A.C.,  F.S.A.,  F.R.I.B.A.,  etc.  Second  Edition. 

London  :  Edward  Stanford,  Charing- cross.  1883.  Pp.  27. 
Me.  White’s  unpretentious  little  pamphlet  may  be  heartily 
recommended  to  pedestrians  who  are  preparing  for  their 
first  knapsack  tour.  The  outcome  of  the  personal  trials 
and  practice  of  “an  old  pedestrian,  with  an  experience 
of  now  forty  years,”  it  describes  what*  is  required  by  the 
ordinary  walker  who  desires  to  be  free  from  all  unneces¬ 
sary  impedimenta.  Simply  and  easily  written,  it  will  be 
found  a  very  useful  guide  to  the  walking  traveller  on  the 
following  important  points  :  the  reduction  to  a  minimum 
of  the  contents  of  the  knapsack ;  the  omission  of  nothing 
essential  to  daily  comfort,  or  average  accident ;  the  adjust¬ 
ment  of  his  load  so  as  to  cause  the  least  possible  incon¬ 
venience  or  fatigue,  or  injury  to  health ;  the  readiest  means 
of  ascertaining  what  are  really  requisites,  and  of  pro¬ 
curing  them ;  and,  commonly,  their  cost.  Carefully  studied 
and  acted  on,  it  will  save  inexperienced  pedestrians  from  the 
mischievous  mistakes  of  overloading  themselves,  and  of 
attempting  to  do  too  much. 


The  Great  Eastern  Railway  Company’ s  Tourist  Guide  to  the 

Continent.  With  Map  and  numerous  Illustrations. 

London  :  125,  Fleet-street,  and  44,  Regent-street.  Pp.  130. 
This  Guide,  of  which  the  present  is  the  fifth  annual  issue, 
supplies  for  a  few  pence  a  large  amount  of  very  useful 
information.  It  gives  outlines  of  easy  tours  in  Holland, 
Belgium,  and  along  the  Moselle  and  the  Rhine,  with  enough 
of  description  of  places  to  add  to  the  interest  without 
trenching  on  the  province  of  the  guide-books.  Short  notices 
are  also  given  of  Nuremberg,  Vienna,  and  Munich,  and  of 
parts  of  Switzerland.  The  illustrations  are  good ;  the  direc¬ 
tions  as  to  routes,  etc.,  clear  and  trustworthy  ;  and  the  in¬ 
formation  generally  well  chosen,  and  sufficient  to  aid 
anyone  in  selecting  an  easy  route  for  a  holiday  trip. 


The  Development  oe  Cancee  peom  Non-malignant 
Disease. — Dr.  Lewis,  Assistant-Physician  to  the  New  York 
Skin  and  Cancer  Hospital,  from  a  general  review  of  what 
has  been  written  on  the  subject,  concludes  : — 1.  Many  dis¬ 
eases  of  a  non-malignant  character  are  not  only  predisposing 
but  exciting  causes  of  cancer.  2.  Such  degeneration  often 
occurs  in  patients  who  have  no  hereditary  predisposition  to 
cancer  ;  and  in  those  who  are  so  predisposed  the  danger  is 
imminent.  3.  The  recognition  of  the  pre-cancerous  stage  of 
the  disease  is  of  the  highest  importance  in  its  successful 
treatment.  4.  While  it  is  true  that  heredity  is  well  attested 
in  many  cases,  its  importance  has  been  greatly  over-estimated 
by  all  the  older  authorities  and  many  writers  of  the  present 
day. — New  York  Med.  Jour.,  June  30. 


REPORTS  OF  SOCIETIES. 

- o- - - 

THE  OPHTHALMOLOGICAL  SOCIETY. 

Thubsday,  July  6. 

Wm.  Bowman,  F.R.S.,  President,  in  the  Chair. 

Financial  Statement. 

The  Treasurer  (Mr.  J.  F.  Streatfeild)  made  his  annual 
statement,  which  showed  that  the  financial  condition  of  the 
Society  was  satisfactory. 

An  alteration  in  the  by-law  relating  to  subscriptions  was 
put  from  the  chair  and  carried. 

The  President  said  that  the  third  session  had  passed 
happily  for  the  Society.  Three  members  from  the  colonies 
or  dependencies,  and  five  from  the  United  Kingdom,  in  addi¬ 
tion  to  fourteen  from  London,  had  joined  the  Society.  The 
sense  of  the  great  loss  experienced  in  the  death  of  Mr. 
Critchett  had  already  found  expression  ;  while  in  Mr.  Lyell 
the  Society  had  lost  a  member  who,  it  was  hoped,  would 
have  contributed  valuable  matter  to  its  records.  The  Presi¬ 
dent  concluded  by  referring  to  the  discussion  on  Eye- 
Symptoms  in  Spinal  Disease,  and  expressed  the  opinion  that 
it  would  act  as  a  stimulus  to  further  inquiry. 

A  Case  of  Sympathetic  Ophthalmia — Operation  on  the 
Exciting  Organ — Recovery. 

Mr.  Simeon  Snell  (Sheffield)  related  the  history  of  a 
man,  aged  thirty-six,  who,  on  October  5,  1882,  ran  a  pack¬ 
ing-needle  into  his  left  eye.  He  came  first  under  observa¬ 
tion  on  October  20  ;  there  was  then  prolapse  of  the  iris,  and 
a  wound  in  the  lower  and  inner  sclero-corneal  junction, 
encroaching  on  the  ciliary  region.  On  November  3  he  had 
plastic  iritis,  which  had  been  preceded  by  “  mistiness  ” 
for  two  or  three  days  in  the  right  eye  ;  the  pupil  was  hardly- 
acted  upon  by  atropine.  On  November  5  his  condition  was 
worse,  and  the  next  day  it  was  still  more  aggravated.  On 
November  6  the  prolapse  was  incised,  and  as  much  iris  as 
possible  excised;  very  little  was  removed,  and  that  only 
by  piecemeal,  as  it  was  incorporated  in  the  tissues.  The 
incision  was  prolonged  on  either  side  in  the  sclerotic,  just 
behind  the  corneal  junction.  On  the  next  day  there  was 
improvement:  the  pupil  soon  dilated,  and  the  iritis  subsided  ; 
the  prolapse  in  the  left  had  disappeared.  On  November 
19  there  appeared  a  little  iritis,  and  perchloride  of  mercury 
was  ordered  internally.  Recovery  soon  took  place.  In  a 
few  weeks  he  resumed  his  work.  April  13,  1883,  in  either 
eye,  v.  §§ ;  and  he  was  able  to  follow  his  employment  as  well 
as  formerly. 

Hemiachromatorsia. 

Mr.  Swanzy  (Dublin)  brought  forward  the  case  of  a- 
gentleman,  aged  seventy-seven,  who,  in  November  last, 
had  a  slight  attack  of  cerebral  apoplexy,  which  rendered 
him  unconscious  for  about  twelve  hours,  and  from  which 
he  completely  recovered  in  the  course  of  a  few  days, 
except  for  some  defect  in  vision,  and  a  confusion  of 
ideas  when  he  made  any  unusual  mental  effort.  He  had 
not,  even  for  a  short  time,  any  hemiplegia,  affection  of  speech, 
or  other  paralysis.  Five  months  later,  Mr.  Swanzy  was  con¬ 
sulted,  the  patient’s  chief  complaint  being  a  difficulty  in 
recognising  his  friends,  even  when  near  to  him.  In  each 
eye,  v.  •£.  In  the  left  eye,  a  slight  peripheral  opacity  of 
the  lens ;  but  in  all  other  respects  the  eyes  were  organi¬ 
cally  sound.  The  defect  in  vision  could  be  accounted  for 
by  senile  changes  in  the  media  and  retina;  but  this  com¬ 
paratively  slight  defect  was  insufficient  to  explain  his 
difficulty  in  recognising  people,  and  Mr.  Swanzy  was  in¬ 
clined  to  regard  it  as  a  disturbance  of  a  cerebral  function. 
Examination  with  the  perimeter  displayed  a  slight  defect  in 
the  right  upper  quadrant  of  each  field.  The  patient  com¬ 
plained  that  his  colour-vision  had  not  been  so  acute  since  the 
attack  in  November,  but  yet  he  was  able  to  perform  the 
Holmgren  tests  with  accuracy.  When  the  fields  were  exa¬ 
mined  with  coloured  wools,  Mr.  Swanzy  found  that  the  left 
side  of  the  field  in  each  eye  was  totally  colour-blind,  while 
with  the  right  side  colours  could  be  distinguished,  although 
in  an  area  concentrically  contracted.  This  and  similar  cases 
clearly  showed  that  the  nervous  elements,  in  which  the  power 
of  perception  of  colour  resided,  were  situated  in  the  brain, 
and  not  in  the  peripheral  visual  apparatus,  and  that  the 


110 


Medical  Times  and  Gazette. 


THE  OPHTHALMOLOGrICAL  SOCIETY. 


July  28, 1883. 


colour-centre  in  the  brain  was  distinct  from  that  for  the 
form -sense,  and  for  ordinary  light-perception. 

The  President  considered  that  the  case  was  of  much 
interest.  He  inquired  whether  the  line  limiting  the  field 
was  quite  vertical  and  through  the  fixation-point. 

Mr.  Brudenell  Carter  observed  that  there  were  cases 
on  record  which  appeared  to  confirm  the  anatomical  specu¬ 
lations  of  Mr.  Swanzy.  He  had  lately  seen  a  case  where,  in 
the  left  eye,  a  colour-scotoma  extended  from  the  fixing- 
point  ten  degrees  on  both  sides.  There  was  a  history  of  the 
use  of  tobacco,  but  no  failure  of  colour- vision — only  general 
lowering. 

Mr.  McHardy  mentioned  the  case  of  a  man  who  became 
•suddenly  colour-blind.  About  ten  days  before  he  came 
under  observation  he  one  day  noticed  that  the  meat  had  a 
most  “  disgusting  ”  slate-blue  colour,  and  he  also,  from  that 
time,  made  mistakes  in  the  colour  of  lights  on  board  ship. 
He  was  found  to  be  quite  red-blind  ;  he  was  suffering  from 
albuminuria,  and  four  days  later  died  of  cerebral  apoplexy, 
which  was  found  at  the  necropsy  to  be  very  extensive. 

Mr.  Uettleship  asked  whether  the  colour-sense  was  de¬ 
fective  in  the  whole  left  half  of  the  field.  Usually  in  these 
-cases  acuteness  of  vision  was  normal,  because  the  dividing 
line  passed  a  little  to  one  side  of  the  fixation-point. 

The  President  remarked  that  in  Mr.  Swanzy’ s  case  one- 
half'  of  the  field  of  vision  for  colour  was  lost,  just  as,  in  cer¬ 
tain  cerebral  lesions,  one-half  of  the  field  of  vision  was  lost ; 
it  might,  therefore,  be  concluded  that  the  loss  of  half  of  the 
field  of  vision  for  colour  was  also  due  to  cerebral  lesion. 

Mr.  Swanzy,  in  reply,  said  that  he  had  taken  great  care 
to  test  the  centre  of  the  field  of  vision;  in  this  case  the 
colour- scotoma,  however,  seemed  to  pass  precisely  through 
the  centre. 

Foreign  Body  in  the  Fundus. 

Mr.  J.  E.  Adams  related  the  case  of  a  young  blacksmith, 
who  was  struck  in  the  left  eye  by  a  chip  from  an  anvil, 
which  penetrated  through  the  tissues  and  vitreous,  and 
lodged  in  the  fundus  above,  and  to  the  outer  side  of  the 
macula.  For  a  few  hours  after  the  injury  the  patient  could 
not  distinguish  light  from  darkness,  but  vision  had  steadily 
improved,  and  was  now  normal.  The  body  was  covered  by 
remains  of  lymph  and  pigment,  and  there  were  some  stria1, 
denoting  the  remains  of  hyalitis.  A  similar  case  had  been 
recorded  by  Mr.  Snell. 

Mr.  Snell  said  that  in  his  case  the  foreign  body  entered 
a  little  beyond  the  sclero-corneal  junction,  and  was  plainly 
visible  a  few  hours  after  the  accident.  When  seen  two 
years  and  a  half  later  the  result  was  good.  More  recently 
lie  had  seen  a  similar  case  in  which  the  particle  passed 
through  the  cornea  and  lens  and  lay  below  the  disc.  At  the 
end  of  two  years  the  lens  became  opaque.  Knapp  had  col¬ 
lected  twelve  cases,  and  bad  advised  the  use  of  the  electro¬ 
magnet,  but  Mr.  Snell  felt  great  hesitation  on  the  point. 

Mr.  W.  Adams  Frost  said  that  he  had  seen  a  case  in 
the  practice  of  Mr.  Waren  Tay  where  the  lens  escaped 
injury  and  the  media  were  clear;  a  glistening  body  could 
be  seen  .close  to  the  macula.  Vision  was  fairly  good,  and 
there  was  no  inflammation. 

Ophthalmoscope  eor  Artists. 

Mr.  J.  E.  Adams  exhibited  and  described  his  ophthalmo¬ 
scope  for  artists ;  and 

Mr.  McHardy  observed  that  as  artists  were  liable  to  a 
kind  of  cramp,  from  the  strain  and  constant  change  from  the 
ophthalmoscope  to  the  pencil,  the  instrument  was  calculated 
to  be  very  useful. 

Anomalous  Distribution  oe  Retinal  Arteries. 

Mr,  J.  B.  Story  (Dublin)  communicated  notes  of  a  case  of 
anomalous  distribution  of  the  retinal  arteries,  where  the 
superior  nasal  artery  gave  a  branch  which  ran  downwards  in 
several  curves,  and  ended  in  the  descending  division  of  the 
artery  near  the  disc,  without  communicating  directly  with 
the  central  artery. 

Mr.  McHardy  said  that  the  appearance  in  the  drawing 
resembled  a  case  which  he  had  seen,  but  his  was  a  case  of 
aneurismal  varix. 

Congenital  Drooping  oe  the  Left  Upper  Eyelid. 

Mr.  Gunn  showed  a  girl,  aged  fifteen,  in  whom  the  left 
upper  eyelid  drooped,  and  the  left  pupil  was  rather  smaller 
than  the  right.  The  drooping  lid  was  raised  every  time  that 


(and  on  no  other  occasions)  the  left  external  pterygoid  was 
put  into  action. 

Dr.  Cholmeley  pointed  out  that  the  eyelid  was  materially 
lifted  when  the  chin  was  turned  quickly  to  the  right.  The 
case  was  subsequently  referred  to  a  committee,  consist¬ 
ing  of  Dr.  Gowers,  Dr.  Mackenzie,  Dr.  Abercrombie,  Mr. 
Lang,  and  Mr.  Gunn. 

Disseminated  Choroido-Ketinitis. 

Mr.  Symons  showed,  for  Mr.  Lawson,  a  drawing  from  a 
case  of  choroido-retinitis  in  a  man  aged  twenty-three  years, 
who  contracted  syphilis  thirty  months  ago. 

Morphcea. 

Mr.  Power  exhibited  a  young  woman  twenty-three  years 
of  age,  with  a  patch  of  morphoea  on  the  left  upper  eyelid. 

Dr.  Mackenzie  thought  that  the  patch  would  eventually 
disappear  if  left  alone. 

Cysticercus. 

Mr.  Hulke  exhibited  a  drawing  from  a  case  of  cysticercus 
in  the  vitreous  humour  ;  the  child  had  subsequently  passed 
under  the  care  of  Mr.  Vernon,  in  St.  Bartholomew’s,  and 
the  case  had  been  published  by  him  elsewhere. 

Multiple  Retinal  Aneurism. 

Mr.  A.  H.  Benson  (Dublin)  showed  a  drawing  of  a  case 
in  which  there  were  numerous  aneurisms  on  the  arteries 
and  veins  of  the  retina.  There  was  no  increase  of  tension. 

Facial,  Conjunctival,  and  Retinal  KiEvus. 

Dr.  Horrocks  exhibited  a  case  of  facial,  conjunctival,  and 
retinal  nsevus.  The  patient  was  a  girl,  nine  years  of  age, 
who  had  been  subject  to  fits  since  her  birth,  and  was  hemi¬ 
plegic  on  the  left  side.  The  right  side  of  the  face,  including 
the  skin  of  the  eyelids  and  forehead,  was  covered  with  a 
nsevus,  giving  a  port-wine-stain  appearance;  the  conjunc¬ 
tiva  was  also  affected.  On  ophthalmoscopic  examination, 
the  retinal  veins  of  the  right  eye  were  seen  to  be  very  tor¬ 
tuous.  Owing  to  her  defective  intellect,  nothing  satisfactory 
could  be  elicited  as  to  vision ;  but,  as  far  as  could  be  made 
out,  she  saw  equally  and  well  with  both  eyes.  Dr.  Horrocks 
pointed  out  that  the  tissues  in  which  the  vascular  dilatation 
occurred  were  epiblastic  structures,  suggesting  the  possi¬ 
bility  that  the  vessels  of  the  pia  mater  on  the  right  side 
were  similarly  affected,  thereby  having  something  to  do  with 
the  left-sided  fits. 

Dr.  S.  Mackenzie  observed  that  Dr.  Allen  Sturge  had 
exhibited,  at  the  Clinical  Society,  a  case  in  which  there  was 
a  nsevus  of  one  side  of  the  face,  and  paralytic  symptoms  on 
the  opposite  side  of  the  body,  and  had  argued  that,  possibly,  a 
nsevoid  condition  existed  within  the  cranium  at  some  part. 
Dr.  Horrocks’s  case  lent  some  support  to  that  view,  though 
it  was  proper  to  remember  that  the  condition  of  the  cerebral 
vessels  had  been  met  with  on  both  sides,  without  any 
symptoms. 

Mr.  Uettleship  said  that,  in  Dr.  Sturge’s  case,  there  was 
nsevus  of  the  sclerotic  also,  and  the  affected  eye  was  larger 
than  the  other. 

Dr.  Horrocks  suggested  that,  in  marked  tortuosity  of 
the  retinal  vessels,  the  condition  might  be  due  to  a  foetal 
disturbance  similar  to  that  which  set  up  cutaneous  nsevus. 


Enlargement  oe  the  Paris  Hospitals. — The  Paris 
Municipal  Council  has  recently  voted  the  sum  of  three  million 
francs  for  the  enlargement  of  the  hospital  accommodation. 
Of  this  sum  two  millions  are  to  be  employed  in  improve¬ 
ments  and  new  construction  in  the  existing  hospitals,  and  the 
third  million  is  to  be  especially  used  for  part  of  the  expenses 
in  the  construction  of  some  new  establishments,  namely,  a 
hospital-hospice  out  of  Paris,  a  small-pox  hospital,  and  a 
hospital  for  incurable  children.  The  hospital-hospice  will 
allow  of  the  discharge  from  the  hospitals  in  the  interior  of 
Paris  of  a  large  number  of  patients  suffering  from  chronic 
diseases,  who  at  present  encumber  them.  This  hospital- 
hospice  is  the  more  urgently  needed  as  there  are  now  2200 
aged  persons  who  are  in  want  of  hospital  accommodation, 
and  whose  numbers  are  always  increasing  by  immigration ; 
for  it  is  calculated  that  of  every  hundred  strangers  who  arrive 
in  Paris  eighty  are  in  a  state  of  poverty.  The  construction 
of  this  hospital  will  eventually  cost  6, 500,000  frs.,  that  of  the 
Enfants  Incurables  3,250,000  frs.,  and  that  of  the  small-pox 
hospital  1,400,000  frs  .—Revue  de  TTierapeutique,  July  15. 


Medical  Times  ana  Gazette. 


MEDICAL  NEWS. 


July  28,  1883.  Ill 


OBITUARY. 

- ♦ - 

THOMAS  CODY,  L.K.C.P.  Edin.,  L.E.C.S.I., 
Surgeon-Major  Bombay  Army. 

We  regret  to  record  that  Mr.  Cody,  of  Her  Majesty’s 
Bombay  Medical  Service,  died  in  Bombay  on  June  21, 
in  the  fortieth  year  of  his  age.  Mr.  Cody  was  driving 
on  the  morning  of  the  20th  to  visit  the  Goculdas  Taj  pal 
Hospital  (a  large  native  general  hospital),  of  which  he 
was  acting  surgeon,  when  his  horse  took  fright  at  a 
municipal  steam-roller,  and  the  carriage  coming  in  contact 
with  a  lamp-post,  Mr.  Cody  was  thrown  violently  to  the 
ground,  and  sustained  a  fracture  of  the  base  of  the  skull.  He 
received  without  delay  every  possible  attention  from  his  pro¬ 
fessional  brethren;  but  he  never  recovered  consciousness, 
and  died  in  the  afternoon  of  the  following  day.  Mr.  Cody,  who 
was  a  native  of  Tipperary,  became  a  Licentiate  of  the  Eoyal 
College  of  Surgeons  in  Ireland  in  1865 ;  in  1866  he  took  the 
licence  of  the  Eoyal  College  of  Physicians  of  Edinburgh, 
and  in  the  same  year  entered  Her  Majesty’s  Indian 
Medical  Service.  He  held,  under  the  Government  of  Bombay, 
various  military  and  civil  appointments,  the  more  important 
of  which  were — Medical  Officer  of  the  19th  Eegiment  of 
Native  Infantry ;  Durbar  Physician  to  His  Highness  the 
Gaekwar  of  Baroda ;  Secretary  and  Statistical  Officer  to  the 
Surgeon- General  of  the  Indian  Medical  Service  (since  desig¬ 
nated  Surgeon-General  to  the  Government  of  Bombay),  of 
which  office  he  was  the  permanent  incumbent ;  and  Officiating 
Surgeon  to  the  Goculdas  Hospital.  He  was  for  sometime 
one  of  the  two  Hon.  Joint- Secretaries  to  the  Medical  and 
Physical  Society  of  Bombay.  In  1878  he  published  some 
interesting  cases  of  “  Caesarian  Section,  with  Eecovery,”  in 
the  Lancet  (vol.  ii.,  page  875) ;  and  last  year  he  contributed 
to  the  same  periodical  three  papers — “  Eemoval  of  Elephan- 
toid  Tumour  of  the  Scrotum,”  “  Elephantiasis  of  the 
Scrotum,”  and  “  Elephantiasis  of  Scrotum ;  Elephantiasis 
of  Labia  Yulvse :  Eecovery.”  His  genial  disposition  endeared 
him  to  all  classes,  which  was  amply  manifested  by  the  large 
attendance  at  his  funeral,  which  was  accompanied  with  full 
military  honours.  The  loss  of  this  talented  practitioner  is 
deeply  felt  alike  by  our  medical  brethren  and  by  the  public 
of  Bombay.  Her  Majesty’s  Indian  Medical  Service  has  lost, 
by  his  death,  one  who,  had  his  career  not  been  thus  sadly 
cut  short,  would  have  done  honour  to  the  Service,  and  through 
it  to  our  profession,  in  India. 


MEDICAL  NEWS. 

- - 

Eoyal  University  of  Ireland. — At  a  meeting  of 
the  Senate  held  on  Thursday,  July  12,  the  following  degrees 
were  conferred  by  the  Eight  Hon.  the  Lord  O’Hagan,  K.P., 
Vice-Chancellor  of  the  University : — 

Degree  of  M.D. — John  Andrews.  Galway;  John  Bolster,  Cork  ;  George 
Clarke,  Belfast ;  Horace  Elliott,  Westminster  Hospital ;  Thomas  Farrelly, 
Galway ;  8.  Forster  Freyer,  Steevens’  Hospital ;  Thomas  G.  Garry,  Galway ; 
John  B.  Graham,  Belfast:  James  Herron,  Belfast;  James  C.  Hood. 
Belfast;  A.  M.  Johnson,  Belfast  and  Galway,  and  Ledwich  School  of 
Medicine;  Patrick  Keelan,  Belfast,  Catholic  University  School;  Isaac  R. 
Lane,  Cork,  Ledwich  School,  and  Royal  College  of  Surgeons,  Ireland  ; 
Bartholomew  Mangan,  Cork,  and  Carmichael  School  of  Medicine  ;  C.  M. 
Mitchell,  Galway ;  W.  J.  Mitchell,  Galway ;  John  A.  Nealon,  Cork,  and 
Carmichael  School  of  Medicine ;  Peter  O'Connell,  Catholic  University 
School  of  Medicine  ;  W.  C.  D.  Prendergast,  Cork  ;  Richard  J.  Purdon, 
Belfast;  Stephen  Scanlan,  Cork;  Michael  J.  Sexton,  Cork;  R.  G.  Thomp¬ 
son,  Cork ;  Francis  G.  Tooker,  Cork ;  J ames  Torrens,  Galway,  Edinburgh 
University,  and  Charing-cross  Hospital ;  George  W.  Weir,  Royal  College 
of  Surgeons,  Ireland. 

Degree  of  M.B.  —Charles  W.  R.  Wynne,  Carmichael  School  of  Medicine. 
Degree  of  M.Oh.—  F.  E.  Adams,  M.D.,  Cork;  C.  W.  Allport,  M.D.,  Cork ; 
John  Andrews,  Galway;  John  Bolster,  Cork;  George  Clarke,  Belfast; 
David  S.  Dunn,  M.D.,  Belfast;  Horace  Elliott,  Westminster  Hospital; 
Thomas  Farrelly,  Galway;  8.  F.  Freyer,  Steevens’  Hospital;  Thomas  G. 
Garry,  Galway;  William  Gibson.  M.D.,  Belfast;  John  B.  Graham, 
Belfast;  Michael  Kelly,  M.D.,  Cork;  Isaac  R.  Lane,  Cork;  Beattie 
McFarlane,  M.D.,  Belfast;  Bartholomew  Mangan,  Cork,  and  Carmichael 
School  of  Medicine ;  W.  J.  Mitchell,  Galway ;  Peter  O’Connell,  Catholic 
University  School  of  Medicine ;  Patrick  O’Gorman,  M.D.,  Galway,  and 
Carmichael  School  of  Medicine  ;  W.  C.  D.  Prendergast,  Cork  ;  Richard  J. 
Purdon,  Belfast ;  Stephen  Scanlan,  Cork ;  Michael  J.  Sexton,  Cork ; 
Simson  Stuart,  M.D.,  University  College,  Liverpool;  S.  A.  L.  Swan,  M.D., 
Queen’s  College,  Belfast;  Charles  W.  R.  Wynne,  Carmichael  School  of 
Medicine. 

For  the  Diploma  in  Obstetrics.  —  JohD  Bolster,  Cork;  Thomas  G.  Garry, 
Galway;  William  Good,  M.D.,  Cork;  John  B.  Graham,  Belfast ;  Michael 
Kelly,  M.D.,  Cork ;  Isaac  R.  Lane,  Cork;  Bartholomew  Mangan,  Cork, 
and  Carmichael  School  of  Medicine;  W.  J.  Mitchell,  Galway;  W.  C.  D. 
Prendergast,  Cork ;  Stephen  Scanlan,  Cork. 


Thirty-seveu  candidates  were  declared  to  have  passed  the 
first,  and  twenty-eight  the  second  examination  in  Medicine. 
The  Senate  ordered  that  the  candidates  who  had  failed  to 
satisfy  the  Examiners  at  the  several  examinations  should  be 
admitted  to  the  examinations  to  be  held  in  September. 

The  Senate  ordered  that,  after  the  year  1883,  all  can¬ 
didates  for  the  diploma  in  Obstetrics  shall  be  required 
to  undergo  a  special  written  examination  in  midwifery, 
gynaecology,  and  diseases  of  children . 


King  and  Queen’s  College  of  Physicians  in 
Ireland. — At  the  usual  quarterly  First  Professional  Exa¬ 
mination,  held  on  Monday,  July  9,  and  following  days,  the 
undermentioned  candidates  were  successful : — 


Dorrian,  Bernard  James.  I  Heffernan,  James. 

Graham,  Cathleeu  Houoria.  |  Van  Overbeke,  Leonie. 

At  the  usual  quarterly  examination  for  the  Certificate  in 
Sanitary  Science,  held  on  Thursday  and  Friday,  July  12 
and  13,  the  certificate  was  granted  to  the  followin°- 
Licentiates  in  Medicine  of  the  College  : — 

Bosanquet,  Adela.  |  Lougheed,  Elizabeth. 

At  the  monthly  examinations  for  the  Licences  of  the 
College,  held  on  July  9  and  four  following  days,  the  under¬ 
mentioned  candidates  were  successful : — 


For  the  Licence  to  practise  Medicine — 

Andrew,  Lsetitia  Harvey,  Edinburgh. 

Blake,  Anthony  Laurence,  Clonbur,  co.  Galway. 

Byrne,  Hugh  John,  Dublin. 

Clayton,  William  Mayne,  Sandycove,  co.  Dublin. 

Cleary,  Michael  Richard,  Herbertstown,  co.  Limerick. 

Cradock,  Lucy  Elizabeth,  Lynn,  Norfolk. 

Drought,  Percy  James,  Blackrock,  co.  Dublin. 

Ensor,  Edwin  Thomas,  M.D.,  New  York. 

Fitzgerald,  Arthur  Ormsby,  Hospital,  co.  Limerick. 
FitzPatrick,  James  Vincent,  New  Swindon,  Wiltshire. 

Forde,  Maurice,  Fermoy,  co.  Cork. 

Hamilton,  James,  Omagh,  co.  Tyrone. 

Henston,  Frederick  Samuel,  Bally kis teen,  co.  Tipperary. 
Keenan,  James,  Dublin. 

Kenealy,  Arabella  Madonna,  Watford,  Herts. 

Kenny,  William,  Limerick. 

Lalor,  Joseph,  Dublin. 

Lane,  James,  Magilligan,  Londonderry. 

Long,  Mark  Henry,  M.D.,  New  York. 

McCraith,  John  E.,  Smyrna,  Asia  Minor. 

McGee,  William,  Dublin. 

McGinity,  Bernard  Alphonsus,  Dublin. 

McNaught,  Frederick  Josiah,  Dublin. 

Maher,  Charles  Henry,  Sydney,  New  South  Wales,  Australia. 
Martin,  John,  Rathmines,  Dublin. 

Moorhead,  Henry,  Tullamore,  King’s  County. 

Neill,  John  Tallaght,  co.  Dublin. 

Nolan,  John  Robert,  Kilbane  House. 

O’Reilly,  Peter  Joseph,  Clones,  co.  Monaghan. 

Roughan,  George  Francis,  Galway. 

Russell,  Bartholomew  Taylor,  Ballinderry  Park,  co.  Tipperary. 
Sheperd,  Albert  Wilberforce,  Dublin. 

Torney,  George  Parsons,  Dublin. 

For  the  Licence  to  practise  Midwifery — 


Andrew,  Lsetitia  Harvey. 
Byrne,  Hugh  John. 

Cleary,  Michael  Richard. 
Cradock,  Lucy  Elizabeth. 
Ensor,  Edwin  Thomas,  M.D., 
New  York. 

Fitzgerald,  Arthur  Ormsby. 
Henston,  Frederick  Samuel. 
Keenan,  James. 

Kenealy,  Arabella  Madonna. 
Kenny,  William. 


Lalor,  Joseph. 

Long,  Mark  Henry,  M.D.,  New 
York. 

McGinity,  Bernard  A. 

McNaught,  Frederick  Josiah. 

Neill,  John. 

Roughan,  George  Francis. 

Sheperd,  Albert  Wilberforce. 
Taylor,  Rogers  WetherellGore,  M.B. 
Univ.  Dub.,  Surgeon  P.  and  O. 
Company’s  Service. 


The  following  Licentiates  in  Medicine  of  the  College,  having" 
complied  with  the  by-laws  relating  to  Membership,  pursuant 
to  the  provisions  of  the  Supplemental  Charter  of  December 
12,  1878,  were  duly  enrolled  Members  of  the  College : — 


Gore,  Albert  Augustus,  L.M.  1S30,  Surgeon-Major  A.M.D. 
Beamish,  Thomas,  L.M.  1863,  Passage  West,  Cork. 
Stephenson,  Edward  Aloysius,  L.M.  1836,  Tramore. 
Bransby,  Roberts,  L.M.  1867,  Eastbourne. 


Eoyal  College  of  Surgeons  of  England. — The 
following  gentlemen,  having  undergone  the  necessary  exa¬ 
minations  for  the  diploma,  were  admitted  Members  of  the 
College,  at  a  meeting  of  the  Court  of  Examiners  on  the 
19th  inst.,  viz. : — 

Callender,  Gerald,  Rugby,  student  of  St.  Mary’s  Hospital. 

Cardozo,  S.  N.,  L  R.C.P.,  Madras,  of  University  College  Hospital. 

Childe,  C.  P.,  Southborough,  Tunbridge  Wells,  of  King’s  College  Hospital, 
Ellis,  C.  C.,  Oswestry,  of  St.  George’s  Hospital. 

Griggs,  W.  A.,  St.  John’s,  S.E.,  of  St.  Bartholomew’s  Hospital. 

Hillaby,  Arthur,  Pontefract,  of  St.  Bartholomew’s  Hospital. 

Jones,  M.  P.,  L.8.A.,  Upper  Lyde,  Hereford,  of  Guy’s  Hospital. 


112 


Medical  Times  and  Gazette. 


MEDICAL  NEWS, 


July  28,  1S83. 


Linnell,  Alfre  Towcester,  student  of  Guy’s  Hospital. 

Llewellyn,  D.  W.  H.,  L.R.C.P.  Lond.,  Osborne-terraee,  S.E.,  of  St. 
Thomas’s  Hospital. 

Maughan,  James,  L.R.C.P.  Lond.,  Liverpool,  of  the  Liverpool  School. 
Phillips,  F.  B.  W.,  Brighton,  of  Guy’s  Hospital. 

Samson,  C.  L.,  Anerley,  of  King’s  College  Hospital. 

Tresidder,  H.  J.,  L.R.C.P.  Lond.,  West  Dulwich,  of  Guy’s  Hospital. 
Wigg,  H.  H.,  Adelaide,  South  Australia,  of  University  College  Hospital. 

Six  candidates  were  referred  for  six  months,  and  four  for 
three  months.  The  following  gentlemen  were  admitted 
Members  on  the  20th  inst.,  viz. : — 

Beaumont,  Edgar,  Upper  Norwood,  student  of  St.  George’s  Hospital. 
Brown,  A.  J.  E.,  L.S. A.,  Rochester,  of  Guy’s  Hospital. 

Clark,  A.  W.,  Dorking,  of  Guy’s  Hospital. 

Cuolahan,  J.  H.,  Bermondsey,  of  Guy’s  Hospital. 

Floyer,  W.  W.,  Victoria-park,  E.,  of  Guy’s  Hospital. 

Green,  C.  D.,  L.R.C.P.  Lond.,  Shardeloes-road,  S.E.,  of  St.  Thomas’s 
Hospital. 

Hunter,  G.  D.,  Cromwell-crescent,  S.W.,  of  St.  George’s  Hospital. 
Kendall,  George,  Clapham-road,  of  Guy’s  Hospital. 

Lilburne,  J.  T.,  L.S. A.,  Duncrieve,  N.B. 

Powell,  H.  E.,  Hereford,  of  St.  Bartholomew’s  Hospital. 

Powell,  J.  J.,  Launceston,  of  University  College  Hospital. 

Robinson,  C.  S.,  L.R.C.P.  Lond.,  Guernsey,  of  St.  George’s  Hospital. 
Robinson,  H.  B.,  Lower  Norwood,  of  St.  Thomas’s  Hospital. 

•Sharpley,  Edward,  Louth,  Lincolnshire,  of  Guy’s  Hospital. 

Williams,  R.  R.,  Llanberis,  North  Wales,  of  King’s  College  Hospital. 
Wilson,  Edward,  Cheltenham,  of  University  College  Hospital. 

Woodson,  A.  A.,  Sheffield,  of  University  College  Hospital. 

Wright,  G.  R.  M.,  L.R.C.P.  Lond.,  Wal worth-road,  S.E.,  of  St.  Bartho- 
'*•  lomew’s  Hospital. 

Five  candidates  passed  in  Surgery,  and  when  qualified  in 
Medicine  will  be  admitted  Members  of  the  College.  Six 
candidates  were  referred  for  six  months,  one  for  nine  months, 
and  one  for  three  months.  The  following  gentlemen  were 
admitted  Members  on  the  23rd  inst.,  viz.  : — 

Allingham,  H.  W.,  Grosvenor-street,  student  of  St.  George’s  Hospital. 
.Arnold,  E.  C.,  Denbigh-street,  S.W.,  of  St.  George’s  Hospital. 

Bredin,  H.  A.,  Liverpool,  of  the  Liverpool  School  of  Medicine. 

Caldwell,  Robert,  Tavistock,  of  the  Westminster  Hospital. 

Cotes,  C.  E.  H.,  Hammersmith,  of  St.  George’s  Hospital. 

Des  Voeux,  H.  A.,  Kensington,  of  St.  George’s  Hospital. 

Ilicwiez,  H.  F.,  L.S.A.,  Haverstock-hill,  of  the  London  Hospital. 

Moline,  F.  P.,  Bristol,  of  University  College  Hospital. 

Moore,  W.  H.,  Silloth,  Cumberland,  of  Guy’s  Hospital. 

Paget,  Stephen,  Harewood-place,  of  St.  Bartholomew’s  Hospital. 

Potter,  Harry.  Denbigh-place,  S.W.,  of  St.  George’s  Hospital. 
Shillingford,  F.  N.,  Peckham,  of  Guy’s  Hospital. 

Southern,  J.  A.,  Clapham-road,  of  St.  Thomas’s  Hospital. 

Sutton,  H.  M.,  L.S.  A.,  Reading,  of  St.  Thomas’s  Hospital. 

Topham,  A.  S.,  Doddington-grove,  of  Guy’s  Hospital. 

Wilkinson,  R.  H.,  East  Dulwich,  of  St.  Bartholomew’s  Hospital. 

Eight  gentlemen  were  approved  in  Surgery,  and  when 
qualified  in  Medicine  will  be  admitted  Members  of  the  Col¬ 
lege.  One  candidate  was  referred  for  three  months,  and 
three  for  six  months.  The  following  gentlemen  passed  on 
the  24th  inst.,  viz. : — 

Atkins,  Ernest,  L.S.A.,  Plumstead,  student  of  the  Charing-cross  Hospital. 
Berkley,  E.  J.  G.,  L.S.  A.,  Hackney,  of  the  Charing-cross  Hospital. 
Brown,  W.  H.,  L.S.A.,  Bexley,  of  University  College  Hospital. 

Evans,  W.  A.,  L.S.A.,  Manchester,  of  the  Manchester  School. 

Gostling,  T.  P.,  L.S.A.,  Diss,  of  University  College  Hospital. 

Hubbard,  A.  J.,  L.S.A.,  Ladbroke-terrace,  of  St.  Thomas’s  Hospital. 
Jennings,  Roberts,  L.R.C.P.  Lond.,  Haslingden,  of  the  Manchester  School. 
Schofield,  A.  T.,  L.R.C.P.  Lond.,  Cambridge- gardens,  of  the  London 
Hospital. 

Thorburn,  William,  L.S. A.,  Rusholme,  of  the  Manchester  School. 
Walker,  Joseph,  L.S.A.,  Kirkley,  of  the  Liverpool  School. 

Whittingdale,  J.  F.  L.,  B.A.  Cantab.,  Ingleton,  of  the  Edinburgh  School. 

Four  gentlemen  were  approved  in  Surgery,  and  when 
qualified  in  Medicine  will  be  admitted  Members  of  the 
College.  Three  candidates  were  referred  for  three  months, 
five  for  six  months,  and  one  for  twelve  months.  The 
following  gentlemen  passed  on  the  25th  inst.,  viz. : — 

Aird,  T.  W.,  L.A.H.  Ire.,  East  India-road,  student  of  the  Dublin  and 
London  Schools. 

Bassett-Smith,  P.  W.,  L.S.  A.,  St.  John’s  Wood,  of  the  Middlesex  Hospital. 
Bennett,  F.  W.,  L.S. A.,  Leicester,  of  the  Manchester  School. 

Broadbent,  Frank,  Collingham,  of  St.  Bartholomew’s  Hospital. 
Cunnington.  C.  W.,  L.S. A.,  Devizes,  of  King’s  College  Hospital. 

Evans,  W.  H.,  L.S. A.,  Montagu-place,  of  University  College  Hospital. 
Griswold,  Gaspar,  M.D.  New  York,  New  York,  of  the  Univ.  of  New  York. 
Reynolds.  E.  S.,  L.S. A.,  Manchester,  of  the  Manchester  School. 

Strathy,  P.  J.,  M.B.  Toronto,  Toronto,  of  the  Toronto  School. 

Seven  candidates  were  referred  for  six  months,  and  one  for 
■three  months. 


Apothecaries’  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday, 
July  19  : — 

Davidson,  John  Matthew,  Jamaica-road,  S.E. 

Greet,  Charles  Harvey,  Vernon-square,  King’s  Cross-road,  W.C. 
Kirby,  Alfred,  Batchworth  Heath,  Rickmans  worth. 

Lilburne,  James  Thomas,  Brunswick-place,  N.W. 

Nelham,  Albert  Edgar,  War  wick-street,  Pimlico. 

Starr,  Wm.  Heuderson,  Roseford-terrace,  West  Kensington-park,  W 


The  following  gentleman  also  on  the  same  day  passed  the 
Primary  Professional  Examination  :  — 

Cropley,  Henry,  London  Hospital. 


BIRTH. 

M oore. — On  July  22,  at  40,  Fitzwilliam-square  West,  Dublin,  the  wife  of 
John  William  Moore,  M.D.,  F.K.Q.C.P.,  of  a  son. 


DEATHS. 

Ayrton,  Matilda.  Chaplin,  M.D,  (Paris),  etc.,  at  68,  Sloane-street,  S.W., 
on  July  19,  aged  37. 

Hammond,  Henry  Samuel,  F.R.C.S.,  late  of  Edmonton,  at  Lewisham, 
Kent,  on  July  24,  in  his  92nd  year. 

Phillips,  Richard,  F.R.C.8.,  at  27,  Leinster-square,  Bayswater,  on 
July  23,Jaged  67.  _ 


VACANCIES. 

In  the  following  list  the  nature  of  the  office  vacant,  the  qualifications  re¬ 
quired  in  the  candidate,  the  person  to  whom  application  should  be  made 
and  the  day  of  election  (as  far  as  known)  are  stated  in  succession. 

Brighton,  Hove,  and  Sussex  Throat  and  Ear  Dispensary,  23,  Queen’s- 
road,  Brighton.— Honorary  Assistant-Surgeon.  Applications,  together 
with  copies  of  testimonials,  to  be  sent  to  Christopher  Challis,  Hon.  Sec. , 
60,  King’s-road,  Brighton  (of  whom  allfurther  particulars  may  be  had), 
on  or  before  July  29. 

Clayton  Hospital  and  Wakefield  General  Dispensary. — House- 
Surgeon.  Salary  £120  per  annum,  with  residence  at  the  Hospital, 
attendance,  coal,  and  gas.  Candidates  must  be  duly  registered  in 
medicine  and  surgery  under  the  Medical  Act,  and  unmarried.  Appli¬ 
cations  to  be  sent  to  John  Binks,  Honorary  Secretary,  on  or  before 
August  6. 

Dental’Hospital  of  London,  Leicester-square,W. — Lecturer  on  Dental 
Anatomy  and  Physiology.  [For  particulars  see  Advertisement.) 

Great  Northern  Hospital,  Caledonian-road,  N. — Junior  Resident 
Medical  Officer.  ( For  particulars  see  Advertisement.) 

Netherfield  Institution  for  Infectious  Diseases,  Liverpool. — 
Resident  Medical  Officer.  Salary  £30  per  annum,  with  board,  etc. 
Candidates  must  be  duly  qualified.  Applications,  with  testimonials, 
to  be  sent  to  Robert  Calder,  Secretary,  4,  Commercial-court,  17,  Water- 
street,  Liverpool  (from  whom  any  further  information  can  be  obtained), 
on  or  before  August  15. 

Queen’s  College,  Cork.— Professorship  of  Midwifery.  (For  particulars 
see  Advertisement.) 


UNION  AND  PAEOCHIAL  MEDICAL  SERVICE. 

***  The  area  of  each  district  is  stated  in  acres.  The  population  is 
computed  according  to  the  census  of  1881. 

RESIGNATIONS. 

Dewsbury  Union.—  Mr.  William  Arthur  has  resigned  the  Mirfield 
District:  area  3548;  population  15,870;  salary  £30  per  annum. 

St.  Mary  Abbotts  ( Kensington )  Parish.  —Mr.  C.  M.  Frost  has  resigned  the 
Workhouse :  salary  £30. 

APPOINTMENTS. 

Alderbury  Union.—  James  Hartley,  L.R.C.P.,  L.R.C.S.  Edin.,  to  the 
Downton  District. 

Burton-on- Trent  Union. — William  Creagh,  L.R.C.S.  Ire.,  D.M.  Dub., 
L.S. A.  Lond.,  to  the  Rosliston  District. 

Chesterton  Union. — Henry  A.  Phillips,  M.B. ,  M.S.  Aber.,  M.R.C.S.E., 
L.S.  A.,  to  the  Fourth  District. 

Church  Stretton  Union. — Thomas  J.  Hughes,  M.R.C.S.E.,  L.S.A.,  to  the 
Workhouse  and  the  First  District. 

Dorchester  Union.—  Edward  J.  Day,  M.R.C.S.E.,  L.S  A.  Lond.,  to  the 
Fordington  District.  F.  B.  Fisher,  M.R.C.S.E.,  L.R.C.P.  Lond.,  to  the 
Broadmayne  District. 

Llanelly  Union.— A.  Devonald,  L.R.C.P.,  L.R.C.S.  Edin.,  to  the 
Llannon  District. 

Tamworth  Union.—  Mr.  W.  Creagh,  L.R.C.S.  Ire.,  L.S.A.  Lond.,  D.M. 
Dub.,  to  the  Clifton  District. 

North  Surrey  District  School. — H.  J.  Prangley,  M.R.C.S.E.,  L.R.C.P., 
L.S. A.,  to  be  Medical  Officer. 

ANALYSTS. 

Peterborough  City. — Mr.  J.  A.  Wanklyn  for  two  years. 

Sussex  County.—  Mr.  E.  H.  Moore  for  the  Eastern  and  Western  Divisions 
for  one  year. 


The  Late  Treasurer  of  G-uy’s  Hospital. — The 
will  of  Mr.  Thomas  Turner,  J.P.,  LL.D.,  for  many  years 
the  Treasurer  of  Guy’s  Hospital,  has  just  been  proved  as 
amounting  to  over  <£99,000,  the  whole  of  which  he  has 
bequeathed  to  his  widow. 

Recognition  of  Testamentary  Capacity  during 
Life. — A  law  was  recently  passed  in  the  Michigan  Legisla¬ 
ture,  allowing  a  person  to  make  his  will,  and  then  during 
his  lifetime  petition  the  Probate  Court  for  citations  to  all 
his  heirs  and  such  other  persons  as  he  deemed  necessary  to 
attend  an  examination  into  his  sanity  and  testamentary 
capacity.  If  it  shall  appear  that  the  person  was  fully  com¬ 
petent  to  make  a  will,  a  decree  to  that  effect  shall  be  made, 
and  the  question  of  incapacity  cannot  be  raised  again,  except 
upon  appeal  from  the  decree.  If  the  testator  subsequently 
becomes  insane,  and  dies  in  that  condition,  his  will,  never¬ 
theless,  cannot  be  questioned  on  this  ground.  The  contents 
of  the  will  are  not  to  be  made  known  until  after  the  death 
of  the  testator. — New  York  Med.  Jour.,  June  30. 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES. 


July  28,  1883.  113 


VITAL  STATISTICS  OF  LONDON. 


Week  ending  Saturday,  July  21,  1883. 


BIRTHS. 

Births  of  Boys,  1316;  Girls,  1243 ;  Total,  2559. 

Corrected  weekly  average  in  the  10  years  1873-82,  260P9. 


DEATHS. 


Males. 

Females. 

Total. 

Deaths  during  the  week . 

906 

875 

1781 

Weekly  average  of  the  ten  years  1873-82,  i 
corrected  to  increased  population  ...  j 

884  9 

809-2 

1694T 

Deaths  ofpeopleaged  80  and  upwards 

... 

38 

DEATHS  IN  SUB-DISTRICTS  FROM  EPIDEMICS. 


1  Enumerated 

Population, 

1881 

(unrevised). 

Small-pox. 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

Whooping- 

cough. 

Typhus. 

Enteric  (or 
Typhoid) 
Fever. 

Simple 

continued 

Fever. 

ce 

! 

Q 

West . 

669833 

3 

1 

3 

3 

1 

74 

North 

905947 

10 

3 

5 

5 

i 

2 

71 

Central 

282238 

s 

1 

4 

2 

... 

30 

East . 

692738 

23 

18 

3 

9 

... 

2 

( 

88 

South . 

1265927 

... 

33 

9 

6 

9 

... 

5 

... 

88 

Total . 

3816483 

77 

32 

21 

28 

l 

10 

... 

351 

METEOROLOGY. 


From  Observations  at  the  Greenwich  Observatory. 


Mean  height  of  barometer  . 

Mean  temperature  . 

Highest  point  of  thermometer 
Lowest  point  of  thermometer  .. 
Mean  dew-point  temperature 

General  direction  of  wind  . 

Whole  amount  of  raininthe  week  .. 


29-691  in. 
56-0° 

69-4° 

436° 

49'8° 
W.S.W. 
0'44  in. 


BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  the 
Week  ending  Saturday,  J uly  21,  in  the  following  large  Towns : — 


I 

Cities 

and 

Boroughs. 

1 

O  1  S  <N 

H  It 

.2  vH 

|  Deaths  Registered  during 
j  the  week  ending  July  21. 

Annual  Rate  of 
Mortality  per  1000  living, 
from  all  causes. 

Temperature 
of  Air  (Fahr.) 

Temp, 
of  Air 
(Cent.) 

Rain 

Fall. 

CD  ° 

.9-2 

-si 

W  a 

o)  .9 
-S'h 

s?® 

tf-S 

CO  0) 

s* 

0) 

(35 

Highest  during 
the  Week. 

!  Lowest  during 
the  Week. 

WeeklyMeanof 
Daily  MeanValues 

Weekly  Mean  of 
Daily  Mean 
Values. 

In  Inches. 

In  Centimetres. 

London  . 

3955814 

2559 

1781 

235 

69-4 

43-6 

56-0 

13-33 

0-44 

1-12 

Brighton  . 

111262 

68 

27 

12-7 

703 

42-6 

56-6 

13-67 

023 

0-58 

Portsmouth 

131478 

S4 

45 

17-9 

•  •• 

... 

... 

... 

... 

... 

Norwich  . 

89612 

45 

25 

14-6 

... 

... 

Plymouth  . 

74977 

40 

22 

15-3 

65-8 

47-3 

55-5 

13-06 

0-88 

224 

Bristol . 

212779 

138 

69 

169 

63-4 

44-0 

52-6 

11-45 

1-32 

3-35 

Wolverhampton  . 

77557 

51 

20 

13-5 

61-8 

40-5 

50-5 

10-28 

1-50 

3-81 

Birmingham 

414S46 

254 

156 

196 

... 

Leicester  ...  ,.. 

129483 

85 

49 

19-7 

66-0 

43-0 

53-7 

12-06 

1-51 

3-84 

Nottingham 

199349 

143 

80 

20-9 

70-0 

39-8 

54-4 

12-44 

1-28 

3-25 

Derby . 

85574 

55 

27 

165 

... 

... 

... 

... 

... 

... 

Birkenhead 

88700 

63 

29 

171 

.  .  . 

... 

... 

... 

Liverpool  . 

566753 

402 

246 

22-6 

6V5 

48-8 

53-1 

11-73 

1-33 

3-38 

Bolton . 

107862 

57 

32 

15-5 

62-5 

44-8 

50'S 

10-45 

2-19 

5-E6 

Manchester 

339252 

223 

162 

249 

... 

... 

... 

... 

c. 

... 

Salford  . 

190465 

113 

78 

21  4 

... 

... 

... 

•  •• 

... 

Oldham  . 

119071 

74 

32 

14-0 

.  .  . 

... 

... 

... 

... 

... 

Blackburn . 

108460 

86 

38 

18-3 

... 

Preston  . 

98564 

70 

46 

24-4 

64-0 

49-0 

545 

1250 

0-91 

2-31 

Huddersfield 

84701 

59 

28 

173 

... 

... 

... 

... 

... 

Halifax  . 

75591 

29 

19 

13T 

... 

Bradford  . 

204807 

104 

52 

13-2 

65-6 

45-8 

53-0 

11-67 

233 

5-92 

Leeds . 

321611 

221 

119 

19-3 

67  0 

44-0 

53-8 

12-12 

1-19 

3-02 

Sheffield  . 

295497!  215 

131 

23-1 

64-0 

42-5 

52"91  11-61 

1-35 

3-43 

Hull  . 

176296 

114 

53 

15-7 

68-0 

40-0 

54-2 

12-33 

0-96 

2'44 

Sunderland 

121117 

92 

47 

20-2 

71-0 

46-0 

55-1 

12-84 

2-14 

5’44 

Newcastle  . 

149164  111 

85 

29-7 

... 

•  •• 

... 

... 

... 

Cardiff . 

90033)  71 

25 

14-5 

... 

... 

... 

... 

... 

... 

For  28  towns ... 

S62C975  5626 

3523 

213 

71-0 

39-8 

53-8 

12-12 

1-30 

3-30 

Edinburgh . 

235946 

130 

86 

19-0 

65-0 

42-4 

53-4 

11-89 

1-81 

4-60 

Glasgow  . 

515589 

440 

250 

25  3 

63-0!  39-5 

53-9 

1217 

0-90 

2-29 

Dublin . ;  ... 

349; 85 

181 

152 

22-7 

63-3  43  1 

546 

1256 

041 

1-04 

At  the  Royal  Observatory,  Greenwich,  the  mean  reading 
of  the  barometer  last  week  was  29'G9  in. ;  the  highest  read¬ 
ing  was  30-00  in.  on  Monday  afternoon,  and  the  lowest 
29'41  in.  on  Saturday  afternoon. 


NOTES,  QUERIES,  AND  REPLIES. 

- ♦ - 

lie  tjjat  qruaiioruQ  mnc(i  sfeall  learn  mnclj. — Bacon. 


The  Contagious  Diseases  Act,  Canterbury . — Since  the  removal  of  the  com¬ 
pulsory  clauses  of  these  Acts,  the  Town  Council  and  the  Poor-law 
Guardians  have  taken  steps  in  favour  of  the  restoration  of  the  clauses, 
and  propose  to  obtain  an  Act  for  the  city  with  provisions  similar  to 
the  Glasgow  Police  Act. 

The  Stationary  Condition  of  the  Population  of  France. — For  some  time  past 
this  question  has  been  a  source  of  uneasiness  to  thoughtful  Frenchmen  * 
Several  schemes  for  stimulating  population  have  been  proposed  in  the 
Chamber,  but  even  their  authors  appeared  to  have  little  confidence  in 
their  efficacy.  It  is  pretty  certain  that  unless  the  French  increase  and 
multiply  at  a  much  faster  rate  than  they  now  do,  France  a  century 
hence  will  exhibit  a  very  sorry  figure  by  the  side  of  other  nations.  An 
employe  of  the  Ministry  of  Commerce  has  recently  made  some  interesting 
calculations  on  the  subject,  which  have  been  published.  But  for  the 
influx  of  strangers,  population  in  France  would  be  considerably  more 
backward  than  it  is.  In  1851  the  number  of  foreigners  in  the  country 
was  only  380,000;  in  1876  it  had  risen  to  800,000;  and  at  present  it  is- 
estimated  at  a  little  over  a  million.  In  Paris  alone  no  fewer  than 
125,000  foreigners  are  constant  residents. 

Selling  Poison  without  a  Proper  Label. — At  an  inquest  held  at  Berwick, 
touching  the  death  of  a  married  woman  who  died  from  an  overdose  of 
morphia  taken  to  induce  sleep,  the  coroner  severely  censured  the 
chemist’s  assistant  for  selling  the  poison  to  deceased’s  little  girl  without 
a  proper  label,  and  expressed  the  opinion  that  the  police  should  take  the 
case  up. 

The  Opium  Traffic.— At  a  public  conference,  held  at  Liverpool  under  the 
auspices  of  the  Anti-Opium  Society,  Mr.  Tong-King-Sing,  managing 
director  of  the  China  Merchants’  Steam  Navigation  Company,  of 
Shanghai,  and  director  of  other  Chinese  companies,  gave  an  address,  in, 
which  he  dwelt  upon  the  noxious  effects  of  opium-smoking  upon  the 
health  and  physique  of  the  Chinese,  and  commented  on  the  action  of 
the  English  Government  in  forcing  the  trade  on  China.  He  emphati¬ 
cally  asserted  that  the  Chinese  Government  was  sincere  in  its  desire  to 
repress  the  use  of  opium  throughout  its  dominions.  A  resolution  was 
carried,  thanking  Mr.  Sing  for  his  address,  and  expressing  sympathy 
with  him  in  his  views,  and  stating  that  the  retention  of  the  opium 
trade  solely  for  the  benefit  of  our  Indian  revenue  was  contrary  to  the 
interests  of  China,  to  international  morality,  and  to  the  honour  of 
England. 

Fortunate' y ,  an  Exceptional  Decision. — The  Lambeth  Vestry  have  declined 
to  incur  the  yearly  expenditure  of  £109  for  the  maintenance  of  the 
churchyard  of  St.  John’s,  Waterloo- road,  as  a  recreation  ground. 

The  Greenwich  Worlchouse. — The  Guardians  have  approved  the  plans  for 
enlarging  the  workhouse  at  a  cost  of  £14,240. 

The  Decent  Vaccination  Question,  St,  Pancras,— The  Workhouse  Visiting- 
Committee  reported  to  the  last  meeting  of  the  Board  of  Guardians* 
touching  the  case  of  the  late  Herbert  Walsh,  that  they  did  not  see  in  the- 
proceedings  of  the  coroner’s  inquest  any  evidence  connecting  the  re¬ 
vaccination  of  the  mother,  Rosina  Walsh,  with  the  subsequent  drying 
up  of  her  milk.  The  Committee,  however,  regarded  this  question,  as 
well  as  that  raised  by  Dr.  Dunlop — viz.,  whether  the  possibility  of  small¬ 
pox  ravaging  a  lying-in  ward  would,  under  the  circumstances  existing- 
at  the  time,  justify  vaccination  at  so  early  a  period  as  one  day  after 
confinement, — as  questions  only  solvable  by  medical  men,  and  would, 
therefore,  suggest  that  this  matter  be  referred  to  the  Local  Government 
Board.  There  was  another  discussion  on  this  subject,  several  members 
expressing  disapproval  of  the  manner  in  which  Dr.  Dunlop  had  acted. 
It  was  urged  that,  Dr.  Buchanan  being  at  the  Local  Government  Board, 
the  recommendation  of  the  Committee  was  a  wise  one.  The  report  was- 
approved. 

Philanthropy.— The  object  of  the  Girls’  Friendly  Society  is  to  provide 
cheap  lodgings  with  reliable  persons  for  young  women  making  their 
way  to  large  towns  and  cities,  where  they  have  probably  no  relatives  or 
friends,  for  the  purpose  of  seeking  employment  in  shops  or  other  places 
of  business. 

The  Hampstead  Hospital  Litigation.— A  circular  letter  has  been  sent  by 
the  Metropolitan  Asylums  District  Board  to  all  the  vestries  and  boards 
of  guardians  in  the  metropolis,  explaining  the  Managers’  position  in 
reference  to  the  Hampstead  Hospital  case  ;  and  replies  from  nearly  all 
the  boards  have  been  received,  the  majority  having  decided  to  take 
no  action  in  the  matter.  The  Board  have  received  a  letter  from  the 
plaintiffs’  solicitor,  submitting  a  proposal  for  the  settlement  of  the 
question  on  the  basis  of  the  Hospital  remaining  in  its  present  condition 
The  whole  subject  is  before  the  General  Purposes  Committee. 

L.  L.,  Paddington.—  The  Act  of  Parliament  under  which  disused  burial- 
grounds  are  laid  out  as  gardens  and  open  spaces  for  the  public  use 
expressly  provides  that  the  playing  of  games  or  sports  shall  not  be 
allowed. 


114 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES 


July  28,  1883. 


The  Royal  College,  of  Surgeons ,  Dublin— Honorary  Fellowships  of  the 
College  have  been  conferred  on  Dr.  Crawford,  Director  of  the  Army 
Medical  Department,  and  Sir  James  Hanbury,  Chief  Medical  Officer  in 
the  Egyptian  campaign. 

Infringing  the  “ Truck  Acts."— A.  shopkeeper  and  master  fustian-cutter,  at 
Sale,  has  been  ordered  to  pay  fines  and  costs  amounting  to  £18,  for 
paying  his  employes  otherwise  than  in  current  coin,  in  contravention  of 
the  law.  He  paid  wages  partly  in  beer  and  groceries. 

Prop  osed  Additional  Vaccination  Station ,  Paddington. — The  Board  of 
Guardians,  on  the  recommendation  of  the  Dispensary  and  Vaccination 
Committee,  propose  that  a  second  vaccination  station  be  supplied  for 
the  Eastern  District,  the  only  station  at  present  being  at  Paddington 
Green.  The  Eastern  District,  under  the  care  of  Dr.  Hibberd,  extended 
from  the  Marble  Arch  to  Kilburn,  and  included  St.  Peter’spark  ;  and 
it  is  recommended  that  the  second  station  he  placed  in  the  latter 
district.  The  matter  will  be  considered  at  the  next  meeting  of  the 
Board. 

Cutting  off  the  Water-Supply :  Responsibility  of  Owners  of  Froperty.— In 
reply  to  a  letter  from  the  Newington  Vestry  with  reference  to  the  water 
companies  cutting  off  the  water-supply  on  non-payment  of  rates,  the 
Local  Government  Board  points  out  the  powers  of  the  Vestry  from  a 
sanitary  point  of  view  to  compel  owners  of  property  to  have  the  water 
laid  on  where  necessary. 

Sanitary  Refects,  Clerkenwell.— The  Vestry  of  this  parish  have  adopted  the 
recommendation  of  the  Sanitary  Committee,  that  powers  should  be  dele¬ 
gated  to  them  to  take  legal  proceedings  under  the  Sanitary  Acts,  where 
necessary,  for  the  enforcement  of  notices  to  abate  nuisances. 

Medical  Certificates  as  to  Boys  remanded  by  Magistrates  to  the  Workhouse.— 
The  Clerk  of  the  City  of  London  Union,  in  pursuance  of  his  instructions, 
has  considered  the  application  of  Dr.  Aveling,  Medical  Officer  of  the 
Homerton  Workhouse,  to  be  paid  for  certifying  as  to  boys  remanded 
by  magistrates  to  the  workhouse  for  the  purpose  of  sending  them  to 
industrial  schools,  and  is  of  opinion  that  the  Guardians  might  pay,  with 
the  consent  of  the  Local  Government  Board,  a  gratuity  to  Dr.  Aveling 
for  so  certifying,  and  that  2s.  6d.  for  each  case  would  be  sufficient  remu¬ 
neration,  and  would  in  this  instance  amount  to  £7.  The  Clerk  remarks 
that  Dr.  Aveling  had  for  several  years  given  his  certificates,  but  had 
only  just  awoke  to  the  fact  that  he  ought  to  be  paid. 

Mortuary  Statistics  at  Ottawa.— A.  lady  has  been  appointed  chief  clerk  of 
these  statistics.  It  is  stated  that  she  is  the  first  woman  who  has  been 
promoted  to  so  important  a  post  in  the  Dominion. 

Fish-Supply  in  the  East  End.—A.t  length  there  appears  to  he  some  prospect 
of  the  successful  utilisation  of  Columbia  Market,  designed  by  its  bene¬ 
volent  founder,  Lady  Burdett-Coutts,  with  the  object  of  cheapening  the 
food-supply  of  the  poor  of  the  Bethnal  Green  district.  It  has  just  been 
opened  again  as  a  fish  market,  under  circumstances  which  we  hope  will 
obviate  defeat,  as  was  previously  the  case  by  the  persistent  opposition  of 
the  Billingsgate  monopolists.  The  apparent  success  of  the  Farringdon 
Market  and  the  Elephant  and  Castle  Market  augurs  well  for  the  future 
of  Columbia  Market. 

The  Effect  of  Tobacco  Smoking  on  Children.— Dr.  G.  Decaisne  has  submitted 
to  the  Society  of  Public  Medicine  the  results  of  some  interesting  obser¬ 
vations  on  the  effects  due  to  the  use  of  tobacco  among  boys.  Thirty-eight 
youths  were  placed  in  his  charge,  whose  ages  varied  from  nine  to  fifteen, 
and  who  were  in  the  habit  of  smoking,  though  the  abuse  of  tobacco 
varied  in  degree.  The  effects,  of  course,  also  varied,  but  were  very  em¬ 
phatic  in  twenty-seven  cases.  In  twenty-two  patients  there  was  distinct 
disturbance  of  the  circulation,  bruit  in  the  carotids,  palpitation,  defi¬ 
ciency  of  digestion,  sluggishness  of  intellect,  and  a  craving,  more 
or  less  pronounced,  for  alcoholic  stimulants.  In  thirteen  instances 
there  was  an  intermittent  pulse.  Analysis  of  the  blood  showed  in 
•eight  cases  a  notable  falling  off  in  the  usual  number  of  red  corpuscles. 
Twelve  boys  suffered  frequently  from  bleeding  of  the  nose  ;  ten  com¬ 
plained  of  agitated  sleep  and  constant  nightmare.  Four  boys  had  ul¬ 
cerated  mouths ;  and  one  of  the  children  became  the  victim  of  pulmonary 
phthisis— a  fact  which  Dr.  Decaisne  attributed  to  thegreat  deterioration 
of  t  he  blood  produced  by  prolonged  and  excessive  use  of  tobacco.  As 
these  children  were  all  more  or  less  lymphatic,  it  was  not  possible  to 
■establish  a  comparison  according  to  temperament;  but  the  younger  the 
child  the  more  marked  were  the  symptoms,  and  the  better-fed  children 
were  those  that  suffered  least.  Eight  of  the  children  in  question  were 
aged  from  nine  to  twelve  years.  Eleven  had  smoked  for  six  months, 
eight  for  one  year,  and  sixteen  for  more  than  two  years.  Out  of  eleven 
hoys  who  were  induced  to  cease  smoking,  six  were  completely  restored 
to  normal  health  after  six  months,  while  the  others  continued  to  suffer 
slightly  for  a  year.  Treatment  with  iron  and  quinine  gave  no  satisfac¬ 
tory  result,  and  it  seems  tolerably  evident  that  the  most  effective,  if  not 
the  only  cure,  is  to  at  once  forswear  the  habit,  which,  to  children  in  any 
case,  is  undoubtedly  pernicious. 

Health  of  Broadstairs.— The  death-rate  of  this  town  still  remains  at  152 
per  1000  per  annum,  the  zymotic  death-rate  being  below  1  per  1000. 
Only  two  deaths  are  referred  to  this  class  of  disease  by  Dr.  Robinson, 
the  Medical  Officer  of  Health,  in  his  last  half-yearly  report,  ending  the 
30th  ult.  This  is  the  fourth  year  in  succession  during  which  the 
mortality  has  been  between  15  aDd  16  per  1000  per  annum. 


Official  Neglect  of  Sanitary  Precautions,  and  its  Consequences. — The  medical 
officer  reported  last  week  to  the  Wednesbury  Local  Board  that  three 
cases  of  small-pox  had  occurred  in  the  parish  in  the  previous  fortnight, 
all  of  them  having  been  imported  into  the  district  from  works  at  West 
Bromwich.  Complaints  were  made  by  several  members  of  the  Board 
of  the  danger  of  a  renewed  outbreak  of  the  disease  to  which  the  town 
was  exposed  through  the  want  of  proper  precautions  on  the  part  of  the 
authorities  of  neighbouring  places. 

Cabby's  Pipe. — The  Prefecture  of  Police  has  put  out  the  pipe  of  the  Paris 
cabdrivers  by  prohibiting  them  to  smoke  when  they  are  driving. 

COMMUNICATIONS  have  been  received  from  — 

The  Secretary  of  the  Pabkes  Museum,  London;  The  Registrar  of 
the  Apothecaries’  Hale,  London ;  The  Secretary  of  the  Sanitary 
Institute  of  Great  Britain,  London  ;  The  Secretary  of  the 
International  Medical  Congress,  Copenhagen :  Mr.  G.  Ellis, 
London;  Dr.  Kelly,  Rotherhithe;  Dr.  John  C.  Luoas,  Ahmedabad  ; 
The  Secretary  of  the  Sanitary  Improvement  Company,  London ; 
Dr.  Dolan,  Halifax ;  The  Sanitary  Commissioner  for  the  Punjaub, 
Lahore ;  Mr.  T.  M.  Stone,  London ;  The  Secretary  of  the  Royal 
Hospital  for  Diseases  of  the  Chest,  London ;  Mr.  Henry  Morris, 
London ;  Dr.  Mercier.  Dartford :  Dr.  Clifford  Beale,  London ;  Dr. 
Norman  Chevers,  London  ;  Mr.  J.  Chatto,  London;  The  Registrar- 
General  for  Scotland,  Edinburgh  ;  Dr.  Edward  Playter,  Toronto ; 
Mr.  J.  R.  Barefoot,  London ;  Dr.  Leslie  Phillips,  Birmingham  ; 
Dr.  McCraith,  Smyrna ;  Mr.  N.  Davies-Colley,  London  ;  The 
Secretary  of  the  National  Association  for  the  Promotion  of 
Social  Science,  etc.,  London. 

BOOKS,  ETC..  RECEIVED  - 

J.  and  A.  Churchill’s  Half-yearly  List  of  New  Books  and  New  Editions, 
January  to  June,  1883 — Report  on  the  Health  of  the  Borough  of 
Birmingham,  etc.,  for  the  Year  1882 —Excision  of  the  Knee-joint,  by 
George  Edgeworth  Fenwick,  M  D.,  C.M.— Proceedings  of  the  Society 
for  Psychical  Research,  April,  1 883— The  Political  Powerlessness  of  the 
Medical  Profession,  by  B.  Foster.  M.D.,  F.R.C.P. — Report  of  the 
Manchester  Royal  Infirmary  and  Dispensary,  etc.,  June  25,  1882,  to 
J une  24, 1883 — The  Hygiene  of  Armies  in  the  Field,  by  Robert  Rawlinson, 
Esq.,  C.B. — Prognosis  in  Cases  of  Refusal  of  Food,  by  Henry  Sutherland, 
M.D. — Health  Lectures  for  the  People,  vol.  vi.  — Report  on  the  Health, 
Sanitary  Condition,  etc.,  of  Kensington,  by  T.  Orme  Dudfield,  M.D. — 
Suggestions  for  Preventing  the  Spread  of  Infectious  Diseases,  by  the 
Vestry  of  the  Parish  of  St.  Mary  Abbotts,  Kensington— Memorandum 
on  the  Threatened  Approach  of  Cholera,  by  the  King  and  Queen’s 
College  of  Physicians  in  Ireland— The  Air  Cure  of  Tubercular  Con¬ 
sumption,  by  Henry  MacCormac,  M.D. —Port  of  London  Sanitary 
Committee  Medical  Officer  of  Health  in  re  Cholera  Regulations — The 
Great  Eastern  Railway  Company’s  Tourist  Guide  to  the  Continent — 
Home  Nursing  and  Sick-Room  Appliances,  by  Eva  C.  E.  Liickes. 

PERIODICALS  AND  NEWSPAPERS  RECEIVED  — 

Lancet— British  Medical  Journal— Medical  Press  and  Circular — Ber¬ 
liner  Klinische  Woehenschrift — Centralblatt  fiir  Chirurgie — Gazette 
des  Hopitaux— Gazette  Medicale— Revista  de  Medicina— Bulletin  de 
1’  Academie  de  Medecine  —Pharmaceutical  J  ournal — W  iener  Medicinische 
Woehenschrift — Revue  Medicale — Gazette  Hebdomadaire— Nature — 
Boston  Medical  and  Surgical  Journal— Louisville  Medical  News — 
Centralblatt  fur  Gynakologie — Le  Concours  Medical— Centralblatt  fiir 
die  Medicinisehen  Wissenschaften — Centralblatt  fur  Klinische  Medicin 
- — Philadelphia  Medical  News— Le  Progrds  Medical — Physician  and 
Surgeon— Philadelphia  Medical  Times— New  York  Medical  Journal — 
Revue  de  Medecine— Therapeutic  Gazette— Australasian  Medical  Gazette 
— American  Journal  of  Obstetrics— New  York  Review— Leisure  Hour — 
Sunday  at  Home — Girl’s  Own  Paper— Friendly  Greetings — Boy’s  Own 
Paper — American  Progress— Polyclinic -Iowa  State  Medical  Reporter 
— Revue  d’Hygiene — Sanitary  Journal— Brain— Caslon’s  Circular. 


APPOINTMENTS  FOR  THE  WEEK. 


July  28.  Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  1 £  p.m. ;  King’s  College,  p.m. ;  Royal 

Free,  2  p.m.;  Royal  London  Ophthalmic,  11  a. ra. ;  Royal  Westminster 
Ophthalmic,  li  p.m. ;  St.  Thomas’s,  l£p.m.:  London,  2  p.m. 

30.  Monday. 

Operations  at  the  Metropolitan  Free,  2  p.m.;  St.  Mark’s  Hospital  for 
Diseases  of  the  Rectum.  2  p.m.;  Royal  London  Ophthalmic,  11  a.ro.; 
Royal  Westminster  Ophthalmic,  lit  p.m. ;  Hospital  for  Women,  2  p.m. 

31.  Tuesday. 

Operations  at  Guy’s,  1J  p.m. ;  Westminster,  2  p.m. ;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  1£  p.m.;  West 
London,  3  p.m.  _ _ 

August  1.  Wednesday. 

Operations  at  University  College,  2  p.m. ;  St.  Mary's,  11  p.m. ;  Middlesex, 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew’s,  lg  p.m.  ;  Great  Northern, 

2  p.m.;  Samaritan,  2J  p.m.;  Royal  London  Ophthalmic,  11  a.m.; 

Royal  Westminster  Ophthalmic,  lit  p.m. ;  St.  Thomas’s,  1J  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m. ;  National  Orthopaedic,  Great 
Portland-street,  10  a.m. _ 

2.  Thursday. 

Operations  at  St.  George’s,  1  p.m. ;  Central  London  Ophthalmic,  1  p.m. ; 
Royal  Orthopaedic,  2  p.m.;  University  College,  2  p.m.;  Royal  London 
Ophthalmic, 11  a.m. ;  Royal  Westminster  Ophthalmic,  li  p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m.;  Hospital  for  Women,  2  p.m.; 
Charing-cross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  2i  p.m. 

3.  Friday. 

Operations  at  Central  LondonOphthalmic,  2  p.m.;  Royal  London  Ophthal¬ 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminster 
Ophthalmic,  lg  p.m. ;  St.  George’s  (ophthalmic  operations),  lj  p.m.; 
Guy’s,  1$  D.m.  ;  St. Thomas’s  (ophthalmic  operations),  2  p.m.;  King’s 
College  (by  Mr.  Lister),  2  p.m. 


BRITISH  MEDICAL  ASSOCIATION. 


Medical 


FIFTY-FIRST  ANNUAL  MEETING 

OF  THE 

BRITISH  MEDICAL  ASSOCIATION, 

Held  in  Liverpool,  July  31  and  August  1,  2,  3,  1883. 


PRESIDENT’S  ADDRESS. 

By  A.  T.  H.  WATERS,  M.D.,  F.R.C.P., 

Senior  Physician  to  the  Royal  Infirmary,  and  Professor  of  Medicine  in 
University  College,  Liverpool. 


THE  PRESENT  ASPECT  AND  FUTURE  PROSPECTS 
OF  MEDICINE. 

Gentlemen, — I  esteem  it  an  honour  of  no  common  kind  to 
be  elected  President  of  the  British  Medical  Association, 
and  to  be  called  upon  to  take  the  chair  at  one  of  its  annual 
.gatherings  ;  and  to  me  the  honour  has  a  special  value,  for 
I  can  look  back  on  many  years  of  close  relation  with  the 
Society :  it  has  been  the  means  by  which  I  have  formed 
friendships  whose  importance  I  cannot  over-estimate,  and 
its  meetings  have  been  amongst  the  most  interesting  cir¬ 
cumstances  of  my  life.  Your  kindness,  therefore — the 
kindness  of  my  fellow -residents,  and  of  the  Association  at 
large — in  placing  me  here  to-day,  deserves  my  warmest 
thanks,  and  will  always  be  held  in  grateful  remembrance. 

Twenty-four  years  have  passed  since  the  Association  met 
in  Liverpool  to  celebrate  its  twenty-seventh  anniversary. 
These  years  have  been  marked  by  the  uninterrupted  pros¬ 
perity  of  our  Society,  by  a  large  increase  in  our  numbers, 
and  an  increasing  interest  in  the  proceedings  of  our  annual 
gatherings.  With  reference  to  our  success,  it  may,  perhaps, 
be  sufficient  to  say  that,  whereas  at  that  time  and  up  to 
1866  we  numbered  about  2300  members,  we  are  now  10,000 
strong.  May  the  future  progress  of  the  Society  be  ever  in 
accordance  with  its  experience  of  the  past ;  and  may  he  who 
shall  open  its  next  session  in  this  city  be  able  to  say,  with 
as  much  truth  as  I  can  to-day,  that  the  Association  has 
increased  in  strength  with  its  increased  years. 

But,  gentlemen,  whilst  we  congratulate  ourselves  on  the 
success  of  our  efforts  in  connexion  with  this  large  Associa¬ 
tion,  let  us  never  forget  that  we  are  all  members  of  a  still 
larger  body — that  we  belong  to  the  great  commonwealth  of 
medicine,  which  knows  no  distinction  of  race,  or  clime,  or 
people  ;  and  that,  whilst  it  is  our  duty,  and  should  always 
be  our  aim,  to  promote  the  special  objects  for  which  our 
Society  was  founded,  our  highest  duty  and  our  noblest  aim 
should  be  to  foster  the  general  interests  of  medicine,  and  to 
endeavour  to  advance  it  as  a  science  and  as  an  art ;  and,  in 
the  few  remarks  which  I  have  to  address  to  you  on  this 
occasion,  I  purpose  to  dwell,  very  briefly,  on  some  of  those 
points  which  seem  to  me  worthy  of  our  attention  with 
reference  to  the  present  condition  and  future  prospects  of 
our  profession  ;  for,  although  there  are  many  topics  of  local 
interest  to  which  I  might  refer,  all  that  relates  to  Liverpool 
— its  medical  history,  its  hospitals,  its  School  of  Medicine, 
its  University  College,  its  public  buildings,  its  river,  and  its 
docks — has  been  so  well  treated  of  in  some  recent  numbers 
of  our  Journal,  that  any  further  observations  on  the  subject 
are  altogether  unnecessary. 

When  last  we  met,  in  Worcester,  we  celebrated  our 
jubilee,  and  it  was  well  to  look  back  on  the  period  which 
had  elapsed  since  our  Society  was  founded,  and  to  refer  with 
satisfaction  to  the  good  work  which  it  had  done,  and  the 
progress  which  medicine  had  made  during  the  previous 
fifty  years.  And  whilst  echoing  to-day  all  that  was  then  so 
ably  expressed,  I  think  it  would  be  well  if  we  were  to  con¬ 
sider  that  we  have  now  entered  on  a  new  phase — that  we 
have  taken,  as  it  were,  a  new  departure,  and  that  with  the 
great  advantages  we  possess  we  should,  as  a  society,  and 
also  as  a  profession,  strive  to  develope  our  science  more 
rapidly  in  the  future  than  it  has  been  developed  in  the  past, 
and  that  our  progress  should  be  more  marked  in  all  that 
relates  to  the  higher  aspirations  of  our  calling. 

Nor  are  there  wanting  signs  which  point  to  the  probability 
of  such  a  consummation.  We  now  see  a  higher  standard  of 
Yol.  II.  1883.  No.  1727. 


August  4, 1883.  115 


medical  education  insisted  on;  we  see,  on  all  sides,  the  in¬ 
ductive  method  of  investigation  brought  to  bear  on  the  great 
problems  of  medicine  ;  more  and  more  we  see  dissatisfac¬ 
tion  with  our  present  uncertain  and  inexact  knowledge; 
and  we  cannot  doubt  that  the  observations  which  are  being 
carried  on,  and  especially  those  which  are  being  conducted 
under  the  auspices  of  our  Collective  Investigation  Com¬ 
mittee  and  of  the  Society  for  the  Cultivation  of  Medicine  by 
Original  Research,  will  before  very  long  bear  fruits,  and 
lead  to  generalisations  of  the  most  important  kind. 

To  my  mind  there  is  nothing  in  the  present  aspect  of 
medicine  more  satisfactory,  or  more  likely  to  raise  it  from 
the  region  of  empiricism  and  place  it  on  a  higher  scientific 
level,  than  the  endeavour  now  being  made  to  render  our 
knowledge  more  definite  and  exact;  and  if  I  were  to  point 
to  one  circumstance  which,  in  my  opinion,  has,  probably 
more  than  any  other,  contributed  to  this  result,  I  should 
say  it  was  the  introduction  into  our  practice  of  instruments 
o  f  precision.  These  have  furnished  us  with  means  by  which 
the  senses  may  be  placed  in  immediate  relation  with  the 
actual  phenomena  of  disease,  and  these  phenomena  are 
sometimes  of  so  simple  a  character,  yet  so  indicative  of  the 
general  morbid  state,  and  require  so  little  mental  analysis, 
that  the  very  tyro  can  almost  read  their  significance. 

No  more  important  step  was  ever  made  in  practical  medi¬ 
cine  than  that  of  the  application  of  physical  principles  to 
the  diagnosis  of  diseases  of  the  chest.  In  what  condition 
would  now  be  our  knowledge  of  diseases  of  the  lungs,  had 
the  researches  so  largely  associated  with  the  name  of 
Laennec  never  been  made  ?  In  what  condition  was  the 
knowledge  of  cardiac  diseases  before  the  investigations  and 
experiments  of  the  physiologist  gave  us  definite  information 
with  reference  to  the  movements  of  the  heart,  the  action  of 
its  valves,  and  the  causes  of  its  sounds  ?  The  differentiation 
of  lung  and  heart  affections,  by  the  aid  of  physical  inquiry, 
the  possibility  of  making  an  exact  diagnosis  without  inves¬ 
tigating  one  single  general  symptom,  constitute  a  triumph 
for  medicine  which  is  not  to  be  surpassed  in  the  practical 
application  of  scientific  principles  in  any  other  department 
of  human  knowledge;  and  we  must  not  forget  that  this 
marked  advance  has  been  achieved  in  a  comparatively  short 
space  of  time,  for  it  was  not  till  1819  that  Laennec  gave  his 
observations  to  the  world. 

What  can  be  more  striking  than  the  results  of  physical 
inquiry  in  pulmonary  or  cardiac  diseases  P  Let  us  suppose 
a  student  in  medicine  following,  for  the  first  time,  a  compe¬ 
tent  teacher  through  the  wards  of  a  hospital.  He  sees  him 
stop  at  the  bedside  of  a  patient  suffering  from  one  of  these 
affections  ;  he  watches  him  as  he  makes  his  examination  ; 
he  hears  a  few  leading  questions  put ;  he  sees  a  few  gentle 
blows  struck ;  a  brief  application  of  the  stethoscope ;  and 
then,  without  any  hesitation,  the  physician,  turning  to  his 
class,  tells  of  the  nature  of  the  case — that  there  is  consoli¬ 
dation  of  a  lung ;  effusion  into  the  pleura ;  disease  of  a  par¬ 
ticular  valve  of  the  heart ;  hypertrophy  of  its  walls,  or  de¬ 
generation  of  its  fibres.  He  speaks  of  the  mode  of  origin  of 
the  affection,  the  course  it  will  probably  take,  and  the  issue 
that  will  come.  Our  student  is  struck  with  astonishment  at 
the  apparent  facility  of  the  diagnosis  and  the  rapidity  with 
which  it  has  been  made.  He  watches  the  progress  of  the 
disease,  and  he  finds  becoming  developed  the  conditions 
which  were  foretold ;  and  (if,  unhappily,  the  case  terminate 
fatally),  on  a  subsequent  day,  following  his  teacher  to  the 
post-mortem  theatre,  he  sees  the  body  of  the  patient  sub¬ 
mitted  to  examination  ;  he  sees  revealed  by  the  scalpel  the 
condition  which  exists.  He  sees  that  there  is  consolidation 
of  a  lung ;  effusion  into  the  pleura ;  valvular  disease  of  the 
heart ;  hypertrophy  of  its  walls,  or  degeneration  of  its 
fibres ;  he  sees,  in  fact,  a  verification,  in  its  minute  details, 
of  the  diagnosis  that  was  made,  and  he  is  apt,  perhaps,  at 
once  to  conclude  that  medicine  is  one  of  the  most  exact  of 
the  sciences. 

It  would  be  well  if  in  all  departments  of  medicine  there 
were  the  same  facilities  for  exact  diagnosis  as  in  diseases  of 
the  heart  and  lungs ;  but  what  the  application  of  acoustic 
principles  has  done  in  these  affections,  the  application  of 
chemical  principles,  and  the  use  of  the  microscope,  the 
ophthalmoscope,  the  laryngoscope,  and  the  sphygmograph, 
have  in  a  measure  done  for  the  diseases  of  some  other 
organs.  And  may  we  not  hope  that,  with  reference  to  the 
diseases  of  the  nervous  system — the  most  obscure  of  al 
which  come  under  the  notice  of  the  physician — the  re- 


116 


Medical  Times  and  Gazette. 


BRITISH  MEDICAL  ASSOCIATION. 


August  4, 1883. 


searches  of  the  present  day,  and  the  attempts  now  being 
made  to  clear  up  our  knowledge  of  the  physiology  of  the 
brain,  and  to  localise  its  various  functions,  may  be  followed 
by  results  which  will  add  largely  to  our  powers  of  dif¬ 
ferentiating  nervous  affections,  and  of  successfully  treating 
them  ? 

Again,  in  referring  to  instruments  of  precision,  let  me 
observe  how  important  are  the  results  which  have  followed 
the  use  of  that  instrument  which,  when  the  Association  last 
met  here,  was  scarcely  ever  used  in  this  country,  but  which 
is  now  the  constant  companion  of  every  practitioner — the 
clinical  thermometer.  How  valuable  is  the  information 
which  it  gives  !  How  intimately  does  it  place  that  impor¬ 
tant  factor  of  fever — increased  temperature — under  our 
observation  !  Without  attempting  to  discuss  the  relations 
of  heat  to  the  other  phenomena  of  fever,  I  may  observe  that, 
in  a  large  number  of  cases  of  disease,  the  measure  of  the 
temperature  is  undoubtedly  the  measure  of  the  danger  ;  and 
that  the  immediate  recognition  of  its  rise  to  an  inordinate 
extent  is  the  first  step  towards  the  application  of  means 
on  which  the  life  of  the  patient  may  depend.  Were 
this  the  proper  occasion,  I  should  like  to  dwell  on  the  great 
value  which  the  scientific  use  of  the  thermometer  has  been, 
and  is  likely  still  further  to  be,  to  the  practical  physician. 
Not  only  has  it  enabled  him  to  recognise  conditions  of  hyper¬ 
pyrexia  fraught  with  extreme  peril,  and  thus  to  use  at  the 
right  moment  measures  for  reducing  temperature  which 
have  been  followed  by  the  most  beneficial  results  ;  not  only 
has  it  afforded  a  means  by  which  the  constant  attendant  on 
the  sick  can  ascertain  the  development  of  serious  symptoms  ; 
but  its  further  application,  and  the  recognition,  by  its  use, 
of  the  special  oscillations  of  temperature  which  characterise 
some  diseases,  have  enabled  the  physician  to  differentiate 
between  affections  in  which  other  means  of  diagnosis  have 
been  insufficient ;  whilst,  by  still  more  extended  observations 
with  the  instrument,  we  shall  perhaps  be  able  to  explain, 
more  fully  than  we  now  can,  the  causes  which  underlie  the 
variations  of  temperature  which  are  so  marked  a  feature  of 
some  affections  ;  and  possibly  this  knowledge  may  influence 
beneficially  our  treatment  of  them.  And,  in  referring  to 
this  subject,  I  cannot  refrain  from  alluding  to  the  fact  that 
it  was  a  Liverpool  physician.  Dr.  Currie,  who,  eai’ly  in  the 
present  century,  was  the  pioneer  in  the  use  of  cold  applica¬ 
tions  to  the  surface  of  the  body  in  the  treatment  of  fevers  ; 
and,  although  Currie’s  practice  fell  into  disuse,  the  merit  of 
initiating  a  method  of  reducing  temperature,  which  the  use 
of  the  thermometer  has  enabled  us  in  the  present  day  to 
place  on  a  more  successful  basis,  may,  I  think,  be  fairly 
claimed  for  him. 

How  often  has  the  use  of  the  laryngoscope  enabled  the 
practitioner  to  recognise  the  true  bearings  of  certain  laryn¬ 
geal  symptoms,  and  to  differentiate  between  organic  disease 
of  the  larynx  and  the  results  of  pressure  from  a  thoracic 
tumour  !  How  often  has  it  enabled  him  to  decide  on  the 
nature  of  a  laryngeal  growth,  and  the  possibility,  or  other¬ 
wise,  of  successful  medical  or  surgical  treatment !  How 
much  do  we  not  owe  to  the  introduction  of  the  ophthalmo¬ 
scope — an  instrument  which  has  literally  thrown  a  flood  of 
light  on  the  affections  of  the  eye,  and  may  be  said,  indeed, 
to  have  revolutionised  the  whole  practice  of  ophthalmic 
medicine ;  whilst,  by  enabling  us  to  recognise  certain  con¬ 
ditions  of  the  eye,  and  to  interpret  their  significance  with 
reference  to  other  morbid  states,  it  has  materially  aided 
the  work  of  the  general  physician  ! 

The  sphygmograph  is  an  instrument  which,  though 
largely  employed  in  hospital  work,  has  not  hitherto  found 
its  way  into  general  use.  It  cannot  be  said  to  have  had 
much  influence  on  our  practice ;  but  I  think  we  often  derive 
important  indications  from  it  with  reference  to  the  state  of 
the  arterial  system,  and  the  degree  of  arterial  tension  which 
exists ;  and  possibly  by  a  more  frequent  employment  of  it 
we  might  be  able  to  recognise,  at  an  earlier  stage  than  we 
now  can,  those  manifestations  of  incipient  disease  which 
frequently  pass  unnoticed,  and  therefore  untreated.  Further, 
in  certain  acute  diseases,  the  sphygmograph  often  gives 
indications  which  are  important  in  regard  to  prognosis. 
The  hyperdierotism  of  the  pulse,  as  shown  by  the  instru¬ 
ment,  may  indicate  the  extreme  gravity  of  a  case  which 
other  symptoms  fail  to  point  out. 

I  am  glad  to  see  that  in  the  Section  of  Medicine  a  discus¬ 
sion  is  to  take  place  on  the  subject  of  arterial  tension,  and  I 
hope  that  some  valuable  information  may  be  elicited  from 


it.  I  believe  that  important  results  may  be  expected  to 
follow  from  more  exact  observation  on  the  condition  of  the 
arterial  system. 

The  great  results  which  have  followed  the  application  of 
physical  principles  to  the  recognition  of  disease,  constitute 
the  common-places  of  medicine  of  the  present  day;  and 
perhaps  I  ought  to  offer  some  apology  for  dwelling  upon 
them ;  they  are,  nevertheless,  the  great  facts  of  medicine, 
they  are  the  facts  to  which  we  can  point  as  showing  the- 
scientific  basis  of  our  art,  and  their  value  can  be  appreciated 
only  by  those  who  are  engaged  in  the  practical  application 
of  therapeutics.  They  are,  moreover,  the  main  guarantee 
which  we  have  for  progress  in  the  future ;  for  who  shall 
doubt  that  the  next  half-century  will  be  more  fertile  in  the- 
production  of  instruments  of  precision,  and  in  bringing- 
scientific  principles  to  bear  on  the  work  of  the  physician, 
than  that  which  has  j  ust  passed  ?  Who  shall  doubt  that  as 
the  result  of  the  more  rigid  application  of  the  inductive- 
method  of  research,  and  more  careful  and  combined  clinical 
investigation,  our  powers  of  generalising  on  disease,  and  of 
differentiating  between  the  variations  which  it  presents,  will' 
be  largely  increased ;  that  diagnosis  will  be  more  easy,  and 
treatment  more  successful  ? 

In  considering  the  standpoint  of  medicine,  we  should 
always  bear  in  mind  that  medicine  must  be  judg'ed  by  the- 
therapeutic  results  which  it  achieves ;  and  in  proportion  as 
we  can  show  that  the  researches  of  the  physiologist,  the 
pathologist,  and  the  chemist,  and  the  application  of  scientific 
principles,  have  enabled  the  physician  to  deal  more  success¬ 
fully  with  disease,  to  anticipate  its  development,  to  recognise- 
its  earliest  symptoms,  to  mitigate  its  severity,  and  reduce 
its  rate  of  mortality,  so  do  we  establish  for  our  art  a  claim 
on  the  confidence  and  gratitude  of  mankind;  and  in  this 
respect  the  present  state  of  medicine  shows  no  slight  advance 
on  the  past,  and  promises  a  more  rapid  progress  in  the 
future.  The  past  five-and-twenty  or  thirty  years — not  to  go 
further  back — have  been  marked  by  the  general  develop¬ 
ment  of  views  with  reference  to  many  diseases,  such  as  have 
largely  and  beneficially  influenced  our  treatment  of  them  p 
and  as  1  took  an  illustration  of  the  value  of  physical  in¬ 
vestigation  from  diseases  of  the  chest,  permit  me  to  refer 
again  to  some  of  these  affections  in  speaking  of  the  question 
of  treatment.  With  regard  to  the  affection  which  we  term- 
pneumonia,  have  we  not  seen  the  introduction  into  practice 
of  a  mode  of  treatment  which  has  deprived  the  disease  of' 
much  of  its  terror,  and  greatly  reduced  its  mortality  ? 
Whatever  be  the  views  which  we  entertain  of  the  nature  of 
pneumonia,  the  important  fact  remains  that  we  may  enume-  . 
rate  amongst  the  successes  of  medicine  of  the  present  day  a 
large  reduction  in  the  mortality  from  the  affection. 

Again,  the  recent  development  of  the  practice  of  tapping 
the  chest  in  pleuritic  effusion — an  operation  comparatively 
rarely  performed  thirty  years  ago — is,  in  my  opinion,  a  very 
marked  improvement  in  therapeutics.  Those  who  have 
carefully  watched  the  progress  of  medicine  in  this  matter, 
know  full  well  how  great  have  been  the  changes  which  have 
taken  place  within  the  last  quarter  of  a  century,  and 
especially  since  the  introduction  of  the  aspirator.  It  is 
impossible  to  refer  to  all  those  to  whom  we  are  indebted 
with  reference  to  this  subject,  but  Trousseau,  as  a  pioneer,, 
and  Bowditch,  whose  large  experience  and  satisfactory 
results  exercised  so  beneficial  an  influence,  I  must  not  pass 
over ;  whilst  there  are  many  in  this  country  to  whom  we 
owe  no  less  a  debt  of  gratitude.  There  is,  perhaps,  from 
the  facility  with  which  tapping  may  be  performed,  and  the 
almost  entire  absence  of  risk  when  it  is  properly  performed, 
a  fear  that  it  may  sometimes  be  resorted  to  unnecessarily. 
But,  from  what  I  may  term  a  somewhat  large  experience  in 
the  operation,  I  can  speak  with  confidence  of  its  value  and 
safety  in  both  acute  and  chronic  effusions ;  and  I  cannot  but 
think  that,  as  the  result  of  the  early  performance  of  the 
operation,  we  shall  see,  every  year,  fewer  of  those  cases  of 
deformed  chest  which  so  frequently  follow  neglected  pleuritic 
effusion. 

How  satisfactory  have  been  the  practical  results  which) 
have  followed  the  researches  that  have  been  made,  within 
the  past  half-century,  into  the  nature  of  continued  fevers  ! 
It  is  now  about  forty  years  since  Stewart  (whose  recent  loss; 
we  have  to  deplore)  published  his  investigations  in  typhus 
and  typhoid,  and  showed  their  distinct  and  separate  indi- 
•  viduality.  Other  labourers  have  since  worked  in  the  same 


Medical  Times  and  Gazette. 


BRITISH  MEDICAL  ASSOCIATION. 


August  4,  1883.  117 


field,  and  have  established,  beyond  a  doubt,  tbe  facts  which 
he  then  demonstrated,  the  knowledge  of  which  has  largely 
tended  to  the  prevention  of  these  affections,  and  enabled 
us  to  trace  to  their  source  many  outbreaks  which,  in  former 
times,  would  have  been  involved  in  mystery.  Nor  can  we 
point,  perhaps,  to  any  one  circumstance  which  has  had  a 
more  beneficial  influence  on  the  treatment  of  these  diseases 
than  the  recognition  of  the  pathological  changes  by  which 
they  are  characterised.  The  precautions  which  we  consider 
imperative  during  convalescence  in  the  one  disease — pre¬ 
cautions  which  may  be,  in  large  measure,  neglected  in  the 
other, — are  but  the  outcome  of  the  careful  investigations 
which  have  been  made  into  the  morbid  changes  by  which 
the  two  affections  are  attended.  And  if  we  have  abandoned 
the  idea  that  these  fevers  can  be  cut  short  by  any  measures, 
or  the  administration  of  any  drug ;  if  we  have  no  faith  in 
any  specific  line  of  treatment,  and  are,  for  the  most  part, 
content  to  watch  our  patients  carefully,  and  to  guide  them, 
as  it  were,  through  their  attacks,  this  is  not  scepticism — it 
is  the  result  of  a  more  intimate  knowledge  of  these  diseases, 
of  a  better  acquaintance  with  their  natural  history,  and  a 
better  appreciation  of  their  pathological  changes.  We  wait 
for  further  insight  into  their  essential  nature,  and  we  are  not 
without  hope  that  fresh  discoveries  will  give  us  increased 
power,  in  regard  both  to  their  prevention  and  their  treatment. 

It  is  impossible  to  enumerate  the  various  affections  in 
which  there  is  a  marked  improvement  in  treatment,  and 
those  which  I  have  referred  to  must  be  considered  simply 
as  illustrations  of  my  position  ;  but  whilst  I  speak  with 
satisfaction  on  this  subject,  I  must  not  forget  to  mention 
that,  in  the  midst  of  many  successes,  we  have  instances  of, 
I  will  not  say  actual,  but  comparative,  failure.  Our  know¬ 
ledge  of  the  pathology  of  some  affections  remains  very 
imperfect,  and  our  therapeutics  are  in  some  respects  very 
unsatisfactory.  Although  rheumatic  fever  is  one  of  the 
most  common  diseases,  it  must  be  confessed  that  we  are 
ignorant  of  its  pathology.  During  the  past  few  years  there 
has  been  introduced  into  practice  a  mode  of  treating  the 
disease  by  the  compounds  of  salicylic  acid,  which  has  met 
with  general  adoption,  and  has  been  largely  successful.  I 
can  add  the  testimony  of  my  experience  in  its  favour; 
but  still,  with  all  the  opportunities  which  we  possess  of 
studying  the  affection,  we  are  as  yet  unable  to  give  any 
satisfactory  explanation  of  its  essential  nature. 

Again,  how  unsatisfactory  is  the  knowledge  we  possess 
with  reference  to  the  pathology  of  diabetes  !  We  have  long 
recognised  its  clinical  features,  and  we  are  often  able  to 
modify  its  course  and  mitigate  its  symptoms  ;  but  of  its  real 
nature  we  are  ignorant,  and  nothing  has  tended  to  show 
this  more  than  the  discussion  recently  carried  on  at  one  of 
our  societies.  But  this  confession  of  our  ignorance  is  one  of 
the  most  promising  features  of  our  day  ;  it  is  that  which  gives 
us  assurance  that  every  effort  will  be  made  towards  increased 
knowledge  in  the  future.  Whence  comes  this  want  of 
success  in  the  investigation  of  the  nature  of  diabetes  ?  We 
have  approached  it  from  the  physiological  side,  from  the 
chemical  side,  and  from  the  pathological  side,  and  have 
failed.  Can  we  hope  that  by  combined  observation  of  its 
clinical  features,  of  its  life-liistory,  and  its  relations  to 
families  and  individual  peculiarities,  we  may  elucidate  its 
nature  ?  May  we  hope  that-  it  is  one  of  those  subjects  which 
will  be  inquired  into,  and  the  problems  of  which  will  be 
solved  by  the  labours  of  our  Collective  Investigation  Com¬ 
mittee  ?  I  commend  it  to  their  consideration. 

And  here  I  must  express  the  great  satisfaction  with  which, 
in  common,  I  am  sure,  with  every  member  of  the  Associa¬ 
tion,  I  have  seen  the  establishment  of  this  Collective  Investi¬ 
gation  Committee,  how  strongly  I  feel  that  it  is  capable  of 
accomplishing  most  valuable  work,  and  how  much  I  think 
we  are  indebted  to  Professor  Humphry  for  initiating  the 
movement.  Doubtless  a  large  part  of  the  work  of  the  Com¬ 
mittee  will  consist  in  collating  facts  with  reference  to  specific 
diseases  ;  but  there  is  one  line  of  inquiry  which,  I  trust,  will 
receive  from  it  a  share  of  attention.  I  mean  the  considera¬ 
tion  of  the  points  of  difference  between  functional  disturb¬ 
ances  and  the  early  symptoms  of  organic  affections.  IIow 
difficult  is  it  sometimes  to  say,  when  some  slight  symptom 
presents  itself,  and  when  no  objective  signs  of  organic  dis¬ 
ease  can  be  discovered,  whether  that  symptom  indicates 
incipient  structural  change  or  mere  functional  disarrange¬ 
ment  !  Upon  the  right  appreciation  of  the  phenomenon, 
however,  the  safety  of  the  patient  may  depend ;  for,  although  < 


we  stand  almost  powerless  to  arrest  the  course  of  confirmed 
structural  changes,  there  can  be  no  doubt  that,  could  we 
recognise  the  earliest  steps  in  these  changes,  could  we  see 
clearly  the  points  of  departure  from  normal  conditions  in 
various  chronic  and  hitherto  incurable  maladies,  we  might 
do  much  to  check  these  alterations  of  structure,  and  prevent 
the  further  progress  of  the  disease. 

In  an  investigation  of  this  kind,  our  hospital  work  is  com¬ 
paratively  useless.  There  we  are  brought  into  relation,  for 
the  most  part,  with  disease  already  well  marked — disease 
which  has  produced  its  easily  recognisable  results ;  and  if 
patients  present  themselves  with  slight  symptoms,  they 
perhaps  soon  recover,  and  are  lost  sight  of.  It  is  in  the 
daily  work  of  private  practice  that  observations  such  as  I 
have  referred  to  can  alone  be  satisfactorily  made  ;  and  it  is 
therefore  to  the  great  bulk  of  practitioners  throughout  the 
country  that  we  must  look  for  aid  in  this  matter.  It  in¬ 
volves  a  lengthened  study  of  each  individual  case  ;  a  close 
watching,  not  for  weeks  or  months,  but  for  years;  and 
perhaps  the  facts  gathered  in  a  lifetime  might  be  but  few. 
It  relates  to  the  consideration  of  subjective  symptoms  which 
we  cannot  accurately  estimate  with  our  present  physical 
means,  but  which  are  intimately  associated  with  individual 
peculiarities  and  idiosyncrasies,  and  often  form  the  most 
important  elements  in  our  diagnosis,  prognosis,  and  treat¬ 
ment.  It  may  be  that,  with  more  refined  instruments  of 
precision  and  greater  scientific  knowledge,  we  shall  bring 
many  of  these  symptoms  within  the  range  of  physically 
recognisable  facts ;  but,  in  the  meantime,  inquiries  such  as 
I  have  referred  to  may  materially  aid  us. 

But,  gentlemen,  of  all  the  questions  which  now  engage 
the  attention  of  the  pathologist  and  physician,  there  is  no 
one  which  surpasses  in  importance  that  which  relates  to  the 
dependence  of  certain  diseases  on  micro-organisms.  The 
subject  is  one  of  the  greatest  possible  interest,  and  fraught 
with  bearings  of  a  practical  character  which  already  have 
had,  and  are  doubtless  destined  still  further  to  have,  a  vast 
influence  on  the  prevention  and  treatment  of  disease.  The 
establishment  of  the  fact  that  pebrine,  chicken-cholera,  and 
splenic  fever  depend  on  the  presence  of  specific  microbes, 
and  that  relapsing  fever  has  associated  with  it,  if  not  indeed 
causing  it,  a  like  organism,  must  be  classed  amongst  the  most 
striking  discoveries  of  the  present  day,  and  undoubtedly 
mark  an  epoch  in  the  history  of  pathological  science ;  whilst 
the  gradually  accumulating  evidence  that  tuberculosis  is  the 
result  of  a  parasitic  element  seems  likely  to  lead  to  its  being 
placed  in  the  same  category  as  those  affections,  the  patho¬ 
logy  of  which  appears  now  to  be  clearly  established.  More¬ 
over,  the  brilliant  results  which  have  followed  the  process 
of  attenuative  culture  of  the  virus  of  some  of  the  affections 
to  which  I  have  referred,  and  the  protective  influence  of 
vaccination  by  these  attenuated  fluids,  as  carried  out  by 
Pasteur,  lead  us  to  hope  that,  by  further  researches  in  the 
same  direction,  we  may  yet  discover  some  means  for  check¬ 
ing  the  ravages  of  tuberculous  and  other  allied  diseases,  as 
certainly  as  the  great  discovery  of  Jenner  has  enabled  us  to 
check  the  ravages  of  small-pox. 

Nor  is  it  possible,  perhaps,  to  point  to  any  single  fact  in 
connexion  with  the  practical  application  of  science  which  is 
more  striking  than  that  of  the  relation  of  disease  to  minute 
organisms.  The  whole  subject  has  been  evolved  from  the 
researches  of  a  few  naturalists  who  studied  the  smallest  of 
living  beings.  What  possible  use,  might  it  not  have  been 
said,  could  investigations  of  this  kind  have  in  reference  to 
the  maladies  either  of  man  or  the  lower  animals  P  And  yet 
we  have  seen  that  these  studies  of  minute  life  have  led  to 
the  prevention  of  a  disease  which  threatened  to  destroy  the 
source  from  which  we  derive  one  of  our  staple  products  of 
manufacture  ;  they  have  been  largely  instrumental  in  check¬ 
ing  the  ravages  of  a  malady  which  is  so  fatal  amongst  the 
flocks  and  herds  of  various  countries ;  they  have  led  to  the 
introduction  into  the  practice  of  surgery  of  a  mode  of  treat¬ 
ment,  the  beneficial  effects  of  which  it  is  not  for  me  to 
dilate  on ;  and,  lastly,  it  seems  likely  that  they  will  mate¬ 
rially  alter  our  views  with  reference  to  some  of  the  most 
serious  diseases  to  which  mankind  is  subject. 

These  facts  tend  to  show  on  how  wide  a  basis  the  science 
and  art  of  medicine  rest,  and  how  closely  their  advance  is 
mixed  up  with,  and  dependent  upon,  the  progress  of  other 
sciences.  In  truth,  there  is  nothing  in  the  whole  range  of 
nature  which  the  physician  may  not  make  use  of  for  the 
purposes  of  his  work. 


118 


Medical  Times  and  Gazette. 


BRITISH  MEDICAL  ASSOCIATION. 


August  4,  1883. 


Of  the  many  problems  which  await  solution  in  connexion 
with  the  subject  which  I  have  just  considered,,  no  one  is  more 
pressing  than  that  of  the  dependence,  or  otherwise,  of  pul¬ 
monary  consumption  on  the  bacillus  which  has  been  so 
largely  found,  not  only  in  the  morbid  deposits  which  result 
from  the  disease,  but  in  the  expectoration  of  phthisical 
patients.  Should  it  be  found  that  in  all  cases  of  genuine 
tubercular  phthisis  the  Bacillus  tuberculosis  is  present,  and 
should  future  researches  show  that  the  disease  is  caused  by 
the  parasite,  a  solidity  will  be  given  to  the  pathology  of  the 
affection,  and  perhaps  the  therapeutics  of  it  will  be  materi¬ 
ally  aided.  Speaking  from  clinical  experience,  I  cannot  but 
conclude  that  the  disease  to  which  we  give  the  name  of 
phthisis  has  more  than  one  mode  of  origin.  Further  inves¬ 
tigation  will  perhaps  clear  up  the  doubt  which  exists  on  this 
point ;  and  here  I  should  like  to  observe  that  there  are  some 
affections  of  the  lungs  which  closely  resemble,  in  their 
clinical  features,  acute  phthisis,  and  yet  which,  under  careful 
treatment,  do  not  go  on  to  a  fatal  issue.  Of  such  cases  I 
have  now  seen  several.  Their  general  symptoms,  their  phy¬ 
sical  signs,  their  temperature-ranges  made  me  conclude  that 
I  had  to  deal  with  cases  of  acute  pulmonary  tuberculosis, 
and  I  have  expected  a  fatal  result,  but  recovery  has  taken 
place.  These  cases  occurred  before  attention  was  directed 
to  the  presence  of  bacilli  in  the  sputum  of  phthisical  patients, 
and  no  examination  of  this  secretion  was  made.  In  instances 
of  a  similar  kind,  we  shall  now  be  able  to  use  this  method 
of  investigation,  and  possibly  it  will  afford  a  valuable  means 
of  differential  diagnosis,  and  enable  us  to  give,  in  cases 
where  the  bacilli  are  absent,  a  more  favourable  prognosis 
than  the  general  symptoms  would  otherwise  warrant.  I 
may  say,  in  regard  to  the  cases  to  which  I  have  referred, 
that  they  were  treated  by  free  nutrition,  the  administration 
of  quinine,  and  a  somewhat  liberal  quantity  of  alcoholic 
stimulants. 

The  great  point  which  remains  to  be  decided,  and  which  I 
hope  the  discussions  which  will  take  place  at  this  meeting 
will  help  to  decide,  is,  whether  the  so-called  Bacillus  tuber¬ 
culosis  is  the  cause,  or  the  consequence,  of  the  tuberculous 
disease. 

I  have  spoken  of  the  advance  which  medicine  has  made 
as  the  result  of  the  application  of  scientific  principles,  and 
an  improved  knowledge  of  physiology  and  pathology  ;  and  I 
would  further  remark  that  the  past  years  have  been  fertile 
in  the  introduction  of  substances  which  are  of  the  highest 
value  to  the  physician  in  the  actual  treatment  of  disease. 
The  bromide  compounds,  chloral,  croton-chloral,  the  various 
forms  of  pepsine  and  pancreatine,  the  salts  of  salicylic  acid, 
may  be  enumerated  amongst  others  which  the  chemist 
has  furnished  for  our  use;  and,  whilst  we  may  perhaps  feel 
that  he  will  best  serve  the  ends  of  medicine  who  shall  teach 
us  how  to  employ  most  successfully  the  remedies  we  already 
possess,  and  whilst  we  would  deprecate  the  incessant  desire 
for  the  introduction  of  new  chemical  compounds,  let  us  by 
no  means  discourage  the  laudable  ambition  of  enriching  our 
Pharmacopoeia  with  agents  of  sterling  value.  We  must 
never  forget  that,  in  addition  to  the  useful  drugs  to  which 
I  have  already  referred,  the  present  age  has  given  us,  by 
the  agency  of  the  chemist,  means  by  which  we  can  annihilate 
the  pangs  of  the  most  painful  manipulations  of  surgery, 
and  obviate  the  tortures  formerly  incidental  to  all  operative 
procedures. 

In  the  face  of  such  a  fact  as  this,  we  may  be  pardoned  if 
we  express  a  doubt  whether  we  have  arrived  at  the  limit  of 
our  therapeutical  discoveries,  and  whether  we  may  not  hope 
that  the  labours  of  the  chemist  will,  in  the  future,  give  us 
new  elements  for  our  use,  or  that  some  of  those  compounds 
which  now  possess  only  a  scientific  interest  may,  in  course 
of  time,  pass  into  the  hands  of  the  practical  physician,  and 
add  to  his  powers  of  controlling  certain  forms  of  disease. 

It  is  not  for  me  to  speak  of  the  triumphs  of  modern 
surgery,  and  the  successful  results  which  have  followed  the 
application  of  scientific  principles  in  this  great  department 
of  medicine.  We  are  apt,  perhaps,  to  conclude  that  it  is 
here  that  the  most  striking  advances  have  been  made ;  but 
I  venture  to  think  that,  in  proportion  to  the  difficulties 
which  have  had  to  be  solved  at  the  hands  of  the  physician 
medicine  pure  has  made  a  progress  as  great  as  that  which 
has  characterised  the  sister  art  of  surgery,  or,  indeed,  any 
other  art  in  which  science  has  been  brought  into  practical 
application.  Consider  how  difficult  are  the  problems  which 


disease  presents ;  the  complexities  of  organic  life  ;  the  many 
peculiarities  and  tendencies  of  each  individual  man ;  the 
inherited  liabilities ;  the  subtle  influences  of  habit,  of  diet, 
and  of  climate ;  and  those  social  and  moral  forces  which 
exercise  so  great  a  power  on  the  varying  conditions  of 
civilised  life ;  and  then  say  whether  it  can  be  expected  that 
we  shall  be  able  readily  to  arrive  at  grand  generalisations 
on  disease.  In  the  great  progress  which  has  been  made 
during  the  past  fifty  years,  we  have  the  strongest  possible 
indication  of  increased  progress  in  the  future.  The  labours- 
of  each  generation  will  correct  some  errors  of  the  preceding 
one,  and  will  carry  us  somewhat  nearer  to  the  truth ;  but 
the  temple  of  medical  science  can  never  be  crowned.  Each 
addition  to  our  knowledge  will  but  point  out  to  us  fresh 
fields  for  labour — new  subjects  for  investigation ;  and  we 
may  rest  assured  that  the  demands  which  will  be  made  on 
the  practitioners  of  medicine  will  ever  be  increasing,  as  it 
shall  become  more  apparent  how  intimately  their  labours, 
and  the  sciences  on  which  medicine  depends,  are  associated 
with  the  well-being  of  mankind. 

And  there  is,  I  think,  a  favourable  circumstance  in  con¬ 
nexion  with  our  profession  at  the  present  time  which  is 
likely  not  only  to  have  a  beneficial  influence  on  its  actual 
advance,  but  with  reference  to  the  estimation  in  which  it 
will  be  held  by  the  public  at  large.  Resting,  as  it  does,  on 
a  basis  of  scientific  observation,  and  depending  for  its  pro¬ 
gress  on  scientific  researches,  it  will  meet  with  more  and 
more  recognition  in  proportion  as  it  appeals  to  a  public 
which  is  more  and  more  scientifically  educated  ;  and  we  now 
see  that  physical  science  is  assuming,  more  and  more,  its 
proper  position  in  the  education  of  the  young.  Whilst  I 
would  express  a  hope  that,  in  the  general  education  of  the 
people,  and  especially  of  those  who  are  in  the  higher  walks 
of  life,  the  cultivation  of  literature  in  its  widest  sense  will 
always  maintain  a  due  prominence,  I  trust  that  the  move¬ 
ment  which  is  now  so  perceptible  with  regard  to  the  teaching 
of  physical  science,  will  continue  to  meet  with  that  support 
which  1  think  it  so  fully  deserves ;  and  in  connexion  with 
this  subject  I  cannot  but  express  the  satisfaction  which  I,, 
and  I  am  sure  I  may  say  we  all,  have  felt  in  seeing  rise  up, 
in  the  various  great  centres  of  population  in  this  kingdom, 
those  institutions  for  higher  education  which  add  so  much 
to  the  teaching  power  of  these  centres.  The  movement  is 
really  a  comparatively  recent  one,  and  we  in  Liverpool  were 
somewhat  backward  in  it ;  but,  a  few  years  ago,  some  of 
those  who  had  long  felt  the  want  which  existed,  determined 
to  make  a  strenuous  effort  to  give  to  this  city  what  Man¬ 
chester,  Birmingham,  and  other  cities  had  already  provided 
for  themselves.  Relying  on  the  liberality  of  the  public  of 
Liverpool,  an  appeal  was  made  for  the  foundation  of  a  col¬ 
lege  in  which  the  higher  branches  of  the  arts  and  sciences 
should  be  taught.  That  appeal  was  largely  responded  to, 
and  now  we  see  in  our  midst  a  college,  with  a  staff  of  pro¬ 
fessors,  which  I  trust  is  destined  to  do  a  work  which  will 
reflect  honour  on  itself,  and  credit  on  those  who  founded  it- 
It  is  true  that,  as  yet,  the  organisation  of  the  institution  is- 
not  complete,  and  that  a  further  sum  of  <£50,000  is  wanted,, 
in  order  that  the  full  advantage  of  affiliation  with  the  new 
Victoria  University  may  be  reaped.  But  we  are  sanguine 
that  this  amount  will  soon  be  forthcoming,  and  that  the 
position  of  equality  with  Owens  College  with  regard  to 
university  degrees  will  be  assured. 

The  School  of  Medicine,  so  long  known  in  connexion  with 
the  Royal  Infirmary,  has  now  become  the  Medical  Faculty 
of  the  College. 

Since  we  met  in  Liverpool,  as  I  have  already  said,  nearly 
a  quarter  of  a  century  has  elapsed ;  and  by  the  gaps  which 
time  has  made  in  our  ranks,  and  the  fact  that  the  Associa¬ 
tion  is  now  reassembled  here,  we  are  reminded  that,  whilst 
individuals  pass  away,  societies  and  communities  may  re¬ 
main.  I  trust  that  the  time  is  far  distant  when  our  society 
will  show  any  symptoms  of  degeneracy  or  decay ;  but  in  its 
very  magnitude  and  its  great  prosperity  there  exists  an 
element  of  danger.  I  have,  however,  the  strongest  possible 
conviction  that  the  wisdom  of  the  Association  guiding  and 
directing  its  executive  body,  which  shall  be  at  once  the  re¬ 
presentative  and  the  reflex  of  the  whole  constituency,  will 
conduct  the  society  safely  through  the  dangers  and  diffi¬ 
culties  which  may  beset  its  path.  United,  we  are  all-power¬ 
ful.  Acting  in  unison,  and  animated  with  one  feeling  for 
the  progress  and  well-being  of  our  profession,  there  is  no 


Jledical  Times  and  Gazette. 


BRITISH  MEDICAL  ASSOCIATION. 


August  4,  1883.  119 


subject  in  connexion  -with  its  scientific,  its  political,  or  its 
social  aspect  which  we  may  not  grapple  with,  and  grapple 
with  successfully.  As  year  by  year  rolls  on,  we  may  hope 
that  our  numbers  will  increase,  until  at  length  it  shall  be 
a  very  exceptional  circumstance  in  this  country  for  a  member 
of  our  calling  not  to  belong  to  the  British  Medical  Associa¬ 
tion.  In  concentrating,  as  we  may  then  be  able  to  do,  the 
whole  force  of  the  body  medical  on  any  given  object,  we  shall 
exercise  a  power  which  may  either  compel  Nature  to  reveal 
her  innermost  secrets,  or  influence  a  Government  in  the 
legislation  of  the  State. 

But  time  warns  me  that  I  must  bring  my  remarks  to  a 
close.  Looking  to  the  results  whieh  have  been  achieved,  I 
feel  warranted  in  saying  that,  with  our  present  advantages, 
and  working  from  our  present  standpoint,  we  have  every 
reason  to  believe  that  the  progress  of  medicine  in  the  future 
will  be  marked  by  more  rapid  sti'ides  than  those  which  have 
•characterised  it  in  the  past ;  and,  standing  here  to-night,  I  • 
can  look  forward  with  confidence  to  the  time  when  a  future 
President  of  the  Association,  inaugurating  the  centenary  of 
its  birth,  shall  speak  with  triumphant  voice  and  in  glowing 
language  of  the  advances  which  our  profession  shall  have 
made.  He  shall  tell  of  improved  methods  of  research,  and 
new  instruments  of  diagnosis;  he  shall  speak  of  the  impor¬ 
tant  generalisations  which  the  collective  investigation  of 
disease,  carried  on  for  fifty  years,  has  led  to ;  he  shall  point 
to  the  greater  facilities  with  which  the  differentiation  be¬ 
tween  functional  disturbances  and  the  early  symptoms  of 
■organic  disease  may  be  effected  ;  he  shall  perhaps  be  able  to 
show  how  many  affections  which  ultimately  lead  to  great 
alteration  of  structure,  and  eventually  to  a  fatal  issue,  have 
their  origin  in  functional  disarrangements  neglected  in  their 
beginnings,  and  gradually  inducing  changes  which  at  length 
become  irremediable  ;  and  thus  he  shall  show  how  closely 
physiology  and  pathology  are  connected.  He  shall,  perhaps, 
be  able  to  point  to  the  establishment  of  the  true  pathology 
of  those  diseases  which  from  recent  investigations  appear  to 
be  dependent  on  the  presence  of  micro-organisms,  of  tuber¬ 
culosis,  and  other  allied  affections,  and,  as  a  result  of  this, 
he  may  possibly  tell  that,  by  the  adoption  of  a  practice 
analogous  to  that  which  has  had  so  marked  a  result  in 
reference  to  splenic  fever  and  chicken-cholera,  and  which 
lias  rendered  famous  the  name  of  Pasteur,  an  almost  com¬ 
plete  immunity  is  enjoyed  from  those  terrible  maladies 
which  have  hitherto  in  large  measure  baffled  the  skill  of  the 
most  accomplished  physicians. 

And,  gentlemen,  amongst  the  many  changes  which,  I 
venture  to  think,  these  revolving  years  will  bring,  may  we 
not  hope  that,  with  the  higher  status  as  a,  science  which 
medicine  shall  have  attained,  and  the  higher  estimation  in 
which  the  profession  shall  be  held,  will  have  come  a  fuller 
recognition  of  the  claims  of  its  members  to  some  of  the 
higher  honours  of  the  State  ?  And  perhaps  the  President  of 
that  occasion,  or  some  of  those  who  may  listen  to  his  words, 
may  belong  to  that  upper  branch  of  our  Legislature  to  which 
hitherto  no  practitioner  of  our  art  has  reached.  The  votaries 
of  medicine  want  no  other  encouragement  than  that  which 
comes  from  advancing  their  own  science  to  stimulate  them 
to  the  highest  exertion  for  the  general  weal,  but  it  cannot 
be  doubted  that,  both  in  the  interest  of  the  public  and  in 
reference  to  the  promotion  of  the  health  and  well-being  of 
the  people,  the  presence  of  medical  men  in  the  House  of 
Lords  would  strengthen  the  powers  of  that  House  and 
beneficially  influence  legislation. 

But  if  the  results  to  which  I  have  alluded,  and  the  advances 
which  I  have  ventured  to  foreshadow,  are  to  be  realised, — if 
medicine  is  to  be  raised  from  the  region  of  empiricism,  and 
to  be  placed  on  a  higher  scientific  level, — and  if  we  in  this 
country  are  to  take  our  part  in  the  researches  by  which  the 
great  problems  now  awaiting  solution  are  to  be  determined, 
then  must  all  unwise  legislative  restriction  on  the  work  of 
the  physiologist  and  pathologist  be  withdrawn  ;  then  must 
all  measures  which  fetter  the  action  of  the  original  in¬ 
vestigator  be  removed ;  and  I  trust  that,  by  the  labours  of 
the  society  which  has  been  established  for  the  cultivation  of 
medicine  by  original  research,  a  more  enlightened  public 
opinion  will  be  formed,  which  will  aid  in  bringing  about 
these  results. 

Medicine  must  more  and  more  proceed  on  the  lines  of 
exact  observation  and  careful  scientific  inquiry ;  and  in 
connexion  with  this  it  is  satisfactory  to  know  that  one  of 
our  great  guilds  is  about  to  devote  a  portion  of  its  means  to  * 


the  encouragement  of  work  such  as  I  have  referred  to  ;  and 
I  trust  that  our  own  society  will  be  able  yearly  to  devote 
larger  sums  than  at  present  to  a  like  cause. 

And  now,  gentlemen,  in  conclusion,  permit  me,  in  the 
name  and  on  behalf  of  the  local  members  of  the  Associa¬ 
tion,  to  bid  you  all  a  cordial  welcome  to  Liverpool.  Our 
Association  is  now  so  numerous  and  so  powerful,  its  meet¬ 
ings  offer  so  many  features  of  interest  and  attraction,  that, 
wherever  they  may  be  appointed  to  be  held,  we  look  forward 
with  confidence  to  large  and  influential  gatherings  ;  but 
we  desire  that  this  meeting  shall  not  only  be  successful  in 
a  scientific  and  professional  point  of  view,  but  shall  also  be 
rendered  interesting  and  agreeable  to  all  who  may  honour 
us  with  their  presence.  We  cannot  show  you  grand  archi¬ 
tectural  monuments  mellowed  by  age  and  famous  in  the 
annals  of  history,  such  as  characterise  our  metropolitan 
towns  ;  we  cannot  take  you  to  classic  halls  like  those  which 
give  so  great  a  charm  to  the  visits  which  we  pay  to  our 
university  cities  ;  but  we  trust  that  in  traversing  the  dif¬ 
ferent  parts  of  this  great  centre  of  commerce,  and  in  visit¬ 
ing  the  docks  which  line  the  shores  of  the  Mersey,  you  may 
see  something  that  will  interest  you ;  and  that  when  your 
temporary  sojourn  amongst  us  shall  be  over,  you  may  feel 
that,  not  only  have  you  assisted  at  a  successful  anniversary 
of  the  British  Medical  Association,  and  contributed  to  the 
promotion  of  those  objects  for  which  it  was  founded,  but 
that  your  visit  has  been  one  of  satisfaction  and  of  pleasure. 


ADDRESS  IN  SURGERY. 

By  EE  GIN  AL  D  HAEEISON,  E.E.C.S., 
Surgeon  to  the  Liverpool  Royal  Infirmary. 

SOME  EECENT  ADVANCES  IN  THE  SURGERY  OF 
THE  URINARY  ORGANS. 

Me.  President  and  Gentlemen, — The  honour  of  address¬ 
ing  you  on  this  occasion  having  been  conferred  upon  me 
by  your  Council,  I  cannot  enter  upon  the  task  that  is  before 
me  without  expressing  my  consciousness  of  inability  to 
accomplish  it  in  the  manner  I  would  desire.  This  sense  of 
insufficiency  is  by  no  means  lessened  when  I  look  at  the 
names  of  those  who  have  preceded  me ;  when  I  remember 
the  interest  with  which  I,  in  common  with  you,  listened  to 
their  words  ;  and  when  I  consider  how  completely  abreast 
this  great  Association  is  kept,  by  means  of  its  Journal,  with 
everything  relating  to  the  progress  of  surgery.  On  the 
other  hand,  long  connexion  with  this  Association  gives  me 
the  assurance  of  having  to  address  a  sympathising  audience 
— one  disposed  to  overlook  defects  in  any  honest  endeavour 
to  set  forth  the  advancement  made  in  our  art. 

Surgery,  I  need  hardly  tell  you,  has  long  been  cultivated 
in  the  new  city  which  has  now  the  honour  of  receiving  you. 
The  hospitals  of  Liverpool,  and  their  records,  show  that 
the  same  ardour  prevails  here  as  elsewhere,  both  at  home 
and  abroad  ;  whilst  its  position  as  a  school  of  surgery  indi¬ 
cates  that  it  has  entered,  not  unsuccessfully,  into  honour¬ 
able  rivalry  with  its  competitors.  But  it  may  be  asked, 
especially  by  those  visiting  Liverpool  for  the  first  time.  Are 
there  no  traditions  here  ?  Are  there  no  footprints  of  those 
who  have  left  behind  them  works  which  place  us  in  their 
debt,  and  which  will  render  their  names  famous  wherever 
and  as  long  as  surgery  is  known  ?  It  seems  to  me  that  one 
advantage  connected  with  the  itinerant  character  of  our 
meetings  is,  that  places  suggest  references  to  local  celebrities 
of  the  past,  whose  works  cannot  be  thought  over  without 
advantage.  In  our  desire  to  push  forward,  we  sometimes 
forget  to  look  back,  and  to  reflect  upon  that  which  has  been 
achieved  and  how  it  was  brought  about.  Such  reflections 
cannot  fail  to  be  of  service  in  reminding  us  that  surgery  is 
not  entirely  of  modern  creation,  that  we  have  a  few  distant 
relations  whose  connexion  it  is  desirable  to  keep  up,  and 
that  there  still  remain  links  which  associate  us  with  the 
great  ones  of  the  past.  These  links  connect  us,  not  here 
alone,  but  everywhere,  with  the  names  of  Park  and  Alanson, 
to  whose  work  I  now  wish  for  a  moment  to  refer. 

Henry  Park  was  Surgeon  to  the  Royal  Infirmary  from 


120 


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BRITISH  MEDICAL  ASSOCIATION. 


August  4,  1883. 


1767  to  1798.  I  cannot  do  better  than  quote  a  passage  which 
our  local  historian.  Sir  James  Picton,  has  selected  ( Edinburgh 
Review,  October,  1872)  as  paying  a  deserved  tribute  to  his 
memory  : — “  In  the  latter  portion  of  the  last  century,  when 
a  vigorous  flash  of  originality  seemed  to  light  up  the  annals 
of  surgery.  Park,  of  the  Liverpool  Infirmai’y,  may  be  said 
to  have  accomplished  the  first  act  of  conservative  surgery. 
His  patient  being  a  sailor,  to  whom  the  loss  of  a  foot  and 
leg  would  have  been  tantamount  to  the  loss  of  his  means  of 
getting  bread,  determined  him  to  make  the  experiment  of 
simply  excising  the  diseased  part— the  knee-joint — and 
retaining  the  foot  and  leg.  This  he  did  so  successfully  that, 
to  use  his  own  words,  the  patient  some  years  after  the  opera¬ 
tion  e  made  several  voyages  to  sea,  in  which  he  was  able  to 
go  aloft  with  considerable  agility,  and  to  perform  all  the 
duties  of  a  seaman ;  that  he  was  twice  shipwrecked,  and  suf¬ 
fered  great  hardship  without  any  further  complaint  in  that 
limb.’  This  was  a  crucial  test  of  success,  that  should  have 
stamped  the  operation  as  one  of  the  greatest  surgical 
triumphs  of  the  time ;  but,  like  so  many  other  great  strides 
taken  in  that  age  of  extreme  vivification,  it  was  in  advance 
of  its  fellows,  and  was  destined  to  be  arrested  for  the  better 
part  of  another  half-century/5 

I  need  not  on  this  occasion  dwell  on  the  claims  that  ex¬ 
cision  of  the  knee-joint  has  to  be  regarded  as  one  of  the 
recognised  operations  in  surgery.  Though  there  may  be 
differences  of  opinion  in  reference  to  the  circumstances  in¬ 
dicating  it,  there  can  be  no  doubt  that  it  will  for  ever  remain 
as  a  brilliant  memorial  of  the  surgeon  whose  name  is 
associated  with  it. 

Of  Mr.  Alanson,  Park’s  colleague,  and  Surgeon  to  the 
Royal  Infirmary  from  1770  to  1794 — whose  work  has  been 
aptly  referred  to  by  Mr.  Sampson  Gamgee(a)  as  “one  of 
those  forgotten  surgical  classics  which  I  would  venture 
strongly  to  impress  on  the  attention  of  my  younger 
brethren  ” — I  will  speak  in  the  following  passage  from  the 
Presidential  Address  of  the  late  Dr.  Vose,  delivered  on  the 
last  occasion  this  Association  met  in  Liverpool : — “  To  Mr. 
Alanson,  formerly  a  Surgeon  to  our  Royal  Infirmary,  we  are 
indebted  for  many  important  suggestions,  made  at  a  time 
when  the  science  of  hygiene  was  but  little  regarded  any¬ 
where.  His  remarks  upon  the  ventilation  of  hospitals,  the 
use  of  iron  bedsteads,  the  necessity  of  frequent  whitewash¬ 
ing,  and  the  establishment  of  sanatoria  in  the  pure  air  of 
the  country  for  convalescent  patients,  testify  to  the  correct¬ 
ness  of  his  professional  judgment,  and  to  his  zeal  for  the 
welfare  of  his  fellow-creatures.  It  is  by  his  treatise  upon 
amputation,  however,  that  the  memory  of  this  gentleman, 
as  an  original  thinker,  in  surgery,  has  the  strongest  claims 
to  our  gratitude  and  regard.  He  tells  us  that,  among 
upwards  of  forty  amputations  performed  upon  the  old 
system,  which  had  come  under  his  notice,  ten  died  of 
tetanus,  two  of  bleeding,  three  from  mortification,  four 
from  exhausting  suppuration ;  while  eighteen  experienced 
haemorrhage,  and  nearly  all  had  excessive  fever.  Most  of 
the  patients  suffered  from  exfoliation  of  bone,  conical 
stumps,  or  wounds  that  would  not  heal.  After  the  adoption 
of  his  improved  method  of  procedure,  he  had  the  satisfac¬ 
tion  of  being  able  to  announce  that,  out  of  upwards  of  thirty 
amputations,  taken  indiscriminately,  which  were  performed 
at  the  Infirmary,  not  one  died,  and  none  had  secondary 
haemorrhage ;  while,  in  a  month  after  operation,  the  wound 
was  either  altogether  or  as  nearly  as  possible  healed  in  all 
the  cases.” 

As  is  well  known,  in  Alanson’s  method  of  amputating, 
provision  was  made  for  the  covering  in  of  the  bone,  after 
its  section,  by  the  integuments. 

Such,  then,  are  illustrations  of  the  useful  work  which  was 
being  done  by  surgeons  in  this  comparatively  modern  city 
about  one  hundred  years  ago.  Gratitude  for  improvements, 
the  value  of  which  is  still  fully  and  freely  acknowledged, 
justifies  the  foregoing  references  to  the  work  of  these 
distinguished  men. 

The  selection  of  material  for  presenting  to  you  to-day  has 
occasioned  me  no  little  anxiety.  Following  immediately 
upon  an  address  which  will  for  ever  render  our  jubilee  year 
memorable — an  address  in  which  justice  was  done,  by  the 
distinguished  representative  of  surgery  from  Ireland,  to  the 
great  subject  of  surgical  progress  generally,  whilst  its 
prominent  features  were  forcibly  brought  out, — I  may  well 
hesitate  where  to  tread. 

(a)  “  Transactions  International  Medical  CoDgress,”  1881,  vol.  ii.,  p.  352. 


In  considering  the  history  of  surgery  as  detailed  in  Mr. 
Stokes’s  admirable  address,  the  thought  naturally  occurs 
that  its  diffusion  is  as  remarkable  as  its  progress.  Compare, 
for  example,  the  condition  of  surgery  prior  to  the  existence 
of  our  Association,  with  its  position  as  set  forth  in  the 
columns  of  our  own  Journal,  or  in  those  of  the  other  great 
representative  of  medical  opinion  in  this  country,  the 
Lancet.  In  the  former  period,  departures  from  the  ordinary 
routine  of  surgical  procedure  were  confined  to  a  few  hands, 
and  the  benefits  resulting  from  improved  methods  of  treat¬ 
ment  were  shared  in  by  a  very  limited  number.  Now,  no' 
sooner  is  a  method  of  treatment  or  an  operation  proved  to 
be  efficient,  than  it  is  taken  up  and  practised  wherever 
scientific  surgery  can  reach  ;  the  peer  is  no  better  off  than 
the  peasant,  and  the  cottage-hospital  rivals  in  its  successes 
those  obtained  in  more  palatial  edifices. 

So  beneficently  catholic  is  our  profession  that  it  hails  with 
the  greatest  satisfaction  not  only  the  discovery  of  new 
means  of  relief,  but  the  adaptation  of  others  to  a  form  which 
permits  of  their  more  general  adoption  and  usefulness ; 
whilst,  on  the  other  hand,  it  regards  with  suspicion  all 
methods  of  treatment  which  unnecessarily  restrict  or  conceal 
that  which  was  intended  for  the  common  good. 

I  propose  to  occupy  the  remainder  of  the  time  at  my  dis¬ 
posal  by  a  reference  to  some  of  the  more  recent  advances 
and  work  in  connexion  with  the  surgery  of  the  urinary 
organs. 

Commencing  with  the  kidneys,  we  are  at  once  struck  with 
what  surgery  is  doing  for  them.  Until  quite  recently  the 
diseases  of  these  organs  were  regarded  as  belonging  almost 
exclusively  to  the  province  of  the  physician,  and  probably 
they  would  have  remained  so  had  preventive  medicine 
obtained  fuller  development. 

A  more  extended  acquaintance  with  the  pathology  of  the 
kidney  has  brought  to  light  conditions  in  which  the  work  of 
the  physician  requires  to  be  supplemented  by  that  of  the 
surgeon.  Pain  arising  from  an  undue  mobility  of  the  organ, 
tumours,  deposits,  haemorrhages,  and  collections  of  fluid 
within  it — all  these  morbid  states  are  now  recognised  as 
capable  of  relief  or  cure  by  fixing,  opening,  or  extirpating 
the  abnormal  or  disordered  organ ;  whilst  numerous  illus¬ 
trations  have  already  been  afforded  of  the  successful  removal 
of  stones  from  positions  where  they  must  have  ultimately 
led  to  the  disorganisation  of  the  kidney  in  which  they  had 
become  impacted. 

It  would  be  premature  at  present  to  endeavour  to  formu¬ 
late  anything  like  precise  rules  in  reference  to  the  applica¬ 
tion  of  the  various  operations  on  the  kidney  to  which  I  have 
briefly  referred;  they  are  at  present  comparatively  new  to 
us,  and  we  must  occupy  ourselves  in  cautiously  moving  in 
the  direction  they  indicate,  and  in  collecting  experience, 
rather  than  in  drawing  conclusions  other  than  very  general 
ones. 

Amongst  many  valuable  contributions  to  the  literature  of 
this  subject  which  have  appeared,  I  would  include  one  by 
Dr.  R.  P.  Harris  ( American  Journal  of  the  Medical  Sciences , 
July,  1882),  of  Philadelphia,  which  contains  an  analysis  of 
one  hundred  cases  of  nephrectomy.  From  this,  as  well  as- 
other  communications  which  have  more  recently  been  pub¬ 
lished  in  this  country,  we  may  draw  at  least  three  conclusions 
of  value,  so  far  as  the  operation  of  extirpation  of  the  kidney 
is  concerned.  These  are  : 

1.  That  nephrectomy  has  been  the  means  of  saving  many 
lives  under  circumstances  where  no  other  method  of  treat¬ 
ment  was  likely  to  be  of  service ; 

2.  That  this  operation  has  been  practised  in  cases  where 
the  probability  of  a  successful  termination  appeared  to  be 
very  remote ;  and 

3.  That  a  method  of  effecting  the  removal  of  the  organ 
different  from  that  which  was  selected,  or  a  procedure  less 
heroic,  might,  in  some  instances,  have  tended  to  increase  the 
chances  of  success. 

In  these  directions,  then — in  selecting  cases  for  operation, 
in  rejecting  others  as  unsuitable,  and  in  determining  rela¬ 
tively  to  the  case  in  question  the  best  method  of  procedure, 
— I  take  it  that  good  work  has  yet  to  be  done. 

It  appears  to  me  that  among  the  difficulties  we  have  to 
contend  with  in  the  application  of  nephrectomy,  two  stand 
out  prominently  :  (1)  the  kidney  it  is  proposed  to  remove  may 
be  the  only  one ;  (2)  the  opposite  organ  may  be  similarly 
affected,  though  in  a  less  degree,  yet  sufficient  to  interfere 
with  those  compensatory  changes  being  carried  out  which 


Kedical  Times  and  Gazette. 


BRITISH  MEDICAL  ASSOCIATION. 


Augu.U,  1883.  121 


are  essential  when  one  excretory  organ  has  to  supply  a  lack 
of  service  on  the  part  of  another.  The  literature  of  this 
subject  will  already  be  found  to  illustrate  the  class  of  diffi¬ 
culties  to  which  I  am  referring. 

The  lesser  proceedings,  which  include  the  exploration  of 
the  kidney,  and  the  removal  of  calculi  and  of  pent-up  fluid, 
are  necessarily  attended  with  a  diminished  risk,  and  have 
already  proved  of  much  value. 

In  undertaking  a  new  class  of  operations,  we  must  bear 
in  mind  the  past  history  of  many  methods  of  treatment,  now 
justly  regarded  as  successes,  but  which,  severally,  had  a 
very  unpromising  commencement.  Look  at  the  unsatis¬ 
factory  position  held  by  ovariotomy  only  within  a  period 
represented  by  the  memory  of  the  majority  of  us  here  pre¬ 
sent  to-day.  Yet  the  high  dignity  to  which  it  has  been 
raised  in  the  rank  of  surgical  operations,  by  the  skill  and 
enterprise  of  Sir  Spencer  Wells,  Keith,  and  others,  is  now 
frankly  and  fully  admitted  by  the  whole  medical  world. 

In  the  treatment  of  certain  affections  of  the  bladder,  we 
shall  find  that  much  progress  has  been  made,  and  that  the 
way  has  recently  been  opened  for  prosecuting  other  im¬ 
portant  advances.  These  will  be  chiefly  illustrated  by  the 
•modern  practice  of  lithotrity  and  the  treatment  of  tumours 
and  intracystic  growths. 

Till  a  few  years  since,  the  removal  of  stone  from  the 
bladder  by  crushing  had  been  conducted  on  the  lines  laid 
•down  by  Civiale  some  half-century  ago.  Though  this  method 
•of  proceeding  has  included  amongst  its  advocates,  past  and 
present,  surgeons  of  eminence,  it  cannot  be  said  that,  as 
Then  practised,  it  was  either  gaining  ground  or  confidence. 
Indeed,  I  think  I  may  say  that  there  was  an  increasing- 
tendency  to  limit  its  application  and  to  substitute  lithotomy 
in  all  cases  but  those  of  the  simplest  kind.  The  mortality 
consequent  upon  the  retention  of  broken  calculi  within  the 
bladder  was  sufficient  to  induce  all  but  the  most  ardent 
•admirers  of  lithotrity  to  hesitate  to  give  it  the  preference 
•over  a  proceeding  in  which,  whatever  might  be  the  risks, 
there  was  at  least  a  guarantee  that  the  whole  of  the  stone 
had  been  removed. 

Whilst  the  surgical  mind  was  thus  to  some  extent  in 
doubt  as  to  the  limits  to  which  the  crushing  operation  of 
atone  might  safely  be  pushed,  two  important  communica¬ 
tions  followed  rapidly  upon  each  other.  That  both  of  them 
should  have  emanated  from  America  merely  indicates  that 
the  desire  to  advance  the  art  of  surgery  is  not  limited  to 
the  old  country,  but  is  a  natural  outcome  of  advancing 
civilisation  and  humanity. 

The  first  of  these  papers  was  by  Dr.  Otis,  of  New  York, 
who  demonstrated  beyond  all  reasonable  doubt,  and  in  a 
manner  which  had  not  previously  been  attempted,  that  the 
male  urethra  was  capable  of  safely  receiving  far  larger  in¬ 
struments  than  were  generally  employed.  Following  upon 
this,  and  probably  influencing  the  views  of  the  author,  came 
Dr.  Bigelow’s  paper  on  the  removal  of  stone  from  the  bladder 
by  crushing  and  withdrawing  it  at  a  single  operation  ;  the 
latter  communication  clearly  showing  that  the  bladder  was 
tolerant  of  much  more  prolonged  manipulation  than  had 
previously  been  believed. 

It  appears  to  me  that  the  originality  of  Bigelow  in  no 
way  detracted  from  the  importance  of  the  work  that  had 
previously  been  done  in  this  country  and  elsewhere,  or  com¬ 
promised  the  acumen  of  those  who  were  most  interested  in 
the  progress  of  this  department  of  surgery. 

That  Bigelow’s  method  of  procedure  is  a  great  step  in 
advance — that  it  has  extended  the  limits  of  lithotrity  and 
curtailed  those  of  lithotomy— there  cannot  be  the  least  doubt. 
But  to  suppose  that  it  is  capable  of  universal  application,  or 
ever  likely  to  be  so,  is  as  unreasonable  as  to  suppose  that 
the  art  of  surgery  in  no  way  differs  from  the  art  of  adminis¬ 
tering  Holloway’s  pills.  But  does  the  lithotrity  of  to-day 
represent  the  finality  of  its  perfection  ?  I  trow  not.  When 
we  consider  what  chemistry,  electricity,  and  other  agencies 
are  doing — how  physical  force  is  in  many  directions  being 
supplanted  by  other  means, — can  we  doubt  that  there  are 
yet  improvements  in  store  in  the  methods  of  effecting  the 
destruction  of  concretions  within  the  body  ?  Nay,  are  there 
not  already  significant  indications  that  such  improvements 
are  nigh  at  hand  ?  Is  it  likely  that  the  fruit  of  the  labours 
of  Garrod,  of  William  Roberts,  of  Ord,  of  Vandyke  Carter, 
and  others  has  been  already  gathered  ?  May  not  a  more 
perfect  knowledge  of  the  physical  and  physiological  laws 
which  regulate  the  production  of  concretions  in  the  human 


body  result  in  enabling  us  not  only  more  surely  to  prevent 
them,  but  to  destroy  them  ? 

Considering  the  great  activity  that  has  within  recent 
years  been  shown  in  demonstrating  the  preventable  nature 
of  many  diseases,  and  the  energy  that  has  been  displayed 
in  grappling  with  them,  it  seems  remarkable  that  no 
adequate  steps  should  have  been  taken  to  ameliorate  the 
hygienic  condition  of  certain  parts  of  this  country  where  the 
amount  of  calculous  disease  is  excessive,  and  the  inhabitants, 
consequently,  are  exposed  to  an  inordinate  risk  of  contract¬ 
ing  it.  The  admirable  address  by  Mr.  Cadge  before  our 
Association  at  Norwich,  in  1874,  furnishes  abundant  data 
for  the  further  prosecution  of  inquiries  of  this  kind.  I  can¬ 
not  help  thinking  that  if  it  could  be  shown  to  be  even 
probable  that  the  dogs,  cats,  rabbits,  or  frogs  of  the  afore¬ 
said  districts  were  inconvenienced  in  a  like  manner  with 
their  owners,  the  matter  would  long  ago  have  been  forced 
upon  our  Legislature  with  all  the  exaggeration  that  usually 
characterises  agitations  of  this  kind. 

Though  surgery  has  invariably  shown  itself  equal  to  the 
circumstances  and  emergencies  with  which  it  has  been 
called  to  cope— though  the  prevalence  of  stone  in  a  district 
has  always  been  compensated  for,  as  far  as  this  is  possible, 
by  the  appearance  of  those  most  competent  to  deal  with  it — 
these  are  no  reasons  why  such  conditions  should  be  per¬ 
mitted  to  continue.  Had  time  or  occasion  offered,  I  think 
it  would  not  be  difficult  to  prove  that  circumstances,  either 
'fortuitous  or  by  design,  have  been  found  to  exercise  a 
marked  influence  in  diminishing  or  increasing,  in  certain 
places,  the  tendency  to  calculous  disease. 

One  word  in  reference  to  lithotomy  before  I  leave  the 
subject  of  stone.  There  is  no  great  operation  in  surgery, 
I  believe,  which  furnishes  more  successful  results  than  this. 
Taking  the  experience  of  the  two  hospitals  in  this  city  with 
which  I  have  been  associated,  I  find  there  have  been  within 
my  recollection  102  cases  of  lithotomy  in  persons  of  all  ages, 
but  chiefly  in  children,  and  operated  on  either  by  my  col¬ 
leagues  or  by  myself.  In  ouly  five  of  these  cases  could  I 
ascertain  that  a  fatal  result  followed.  My  late  esteemed 
friend,  and  our  former  associate,  Mr.  Southam,  speaking  of 
his  own  experience  of  lithotomy  at  Manchester,  informed 
me  that  he  had  operated  120  times,  and  could  only  recall 
one  death.  In  the  great  majority  of  the  Liverpool  cases 
the  stones  were  not  exceedingly  large,  and  I  have  no  doubt 
that  many  of  them  might  have  been  removed  by  lithotrity. 
I  question,  however,  whether  the  small  mortality  these 
figures  indicate  would  thereby  have  been  still  further  dimi¬ 
nished,  even  if  the  calculation  were  made  on  a  basis  corre¬ 
sponding  with  the  most  successful  statistics  in  lithotrity 
that  have  hitherto  been  obtained. 

Passing  to  tumours  of  the  bladder,  it  is  not  surprising, 
seeing  what  has  been  done  for  tumours  of  the  ovaries, 
uterus,  and  intestines,  by  Sir  Spencer  W ells,  Keith,  Lawson 
Tait,  Treves,  and  others,  that  growths  occupying  the  inte¬ 
rior  of  the  bladder  should  have  received  special  attention. 
Though  the  literature  relating  to  this  subject  has  been  of 
a  somewhat  fragmentary  character,  such  compilations  as 
Stein’s  recent  work,  “  A  Study  of  Tumours  of  the  Bladder,” 
conclusively  show  that  some  gratifying  results  have  already 
been  attained  in  both  sexes.  The  great  distress  connected 
with  this  class  of  growths,  the  uncertainty  as  to  the  precise 
nature  of  the  affection  in  the  first  instance,  and  subse¬ 
quently  the  kind  of  symptoms  that  accompany  it,  have 
naturally  suggested  the  employment  of  means  having  for 
their  object  their  removal  by  operation. 

Sir  Henry  Thompson  has  done  good  service  in  giving 
prominence  to  the  employment  of  digital  exploration  of  the 
bladder,  and  in  furnishing  illustrations  of  the  great  advantage 
that  this  proceeding  is  capable  of  affording  in  suitable  cases. 

From  a  consideration  of  some  of  the  extremely  valuable 
records  which  have  been  published  by  various  surgeons, 
where  the  bladder  has  been  opened  for  the  removal  of 
tumours,  it  appears  to  me  that  it  might  have  been  better 
had  the  operative  proceeding  terminated  with  the  detection 
and  exploration  of  the  growth  by  the  finger.  The  chief 
dangers  which  experience  has  shown  to  be  liable  to  attend 
the  performance  of  this  class  of  operations,  are  : 

1.  The  chance  of  rupturing  a  bladder,  the  coats  of  which 
have  been  rendered  less  resisting  than  natural. 

2.  The  provocation  of  a  haemorrhage  which  it  has  been 
found  difficult  to  control. 

3.  An  incomplete  removal  of  the  growth. 


122 


Medical  Times  and  Gazette. 


BRITISH  MEDICAL  ASSOCIATION. 


August  4, 1S83. 


On  the  other  hand,  an  examination  of  many  tumours  of 
this  kind,  of  which  villous  growths  or  tufts  furnish  the  best 
examples,  shows  that  there  is  nothing  in  their  connexions 
or  relations  which  need  necessarily  interfere  with  their  com¬ 
plete  removal.  Precise  information  as  to  the  presence  and 
attachments  of  these  growths  we  may  now  obtain  with  com¬ 
parative  safety.  Whether  their  removal  is  to  follow  upon 
their  discovery  will  be  a  matter  for  further  consideration. 

With  the  view  of  extending  our  knowledge  of  these 
growths,  a  committee  of  this  Association  is  occupied  in 
collecting  information  relating  to  them.  The  report  of  this 
committee  will,  I  hope,  form  the  basis  of  an  interesting  dis¬ 
cussion  in  the  Pathological  Section,  which  will  be  opened  by 
Mr.  Paul. 

I  now  come  to  speak  of  the  prostate,  and  I  shall  do  so  in 
reference  to  the  part  it  takes  in  obstructing  micturition,  for 
the  reason  that  it  is  this  symptom  which,  in  some  form  or 
other,  brings  the  patient  under  our  care.  It  appears  to  me 
that  enlargement  of  the  prostate  is  specially  interesting  to 
us  in  relation  to  its  earliest,  and  to  its  most  advanced,  forms, 
and  it  is  to  these  that  I  shall  more  directly  refer. 

If  we  take  the  obstructive  disorders  of  the  urinary  appa¬ 
ratus,  and  inquire  what  feature  of  them  is  most  detrimental 
to  the  associated  parts,  the  answer  undoubtedly  will  be,  the 
misdirection  of  the  muscular  force  that  is  thereby  entailed. 
How  can  we  explain  the  structural  alterations  which  take 
place  behind  the  obstructed  point,  and  which  manifest 
themselves  in  different  ways,  except  as  the  results  of  uri-  , 
nary  retention  and  retrograding  pressure  ?  How  frequently 
do  we  find,  in  cases  of  stricture  or  enlarged  prostate,  that 
the  whole  of  the  apparatus  behind  the  primary  constriction 
consists  of  little  else  than  dilated  saccules  and  tubes  !  Is 
not  this  distinct  evidence  of  back-pressure  going  on,  though 
it  may  be  imperceptible,  from  the  moment  that  impediment 
arises  to  the  escape  of  urine  from  the  bladder  ?  The  more 
we  study  animal  mechanics,  either  in  their  physiological  or 
pathological  application,  the  more  can  we  appreciate  the 
truism  that  force  is  never  lost.  If  it  is  not  permitted  to  act 
for  good,  it  must  be  productive  of  evil ;  if  it  is  not  exerted 
towards  the  legitimate  fulfilment  of  a  normal  act,  it  must 
inevitably  exercise  a  corresponding  pressure  in  an  abnormal 
direction.  Whenever  I  see,  in  the  post-mortem  room,  an 
ordinary  specimen  of  dilated  kidney,  tortuous  ureter,  or 
sacculated  bladder,  associated  with  an  enlarged  prostate  or 
a  stricture,  the  expression  “  misdirected  force  ”  almost 
involuntarily  escapes  from  me. 

Such  considerations  as  these  have  long  led  me  to  believe 
that  our  treatment  of  prostatic  stricture — or  by  whatever 
name  we  know  it — commences,  as  a  rule,  far  too  late ;  we 
delay  until  the  bladder  shows,  by  the  formation  of  a  pouch, 
or  a  saccule,  behind  the  prostate,  the  first  bad  influence  of 
back-pressure  before  we  seek  to  rectify  it. 

I  have  endeavoured  to  prove  how  much  good  may  be  done 
by  the  adoption  of  judicious  mechanical  treatment  on  the 
appearance  of  indications  that  the  prostate  is  commencing 
to  obstruct  micturition,  and  I  have  founded  my  suggestion 
upon  a  condition  which  may  be  seen  illustrated  in  any 
museum — viz.,  one  in  which,  though  the  gland  has  become 
large,  obstruction  has  not  been  known  to  occur.  An  ex¬ 
tended  adoption  of  this  practice  has  convinced  me  that  the 
pressing  symptoms  connected  with  an  enlarging  prostate 
may  be  kept  in  abeyance  by  the  timely  employment  of  those 
principles  of  treatment  which  are  generally  recognised  as 
being  applicable  to  any  tubes  within  the  body  which  are 
threatened  with  occlusion,  and  are  within  our  reach. 

In  the  more  advanced  forms  of  prostatic  enlargement, 
where  the  bladder  has  been  converted  into  a  receptacle  little 
better  than  a  chronic  abscess  in  which  urine  stagnates, 
surgery  has  done  much  to  afford  relief. 

When  the  comfort  that  catheterism  is  capable  of  afford¬ 
ing  has  ceased  to  be  effectual,  other  plans  of  establishing  a 
drain  for  the  urine  are  at  our  disposal.  It  is  not  necessary 
that  I  should  discuss  the  various  means  of  effecting  this ; 
let  me,  however,  say  a  few  words  in  reference  to  two  which 
have  more  recently  come  under  notice ;  these  are — first, 
incision  into  the  bladder  from  the  perineum ;  and,  secondly, 
paracentesis  through  the  enlarged  gland. 

For  the  purpose  of  securing  a  more  or  less  permanent 
channel  for  the  escape  of  urine  from  the  bladder,  other  than 
by  the  urethra,  I  must  admit  that,  following  the  practice  of 
Syme,  and  to  some  extent  of  Edward  Cock,  I  have  a  decided 
preference  for  an  incision  through  the  perineum,  on  the 


twofold  ground  of  safety  and  comfort.  We  have  had 
numerous  examples  of  the  great  benefit  that  cystotomy  is 
capable  of  affording  for  bladder  affections  dependent  upon 
a  large  prostate — none  perhaps  more  striking  than  the  case 
narrated  by  Mr.  Lund,  on  the  memorable  occasion  of  the 
meeting  in  London  of  the  International  Medical  Congress. 
The  paper  closes  with  this  observation :  “  I  have  thus 
placed  on  record  this  case,  unique  in  its  character,  and  in¬ 
teresting  and  encouraging  in  its  results,  with  the  hope  that, 
should  a  similar  case  occur  to  any  surgeon  now  present,  he 
will  not  hesitate  to  give  his  patient  the  chance  of  benefit 
from  a  course  of  procedure  so  simple  in  its  nature,  'and  so 
likely  to  be  followed  by  temporary,  if  not  permanent,  bene¬ 
fit.” — “Transactions  of  the  International  Medical  Congress,” 
vol.  ii. 

I  may  be  permitted  here  to  submit  to  your  notice  a  method 
of  puncturing  the  bladder  through  the  enlarged  prostate 
which  has  afforded  very  gratifying  results.  It  consists  in 
passing  the  trocar  through  the  gland,  and  retaining  it  in  the- 
perineum,  so  as  to  afford  a  permanent  as  well  as  a  con¬ 
venient  drain  for  the  urine.  I  should  have  had  more  diffi¬ 
dence  in  commending  this  operation  to  your  notice  had  it 
not  received  the  approval  of  our  distinguished  associate. 
Professor  Gross,  whose  contributions  to  the  surgery  of  the- 
urinary  organs  are  held  in  deservedly  high  repute  on  both 
sides  of  the  Atlantic. 

Though  the  primary  object  of  cystotomy,  as  usually  prac¬ 
tised,  is  merely  to  place  the  bladder  at  rest  by  providing  a 
continuous  drain  for  the  urine  as  well  as  the  products  of 
cystitis,  it  occurred  to  me,  as  it  had  already  done  to  others, 
that  it  would  be  possible  to  extend  this  proceeding,  with  the 
view  of  removing  those  barriers  to  micturition  which  the 
hypertrophied  gland  so  frequently  presents. 

It  was  to  meet  conditions  such  as  these  that  Mercier- 
introduced  and  practised  division  of  the  prostatic  bar  by 
means  of  a  cutting  instrument  introduced  along  the  urethra. 
This  plan,  though  admirable  in  its  conception,  was  open  to 
the  objection  that  in  its  execution  it  was  necessarily  un¬ 
certain,  there  being  no  means  of  surely  ascertaining  that 
the  section  was  confined  to  the  obstruction  to  be  removed. 
On  carefully  considering  the  position  of  matters,  as  well  as 
the  proposals  that  had  been  made,  it  appeared  to  me  more 
reasonable  to  attempt  to  divide  the  prostatic  obstruction  at 
the  neck  of  the  bladder  from  an  opening  made  into  the 
membranous  urethra,  than  by  means  of  instruments  which 
had  to  traverse  the  whole  length  of  the  canal.  I  have 
recently  brought  under  notice  a  case  ( British  Medical 
Journal,  June  9,  1883)  in  which  I  thought  it  desirable  to 
explore  the  prostatic  urethra  from  an  opening  made  in  the 
perineum,  and  through  which  I  was  enabled  to  divide  with 
precision  a  prostatic  barrier.  The  division  of  this  portion 
of  the  gland  was  followed  by  complete  restoration  of  the- 
power  of  micturition,  and  has  so  far  proved  of  permanent 
advantage. 

The  proceeding  which  I  have  thus  put  into  practice  seems- 
first  to  have  suggested  itself  to  Mr.  Guthrie,  but  I  cannot 
find  that  he  ever  employed  it.  That  it  is  not  identical  with 
the  somewhat  extensive  incision  of  the  prostate  as  for  lateral 
lithotomy,  which  was  practised  by  Sir  William  Blizard,  is 
at  once  obvious.  Its  aim  is  to  divide  the  obstruction— and 
the  obstruction  alone — by  an  opening  so  planned  as  not  to 
expose  the  patient  to  undue  risk  ;  whilst,  "at  the  same  time, 
it  is  capable  of  affording  the  greatest  amount  of  room  for 
manipulation  by  an  extension  of  the  incision,  should  this  be- 
found  to  be  necessary. 

I  need  hardly  observe  that  a  proceeding  of  this  kind  should 
be  undertaken  before  the  bladder  has  passed  into  a  condi¬ 
tion  of  confirmed  and  irremediable  atrophy;  otherwise,, 
though  we  may  succeed  in  removing  an  obstacle  to  the  in¬ 
troduction  of  the  catheter,  our  prospect  of  restoring  the 
power  of  micturition  will  be  as  hopeless  as  it  has  proved  to 
be  under  somewhat  similar  circumstances  where  the  operation, 
of  lithotomy  has  been  undertaken. 

It  is  impossible  to  avoid  the  conclusion,  from  their  exa¬ 
mination  after  death,  that  many  atonied  bladders  might 
have  been  prevented  becoming  so  by  the  timely  removal  of 
the  obstruction  by  which  a  condition  of  permanent  paralysis 
was  induced  and  maintained. 

The  operative  treatment  of  the  enlarged  prostate,  when 
it  obstructs  micturition  to  a  degree  that  cannot  be  met  by 
judicious  catheterism,  is  yet,  I  believe,  open  to  considerable 
I  improvement. 


.Medical  Times  and  Gazette. 


BRITISH  MEDICAL  ASSOCIATION. 


August  4, 1883.  12  3 


Though  the  literature  relating  to  either  complete  or 
partial  excision  of  the  prostate  is  very  limited,  there  is  much 
in  it  of  promise.  In  one  case,  where  I  extirpated  the  whole 
gland  for  malignant  disease,  the  benefit  that  followed  far 
exceeded  my  expectations.  It  was  that  of  a  middle-aged 
man,  who,  by  reason  of  a  carcinomatous  prostate,  was 
threatened  with  a  speedy  and  painful  death.  I  cut  down 
upon  the  gland  in  the  median  line,  and  succeeded  in  enu¬ 
cleating  it  tolerably  cleanly  with  my  finger.  I  saw  this 
patient  eight  months  afterwards  in  very  fair  health,  and 
•quite  able  to  go  about  his  business.  So  far,  he  has  enjoyed 
an  immunity  from  the  symptoms  which  induced  me  to  per¬ 
form  this  operation ;  and,  though  his  disease  is  a  malignant 
•one,  we  have  every  reason  to  be  content  with  the  results 
•obtained. 

Then  we  have  numerous  examples  where  considerable 
masses  of  the  prostate  have  been  removed  with  very  great 
advantage  in  the  course  of  operations  on  the  bladder. 
Amongst  these  I  would  specially  mention  an  important 
case  by  Mr.  Bickersteth  (Royal  Medical  and  Chirurgical 
Society,  1882),  and,  more  recently,  another  by  Dr.  John 
Ashhurst,  of  Philadelphia,  in  which  the  whole  of  an  enlarged 
third  lobe  was  successfully  removed. 

Cases  such  as  these  seem  to  favour  the  hope  that  operative 
surgery  will  be  found  capable  of  affording  more  relief  in 
exceptional  instances  of  this  kind,  and  of  extending  to  the 
large  prostate  the  treatment  which  in  some  degree  is 
applicable  to  other  deep-seated  growths. 

Passing  to  the  urethra,  I  would  again  take  the  opportunity 
of  adverting  to  the  value  of  Otis’s  work  in  regard  to  the 
dimensions  and  dilatability  of  this  canal ;  if  he  had  done 
no  more  than  contribute  to  the  improvement  of  lithotrity — 
and  this  cannot  be  questioned— we  should  still  be  largely 
in  his  debt.  I  cannot,  however,  follow  him  in  his  views 
•relating  to  the  performance  of  internal  urethrotomy  as  a 
means  of  treating  stricture  of  the  urethra.  My  impression 
is,  that  this  operation  is  losing  instead  of  gaining  ground 
in  the  opinion  of  many  who  have  ample  opportunities  of 
judging  fairly  of  its  merits.  That  it  is  an  operation  fitted 
for  the  treatment  of  stricture  in  its  early  stage  is  a  con¬ 
clusion  I  am  disposed  to  take  exception  to,  on  the  ground 
that  it  is  neither  necessary  nor  safe  as  compared  with  other 
methods.  I  believe  that,  in  its  early  stage,  stricture  may 
be  successfully  combated  by  the  employment  of  thorough 
cleanliness  combined  with  the  judicious  use  of  dilatation, 
•as  we  are  accustomed  to  practise  it  in  this  country. 

If  internal  urethrotomy  gave  a  greater  immunity  than 
other  operations  from  a  recurrence  of  stricture,  or  did  away 
with  the  necessity  for  subsequent  mechanical  dilatation, 
"then,  perhaps,  with  the  view  of  avoiding  other  risks  to  which 
all  persons  suffering  from  stricture  are  liable,  I  might  feel 
more  disposed  to  employ  it ;  but,  as  such  is  not  the  case,  and 
the  risk  attending  its  performance  is  not  inconsiderable,  I 
cannot  concede  the  importance  which  is  claimed  for  it  by  its 
more  ardent  admirers.  That  internal  urethrotomy  in  some 
cases  is  a  necessity — as  by  it  we  are  enabled  to  render  amen¬ 
able  to  treatment  a  stricture  hitherto  intractable — I  am 
willing  to  admit;  but  to  recommend  it  as  capable  of  effecting 
a  permanent  cure  is  quite  another  thing. 

The  treatment  of  impassable  stricture  of  the  urethra  has 
received  an  important  addition  by  the  practice  which  Mr. 
Wheelhouse  has  introduced,  the  great  credit  of  which  he 
seems  desirous  rather  of  sharing  with  his  surgical  colleagues 
than  of  appropriating  to  himself,  as  I  see  he  always  refers  to 
it  as  the  “  Leeds  operation.”  Like  other  conditions  which 
may  be  spoken  of  as  relative  to  something  else,  rather  than 
as  fixed  or  defined,  the  impassable  stricture  is,  I  believe, 
gradually  becoming  rarer — a  circumstance  which  is  largely 
due  to  the  great  improvement  that  has  taken  place  in  the 
construction  of  instruments  specially  adapted  to  their  treat¬ 
ment,  amongst  which  I  may  mention  the  filiform  bougies 
and  the  tunnelled  instruments  of  Gouley,  of  New  York. 
For  the  purpose  intended,  I  do  not  think  there  is  any  pro¬ 
ceeding  equal  to  that  which  Mr.  Wheelhouse  has  introduced ; 
and  I  have  no  hesitation  in  including  it  amongst  the  im¬ 
provements  to  which  I  am  now  referring. 

Permit  me,  without  apology,  in  this  mechanical  age,  where 
invention  after  invention  for  the  treatment  of  stricture  comes 
upon  us  with  marvellous  rapidity,  to  claim  a  moment’s  con¬ 
sideration  for  what  Mr.  Savory  has  called  the  medical  aspect 
•of  this  question.  We  all  know  what  irritation  is  :  there  is 
.such  a  thing  as  irritation  of  a  stricture,  either  by  what  passes 


through  it  naturally  or  is  introduced  to  correct  it.  Let  us 
not  disregard,  as  a  principle  of  our  treatment,  the  importance 
of  securing  for  the  urethra  that  physiological  rest  of  which 
the  late  Mr.  Hilton  wrote  so  well. 

The  question  may  here  very  properly  be  asked,  whether, 
in  our  search  for  novelties  as  improvements  in  treatment, 
we  have  discovered  any  new  diseases,  the  better  manage¬ 
ment  of  which,  by  reason  of  our  recent  acquaintance  with 
them,  we  may  in  all  fairness  leave  to  our  descendants  to 
determine.  The  admirable  Bradshawe  Address  of  Sir  James 
Paget  will,  no  doubt,  have  the  effect  of  quickening  our 
perceptions  in  this  direction. 

Though  I  cannot  point  to  any  discoveries  of  this  kind  as 
affecting  the  region  which  is  now  occupying  our  atten¬ 
tion,  I  may  note  one  gratifying  result  of  extended  clinical 
and  pathological  investigation  :  I  refer  to  the  j  uster  assign¬ 
ment  of  symptoms  to  the  causes  producing  them — symp¬ 
toms  which,  not  very  long  ago,  were  looked  upon  as  consti¬ 
tuting  independent  diseases.  But,  if  we  have  not  discovered 
any  new  diseases,  we  must  remember  that  varying  circum¬ 
stances  may  at  one  time  add  intensity  to  some  disorders, 
and  considerably  modify  the  progress  of  others.  I  have  a 
strong  impression  that  the  times  through  which  we  are 
passing,  characterised  as  they  are  by  the  production  of  great 
and  continuous  nerve -tension,  have  brought  into  prominence 
a  state  of  brain-strain  which  is  apt  to  show  itself  in  any 
organ  which  may  happen  to  be  deranged  or  is  overtaxed. 

A  recent  author  seemed  rather  to  conclude  that  tension  of 
this  kind  was  most  injuriously  felt  and  shown  by  our 
American  cousin,  whilst  the  Britisher,  for  some  reason  or 
other,  was  less  influenced  in  this  manner.  Whether  this  be 
so  or  not,  I  am  not  prepared  to  decide,  but  I  am  disposed  to 
believe  that  purely  nervous  affections — affections  associated, 
as  far  as  we  can  determine,  with  no  obvious  structural 
alteration — are  more  common  than  they  used  to  be.  That 
they  occasion  much  distress,  and  cause  persons  who  suffer 
from  them  to  be  unduly  apprehensive,  will  be  generally 
admitted.  Nay,  further,  by  their  mimicry  of  more  certain 
diseases,  they  induce  a  condition  of  anxiety  which  is  often 
intolerable.  It  is  well,  too,  to  bear  in  mind  that  the  in¬ 
terpretation  of  symptoms,  as  also  their  prevention  and 
amendment,  are  frequently  to  a  large  extent  dependent 
on  a  recognition  of  the  possible  existence  in  a  patient  of 
exaggerated  nerve-tension. 

Before  an  audience  of  this  kind  it  would  be  presumptuous 
on  my  part  to  indicate  in  detail  the  many  improvements 
that  have  taken  place  in  the  treatment  of  surgical  disorders 
of  the  urinary  organs ;  further,  where  there  have  been  so 
many  contributors  toward  this  progress  it  would  be  invidious 
for  me  to  particularise. 

Let  me,  however,  in  common  fairness  to  those  to  whom 
we  are  much  indebted,  say  one  word  in  reference  to  the 
advance  that  has  been  steadily  made  in  the  construction  of 
the  means  and  appliances  used  for  these  purposes. 

I  can  remember  some  instruments  which  five-and-twenty 
years  ago,  or  even  less,  were  regarded  as  improvements,  but 
have  now  passed  into  obscurity  or  to  the  shelves  of  the 
museum.  In  no  department  of  applied  mechanics  has  greater 
perfection  been  obtained  than  by  the  surgical  mechanician, 
and  nowhere  is  this  better  illustrated  than  in  the  instruments 
employed  in  the  treatment  of  urinary  diseases. 

It  seems  almost  ungenerous,  after  referring  to  several 
proceedings  of  an  operative  kind,  the  doing  of  which  entails 
pain  and  involve  risk  for  the  sake  of  advantages  to  follow, 
that  I  should  allow  to  pass  unnoticed  the  work  of  those  who 
have  removed  the  one  and  lessened,  the  other.  In  chloro¬ 
form  and  anaesthetics  we  have  a  priceless  boon,  without 
which  surgery  would  long  ago  have  been  at  a  standstill, 
and  many° persons  now  living  in  comfort  and  enjoyment 
would  ere  this  have  ceased  to  exist.  I  am  not  old  enough 
to  remember  the  pre-anaesthetic  age,  and,  therefore,  am 
unable  to  draw  a  contrast  which  will  be  a  vivid  one  to  some 
of  the  “  elder  brethren”  I  am  addressing  to-day.  I  am 
reminded,  however,  of  an  incident  bearing  upon  such  a 
contrast,  which,  with  your  permission,  I  will  briefly  relate. 

Some  two  years  ago,  a  sea-captain,  a  patient  of  mine,  and 
by  no  means  a  bad  amateur  doctor,  on  returning  from  sea, 
told  me  somewhat  gleefully  that  he  had  successfully  performed 
an  amputation.  Whilst  his  ship  was  at  Ruruta,  an  uncivi¬ 
lised  island  in  the  South  Pacific,  a  poor  native  got  his  arm 
entangled  in  a  sugar-crushing  machine.  As  there  was  no 
doctor  on  the  island,  my  friend  the  captain  was  summoned. 


124 


Medical  Times  and  Gazette- 


RICHARDSON  ON  THE  COLLAPSE  OF  CHOLERA. 


August  4,  1883. 


and  at  once  saw  the  necessity  for  removing  the  shattered 
fragments  of  the  limb.  The  shrieks  and  straggles  of  the 
powerful  aboriginal  were  most  fearful.  Recognising  the 
necessity  for  taking  steps  to  save  the  man’s  life,  the  captain 
hurried  off  to  his  ship  and  returned  with  the  necessary  im¬ 
plements,  together  with  a  quart  of  the  newest  and  most 
potent  rum.  In  the  absence  of  chloroform,  he  induced  his 
patient  to  swallow  this  fiery  compound,  wineglassful  after 
wineglassful,  until  intoxication  was  induced,  and  subsequently 
profound  alcoholic  insensibility.  Then  the  tourniquet  was 
applied,  and  amputation  successfully  performed.  Recovery 
rapidly  took  place.  So  pleased  was  the  savage  with  the 
effects  of  anaesthesia  that  he  subsequently  offered  to  let  my 
friend  cut  off  some  of  his  toes,  provided  that  the  process  of 
inducing  insensibility  was  repeated. 

Next  in  importance  to  chloroform  and  anaesthetics  are 
those  means  which  have  been  recently  promulgated  for 
diminishing  some  of  the  greater  risks  contingent  upon 
wounds  and  surgical  operations.  About  antiseptics,  I  desire 
to  speak  in  no  uncertain  terms.  Though  our  views  may  not 
be  unanimous,  though  some  of  us  may  be  sceptical  about 
the  import  of  germs,  and  of  sprays,  and  of  other  details, 
can  we  doubt  that  when  the  surgical  historian  of  the  nine¬ 
teenth  century  has  to  recount  the  men  as  well  as  the 
measures  that  have  favourably  influenced  the  progress  our 
art  has  made,  the  name  of  Lister  will  occupy  a  conspicuous 
place  ? 

I  have  now  done.  It  has  not  been  my  ambition  to  hold 
up  to  you  a  golden  calf  ;  to  attempt  to  dress  it  in  flowers  of 
rhetoric,  and  to  ask  you  to  worship  it.  I  have  rather 
endeavoured  to  remind  you  of  some  of  the  directions  in 
which  surgery  is  now  travelling,  and  to  estimate  in  a 
measure  the  pace  at  which  it  is  going.  It  is  impossible  to 
engage  in  a  work  of  this  kind  without  a  full  conviction 
that  though  our  art  is  an  imperfect  one,  it  is  distinctly  a 
progressive  one.  In  the  course  of  your  visit  to  this,  which 
has  been  aptly  referred  to  as  the  second  city  of  the  empire, 
you  will  find  almost  all  the  arts  and  sciences  laid  under 
contribution  for  the  development  of  commercial  enterprise. 
The  activity  displayed  in  the  promotion  of  trade  and 
commerce  will  probably  suggest  the  inquiry  whether  we  are 
constantly  progressive,  whether  we  are  in  correspondence 
with  the  times  in  which  we  live. 

There  need,  however,  be  no  hesitation  in  asserting  that, 
whether  we  are  regarded  as  preventers  of  disease,  or  as 
practitioners  of  medicine  or  of  surgery,  every  one  of  us  in 
his  daily  practice  is  constantly  demonstrating  that  year  by 
year  something  additional  is  contributed  by  our  profession 
to  the  comfort  and  the  life  of  man. 


The  Watercress. — Dr.  Grellety,  of  Vichy,  brought 
before  the  Therapeutical  Society  ( Bulletin ,  June  30)  the 
question  whether  this  popular  article  of  diet  possesses  any 
of  the  depurative  qualities  popularly  attributed  to  it.  He 
is  of  opinion  that  it  does  not,  and  that  it  is  indigestible  to 
most  stomachs.  It  has  acquired  an  undeserved  reputation, 
and  may  be  mischievous  in  the  various  forms  of  dyspepsia. 
— Dr.  Noel  Gueneau  de  Mussy,  however,  is  of  opinion  that 
this  plant  is  possessed  of  real  therapeutical  powers,  and  he 
has  on  many  occasions  derived  advantage  from  it  in  chronic 
cutaneous  affections.  He  recommends  its  being  prepared 
for  the  table  in  the  same  way  as  spinach,  when  it  is  easily 
digested  and  of  a  pleasant  taste.  Or  the  cress  may  be  care¬ 
fully  washed,  cut  up  into  small  pieces,  and  then  submitted  to 
a  press  in  order  that  its  juice  may  be  expressed.  This  is  a 
little  acrid,  but  may  be  corrected  by  syrup  of  bitter  oranges 
or  of  horseradish. — Dr.  Campardon  has  also  found  it  of 
utility  in  dartrous  affections,  as  Dr.  C.  Paul  has  in  several 
cases  of  diabetes. 

Foetid  Feet. — M.  Vieusse,  principal  medical  officer  at 
the  Military  Hospital  at  Oran,  states  that  excessive  sweating 
of  the  feet,  under  whatever  form  it  appears  (whether  as 
mere  hypersecretion,  accompanied  by  severe  pain,  or  with 
foetidity),  can  be  quickly  cured  by  frictions  carefully  con¬ 
ducted  with  the  subnitrate  of  bismuth  ;  and  even  in  the  few 
cases  where  this  suppresses  the  abundant  sweating  only 
temporarily,  it  still  removes  the  severe  pain  and  the  foetidity 
which  often  accompany  the  secretion.  He  has  never  found 
any  ill  consequence  follow  the  suppression  of  the  sweating. 
— Gaz.  Hebd.,  July  27. 


« 

ON  FEEDING  BY  THE  VEINS 
AND  ON  INTRAPERITONEAL  INJECTION 
IN  THE  COLLAPSE  OF  CHOLERA. 

By  BENJAMIN  WARD  RICHARDSON,  M.D.,  F.R.S- 


Many  years  ago,  in  the  pages  of  the  Medical  Times  and 
Gazette,  I  treated  on  the  subjects  named  in  the  above  title,, 
and  now  that  cholera  and  its  medical  scientific  treatment  is 
once  more  under  earnest  consideration,  I  am  glad  to  find' 
that  my  suggestions  are  not  forgotten.  Some  old  friends 
who  still  retain  my  essays  in  their  memory  have  written 
to  ask  me  for  copies  of  them  ;  and  some  new  friends — thanks 
to  Dr.  Neale’s  excellent  Digest  ” — have  made  the  same 
request. 

On  inquiry,  I  find  that  the  essays  are  long  since  out  of 
print,  and  I  trust,  therefore,  I  may  be  excused  for  recasting 
them  in  very  brief  form  for  your  present  readers. 

There  is  one  essay,  published  in  the  Medical  Times  and 
Gazette  for  August  11,  1866,  to  which  I  would  first  refer, 
and  to  which  I  would  append  a  few  new  sentences. 

When  that  paper  was  undergoing  construction,  tw® 
theories — or  perhaps  it  would  be  better  to  call  them  hypo¬ 
theses — were  before  me. 

1.  The  hypothesis  of  Snow,  which  is  better  expressed  in  his 
oration  on  “  Continuous  Molecular  Changes,”  than  even  in 
his  work  on  Cholera,  and  which  supposes  that  cholera  is  due 
exclusively  to  a  living  cell,  which,  passing  off  in  the  excre¬ 
tions  of  the  affected,  is  always  swallowed — usually  through 
water — by  those  who  are  infected,  and  which,  increasing  in 
the  alimentary  canal,  is  the  cause  of  the  extraction  of  water 
and  of  the  subsequent  symptoms  which  distinguish  the- 
disease. 

2.  An  hypothesis  which  I  had  myself  formed,  and  have- 
since  then  called  the  nervous  or  glandular  hypothesis,  and 
which  supposes  that  the  copious  exudation  from  the  alimen¬ 
tary  canal  may  be  due  to  organic  nervous  paralysis  induced 
by  the  action  of  some  morbific  agent  or  influence  on  the 
vital  nervous  centres,  under  which  there  is  profuse  discharge 
from  glandular  structures,  like  to  that  discharge  which 
occurs  from  the  salivary  glands  in  some  forms  of  paralysis, 
or  from  the  skin  in  colliquative  sweating  and  in  sweating 
sickness. 

The  hypotheses  were,  however,  set  aside  for  the  moment, 
in  order  that  the  symptoms  only  should  be  brought  under 
consideration  with  reference  to  treatment.  In  this  study 
I  was  very  much  aided  by  the  researches  I  had  made,  and 
which  also  found  their  way  into  these  columns,  on  the 
influence  of  extreme  cold  on  nervous  activity. 

In  the  main  I  was  led  to  the  conclusion,  which  I  should 
still  maintain,  that  every  fatal  sign  and  every  danger  in 
cholera  is  due  to  the  one  simple  act  of  the  removal  of  water 
from  the  tissues,  and  especially  from  the  nervous  structures; 
to  disturbance  of  nervous  action  by  that  removal ;  and  to 
excessive  reduction  of  heat,  sensible  and  latent,  from  the 
body. 

The  treatment  suggested  during  collapse,  and  based  on 
these  views,  introduced  the  consideration  of  the  plan  of 
feeding  by  the  veins,  and  of  intra-peritoneal  injection. 

The  lines  of  treatment,  as  they  appeared  and,  with  some- 
additions,  appear  to  me,  were  much  the  same  as  should  be 
pursued  in  cases  of  exposure  to  extreme  cold,  where  the 
body  has  been  brought  to  several  degrees  below  the  natural 
standard  of  heat,  and  where,  owing  to  the  cold,  the  surface  of 
the  body  is  blue,  the  blood  all  but  stagnant,  and  the  con¬ 
sciousness  reduced  or  lost.  In  such  a  case  it  would  be  folly 
to  charge  the  affected  person  with  cold  iced  drinks,  for  by 
such  means  the  temperature  of  the  body  would  possibly  be- 
further  reduced.  In  such  a  case  it  would  be  folly  to  plunge 
the  person  into  a  hot  bath,  for  although  there  might,  there¬ 
upon,  be  a  sudden  reaction,  there  would  be  no  source  of  supply 
of  heat,  but  merely  a  heat  shock  or  stroke,  under  which  the 
remaining  vital  powers  would  be  called  into  sudden  activity, 
to  cease  directly  in  death — the  glacial  form  of  inaction  and 
rigidity,  which  is  not  of  necessity  fatal,  being  transformed 
into  the  pectous  change,  or  true  rigor  mortis  of  the  nervous, 
vascular,  and  muscular  fluids,  from  which  there  is  no  known 


Medical  Times  and  Gazette. 


August  4,  1883.  125 


RICHARDSON  ON  THE  COLLAPSE  OF  CHOLERA. 


mode  of  resolution.  In  such  a  case  it  would,  as  it  seemed 
to  me,  he  also  useless  to  place  the  affected  person  in  the  hot¬ 
air  hath,  because  exposure  to  heated  air,  under  conditions  in 
which  the  capacity  of  the  blood  to  circulate  freely  is  lost, 
would  only  tend  to  increase  the  danger  of  coagulation  of  the 
blood  in  the  body,  and,  by  quickening  evaporation  of  water 
from  the  respiratory  surfaces,  to  intensify  the  exhaust  of 
water  from  the  body. 

The  first  point  of  practice  in  the  collapse  was,  then,  I 
thought,  to  place  the  sufferer  in  a  medium  temperature,  not 
below  50°  and  not  above  60°  Fahr.,  so  that  neither  the  chill¬ 
ing  action  of  cold  nor  the  exhausting  action  of  heat  should 
exert  a  destructive  influence ;  though  heat,  I  ta,ke  it,  is 
really  the  more  dangerous  of  the  two — a  suspicion  which 
the  experience  of  cholera  in  tropical  temperatures  too  fully 
confirms. 

The  next  point  of  practice  in  the  stage  of  collapse,  which 
was  suggested  as  the  most  rational,  was  that  of  feeding. 
Anyone  who  has  seen  many  cases  of  cholera  will  recall  that, 
notwithstanding  the  vomiting,  the  patient  may,  by  careful 
attention,  be  made  to  take  by  the  month  a  very  large 
quantity  of  fluid.  I  have,  myself,  succeeded  in  administer¬ 
ing  a  quart  of  fluid  per  hour  to  the  person  stricken  with 
cholera ;  and  as  the  complaint  of  thirst  is  a  common  com¬ 
plaint  there  is  never  much  difficulty  in  the  persuasion. 

The  fluid  to  be  supplied  should,  I  held,  on  all  rational 
grounds,  be  one  that  shall  fulfil  two  purposes.  It  should  not 
make  the  body  cooler  by  extracting  heat,  it  should  not  pro¬ 
duce  local  reaction  by  instant  excess  of  heat ;  but  it  should 
be  supplied  after  it  has  been  raised  from  fifteen  to  twenty 
degrees  above  the  animal  temperature.  I  had  often  seen 
vomiting  re-excited  after  that  symptom  had  considerably 
decreased  from  the  simple  process  of  administering  a  drink 
too  heated  or  too  stimulating. 

So  much  for  the  warmth  of  the  fluid  supplied ;  next,  as  to 
the  nature  of  it. 

One  of  the  old  school  of  London  physicians.  Dr.  Walsham, 
whose  long  practice  had  made  him  less  confident  than  his 
Fellows  in  the  use  of  drugs,  created  some  surprise  during  the 
great  epidemic  of  1832  by  stating  his  opinion  that  he  had 
seen  more  success  from  the  free  administration  of  chicken- 
broth  in  cholera  than  from  any  other  mode  of  treatment.  I 
do  not  doubt  that  in  a  large  run  of  cases  this  simple  plan  of 
treatment  would  be  attended  with  excellent  results.  But  in 
1866  I  endeavoured  to  act  on  a  better  principle  than  this  by 
inventing  a  food  which,  rendered  soluble  by  heat,  should  not 
only  supply  colloidal  food,  but  should  yield  up  heat  to  the 
body  after  it  was  taken,  during  the  time  that  it  would  be 
cooling  within  the  body. 

Taking  advantage  of  the  fact  that  crvstallisable  fat  when 
mixed  with  albumen  can  be  dissolved  by  the  heat  of  water, 
which  heat  it  fixes  in  becoming  soluble,  and  gives  up  again 
on  solidifying,  I  set  to  work  to  produce  a  food  having  the 
properties  named.  After  numerous  attempts  the  following 
proved  most  successful : — 

Take  of  pure  stearine  two  ounces  by  weight ;  of  best  fresh 
butter,  two  ounces  ;  of  whites  and  yolks  of  eggs,  well  beaten 
up,  eight  ounces;  of  carbonate  of  soda,  twenty  grains; 
of  common  salt,  eighty  grains ;  of  distilled  water,  two 
ounces. 

In  preparation  for  food,  first  dissolve  with  heat  the  stearine 
and  the  butter  until  they  are  both  melted,  then  add  the 
carbonate  of  soda  and  common  salt  to  the  eggs,  and  when 
these  salts  are  dissolved  in  the  egg-fluid,  mix  it  with  the 
oily  fluid,  taking  care  that  the  latter  is  not  of  a  temperature 
above  140°  Fahr.  Let  the  whole  cool  to  a  soft  consistence, 
and  finally,  on  a  slab  or  a  board,  rub  in  the  water  with  a 
broad  spatula.  The  compound  may  now  be  placed  in  a  wide¬ 
mouthed  jar ;  in  a  little  time  it  settles  into  a  moderately 
hard  mass,  and  is  ready  for  use. 

In  administering  this  compound,  take  one  ounce,  place 
it  in  a  large  breakfast  cup,  and  rub  it  up  equally  with  a 
teaspoonful  of  glycerine  or  a  teaspoonful  of  honey.  Next 
pour  upon  the  mass  three  ounces  of  distilled  water,  actually 
boiling,  and  incorporate  well.  The  solid  substance  will  now 
quickly  and  evenly  dissolve,  and  will  be  at  once  so  cool  that 
it  can  be  taken  as  a  pleasant  drink,  like  a  broth  in  flavour. 
The  thermometer  plunged  in  it  at  once  will  only  register  from 
130°  to  135°  Fahr.  In  this  process  the  heat  of  the  boiling 
water  has  been  mainly  (allowance  must  be  made  for  con¬ 
duction  and  radiation)  expended  in  rendering  fluid  the  solid 
matter.  We  may  estimate  safely,  that  in  addition  to  the 


sensible  heat,  44°  have  been  rendered  latent  for  every  ounce 
fluid  at  least,  which  heat  will  be  gradually  yielded  up  within 
the  body. 

Contrasted  with  the  supply  of  a  pint  of  ordinary  water 
at  40°,  I  estimated  that  a  pint  of  this  fluid  would  effect  a 
difference  equal  in  value  to  204°  Fahr. 

Feeding  by  the  Veins. 

When  feeding  by  the  mouth  is  impossible,  the  next  indica¬ 
tion  in  the  stage  of  collapse  is  to  feed  by  the  veins.  In 
using  this  term  I  wish  to  make  a  difference  between  mere 
injection  of  the  veins  with  watery  fluid  and  feeding  by  the 
veins.  My  proposition  was,  and  is,  to  feed — to  feed  in  the 
same  way,  as  nearly  as  can  be  imitated,  as  the  venous 
system  is  fed  in  health  from  the  alimentary  canal  through  the 
thoracic  duct — slowly  and  steadily,  so  as  to  supply  food  as 
well  as  water. 

Up  to  this  time  we  have  been  content  to  inject  warm 
saline  solutions  into  the  veins.  The  results  have  been  often 
astounding,  almost  always  delusive.  In  some  instances  it 
has  seemed  as  if  the  injection  has  restored  the  dead  to  life, 
but  the  collapse  has  only  too  surely  recurred.  In  a  case 
which  I  attended  with  the  late  Mr.  Ansell  and  Dr.  (after¬ 
wards  Sir)  John  Cormack,  in  1854,  we  injected  into  the 
veins  of  a  collapsed  woman  two  pints  of  warm  saline  solu¬ 
tion  four  successive  times,  and  each  time  with  the  effect  of 
restoring  her  from  apparent  death  to  consciousness  and 
power  of  movement,  thus  evidently  extending  her  life 
over  thirty  hours,  but  only  for  her  to  die  at  last  actually 
ex-sanguine. 

The  reason  why  certain  immediate  but  not  lasting  benefits 
have  followed  these  injections  is,  that  they  have  been  injected 
after  the  fluids  used  have  been  heated  up  to,  or  above,  blood- 
heat  ;  the  heat  thus  supplied  has  been  the  underlying  basis 
of  the  transient  success.  Any  experimentalist  can  prove 
this  by  injecting  the  solutions  into  the  systems  of  animals 
killed  by  chloroform  and  immediately  exposed  to  intense 
cold.  He  will  find  himself  able  to  reproduce  general  mus¬ 
cular  movements  with  the  solutions  named,  equally  well 
with  each,  if  they  are  heated  to  the  same  degree,  i.e.,  from 
106°  to  115°  Fahr.  He  will  find  them  all  equally  negative 
if  they  are  not  thus  raised  in  temperature.  Hence,  we  must 
consider  the  question  of  transfusion  in  a  new  light,  or  success 
will  continue  to  be  temporary,  and  nothing  more. 

[To  he  continued.') 


Health  of  the  City  of  Glasgow. — At  the  usual 
fortnightly  meeting  of  the  Glasgow  Town  Council  it  was 
stated  that  the  death-rate  last  week  had  fallen  to  22,  and 
that  the  city  is  in  a  much  more  satisfactory  condition  than 
it  has  been  for  some  time.  The  Health  Committee  had  placed 
themselves  in  communication  with  the  harbour  authorities 
both  in  Glasgow  and  Greenock  with  a  view  to  the  prevention 
of  cholera,  and  the  shipping  entering  the  river  was  being 
carefully  watched. 

Reparation  of  Fractures  in  the  Subjects  of 
Diabetes. — Prof.  Verneuil  having  related  to  the  Academie 
de  Medecine  ( Bulletin ,  July  24)  some  cases  of  fracture  with 
defective  union  in  diabetes  (in  continuation  of  former  com¬ 
munications  on  the  relations  which  exist  between  trau¬ 
matic  injuries  and  general  diseases),  concludes  as  follows : 
— 1.  The  delay  or  absence  of  consolidation  in  these  three 
cases  of  fracture  would  seem  to  be  referable  to  the  dyscrasia 
recognised  to  exist  in  diabetes.  2.  This  delay  or  absence  of 
consolidation  necessarily  implies  a  delay  or  suppression  of 
reparatory  power,  a  special  form  of  nutrition.  3.  Whence 
we  may  conclude  that  diabetes,  when  it  impedes  or  prevents 
the  formation  of  callus,  leads  to,  if  it  even  does  not  directly 
cause,  the  diminution  or  suppression  of  nutrition. 

Quassine. — M.  Vigier  states  ( Gazette  Htbdomadaire , 
July  27)  that  quassine  is  a  very  reliable  medicine,  and  that 
the  amorphous  quassia  isnowprepared  in  avery  pure  manner, 
and  possesses  all  the  properties  of  crystallised  quassine, 
while  it  is  much  cheaper  and  more  easily  administered. 
The  crystallised  quassine  acts  so  energetically  that  even 
a  few  milligrammes  cause  very  disagreeable  sensations  in 
the  throat.  The  amorphous  form  should  be  given  in  pills, 
two  grammes  being  combined  with  nine  grammes  of  an 
excipient  and  formed  into  100  pills,  of  which  two  or  three 
are  to  be  taken  daily. 


MEDICAL  AND  SUEGICAL  PEACTICE. 


August  4,  1S83. 


1 

Medical  Times  and  Gazette . 


EEPOETS  OF 

HOSPITAL  PRACTICE  IN  MEDICINE 
AND  SURGERY. 


THE  MIDDLESEX  HOSPITAL. 


CASES  OF  EXTEENAL  MEDIAN  UEETHEOTOMY 
UNDEE  THE  CAEE  OF  ME.  H.  MOEEIS. 

( Concluded  from  page  92.) 

Case  3. — Enlarged  and  Engorged  Prostate — Retention  of 

Urine — Severe  Haemorrhage  into  Bladder — Median  Ure¬ 
throtomy — Recovery. 

[From  notes  by  tlie  Dresser,  E.  H.  Freeland.] 

William  L.,  aged  sixty-six,  bootmaker,  admitted  into 
Broderip  ward,  January  1,  1883. 

History. — Patient  states  that  about  twelve  months  ago  he 
first  experienced  some  difficulty  in  passing  water.  He  had 
attended  a  funeral  and  had  gone  a  long  way  to  it,  and  on 
returning  he  attempted  to  micturate,  after  holding  his  urine 
with  an  effort  for  some  time.  He  could  not  pass  water, 
however,  though  he  strained  a  long  while  and  had  an  ardent 
desire  to  do  so.  A  catheter  had  to  be  used,  and  blood  was 
drawn  off  with  the  urine.  After  this  he  recovered  the  power 
to  micturate,  but  his  urine  continued  bloody  for  a  day 
or  two.  Since  that  time,  he  says,  he  has  had  a  more 
frequent  desire  to  pass  water  than  he  used  to  have,  and  this 
has  been  greatly  aggravated  during  the  last  three  months. 
The  stream  of  urine  has  been  gradually  getting  smaller. 
Three  months  ago  he  had  an  attack  of  retention  similar  to 
the  first,  and  again  blood  was  passed  in  his  urine.  The 
frequency  of  micturition  has  been  increasing  up  to  the 
present  time.  He  has  been  under  treatment  at  intervals  as 
an  out-patient  during  the  last  twelve  months,  and  catheters 
have  been  passed  at  various  times.  A  few  days  ago,  whilst 
at  a  friend’s  house,  he  experienced  a  sudden  desire  to  pass 
water,  which,  however,  he  was  quite  unable  to  do.  He  again 
applied  for  relief  at  the  hospital,  and  has  continued  to  come 
to  have  a  catheter  passed  daily  since  then. 

State  on  Admission. — Eetention  of  three  hours’  dura¬ 
tion.  Hypogastric  dulness  and  pain  extending  to  umbilicus. 
Several  unsuccessful  attempts  had  been  made  to  pass  a 
catheter,  giving  rise  to  considerable  haemorrhage.  After  a 
warm  bath  and  a  full  dose  of  opium,  he  succeeded  in  passing 
some  highly  blood-charged  urine. 

January  2. — A  No.  5  catheter  was  passed  about  3  p.m., 
and  a  quantity  of  dark  brown  ammoniacal  urine  drawn  off. 
The  catheter  was  tied  in  until  12  p.m.,  when,  being  clogged, 
it  was  removed,  and  a  No.  12  gum-elastic  prostatic  catheter 
passed  with  ease.  A  quantity  of  bloody,  offensively- smelling 
urine  was  again  evacuated.  It  was  clear  that  there  was  a 
very  large  amount  of  blood  in  his  bladder,  and  that  bleeding 
was  still  goiug  on.  Ext.  ergotse  liq.  5  j.  4tis  horis. 

3rd. — About  4.30  p.m.  a  No.  12  gum-elastic  catheter  was 
passed,  and  about  fifteen  ounces  of  thick,  blood-stained 
urine  drawn  off.  A  digital  examination  per  rectum  re¬ 
vealed  an  enlarged  prostate,  and  the  question  arose  as  to 
whether  the  bleeding  was  due  to  a  congested  prostate  or  to 
a  growth  in  the  bladder.  It  seemed  most  likely  to  come 
from  the  enlarged  and  irritated  prostate.  Urine  :  Specific 
gravity  1020 ;  acid ;  bloody,  thick,  dark  red ;  copious  deposit ; 
microscopical  examination  shows  pus  and  blood.  To-night 
a  flexible  india-rubber  catheter  was  passed,  and  not  left  in 
the  bladder.  Feels  easier;  sleeps  and  takes  his  food  well. 

;  4th. — At  12  p.m.  a  No.  8  silver  catheter  was  passed,  and 
about  a  pint  of  almost  black  urine  drawn  off  ;  it  was  very 
offensive,  and  more  viscid  than  yesterday.  At  midnight  a 
catheter  was  again  passed,  and  a  quantity  of  thick  urine 
drawn  off.  The  patient  was  becoming  exhausted,  and  it 
was  clear  that  if  the  bleeding  and  spasmodic  pain  continued 
he  would  soon  sink;  moreover,  the  use  of  the  catheter 
seemed  to  aggravate  the  bleeding. 

5th. — At  2  p.m.  patient  was  taken  to  the  theatre  and 
placed  under  the  influence  of  an  anaesthetic.  After  putting 
him  in  the  lithotomy  position,  a  grooved  staff  was  passed 
down  the  urethra,  and  an  incision  was  then  made  on  this 
through  the  median  line  of  the  perineum,  about  one  inch 
in  length  and  three-quarters  of  an  inch  in  front  of  the 
anus.  The  staff  was  then  removed,  but  no  urine  flowed 
from  the  wound.  By  a  digital  examination  it  was  impossible 


to  reach  the  interior  of  the  bladder,  because  of  the  large 
size  of  the  prostate.  A  gum-elastic  catheter  was  then 
passed  through  the  wound  into  the  bladder,  and  a  quantity 
of  thick,  dark  urine  drawn  off.  A  metal  sound  was  next 
passed,  but  nothing  could  be  detected.  A  No.  12  gum- 
elastic  catheter  was  tied  in  the  bladder,  and  a  tube  attached 
to  it  carried  off  the  urine  to  a  vessel  beneath  the  bed. 
Supp.  morphia  gr.  ss.  statim  ;  evening  temperature  102  6°. 

Gth. —  3  a.m.  :  Temperature  99 '2° ;  pulse  89.  Urine  :  Sixty 
ounces  run  off ;  still  bloody,  but  a  little  lighter  in  colour, 
and  gives  less  deposit ;  contains  pus  and  bacilli  as  well 
as  blood.  Slept  well  last  night ;  feels  comfortable ;  no  pain. 

10th. — Tube  removed  from  the  bladder  yesterday.  Did 
not  sleep  much  last  night.  Complains  of  pain  at  the  root 
of  his  penis  on  trying  to  pass  his  urine.  Seems  better. 
Pulse  84.  His  bladder  was  relieved  last  night  at  10.30,  and 
again  this  morning,  by  a  catheter  introduced  through  the 
wound ;  this  gave  him  a  good  deal  of  pain  for  a  few  minutes. 
Temperature  99 •  6°. 

12th. — Urine  drawn  off  at  10  a.m. ;  less  smoky ;  still 
offensive.  Catheter  tied  in  bladder  again,  but  he  did  not 
retain  it  long. 

17th. — Passes  urine  of  his  own  accord  through  his  peri¬ 
neum,  but  with  some  pain.  Catheter  (passed  through  the 
wound)  still  used  at  night. 

22nd. — Passes  water  more  easily  through  his  perineum; 
no  pain. 

24th.— Now  has  control  over  his  water,  which  he  passes 
through  the  wound.  Has  complete  control  over  his  bladder. 
Expresses  himself  as  much  better  than  before  the  operation. 
Urine  is  not  offensive. 

25th. — Catheter  left  off  at  night  for  first  time  yesterday. 
Passes  water  easily ;  looks  and  feels  well ;  still  passes  water 
through  perineum. 

26tli. — Last  night  he  passed  water  through  the  natural 
channel,  very  little  coming  through  incision  in  perineum ; 
feels  much  better.  Catheter  again  passed  through  the 
wound  last  night.  Urine  clear — straw-coloured. 

31st.— Catheter,  which  hitherto  had  been  passed  daily, 
has  not  been  passed  since  27th.  Has  no  pain,  and  passes 
water  freely  through  perineum.  Is  gaining  flesh. 

Discharged,  looking  a  very  different  man  to  when  he 
entered  the  hospital.  Urine  perfectly  normal.  Has  gained 
strength,  and  expresses  himself  as  being  in  a  much  better 
state  than  before  the  operation.  For  several  weeks  he  came 
once  a  week  to  hospital  to  have  a  catheter  passed  through 
the  opening  in  his  perineum,  as  it  was  thought  desirable  to 
keep  it  pervious.  In  March,  as  he  felt  his  bladder  so  well, 
he  desired  that  the  wound  should  be  allowed  to  close,  and 
he  undertook  to  pass  a  full-sized  catheter  for  himself,  per 
urethram,  once  or  twice  a  week.  Since  April  the  perineal 
wound  has  been  closed,  and  he  remains  quite  well  and 
comfortable. 

Remarks. — When  admitted,  it  was  stated  that  he  had 
stricture  of  the  urethra,  and  no  catheter  could  be  passed  on 
account  of  the  spasm  ;  there  had  been  much  loss  of  blood 
per  urethram.  I  found,  however,  that  a  full-sized  catheter 
could  be  easily  introduced ;  but  as  four  days  passed, 
and  I  had  myself  to  catheterise  him  twice  daily,  and  the 
haemorrhage  was  still  going  on,  I  decided  to  establish  a 
shorter  and  easier  route  to  the  bladder.  The  operation  of 
median  urethrotomy  would,  I  considered,  by  making  cathe- 
terisrn  simple  and  less  irritating  to  the  bladder  and  prostate, 
tend  to  stop  the  bleeding  if  due  to  engorgement  of  that 
organ  ;  and  besides,  would  enable  me  to  explore  the  bladder 
with  my  finger,  and  satisfy  any  doubts  as  to  whether  a 
foreign  body  or  a  tumour  was  the  source  of  bleeding.  The 
first  point  was  gained,  and  the  result  was  all  that  could 
be  desired ;  but  the  digital  exploration  of  the  bladder 
ivas  an  impossibility.  Yet  the  man  was  tall  and  spare,  and 
had  a  well-shaped  pelvis,  of  only  average  depth.  It  ivas 
the  very  considerable  enlargement  of  the  prostate  which 
prevented  my  finger-tip  getting  to  the  neck  of  the  bladder  ; 
but  the  favourable  termination  of  the  case  cleared  away  all 
doubts  as  to  the  simple  character  of  the  source  of  the 
haemorrhage. 

Case  4. — Calculus  in  a  Diverticulum  of  the  Bladder — Cystitis 
— Median  External  Urethrotomy — Convalescence. 

William  B.,  aged  forty-three,  an  engraver,  was  admitted 
on  May  7,  1883,  by  the  request  of  a  medical  friend. 

History. — Patient  stated  that  he  had  had  a  gradually 


Medical  Times  and  Gazette.  PRESENT  ASPECT  AND  FUTURE  PROSPECTS  OP  MEDICINE.  August  4,  is®.  127 


increasing  weakness  of  the  bladder  since  January,  and  that 
on  going  to  bed  one  night  in  February  he  was  unable  to  pass 
his  water  at  all,  but  during  the  night  he  voided  it  little  by 
little.  He  continued  to  micturate  at  frequent  intervals, 
but  a  month  later  he  had  complete  retention  for  twelve 
hours,  for  which  he  went  into  St.  Thomas’s  Hospital,  where 
he  was  sounded  very  carefully  for  stone,  and  treated  for 
cystitis.  After  leaving  the  hospital  he  voided  some  small 
gravel-like  deposits — some  of  which  were  hard  and  some 
soft — in  his  urine.  He  returned  to  St.  Thomas’s,  and  was 
again  sounded.  He,  however,  had  been  getting  worse,  and 
his  desire  to  pass  water  had  increased  as  the  urine  became 
thicker. 

On  Admission.— I  found  the  patient  crippled  and  deformed, 
his  left  thigh  having  been  amputated  through  the  junction  of 
the  middle  and  upper  thirds,  his  pelvis  much  tilted,  and  his 
right  thigh  anchylosed  in  a  partially  flexed  and  strongly 
adducted  position  from  old  hip- joint  disease.  He  had  a  con¬ 
stant  desire  to  pass  urine,  with  difficulty  in  doing  so ;  and  pain 
in  the  hypogastrium.  He  micturated,  on  an  average,  every 
hour  and  a  half,  passing  each  time  about  three  ounces  of 
very  thick  (about  half  deposit  on  standing),  offensive  urine, 
of  specific  gravity  1020,  of  alkaline  reaction,  and  contain¬ 
ing  pus  and  ammoniaco-magnesian  phosphates  and  large 
quantities  of  bacteria. 

Mr.  Morris  suspected  stone,  and  wished  to  sound  him, 
but  the  patient  objected,  as  he  had  been  quite  recently 
sounded  by  two  distinguished  surgeons,  and  nothing  was 
found.  Examined  per  rectum,  the  prostate  was  found  en¬ 
larged,  but  nothing  could  be  felt  in  the  bladder.  Daily 
irrigation  of  the  bladder  through  a  full-sized  flexible  rubber 
catheter,  rest  in  bed,  and  the  usual  dietetic  and  medicinal 
treatment,  were  ordered. 

For  several  days  he  improved;  the  urine  became  acid, 
the  frequency  of  micturition  and  the  amount  of  muco-pus 
diminished,  but  he  still  complained  of  a  pain  in  passing 
water,  and  spasm  in  the  urethra. 

These  symptoms  increasing,  he  was  persuaded  to  have 
median  urethrotomy  performed.  The  membranous  urethra 
was  accordingly  divided  on  a  staff  on  June  12,  when  the 
bladder  was  washed  out ;  but  it  was  found  impossible, 
owing  to  the  enlarged  prostate,  and  the  great  depth  of  the 
perineum,  to  reach  the  bladder  with  the  finger.  There  was 
some  smart  haemorrhage  from  the  wound,  which  recurred 
in  the  evening  after  the  operation,  but  which  was  easily 
controlled  by  a  little  well-adjusted  pressure  applied  around 
the  tube  which  had  been  left  in  the  bladder.  He  was  greatly 
relieved  by  the  operation,  and  slept  several  hours  right  off 
during  the  nights. 

On  June  18  the  catheter  was  removed,  and  its  end 
found  coated  with  phosphates.  During  the  night  and  next 
morning,  however,  he  passed  some  of  his  urine  through  the 
penis,  in  consequence  of  which  a  catheter  was  re-introduced. 
In  doing  this  Mr.  Morris  felt  the  walls  of  the  contracted 
bladder ;  but  on  slightly  shifting  the  catheter  it  passed  on 
easily  for  some  distance,  and  struck  what  seemed  like  a 
stone ;  but  as  the  catheter  was  not  a  metal  one,  no 
characteristic  sound  was  elicited. 

On  June  20  an  anaesthetic  was  again  given,  and  a  straight 
sound  introduced  through  the  wound  into  the  bladder,  the 
walls  of  which  were  contracted  ;  but  at  one  spot  on  the  pos¬ 
terior  aspect  the  sound  could  be  made  to  slip  onwards  a  long 
distance,  and  at  once  a  distinct  proof  of  a  stone  was  gained. 
An  effort  was  made  to  extract  the  stone  with  a  pair  of  long 
slender  forceps,  so  as  to  obviate  a  further  incision  of  the 
urethra,  but  a  firm  grip  could  not  be  got  by  them.  It 
therefore  became  necessary  to  enlarge  the  deep  part  of  the 
wound.  With  a  little  coaxing  Mr.  Morris  could  now  pass 
his  finger  well  into  the  bladder  and  touch  the  stone,  which 
had  been  drawn  to  the  base  of  the  bladder.  With  a  full- 
sized  straight  lithotomy-forceps  the  stone  was  then  ex¬ 
tracted.  It  proved  to  be  a  mulberry  calculus  with  several 
very  pointed  offshoots,  and  weighed  sixty-six  grains.  The 
man  at  once  had  almost  complete  relief. 

He  has  convalesced  very  slowly,  but  is  now  able  to  sit  up 
and  get  about  the  ward.  No  catheterism  has  been  employed 
since  the  operation,  but  the  wound,  which  is  still  open,  has 
been  daily  irrigated.  Nearly  all  the  urine  is  still  discharged 
through  the  wound,  and  it  is  well  that  it  keeps  open,  as,  after 
such  a  very  severe  and  protracted  cystitis,  his  bladder  for  the 
time  being  is  all  the  better  for  prolonged  rest. 

Remarks. — It  needed  some  little  scheming  to  pass  a  rigid 


catheter  along  a  urethra  so  much  disturbed  in  its  curves  by 
the  fixed  adduction  of  the  thigh  and  the  tilting  of  the  pelvis. 
For  the  same  reason  there  was  much  difficulty  in  fully 
manipulating  a  sound  in  his  bladder.  This,  together  with 
the  fact  that  the  calculus  was  lodged  in  a  recess  of  the 
bladder,  rendered  the  detection  of  the  stone  impossible 
until  the  sound  was  passed  through  the  perineal  wound. 
Knowing  the  result  of  previous  soundings,  and  the  very 
highly  irritable  and  contracted  state  of  the  bladder,  I  did 
not  do  more  than  introduce  a  tube  at  the  time  of  opening 
his  urethra ;  but  the  first  time  I  passed  a  catheter  through 
the  wound  its  course  was  almost  direct  to  the  pouch  in 
which  the  stone  lay.  Thus  the  operation  made  it  possible 
to  detect  the  cause  (here  obscure)  of  the  cystitis,  and  to 
remove  it.  Though  there  is  reason  to  think  the  patient  is 
the  subject  of  disease  of  the  kidneys,  which  may  prevent  his 
restoration  to  perfect  health,  there  can  be  no  doubt  as  to  the 
benefit  he  has  derived  from  “  external  median  urethrotomy.” 

N.B. — Attention  may  here  be  drawn  to  the  great  advan¬ 
tage  in  this  and  such-like  cases  of  the  use  of  German  moss- 
peat  for  pillows,  upon  which  the  patient’s  buttocks  rest 
whilst  the  urine  drains  into  the  peat.  The  peat  has  great 
power  of  fixing  ammonia,  and  absorbs  about  eight  times  its 
weight  of  water.  It  has  for  many  months  been  largely 
used  in  the  wards  of  the  Middlesex  Hospital. 


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- - 

THE  PEESENT  ASPECT  AND  FTJTHEE  PEOSPECTS 
OF  MEDICINE. 

In  medicine,  as  in  other  branches  of  science,  using  the  word 
in  its  widest  sense,  all  progress,  in  order  to  be  sure  and  last¬ 
ing,  must  be  built  on  a  firm  basis  ;  none  other  can  withstand 
the  searching  inquiry  of  experience.  All  real  advance,  then, 
in  medicine  is,  we  may  take  it,  mainly  the  result  of  a  correct 
appreciation  of  the  labours  of  our  predecessors  and  a  due 
apportionment  of  their  respective  merits.  An  annual 
meeting  naturally  suggests  a  review  of  what  has  been  ac¬ 
complished  not  only  during  the  preceding  year,  but  also  of 
all  the  work  that  has  been  done  up  to  that  date  ;  it  affords 
a  convenient  opportunity  for  abstracting  from  that  work  all 
that  is  new,  and  inviting  special  attention  to  it  in  the  future  • 
and  lastly,  it  forms  a  fitting  occasion  for  looking  forward  and 


28 


Medic»l  Times  and  Gazette. 


ARSENIC  IN  CERTAIN  FORMS  OF  ANAEMIA. 


August  4,  1883. 


anticipating  the  progress  that  may  not  unreasonably  be 
hoped  for. 

At  the  annual  meeting  of  the  British  Medical  Association 
now  being  held  in  Liverpool,  the  new  President  chose  for  his 
subject  the  Present  Aspect  and  Future  Prosperity  of  Medi¬ 
cine.  It  is  a  subject  which  affords  no  little  ground  for  satis¬ 
faction.  Our  standard  of  medical  education  is  higher  than  it 
has  ever  been  before ;  many  of  the  great  problems  are  being 
vigorously  attacked ;  the  uncertainty  of  our  knowledge  on 
many  important  points  is  deeply  felt,  and  is  stirring  up  men  to 
great  efforts  to  remedy  it.  One  great  cause  of  all  this  has  been, 
as  Dr.  Waters  justly  observes,  the  introduction  of  instruments 
of  precision  into  our  practice — the  stethoscope,  microscope, 
thermometer,  ophthalmoscope,  laryngoscope,  and  sphygmo- 
graph  having  furnished  us  with  means  by  which  the  senses 
may  be  placed  in  immediate  relation  with  the  actual  pheno¬ 
mena  of  disease,  phenomena  which  may  be  of  the  most  simple 
character,  and  yet  so  indicative  of  the  general  morbid  state  as 
to  be  intelligible  almost  to  anyone.  The  stethoscope  has  now 
become  such  a  sine  qua  non  to  a  medical  man  that  it  is  hard 
to  realise  that  fifty  years  ago  it  had  hardly  found  its  way 
into  this  country,  even  to  our  metropolitan  schools  ;  for,  like 
most  great  discoveries  and  improvements,  it  was  treated 
with  much  contempt  by  those  who  considered  that  they  had 
always  got  on  very  well  without  it.  The  thermometer  has 
won  for  itself,  with  perhaps  less  opposition,  a  position  of 
almost  equal  importance.  It  is  doubtful  whether  the 
ophthalmoscope,  laryngoscope,  or  sphygmograph  will  ever 
come  into  very  general  use  :  their  employment  necessitates 
the  cordial  co-operation  of  the  patient,  and  special  training 
on  the  part  of  the  practitioner ;  and  even  those  who  are  most 
enthusiastic  as  to  their  value  would  not  wish  to  class  them 
as  equal  in  importance  to  the  stethoscope  and  thermometer. 
Turning  to  the  subject  of  treatment.  Dr.  Waters  reminded 
his  audience  that,  after  all,  these  improved  methods  of 
diagnosis  owed  their  chief  value  to  the  more  scientific  and 
more  rational  lines  of  treatment  to  which  they  more  or  less 
directly  led  the  way ;  for  although  much  of  our  treatment  is 
still  purely  empirical,  yet  there  is  decidedly  less  empiricism 
now  than  there  was  fifty  years  ago ;  and,  indeed,  it  requires 
but  little  consideration  to  see  that  this  must  of  necessity  be  the 
case.  Rational  treatment  can  proceed  only  from  clear  views 
of  the  nature  of  the  disease  to  be  treated,  and  nothing  has  done 
so  much  to  remodel  and  reform  the  whole  system  of  treatment 
as  Laennec’s  grand  work,  the  introduction  of  the  stethoscope. 
In  our  own  day,  what  with  the  rapid  means  of  communica¬ 
tion  between  all  parts  of  the  world,  and  the  readiness  with 
which  knowledge  is  diffused  by  the  medium  of  societies  and 
medical  journals,  it  is  not  to  be  expected  that  any  one  man 
will  be  able  to  give  to  the  world  anything  that  can  equal  in 
utility  the  stethoscope ;  but  the  germ  theory  of  disease  has 
already,  at  the  hands  of  Mr.  Lister,  been  productive  of 
benefit  to  thousands,  and  probably  even  more  so  on  the  Con¬ 
tinent  than  in  our  own  country.  The  researches  of  M. 
Pasteur,  in  a  kindred  subject,  seem  likely  to  bid  fair  to 
abolish  some  of  the  most  fatal  disorders  of  the  lower 
animals,  and  will  thus  indirectly,  and,  it  is  to  be  hoped, 
directly  also  at  no  very  distant  date,  benefit  the  human 
race. 

Looking  on  for  half  a  century.  Dr.  Waters  foretold  that 
his  successor  in  the  presidential  chair  would  have  many 
triumphs  to  record.  Improved  methods  of  research  and 
new  instruments  of  diagnosis  there  will  doubtless  be.  The 
work  of  collective  investigation,  so  recently  inaugurated,  will 
by  that  time,  if  ever,  have  borne  fruit ;  and  we  shall  know 
something  more  of  the  beginnings  of  real  disease,  and  be  able 
to  distinguish  with  greater  certainty  than  at  present  between 
functional  disturbance  and  organic  disease.  Many  missing 
links  between  physiology  and  pathology  will  then  have 


been  supplied ;  and  we  shall  know  the  exact  relation  of 
micro-organisms  to  disease,  whether  cause  or  effect — a  point 
on  which  we  certainly  lack  conclusive  evidence  at  present. 
And  whilst  looking  forward  to  the  attainment  of  these  re¬ 
sults  (and  it  seems  impossible  to  doubt  but  that  some  day 
they  will  be  reached)  we  are  naturally  tempted  to  peer  much 
further  into  futurity,  and  try  to  picture  to  ourselves  the 
time  when  many  of  our  most  common  diseases  shall  have 
become  unknown.  Syphilis,  for  instance,  is  a  disease  that 
should  disappear  altogether — provided,  that  is,  that  Govern¬ 
ments  do  not  always  keep  open  minds  on  the  subject;  typhoid 
fever  and  diphtheria,  and  perhaps  all  the  zymotic  diseases, 
will  then  have  been  rendered  impossible  occurrences ;  and 
gout,  cirrhosis  of  the  liver,  and  Bright’s  diseases  will  only 
be  known  by  book-learning.  If  the  speculations  of  our  own 
time  prove  well  founded,  tubercle,  and  perhaps  cancer,  sar¬ 
coma,  et  id  genus  omne,  will  be  as  unheard  of  then,  as  the 
sweating  sickness  of  the  time  of  Caius  is  now.  When  that 
happy  age  arrives,  it  is  probable  that  people  will  have  given 
up  eating  and  drinking  too  much,  and,  on  the  other  hand, 
everyone  will  have  enough.  When  that  stage  has  been 
reached  there  will  be  nothing  for  the  medical  man  to  do 
but  deal  with  the  effects  of  accident  or  unexpected  changes 
of  climate ;  and  there  will  then  hardly  be  the  same  urgent 
necessity  for  a  representative  in  the  Upper  House,  which 
at  present  appears  to  be  so  acutely  felt  in  some  quarters. 


THE  VALUE  OF  ARSENIC  IN  CERTAIN  FORMS 
OF  ANfiEMIA. 

A  vert  interesting  communication,  f<On  the  Arsenical 
Treatment  of  Leukaemia,  Pseudo-Leukaemia,  and  Progres¬ 
sive  Pernicious  Anaemia,  with  some  Remarks  on  the  Mutual 
Relation  of  these  Diseases,”  is  given  by  Dr.  F.  W.  Warf- 
vinge,  of  Stockholm,  in  a  recent  number  of  the  NordisJd 
Medicinslct  ArJciv.  It  appears  that  in  the  space  of  little 
more  than  four  years  since  the  Hospital  of  Sabbatsberg, 
in  Stockholm,  has  been  open,  there  have  been  under 
treatment  in  that  institution  no  less  than  eleven  cases 
of  progressive  pernicious  anaemia,  and  the  same  number 
of  pseudo-leukaemia,  but  only  two  of  leukaemia,  thus  show¬ 
ing  that  the  two  former  diseases  are  relatively  common 
in  Stockholm,  and  that  they  are  much  more  common  than 
leukaemia.  The  two  cases  of  leukaemia,  seven  cases  of 
pseudo-leukaemia,  and  seven  of  progressive  pernicious 
anaemia  were  treated  with  arsenic  by  Dr.  Warfvinge  with 
the  following  results.  One  of  the  cases  of  leukaemia  was 
of  a  slightly  advanced  lymphatic  form,  and  the  patient 
was  able  to  leave  the  hospital  after  an  arsenical  treat¬ 
ment  of  three  months’  duration  (internally  and  by  in¬ 
jection).  He  presented  all  the  appearances  of  perfect 
cure :  the  lymphatic  glands  had  returned  to  their  normal 
dimensions,  and  the  number  of  white  globules  was  reduced 
to  the  ordinary  proportion.  The  other  case  was  of  a  very 
advanced  splenic  form,  with  an  enormous  spleen,  and  the 
number  of  white  globules  was  equal  to  the  red  ones.  The 
spleen  was  considerably  reduced  in  size  under  an  arsenical 
treatment  of  twelve  weeks’  duration,  the  number  of  white 
globules  was  reduced  to  the  proportion  of  one  to  ten,  and 
the  general  health  improved  at  the  same  time.  But  the 
cure  was  slow,  and  was  only  a  little  advanced  when  the 
patient,  a  feeble  girl,  sixteen  years  old,  wished  to  return 
home.  A  few  injections  of  Fowler’s  solution,  made  in  the 
spleen  towards  the  end  of  the  treatment,  were  perfectly 
innocuous. 

In  the  cases  of  pseudo-leukaemia,  the  arsenical  treatment, 
which  lasted  only  a  few  days,  was  nearly  ineffectual  in  two 
instances,  one  of  the  patients  not  wishing  to  remain  in  the 


Medical  Times  and  Gazette. 


SAVE  US  FROM  OUR  FRIENDS  ! 


Augrst  4,  lc83.  1  29 


hospital,  and  the  diagnosis  in  the  other  being  made  only  a 
few  days  before  death.  In  the  remaining  five  cases  the 
result  was  more  favourable.  In  one  of  them,  in  which 
iodide  of  iron  had  been  ineffectually  administered,  and  the 
Sachexia  and  marasmus  had  reached  an  extreme  degree, 
the  arsenical  treatment  for  five  weeks  produced  a  remark¬ 
able  progressive  improvement.  At  the  end  of  this  time  the 
patient  presented  the  appearance  of  excellent  health,  had  a 
voracious  appetite,  very  good  muscular  strength,  the  spleen 
was  normal,  and  there  were  only  insignificant  remains  of 
hypertrophy  of  the  glands,  and,  besides,  the  number  of  red 
corpuscles  had  increased.  Unfortunately,  six  months  after 
the  patient  had  gone  home  from  the  hospital  into  the 
couptry,  where  he  lived,  he  had  a  relapse  which  ended  in 
death.  In  another  case  the  arsenic  also  produced  a  remark¬ 
able  effect  on  the  hypertrophy  of  the  glands.  This  was 
particularly  the  case  after  arsenical  injections  into  the 
glandular  parenchyma,  the  effect  of  which  was  very  striking, 
the  diminution  of  the  swellings  being  rapid  and  consider¬ 
able,  but  confined  to  the  glands  which  were  injected.  The 
patient,  who  suffered  all  the  time  from  asthma,  had  occa¬ 
sionally  severe  attacks  of  suffocation,  and  died  in  one  of  them, 
caused,  as  was  shown  at  the  autopsy,  by  the  presshre  of  the 
mediastinal  glands,  which  were  much  swollen  and  had  not 
undergone  reduction  like  those  which  were  reached  by  the 
injections.  In  two  other  less  severe  cases  of  lymphatic 
pseudo-leukaemia  the  beneficial  effect  of  the  arsenic  was  un¬ 
questionable  ;  the  use  of  this  remedy  for  from  three  to  five 
months  produced  a  slow  diminution  of  the  swellings,  and 
such  a  decided  amelioration  of  the  general  health  that  the 
patients  on  their  discharge  from  the  hospital  appeared  per¬ 
fectly  well.  In  the  fifth  case,  a  lymphatic  pseudo-leukaemia 
with  marked  hypertrophy  of  the  glands  of  the  neck  and 
mediastinum  together  with  general  prostration,  the  internal 
use  of  arsenic  reduced  the  glandular  swellings  and  brought 
about  a  satisfactory  general  condition,  which  has  lasted  for 
a  year. 

Of  the  cases  of  pernicious  progressive  anaemia,  one  rapidly 
became  worse  for  a  week  during  which  iron  was  adminis¬ 
tered  :  the  anaemia  and  cachexia  had  decidedly  increased,  and 
the  number  of  red  corpuscles  had  diminished  ;  but  after  the 
employment  of  arsenic  there  was  uninterrupted  improve¬ 
ment,  which  was  so  well  marked  that  at  the  end  of  two 
months  the  patient,  being  regarded  as  cured,  ceased  to  take 
the  arsenic,  but  on  the  next  day  after  its  discontinuance  he 
was  attacked  with  violent  acute  nephritis  terminating  in 
death.  The  autopsy  proved  the  total  absence  of  the  ordi¬ 
nary  signs  of  pernicious  anaemia.  In  another  case  the 
patient  came  to  the  hospital  almost  in  a  dying  state,  and 
died  in  six  days  in  spite  of  arsenical  treatment ;  but  it 
appeared  that  at  an  early  period  of  the  affection  there  had 
been  a  decided  improvement  on  two  occasions  under  the  use  of 
small  doses  of  arsenic.  In  the  third  case  iron  had  been  un¬ 
successfully  employed  together  with  other  tonics,  but  on  the 
administration  of  arsenic  there  was  a  continuous  improve¬ 
ment.  The  red  globules  in  three  weeks  had  been  increased 
threefold,  and  at  the  end  of  four  months  they  were  eight 
times  more  numerous ;  but  two  months  afterwards  there 
was  a  relapse,  which  again  yielded  to  a  fresh  employment  of 
arsenic,  and  health  was  restored,  at  least  for  nearly  a  year, 
during  which  Dr.  Warfvinge  occasionally  saw  the  patient. 
In  the  fourth  case  the  symptoms  grew  worse  under  the  use 
of  iron,  but  when  the  arsenical  treatment  was  adopted  there 
was  a  gradual  improvement :  the  health  returned,  and  the 
number  of  red  corpuscles  was  quintupled.  But  there  was 
a  relapse  at  the  end  of  about  seven  months,  and  arsenic  was 
again  employed  :  health  was  again  restored,  and  the  red  cor¬ 
puscles  were  increased  in  number ;  a  persistent  diarrhoea, 
however,  compelled  the  discontinuance  of  the  arsenic,  and 


the  patient  died  from  weakness.  In  the  fifth  case  the 
malady  was  increased  under  the  use  of  iron,  and  the  patient 
was  at  the  worst  when  the  arsenical  treatment  was  begun,  but 
from  that  time  there  was  marked  improvement :  the  patient 
was  able  to  leave  his  bed  at  the  end  of  five  weeks,  and  the 
blood  was  two  and  a  half  times  richer  ;  when  he  left  the 
hospital  the  number  of  red  corpuscles  was  about  four  times 
more  than  at  the  beginning  of  the  treatment.  In  the  sixth 
case,  which  was  less  advanced,  iron  in  large  doses  produced 
no  effect,  but  after  only  eight  days  of  treatment  by  arsenic 
the  patient  began  to  improve,  and  presented  the  appearance ' 
of  health  at  the  end  of  five  weeks,  the  number  of  corpuscles 
being  tripled.  In  the  seventh  case  the  result  of  the  arsenical 
treatment  was  equally  favourable :  the  health  of  the  patient 
was  remarkably  improved  after  two  months  and  a  half  of 
treatment,  and  the  number  of  red  corpuscles  was  largely 
augmented.  It  appears,  however,  that  the  patient  died 
abroad,  probably  from  a  relapse.  Dr.  Warfvinge  adds  that 
two  cases  of  pernicious  anaemia  are  still  under  his  treatment, 
and  are  slowly  but  uninterruptedly  improving. 

Dr.  W arfvinge  remarks  that  the  fact  of  these  three  mala¬ 
dies — pernicious  anaemia,  leukaemia,  and  pseudo-leukaemia 
— being  equally  benefited  by  the  use  of  arsenic  seems  to 
show  a  certain  degree  of  relationship  between  them,  and 
in  proof  of  this  position  he  passes  in  review  the  principal 
symptoms  presented  and  the  anatomical  and  pathological 
changes,  particularly  insisting  on  the  change  in  the  blood. 
Although  the  three  diseases  exhibit  certain  points  of 
difference,  there  is  yet  a  character  common  to  them  all, 
namely,  the  diminution  of  the  number  of  red  corpuscles, 
with  a  modification  of  their  form  and  size,  the  diminution 
depending  less  on  the  decrease  in  the  formation  of  new 
corpuscles  than  on  the  abnormal  destruction  of  the  existing 
corpuscles.  Dr.  Warfvinge  regards  the  alteration  in  the  blood 
as  the  primary  cause  of  these  maladies,  and  he  considers 
as  secondary  affections,  caused  by  dyscrasic  irritation,  not 
only  the  changes  in  the  spinal  cord,  but  also  the  hypertrophy 
of  the  lymphatic  glands  and  the  spleen,  and  the  lymphatic 
neoplasms  in  various  situations.  The  alterations  observed 
in  the  spinal  cord,  well  known  in  leukaemia,  he  has  also 
found  in  all  the  cases  of  pseudo-leukaemia  and  pernicious 
anaemia  which  have  been  examined  after  death,  and  he 
regards  these  alterations  as  common  to  the  three  affections, 
in  all  of  which,  moreover,  there  are  anaemia  with  cachexia, 
a  disposition  to  haemorrhages,  especially  of  the  retina, 
oedema  in  various  parts  and  transudations,  and  fatty 
degeneration  of  different  organs,  especially  the  heart.  The 
dose  of  arsenic  employed  by  Dr.  Warfvinge  was  four  drops 
of  Fowler’s  solution  given  two  or  three  times  a  day,  and 
four  drops  of  the  same  daily  when  used  as  an  injection. 


SAVE  US  FROM  OUR  FRIENDS! 

We  cannot  altogether  agree  with  the  letter  of  Dr.  Alfred 
Carpenter  to  the  Times,  and  that  portion  of  it  advocat¬ 
ing  the  election  of  medical  men  to  the  peerage  appears  to  us 
regrettable.  Dr.  Carpenter’s  argument  is  that  the  members 
of  the  medical  profession,  and  especially,  it  would  appear, 
those  who  are  connected  with  the  Army,  are  insufficiently 
rewarded  for  their  services  ;  that  they  are  deprived  of  that 
incentive  to  exertion  which  a  prospective  peerage  offers  to  an 
ambitious  mind ;  that  the  interests  of  the  nation  suffer  from 
the  want  of  some  influential  representative  of  the  medical 
profession  in  Parliament ;  that  “  the  heroic  deeds  which  are 
every  day  unostentatiously  performed  by  every  practising 
member  of  the  medical  profession”  are  partly  wasted 
because  there  is  not  a  single  medical  peer  to  “  publish  them 
to  the  world  and  that  the  medical  profession  will  not  be 


Medical  Times  and  Gazette. 


MEDICAL  FAMILY  REGISTER. 


August  4,  1883. 


130 


treated  justly  until  it  obtains  some  political  power,  and  until 
it  has  a  representative  in  Parliament  to  make  its  claims 
heard.  It  is  but  just  to  the  profession  to  say  that  Dr. 
Carpenter  speaks,  and  claims  to  speak,  for  himself  only ; 
and  we  trust  and  believe  that  in  making  this  request  he 
does  not  represent  the  views  of  any  considerable  section 
of  the  profession.  The  members  of  the  medical  profession 
have  known  how  to  do  their  duty  in  times  past,  and 
have  done  ib  without  any  such  artificial  incentive  as 
this  that  Dr.  Carpenter  would  provide  for  them ;  and  we 
have  no  reason  to  believe,  nor  will  we  allow,  that  the  medical 
men  of  the  present  day  are  one  whit  behind  their  prede¬ 
cessors  and  their  forefathers  in  single-hearted  and  unselfish 
devotion  to  duty.  It  is  possible  that  the  medical  profession 
is  deprived  of  the  services  of  some  men  to  whom  a  peerage 
is  an  object  of  ambition ;  but  it  is  doubtful  whether  such  a 
deprivation  is  any  real  loss.  There  is  no  thoroughfare  to  a 
peerage  through  any  other  tract  of  science,  and  yet  science 
progresses,  and  progresses  with  ever-accelerating  velocity. 
It  is  difficult  to  believe  that  anyone  who  is  not  inspired  and 
impelled  by  the  love  of  [science  for  its  own  sake  will  be 
induced  to  follow  it  with  any  share  of  that  enthusiasm  which 
alone  can  bring  success  by  the  distant  prospect  of  a  peerage. 
The  importance  of  an  adequate  representation  of  the  medical 
profession  in  Parliament  no  one  can  gainsay.  Ib  is  right 
that  every  section  of  the  population  should  be  represented 
in  proportion  to  its  importance  to  the  nation  and  to  its 
numbers,  and  it  is  unquestionable  that  medical  men  share 
with  some  other  classes  the  disadvantage  of  a  very  great 
lack  of  representation ;  but  this  disadvantage  cannot  be 
compensated  by  the  presence  of  one  or  two,  or  half-a-dozen 
or  more,  medical  peers  in  the  Upper  House  of  Parliament. 
If  it  is  necessary,  in  order  to  obtain  justice  to  the  medical 
profession  (whatever  that  may  mean),  that  its  interests 
should  be  specially  represented  in  Parliament,  it  is  not  by 
any  representative  in  the  House  of  Peers  that  such  an 
advantage  is  to  be  gained.  If,  as  Dr.  Carpenter  says,  the 
just  claims  of  the  profession  will  not  obtain  recognition 
until  it  is  able  to  wield  some  political  power,  then  let  us 
strive  with  might  and  main  to  return  members  pledged  to 
our  interests,  and  to  the  interests  of  medical  science  as 
affecting  the  nation,  to  the  House  of  Commons.  Such  re¬ 
presentatives  would  at  least  command  attention.  Their 
views  on  medical  subjects  would  compel  consideration  from 
any  Government.  But  so  much  cannot  be  said  of  any  repre¬ 
sentatives  that  we  might  obtain  in  the  House  of  Lords,  and 
for  this  reason  :  that  every  vote  in  the  House  of  Commons  is 
of  importance,  but  the  loss  of  a  vote  in  the  Upper  House 
has  no  terror  for  the  Government.  However  persistently 
the  medical  peers  were  to  “  publish  to  the  world  the 
heroic  deeds  which  are  every  day  unostentatiously  per¬ 
formed  by  every  practising  member  of  the  medical  pro¬ 
fession/’  it  is  very  doubtful  whether  such  a  proceeding 
would  enhance  either  their  own  popularity  or  that  of  the 
profession  to  which  they  belonged.  No ;  save  us  from  our 
friends,  and  especially  from  those  who  ask  things  in  our 
name  !  When  a  man  has  faithfully  endeavoured  to  do  his 
duty  and  to  serve  his  fellow-men,  the  public  recognition  of  his 
efforts  is  indeed  most  grateful  to  him.  The  bestowal  of  a 
symbol  of  this  recognition  by  the  Government  which  repre¬ 
sents  his  countrymen  is  an  honour  of  which,  when  it  is 
offered  freely  and  spontaneously,  he  may  justly  be  proud, 
or,  if  he  considers  it  inadequate,  he  may  courteously  and 
with  dignity  decline  it,  as  Dr.  Banks  has  very  properly 
done ;  but  when  a  distinction  of  this  kind  is  extracted  by 
solicitation,  the  gift  loses  all  its  grace,  and  the  title  all  its 
honour.  Medical  men  who  take  on  themselves  the  un¬ 
gracious  task  of  asking  for  such  things  must  expect  little 
gratitude  at  the  hands  of  their  professional  brethren. 


MEDICAL  FAMILY  REGISTER. 

Mr.  Francis  Galton  is  well  known  as  an  earnest  and  able 
student  of  and  inquirer  into  the  subject  of  heredity.  He 
has  published  works,  that  have  made  their  mark,  on 
“  Hereditary  Genius,”  on  the  “  Antecedents  of  Scientific 
Men,”  and  one  entitled  “  Inquiries  into  Human  Faculty.”' 
In  the  last-named  work,  and  in  an  article  published  in  the 
Fortnightly  Review  last  year,  he  has  dwelt  emphatically  on  tte 
great  importance  of  Medical  Family  Registers.  He  takes  a 
deep  interest  in  everything  “  that  can  throw  light  on  the 
physiological  causes  of  the  rise  and  decay  of  families,  and, 
consequently,  on  that  of  races  ”;  and  he  is  convinced  that, 
before  we  can  gain  any  real  insight  into  the  causes  “  upon 
which  the  future  evolution  of  humanity  depends,”  we  must 
possess  “  a  large  number  of  complete  medical,  or,  rather, 
anthropological  family  registers,  regarding  men  simply  as 
live  stock,  and  showing  the  whole  produce  of  the  unions 
of  different  varieties  of  them.”  And  he  has  the  courage 
of  his  opinions.  In  the  current  number  of  the  Fort¬ 
nightly  Review  he  announces  his  attention  of  offering- 
substantial  prizes — £500  in  all, — open  to  competition 
among  all  members  of  the  medical  profession,  for  complete 
medical  histories  of  their  own  families,  and  the  families 
of  their  wives,  and  of  their  children.  He  has  drafted  a 
scheme  for  these  registers,  which  has  been  approved  by 
Mr.  Simon,  and  some  other  “  eminent  medical  men  of  varie 
attainments,”  among  whom  he  names  Dr.  Beddoe,  Dr. 
Matthews  Duncan,  Sir  William  Gull,  Dr.  Ogle  of  the 
Registrar- General’s  Department,  and  a  few  other  well-known 
men.  And  the  examination  of  the  registers  sent  in,  and  the 
awarding  of  the  prizes,  will  cost  him,  he  calculates,  an  addi¬ 
tional  <£500.  All  medical  men  will  admit  that  medical  family 
records  would  be  of  great  value  as  aids  and  guides  to  them 
as  practitioners  and  family  advisers ;  but  will  it  ever  be 
possible  to  obtain  them  ?  Mr.  Galton  fully  recognises  the 
difficulties  in  the  way.  Men  and  women  generally,  he  admits, 
will  not  yet,  foolish  and  wrong  as  it  may  be,  record  their 
family  secrets  of  disease.  But  he  thinks  medical  men 
“  may  be  tempted  by  an  appeal  to  their  scientific 
zeal,  backed  by  the  offer  of  considerable  prizes,  to  write 
about  themselves  at  their  best,  and  in  great  multitudes.” 
Hence  his  scheme.  His  register  is  to  embrace  the  medical 
history  of  four  generations — i.e.,  it  is  to  begin  with  the 
grandparents  of  the  compiler  and  of  his  wife,  to  pass  down 
through  all  their  uncles  and  aunts,  and  brothers  and  sisters, 
include  themselves,  and  [end  with  their  children.  Infor¬ 
mation  is  to  be  given  on,  generally  speaking,  the  following 
characteristics: — Race;  Conditions  of  Life;  Form  and 
Feature;  Health;  Vigour;  Sensation ;  Artistic  Capacities  j 
Intellect  and  Character ,  and  an  appendix  is  to  be  added, 
giving  an  analysis  of  the  medical  history  and  other  cha¬ 
racteristics  of  the  family,  concerning— (1)  those  on  the 
Compiler’s  side;  (2)  those  on  the  side  of  his  Wife; 
and  (3)  concerning  their  Children.  Mr.  Galton  draws  a 
charming  picture  of  the  interest  that  will  be  taken  in 
the  compilation  of  such  registers — the  pleasant  correspon¬ 
dence  with  half -forgotten  friends,  the  new  and  agreeable 
bond  thus  created  between  relations  living  at  a  distance, 
and  so  on, — all  of  which  does  credit  to  his  powers  of  imagi¬ 
nation.  The  whole  scheme  is  the  scheme  of  an  enthusiast ; 
but  what  does  not  the  world  owe  to  enthusiasts  ?  Without 
them,  civilisation,  knowledge,  and  even  material  prosperity 
would  make  very  little,  if  any,  progress.  It  appears  to  us 
that  Mr.  Galton’s  scheme  is  too  wide  for  a  beginning  :  we 
greatly  doubt  whether  many  medical  men,  or  many  men  of 
any  class  in  large  numbers,  could  compile  anything  like  a 
full  medical  history  of  their  grandparents,  their  uncles,  and 
their  aunts,  let  them  try  ever  so  honestly  to  do  so;  we 


Medical  Times  and  Gazette. 


THE  WEEK. 


August  4, 1883.  131 


fear  lie  asks  for  information  on  too  many  points — - i.e .,  that 
the  scheme  is  too  minute  in  detail ;  and  we  confess  that 
we  greatly  doubt  his  invitation  meeting  with  any  large 
response.  We,  however,  heartily  wish  him  a  success 
so  large  and  complete  as  to  really  reward  him  for  his 
expenditure  and  labours. 


THE  WEEK. 

TOPICS  OP  THE  DAT. 

The  chances  for  and  against  the  introduction  into  this 
country  of  cholera  from  Egypt  constitute  the  most  engross¬ 
ing  topic  of  the  day,  and,  as  usual,  the  alarmists  are  ready 
to  make  capital  out  of  every  sudden  death  reported.  The 
Press  can  do  no  good,  and  may  certainly  do  much  harm,  by 
stating  that  a  death  from  this  disease  has  occurred  at  Llan- 
fyllin,  Montgomeryshire,  after  an  illness  of  twenty-four 
hours  only,  and  another  so  near  as  the  London  Docks.  A 
still  more  sudden  case  of  reputed  cholera  is  stated  to  have 
■occurred  a  few  days  ago  in  Kensington,  the  sufferer  being  an 
intemperate  stableman,  who  succumbed  only  two  hours  after 
being  attacked.  These  cases  have  been  communicated  to 
the  Local  Government  Board  authorities,  but  these  latter, 
very  naturally,  do  not  believe  that  one  or  two  isolated  attacks 
imply  an  outbreak  of  Asiatic  cholera  in  England,  and  feel 
convinced  that  they  have  no  connexion  with  the  prevalence 
of  the  epidemic  in  the  East.  At  this  time  of  year  the  mor¬ 
ality  from  diarrhoea  and  simple  or  summer  cholera  always 
rises,  occasionally  reaching  a  very  high  figure,  and  includes 
sometimes  adults,  as  well  as  children.  It  would,  however, 
be  absurd  to  expect  the  daily  press  to  refuse  insertion  to 
sensational  paragraphs  respecting  “  reported  ”  cases  of 
cholera  in  London,  and  like  announcements. 

A  deputation,  chiefly  composed  of  medical  men  (most  of 
them  members  of  the  British  Medical  Association),  but  ac¬ 
companied  by  several  members  of  Parliament,  waited  last 
week  upon  Mr.  Chamberlain,  at  the  Board  of  Trade,  to  ask 
him  to  appoint  a  Departmental  Committee  to  consider  the 
unsatisfactory  state  of  the  medical  and  sanitary  administra¬ 
tion  of  the  Atlantic  steamships,  and  the  position  of  ship 
surgeons.  They  commented  very  strongly  on  the  want  of 
precaution  on  board  emigrant  vessels  crossing  the  Atlantic, 
the  result  of  which  was  the  sacrifice  annually  of  a  large 
number  of  human  lives.  They  suggested  that,  in  order  to 
•secure  practitioners  more  qualified  to  deal  with  the  cases 
which  came  before  them,  the  shipowners  should  be  called 
upon  to  increase  the  remuneration  of  the  medical  men,  who 
were  to  be  appointed  by  the  Board  of  Trade,  and  that  the 
American  Government  should  be  requested  to  contribute  a 
small  sum  for  the  vaccination  which  they  required  to  be 
performed  on  board  the  vessels.  Mr.  Chamberlain,  in  reply, 
admitted  that  the  questions  of  qualification  and  status 
might  fairly  be  considered.  As  to  the  suggestion  that  the 
medical  officers  should  be  under  the  control  of  the  Board  of 
Trade,  he  could  not  entertain  such  a  proposal  for  a  moment. 
As  regarded  the  other  points,  he  might  say  that  it  was  his 
intention  to  introduce  into  Parliament  during  next  session  a 
Bill  for  the  amendment  of  the  Merchant  Shipping  Act,  and 
in  that  Bill  it  was  intended  to  deal  with  the  question  of 
security,  and  to  establish  a  Shipping  Council,  which  might 
be  a  court  of  appeal  between  the  Board  of  Trade  and  the 
shipowners. 

Once  more  the  state  of  the  water  in  the  Regent's  Canal 
has  caused  serious  complaints  to  be  made  to  the  local 
authorities  of  Marylebone.  With  a  view  of  ascertaining 
how  far  such  complaints  were  justified.  Dr.  A.  Wynter 
Blyth,  the  Medical  Officer  of  Health  for  that  parish,  has 
made  an  inspection  of  that  portion  of  the  canal  that  runs 
through  Marylebone  parish,  and  has  reported  thereon.  On 


J uly  2  and  4,  in  company  with  the  sanitary  inspector,  he 
made  a  careful  examination  from  a  row-boat,  and  found 
that,  amongst  other  things,  the  stream  contained  the  dead 
bodies  of  animals,  that  had  been  allowed  to  float  about  for 
some  time.  About  ten  yards  east  of  Primrose  Hill-bridge 
there  was  a  very  offensive  deposit  of  black  mud,  three  feet 
in  depth,  of  which  samples  were  taken.  He  had  examined 
the  water  chemically,  and  found  it  five  or  six  times  more 
impure  than  the  river  Thames.  The  mud  is  offensive  to  the 
smell,  and  evolves  the  usual  gases  accompanying  decomposi¬ 
tion.  It  is  composed  of  animal  and  vegetable  debris,  and 
earthy  matter.  Dr.  Blyth  considers  the  mud,  the  putrid 
animals,  and  the  accumulations  of  excretions,  are  all 
nuisances  in  the  legal  sense  of  the  term,  and  injurious, 
or  likely  to  be  injurious,  to  the  public  health.  He  considers 
that  the  whole  of  the  mud  should  be  removed  by  dredging, 
and  that  nothing  short  of  a  daily  scavenging  will  be 
satisfactory. 

The  attention  of  the  French  Academy  of  Sciences  has  re¬ 
cently  been  occupied  by  an  important  subject — namely,  the 
best  method  of  completely  destroying  the  carcases  of  animals 
which  have  died  of  contagious  diseases, — M.  Pasteur  having, 
as  is  well  known,  shown  that  burying  the  bodies  does  not 
kill  the  germs  of  the  disease,  and  they  may  be  brought  to 
the  surface  again  by  worms.  It  had  been  proposed  to  burn 
the  carcases ;  but  the  new  process  of  M.  Girard  is  even 
simpler  and  more  economical.  It  consists  in  dissolving  the 
carcases  in  cold  concentrated  sulphuric  acid,  and  utilising 
the  resulting  liquid  for  the  production  of  superphosphate  of 
lime.  At  the  end  of  eighty  hours  the  entire  carcase  is  dis¬ 
solved  in  the  acid,  and  only  a  coloured  liquid  remains.  The 
destruction  of  germs  is  thus  complete,  as  has  been  proved 
by  inoculation  with  the  insoluble  residue  of  the  liquid. 
According  to  recent  experiments  made  at  St.  Gobain,  321 
kilogrammes  of  sulphuric  acid  (at  60°  proof)  dissolved  in  ten 
days  nine  sheep  weighing  204  kilogrammes.  From  the  525 
kilogrammes  of  liquid  remaining,  M.  Girard  extracted  25 
kilogrammes  of  grease,  and  500  kilogrammes  of  acid,  which, 
mixed  with  440  kilogrammes  of  coprolites  from  Ardennes, 
produced  940  kilogrammes  of  superphosphate  of  lime,  con¬ 
taining  30  per  cent,  of  nitrogen.  In  addition  there  was  a 
quantity  of  soluble  acid  and  insoluble  phosphoric  acid 
obtained. 

An  important  decision  was  recently  given  by  Mr.  Barstow 
at  the  Clerkenwell  Police-court,  in  the  case  of  a  summons 
taken  out  by  the  St.  Pancras  Yestry  against  an  owner  of 
property  in  that  parish.  The  summons  was  obtained  against 
the  defendant  on  account  of  his  having  neglected  to  connect 
a  water-supply  with  closets  in  five  houses  owned  by  him  in 
Aldenham-street,  St.  Pancras.  A  second  summons  charged 
him  with  disobeying  an  order  issued  to  him  by  the  Vestry 
to  carry  out  the  sanitary  arrangements  in  question.  Mr. 
Barstow,  remarking  that  the  case  was  a  very  bad  one, 
ordered  the  defendant  to  pay  a  fine  of  £5  for  each  house  on 
the  first  summons,  and  a  fine  of  £1  for  each  house  for 
every  day  after  the  expiration  of  the  fortnight  allowed  him, 
viz.,  five  days.  The  amount  would  therefore  be  <£25  on  each 
summons,  or  a  total  penalty  of  .£50  and  costs. 

We  last  week  alluded  to  a  heavy  sentence  passed  upon  a 
butcher  at  West  Ham  for  dealing  in  diseased  meat,  and  we 
have  now  to  record  a  praiseworthy  effort  on  the  part  of  the 
Birmingham  magistrates  to  put  a  stop  to  this  disgusting 
and  dangerous  practice.  A  butcher  in  that  town  was  re¬ 
cently  brought  before  them,  charged  with  having  in  his 
possession  a  quantity  of  pickled  diseased  meat.  The  case 
having  been  fully  proved,  he  was  sentenced  to  two  months’ 
imprisonment  with  hard  labour,  in  default  of  paying  a  fine 
of  £20  and  costs.  In  another  case,  a  well-to-do  butcher  in 


132 


Medical  Times  and  Gazette. 


THE  WEEK. 


August  4,  1883. 


Summer-lane,  Birmingham,  was  sent  to  gaol  with  hard 
labour  for  three  months,  without  the  option  of  a  fine,  for 
exposing  for  sale  for  human  food  various  parts  of  pork,  the 
animals  having  died  from  swine  fever.  The  magistrates 
described  these  cases  as  gross  in  the  extreme,  and  regretted 
their  inability  to  impose  more  severe  sentences. 

On  Saturday  afternoon  last,  the  Princess  of  Wales,  one 
of  the  patronesses  of  the  institution — accompanied  by  the 
princesses  her  daughters  and  the  Hereditary  Princess 
of  Saxe-Meiningen,  visited  the  Royal  Hospital  for  Women 
and  Children  in  the  Waterloo-road.  The  Royal  party  were 
received,  on  their  arrival,  by  Mr.  J.  P.  Briscoe,  the  House- 
Surgeon,  by  whom  they  were  conducted  round  the  esta¬ 
blishment.  Her  Royal  Highness  had  provided  herself  with 
ample  supplies  of  fruit  and  flowers,  and  these,  in  passing 
through  the  wards,  she  personally  distributed  to  the  different 
patients,  the  gifts  in  each  case  being  accompanied  by  words 
of  kindly  sympathy.  The  visit  lasted  more  than  an  hour, 
and  at  its  termination  the  Princess  expressed  her  satisfac¬ 
tion  with  the  arrangements  and  general  management  of  the 
institution. 

At  the  last  weekly  meeting  of  the  Hackney  Board  of 
Guardians,  a  question  was  asked  as  to  whether  it  came 
within  the  province  of  the  Metropolitan  Asylums  Board  to 
provide  for  any  such  emergency  as  an  outbreak  of  cholera 
within  the  metropolitan  area.  Mr.  Andrew  Wentzell,  the 
Hackney  member  of  that  Board,  pointed  out  that  consider¬ 
able  difficulty  would  be  experienced  as  to  the  removal  of 
cholera  patients  to  hospitals,  the  disease  being  so  rapid  in 
its  progress.  Though  it  did  not  come  within  the  province 
of  the  Asylums  Board  to  provide  for  this  emergency,  yet 
they  were  alive  to  the  possibility  of  the  cholera  coming  to 
London,  and  would  be  quite  ready  to  carry  out  without 
delay  anything  that  the  Local  Government  Board  might 
order  them  to  do. 

Three  deaths  have  occurred  since  the  outbreak  of  diph¬ 
theria  among  the  troops  at  Aldershot,  but  the  remaining 
cases  are  reported  to  be  doing  well.  It  is  generally  believed 
that  the  men  who  returned  from  the  Egyptian  campaign 
were  the  first  to  contract  and  spread  the  disease.  It  was  at 
first  reported  that  this  sickness  arose  from  the  badness  of 
the  drinking-water  at  the  camp,  but  this  has  since  been 
contradicted. 


THE  CHOLERA  IN  EGYPT. 

The  telegrams  from  Egypt  on  the  last  day  of  July  and 
August  1  have  been  encouraging  to  this  extent :  that  they 
state  that  the  recent  cases  of  cholera  have  been  of  a  less 
virulent  character,  and  the  proportion  of  recoveries  to 
attacks  has  been  larger.  But  among  the  British  troops  the 
attacks  are  still  very  numerous,  and  the  rate  of  mortality 
high.  The  report  from  Alexandria,  of  date  August  1, 
records  twenty-nine  deaths  from  cholera  among  our  troops 
in  the  previous  twenty-four  hours,  and  gives  the  corrected 
total  of  deaths  up  to  that  time  as — officers,  three ;  men, 
eighty.  The  extraordinary  Council  of  the  Government,  of 
which  Generals  Stephenson  and  Wood,  Baker  Pasha,  and 
Dr.  Hunter  are  members,  have  declared  the  Board  of  Health 
to  be  utterly  incompetent ;  and  Dr.  Hunter  has  been  autho¬ 
rised  to  telegraph  to  India  for  the  services  of  a  Deputy 
Sanitary  Commissioner,  eight  Anglo-Indian  medical  officers, 
and  forty  trained  Moslem  hospital  assistants.  On  Wednes¬ 
day  a  detachment  of  the  Army  Hospital  Corps,  numbering 
forty-three  non-commissioned  officers  and  men,  with  one 
warrant  officer,  were  received  on  board  the  Peninsular  and 
Oriental  Company’s  steamer  Carthage  for  conveyance  to 
Egypt,  -tyhere^  they  are  to  be  employed  in  the  cholera 
hospitals-.'-  s. 


THE  MEDICAL  ACT  AMENDMENT  BILL. 

On  Wednesday,  the  1st  inst.,  Mr.  Mundella  received  a  depu¬ 
tation  representing  the  Scotch  graduates  practising  in 
London.  The  object  of  the  deputation  was  to  press  upon 
Mr.  Mundella  the  importance  of  securing  to  the  Universities 
a  preponderance,  as  compared  with  the  Corporations,  on  the 
Divisional  Board  for  Scotland.  Sir  Lyon  Playfair  having- 
introduced  the  deputation.  Sir  Andrew  Clark,  Dr.  Dyce 
Duckworth,  and  Dr.  Cobbold  urged  that  the  Universities, 
as  teaching  and  as  examining  bodies,  had  the  confidence  of 
the  profession  in  a  higher  degree  than  the  Corporations. 
Mr.  Mundella  promised  that  the  Universities  shall  have  a 
preponderating  influence  on  the  Divisional  Board,  and  stated 
that  he  hoped  to  be  able  to  pass  the  Bill  this  session. 


ROYAL  COLLEGE  OE  PHYSICIANS. 

At  a  meeting  of  the  Royal  College  of  Physicians  of  London, 
held  on  J uly  26,  Dr.  William  Osier,  of  Montreal,  was  admitted 
Fellow  of  the  College,  in  absentia ;  Dr.  Theodore  Dyke 
Acland,  having  passed  the  required  examination,  was  elected, 
in  absentid,  Member  of  the  College.  A  letter  -was  received 
from  Lord  Granville,  stating  that  he  had  requested  the 
Netherlands  Minister  to  afford  every  facility  to  Dr.  Duck¬ 
worth  and  Dr.  Ewart,  who  had  been  appointed  to  represent 
the  College  at  the  Congress  at  Amsterdam.  The  College 
were  informed  that  the  appointment  of  Sherard  Pro¬ 
fessor  of  Botany  in  the  University  of  Oxford,  hitherto 
made  by  the  President  and  Council,  was,  by  a  recent  Act  of 
Parliament,  vested  in  Oxford  University.  The  President 
stated  that  the  marble  sarcophagus  for  Harvey’s  remains- 
had  been  completed,  and  it  was  proposed  to  have  a  suitable 
ceremonial  in  October,  at  which  the  Fellows  were  invited  to- 
attend.  Drs.  Fincham  and  Wilson  Fox  were  elected  Censors 
of  the  College,  in  place  of  Drs.  Munk  and  Lionel  Beale 
Dr.  Gowers  was  elected  a  Curator  of  the  Museum,  in  place  of 
Dr.  Southey.  Among  the  Examiners,  the  newly  elected 
were  Dr.  John  Harley  in  Physiology,  and  Dr.  Broadbent 
in  Medical  Anatomy  and  the  Principles  and  Practice  of 
Medicine.  A  report  was  received  from  the  Committee  on 
the  Medical  Acts  Amendment  Bill,  which  stated  that 
all  the  amendments  recommended  by  the  College  had  been 
introduced  into  the  Bill. 


THE  INDIAN  MEDICAL  SERVICE. 

In  the  House  of  Commons,  on  Monday  last,  the  Under 
Secretary  of  State  for  India  gave  some  information  of 
importance  to  officers  of,  and  would-be  candidates  for  com¬ 
missions  in,  the  Indian  Medical  Service.  Replying  to  a 
question  from  Mr.  O’Shea,  he  said,  *f  The  first  and  governing- 
qualification  for  the  receipt  of  600  rupees  a  month  is  that 
the  surgeon  of  five  years’  service  who  has  passed  the 
language  test  shall  be  in  substantive  charge  of  a  regiment- 
Till  then  he  is  only  strictly  entitled  to  unemployed  pay- 
The  Bengal  Army  List  shows  that  on  January  1,  1883,  of 
the  eighty-five  surgeons  appointed  during  the  six  previous- 
years,  twenty-two  were  holding  substantive  or  acting  civil' 
appointments  of  varying  rates  of  staff  pay,  and  eight  had 
not  passed  the  language  test.  Of  the  remaining  fifty-five, 
only  four  were  in  substantive  charge  of  regiments,  and 
therefore  entitled  to  the  full  rate  of  salary  prescribed  in 
paragraph  18  of  the  memorandum  supplied  by  the  India 
Office ;  but  twenty -four  were  officiating  for  the  actual 
holders  of  appointments,  and  were  drawing  acting  allow¬ 
ances,  which,  though  less  than  the  full  rate  of  salary,  is 
more  than  the  unemployed  pay.  The  twenty-seven  remain¬ 
ing  officers  held  no  charge,  either  substantive  or  acting,  and 
were  drawing  only  unemployed  pay,  as  notified  in  the- 
memorandum.”  This  memorandum  is.  Mr.  Cross  admits. 


Medical  Times  and  Gazette. 


THE  WEEK. 


August  4,  1883.  133 


the  only  official  information  furnished  to  candidates  for  the 
Service.  It  mentions  only  the  salaries  of  the  substantive 
appointments  tenable  by  medical  officers,  and  does  not  refer 
to  the  rates  of  officiating  pay,  which  are  not  substituted  for 
the  rates  laid  down  in  the  memorandum,  but  are  supple¬ 
mentary  to  them,  being  payments  to  officers  who  do  not 
come  under  the  conditions  of  the  memorandum. 


DISTRIBUTION  OP  THIS  YEAR’S  HOSPITAL  SUNDAY 
COLLECTION. 

On  Monday  last  a  meeting  of  the  Council  of  the  Hospital 
Sunday  Fund  was  held  at  the  Mansion  House  for  the  pur¬ 
pose  of  distributing  the  amount  collected  this  year.  It  was 
shown  that  the  total  amount  available  for  distribution,  after 
allowing  sufficiently  for  liabilities  and  the  usual  current 
expenses,  was  <£32,243  (a  less  sum  than  last  year),  of  which 
the  Distribution  Committee  recommended  the  payment  of 
£29,664  to  ninety- seven  hospitals,  including  six  institutions 
which  might  be  classed  as  hospitals,  and  £2579  to  fifty-one 
dispensaries.  In  addition,  4  per  cent,  of  the  total  sum  col¬ 
lected,  amounting  to  £1400,  was  set  aside  for  the  purchase 
of  surgical  appliances.  The  institutions  benefited  were 
three  more  than  last  year,  and  forty-three  more  than  in  the 
first  year  of  the  collection.  The  number  of  deputations 
invited  to  confer  with  the  Committee,  and  to  offer  explana¬ 
tions  on  matters  of  apparently  unsatisfactory  character, 
was  twelve.  Of  these,  two  attended  from  hospitals  to  which, 
after  those  interviews,  the  Committee  agreed  to  raise  their 
awards.  Seven  sent  replies;  from  three  no  answers  were 
received ;  and  the  application  of  a  medical  aid  society  was 
so  unsatisfactory  as  to  render  its  rejection  absolutely  neces¬ 
sary.  Amongst  the  awards  may  be  mentioned  the  following  : 
— General  Hospitals:  Charing-cross,  £731;  French,  £230; 
German,  £731  ;  Great  Northern,  £225  ;  King’s  College, 
£1462  ;  London,  £3011 ;  Metropolitan  Free,  £281 ;  Poplar, 
£315;  Royal  Free,  £450;  St.  George’s,  £1677;  SS.  John 
and  Elizabeth,  £123  ;  St.  Mary’s,  £1065 ;  Seamen’s,  Green¬ 
wich,  £787  ;  Middlesex,  £1518  ;  Tottenham  Training  Hos¬ 
pital,  £223;  University  College,  £1004;  West  London, 
£309 ;  Westminster,  £900.  Special  Hospitals :  Diseases  of 
the  Chest,  Victoria-park,  £731 ;  Brompton  Consumption, 
£1250 ;  North  London  Consumption,  £257 ;  Diseases  of  the 
Chest,  City-road,  £225 ;  National,  for  Consumption,  Vent- 
nor,  £337.  Bishop  Claughton  moved  the  adoption  of  the 
report  of  the  Distribution  Committee,  and  Sir  E.  H.  Currie 
seconded  it ;  but  the  latter  gentleman  remarked  that  the 
amount  of  £30,000  realised  was  hardly  representative  of  the 
vast  wealth  of  the  metropolis,  especially  when  it  was 
recollected  that  from  one  church  alone  (St.  Michael’s,  Chester- 
square)  £1000  was  this  year  received.  Before  separating,  the 
chairman  of  the  meeting.  Sir  Sydney  Waterlow,  made  some 
observations  on  the  circumstance  that  in  one  church,  if  not 
more,  only  part  of  the  collections  had  been  sent  to  the  Fund. 
Not  much  harm  had  been  done  at  present,  he  thought,  but 
the  Committee  did  not  wish  the  practice  to  grow,  and  they 
would  appeal  to  the  clergy  in  future  to  devote  the  entire 
collections  on  Hospital  Sunday  to  the  Fund. 


THE  UNCERTAINTIES  OF  THE  MEDICAL  PROFESSION. 

The  case  of  Benthall  v.  the  Earl  of  Kilmorey  and  others, 
heard  before  Mr.  Justice  Chitty,  in  the  Chancery  Division 
of  the  High  Court  of  Justice,  on  the  20th  ult.,  would  seem 
to  illustrate  the  wide  difference  which  so  often  exists  between 
law  and  equity.  The  plaintiff  in  1880  was  appointed 
Resident  Medical  Superintendent  of  St.  John’s  Hospital, 
Twickenham,  and  he  brought  this  action  for  a  declaration 
that  he  was  entitled  to  hold  such  office  during  his  good 
behaviour.  He  moved  for  an  interim  injunction  restraining 


the  defendants,  the  trustees  and  Committee  of  the  Hospital, 
from  disturbing  him  in  his  office,  and  from  ejecting  him 
from  his  residence  in  the  building;  from  suspending  the 
work  of  the  Hospital,  and  from  otherwise  interfering  with 
his  tenure  of  office.  It  appeared  that,  by  the  rules  under  which 
the  Hospital  was  constituted,  discretion  was  given  to  the 
Committee  to  remove  the  Resident  Medical  Superintendent 
by  written  notice  of  three  months,  and  of  declaring  the  office 
vacant  on  proof  satisfactory  to  them  of  neglect  of  duty,  or 
of  wilful  disobedience  to  the  rules  of  the  institution.  The 
plaintiff  complained  that  although  he  had  been  put  to  great 
expense  by  the  sacrifices  he  had  made  when  he  accepted  the 
office,  and  had  spent  a  sum  of  £400  in  improving  the  resi¬ 
dence  attached  thereto,  he  had  recently  received  a  three 
months’  notice  to  determine  his  engagement,  on  the  ground 
that  the  Hospital  could  not  be  carried  on  upon  its  present 
footing  for  want  of  funds,  and  that  an  application  was  about 
to  be  made  to  the  Charity  Commissioners  for  a  new  scheme 
not  including  the  office  of  Resident  Medical  Superintendent. 
The  plaintiff’s  case  was,  that  as  he  had  been  guilty  of  no 
misconduct,  the  Committee  were  acting  ultra  vires  in  dis¬ 
missing  him  from  an  office  to  which  he  had  an  indefeasible 
title  under  the  provisions  of  the  trustee  deed.  The  defen¬ 
dants  took  the  preliminary  objection  that  the  plaintiff, 
before  commencing  his  action,  had  not  obtained  the  sanction 
of  the  Charity  Commissioners,  as  required  by  Section  17 
of  the  Charitable  Trusts  Act,  1S53.  This  objection  Mr. 
Justice  Chitty  held  to  be  fatal  to  the  plaintiff’s  case.  He 
admitted  that  if  an  application  had  been  made  to  the  Charity 
Commissioners  for  their  consent  to  the  action  it  would  pro¬ 
bably  have  been  refused ;  but,  on  the  other  hand,  he  thought 
there  was  little  doubt  that,  in  preparing  a  new  scheme  for 
the  charity,  they  would  have  given  weight  to  the  claims  of 
the  plaintiff.  The  motion  was  accordingly  refused  with  costs. 


UNIVERSITY  OF  GLASGOW. 

The  graduation  ceremony  in  connexion  with  the  Medical 
Faculty  of  the  University  of  Glasgow  took  place  on  the 
26th  ult.  in  the  lower  hall  of  the  Museum.  Principal  Caird 
capped  the  graduates,  who  were  presented  by  Professor 
Leishman ;  and  Professor  Gairdner  afterwards  delivered  the 
usual  vacation  address  to  the  new  graduates.  It  was  very 
pleasing  to  see  the  old  familiar  face  of  Professor  Allen 
Thomson,  who  received  a  very  warm  reception  from  both 
new  and  old  students.  Many  of  Dr.  Thomson’s  old  students 
received  the  degree  of  M.D.  Professor  Gairdner  gave  a 
very  interesting  address,  encouraging  the  new  graduates, 
and  holding  up  as  examples  many  former  graduates  of  the 
University  who,  in  their  student  career  and  since  then, 
have  distinguished  themselves. 


THE  RESULT  OF  THE  LATE  CHLOROFORM  CONTROVERSY. 

As  one  of  the  results  of  the  late  chloroform  controversy  in 
connexion  with  the  Royal  Infirmary,  Drs.  Samuel  J.  Moore 
and  Dunlop,  the  Crown  officials,  received  instructions  to 
make  post-mortem  examinations  in  all  cases  of  death 
reported  as  having  taken  place  under  the  influence  of 
anaesthetics,  and  that  the  reports  of  these  gentlemen  are 
to  be  submitted  to  the  Crown  authorities  in  Edinburgh.  In 
England  similar  cases  come  under  the  investigation  of  the 
coroner.  This  step  has  been  taken  to  infuse  confidence  in 
the  minds  of  the  public,  and  to  make  them  see  that  the 
authorities  have  resolved  to  adopt  such  a  measure  as  a 
means  for  securing  the  careful  administration  of  anaesthetics. 
On  inquiry,  it  seems  that  this  new  rule  refers  only  to  cases 
of  deaths  occurring  in  public  hospitals.  The  Procurator- 
Fiscal  will  not  interfere  with  cases  which^u^y^op^^ 
private  practice  unless  reported  to  him.  ' 

CVlRAOF! 


134 


Medical  Times  and  Gazette. 


THE  WEEK. 


August  4,  1883. 


THE  DISEASES  PREVENTION  (METROPOLIS)  ACT. 

The  object  of  tliis  Bill,  of  which  Sir  C.  Dilke  has  given 
notice,  is  to  enable  the  Local  Government  Board  to  assign 
to  the  Managers  of  the  Metropolitan  Asylums  District  the 
•duty  of  providing  hospital  accommodation  for  cholera 
patients,  if  an  outbreak  of  cholera  leads  to  the  Diseases 
Prevention  Act,  1855,  being  put  in  force  in  the  metropolis. 
But  the  Bill  will  leave  to  the  vestries  the  powers  they  now 
possess,  either  as  sanitary  or  as  local  authorities,  under  the 
Diseases  Prevention  Act.  The  Bill  also  provides  that  in 
The  case  of  vestries  providing  cholera  hospitals,  the  cost  of 
the  hospital  buildings  and  a  considerable  proportion  of  the 
salaries  of  the  officers  and  attendants  employed  in  the 
hospitals  shall  be  a  charge  on  the  Metropolitan  Common 
Poor  Fund — i.e.,  a  charge  not  on  a  particular  locality,  but 
-on  the  whole  metropolis. 


THE  PARIS  WEEKLY  RETURN . 

The  number  of  deaths  for  the  twenty-ninth  week  of  18S3, 
terminating  July  18,  was  993  (571  males  and  422  females), 
and  of  these  there  were  from  typhoid  fever  34,  small-pox 
6,  measles  28,  scarlatina  3,  pertussis  10,  diphtheria  and 
croup  32,  erysipelas  4,  and  puerperal  infections  5.  There 
were  also  52  deaths  from  tubercular  and  acute  meningitis, 
190  from  phthisis,  17  from  acute  bronchitis,  43  from  pneu¬ 
monia,  178  from  infantile  athrepsia  (61  of  the  infants  having 
been  wholly  or  partially  suckled),  and  33  violent  deaths  (28 
males  and  5  females).  The  deaths  for  this  week  were  ex¬ 
ceptionally  few,  even  in  comparison  with  those  of  recent 
weeks ;  and  the  epidemic  diseases  call  for  no  remark.  It  is 
•exclusively  among  adults  and  the  aged  that  the  slight  mor¬ 
tality  has  occurred  during  recent  weeks.  During  the  last 
week  250  infants  have  died,  athrepsia  having  carried  off  the 
•exceptional  number  of  178.  The  increase  of  mortality  in 
summer  among  infants,  and  its  decrease  amongst  the  aged, 
are,  however,  matters  of  usual  occurrence.  The  births  for 
the  week  amounted  to  1224,  viz.,  567  males  (414  legitimate 
and  153  illegitimate)  and  557  females  (411  legitimate  and 
146  illegitimate)  :  94  infants  were  either  born  dead  or  died 
within  twenty-four  hours,  viz.,  58  males  (47  legitimate 
and  11  illegitimate)  and  36  females  (30  legitimate  and  6 
illegitimate) . 

THE  PORT  SANITARY  AUTHORITY  AND  THE  CHOLERA 
REGULATIONS. 

We  have  received  a  copy  of  the  report  of  Dr.  William 
Collingridge  (Medical  Officer  of  Health  to  the  Port  of 
London)  to  the  Port  Sanitary  Committee  on  the  Cholera 
Regulations  of  the  Local  Government  Board,  which  were 
published  in  the  London  Gazette.  The  report  deals  with 
each  of  the  articles  of  those  regulations  seriatim,  and  shows 
the  steps  which  have  been  taken,  or  for  which  arrange¬ 
ments  have  been  made,  to  give  effect  to  each  of  those  articles 
should  the  occasion  arise.  The  duty  in  the  first  instance  of 
discovering  an  infected  ship  rests  with  the  Customs  autho¬ 
rities  at  Gravesend,  but  even  after  a  ship  has  been  passed 
by  them  she  may  be  detained  by  the  Medical  Officer  of 
Health  if  he  has  reasonable  grounds  for  believing  her  to  be 
infected.  Supposing  that  the  Customs  officer  finds  that  the 
ship  is  infected,  he  will  detain  her  and  communicate  at  once 
with  the  Port  Medical  Officer  at  Greenwich,  who  will,  with¬ 
out  delay,  proceed  to  inspect  the  ship,  and  take  medical 
•charge  of  the  vessel.  He  will  examine  every  person  on 
board,  and  if  he  finds  any  cases  of  cholera,  the  ship  will  be 
moored  close  to  the  hospital-ship  Rhin,  and  such  case  or 
cases  transferred  to  the  latter.  Those  who  are  found  to  be 
healthy  will  at  once  leave  the  vessel,  leaving  their  names 
and  places  of  destination,  which  will  be  of  use  in  subse¬ 
quently  tracing  the  source  of  infection,  should  any  arise. 


The  vessel  will  then  be  thoroughly  disinfected,  and  any 
linen  or  clothing  worn  by  those  infected  will  be  destroyed 
on  board.  The  bodies  of  any  who  may  die  from  cholera 
may  be  ordered  to  be  taken  out  to  sea,  but  an  alternative 
funeral  on  shore  is  allowed  if  carried  out  by  the  Sanitary 
Authority.  We  think  that  the  report  is  eminently  satis¬ 
factory,  as  showing  that  the  authorities  are  doing  their  best 
to  provide  against  the  introduction  of  cholera  into  London, 
by  way  of  the  Thames  at  any  rate. 


THE  MEDICO-PSYCHOLOGICAL  ASSOCIATION. 

The  annual  meeting  of  the  Medico-Psychological  Associa¬ 
tion  was  held  on  Friday,  July  27,  at  the  Royal  College  of 
Physicians,  London ;  Dr.  Orange,  of  Broadmoor,  presiding- 
After  a  vote  of  thanks  to  Dr.  Gairdner,  the  outgoing 
President,  the  appointment  of  officers  and  Council,  etc.,  took 
place ;  Dr.  Manley  was  appointed  President  for  the  ensuing 
year.  New  statistical  tables,  which  had  been  on  trial  for  a 
year,  were  adopted,  subject  to  certain  revision.  At  the 
afternoon  meeting,  Dr.  Orange  delivered  his  presidential 
address  on  the  subject  of  criminal  lunacy;  and  a  long  and 
important  discussion  ensued,  in  which  Dr.  Bucknill,  Dr. 
Hack  Tuke,  Dr.  Nugent,  and  others  took  part.  A  resolution 
was  ultimately  adopted,  to  the  effect  that  prisoners  suspected 
of  being  mentally  deranged  should  be  examined  by  compe¬ 
tent  medical  men  as  soon  as  possible  after  the  commission 
of  the  crime  with  which  they  were  charged,  such  examina¬ 
tion  to  be  provided  by  the  Treasury,  the  examiners  being  the 
prison  medical  officer,  the  county  asylum  medical  officer,  and 
a  neighbouring  practitioner. 


A  CASE  OF  PROGRESSIVE  TOTAL  HEMIATROPHIA. 

Dr.  Henschen,  of  Upsala,  relates  in  a  recent  number  of 
the  Nordisld  Medicinislct  Arkiv  a  case  which  is  almost  unique 
in  medical  literature — presenting,  as  it  does,  a  series  of  atro¬ 
phic  changes  of  half  of  the  body,  in  the  skin  and  subcutaneous 
tissue,  as  well  as  in  the  muscles,  bones,  and  joints,  princi¬ 
pally  in  the  face,  the  left  arm,  the  left  leg,  and  partly  the 
left  half  of  the  trunk.  The  patient  is  still  living,  and  there¬ 
fore  the  pathological  changes  cannot  be  defined  with  any 
accuracy ;  but  the  appearances  of  the  body,  which  are  repre¬ 
sented  in  a  plate  accompanying  the  paper,  are  very  striking, 
showing  an  extreme  degree  of  emaciation  of  the  left  arm  and 
leg,  and  an  appearance  of  the  face  almost  identical  with  that 
seen  in  progressive  facial  hemiatrophia.  The  cranium  above 
the  eyebrows  is  nearly  symmetrical,  but  on  the  plane  below 
them  the  face  exhibits  a  most  marked  asymmetry,  the  left 
half  being  considerably  smaller  than  the  right.  The  nose  is, 
as  it  were,  pushed  towards  the  left ;  the  left  cheek  is  deeply 
sunken,  destitute  of  fat,  and  surrounded  with  deep  radiating 
wrinkles;  the  eye  is  very  much  sunken,  but  otherwise 
healthy ;  the  eyelids  deprived  of  their  fat ;  the  left  zygo¬ 
matic  arch  atrophied,  as  well  as  the  soft  parts  surrounding 
this  bony  process.  The  skin  and  the  lips  of  the  left  side  are 
very  thin ;  the  upper  and  lower  maxillary  bones  of  this  side 
are  much  atrophied.  The  teeth  have  been  shed ;  the  alveolar 
process  of  the  left  upper  maxillary  bone  is  wanting  behind 
the  second  molar  tooth,  and  the  raphe  of  the  palate  is  drawn 
to  the  left.  All  the  right  side  of  the  face  is  healthy,  with 
abundant  fat.  The  neck  is  symmetrical.  All  the  left  half 
of  the  trunk  is  rather  smaller  than  the  right,  but,  with  this 
exception,  it  is  nearly  alike,  though  some  of  the  parts  are 
atrophied.  Over  these  atrophied  parts  the  skin  is  as  thin  as 
paper,  and  the  subcutaneous  fat  is  almost  entirely  wanting, 
so  that  the  muscular  fibres  form  evident  projections  on  the 
skin.  The  left  arm  and  leg  are  remarkably  atrophied,  the 
fat  being  almost  completely  absent,  the  skin  very  thin,  the 
muscles  wasted,  the  joints  altered  in  character,  and  some  of 


Medical  Times  and  Gazette. 


THE  BRITISH  MEDICAL  ASSOCIATION. 


August  4,  1S83.  135 


the  bones  united  together — as,  for  instance,  the  tibia  and 
fibula, — and  the  tibio-tarsal  jointjs  anchylosed.  The  tactile 
sensibility  of  the  atrophied  parts  is  not  remarkably  altered, 
except  that  the  left  leg  is  more  sensitive  than  the  right, 
being  more  easily  affected  by  cold,  and  perhaps  also,  by 
electric  irritation.  The  patient,  who  is  now  forty- six  years 
old,  was  healthy  up  to  the  age  of  fourteen,  when  he  suffered 
from  a  slight  sprain  of  the  left  ankle-joint,  and  shortly 
afterwards  he  had  an  erysipelatous  inflammation  of  the  left 
leg.  Since  that  time  he  suffered  from  pricking  and  shooting 
in  the  left  half  of  the  body,  and  at  the  end  of  three  months 
some  changes  appeared  in  the  extremities  and  the  trunk, 
and,  six  months  later,  in  the  face.  At  this  time  he  suffered 
from  severe  attacks  of  headache.  At  nineteen  years  of  age 
he  had  melancholia,  but  he  recovered,  and  now  enjoys  good 
health.  He  married  at  the  age  of  forty,  and  had  a  healthy 
and  well-formed  child.  All  the  changes  above  described 
first  appeared,  therefore,  a  short  time  after  a  sprain  of 
the  left  ankle-joint.  They  have  continued  since  that 
period,  and  the  morbid  process  went  on  ascending  to  the 
central  nervous  system,  the  anatomico-pathological  process 
being  at  present  unknown,  as  well  as  the  course  which  it 
has  followed  in  the  nervous  centres. 


Sir  Edwin  Saunders,  Dental  Surgeon  to  Her  Majesty 
the  Queen,  has  presented  the  leasehold  premises,  39, 
Leicester- square,  of  the  value  of  <£2400,  immediately  ad¬ 
joining  the  Dental  Hospital  of  London,  to  the  authorities 
of  that  charity,  for  the  purpose  of  its  enlargement. 


The  foundation-stone  of  the  new  hospital  which  is  to  be 
in  connexion  with,  and  a  memorial  of  the  centenary  of,  the 
Eoyal  Kent  Dispensary,  was  laid  on  Wednesday  last  by  the 
Earl  of  Dartmouth.  It  will  be  remembered  that  the  new 
hospital  is  also  intended  as  a  memorial  of  the  late  Canon 
Miller,  for  many  years  Yicar  of  Greenwich,  and  one  of  the 
most  active  introducers  and  promoters  of  Hospital  Sunday 
in  the  metropolis. 

Professor  G.  M.  Humphry,  M.D.,  F.E.S.,  has  accepted 
the  presidentship  of  the  Congress  of  the  Sanitary  Institute 
of  Great  Britain,  to  be  held  in  Glasgow  in  September  next. 

Mr.  Field,  Aural  Surgeon  to  St.  Mary’s  Hospital,  has 
been  appointed  Dean  to  the  Medical  School. 


The  graduation  ceremony  in  the  University  of  Edinburgh 
took  place  on  the  1st  inst.,  when  the  degree  of  Doctor  of 
Medicine  was  conferred  on  30  candidates,  and  the  degrees 
of  Bachelor  of  Medicine  and  Master  in  Surgery  on  138. 
William  Hunter  gained  the  “  Ettles  Medical  Scholarship,” 
as  the  most  distinguished  Bachelor  of  Medicine  and  Master 
in  Surgery  of  the  year ;  and  the  “  Beaney  Prize,”  as  the 
graduate  who  obtained  the  highest  marks  in  anatomy, 
surgery,  and  clinical  surgery. 

The  Brunton  Memorial  Prize  of  the  University  of 
Glasgow,  given  to  the  most  distinguished  graduate  in 
medicine  of  the  year,  has  been  won  this  year  by  John  Innes 
Dunlop,  M.B.,  C.M.  _ 

At  a  meeting  of  the  Court  of  Assistants  of  the  Society 
of  Apothecaries  of  London,  held  on  July  30,  the  Gold 
Medal  for  Botany  was  presented  to  George  Bernard 
Hoffmeister,  of  St.  Bartholomew’s  Hospital ;  the  Silver 
Medal  and  a  book  to  Frederic  William  Green,  also  of  St. 
Bartholomew’s.  The  examination  for  prizes  in  Materia 
Medica  and  Pharmaceutical  Chemistry  will  take  place  on 
Wednesday,  August  15. 


Mr.  Edward  Thomas  Thring,  University  College  Hos¬ 
pital,  M.E.C.S.  and  L.E.C.P.,  has  been  elected  to  the 
Medical  Scholarship  of  the  Society  of  Apothecaries  of 
London.  The  scholarship  is  of  the  annual  value  of  <£100,, 
and  is  tenable  for  two  years.  The  Surgical  Scholarship  will 
be  competed  for  at  the  close  of  the  winter  session  1883-84. 


ANNUAL  MEETING  OF  THE  BRITISH 
MEDICAL  ASSOCIATION. 

(From  our  Special  Correspondent.) 

Liverpool,  August  1 . 

Few,  if  any  other,  towns  like  Livei-pool  can  boast  of  having- 
entertained  the  British  Medical  Association  three  .times; 
and  what  is  more  remarkable  is  the  fact  that  each  previous 
meeting  in  Liverpool  has  been  characterised  by  the  discus¬ 
sion  and  adoption  of  new  rules,  or  new  proj  ects,  the  carrying 
out  of  which  has  been  of  great  and  vital  interest  to  the  well¬ 
being  and  progress  of  the  profession.  Thus,  in  1839,  the- 
“ Provincial  Medical  and  Surgical  Association”  (as  the 
British  Medical  Association  was  then  called)  met  in  Liver¬ 
pool  under  the  presidency  of  the  late  Dr.  Thomas  Jeffreys,, 
for  its  seventh  anniversary,  when  the  business  occupied  two- 
days.  On  that  occasion  the  Council  first  gave  expression 
to  the  desirability  of  a  single  examining  and  licensing  Board 
in  each  of  the  divisions  of  the  United  Kingdom,  and  pro¬ 
moted  a  sub-committee  for  the  consideration  of  the  scheme  ? 
the  subject  of  vaccination  was  discussed,  a  long  and  very 
able  report  was  presented  on  the  state  of  vaccination,  and 
the  importance  of  free  vaccination  by  properly  trained  and 
efficient  vaccinators  was  urged  and  insisted  upon. 

Again,  in  1859,  the  twenty-seventh  anniversary  meeting 
was  held  in’ this  same  city — then  a  town.  At  that  meeting- 
the  Address  in  Physiology  was  delivered  by  Dr.  A.  T.  H. 
Waters,  who  so  fittingly  presided  over  the  present  meet¬ 
ing.  On  both  those  occasions  the  meetings  were  held 
in  the  Medical  Institution.  In  this  present  year  of  grace,, 
however,  the  Association  has  outgrown  that  building,  and 
its  meetings  are  being  held  in  the  Liverpool  College,  the 
whole  of  which  is  hardly  sufficient  to  accommodate  the 
ten  sections  into  which  the  work  has  had  to  be  divided. 
This  year  will  be  memorable  from  the  fact  that  a  radical 
change  in  the  management  of  the  Association  is  to  be  pro¬ 
posed  and  decided  upon.  I  say  decided  upon,  for  by  its 
constitution  it  is  impossible  to  do  more  than  decide  on  any 
change ;  time  is  required,  and  many  formalities  must  be 
gone  through,  before  these  proposed  changes  can  become 
law :  hence  we  remain  in  statu  quo  until  the  meeting  in 
1884,  when  the  new  rules,  by  which  a  more  direct  representa¬ 
tion  of  the  Association  in  its  governing  body  will  come  into- 
force.  The  selection  of  a  place  like  Liverpool  for  this  year’s 
meeting  was  doubtless  determined  upon  by  the  importance 
of  the  business  to  be  transacted  ;  and  members  have  shown 
their  sense  of  its  importance  by  mustering  in  very  large 
numbers.  I  will  not  anticipate  what  I  must  again  refer  to- 
later  on,  beyond  saying  that  the  changes  in  the  rules  (more 
or  less)  were  suggested  by  private  members  last  year  at 
Worcester ;  and  although  at  that  time  not  acceptable  to  the 
Council,  they  were  supported  by  so  powerful  a  vote  of' 
members  outside  the  Council,  as  to  be  referred  back  to  the 
Council  for  consideration.  The  Council  have,  I  think,  done 
well  in  reconsidering  their  views  as  expressed  by  one  or  two 
of  their  members  last  year. 

According  to  the  custom  of  many  preceding  years,  the 
work  of  the  meeting  was  inaugurated  by  a  service  in  the 
Pro-Cathedral,  when  Dr.  Eyle,  the  Bishop  of  the  diocese,, 
preached,  choosing  for  his  text,  “and  Luke,  the  beloved 
physician.”  The  reverend  prelate  first  dwelt  on  the  im¬ 
portance  which  the  Christian  dispensation  attaches  to  the 
body,  as  opposed  to  the  contempt  shown  for  it  by  the  heathen 
philosophers.  This  was  illustrated  by  the  fact  of  the  resur¬ 
rection  of  the  body  of  Christ,  and  by  the  teaching  of  the 
apostles.  Where  and  how  could  the  graces  of  temperance, 

1  sobriety,  chastity,  or  self-denial,  he  asked,  be  shown  forth 


136 


Medical  Times  and  Gazette. 


THE  BRITISH  MEDICAL  ASSOCIATION. 


August  4,  1883. 


except  in  and  through  the  body  ?  He  referred,  in  this  con¬ 
nexion,  to  the  Rev.  Dr.  Hobart’s  work  on  “  The  Medical 
Language  of  St.  Luke,”  as  proving  that  Luke  was  an  edu¬ 
cated  physician  in  our  sense  of  the  word.  A  very  flattering 
tribute  was  paid  to  the  humanity  and  devotion  of  the  profes¬ 
sion  by  the  Bishop  towards  the  conclusion  of  his  sermon, 
after  which  there  was  an  offertory,  the  proceeds  to  be  devoted 
to  the  British  Medical  Fund. 

The  real  work  may  be  said  to  have  commenced  with  the 
first  general  meeting,  which  was  held  in  the  theatre  of  the 
College.  The  minutes  of  the  last  annual  meeting  having 
“been  read  and  confirmed.  Dr.  Strange,  the  retiring  President, 
in  a  few  well-chosen  words,  thanked  the  Association  for  the 
honour  they  had  conferred  upon  him,  and  expressed  the 
pleasure  which  his  year  of  office  had  given  him.  He  then 
relinquished  the  chair  to  his  successor.  Dr.  A.  J.  H.  Waters, 
who  briefly  acknowledged  his  acclamation  to  office.  The 
report  of  Council,  with  financial  statements  for  the  year 
ending  December  31  last,  was  next  presented  and  adopted. 
The  finances  of  the  Society  are  exceedingly  satisfactory, 
and  leave  nothing  to  be  desired.  Reference  was  next  made 
to  the  changes  in  the  by-laws,  which  it  was  proposed  to 
submit  for  discussion.  Mr.  Wheelhouse,  as  President  of 
the  Council,  briefly  explained  the  nature  of  the  proposed 
changes,  and  the  reasons  which  had  induced  the  Council 
to  propose  them.  It  was,  he  said,  in  response  to  a  wish 
which  had  been  widely  expressed  that  the  branches  could 
be  more  directly  represented  in  the  Council.  The  changes 
proposed  were  radical,  and  required  most  careful  considera¬ 
tion  :  their  acceptance  swept  away  the  present  Council 
and  the  Committee  of  Council,  who  had  done  good  service. 
Besides  this,  the  articles  of  association  would  have  to  be 
altered,  for  some  of  the  new  by-laws  were  inconsistent  with 
these  articles.  He  would  just  explain,  therefore,  that  the 
new  by-laws  were  only  proposed.  It  was  desirable  that  they 
should  be  considered,  discussed,  and,  if  necessary,  amended, 
and  finally,  when  they  were  approved  by  the  Association, 
they  could  be  formally  proposed  for  adoption  at  some  meet¬ 
ing  which  would  have  to  be  specially  convened  for  the 
purpose.  Next,  the  articles  of  association  would  have  to 
be  altered.  It  was  evident,  therefore,  that  the  new  rules 
could  not  come  into  force  before  next  year.  Meanwhile,  the 
present  Committee  of  Council  would  continue  to  act  as  hereto¬ 
fore.  I  cannot  do  more  than  glance  at  some  of  the  more  im¬ 
portant  changes  which  were  proposed,  and  which,  as  I  now 
write,  have  been  practically  adopted.  The  branches  will 
have  direct  representation,  and  the  number  of  representa¬ 
tives  from  each  branch  will  depend  in  some  measure  on  the 
number  of  members  constituting  the  branch.  Members 
unattached  to  branches  (about  one-third  of  the  entire  num¬ 
ber  of  members  of  the  Association)  will  still  be  unrepresented 
on  the  Council.  From  this  Council  a  sub-committee  is  to 
be  elected,  to  be  called  the  Journal  and  Finance  Committee, 
consisting  of  fifteen  members,  together  with  sundry  ex 
officio  members,  of  whom  three  shall  form  a  quorum. 
Doubtless,  as  heretofore,  the  work  of  the  Association  will 
be  carried  on  by  this  sub-committee.  An  important  rule 
is  also  proposed,  which  says  that  “  the  three  elected 
members  who  shall  have  been  longest  in  office  shall  retire 
annually.”  This  is  also  a  concession  wrung  from  the 
expiring  Council,  and  has  for  its  main  object  the  gradual 
introduction  of  “  new  blood.”  The  change  is  an  important 
one,  and  can  hardly  fail  to  prove  of  service.  An  attempt 
was  made  to  exclude  homoeopaths  and  advertisers  by  a 
special  by-law ;  but,  after  a  stormy  and  largely  irrelevant 
discussion,  the  motion  was  lost.  I  cannot  but  refer  briefly 
here  to  the  great  disorder  which  prevailed  during  the  dis¬ 
cussion  of  these  by-laws.  The  cries  and  noise,  the  disre¬ 
gard  of  the  chair,  and  the  general  unbusiness-like  manner 
in  which  the  proceedings  were  conducted,  were  quite  unlike 
anything  I  ever  saw,  except,  perhaps,  at  a  similar  meeting 
last  year  at  Worcester.  It  would  certainly  be  in  the  in¬ 
terests  of  the  Association  if  the  President  would  post  him¬ 
self  up  in  the  rules  which  govern  such  meetings,  and  insist 
on  their  being  adhered  to,  or  else  dissolve  the  meeting. 
Nor  were  the  proceedings  much  less  disorderly  at  the 
adjourned  meeting  in  the  evening,  at  which  the  by-laws 
were  further  discussed.  Suffice  it  to  say  that,  finally,  with 
a  few  modifications  and  improvements,  the  new  by-laws,  as 
proposed  by  the  special  Committee,  were  accepted ;  and  it 
was  decided  to  recommend  their  adoption  at  a  later  stage  of 
this  annual  meeting. 


The  evening  meeting  (just  alluded  to)  commenced  with 
the  President’s  Address.  It  dealt  with  generalities  rather 
than  with  any  special  theme.  His  own  connexion  with  the 
growth  of  the  Association,  and  its  work,  were  first  touched 
upon  ;  then  came  the  subject-matter  of  his  address,  to  which 
I  may  refer  the  reader.  While  I  cannot  but  feel  that  I  have 
listened  to  more  brilliant  discourses,  yet  I  would  not  too 
lightly  speak  of  the  task  which  the  incoming  President  is 
expected  to  fulfil,  nor  of  the  manner  in  which  Dr.  Waters 
discharged  his  unenviable  duty.  I  cannot  say  much  in 
favour  of  the  acoustic  properties  of  the  theatre  in  which  it 
was  delivered  ;  and  the  imperfect  manner  in  which  I  heard 
what  was  said  may,  perhaps,  account  somewhat  for  the 
rather  faint  praise  I  have  bestowed  on  it. 

This  morning  (Wednesday)  there  was  a  second  general 
meeting,  at  which  a  little  formal  business  was  transacted. 
The  President  announced  that  a  pressing  invitation  from 
Belfast  to  hold  the  next  annual  meeting  in  that  city  had 
been  accepted,  and  proposed  that  Dr.  Cummings  be  elected 
President-elect.  This  was  put  and  carried  by  acclamation. 
The  chief  work  was  Mr.  Reginald  Harrison’s  Address  in 
Surgery.  It  dealt  chiefly  with  urinary  organs,  the  surgical 
treatment  of  the  kidney,  of  the  bladder,  and  of  the  urethra. 
It  was  well  delivered,  contained  matter  of  great  interest, 
and,  at  its  close,  elicited  from  the  audience  a  most  hearty 
vote  of  appreciation.  After  a  brief  adjournment  for  luncheon, 
sectional  work  commenced  with  great  vigour.  In  the  Section 
of  Medicine  the  afternoon  was  devoted  to  nervous  diseases, 
work  being  inaugurated  by  a  discussion  on  Aphasia.  In  the 
Surgical  Section,  Mr.  Rushton  Parker  opened  up  the  subject 
of  Intestinal  Obstruction;  while  Dr.  Dreschfeld  discoursed 
learnedly  on  Micro-organisms  in  the  Pathological  Section. 
In  the  Section  of  Children’s  Diseases,  after  an  interesting 
opening  address  from  the  President  (Dr.  Gee)  on  the  early 
literature  of  this  department  of  medicine,  Dr.  Barlow  intro¬ 
duced  a  discussion  on  Rheumatism  and  its  Allies  in  Children. 
The  author  endeavoured  to  expand  the  meaning  of  the  term 
rheumatism,  and  showed  how  varied  and  manifold  its  mani¬ 
festations  are.  A  discussion  followed,  which  occupied  the 
entire  afternoon. 


Robert  Koch. — The  Berlin  correspondent  of  the 
Philadelphia  Med.  News  of  June  23,  furnishes  the  follow¬ 
ing  account  of  this  great  investigator: — “There  is  no 
Berlin  correspondent  to-day  who  could  avoid  to  mention  the 
name  of  Robert  Koch  in  one  way  or  another.  Therefore,  it 
may  be  of  some  interest  for  Western  readers  to  hear  that 
this  eminent  man  did  not  belong  to  the  medical  staff  of 
some  great  hospital,  or  to  the  faculty  of  some  celebrated 
university,  but  that  he  was  a  simple  practitioner  and  State- 
physician  in  Wollstein  (a  small  provincial  town  not  far  from 
the  Russian  frontier),  at  the  very  moment  when  he  finished 
his  luminous  experiments  on  the  bacillus  anthracis  and  on 
septicaemia  in  mice.  Struck  by  the  profound  ingenuity 
and  exactitude  of  those  experiments.  Prof.  Cohn,  the  well- 
known  botanist  of  Breslau,  in  whose  laboratory  Koch  had 
executed  his  first  inquiries,  made  the  proposition  to  him  of 
coming  to  his  University.  He  did  so,  but  failed  to  get  an 
appointment,  and,  after  a  half-year’s  waiting,  returned  to 
his  former  residence.  Perchance,  only  a  year  later  (in  1880), 
Prof.  Finkelnburg,  of  Bonn,  resigned  his  post  of  Privy- 
Councillor  to  the  Imperial  Board  of  Health  ( Beichsgesund - 
heitsamt )  in  Berlin,  and  the  Director  Struck  offered  it  to 
the  provincial  practitioner.  Once  put  into  his  element, 
Koch  developed  an  admirable  activity.  He  filled  his 
laboratory  with  all  the  instruments  necessary  for  fruitful 
scientific  researches  in  practical  etiology,  and  began  to  work 
assiduously,  but  silently,  until  he  went  forth  into  one  of  the 
greatest  scientific  discoveries  of  the  century,  viz.,  the  plain 
and  clear  fact  of  a  bacillus  representing  the  active  principle 
of  the  tuberculous  process — which  fact  stands  unshaken  even 
by  the  somewhat  hazardous  attack  of  Spina,  of  the  Vienna 
Pathological  School.  Koch  is  now  at  work  gathering  all 
clinical  facts  which  may  contribute  to  confirm  his  theory  of 
the  communicability  of  phthisis.  Besides  this,  he  and  his  able 
assistants  are  fully  occupied  by  a  vast  series  of  experiments 
in  the  etiology  of  other  infectious  diseases,  the  influence  of 
preventive  inoculations,  and  the  efficacy  of  disinfecting 
methods.  The  discovery  of  a  bacillus  belonging  to  farcy, 
made  by  Prof.  Schiitz  and  Dr.  Loffler,  may  be  mentioned  as 
one  of  the  most  important  results  in  the  first  direction.” 


Medical  Times  and  Gazette. 


MEDICAL  MATTERS  IN  PARLIAMENT. 


August  4,  1883.  1 3-7 


MEDICAL  MATTERS  IN  PARLIAMENT. 


House  of  Commons — Thursday,  July  26. 

The  Smoke  Nuisance  Act. — In  reply  to  Mr.  Cubitt,  Sir 
W.  Harcourt  promised  to  lay  upon  the  table  of  the  House  a 
correspondence  between  himself  and  the  Duke  of  West¬ 
minster  on  the  subject  of  the  defective  administration  of 
the  Smoke  Nuisance  Act  in  the  metropolis.  He  also  stated 
that  a  further  inspection  had  been  made  by  the  Chief  Com¬ 
missioner  of  the  Police,  when  it  appeared  that  the  potteries 
of  the  metropolis  had  not  complied  with  the  Act;  steps  had 
consequently  been  taken  with  a  view  to  the  institution  of 
proceedings  against  them,  but  the  proprietors  had  promised 
to  make  satisfactory  plans  for  abating  the  nuisance. 

The  Cholera  in  Egypt. — In  reply  to  several  questions.  Lord 
Hartington  said  that  the  proportion  of  sick  among  the  Duke 
of  Cornwall’s  Light  Infantry  at  Ramleh  was  120  out  of  a 
strength  of  784,  or  15  3  per  cent.  One-fourth  of  the  cases 
were  venereal ;  and  there  had  been  some  increase  of  febrile 
diseases,  dysentery,  and  diarrhoea.  The  question  of  moving 
the  regiments  must  be  left  to  be  decided  by  the  general  officer 
in  command,  with  the  advice  of  his  principal  medical  officer. 
They  only  could  have  full  cognisance  of  all  the  circum¬ 
stances,  and  he  had  every  confidence  in  their  discrimination 
and  judgment.  Fourteen  cases  of  cholera  had  occurred 
among  the  troops,  and  eleven  had  proved  fatal.  He  had 
made  arrangements  for  the  publication  of  nominal  returns 
of  the  soldiers  dying  of  cholera  in  Egypt, 

Friday,  July  27. 

The  Cholera.— Sir  Stafford  Northcote  asked  whether  the 
Government  had  any  information,  confirmatory  or  otherwise, 
of  the  report  that  cholera  had  appeared  in  this  country ;  to 
which  Sir  C.  Dilke  replied  :  Those  suspicious  cases  that  have 
been  investigated  during  the  last  fortnight  have  all  proved, 
on  the  report  of  the  medical  men,  to  be  cases  of  simple 
cholera.  There  certainly  appears  to  be  no  Asiatic  or  epi¬ 
demic  cholera  in  this  country  ;  and,  so  far  as  I  know,  there 
is  none  in  Europe  up  to  the  present  time.  The  deaths  from 
simple  cholera  in  England  are  at  present  much  below  the 
average  for  this  time  of  the  year.  In  London  last  week  the 
number  of  deaths  attributed  to  summer-cholera  was  only 
half  the  average. 

Monday,  July  30. 

The^Cholera  in  India. — Mr.  O’Donnell  asked  the  Under 
Secretary  for  India  whether  during  the  week  ending  May  30 
there  were  636  cases  of  cholera  and  278  deaths  in  the 
Poonah  district,  and  395  cases  with  220  deaths  in  the 
Thana  district;  and  whether  this  proportion  of  deaths 
proved  the  virulence  of  the  epidemic ;  and  whether,  in 
reference  to  some  districts,  as  in  Ahmednagar,  the  official 
reports  failed  to  give  any  statistics,  but  confined  themselves 
to  the  statement  that  there  was  “cholera  throughout  the 
district.” — Mr.  Cross  said  that  the  figures  quoted  for  the 
Poonah  and  Thana  districts  were  correct.  As  to  the  rest 
of  the  question,  he  said  that  generally  the  weekly  season 
returns  from  the  separate  districts  were  not  published 
unless  the  mortality  was  excessive.  The  statistics  for 
Ahmednagar  had  been  published  weekly  since  June  5. 
Complete  cholera  statistics  were  given  in  the  sanitary  returns 
made  up  at  the  close  of  the  year.  Up  to  the  end  of  last 
month  cholera  was  very  prevalent  in  the  Deccan  districts 
of  Bombay,  though  the  rest  of  the  presidency  was  unusually 
free  from  it.  The  present  epidemic  did  not  appear  to  be  of 
exceptional  virulence.  In  1881,  with  16,700  deaths,  the  ratio 
of  mortality  to  attacks  was  over  47  per  cent.,  while  in  the 
present  epidemic  the  ratio  is  43.  The  average  deaths  from 
cholera  in  the  Bombay  Presidency  for  the  fifteen  years 
ending  1880  had  been  20,172  per  annum,  most  of  which 
occurred  between  May  and  September. 

The  Contagious  Diseases  Acts. — In  reply  to  questions  from 
Dr.  Farquharson,  Mr.  Hopwood,  and  Mr.  Macliver,  the 
Marquis  of  Hartington  said  he  was  ready,  if  it  was  moved 
for,  to  lay  on  the  table  of  the  House  a  memorial  recently 
sent  to  the  First  Lord  of  the  Treasury,  showing  the  result 
of  the  suspension  of  the  compulsory  examination  of  public 
women  ;  and  the  reply  to  it.  It  was  true  that  the  ratio  of 
contagious  diseases  among  the  troops  in  the  protected  dis¬ 
tricts  rose  dui’ing  1877  to  1880  from  35  per  1000  to  74  per 
1000— an  increase  of  39  per  1000.  But,  he  added,  it  was 


also  true  that  during  the  same  period  the  increase  in  the 
non-protected  districts  was  from  68  per  1000  to  119  per  1000 
— an  increase  of  51  per  1000.  A  serious  wave  of  venereal 
disease  seemed  to  have  risen  in  1880,  as  there  was  a  sudden 
rise  of  27  per  1000  in  the  ratio  of  the  diseases  in  protected 
districts,  and  of  59  per  1000  in  fourteen  large  stations 
not  under  the  Acts.  By  the  later  returns  for  1881,  not 
yet  published,  he  found  that  the  ratio  for  protected 
districts  remained  at  74  per  1000,  while  that  for  unprotected 
districts  had  risen  to  126  per  1000.  He  admitted  that  there 
had  been  a  large  increase  in  the  number  of  patients  suffering 
from  venereal  disease  in  the  naval  and  military  hospitals  at 
Stoke  and  Stonehouse;  the  number  at  Stoke  being  185, 
against  118,  and  at  Stonehouse  100,  against  45,  as  compared 
with  ten  weeks  of  the  same  period  last  year,  when  the  Con¬ 
tagious  Diseases  Acts  were  in  full  force.  There  had  un¬ 
doubtedly  been  a  serious  increase  in  the  amount  of  the  dis¬ 
ease  in  the  protected  districts,  but  there  had  also  been  a  large, 
though  by  comparison  a  lesser,  increase  in  the  unprotected 
districts,  which  would  seem  to  point  to  the  presence  of  some 
other  causes  as  well  as  the  suspension  of  compulsory  exa¬ 
mination  of  public  women ;  and  therefore  the  Government 
preferred  to  wait  the  result  of  further  experience  before  de¬ 
ciding  on  any  line  of  action. — In  reply  to  a  question  from 
Sir  H.  Wolff,  the  noble  marquis  added  that,  though  the 
Government  had  dropped  the  Detention  in  Hospitals  Bill, 
he  did  not  propose  to  do  anything  till  they  had  further 
experience  of  the  working  of  the  present  system. — Replying 
to  questions  on  the  same  subject  from  Lord  E.  Cecil  and 
other  members.  Sir  W.  Harcourt  said  the  only  connexion 
of  the  Home  Office  with  the  Acts  is  that  the  Metropolitan 
Police  were  recommended  as  an  alternative  agency  in  the 
working  of  them,  but  they  were  not  essential  to  it.  It  was 
only  in  exceptional  circumstances  that  they  were  employed 
in  preserving  law  and  order  elsewhere  than  in  the  metro¬ 
polis,  and  in  his  opinion  they  were  already  employed  too- 
much  elsewhere.  It  was  no  part  of  the  duty  of  the 
Home  Office  to  instruct  local  authorities  as  to  what  they 
should  do  in  the  matter. 

Army  Nurses. — The  Marquis  of  Hartington,  in  answer  to 
Baron  H.  de  Worms,  said  the  pay  of  an  Army  female  nurse 
is  not  stopped  when  she  is  in  hospital  owing  to  her  having 
caught  an  infectious  disease  from  a  soldier  whom  she  has 
nursed ;  though  an  orderly  of  the  Army  Hospital  Corps  in 
the  same  circumstances  does  lose  his  extra  pay. 

Tuesday,  July  31. 

The  London  Water-Supply. — Dr.  Cameron  asked  whether 
the  attention  of  the  President  of  the  Local  Government  Board 
had  been  called  to  a  resolution  passed  at  a  meeting  of  the 
Medical  Officers  of  Health  of  the  metropolis  regarding  the 
water-supply ;  and  whether  he  would  consider  the  propriety 
of  directing,  at  least  temporarily,  control  analyses,  and  sup¬ 
plementing  them  by  examinations  for  microbic  impurities 
by  the  methods  devised  by  Professor  Koch  and  Dr.  Angus 
Smith. — Sir  C.  Dilke  said  the  resolution  referred  to  had  been 
communicated  to  the  Board.  They  did  not  find  that  the 
water-supply  was  referred  to  in  it  as  “  the  important  sanitary 
defect  of  the  metropolis.”  The  members  of  the  Confer¬ 
ence  expressed  their  views  as  to  the  importance  of  a  pure 
public  water-supply,  and  stated  that  the  amendment  of  the 
water  service  in  detail  would  receive  the  attention  of  the 
medical  officers  of  health.  Experience  had  shown  the  need 
of  watchfulness  in  the  reservoirs  and  mains  of  the  water 
companies.  The  Board  had  brought  the  resolution  under 
the  special  notice  of  the  Water  Examiner  of  the  metropolis. 
The  Board  had  full  confidence  in  the  analyses  made  for  them 
by  Professor  Frankland,  and  at  present  did  not  see  any 
sufficient  reason  for  obtaining  control  analyses.  They  had 
some  time  since  arranged  for  samples  of  the  water  of  the 
several  metropolitan  companies  being  supplied  to  Dr.  Angus 
Smith,  for  examination  according  to  the  method  mentioned. 
As  to  Mr.  M.  Henry’s  useful  suggestion,  that  water  should 
be  supplied  direct  from  the  mains  by  standards  in  the  streets, 
so  as  to  avoid  contamination  in  cisterns,  etc.,  all  he  could 
say  at  present  was  that  attention  had  been  called  to  the 
point. 

The  Contagious  Diseases  Acts.— Mr.  Gladstone,  m  reply  to 
a  question  from  Lord  E.  Cecil,  said  he  had  consulted  with 
the  Secretary  of  State  for  War,  and  was  of  opinion,  with 
him,  that  the  time  which  had  elapsed  since  the  resolution 
against  the  compulsory  provisions  of  the  Act  was  adopted  by 


138 


Medical  Times  and  Gazette. 


FROM  ABROAD. 


August  4, 1883. 


the  House  did  not  disclose  a  state  of  things  sufficient  to 
warrant  the  Government  in  arriving  at  any  positive  con¬ 
clusion,  or  in  undertaking  to  announce  any  particular  course 
■of  action.  Out  of  a  strength  of  40,000  men  there  had  been 
twenty-seven  additional  admissions  per  week.  Some  part 
of  the  increase,  however,  might  be  explained  by  the  circum¬ 
stances  surrounding  the  removal  of  troops  to  different  places. 
Replying  to  Captain  Price,  he  further  said  he  was  aware 
that  the  restrictions  of  the  Acts,  whatever  they  were, 
operated  upon  the  population  of  the  places  subject  to  the 
Acts  as  well  as  on  the  troops  garrisoning  those  places.  But 
if  it  was  true  that  there  were  hundreds  of  young  girls  and 
women  on  the  streets  who  would  not  have  dared  to  carry 
on  their  trade  had  the  Acts  been  in  force,  it  appeared  to  him 
that  the  police  would  have  power  to  deal  with  such  abuses 
as  they  arose. 


FROM  ABEOAD. 

Excisions  and  Amputations  in  Tubercular  Subjects. 
Prop.  Ollier,  in  a  paper  published  in  the  Lyon  M6d.} 
June  3,  thus  sums  up  the  conclusions  which  his  extensive 
practice  in  this  class  of  affections  has  led  him  to  arrive 
at . — 

“  1.  Articular  excisions  performed  on  tuberculous  subjects 
may  be  attended  with  durable  success.  They  allow  not  only  of 
a  local  cure  being  obtained,  but  also  of  those  general  accidents 
being  eradicated  which  have  their  source  in  the  absorption 
of  the  products  of  articular  tubercular  disease.  2.  The 
gravity  of  the  tuberculosis  is  very  variable.  It  may  remain 
for  a  long  time  local,  cr  what  appears  to  be  so,  so  slow  is  its 
progress,  and  so  long  does  it  continue  unaccompanied  by 
general  phenomena.  The  question  of  soil  ( terrain )  seems 
to  exert  a  capital  influence.  3.  It  is  probable  that,  in  the 
anatomical  group  of  tubercular  lesions,  there  may  be 
pyogenic  affections  of  different  kinds.  Histology  has  not  as 
yet  furnished  us  with  the  means  of  making  these  distinctions. 
Inoculation  and  a  study  of  the  tubercular  microbe  will 
probably  allow  of  our  soon  establishing  differences  which,  at 
the  present  time,  we  can  only  suspect.  While  awaiting  the 
time  when  more  complete  notions  concerning  the  tuber- 
-cular  microbe  will  allow  of  our  measuring  the  gravity 
of  the  affections  termed  tubercular,  we  should  establish  our 
prognosis  and  our  operative  indications  upon  the  progress 
of  the  affections,  and  the  clinical  characters.  4.  Articular 
excisions  in  subjects  who  have  presented  all  the  anatomical 
and  clinical  signs  of  a  tubercular  affection  have  enabled  us 
to  obtain  cures  which  have  been  maintained  for  fifteen  years 
and  more.  5.  Amputations  should  be  preferred  to  excisions 
in  the  grave  forms  of  articular  tuberculosis,  especially  in 
lesions  of  the  lower  extremities.  We  should  have  recourse 
to  them  when  it  is  a  matter  of  importance  to  suppress  with¬ 
out  delay  a  suppuration  which  threatens  life.  6.  In  prin¬ 
ciple,  amputations  offer  more  shelter  against  secondary 
infections  than  excisions ;  but  they  never  constitute  a  radical 
operation.  The  deep-seated  and  inaccessible  ganglions, 
already  invaded  by  the  tuberculosis,  subsist  in  the  one  case 
as  in  the  other.  7.  An  excision  followed  by  a  complete  local 
cure — that  is  to  say,  by  the  definitive  cicatrisation  of  the 
wound  from  the  operation — does  not  expose  more  than  ampu¬ 
tation  to  secondary  tubercular  infection.  8.  Hygiene  and 
general  medication  are  of  great  importance  in  the  modifica¬ 
tion  of  the  soil  in  which  tuberculosis  may  become  developed. 
Local  modifications  may  destroy  the  tubercular  tissues,  and 
transform  them  into  stable  cicatricial  tissue — such  modifica¬ 
tions,  moreover,  taking  place  spontaneously  in  many  sub¬ 
jects,  and  especially  in  children.  Notwithstanding  the 
inoculability  of  its  products,  tuberculosis  cannot  be  assimi¬ 
lated  to  cancer,  whether  as  regards  its  prognosis  or  thera¬ 
peutical  indications.” 


Hemorrhage  into  the  Nervous  Centres  during 
Purpura  Hemorrhagica. 

Dr.  Duplaix  terminates  a  paper,  published  in  the  Archives 
G&niroXes  for  April  and  May,  with  the  following  conclu¬ 
sions  : — r‘  1.  There  exist  in  the  course  of  purpura  hsemor- 
rhagica  certain  cerebral  disturbances  which  are  of  frequent 
occurrence,  and  which  depend  upon  cerebral  lesions.  2.  These 
cerebral  manifestations  are  very  variable  in  their  intensity. 


Sometimes  they  are  scarcely  marked  and  pass  unperceived, 
while  at  others  they  are  sufficiently  violent  to  prove  fatal. 

3.  They  recognise  as  their  cause  certain  modifications  in  the 
condition  of  the  nervous  centres.  Most  frequently  it  is 
to  cerebral  ana3inia  that  they  owe  their  appearance,  but 
there  are  cases  in  which  haemorrhages  give  rise  to  them. 

4.  Those  haemorrhages  are  most  often  of  but  slight  extent. 
They  occupy  sometimes  the  meninges  and  sometimes 
the  cerebral  substance,  and  oftentimes  both  the  meninges 
and  the  brain.  5.  True  haemorrhagic  centres  may  exist 
without  any  fixed  seat,  the  consequences  of  which  are  the 
same  as  those  of  ordinary  cerebral  haemorrhage.  6.  The 
haemorrhages,  whatever  may  be  their  extent,  are  very  rare, 
and  this  rarity  is  explained  by  the  complete  cerebral 
anaemia  which  exists  in  most  of  these  patients.  7.  Their 
pathogeny  does  not  differ  from  that  of  haemorrhages  of  other 
organs,  but  we  must  take  into  account  the  conditions  of  the 
circulation  and  of  the  vascular  changes  which  have  been  de¬ 
scribed,  especially  in  the  cases  in  which  intense  accidents 
have  been  slow  of  production  in  debilitated  subjects.  8.  The 
clinical  manifestations  have  been  very  variable,  and  in  rela¬ 
tion  to  the  extent  and  intensity  of  the  lesions ;  neverthe¬ 
less,  there  are  cases  in  which,  in  spite  of  the  existence  of 
lesions,  no  symptom  has  been  observed  during  life,  and 
others  in  which  anaemia  has  been  the  sole  lesion  observed  in 
patients  who  have  presented  marked  symptoms.  The  lesions 
taking  place  in  centres  ( foyers )  are  the  only  ones  which 
have  well-defined  symptoms.  8.  The  diagnosis  is  difficult 
in  most  cases,  and  haemorrhage  should  be  suspected  always, 
notwithstanding  the  more  frequent  occurrence  of  anaemia. 
The  prognosis  is  directly  proportionate  to  the  intensity  of 
the  nervous  accidents.” 


GENERAL  CORRESPONDENCE. 

- o - 

THE  SANITARY  LESSONS  OF  INDIAN  EPIDEMICS. 
Letter  from  Inspector-General  R.  Lawson. 


[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sir, — In  your  remarks  on  the  paper  of  Dr.  Cuningham,  on 
the  “  Sanitary  Lessons  of  Indian  Epidemics,”  in  the  Medical 
Times  and  Gazette  of  July  21,  you  object  to  his  statement 
that  there  is  no  evidence  to  prove  that  cholera  is  caused  by 
any  special  contagium  developed  in  the  bodies  of  the  sick, 
and  communicated,  either  directly  or  indirectly,  by  human 
intercourse,  on  the  ground  that  in  Europe,  and  from  Europe 
to  America,  it  has  invariably  followed  the  great  routes  of 
trade,  and  that  in  countries  which  have  direct  communica¬ 
tion  by  sea  only  with  others  where  it  is  endemic  or  epidemic, 
it  has  invariably  made  its  first  appearance  in  those  seaport 
towns  which  lie  on  the  routes  of  such  intercourse;  and  as 
constantly  among  persons  just  arrived  from  infected  ports 
abroad.  As  Dr.  Cuningham  has  left  England  on  his  return 
to  India,  and  it  is  of  especial  importance,  at  the  present 
juncture,  that  we  should  confine  our  theories  of  the  causa¬ 
tion  and  mode  of  transmission  of  cholera  to  what  we  can 
establish  by  logical  inferences  from  ascertained  facts,  I 
venture  to  draw  your  attention  to  some  facts  bearing  on  this 
question  you  have  inadvertently  overlooked. 

The  epidemic  of  1873  in  the  United  States  commenced  at 
New  Orleans  in  February,  and,  during  the  summer,  extended 
northwards  along  the  valley  of  the  Mississippi,  and  east¬ 
wards  and  westwards  along  those  of  the  Ohio  and  Missouri, 
respectively,  but  did  not  pass  into  the  valley  of  the  St. 
Lawrence  and  great  lakes,  or  cross  the  Alleghany  range,  so 
that  the  whole  Atlantic  seaboard  and  the  country  south  of 
the  lakes  remained  exempt,  save  at  the  south-west  corner  of 
Lake  Michigan,  where  Chicago  came  within  the  epidemic 
field.  The  earliest  known  case  occurred  on  February  8,  in  a 
man  who  came  from  Pensacola  two  months  previously,  and 
had  since  resided  in  New  Orleans ;  the  second,  on  the 
following  day,  was  in  a  man  who  had  lived  in  New  Orleans 
four  years  :  these  men  lived  at  a  considerable  distance  from, 
and  had  had  no  communication  with,  each  other.  The  next 
case  occurred  on  February  27 ;  and  from  that  date  to 
March  31,  inclusive,  eighteen  attacks  were  recorded :  of 
these,  all  except  four  were  residents  in  New  Orleans,  though 
at  points  much  separated  from  each  other ;  of  the  four  non¬ 
residents,  two  came  from  the  Washita  River  above  New 
Orleans,  the  other  two  from  the  country,  the  place  not  speci- 


Medical  Times  and  Gazette. 


GENERAL  CORRESPONDENCE. 


August  4,  1833.  139 


fied,  but  they  were  not  recent  arrivals  from  Europe.  The 
Board  of  Health  at  Hew  Orleans  was  most  anxious  to  obtain 
exact  information  on  every  point  connected  with  the  origin 
of  the  disease,  and  investigated  “all  modes  of  infection  and 
importation,  as  by  visiting  ships,  the  washing  of  clothing 
for  persons  connected  with  shipping,  visiting  sailors’  board- 
ing-houses,  contaminated  drinking-water,  etc.,”  not  only  in 
these  instances,  but  in  every  subsequent  attack  during  the 
outbreak,  and  was  led  to  the  conclusion  that  it  was  endemic 
and  had  not  been  imported.  Surgeon  Yan  Buren  Hubbard, 
TJ.S.A.,  who  made  an  investigation  in  1874,  at  the  instance 
of  the  central  Government,  admitted,  “  It  has  been  found 
utterly  impossible  to  establish  the  arrival  of  individuals  who 
were  personally  affected  with  cholera,”  but,  instead  of  stop¬ 
ping  there,  he  fell  back  on  theory  where  facts  failed  him, 
and  expressed  his  belief  that  the  disease  must  have  been 
introduced  by  emigrants  from  Europe,  for  which  he  offered 
no  better  reason  than  that  quarantine  had  been  enforced 
with  laxity,  and  that  cases  of  cholera  might  have  passed 
without  detection. 

Three  instances  occurred  during  this  epidemic  in  which 
parties  of  emigrants  from  Europe  landed  at  New  York  in 
good  health  and  proceeded  to  their  destinations  in  the 
Western  States,  where,  after  opening  the  packages  containing 
their  spare  clothing  and  bedding,  which  had  not  been  ex¬ 
posed  to  the  air  since  their  departure  from  Europe,  they 
were  attacked  with  cholera ;  and  the  inference  was  drawn 
that  these  articles  had  conveyed  the  materies  morbi, 
which,  on  being  diffused,  caused  the  disease  among  them. 
The  first  of  these  parties  were  Swedes,  who  had  passed 
three  weeks  at  Bergen,  in  the  island  of  Eugen,  in  May, 
and  early  in  June  sailed  for  New  York,  where  they 
arrived  on  the  26th  of  that  month  ;  the  second  were  Dutch, 
who  had  left  Tubbergen,  on  the  eastern  frontier  of  Holland, 
on  May  31,  for  Eotterdam  and  England,  and  reached  New 
York  on  July  5.  The  third  were  Eussians,  from  the  South; 
neither  the  exact  locality  from  which  they  came,  the  date  of 
their  leaving  it  or  of  their  arrival  at  New  York,  are  given,  but 
they  reached  their  destination,  Yankton,  in  Dakota,  about 
August  25.  Now,  on  tracing  the  distribution  of  cholera  in 
Europe  in  1873,  it  is  found  that  the  disease  did  not  appear 
in  Eugen  that  year  at  all,  neither  was  there  any  in  Holland 
in  May ;  in  its  progress  from  Poland  and  Bohemia,  where  it 
Ead  been  during  the  winter,  it  reached  Frankfort,  Magde¬ 
burg,  and  Berlin  in  the  middle  of  July  only,  though  in 
Hamburg  the  first  case  was  met  with  on  June  21,  and  in  the 
next  three  weeks  there  were  only  six  fatal  cases.  In  these 
two  instances,  then,  the  theory  of  importation  breaks  down 
at  the  commencement,  there  having  been  no  cholera  at  the 
points  of  departure  to  supply  the  required  materies  morbi. 
The  want  of  information  as  to  dates  and  places,  in  the  case 
of  the  Eussian  party,  prevents  a  specific  investigation  in 
their  instance,  but  the  Eussian  returns  show  that  several  of 
the  governments  bordering  on  or  near  the  Black  Sea  were 
free  from  cholera  in  1873,  and  most  of  the  others  had  it  in  a 
very  slight  degree  only,  and  comparatively  late  in  the  season; 
so  that  even  the  probability  of  infection  of  bedding,  etc.,  in 
this  case  is  of  the  most  shadowy  description.  When  it  is 
considered,  however,  that  the  party  on  their  way  from  New 
York  had  to  pass  through  an  extensive  range  of  country 
actually  under  the  epidemic  at  the  time,  it  will  be  seen  it  is 
impossible  to  exclude  the  operation  of  the  causes  of  the 
disease  they  were  there  exposed  to,  which  must  have  been 
done  before  it  could  be  accepted  as  due  to  materies  morbi 
brought  from  Europe.  The  above  details  are  taken  from 
the  official  Eeport  “  On  the  Cholera  Epidemic  of  1873  in  the 
United  States,”  Washington,  1875.  A  notice  of  the  Eeport 
may  be  seen  in  the  British  and  Foreign  Medico-Chirurgical 
Review  for  July,  1876. 

Turning  now  to  England,  there  were  several  manifestations 
of  malignant  cholera  in  1865,  when  the  disease  was  extend¬ 
ing  over  the  South  of  Europe  as  an  epidemic,  in  which  form 
it  did  not  reach  this  country  until  the  following  year.  These 
manifestations  were  investigated  minutely  at  the  time,  and 
the  results  are  of  particular  value  in  this  inquiry.  The 
chief  outbreak  was  at  Southampton  and  its  immediate 
vicinity,  with  contemporaneous  manifestations  at  Weston 
Common  and  Bitterne,  places  two  miles  from  Southampton, 
in  different  directions.  A  case  had  occurred  in  Southampton 
on  August  12,  which  Dr.  Langsbaffe,  who  treated  it,  first 
thought  to  be  a  severe  attack  of  cholera  nostras,  but  sub¬ 
sequently  was  inclined  to  consider  as  true  Asiatic  cholera. 


The  first  case,  recognised  at  the  time  as  malignant  cholera, 
appeared  on  September  22  in  a  man  named  Eose,  who  resided 
at  Brewhouse-court,  five  furlongs  from  the  railway  station. 
Eose  had  been  affected  with  diarrhoea  from  the  17th,  and 
died  on  September  24.  On  the  23rd  a  lad  named  Hill,  re¬ 
siding  at  Weston  Common,  was  attacked,  having  had  diar¬ 
rhoea  for  two  days  previously ;  and  onjthe  26th  his  father  and 
sister  were  also  attacked  with  cholera.  On  the  27th  a  man 
named  Stanley  and  his  son  were  attacked  at  Bitterne,  the 
latter  having  had  diarrhoea  since  17th,  and  the  former  since 
the  24th.  On  the  28th  there  was  another  attack  of  cholera 
in  Southampton;  and  the  disease  went  on  -until  November  4, 
when,  including  all  the  localities  named  above,  there  had 
been  sixty  persons  attacked.  The  late  Dr.  Parkes  investi¬ 
gated  this  outbreak  at  the  instance  of  the  Local  Government 
Board,  with  all  the  zeal  and  ability  which  characterised 
him,  and  in  his  narrative  of  it  in  the  Eighth  Eeport  of  the 
Medical  Officer  of  the  Privy  Council  (from  which  the  above 
details  are  taken),  in  summing  up  the  results,  he  stated  : — 
"  The  origin  by  an  unknown  epidemic  influence,  alone  or 
coinciding  with  local  conditions,  presents  formidable  diffi¬ 
culties,  even  if  we  cannot  quite  reject  it.  The  origin  by  im¬ 
portation  is  deficient  in  precision  of  evidence.” — (Page  436.) 
In  short,  though  firmly  believing  in  the  possibility  of  the 
cause  being  introduced  in  this  way,  he  utterly  failed  to  trace 
importation  in  any  instance. 

About  this  time  another  outbreak  took  place  at  Theydon 
Bois,  in  Essex,  which,  had  the  facts  connected  with  it  come 
fairly  before  Dr.  Parkes,  might  have  influenced  his  opinion 
regarding  epidemic  influences.  Mr.  and  Mrs.  Groombidge, 
from  Theydon  Bois,  had  been  at  Weymouth  for  their  health 
for  fifteen  days,  when,  on  September  23,  the  former  passed 
some  time  on  the  hills  overlooking  Portland  harbour,  ex¬ 
posed  to  a  strong  breeze  from  the  sea;  while  in  this  situa¬ 
tion  he  became  indisposed,  and  diarrhoea,  sickness,  and  cramp 
ensued,  from  which  he  suffered  on  that  and  the  following 
day.  On  the  25th  he  was  still  ailing,  but  able  to  travel, 
and  he  and  his  wife  returned  to  Theydon  Bois  by  railway 
from  Weymouth  to  Southampton,  and  on  to  London,  and 
neither  seems  to  have  left  the  station  while  at  Southampton. 
Onreaching  home,  Mrs.  Groombridge  (aged  fifty)  complained 
of  pain  in  the  back  and  some  discomfort  in  stomach  and 
bowels,  which  she  attributed  to  the  shaking  of  the  train. 
On  the  26th  diarrhoea  ensued,  followed  by  sickness  and 
cramps  on  28th,  and  collapse  on  29th.  Eeaction  commenced 
on  30th,  secondary  fever  succeeded,  and  she  died  on  October  11. 
On  September  30  a  daughter,  aged  eight,  was  attacked  with 
cholera,  and  died  the  same  night ;  and  in  the  next  week  six 
other  persons  of,  or  immediately  connected  with,  the  family 
contracted  the  disease  (including  Mr.  Groombridge  himself 
on  October  6),  and  some  others  followed.  It  was  sub¬ 
sequently  found  that  the  soil-pipe  from  the  water-closet 
leaked  into  the  well  from  which  the  water  for  household  use 
was  drawn,  and  from  the  appearance  of  the  spot  this  seemed 
to  have  been  going  on  for  a  considerable  period. 

Now  the  question  arises.  Where  did  Mrs.  Groombridge 
contract  cholera  ?  Mr.  Eadcliffe  was  informed  by  the  local 
medical  practitioners  and  others,  that  neither  epidemic 
cholera,  nor  anything  resembling  it,  choleraic  diarrhoea,  nor 
autumnal  cholera,  had  been  observed  at  Weymouth,  Port¬ 
land,  or  Dorchester  in  September,  1865  ( Transactions  of 
the  Epidemiological  Society ,  vol.  iii.,  page  95).  At  South¬ 
ampton,  as  already  mentioned,  the  first  attack  of  cholera 
(at  this  time)  was  on  the  22nd,  followed  by  death  on  the 
24th,  at  a  point  five  furlongs  from  the  railway  station ;  and 
a  second  case  occurred  at  Weston  Common,  two  miles  from 
Southampton;  but  as  neither  Mrs.  Groombridge  nor  her 
husband  left  the  station  or  railway,  communication  with 
either  was  out  of  the  question ;  and  from  Southampton  to 
Theydon  Bois  no  case  of  the  disease  was  known.  On  reach¬ 
ing  home  it  is  highly  probable  that  the  use  of  contaminated 
water  from  the  house-well  aggravated,  if  it  did  not  excite, 
Mrs.  Groombridge’s  diarrhoea;  but  as,  up  to  this  time,  no 
cholera  evacuation  could  have  had  access  to  it,  the  so-called 
materies  morbi  was  wanting,  and  the  theory  which  would 
account  for  the  attack  by  means  of  this  breaks  down.  It 
may  be  asserted  that  Mr.  Groombridge’s  attack  at  Weymouth 
was  one  of  cholera,  and  that  the  well  was  contaminated  by 
his  evacuations ;  but,  even  if  this  were  so,  it  only  removes  the 
difficulty  of  accounting  for  the  first  case  from  his  wife  to 
him,  and  the  evidence  is  equally  conclusive  against  his 
having  contracted  it  from  a  previous  case  as  with  her. 


Medical  Times  and  Gazette. 


OBITUARY. 


August  4, 18S3. 


140 


The  evidence,  then,  leaves  no  alternative  but  to  fall  back 
on  epidemic  influence  coinciding  with  local  conditions — a 
combination  Dr.  Parkes  admitted  he  could  not  quite  reject. 
That  the  local  conditions  were  unusual  at  the  time  around 
Theydon  Bois  is  indicated  by  the  fact  that  several  cases  of 
common  sporadic  cholera  occurred  in  the  neighbouring  dis¬ 
tricts  of  Epping,  Harlow,  andMitchingham,  quite  unconnected 
with  the  Groombridge  family. 

It  is  obvious  that  as  the  combination  of  epidemic  influence 
with  local  causes  gave  origin  to  one  case,  under  favourable 
conditions  it  may  produce  an  epidemic ;  and,  as  the  epidemic 
factor  is  necessary  to  the  result,  no  higher  claim  can  be 
made  for  the  cholera  evacuations  in  evolving  it,  than  for 
other  forms  of  organic  matter  undergoing  change — such  as 
ordinary  sewage,  tainted  meat  or  fish,  or  overripe  and 
acescent  fruit,  or  even  sulphate  of  magnesia  or  other  pur¬ 
gatives,  the  employment  of  any  of  which  is  well  known  to 
be  very  hazardous  when  cholera  is  present,  and  which  can¬ 
not  be  regarded  as  containing  the  materies  morbi  of  the 
disease  as  derived  from  the  bodies  of  those  labouring  under 
it.  The  recognition  of  the  Epidemic  Influence  not  only 
enables  a  rational  explanation  to  be  given  of  all  the  facts 
detailed  above  (both  in  America  and  at  Southampton) ,  but 
accounts  for  many  other  outbreaks  of  cholera  for  which  no 
importation  could  be  made  out ;  and  no  theory  which  does 
not  take  cognisance  of  it  can  be  regarded  as  embracing  the 
whole  forces  in  operation.  It  may  be  said  we  do  not  know 
the  intimate  nature  of  Epidemic  Influence.  True;  neither 
do  we  know  the  intimate  nature  of  gravitation,  but  we 
recognise  its  existence,  and  have  become  acquainted  with 
the  conditions  under  which  it  operates,  which  informa¬ 
tion  we  employ  to  meet  the  requirements  of  daily  life  as 
they  arise.  So  it  must  be  with  Epidemic  Influence.  Dr. 
Cuningham’s  Indian  experience  has  led  him  to  certain 
practical  conclusions  involving  some  of  these  conditions,  and 
if  we  in  this  country  wish  to  test  their  correctness,  we  can 
only  hope  to  do  so  with  success  by  analysing  critically  such 
evidence  as  presents  the  facts  in  a  form  that  admits  of  our 
excluding  what  is  non-essential  in  the  combination  of  cir¬ 
cumstances  by  which  they  are  so  frequently  accompanied. 
The  analysis  of  facts  from  independent  sources  here  made  is 
altogether  favourable  to  Dr.  Cuningham’s  views. 

I  am,  &c.,  Robebt  Lawson, 

London,  July  26.  Inspector- General  of  Hospitals. 


[The  position  of  the  agnostic  is  de  facto  unimpugnable. 
But  all  that  Mr.  Lawson’s  letter  proves  is,  what  nobody 
denies,  that  in  certain  cases  it  was  not  possible  to  discover 
the  origin  of  the  outbreak  in  importation.  The  same  might 
be  shown  in  countless  instances  of  diseases  which,  like  small¬ 
pox  and  measles,  are  generally  communicated  by  immediate 
contact  with  affected  individuals.  Much  more  probable  is 
it  with  those  which,  like  cholera  and  enteric  fever,  are  mostly 
propagated  by  water  and  ground-air  infected  by  others 
who  have  gone  before.  But  no  number  of  negative  cases 
— cases  in  which  information  is  simply  wanting  (for  Mr. 
Lawson  cannot  disprove  the  possibility  of  its  importation  into 
one  country  when  it  was  raging  in  others  with  which  inter¬ 
course  was  going  on), — no  number  of  such  cases  can  invalidate 
the  conclusions  to  be  drawn  from  numerous  examples,  for 
which  we  would  refer  Mr.  Lawson  to  the  same  American 
report,  in  which  the  facts  are  positive  and  irrefragable — e.g., 
that  at  Altenburg.  But  if  Mr.  Lawson  will  read  page  101, 
he  will  find  that  the  epidemic  at  Hew  Orleans  was  by  no 
means  of  the  type  with  which  he  is  so  familiar  in  India, 
which  now  rages  in  Egypt,  or  which  visited  Europe  and 
America  in  1832,  1848,  1854,  1865-66,  and  1872-73  ;  but 
resembled  rather  the  severe  diarrhoeas  which  prevail 
everywhere  in  hot  weather  among  insanitary  surroundings. 
The  symptoms  yielded  speedily  to  treatment,  especially 
morphia  injection ;  the  mortality  was  very  small,  being 
variously  estimated  at  3  to  12  per  cent.,  and  the  severest 
cases  rarely  ended  fatally.  If  so,  not  only  Mr.  Lawson’s 
conclusions,  but  his  premises,  fall  to  the  ground.  As  to  the 
German  and  Russian  immigrants,  though  it  would  be  hard 
to  prove  that  any  part  of  Eastern  Europe  was  entirely  free 
from  cholera,  there  is  no  need  to  assume  that  they  brought 
it  with  them.  It  is  enough  that  they  travelled  through  an 
infected  district  when  in  a  susceptible  state  from  fatigue, 
and  probably  want  and  dirt. — Ed.  Med.  Times  and  Gaz.f 


ALEXANDER  PATRICK  STEWART,  M.D.,  E.R.C.P. 

In  the  fulness  of  years,  and  after  a  life  which  had  through¬ 
out  been  marked  by  high  principle  and  singular  unselfish¬ 
ness,  Dr.  Patrick  Stewart  died  on  July  17,  in  the  house 
which  he  occupied  in  Grosvenor-street  for  thirty-eight  years. 
He  was  known  and  beloved  by  many,  especially  in  London, 
where  he  had  resided  since  the  year  1839 ;  but  he  ever  re¬ 
tained  the  clannish  virtues  that  so  strongly  stamp  the 
character  of  the  Scot :  he  never  forgot  the  land  of  his 
birth,  and  he  ever  took  a  keen  interest  in  those  of  her  sons  who 
had  embraced  the  same  profession  as  himself.  His  father 
was  the  Rev.  Andrew  Stewart,  M.D.,  minister  of  Bolton, East 
Lothian,  who  in  early  life  had  entered  the  medical  profes¬ 
sion,  and  obtained  therein  considerable  reputation  for  his 
rational  treatment  of  consumption  ;  and  his  mother  was  a 
sister  of  the  late  Lord  Blantyre,  and  had  been  one  of  his 
father’s  patients  before  he  relinquished  the  medical  pro¬ 
fession  for  the  ministry.  Alexander  Patrick  Stewart  was 
born  in  1813,  and  graduated  in  Arts  and  in  Medicine  in 
Glasgow  University,  taking  the  degree  of  M.D.  in  1838; 
and  subsequently  studied  for  about  eighteen  months  in 
Paris  and  Berlin.  The  most  notable  of  his  contributions  to 
medical  science  appeared  almost  in  those  student  days,  for  it 
was  at  Glasgow  that  he  was  stimulated  to  initiate  his  inquiry 
into  the  nature  of  typhus  and  typhoid  fever,  and  it  was  in 
Paris,  in  1840,  that  his  essay  first  appeared.  The  ardour 
with  which  he  threw  himself  into  that  work,  and  the  desire 
for  knowledge  that  led  him  to  extend  his  curriculum  of  study 
beyond  ordinary  limits,  promised  much  for  his  future';  but 
as  years  passed  on  he  turned  his  attention  to  other  channels, 
more  useful,  perhaps,  for  the|mass  of  his  fellow-practitioners, 
than  for  enhancing  his  reputation  as  a  scientific  physician. 
His  powers  and  attainments,  however,  were  fully  appre¬ 
ciated,  and  whilst  holding  the  appointment  of  Physician  to 
the  St.  Pancras  General  Dispensary,  he  was  appointed 
Lecturer  on  Materia  Medica  to  the  Middlesex  Hospital 
Medical  School  in  1848,  holding  the  chair  in  conjunction 
with  Dr.  Gordon  Latham.  In  1850  a  vacancy  on  the  hospital 
staff  having  been  created  by  the  resignation  of  Dr.  Latham, 
Dr.  Stewart  was  elected  Assistant-Physician,  and  for  several 
years  had  sole  charge  of  the  medical  out-patient  department. 
He  was  also  appointed  co-Lecturer  on  Medicine  with  Dr. 
Seth  Thompson ;  and  in  1855,  on  the  resignation  of  the  latter, 
he  had  for  his  coadjutor  Dr.  S.  J.  Goodfellow,  when  Dr. 
Stewart  himself  was  promoted  to  the  office  of  Physician. 
He  retained  this  office  until  1866,  when  he  resigned.  His 
old  pupils  speak  of  him  with  affection,  for  his  kindness  and 
consideration  endeared  him  to  many.  As  a  lecturer  he  was 
fluent  and  eloquent,  and  in  the  wards  he  was  always  kind, 
considerate,  and  sympathetic ;  but  the  same  reason  which 
prevented  his  giving  to  the  world  contributions  from  his 
experience,  militated  also  against  the  due  performance  of 
his  hospital  duties,  and  may  have  led  to  his  desire  to  resign 
them  at  an  earlier  date  than  obligatory.  However  this  may 
be,  it  would  be  wrong  to  conclude  that  Dr.  Stewart  cared 
little  for  the  scientific  part  of  his  profession,  which  he  had 
pursued  so  ardently  in  early  years.  On  the  contrary,  he  was 
a  frequent  attendant  at  the  various  medical  societies  ;  had 
held  the  office  of  Librarian  to  the  Royal  Medical  and  Chirur- 
gical  Society,  and  was  one  of  the  original  members  and  later 
Vice-President  of  the  Clinical  Society. 

He  was  most  frequently  before  us,  perhaps,  in  connexion 
with  the  British  Medical  Association,  of  which  he  early  became 
a  warm  adherent.  He  believed  fully  in  the  principles  upon 
which  this  Association  was  founded,  and  lived  to  see  it  attain 
a  degree  of  popularity  and  prosperity  which  its  promoters 
could  hardly  have  dreamt  of.  At  all  its  meetings  Dr. 
Stewart  was  constantly  present.  The  confidence  placed  in 
his  sagacious  counsels  was  such  that  for  thirty  years  he  was 
a  member  of  the  Council  of  the  Metropolitan  Counties 
Branch,  and  for  a  great  part  of  that  time  one  of  its 
honorary  secretaries ;  and  for  many  years  he  had  a  seat  on 
the  governing  body  of  the  Association.  The  esteem  in 
which  he  was  held  was  evinced  in  the  presentation  in  1875, 
by  members  of  the  Association,  of  a  testimonial  for  his 
services  to  the  profession  and  the  public  whilst  holding  the 
office  of  secretary  of  the  branch  above  mentioned.  At  his 
own  desire  by  far  the  greater  part  of  the  amount  col- 


OBITUARY. 


1 


Medical  Times  and  Gazette.  .  -  ,  ,  .  .  MEDICAL  NEWS. 


August  4,  1883.  141 


lected  for  this  purpose  was  made  over  to  the  Association 
to  form  “  a  fund  for  the  recognition  and  encouragement 
of  important  researches  into  the-  origin,  spread,  and  pre¬ 
vention  of  epidemic  disease”;  and  the  first  award  of  the 
“  Stewart  Prize  ”  was  made  last  year  to  Dr.  Vandyke 
Carter  for  his  work  on  Spirillum  Fever.  Dr.  Stewart 
was  also  much  interested  in  sanitary  science,  and  read 
an  important  paper  upon  the  Medical  Aspects  of  Sani¬ 
tary  Reform  at  the  meeting  of  the  Social  Science  Asso¬ 
ciation  in  1877.  It  was  in  labours  such  as  these  that 
he  felt  most  at  home  ;  but  he  was  also  a  staunch  poli¬ 
tician  ,  and  in  Parliamentary  elections  was  found  always 
ready  to  give  his  warm  support  to  movements  of  the 
Glasgow  and  Aberdeen  Universities  in  behalf  of  the  Liberal 
cause.  Thus  was  his  life  passed — running  its  even  course, 
and  free  from  any  disturbing  influences.  He  was  eminently 
a  good,  upright,  conscientious,  honourable,  and  kind-hearted 
man;  guided  in  his  life  and  conduct  by  deep  religious 
feeling  and  belief.  He  never  married.  Of  his  two  brothers, 
one,  David  Stewart,  entered  the  Army  Medical  Service,  and 
lost  his  life  during  the  Afghan  war  of  1841 ;  and  the  other, 
the  Rev.  Dr.  Robert  Stewart,  gave  up  his  charge  at  the  dis¬ 
ruption  of  the  Scottish  Kirk,  and  is  now  Presbyterian 
minister  at  Leghorn. 

Before  we  close  this  notice,  a  few  remarks  should  be  made 
upon  the  subject  which  has  given  him  special  distinction. 
His  paper  entitled  “  Some  Considerations  on  the  Nature 
and  Pathology  of  Typhus  and  Typhoid  Fever,  applied  to  the 
solution  of  the  question  of  the  identity  or  non-identity  of 
the  two  diseases,”  appeared  in  the  Edinburgh  Medical  and 
Surgical  Journal  for  October,  1840.  The  essay,  which 
occupies  some  fifty  pages  of  the  journal,  was  read  before 
the  Parisian  Medical  Society  on  April  16  and  23  of  that  year ; 
and  it  is  quite  possible  that  the  attention  paid  to  it  in  this 
country  would  have  been  greater  had  it  been  read — like  the 
paper  on  the  same  subject  by  Sir  (then  Dr.)  W.  Jenner,  in 
1849 — before  the  Royal  Medical  and  Chirurgical  Society. 
The  clear,  logical,  and  simple  statements  of  fact  in 
Jenner’s  paper  succeeded  in  doing  what  neither  Stewart 
nor  others  had  done,  viz.,  in  convincing  medical  men  upon 
the  absolute  dissimilarity  in  cause,  symptoms,  and  path¬ 
ology  between  these  two  affections ;  and  the  conclusions 
somewhat  hesitatingly  drawn  by  Stewart  in  1840  were 
irresistibly  established  by  Jenner  in  1849.  It  must  also  be 
remembered  that,  for  several  years  before  Stewart’s  paper, 
suggestions  and  facts  were  being  presented,  all  tending  to  the 
same  end ;  whilst,  in  particular,  the  anatomical  researches  of 
Chomel  and  his  pupils  were  demonstrating  the  occurrence  of 
intestinal  lesions  in  a  certain  proportion  of  cases  of  fever,  which 
were  called  “  typhoid,”  but  not  then  clinically  distinguished 
from  the  general  type  of  typhus.  In  Glasgow,  Stewart 
must  have  gained  from  Dr.  Perry  some  of  the  ideas  which 
he  afterwards  elaborated  so  thoroughly ;  for  there  can  be  no 
doubt  that  Dr.  Perry  did  teach,  although  necessarily  in  but 
a  tentative  manner,  the  existence  of  the  two  types  of  fever, 
and  published  a  paper  on  the  subject  in  1836;  and  even  in 
Philadelphia  the  same  doctrines  were  being  also  taught  by  Dr. 
Girlard.  The  appearance  of  Stewart’s  paper  ought,  then,  to 
have  had  a  more  decided  influence  upon  the  question  which  was 
agitating  medical  thought  in  all  parts  of  the  world  than  it 
did ;  and,  perchance,  if  he  had  drawn  his  conclusions  with  a 
bolder  hand,  such  might  have  been  the  case.  The  essay 
begins  with  an  allusion  to  the  difficulties  that  beset  the 
question  and  the  controversy  then  being  raised  about  it ;  and 
then  the  author  goes  on  to  point  out  how,  when  he  was  at 
Glasgow,  he  was  struck  with  the  occurrence  of  two  distinct 
classes  of  cases  of  fever — the  one  marked  by  its  severity, 
rapidity,  and  absence  of  all  local  lesions ;  the  other  running 
a  more  protracted  course  and  mostly  characterised  by  such 
lesions, — and  he  then  proceeds  to  discuss  various  points  of 
difference  systematically,  showing  that  the  causes  of  typhus 
were  far  better  known  than  those  of  typhoid,  and  holding 
it  to  be  doubtful  whether  the  latter  really  depended  on  a 
specific  poison,  and  if  so,  whether  the  poison  was  or  was  not 
generated  under  the  same  condition  as  that  of  typhus. 
Some  cases  of  typhoid  fever  are  given  to  illustrate  the 
general  clinical  course  of  the  malady ;  and  then  he  dwells  at 
considerable  length  upon  the  symptoms,  analysing  them  in 
a  most  exhaustive  manner.  In  this  way  he  demonstrates 
the  abdominal  characters  of  typhoid  fever,  and  clearly 
describes  the  difference  in  the  eruption  of  typhus  and  of 
typhoid.  The  crowning  distinction  is  made  by  the  demonstra¬ 


tion  of  the  invariable  presence  of  intestinal  lesions  in  cases- 
marked  by  typhoid  characters  clinically,  and  the  absence  of 
such  lesions  in  the  purely  typhus  cases.  A  few  paragraphs 
enforce  the  lesson  of  the  different  lines  of  treatment  to  bn 
applied  in  each  variety  of  fever ;  and,  with  pardonable 
diffidence.  Dr.  Stewart  thus  sums  up  : — “  On  a  review,  then,, 
of  all  that  has  been  advanced,  it  would  appear  that 
typhus  and  typhoid  fever  present  important  differences 
as  regards  their  probable  origin,  their  proximate  causes, 
their  course,  many  of  iheir  symptoms,  their  diseased  ap¬ 
pearances,  and  the  treatment  applied  in  each.  Are  they, 
then,  identical,  or  are  they  not  ?  I  feel  that  it  would 
be  presumptuous  in  me  to  hazard  a  direct  reply ;  nor  do 
I  demand  an  answer  in  the  affirmative  merely  on  the  faith 
of  what  I  have  stated.  All  I  can  ask  or  wish  for  is  careful., 
extensive,  and  minute  inquiry,  without  prepossession  or  love 
of  system,  and  a  satisfactory  solution  must  soon  be  arrived 
at.”  We  have  dwelt  at  length  upon  this  fruit  of  his  early 
labours  because  we  feel  that  it  is  by  this  work  that  Patrick 
Stewart  in  the  future  will  be  most  remembered ;  because  in 
his  lifetime  the  essay  seemed  to  be  unknown  to  many  or 
forgotten  by  others ;  and  because  of  the  regret  that  he  did 
not  himself  continue  the  researches  which  he  left  to  others 
to  complete. 

Few  men  have  made  more  friends  than  he,  and  “Pat 
Stewart  ”  was  widely  beloved.  There  was  a  geniality  and. 
kindness  about  the  man  which,  notwithstanding  his  love  of 
political  Avarfare,  always  came  uppermost.  “No  man,” 
writes  one  who  knew  him  well,  “  was  ever  more  ready  to 
help  a  friend,  or  even  a  casual  acquaintance.”  Staunch  in 
his  patriotism,  there  are  many  of  his  nationality  new  in. 
London  who  owe  much  to  him  for  his  sympathy  and  kind¬ 
ness  in  their  early  ventures  ;  and  some  who  have  since  made 
their  mark  might  never  have  been  introduced  into  the- 
metropolis  had  it  not  been  for  Stewart.  Of  late  years 
his  health  had  been  failing  much,  and  he  passed  through 
more  than  one  severe  illness  which  caused  great  anxiety 
to  his  friends.  When  the  end  came  he  did  not  suffer 
long,  for  only  a  few  days  before  the  fatal  cardiac  seizure- 
he  had  been  present  at  a  meeting  of  the  Committee  of 
Council  of  the  British  Medical  Association.  In  his  death, 
our  profession  is  the  poorer  by  a  straightforward,  honourable 
gentleman,  who  combined  in  himself  so  many  of  those- 
qualities  which  endure  the  most  in  the  affectionate  memory 
of  those  whom  he  leaves  behind. 


MEDICAL  NEWS. 


Royal  College  of  Physicians  of  London, — The  fol¬ 
lowing  gentlemen  were  admitted  Members  on  July  26  : — 

Coxwell,  Charles  Fillingham,  M.B.  Camb.,  London  Hospital,  E. 

Fox,  Thomas  Colcott,  M.B.  Lond.,  14,  Harley-street,  W. 

Griffith,  Walter  Spencer  Anderson,  L.R.C.P.,  66,  Guilford-street,  W.C. 
Jenkins,  Edward  J ohnstone,  M.B.  Oxon.,  St.  Bartholomew’s  Hospital,  E.C„ 
Kilner,  Walter  John,  M.B.  Camb.,  104,  Ladbroke-grove-road,  W. 

Krauss,  Adolph,  M.D.  Munich,  German  Hospital,  Dalston,  E. 

Nias,  Joseph  Baldwin,  M.B.  Oxon.,  56,  Montagu-square,  W. 

Paget,  William  Smith,  M.D.  Lond.,  Great  Crosby,  Liverpool. 

Syers,  Henry  Walter,  M.D.  Camb.,  Pokesdown,  Bournemouth. 

The  following  gentlemen  were  admitted  Licentiates  oil 
July  26  :  — 

Audland,  William  Edward,  22,  Merrick-square,  S.E. 

Barefoot,  John  Bichard,  121,  Chesterton-road,  W. 

Barron,  Hunter  Jackson,  M.B.  Edin.,  10,  Endsleigh-street,  W.C. 
Bassett-Smith,  Percy  William,  62,  Alexandra-road,  N.W. 

Beales,  Thomas  William  Lewis,  190,  Holland-road,  W. 

Blagg,  Arthur  Frederick,  Infirmary,  Bochdale. 

Cardozo,  Samuel  Nunez,  68,  Guilford-street,  W.C. 

Carlyon,  Edward  Tresiddy,  12,  River-street,  E.C. 

Cleaver,  William  Fidler,  M.D.  Kingston,  18,  Easy-row,  Birmingham. 
Collins,  Edward  Treacher,  1,  Albert-terrace,  N.W. 

Collins,  Octavius  Augustus  Glasier,  St.  Bartholomew’s  Hospital,  E.C. 

D’ Aguiar,  Joao  Gomes,  18,  Edward-street,  N.W. 

Dalton,  Arthur  John,  2,  Roslin-villas,  South  Norwood,  S.E. 

Davies,  Edward  Cluneglas,  Portfaen,  Lampeter. 

Dowson,  John,  Guy’s  Hospital,  S.E. 

Edwards,  Arthur  Rea,  King’s  College  Hospital,  W.C. 

Embleton,  Dennis  Cawood,  25,  Park-crescent,  N.W. 

Gandevia,  Naoroji  Baranji,  3,  Whitehall-gardens,  S.W. 

Gardner,  Thomas  Frederick,  University  Hospital,  W.C. 

Green,  Charles  David,  73,  Shardeloes-road,  S.E. 

Gunn,  Donald  Stilwell,  51,  Park  Village  East,  N.W. 

Hodges,  Herbert  Uhamney,  Watton,  Hertford. 

Howard,  Heaton  Clark,  102,  Lansdowne-road,  S.W. 

Hubbard,  Arthur  John,  1,  Ladbroke-terrace,  W. 

Jennings,  Robert,  Haslingden,  Manchester. 

Johnston,  George  David,  St.  Thomas’s  Hospital,  S.E. 

Knill,  Edwin  Gilmore.  55,  Torrington-square,  W.C. 

‘  Lathern,  John  Simpson,  M.D.  McGill,  2,  Cornwall- road,  Stroud  Green,  N. 


142 


Medical  Times  and  Gazette. 


MEDICAL  NEWS, 


August  4,  1883. 


Littlewood,  John  Oscroft,  Guy’s  Hospital,  S.E. 

Llewellyn,  David  William  Henry,  St.  Thomas’s  Hospita1,  S.E. 
Mason,  Arthur  Henry,  15,  Granby-street,  N.W. 

Maughan,  James,  111,  Bedford-street,  Liverpool. 

Payne,  Frank  Cobham,  Plaistow,  E. 

Pinching,  Horace  Henderson,  14,  Milner-street,  S.W. 

Poison,  James  Ronald,  Stoke  Prior,  Bromsgrove. 

Pomfret,  Henry  Waytes,  Hollingworth,  Manchester. 

Roberts,  Arthur  Henry,  Greenhill-road,  N.W. 

Robinson,  Clement  Sumner,  St.  George’s  Hospital.  S.W. 

Rogers,  Frederick  Arthur,  Grange-road,  Ealing,  W. 

Salter,  Stephen  Thomas,  28,  Woburn-place,  W.C. 

Schofield,  Alfred  Taylor,  28,  Cambridge-fun^us,  W. 

Shone,  William  Vernon,  15,  Granby-street,  N.W. 

Square,  James  Elliot,  22,  Eastbourne-terrace,  W . 

Stroyan,  Frederick,  e,  Milman-street,  W.C. 

Tresidder,  Harry  Innis,  Dulwich,  S.E. 

Waldy,  John,  62,  Stafford- place,  S.W. 

Walker,  Charles  Rotherham,  Gainsborough  House,  Leytonstone,  E. 
Walker,  John  William,  9,  Lidlington-place,  N.W. 

Walsh,  John  Henry  Tull,  Cancer  Hospital,  Brompton,  S.W. 

Ward,  Anthony  Arthur,  33,  Walpole-street,  W. 

Williams,  John  Worthy,  58,  Acre-lane,  S.W. 

Wilson,  Alexander,  Royal  Infirmary.  Manchester. 

Withers,  Oliver,  New  Basford,  Nottingham. 

Wood,  Edward  Archer,  17,  St.  Mary’s-square,  W. 

Wright,  Gaskoin  Richard  Morden,  128,  Walworth -road,  S.E. 


Royal  College  of  Surgeons  of  England. — The 
following  gentlemen,  having  undergone  the  necessary  exa¬ 
minations  for  the  diploma,  were  admitted  Members  of  the 
College,  at  a  meeting  of  the  Court  of  Examiners  on  the 
26th  ult.,  viz. : — 

Dudley,  William,  L.S.A.,  Kidderminster,  student  of  the  Birmingham 
School  of  Medicine. 

Faraker,  J.  J.,  L  S.A.,  Cheshunt,  of  Guy’s  Hospital. 

Fireman,  A.  L.,  L.S.A.,  Howden,  Yorks,  of  Guy’s  Hospital. 

Griffin,  S.  N.  R.  P.,  L.S.A.,  Padstow,  Cornwall,  of  St.  Mary’s  Hospital. 
Merrifield,  S.  S.,  L.S.A.,  Plymouth,  of  King’s  College  Hospital. 

Shone,  W.  V.,  L.R.C.P.L.,  Great  Marlow,  of  University  College  Hospital. 
Stevens,  F.  J.,  L.S.A.,  King-street,  Kensington,  of  St.  Bartholomew’s 
Hospital. 

Street,  C.  T.,  Barnetby,  Lincolnshire,  of  St.  George’s  Hospital. 

Four  gentlemen  passed  in  Surgery,  and  when  qualified  in 
Medicine  will  be  admitted  Members  of  the  College.  Nine 
candidates  having  failed  to  acquit  themselves  to  the  satis¬ 
faction  of  the  Court  of  Examiners  were  referred  to  their 
professional  studies  for  six  months,  three  for  three  months, 
and  two  for  nine  months.  The  following  gentlemen  passed 
on  the  27th  ult..  viz.  • — 

Brenton,  W.  H.,  L.S.A.,  Plymouth,  student  of  Guy’s  Hospital. 

D’Aguiar,  J.  G.,  L.S.A.,  British  Guiana,  of  the  Middlesex  Hospital. 
Gunn,  D.  S.,  L.R.C.P.L.,  Park  Village  East,  N.W.,  of  University  College 
Hospital. 

Hodges,  Janies,  L.S.A.,  Henley-on-Thames,  of  King’s  College  Hospital. 
Jago,  J.  S.,  L.S.A.,  Torpoint,  Cornwall,  of  Guy’s  Hospital. 

Lace,  W.  F.,  L.S.A.,  Pill,  near  Bristol,  of  King’s  College  Hospital. 

Ogle,  A.  W.,  L.S.A.,  Sevenoaks,  of  the  Middlesex  Hospital. 

Parkinson,  W.  J.,  Bradford,  Yorks,  of  Guy’s  Hospital. 

Short,  S.  S.,  L.S.A.,  Edgbaston,  of  King’s  College  Hospital. 

Spencer,  H.  R.,  L.S.A.,  Atherstone,  Warwickshire,  of  University  College 
Hospital. 

Wood,  N.  T.,  Knightsbridge,  of  St.  George’s  Hospital. 

Three  gentlemen  passed  in  Surgery,  and  when  qualified  in 
Medicine  will  be  admitted  Members  of  the  College.  Nine 
candidates  were  referred  for  six  months,  one  for  three  months, 
one  for  nine  months,  and  one  for  twelve  months.  The 
following  gentlemen  passed  on  the  30th  ult.,  viz. : — 

Myddelton-Gavey,  E.  H.,  L.S.A.,  Hilldrop-crescent,  N.,  student  of  St. 

Bartholomew’s  Hospital. 

Tenison,  E.  H.,  L.S.A.,  Uxbridge-road,  W. 

Nine  candidates  were  referred. 


Apothecaries’  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday, 
July  26  : — 

Bowen,  Randall  Edward  Arthur,  Stoekwell. 

Chalmers,  Alexander  Henry,  Howard-road,  Penge. 

Dyer,  Sidney  Reginald,  Harlesden. 

Harris,  Charles  Joshua  Joseph,  Strathblaine-road,  Wandsworth  Common. 
Jollye,  Arthur  Dixon,  Donington,  Spalding,  Lincolnshire. 

Lace,  William  Francis,  Pill,  near  Bristol. 

Travis,  William  Owen,  Liverpool. 

Williams,  Frederick  Newton,  George’s- square,  S.W. 

Wilson,  William,  Drumbain,  Ayr,  N.B. 

The  following  gentlemen  also  on  the  same  day  passed  their 
Primary  Professional  Examination  : — 

Brickwell,  Henry  Taylor,  London  Hospital. 

Long,  John  William  Francis,  Guy’s  Hospital. 


APPOINTMENTS. 

Kino,  David  A.,  M.B.  Lond.,  M.R.C.P. — Assistant-Physician  to  the 
Hospital  for  Consumption,  etc.,  Brompton,  vice  Dr.  Owen,  resigned. 


Smith,  Joseph,  M.R.C.S.,  S.Sc.C.,  Camb. — Medical  Superintendent  to  the 
Dalrymple  Home  for  Inebriates. 

Thomson,  St.  Clair,  M.R.C.S.E. — House-Surgeon  to  King’s  College 
Hospital,  vice  B.  H.  L.  Stivens,  3H.R.C.8.E.,  resigned. 


DEATHS. 

Braui-ord,  Henry,  Surgeon-Major  A.M.D.,  at  San  Francisco,  on  July  28, 
aged  33. 

Lewis,  Charles  Blake,  Surgeon  A.M.D.,  at  El  Warden,  near  Cairo,  on 
July  30,  aged  29. 


VACANCIES. 

Clayton  Hospital  and  Wakefield  General  Dispensary. — House- 
Surgeon.  Salary  £120  per  annum,  with  residence  at  the  Hospital, 
attendance,  coal,  and  gas.  Candidates  must  be  duly  registered  in 
medicine  and  surgery  under  the  Medical  Act,  and  unmarried.  Appli¬ 
cations  to  be  sent  to  John  Binks,  Honorary  Secretary,  on  or  before 
August  6. 

Gloucester  County  Asylum.— Assistant  Medical  Officer.  Salary  £100 
per  annum,  with  board,  lodging,  and  washing.  Candidates  must  be 
duly  qualified  men,  registered  both  in  medicine  and  surgery,  and  not 
over  thirty  years  of  age.  Applications,  with  testimonials,  to  be  sent  to 
the  Medical  Superintendent  (from  whom  all  further  information  can  be 
obtained),  on  or  before  August  20. 

Great  Northern  Hospital,  Caledonian-road,  N. — Junior  Resident 
Medical  Officer.  ( For  particulars  see  Advertisement.) 

Netherfield  Institution  for  Infectious  Diseases,  Liverpool.— 
Resident  Medical  Officer.  Salary  £80  per  annum,  with  board,  etc. 
Candidates  must  be  duly  qualified.  Applications,  with  testimonials," 
to  be  sent  to  Robert  Calder,  Secretary,  4,  Commercial-court,  17,  Water- 
street,  Liverpool  (from  whom  any  further  information  can  be  obtained), 
on  or  before  August  15. 


UNION  AND  PAROCHIAL  MEDICAL  SERVICE. 

***  The  area  of  each  district  is  stated  in  acres.  The  population  is 
computed  according  to  the  census  of  1881. 

RESIGNATIONS. 

Driffield  Union.— Mr.  John  Dickson  has  resigned  the  Frodingham 
District :  area  12,410  ;  population  2163  ;  salary  £23  per  annum. 

Manchester  Township.—  Mr.  Alexander  Wattie  has  resigned  the  office  of 
Resident  Assistant  Medical  Officer  :  salary  £150  per  annum. 

APPOINTMENTS. 

Bury  Union. — Thomas  Mellor,  M.R.C.S.  Lond.  and  L.S.A.,  to  the 
Workhouse. 

Church  Stretton  Union. — Adrian  Carey,  M.R.C.S.  Eng.,  to  the  Fourth 
District. 

Liskeard  Union.— Robert  B.  Mole,  M.R.C.S.  Eng.,  L.R.C.P.  Edin.,  to 
the  Seventh  District. 

Stoke  Damerel  Parish.— W.  W.  Pryn,  M.R.C.S.E.,  L.S.A.  Lond.,  to  the 
Clowance  and  St.  John’s  District. 


The  Library  of  the  Obstetrical  Society  will  be  closed 
from  August  13  to  September  13. 

Sore  Nipples. — Dr.  Tauszky  recommends  the  follow¬ 
ing  application  for  excoriated  nipples : — Balsam  Peru  4, 
almond  oil  6,  rose-water  35,  and  mucilage  6  parts. — New  York 
Med.  Record,  May  26. 


APPOINTMENTS  EOR  THE  WEEK. 

August  4.  Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  1 J  p.m. ;  King’s  College,  1J  p.m. ;  Royal 
Free,  2  p.m.;  Royal  London  Ophthalmic,  11  a.m. ;  Royal  Westminster 
Ophthalmic,  14  p.m. ;  St.  Thomas’s,  14  p.m. ;  London,  2  p.m. 

6.  Monday. 

Operations  at  the  Metropolitan  Free,  2  p.m.;  St.  Mark’s  Hospital  for 
Diseases  of  the  Rectum.  2  p.m.;  Royal  London  Ophthalmic,  11  a.m.; 
Royal  Westminster  Ophthalmic,  14  p.m. ;  Hospital  for  Women,  2  p.m. 

7.  Tuesday. 

Operations  at  Guy’s,  14  p.m.  ;  Westminster,  2  p.m. ;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  14  p.m.  ;  West 
London,  3  p.m. 

8.  Wednesday. 

Operations  at  University  College,  2  p.m. ;  St.  Mary’s,  If  p.m.  ;  Middlesex, 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew’s,  1|  p.m.  ;  Great  Northern', 

2  p.m. ;  Samaritan,  24  p.m. ;  Royal  London  Ophthalmic,  11  a.m. ; 

Royal  Westminster  Ophthalmic,  14  p.m. ;  St.  Thomas’s,  14  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m. ;  National  Orthopaedic,  Great 
Portland-street.  10  a.m. _ 

9.  Thursday. 

Operations  at  St.  George’s,  1  p.m. ;  Central  London  Ophthalmic,  1  p.m.; 
Royal  Orthopaedic,  2  p.m.;  University  College,  2  p.m.;  Royal  London 
Ophthalmic, 11  a.m. ;  Royal  Westminster  Ophthalmic,  14  p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m. ;  Hospital  for  Women,  2  p.m. ; 
Charing-cross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  24  p.m. 

10.  Friday. 

Operations  atCentralLondonOphthalmic,2p.m.;  Royal  London  Ophthal¬ 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminster 
Ophthalmic,  14p.m.;  St.  George’s  (ophthalmic  operations),  If  p.m.; 
Guy’s,  14  p.m.  ;  St. Thomas’s  (ophthalmic  operations),  2  p.m.;  King’s 
College  (by  Mr.  Lister),  2  p.m. 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES. 


August'4, 1883.  143 


VITAL  STATISTICS  OF  LONDON. 


NOTES,  QUERIES,  AND  REPLIES. 


Week  ending  Saturday,  July  28,  1883. 

BIRTHS. 

Births  of  Boys,  1350;  Girls,  1281 ;  Total,  2631. 

Corrected  weekly  average  in  the  10  years  1873-82,  2645'!. 

DEATHS. 


Males. 

Females. 

Total. 

Deaths  during  the  week . 

847 

758 

1605 

Weekly  average  of  the  ten  years  1873-82,  i 

929-5 

840-8 

1770-3 

41 

corrected  to  increased  population  ...  j 

Deaths  of  people  aged  80  and  upwards 

DEATHS  IN  8UB-DI8TRICT3  FROM  EPIDEMICS. 


Enumerated 

Population, 

1881 

(unrevised). 

Small-pox. 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

bo 

.9* 

Q.60 

O  o 

O 

Typhus. 

ft  _ 

.S' g  ® 

aj  ft  a) 
■£ 

Cl  Lj 

Simple 

continued 

Fever. 

Diarrhoea.  1 

West . 

669833 

4 

3 

1 

4 

40 

North 

905947 

... 

6 

5 

4 

6 

6 

i 

65 

Central 

282338 

1 

6 

... 

2 

3 

... 

... 

19 

East . 

692738 

... 

24 

15 

3 

6 

... 

4 

59 

South . 

1265927 

5 

23 

9 

3 

10 

1 

3 

l 

71 

Total . 

3816483 

6 

63 

32 

13 

29 

1 

13 

2 

254 

METEOROLOGY. 


From  Observations  at  the  Greenwich  Observatory. 


Mean  height  of  barometer 

Mean  temperature  . 

Highest  point  of  thermometer 
Lowest  point  of  thermometer 
Mean  dew-pointtemperature 
General  direction  of  wind 
Whole  amount  of  rain  in  the  week  . 


29-784  in. 
57-4” 

73-6° 

47'7° 

51-8° 

Variable. 
041  in. 


BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  the 
Week  ending  Saturday,  July  28,  in  the  following  large  Towns : — 


Cities 

and 

Boroughs. 

Estimated  Population  to 
middle  of  the  year  1883. 

j  Births  Registered  during 

1  the  week  ending  July  28. 

|  Deaths  Registered  during 
i  the  week  ending  July  28. 

Annual  Rate  of 
Mortality  por  1000  living, 
from  all  causes. 

Temperature 
of  Air  (Fahr.) 

Temp, 
of  Air 
(Cent.) 

Rain 

Fall. 

Highest  during 
the  Week. 

1  Lowest  during 
|  theWeek. 

Weekly  Mean  of 
Daily  MeanValues 

Weekly  Mean  of 
Daily  Mean 
Values. 

In  Inches. 

In  Centimetres,  j 

London  . 

3955814 

2531 

1605 

212 

73-6 

47-7 

57-4 

14-11 

0-41 

1-04 

Brighton  . 

111262 

60 

42 

19-7 

753 

49-2 

58-4 

14-66 

038 

0-97 

Portsmouth 

13147S 

88 

38 

15-1 

•  •• 

... 

... 

... 

... 

... 

Norwich  . 

89612 

48 

30 

17-5 

... 

... 

... 

... 

... 

Plymouth  . 

74977 

46 

21 

14-6 

71-2 

47-0 

57-4 

14-11 

008 

0-20 

Bristol . 

212779 

126 

63 

15-4 

722 

47-8 

55’4 

13-00 

0-60 

1-52 

Wolverhampton  . 

77557 

43 

24 

16-2 

631 

43-1 

51-0 

10-56 

0-17 

0-43 

Birmingham 

414846 

279 

148 

18-6 

... 

... 

... 

... 

... 

Leicester  ...  ,.. 

129483 

91 

52 

21-0 

... 

... 

... 

Nottingham 

199349 

148 

72 

18-8 

67-4 

4P5 

53-8 

1212 

0-19 

0-48 

Derby . 

85674 

52 

26 

15-9 

... 

... 

... 

... 

... 

... 

Birkenhead 

88700 

61 

18 

10-6 

... 

... 

... 

... 

Liverpool  . 

566763 

376 

272 

250 

63-7 

49-2 

546 

12-56 

0-57 

1*45 

Bolton ...  .,.  ... 

107862 

77 

46 

223 

... 

... 

... 

... 

Manchester 

339262 

235 

166 

25-5 

... 

... 

... 

... 

c. 

... 

8alford  ...  ... 

190465 

126 

62 

17-0 

... 

•  •• 

... 

... 

Oldham  . 

119071 

70 

36 

15-8 

... 

... 

... 

... 

Blackburn . 

108460 

86 

29 

13-9 

... 

... 

... 

... 

... 

Prestos  . 

98564 

72 

32 

16’9 

64-5 

47-0 

539 

1217 

0-20 

0-51 

Huddersfield 

84701 

46 

22 

13-6 

... 

... 

... 

... 

Halifix  . 

75591 

47 

23 

15-9 

... 

... 

... 

... 

Bradford  . 

204807 

103 

62 

15-8 

64-7 

45-8 

53-2 

11-78 

0  27 

0-69 

Leeia . 

321611 

225 

131 

21-3 

65  0 

46-0 

53-8 

12-12 

099 

2-61 

Sheffield  . 

295497 

213 

110 

19-4 

70-0 

460 

54-9 

12-72 

o-io 

0-25 

Hall  . 

176296 

120 

51 

15-1 

70-0 

41-0 

535 

11-95 

037 

0-94 

Sanderland 

121117 

121 

43 

18-5 

... 

... 

... 

... 

... 

Newcastle  . 

149464 

117 

68 

237 

... 

... 

... 

... 

... 

Cardiff . 

90033 

66 

33 

19-1 

... 

... 

... 

... 

... 

... 

For  28  towns... 

S62C975 

5773 

3325 

20-1 

76-3 

41-0 

54-8 

12-67 

0-36 

0-91 

Edinburgh . 

235946 

137 

77 

170 

65-8 

43-4 

635 

11-95 

0-45 

1-14 

Glasgow  . 

615589 

367 

214 

21-7 

71-0 

42-5 

56-0 

13-33 

0-18 

0-46 

Dublin . 

349685 

186 

146 

21-8 

70-0 

430 

54-6 

12-53 

1-18 

3-00 

At  the  Royal  Observatory,  Greenwich,  the  mean  reading 
of  the  barometer  last  week  was  29’78  in. ;  the  lowest  read¬ 
ing  was  29-47  in.  at  the  beginning  of  the  week,  and  the 
highest  29'98  in.  on  Friday  evening. 


- ♦ - 

He  tfcai  questioned  tnatjj  s^all  learn  tmtejj. — Bacon. 

A  Provincial  Teacher.— From  July,  1882,  to  July,  1883,  there  were  1119 
students  from  recognised  medical  schools  examined  for  the  diploma  of 
membership  of  the  College  of  Surgeons,  of  which  number  795  passed 
the  primary  and  324  were  rejected.  For  the  final  examination  there 
were  769  candidates,  of  -which  number  488  were  admitted  members  and 
281  rejected.  “Pass  and  Pluck”  was  published  in  this  journal  last 
week. 

Alleged  Water-Pollution  —At  the  Yorkshire  Summer  Assizes,  in  the  Nisi 
Prius  Court,  the  action  Fovell  v.  Normanton  Local  Board  was  tried 
without  a  jury.  The  plaintiff  complained  that  the  defendants  polluted 
the  water  which  ran  through  certain  lands  by  sending  sewage  matter 
therein,  thereby  rendering  the  water  unfit  for  domestic  purposes.  An 
injunction  was  applied  for.  The  defendants,  it  appeared,  had  tried  two 
systems  of  sewerage,  but  they  had  failed,  and  they  were  now  endeavour, 
ing  to  carry  out  another  system,  and  asked  for  time.  They  had  already 
spent  £17,000,  and  would  have  to  apply  for  another  grant  of  money.  It 
was  arranged  that  a  verdict  should  be  taken  for  the  plaintiff  -  an  injunc¬ 
tion  being  granted  by  his  lordship,  which  would  stand  in  abeyance  for 
the  present,  to  eee  if  remedies  were  commenced  in  the  meantime. 

Stratford-on-  Avon  Infirmary . — Mrs.  Ledbrook,  of  Hatton  Rock,  Stratford- 
on-Avon,  has  left  by  her  will  £509,  free  of  duty,  to  the  Infirmary. 

An  Entertainment  for  a  Charitable  Purpose  Declined. — The  Council  of  the 
Rugby  Hospital  have  declined  the  offer  of  a  theatrical  establishment  in 
the  town  to  give  a  benefit  performance  for  the  institution.  The  manager 
was  willing  for  the  Council  to  select  what  play  they  chose. 

The  Q-erms  of  Yellow  Fever. — Mr.  Corbett,  British  Minister  in  Brazil,  in 
reporting  the  disastrous  outbreak  of  yellow  fever  in  Rio  this  summer, 
refers  to  the  remarkable  results  of  the  researches  into  the  causes  of  inf  ec- 
tion  made  by  Dr.  Freire,  one  of  the  Medical  Commission  appointed  by 
the  Brazilian  Government  with  that  object.  Having  got  from  a  foot 
below  the  surface  of  the  soil  in  the  cemetery  some  earth  from  the  grave 
of  a  person  who  had  died  about  a  year  previously  of  this  disease,  Dr. 
Freire  subjected  it  to  examination  under  a  microscope  magnifying  740 
diameters,  and  discovered  “myriads  of  living  organisms  exactly  identical 
with  those  found  in  the  vomitings,  the  blood,  and  other  organic  liquids 
of  persons  who  have  died  of  the  fever.”  The  observations,  which  are 
given  in  detail,  together  with  other  interesting  experiments  in  the 
reports  Mr.  Corbett  forwards,  are  verified  by  three  other  medical  men. 
They  show,  according  to  Dr.  Freire,  that  “  the  germs  of  yellow  fever 
perpetuate  themselves  in  the  cemeteries,  which  are  like  so  many  nur¬ 
series  for  the  preparation  of  new  generations  destined  to  devastate  the 
city.”  Mr.  Corbett  remarks — what  is  a  significant  fact — that  few  or  no 
cases  have  occurred  amongst  the  shipping  in  the  port,  and  that  this 
immunity  is  attributed  to  the  effect  of  a  police  regulation  by  which 
vessels  are  obliged,  at  this  season,  to  move  to  some  distance  from  the 
shore. 

Considerate  Offer. — The  Mole-end  Old  Town  Guardians  have  accepted  an 
offer  from  Dr.  T.  Loane  to  take  the  school-children  to  Rye  House  for 
a  day’s  outing. 

The  Cultivation  of  Flowers  by  Poor  Children —An  exhibition  of  flowers 
took  place  a  few  days  ago  in  the  Yestry  Hall,  St.  Paneras-road.  The 
entries  were  854  in  number,  supplied  by  497  children.  It  is  the  outcome 
of  seven  years  of  encouragement  given  to  the  children  of  the  poorer 
classes,  who  have  been  thus  taught  to  take  an  interest  in  a  thing  which 
may  permanently  affect  for  good  not  only  the  taste,  but  the  habits  of 
these  young  people. 

3.  M.  3.— The  examinations  at  the  College  of  Surgeons  for  the  present 
session  have  been  brought  to  a  close. 

The  Medical  Officers  of  the  Leeds  Infirmary  and  Inquests. — The  Leeds  Mercury 
states  that  during  the  holding  of  inquests  at  the  Leeds  Town  Hall,  Mr. 
W.  Waddington,  an  Assistant-Surgeon  at  the  Infirmary,  stated  that  no 
officer  was  in  attendance  to  give  evidence  in  a  certain  case,  as  no  one 
had  been  subpoenaed.  The  Coroner  remarked  that  he  had  always  tried 
to  suit  the  convenience  of  medical  officers  of  the  Infirmary  by  taking 
their  evidence  at  the  earliest  possible  moment,  and  at  once  releasing 
them.  It  now  appeared  that  one  of  the  officers  refused  to  attend  upon 
mere  notice,  as  he  had  formerly  done,  and  required  a  subpoena.  In 
future  he  should  take  care  that  subpoenas  were  issued  in  every  case,  and 
that  medical  officers  should  take  their  turn  in  giving  evidence.  The  con¬ 
sequence,  in  this  instance,  was  that  the  jury  were  put  to  great  incon¬ 
venience  and  loss  of  time,  as  they  would  have  to  meet  the  next  day  to 
consider  the  case.  The  jury  expressed  their  concurrence  with  the 
coroner’s  remarks  upon  the  action  of  the  medical  officer.  (It  would  be 
edifying  to  hear  the  story  told  by  the  medical  officers  of  the  Infirmary.) 

Dover. — The  official  return  for  the  past  quarter,  ending  June  30,  shows 
that  the  general  death-rate  was  slightly  above  the  recent  low  average, 
but  the  zymotic  and  infant  mortality  was  low,  the  excess  being  among 
persons  well  advanced  in  life. 


NOTES,  QUERIES,  AND  REPLIES 


August  4,  18S?- 


144 


Medical  Times  and  Gazette. 


Robert  Williams. — The  large  piece  of  sculpture  in  the  Museum  Hall  of  the. 
College  of  Surgeons  is  by  the  late  Mr.  J.  G.  Lough,  A.R.A.  His  widow, 
who  survives,  is  a  sister  of  Sir  James  Paget,  Bart. 

Marine  Stores  a  Nuisance.  —  The  Kensington  Vestry  has  resolved  that  the 
attention  of  the  Metropolitan  Board  of  Works  be  directed  to  the  serious 
character  of  the  nuisance  caused  by  the  collection  of  putrid  animal 
matter  at  marine  stores,  and  that  the  Board  be  requested  to  consider  as 
to  the  desirability  of  the  business  of  a  “marine  store  dealer”  being 
declared  an  “  offensive  business  ”  under  the  provisions  of  the  Slaughter¬ 
houses  (Metropolis)  Act,  1874. 

When  Doctors  Differ,  die.— At  the  recent  Stafford  Assizes,  in  a  compensation 
case,  Gibbs  v.  the  London  and  North-Western  Railway  Company,  the 
medical  evidence  -was  of  a  very  conflicting  character.  The  plaintiff, 
who  had  been  acting  for  some  years  as  the  district  manager  of  the 
Employers’  Liability  Assurance  Company,  was  a  passenger  from  Stoke 
to  Birmingham  on  December  12  last,  when  the  train,  by  which  he  was 
travelling,  in  entering  New-street  Station  at  high  speed,  came  into 
collision  with  a  Midland  train  that  was  standing  at  the  platform.  The 
plaintiff,  among  other  passengers,  was  thrown  violently  forwards  and 
then  backwards  by  the  shock,  and  his  back,  coming  in  contact  with  the 
dividing  arm  of  the  seat  upon  which  he  had  been  sitting,  sustained 
injuries,  which,  according  to  his  statement,  had  practically  incapacitated 
him  for  business  ever  since,  and  would  render  him  incapable  of  following 
his  avocation  for  some  time  to  come.  For  theseinjuries  he  claimed  £2000 
damages.  The  defendants  disputed  the  claim,  on  the  ground-that  the 
injuries  had  been  greatly  exaggerated,  and  that  the  damages  demanded 
were  excessive.  For  the  plaintiff,  medical  witnesses  testified  that  he 
had  sustained  serious  injury  to  the  spine,  producing  spinal  irritation, 
and  that  it  would  be  from  one  to  two  years  before  he  could  possibly 
recover  his  health.  On  the  other  hand,  medical  experts,  on  behalf  of 
the  defendant  Company,  declared  the  injuries  received  by  the  plaintiff 
were  of  a  most  trivial  character,  and  confined  to  a  few  bruises  on  the 
calves  of  the  legs.  Mr.  Oliver  Pemberton,  one  of  the  railway  company’s 
surgeons,  stated  that  when  the  plaintiff  called  upon  him  for  examination) 
two  days  after  the  accident,  he  complained  only  of  having  been 
shaken,  and  having  sustained  a  blow  on  the  back  of  the  head,  and 
that  there  was  no  indication  of  any  injury  to  the  spine.  Three  days 
later  he  saw  the  plaintiff  in  the  presence  of  his  medical  attendant, 
Mr.  Warden,  who  maintained,  in  opposition  to  the  witness,  that  there 
was  spinal  injury.  Mr.  Bartleet  and  Dr.  Wade  concurred  in  Mr. 
Warden’s  opinion  as  to  the  serious  nature  of  the  injuries ;  whilst  Mr.  Page, 
of  London,  corroborated  the  testimony  of  Mr.  Oliver  Pemberton.  It 
was  shown  that  the  plaintiff’s  business  had  greatly  fallen  off  since  the 
accident,  and  that  he  had  spent  a  good  deal  of  time  and  money  in  going 
from  one  health  resort  to  another,  and  had  obtained  medical  advice  in 
the  places  he  visited.  Ultimately,  a  verdict  for  the  plaintiff  with  £1150 
damages  was  returned. 

Fever  Epidemic ,  Kilbarchan.— In  this  village  there  has  been  for  some  time 
past  a  constant  occurrence  of  fever.  It  has  been  most  prevalent  in  those 
parts  of  the  village  where  the  streets  are  narrowest  and  the  buildings 
most  compact.  Several  cases  have  been  reported  in  High  Barholm. 
It  is  stated  that  the  village  has  not  been  entirely  free  of  fever  for  the 
past  six  months. 

A  Well-merited  Punishment. — The  Bolton  county  magistrates  have  made  a 
severe  example  of  a  man  charged  with  offering  diseased  meat  for  sale . 
A  cow  jobber  was  prosecuted  for  having  on  his  premises  the  carcase  of 
a  cow  in  an  extremely  diseased  condition,  but  dressed  for  food,  The 
meat  had  been  previously  condemned,  and  buried  in  quicklime  ;  but  the 
defendant  at  night  exhumed  the  carcase,  and  was  detected  carting  it 
away  by  the  police,  who  took  charge  of  it  for  a  second  time.  He  was 
committed  to  prison  for  three  months,  the  Bench  regretting  that  the 
Act  precluded  the  imposition  of  hard  labour. 

A  Successful  Experiment. — The  fish  dinners  introduced  in  the  Bristol  Work- 
house  have  proved  most  satisfactory.  All  the  inmates,  and  especially  the 
sick  patients,  were  delighted  with  the  change.  Dr.  Grace,  the  Medical 
Officer,  considered  it  was  one  of  the  best  improvements  the  Board  had 
effected. 


The  Proposed  New  Hospital,  Rome. — According  to  the  official  notice,  the 
plans  are  to  include,  of  course,  the  necessary  administrative  offices, 
a  medico-ehirurgical  hospital  of  450  to  500  beds,  and  a  number  of  special 
departments  for  various  classes  of  diseases.  The  hospital  and  polyclinical 
branches  are  to  be  constructed  on  the  pavilion  system,  with  buildings 
one  storey  high.  The  separate  wards  are  not  to  contain  more  than 
sixteen  or  eighteen  beds. 

Infantile  Mortality. — A  correspondent  states  that  fifty-five  children  died 
of  measles  and  whooping-cough  on  board  the  steamer  Hankow  during 
her  voyage  from  London  to  the  Sandwich  Islands. 


The  British  Workmen's  Assurance  Company. — At  the  Nottingham  Assizes, 
Baron  Huddleston,  in  discharging  three  persons  charged  with  con¬ 
spiring  to  defraud  this  Company,  said  he  wished  it  to  be  known  that 
the  directors  and  officers  of  such  companies  who  received  premiums 
from  persons,  at  the  same  time  knowing  such  persons  had  no  insurable 
interest  in  the  lives  of  those  insured,  were  liable  to  be  indicted.  The 
great  evil  of  small  companiesjwasjhat  they  induced  poor  people  to 


gamble  on  lives. 


VJ r  f'fivFOR 

^VUDRARy  A  / 


Overcrowding  and  Defective  Sanitary  Arrangements. — At  an  inquest  held 
by  the  Coroner  for  East  Middlesex  on  the  body  of  a  child  aged  seven 
months,  whose  parents  resided  in  London  Fields,  the  jury,  in  accordance 
with  the  medical  testimony,  found  that  the  deceased  had  died  from 
“  choleraic  diarrhoea,  accelerated  by  overcrowding  and  defective  sanitary 
arranjromeHts.”  It  appeared  four  other  children  were  down  with  a 
similar  disease  in  the  same  house,  which  contains  four  roooms  and  a 
kitchen.  The  parents  of  the  deceased,  with  their  three  children,  occupied 
one  room ;  two  other  rooms  were  each  tenanted  by  a  small  family  ;  and 
the  landlord  and  his  own  family  occupied  the  remaining  room  and  the 
kitchen.  A  midden  and  a  closet  (to  which  no  water  was  laid  on)  were 
the  only  offices  attached  to  the  miserable  tenement.  The  house  was  very 
dirty,  and  an  abominable  stench  pervaded  the  overcrowded  apartments. 
The  district  sanitary  authorities  will,  it  is  hoped,  at  once  vigorously 
deal  with  the  evils  which  are  remediable  of  this  wretched  dwelling,  and 
carry  out  an  inspection  of  other  tenements  in  the  locality. 

Vox. — Most  of  the  modern  hospitals  in  India  are  lined  with  the  smooth 
and  “  washable”  substance  known  as  chunam  (mortar  made  with  lime 
produced  from  a  small  shell,  and  varnished) .  The  nearest  approach  to 
it  with  us  is  the  glazed  tile  so  well  known  in  the  potteries  in  Stafford¬ 
shire. 

An  Enterprising  Mayor. — As  a  protest  against  the  monopoly  of  fish  profits 
existing  in  provincial  towns,  the  Mayor  of  Stafford,  at  his  own  risk, 
ordered  a  ton  or  two  of  fish  direct  from  Grimsby,  and  announced  to  sell 
it  at  2d.  per  pound  in  the  fish  market.  The  average  price  of  fish  in 
Stafford  has  teen  8d.  per  pound.  There  was  an  enormous  rush  to  the 
market,  and  the  whole  of  the  fish  was  quickly  sold.  The  experiment  is 
to  be  repeated,  and  it  was,  it  is  stated,  suggested  by  the  aim  and  object 
of  the  Fisheries  Exhibition.  Did  the  sale  repay  the  Mayor  and  leave 
him  a  moderate  profit  ?  If  not,  it  was  hard  on  the  fishmongers. 

COMMUNICATIONS  have  been  received  from — 

The  Secretary  of  the  British  Medical  Association,  London;  Dr.  Ad. 
Claus,  Frieburg  ;  Mr.  J.  F.  Pink,  London  ;  Captain  Francis  Galton! 
F.R.S.,  London;  Dr.  Norman  Kerr,  London;  Dr.  Leslie  Phillips 
Birmingham  ;  The  Bedell  of  the  Royal  College  of  Physicians! 
London  ;  Inspector-General  Robert  Lawson,  London  ;  The  Registrar 
of  the  Apothecaries’  Hall,  London ;  The  Secretary  of  the  Local 
Government  Board,  London;  Dr.  Mercier,  Dartford;  Dr.  Waters, 
Liverpool;  Dr.  Rayner,  Hanwell;  Dr.  Higham  Hill,  London;  Dr.  A. 
T.  Thomson,  Glasgow ;  The  Secretary  of  the  Great  Eastern  Rail¬ 
way  Publishing  Department,,  London  ;  The  Secretary  of  the 
Sanitary  Institute  of  Great  Britain,  London;  Dr.  McKendrick, 
Glasgow;  Mr.  Reginald  Harrison,  Liverpool;  The  Registrar- 
General  for  Scotland.  Edinburgh  ;  Dr.  Sonsino,  Cairo,  Egypt ;  The 
Secretary  of  the  Society  for  the  Administration  of  Hospitals, 
London  ;  Mr.  J.  Chatto,  London ;  The  Honorary  Secretary  of  the 
Obstetrical  Society  of  London  ;  Mr.  T.  M.  Stone,  London. 

BOOKS,  ETC..  RECEIVED  - 

The  Operative  Treatment  of  Hare-Lip,  by  James  Whitson,  M.D.,  etc.— A 
Rectal  Obturator,  by  David  Prince,  M.D.— The  Bead  Suture,  by  David 
Prince,  M.D.— Whitelead  Workers— Correspondence  relating  to  the 
Sanitary  State  of  the  Town  of  Port-Royal,  1883— The  Life  and  Work  of 
St.  Paul,  by  F.  W.  Farrar,  D.D.— Holborn  District  Board  of  Works 
Annual  Report— On  Nasal  Cough,  by  John  N.  Mackenzie,  M.D.— On  a 
Hitherto  Undescribed  Malformation  of  the  Naso-Pharynx,  by  J.  N. 
Mackenzie,  M.D.,  of  Baltimore— The  Extra  Pharmacopoeia,  by  Wm". 
Martindale,  E.C.S.— A  Trip  to  the  Ardennes— The  Moselle— Holidays 
in  Holland— Health  Lectures  for  the  People,  vol.  vi.—  History  of  Rome, 
etc.,  by  Victor  Duruy,  part  7. 

PERIODICALS  AND  NEWSPAPERS  RECEIVED— 

Lancet— British  Medical  Journal— Medical  Press  and  Circular — Ber¬ 
liner  Klinisehe  Woehenschrift— Centralblatt  fur  Chirurgie — Gazette 
des  Hopitaux— Gazette  Mddieale— Revista  de  Medicina— Bulletin  de 
1’  Academie  de  Medecine— Pharmaceutical  J ournal— W iener  Medieinische 

Woehenschrift— Revue  Mddicale— Gazette  Hebdomadaire— Nature _ 

Boston  Medical  and  Surgical  Journal — Louisville  Medical  News _ 

Centralblatt  fur  Gyniikologie — Le  Concours  Medical— Centralblatt  fur 
die  Medicinisclien  Wissensckaf ten— Centralblatt  fur  Klinisehe  Medicin 
—Philadelphia  Medical  News— Le  Progres  Mddical— Physician  and 
Surgeon— Philadelphia  Medical  Times— New  York  Medical  Journal — 
Detroit  Lancet — Glasgow  Herald,  July  27— Journal  of  Cutaneous  and 
Venereal  Diseases — Students’ Journal  andHospital  Gazette— Fortnightly 
Review — National  Anti-Compulsory  Vaccination  Reporter -Australian 
Medical  Journal— Ophthalmic  Review — Dublin  Journal  of  Medical 
Science  —Birmingham  Medical  Review  -  American  J  ournal  of  Neurology 
and  Psychiatry — Toronto  Sanitary  Journal— Glasgow  Medica,  Journal 
— Archives  Gdnerales  de  Mfidecine— Edinburgh  Medical  J  ournal— The 
Veterinarian.  >. 


Administration  oe  Hospitals. — The  first  meeting 
of  the  Provisional  Committee  of  Hospital  Managers,  ip- 
pointed.  at  the  recent  conference  held  under  the  auspices  of 
the  Social  Science  Association,  took  place  on  Monday  Iasi. 
Steps  were  taken  for  adding  further  names  to  the  Committee, 
and  a  sub-committee  was  appointed  to  prepare  a  draft  pro¬ 
gramme  for  consideration  by  the  enlarged  Committee,  the 
members  of  which  will  be  called  together  in  the  autumfi. 

Charitable  Bequests. — Under  the  will  of  the  late 
Mr.  Thomas  Grarfit,  M.P.,  the  following  medical  charities 
will  be  benefited  : — The  Lincoln  and  County  Hospital,  ,£200 ; 
Boston  Dispensary,  £100 ;  Boston  Cottage  Hospital,  £100  ; 
Louth  Hospital  and  Dispensary,  £100 ;  Horncastle  Dispen¬ 
sary,  £100;  and  Mablethorpe  Convalescent  Home,  £100; 
making  a  total  of  £700. 


/co-Bradford^' 

\  LIBRARY  S  *? 

M  eh^I^flnjPs  in.drt*  zpttp.--^  M= 


BRITISH  MEDICAL  ASSOCIATION. 


August  11,  1883.  145 


FIFTY-FIRST  ANNUAL  MEETING 


OF  THE 

BRITISH  MEDICAL  ASSOCIATION, 

Held  in  Liverpool,  July  31  and  August  1,  2,  3,  1883. 


ADDRESS  IN  PATHOLOGY. 

By  CHARLES  CREIGHTON,  M.D. 


ON  THE  AUTONOMOUS  LIFE  OF  THE  SPECIFIC  INFECTIONS. 
Mr.  President  and  Gentlemen, — I  have  unusually  good 
reasons  for  prefacing  my  address  with  an  apology.  I  can¬ 
not  claim  to  speak  from  the  fulness  of  experience,  which 
has  given  so  much  value  and  distinction  to  the  addresses 
that  have  been  delivered  before  the  Association;  and  I 
have  a  subject  assigned  to  me  which  demands  experience 
and  a  mature  judgment  in  no  ordinary  degree.  Pathology 
is  a  growing  science,  its  aspects  are  constantly  changing,  a 
single  year’s  work  brings  us  a  multitude  of  new  and  often 
puzzling  facts ;  and  although  the  issues  are  of  the  most 
momentous  kind,  not  even  the  wisest  and  most  judicial 
minds  in  the  profession  can  always  see  their  way  to  a  clear 
and  definite  opinion. 

But,  amidst  all  this  uncertainty,  there  is  one  central  and 
guiding  principle  in  the  doctrine  of  disease  which  we  may 
hold  fast  to.  It  is  the  physiological  principle,  or  the  idea 
that  diseased  states  of  the  body  are  but  modifications  of 
healthy  states,  deviations  from  the  beaten  track,  perturba¬ 
tions  of  the  normal  life,  shortcomings  of  the  physiological 
standard.  Thus,  even  in  so  formidable  a  malady  as  diabetes 
we  are  still  within  sight  of  the  line  of  health  :  there  may  be  a 
physiological  glycosuria  ;  and  that  fact,  as  Dr.  Bence  Jones 
says,  proves  to  us  that  the  disease  is  only  a  little  way  dis¬ 
tant  from  health.  “  Here  as  elsewhere,”  says  that  eminent 
chemist  and  pathologist,  “  there  is  no  definite  limit  where 
health  ends  and  disease  begins.”  To  find  the  proper  phy¬ 
siological  analogies  for  diseased  processes  is  the  task  of 
modern  pathology ;  and  I  do  not  think  that  there  is,  in 
the  whole  range  of  science,  any  better  kind  of  intellectual 
exercise  than  to  expose  the  working  of  the  ordinary  laws  of 
structure  and  function  under  the  mask  of  disease.  The 
physiological  idea  is,  indeed,  the  hope  and  inspiration  of 
pathological  science,  as  it  is  also  of  medical  practice.  But 
there  is  no  reason  why  I  should  attempt  to  say  again  what 
has  so  often  been  well  said  before.  Members  of  the  Associa¬ 
tion  who  heard  Professor  Michael  Foster,  at  the  Cambridge 
meeting,  discourse  on  the  “Relations  of  Physiology  to 
Pathology,”  will  not  have  forgotten  how  he  proved  that  the 
difference  between  these  two  sciences  was  merely  a  super¬ 
ficial  difference,  whether  as  regarded  method  or  subject- 
matter.  We  shall,  most  of  us,  also  recall  Professor  Huxley’s 
lucid  exposition  before  the  International  Medical  Congress, 
ofthe  “Connexion  of  the  Biological  Sciences  with  Medicine,” 
wherein  he  showed  that  pathology  was  that  branch  of  biology 
which  concerned  itself  with  perturbations  of  the  normal 
life. 

That  view  of  pathology  is  one  that  we  all  share  ;  and  as  I 
have  endeavoured,  according  to  my  opportunities,  to  work 
out  physiological  analogies  of  disease  in  particular  instances, 

I  shall  not  be  suspected  of  any  want  of  sympathy  with  the 
general  principle.  But  I  am  none  the  less  confronted  with 
the  difficulty  that  a  great  deal  of  pathology  appears  to  be 
quite  different  in  kind  from  any  physiology  known  to  us. 
What  are  the  physiological  analogies  of  the  infective  and 
constitutional  diseases,  and  how  large  a  part  of  pathology 
do  the  diseases  of  that  class  stand  for  ? 

There  is,  I  believe,  a  serious  difficulty  here,  and  a  difficulty 
that  made  itself  felt  in  the  very  first  system  of  physiological 
medicine  that  was  given  to  the  world.  Broussais  was  the 
author  of  the  first  attempt  at  a  physiological  scheme  of 
disease  ;  and  it  was  only  a  year  or  two  ago  that  Professor 
Charcot  was  claiming  for  his  brilliant  countryman  the  credit 
of  having  broken  down  the  dualism  of  health  and  disease, 
and  of  having  eradicated  that  old  and  pernicious  habit  of  I 

Vol.  II.  1883.  No.  1728. 


regarding  disease  as  a  separate  entity.  But  Professor  Char¬ 
cot  said  nothing  of  the  rock  on  which  Broussais  is  generally 
accounted  to  have  made  shipwreck.  The  author  of  the  first 
physiological  medicine  was  thorough-going,  and  it  was 
because  he  endeavoured  to  be  comprehensive  and  consistent 
that  he  failed.  He  left  out  no  great  disease  from  his 
physiological  scheme,  not  even  typhus  nor  Asiatic  cholera  ; 
they  were  all  perturbations  of  the  normal  life,  and  a  good 
many  of  them  were  forms  of  gastro-enteritis.  Professor 
Charcot  maybe  right  in  claiming  the  physiological  medicine 
of  Broussais  as  the  example  for  all  subsequent  times ;  but 
it  is  quite  certain  that  it  served  also  as  a  warning  to  those 
who  next  took  the  physiological  medicine  in  hand.  They 
were  careful  to  lighten  the  ship  by  throwing  overboard 
Asiatic  cholera,  typhus  fever,  and,  in  fact,  the  whole  of  th® 
acute  and  chronic  infections.  Just  about  the  time  when 
the  thorough-going  system  of  Broussais  had  provoked  the 
inevitable  reaction,  Professor  Henlehad  made  his  suggestion 
about  minute  parasitic  organisms  being  the  causes  of  the 
specific  infective  diseases ;  and  it  is  curious  to  read,  at  a 
distance  of  forty  years,  in  the  first  volume  of  the  German 
Archives  of  Physiological  Medicine  (page  88),  how  Griesinger, 
one  of  its  sponsors,  promptly  availed  himself  of  the  parasitic 
hypothesis  of  Henle  in  order  to  account  for  all  those  diseases 
which  had  been  prudently  omitted  from  the  physiological 
programme. 

But  I  venture  to  say  that,  when  we  congratulate  ourselves 
upon  the  physiological  basis  of  pathology,  we  do  not  always 
reflect  how  much  of  disease  is  thus  excluded  from  the  class 
of  disturbed  physiological  processes,  and  how  small  a 
fraction  remains  to  fill  the  physiological  categories.  There 
are  several  passages  in  Sydenham’s  works  in  which  he  gives 
his  estimate  of  the  proportion  that  the  species  of  disease — 
the  morhi  typo  induti — bear  to  the  rest ;  he  estimates 
diseases  of  a  specific  type  at  two-thirds  of  the  whole ;  and 
it  will  be  admitted,  I  think,  when  we  look  abroad  as  well  as 
at  home,  and  when  we  read  history  as  well  as  contemporary 
records,  that  this  estimate  shows  his  fairness  of  mind  and 
his  sense  of  proportion. 

The  serious  difficulty,  then,  which  I  spoke  of — the 
difficulty  that  must  have  been  present  to  the  mind  of 
Broussais,  and  must  occur  more  or  less  to  everyone — is  that 
a  physiological  medicine,  which  leaves  out  the  larger  and 
more  formidable  half  of  disease,  is  hardly  worthy  of  the 
name.  The  doctrine  that  morbid  processes  are  after  all 
merely  perturbations  of  normal  processes,  or,  as  Hunter  said, 
“a  perversion  of  the  natural  actions  of  the  animal  economy,” 
is  the  great  principle  of  scientific  pathology ;  but  we  shall 
have  to  speak  less  enthusiastically  of  it,  if  it  should  appear 
that  it  has  no  place  for  the  long  list  of  infective  diseases — 
for  plague,  for  cholera,  for  yellow  fever,  for  typhus,  for 
small-pox,  for  leprosy,  for  syphilis,  for  cancer,  for  con¬ 
sumption.  If  the  physiological  idea  is  to  be  good  for  any¬ 
thing,  it  ought  to  be  good  for  those  ;  for  they  are  the  real 
difficulties  of  pathological  science,  and  the  real  opprobria  of 
the  medical  art. 

I  am  sanguine  enough  to  believe  that  the  physiological 
doctrine  will  one  day  be  shown  to  be  as  large  in  its  applica¬ 
tion  as  it  is  rational  and  hopeful  in  its  spirit.  It  is  for  that 
reason  that  I  have  decided  to  use  this  public  opportunity 
that  has  come  to  me — and  come  to  me  most  unexpectedly 
and,  I  feel,  most  undeservedly — in  order  to  speak  of  certain 
aspects  of  the  specific  infections,  which  are  perhaps  not  the 
aspects  most  commonly  brought  before  us  at  present.  One 
would  wish  to  think  of  these  diseases,  strange  and  terrible 
though  they  be,  as  still  joined  in  continuity  with  the 
common  disorders  of  structure  and  function  ;  and  I  am 
accustomed  to  express  for  myself  this  connexion  by  a 
formula,  which  has  no  other  value  than  belongs  to  a  mode 
of  thought  or  a  form  of  words,  but  may  still  serve  as  a 
convenient  or  empirical  standing  ground  for  those  who  seek 
to  observe  a  certain  unity  and  sequence  in  their  study  of 
disease. 

I  shall  endeavour,  then,  to  discover  some  relation  between 
common  aberrations  of  structure  and  function  and  the 
specific  infections,  or  a  relation  between  disordered  states 
of  the  body  and  the  self-existent  species  of  disease  ;  and  I 
shall  make  this  attempt  with  two  or  three  representative 
instances.  It  will  be  convenient  to  begin  with  cancer,  for 
the  reason  that  the  suggestions  that  I  have  to  make  arise 
most  naturally  out  of  the  study  of  cancer. 

Cancer  is  an  infection,  although  its  infective  power  does 


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August  11, 18831, 


not  extend,  except  in  heredity,  beyond  the  individual  body 
in  which  the  disease  takes  its  rise.  I  do  not  forget  that 
some  pathologists  consider  cancer  to  be  no  more  than  an 
overgrowth  of  epithelium.  But  we  shall  find  it  difficult  to 
explain  to  a  patient  with  cancer  that  he  is  suffering  merely 
from  an  overgrowth  of  his  epithelium.  All  the  world  knows 
what  cancer  is,  and  no  microscopic  analysis  will  ever 
persuade  men  that  cancer  is  anything  but  the  devouring 
thing,  the  implacable  enemy,  that  the  common  eye  sees  it 
to  be.  What  the  microscope  does  show  us,  is  that  a 
cancerous  tumour  has  not  always  been  cancerous.  If  we 
take  any  of  the  common  seats  of  cancer — the  stomach,  or 
the  uterus,  or  the  breast, — we  shall  find  that  the  disease 
may  be  traced  back  to  a  point  at  which  it  comes  within  the 
Category  of  structural  and  functional  irregularities.  I  say 
structural  and  functional,  because  it  seems  to  me  that  if  we 
attend  only  to  the  structural  features  of  the  disorder,  as 
some  of  our  German  colleagues  are  content  to  do,  we  are 
likely  to  miss  the  central  idea  of  the  deviation  from  the 
normal.  In  the  favourite  seats  of  cancer,  the  secretory  func¬ 
tion  is  not  always  or  altogether  what  we  often  take  secretion 
to  be.  Under  certain  circumstances,  solid  products,  or  cells, 
form  part  of  the  secretion,  and  those  cells  do  not  always 
get  carried  off,  as  the  cells  do  in  an  ordinary  catarrh,  by 
discharge  from  the  surface,  or  by  way  of  the  lymphatic 
drainage,  but  they  may  stagnate  and  accumulate  in  the 
deeper  textures  of  the  organ  or  part.  So  far,  there  is 
nothing  in  the  morbid  process  for  which  we  may  not  find 
close  physiological  analogies.  In  some  of  the  secretions  of 
the  invertebrata,  and  even  in  certain  glands  of  the  higher 
animals,  the  secretion  retains  its  solid  or  cellular  character 
for  a  considerable  time.  Again,  the  heaping  up  of  the  solid 
or  bye-products  of  secretion  in  the  spaces  of  the  underlying 
connective  tissue  is  found  to  occur  in  the  breast  as  a 
perfectly  natural  incident. 

Still  further,  the  free  space  of  a  gland  may  become  filled 
with  cast-off  epithelial  cells ;  or  the  epithelial  lining  may 
be  raised  into  wart-like  growths.  Even  a  whole  gland,  like 
the  breast,  or  a  whole  lobe  of  the  gland,  may  be  uniformly 
affected  in  the  way  of  overgrowth,  producing  an  adenom¬ 
atous  condition,  or  the  condition  of  simple  glandular 
tumour.  There  is  nothing  cancerous  in  all  this  ;  we  are 
still  within  sight  of  the  line  of  health.  The  cancerous 
element  comes  in  usually  after  a  particular  time  of  life,  and 
it  consists  in  the  implication  of  other  tissues  than  the 
glandular  or  secreting  structure,  whose  irregularities  were 
the  exciting  cause.  Epithelial  cells  that  have  not  been 
used  for  secretion  can  become  mischievous  as  infecting 
cells,  and  if  we  now  examine  the  region  of  disease,  we  shall 
find  the  marvellous  spectacle  of  an  epithelial  kind  of 
structure  springing  from  the  tissues  around  where  there  is 
no  epithelium  naturally  ;  a  little  later,  the  same  epithelial 
pattern  is,  as  it  were,  carved  out  of  the  parenchyma  of 
lymphatic  glands,  or  of  the  liver,  or  in  the  deeper  layers  of 
the  skin,  or  even  in  still  more  unexpected  places.  The 
pattern  of  this  widely  distributed  structure  is  always 
the  same  in  a  given  case,  and  there  is  always  something 
in  it  which  reminds  us  of  the  primary  seat  of  glandular 
disturbance.  An  intelligible  disorder  of  structure  and 
function,  not  without  its  close  analogies  in  physiology,  has 
acquired  a  kind  of  individuality  or  independence,  and  a 
power  to  reproduce  itself  throughout  the  body;  or,  in 
other  words,  it  has  become  a  ravaging  cancer. 

I  shall  not  delay  here  to  go  into  the  particulars  of  this 
extraordinary  process,  or  to  enter  upon  any  controversial 
matters.  I  take  cancer  as  a  striking  instance  of  a  disease 
which  may  be  traced  along  the  track  of  physiological  per¬ 
turbations  for  a  certain  distance,  after  which  it  becomes 
what  all  the  world  knows  it  to  be — a  semi-independent  life, 
an  imperium  in  imperio,  a  power  inseparable  from  the 
general  life  of  the  body,  compatible  even  with  blooming 
health  for  a  time,  but  in  the  end  sure  to  gain  the  mastery. 

In  taking  a  full  and  fair  view  of  cancer,  of  its  physio¬ 
logical  beginnings,  and  its  ultra-physiological  course,  we 
cannot  but  admit  that  there  is  some  truth  in  that  hard 
saying  of  Paracelsus  :  “  In  such  a  disease,  a  man  is  himself 
and  another ;  he  has  two  bodies  at  one  time,  enclosed  the 
one  in  the  other,  and  yet  he  is  one  man/’  This  kind  of 
Platonic  mysticism  is  not  what  one  would  choose  to  import 
into  exact  science.  But  we  are  bound  by  a  regard  for  facts  ; 
and  I  do  not  see  how  the  facts  of  cancer,  whether  they  be 
microscopic  or  clinical,  can  be  done  justice  to,  unless  we 


admit  that  a  state  of  the  body  may  be  raised  to  the  power* 
and  dignity  of  a  life  of  semi-independence.  I  purpose  speak¬ 
ing,  in  the  sequel,  of  this  semi-independence  under  the  name 
of  autonomy ;  and  I  shall  endeavour  to  show,  in  the  case  of 
two  or  three  other  representative  infective  diseases,  how  & 
perturbation  of  the  physiological  life  has  acquired  its  auto¬ 
nomy,  or  what  the  pre-autonomous  stage  of  those  infections- 
may  have  been.  This  doctrine  of  acquired  autonomy  and  the 
pre-autonomous  stage  is  the  formula  in  terms  of  which  I 
would  express  the  relation  between  ordinary  perturbations 
of  structure  and  function  and  the  specific  infections^  the- 
relation  between  disoi'dered  states  of  the  body  and  the  self- 
existent  species  of  disease. 

If  cancer  has  always  been  the  great  popular  instance  of  a- 
disease  enjoying  a  kind  of  life  of  its  own  within  the  body,, 
consumption  hardly  yields  to  it  in  its  relentlessness,  and  it 
far  exceeds  it  in  its  prevalence.  Is  it  possible,  in  the  case- 
of  consumption,  to  show  that  a  wasting  infection  has- 
arisen  out  of  common  disturbances  of  the  physiological 
life  ?  Before  so  critical  an  audience,  I  shall  not  have  the- 
hardihood  to  speak  of  consumption  in  general — of  the' 
disease  about  which  so  great  masters  in  pathology  a© 
Laennec  and  Virchow  have  differed  widely.  But  there- 
is  a  form  of  tubercle,  the  bovine  form,  in  which  the 
facts  are  much  less  ambiguous,  and  much  easier  to  deal' 
with,  and,  as  it  happens,  more  familiar  to  myself 
and  for  bovine  tubercle,  or,  as  it  is  sometimes  called,, 
the  pearl-disease,  I  shall  venture  to  inquire  whether 
the  small  beginnings  of  it  may  not  be  found  in  a  cer¬ 
tain  kind  of  disturbance  of  ruminant  nutrition,  just  as 
we  find  the  pre-cancerous  stage  of  cancer  in  certain 
irregularities  of  the  apparatus  and  process  of  secretion. 
Those  beginnings  would  correspond  to  what  I  have  called 
the  pre-autonomous  stage ;  while  the  autonomous  life  of  the 
disease,  as  a  semi-independent  thing,  would  be  shown  in  its 
infectiveness. 

Bovine  tubercle  is  a  more  complete  example  of  infection 
than  cancer.  It  is  a  constitutional  disease  pervading  the 
whole  body;  it  is  likely  to  end  in  wasting  and  cachexia  ;  it 
is  very  liable  to  be  inherited  by  the  offspring;  it  can  be 
given  to  other  animals,  by  inoculation  or  by  feeding,  in 
experiments,  and  probably  also  by  accident ;  and  there  are 
recorded  cases  in  veterinary  practice,  which  lead  us  to  think 
that  it  hangs  about  a  stall,  or  spreads  from  stall  to  stall  by 
volatile  contagion.  There  is,  in  fact,  no  disease,  in  human 
or  veterinary  pathology,  that  shows  a  more  complete 
autonomy  ;  it  is  constitutional,  hereditary,  infective,  and 
contagious.  .  ~ 

The  pearl-disease  is  peculiarly  a  ruminant  malady,  and 
it  is  curiously  limited  within  the  ruminant  order  itself.  It 
does  not  occur  in  the  sheep,  nor,  as  far  as  we  know,  in  the 
deer  ;  and  by  far  the  larger  number  of  cases  are  found  in 
the  domesticated  bovine  species,  in  which  it  is,  indeed,  much 
too  common.  I  have  been  on  the  outlook  for  specimens  of' 
it  among  the  animals  that  die  in  the  Zoological  Gardens  in 
London,  and  my  experience  hitherto  has  been  curious  and 
suggestive.  I  have  hitherto  found  the  peculiar  anatomical 
characters  of  this  form  of  tubercle  in  only  three  species  : 
the  eland,  a  large  South  African  antelope,  like  a  cow  ;  the 
nilghau,  a  large  Indian  antelope,  whose  name  means  “  the 
blue  cow  and  the  prong-horned  antelope  from  America, 
another  of  those  half-way  animals  between  the  bovines  and 
the  antelopes,  which  the  late  Mr.  Forbes,  the  Prosector  at 
the  Zoological  Gardens,  took  much  interest  in  as  a  transi¬ 
tion  species.  It  is  certainly  a  remarkable  thing  that  those 
antelopes,  which  resemble  the  bovines  so  closely  In  zoological 
characters,  should  resemble  them  also  in  their  liability, 
under  confinement,  to  a  distinctive  kind  of  new  formation. 
This  kind  of  tubercle  is  not  only  an  affair  of  the  ruminant 
order,  but  it  is  an  affair  of  a  small  group  of  ruminants, 
mostly  belonging  to  one  genus. 

What,  then,  are  the  distinctive  anatomical  characters  of 
this  distinctively  ruminant  disease  ?  The  morbid  anatomy 
of  bovine  tuberculosis  has  been  written  with  as  little 
reference  to  theory  or  preconceived  opinion  as  could  be 
wished.  It  has  been,  in  great  part,  observed  by  those 
whose  business  lies  with  cattle ;  and  the  popular  names  of 
the  disease  in  all  countries  will  show  us  how  it  has  presented 
itself  to  the  common  observer.  The  various  names  show 
that  it  is  primarily  an  affection  of  the  serous  membranes ; 
the  Germans  have  called  it  the  “  pearl-disease/5  from  the 
rounded  whitish  nodules  attached  to  the  abdominal  and 


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August  11, 1883.  147 


thoracic  surfaces  ;  the  French  have  named  it  “  pommeliere,” 
from  a  fancied  resemblance  of  the  nodules  to  clusters  of 
potatoes ;  in  England,  it  has  been  called  “  the  grapes 
and  in  Scotland,  “  angle-berries/’  I  am  merely  repeating 
the  language  of  all  authorities,  including  Professor  Virchow, 
when  I  say  that  the  disease  is  primarily  one  of  the  serous 
membranes— a  growth  of  multiple  nodules,  usually  small 
and  flattened,  often  suspended  by  a  stalk,  and  sometimes 
as  large  as  a  cherry  or  an  apple.  These  are  the  beginnings 
of  the  disease ;  but  it  extends  from  the  serous  membranes, 
by  infection,  to  the  lymphatic  glands,  which  become 
changed  into  the  same  mortar-like  substance  that  is  found 
in  the  degenerated  nodules.  The  lungs,  also,  are  very  apt 
to  get  infected,  as  they  so  often  do  with  new  formations  of 
a  sarcomatous  nature  ;  and  the  infection  may,  in  the  end, 
reach  most  of  the  organs,  as  well  as  the  bones  and  joints, 
causing  the  animal  to  die  of  general  cachexia  and  wasting. 

Such  is  the  usual  sequence  of  events  where  the  disease  is 
originally  acquired ;  but  in  the  cases  of  inheritance — and 
these  are  now  estimated  at  more  than  one-half —there  may 
be  some  departure  from  this  order  ;  in  them,  the  formations 
in  the  lymphatic  glands,  lungs,  and  other  viscera,  may  be 
more  conspicuous  than  the  serous-membrane  nodules  ;  but 
even  in  the  inherited  disease,  the  pleural  or  peritoneal 
surfaces  will  usually  show  characteristic  traces  of  the 
primary  new  formation.  Some  allowance  must  be  made  for 
certain  modifications  in  the  order  and  distribution  of  the 
disease,  when  it  is  communicated  directly  to  the  offspring 
by  a  sire  or  dame  which  had  acquired  it ;  and  it  is  all  the 
more  necessary  to  be  clear  on  this  point,  since,  at  the 
present  day,  the  hereditary  taint  would  seem  to  be  so 
widely  distributed  throughout  the  bovine  stock  as  to 
obscure  somewhat  the  original  characters  of  the  disease. 
In  what  I  have  to  say,  I  must  speak  of  the  disease  as  it  is 
primarily  acquired,  and  as  it  is  described  in  the  earliest 
writings,  and  by  its  popular  names. 

It  starts,  then,  as  a  multiple  nodular  condition  of  the 
abdominal  and  thoracic  serous  surfaces,  it  acquires  the 
character  of  a  constitutional  disease,  it  goes  all  through  the 
body,  it  passes  directly  to  the  offspring,  it  may  be  inoculated 
upon  healthy  animals  or  communicated  to  them  by  feeding, 
and  it  is  not  improbable  that  it  passes  by  volatile  contagion. 
The  infectiveness  within  the  original  body,  and  the  faculty 
of  passing  to  other  animals,  is  what  I  would  call  its  autono¬ 
mous  life,  and  I  would  look  for  its  pre-autonomous  stage  in 
the  peculiar  groups  of  multiple  nodules  on  the  serous  sur¬ 
faces.  What,  then,  is  the  origin  of  these  nodules  P  In  what 
relation  do  they  stand  to  any  known  disorders  of  ruminant 
nutrition,  or,  rather,  of  the  nutrition  of  those  ruminants 
that  are  closely  confined,  artificially  fed,  and  over-milked  ? 

I  am  not  aware  that  the  suggestion  which  I  have  to 
make  has  occurred  to  anyone  before,  and  I  put  it  forward, 
therefore,  with  some  diffidence.  This  suggestion  arises  out 
of  a  consideration  of  the  forms  and  favourite  seats  of 
the  nodules,  and  of  their  structure,  and  degenerations. 
One  cannot  help  observing  that  these  multiple  nodules 
are  especially  apt  to  grow  in  the  seats  of  fat-formation, 
and  to  assume  the  external  form  of  deposits  of  fat,  either 
the  stalked  and  pendulous  form,  or  the  flattened  form 
of  confluent  lobules  or  patches.  Now,  the  bovines  are  some¬ 
what  peculiar  in  th  cway  in  which  they  lay  on  fat.  They 
have  not  so  much  of  subcutaneous  fat  as  the  sheep  or  the 
pig,  but  they  are  very  apt  to  have  internal  formations  of 
adipose  tissue,  sometimes  in  situations  where  one  would 
imagine  that  it  could  serve  none  of  the  ordinary  purposes 
of  fat.  Besides  the  common  deposits  of  fat  about  the 
abdominal  organs  and  in  the  thorax,  there  may  be  lumpy 
masses  of  it  even  on  the  pleura  covering  the  ribs,  and  on 
the  diaphragm ;  and,  in  highly  fed  animals,  it  is  not 
unusual  to  find  a  lobulated  layer  of  the  same  tissue 
all  over  the  surface  of  the  spleen,  and  even  on  the  surface 
of  the  liver.  It  can  hardly  escape  us  that  those  serous 
surfaces  which  are  invaded  in  the  course  of  this  excessive 
fat-forming  habit  are  just  the  localities  where  the  pearl 
nodules  are  found.  There  is,  indeed,  one  rather  important 
exception  to  this  rule,  namely,  the  borders  and  surfaces  of 
the  lungs.  I  cannot  say  whether  a  border  of  fat  ever  occurs 
round  the  margins  of  the  lungs  in  cattle  as  [it  occurs  round 
the  spleen  and  liver,  or  under  the  pulmonary  pleura,  as  it 
is  found  under  the  costal  pleura ;  but,  if  that  should  be  the 
case,  the  analogy  with  the  pearl-disease  would  be  complete, 
so  far  as  situation  goes  ;  otherwise,  we  must  explain  the 


nodule  of  the  pulmonary  pleura  on  the  hypothesis  of 
secondary  infection.  As  regards  form,  the  resemblance 
between  the  physiological  and  the  pathological  formations 
is  most  striking  ;  in  both  cases  we  may  find  either  a  finely 
lobulated  stratum  of  translucent  tissue,  or  coarser  lumpy 
masses,  or  pendulous  nodules. 

But,  after  all,  the  diseased  nodules  of  the  serous  mem¬ 
branes  are  not  fat,  or,  at  all  events,  they  are  not  composed 
of  adipose  tissue  throughout  most  of  their  extent.  They 
are  not  multiple  lipomata  ;  but  it  would  be  strictly  correct 
to  describe  them  as  multiple  fibromata,  or  sarcomata  with 
a  deficient  blood-supply,  or  rather  as  a  multiple  tumour- 
formation  containing  a  mixture  of  those  two  kinds  of 
tissue,  growing  in  the  seats  of  fat-formation,  and  assuming 
the  lobulated,  or  lumpy,  or  pendulous  forms  of  the  sub- 
serous  fat. 

I  do  not  think  that  I  have  gone  beyond  the  facts  in  this 
statement  of  the  naked-eye  characters  of  the  primary  new 
growths  to  which  the  bovines  are  so  liable,  and  I  cannot 
help  thinking  that  there  must  be  some  connexion  between 
them  and  vicissitudes  in  the  nutrition  of  those  animals  as 
manifested  in  that  tissue  which  would  be  most  affected  in 
nutrition,  namely,  the  fat-tissue.  The  facts  may  be  ex¬ 
plained  in  two  ways,  both  of  which  may  be  applicable, 
although  I  would  regard  one  of  them  as  more  probable  than 
the  other.  Either  the  formations  on  the  serous  membranes 
are  atrophied  or  degenerate  masses  of  fat  in  which  the 
blood-supply  has  failed  to  a  great  extent,  or  they  are 
radically  new  growths  which  have  sprung  up  in  the  old 
lines  of  fat-formation,  or  where  fat  may  once  have  been. 
The  description  in  a  veterinary  text-book  of  retrogressive 
changes  in  the  multiple  lipomata  of  the  serous  membranes, 
reads  very  much  like  a  description  of  some  of  the  bovine 
tubercles  that  we  meet  with ;  the  oily  contents  of  the  fat- 
cells  disappear,  the  connective  tissue  hardens  and  thickens, 
calcareous  matter  is  deposited,  and  a  mortar-like  substance 
takes  the  place  of  what  once  was  fat.  But  there  is  another 
and  perhaps  better  way  of  accounting  for  the  fact  that  the 
morbid  growths  are  found  in  some  of  the  favourite  seats  of 
the  internal  fat  and  in  its  peculiar  shapes.  It  is  a  well- 
known  zoological  characteristic  of  the  bovines  that  their 
fat  is  naturally  apt  to  come  and  go  from  time  to  time,  in 
the  wild  state,  according  to  the  periodicity  of  the  seasons, 
and  in  the  domesticated  state,  according  to  a  multitude  of 
artificial  practices  in  the  management  of  dairy  and  farm 
stock.  Nothing  can  be  more  artificial,  for  example,  than 
the  conditions  which  cows  in  town  dairies  are  subjected 
to  ;  the  close  confinement,  the  unnatural  feeding,  and  the 
excessive  milking.  It  is  quite  conceivable  that  an  animal, 
under  those  circumstances,  and  more  especially  when  it  is 
growing  old,  would  depart  from  its  natural  fat-forming 
habit,  and  put  on,  instead,  an  embryonic  kind  of  tissue, 
which  is  neither  fat  nor  anything  else  of  a  physiological 
kind,  although  it  occupies  the  old  seats  of  adipose  tissue, 
runs  into  the  familiar  mould,  as  it  were,  and  grows  to  the 
old  pattern. 

Whether  we  take  the  one  explanation  or  the  other,  or 
the  two  together,  there  is,  I  think,  a  pretty  strong  chain  of 
evidence  that  bovine  tubercle  begins  as  a  disorder  of 
nutrition.  It  is  oftenest  acquired  by  animals  that  are 
farthest  removed  from  their  natural  conditions— by  cows 
imprisoned  in  town  dairies  ;  and  the  disease  that  those 
animals  are  so  peculiarly  liable  to  begins  as  a  kind  of 
multiple  morbid  growth,  which  occupies  the  very  seats  of 
the  internal  fat  and  runs  into  its  very  shapes.  Now,  the 
abdominal  and  thoracic  fat  is  precisely  the  tissue  that 
might  be  expected  to  show  the  effects  of  malnutrition  in 
the  way  of  structural  changes.  The  tubercles  are  simply 
collections  of  embryonic  tissue  in  which  the  formation  of 
bloodvessels  has  been  inadequate,  and  in  which  degenera¬ 
tion  has  inevitably  followed  ;  and  anyone  who  has  studied 
the  development  of  fat  will  readily  admit  that  the  same 
embryonic  cells  growing  in  the  particular  localities  might 
have  become  fat-cells  if  the  blood-supply  had  been  sufficient. 

Whether  I  have  indicated  truly  or  not  the  circumstances 
in  which  we  should  seek  for  the  beginnings  of  this  peculiar 
kind  of  new  growth,  I  am  confident,  at  least,  that  we  must 
look  for  these  beginnings  in  some  physiological  disorder  or 
other  within  the  small  group  of  ruminants,  and  not  else¬ 
where.  Disordered  nutrition  appears  to  me  to  be  able  to 
account  for  this  kind  of  multiple  tumour-disease,  just  as  I 
believe  that  disordered  secretion  can  account  for  the 


M“dical  Times  andGazette. 


BRITISH  MEDICAL  ASSOCIATION. 


August  11, 1863. 


beginnings  of  cancer.  Disordered  nutrition  shows  itself  in 
various  ways  within  the  body ;  but  there  is  only  one  tissue 
that  it  specially  affects,  and  that  is  the  adipose  tissue,  just 
as  the  glandular  tissue  is  the  proper  seat  of  secretory 
disturbances.  In  the  one  case  as  in  the  other,  the  disorder 
of  function  finds  a  structural  expression;  it  acquires 
length,  breadth,  and  thickness ;  or,  in  other  words,  it 
results  in  a  tumour.  The  functional  disease  thus  acquires 
the  degree  of  individuality  which  may  be  ascribed  to  a 
tumour,  and  that  must  be  the  beginning  of  its  life  of 
semi-independence  within  the  body.  In  both  cases  the 
pre-autonomous  stage  is  a  common  disorder  of  structure 
and  function — of  secretion  in  the  one  case,  and  of  nutri¬ 
tion  in  the  other ;  and  each  goes  on  to  acquire  the  mys¬ 
terious  power  of  infection.  But  they  become  autonomous 
in  different  ways,  or  under  different  circumstances.  I  have 
already  spoken  briefly  of  cancerous  infectiveness,  and  I  have 
elsewhere  endeavour  to  trace  the  connexion  between  it  and 
the  antecedent  glandular  disturbances.  In  bovine  tubercle, 
I  should  ascribe  the  infectiveness  to  the  multiplicity  of  the 
primary  nodules,  and  to  the  fact  of  their  being  seated  on 
the  serous  membranes,  which  are  so  fundamental  a  part 
of  the  lymphatic  system.  Multiple  tumours  of  the  serous 
membranes  are  favourably  situated  for  infecting  the  lym¬ 
phatic  glands,  and  the  infection  of  the  lymphatic  glands 
is  only  the  beginning  of  an  autonomous  career.  Professor 
Virchow  has  shown,  in  his  great  work  on  morbid  growths, 
how  the  lobules  of  abdominal  fat  may  become  multiple 
stalked  lipomata,  each  lobule  becoming  a  kind  of  individual 
tumour,  and  growing  as  such  ;  and  he  adds  the  follow¬ 
ing  remarkable  words :  “  There  is  no  doubt  that  this  kind 
of  multiplicity  does  not  differ  altogether  from  what  we  find 
in  malignant  tumours  or  in  an  infective  dyscrasia.”  And  if 
that  can  be  said  of  multiple  lipomata  still  retaining  the 
proper  structure  and  nutrition  of  fat,  it  can  be  said,  with 
even  greater  truth,  of  those  multiple  growths  of  the  abdo¬ 
minal  and  thoracic  surfaces  which  we  have  good  reason  for 
taking  to  be  rather  the  degenerations  or  substitutes  of  the 
fat. 

There  is  one  other  point  to  be  noted  in  connexion  with 
bovine  tubercle.  It  may  or  may  not  be  primarily  due,  as  I 
have  supposed,  to  an  error  of  nutrition  in  the  abdominal  and 
thoracic  deposits  of  fat,  but  its  morphological  characters 
are  certainly  peculiar,  and  they  belong,  in  a  sense,  to  the 
bovine  organisation.  If  I  may  so  speak,  it  has  sprung  out 
of  bovine  soil,  and  the  marks  of  its  bovine  origin  never 
quite  leave  it,  even  when  it  is  set  up  in  the  bodies  of 
animals  widely  removed  from  the  ruminants.  A  mere  con¬ 
dition  or  state  of  the  ruminant  body  can  be  abstracted,  as 
it  were,  from  all  other  ruminant  conditions,  and  made  to 
live  in  another  body ;  and  that  is  an  extreme  instance  of 
what  is  meant  by  the  autonomous  life  of  the  specific  infec¬ 
tions,  or  of  the  semi-independent  existence  of  the  species  of 
disease. 

Having  presented  cancer,  and  one  of  the  varieties  of 
tubercle,  in  this  light,  I  shall  next  inquire  whether  this 
formula  of  an  acquired  autonomy  may  not  be  applied  to  a 
third  great  disease,  representative  of  another  class  of  infec¬ 
tions — I  mean  small-pox.  Small-pox  may  be  looked  at  from 
more  than  one  point  of  view  without  losing  sight  of  its  main 
features.  Our  great  English  dermatologist,  Willan,  looked 
upon  small-pox  as  a  skin  disease;  but  Willan  was  also  one 
of  the  first  to  investigate  the  history  of  small-pox  epidemics 
throughout  the  world,  and  he  was  not  likely,  therefore,  to 
underrate  its  importance  as  a  pestilence.  Hebra  also  ranks 
small-pox  among  the  cutaneous  disorders,  and  the  authori¬ 
ties  of  the  Allgemeine  Krankenhaus  at  Vienna  have  given 
practical  effect  to  Hebra’s  doctrine  so  far  as  to  place  the 
small-pox  wards  under  the  department  for  diseases  of  the 
skin ;  and  I  can  testify,  from  an  experience  of  the  Vienna 
small-pox  wards,  that  the  disease  does  not  lose  any  of  its 
contagious  power  by  being  classified  among  skin  diseases. 
An  experience  gained  under  those  circumstances  is  apt  to 
make  an  impression,  and  from  that  time  I  have  never  been 
quite  able  to  think  of  small-pox  except  as  an  ill-smelling 
condition  of  the  human  skin  which  one  person  may  impart 
to  another.  It  is  a  skin  disease  which  has  been  reproduced 
with  the  greatest  accuracy  and  fidelity  in  millions  of  copies 
for  hundreds  of  years,  and  the  extraordinary  closeness  of 
the  mimicry  has  given  rise  to  the  opinion  that  the  disease 
is  really  the  uniform  effect  of  some  unknown  poison.  But 
the  anatomical  structure  and  evolution  of  the  pock  is  too 


elaborate  to  be  the  simple  and  direct  effect  of  an  extrinsic 
poison  ;  it  is  not  like  a  flea-bite,  or  like  the  nettle-rash 
which  comes  out  in  some  peculiarly  constituted  persons  after 
eating  shell-fish,  or,  as  I  have  known,  even  from  eating  a 
single  wholesome  strawberry.  The  pock  is  a  complicated 
affair,  and  there  is  a  history  written  in  it,  a  history  of  cha¬ 
racters  acquired  bit  by  bit,  as  in  the  evolution  of  living 
things,  a  history  which  has  been  transacted  within  the 
body ;  and  the  stages  of  this  history  are  run  through  with 
more  or  less  completeness  in  every  case  of  the  communi¬ 
cated  disease.  The  papules  had  developed  fluid  in  their 
summits,  they  had  grown  in  a  peculiar  way  to  the  breadth, 
the  original  centre  had  become  a  distinct  depression ; 
and,  in  the  course  of  this  evolution,  certain  partitions  had 
been  formed  in  the  interior  of  the  pock.  Further,  the  pock 
is  more  deeply  rooted  in  the  skin  than  most  skin  diseases 
known  to  us  ;  for  its  base  goes  down  to  the  vascular  layer 
of  the  corium,  and,  when  it  scabs,  it  leaves  a  considerable 
defect  of  substance  (more  particularly  in  those  localities 
such  as  the  face,  where  the  vascular  layer  of  the  corium  is 
well  developed),  a  peculiarity  among  skin  diseases  which 
can  hardly  be  matched,  unless  it  be  in  some  of  the  tropical 
forms  of  impetigo.  This  skin  disease  is  ushered  in  by 
much  constitutional  disturbance  or  fever ;  and,  as  in  some 
other  skin  diseases  which  are  not  contagious,  the  fever 
abates  when  the  eruption  has  come  out,  and  the  subsequent 
constitutional  disturbance  is  exactly  in  proportion  to  the 
number  of  the  pocks. 

The  remarkable  thing  is  that  all  this  complexity  of 
anatomical  structure,  of  stages  of  evolution,  and  of 
characteristic  fever,  should  have  preserved  its  unity  and 
individuality  through  so  many  transmissions,  in  all  sorts 
and  conditions  of  men,  and  in  all  parts  of  the  world.  The 
disease  possesses  what  I  would  call  autonomy  in  a  high 
degree,  and,  from  that  point  of  view,  it  becomes  a  matter  of 
no  ordinary  interest  to  inquire  into  its  pre-autonomous 
history. 

Professor  Hirsch,  in  his  “  Handbook  of  Geographical  and 
Historical  Pathology”  (a  work  which  we  are  soon  to  have  in 
an  English  dress),  concludes  an  elaborate  review  of  the 
historical  evidence  about  small-pox  with  the  opinion  that 
we  have  to  go  to  tropical  countries,  to  Hindostan  and  to  the 
interior  of  Africa,  for  its  original  seats,  and  to  go  back  to  a- 
remote  antiquity  to  find  the  beginnings  of  it.  Lichtenstein, 
one  of  the  early  explorers  of  Africa  from  the  southern  end, 
found  small-pox  to  be  prevalent  wherever  he  penetrated, 
and  he  found  it  among  tribes  who  professed  to  have  got  it 
from  nations  still  farther  from  the  sea.  According  to 
Pruner,  the  disease  is  peculiarly  an  African  disease.  We 
may  take  it,  therefore,  that  small-pox  was  originally  a 
disease  of  the  black  skin,  and  it  is  in  keeping  with  that 
historical  and  geographical  induction  to  find  that  the 
black-skinned  races  are  by  far  the  most  susceptible  of 
the  disease  even  nowadays,  when  it  is  set  up  only  by 
contagion. 

It  is  impossible  to  speculate  to  any  purpose  on  the  rise 
and  development  of  small-pox  out  of  some  common  and 
frequent  disorder  of  the  black  skin  under  such  influences  as 
tropical  heat  and  moisture,  or  under  the  peculiar  conditions 
which  obtain  among  the  swarming  populations  of  tropical 
countries.  One  naturally  thinks  of  a  complex  form  of 
“  febrile  lichen,”  a  skin  disease  which  Dr.  George  Gregory 
admits  that  he  could  not  always  diagnose  from  small-pox  ; 
and  if  we  imagine  a  widely  prevalent  kind  of  febrile  lichen  to 
follow  somewhat  the  same  development  that  Willan  de¬ 
scribes  in  a  remarkable  case  of  lichen  agrius,  we  should 
have  a  not  very  remote  analogy  for  what  I  should  call  the 
pre-autonomous  stage  of  small-pox,  both  in  the  structural 
characters  and  in  the  constitutional  fever.  We  are,  at  least, 
justified  in  thinking  of  some  form  of  tropical  skin-disease, 
widely  spread  within  a  certain  zone,  very  apt  to  recur  in 
the  individual,  and  with  each  recurrence  to  become  more 
inveterate,  and  to  develope  a  more  complex  structure.  Given 
a  number  of  people  suffering  from  such  a  cutaneous  disorder 
at  one  time,  and  some  great  migration  or  invasion,  and  we 
shall  probably  have  the  circumstances  under  which  the 
skin  disease  would  become  communicable,  would  pass  by 
contagion  to  the  skins  of  those  who  had  never  incurred  the 
disease  by  natural  causes,  and  pass  all  the  more  easily  to 
them  if  they  belonged  to  an  entirely  different  race,  or 
presented  the  ordinary  contrasts  of  civilisation  and  bar¬ 
barism,  of  white  skin  and  black. 


Medical  Times  and  Gazette. 


BRITISH  MEDICAL  ASSOCIATION. 


August  11, 1883.  149 


I  do  not  say  that  it  is  an  easy  thing  to  construct  the 
circumstances  under  which  this  disease  of  the  black  skin 
acquired,  what  I  would  call,  its  autonomy.  It  was  pro¬ 
bably  a  gradual  process  ;  its  semi-independence  must  have 
been  hardly  won  and  slowly  consolidated,  until,  at  length, 
it  was  ready  to  start  on  its  devastating  campaigns.  Small¬ 
pox  has  been  a  disease  on  so  stupendous  a  scale,  that  it 
must  seem  to  be  mere  hardihood  to  speak  of  it  as  a  con¬ 
dition  cf  the  skin,  originally  acquired  in  the  tropics,  which 
has  been  passed  on  from  one  body  to  another.  But,  even  if 
history  and  geographical  distribution  had  told  us  nothing, 
the  loathsomeness,  the  peculiar  odour,  and  the  no  less 
peculiar  scars  of  small-pox,  might  of  themselves  suggest 
.another  skin  than  ours ;  and  I  have  seen  too  many  instances 
of  the  minute  mimicry  that  goes  with  every  infection,  to 
feel  any  surprise  that  a  disease,  which  is  native  under  a 
tropical  sun,  should  impress  upon  its  victims  in  every  coun¬ 
try  something  even  of  the  primary  ethnological  characters. 

And  now  let  us  compare  the  autonomous  disease,  as  we 
know  it,  with  the  original  skin  disease  out  of  which  it  must 
have  grown.  The  contagious  small-pox  is  distinguished  by 
what  Sir  Thomas  Watson  calls  “the  very  curious  fact  ”  that 
it  generally  occurs  but  once  in  a  person’s  life.  “  In  this,” 
says  Watson,  “the  contagious  disease  offers  a  remarkable 
contrast  to  inflammations,  which,  having  happened  once, 
-are,  for  that  very  reason,  more  apt  to  happen  again ;  and 
he  goes  on  to  show  the  impropriety  of  ranking  small¬ 
pox  under  the  head  of  cutaneous  diseases  ;  it  would  “  more 
rightly  be  called  a  blood  disease.”  But  there  need  be  no 
antagonism  between  the  view  of  small-pox  as  a  cutaneous 
disease,  and  the  view  of  it  as  an  infection.  This  formula  of 
.an  acquired  autonomy,  and  of  a  pre-autonomous  stage, 
which  I  have  been  recommending  as  a  sort  of  nostrum  for 
our  intellectual  difficulties,  appears  to  me  to  be  a  means  of 
reconciling  those  antagonistic  opinions  which  have  arisen, 
not  so  much  in  connexion  with  small-pox,  as  in  the  con¬ 
troversies  about  some  other  infective  diseases,  which  are 
supposed  still  to  develope  de  novo  from  time  to  time.  Small 
pox,  in  its  pre-autonomous  stage,  would  be  precisely  that 
kind  of  skin  disease  which,  having  happened  once,  is,  for 
that  very  reason,  more  apt  to  happen  again  ;  it  would  recur 
in  the  same  spots,  as  in  the  early  stages  of  leprosy,  and  it 
would  become  more  rooted  and  more  inveterate  each  time 
it  came  back.  The  inveteracy  of  this  morbid  condition  of 
the  skin,  due  in  part  to  neglect,  would  be  its  first  step 
towards  acquiring  that  remarkable  power  of  semi-indepen¬ 
dence  within  the  body,  which  I  have  been  endeavouring  to 
illustrate  under  the  name  of  autonomy ;  it  is  this  acquired 
power  that  enables  it  to  pass  to  another  person’s  skin  as  an 
individual  state  of  the  body,  which  can  be,  as  it  were,  ab¬ 
stracted  ;  and  its  individuality  is  proved  by  the  best  of  all 
tests  of  what  constitutes  an  individual — the  test  of  parent¬ 
age  ;  for  the  skin  disease  that  springs  up  in  the  contaminated 
body  is  exactly  like  the  skin  disease  which  must  have  been 
originally  acquired.  But  the  infected  or  impregnated  body 
runs  through  all  the  stages  of  the  malady-papule,  vesicle, 
pustule,  scabbing,  and  scarring — in  rapid  succession  in  two 
or  three  weeks,  and  it  is  thenceforward  done  with  that 
particular  form  of  skin  disease  for  ever.  This  autonomous 
form  of  the  disease  is  a  brief  abstract  and  chronicle  of  its 
whole  protracted  development  or  evolution  ;  it  sums  up  the 
past,  and  just  as  it  sums  up  the  past,  so  it  anticipates  the 
future. 

Small-pox  appears,  then,  to  be  a  clear  case  of  a  morbid 
condition  of  the  body — namely,  a  cutaneous  condition — which 
has  been  enabled  to  lead  a  kind  of  independent  life.  But 
small-pox  is  one  of  those  diseases  that  always  pass  directly 
from  one  body  to  another,  and  the  direct  succession  of  cases 
does  not  appear  ever  to  have  been  broken.  There  is, 
however,  another  large  class  of  infections,  corresponding  to 
Pettenkofer’s  division  of  the  exogenous  contagia,  which  are 
not  only  able  to  subsist  for  long  periods  outside  the  human 
body,  but  which  even  require  a  certain  amount  of  external 
putrefaction  in  order  to  make  them  potent.  Cholera  is  one 
great  example  of  a  disease  of  the  exogenous  group,  and 
yellow  fever  is  another ;  and  I  shall  ask  your  attention  for 
a  few  minutes  to  some  facts  relating  to  the  latter  disease ; 
for  here,  at  least,  it  must  seem  as  if  we  had  got  quite  away 
from  common  disorders  of  structure  or  function,  and  into  an 
absolutely  separate  region  of  disease,  where  the  physio¬ 
logical  principle  does  not  serve  us. 

Yellow  fever  is  one  of  those  maladies  in  which  historical 


and  geographical  facts  are  of  even  greater  importance  than 
microscopic  or  chemical,  and  hardly  less  important  than 
clinical ;  and,  as  I  have  been  lately  occupied  in  turning 
into  English  the  German  sentences  of  Professor  Hirsch’s 
treatise  on  Geographical  and  Historical  Pathology,  I  have 
had  occasion  to  reflect  upon  the  more  salient  facts  in  the 
history  and  geography  of  yellow  fever.  The  first  point  that 
strikes  one  is,  that  it  appeared  in  the  seventeenth  century  as 
a  new  disease.  For  more  than  a  century  after  the  Spanish 
conquest  of  America,  and  for  many  years  after  the  first 
English  and  French  colonisation  in  the  West,  there  was  no 
yellow  fever,  and,  when  it  did  come  to  Guadaloupe  and 
Barbadoes,  it  was  recognised  as  something  quite  different 
from  the  ever-present  malarial  fever.  The  next  point  is, 
that  there  is  something  quite  peculiar  in  its  geographical 
distribution.  At  the  present  day,  we  are  apt  to  think  of 
yellow  fever  as  the  fever  of  the  Gulf  of  Mexico  and  Brazil ; 
but  it  had  been  the  scourge  of  Philadelphia,  and  even  of 
New  England,  for  many  years  before  it  broke  out  in  New 
Orleans  at  all  (1796) ;  and  its  first  appearance  at  Bio  was 
in  1849.  In  reading  Bancroft’s  treatise  on  this  disease, 
published  in  1811,  it  is  curious  to  notice  how  much  yellow 
fever  has  shifted  its  ground ;  it  has  always  remained  true  to 
certain  shipping  places  in  the  West  Indies,  but  the  other 
great  centres  in  Bancroft’s  time  have  absolutely  ceased  to 
be  the  seats  of  yellow  fever ;  and  some  of  the  places  that 
are  among  the  worst  seats  of  the  fever  now  are  not  even 
mentioned  in  Bancroft’s  pages.  In  fact,  it  is  not  latitude 
and  longitude  that  explains  the  peculiar  distribution  of  the 
disease.  There  is  only  one  thing  that  covers  its  history, 
and  its  geography  and  the  remarkable  changes  in  its 
distribution,  and  that  is  the  slave-trade.  Disregarding  its 
occasional  and  widely  ranging  excursions,  and  confining  the 
attention  to  the  localities  where  it  is  or  has  been,  at  one 
time  or  another,  endemic  or  repeatedly  epidemic,  these  are 
found  to  be  the  creeks  and  wharves  and  low  shipping- 
quarters  of  the  ports  of  debarcation  of  the  slave-trade, 
together  with  a  few  much  less  endemic,  but  not  less  signi¬ 
ficant,  spots  in  Spain  and  on  the  West  Coast  of  Africa — 
the  places  to  which  vessels  engaged  in  the  contraband 
slave-trade  had  gone  on  their  return  voyage.  The  single 
exception  to  this  curious  rule  is  Peru  ;  but  Peru  is  hardly 
an  exception,  when  we  bear  in  mind  the  many  points  of 
resemblance  between  its  Coolie  trade  across  the  Pacific 
and  the  old  African  slave-trade. 

It  was  an  inquiry  into  the  disastrous  outbreak  at 
Barcelona  in  1821,  in  which  5000  persons  died,  that  gave 
the  first  clue  to  the  connexion  between  yellow  fever  and 
the  slave-trade.  The  circumstances  were  investigated  by 
Dr.  Audouard  for  the  French  Government,  and  the  same 
physician  was  sent  again  in  1823  to  inquire  into  a  more 
limited  epidemic  at  a  small  port  in  Biscay.  The  facts  were 
very  much  the  same  in  the  two  outbreaks  :  ship-carpenters, 
engaged  in  repairing  vessels  that  had  arrived  some  time 
before  from  the  West  Indies,  were  seized  with  a  prostrating 
illness,  which  they  attributed  to  putrid  emanations  from 
the  bilge-water,  and  they  became  the  first  victims  of  an 
epidemic  which  proved  to  be  yellow  fever.  Dr.  Audouard 
found  that  the  vessel  which  started  the  infection  in  the  1823 
epidemic  was  a  slaver ;  and,  on  recalling  the  facts  of  the 
Barcelona  outbreak  two  years  before,  he  found  that  the  two 
vessels  chiefly  concerned  in  it  were  also  slavers,  in  proof  of 
which,  he  said,  they  might  still  be  seen  with  the  irons  for 
securing  the  slaves  fixed  in  the  planking  of  their  holds. 
It  was  ascertained  also  that  one  of  them  had  had  an  ex¬ 
traordinary  amount  of  dysenteric  sickness  and  mortality 
among  her  human  cargo  on  the  previous  voyage.  He  cal¬ 
culated  that  about  sixty  Spanish  vessels  had  been  engaged 
in  this  contraband  trade  in  1820,  that  they  had  taken  out 
about  15,000  slaves  from  Africa  to  the  West  Indies,  and 
had  returned  to  Spain  with  merchandise  before  going 
down  to  the  African  coast  for  their  next  cargoes.  This 
was,  in  fact,  the  time  of  the  irregular  slave-trade,  when 
the  vessels  were  not  adapted  for  it,  and  the  crowding  and 
sickness  on  board  were  at  their  worst ;  and  this  period 
corresponds  to  the  remarkable  outburst  of  yellow  fever, 
both  in  America  and  in  Spain  and  on  the  W est  Coast  of 
Africa,  from  about  1790  to  1820. 

It  is  a  perfectly  well-known  fact,  admitted  equally  by 
Lind  and  Bancroft,  that  the  slaves  on  board  a  slave-ship  did 
not  suffer  from  yellow  fever,  although  they  suffered  much 
from  dysentery  and  from  what  used  to  be  called  the  “  horrors 


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150 


of  the  middle  passage  so  that  a  slave-ship  would  arrive  at 
her  destination  with  no  contagious  fever  on  board,  but 
saturated  with  the  filth  of  her  human  cargo.  The  facts 
discovered  by  Dr.  Audouard  in  two  Spanish  outbreaks 
suggested  to  him  a  general  theory  of  yellow  fever ;  it  was  a 
peculiar  form  of  typhus,  due  to  the  emanations  from  the  putrid 
dysenteric  discharges  of  the  negro,  and  the  fever  owed  its 
well-marked  specific  type  to  the  fact  that  the  matters  which 
excited  it  could  be  traced  to  the  negro  body.  There  was 
something,  he  said,  quite  peculiar  in  the  negro  constitution, 
and  it  was  not  surprising  that  the  discharges  from  his  sick 
body  should  be  able,  when  fermented,  to  produce  in  others  a 
typhus  fever  of  a  peculiar  type. 

Dr.  Audouard’s  papers  were  communicated  to  the  French 
Koyal  Academy  of  Sciences,  and  accepted  for  publication. 
They  Academy,  however,  did  not  adopt  his  opinions,  and 
the  pointed  out,  after  the  manner  of  academies,  that  his 
facts  related  to  only  three  slave-ships  and  to  only  two  out¬ 
breaks.  But  the  author  had  shown  that  a  great  part  of  the 
West  Indian  trade  with  Spain  was  carried  on  by  ships  en¬ 
gaged  in  the  contraband  slave-trade,  and  that  the  same 
circumstances  which  led  to  the  epidemics  investigated  by 
himself  must  have  arisen  often  at  all  the  Spanish  ports 
where  yellow  fever  was  an  almost  annual  occurrence.  Not 
only  so,  but  the  whole  history  and  geography  of  yellow  fever 
in  America  was  on  his  side ;  seaports  where  cargoes  of  slaves 
had  been  landed  year  after  year  had  presumably  become 
saturated  with  the  peculiar  filth  of  the  trade,  and  it  is  just 
the  landing-places  and  shipping-quarters  of  those  ports  that 
are  the  foci  of  infection.  In  some  of  them,  such  as  Yera 
Cruz,  the  poison  seems  to  have  become  peculiarly  fixed  in 
the  soil,  so  as  to  defy  all  attempts  at  getting  rid  of  it.  But 
in  the  great  cities  on  the  Atlantic  seaboard  of  the  United 
States,  the  fever  was  practically  eradicated  soon  after  the 
importation  of  negroes  ceased.  During  the  sixteen  years 
after  that  date  (1808),  yellow  fever  appeared  only  seven  times 
in  the  different  ports  of  the  Union,  whereas  in  the  sixteen 
years  preceding  the  abolition  of  the  traffic  it  had  broken  out 
fifty-eight  times. 

In  the  Spanish  seaports  also,  the  great  epidemics  of  yellow 
fever  are  an  almost  forgotten  tradition.  But  in  Brazil  they 
are  of  recent  date,  the  first  of  them  as  recently  as  1849,  and 
Brazil  was  then,  and  had  been  for  some  time,  the  great 
market  for  the  African  slaves,  when  the  ports  of  other 
countries  except  Cuba  were  closed  to  them. 

A  still  more  unlooked-for  confirmation  of  Dr.  Audouard’s 
theory  may  be  discovered  in  the  establishment  of  yellow 
fever  in  the  seaports  of  Peru  within  quite  recent  times ; 
the  first  outbreak  having  been  at  Callao  and  Lima  in  1853. 
An  account  of  it  was  sent  from  Lima  to  the  Edinburgh 
Medical  Journal  by  Dr.  Archibald  Smith,  who  says  :  “  The 
first  cases  of  the  Lima  fever  were  vulgarly  attributed  to 
the  excessively  crowded  shiploads  landed  at  Callao  of  poor 
and  sickly  Chinese,  who  were  ill-fed,  ill-clothed,  and  badly 
cared  for  on  the  voyage  from  their  native  country.  But,” 
he  adds,  “  I,  as  a  practitioner,  could  not  trace  any  symptoms 
of  this  fever  to  them.”  But  Dr.  Smith’s  objection  to  the 
popular  explanation  of  the  yellow  fever  in  Peru  is  precisely 
the  strongest  argument  in  favour  of  it :  the  Chinese,  like 
the  negroes,  did  not  suffer  from  yellow  fever,  and  they  are 
said,  indeed,  never  to  take  it  on  shore ;  but  they  suffered 
from  those  dysenteric  and  other  non-contagious  ailments 
which  were  the  antecedents  of  yellow  fever.  The  disease, 
since  that  time,  has  appeared  at  various  other  ports  on  the 
Peruvian  coast ;  its  outbreak  at  one  of  them,  in  1868,  was 
so  sudden  that  the  populace  attributed  it  to  an  earthquake  ; 
but  a  communication  sent  to  the  French  Foreign  Office 
more  reasonably  connects  it  with  the  Chinese  immigration, 
which,  as  the  report  says,  has  profoundly  changed  the 
sanitary  condition  of  the  whole  Peruvian  coast. 

But  there  is  another  argument  for  Dr.  Audouard’s  theory, 
which  he  makes  hardly  any  use  of.  It  is  the  immunity  of 
the  negro  from  yellow  fever,  notwithstanding  his  great 
liability  to  cholera  and  the  common  forms  of  typhus,  includ¬ 
ing  ship-typhus.  This  immunity  is  perhaps  not  so  striking 
now,  when  the  negro  blood  is  less  pure,  but  all  the  earlier 
authors  were  much  impressed  by  it.  Thus,  Doughty,  who 
saw  much  of  yellow  fever  in  Jamaica  at  the  beginning  of  the 
century,  says :  “  In  the  natives  of  Africa,  the  constitution 
appeared  to  me  as  secure  against  yellow  fever  as  a  person 
who  has  had  the  small-pox  — and  he  might  have  said  the 
yellow  fever  itself — “  is  against  its  recurrence.”  Fenner,  a 


August  11,  1883. 


more  recent  authority  in  New  Orleans,  says  :  “  It  is  a  well- 
established  fact  that  there  is  something  in  the  negro  con¬ 
stitution  that  affords  him  a  protection  against  the  worst 
effects  of  yellow  fever,  but  what  it  is  I  am  unable  to 
say.”  Mr.  Clarke,  the  author  of  a  paper  on  the  “  Topo¬ 
graphy  and  Diseases  of  the  Gold  Coast,”  in  the  first 
volume  of  the  Epidemiological  Transactions,  says  :  “  I  have 
heard  and  read  of  negroes  taking  yellow  fever,  but  in  m> 
case  did  it  happen  at  Sierra  Leone  during  its  prevalence  in 
1837,  1838,  1839,  1847 ;  nor,  so  far  as  I  understand,  in  1859 
and  no  example  of  it  occurred  to  any  of  my  medical  brethren 
in  the  course  of  their  practice.”  This  is  certainly  a  remark¬ 
able  testimony,  when  we  consider  that  ninety-nine  hun¬ 
dredths  of  the  population  of  Sierra  Leone  are  negroes.  And! 
to  show  that  this  is  the  immunity  of  negro  blood,  and  not  of 
acclimatisation,  I  take  the  most  remarkable  experience  of 
all,  that  of  the  French  expedition  to  Mexico  from  1862  to 
1866.  There  was  a  heavy  mortality  from  yellow  fever  among 
the  motley  gathering  of  troops  at  Yera  Cruz  in  the  summer 
of  1866 ;  not  only  the  French  soldiers,  but  Arabs  from 
Algiers,  Indians  from  the  interior  of  Mexico,  and  Creole 
troops  from  the  West  Indies,  were  decimated  by  it ;  whereas,, 
in  a  body  of  400  negro  soldiers  from  the  West  Indies,  there 
were  only  three  cases,  with  one  death ;  and  in  a  black  regi¬ 
ment  of  500  men  raised  in  the  Soudan  and  Nubia,  there  was 
not  a  single  case. 

If,  then,  we  put  together  the  facts  of  this  remarkable 
disease :  when  we  consider  that  its  advent  into  the  world 
coincided  with  the  rise  of  the  slave-trade ;  that  its  habitat 
is  or  has  been  the  ports  of  debarcation  of  the  slave-trade,, 
and  those  places  in  Spain  and  the  West  Coast  of  Africa  to 
which  slave-ships  went  on  their  return  voyage;  that  its 
exacerbations  have  coincided  with  the  most  lawless  period  of 
the  negro  traffic ;  that  it  gained  a  footing  in  the  ports  of 
Brazil  in  1849,  when  the  slave-trade  flowed  into  that 
channel;  and  that  it  has  become  endemic  subsequent  to  1853 
on  the  Pacific  coast  of  South  America,  in  those  ports  of  Peru 
which  were  the  seat  of  an  infamous  Coolie  traffic — we  cannot 
but  see  in  all  this  concurrence  of  testimony  a  proof  that 
Dr.  Audouard  was  right  in  describing  yellow  fever  as  a 
peculiar  form  of  typhus,  originating  at  all  its  endemic 
centres  in  the  filth  of  slave-ships,  just  as  he  showed  that  it 
had  so  originated,  as  a  matter  of  fact,  in  two  of  the  Spanish 
outbreaks.  But  if  that  evidence  should  not  be  enough,  we 
have  only  to  add  the  fact  that  the  negro  cannot  take  the 
disease,  although  it  rages  most  in  the  very  quarters  where 
negroes  live.  The  yellow  fever  still  lurks  about  the  wharves 
and  shipping  quarters  of  towns  where  cargoes  of  slaves  used 
to  be  landed ;  and  every  few  years,  when  the  weather  is  at 
the  hottest,  it  rises  into  a  pestilence,  as  if  it  were  the  ghost 
of  the  slave-trade  walking.  But  it  passes  by  the  negro,  as 
if  it  recognised  the  ties  of  blood ;  and  I  want  no  other  fact 
than  that  to  prove  that  even  this  infection,  belonging  to  the 
exogenous  group,  is  but  one  step  removed  from  perturbations 
of  the  normal  life,  and  that  it  carries  with  it  the  indelible 
stain  of  its  origin. 

The  connexion  between  yellow  fever  and  the  dysenteric 
and  other  discharges  of  the  negro  body,  is  only  a  part  of  that 
general  connexion  between  dysentery  and  typhus  which  has 
often  been  noticed  in  wars  and  famines.  It  formed  the 
subject  of  a  debate,  in  1861,  before  the  Epidemiological 
Society,  in  which  the  late  Dr.  Murchison  gave  an  outline  of 
the  argument  that  he  afterwards  maintained  with  so  much 
learning  and  research  in  his  treatise  on  Continued  Fevers. 
The  celebrated  cases  of  gaol-fever,  in  which  prisoners  brought 
up  at  the  assizes  gave  typhus  to  the  judges,  and  counsel,  and 
jury,  are  full  of  pathological  interest ;  and  it  may  be  well, 
at  the  present  day,  to  recall  the  fact,  which  arrested  the 
attention  of  Lord  Bacon,  that  the  prisoners  were  not 
suffering  from  typhus  themselves.  But  we  need  not  go 
farther  back  than  twenty  years  ago,  nor  farther  away  than 
the  city  of  Liverpool,  for  proofs  of  the  de  novo  origin  of  a 
specific  fever ;  no  more  striking  proof  was  ever  given  of  the 
genesis  of  typhus  out  of  dysenteric  and  other  filth  than  in 
the  case  of  the  Egyptian  frigate  which  came  from  Alexandria 
to  the  Mersey  in  1862  to  be  refitted.  There  were  400  Arabs 
on  board,  who  had  suffered  a  good  deal  from  diarrhoea  and 
dysentery ;  they  had  met  with  rough  weather  all  the  way 
from  Alexandria,  and  the  hatches  had  been  battened  down 
for  two  or  three  weeks  continuously.  When  the  ship  arrived 
in  the  Mersey,  the  ’tween  decks  was  in  a  disgusting  state  of 
filth,  and  the  pilot  who  took  the  vessel  up  the  river  remarked 


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August  11,  1883.  151 


to  his  wife  when  he  went  home  that  that  ship  would  be 
heard  of  again.  He  was  himself  the  first  victim,  for  he  was 
seized  with  a  fatal  form  of  haemorrhagic  typhus  about  a 
week  afterwards.  More  than  one  hundred  of  the  crew  were  on 
the  sick-list,  chiefly  from  dysentery,  but  it  was  carefully  ascer¬ 
tained  that  none  of  the  cases  were  typhus.  Most  of  the 
Arabs  went  to  a  public  bath  in  their  filthy  state,  and  in  a 
few  days  typhus  broke  out  among  the  bath  attendants. 
Some  of  the  crew  were  admitted  into  the  Southern  Hospital 
for  various  non-contagious  disorders,  and  there  also  typhus 
broke  out. 

All  the  facts  of  this  most  interesting  case  were  communi¬ 
cated  to  the  Epidemiological  Society  by  the  late  Dr. 
Duncan,  medical  officer  of  health.  It  was  Dr.  Duncan’s 
opinion,  and  also  Dr.  Cameron’s,  the  present  President  of 
the  Medical  Section,  that  the  outbreak  was  clearly  traceable 
to  the  Egyptian  ship  and  her  filthy  crew,  but  that  it  was  not 
traceable  to  pre-existing  cases  of  typhus,  whether  on  the 
voyage,  or  in  Alexandria  before  sailing. 

There  is  one  other  class  of  cases  which  I  shall  just 
mention — the  cases  in  which  the  mere  contact  of  human 
beings  in  an  average  state  of  health  and  cleanliness  sets 
up  various  epidemic  disorders  among  the  inhabitants  of 
remote  islands,  where  strangers  rarely  come.  Mr.  Darwin, 
in  his  narrative  of  the  voyage  of  the  Beagle,  quotes 
instances  of  this  in  the  South  Seas,  on  the  excellent  autho¬ 
rity  of  Williams,  the  missionary ;  and  it  is  to  typhus  that 
Mr.  Darwin  compares  these  cases.  “  It  would  almost  ap¬ 
pear,”  he  says,  “  as  if  the  effluvium  of  one  set  of  men  shut  up 
some  time  together  was  poisonous  when  inhaled  by  others, 
and  possibly  more  so  if  the  men  be  of  different  races.” 

I  shall  take  one  other  illustration  of  the  doctrine  of 
acquired  autonomy,  and  I  shall  take  both  the  facts  and  the 
doctrine  from  Sir  Thomas  Watson.  The  English  troops 
that  served  in  Egypt  in  1801,  under  Sir  Ralph  Abercromby, 
suffered  much  from  the  ophthalmia  of  that  country,  which 
is  always  brought  on  by  exposure  to  cold  after  being  heated, 
by  the  glare  of  the  white  and  parched  ground,  by  the  dust 
in  the  air,  and  such-like  causes  peculiar  to  the  climate  of 
Lower  Egypt.  No  one,  in  those  days,  thought  that  Egyptian 
ophthalmia  was  a  specific  infection.  But  some  of  the  British 
soldiers  returned  with  it  uncured,  and  it  soon  became  con¬ 
tagious  in  the  home  garrisons ;  and  it  was  found,  after  a 
lapse  of  eight  or  nine  years,  that  there  were  no  fewer  than 
2317  soldiers  pensioners  upon  the  public  bounty  from  blind¬ 
ness  in  consequence  of  ophthalmia.  Those  who  knew  the 
disease  as  it  occurs  in  Egypt  denied  that  it  was  contagious, 
and  those  who  saw  it  in  England  were  as  positive  that  it 
was  contagious.  Watson  reconciles  the  two  views.  He 
says  that  “  there  is  nothing  absurd  nor  unlikely  in  the 
supposition  that  diseases  may  first  arise  from  some  other 
source,  and  then  become  capable  of  spreading  by  contagion  ” ; 
and  he  says  elsewhere  :  “  My  own  creed  upon  the  matter  is 
this — that  the  disease  may,  and  often  does,  arise  indepen¬ 
dently  of  contagion,  from  the  agency  of  ordinary  causes  of 
inflammation  ;  and  that,  having  so  originated,  it  acquires 
eontagious  properties,  which  develope  themselves  only  under 
circumstances  that  favour  the  propagation  of  most  of  the 
contagious  complaints.”  A  parallel  to  the  Egyptian  oph¬ 
thalmia  of  1801  may  be  found  in  certain  cases  of  syphilis 
described  by  Baron  Larrey  in  his  surgical  history  of  the 
same  campaign.  The  Alexandrian  syphilis,  which  the 
French  troops  contracted  freely,  was  peculiarly  free  from 
“  grave  symptoms  ”  and  “  easily  cured  ”;  but  it  proved  very 
“  obstinate  and  difficult  to  destroy  ”  in  those  who  brought 
it  back  with  them  to  France. 

In  choosing  to  speak  of  infective  diseases  from  a  stand¬ 
point  which  is  not  the  dominant  standpoint  of  the  time,  I 
fear  that  I  have  laid  myself  open  to  the  charge  of  taking 
advantage  of  a  public  opportunity  in  order  to  get  a  hearing 
for  a  somewhat  peculiar  view  ;  but  the  words  which  I  have 
just  quoted  from  Sir  Thomas  Watson  will  show  that  this 
doctrine  of  common  disorders  acquiring  specific  power  has 
not  been  absent  from  the  thoughts  of  those  who  lived  in 
the  philosophical  period  of  medicine.  Nothing  would  be 
more  agreeable  than  to  adduce  other  instances  of  the  same 
kind  from  the  history  of  medicine,  and  I  especially  regret 
that  time  will  not  permit  me  to  say  something  of  this 
principle  of  autonomy,  as  it  was  held  by  the  thoughtful 
and  talented  writers  who  were  known  in  Germany  fifty  years 
ago  as  the  natural  history  school.  But  in  anything  that 
concerns  the  natural  history  of  disease,  we  may  go  direct  to 


Sydenham,  who  was  the  author  of  the  phrase,  and  in 
Sydenham  we  shall  find  a  very  explicit  statement  of  the 
doctrine  of  an  acquired  autonomy,  and  a  pre-autonomous 
stage  in  the  specific  diseases.  Sydenham  uses  the  language 
of  the  humoral  pathology  of  his  time,  but  that  matters 
little.  The  humours,  he  says,  may,  under  certain  circum¬ 
stances,  be  raised  to  the  dignity  of  a  substantial  form  or  to 
a  species,  a  specific  disease  being  one  that  takes  its  rise  in 
this  specific  exaltation  or  specification  of  some  j  uice  of  the 
body ;  and  he  expressly  mentions  the  antecedent  condition 
of  the  humour  before  it  had  put  on  its  species — antequam 
hanc  induerat  speciem.  If  I  have  preferred  to  speak  of 
the  acquired  autonomy  of  a  disease,  and  of  its  pre-autono¬ 
mous  stage,  I  mean  no  more  than  Sydenham  means  here,  as 
the  context  of  the  passage  would  show. 

Sydenham  compares  these  species  of  disease  to  the  species 
of  animals  and  plants,  only  that  their  life  is  an  integral 
part  of  the  general  life  of  the  body  ;  and  as  we  have  an 
Origin  of  Species  for  animals  and  plants,  it  is  natural  to 
think  of  the  origin  of  disease  species.  But  there  is  a 
difficulty  in  the  latter  which  the  Darwinian  problem  is  free 
from.  In  the  origin  of  species,  we  are  dealing  with  indi¬ 
vidual  things,  each  with  its  well-rounded,  independent  life ; 
but  where  is  the  individual  life  in  disease  ?  In  my  humble 
opinion,  the  germ  will  not  serve  our  purpose,  for,  according 
to  the  great  Darwinian  analogy,  the  germ  is  always  a  part 
of  the  individual,  and  always  presupposes  the  individual. 
The  germ,  or  the  sperm,  is  no  doubt  a  peculiarly  important 
part,  and  it  is  charged  with  the  most  marvellous  represen¬ 
tative  powers  ;  but  it  is  always  representative  of  the 
individual,  and  it  derives  its  powers  from  the  individual. 
Such,  at  least,  is  our  only  analogy. 

If,  then,  we  must  have  the  individual  to  start  with,  before 
we  can  apply  the  “  origin  of  species  ”  to  disease,  we  come 
back  to  the  old  question,  how  a  morbid  state  of  the  body 
can  become  a  semi-independent  thing,  how  it  can  exist,  not 
in  absolute  independence  of  the  body,  but  autonomous 
within  it,  an  imperium  in  imperio.  This  is  the  perplexing 
question  which  I  stated  at  the  outset  with  reference  to 
cancer,  a  disease  which  in  the  popular  estimation  is  almost 
synonymous  with  a  semi-independent  life,  and  I  quoted  the 
words  of  Paracelsus  :  “  In  such  a  disease,  a  man  is  himself 
and  another ;  he  has  two  bodies  at  one  time,  enclosed  the 
one  in  the  other,  and  yet  he  is  one  man.”  I  have  spoken  to 
several  metaphysical  friends  of  the  difficulty  of  conceiving 
how  a  mere  state  of  the  body,  a  complex  or  integrated 
morbid  state,  can  become  an  individual  existence  with  the 
power  of  propagating  itself ;  but  I  cannot  say  that  I  have 
got  anything  satisfactory  out  of  them.  We  shall  probably 
have  to  settle  this  question  within  our  own  science  as  a  part 
of  the  subject-matter  of  pathology.  Pathology  is  indeed 
varied  enough  in  its  subject-matter.  It  studies  disease  on 
many  sides,  as  the  founder  of  this  Association  planned  that 
it  should  be  studied— the  side  of  its  anatomy  and  its  physio¬ 
logy,  of  its  geography  and  its  ethnology,  of  its  history  and 
its  natural  history.  Its  aspects  are  as  various  and  attractive 
as  the  fruit  trees  in  the  Mohammedan  paradise.  But  there 
is  nothing  in  all  this  boundless  field  of  inquiry  that  is  more 
likely  to  occupy  the  mind  of  the  profession  for  years  to  come, 
as  it  has  occupied  it  in  times  past,  than  the  difficulty  for 
conceiving  how  a  state  or  condition  of  the  body  can  become 
a  species  of  disease. 


General  Eczema. — Treating  of  a  case  of  general 
eczema  covering  the  whole  body  of  a  child,  Dr.  Draper,  of 
the  New  York  Hospital,  stated  that  he  had  found  the  follow¬ 
ing  to  be  a  good  local  application,  being  both  a  protective 
and  stimulant : — Jjt.  Zinci  oxyd.,  olei  juniper,  adipis,  aa  5 j  - 
This  was  spread  over  the  whole  surface,  and  when  the 
epidermis  had  been  removed  a  layer  of  lint  was  put  over  the 
part,  and  the  ointment  spread  over  this.  Opium  was  also 
used  for  the  relief  of  the  itching  and  sleeplessness.  "  In  any 
disease  where  we  have  itching  and  wakefulness,  there  is  a 
loss  of  nervous  tone  from  deprivation  of  rest,  which  aggra¬ 
vates  the  disease.  Good  rest  must  therefore  be  procured 
first.  I  hope,  gentlemen,  that  the  day  is  not  far  distant 
when  some  of  you  will  distinguish  yourselves  by  curing  a 
case  of  general  eczema ;  for  curing  this  disease  will  give  you 
more  reputation  than  almost  any  other  achievement.  And 
it  can  be  cured  by  patient  and  long-continued  efforts.” — 
Phil.  Med.  Reporter,  July  14. 


Medical  Times  and  Gazette. 


BRITISH  MEDICAL  ASSOCIATION. 


August  11,  1883, 


152 


AN  ADDRESS 

DELIVERED  AT  THE  OPENING  OF 

THE  SECTION  OF  OBSTETRIC  MEDICINE, 

At  the  Annual  Meeting  of  the  British  Medical  Association 
in  Liverpool,  August,  1883. 

By  GRAIL Y  HEWITT,  M.D.,  F.R.C.P., 

Professor  of  Obstetric  Medicine,  University  College ;  President  of  Section. 

THE  QUESTION  OF  FOOD  IN  OBSTETRIC  AND 
GYNAECOLOGICAL  PRACTICE. 

I  take  advantage  of  this  opportunity  to  present  to  you  a 
few  observations  on  a  matter  which  has  for  some  years 
deeply  interested  me,  and  concerning  which  I  have  arrived 
at  conclusions  which,  to  me  at  all  events,  appear  to  possess 
a  certain  value,  viz..  The  Question  of  Food  in  Obstetric  and 
Gynecological  Practice. 

Now,  it  may  appear  unnecessary  at  this  period  of  medical 
history,  and  in  the  present  advanced  state,  as  it  is  considered 
to  be,  of  medical  knowledge,  to  insist  on  the  importance  of 
food  in  maintaining  a  healthy  activity  of  the  vital  processes. 
But  a  lengthened  experience  has  convinced  me  that  the 
public  at  large  have  no  practical  knowledge  of  this,  and 
that  the  most  disastrous  effects  result  in  multitudes  of  cases 
from  this  ignorance  of  simple  physiological  laws. 

Engaged  as  I  have  been  more  particularly  in  obstetric  and 
gynaecological  practice,  the  non-observance  of  these  impor¬ 
tant  physiological  laws  in  connexion  with  the  occurrence  of 
diseases  of  the  uterus,  disturbances  of  the  functions  of  the 
uterus  and  ovaries,  and  the  diseases  incidental  to  childbed, 
has  forced  itself  on  my  notice.  It  is  pretty  certain  that  the 
generalisation  which  applies  to  these  classes  of  disease 
extends,  or  would  be  found  to  extend,  to  diseases  of  other 
organs  of  the  body,  for  it  is  the  merit  of  a  true  generalisation 
that  it  is  of  wide  application. 

There  are  certain  terms  in  general  use  by  the  public  and 
by  the  profession  which  are  often  employed  in  a  vague, 
unmeaning,  and  indefinite  manner— such  as  “  weakness/’ 
“  delicacy,”  etc. — whereby  it  is  intended  to  designate  a  con¬ 
dition  very  frequently  met  with,  but  the  essential  nature  of 
which  is,  as  my  experience  has  shown  me,  very  imperfectly 
apprehended.  It  is  well  recognised  that  this  weakness, 
delicacy,  or  what  not,  is  very  commonly  observed  not  only 
in  young  women  coming  under  the  notice  of  the  gynaecolo¬ 
gist,  but  also  in  women  who  have  arrived  at  adult  age,  and 
suffering  from  disorders  in  connexion  with  pregnancy,  par¬ 
turition,  and  childbed.  My  observation  has  in  a  particular 
degree  been  attracted  to  the  presence  of  this  condition.  I 
have  taken  every  opportunity  in  my  power  for  analysing  its 
nature  and  ascertaining  its  essential  cause.  One  conclusion 
arrived  at  is,  that  this  general  weakness  is  very  far  more 
common  than  is  supposed  as  an  antecedent  in  cases  coming 
under  our  notice  as  gynecologists,  and  it  may  even  be  said 
that  it  is  almost  invariably  present  in  a  marked  form  in 
such  cases.  Another  conclusion  is,  that  the  “  weakness  ”  is 
associated  with  and  caused  by  a  long-continued  inadequate 
dietary,  and  that  it  is  essentially  what  may  be  termed 
“  chronic  starvation.”  The  rational  view  of  the  matter  is, 
that  this  “  weakness  ”  is,  in  the  very  large  majority  of  cases, 
preventable ;  that  it  should  be  regarded  as  the  first  stage  of 
a  serious  possible  disease ;  that  it  is  mostly  the  result  of 
chronic  starvation ;  that  it  is  curable,  to  a  greater  or  less 
degree,  in  most  cases ;  and  that  it  is  of  the  highest  impor¬ 
tance  that  it  should  be  formally  and  carefully  treated,  as 
other  diseases  are,  instead  of  being  allowed  to  smoulder  on 
until  the  constitution  is  thoroughly  undermined,  or  until 
some  ailment  distinctly  classified  in  our  nosology  makes  its 
appearance. 

It  is  a  remarkable  circumstance  that  so  little  as  yet  seems 
to  have  been  done  in  the  investigation  of  the  effects  of  an 
insufficient  dietary,  looking  at  it  from  the  quantitative  point 
of  view,  although  the  effects  of  complete  deprivation  of  food 
are  well  known.  Thus,  in  the  last  edition  of  Parkes’s  well- 
known  work  on  Hygiene,  it  is  stated  that  little  is  known  on 
the  subject  of  the  effects  of  insufficiency  of  food ;  and  the 
space  devoted  to  the  consideration  of  this  matter  is  less  than 
one  page. 

It  is  curious  that  the  physiological  law  and  the  popular 
impression  (shall I  say,  in  too  many  instances,  the  “medical” 


impression)  are  found  widely  different.  Physiology  teaches 
the  necessity  for  a  continuous  supply  of  a  certain  quantity 
of  food.  The  popular  impression  is,  that  some  people  do- 
not  require  so  much  food  as  others ;  and,  consequently, 
important  quantitative  diminution  in  the  supply  often 
escapes  attention.  I  must  confess  that,  not  very  many  years 
ago,  I  shared  in  the  popular  impression.  What  induced  me 
to  form  the  opposite  conclusion  was  that,  in  the  first  place, 

I  was  struck  with  the  fact  that,  in  almost  every  case  coming 
under  my  notice,  a  state  of  what  was  termed  “  weakness  ” 
by  the  patient  had  been  notably  present ;  and,  secondly,, 
that,  on  inquiry,  this  weakness  was  almost  always  found  to 
be  associated  with  a  notably  deficient  dietary.  For  the  last 
six  or  seven  years  I  have  tested  the  accuracy  and  applica¬ 
bility  of  these  generalisations,  by  carefully  inquiring  into  the 
past  history  of  patients — mostly  suffering  from  some  uterine 
or  ovarian  disease,  or  some  affection  incidental  to  childbed  j 
and  these  conclusions  have  stood  the  test  of  this  long- 
extended  inquiry.  I  have  to  state  the  important  conclu¬ 
sion,  that  a  continuous  insufficiency  of  food,  or  what  may 
be  termed  a  “  chronic  starvation,”  more  or  less  intense  in 
different  cases,  was  found  to  have  existed  almost  univer¬ 
sally.  Consequently,  I  have  naturally  been  led  to  consider 
chronic  starvation  as  a  most  important  factor  in  disease,, 
certainly  in  those  classes  of  cases  which  have  come  more 
particularly  under  my  notice. 

A  few  typical  instances  were  given,  as — 

A  young  married  lady,  aged  twenty-four,  consulted  me  for 
a  severe  retroflexion  of  the  uterus,  which  appeared  to  have 
set  in  shortly  after  her  first  labour,  some  months  previously. 
She  underwent  treatment  for  this  affection;  and,  in  the 
course  of  it,  one  day  her  mother  came  with  her,  and  inquired 
of  me  why  it  was  that  her  daughter  had  become  liable  to 
this  affection.  I  replied  that,  in  all  probability,  it  was  due 
to  a  previous  condition  of  weakness,  and  insufficiency  of 
meat  as  an  article  of  food.  “Yes,”  said  the  patient,  “that 
is  very  likely  true ;  for  when  I  married,  and  could  please 
myself,  being  very  fond  of  sweets,  I  took  little  ordinary 
food  during  the  first  year,  but  lived  chiefly  on  sweets,  and 
ate  little  or  no  meat  at  all.” 

A  young  lady,  aged  eighteen,  suffered  much  from  menor¬ 
rhagia,  and  her  condition  became  finally  one  of  complete 
inability  for  exertion.  It  was  ascertained  that  this  patient 
had  lived  regularly  as  regards  her  diet,  but  that  her  diet 
consisted  principally  of  bread  and  puddings  ;  and,  having 
a  marked  aversion  to  meat,  she  had  taken  very  little  for  two 
or  three  years  previously ;  and  it  is  the  fact  that  I  was 
afterwards  consulted  by  two  of  her  sisters  presenting  uterine 
symptoms,  and  with  a  corresponding  history  as  regards 
the  previous  dietary. 

I  have  been  much  interested  in  observing,  also,  the  effects 
of  previous  insufficiency  of  food  in  apparently  predisposing 
patients  to  attacks  of  puerperal  septicaemia.  In  the  cases 
of  this  disease  which  I  have  seen  in  consultation,  I  hardly 
recollect  having  seen  a  case  where  the  patient  so  affected 
had,  during  the  pregnancy,  lived  fairly  well;  and  the  worst 
cases  have  been  those  in  which  the  patients  fed  badly  and 
insufficiently  during  the  pregnancy,  and  had  been  fed  on  a 
gruel  diet  after  the  labour  was  over.  In  cases  where  severe 
sickness  during  the  early  part  of  the  pregnancy  prevents 
the  proper  nutrition  of  the  patient,  the  system  is  liable  to 
become  much  impoverished,  and  an  insufficient  dietary  may 
be,  and  often  is,  the  preliminary  to  a  dangerous  childbed. 

With  very  few  exceptions,  and  those  exceptions  only 
tending  to  prove  the  rule,  it  is,  I  hold,  impossible  to  find 
patients  suffering  from  chronic  uterine  disease,  who  have 
not  undergone,  at  some  former  period,  what  may  be  termed 
a  starvation  process ;  and  careful  inquiry  generally  elicits 
the  fact  that  the  quantitative  deficiency  in  the  diet  extended 
over  a  considerable  period.  In  many  cases,  the  patients  are- 
found  to  be  still  under  the  influence  of  a  deficiency  in  this 
direction,  and  to  be  “eating,”  as  the  expression  is,  “  next  to* 
nothing.” 

The  period  of  life  during  which  quantitative  deficiencies 
in  the  dietary  are  most  common,  is  the  two  or  three  years 
immediately  following  the  arrival  of  puberty.  The  girl  is 
at  school  probably,  her  appetite  is  bad,  or  the  food  is  not 
palatable,  or  is  deficient  in  important  particulars,  or,  as  I 
have  found  in  some  cases,  she  eats  little  in  order  to  keep- 
thin ;  the  strength  fails,  the  appetite  diminishes,  and  a  habit 
of  taking  little  is  formed — particularly  little  animal  food  is 
taken.  Three  or  four  years  of  the  most  critical  stages  of  life- 


Medical  Times  and  Gazette. 


CHEVERS  ON  THE  ORDINARY  DISEASES  OF  INDIA. 


August  It,  1883.  153 


are  thus  passed — a  time  at  which  the  body  should  be  growing 
fast,  and  to  maintain  this  growth  in  adequate  vigour,  large 
supplies  of  nutritious  material  are  required ;  instead  of  which, 
the  supply  is  fax  below  the  normal  standard.  The  result  is 
a  general  impairment  of  vigour  and  of  vital  action.  On  the 
generative  organs,  the  effect  is,  as  I  have  observed  in 
numbers  of  cases,  most  decidedly  injurious;  and  the  effect, 
in  most  instances,  is  of  this  kind,  that  the  tissues  of  the 
uterus  lose  their  normal  firm,  healthy  consistence. 

It  is  generally  admitted  by  authorities  on  the  subject  of 
diet  that  nitrogen  is  the  most  essential  of  all  foods,  and  that 
a  certain  amount — about  three  hundred  grains— should  be 
■taken  daily.  In  cases  of  chronic  insufficiency  of  food,  it 
appears  that  the  diminution  in  quantity  of  food  most  fre¬ 
quently  affects  the  nitrogen.  Meat  is  the  article  of  diet 
which,  as  a  rule,  is  the  source  of  the  greater  part  of  the 
■needed  amount  of  nitrogen,  for,  in  England,  at  all  events, 
meat  is  the  popular  article  of  food  ;  and,  in  cases  of  chronic 
starvation,  we  mostly  find  that  the  quantity  of  meat  taken 
is  exceedingly  small.  “  Never  a  meat-eater,”  “  Do  not  like 
meat,”  “  Have  got  out  of  the  habit  of  taking  meat  ” — such 
are  common  replies  made  to  interrogations  of  patients  under 
rfchese  circumstances. 

No  doubt,  meat  can  be  replaced  dietetically  by  other  foods 
•containing  nitrogen  in  sufficient  quantity ;  but  practically, 
owing  to  the  habits  of  families,  good  substitutes  for  meat 
are  not  easy  to  find.  The  weakly  one  of  the  family  is  too 
often  allowed  to  take  her  own  course,  and,  if  she  does  not 
take  meat,  often  gets  nothing  sufficiently  nitrogenous  to 
answer  the  same  purpose.  Of  all  the  nitrogenous  foods, 
meat  is  admitted  by  all  authorities  to  be  the  most  easily 
•digested,  most  easily  assimilable,  and  most  rapid  in  its 
nutritive  action.  Milk  is,  of  course,  a  most  valuable  alter¬ 
native  food ;  but,  in  these  cases  of  absence  of  sufficient  meat, 
we  do  not  find  it  has  ever  been  taken  in  any  such  quantity 
•as  to  make  up  for  the  deficiency ;  and  the  quantity  of  bread 
consumed,  even  supposing  it  to  be  pure  and  of  good  quality, 
as  in  such  cases  entirely  inadequate  to  supply  the  required 
•quantity  of  nitrogen.  I  need  not  allude  to  the  effect  of 
deficiency  in  the  other  constituents  of  the  diet.  It  is  suffi¬ 
cient  for  my  present  purpose  to  show  that  the  nitrogenous 
elements,  while  they  are  of  all  the  most  important,  are 
those  which  are  markedly  absent  in  the  cases  now  under 
consideration. 

There  are  few  observations  bearing  on  the  subject  now 
cinder  discussion  which  can  be  quoted  from  published  works. 
Professor  Yoit  {“  Untersuchung  der  Kost,”  Munich,  1877) 
mentions  an  interesting  fact.  In  a  public  institution,  a 
home  for  girls,  on  which,  he  reports,  the  diet  included  an 
•average  quantity  of  170  grains  of  nitrogen  only,  the  girls 
.appeared  healthy,  but  their  muscles  were  found  to  be  weak, 
and  menstruation  was  found  to  be  delayed  in  many  cases 
until  the  sixteenth  or  seventeenth  year. 

Parkes  states  that  when  the  nitrogen  is  reduced  to  from 
'70  to  100  grains  daily,  the  body  gradually  lessens  in  activity, 
and  passes  into  a  more  or  less  adynamic  condition,  which 
predisposes  to  the  attacks  of  all  the  specific  diseases, 
©specially  malarious  affections,  typhus,  and  pneumonia,  etc. 

It  must  be  assumed  from  what  is  known  that  if  the 
minimum  quantity  of  nitrogen — which,  for  the  sake  of 
■•argument,  we  may  put  as  low  as  250  grains  in  the  case  of  a 
young  woman — be  not  given,  a  condition  of  weakness  will 
soon  be  induced,  and  with  greater  or  less  rapidity,  according 
as  the  quantity  of  nitrogen  falls  much  or  little  below  this 
250  grains  per  diem.  Thus  it  is  easy  to  understand  why,  in 
a  year  or  two,  with  an  average  daily  consumption  of  only 
100  grains  of  nitrogen,  for  instance,  important  modifications 
of  the  nutritive  processes  are  effected,  whereby  there  is 
’orodueed  a  direct  predisposition  to  disease. 

It  is  now  some  sixteen  years  ago  since  I  first  publicly 
-discoursed  on  the  importance  of  nutrition  in  the  treatment 
•of  disease.  I  have  made  it  the  basis  of  my  practice  for  some 
years  past;  and  four  years  ago  I  described  the  condition  to 
which  I  have  now  again  referred  as  “  chronic  starvation.” 
In  the  United  States,  Dr.  Weir  Mitchell  has  employed  a 
system  of  rapid  feeding,  assisted  by  massage  and  electricity, 
for  the  cure  of  weakly,  nervous  sufferers — a  system  which  has 
(been  found  most  successful ;  and  Dr.  Playfair  has  done  good 
service  in  introducing  Dr.  Weir  Mitchell’s  method  into  this 
country.  The  method  in  question  is  essentially  a  rapidly 
acting  means  of  introducing  nutritive  material  into  the 
.system,  and  it  is  dependent  for  its  success  on  the  fact  that 


the  principle  of  the  curative  influence  and  action  of  food 
adequately  recognised. 

The  conclusion  which  is  obviously  suggested  by  the  fore¬ 
going  considerations,  is  the  necessity  for  a  greater  attention 
to  the  question  of  diet,  in  the  bringing  up  of  families,  than 
appears  at  present  to  be  given  to  it.  We  all  know  that 
health  and  a  good  appetite  usually  go  together.  But  it 
seems  to  be  too  frequently  the  case  that,  when  the  appetite 
is  absent,  such  absence  is  taken  as  a  matter  of  course,  and 
receives  no  notice.  It  results,  from  what  has  been  stated, 
that  absence  of  appetite  may  lead  to  most  serious  results. 
It  is  not  immediately  dangerous,  but  it  is  the  first  step 
possibly  in  the  downward  course.  A  continuously  bad 
appetite  constitutes  a  grave  condition,  and  should  be 
seriously  regarded. 

If  it  be  a  rigorously  proved  fact,  that  the  human  body  is 
dependent  for  its  existence,  in  a  state  of  vigour,  on  an 
adequate  and  regular  supply  of  food,  it  behoves  us  to  take 
all  possible  opportunities  of  enforcing  this  great  principle; 
and  in  making  it  known  as  a  great  and  universally  applicable 
measure  and  precaution  in  the  prevention  of  disease. 


PEACTICAL  NOTES  ON 

THE  ORDINARY  DISEASES  OF  INDIA, 

ESPECIALLY  THOSE  PREVALENT  IN  BENGAL. 

By  NOEMAN  CHEYEES,  C.I.E.,  M.D. 

[Continued  from  page  91.) 

MALAEIAL  CACHEXIA — Continued. 

Treatment  of  Splenic  Disease. — If  there  be  great  pain  and 
tenderness,  evidence  of  splenic  peritonitis,  we  apply  sinap¬ 
isms  freely,  and  keep  the  bowels  gently  open,  guarding 
quinine  with  ipecacuanha,  and  always  bearing  in  mind  that 
to  relieve  spleen  we  must  remove  fever ;  and  that,  as  long  as 
the  spleen  remains  unaffected  by  treatment,  fever  is  liable  to 
recur,  and  vice  versa.  The  use  of  frequent  doses  of  purga¬ 
tive  medicine  was  a  leading  feature  in  the  old  showy  heroic 
practice  of  physic  in  the  East.  A  course  of  treatment 
which  caused  daily  shrinking  of  the  mass  recommended 
itself  to  everyone.  When  a  patient  with  recent  splenic 
enlargement  happens  to  get  an  attack  of  diarrhoea,  this 
result  is  often  strikingly  remarkable. 

Considering  that  Twining  points  out  that  in  splenic  dis¬ 
ease  "  intractable  diarrhoea  appears  to  be  the  most  common 
precursor  of  death  in  Bengal,”  it  is  strange  that  purgative 
spleen  mixtures  held  their  ground  for  some  twenty-five 
years  longer,  well  into  my  own  time — nay,  even  up  to  the 
present  day.  Knowing  that,  in  these  cases,  it  is  self-evidently 
our  business  to  nourish  and  strengthen  the  patient,  and  to 
protect  him  from  all  causes  of  bowel  irritation,  I  always 
eschewed  these  evacuant <f  spleen  mixtures,”  giving  plenty 
of  quinine  and  iron,  and  the  best  food,  maintaining  gentle, 
steady  pressure  by  a  broad  flannel  bandage,  and  frequently 
employing  sinapisms,  and,  where  the  case  was  very  obstinate, 
the  galvanic  current.  Here  the  great  probability  that  anti¬ 
scorbutic  treatment  is  needful  must  never  be  overlooked. 

Soon  after  my  retirement,  a  few  years  ago,  I  was  requested 
by  an  old  professional  brother  to  see  a  civil  officer,  a  relative 
of  his,  who  had  returned  from  the  North-Western  Provinces 
of  India  in  a  state  of  splenic  cachexia.  He  had  contracted 
fever  and  spleen  while  engaged  in  his  favourite  amusement, 
search  for  wild  fowl — he  being  an  ornithologist,  and  one  of 
a  class,  in  all  times  numerous  in  India,  who,  not  satisfied  to 
wait  until  fever  comes  to  them,  spend  much  of  their  leisure 
in  deadly  marshes  and  jungles  practically  in  search  for  it. 
I  found  a  middle-aged  man,  much  angemiated,  with  a  some¬ 
what  contracted  liver,  a  splen  ingens,  and  a  moderate  amount 
of  ascites.  He  had  more  than  once  vomited  a  large  quantity 
of  blood.  I  was  told  that  his  urine  was  albuminous ;  but 
either  this  was  a  mistake  or  the  condition  was  transient.  I 
therefore  said  that  we  could  not  use  diuretics  against  the 
dropsy.  He  had  not  long  since  suffered  from  dysentery. 
Hence  I  forbade  the  use  of  strong  purgatives,  knowing 
how  extremely  liable  these  patients  are  to  fatal  intestinal 
flux.  Here  was  what  I  have  been  in  the  habit  of  calling  a 
“  constitutional  fix.”  I,  however,  said  that  I  thought  much 
could  be  effected  by  employing  moderate  but  sustained 


154 


Hedical  Times  and  Gsusette. 


CHEVERS  ON  THE  ORDINARY  DISEASES  OF  INDIA. 


August  11,  1833. 


counter-irritation  over  the  spleen  and  liver,  by  bandaging 
the  abdomen,  by  maintaining  normal  cutaneous  action,  and 
especially  by  the  steady  use  of  quinine.  I,  however,  found 
everyone’s  hand  against  me.  “  Remove  the  dropsical  effu¬ 
sion  by  cathartics,”  said  a  young  Indian  surgeon ;  and  an  old 
and  great  London  physician  (since  deceased),  who  had  served 
for  a  short  time  in  India,  entirely  agreed  with  him.  They 
were  clearly  of  the  opinion  (which  has  a  very  restricted 
validity  in  English  cases)  that  drastics  are  effectual  agents  in 
abdominal  dropsy, — whereas  the  axiom,  drastics  are  deadly 
in  Indian  dropsies,  which,  whether  we  use  purgatives  or  not, 
commonly  terminate  by  intestinal  flux,  is  the  outcome  of  my 
experience.  The  patient  also,  oppressed  by  a  sense  of 
abdominal  weight,  craved  for  strong  purgatives.  I  and  my 
opinions  were,  consequently,  set  aside.  I  must  admit  that, 
as  I  was  informed  after  his  death,  he  seems  to  have  borne  a 
system  of  drainage  by  purgation  longer  and  better  than  I 
expected.  He  lived  for  many  months,  being  apparently  a 
man  of  strong  constitution ;  but  I  believe  that  he  would 
have  recovered  had  he  followed  my  plan,  indicated  above,  to 
which,  had  I  found  the  kidneys  healthy,  I  should  have 
added  the  use  of  very  moderate  diuresis,  and  a  course  of 
ipecacuanha  in  small  doses  directed  to  the  liver,  the  con¬ 
dition  of  which  was,  doubtless,  one  of  the  causes  of  the 
ascites. 

The  local  inunction  of  an  ointment  of  the  biniodide  of 
mercury  has  the  high  recommendation  of  excellent  au¬ 
thorities.  I  may  have  given  it  an  insufficient  trial.  The 
ointment  was  rubbed  over  the  whole  surface  corresponding 
with  the  enlarged  organ,  and  the  native  patient  was 
directed  to  lie  with  the  abdomen  exposed  to  the  sun.  The 
pain  was  so  great,  and  the  raw  surface  left  so  extensive, 
that  I  abandoned  the  treatment  after  having  employed 
it  for  a  short  time  in  a  few  cases.  Dr.  Francis  Day  has 
seen  it  salivate  in  Elephantiasis.  Long  before  I  went  to 
India,  the  internal  use  of  mercury  in  cases  of  spleen  was 
reprobated  by  Twining  in  European  practice — unhappily 
not  in  that  of  the  native  Kobirajes.  It  produces  the  most 
terrible  salivation,  and  often  cancrum  oris.  Those  who  are 
the  subjects  of  malarial  cachexia  are  very  liable  to  be  sali¬ 
vated  by  small  doses  of  mercury.  When  I  was  inexperienced 
in  the  country,  I  prescribed  a  grain  or  two  of  calomel,  in  a 
purgative  dose,  to  a  high  native  official,  of  unhealthy  appear¬ 
ance,  who  complained  of  slight  hepatic  disorder.  Severe 
salivation,  promptly  checked,  and  a  strong  self-inculcated 
lesson  to  the  prescriber,  were  the  results. 

Early  in  1852  a  middle-aged  East  Indian,  stationed  in 
a  very  malarious  spot  near  Chittagong,  and  who  had  several 
times  been  under  my  care  for  obstinate  attacks  of  inter¬ 
mittent  fever,  resulting  in  very  considerable  enlargement 
and  induration  of  the  spleen,  was  attacked  with  epidemic 
cholera.  He  was  actively  treated  with  mercury  by  a  native 
doctor.  He  recovered,  but  with  fearful  salivation.  I  found 
him  greatly  reduced,  and  perfectly  blanched  by  profuse  and 
constant  haemorrhage  from  the  gums,  which  were  sloughing 
extensively,  and  exhaling  an  insupportable  foetor.  Every 
styptic  known  to  the  native  doctor  had  been  employed  in 
vain.  I  prescribed  an  iodine  gargle,  with  nourishing  diet 
and  port  wine.  The  haemorrhage  was  almost  immediately 
arrested,  and  recovery  was  speedy,  and  as  complete  as  could 
be  expected  in  one  who  had  suffered  so  long  from  malarious 
influence.  It  did  not  appear  that  the  teeth  were  at  all 
injured. 

I  had  great  success  in  the  use  of  a  wash  of  from  two  to 
five  drachms  of  compound  tincture  of  iodine  to  eight  ounces 
of  water,  both  as  a  prophylactic  and  as  a  cure,  in  mercurial 
salivation.  Just  as  the  fame  of  mercury  was  expiring  in 
India  I  published  the  result,  (a) 

Early  in  1854,  at  Howrah,  I  was  called  to  see  a  poor 
European  woman,  perhaps  not  of  pure  blood,  who  had  been 
attacked  with  cholera  during  the  preceding  night.  I  had 
before  attended  her  for  hepatic  congestion  supervening  upon 
chronic  dysentery ;  and  she  had,  for  a  considerable  time 
previously,  suffered  from  enlargement  of  the  spleen.  I 
found  her  much  collapsed,  and  the  spleen  could  be  felt  for  a 
hand’s  breadth  below  the  ribs.  Calomel  was  then  the 
remedy  for  cholera,  and  it  certainly  appeared  to  have  much 
to  recommend  it.  Five  or  six  pills  containing  calomel  had 
already  been  given  by  Mr.  Burgess.  I  recommended  that,  not¬ 
withstanding  the  presence  of  splenic  disease,  a  grain  of  calomel 
should  be  continued  every  half-hour.  Altogether,  about 
(a)  Indian  Annals  of  Medical  Science,  No.  2  for  1854,  page  604. 


twenty  grains  were  given.  The  result  was  favourable ;  but, 
although  a  gargle  containing  three  drachms  of  the  tincture 
of  iodine  to  eight  ounces  of  water  was  very  early  employed, 
moderate  salivation  set  in.  The  tincture  was  afterwards 
increased  to  five  drachms;  the  mouth  remained  slightly  sore 
for  about  a  week :  at  the  end  of  that  period  the  spleen  had 
become  reduced  to  about  one-half  of  its  former  size,  and 
she  expressed  herself  as  feeling  better  than  she  had  been; 
for  a  considerable  time  previous  to  the  attack.  I  carefully 
examined  the  urine,  but  could  not  succeed  in  detecting  the 
presence  of  iodine. 

Some  idea  of  the  prevalence  of  splenic  enlargement 
among  the  native  poor  in  the  neighbourhood  of  Calcutta 
may  be  formed  by  driving  out  upon  the  main  roads  in  the 
early  morning.  Crowds  of  natives,  wearing  only  the  dhotee 
around  their  loins,  come  in  tottering  under  enormous 
basketsful  of  vegetables  carried  on  their  heads,  their  spindle 
shanks  bending  aesthetically  in  all  but  the  right  directions. 
They  are  active,  but  generally  emaciated,  and  nearly  every 
one  has  his  epigastrium  and  his  left  hypochondrium  thickly 
beset  with  flat,  shiny  cicatrices,  each  of  the  diameter  of  a  half- 
crown.  These  are  consequent  upon  deep  eschars  produced  by 
the  application,  generally  in  childhood,  of  a  hot  gool,  a  round 
mass,  prepared  from  charcoal,  by  which  the  tobacco  is  kept 
alight  in  hookahs.  Certainly  this  formidable  remedy  effects 
many  cures.  How  many  deaths  it  causes,  is  only  to  be  judged 
of  by  the  not  infrequent  occurrence  of  cases  like  one  which: 
was  admitted  to  my  ward  shortly  before  I  left  India.  A 
poor  moribund  native  boy,  in  extreme  splenic  cachexia, 
with  a  hole  completely  through  the  abdominal  parietes, 
caused  by  sloughing  following  the  application  of  a  gool.  In 
like  manner,  in  English  practice,  blistering  over  the  spleen 
was  often  useful,  but  was  found  to  be  very  liable  to  cause 
sloughing.  The  natives,  considering  that  a  demon  has 
taken  up  its  abode  in  the  spleen,  endeavour  to  kill  the 
intruder  by  a  rude  mode  of  acupuncture,  the  introduction  of 
iron  skewers — H.  H.  Wilson  said,  red-hot.  I  recollect  that 
an  ancient  rhinoceros,  at  Barrackpore,  was  in  considerable 
repute  among  the  natives,  who  bought  and  drank  his  urine 
as  a  spleen-cure. 

In  Calcutta  the  Kobirajes  frequently  give  strong  sulphuric 
acid  as  a  cure  for  spleen.  The  acid  used  is  generally  im¬ 
pure,  but  it  chars  whatever  it  touches.  I  had  four  cases  at 
different  times.  In  one,  a  man  took  about  half  a  drachm  of 
the  plain  acid  on  his  tongue.  His  fauces  were  whitened. 
This  quantity  of  fluid,  when  swallowed,  scarcely  reaches  the 
stomach.  He  remained  in  the  hospital  for  a  few  days 
without  any  bad  symptom.  More  usually,  the  acid  is 
enclosed  in  a  sweetmeat,  capsule-like,  and  so  swallowed.  A 
mother  and  daughter,  with  spleen,  who  had  been  thus 
treated,  were  under  my  care.  They  were  nourished,  for  about 
six  weeks,  wholly  by  enemata.  The  daughter,  but  for  her 
cachectic  state,  might  apparently  have  recovered.  In  the 
mother,  the  corrosive  had  evidently  been  propelled  by  the 
stomach’s  action  against  the  pylorus,  which  was  so  extremely 
contracted  by  firm  and  even  cicatrisation  as  scarcely  to  allow 
the  passage  of  a  goose-quill. 

When  a  well-to-do  European  becomes  the  subject  of 
splenic  enlargement  he  generally  comes  to  Europe.  In  some 
cases  the  enlargement,  although  considerable  and  very  obsti¬ 
nate,  refusing  to  subside  under  any  treatment,  appears  to 
give  little  or  no  trouble.  Some  months  ago  I  watehed  a 
brother  officer  on  his  way  down  Regent-street,  thinking  that 
England  did  not  contain  a  more  healthy-looking,  active, 
red-blooded  man  of  sixty  or  upwards.  Being  an  ardent 
sportsman,  he  got  a  huge  hard  spleen  in  the  jungles  of 
Balasore.  This,  to  my  knowledge,  remained  unreduced  for 
at  least  twelve  years  of  efficient  service  in  India,  (b) 

Of  late  years,  removal  of  enlarged  spleens  in  cases  of  leu¬ 
kaemia,  etc.,  has  been  recommended  and  practised.  Twenty- 
nine  years  ago  I  published  my  opinion  (“  Medical  Jurispru¬ 
dence  for  India,”  page  462),  that  surgeons  should  be 
prepared  to  perform  this  operation,  which  I  had  practised 
upon  the  dead  body,  in  traumatic  cases ;  but,  even  with 
the  record  of  Crede’s  and  Franzolini’s  apparently  successful 
cases  before  us,  I  am  not  convinced  that  we  are  justified  in 
removing  the  spleen  in  any  condition  of  disease. 

( To  be  continued.') 


(b'  Valuable  papers  on  Splenic  Disease  in  India,  by  Twining  and 
H.  H.  WilsoD,  will  be  found  in  Bengal  Med.  and  Phys.  Trans.,  vol.  iii. ; 
1  and  by  J.  0.  Voigt,  Ind.  Jour,  of  Med.  and  Phys.  Sc.  for  1836,  page  5S9. 


RICHARDSON  ON  THE  COLLAPSE  OF  CHOLERA. 


August  11, 1883.  155 


Medical  Times  and  Gazette. 


ON  FEEDING  BY  THE  VEINS 
AND  ON  INTRAPERITONEAL  INJECTION 
IN  THE  COLLAPSE  OF  CHOLERA. 

By  BENJAMIN  WARD  RICHARDSON,  M.D.,  P.R.S. 


( Continued  from  page  125.) 

The  process  of  injecting  warm  saline  solutions  into  the 
veins  during  the  collapse  of  cholera  cannot  be  expected  to 
prove  of  more  than  temporary  service.  But  the  passing 
effects  are  of  a  kind  never  to  be  forgotten  by  those  who  have 
once  seen  them.  They  indicate  clearly  that  the  plan  is  im¬ 
portant  in  principle,  faulty  in  detail.  If  a  person  apparently 
dead  from  the  collapse  can  he  raised  back  to  consciousness 
and  to  other  signs  of  renewed  life,  why  should  not  the  re¬ 
animation  be  sustained  ? 

The  general  impression  as  to  the  cause  of  failure  has 
been  that  the  injected  fluid  is  thrown — if  I  may  use  such 
an  expression — into  a  leaking  vessel.  The  fluid  fulfils 
certain  purposes  of  life  for  a  short  time  :  it  supplies  warmth ; 
it  dilutes  the  condensed  blood  ;  it  enables  the  blood  to 
course  more  freely  through  the  vessels  :  and  upon  these 
changes  the  phenomena  of  reanimation  are  presented.  But, 
as  the  temporary  recovery  from  the  collapse  becomes  de¬ 
veloped,  so,  following  upon  it,  the  symptoms  and  cause  of 
collapse  recur.  In  other  words,  with  the  recovery  there  is 
return  of  the  profuse  discharge  from  the  alimentary  canal. 
In  Mr.  Ansell’s  case  we  had  no  doubt  at  all  that  during 
the  last  collapse  which  passed  into  death  we  could  have 
brought  back  a  short  flickering  of  life,  and  as  the  tube  for 
injecting  was  still  tied  in  the  vein  we  were  much  tempted 
to  do  it.  We  were  stopped  by  the  feeling  that  it  were  both 
useless  and  cruel  to  wake  up  the  practically  dead  body  to 
momentary  existence,  and  permit  it,  with  pain  and  fear,  to 
die  again.  So  we  withheld  our  art  because  it  was  like  a 
broken  reed. 

It  is  worthy  of  notice  that  in  almost  all — according  to  my 
own  observation,  in  all — cases  of  collapse  the  discharges  from 
the  alimentary  canal  cease  some  time  before  death ;  and 
from  this  calm  I  have  two  or  three  times  seen  an  altogether 
unexpected  recovery, — patients  who  have  been  left  as  hopeless 
making  slow  but  safe  return  to  health.  The  fact  here 
named  has  strongly  impressed  many  of  our  best  observers, 
and  has  led  some  of  them  to  feel  that,  taking  it  all  in  all,  a 
patient  in  the  last  stages  of  collapse  may  have  better 
chances  of  recovery  by  being  left  to  what  seems  his  fate 
than  by  being  subjected  to  a  doubtful  line  of  restorative 
treatment. 

For  my  own  part  I  agree  with  the  view  thus  expressed  so 
long  as  the  treatment  remains  doubtful.  The  question  we 
have  to  solve  is,  Can  the  doubtful  be  made  the  certain  or 
more  certain  P 

In  studying  this  question,  the  fact  of  the  calm  which 
accompanies  the  approach  to  death,  and  of  the  occasional 
recovery  under  such  condition,  should  be  added  to  the  facts 
previously  stated  in  reference  to  the  action  of  warm  saline 
solutions  injected  into  the  veins.  The  one  series  of  fact 
throws  light  upon  the  other. 

The  cessation  of  the  drain  from  the  alimentary  surface  is 
due  to  the  state  of  the  tissues  and  of  the  blood  of  the 
affected.  The  blood  extremely  condensed,  and  the  tissues 
deprived  of  water,  the  discharge  ceases  by  necessity.  Then 
the  condensed  blood,  if  it  can  circulate  at  all,  greedily  reab¬ 
sorbs  water,  and  gaining,  very  slowly,  more  volume,  restores, 
also  very  slowly,  the  vital  functions,  leaving  the  alimentary 
canal  free  from  pressure  of  fluid,  and  in  a  state  of  rest, 
favourable  to  recovery.  When,  in  the  stage  of  collapse, 
we  inject  a  warm  saline  solution,  we  very  quickly  revivify 
the  heart  by  the  warmth,  we  dilute  the  condensed  blood, 
we  increase  the  volume  of  blood,  and  we  put  direct  pressure 
immediately  upon  the  alimentary  surface ;  and,  thereupon, 
we  reproduce  the  discharge. 

It  is  like  producing  a  secondary  haemorrhage. 

There  is  an  experimental  fact  which  I  once  before  pub¬ 
lished  in  this  journal,  and  which  bears  directly  on  the  point 
now  in  hand.  I  showed  that  if  we  take  an  animal  that  is 
just  dead  from  chloroform,  and  inject  warm  watery  solutions 
into  its  circulation  by  the  aorta,  the  abdominal  viscera,  as 


the  parts  the  least  resistant,  are  the  parts  which  receive 
nearly  the  whole  of  the  injection,  the  intestines  alone  re¬ 
ceiving  more  than  half  the  weight  of  the  fluid.  So  when 
we  inject  the  veins  in  cholera,  if  the  fluid  be  carried  over 
the  lungs  to  the  left  heart,  it  is  injected  by  the  left  heart 
mainly  into  the  intestinal  surfaces,  from  whence,  in  cholera, 
it  finds  instant  escape  from  the  body. 

The  two  sets  of  facts — the  one  of  occasional  slow  spon¬ 
taneous  recovery,  the  other  of  temporary  rapid  reanimation 
under  injection  of  saline  solutions — throw  light,  I  repeat, 
on  each  other.  They  indicate  too,  as  it  appears  to  my  mind, 
not  that  we  should  throw  up  the  process  of  injection,  in. 
despair,  as  a  remedy  worse  than  the  disease,  but  that  we 
should  gather  from  what  we  have  observed  the  lesson  that 
injection  by  the  veins  must  no  longer  be  a  process  of  forcing 
so  much  fluid  direct  into  what  is  practically  a  bleeding 
body,  but  that  it  must  be  performed  as  aprocess  of  feeding— 
a  slow  process  in  respect  to  operation  ;  a  sustaining  process  in 
respect  to  supply  of  fluid. 

Our  problem  is  to  find  a  fluid  which,  being  gradually  and 
steadily  infused,  will  just  keep  the  animal  fire  alive  while 
time  is  given  for  the  alimentary  affection,  whatever  the 
nature  of  it  may  be,  to  run  its  course  and  cease — a  result 
which  is  all  but  certain  in  the  majority  of  cases  when  time 
is  obtained. 

What  shall  the  fluid  be  P 

Injection  of  Blood.— The  mind  first  refers  to  blood  as  the 
fluid  which  of  all  fluids  would  answer  the  purpose.  The 
objections  to  it  are  too  many  to  permit  of  its  recommenda¬ 
tion  as  a  practical  method. 

In  the  first  place,  during  the  existence  of  an  epidemic 
people  are  so  panic-stricken  the  physician  can  never  depend 
on  supplies  of  blood  from  the  unaffected.  In  the  next  place, 
it  is  not  by  the  injection  of  a  large  quantity  of  blood  at  one 
time  that  the  service  which  is  required  can  be  insured.  In 
the  third  place,  blood  in  its  total  is  not  the  fluid  that  is 
wanted.  If,  while  being  injected,  the  blood  coagulate  ever 
so  slightly,  if  it  form  ever  so  small  a  clot,  it  sets  up  the 
risk  of  causing  a  general  coagulation  in  the  blood,  already 
in  trembling  equilibrium,  of  the  patient.  Again,  in  the 
blood  remaining  in  the  body  of  the  patient,  there  is  still 
the  corpuscular  material  and  the  fibrinous,  so  that  more 
corpuscle  and  more  fibrine  are  not  wanted,  but  a  fluid  that 
will  gradually  dilute,  and  restore,  and  utilise  what  remains 
in  the  vessels.  Could  we  by  some  excellent  device  separate 
the  serum  of  blood  flowing  from  the  vein  of  a  healthy  person, 
and  slowly  infuse  the  serum  only,  we  might  expect  the  best 
results.  That  would  be  a  scientific  procedure.  Could  we  add 
chyle  to  the  serum  the  procedure  would  be  theoretically 
perfect.  We  should  then,  as  we  injected,  be  giving  the 
collapsed  man  an  external  alimentary  system,  and  should  be 
putting  him  into  a  condition  in  which  it  would  be  difficult 
for  him  to  die.  He  has,  for  the  time,  lost  his  alimentary 
system.  We  have  lent  him  one. 

[To  be  continued.) 


The  Perchloride  op  Iron  in  Skin  Diseases. — Dr. 
Casarini,  in  the  Spallanzani,  states  that  the  external  em¬ 
ployment  of  perchloride  of  iron  is  highly  useful  in  many 
chronic  diseases  of  the  skin,  employed  as  an  ointment  con¬ 
sisting  of  one,  two,  or  three  parts  to  thirty  of  lard,  or  as  a 
lotion  mixed  with  two  or  three  parts  of  water.  The  diseases 
in  which  it  is  most  efficacious  are  subacute  and  chronic 
psoriasis,  eczematous  lichen,  and  eczema — after  all  acute 
symptoms  have  subsided.  From  the  cases  he  has  employed 
it  in  he  draws  these  conclusions  : — 1.  The  perchloride  is  a 
highly  efficacious  remedy  in  the  treatment  of  simple  and 
haemorrhagic  purpura.  2.  It  is  very  useful  in  the  chloro- 
anaemic  condition  which  often  accompanies  certain  skin 
diseases,  such  as  rupia,  ecthyma,  and  impetigo.  3.  It  is 
employed  externally  with  promptly  efficacious  results  for 
ulcers  dependent  on  scrofula  and  constitutional  syphilis. 
4.  Used  as  an  ointment  it  modifies  in  a  most  efficacious 
manner  the  squamous  skin  diseases,  and  especially  psoriasis. 
— Pressc  Mdd.  Beige,  July  29. 

Obstinate  Hiccough. — Dr.  Martin  Burke  reports  in 
the  New  York  Med.  Record,  June  30,  two  cases  of  very 
obstinate  hiccough,  in  which,  after  various  remedies  had 
been  tried  in  vain,  the  hiccough  was  arrested  by  firm  com¬ 
pression  of  the  heaving  ribs  made  by  means  of  the  hands. 


156 


Medical  Times  and  Gazette- 


THE  ADDRESS  IH  PATHOLOGY  AT  LIVERPOOL. 


August  11,  1883. 


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epical  (!  i mi's  aait  (labile. 


SATURDAY,  AUGUST  11,  1883. 


THE  ADDRESS  IN  PATHOLOGY  AT  LIVERPOOL. 
The  position  of  an  orator  chosen  and  appointed  to  discourse 
to  a  well-disposed  audience  upon  a  subject  which  he  may 
fairly  call  his  own,  is,  in  many  respects,  an  enviable  one  : 
enviable,  in  the  first  instance,  as  indicating  eminence 
amongst  his  fellows,  but  still  more  enviable  in  the  oppor¬ 
tunity  which  it  brings  to  him  of  presenting  in  the  most 
favourable  light,  and  without  fear  of  dissent  or  contradiction, 
views  upon  this  or  that  phase  of  his  subject  which  choice  or 
accident  may  have  given  him  the  means  of  elaborating  in 
private.  The  opportunity,  further,  is  open  to  him  to  bring 
forward  new  observations,  new  facts,  and  new  deductions 
from  them,  in  such  a  way  as  to  secure  immediate  and  com¬ 
plete  publicity.  Dr.  Creighton  has  not  missed  his  oppor¬ 
tunity.  His  address  is  full  of  interest.  It  is  admirably 
arranged,  and  contains  not  only  many  new  observations,  but 
numerous  suggestions  which,  however  much  we  may  be  dis¬ 
posed  to  disagree  with  the  conclusions  to  which  they  are 
made  to  point,  are  full  of  value  in  themselves.  The  main 
conclusion  that  the  orator  would  have  us  draw  is  one  that 
is  altogether  difficult  of  acceptance.  Briefly,  the  object  of 
Dr.  Creighton’s  address  is  to  assert  the  proposition  that 
disease  is  not  in  itself  an  entity,  apart  in  its  origin  and 
development  from  the  human  organisation,  but  rather  that 
all  morbid  processes  have  had  their  origin  in  some  dis¬ 
turbed  physiological  process,  and  to  extend  this  view  to 
the  infective  diseases,  and  more  especially,  by  way  of  illus¬ 
tration,  to  some  of  those  for  whose  origin  a  different  ex¬ 
planation  has  of  late  years  found  very  general  acceptance. 
A  normal  physiological  process — as,  for  instance,  the  re¬ 
generation  of  epithelium— may  become  so  modified  as  to  give 
rise  to  an  excessive  production  of  normal  cells  at  any  given 
point.  For  a  while  this  may  go  on,  and  still  be  regarded  as 
being  within  physiological  limits.  No  disturbance  of  func¬ 
tion  takes  place.  With  the  extension  of  the  process  a  new 
feature  appears.  The  overgrowth  of  epithelium  is  found  to 
occur  in  other  epithelial  tissues  in  vascular  continuity  with 


it,  and,  finally,  in  tissues  other  than  epithelial.  Thus  it  has 
acquired  for  itself  a  semi-independence,  and  to  this  property 
Dr.  Creighton  gives  the  name  of  autonomy.  It  follows 
then,  he  argues,  that  a  pre-autonomous  stage,  or  a  stage  of 
disturbed  physiology,  is  a  characteristic  of  autonomous  or 
infectious  diseases ;  and,  in  illustration  of  this  view,  he  works 
out  an  ingenious  and  interesting,  though  by  no  means  con¬ 
vincing,  history  of  the  antecedent  pathology  of  bovine  tuber¬ 
culosis,  of  small-pox,  and  of  yellow  fever.  To  many  it 
would  appear  that  to  attempt  to  find  a  physiological  origin 
for  the  infectious  diseases  upon  which  so  much  light  has 
only  recently  been  thrown  to  prove  their  independent 
origin,  is  a  retrograde  movement.  Such  a  feeling  may 
probably  have  occurred  also  to  Dr.  Creighton,  and  more 
than  once  throughout  his  address  we  find  him  quoting  the 
speculative  writings  of  the  older  authors  in  support  of  his 
views. 

That  the  great  weight  of  evidence,  as  we  at  present 
possess  it,  inclines  rather  to  oppose  than  to  support  the 
theory  which  he  promulgates,  is  undoubted,  and  no  good 
purpose  could  be  served  in  adducing  it  here  in  opposition 
thereto.  Our  purpose  should  rather  be  to  regard  the 
question  from  the  point  of  view  of  its  author.  The  study 
of  bovine  tuberculosis,  which  he  selects  in  preference  to 
that  of  the  disease  as  it  affects  human  beings,  is,  and  will 
doubtless  continue  to  be,  particularly  associated  with  Dr. 
Creighton’s  name,  and  his  views  upon  its  origin  and  deve¬ 
lopment  possess,  therefore,  special  value.  He  inclines  to 
the  belief  that  bovine  tuberculosis  is,  in  its  origin,  a  dis¬ 
order  of  nutrition.  The  chain  of  evidence  by  which  he  is 
led  to  this  conclusion  presents  many  points  which  are  new 
to  pathology.  One  of  these,  and  the  most  important,  arises 
out  of  the  observations  which  he  has  made  of  the  physiolo¬ 
gical  peculiarities  of  the  tissue  in  which  the  nodules  of  tuber¬ 
cular  material  are  generally  found.  In  many  of  the  bovine 
animals,  and  especially  those  in  confinement  under  un¬ 
healthy  conditions,  he  has  observed  that  deposits  of  fat  are 
apt  to  occur  in  places  where  fat  is  seldom  present,  and 
that  tins  abnormal  distribution  of  fat  corresponds  very 
closely  with  the  distribution  of  the  tubercular  nodules. 
Under  conditions  of  artificial  feeding  and  over-milking, 
these  abnormal  and  apparently  purposeless  deposits  of  fat 
are  apt  to  appear  and  disappear,  sometimes  with  consider¬ 
able  rapidity.  The  microscopic  structure  of  the  tubercular 
nodules  suggests  the  view  that  they  are  in  reality  only  unsuc¬ 
cessful  efforts  at  fat  formation,  and  hence  that  the  process  of 
their  formation  is  one  of  disturbed  nutrition.  Infection  of 
other  parts  in  no  way  connected  with  fat  formation,  or  even 
with  lymphoid  proliferation,  takes  place  from  these  centres. 
In  other  words,  the  disease,  from  a  starting-point  of  dis¬ 
turbed  nutrition,  rapidly  acquires  autonomy.  The  theory 
is  ingenious,  and  so  far  the  observations  on  which  it  is 
founded  stand  alone.  In  the  form  of  tuberculosis  affecting 
man  no  such  connexion  can  be  traced.  Fatty  deposits  upon 
the  serous  membranes  are  less  common,  but  it  is  worthy  of 
remark  that  the  fatty  deposits  upon  the  heart,  which  also 
may  vary  in  extent  with  the  general  nutrition  of  the  body, 
show  no  tendency  to  develope  or  degenerate  into  centres  of 
tubercular  infection.  From  the  starting-point  of  a  disorder 
of  function,  the  progress  to  the  development  of  autonomy 
is  clearly  made  out  as  far  as  regards  the  individual  subject. 
The  steps  by  which  a  disease  that  has  become  so  auto¬ 
nomous  acquires  the  power  of  infectiveness — the  power  of 
completely  reproducing  itself  in  some  other  individual  body 
— are  left  out  of  consideration.  Both  with  respect  to  small¬ 
pox  and  to  yellow  fever  Dr.  Creighton  shows  us  that  some 
reasonable  grounds  exist  for  supposing  that  they  are  both 
diseases  which  have  at  some  period  enjoyed  a  pre-autonomous 
stage — but  that  is  all.  Small-pox,  coming  originally  from 


Medical  Times  and  Gazette. 


THE  ADDRESS  IN  SURGERY  AT  LIVERPOOL. 


August  11,  1683.  157 


uncivilised  countries,  can  show  nothing  but  its  own  singu¬ 
larly  complex  rash  in  support  of  the  view  that  its  origin  has 
been  one  of  disordered  nutrition  of  the  shin.  Yellow  fever, 
about  the  etiology  of  which  many  most  interesting  and  valu¬ 
able  facts  are  collated,  appears  to  have  owed  its  origin  to  the 
dysenteric  and  other  excreta  of  negro  slaves — following  dog¬ 
gedly,  as  it  appears  to  have  done,  the  progress  of  the  negro 
slave  trade  throughout  the  world.  The  one  point  in  its  his¬ 
tory  to  which  Dr.  Creighton  triumphantly  points  as  a  proof 
of  the  origin  of  the  disease  having  existed  in  disturbed  phy¬ 
siological  processes,  is  the  fact  that  the  negro  slave  to  the 
present  day  appears  to  enjoy  immunity  from  the  ravages  of 
yellow  fever,  even  under  circumstances  most  fatal  to  other 
races. 

Interesting  as  Dr.  Creighton’s  address  is,  it  must  still  be 
questioned  whether  this  theory  of  acquired  autonomy  of 
specific  diseases  does  not  present  more  difficulties  to  the 
average  intellect  than  the  view  of  their  complete  inde¬ 
pendence.  Be  the  origins  of  small-pox,  of  yellow  fever,  or 
of  typhus  what  they  may,  the  conditions  under  which  they 
now  occur  to  us  are,  as  far  as  can  be  at  present  proved,  con¬ 
ditions  of  complete  independence,  and  it  is  only  by  due  re¬ 
cognition  of  this  fact  that  they  can  be  practically  dealt  with. 
As  an  attempt  to  check  for  a  moment  the  overwhelming 
tide  of  opinion  as  to  the  parasitic  nature  of  many  of  the 
specific  fevers,  of  which  it  makes  no  mention  whatever,  the 
address  may  be  looked  upon  as  a  praiseworthy  effort, 
although  we  cannot  regard  it  as  sufficiently  strong  in  argu¬ 
ment  or  convincing  in  proof  to  obtain  any  marked  measure 
of  success. 


THE  ADDRESS  IN  SURGERY  AT  LIVERPOOL. 
Mb.  Habbison’s  address  was  practical  and  common-sense  in 
character  rather  than  brilliant  or  ambitious.  He  had  set 
himself  to  his  task  with  the  determination  of  accomplishing 
a  useful,  not  a  speculative  l-esult ;  of  examining  facts,  instead 
of  playing  with  theories ;  and  of  stating  his  case  in  clear, 
simple  language,  without  striving  for  effects  of  rhetoric  or 
attempting  flights  of  oratory.  The  address  deals  with  that 
special  department  of  surgery  to  which  the  orator  has  devoted 
so  much,  and  is  nosv  devoting  nearly  the  whole,  of  his  time 
and  professional  thought,  and  in  which  he  has  made  himself 
an  acknowledged  authority — namely,  the  surgery  of  the 
urinary  organs ;  and  it  was  listened  to  by  a  very  large  audi¬ 
ence  with  an  amount  of  interest  and  attention  which,  whilst 
complimentary  and  gratifying  to  the  speaker,  showed  also 
an  appreciation  of  the  views  and  practical  knowledge  set 
forth  by  him.  He  first  pointed  out,  as  was  fitting,  that 
the  city  then  receiving  the  Association  had  in  its  hospital 
records  evidence  of  the  ardour  with  which  surgery  had  been 
studied  and  practised  there  in  times  gone  by ;  and  therefore, 
he  remarked,  that  in  our  desire  to  push  forward  it  was 
now  and  then  of  value  to  look  back  and  reflect  upon  what 
has  been  achieved  in  the  past.  Such  reflections  do  not  fail 
to  be  of  service  in  reminding  us  that  surgery  is  not  entirely 
of  modern  creation,  that  almost  in  every  direction  much  of 
what  we  are  apt  now  to  think  new  has  been  anticipated  or 
thought  over  before;  and  in  the  case  of  Liverpool  they 
bring  to  our  remembrance  the  honoured  names  of  Park 
and  Alanson.  Excision  of  the  knee  will  be  for  ever  a 
brilliant  memorial  of  Park,  who  was  Surgeon  to  the  Royal 
Infirmary  from  1767  to  1798;  whilst  Alanson,  who  was 
Park’s  colleague,  and  Surgeon  to  the  Royal  Infirmary  from 
1770  to  1794,  is  and  will  be  remembered  by  his  treatise  on 
amputation,  and  the  great  diminution  in  mortality  which 
his  method  of  amputating  effected. 

After  referring  to  the  remarkable  diffusion  of  surgical 
progress,  and  the  widespread  and  thorough  trial  that  any 


addition  to  or  modification  of  the  usual  surgical  methods 
of  treatment  nowadays  receives,  Mr.  Harrison  commenced 
the  consideration  of  his  subject  by  a  review  of  the  more  re¬ 
cent  advances  and  work  in  connexion  with  the  surgery  of 
the  kidneys.  Sir  William  Lawrence,  we  believe,  used  to 
begin  his  lectures  on  the  urinary  organs  with  the  remark, 
“  Thank  goodness,  the  kidney  is  an  organ  with  which 
operative  surgery  has  nothing  to  do.”  To-day  the  opera¬ 
tions  on  the  kidney  form  one  of  the  leading  subjects  of 
surgical  thought  and  discussion ;  and  Mr.  Harrison  drew 
attention  to  an  article  in  a  recent  number  of  the  American 
Journal  of  the  Medical  Sciences,  which  contains  an  analy¬ 
sis  of  100  cases  of  nephrectomy  alone.  His  comment 
on  this  is :  “  Until  quite  recently,  the  diseases  of  these 
organs  were  regarded  as  belonging  almost  exclusively  to 
the  province  of  the  physician,  and  probably  they  would  have 
remained  so  had  preventive  medicine  obtained  fuller  develop¬ 
ment.  A  more  extended  acquaintance  with  the  pathology 
of  the  kidney  has  brought  to  light  conditions  in  which  the 
work  of  the  physician  requires  to  be  supplemented  by  that 
of  the  surgeon.”  But  Mr.  Harrison,  far  from  being  carried 
away  by  an  enthusiasm  for  this  new  surgery,  balances  it  in 
the  scales  of  good  and  evil,  and  concludes — (1)  that  nephrec¬ 
tomy  has  been  the  means  of  saving  many  lives  under  cir¬ 
cumstances  where  no  other  method  of  treatment  was  likely 
to  be  of  service ;  (2)  that  this  operation  has  been  practised 
in  cases  where  the  probability  of  a  successful  termination 
appeared  to  be  very  remote ;  and  (3)  that  a  method  of 
effecting  the  removal  of  the  organ  different  from  that  which 
was  selected,  or  a  procedure  less  heroic,  might,  in  some 
instances,  have  tended  to  increase  the  chances  of  success. 

With  reference  to  the  other  operations  on  the  kidney — 
nephro-lithotomy,  nephrotomy,  and  the  treatment  by  lay¬ 
ing  open  of  large  hydatid  cysts  of  the  kidney — Mr. 
Harrison  has  nothing  special  to  say :  he  alludes  to  them 
by  implication,  but  nothing  more.  Yet  it  is  here,  we 
think,  that  the  value  of  renal  surgery  will  prove  itself  to  be 
greatest.  Calculus  and  its  results,  and  the  collection  of 
large  quantities  of  fluid  in  the  pelvis,  or  in  a  new- 
formed  cyst  of  the  kidney,  are  not  uncommon  condi¬ 
tions,  and  are  very  amenable  to  relief  by  operation;  but 
the  tumours  of  the  kidney  are  few  and  far  between  in 
comparison,  and  their  removal  is  attended  with  more  risk. 
Moreover,  nephrectomy  will  be  shirked  by  many  practitioners, 
who  might  and  would  prudently  perform  the  less  formidable 
operations;  and  it  must  further  be  borne  in  mind,  even  by 
the  most  adroit  and  boldest  of  surgeons,  that  there  are  many 
cases  of  diseased  and  suppurating  kidney  in  which  complete 
extirpation  of  the  organ  even  in  the  post-mortem  room  is 
an  absolute  impossibility,  and  in  which,  therefore,  the  only 
relief  obtainable  (and  it  is,  not  seldom,  very  great)  is  by 
means  of  nephrotomy,  irrigation,  and  drainage. 

Passing  to  the  surgery  of  the  bladder,  Mr.  Harrison  first 
points  out  that  whereas  the  surgical  mind  had  begun  to 
waver  as  to  the  value  of  lithotrity,  as  practised  on  the  lines 
laid  down  by  Civiale,  in  all  but  cases  of  the  simplest  kind, 
two  important  communications,  following  closely  one  upon 
the  other,  and  both  of  them  emanating  from  America,  have 
enormously  advanced  the  position  of  lithotrity,  and  in¬ 
creased  the  estimation  in  which  it  is  held.  The  first  of  these 
communications  was  that  by  Otis,  showing  that  the  male 
urethra  was  capable  of  safely  receiving  far  larger  instru¬ 
ments  than  had  previously  been  employed;  and  the  second 
was  Bigelow’s  writings  and  demonstrations  on  crushing  and 
removing  vesical  calculi  at  a  single  sitting.  That  Bigelow’s 
method  of  procedure  is  a  great  step  in  advance,  and  has 
extended  the  limits  of  lithotrity  and  curtailed  those  of  litho¬ 
tomy,  must  be  freely  admitted,  though  we  must  not  suppose 
it  capable  of  universal  application,  or  that  the  finality  of 


158  Medical  Tinv1"  and  Cnzotte.  KING’S  COLLEGE  HOSPITAL  AND  ST.  JOHN’S  HOUSE. 


its  perfection  has  been  attained.  Justice  to  lithotomy  does 
not  escape  the  author  of  the  address,  who  says,  “  There  is  no 
great  operation  in  surgery  which  furnishes  more  successful 
results  than  this.  Taking  the  experience  of  the  two  hos¬ 
pitals  in  this  city  with  which  I  have  been  associated,  I  find 
there  have  been  within  my  recollection  102  cases  of  litho¬ 
tomy  in  persons  of  all  ages,  but  chiefly  in  children.  In 
only  five  of  these  cases  could  I  ascertain  that  a  fatal  result 
followed.”  Mr.  Harrison’s  figures  confirm  the  opinion  long 
and  generally  held  respecting  lithotomy  in  persons  not  be¬ 
yond  puberty.  From  a  consideration  of  the  cases  in  which 
the  bladder  has  been  opened  for  the  removal  of  tumours,  he 
thinks  it  might  have  been  better  had  the  operative  proceed¬ 
ing  terminated  with  the  detection  and  exploration  of  the 
growth  by  the  finger ;  and  it  must  be  allowed  that  experience 
has  shown  the  chance  of  rupturing  or  tearing  away  the  walls 
of  the  bladder,  and  of  inducing  uncontrollable  hemorrhage, 
to  be  real  dangers  which  ought  to  be  well  weighed  before 
attempting  to  remove  bladder-growths— more  especially  as 
many  of  them  are  capable  of  only  very  partial  or  incom¬ 
plete  removal.  When  their  removal  is  to  follow  upon  their 
discovery,  and  when  it  is  not,  must  be  a  matter  for  future 
consideration  and  decision.  Good  service  has,  the  orator 
considers,  been  done  by  giving  prominence  to  the  employ¬ 
ment  of  digital  exploration  of  the  bladder,  and  in  furnishing 
illustrations  of  the  great  advantage  that  this  proceeding  is 
capable  of  affording  in  suitable  cases.  In  this  opinion  we 
cordially  agree,  and  the  last  two  numbers  alone  of  the 
Medical  Times  and  Gazette  have  contained  the  records  of 
cases  which  amply  and  clearly  justify  it. 

How  to  deal  with  the  ill-consequences  of  enlargement  of 
the  prostate,  when  the  comfort  that  catheterism  is  often 
capable  of  affording  has  ceased  to  be  attainable,  is  con¬ 
sidered,  and  preference  is  given,  on  the  grounds  of  safety 
and  comfort,  to  establishing  a  drain  for  the  urine  by  an 
incision  through  the  perineum  on  the  lines  of  Syme’s  and 
Cock’s  operations.  Attention  is,  however,  favourably  drawn 
to  the  method  of  puncturing  the  bladder  through  the  en¬ 
larged  prostate,  which  has  afforded  very  gratifying  results 
in  Mr.  Harrison’s  practice,  and  has  received  the  approval 
of  the  distinguished  and  venerable  Professor  Gross.  The 
proceeding  consists  “  in  passing  the  trocar  through  the 
gland,  and  retaining  it  in  the  perineum,  so  as  to  afford  a 
permanent  as  well  as  a  convenient  drain  for  the  urine.” 
Mr.  Harrison  further  advises  that  in  cases  in  which  a  pro¬ 
static  bar  is  obstructing  or  complicating  micturition,  it 
should  be  early  divided  at  the  neck  of  the  bladder  through 
an  opening  made  into  the  membranous  urethra,  rather  than 
by  means  of  a  cutting  instrument  made  to  traverse  the 
whole  length  of  the  canal  after  the  manner  of  Mercier.  He 
considers  the  operative  treatment  of  enlarged  prostate,  when 
it  obstructs  micturition  to  a  degree  that  cannot  be  overcome 
by  the  use  of  the  catheter,  is  yet  open  to  considerable 
improvements;  and  avers  that  the  partial  and  complete 
excision  of  the  gland  is  an  operation  of  much  promise.  He 
refers  to  a  case  in  which  he  very  successfully  excised  the 
whole  of  the  prostate  for  malignant  disease  in  a  middle- 
aged  man,  by  cutting  down  upon  it  in  the  median  line,  and 
cleanly  enucleating  it  with  his  finger ;  the  benefit  which 
followed  far  exceeded  Mr.  Harrison’s  expectations,  and  eight 
months  after  the  operation  the  patient  was  still  in  fair 
health  and  quite  able  to  attend  to  his  business. 

Passing  to  the  surgery  of  the  urethra,  Mr.  Harrison 
refuses  to  follow  Otis  in  his  views  relating  to  the  perform¬ 
ance  of  internal  urethrotomy  as  a  means  of  treating  stric¬ 
tures,  and  thinks  the  operation  is  losing,  instead  of  gaining, 
ground  in  the  opinion  of  many  who  have  ample  oppor¬ 
tunities  of  judging  fairly  of  its  merits.  He  says,  and,  as  we 
think,  rightly,  that  it  is  an  operation  neither  necessary  nor 


August  11, 1883. 

safe  in  the  early  stages  of  stricture,  and  in  none  does  it 
give  a  greater  immunity  from  recurrence  than  other  opera¬ 
tions.  His  remarks  on  this  subject  of  the  treatment  of 
strictures  afford  a  good  example  of  the  individuality,  com¬ 
prehensiveness  of  view,  and  common  sense  which  we  see 
running  through  the  whole  of  the  address.  With  respect  to 
Otis’s  work  in  reference  to  the  dimensions  and  dilatability 
of  the  urethra,  Mr.  Harrison  adds,  “  If  he  had  done  no  more 
than  contribute  to  the  improvement  of  lithotrity — and  this 
cannot  be  questioned — we  should  still  be  largely  in  his 
debt.” 

We  need  not  follow  the  orator  in  his  thoughts  about 
brain-strain  and  the  probable  effects  of  nerve-tension  on 
the  urinary  organs,  nor  notice  his  remarks  on  instrument 
designers  and  makers,  chloroform,  and  antiseptics,  but  will 
conclude  by  saying  that  he  has  very  well  pointed  out  in 
this  address  the  prominent  improvements  and  features  in 
the  treatment  of  a  most  important  class  of  the  surgical 
affections. 


KING’S  COLLEGE  HOSPITAL  AND  ST.  JOHN’S 

HOUSE. 

It  has  for  some  time  been  rumoured  that  the  relations 
between  the  Sister-Matron  of  King’s  College  Hospital  and 
the  Lady  Superior  of  St.  John’s  House,  on  the  one  hand,  and 
the  Medical  Staff  and  the  Committee  of  the  Hospital  on 
the  other,  were  dangerously  strained;  and  matters  have 
come  to  a  crisis.  It  appears  that  some  months  ago  the  Sister- 
Matron,  otherwise  called  the  Sister  in  Charge,  at  the  Hos¬ 
pital  forwarded  to  the  Committee  of  the  Hospital  a  report 
complaining  of  the  behaviour  and  language  of  one  of  the 
medical  officers  to  a  patient  in  the  obstetric  department, 
adding  that  the  complaint  was  one  of  long  standing  and  of 
frequent  recurrence.  The  Hospital  Committee  caused  an 
investigation  to  be  made  into  the  matter,  and,  as  a  result  of 
this,  they  informed  the  Sister  that  a  sub-committee  had 
reported  that  the  evidence  laid  before  them  was  entirely 
insufficient  to  sustain  the  charge  brought  against  the 
medical  officer;  that  the  Committee  had  therefore  in¬ 
formed  him  they  entirely  exonerated  him  from  it,  and 
that  they  regretted  the  charge  should  have  been  made. 
This  might,  in  happier  circumstances,  have  ended  the 
matter ;  but  it  must  be  supposed  that  the  relations  between 
the  Sister-Matron  and  the  Medical  Staff  had  not  previously 
been  all  that  was  to  be  desired,  for  the  Medical  Board  made 
use  of  the  complaint  and  its  results  to  urge  the  removal  of 
the  Sister-Matron,  alleging  that  she  had  for  some  time  past 
adopted  a  line  of  conduct  adverse  to  the  harmonious  working 
of  the  Hospital,  and  prejudicial  to  the  interests  of  the 
Medical  School.  The  Council  of  St.  John’s  House  reco°-- 
nised  the  justice  of  the  complaint  made  by  the  medical 
officers,  in  so  far  that  they  took  steps  for  removing  the 
Sister-Matron,  and  informed  the  Committee  of  the  Hospital 
that  she  would  retire.  It  appears,  however,  that  the  Sister 
in  question  never  had  expressed  any  intention  of  retiring, 
and  that,  in  fact,  she  positively  declined  taking  any  such 
step.  She  was  supported  in  her  determination,  we  under¬ 
stand,  by  the  Lady  Superior  of  St.  John’s  House,  and  by 
all  the  Sisters  nursing  in  King’s  College  Hospital ;  and, 
as  the  Council  of  the  House  were  in  accord  with  the 
authorities  of  the  Hospital  as  to  the  matter  in  dispute, 
they  could  not  yield  to  the  Sisters.  The  result  has  been  that 
the  Lady  Superior,  the  late  Sister-Matron,  known  as  Sister 
Aimee,  and  some  thirty  others  of  the  Sisters,  have  sent  in  their 
resignations,  and  withdrawn  from  all  connexion  with  both 
St.  John’s  House  and  the  Hospital.  Such  a  dispute  and  its 
results  are  very  deplorable.  But  if  lady  nurses,  whether 
they  belong  to  a  religious  sisterhood  or  not— and  St.  John’s 


Medical  Times  and  Gazette. 


THE  WEEK. 


August  11,  1883.  159 


House  is  not  a  religious  sisterhood  in  the  special  sense  of 
that  term,— will  so  magnify  their  office  as  to  set  their  autho¬ 
rity  above  that  of  the  medical  staff  of  a  hospital,  or  of  the 
medical  attendants  in  private  cases,  mischief  must  come  of 
it.  As  our  contemporary,  the  Times,  remarks  in  commenting 
on  this  quarrel,  “  So  long  as  the  medical  staff  and  a  nursing 
sisterhood  can  work  in  harmony,  everyone  would  admit  that 
their  co-operation  must  redound  to  the  vast  benefit  of  the 
hospital  in  which  they  serve.  .  .  .  Medical  men  would 
he  the  last  to  undervalue  or  despise  their  salutary  and 
beneficent  influence.”  But  they,  as  regards  medical  men, 
must  be  second,  not  first.  “  The  moment  the  question  is 
raised,  whether  in  the  last  resort  the  sisters  or  the  doctors 
are  to  rule,  there  is  but  one  answer  to  be  given.  The  final 
authority  must  rest  with  the  medical  staff.”  In  the  case  in 
question  the  Sisters  appear  to  have  put  themselves  hopelessly 
in  the  wi’ong ;  they  set  their  own  opinions  above  those  not  of 
the  Medical  Staff  only,  but  also  of  the  lay  authorities  of  the 
Hospital  and  of  the  Council  of  St.  John’s  House.  The 
governing  authorities  on  both  sides — the  Hospital  as  well  as 
the  House — have,  we  believe,  been  very  earnest  in  trying  to 
induce  the  Sisters  to  take  a  less  exalted  and  more  practical 
view  of  their  office  and  functidns,  and  have  shown  great 
patience  in  the  matter;  but  in  vain.  We  believe  that 
the  Council  of  St.  John’s  House  even  invited  the  protest¬ 
ing  Sisters  to  state  on  what  conditions,  if  any,  they  would 
reconsider  and  withdraw  their  resignations ;  but  that  the 
terms  proposed  in  reply  were  so  preposterous  as  to  show 
that  all  further  negotiations  would  be  utterly  hopeless. 
We  have  a  notion  that  one  of  the  conditions  was  that  the 
St.  John’s  House  should  boycott  King’s  College  Hospital 
for  ever  and  aye ;  but  that  seems  too  ludicrous  to  be  true.  It 
is  true,  however,  that  the  rupture  between  these  ladies  and 
St.  John’s  House  and  the  Hospital  is  complete  and  final. 
Fortunately,  the  consequences  have  not  been  serious  for 
those  institutions.  The  nursing  of  the  Hospital  has  been 
perfectly  carried  out,  and  the  Sister-Matron’s  duties  have 
been  entrusted  to  other  and  competent  hands ;  while  the 
St.  John’s  House  continues  and  will  continue  its  great  work 
of  striving  to  improve  the  qualifications  and  to  raise  the 
character  of  nurses  for  the  sick  in  hospitals,  among  the  poor, 
and  in  private  families,  by  providing  for  them  professional 
training,  together  with  moral  and  religious  discipline. 


THE  WEEK. 

TOPICS  OP  THE  DAT. 

An  influential  deputation  from  the  members  of  the  London 
Vestries  and  the  Metropolitan  District  Boards,  last  week 
waited  upon  the  Home  Secretary,  with  whom  was  the  Presi¬ 
dent  of  the  Local  Government  Board,  in  order  to  make 
certain  representations  relative  to  the  increased  charges 
now  being  made  by  the  water  companies  of  the  metropolis. 
Mr.  W.  H.  Smith,  M.P.,  in  introducing  the  deputation, 
remarked  that  recently,  and  particularly  within  the  last 
six  months,  the  water  companies  had  greatly  increased 
their  charges  under  the  powers  which  they  possessed. 
If  not  impossible,  it  would  at  any  rate  be  most  diffi¬ 
cult  for  the  individual  occupier  of  a  house  to  resist 
their  demand,  and,  moreover,  in  doing  so  he  would 
have  to  face  very  heavy  legal  expenses,  which  would 
be  greatly  in  excess  of  the  increased  charge  he  was  called 
upon  to  pay.  Under  these  circumstances  the  deputation 
had  come  to  the  Home  Secretary  to  solicit  the  relief  to 
which  they  believed  themselves  entitled.  Mr.  Farrer  then 
explained  at  some  length  the  whole  circumstances  of  the 
case,  and  showed  that  the  vestries  had  no  organisation 
among  themselves  by  which  they  could  bring  the  question 
before  Parliament,  and  they  therefore  felt  that  the  Govern¬ 


ment  should  take  the  question  up.  In  replying  to  the 
deputation,  the  Home  Secretary  promptly  availed  himself 
of  the  occasion  as  offering  him  an  excellent  opportunity  for 
delivering  a  satirical  lecture  on  the  present  misgovernment 
of  London,  and  in  his  own  peculiar  style  he  proceeded  to 
inform  them  that  the  Government  did  not  intend  to  attempt 
the  municipal  administration  of  London,  so  that,  while  fully 
recognising  the  evils  of  the  system  they  had  come  to  com¬ 
plain  of,  he  refused  to  hold  out  any  hope  that  the  Govern¬ 
ment  would  interfere  in  the  matter.  It  has  to  be  re¬ 
membered  that  Sir  William  Harcourt  wa3  foremost  in  the 
opposition  to  the  water-supply  scheme  of  the  late  Conserva¬ 
tive  Government,  and  it  is  greatly  owing  to  his  exertions 
upon  that  occasion  that  the  water  companies  now  enjoy  a 
net  income  exceeding  by  =£30,000  a  year  the  interest  on  the 
gross  sum  they  would  then  have  received  for  their  rights, 
privileges,  and  plant. 

At  the  last  meeting  of  the  City  Commission  of  Sewers  a 
letter  was  read  from  the  Home  Secretary,  calling  the  atten¬ 
tion  of  the  Commission,  as  the  sanitary  authority  for  the 
City  of  London,  to  the  especial  expediency  of  putting  into 
early  operation,  wherever  it  might  be  necessary,  the  pro¬ 
visions  of  the  Artisans’  and  Labourers’  Dwellings  Acts, 
1875-82.  Also  suggesting  that  the  Commissioners  should 

give  directions  to  their  Medical  Officer  of  Health  to  examine, 

°  .  .  ,  r 

at  his  earliest  convenience,  the  district  under  his  charge, 
and  to  make  official  representations  to  the  Commission  of 
all  such  areas  as  he  should  consider  to  be  unhealthy,  with  a 
view  to  the  Commission  making  them  the  subject  of  im¬ 
provement  schemes,  to  be  confirmed  by  Parliament  in  the 
course  of  next  session.  The  letter  was  ordered  to  be  referred 
to  a  committee,  the  Medical  Officer  having  the  matter  already 
before  him.  The  Sanitary  Committee  next  brought  up  a  re¬ 
port  in  regard  to  the  suggestions  recently  made  by  the  Medical 
Officer  of  Health  in  reference  to  various  sanitary  arrangements 
necessary  to  guard  against  cholera.  They  recommended 
that  most  of  the  suggestions  should  be  adopted,  especially 
in  regard  to  the  flushing  and  disinfecting  of  sewers  and 
|  catchpits,  the  removal  of  refuse,  the  cleansing  of  the 
various  alleys  and  courts,  the  disinfection  of  stables,  the 
examination  of  cisterns  and  the  water-supply,  the  prosecu¬ 
tion  of  offenders  under  the  Smoke  Act,  the  increased  vigi¬ 
lance  in  detecting  and  seizing  unsound  food,  and  lastly,  in 
the  event  of  an  outbreak,  a  house-to-house  visitation  by 
medical  men.  Dr.  Sedgwick  Saunders  reported  that  the 
total  quantity  of  meat  brought  into  the  Central  Markets  at 
Smithfield  during  July  had  been  16,383  tons,  of  which  twenty- 
five  tons  were  seized  as  unfit  for  human  food.  Urgent  com¬ 
plaints,  he  said,  continued  to  reach  him  regarding  nuisances 
arising  from  gullies  and  sewer  ventilators  in  the  public 
streets.  The  rate  of  mortality  in  the  City  for  the  previous 
week  was  only  14T9  per  1000,  as  compared  with  an  average 
of  21'3  per  1000  in  the  twenty-eight  great  towns  of  England 
and  Wales.  Several  cases  of  choleraic  diarrhoea,  of  which  one 
had  proved  fatal,  had  been  treated  in  the  City,  and  most  of 
them  were  directly  traced  to  the  eating  of  unsound  food. 
The  fatal  case  was  said  to  have  been  caused  by  eating  bad 
pork  ;  while  a  whole  family  had  been  dangerously  ill  through 
eating  tainted  fish. 

Kecently,  at  the  Hammersmith  Poli  ce-court,  Mr.  Jones, 
clerk  to  the  District  Board  of  Works,  applied  to  Mr. 
Partridge  for  an  order  to  the  relieving  officer  of  Fulham 
to  bury  the  body  of  a  child  who  died  from  measles  on 
the  17th  ult.  He  stated  that  the  body  remained  in  the  same 
room  with  the  mother  and  four  other  children  until  the  23rd 
ult.,  when  Dr.  Collier,  the  Medical  Officer  of  Health,  caused 
it  to  be  removed  to  the  mortuary  for  the  safety  of  the 
family.  Mr.  Jones  now  applied,  under  the  twenty-seventh 


160 


Medical  Times  and  Gazette. 


THE  WEEK. 


August  11, 1883. 


section  of  the  Sanitary  Act,  for  an  order  to  be  issued  on  the 
relieving  officer,  requiring  him  to  bury  the  body.  Mr. 
Partridge  wished  to  know  why  the  body  had  not  been 
buried  before,  and  remarked  upon  the  dangerous  delay. 
Mr.  Jones  said  an  application  was  made  to  the  relieving 
officer  by  the  mother  and  the  Board’s  inspector,  but  he  re¬ 
fused  to  move  without  an  order  from  a  magistrate.  Mr. 
Partridge  remarked  on  this  as  very  extraordinary  conduct. 
He  granted  the  order  for  the  interment  of  the  child,  and  de¬ 
sired  that  the  case  might  be  brought  to  the  notice  of  the 
Board  of  Guardians,  as  the  relieving  officer  appeared  to  have 
dangerously  neglected  his  duty. 

The  Stockton  and  Middlesborough  Water  Board  is  about 
to  carry  out  one  of  the  great  works  it  has  authority  to  con¬ 
struct  for  the  provision  of  an  additional  supply  of  water  to 
the  district.  The  Board  was  formed  seven  years  ago,  when 
the  consumption  of  water  was  decreasing,  owing  to  the 
dulness  of  trade,  but  within  the  last  four  years  the  consump¬ 
tion  has  advanced  so  rapidly  that  it  now  exceeds  the  legal 
maximum  the  Board  has  power  to  pump,  viz.,  60,000,000 
gallons  weekly.  The  present  supply  is  drawn  exclusively 
from  the  river  Tees,  and  there  have  been  complaints  for  a 
long  period  as  to  the  polluted  nature  of  that  source,  and 
power  was  given  seven  years  ago  to  construct  large  works 
in  Upper  Teesdale.  One  part  of  this  scheme  is  now  about 
to  be  carried  out,  viz.,  the  construction  of  the  Hury  and 
Blackton  reservoirs  at  an  estimated  cost  of  about  <£365,000. 
By  it  an  ultimate  addition  of  46,000,000  gallons  per  week  is 
expected  to  be  obtained ;  but  it  would  be  by  the  construction 
of  the  reservoirs  as  compensating  reservoirs  only,  the  addi¬ 
tional  supply  being  pumped  from  the  river.  The  cost  of 
the  Hury  reservoir  alone,  which  is  expected  to  give  32,000,000 
gallons  of  water  weekly,  is  estimated  at  <£286,000. 

The  west  wing  of  the  West  London  Hospital,  Hammer¬ 
smith-road,  was  opened  on  Saturday  afternoon  last  by  Her 
Eoyal  Highness  the  Duchess  of  Teck.  The  charity  is  fortu¬ 
nate  in  having  the  Prince  of  Wales  for  its  patron,  and  the 
Duke  of  Devonshire  for  its  president.  The  new  portion, 
formally  opened  on  Saturday,  has  been  provided  chiefly 
through  the  liberality  of  the  Homage  Jury  of  the  Manor  of 
Fulham,  and  of  a  lady  whose  name  is  not  disclosed.  The 
former  gave  £2000,  and  the  latter  £500.  The  total  cost  of 
the  present  extension,  including  furnishing,  is  set  down  at 
nearly  £6000 ;  one  of  the  new  wards  is  to  be  appropriated  to 
children,  and  will  contain  about  thirty  cots.  Another  is  to 
be  devoted  to  male  surgical,  and  a  third  to  female  surgical 
cases. 

At  the  final  meeting  of  the  British  Medical  Association, 
at  Liverpool,  Dr.  Fitzpatrick  (West  Derby)  moved  that  the 
Parliamentary  Bills  Committee  be  instructed  to  oppose  any 
attempt  to  repeal  the  Contagious  Diseases  Acts,  and  to 
endeavour  to  induce  the  Government  to  resume  the  working 
of  those  measures.  Surgeon-Major  McCormack  seconded 
the  motion.  Amid  great  uproar.  Dr.  E.  Whittle  (Liverpool) 
supported  the  repeal  of  the  Acts.  The  meeting  ultimately 
refused  to  hear  him,  but  he  succeeded  in  moving  that  no 
action  be  taken  in  the  matter.  Another  speaker  against  the 
Acts  failed  to  obtain  a  hearing ;  and  eventually  Dr. 
Fitzpatrick’s  motion  was  carried. 


THE  CHOLERA  IN  EGYPT. 

The  reports  from  Egypt  continue  to  improve  as  regards 
both  the  number  of  deaths  from  cholera  and  the  rate  of 
mortality.  The  telegram  from  Alexandria,  of  date  August  8, 
gave  the  deaths  recorded  during  the  previous  twenty-four 
hours  as  at  Cairo  70,  at  Minieh  27,  at  Girzeh  24,  at  Zagazig 
21,  at  Tantah.  18,  at  Kafrzayat  17,  at  Alexandria  17,  at 


Eosetta  15,  at  Atfeh  14,  and  in  the  rest  of  Egypt  416.  The 
total  loss  by  cholera  among  the  British  troops  had  been 
brought  up  to  123  officers  and  men.  The  latest  telegram 
stated  that  the  improvement  in  the  condition  was  progress¬ 
ing  at  all  the  stations  :  there  had  been  only  one  fresh  case 
of  cholera  among  the  troops,  and  one  death  from  cholera 
since  the  previous  day.  A  correspondent  of  the  Times  speaks 
in  the  highest  terms  of  the  devotion  the  officers  were  showing 
to  their  men;  transforming  themselves  into  sick-nurses, 
sitting  day  and  night  with  their  men,  carrying  them  in  their 
arms,  and  performing  all  and  any  services  for  them.  We 
regret  to  learn  that  Superintending  Sister  Jones,  well-known 
for  her  work  among  the  sick,  has  been  instantaneously 
killed  in  a  carriage  accident  at  Helouan. 


THE  HEALTH  OE  LONDON. 

The  Eegistrar- General’s  return  for  the  week  ending  July  28 
showed  that  in  London  the  deaths  were  165  below  the 
average  numbers  in  the  corresponding  weeks  of  the  last  ten 
years.  The  annual  rate  of  mortality  from  all  causes,  which 
had  steadily  increased  in  the  six  preceding  weeks  from  16-91 
to  23- 5,  declined  again  in  the  week  ending  July  28  to  21 ‘2. 
The  deaths  attributed  to  diarrhoea  and  dysentery,  which  had 
been  72,  167,  327,  and  351  in  the  four  preceding  weeks,  de¬ 
clined  to  254,  and  were  66  below  the  corrected  weekly  average; 
237  of  these  deaths  were  of  infants  and  children  under  five 
years  of  age.  The  deaths  of  8  infants  and  children  and 
of  1  adult  aged  sixty-three  years  were  referred  to  simple 
cholera  or  choleraic  diarrhoea.  In  the  Outer  Eing,  38  fatal 
cases  of  diarrhoea  (including  11  in  the  West  Ham  district, 
and  5  in  Eichmond  sub-district)  were  recorded.  Last  week, 
i.e.,  the  week  ending  August  4,  the  rate  of  mortality  from  all 
causes  had  further  declined  to  19-3.  The  deaths  included 
168  from  diarrhoea  and  dysentery,  and  6  from  simple  cholera 
and  choleraic  diarrhoea;  this  total  was  126  below  the 
corrected  weekly  average ;  150  of  the  deaths  attributed  to 
diarrhoea  and  dysentery  were  of  infants  and  children  under 
five  years  of  age.  The  deaths  of  4  children  and  2  adults 
were  referred  to  simple  cholera  or  to  choleraic  diarrhoea. 
In  the  Outer  Eing,  29  fatal  cases  of  diarrhoea  were  recorded, 
10  of  which  were  returned  in  the  West  Ham  district. 


COMMUNICABILITY  OE  SYPHILIS  TO  ANIMALS. 

The  last  number  of  the  Wiener  Mediz.  Woch.,  No.  29,  con¬ 
tains  two  papers  on  the  above  subject.  One  is  from  the  pen 
of  Dr.  Kobner,  who  worked  at  this  subject  many  years  ago, 
and  has  again  devoted  some  labour  to  the  question.  The 
other  originates  with  Neumann,  an  account  of  whose  still 
recent  researches  we  had  occasion  to  give  in  abstract  on 
page  619  of  our  first  volume  for  the  present  year.  Both  in¬ 
vestigators  again  arrive  at  the  conclusion  that  true  syphilis 
cannot  be  transmitted  to  animals.  Kobner  obtained  posi¬ 
tive  results  with  inoculations  performed  with  scrapings 
from  a  soft  chancre  on  rabbits.  Frequent  inoculations 
with  pus  from  simple  and  scrofulous  buboes  always  gave 
no  result.  Kobner  concludes  that  there  is  a  specific  con- 
tagium  in  the  pus  from  a  soft  sore.  Something  more  is 
necessary  than  mere  contact  if  successful  inoculations  with 
the  pus  from  a  soft  chancre  are  to  be  made.  There  must 
be  a  wound;  and  the  deeper  this  goes,  the  greater  the 
certainty  of  a  successful  result.  Experiments  were  chiefly 
performed  on  the  conjunctival  sac  of  rabbits.  Klebs, 
Aufrecht,  Birch-Hirschfeld,  and  Morison  have  found  bacilli 
in  syphilitic  new  growths,  but  Kobner  has  to  confess  that, 
in  spite  of  trials  with  all  the  new  methods  of  staining, 
he  has  been  unable  to  find  the  bacilli  in  excised  papules  of 
the  skin  and  indurations  where  the  surface  was  quite 
unbroken. 


Medical  Times  and  Gazette. 


THE  WEEK. 


August  11,  1883.  161 


THE  WATER-SUPPLY. 

For  a  considerable  time  Colonel  Bolton,  in  liis  monthly 
water  reports,  has  drawn  attention  to  the  fact  that,  as  re¬ 
gards  organic  pollution  of  the  London  water-supply,  the 
most  frequent  and  dangerous  sources  are  the  cisterns  and 
"butts  in  which  the  water  is  stored.  On  his  suggestion,  the 
water  companies  have  arranged  to  give  notice  to  every  house¬ 
holder  of  the  great  importance  of  having  all  cisterns,  butts, 
and  other  receptacles  for  the  storage  of  water  thoroughly 
cleansed.  The  companies  will  send  out  some  650,000 
notices  to  that  effect. 


THE  PARIS  WEEKLY  RETURN. 

The  number  of  deaths  for  the  thirtieth  week  of  1883, 
terminating  July  25,  was  1002  (553  males  and  449  females), 
and  of  these  there  were  from  typhoid  fever  32,  small-pox 
12,  measles  16,  scarlatina  5,  pertussis  15,  diphtheria  and 
croup  24,  dysentery  2,  erysipelas  3,  and  puerperal  infec¬ 
tions  4.  There  were  also  50  deaths  from  tubercular  and 
acute  meningitis,  181  from  phthisis,  12  from  acute  bron¬ 
chitis,  64  from  pneumonia,  131  from  infantile  athrepsia  (40 
of  the  infants  having  been  wholly  or  partially  suckled),  and 
29  violent  deaths  (20  males  and  9  females).  The  health 
of  Paris  continues  satisfactory,  the  deaths  from  all  epidemic 
affections  being  relatively  rare.  The  number  of  admissions 
for  typhoid  fever  has  diminished  from  127,  three  weeks  since, 
to  64.  The  births  for  the  week  amounted  to  1221,  viz.,  560 
males  (411  legitimate  and  149  illegitimate)  and  661  females 
(491  legitimate  and  170  illegitimate).  The  female  births, 
contrary  to  the  normal  rule,  have  greatly  exceeded  the  male 
births  this  week,  and  it  is  possible  that  there  may  be  some 
error  in  the  returns  :  97  infants  were  either  born  dead  or 
died  within  twenty-four  hours,  viz.,  61  males  (43  legitimate 
and  18  illegitimate)  and  36  females  (21  legitimate  and  15 
illegitimate). 


MOLLUSCUM  CONTAGIOSUM  GIGANTEUM. 

Under  this  name  Dr.  S.  Laache,  of  the  Anatomico-Patho¬ 
logical  Institute  of  Christiania,  describes,  in  a  recent  number 
of  the  Nordislct  Mediciniskt  Arkiv,  a  tumour  extirpated  from 
the  nape  of  the  neck  of  a  female,  aged  fifty-six.  This 
tumour,  which  had  lasted  for  thirty  years,  but  had  increased 
considerably  for  the  last  four  years,  was  of  the  size  of  the 
fist,  with  nodulations  or  unequal  protuberances  on  the  sur¬ 
face  ;  it  was  covered  at  its  base  with  normal  skin,  sending 
tongue-like  ramifications  over  the  whole  tumour,  and  which 
were  transformed  at  last  into  a  delicate  membrane,  half  pel¬ 
licular  and  half  granular,  covering  the  whole  mass  except  at 
the  summit,  where  there  was  a  flat  crateriform  depression. 
Under  this  incomplete  covering  there  was  the  mass  of  the 
tumour,  which,  as  it  were,  undulated  against  the  surface. 
The  cut  surface,  equally  composed  of  nuclei  of  unequal  size, 
separated  by  septa  of  cellular  tissue,  presented  a  granular 
aspect,  but  without  the  knife  being  covered  with  adipose 
matters.  Examined  by  the  microscope,  the  lobules  con¬ 
tained,  in  the  circumference,  cellules  evidently  resembling 
epidermis,  while  in  the  centre  were  seen  a  considerable 
quantity  of  corpuscles  with  an  adipose  or  waxy  lustre 
strongly  resembling  amyloid  tissue.  In  all  other  respects 
they  resembled  the  corpuscles  of  molluscum,  with  which  the 
author  compared  them.  In  his  remarks  on  the  case.  Dr. 
Laache  discusses  the  differential  diagnosis  between  mol¬ 
luscum  and  epithelioma  or  cancroid,  to  which  last  the 
tumour  was  at  first  referred.  From  cancroid,  however,  the 
molluscum  in  question  was  distinguished  by  its  definite 
form  and  its  tendency  to  grow  outwards,  besides  by  its 
being  covered  entirely  by  a  kind  of  delicate  skin  without 
any  apparent  ulceration.  It  was,  however,  the  presence  in 


considerable  quantity  of  corpuscles  of  molluscum  which 
determined  the  diagnosis.  The  author  admits,  however, 
that,  as  regards  prognosis,  the  tumour  could  not  be  regarded 
as  being  so  benignant  as  ordinary  molluscum,  and  he  there¬ 
fore  thinks  he  ought  to  consider  it  as  a  transitional  form 
between  the  malignant  epithelial  tumour  and  the  benignant 
one.  He  observes  that  there  was  no  relapse  at  the  end  of 
more  than  six  months.  In  conclusion.  Dr.  Laache  considers 
the  presence  of  nuclei  in  several  of  the  shining  corpuscles 
as  a  proof  in  favour  of  the  opinion  that  the  corpuscles  of 
molluscum  are  the  results  of  a  peculiar  degeneration  of 
pre-existent  epidermic  cellules. 


BRITISH  MEDICAL  SERVICE. 

The  following  is  the  list  of  the  marks  gained  by  Surgeons 
on  probation  in  the  Medical  Department  of  the  British  Army 
at  the  close  of  the  Netley  examination  (August,  1882). 
The  order  of  position  of  these  gentlemen  is  not  affected  by 
marks  they  have  gained  at  the  Netley  examination  : — 


Netley 

Netley 

marks. 

marks. 

1. 

D.  Bruce  .  .  . 

.  2975 

8. 

P.  J.  Gallwey  .  . 

1699 

2. 

H.  C.  Gordon 

.  2320 

9. 

R.  R.  H.  Moore 

2000 

3. 

H.  L.  Bell  .  . 

.  2186 

10.P.J.B.O’Shaughnessyl455 

4. 

J.  Riordan  .  . 

.  2285 

11. 

J.  R.  S.  Robertson 

1965 

5. 

H.  A.  De  Lorn  . 

.  2101 

12. 

A.  E.  Tate  .  .  . 

2050 

6. 

R.  H.  Firth  .  . 

.  2460 

13. 

C.  E.  Faunce  .  . 

1792 

7. 

G.  Nelis  .  .  . 

.  1990 

14. 

W.  H.  Lendrum  . 

2200 

15.  H.  J.  Wyatt  .  .  .  1613  Netley  marks. 


The  first-named  gentleman  gained  the  Montefiore  Second 
Prize. 


PROFESSOR  OWEN,  C.B.,  LL.D.,  F.R.S.,  F.R.C.S. 

The  members  of  our  profession  and  the  public  generally  will 
be  glad  to  hear  that  at  a  meeting  of  the  Council  of  the  Royal 
College  of  Surgeons,  held  on  the  9th  inst.,  the  Honorary 
Gold  Medal  of  the  College  was  unanimously  awarded  to  Pro¬ 
fessor  Owen,  in  recognition  of  his  very  numerous  and  im¬ 
portant  contributions  to  biological  science,  and  of  the 
valuable  services  which  he  rendered  to  the  College  while  he 
was  Conservator  of  the  Museum,  and  Hunterian  Professor  of 
Comparative  Anatomy  and  Physiology.  By  some  this 
honour  may  be  considered  a  somewhat  tardy  recognition  of 
laborious  services,  seeing  that  the  learned  Professor  must  be 
almost,  if  not  quite,  an  octogenarian,  as  he  was  admitted  a 
Member  of  the  College  so  long  ago  as  August,  1826,  and  was 
elected  an  Honorary  Fellow  of  the  College  in  the  first  batch 
of  Members  upon  whom  that  honour  was  confirmed — vis., 
December,  1843.  He  has  done  eminently  good  suit  and 
service  in  the  College,  having  been  elected  Assistant- 
Conservator  of  the  Museum  in  1827 ;  and  Conservator  from 
1842  to  1852,  when  he  retired  on  receiving  the  appointment 
of  Keeper  of  the  Natural  History  Department  in  the  British 
Museum.  He  was  for  some  years  Hunterian  Professor  of 
Comparative  Anatomy  and  Physiology  in  the  College,  to 
which  office  he  was  elected  in  1835.  This  medal  was  esta¬ 
blished  in  1800,  when  it  was  awarded  to  Professor  James 
Wilson,  and  has  only  been  presented  six  times,  the  other 
recipients  of  it  being— Mr.  James  Parkinson,  in  1822 ;  Mr. 
Joseph  Swan,  in  1825;  Dr.  George  Bennett ,  F.R.S.,  in  1834; 
Mr.  William  Lodewyk  Crowther,  F.R.C.S.,  in  1869;  and  Dr. 
Thomas  Bevill  Peacock,  in  1876.  (The  gentlemen  whose 
names  are  printed  in  italics  are  still  living.) 


THE  CONVICT  DR.  GALLAHER.' 

The  Philadelphia  Medical  News  (July  14)  states: — “Dr. 
Thomas  Gallaher  (not  Gallagher,  as  usually  written),  who 
has  recently  received  a  life  sentence  as  one  of  the  leaders 
in  the  dynamite  conspiracy  in  London,  is  a  regularly  edu- 


162 


Medlca'  Times  and  Gazette. 


THE  WEEK. 


August  11, 188S. 


cated  physician,  having  graduated  at  Bellevue  Medical 
College  in  1879.  Soon  after  taking  his  degree  he  made  his 
residence  at  Greenpoint  and  joined  the  King’s  County 
Medical  Society.  His  appearance  was  not  that  of  one  fitted 
for  stratagem  and  conspiracy ;  he  was  quiet  and  retiring  in 
disposition,  apparently.  It  is  generally  believed  that  he  has 
fallen  into  this  distressing  position  on  account  of  the  lot 
falling  to  him  under  the  arbitrary  rule  of .  some  secret 
society  with  whioh  he  had  become  entangled.” 


DISTINCTIONS  TO  ARMY  SURGEONS. 

“  A  Surgeon- General  ”  writes  to  the  Times  of  last  Wednes¬ 
day  to  corroborate  the  statements  that  have  been  made  as  to 
the  unfair  treatment  to  which  medical  officers  in  the  Army  are 
subjected.  We  have  always  deprecated  any  sort  of  pursuit 
of  honorary  titles  by  medical  men  ;  but  there  are  occasions 
when  the  non-bestowal  of  such  titles  becomes  not  merely  an 
injustice  and  a  wrong,  but  a  positive  insult.  Such  a  case 
is  that  related  by  the  Times’  correspondent  in  the  following 

terms: — “Dr.  - ,  C.B.,  Y.C.,  compulsorily  retired,  after 

nearly  forty  years’  service  in  all  parts  of  the  empire,  in¬ 
cluding  the  entire  Crimean  campaign  and  several  cholera 
epidemics ;  was  twice  in  medical  charge  of  an  army  in  the 
field,  and  repeatedly  mentioned  in  despatches,  as  well  as 
specially  recommended  for  some  mark  of  Her  Majesty’s 
approbation  for  distinguished  conduct  in  the  field,  where  he 
was  frequently  under  fire  in  the  execution  of  his  duty,  and 
a  second  time  earned  the  Victoria  Cross  and  received  the 
thanks  of  the  Government  for  special  services ;  has  been 
twice  recommended  by  the  general  officer  under  whom  he 
served  for  promotion  in  the  Order  of  the  Bath,  of  which  he 
has  been  a  C.B.  for  twenty-eight  years;  and,  notwithstanding 
his  services  in  two  subsequent  wars,  is  still,  as  far  as  honours 
are  concerned,  in  the  same  position,  while  his  juniors  in  the 
order  in  all  branches  of  the  Service  have  been  promoted 
over  his  head.  I  venture  to  think  there  is  no  officer  in  any 
other  branch  of  the  Service  whose  claims  have  received  such 
scant  justice,  and  would  suggest  that  some  independent 
member  of  Parliament  should  call  for  the  correspondence  in 
this  and  similar  cases.”  We  commend  the  concluding 
remarks  to  the  notice  of  Sir  Lyon  Playfair,  of  Dr.  Cameron, 
and  of  Sir  John  Lubbock,  whose  constituency  includes  a 
larger  number  of  medical  men  than  that  of  perhaps  any 
other  English  member. 


KAIRIN. 

An  excellent  series  of  clinical  observations  on  the  anti¬ 
febrile  action  of  kairin  has  been  contributed  to  the  Berliner 
Klin.  Woch.,  No.  31,  by  Paul  Guttmann.  The  number  of 
experiments  made  upon  forty-two  patients  was  seventy-two. 
These  included  cases  of  pneumonia,  measles,  phthisis,  typhoid 
fever,  scarlatina,  pleurisy,  peritonitis,  erysipelas,  ague,  and 
septicaemia.  It  is  understood  that  the  experiments  were  only 
made  when  the  fever  in  the  above  diseases  was  present  and 
likely  to  remain  so.  This  principle  was  carried  out  as  far  as 
possible,  and  the  drug  was  administered  in  the  latter  part  of 
the  morning,  and  continued  till  the  end  of  the  afternoon.  In 
the  majority  of  cases  the  temperature  ranged  from  39-5°  to 
40- 5°  Cent,  when  the  experiment  was  commenced.  It  was 
shown  that  kairin,  administered  in  hourly  doses  of  one-half 
to  one  gramme,  was  soon  followed  by  a  gradual  fall  in  the 
temperature  of  the  body:  so  that  in  from  three  to  four 
and  a  half  hours  after  commencement,  in  the  majority 
of  cases,  a  considerable  reduction  had  taken  place,  and 
in  several  the  register  indicated  a  normal  body  heat 
By  repeated  doses  of  a  gramme  of  the  kairin  the  norma, 
temperature  may  always  be  gained— this  is  vouched  for  by 
Filehne  and  Guttmann.  The  course  of  the  downward  curve 


is  sketched.  In  many  patients  a  notable  degree  of  perspira¬ 
tion  was  met  with — especially  in  cases  of  phthisis.  As  the 
temperature  falls  the  pulse  becomes  less  frequent.  No  un¬ 
pleasant  symptoms  were  caused  by  the  kairin,  which  was 
used  freshly  prepared ;  older  specimens  may  give  rise  to 
cyanosis  and  collapse.  The  antipyretic  effect  of  kairin  is 
not  weakened  through  repeated  use ;  each  new  dose  is  fol¬ 
lowed  by  the  usual  result.  Kairin  is  incapable  of  shortening 
the  disease  or  altering  its  phenomena.  Greenish  coloura¬ 
tion  of  the  urine  appears  about  twelve  hours  after  the 
administration  of  the  drug,  and  lasts  generally  for  about 
twenty-four  hours.  A  contrast  is  made  between  the  effects 
of  quinine  and  those  of  kairin.  The  latter  acts  more  rapidly, 
but  is  of  shorter  duration  ;  the  former  is  just  the  opposite. 
Kairin  given  in  hourly  doses  of  one  gramme,  after  the  em¬ 
ployment  of  three  to  four  grammes,  has  a  more^  powerful 
and  constant  anti-febrile  effect  than  quinine  in  doses  of  one 
and  a  half  to  two  grammes.  Owing  to  the  high  price  of  the 
new  remedy,  it  is  probable  that  its  extensive  introduction, 
must  be  postponed. 


INDIAN  MEDICAL  SERVICE. 


The  following  is  the  list  of  Surgeons  on  probation  in  Her 
Majesty’s  Indian  Medical  Service  who  were  successful  at 
both  the  London  and  Netley  examinations  (August,  1883). 
The  final  positions  of  these  gentlemen  are  determined  by 
the  marks  gained  in  London  added  to  those  gained  at  Netley, 
and  the  combined  numbers  are  accordingly  shown  in  the  list 
which  follows  : — 


Combined 

marks. 

1.  J.  M.  Young  .  .  5680 

2.  G.  Jameson .  .  .  5257 

5.  A.  0.  Evans  .  .  . 


Combined 

to  urlrc 

3.  M.  A.  T.  Collie  .  5225 

4.  W.  H.  Quicke  .  4733 
4691  combined  marks. 


The  first-named  gentleman  gained  the  Herbert  Prize,  the 
Martin  Memorial  Gold  Medal,  the  Montefiore  Medal,  and 
the  Parkes  Memorial  Bronze  Medal. 


THE  EISTEDDFOD. 

This  great  Welsh  festival,  which  is  said  by  its  adherents — 
or,  at  all  events,  by  some  of  them — to  date  from  the  fifth 
century,  is  changing  with  the  times.  It  now,  through  the 
Honourable  Cymmodorion  Society,  adds  science,  art,  and 
literature  to  its  programme.  Last  year.  Dr.  Richardson, 
by  invitation  of  the  Council  of  the  Cymmodorion,  opened  the 
proceedings  with  an  address  on  the  subject  of  “  Race  and 
Life  on  English  Soil.”  This  year  he  presides  over  the 
Science  Section,  and  inaugurated  it  on  Thursday  morning, 
in  the  Town  Hall,  Cardiff,  with  a  presidential  address  on. 
“  Science  in  Every-day  Life.” 


COLLECTIVE  INVESTIGATION  IN  GERMANY. 

A  committee  has  been  formed  in  Germany  for  the  purpose 
of  organising  the  collective  investigation  of  disease,  in  a 
manner  analogous  to  that  which,  through  the  initiative  of 
Professor  Humphry,  has  been  adopted  in  this  country.  It 
has  commenced  its  work  by  sending  out,  to  all  qualified 
medical  men,  a  card  of  inquiries  concerning  phthisis.  This 
disease  has  been  chosen  on  account  of  the  great  interest 
excited  by  the  recent  discovery  of  a  supposed  tubercle- 
bacillus.  The  card  concerning  phthisis  contains  four  sets  of 
questions,  which  relate— (1)  to  its  inheritance;  (2)  to  its 
contagiousness  ;  (3)  to  its  curability ;  and  (4)  to  the  passing 
of  pneumonia  into  phthisis.  These  are  preceded  by  a  num¬ 
ber  of  general  questions  concerning  the  case.  The  inquiries 
are  very  detailed,  and,  if  adequately  and  correctly  filled  up, 
a  very  large  body  of  facts  will  be  at  the  disposal  of  the 
committee.  The  committee  consists  of  the  following  names  r 
— Bernhardt,  Blumenthal,  Ewald,  Fraentzel,  Frerichs,  S. 


Medical  Times  and  Gazett*. 


THE  BRITISH  MEDICAL  ASSOCIATION. 


August  II,  1883.  163 


Guttmann,  Jastrowitz,  Kalischer,  Klatsch,  Leyden,  Litten,  D. 
Loewenthal,  W.  Lublinski,  Riess,  F.  Strassmann,  Wernich, 
Zander.  The  secretaries  are  Dr.  S.  Guttmann  and  Dr.  W. 
Lublinski,  of  Berlin. 

THE  DOINGS  OF  THE  METROPOLITAN  ASYLUMS  BOARD. 

At  the  usual  fortnightly  meeting  of  the  Managers  of  the 
Metropolitan  Asylums  Board,  held  on  Saturday  last,  a 
motion  was  considered,  expressing  the  opinion  of  the 
Eastern  District  Hospitals’  Committee  that  an  additional 
fever  hospital  in  the  East-end  of  London  was  necessary,  and 
requesting  the  Local  Government  Board,  should  they  also  be 
convinced  of  such  necessity,  to  authorise  the  Managers  to 
take  the  necessary  steps  in  the  matter.  The  Board,  after  a 
long  discussion,  decided  to  adopt  the  motion.  The  General 
Purposes  Committee  was  also  empowered  to  elaborate  a 
scheme  for  the  provision  of  such  hospital  buildings,  upon 
land  about  to  be  acquired  at  Darenth,  as  would  form  the 
nucleus  of  accommodation  for  1000  convalescent  small-pox 
patients ;  and  upon  the  recommendation  of  this  Committee 
it  was  decided  to  apply  to  the  Local  Government  Board 
for  power  to  raise  upon  loan  the  sum  of  .£10,000,  the 
estimated  cost  of  converting  the  Castalia  into  a  floating 
hospital  for  the  reception  and  treatment  of  small-pox 
patients.  The  returns  from  the  small-pox  asylums  showed 
that  during  the  fortnight  10  patients  had  been  ad¬ 
mitted,  18  had  been  discharged,  45  remained  under  treat¬ 
ment,  and  there  were  177  beds  available.  Compared  with 
the  returns  of  the  previous  fortnight,  these  figures  showed 
a  decrease  in  the  total  number  remaining  under  treatment 
of  8.  The  returns  from  the  fever  hospitals  showed  that 
during  the  fortnight  96  patients  had  been  admitted,  8  had 
died,  49  had  been  discharged — leaving  347  still  under  treat¬ 
ment,  and  524  beds  available.  These  figures  give  an  increase 
in  the  total  number  remaining  under  treatment,  as  compared 
with  the  preceding  fortnight,  of  35.  The  347  cases  under 
treatment  were  composed  of  296  scarlet-fever  patients  and 
51  enteric-fever  patients. 


In  answer  to  a  question  from  Sir  Trevor  Lawrence,  in  the 
House  of  Commons,  on  Monday,  Mr.  Gladstone  said  that  it 
is  undoubtedly  the  intention  of  the  Government  to  proceed 
with  the  Medical  Act  Amendment  Bill.  It  had  come  down 
from  the  House  of  Lords,  and  precedence  was  given  to  other 
Bills ;  hence  the  delay  in  proceeding  with  it. 

In  view  of  the  possibility  of  an  outbreak  of  cholera  in 
Paris,  the  City  Municipal  Council  have  voted  480,000  fr. 
for  the  erection  of  wooden  buildings  in  the  bastions  of  the 
fortifications,  to  serve  as  hospitals.  Ultimately,  these  will 
be  used  for  patients  suffering  from  other  contagious  diseases. 

The  Woolwich  Board  of  Guardians  has  increased  the 
medical  fees  for  lunacy  cases  from  ten  to  twenty  shillings. 

A  sad  event  happened  on  Saturday  last,  at  Normansfield, 
Hampton  Wick.  Lieutenant  Everleigh  Down,  the  eldest  son 
of  Dr.  Langdon  Down,  accidentally  wounded  himself  in  the 
thigh  with  a  chisel.  In  spite  of  all  that  could  be  done  to 
arrest  hemorrhage,  he  died  the  same  evening.  We  are  sure 
that  the  profession  will  deeply  sympathise  with  Dr.  and 
Mrs.  Langdon  Down  in  their  heavy  bereavement. 

We  regret  to  see  announced  the  death  of  Professor  Parrot, 
of  Paris.  He  is  known  to  fame  by  his  writings,  chiefly  upon 
the  subject  of  children’s  diseases.  It  will  be  remembered 
that  a  few  years  ago  he  demonstrated  before  the  Patho¬ 
logical  Society  of  London,  during  the  presidency  of  Mr. 
Jonathan  Hutchinson,  the  osseous  lesions  which  he  had 
found  in  cases  of  hereditary  syphilis. 


ANNUAL  MEETING  OF  THE  BRITISH 
MEDICAL  ASSOCIATION. 


( From  our  Special  Correspondent.) 

Liverpool,  August  4. 

The  second  general  meeting  was  held  on  Wednesday  morn¬ 
ing  :  the  business  was  formal  and  brief.  The  President  of 
the  Council  read  out  the  names  of  those  who  had  been, 
elected  to  serve  on  the  Committee  of  Council,  and  then 
stated  that,  in  response  to  a  very  cordial  invitation  from  the 
profession  at  Belfast,  the  next  meeting  would  be  held  there,, 
and  he  moved  that  Dr.  Cuming  be  nominated  President¬ 
elect.  This  was  carried  by  acclamation.  The  Address  in 
Surgery  followed  (which  has  already  appeared  in  these 
columns  in  full). 

An  important  though  scanty  meeting  of  Volunteer  Sur¬ 
geons  was  held,  at  which  Surgeon-Major  Parsons  pre¬ 
sided.  Surgeon-Major  Evatt  read  a  paper  on  Volunteer 
Medical  Organisation.  He  contended  that  if  the  Volunteer 
Medical  Service  was  to  be  worth  anything  at  all  it  must  be 
properly  organised,  should  have  its  own  uniform,  and 
undergo  a  systematised  course  of  instruction.  He  recom¬ 
mended  that,  besides  being  attached,  as  at  present,  to  regi¬ 
ments,  they  should  be  organised  into  a  department  resem¬ 
bling  that  of  the  regular  Army,  and  wear  a  similar  uniform. 
Doubtless,  some  such  organisation  will  become  incumbent' 
on  the  Volunteer  Medical  Service ;  and  the  Government 
would  do  well  to  encourage  it  warmly.  The  regular  Medical 
Department  is  much  too  small  to  meet  the  requirements  of 
active  military  service,  and  they  are  compelled  to  accept  the 
help  of  anyone  who  volunteers.  If  a  Volunteer  Medical 
Department  of  properly  trained  men,  accustomed  to  disci¬ 
pline,  and  from  which  they  could  select,  were  at  their  dis¬ 
posal  in  war  time,  the  advantages  to  the  Army  would  prove 
of  the  highest  importance  and  value.  Militia  Surgeons  also 
held  a  meeting  to  discuss  their  own  concerns,  and  chiefly 
their  grievance  about  the  retiring  pension  on  reaching  the 
age  of  sixty-five  years,  which  an  Act  of  Parliament  of 
George  II.  allows  them,  and  which  has  lately  been  dis¬ 
allowed,  although  the  Act  has  never  been  repealed.  A 
third  general  meeting,  which  subsequently  resolved  itself 
into  an  extraordinary  meeting,  was  held  on  Thursday,  at 
which  the  proposed  alteration  in  the  by-laws  and  in  the 
articles  of  association  were  further  discussed  and  agreed 
upon.  With  a  view  to  meet  certain  technical  details,  the 
resolutions  will  have  to  be  confirmed  at  a  second  statutory- 
extraordinary  general  meeting,  and  this  it  was  decided  to 
hold  in  London  on  the  17th  inst.,  when  the  new  by-laws,  to 
which  I  alluded  in  my  last  letter,  will  actually  become  law, 
though  they  do  not  come  into  force  until  the  annual  meeting 
next  year.  This  being  settled,  some  further  ordinary  business 
was  transacted.  The  most  important  of  this  referred  to  the 
work  of  the  Collective  Investigation  Committee.  The  report 
showed  that  some  seven  subjects  are  under  consideration — ■ 
the  communicability  of  phthisis  ;  acute  pneumonia,  its  epi¬ 
demic  prevalence,  communicability,  and  association  with 
other  diseases  ;  chorea ;  rheumatism ;  diphtheria  ;  and  syphilis 
— truly  a  goodly  list.  Votes  of  thanks  to  the  various  sub¬ 
committees  who  are  engaged  in  analysing  these  reports  were 
passed.  I  am  pleased  to  be  able  to  say  that  ithas  been  decided 
to  pay  these  gentlemen  for  their  services.  The  reports,  if  they 
are  to  be  worth  anything,  will  necessitate  a  vast  amount  of 
work,  and  it  would  hardly  be  fair  to  expect  those  who 
undertake  it  to  do  so  without  some  remuneration.  Of  all  their 
work  which  the  Association  has  at  present  initiated,  there 
is  none,  in  my  opinion,  equal  in  importance  to  this.  Our 
American  and  also  our  continental  brethren  have  started  a 
similar  work,  and  it  is  modelled  on  the  plan  laid  down  by 
the  Association.  It  may  be  hoped,  therefore,  that  real  good 
will  result  in  the  course  of  time..  I  trust,  however,  that  the 
Committee  will  not  be  led  to  hurry  these  investigations,  on 
the  false  principle  of  having  something  to  show  for  the 
money  which  must  be  spent  out  of  hand  in  setting  the 
investigations  a-going. 

On  Friday  morning  the  third  and  last  of  the  addresses-in- 
chief  was  delivered  before  a  large  and  interested  audience 
by  Dr.  Creighton.  I  shall  not — especially  as  I  cannot 
agree  with  him  in  his  arguments — attempt  offhand  a 


164 


Medical  Times  and  Gazette. 


THE  BRITISH  MEDICAL  ASSOCIATION. 


August  11,  1883. 


resume  of  an  address  which  was  so  obviously  the  outcome  of 
much  thought  and  research.  Following  on  the  lines  of  his 
■observations  as  to  the  nature  of  cancer,  he  argued  that  the 
specific  fevers  are  but  “  modifications  of  healthy  states, 
deviations  from  the  beaten  track,  perturbations  of  the 
normal  life,  or  shortcomings  of  the  physiological  standard.” 
The  Scientific  Grants  Committee  presented  their  report 
for  the  past  year.  They  also  propose  a  very  important  new 
departure,  viz.,  that  with  a  view  to  more  effectual  and  larger 
encouragement  of  scientific  medical  research  two  scholar¬ 
ships,  of  the  annual  value  of  .£150,  be  founded.  They  are 
to  be  tenable,  at  the  discretion  of  the  Committee,  for  three 
years.  They  reported  also  that  a  fully  equipped  physiolo¬ 
gical  laboratory  had  been  placed  at  their  service,  but  that 
they  had  not  yet  had  time  to  consider  this  proposal.  It  was 
thought  its  acceptance  would  involve  the  Association  in  an 
expenditure  of  about  £400  per  annum.  The  reports  of  the 
Medical  Reform  Committee,  of  the  Parliamentary  Bills 
Committee,  of  the  Habitual  Drunkards  Committee,  were  all 
read  and  approved,  and  formal  votes  of  thanks  to  all  those 
who  had  contributed  to  the  success  and  pleasure  of  the  Liver¬ 
pool  meeting  brought  the  business  of  the  meeting  to  a  close. 

I  will  now  try  and  give  a  bird’s-eye  view  of  the  medical 
work  which  was  done.  This,  as  you  know,  was  subdivided 
into  ten  sections.  Subjects  of  interest  were  selected  for 
■special  discussion  in  nearly  all  the  sections  ;  and,  on  their 
conclusion,  papers  of  general  interest  were  read.  I  am  bound 
to  say  that  the  former  attracted  the  larger  share  of  atten¬ 
tion.  In  the  Medicine  Section,  Wednesday  was  devoted  to  the 
consideration  of  papers  on  the  Nervous  System.  Dr.  Gairdner 
commenced,  by  reading  an  elaborate  paper  on  Aphasia,  which 
occupied  a  considerable  part  of  the  sitting.  Drs.  Jackson, 
Broadbent,  Drummond,  Ireland,  Allbutt,  Wahltuch,  and 
others  took  part.  Subsequently,  Dr.  Broadbent  opened  up 
the  subject  of  Arterial  Tension,  and  drew  attention  to  its 
•causes  and  consequences.  Later  on,  papers  on  Phthisis  and 
other  lung  diseases  were  read;  and  on  the  Friday,  Dr.  Stephen 
Mackenzie  discussed  the  nature  of  Purpura  in  an  able  and 
suggestive  paper,  of  which  the  following  is  a  brief  abstract :  — 
He  thought  all  would  agree  with  him  that  the  nosological 
position  of  purpura  was  unsatisfactory.  If  in  a  case  the  cause 
was  known,  or  there  were  definite  concomitants,  it  was  looked 
Tupon  as  symptomatic ;  whilst  of  so-called  genuine  or  idio¬ 
pathic  purpura  little  or  nothing  was  understood.  The  first 
question  he  would  ask  was,  “  Are  there  any  pathological 
changes  peculiar  to,  or  characteristic  of,  purpura  which 
connect  the  cases,  presenting  the  clinical  features  of  this 
disease,  by  such  a  tie  as  to  give  them  a  close  relationship, 
however  dissimilar  some  of  their  features  ?  ”  He  then  pro¬ 
ceeded  to  review  what  is  known  of  the  conditions  of  the 
blood,  bloodvessels,  and  vessel- regulating  mechanism, in  cases 
of  purpura ;  and  considered  that,  whilst  there  are  proved  or 
probable  alterations  in  the  blood,  bloodvessels,  and  nervous 
system  in  certain  cases,  no  one  of  these  is  sufficiently  constant 
to  unite  all  forms  of  purpura  in  such  a  way  that  we  can  re¬ 
gard  them  as  different  varieties  only  of  one  common  process ; 
and  as  there  is  no  etiological  factor  common  to  them,  he  con¬ 
cluded  that  we  cannot  assign  to  purpura  the  position  of  a 
clinical  entity.  The  next  question  he  asked  was,  “Is  the 
haemorrhage  that  is  the  one  characteristic  of  purpura  an 
isolated  phenomenon,  or  do  we  not  see  haemorrhage  asso¬ 
ciated  with  various  other  morbid  processes  going  on  in  the 
skin  and  elsewhere  ?  ”  In  this  connexion  he  discussed 
briefly  purpura  papillosa,  purpura  urticans,  haemorrhagic 
herpes  and  pemphigus,  erythema,  etc.  For  his  part  he 
looked  upon  purpura  in  all  cases  as  a  symptom,  not  of  one 
but  of  various  morbid  states.  This  view  had  the  advantage 
that  when  encountered  we  have  in  purpura,  as  in  oedema, 
jaundice,  etc.,  to  endeavour  to  trace  its  cause  or  explain  its 
meaning.  After  some  remarks  as  to  influences  combining 
to  produce  purpura,  he  passed  on  to  say  that,  regarding 
purpura  as  a  symptom,  it  was  still  useful  to  attempt  an 
■arrangement  of  the  cases  in  which  it  occurred.  He  alluded 
to  a  classification  proposed  .by  Dr.  Du  Castel,  but  himself 
suggested  the  following  arrangement : — 1.  Hsemic  purpura. 
2.  Toxic  purpura.  3.  Mechanical  purpura.  4.  Neurotic 
purpura.  Under  the  head  of  hsemic  purpura  he  would  place  all 
cases  in  which  there  is  some  known  or  supposedblood  disorder, 
as  the  specific  fevers,  idiopathic,  splenic,  and  other  forms  of 
anaemia,  leucocy thaemia,  scurvy,  jaundice,  etc.  In  the  category 
of  toxic  purpura  (drug  purpura)  he  would  place  all  cases 
in  which  purpura  arises  from  adventitious  matters  entering 


the  system.  Though  such  matters,  no  doubt,  entered  the 
blood,  we  do  not  know  in  many  cases  whether  they  act 
directly  through  the  blood,  through  the  nervous  system, 
or  in  some  other  manner.  Besides,  etiologically,  they  are 
so  distinct  that  it  is  advantageous  to  separate  them  from 
class  1.  Under  purpura  from  mechanical  causes  he  would 
place  that  arising  in  connexion  with  feeble  circulation,  pur¬ 
pura  from  varicose  veins,  paroxysms  of  coughing,  thrombosis 
of  venous  trunks,  and  (probably)  senile  purpura.  In  the 
category  of  neurotic  purpura  he  would  place  all  cases  in 
which  the  nervous  system  is  primarily  at  fault,  as  tabetic 
purpura,  purpura  in  connexion  with  disease  of  the  central 
nervous  system  and  neuralgia,  purpura  urticans,  and  neurotic 
eruptions  becoming  haemorrhagic. 

In  my  last  letter  I  briefly  mentioned  the  discussion  on  the 
treatment  of  Intestinal  Obstruction.  Mr.  Rushton  Parker 
led  off,  and  was  followed  by  Dr.  Waters,  Mr.  Morgan,  Sir 
Spencer  Wells,  Mr.  Gould,  and  many  others.  The  value  of 
Plaster-of-Paris  Bandages  in  the  treatment  of  recent  frac¬ 
tures  was  introduced  by  Mr.  Heath;  while  Mr.  Croft 
demonstrated  a  ready  mode  of  applying  them.  On  Thurs¬ 
day  afternoon  the  discussion  on  Surgical  Diseases  of  the 
Kidney,  and  the  operations  for  their  relief,  was  opened  by 
Mr.  Clement  Lucas.  The  following  is  an  abstract  of  the 
paper.  His  contention  was  that  all  one-sided  disease  was 
amenable  to  surgical  treatment.  He  commenced  by  allud¬ 
ing  to  the  new  interest  which  was  awakened  in  these 
diseases  by  Professor  Simon,  of  Heidelberg,  and  spoke  of 
the  rapid  growth  and  recognition  of  renal  surgery  as 
the  most  remarkable  occurrence  of  this  decade.  Casting 
a  glance  over  the  various  diseases  of  the  kidney,  he  said  it 
was  evident  that  those  affections  which  attack  equally  the 
two  organs  (such  as  the  various  degenerations  included 
under  the  generic  term  of  Bright’s  disease)  must  ever 
remain  outside  the  province  of  surgery,  but  most  of  the 
diseases  which  were  unilateral  would  be  found  to  lie  within 
the  region  of  surgical  relief.  Painful  movable  or  floating 
kidney  was  a  disturbance  of  a  mechanical  nature,  only  to  be 
treated  by  mechanical  means.  Probably,  simple  exploration 
through  the  loin,  and  replacement  of  the  kidney  in  position, 
would  be  found  sufficient  to  cure  the  greater  number  of 
cases;  the  adhesion  resulting  from  the  healing  process  serving 
to  bind  the  kidney  in  position.  A  slightly  severer  operation 
was  that  of  Dr.  Hahn,  called  nephroraphy,  which  consisted 
in  exposing  the  kidney  through  the  loin,  and  stitching  its 
capsule  to  the  margins  of  the  wound.  Eight  cases  in  which 
this  has  been  performed  recovered  and  were  relieved. 
There  might  still  be  cases  where  the  symptoms  were  of 
a  severe  character,  or  where  other  means  had  failed 
which  would  justify  nephrectomy.  Martin,  of  Berlin, 
had  extirpated  six  floating  kidneys,  operating  each  time 
through  the  peritoneum ;  four  were  cured  and  two  died. 
Hydronephrosis  was  another  affection  which  admitted  of 
surgical  relief.  After  discussing  the  origin  of  the  two 
forms,  congenital  and  acquired,  the  author  advised  first 
aspiration,  then  tapping  and  drainage  through  the  loin,  the 
cyst  being  exposed  and  its  edges  being  stitched  to  the 
margins  of  the  wound.  Should  the  sinus  fail  to  close,  the 
contracted  cyst  might  be  excised  through  the  loin.  These 
cases  had  been  mistaken  for  ovarian  tumours,  and  operated 
upon  as  such.  Some  might  think  it  advisable  to  remove 
these  dilated  kidneys  by  abdominal  section,  but  the  plan 
recommended  was  safer.  Isolated  cysts  of  the  kidney  should 
be  aspirated,  and,  this  failing,  should  be  drained  through 
the  loin.  The  kidney  structure  was  not  diseased,  except  by 
pressure.  Hydatids  of  the  kidney  were  rare,  and  had  a 
tendency  to  discharge  through  the  pelvis.  Aspiration  or 
syphon-tapping  was  usually  sufficient  to  effect  a  cure. 
Pyonephrosis,  which  resembled  hydronephrosis  anatomi¬ 
cally,  but  contained  pus  instead  of  watery  fluid,  if  one¬ 
sided,  was  to  be  relieved  by  surgical  means.  The  double 
pyelitis,  with  distension  and  suppuration  resulting  from 
stricture,  enlarged  prostate,  and  calculus,  was  inappro¬ 
priately  named  “surgical  kidney.”  He  suggested  the  term 
“  reflux  ”  pyelitis  would  better  express  this  condition.  When 
pyonephrosis  existed  on  one  side  only  there  was  some 
obstruction  to  the  ureter.  Calculus  and  strumous  pyelitis 
were  frequent  causes  of  one-sided  pyonephrosis.  Pyo- 
nephrotic  tumours  had  been  successfully  removed  by  abdo¬ 
minal  section,  but  the  risk  of  drawing  out  a  bag  of  pus 
through  the  peritoneal  cavity  was  such  that  the  author  could 
not  recommend  this  proceeding.  He  advised  that  the  abscess- 


Medical  Times  and  Gazette. 


THE  BRITISH  ]VIEDICAL  ASSOCIATION. 


August  11, 1883.  1 65 


cavity  should  first  be  opened  through  the  loin,  disinfected, 
and  drained,  which  would  be  sufficient  to  cure  a  large 
number.  Should  a  sinus  remain,  the  kidney  might  be  excised 
through  the  loin.  In  this  case  the  capsule  should  be  left 
behind,  otherwise  the  peritoneum  or  colon  was  liable  to  be 
torn  open  in  endeavouring  to  separate  the  adhesions.  Out 
of  twenty-eight  cases  in  which  nephrectomy  had  been  per¬ 
formed  for  pyonephrosis  there  had  been  seventeen  recoveries 
and  eleven  deaths;  but  it  was  a  thing  most  worthy  of  note 
that  in  six  of  these  cases  the  abscess-cavities  had  previously 
discharged  themselves  through  the  loin,  and  all  these  six 
recovered.  Calculus  of  the  kidney  would  most  often  suggest 
operation.  The  diagnosis  was  the  chief  difficulty.  Strumous 
kidneys  would  be  often  explored  on  the  supposition  of 
calculus,  but  antiseptic  exploration  through  the  loin  was  a 
trivial  operation,  the  wound  healing  primarily  without 
rise  of  temperature.  Two  cases  explored  by  the  author 
were  quoted  in  illustration.  Several  cases  of  nephro-litho- 
tomy  were  published  in  the  Clinical  Society’s  Transactions, 
and  the  operation  had  been  twice  successfully  performed 
in  Guy’s  Hospital  during  the  present  year.  Neoplasms 
of  the  kidney,  when  large,  would  have  to  be  removed 
through  the  peritoneum.  In  these  cases,  Langenbuch’s 
excision  on  the  outer  edge  of  the  rectus  was  the  best. 
Inj  uries  to  the  kidney,  though  not  included  under  the  title 
of  this  paper,  were  alluded  to  as  occasionally  suggesting 
nephrectomy.  After  entering  into  details  on  certain  points 
in  the  operations,  the  author  said  a  combination  of  two  in¬ 
cisions  (which  he  had  employed)  would  be  found  to  give  the 
most  room  when  operating  through  the  loin — viz.,  an 
oblique  incision  parallel  with  the  last  rib,  higher  than  the 
colotomy  incision,  within  about  half  an  inch  of  the  rib ;  and 
a  vertical  incision  on  the  outer  edge  of  the  quadratus 
lumborum,  commencing  at  the  upper  edge  of  the  last  rib,  and 
extending  to  the  iliac  crest.  In  conclusion,  he  urged  that 
antiseptic  exploration  of  the  kidney  through  the  loin  was  a 
simple  and  not  at  all  a  dangerous  operation,  which  may  be 
undertaken  without  anxiety  in  any  case  where  a  calculus  is 
suspected ;  that  it  is  generally  safer  to  tap  and  drain  fluid 
tumours  before  proceeding  to  remove  them;  that,  when 
nephrectomy  is  decided  upon,  the  extraperitoneal  operation 
through  the  loin  should  always  be  chosen  for  any  tumour  it 
is  possible  to  withdraw  through  the  limited  space  at  dis¬ 
posal  ;  finally,  if  this  course  be  adopted,  the  transperitoneal 
operation  will  be  reserved  for  large  solid  tumours,  and 
perhaps  some  floating  kidneys. 

Many  other  papers  of  interest  were  also  read.  Among 
them  may  be  mentioned  one  by  Mr.  Malcolm  Morris  on  the 
advantages  of  Scarification  over  Scraping  in  the  Treatment 
of  Lupus  ;  and  one  on  the  Removal  of  the  Tongue,  by  Mr. 
Morrant  Baker. 

In  the  Section  of  Children’s  Diseases,  Dr.  Gee  opened  the 
proceedings  by  a  brief  review  of  the  earliest  literature  on 
this  subject.  It  appeared  to  be  very  scant;  only  one  or  two 
works  being  of  any  consequence,  or  held  in  any  estimation 
at  the  present  time — of  these  Glisson’s  “  De  Rachitide  ” 
was  by  far  the  most  important.  Dr.  Gee  thought  one  fact 
stood  out  more  prominently  than  any  other,  viz.,  this  :  that 
none  of  his  authors  appeared  to  have  been  a  specialist. 
He  congratulated  himself  on  being  connected  with  an  adult 
as  well  as  a  children’s  hospital,  and  believed  that  his  know¬ 
ledge  of  children’s  diseases  was  more  extensive  in  conse¬ 
quence.  Dr.  Barlow  opened  a  discussion  on  Rheumatism 
and  its  allies;  he  took  a  broad  view  of  the  subject,  and 
directed  attention  to  the  less  serious  sequels  as  very  im¬ 
portant.  Dr.  Ashby  followed  with  a  paper  on  Scarlatinal 
Rheumatism,  contending  that  the  symptoms  were  those  of 
pyaemia  rather  than  true  rheumatism.  The  discussion 
occupied  the  whole  afternoon.  Dr.  Ballard  introduced  the 
subject  of  Infantile  Diarrhoea — truly  a  very  important 
and  pressing  subject  just  at  the  present  time.  Dr.  Gee 
also  contributed  a  suggestive  paper  on  Albuminous  and 
Purulent  Urines  in  Children.  The  moral  was,  always  to 
examine  the  urine  when  any  severe  but  obscure  symp¬ 
toms  developed  themselves.  Dr.  Bury  read  a  case  of 
Osteomalacia  in  a  child.  The  signs  of  ordinary  rickets 
were  almost  entirely  absent.  The  author  seemed  to  regard 
the  case  as  true  osteomalacia,  and  identical  with  the  dis¬ 
ease  as  seen  in  adults.  Mr.  Baker  opened  a  discussion  on 
Epiphysial  Necrosis  and  its  consequences.  He  said  that 
he  would  confine  his  remarks  to  the  subject  of  inflamma¬ 
tion  and  necrosis  of  the  epiphyses  of  long  bones  and  the 


neighbouring  tissue,  leaving  out  of  consideration,  however, 
their  inflammatory  or  other  conditions  which  are  the  result 
of  specific  diseases — as  rickets,  syphilis,  or  scurvy.  He 
suggested  the  following  as  suitable  points  for  discussion :  — 

1.  The  frequency  of  acute  inflammation  and  suppuration 
within  joints  (especially  the  knee-joint)  as  a  result  of  necrosis 
of  an  epiphysis,  or  the  bony  texture  in  its  neighbourhood. 

2.  The  good  result  of  free  incision  into  the  joint  with  efficient 
drainage.  3.  The  simulation  of  necrosis  of  the  shaft  of  a 
long  bone  by  tracking  of  pus  beneath  its  periosteum  for 
some  distance  from  its  origin,  in  disease  of  an  epiphysis* 
4.  The  frequency  with  which  necrosis  of  the  epiphysis  of 
the  head  of  the  femur  is  the  cause  of  hip-joint  disease ;  and 
the  special  propriety  of  excision  at  a  later  stage  in  such 
cases.  5.  The  difficulties  in  regard  to  diagnosis  in  cases  of 
disease  of  an  epiphysis,  attended  by  secondary  inflammation 
of  the  neighbouring  joint,  but  without  direct  communication 
between  the  abscess  in  the  epiphysis  and  the  interior  of  the 
joint.  6.  The  relation  between  subperiosteal  suppuration 
and  necrosis. 

In  the  Pathological  Section,  Dr.  T.  H.  Green’s  opening 
address  chiefly  had  reference  to  the  Pathology  of  Phthisis — 
the  relationship  of  germs  as  causes,  and  the  social  questions 
which  naturally  arise  out  of  this.  Dr.  Dreschfeld  opened  a 
special  discussion  on  Micro-organisms.  He  contended  that 
in  some  cases  the  organisms  were  clearly  the  fons  et  origo  of 
disease,  while  in  others  they  only  appeared  to  develope  in 
the  course  of  disease.  Mr.  Symonds  opened  a  discussion  on 
Chronic  Inflammations  in  Bone.  A  reference  to  the  sub¬ 
joined  abstract  will  show  how  he  considers  that  the  bone- 
substance  remains  passive  under  all  circumstances,  while 
the  periosteum  is  the  source  of  the  diseased  process  : — 
The  author  first  explained  that  the  paper  had  arisen  out 
cf  a  study  of  thickened  bones  found  in  museums,  and  the 
object  was  to  inquire  into  the  causes  which  led  to  this 
change,  and  to  single  out  from  the  numerous  examples 
variously  described  as  hyperostosis,  osteoporosis,  hyper¬ 
trophy,  etc.,  such  as  could  be  unmistakably  referred  to 
recognised  causes,  and  to  use  the  information  thus  acquired 
for  the  elucidation  of  the  more  obscure  affections.  In 
order  to  facilitate  the  inquiry,  the  long  bones  were  first 
considered ;  afterwards  those  of  the  cranium.  Amongst 
causes  in  the  first  group,  chronic  simple  inflammation 
was  taken  as  the  most  frequent,  and  the  manner  in 
which  enlargement  was  brought  about  was  explained* 
Reasons  were  stated,  .in  support  of  the  view  that  all 
increase  in  diameter  was  due  to  a  surface  addition  from 
the  periosteum,  in  opposition  to  the  generally  received 
opinion  that  a  bone  could  be  also  enlarged  from  expansion. 
Copies  of  Mr.  Stanley’s  drawings,  plates  from  Sir  James 
Paget’s  work  on  Pathology,  and  specimens  from  the  museum 
at  Guy’s  Hospital  (kindly  furnished  by  the  curator.  Dr. 
Goodhart)  were  used  to  illustrate  the  subject.  The  dis¬ 
appearance  of  the  compact  tissue  was  explained  as  due  to  its 
cancellation  from  osteitis,  or  to  its  physiological  remodelling 
as  a  consequence  of  having  become  embedded  by  new  bone.  It 
was  urged  that  the  use  of  the  term  “  expansion,”  as  applied  to 
the  effect  of  inflammation  in  bone,  was  misleading,  and  based 
upon  an  incorrect  interpretation  of  the  appearances  found... 
The  causes  leading  to  enlargement  in  long  bones  were  stated 
to  be — 1.  Chronic  inflammation  due  to  syphilis,  struma,  and 
irritation  from  a  sequestrum.  2.  Chronic  congestion,  and 
subsequently  chronic  inflammation,  of  the  periosteum  under 
an  ulcer ;  and,  as  coming  under  the  same  heading,  the  en¬ 
largement  occurring  in  chronic  oedema,  as  in  obstructed 
lymphatics,  and  in  the  elephantoid  condition  seen  in  the  leg.. 
‘3.  Hypertrophy.  This,  it  was  suggested,  accounted  for  but 
few  examples,  except  those  of  elongation ;  and  this  effect 
was  suggested  as  due  rather  to  an  epiphysial  overgrowth* 
4.  Osteitis  deformans.  This  disease,  it  was  thought,  differed 
from  common  inflammation  in  the  mode  in  which  it  produced 
its  effects,  and  was  suggested  as  owning  a  method  of  increase 
peculiarly  its  own.  It  was  suggested  that  no  specimens  could 
be  attributed  to  the  effect  of  rickets  or  osteomalacia. 
The  various  forms  of  thickened  crania  were  divided  into 
four  groups.  In  the  first  were  placed  those  with  a  normal 
structure,  but  thick ;  the  external  and  internal  tables  thin, 
and  distinct.  Specimens  considered  by  Paget  to  illustrate 
concentric  hypertrophy,  but  suggested  as  representing  either 
the  adult  rachitic  skull  or  one  in  which  early  closure  of  the 
sutures  occurred  from  an  arrested  growth  of  the  brain.  In 
the  second,  the  skull  found  in  osteitis  deformans.  So  far  as 


166 


Medical  Times  and  Gazette. 


ARMY  MEDICAL  SCHOOL,  NETLEY. 


August  11,  1883. 


tgS,1  1  -  ■  '■  ,  ■  - 

is  known,  this  is  the  only  disease  leading  to  the  production 
of  the  appearances  found.  Reasons  were  given  for  denying 
that  osteomalacia  ever  produced  such  appearances,  and  it 
was  suggested  that  in  these  cases  the  thickening  of  the  skull 
was  a  coincidence  of  a  normally  thick  skull  with  osteomalacia. 
In  the  third  group  were  placed  those  thick  skulls  of  greater 
density  than  any  of  the  preceding,  and  showing  besides 
nodular  outgrowths  on  the  inner  table.  In  the  last,  those 
associated  with  a  similar  change  in  the  facial  bones,  and 
known  as  leontiasis  ossea.  To  this,  it  was  suggested,  Mr. 
Bickersteth’s  specimens  probably  belonged. 

I  have  not  nearly  exhausted  the  list  yet — but  I  have 
already  far  exceeded  the  limits  of  a  letter.  It  will  be  seen 
that  work  is  the  order  of  the  day  at  these  annual  meetings. 
I  only  regret  my  inability  to  have  been  in  all  the  sections  at 
the  same  time. 

After  the  serious  part  of  the  work  was  concluded,  a 
day  was,  as  usual,  devoted  to  pleasure.  Excursions  to 
Chester  and  Eaton  Hall,  to  Conway  and  Llandudno,  to 
Southport  and  Blackpool,  and  to  Lancaster,  offered  a 
pleasing  variety  of  attractions.  Some  excursions,  I  believe, 
attracted  larger  numbers  of  visitors  than  had  been  arranged 
for,  but  all  who  went  found  themselves  welcome.  They 
were  conceived  in  admirable  spirit,  and  it  was  the  more  to 
be  regretted,  therefore,  that  the  details  of  carrying  them  out 
were  in  some  respects  faulty.  There  was  a  want  of  punc¬ 
tuality,  as  well  as  a  general  deficiency  of  oversight  and  leader¬ 
ship,  which  made  itself  especially  felt  on  starting.  Thus, 
in  one  of  the  river  excursions,  owing  to  the  want  of  punc¬ 
tuality,  the  tide  had  run  out  so  far  that  the  steamer  could  not 
get  into  dock,  and  the  announced  object  of  the  party  was 
defeated.  I  do  not  refer  to  this  in  any  ungrateful  spirit,  but  in 
the  hope  that  in  future  excursions  punctuality  will  be  insisted 
upon  if  a  few  visitors  who  are  unpunctual  are  left  behind,  this 
will  be  better  than  to  disappoint  the  whole  party.  I  regret 
to  find  that  an  accident  occurred  in  connexion  with  the 
•Conway  excursion.  Some  men  who  were  about  to  welcome 
the  party  with  a  feu  de  joie  on  their  arrival  at  Conway  got 
seriously  damaged.  In  attempting  to  reload  the  cannon 
while  it  was  still  hot  the  powder  exploded.  One  man  lost 
bis  arm,  and  another  his  sight  in  part,  while  others  were 
less  seriously  injured.  The  visiting  party  subscribed  forty 
guineas  towards  their  immediate  wants.  The  weather 
during  the  whole  meeting  was  simply  charming,  and  added 
much  to  the  pleasure  of  this  very  successful  meeting. 


Contusions  of  the  Brain.— Dr.  Lidell,  late  Surgeon 
ho  Bellevue  Hospital,  in  an  elaborate  practical  paper  upon 
this  subject  in  the  July  number  of  the  American  Journal  of 
the  Medical  Sciences,  discusses  this  large  and  very  important 
■class  of  injuries.  While  much  is  said  in  our  text-books 
on  the  subject  of  cerebral  concussion — of  its  dangers  and 
importance — but  small,  if  any,  mention  is  made  of  the  con¬ 
tusions  of  the  brain,  which  so  very  often  complicate  the 
concussions,  and  impart  to  them  whatever  of  gravity,  be  it 
much  or  little,  that  they  possess.  And  still  less  mention  is 
made  of  contusions  of  the  spinal  cord.  Ho  wonder,  then,  that 
bruises  of  the  brain-structure  and  spinal-cord  substance 
occur  much  more  frequently  than  is  generally  supposed, 
that  the  relationship  which  exists  between  these  injuries 
nnd  concussion  is  not  well  understood,  and  that  the  bruises 
of  those  organs  often  escape  even  all  suspicion  during  life. 
That  slight  or  even  moderate  concussion  of  the  brain  some¬ 
times,  perhaps  not  infrequently,  occurs  without  being  com¬ 
plicated  with  contusion  of  the  brain.  Hr.  Lidell  does  not 
doubt.  Contusion  of  the  brain  is  therefore,  he  believes,  not 
synonymous  with  concussion ;  but,  at  the  same  time,  all 
the  evidence  now  collected  tends  to  prove  that  the  severe 
instances  of  cerebral  concussion  are  always  complicated  with 
cerebral  contusion.  Concussion,  however,  derives  its  chief 
importance  from  the  fact  that  it  is  very  often  associated 
with  contusion ;  and,  in  examining  a  case  of  cerebral  con¬ 
cussion,  the  question  of  most  importance  for  the  surgeon  to 
decide  is  whether  or  not  cerebral  contusion  is  also  present. 
These  are  points  of  doctrine  which  practically  have  much 
interest  for  patients  as  well  as  practitioners  because  of  the 
influence  they  are  likely  to  exert  in  procuring  a  correct 
diagnosis  and  a  wise  treatment ;  for  in  the  disorders  of  no 
other  parts  of  the  body  is  it  more  sure  that  an  accurate 
diagnosis  begets  a  wise  plan  of  treatment  than  in  those  of 
“the  brain  and  spinal  cord. — Neiv  York  Med.  Jour.,  July  14. 


ARMY  MEDICAL  SCHOOL,  KETLEY. 

The  summer  session  of  the  Army  Medical  School  terminated 
on  Monday,  the  6th  inst.,  when  the  prizes  at  the  disposal  of 
the  Senate  of  the  School  were  handed  to  the  successful  com¬ 
petitors,  before  a  large  assembly  of  distinguished  officers  and 
other  visitors,  by  Sir  Galbraith  Logan,  K.C.B.,  who  was 
Director-General  of  the  Army  Medical  Department  between 
the  years  1867  and  1874.  During  the  period  Sir  Galbraith 
Logan  occupied  this  high  official  position,  he  always  exhi¬ 
bited  a  strong  personal  interest  in  the  School,  and  took  an 
active  part  in  its  administration  ;  and,  as  he  mentioned  in 
commencing  his  address,  when  he  acceded  to  the  request  of 
the  Senate  to  distribute  the  prizes,  and  to  deliver  some  re¬ 
marks  on  the  occasion,  he  had  been  chiefly  prompted  to  do 
so  by  the  strong  desire  he  felt  to  show  publicly  the  great 
value  he  still  attached  to  the  establishment. 

At  the  commencement  of  the  proceedings,  the  lists  of  the 
surgeons  on  probation  who  had  passed  successfully  through 
the  courses  of  special  instruction  for  the  Medical  Depart¬ 
ments  of  Her  Majesty’s  British  and  Indian  Armies  were  read 
by  Surgeon-General  Longmore,  C.B.,  together  with  various 
reports  on  the  results  of  the  examinations  intended  for  the 
information  of  the  Secretaries  of  State  for  War  and  India. 

A  notable  feature  of  the  present  session  has  been  that  all 
the  prizes,  with  a  single  exception,  have  been  carried  off  by 
one  of  the  surgeons  on  probation — Mr.  J.  M.  Young,  of  the 
Indian  Medical  Service.  This  gentleman,  we  are  informed, 
acquired  his  professional  education  at  Glasgow  and  Vienna. 
In  handing  to  Mr.  Young,  in  succession,  the  Herbert, 
Martin,  Parkes,  and  Montefiore  medals  and  prizes.  Sir 
Galbraith  Logan  made  some  happy  references  to  the 
special  advantages  that  might  be  hoped  for,  to  the 
public  service,  from  the  superior  ability  which  Mr.  Young 
had  manifested  in  the  various  branches  of  professional 
knowledge  which  the  rewards  represented ;  and  he  dwelt 
also  with  much  feeling  on  the  exalted  characters  and  distin¬ 
guished  services  of  Dr.  Parkes  and  Sir  Ranald  Martin,  with 
both  of  whom  he  had  been  on  terms  of  intimate  friendship, 
and  to  perpetuate  whose  memories  the  medals  bearing  their 
names  had  been  founded.  He  said  he  could  not  imagine 
two  nobler  patterns  of  life  to  set  before  the  young  surgeons 
for  imitation,  than  the  lives  and  careers  of  those  eminent 
members  of  the  medical  profession  in  the  two  branches  of 
the  military  service,  the  British  arid  the  Indian,  to  which 
Dr.  Parkes  and  Sir  Ranald  Martin  had  respectively  be¬ 
longed.  We  cannot  place  before  our  readers  the  whole  of 
Sir  Galbraith  Logan’s  address,  which  extended  over  a 
wide  range  of  subjects,  and  was  listened  to  with  marked 
attention,  but  one  fact  that  he  mentioned  in  the  course 
of  his  remarks  has  not  perhaps  been  noticed  generally,  and 
to  the  degree  which  it  deserves,  though  it  has  been  dwelt 
on  in  our  pages.  In  speaking  of  the  excellent  manner  in 
which  the  Medical  Service  was  conducted  during  the  recent 
campaign  in  Egypt,  as  shown  by  the  professional  results, 
and  when  particularly  alluding  to  the  changes  that  had 
taken  place  in  the  manner  of  treating  Egyptian  ophthalmia. 
Sir  Galbraith  stated  that,  as  was  now  well  known,  not  a 
single  case  of  blindness  had  resulted  from  the  late  campaign. 
On  the  other  hand,  in  the  earlier  campaign  under  Sir  Ralph 
Abercrombie,  not  only  was  an  enormous  expense  entailed 
on  the  State  in  pensioning  the  very  large  number  of 
soldiers  who  became  deprived  of  sight  from  the  disease, 
but,  beyond  that,  the  ophthalmia  acquired  such  a  perni¬ 
cious  character,  and  proved  so  infectious  among  the  men 
who  escaped  from  the  extreme  result  of  blindness,  that, 
as  regarded  some  of  the  regiments  which  served  in  that 
war,  the  disease  was  not  eradicated  from  them  for  five-and- 
twenty  years  afterwards.  Thus  a  great  additional  cost 
was  entailed  on  the  country,  both  in  the  disability  for 
service  and  necessary  hospital  treatment  to  which  the  per¬ 
sistence  of  the  disease  led,  as  well  as  in  the  invaliding 
and  discharge  from  the  army  which  its  consequences  in 
numerous  instances  rendered  unavoidable. 

After  the  proceedings  in  the  lecture-room  of  the  School 
were  concluded,  the  company  was  entertained  at  luncheon 
by  the  officers  of  the  Army  Medical  Staff  in  their  spacious 
mess-room. 


Medical  Times  and  Gazette. 


MEDICAL  MATTERS  IN  PARLIAMENT. 


August  11 , 1883.  167 


MEDICAL  MATTERS  IN  PARLIAMENT. 


House  op  Commons — Thursday,  August  2. 

Vaccination. — In  reply  to  a  question  from  Mr.  Hopwood  as 
to  the  propriety  of  vaccinating  within  a  few  hours  after  child¬ 
birth  ,  Mr.  G.  Russell  said  that  the  motion  had  been  referred  by 
the  Guardians  of  St.  Pancras  to  a  committee,  who  had  stated, 
in  their  report,  that  they  regarded  the  question  as  one  solv¬ 
able  by  medical  men  only,  and  they  suggested  a  reference 
to  the  Local  Government  Board.  The  Board  of  Guardians 
approved  the  report,  and  carried  out  the  suggestion ;  and 
the  Local  Government  Board  had  replied  that  they  had 
nothing  to  add  to  their  letter  addressed,  in  June  last,  to 
the  Resident  Medical  Officer  of  the  St.  Pancras  Workhouse, 
which  was  to  the  effect  that,  while  providing  for  the  in¬ 
mates  of  the  workhouse  in  its  several  departments  such 
revaccination  as  is  proper  in  order  to  guard  each  department 
from  danger  of  small-pox,  it  is  undesirable  to  allow  the 
accidents  of  the  lying-in  room  to  become  confused  in  the 
minds  of  patients  with  the  results  of  vaccination  ;  and  that 
the  medical  officer  would  do  well  to  hold  this  considera¬ 
tion  in  view,  as  affecting  the  question  of  revaccinating 
women  within  a  short  period  after  labour. 

Cholera  Hospitals  for  Ireland. — In  reply  to  a  question 
from  Colonel  Nolan,  Mr.  Trevelyan  said  :  It  rests  with  the 
several  sanitary  authorities,  and  not  with  the  Local  Govern¬ 
ment  Board,  to  provide  temporary  hospitals  for  cholera 
patients,  and  the  Board  have  not  portable  hospitals  at  their 
disposal,  nor  have  they  power  to  take  sites  compulsorily  for 
such  hospitals.  The  matter  had  been  brought  under  the 
notice  of  the  sanitary  authorities  by  a  recent  order  of  the 
Local  Government  Board. 

Diseases  Prevention  ( Metropolis )  Amendment  Bill. — Sir 
C.  Dilke,  in  introducing  this  Bill,  which  was  read  a  first 
time,  said  the  main  object  of  it  was  to  provide  a  second  cen¬ 
tral  body  for  dealing  with  cholera  and  other  infectious 
diseases,  in  addition  to  the  local  authorities,  of  which  there 
were  thirty-eight  in  the  metropolis.  He  was  glad  to  say 
that  authority  was  the  Metropolitan  Asylums  Board.  The 
general  health  in  the  country  was  very  satisfactory,  but  in 
London  there  was  a  large  mortality  from  diarrhoea  among 
children  from  one  year  upwards.  It  was  desirable,  there¬ 
fore,  that  additional  precautions  should  be  taken,  as  the 
danger  of  cholera  would  not  be  passed  until  abcait  six  weeks 
from  the  present  time.  . 

Friday,  August  3. 

Increase  of  Venereal  Disease  in  Naval  and  Military  Hos¬ 
pitals. — In  reply  to  Mr.  Hopwood,  the  Marquis  of  Hartington 
said  it  was  not  easy  to  fix  the  naval  population  on  which 
hospital  ratios  at  Plymouth  have  to  be  formed,  as  it  fluc¬ 
tuates  from  day  to  day  by  the  arrival  and  departure  of 
vessels.  But  his  statement  on  July  30  was  based  on  the 
following  actual  returns.  As  regards  the  military  forces, 
the  admissions  to  hospital  for  venereal  diseases  in  the  ten 
weeks  ended  July  20,  1883,  were  183,  on  a  force  of  2859; 
while  for  the  corresponding  ten  weeks  of  1882  the  admissions 
from  the  same  causes  were  116,  on  a  force  of  2457  men. 
With  reference  to  the  Navy,  the  return  could  not  be  pro¬ 
cured  at  once  by  weeks,  but  it  was  found  that  on  July  21, 
1883,  there  were  121  venereal  cases  in  hospital,  on  a  force  of 
7309 ;  while  on  the  corresponding  day  of  1882  the  number 
was  47,  on  a  force  of  7334.  The  total  admissions  to  hospital 
for  military  patients  for  the  ten  weeks  was  larger  in  1883 
than  in  1882,  the  number  rising  from  312  to  460,  the  venereal 
patients  accounting  for  67  out  of  the  increase  of  148.  The 
total  in  hospital  as  regarded  naval  patients  similarly  in¬ 
creased,  from  463  in  1882  to  357  in  1883,  the  venereal 
patients  accounting  for  74  out  of  a  total  increment  of  94. 

Monday,  August  6. 

The  Water-Supply  of  London. — In  reply  to  a  question 
from  Mr.  Broadhurst,  Sir  C.  Dilke  said  that  the  number  of 
services  of  the  New  River  Company  on  the  constant  supply 
system  is  19,464  out  of  a  total  of  138,650,  and  is  practically 
confined  to  Shoreditch  and  parts  of  the  City.  All  new  houses 
in  the  district  are  required  to  be  provided  with  water- fittings 
adapted  for  the  constant  supply  system.  The  Local  Govern¬ 
ment  Board  were  not  empowered  to  compel  the  Metropolitan 
Board  of  Works  to  act  in  the  matter.  He  added  that  the 


I  total  number  of  supplies  to  houses,  etc.,  by  the  London 
I  water  companies  is  653,000,  and  that  the  houses  having  the 
constant  service  are  about  one-third  of  that  number.  A 
further  question  on  the  subject  was  put  to  the  chairman  of 
the  Metropolitan  Board  of  Works,  who  replied  that  the 
Board  had  not  called  on  any  of  the  water  companies  to  give 
a  constant  supply,  because  it  can  only  be  given  subject  to 
regulations  which  the  Board  consider  unnecessarily  expensi  w 
and  harassing  to  the  owners  of  houses.  But  the  Board  had 
never  offered  any  obstacle  or  objection  to  a  water  company 
introducing  the  constant  system  into  its  district  whenever 
circumstances  appeared  to  render  it  desirable. 

The  Pollution  of  the  River  Thames. — In  answer  to  a  ques¬ 
tion  from  Mr.  Firth,  Sir  C.  Dilke  said  that  the  statement  in 
the  Nineteenth  Century,  to  the  effect  that  the  water  supplied 
by  five  of  the  London  water  companies  consists  of  Thames 
water  mixed  with  the  sewage  of  more  than  half  a  million  of 
human  beings,  bears  the  signature  of  Percy  Faraday 
Frankland,  not  of  Professor  Edward  Frankland,  the  analyst 
of  the  Local  Government  Board.  The  Conservators  of  the 
River  Thames  state  in  their  last  report  that  the  Thames 
and  its  tributaries  within  ten  miles  of  the  river  are  placed, 
under  constant  supervision,  in  order  that  any  effluent  con¬ 
sisting  of  sewage  or  of  offensive  and  injurious  matter  may 
at  once  be  detected  and  stopped.  The  towns  on  the  Thames 
above  the  inlets  of  the  water  companies  which  supply  the 
metropolis  have  spent  large  sums  in  diverting  their  sewage, 
and  that  part  of  the  river  may  be  considered  practically  free 
from  sewage  pollution.  The  Local  Government  Board  had 
referred  to  the  annual  reports  made  to  them  by  Dr. 
Frankland  for  several  years  past,  but  did  not  find  that  in 
any  of  them  he  had  stated  that  “  minute  organisms,  calcu¬ 
lated  to  promote  zymotic  disease/’  are  to  be  found  in  the 
water  supplied  by  the  London  water  companies,  and  that, 
in  order  to  avert  another  epidemic  of  cholera,  “  the  rivers 
Thames  and  Lea  must  be  wholly  abandoned  as  sources  of 
water-supply.”  The  Board  found  that  on  two  occasions 
only  in  1882  were  living  organisms  detected  by  him  ;  and  he 
stated  that  this  showed  increased  care  on  the  part  of  the 
companies  in  the  treatment  and  filtration  of  water. 

Overwork  of  Brain  and  the  Increase  of  Lunacy. — Mr. 
Leighton  asked  the  Vice-President  of  the  Council  whether 
he  could  state  on  the  authority  of  the  Lunacy  Commis¬ 
sioners  whether  there  had  been  during  the  last  ten  years 
a  material  increase  of  brain  diseases  and  lunacy  among 
the  children  of  schools  and  teachers  in  schools. — Mr. 
Mundella  replied  :  He  had  asked  the  Commissioners,  and  they 
said  that  children  sent  to  asylums  are  usually  idiots,  and 
that  it  is  only  occasionally  an  insane  child  is  met  with. 
The  number  of  children  under  fifteen  admitted,  so  far  from 
increasing  of  late  years,  has  fallen  from  306  in  1872  to  286- 
in  1882,  notwithstanding  an  increase  of  two  millions  and  a 
half  to  the  population  in  the  interval.  So  far  as  teachers 
are  concerned,  the  Commissioners  referred  him  to  their  re¬ 
port  of  last  year,  which  states  that  of  the  group  described  as 
teachers,  schoolmasters,  schoolmistresses,  governesses,  pro¬ 
fessors,  and  lecturers,  out  of  127,140  persons  classed  under 
this  head  in  1871,  154  only  were  committed  to  asylums  in 
1881.  This  is  a  lower  proportion  than  in  almost  any  other 
profession.  The  clergy,  the  legal  and  medical  professions, 
the  Army  and  Navy,  civil  engineers,  and  others  all  showed  a 
much  higher  average.  Out  of  746  teachers  applying  to  the 
Education  Department  for  pensions  since  1875,  incapaci¬ 
tated  from  continuing  their  profession,  24  only  are  returned 
as  suffering  from  brain  affections  in  any  form.  The  state¬ 
ment  made  by  him  on  a  former  occasion — viz.,  that  the 
death-rate  of  children  between  five  and  fifteen  years  of  age 
had  fallen  fully  19  per  cent,  since  1870,  and  that  the  death- 
rate  from  brain  diseases  was  O' 5  per  1000 — had  been  incor¬ 
rectly  reported,  the  latter  rate  having  been  put  as  5  per  1000. 
— Mr.  Donaldson-Hudson  asked  whether  the  Vice-President 
would  consider  the  expediency  of  making  such  modification 
in  the  new  Code  as  would  admit  of  a  percentage  of  children 
being  excused  examination,  without  diminishing  the  grant 
to  the  whole  class,  in  cases  where  some  of  the  children  are 
naturally  incapable,  and  where  it  is  injurious  to  their  health 
to  be  pressed  forward  for  examination. — Mr.  Mundella,  in 
reply,  said  :  The  Code,  as  it  stands,  is  more  fair  and  more 
liberal  than  the  proposal  made,  as  it  allows  any  number  of 
children  to  be  withheld  by  managers  from  examination 
when  a  reasonable  excuse  can  be  established.  If  a  fixed  per¬ 
centage  were  laid  down,  it  might  work  unfairly  in  different 


168 


Medical  Times  and  Gazette. 


FROM  ABROAD. 


August  11,  1883. 


schools.  In  the  instructions  to  Her  Majesty’s  inspectors  of 
schools,  as  to  the  scholars  who  may  he  withheld  from  exami¬ 
nation,  all  that  is  reasonable  and  j  ust  both  to  teachers  and 
scholars  is,  I  think,  provided  for. 

Vaccine  Lymph. — In  reply  to  questions  on  this  subject 
from  Mr.  A.  O’Connor,  Mr.  G.  Russell  said  :  Government  have 
nothing  to  do  with  any  lymph  but  that  supplied  from  their 
own  establishment.  This  is  of  two  kinds — the  one  collected 
from  children’s  arms  by  approved  vaccinators  in  various 
parts  of  the  country,  and  examined  at  the  Board  offices ; 
the  other  cultivated  from  calf  to  calf  at  the  Board’s 
station  in  Lamb’s  Conduit-street.  These  are  known  as 
the  humanised  lymph  and  the  animal  lymph  (of  the  Esta¬ 
blishment)  respectively.  Watch  is  always  kept  for  every 
indication  of  the  quality  of  the  lymph  supplied.  Ho  reason 
appears  for  supposing  that  any  variety  of  it  can  cause  any 
disease  except  vaccinia,  or  any  other  result  than  to  protect 
from  small-pox.  Public  vaccinators  are  required,  under 
penalties,  to  keep  a  record  of  the  source  from  which  they 
obtain  their  lymph.  Government  do  their  best  to  secure 
that  all  lymph  they  supply  shall  be  free  from  suspicion  : 
and  I  do  not  see  that  there  could  be  any  more  positive 
“  guarantee”  of  its  purity. 

Honours  to  the  Medical  Profession. — Replying  to  a  ques¬ 
tion  from  Colonel  King-Harman,  Mr.  Gladstone  said : 
There  are  three  medical  bodies  in  this  country' — -one  in 
England,  one  in  Scotland,  and  one  in  Ireland.  It  is  true 
that  in  England  there  have  been  recently  conferred  upon 
two  distinguished  gentlemen  of  the  medical  profession  the 
honour  of  baronetcies,  and  upon  one  gentleman  of  distin¬ 
guished  position  the  honour  of  knighthood.  In  Ireland  one 
distinguished  member  has  received  the  honour  of  knight¬ 
hood  ;  and  in  Scotland  there  has  been  no  honour  at  all. 
But  great  efforts  have  been  made,  and  further  efforts 
are  in  progress  by  means  of  a  Bill  in  this  House,  to 
make  the  profession  in  the  three  countries  one  in 
standard,  and  one  in  authority.  We  attach  great  im¬ 
portance  to  that  Bill.  We  regard  the  profession  as  one, 
and  the  question  of  the  nationality  of  the  persons  selected 
for  the  honour  is  a  secondary  consideration,  to  which  we 
can  give  nothing  but  a  secondary  importance.  I  do  not,  in 
advising  the  Crown  with  respect  to  honours  of  this  kind, 
proceed  upon  my  authority  alone,  but  I  endeavour  to  inform 
myself  by  very  full  consultation  with  those  who  are  known  and 
regarded  as  the  heads  of  both  the  medical  and  the  surgical 
Branches  of  the  profession — heads  not  in  a  formal  sense,  but 
as  probably  being  the  most  eminent  persons  in  those 
branches.  It  was  upon  full  consultation  with  them  that  I 
advised  the  Crown  on  the  recent  occasion.  Mr.  Gladstone 
further  observed  that  knighthood  is  a  very  considerable 


honour,  being  held  by  the  judges  of  the  land  and  by  the 


law  officers  of  the  Crown. 

Tuesday,  August  7. 

The  Burial  Acts. — Mr.  Richards  asked  the  Home  Secretary 
whether,  considering  the  difficulties  experienced  by  local 
authorities  in  providing  new  cemeteries,  he  would  next  session 
introduce  a  Bill  to  amend  the  Burial  Acts. — Sir  W.  Harcourt 
said  that  nobody  was  more  conscious  than  he  was  of  the 
difficulties  of  attempting  to  settle  this  question  ;  the  diffi¬ 
culties  came  before  him  every  day.  He  hoped  that  in  the 
course  of  next  session  something  would  be  done  towards  the 
settlement  of  a  question  felt  by  everybody  to  be  now  in  a 
most  unsatisfactory  state.  He  would  carefully  consider  the 
matter,  and  see  how  far  the  Government  could  endeavour  to 
deal  with  it. 

The  Diseases  Prevention  ( Metropolis )  Bill. — The  report  of 
this  Bill  was  received ;  and  the  Bill  was  read  the  third  time 


Pathognomonic  Sign  of  Fracture  of  the  Cervix  of 
the  Femur. — Prof.  Bezzi,  after  showing,  in  the  Spallanzani, 
the  difficulties  and  uncertainties  which  often  attend  the  dia¬ 
gnosis  of  this  accident,  observes  that  at  the  Milan  Hospital 
a  traditional  practice  exists  of  exploring,  whenever  fracture 
of  the  neck  of  the  femur  is  suspected,  the  short  space 
between  the  trochanter  and  the  crest  of  the  ilium.  In  place 
uf  the  considerable  resistance  which  is  there  produced  in  the 
sound  limb  through  the  tension  of  the  tensor  muscle  of  the 
fascia  lata,  there  is  found,  when  the  injury  has  occurred,  a 
deep  depression,  due  evidently  to  the  diminution  in  the 
tension  of  this  muscle,  owing  to  the  approximation  of  its 
points  of  attachment. — Presse  Med.  Beige,  July  29.  - 

^av;sh 


FROM  ABROAD. 


Chloral  Poisoning. 

In  a  clinical  lecture  delivered  by  Prof.  I)a  Costa  at  the 
Pennsylvania  Hospital  (Phil.  Med.  Times,  March  24),  after 
describing  the  case  of  a  man  who  had  taken  seven  drachms 
of  chloral,  he  proceeds  :  — 

“  What  are  the  remedies  to  be  applied  in  acute  chloral 
poisoning  ?  They  are  principally  designed :  (1)  to  sustain 
the  action  of  the  heart,  such  as  ammonia  and  brandy  ;  (2)  to 
keep  up  the  breathing  by  artificial  respiration ;  (3)  to  keep 
the  patient  warm ;  and  (4)  to  use  electricity  as  a  cutaneous 
stimulant.  Thus  far  you  would  treat  a  case  as  an  ordinary 
one  of  narcotic  poisoning.  But  is  there  no  remedy  that  will 
counteract  the  depressing  effect  of  the  chloral  upon  the 
nervous  centres,  and  particularly  the  respiratory  centre  ? 
Yes ;  the  remedy  for  this  purpose  is  strychnia,  which  an¬ 
tagonises  the  chloral.  It  may  be  used  hypodermically : 
one-sixtieth  of  a  grain  every  three  hours  at  first  (and  it 
would  have  been  given  oftener  in  this  case,  but  it  was  not 
needed).  Strychnia  is  the  physiological  antidote  :  it  stimu¬ 
lates  the  centres  which  have  been  depressed.  When  re¬ 
covery  takes  place  it  is  usually  rapid. 

“  A  few  words  on  the  subject’ of  chronic  chloral  poisoning 
may  be  of  interest.  Since  the  introduction  of  this  valuable 
but  seductive  remedy,  people  have  gradually  learned  that 
chloral  produces  sleep,  and  relieves  the  condition  of  “  ner¬ 
vousness  ”  or  restlessness  that  is  so  common  a  cause  of 
insomnia;  and  they  now  resort  to  it  just  as  they  do  to 
opium,  to  get  relief  from  any  inconvenience.  In  this  way 
they  form  a  chloral  habit  that  may  be  as  injurious  as  the 


opium  habit.  Chloral,  when  it  is  thus  taken  for  a  length  of 


time  in  ordinary  or  small  doses,  will  give  rise  to  peculiar 
symptoms  which  you  should  be  able  to  recognise.  These 
symptoms  are  principally  indicative  of  disorder  of  the  nervous 
system  and  the  circulatory  apparatus.  As  these  features 
are  peculiar,  and  of  general  interest,  I  will  discuss  a  few  of 
them  with  you.  First  let  us  consider  this  question :  Can 
a  man  become  habituated  to  the  use  of  chloral  as  he  may  to 
the  use  of  morphia  P  There  is  a  good  deal  of  difference  of 
opinion  among  observers,  and,  I  think,  a  great  differ¬ 
ence,  in  this  regard,  in  individuals.  It  has  been  my 
experience  to  find  in  some  people  great  susceptibility  to 
chloral,  which  does  not  pass  away.  Some  persons  are  always 
affected  by  small  doses,  while  others  require  the  amount  to 
be  increased  in  order  to  keep  up  the  effects,  until  enor¬ 
mous  doses  are  used.  [A  case  was  referred  to  in  which  the 
prolonged  and  increased  use  of  chloral  gave  rise  to  all  the 
symptoms  of  delirium  tremens,  showing  that  in  some 
persons  the  system  becomes  habituated  to  larger  and  larger 
doses  of  chloral,  the  smaller  doses  failing  to  produce  the 
desired  effect.] 

“Among  the  more  striking  features  of  chronic  chloralism 
is  muscular  weakness,  which  is  particularly  manifested  in 
the  legs.  There  is  such  marked  debility,  that  in  attempting 
to  walk  the  patient  appears  to  be  paralysed.  There  is  no 
special  group  of  muscles  that  is  affected,  but  there  is  a 
general  loss  of  power  in  the  limbs.  This  paresis  may  also 


manifest  itself  in  the  upper  extremities.  As  regards  other 


symptoms,  there  are  some  in  connexion  with  the  circulation 
and  nervous  system  that  deserve  discussion.  There  is  feeble 
action  of  the  heart,  with  cold  extremities,  and  a  tendency 


to  profuse  sweating.  The  pulse  is  accelerated,  but  weak ; 


arterial  tension  is  reduced.  The  nervous  phenomena  are 
very  remarkable.  Active  delirium,  like  that  from  alcohol, 
has  already  been  mentioned,  but  there  is  also  a  less  marked 
condition  of  the  mind  which  is  even  more  significant.  The 
patient  becomes  constantly  dull  and  dreamy ;  the  will-power 
seems  completely  wanting ;  the  judgment  and  intellectual 
faculties  are  impaired.  The  vaso-motor  centres  lose,  to  a 
certain  extent,  their  functional  powers.  This  is  partly  shown 
by  the  condition  of  the  cutaneous  circulation  ;  the  extremities 
become  cold  and  blue,  and  there  is  also  a  strange  tendency  to 
cutaneous  eruptions.  I  have  noticed  erythematous  blushes 
come  and  go  with  great  rapidity,  and  I  have  seen  papular 
eruptions  more  or  less  red  and  itching — not  always  the  same. 
Therefore,  in  addition  to  the  alteration  in  secretions  (the 
perspirations  already  referred  to)  we  may  have  various 
inflammations  of  the  skin  as  a  result  of  chronic  chloral 
jpoisoning.  Sugar  may  appear  in  the 


RADFORD 
«\  library 


urine,  although  it  is 


Medical  Times  and  Gazette. 


GENERAL  CORRESPONDENCE. 


Augtist  11,  1883.  169 


not  constant — at  least,  I  cannot  say  that  I  have  found  it  so. 
In  some  cases  the  bodily  nutrition  is  well  maintained,  and 
the  appetite  remains  good  ;  but  the  contrary  is  the  case  of 
others.  •  Digestion  is  not  materially  influenced,  except  that 
there  may  be  relaxation  of  the  bowels  in  place  of  the 
constipation  accompanying  opium. 

“  What  should  be  the  treatment  of  chronic  chloral 
cases  ?  Suppose  that  a  patient  like  this  says  that  the  habit 
is  growing  upon  him,  and  comes  to  you  for  advice,  what 
course  Bhould  you  pursue  ?  I  would  answer  that  you  must 
reduce  the  dose  gradually.  As  large  doses  are  only  given 
exceptionally,  there  will  be  less  difficulty  on  this  score  than 
with  opium  ;  but  as  you  reduce  it,  I  would  strongly  advise 
you  to  give  strychnia  or  nux  vomica,  for  its  effects  on  the 
nervous  system.  It  antagonises  the  effects  of  the  chloral, 
and  acts  at  the  same  time  as  a  tonic.  Those  nervous  centres 
which  are  reduced  in  their  activity  by  the  paralysing  effects 
of  the  chloral  are  stimulated  by  strychnia.  If  you  use 
strychnia,  you  may  stop  the  chloral  almost  at  once,  without 
any  bad  effects  being  observed.” 


GENERAL  CORRESPONDENCE. 


THE  SANITARY  LESSONS  OF  INDIAN  EPIDEMICS. 

Letter  from  Inspector-General  R.  Lawson. 

[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sir, — While  thanking  you  for  the  readiness  with  which  you 
inserted  my  letter  of  July  26  in  the  Medical  Times  and 
Gazette,  I  deem  it  necessary  to  offer  the  following  remarks 
on  one  point  in  the  observations  you  appended  to  it.  You 
refer  me  to  page  101  of  the  Report  on  the  Cholera  Epidemic 
in  the  United  States  in  1873,  to  show  that  the  disease  at 
New  Orleans  was  not  of  the  type  common  in  India,  or  which 
now  rages  in  Egypt,  but  resembled  the  severe  diarrhoea 
which  prevails  everywhere  in  hot  weather  among  insanitary 
surroundings ;  and  from  this  you  consider  that  not  only  my 
conclusions,  but  my  premises,  fall  to  the  ground.  Now,  the 
disease  commenced  in  February,  and  up  to  the  beginning  of 
April,  when  the  weather  could  not  be  called  hot,  there  had 
been  “  thirty-one  cases,  of  which  two  (2)  were  recoveries  " 
(Report,  page  97).  This  does  not  indicate  a  slight  form  of 
disease,  to  begin  with,  whatever  it  became  subsequently  as 
the  usual  season  for  diarrhoea  came  on. 

Again,  as  to  the  relation  in  which  the  first  cases  stood  to 
the  subsequent  spread  of  the  disease,  and  as  to  its  nature, 
I  refer  you  to  page  1  of  the  Report,  where  it  is  stated  that 
in  1873  cholera  prevailed  throughout  thb  valley  of  the 
Mississippi,  commencing  at  New  Orleans,  from  which  it 
extended  northwards,  and  became  epidemic  at  all  points 
attacked.  The  vast  majority  of  the  medical  men  who  were 
engaged  in  combating  the  disease  were  unanimous  in  pro¬ 
nouncing  it  Asiatic  cholera.  A  second  class — respectable, 
both  numerically  and  intellectually — recognised  the  disease 
to  have  been  cholera  in  a  fatal  form,  but  of  American  origin  ; 
while  others  regarded  it  as  a  pernicious  bilious  or  malarial 
form  of  fever.  The  general  consensus  of  opinion,  then,  was 
that  the  disease  was  a  fatal  form  of  cholera — a  conclusion 
which  few  who  have  perused  the  Report  carefully  will  be 
inclined  to  doubt. 

These  facts  place  my  premises  regarding  the  outbreak  at 
New  Orleans  beyond  question,  and  I  must  leave  your  readers 
to  form  their  own  opinions  as  to  whether  my  mode  of  treat¬ 
ing  these  premises,  or  that  you  seem  to  recommend,  is  most 
in  harmony  with  the  modern  spirit  of  research,  or  most 
likely  to  enable  them  to  clear  away  the  obscurity  which  now 
envelopes  the  mode  of  origin  and  of  spread  of  cholera. 

I  am,  &c.,  Robert  Lawson, 

London,  August  6.  Inspector-General  of  Hospitals. 


THE  RECENT  LUNACY  APPOINTMENT. 


[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sir, — The  appointment,  recently  made,  of  a  successor  to 
Dr.  Nairne,  on  his  retirement  from  the  Lunacy  Board,  ought 
not  to  be  allowed  to  pass  unchallenged  in  your  pages,  if  for 
no  other  reason  than  that  it  may  not  be  said  in  its  defence 
that  so  great  an  injustice  was  not  protested  against  at  the 
time  in  the  columns  of  the  medical  journals.  The  ground 


of  complaint  which  is  felt  by  all  practising  lunacy  is 
this:  that  the  office  has  been  given  to  one  who  has  not 
made  the  subject  his  study,  yet  upon  whom  devolves  the 
duty  of  ascertaining  whether  the  asylums  of  this  country 
meet  the  special  needs  of  the  insane,  whether  those  who  are- 
confined  in  them  are  labouring  under  insanity,  and  whether 
their  discharge  would  prove  dangerous  to  society.  Many 
are  the  delicate  questions  which  from  time  to  time  arise 
between  the  superintendents  and  the  patients,  in  which  the 
character  of  the  former  and  the  interests  of  the  latter  are  alike 
at  stake,  and  in  regard  to  which  the  report  of  a  Commissioner 
will  be  of  the  gravest  import.  Between  seventy  and  eighty 
thousand  lunatics  are  now  confided  to  the  supervision  of  the 
Lunacy  Commissioners,  and  common  humanity,  one  would 
have  thought,  might  have  induced  the  Lord  Chancellor  to  ap¬ 
point  some  physician  acquainted  with  the  peculiar  necessities 
of  the  insane,  and  familiar  with  the  arrangements  of  asylums. 
So  long  as  the  British  taxpayer  has  to  provide  for  Commis¬ 
sioners  in  Lunacy,  he  may  be  excused  if  he  demands  that 
well-qualified  men  should  be  appointed.  Unfortunately, 
this  is  not  the  first  time  such  a  mistaken  appointment  has 
been  made,  and,  strange  to  say,  this  very  fact  is  adduced  as 
a  reason — a  precedent — for  repeating  it.  It  might  have  been 
expected  that  the  present  Lord  Chancellor  would  have  seized 
the  opportunity  afforded  him  of  rising  to  a  higher  standard, 
and  would  have  shown  that  he  at  least  does  not  think  it  a 
matter  of  indifference  to  whom  the  needs  of  the  insane  are 
entrusted.  As  well  might  a  man  ignorant  of  sanitation  be 
appointed  to  examine  the  drainage  in  a  locality  where  fever 
has  broken  out,  as  a  man  who  has  never  made  lunacy  his 
study  be  appointed  a  Medical  Commissioner  in  Lunacy.  The 
audacity  of  such  appointments  is  only  equalled  by  the  bold¬ 
ness  of  the  men  who,  knowing  their  ignorance,  are  willing  to 
seek  and  take  them.  Were  it  not  that  a  gentleman  thus 
appointed  voluntarily  brings  discomfort  upon  himself,  we 
should  pity  the  Commissioner  who,  having  to  visit  asylums 
and  criticise  the  action  of  their  superintendents,  must  face 
the  resentful  antagonism  of  those  who  feel  acutely  having- 
to  receive  as  an  inspector  one  who  is  unqualified  to  form  a 
just  opinion  on  the  questions  which  arise  affecting  their 
conduct.  I  am,  &c., 

August  7.  Medico-Psychologictjs. 


The  Tampon  in  Placenta  Pilevia. — Dr.  Curtis 
Smith,  of  Aurora,  Indiana,  in  a  paper  in  the  Phil.  Med. 
Reporter  (July  14),  after  adverting  to  the  circumstances 
in  which  the  tampon  is  indicated  in  these  cases,  goes  on  to 
speak  of  its  mode  of  application.  “We,  have  tried  several 
methods.  A  very  good  plan  is  to  take  small  bits  of  fine 
muslin  and  pack  them  on  bit  by  bit  until  the  vagina  will 
not  receive  any  more,  making  it  very  tight.  This  form  is 
very  annoying  to  remove,  because  of  the  necessity  of  such 
frequent  returns  to  the  vagina  for  the  pieces  composing  it. 
A  better  way  is  to  take  long  narrow  strips  of  soft  muslin  and 
pack  it  tightly.  This  is  easily  removed.  Common  cotton¬ 
wool  answers  well ;  also  tow,  when  well  cleaned  and  soft. 
When  a  speculum  is  at  hand  it  should  be  used,  as  by  it  the 
vulva  is  protected.  But  a  speculum  and  long  forceps  are 
rarely  at  hand  in  cases  at  the  moment  most  needed.  If  the 
tampon  material  is  well  soaked  in  cold  water  it  will  have  a 
tendency  to  check  the  flow,  and  the  water  will  fill  the 
meshes  so  that  it  will  take  up  less  blood.  Besides,  it  can 
be  packed  tighter  when  wet  than  dry.  I  have  by  some  of 
these  methods  tamponed  the  vagina  so  tight  that  not  a  drop 
of  blood  could  escape,  and  the  tampon  would  not  be  soiled 
to  half  its  depth.  A  tampon  of  any  of  these  materials  will, 
of  course,  absorb  some  blood,  but  if  it  is  wet  when  intro¬ 
duced,  and  packed  very  tight,  it  cannot  absorb  much,  and 
will  hold  the  blood  until  a  firm  clot  forms.  I  wish  again  to 
enter  my  protest  against  using  the  tampon  indiscriminately. 
When  we  find  the  os  soft  or  dilated,  and  the  uterine  fibre 
flaccid,  this  means  is  a  dangerous  remedy.  But,  under  the 
opposite  conditions,  it  is  a  valuable  measure.  The  india- 
rubber  bag  makes  a  fine  tampon,  but  it  is  not  likely  to  be 
at  hand.” 

Homoeopathic  Adulteration. — Prof.  J.  Edwards 
Smith  has  devoted  a  year  to  the  study  and  discovery,  of 
adulterations  in  homoeopathic  medicines  !  When  adulteration 
strikes  the  attenuated  and  gossamer  fabric  of  the  sim.  sim. 
cur.  materia  medica,  we  may  well  believe  that  vice  reaches, 
every  fibre  of  our  social  system. — N.Y.  Med.  Record, jJuly  14. 


170 


Medical  Times  and  Gazette. 


MEDICAL  NEWS, 


August  11,  1883. 


MEDICAL  NEWS. 

- * - 

University  oe  London. — Appended  is  a  classified 
list  of  the  successful  candidates  at  the  recent  Preliminary 
^Scientific  (M.B.)  Examination  : — 

r  First  Division. — Evelyn  Oliver  Ashe,  Owens  College ;  Percy  Ashworth,  (a) 
'Owens  College ;  George  Barlow,  Owens  College;  George  Black, (a)  Guy’s 
Hospital ;  John  Telfer  Calvert,  Owens,'College  and  St.  Thomas’s  Hospital ; 
Henry  Johnstone  Campbell, (a)  Guy’s  Hospital  and  private  tuition  ;  John 
Shaw  Willes  Chitty,  Charing-cross  Hospital ;  Herbert  Edmund  Cuff,  Guy’s 
Hospital:  Charles  Hermann  Eernau,  University  College;  Walter  Ross 
Jordan,  Queen’s  College  and  King  Edward’s  High  School,  Birmingham; 
G-eorge  Edward  Rennie,  B.A.  Sydney,  University  College  ;  John  Lloyd 
Roberts,  Guy’s  Hospital ;  Ernest  Alfred  Sadler,  Mason  College,  Birming¬ 
ham;  Ramon  Alexander  Sawyer,  Guy’s  Hospital;  Thomas  Wilson 
Smith, (b)  Guy’s  Hospital;  Ernest  Henry  Starling,  Guy’s  Hospital;  John 
Price  Williams,  Owens  College ;  William  Griffith  Williams,  Owens 
College;  Prank  Lomax  Wood,  Owens  College. 

Second  Division. — Horatio  George  Adamson,  St.  Bartholomew’s  Hospital ; 
Richard  Alcock,  Owens  College;  Launcelot  William  Andrews, (c)  St. 
Bartholomew’s  Hospital;  Kaikhosro  Nagarvanji  Bahadhurji,  University 
•College ;  Laurence  Augustus  Baine,(a)  Mason  College  and  College  of 
Physical  Science,  Newcastle-on-Tyne  ;  Robert  William  Baker,  University 
•College ;  Marmaduke  Bannister,  Owens  College  ;  Wilfred  Martin  Barclay, 
Bristol  Medical  School ;  Arthur  Baxendell,  Owens  College  ;  James  Thomas 
Bays,  University  College  and  private  study ;  George  Arthur  Berry,  Owens 
College;  James  Edward  Huxley  Blake,  (a)  Mason  College,  Birmingham; 
Hubert  William  Boyce,  University  College ;  Albert  Edward  Brindley, 
•Owens  College ;  William  Frederick  Brook,  St.  Thomas’s  Hospital  and 
private  study  and  tuition ;  George  Percy  Brownlow,  St.  Bartholomew’s 
Hospital ;  Lewis  Thomas  Fraser  Bryett,  King’s  College ;  Solomon  Bueno 
de  Mesquita,  Guy’s  Hospital ;  James  Joseph  Buist,  (b)  St.  Bartholomew’s 
Hospital;  Cyril  Cecil  Barrow  Burt,  Westminster  Hospital;  Robert 
James  Carter,  King’s  College;  Arthur  Morgan  Cass,  Owens  College; 
■George  William  Chester,  University  College,  Liverpool;  Francis  William 
Clark,  Middlesex  Hospital;  Walter  Stacy  Colman,  University  of 
Edinburgh  and  private  study ;  Cecil  Whitehall  Cooke,  St.  Thomas’s 
Hospital;  Cecil  Howard  Cribb,(a)  University  College  and  Royal 
School  of  Mines ;  J ohn  Cunningham,  Royal  Infirmary  School  of  Medi¬ 
cine,  Liverpool ;  Edward  Deanesly,  University  College ;  Edward 
Meyer  de  J ong,  Owens  College ;  Charles  Duer,(a)  University  College  ; 
Arthur  Ellis  Durham, (a)  University  College  ;  John  Edward  Dyer,  Univer¬ 
sity  College;  Henry  Augustus  Edmonds, (b)  Guy’s  Hospital;  Frank 
Fawssett,  St.  Thomas’s  Hospital;  John  Gardiner, (a)  Owens  College; 
Arthur  Henry  Gault,  Owens  College ;  George  Taylor  Gifford,  King’s 
College ;  J  ohn  Edwin  Gould,  (a)  U  ni  versity  College ;  Blenman  Buhot 
Grayfoot,  University  of  Edinburgh;  George  Frederick  Grierson,  Owens 
■College  ;  Edwin  Birchall  Hastings,  (a)  University  College ;  Harold  Hebble- 
thwaite,  Leeds  School  of  Medicine  and  Yorkshire  College ;  Philip  Henry 
Hensley,  King’s  College;  Sydney  Ernest  Holder,  University  College; 
Harold  J ohnson,  St.  Bartholomew’s  Hospital  and  private  study  ;  Charles 
Saint  Johnston,  Mason  College,  Birmingham  ;  David  Thomas  Jones,  (d) 
University  College  of  Wales;  Herbert  Saunders  Wansbrough  Jones, (a) 
New  Kingswood  School ;  Henry  Truman  Kelsall,  London  Hospital ; 
Arthur  Beresford  Kingsford,  University  College  ;  Arthur  Leche,  Univer¬ 
sity  College,  Bristol ;  Milton  Prentice  Ledward,  Owens  College  ;  John 
Henry  Lightbody,  Royal  Infirmary  School  of  Medicine,  and  University 
College,  Liverpool ;  William  Kenneth  Mackenzie,  King’s  College  ;  Ludovic 
William  Darra  Mair,  Epsom  College ;  Morgan  John  Morgan,  University 
College  of  Wales;  Enoch  Moss,  Guy’s  Hospital;  Charles  Pye  Oliver, 
Charing-cross  Hospital ;  William  Theophilus  Ord,  Bristol  Medical  School 
and  private  study  and  tuition;  George  John  Padbury,  Guy’s  Hospital; 
George  Dines  Parker, (e)  University  College  of  Wales;  John  Porter 
Parkinson,  University  College;  Edward  Posnett, (e)  Yorkshire  College, 
Leeds;  Llewellyn  William  Powell,  University  College;  Philip  Nicholas 
Handall,  Guy’s  Hospital ;  William  Halse  Rivers  Rivers,  St.  Bartho- 
lomew’s  Hospital;  Joseph  Crofts  Rossall,  St.  Mary’s  Hospital  and 
private  tuition ;  Mary  Royce,  University  College  and  private  study ; 
Frank  Percy  Sarjant,  Guy’s  Hospital ;  Frank  Savery,  University  Col¬ 
lege  ;  Guy  Bellingham  Smith,  University  College ;  Nugent  Edward 
Smyth,  Mason  College,  Birmingham ;  Ernest  Hugh  Snell,  Mason  College. 
Birmingham;  G.  Whitefield  Sutherland,  B.A.  Sydney,  University  of 
Edinburgh  and  University  College;  Henry  Symonds,  St.  Bartholomew’s 
Hospital ;  Frederick  Howard  Taylor,  London  Hospital  and  private 
study ;  Stuart  Alexander  Tidey,  St.  Mary’s  Hospital  and  private  tuition ; 
John  Herbert  Tonking,  St.  Thomas’s  Hospital ;  William  Elliot  Tresidder, 
Guy’s  Hospital ;  Alfred  Herbert  Tubby,  Guy’s  Hospital ;  Edward  Hamilton 
Tuckett,  University  College,  Bristol,  and  private  study ;  Charles  Hazlitt 
Upham,  private  study;  Alfred  Ellis  Vaughan,  Owens  College;  Herbert 
Edmund  Vincent,  Guy’s  Hospital;  Ernest  Ward,(e)  Bristol  Medical 
School ;  Howard  Percy  Ward,  Felsted  School  and  King’s  College ;  Henry 
Edward  Whitehead,  (a)  St.  Bartholomew’s  Hospital ;  Frank  Stanley  Wood, 
Guy’s  Hospital ;  John  Edwin  Wood,  B.  A.,(c)  Yorkshire  College,  Leeds. 

Experimental  Physics  only. — Henry  Talbot  Sidney  Aveline,  private  study ; 
•Samuel  Frederick  Holloway,  Guy’s  Hospital :  Frank  Arthur  Spreat,  St. 
Bartholomew’s  Hospital  and  private  tuition  ;  John  Herbert  Stacy,  private 
■study ;  Richard  John  Stephens,  King’s  College. 

Botany  only.— Joseph  Richard  Mary  Brennan,  Owens  College. 

Zoology  only. — Leonard  Arthur  Bidwell,  St.  Thomas’s  Hospital. 

(a)  These  candidates  have  also  passed  in  the  Mathematics  of  the  Inter¬ 
mediate  Examination  in  Science,  and  have  thus  become  admissible  to  the 
3B.Sc.  Examination. 

(b)  These  candidates  have  postponed  their’ examination  in  Zoology. 

(®)  These  candidates  have  postponed  their  examination  in  Chemistry. 

(d)  This  candidate  has  postponed  his  examination  in  Botany. 

(e)  These  candidates  have  postponed  their  examination  in  Physics. 

Apothecaries’  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday, 
August  2  : — 


Beard,  Thomas,  Bath-street,  Birmingham. 

Hardy,  Walter  Mitchell,  Buttershaw,  Bradford. 

Hendley,  Harold,  West  London  Hospital. 

Ley,  Herbert,  Westbourne-terraee,  W. 

Miiler,  Thomas  Hugh,  Woburn,  Bedfordshire. 

Pring,  Arthur,  Barnes,  S.W. 

Pullin,  Bingley  Gibbes,  Holford-square,  W.C. 

Ray,  Dwarka  Nath,  Bengal. 

Stace,  Arthur  Frank,  Bayswater,  W. 

Steedman,  John  Francis,  St.  Bartholomew’s  Hospital. 

The  following  gentlemen  also  on  the  same  day  passed  their 
Primary  Professional  Examination  : — 

Burns,  Alfred  Hugh,  St.  Thomas’s  Hospital. 

■  Cropley,  Alfred,  London  Hospital. 

Kelson,  William  Henry,  St.  Thomas-road,  S.E. 


DEATHS. 

McClelland,  John,  M.D.,  of  6,  Lancaster-terrace,  Regent’s-park,  W.,  at 
29,  Marina,  St.  Leonards-on-Sea,  on  July  31. 

Southam,  Thomas,  M.R.C.S.,  L.S.A.,  at  Thorpe-road,  Peterborough,  on 
August  2,  aged  74. 


VACANCIES. 

General  Hospital  for  Sick  Children,  Pendlebury,  Manchester.— 
Junior  Resident  Medical  Officer.  Salary  £80  per  annum,  with  board, 
etc.  Candidates  must  be  doubly  qualified  and  on  the  Medical  Register. 
Applications,  stating  age,  with  testimonials,  to  be  sent  to  the  Chairman 
of  the  Medical  Board  on  or  before  August  18. 

General  Infirmary  at  Gloucester  and  the  Gloucestershire  Eye 
Institution. — House-Surgeon.  Salary  at  the  rate  of  £100  per  annum, 
with  board,  lodging,  and  washing.  Candidates  must  possess  a  medical 
and  surgical  qualification  and  be  registered.  Applications,  with  testi¬ 
monials,  to  be  forwarded  to  the  Secretary  on  or  before  September  1. 

Gloucester  County  Asylum. — Assistant  Medical  Officer.  Salary  £100 

t  per  annum,  with  board,  lodging,  and  washing.  Candidates  must  be 
duly  qualified  men,  registered  both  in  medicine  and  surgery,  and  not 
over  thirty  years  of  age.  Applications,  with  testimonials,  to  be  sent  to 
the  Medical  Superintendent  (from  whom  all  further  information  can  be 
obtained),  on  or  before  August  20. 

Great  Northern  Hospital,  Caledonian-road,  N. — Junior  Resident 
Medical  Officer.  ( For  particulars  see  Advertisement.) 

Hartlepools  Hospital  and  Dispensary. — House-Surgeon  and  Secretary. 
Salary  £100  per  annum,  with  board,  lodging,  and  washing.  Applications 
and  testimonials  to  be  sent  to  J.  Rawlings,  Esq.,  13,  Cliff -terrace, 
Hartlepool,  not  later  than  August  18. 

Netherfield  Institution  for  Infectious  Diseases,  Liverpool. — 
Resident  Medical  Officer.  Salary  £80  per  annum,  with  board,  etc. 
Candidates  must  be  duly  qualified.  Applications,  with  testimonials, 
to  be  sent  to  Robert  Calder,  Secretary,  4,  Commercial-court,  17,  Water- 
street,  Liverpool  (from  whom  any  further  information  can  be  obtained), 
on  or  before  August  15. 

Weston-super-Mare  Hospital  and  Dispensary.  —  House-Surgeon. 
Salary  £70  per  annum,  with  board,  lodging,  and  washing.  Candidates 
possess  a  registered  surgical  and  medical  qualification.  Applications, 
with  qualifications  and  testimonials,  to  be  sent  to  the  Secretary,  on  or 
before  August  15.  The  election  will  take  place  on  August  23. 


UNION  AND  PAROCHIAL  MEDICAL  SERVICE. 

***  The  area  of  each  district  is  stated  in  acres.  The  population  is 
computed  according  to  the  census  of  1881. 

RESIGNATIONS. 

Cockermouth  Union. — Mr.  Thomas  Sadler  Douglas  has  resigned  the 
Workington  District :  area  16,235 ;  population  19,854 ;  salary  £30  per  annum. 

Peterborough  Union. — The  offices  of  Medical  Officer  for  the  Second  District 
and  for  the  Workhouse  are  vacant  by  the  death  of  Mr.  Thomas  Southam  : 
area  12,371;  population  22,592;  salary  by  fee  per  case.  Salary  for 
Workhouse  £45  per  annum. 

Ross  Union. — Dr.  C.  C.  Cocks  has  resigned  the  Fourth  District :  area 
15,110  ;  population  2901 ;  salary  £76  10s.  per  annum. 

APPOINTMENTS. 

Henley  Union. — George  Owen  Willis,  L.R.C.P.  and  L.R.C.S.  Edin. 
L.F.P.&  S.  Glasg.,  to  the  Greys  District.  '■ 

Petworth  Union.— Ralph  Jean  MacDermott,  B.A.,  M.B.  and  M.C.  Trin. 
Coll.  Dub.,  and  L.M.,  to  the  Third  District. 

Westbury-on-Sevem  Union. — William  Crawshay  Heane,  M.R.C.S.  Eng. 
and  L.S.  A.,  to  the  Fourth  District. 

Wilton  Union. — Challoner  Clay,  L.R.C.P.  and  L.R.C.S.  Edin.,  to  the 
Fovant  District. 


Handsome  Bequests  for  Veterinary  and  Medical 
Science. — Under  the  will  of  Miss  Mary  Diet,  who  died  re¬ 
cently,  the  residue  of  her  estate,  after  paying  certain 
legacies  (including  .£100  to  the  Society  for  Widows  of 
Veterinary  Surgeons),  is  to  he  retained  by  her  trustees  until 
it  amounts  to  £20,000.  It  is  then  to  be  divided,  and 
£10,000  given  for  the  furtherance  of  veterinary  science  in 
connexion  with  the  Veterinary  College  founded  by  the 
brother  of  the  testatrix — the  late  Professor  Dick — in  Edin¬ 
burgh  ;  and  the  other  £10,000  to  be  applied  in  founding  in 
Edinburgh  University  a  professorship  either  of  comparative 
anatomy  or  of  surgical  anatomy,  whichever  her  trustees  may 
consider  most  required  in  the  interests  of  medical  science. 

The  Library  of  the  Royal  Medical  and  Chirurgical 
Society  will  be  closed  on  Monday,  August  13,  and  reopened 
on  Thursday,  September  13  next. 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES 


August  11, 1883.  171 


VITAL  STATISTICS  OF  LONDON. 

Week  ending  Saturday,  August  4,  1883. 


BIRTHS. 

Births  of  Boys,  1253;  Girls,  1252;  Total,  2505. 

Corrected  weekly  average  in  the  10  years  1873-82,  2571'7. 


DEATHS. 


Males. 

Females. 

Total. 

Deaths  during  the  week . 

738 

727 

1465 

Weekly  average  of  the  ten  years  1873-82,  / 
corrected  to  increased  population  ...  J 

8703 

818-3 

168S6 

Deaths  of  peopleaged  80  and  upwards 

... 

... 

54 

DEATHS  IN  SUB-DI8TRICT3  FROM;  EPIDEMICS. 


1  Enumerated 

Population, 

1881 

(unrevised). 

Small-pox. 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

.3* 

ft  bfl 
o  P 

O  o 

O 

Typhus. 

Enteric  (or 
Typhoid) 
Fever. 

Simple 

continued 

Fever. 

Diarrhoea.  1 

West . 

669633 

3 

8 

1 

5 

3 

32 

North 

905947 

i 

12 

5 

4 

3 

... 

1 

32 

Central 

282238  ... 

6 

5 

3 

2 

... 

•  •• 

*  tt 

13 

East . 

692738 

21 

13 

3 

6 

1 

1 

30 

South . 

1265927 

27 

8 

5 

7 

... 

1 

... 

61 

Total . 

3816483 

1 

68 

39 

16 

23 

1 

6 

... 

168 

METEOROLOGY. 

From  Observations  at  the  Greenwich  Observatory. 


Mean  height  of  barometer  . 

•••  ...  t 

...  29-810  in. 

Mean  temperature  . 

...  ...  . 

...  60-6° 

Highest  point  of  thermometer 

. 

.  ...  766° 

Lowest  point  of  thermometer 

.  ...  466° 

Mean  dew-point  temperature 

...  ... 

...  53-4° 

General  direction  of  wind  . 

...  S.W. 

Whole  amount  of  rain  in  the  week  ... 

. 

.  ...  0'22  in. 

BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  the 
Week  ending  Saturday,  August  4,  in  the  following  large  Towns : — 


Cities 

and 

Boroughs. 

Estimated  Population  to 
middle  of  the  year  1883. 

j  Births  Registered  during 
the  week  ending  Aug.  4. 

t  Deaths  Registered  during 
;  (the  week  ending  Aug.  4. 

Annual  Rate  of 
Mortality  per  1000  living, 
from  all  causf  s. 

Temperature 
of  Air  (Fahr.) 

Temp, 
of  Air 
(Cent.) 

Rain 

Fall. 

Highest  during 
the  Week. 

Lowestduring 
|  the  Week. 

Weekly  Mean  of 
Daily  MeanValues 

Weekly  Mean  of 
Daily  Mean 
Values. 

In  Inches. 

In  Centimetres. 

London 

3955814 

2505 

1465 

193 

76-6 

46-6 

60-6 

15-90 

022 

056 

Brighton  ... 

... 

111262 

44 

28 

131 

74-0 

51-8 

61-4 

16-33 

021 

0-53 

Portsmouth 

... 

131478 

72 

47 

18-7 

_ 

... 

... 

Norwich  ... 

89612 

50 

30 

175 

... 

... 

Plymouth  ... 

74977 

40 

14 

97 

720 

49-0 

57-7 

14-28 

0-67 

1-70 

Bristol . 

... 

212779 

135 

61 

15-0 

69-6 

48-4 

57-2 

14-00 

0-70 

1-78 

Wolverhampton  . 

77557 

38 

24 

16-2 

69-5 

43-1 

56-1 

13  39 

0-43(1-09 

Birmingham 

... 

414846 

277 

161 

20-2 

... 

... 

... 

Leicester  ... 

'  t* 

129483 

98 

45 

18-1 

.  .  . 

Nottingham 

... 

199349 

171 

73 

191 

74-6 

43-0 

5S-4 

1466 

0-08 

0-20 

Derby . 

... 

85574 

59 

18 

11-0 

... 

... 

... 

... 

Birkenhead 

... 

88700 

69 

19 

11-2 

... 

... 

Liverpool  ... 

... 

566753 

349 

304 

28-0 

67-2 

52-1 

58  0 

14-44 

0-05 

0-13 

Bolton . 

107862 

60 

39 

18-9 

68  5 

48-0 

55-6 

1312 

0-17 

0-43 

Manchester 

.  . . 

339252 

219 

152 

234 

... 

•  »* 

... 

... 

Salford 

190465 

136 

72 

197 

... 

•  •• 

... 

Oldham 

119071 

51 

48 

210 

.  .  • 

... 

... 

Blackburn  ... 

108460 

76 

41 

19-7 

... 

Preston 

98564 

76 

51 

27-0 

69-C 

51-0 

59-0 

15-00 

0-03 

OD 

p 

O 

Huddersfield 

... 

84701 

37 

37 

228 

... 

... 

... 

... 

Halifax 

75591 

39 

22 

152 

... 

... 

Bradford  ... 

... 

204807 

108 

75 

19-1 

736 

47-5 

58-3 

14-61 

1-00 

2-64 

Leeds . 

... 

321611 

194 

139 

22-6 

71-0 

45-0 

68-0 

14-44 

079 

2-01 

Sheffield 

295497 

230 

116 

203 

73-0 

49-0 

58-0 

14-44 

0-22 

0-66 

Hull  . 

176296 

119 

53 

15-7 

75-0 

47-0 

581 

14-50 

017 

0-43 

Sunderland 

121117 

112 

49 

21-1 

... 

... 

... 

... 

... 

Newcastle  ... 

... 

149464 

95 

95 

332 

... 

... 

... 

... 

Cardiff . 

... 

90033 

68 

19 

110 

... 

... 

... 

... 

... 

For  28  towns 

... 

862C975 

5527 

3296 

200 

766 

430 

58-2 

14  55 

0-36 

0*91 

Edinburgh  ... 

235946 

131 

92 

20-3 

67-7 

45-5 

667 

1372 

0-72 

CD 

CO 

Glasgow 

515589 

402 

246 

249 

... 

1 

... 

... 

Dublin . 

... 

349383 

191 

115 

17-2 

667 

48-0:57-6 

1423 

0-32 

oo 

o 

At  the  Royal  Observatory,  Greenwich,  the  mean  reading 
of  the  barometer  last  week  was  29’Sl  in. ;  the  lowest  read¬ 
ing  was  29 ’44  in.  on  Monday  at  noon,  and  the  highest 
30-07  in.  on  Saturday  at  noon. 


NOTES,  QUERIES,  AND  REPLIES. 

- #. - 

He  tjrat  questioned  matjj  s^all  learn  muffr. — Bacon. 

B.  N. — The  dose  of  the  hydrochlorate  of  pilocarpine  is  from  ^  to  }  grain* 
by  mouth ;  and  from  fg  to  £  grain  hypodermically. 

The  Contagious  Diseases  Acts,  Devonport. — The  Devonport  Board  of  Com¬ 
missioners  have  again  discussed  the  action  of  the  Government  in* 
suspending  these  Acts,  and  have  resolved  to  take  further  action  in  con¬ 
junction  with  the  whole  of  the  local  authorities  in  the  Three  Towns, 
with  the  view  of  inducing  the  Government  to  reconsider  their  recent 
decision.  It  was  stated  that  in  Plymouth,  Stonehouse,  and  Devonport- 
the  suspension  of  the  compulsory  clauses  had  proved  a  grievous  calamity, 
and  it  was  unanimously  resolved  to  forward  a  second  memorial  to  the 
Government,  urging  the  great  importance  of  continuing  the  operation  of 
the  Acts. 

F.  R.S.— Dr.  John  Davy  was  the  brother  of  Sir  Humphry  Davy.  Some 
“  Recollections  ”  of  him  were  recorded  by  Professor  Gulliver  in  the 
Medical  Times  and  Gazette,  September  23,  1871.  The  warmest  friendship, 
existed  between  these  distinguished  men.  Of  Dr.  Davy,  Sir  Humphry 
says  in  his  Autobiography — 

“He  broke  no  promise,  served  no  vulgar  end  ; 

He  gained  no  title,  and  he  lost  no  friend.” 

A  Sanitary  Requisite,  Brighton—  During  the  past  ten  years  the  question  of 
a  public  abattoir  has  been  on  several  occasions  agitated,  but  no  practical 
result  has  been  attained,  chiefly  on  account  of  the  opposition  of  the  local 
butchers.  The  subject  is  again  revived,  and  an  influential  deputation 
has  lately  waited  upon  the  Sanitary  Committee  of  the  Town  Council,  and 
presented  a  memorial  signed  by  nearly  three  thousand  persons,  setting 
forth  the  necessity  of  such  an  establishment  in  the  Borough. 

A  Nurse  and  Infected  Clothing. — A  nurse  has  been  sentenced  by  the  Bir¬ 
mingham  magistrates  to  six  months’  imprisonment  with  hard  labour 
for  stealing  a  quantity  of  wearing  apparel  belonging  to  two  persons 
(husband  and  wife)  who  had  suffered  from  small-pox,  and  whom  she 
had  nursed  during  their  illness.  She  pledged  the  clothing  at  various- 
pawnbrokers’  shops,  but  the  greater  portion  of  it  has  been  recovered  by 
the  police.  The  goods,  and  also  the  shops,  were  subsequently  disinfected. 
When  arrested,  the  defendant  was  wearing  the  garments  which  she  wore 
when  nursing  the  prosecutor  and  his  wife. 

The  Holbeck  and  Leeds  Board  of  Guardians. — A  notice  of  motion  stands  for 
discussion  at  the  next  meeting  of  the  Holbeck  Board,  that  the  resolution 
in  favour  of  co-operating  with  the  Leeds  Guardians  on  the  amalgama¬ 
tion  of  several  poor-law  unions  be  rescinded. 

The  London  School  Board  and  Infectious  Diseases. — At  the  last  meeting  of 
the  Board  a  resolution  was  passed,  that  any  child  showing  symptoms  of 
an  infectious  disease,  or  any  child  coming  from  a  house  where  infectious 
disease  existed,  should  be  sent  home  at  once.  The  medical  officer  of 
health  for  the  district  must,  at  the  same  time,  be  informed  of  the- 
child’s  exclusion,  and  furnished  with  the  name  and  address  of  the  child, 
and  the  reason  for  its  exclusion.  When  there  is  not  a  medical  officer 
of  health,  the  information  must  be  forwarded  to  the  sanitary  authority. 
Any  child  suffering  from  scarlet  fever,  diphtheria,  small-pox,  or  typhus 
fever,  and  excluded  under  this  rule,  should  not  be  allowed  to  resume 
attendance  at  school  within  two  months,  unless  a  certificate  from  the 
medical  officer  of  the  sanitary  authority  or  of  the  union  was  produced 
to  show  that  it  may  safely  be  re-admitted  ;  and  when  a  child  has  been 
attended  by  a  duly  qualified  medical  practitioner,  his  signature  shall  be 
sufficient. 

Workmen's,  etc..  Clubs,  Liverpool.— Communications  have  recently  passed 
between  the  Home  Secretary  and  the  Liverpool  Watch  Committee  on 
the  subject  of  the  clubs  in  the  city,  of  which  there  are  many,  and  where 
drinking  is  alleged  to  be  carried  on.  A  report  has  been  prepared  and 
sent  to  the  Home  Office,  giving  the  number  of  clubs  and  the  modes  om 
which  they  are  carried  on  in  the  city.  This  information  is  required,  it 
is  stated,  preparatory  to  legislation  on  clubs. 

Scarborough—  The  deaths  in  this  town  for  the  fortnight  ending  the  28tb 
ult.  were  fifteen,  showing  a  death-rate  of  11'37  per  1000,  against  1573  in 
the  same  period  last  year. 

Outbreak  of  Diphtheria  in  Caine,  near  Bowood.1 — Touching  a  rather  alarm¬ 
ing  report  of  an  outbreak  of  diphtheria,  the  Mayor  writes,  on  the  25tts 
ult.  :  —  “  I  learn  from  inquiry  that  there  are  now  only  four  cases  among 
children  and  one  adult.  There  has  been  a  total  of  twenly-six  cases, 
resulting  in  four  deaths  among  children  and  not  one  adult  death.  The- 
ventilation  shafts  being  placed  completes  an  efficient  system  of  drain¬ 
age  which  has  been  lately  carried  out,  and  the  schools  have  been  closed 
a  little  earlier  than  the  regular  holidays  as  a  precautionary  measure. 
Within  the  past  year  a  private  company  has  brought  a  bountiful  supply 
of  pure  water  into  the  town,  and  Caine  may  be  considered  as  one  of  the- 
healthiest  of  English  towns.” 

Convalescent  Nome  for  Children,  Dundonald.-  In  this  village  a  convalescent, 
home  has  just  been  opened  by  the  Countess  of  Eglinton,  established, 
mainly  by  the  Hon.  Mr.  and  Mrs.  Vernon,  of  Auchans. 


172 


Medical  Tiraes  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES 


August  11, 1883. 


Dr.  J .  M.,  Liverpool. — In  his  interesting"  Retrospect  of  a  Long  Life,”  Mr 
S.  C.  Hall  states  that  Mr.  Edmund  Macnaghten,  of  Bushmills,  co. 
Antrim,  married  his  second  wife  when  he  was  eighty-two  years  of  age- 
By  this  marriage  he  became  the  father  of  two  sons,  the  eldest  of  whom 
was  a  Lord  of  the  Treasury  from  1819  to  1830 ;  the  youngest  was  born 
when  his  father  was  eighty-four  years  of  age.  Mr.  Macnaghten  lived 
till  1781,  and  died  at  the  age  of  102  years.  He  is  described  as  a  fine, 
hale,  handsome  old  man. 

Curious  Observation— A.  French  writer  observes  that  the  initials  of  the  five 
elements  (in  their  French  names)  which  enter  chiefly  into  the  composi¬ 
tion  of  organic  matter— namely,  carbone,  hydrogene,  azote,  oxygene,  and 
soufre — spell  chaos. 

Prosecutions  for  Milk  Adulteration,  and  the  Fines  imposed.— Mr.  Wigner, 
analyst,  in  his  report  to  the  Plumstead  Board  of  Works,  advises  the 
Board  to  prosecute  all  persons  selling  milk  found  adulterated  with 
10  per  cent.,  or  even  less,  of  water — a  suggestion  which  met  with  the 
approval  of  the  Board  ;  and  it  was  also  decided  to  write  to  the  Home 
Secretary,  urging  him  to  point  out  to  the  police  magistrates  the 
importance  of  making  the  fines  for  adulteration  heavier. 

Bearranging  the  Medical  Districts  of  the  City  of  London  Union. — The  Board 
of  Guardians  have  decided  on  a  rearrangement  of  the  outdoor  medical 
districts.  Two  of  the  district  medical  officers— Dr.  Smith  and  Mr. 
Humphreys — having  tendered  their  resignations,  the  occasion  is  con¬ 
sidered  opportune  for  carrying  out  the  alterations  proposed.  The 
opinion  of  the  Board  is  that  the  districts  for  the  supply  of  medical  relief 
to  the  poor,  as  well  as  for  the  general  benefit  of  the  Union,  as  at  pre¬ 
sent  existing,  should  be  changed,  and  that,  in  the  place  of  six  districts, 
three  only  for  the  future  should  exist.  Towards  effecting  this  change 
a  six  months’  notice  was  decided  to  be  given  to  Mr.  Read  to  determine 
his  office  of  medical  officer  of  the  present  district  No.  2.  Dr.  Thompson, 
Mr.  Brown,  and  Mr.  Sequeira,  having  acquiesced  in  the  alteration  of 
their  present  districts,  and  consented  to  act  for  the  new  districts,  it  was 
decided  that  they  be  appointed  respectively  to  those  districts  at  a  salary 
of  £220  per  annum  each. 

Vacant  Coronership. — The  Town  Council  of  Hythe  have  declared  the 
coronership  vacant,  in  consequence  of  the  mysterious  disappearance  six 
weeks  ago  of  Mr.  W.  8.  Smith,  Clerk  of  the  Peace  and  Coroner  for  the 
borough. 

Brandy  as  a  Medicine.— The  magistrates  at  Tredegar  had  lately  to  decide 
a  rather  novel  case.  The  landlord  of  an  inn  was  charged  with  having 
supplied  brandy  to  a  customer  during  prohibited  hours.  He  successfully 
urged  in  his  defence  that  the  brandy  was  only  supplied  as  medicine. 
The  magistrates  dismissed  the  case.  But  the  Licensing  Act,  1874, 
prescribes  the  penalty  for  selling  intoxicating  liquors  during  prohibited 
hours,  and  specifies  certain  cases  in  which  the  seller  may  be  excused, 
although  it  does  not  include  among  them  the  sale  of  spirits  for  medicinal 
purposes. 

The  Valrymple  Inebriate  Home. — This  Home  is  established  under  the 
Habitual  Drunkards  Act,  1879,  at  “  The  Cedars,”  Rickmansworth.  It 
is  a  freehold  property,  and  has  been  obtained  for  £3700.  The  house 
contains  twenty  large  rooms,  and  has  around  it  laid-out  grounds  of 
about  four  acres  and  a  half.  Money  is  still  wanted  to  complete  the 
purchase  and  furnish. 

Cheap  Fish  Supply  for  Workhouses.— A  smack  owner  of  the  Grimsby  Docks 
has  offered  to  supply  the  Islington  Guardians,  for  the  Workhouse,  at  2d. 
per  lb.,  ready  dressed  for  cooking,  cod,  ling,  haddock,  skate,  whiting, 
and  gurnet.  If  a  large  quantity  be  required,  soles,  turbot,  salmon,  etc., 
in  season,  for  the  officers,  at  the  same  price.  He  is  supplying  over  forty 
public  institutions,  and  has  given  satisfaction.  The  offer  was  referred 

"to  the  Visiting  Committee  of  the  Board  for  consideration  and  report. 

The  Butterine  Company. — This  Company  has  held  an  exhibition  of  samples 
of  butterine  at  the  Cannon-street  Hotel,  in  order  to  show  that  the 
article  compares  favourably  with  real  butter,  for  which  it  is  a  cheap 
substitute.  The  difference  between  butter  and  butterine  would  appear 
to  be  that  the  one  is  based  upon  the  fat  drawn  from  milk,  and  the  other 
upon  the  internal  fat  of  cattle.  The  appearance  of  the  butterine  was 
precisely  like  that  of  real  butter,  and  in  taste  butterine  would  pass  for 
good  butter. 

Church  Public-house  Property. — The  Ecclesiastical  Commissioners,  it  is 
stated,  contemplate  taking  certain  action  in  regard  to  public-houses  of 
which  they  are  the  owners. 

Cur  Nuisance  Inspectors  and  Bad  Fruit.—  It  transpired,  on  an  application 
of  the  sanitary  officer  of  St.  George’s  Vestry,  Borough,  to  the  Southwark 
magistrate  for  an  order  for  the  immediate  destruction  of  a  large  quan¬ 
tity  of  Australian  apples  which  were  utterly  rotten,  that  the  inspectors 
employed  by  the  City  authority  seldom  examined  the  foreign  fruit,  and 
costermongers  frequently  complained  of  receiving  bad  samples. 

Children  in  American  Factories. — It  is  stated  that  the  New  Jersey  Protec¬ 
tion  Law  is  to  be  strictly  enforced.  It  forbids  the  employment  of  girls 
under  fourteen,  and  boys  under  twelve  years  of  age,  in  factories.  It  is 
estimated  that  nearly  two  thousand  children  of  the  prescribed  ages  are 
employed  in  the  factories,  shops,  and  stores  of  Trenton  alone.  The 
inspector,  recently  appointed,  is  visiting  the  various  districts,  and 
announces  his  determination  to  enforce  the  statute  to  the  letter. 


Egyptian  Bags  and  Cholera.— During  a  discussion  at  the  Liverpool  Town 
Council,  last  week,  on  the  danger  arising  from  the  arrival  in  the  port  of 
cargoes  of  rags  collected  in  Egypt  and  sent  to  Liverpool,  it  transpired 
that  the  medical  adviser  of  the  Local  Government  Board  seemed  to  have 
doubts  whether  cholera  could  be  spread  from  rags,  and  requested  that 
information  should  be  given  him  as  to  any  specific  case  in  which  cholera 
had  been  conveyed  through  rags.  It  is  stated  that  the  authorities  at 
Alexandria  were  prohibiting  the  exportation  of  rags  altogether. 

Legal  Powers  for  the  Abatement  of  Nuisances. — The  solicitors  to  the  Clerken- 
well  Vestry  advise  that  the  Vestry  can  legally  delegate  power  to  the 
Sanitary  Committee  to  take  action  for  the  abatement  of  nuisances  under 
the  Nuisances  Removal  Act.  The  Sanitary  Committee  desired  that 
powers  be  delegated  to  them  to  take  legal  proceedings  under  the  Sani¬ 
tary  Acts,  where  necessary,  for  the  enforcement  of  notices  to  abate 
nuisances. 

Unwholesome  Food.—  At  the  Worship-street  Police-court,  upon  an  applica¬ 
tion  by  the  sanitary  inspector,  Shoreditch,  the  magistrate  granted  an 
order  for  the  destruction  of  a  large  quantity  of  bullocks’  hearts  which 
were  offered  for  sale  in  the  district  at  3d.  a  pound.  These  hearts  had 
been  imported  from  Russia,  and  were  in  an  advanced  stage  of  decompo¬ 
sition. - At  Bradford,  a  sausage-maker  has  been  sent  to  prison  for  three 

months  with  hard  labour,  for  having  on  his  premises  a  quantity  of  meat 
diseased  and  unfit  for  human  food.  It  was  stated  that  the  defendant 
had  branch  shops  in  Liverpool  and  London. 

COMMUNICATIONS  have  been  received  from — 

Dr.  Brinsley'  Nicholson,  London ;  Dr.  B.  W.  Richardson,  F.R.S., 
London ;  Dr.  Mercier,  London  ;  Dr.  C.  R.  Francis,  London  ;  Dr.  N. 
Cheyers,  London;  The  Registrar  of  the  Apothecaries’  Hall, 
London;  The  Secretary  of  the  Royal  College  of  Surgeons  of 
Edinburgh;  Messrs.  Mottershead  and  Co.,  Manchester ;  Mr.  J.  H. 
Williams,  Denbigh;  Dr.  W.  H.  Pbarse,  Plymouth  ;  The  Secretary 
of  the  University  of  Edinburgh  ;  Mr.  J.  Chatto,  London ;  Dr.  J.  M. 
Bruce,  London  ;  Inspector-General  Robert  Lawson,  London ;  Mr.  T. 
M.  Stone,  London ;  The  Secretary  of  the  Army  Medical  School, 
Netley  ;  Dr.  J.  W.  Moore,  Dublin;  The  Registrar-General  fob 
Scotland,  Edinburgh ;  The  Sanitary  Commissioner,  Punjab  ;  The 
Secretary  of  the  University  of  Glasgow;  The  Registrar-General 
for  Queensland  ;  The  Registrar-General  for  England. 

BOOKS,  ETC.,  RECEIVED  - 

A  New  Departure  in  Medical  Electricity— Experimental  Researches  of  the 
Tension  of  the  Vocal  Bands,  by  F.  H.  Hooper,  M.D. — Bes  Effets  Com¬ 
pares  de  Divers  Traitements  de  la  Fievre  Typhoide,  par  le  Dr.  Buboue 
—  An  Atlas  of  Hlustrations  of  Pathology  :  fasc.  v.,  Diseases  of  the  Liver 
(The  New  Sydenham  Society)— Dwellings  and  the  Death-rate  of  Man¬ 
chester,  by  A.  Samuelson,  M.D. 

PERIODICALS  AND  NEWSPAPERS  RECEIVED  — 

Lancet— British  Medical  Journal— Medical  Press  and  Circular — Ber¬ 
liner  Klinische  Wochenschrift — Centralblatt  fur  Chirurgie — Gazette 
des  Hopitaux— Gazette  Medicale— Revista  de  Medicina — Bulletin  de 
1’AcaddmiedeMedecine—  Pharmaceutical  Journal — Wiener  Medicinische 
Wochenschrift — Revue  Medicale— Gazette  Hebdomadaire— Nature — 
Boston  Medical  and  Surgical  Journal— Louisville  Medical  News — 
Centralblatt  fur  Gynakologie — Le  Concours  Medical— Centralblatt  fur 
die  Medicinischen  Wissenschaften — Centralblatt  fiir  Klinische  Medicin 
— Philadelphia  Medical  News— Le  Progres  Mbdical — Revue  Mensuelle 
de  Laryngologie,  d’Otologie,  etc. — Journal  of  Anatomy  and  Physiology, 
etc. — Analyst— Practitioner — Ballymoney  Free  Press,  August  2 — Week- 
blad— L’lmpartialite  Medicale — Journal  de  Saxon — Indian  Medical 
Gazette — Alienist  and  Neurologist — An  Ephemeris  of  Materia  Medica, 
etc. 


APPOINTMENTS  POE  THE  WEEK. 

August  11.  Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  l£  p.m. ;  King’s  College,  1 J  p.m. ;  Royal 
Free,  2  p.m.;  Royal  London  Ophthalmic,  11  a.m. ;  Royal  Westminster 
Ophthalmic,  li  p.m. ;  St.  Thomas’s,  ljp.m.;  London,  2  p.m. 

13.  Monday. 

Operations  at  the  Metropolitan  Free,  2  p.m. ;  St.  Mark’s  Hospital  for 
Diseases  of  the  Rectum.  2  p.m.;  Royal  London  Ophthalmic,  11  a.m.; 
Royal  Westminster  Ophthalmic,  li  p.m. ;  Hospital  for  Women,  2  p.m. 

14.  Tuesday. 

Operations  at  Guy’s,  li  p.m. ;  Westminster,  2  p.m. ;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  li  p.m.;  West 
London,  3  p .m. _ 

15.  Wednesday. 

Operations  at  University  College.  2  p.m. ;  St.  Mary’s,  li  p.m. ;  Middlesex, 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew's,  li  p.m.  ;  Great  Northern, 

2  p.m. ;  Samaritan,  2i  p.m. ;  Royal  London  Ophthalmic,  11  a.m. ; 
Royal  Westminster  Ophthalmic,  li  p.m. ;  St.  Thomas’s,  li  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m.;  National  Orthopaedic,  Great 
Portland-street.  10  a.m. 

16.  Thursday. 

Operations  at  St.  George’s,  1  p.m. ;  Central  London  Ophthalmic,  1  p.m.; 
Royal  Orthopaedic,  2  p.m.;  University  College,  2  p.m.;  Royal  London 
Ophthalmic, 11  a.m. ;  Royal  Westminster  Ophthalmic,  li  p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m. ;  Hospital  for  Women,  2  p.m. ; 
Charing-cross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  2i  p.m. 

17.  Friday. 

Operations  at  Central  London  Ophthalmic,  2  p.m. ;  Royal  London  Ophthal¬ 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminster 
Ophthalmic,  lip.m.;  8t.  George’s  (ophthalmic  operations),  If  p.m. ; 
Guy’s,  11  p.m. ;  St.  Thomas’s  (ophthalmic  operations),  2  p.m. ;  King’s 
College  (by  Mr.  Lister),  2  p.m. 


Ctf.'fSHpsB? 

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Ru 

LIBRARY 


Medical  Times  and  Gazette. 


COWELL  ON  STRANGULATED  EEMORAL  HERNIA.  August  is,  ms.  173 


CLINICAL  LECTURE 

ON  A  CASE  OF  STRANGULATED  FEMORAL 

HERNIA, 

COMPLICATED  WITH  OLD  PERITONEAL  ADHESIONS. 

Delivered  at  Westminster  Hospital. 

By  GEORGE  COWELL,  F.R.C.S., 

Senior  Surgeon. 


Gentlemen, — The  patient  whom  you  have  just  seen  in 
Queen  Anne  Ward,  and  who  will  he  discharged  to-morrow, 
is  one  to  whose  case  I  have  frequently  called  your  attention 
during  the  seven  weeks  that  she  has  been  an  inmate  of  the 
Hospital.  Many  of  you  have  watched  the  progress  of  this 
patient  with  considerable  interest,  and  I  make  no  apology 
for  inviting  you,  in  our  lecture  to-day,  to  go  through  the 
history  of  the  case  from  the  beginning,  even  at  the  risk  of 
repeating  much  that  I  have  already  said  to  you.  The  case 
is  as  instructive  as  it  is  interesting,  since  it  especially  affords 
•an  opportunity  of  adding  to  your  stock  of  experience  of  the 
complications  that  may  occur  in  cases  of  strangulated  hernia, 
and  illustrates  some  of  the  difficulties  that  have  to  be 
overcome  in  dealing  with  them. 

I  will  first  read  to  you  the  notes  of  the  case,  which  has 
been  fully  reported  by  Mr.  F.  W.  McDonogli,  one  of  my 
dressers,  and  afterwards  call  your  attention  to  its  important 
features. 

Ellen  J.,  aged  forty-eight,  married,  was  admitted  seven 
weeks  ago  to  Queen  Anne  Ward,  under  Mr.  Cowell’s  care, 
suffering  from  symptoms  of  strangulated  hernia. 

Her  previous  history  is  that  seven  years  ago,  after  a 
fatiguing  walk,  she  had  severe  pain  and  tenderness  in  the 
right  groin.  This  passed  off  in  a  few  days,  but  she  dis¬ 
covered  in  the  same  position  a  swelling  about  the  size  of  a 
small  walnut,  which,  however,  she  could  easily  reduce. 
Nothing  further  was  thought  of  it  until  about  two  years 
ago,  when,  finding  that  the  tumour  had  gradually  become 
as  large  as  a  hen’s  egg,  she  was  advised  to  get  a  truss. 
This  truss  was  a  badly  fitting  one ;  it  often  slipped  out  of 
place,  and  was  worn  irregularly.  Sometimes,  after  more 
standing  about  than  usual,  the  hernia  became  tense,  painful, 
and  difficult  to  get  back,  but  up  to  the  present  she  states 
that  she  has  always  succeeded  in  returning  it.  Since  she 
has  been  ruptured  she  has  had  one  miscarriage  and  one 
child  born  alive.  At  both  these  times  the  hernia,  though 
down,  in  no  way  inconvenienced  her. 

The  immediate  history  is  that  of  late  the  patient  has  been 
suffering  from  a  bad  cough,  and  that  directly  after  a  long 
walk  on  the  evening  of  the  day  previous  to  her  admission  a 
violent  fit  of  coughing  came  on.  The  account  that  she  gives 
is  that  the  walking  had  displaced  her  truss,  allowing  a  little 
of  the  hernia  to  escape,  and  that  the  coughing  had  forced 
it  down  completely.  About  two  hours  afterwards  she  had 
pain  in  the  abdomen,  and,  feeling  sick,  took  a  tumbler  of  salt- 
and-water  in  order  to  induce  vomiting.  The  hernia  now 
"became  s  wollen  and  painful,  and  she  removed  the  truss  and 
tried  to  reduce  the  hernia.  Finding  herself  unable  to  do  so, 
she  sent  for  a  medical  man,  who,  after  applying  the  taxis 
under  chloroform,  had  ordered  her  to  be  placed  in  a  hot  bath 
for  an  hour. 

The  patient  was  admitted  to  the  Hospital  about  six 
hours  after  the  occurrence  of  the  first  symptoms.  Her  face 
was  pale,  pinched,  and  anxious  in  expression.  She  was  much 
troubled  with  eructation,  and  she  vomited  a  yellowish,  semi¬ 
fluid  matter  without  any  characteristic  smell  about  it.  She 
also  complained  of  a  heavy,  dragging  pain  in  the  abdomen, 
and  a  twisting  sensation  around  the  umbilicus.  On  the 
right  side  there  was  a  very  tense  femoral  hernia  about  the 
size  of  a  duck’s  egg. 

Reduction  was  not  immediately  attempted,  on  account  of 
the  somewhat  prolonged  manipulation  the  hernia  had  under¬ 
gone  before  admission.  Fifteen  minims  of  tincture  of  opium 
were  administered,  and  an  ice-bag  was  applied  to  the  hernia. 
The  symptoms  continued  unabated,  and  in  the  morning  the 
House-Surgeon  made  a  gentle  trial  of  the  taxis,  but  with¬ 
out  result.  The  ice-bag  was  continued,  and  the  patient 
was  seen  at  2  p.m.  by  Mr.  Cowell,  who  at  once  decided  to 

Vol.  II.  1883.  No.  1729. 


operate.  The  vomiting  was  not  stercoraceous,  but  the 
hernia  was  tense  and  painful,  and  there  was  an  anxious 
expression  of  face.  The  operation  was  performed  under 
chloroform  with  antiseptic  precautions.  An  incision  nearly 
four  inches  long  was  made  through  the  skin  over  the 
tumour,  and  the  various  coverings  of  the  hernia  were 
opened  up  on  a  broad  director.  It  was  found  necessary  to 
open  the  sac,  and  the  stricture  (Gimbernat’s  ligament)  was 
divided,  and  the  gut  (of  a  light  claret  colour)  was,  after 
being  examined,  returned.  A  piece  of  omentum,  which 
formed  part  of  the  hernia,  was  held  by  adhesions,  and 
irreducible.  A  portion  of  it  was  ligatured  and  cut  through, 
and  the  stump  was  left  in  the  wound.  Mr.  Cowell  passed 
his  finger  through  the  wound  by  the  side  of  the  omental 
stump,  and  found  the  returned  gut  free.  The  wound  was 
sewn  up,  the  ends  of  ligature  around  omentum  being  left 
out.  A  thick  pad  of  antiseptic  gauze  was  firmly  bandaged 
on  with  a  spica  of  the  same  material.  There  was  very 
little  bleeding  and  no  vessel  was  tied.  As  the  patient  left 
the  theatre  she  was  very  sick,  the  vomit  being  yellowish- 
brown  in  colour.  At  4  p.m.,  pulse  136;  respirations  26; 
temperature  99‘2°.  At  8  p.m.,  temperature  102°.  At  12  p.m., 
temperature  100°. 

The  next  day  (Wednesday)  the  note  was:  “The  sickness 
continued  at  intervals  throughout  the  night;  some  sleep 
was  obtained,  however.  An  opium  pill  was  given,  but 
vomited  up  immediately.  Shortly  afterwards  she  retained 
ten  minims  of  tincture  of  opium.  Nothing  else  but  ice  was 
taken.” 

At  11  a.m.,  pulse  108 ;  respirations  26.  At  5  p.m.,  pulse 
136 ;  respirations  36.  Still  sick ;  vomit  is  dark  brown,  and 
has  a  slightly  faecal  odour.  Temperature  until  12  noon 
kept  at  100°;  at  4  p.m.  it  was  101°,  and  at  8  p.m.  102°. 
During  the  day  she  took  about  three  ounces  of  brandy  in 
iced  water.  Face  is  still  very  pale  and  pinched;  no  pain 
complained  of. 

Thursday. — The  sickness  has  continued  throughout  the 
night,  and  the  patient  has  had  but  little  sleep.  The  vomit 
is  darker,  and  has  a  slightly  faecal  odour.  On  Mr.  Cowell’s 
arrival,  at  1'  p.m.  (pulse  128;  respirations  30;  temperature 
100°),  the  dressings  were  removed  under  antiseptics,  the 
sutures  divided,  and  the  wound,  which  was  healing  by  first 
intention,  was  opened.  A  knuckle  of  intestine  was  found 
occupying  the  wound.  It  was  seen  to  be  bright  and  injected, 
and  had  evidently  formed  part  of  the  former  hernia.  It 
was  easily  reduced,  and  pushed  by  the  finger  a  short  distance 
from  the  femoral  ring.  The  wound  was  closed  with  sutures 
as  before,  and  a  graduated  compress  of  lint  was  very  firmly 
applied  with  a  spica  of  ordinary  bandage.  The  patient  was 
very  sick  soon  afterwards.  At  8  p.m.  the  abdomen  was 
slightly  tympanitic,  but  not  very  sensitive  on  pressure.  An 
enema  (soap-and- water  one  pint  at  normal  temperature)  was 
administered,  and  acted  slightly.  Sickness  by  this  time 
had  much  abated,  several  sips  of  mixed  beef-tea  and  brandy 
being  taken.  Temperature  102°,  and  at  12  p.m.  99-4°. 

Friday. — Patient  has  passed  a  good  night,  but  is  still 
sick  occasionally.  Has  felt  no  great  pain  or  inconvenience. 
The  tympanites  has  diminished.  Temperature  at  10  a.m., 
98-8° ;  pulse  132  ;  respirations  32.  Tongue  small,  pointed, 
red,  and  moist;  a  little  white  fur  on  dorsum.  Has  taken 
several  sips  of  beef -tea  aud  brandy  mixed  with  iced  water. 
She  wants  “  a  good  drink  of  milk.”  Face  is  still  pale ;  has 
a  slight  yellowish  tinge  and  looks  anxious.  At  twelve  noon 
temperature  was  99° ;  pulse  148 ;  respirations  32.  Patient 
now  had  a  second  enema,  which  gave  some  relief,  but  did 
not  result  in  any  satisfactory  bowel  action.  At  4  p.m.  the 
patient  was  seen  by  Mr.  Cowell.  There  had  been  some 
return  of  the  sickness  accompanied  by  a  slight  cough.  A 
dose  of  tinct.  opii  (fifteen  minims)  had  been  given.  The 
vomit  is  of  a  light  yellowish-brown  colour,  and  of  a  slightly 
faecal  odour,  and  is  only  brought  up  with  much  retching. 
The  patient  is  weaker.  The  temperature  is  96°.  Mr.  Cowell, 
finding  that  there  were  still  signs  of  intestinal  obstruction, 
decided  to  re-examine  the  wound  and  the  gut  in  its  neigh¬ 
bourhood.  On  removing  the  dressings,  which  were  not  dis¬ 
placed,  and  opening  the  wound,  which  was  not  looking 
healthy  as  on  the  previous  day,  what  appeared  to  be  the 
same  piece  of  intestine  was  found  down  again.  The  patient 
was  put  under  the  influence  of  chloroform.  Mr.  Cowell  in¬ 
troduced  his  finger  through  the  wound  along  the  intestine 
as  far  as  it  would  reach,  when  the  point  just  touched 
what  appeared  to  be  a  constriction  of  the  intestine.  Thi.- 


174 


Medical  Times  and  Gazette. 


COWELL  ON  STRANGULATED  FEMORAL  HERNIA. 


August  18, 1883. 


was  pulled  down  through  the  crural  ring,  and  it  was  found 
that  there  was  a  broad  band  of  adhesion  of  peritoneum 
loosely  surrounding  the  gut.  This  was  easily  broken  down 
with  the  finger.  Further  examination  showed  that  higher 
still  there  was  a  second  narrower  band  of  adhesion  con¬ 
stricting  the  intestine  in  a  similar  way.  This  also  having 
been  torn  through,  the  gut  was  cleansed  with  a  sponge 
dipped  in  weak  carbolic  lotion,  and  returned.  It  was  well 
pushed  aside  in  order  that  the  same  portion  of  intestine 
might  not  present  again  at  the  crural  ring,  and  a  sponge 
was  thrust  in  the  wound  and  kept  there  by  means  of  a  pad 
of  lint  and  a  spica  bandage.  The  carbolic  spray  was  used 
throughout.  At  8  p.m.,  pulse  104;  respirations  28;  tempera¬ 
ture  96’8°.  Has  been  sick  twice  since  the  operation,  and 
has  had  a  natural  motion,  dark  in  colour  and  very  offensive. 
Temperature  at  12  p.m.,  98’2°. 

Saturday. — Patient  was  much  troubled  with  cough  during 
the  night,  and  had  a  slight  headache,  but  no  sickness. 
Temperature  at  8  a.m.,  97'4°  ;  pulse  148  ;  respirations  28.  At 
8  p.m.,  temperature  98‘4° ;  pulse  124 ;  respirations  24.  Bowels 
have  been  opened  naturally  three  times ;  stools  still  dark  and 
offensive.  No  sickness  all  day.  The  wound  was  dressed, 
and  a  fresh  sponge  applied. 

Sunday. — Is  very  much  better,  having  passed  a  good  night. 
Temperature  at  4  a.m.,  96'4°;  at  8  a.m.,  98'2°.  Bowels  open 
again.  The  cough  is  better  and  the  headache  is  gone.  At 
12  noon,  temperature  97° ;  pulse  120 ;  respirations  24.  Wound 
dressed  in  the  afternoon  ;  sponge  taken  out ;  some  sloughing 
omentum  removed,  and  ligature  now  came  away.  A  fresh 
sponge  was  put  in,  and  kept  there  with  a  compress  of  lint 
and  spica  as  before.  At  12  p.m.,  temperature  98-2°.  Tinct. 
opii  Tl\xv.  was  given,  as  patient  was  wakeful.  Nearly  two 
pints  of  beef-tea,  the  same  quantity  of  milk,  and  six  ounces 
of  brandy,  together  with  ice  ad  lib.,  have  been  taken  during 
the  past  twenty-four  hours. 

Monday. — Cough  was  troublesome  again  during  the  night. 
This  morning  she  feels  stronger,  looks  less  pale,  and  has 
quite  lost  her  anxious  look.  A  fresh  sponge  was  put  in  the 
wound  to-day,  but  not  quite  so  deeply.  Some  more  slough 
was  removed  ;  rest  of  wound  looked  clean.  Temperature  at 
4  a.m.  was  97° ;  normal  the  rest  of  the  day.  Pulse  averaged 
108°,  and  respirations  24.  Bowels  well  opened ;  stools  more 
natural . 

Tuesday. — Passed  a  good  night ;  this  morning  she  is  quite 
comfortable,  cough  having  nearly  left  her.  She  sleeps  at 
intervals  throughout  the  day,  awaking  suddenly  with  a 
start.  Pulse  104 ;  respirations  28 ;  temperature  normal  all 
day.  Wound  dressed  in  the  afternoon  ;  no  slough  removed, 
but  slight  offensive  serous  discharge  on  sponge.  Bowels 
not  open  all  day.  Is  to  be  fed  less  frequently,  more  being 
given  at  a  time. 

Wednesday. — During  the  night  she  complained  of  flatu¬ 
lence,  and  was  relieved  by  an  enema.  At  12  noon,  pulse  100 ; 
respirations  24 ;  temperature  normal.  Wound  dressed  as 
before;  was  clean  and  looked  smaller.  Bowels  opened 
naturally  during  the  day. 

The  next  day  no  sponge  was  put  in  the  wound,  but  a  small 
pad  of  lint  was  placed  on  each  side  of  it  to  press  the  edges 
together,  and  a  larger  one  over  these,  secured  by  a  spica. 
The  temperature,  pulse,  and  respiration  were  normal,  and 
the  bowels  open.  The  cough  is  now  very  slight. 

Subsequently  the  wound  was  dressed  every  day,  and 
rapidly  healed.  The  appetite  gradually  improved.  On  the 
thirteenth  day  after  the  last  operation,  fish  was  ordered  in 
addition  to  the  milk  and  beef-tea  diet,  and  eleven  days  later, 
meat  was  substituted  for  the  fish.  The  patient  has  steadily 
gained  strength,  and  the  recovery  has  been  uninterrupted. 

This,  gentlemen,  is  the  history  of  the  case.  The  first 
point  to  which  I  wish  to  call  your  attention  is  the  signifi¬ 
cance  of  the  symptoms.  The  patient  has  been  ruptured  for 
seven  years,  had  herself  been  able  to  reduce  the  small  but 
gradually  increasing  hernia,  and  had  therefore  not  sought 
surgical  advice  until  about  two  years  ago.  She  was  then 
advised  to  get  a  truss,  but,  as  it  did  not  fit  her,  it  was  worn 
with  great  irregularity.  Let  me  say,  in  passing,  that  a 
surgeon  has  not  discharged  his  duty  to  his  patient  when  he 
has  prescribed  a  truss.  A  truss  must  fit  accurately,  or  it 
will  not  be  worn  with  comfort  by  the  patient,  and  will  fail  to 
fulfil  the  object  for  which  it  is  ordered — that  of  preventing 
the  descent  of  the  hernia.  Neither  the  patient  nor  the 
instrument-maker  are  the  proper  judges  of  the  efficiency  of 


a  truss,  and  it  is  as  important  for  the  surgeon  to  see  froi^. 
time  to  time  the  patient  for  whom  he  has  ordered  a  truss,  as 
it  is  for  the  physician  to  see  the  patient  for  whom  potent 
drugs  may  have  been  prescribed.  I  advise  you,  at  all  events, 
to  make  it  a  rule  to  see  for  yourself  that  a  patient,  for  whom 
a  truss  has  been  ordered  for  the  first  time,  is  in  possession, 
of  an  instrument  which  fulfils  the  desired  objects.  The 
symptoms  of  pain  and  nausea  in  our  patient  seem  to  have 
commenced  two  hours  after  the  descent  of  the  hernia,  when 
she  sought  relief  from  her  symptoms  by  taking  an  emetic  in 
the  shape  of  a  tumbler  of  salt-and-water.  This  was  pro¬ 
bably  unfortunate,  as  it  could  hardly  have  failed  to  increase 
the  tension  in  the  hernia,  and  rapidly  to  favour  the  esta¬ 
blishment  of  a  condition  of  strangulation.  Her  subsequent 
attempts  to  reduce  the  hernia  of  course  failed,  as  did  those 
of  the  surgeon  who  was  sent  for,  and  who  very  properly 
sought  the  aid  of  an  anaesthetic. 

By  the  time  that  the  patient  was  admitted  to  the  hospital 
the  rupture  was  really  in  a  condition  of  strangulation,  bat 
it  is  probable  that  at  this  hour  (soon  after  midnight)  the 
symptoms  were  by  no  means  urgent.  They,  however, 
gradually  became  more  so  during  the  night,  and  when  I 
saw  her  the  constipation  had  been  complete  for  nineteen  or 
twenty  hours,  and  the  pain  in  the  hernia  and  in  the 
abdomen,  and  the  vomiting  (not  stercoraceous),  were  pro¬ 
nounced.  The  hernia  too  was  very  tense,  and  there  was 
certainly  a  “  pale,  pinched,  and  anxious  ”  expression  of 
face,  though  not  to  any  marked  degree.  Still,  there  was  no 
doubt  as  to  the  propriety  of  at  once  proceeding  to  place  the 
patient  under  the  influence  of  an  anaesthetic,  and,  if  neces¬ 
sary,  to  operate.  No  prolonged  use  of  the  taxis  was  made, 
as  it  is  unwise,  either  when  the  symptoms  have  lasted  for 
some  time,  or  when,  as  in  the  case  before  us,  vigorous 
applications  of  the  taxis  have  been  previously  made.  It 
was  found  necessary  to  open  the  sac,  for,  although  the  hernia 
was  very  tense,  the  almost  absence  of  resonance  pointed  to 
the  probability  of  the  presence  of  omentum.  This  was  found 
to  be  the  case,  and  some  bands  of  adhesion  which  existed 
between  the  omentum  and  the  sac  rendered  it  very  difficult 
to  return  the  large  knuckle  of  not  very  dark-coloured  in¬ 
testine.  The  omentum  was  irreducible,  and  I  thought  it 
advisable  to  ligature  a  portion  of  it,  leaving  the  stump  with 
the  adhesions  to  close  the  femoral  ring. 

We  now  come  to  an  instructive  point  of  this  case.  I  have 
before  impressed  upon  you  the  great  importance,  after  the 
wound  has  been  sponged,  of  passing  the  finger  through  the 
ring  to  ascertain  that  the  portion  of  intestine  which  has 
been  returned  is  free  within  the  peritoneal  cavity.  The 
subsequent  history  of  this  case  teaches  us  that,*at  least  in 
old  hernias,  this  examination  must  be  as  thorough  and  com¬ 
plete  as  the  finger  of  the  surgeon  will  permit.  Had  I  passed 
my  finger  a  little  further  than  I  did  when  making  my  final 
examination  before  closing  the  wound,  I  should  in  all  pro¬ 
bability  have  discovered  the  bands  of  adhesion  which  con¬ 
tinued  to  constrict,  although  they  did  not  strangulate,  the 
intestine,  and  which  were  probably  within  reach  of  the  tip 
of  my  finger.  I  should  thus  have  spared  my  patient  three 
additional  days  of  suffering  and  much  increased  danger. 

I  need  hardly  point  out  to  you  the  impunity  with  which 
omentum  may  be  removed.  There  is  often  great  difficulty 
in  returning  even  a  not  very  large  piece  of  omentum.  It 
can  only  be  done  by  beginning  at  one  edge  of  it,  and 
gradually  paying  it  in.  If  there  be  any  difficulty,  or  if 
there  are  adhesions,  it  may  be  left  if  quite  healthy,  but  it 
is  often  safer  to  place  a  ligature  tightly  round  it  and  to  cut 
it  off.  This  should  always  be  done  if  the  omentum  is  in¬ 
flamed  or  indurated,  or  has  in  any  way  been  altered  by  the 
strangulation.  The  plug  which  is  thus  formed  should  be 
secured  in  the  ring  as  was  done  in  this  case,  as,  if  it  becomes 
firmly  adherent,  it  is  sometimes  efficacious,  when  firmly 
supported  by  a  truss,  in  preventing  the  subsequent  descent 
of  the  hernia. 

Another  practical  point  which  is  worthy  of  notice  is  the 
great  advantage  of  inserting  a  sponge  in  the  wound.  In 
consequence  of  the  re-opening  of  the  wound  by  the  escape 
of  intestine  and  for  exploration  there  was  some  loss  of 
vitality  of  the  coverings  of  the  hernia  and  some  discharge. 
After  the  liberation  and  reduction  of  the  hernia  at  the  last 
operation  the  wound  was  plugged  with  a  sponge  washed  in 
carbolic  solution.  This  was  retained  in  position  by  a  firmly 
applied  pad  and  bandage.  The  sponge  soaked  up  all  the 
discharge,  and  the  wound  very  rapidly  cleaned  and  granu- 


If  edits!  Times  and  Gazette. 


GEE  ON  LITERATURE  OF  DISEASES  OF  CHILDHOOD. 


August  18, 1383.  175 


lated.  A  clean  sponge  was  applied  daily  for  five  days,  and 
then  it  was  discontinued. 

I  have  several  times  used  a  sponge  in  this  way,  and  can 
strongly  recommend  it  whenever  it  is  necessary  to  leave  a 
stump  of  omentum  secured  by  a  ligature.  There  is  nearly 
always  in  these  cases  some  slight  amount  of  sloughing,  and 
a  clean  sponge  changed  once  or  twice  daily  is  the  best  form 
•of  absorbent  dressing  with  which  I  am  acquainted.  The 
•elasticity  of  the  sponge  adds  to  its  effect  upon  the  wound. 


AN  ADDRESS 

DELIVERED  AT  THE  OPENING  OP 

THE  SECTION  OF  DISEASES  OF  CHILDREN, 

At  the  Annual  Meeting  of  the  British  Medical  Association 
in  Liverpool,  August,  1883. 

By  SAMUEL  GEE,  M.D.,  F.E.C.P., 

Physician  to  St.  Bartholomew’s  Hospital  and  to  the  Hospital  for 
Sick  Children. 


A  SURVEY  OF  THE  LITERATURE  OF  THE  DISEASES  OF 
CHILDHOOD. 

In  all  studies  of  this  kind,  we  turn  to  Hippocrates  first  of 
all.  Among  the  numerous  treatises  which  bear  his  name, 
there  is  only  one  which  is  devoted  to  the  pathology  of 
children,  and  that  is  the  essay  on  Dentition.  It  is  a  chain 
of  aphorisms,  concerning  the  common  disorders  of  children 
who  are  teething  :  vomiting,  diarrhoea,  cough,  convulsions, 
and  fever  are  mentioned;  but  almost  half  the  treatise  relates 
to  “  ulcers  of  the  tonsils,”  a  disease  difficult  to  identify  in 
modern  practice.  In  the  work  which  especially  bears  the 
name  of  the  “  Aphorisms,”  there  are  some  slight  references  to 
children’s  diseases  :  e.g.,  in  bk.  iii.,  aph.  24,  25,  26.  “  To 
little  and  newborn  children :  aphth®,  vomiting,  coughs, 
sleeplessness,  frights,  inflammation  of  the  navel,  watery 
discharges  from  the  ears ;  at  the  approach  of  dentition  : 
pruritus  of  the  gums,  fevers,  convulsions,  diarrhoea,  espe¬ 
cially  in  cutting  the  canine  teeth,  and  in  those  who  are 
particularly  fat,  and  have  constipated  bowels;  to  persons 
•somewhat  older :  affections  of  the  tonsils,  incurvation  of 
the  spine  at  the  vertebra  next  the  occiput,  asthma,  calculus, 
round,  worms,  ascarides,  acrochordon,  satyriasmus,  choerades, 
and  other  phymata.”  But,  in  all  the  Hippocratic  treatises, 
the  passage  which  is,  for  us,  the  most  interesting  by  far,  is 
that  remarkable  description  of  mumps,  which  we  find  at  the 
beginning  of  the  first  book  of  the  “  Epidemics.”  I  believe  we 
may  affirm  that  it  is  the  only  description  left  us  by  the 
ancients  of  that  one  of  the  very  few  acute  specific  diseases 
which  they  knew.  Although  mumps  is  thus  the  earliest 
acute  specific  disease  to  be  recorded,  yet  has  it  been  the  last 
to  gain  universal  acceptance  ;  you  will  remember  that  Eelix 
Niemeyer  does  not  admit  the  acute  specific  form  of  parotitis 
which  we  call  mumps.  In  Celsus,  Areteeus,  and  Aurelian  I 
do  not  recollect  anything  relative  to  children’s  diseases 
worth  notice ;  nor  need  I  refer  to  the  little  which  Paulus  has 
to  say  upon  our  topic. 

The  name  of  Rhazes  must  be  held  in  honour  by  us,  for 
he  is  the  earliest  writer  of  a  treatise  upon  the  diseases  of 
•children— -such  as  it  is ;  for  the  chapters,  which  are  very 
short,  consist  almost  wholly  of  therapeutics,  often  absurd 
enough.  Of  semeiology,  or  description  of  disease,  there  is 
little  or  nothing.  Rhazes  was  born  gbout  the  middle  of  the 
ninth  century,  in  Persia.  He  has  another  claim  to  our 
notice,  inasmuch  as  the  earliest  extant  writings  upon  small¬ 
pox  and  measles  bear  his  name. 

The  seven  hundred  years  which  passed  away  between 
Rhazes  and  Francis  Glisson,  added  hardly  anything  to 
knowledge.  Yet  I  must  mention  the  first  English  book 
upon  children’s  diseases,  namely,  “The  Boke  of  Childerne, 
composed  by  Thomas  Phayer,  studiouse  in  Philosophie  and 
Physicke,”  published  in  1544.  This  is  that  same  Phayer 
who  is  better  known  as  a  translator  of  a  part  of  the  iEneid. 
It  is  clear  that  Phayer’s  book  is  founded  upon  Rhazes,  who 
is  referred  to  in  several  places,  and  in  one  is  spoken  of  as 
“  Rasis,  a  solemne  practicioner  among  phisicions.”  But 
Phayer’s  list  of  diseases  is  fuller  than  that  of  Rhazes,  and 
perhaps  it  will  not  be  found  wearisome  to  read  the  heads  of 
the  sundry  chapters  of  Phayer’s  little  book. 


The  sixteenth  century  was  rife  in  Latin  poetry,  and  even 
in  medicine  the  poets  found  work  for  their  muses.  You  all 
know  the  name  of  Fracastorius,  the  author  of  the  poem 
called  “Syphilis,”  in  three  books.  (I  may  just  say,  in  this 
place,  that  Paracelsus  was  the  first  to  mention  inherited 
syphilis,  in  1529.)  Fifty-four  years  after  the  appearance  of 
Fracastorius’s  poem — namely,  in  1584 — Gaucher  de  Sainte 
Marthe,  or  Scasvola  Sammarthanus  (as  he  Latinised  his 
name),  published  a  poem,  also  in  three  books,  called  “  Paodo- 
trophia  ” — that  is  to  say,  the  rearing  of  children.  The  first 
book  relates  to  the  feetus,  or,  what  is  the  same  thing,  to  the 
management  of  pregnant  women;  the  second,  to  the 
management  of  sucklings  ;  and  the  third,  to  their  diseases. 
Ste.  Marthe  was  a  French  gentleman,  but  not,  as  might  be 
supposed,  a  physician.  His  merits  as  a  Latin  poet  I  will 
not  pretend  to  gauge.  Some  have  held  his  “  Psedotrophia  ” 
to  fall  not  far  short  of  the  “  Georgies  ”;  and  it  might  be 
asked  why  the  rearing  of  babies  should  sound  more  like 
burlesque  in  a  poem  than  the  rearing  of  corn,  vines,  and 
cattle.  Be  this  as  it  may,  the  poem  has  been  translated  into 
English  twice.  The  earlier  translation  is  anonymous,  and 
was  published  in  1710  ;  the  latter  is  by  H.  W.  Tytler,  M.D., 
and  appeared  in  1797.  Ty tier’s  version  is  closer  to  the 
original,  but  dull ;  whilst  there  is  a  coarse  vigour  about  the 
earlier  translation  which  makes  it  amusing. 

Here  I  may  just  allude  to  an  Italian  poem  upon  the 
suckling  of  children,  written  about  1560,  by  Luigi  Tansillo — 
the  title,  “  La  Balia,”  or  “  The  Nurse  ” — and  it  was  deemed 
worthy  of  translation  by  the  eminent  citizen  of  Liverpool, 
William  Roscoe.  The  second  edition,  which  I  possess,  bears 
date  1800.  The  author  denounces  wet-nurses,  and  exhorts 
the  Italian  ladies  themselves  to  suckle  their  children. 

Leaving  this  laureate  fraternity  of  poets,  let  me  speak  of 
a  little  book  entitled  “  De  Morbis  Puerorum,  or  a  Treatise 
of  the  Diseases  of  Children,  etc.,  by  Robert  Pemell,  Prac¬ 
titioner  in  Physick  at  Cranebrooke  in  Kent,  May  the  29, 
1653.”  He,  no  doubt,  practised  among  the  rich  clothiers  who 
then  dwelt  in  the  Weald  of  Kent,  and  in  Cranbrook  espe¬ 
cially.  His  book  is  an  improvement  upon  Phayer’s,  yet, 
perhaps,  it  is  hardly  too  much  to  say  that  there  had  been  no 
great  increase  of  knowledge  since  the  time  of  Rhazes,  or 
even  of  Hippocrates. 

But  better  things  were  at  hand.  On  the  thirtieth  page  of 
this  book,  Pemell  refers  to  “a  learned  treatise  set  forth 
lately  by  three  or  four  doctors,”  on  rickets.  This  was  no 
other  than  Glisson’s  “  De  Rachitide  sive  Morbo  Puerili,  qui 
vulgo  The  Rickets  dicitur,  Tractatus,”  first  published  in  1650. 
Glisson  marks  the  beginning  of  a  new  epoch  in  the  know¬ 
ledge  of  children’s  diseases,  and*  may  be  said  to  hold  a  place 
like  that  of  Yesalius  in  human  anatomy,  of  Harvey  in 
physiology,  of  Morgagni  in  morbid  anatomy,  and  of  Laennec 
in  semeiology.  There  can  be  no  doubt  that  Glisson  dis¬ 
covered  rickets,  yet  he  was  not  the  first  to  print  a  book  upon 
the  subject.  He  spent  more  than  five  years  in  writing  his 
treatise,  and  he  was  helped  by  other  Fellows  of  the  College 
of  Physicians;  so  that  rickets  had  been  much  talked  about 
before  the  appearance  of  Glisson’s  book,  and  he  was  fore¬ 
stalled  by  those  who  had  the  pen  of  a  ready  writer. 
I  may  mention  Theophilus  de  Garencieres,  who  is  said  to 
have  published  at  London,  in  1647,  a  small  book  upon  rickets, 
entitled  “  Anglia;  Flagellum,  seu  Tabes  Anglica,”  which  I 
have  not  seen. (a)  In  1649,  Arnold  Boot  published,  at 
London,  a  small  book,  entitled  “  Observations  Medic®  de 
Affectibus  Omissis,”  the  twelfth  chapter  of  which  contains 
a  description  of  “  tabes  pectorea,”  or  rickets.  But  what 
shall  I  say  of  Daniel  Whistler,  who,  in  1684,  published  in 
London  an  essay  upon  rickets,  which  he  pretended  to  be  a 
reprint  of  an  academical  thesis  which  he  had  first  printed 
in  1645,  or  five  years  before  Glisson’s  book  appeared  ?  I 
cannot  help  thinking  that  too  much  trust  has  been  put  upon 
Whistler’s  word  of  honour.  Haller,  for  instance,  in  his 
“Bibliotheca  Medica  Practica”  (1777),  speaks  (vol.  ii.,  p. 
706)  of  an  academical  disputation,  “  De  Morbo  Puerili  dicto 
Rickets,”  published  at  Leyden  in  1645,  by  Daniel  Whist  (sic). 
The  mistake  in  Whistler’s  name  makes  it  doubtful  whether 

(a)  Since  the  above  was  written  I  have,  through  the  kindness  of  Dr. 
Allchin,  perused  the  copy  of  “De  Garencieres”  which  belongs  to  the 
Medical  Society,  and  I  find  that  the  treatise  does  not  relate  to  rickets  at 
all,  but  to  a  kind  of  pulmonary  consumption,  not  easy  to  identify.  Yet 
the  book  has  been  largely  quoted,  especially  by  the  Germans,  as  a 
treatise  on  rickets;  the  title,  I  suppose,  misled  them.  The  learning 
of  too  many  goes  no  further  than  the  title-page,  and  this  at  second 
hand. 


176 


Med'cal  Times  and  Gazette. 


GEE  ON  LITERATURE  OF  DISEASES  OF  CHILDHOOD. 


August  18, 1883". 


Haller  had  seen  the  disputation  which  he  quotes.  Dr. 
Norman  Moore,  some  years  ago,  caused  inquiries  after  this 
alleged  thesis  of  Whistler’s  to  be  made  at  Leyden,  and  he 
tells  me  that  they  know  nothing  about  it  there.  It  was  in 
1684,  the  year  wherein  Whistler  published  his  essay  in 
London,  that  he  died  in  well-deserved  disgrace,  having 
robbed  the  College  of  Physicians,  of  which  he  was  then 
President.  Wherefore,  in  that  year,  his  word  of  honour  was 
about  as  trustworthy  as  a  dicer’s  oath.  In  short,  Dr.  Moore 
believes,  and  I  agree  with  him,  that  Whistler’s  academical 
disputation  of  1645  may  be  but  another  of  Whistler’s 
frauds. 

Glisson,  I  say,  discovered  rickets.  He  asserts  that  rickets 
was  a  new  disease,  which  had  first  appeared  in  Dorset  and 
Somerset  about  1620.  But  Glisson  was  born  in  Dorset  in 
1597 ;  so  that  in  1620  he  would  be  twenty-three  years  old ; 
and  the  doubt  rises  whether  the  newness  belonged  to  the 
disease,  or  to  the  mental  eye  of  the  young  man.  In  general 
I  am  not  disposed  to  put  much  faith  in  the  upspringing 
of  new  diseases.  I  find  it  more  easy  to  believe  that  they 
have  been  overlooked ;  still  more,  that  they  have  been  con¬ 
founded.  I  find  it  more  easy  to  believe  that  men  have 
been  blind,  rather  than  that  nature  has  been  inconstant 
during  the  few  hundred  years  which  go  to  make  up  written 
history.  Else  we  must  suppose  that  a  new  Pandora  has 
emptied  her  box  upon  our  unhappy  age,  so  many  are  the 
new  diseases  which  we  know  only  too  well,  and  our  fathers 
knew  not  at  all.  I  can  believe  that  morbid  poisons  spread 
from  one  part  of  the  world  to  another,  as  the  intercourse  of 
men  becomes  more  free.  I  can  believe  that  syphilis  first 
appeared  in  Europe  at  the  end  of  the  fifteenth  century,  and, 
if  I  could  believe  that  rickets  is  nothing  but  a  form  of  in¬ 
herited  syphilis,  I  would  admit  it  to  be  possible  that  rickets 
arose  about  a  hundred  years  later.  Otherwise,  if  it  be  due 
to  the  operation  of  common  causes,  it  must  have  existed  so 
long  as  the  present  conditions  of  human  life. 

In  the  same  shire  of  Dorset  was  born,  twenty-seven  years 
after  Glisson,  a  man  whose  name  is  still  more  famous, 
Thomas  Sydenham.  In  his  writings  we  find  the  first  clear 
references  to  three  diseases  of  childhood  under  their  present 
names ;  I  mean  whooping-cough,  Vitus’  dance,  and  scarlet 
fever.  But  Sydenham  makes  no  claim  to  have  discovered 
these  diseases ;  yet  his  descriptions  are  a  starting-point  in 
their  history.  With  regard  to  his  description  of  scarlet 
fever,  I  must  say  that  it  seems  to  me  to  tally  more  with 
the  scarlatiniform  kind  of  roseola  described  by  Dr.  Maton, 
than  with  what  we  call  scarlet  fever.  I  cannot  omit  to  remind 
you  that  Sydenham  has  left  us  the  first  good  and  sufficient 
history  of  measles. 

Sydenham  was  prone  to  jesting  of  that  grave  kind  which 
dullards  misunderstand.  You  remember  the  answer  which 
he  gave  to  Blackmore,  who  asked  for  advice  as  to  medical 
books  :  “  Read  Don  Quixote,  sir.”  Dr.  Walter  Harris  fell 
another  victim  to  Sydenham’s  naughty  habit.  Harris  had 
written  a  book,  “  De  Morbis  Acutis  Infantum  and,  show¬ 
ing  it  to  Sydenham,  the  great  man  said  that  it  was  the 
only  book  which  he  himself  would  fain  have  written.  With 
this  imprimatur,  the  book  was  republished  several  times, 
and  translated  three  times  into  English — namely,  by  W. 
Cockburn,  M.D.,  John  Martyn,  and  by  an  anonymous  hand 
in  a  collection  of  tracts  on  children’s  diseases  published  in 
1742.  Yet  Harris’s  is  a  poor  production ;  all  that  I  have 
carried  away  from  a  perusal  is,  that  he  attended  the  son  of 
the  Right  Hon.  the  Earl  of  This,  and  the  daughter  of  the 
Right  Rev.  the  Bishop  of  That,  to  say  nothing  about  people 
of  inferior  quality. 

With  the  eighteenth  century,  books  upon  our  topic  become 
numerous.  Most  of  them  are  bad  enough,  but  those  which 
were  written  to  teach  (or  to  catch)  the  people  are  by  far 
the  worst.  Some  of  these  books  of  advice  to  mothers,  on 
the  rearing,  and  feeding,  and  nursing  of  children,  sick  and 
well,  are,  indeed,  masterpieces  of  twaddle.  It  would  almost 
seem  as  if  the  writers  wished  to  make  good  the  saying  that 
an  old  woman  is  the  best  doctor  for  a  baby.  Yet,  perhaps, 
this  excuse  may  be  made,  that  the  ignorance  of  most  women 
is  such  that  even  twaddle  is  better  than  nothing. 

Take  Boerhaave’s  “  Aphorisms  ”  for  a  standard  of  know¬ 
ledge  at  the  beginning  of  the  century,  and  you  will  find 
that  teeth  and  worms,  like  two  inauspicious  planets,  still 
rule  the  sphere  of  children’s  diseases.  And  mark  the  sim¬ 
plicity  of  this  pathology— until  two  years  of  age,  or  a  little 
later,  children  are  breeding  their  teeth ;  afterwards  worms 


become  common :  so  that,  between  the  one  and  the  other, 
we  never  need  to*  fail  for  a  diagnosis ! 

In  the  eighteenth  century  children’s  diseases  came  to  be 
much  better  understood  in  three  particulars — namely,  croup, 
tubercular  meningitis,  and  the  eruptive  fevers.  First,  with, 
regard  to  croup.  It  is  spoken  of  under  the  name  of  “  the 
croops,”  by  Dr.  Patrick  Blair,  in  a  letter  to  Dr.  Richard 
Mead,  dated  Coupar  of  Angus,  July  6,  1713,  and  published! 
in  a  book  entitled  “  Miscellaneous  Observations,  etc.,”' 
London,  1718  (page  92).  But  Blair’s  description  is  very 
meagre,  and  the  first  adequate  history  of  croup  is  Francis 
Home’s,  published  at  Edinburgh  in  1765.  The  first  bronch- 
otomy  in  croup  was  performed  by  John  An  dree  on  February 
11,  1782,  at  Hertford,  I  believe.  In  a  paper  read  before  tlm 
Medical  Society  of  London  on  October  31,  1796,  Henry 
Field  first  distinguished  spasmodic  from  inflammatory- 
croup. 

Next,  with  regard  to  acute  hydrocephalus,  or  tubercular- 
meningitis  as  we  now  call  it.  Single  and  ill-described  cases, 
of  the  disease  were  published  by  Dr.  St.  Clair  and  Mr.  John 
Paisley  before  the  appearance  of  the  treatise  of  Robert 
Whytt.  Yet  no  damage  can  be  done  to  the  claim  brought 
forward  on  behalf  of  Whytt,  that  he  must  be  deemed  the 
discoverer  of  acute  hydrocephalus,  inasmuch  as  he  was  the 
first  to  write  a  history  of  the  disease,  in  the  true  empiric 
sense  of  the  word  history.  Whytt’ s  “  Observations  ”  were 
published  at  Edinburgh  in  1768,  two  years  after  liis 
death. 

Lastly,  with  regard  to  the  eruptive  fevers,  small-pox  and 
measles  had  been  well  distinguished  by  Sydenham.  In  1730,. 
Fuller  affirmed  that  chicken-pox  (or  crystals,  as  he  calls  it)) 
was  a  distinct  disease.  But  Heberden’s  paper,  read  before 
the  College  of  Physicians  on  August  11,  1767,  is  the  real 
beginning  of  our  knowledge  about  chicken-pox.  The  anginal 
form  of  scarlet  fever  was  first  studied  in  this  century;; 
Fothergill’s  “  Account  ”  appeared  in  1748;  and  in  1779 
Withering  established  the  scarlatinal  nature  of  the  disease.. 
In  1798,  Edward  Jenner  published  his  “  Inquiry  into  Cow- 
pox.”  And,  in  order  to  complete  this  topic,  I  will  just  enter 
the  next  century  and  refer  to  Maton’ s  paper,  read  before 
the  College  of  Physicians  on  April  4,  1814,  wherein  the- 
scarlatiniform  variety  of  contagious  roseola  is  first  described. 

Poets  still  found  themes  in  our  branch  of  knowledge-. 
Dr.  Hugh  Downman,  of  Exeter,  published  in  1774  the  first 
instalment  of  a  didactic  poem  entitled  “  Infancy ;  or,  the 
Management  of  Children.”  The  poem,  complete  in  six 
books,  was  published  in  1788.  The  copy  I  possess  is  called 
the  sixth  edition,  and  dated  1802.  Unluckily,  Downman 
writes  in  metre  without  rhyme,  and  blank  verse  opens  the 
floodgates  of  prolixity. 

We  have  now  reached  the  nineteenth  century,  and  litera¬ 
ture  becomes  so  immense  that  any  chronicle  and  brief  abstract 
of  the  time  will  be  very  defective.  The  great  increase  of 
knowledge  in  our  age  has  been  chiefly  due  to  two  causes,. 
namely,  to  the  study  of  morbid  anatomy,  and  to  the  in¬ 
vention  of  the  methods  of  physical  examination,  which 
are,  indeed,  the  study  of  morbid  anatomy  in  the  living 
subject.  In  both  these  respects  pre-eminent,  the  name- 
of  Laennec  at  once  comes  to  mind ;  and  no  man,  since- 
Hippocrates,  has  exerted  so  powerful  an  influence  upon 
medicine  as  he.  His  fame  as  the  inventor  of  auscultation 
has  dimmed  what  would  otherwise  have  been  his  fame  as  a 
morbid  anatomist.  And  I  must  not  forget  Bayle,  whose 
book  on  Phthisis,  published  in  1810,  and  whose  earlier 
papers,  are  the  starting-point  of  the  modern  doctrine  of 
tubercle ;  and  how  large  a  part  tubercle  plays  in  the  path¬ 
ology  of  children  I  need  not  say.  Bretonneau’s  work  upon 
diphtheria  and  typhoidfever  was  so  original  and  so  conclusive- 
that  he  may  almost  be  said  to  have  discovered  those  dis¬ 
eases.  It  was  in  France  that  inherited  syphilis  was  first 
discussed  in  a  manner  such  as  the  importance  of  the  topic 
deserved.  Duchenne  discovered  the  pseudo-hypertrophic 
form  of  paralysis,  and  what  he  calls  obstetrical  paralysis.” 
And,  lastly,  how  successful  the  pathology  of  the  nervous 
system  has  been  cultivated  by  living  Frenchmen,  you  all 
know  well. 

Coming  back  to  our  own  country,  I  will  refer  to  the  work 
of  Willan  upon  skin  diseases  ;  to  John  Clarke,  whose  descrip¬ 
tion  of  laryngismus  stridulus  is  the  first  which  deserves 
notice ;  to  William  Charles  Wells,  the  discoverer  of  scarla¬ 
tinal  albuminuria ;  to  John  Burne,  whose  papers  upon  typh¬ 
litis  are  the  beginning  of  definite  knowledge  of  that  disease  $ 


Medical  Time*  and  Gazette. 


MERCIER  ON  METAPHYSICS  IN  PATHOLOGY. 


August  18,  1883.  177 


and  to  George  Gregory,  of  whom  the  same  may  he  said  with 
regard  to  tubercular  peritonitis. 

Dr.  Bowditch  of  America  is  still  alive,  yet  I  cannot  help 
alluding  to  his  invention  of  the  method  of  paracentesis 
which  is  now  commonly  called  aspiration.  It  is  true  that 
adaptation  of  a  syringe  to  a  cannula  is  as  old  as  Anel,  and 
perhaps  older ;  but  it  is  no  less  true  that  the  chest  was 
mot  aspirated  before  the  day  of  Dr.  Bowditch. 

Lastly,  I  must  mention  the  three  most  useful  means  of 
physical  examination  which  we  owe  to  Germany,  namely, 
-the  thermometer,  re-introduced  by  W underlich ;  the  oph¬ 
thalmoscope,  invented  by  Helmholtz ;  and  the  laryngoscope 
•of  Tiirck  and  Czermak. 

Before  I  sit  down,  I  wish  to  bring  before  you  one  truth, 
-which  this  sketch  makes  very  clear.  Looking  over  the 
names  of  the  men  whom  we  have  celebrated — the  men  who 
Lave  made  our  knowledge  what  it  is, — I  do  not  find  one  who 
•could  be  called  a  specialist  in  children’s  diseases ;  but  the 
multitude  are  mad  after  specialties.  Ho  wonder !  for  we 
are  the  descendants  of  those  who,  in  their  sickness,  wor¬ 
shipped  fetishes  and  charms,  or  sought  after  star-gazers 
and  the  touch  of  kings.  Our  children  will  deem  us  to  be, 
in  other  respects,  no  less  simple.  Besides,  it  is  a  true  say¬ 
ing  that  “  the  world  suspects  a  man  who  can  do  two  things 
well.”  As  the  poet  says  : — 

“  One  science  only  will  one  genius  fit ; 

So  vast  is  art,  so  narrow  human  wit.” 

But  art  is  not  yet  so  vast,  nor  human  wit  so  narrow, 
ihat  the  diseases  of  children  need  be  made  a  specialty ; 
and  I  believe  that  none  of  us  are  specialists  in  the  popular 
and  evil  sense  of  the  word.  For  my  own  part,  if  I  may 
speak  so  much  of  myself,  being  physician  to  a  hospital  for 
children,  and  to  a  much  greater  hospital  for  people  of  all 
ages,  I  can  see  that  my  knowledge  of  children’s  diseases 
would  be  much  poorer  and  meaner  than  it  is,  were  it  not 
for  the  larger  experience  I  gain  at  St.  Bartholomew’s.  I 
wish  that  the  governors  of  the  general  hospitals  would  make 
more  provision  for  sick  children,  and  then  the  need  for 
special  children’s  hospitals  would  pass  away. 


Starchy  Foods  for  Infants. — In  a  paper  in  the 
Boston  Med.  Jour.,  July  12,  Dr.  Keating,  of  the  Philadelphia 
Hospital,  relates  several  experiments  which  he  has  made  in 
refutation  of  the  prevalent  idea  that  until  the  third  month, 
or  even  later,  no  saliva  is  secreted,  and  therefore  that  starchy 
foods  cannot  be  assimilated.  He  observes  that  this  seems 
surprising  enough  in  face  of  the  fact  that  among  the  poorer 
classes  children  are  often  found  to  thrive  very  well  when  fed 
upon  corn,  starch,  and  other  farina,  to  the  exclusion  of  other 
food.  His  experiments  were  made  with  the  saliva  of  twenty- 
one  children  varying  in  age  from  six  days  to  seventeen 
months.  From  these  he  concludes — 1.  The  saliva  of  some 
infants  possesses  the  power  of  converting  starch  into  glucose 
without  regard  to  age.  2.  The  age  of  infants  cannot  be 
taken  as  an  indication  of  this  property  of  the  saliva.  3.  When 
such  a  condition  is  found  to  exist,  a  small  quantity  of  well- 
prepared  farinaceous  food  is  valuable  as  an  element  of  diet, 
incorporated  with  cow’s  milk.  4.  An  examination  of  the 
stools  of  children  so  fed  would  be  a  guide  as  to  the  quantity 
of  starchy  food  to  be  used ;  and  when  farinaceous  food  is 
employed,  slow  feeding  is  probably  preferable  to  the  bottle. 

The  Blind  in  Japan. — Dr.  Whitney,  writing  from 
Tokio  to  the  Philadelphia  Med.  Times,  April  7,  states  that 
the  blind  in  Japan,  who  are  numerous,  gain,  in  a  great  many 
instances,  a  comfortable  living  by  performing  shampooing 
or  massage,  as  ordered  by  Japanese  physicians  in  various 
diseases.  Formerly  also  they  were  allowed,  after  undergoing 
rigorous  examinations,  to  perform  acupuncture;  and  the 
skill  and  anatomical  knowledge  they  sometimes  exhibited 
was  wonderful.  Not  only  had  they  a  gentle  touch  and  an 
almost  instinctive  appreciation  of  the  seat  of  pain,  but  many 
of  them  knew  all  the  superficial  muscles,  and  could  tell  in  what 
position  to  insert  the  needles  for  the  cure  of  certain  diseases. 
Unfortunately,  they  also  sometimes  conveyed  scabies  and 
other  diseases  to  their  patients,  and  thus  fell  out  of  repute. 
Their  services,  however,  as  shampooers  are  still  in  great 
demand.  They  were  formerly  endowed  by  law  with  various 
privileges,  but  these  have  been  abolished,  and  the  “  pro¬ 
fession”  thrown  open.  Dr.  Whitney  suggests  that  this 
useful  art  might  be  taught  to  some  of  the  blind  in  America. 


METAPHYSICS  IN  PATHOLOGY. 

By  CHAKLES  MEECIEE,  M.B.,  etc. 

Dr.  Creighton’s  Address  in  Pathology  at  the  recent 
meeting  of  the  British  Medical  Association  appears  to  me  a 
very  memorable  one,  and  as  the  chief  obstacle  to  the  clear 
conception  of  a  very  important  and,  I  believe,  most  fruitful 
hypothesis  is  a  difficulty  which  Dr.  Creighton  himself  terms 
metaphysical,  an  attempt  to  solve  this  problem  may  be  of 
service  to  him  and  to  other  workers  in  the  same  field.  Since 
the  day  of  Auguste  Comte  no  one  has  dared  openly  to  avow 
himself  a  metaphysician.  The  term  metaphysics  is  rarely 
now  restricted  to  its  rigorous  scientific  meaning,  but  is 
commonly  used  in  an  epithetical  sense  to  stigmatise  any 
unpopular  doctrine  ;  and  “  metaphysician  ”  is  considered  to 
be  another  name  for  that  unfortunate  class  of  persons  whose 
defects  of  character  are  set  forth  with  so  much  emphasis  in 
the  Book  of  Proverbs.  The  metaphysician  is  a  scientific 
outcast— a  pariah ;  he  is  despised  and  rejected  of  men;  he 
is  become  a  by-word  and  a  shaking  of  the  head  ;  his  doctrines 
are  Anathema,  Maranatha, — which  I  believe  is  something 
very  bad  indeed.  Dr.  Creighton  passes  him  by  on  the  other 
side.  Dr.  Balthazar  Foster  points  at  him  with  the  finger 
of  scorn,  and  the  British  Medical  Journal  says  to  him  Tush. 
When  I  say,  therefore,  that  we  all  talk  and  think  metaphysi¬ 
cally  at  times,  that  scientific  men  very  frequently  do  so,  and 
that  the  most  severely  practical  men  are  the  greatest  sinners 
in  this  respect,  I  have  no  doubt  that  the  statement  will 
arouse  as  much  astonishment  as  M.  Jourdain  experienced 
on  a  similar  occasion.  If  I  can  show  that  the  problem, 
which  Dr.  Creighton  thinks  is  likely  to  occupy  the  mind  of 
the  profession  for  years  to  come,  admits  of  immediate  and 
definite  solution ,  I  shall  claim  some  consideration  for  the 
discredited  calling  of  metaphysics ;  and  when  I  find  Dr. 
Creighton  able  to  conceive,  and  willing  to  admit,  the 
existence  of  such  a  highly  metaphysical  entity  as  “the 
mind  of  the  profession,”  I  do  not  despair  of  being  able  some 
day  to  welcome  him  to  the  ranks  of  those  who  profess  and 
call  themselves  metaphysicians. 

I  have  called  the  Address  a  very  memorable  one ;  and  for 
this  reason — that  it  is  the  first  attempt  to  apply  the  great 
Doctrine  of  Evolution  to  the  question  of  the  origin  of 
specific  diseases.  It  is  not,  indeed,  the  first  introduction  of 
the  doctrine  into  medicine.  For  years  past  it  has  been  applied 
by  Dr.  Hughlings-Jackson  to  the  elucidation  of  diseases 
of  the  nervous  system,  but  the  method  of  its  application  to 
this  region  of  pathology  is  of  a  totally  different  character  from 
that  by  which  Dr.  Creighton  attempts  to  solve  the  mystery 
of  the  existence  of  specific  diseases.  With  regard  to  nervous 
diseases  the  assumption  is  made  that  the  body  and  its  func¬ 
tions  have  become  what  they  are  by  a  gradual  process  of 
evolution  extending  through  an  immeasurable  past,  and 
that  the  changes  of  structure  and  disorders  of  function  that 
we  term  disease  are  manifestations  of  the  complementary 
process  of  Dissolution,  which  is,  speaking  generally,  a  de¬ 
struction  following  the  inverse  order  of  the  construction. 
The  process  of  evolution  is  considered  as  it  builds  up  the 
structures  and  functions  of  the  body  ;  the  process  of  disso¬ 
lution  is  considered  as  it  tears  them  down :  and  this  latter 
process  is  itself  the  disease.  Dr.  Creighton’s  method  of 
applying  the  doctrine  is  a  very  different  one,  as  befits  the 
very  different  nature  of  the  phenomena  to  which  he 
applies  it.  He  takes  a  disease,  such  as  small-pox  or  tuber¬ 
culosis,  which,  as  we  know  it,  is  an  aggregate  of  enormous 
complexity,  and  involves  processes  so  different  from  those  of 
health  that  there  is  no  discernible  community  of  nature 
between  the  two;  and  he  endeavours  to  show  that  this  com¬ 
plex  disease  may  have  gone  through  a  process  of  evolution 
comparable  with  that  of  the  body  itself.  It  may  have  begun 
as  a  trivial  departure  from  normal  processes,  and  by  the 
successive  accumulations  of  small  increments  of  change,  it 
may  at  length  have  become  the  complicated  aggregate  that 
we  know,  just  as  the  body  with  all  its  infinite  complexity  has 
evolved  from  a  structureless  speck  of  protoplasm.  Over  the 
gap  that  separates  the  processes  of  health  from  those  of 
disease,  and  that  seems  so  impassable,  he  throws  a  bridge 
of  successive  minute  modifications  strictly  comparable  with 
that  by  which  Darwin  passes  from  one  species  of  animal  or 


173 


Medical  Times  and  Gazette. 


MERCIER  ON  METAPHYSICS  IN  PATHOLOGY. 


August  18,  1883. 


vegetable  form  to  another.  But  here  comes  in  the  difficulty. 

It  is  easy  to  imagine  an  animal  or  vegetable  form  becoming 
slightly  altered ;  easy  to  imagine  the  offspring  inheriting  the 
alteration ;  easy  to  imagine  the  alteration  becoming  more 
pronounced  in  each  successive  generation,  until  the  diver¬ 
gence  of  form  from  the  ancestor  that  first  began  to  vary  is 
very  great  indeed.  But  how  are  we  to  imagine  a  similar 
process  as  taking  place  in  the  case  of  a  disease  P  The  disease 
has  not  a  definite  form  and  structure  like  the  animal. 
We  cannot  take  a  series  of  forms  of  disease,  and  pin  them 
upon  cork  or  preserve  them  in  spirits.  We  can  preserve 
pathological  specimens,  no  doubt;  but  when  we  look  at 
them  we  are  not  looking  at  a  disease — we  are  looking  at 
portions  of  the  individual  in  whom  the  disease  existed. 
Looked  at  in  one  way,  the  disease  is  definite  enough.  We 
can  trace  its  progress  from  country  to  country ;  we  can  see 
how  it  spreads  along  railways  and  rivers ;  we  can  observe  its 
passage  from  one  patient  to  another;  we  can  watch  its  course 
— -its  rise  and  progress  and  decline.  We  can  distinguish  one 
disease  from  another ;  we  can  recognise  variations  in  the 
same  disease,  and  say.  This  is  a  mild  form,  this  a  severe  one ; 
yet,  when  we  ask  what  this  thing  is  about  which  we  know  so 
much,  we  are  nonplussed.  We  can  analyse  the  diseased 
secretions,  but  they  are  not  the  disease.  We  can  put  the 
diseased  tissues  under  the  microscope,  but  they  are  not  the 
disease.  We  can  measure  the  alteration  of  temperature, 
describe  the  physical  signs,  and  photograph  the  eruption ; 
but  yet  we  have  not  seen  the  disease.  We  can  see  the 
bacilli  in  the  blood  and  in  the  tissues ;  we  can  track  them  into 
the  discharges,  follow  them  down  the  drains,  pursue  them 
through  the  soil,  trace  them  in  the  drinking-water,  and 
recognise  them  in  the  blood  and  tissues  of  a  fresh  patient ; 
but  the  bacilli  are  not  the  disease.  We  say  that  they 
communicate  the  disease ;  but  what  is  this  thing  that 
they  communicate  ?  This  is  Dr.  Creighton’s  difficulty 
— to  understand  “  how  a  morbid  state  of  the  body  can 
become  a  semi-independent  thing ;  how  it  can  exist,  not 
in  absolute  independence  of  the  body,  but  autonomous 
within  it,  an  imperium  in  imperio.”  He  finds  a  “difficulty 
in  conceiving  how  a  mere  state  of  the  body  .  .  .  can  become 
an  individual  existence  with  the  power  of  propagating  itself.” 
Now,  in  the  first  place,  I  would  demur  to  the  above  expres¬ 
sions.  Dr.  Creighton  speaks  of  a  disease  as  a  “morbid 
state  ” — a  “  state  of  the  body.”  This  is,  I  have  no  doubt, 
an  oversight ;  but  it  is  a  very  important  one  indeed,  and 
when  it  is  rectified  the  problem  is  half  solved.  A  disease  is 
not  a  morbid  state.  It  is  one  of  the  main  objects  of  Dr. 
Creighton’s  own  paper  to  insist  on  the  doctrine  that  patho¬ 
logy  is  physiology  gone  wrong.  But  physiology  does  not 
deal  with  bodily  states ;  that  is  the  province  of  morphology. 
Physiology  is  the  science  of  bodily  processes,  of  organs  in 
action  ;  and,  similarly,  pathology,  (as  distinguished  from 
morbid  morphology,  is  the  science  of  bodily  processes  gone 
wrong,  of  organs  acting  wrongly.  Albumen  in  the  urine  is 
not  a  disease.  “Granular  kidney”  is  not  a  disease.  The 
hypertrophied  heart  and  the  thickened  arteries  are  not  the 
disease.  These  are  only  its  conditions.  The  disease  is  the 
aggregate  of  disorders  of  function  that  these  changes  of 
structure  allow  or  necessitate.  The  secretion  of  albumen  by 
the  kidney  is  a  part  of  the  disease ;  the  increased  action  of 
the  heart  is  part  of  the  disease ;  the  increased  pressure  of 
the  blood  against  the  walls  of  the  bloodvessels  is  another 
part ;  and  the  sum  of  these  and  of  all  other  correlated  dis¬ 
orders  of  process  throughout  the  body  constitute  what  we 
call  the  disease.  When,  therefore,  we  speak  of  “  a  disease” 
we  must,  if  we  are  to  avoid  confusion,  follow  the  rule  of 
Pascal,  and  substitute  mentally  for  this  term  the  definition 
that  we  attach  to  it.  If  we  make  this  substitution  in  Dr. 
Creighton’s  expressions,  the  problem  that  we  have  to  solve 
is  this,  “  How  can  a  group  of  disorders  of  function  become 
an  individual  existence,  with  the  power  of  propagating 
itself  ?  ”  There  is  one  sense  in  which,  of  course,  it  cannot 
become  an  individual  existence.  It  cannot  exist  apart 
from  the  persons  in  whom  it  occurs.  There  can  be  no 
disorders  of  process  where  there  are  no  processes  to  be 
disordered.  Hence  in  a  dead  body  there  can  be  no 
disease,  but  only  altered  structures.  What  is  it,  then,  that 
is  communicated  when  one  person  catches  a  disease  from 
another  ?  A  particular  kind  of  change  in  the  bodily  pro¬ 
cesses,  or  some  of  them.  Has  this  substitution  of  terms 
made  our  conceptions  any  clearer  ?  Can  we  imagine  a  par¬ 
ticular  kind  of  change  as  being  “a  semi-independent  thing, 


existing  not  in  absolute  independence  of  the  body,  but 
autonomous  with  it,”  any  more  easily  than  we  can  conceive 
a  bodily  state  as  so  existing  ?  I  think  there  is  abundant 
evidence  that  we  can.  In  a  “following  stroke”  at  billiards 
the  player’s  ball  strikes  the  red,  and  communicates  to  it 
a  movement  in  its  own  direction.  From  one  ball  there  is  com¬ 
municated  to  the  other  a  particular  kind  of  change.  The 
particular  movement  does  not  exist  apart  from  the  bodies 
moving,  and  yet  it  has  a  semi-independent  existence,  or 
autonomy,  in  that  it  is  not  the  same  thing  as  the  bodies 
moving.  It  is  separable  from  them ;  it  is  communicated  to 
them  from  without ;  and  it  is  propagated  from  one  to  the- 
other.  Although  this  instance  satisfies  the  letter  of  the- 
law,  the  kind  of  change  communicated  is  so  remote  from  the- 
kind  that  is  communicated  in  disease  that  the  illustration 
may  not  be  allowed  to  be  fairly  applicable. 

Consider,  however,  the  case  of  magnetism.  This  is  dealt 
with  as  a  substantial  entity.  It  is  accepted  as  something 
quite  different  from  the  metal  by  which  it  is  manifested. 
Yet  it  never  appears  apart  from  the  metal.  It  sometimes, 
appears  spontaneously,  but  more  often  it  is  communicated 
from  one  piece  of  iron  to  another.  From  one  piece  of  iron 
it  may  be  communicated  to  an  indefinite  number  of  others. 
Not  only  has  it  the  power  of  propagating  itself,  but  it  is- 
highly  infectious ;  it  passes  with  the  greatest  ease  to  other 
pieces  of  iron  in  its  neighbourhood.  Let  me  add  that  it  is- 
peculiarly  apt  to  originate  in  certain  states  of  the  weather. 
From  the  point  of  view  of  the  watchmaker  it  is  a  veritable 
disease  of  the  metal.  And  what  is  this  semi-independent 
entity  ?  It  is  a  particular  change  in  the  movements  of  the 
metallic  molecules — we  may  call  it,  almost  without  metaphor, 
a  specific  affection  of  their  functions ;  and  the  aggregate  of 
all  the  changes  of  the  molecular  processes  is  the  magnetism 
of  the  bar  of  metal. 

The  objection  may  be  made  that  no  fair  or  valid  com¬ 
parison  can  be  made  between  the  vital  processes  of  a  living 
organism  and  the  purely  mechanical  vibrations  in  a  bar  of 
metal.  Let  us,  then,  come  still  nearer  home,  and  see  if 
there  are  no  phenomena  of  the  normal  organism  with  which 
the  phenomena  of  disease  can  in  this  respect  be  compared. 
The  art  of  music,  or,  to  put  the  same  idea  in  terms  more- 
concrete,  the  art  of  playing  on  the  piano,  is,  considered  phy¬ 
siologically,  an  aggregate  of  movements,  that  is  to  say,  of 
orderly  processes  or  functions.  These  functions  have,  of 
course,  no  existence  apart  from  the  body  in  which  they  occur.. 
There  is  no  playing  on  the  piano  without  a  person  to  play  j; 
and  yet  we  find  no  difficulty  in  recognising  that  the  art  of 
playing  the  piano  is  something  quite  different  from  the 
person  who  plays.  People  who  have  never  heard  of  meta¬ 
physics  are  quite  accustomed  to  speak  of  -an  art  as  a  separate 
thing,  and  to  speak  of  its  progress  and  development  and 
decline  without  any  reference  to  the  persons  who  manifest 
it;  and  yet  without  these  persons  the  art  would,  of  course, 
have  no  existence.  Like  the  specific  diseases,  the  art  cannot 
exist  independently  of  the  persons  by  whom  it  is  manifested;, 
like  them,  it  could  not  exist  in  a  developed  form  unless  it 
had  undergone  cultivation  in  innumerable  predecessors  of 
the  person  in  whom  it  so  exists  ;  like  them,  it  could  not  exist 
in  any  person  in  a  developed  form  unless  it  had  been  com¬ 
municated  to  him  from  one  of  these  predecessors.  The  art 
may  be  considered  as  it  exists  and  developes  in  a  single  in¬ 
dividual,  just  as  a  disease  may  be  studied  in  a  single  case 
and  again,  the  art  may  be  considered  as  it  exists  in  many 
individuals,  just  as  a  disease  may  be  studied  not  in  indi¬ 
vidual  cases,  but  as  an  epidemic.  It  is  evident  that,  in  the 
latter  case,  both  the  art  and  the  disease  are  more  completely- 
abstracted  from  the  persons  in  whom  they  occur,  are  treated, 
as  having  a  more  independent  existence.  When  we  con¬ 
sider  a  single  case  of  disease,  it  is  impossible  to  put  out  of 
sight  for  a  moment  the  patient  who  is  its  object.  But  when 
we  consider  an  epidemic  it  is  possible  to  treat  of  the  direc¬ 
tion  and  rapidity  of  its  spread,  and  of  the  means  of  transport, 
without  more  than  a  tacit  and  subconscious  reference  to  the 
patients  by  whom  it  was  manifested.  Similarly,  when  we- 
consider  the  skill  of  a  single  musician,  we  cannot  drop 
out  of  sight  the  person  by  whom  it  is  displayed  ;  but  when, 
we  compare  the  English  style  of  playing  with  the  German, 
the  personality  of  individual  musicians  is  subordinated,, 
and  the  art  is  much  more  separately  and  abstractedly  con¬ 
sidered.  We  may  paraphrase  Dr.  Creighton’s  expressions,, 
and  say  of  the  art  of  piano-playing,  as  he  says  of  disease,  that,, 
although  it  is  a  mere  group  of  bodily  processes. — a  complex 


Medical  Times  and  Gazette. 


RICHARDSON  ON  THE  COLLAPSE  OF  CHOLERA. 


August  18,  1883.  179 


■or  integrated  group, — it  has  become  an  individual  existence, 
with  a  power  of  propagating  itself ;  it  has  become  a  semi- 
independent  thing,  and  exists  not  in  absolute  independence 
•of  the  body,  but  autonomous  within  it.  We  speak  of  the 
•origin  of  an  art,  and  assign  to  it  a  definite  date  and  place ; 
we  speak  of  its  progress,  of  its  rise  in  complexity,  of  the 
development  of  its  resources,  of  its  cultivation,  of  its  de¬ 
gradation  at  this  period  and  its  rejuvenescence  at  that ;  we 
divide  it  into  varieties,  and  define  their  differences  ;  we  speak 
•of  it  being  attacked  and  defended ;  we  treat  it  in  every  way 
as  if  it  were  an  entity  having  an  independent  existence ; 
and  yet  we  know  all  the  time  that,  apart  from  artists,  the 
art  does  not  exist.  If,  therefore,  we  can  form  a  clear  con¬ 
ception  of  an  art  as  an  entity  distinct  from  the  individuals 
by  whom  it  is  manifested — a  feat  which  does  not  need  a 
vast  amount  of  metaphysical  knowledge — there  can  surely 
be  no  difficulty  in  forming  an  equally  clear  conception  of  the 
Ikind  of  independence  that  is  possessed  by  a  disease.  The 
only  pre-requisite  is  to  remember  that  the  disease,  like  the 
art,  is  a  group  of  processes,  and  not  a  “  mere  bodily  state.” 
And  if  the  chief  stumbling-block  in  the  way  of  the  accept¬ 
ance  of  Dr.  Creighton’s  hypothesis  is  “  the  difficulty  of 
conceiving  how  a  ...  .  condition  of  the  body  can  become 
a  species  of  disease,”  he  may,  I  think,  rest  assured  that  its 
acceptance  is  not  far  off. 

Having  helped  Dr.  Creighton,  as  I  hope  successfully,  over 
this  metaphysical  stile,  I  will  venture  a  short  distance  with 
him  ultra  crepidam.  The  particular  ways  in  which  he  sug¬ 
gests  that  the  various  specific  diseases  have  become  developed, 
are  not  supported  by  a  sufficient  number  of  facts  to  gain  ac¬ 
ceptance,  or  even  to  give  them  a  primd  facie  appearance  of 
probability ;  but  this  is  a  matter  of  no  importance.  What 
he  has  done  is  to  indicate  a  mode  of  origin  for  these  diseases 
which  is  in  accordance  with  the  mode  of  origin  of  every  other 
vital  process — nay  more,  of  every  complex  entity  whose 
•origin  can  be  traced.  In  addition  to  this  indication  of  the 
/general  mode,  he  has  given  the  outline  of  certain  special 
modes  in  which  individual  diseases  may  possibly  have  origi¬ 
nated.  Whether  they  actually  did  so  originate  or  no  is  im¬ 
material.  It  was  enough  to  show  that  they  could  have  done 
•so.  The  detailed  exposition  of  the  process  will,  we  may  be 
•sure,  be  the  work  of  many  years  of  laborious  research 
by  many  observers,  but  to  Dr.  Creighton  belongs  the 
great  merit  of  having  indicated  the  direction  that  this 
research  must  take.  As  to  his  ignoring  the  existence  of 
bacilli,  for  which  he  has  been  taken  to  task,  this  appears 
vfco  me  entirely  beside  the  question.  Grant  to  bacilli  all 
•the  powers  and  properties  with  which  it  is  the  fashion  to 
»eredit  them, — grant  that  they  are  the  materies  morbi,  the 
■essence  and  soul  of  the  disease, — the  question  still  remains. 
How  did  these  particular  kinds  of  bacilli  originate,  and  how 
did  they  acquire  the  marvellous  properties  that  they  pos¬ 
sess  ?  Did  they  spring  into  existence  in  the  full  maturity 
•of  their  baleful  powers  at  some  past  period  of  the  world’s 
•existence,  or  did  they,  like  every  other  organism,  acquire 
i their  special  characters  by  a  slow  and  gradual  process  of 
■  differentiation  and  evolution  ?  Once  the  problem  has  been 
stated,  the  answer  can  scarcely  be  doubtful.  Little  or 
nothing  as  we  know  at  present  of  the  steps  of  the  process, 
steps  there  must  surely  have  been ;  it  remains  for  future 
workers  to  trace  them  out. 


Synovitis  of  the  Whist  with  Rice-like  Bodies. — 
Incision  in  these  cases  has  come  again  into  favour  as  one  of 
the  consequences  of  antiseptic  surgery.  MM.  Yerneuil, 
Nicaise,  and  Notta  have  communicated  to  the  Societe  de 
'Chirurgie  several  remarkable  examples  of  its  successful 
•employment ;  and  M.  Lafosse  has  recently  published  a  these 
in  which  the  whole  subject  is  reviewed.  He  concludes  that 
medical  means,  such  as  blistering,  revulsives,  etc.,  have  no 
effect  in  these  cases.  Compression  by  bandages  steeped  in 
alcohol  or  various  stimulant  liquids  are  sometimes  useful, 
but  they  only  act  by  repelling  the  riziform  bodies  into  the 
neighbouring  tendinous  sheaths.  Injections  of  tincture  of 
•iodine  give  better  results,  but  they  are  only  applicable  to 
unilocular  cysts.  Incision  and  drainage,  which  formerly 
were  followed  by  severe  accidents,  such  as  purulent  sinuses, 
phlegmon,  and  purulent  infection,  are  now  attended  by  the 
best  results  when  performed  under  the  strict  antiseptic 
method.  Cures  by  the  first  intention,  although  possible,  are 
•quite  exceptional. — Jour,  de  The  rap  ,  July  25. 


ON  FEEDING  BY  THE  VEINS 
AND  ON  INTRAPERITONEAL  INJECTION 
IN  THE  COLLAPSE  OF  CHOLERA. 

By  BENJAMIN  WARD  RICHARDSON,  M.D.,  P.R.S. 

( Continued,  from  page  155.) 

Injection  of  Milk  into  the  Veins  in  Cholera. — My  late 
friend  Dr.  W.  Bird  Herepath,  of  Bristol,  suggested  in  the 
pages  of  the  Association  Medical  Journal  the  transfusion  of 
milk  in  cases  of  cholera.  This  suggestion  was  made  on 
September  1,  1854,  but  I  am  not  aware  that  the  practice 
was  adopted  by  anyone  in  our  country.  In  Canada,  how¬ 
ever,  the  same  suggestion  occurred,  I  believe  quite  in¬ 
dependently,  to  Dr.  James  Bovell,  of  Toronto,  and  he  was 
bold  enough  to  put  the  plan  to  the  test  of  practical  experi¬ 
ment.  In  an  essay  which  he  read  before  the  Canadian 
Institute,  and  afterwards  published  in  a  separate  form.  Dr. 
Bovell  gave  a  history  of  six  cases  treated  during  their  last 
Btages  by  the  transfusion  into  the  veins  of  freshly  drawn 
cow’s  milk.  In  two  of  these  cases,  which  seem  to  have 
been  extreme  in  character  and  hopeless,  the  treatment  was 
followed  by  recovery.  The  others  died,  but  they  too  appear 
to  have  been  benefited  for  a  short  period. 

It  is  to  be  observed  that  in  these  cases  Bovell  injected 
comparatively  small  quantities  of  milk.  In  one  of  his 
successful  cases  he  threw  in  twelve  ounces,  in  another  only 
eight.  These,  nevertheless,  may  have  proved  quite  sufficient 
quantities  to  have  saved  the  life,  for  the  process  was  one 
of  feeding  by  the  veins.  Moreover,  the  results  were,  without 
any  doubt,  much  better  than  those  which  have  followed  in¬ 
jections  of  saline  solutions,  recoveries  of  two  in  six  being 
no  contemptible  success. 

The  disadvantages  connected  with  milk  seem  to  me  to  be 
twofold.  I  found  by  the  experiment  of  mixing  milk  with 
blood  that  the  milk  does  not  hold  the  blood-corpuscles  in 
good  suspension.  I  also  found  that  when  fresh  defibrinated 
blood  warmed  to  100°  was  mixed  with  fresh  milk  at  the 
same  temperature,  there  was  very  quick  coagulation  of  the 
caseine,  so  that  the  combined  fluids  did  not  flow  readily 
through  the  injecting  needle. 

At  the  same  time  Bovell’s  practice  deserves  to  be  well  re¬ 
membered,  for  it  may  be  that  milk  might  prove  an  admirable 
basis  for  a  feeding  fluid  by  the  veins.  It  might  be  advisable 
I  to  charge  milk  with  saline  substance,  or  with  saline  sub¬ 
stance  and  some  other  body — say  glycerine,  or  solution  of 
grape  sugar — which  would  have  the  tendency  to  prevent  the 
objections  to  which  I  have  referred.  The  addition  of  phos¬ 
phate  of  soda  in  the  proportion  of  twenty  grains  to  the  pint 
of  milk  would  prevent  coagulation  of  caseine;  and  the 
addition  of  glycerine  or  of  solution  of  grape  sugar  of 
specific  gravity  1150  in  the  proportion  of  two  ounces  to  the 
pint  would  prove  a  good  menstruum  for  the  suspension  of 
the  corpuscles.  Such  solution,  warmed  to  the  blood  tem¬ 
perature,  and  slowly  injected,  would,  I  doubt  not,  be 
admirably  adapted  to  the  treatment  of  the  collapse. 

The  use  of  saline  injections  purely  cannot,  I  think,  be 
expected  to  be  of  permanent  service,  for  reasons  already 
explained.  The  saline  solution  does  not  sustain,  is  not  in 
fact  a  food,  while  it  interferes  with  the  physical  character 
of  the  corpuscles,  reducing  them  in  size  and  causing  great 
irregularity  of  outline.  Water  simply  could  scarcely  be 
expected  to  render  service  when  injected :  it  dilutes  the 
blood  extremely,  but  it  has  no  sustaining  power,  and,  by 
rapid  cooling,  tends  to  reduce  the  temperature  of  the  tissues. 

In  1866  I  conducted  a  long  research  in  order  to  find  out 
a  fluid  which  would  most  determinately  take  up  and  dis¬ 
tribute  the  corpuscles  of  blood  which  had  been  condensed 
by  the  slow  evaporation  of  one-third  of  its  water.  The 
compound  which  yielded  the  best  response  to  this  inquiry 
was  made  as  follows  : — Of  white  of  egg  take  four  ounces  by 
weight,  of  common  salt  one  drachm,  of  phosphate  of  soda 
one  scruple,  of  clarified  animal  fat  one  ounce,  of  pure  gly¬ 
cerine  two  ounces,  of  water  sufficient  to  make  one  pint.  In 
preparing,  dissolve  the  common  salt  and  phosphate  of  soda 
in  the  water,  and  having  well  whipped  the  albumen,  add 
that  also  to  the  water.  Place  the  mixture  on  a  water-bath, 
and  raise  the  temperature  to  135°  ;  keep  the  mixture  steadily 
stirred,  and  digest  at  this  temperature  for  one  hour.  This 


180 


Medical  Times  and  Gazette. 


MEDICAL  AND  SURGICAL  PRACTICE. 


August  18, 1883. 


constitutes  an  artificial  serum,  the  albumen  of  which  hydrates 
freely.  Having  taken  the  artificial  serum  off  the  bath,  place 
the  fat  and  the  glycerine  together  in  a  crucible,  and  melt  the 
fat  in  the  glycerine.  When  the  process  of  solution  of  fat  is 
complete,  pour  the  solution  into  the  artificial  serum  at 
120’  Fahr.,  and  stir  in  carefully ;  set  aside  that  the  fluid 
may  cool  to  80°  Fahr.,  at  which  point  all  the  fat  that  is  in¬ 
soluble  at  80°  will  float  on  the  surface.  Take  this  off,  and 
filter  carefully. 

The  fluid  thus  obtained  is  of  pinkish  colour,  of  saline, 
sweetish  taste,  and  of  specific  gravity  1038.  It  picks  up 
semi-fluid  blood  with  instant  readiness,  and  diffuses  it 
most  equally.  Heated,  it  takes  up  one-third  more  caloric 
than  water  in  the  same  time ;  and  in  cooling  it  restores 
nearly  one-third  more. 

The  fluid  here  described  would,  I  believe,  prove  most  ser¬ 
viceable  for  feeding  by  the  veins  during  the  collapse,  if 
slowly  injected  in  proportions  of  not  more  than  four  to  six 
ounces  at  each  injection. 

I  have  a  word  to  say  in  reference  to  the  mode  of  injecting 
the  veins.  The  greatest  mischief  has  arisen  in  transfusion 
from  errors  in  the  process.  The  operator  should  ever  re¬ 
member  that  in  this  operation  he  is  feeding,  not  forcing;  he 
should  keep  in  mind  how  gradually  Nature  feeds  the  veins 
by  the  thoracic  duct,  and  should  imitate  her ;  there  is  no 
necessity  for  force,  none  for  hurry. 

Above  all  things,  in  feeding  by  the  veins,  the  syringe 
should  be  thrown  aside  ;  it  is  a  dangerous  and  bad  instru¬ 
ment  for  the  purpose.  To  replace  it  I  constructed  a  simple 
instrument,  which  consists  of  a  glass  cylinder  with  a  flexible 
tube  running  from  its  lower  part  or  chamber  for  insertion, 
by  means  of  a  quill  or  hollow  probe,  into  the  vein  to  be 
injected.  The  upper  part  of  the  cylinder  is  provided  with 
a  stopper,  through  which  a  tube  passes  connected  with  a 
small  pair  of  hand-bellows.  Within  the  cylinder  is  a  small 
hollow  ball  or  safety-valve  regulator,  which  floats,  if  there 
be  fluid  in  the  cylinder,  until  the  fluid  allows  it  to  descend 
to  a  constricted  lower  part  of  the  cylinder,  when  all 
further  passage  of  fluid  is  prevented.  The  flow  of  liquid 
along  the  escape-tube  can  be  checked  or  set  at  liberty  at 
pleasure  by  a  spring-clip. 

In  using  this  instrument,  the  warm  fluid  to  be  injected  is 
placed  in  the  cylinder,  and  a  little  is  allowed  to  run  through 
the  escape-tube  to  displace  all  the  air ;  next,  the  escape-tube 
is  closed  by  means  of  the  clip.  Then,  having  opened  the 
vein  while  it  is  being  pressed  upon  from  above,  the  quill  or 
hollow  probe  at  the  end  of  the  escape-tube  is  inserted  and 
fixed,  and,  when  all  is  ready  for  the  fluid  to  flow,  the  clip  is 
removed,  and  the  cylinder  raised  one  or  two  feet  above  the 
patient.  The  pressure  so  induced  will  now  usually  suffice 
to  force  the  fluid  into  the  body  equally  and  gently;  but, 
if  there  be  any  obstruction,  the  merest  pressure  of  the 
lower  ball  of  the  hand-bellows  will  remove  it.  As  the  fluid 
descends,  the  hollow  ball  goes  down  with  it  to  within  three 
inches  of  the  bottom  of  the  cylinder,  where  it  is  opposed  by 
the  constricted  neck,  which  is  effectually  closed  by  the  ball 
valve,  so  that  no  air  can  possibly  get  into  the  vein. 

Injection  of  the  Peritoneum  or  Cellular  Tissue 
in  the  Collapse  of  Cholera. 

On  August  22,  1854,  I  submitted  to  the  East  Surrey 
Medical  Society  a  suggestion  for  the  treatment  of  cholera 
daring  collapse  by  the  production  of  artificial  peritoneal  or 
of  cellular  dropsy.  The  idea,  which  was  based  entirely  on 
physiological  research,  created  considerable  attention  at  the 
time,  and  the  suggestion,  so  far  as  it  relates  to  injection  of 
the  peritoneum,  has  within  these  last  years  been  appro¬ 
priated  without  a  syllable  of  acknowledgment.  I  found  in 
my  original  research  that  distilled  water  warmed  to  the  tem¬ 
perature  of  the  body  might  be  injected  without  the  slightest 
danger,  either  into  the  peritoneum  or  into  the  cellular 
tissue  of  warm-blooded  animals,  provided  that  the  quantity 
injected  was  limited  in  amount  to  less  than  a  fifth  part 
of  the  weight  of  the  body  of  the  animal.  I  found  also  that 
when  the  body  was  greatly  reduced  from  removal  of  fluid, 
water  injected  into  the  parts  described  was  almost  imme¬ 
diately  absorbed,  and  that  the  peritoneum  was  a  sac  from 
which  the  absorption  of  very  large  quantities  of  water 
would  take  place  without  mischief.  The  practice  was  tried 
in  two  cases  of  cholera  in  man.  In  one  case  of  my  own, 
eight  pints  of  water  were  injected  into  the  peritoneum  of  a 
patient  in  collapse ;  and  in  another  case,  ten  pints  were 


injected  by  a  practitioner  in  Wiltshire  whose  name  I  un¬ 
fortunately  forget.  In  both  cases  the  patients  recovered, 
but  in  neither  was  the  collapse  so  complete  as  to  convey  the 
positive  assurance  that  recovery  might  not  have  taken  place 
if  the  injection  had  not  been  made.  I  think  it  worth 
while  to  record  these  facts  relating  to  intra-peritoneal  in¬ 
jection  without  further  comment,  but  I  am  of  opinion  that 
the  plan  of  feeding  by  the  veins  is  the  sounder  practice. 

(To  be  concluded.) 


EEPOETS  OF 

HOSPITAL  PRACTICE  IN  MEDICINE 
AND  SURGERY. 


EAST  LONDON  HOSPITAL  FOR  CHILDREN. 


P E E ITE O C HAN T E E IC  ABSCESS — SUBSEQUENT 

COXITIS— EXCISION  —  APPAEENT  EECOYEEY — 

LAEDACEOTJS  DISEASE  THEEE  YE  AES  LATEE 

—DEATH— AUTOPSY. 

(Under  the  care  of  Mr.  R.  W.  PARKER.) 

I.  C.,  aged  two  and  a  half  years,  was  admitted  into  the 
East  London  Children’s  Hospital,  April  30,  1879. 

The  child’s  family  history  was  good ;  which  means  to  say 
that  there  was  an  absence  of  “  consumption,”  rheumatism, 
and  scrofulous  affections. 

Previous  History. — The  mother  tells  us  that  the  child 
had  whooping-cough,  followed  by  “  bronchitis  ”  six  months 
ago ;  he  has  never  been  so  strong  since.  He  has  had  during 
the  last  few  months  several  “  small  abscesses  ”  in  different 
places — back  of  scalp,  back,  axilla,  and  on  the  wrist ;  these 
were  opened  and  got  better.  Eleven  days  before  admission 
a  swelling  began  in  the  lower  part  of  the  right  buttock, 
which  was  hard  and  painful,  and  which  has  gradually 
enlarged. 

Present  Condition. — On  admission  there  is  a  large  fluctuat¬ 
ing  swelling  around  and  behind  the  great  trochanter,  the 
skin  over  which  is  normal.  It  does  not  appear  to  be  painful. 
The  thigh  is  partially  flexed  on  the  abdomen,  and  somewhat 
rotated  outwards.  The  child  is  very  rickety.  The  bones  of 
the  arms  and  of  the  legs  are  curved  considerably,  while  the- 
radial  epiphyses  are  much  enlarged.  The  child  is  poorly 
nourished.  There  is  no  pain  in,  or  fixation  of,  the  hip-joint. 

May  1. — The  abscess  was  opened  in  its  most  dependent 
part,  and  a  very  large  quantity  of  pus  was  evacuated.  A 
drainage-tube  was  put  in.  The  abscess-cavity  appeared  to  be 
quite  circumscribed  ;  it  was  superficial  to  the  muscles,  and 
did  not  appear  to  have  any  deep  connexions.  A  weight  and 
extension  were  ordered  for  each  leg,  rather  in  view  of 
straightening  the  rickety  curves  and  of  keeping  the  child 
quiet  in  bed  than  for  any  reason  connected  with  the  abscess. 

3rd. — There  is  still  a  copious  discharge.  The  child  takes 
his  food  well.  The  evening  temperature  101°. 

20th. — The  discharge  has  gone  on  since  last  date,  varying 
slightly  in  amount.  The  general  condition  remains  sta¬ 
tionary.  For  a  day  or  two  past  he  has  had  otorrhcea  from 
both  ears,  and  one  or  two  other  small  abscesses  about  the 
body.  The  temperature  is  irregular — 98°  to  101°.  He  takes 
food  very  well. 

June  14. — Extension  is  still  kept  up  on  both  legs.  The 
boy  occasionally  complains  of  pain  in  and  about  the  hip- 
joint,  but  nothing  can  be  detected  beyond  this.  The  joint 
was  examined  under  chloroform,  but  with  a  negative  result. 

July  2. — The  condition  remains  as  before.  There  is  some 
pain  and  tenderness  about  the  hip  on  movement  or  handling. 
The  abscess-cavity  has  contracted.  A  probe  introduced  does 
not  come  upon  bare  bone  anywhere.  Temperature  has  been 
normal  lately. 

24th. — Examined  again  under  chloroform.  It  was  felt 
that  the  condition  of  the  hip-joint  was  threatening  and  un¬ 
satisfactory,  although  nothing  very  definite  could  be  made- 
out.  The  temperature  has  been  rather  high  again. 

August  19. — It  was  noted,  “No  real  improvement  in  the 
condition  up  to  this  date.  The  leg  is  never  moved  volun¬ 
tarily,  and  passive  movements  cause  pain.  There  is  some 
general  thickening  in  the  upper  third  of  the  femur,  with 
oedema  of  the  soft  parts.” 

September  23. — By  this  time  the  hip- joint  was  obviously 
affected;  there  was  fulness  on  its  anterior  surface,  but  not 


Medical  Times  and  Gazette. 


MEDICAL  AND  SURGICAL  PRACTICE. 


August  18,  1863.  181 


fluctuation  ;  no  grating  on  passive  motion  under  chloroform. 
The  femur  continued  thickened.  A  diagnosis  was  made  of 
slow  caries  of  the  npper  part  of  the  femur,  leading  to 
changes  in  the  head  of  the  femur  at  its  epiphysial  line,  with 
infiltration  of  inflammatory  products  into  the  joint. 

October  14. — The  child  has  been  as  well  fed  up  as  possible 
since  last  note,  and  permission  to  excise  the  joint  obtained 
from  the  friends,  who  at  first  objected  to  any  operative 
proceedings.  TJnder  chloroform  the  joint  was  excised.  The 
head  of  the  bone  was  in  part  absorbed,  the  remainder  was 
necrosed.  The  neck  of  the  bone  was  extensively  carious, 
soft,  and  fatty. 

21st.  — Child  has  borne  the  operation  very  well.  He  lies 
very  apathetic ;  takes  his  food  and  handles  his  toys  with 
remarkable  indifference ;  and  never  talks.  The  wounds 
look  healthy,  and  the  discharge  is  sweet. 

30th. — He  has  improved;  his  temperature  is  but  slightly 
above  normal. 

December  1. — Wound  is  healthy,  and  almost  cicatrised ;  but 
the  original  abscess  sinuses  are  open,  and  discharge  a  little. 

5th. — The  boy  was  up. 

January  18,  1880. — He  was  discharged  into  the  country. 

He  was  seen  occasionally  between  this  and  the  next  date. 
His  sinuses  gradually  healed  up,  and  the  boy  grew  fat  and 
looked  well. 

February  2,  1883. — All  the  wTounds  were  quite  healed,  and 
the  cicatrices  were  white  and  supple.  There  was  no  evidence 
of  local  disease.  His  mother  brought  him  on  account  of 
“  dropsy.”  She  gave  a  history  which  led  to  the  belief 
that  the  boy  had  probably  passed  through  a  mild  attack  of 
scarlet  fever  (prevalent  at  the  time),  and  that  this  dropsy 
was  due  to  scarlatinal  nephritis.  On  this  account  he  could 
not  be  readmitted  to  the  hospital,  and  thus  had  to  be  treated 
as  an  out-patient.  There  was  no  desquamation  at  this  time. 
His  urine  had  a  specific  gravity  of  1019 ;  it  was  acid,  and 
loaded  with  albumen.  In  quantity,  the  mother  said  it  was, 
as  it  always  had  been,  rather  scanty.  There  was  general 
oedema  over  the  body,  most  marked  in  the  feet;  the  oedema 
first  became  manifest  in  his  face,  and  had  come  on  within 
the  last  week  or  two.  He  was  ordered  some  acetate  of 
potash  and  decoction  of  broom. 

16th. — His  mother  reported  that  the  urine  was  more 
copious,  and  that  the  stools  were  watery.  He  vomited  fre¬ 
quently,  especially  after  drinking  anything.  The  boy  was 
not  seen  this  visit,  and  there  was  no  urine  for  examination. 

23rd. — The  mother  came  to  report  that  the  child  was  much 
worse,  and  that  he  was  passing  blood  in  his  urine,  and  too 
ill  to  be  brought  out,  unless  he  could  be  kept  in  the  hospital. 
He  was  therefore  sent  for,  and  readmitted. 

24th.— Urine  pale  straw-coloured  ;  scanty  ;  it  became 
almost  solid  on  boiling.  No  casts  were  found  on  micro¬ 
scopic  examination,  and  there  were  no  blood-corpuscles.  He 
had  had  eight  motions  during  the  night,  with  some  strain¬ 
ing,  and  a  few  streaks  of  blood,  in  the  last.  He  was  not 
taking  any  medicine  at  this  time.  A  vapour-bath  was 
ordered.  He  sweated  profusely  during  as  well  as  after 
this  bath.  He  died  the  same  night. 

Autopsy. — There  was  no  fluid  either  in  the  abdomen,  the 
pleurae,  or  in  the  pericardium.  The  lungs  were  oedematous  ; 
there  were  old  adhesions  on  the  left  side.  Heart  was 
normal.  The  liver  was  waxy,  and  weighed  twenty-seven 
ounces  and  a  half.  The  kidneys  each  weighed  seven  ounces 
and  a  half ;  their  capsules  readily  peeled  off ;  the  cortical 
substance  was  swollen  and  the  whole  of  the  organ  pale. 
The  joint  was  examined  carefully — it  was  at  first  hoped 
that  a  specimen  of  repair  after  excision  would  have  been 
found.  On  the  contrary,  a  process  of  slow  caries  was  going 
on  in  the  iliac  bone ;  it  was  surrounded  by  thick  inspissated 
pus,  which  had  raised  the  periosteum  from  the  pelvic  surface 
of  the  bone,  leaving  it  finely  eroded.  The  upper  part  of  the 
femur  was  connected  to  the  remnants  of  the  old  capsular 
ligament  by  firm,  unyielding,  gristly  connective  tissue.  The 
cicatrices  were  quite  firm  and  apparently  healthy.  There 
were  a  few  enlarged  glands  in  the  corresponding  groin. 

Remarks  (by  Mr.  Parker). — I  was  as  much  disappointed  as 
surprised  to  find  a  continuance  of  the  mischief  at  the  hip, 
which  I  hoped  I  had  removed.  Doubtless  this  long  con¬ 
tinued  pus-formation  was  the  forerunner  of  the  lardaeeous 
disease  of  which  the  child  died.  Always  weakly,  it  had  no 
strength  to  throw  off  its  disease,  and  living  under  very  un¬ 
favourable  hygienic  surroundings  did  nothing  to  improve  its 
constitutional  debility.  The  question  of  scarlatinal  nephritis 


was,  I  think,  negatived  not  only  by  the  microscopic  exa¬ 
mination  of  the  urine,  which  showed  an  absence  of  casts, 
hut  also  by  the  presence  of  lardaeeous  changes  in  the  liver 
and  spleen,  although  these  were  but  slight  in  comparison 
with  some  cases  which  seem  to  live  on  notwithstanding. 
There  was  an  amount  of  pulmonary  oedema,  too,  which  was 
sufficient  to  seriously  jeopardise  life,  and  yet  he  did  not 
present  much  distress  until  within  an  hour  or  two  of  his 
death.  The  connexion  between  peritrochanteric  abscesses 
and  the  hip- joint  is  very  obscure.  Since  the  above  case 
came  under  my  observation  I  have  seen  many  cases  of 
hip  disease  which  have  seemed  to  begin  in  this  manner. 
I  am  inclined  to  regard  them  as  bursae  connected  with  the 
joint,  which  enlarge.  From  some  cause  a  joint  takes  on  a 
morbid  action,  and,  as  a  consequence,  there  is  an  increase  in 
the  secretion  of  that  joint.  If  the  capsule  is  perfectly  closed 
and  unconnected  with  any  bursae,  tension  quickly  results, 
and  pain  with  other  manifestations  soon  attracts  attention. 
On  the  other  hand,  if  the  increased  secretion  finds  its  way 
out  into  some  bursae,  or  elsewhere,  the  disease  may  go  on  in 
the  joint  for  some  time  before  its  presence  is  really  detected. 
I  believe  that  this  occurred  in  my  case.  I  have  since  adopted 
precautionary  measures  in  similar  cases,  and,  among  the 
most  prominent,  the  strictest  antiseptic  measures  whenever 
it  is  necessary  to  incise  abscesses  such  as  these. 


Effects  of  Noise  upon  Diseased  and  Healthy 
Ears. — Dr.  St.  John  Eoosa  thus  sums  up  the  conclusions 
from  a  paper  which  he  read  to  the  Medical  Society  of  New 
York  (New  York  Med.  Record,  April  28),  bearing  the  above 
title : — 1.  There  is  a  large  class  of  people  suffering  from 
impairment  of  hearing  in  ordinary  places  who  hear  very 
acutely  and  with  comfort  amid  a  great  din  or  noise.  2.  The 
disease  causing  the  impairment  of  hearing  thus  relieved  is 
situated  in  the  middle  ear.  It  has  been  usually  observed  in 
the  chronic  non-suppurative  form  of  disease  of  the  middle 
ear,  but  it  may  also  be  found  in  acute  and  subacute  catarrh 
of  this  part,  as  w'ell  as  in  the  chronic  suppurative  process. 
3.  The  proximate  cause  of  this  phenomenon  is  not  as  yet 
positively  known.  It  is  probably  to  be  found  in  some  change 
in  the  action  of  morbid  articulation  of  the  stapes  with  the 
fenestra  ovalis.  4.  The  hearing-power  of  persons  working 
in  such  a  din  as  that  of  a  boiler-maker’s  shop  invariably 
becomes  impaired.  5.  The  lesion  caused  by  this  occupation  is 
one  of  the  labyrinth,  or  of  the  trunk  of  the  acoustic  nerve. 
6.  Persons  thus  affected  do  not  hear  better  in  a  noise.  Their 
hearing-power  is  better  in  a  quiet  place,  and  becomes  better 
after  prolonged  absence  from  the  exciting  cause  of  their 
impaired  hearing.  7.  The  cases  of  inspissated  cerumen  and 
catarrh  of  the  middle  ear,  occurring  among  boiler-makers, 
are  such  as  occur  among  those  engaged  in  other  occupa¬ 
tions,  and  mask  and  complicate  the  fundamental  primary 
trouble  so  long  known  as  boiler-makers’  deafness.  8.  In 
disease  of  the  labyrinth  or  acoustic  nerve,  the  tuning-fork 
“0”  is  heard  louder  and  longer  through  the  air  than 
through  the  bones  of  the  head.  In  the  course  of  the  dis¬ 
cussion  on  the  paper.  Dr.  Eoosa  observed  that  he  had 
assumed  two  things  which  he  expected  would  be  doubted, 
and  they  had  been  doubted  ;  but  he  did  not  think  that  they 
had  been  disproved.  He  had  the  fortune  to  be  a  pioneer  in 
this  kind  of  investigation,  and  had  come  to  believe  that  in 
the  tuning-fork  we  have  the  means  of  making  a  differen¬ 
tial  diagnosis  between  disease  of  the  middle  and  internal 
ear.  Hearing  bells  in  a  noise  was  another  means  ;  and  by 
employing  these  two  aids  he  believed  that  a  differential 
diagnosis  in  these  cases  could  be  satisfactorily  made.  Prac¬ 
tice  in  ear  diseases  has  gone  to  extremes.  Only  a  few 
years  ago  nearly  every  otologist  followed  Kramer,  who  said 
that  the  acoustic  nerve  was  the  part  most  commonly 
affected ;  then  Wilde,  who  said  that  disease  of  the  middle 
ear  explained  all  the  symptoms ;  later,  the  Germans,  who 
came  with  catarrh  of  the  middle  ear,  and  swallowed  all  pre¬ 
vious  theories.  At  present,  no  matter  what  the  affection  may 
be,  the  organ  must  be  blowed  up  almost  invariably,  accord¬ 
ing  to  some  authorities,  and  their  teaching  is  practised  by  a 
great  number  of  otologists.  Dr.  Eoosa  was  contending 
against  that  view,  and  was  trying  to  prove  that  there  is 
quite  a  large  proportion  of  cases  of  deafness  in  every 
vicinity,  due  to  acoustic  trouble,  which  are  incurable  ;  and 
that  it  is  better  to  let  them  alone  than  to  be  continually 
blowing  them  up  with  an  apparatus. 


182 


Medical  Times  and  Gazette. 


LUNACY  LAW  REFORM. 


August  18, 1883. 


TEEMS  OF  SUBSCEIPTION. 


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British  Islands . Twelve 

39  99  . SiX 

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States  of  America  .  .  .\Twdv* 


yy  »  yy 

India  (viti  Brindisi) 

99  • 


.  Six 
.  Twelve 
.  Six 


Months 

yy 

yy 

yy 

yy 

yy 


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0  14  0 

1  10  0 

0  15  0 
1  12  6 
0  16  6 


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SATUEDAY,  AUGUST  18,  1883. 


- ♦ - 

LUNACY  LAW  EEFOEM. 

The  Government  have  determined  to  reform  the  law  of 
lunacy.  It  has  long  been  anticipated  that  this  subject 
would  occupy  the  attention  of  the  Legislature,  but  there  has 
been  little  expectation  on  the  part  of  the  medical  profes¬ 
sion,  nor,  we  believe,  was  the  idea  entertained  even  by 
members  of  Parliament  who,  like  Mr.  Dillwyn,  have  spe¬ 
cially  interested  themselves  in  the  subject,  that  it  would  be 
taken  in  hand  so  soon,  and  treated  after  so  revolutionary 
and  drastic  a  fashion.  Those  who  are  acquainted  with 
Lord  Shaftesbury’s  views,  and  who  realise  the  great 
authority  with  which  he  speaks,  and  the  powerful  in¬ 
fluence  of  his  opinions,  have  accustomed  themselves  to 
believe,  indeed,  that  the  system  of  private  asylums  was  one 
which,  good  or  bad,  must  eventually  be  crushed  beneath 
the  weight  of  public  opinion  ;  but  the  fate  of  Mr.  Dillwyn’ s 
motion  on  this  subject  in  a  previous  session  of  the  present 
Parliament  has,  of  course,  rendered  any  action  of  this  de¬ 
scription  impossible  for  the  present,  and  the  proprietors  of 
these  institutions  may  breathe  freely  for  a  time.  The  pro¬ 
posed  reform  has  no  direct  reference  to  the  detention  of 
patients  in  private  asylums,  nor  indeed  in  asylums  of  any 
description,  but  refers  only  to  those  who  have  brought  them¬ 
selves  within  the  meshes  of  the  criminal  law.  The  defects 
in  our  methods  of  determining  the  sanity  or  insanity  of 
persons  accused  or  convicted  of  crime  are  so  glaring,  so 
widely  recognised,  so  frequently  forced  upon  our  notice  by 
notorious  trials,  that,  far  from  wondering  at  any  effort  being 
made  to  remove  them,  we  can  only  be  astonished  that  they 
have  been  suffered  to  remain  so  long  unremedied.  The 
system  of  calling  experts  for  the  defence,  and  rebutting 
their  evidence  by  that  of  experts  for  the  prosecution,  is  so 
utterly  indefensible,  that,  after  the  attention  of  the  public 
had  been  prominently  called  to  its  shortcomings  by  the 
scandal  of  the  Guiteau  trial,  it  was  manifestly  doomed ;  and 
the  substitution  of  medical  assessors  appointed  by  the  court 
is  known  to  be  the  alternative  recommended  with  one  voice 


by  all  men  competent  to  speak  on  the  subject.  Such  a 
reform  as  this  will  certainly  mark  an  era  in  the  history  of 
the  criminal  law  of  this  country,  and  will  entitle  the  Govern¬ 
ment  that  carries  it  out  to  the  gratitude  of  the  medical  pro¬ 
fession,  and  the  esteem  of  the  country  at  large.  The  reform 
that  the  Government  have  now  in  hand  does  not,  how¬ 
ever,  extend  quite  so  far  as  we  could  wish  in  this  direction. 
In  a  very  important  letter  to  the  Times,  Dr.  Bower  made 
the  suggestion  that  the  system  for  ascertaining  the  con¬ 
dition  of  a  prisoner’s  mind  which  is  in  vogue,  it  appears, 
in  Norway  and  elsewhere,  should  be  adopted  in  this  country. 
The  system  is  an  excellent  one.  Prison  surgeons,  as  Dr. 
Bower  says,  are  not  required  to  possess  any  special  know¬ 
ledge  of  insanity,  and  in  the  rare  cases  where  the  advice  of 
specialists  is  taken  by  the  authorities,  brief  interviews  only 
can  be  obtained ;  and  for  the  detection  of  either  feigned  or 
concealed  insanity  it  is  necessary  for  the  examining  physician 
to  have  the  opportunity  of  continuous  observation  of  the 
person  for  several  days,  and  even  weeks.  In  order  to  supply 
these  opportunities  a  prisoner  should,  it  is  evident,  be 
removed  to  an  “observation-ward”  in  some  public  asylum, 
where  his  case  can  be  thoroughly  investigated.  Such  a 
method  supplies  a  most  efficient  means,  and  probably  the 
only  efficient  means,  for  determining  with  certainty  the 
question  of  sanity  or  insanity  in  such  cases  as  those  sup¬ 
posed ;  and  when  it  is  adopted  a  great  advance  will  have 
been  made  both  in  the  certainty  and  in  the  humanity  of  the 
law,  which,  properly  considered,  are  the  same  thing.  The 
reform  in  the  law  which  is  immediately  to  be  carried  out, 
and  which  can  scarcely  meet  with  serious  opposition  from 
any  quarter,  does  not,  however,  go  even  so  far  as  this. 

The  Bill  that  has  been  introduced  into  the  House  of 
Lords  by  the  Lord  Chancellor  (particulars  of  which  will  be 
found  in  another  column)  does  not  cover  all  the  ground 
that  is  occupied  by  the  questions  we  have  just  con¬ 
sidered.  It  provides  that  where  a  prisoner  on  his  trial  is 
found  to  have  been  insane  at  the  time  that  he  committed 
the  offence  for  which  he  is  tried,  the  jury  shall  return  a 
special  verdict  to  the  effect  that  he  is  guilty  of  the  offence, 
but  was  insane  at  the  time  that  he  committed  it.  The  whole 
scope  and  intention  of  the  Bill  is  to  substitute  a  verdict  of 
“  Guilty,  but  insane  ”  for  the  verdict  of  "  Not  guilty,  on 
the  ground  of  insanity,” — a  technical,  or  rather  a  verbal,  im-‘ 
provement  that  will  leave  all  proceedings  connected  with  the 
trial  of  the  prisoner,and  his  treatment  before  and  after  trial, 
exactly  as  they  are  at  present !  This  is  the  reform  on  which 
the  Government  have  determined.  For  this  purpose  a  Bill  is 
to  be  brought  in,  to  be  read  a  first  time,  to  be  read  a  second 
time,  to  be  referred  to  a  committee,  to  be  reported,  to  be  con¬ 
sidered  on  report,  to  be  read  a  third  time,  and  to  be  passed 
through  the  House  of  Lords ;  and  when  these  proceedings 
are  complete,  the  same  process  has  to  be  gone  through  in  the 
other  House,  and  finally  the  Eoyal  Assent  will  make  the  Bill 
law.  To  put  in  motion  the  cumbrous  machinery  of  legisla¬ 
tion,  and  to  pass  an  Act  of  Parliament,  for  the  sole  purpose 
of  altering  one  form  of  words  for  another  form  of  worcls 
having  virtually  the  same  meaning  and  exactly  the  same 
practical  effect,  is  a  proceeding  at  which  the  non-legal  mind 
may  well  be  amazed.  During  a  session  which  is  so  blocked 
with  an  excess  of  legislative  business  that  the'  Government 
have  again  and  again  lamented  their  inability  to  pass 
measures  of  the  utmost  importance,  and  have  denounced  in 
the  strongest  terms  the  “  veiled  obstruction  ”  which,  they  say, 
has  prevented  them, — a  session  in  which  the  Opposition  has 
again  and  again  expressed  its  triumph  at  the  inability  of  the 
Government  to  deal  with  the  mass  of  business  before  them, — 
the  Lord  Chancellor  can  find  time  to  bring  in  a  Bill  of  four 
hundred  and  twenty  words  for  the  purpose  of  substituting 
three  words  for  seven  !  It  is  not  that  there  is  no  other  means 


Medical  Times  and  Gazette. 


HiEMOGLOBIMIMIA. 


August  18, 1883.  183 


of  effecting  this  important  reform.  A  Bill  is  already  in  ex¬ 
istence,  has  been  read  a  first  time,  and  a  second  time,  re¬ 
ferred  to  a  Grand  Committee  and  considered  there,  which  has 
for  its  purpose  to  codify  the  whole  criminal  law ;  and  although 
it  will  not  reach  its  third  reading  this  session,  it  will  pro¬ 
bably  do  so  next  session,  and  certainly,  accidents  apart, 
during  the  present  Parliament ;  and  it  might  seem  to  the 
uninitiated  as  if  the  alteration  in  the  wording  of  a  verdict 
were  a  matter  of  such  petty  detail  that  it  might  well  be 
relegated  to  some  sub-clause  in  a  Criminal  Code  Bill.  But 
the  highest  legal  authority  in  the  kingdom  thinks  other¬ 
wise.  The  defect  which  hurts  nobody  is  too  important ;  the 
reform  that  has  slumbered  for  generations  is  too  urgent  to 
wait  for  the  general  revision  of  the  Criminal  Code  !  It 
must  be  done  instantly ;  it  must  have  an  Act  to  itself ! 
Who  can  say  after  this  that  the  Government  is  indifferent 
to  the  reform  of  the  lunacy  law  ?  Seriously,  what  are  we 
to  think  of  a  Lord  Chancellor  who.  can  bring  his  office  into 
ridicule  by  legislation  of  this  character  ?  Such  a  proceeding 
might  have  well  suited  the  disposition  of  Lord  Eldon,  but 
even  among  lawyers  hair-splitting  has  now  gone  out  of 
repute;  and  the  last  person  to  revive  so  evil  a  practice  should 
be  the  Lord  Chancellor  of  a  reforming  Ministry. 


HEMOGLOBIN  A1MIA. 

Professor  Ponfick  has  recently  published  an  article  in 
the  Berliner  Klinische  Wochenschrift,  No.  26,  on  haemo- 
globinasmia  and  its  consequences.  It  is  known  that  many 
agencies  have  the  property  of  displacing  the  haemoglobin 
from  the  red  blood-discs,  so  that  the  colouring  matter  is 
discharged  into  the  blood-plasma.  The  transfusion  of  foreign 
blood,  i.e.,  blood  from  a  donor  of  different  species  to  the 
receiver,  burns  of  the  surface  of  the  body,  and  many  che¬ 
mical  substances  (pyrogallic  acid,  arseniuretted  hydrogen, 
potassic  chloride,  etc.),  possess  this  property.  Peculiar  as 
is  the  bond  of  connexion  between  the  stroma  of  the  red 
blood-disc  and  its  haemoglobin,  yet  the  union  is  very  easily 
dissolved.  In  fact,  to  prepare  haemoglobin  from  the  dog’s 
blood,  it  is  sufficient  to  add  ether,  and  keep  in  a  cool  place, 
then  filter  the  red  mass  of  crystals  thus  formed,  redissolve 
in  water,  and  recrystallise.  From  what  has  been  said,  there 
will  be  no  difficulty  in  comprehending  the  full  meaning  of 
the  term  haemoglobinaemia.  The  notions  which  Ponfick  has 
on  the  subject  may  be  enumerated  in  the  following  fashion. 
There  are  different  degrees  of  haemoglobinaemia.  When 
this  state  exists  the  altered  products  (of  the  blood)  are 
disposed  of  in  three  directions.  The  spleen  is  enlarged 
with  the  fragments  resulting  from  the  destruction  of  the 
blood — that  is  one  direction.  The  liver  secretes  an  exces¬ 
sive  quantity  of  bile  (hypercholia) ;  and,  lastly,  the  debris 
of  the  decomposition  of  the  blood  (implied  in  the  setting 
free  into  the  blood-plasma  of  the  haemoglobin)  is  excreted 
by  the  kidneys.  With  limited  haemoglobinaemia  there  is 
neither  haemoglobinuria  nor  icterus.  When  the  haemoglobin- 
aemia  is  greater  in  degree,  some  of  the  colouring  matter 
of  the  blood  appears  in  the  urine,  and  there  are  signs  of 
slight  and  transient  jaundice.  Profound  destruction  of  the 
red  blood-elements  is  followed  almost  instantaneously  by 
intense  and  prolonged  haemoglobinuria  (associated  with 
exudative  nephritis)  as  well  as  marked  and  severe  icterus. 

Much  food  for  re  flection  is  offered  in  these  scientific  specula¬ 
tions  by  Ponfick.  The  views  promulgated  may  help  to  throw 
light  on  many  morbid  phenomena.  Good  grounds  certainly 
exist  for  the  opinion  that  the  spleen  and  possibly  other 
organs  are  concerned  in  the  destruction  of  the  red  blood- 
discs.  A  further  consideration  is  the  fact  that  the  blood  is 
constantly  being  destroyed  and  renewed.  Now,  if  there  be 


constantly  going  on  a  dissolution  of  the  red  blood-elements, 
it  follows  that  at  least  a  local  hsemoglobinsemia  always 
exists  ;  unless,  indeed,  we  regard  the  dissolution  as  always 
occurring  in  the  solid  elements  of  the  tissues  concerned. 
Some  physiologists  teach  that  the  haemoglobin  thus  set 
free  is  converted,  probably  by  the  hepatic  tissue,  into  bili¬ 
rubin,  the  principal  colour-constituent  of  the  bile.  There 
is  much  plausibility  in  such  a  view.  Indeed,  it  is  very  pro¬ 
bable  that  haemoglobin  is  the  source  of  all  the  pigments  of 
the  body.  Granting  these  considerations,  we  may  conceive 
how,  step  by  step,  an  increase  in  the  degree  of  haemoglobin¬ 
aemia  may  entail  all  the  consequences  which  Ponfick  has 
claimed  for  this  excessive  destruction  of  the  red  blood-discs  in 
the  blood  circulation.  The  importance  of  these  plausible  con¬ 
jectures  in  connexion  with  the  explanation  of  the  occurrence 
of  haematinuria  and  jaundice,  which  have  been  so  often  ob¬ 
served  in  malignant  and  septic  fevers,  is  obvious.  Again, 
haematinuria  has  been  met  with  in  purpura  and  scurvy, 
also  after  poisoning  by  arseniuretted  hydrogen  or  carbonic 
anhydride,  and  as  a  distinct  affection,  named  paroxysmal  or 
intermittent  haematinuria.  The  relations  which  have  been 
observed  to  subsist  between  ague,  oxaluria,  rheumatism,  and 
this  intermittent  haematinuria  are  well  worth  remembering 
at  this  time.  If  the  enlargement  of  the  spleen  in  ague 
coincide  with  the  excessive  production  of  haemoglobinaemia 
we  might  expect  some  corresponding  evidence  of  the  ex¬ 
cessive  production  of  blood-pigment.  It  would  perhaps 
require  no  great  ingenuity  of  argument  to  harmonise  these 
considerations  with  the  facts  observed  in  acute  and  chronic 
malarial  poisoning.  Haemoglobinaemia  may  be  looked  upon 
also  as  the  precursor  of  icterus  in  the  form  which  has  been 
known  as  "  haematogenous jaundice.  The  actual  coexist¬ 
ence  of  haemoglobinuria  and  icterus  is  spoken  of  by  Ponfick, 
and  he  believes  that  the  haemoglobin  passes  over  unchanged 
in  the  urine  when  the  liver  is  incapable  of  converting  it  into 
bilirubin,  the  power  which  the  liver  has  in  this  direction 
being  limited. 


TROPHIC  NERVES  AND  NERVE-CENTRES. 
Amongst  the  pressing  problems  of  general  physiology  and 
pathology  there  are  few  that  are  at  once  more  complex  in 
themselves,  and  more  promising  in  their  solution,  than  the  rela¬ 
tion  of  the  nervous  system  to  nutrition.  “  Trophic  ”  nerves 
have  been  long  and  patiently  searched  for,  and  many  have 
been  the  positive  and  negative  arguments  to  which  we  have 
had  to  listen  in  the  discussion  as  to  their  existence.  The 
cornea  was  long  the  favourite  battle-field  of  the  opposed 
doctrines,  and  we  confess  to  having  felt  heartily  tired  of 
ulcerative  keratitis  after  lesion  of  the  fifth  nerve.  Perhaps 
at  that  time  we  were  inclined  to  look  upon  trophic  nerves  as 
nothing  more  than  physiological  curiosities  in  their  way, 
with  little  or  no  bearing  upon  the  greater  and  graver  ques¬ 
tions  of  pathology.  It  must  be  acknowledged  that  opinions 
are  now  greatly  changed  in  this  matter.  The  remarkable 
series  of  cases  of  disease  of  the  skin,  joints,  bones,  nails, 
teeth,  and  hair — not  to  mention  other  structures — which 
have  been  traced  to  connexion  with  lesion  of  the  nerves  or 
nerve-centres,  whether  traumatic  or  not,  are  alone  sufficient 
to  arrest  our  attention.  The  very  suggestive  associations 
between  the  phenomena  of  rheumatism  and  allied  disorders, 
on  the  one  hand,  and  the  nervous  centres  for  the  motorial, 
circulatory,  and  heat  functions,  on  the  other  hand,  have  led 
to  various  theories  of  the  “  trophic  ”  origin  of  these  morbid 
conditions.  And,  of  equally  extensive  interest,  the  influence 
of  nervine  drugs,  and  other  therapeutical  measures  which 
affect  the  nervous  system,  upon  nutrition  as  a  whole,  and 
upon  pyrexia  in  particular,  has  come  to  claim  the  earnest 
attention  of  the  pharmacologist. 


Medical  Times  aad  Gazette. 


THE  WEEK. 


August  18, 1883. 


184 

The  area  of  importance  attaching  to  the  doctrine  of 
trophic  nerves  and  trophic  centres  having  thus  enormously 
widened,  it  is  not  remarkable  that  attempts  have  been 
renewed  to  investigate  the  physiology  of  the  connexion 
between  the  central  nervous  system  and  the  life  of  the 
outlying  tissues.  It  seems  curious  at  first  sight  that 
pathology  should  furnish  the  chief  material  for  such  in¬ 
vestigations,  but  such  is  the  case.  The  closest  examina¬ 
tion  of  ganglia,  nerve  fibres  and  cells,  has  not,  so  far  as  we 
are  aware,  revealed  much  more  than  was  described  by 
Heidenhain,  Pfliiger,  and  others  respecting  the  changes  of 
secreting  cells  under  the  influence  of  nervous  stimuli.  It  is 
to  experimental  pathology  and  to  clinical  medicine  and 
surgery  that  we  must  turn,  if  we  wish  to  become  possessed  of 
facts  bearing  on  nutritive  nerves  and  centres,  although  we 
thankfully  acknowledge  much  assistance  from  experimental 
physiology  also. 

The  results  of  recent  investigations  have  given  a  very 
interesting  turn  to  our  views  on  this  subject,  indicating, 
as  they  very  plainly  do,  that  there  is  a  medium  between 
the  nervous  structures  and  the  tissues  in  many — we  do  not 
say  in  all— instances,  and  that  this  medium  is  the  circula¬ 
tion.  In  other  words,  it  would  appear  that  a  large  number 
of  the  cases  of  “trophic”  lesions  are  really  immediately 
referable  to  changes  in  the  nutrient  vessels  of  the  affected 
part,  the  result  of  disturbances  of  the  vaso-motor  system 
of  nerves  and  centres.  We  have  now  to  record  the  re¬ 
sults  of  a  long  and  laborious  investigation  carried  out  by 
Lewaschew,  of  St.  Petersburg,  and  recorded  in  Pfliiger’ s 
Archiv  (xxviii.,  p.  389),  Virchow’s  Archiv  (xcii.,  p.  152),  and 
Gentralblatt  f.  d.  Med.  TPiss.  (1883,  p.  193).  Lewaschew 
seems  to  have  set  himself  to  discover,  if  possible,  the  in¬ 
fluence  of  lesions  of  nerves  in  the  production  of  aneurysm 
and  other  diseases  of  the  vessels ;  and  he  obtained,  in  addi¬ 
tion  to  these,  very  important  changes  in  the  bones,  skin, 
muscles,  and  other  structures  of  the  leg  and  foot  (in  the 
dog)  when  the  sciatic  nerve  was  injured.  The  method 
followed  was  to  irritate  the  sciatic  nerve  with  medicated 
ligatures,  and  watch  the  result.  The  first  phenomena  in 
the  limb  may  be  described  as  the  effects  of  dilatation  of  the 
vessels  :  the  parts  became  hypersemic,  swollen,  and  tender, 
and  the  vessels  pulsated.  And  these  changes  were  not 
■evanescent ;  on  the  contrary,  they  lasted  several  months, 
after  which  they  declined  with  some  rapidity,  leaving 
certain  more  permanent  lesions  appreciable  behind  them. 
The  muscles  and  skin  appeared  atrophied,  the  subcutaneous 
tissues  were  sclerosed,  the  local  temperature  fell,  the  bones 
were  reduced  in  size,  and  the  vessels  were  locally  dilated. 
Careful  microscopical  examination  revealed  vascular  dila¬ 
tation,  perivascular  growth,  and  finally  a  regular  cirrhosis 
or  sclerosis  of  the  parts.  All  this,  let  it  be  noted,  was  the 
outcome  of  an  interference  with  the  sciatic  nerve  insufficient 
to  paralyse  the  muscles  of  the  limb.  Lewaschew’s  opinion 
is  very  distinctly  in  favour  of  the  view  that  the  primary 
vascular  dilatation  was  not  a  'paralytic,  but  an  active 
phenomenon,  the  result  of  irritation  of  vaso-dilaior  nerves. 
A  comparatively  new  aspect  of  the  question  is  here  pre¬ 
sented  to  us,  and  the  present  investigation  is  but  one 
of  several  which  have  recently  brought  into  prominence  the 
existence  and  importance  of  the  second  system  of  vascular 
nerves,  which— in  opposition  to  the  vaso-motor  fibres— act 
as  vessel-dilators,  and  increase  the  flow  of  blood  through  a 
part.  Within  the  last  few  weeks.  Professor  Bowditch  and  Dr. 
J.  W.  Warren,  of  Boston,  have  announced  that  a  rapidly 
interrupted  induction-current  will  cause  contraction  of  the 
vessels  innervated  by  the  sciatic,  to  the  cut  (peripheral)  end 
of  which  it  is  applied  ;  whilst  a  slowly  interrupted  current, 
under  the  same  circumstances,  will  be  followed  by  dilatation 
of  the  vessels  (Centralblatt  f.  d.  Med.  Wiss.,  1883,  July  21, 


p.  513).  These  and  similar  results  in  the  same  direction  re¬ 
mind  us  of  the  “  glossy  swelling  ”  and  associated  changes, 
observed  by  Weir  Mitchell  and  others  after  injury  to  nerve  - 
trunks.  Altogether,  it  would  appear  as  if  we  had  now  made 
a  decided  step  forwards  in  the  explanation  of  trophic  lesions 
as  a  whole,  and  a  step,  we  trust,  towards  the  solution  of 
the  other  all-important  problems  in  general  pathology  to 
which  we  have  referred  above. 


THE  WEEK. 

TOPICS  OP  THE  DAT. 

It  is  undoubtedly  a  matter  for  public  congratulation  that 
Mr.  Archibald  Dobbs  has  established  his  case  against  the 
Grand  Junction  Waterworks  Company.  The  plaintiff  occu¬ 
pied  a  house  in  Westbourne-park,  and  the  Company,  being 
authorised  by  the  Act  15  and  16  Vic.,  c.  157,  to  levy  water- 
rates  on  dwelling-houses  according  to  their  “  annual  value,” 
made  an  assessment  on  him  at  the  “gross  rent,”  without 
making  the  deductions — tenants’  repairs,  insurance,  tenants’ 
rates,  etc. — which  are  usually  made  in  order  to  reach  the  net 
value  on  which  the  poor-rate  is  assessed.  Mr.  Dobbs  in¬ 
sisted  that  the  true  basis  of  rating  was  the  net  value  alone. 
The  metropolitan  police  magistrate  before  whom  Mr.  Dobbs 
was  summoned  decided  that  he  was  liable  on  the  gross  value, 
but  stated  a  case  for  the  opinion  of  theQueen’s  Bench  Division. 
The  Queen’s  Bench  Division,  consisting  of  Justices  Field  and 
Bowen,  reversed  the  decision  of  the  magistrate,  holding  that 
Mr.  Dobbs  was  liable  on  the  net  value  only.  The  Court  of 
Appeal — viz..  Lord  Coleridge  and  Lords  Justices  Baggallay 
and  Lindley — reversed  the  decision  of  the  Queen’s  Bench 
Division,  and  held  that  the  assessment  should  be  made  on 
the  gross  value.  The  appeal  from  their  decision  to  the 
House  of  Lords  was  argued  at  considerable  length,  and  the 
Lord  Chancellor  has  now  announced  that  their  lordships  are 
unanimously  of  opinion  that  the  decision  of  the  Court  of 
Appeal  should  be  reversed,  and  that  of  the  Queen’s  Bench 
Division  restored,  for  reasons  which  would  be  given  here¬ 
after.  It  is  calculated  that  this  decision  will  bring  about  to 
householders  a  reduction  of  about  4  per  cent,  in  their  water- 
rates,  that  being  the  difference  between  the  “  gross  estimated 
rental,”  on  which  the  Grand  Junction  Company  contended 
that  the  percentage  for  water  should  be  charged,  and  the 
“  net  rateable  value,”  which  Mr.  Dobbs  put  forward  as  the 
right  basis.  The  legal  opinion,  however,  seems  to  be  that 
the  householder  will  not  be  able  to  recover  from  the  com¬ 
panies  any  part  of  the  sums  overpaid  to  them.  The  Law 
Journal  thinks  it  is  a  remarkable  commentary  on  the 
absence  of  all  control  over  private  bodies  fulfilling  public 
duties,  that  from  the  year  on  which  the  Queen  came  to 
the  throne  until  now,  verging  on  half  a  century,  water- 
rates  have  been  charged  4  per  cent,  higher  than  the  law 
allowed. 

Messrs.  Edwards  and  Symes,  of  Millwall,  having  com¬ 
pleted  the  ambulance  small-pox  steamer  constructed  by 
them  for  the  Metropolitan  Asylums  Board,  she  was  last 
week  launched  in  the  presence  of  a  large  company.  It  is 
almost  unnecessary  to  remark  that  this  is  the  first  vessel 
ever  launched  in  connexion  with  Poor-law  administration  ; 
but,  as  Mr.  Galsworthy,  the  chairman  of  the  Metropolitan 
Asylums  Board,  explained,  the  building  of  this  vessel  is  one 
of  the  links  in  the  chain  of  experiments  which  the  Board 
are  making  to  endeavour  to  carry  out  the  views  of  the  Boyal 
Commission  in  respect  to  the  establishment  of  floating 
small-pox  hospitals.  The  vessel,  which  was  duly  christened 
by  Mrs.  Galsworthy  the  Red  Cross,  is  built  of  iron,  and  is 
104  ft.  in  length,  by  16  ft.  6  in.  in  breadth,  and  6  ft.  deep. 
She  is  a  paddle  steamer,  and,  under  contract,  is  to  be  de¬ 
livered  to  the  Asylums  Board  complete  in  every  particular 


Medical  Time*  and  Gazette. 


THE  WEEK. 


August  18, 1883.  185 


— even  to  furniture — for  a  sum  of  .£4500.  The  ambulance 
arrangements  will  comprise  eighteen  berths  forward,  for 
the  transit  of  acute  cases,  and  cabin  accommodation  aft  for 
convalescent  patients. 

The  following  case,  which  was  heard  at  the  West  Ham 
Police-court,  once  more  raises  the  question  as  to  the  ad¬ 
visability  of  establishing  public  furnaces  for  the  destruction 
of  refuse  by  burning,  as  is  done  in  some  country  towns.  The 
Surveyor  of  the  Mile  End  Old  Town  Vestry  appeared  to  an 
adjourned  summons  taken  out  by  the  Chief  Sanitary  Inspector 
of  the  West  Ham  Local  Board,  for  depositing  the  contents 
of  dustbins  and  other  offensive  matter,  in  such  a  state  as  to 
be  a  nuisance  or  injurious  to  health,  on  the  1st  inst.  The 
Mile  End  Old  Town  Vestry  had,  it  appeared,  received  per¬ 
mission  from  the  Carpenters’  Company  to  shoot  their 
rubbish  on  a  piece  of  ground  in  Carpenters’-road,  Stratford, 
and  on  August  1  about  200  cart-loads  were  deposited  there, 
creating  a  great  stench ;  and  when  the  Sanitary  Officer  of 
West  Ham  visited  the  spot  with  Dr.  Drake,  the  latter  at 
once  pronounced  the  stuff  to  be  a  nuisance.  In  defence  it  was 
endeavoured  to  be  shown  that  no  nuisance  was  created.  The 
magistrate  did  not  give  his  decision  until  he  had  himself 
inspected  the  ground,  when  he  decided  that  the  deposit  was 
a  nuisance,  and  made  an  order  for  its  abatement.  A  public 
furnace  would  have  reduced  all  this  offensive  animal  and 
vegetable  matter  to  ashes,  and  would  have  obviated  the 
danger  of  forming  an  unhealthy  foundation  for  future 
buildings. 

At  the  meeting  recently  convened  by  the  National  Smoke 
Abatement  Institution  to  be  held  at  the  Mansion  House, 
the  Chairman  (the  Lord  Mayor),  in  opening  the  proceedings, 
said  that  the  object  of  the  Institution  was  nothing  less  than 
the  rendering  more  pure  the  air  of  large  towns,  and  the 
consequent  improvement  in  the  health  of  their  inhabitants. 
The  vast  quantity  of  smoke  which  was  created  in  all  large 
towns  was  known  to  be  productive  of  great  damage  to  life 
and  health,  and  if  the  labours  of  the  Institution  resulted 
an  a  purer  atmosphere  being  obtained,  very  great  benefit 
would  be  derived.  He  had  lately  been  particularly  struck 
with  the  purity  of  the  atmosphere  in  the  City  on  a  Sunday, 
which  was  due  to  the  fact  that  so  few  fires  were  alight  on 
that  day.  The  Duke  of  Westminster,  who  had  subscribed 
the  munificent  sum  of  £500  to  the  funds  of  the  Institution, 
moved  the  adoption  of  the  report.  In  doing  so  he  said  he 
had  authority  for  stating  that,  in  addition  to  the  danger  of 
the  lives  and  health  of  the  population  of  London,  the  value 
of  the  unburnt  fuel  which  escaped  in  the  shape  of  smoke 
in  the  metropolis  alone  was  one  million  sterling,  while  the 
damage  this  smoke  did  to  property  was  at  least  twice  as 
much.  Sir  Spencer  Wells  having  seconded,  and  Sir  F.  Abel, 
F.R.S.,  having  supported  the  adoption  of  the  report,  it  was 
unanimously  agreed  to.  The  Duke  of  Northumberland 
next  moved  a  resolution,  which  was  carried,  to  the  effect 
that  inquiry  into  the  resources  of  technical  science  for  the 
abatement  of  smoke  was  desirable,  and  that  the  Govern¬ 
ment  should  be  urged  to  appoint  a  Royal  Commission  for 
that  purpose. 

We  have  often  had  to  record  serious  cases  of  milk  adul. 
deration  in  this  country,  but  none  of  them  have  come  up  to 
a  case  recently  reported  to  have  occurred  in  Ireland.  At  the 
Dublin  Police-court,  on  the  10th  inst.,  a  milk  contractor  to 
the  Ship- street  Barracks  was  summoned,  at  the  suit  of  one 
•of  the  food  inspectors,  for  having  on  July  25  supplied  a 
quantity  of  new  milk  for  the  use  of  the  1st  Battalion  East 
Kent  Regiment,  which  was  adulterated  with  248  per  cent,  of 
added  water,  or  nearly  two  gallons  and  a  half  of  water  to 
one  gallon  of  milk.  The  milk  was  analysed  by  Dr.  Cameron, 
the  public  analyst,  who  certified  the  adulteration  mentioned. 


The  case  was  somewhat  complicated  by  a  charge  which  was 
brought  against  the  food  inspector  of  having  recommended 
another  milk  contractor  to  take  up  the  contract  of  the 
accused  milk-seller,  but  in  reality  this  had  nothing  to  do 
with  the  present  charge,  and  at  the  end  of  the  proceedings 
the  defendant  was  fined  .£20. 

The  daily  press  continues  to  be  appealed  to  by  cor¬ 
respondents  from  the  various  garrison  towns,  to  bring  to 
public  notice  the  disastrous  effects  which  are,  even  at  this 
early  date,  accruing  from  the  late  interference  with  the 
action  of  the  Contagious  Diseases  Acts.  In  nearly  every 
case  the  writers  are  persons  who  speak  with  authority,  and 
who  come  forward  to  ventilate  the  question  on  purely  social 
and  sanitary  grounds,  apart  from  any  partisan  feelings. 
At  Aldershot,  within  the  last  three  months,  the  cases  of 
venereal  disease  have  increased  50  per  cent. ;  but  this  is  not 
the  worst  feature,  for  the  type  of  the  disease  has  become  dis¬ 
tinctly  worse.  The  military  hospitals  are  returning  to  their 
former  condition  of  an  excess  of  syphilitic  patients,  and  it  is 
well  known  that  every  regiment  contains  a  large  number  of 
men  who,  though  suffering  from  the  disease,  refrain  from 
reporting  themselves  to  the  doctor.  In  the  military  hospital 
at  Stoke,  Devonport,  patients  have  risen  to  184  from  118  ;  in 
the  naval  hospital,  Stonehouse,  to  100  from  45 ;  while  for 
reasons  similar  to  those  mentioned  in  the  case  of  Aldershot, 
no  official  returns  convey  an  adequate  idea  of  the  total 
number  of  cases.  The  Portsmouth  Evening  News  has  also 
in  the  most  earnest  manner  called  attention  to  the  alarm¬ 
ing  condition  of  both  soldiers  and  sailors  at  Portsmouth 
and  Southampton.  It  is  pointed  out  that,  even  when 
the  Acts  were  in  full  force,  men  in  large  numbers  were 
annually  discharged  as  unfit  for  service,  in  the  worst 
stages  of  the  disease  ;  and  under  the  present  system,  or 
want  of  system,  hundreds  of  men  will  every  year  be  sent 
adrift  to  spread  this  horrible  scourge  broadcast  through 
the  land.  It  may  very  fairly  be  asked,  what  would  have 
been  thought  of  the  Government  which  would  deliberately 
proceed  to  paralyse  all  established  efforts  to  deal  with 
the  suppression  of  small-pox  or  scarlet  fever  ?  Yet  this  is 
undoubtedly  a  parallel  case;  but,  unfortunately,  the  ques¬ 
tion  is  surrounded  with  a  morbid  sentimentality  which  has 
induced  a  large  section  of  otherwise  right-minded  persons 
to  advocate  tenets  which  bring  them  very  nearly  into  the 
category  of  Peculiar  People. 

It  seems  unfortunate  that  some  definite  arrangements 
cannot  be  made  for  the  burial  of  poor  persons  who  die  in 
Guy’s  Hospital,  since  it  is  hardly  creditable  that  in  this 
great  city,  every  now  and  again,  cases  such  as  that  which 
occurred  last  week  have  to  be  recorded.  A  poor  woman 
applied  at  the  Southwark  Police-court,  and  stated  that  her 
father  had  just  died  in  Guy’s  Hospital,  but  she  was  not  in 
a  position  to  bury  him.  The  relieving  officer  of  St.  George’s 
Parish,  in  which  her  father  had  lived,  referred  her  to  the  officer 
in  Bermondsey  Parish,  who  told  her  that  he  had  nothing  to 
do  with  it,  and  advised  her  to  see  the  officer  in  the  parish 
of  St.  Olave's.  The  latter,  however,  would  have  nothing  to 
say  in  the  matter,  so  she  returned  to  the  Hospital,  but  was 
informed  there  that  they  could  not  bury  her  father,  as  they  had 
no  funds  for  that  purpose.  Mr.  Bridge  ordered  the  body  to 
be  removed  to  St.  George’s  mortuary,  and  directed  that 
some  inquiries  should  be  made.  Two  days  afterwards  it  was 
reported  to  him  that  a  gentleman  had  paid  for  the  removal 
of  the  body  to  St.  George’s  mortuary,  and  the  parish 
authorities  had  given  an  order  for  interment,  the  difficulty 
having  arisen  through  a  dispute  between  the  different 
parochial  authorities.  Mr.  Bridge  commented,  with  some 
severity,  on  the  whole  proceedings,  and  said  that  it  was  a 
reproach  to  all  the  parties  concerned. 


186 


Medical  Times  and  Gazette. 


THE  WEEK. 


August  18, 1883. 


THE  CHOLERA  IN  EGYPT. 

The  last  telegram  received  at  the  War  Office  from  the 
General  Officer  commanding  in  Egypt,  which  was  from 
Cairo  and  dated  August  15,  stated  that  at  El  Warden  one 
soldier  of  the  Gordon  Highlanders,  who  had  been  in  hospital 
with  dysentery  since  the  8th  inst.,  was  attacked  with  cholera 
on  the  13th,  and  died  on  the  14th.  At  Helouan  also,  a 
soldier  of  the  same  regiment,  in  hospital  with  febricula  since 
the  11th  inst.,  was  attacked  with  cholera  and  died  on  the 
14th.  There  have  been  no  fresh  cases  at  any  other  station. 
The  Times  correspondent  at  Alexandria  states  that  the 
Khedive  had,  on  the  15th  inst.,  visited  the  German-English 
Hospital,  the  Greek  Hospital,  and  the  Gabarri  Cholera  Hos¬ 
pital  established  by  the  Alexandrian  Voluntary  Committee, 
where  his  Highness  spoke  to  the  cholera  patients,  and  com¬ 
plimented  the  medical  men  and  the  nurses  on  the  arrange¬ 
ments.  The  prevalence  and  severity  of  the  disease  appear 
to  be  lessening  everywhere.  In  Alexandria  the  deaths  from 
cholera  in  the  last  reported  period  of  twenty-four  hours  were 
forty ;  but  the  Alexandria  death-rate  from  ordinary  diseases 
was  very  high. 


THE  HEALTH  OP  LONDON. 

The  Registrar-General’s  return  shows  that  the  annual  rate 
of  mortality  for  the  week  ending  August  11  in  twenty-eight 
great  towns  of  England  and  Wales  averaged  18-4  per  1000. 
The  six  healthiest  places  were — Halifax,  Wolverhampton, 
Birkenhead,  Blackburn,  Bradford,  and  Derby.  In  London 
the  births  were  291,  and  the  deaths  327  below  the  average 
numbers  in  the  corresponding  weeks  of  the  last  ten  years. 
The  annual  rate  of  mortality  from  all  causes,  which  had  been 
equal  to  23'5,  21'2,  and  19-3  per  1000  in  the  three  preceding 
weeks,  further  declined  last  week  to  173.  The  deaths  at¬ 
tributed  to  diarrhoea  and  dysentery,  which  had  been  351, 
254,  and  16S  in  the  three  preceding  weeks,  fell  to  94  last 
week,  and  were  176  below  the  corrected  weekly  average  ;  69 
were  of  infants  under  one  year  of  age,  and  18  of  children 
between  one  and  five  years  of  age.  The  death  of  one  child, 
twenty  months  old,  was  referred  to  choleraic  diarrhoea.  In 
the  Outer  Ring  the  25  deaths  attributed  to  diarrhoea  included 
9  in  West  Ham  and  7  in  Edmonton  districts. 


HOSPITAL  ACCOMMODATION  FOR  GLASGOW. 

Dr.  Russell,  Medical  Officer  of  Health,  has  issued  a 
“Memorandum  on  the  Hospital  Accommodation  for  Infectious 
Diseases  in  Glasgow.”  The  first  question  with  which  Dr. 
Russell  deals  is  thus  stated — “  What  ought  to  be  the  aggre¬ 
gate  extent  of  hospital  accommodation  in  Glasgow  ?  ”  On 
this  subject  he  reviews  the  past  experience  of  the  city,  and 
gives  tables  showing  the  hospital  bed  accommodation,  and 
the  highest  and  lowest  numbers  of  patients  under  treatment 
at  one  time.  Regarding  this  first  question  his  opinion  is 
that  the  aggregate  fever  requirements  of  Glasgow  cannot 
be  less  than  550  to  600  beds.  For  small-pox  alone  there  is 
hospital  accommodation  with  150  beds;  and  he  hopes  that, 
by  timely  isolation  and  stringent  vaccination,  demands  on 
hospital  accommodation  may  be  as  favourable  as  in  London. 
It  may  be  noted  that  the  aggregate  hospital  accommodation 
recommended  by  the  Royal  Commission  for  London  equals 
1-32  per  1000  of  the  population,  with  space  to  extend  it  to 
1-48.  The  aggregate  which  is  recommended  for  Glasgow  is 
T31  to  1*41.  The  next  question  considered  is — “Ought  all 
the  epidemic  bed  accommodation  of  Glasgow  to  be  concen¬ 
trated  in  one  place,  or  ought  there  to  be  more  than  one 
hospital.”  Dr.  Russell  says — “  It  is  obvious  that  the  size 
of  infectious  hospitals  must  be  kept  within  reasonably 
manageable  limits,  and  the  experience  of  general  hospitals 
affords  no  criterion  for  the  determination  of  the  size  proper 


for  fever  hospitals.  It  is  believed  that  the  difficulty  ex¬ 
perienced  at  times  in  getting  parents  to  trust  their  children 
in  hospitals  arises  from  temporary  deterioration  in  the 
ward  service  in  times  of  pressure,  and  that  much  of  the 
mischief  caused  by  small-pox  hospitals  in  their  environs  had 
its  origin  in  epidemic  expansion  beyond  the  efficient  control 
of  the  chief  officials.”  From  this  point  of  view  the  conclu¬ 
sion  is  that  there  must  be  at  least  two  fever  hospitals  for 
Glasgow,  and  having  300  beds  in  each  ;  but  there  would  not 
be  any  serious  objection  to  having  one  of  350  and  the  other 
of  250,  or  even  400  in  one  and  200  in  the  other.  Dr.  Russell 
is  further  of  opinion  that  two  hospitals  of  300  beds  each 
could  be  managed  as  economically  as  one  with  600  beds  it 
fully  occupied ;  but  the  general  principal  is  all-important. 
He  then  makes  suggestions  as  to  the  structure  and  adminis¬ 
tration  of  “  Belvedere  Fever  Hospital,”  and  recommend© 
alterations  and  improvements. 


TRIAL  OP  LUNATICS  BILL. 

The  Bill  introduced  by  the  Lord  Chancellor  “  to  amend  the 
law  respecting  the  trial  and  custody  of  insane  persons- 
charged  with  offences,”  provides  as  follows  : — “  1.  Where  in 
any  indictment  or  information  any  act  or  omission  is  charged 
against  any  person  as  an  offence,  and  it  is  given  in  evidence- 
on  the  trial  of  such  person  for  that  offence  that  he  was 
insane,  so  as  not  to  be  responsible,  according  to  law,  for  his 
actions  at  the  time  when  the  act  was  done  or  omission  made, 
then,  if  it  appears  to  the  jury  before  whom  such  person  is 
tried  that  he  did  the  act  or  made  the  omission  charged,  but 
was  insane  as  aforesaid  at  the  time  when  he  did  or  made 
the  same,  the  jury  shall  return  a  special  verdict  to  the  effect 
that  the  accused  was  guilty  of  the  act  or  omission  charged 
against  him,  but  was  insane  as  aforesaid  at  the  time  when 
he  did  the  act  or  made  the  omission.  2.  Where  such  special 
verdict  is  found,  the  court  shall  order  the  accused  to  be  kept 
in  custody  as  a  criminal  lunatic,  in  such  place  and  in  such 
manner  as  the  court  shall  direct,  till  Her  Majesty’s  pleasure 
shall  be  known ;  and  it  shall  be  lawful  for  Her  Majesty 
thereupon,  and  from  time  to  time,  to  give  such  order  for  the 
safe  custody  of  the  said  person  during  her  pleasure,  in  such 
place  and  in  such  manner  as  to  Her  Majesty  may  seem  fit. 
3.  All  provisions  in  any  existing  Act,  or  in  any  rules  or  orders 
made  in  pursuance  of  any  existing  Act,  having  reference  to- 
a  person  or  persons  acquitted  on  the  ground  of  insanity, 
shall  apply  to  a  person  or  persons  in  respect  of  whom  a  special 
verdict  is  found  under  this  Act.” 


ZYMOTIC  DISEASES  IN  NEWCASTLE-UPON-TYNE. 

The  Medical  Officer  of  Health  for  Newcastle,  Mr.  Henry  E„ 
Armstrong,  in  submitting  his  annual  report  for  the  year- 
1882,  remarks  that  the  experience  of  the  past  twelve  months 
has  been  of  exceptional  sanitary  interest.  The  concurrent 
prevalence  during  many  months  of  typhus  and  small-pox, 
to  an  extent  greater  than  has  been  assumed  by  either  dis¬ 
ease  in  any  other  corresponding  period  of  the  past  decade, 
has  been  a  subject  of  serious  responsibility,  and  has  taxed 
the  exertions  of  the  Sanitary  Authority  to  the  uttermost. 
The  rate  of  mortality  from  the  chief  zymotic  diseases  is- 
shown  to  have  been  3-9  per  1000  of  population,  as  compared 
with  rates  of  30  and  3'3  in  1880  and  1881  respectively. 
Thus  the  deaths  from  small-pox  numbered  57,  as  against 
10  in  1881;  from  scarlet  fever,  82,  against  52;  from 
whooping-cough,  107,  against  70 ;  from  typhus,  30,  against 
20  ;  and  from  diarrhoea,  159,  against  149.  Newcastle-upon- 
Tyne  is  not  absolutely  deficient  of  means  for  isolating 
persons  suffering  from  infections  diseases,  but  during  the 
past  year  the  hospital  requirements  were  found  to  be  in¬ 
sufficient;  and  consequently  in  August  a  small-pox  con- 


Medical  Times  and  Gazette. 


THE  WEEK. 


August  18,  1883.  187 


valeacent  home  was  opened  at  Byker,  and  towards  the  close 
of  the  year  a  temporary  small-pox  hospital,  built  of  wood, 
was  erected  on  the  Town  Moor,  in  an  open  airy  situation, 
remote  from  dwellings.  Upon  the  completion  of  this  latter 
building  it  was  considered  expedient  to  close  the  small-pox 
wards  in  the  Bath-lane  Hospital,  since  it  was  evident  that 
the  results  of  treatment  were  becoming  unsatisfactory, 
several  cases  being  accompanied  with  erysipelas  and  other 
allied  forms  of  disease.  Moreover,  the  report  says,  there 
was  a  suspicious  prevalence  of  small-pox  in  Stowell-street 
and  the  densely  populated  locality  adjoining  the  Hospital 
premises. 


THE  APOTHECARIES*  HALL  OE  IRELAND. 

At  the  annual  meeting  of  the  General  Council  of  the 
Apothecaries’  Hall  of  Ireland,  convened  by  authority  of 
the  Act  of  Incorporation  on  August  1,  1883,  the  follow¬ 
ing  members  were  elected  as  office-bearers  for  the  en¬ 
suing  year : — Governor  :  Thomas  Collins,  Esq.  Deputy 
Governor :  Robert  Montgomery,  Esq.  Court  of  Directors 
<md  Examiners :  Edward  H.  Bolland,  John  Evans,  Arthur 
Harvey,  Charles  Holmes,  Charles  H.  Leet,  Charles  F. 
Moore,  Henry  P.  Nolan,  Richard  George  O’Flaherty,  Edward 
J.  O’Neill,  Sir  George  B.  Owens,  John  Ryan,  James  Shaw, 
George  Wyse,  Esqs.  Representative  on  the  General  Medical 
'Council :  Thomas  Collins,  Esq. 


ROLLESTON  MEMORIAL. 

The  total  sum  subscribed  for  the  Rolleston  Memorial 
amounted  to  ,£1183  5s.,  to  which  was  added  £59  7s.  5d., 
•dividends  paid  on  sums  invested  from  time  to  time  in  Consols 
before  the  list  was  closed.  Deducting  all  expenses,  a  capital 
sum  of  <£1205  15s.  8d.  remained,  which  has  been  invested 
in  =£1200  Three  per  Cent.  Consols.  This  sum  has  now  been 
transferred  to  the  Chancellor,  Masters,  and  Scholars  of  the 
University  of  Oxford,  and  accepted  by  them  as  the  Rolleston 
Memorial  Fund  under  the  following  conditions  : — That  the 
fund  be  expended  in  the  institution  of  a  prize  to  be  awarded 
•every  two  years,  and  that  the  prize  be  given  for  original  re¬ 
search  in  any  subject  comprised  under  the  following  heads  : — 
Animal  and  vegetable  morphology,  physiology  and  pathology, 
and  anthropology— to  be  selected  by  the  candidates  them¬ 
selves.  That  the  period  during  which  this  prize  may  be  obtained 
by  a  candidate  be  limited  to  ten  years  after  the  date  of  matri- 
■culation ;  and  that,  with  a  view  to  render  the  prize  as  widely 
associated  with  Professor  Rolleston’s  name  as  possible,  it  be 
■open  to  the  members  of  the  Universities  of  Oxford  and 
•Cambridge.  That  the  amount  collected  after  payment  of 
all  expenses  be  made  over  as  a  trust  fund  to  the  University 
of  Oxford,  which  should  appoint  the  necessary  trustees,  carry 
•out  all  other  arrangements,  and  make  regulations.  That  if 
•no  memoir  be  considered  of  sufficient  merit,  the  value  of  the 
prize  for  that  year  be  added  to  the  capital  of  the  fund.  And 
that  the  prize  shall  be  called  “  The  Rolleston  Memorial 
Prize,”  and  shall  consist  of  so  much  of  two  years’  income  of 
the  fund  as  shall  remain  after  payment  of  all  expenses 
incidental  to  the  trust. 


st.  george’s  hospital. 

From  a  very  interesting  report  by  Mr.  Charles  Hawkins, 
F.R.C.S.,  sometime  a  member  of  the  Council  of  the  Royal 
College  of  Surgeons,  it  appears  that  from  1873  to  1883  the 
number  of  in-patients  in  St.  George’s  Hospital  amounted 
to  35,654,  and  the  out-patients  to  146,953,  making  the  large 
total  of  182,607.  In  analysing  the  expense  per  patient  in 
1830  and  1880,  the  variation  in  cost  is  curious  in  some  of 
the  items.  Meat  in  the  former  year  cost  18s.  4d.  per 
patient ;  in  the  latter  it  had  increased,  as  might  be  expected. 


to  £1  2s.  2d.  On  the  other  side,  bread  and  flour,  which 
in  1830  cost  103.  7d.  per  head,  had  fallen  to  4s.  Id.  in  1880. 
Wines  and  spirits  in  1830  amounted  to  only  10d.,  but  in 
1880  had  increased  to  3s.  3d.  For  officers,  nurses,  and 
servants,  in  1830  the  cost  was  <£1  0s.  3d. ;  in  1880  it  had 
increased  to  <£1  14s.  3d.  There  are  now  431  beds  in  the 
Hospital. 


THE  PARIS  WEEKLY  RETURN. 

The  number  of  deaths  for  the  thirty-first  week  of  1883, 
terminating  August  1,  was  950  (509  males  and  441  females), 
and  of  these  there  were  from  typhoid  fever  30,  small-pox 
8,  measles  22,  scarlatina  2,  pertussis  13,  diphtheria  and 
croup  23,  erysipelas  4,  and  puerperal  infections  4.  There 
were  also  48  deaths  from  tubercular  and  acute  meningitis, 
169  from  phthisis,  17  from  acute  bronchitis,  43  from  pneu¬ 
monia,  114  from  infantile  athrepsia  (44  of  the  infants  having 
been  wholly  or  partially  suckled),  and  33  violent  deaths 
(24  males  and  9  females).  This  week’s  mortality  is  the 
smallest  that  has  been  registered  this  year,  being  notably 
inferior  to  the  mean  of  the  last  four  weeks  (1012).  The 
epidemic  diseases  call  for  no  remark  :  typhoid  fever,  which 
had  exhibited  a  recrudescence  at  the  end  of  June,  having- 
fallen  back  to  its  habitual  number  (80).  Measles  is  the 
only  epidemic  disease  that  has  increased  somewhat.  The 
number  of  deaths  from  phthisis  (169)  may  be  regarded  as 
normal  for  this  time  of  year.  Pneumonia  and  athrepsia 
have  both  diminished.  The  births  for  the  week  amounted 
to  1160,  viz.,  533  males  (400  legitimate  and  133  illegitimate) 
and  627  females  (455  legitimate  and  172  illegitimate),  the 
great  preponderance  of  female  births  being  again  remark¬ 
able:  96  infants  were  either  born  dead  or  died  within 
twenty-four  hours,  viz.,  57  males  (45  legitimate  and  12  ille¬ 
gitimate)  and  39  females  (31  legitimate  and  8  illegitimate). 


THE  ABERDEEN  POISONING  CASE. 

A  compromise  has  been  effected  in  the  action  brought  in 
the  Aberdeen  Sheriff  Court,  lately,  by  a  widow  against  a 
druggist  in  Aberdeen,  in  which  £750  was  claimed  as  damage 
for  the  loss  of  her  husband.  The  plaintiff  purchased  from 
the  defendant’s  shop  a  quantity  of  salicylate  of  soda,  which 
she  ascertained  from  a  weekly  periodical  was  a  specific  for 
the  ailment,  rheumatism,  from  which  her  husband  was  suf¬ 
fering.  She  administered  a  dose  of  the  drug  to  him,  and  he 
died  within  seventeen  hours  with  symptoms  of  narcotic 
poisoning.  The  averment  on  which  the  action  was  founded 
was  that  the  drug  purchased  from  the  defendant  was  not  of 
the  nature  of  salicylate  of  soda,  but  was  an  injurious  article, 
and  had  caused  her  husband’s  death.  This  averment  the 
defendant  denied,  pleading  that  the  same  drug  had  been 
sold  to  other  customers  without  producing  any  pernicious 
effect,  and  that  the  death  of  the  plaintiff’s  husband 
was  due  to  other  causes.  The  defendant,  however,  agreed 
to  pay  £400  to  the  plaintiff  in  full  satisfaction  of  all 
damages  sued  for,  and  costs.  The  Sheriff  considered  that  the 
settlement  arrived  at  was  very  satisfactory,  and  authorised 
it.  It  was  stated  in  court  by  the  counsel  for  the  plaintiff 
that  Mr.  Sangster,  the  druggist,  had  obtained  the  drug 
from  an  eminently  respectable  firm  of  chemists,  and  was 
entitled  to  trust  that  he  should  get  it  in  a  pure  state ;  and, 
moreover,  that  the  remainder  of  the  powders  supplied  to  the 
plaintiff  had  been  examined,  on  the  part  of  the  Crown,  by 
a  medical  gentleman,  who  had  reported  that  they  consisted 
wholly  of  salicylate  of  soda.  It  had  since  been  proved  that 
this  examination  of  the  powders  had  been  incomplete,  the 
test  for  salicylate  of  soda  only  having  been  applied.  There 
was  nothing  to  show  that  the  druggist  had  bggn-to  blame. 
But  it  appears  that  on  August  1 


188 


Medical  Times  and  Gazette. 


THE  WEEK. 


August  18,  1883. 


question  were  sent  to  Dr.  Stevenson  Macadam,  of  Edinburgh, 
for  examination ;  and  his  report,  as  published  in  the  Aber¬ 
deen  Evening  Express  of  the  8th  inst.,  states  :  “  The  qualita¬ 
tive  analysis  revealed  the  presence  of  salicylate  of  soda, 
accompanied  by  much  soluble  morphia  salt,  and  giving  all 
the  reactions  and  tests  for  muriate  of  morphia.  The  quanti¬ 
tative  analysis  of  the  powder  yielded  as  follows  : — Morphia 
crystallised  49-60  per  cent.,  equal  to  muriate  of  morphia 
52’63  per  cent.”  Each  powder  supplied  by  the  druggist — 
fifteen  grains— contained,  therefore,  a  most  deadly  dose  of  a 
narcotic  poison.  Every  effort  ought  to  be  made  to  dis¬ 
cover  when,  where,  and  how  this  fatal  admixture  of  the  two 
drugs  occurred ;  though,  as  the  case  in  question  happened 
early  in  January  last,  this  may  be  very  difficult,  if  not 
impossible. 


THE  METROPOLITAN  WATER-SUPPLY  FOR  JUNE  LAST. 
The  report  of  the  Metropolitan  Water  Examiners  for  the 
month  of  June  last  has  again  to  be  pronounced  satisfactory. 
Treating  of  the  water  previous  to  filtration.  Colonel  Bolton 
says  the  state  of  the  river  Thames  at  Hampton,  Molesey, 
and  Sunbury,  where  the  intakes  of  most  of  the  companies 
are  situated,  was  good  during  the  whole  of  the  month,  with 
the  exception  of  the  23rd  and  24th,  when  it  was  bad. 
According  to  Dr.  Frankland’s  report,  the  Thames  water 
sent  out  by  the  Chelsea,  West  Middlesex,  Southwark, 
Grand  Junction,  and  Lambeth  Companies  was  again  un¬ 
usually  free  from  organic  matter.  With  the  exception 
of  that  supplied  by  the  Grand  Junction  Company,  which 
was  very  slightly  turbid,  all  the  water  was  efficiently 
filtered  before  delivery.  The  water  drawn  from  the  Lea 
and  distributed  by  the  New  River  and  East  London 
Companies  was  also  exceptionally  free  from  organic  im¬ 
purity,  the  New  River  Company’s  supply  being,  chemically, 
but  slightly  inferior  to  the  best  of  the  deep-well  waters. 
It  has  to  be  noticed  that  the  authorities  at  the  Local 
Government  Board  do  not  appear  to  act  upon  Colonel 
Bolton’s  suggestions :  month  after  month  that  gentleman 
proposes  that  the  question  of  a  practical  standard  of  quality 
(including  both  the  organic  and  inorganic  matter  contained 
in  water)  should  be  considered  and  determined,  so  that  the 
engineers  connected  with  the  companies  should  be  made  to 
work  up  to  it ;  but  the  periodical  reports  do  not  show  that 
any  steps  have  been,  or  are  being,  taken  in  the  matter. 


FATAL  FIRE  IN  A  PRIVATE  LUNATIC  ASYLUM. 

A  disastrous  fire  broke  out  about  two  o’clock  on  Tuesday 
morning,  at  Southall  Park,  a  private  lunatic  asylum  occu¬ 
pied  by  Dr.  R.  Boyd,  formerly  Resident  Physician  at  St. 
Marylebone  Infirmary,  and  afterwards  Superintendent  and 
Physician  of  the  Somerset  and  Bath  Lunatic  Asylum.  The 
number  of  his  private  patients  in  the  house  at  Southall  Park 
averaged  from  twenty  to  thirty.  The  fire  was  discovered 
by  a  female  attendant,  and  the  alarm  given  shortly  after 
2  a.m.  ;  and,  though  assistance  quickly  arrived,  great  diffi¬ 
culty  was  found  in  obtaining  water,  the  nearest  supply 
being  from  a  shallow  pool  at  a  considerable  distance 
from  the  house.  Everything  possible  in  the  circumstances 
seems  to  have  been  done  to  rescue  the  patients  and  other 
inmates ;  but  two  of  the  patients.  Captain  Williams  and 
Mrs.  Cullimore,  are  missing ;  and  it  is  also  reported  that 
Dr.  Boyd,  his  son  (Mr.  William  Boyd,  who  was  on  a  visit 
to  his  father),  and  one  of  the  servants  have  perished  in  the 
flames ;  and  Miss  B.  Boyd  (a  daughter  of  Dr.  Boyd),  Mr. 
R.  K.  Boyd  (another  son),  and  some  servants  received  more 
or  less  severe  injuries.  It  is  said  that  Dr.  Boyd  had  escaped 
from  the  house,  but  returned  to  it  to  aid  in  saving  others, 
and  was  buried — with  his  son,  the  patients  named  above. 


and  the  cook  of  the  establishment — under  the  mass  of  ruins 
of  the  building.  Every  effort  is  being  made  to  search  the 
still  smoking  and  heated  piles  of  debris,  but  at  present 
no  human  remains  have  been  found.  The  cause  of  this  de¬ 
plorable  catastrophe  will  be  investigated  as  fully  as  possible  j 
but  one  or  two  questions  that  present  themselves  demand 
immediate  attention.  How  came  it  that  this  licensed  asylum 
was  allowed  to  be  carried  on  for  years  in  circumstances,  as 
regards  water-supply,  that  made  a  fatal  disaster  inevitable 
in  the  event  of  fire  ?  What  precautions  against,  and  pro¬ 
visions  for  prompt  and  efficient  action  in  case  of,  fire  are 
required  before  the  Commissioners  of  Lunacy  will  license 
an  asylum  ?  and  what  amount  of  supervision  do  they  exercise 
over  these  matters  in  existing  asylums  ?  We  have  under¬ 
stood  that  the  Commissioners  have  been  inquiring  into,  or 
considering,  these  subjects  a  good  deal  during  the  last  year 
or  two :  we  should  like  to  know  with  what  result,  if  any ; 
and  what  their  opinion  was  with  respect  to  the  possible 
supply  of  water  in  case  of  a  fire  at  Southall  Park. 


TYPHUS  IN  THE  ISLAND  OF  SKYE. 

There  can  be  no  question  that  there  has  been  a  severe  out¬ 
break  of  typhus  fever  in  the  Island  of  Skye.  In  answer  to 
a  question  from  Dr.  Cameron  on  Tuesday  last,  the  Lord 
Advocate  for  Scotland  stated  that  there  had  been  five-and- 
twenty  cases  of  typhus  in  the  island  in  about  five  months, 
and  three  cases  had  proved  fatal.  He  added  that  the  nature 
of  the  fever  was  not  at  first  fully  recognised.  W e  are  sorry 
to  hear  that  a  medical  man  who  had  been  attending  the 
cases  had  caught  the  fever,  and  at  the  date  of  the  last  report 
was  lying  dangerously  ill.  It  did  not  appear  from  the  Lord 
Advocate’s  statement  that  any  special  steps  were  being  taken 
to  isolate  the  fever  cases,  or  indeed  in  any  way,  medically  or 
otherwise,  to  provide  due  care  for  the  sick,  or  to  prevent  the 
spread  of  infection. 


HEALTH  OF  GLASGOW. 

During  the  fortnight  ending  August  4  there  were  453 
deaths  registered  in  place  of  480  for  the  preceding  fort¬ 
night  (a  decrease  of  27),  representing  a  death-rate  of  232  in 
place  of  24- 4  per  1000  living.  The  death-rate  in  the  first 
week  of  the  fortnight  was  2P6,  and  in  the  second  24-8- 
The  number  of  deaths  below  one  year  was  108  in  place  of 
120,  and  of  persons  aged  sixty  years  and  upwards  74  instead 
of  58.  There  were  38  deaths  from  diarrhoea  in  place  of 
27  and  9  during  the  preceding  two  fortnights.  This  number 
is  less  than  is  usual  at  this  season  of  the  year,  and  wholly 
confined  to  children.  The  number  of  deaths  from  fever 
was  4  instead  of  3,  viz.,  3  from  typhus  and  1  from  enteric, 
fevers.  There  were  53  deaths  from  infectious  diseases  of 
children  instead  of  67,  viz.,  24  from  whooping-cough,  15  from 
measles,  and  14  from  scarlet  fever ;  and  since  the  spring  of 
the  year  this  has  been  the  lowest  number  of  deaths 
from  measles.  The  number  of  cases  of  fever  registered 
was  49  instead  of  17,  viz.,  29  of  typhus  fever  and  20  of 
enteric  fever,  the  increase  of  the  former  being  most  unusual 
at  this  season  of  the  year.  For  many  years  there  had 
not  been  so  many  cases  in  one  fortnight— not  even  in  mid¬ 
winter.  The  majority  of  them  came  from  the  southern 
districts.  Overcrowding  and  personal  dirt  seem  to  be  the 
chief  factors  in  almost  every  instance,  and,  as  the  health, 
officer  suggests,  the  accession  of  tramps  during  the  Fair 
Holidays.  It  looks  most  ominous  for  the  winter,  especially 
when  it  is  remembered  that  typhus  has  been  epidemic  in 
Liverpool  for  some  months,  and  still  continues  active.  The 
reception-house  has  been  insufficient  for  receiving  all  the 
infected  families  into  quarantine ;  it  contains  only  thirty 
beds,  and  there  are  at  present  thirty-five  inmates,  and  many 


August  18,  1883.  189 


THE  WEEK. 


Medical  Time*  and  Gazette. 

more  who  wished  to  go  could  not  he  received.  It  has  been 
suggested  that  another  reception-house  should  be  erected 
on  the  south  side  of  the  river,  as  at  present  the  sanitary 
authorities  are  seriously  hampered  in  dealing  efficiently  with 
typhus  fever. 


ROYAL  COLLEGE  OF  SURGEONS  OF  ENGLAND. 

At  the  meeting  of  the  Council  of  the  Royal  College  of  Sur¬ 
geons,  held  on  the  9th  inst.,  Mr.  J.  Whitaker  Hulke,  F.R.S., 
was  elected  a  member  of  the  Board  of  Examiners  in  Dental 
Surgery,  in  the  place  rendered  vacant  by  the  retirement  of 
Mr.  Timothy  Holmes.  Mr.  Erich  sen’s  motion — “  That  it  be 
referred  to  the  Committee  on  the  mode  of  voting  for  election 
to  the  Council  to  consider  generally  the  charters  and  by¬ 
laws  of  the  College,  and  to  report  to  the  Council  whether  in 
their  opinion  it  is  desirable  that  any,  and  if  so,  what,  altera¬ 
tions  should  be  made  therein,” — was  carried  unanimously. 
The  Council  also  resolved — ■"  That  the  Council  gives  notice 
to  the  several  medical  authorities  in  England  of  its  with¬ 
drawal  from  the  scheme  for  an  Examining  Board  for 
England,  dated  May  1,  1877,  which  Scheme,  although 
agreed  to  by  those  authorities  and  approved  and  sanctioned 
by  the  General  Medical  Council,  has  never  come  into  opera¬ 
tion”;  further — “  That  notice  of  this  withdrawal  be  also  com¬ 
municated  to  the  General  Medical  Council.”  And  resolved 
— “  That,  without  waiting  for  the  confirmation  of  these 
Minutes,  the  President  and  Vice-Presidents  be  authorised 
to  give  effect  to  the  foregoing  resolutions.”  From  the 
annual  report  of  the  receipts  and  expenditure  of  the  Col¬ 
lege  laid  before  the  Council  at  the  meeting  it  appears 
that  the  former  amounted  to  ,£19,374  19s.  2d.,  derived  prin¬ 
cipally  in  fees  paid  by  students  on  their  examinations  for 
membership  and  fellowship  of  the  College,  viz.,  <£16,249  2s. ; 
rents  from  chambers  adjoining  the  College,  .£1524  8s.; 
dividends  and  stock,  £1124  5s.  2d. ;  fees  paid  on  admission 
to  the  fellowship,  Council,  and  Court  of  Examiners,  £115 10s.; 
receipts  from  trust  funds,  £345  17s.  6d.  The  total  ex¬ 
penditure  amounted  to  £19,446  8s.  5d.,  the  largest  item 
being  in  fees  paid  to  members  of  Council,  Court,  and  Boards 
of  Examiners,  viz.,  £7374  19s.  6d.  Salaries  and  wages  for 
the  large  staff  of  officers  and  servants  for  the  three  de¬ 
partments  of  the  office,  museum,  and  library,  absorbed 
£3849  18s.  5d.  Stamps,  taxes,  and  rates  (exclusive  of 
postage),  £1427  16s.  6d.  ;  alterations,  repairs,  and  painting, 
£2142  11s.  ;  miscellaneous  items,  £433  14s.  2d.  On  the 
right  side  appears  the  respectable  balance  at  the  bankers  of 
£2087  10s.  4d.  The  report  is  signed  by  Mr.  J.  Whitaker 
Hulke  as  Chairman  of  the  Committee  of  Auditors. 


PAGET’S  DISEASE  OF  THE  NIPPLE. 

Hitherto  the  recognition  of  a  peculiar  “  eczematous  ” 
condition  of  the  nipple  as  premonitory  of  cancer  of  the 
breast  has  been  almost  confined  to  observers  in  our  own 
country,  and  it  is  satisfactory,  therefore,  to  note  that  Dr. 
Louis  A.  Diihring  agrees  that  it  is  not  an  eczema,  but  a 
rare  and  peculiar  disease  with  a  malignant  tendency.  He 
thinks  it  a  disease  entitled  to  special  consideration,  and 
says  it  must  be  distinguished  from  eczema,  which  it 
resembles,  and  from  ordinary  cancer,  which  it  is  altogether 
unlike  in  its  early  stages.  The  disease  is  essentially  chronic, 
as  is  well  shown  in  the  two  cases  which  he  reports  (American 
Journal  of  Medical  Science,  July),  where  the  progress  of  the 
disease  was  not  only  slow  but  insidious,  no  suspicion  of 
malignancy  arising  until  after  the  lapse  of  ten  years  in  the 
one  case  and  five  in  the  other.  The  points  in  which  the 
disease  in  these  two  patients  differed  from  eczema  seem  to 
have  been  the  following : — Itching  did  not  become  a  pro¬ 
minent  symptom  until  after  the  lapse  of  some  years ;  it 


usually  appears  early  in  eczema.  The  circumscribed 
sharply  defined  outline  of  the  lesion,  its  slightly  elevated 
border,  and  brilliant  colour,  are  all  points  which  distinguish 
it  from  true  eczema.  The  absence  of  the  eczematous 
surface,  characterised  by  an  appreciable  discharge,  or  by 
vesicles,  pustules,  or  puncta,  coming  and  going  from  time  to 
time,  and  the  absence  of  exacerbations,  so  usual  in  eczema, 
may  also  be  noted  as  of  service  in  the  differential  diagnosis. 
We  have  little  doubt  that  in  years  to  come  this  disease  will 
be  much  more  frequent,  or  rather  will  be  found  much  more 
frequently,  than  it  is  now.  It  is  just  one  of  those  diseases 
which  is  not  observed  until  it  is  looked  for,  and  can  only 
be  recognised  by  those  who  pay  careful  and  minute  attention 
to  these  cases  of  affections  of  the  nipple.  The  importance 
from  the  point  of  view  of  the  patient  of  recognising  at  an 
early  date  the  real  nature  of  the  disease  in  a  case  of  this 
class  is  so  obvious  that  it  would  be  superfluous  to  dwell 
upon  it. 

The  "  Bradshawe  Lecture  ”  of  the  Royal  College  of 
Physicians  will  be  delivered  at  the  above  College  to-morrow 
(Saturday,  the  18th  inst.),  at  four  o’clock,  by  Dr.  J.  Wickham 
Legg,  who  has  chosen  for  his  subject  "  Cardiac  Aneurysms.” 


It  is  stated  that  the  Departmental  Committee  appointed 
by  the  Home  Secretary  to  inquire  and  report  as  to  the  duties 
of  the  office  of  Public  Prosecutor  have  adjourned  the- 
remainder  of  the  investigation  until  November. 


Dr.  Little,  Medical  Officer  of  Health,  Whitechapel: 
District,  has  sent  in  his  resignation.  He  feels  that,  in  con¬ 
sequence  of  his  advanced  age  (being  within  five  weeks  of 
seventy-eight  years),  he  is  not  physically  able  to  give  such 
attention  to  the  welfare  of  the  district  as  it  really  demands. 
The  letter  was  referred  to  the  Committee  of  Works. 


We  understand  that  Sir  T.  Spencer  Wells  has  been  elected 
an  Honorary  Fellow  of  the  Physical  and  Medical  Society  of 
Erlangen. 

At  a  meeting  of  the  Court  of  Governors  of  St.  Bartholo¬ 
mew’s  Hospital  on  the  14th  inst..  Dr.  Dyce  Duckworth  was 
elected  Physician,  in  place  of  Dr.  Southey,  resigned.  At 
the  same  time  the  post  of  Assistant-Physician  was  declared 
vacant.  Applications  for  the  appointment  are  to  be  sent  to 
the  Clerk  of  the  Hospital  by  September  11,  and  the  election 
will  take  place  on  September  27  prox. 


The  Library  and  Museum  of  the  Royal  College  of 
Surgeons  will  be  closed  on  Friday,  the  31st  inst.,  for  the 
annual  cleaning  and  re-arrangement  of  their  respective- 
contents,  and  will  be  re-opened  on  Monday,  October  1. 


J equtrity  in  Granular  Ophthalmia. — The  quali¬ 
fication  of  the  loud  praises  which  usually  attend  the  intro¬ 
duction  of  new  remedies  is  beginning  to  appear  in  relation 
to  the  treatment  of  granular  ophthalmia  by  jequirity.  Dr. 
Deneffe,  of  Ghent,  where  the  disease  has  long  been  one  of  the 
troubles  of  the  surgical  clinics,  in  a  paper  read  at  the  Brussels 
Academy  of  Medicine  ( Journal  de  Thdrapeutique,  July  25) 
states  that  after  having  made  several  trials  of  it  he  has  to- 
report  that  any  efficacy  it  possesses  is  fugitive,  and  that 
it  is  not  to  be  compared  with  inoculation  of  gonorrhoeal 
discharge  in  its  power  of  exciting  a  curative  purulent  oph¬ 
thalmia.  Dr.  Terrier  also,  in  a  communication  to  the  Paris 
Societe  de  Chirurgie,  states  that,  after  the  inflammation 
produced  by  the  jequirity  has  subsided,  the  granulations 
remain  in  much  the  same  condition  as  they  were  prior  to 
its  application. 


190 


Medical  Times  and  Gazette" 


MEDICAL  MATTERS  IN'  PARLIAMENT. 


August  18, 1883. 


MEDICAL  MATTERS  IN  PARLIAMENT. 


House  op  Commons — Thursday,  August  9. 

Education  and  Lunacy. — Mr.  Leighton  asked  the  Vice- 
President  of  the  Council  whether  he  had  seen  that  in  the 
last  report  of  the  Lunacy  Commissioners  it  was  stated  that, 
while  the  number  of  pauper  children  had  decreased  since 
the  passing  of  the  Education  Act  from  393,000  in  1871  to 
:270,000  in  1882,  the  number  of  pauper  lunatic  children  had 
increased  from  962  to  1332,  and  that  the  proportion  of 
pauper  lunatic  children  to  pauper  children  had  during  the 
same  period  arisen  from  "24  to  ‘29  per  cent. ;  and  whether 
lie  would  cause  special  inquiry  to  be  made  by  Her  Majesty’s 
School  Inspectors  during  the  ensuing  year  on  the  subject  of 
over-pressure  in  the  elementary  schools  of  the  country.  In 
reply,  Mr.  Mundella  said  that  the  figures  quoted  in  the 
question  were  accurate ;  but  they  had  no  relation  to  each 
other,  or  to  the  Education  Act  of  1870.  It  was  true  that 
there  was  an  increase  of  369  pauper  children  of  defective 
intellect  in  the  eleven  years  1871  to  1882  ;  but  these  were  a 
permanent  and  growing  charge  on  the  community,  whereas 
the  larger  figures  quoted,  representing  children  in  receipt 
of  relief,  were  fluctuating,  and  since  1863  had,  with  occa¬ 
sional  variations,  been  steadily  declining.  The  increase  in 
the  number  of  pauper  children  of  defective  intellect  was  due 
to  the  increase  of  population,  to  the  advantages  of  better 
treatment  in  idiot  asylums  and  licensed  houses,  and  to  the 
fact  that  a  Government  grant  had  been  made  in  1875  towards 
the  maintenance  of  this  class  in  asylums.  These  children 
are  rarely  insane,  but  generally  are  idiots  or  imbeciles  from 
birth.  He  had  already  made  inquiry  of  several  of  the 
senior  inspectors  of  schools  as  to  the  alleged  over-pressure, 
and  he  should  continue  to  watch  very  carefully  the  effect  of 
the  recent  Code  in  this  respect. 

Irish  Police- Surgeons. — Mr.  Trevelyan,  in  reply  to  ques¬ 
tions  put  by  Dr.  Lyons  and  Mr.  Leamy,  said  the  appoint¬ 
ment  of  surgeons  to  the  Irish  Constabulary  rested  with  the 
Inspector- General  of  the  force,  and  in  making  the  recent 
appointment  at  Waterford  that  officer  believed  he  had 
secured  for  the  constabulary  the  best  available  medical 
advice.  The  gentleman  appointed  was  medical  officer  to  the 
Fever  Hospital,  where  the  constabulary  are  treated.  There 
was  a  departmental  rule  that  dispensary  surgeons  should  have 
preference  for  constabulary  appointments ;  but  exceptions 
to  the  rule  were  sometimes  made.  He  hoped  to  inquire  into 
the  matter,  and  should  be  glad  to  know  the  general  view  on 
the  subject. 

Thames  Water. — Mr.  Firth  put  a  long  question  to  the 
President  of  the  Local  Government  Board  with  regard  to  the 
quality  of  the  river-water  supply  to  the  metropolis,  quoting 
from  Dr.  Frankland’s  reports,  and  calling  attention  espe¬ 
cially  to  Dr.  Frankland’s  statement  in  1881,  that  “’the  water, 
both  of  the  Thames  and  the  Lea,  is  becoming  year  by  year 
less  suitable  for  domestic  use.  There  is  no  protection 
-against  noxious  organic  mater  in  polluted  river-water,  even 
when  efficiently  filtered  and  his  statement  in  1882 :  “  The 
Inner  Circle  of  London  was  supplied,  as  usual,  by  eight 
■companies  with  water,  the  daily  average  volume  of  which 
was  149,190,193  gallons,  an  increase  of  nearly  seven  million 
gallons  on  the  previous  year.  Of  this  74,311,816  gallons 
were  at  times  largely  polluted  with  organic  matters ; 
■35,999,067  gallons  were  occasionally  so  polluted,  but  to  a  less 
degree ;  while  only  8,879,310  gallons  were  of  uniformly  good 
quality  for  drinking.” — Sir  C.  Dilke,  after  observing  that 
the  statements  referred  to  applied  to  the  years  1880  and 
1881,  said  that  Dr.  Frankland’s  general  report  for  1882  was 
qualified  by  the  statement,  “  The  comparative  freedom  from 
■excessive  organic  pollution  which  has  been  observed  in  the 
Thames  water  since  the  year  1875  is  probably  due  to  the  in¬ 
creased  storage  space  acquired  by  the  companies  drawing 
;from  this  source.  In  consequence  of  this  increased  storage 
■capacity,  it  is  no  longer  necessary  to  impound  the  worst 
flood  waters.”  And  he  quoted  from  Dr.  Frankland’s  reports 
for  April  and  May  in  the  present  year,  showing  that  the 
Thames  water  and  the  water  from  the  river  Lea,  as  deli¬ 
vered  by  the  companies,  had  been  in  ‘fan  efficiently  filtered 
condition,”  and  “  for  river- water  unusually  free  from  organic 
matter,”  while  the  water  delivered  by  the  New  Liver 
Company  was  still  purer. 


Friday,  August  10. 

London  Water. — Mr.  Torrens  asked  the  President  of  the 
Local  Government  Board  whether  the  rate  of  mortality  in 
the  ten  cities  and  boroughs  of  the  metropolis  was  not  much 
less  than  in  several  of  the  large  provincial  towns  of  the 
United  Kingdom,  whose  supply  of  water  was  drawn  wholly 
or  in  part  from  other  than  riverine  sources,  and  the  sale  of 
which  to  consumers  was  altogether  in  the  hands  of  the 
municipal  corporations. — Sir  C.  Dilke  said  he  believed  that, 
taking  the  towns  in  the  United  Kingdom  with  a  population 
above  100,000,  and  excluding  those  whose  supply  of  water  is 
furnished  by  companies,  or  where  the  supply  is  wholly  or 
partly  from  rivers,  there  were  nine  towns  where,  according 
to  the  last  published  quarterly  return  of  the  Legistrar- 
General,  the  rate  was  higher  than  in  London,  and  four 
where  it  was  lower. 

House  of  Lords— Monday,  August  13. 

Diseases  Prevention  ( Metropolis )  Bill. — Lord  Carrington, 
in  moving  the  second  reading  of  this  Bill,  observed  that 
there  had  been  some  difficulty  in  putting  in  force  the  Dis¬ 
eases  Prevention  Act  of  1855  in  the  metropolis,  on  account 
of  the  number  of  vestries ;  and  the  present  Bill  proposed  to 
deal  with  that  difficulty  by  falling  back  on  the  Managers  of 
the  Metropolitan  Asylums  District.  The  introduction  of  the 
Bill  had  been  considered  absolutely  necessary  for  the  safety 
of  the  metropolis  in  the  event  of  a  cholera  epidemic ;  and 
in  order  to  avoid,  if  possible,  any  opposition  to  the  Bill,  it 
was  proposed  to  limit  its  duration  to  September  1,  1884. 
The  deputation  of  the  Managers  of  the  Metropolitan 
Asylums  District  had  met  the  President  of  the  Local 
Government  Board  on  Thursday  last,  and  had  expressed 
themselves  as  willing  to  do  all  in  their  power.  They  would 
constitute  themselves  the  first  line  of  defence,  and  trusted 
to  work  in  harmony  with  the  vestries  and  the  Board  of 
Works. — The  Marquis  of  Salisbury  thought  it  was  very  right 
to  grant  special  powers  to  deal  with  the  cholera ;  but  scarcely 
necessary  to  include  other  infectious  diseases  within  the 
scope  of  the  Bill ;  but  he  did  not  oppose  the  second  reading 
of  it.  The  Bill  was  then  read  a  second  time. 

The  Trial  of  Lunatics  Bill  was  read  a  third  time  and 
passed. 

House  of  Commons — Monday,  August  13. 

The  Medical  Acts  Amendment  Bill. — In  reply  to  Sir  Lyon 
Playfair,  Mr.  Gladstone  said :  Owing  to  the  important 
interests  involved  in  this  Bill,  we  are  most  anxious  to  take 
the  discussion  and  obtain  the  j  udgment  of  the  House  upon 
it  on  the  earliest  day  we  can,  but  the  progress  made  with 
certain  other  Bills  is  not  sufficient  to  allow  me  to  name  a 
day  at  the  present.  I  hope  in  the  course  of  three  or  four 
days  to  be  able  to  do  so. 

House  of  Lords — Tuesday,  August  14. 

The  Diseases  Prevention  ( Metropolis )  Bill  passed  through 
Committee. 

House  of  Commons — Tuesday,  August  14. 

Employment  for  Irish  Lunatics. — In  reply  to  Mr.  Healy, 
Mr.  Trevelyan  said  it  had  been  the  practice  for  some  years 
past  to  allow  patients  in  the  Down  Asylum  to  be  occasionally 
employed  in  harvest  work  on  farms  adjoining  the  Asylum. 
They  got  no  remuneration  beyond  food  and  refreshments. 
The  patients  looked  upon  this  work  as  a  favour  and  recrea¬ 
tion,  and  it  was  approved  of  by  both  the  inspectors  of 
lunatics  and  of  the  resident  medical  superintendent.  Full 
employment  of  the  same  kind  was  being  provided  for  on 
land  lately  acquired  by  the  Asylum. 

The  Army  Hospital  Services. — Eeplying  to  Mr.  Dawnay, 
Lord  Hartington  said  he  proposed,  as  soon  as  possible  after 
the  end  of  the  session,  to  examine  carefully  all  the  recom¬ 
mendations  of  Lord  Morley’s  Committee,  and  to  consider 
how  far  they  shall  be  adopted  and  given  effect  to  in  next 
year’s  estimates.  With  regard  to  the  recommended  change 
in  the  position  of  the  medical  officer  with  the  Household 
Troops,  he  could  not  undertake  that  no  steps  should  be  taken 
towards  its  adoption  until  the  matter  had  been  before  the 
House,  because  the  Government  must  take  the  responsibility 
of  deciding  such  a  matter.  The  House  might  discuss  it 
fully  next  year  when  the  Army  Estimates  came  before  them. 

Army  Vaccination. — Mr.  Biggar  asked  the  Secretary  of 
State  for  War  whether  it  had  come  to  his  knowledge  that 
sixty-eight  recruits  were  vaccinated  atDortrecht,  in  Holland, 


Medical  Times  and  Gazette. 


FROM  ABROAD. 


August  18, 1883.  191 


on  May  25  last,  of  whom  eight  were  found  to  be  seriously 
injured,  three  having  subsequently  died;  whether  the  fact 
of  those  injuries  and  fatalities  was  subsequently  brought 
to  the  attention  of  the  Netherlands  Parliament,  and  a 
circular  issued  by  M.  Weitzel,  the  Minister  for  War,  noti¬ 
fying  recruits  that  vaccination  was  not  to  be  considered 
obligatory,  but  optional;  and  whether  some  such  altera¬ 
tion  would  be  made  in  our  military  regulations. — Lord 
Hartington  replied  that  the  War  Office  knew  nothing  about 
the  occurrences  mentioned,  but  he  would  make  inquiry 
through  the  Foreign  Office.  There  was  no  intention  of 
abolishing  or  modifying  the  system  of  vaccinating  or  re¬ 
vaccinating  recruits,  which  had  acted  most  successfully  in 
protecting  soldiers  from  small-pox,  and  against  which 
recruits  had,  so  far  as  was  known,  offered  no  objection. 

Wednesday,  August  15. 

Importation  of  Disease  by  Bags. — Sir  Stafford  Northcote 
asked  the  President  of  the  Local  Government  Board  whether 
his  attention  had  been  called  to  some  cases  of  small-pox 
reported  from  a  place  in  his  constituency,  which  were 
supposed  to  have  originated  from  foreign  rags  employed  in 
certain  paper-mills. — Sir  C.  Dilke  said  the  matter  was  under 
consideration,  and,  in  case  of  there  being  any  strong  proba¬ 
bility  of  the  alleged  facts  being  true,  an  inquiry  would  be 
held  to  see  the  exact  bearing  of  those  facts.  The  orders  of 
the  Local  Government  Board  at  present  had  reference  to 
Egypt  only.  There  was  no  authentic  case  of  cholera  being 
imported  by  rags,  but  there  had  been  one  case  of  such 
importation  of  small-pox. 


FROM  ABROAD. 

Ectopia  op  the  Heart. 

Prop.  Tarnier,  at  the  meeting  of  the  Academie  de  Medecine 
of  July  31,  introduced  to  its  notice  a  highly  interesting  case 
of  ectopia  of  the  heart.  The  subject  of  it  is  a  woman  at 
the  end  of  her  pregnancy  with  her  second  child,  no  incon¬ 
venience  having  attended  her  first  delivery.  The  sternum 
is  bifid  at  its  lower  portion,  so  that  the  heart  lies  just  below 
the  skin.  The  ventricles  can  be  taken  hold  of  by  the  hand, 
but  in  order  to  feel  the  pulsation  of  the  auricles  the  fingers 
must  be  passed  into  the  upper  part  of  the  sternal  cleft. 
The  patient  is  also  the  subject  of  an  umbilical  hernia,  and 
the  displaced  heart  seems  to  have  some  immediate  relations 
with  this  hernia.  It  would  be  difficult  to  appreciate  the 
exact  relations  of  the  displaced  organ.  Is  the  pericardium 
intact  ?  Is  the  heart  free  in  the  abdominal  cavity  ?  It  is 
absolutely  impossible  to  pronounce  an  opinion  on  this 
point.  All  that  can  be  affirmed  is,  that  the  diaphragm  is 
perforated,  and  that  it  is  through  this  perforation  the  heart 
has  passed,  and  become  placed  under  the  skin,  accompanied 
or  not  with  its  proper  serous  membrane.  After  the  woman 
has  been  delivered  at  the  Maternit6,  where  she  is  at  present, 
the  phenomena  will  be  investigated  by  MM.  Marey  and 
Franck. 

Prof.  Marey  stated  that  he  and  M.  Franck  had  already 
taken  some  tracings.  “This  is/’  he  observed,  “one  of  the 
most  interesting  of  cases,  for  it  will  allow,  I  have  no  doubt, 
of  our  verifying  on  the  human  subject  the  results  obtained 
by  experiments  made  on  the  heart  in  animals,  such  as  the 
synchronism  of  the  ventricles,  etc.  In  this  way,  and  without 
insisting  at  present  more  on  the  subject,  the  exploration  of 
the  heart  of  this  woman  will  allow  of  our  exhibiting  the 
illusion  which  has  given  rise  to  the  theory  of  Beau  for  the 
explanation  of  the  pulsations  of  the  heart.  Beau  explained 
the  beating  of  the  heart  by  cardiac  dilatation  under  the 
influence  of  the  afflux  of  blood  at  the  moment  of  the  ven¬ 
tricular  diastole.  This  opinion  appeared  logical,  for  it  is 
rational  to  admit  that  the  impulse  is  produced  at  the  instant 
when  the  organ  increases  in  volume,  and  not  when  it  con¬ 
tracts  upon  itself.  But  this  explanation,  however  logical  it 
may  appear,  is  not  the  true  one,  and  if  any  doubt  exists 
about  it  an  examination  of  this  patient  must  carry  conviction. 
If,  in  place  of  looking  at  her  heart,  we  seize  hold  of  it  with 
the  fingers,  we  prove  in  the  most  distinct  manner  that  it  is 
not  when  the  heart  is  largest  that  the  impulse  is  produced, 
but  really  when  it  is  hardest.  If  the  Academy  will  appoint 


a  committee  in  order  to  examine  this  woman  in  relation  to- 
cardiac  physiology,  and  it  does  me  the  honour  of  placing  me 
on  it,  we  shall  be  able  after  her  delivery  to  undertake  a 
series  of  researches  for  the  elucidation  of  these  various  points. 
Cases  of  this  kind  are,  in  fact,  extremely  rare  in  the  adult, 
and  I  have  only  been  informed  of  one  which  existed  at 
Ribeauvillers,  in  Alsace.”  A  committee,  consisting  of  Pro¬ 
fessors  Yulpian,  Sappey,  and  Marey,  was  appointed. 


The  Cephalalgia  of  Adolescence. 

The  Gazette  des  Hopitaux  of  May  19  notices  a  recent  pub¬ 
lication  of  Dr.  Rene.  Blache,  under  the  title  of  Cephalalgie 
de  Croissance.  This,  of  course,  is  no  new  condition,  for  most 
practitioners  must  have  met  with  examples  of  it  more  or  less- 
frequently,  and  have  generally  given  it  only  the  significance- 
of  a  mere  symptom.  But  for  Dr.  Blache  it  constitutes  in 
some  cases  a  definite  morbid  condition — a  special  disease  of 
adolescence.  It  is  a  persistent  cephalalgia,  accompanied  by 
various  disturbances  of  the  nervous  and  circulatory  systems, 
more  or  less  fleeting  giddiness,  and  sometimes  attempts  at 
vomiting.  These  may  return  daily  for  months,  not  at  the- 
same  time  of  day,  but  at  any  time  that  the  patient  undertakes- 
intellectual  labour  of  any  continuity  requiring  a  certain 
amount  of  attention.  It  has  been  generally  in  subjects  from 
ten  to  eighteen  years  of  age  that  Dr.  Blache  has  met  with 
this  form  of  cephalalgia,  which  occurs  alike  in  young  boys- 
and  girls,  but  most  frequently  in  the  former.  The  seat  of 
the  pain  is  usually  confined  to  the  forehead,  but  sometim.es- 
it  corresponds  to  the  whole  hairy  scalp,  from  the  vertex  to- 
a  circular  line  passing  on  a  level  with  the  orbits  and  mastoid 
process.  The  pain  is  never  unilateral,  as  in  true  migraine. 
At  the  same  time  a  change  of  disposition  takes  place,  the- 
subject  becoming  nervous  and  irritable;  but  the  inaptitude- 
for  work  is  the  most  constant  and  uniform  symptom.  The 
practitioner  in  such  a  case  may  find  himself  in  a  somewhat 
delicate  position ;  for  while,  on  the  one  hand,  he  may  have- 
to  suspect  a  simulated  affection  all  the  symptoms  of  which 
are  subjective,  he  may,  on  the  other,  have  to  do  with  only  a 
too  real  affection.  Great  attention  to  the  case,  a  strict  sur¬ 
veillance  of  the  young  persons  who  complain  of  the  pains, 
the  persistence  of  these  and  their  resistance  to  the  usual, 
remedies,  will  in  the  end  lead  to  a  conviction  of  the  reality 
of  the  affection.  Its  duration  is  not  of  a  few  days  only,  or 
even  for  some  weeks,  but  for  months  and  even  years,  so 
that  simulation  would  be  difficult  indeed.  The  inaptitude 
for  intellectual  labour,  so  far  from  being  made  a  pretext 
for  idleness  and  amusement,  often  becomes  with  these  young 
persons  a  subject  of  poignant  regret.  Besides  these  cases 
of  cephalalgia,  which  are  temporarily  produced  under  the- 
influence  of  efforts  at  intellectual  work  which  surpass  the 
strength  of  the  scholar,  and  which  may  be  regarded  as  the 
benign  and  usual  form  of  the  affection.  Dr.  Blache  refers- 
to  other  cases,  in  which  the  cephalalgia  is  constant,  and 
undergoes  exacerbation  whenever  mental  exertion  is  at¬ 
tempted.  Cases  of  this  kind  seem  to  be  especially  con¬ 
nected  with  diasthetic  heredity;  and  among  the  cases- 
reported  are  those  of  young  persons  the  issue  of  arthritic- 
or  neuropathic  parents.  Dr.  Maurice  Perrin,  consulted  in 
some  of  these  eases,  has  offered  the  opinion  that  most  off 
the  subjects  of  this  cephalalgia  suffered  from  hypermetropia 
or  astigmatism,  and  that  these  pains  were  especially,  if  not 
exclusively,  attributable  to  the  attempts  at  accommodation 
of  the  eye.  But  Dr.  Blache,  while  admitting  the  possible 
concurrence  of  these  disturbances  of  vision,  has  met  with, 
cases  in  which  the  employment  of  appropriate  glasses- 
exerted  no  beneficial  effect,  the  cephalalgia  being  quite  inde¬ 
pendent  of  the  condition  of  the  eyes.  Active  life  in  the- 
open  air,  the  use  of  appropriate  glasses  when  visual  trouble- 
exists,  and  above  all  the  absolute  cessation  of  intellectual 
labour  for  a  prolonged  period,  have  proved,  together  with 
hydrotherapia,  the  sole  means  which  have  given  any  relief, 
and  sometimes  have  caused  the  disappearance  of  the  pains, 
which  are  often  so  severe  as  to  render  existence  miserable. 


Adulteration  of  Lard. — It  is  openly  admitted  by 
the  lard  dealers  of  Chicago  that  all  lard  is  adulterated  from 
10  to  50  per  cent.  In  all  but  the  yorst  grades  the  adulte¬ 
ration  is  harmless,  being  oleo-margarine, '  cottonseed  oil, 
vegetable  oils,  and  tallow. — New  York  Med.  Record,  July  14. 


192 


Medical  Times  and  Gazette- 


SANITARY  CONDITION  OF  PORTSMOUTH  IN  1882. 


August  18,  1883. 


-  '  —  '  1  - -  .  —  .  .  .  — 

THE  COMPULSORY  NOTIFICATION  OF 
INFECTIOUS  DISEASE. 

By  Professor  W.  H.  CORFIELD,  M.A.,  M.D. 

The  following  is  an  abstract  of  a  paper  read  by  Professor 
Corfield,  at  the  meeting  of  the  Sanitary  Institute  of  Great 
Britain,  on  July  24.  The  Professor  said  that  the  facts  which 
he  proposed  to  lay  before  his  audience  had  been  chiefly  ob¬ 
tained  from  replies  to  a  set  of  questions  which  he  had  sent  to 
the  medical  officers  of  health  of  the  various  towns  where  regu¬ 
lations  for  the  compulsory  notification  of  infectious  disease 
were  in  force.  After  giving  statistics  and  opinions  of  the 
medical  officers  of  health  as  to  the  satisfactory  working  of 
the  regulations  in  the  eighteen  towns  from  which  he  had 
received  returns,  the  author  said : — 

From  the  facts  that  I  have  laid  before  you,  I  have  been 
forced  to  the  conclusion  that  the  compulsory  notification 
of  “  infectious  diseases  ”  is  a  very  important  sanitary  mea¬ 
sure,  and  a  great  boon  to  the  community  to  whom  it  has 
been  applied.  There  can  be  no  doubt  whatever  that,  in  a 
vast  number  of  cases,  information  has  been  obtained  of  the 
■existence  of  infectious  disease,  which,  but  for  compulsion, 
would  never  have  been  obtained  at  all,  or,  if  obtained,  would 
liave  come  too  late  to  be  of  much  service. 

Everyone  who  has  had  anything  to  do  with  the  prevention 
of  epidemic  diseases,  knows  that  the  most  important  thing 
■of  all  is  to  get  the  earliest  information  of  the  cases  that 
arise ;  and  that  an  epidemic  may  be  checked  and  stamped 
out  with  comparative  ease  if  it  is  taken  in  hand  early  enough, 
but  that  the  difficulty  increases  every  day  that  is  lost.  The 
objection  that  cases  of  concealment  are  likely  or  even 
■certain  to  occur  where  such  Acts  are  in  force,  has  been  com¬ 
pletely  met  by  the  quotations  that  I  have  made  to  you  ;  but, 
to  my  mind,  this  objection,  of  which  so  much  has  been  made, 
is  so  childish  as  to  be  almost  ludicrous.  If  there  are  cases 
of  concealment  every  day  where  such  an  Act  is  in  force, 
there  are  many  times  as  many  such  cases  where  no 
Act  is  in  force.  One  would  have  thought  that  it  must 
have  been  obvious  to  everyone,  that  in  the  towns  where 
a  hundred  cases  are  reported  under  the  Act,  while  only 
ten  were  reported  during  the  same  time  before  the  Act 
was  passed,  at  any  rate  there  were  ninety  cases  re¬ 
ported  under  the  Act  which  would  have  been  concealed 
without  it.  With  regard  to  the  vexed  question  as  to 
whether  the  medical  attendant  or  the  householder,  or  both, 
should  be  compelled  to  notify  the  existence  of  cases  of  these 
diseases  tb  the  sanitary  authority,  the  most  general  prac¬ 
tice  appears  to  be  to  make  it  compulsory  upon  both  ;  but  the 
•evidence,  as  I  understand  it,  shows  that  at  any  rate  medical 
men  should  be  required  to  give  the  information  ;  and  also 
that  they  should  be  required  to  give  it  direct  to  the  sanitary 
Authority,  rather  than  to  the  householder.  This  is  a  matter 
upon  which  I  do  not  wish  to  insist  strongly,  but  simply  to 
give  the  impression  that  the  results  of  the  inquiries  have 
left  upon  my  mind.  I  think  that  the  evidence  is  very  strong 
that  in  most  places,  at  any  rate,  little  or  no  difficulty  has 
arisen  from  the  medical  men  being  compelled  to  give 
this  information.  As  to  the  suggestion  that  these  Acts, 
so  far  from  diminishing  the  number  of  cases  of  infec¬ 
tious  diseases,  are  likely  to  increase  them,  I  would  ask 
you.  Do  you  think  it  likely  that,  without  any  exception, 
the  medical  officers  of  health  of  the  towns  where  these  Acts 
are  in  force  would  support  them  strongly  if  they  thought 
the  number  of  cases  of  infectious  diseases  was  going  to  be 
increased  by  them  ?  The  business  of  the  medical  officer  of 
health  is  to  prevent  disease — especially  such  diseases  as 
these,— and  he  gains  credit  by  doing  this,  and  not  by  in¬ 
creasing  them.  Do  you  suppose  that  these  medical  officers 
of  health  do  not  know  their  own  business  P  or  do  you  suppose 
that  they  have  combined  together  to  do  that  which  must 
certainly  bring  discredit  upon  themselves  ?  I  ask  you,  on 
the  contrary,  to  believe  that  the  medical  officers  of  health  of 
these  towns  know  the  way  to  prevent  infectious  diseases 
from  spreading,  and  are  doing  their  utmost  to  lead  the 
medical  profession  and  the  public  generally  up  to  the  point 
of  seeing  the  great  need  for  the  passing  of  such  an  Act  as 
those  which  have  been  so  beneficial  where  they  have  been 
applied  for  the  whole  kingdom.  And  I  take  this  opportunity 


_ _ _ 

of  thanking  all  those  gentlemen  for  the  trouble  they  have 
taken  in  answering  the  questions  sent  to  them,  and  so 
enabling  us  to  epitomise  the  evidence  on  the  subject. 


SANITARY  CONDITION  OF  THE  BOROUGH 
OF  PORTSMOUTH  IN  1882. 

At  the  outset  of  his  elaborate  Report  to  the  Urban  Sanitary 
Authority  of  the  Borough  of  Portsmouth  for  the  year 
1882,  Dr.  Syke3,  Medical  Officer  of  Health,  points  out  the 
objections  to  estimating  the  population  of  Portsmouth 
by  the  usual  processes,  and  he  details  the  plan  he  adopted 
in  order  to  obtain  an  approximately  truthful  estimate  of  the 
civil  population  of  the  borough  in  the  middle  of  the  year. 
He  says  :  “  In  order  to  accomplish  this  object  I  have  excluded 
the  convict  prison,  and  nearly  the  whole  of  the  military 
population,  as  well  as  nearly  the  whole  of  the  population 
afloat ;  I  say  nearly,  because  a  certain  number  of  soldiers 
and  sailors  settle  here  after  having  served  their  time,  and 
become  a  portion  of  the  civil  population.  As  these  spend 
the  latter  portion  of  their  lives  here,  during  which  the  rate 
of  mortality  is  great,  it  is  obviously  fair  to  include  as 
belonging  to  us  those  who  in  course  of  time  will  settle  down 
here.  I  have  therefore  assumed  that  a  number  equal  to 
those  now  living  in  the  borough,  and  actually  in  the  receipt 
of  pensions,  belong  to  us,  though  they  are  now  in  active  ser¬ 
vice  ;  and  as  these  will  after  service  settle  down  in  all 
portions  of  the  borough,  I  have  distributed  them  over  its 
several  sub-divisions  in  proportion  to  the  population  of  each.” 
The  total  number  of  births  in  the  borough  for  the  year  was 
4506,  2289  being  male  and  2217  female,  the  birth-rate  being 
slightly  higher  than  the  average  one  for  the  previous  ten 
years.  The  deaths  were  2778,  which  gives  a  higher  death- 
rate  than  the  average  of  the  previous  ten  years.  The 
borough  is  divided  into  five  sub-districts  or  sub-divisions,  viz., 
Portsmouth,  Portsea,  Kingston,  Landport,  and  Southsea ; 
and,  as  might  be  expected,  the  death-rate  is  by  no  means  the 
same  in  all.  There  has  been  no  small-pox  during  the  year. 
A  severe  epidemic  of  measles  commenced  in  the  middle  of 
February,  and  lasted  until  the  end  of  June,  causing  no  less 
than  156  deaths.  As  soon  as  it  was  brought  to  their  notice 
the  Urban  Sanitary  Authority  printed  some  “  Suggestions 
for  the  Prevention  of  the  Spread  of  Measles,”  and  distributed 
them  throughout  the  borough ;  they  contain  plain,  sound 
advice  regarding  the  separation  of  the  sick,  the  ventilation 
of  the  sick-room,  disinfection  of  clothes,  attendance  of 
children  at  school,  etc.,  and  conclude  with  an  offer  to 
give  disinfectants  gratuitously  on  personal  application  at 
the  offices.  Dr.  Sykes  says  that  an  epidemic  of  measles  was 
due  that  year,  as  the  last  one  was  in  1876,  and  it  seems  to 
recur  every  five  or  six  years.  For  the  same  reason  he  is 
expecting  an  epidemic  of  scarlet  fever,  which  had  caused 
forty  deaths  during  the  year — a  greater  number  than  in  any 
year  since  the  previous  outbreak  in  1876.  Diphtheria  caused 
106  deaths,  there  having  been  a  serious  epidemic  of  it  during 
the  latter  part  of  1881,  which  was  at  its  height  at  the  com¬ 
mencement  of  the  year.  Dr.  Sykes,  in  his  report  for  the  pre¬ 
vious  year,  expressed  the  opinion  that  the  epidemic  was  spread 
in  the  first  instance  by  direct  infection,  and  later  by  emana¬ 
tions  from  the  sewers,  which  became  highly  charged  with  the 
poisonous  germs  of  diphtheria,  and  he  now  says,  “  I  have 
not  yet  met  with  any  new  facts  to  alter  the  opinion  I  then 
formed  upon  the  matter,  and  the  recent  discovery  of  the 
scandalous  manner  in  which  the  cleansing  of  the  sewers  had 
been  neglected,  only  shows  what  a  suitable  nidus  they  were 
for  the  multiplication  and  growth  of  the  germs  of  diph¬ 
theria.”  Enteric  fever  is  credited  with  eighty-six  deaths, 
and  simple  continued  fever  with  ten,  during  the  year.  Dr. 
Sykes  adopts  Pettenkofer’s  views  of  the  part  played  by  the 
variations  in  the  level  of  the  ground- water  in  the  causation 
of  typhoid  fever,  and  he  points  out  that  their  soil  is  a  light, 
porous,  gravelly  one,  which  has  for  years  been  organically 
polluted  by  cesspits,  and  that  the  influence  of  the  tides  and 
rainfall  must  be  causing  constant  changes  in  the  level  of  the 
ground- water.  In  order  to  obviate  this  pollution  of  the  soil 
as  far  as  possible,  a  careful  watch  should  be  kept  upon  the 
public  sewers  to  prevent  leakage ;  a3  many  open  spaces  as 


Medical  Times  and  Gazette. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


August  18,  1883.  193 


possible  should  be  kept  unbuilt  upon,  to  allow  free  diffusion 
of  the  atmosphere  with  the  ground-air,  that  the  organic 
impurities  of  the  soil  may  be  oxidised  and  rendered  harm¬ 
less  ;  and,  lastly,  the  basement  of  every  house  should  be  laid 
with  an  impervious  coating  of  concrete  so  as  to  absolutely 
prevent  the  entrance  of  the  ground-air.  A  thorough  inspec¬ 
tion  of  the  public  sewers  during  the  year  led  to  the  discovery 
that  they  were  in  a  disgraceful  state  from  neglect  to  keep 
them  free  from  deposit,  and  the  Report  points  out  that  700 
additional  ventilators  are  required  to  make  the  number 
one  for  every  hundred  yards  of  sewer.  In  regard  to 
house-drainage,  many  houses  have  been  supplied  with 
efficient  ventilation  shafts,  and  some  few  with  an  inter¬ 
cepting  arrangement  as  well ;  and  some  new  by-laws  are 
shortly  to  be  enforced,  providing  for  both  these  improvements 
in  all  new  buildings  subsequently  erected.  In  conclusion. 
Dr.  Sykes  makes  an  earnest  appeal  for  the  carrying  out  of 
sanitary  reforms  with  more  vigour  if  Portsmouth  is  ever  to 
take  its  proper  position  as  one  of  the  healthiest  towns  in 
England.  A.  word  of  praise  is  due  to  Dr.  Sykes  for  the  great 
pains  he  has  bestowed  on  the  map  of  the  district,  in  which 
the  houses  where  cases  of  diphtheria,  scarlet  fever,  or  enteric 
fever,  have  occurred,  as  well  as  those  where  fatal  cases  of 
measles  have  taken  place,  are  designated  by  distinctive 
marks. 


REVIEWS  AND  NOTICES  OF  BOOKS. 

- «. - 

Practical  Treatise  on  the  Diseases  of  the  Uterus,  Ovaries,  and 
Fallopian  Tubes.  By  A.  Courty,  Professor  of  Clinical 
Surgery,  Montpellier.  Translated  from  the  Third  Edition 
by  his  Pupil,  Agnes  McLaren,  M.D.,  M.K.Q.C.P.I. ;  with 
Preface  by  J.  Matthews  Duncan,  M.D.,  LL.D.,  F.R.S.E., 
Obstetric  Physician  to  St.  Bartholomew’s  Hospital. 
London  :  J.  and  A.  Churchill.  1882.  Pp.  810. 

The  position  and  reputation  of  Professor  Courty  will  cause 
this  book  to  be  widely  read.  It  is  possible  also  that  some 
may  be  induced  to  study  it  by  seeing  that  it  is  introduced 
by  a  preface  from  the  pen  of  Dr.  Matthews  Duncan — a  fact 
which  it  would  not  be  unreasonable  to  take  as  indicating 
that  that  distinguished  physician  in  the  main  approved  its 
tendency  and  teaching.  Anyone  who  should  for  that  reason 
get  the  book  will  find  a  surprise  in  store  for  him  :  for  the 
teaching  of  Courty  is  as  opposite  to  that  of  Duncan  as,  treat¬ 
ing  of  the  same  subject,  and  going  over  the  same  ground¬ 
work  of  admitted  fact,  it  can  well  be.  We  note  that  the 
preface,  while  laudatory  of  the  author  and  of  the  trans¬ 
lator,  has  nothing  better  to  say  of  the  book  than  that 
it  is  important,  and  a  recognised  exponent  of  French  doc¬ 
trine,  and  on  these  grounds  to  be  recommended  for  careful 
study. 

Coming  to  the  book  itself,  we  find  that  the  first  ninety  pages 
describe  the  anatomy,  physiology,  and  teratology  of  the  female 
generative  organs.  This  part,  like  m  ost  French  works  on  allied 
subjects,  is  full  and  clear.  Then  we  have  150  pages  devoted 
to  “  a  general  survey  of  uterine  diseases.”  The  impression 
which  this  part  of  the  work  is  likely  to  produce  on  the 
mind  of  the  learner  is,  we  think,  an  undesirable  one. 
Professor  Courty  seems  to  be  among  those  who  hold  that 
any  symptom  may  be  produced  as  a  reflex  effect  of  slight 
uterine  change  :  disorders  of  the  uterus  of  the  most  trivial 
kind,  possibly  not  causing  any  observed  disturbance  of 
function  or  local  uneasiness,  may  yet  manifest  themselves 
hy  symptoms  connected  with  some  distant  part.  From  this 
doctrine  the  practical  corollary  follows :  when  a  woman 
complains  of  any  symptom  of  which  the  causation  is  obscure, 
examine  the  uterus,  no  matter  whether  there  are  any  com¬ 
plaints  directly  referable  to  it  or  not,  and  treat  any  condi¬ 
tion,  however  apparently  unimportant,  which  in  the  slightest 
degree  is  not  normal.  That  no  one  may  think  that  we 
exaggerate,  we  quote  the  following  “presumptive  signs 
indicating  uterine  disease  ” :  gastralgia,  nausea,  dyspepsia, 
anorexia,  perverted  appetite,  oesophageal  constriction,  globus 
hystericus,  enlargement  of  liver  and  gall-bladder,  palpita¬ 
tion,  visceral  and  other  neuralgias,  hysteria,  local  anaesthesia, 
hyperaesthesia,  spasms,  cough,  paralysis,  anaemia,  emaciation, 
corpulency.  Of  course,  it  cannot  be  denied  that  uterine  disease 
of  a  serious  kind  may  sometimes  indirectly,  or  along  with 
other  conditions,  produce  these  complaints.  To  show  Pro¬ 


fessor  Courty’s  teaching  as  to  the  slightness  of  the  local 
maladies  which  are  capable  of  causing  all  these  troubles, 
we  will  further  quote — “The  most  insignificant  functional 
disorder  is  sufficient  to  disturb  the  whole  economy.  It  is 
very  striking  to  observe  the  disproportionate  magnitude  of 
this  general  disturbance  compared  to  the  insignificance  of  the 
change  which  has  produced  it.” — (Page  99.)  “  Predomi¬ 

nance  of  general  symptoms  may  be  so  marked  as  completely 
to  efface  all  local  phenomena.” — (Page  24.)  Looking  at  this, 
as  it  ought  to  be  looked  at,  from  the  point  of  view  of  the 
general  physician,  we  have  no  hesitation  in  expressing  our 
own  belief  that  insignificant  functional  disorders  of  the 
uterus  are  far  more  commonly  the  result  of  disturbance  of 
the  whole  economy  from  some  other  cause  than  the  causes 
of  such  disturbance.  We  think  that  Professor  Courty’s 
teaching  on  this  point  tends  to  favour  unnecessary,  and 
therefore  injurious,  local  treatment  of  the  genital  organs. 
We  find  further  (page  151)  a  statement  that  “  experience 
teaches  us  that  diseases  of  the  womb  have  no  tendency  to 
spontaneous  cure.”  We  are  quite  sure  that  many  will  get 
well  with  very  simple  treatment,  and  fear  that  there  are 
only  too  many  which  are  maintained  simply  by  local  treat¬ 
ment,  and  get  well  when  local  treatment  is  left  off.  The 
whole  of  this  section  of  the  work  is  characterised,  as  it  seems 
to  us,  by  a  magnifying  of  subjective  symptoms,  of  trifling 
local  alterations,  and  of  unimportant  details  of  treatment. 
As  an  example  of  the  latter,  we  read  (page  167) — “  The 
patient  should  lie  horizontally,  the  pelvis  on  a  level  with 
the  shoulders  or  higher,  the  head  resting  on  a  pillow,  the 
legs  and  thighs  flexed  and  supported  by  pillows  under  the 
thighs ;  in  short,  the  muscles  relaxed  by  semiflexion.”  Is 
there  any  evidence  that  it  matters  one  iota,  in  chronic 
uterine  disease,  whether  the  patient  in  bed  lies  with  her 
legs  bent  or  straight  ?  The  pathological  part  of  this  section 
seems  to  us  more  likely  to  retard  than  to  hasten  the  attain¬ 
ment  of  exact  knowledge  concerning  uterine  maladies.  It  is 
characterised  by  an  abundant  use  of  vague  hypothetical 
terms,  expressing  generalisations  of  the  widest  scope,  but 
which  are  neither  defined  nor  proved,  and  therefore  neither 
convey  information  nor  are  capable  of  refutation.  As  an 
example,  take  the  following  sentence : — “  Engorgement,  or 
the  presence  of  interstitial  plasma,  which  is  something 
between  oedema,  congestion,  and  hypertrophy,  naturally 
indicates  the  use  of  resolvents.” 

The  chapters  in  which  uterine  diseases  are  considered  in 
detail  are  far  better  than  the  first  part  of  the  work  would 
have  led  us  to  expect.  They  are  very  full  and  clear,  and 
make  the  work  a  very  valuable  one.  As  instances  of  the 
great  divergence  between  the  author  of  the  book  and  the 
writer  of  the  preface,  we  may  mention  that  116  pages 
are  devoted  to  describing  the  changes  in  position  of  the 
uterus,  thirty-two  of  them  being  taken  up  exclusively  with 
flexions.  We  regret  that  the  space  which  we  have  been 
obliged  to  occupy  in  explaining  our  dissent  from  the  teach¬ 
ing  of  the  earlier  part  of  the  work  precludes  us  from  the 
more  grateful  task  of  particular  comment  on  the  parts 
which  seem  to  us  especially  good.  We  would  say,  briefly, 
that  the  only  adverse  criticisms  which  we  should  make  upon 
the  latter  chapters  are  the  same  as  those  which  we  have  made 
upon  the  earlier,  viz.,  that  the  author  seems  to  us  to  make 
too  much  of  trivial  local  changes,  and  to  ignore  the  fact 
that  uterine  symptoms  will  often  disappear  when  the 
patient’s  general  health  is  improved,  without  any  local 
treatment.  The  merit  of  the  book — and  it  has  great  merit — 
is  in  the  admirable  clearness  with  which  practical  details  are 
described.  The  chief  special  feature  in  it  is  the  elaborate  dis¬ 
tinction  which  is  drawn  between  fluxion,  congestion,  inflam¬ 
mation,  engorgement,  oedema,  hypertrophy,  and  subinvolution 
of  the  uterus.  That  the  changes  denoted  by  these  terms 
take  place  we  do  not  doubt.  But  the  transition  from  one  to 
the  other  is  so  gradual,  they  so  often  co-exist  and  are  blended, 
that  it  must  be  quite  exceptionally  that,  even  with  the 
scalpel  and  the  microscope,  the  morbid  condition  can  be 
with  strict  accuracy  labelled  with  one  alone  of  these  terms. 
And  in  practice  so  few  observers  have  had  the  opportunity 
of  checking  the  clinical  diagnosis  of  disease  of  the  uterus  by 
comparison  with  the  results  of  post-mortem  dissection,  that 
we  cannot  but  suspect  that  the  elaborate  table  which 
Professor  Courty  gives  of  the  differentiated  symptoms,  etc., 
of  these  different  conditions  is  but  a  theoretical  refinement 
— to  borrow  a  term  from  Dr.  Duncan,  a  “  symptomatic  castle¬ 
building.” 


194 


Medical  Times  and  Gazette. 


EE  VIEWS  AND  NOTICES  OF  BOOKS. 


August  18,  1883. 


Saint  Bartholomew’s  Hospital  Reports.  Edited  by  W.  S. 

Church,  M.D.,  and  John  Langton,  F.R.C.S.  Vol.  XVIII. 

London  :  Smith,  Elder,  and  Co.  1S82.  Pp.  574. 

The  eighteenth  volume  of  the  Saint  Bartholomew’s  Hospital 
_ Reports  contains  some  interesting  and  valuable  matter.  It 
opens  with  a  paper  by  Dr.  Gee,  on  “  Eitful  or  Recurrent 
Vomiting.”  He  describes  a  disorder  met  with  in  children, 
beginning  often  very  early  in  life,  and  consisting  of  attacks 
of  vomiting,  generally  accompanied  with  abdominal  pain, 
and  sometimes  with  disorder  of  the  bowels,  recurring  at 
uncertain  intervals,  sometimes  without  discoverable  cause, 
sometimes  provoked  by  fatigue,  excitement,  exposure  to  cold, 
or  indigestible  food.  The  treatment  which  Dr.  Gee  recom¬ 
mends  is  during  the  attack  to  limit  the  diet  and  give  small 
-doses  of  grey  powder  or  calomel.  By  way  of  prevention  he 
advises  that  upon  the  appearance  of  any  premonitory 
symptom  a  mild  laxative  should  be  given.  Dr.  Wickham 
Legg  contributes  a  "  Note  on  the  History  of  Exophthalmic 
Goitre.”  The  main  object  of  it  is  to  throw  light  on  the 
respective  claims  of  Graves  and  Basedow  to  be  considered 
as  the  founders  of  our  knowledge  of  this  disease.  Dr. 
Wickham  Legg  is  of  opinion  that  the  honour  belongs 
to  Dublin  ;  and  that  Basedow,  by  attaching  too  much 
importance  to  the  state  of  the  eyes,  rather  retarded 
the  attainment  of  a  true  comprehension  of  the  malady. 
The  department  of  orthopasdic  surgery  is  represented  by 
papers  by  Mr.  Walsham,  on  the  treatment  of  deviation 
of  the  nasal  septum  by  forcible  straightening,  accompanied 
with  stellar  division  of  the  septal  cartilage ;  by  Mr.  Howard 
Marsh,  on  rickets,  knock-knee,  flat-foot,  and  lateral  curva¬ 
ture;  and  by  Mr.  Willet,  on  manipulation  as  a  means  of 
treatment  of  flat-foot,  especially  in  the  acute  form.  Mr. 
Marsh  expresses  a  strong  opinion,  which  he  supports  by 
illustrative  cases  and  other  arguments,  that  rickety  curva¬ 
tures  of  the  long  bones  tend  to  disappear  spontaneously  in 
the  process  of  growth,  even  without  mechanical  treatment. 
Sayre’s  plaster  jacket,  Mr.  Marsh  thinks,  has  been  greatly 
■overpraised.  Cooking’s  poroplastic  jacket  he  regards  as  in 
every  way  better,  and  gives  good  reasons  for  his  preference. 
Dr.  J.  A.  Ormerod  contributes  a  set  of  clinical  observations 
on  the  state  of  the  larynx  in  phthisis ;  and  Mr.  Butlin,  who 
is  in  charge  of  the  throat  department  of  the  Hospital, 
reports  some  interesting  cases  of  laryngeal  disease.  A  mono¬ 
graph  on  imperforate  rectum  and  anus  in  infants,  by  Mr. 
Harrison  Cripps,  gives  in  a  succinct  form  what  is  at  present 
known  of  this  malformation  and  its  treatment.  Dr.  Vincent 
Harris  writes  on  the  diagnostic  value  of  cardiac  murmurs ; 
and  incidentally  calls  attention  to  the  large  degree  in  which 
our  knowledge  of  the  natural  and  morbid  cardiac  sounds  is 
derived  from  experiments  on  living  animals.  Dr.  David  A. 
King  contributes  a  careful  analysis  of  seventy  cases  of  enteric 
fever.  Dr.  Laurence  Humphry,  the  Resident  Medical  Officer 
-of  the  Victoria-park  Hospital,  states  the  result  of  his  inves¬ 
tigations,  made  in  that  institution,  into  the  presence  of  the 
so-called  tubercle-bacillus.  He  is  inclined  to  believe  that 
there  is  “  some  bind  of  relation  between  the  number  of  the 
"bacilli  and  the  stage  or  variety  of  the  disease.”  We  next 
come  to  a  paper  on  the  scoliotic  pelvis,  by  Dr.  Charnpneys 
— one  of  the  series  of  contributions  to  the  scientific  study  of 
pelvic  deformity  with  which  his  name  is  so  creditably  asso¬ 
ciated.  Mr.  Langton  gives  the  results  of  his  exceptionally 
large  experience  of  hernia  of  the  ovary.  Dr.  Norman  Moore 
reports  some  pathological  observations  on  the  pancreas. 
Mr.  Walsham  considers  ably  and  fully  the  question,  “Is 
trephining  the  skull  a  dangerous  operation  per  se?”  From 
an  analysis  of  686  cases,  he  concludes  that  the  danger  of 
trephining  is  over-estimated ;  that  in  many  cases  in  which 
-death  has  followed  it  the  operation  had  nothing  to  do  with 
the  fatal  issue ;  and  that  in  itself  trephining  is  attended  with 
"but  slight  risk.  The  percentage  of  deaths  due  to  the  opera¬ 
tion  he  puts,  from  published  cases,  at  10k  per  cent.,  and  he 
thinks  this  may  probably  be  much  diminished  by  improve¬ 
ment  and  greater  care  in  the  mode  of  operation  and  after  treat¬ 
ment.  Several  papers  in  the  volume  detail  cases  of  especial 
interest,  viz. : — One  of  lesion  of  the  sympathetic  nerve  in  the 
neck,  by  Drs.  Gee  and  Abercrombie ;  two  of  hemiatrophia 
facialis,  by  Messrs.  Jessop  and  Browne ;  three  of  removal  by 
operation  of  cancer  of  the  rectum,  by  Mr.  Morrant  Baker ; 
a  fatal  case  of  perimetritis,  by  Mr.  Walter  S.  A.  Griffith; 
■a  case  of  intracranial  aneurism,  by  Mr.  Henry  Smith ;  and 
some  cases  from  Dr.  Gee’s  wards,  by  Messrs.  Oswald  Browne 


I  and  D’Arcy  Power.  Dr.  Samuel  West  writes  briefly  on  the 
I  mutual  relation  of  pain  and  haemorrhage,  pointing  out  how 
the  latter  frequently  relieves  the  former.  Drs.  Lauder 
Brunton  and  Cash  publish  a  chemical  investigation  on  the 
influence  of  various  alkaloids  on  processes  of  oxidation. 
Mr.  W.  A.  Steavenson  contributes  some  useful  notes  on 
tracheotomy,  based  on  an  experience  of  fifty-three  cases. 
The  point  to  which  he  calls  particular  attention  is  the  diffi¬ 
culty  often  experienced  by  the  patient  in  dispensing  with  the 
tube  after  the  operation.  He  follows  Mr.  Parker  in  attach¬ 
ing  great  importance  to  diligent  after-treatment,  for  the 
carrying  out  of  which  he  advises  relays  of  students  or 
nurses.  Dr.  Norman  Moore  supplies  a  paper  of  much  anti¬ 
quarian  interest  on  the  physicians  and  surgeons  of  St. 
Bartholomew’s  Hospital  before  the  time  of  Harvey.  Dr. 
Duckworth  writes  on  diabetes  in  relation  to  arthritism.  He 
argues  in  favour  of  the  existence  of  a  gouty  diabetes — a 
form  which  does  not  “  present  the  ordinary  aspect  or  recog¬ 
nised  symptoms  of  diabetes  as  commonly  understood.”  It 
occurs  generally  in  male  patients  robust  in  appearance,  in 
middle  life,  often  with  obesity.  When  under  treatment  the 
sugar  disappears  from  the  urine,  gouty  symptoms  often 
supervene.  The  volume  finally  contains  the  proceedings  of 
the  Abernethian  Society ;  an  account  by  Mr.  Bowlby  of  the 
specimens  added  to  the  Museum  during  the  year;  and 
statistical  tables,  drawn  up  by  the  Registrars,  of  the  patients 
under  treatment  during  the  year. 


Brain,  No.  XXII.,  July,  1883. 

The  current  number  of  Brain  is  exceptionally  good,  being 
quite  remarkable  for  the  number  and  excellence  of  the  illus¬ 
trations.  Professor  Westphal  leads  off  with  a  masterly  paper 
on  Syringomyelia  (Hydromyelia),  which  is  illustrated  by 
thirteen  coloured  lithographs  of  great  beauty.  He  arrives 
at  the  conclusion  that  the  cavity  in  the  spinal  cord  is  an 
unobliterated  portion  of  the  longitudinal  groove  which,  in  the 
embyro,  divides  the  posterior  half  of  the  spinal  cord  into 
two ;  and  that  in  the  parietes  of  this  groove,  now  become  a 
cavity,  a  fibrous  neoplasm  becomes  developed.  Five  very  in¬ 
structive  cases  of  tumours  in  the  neighbourhood  of  the  valve 
of  Vieussens  are  related  by  Dr.  Bristowe,  who  introduces  them 
with  a  few  remarks  that  make  us  wish  for  more.  Dr.  Mercier 
contributes  an  admirably  well-studied  case  of  epilepsy,  illus¬ 
trated  by  instantaneous  photographs  taken  during  the  pro¬ 
gress  of  the  convulsions.  Professor  Hamilton,  of  Aberdeen, 
brings  forward  a  novel  method  of  demonstrating  the  course 
of  fibres  in  the  brain.  A  thin  section  through  the  entire 
brain  is  placed  between  two  thin  layers  of  gelatine,  which 
unite  with  one  another  around  and  through  the  section. 
The  slice  of  brain  thus  prepared  is  dried,  and  in  this  condi¬ 
tion  can  be  handled,  tied  up  in  bundles,  transmitted  by 
post,  and  subjected  to  moderately  rough  treatment  without 
harm.  When  it  is  to  be  examined  it  is  soaked  in  water,  in 
which  it  expands  greatly.  While  still  wet  it  is  spread  on 
glass,  and,  becoming  adherent,  dries  so  as  to  retain  its  en¬ 
larged  area.  It  may  again  be  taken  from  the  plate,  ex¬ 
panded  by  soaking,  and  the  expansion  rendered  permanent 
by  drying  on  glass  ;  and  this  process  may  be  repeated  several 
times.  Dr.  Stephen  Mackenzie  relates  a  case  of  loss  of  both 
knee-jerks  from  one-sided  brain  disease,  and  advances  a 
very  ingenious  hypothesis  to  account  for  this  puzzling  con¬ 
dition  of  things.  A  case  of  sawyer’s  cramp — a  somewhat  un¬ 
usual  “  professional  ”  malady — is  recorded  by  Dr.  Poore. 
The  Clinical  Cases  are  as  important  as  usual,  and  more  than 
usually  numerous.  They  include  one  of  cerebral  tumour  by 
Dr.  A.  Bruce,  which  again  is  illustrated  by  four  excellent 
lithographs  ;  a  case  of  epileptiform  migraine  by  Dr.  Clifford 
Allbutt;  two  cases  of  tabes  dorsalis  with  joint  disease  by 
Dr.  Ormerod ;  and  two  cases  of  Meniere’s  disease  by  Dr. 
Alexander  McAldowie.  W e  are  glad  to  notice  a  great  exten¬ 
sion  of  the  space  devoted  to  Clinical  Digests  and  Abstracts 
from  Journals,  a  department  that  is  much  more  completely 
worked  out  in  this  number  than  has  been  customary 
hitherto. 


Lumbago  may  be  quickly  relieved  by  binding  a  piece 
of  oil-skin  cloth,  such  as  is  used  to  cover  tables,  oyer  the 
loins  outside  the  flannel  shirt.  Profuse  perspiration  is  pro¬ 
duced,  which  rapidly  relieves  the  pain. — Philadelphia  Med. 
Reporter ,  July  7. 


Medical  Times  and  Gazette. 


GENEKAL  CORRESPONDENCE, 


August  18,  1S83.  195 


GENERAL  CORRESPONDENCE. 

- ■©■ - 

EGYPTIAN  OPHTHALMIA  IN  ENGLAND. 

[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sib, — In  your  issue  of  August  11  I  notice  two  allusions  to 
Egyptian  ophthalmia.  Sir  Galbraith  Logan,  in  his  address  to 
the  School  at  Netley,  contrasts  the  effects  of  the  disease  under 
modern  treatment  with  those  which  followed  the  treatment 
adopted  in  a  former  campaign  under  Sir  Ralph  Abercromby. 
Dr.  Charles  Creighton,  in  his  address  to  the  British 
Medical  Association,  also  notices  the  great  sufferings  of  our 
troops  from  ophthalmia  in  Abercromby’s  campaign.  It  is 
satisfactory  to  observe  that  the  treatment  of  the  disease  has 
improved,  but  I  think  there  is  a  lesson  to  be  learned  in  both 
addresses  with  regard  to  its  prevention.  It  seems  possible 
that  the  ophthalmia,  which  can  be  managed  in  Egypt, 
may  prove  unmanageable  if  imported  into  England.  Sir 
Galbraith  Logan  notices  that  the  ophthalmia  brought  to 
England  by  Abercromby’s  troops  “acquired  such  a  per¬ 
nicious  character,  and  proved  so  infectious  among  the  men 
who  escaped  from  the  extreme  result  of  blindness,  that,  as 
regarded  some  of  the  regiments  which  served  in  that  war, 
the  disease  was  not  eradicated  from  them  for  five-and-twenty 
years  after.”  Dr.  Creighton  also  alludes  to  the  virulence  of 
the  disease  after  its  importation  into  England,  and  remarks  : 
“  No  one  in  those  days  thought  that  Egyptian  ophthalmia 
was  a  specific  infection.  But  some  of  the  British  soldiers  re¬ 
turned  with  it  uncured ;  and  it  soon  became  contagious  in  the 
home  garrisons ;  and  it  was  found  after  a  lapse  of  eight  or 
nine  years  that  there  were  no  fewer  than  2317  soldiers  pen¬ 
sioners  upon  the  public  bounty  from  blindness  in  consequence 
of  ophthalmia.  Those  who  knew  the  disease  in  Egypt  denied 
that  it  was  contagious,  and  those  who  saw  it  in  England  were 
as  positive  that  it  was  contagious.” 

It  seems  possible  that  the  two  views  may  be  reconciled, 
and  that  Egyptian  ophthalmia  may  become  dangerously 
contagious  in  the  colder  climates  of  Europe.  Would  it  not 
be  well  to  be  warned  in  time,  and  to  take  care  that  no  men 
suffering  from  ophthalmia  are  brought  back  to  England 
until  a  perfect  cure  has  been  effected  ? 

I  am,  &c.,  “  Caution.” 

[This  subject  was  dealt  with,  and  the  necessity  of  precau¬ 
tions  to  avoid  a  reproduction  of  contagious  ophthalmia 
among  our  soldiers  in  England,  pointed  out  by  us,  in  an 
article  on  "  Egyptian  Ophthalmia  ”  last  autumn. — See 
Medical  Times  and  Gazette,  vol.  ii.,  page  247,  1882.] 


OBITUARY. 

- ♦ - 

Mbs.  CHAPLIN  AYRTON,  M.D.  Pabis,  L.K.Q.C.P.I. 
We  regret  to  record  the  death  of  Mrs.  Chaplin  Ayrton,  M.D. 
This  lady  was  born  at  Honfleur,  of  English  parents,  in  1846, 
and  was  one  of  the  most  able  and  gifted  of  the  first  Edin¬ 
burgh  class  of  women-students,  forming  one  of  the  famous 
“  Septem  contra  Edinem.”  At  Surgeons’  Hall  she  especially 
distinguished  herself  in  anatomy,  and  the  beautiful  coloured 
drawings  which  she  made  of  all  her  dissections  in  their 
various  stages  were  the  admiration  of  her  teachers  as  well 
as  of  her  fellow-students.  Had  her  sympathetic  nature  then 
had  freer  scope,  the  medical  woman  question  in  Edinburgh 
might  have  been  brought  to  a  different  termination.  When 
all  hope  of  University  recognition  was  at  an  end  there,  and 
after  having  passed  her  first  professional  examination  as  an 
undergraduate  of  the  University.  Mrs.  Ayrtonleft  Edinburgh 
for  Paris  in  1872 ;  and  in  the  following  year  she  accompanied 
her  husband,  Professor  Ayrton,  to  Japan,  where  she  re¬ 
mained  until  1877.  While  there  she  taught  midwifery  to  a 
class  of  Japanese  women,  having  previously  herself  obtained 
the  licence  of  the  Obstetrical  Society  of  London.  On  her 
return  to  Europe,  Mrs.  Ayrton  completed  the  prescribed 
course  of  study  at  the  hospitals  and  medical  school  of  Paris, 
and  then  took  her  degree  of  M.D.  in  1879.  Her  graduation 
thesis,  “  Researches  on  the  General  Dimensions  and  the 
Development  of  the  Body  among  the  Japanese,”  comprised 
the  results  of  much  careful  and  scientific  observation,  with 
deductions  as  to  the  effects  on  the  race  of  the  successive 
foreign  immigrations  into  the  country,  and  was  illustrated 


by  lithographs  drawn  on  the  stone  by  herself.  She  subse¬ 
quently  became  a  licentiate  in  medicine  and  in  midwifery 
of  the  King  and  Queen’s  College  of  Physicians  in  Ireland, 
and  after  some  further  clinical  study  was  preparing  to 
establish  herself  in  practice  in  London,  when  her  health, 
which  had  been  severely  tried  by  the  vicissitudes  of  the  long, 
wearying  struggles  of  her  student  life,  broke  down ;  and  the 
remaining  three  winters  of  her  life  were  spent  in  a  vain 
fight  with  disease  on  the  shores  of  the  Mediterranean.  Mrs. 
Ayrton  died  of  phthisis  on  July  19,  at  the  early  age  of  thirty- 
seven,  leaving  behind  her  one  child,  a  daughter.  During- 
her  short  life  Mrs.  Ayrton  contributed  many  articles  to 
medical  and  other  papers,  and  was  the  author  of  a  well- 
known  work,  also  illustrated  by  herself,  called  “  Child-Life 
in  Japan.”  We  understand  that  she  leaves  ready  drawn 
on  the  wood  by  herself  all  the  illustrations,  as  well  as  the 
manuscript,  for  a  further  work  on  Japanese  life. 


MEDICAL  NEWS. 

- •# - 

University  of  Glasgow. — List  of  degrees  conferred 
in  the  Faculty  of  Medicine  : — 

Doctors  op  Medicine  (M.D.). 

George  Richard  Allan,  B.A.,  M.B.,  England;  Angus  Campbell,  M.B., 
Scotland  (Thesis— Certain  Dangers  to  Health  which  result  from  the  present 
system  of  Elementary  Education  in  Scotland) ;  William  Alexander  Caskie, 
Ml.,  M.B.,  Scotland  (Thesis— Observations  in  Midwifery,  with  Special 
Reference  to  the  Use  of  the  Forceps) ;  David  Couper,  M.B.,  Scotland 
(Thesis -Epidemic  and  Sporadic  Diphtheria)  ;  Andrew  Denholm,  M.B., 
Scotland  (Thesis— The  Nature  and  Causes  of  Erysipelas);  John  Highet, 
M.B.,  Scotland  (Thesis — Infantile  Diarrhcea)  ;  Thomas  Ballantyne  Howie, 
M.B.,  Scotland  (Thesis — Some  Remarks  on  the  Etiology  and  Treatment  of 
Diphtheria);  David  Wood  Inglis,(a)  M.A.,  M.B.,  Scotland  (Thesis— On 
the  Prevention  of  Lead  Poisoning  among  Workers  in  Whitelead  Fac¬ 
tories)  ;  David  Newman, (a)  M.B.,  Scotland  (Thesis -Displacements  of  the- 
Kidney) ;  Edward  Graham  Ochiltree.  M.B.,  Australia  (Thesis— Hydatids 
of  the  Lung) ;  Richard  Prichard,  M.B.,  Wales  (Thesis— A  Clinical  Review 
of  nearly  400  cases  of  Scarlet  Fever) ;  Charles  William  Stewart.  M.  A., 
M.B.,  Scotland  (Thesis — Recent  Researches  on  Tubercle:  their  Relation 
to  certain  points  in  connexion  with  Pulmonary  Disease,  with  Illustrative 
Cases,  etc.);  James  Mitchell  Wilson,  M.B.,  Scotland;  John  M.  Yair, 
M.B.,  Scotland  (Thesis— A  Case  of  Enlarged  Prostate,  with  Sacculation  of 
the  Bladder  and  Hidden  Calculus  i. 

Bachelors  op  Medicine  and  Masters  in  Surgery  (M.B.  andC.M.). 

William  B.  Aitken,  Scotland ;  Samuel  Alexander,  Ireland  ;  Thomas  G, 
Alexander,  Scotland ;  David  Arthur,  Scotland ;  Robert  E.  Beveridge, 
Scotland :  Benjamin  Blaine,  South  Africa ;  James  J.  Campbell,  Scotland  ; 
William  Campbell,  Scotland;  John  Clerk,  Scotland;  Francis  H.  Colvin,. 
M.A.,  Scotland ;  John  C.  Crawford,  Scotland ;  Robert  Davidson,  Scotland  j 
Makhan  Lai  Day,  India ;  J.  Innes  Dunlop,  Scotland  ;  William  Dunlop, 
Scotland ;  William  A.  Forsyth,  Scotland  ;  George  C.  H.  Fulton,  Scotland  ; 
Herbert  M.  Gay,  England;  James  F.  Gemmel,  Scotland;  William  Gibb, 
Scotland ;  William  F.  Gibb,  Scotland ;  William  Gordon,  Scotland ;; 
Robert  Gourlay,  Scotland ;  James  Hamilton,  Scotland ;  William  T. 
Hamilton,  South  Africa;  James  M.  Headrick,  Scotland  ;  J.  C.  Herbertson, 
M.A.,  Scotland;  Peter  Hodge,  Scotland:  George  M.  Hogg,  England;. 
Thomas  Howard,  Scotland ;  Alexander  Howie,  Scotland  ;  Robert  R, 
Hunter,  Scotland;  Crei’t.  Hutchinson,  Ireland;  Alexander  Johnston, 
Scotland;  Francis  Johnston,  Scotland;  George  G.  Kenny,  India;  John 
Kerr,  Scotland ;  James  B.  Lawson,  Scotland;  William  Little,  England; 
William  Martin,  Scotland ;  Alexander  Morison,  Scotland ;  George  A- 
Morris,  Scotland ;  James  S.  Muir,  Scotland ;  Henry  D.  M'Culloch.  India  ; 
John  M‘Donald,  Scotland ;  Neil  C.  M'Donald,  Scotland ;  John  F.  Mac- 
gregor,  Scotland ;  Daniel  M'Kenzie,  Scotland ;  Hugh  M.  MacKintosh, 
Scotland  ;  Archibald  M‘Lean,  Scotland ;  J.  R.  Macnaughton,  Scotland ; 
David  Orr,  Scotland:  John  T.  Prangnell.  Scotland;  Francis  S.  Prosser, 
Wales;  W.  F.  Quaife,  B.A.,  Sydney;  David T.  Richard,  Wales;  R.  A.  D. 
Robb,  Scotland  ;  John  M.  Robertson, 'Scotland!;  John  Russell,  Scotland  r 
A.  J.  F.  Skottowe,  India;  William  A.  Soga,  South  Africa;  William 
Stafford,  England;  Ross  S.  Steele,  Scotland;  Andrew  Stewart,  Scotland; 
William  L.  Strain,  Scotland  ;  William  Vost,  Scotland  ;  Alfred  Williams, 
England;  John  C.  Wilson,  Scotland;  John  C.  Young,  Scotland;  John 
Young,  Scotland;  Robert  H.  Young,  Scotland;  R.  B.  Young,  M.A.„ 
Scotland ;  William  T.  Adam,  Scotland ;  Robert  M‘G.  Binnie,  Scotland ; 
Alexander  Dickson,  Scotland  ;  James  Gibson,  Scotland ;  James  Gledhill, 
England;  John  Logan,  Scotland;  John  W.  Murray,  Scotland ;  John  F, 
M'Gregor,  Scotland;  David  M.  Smith,  Scotland;  Patrick  H.  Walker, 
Scotland. 

The  following  gentlemen  were  named  as  entitled  to  honours, 
to  high  commendation,  and  to  commendation,  on  account  of 
distinguished  merit  at  the  various  examinations  for  the 
degrees  of  M.B.  and  C.M. : — 

Honours. — John  Innes  Dunlop. 

High  Commendation. — William  A.  Forsyth. 

Commendation. -Benjamin  Blaine,  Francis  H.  Colvin,  M.A.,  James  F. 
Gemmel,  William  Gibb,  William  F.  Gibb,  William  Little,  Alfred  Williams, 
R.  Bruce  Young,  M.A.  _ 

Faculty  of  Physicians  and  Surgeons  of  Glasgow. 
— During  the  April  sittings  of  the  Examiners,  the  following 
gentlemen  were  admitted  Licentiates  of  the  Faculty  : — 

H.  M.  Baylis,  Southport ;  William  Belcher,  Cork ;  Gilbert  H.  Coates, 
Glasgow;  J.  C.  Edmiston,  Rutherglen;  John  F.  Harrison,  Manchester; 

(a)  Commended  for  thesis. 


195 


Medical  Times  and  Gazette. 


MEDICAL  NEWS, 


August  18,  1883. 


Alfred  Hill,  York;  Ralph  'William  Hodges,  Queenstown;  William  H. 
Holden,  Bolton ;  J.  Jenkins,  Ancaster;  J.  H.  MacMullan,  Belfast;  Ed. 
James  H.  Midwinter,  Barnet ;  Thomas  Mowat,  Glasgow ;  E.  A.  Praeger, 
Hitehin;  G.  W.  A.  Ross,  Glasgow;  R.  Steele,  Glasgow;  And.  W.  Walker, 
Edinburgh ;  Henry  Willett,  Great  Budworth. 

The  following  have  passed  the  final  examination  for  the 
double  qualification,  and  been  admitted  Licentiates  of  the 
Faculty  and  of  the  Eoyal  College  of  Physicians  of  Edinburgh : 

Alexander  Cameron,  Glasgow ;  Thomas  E.  Eliteroft,  Preston ;  David 
K.  Given,  Newtonstewart ;  Thomas  Gray,  M.D.,  Ontario ;  Archibald  S.  T. 
Johnstone,  Bridge  of  Allan ;  Nannystamby  Eappayah,  Ceylon  ;  Harold 
Charles  Ling,  Glasgow  ;  Thomas  B.  Macfarlane,  Glasgow  ;  Walter  Morris, 
Glasgow;  Samuel  A.  Metherell,  Glasgow;  Richard  Henry  Quine,  Isle  of 
Man;  John  C.  Urquhart,  Glasgow  ;  Henry  O.  Watson,  Leeds. 


Eoyal  Colleges  oe  Physicians  and  Surgeons, 
Edinburgh. — Double  Qualification. — The  following  gen¬ 
tlemen  passed  their  First  Professional  Examination  during 
the  July  sittings  of  the  examiners  ; — 

Denis  Hassett,  Waterford ;  William  Gibb,  Dundee ;  Richard  Crawshaw 
Holt,  Accrington ;  Charles  Oliver  Stan  well,  Rochdale ;  Francisco  Fernandes, 
Demerara;  William  Bernard  Thomas  Connolly,  Dublin;  Edward  John 
Thomas,  Chester ;  William  Davies,  Manchester ;  Richard  Townsend 
Herbert  Bland,  Plymouth ;  Ralph  Bennett  Sidebottom,  Mottram  ;  William 
Knott,  Oldham ;  Henry  Caudwell,  London ;  Herbert  Peck,  Wigan ;  Charles 
Augustus  Thorne,  Ireland ;  Hubert  William  Burke,  eo.  Down  ;  William 
Booth,  Innerleithen ;  Edwin  Joseph  Booth,  Durham;  Frederick  Martin, 
Dublin ;  Ernest  Frederic  Eliot,  Birmingham ;  John  Hepburn  Dudgeon, 
Birmingham;  Thomas  Valentine  Devey,  Wolsingham ;  Robert  Hall,  co. 
Down;  Arthur  Windham  Martin,  Shropshire;  George  Lennox  Moore, 
■Staffordshire;  John  Charles  French,  co.  Durham;  Samuel  Henry  Steele, 
Staffordshire;  Richard  Arthur  Scott,  Yorkshire ;  Arthur  Edward  Newbury 
Browne,  London ;  Benjamin  Sidney  Browne,  West  Bromwich ;  Samuel 
Homer  Craig,  co.  Londonderry ;  George  Todd,  Manchester ;  Richard 
Griffith,  Carnarvon;  Edward  John  Hawkes,  Brighton;  Francois  Lion 
Heisler,  Mauritius  ;  Charles  Farrell,  Dublin ;  George  Thomas  Hartley, 
Castleford ;  Francis  Sidley,  Eagar,  co.  Kildare;  Alfred  Ernest  Weightman, 
Liverpool;  Benjamin  Baynham,  Dublin. 

During  July  and  August  the  following  gentlemen  passed 
their  Final  Examination,  and  were  admitted  L.E.C.P.  Edin. 
and  L.R.C.S.  Edin. : — 

William  Bradley,  Dublin ;  John  Nelms  Hawtin,  Bristol ;  James  Maher, 
Ballinasloe ;  J ohn  Edmund  Hutchings  Stephens,  Penryn,  Cornwall ; 
Hubert  Hartley,  Yorkshire ;  Thomas  Williams,  Anglesey  ;  Charles 
Williams,  London ;  William  Henry  Miller,  Canary  Islands ;  John  Joseph 
Butler,  Limerick  ;  Thomas  Macdonnell  Parr,  Chatham ;  Alfred  Everley 
Taylor,  Scarborough;  Joseph  Macnab,  co.  Cork;  Edward  Joseph 
Fernandez,  Hong-kong ;  Highett  Philip  Westbury,  Burbage ;  Charles 
Walter  Hemming,  Gloucestershire;  William  Steuart,  Edinburgh ;  Odoardo 
Tomaso  Achile  Villani  Van-Vestrant,  London ;  Robert  Ashburner, 
Diversion ;  John  Hepburn,  Rathin;  John  Walter  Burbidge,  London; 
Benjamin  Franklin  Wright  Hurdman,  Canada;  James  Fallon,  Athlone; 
Hubert  William  Burke,  co.  Devon  ;  John  Poyntz  Rice,  co.  Kerry  ;  Frank 
Pritchard  Month,  Chester ;  David  Anderson,  Dollar;  Alexander  Thomas 
Leonard,  co.  Galway;  Laurence  John  Raymond  Louis  Quin,  Belfast; 
Frederick  Knollys  Pigott,  Wexford  ;  Charles  William  Purves,  Hunting¬ 
don  ;  Edward  Morse,  Crewkerne  ;  Fitzgerald  TJniaeke  Anderson,  Halifax, 
N.S. ;  Alfred  Thomas,  Lancashire;  George  Blake  Masson,  Darjeeling; 
Patrick  Kehir,  Templemore;  John  William  Walter  Poyntz,  Bombay; 
Harry  Major  Leckenby  Williamson,  London;  Theodore  Thomson,  Aber¬ 
deen;  Alexander  Sutherland,  Dumbarton;  Eugene  Wilton  Anderson, 
Victoria ;  Edgar  George  Bulleid,  London. 


Eoyal  College  of  Surgeons,  Edinburgh. — During 
the  July  sittings  of  the  examiners  the  following  gentle¬ 
men  passed  their  Final  Examination,  and  were  admitted 
L.R.C.S.  Edin. 

Albert  Bleckly  Clarke,  Cambridgeshire;  Joseph  Harrison,  Bradford; 
Archibald  James  Alexander  Campbell,  Perth ;  William  Frederick  Walker, 
Dover ;  William  Houston  Low,  Ayrshire. 

The  following  gentlemen  passed  their  First  Professional 
Examination  for  the  Licence  in  Dental  Surgery  : — 

James  Main  Nicol,  London;  James  Johnstone,  Nottingham;  Alfred 
Henry  Thomas,  Chester ;  Aitken  W.  Cormack,  Edinburgh. 

The  following  gentleman  passed  the  Final  Examination, 
and  was  admitted  L.D.S. : — 

Charles  William  Glassington,  London. 


King  and  Queen’s  College  of  Physicians  in 
Ireland. — At  a  special  examination  for  the  Licences  of  the 
College,  held  on  Friday,  Saturday,  and  Monday,  July  27,  28, 
and  30,  the  following  candidate  was  successful : — 

For  the  Licence  to  practise  Medicine — 

Egan,  Charles  James,  M.R.C.S.  Eng.,  1S57,  King  William’s  Town,  Cape 
of  Good  Hope. 

For  the  Licence  to  practise  Midwifery — 

Egan,  Charles  James. 


Eoyal  College  of  Surgeons  in  Ireland. — At  the 
July  Stated  Examinations  the  following  candidates,  having 
passed  the  required  examinations  for  the  diploma,  and 


taken  the  declaration  and  signed  the  roll,  were  admitted 
Licentiates,  viz.  : — 

Frederick  W.  Allwright,  George  Browning,  John  J.  Buggy,  John  V. 
Byrne,  Alexander  Carte,  Robert  H.  Clement,  William  Clifford,  Arthur 
Cole,  George  P.  Cope,  Richard  J.  D’Arcy,  Samuel  R.  Deane,  William 
Delahunt,  Patrick  Donnellan,  Patrick  Duff,  John  Foley,  Thomas  F. 
Griffin,  Thomas  G.  H.  Hall,  Frederick  S.  Heuston,  Andrew  Hunter, 
Joseph  P.  Kelly,  John  M.  P.  Kennedy,  Daniel  Kenny,  Nathaniel  S. 
Manning,  Jeremiah  T.  Martin,  John  Martin,  Alfred  H.  Middleton,  Thomas 
Moyles,  Richard  Murphy,  Andrew  J.  O’Flanagan,  Joseph  A.  Purdon, 
William  H.  B.  Robinson,  George  F.  Roughan,  Bartholomew  Russell, 
Robert  U.  Russell,  William  S.  Sprent,  Edward  C.  Stack,  William  L. 
Symes,  and  Charles  W.  Wynne. 

Thirteen  were  stqpped. 

Apothecaries’  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday, 
August  9  : — 

Bredin,  Howard  Albert,  St.  Edmond’s-road,  Bootle,  Liverpool. 
Child,  Herbert,  Headingley,  Leeds. 

Lankester,  Herbert  Henry,  High-street,  Leicester. 

Leeming,  Robert  Whinerey,  Holly  Lodge,  Buckhurst  Hill,  Essex. 
The  following  gentleman  also  on  the  same  day  passed  the 
Primary  Professional  Examination  : — 

Soden,  Thomas  Armand  Bourne,  Charing-cross  Hospital. 


DEATHS. 

Harrisson,  Henry,  M.R.C.S,,  late  of  Upper  Montague-streefc,  W.,  at 
Gunnersbury,  on  August  11,  aged  72. 

MoOscar,  John,  M.D.,  at  4,  Argyll-street,  Regent-street,  on  August  8, 
aged  56. 

Oxford,  Richard,  M.R.C.S.,  J.P.,  late  of  Bridgwater,  Somerset,  at 
Sunnyside,  Oldfield  Park,  Bath,  on  August  8,  in  his  65th  year. 

Southby,  Anthony,  M.D.,  at  Bulford  House,  Wilts,  on  August  10, 
aged  83. 


VACANCIES. 

Borough  of  Sheffield. — Medical  Officer  of  Health.  ( For  particulars  sec 
Advertisement. ) 

Chester  General  Infirmary. — House-Surgeon.  Salary  to  commence  at 
£80  per  annum,  with  residence  and  maintenance.  Candidates  must 
possess  double  qualifications  and  be  duly  registered.  Testimonials  to  be 
addressed  to  the  Chairman  of  the  Board,  on  or  before  August  27. 

General  Hospital  for  Sick  Children,  Pendlebury,  Manchester.— 
Junior  Resident  Medical  Officer.  Salary  £80  per  annum,  with  board, 
etc.  Candidates  must  be  doubly  qualified  and  on  the  Medical  Register. 
Applications,  stating  age,  with  testimonials,  to  be  sent  to  the  Chairman 
of  the  Medical  Board  on  or  before  August  18. 

General  Infirmary  at  Gloucester  and  the  Gloucestershire  Eye 
Institution.— House-Surgeon.  Salary  at  the  rate  of  £100  per  annum, 
with  board,  lodging,  and  washing.  Candidates  must  possess  a  medical 
and  surgical  qualification  and  be  registered.  Applications,  with  testi¬ 
monials,  to  be  forwarded  to  the  Secretary  on  or  before  September  1. 

Gloucester  County  Asylum. — Assistant  Medical  Officer.  Salary  £100 
per  annum,  with  board,  lodging,  and  washing.  Candidates  must  be 
duly  qualified  men,  registered  both  in  medicine  and  surgery,  and  not 
over  thirty  years  of  age.  Applications,  with  testimonials,  to  be  sent  to 
the  Medical  Superintendent  (from  whom  all  further  information  can  be 
obtained),  on  or  before  August  20. 

Hartlepools  Hospital  and  Dispensary.— House-Surgeon  and  Secretary. 
Salary  £100  per  annum,  with  board,  lodging,  and  washing.  Applications 
and  testimonials  to  be  sent  to  J.  Rawlings,  Esq.,  13,  Cliff -terrace, 
Hartlepool,  not  later  than  August  18. 

Jersey  Public  Lunatic  Asylum. — Superintendent  Medical  Officer.  ( For 
particulars  see  Advertisement.) 

Liverpool  Royal  Southern  Hospital. — Senior  House-Surgeon.  ( For 
particulars  see  Advertisement.) 

Wallasey  Dispensary. — House-Surgeon.  [For  particulars  see  Advertise¬ 
ment.) 

Western  Ophthalmic  Hospital,  155,  Marylebone-road,  W.— Surgeon. 
Candidates  must  be  Members  or  Fellows  of  the  Royal  College  of  Sur¬ 
geons  of  England,  and  have  attended  ophthalmic  practice  for  twelve 
months.  Address,  Secretary,  at  the  Hospital,  on  or  before  September  1. 

Weston-super-Mare  Hospital  and  Dispensary.  —  House-Surgeon. 
Salary  £70  per  annum,  with  board,  lodging,  and  washing.  Candidates 
possess  a  registered  surgical  and  medical  qualification.  Applications, 
with  qualifications  and  testimonials,  to  be  sent  to  the  Secretary,  on  or 
before  August  15.  The  election  will  take  place  on  August  23. 


Papal  Honours.— His  Holiness  the  Pope  has  just 
conferred  the  Knight  Commandership  of  the  Illustrious 
Order  of  Pius  on  Dr.  Anthony  Colling  Brownless,  K.Gr.Gr., 
Vice-Chancellor  of  the  University  of  Melbourne,  and  Senior 
Consulting  Physician,  Melbourne  Hospital.  This  decora¬ 
tion  carries  with  it  a  patent  of  nobility.  The  order  is  a 
temporal  one,  and  is  conferred  upon  members  of  all  reli¬ 
gious  creeds  who,  from  their  distinguished  attainments, 
high  official  rank,  or  great  public  services,  are  considered 
worthy  of  the  honour.  Dr.  Brownless,  who  received  his 
professional  education  at  St.  Bartholomew’s  Hospital,  is  an 
M.D.  of  the  University  of  St.  Andrews  and  of  Melbourne 
University,  and  is  a  Member  also  of  the  Eoyal  College  of 
Surgeons  of  England. 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES. 


August  18, 1883.  197 


VITAL  STATISTICS  OF  LONDON. 

Week  ending  Saturday,  August  11,  1883. 

BIRTHS. 

Births  of  Boys,  1162;  Girls,  1039;  Total,  2261. 

Corrected  weekly  average  in  the  10  years  1873-82,  2552'0. 

DEATHS. 


Males. 

Females. 

Total. 

Deaths  during  the  week . 

Weekly  average  of  the  ten  years  1873-82,  1 
corrected  to  increased  population  ...  J 

653 

S621 

659 

776-7 

1312 

1638  S 

Deaths  of  people  aged  80  and  upwards 

... 

... 

40 

DEATHS  IN  SUB-DISTRICTS  FROM  EPIDEMICS. 


1  Enumerated 

Population, 

1881 

(unrevised). 

Small-pox. 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

bfl 

.9* 

P,  5fl 

2  o 

rQ  O 

Typhus. 

Enteric  (or 
Typhoid) 
Fever. 

Simple 

continued 

Fever. 

Diarrhoea.  1 

West . 

669633 

7 

7 

2 

4 

, 

3 

22 

North 

906947 

i 

4 

16 

9 

5 

1 

6 

16 

Central 

282238 

4 

3 

5 

... 

•  •• 

1 

12 

East . 

692738 

,, 

16 

19 

2 

2 

•  •• 

2 

12 

South . 

1265927 

1 

25 

14 

3 

4 

... 

3 

... 

32 

Total . 

3816483 

2 

56 

59 

21 

15 

1 

15 

... 

94 

METEOROLOGY. 


From  Observations  at  the  Greenwich  Observatory. 


Mean  height  of  barometer  . 

Mean  temperature  . 

Highest  point  of  thermometer 
Lowest  point  of  thermometer 
Mean  dew-point  temperature 

General  direction  of  wind  . 

Whole  amount  of  rain  in  the  week  .. 


...  29-681  in. 
...  69-4° 

...  72-3° 

...  49-7° 

52*2° 

S.W.  &W.S.W. 
...  0'28  in. 


BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  the 
Week  ending  Saturday,  August  11,  in  the  following  large  Towns : — 


Cities 

and 

Boroughs. 

Estimated  Population  to 
middle  of  the  year  1883. 

|  Births  Registered  during 
the  week  ending  Aug.  11. 

|  Deaths  Registered  during 
j  the  week  ending  Aug.  11. 

Annual  Rate  of 
Mortality  per  100C  living, 
from  all  causes. 

Temperature 
of  Air  (Fahr.) 

Temp, 
of  Air 
(Cent.) 

Rain 

Fall. 

Highestduring 
the  Week. 

Lowest  during 
the  Week. 

Weekly  Mean  of 
Daily  MeanValues 

Weekly  Mean  of 
Daily  Mean 
Values. 

In  Inches. 

In  Centimetres. 

London  . 

3955814 

2261 

1312 

17-3 

72-3 

49-7 

59-4 

15-22 

0-28 

071 

Brighton  . 

111262 

59 

40 

18-8 

71-3 

51-0 

60-4 

15-78 

043 

1-09 

Portsmouth 

131478 

61 

37 

14-7 

•  •• 

.  .  . 

... 

Norwich  . 

89612 

49 

26 

15-1 

' 

... 

... 

... 

... 

Plymouth  . 

74977 

48 

31 

21-6 

71-1 

52-4 

58-8 

14-89 

0-27 

0-69 

Bristol . 

212779 

119 

61 

15-0 

... 

... 

Wolverhampton  . 

77557 

45 

17 

11-4 

705 

426 

54-4 

12-44 

0-84 

2-13 

Birmingham 

414846 

246 

145 

18-2 

,,, 

... 

... 

... 

... 

... 

Leicester  ...  ,.. 

129483 

65 

48 

19-3 

... 

,  . 

... 

Nottingham 

199349 

103 

69 

18-1 

74-6 

434 

56-4 

1355 

114 

2-90 

Derby . 

86574 

53 

23 

14-0 

... 

... 

... 

... 

... 

... 

Birkenhead 

88700 

48 

22 

129 

•  •• 

... 

Liverpool  . 

566753 

293 

285 

26-2 

65-7 

50-7 

55  3 

12-95 

1-56 

394 

Bolton . 

107862 

64 

35 

16-9 

63-7 

44-7 

53-0 

11-67 

2-37 

6-02 

Manchester 

339252 

207 

155 

238 

... 

... 

... 

Salford  . 

190465 

116 

86 

236 

... 

... 

... 

... 

Oldham  . 

119071 

78 

34 

149 

... 

... 

... 

Blackburn . 

108460 

66 

29 

13-9 

... 

.  .  . 

... 

... 

Preston  . 

98564 

68 

43 

22-8 

69-0 

52-0 

56-5 

13-61 

1-39 

3-53 

Huddersfield 

84701 

57 

24 

14-8 

... 

... 

... 

... 

... 

Halifax  . 

75591 

37 

16 

110 

... 

... 

... 

... 

Bradford  . 

204807 

111 

55 

14-0 

69-6 

50-2 

56-6 

13  67 

6-58 

1-47 

Leeds . 

321611 

194 

108 

17-5 

73-0 

49-0 

57-5 

14-17 

0-47 

1-19 

Sheffield  . 

295497 

174 

131 

23-1 

68-0 

48-0 

65-3 

12-95 

0-89 

2-26 

Hull  . 

176296 

115 

63 

186 

72-0 

45-0 

55-1 

12-84 

0-75 

1-90 

Sunderland  *  ... 

121117 

96 

49 

21-1 

73-0 

48-0 

58-4 

14-66 

0-52 

1-32 

Newcastle  . 

149464 

90 

(55 

22-7 

,  , 

... 

... 

... 

... 

... 

Cardiff . 

90033 

65 

30 

17-4 

... 

... 

... 

... 

... 

... 

For  28  towns... 

S62C975 

498S 

3039 

184 

74-6 

42-6 

56-7 

13-72 

0-88 

2-24 

Edinburgh . 

235946-  126 

70 

155 

66-0 

48-2 

66-C 

1333 

0-36 

097 

Glasgow  . 

515589:  317 

j  245 

24-8 

65-0 

49-0 

'56-4  1355 

1-13 

287 

Dublin . 

1  349385  206 

1  140 

20-9 

67'7 

47-2 

157-1  13-95 

1-94 

4-93 

At  tlie  Royal  Observatory,  Greenwich,  the  mean  reading 
of  the  barometer  last  week  was  29-68  in. ;  the  highest  read¬ 
ing  was  30-01  in.  at  the  beginning  of  the  week,  and  the 
lowest  29"43  in.  on  Friday  afternoon. 


NOTES,  QUERIES,  AND  REPLIES. 

- * - 

H*  ifrat  qntsthmetjr  mnt|j  s^all  learn  rnrtcfr. — Bacon. 


Medical  Union  Society. 

TO  THE  EDITOR  OP  THE  MEDICAL  TIMES  AND  GAZETTE. 

Sir, — I  should  take  it  as  a  favour  if  you  would  kindly  notify  in  the* 
columns  of  your  journal,  that  daring  the  vacation,  and  consequent  closure- 
of  the  rooms,  of  the  Medical  Union  Society,  members  wishing  to  obtain 
or  exchange  books  from  the  Society’s  library,  or  Messrs.  W.  H.  Smith 
and  Sons’  circulating  library  in  connexion  therewith,  can  do  so  by  applying 
to  me  at  3,  King’s  Bench  Walk,  Temple,  any  day  (Saturdays  and  Sundays 
excepted),  between  the  hours  of  10  a.m.  and  4  p.m. 

I  am,  &c.,  James  Greenwood, 

August  11.  Hon.  General  Secretary. 

A  Hint  prom  America. 

A  man  obtained  a  verdict  for  $1000  damages  against  the  City  of  Elkhart,. 
Ind.,  for  injuries  sustained  by  being  thrown  from  a  waggon  on  an  un¬ 
finished  street.  He  asserted  that  kidney  disease  ensued.  The  cityputa 
life  insurance  agent  on  his  track,  who  induced  him  to  make  application 
for  a  policy.  In  this  application  he  has  made  affidavit  that  he  was  not  . 
afflicted  with  kidney  disease,  and  never  had  been.  The  Court  has  granteA 
the  city  a  new  trial,  and  the  authorities  are  congratulating  themselves  on 
the  success  of  their  stratagem. — Boston  Medical  and  Surgical  J ournal. 

“  Cramming.” —In  distributing  the  prizes  awarded  to  the  successful 
students  at  the  Macclesfield  Grammar  School,  the  Bishop  of  Manchester 
condemned  the  system  of  “  cramming,”  which  he  said  was  too  common 
in  our  schools.  The  Americans  had  found  it  to  be  a  false  educational 
basis,  and  had  had  to  retrace  their  steps. 

Umbrellas  for  Soldiers  in  India. — The  Times  of  India  advocates  umbrellas 
for  soldiers.  It  says  the  result  of  not  using  them  is  to  fill  the  hospitals ; 
but  what  matters  this,  so  that  the  effeminacy  of  hoisting  an  umbrella  is 
avoided  ?  In  these  times  the  military  fashions  are  set  by  commanding- 
officers,  whose  theory  is  that  men  can  be  “  inured”  to  the  sun  by  freely 
exposing  them  to  its  full  force.  Umbrellas  for  soldiers  on  parade,  or  for 
use  in  the  mornings  or  evenings,  no  one  would  recommend  ;  but  there 
are  many  occasions  when  umbrellas  would  prove  an  immense  boon  to 
the  men. 

Health  of  Manchester. — Dr.  Samelson  recently  read  at  the  Memorial  Hall, 
before  a  combined  meeting  of  the  Manchester  and  Salford  Sanitary 
Association  and  other  bodies,  a  paper  on  the  health  of  Manchester, 
which  has  since  been  published.  It  directs  attention  to  the  fact  that 
Manchester  continues,  in  turn  with  Liverpool,  to  hold  the  position  of  the 
most  unhealthy  of  the  towns  in  England,  and  shows  by  official  evidence- 
that  the  unsatisfactory  condition  of  the  dwelling-houses,  new  as  well  as- 
old,  of  the  mass  of  the  people  must  be  regarded  as  one  of  the  foremost- 
causes  of  ill-health.  He  recommends  that  effect  should  be  given  with 
greater  promptness  to  the  suggestions  and  counsels  of  the  Medical 
Officer  of  Health,  and  urgently  exhorts  the  Corporation  no  longer  to- 
postpone  “  the  often  prayed  for  ”  amplification  and  consolidation  of  their 
building  by-laws. 

Cremation,  Italy.  —A  new  building,  intended  for  the  cremation  of  the  dead 
has  been  erected  in  the  Campo  Yerano,  in  the  neighbourhood  of  Rome, 
It  is  divided  into  three  parts— the  hall  reserved  for  the  relatives  of  the- 
deceased,  the  furnace,  and  the  catacombs.  The  increasing  dread  of  in¬ 
fectious  disease  is  expected  to  lead  to  a  considerable  increase  in  the 
practice  of  cremation  in  Rome. 

Anti-Beer- Adulteration  Association. — At  a  meeting  of  the  Association  held) 
at  Maidstone,  the  President  stated  that  last  year  brewers  used  substitutes- 
equal  to  245,000  cwts.  of  hops,  and  urged  that,  as  beer  purported  to  be  a 
liquor  made  of  malt  and  hops,  it  was  necessary  that  a  liquor  differently 
compounded  should  not  be  allowed  to  be  sold  under  that  name.  Reso¬ 
lutions  were  passed  approving  of  the  objects  of  the  Association,  and) 
that,  to  prevent  the  practices  complained  of,  rewards  should  be  offered 
for  information  as  to  the  secret  use  of  substitutes,  and  also  to  call 
on  dealers  in  substitutes  to  declare  their  sales  to  the  Government 
department. 

Froposed  Local  Board  for  Eastbourne. — A  public  meeting  is  to  be  convened 
for  the  purpose  of  promoting  a  petition  to  the  Local  Government  Board 
for  their  sanction  to  establish  a  local  board  for  the  town.  The  inhabi¬ 
tants  are  realising  the  importance  of  improvements  in  the  local 
drainage,  and  of  efficient  supervision  of  building,  which  is  carried  on. 
largely  in  the  town  and  neighbourhood. 

A  Difference  of  Medical  Opinion— At  the  Birmingham  Police-court  an  ex¬ 
policeman  was  brought  up,  on  remand,  charged  with  the  manslaughter 
of  his  wife.  The  prisoner  stands  committed,  on  the  coroner’s  warrant, 
upon  the  evidence  of  the  surgeon  who  made  a  post-mortem  examination 
of  the  body  and  deposed  that  the  death  had  been  directly  accelerated  by 
violence.  On  the  other  hand.  Dr.  W.  Barratt,  who  attended  the  woman 
in  her  last  illness,  now  gave  it  as  his  opinion  that  the  effects  of  the 
violence  which  caused  the  bruises  described  had  passed  off,  and  had 
nothing  to  do  with  death.  On  this  conflict  of  evidence  the  magistrate 
stopped  the  case,  and  the  delinquent  was  discharged  so  far  as  the 
magistrate’s  jurisdiction  was  concerned. 


193 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES 


August  IS,  1883. 


Souses  Unjit  for  Occupation, — Dr.  Bianchi,  Medical  Officer  of  Health 
for  St.  Saviour’s  (Borough)  District  Board  of  Works,  reports  to 
the  Board  the  particulars  of  forty-one  houses,  all  of  which  were  more 
or  less  bad,  and  past  proper  repair,  and  not  one  of  which  was  fit  for 
habitation.  He  recommended  that  his  report  be  forwarded,  through 
the  Sanitary  Committee,  to  the  Metropolitan  Board  of  Works.  Referred 
to  the  Sanitary  Committee. 

Public  Park,  Oldbury.— The  Local  Board  has  taken  steps  for  acquiring  a 
public  park,  recreation  ground,  and  baths  for  the  town.  It  is  proposed 
to  purchase  about  seventy  acres  of  the  Round’s-green  Hills. 

Cleansing  House-Cisterns— A.  suggestion  is  made  that  the  water  companies 
should  supply  the  proper  staff  and  necessary  materials  at  a  certain 
small  charge  to  cleanse  periodically  the  house  water-cistern.  The  cistern 
.is  invariably  placed  in  a  most  inconvenient  position,  and  it  is  not  with¬ 
out  difficulty  and  some  risk  it  can  be  got  at  for  this  purpose.  The 
ordinary  female  servant  cannot,  consequently,  do  the  work  ;  hence  the 
reason  that  ninety-nine  cisterns  out  of  a  hundred  are  not  cleansed  for 
years.  The  utility  of  the  suggestion  is  obvious,  but  the  water  companies 
are  hardly  likely  to  adopt  it.  An  independent  organisation,  however, 
for  the  proposed  work  would,  we  think,  meet  with  the  general  support 
of  the  public. 

Reeve—  Yes  ;  it  is  stated  that, ’notwithstanding  the  fact  that  something  like 
one  hundred  and  eighty  tons  of  butterine  are  brought  into  the  London 
market  every  week,  the  demand  for  English-made  butterine  exceeds  the 
supply. 

Last  Week’s  Bank  Holiday. — At  the  Metropolitan  Police-courts,  with  an  ex¬ 
ception  or  two,  the  magistrates  had  before  them  no  more  than  the  usual 
number  of  charges  consequent  upon  this  public  holiday.  The  West¬ 
minster  magistrate  remarked,  on  the  day  following  the  holiday,  that  the 
charges  showed  a  great  falling  off  as  regarded  cases  of  drunkenness, 
and  at  most  of  the  courts  such  was  also  found  to  be  the  case.  It  would 
appear  that  the  general  decline  of  insobriety  on  these  occasions  and 
the  progress  of  education  are  producing  an  ameliorating  effect  in  the 
habits  of  the  working  classes. 

A  Well-merited  but  not  very  Generous  Recognition. — The  Town  Council  of 
Birmingham,  on  rewarding  the  borough  police  officers  who  were  in¬ 
strumental  in  arresting  Whitehead  and  the  other  conspirators,  awarded 
their  thanks  to  Dr.  Hill ,  the  borough  analyst,  for  the  assistance  he  had 
rendered  in  the  destruction  of  the  dangerous  explosives  found  at 
Whitehead’s  nitro-glycerine  distillery. 

The  Wandsworth  District  Board  of  Works  and  the  Police  Magistrate. — At  the 
last  meeting  of  the  Board  attention  was  directed  to  certain  summonses 
which  had  been  taken  out  by  the  Board  as  to  nuisances  affecting  the 
health  of  the  public,  which  had  been  adjourned  for  eight  weeks  by  the 
magistrate  at  Wandsworth.  After  some  discussion,  a  resolution  was 
adopted,  that  a  letter  be  written  to  the  Home  Secretary,  calling  his 
attention  to  the  want  of  proper  provision  in  that  district  for  the  hear¬ 
ing  of  summonses,  particularly  to  the  above-mentioned  nuisance  case, 
and  to  the  great  danger  that,  under  the  present  circumstances,  may 
arise  in  consequence ;  also,  that  for  some  years  it  has  been  quite  im¬ 
possible  the  business  of  that  large  district  (containing  a  population  of 
some  200,000)  could  be  carried  on  at  the  Love-lane  Police-court,  and 
asking  that  proper  accommodation  may  be  at  once  provided  in  a  more 
central  position. 

Paying  Philanthropy. — The  Improved  Industrial  (Dwellings  Company  now 
possesses  thirty-two  estates  in  various  parts  of  the  metropolis,  on  which 
4144  dwellings  have  been  erected  and  are  in  occupation ;  6t5  more  are 
in  course  of  erection — making  a  total  of  4759  tenements.  On  the  com¬ 
pletion  of  these  the  number  of  persons  residing  in  the  Company’s 
dwellings  will  be  nearly  25,000.  The  gross  rents  of  the  past  half-year 
amounted  to  £37,889.  The  usual  dividend  of  6  per  cent,  has  been 
declared  after  carrying  to  the  reserve  fund  £3000. 

Stillborn  Children.  —  After  considerable  deliberation  on  the  evidence 
adduced  at  an  inquiry  held  at  the  Middlesex  Hospital,  before  Dr. 
Danford  Thomas,  respecting  the  death  of  a  male  child,  the  following 
verdict  was  returned “  That  the  deceased  child  died  from  the  effects 
of  debility,  from  want  of  vital  power  at  birth,  and  from  natural  causes  ; 
and  the  jurors,  having  heard  in  evidence  that  the  midwife  agreed  to 
undertake  the  burial  of  the  said  child,  and  accept  the  sum  of  5s.  for  so 
doing,  and  instead  of  so  doing  disposed  of  it  to  the  authorities  of 
Middlesex  Hospital  as  a  stillborn  child,  do  consider  she  is  amenable  to 
the  law  for  so  doing;  and,  further,  they  would  suggest  that  more 
stringent  measures  should  be  adopted  at  the  Middlesex  Hospital  to 
ascertain  whether  or  no  such  children  brought  to  the  Hospital  are 
stillborn  or  otherwise.” 

Copper  Salts  as  Preservatives  from  Disease. — Regarding  the  virtues  of  copper 
as  a  protection  against  infectious  disease,  Dr.  Burq  has  inquired  as  to 
the  death-rate  amongst  copper  workers  during  the  last  epidemic  of 
typhoid  fever  in  Paris,  and  finds  further  confirmation  of  his  views.  He 
believes  that  the  organism  of  workmen  exposed  to  the  action  of  copper 
undergoes  a  progressive  impregnation  opposed  to  the  development  of 
the  microbes  of  infectious  diseases.  He  proposes  to  verify  this  conclusion 
by  studying  the  action  of  salts  of  copper  upon  the  microbes  cultivated 
by  M.  Pasteur. 


Waterworks,  Birmingham.— The  new  storage  reservoir  at  Shustoke,  the 
property  of  the  Corporation,  was  opened  on  the  4th  inst.,  and  its  area 
is  ninety  acres.  The  Birmingham  Water  Department  has  now  a  total 
storage  capacity  of  650  millions  of  gallons,  and  is  in  a  position  to  deliver 
twelve  millions  of  gallons  of  water  a  day  for  seventy  or  eighty  days 
during  a  period  of  drought.  The  contract  for  the  works  was  taken  at 
£78,900. 

Keighley  Cottage  Hospital. — The  annual  report,  just  issued,  remarks  on  the 
great  success  which  has  characterised  the  efforts  of  the  past  year,  the 
increase  in  the  receipts  being  a  notable  feature.  The  amount  contributed 
by  workpeople  was  more  thau  doubled  ;  gifts  of  £100  and  £50  had  been 
received.  The  debt  on  the  Hospital  had  been  reduced  by  £t?6  7s., 
leaving  £76  19s.  4d.  due  to  the  Treasurer,  which  it  was  expected  would 
be  shortly  cleared  off. 

“  Doctored  ”  Claret. — Mr.  Sandwith,  British  Consul  in  Crete,  reporting  on 
the  production  of  wine  in  the  island  last  year,  refers  to  the  Greek  wines, 
which  are  shipped  to  France  notoriously  for  the  purpose  of  being 
“  manipulated”  and  re-exported,  under  the  name  of  claret,  at  prices 
which  averaged  only  8|d.  a  gallon,  free  aboard  ship. 

COMMUNICATIONS  have  been  received  from — 

Dr.  Sutherland,  London;  Messrs.  Blakiston  and  Co..  Philadelphia; 
The  Medical  Officer  of  Health  for  Hove,  Hove ;  The  Registrar 
of  the  Apothecaries’  Hall,  London;  Mr.  F.  H.  Williams,  Glasgow; 
The  Secretary  of  the  Medical  Faculty,  Aberdeen ;  The  Registrar- 
General  for  Ireland,  Dublin;  Dr.  Mercier,  Dartford;  Dr.  Clifford 
Beale,  London;  Mr.  J.  Chatto,  London;  Mr.  T.  M.  Stone,  London: 
Mr.  Joseph  Hadley,  London ;  Mr.  James  Greenwood,  London ;  The 
Registrar-General  for  Scotland,  Edinburgh ;  Dr.  Norman  Kerr, 
London;  Dr.  John  C.  Lucas,  India;  Dr.  B.  W.  Richardson,  F.R.S., 
London. 

BOOKS.  ETC.,  RECEIVED  - 

Bristol  Sanitary  Authority  :  Prevention  of  Cholera — The  Preservation  of 
Fish  Life  in  Rivers,  etc.,  by  Hon.  W.  F.  B.  Massey  Mainwaring — Report 
on  the  Sanitary  Condition  of  the  City  and  County  of  Bristol  during  the 
Quarter  ending  June  30,  1833— How  to  Meet  Cholera— A  Guide  to  the 
Practical  Examination  of  Urine,  by  James  Tyson,  M.D. — Alcoholic 
Inebriety,  by  Joseph  Parrish,  M.D. — Report  on  the  Health  of  the 
Borough  of  Birmingham  for  the  Quarter  ending  June  30,  1883— On  the 
Natural  History  of  Dysmenorrhcea,  by  John  Williams.  M.D  .  F.R.C.P. 
— Hammam  Rirha,  by  G  H.  Brandt,  M.D.  — Royat,  by  G.  H.  Brandt, 
M.D.— Tuberculosis,  by  Eric  E.  Battler,  M.D. —  Report  of  Proceedings 
at  the  Annual  Distribution  of  Prizes  of  the  Ceylon  Medical  College — 
The  Sanitary  Clauses  of  the  Draft  Glasgow  Police  Bill,  by  Eben.  Duncan, 
M.D.,  etc. 

PERIODICALS  AND  NEWSPAPERS  RECEIVED  — 

Lancet— British  Medical  Journal— Medical  Press  and  Circular — Ber¬ 
liner  Klinische  Woehenschrift — Centralblatt  fur  Chirurgie — Gazette 
des  Hopitaux — Gazette  MMicale— Revista  de  Medicina — Bulletin  de 
1’  AcadSmie  de  Medecine— Pharmaceutical  Journal — Wiener  Medicinische 
Woehenschrift — Revue  Medicale— Gazette  Hebdomadaire— Nature — 
Boston  Medical  and  Surgical  Journal— Louisville  Medical  News— 
Centralblatt  fur  Gynakologie — Le  Concours  Medical— Centralblatt  fur 
die  Medicinischen  Wissenschaf  ten— Centralblatt  fur  Klinische  Medicin 
— Philadelphia  Medical  News— Le  Progress  Medical — Ciencias  Medicas 
— Liverpool  Medico-Chirurgical  Journal — Popular  Science  News  and 
Boston  Journal  of  Chemistry— Aberdeen  Journal,  August  6 — Western 
Medical  Reporter— Physician  and  Surgeon— Journal  of  Cutaneous  and 
Venereal  Diseases— New  York  Medical  Journal — Canada  Lancet  — 
Therapeutic  Gazette— Philanthropist— North  Carolina  Medical  Journal 
—Students’  Journal  and  Hospital  Gazette  -  Chemist  and  Druggist. 


APPOINTMENTS  FOR  THE  WEEK. 

August  18.  Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  14  p.m. ;  King’s  College,  1£  p.m. ;  Royal 
Free,  2  p.m.;  Royal  London  Ophthalmic,  11  a.m. ;  Royal  Westminster 
Ophthalmic,  li  p.m. ;  St.  Thomas’s,  li  p.m. ;  London,  2  p.m. 

20.  Monday. 

Operations  at  the  Metropolitan  Free,  2  p.m. ;  St.  Mark’s  Hospital  for 
Diseases  of  the  Rectum.  2  p.m.;  Royal  London  Ophthalmic.il  a.m.; 
Royal  Westminster  Ophthalmic,  li  p.m. ;  Hospital  for  Women,  2  p.m. 

21.  Tuesday. 

Operations  at  Guy’s,  li  p.m. ;  Westminster,  2  p.m. ;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  li  p.m.;  West 
London,  3  p.m. 

22.  Wednesday. 

Operations  at  University  College,  2  p.m. ;  St.  Mary’s,  If  p.m. ;  Middlesex, 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew’s,  li  p.m.  ;  Great  Northern, 

2  p.m. ;  Samaritan,  2i  p.m. ;  Royal  London  Ophthalmic,  11  a.m. ; 

Royal  Westminster  Ophthalmic,  li  p.m. ;  St.  Thomas’s,  li  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m. ;  National  Orthopaedic,  Great 
Portland-street.  10  a.m.  _ 

23.  Thursday. 

Operations  at  St.  George’s,  1  p.m. ;  Central  London  Ophthalmic,  1  p.m. ; 
Royal  Orthopaedic,  2  p.m.;  University  College,  2  p.m.;  Royal  London 
Ophthalmic,  11  a.m. ;  Royal  Westminster  Ophthalmic,  14  p.m. ;  Hospitaj 
for  Diseases  of  the  Throat,  2  p.m. ;  Hospital  for  Women,  2  p.m.  . 
Charing-cross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  2,j  p.m.  ’ 

24.  Friday. 

Operations  at  Central  LondonOphthalmic,  2  p.m. ;  Royal  London  Ophthal¬ 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminster 
Ophthalmic,  lip.m.;  St.  George's  (ophthalmic  operations),  1)  p.m.; 
Guy’s,  14  p.m. ;  St. Thomas’s  (ophthalmic  operations),  2  p.m. ;  King’s 
College  (by  Mr.  Lister),  2  p.m. 


Medical  Times  and  Gazette. 


LEGG  ON  CARDIAC  ANEURYSMS. 


August  25, 1883.  199 


THE  BRAD  SH  A  WE  LECTURE 

ON  CARDIAC  ANEURYSMS. 

Delivered  before  the  Royal  College  of  Physicians  of 
London,  August  18,  1883. 

By  JOHN  WICKHAM  LEGG,  F.K.C.P.  Lond., 

.Assistant  Physician  to,  and  Lecturer'on  Pathological  Anatomy  at, 

St.  Bartholomew’s  Hospital. 


When,  Sir,  you  did  me  the  honour  of  nominating  me  to  the 
office  of  Bradshawe  Lecturer,  I  felt  that  within  the  hour 
allotted  to  the  discourse  I  could  not  attempt  to  deal  with 
any  large  or  wide  topic  in  Medicine  or  Pathology.  I  propose, 
^therefore,  to  ask  the  College  to  consider  the  subject  of 
-Aneurysms  of  the  Heart ;  appearances  which  are  indeed  but 
.artificial  varieties  in  the  phenomena  of  myocarditis  and  of 
endocarditis ;  but  in  making  a  special  study  of  which  we 
sire  following  in  the  footsteps  of  many  distinguished  morbid 
anatomists,  whether  within  or  without  the  threshold  of  this 
ancient  and  learned  Society. 

As  everyone  knows,  the  word  aneurysm  means  a  dilata¬ 
tion  ;  and,  accordingly,  in  the  early  days  of  morbid  anatomy 
at  was  applied  to  that  state  of  the  heart  which  is  now  called 
•dilatation.  This  manner  of  speech  continued  till  late  into 
the  present  century,  so  that  we  frequently  find  the  word 
aneurysm  of  the  heart  used  to  signify  a  simple  dilatation. 
But  the  first  observers  of  the  partial  dilatations  of  the  walls 
— John  Hunter  and  Matthew  Baillie — used  the  word  aneu¬ 
rysm  to  describe  them  ;  and  this  name  of  aneurysm  to  signify 
the  partial  dilatations  has  been  retained  ever  since. 

The  first  observations  of  partial  aneui-ysm  of  the  left 
ventricle  appear  to  have  been  made  within  a  few  months  of 
•each  other.  In  1757,  Galeati  published  a  case  which  would 
seem  in  all  likelihood  to  have  been  a  ruptured  aneurysm, 
though  Dr.  Peacock  does  express  some  doubt.  Be  this  as  it 
may,  there  can  be  no  doubt  that  in  the  April  of  the  same 
year  John  Hunter  found  an  aneurysm  of  the  apex  in  the 
body  of  an  old  man  who  had  suddenly  died.  In  Hunter’s 
■exact  words:  “At  the  apex  it  was  forming  itself  into  a  kind 
of  aneurism,  becoming  there  very  thin.”  Two  years  later, 
Walter,  of  Berlin,  received  from  Buttner,  of  Konigsberg,  a 
heart  with  an  aneurysm  almost  as  large  as  the  heart  itself, 
;and  which  Walter  described  in  1785  to  the  Academy  at 
Berlin. 

Under  the  head  of  “  Aneurysm  of  the  Heart  ”  in  the  first 
■edition  of  Matthew  Baillie,  there  is  a  definition  of  the 
•disease  which  is  good  even  at  the  present  day.  “  It  con¬ 
sists,”  he  says,  “  in  a  part  of  it  (be.,  the  heart)  being 
dilated  into  a  pouch  which  is  commonly  more  or  less  filled 
with  coagulated  blood.”  Matthew  Baillie  also  speaks  of 
aneurysm  of  the  heart  as  a  rare  disease,  an  opinion  in 
which  I  think  most  pathologists  will  agree. 

During  the  nine  years  that  I  was  in  the  post-mortem 
.room  at  St.  Bartholomew’s  Hospital  there  were  1890  exami¬ 
nations  made;  only  three  cases  of  aneurysm  of  the  left 
ventricle  were  found.  A  higher  ratio  is  given  by  Willigk, 
of  Prague.  In  that  town  there  were  1600  examinations 
made  from  February  1,  1850,  to  February  1,  1852,  and  as 
many  as  nine  cases  of  “partial  aneurysms  of  the  heart” 
were  seen.  Heschl,  as  the  outcome  of  34,000  examinations 
at  Vienna,  would  seem  to  give  the  proportion  as  one  to  every 
200,  though  it  must  be  owned  that  his  statement  is  not 
quite  plain ;  but,  granting  that  it  refers  to  cardiac  aneurysm, 
his  numbers  agree  more  with  those  of  Willigk  than  with 
mine. 

Throughout  Thurnam’s  essay,  which,  although  written 
nearly  fifty  .years  ago,  is  still  the  best  that  has  appeared,  he 
has  applied  the  numerical  method  to  all  the  details  of  his 
subject.  This  plan  of  investigation  (the  favourite  of 
Louis),  so  much  in  vogue  when  Thurnam  wrote,  has  in  our 
day  fallen  again  into  disuse.  But  if  we  desire  to  make 
nny  comparison  between  Thurnam’s  results  and  those  of 
later  observers,  it  will  be  necessary  still  to  follow  Thurnam’s 
method ;  and  though  I  cannot  myself  rate  numeration  as 
one  of  the  most  valued  discoveries  in  the  history  of  human 
progress,  yet  on  this  occasion  we  are  forced  to  reckon  with 
Thurnam’s  work,  and  we  must  therefore  stand  in  Thurnam’s 

Von.  II.  1883.  No.  1730. 


ways.  In  order,  however,  to  avoid  using  Thurnam’s  figures 
over  again,  and  comparing  together  the  same  cases  with  only 
a  few  more  added  to  them  (an  error  which  has  not  been 
everywhere  and  always  avoided),  I  have  taken  only  the 
cases  which  were  published  after  Thurnam’s  essay,  and  I 
have  made  my  starting-point  the  year  1840. 

Of  aneurysm  of  the  left  ventricle  I  have  collected  over 
eighty  cases  (about  the  same  number  as  Thurnam’s),  so 
that  our  results  can  be  conveniently  compared.  First  as 
to  the  place  of  the  aneurysm.  Breschet  taught  that  the 
apex  was  the  ordinary  spot  at  which  aneurysm  formed.  But 
in  Thurnam’s  collection  there  were  27  cases  of  aneurysm 
of  the  apex ;  elsewhere  39,  of  which  21  were  at  the  base. 
So  not  only  were  other  parts  of  the  muscular  walls  besides 
the  apex  the  seat  of  aneurysm,  but  the  apex  itself  furnished 
a  fewer  number  than  the  walls.  In  my  own  collection  59 
were  at  the  apex  and  31  at  other  parts  of  the  left  ven¬ 
tricle,  thus  restoring  the  predominance  of  the  apex,  but  by 
no  means  to  the  exclusive  place  which  it  took  in  Breschet’s 
monograph.  In  21  of  Thurnam’s  the  aneurysm  was  at  the 
base  of  the  ventricle,  thus  almost  rivalling  the  apex.  In 
the  observations  which  I  have  seen  I  did  not  find  myself 
able  to  make  any  sharp  separation  between  the  aneurysms  of 
the  base  and  those  of  the  walls. 

Then  as  to  sex.  Thurnam  has  30  men  against  10  women. 
I  find  61  men  to  24  women;  a  higher  proportion  of  women, 
therefore,  than  Thurnam.  If  the  cases  be  divided  into 
aneurysms  of  the  apex  and  of  the  walls,  the  proportion  is 
altered.  Of  the  apex,  there  were  41  men  to  18  women;  and 
of  the  walls,  23  men  to  6  women. 

Then  as  to  age.  Out  of  35  cases,  Thurnam  found  the 
highest  number  (9)  between  twenty  and  thirty;  3  between 
thirty  and  forty ;  6  between  fifty  and  sixty  ;  4  between  sixty 
and  seventy;  and  7  between  seventy  and  eighty.  Out  of  81, 
I  have  found  the  highest  number,  on  the  contrary  (19), 
between  fifty  and  sixty ;  14  between  sixty  and  seventy ;  and 
only  9  between  seventy  and  eighty.  So  also  between  twenty 
and  thirty  only  12  eases  were  found,  and  6  between  thirty 
and  forty ;  15  between  forty  and  fifty ;  so  that  the  greatest 
number  fall  between  forty  and  seventy.  Out  of  81  cases,  48 
were  between  the  ages  of  forty  and  seventy.  Aneurysm  of  the 
heart  would,  therefore,  appear  to  be  a  disease  of  middle  and 
advanced  life,  rather  than  a  disease  specially  common  below 
thirty,  as  Thurnam  believed.  Loebl  also  found  in  his  col¬ 
lection  that  most  cases  were  seen  between  twenty  and 
thirty ;  but  he  wrote  so  soon  after  Thurnam,  that  I  fear, 
in  this  matter,  he  only  too  faithfully  reflects  Thurnam’s 
statistics. 

Thurnam  attempted  to  carry  into  the  pathology  of  aneu¬ 
rysms  of  the  heart  the  same  multiplicity  of  division  which 
in  his  time  perplexed  the  student  of  arterial  aneurysms. 
As  to  these,  it  will  not  be  needful  to  do  more  than  here  to 
make  this  mention  of  them.  There  is,  indeed,  one  point  of 
importance,  whether  the  aneurysms  of  the  left  ventricle 
be  true  or  false.  Breschet  taught  that  in  all  cases  the  aneu¬ 
rysm  was  false,  that  there  was  a  rupture  or  ulceration  of  the 
endocardium ;  and  the  blood,  burrowing  in  the  muscular 
wall,  in  this  way  formed  the  aneurysm.  This  statement 
must  now  be  abandoned.  No  one  who  has  examined  a  cardiac 
aneurysm  with  the  aid  of  the  microscope  will  assert  that 
the  endocardium,  however  changed,  does  not  enter  into  and 
clothe  the  inside  of  the  sac.  Representatives  of  all  the  con¬ 
stituents  of  the  walls  of  the  heart,  endocardium,  myo¬ 
cardium,  and  pericardium,  are  to  be  found  in  the  wall 
of  every  aneurysm.  The  “diffused  true  aneurysm”  of 
Thurnam  must  of  necessity  involve  the  apex  of  the  heart, 
as  it  is  part  of  its  definition  that  the  whole  circumference 
of  the  ventricle  is  involved  in  the  disease. 

Putting  aside  the  congenital  diverticula  from  the  apex  of 
the  ventricle,  which  have  been  described,  the  youngest  case 
yet  known  is  one  reported  by  Dr.  Wilks ;  a  little  girl  of 
twelve  died  suddenly  while  at  play  from  the  bursting  of  the 
aneurysm.  The  oldest,  that  of  Mr.  Meade’s,  a  man  of 
eighty-eight,  in  the  enjoyment  of  good  health  up  to  the 
time  of  his  sudden  death,  which  was  caused  by  rupture  of 
the  ventricle  at  a  place  where  there  was  some  bulging. 

As  regards  size,  shape,  arrangements,  and  contents  of  the 
sac,  I  have  little  or  nothing  to  add  to  the  description  given 
of  them  by  Thurnam . 

Since  the  days  of  Cruveilhier  it  seems  to  have  been 
agreed  that  the  greater  number  of  aneurysms  of  the  left 
ventricle  have  their  source  in  the  weakening  of  the  walls 


200 


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LEGG  OUST  CARDIAC  ANEURYSMS. 


August  25, 1883V 


caused  by  a  degeneration  of  the  muscular  tissue  into  fibrous 
scars.  As  Cruveilhier  says,  this  pathological  state  is  not  so 
uncommon.  I  have  met  with  two  forms — one  is  a  firm, 
white,  almost  cartilaginous,  extra-vascular  growth,  em¬ 
bedded  in  the  walls  of  the  heart,  scattered  diffusely  in  islets 
around  one  large  mass,  or  in  several  large  masses  at  a 
distance  from  one  another,  irregular  in  shape  and  sharply 
separated  from  the  suri’ounding  tissue.  Under  the  micro¬ 
scope  there  is  seen  a  transparent  or  slightly  fibrillar  matrix, 
in  which  appear  nuclei,  rounded  in  shape,  and  varying  in 
size  from  a  red  to  a  colourless  blood  corpuscle.  Around  the 
nuclei  may  be  traced  cells  about  double  the  size  of  the 
nuclei,  rounded,  oval,  or  even  spindle-shaped.  At  the 
borders  of  the  new  growth  the  matrix  is  the  prominent 
feature,  passing  between  and  separating  the  muscular 
fibres,  and  containing  but  a  small  number  of  nuclei.  Pass¬ 
ing  away  from  the  edges  towards  the  centre  of  the  growth, 
the  nuclei  become  much  more  abundant,  until  at  last  they 
form  the  greater  part  of  the  growth.  In  the  middle  of  the 
tumour  there  is  seen  a  confused  granular  mass,  in  which  no 
very  definite  structure  can  be  made  out,  a  few  fibres  and 
deformed  nuclei  being  now  and  then  detected.  No  giant 
cells  can  be  seen. 

The  other  form  differs  from  that  just  described  both  in  its 
naked-eye  characters  and  in  those  seen  under  the  microscope. 
It  is  of  a  white  colour,  not  firm,  but  compressible,  tough, 
amply  supplied  with  vessels,  creaking  under  the  knife  like 
the  cirrhotic  liver,  of  a  distinctly  fibrous  appearance,  the 
fibres  having  a  definite  direction  usually  following  that  of 
the  muscular  tissue  which  they  have  displaced.  Commonly 
there  is  only  one  of  these  fibrous  patches.  Under  the 
microscope  the  resemblance  to  fibrous  tissue  is  more  com¬ 
plete.  Sometimes  tissue  with  fine,  delicate,  wavy  fibres, 
hardly  to  be  distinguished  from  fibrous  tissue,  may  be  seen ; 
at  others,  ill-formed,  coarse  fibres,  with  no  definite  direction, 
but  rather  tangled,  and  mixed  with  oil  globules  and  granules, 
make  up  the  bulk  of  the  section.  In  this  form  there  are  no 
large  nuclei  with  cells,  or  translucent  matrix,  but  the  whole 
is  formed  of  fibres.  Now  and  then  a  muscular  fibre,  show¬ 
ing  well-marked  striation,  will  make  its  appearance,  running 
in  the  same  direction  as  the  fibres. 

Whether  these  two  forms  be  the  same,  differing  merely 
by  their  age,  I  do  not  think  that  there  are,  at  the  present 
moment,  sufficient  grounds  to  determine.  I  incline,  how¬ 
ever,  to  the  opinion  that  they  are  distinct.  As  early  as  1872 
I  had  put  these  two  varieties  side  by  side  in  a  paper  in  the 
St.  Bartholomew’s  Hospital  Reports. 

What,  however,  is  the  cause  of  this  fibrous  degeneration 
of  the  heart  ?  Yirchow  is,  it  would  seem,  the  mainspring 
of  the  opinion  that  would  refer  all  these  changes  to  syphilis. 
Doubtless  owing  to  his  authority,  these  fibrous  changes  in 
the  heart  were,  for  several  years,  almost  unanimously  set 
down  as  one  of  the  manifestations  of  syphilis.  But  of  late 
years  a  reaction  has  set  in.  We  have  learnt  to  trust  less  to 
the  morphological  character  of  the  growths,  and  more  to  the 
evidences  of  syphilis  in  other  parts  of  the  body.  Many 
cases  of  fibrous  disease  of  the  heart  have  been  seen  of  late, 
in  which  no  other  evidence  of  syphilis  could  be  found, 
although  diligently  sought  for. 

Within  the  last  year  or  two  another  theory  has  been 
broached,  which  attributes  these  changes  in  the  muscular 
walls  of  the  heart  to  an  interference  with  their  nutrition 
by  the  coronary  arteries.  It  is  now  more  than  thirty  years 
ago  since  you,  sir,  demonstrated  that  the  ligature  of  the 
coronary  arteries  of  the  heart  was  quickly  followed  by 
sudden  death.  It  had  been  maintained  by  Chirac  at  the  end 
of  the  seventeenth  century  that  no  such  sudden  failure  of 
life  followed  the  occlusion  of  these  arteries ;  and,  within  the 
last  twenty  years,  Panum,  Albert  von  Bezold,  and,  more 
lately,  Samuelson,  have  expressed  the  same  opinion  as  Chirac. 
But,  in  the  first  fortnight  of  1881,  G.  See,  with  his  fellow- 
workers,  Bochefontaine  and  Boussy,  read  before  the  Academy 
of  Sciences  at  Paris  a  paper,  in  which  they  gave  the  results 
of  their  experiments  on  occlusion  of  the  coronary  arteries. 
They  found  within  one  or  two  minutes  of  the  ligature  of 
both  coronary  arteries  that  the  movements  of  the  heart 
ceased ;  and  much  the  same  result  followed  if  one  or  other 
coronary  artery  were  tied,  only  that  ligature  of  the  right 
caused  death  a  little  less  rapidly  than  ligature  of  the  left. 
In  the  September  number  of  Virchow’s  Archives  for  the  same 
year,  Cohnheim  published  a  series  of  experiments  on  the 
same  subject,  coming  much  to  the  same  conclusion  as  See. 


Sudden  cessation  of  the  contractions  of  the  heart  followed1 
ligature  of  one  coronary  artery,  on  an  average,  in  100' 
seconds.  Upon  this  proposition  that  the  heart  ceases  to 
contract  immediately  after  occlusion  of  a  coronary  artery, 
Cohnheim  has  built  a  theory  of  the  origin  of  fibrous  myo¬ 
carditis— viz.,  that  it  is  due  to  plugging  of  the  cardiac 
arteries  ;  in  other  words,  that  the  fibrous  myocarditis  is  a 
necrobiotic  process  like  that  of  infarction.  Karl  Huber  has 
thought  to  support  Cohnheim’s  view  of  the  part  which  the- 
coronary  arteries  play  in  the  formation  of  aneurysms  of  the- 
heart  by  bringing  together  eighteen  cases  of  fibrous  de¬ 
generation  of  the  cardiac  walls,  noticed  in  the  Leipzig  Patho¬ 
logical  Institute,  in  all  of  which  he  found  highly  marked 
atheroma  of  the  coronary  arteries.  Now,  one  is  at  once 
struck,  in  looking  over  Huber’s  table,  by  the  advanced  age- 
of  nearly  all  his  cases.  Only  4  are  below  six±y-two,  the 
youngest  being  forty- seven;  6  of  the  rest  are  over  seventy 
years,  2  are  over  eighty,  and  2  over  ninety,  so  that  it  is 
hardly  surprising  that  extensive  atheroma  should  be  found. 
Indeed,  atheroma  in  the  coronary  arteries  is  not  very- 
rare.  After  forty  it  is  a  common  appearance,  and  indeed 
it  may  be  seen  much  earlier.  I  have  noticed  it  in  a 
boy  of  sixteen,  and  some  have  thought  the  coronary 
arteries  more  subject  to  atheroma  than  any  other  in  the- 
body — an  opinion  which  my  own  experience  leads  me- 
rather  to  accept  than  to  reject.  It  is  possible  that  their- 
peculiar  structure,  described  by  Dr.  Norman  Chevers,  may 
have  some  relation  to  their  proneness  to  atheroma.  Whether, 
on  the  other  hand,  some  interference  with  the  blood-supply, 
in  the  shape  of  atheroma  or  plugging,  always  precedes- 
chronic  myocarditis,  the  following  facts  may  help  us  to- 
judge.  There  are  in  the  museum  of  St.  Bartholomew’s ^ 
Hospital  six  specimens  of  aneurysm  of  the  heart  due  to 
fibrous  degeneration  of  the  walls.  All  but  one  have  been 
taken  from  young  persons  below  forty.  The  coronary 
arteries  have  been  traced  in  all,  but  no  marked  change  dis¬ 
covered  in  any  but  the  heart  taken  from  the  man  of  forty 
to  fifty  years.  In  him  early  atheroma  was  found.  In  the 
heart  from  a  girl  of  nineteen  a  branch  of  the  left  coronary 
artery  passed  over  the  tumour,  and,  as  might  be  expected,, 
was  there  plugged  by  a  thrombus.  No  source  of  emboli,, 
save  the  aneurysms  themselves,  could  be  found  in  the- 
hearts,  though,  of  course,  it  may  be  answered  that  the 
thrombi  had  been  there,  but  had  been  washed  away.  In  the 
published  cases  of  aneurysm  in  which  the  coronary  arteries 
were  reported  to  be  healthy,  the  patient  was  young — twenty- 
five  in  Craigie’s  case,  thirty  in  Dr.  Hilton  Pagge’s,  thirty- 
nine  in  Leyden’s,  and  even  forty- four  in  Lancereaux’s ;  but 
the  cases  in  which  the  arteries  were  diseased  were  nearly 
all  over  fifty.  It  is  true  that  in  Dr.  Cholmeley’s  case  the- 
man  was  forty-eight,  but  even  here  the  arteries,  though 
thick-walled  and  rigid,  were  permeable.  To  me  it  seems- 
far  more  likely  that  the  atheroma  follows  the  age  of  the 
patient,  and  is  independent  of  the  fibrous  scarring,  than 
that  the  atheroma  causes  the  fibrous  degeneration. 

There  is  but  little  evidence  to  bring  forward  that  blocking 
of  the  coronary  arteries  causes  a  fibrinous  myocarditis. 
There  are  many  cases  on  record  in  which  the  arteries  were 
blocked,  and  yet  no  mention  is  made  of  fibrous  changes.  I 
will  speak  particularly  of  Dr.  Greenfield’s  carefully  recorded 
case.  In  a  woman,  aged  twenty-seven,  the  orifices  of  the- 
coronarv  arteries  were  completely  concealed  by  the  swell¬ 
ing  of  the  coat  of  the  aorta,  and  were  indicated  only  by 
small  vertical  puckerings  on  the  surface.  To  the  micro¬ 
scope  only,  many  hours  after  death,  the  muscular  tissue 
showed  slight  but  widely  distributed  fatty  degeneration  in 
the  centre  of  many  of  the  fibres,  but  no  fibrous  changes  are 
spoken  of. 

Further,  if  fibrous  myocarditis  be  due  to  the  plugging  or 
occlusion  of  the  coronary  arteries,  it  is  hard  to  explain  why 
it  should  be  so  limited  to  the  left  ventricle.  I  have  seen 
many  cases  of  fibrous  myocarditis,  but]  as  far  as  I  can 
remember,  the  disease  had  begun  in  all  in  the  left  ventricle, 
not  in  the  right ;  and  the  same  may  be  said  of  the  cases  col¬ 
lected  by  Dr.  Hilton  Fagge  and  by  Huber,  in  which  the 
right  ventricle  has  very  rarely  shared  in  the  disease ;  and 
even  when  this  has  been  the  case  it  was  rather  by  spreading 
than  by  the  appearance  of  a  fresh  centre. 

In  ascribing  the  cause  of  fibrous  myocarditis  to  blocking 
of  the  arteries,  Cohnheim  also  appeals  to  a  statement  which 
may  be  found  in  many  anatomical  books,  and  which  he- 
himself  professes  to  have  confirmed,  viz.,  that  the  coronary 


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LEGG  ON  CARDIAC  ANEURYSMS. 


August  25, 1883.  201 


arteries  do  not  anastomose.  Undoubtedly  this  is  an  im¬ 
portant  aid  to  Cohnheim’s  view;  I  determined,  therefore,  to 
test  it  for  myself.  A  number  of  human  hearts  were  injected 
with  blue-coloured  size.  On  injecting  the  main  branch  of 
one  coronary  artery,  the  other  was  very  readily  filled,  and 
they  communicated,  not,  as  some  writers  assert,  by  the 
branches  in  the  horizontal  sulcus  of  the  heart,  but  by 
branches  over  the  ventricles  and  apex.  One  large  branch 
could  be  seen  passing  directly  over  the  apex,  by  which  a 
good  supply  of  blood  would  seem  to  be  given  to  this  part. 

These  injections  were  kindly  made  for  me  by  Mr.  A.  A. 
Bowlby,  the  curator  of  the  museum  at  St.  Bartholomew’s. 
I  afterwards  repeated  them  myself  in  the  heart  of  the  sheep, 
and  with  the  same  result. 

The  results  at  which  I  have  arrived  are  so  like  to  those 
lately  published  by  Dr.  Samuel  West,  that,  to  avoid  any 
suspicion  of  borrowing  from  him,  I  am  anxious  to  state  that 
the  experiments  were  made  in  the  Christmas  vacation  of 
1882,  and  that  I  was  quite  unacquainted  with  the  fact  that 
Dr.  West  had  undertaken  a  research  upon  this  subject  until 
.a  fortnight  before  it  was  published.  Thus,  my  own  experi¬ 
ments  were  quite  independent  of  Dr.  West’s;  they  were 
from  the  first  intended  to  form  part  of  the  argument  in  this 
lecture,  and  to  be  read  before  this  College. 

There  is  one  case,  that  of  Mr.  A.  W.  Stocks,  which  may 
be  quoted  as  affording  support  to  the  theory  of  aneurysm 
from  want  of  nutrition.  In  a  woman,  aged  twenty-seven, 
there  was  found  a  locsyL  atrophy  at  the  apex  of  the  left 
ventricle,  and  here  the  wall  was  so  thin  as  to  be  translucent. 
One  coronary  artery  was  said  to  be  absent.  Here  there 
seems  a  case  much  in  favour  of  Cohnheim’s  view.  But  I 
have  communicated  with  Mr.  Stocks,  and  he  has  very  kindly 
informed  me  that  the  newspaper  account  which  I  have  seen 
of  his  case  is  incorrect,  and  that  the  distribution  of  the 
coronary  arteries  was  quite  natural,  only  they  arose  by  a 
common  triink. 

None  of  the  causes  of  fibrous  myocarditis  which  have  been 
brought  forward  can  be  looked  upon  as  proved.  Thurnam 
suspected  that  the  pericarditis  which  so  commonly  attends 
aneurysm  might  be  the  cause  rather  than  the  effect — a 
speculation  which  I  do  not  think  would  now  find  favour  with 
many.  Of  the  cause  of  fibrous  myocarditis,  it  must  be  owned, 
we  have  as  yet  no  clear  knowledge ;  but  I  incline  myself  to 
the  opinion  that  it  will  be  found  some  day  to  be  closely  akin 
to  those  causes  which  make  endocarditis  and  so  many  other 
pathological  processes  choose  as  their  seat  the  left  ventricle 
and  the  left  endocardium  rather  than  any  other  chamber  of 
the  heart. 

It  has  been  said  that  from  the  days  of  Cruveilhier  and 
Thurnam  morbid  anatomists  have  looked  upon  fibrous  myo¬ 
carditis  as  the  chief  cause  of  aneurysm.  Dr.  Hilton  Fagge, 
in  a  paper  which  must  be  known  to  every  Fellow  of  this 
College,  and  to  which  I  am  myself  much  indebted,  has  gone 
a  step  further,  and  asserted  it  to  be  the  only  cause  of 
aneurysm.  This  opinion  seems  to  me  somewhat  too  abso¬ 
lute.  It  must  be  owned,  it  is  true,  that,  as  time  goes  on,  the 
number  of  cases  set  down  to  any  other  cause  than  fibrous 
myocarditis  hardly  increases ;  but  fatty  degeneration  cer¬ 
tainly  deserves  attention  as  a  cause  of  aneurysm.  Dr. 
Fletcher’s  case,  sometimes  quoted,  seems  to  have  been  one 
of  fatty  degeneration  without  aneurysm ;  and  in  Mr.  Meade’s 
case  it  may  be  said  that  the  bulging  was  post-mortem,  and 
caused  by  the  rupture  of  the  heart.  But  in  Dr.  Peter  Mere 
-Latham’s  case  there  can  be  no  doubt  that  there  was  an 
aneurysm  with  thin,  easily  torn  walls,  and  that  the  whole 
muscular  tissue  of  the  heart  “  was  flabby,  pale,  and  lacerable 
— a  condition  which  seemed  to  arise  from  its  partial  conver¬ 
sion  into  fat.”  Then  Pelvet  has  himself  observed  the  fol¬ 
lowing  case  : — A  woman  fifty-nine  years  of  age  died  with  all 
the  symptoms  of  angina  pectoris  in  one  of  Potain’s  wards 
at  the  Necker  Hospital  at  Paris.  Close  to  the  septum  in 
the  lower  third  of  the  fore  surface  of  the  heart  there  was  a 
bulging  the  size  of  a  small  orange;  its  walls,  thin  and  little 
resistant,  were  composed  of  the  three  layers,  pericardium, 
myocardium,  and  endocardium ;  but  the  myocardium  showed 
highly  marked  fatty  degeneration,  with  hardly  any  striation 
of  the  muscular  fibres.  The  same  morbid  appearance  ex¬ 
tended  in  a  less  degree  through  the  other  parts  of  the  heart. 

There  is  also  a  case  of  Leyden’s  :  in  a  man,  who  was  thirty- 
nine  years  of  age  and  very  fat,  a  small  aneurysm  of  the  left 
apex  was  seen.  No  very  great  fatty  degeneration  of  the 
fibres  was  noticed,  but  in  some  parts  of  the  heart,  especially 


abundant  at  the  apex  of  the  left  ventricle,  there  were  found 
narrow  septa  of  adipose  tissue  pushing  themselves  between 
the  muscular  fibres,  and  causing  much  separation  of  the 
fibres.  Then,  in  a  few  places  and  in  small  number,  were 
seen  between  the  muscular  fibres  spaces  of  fibrous  tissue 
showing  a  few  nuclei  and  fat-drops.  These  fibrous  patches 
could  be  seen  only  with  the  microscope,  and  Leyden  was  of 
opinion  that  they  were  the  result  of  the  absorption  of  the 
adipose  tissue  which  at  first  separated  the  muscular  fibres 
from  one  another.  Dr.  Hilton  Fagge  would  doubtless  prefer 
to  read  these  phenomena  backwards,  but  I  submit  to  him 
both  Dr.  P.  M.  Latham’s,  Pelvet’s,  and  Leyden’s  cases  as 
worthy  of  his  consideration. 

May  the  rupture  of  cysts  or  of  abscesses  into  the  cavity 
of  the  heart  be  the  beginning  of  aneurysm  ?  With  former 
observers  I  am  inclined  to  think  that  this  is  possible,  but 
that  it  is  not  yet  proved.  Some  forty  years  ago  Griesinger 
described  a  cavity  left  in  the  septum  of  the  ventricles  by 
the  escape  of  a  hydatid  ;  and  in  1859  the  late  Dr.  George 
Budd  showed  to  the  Pathological  Society  a  similar  cavity  at 
the  apex  of  the  right  ventricle.  Dr.  Wilks  has  described  a 
very  interesting  case  :  the  hydatid  was  found  loose  in  the 
left  ventricle,  and  at  the  apex  was  a  hard,  opaque,  carti¬ 
laginous  structure  of  the  size  of  half-a-crown,  where  the 
muscular  tissue  was  absent.  It  seems  likely  that  if  the 
hydatid  had  been  small  enough  to  have  escaped  into  the 
general  circulation,  and  thus  to  have  allowed  the  patient 
to  go  on  living,  the  foundation  of  an  aneurysm  in  all  these 
cases  would  have  been  laid. 

With  the  supposition  of  abscesses  bursting  into  the  cavity 
of  the  heart  the  matter  is  different.  I  have  been  unable 
to  satisfy  myself,  in  any  one  of  the  cases  which  have  been 
brought  forward  in  evidence,  that  an  abscess  or  the  contents 
of  a  cyst  had  escaped  into  the  ventricle.  Abscesses,  no  doubt, 
do  form  at  the  apex,  but  their  tendency  is  to  burst  into  the 
pericardium  rather  than  into  the  endocardium.  Of  the 
other  cases  of  cysts,  I  have  little  doubt  that  they  are 
instances  of  puriform  softening  of  thrombi  which  have 
formed  at  the  apex — no  unusual  place  for  such  to  be  found. 

Some  of  the  cases  of  acute  abscess  of  the  heart  have  been 
seen  in  the  undefended  space,  and  these,  there  can  be  little 
doubt,  are  instances  of  the  acute  aneurysm  of  this  spot,  and 
they  will  be  discussed  under  this  heading  a  little  later  on. 
There  is,  indeed,  an  acute  aneurysm  described  by  Herzfelder, 
who  had  the  authority  of  Rokitansky  for  describing  it  as 
due  to  an  acute  myocarditis  ;  but  there  was  no  suppuration, 
the  cardiac  wall  was  only  softened  and  discoloured. 

The  only  case  of  aneurysm  of  traumatic  origin  that  I  can 
find  is  one  described  by  Miihlig.  The  patient  had  been 
stabbed  ten  years  before  death  in  the  region  of  the  heart, 
and  a  scar  led  from  the  place  of  the  wound  to  the  apex  of 
the  right  ventricle ;  here  a  large  bulging  of  the  wall  had 
formed,  which  had  all  the  characters  of  an  ordinary  aneu¬ 
rysm  of  the  left  ventricle  formed  by  disease. 

At  this  place  we  leave  the  aneurysms  of  the  left  ventricle. 
Of  aneurysms  of  the  other  chambers  of  the  heart  there  is 
but  little  to  say.  When  we  have  consented  to  the  state¬ 
ment  that  fibrous  myocarditis  is  the  chief  cause  of  aneu¬ 
rysm,  it  will  follow  that  aneurysm  is  but  rarely  seen  else¬ 
where  than  in  the  left  ventricle.  Besides  the  one  observa¬ 
tion  of  traumatic  aneurysm  of  the  right  ventricle,  there  are 
a  few  other  cases  known  of  aneurysm  from  disease.  Quite 
as  rare  are  cases  of  true  aneurysm  of  the  left  auricle,  those 
appearances  which  have  been  called  by  this  name  being  mere 
dilatations  of  the  whole  auricle  secondary  to  mitral  con¬ 
striction.  Of  aneurysm  of  the  right  auricle  there  is  this 
one  specimen,  which  I  removed  from  the  body  of  a  patient 
who  died  at  St.  Bartholomew’s  Hospital;  and  there  is  also  one 
case  by  Berthold,  in  which  the  aneurysm  was  so  large  that 
it  penetrated  the  chest- wall,  and  formed  a  pulsating  tumour 
outside  the  chest. 

I  will  now  turn  to  the  aneurysms  of  the  septa  of  the 
heart.  A  very  rare  instance,  almost  the  only  one  on  record, 
is  to  be  seen  here  in  Dr.  Peacock’s  specimen  of  aneurysm 
of  the  septum  of  the  auricles.  Aneurysm  of  the  muscular 
septum  is  nothing  so  rare,  although  not  common,  but  it 
does  not  appear  to  differ  greatly  from  aneurysms  of  any 
other  part  of  the  muscular  wall.  Then  as  to  aneurysms 
of  the  undefended  space. 

It  would  seem  to  be  still  undetermined  by  whom  the  un¬ 
defended  space  was  first  noticed.  It  was  described  by 
Albers  in  the  phoca  before  1S05,  and  in  1818  some  French 


202 


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LEGG  0 N  CARDIAC  ANEURYSMS. 


August  25,  1883. 


anatomists  seem  to  have  been  quite  familiar  with  it. 
Thurnam  speaks  of  it  in  1838  as  well  known,  and  Peacock 
in  1846  uses  the  words  “  undefended  space”  without  any 
introduction  of  the  term.  Despite  a  few  unimportant  ob¬ 
servations  of  defective  septum  early  in  the  present  century, 
aneurysm  of  the  undefended  space  was  little  noticed  until 
Thurnam  drew  attention  to  the  possibilities  of  such  a  morbid 
appearance. 

He  says  : — “  It  is  well  known  to  anatomists  that  the 
highest  part  of  the  septum,  which  occupies  the  angle 
between  the  posterior  and  right  aortic  valves,  and  which  in 
some  instances  of  congenital  malformation  is  deficient,  is  in 
the  human  subject  formed  not  of  muscular  fibres,  but 
simply  of  the  endocardium  of  the  right  and  left  ventricles, 
almost  in  apposition,  and  strengthened  only  by  the  inter¬ 
position  of  a  little  fibrous  tissue  continuous  with  that  of  the 
aorta.  ...  In  many  ruminant  animals  this  point  is  well 
secured  by  an  osseous  plate,  but  in  man,  as  a  comparatively 
weak  spot,  it  is  perhaps  probable  that  occasionally  it  may 
become  the  seat  of  aneurysmal  dilatation.”  Later  on,  in  the 
same  paper,  Thurnam  describes  this  specimen  in  the  Museum 
of  the  Royal  College  of  Surgeons,  which  is  undoubtedly  a  pre¬ 
paration  of  aneurysm  of  the  undefended  space;  he  says  he 
had  discarded  the  opinion  that  it  was  not  congenital.  Indi¬ 
vidual  cases  were  described  soon  after  by  Peacock,  Todd,  and 
Pereira ;  Dietrich  of  Prague  doing  good  service  by  showing 
how  often  the  undefended  space  was  the  seat  of  disease. 
Yet  any  continuous  study  of  the  aneurysms  of  this  space 
can  hardly  be  said  to  have  been  made  until  Pelvet  published 
his  monograph.  In  this  he  insisted  upon  endocarditis  as  the 
sole  cause  of  aneurysm  of  the  undefended  space ;  while 
Rokitansky,  some  ten  years  after,  in  his  work  on  the  im¬ 
perfect  septa  of  the  heart,  fully  allows  of  congenital  weak¬ 
ness  as  a  cause  of  aneurysm.  I  would  remark  that,  at  the 
same  time  as  Rokitansky’s  book  was  published,  and  certainly 
without  any  knowledge  of  it,  I  showed  a  specimen  to  the 
Pathological  Society,  in  which  it  seemed  clear  that  the 
aneurysm  had  a  congenital  origin,  and  I  asserted  that  Pelvet 
had  been  too  exclusive  in  assigning  acute  endocarditis  as 
the  cause  of  all. 

I  may  now  point  out  that  these  aneurysms  possess  a 
character  in  common  with  aneurysms  of  the  muscular  septa, 
which  is  that  the  bulging  takes  place  in  accordance  with  the 
greatest  pressure  :  thus  the  bulging  is  always  from  the  left 
to  the  right  side  of  the  heart ;  the  concave  surface  being 
on  the  left  side,  the  convex  on  the  right. 

Aneurysms  of  the  undefended  space  must,  I  think,  be 
divided  into  two  kinds — one  which  owes  its  origin  to  some 
congenital  defect  of  the  undefended  space ;  the  other  due  to 
acute  endocarditis,  or  its  consequences.  The  one  may  be 
called  congenital ;  the  other  acute.  The  congenital  aneu¬ 
rysm  is  usually  limited  in  size  by  the  boundaries  of  the  un¬ 
defended  space  itself ;  it  follows  the  same  anatomical  lines 
as  the  undefended  space.  Thus  its  size  rarely  exceeds  half 
a  walnut;  the  sac  is  commonly  thin,  translucent,  and  smooth, 
though  occasionally  the  inner  surface  shows  irregularities. 
In  one  of  my  own  cases  and  in  Zahn’s  there  were  lines 
crossing  the  sac,  arranged  like  the  musculi  pectinati  of  the 
right  auricle  ;  and  in  one  of  Rokitansky’s  cases  these  were 
more  pronounced,  and  were  like  septa  incompletely  dividing 
the  sac.  As  a  rule  the  sac  has  no  fibrinous  contents,  unlike 
the  acute  aneurism.  The  shape  of  the  mouth  of  the  sac 
is  commonly  rounded,  sometimes  triangular,  thus  preserving 
the  rough  outline  of  the  undefended  space.  The  whole  of 
this  space  need  not  form  part  of  the  aneurysm.  In  two  of 
Rokitansky’s  cases  only  the  anterior  half  was  involved,  and 
in  a  third  only  the  anterior  two-thirds. 

On  the  right  side  of  the  undefended  space  it  is  usually 
divided  into  two  by  the  ring  of  the  tricuspid;  thus  the  upper 
part  is  in  the  right  auricle,  the  lower  in  the  right  ventricle. 
Or  the  right  side  of  the  undefended  space  may  be  wholly  in 
the  right  auricle,  or  wholly  in  the  right  ventricle.  The 
same  rules  govern  the  disposition  of  the  right  side  of  the 
congenital  aneurysm.  The  sac  may  be  wholly  above  or 
wholly  below  the  tricuspid  ring.  It  may  be  divided  into  two 
sacs — a  point  which  is  particularly  described  in  the  late  Dr. 
Pearson  Irvine’s  case- or  it  may  be  divided  still  more: 
into  three,  as  in  Rokitansky’s  case,  or  four,  as  in  Pereira’s 
and  Thurnam’s.  In  Reinhard’s  two  cases  there  were  also 
signs  on  the  sacs  of  further  secondary  dilatations. 

I  have  lately  come  across  a  very  interesting  case,  taken 
from  a  patient  of  Dr.  Dickinson’s,  by  whose  courtesy  I  am 


allowed  to  speak  of  it  here.  The  aneurysm  has  pointed  at 
the  level  of  the  tricuspid  ring,  thus  separating  the  lamina; 
of  the  tricuspid  valve,  opening  them  up,  so  that  the  sac 
appears  to  burrow  in  the  very  substance  of  the  tricuspid! 
valve  itself. 

As  a  rule,  there  is  nothing  in  the  hearts  in  which  con¬ 
genital  aneurysms  are  found  to  lead  to  the  belief  that  an  acute 
endocarditis  was  in  progress  just  before  the  patient’s  death; 
though,  of  course,  an  acute  endocarditis  may  take  place  in  a 
heart  affected  with  congenital  aneurysm,  as  in  Dr.  Peacock’s 
case. 

There  is  nothing  remarkable  about  the  age  or  sex  of  those 
affected  with  congenital  aneurysm,  nor  in  the  diseases  which 
cause  their  death. 

On  the  other  hand,  the  acute  aneurysm  which  arises  from 
endocarditis  is  often  concealed,  when  first  the  heart  is  opened, 
by  the  vegetations  which  fill  the  mouth  of  the  aorta.  The 
aortic  valves  are  covered  with  these  growths  ;  having  been 
much  injured  by  the  violence  of  the  endocarditis,  they  are 
often  separated  from  their  attachments  to  the  aorta,  and  long- 
bridles  hang  down  into  the  ventricle,  to  the  friction  of  which 
against  the  wall  or  the  undefended  space  it  is  thought  that 
the  aneurysm  may  in  some  cases  be  due.  The  opening; 
into  the  aneurysm  is  irregular  and  ragged  (though  in 
Rokitansky’s  sixth  case  the  border  was  remarkably  rounded’ 
and  smooth),  its  shape  and  size  uncertain, -its  contents  clot3, 
stratified  fibrine,  or  half  fluid,  or  undergoing  the  puriform 
change ;  the  walls  ragged,  and  the  muscular  part  of  the 
septum  involved  in  the  destructive  inflammation.  The 
process  which  forms  the  aneurysm  undermines  the  tissues 
of  the  heart,  and  thus  at  each  contraction  of  the  ventricle 
the  blood  is  further  forced  into  the  septum.  Though  it  is= 
true  that  the  acute  aneurysm  often  does  project  upon  the 
tricuspid  just  where  the  congenital  aneurysm  does,  yet  the 
acute  aneurysm  often  burrows  amongst  the  structures  of  the 
heart  in  other  directions.  In  Peyrot’s  case  the  aneurysm 
burrowed  in  two  ways :  one  opening  into  the  right  auricle 
through  the  auricular  septum,  the  other  into  the  left  auricle;-, 
in  Peacock’s  last  case,  in  Lombard’s  and  Shillito’s  cases,, 
there  was  also  an  opening  into  the  left  auricle.  The  same 
thing  happened  in  Barbeu-Dubourg’s  case,  but  here  there 
was  a  second  tunnel,  opening  between  the  aorta  and  pulmo¬ 
nary  artery.  In  Jaccoud’s  the  opening  was  between  the 
two  auricles  and  the  aorta;  and  in  several  others  the- 
aneurysm  has  reached  the  surface  of  the  pericardium. 

These  acute  aneurysms  have  sometimes  been  attributed! 
to  the  effects  of  friction.  So  long  ago  as  1868  Dr.  Moxon 
drew  the  attention  of  the  Pathological  Society  to  the 
erosions  which  might  be  caused  by  the  friction  of  long- 
vegetations  hanging  to  the  valves  of  the  aorta.  Ponfick,. 
later  on,  took  up  the  same  idea,  and  thought  that  friction 
might  lead  to  the  perforation  of  the  undefended  space  and! 
a  fistulous  opening. 

Closely  akin  to  this  subject  of  acute  aneurysm  of  the  un¬ 
defended  space  is  the  subject  of  valvular  aneurysm.  Morand, 
in  1729,  described  an  aneurysm  of  the  mitral  valve ;  but  ft- 
was  not,  as  far  as  we  know,  until  1812  that  Laennec  and 
Pizeau  described  another.  Cruveilhier  shortly  spoke  of  a 
third  specimen  in  1829,  and  in  1850  gave  the  name  of 
hernia  to  these  appearances ;  and  Thurnam  gave  details  in 
1838  of  a  case  taken  from  a  soldier  who  had  died  suddenly 
in  Fort  Pitt  in  1812.  This  observer  would  also  seem  to  have- 
been  the  first  to  describe  aneurysm  of  the  aortic  valves,, 
though  he  was  followed  in  a  few  months  by  Sir  Dominic- 
Corrigan,  and  shortly  after  by  Bouillaud. 

Few  writers  have  dealt  at  length  with  valvular  aneu¬ 
rysms.  In  1843,  Loebl  devoted  a  few  pages  to  the  examina¬ 
tion  of  the  six  or  eight  cases  then  on  record.  In  1873!, 
Jaster,  and  in  1S81,  Laurand,  wrote  their  theses  on  this 
subject;  but  Biach  may  be  said  to  have  been  the  first,  even- 
if  we  remember  Pelvet’s  work,  who  attempted  a  serious 
study  of  this  lesion.  To  his  essay,  which  aopeared  in  1878, 
I  am  much  indebted.  It  contains  full  details  of  many 
recorded  cases  which  either  cannot  be  seen  in  this  country, 
or  are  only  to  be  read  in  meagre  abstracts. 

Biach  was  able  to  collect  46  cases,  and,  by  adding  those- 
which  have  been  published  since  or  were  unknown  to  him, 
a  sum  of  90  has  been  added  up,  of  which  44  were  cases  of 
aortic,  and  43  of  mitral,  aneurysm  ;  while  in  3  cases  there- 
was  aneurysm  both  of  the  aortic  and  mitral  valves.  These 
numbers  are  in  marked  contrast  to  those  of  earlier  ob¬ 
servers,  who  have  nearly  all  found  mitral  aneurysms  far 


Medical  Tides  and  Gazette. 


LEGG  ON  CARDIAC  ANEURYSMS. 


August  25,  1883.  2  03 


more  common  than  aortic.  Pel  vet  gives  16  as  the  number 
for  the  mitral,  and  7  for  the  aortic.  Biach,  24  for  the 
mitral,  18  for  the  aortic  valves.  If  we  may  trust  the  out¬ 
come  of  a  larger  number  of  figures,  the  aortic  and  mitral  are 
•about  equally  prone  to  aneurysm. 

But  it  is  quite  otherwise  with  the  right  and  left  sides  of 
the  heart.  The  right  side  very  rarely,  if  ever,  shows  any 
aneurysms  of  the  valves.  It  has  often  been  said  that  in¬ 
stances  are  known  of  tricuspid  valvular  aneurysm.  Doubt¬ 
less  this  is  due  to  a  misunderstanding  of  Thurnam’s  speci¬ 
men,  which  is  merely  an  aneurysm  of  the  undefended  space 
-opening  up  the  tricuspid  valve,  and  causing  dilatation  in  its 
substance.  The  same  explanation  holds  of  Biach’s  thirty- 
eighth  and  thirty-ninth  cases. 

It  is  somewhat  different  with  the  pulmonary  valves. 
Buhl  has  described  a  museum  specimen  in  which  aneurysms 
were  found  on  every  sigmoid  valve,  pulmonary  or  aortic. 
And  in  Biach’s  nineteenth  case  there  were  small  sacs  on 
the  posterior  valve  projecting  into  the  ventricle. 

_  -^-n  excellent  reason  for  the  rarity  of  aneurysms  on  the 
right  side  of  the  heart  is  given  when  it  is  said  that  valvular 
aneurysms  are  almost  invariably  due  to  endocarditis.  It  is 
one  of  the  commonplaces  of  pathology  that  in  extra-uterine 
life  endocarditis  is  confined  to  the  left  side  of  the  heart,  so 
that  valvular  aneurysms  will  in  like  manner  be  confined  to 
The  same  side. 

It  may  be  disputed  whether  there  be  anything  sui  generis 
in  the  endocarditis  which  is  followed  by  the  formation  of 
aneurysms  ;  but  it  is  hardly  possible  to  decide  this  question 
from  the  materials  now  before  us.  Those  who  have  recoi’ded 
cases  of  valvular  aneurysms  have  not  often  thought  it  worth 
their  while  to  go  into  many  details  of  aetiology.  For 
instance,,  out  of  the  90  cases  which  I  have  collected,  no 
information,  negative  or  positive,  as  to  rheumatism,  is 
given  in  47.  In  15  (2  of  whom  had  a  rheumatic  parent) 
rheumatism  is  denied  at  any  time  in  the  history  of  the 
patient;  while  in  the  remaining  18  the  patient  suffered 
from  rheumatic  fever  during  the  time  that  he  was  under 
observation,  or  before  this. 

Of  syphilis  we  have  less  information  than  of  rheu¬ 
matism.  In  only  3  of  the  cases  is  syphilis  affirmed  (2 
of  my  own  and  1  of  Dr.  Osier’s).  In  5  others  the  busi¬ 
ness  of  the  patient  (soldier  or  sailor)  may  lead  some  to  assert 
that  syphilis  must  have  been  contracted.  In  2  scars  on 
the  liver  were  seen,  in  one  case  attributed  to  infarctions. 
■Other  signs  of  syphilis  are  not  spoken  of.  It  seems  some¬ 
what  strange  that  so  little  heed  should  have  been  given  to 
syphilis  as  a  possible  cause  of  aneurysm,  when  we  consider 
the  great  authorities  who  have  set  down  syphilis  as  a  cause 
of  all  valvular  vegetations. 

So  long  ago  as  1862,  Heschl  pointed  out  the  coincidence  of 
disease  of  the  aortic  orifice  with  pneumonia,  especially  of  a 
suppurative  pneumonia;  quite  lately,  Dr.  Osier  has  published 
a  series  of  cases  in  which  infectious  or  malignant  endocarditis 
was  associated  in  every  case  with  pneumonia.  In  five  cases 
-of  aortic  valvular  aneurysm,  pneumonia  is  recorded.  Valvular 
aneurysm  is  also  recorded  in  about  half  a  dozen  cases  of 
puerperal  endocarditis. 

V  ith  Heschl  I  feel  inclined  to  divide  valvular  aneurysms 
into  true  and  false— into  the  acute  and  chronic.  A  peculiarly 
virulent  or  acute  endocarditis  does  not  in  every  case  seem 
needful  for  the  production  of  a  valvular  aneurvsm.  In  June 
last  a  woman  died  suddenly,  just  after  I  had  admitted  her 
into  St.  Bartholomew’s  Hospital,  and  aneurysm  was  found 
on  one  of  the  aortic  valves,  the  endocardium  on  both  sides 
clothing  the  sac  without  any  solution  of  continuity  or  growth 
of  vegetations. 

That  these  aneurysms  are  caused  by  the'pressure  of  the 
blood  was  long  ago  pointed  out  by  Laennec,  and  of  the  forma¬ 
tion  of  the  aneurysm  the  best  explanation  seems  to  be  as  fol¬ 
lows  :  Some  part  of  the  valve  gives  way,  most  commonly  the 
endocardium,  from  ulceration,  friction,  or  some  other  cause. 
At  this  point  the  valve  is,  of  course,  weakened,  and  unable 
to  resist  the  force  of  the  blood.  It  follows  that  the  valve 
bulges  at  the  weakened  spot,  and  bulges  in  a  direction  which 
is  the  same  as  the  direction  of  the  pressure  of  the  blood.  For 
example,  if  the  aneurysm  be  on  the  mitral  valve,  the  con¬ 
vexity  or  bulged  part  is  on  the  auricular  surface  of  the 
valve.  If  the  aneurysm  be  on  the  aortic  valves,  the  aneu¬ 
rysm  points  into  the  ventricle.  Thus  far  all  are  agreed. 
But  the  question  now  arises,  whether  it  be  the  endocardium 
on  one  particular  side  of  the  valve  which  must  be  ulcerated 


to  form  the  aneurysm.  Dr.  Joseph  Coats  has  lately  insisted 
that  it  is  one  side  of  the  valve  only  which  is  at  fault.  His 
view  is  this  :  Endocarditis  is  more  common  on  the  ventricular 
side  of  the  aortic  flaps,  and  it  is  this  which  is  weakened. 
The  fall  of  the  blood,  therefore,  against  the  valve  tends  to 
push  the  fibrous  or  elastic  middle  tissue  of  the  valve,  followed 
by  the  endocardium  lining  the  aortic  side,  out  through  the 
weakened  spot  into  the  ventricle,  and  thus  to  form  the 
aneurysmal  sac.  I  do  not  know  if  Dr.  Coats  intend  his 
proposition  to  be  a  general  one  ;  but  while  gladly  admitting 
that  it  is  an  explanation  of  certain  cases  of  aneurysm  (espe¬ 
cially  on  the  aortic  valves),  I  do  not  myself  think  that  it 
applies  in  all  cases.  I  have  seen  specimens  in  which  the  ab¬ 
sence  of  all  endocarditis  on  the  bulged  side,  and  the  smooth 
continuous  covering  of  endocardium  over  the  aneurysm, 
forbade  the  notion  that  the  process  had  begun  on  the 
bulged  side.  In  support  of  this  statement,  besides  my  own 
cases,  I  may  refer  to  those  of  Dr.  Andrew,  Dr.  Walter  Smith, 
and  Dr.  Wilks,  where  the  endocardium  on  the  ventricular 
side  of  the  mitral  was  sharply  cut,  or  there  was  a  smooth 
continuous  endocardium  covering  the  sac  on  the  auricular 
surface  of  the  valve. 

I  am  thus  inclined  to  believe  that  destruction  of  the  en¬ 
docardium  on  either  side  of  the  valve  may  lead  to  the 
formation  of  valvular  aneurysms,  and  that  Dr.  Coats’  ex¬ 
planation  may  often  apply  to  the  aortic  valves  ;  the  other, 
to  the  mitral. 

Endocarditis,  acute  and  chronic,  is  the  chief,  I  had  almost 
said  the  sole,  cause  of  valvular  aneurysms.  I  will  now 
allude  to  a  cause  which  is  not  endocarditis  itself,  but  a  conse¬ 
quence  of  endocarditis — friction  from  long  vegetations 
dependent  from  other  parts  of  the  heart.  I  have  already 
spoken  of  friction  as  a  cause  of  acute  aneurysm  of  the  un¬ 
defended  space  ;  and  the  same  long  vegetations  may  hang 
from  the  aortic  valves  and  rub  against  the  ventricular 
surface  of  the  mitral,  and  in  this  way  lead  to  aneurysm.  Dr. 
Sidney  Coupland  thinks  that  in  his  case  there  was  evidence 
of  such  a  process. 

If  the  aneurysm  last  long  enough,  it  usually  becomes  per¬ 
forated,  and  the  seat  of  the  perforation  is  usually  at  the 
apex  of  the  aneurysm.  This  last  phenomenon  is  no  doubt  due 
to  a  continuation  of  the  same  destructive  pressure  of  the 
blood  that  first  caused  the  dilatation.  Hot  unfrequently 
the  valve  becomes  perforated  in  two  places,  or  there  may 
be  three  openings,  as  in  Homolles’,  or  several,  as  in  Dr. 
Lawrence  Humphry’s. 

There  are  some  few  cases  in  which  the  disposition  of  the 
sac  on  the  valve  has  not  corresponded  with  the  law  that  the 
sac  must  project  in  the  same  direction  as  the  blood-pressure. 
Cases  of  this  kind  have  been  recorded  by  Dr.  Walshe,  Dr. 
Cayley,  and  Marchant.  Dr.  Walshe  finds  his  case  hard  to 
explain,  and  even  so  accomplished  a  morbid  anatomist  as 
Dr.  Cayley  refuses  to  give  an  opinion  whether  in  his  case 
the  lesion  was  congenital  or  rheumatic.  Suppose  some 
haemorrhage  (such  have  been  described  of  late)  to  take  place 
into  the  auricular  aspect  of  the  mitral  and  burst ;  an  acci¬ 
dent  like  this  might  lay  the  foundation  of  an  aneurysmal 
sac  bulging  towards  the  ventricle. 

The  shape  of  these  valvular  aneurysms  tends  to  the 
round;  after  it  have  lasted  some  time  it  becomes  longer. 
On  the  aortic  valves  they  have  been  compared  by  Bouillaud 
to  swallows’  nests,  but,  as  the  aortic  valves  themselves  are 
of  this  shape,  the  comparison  is  superfluous.  When  pro¬ 
longed  they  are  like  the  end  of  a  finger  of  a  glove  or  a 
sugar-loaf.  I  have  never  seen  them  as  pouches  with  narrow 
necks  at  their  place  of  attachment,  though  such  have  been 
described  by  Pel  vet  and  Dr.  Joseph  Coats.  These  remarks 
apply  exclusively  to  the  aortic  valves  ;  on  the  mitral,  the 
aneurysms  are  elevations,  raised,  rounded,  or  slightly  pro¬ 
longed  swellings,  but  I  do  not  know  of  an  example  in  which 
they  have  become  like  the  finger  of  a  glove  or  pedunculated. 

As  to  the  size  of  these  aneurysms,  they  vary,  from  being 
just  large  enough  to  be  perceptible  eminences  on  the  valve, 
to  the  size  of — on  the  mitral,  a  large  walnut,  as  in  Thurnam’s 
and  Dr.  Wilks’  cases ;  and  on  the  aortic,  to  the  size  of  a  large 
marble,  as  in  one  of  Dr.  Osier’s  cases. 

One  sigmoid  or  one  flap  of  the  mitral  not  uncommonly 
shows  two  aneurysms  at  the  same  time.  Cruveilhier  speaks 
of  three  or  four  on  the  same  valve. 

Is  any  one  flap  of  the  aortic  or  mitral  valves  more  prone 
to  aneurysms  than  its  fellows  ?  As  to  the  mitral,  it  might 
be  looked  for  that  the  large  flap,  against  which  all  the 


204 


Medical  Times  and  Gazette. 


SCHAFER  ON  THE  STRUCTURE  OF  THE  ANIMAL  CELL. 


August  25, 1883, 


pressure  of  the  blood  is  directed,  should  he  aneurysmal 
rather  than  the  small.  And  this  is  really  the  case.  Out  of 
forty-three  cases  on  record,  the  valves  were  distinguished  in 
thirty-two.  In  twenty-eight  of  these  the  aneurysm  has  been 
seated  on  the  large,  aortic,  or  anterior  flap  of  the  mitral  (if 
we  take  these  adjectives  as  meaning  the  same),  and  in  one 
case  on  the  inner,  and  in  another  on  the  Septum-gipfels  of 
the  mitral  (which  I  judge  to  he  the  same  as  the  large  flap). 
There  remain  two  cases  in  which  the  small  flap  showed  an 
aneurysm ;  one  of  my  own,  and  Dr.  Wilks’  case,  in  which 
latter  the  swelling  was  on  the  “  posterior  ”  curtain,  and  was 
the  size  of  a  waluut. 

If  there  be  a  reason  for  a  preference  of  the  larger  flap  of 
the  mitral,  yet  there  would  appear,  beforehand,  no  good 
reason  for  any  preference  of  one  of  the  three  flaps  of  the 
aortic  valves.  Yet  the  posterior  valve  is  certainly  marked 
out,  although  in  no  such  decided  way  as  the  large  flap  of  the 
mitral.  There  are  thirty-five  cases  in  which  the  name  of 
the  valve  is  given,  and  in  twenty-five  of  these  the  posterior 
valve  (right  posterior  of  Sibson)  was  aneurysmal ,-  and  in 
thirteen  of  these  the  posterior  valve  was  the  only  one  aneu¬ 
rysmal.  Aneurysms  were  seen  on  the  right  valve  only  (right 
anterior  of  Sibson)  three  times ;  on  the  left  (left  posterior) 
twice,  without  aneurysms  on  the  other  valves.  The  posterior 
and  right  showed  aneurysms  together  in  eight  cases,  and  all 
three  valves  were  aneurysmal  in  four  cases.  It  may  be  noted 
that  the  posterior  and  right  valves,  which  are  so  often  aneu¬ 
rysmal,  are  near  neighbours  of  the  undefended  space  which 
is  so  specially  subject  to  endocarditis. 

Aneurysms  seem  to  be  not  very  unfrequent  in  fused  aortic 
valves.  Six  of  such  cases  have  been  recorded. 

As  to  sex,  men  show  a  marked  preponderance  over  women. 
There  are  thirty  men  with  mitral  aneurysms  against  eight 
women,  and  twenty-nine  men  with  aortic  valvular  aneurysms 
against  eleven  women.  As  to  age,  the  greatest  number  is 
seen  between  twenty  and  forty. 

I  will  now  devote  a  few  words  to  the  consideration  of 
aneurysms  of  the  coronary  arteries. ,  In  3  870,  while  I  was 
examining  the  body  of  a  boy  seven  years  old,  who  had  died 
of  meningitis,  I  came  across  three  small  bodies  on  the  back 
of  the  heart,  which  turned  out  to  be  aneurysms  of  the  coro¬ 
nary  artery.  Dr.  Gee  published  an  account  of  them  in  the 
St.  Bartholomew’s  Hospital  Reports.  Although  it  is  some¬ 
times  said  that  Hedlund  was  the  first  to  describe  these  aneu¬ 
rysms,  yet  I  find  a  record  of  dilatation  of  the  coronary  artery 
in  Morgagni  (“  De  Sedibus,”  xxvii.,  sec.  28).  One  of  the 
coronary  arteries  was  dilated  to  the  size  of  the  carotid. 
Cases  were  afterwards  recorded  by  Merat  in  1818,  Hedlund 
in  1816,  and  Peste  in  1843.  Dr.  Peacock  seems  to  have  been 
the  first  in  this  country  to  describe  a  case. 

Excluding  all  cases  of  dilatation  of  the  origin  of  the  coro¬ 
nary  arteries  as  they  arise  out  of  the  sinus  of  Valsalva, 
and  of  aneurysms  which  are  merely  part  of  multiple  aneu¬ 
rysms  all  over  the  body,  there  remain  about  thirteen  cases 
on  record.  Of  these  the  sex  is  recorded  in  twelve,  and  in 
eleven  it  was  male.  As  to  age,  my  case  is  the  youngest, 
the  hoy  being  but  seven  years  old.  Five  of  all  the  cases 
whose  age  is  known  were  between  twenty  and  thirty,  so  that 
one-half  of  the  cases  were  below  thirty.  The  remainder  were 
forty,  fifty-one,  fifty-nine,  sixty,  sixty-three,  and  seventy- 
seven  years  of  age. 

In  six  out  of  the  thirteen  the  cause  of  death  was  rupture 
of  the  aneurysm.  Thus  death  was  caused  by  rupture  in 
nearly  one-half. 

In  four  out  of  the  thirteen  the  aneurysms  were  multiple — 
that  is,  not  less  than  three.  In  my  own  case  and  Dr.  John 
W.  Ogle’s  there  were  three,  in  House’s  five,  while  in  Dr. 
Bristowe’s  case  the  aneurysms  were  numerous,  nodules 
being  seen  on  the  coronary  arteries  in  size  from  peas  to 
tares.  This  case  at  once  brings  to  mind  the  multiple 
aneurysms,  not  only  of  the  coronary  arteries,  but  of  the 
whole  of  the  body,  which  have  been  described,  and  of  which 
a  case  appears  in  the  current  number  of  the  Archives  de 
Physiologie.  They  resemble  the  coronary  aneurysm  in  all  the 
patients  being  men,  and,  with  the  exception  of  the  case  just 
named,  young  men  under  thirty ;  also,  with  one  exception, 
the  patients  were  known  to  be  syphilitic.  Pelletan,  early 
in  this  century,  affirmed  that  the  cause  of  the  “  aneurysmal 
diathesis  ”  was  syphilis,  but  he  owns  that  he  had  no  evidence 
for  his  speculation,  and  even  now  it  would  be  rash  to  affirm 
that  the  real  cause  of  these  little  dilatations  is  syphilis. 
In  the  little  boy  of  seven  there  was  nothing  that  pointed  to 


acquired  syphilis.  One  might  also  compare  these  miliary' 
aneurysms  of  the  heart  to  the  miliary  aneurysms  seen  in 
the  brain,  and  which  are  limited  to  one  organ,  and  have  a 
tendency  to  rupture. 

Nearly  twenty  years  ago.  Dr.  John  W.  Ogle  explained 
his  case  of  aneurysms  of  the  coronary  artery  by  following- 
up  the  theory  which  he  had  first  published  in  1857,  that 
aneurysm  in  young  persons  might  often  be  caused  by  emboli.. 
This  same  idea  has  been  expressed  by  Mr.  Tufnell,  Mr. 
Holmes,  Dr.  Church,  and  last  of  all  by  Ponfick.  The  coro¬ 
nary  arteries,  however,  are  singularly  exempt  from  emboli,, 
and  there  does  not  seem  evidence  that  in  all  cases  the? 
sources  of  emboli  were  present. 


AN  ADDRESS 

DELIVERED  AT  THE  OPENING!  OF 

THE  SECTION  OE  PHYSIOLOGY,, 

At  the  Annual  Meeting  of  the  British  Medical  Association u 
in  Liverpool,  August,  1883. 

By  E.  H.  SCHAFER,  F.R.S., 

Jodrell  Professor  of  Physiology  in  University  College,  London. 


THE  STRUCTURE  OF  THE  ANIMAL  CELL. 

The  subject  which  I  have  selected  to  bring  before  you  iir 
this  section  is  the  structure  of  the  animal  cells.  To  physi¬ 
ologists  and  pathologists  this  is  a  subject  of  so  general  am 
interest  as  to  need  no  apology  for  its  introduction.  Espe¬ 
cially  does  this  seem  an  appropriate  time  and  occasion  for- 
its  review,  by  reason  of  the  fact  that  there  is  no  single 
subject  in  anatomical  or  physiological  science  which  has 
absorbed  of  late  more  attention  than  this  one,  and  moreover 
because  it  is  one  in  which  I  myself,  who  have  been  honoured 
by  being  selected  to  preside  on  this  occasion,  have  for  many 
years  taken  a  particular  interest. 

In  the  first  place,  let  us  consider  the  views  which  were 
formerly  held  regarding  the  structure  of  the  animal  cell. 
The  earliest  notion  was  that  expressed  by  its  name — a 
hollow  space  enclosed  by  firm  walls.  The  space  was  occupied 
by  fluid,  which  might  contain  granules.  Schwann  (“  Micro¬ 
scopical  Researches,”  1839  ;  Sydenham  Society’s  translation^ 
1847)  succeeded  in  crushing  a  young  cartilage-cell  ;  it 
“  suddenly  shrank  together,  whilst  a  clear  fluid  streamed 
out,  thus  proving  the  contents  of  the  cell  to  be  fluid  and 
transparent.”  The  wall  is  essential  to  the  idea  of  the  cell 
even  the  lymph-  and  pus- corpuscles  have  an  envelope  or  cell- 
membrane  enclosing  the  cell-contents.  Mucus-corpuscles 
are  exceptional  in  so  far  as  that  “  an  especial  cell- membrane 
cannot  be  distinguished  ”  in  them ;  it  may,  nevertheless,, 
still  exist.  The  nucleus  is  a  simple  vesicle  filled  with  fluid,, 
with,  at  the  most,  one  or  more  solid  particles — nucleoli — 
suspended  in  the  fluid ;  it  is  not  essential  to  the  idea  of  a  cell,  or 
at  least  may  disappear  even  from  living  succulent  cells  ;  it 
is  often  adherent  to  the  cell-wall.  This  notion  of  the  animal 
cell  is  an  extension  of  that  which  had  been  already  formed 
from  observations  on  the  vegetable  cell;  no  independent  line 
is  taken.  The  facts  regarding  the  plant-cell  seem  clear  enough :: 
the  elements  are  large  and  conspicuous ;  what  more  likely 
than  that  the  animal  cell  should  possess  the  same  structure?' 

The  most  conspicuous  fact  in  this  idea  of  the  cell  is  the 
importance  of  the  cell-membrane.  This  did  not  serve 
merely  to  enclose  the  fluid  contents  of  the  cell ;  it  had  a 
direct  relation  to  nutrition  and  growth.  Kolliker  (“  Manual 
of  Human  Histology,”  1852  ;  Sydenham  Society’s  transla¬ 
tion,  1853)  expressly  declares  that  “  the  power  of  growth  is 
not  simply  innate  in  every  organic  membrane,  manifesting 
itself  when  sufficient  formative  material  is  offered,  but  re¬ 
quires  special  conditions,  which  are  only  realised  by  the  cell- 
membrane.”  Further,  “While  the  membranes  grow  by  the- 
attraction  of  material  from  the  surrounding  fluid  by  virtue- 
of  their  priority,  they  allow  substances  to  penetrate  into  their 
interior.  This  filling,  however,  does  not  take  place  by  the 
cells  admitting  every  kind  of  matter  indiscriminately,  but 
they  .  .  .  take  up  one  constituent  (of  the  cytoblastema)  and 
reject  another.”  And  this  selection  is  the  property  of  the 
cell-membranes,  for  a  little  further  on  we  read,  “  The  cell- 
membranes  do  not  act  as  mere  filters,  but  allow  one  sub¬ 
stance  or  another  to  permeate  them,  according  to  their 


'Medical  Times  and  Gazette. 


SCHAFER  OH  THE  STRUCTURE  OF  THE  ANIMAL  CELL.  August  23)  isss.  205 


•chemical  constitution,  the  constitution  of  the  fluid  which 
imbues  them,  their  condition  of  aggregation,  and  their 
■thickness.”  This  is  not  a  mere  process  of  endosmosis, 
although  this  also  “must  be  taken  into  account  as  a  condi¬ 
tion  in  the  absorptive  action  of  cells,  though  hitherto  it  has 
'been  too  freely  appealed  to,  and  cells  have  been  too  often 
•considered  as  vesicles  provided  with  merely  indifferent  porous 
membranes.” 

Given  such  structural  conditions — a  vesicle  filled  with 
■fluid,  and  enclosed  by  a  structureless  membrane — it  was  not 
•easy  to  understand  how  changes  were  brought  about  in  the 
•cell-contents,  although  the  occurrence  of  such  changes 
was  not  to  be  ignored.  Schwann  assumed  the  existence 
■of  a  special  force — metabolic  force — capable  of  producing 
such  changes ;  but  this  assumption  could  not,  of  course, 
advance  the  explanation.  Others  were  disposed  to  endue 
dffie  nucleus  with  a  kind  of  catalytic  power ;  others,  the  cell- 
membrane.  There  was  an  obvious  difficulty  in  comprehend¬ 
ing  how  this  seemingly  inert  bag  of  fluid  could  be  endowed 
an  so  remarkable  a  manner  as  to  minister  to  development 
•and  growth,  to  nutrition,  secretion,  tissue-formation,  and 
■even  to  contractility  and  motion. (a) 

The  establishment  of  two  important  facts  led  eventually 
to  the  overthrow  of  the  vesicular  theory  of  cell-structure. 
One  was  the  existence  of  cells  without  an  envelope.  It  was 
admitted,  even  by  Schwann,  and  by  most  observers  after 
him,  that  in  some  cells,  pale  blood-corpuscles  amongst  the 
number,  it  was  not  possible  to  demonstrate  the  existence  of 
a  cell-membrane.  Its  existence  in  them  was  merely  assumed. 
“The  second  fact  was  the  exhibition  by  cells  of  those  peculiar 
a,nd  indefinite  changes  of  shape  which  are  known  under  the 
.name  of  “  amoeboid  movements.”  (b) 

It  had,  moreover,  by  this  time  been  shown  by  the  botanists 
that  the  vegetable  cell  is  something  more  than  a  simple 
cellulose  vesicle  with  fluid  contents  and  a  nucleus.  It  was 
admitted  that  the  nucleus  was  embedded  in  a  clump  of  soft 
•substance,  clear  and  transparent  indeed,  but  yet  somewhat 
more  solid  than  the  rest  of  the  cell-contents  ;  that  a  layer  of 
^similar  substance  lined  the  cellulose  wall,  and  that  threads 
of  it  might  here  and  there  cross  the  cell-cavity.  V.  Mohl 
(“VermischteSchriften,”  1845)  termed  this  substance  “proto¬ 
plasm  ”j  the  name  was  afterwards  extended  to  the  substance 
of  the  animal  cell,  and  the  properties  which  had  before  been 
supposed  inherent  in  the  cell-membranes  began  to  be  trans¬ 
ferred  to  it. 

Histologists  were,  therefore,  fully  prepared  to  receive  a  new 
■definition  of  the  animal  cell  when,  in  18G1,  Max  Schultze 
;(“  Ueber  Muskelkorperchen  u.  das,  was  man  eine  Zelle  zu 
mennen  habe,”  Arch.  f.  Anat.,  1861)  clearly  showed  that  the 
vesicular  theory  could  no  longer  be  upheld,  but  must  be  re¬ 
placed  by  a  totally  different  idea.  It  was  demonstrable  that, 
in  many  instances,  no  membrane  exists  ;  it  was  also  demon¬ 
strable  that  the  cell  substance  is  in  most  cases  not  fluid,  but 
■composed  of  the  soft  contractile  substance  already  known  as 
protoplasm  or  sarcode.  A  clump  of  protoplasm  enclosing  a 
nucleus  is  for  the  future  to  be  looked  upon  as  sufficient  to 
■constitute  a  cell.  There  may,  it  is  true,  be  a  cell-mem- 
Sbrane ;  there  may  be  adventitious  granules,  globules,  in  the 
protoplasm ;  but  these  are  accidental,  not  essential  to  the 
■definition  ;  they  may,  indeed,  even  interfere  with  some  of 
■the  manifestations  of  vital  activity  which  are  otherwise  ex¬ 
hibited  by  the  protoplasm.  The  cells  which,  under  the  pre¬ 
vious  theory,  were  exceptional,  are  henceforth  typical— the 
colourless  blood-corpuscle,  the  embryonic  cell ;  those  which 
were  most  typical — cartilage-cells,  epithelium-cells,  cells  of 
the  chorda  dorsalis — are  specially  modified ;  degenerated, 
-•some  of  them,  with  their  activity  reduced,  or  narrowed  into 
the  performance  of  a  single  function.  The  cell-membrane 
has  had  its  day.  Even  when  present,  it  is  no  longer  re- 

fa)  The  contractions  which  had  up  to  this  time  been  observed  in  pro¬ 
tozoa,  or  in  some  cells  of  metazoa,  were  very  generally  referred  to  the 
cell-membranes.  It  was  Donders  who  first  ascribed  contractility  to  the 
cell-contents  instead  of  to  the  cell-membranes,  butLeydig  had  long  before 
contended  for  the  importance  of  the  cell-contents  relatively  to  the  cell- 
membrane. 

(b)  These  were  first  described  in  the  pale  blood-corpuscle  by  Wharton 
.Tones  {Phil.  Trans.,  1846),  but  it  was  not  immediately  that  the  importance 
of  his  observation  was  recognised.  Even  after  several  years  the  cell- 
membrane  still  held  its  own :  so  that,  in  1853.  Busk  and  Huxley  (trans¬ 
lation  of  Kolliker’s  “  Manual,”  note  on  page  4  ),  alluding  to  this  very  case, 
write :  “  It  is  certainly  the  membrane  which  contracts  in  these  cases,  for 
it  pushes  out  processes  which  are  only  subsequently  filled  by  the  granular 
contents.”  But  the  membrane  here  spoken  of  is  evidently  something  very 
different  from  the  mere  fibre  which  had  previously  been  assumed  to  enclose 
Che  contents  of  the  corpuscle. 


garded  as  of  any  functional  importance.  It  renders  the 
cells  more  inert,  instead  of  more  active;  it  prevents  those 
amoeboid  movements,  those  manifestations  of  contractility, 
whose  importance  is  by  this  time  completely  acknowledged. 

But  what,  after  all,  is  this  protoplasm,  upon  which  the 
attention  of  biologists  is  now  concentrated,  which  performs 
so  many  and  such  various  functions,  which  is  recognised  as  the 
living  substance  par  excellence  ?  A  speck  of  jelly  or  slime  ; 
structureless — at  least,  not  necessarily  exhibiting  any 
structure ;  homogeneous,  except  for  the  possible  presence  of 
granules  of  other  material,  or  globules  of  fat  or  fluid  em¬ 
bedded  in  it ;  unformed  itself,  yet  capable  of  forming  all 
the  tissues,  all  the  secretions,  all  the  products  of  the  animal 
body  (Beale).  Its  chemical  composition  but  little  known  ; 
certainly  a  large  proportion  of  water ;  next  to  this,  a  proteid 
substance  or  substances,  inorganic  salts,  protagon,  glycogen, 
fatty  and  other  matters  also  found ;  but  who  knows  whether 
essential  or  accidental  ?  The  molecular  constitution  only 
guessed  at,  and  that  probably  badly.  It  is  true,  we  have 
advanced  a  step  in  our  definitions ;  but  are  we  nearer  an 
explanation  of  the  manner  in  which  these  wondrous  phe¬ 
nomena  of  growth,  of  chemical  metamorphosis,  of  movement 
and  contractility,  are  brought  about  ?  I  think  that  no  one 
would  venture  upon  an  affirmative  answer. 

As  for  the  nucleus  and  nucleolus,  these  occupy  much  the 
same  position  in  this  scheme  that  they  did  in  the  previous 
one.  It  is  true  we  no  longer  hear  of  the  “  action  of  the 
nucleus  ”  upon  the  cell-contents.  Its  special  reproductive 
function  has  long  since  been  fully  recognised ;  in  respect  of 
its  structure,  little  or  no  advance  has  been  made.  The 
second  picture  of  cell-structure  which  I  have  presented  to  you 
is  the  one  with  which  we  are  most  of  us  familiar :  the  speck 
of  protoplasm  enclosing  a  nucleus,  devoid  of  structure,  but 
capable  of  varied  functions.  I  will  now  invite  you  to  con¬ 
sider  a  third  picture,  which  has  been  gradually  developing 
during  recent  years,  and  which  at  the  present  moment  bids 
fair  to  supplant  the  other. 

Imagine  a  round,  soft  sponge,  the  horny  skeleton  replaced 
by  soft  contractile  substance,  the  interstices  occupied  by 
fluid,  a  spherical  vesicle  embedded  at  one  part  in  like  sub¬ 
stance,  and  you  have  at  once  an  idea  of  the  most  modern  view 
of  cell-structure.  Suppose,  further,  the  network  or  sponge- 
work  capable  of  conti'acting  so  as  to  express  fluid  from  the 
meshes,  or  expanding  so  as  to  admit  more  fluid  into  them  ; 
suppose  granules  of  various  kinds  to  be  floating  in  this 
fluid,  and  to  be  moved  from  place  to  place  within  the  cell 
by  the  currents  caused  by  such  contractions  ;  suppose  mate¬ 
rials  formed  within,  or  imbibed  by,  the  cell  to  accumulate 
in  this  interstitial  fluid,  ready,  as  in  many  secreting  cells, 
to  be  discharged  from  the  cell  by  the  contraction  of  the 
network  (in  obedience  to  an  excitation  operating  either 
directly  upon  the  cell  or  indirectly  through  the  nervous 
system) ;  even  suppose,  in  ciliated  cells,  rhythmic  contrac¬ 
tions  of  the  network  acting  upon  the  bases  of  the  cilia, 
which  are  prolonged  into  the  cell,  and  in  this  way  causing 
to-and-fro  movements  of  the  projecting  cilia, — given  this 
structure,  combined  with  the  contractile  function,  and,  in  a 
comparatively  simple  fashion,  many  of  the  phenomena  of 
cell-activity  can  be  explained. 

But  before  we  accept  definitely  this  new  theory  of  cell- 
structure,  it  behoves  us  thoroughly  to  examine  the  grounds 
upon  which  it  is  based.  In  the  first  place,  it  maybe  pointed 
out  that  the  view  is  not  so  novel  as  may,  perhaps,  be  sup¬ 
posed.  Strieker,  in  his  handbook  (article  on  “  The  Cell,” 
p.  20,  1871),  devotes  a  page  to  its  discussion,  for  the  possi¬ 
bility  of  such  a  structure  had  already,  even  then,  been 
mooted  for  some  time,  and  that  by  physiologists  of  the 
highest  eminence. 

Strieker  writes  thus  :  “Briicke  (“  IJeber  d.  sog.  Molecular- 
bewegungen  ”)  ascribes  to  the  salivary  corpuscles  a  system  of 
spaces,  in  which  an  intracellular  fluid  is  contained.  He 
claims  the  same  for  the  protoplasm  of  the  vegetable  cells 
in  the  hairs  of  the  stinging-nettle.  Heidenhain  (“  Studien 
des  Physiol.  Instituts  in  Breslau,  II.”)  agrees  with  this  view, 
and  further  suggests  that  the  intracellular  fluid  is  moved  by 
the  protoplasm  in  the  same  way  as  the  intestinal  contents 
by  the  peristaltic  movements  of  the  intestinal  wall.”  The 
considerable  space,  within  many  vegetable  cells,  occupied  by 
fluid,  across  which  threads  of  protoplasms  here  and  there 
pass,  is  not  here  meant,  for  it  is  expressly  stated  that  “  this 
cell-fluid  is  not  to  be  confounded  with  that  which  is  assumed 
to  exist  in  the  interstices  of  the  protoplasm.”  Further :  “In 


206 


Medfcal  Times  and  Gazette. 


SCHAFER  ON  THE  STRUCTURE  OF  THE  ANIMAL  CELL. 


August  25,  1883. 


the  case  of  the  flask-shaped  glands  of  the  frog’s  eyelid,  it  is 
seen  that  the  bulk  of  the  gland-cells  undergoes  considerable 
variation.  At  times  the  cells  project  so  far  into  the  lumen 
as  to  reduce  this  to  the  smallest  possible  compass  ;  at  other 
times  they  are  so  contracted  as  to  cause  the  gland  to  re¬ 
semble  a  bladder  merely  lined  with  epithelium-cells.  It  is 
not  easy  to  explain  this  change,  otherwise  than  by  sup¬ 
posing  that  the  gland-cells  have,  by  contracting,  squeezed 
fluid  out  of  their  substance  ” — an  idea  which  has  later  been 
still  further  developed  by  Strieker,  who,  in  conjunction  with 
Spina,  has  been  able  actually  to  observe  the  contractions  of 
the  cells  which  were  then  only  assumed. 

Although,  therefore,  this  modern  view  of  the  structure  of 
protoplasm,  as  a  network  or  spongework  with  fluid  inter¬ 
stices,  is  not  altogether  novel,  yet  its  advocates  now  claim 
for  it  an  entirely  different  standing.  Then  it  was  merely  a 
theoretical  assumption,  now  it  claims  to  rest  upon  observed 
facts.  Let  us  see,  then,  for  ourselves  what  these  facts  really 
are,  and  what  they  really  prove. 

In  cells  of  the  most  various  kinds — ova,  pale  blood-cor¬ 
puscles,  epithelium  cells,  nerve  cells,  vegetable  cells,  which 
have  been  subjected  to  the  action  of  hardening  fluids,  such 
as  alcohol,  bichromate  of  potash,  picric  acid,  and  especially 
chromic  acid,  it  is  easy  to  convince  one’s  self  of  the  presence 
in  the  cell-substance  of  a  fine  and  closely  interlaced  network 
of  fibrils.  This  fact,  which  was  first  distinctly  pointed  out 
by  Frommann,  and  independently  by  Heitzmann,  was  soon 
supported  by  the  extensive  observations  of  Klein,  and  by  the 
more  special  works  of  Arnold,  Schwalbe,  Flemming,  and  other 
histologists.  Arguing,  then,  from  this  alone — viz.,  the  ap¬ 
pearance  of  protoplasm  after  it  has  been  subjected  to  the 
influence  of  hardening  reagents,  we  should  have  no  hesita¬ 
tion  in  ascribing  to  that  substance  the  sponge- like  structure 
which  the  theory  we  are  considering  assumes  that  it 
possesses. 

But,  before  coming  to  a  decision  upon  this  subject,  it  be¬ 
hoves  us  to  inquire  how  far  we  are  justified  in  assuming  that 
the  structure  which  protoplasm  exhibits  after  the  action  of 
reagents  exists  in  the  same  protoplasm  in  the  living  and 
unaltered  condition.  It  is  also  important  to  ascertain 
whether  the  reagents  we  are  in  the  habit  of  employing  are 
capable  of  themselves  producing  appearances  such  as  those 
we  have  to  deal  with. 

To  reply  first  to  the  latter  inquiry :  it  must  be  conceded 
that  the  hardening  reagents  which  we  employ  are  undoubt¬ 
edly  capable  of  producing  in  organic  fluid  and  semi-fluid 
substances  coagula,  which,  under  conditions  at  present  ill 
understood,  may  assume  the  form  of  networks.  Unless, 
therefore,  the  intracellular  networks  which  are  observed  are 
constant  in  appearance  in  the  same  cells,  no  matter  what 
the  hardening  agent  employed — constant,  that  is,  in  the 
general  disposition  of  the  fibrils, — the  objection  is  undoubt¬ 
edly  open  that  the  apparent  structure  may  be  the  result  of 
the  action  of  the  reagents.  But  if  it  can  be  shown  that  even 
in  the  fresh  and  living  protoplasm  there  exist,  although  not 
perhaps  distinctly  visible,  yet  sufficient  indications  of  the 
presence  of  such  a  network,  this  objection  would,  in  a  great 
degree,  be  invalidated  ;  for  it  is  conceivable,  indeed  certain, 
that  different  reagents  may  produce  somewhat  different 
changes  in  a  pre-existent  network,  and  in  this  way  give  it 
somewhat  of  a  different  character.  Practically,  then,  the 
decision  of  the  question  ultimately  turns  upon  the  existence 
or  non-existence  of  this  structure  in  living  protoplasm, 
especially  in  the  protoplasm  of  cells,  which  exhibit  it 
distinctly  after  the  action  of  reagents. 

For  the  special  study  of  this  question  it  will,  perhaps,  be 
well  to  select  two  or  three  specific  examples,  and  we  may 
choose  for  the  purpose  cells  of  such  widely  different  appear¬ 
ance  and  functions  as  a  colourless  blood-corpuscle,  a 
cartilage-cell,  and  a  glandular  epithelium-cell,  all  of  which 
are  admitted  to  show  a  reticular  cell-structure  in  hardened 
preparations.  Let  us  see,  then,  what  is  observable  in  them 
in  the  living  condition. (c) 

The  colourless  blood-corpuscle  of  the  newt  or  salamander 
is  the  easiest  of  cells  to  observe  in  the  living  state.  Thus 

(c)  The  necessity  of  insisting  upon  the  examination  of  a  cell  in  an  ab¬ 
solutely  normal  living  condition  in  order  to  determine  a  point  of  this 
nature,  must  be  evident  from  the  known  fact  that  protoplasm,  which  is 
semi-fluid  during  life,  undergoes,  immediately  after  death,  a  kind  of 
coagulation  analogous  to  that  which  occurs  in  muscle  and  in  blood-plasma. 
It  is  in  consequence  of  this  coagulation  that  a  tissue  like  that  of  the  liver, 
which  is  mainly  composed  of  protoplasmic  cells,  becomes  much  firmer  and 
more  rigid  after  death  than  it  was  during  life.  We  cannot  certainly  say 


seen,  its  protoplasm  is  clear  ;  and,  when  the  corpuscle  is 
flattened  against  the  cover-glass,  it  is  so  completely  exposed 
to  view  that,  with  the  carefully  constructed  objectives  which 
are  now  made,  it  is  difficult  to  believe  that  any  indications; 
of  structure  which  it  might  present  would  remain  wholly  un¬ 
detected.  Under  these  conditions,  the  nucleus  is  obvious, 
and  the  reticular  structure  of  the  nucleus  is  evident  enough. 
But,  in  the  protoplasm  itself,  what  can  be  seen  ?  In  some- 
corpuscles,  a  number  of  distinct  refracting  granules,  grouped! 
around  the  nucleus,  sometimes  on  one  side  of  this.  The 
granules  are  embedded  in  the  clear  protoplasm ;  they  move- 
from  place  to  place  within  the  cell,  gliding  as  a  group  from 
one  part  to  another,  flowing  into  previously  clear  protrusions 
of  the  cell,  to  all  appearance  freely,  and  in  no  way  seeming^ 
to  encounter  obstacles.  In  other  corpuscles,  clear  spaces,, 
vacuoles,  less  refracting  than  the  protoplasm  which  encloses 
them,  occupied  by  fluid— one,  two,  or  more  in  the  cell — occur¬ 
ring  in  the  granular  corpuscles  as  well  as  in  others.  In  some 
corpuscles  are  many  such  vacuoles;  in  some,  indeed,  the  proto¬ 
plasm  is  crowded  with  them;  they  are  of  varying  size;  they 
appear  to  increase  in  number  if  the  preparation  be  kept  for 
a  time — can,  in  fact,  be  seen  in  process  of  formation,  pro¬ 
duced  by  enclosure  of  fluid  at  the  periphery  of  the  cor¬ 
puscle.  When  thus  numerous,  the  protoplasm,  in  optical 
section,  has  all  the  appearance  of  a  network ;  but  the  meshes 
are  not  like  those  of  a  sponge ;  they  do  not  intercommuni¬ 
cate  ;  they  are  isolated  spaces,  filled  by  clear  drops  of  fluid, 
embedded  in  an  otherwise  continuous  and  homogeneous 
protoplasm. 

To  take,  now,  the  second  example,  that  of  the  cartilage¬ 
cell.  This,  which  in  the  hardened  tissue  shows  a  fine  net¬ 
work  in  its  protoplasm  (Frommann),  has  been  carefully 
observed  in  the  living  state  by  Flemming,  with  special 
reference  to  this  very  question  (of  the  pre-existence  of 
the  intracellular  network).  Hear,  therefore,  what  Flemming 
has  to  tell  us  regarding  the  appearance  of  the  living 
cartilage-cell — his  object  the  gill-lamina  of  the  salamander 
tadpole,  his  objective  the  one-eighteenth  oil-immersion 
of  Zeiss,  the  observer  himself  conspicuous  for  his  keen¬ 
ness  of  observation ;  witness  the  result  of  his  work  on  the- 
division  of  nuclei.  This  is  what  he  says  regarding  it  (“  Zell- 
substanz,”  page  22,  1882)  :  “That  the  filaments  can  be  seen 
to  be  united  together  into  a  network,  so  that  there  is  a  real 
connexion  of  the  filaments  with  the  peripheral  part  of  the- 
nucleus  ....  I  am  compelled,  in  spite  of  Frommann’s 
positive  assertions  to  the  contrary,  to  deny.”  The  filaments 
here  spoken  of  are  peculiar  convoluted  threads  of  variable 
length,  which,  as  well  as  fatty  and  other  granules,  can  be- 
seen  suspended  in  the  otherwise  clear  substance  of  the  cell. 
Their  nature  will  be  referred  to  later. 

Lastly,  let  us  go  to  the  glandular  epithelium -cell.  Exa¬ 
mined  in  the  resting  (fasting)  condition,  and  with  a  good 
objective,  nothing  can  be  more  distinct  than  the  reticular 
structure  of  the  epithelium-cells  of  the  parotid  in  sections 
of  the  hardened  tissue.  A  fine  close  and  uniform  network 
with  clear  interstices— this  is  the  apparent  structure  of  the 
protoplasm.  But  turn  to  the  living  cell.  Langley  has  shown 
us  how,  in  the  thin  outlying  parts  of  the  gland  in  the  rabbit,, 
we  may  examine  the  cells,  the  blood  still  circulating  in  the 
vessels  of  the  acinus,  the  normal  conditions  almost  perfectly 
preserved.  And  what  is  here  to  be  seen  ?  Each  cell  packed 
full  of  granules,  distinct  strongly  refracting  granules,  em¬ 
bedded  in  clear  protoplasm — distinct  granules,  certainly  not 
merely  nodes  of  a  network.  Crush  a  cell  in  serum,  and 
observe  the  granules  set  free.  And  yet,  in  the  cell  hardened 
in  alcohol  or  chromic  acid,  no  sign  of  granules,  their  places 
taken  by  clear  spaces,  the  protoplasm  between  them  and 
enclosing  them  in  the  form  of  a  fine  network,  (d) 

But,  it  may  be  asked,  may  not  this  protoplasm,  itself  be¬ 
tween  the  vacuoles  in  the  case  of  the  pale  blood-corpuscle,, 
and  between  the  granules  in  the  case  of  the  epithelium-cell, 
possess  a  yet  fine  reticular  structure  ?  Such  a  possibility 
cannot  be  denied.  Theoretically,  it  may  even  be  probable 
all  that  can  be  said  is,  that  in  the  living  condition  no  such 
structure  is  visible. 


that  this  coagulation  is  not  accompanied  by  the  formation  of  fibrils  like 
those  which  are  exuded  from  blood-plasma  in  the  form  of  fibrin,  so  that, 
even  if  we  are  able  to  observe  such  fibrils,  without  the  action  of  reagents,, 
in  a  cell,  the  protoplasm  of  which  is  already  coagulated,  it  does  not  follow 
that  they  are  also  present  in  the  living  condition. 

(d)  Cdmpare  Flemming  (“  Zell-suhstanz,”  etc.,  page  42) .  Flemming  has- 
gone  wrong  in  this  instance,  in  consequence  of  relying  solely  on  hardened) 
preparations. 


Medical  Times  and  Gazette. 


SCHAFER  on  the  structure  of  the  animal  cell. 


August  25,  1S83.  207 


It  is,  however,  to  be  distinctly  understood  that  although 
ithis  must  be  stated  regarding  the  structure  of  the  proto¬ 
plasm  of  animal  cells  in  general,  and  although  doubt  still 
rests  on  the  existence  of  a  constant  and  definite  structure  in 
;all  protoplasm  indiscriminately,  this  doubt  is  by  no  means 
to  be  extended  to  individual  cases.  In  cells  which  have  be- 
•come  highly  specialised  as  to  function  there  is  every  proba¬ 
bility  that  some  specialisation  of  structure  will  ere  long 
^become  manifest.  And  such  we  accordingly  find.  Without 
unnecessarily  multiplying  examples,  I  may  instance  the 
fibrillation  of  muscular  fibres,  both  voluntary  and  involun¬ 
tary,  the  fibrillation  of  nerve-cells  and  fibres,  that  of  many 
•ciliated  cells,  of  some  secreting  cells,  and  even  the  convoluted 
filaments  in  the  cartilage-cell  already  referred  to.  Of  the  j 
pre-existence  of  these  structures  there  is  no  reasonable 
•doubt,  but  they  are  not  of  general  occurrence,  and  it  is 
neither  possible  nor  permissible  to  infer  from  them  a  definite 
and  uniform  structure  for  all  protoplasm. 

The  structure  of  the  nucleus  has  been  no  less  an  object  of 
recent  investigation  than  that  of  the  rest  of  the  cell,  but 
there  is  a  much  greater  agreement  amongst  histologists 
with  regard  to  it ;  and  its  consideration  need  not  detain  us 
so  long  as  that  of  the  cell-protoplasm.  The  original  idea  of 
the  nucleus  was  a  spherical  vesicle,  bounded  by  a  definite 
membrane.  The  membrane  encloses  a  fluid,  and  separates 
this  nuclear  fluid  from  the  fluid  contents  of  the  cell,  (e)  In 
the  nucleus  fluid  there  are  discovered  one  or  more  round 
solid  particles — nucleoli.  Therefore  a  cell  consists  of  a 
nuclelus  in  the  centre,  outside  this  a  membrane  forming 
and  enclosing  the  nucleus,  outside  this  another  membrane 
enclosing  the  cell-contents  and  forming  the  cell. 

The  original  idea  of  the  structure  of  the  nucleus  persists 
long  after  the  original  idea  of  the  structure  of  the  cell  has 
been  superseded.  The  nucleus  of  the  protoplasmic  cell  of 
Max  Sehultze  is  practically  identical  with  the  nucleus  of  the 
•vesicular  cell  of  Schwann.  If  anything,  the  importance 
■of  the  nucleus  has  receded.  The  original  nucleus  could 
exert  an  action  upon  the  cell-contents.  Now  it  is  doubtful 
whether  the  changes  which  the  nucleus  can  be  observed 
to  undergo  may  not  really  be  passive,  may  not  really  be 
.produced  by  the  amoeboid  activity  of  the  cell-protoplasm. 
It  is  only  quite  lately  that  the  nucleus  has  reassumed 
its  pristine  importance ;  that  the  independence  of  its 
•changes  has  been  recognised,  can  in  fact  not  fail  to 
be  acknowledged.  Its  function  is  unquestionable  ;  it 
initiates,  presides  over,  the  reproduction  of  the  cell ;  in 
some  cases  is  concerned  in  promoting  its  rejuvenescence. 
We  are  no  longer  content  to  accept  as  the  typical  structure 
•of  the  nucleus  of  a  living  active  cell  an  inert  vesicle,  en¬ 
closing  a  fluid  and  one  or  more  solid  particles.  We  can 
recognise  in  nearly  all  cases  a  further  structure — a  network, 
•coarser  or  finer,  open  or  close,  of  threads  which  pervade  the 
nucleus,  and  unite  the  nucleoli  to  the  enclosing  membrane. 
There  is  no  doubt  as  to  the  existence  of  this  intranuclear 
cell.  It  is  even  more  constant  than  the  nucleoli,  for  the 
latter  may  not  always  be  visible;  the  network  of  filaments 
•is  seldom  absent.  First  noticed  in  certain  specialised  cells, 
and  judged  peculiar  to  them,  it  is  now  recognised  in  cells  of 
•every  kind,  ova,  nerve-cells,  muscular  cells,  epithelium-cells, 
colourless  blood- corpuscles,  coloured  blood-corpuscles  of 
ovipara.  As  in  so  many  other  instances,  one  is  astonished 
that  so  obvious  a  structure  should  have  remained  so  long 
•obscure. 

With  this  network  the  nucleoli  are  connected ;  indeed, 
many  particles  which  were  before  described  as  nucleoli  are 
now  only  recognised  as  thickenings  of  the  network.  The 
network  is  not  inert ;  it  alters  from  time  to  time,  as  do  also 
the  nucleoli ;  it  is  probably  contractile  :  certainly  changes 
•  of  shape  may  sometimes  be  observed  in  the  nucleus,  both 
within  the  cell  and  when  escaped  from  the  ruptured  cell. 
In  division,  moreover,  the  filaments  and  the  whole  sub¬ 
stance  of  the  nucleus  undergo  changes  as  rapid  as  remark¬ 
able.  Altogether,  it  is  clear  that  the  nucleus  is  capable  of 
a  large  amount  of  independent  vital  activity.  What  more 
natural,  then,  than  to  regard  it  as  consisting  of  protoplasm 
in  no  essential  point  differing  from  the  rest  of  the  proto¬ 
plasm  of  the  cell  ?  This  view  (indicated  first  by  Beale, 
who  included  the  nucleus  and  protoplasm  of  the  cell  to¬ 
gether  under  the  term  "formative  matter”)  has,  in  fact, 
•been  adopted  by  Frommann,  Heitzmann,  Klein,  and  Strieker 

(e)  Some  of  the  older  histologists  regarded  the  nucleus  as  solid  and 
ihomogeneous. 


— histologists  who  wrere  among  the  first  to  pave  the  way  for 
the  general  recognition  of  the  reticular  structure  of  the 
nucleus.  They  bring  the  nucleus  into  absolute  continuity 
with  the  protoplasm,  its  filaments  prolonged  into  those  of 
the  protoplasm,  its  membrane  little  but  a  closer  interlace¬ 
ment  of  the  same  filaments,  the  nucleoli  only  thickenings 
of  the  filaments.  Throughout  the  whole  cell-nucleus  and 
cell-protoplasm  is  a  continuous  network  of  protoplasm. 
Apart  altogether,  however,  from  the  reasonable  doubt  of  the 
pre-existence  of  fibres  in  all  cell-protoplasm,  this  conclu¬ 
sion  is  one  which,  in  the  face  of  the  striking  contrast  of 
chemical  nature  (as  shown  by  their  behaviour  to  reagents 
and  staining  fluids)  between  nucleus  and  protoplasm,  can 
in  no  way  be  upheld.(f) 

Putting  aside,  then,  this  continuity  with  the  cell-proto- 
plasm,  it  is  admitted  that  the  typical  nucleus  is  composed 
of  the  following  parts  : — (1)  A  nuclear  membrane  bounding 
it  externally ;  (2)  a  network  of  fibres ;  (3)  a  nucleolus  or 
nucleoli;  (4)  a  clear  substance  filling  the  nucleus  in  the 
meshes  of  the  network  of  fibres.  1,  2,  and  3  agree,  on  the 
whole,  chemically  with  one  another,  although  optically  they 
present  differences  ;  they  differ  entirely,  both  optically  and 
chemically,  from  4 ;  they  appear  to  be  more  solid,  4  more 
fluid ;  they  are,  therefore,  grouped  together  under  the  name 
nucleoplasm,  or  karyoplasm,  whilst  the  clear  substance  is 
termed  the  nuclear  juice,  or  matrix.  When  a  nucleus 
divides,  all  its  karyoplasmic  parts  blend ;  the  distinction 
between  them  is  lost ;  they  are  transformed  into  a  system 
of  contorted  fibres,  embedded  in  clear  matrix.  These  fibres 
undergo  remarkable  changes,  apparently  spontaneous,  which 
result  in  their  separation  into  two  groups,  and  the  reforma¬ 
tion  of  the  structure  of  a  typical  resting  nucleus  from  each 
group.  Into  the  details  of  these  remarkable  changes  I  do 
not  propose  here  to  enter  ;  I  refer  to  their  occurrence  only 
as  showing  the  individuality,  the  independence  of  the 
nucleus.  When  we  believed  that  a  nucleus  divided  simply 
by  undergoing  a  process  of  constriction  into  two,  it  was 
conceivable  that  the  constriction  might  be  produced,  not  by 
any  exercise  of  spontaneity  on  the  part  of  the  nucleus,  but 
by  the  presence  of  the  surrounding  protoplasm.  Such  a 
notion  is  no  longer  tenable ;  the  nucleus  possesses  an  inde¬ 
pendent  activity,  as  well  marked  as  that  of  the  protoplasm 
itself. 

It  seems  probable  that  we  are  on  the  eve  of  yet  further 
discoveries  with  regard  to  the  structure  of  the  nucleus.  It 
has,  indeed,  been  shown  by  Balbiani  that,  in  certain  cells  of 
chironomus  larvae,  the  nuclear  filaments  are  transversely 
marked  at  short  and  regular  intervals,  as  if  made  up  of  a 
succession  of  particles  cohering  together  in  series.  And  it 
may  well  happen  that  this  proves  a  general  feature  in  the 
structure  of  nucleoplasm,  and  that  the  changes  which  occur 
in  division  may  be  ultimately  referred  to  re-arrangements  of 
their  constituent  particles.  It  is  even  conceivable  that  we 
may  some  day  gain  an  insight  into  the  nature  and  mode  of 
action  of  the  forces  which  cause  such  re  arrangement,  and 
even  discover  means  to  modify  or  restrain  their  action.  No 
doubt,  the  idea  is  yet  chimerical,  but  it  is  almost  justified 
by  the  prodigious  advantages  which  have  of  late  been  made 
in  our  knowledge  of  the  structure  and  changes  of  the  cell- 
nucleus. 

It  would  appear,  then,  that  the  nucleus  of  the  cell  is  not 
the  structureless  body  which  we,  at  one  time,  thought  it ;  on 
the  contrary,  it  has  a  manifest  and  complicated  structure, 
which  has  not  even  yet  been  fully  unravelled,  and,  in  the 
performance  of  its  function,  it  exhibits  changes  of  structure 
which,  until  lately,  had  remained  entirely  unsuspected.  Re¬ 
garding  the  body  of  the  cells,  we  must  be  less  positive ;  that, 
in  special  cases,  it  is  differentiated,  is  undoubted  ;  that,  in  all 
cases,  it  is  reticular,  is  not  proved,  although  theoretical 
considerations  render  such  a  structure  not  improbable. 

I  think  we  should  be  cautious  of  accepting  conclusions 
which,  however  much  supported  by  theory,  do  not  rest  on 
the  basis  of  incontrovertible  facts.  Some  histologists  and 

(f)  There  is  not  even  a  probability  that  nuclei  can  be  formed,  de  novo, 
out  of  protoplasm,  or  from  anything  but  a  pre-existing  nucleus.  The 
doctrine  of  free  cell-formation,  which  originated  in  the  days  of  Schleiden 
and  Schwann,  and  which  supposed  the  deposition  of  nuclei  in  a  homo¬ 
geneous  blastema,  and  the  formation  of  cell- substance  around  them,  has 
long  been  given  up  as  a  general  principle,  although  the  new  formation  of 
nuclei,  independently  of  pre-existing  nuclei,  has  long  lingered.  It  would 
seem,  however,  that  it  must  now  definitely  be  surrendered.  All  recent 
researches  on  cell-formation  and  multiplication  point  to  the  fact  that  the 
dictum  of  Virchow  with  regard  to  the  cell  must  be  extended  to  the 
nucleus  :  Omnia  nucleus  a  nucleo. 


208 


Medical  Times  and  Gazette. 


CHEVERS  ON  THE  ORDINARY  DISEASES  OF  INDIA. 


August  25,  1833. 


pathologists  would  carry  the  reticular  theory  farther  even 
than  the  limits  of  the  cell.  Continuing  the  protoplasmic 
network  into  the  intercellular  substance,  they  pervade  all 
parts  with  it,  binding  together  the  separate  cells  of  the 
organisms  with  a  web,  whose  closely  linked  threads  are  finer 
than  the  finest  gossamer,  conveying  the  marvellous  properties 
of  protoplasm — its  formative  power,  its  chemical  activities  — 
to  the  most  remote  recesses  of  the  organism.  Inspired  with 
enthusiasm  for  a  new  theory,  they  do  not  hesitate  to  cany 
it  beyond  the  point  which  properly  observed  facts  justify. 
We  ourselves  should  have  a  care,  lest,  enticed  by  the  facility 
with  which  certain  phenomena  seem  to  be  explained,  we 
follow  too  far  along  paths  which  lead  away  from  the  track  of 
conscientious  observation  and  just  surmise. 


PRACTICAL  NOTES  ON 

THE  ORDINARY  DISEAS'ES  OF  INDIA, 

ESPECIALLY  THOSE  PREVALENT  IN  BENGAL. 

By  NORMAN  CHEVERS,  C.IE,  M.D., 

Late  Senior  Physician  and  Professor  of  Medicine,  Medical  College 
and  Hospital,  Calcutta. 

( Continued  from  page  154.) 

CHOLERA  ASIATICA  MALIGNA. (a) 

The  Cholera  of  Lower  Bengal,  of  which  I  had  more  than 
twenty-seven  years’  experience,  has  been  so  fully  and  faith¬ 
fully  represented  in  works  of  great  labour  and  research  by 
several  contemporaries  of  my  own,  that  I  shall  not  offer  a 
description  of  its  general  characters  which  will  be  found 
amply  detailed  in  the  valuable  monographs  of  John 
Macpherson  (“Cholera  in  its  Home,”  and  “ Annals  of 
Cholera”),  of  Edward  Goodeve  (Art.  “Cholera”  in  Reynolds’s 
“  System  of  Medicine  ”),  and  Charles  Macnamara.  I  shalL 
therefore,  only  submit  to  my  readers  notes  upon  very  impor¬ 
tant  points  which  have  received  my  special  attention. 

Cholera  a  Pernicious  Fever. 

A  great  body  of  well-ascertained  facts  supports  the 
position  taken  up  by  the  College  of  Physicians,  in  their 
Nomenclature  of  Diseases,  that  Cholera  is  a  Pernicious 
Fever.  Many  Indian  observers  have  maintained  this  view, 
and  careful  study  of  disease  in  India  goes  far  to  confirm  it. 
I  have  here  placed  before  myself  the  duty  of  stating  facts, 
not  of  forming  theories,  or  of  discussing  the  theories  of 
others,  except  by  showing  how  far  well-ascertained  facts 
uphold  or  are  opposed  to  them.  I  do  not  consider  that 
the  present  state  of  our  knowledge  permits  others  or  myself 
to  write  dogmatically  upon  the  perplexed  question  of  the 
Cause  of  Cholera,  but  I  am  strongly  led,  by  observation  and 
reading,  to  side  with  the  maintainers  of  the  Fever  doctrine. 

In  previous  chapters  I  have  described  several  forms  of 
Pernicious  Fever,  which  certainly  have  the  appearance  of 
forming  a  continuous  chain  of  clear,  intermediate  etiological 
links  between  the  Malarious  Remittent  of  India  and  Asiatic 
Cholera.  I  will  beg  the  reader  to  place  the  volumes  ( Medical 
Times  and  Gazette,  vol.  ii.  for  1882  and  vol.  i.  for  1883) 
before  him,  and  to  look  back  to  these  cases  and  observations 
as  I  shall  now  refer  to  them. 

1.  To  me  it  appears  that  Allan  Webb’s  cases  of  so-called 
“  Hill  Colic”  (page  406,  vol.  i.  for  1883),  and  my  case  of  the 
Mohammedan  in  the  following  page,  may  be  taken  as  form¬ 
ing  the  first  links  in  this  connective  chain.  Here  we  have 
the  strongest  expression  of  Algide  Pernicious  Fever,  with 
intestinal  lesion,  but  without  Cholera  stools  ;  rapid  death 
by  nervous  shock  and  blood-poisoning,  with  collapse  as  its 
main  characteristic, — vitality  failing  almost  suddenly  under 
an  overwhelming  dose  of  a  strong  poison. 

2.  Next  in  order  we  have  cases  of  well-marked  and  fully 
developed  Remittent  Fever,  by  no  means  rare  in  India, 
represented  by  Dr.  Sutherland’s  case  (vol.  ii.  for  1882,  page 

(a)  In  commencing  the  publication  of  these  Notes,  I  said  that  it  was 
my  intention  to  arrange  them  “  in  accordance  with  the  Nomenclature  of 
Diseases  promulgated  by  the  College  of  Physicians.”  Until  now,  this 
order  of  sequence  has  been  strictly  adhered  to ;  but,  seeing  that  at  present 
the  attention  of  the  profession  is  specially  directed  to  Cholera,  it  appears 
right  that  my  observations  upon  this  disease  should  appear  at  once,  the 
notes  upon  Malarious  Cachexia  being  resumed  hereafter. 


689),  and  by  Mr.  Raleigh’s  cases  (vol.  i.  for  1883,  page  266), 
taking  on  the  diaphoretic  algide  form — collapse  threatening 
death,  with  sweating,  but  without  vomiting  and  purging,  at 
the  end  of  a  regular  paroxysm  of  fever. 

3.  The  next  link  is  formed  by  so-called  cases  of  “  Haemor¬ 
rhagic  Dysentery  ”  (which,  however,  display  no  character  of 
true  dysentery),  not  infrequent  in  India,  where  paludal 
fever  displays  the-  pernicious  character  by  an  enormous, 
flow  of  disintegrated  blood  from  the  bowels  with  collapse 
( vide  Mr.  Hare’s  case,  vol.  i.  for  1883,  page  407). 

4.  Then  come  cases,  undoubtedly  of  fever,  with  heat  of' 
skin,  with  or  without  vomiting,  and  with  copious  discharges' 
of  thin  sanguinolent  fluid,  such  as  the  following,  by  Baboo 
Odoy  Chand  Dutt:(b) — A  native  prisoner,  aged  twenty,, 
was  admitted  with  Intermittent  Fever,  not  apparently 
very  severe,  of  six  days’  standing.  The  next  day  it  was  re¬ 
ported  that  he  had  fever  throughout  the  preceding  day  and 
night,  which  remitted.  On  the  third  day  there  was  the  same 
report.  At  4  p.m.  he  had  three  copious  watery  stools  of  a, 
bright  red  colour,  very  thin,  without  large  coagula.  He 
became  pulseless  and  collapsed,  and  died  in  an  hour.  The 
peritoneum  and  large  intestines  generally  were  congested.. 
About  a  pint  of  reddish  serum  was  effused  into  the  ab¬ 
dominal  cavity.  Caecum  congested,  thickened,  and  covered 
with  red  patches.  Large  intestines  filled  with  a  dark-yellow- 
fluid. 

Six  months  later,  a  prisoner,  aged  thirty,  complained  of' 
fever  for  two  days,  for  which  he  only  sought  admission  to* 
hospital  on  the  third  day.  He  had  vomiting  and  purging 
that  morning.  In  the  afternoon  he  had  two  copious  watery 
stools  of  a  deep  dark-red  colour,  with  flocculent  yellowish- 
deposits,  and  vomited  thrice — bile  and  mucus.  He  was  found 
with  sunken  eyes  and  very  feeble  pulse,  abdomen  sunken  and 
free  from  tenderness,  very  restless.  He  had  one  scanty 
stool  at  night  of  a  deep  red  colour.  On  the  following  morn¬ 
ing  collapse  had  passed  away,  but  there  was  sickness  and 
retching.  He  had  strong  fever  at  noon,  which  left  him  in 
the  evening  with  a  weak  pulse.  On  the  next  day  he  had 
fever  with  sickness  from  noon  till  4  p.m.,  less  strong  than 
on  the  preceding  day.  Quinine  had  begun  to  tell.  On  the- 
following  day  he  felt  pretty  well,  but  very  weak.  He  had 
no  further  bad  symptoms. 

5.  I  twice  saw,  in  Bengal,  an  outbreak  of  a  disease  which 
wanted  none  of  the  usual  characteristic  symptoms  of  true 
Asiatic  Cholera,  except  that  the  rice-water  stools  were  blood- 
tinged.  [In  another  similar  outbreak  I  would  recommend 
careful  thermo  metrical  observations.] 

In  the  museum  at  Haslar  Hospital  there  used  to  be  a 
dried  preparation  of  the  lower  part  of  the  ileum  taken  from 
a  patient  who  died  in  the  first  Epidemic  outbreak  of  Asiatic 
Cholera  in  England  in  1832.  For  about  a  foot  above  the 
csecum  it  was  of  a  deep  mulberry-red  colour. 

In  the  only  outbreak  of  truly  Epidemic  Cholera  that  I 
chanced  to  see  in  Bengal,  in  1849,  I  found,  in  all  of  my 
numerous  fatal  cases,  intense  redness  of  the  lower  part  of  the 
small  intestine  (over  which  there  was  great  tenderness  during: 
life) .  The  stools  were  rice-water-like  without  the  slightest, 
tinge  of  blood.  This  was  accounted  for  by  the  presence  of 
a  condition  which  I  have  never  again  met  with  in  cholera. 
The  congested  mucous  membrane  was  evenly  coated  by  a 
strongly  adherent,  croupous-like,  white  exudation,  nearly  as-- 
thick  as  the  intestine  itself.  From  the  inner  surface  of  this, 
thin  white  processes  floated  convergently  towards  the  axis- 
of  the  canal  into  shreddy  rice-water  fluid.  Clearly,  all 
passage  through  the  inflamed  gut  had  ceased  some  time 
before  death.  Mentioning  this  to  the  intelligent  Madras 
Dresser  who  assisted  me  in  my  military  hospital,  I  was  told 
that  the  regiment  had  suffered  from  such  a  type  of  Cholera 
in  Madras  some  years  previously ;  and  he  showed  me,  in 
some  of  the  older  men,  huge  cicatrices  in  the  right  iliac 
fossa,  evidently  caused  by  some  powerful  escharotic.  I 
counter-irritated  so  decidedly  in  the  case  of  our  Chaplain 
that,  for  years  afterwards,  he  struck  his  side  whenever  we 
met.(c) 

6.  At  vol.  i.  for  1883,  page  407,  I  have  given  cases  by  Dr 

(b)  Indian  Medical  Gazette ,  February,  1869. 

(e)  Although  he  does  not  describe  this  type  of  Cholera,  Annesley  ref ers  to 
this  mode  of  treatment  (“  Sketches,”  1 829,  page  157):  “A nitric  acid  blister 
has  been  strongly  recommended,  and  I  have  given  it  a  full  trial,”  .  .  .  *‘it 
always  made  an  eschar.”  “  Scalding  water  has  been  recommended  as  a 
blister.”  As  in  Cholera  the  gravest  incidence  of  disease  is  always  upon 
the  lower  part  of  the  ileum,  I  think  that  we  should  never  fail  to  apply 
strong  counter-irritation  over  the  right  iliac  fossa.  I  always  did  so. 


Meilcal  Times  and  Gazette. 


CHEVERS  ON  THE  ORDINARY  DISEASES  OF  INDIA. 


August  25,  1883.  2  09 


Geddes  and  myself,  which  might  be  regarded  as  examples 
of  true  Cholera,  save  that  rice-water  stools  occurred  in  the 
course  of  Fever. 

Under  this  head  we  must  class  a  type  of  Fever  (some  con¬ 
sidered  it  to  be  true  Cholera — which  it  assuredly  was  not) 
described  by  Dr.  Murray  in  1840(d)  as  the  “  Malwa  Sweat¬ 
ing  Sickness.”  The  attack  commenced  with  rigors  or  chilli¬ 
ness,  followed  by  dull  headache,  increased  heat  of  skin,  and 
dilated  pupils,  a  burning  sensation  at  the  epigastrium,  with 
restlessness  and  thirst,  and  generally  copious  watery  motions 
smelling  like  the  flesh  of  carnivorous  animals  slightly  tainted. 
In  many  cases  there  was  vomiting  of  a  similar  fluid,  with 
cramps  in  the  extremities  ;  and  the  skin  soon  became  bathed 
in  perspiration.  There  was  great  oppression  in  breathing, 
with  anxiety  and  praecordial  uneasiness  and  weak  rapid  pulse. 
At  the  commencement,  there  was  prostration  of  strength, 
with  a  feeling  of  exhaustion  ;  and  afterwards  there  was  real 
debility,  sometimes  extending  long  into  convalescence.  In 
the  severest  forms  of  the  disease,  all  bodily  uneasiness  soon 
ceased,  except  that  arising  from  the  thirst  and  the  pectoral 
oppression  ;  the  perspiration  continued  excessive  and  became 
cold.  The  mental  faculties  remained  clear  till  towards  the 
end,  when,  coma  gradually  intervening,  death  sometimes 
ensued  within  ten  hours  of  the  commencement  of  the  attack. 
Vomiting  and  cramps  were  neither  constant  nor  prominent 
symptoms ;  but,  in  the  severe  cases,  no  urine  was  passed, 
nor  was  there  any  bile  in  the  evacuations  till  reaction 
ensued. 

When  the  disease  took  a  more  favourable  turn,  the  pulse 
became  more  full  and  the  praecordial  oppression  diminished  ; 
some  dark  green  f esculent  matter  was  passed  by  stool,  a 
little  urine  was  secreted,  and  the  patient  slept.  If  the  case 
did  not  proceed  at  once  to  convalescence,  the  pulse  did  not 
become  natural,  the  pupils  remained  sluggish,  there  was 
anxiety,  and  the  skin  continued  muddy  and  strongly 
perspiring. 

After  a  remission  of  twenty-four  or  forty-eight  hours, 
sometimes  anticipating  by  two  hours,  the  same  train  of 
symptoms  was  apt  to  be  renewed.  The  skin  became  dry  at 
first,  and  sometimes  hot ;  the  burning  sensation  in  the 
epigastrium  recurred,  followed  by  two  or  three  watery 
nauseous  stools,  and  great  exhaustion  of  strength  ;  and, 
although  the  skin  became  cold,  the  perspiration  increased. 
There  was  occasionally  wandering  of  the  mind,  but  extreme 
collapse,  with  a  state  approaching  coma,  was  more  common  ; 
and  these  increased  after  each  periodic  exacerbation  or 
paroxysm  if  "the  case  was  proceeding  unfavourably.  There 
were  never  any  cramps  after  the  first  attack,  and  vomiting 
was  also  less  frequent.  The  appearance  of  the  stools  was 
brown,  green,  or  yellowish — the  latter  being  most  favourable. 

As  the  disease  went  on,  remission  succeeded  the  paroxysms 
with  a  regular  periodicity.  When  the  patient  was  to  recover, 
the  attacks  became  more  slight,  and  sometimes  convalescence 
was  rapid,  without  leaving  any  organic  derangement ;  but, 
when  the  disease  was  of  a  dangerous  character,  the  collapsed 
and  comatose  states  were  more  prolonged  after  each  exa¬ 
cerbation,  and  sometimes  the  patient  never  rallied  after 
they  came  on.  One  patient  remained  three  days  in  a  state 
of  coma,  yet  ultimately  recovered ;  in  one  case  convulsion 
preceded  it,  and  in  two  others  it  came  on  after  very  acute 
pain  in  the  region  of  the  kidneys,  which  appeared  to  be 
spasmodic,  as  it  subsided  suddenly.  In  several  cases  un¬ 
easiness  was  complained  of  about  the  heart,  and  continued 
for  some  time  after  convalescence  was  established.  Dr. 
Murray  was  strongly  inclined  to  think  that  this  was  caused 
by  the  formation  of  coagula  in  some  of  the  heart’s  cavities. 

In  commenting  on  the  above  report.  Dr.  Corbyn  wrote 
very  curtly,  that  this  disease,  “of  a  periodic  remittent 
character,  attended  with  a  peculiar  foetid  perspiration  con¬ 
nected  with  a  depraved  condition  of  the  blood,  is  nothing 
more  than  a  modified  form  of  Cholera  which  has  occurred  in 
various  situations  in  India,  but  especially  at  the  Presidency  ” 
(Calcutta).  This  disease  (which  Dr.  Murray,  Senior,  desig¬ 
nated  “  Febris  Remittens  Choleroidea  ”)  has,  however,  shown 
itself  repeatedly  elsewhere,  and  has  been  generally  recog¬ 
nised  by  those  who  witnessed  its  ravages  as  a  Pernicious 
type  of  Remittent  Fever. 

In  the  following  example,  this  fever  appeared  during  the 
prevalence  of  Cholera  in  the  regiment,  and  may  almost  be 
regarded  as  a  hybrid  of  this ‘disease.  This  history  is  one 


of  singular  interest  as  showing  the  close  relationship  which 
exists  between  Pernicious  Remittent  and  Cholera. 

In  November,  1840  (nearly  contemporaneously  with  the 
appearance  of  the  “  Sweating  Sickness  ”  at  Malwa),  a  wing 
of  H.M.’s  4th  Regiment  were  in  camp.  Cholera  having 
prevailed  at  headquarters,  near  Bellary,  an  inland  station 
centrally  placed  between  Madras  and  Bombay.  Drunken¬ 
ness  was  prevalent,  and  the  men  were  exposed  to  the  sun 
and  to  the  chilly  nights  without  adequate  clothing. 
Throughout  the  preceding  month  there  had  prevailed  an 
aggravated  form  of  Remittent  Fever  “  of  a  highly  sthenie 
character,  presenting  many  of  the  features  of  the  Ardent 
Remittent  of  the  West  Indies.”  The  fever  now,  however, 
became  congestive,  manifesting  a  strong  tendency  to  ter¬ 
minate  either  in  sudden  cerebral  effusion  or  in  prostration 
and  collapse.  Mr.  W.  Parry  says  that,  in  most  instances, 
it  was  ushered  in  by  dull  pain  in  the  head,  giddiness,  nausea, 
oppression  at  the  praecordia,  thirst,  restlessness,  and  a  feeling 
of  extreme  exhaustion ;  the  countenance  was  either  dull  and 
heavy,  or  anxious.  There  was  seldom  much  febrile  reaction, 
and  the  pulse  was  mostly  very  weak  and  small.  Death  was 
ushered  in  by  sudden  prostration  and  collapse,  sudden 
sharpening  of  the  features,  and  a  severe,  but  undefinable, 
sense  of  uneasiness  and  suffering  at  the  praecordia,  attended 
by  frequent  sighing  and  extreme  jactitation.  Soon  after 
this,  two  or  three  watery  evacuations  were  passed  in  rapid 
succession,  and  these  were  instantly  followed  by  extreme 
collapse.  The  body  became  all  at  once  deadly  cold  and 
covered  with  a  clammy,  unhealthy  sweat.  Pulse  almost 
imperceptible.  Drowsiness  supervened,  and  soon  terminated 
in  fatal  coma.  The  above  was  the  type  assumed  by  the 
disease  in  wrorn-out  and  intemperate  men.  In  more  youthful 
and  unbroken  constitutions,  and  indeed  in  the  more  ordinary 
type  of  this  fever,  there  was  generally  much  greater  febrile 
and  vascular  development,  and  a  greater  tendency  to  assume 
a  very  irregular  periodic  type,  most  frequently  an  irregular 
quotidian  or  double  tertian.  In  two  men,  after  what  appeared 
to  be  a  complete  intermission  for  two  days,  the  paroxysm 
commenced  with  severe  convulsion — in  one,  ending  in  para¬ 
lysis  and  coma,  fatal  the  next  day  ;  in  the  other,  merging 
in  long-continued  stupor,  which  passed  off  by  very  slow 
degrees.  In  other  cases,  in  which  the  disease  had  observed 
considerable  regularity  for  three  or  four  days,  instead  of 
a  recurrence  of  the  regular  paroxysm  at  the  anticipated 
hour,  there  was  sudden  collapse,  the  body  became  cold  and 
covered  with  clammy,  unhealthy  sweat,  the  limbs  and 
countenance  purple,  and  the  circulation  nearly  arrested. 
This  profound  collapse  occurred  in  one  individual  at  nearly 
the  same  hour  for  three  successive  days,  after  which  he 
gradually  recovered. (e) 

At  page  266,  vol.  i.  for  1883,  I  have  cited  the  description 
of  the  leading  features  of  an  outbreak  of  Pernicious  Remit¬ 
tent,  which  occurred  in  H.M.  6th  Foot,  stationed  at  Deesa, 
Bombay  Presidency,  in  September  and  October,  1835.  In 
many  of  these  cases  there  was  deadly  collapse. 

“  With  this  sudden  sinking  there  sometimes  existed  in¬ 
ternal  heat  and  thirst.  The  extremities  were  often  deadly 
cold,  while  the  trunk  was  warm.”  In  some  cases  there  were 
“  evening  exacerbations,  somnolency,  immobility  of  pupils, 
or  bilious  vomiting  and  watery  purging  two  or  three  days 
before  death.”  “In  other  cases,  of  considerable  severity  at 
first,  there  were  nocturnal  perspirations  so  profuse  as  to 
drench  the  bedding.”  Dr.  R.  Brown  also  described  this  out¬ 
break  as  it  occurred,  at  the  same  time,  at  Deesa  in  his  troop 
of  Horse  Artillery.  His  description  of  the  disease  fully 
agrees  with  that  by  Dr.  Jackson,  of  the  6th  Foot,  which 
I  have  cited.  After  two  or  three  days  of  suffering  from 
a  sense  of  extreme  exhaustion,  there  would  be  a  few  rigors, 
with  shrunken  features,  oppressive  headache,  epigastric 
weight  and  tenderness,  with  much  nausea  and  ineffec¬ 
tual  retching,  followed  by  some  reaction,  raised  tempera¬ 
ture,  acute  headache  with  occasional  delirium,  bowels  gene¬ 
rally  torpid,  nausea  constant,  retching  distressing,  some¬ 
times  followed  by  vomiting  of  dark-coloured  fluid.  This 
stage  was  very  uncertain  in  duration,  sometimes  partially 
remilting  and  again  returning.  At  length  perspiration 
would  break  out,  happily  sometimes  warm  and  general, 
bringing  relief  of  all  the  symptoms  for  a  time :  sometimes, 
not  unfrequently,  partial,  cold  and  clammy,  without  relief 
of  symptoms,  with  continued  irritability  of  stomach;  feeble, 


(d)  Madras  Quar.  Med.  Jour.,  vol.  ii.,  page  77 ;  and  vol.  iii.,  page  807. 


(<)  bid.  Jour,  of  Med.  and  Phys.  Science  for  1812,  ;  age  389. 


210 


Medical  Times  and  Gazette. 


RICHARDSON  ON  THE  TREATMENT  OF  CHOLERA. 


August  25,  1883. 


quick,  compressible  pulse ;  great  depression  of  spirits  ;  occa¬ 
sionally  involuntary  passing  of  watery  stools  ;  urine  scanty, 
dysuria.  In  many  cases  this  condition,  which  seemed  almost 
to  amount  to  irretrievable  collapse,  continued  for  a  long 
time,  and  would  be  succeeded  by  a  reaction,  generally  less 
strong  than  the  previous  one,  but  marked  with  symptoms 
of  congestion  of  livei’,  spleen,  or  brain ;  and  this  process 
would  be  again  gone  through  until  the  disease  was  subdued. 

7.  Last  in  this  progressive  series,  which  has  not,  I  believe, 
been  thus  fully  traced  out  by  any  preceding  observer,  is  the 
fully  developed  expression  of  Pernicious  Fever  in  Malignant 
Asiatic  Cholera. 

Several  authorities — Hutchinson,  Searle,  and  others — 
held,  long  before  I  went  to  India,  that  Cholera  is  Fever, 
the  gravest  development  of  the  potency  of  marsh  poison. 
Many  of  our  data  are  in  favour  of  this  opinion,  and  I  doubt 
if  there  is  any  fact  in  its  history  which  is  irreconcilable  with 
this  view.  At  the  same  time  I  do  not  think  that,  consider¬ 
ing  the  large  means  of  research,  upon  the  lines  so  ably 
followed  by  Drs.  Lewis  and  Cunningham,  still  open  to  us, 
we  should  be  justified,  at  present,  in  adopting  this  or  any 
other  theory  of  the  cause  of  Cholera.  I  shall  continue  to 
watch  the  quest  for  the  “  Cholera  germ  ”  with  a  perfectly 
open  mind,  equally  prepared  to  learn  that,  if  such  an 
organism  really  exists — which  appears  most  doubtful — it  is 
a  hitherto  undetected  microzyme,  or  the  at  present  rather 
slighted  Bacillus  Malarice. 

[To  be  continued.') 


ON  THE  TREATMENT  OF  CHOLERA 
DURING  THE  FIRST  STAGE  AND  DURING 
THE  FEVER  OE  REACTION. 

By  BENJAMIN  WARD  RICHARDSON,  M.D.,  F.R.S. 

( Concluded  from  page  180.) 

In  the  three  previous  papers  I  have  kept  closely  to  the  sub  - 
ject  of  the  treatment  of  cholera  in  the  stage  of  collapse.  I 
would  in  this  final  short  communication  touch  on  the  treat¬ 
ment  of  the  first  stage  and  of  the  stage  of  reaction. 

Without  suggesting  that  fear  may  be  a  cause  of  true 
malignant  cholera,  I  am  quite  sure  that  fear  is  a  frequent 
cause  of  intensification  of  the  symptoms ;  and  that  a  cheerful 
countenance  and  an  assuring  word  by  the  medical  attendant 
is  a  splendid  prescription.  I  put  this  first  because  that  is 
its  true  place. 

Frequent  visits  by  the  medical  attendant  are  all-important. 
I  am  as  certain  as  I  can  be  of  anything  in  practice  that,  in 
1854,  I  was  the  means  of  saving  four  cases  by  attention  to 
this  rule  of  practice.  As  far  as  I  could,  I  visited  every 
serious  case  every  two  hours.  I  then  saw  that  all  directions 
were  being  carried  out  faithfully.  I  encouraged  the  atten¬ 
dants  to  hold  on  steadily,  and  not  to  be  alarmed.  I  saw 
that  the  utensils  into  which  the  discharges  were  received 
were  carefully  cleansed,  and  that  the  cloths  used  for  drying 
the  earthenware  cups  and  basins  for  the  patient  were  not 
used  for  other  purposes.  I  saw  that  the  room  was  kept  at 
an  equable  temperature,  and  that  the  patient  was  not  only 
kept  quietly  recumbent,  but  that  food  and  medicine  were 
duly  administered. 

The  treatment  of  the  early  stage  resolves  itself  into 
three  parts — 

The  Hygienic. 

The  Dietetic. 

The  Medicinal. 

The  Hygienic  Treatment. — It  seems  to  me  essential,  when¬ 
ever  it  is  possible,  to  treat  the  patient  at  his  own  home. 
The  plan  of  transporting  patients  a  distance,  to  a  hospital, 
is  most  critical.  The  motion  keeps  up  the  intestinal  dis¬ 
turbance,  and  the  mental  trouble  engendered  is  extremely 
depressing.  .It  is  also  very  difficult  to  treat  several  patients 
at  one  time  in  one  room  or  ward.  Some  are  sure  to  die  in 
the  presence  of  the  living,  and  the  moral  effect  on  the  living 
is  disastrous  to  a  degree  which  has  to  be  witnessed  to  be 
understood. 

The  patient,  then,  retained  in  a  single  room,  should  be 
induced  at  once  to  lie  down  at  full  length,  with  the  head  a 
little  raised.  He  is  best  lying  flat  on  the  back,  and  he  ought 
to  be  accommodated  on  a  small  iron  or  truckle  bedstead. 


which  should  be  so  far  removed  from  the  walls  that  every¬ 
one  can  walk  round  it  freely.  When  it  can  be  obtained,  an 
india-rubber  sheet  should  be  placed  over  the  lower  blanket 
that  covers  the  mattress,  with  the  lower  sheet  over  it.  An 
upper  sheet,  with  two  or  three  light  blankets,  should  form 
the  covering  of  the  sick ;  and  it  should  be  loosely  laid  on,  so 
that  there  may  be  no  difficulty  of  movement. 

The  bed  should  be  divested  of  all  unnecessary  curtains 
and  valances,  and  the  room  should  be  cleared  of  carpets  and 
of  all  stuffed  furniture.  By  the  side  of  the  bed  there  should 
be  at  hand  three  or  four  enamelled  iron  basins  and  a  store 
of  small,  clean,  cheap  cloths.  The  vomited  fluid  from  the 
patient  can  be  received  into  one  of  the  basins  without  much 
movement.  A  night-stool  should  also  be  by  the  bedside,  to 
receive  the  excreted  fluids  immediately.  Nothing  is  so  good 
as  a  large  iron  pail  containing  a  solution  of  iron  sulphate. 
There  should  be  put  into  the  pail  a  pound  of  iron  sulphate, 
and  on  that  four  quarts  of  water  should  be  poured.  Every 
vomit  and  every  purge  should  be  transferred  at  once  to  this 
pail.  When  the  pail  is  getting  charged,  its  contents  can  be 
cast  down  the  watercloset,  with  more  water,  without  letting 
any  remaining  undissolved  crystals  of  the  sulphate  escape. 
So  long  as  there  are  crystals  of  the  sulphate  undergoing 
solution  in  the  pail  it  is  ready  for  use.  A  store  of  solution 
of  the  sulphate  may  also  be  advantageously  kept  in  another 
vessel,  and  the  utensils  may  be  rinsed  with  that  solution, 
and  dried  with  one  of  the  cloths.  After  use,  each  cloth 
should  be  torn  up  and  burned.  The  dry  cloths,  so  often  re¬ 
quired  by  the  patient  for  drying  the  lips,  should,  in  like 
manner,  be  burned  at  once. 

The  room  should  be  freely  ventilated,  and  in  it  there  should 
always  be  a  fire.  The  temperature  of  the  air  should  be  60° 
Fahr.  All  fads  of  hanging  cloths  saturated  with  disinfect¬ 
ing  solutions  about  the  room  are,  in  my  opinion,  useless  and 
hurtful.  They  keep  up  dampness  of  the  air,  and  encourage 
slovenly  uncleanliness.  There  should  always  be  abundance 
of  light  in  the  room.  The  direct  light  may  be  screened 
from  the  patient  if  he  find  it  distressing,  but  the  room 
should  be  flooded  with  light  when  it  can  be,  so  that 
no  speck  of  impurity  may  escape  detection.  For  destroy¬ 
ing  disagreeable  odour  there  is  nothing  so  good  as  the 
volatilisation,  from  time  to  time,  of  a  little  iodine,  until 
the  odour  of  the  iodine  is  just  perceptible  in  all  parts 
of  the  room.  Ten  grains  of  iodine  placed  in  an  evaporating- 
dish,  and  evaporated  with  a  spirit-lamp,  is  sufficient  for  a 
room  12  ft.  by  12  ft.  by  10  ft.  Messrs.  Krohne  and  Sesemann 
once  constructed  for  mean  iodine  vaporiser,  which  answered 
well,  but  anyone  can  improvise  a  vaporiser.  If  an  evaporat¬ 
ing-dish  is  not  at  hand,  the  saucer  part  of  a  common  flower¬ 
pot  will  do,  or  a  fire-shovel  slightly  heated  over  the  fire  may 
be  brought  out  into  the  room  and  the  iodine  cast  on  it. 

Dietetic  Treatment. — Cool — not  cold— neutral  and  sus¬ 
taining  fluids  are  the  best  foods.  Cold  fluids  increase  the 
cold  of  the  body ;  heated  fluids  tend  to  excite  vomiting.  The 
fluid,  the  formula  for  which  I  gave  in  a  previous  paper,  and 
thin  chicken-broth,  are  typical  drinks.  Milk  which  has 
been  boiled,  and  afterwards  mixed  with  water  that  has  also 
been  boiled  and  brought  down  to  tepid,  is  excellent  when  it 
can  be  retained,  but  in  many  persons  the  caseine  coagulates, 
and  then  the  drink  is  vomited.  Some  patients  prefer  water 
or  very  weak  cool  tea  to  everything  else,  and  this  often 
answers  excellently.  To  try  to  introduce  solid  food  by 
the  mouth  is  quite  in  vain ;  such  food  irritates,  produces 
flatulency,  and  excites  intestinal  disturbance. 

The  patient  should  be  induced  to  drink  slowly — imme¬ 
diately  after  vomiting  is  a  suitable  time.  If  he  drink 
slowly  he  may  drink  as  freely  as  he  please  should  no  un¬ 
easiness  or  distension  be  produced.  I  am  almost  afraid  to 
treat  on  the  administration  of  alcoholic  drinks  in  cholera, 
for  fear  that  I  may  be  accused  of  writing  under  what  is 
called  prejudice  respecting  those  drinks.  But  it  would  be 
cowardly  on  that  account  to  suppress  what  I  feel  to  be  most 
importantly  true,  namely,  that  the  use  of  such  drinks  in 
any  form  is  systematically  pernicious  in  cholera.  Tears 
before  I  held  the  views  respecting  alcohol  which  I  now 
hold,  I  had  learned  by  what  I  had  observed,  first,  that  no 
good  whatever  follows  the  use  of  alcohol  in  cholera,  and, 
secondly,  that  the  local  stimulation  it  causes  excites  vomiting, 
induces  a  febrile  excitement,  and  favours  after-prostration. 
It  was  difficult  to  keep  alcohoj-drinkers  from  taking  it  freely, 
and  it  was  too  easy  to  detect  that  these  persons  were  they 
who  died  most  frequently  and  rapidly.  How  any  authority 


Medical  Times  and  Gazette. 


MEDICAL  AND  SURGICAL  PRACTICE. 


August  25, 1883.  211 


could  recommend  such  a  vile  admixture  as  brandy-punch 
for  the  indiscriminate  use  of  people  falling  ill  with  cholera  I 
am  utterly  at  a  loss  to  understand,  nor  can  I  either  from  the 
practical  or  physiological  side  see,  at  any  moment,  a  place 
for  alcohol  in  the  treatment. 

Medicinal  Treatment. — Without  entering  into  any  con¬ 
troversy  as  to  different  modes  of  medicinal  treatment,  I 
would  record,  in  briefest  space,  what  has  seemed  to  be  the 
most  effective  method. 

In  cases  where  it  is  clearly  shown  that  the  symptoms  have 
followed  indulgence  in  any  kind  of  food  or  fruit  that  has 
created  stomachic  or  intestinal  derangement,  I  have  found  it 
good  practice  always  to  administer  a  dose  of  castor  oil,  and,  if 
necessary,  to  repeat  the  dose.  After  Dr.  George  Johnson’s 
essay  on  administration  of  castor  oil  I  was  bolder  than 
before  as  to  this  plan,  and,  I  think,  with  favourable  results. 
So  soon  as  the  oil  has  acted  by  the  bowels — for,  singularly 
enough,  it  rarely  excites  vomiting — I  have  given  in  every 
case  a  mixture  containing  creasote,  opium,  and  camphor. 
The  following  is  a  good  form  : — Pure  creasote,  flfxij. ;  com¬ 
pound  tincture  of  camphor,  oss-  ;  pure  glycerine,  gss.  ; 
distilled  water,  §ss. — to  make  a  mixture  of  twelve  doses,  of 
which  one  fluid  drachm  in  a  wineglassful  of  water  may  be 
taken  every  hour  until  the  vomitings  and  the  discharges 
from  the  bowels  are  relieved,  (a) 

The  first  suggestion  for  the  use  of  creasote  in  cholera  was 
made  by  my  late  friend,  Mr.  H.  Stephens,  of  Finchley,  the 
favourite  fellow-student  of  Keats  the  poet,  and  himself  a 
man  of  signal  genius.  It  was  afterwards,  and  quite  inde¬ 
pendently,  introduced  and  used  with  remarkable  success,  in 
1848,  by  my  friend  and  once  fellow-student,  Mr.  C.  N.  Spinks, 
of  Warrington;  and  in  1850  the  use  of  it  formed  the  sub¬ 
ject  of  an  essay  from  my  own  pen  in  the  old  Medical  Gazette 
during  the  editorship  of  the  late  Dr.  Alfred  Swain e  Taylor. 
On  the  question  of  this  line  of  medicinal  treatment  I  have 
never  seen  the  slightest  occasion  to  change  my  views. 
Creasote  in  small  repeated  doses,  in  combination  with  opium 
and  camphor,  as  formulated  above,  checks  the  choleraic 
discharge,  relieves  the  spasm,  and  is  the  most  demonstrably 
curative  of  any  remedy  I  have  known. 

Treatment  in  the  Stage  of  Reaction. — I  doubt  if  there  be 
any  stage  of  cholera  in  which  more  careful  treatment  is 
demanded  than  the  stage  of  reaction.  One  is  very  apt  to 
be  deceived  by  the  transition  from  the  cold  stage  of  collapse 
to  the  stage  of  fever.  At  first  all  seems  well.  The  cold  ex¬ 
tremities  become  warm;  the  cold  breath,  so  characteristic 
of  cholera  that  it  would  yield  a  diagnosis  almost  of  itself  to 
those  who  have  seen  cholera,  is  again  natural;  the  cramps 
have  ceased ;  the  mind  of  the  patient  is  easy  ;  the  anxious, 
shrunken  expression  has  departed;  the  voice  has  lost  its 
bleating  sadness ;  everything  bids  fair  for  recovery.  An 
hour  or  two  passes,  and  all  is  changed  :  there  is  intense  fever, 
dry  skin,  parched  tongue,  nausea,  often  delirium,  and  too 
often  a  second  collapse,  assuming  what  was  once  commonly 
called  the  typhoid  type. 

The  reaction  is  as  close  as  it  can  be  to  that  which  succeeds 
exposure  to  extreme  cold  or  starvation,  and  the  treatment 
required  to  meet  it  is  practically  the  same. 

When  the  stage  of  collapse  has  decidedly  passed  away,  the 
safest  practice  is  to  prevent  every  artificial  means  of  stimu¬ 
lation.  Hot  drinks,  rich  foods,  alcoholic  stimulants,  over¬ 
clothing,  over-heating  of  the  air  of  the  room,  are  all  to  be 
specially  avoided.  The  patient  may  continue  to  drink  cool 
watery  fluids,  he  may  be  allowed  watery  fruits  like  melon, 
but  he  must  not  be  rapidly  fed.  He  may  be  relieved  of 
medicine.  He  must  be  allowed  to  rest  and  sleep. 

If,  in  spite  of  all  precautions,  the  febrile  state  does  occur, 
and  if  the  pyrexia  runs  high,  the  plan  is  to  combine  the 
application  of  the  cold  band  to  the  cervical  region  and  to 
the  head,  with  administration  of  cool  drinks  in  abundance, 
and  continued  absolute  rest. 

Medicinally,  ammonia,  largely  diluted  with  water  and 
milk,  is  the  agent  most  likely  to  retain  the  fluidity  of  the 
blood  and  prevent  septic  change.  Or  ammonia  might  be 
exhibited  by  inhalation  in  the  form  of  ammoniated  chloro¬ 
form,  after  the  manner  I  have  recently  suggested  for  the 
reduction  of  zymotic  pyrexia. 

(a)  This  form,  prescribed  by  me  for  an  ingenious  English  lady  who  re¬ 
covered  from  a  severe  choleraic  attack,  was  carried  by  her  to  Southern 
America,  and  was  used  by  her  there,  in  a  district  where  there  was  deficient 
medical  assistance,  with  such  good  effects,  that  she  became,  during  an  epi¬ 
demic  outbreak,  a  noted  healer  amongst  the  native  population,  and  netted 
no  inconsiderable  sum  of  money  as  well  as  credit  for  her  curative  skill. 


REPORTS  OF 

HOSPITAL  PRACTICE  IN'  MEDICINE 
AND  SURGERY. 

- « — - - 

LONDON  HOSPITAL. 

PROLAPSUS  UTERI— ELYTRORRHAPHY. 

(Under  the  care  of  Dr.  HERMAN.) 

[Reported  by  Mr.  E.  English.] 

S.  C.,  aged  forty-seven,  laundress,  admitted  into  the  London 
Hospital,  July  6,  1880,  complaining  of  “  the  womb  coming 
down.”  States  that  her  mother  and  a  sister  suffered  in  a 
similar  manner.  Patient  has  had  to  work  hard  all  her  life. 
Married  at  thirty-three;  had  two  children — the  last  ten 
years  ago  :  both  labours  good.  About  two  years  ago  had  a 
fall  on  the  lower  part  of  her  back  ;  had  to  take  to  bed  a  day 
or  two  after  it,  and  felt  weak  for  some  time  after  it.  About 
two  months  after  the  fall  she  first  noticed  the  womb  coming 
down.  At  first  she  could  easily  reduce  it,  and  after  reduction 
it  kept  up  some  time,  but  latterly  it  had  protruded  further, 
and  been  more  difficult  to  keep  up.  Bowels  very  confined; 
pain  and  difficulty  in  defsecation.  Patient  is  sometimes,  but 
not  always,  unable  to  properly  retain  urine.  Had  had  no 
treatment  until  June  19,  when  she  came  to  the  out-patient 
department.  The  vaginal  orifice  was  large;  there  was  a 
cystocele,  and  when  the  patient  strained,  the  cervix  uteri 
protruded  from  the  vulva.  The  sound  entered  four  inches. 
She  was  given  a  cup-and-stem  pessary,  supported  by  bands 
attached  to  a  waist-belt ;  but  as  she  was  not  satisfied  with 
the  relief  which  this  gave  her,  she  was  admitted  into  the 
hospital. 

July  16. — A  diamond-shaped  piece  of  mucous  membrane 
was  dissected  off  the  anterior  vaginal  wall,  and  the  edges 
brought  together  by  sutures. 

28th. — Posterior  elytrorrhaphy  was  performed,  the  stifches 
being  inserted  in  the  manner  recommended  by  Emmett — 
that  is,  each  suture  sunk  throughout  in  the  posterior  vaginal 
wall,  so  as  to  draw  the  denuded  surface  of  the  vaginal  wall 
forward  into  contact  with  that  on  the  labia.  Good  union 
took  place,  and  on  September  18  the  patient  was  discharged, 
wearing  a  thick  india-rubber  ring,  which  she  said  was  quite 
comfortable. 

July  24,  1883. — Patient  still  wearing  the  ring,  having 
attended  once  in  six  months  since  operation.  Is  quite  com¬ 
fortable.  No  trouble  of  any  kind  with  uterus. 

Remarks. — This  case  illustrates  the  kind  of  benefit  which 
may  be  expected  from  surgical  operations  upon  the  vagina 
in  cases  of  prolapsus  uteri.  Descent  of  the  uterus  does  not 
result  merely  from  an  alteration  in  the  lower  part  of  the 
vagina.  To  permit  it  there  must  be  relaxation,  not  simply 
of  the  vaginal  outlet,  but  of  the  peritoneal  folds,  muscles, 
fascise,  and  cellular  tissue  which  hold  the  uterus  in  position 
and  form  the  floor  of  the  pelvis ;  and  an  operation  on  the 
vagina  cannot  restore  these  parts  to  their  natural  condition. 
Hence  the  almost  invariable  failure  of  operations  upon  the 
vagina  to  give  lasting  relief  in  these  cases.  When  the  patient 
gets  about,  the  prolapse  begins  to  recur.  The  anterior 
vaginal  wall,  which  is  commonly  the  first  part  to  come  down, 
gradually  dilates,  like  a  blunt  wedge,  the  artificially  narrowed 
vaginal  orifice,  and  the  state  of  things  antecedent  to  the 
operation  is  before  long  reproduced.  But  narrowing  of  the 
vaginal  orifice  by  an  operation  will  enable  a  vaginal  pessary 
to  be  retained,  and  this  will  support  the  uterus.  The  pessary 
is  retained  by  the  vaginal  wall,  or  by  the  pubic  arch  (accord¬ 
ing  to  the  kind  of  pessary  employed),  and  does  not  press  into 
and  dilate  the  vaginal  orifice.  Hence,  with  the  assistance  of 
such  an  instrument,  the  uterus  may  be  permanently  kept 
up.  In  this  case,  relief  at  the  end  of  three  years  is  as  com¬ 
plete  as  when  the  patient  left  the  hospital.  The  operation 
will  not  enable  the  patient  to  do  without  a  mechanical  sup¬ 
port  ;  but  where  the  wearing  of  one  with  external  straps  is 
irksome,  we  can  at  least  promise  by  this  operation  to  remove 
the  necessity  for  an  instrument  of  that  kind. 


Chloroform  in  Earache. — A  correspondent  of  the 
Druggists’  Circular  states  that  a  mixture  of  one  ounce  of 
olive  oil  and  one  drachm  of  chloroform  is  a  most  speedy  and 
effectual  remedy  in  earache.  It  should  be  well  shaken,  and 
twenty-five  to  thirty  drops  dropped  into  tbe  ear,  which  is 
then  to  be  closed  with  cotton-wool. — Phil.  Med.  Rep.,  J uly  28. 


212 


Medical  Times  and  Gazette. 


LORD  MORLEY’S  COMMITTEE. 


August  25,  1883. 


TOWN’S  HOSPITAL,  GLASGOW. 


NOTES  OF  A  CASE  OF  PUERPERAL  ECLAMPSIA, 
WITH  SUCCESSFUL  DELIVERY  BY  BRAXTON 
HICKS’S  METHOD. 

[Reported  by  T.  Hammond  ‘WTlt.tams.  L.R.C.P.E.,  etc.,  late  Senior 
Assistant  Medical  Officer.! 

S.  W.,  aged  twenty-four,  a  washerwoman,  was  admitted  on 
May  16,  1883.  She  was  in  fair  health  and  condition,  and  at 
full  period  of  pregnancy,  when  she  was  seized  with  con¬ 
vulsions,  having  had  three  severe  fits  at  intervals  of  an  hour. 
The  convulsions  were  general,  lasting  three  to  five  minutes, 
the  patient  remaining  in  a  state  of  stupor  for  about  half 
an  hour  afterwards.  Artificial  respiration  was  commenced 
after  the  last  fit ;  previously  the  breathing  had  ceased,  and 
pulse  was  only  perceptible.  After  respiration  was  fully 
established,  chloroform  was  inhaled  by  patient,  and  she 
was  kept  under  its  influence  for  six  hours.  At  the  onset 
an  examination  per  vaginam  showed  that  the  head  was 
presenting,  but  the  os  did  not  admit  more  than  the  point 
of  the  finger.  Before  the  administration  of  the  chloroform 
a  catheter  was  passed,  and  urine  drawn  from  bladder  and 
examined,  proving  to  be  highly  albuminous.  (Edema  of  the 
feet  and  ankles  was  also  noticed  to  a  slight  degree.  Dr. 
Robertson,  who  was  called  in  consultation,  after  dilating  the 
os  uteri  to  allow  the  introduction  of  the  points  of  two  fingers, 
performed  bipolar  version,  bringing  down  the  feet,  then 
rupturing  the  membranes,  and  delivering  the  mother  of  a 
healthy  living  child.  The  placenta  was  expelled  in  about  five 
minutes  after  the  birth  of  the  child.  Haemorrhage  occurred, 
and  continued  for  a  quarter  of  an  hour  after  termination  of 
third  stage.  Clots  were  removed  from  vagina,  and  firm 
pressure  applied  over  fundus,  but  the  uterus  tended  to  relax 
until  the  patient  suddenly  had  another  convulsion,  after 
■which  the  haemorrhage  ceased.  Pulse  was  at  this  time  ex¬ 
tremely  weak  and  irregular,  and  the  respirations  panting  in 
character.  Stimulants  were  given  by  mouth,  but  the  stomach 
rejected  them  immediately.  Fifteen  minims  of  sulphuric 
ether  were  injected  subcutaneously  every  quarter  of  an  hour 
with  marked  beneficial  effect.  The  ether  was  detected  in 
breath  five  minutes  after  first  injection.  Several  severe 
rigors  supervened  ;  limbs  were  noticed  to  be  in  a  state  of 
tonic  spasm,  and,  fearing  another  fit  was  imminent,  again 
chloroform  was  inhaled  for  about  half  an  hour.  No 
convulsions  occurred  afterwards,  but  the  patient  for  the 
next  five  hours  remained  in  a  semi-unconscious  condition. 
The  pulse  increased  in  rapidity,  and  improved  in  tone  from 
78  to  112,  and  temperature  rose  from  97°  Fahr.  to  lOO'S” 
Fahr.  after  the  ether  injections.  Nutrient  injections  were 
given  per  rectum,  and  a  little  brandy  by  mouth,  which  the 
stomach  now  retained.  The  patient  made  a  good  recovery, 
and  was  dismissed  after  being  in  ward  for  four  weeks. 

The  case  may  be  a  little  interesting,  in  respect  of  the 
method  employed  in  turning ;  the  temporary  and  rapid 
stimulating  effects  of  subcutaneous  injections  of  sulphuric 
ether;  and  the  cessation  of  haemorrhage  after  the  last  con¬ 
vulsive  seizure. 


Effects  of  Telegraphy  on  the  Health.— The 
conspicuous  position  in  which  telegraphers  have  been  placed 
in  the  present  strike  has  served,  among  other  things,  to 
call  attention  to  the  great  demands  made  by  that  calling 
upon  the  nervous  systems  of  those  who  follow  it.  The 
first- class  operators  all  read  by  sound,  and  in  a  large  office 
where  a  hundred  or  more  receivers  are  all  buzzing  at  once, 
the  strain  upon  the  organ  of  hearing,  as  well  as  upon  the 
cerebral  centre  of  audition,  protracted  as  it  is  through  ten 
hours  daily,  is  very  great.  Of  course,  in  this  as  in  every 
other  occupation,  it  is  true,  to  a  certain  extent,  that 
ct  custom  makes  it  a  thing  of  easiness.  Yet,  to  discrimi¬ 
nate  between  the  longer  and  shorter  dashes  in  an  instru¬ 
ment  clicking  at  the  rate  of  a  very  large  number  of  words 
per  minute,  involves  none  the  less  a  very  close  exercise  of 
the  attention,  even  when  it  is  done  only  for  the  regular 
working-hours,  while  those  operators  who  have  been 
obliged,  since  the  strike,  to  work  double  time,  have  been 
excessively  exhausted.  The  nervous  and  muscular  energy 
expended  by  a  rapid  sender  is  perhaps  still  greater.  It  is 
said  that  few  operators  are  good  for  much  after  the  age  of 
thirty-eight.” — Boston  Med.  Jour.,  July  26. 


TERMS  OF  SUBSCRIPTION. 


British  Islands 
>1  )» 


(Free  by  post.) 
.  .  .  Twelve 

.  .  .  Six 


The  Colonies  and  the  United  7 
States  of  America  .  .  .  j 

M  »  99  • 

India  (vid  Brindisi)  .  .  . 

>9  •  •  • 


Twelve 

Six 

Twelve 

Six 


Months 

99 

99 

99 

99 

99 


jei  8  o 

0  14  0 

1  10  0 

0  15  0 
1  12  6 
0  16  6 


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JJJtMal  Ci incs  anfo 


SATURDAY,  AUGUST  25,  1S83. 


LORD  MORLEY’S  COMMITTEE. 

It  must  be  admitted  that  Her  Majesty’s  Government  have 
shown  considerable  skill  during  the  present  session  in 
staving  off  discussion  on  disagreeable  questions ;  and  they 
have  also  been  aided  by  good  fortune  in  their  efforts  of  this 
kind.  We  have  nothing  to  do  here,  of  course,  with  topics 
of  a  political  or  diplomatic  character,  and  propose  to  speak 
only  of  their  escape  from  any  serious  debate  on  the  Report 
of  Lord  Morley’s  Committee  on  the  Army  Hospital  Services 
in  the  field.  When  complaints  were  first  made  of  much  of 
the  evidence  brought  before  that  Committee  respecting  the 
services  of  the  Army  Medical  Department  during  the 
Egyptian  campaign,  all  discussion  of  the  matter  was  depre¬ 
cated  as  untimely  and  inconvenient ;  and  the  Government- 
promised,  or  at  least  implied,  that  an  opportunity  of 
discussion  should  be  given  when  the  Army  Estimates 
came  before  the  House  of  Commons.  As  the  session  pro¬ 
ceeded  an  inquiry  was  made  now  and  again  as  to  when  the 
Army  Estimates  would  be  brought  forward,  but  the  Govern¬ 
ment  were  never  able  to  name  a  time.  The  Report  was 
made  the  subject  of  a  discussion  in  the  House  of  Lords  by 
Lord  Bury ;  but  there  fortune  befriended  the  Government, 
for  the  points  in  the  Report  chiefly,  and  almost  solely,  dwelt 
on  were  the  superior  merits  of  the  regimental  system  of 
army  medical  officers  as  compared  with  the  departmental 
system,  and  the  supposed  necessity  of  having  a  military 
commandant  over  every  army  hospital;  and  it  was  very 
easy  for  the  Government  to  defend  the  conclusions  arrived 
at  by  Lord  Morley’s  Committee  on  these  points.  Time 
went  on,  and  still  no  date  could  be  fixed  on  for  bringing 
the  vote  for  medical  establishments  and  services  before  the 
House  of  Commons,  till  at  length  it  was  brought  on  at 
the  fag  end  of  a  very  prolonged  and  wearisome  session, 
on  Saturday,  the  18th  inst.,  when  the  House  of  Commons  was 
thinned  by  the  absence  of  every  member  who  had  been  able 
to  get  away  from  London ;  and  those  who  were  left  were 
only  anxious  to  bring  the  session  to  an  end  as  speedily  as 


•Medical  Times  and  Gazette. 


WHITE-LEAD  WORKERS. 


August  2;,  1883.  213 


possible.  And  then,  again,  the  points  dealt  with  were  the 
present  system  of  army  medical  officers ;  the  question 
whether  it  shallbe  applied  to  the  Household  Troops  as  well  as 
to  the  rest  of  the  Army  ;  and  the  imperfections  of  the  Army 
Hospital  Corps,  which  are  not  disputed.  The  Secretary  of 
•State  for  War,  in  order  to  shorten  the  discussion,  promised 
that  he  would  as  soon  as  possible  go  carefully  into  the  re¬ 
commendations  made  by  Lord  Morley’s  Committee,  and  con¬ 
sider  to  what  extent  they  could  be  adopted ;  but  that  no  im¬ 
portant  changes,  “involving  the  issue  of  a  Royal  Warrant, 
should  be  made  until  an  opportunity  had  been  afforded  the 
House  of  discussing  the  matter.”  And  he  further  said  he 
thought  the  discussion  of  the  Report  had  better  be  post¬ 
poned  until  the  action  the  Government  proposed  to  take 
upon  it  was  brought  forward  in  the  early  part  of  next 
year.  We  have  no  idea  as  to  how  elastic  the  term  “no 
-changes  involving  the  issue  of  a  Royal  Warrant  ”  may  not 
be;  and,  certainly,  the  promise  of  a  discussion  of  Lord 
Morley’s  Report  in  the  early  part  of  next  year  will  be  very 
cold  comfort  to  the  army  medical  officers.  No  opportunity 
has  been  given  of  pointing  out  the  grievous  injustice  done 
them  in  that  Report ;  and  next  year  the  matter  will  be  an 
old  story,”  and  it  will  be  almost  impossible  to  raise  any 
serious  discussion  upon  it.  It  was  a  bold  thing,  considering 
the  history  of  recent  sessions  of  Parliament,  to  speak 
.seriously  at  this  time  of  what  subjects  the  Government 
will  bring  forward  in  the  early  part  of  next  year  ”;  and 
dhe  Ministry  must  have  felt  very  sure  of  the  eagerness 
•of  a  “  wearied  and  jaded  House  ”  to  close  the  session 
when  they  ventured  on  such  a  device  for  shortening 
;a  discussion.  And,  in  fact,  the  further  wrong  done  to  the 
•officers  of  the  Army  Medical  Department  in  fatally  deferring 
all  opportunity  of  exposing  the  flagrant  injustice  of  the 
charges  brought  against  their  Service  in  Egypt,  is  not  to  be 
laid  at  the  door  of  the  Government  alone.  Had  any  large 
number  of  the  members  of  the  House  of  Commons  taken 
any  real  interest  in  the  matter.  Her  Majesty’s  Ministers 
might,  without  any  great  difficulty,  have  been  brought  to 
•see  the  necessity  of  providing  time  and  occasion  for  discuss¬ 
ing  the  alleged  grievance.  But  anything  like  a  general 
comprehension  of  or  care  about  the  question,  whether  or 
not  the  army  doctors  had  been  wronged,  was  certainly 
not  to  be  found  in  the  Lower  House  of  Legislature.  It 
appears  also  but  too  certain  that  the  General  Officer 
<Commanding-in-Chief  during  the  Egyptian  Campaign, 
though  a  successful  soldier,  is  wanting  in  some  of  the  quali¬ 
ties  essential  to  greatness  of  character.  He  knows,  better 
"than  most  men,  the  strictness  of  the  Army  Regulations,  that 
fetter  any  real  freedom  of  action  by  medical  officers,  and  he 
knows,  as  well,  all  the  special  difficulties  that  were  placed 
in  the  way  of  those  officers  when  active  hostilities  on  land 
commenced  ;  but  he  has  never  had  the  moral  courage  or  the 
generosity  to  acknowledge  that  all  the  defects  shown,  for  a 
very  brief  time  only,  in  the  equipment  and  general  manage- 
ment  of  the  hospitals  at  Ismailia  and  Cairo  were  caused 
entirely  by  his  own  conduct  of  the  campaign.  Yet  it  is  the 
simple  truth  that  all  the  shortcomings  most  complained  of, 
•excepting  as  to  the  character  of  the  cooking,  were  due 
entirely  to  the  suddenness  and  the  rapidity  of  the  military 
movements  after  Lord  Wolseley  commenced  active  hostilities. 


WHITE-LEAD  WORKERS. 

During  the  past  year  public  attention  has  been  perhaps 
more  pointedly  than  ever  directed  to  the  dangers  attending 
the  manufacture  of  white-lead.  In  the  summer  of  1882 
several  inquests  in  cases  of  death  from  lead-poisoning,  and 
the  reports  of  the  medical  superintendents  of  the  Holborn 
.and  Shoreditch  TJnion  Infirmaries,  created  some  sensation. 


and  called  forth  articles  in  the  daily  papers  ;  but  the  manu¬ 
facturers  endeavoured  to  treat  the  alarm  as  a  needless 
scare,  and  to  attribute  the  cases  of  death  and  disease  to  the 
obstinate  neglect  of  precautions  and  wilful  recklessness  of 
the  operatives — mostly  women  of  a  low  class — among  whom 
they  occurred.  Acting  on  the  suggestion  of  their  medical 
officers,  the  Boards  of  Guardians  of  the  Shoreditch,  Hol¬ 
born,  Poplar,  Newcastle,  and  Gateshead  Unions  addressed 
memorials  on  the  subject  to  the  Home  Secretary  ;  and  Mr. 
Redgrave,  the  veteran  Inspector  of  Factories,  was  instructed 
to  institute  an  inquiry.  In  his  report,  dated  November  30, 
1882,  he  says  :  “  The  careful  inquiry  I  have  made  has  shown 
me  that  the  temporary  illnesses  and  permanent  disabilities 
which  affect  those  working  in  white-lead  far  exceed  anything 
that  has  come  before  the  public.”  If  these  were  limited  to 
colic,  which  soon  yields  to  treatment,  the  evil  would  not  be 
so  urgent ;  but,  besides  lead-palsy,  more  or  less  amenable  to 
a  course  of  iodide  of  potassium,  the  medical  reports  mention 
cases  of  permanent  blindness,  and  of  convulsions  which, 
though  often  described  as  epilepsy,  are  in  fact  of  the  nature 
of  meningitis,  and  frequently  fatal  within  twenty-four  hours. 
Two  such  have  come  under  our  own  notice  in  the  last  few 
weeks.  Such  are  the  consequences  of  lead-poisoning  as  seen 
in  these  factories  ;  and  the  questions  are — How  are  they 
caused  ?  and  How  can  they  be  prevented  ? 

Anyone  visiting  the  works  will  have  his  attention  directed 
to  workmen  who  have  enjoyed  good  health  for  ten,  twenty, 
or  more  years,  and  will  be  told  that  the  blame  rests  with  the 
women,  who,  averse  to  soap-and-water,  and  careless,  igno¬ 
rant,  and  headstrong,  bring  the  consequences  on  themselves. 
They  may  be  all  this  and  more — ill-fed,  dissipated,  and  so 
forth, — but  the  fact  is  that  while  the  men — for  the  most  part 
steady,  respectable,  and  sober — are  employed  in  casting  the 
metallic  lead,  and  in  grinding  and  mixing  the  white-lead 
(processes  conducted  in  the  wet  way,  and  therefore  with 
ordinary  care  devoid  of  serious  danger),  the  miserable 
casual  females,  who  alternate  labour  at  the  lead  works 
with  haymaking,  hop-picking,  or  street  life,  are  employed 
in  “unstacking,”  “stoving,”  and  “drawing” — dry  and 
dusty  operations.  The  irresistible  conclusion  to  be  drawn 
from  Mr.  Redgrave’s  report  is,  that  no  amount  of  pre¬ 
cautions,  however  rigidly  enforced  and  conscientiously 
carried  out,  can  have  any  appreciable  effect  in  lessening 
the  danger  or  the  evils  inseparable  therefrom.  Indeed, 
the  recommendations  drawn  up  by  Mr.  Redgrave,  which, 
when  laid  before  Parliament,  were  pronounced  by  some 
as  simply  impracticable  in  their  stringency,  are  but  a 
mild  copy  of  those  actually  enforced  in  one  factory,  where, 
in  addition  to  endless  ablutions,  etc.,  every  man  and  woman 
is  compelled  to  wear  flannel  combinations,  oilskin  petticoats 
or  aprons,  headcloths,  respirators,  etc.,  when  employed  in 
dangerous  work.  But  even  in  this  model  establishment 
from  10  to  40  per  cent,  of  the  operatives  constantly  suffer  from 
one  or  other  form  of  lead-poisoning.  The  fine  dust  enters 
the  mouth  and  lungs,  penetrates  the  clothing,  and  baffles 
the  care  and  ingenuity  of  masters  and  employed.  White- 
lead  cannot  be  considered  as  a  definite  chemical  combina¬ 
tion,  it  is  a  mixture  of  carbonate  and  hydrate  approxi¬ 
mately  represented  by  the  formula  2PbC03+P  bK-Oh  It 
is  made  by  exposing  thin  corrugated  sheets  of  metallic 
lead  to  the  vapour  rising  from  jars  of  crude  acetic  acid  (wood 
vinegar)  under  the  heat  evolved  from  fermenting  tan  in  the 
stacks  built  up  of  layers  of  each  of  these  matters  and  lef 
to  stand  for  about  three  months.  When  the  stack  is  taken 
down  the  crusts  of  white-lead  are  scraped  off,  and  the  unaltered 
lead  is  recast  for  further  exposure  to  acid  and  heat  in  the 
next  stacking.  “  Stoving  ”  consists  in  carrying  the  pasty 
mass  of  ground  white-lead  in  pans  to  the  oven  ;  and  “  draw¬ 
ing  ”  is  the  removal  of  these  pans,  and  emptying  thei 


214 


Medical  Times  and  Gazette. 


THE  MEDICAL  ACTS  AMENDMENT  BILL. 


August  25,  1883. 


contents  when  sufficiently  dried  into  casks.  For  many  years 
past  attempts  have  been  made  to  find  a  remedy  in  two  direc¬ 
tions — either  to  find  a  less  injurious  process  than  the 
so-called  Dutch  method  of  making  white-lead,  or  to  dis¬ 
cover  a  substitute  for  lead  in  any  form.  The  most  success¬ 
ful  of  the  substitutes  proposed  has  been  the  mixed  silicates 
of  zinc  and  barium,  which  possess  the  further  merit  of 
not  blackening  by  exposure  to  sulphides  in  the  atmosphere. 
But  though,  when  first  applied,  the  best  of  these  (the 
Albissima  and  Charlton  Company’s  paints)  appear  to  equal 
the  lead  colours  in  body  and  covering  power,  we  are  assured 
by  a  West-end  builder,  who  has  given  them  a  fair  and  full 
trial,  that  they  tend  to  crumble  off,  and  in  permanence  are 
inferior  to  the  lead  paints  even  for  indoor,  and  much 
more  so  for  outdoor,  use.  In  the  former  directions  it 
has  been  sought  to  obtain  a  white-lead  by  precipitation, 
but  the  product,  as  for  some  time  past  turned  out  by 
one  factory,  is  a  crystalline  carbonate,  very  inferior  to 
the  soft  amorphous  mixture  yielded  by  the  stack  process. 
But  we  would  call  the  attention  alike  of  sanitarians, 
philanthropists,  and  practical  men  to  a  new  process  already 
patented  by  Professor  E.  Y.  Gardner,  and  now  in  operation 
at  his  works  at  Deptford,  in  which,  by  the  aid  of  elec¬ 
tricity  and  the  production  of  carbonic  acid  applied  through 
a  special  apparatus,  together  with  the  necessary  acid  vapour 
at  a  proper  temperature,  the  formation  of  a  genuine  white- 
lead  of  the  purest  colour  and  the  best  quality  is  rapidly  and 
cheaply  carried  out  in  closed  chambers,  the  lead  resting 
upon  shelves,  which,  when  the  conversion  is  complete,  are 
lifted  out  and  emptied  (the  men’s  hands  not  touching  the 
lead,  and  no  dust  being  raised)  into  a  closed  combination 
of  machinery,  whence  it  issues  as  a  white  paint,  ready 
ground  for  the  market,  or,  if  preferred,  as  a  dry  powder. 
Should  this  process  prove  as  successful  and  cheap  as  is 
alleged,  there  is  no  reason  why,  at  any  rate  after  the  ex¬ 
piration  of  the  present  patent,  the  old  stack  process  should 
not  be  henceforth  prohibited  by  law. 


THE  MEDICAL  ACTS  AMENDMENT  BILL. 

No  one  who  watched  intelligently  the  course  of  business  in 
Parliament  during  last  week  can  have  believed  it  was  at  all 
probable,  not  to  say  possible,  that  the  Medical  Acts  Amend¬ 
ment  Bill  would  become  law  this  year.  The  business  of 
getting  Bills  talked  over  and  passed  through  the  necessary 
stages — we  cannot  call  it  legislation — was  pressed  on  with 
all  possible  haste,  and  the  Medical  Bill  did  seem,  by  the 
end  of  the  week,  to  have  risen  in  the  business  papers  of 
the  House  of  Commons  to  nearly  within  a  measurable 
distance  of  being  brought  forward  for  a  second  reading. 
But,  at  the  same  time,  it  was  known  that  the  Bill  was 
blocked  by  Colonel  King-Harman  on  the  part  of  some  of 
the  Irish  bodies,  and  by  Mr.  Waddy  on  the  part  of  the 
Scottish  Corporations  and  of,  we  suppose,  the  Extra-mural 
Medical  Schools  in  Scotland ;  and  unless  the  blockings 
were  removed  it  was  impossible  for  the  second  reading  of 
the  Bill  to  be  brought  forward  after  12.30  p.m.  But 
there  seemed  very  little  chance  of  any  such  tempering 
of  the  opposition  to  it,  as  deputations  from  the  hostile 
bodies  in  Scotland  and  in  Ireland  were  in  London  for 
the  purpose  of  securing  a  determined  resistance  to  the 
second  reading,  unless,  of  course,  their  objections  to  the 
measure  were  met  with  some  amount  of  consideration  and 
concession;  and  of  that  there  appeared  to  be  very  slight 
probability.  Still,  notwithstanding  .all  this,  the  Bill  re¬ 
mained  on  the  business  paper  of  the  House  until  the 
evening  of  the  22nd,  when  it  was  at  last  withdrawn.  Dr. 
Lyons  and  some  other  members  inquired  whether  the 
Ministry  really  yet  entertained  any  hope  of  passing  the  Bill^ 


and  urged  the  difficulty  of  proceeding  with  it,  considering 
the  opposition  it  had  met  with ;  and  Mr.  Gladstone,  in  reply,, 
said  they  had  hoped  to  get  the  second  reading  on  the  even¬ 
ing  of  the  21st,  and,  if  that  had  been  accomplished,  they 
might  have  hoped  to  proceed  with  the  measure.  He  had  not 
had  an  opportunity  of  consulting  the  Lord  President  of  the 
Council,  who  had  conducted  the  Bill  through  the  House  of 
Lords ;  but  he  felt  that  as  we  had  reached  August  the  22nd, 
and  the  close  of  business  was  being  anticipated,  he  was  bound 
to  state  that,  in  the  opinion  of  the  Government,  the  loss  of  the 
opportunity  of  the  previous  night  was  fatal  to  the  chances  of 
the  Bill.  They  could  not  now  take  the  second  reading  before 
Thursday,  and  it  was  obvious  that  they  could  not  get  it  through 
this  session.  It  was  therefore  with  the  deepest  regret  that  he 
had  to  announce  that  it  was  beyond  their  power  to  carry  the 
measure.  Mr.  Gladstone  did  not  add,  regarding  the  Medical 
Act  Amendment  Bill,  what  he  had  said  just  before  with 
reference  to  the  Irish  Eegistration  Bill,  viz.,  that  it  was  not 
only  the  desire  of  Her  Majesty’s  Government  to  introduce 
the  Bill  at  the  very  commencement  of  next  session,  but  to 
press  it  on  the  attention  of  Parliament.  But,  though  Mr. 
Gladstone  said  nothing  in  the  House  of  the  intentions  of 
Government  regarding  the  Medical  Bill,  we  have  good  reason 
to  believe  that  the  President  and  Vice-President  of  the 
Council  have  very  decided  wishes  and  intentions  on  the  sub¬ 
ject.  They  have  devoted  a  great  amount  of  time  and  labour 
to  the  Bill ;  they  have  been  untiring  in  seeing  all  objectors, 
to  the  measure,  and  in  considering  and  weighing  all  objec¬ 
tions  to  it ;  they  carried  it  very  successfully  through  the 
House  of  Lords  early  in  the  session;  they  have  improved 
it  by  accepting  reasonable  amendments ;  and  they  have 
done  their  utmost,  by  attention  and  courtesy,  to  over¬ 
come  objections  to  what  they  considered  essential  points, 
in  it :  and  all  their  time  and  brain-labour  have  been 
thrown  away;  and  the  Bill  has  been  wrecked  by  a  little- 
persistent  stolid  hostility.  We  had  no  great  admiration  for 
the  measure  ourselves,  but  it  contained  some  very  necessary 
provisions,  and  we  were  quite  willing  to  accept  it,  in  order 
to  put  an  end,  for  some  years  at  any  rate,  to  the  agitation, 
for  medical  legislation  ;  and  we  suspect  the  Scottish  and 
Irish  Corporations  may  find  that  they  have  made  a  mistake. 
We  believe  that  the  Bill  will  be  introduced  into  the  House 
of  Lords  again  as  early  as  possible  next  session,  and  that  it 
will  be  pressed  forward  rapidly  with  the  full  intention  of 
getting  it  through  the  Lower  House  also;  and  we  think 
it  not  improbable  that  it  may  be  made  even  less  palatable 
to  some  of  the  medical  authorities  in  Scotland  and  Ireland 
than  was  the  slaughtered  Bill. 


THE  BEADSHAWE  LECTUEE. 
FoETUNATEnv  for  the  advance  of  knowledge,  all  men  are 
not  constituted  alike.  Some  men  never  trouble  themselves 
about  the  writings  of  those  who  have  gone  before,  others 
revel  in  their  study ;  to  some  the  sifting  of  the  literature  of 
any  one  special  point  is  a  penance,  to  others  it  is  a  labour  of 
love.  To  this  latter  class  Dr.  Wickham  L egg  undoubtedly 
belongs.  He  has  already  given  ample  proof  of  it  in  his 
writings  ;  and,  if  further  proof  be  needed,  the  reader  has. 
only  to  turn  to  the  Bradshawe  Lecture  delivered  before  the 
Boyal  College  of  Physicians  on  Saturday  last — which  appears 
in  our  pages  to-day— to  be  fully  convinced.  All  English 
pathologists  will,  we  believe,  agree  with  Dr.  Legg  that 
an  aneurysm  of  the  heart  is  a  rare  disease.  It  is  generally 
regarded  in  the  light  of  a  curiosity  rather  than  anything 
else,  as  being  outside  the  pale  of  diagnosis  and  beyond  the 
reach  of  treatment ;  and,  so  far  as  these  two  points  are 
concerned.  Dr.  Legg  has  added  nothing  to  our  knowledge. 

After  a  reference  to  John  Hunter  and  Matthew  Baillie,. 


Medical  Times  and  Gazette. 


THE  WEEK. 


August  25, 1883.  2  1  5 


•who  were  probably  the  first  writers  who  used  the  word 
aneurysm  to  signify  a  partial  dilatation  of  the  walls  of  the 
heart.  Dr.  Legg  referred  to  Thurnam’s  essay,  which,  though 
it  appeared  nearly  half  a  century  ago,  is  still  the  most  im¬ 
portant  monograph  on  the  subject  in  the  English  language. 
By  examining  all  the  cases  recorded  since  Thurnam’s  paper 
was  published.  Dr.  Legg  found  that  the  apex  was  much 
more  frequently  the  seat  of  the  aneurysm  than  any  other 
part,  thus  differing  from  Thurnam,  as  he  also  did  in  the 
matter  of  the  age  of  the  patient — Legg  finding  it  a  disease 
of  middle  and  advanced  life,  Thurnam  finding  it  more 
common  under  thirty  years  of  age.  The  most  universally 
(by  some  the  only)  admitted  cause  of  aneurysm  of  the  wall 
of  the  left  ventricle  is  a  fibroid  degeneration  thereof.  Dr. 
Legg  believes,  without,  however,  expressing  himself  too 
positively  on  the  subject,  that  there  are  two  forms  of  this 
fibroid  degeneration  ;  at  any  rate,  the  chief  and  most  im¬ 
portant  question  is,  what  is  the  cause  of  it?  Syphilis 
cannot  be  made  to  account  for  all  the  cases.  Cohnheim 
has  recently  put  forward  the  view  that  these  degenerated 
patches  in  the  ventricular  wall  were  the  result  of  occlusion 
in  a  coronary  artery,  and  in  fact  corresponded  to  an  infarc¬ 
tion  in  any  of  the  viscera,  and  this  view  he  supported  by 
the  assertion  that  the  coronary  arteries  do  not  anastomose  ; 
the  truth  of  this  statement  Dr.  Legg  is  unable  to  bear  out, 
■as  he  found  by  careful  experiments  that  one  coronary  artery 
could  be  readily  filled  from  the  other,  the  fluid  passing  by 
branches  over  the  ventricle  and  apex.  In  the  publication 
•of  these  experiments  and  results  Dr.  Legg  has  been  antici¬ 
pated  by  Dr.  Samuel  West,  who  had  been  coincidently  and 
independently  investigating  the  same  point.  Dr.  Legg 
■concluded  this  part  of  his  subject  as  follows: — “ None  of 
the  causes  of  fibrous  myocarditis  which  have  been  brought 

forward  can  be  looked  upon  as  proved . Of  the  cause 

of  fibrous  myocarditis,  it  must  be  owned  we  have  as  yet  no 
clear  knowledge ;  but  I  incline  myself  to  the  opinion  that  it 
will  be  found  some  day  to  be  closely  akin  to  those  causes 
which  make  endocarditis  and  so  many  other  pathological 
processes  choose  as  their  seat  the  left  ventricle  and  the  left 
•endocardium  rather  than  any  other  chamber  of  the  heart.” 
Amongst  other  causes  besides  a  fibroid  change  admitted  by 
Dr.  Legg  as  possible,  are  fatty  degeneration,  the  rupture  of 
cysts  or  abscesses  into  the  ventricles,  and  wounds.- 

Aneurysms  of  the  right  ventricle  and  auricles  are  so  rare 
as  only  to  need  the  briefest  mention.  Aneurysms  of  the 
“  undefended  space  ”  would  appear  to  be  either  congenital 
■or  due  to  endocarditis ;  in  the  latter  case  it  is  probable  that 
they  are  often  dependent  upon  the  friction  of  long  vegeta¬ 
tions  hanging  from  the  aortic  valves.  Aneurysms  of  the 
valves  themselves  are  probably  almost  invariably  due  to 
•endocarditis.  In  bringing  these  very  few  remarks  to  a  close 
we  would  express  our  high  sense  of  the  value  of  an  occasional 
■summing  up,  such  as  has  been  provided  in  the  present  in¬ 
stance,  of  our  knowledge  on  abstruse  points  in  medicine  or 
pathology. 


THE  WEEK. 

TOPICS  OF  THE  DAT. 

In  any  other  but  an  eastern  country  it  might  fairly  be 
predicted  that  the  outbreak  of  cholera  in  Egypt  had  reached 
its  climax,  and  was  slowly,  but  gradually,  dying  out.  But 
with  a  knowledge  of  the  objections  (religious  and  personal) 
<of  the  population  to  sanitary  enactments,  or  either  to  en¬ 
forcement  of  them,  it  would  be  hazardous  to  proffer  such 
an  opinion  at  present.  The  correspondent  of  the  Standard 
recently  reported  that  an  examination  of  the  Cairo  water- 
supply  showed  that,  before  its  recent  rise,  the  Nile  was 
-charged  with  animal  organisms  to  such  an  extent,  that  the 


water  resembled  the  product  of  a  stagnant  English  ditch. 
Since  the  rise  of  the  river,  however,  there  has  been  a 
slight  improvement,  but  it  has  now  become  so  muddy 
that  it  is  difficult  to  examine  it.  One  great  defect  of 
the  source  of  the  town  supply  lies  in  the  fact  that 
there  is  only  a  single  receiving-tank,  which,  being  in 
daily  use,  is  never  thoroughly  cleansed.  The  water  of  the 
Khaleeg  Canal,  again,  is  much  worse  than  that  in  the  river, 
and  exhaustive  analyses  of  its  condition  at  various  points 
have  been  ordered  to  be  made.  Surgeon-General  Hunter  is 
stated  to  be  engaged  in  elaborating  a  drainage  scheme  for 
Cairo.  Each  house  is  to  be  provided  with  a  cesspool,  which, 
with  all  connecting  pipes,  will  be  of  glazed  bricks ;  these 
cesspools  will  be  emptied  at  stated  intervals,  and  the  sewage 
carried  away  by  iron  carts,  and  eventually  conveyed  some 
twenty  miles  into  the  desert  by  a  special  line  of  rail.  Who 
or  what  power  is  to  guarantee  the  efficient  working  of  such 
a  system  in  Egypt  ? 

The  Regent’s  Canal,  City,  and  Docks  Railway  (various 
Powers)  Bill  has  passed  the  House  of  Commons  without 
opposition.  In  his  report  upon  it.  Sir  Arthur  Otway  states 
“  that  the  attention  of  the  Committee  had  been  directed  by 
the  Local  Government  Board  to  complaints  which  had  been 
made  respecting  the  sanitary  condition  of  the  canal,  on  the 
ground  that  dead  bodies  of  animals  had  been  allowed  to 
remain  therein,  and  that  in  certain  places  deposits  of  offen¬ 
sive  mud  existed.”  The  Committee  examined  the  chairman 
and  engineer  of  the  Company  upon  the  subject,  and  received 
from  the  former  an  undertaking  that  the  Company  would  do 
all  that  was  reasonable  and  practicable  towards  putting  and 
maintaining  the  canal  in  a  satisfactory  sanitary  condition. 
It  was  also  proved  that  since  the  canal  had  come  into  the 
possession  of  the  present  Company,  on  March  31  last,  they 
had  taken  additional  means  for  scouring  it,  and  that  the  old 
accumulations  of  mud  were  already  in  course  of  removal  by 
dredging. 

The  monthly  return  of  the  Registrar-General  for  Scotland 
for  June  last  shows  that  in  the  eight  principal  towns  of 
North  Britain  there  were  registered  during  the  period  the 
births  of  3661  children  and  the  deaths  of  2547  persons. 
Allowing  for  increase  of  population  this  latter  number  is 
129  above  the  average  for  the  month  of  June  during  the 
past  ten  years.  A  comparison  of  the  deaths  registered  in 
the  eight  towns  shows  that  during  this  month  the  mortality 
was  at  the  annual  rate  of  17  deaths  per  thousand  persons  in 
Leith,  19  in  Edinburgh,  20  in  Aberdeen,  21  in  Perth,  24  in 
Dundee,  27  in  Paisley,  28  in  Greenock,  and  30  in  Glasgow 
Of  the  2547  deaths,  1065,  or  4P8  per  cent.,  were  children 
under  five  years  of  age.  The  miasmatic  order  of  the  zymotic 
class  of  diseases  caused  471  deaths,  and  constituted  18' 5 
per  cent,  of  the  whole  mortality ;  this  rate  was,  however, 
exceeded  in  Glasgow,  Greenock,  and  Leith.  Measles  was  the 
most  fatal  epidemic,  having  caused  173  deaths,  or  6-8  per 
cent,  of  the  whole.  In  Glasgow  10'2,  in  Greenock  12-2, 
and  in  Leith  8  7  per  cent,  of  the  deaths  resulted  from 
measles.  Whooping-cough  proved  the  next  most  fatal  dis¬ 
order,  122  deaths  being  attributed  to  it.  The  deaths  from 
inflammatory  affections  of  the  respiratory  organs  (not  in¬ 
cluding  consumption,  whooping-cough,  or  croup)  amounted 
to  468,  or  18-4  per  cent.  Those  from  consumption  alone 
numbered  331,  or  13'0  per  cent.  One  male  and  four  females 
were  aged  ninety  years  and  upwards,  the  oldest  of  whom  was  a 
widow  ninety-five  years  of  age. 

At  the  Wandsworth  Police-court,  Mr.  Besley  recently 
appeared  on  behalf  of  the  Southwark  and  Yauxhall  Water¬ 
works  Company,  who  had  been  summoned  by  a  householder 
of  Battersea  for  refusing  to  supply  him  with  water.  The  com¬ 
plainant  had  been  before  the  Court  on  many  occasions  in  re¬ 
spect  to  the  supply  which  had  been  cut  off  as  he  was  in  arrears 


216 


Meilca’  Times  and  Gazette. 


THE  WEEK. 


August  25,  1883. 


of  tlie  rate,  and  at  last  a  summons  was  granted.  He  had 
paid  on  the  higher  valuation,  after  objecting  to  it  for  some 
time,  and  the  Company  still  refused  to  furnish  the  supply  of 
water.  Mr.  Besley,  with  reference  to  the  late  decision  of 
Dobbs  v.  the  Grand  Junction  Waterworks  Company,  in  the 
House  of  Lords,  said  that  the  only  fact  they  knew  of  that 
decision  was  that  the  judgment  in  the  Court  of  Queen's 
Bench  was  reinstated,  and  that  was  based  on  a  clause  in  a 
private  Act  of  Parliament  which  did  not  apply  to  the  com¬ 
pany  he  represented.  He  admitted  that  the  water  had  been 
cut  off,  and  the  money  subsequently  tendered,  but  it  was 
not  sufficient.  He,  however,  suggested  that  the  present 
case  should  stand  over  until  the  decision  of  the  House  of 
Lords  was  fully  reported,  since  at  present  they  did  not  know 
what  their  rights  were,  the  water  in  the  meantime  to  be 
furnished,  and  the  amount  tendered  to  be  accepted  without 
prejudice.  This  arrangement  was  ultimately  agreed  to. 

A  largely  attended  meeting  of  delegates  from  the  metro¬ 
politan  lodges  of  the  Labourers’  Union  was  held  on  Saturday 
evening  last,  for  the  purpose  of  considering  the  reply  of  the 
Prime  Minister  to  a  resolution  recently  forwarded  to  him  by 
the  Union  relative  to  the  necessity  of  appointing  a  Royal 
Commission  to  inquire  into  the  present  condition  of  the 
housing  of  the  labouring  classes.  Mr.  Gladstone’s  reply  only 
promised  to  refer  the  matter  to  the  Home  Secretary,  and  the 
president  of  the  meeting  observed  that,  owing  to  the  destruc¬ 
tion  of  dwellings,  the  working  classes  were  compelled  to  herd 
together,  irrespective  of  age,  sex,  or  even  numbers,  within 
the  wretched  hovels  which  were  at  an  easy  distance  from  their 
work  ;  and  in  many  instances  their  rents  had  been  doubled. 
With  the  prospect  of  a  visitation  of  cholera,  the  question  of 
overcrowding  was  a  vital  one ;  and,  as  the  labouring  classes 
would  in  all  probability  be  the  first  to  be  attacked,  no  time 
should  be  lost  in  drawing  attention  to  the  unsanitary  sur¬ 
roundings  of  the  dwellings  of  the  London  poor.  The  follow¬ 
ing  resolution  was  ultimately  adopted  : — “  That  this  meeting 
urgently  draws  the  attention  of  the  Home  Secretary  to  the 
necessity  of  immediately  appointing  a  Commission  to  inquire 
into  the  dwelling  accommodation  of  the  working  classes  of 
the  metropolis,  with  a  view  to  speedy  legislation  thereon, 
and  more  especially  the  operation  of  the  Artisans’  and 
Labourers’  Acts,  which,  whilst  demolishing  thousands  of 
the  homes  of  the  poor,  provides  no  adequate  accommoda¬ 
tion  for  those  compulsorily  disturbed,  and  thus  augments 
the  miseries  of  overcrowding,  to  the  increase  of  vice  and 
immorality  of  every  description,  occasioning  a  state  of  things 
not  to  be  tolerated  by  any  civilised  government,  but  more 
especially  by  a  Government  whose  progressive  programme 
gained  for  it  the  support  of  the  working-classes  at  the  last 
general  election.” 

When  the  rainfall  of  the  past  few  years  and  the  frequent 
complaints  of  wet  weather  this  year  are  taken  into  con¬ 
sideration,  it  appears  somewhat  surprising  to  hear  of  places 
suffering  from  a  water-famine.  But,  in  addition  to  the  break¬ 
down  of  the  arrangements  for  supplying  Richmond  in 
Surrey  with  water,  we  hear  that  in  Northampton,  at  the 
present  time,  there  is  much  suffering  from  water-famine. 
Dor  some  time  past  the  water  has  been  failing,  and  on 
Saturday  last  there  was  no  supply.  On  Sunday  water  was 
only  turned  on  for  a  few  minutes,  and  was  shut  off  again 
before  most  of  the  inhabitants  had  secured  any  supply. 
Monday  showed  no  improvement  in  this  state  of  affairs,  and 
the  poorer  class  of  the  inhabitants  had  recourse  for  drinking- 
water  to  springs,  which,  it  is  alleged,  are  contaminated. 


THE  INDIAN  MEDICAL  SERVICE. 

In  the  House  of  Commons,  on  Thursday  evening,  last  week, 
Mr.  Cross  said,  in  replying  to  a  question  from  Mr.  Gibson,  I 


that  he  had  several  times  explained  the  cause  of  there  being 
a  temporary  excess  of  medical  officers  who  do  not  hold  the 
substantive  appointments  which  command  the  higher  rates 
of  pay  ;  and  he  had  explained  how  the  difficulty  was  being 
met.  It  was  not  probable  that  any  inquiry  could  add  to  the 
Secretary  of  State’s  information  on  the  subject,  and  it  was 
not  proposed  to  make  any  change  in  the  existing  system  by 
which  officers  succeed  to  substantive  medical  charges  in 
India.  Mr.  Gibson,  naturally  not  deeming  this  reply  satis  - 
factory,  gave  notice  that  early  next  session  he  should  call 
attention  to  the  subject,  unless  a  remedy  had  been  applied- 
in  the  meantime. 


LONDON  WATER-SUPPLY. 

The  report  of  Messrs.  Crookes,  Odling,  and  Tidy  on 
the  composition  and  quality  of  daily  samples  of  water 
supplied  to  London  for  the  month  ending  July  31,  states 
that  of  182  samples  of  water  submitted  to  examination,  the- 
whole,  without  exception,  were  clear,  bright,  and  well 
filtered ;  and  that  in  respect  to  aeration,  and  to  general 
freedom  from  colour  and  excess  of  organic  matter,  they  have 
maintained  their  excellent  character,  although  in  one  ex¬ 
ceptional  sample  the  proportion  of  organic  matter  present 
was  in  excess  of  what  is  customary  at  this  season  of  the  year. 
They  find  great  fault  with  Dr.  Frankland’s  report  to  the- 
Registrar-General,  and  with  his  method  of  estimating  the 
“  organic  impurity  ”  in  the  riverian  water.  Thus  they 
observe  that,  in  his  report  for  the  month  of  June,  “it  is. 
stated  that  the  river-derived  waters  supplied  to  London 
contained  from  nearly  two  to  two-and-three-quarter  times 
as  much  f  organic  impurity  ’  as  a  certain  well-water  standard 
peculiar  to  the  reporter.  As  usual,  it  is  not  thought  ad¬ 
visable  to  point  out  that,  measured  by  the  same  peculiar- 
standard,  the  c  organic  impurity  ’  of  the  highly  reputed 
Loch  Katrine  water  supplied  to  Glasgow  is,  according  to  the 
reporter’s  own  figures,  in  excess  of  that  present  in  the  Grand 
Junction,  Chelsea,  West  Middlesex,  Lambeth,  and  East 
London  Companies’  waters,  and  is  double  that  present  in  the- 
New  River  Company’s  water.”  The  three  reporters  then  go¬ 
on  to  say  : — “We  would  renew  our  protest  against  the  use 
of  this  misleading  scale  of  implied  unwholesomeness,  and 
the  partisan  purposes  it  is  skilfully  made  to  subserve — a 
protest  especially  called  for  at  the  present  time,  when  the 
possible  spread  of  cholera  to  the  United  Kingdom  has  directed 
unusual  attention  to  questions  of  water-supply,  and  more- 
particularly  to  the  supply  of  the  metropolis.  Now,  either  this, 
supply  is  wholesome  and  suitable,  as  well  during  periods- 
of  epidemic  as  at  other  periods,  or  it  is  unwholesome,  and 
therefore  unsuitable.  The  present  sources,  if  unwholesome,, 
ought  clearly  to  be  abandoned,  at  almost  any  cost.  But  if 
these  sources,  from  which  water  has  been  supplied  con¬ 
tinuously  to  the  largest  and  one  of  the  healthiest  among 
great  cities,  are  determined  by  competent  and  impartial' 
authority  to  be  wholesome,  it  would  seem  scarcely  fitting 
that  an  official  reporter,  whatever  the  earnestness  of  his 
personal  convictions,  should,  by  appealing  to  an  arbitrary 
scale  of  his  own  invention,  and  with  the  object  of  enforcing 
his  own  individual  view,  subject  these  sources  to  persistent 
disparagement,  and  thereby  create  the  unfounded  alarms 
that  were  so  strongly  deprecated  by  the  Royal  Commission, 
who  last  inquired  into  the  water-supply  of  London.  The- 
public  ought  persistently  to  bear  in  mind,  and  make  due- 
allowance  for  the  fact,  that  the  monthly  reports  to  the 
Registrar-General  are  furnished  by  a  chemist  eminently 
hostile  to  the  present  riverian  supply ;  and  one  whose  views 
and  startling  modes  of  statement  were  alike  discountenanced! 
by  the  late  Royal  Commission  when  having  his  reports  and 
evidence  under  consideration.”  Altogether,  the  public  must 
feel  very  helpless  in  this  pretty  quarrel  between-  the  water 


Medical  Times  and  Gazette. 


THE  WEEK. 


August  25,  1883.  217 


examiners,  and  must  be  much  puzzled  to  know  what  to  think 
about  the  character  of  the  water-supply.  It  is  only  fair  to  note 
that  Messrs.  Crookes,  Odling,  and  Tidy  are  men  of  marked 
position,  and  that  in  their  report,  which  is  addressed  to  “The 
Water  Examiner,  Metropolis  Water  Act,  1871,”  they  say, 
“  Our  examinations  are  made,  as  you  are  aware,  under  in¬ 
structions  from  the  water  companies  ;  the  collection  of 
samples,  however,  as  well  as  the  methods  of  analysis,  and 
the  form  of  publication  of  the  results,  being  left  entirely  to 
ourselves,  the  companies  taking  no  part  in  the  matter  beyond 
bearing  the  expenses.” 


THE  ARMY  MEDICAL  DEPARTMENT. 

The  following  is  a  list,  in  order  of  merit,  of  the  twenty  can¬ 
didates  who  were  successful  for  appointments  as  Surgeons 
in  Her  Majesty’s  British  Medical  Service  at  the  competitive 
examination  in  London  on  August  13,  with  the  number  of 
marks  obtained  by  each  :  — 


O.  G.  D.  Bradshaw 

Marks. 

.  2410 

F.  S.  Henston  .  . 

Marks. 
.  2100 

M.  Kelly  .... 

.  2375 

R.  J.  A.  Durant 

.  2055 

H.  H.  Pinching  .  . 

.  2355 

G.  F.  Gubbin  .  . 

.  2030 

R.  J.  Geddes  .  .  . 

.  2350 

J.  P.  Myles  .  .  . 

.  1980 

W.  Kelly  .... 

.  2185 

R.  Lesly  .... 

.  |  1975 

D.  V.  O’Connell  . 

.  2170 

H.  P.  Birch  .  .  . 

.  1  1975 

A.  Dodd  .... 

.  2140 

M.  O’D.  Braddell  . 

.  1880 

G.  Wilson  .  .  . 

.  2121 

J.  J.  C.  Donnett 

.  1870 

J.  M.  Reid  .  .  . 

.  (  2105 

H.  M.  Sloggett  .  . 

.  1845 

T.  B.  Winter  .  . 

.  \  2105 

C.  S.  Robinson  .  . 

.  1755 

CEREBRAL  LOCALISATION. 

The  centre  for  movements  of  the  thumb  has  been  indicated 
on  more  than  one  occasion  by  the  autopsy  of  a  patient  who 
had  had  paralysis  limited  to  the  thumb,  and  we  now  have, 
at  the  hands  of  M.  Lepine  ( Revue  de  Medecine,  July,  1883), 
pathological  evidence  brought  before  us  of  the  site  of  the 
centre  for  the  movements  of  the  fingers.  The  case  in 
question  was  that  of  a  young  woman  the  subject  of  phthisis, 
in  whom  partial  paralysis  of  the  right  arm  supervened 
suddenly  one  night,  the  movements  of  flexion  and  extension 
of  the  hand  being  lost,  as  also  those  of  the  fingers,  but  the 
thumb  showed  no  loss  of  power  at  all.  There  was  no  impair¬ 
ment  of  sensation  in  the  hand.  The  patient  died  the  next  day, 
and  at  the  post-mortem  examination  there  was  found  on  the 
external  aspect  of  the  left  hemisphere  a  group  of  tubercular 
granulations,  forming  a  mass  about  the  size  of  a  bean,  situated 
in  the  furrow  which  separates  the  ascending  parietal  con¬ 
volution  from  the  parietal  lobule ;  it  was  four  centimetres 
from  the  median  fissure  between  the  two  hemispheres,  and 
five  centimetres  from  the  fissure  of  Sylvius.  It  was  situated 
in  the  meninges,  and  was  easily  stripped  off  with  these  from 
the  surface  of  the  brain.  At  the  point  where  it  rested  there 
was  a  cup-shaped  depression  of  the  grey  matter,  but  no  loss 
of  substance,  and  it  must  therefore  be  presumed  that  the 
symptoms  were  due  to  the  anaemia  caused  by  the  pressure. 
Tubercular  affections  of  the  brain  are  so  frequently  multiple 
or  widely  diffused  that  it  is  not  often  they  can  be  of  much 
use  in  advancing  our  knowledge  of  the  functions  of  the 
different  parts  of  the  cerebral  cortex.  The  present  case  is 
therefore  unusual  in  that  respect  as  well  as  in  the  site  of 
the  lesion. 


OPENING  OF  THE  NORFOLK  AND  NORWICH  HOSPITAL. 

On  Monday  last  the  new  buildings  of  the  Norfolk  and 
Norwich  Hospital,  the  foundation-stone  of  which  was  laid 
by  the  Prince  and  Princess  of  Wales  in  July,  1879,  were 
publicly  opened  by  the  Duke  and  Duchess  of  Connaught, 
in  the  presence  of  a  large  assembly  of  spectators.  The 
usual  formalities  having  been  gone  through,  terminating 
with  an  address  to  their  Royal  Highnesses,  a  specially 


designed  silver  key  was  presented  to  the  Duke  as  a  memento- 
of  the  day’s  proceedings,  and  also  a  handsomely  bound  little 
work  giving  an  account  of  the  birth  and  parentage  of  the- 
new  Hospital.  In  acknowledging  the  address,  the  Duke 
of  Connaught  congratulated  the  assembly  on  the  comple¬ 
tion  of  such  an  important  hospital,  built  with  all  the  im¬ 
provements  which  modern  science  could  suggest.  It  was 
gratifying,  he  said,  to  reflect  on  the  immense  amount  of  good 
which  the  former  Hospital  had  already  conferred  on  the 
sick  and  maimed  of  the  county  and  city,  and,  under  Divine¬ 
blessing,  he  hoped  that  the  present  Hospital  might  prove  as- 
great  a  benefit  in  the  future  as  the  former  one  had  been  in  the- 
past.  The  Duke  having  formally  declared  the  new  buildings- 
open,  the  Royal  party  inspected  the  occupied  wards,  as  wel 
as  the  west  portion  of  the  Hospital.  They  next  visited  a 
bazaar,  on  a  very  extensive  scale,  which  was  being  held  in 
the  east  portion  of  the  institution,  with  the  view  of  raising. 
<£5000 — the  sum  still  required  to  clear  the  new  buildings, 
from  debt,  their  total  cost  having  been  about  .£57,000.  To- 
this  bazaar  the  Prince  of  Wales  had  contributed  a  num¬ 
ber  of  valuable  birds  and  animals  from  his  collection  at 
Sandringham. 

THE  SOUTHALL  PARK  DISASTER. 

Dr.  Diplock  has  decided  that  the  fragments  of  calcined1 
human  bones  discovered  among  the  ruins  of  the  Southall 
Lunatic  Asylum  are  not  sufficient  to  justify  him  in  holding 
an  inquest  upon  them.  It  is  understood  that  Dr.  McDonald,, 
who  has  sedulously  watched  the  search  among  the  ruins,, 
was  of  opinion  that  the  discovery  of  some  of  the  vertebral, 
bones  was  enough  to  justify  the  opening  of  an  inquest ;  but 
Dr.  Diplock  holds  “  that  inquests  cannot  be  taken  upon  the- 
bones  of  the  persons  found  in  the  ashes  of  the  house.”  It 
is  said  that  the  Commissioners  in  Lunacy  will  institute  an 
inquiry  into  the  water-supply  and  appliances  for  extinguish¬ 
ing  fire  at  Southall  Park.  Since  we  last  wrote  upon  this- 
subject  it  has  been  authoritatively  stated  that  within  a  few 
yards  of  the  house  there  is  a  well,  which  has  never  been 
known  to  fail  in  the  driest  summers,  and  from  which  a  con¬ 
stant  stream  of  water  had  been  thrown  on  the  burning- 
ruins  by  a  double  manual  pump  for  two  days  and  nights- 
without  once  failing.  But  unfortunately  the  existence  of 
this  well  was  not  thought  of  at  the  time  of  the  fire. 


THE  PARIS  WEEKLY  RETURN. 

The  number  of  deaths  for  the  thirty-second  week  of  1883- 
terminating  August  8,  was  998  (518  males  and  480  females),, 
and  of  these  there  were  from  typhoid  fever  37,  small-pox. 
4,  measles  30,  scarlatina  5,  pertussis  13,  diphtheria  and 
croup  24,  erysipelas  5,  and  puerperal  infections  5.  There- 
were  also  49  deaths  from  tubercular  and  acute  meningitis,. 
183  from  phthisis,  22  from  acute  bronchitis,  39  from  pneu¬ 
monia,  136  from  infantile  athrepsia  (42  of  the  infants  having 
been  wholly  or  partially  suckled),  and  3S  violent  deaths  (33- 
males  and  5  females).  The  mortality  still  keeps  low,  but  it 
is  the  normal  mortality  of  this  time  of  the  year ;  for  the  mean 
of  the  same  week  for  the  last  five  years  also  gives  998  deaths,, 
or  23T7  per  1000  of  inhabitants  of  Paris.  This  proportion,, 
however,  calculated  on  the  census  taken  two  years  ago(  since- 
when  the  population  has  increased),  is  somewhat  higher  than- 
the  reality.  Typhoid  fever  has  caused  7  more  deaths  than 
during  the  present  week,  while  the  admissions  have  risen 
from  98  to  132 ;  the  admissions  for  diphtheria  also  having 
risen  from  19  to  30.  The  births  for  the  week  amounted  to- 
1268,  viz.,  645  males  (481  legitimate  and  164  illegitimate) 
and  623  females  (460  legitimate  and  163  illegitimate)  :  92: 
infants  were  either  born  dead  or  died  within  twenty-four- 
hours,  viz.,  52  males  (38  legitimate  and  14  illegitimate)  andi 
40  females  (27  legitimate  and  13  illegitimate). 


218 


Medical  Times  and  Gazette. 


THE  WEEK. 


August  25,  1883. 


THE  RICHMOND  WATER-SUPPLY. 

The  utter  failure  of  the  arrangements  for  supplying  Bich- 
mond,in  Surrey,  with  water  has  made  itself  painfully  notorious 
•during  the  last  few  days.  For  two  whole  days  we  learn  that 
the  greater  part  of  the  town  was  left  entirely  without  water, 
and  some  portions  for  four  or  five  days.  It  is  unnecessary 
to  point  out  the  great  dangers  to  public  health  that  are 
likely  to  arise  from  a  dearth  of  water,  especially  at  the 
present  season  of  the  year.  It  appears  that  the  Yestry  have 
been  for  some  years  past  engaged  in  sinking  a  new  artesian 
■well  to  supplement  the  existing  source,  and  after  the  ex¬ 
penditure  of  a  very  large  sum  of  money  they  were  unable 
to  give  any  estimate  as  to  the  time  when  the  water  would 
probably  be  reached.  IJnder  these  circumstances  it  is  not 
•surprising  to  find  that  public  opinion  is  being  roused  in  the 
town,  and  that  a  meeting  of  ratepayers  will  shortly  be  held 
to  endeavour  to  obtain  a  Government  inquiry  as  to  the  mis¬ 
management  of  the  town. 


NEW  SYDENHAM  SOCIETY. 

'The  twenty-fifth  annual  meeting  of  this  Society  was  held 
in  Liverpool  on  the  3rd  inst.,  when  the  following  report  was 
presented  and  adopted : — “  In  presenting  their  report  for 
the  past  year  the  Council  has  little  to  state  beyond  the 
record  of  the  works  published,  and  the  announcement  of 
those  in  preparation.  The  production  of  the  Lexicon  of 
Medical  Terms  has  been  continued  with  as  much  speed  as 
■circumstances  have  permitted,  and  two  numbers  have,  as 
usual,  been  issued  during  the  year.  The  issue  for  the 
•current  year  will  probably  consist  of — a  fasciculus  of 
the  Atlas  of  Pathology;  selections  from  the  Works  of 
Duchenne  (of  Boulogne),  edited  by  Dr.  Vivian  Poore ;  two 
or  more  parts  of  the  Lexicon  of  Medical  Terms ;  the 
first  volume  of  Hirsch’s  work  on  Historico-Geographical 
Pathology,  translated  by  Dr.  Creighton;  a  volume  of 
Selected  Monographs,  of  which  Senator  on  Albuminuria 
and  Landau  on  Movable  Kidney  will  form  part.  The 
works  which  have  been  issued  during  the  past  (twenty- 
fourth)  year  are  the  following : — 98.  Stokes  on  Diseases  of 
the  Chest;  99.  Atlas  of  Portraits  of  Skin  Diseases,  fasciculus 
xvi. ;  100.  The  Collected  Works  of  Dr.  Warburton  Begbie  ; 
101.  Lexicon  of  Medical  Terms,  part  vii. ;  102.  Charcot, 
Localisation  of  Cerebral  Disease  ;  103.  Lexicon,  part  viii. 
Amongst  those  which  are  in  preparation  are — a  fasciculus  of 
the  Atlas  of  Portraits  of  Skin  Diseases  ;  the  Collected  Works 
•of  Dr.  Peacock,  with  memoir  and  portrait;  one  or  more 
volumes  of  Selected  Clinical  Lectures  from  German  sources. 
The  Society’s  accounts  for  the  year  have  been  audited  as 
•usual,  and  a  balance-sheet  prepared.”  The  following  is  the 
list  of  officers  for  1883-84 : — President :  ^William  Bowman, 
Esq.,  F.E.S.,  LL.D.  Vice-Presidents :  *Henry  W.  Acland, 
M.D.,  F.B.S.,  LL.D.,  Oxford;  G.  W.  Balfour,  M.D.  Edin¬ 
burgh;  Bobert  Barnes,  M.D.;  #E.  B.  Bickersteth,  Esq., 
Liverpool;  W.  H.  Broadbent,  M.D. ;  John  Cleland,  M.D., 
Glasgow;  Sir  W.W.  Gull,  M.D.  ,F.B.S.,  Bart.;  Joseph  Lister, 
Esq.,  F.B.  S.  ;  Sir  William  Mac  Cormac ;  Bobert  McDonnell, 
A.B.,  M.D.,  Dublin  :  Sir  James  Paget,  F.B.S.,  LL.D.,  Bart. ; 
*Sir  G.  H.  Porter,  M.D.,  Dublin;  *  James  Bussell,  M.D., 
Birmingham;  William  Eutherford,  M.D.,  F.E.S.,  Edin¬ 
burgh;  Hermann  Weber,  M.D. ;  Sir  T.  Spencer  Wells,  Bart. 
Council :  James  Andrew,  M.D. ;  J.  H.  Aveling,  M.D. ;  Thos. 
Barlow,  M.D. ;  *Eichard  Barwell,  Esq. ;  B.  L.  Bowles,  M.D., 
Folkestone;  *J.  Crichton  Browne,  M.D. ;  Lauder  Brunton, 
M.D.,  F.B.S. ;  Thomas  Buzzard,  M.D. ;  *W.  B.  Clieadle, 
M.D. ;  W.  Cholmeley,  M.D. ;  W.  Clement  Daniel,  M.D., 
Epsom;  J.  Langdon  H.  Down,  M.D.;  J.  Matthews  Duncan, 
M.D. ;  John  Easton,  M.D. ;  Balthazar  Foster,  M.D.,  Bir¬ 
mingham  ;  *T.  F.  Grimsdale,  Esq.,  Liverpool;  C.  J.  Hare, 


M.D. ;  G.  E.  Herman,  M.D. ;  T.  B.  Jessop,  Esq.,  Leeds; 
Thomas  Keith,  M.D.,  Edinburgh;  *G.  H.  Kidd,  M.D., 
Dublin ;  Stephen  Mackenzie,  M.D. ;  #S.  W.  North,  Esq., 
York  ;  W.  B.  Page,  Esq.,  Carlisle  ;  William  Eoberts,  M.D., 
Manchester;  G.  H.  Savage,  M.D. ;  J.  W.  F.  Smith-Shand, 
M.D.,  Aberdeen ;  Septimus  W.  Sibley,  Esq.  ;  *E.  B. 
Townsend,  M.D.,  Cork;  *C.  Whipple,  Esq.,  Plymouth. 
Treasurer:  W.  Sedgwick  Saunders,  M.D. ,  13,  Queen-street, 
Cheapside,  E.C.  Auditors  :  E.  Clapton,  M.D. ;  S.  Fenwick, 
M.D.,  F.  M.  Corner,  Esq.  Honorary  Secretary  :  Jonathan 
Hutchinson,  Esq.,  F.B.S.,  15,  Cavendish-square,  W.  (Those 
marked  with  an  asterisk  were  not  in  office  last  year.) 


THE  ZYMOTIC  DEATH-RATE  IN  ENGLISH  HEALTH-RESORTS. 

In  accordance  with  his  usual  custom,  the  Begistrar-General 
for  England,  in  his  return  for  the  June  quarter  of  the  present 
year,  gives  the  statistics  of  mortality  for  forty-six  of  the 
English  holiday-  and  health-resorts.  The  mean  annual  death- 
rate  in  the  forty-six  health-resorts  during  the  second  quarter 
of  the  present  year  was  17'9,  and  the  zymotic  rate  1'28  per 
1000.  These  rates  contrast  favourably  not  only  with  those 
for  all  England  and  Wales  (which  were  20  J  and  18-9  respec¬ 
tively),  but  also  with  those  of  the  rural  districts  generally. 
The  rates  last  quarter  in  England  and  Wales,  exclusive  of 
the  seventy-eight  chief  towns  or  urban  districts,  were  19-2 
from  all  causes,  and  l-7  from  the  principal  zymotic  dis¬ 
eases.  It  is  but  just  to  these  health-resorts,  the  Begistrar- 
General  observes,  to  note  that  their  death-rates  are,  doubt¬ 
lessly,  in  some  degree  higher  than  they  would  otherwise 
be,  owing  to  the  very  fact  of  their  being  health-resorts,  or 
places  to  which  persons  in  weak  health  flock  in  consider¬ 
able  numbers  in  the  hope  of  receiving  benefit ;  but,  again, 
this  affects  the  general  death-rate  much  more  than  the 
death-rate  from  zymotic  diseases.  The  zymotic  death-rate 
per  1000  was  O’OO  in  Deal  and  Walmer,  Littlehampton, 
Bognor,  Tenby,  and  Harrogate.  It  was  under  l’OO  per 
1000  in  Whitby,  Yarmouth,  Southend,  Herne  Bay,  Margate, 
Dover,  Hastings  and  St.  Leonards,  Eastbourne  and  Seaford, 
Brighton,  Exmouth,  Teignmouth  and  Dawlish,  Torquay, 
Ilfracombe,  Beaumaris,  Llandudno,  Ehyl,  Southport,  Black¬ 
pool  and  Fleetwood,  Clifton,  Malvern,  Leamingfon,  and 
Buxton.  In  Lowestoft,  however,  it  was  2-23,  mainly  owing 
to  measles  ;  in  Bamsgate,  2  24,  chiefly  from  “  fever  ”;  in 
Folkestone,  4'95  ;  in  Aberystwith,  3-ll ;  and  in  Bangor,  8" 48 
— in  each  case  mainly  due  to  the  mortality  from  whooping- 
cough.  In  the  remainder  of  the  forty-six  watering-places 
the  zymotic  death-rate  was  over  1*00  and  under  2-00. 


THE  ERENCH  ASSOCIATION  TOR  THE  ADVANCEMENT  OE 

SCIENCE. 

This  body  opened  its  twelfth  session  at  Bouen  on  the  16th 
inst.,  the  meeting  being  attended  by  great  numbers, 
although  not  by  many  of  the  leaders  in  science.  Medicine, 
as  usual,  was  chiefly  represented  by  Prof.  Verneuil,  M. 
Despres  having  declined  the  invitation  to  what  he  terms  the 
“scientific  fair.”  M.  Masson,. the  treasurer  of  the  Associa¬ 
tion,  gave  a  flattering  account  of  its  financial  position,  its 
annual  income  and  capital  having  greatly  increased,  while 
it  was  able  to  vote  13,000  fr.  for  scientific  grants.  Com 
paring  the  progress  of  this  Association  with  that  of  the 
British,  upon  which  it  was  modelled,  M.  Masson  pointed  out 
that  the  capital  of  the  two  Associations  was  nearly  the  same, 
although  the  British  has  reached  the  fifty-second  year  of  its 
existence,  while  the  French  is  only  just  entering  upon  its 
teens.  And  while  the  British  Association  only  numbers 
3500,  the  French  has  already  4000  adherents.  “  When  we 
have  reached  our  fifty-second  year,”  M.  Masson  went  on  to 
say  with  the  enthusiasm  befitting  the  eulogist  of  so  youth- 


Medical  Times  and  Gazette. 


THE  WEEK. 


August  25,  1883.  2  1  91 


ful  an  institution,  “  we  shall  certainly  be  able  to  dispose  of 
a  capital  of  several  millions ;  and  the  French  Association, 
which  already  draws  to  its  bosom  so  large  a  number  of 
illustrious  personalities,  will  enjoy  an  immense  influence 
over  the  scientific  progress  of  our  country,  and  consequently 
of  the  entire  world.”  Heartily  do  we  hope  that  the  Associa¬ 
tion,  at  the  end  of  the  half-century  thus  prevised,  may  feel 
none  of  the  damping  effects  of  old  age  ! 


LESIONS  OF  THE  FOOT  IN  TABES. 

The  changes  which  take  place  in  the  long  bones  and  large 
joints  of  the  body  in  tabes  are,  thanks  to  the  labours  of 
Charcot,  now  universally  known  and  recognised.  To  these 
we  have  now  to  add  a  somewhat  similar  affection  of  the 
bones  of  the  foot  owning  the  same  cause.  At  a  recent 
meeting  of  the  Societe  Anatomique  de  Paris  ( Progres 
Medical,  18S3,  Ho.  31),  MM.  Charcot  and  Fere  read  a  com¬ 
munication  on  "  The  Tabetic  Foot.”  The  clinical  cha¬ 
racters  of  this  condition  are  briefly  the  following  : — The 
inner  border  of  the  foot  shows  a  considerable  thickening 
from  the  ankle  to  the  tarso-metatarsal  articulation  or  there¬ 
abouts,  so  that  the  arch  of  the  foot  disappears ;  the  meta¬ 
tarsus  appears  to  be  dislocated  outwards,  so  that  an  angular 
projection  is  formed  on  the  inner  side  of  the  foot.  Pain  is 
hardly  ever  present,  and  neither  redness  nor  crepitation  in  the 
joints  has  been  hitherto  recognised.  MM.  Charcot  and  Fere 
have  had  the  opportunity  of  examining  one  foot  post-mortem, 
when  they  found  that  the  inferior  articular  surface  of  the 
astragalus  and  the  articular  surface  of  the  os  calcis  were 
eroded  and  worn,  their  margins  presenting  small  vegetations ; 
there  was  a  transverse  fracture  of  the  astragalus  through 
the  neck ;  the  scaphoid  and  cuboid  were  so  much  worn  as 
to  be  hardly  recognisable.  The  first  cuneiform  bone  was 
increased  in  thickness  from  above  downwards,  as  also  was 
the  first  metatarsal  bone,  to  which  it  was  anchylosed.  The 
second  cuneiform  bone  was  likewise  distorted  and  anchylosed 
to  the  second  metatarsal  bone.  The  third  cuneiform  bone 
was  represented  simply  by  a  number  of  small  fragments. 
All  the  bones  of  the  tarsus  and  metatarsus  had  a  spongy 
appearance,  and  were  unusually  light  and  friable. 


TYPHOID  FEVER  AT  A  WATERING-PLACE. 

Dr.  Blaxall  has  recently  inquired  into  an  outbreak  of 
typhoid  fever  which  was  believed  to  have  originated  in  a 
lodging-house  at  Weston-super-Mare,  and  has  made  a  report 
to  the  Local  Government  Board  on  the  sanitary  condition  of 
the  lodging-houses  generally  in  that  town.  The  facts  in 
regard  to  the  outbreak  are  very  simple.  Two  families 
coming  from  different  parts  of  the  country  spent  a  portion 
of  last  summer  in  the  same  lodging-house  in  Weston-super- 
Mare.  One  family  left  on  August  8.  the  other  on  August  10. 
Out  of  the  fourteen  persons  in  these  two  families  no  less 
than  eight  were  attacked  with  typhoid  fever  within  fifteen 
days  of  leaving  Weston,  and  three  cases  proved  fatal.  There 
was  no  reason  to  believe  that  in  either  instance  the  disease 
was  contracted  after  the  family  left  Weston,  and  the  fact 
that  both  families  occupied  the  same  house  at  the  same  time 
pointed  strongly  to  it  as  the  probable  source  of  infection. 
The  result  of  the  investigation  into  the  sanitary  condition 
of  this  lodging-house  disclosed  the  fact  that  a  closet  situated 
in  the  back  yard,  and  discharging  into  the  sewer,  was  unpro¬ 
vided  with  any  water  for  flushing.  The  water-supply  of  the 
house  was  derived  from  a  pump  in  the  scullery,  the  water 
from  which  was  analysed  by  the  local  medical  officer  of 
health  as  soon  as  the  cases  of  typhoid  fever  were  brought 
under  his  notice,  and  found  to  be  contaminated,  the  well 
was  thereupon  closed.  The  drain  from  the  scullery  sink  re¬ 
ceived  the  soil-pipe  from  the  indoor  water-closet,  and  opened 


into  an  eject  which  also  received  the  soil-pipe  from  the 
closet  in  the  yard.  This  eject  was  built  of  brick  and  covered 
in.  On  being  opened  it  was  found  to  be  filled  with  offensive 
decomposing  excrement,  the  soil-pipe  leading  into  it  being 
completely  blocked.  Unfortunately,  Dr.  Blaxall  was  unable 
to  ascertain  the  exact  relation  of  the  sink-drain  to  the  well,  as 
the  landlord  would  not  permit  the  latter  to  be  reopened ;  but 
there  could  be  very  little  doubt  that  the  former  was  the  cause 
of  the  contamination  of  the  well-water.  Dr.  Blaxall  learnt 
that  in  houses  in  the  same  row  the  wells  were  much  influenced 
by  the  tide,  the  water  in  them  falling  with  the  rising  tide, 
and  rising  again  with  the  fall  of  the  tide.  Ho  other  cases 
of  typhoid  fever  were  known  to  have  occurred  in  Weston 
for  several  months  previously,  so  that  the  disease  would 
seem  to  have  originated  in  that  particular  house.  Two- 
other  points  are  worth  noting  as  bearing  on  the  cause  of  the- 
outbreak,  viz. 1.  This  was  the  only  house  in  the  row 
using  well-water.  The  wells  belonging  to  the  other  houses 
had  previously,  at  different  times,  been  found  contaminated. 
2.  A  third  family,  who  were  staying  in  the  same  lodging- 
house  during  the  same  period,  refrained  from  drinking  the- 
water,  and  were  none  of  them  attacked  with  typhoid  fever. 
The  conclusion,  then,  is  almost  irresistible  that  the  outbreak 
was  due  to  the  use  of  contaminated  well-water  for  drinking 
purposes,  but  as  to  how  the  specific  typhoid  fever-poison  (if 
there  be  such)  made  its  way  into  this  water  there  is  no- 
evidence  to  show. 


THE  SANITARY  INSTITUTE  OF  GREAT  BRITAIN. 

The  Autumn  Congress  for  1883  of  the  Sanitary  Institute  of 
Great  Britain  will  be  held  at  Glasgow,  from  September  25 
to  29,  in  the  St.  Andrew’s  Halls,  under  the  presidency  of 
Professor  G.  M.  Humphry,  M.D.,  F.R.S.,  who  will  deliver 
the  opening  address  on  Tuesday,  September  25,  at  8  p.m. 
The  Congress  will  be  divided  into  three  sections  : — I.  Sani¬ 
tary  Science  and  Preventive  Medicine  :  President,  Professor 
W.  T.  Gairdner,  M.D.,  LL.D. ;  Hon.  Secretaries,  Councillor 
J.  A.  Russell,  M.A.,  M.B.,  B.Sc.,  Kenneth  M.  Maeleod, 
James  Christie,  A. M  ,  M.D.  II.  Engineering  and  Architec¬ 
ture  :  President,  Professor  T.  Roger  Smith,  F.R.I.B.A.  j 
Hon.  Secretaries,  H.  H.  Collins,  F.R.S.,  B.A.,  Alexander 
Frew,  C.E.,  A.  Lindsay  Miller,  architect.  III.  Chemistry, 
Meteorology,  and  Geology :  President,  R.  Angus  Smith, 
Ph.D.,  F.R.S. ;  Hon.  Secretaries,  W.  R.  E.  Coles,  James  J. 
Dobie,  D.Sc.,  A.  Buchanan,  M.A.,  F.R.S.E.,  J.  B.  Murdoch- 
The  Council  invite  papers  on  the  subjects  belonging  to  the- 
several  sections,  and  will  welcome  the  personal  co-operation 
and  support  of  all  who  are  interested  in  the  diffusion  of 
sanitary  knowledge. 


It  was  officially  stated  in  the  House  of  Commons,  on 
Thursday  last  week,  that  Surgeon- General  Hunter,  M.D.,. 
who  was  sent  out  to  Egypt  by  the  Government,  has  instruc¬ 
tions  to  report  on  the  whole  subject  of  the  cholera  outbreak 
there,  and  that  his  reports  will  be  presented  to  Parliament. 


The  Government  having  proved  powerless  to  so  regulate- 
the  course  and  progress  of  business  in  the  House  of  Commons 
as  to)  afford  time  and  opportunity  for  a  discussion  on  the 
Report  of  Lord  Morley’s  Committee,  Mr.  Gibson  has  given 
notice  that  he  will  call  attention  to  the  Report  early  next 
session.  _ 

The  fifty-third  annual  meeting  of  the  British  Association 
for  the  Advancement  of  Science  will  be  held  at  Southport 
from  September  19  to  27.  Dr.  Cayley,  Sadlerian  Professor 
of  Mathematics  in  the  University  of  Cambridge,  is  President 
for  the  year. 


220 


Medical  Times  and  Gazette. 


MEDICAL  MATTEES  IN  PARLIAMENT. 


August  25, 1833. 


The  sum  of  830,000  marks,  subscribed  by  Germany  as  a 
compliment  to  the  Crown  Prince  and  Princess  on  the 
•occasion  of  their  silver  wedding,  has  been  appropriated  for 
vthe  benefit  of  various  sanitary  and  benevolent  institutions 
dn  Germany. 

Two  chemists  at  Nottingham  have  been  fined  £5  each, 
•on  a  prosecution  by  the  Health  Committee  of  the  Corpora¬ 
tion,  for  having  sold  adulterated  lime-water.  On  analysis, 
dhe  lime-water  was  found  to  be  deficient  in  lime  to  the 
•extent  of  over  40  per  cent.  Both  the  defendants  pleaded 
•guilty.  _ 

A  case  of  death  from  a  wasp  sting  has  just  occurred  in 
t.he  person  of  Miss  Arkwright,  aged  fifty-five,  of  Mark  Hall, 
aiear  Harlow,  who  died  within  half  an  hour  after  receiving 
the  sting  on  her  little  finger.  At  the  inquest  it  was  stated 
that  she  fainted  almost  immediately  after  being  stung,  and 
aiever  recovered  consciousness.  Dr.  Day  deposed  that  death 
nsued  from  syncope,  produced  from  excessive  pain  caused 
iby  the  wasp  sting. 


Infants’  Foods. — A  lecture  on  this  subject,  delivered 
before  the  College  of  Physicians,  Philadelphia,  by  Dr. 
Deeds,  and  published  in  full  detail  in  the  Phil.  Med.  News, 
July  21,  is  terminated  by  the  following  conclusions: — 
I.  Cow’s  milk  is  in  no  sense  a  substitute  for  woman’s  milk. 
.2.  Attenuation  with  water  alone  is  inadequate,  and  chemical 
metamorphosis  or,  mechanically,  the  addition  of  some  inert 
-attenuant  is  required,  in  order  to  permit  of  the  ready  diges¬ 
tibility  of  cow’s  milk.  3.  The  utility  of  manufactured  in¬ 
fants’  foods  is  to  act  as  such  attenuants,  and  as  such  they 
fake  the  place  of  simple  barley-  or  oatmeal-water,  sugar, 
•cream,  arrowroot,  etc.,  used  in  former  times.  4.  The  results 
•of  both  chemical  and  physiological  analysis  are  opposed  to 
.any  but  a  sparing  use  of  preparations  containing  large  per¬ 
centages  of  starch.  5.  It  is  eminently  probable  that,  besides 
acting  as  attenuants,  the  matters  extracted  in  the  prepara¬ 
tion  of  barley-  and  oatmeal- water,  and  still  more  the  soluble 
•albuminoid  extractives  obtained  at  ordinary  temperatures 
•.(whereby  coagulation  is  prevented)  by  Liebig’s  process,  have 
a  great  independent  value  of  their  own.  For  this  reason, 
instead  of  employing  starch,  gum,  gelatine,  sugar,  etc.,  the 
"use  of  a  natural  cereal  extractive,  containing  saccharine  and 
-gummy  matters  and  soluble  albuminoids  as  well,  such  as  our 
great  and  inspired  leader,  Liebig,  himself  advocated,  is  in 
accordance  with  the  development  of  science  since  his  death. 
6.  The  use  of  food  made  of  equal  parts  of  milk,  cream,  lime- 
water,  and  weak  arrowroot-water,  as  employed  for  years  by 
Dr.  Meigs,  is  sustained  by  theory,  analysis,  and  practice. 
Tt  provides  for  the  increase  of  fat  to  an  amount  comparable 
■to  that  contained  in  human  milk.  It  adds  alkali  to  perma- 
sient  reaction,  and  to  convert  casein  into  soluble  albu¬ 
minates.  It  adds  a  little  bland  attenuant.  And  if,  in 
addition,  the  amount  of  milk-sugar  were  raised,  and,  instead 
of  arrowroot-water,  barley-  or  oatmeal-water  were  substi¬ 
tuted,  as  the  case  demanded,  it  would  approach  still  more 
nearly  to  the  conditions  required. 

A  Medical  Census  at  Paris.— The  Prefet  de  Police 
•of  Paris  has  had  an  exact  census  taken  of  all  the  prac¬ 
titioners  in  Paris  at  the  present  time.  There  are  in  Paris 
and  the  communes  of  the  department  of  the  Seine  1915 
-doctors  of  medicine,  12  doctors  of  surgery,  83  officiers  de 
sante,  43  foreign  doctors,  1500  midwives,  845  pharmaciens, 
and  95  veterinary  doctors.  The  eldest  doctor  in  Paris  is 
M.  Segalas,  who  obtained  his  diploma  in  1817,  and  has  there¬ 
fore  been  in  practice  during  sixty-six  years  ;  and  next  to  him 
•comes  M.  Ricord,  born  in  1800  and  made  a  doctor  in  1826.  The 
.-eldest  midwife  received  her  diploma  in  1815,  and  has  con¬ 
tinued  to  practise  ever  since.  She  states  that  during  her 
sixty-eight  years  of  practice  she  has  had  an  average  of  100 
cases  per  annum,  having  therefore  brought  into  the  world 
■6800  infants.  Among  the  doctors  of  medicine  two  are  women, 
-one  a  French  woman  and  another  a  Russian.  These  figures 
-are,  of  course,  exclusive  of  the  host  of  illegal  practitioners 
of  all  kinds  to  be  found  in  Paris. — Rev.  de  ThSrapeutigue, 
August  1. 


MEDICAL  MATTERS  IN  PARLIAMENT. 

House  oe  Lords— Thursday,  August  16. 

The  Diseases  Prevention  ( Metropolis )  Bill  was  read  a  third 
time  and  passed. 

House  of  Commons — Thursday,  August  16. 

Irish  Police  Surgeons. — In  reply  to  a  question  from  Mr. 
Leamy  on  this  subject,  Mr.  Trevelyan  again  stated  that  the 
rule  under  which  these  appointments  are  given  to  dispensary 
doctors  is  not  an  invariable  one,  and  that  it  had  not  here¬ 
tofore  been  observed  in  Waterford  and  some  other  large 
towns.  Most  constabulary  cases,  other  than  fever  cases, 
were  treated  in  barracks,  if  slight,  or  sent  to  St.  Stephen’s 
Hospital,  Dublin,  if  serious.  The  County  Inspector  thought 
it  best  to  have  the  men  all  under  the  care  of  one  surgeon, 
and  Dr.  Connolly,  who  has  been  appointed,  is  physician  to 
the  Fever  Hospital,  where  many  of  the  men  are,  from  time 
to  time,  treated. 

Sewer  Ventilation. — Replying  to  Mr.  J.  Talbot,  Sir  C. 
Dilke  said  it  was,  generally  speaking,  the  duty  of  the  local 
authority  to  attend  to  the  ventilation  of  the  sewers  in  the 
roadways  ;  and  in  London  that  authority  was  the  Metro¬ 
politan  Board  of  Works.  He  believed  that  the  opinion  of 
scientific  men  was  opposed  to  the  system  of  carrying  the 
ventilation  of  the  sewers  above  the  street  level  by  means  of 
shafts.  There  was  great  danger  lest,  in  altering  the  system  of 
ordinary  traps,  sewer-gas  should  escape  into  dwelling-houses. 

Vaccination  Disasters.— Mr.  Hopwood  asked  the  Secretary 
of  the  Local  Government  Board  whether  his  attention  had 
been  called  to  the  cases  of  five  children  now  suffering  severely 
at  Deptford  from  syphilis  communicated  by  vaccination  from 
one  other  child. — Mr.  G.  Russell  replied  that  inquiry  had 
already  been  made  into  the  matter;  and  the  Board  are  in¬ 
formed  that  there  is  not  the  smallest  reason  for  saying  that 
those  children  had  syphilis.  Four,  not  five,  children  vac¬ 
cinated,  with  seventeen  others,  from  one  vaccinifer,  got 
more  or  less  of  a  common  skin  disease — eczema— afterwards. 
Each  of  the  four  children  lived  in  a  state  of  squalor.  The 
other  seventeen  children  remained  well. — Mr.  Hopwood  also 
asked  about  two  children  in  Shoreditch  who  had,  as  alleged 
by  their  parents,  died  from  vaccination;  and  Mr.  G.  Russell 
stated,  in  reply,  that  both  the  children  mentioned  died  from 
diarrhoea,  and  the  one  case  had  nothing  whatever  to  do  with 
the  other.  The  Board  were  informed  that  the  mother  of 
the  child  Kerridge  had  no  idea  of  attributing  the  death  to 
vaccination :  the  child  had  not  had  any  eruptions.  The 
other  child  (Howden)  was  weakly  at  the  ordinary  age  for 
vaccination,  and  the  operation  was  deferred  till  it  was 
eight  months  old.  It  had  some  eruption  afterwards,  but  no 
abscesses.  Death  was  caused  by  diarrhoea  three  months 
later.  It  was  reported  that  the  medical  practitioner  in 
attendance  had  said  that  the  lymph  used  had  to  do  with 
the  child’s  subsequent  illness ;  but  he  denied  having  said 
anything  of  the  kind,  and  stated  that  he  had  a  great 
number  of  cases  of  diarrhoea  in  his  practice  at  the  time.  In¬ 
quiries  had  been  made  as  to  other  children  vaccinated  from 
the  same  vaccinifers,  and  no  irregularities  in  the  results 
could  be  discovered. 

The  Insanitary  Condition  of  the  Regent’s  Canal. — Reply¬ 
ing  to  a  question  from  Mr.  D.  Grant,  Sir  C.  Dilke  said  if  it 
was  true,  as  stated,  that  the  Zoological  Gardens  drained  into 
the  Regent’s  Canal,  and  that  the  state  of  the  canal  was  a 
danger  to  the  public  health,  he  did  not  see  why  the  local 
authority  should  not  proceed  against  the  Company  under 
the  ordinary  Act  for  the  removal  of  nuisances. 

Vaccination  in  the  Army. — Mr.  A.  O’Connor  asked  the 
Secretary  of  State  for  War  under  what  authority  the  follow¬ 
ing  regulations  for  the  Army  Medical  Department  were 
issued Every  recruit  without  exception  will  be  vac¬ 
cinated  on  joining  the  headquarters  or  depot  of  the  corps 
to  which  he  belongs,  unless  the  operation  is  certified  to 
have  been  already  successfully  performed  subsequently 
to  his  enlistment  ” ;  and  “  The  medical-history  sheet  of 
every  soldier  will  furnish  information  whether  he  has 
been  revaccinated  ;  and  medical  officers  will  revacci¬ 
nate  those  cases  where  no  such  record  exists.” — Lord 
Hartington,  in  reply,  said :  The  Secretary  of  State  for 
War  is  responsible  to  the  Crown  and  to  Parliament  for  the 
efficiency  of  the  Army,  and  has  always  been  held  to  have 
authority  to  issue  such  regulations  as  are  necessary  for 


Medical  Times  and  Gazette. 


MEDICAL  MATTERS  IN  PARLIAMENT. 


August  25, 1883.  221 


securing  that  object,  including,  of  course,  its  maintenance 
in  health.  The  fourteenth  paragraph  of  Section  14  of  the 
Queen’s  Regulations  and  Orders  for  the  Army,  issued  under 
the  sanction  of  Her  Majesty,  lays  down  that  “  medical 
officers  during  duty  with  troops  will  in  all  medical  and 
sanitary  duties  be  guided  by  the  Army  Medical  Regula¬ 
tions,”  which  contain  the  paragraph  quoted,  and  thus,  I 
conceive,  give  to  the  Medical  Regulations  the  same 
authority  as  the  Queen’s  Regulations  themselves. — Mr.  A. 
O’Connor  considered  that  the  Secretary  had  acted  ultra 
vires,  and  he  should  therefore  oppose  any  charge  in  con¬ 
nexion  with  vaccination  in  the  Army. 

Saturday,  August  18. 

Army  Medical  Department. — On  the  vote  for  Medical 
Establishments  and  Services,  Sir  H.  Fletcher  called  atten¬ 
tion  to  the  divergence  of  opinion  as  to  the  medical  services 
in  the  Egyptian  campaign.  He  regretted  the  abolition  of 
the  regimental  system  of  Army  Medical  Service,  and  thought 
that  the  new  system  worked  most  unsatisfactorily  in  some 
respects.  It  would  no  doubt  be  impossible  to  return  to  the 
old  system  in  its  entirety ;  but  he  contended  that  it  ought 
to  be  reverted  to  to  the  extent  of  attaching  a  medical  officer  to 
a  regiment  for,  at  the  least,  five  years.  He  protested  against 
the  extension  of  the  present  system  to  the  Household  Troops. 
He  complained  of  the  unsatisfactory  state  of  the  Army  Hos¬ 
pital  Corps,  and  considered  that  the  maintenance  of  disci¬ 
pline  in  hospitals  necessitated  the  appointment  of  military 
commandants. — The  Marquis  of  Hartington  intervened  for 
a  few  minutes  to  make  a  statement  which  he  hoped  might 
shorten  the  discussion  on  the  vote.  He  had  said  on  a  pre¬ 
vious  occasion  that  as  soon  as  possible  after  the  recess  it  was 
proposed  to  go  through  the  recommendations  made  by  Lord 
Morley’s  Committee,  and  consider  to  what  extent  they  could 
be  adopted.  The  responsibility  of  any  decision  arrived  at  must 
rest  ultimately  with  the  Government ;  but,  at  the  same  time, 
considering  that  the  House  had  not  had  an  occasion  to  discuss 
the  recommendations  of  the  Committee,  he  was  prepared  to 
undertake  that  no  important  changes  involving  the  issue  of 
a  Royal  Warrant  should  be  made  until  an  opportunity  had 
been  afforded  the  House  of  discussing  the  matter. — Mr. 
Acland  and  Colonel  Alexander  made  some  general  remarks 
on  the  Army  Medical  Service  and  on  the  Army  Hospital 
Corps  ;  and  Dr.  Lyons  complained  of  the  sons  of  army 
medical  officers  being  ineligible  for  Queen’s  cadetships. — 
After  which,  the  Marquis  of  Hartington  said  he  thought  the 
discussion  of  Lord  Morley’s  report  had  better  be  postponed 
until  the  action  the  Government  proposed  to  take  on  it  next 
year  should  be  brought  forward  early  in  the  session.  He 
had  carefully  studied  all  the  evidence  in  the  report  of  Lord 
Morley’s  Committee  on  the  subject  of  the  regimental  and 
departmental  systems,  and  he  had  failed  to  see  in  any  part 
of  the  report  any  proof  that  the  present  system  had  had  an 
evil  effect  during  the  Egyptian  campaign.  As  to  the  Array 
Hospital  Corps,  it  was  impossible  in  times  of  peace  to  keep 
in  idleness  an  army  hospital  corps  sufficient  to  deal  with  a 
great  war ;  but  he  agreed  that  every  effort  should  be  made 
to  increase  as  rapidly  as  possible  the  reserve  force  of  the 
corps.  He  pointed  to  the  remarkable  success  of  the  Army 
Medical  Service  in  the  preservation  of  life — the  main  object 
of  the  service.  As  to  the  exclusion  of  the  sons  of  medical 
officers  from  the  Queen’s  cadetships,  while  the  converse 
prevailed  with  regard  to  the  sons  of  so-called  combatant 
officers,  he  said  the  object  in  the  case  of  the  latter  officers 
was  that  their  sons  might  be  trained  for  the  same  profession 
as  their  fathers  ;  but  the  same  reason  did  not  hold  good  in 
the  case  of  medical  officers. 

Vaccination  in  the  Army. — In  reply  to  Mr.  A.  O’Connor, 
Lord  Hartington  said  he  had  made  inquiries,  and  had  been 
unable  to  find  a  single  instance  of  a  recruit  having  objected 
to  being  revaccinated.  The  legal  right  of  the  Secretary  of 
State  to  require  every  recruit  to  be  revaccinated  had  never 
been  raised  in  a  court  of  law.  But  he  imagined  it  was  un¬ 
doubtedly  within  the  power  of  the  Secretary  of  State,  who 
was  responsible  to  Parliament,  to  advise  Her  Majesty  to 
make  any  order  which  would,  according  to  the  best  medical 
opinion,  tend  to  promote  the  health  of  the  Army. 

The  Contagious  Diseases  Acts. — A  long,  discursive,  and 
somewhat  disorderly  discussion  took  place  regarding  the 
administration  of  these  Acts,  in  the  course  of  which  Lord 
Hartington  observed  that  a  new  argument  had  been  intro¬ 
duced,  viz.,  that  the  towns  to  which  the  Acts  had  applied  had 


a  right  to  protection  against  the  consequences  resulting 
from  the  introduction  of  large  numbers  of  soldiers  and 
sailors  into  those  towns.  To  this  contention  he  replied  that 
the  Acts  gave  no  powers  whatever  to  the  police  to  suppress 
vice.  That  they  had  an  indirect  effect  in  that  direction 
was  true;  but  when  the  Acts  were  passed  that  effect  was; 
not  contemplated.  He  believed  that  the  preservation  of 
public  order  and  decency  could  be  secured  independently  of 
the  Acts.  He  regretted  the  resolution  which  the  House  had 
arrived  at  in  regard  to  the  Acts ;  but  it  was  useless  to  ex¬ 
aggerate  the  consequences  of  what  had  taken  place.  A 
memorial  had  been  presented,  in  which  it  was  stated  that,, 
in  consequence  of  the  suspension  of  the  Acts,  no  women 
had  since  entered  the  hospitals.  The  fact  was  that  there 
were  133  women  now  in  hospital,  almost  all  of  whom  hadt 
entered  voluntarily.  As  that  was  half  the  number  that 
were  in  hospital  before  the  Acts  were  suspended,  it  could 
not  be  said  that  the  suspension  had  made  the  Acts  inopera¬ 
tive. — Mr.  Bulwer  said  he  was  on  the  Committee  appointed 
to  consider  the  operation  of  the  Acts,  and  when  he  joined  it 
he  was  strongly  prejudiced  against  the  Acts.  But  he  had 
not  served  upon  the  Committee  long  before  he  came  to  the 
conclusion  that  the  opposition  to  the  Acts  was  based  upon  a 
mass  of  falsehoods.  The  cases  adduced  of  maladministration 
in  connexion  with  the  measures,  and  of  injustice,  had  no 
foundation  whatever;  while  as  to  the  good  effects  of  the 
Acts  there  could  be  no  doubt. 

House  of  Lords — Monday,  August  20. 

The  Royal  Assent  was  given,  by  commission,  to  the- 
following  Bills  :  Payment  of  Wages  in  Public-Houses  Pro¬ 
hibition  Act,  1883,  and  the  Diseases  Prevention  (Metropolis)- 
Act,  1883. 

House  of  Commons — Monday,  August  20. 

Inoculation  by  Vaccination. — Replying  to  a  question  from. 
Mr.  Hopwood,  Mr.  G.  Russell  said  that  it  was  a  fact  that  an 
operation  professing  to  be  vaccination  could  be  made  the 
means  of  communicating  syphilis,  and  that  fact  was  well 
known,  chiefly  through  some  foreign  experiences  and  Dr. 
Cory’s  experiment ;  but  it  was  not  the  fact,  in  general  terms,, 
that  syphilis  was  inoculated  by  vaccination.  The  committee 
to  which  Dr.  Cory’s  case  was  referred  had  completed  their  in¬ 
quiry  and  made  their  report,  which  would  appear  in  the  annual 
report  of  the  Medical  Officer  of  the  Local  Government  Board. . 

Tuesday,  August  21. 

Pollution  of  the  Thames. — Replying  to  Mr.  Labouchere,. 
Sir  C.  Dilke  admitted  that  the  drainage  of  Kingston,  Rich¬ 
mond,  and  other  localities  below  the  intake  of  the  water 
companies  is  still  discharged  into  the  Thames.  The  quan¬ 
tity  of  the  water  taken  by  the  companies  was,  however,, 
comparatively  small,  being  not  more  than  a  seventh  of  the 
ordinary  dry-weather  flow  over  Teddington  Weir,  while  the 
volume  of  the  tidal  water  of  spring  tides  was  immensely 
greater.  The  flow  of  the  river  through  the  sewage-polluted 
parts  could  hardly,  therefore,  be  seriously  lessened  by  the 
quantity  taken  by  the  London  water  companies.  The  Lower 
Thames  Yalley  main  sewerage  district  had  been  constituted 
for  the  purpose  of  providing  a  system  for  the  disposal  of  the 
sewage  without  contravening  the  provisions  of  the  Thames 
Conservancy  Acts.  But,  unfortunately,  works  for  that  pur¬ 
pose  have  not  yet  been  carried  out.  The  Local  Government 
Board  had  granted  the  Main  Sewerage  Board  another  year’s 
protection  from  liability  to  prosecution  under  the  Thames 
Conservancy  Acts,  but  with  a  distinct  intimation  that  unless 
it  could  be  satisfactorily  shown,  before  the  expiration  of 
that  period,  that  the  Sewerage  Board  were  taking  active  steps 
to  carry  out  the  purposes  for  which  they  were  constituted, 
they  would  probably  not  easily  obtain  any  farther  period 
of  grace. 

Army  and  India  Medical  Officers. — In  reply  to  Mr.  Acland,. 
Lord  Hartington  said  :  The  examination  at  the  conclusion 
of  the  Nctley  course  of  instruction  is,  in  the  case  of  the 
Army  Medical  Department  candidates,  a  pass  examination 
merely,  their  relative  precedence  having  been  settled  by  the 
results  of  the  entrance  examination.  With  the  Indian  Army 
candidates  the  Netley  course  is  competitive,  and  aids  in 
determining  the  position  of  the  candidates  during  subse¬ 
quent  service.  The  system  for  the  British  officers  was 
deliberately  adopted,  after  a  very  full  inquiry,  by  a  Com¬ 
mittee  appointed  to  consider  the  causes  of  the  unsatisfactory 
supply  of  candidates  for  the  Army  Medical  Service,  and  the 
Committee  took  evidence  on  this  particular  point. 


222 


Medical  Times  and  Gazette. 


FROM  ABROAD. 


August  25,  1883. 


FROM  ABROAD. 

Iodide  of  Potassium  in  Non-Syphilitic  Nervous  Disease. 

Dr.  Seguin  read  an  interesting  paper  at  tlie  New  York 
Neurological  Society  (which  he  has  since  published  in  his 
Archives  of  Medicine  for  June)  on  “The  Efficacy  of  Iodide 
■of  Potassium  in  Non-Syphilitic  Organic  Disease  of  the  Cen¬ 
tral  Nervous  System/5  in  which  he  protests  against  the 
so  generally  admitted  belief  in  the  specific  action  of  the 
iodide  in  syphilis:  He  is,  in  fact,  no  believer  in  what  he 
terms  the  “  comfortable 55  doctrine  of  the  specific  action  of 
any  remedies — a  doctrine  which  he  regards  as  fallacious  and 
unscientific  as  it  is  comfortable, — and  agrees  with  those  who 
think  that  remedies  act  on  the  organism  as  a  whole,  or  on 
its  apparatuses,  or  on  some  of  its  tissues,  or  on  its  constituent 
-chemical  ingredients;  in  a  physiological  way,  i.e.,  by  and 
through  the  operation  of  chemical  and  physiological  laws 
already  operative  in  the  animal  body.  Many,  however, 
believe  in  the  specific  action  of  the  iodide,  regarding  it  as  a 
sort  of  reagent  in  syphilis.  In  their  view,  the  result  of  its 
employment  in  the  presence  of  certain  symptoms  determines 
whether  these  are  due  to  a  syphilitic  origin  or  not,  and  that 
in  spite  of  the  denial  of  the  patient  or  the  history  of  the 
case.  Such  a  view  may  be  attended  by  dangerous  conse¬ 
quences .  On  the  one  hand,  it  prevents  the  administration 
■of  the  iodide  in  full  doses  in  cases  of  organic  cerebral  disease 
where  there  is  no  indication  of  syphilis  ;  and,  on  the  other 
hand,  after  the  symptoms  have  yielded  to  the  iodide,  the 
patient  is  regarded  as  having  carelessly  or  erroneously 
deceived  the  practitioner  with  regard  to  the  existence  of 
syphilis,  and  is  liable  to  receive  further  erroneous  advice  or 
treatment  under  that  supposition. 

In  the  present  paper  Dr.  Seguin  confines  himself  to  a 
•clinical  view  of  the  question  obtained  from  the  examination 
■of  certain  cases  which  have  come  under  his  notice,  and 
which  he  believes  exhibit  the  efficacy  of  the  iodide  in  non- 
syphilitic  nervous  disease.  These  are  nine  in  number, 
which  he  has  arranged  in  two  groups.  In  the  first  group, 
consisting  of  three  cases  of  organic  disease  of  the  brain, 
many  threatening  symptoms  were  relieved,  in  some  of  them 
immediately,  and  on  different  occasions,  by  the  free  use  of 
iodide.  In  all  of  these  post-mortem  examinations  were 
made,  and  the  gross  lesions  found.  In  all  of  them  there 
was  no  clinical  or  histological  evidence  of  syphilis.  The 
second  group  consists  of  six  cases,  which  are  still  living, 
-some  cured.  “  I  divide  this  group  into  two  classes.  The 
first  is  made  up  of  three  cases  of  organic  cerebral  disease 
in  the  adult,  two  of  them  cured,  and  the  third  twice  relieved 
of  most  of  his  symptoms  by  the  iodide.  The  other  class  is 
composed  of  three  cases  of  basal  meningitis  with  optic 
neuritis  in  little  children,  who  recovered  rapidly  while 
under  the  influence  of  the  remedy.  I  attach  much  less 
importance  to  these  infantile  cases,  because  of  the  doubt 
that  must  remain  as  to  there  having  been  anything  more 
than  optic  neuritis.  Still,  they  have  a  certain  value  in  a 
purely  clinical  paper  like  this  one.55 

Dr.  Seguin  relates  these  cases  in  minute  detail,  and  replies 
in  advance  to  some  of  the  objections  that  may  be  adduced 
to  the  cogency  of  their  testimony.  In  regard  to  the  doses 
•employed,  he  has  increased  these  much  of  late  years,  and 
observes  that  it  is  surprising  how  well  patients  of  all  ages 
will  bear  doses  of  from  50  to  150  drops  of  a  saturated  solu¬ 
tion  three  times  a  day,  without  the  production  of  iodism  or 
gastric  catarrh.  “  I  give  it  largely  diluted,  in  from  a  half 
to  a  full  tumbler  of  water,  and  always  on  an  empty  stomach, 
ho  diminish  the  risk  of  decomposition.  In  the  last  two  or 
three  years  I  have  adopted  a  plan  which  I  think  further 
assists  immediate  absorption  of  the  iodide  as  such — viz.,  the 
use  of  Vichy  instead  of  common  water  as  a  vehicle — or,  as 
a  substitute  for  poor  patients,  a  solution  of  bicarbonate  of 
soda.  I  may  add  that  in  several  patients  digestion  has  been 
improved  by  the  iodide.  Even  if  the  iodide  cannot  always 
•cure  organic  disease  of  the  brain,  it  seems  to  relieve  symp¬ 
toms.  If  by  the  free  use  of  such  a  remedy — one  not  directly 
harmful — we  can  diminish  intracranial  tension,  remove 
oedema,  or  perhaps  check  the  growth  of  some  neoplasm, 
thereby  relieving  pain  and  other  distressing  symptoms, 
would  not  this  be  a  gain  to  our  therapeutics  ?  55 


Employment  of  the  Forceps. 

Dr.  Elliot  Kichardson  read  a  paper  upon  this  subject 
before  the  Philadelphia  Medical  Society,  the  general  tenour 
of  which  may  be  judged  of  by  the  concluding  paragraph  : — 
“My  object  in  writing  this  paper  is  to  call  attention,  in 
this  age  of  most  free,  if  not  reckless,  use  of  the  forceps, 
to  what  we  are  doing  in  all  its  bearings :  to  compare  our¬ 
selves  with  those  who  were  at  least  our  equals  in  the  past, 
and  to  ask  whether  they  were  all  wrong  and  we  altogether 
in  the  right.  To  repeat  what  I  have  already  said,  while 
conservatism  is  not  always  wise,  neither  is  all  progress  im¬ 
provement.  While  I  would  not  hedge  the  forceps  round 
with  rules  which  would  often  restrict  its  proper  use,  I 
submit  that  teachers  in  the  present  day  err  in  not  impress¬ 
ing  upon  the  minds  of  their  auditors  with  sufficient  em¬ 
phasis  the  danger  attendant  upon  the  imprudent  use  of 
the  forceps,  particularly  when  it  is  applied  within  the 
uterus,  and  in  not  calling  their  attention  more  closely  to 
the  value  of  time,  and  of  the  slow,  rhythmical  succession  of 
the  expulsive  efforts,  whether  made  by  the  mother  herself, 
or  imitated  by  the  physician  with  his  forceps  in  so  mould¬ 
ing  the  foetal  head  and  dilating  the  maternal  parts  as  to 
preserve  the  integrity  of  the  tissues  of  both,  without  inter¬ 
fering  dangerously  with  the  uterus  or  placental  circulation. 
To  my  mind  there  is  wisdom  in  the  words  of  the  illustrious 
Smellie,  who  more  than  a  century  ago  wrote  the  sentence 
already  quoted  :  f  I  did  not  then  recommend  the  use  of  the 
long  forceps,  because  I  was  afraid  of  encouraging  young 
practitioners  to  exert  too  great  force  and  give  their  assistance 
too  soon.5  55 

In  the  discussion  which  followed  the  reading  of  the  paper 
(. Philadelphia  Medical  Times,  April  7),  approval  was  almost 
unanimously  expressed  of  the  views  it  upheld,  a  general 
conviction  seeming  to  prevail  that  the  forceps  at  the  present 
time  is  not  employed  with  sufficient  discretion.  Prof. 
Goodell  expressed  himself  as  follows  : — “  The  older  he  gets 
the  more  conservative  he  becomes  in  the  use  of  the  forceps. 
He  agreed  with  Baudelocque  and  Hunter  that  in  the 
aggregate  it  had  done  more  harm  than  good.  Men  of  large 
experience  and  special  skill  may  be  capable  of  using  it,  but 
many  practitioners  use  it  recklessly.  It  is  often  applied,  he 
feared,  more  for  the  sake  of  the  practitioner  than  for  that 
of  the  woman.  In  his  experience  many  cases  of  lacerated  cer¬ 
vices  and  lacerated  perineums  are  due  to  forceps  operations. 
The  main  safeguard  against  such  accidents  is  for  young  prac¬ 
titioners  to  removethe  bladeswhen  the  head  is  pressing  on  the 
perineum.  It  cannot  be  doubted,  however,  that  in  certain 
positions  the  forceps  may  act  as  a  protection  against  lacera¬ 
tion,  as,  for  instance,  in  the  occipito-posterior  position,  or 
in  anterior  positions  with  too  great  flexion.  He  fully  agreed 
with  Dr.  Mills  in  reference  to  the  injury  occasionally  done 
to  the  heads  and  brains  of  children  by  forcible  compression 
with  the  forceps,  especially  when  faultily  applied.  In  using 
the  forceps  in  difficult  cases  we  should  proceed  with  de¬ 
liberation,  making  traction  for  a  short  time,  and  then  either 
loosen  the  blades,  if  we  stay  by  the  patient,  or  remove  them 
and  go  away  for  a  while.  On  returning,  it  will  be  found 
that  the  head  has  become  moulded  to  the  pelvic  canal,  and 
can  be  brought  down  still  lower,  or  delivered.55 


Colonial  Doctors. — In  connexion  with  the  Amster¬ 
dam  Exhibition  now  being  held,  there  will  be  an  Inter¬ 
national  Congress  of  Colonial  Doctors  under  the  patronage 
of  the  King  of  the  Netherlands.  They  will  sit  from  the  6th 
to  the  8th  prox.  Several  fetes  will  be  specially  organised 
in  honour  of  the  visitors  to  this  interesting  Congress. 

Medical  Students  in  Germany  and  Switzerland 
during  the  Summer  Session  of  1S83. — The  entire  number 
of  medical  students  in  the  twenty  German  universities  during 
the  summer  session  of  1883  was  6350,  viz.,  5973  Germans, 
and  377  foreigners.  During  the  winter  session  of  1882-83 
there  were  5793,  viz.,  5430  Germans  and  363  foreigners.  In 
the  four  Swiss  universities  there  were  during  the  summer 
session  541  medical  students  (484  male  and  57  female).  Of 
the  541  there  were  387  natives  of  S  witzerland  (380  men  and 
four  women)  and  157  foreigners  (104  men  and  53  women). 
In  the  winter  session  of  1882-83  there  were  543  students 
(492  men  and  51  women),  393  being  Swiss  (all  men). — 
Deutsche  Med,  Woch.,  July  18. 


JMnHif'nl  TlrrtOS  and  CiH7.Pttt*. 


GENERAL  CORRESPONDENCE. 


August  2*,  1883.  223 


GENERAL  CORRESPONDENCE. 


VITAL  STATISTICS  OF  LONDON. 


- -o - 

METAPHYSICS  IN  PATHOLOGY. 
Letter  from  Mr.  Kenneth  W.  Millican. 


[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sir, — Dr.  Mercier,  in  an  article  with  the  above  heading  in 
your  issue  of  August  18,  says  :  "  I  have  called  the  address  a 
very  memorable  one,  and  for  this  reason — that  it  is  the  first  at¬ 
tempt  to  apply  the  great  doctrine  of  evolution  to  the  question 
of  the  origin  of  specific  diseases.” 

Will  you  kindly  allow  me  to  call  Dr.  Mercier’s  attention 
to  a  paper  “  On  some  Suggestions  for  a  Modification  of 
the  Germ  Theory  of  Disease,”  read  before  the  Medical 
Society  of  London  in  February  last  year,  and  published  in 
abstract  in  the  Lancet  of  March  18  P  Also  to  a  more  com¬ 
plete  working  out  of  the  same  idea  under  the  heading  of 
“  The  Etiology  of  the  Acute  Specific  Infectious  Diseases,” 
a  paper  read  before  the  Section  of  Public  Medicine  at 
Worcester  last  year,  and  published  in  extenso  in  the  British 
Medical  Journal  of  September  30,  1882  ? 

Dr.  Mercier  will,  I  think,  then  see  that  Dr.  Creighton’s 
address  is  not  the  first  attempt  to  apply  the  great  doctrine 
of  evolution  to  the  question  of  the  origin  of  specific  diseases. 

-  I  apologise  for  taking  up  your  space,  and  remain 

Yours,  &e.,  Kenneth  W.  Millican. 

North  Lodge,  Kineton,  Warwick. 


OBITUARY. 

- ♦ - 

PROFESSOR  PARROT. 

The  son  of  a  medical  practitioner  at  Excideuil  (Dordogne), 
Prof.  Parrot  was  born  there  in  1829,  and  although  he  did 
not  receive  his  diploma  until  1857,  yet,  being  a  hard  worker 
and  capable  of  great  perseverance,  he  rapidly  passed  through 
the  various  stages  of  professional  distinction.  He  was  made 
Professor  of  the  Faculty  in  1876,  and  Member  of  the 
Academy  of  Medicine  in  1878.  He  died  August  5,  and  was 
buried  in  his  native  place,  all  ceremonies  having  been  dis¬ 
pensed  with  at  his  grave  by  his  special  request.  The  Gazette 
Hebdomadaire,  after  mentioning  that  his  death  was  due  to 
a  double  pneumonia,  incomplete  convalescence  from  which 
became  complicated  with  disease  in  the  abdomen,  goes  on 
to  say :  — 

“  His  health  had  always  been  very  delicate,  and  during 
his  latter  years  he  had  not  been  sufficiently  careful  of  it.  Led 
away  by  his  ardour  for  anatomical  investigations,  he  passed 
long  hours  in  the  small  theatre  attached  to  the  Hospice  des 
Enfants  Assistes,  encumbered  with  macerating  specimens, 
and  engaged  in  far  too  prolonged  dissections  and  micro¬ 
scopical  investigations.  Parrot  was  indeed  a  great  worker, 
and  his  productions  were  already  considerable.  At  the 
commencement  of  his  career  his  these  on  Zona  excited 
special  attention ;  and,  formerly  an  interne  under  Beau,  he 
acquired  a  great  predilection  for  the  study  of  the  respi¬ 
ratory  and  cardio-vascular  sounds,  concerning  which  he 
published  several  important  notes  and  memoirs.  His  articles 
in  the  ‘  Dictionnaire  Encyclopedique  ’  on  asthma,  angina 
pectoris,  asystolia,  chlorosis,  cerebral  softening,  chromi- 
drosis,  and  the  heart  figure  among  the  most  important  con¬ 
tributions  in  that  great  collection.  He  published  also  in  the 
Gazette  Hebdomadaire  a  memoir  on  blood-sweats,  which  is 
often  quoted.  Since  his  appointment  to  the  Hospice  des 
Enfants  Assistes  his  attention  has  been  especially  directed 
to  the  diseases  of  children ;  and  his  researches  on  the  rela¬ 
tions  of  rickets  and  certain  alterations  in  the  osseous  system 
with  hereditary  syphilis  have  excited  great  attention. 
They  are  found  summed  up,  together  with  many  other  in¬ 
vestigations,  in  his  ‘  Lemons  Cliniques  sur  l’Athrepsie,’  which 
conferred  upon  him  a  place  of  honour  among  the  masters  of 
infantile  pathology.  Parrot  was  one  of  those  ever  on  the 
search  for  new  routes,  and  all  that  he  has  published  bears  a 
seal  of  his  personality.  He  disliked  the  repetition  of  others, 
and  his  mind,  like  his  friendships,  had  nothing  commonplace 
about  it.” 


Week  ending  Saturday,  August  18,  1883. 


BIRTHS. 

Births  of  Boys,  1398;  Girls,  1254;  Total,  2652. 

Corrected  weekly  average  in  the  10  years  1873-82,  2679'3. 


DEATHS. 


Males. 

Females. 

Total. 

Deaths  during  the  week . 

756 

681 

1437 

Weekly  average  of  the  ten  years  1873-82,  1 
corrected  to  increased  population  ...  ) 

827  1 

759'1 

1586-2: 

Deaths  of  people  aged  80  and  upwards 

... 

46 

DEATHS  IN  SUB-DISTRICTS  FROM  EPIDEMICS. 


I  Enumerated 

Population, 

1881 

(unrevised). 

Small-pox. 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

Whooping- 

cough. 

Typhus. 

Enteric  (or 

Typhoid) 

Fever. 

Simple 

continued 

Fever. 

CC 

a 

f 

Q 

West . 

669633  ... 

S 

1 

2 

13 

North 

905947,  2 

10 

14 

3 

4 

... 

1 

i 

31. 

Central 

282238  ... 

4 

1 

1 

2 

1 

2 

•  *» 

10 

East  ... 

692738  ... 

17 

8 

3 

4 

... 

1 

19 

South . 

1265927  ... 

31 

11 

2 

14 

1 

5 

... 

40 

Total . 

3816483  ;  2 

70 

35 

9 

26 

2 

9 

1 

119 

METEOROLOGY. 


From  Observations  at  the  Greenwich  Observatory. 


Mean  height  of  barometer 

Mean  temperature  . 

Highest  point  of  thermometer 
Lowest  point  of  thermometer 
Mean  dew-point  temperature 
General  direction  of  wind 
Whole  amount  of  rain  in  the  week  . 


...  29 '806  in-. 
...  62 '3° 

...  83'3“ 

...  463° 

...  53'2 
...  S.W. 

...  0'07  in. 


BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  the- 
Week  ending  Saturday,  August  18,  in  the  following  large  Towns : — 


Cities 

and 

Boroughs. 

Estimated  Population  to 
middle  of  the  year  1883. 

!  Births  Registered  during 
the  week  ending  Aug.  18. 

I  Deaths  Registered  during 
i  the  week  ending  Aug.  18. 

Annual  Rate  of 
Mortality  per  1000  living, 
from  all  causes. 

Temperature 
of  Air  (Fahr.] 

Temp, 
of  Air 
(Cent.' 

Rain 

Fall. 

Highest  during 
the  Week. 

1  Lowest  during 
the  Week. 

Weekly  Mean  of 
Daily  MeanValues 

Weekly  Mean  of 
Daily  Mean 
Values. 

In  Inches. 

0Q 

a> 

i 

1 

s 

a- 

A 

London  ...  . 

;  39558 14 

2652 

1437 

19  0 

83  3  46  3 

62-3 

1684 

007 

o-is 

Brighton  . 

-  111262 

65 

39 

183 

71-5  60  0 

60-0 

15-56 

026 

0-6& 

Portsmouth 

131478 

92 

52 

20'6 

•  •• 

... 

... 

... 

... 

... 

Norwich  . 

:  89612 

68 

23 

134 

... 

... 

... 

... 

... 

Plymouth  . 

]  74977 

42 

29 

20-2 

67-0,48-0 

58-1 

14-50 

0-20 

0-51 

Bristol . 

f  212779 

126 

61 

15-0 

78-0' 48-5 

58-5 

14-72 

046 

117 

Wolverhampton  . 

77557 

56 

26 

175 

755 

42-5 

57-2 

14-00 

0-17 

0-43 

Birmingham 

414846 

2S5 

144 

18-1 

... 

... 

... 

... 

Leicester  ...  ,.. 

129483 

87 

63 

21-4 

76-5 

45-2 

59-5 

15  28 

0-19 

0-4S 

Nottingham 

199349 

167 

89 

233 

78-1 

436 

58-7 

14-83 

0-16 

041. 

Derby . 

85574 

58 

35 

213 

... 

... 

... 

... 

... 

... 

Birkenhead 

88700 

68 

33 

194 

... 

... 

... 

... 

... 

... 

Liverpool  . 

566753 

375 

295 

27-2 

... 

... 

... 

.... 

Bolton . 

107862 

81 

38 

18-4 

... 

... 

... 

... 

... 

Manchester 

339252 

225 

170 

261 

... 

... 

... 

... 

... 

Salford  . 

190465 

154 

85 

23  3 

... 

... 

... 

... 

... 

Oldham  . 

119071 

88 

48 

21-0 

... 

... 

... 

... 

... 

Blackburn . 

108460 

87 

47 

22  6 

... 

... 

... 

... 

... 

Preston  . 

98564 

76 

49 

25-9 

70-C 

47-0 

566 

13  67 

092 

2  3* 

Huddersfield 

84701 

47 

35 

216 

... 

... 

...  I 

... 

... 

... 

Halifax  . 

75591 

39 

18 

12-4 

... 

... 

...  1 

... 

Bradford  . 

204807 

135 

67 

171 

72-8 

49-1 

57-8 

14-34 

0-37 

0-94, 

Leeds  . 

321611 

253 

133 

216 

74  0 

48-0 

58-9 

1494 

0-34 

0-86 

Sheffield  . 

295497 

219 

126 

22-1 

73-0 

44-5 

57-7 

1428 

014 

0-36 

Hull  . 

176296 

108 

54 

160 

77-0 

42-0 

68-9 

14-94 

0-14 

0-36. 

Sunderland 

121117 

94 

61 

26-3 

77-0 

45-0 

69-2 

1511 

1-79 

4-55. 

Newcastle  . 1 

149(64 

109 

68 

237 

... 

... 

... 

... 

... 

... 

Cardiff . 

90033 

79 

28; 

16-2 

... 

...  1 

| 

... 

... 

... 

For  28  towns ... 

86219  5 

5915 

1342 

202 

83-3 

420 

58-7 

14-83 

0-40 

1-02: 

Edinburgh . 

2559  46; 

116 

89 

19-7 

68  8  45-0, 

57-7 

14-28 

1-45 

3-68: 

Glasgow  . 

515589, 

386, 

220, 

223 

6«"0  44-0’ 

571 

13-95 

1-89 

4-80 

Dublin . I 

349:85 

1971 

167; 

24-9 

67-6  39-5 

56-7 

13-72 

1-511 

3-84 

At  the  Royal  Observatory,  Greenwich,  the  mean  reading 
of  the  barometer  last  week  was  29’81  in. ;  the  lowest  read¬ 
ing  was  29'50  in.  on  Wednesday  morning,  and  the  highest 
30'05  in.  at  the  end  of  the  week. 


224 


Medical  Times  and  Gazette. 


MEDICAL  NEWS, 


August  25,  1833. 


MEDICAL  NEWS. 

- - 

University  of  Edinburgh. — Appended  is  a  list  of 
•candidates  who  received  the  degree  of  Doctor  of  Medicine, 
and  the  degrees  of  Bachelor  of  Medicine  and  Master  in 
Surgery  of  this  University  on  Wednesday,  August  1 
The  Degree  of  Doctor  op  Medicine. 

[With  the  Titles  of  the  Theses.) 

Allan,  Francis  John,  Scotland,  M.B.  and  C.M.,  1880 — The  Etiology  of 
Phthisis  Pulmonalis. 

Ashdown,  George  William  Wetton,  England,  M.B.  and  C.M.,  1880- 
Diseases  of  the  Ear. (a) 

Bain,  David  Beattie,  Scotland,  M.B.  and  C.M.,  1872 — The  Physiological 
Dynamics  of  the  Skin,  (a) 

Balfour,  Isaac  Bayley  (D.Sc.  Edin.),  Scotland,  M.B.  and  C.M.  (with 
Second  Class  Honours),  1877 — The  Phoenogamic  Flora  of  the  Island  of 
Socotra,  (b,  c) 

Barbour,  Alexander  Hugh  Freeland  (M.A.  Edin.),  Scotland,  B.Sc.,  M.B. , 
and  C.M.  (with  Second  Class  Honours),  1879 — Spinal  Deformity  in 
Relation  to  Obstetrics,  (b,  c) 

Baxter,  William,  Scotland,  M.B.  and  C.M.,  1877 — Burns,  followed  by 
certain  Complications. 

Berry,  John  Bright,  England,  M.B.  and  C.M.  (with  Second  Class  Honours), 
1880 — Chronic  Lead-Poisoning,  (a) 

Blaikie,  Robert  Henry  (M.A.  Edin.),  Scotland,  M.B.  and  C.M.,  1881- 
Paracentesis  Pericardii. 

Cameron,  John,  Scotland,  M.B.  and  C.M.,  1877— Obstetrics  and  Gynae¬ 
cology. 

Craig,  James,  Scotland,  M.B.  and  C.M.,  1872 — Scarlet  Fever. (a) 

Firth,  Eustace,  England,  M.B.  and  C.M.,  1880-  On  Suicide. 

Fraser,  Frederick  William  Dyce  (M.A.  Edin.),  Scotland,  M.B.  and  C.M., 
1878— On  the  Etiology  of  Scarlet  Fever,  (d,  e) 

Fraser,  James  William,  England,  M.B.  and  C.M.  (with  First  Class 
Honours),  1880— Action  of  Infused  Beverages  on  Peptic  Digestion. (b,  c) 
Hartley,  Alfred,  England,  M.B.  and  C.M,,  1881— Measles. 

Hassall,  John,  England,  M.B.  and  C.M.,  1878— Epididymitis  and 
Orchitis. (b,  c) 

Hern,  John,  England,  M.B.,  1881 — Locomotor  Ataxia,  (a) 

Illingworth,  Charles  Rumney,  England,  M.B.  and  C.M.  (with  Second  Class 
Honours),  1877— On  the  Physiology  of  the  Larynx. (a) 

Johnston,  Robert  M‘Kenzie,  Scotland,  M.B.  and  C.M.,  1881— Psoriasis, 
with  special  reference  to  Treatment. 

Kay,  Walter  Smith,  Scotland,  M.B.  and  C.M.,  1877— General  Paralysis  of 
the  Insane. 

Lewis,  Thomas  Preston,  England,  M.B.  and  C.M.,  1877— On  Etiology. 
M‘Dowall,  John  Greig,  Scotland,  M.B.  and  C.M.,  1873— The  Use  of 
Sedatives  in  the  Treatment  of  the  Insane,  (a) 

Retief,  Petrus  Jacobus,  Cape  of  Good  Hope,  M.B.  and  C.M.,  1880— The 
Action  of  Copaiva  Balsam  (received  the  degree  on  April  20,  1883). (a) 
Robertson,  Alexander  Milne,  Scotland,  M.B.  and  C.M.,  1872 — Anthro¬ 
pological  Account  of  the  Aborigines  of  Western  Australia,  together 
with  the  Climate,  etc.,  of  the  Country. (a) 

Robertson,  James  George,  Africa,  M.B.  and  C.M. ,  1876— Jaborandi  and 
Pilocarpin.(a) 

Rose,  Alexander  Simpson,  Scotland,  M.B.  and  C.M.,  1880— Notes  on  some 
of  the  more  Prevalent  Diseases  of  the  Egyptian  Expedition  of  1882-83.(a) 
•Smith,  Thomas  Henry,  England,  M.B.  and  C.M.,  1877 — Angina  Pectoris. 
Watkins,  Arnold  Hirst,  England,  M.B.  and  C.M.  (with  Second  Class 
Honours),  1875 — Tracheotomy  for  Croup  and  Diphtheria. (a) 

Waugh,  John  (M.A.  Edin.),  Scotland,  M.B.  and  C.M.,  1881— On  the 
Pathogenesis  of  Croupous  Pneumonia. (a) 

Weight,  Rowland  Hill,  England,  M.B.  and  C.M.,  I860 — Hvdrothera- 
peutics  in  Febrile  Conditions. 

Wortabet,  Henry  George  Luther,  Syria,  M.B.  and  C.M.,  1878— Calculi  of 
the  Urinary  System. 

Tiie  Degree  of  Doctor  of  Medicine  under  the  Old  Statutes. 
[With  the  Title  of  the  Thesis.) 

Reid,  George  More,  Scotland — On  the  Radical  Cure  of  Hernia,  with  special 
reference  to  some  of  the  Methods  that  have  been  adopted  for  that 
purpose. 

The  Degree  of  Bachelor  of  Medicine  and  Master  in  Surgery. 
Augustus  Whitehom  Addinsell,  England ;  Alfred  Aikman,  Scotland  ; 
Chas.  Aitken,  India;  George  Forbes  Alexander, (c)  Scotland;  Edwin  Baily, 
England;  Percy  John  Baily, (e)  England;  John  William  Ballantyne, 
Scotland;  Thomas  Lane  Bancroft,  England;  Theodore  Hugh  Barker, (e) 
Australia;  William  Henry  Barrett,  Gibraltar;  Hunter  Jackson  Barron, 
England;  David  George  Bennet  (B.A.  New  Brunswick),  Canada;  Patrick 
Hunter  Bett,  Scotland;  William  Bird,  England  ;  John  Bowes,  Scotland 
(received  the  degrees  on  November  25,  1882) ;  George  Thomas  Broatch, 
Scotland  ;  Charles  Brown,  Scotland  ;  John  Henry  Brown,  England  ; 
Andrew  Crichton  Buist,  Scotland ;  Thomas  Marshall  Buncle,  Scotland ; 
•George  Schuyler  Cardew,  India ;  James  Matthew  Caw,  Scotland;  Edwin 
.Albert  Chill,  India ;  Michael  Clark,  England ;  Ronald  Clark,  Scotland ; 
Arthur  Henry  Weiss  Clemow,  England ;  Charles  Newberry  Cobbett,  Eng¬ 
land  ;  Philip  Cockburn,  Scotland  (received  the  degrees  on  November  25, 
1882) ;  Horace  Cocks,  England ;  Sidney  Alfred  Comber,  England  ;  Francis 
Gillies  Connor,  Australia;  William  Cotton  (M.A.),  Scotland;  James 
Craig,  Scotland  ^William  Cumming,(e)  Scotland;  James  Dalgleish,  Scot¬ 
land  ;  Thomas  Kennedy  Dalziel,  Scotland  ;  Daniel  Rees  Davies,  England  ; 
John  Davies,  Wales  ;  William  Hugo  Davies,  England ;  Thomas  Harrison 
Davison,  England ;  Archibald  Telford  Dochardje)  Scotland ;  Archibald 
Donald(e)  (M.A.  Edin.),  Scotland;  Herbert  Johnson  Dring,  England; 
Alexander  Peters  Drummond,  Scotland;  William  Duff,(e)  Scotland; 
George  Duncan,  Scotland  ;  Thomas  Edward  Dyson,  England  ;  David 
Griffith  Evans,  Anglesey  ;  Thomas  Johnson  Fletcher,  England  ; 
Boston  Elphinstone  Fordyce,  Scotland  ;  William  Henry  Francis,  Chili  , 

(a)  Commended  for  dissertation. 

(b)  Obtained  prize  for  dissertation. 

(c)  Passed  the  examinations  with  First  Class  Honours. 

(d)  Deemed  worthy  of  competing  for  dissertation  prizes. 

(e)  Passed  the  examinations  with  Second  Class  Honours. 


Alexander  George  Fraser  (M.A.  Aberdeen),  Scotland  ;  William 
Duncan  Fraser,  Wales;  Arthur  Fuller, (e)  England;  Matthew  Henry 
Gardiner  (M.A.  Glasg.),  Scotland;  Walter  Chancellor  Garman,  England; 
Robert  Ritchie  Giddings,  England;  Frank  William  Albion  Godfrey,  (e) 
Australia  ;  Robert  Gordon,  England ;  William  Bruce  Gowans,  Scotland ; 
Vernon  John  GreeDhough  (B.A.  Cantab.),  England;  Francis  Walter 
Grierson, (e)  Scotland;  Matthew  Wilkins  Gutteridge,  England  ;  Francis 
James  Hall,  England;  Frederick  William  George  Hall,  India;  Patrick 
Brodie  Handyside,  Scotland;  Robert  Hardie,  Scotland  (received  the 
degrees  on  November  25,  1882) ;  James  Heath,  Ireland;  Edward  Bateman 
Hector,  Scotland ;  Robert  Dundas  Helm,  Scotland ;  John  Henderson 
(M.A.  Q.U.  Irel.),  Ireland;  George  Hewlett, (c)  Ireland;  John  Stonely 
Hill,  England;  Thomas  Knight  Hill,  England;  John  Hoyle,  England; 
James  Hunter,  Scotland;  William  Hunter, (c)  Scotland;  John  Hutson 
(B.A.  Durh.),  Barbadoes ;  Robert  Inch,  Scotland ;  George  Irving  (M.A. 
Edin.),  Scotland;  John  Lowthian  Jackson,  England;  Adam  Jameson, 
Scotland:  Samuel  Johnson,  India;  Charles  Hampson  Jones,  America; 
Francis  William  Brandram  Jones,  England ;  John  Gregory  Jordan,  Cal¬ 
cutta;  John  Edward  Harry  Kelso,  India;  John  Spence  Law,  Scotland; 
Thomas  Spencer  Lawry,  New  Zealand ;  William  Murray  Leslie,  Scotland ; 
Joseph  Alexandre  Lestrade,  St.  Lucia;  Henry  James  Ley,  England; 
Charles  Louis  Lightfoot,  England ;  Henry  Sanderson  Lloyd,  Australia  ; 
Robert  Thomas  Bell  Lorraine,  Scotland ;  John  Alfred  Loudon,  England  ; 
Thomas  Malcolm  Murray  Lyon,  Scotland;  Herbert  Macandrew,  New 
Zealand;  John  Cowan  M'Clew,  Scotland;  John  Macdonald,  Scotland; 
William  Fraser  Macdonald,  Scotland ;  Allan  Macfadyen,  Scotland ;  Alex. 
Duncan  Macgregor,  Scotland  (received  the  degrees  on  January  27,  1883)  ; 
John  Archibald  MTntyre,  Shetland ;  Francis  Alphonsus  Maciver,  England ; 
George  Mackay,  (e)  Madras;  William  Alexander  Mackay,  Scotland  (re¬ 
ceived  the  degrees  on  April  20.  1883)  ;  Archibald  Mackenzie, (c)  Natal; 
Robert  Mackenzie,  Scotland  ;  Frank  Irvine  Mackinnon,  Scotland  ;  John 
McLachlan,  Scotland ;  Charles  George  Maclagan,  Berwick-on-Tweed ; 
James  Alexander  M'Laren,  Scotland  ;  John  Shaw  M'Laren  (M.A.  Edin.), 
Scotland;  James  Macpherson,  New  Zealand ;  William  Aberdein  Malcolm, 
Scotland  ;  Augustus  Alexander  Matheson,  Scotland ;  Farquhar  William 
Matheson,  Scotland ;  Duncan  Menzies  (M.A.  St.  And.),  Scotland;  Alex. 
Cameron  Miller,  Scotland ;  Ralph  Smith  Miller,  Scotland  ;  William  Henry 
Miller,  Canary  Islands ;  David  Milligan,  Scotland ;  James  Milne,  Australia ; 
Robert  Peter  Mitchell,  Scotland ;  Pieter  de  Villiers  Moll,  South  Africa ; 
Arthur  Rowley  Moody,  England ;  Robert  James  Anderson  Moore,  Isle  of 
Man  ;  Benjamin  Michael  Moorehouse,  New  Zealand ;  Upendra  Nath 
Mukerji,  Calcutta  ;  Andrew  Watson  Munro,  Scotland;  Alexander  Brown 
Murdoch,  Scotland;  James  Adam  Johnston  Murray,  England;  Andrew 
Scott  Myrtle,  England  ;  John  Headley  Neale,  England;  Andrew  Murray 
Neethling,  Cape  of  Good  Hope;  Gustavus  Paul  Nicolet,  Belgium;  Gerrit 
Nieuwoudt(c)  (B.A.  Cape  of  Good  Hope),  Cape  of  Good  Hope ;  John 
Tawse  Nisbet,  Scotland ;  John  Orr,  India ;  George  Dali  Orrock,  Scotland ; 
Owen  Richard  Pughe  Owen,(e)  Wales  ;  George  Park(e)  (M.A.  St.  And.), 
America ;  Andrew  Melville  Paterson,  (c)  England ;  Walter  Petter,  England ; 
William  Ernest  Porter,  England  ;  Alexander  William  Gordon  Price, 
India  ;  William  Locking  Price,  India;  Joseph  Priestley  (B.A.  Lond.), 
England;  James  Black  Roberts,  England;  James  Stirling  Robertson(e) 
(M.A.  Edin.),  Scotland;  Thomas  Murray  Robertson, (e)  India;  Arthur 
Robinson,  (e)  England ;  Chisholm  Ross,  Australia  ;  Frank  Rothera,  Eng¬ 
land  ;  Henry  Davis  Rowan,  India ;  Mark  Anthony  Savage,  Ireland  ; 
Harry  Scott,  England ;  Stanley  Scott,  England ;  William  Duncan  Scott 
(B.A.  Oxon. ),  Scotland ;  Lloyd  Grant  Smith,  England ;  Arthur  Edward  Cecil 
Spence,  India  ;  William  Spence,  Scotland  (received  the  degrees  on  Nov.  25, 
1882) ;  Alexander  Stables,  Scotland  ;  Arthur  Cowell  Stark,  England ; 
John  Steell,  India;  Charles  Stein,  (Scotland ;  James  Robert  Stevenson, 
Scotland  (received  the  degrees  on  November  25,  1882)  ;  Arthur  Jallard 
Stiles,  England ;  William  Malcolm  Sturrock,  Scotland  ;  Allan  Cuthbertson 
Sym,  Scotland ;  George  Peter  Taylor,  England  ;  Andrew  Thomson,  Scot¬ 
land  ;  Daniel  Gibson  Pearce  Thomson,  Scotland ;  George  Thomson, 
Scotland;  Richard  Vassie,  Scotland;  John  Walther,  England;  Allan 
Ogier  Ward,  England;  Edward  Henry  Warner,  England;  Alexander 
Oswald  Cowan  Watson,  India  ;  Walter  Frederick  Rodolph  de  Watteville, 
Switzerland ;  James  Bates  Wilkinson,  England  ;  Henry  Arnot  Wilson, 
Scotland ;  J ames  Thomas  Wilson, (e)  Scotland ;  Theodore  Stacey  Wilson(e) 
(B.Sc.  Edin.),  England;  Edwin  Aubrey  Witchell,  England;  Alexander 
John  Wood,  India ;  George  Benington  Wood,  England ;  Thomas  Wood, 
Scotland  (received  the  degrees  on  April  20,  1883) ;  Peter  Yates,  England  ; 
Arthur  Charles  Younan,(e)  Calcutta. 

The  Ettles  Scholarship  for  1883  has  been  awarded  to 
William  Hunter,  M.B.,  C.M. ;  the  Beaney  Prize  to  William 
Hunter,  M.B.,  C.M. ;  the  Buchanan  Scholarship  to  John 
William  Ballantyne,  M.B.,  C.M. ;  the  James  Scott  Scholar¬ 
ship  to  George  Forbes  Alexander,  M.B.,  C.M. ;  and  the 
Dobbie-Smith  Gold  Medal  to  John  E.  Henderson,  Student 
of  Medicine. 

The  following  candidates  passed  the  Second  Professional 
Examination  in  July  : — 

A.  M.  Adams,  N.  E.  Aldridge,  J.  B.  Bawden,  David  Berry,  Alexander 
Bissett,  Reginald  Bowman,  Herbert  Bramwell,  D.  M.  Brown,  T.  A. 
Brown,  R.  F.  Burt,  E.  K.  Campbell,  J.  G.  Cassells,  L.  M.  F.  Christian, 
T.  G.  Churcher,  A.  H.  Croucher,  Daniel  Davies- Jones,  Thomas  Easton, 
Edwin  Eckersley,  Francisco  Fernandes,  Thomas  Fraser,  T.  A.  W.  Fulton 
(with  distinction),  C.  H.  Gage-Brown,  W.  D.  Grieve,  W.  T.  Gubbin,  T.M. 
Hodgson,  W.  A.  Holmes,  T.  A.  F.  Hood,  Robert  Howden  (with  distinc¬ 
tion),  E.  M.  Inglis,  Hugh  John,  David  Laing,  A.  E.  Langschmidt,  C.  N. 
Fee,  C.  L.  Lempriere,  C.  J.  Lewis  (with  distinction),  W.  G.  Little,  J.  S. 
M'Cracken,  A.  G.  Macdonald,  John  Macdonald,  W.  C.  M‘Ewan,  John 
M'Gibbon,  Alistair  Macgregor,  William  Mackay,  William  B.  Mackay, 
F.  L.  Mackenzie,  J.  C.  Mackenzie,  A.  R.  Macmillan,  Archibald  Macqueen, 
L.  G.  Malham,  W.  H.  Van  der  Merwe,  David  Morgan,  J.  H.  Neethling, 
C.  E.  Paterson,  E.  F.  T.  Price,  A.  C.  Purchas,  C.  W.  Purves,  T.  R.  Rait, 

F.  M.  Reynolds,  John  Richards,  William  Richards,  J.  B.  Ridley,  J.  C. 
Robertson,  R.  M.  Robertson,  T.  H.  Robinson,  W.  L.  Ross,  A.  J.  T.  Roux, 
J oseph  Rutter  ( with  distinction) ,  Y.  S.  Sanitwongse,  Herbert  Shelmerdine, 
R.  D.  Shiels,  A.  H.  Smith,  George  Smith  (with  distinction),  S.  H.  A. 
Stephenson,  C.  H.  Stewart,  B.Sc.,  H.  J.  Styles  (with  distinction),  J.  W. 
Stirling,  J.  F.  Sturrock,  John  Sykes,  John  Tomlinson,  J.  R.  Wallace, 
J.  E.  West,  F.  G.  Westenra,  R.  H.  A.  Whiteloeke,  S.  T.  Williamson, 

G.  E.  C.  Wood,  J.  W.  Wyncoll,  J.  C.  Young. 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES. 


August  25,  1883.  2  2  5 


Apothecaries’  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday, 
August  16  : — 

Harris,  John  'William,  Woodhaye,  Ivybridge,  S.  Devon. 
Mountain,  John  Joseph,  Hull. 

Newton,  Rupert  William,  The  Square,  Kenilworth. 

Oram,  Percy  Sprague,  Amhurst-road,  N. 

Penny,  Edmund  John,  The  Vicarage,  Abbotsbury,  Dorset. 
Whitfield,  John  Neil,  Moss-street,  Haywood. 


APPOINTMENTS. 

%*  The  Editor  will  thank  gentlemen  to  forward  to  the  Publishing-office, 
as  early  as  possible,  information  as  to  all  new  Appointments  that  take 
place.  - 

Ewart,  Joseph,  M.D.— Physician  to  the  Royal  Alexandra  Hospital  for 
Sick  Children,  Brighton. 

Mackey,  Edward,  M.D.— Physician  to  the  Royal  Alexandra  Hospital  for 
Sick  Children,  Brighton. 


DEATHS. 

McDonald,  John  Alexander,  M.D.,  late  of  Woburn,  Bedfordshire,  at 
Horsham,  Sussex,  on  August  17. 

Smith,  John  Alexander,  M.D.,  Treasurer  Royal  College  of  Physicians, 
Edinburgh,  etc.,  at  Edinburgh,  on  August  17. 


VACANCIES. 

In  the  following  list  the  nature  of  the  office  vacant,  the  qualifications  re¬ 
quired  in  the  candidate,  the  person  to  whom  application  should  be  made 
and  the  day  of  election  (as  far  as  known)  are  stated  in  succession. 

Central  London  Ophthalmic  Hospital,  Gray’s -inn-road,  W.C. — 
Assistant-Surgeon.  Candidates  must  be  Fellows  or  Members  of  the 
Royal  College  of  Surgeons  of  London,  Edinburgh,  or  Dublin,  and  must 
produce  certificates  of  having  attended  the  practice  of  some  ophthalmic 
institution  for  at  least  six  months.  Testimonials  to  be  sent  to  the 
Secretary,  on  or  before  September  8. 

Chester  General  Infirmary. — House-Surgeon.  Salary  to  commence  at 
£80  per  annum,  with  residence  and  maintenance.  Candidates  must 
possess  double  qualifications  and  be  duly  registered.  Testimonials  to  be 
addressed  to  the  Chairman  of  the  Board,  on  or  before  August  27. 

Clinical  Hospital  for  Women  and  Children,  Park-place,  Man¬ 
chester. — House-Surgeon.  Salary  £80  per  annum,  with  apartments 
and  board.  Candidates  must  be  duly  qualified  practitioners.  Applica¬ 
tions,  with  testimonials,  stating  age,  to  be  sent  to  Mr.  Edwin  W.  Marshall, 
Secretary,  38,  Barton-arcade,  Manchester,  not  later  than  August  28. 

General  Infirmary  at  Gloucester  and  the  Gloucestershire  Eye 
Institution. — House-Surgeon.  Salary  at  the  rate  of  £103  per  annum, 
with  board,  lodging,  and  washing.  Candidates  must  possess  a  medical 
and  surgical  qualification  and  be  registered.  Applications,' with  testi¬ 
monials,  to  be  forwarded  to  the  Secretary  on  or  before  September  1. 

Jersey  Public  Lunatic  Asylum. — Superintendent  Medical  Officer.  [For 
particulars  see.  Advertisement.) 

Liverpool  Royal  Southern  Hospital. — Senior  House-Surgeon.  ( For 
particulars  see  Advertisement.) 

Royal  South  London  Dispensary,  St.  George’s  Cross,  Lambeth,  S.E. — 
Honorary  District-Surgeon.  Apply  to  Mr.  Hentsch,  at  the  Dispensary, 
on  or  before  September  1. 

Wallasey  Dispensary.— House-Surgeon.  ( For  particulars  see  Advertise¬ 
ment.) 

Western  Ophthalmic  Hospital,  155,  Marylebone-road,  W.  — Surgeon. 
Candidates  must  be  Members  or  Fellows  of  the  Royal  College  of  Sur¬ 
geons  of  England,  and  have  attended  ophthalmic  practice  for  twelve 
months.  Address,  Secretary,  at  the  Hospital,  on  or  before  September  1. 


UNION  AND  PAROCHIAL  MEDICAL  SERVICE. 

***  The  area  of  each  district  is  stated  in  acres.  The  population  is 
computed  according  to  the  census  of  1881. 

RESIGNATIONS. 

Abingdon  Union. — Dr.  George  Gossett  has  resigned  the  First  District : 
area  7242 ;  population  5406  ;  salary  £107  per  annum. 

Bingham  Union. — Mr.  W.  P.  Blumer  has  resigned  the  West  District : 
area  15,748 ;  population  2947 ;  salary  £30  per  annum. 

Gockermouth  Union. — Mr.  Joseph  Pearson  has  resigned  the  Maryport 
District :  area  21,778 ;  population  17,976 ;  salary  £75  per  annum. 

Dursley  Union. — Mr.  Francis  James  Joynes  has  resigned  the  Third 
District :  area  6410 ;  population  2157  ;  salary  £80  per  annum. 

Greenwich  Union. — Mr.  A.  J.  Bathe  has  resigned  the  office  of  Assistant 
Medical  Officer  at  the  Infirmary.  Salary  £100  per  annum  and  board  and 
lodging. 

Norwich  Union. — The  office  of  Medical  Officer  for  the  First  District  is 
vacant :  population  7829 ;  salary  £80  per  annum. 

APPOINTMENTS. 

Alcester  Union. — Robert  William  Jephcott,  L.R.C.P.,  L.R.C.S.,  andL.M. 
Edin.,  to  the  Alcester  District  and  the  Workhouse. 

Liverpool  Parish.-  John  Henderson  Brannigan,  L.B.C.P.  andL.R.C.S. 
Edin.,  Assistant  Medical  Officer  at  the  Workhouse. 

Manchester  Township. — William  Henry  Winder,  M.R.C.S.  Eng.  and 
L.R.C.P.  Loud.,  to  be  Resident  Assistant  Medical  Officer  at  the  Crumpsall 
Workhouse. 

Manchester  Union.— James  Richmond,  M.R.C.S.  Eng.  and  M.B.,  to  the 
office  of  Assistant  Medical  Officer  at  Crumpsall  Workhouse. 

New  Winchester  Union. — David  Brown,  M.R.C.S.  Eng.,  L.K.&Q..C.P. 
Ire.,  to  the  Second  District. 

Okehampton  Union.—  John  Arthur  Kempe,  M.R.C.S.  Eng.,  L.R.C.P. 
Lond.,  to  the  North  Pawson  District. 


NOTES,  QUERIES,  AND  REPLIES. 

■ - ♦ - 

He  tjjat  questioned  murjj  s^all  learn  mntlj. — Bacon. 


M.  P.  W . — Consult  any  physician  on  the  staff  of  any  of  the  metropolitan) 
general  hospitals. 

A  Colonial  Surgeon. — One  of  the  gentlemen  who  signed  your  recommenda¬ 
tion  for  the  Fellowship  not  having  himself  signed  the  by-laws  since- 
he  was  elected  a  Fellow,  the  Council  was  unable  to  proceed  to  the 
election.  If  this  error  is  rectified  the  election  will  take  place  in 
October.  Your  old  friend  Mr.  Stone  informs  us  that  he  will  get  this 
matter  remedied  for  you  by  a  mutual  friend. 

A  Sergeant’s  Letter  from  Cairo. — “A  good  many  soldiers  have  broken 
their  pledges  as  teetotalers  through  the  offer  of  the  ration  of  rum,  the 
intense  heat,  and  the  bad  water.  The  latter  is  frequently  almost  as-, 
thick  and  as  black  as  ink,  and  it  may  be  that  a  short  distance  from 
you,  in  the  canal  or  pool,  is  the  dead  body  of  a  horse  or  camel.  Under 
these  circumstances  all  you  have  to  do  is  to  dip  your  can  in  the  liquid,, 
apply  it  to  your  lips,  and  think  you  are  drinking  clear  water  !  Nice, 
isn’t  it  ?  ” 

Vaccination  in  St.  Pancras  Workhouse:  The  Rosina  Walsh  Case.— The  Secre¬ 
tary  of  the  Local  Government  Board  has  addressed  the  following  letter 
to  Dr.  Dunlop “  Adverting  to  your  statement,  that  you  do  not  re¬ 
member  having  asked  Rosina  Walsh  before  you  performed  the  opera¬ 
tion  whether  she  had  ever  been  revaccinated,  I  am  to  state  that  the 
Board  consider  that  if  you  did  not  in  fact  make  this  inquiry,  it  was  your 
duty  to  have  done  so.  With  regard  to  the  allegation  that  the  operation 
was  performed  without  the  woman’s  consent,  the  Board  directs  me  to 
say  generally,  that  they  are  of  opinion  that  the  mere  fact  of  there 
being  no  expressed  objection  on  the  part  of  the  patient  should  not  be- 
regarded  as  equivalent  to  his  or  her  concurrence.  On  the  question  of 
the  revaccination  of  women  after  confinement,  I  am  to  state  that  while¬ 
providing  for  the  inmates  of  the  workhouse  in  its  several  departments 
such  revaccination  as  is  proper  in  order  to  guard  each  department 
from  danger  of  small-pox,  the  Board  are  advised  that  it  is  undesirable- 
to  allow  the  accidents  of  the  lying-in  room  to  be  confounded  in  the- 
mind  of  patients  with  the  results  of  vaccination,  and  you  will  do  well! 
to  hold  this  consideration  in  view  as  affecting  the  question  of  revacci¬ 
nating  women  within  a  short  period  of  labour.” 

The  Medical  College  Hospital ,  Calcutta. — The  Indian  Daily  News  states  that 
a  native  lady  has  already  been  enrolled  as  a  pupil  in  the  primary  class. 
Dr.  Johnson.— The  late  Dr.  Robert  Boyd,  who  perished  in  the  destruction 
by  fire  of  his  asylum,  must  have  been  seventy-five  years  of  age,  seeing- 
he  was  admitted  a  Member  of  the  London  College  of  Surgeons  in  1830, 
when  the  regulations  of  the  College  required  he  should  then  be  twenty- 
two  years  of  age.  Dr.  Boyd  was  an  Irish  gentleman  ;  he  and  the  late- 
Professor  George  Gulliver  married  sisters. 

A  New  Cottage  Hospital,  Trowbridge.— A  cottage  hospital,  the  gift  of  Mr. 
Jesse  Gouldsmith,  son  of  the  late  Mr.  Gouldsmith,  of  Clifton,  to  the- 
town,  is  in  course  of  erection,  and  it  is  understood  that  the  generous 
donor  will  also  endow  it.  The  building  will  include  a  soup-kitchen,  and 
the  total  cost  is  estimated  at  £3000. 

Vaccination,  Eastbourne.— On  the  13th  inst.  no  less  than  sixty-eight  persons 
were  summoned  before  the  magistrates  for  not  complying  with  the  law. 
Several  of  them  had  three  children  unvaccinated,  and  others  had  been 
previously  convicted  for  a  similar  offence.  Fines  were  imposed  in  some 
cases,  and  orders  for  vaccination  made  in  others.  As  to  the  latter  the 
delinquents,  without  exception,  declared  they  would  not  obey  the  order. 
Tobacco-Smoking  Nations.— A  statistical  comparison  recently  published, 
showing  the  relative  extent  to  which  various  nations  are  addicted  to- 
the  use  of  tobacco,  gives  the  proportions  as  follows For  England, 
France,  and  Russia,  5  ;  for  Italy,  7  ;  for  Cuba,  11 ;  for  Austria,  14  ;  for- 
Germany  and  North  America,  15 ;  for  Belgium,  24  ;  and  for  Holland,  28. 
Mexico,  however,  even  surpasses  Holland,  for  there  everyone  is  a 
smoker.  The  school  children  who  have  done  best  in  their  studies  are 
rewarded  by  being  allowed  to  smoke  a  cigar  as  they  stand  or  sit  at  their- 
lessons.  The  schoolmaster  himself  is  seldom  without  a  cigar  in  his 
mouth.  In  the  law  courts  all  persons  commonly  enjoy  their  tobacco 
freely,  and  even  the  accused  in  a  criminal  trial  is  not  denied  this 
indulgence. 

The  Noel  Park  Estate,  Hornsey-  This  is  the  third  building  enterprise  of  the 
Artisans’,  Labourers’,  and  General  Dwellings  Company.  No  public- 
houses  will  be  permitted  in  any  part  of  it,  although  it  will  comprise 
2600  houses,  covering  nearly  one  hundred  acres.  The  rents  of  the  houses- 
(including  all  rates  and  taxes)  range  from  11s.  6d.  for  the  first-class- 
houses,  containing  eight  rooms,  to  6s.  per  week  for  the  fifth-class  houses, 
which  contain  four  rooms  and  a  washhouse. 

Quarantine  in  Excess.—  A  German  merchant,  a  few  days  ago,  received  a 
telegram  from  Damietta.  Noticing  that  it  had  been  detained  twenty- 
four  hours,  he  made  inquiries,  when  he  was  told  that  the  telegram  came 
from  a  cholera-stricken  district,  and  they  were  compelled  to  disinfect  it 
according  to  the  regulations  of  the  authorities  ! 


226 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES 


August  25,  1883. 


A-n  Old  Subscriber.  —  The  first  number  of  the  Medical  Times  was  published 
September  28,  1839.  The  “  Medical  Portraits  ”  appeared  in  that  and 
succeeding  volumes.  You  will  find  a  complete  set  in  the  library  of  the 
College  of  Surgeons,  but  remember  it  will  be  closed  during  the  month 
of  September. 

I Precautions  in  Belgian  Theatres. — The  Communal  Council  of  Brussels  have 
issued  some  new  regulations,  which  are  specially  directed  against 
“sensational  scenes  of  the  kind  which  introduce  fire  and  explosives.” 
No  such  scenes  are  henceforth  to  be  allowed  without  the  permission  of 
■the  authorities,  and  then  only  under  prescribed  conditions.  The  manu¬ 
facture  or  storing  of  explosive  substances  in  theatres  is  prohibited. 
dSuch  substances,  when  permitted,  are  to  be  kept  in  a  building  apart,  in 
the  charge  of  the  firemen  of  the  establishment,  and  can  only  be  intro¬ 
duced  by  them  immediately  before  they  are  required  for  scenic  effects. 

Water  Cisterns:  An  Economical  Improvement.  — The  Building  and  Engineer¬ 
ing  Times  states  “  We  suppose  that  in  some  future  day,  when  sanitary 
-appliances  and  precautions  shall  be  in  universal  use,  the  modem  prac¬ 
tice  of  having  one  cistern  from  which  are  drawn  the  supply  of  drinking- 
"water  and  the  supply  for  flushing  a  closet  will  be  looked  upon  as  a  relic 
of  barbaric  uncleanliness.  But  there  are  thousands  of  houses  inhabited 
by  respectable  people  where  the  single  cistern  is  thus  employed.  It  is 
really  worth  while  knowing  that  at  a  comparatively  small  expense  this 
may  he  avoided.  A  partition  may  be  placed  in  the  cistern  reaching  to 
half  an  inch  higher  than  the  top  of  the  waste-pipe,  and  separating  the 
■closet  valve  from  the  domestic  supply  pipe.  As  those  are  usually  at 
■different  ends  of  the  cistern  this  is  easy.  When  the  water  is  ‘  turned 
on  ’  the  domestic  half  is  first  filled,  and  the  water  overflows  to  fill  the 
other  half.  Two  cisterns  are  thus  practically  provided  in  the  room  of 
one,  and  the  drinking-water  is  thus  effectually  separated  from  that 
required  for  the  closet.  We  have  actually  tried  this  plan,  and  can 
speak  favourably  of  it.  The  water  company’s  inspector,  it  is  true,  was 
puzzled  by  it,  and  thought  it  rather  irregular,  but  he  was  unable  to 
charge  anything  extra  for  it,  so  that  we  obtained  all  the  advantage  of  a 
second  cistern,  without  paying  4s.  a  year  to  a  rapacious  company.  The 
■cost  of  the  contrivance  is  under  half-a  sovereign,  and  no  doubt  it  was 
repaid  over  and  over  again  by  the  greater  purity  of  our  drinking- 
water.” 

.Money  in  Lieu  of  Beer ;  Fish  Dinners. — The  Local  Government  Board  has 
assented  to  the  proposal  of  the  Islington  Board  of  Guardians  to  pay  the 
several  officers  of  the  schools  at  the  rate  of  £3  per  annum  each  in  lieu  of 
the  usual  allowance  of  beer.  The  number  altogether  will  be  twenty. 
The  Guardians  have  decided  to  try,  as  an  experiment,  fish  dinners  for 
the  inmates  of  the  workhouse  once  a  week  for  a  fortnight. 

A  Sad  Catastrophe. — Mr.  Robert  W.  Corry,  son  of  Mr.  R.  W.  Corry,  of 
Belfast,  and  nephew  of  Mr.  J.  P.  Corry,  M.P.,  recently  went  out,  accom¬ 
panied  by  a  friend,  on  a  botanising  excursion  in  Lough  Gill ;  both  have 
been  drowned.  Mr.  R.  W.  Corry  held  a  high  position  as  botanist  at 
Cambridge,  where  he  resided.  He  was  one  of  the  Lecturers  on  Botany 
in  the  Medical  and  Biological  Schools.  Early  in  the  present  year  he  was 
appointed  Lecturer  on  Botany  at  Girton  College,  and  was  elected  a 
Bellow  of  the  Cambridge  Philosophical  Society.  Lately  he  was  awarded 
-a  supplementary  science  grant  by  the  Royal  Irish  Academy,  in  addition 
to  that  granted  last  year,  to  aid  in  the  completion  of  a  botanical  survey 
of  the  Ben  Bulben  Range,  County  Sligo. 

'.The  Small-pox  Epidemic,  Wednesbury  .—The  Sanitary  Authority  has 
succeeded  in  stamping  out  small-pox  in  the  district,  where  it  has  pre¬ 
vailed  for  two  years.  The  disease  was  brought  into  the  town,  and  seven 
hundred  cases  have  occurred,  resulting  in  fifty  deaths.  A  thorough 
system  of  isolation  was  carried  out,  and  the  authorities  erected  marquees 
in  a  field,  to  which  affected  persons  were  immediately  removed. 

The  Liquor  Trade  and  its  Profits. — A  publican,  a  witness  in  a  case  recently 
heard  at  Preston,  said  the  profit  on  spirits  was  about  100  per  cent. ;  and 
another,  who  had  been  in  the  trade  all  his  life,  stated  that  for  an  ex¬ 
penditure  of  £100  there  ought  to  “be  a  return  of  £200,  for  after  rent, 
rates,  and  taxes  were  paid  there  should  be  a  net  profit  left  of  40  or  50 
per  cent. ! 

'The  Dewsbury  and  District  Infirmary.— This  institution  has  just  been 
opened.  The  Infirmary  has  cost  about  £17,000,  including  the  site,  and 
provides  accommodation  for  fifty  in-patients. 

'The  High  Death-Rate,  St.  Petersburg.  —  The  annual  death-rate  of  this  city 
is  over  61  per  thousand  of  the  population.  This  excessive  mortality  may 
be  largely  accounted  for  by  the  quality  of  the  water  supplied  to  the 
inhabitants.  Steps  are  about  to  be  taken  to  remedy  this,  no  douht, 
.serious  evil.  The  Prefect  of  St.  Petersburg  has  lately  called  the  atten¬ 
tion  of  the  Mayor  to  the  results  of  an  extensive  series  of  experiments, 
confirming  the  general  complaints  of  the  disagreeable  flavour  and 
;nauseating  odour  of  the  water  in  common  use.  The  subject  has  been 
referred  to  a  municipal  committee,  who  have  reported  that  it  is  urgently 
necessary  that  filters  should  be  established  in  connexion  with  the  supply 
in  every  house  in  the  city,  at  an  estimated  cost  of  200,000  roubles.  The 
water  company,  sheltering  itself  under  the  terms  of  its  contract,  has 
refused  to  bear  this  expense,  and  it  is  admitted  that  it  would  be  difficult 
to  compel  the  landlords  of  houses  to  undertake  the  task.  In  these 
■circumstances  it  is  suggested  that  this  reform  shall  be  carried  out 
immediately  at  the  cost  of  th£  municipality. 


The  Dustbin  :  A  Good  Example. — The  Poplar  District  Board  ofWorks  has 
resolved — “  That,  in  order  to  prevent  the  accumulation  of  dust  and 
house-refuse,  the  Board  provide  receptacles,  and  deliver  the  same  at 
such  houses  as  may  hereafter  be  considered  advisable  in  their  district, 
for  the  occupiers  to  place  all  dust  and  refuse  therein,  such  receptacles  to 
be  placed  on  the  pavement  outside  the  houses,  at  such  times  as  may  be 
hereafter  fixed,  so  that  such  receptacles  may  be  emptied.”  The  Board 
expressed  the  doubt  whether,  among  the  rougher  portion  of  the  popu¬ 
lation,  the  system  will  be  found  to  be  practicable.  But  the  experiment 
is  to  have  a  full  and  fair  trial. 

Dr.  MacS.,  Whitechapel.— Only  one  member  of  the  Council  of  the  College 
of  Surgeons  has  died  whilst  filling  the  President’s  chair,  viz.,  Mr. 
Richard  Clement  Headington,  Surgeon  to  the  London  Hospital,  who 
was  succeeded  by  Mr.  Robert  Keate,  Surgeon  to  St.  George’s  Hospital, 
in  1830.  He  held  office  during  that  and  the  succeeding  year.  The  new 
Calendar  of  the  College  will  not  be  published  for  some  weeks  ;  it  will, 
like  its  predecessors,  give  you  all  the  desired  information. 

A  Medical  Attendant's  Bill. — “I  understood  you  to  say  that  your  charges 
would  be  light,”  complained  a  patient  when  his  doctor  handed  him  a 
tremendous  bill.  *’  I  believe  I  said  my  fees  would  be  nominal,”  was  the 
reply;  ‘‘but - .”  “  Oh,  I  see,”  interrupted  the  patient ;  “jjAenomenal 

COMMUNICATIONS  have  been  received  from — 

Mr.  Kenneth  W.  Millican,  Kineton  ;  The  Secbetary  of  the  Quekett 
Microscopical  Club,  London;  The  Secretary  of  the  Sanitary 
Institute  of  Great  Britain,  London;  Mr.  Jonathan  Hutchinson, 
F.R.S.,  London ;  Mr.  David  Willis, London;  Mr.  J.  Ckatto,  London  ; 
Dr.  George  Buchanan,  F.R.8.,  London;  Dr.  C.  Mercier,  Dartford  ; 
Dr.  Henry  Msudsley,  London ;  Dr.  J.  Wickham  Lego,  London  ;  Mr. 
T.  M.  Stone,  London  ;  The  Honorary  Secretary  of  the  Association 
of  Bellows  of  the  R  iyal  College  of  Subgeons  of  England, 
Liverpool;  The  Secretary  of  the  University  of  London,  London  ; 
The  Director-General  of  the  Army  Medical  Department,  London  ; 
Dr.  Bruce.  London;  The  Dean  of  the  Western  Medical  School, 
Glasgow;  The  Registrar  of  the  Apothecaries’  Hall,  London;  The 
Registrar-General  for  Scotland,  Edinburgh. 

BOOKS,  ETC..  RECEIVED  - 

Dei  Germi  ad.Organismi  Inferiori,  del  Dotti  Antonio  Ceci— Transactions 
of  the  Vaccination  Inquiry,  by  Montague  D.  Makuna,  part  i. — The 
Pharmacopoeia  of  the  North-Eastern  Hospital  for  Children— The  Law 
of  Sex,  by  George  B.  Starkweather,  F.R.G.S. — Speeches  of  Mr.  P.  A. 
Taylor  and  Mr.  C.  H.  Hop  wood  on  Vaccination — Metropolitan  Asylums 
Board  :  Report  of  the  South-Eastern  District  Hospital  for  1882 — Lund 
on  the  Antiseptic  Question. 

PERIODICALS  AND  NEWSPAPERS  RECEIVED  - 
Lancet— British  Medical  Journal— Medical  Press  and  Circular — Ber¬ 
liner  Klinisehe  Wochenschrift— Centralblatt  fiir  Chirurgie — Gazette 
des  Hopitaux— Gazette  Medicale— Revista  de  Medicina— Bulletin  de 
1’  Academie  de  Medeeine— Pharmaceutical  J ournal — W iener  Medicinisohe 
Wochenschrift — Revue  M5dieale— Gazette  Hebdomadaire — Nature — 
Boston  Medical  and  Surgical  Journal— Louisville  Medical  News— 
Centralblatt  fiir  Gynakologie — Le  Concours  Medical— Centralblatt  fiir 
die  Medicinischen  Wissenschaf  ten— Centralblatt  fiir  Klinisehe  Medicin 
— Philadelphia  Medical  News— Le  Progres  Medical — Ciencias  M£dicas  — 
Canadian  Practitioner- Maryland  Medical  Journal,  July  28  and  August 
4— Journal  of  the  Vigilance  Association— Journal  of  the  British  Dental 
Association — Detroit  Lancet— Hawick  Express,  August  18— American 
Journal  of  Obstetrics— Medicinisch-Chirurgisches  Correspondenz-Blatt 
— Australasian  Medical  Gazette  -  Centralblatt  fiir  Nervenheilkunde,  etc. 


APPOINTMENTS  EOR  THE  WEEK. 


August  25.  Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  l£  p.m. ;  King’s  College,  1£  p.m. ;  Royal 
Eree,  2  p.m.;  Royal  London  Ophthalmic,  11  a. m. ;  Royal  Westminster 
Ophthalmic,  ljp.m.;  St.  Thomas’s,  l&p.m.;  London,  2  p.m. 

27.  Monday. 

Operations  at  the  Metropolitan  Free,  2  p.m.;  St.  Mark’s  Hospital  for 
Diseases  of  the  Rectum.  2  p.m.;  Royal  London  Ophthalmic,  11  a.m.; 
Royal  Westminster  Ophthalmic,  1J  p.m. ;  Hospital  for  Women,  2  p.m. 

28.  Tuesday. 

Operations  at  Guy’s,  1£  p.m. ;  Westminster,  2  p.m. ;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  1&  p.m.;  West 
London.  3  p.m.  _ _ 

29.  Wednesday. 

Operations  at  University  College.  2  p.m. ;  St.  Mary’s,  If  p.m.  ;  Middlesex, 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew’s,  1£  p.m.  ;  Great  Northern, 

2  p.m. ;  Samaritan,  2J  p.m. ;  Royal  London  Ophthalmic,  11  a.m. ; 
Royal  Westminster  Ophthalmic,  l£  p.m. ;  St.  Thomas’s,  1J  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m. ;  National  Orthopaedic,  Great 
Portland-street.  10  a.m. 

30.  Thursday. 

Operations  at  St.  George’s,  1  p.m. ;  Central  London  Ophthalmic,  1  p.m. ; 
Royal  Orthopaedic,  2  p.m.;  University  College,  2  p.m.;  Royal  London 
Ophthalmic, 11  a.m. ;  Royal  Westminster  Ophthalmic,  1£  p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m. ;  Hospital  for  Women,  2  p.m. ; 
Charing-cross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  2£  p.m. 

31.  Friday. 

Operations  at  Central  LondonOphthalmic,  2  p.m. ;  Royal  London  Ophthal¬ 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminster 
Ophthalmic,  ljp.m.;  St.  George’s  (ophthalmic  operations),  1 1  p.m.; 
Guy’s,  14  p.m. ;  St.  Thomas’s  (ophthalmic  operations),  2  p.m.;  King’s 
I  College  (by  Mr.  Lister),  2  p.m. 


DELIVERED  AT 

THE  HUNTERIAN  SOCIETY 

On  February  28,  1883. 

By  WALTER  RIVINGTON,  M.S.  Lond.,  F.R.C.S.  Eng., 

Surgeon  to  the  London  Hospital. 

Gentlemen, — The  first  and  not  the  least  agreeable  of  the 
duties  which  devolve  upon  me  as  the  result  of  my  election 
to  the  highly  honourable  office  of  President  of  the  Hunterian 
Society  is  to  thank  the  members  for  the  distinction  thus 
conferred  upon  me.  My  sense  of  this  honour  has  been 
deepened  by  glancing  over  the  names  inscribed  in  the  list  of 
Presidents  of  the  Hunterian  Society.  Here  we  find  the 
names  of  Blizard,  Robinson,  the  two  Babingtons,  Travers, 
Billing,  Callaway,  Aston  Key,  Bransby  Cooper,  Whiting, 
John  Scott,  William  Cooke,  Luke,  Bright,  Macmurdo, 
Ramsbotham,  Cock,  Marshall  Hughes,  John  Adams,  Henry 
Greenwood,  Hilton,  Lever,  Curling,  Barlow,  Solly,  Little, 
Walne,  Risdon  Bennett,  Critchett,  Daldy,  Smee,  Stephen 
Ward,  John  Jackson,  Peacock,  Jonathan  Hutchinson, 
Herbert  Davies,  Bryant,  Robert  Barnes,  Sedgwick  Saunders, 
Pot  her  by,  Arthur  Durham,  Crosby,  Braxton  Hicks,  John 
Gouper,  Burchell,  and  Hughlings-Jackson.  Many  of  these 
names  are  “familiar  in  our  mouths  as  household  words,” 
and  are  indelibly  inscribed  upon  the  scroll  of  fame.  Here 
are  men  who  have  made  important  improvements  in  science, 
who  have  carried  out  original  investigations,  who  have  dis¬ 
covered  new  diseases,  or  first  supplied  the  correct  interpre¬ 
tation  of  conditions  previously  known  but  wrongly  under¬ 
stood  ;  men  who  have  devised  effective  treatment  for  diseases 
and  deformities  ;  men  who  have  held  the  foremost  position 
in  special  branches  of  our  art ;  men  eminent  as  exponents  of 
clinical  medicine  and  surgery,  or  as  successful  teachers  of 
sciences  embraced  in  the  medical  curriculum ;— leaders  of 
the  profession  both  in  theory  and  practice.  And  last,  though 
by  no  means,  in  my  humble  judgment,  the  least  in  merit,  are 
the  names  of  general  practitioners,  Orators  of  the  Society, 
who  have  been  held  in  estimation  by  their  professional 
brethren,  and  who,  by  their  high  and  honourable  conduct  as 
trusted  family  counsellors,  have  maintained  before  the  main 
body  of  the  public  the  true  dignity  of  medicine.  A  list  of 
names  like  that  which  I  have  placed  before  you  constitutes 
■of  itself  an  eloquent  vindication  of  the  policy  which  led  to 
the  foundation  of  the  Hunterian  Society,  and  is  the  best  of 
all  possible  proofs  of  the  value  of  the  Society,  and  of  the 
-opinion  entertained  of  it  within  the  sphere  of  its  operation 
by  the  profession  itself.  Fortunately,  however,  notwith¬ 
standing  their  eminence,  the  prosperity  of  the  Hunterian 
-Society  does  not  depend  upon  the  President,  however  advan¬ 
tageous  it  may  be  that  the  edifice  should  be  appropriately 
-crowned.  It  is  upon  the  active  support  and  interest  dis¬ 
played  by  the  main  body  of  the  members,  upon  the  social 
tie  arising  from  our  acquaintance  with  each  other,  and  our 
unrestrained  intercourse  at  our  meetings  imparting  a  feeling 
of  friendship  and  brotherhood  not  met  with  to  a  like  extent 
at  any  West-end  society,  that  we  have  to  rely.  Our 
-■dinners  are  an  excellent  institution,  and  do  something  to 
"keep  up  the  popularity  of  the  Society.  Our  library  is  con¬ 
venient  for  reference,  and  our  librarians  have  been  inde¬ 
fatigable.  Both  our  Librarians  and,  our  Treasurers  show 
their  interest  in  the  maintenance  of  the  Society  by  holding 
their  offices  for  long  periods — a  steadfastness  by  which  the 
Society  greatly  benefits.  But,  first  and  foremost  amongst 
us,  the  real  generals  and  leaders  of  our  army,  are  our  Secre¬ 
taries,  on  whom  we  depend  largely  for  keeping  up  the  sup¬ 
plies  of  papers  and  contributions.  The  list  of  our  Secretaries 
is  a  very  goodly  list,  and  names  may  be  seen  in  the  list 
which  are  not  to  be  found  in  the  list  of  Presidents — but 
names  of  distinguished  men,  which  it  is  a  pleasure  to 
recall.  There,  for  instance,  is  the  name  of  Dr.  Habershon  ; 
and  all  will  remember  the  loss  which  the  Society  and 
the  profession  deplored  in  the  early  death  of  a  former 
Secretary— a  rising  man  of  great  promise,  integrity,  and 
capacity — Dr.  John  J.  Phillips,  of  Guy’s.  Again,  if  you  com¬ 
pare  the  list  of  Presidents  with  the  list  of  Orators,  you  find 

Yon.  II.  1883.  No.  1731. 


that  there  are  names  in  each  list  not  inscribed  in  the  other. 
Out  of  48  Presidents  37  have  delivered  the  Oration  ;  out  of 
55  Orators  37  have  occupied  the  Presidential  chair,  leaving, 
after  deducting  the  names  of  those  who  may  be  among  my 
successors,  a  balance  composed  of  men  of  high  standing  in 
the  profession,  now  and  formerly,  who  ought  to  be  had  in 
more  constant  remembrance.  I  will  mention  Dr.  Conquest, 
Mr.  Coulson,  Mr.  Bell,  Dr.  Ashwell,  Dr.  Thomson,  Dr.  Owen 
Rees,  Dr.  Ridge,  Mr.  Thomas  Callaway,  junior.  Dr.  Oldham, 
Dr.  Munk,  and  Sir  William  GulU  |Hence,  I  think,  it  would 
be  an  improvement  if  we  printed  in  our  annual  Transactions 
not  merely  the  list  of  Presidents,  but  the  list  of  Secretaries, 
Orators,  Treasurers,  and  Librarians.  The  space  occupied 
would  not  be  great,  and  an  agreeable  completeness  would  be 
imparted  to  our  record. 

Our  Society  was  founded  in  February,  1819,  and  is  the 
third  in  the  metropolis  in  point  of  age,  having  been  preceded 
by  the  Medical  Society,  established  in  1773,  and  the  Medico- 
Chirurgical  in  1805.  Never  was  it  more  flourishing  than  it 
is  now.  At  the  end  of  the  first  year  of  its  existence  it 
embraced  53  members ;  four  years  later  there  were  79  ordi¬ 
nary  members  and  33  corresponding  members  ;  in  1870  the 
number  of  members  had  risen  to  120  ;  and  in  1881-82  it  stood 
at  130,  together  with  2  honorary  members  and  26  corre¬ 
sponding  members.  Speaking  of  the  order  of  corresponding 
members  in  1869,  Dr.  Fotherby  said — “  It  may  be  remarked 
here  that  the  institution  of  the  latter  class  has  been  a  failure 
in  the  Society’s  operations.  It  was  expected  that  this  free 
membership  would  secure  in  return  an  occasional  communi¬ 
cation  from  the  recipient;  ;  but  the  title  appears  to  be  under¬ 
stood  as  lucus  a  non  lucendo — corresponding  members  do 
not  correspond.”  This  description  remains  as  true  at  the 
present  time  as  when  it  was  uttered  fourteen  years  ago. 

Our  income  is  adequate  to  our  wants,  and  there  is  generally 
a  small  balance  at  the  end  of  the  year. 

Our  Society  is  one  of  the  most  complete  medical  societies 
in  the  metropolis ;  for  it  has  its  library,  its  dinner,  and  its 
Oration,  as  well  as  its  business  meetings.  It  is  also  distin¬ 
guished  for  its  universality.  No  kind  of  medical  communi¬ 
cation  is  excluded.  It  is  at  once  a  pathological  society,  a 
clinical  society,  a  medico-chirurgical  society,  an  obstetrical 
society,  and  an  ophthalmological  society.  Moreover,  papers 
have  occasionally  been  read  upon  topics  of  general  profes¬ 
sional  interest.  Many  of  the  communications  offered— and 
certainly  not  the  least  interesting  and  instructive— are 
histories  of  cases,  illustrated  often  by  the  presence  of  the 
patients  themselves.  Possibly  the  rule  which  prevents  the 
publication  of  our  proceedings  in  the  weekly  journals  may 
operate  unfavourably  in  some  respects  as  regards  the 
increase  of  the  Society  and  the  number  of  papers  and  other 
communications,  but  it  has  counterbalancing  advantages, 
and  stare  super  vias  antiquas  is  a  safe  motto  to  follow  in 
this  particular.  That  it  does  not  seriously  interfere  with 
the  supply  of  good  material  is  shown  by  the  fact  that  many 
of  the  papers  read  are  published  by  the  authors  in  the 
medical  periodicals.  At  the  moment  I  recall  papers  by  Mr. 
Hutchinson,  Dr.  Stephen  Mackenzie,  Dr.  Herman,  Dr. 
Bedford  Fenwick,  Dr.  Hughlings-Jackson,  Dr.  Fletcher 
Beach,  Mr.  Jennings,  and  myself.  If  I  may  be  pardoned 
for  a  moment  referring  to  my  own  papers  I  would  mention 
that  I  have  read  six  formal  papers  before  this  Society  and 
all  have  appeared  in  some  form  or  other  in  a  medical  perio¬ 
dical,  five  of  them  almost  as  they  were  read  to  the  Society. 
All  contained  material  which  I  valued,  which  was  the  best  at 
my  disposal  at  the  time,  and  would  have  been  brought  before 
some  West-end  society  if  I  had  not  been  perfectly  contented 
with  the  more  retiring  medium  of  the  Hunterian  Society. 
Our  papers,  which  are  of  varied  interest,  are  supplemented 
by  our  Orations,  which  have  dealt  with  a  very  wide  range  of 
topics — scientific,  ethical,  historical,  political,  statistical,  edu¬ 
cational,  philosophical,  and  didactic.  Bound  together,  they 
would  form  a  valuable  and  instructive  volume.  Two  of  these 
Orations  stand  out  prominently  as  records  of  the  past  work  of 
the  Society,  peculiarly  interesting  to  any  new  members  who 
may  be  desirous  of  making  themselves  acquainted  with  the 
Transactions  of  the  Society  in  former  years,  forming  a  just 
estimate  of  the  value  of  the  Society  to  the  busy  practitioner, 
and  judging  how  far  it  has  fulfilled  the  chief  design  of  the 
founders  of°the  Association  in  “  promoting  the  extension  of 
scientific  and  practical  knowledge  by  free  and  candid  com¬ 
munication  and  discussion  among  its  members.”  The  first 
Oration  to  which  I  refer  is  that  given  by  Dr.  Fotherby  on 


Medical  Times  and  Gazette. 


RIVINGTON’S  PRESIDENTIAL  ADDRESS. 


Sept.  1, 188?. 


228 


the  occasion  of  the  jubilee  of  the  Society.  It  contained  a 
history  of  the  origin  of  scientific  associations,  and  a  full 
description  of  the  origin  and  progress  of  the  Hunterian 
Society  up  to  the  year  18G9,  in  which  it  was  delivered.  The 
second  was  the  Oration  of  Mr.  Bryant  in  1870,  which  largely 
supplemented  the  information  afforded  by  Dr.  Fotherby 
concerning  the  papers  which  had  been  read  in  years  gone 
by.  Mr.  Bryant’s  review  constitutes  a  very  interesting  ex¬ 
position  of  the  advances  made  in  medical  science  and 
practice  during  a  period  of  fifty  years.  In  using  the 
term  “science”  in  connexion  with  medicine,  I  am  well 
aware  that  the  question  has  often  been  sceptically  asked.  Is 
medicine  a  science  or  an  art  ?  and  that  some  have  arrived  at 
the  conclusion  that  it  is  only  an  art — a  craft  destitute  of 
exact  principles,  and  founded  upon  mere  empiricism.  How 
unjust  this  is  to  medicine  (and  medicine  embraces  surgery) 
a  little  reflection  will  show.  What  is  art  and  what  is 
science  ?  Art  is  the  application  of  knowledge,  or  power  to 
effect  a  definite  purpose,  and,  as  this  purpose  may  either 
have  for  its  immediate  object  utility  to  man,  or  make  direct 
utility  secondary  to  pleasure  or  gratification  of  the  senses 
and  taste,  art  comprehends  the  useful  arts  and  the  fine  arts. 
The  use  and  advantage  of  man  is  the  great  aim  of  medicine  ; 
and  j  ust  in  proportion  as  it  is  subservient  to  this  end,  and 
is  practised  with  this  purpose  in  the  foreground,  whilst  the 
advantage  of  the  practitioner,  though  not  by  any  means  to 
be  neglected,  is  duly  subordinated  to  the  general  weal,  does 
medicine  take  rank  as  a  profession;  and  just  in  proportion  as 
the  general  weal  both  of  the  public  and  the  profession  itself 
is  subordinated  to  the  immediate  advantage  of  the  practi¬ 
tioner  does  medicine  sink  into  a  trade  or  a  low  kind  of  traffic. 
A  science  is  a  body  of  truths  whose  principles  can  be  known 
or  separated — a  collection  of  facts  which  can  be  reduced 
into  order  by  classification  and  methodical  arrangement, 
or  a  branch  of  knowledge  made  the  subject  of  in¬ 
vestigation  with  a  view  to  the  discovery  of  principles. 
The  essence  of  science  consists  in  its  embodiment  of 
general  facts,  principles,  or  laws  deduced  from  a  number  of 
isolated  facts  or  observations  collected  by  individuals. 
Clearly,  then,  medicine  is  not  merely  an  art,  but  a  science 
also,  however  imperfect  as  yet,  and  however  large  the  gaps 
which  have  still  to  be  filled.  These  imperfections  and 
these  gaps  are  explained  by  the  circumstance  that,  as  a 
science,  medicine  is  distinguished  by  its  extreme  complexity. 
Medicine  dealing  with  causes  and  effects  is  a  branch  of 
natural  science.  It  comprises  both  the  natural  history  of 
the  ailments  to  which  flesh  is  heir — to  which  I  must  confine 
my  observations  this  evening — and  the  knowledge  of  the 
means  or  therapeutics  by  which  these  ailments  may  be  pre¬ 
vented,  cured,  or  relieved.  Now  observe  how  complex  is 
even  the  first  half  of  the  science  of  medicine :  the  natural 
history  of  diseases,  their  causes,  symptoms,  and  course,  their 
effects  and  complications,  and  the  morbid  changes  which 
are  found  after  death.  Observe  how  essentially  dependent 
is  medicine  for  its  development  on  various  allied  and  sub¬ 
ordinate  branches  of  knowledge,  or  the  natural  sciences  on 
which  its  foundations  are  laid.  A  complete  knowledge  of 
the  structure  and  relations  of  the  parts  and  organs  of  the 
human  body  in  health  (or  anatomy),  and  a  complete  know¬ 
ledge  of  the  mechanism,  motions,  functions,  and  changes  of 
the  human  body  in  health  (or  physiology),  and  to  some 
extent  the  anatomy  and  physiology  of  the  lower  animals, 
and  of  plants,  or  vegetable  organisms,  are  absolutely  neces¬ 
sary  as  preliminaries  to  the  advance  of  medicine  as  a 
science.  Moreover,  both  anatomy  and  physiology  are 
largely  dependent  upon  physics  and  chemistry,  which 
must  be  perfected  before  they  can  be  applied  to  assist 
the  progress  of  anatomy  and  physiology.  Under  physics 
must  be  included  the  invention  of  scientific  instru¬ 
ments,  such  as  the  microscope,  ophthalmoscope,  and  others, 
without  which  investigation  of  healthy  appearances  and 
morbid  changes  could  not  be  prosecuted.  In  this  com¬ 
plexity  of  medicine  as  a  science  lies  the  germ  of  a  distinc¬ 
tion  between  medicine  as  a  science  and  medicine  as  an  art. 
As  an  art,  medicine  may  flourish  empirically  from  mere 
observation  of  the  common  facts  of  disease,  and  the  effects 
of  remedies,  without  the  existence  of  anything  that  can 
strictly  be  called  medical  science,  and  with  very  slender 
knowledge  of  the  human  frame.  Possessing  a  limited  ac¬ 
quaintance  with  human  anatomy,  and  little,  if  any,  physi¬ 
ology  or  chemistry,  Hippocrates  could  give  such  graphic 
accounts  of  diseases  and  injuries  that  they  may  be  recog¬ 


nised  from  his  descriptions  at  the  present  day.  By  a  close- 
observation  of  the  countenance,  the  decubitus,  the  evacua¬ 
tions  and  discharges,  and  other  general  indications,  he  was; 
able  to  predict  the  probable  termination  of  the  case  in, 
recovery  or  death.  He  could  observe  the  effects  of  climate, 
situation,  and  soil  upon  the  race.  He  recognised  the  powers; 
of  nature  in  resisting  and  overcoming  disease,  and  in  the- 
repair  of  injuries.  But  when  we  come  to  the  causes  of 
disease  we  have  to  be  satisfied  with  his  acknowledgment 
of  natural  causes,  such  as  the  action  of  the  air,  and  the- 
great  negative  virtue  of  rejecting  the  supernatural  agencies,, 
to  which  diseases  were  popularly  ascribed  in  ancient  times, 
and  which  have  played  so  conspicuous  a  part  in  the  history 
of  medicine  since  the  introduction  of  Christianity  almost  up  to- 
the  present  day.  Hippocrates  was  a  great  clinical  physician 
and  surgeon — a  practitioner  distinguished  for  acuteness  of  ob¬ 
servation  and  common  sense.  The  theory  or  science  of  Hippo¬ 
crates  was  represented  by  the  doctrines  of  the  four  elements,, 
earth,  air,  fire,  and  water ;  the  four  temperaments ;  the  four 
conditions,  hot,  cold,  moist,  and  dry;  and  the  four  humours, 
blood,  yellow  bile,  black  bile,  and  phlegm,  which  acted 
and  reacted  upon  each  other  in  a  wonderful  and  recondite- 
manner.  Doubtless,  Ccelius  Aurelianus  was  right  in  his  day 
and  generation  in  considering  it  unnecessary  to  inquire  into- 
hidden  or  recondite  causes  of  diseases,  and  to  be  satisfied 
with  recognising  their  existence  and  discovering  the  means 
of  removing  them.  The  recognition  of  diseases  and  the 
means  of  removing  them  are  essentially  the  art  of  medicine- 
and  surgery;  and  though  neither  advanced  far  without 
scientific  knowledge,  they  made  some  progress.  Even  im 
the  infancy  of  medical  art,  wounds  could  be  bound  up  and! 
dressed,  fractured  bones  could  be  set,  dislocations  could  be- 
reduced,  old  women  could  cull  simples,  apothecaries  could 
mix  theriacum  with  its  more  than  sixty  ingredients, 
priests  could  perform  circumcision  or  cut  for  stone, — but 
the  art  cannot  be  practised  according  to  science  until 
every  step  of  the  practical  processes  can  be  explained  and! 
understood.  Everything  would  be  done  by  rule  of  thumb,, 
or  in  accordance  with  fanciful  and  extravagant  hypo¬ 
theses,  the  figments  of  an  uncontrolled  imagination.  The- 
whole  of  the  practice  of  medicine  would  consist  in  the 
application  of  remedies,  of  whose  properties  little  was; 
known,  to  diseases  imperfectly  understood,  and  the  use  of 
means  of  which  little  explanation  could  be  offered  beyond 
the  bare  fact  that  they  had  been  found  by  experience  to- 
accomplish  the  end  in  view.  It  is  this  aspect  of  medicine- 
which  has  the  greatest  attraction  for  the  public,  and  by 
which  it  is  often  guided  or  misguided.  The  public  believes- 
in  experience  rather  than  in  science,  believes  that  there  are 
nostrums  (or  “arcana,”  as  Paracelsus  termed  them)  for 
everything,  and  that  whilst  a  regular  practitioner  educated 
in  the  schools  may  be  able  to  determine  the  nature  of  its 
complaints,  to  diagnose  them,  and  to  give  them  long- 
classical  names,  the  means  of  cure  are  frequently  in  the- 
hands  of  charlatans  and  uneducated  pretenders.  The  public 
agrees  with  Boyle  when  he  wrote,  “  I  had  much  rather  that 
the  physician  of  a  friend  of  mine  should  keep  his  patient  by 
powerful  medicines  from  dying  than  tell  me  punctually 
when  he  shall  die,  or  show  me  in  the  opened  carcase  why 
it  may  be  supposed  he  lived  no  longer.” 

[To  be  continued.) 


Vleminckx’s  Solution  in  Acne  Rosacea. — Dr. 
Stelwagen,  in  relation  to  the  obstinate  nature  of  this  dis¬ 
ease,  communicates  some  cases  to  the  Philadelphia  Med! 
Neivs,  July  7,  in  proof  of  the  benefit  which  may  often  be 
derived  from  the  application  of  Yleminckx’s  solution.  This, 
is  made  by  adding  one  part  of  lime  and  two  parts  of  sub¬ 
limed  sulphur,  or  flowers  of  sulphur,  to  twenty  parts  of 
water.  This  is  boiled  down  to  about  twelve  parts,  cooled, 
and  filtered.  The  result  is  a  dark,  orange-yellow  liquid, 
with  a  strong  odour  of  sulphuretted  hydrogen,  which  is  to  be 
diluted  as  occasion  may  require.  Dr.  Stelwagen  has  usually 
commenced  with  one  part  to  four  or  five  parts  of  water, 
gradually  increasing  to  one  to  three  or  stronger,  applied  for 
some  minutes  at  bedtime,  and,  if  possible,  twice  a  day. 
He  has  used  it  only  in  the  milder  forms  of  the  disease,  in 
which,  although  it  often  fails,  he  regards  it  as  the  most 
reliable  single  remedy.  In  the  hypertrophied  form  of  acne 
he  has  never  tried  it,  believing  that  in  this  it  would  be  of 
little  avail. 


Medical  Times  and  Gazette. 


ANDERSON  ON  DISEASES  OF  THE  SKIN. 


Sept.  1  1883.  229 


Typhus. 

1.  Often  history  of  ex¬ 
posure  to  the  contagion  of 
Typhus,  and  period  of  in¬ 
tubation  rarely  more  than 
twelve  days. 

2.  Typhus  sets  in  suddenly, 
■often  with  rigor,  and  erup¬ 
tion  appears  from  fourth  to 
seventh  day,  there  being  well- 
marked  fever  throughout, 
which  in  the  second  week 
usually  assumes  the  typhoid 
type. 

3.  Eruption  often  becomes 
petechial. 

4.  Eruption  subsides  in  a 
week  or  ten  days. 

5.  Eruption  accompanied 
hy  the  other  symptoms  of 
Typhus. 


Typhus. 

1.  Often  history  of  ex¬ 
posure  to  contagion  after  a 
period  of  incubation  of  rarely 
more  than  twelve  days. 


Roseola  Syphilitica. 

1.  History  of  preceding 
chancre,  followed  by  Eoseola 
in  from  one  to  two  months. 


2.  There  may  be  slight 
fever  at  the  outset,  but  it 
soon  subsides. 


3.  Eruption  does  not  be¬ 
come  petechial. 

4.  Eruption  often  lasts  for 
many  weeks. 

5.  Accompanied  by  other 
manifestations  of  secondary 
Syphilis,  e.g.,  Alopecia,  An¬ 
gina,  gland  enlargements, 
nocturnal  Rheumatism,  etc. 

Copaiba  and  Cubebs  Rashes. 

1.  Occurs  in  those  who 
have  been  taking  Copaiba  or 
Cubebs;  and  odour  of  these 
medicines  often  perceptible 
in  the  urine. 


2.  Eruption  usually  absent 
from  the  face,  and  often  from 
the  lower  extremities. 

3.  The  eruption  unaccom¬ 
panied  by  heat  or  itching. 

4.  Eruption  often  becomes 
petechial. 

5.  The  eruption  disappears 
when  convalescence  sets  in. 

6.  Eever  is  well  marked 
throughout,  and  in  the  second 
week  usually  assumes  the 
typhoid  type. 


2.  Eruption  more  exten¬ 
sively  diffused,  as  a  rule,  and 
often  on  the  face. 

3.  The  eruption  intensely 
itchy. 

4.  Eruption  never  pete¬ 
chial,  but  often  urticaria-like 
blotches  are  developed. 

5.  The  eruption  disappears 
within  a  few  days  of  the 
cessation  of  the  medicine. 

6.  Some  fever  may  be  pre¬ 
sent  in  the  acute  stage,  but 
it  is  moderate,  and  never 
assumes  the  typhoid  type. 


THE  DIAGNOSIS  OF  DISEASES  OF  THE  SKIN. 

By  DR.  McCALL  ANDERSON, 

Professor  of  Clinical  Medicine  in  the  University  of  Glasgow  ; 
Physician  to  the  Western  Infirmary,  and  to  the  Special  Wards  for  Diseases 

of  the  Skin. 


Lecture  XIX. 

B.— ORGANIC  AFFECTIONS. 

Those  defined  by  Uniform  Causes. 

4.  The  Eruptive  Fevers. 

It  would  be  quite  out  of  place  here  To  deal  in  an  exhaustive 
way  with  this  group  of  diseases,  so  that  the  following  re¬ 
marks  have  reference  principally  to  the  eruptions  charac¬ 
teristic  of  each,  and  their  differential  diagnosis. 

The  specific  fevers  accompanied  by  special  eruptions  are 
eight  in  number,  viz.  : — 


a.  Typhus. 

b.  Enteric  fever. 

c.  Morbilli. 

d.  Scarlatina. 


e.  Rubeola. 

f.  Variola. 

G.  Varicella. 
h.  Dengue. 


A.  Typhus. — In  this  fever  the  eruption  usually  makes  its 
appearance  from  the  fourth  to  the  seventh  day  :  it  is  rarely 
seen  upon  the  face,  and  is  chiefly  met  with  on  the  trunk  and 
arms,  the  abdomen  and  chest  being  the  parts  usually  first 
involved.  It  consists  of  dusky-pink,  irregular,  slightly 
raised  spots,  unaccompanied  by  heat  or  itching,  and  giving 
a  mottled  appearance  to  the  skin  so  as  sometimes  to  re¬ 
semble  Syphilitic  Roseola.  At  first  it  disappears  entirely  on 
pressure,  but  in  a  day  or  two  only  partially,  at  which  stage 
it  becomes  more  dusky  in  tint  and  is  no  longer  elevated. 
In  the  later  stages  of  the  fever,  too,  in  the  centres  of  some 
of  the  spots,  minute  extravasations  of  blood  (petechias)  are 
commonly  observed.  The  eruption  all  comes  out  at  once — 
never  in  successive  crops  as  in  enteric  fever, — and  generally 
does  not  disappear  finally  until  convalescence  has  set  in, 
unless  the  disease  is  prolonged  by  complications  or  sequelae ; 
it  is  rarely  absent,  though  oftener  in  children  than  in  adults ; 
and  the  more  copious  the  eruption,  and  the  more  livid  and 
petechial  it  becomes,  the  more  severe,  as  a  rule,  is  the  attack. 
The  odour  emanating  from  the  skin  and  lungs  in  the  latter 
part  of  the  fever  somewhat  resembles  that  of  mice,  and  is 
very  characteristic — so  much  so  that  fever -nurses  can  often, 
from  detecting  this  typhus-odour,  form  a  shrewd  suspicion 
as  to  the  diagnosis. 

The  following  points  should  assist  in  distinguishing  the 
eruption  of  typhus  from  Syphilitic  Roseola  on  the  one  hand, 
and  those  due  to  the  administration  of  Copaiba  and  Cubebs 
on  the  other : — 


b.  Enteric  Fever  (Typhoid  Fever). — The  eruption  in  this 
fever  makes  its  appearance  from  the  seventh  to  the  twelfth 
day :  it  is  generally  met  with  upon  the  abdomen,  chest,  and 
back,  is  unusual  on  the  extremities,  and  very  rare  on  the 
face.  It  consists  of  round,  moderately  elevated,  rose- 
coloured  spots  from  one  to  two  lines  in  diameter,  which — 
unlike  the  eruption  of  Typhus — never  become  petechial, 
and  disappear  on  pressure  throughout.  They  always  come 
out  in  successive  crops,  so  that  while  each  spot  remains  for 
four  or  five  days,  the  whole  duration  of  the  eruption  is  from 
eight  to  twenty  days.  Sometimes  only  two  or  three  spots 
come  out  at  a  time,  but  in  rare  cases  there  may  be  hundreds. 
Generally  each  crop  consists  of  from  two  or  three  to  two 
dozen.  They  are  more  numerous,  as  a  rule,  in  adults  than 
in  children,  and  there  is  no  relation,  as  in  Typhus,  between 
the  amount  of  the  eruption  and  the  severity  of  the  fever ; 
indeed,  some  even  go  the  length  of  asserting  that  an 
abundant  eruption  coincides  with  a  mild  attack  of  the  fever. 
Sometimes  it  is  absent  altogether — much  more  frequently 
than  in  Typhus, — and  sometimes  two  or  three  days  before 
the  characteristic  spots  are  observed  a  scarlet  rash  is 
diffused  over  the  whole  body,  which  somewhat  resembles 
that  of  Scarlatina. 

In  those  cases  in  which  there  is  a  relapse  of  the  fever — 
which,  according  to  Murchison,  occurs  about  once  in  fourteen 
cases — the  eruption  reappears  with  all  the  other  symptoms. 
The  following  table  may  be  of  use  in  distinguishing  Enteric 
from  Typhus  Fever,  two  diseases  which,  until  they  were 
differentiated  by  the  late  Dr.  Perry,  of  Glasgow,  in  recent 
years,  were  supposed  to  be  identical : — 


Enteric. 

1.  Generally  insidious  at 
its  onset,  and  slowly  sub¬ 
sides. 

2.  Average  duration  three 
to  four  weeks. 

3.  Eruption  appears  from 
seventh  to  twelfth  day.  Con¬ 
sists  of  rounded  papulae, 
which  disappear  on  pressure 
throughout ;  are  never  pete¬ 
chial ;  and  occur  in  successive 
crops,  the  duration  of  each 
spot  being  from  three  to  five 
days. 


4.  No  peculiar  odour  ema¬ 
nates  from  the  patient. 

5.  Eye  clear;  pupil  dilated 
as  disease  advances ;  and  a 
circumscribed  flush  on  the 
cheek. 

6.  Bowels  generally  loose 
(constipation  may  continue 
throughout) ;  evacuations  of 
the  colour  of  pea  soup ;  abdo¬ 
men  tympanitic;  pain  and 
gurgling  in  right  iliac  region. 

7.  Epistaxis  and  Melaena 
frequent;  peritonitis  a  com¬ 
mon  complication. 

8.  Prostration  only  great 
towards  end  of  severe  cases. 


Typhus. 

1.  More  sudden  at  its  on¬ 
set  (generally  with  rigor) 
and  subsidence. 

2.  Duration  in  uncompli¬ 
cated  cases  two  weeks. 

3.  Eruption  appears  from 
fourth  to  seventh  day ;  gives 
a  mottled  appearance  to  the 
skin ;  after  a  day  or  two 
does  not  entirely  disappear 
on  pressure ;  petechias  often 
seen  in  the  centre  of  the 
spots  in  the  second  week ; 
never  occurs  in  successive 
crops,  and  continues  till  con¬ 
valescence  in  uncomplicated 
cases. 

4.  Odour  peculiar  and  cha¬ 
racteristic. 

5.  Eye  injected;  pupil  con¬ 
tracted  in  severe  eases  ;  face 
flushed ;  expression  heavy, 
dull,  and  stupid. 

6.  Bowels  generally  costive, 
and  no  abdominal  symptoms 
present. 


7.  Epistaxis  and  Melee na 
rare  ;  peritonitis  never  occurs, 
but  hypostatic  congestion  of 
lungs  frequent. 

8.  Prostration  is  present 
from  the  first. 


230 


Medical  Times  and  Gazette. 


ANDEESON  ON  DISEASES  OE  THE  SKIN. 


Sept.  1,  18&3- 


Besides  the  foregoing  there  are  differences  in  the  tempera¬ 
ture  which  our  space  will  not  permit  of  our  entering  upon 
in  detail. 

c.  Morbilli  (Measles). — The  eruption  of  Measles  is  preceded 
by  fever  and  catarrh  of  the  whole  respiratory  tract  for  four 
days,  during  which  time  Diarrhoea  also  is  a  common  symptom. 

It  may  first  make  its  appearance  where  the  skin  is  congested, 
as  at  the  site  of  a  sinapism,  or  where  it  has  been  pressed 
upon,  hut  unless  it  is  diverted  in  some  such  way  from  its 
usual  starting-point,  it  begins  on  the  nape  of  the  neck  and 
on  the  temples,  whence  it  spreads  forwards  to  the  face  and 
then  down  the  body,  the  lower  extremities  being  last  in¬ 
volved  as  well  as,  usually,  least  affected.  The  whole  erup¬ 
tion  is  generally  out  within  a  space  of  three  days.  Para¬ 
lysed  limbs,  as  a  rule,  are  only  partially  implicated,  and, 
indeed,  not  unfrequently  escape  altogether.  The  colour  of 
the  eruption  is  usually  that  of  a  deep  pinkish-red,  although, 
in  malignant  cases,  it  may  have  a  livid  appearance;  it 
occurs  in  the  shape  of  slightly  elevated  spots,  which  dis¬ 
appear  on  pressure,  and  which  are  often  of  an  irregular 
shape,  but  which,  in  typical  cases,  are  arranged  in  segments 
of  circles  or  crescents,  owing  probably  to  the  mode  of  distri¬ 
bution  of  the  cutaneous  nerve-filaments.  In  some  cases, 
especially  either  before  or  after  an  epidemic  is  at  its  height, 
the  eruption  may  be  partial,  involving  chiefly  the  face  and 
2ieck,  and,  should  any  internal  complication  occur,  one  of 
the  first  evidences  of  it  is  usually  the  sudden  fading  or  dis¬ 
appearance  of  the  eruption  :  hence  the  erroneous  belief  that 
internal  complications  are  frequently  the  result  of  the  driv¬ 
ing  in  of  the  eruption.  On  the  other  hand,  if  Measles  attacks 
a  person  labouring  under  some  other  affection  of  the  skin, 
such  as  Eczema,  the  eczematous  eruption  disappears,  to 
reappear,  generally,  when  the  fever  has  run  its  course,  per¬ 
haps  even  in  a  more  aggravated  form.  It  occasionally 
happens  that  Measles  is  unaccompanied  by  eruption,  the 
fever  and  catarrhal  symptoms  being  alone  present,  and  the 
specific  nature  of  such  cases  is  proved  by  the  fact  of  their 
occurring  during  an  epidemic  of  Measles  in  persons  who  are 
exposed  to  infection,  who  have  not  had  the  disease,  and  who 
do  not  take  it  at  any  subsequent  period. 

The  fever,  catarrhal  symptoms,  and  eruption  are  at  their 
height  upon  the  eighth  day  of  the  disease,  and,  if  there  is  no 
complication,  they  all  subside  together,  the  eruption  fading 
first  on  the  parts  primarily  attacked,  though  rather  more 
quickly  on  exposed  situations.  It  is  usually  followed  by 
slight  branny  desquamation,  especially  on  the  face  and 
upper  part  of  the  body,  and  by  slight  pigmentary  stains, 
which,  however,  soon  disappear. 

The  diseases  most  apt  to  be  mistaken  for  Measles  are 
Roseola,  Scarlatina,  Rubeola,  and  Variola.  For  the  diagnosis 
of  the  last  three  we  must  refer  the  reader  to  the  descriptions 
of  these  diseases  which  follow,  while  the  following  points 
serve  to  distinguish  the  first :  — 

In  Roseola  the  spots  are  of  a  brighter  red,  and  have 
no  tendency  to  crescentic  arrangement,  nor  do  they  com¬ 
mence  on  the  nape  and  temple,  spread  forward  to  the  face, 
and  thence  down  the  body,  as  in  Measles.  The  eruption  is 
unaccompanied  by  fever  and  catarrh,  and  the  affection  is 
neither  epidemic  nor  contagious. 

D.  Scarlatina  (Scarlet  Fever).— The  eruption  of  Scarlet 
F ever  makes  its  appearance  on  the  second,  or  third  day  at 
furthest ;  it  is  generally  first  observed  on  the  neck  and  upper 
part  of  the  chest,  whence  it  spreads  down  over  the  body,  the 
face  usually  being  spared,  and  palsied  limbs  not  being 
attacked,  or  only  to  a  slight  extent.  Such  is  the  usual  order 
of  invasion,  but  if  the  skin  has  been  congested  at  any  part, 
as  the  result,  for  example,  of  the  application  of  sinapisms  or 
the  undue  compression  of  the  body  by  the  clothing,  the  erup¬ 
tion  may  first  make  its  appearance  at  that  part.  It  consists 
of  minute  red  dots  situated  at  the  orifices  of  the  follicles, 
which  at  first  are  discrete,  but  rapidly  increase  in  number, 
and  soon  coalesce,  forming  a  uniform  or  punctated  eruption ; 
and  when,  as  exceptionally  happens,  the  congestion  of  the 
orifices  of  the  follicles  is  great,  the  swelling  thus  produced 
may  give  a  rough  feeling  to  the  affected  surface.  Some¬ 
times  the  eruption  occurs  in  patches,  but  often  it  is  pretty 
universal,  leaving  no  intervals  of  sound  skin.  When  fully 
out  the  surface  resembles  that  of  a  boiled  lobster,  the  colour 
disappearing  on  pressure,  but  in  severe  cases  it  assumes  a 
dusky  red  tint,  and  very  exceptionally  becomes  livid  or  even 
petechial.  In  two  or  three  days  the  eruption  begins  to  fade, 
the  subsidence  being  first  observed,  as  might  be  expected,  I 


at  the  parts  first  attacked,  and  about  the  eighth  or  ninth 
day  of  the  fever  the  skin  begins  to  peel,  the  desquamative 
process  occupying  one  or  two  weeks.  In  slight  attacks,  and 
where  the  eruption  is  slight,  the  scaling  is  proportionately 
trifling,  but  in  pronounced  cases  it  is  well  marked,  and 
occasionally  the  skin  of  the  sole  or  palm,  even  including  the 
nails,  desquamates  in  one  piece.  This  exfoliation  of  the 
epidermis  is  accompanied  by  some  elevation  of  temperature, 
and  great  care  is  required  during  its  continuance,  else- 
troublesome  sequelae  are  pretty  sure  to  be  encountered. 
The  eruption  is  rarely  altogether  absent,  although,  when 
slight,  it  may  be  overlooked. 

The  diseases  most  apt  to  be  mistaken  for  Scarlatina  are 
certain  cases  of  Erythema  and  Morbilli. 


Scarlatina. 

1.  Infectious,  and  second 
attacks  rare. 

2.  Eruption  appears  on 
second  day,  and  with  well- 
marked  fever. 

3.  Commences  usually  on 
neck  and  top  of  chest,  whence 
it  spreads  down  the  body. 

4.  Disappears  slowly,  and 
with  decided  desquamation. 

5.  The  “  strawberry  tongue” 
is  usually  seen,  and  there  is 
sore -throat. 

6.  Frequently  complicated 
with  Rheumatism,  suppura- 
tiofl  of  the  middle  ear,  or  in¬ 
flammation  of  the  cellular 
tissue  of  the  neck  (Scarlatinal 
Bubo). 

7.  Frequently  followed  by 
Dropsy  from  implication  of 
the  kidneys. 

Scarlatina. 

1.  History  of  exposure  to 
the  infection  of  Scarlatina. 

2.  Eruption  appears  on  the 
second  day,  and  is  fully  out  in 
less  than  twenty-four  hours. 

3.  Eruption  not  usually  on 
the  face. 

4.  Nearly  as  pronounced 
on  extremities  as  on  trunk. 

5.  Rash  is  scarlet. 

6.  Eruption  uniform  or 
punctated. 

7.  Desquamation  usually  a 
marked  feature. 

8.  Accompanied  by  sore- 
throat. 

9.  The  “  strawberry  tongue” 
is  usually  seen. 

10.  The  fever  is  high. 

11.  Frequently  accompanied 
or  followed  by  Scarlatinal 
Bubo  or  Dropsy. 


Erythema,  the  so-called  Ery¬ 
thema  Scarlatiniformis. 

1.  Not  infectious,  and  re¬ 
lapses  common. 

2.  Eruption  is  often  the 
first  symptom,  and  little,  if 
any,  fever. 

3.  May  commence  on  an;y 
part. 

4.  Begins  to  fade  in  twenty- 
four  to  forty-eight  hours,  and- 
desquamation  trifling. 

5.  Tongue  not  specially 
affected,  and  throat  not  at¬ 
tacked,  or  only  slightly  con¬ 
gested. 

6.  An  uncomplicated  affec¬ 
tion. 


7.  No  sequelae. 


Morbilli  (Measles). 

1.  History  of  exposure  to- 
the  infection  of  Measles. 

2.  Eruption  appears  on  the 
fourth  day,  and  is  not  fully  out 
in  less  than  thirty-six  hours. 

3.  Usually  abundant  on  the- 
face. 

4.  Much  more  scanty  on 
extremities  than  on  face  and 
trunk. 

5.  It  is  pinkish-red. 

6.  Spots  more  discrete,  and 
often  arranged  in  crescents. 

7.  Desquamation  slight. 

8.  Catarrh  of  whole  respi¬ 
ratory  tract  precedes  and  ac¬ 
companies  eruption. 

9.  Tongue  not  characteris¬ 
tically  affected. 

10.  The  fever  is  less  intense. 

11.  Sometimes  accompanied 
or  followed  by  Bronchitis  or 
Pneumonia. 


e.  Rubeola  (Epidemic  Roseola ;  Rotheln — German  Measles) . 
—  Some  physicians  seem  to  be  under  the  belief  that  this  is  a 
hybrid  of  Measles  and  Scarlet  Fever ;  others  that  it  is  a 
modified  form  of  Measles — just  as  some  still  assert  that 
Chicken-pox  is  a  modified  form  of  Small-pox.  The  general 
view,  however,  is  that  it  is  a  substantive  affection. 

The  eruption  appears  at  the  very  outset  or  within  a  day 
or  two,  and  at  all  events  it  is  rarely  so  late  of  manifesting 
itself  as  in  Measles  :  it  may  appear  upon  any  part,  but  is 
especially  apt  to  attack  the  trunk  of  the  body  and  the  ex¬ 
tremities.  The  spots  are  larger,  paler,  and  less  elevated! 
than  in  Measles ;  they  are  also  more  scattered,  and  have  no 
tendency  to  assume  the  crescentic  form :  they  are  very 
itchy  too,  and  much  more  fleeting,  disappearing  in  a  couple 


Medical  Times  and  Gazette. 


ANDERSON  ON  DISEASES  OF  THE  SKIN. 


Sept.  1,  1883.  231 


of  days,  though,  they  may  reappear  several  times  in  the 
•course  of  a  week. 

The  fever  is  usually  very  moderate,  and  disappears  as  the 
eruption  fades ;  the  catarrhal  symptoms  of  Measles  are  not 
.present,  and  there  is  no  sore-throat  as  in  Scarlatina,  or  only 
to  a  very  trifling  extent ;  and  there  are  none  of  the  compli¬ 
cations  or  sequelae  of  either  disease.  This  affection  is  espe¬ 
cially  common  in  children,  and  is  said  to  be  contagious,  and 
sometimes  epidemic;  but  one  attack  does  not  protect  the 
system  from  another,  nor  are  those  who  have  had  Measles 
or  Scarlatina  less  liable  to  suffer  than  those  who  have  not. 

f.  Variola  (Small-pox). — In  this  disease  the  eruption  makes 
its  appearance  on  the  second  or  third  day  of  the  fever  (which, 
in  typical  cases,  is  ushered  in  by  severe  headache,  severe 
pains,  especially  in  the  back,  and  vomiting) ,  and  the  earlier 
it  is  observed  the  more  serious  is  the  case  likely  to  be.  It 
usually  comes  out  in  three  successive  crops,  with  an  interval 
of  some  hours  between  each :  the  first  on  the  face,  neck,  and 
upper  extremities  ;  the  second  on  the  trunk  ;  and  the  third 
on  the  lower  extremities.  For  the  first  two  days  it  is  papular 
in  character,  for  the  next  four  it  is  vesicular,  and  on  the 
^seventh  or  eighth  it  is  pustular. 

The  papules,  which  for  the  most  part  are  situated  at  the 
-orifices  of  the  hair  or  sebaceous  follicles,  are  firm,  red,  acu¬ 
minated,  and  about  the  size  of  millet-seeds ;  and,  no  matter 
liow  numerous  they  are,  they  never  coalesce.  On  the  third 
■day  they  gradually  become  converted  into  vesicles,  the  con¬ 
tents  of  which  gradually  change  from  serum  into  pus,  so 
that  by  the  seventh  or  eighth  day  the  eruption  is  pustular. 
Owing  to  the  adhesion  of  the  epidermis  to  the  cutis  in  the 
■centre  of  each,  both  vesicles  and  pustules  are  depressed  in 
the  centre  (umbilicated)  ;  but  when  the  pustules  become 
much  distended,  this  adhesion  to  the  cutis  gives  way,  and 
they  become  spheroidal.  At  this  stage  each  is  surrounded 
hy  a  red  areola,  the  pressure  of  the  pus  upon  the  capillaries 
beneath  having  driven  the  blood  to  the  periphery.  As  the 
pustular  stage  becomes  developed  the  parts  swell,  the  amount 
of  the  swelling  depending  not  only  on  the  amount,  but  also 
•on  the  seat  of  the  eruption,  being  most  marked  where  there 
is  much  loose  cellular  tissue,  especially  on  the  face,  where  it 
may  be  very  great,  and  close  the  eyes  completely.  At  this 
stage  the  odour  emanating  from  the  patient  is  peculiar  and 
•characteristic.  When  the  papular  stage  is  fully  developed, 
the  fever  and  discomfort  in  great  measure  subside,  to  re¬ 
appear  in  the  pustular  stage,  and  this  “f  ever  of  suppuration  ” 
or  “secondary  fever”  is  usually  in  proportion  to  the  extent 
of  the  eruption.  This  is  the  most  critical  time  for  the 
patient. 

About  the  eighth  or  ninth  day  of  the  eruption  it  com¬ 
mences  to  desiccate,  a  dark  spot  appearing  on  the  top  of 
each  pustule ;  or  the  pustules  burst,  and  the  contents  dry 
up  into  crusts,  which  generally  separate  between  the  eleventh 
and  fourteenth  days.  Each  crust,  when  it  falls,  leaves 
behind  it  a  little  prominence  of  a  violet  tint,  which  is  the 
seat  of  repeated  desquamation,  the  scales  gradually  becom¬ 
ing  less  distinct,  until,  in  from  four  to  six  weeks,  the 
desquamation  ceases,  and  little  depressions  are  left  at  the 
site  of  most  of  the  pustules,  which  gradually  become  white. 
The  number  of  pustules  developed  varies  exceedingly :  occa¬ 
sionally  there  may  be  only  half  a  dozen ;  generally  there  are 
some  hundreds  ;  and  not  unfrequently  they  may  be  counted 
by  the  thousand.  The  face  is  the  part  which  suffers  most ; 
and  Dr.  Aitken,  in  his  excellent  work  on  the  “  Practice  of 
Medicine,”  says  that  if  the  total  number  of  pustules  reaches 
10,000,  at  least  2000  of  these  will  be  found  upon  the  face. 
In  severe  cases  the  eruption  is  so  abundant  that  many  of 
the  pustules  coalesce,  constituting  what  is  called  “  confluent 
■Small-pox,”  and  the  disease  is  proportionately  severe ;  but 
when  the  eruption  is  not  abundant  the  case  is  usually  mild 
(Varioloid),  as  when  it  occurs  in  persons  who  have  been  suc¬ 
cessfully  vaccinated  at  no  distant  date  (modified  Small-pox). 
The  mucous  membranes  are  often  attacked  as  well  as  the 
skin,  though  in  a  less  degree,  especially  the  mucous  mem¬ 
brane  of  the  throat  and  mouth,  in  which  case  salivation  and 
sore-throat  are  usually  present :  the  mucous  membrane  of 
the  eyes  may  also  be  the  seat  of  pustules,  when  conjunc¬ 
tivitis  is  present,  and  in  some  cases  ulceration  ensues,  which 
may  result  in  destruction  of  vision. 

In  the  confluent  form  of  Small-pox,  albuminuria  is  as  con¬ 
stantly  present  in  the  acute  stage  as  in  cases  of  Scarlatina  ; 
it  seems  to  occur  in  about  one-third  of  all  cases,  and  in  the 
last  stage  is  occasionally  associated  with  anasarca. 


There  are  some  who  hold  that  Small-pox  may  co-exist 
with  other  fevers,  such  as  Scarlatina  and  Measles.  The 
accuracy  of  this  statement  is  open  to  serious  doubt,  but 
sometimes  a  diffuse  Erythema  covers  the  whole  body,  or 
bright-red  spots,  varying  in  size  from  that  of  a  lentil  to 
that  of  a  finger-nail  (Roseola),  appear  first  on  the  face,  and 
later  on  upon  the  trunk  of  the  body.  This  eruption  usually 
lasts  from  twelve  to  twenty-four  hours,  and  disappears  as 
the  typical  Small-pox  eruption  comes  out.  Occasionally  an 
erythematous  eruption  appears  at  the  commencement  of  the 
disease  on  the  belly  and  inner  aspect  of  the  thighs,  to  dis¬ 
appear  gradually  when  the  typical  Small-pox  eruption  sets 
in,  but  the  latter  does  not  attack  the  parts  which  have  been 
the  seat  of  this  Erythema.  It  is  oftener  observed  in  some 
epidemics  than  in  others,  in  females  than  in  males,  and 
is  frequently  fatal,  especially  if  the  hypersemia  becomes 
purpurous  (Hebra). 

The  diseases  most  apt  to  be  mistaken  for  Small-pox  are 
Chicken-pox  (see  that  disease).  Measles,  and  pustular  Syphi¬ 
litic  eruptions. 

When  the  eruption  of  Measles  assumes  the  papular  form 
it  may  be  mistaken  for  Small-pox  in  the  papular  stage.  But 
in  the  former  the  eruption,  which  is  preceded  and  accom¬ 
panied  by  catarrh  of  the  respiratory  tract,  does  not  come 
out  till  the  fourth  day,  and  the  papules  are  larger  and 
darker  in  tint,  and  of  uniform  size  throughout ;  whereas  in 
Small-pox  those  on  the  face,  which  are  first  to  make  their 
appearance,  are  larger  than  those  on  the  limbs,  which  are 
more  recent.  The  fever,  too,  in  Small-pox  subsides  when 
the  papules  are  fully  out,  to  reappear  in  the  stage  of  sup¬ 
puration;  while  in  Measles  the  fever  steadily  increases 
whilst  the  eruption  advances,  and  does  not  diminish  until  it 
is  beginning  to  fade.  In  a  few  days  all  doubt  as  to  the 
diagnosis  is  at  an  end,  for  while  the  papules  of  Measles 
subside  into  macuke,  those  of  Small-pox  pass  into  the 
vesicular  stage. 

In  Pustular  Syphilis  the  pustules  may  resemble  those  of 
Small-pox,  although  they  are  not  umbilicated,  but  the  erup¬ 
tion  does  not  invade  the  body  in  the  regular  order  before 
mentioned,  and  does  not  pass  rapidly  through  the  papular 
and  vesicular  stages  before  becoming  pustular,  while  it  has  a 
tendency  to  occur  in  crescents  or  circles.  There  is  little  if 
any  accompanying  fever,  and  although  there  may  be  ulcera¬ 
tion  of  the  throat,  no  pustules  are  to  be  observed  upon  the 
fauces.  The  eruption  is  not  accompanied  by  the  peculiar 
odour  characteristic  of  Small-pox,  and  is  much  more  chronic 
in  its  course.  There  is  usually,  too,  a  history  of  Syphilis 
having  been  contracted,  and  the  pustular  eruption  is 
generally  accompanied  by  other  manifestations  of  Syphilis. 

G.  Varicella  (Chicken-pox). — This  disease,  although  it 
somewhat  resembles,  is  altogether  distinct  from  Small-pox, 
and  therefore  neither  vaccination  nor  a  previous  attack  of 
the  latter  afford  any  protection  from  it.  Though  not  con¬ 
fined  to,  it  is  most  frequently  met  with  in  children.  The 
fever  is  usually  very  moderate,  being  generally  most  distinct 
when  the  eruption  first  comes  out,  soon  after  which  it  dis¬ 
appears.  The  eruption  may  be  the  first  symptom  observed, 
or  it  may  not  appear  even  until  the  fourth  day  of  the  fever  : 
in  the  majority  of  cases,  however,  it  occurs  on  the  first  or 
second  day — first  on  the  upper  part  of  the  body,  especially 
the  back ;  later  on,  on  the  face  and  extremities.  As  a  rule, 
it  is  scanty  in  amount,  especially  on  the  extremities;  but,  no 
matter  how  abundant  it  may  be,  it  is  never  confluent.  At 
first  it  appears  in  the  shape  of  red  papules,  which  soon 
change  into  vesicles  :  these  are  not  usually  umbilicated,  but 
on  the  second  or  third  day  their  contents  become  opaque, 
and  in  a  few  days  dry  up  into  crusts,  which  in  turn  soon  fall 
off.  The  papular  stage  may  be  absent,  vesicles  appearing 
from  the  first,  and  sometimes,  especially  if  the  eruption  is 
scratched,  the  vesicles  change  into  pustules,  and  then  cica¬ 
trices  may  be  left :  occasionally,  too,  a  few  vesicles  are  seen 
upon  the  mucous  membranes,  especially  on  the  fauces.  The 
only  disease  likely  to  be  mistaken  for  Varicella  is  an  attack  of 
Small-pox  which  has  been  modified  by  vaccination,  in  dis¬ 
tinguishing  which  the  following  points  may  be  of  service  :  — 

.  77  Varioloid  {modified  Small- 

Vancella.  pox). 

1.  History  of  infection  1.  History  of  infection 
from  other  cases  of  Chicken-  from  other  cases  of  Small¬ 
pox,  or  occurring  during  an  pox,  or  occurring  during  an 
epidemic  of  the  same.  epidemic  of  the  same. 


232 


M<  dlcal  Times  and  Gazette. 


CHEVERS  ON  THE  ORDINARY  DISEASES  OF  INDIA. 


Sept.  1, 1883- 


2.  Vaccination  is  no  pm 
tection  against  its  attacks. 


3.  Fever  slight  and  of 
short  duration,  and  no  secon¬ 
dary  fever. 

4.  Eruption  appears  from 
the  first  to  the  fourth  day, 
and  generally  on  the  upper 
part  of  the  body  at  first. 

5.  Papules  less  pronounced 
rapidly  change  into  vesicles, 
and  often  do  not  become 
pustular  at  all. 


2.  Vaccination — for  a  cer¬ 
tain  number  of  years  at  least 
— affords  almost  complete 
protection  from  Small-pox, 
unless  the  virus  is  already 
in  the  system  at  the  time  of 
vaccination. 

3.  Fever  more  pronounced, 
and  secondary  fever  in  the 
stage  of  suppuration. 

4.  Eruption  appears  on  the 
second  day,  and  first  of  all 
on  the  face. 

5.  Papules  more  pro¬ 
nounced.  Eruption  for  two 
days  remains  papular ;  for 
next  four  days  is  vesicular ; 
and  on  the  seventh  or  eighth 


day  is  pustular ;  but  may 
abort  in  the  papular  stage. 

6.  Whole  duration  of  the  6.  Whole  duration  of  the 
disease  not  more  than  a  week,  disease  much  longer,  and 
and  no  complications.  complications  not  unfre¬ 

quent. 

h.  Dengue  (Dandy  Fever). — This  fever — an  excellent 
account  of  which  is  given  by  Professor  Aitken  in  Reynolds’ 
“System  of  Medicine” — is  not  met  with  in  this  country, 
but  only  in  warm  climates,  especially  in  the  East  and  West 
Indies.  The  first  accounts  we  have  of  it  came  from  Rangoon, 
where,  in  1824,  many  of  the  troops  under  Sir  Archibald 
Campbell  suffered,  and,  about  the  same  time,  the  great 
majority  of  the  inhabitants  of  Calcutta  were  attacked ;  in 
1827  almost  the  whole  of  the  inhabitants  of  St.  Thomas’s 
were  seized,  and  wherever  it  has  appeared  it  has  usually 
followed  the  track  of  human  intercourse.  It  attacks  all 
ranks  and  conditions  of  men,  appears  at  all  ages,  and  with 
equal  frequency  in  the  two  sexes.  It  is  highly  contagious,  and 
neither  Scarlet  Fever  nor  Measles  affords  any  protection 
from  its  ravages. 

It  usually  sets  in  suddenly — sometimes  with  rigor, — the 
fever  being  high  from  the  first,  and  accompanied  by  redness 
and  watering  of  the  eyes,  suffusion  of  the  face,  frontal  head¬ 
ache,  and  severe  pain  in  the  spine  and  joints  :  there  is  often, 
too,  heat  and  pain  at  the  epigastrium,  with  vomiting,  which 
may  be  very  persistent,  and  in  any  case  prostration  is  pro¬ 
nounced  from  the  first.  These  symptoms  rapidly  increase 
in  intensity,  the  joints  become  swollen,  with  a  tendency,  as 
in  Rheumatic  Fever,  for  the  articular  affection  to  flit  about. 
In  a  day  or  two  the  joint  affection,  which  is  often  excruciat¬ 
ing,  and  the  fever  are  relieved  by  perspiration,  but  on  the 
third  or  fourth  day  all  the  symptoms  return  with  increasing 
intensity,  and  an  eruption  usually  appears.  It  seems  to 
vary  somewhat  in  character,  sometimes  having  the  appear¬ 
ance  of  Erythema  with  considerable  swelling,  sometimes 
resembling  the  eruption  of  Measles,  or  Scarlet  Fever,  or 
Nettle  Rash,  and,  according  to  Dr.  Furlonge,  being  intense 
in  proportion  to  the  intensity  of  the  gastric  disturbance  :  it 
may  be  associated  with  the  development  of  boils.  It  com¬ 
mences  on  the  hands,  or  on  the  hands  and  feet,  whence  it 
rapidly  spreads  over  the  body,  although  it  may  be  partial, 
especially  on  the  extremities.  During  its  continuance  it  is 
often  intensely  itchy,  but  within  twenty-four  hours  it  begins 
to  fade,  being  followed  by  more  or  less  desquamation. 
About  the  sixth  or  seventh  day,  with  the  disappearance  of 
the  eruption,  the  fever  subsides,  and  the  patient  appears  to 
be  convalescent,  but  in  a  short  time  there  is  a  relapse,  with 
reappearance  of  all  the  symptoms,  which  may  be  even  as 
severe  as  the  first  attack,  but  it  is  of  short  duration,  being 
usually  at  an  end  within  two  or  three  days ;  sometimes  this 
is  followed  by  a  second  or  even  a  third  relapse.  Occasionally 
the  disease  is  complicated  with  swelling  of  the  lymphatic  or 
salivary  glands,  and  in  the  latter  case  salivation  is  a  marked 
feature.  Sometimes,  too,  ophthalmia  is  present,  and  occa¬ 
sionally  subacute  inflammation  of  the  liver  with  jaundice 
occurs.  Although  a  very  painful  affection,  it  is  rarely  fatal, 
and  then  usually  as  the  result  of  syncope  in  the  stage  of 
defervescence ;  but  it  leaves  the  patient  excessively  weak, 
and  often  with  a  heritage  of  pain  and  swelling  of  the  joints, 
so  that  recovery  may  not  be  complete  for  two  or  three 
months.  There  are  some  who  hold  that  it  is  nothing  more 
nor  less  than  Relapsing  Fever  modified  by  climate — an 


opinion,  however,  which  does  not  appear  to  us  to  be  well 
founded ;  and  in  any  case  it  seems  to  be  much  more  asso¬ 
ciated  with  heat,  moisture,  and  vicissitudes  of  weather 
than  with  privation. 


PRACTICAL  NOTES  ON 

THE  ORDINARY  DISEAS'ES  OF  INDIA,. 

ESPECIALLY  THOSE  PREVALENT  IN  BENGAL. 

By  NORMAN  CHEVERS,  C.I.E.,  M.D., 

Late  Senior  Physician  and  Professor  of  Medicine,  Medical  College 
and  Hospital,  Calcutta. 


( Oontinued  from  page  210.) 

CHOLERA  ASIATICA  MALIGNA — Continued. 

If  we  accept  the  opinion  that  Cholera  is  a  Pernicious- 
Fever,  we  must  not  expect  to  find  that  it  is  either  contagious, 
as  small-pox  is,  or  that  it  is  propagated  from  individual  to 
individual,  as  a  specific  poison,  as  syphilis  is. 

All  my  large  personal  experience  of  the  disease  in  Bengal 
— its  home — and  all  that  I  have  read,  confirm  my  belief  that 
the  essentials  to  its  occurrence  are  (1)  an  atmospheric  or  tel¬ 
luric  condition,  epidemic  or  endemic,  due,  it  may  be,  to  some 
undetected  abnormality  in  the  air  or  in  the  earth — electric,, 
volcanic,  or  other — or  to  the  presence  of  some  un- demonstrated 
microzyme  or  germ,  which  predisposes  those  who  live  within 
the  area  of  its  occupation  to  cholera ;  and  (2)  an  exciting 
cause,  such  as  panic,  fatigue,  want,  or  unwholesome  ingesta, 
— say,  a  dose  of  Epsom  salts,  putrid  fish  or  meat,  crude  fruit, 
or  water  impregnated  with  various  impurities,  such  as  cholera 
excreta,  etc.,  etc.,  etc.  No  one  has  proved,  to  my  satisfac¬ 
tion,  that  cholera  stools  contain  a  specific  poison  capable  of 
propagating  cholera  to  those  who  swallow  it.  True,  some 
of  the  facts  which  are  adduced  in  support  of  their  doctrine 
by  those  who  hold  that  cholera  is  propagated  exclusively  by 
cholera  stools,  are  striking :  but  these  facts  are  very  few, 
considering  the  great  prevalence  of  the  disease  and  the  vast 
number  of  those  who  have  studied  it  practically ;  and,  care¬ 
fully  sifted,  the  strongest  of  them  fall  short  of  absolute 
demonstration.  Thus  great  weight  is  given  to  the  fact  that, 
in  one  of  the  later  visitations  of  this  metropolis  by  Cholera, 
the  ravages  of  the  pestilence  were  signally  incident  upon 
the  East  of  London.  Upon  special  inquiry,  more  than  one 
of  our  best  sanitary  authorities  discovered  that,  when  the 
disease  was  most  active,  the  inhabitants  were  drinking  un¬ 
filtered  water  from  the  river  Lea  ,•  and  that,  at  the  same 
time,  -this  water  had  received  cholera  stools.  This  is  a 
showy  fact,  but  it  quite  falls  short  of  demonstrating  that  a 
specific  poison  in  water  caused  this  outbreak,  seeing  that, 
whenever  pestilence  has  visited  London,  its  incidence  has 
ever  been  most  heavy  at  the  East-end,  where  poverty  and 
sanitary  neglect,  in  a  marshy  atmosphere,  have  always 
prevailed,  (a)  and  that  filthy  drinking-water  has  always  been 
recognised  as  a  valid  exciting  cause  of  cholera, — as  a  strong 
solution  of  Epsom  salts  also  undoubtedly  is. 

Mr.  Macnamara  states(b)  that  the  following  remarkable 
accident  occurred  within  his  own  observation: — A  small 
quantity  of  a  fresh  rice-water  stool,  passed  by  a  patient 
suffering  from  cholera,  was  accidentally  mixed  with  some 
four  or  five  gallons  of  impure  water,  and  the  mixture 
exposed  to  the  rays  of  the  tropical  sun  for  twelve  hours. 
Early  the  following  morning  nineteen  people  each  swallowed 
about  an  ounce  of  this  contaminated  water.  Within  thirty- 
six  hours  five  of  these  persons  were  seized  with  cholera. 

This  again  is  a  striking  fact.  Still,  it  quite  fails  to- 
prove  that  the  rice-water  cholera  stool  contains,  and  is- 

(a)  In  illustration  of  this  point,  I  may  as  well  quote  verbatim  the  words 
which  I  used  in  November  last  ( Medical  Times  and  Gazette  for  November  11, 
1882,  page  577),  when  speaking  of  the  general  unhealthiness  of  East 
London,  without  having  my  attention  at  all  particularly  directed  to  the 
subject  of  Cholera :  —  “  We  read  that,  in  the  first  year  of  Charles  the  First, 
Stepney  lost  2978  persons  by  the  Plague  ;  and  that  in  1665  Plague  again  ap¬ 
peared  there,  and.  according  to  the  parish  clerk’s  account,  swept  off  6583 
persons.”  .  .  .  “  It  is  stated,  in  the  ‘  Life  of  Lord  Clarendon,’  that  ‘the 
Plague  had  swept  away  so  many  seamen  (Stepney  and  the  places  adjacent, 
which  were  their  common  habitation,  being  almost  depopulated)  that  there 
seemed  to  be  an  impossibility  to  procure  sailors  to  set  out  the  fleet.’ 
Stepney  lost  a  character  for  salubrity,  which  it  had  somehow  obtained, 
when,  in  1814  and  1866,  many  cases  of  cholera  occurred  in  its 
neighbourhood.” 

(b)  “  Cholera,”  Cluain’s  11  Dictionary,”  page  240. 


Medical  Times  and  Gazette. 


CHEVEES  ON  THE  OEDINAEY  DISEASES  OF  INDIA. 


Sept.  1,  1893.  2  3  3 


capable  of  communicating,  when  swallowed,  the  specific 
poison  of  cholera,  as  the  virus  of  syphilis  and  variola  con¬ 
tain,  and,  when  inoculated,  communicate,  those  two  diseases. 
Indeed,  the  fact  that  scarcely  more  than  25  per  cent,  of 
those  who  swallowed  the  poison  became  the  subjects  of 
cholera  may  be  received  with  surprise  by  some  that  so  many 
escaped,  may  be  viewed  by  others  as  an  evidence  that  no 
poison  was  swallowed,  and  must  be  received  by  all  as  proof 
that,  if  cholera  stools  do  contain  a  specific  poison  of  cholera, 
that  poison  is  far  less  sure  in  its  action  on  the  system  than 
various  recognised  specific  poisons  are.  Thus,  if  three 
groups  of  persons  (1)  took  scruple  doses  of  arsenic,  were  (2) 
inoculated  with  small-pox,  or  (3)  with  syphilis,  it  can  hardly 
be  doubted  that  more  than  25  per  cent,  of  each  party  would 
manifest  the  specific  action  of  each  of  these  three  poisons. 

Then,  should  it  be  argued  by  one  unacquainted  with  the 
natural  history  of  Indian  Cholera,  that  the  fact  that  so  many 
as  five  out  of  a  party  of  nineteen  were  attacked  with  Cholera, 
creates  strong  suspicion  of  cholera-poisoning,  I  shall  pre¬ 
sently  give  a  case,  by  Dr.  Macpherson,  in  which  five  out  of 
eighteen  inhabitants  of  a  house  were  attacked  with  cholera, 
three  fatally,  when  there  did  not  exist  any  evidence  or  sus¬ 
picion  of  cholera  poisoning.  So,  too,  many  cases  have  been 
adduced  in  which  pilgrims,  travelling  in  the  course  of  a  cholera 
epidemic,  reached  a  town  and  were  attacked  with  cholera, 
whereupon  cholera  appeared  in  that  town.  To  this  argument 
of  the  propagationists  their  opponents  reply  by  inquiring. 
Would  not  the  epidemic  have  appeared  in  the  town,  precisely 
as  it  did,  if  the  pilgrims  had  never  come  ?  Does  the  admis¬ 
sion  of  a  cholera  patient  to  a  hospital  impest  that  hospital 
with  cholera  ? 

In  considering  this  question,  it  is  noteworthy  that  nearly 
the  whole  of  the  Indian  authorities  who  believe  that  cholera 
is  communicable  by  the  dejecta  judge  from  their  experience 
of  epidemic  cholera  in  the  North-Western  Provinces ;  whereas 
nearly  all  who  have  long  worked  in  Lower  Bengal,  the  fixed 
endemic  area  of  cholera,  doubt  that  this  disease  is  at  all 
communicable  from  man  to  man. 

Thus,  only  a  day  or  two  ago,  a  brother  officer,  of  remark¬ 
able  distinction,  who  has  retired  after  long  service  both  Up 
Country  and  in  Lower  Bengal,  told  me  that  he  long  sought 
in  vain  for  an  instance  of  a  servant  who  had  got  cholera  in 
the  wards  of  a  cholera  hospital.  At  length  he  found  a  napit 
(barber)  who  had  been  attacked  under  what  appeared  to  be 
suspicious  circumstances.  To  the  inquiry,  “  Have  you  been 
shaving  cholera  patients?”  he  replied,  “I  never  shaved  a 
cholera  patient.” 

During  fifteen  years,  with  some  breaks,  in  which  I  was 
Senior  Physician  of  the  largest  hospital  in  India,  which  was 
rarely  free  from  cholera  cases,  no  medical  officer,  nurse,  or 
native  hospital  attendant  (altogether  a  large  body)  was 
attacked  with  cholera.  When  I  first  assumed  charge,  all  the 
cholera  cases  were  treated  in  the  general  wards,  side  by  side 
with  the  other  sick.  After  some  years,  I  fitted  up  a  cholera 
ward  for  men;  but,  up  to  the  day  on  which  I  left  India,  I  could 
never  obtain  separate  accommodation  for  the  women.  Still, 
in  those  fifteen  years  of  never-ceasing  cholera  prevalence, 
I  can  recollect  no  patient  who  was  attacked  with  cholera  in 
hospital,  with  the  exception  of  Willie  Marshall,  a  little  patient 
of  my  own.  Therefore  there  is  nothing  in  my  own  experience 
that  favours  the  opinion,  entertained  by  many,  that  every 
cholera  patient  is  to  be  regarded  as  a  centre  from  whom 
pestilence  radiates. 

At  a  recent  meeting  of  the  Epidemiological  Society,  Dr. 
Cuningham  stated  that  he  had  collected  nearly  eight  thou¬ 
sand  cases  of  cholera  attendants,  of  whom  only  150  were 
attacked, — these,  like  all  their  neighbours,  having  to  share 
the  danger.  Dr.  De  Renzy  replied  that  it  had  been  known 
that  soldiers,  told  off  to  attend  their  sick  comrades  in  the 
-cholera  wards  of  European  corps,  suffered  largely.  Here  it 
should  be  borne  in  mind  (1)  that,  when  epidemic  cholera 
attacks  a  European  regiment,  all  are  in  great  danger  ;  that, 

(2)  gallant  as  the  English  soldier  generally  is  in  battle, 
and  devoted  as  he  is  in  attention  to  his  sick  comrades,  the 
first  outbreak  of  cholera  pestilence  always  raises  panic — a 
strongly  predisposing  cause — throughout  the  regiment,  espe¬ 
cially  when  the  medical  officers  are  propagationists  ;  whereas 

(3)  work  with  cholera  patients,  which  he  knows  by  experience 
to  be  unattended  with  the  slightest  danger  to  himself,  is  the 
daily  business  of  the  native  hospital  attendant,  who,  although 
not  courageous,  generally  has  fair  good  sense. 

At  the  Calcutta  Medical  College,  I  had  a  little  town  within 


my  walls,  numbering,  at  mid-day,  upwards  of  two  thousand 
inhabitants,  a  very  large  majority  of  whom  were  in  some 
way  concerned  with  our  very  numerous  cholera  sick.  Our 
sanitary  arrangements  were  fairly  good,  but  very  far  from 
perfect,  seeing  that  the  hospital  was  a  faulty  building, 
standing  in  a  nice,  but  narrow,  open  space  in  the  heart  of  a 
dense  and  most  noisome  bazaar,  containing  a  little  Venice 
of  open  sewer  cesspools.  In  fifteen  years,  one  patient  was 
attacked  in  the  hospital  of  300  beds, — no  attendant.  In  the 
adjoining  College,  one  student  was  attacked,  but  no  servant. 
This,  in  a  city  where  cholera  rages  as  a  pestilence  for  four 
months  in  every  year,  and  from  which  the  disease  is  never 
absent.  I  look  upon  those  two  cholera  cases  merely  as  our 
share  of  suffering  from  the  cholera  influence  which  hung 
constantly  over  us  throughout  all  those  fifteen  years. 

Then,  with  regard  to  my  own  personal  and  home  ex¬ 
perience  (which  is  also  the  experience  of  thousands  of  other 
well-to-do  Englishmen,  their  wives  and  children,  who  lived 
in  Bengal  while  I  did),— in  all  those  years,  although  we  were 
certainly  very  scrupulous  in  choosing  the  best  drinking- 
water,  and  in  having  that  filtered  and  boiled,  it  cannot  be 
doubted  that,  if  there  be  a  cholera  poison— which,  if  it  be 
a  solid  or  a  gas,  must  exist  abundantly  in  the  horrible  dust 
(Budd)  and  fog  of  Calcutta— we  must  have  taken  it  into  our 
systems  almost  in  everything  that  we  swallowed  and  in 
every  breath  we  drew,  to  say  nothing  of  the  fact  that,  during 
more  than  half  my  long  service  in  India,  we  lived,  with 
windows  open  day  and  night,  less  than  a  hundred  yards  to 
leeward  of  a  cholera  hospital. 

All  those  who  think  as  I  do  on  this  subject  are  constantly 
saying  to  the  propagationists,  "  You  are  too  ready  to  read 
cause  and  effect  where  we  merely  recognise  striking  coinci¬ 
dence. ”(c)  Still,  as  the  opinion  that  the  disease  is  propagated 
by  water  containing  cholera  dejecta  is  held  tenaciously,  at 
this  moment,  as  a  guide  in  preventive  legislation,  by  many 
physicians  of  great  experience  and  scientific  eminence,  and 
as  the  question  is  one  of  such  great  importance  to  suffering 
humanity,  I  have  no  hesitation  in  stating  my  opinion  that 
it  ought,  should  Cholera  arise  among  us  here,  to  be  put  to  a 
crucial  test  “  in  corporibus  vilorum.”  As  this  disease  is  not 
proved  to  be  communicable  to  the  lower  animals,  and  as  the 
anti-vivisectionists  would  probably  not  allow  us  to  make  ex¬ 
periments  if  serious  doubt  remained,  the  Government  ought 
to  be  moved  to  permit  it  to  be  tried  upon  criminals  condemned 
to  death.  As  these  poor  creatures  would  be  well  attended  to, 
I  believe  that,  even  if  it  be  true  that  the  dejecta  contain  and 
communicate  the  specific  poison  of  cholera,  at  least  three- 
fourths  of  their  number,  if  not  all,  would  escape  with  life. 

Until  this  is  done,  and  afterwards,  I  shall  retain  the  belief 
that,  on  every  ground,  we  should  as  far  as  possible  avoid 
swallowing  cholera  matter,  not  because  I  consider  that  this 
is  the  specific  poison  of  cholera,  but  because  it  is  a  putrid 
irritant  which  is  likely  “  to  disagree,”  and  so  to  become  an 
exciting  cause  of  cholera,  as  Epsom  salts  and  putrid  fish 
unquestionably  are. 

The  discovery  of  the  cause  of  Cholera  will  probably  never 
be  vouchsafed  to  a  man  of  narrow  and  one-sided  views.  I 
believe  that  nothing  valid  will  be  revealed  to  us  unless  we 
grasp  and  correlate  all  proved  facts.  He  who  enters  upon 
the  quest  must  recognise  no  opponents.  All  working  in  the 
field  must  be  regarded  as  fellow-labourers  and  helpers,  save 
those  who  are  absolutely  ignorant  or  dishonest.  He  who 
is  so  happy  as  to  grasp  the  truth  will  certainly  perceive  that 
it  is  reconcilable  with  all  the  good  work  of  men  holding  all 
opinions.  “  Why,”  it  may  be  said, ‘‘you  affect  broad  views, 
while  you  are  really  a  bigoted  anti-propagationist !  My 
reply  is,  “  Not  so  ;  I  am  an  agnostic,  with  a  strong  anti- 
propagationist  impression,  which  may  possibly  be  removable, 
but  which  is  quite  unshaken  at  present. 

As  I  have  already  said,  I  have  so  generally  noticed  that 
those  of  my  most  experienced  brother  officers  who  have  been 
propagationists  have  made  their  observations  chiefly  in  the 
Epidemic  field  of  cholera  in  Upper  India,  while  the  anti-pro- 
pacationists  have  generally  practised  in  the  Endemic  area 
of  ^Bengal  Proper,— a  very  large  proportion  of  those  whose 
observations  have  been  restricted  to  the  cholera  epidemics 
of  Europe  being  propagationists, — that  it  stands  as  a  fair 


(c)  Mr  Froude  has  lately  recalled  Luther’s  commentary  upon  astrology. 

It  is  like  dice-throwing.  You  say  that  you  have  a  pair  of  dice  that 
Lwavs  throw  twice  six— you  throw  two,  three,  four,  five,  six,  and  you 
ike  no  notice.  When  twice  six  turns  up  you  think  it  proves  your  case, 
he  astrologer  is  right  once  or  twice,  and  boasts  of  his  art.  He  overlooks 
is  mistakes.” 


Medical  Times  and  Gazette. 


NICHOLSON  ON  TURPENTINE  IN  SECONDARY  SYPHILIS. 


Sept.  1,  1883. 


234 


question.  Is  or  is  not  Epidemic  cholera  propagated  by  the 
dejecta,  while  the  Endemic  disease  of  Lower  Bengal  is  not  ? 
My  mind  has,  for  many  years,  been  open  to  this  question, 
which  has  often  occupied  my  thoughts.  But  I  have  never 
seen  or  heard  anything  which,  upon  close  investigation, 
shakes  my  firm  impression  that  a  specific  cholera  poison  is 
not  contained  in  the  stools. 

Pace  M.  Fauvel,  I  do  not  hold  these  views  “  in  accord¬ 
ance  with  the  commercial  interest  of  my  country,”  (d)  being 
quite  unaware  what  that  “  interest”  is — save  that  it  appears 
to  me  that,  if  I  were  a  Bristol  merchant,  it  would  not  be  to 
my  “  interest  ”  to  see  that  port  impested  by  cholera.  It  has 
never  been  my  fortune  to  enjoy  the  rest  afforded  by  a  prolonged 
term  of  quarantine ;  but,  having  been  conducted  through  the 
Alexandria  railway  station  in  five  journeys  to  and  from  India, 
I  can  affirm  that,  adding  together  all  the  terms  of  my  stay 
at  that  place,  not  three  hours  of  my  life  have  been  spent  on 
shore  at  Alexandria.  I  have  been  conveyed  in  what  appeared 
to  be  a  pig-boat  to  and  from  the  steamer,  and  have  been 
taken  across  the  desert  in  a  vehicle  of  bare  boards  which 
had  the  look  and  comfort  of  a  sheep-van.  I  have  seen  an 
Egyptian  receive  a  sixpenny-piece  from  an  Englishman  in 
the  bowl  of  a  gravy- spoon  filled  with  water  ;  and  I,  together 
with  the  rest  of  my  fellow-passengers,  have  been  constrained 
by  a  straw-hatted  official  to  soak  and  wring  out,  in  public, 
the  contents  of  my  clothes-bag  on  the  deck  of  a  P.  and  O. 
steamer,  in  the  shadow  of  Monte  Christo’s  prison — apparently 
with  an  intention  of  liberating  the  cholera-germ,  and  of 
giving  it  a  habitat  in  French  waters.  Still  I  remain  abso¬ 
lutely  unconvinced  of  the  preventive  efficacy  of  sanitary 
cordons  and  of  quarantine  in  cutting  off  the  approach  of 
that  which  does  not  travel,  and  in  arresting  the  propagation 
of  that  which  is  never  propagated. 

( To  le  concluded.) 


ON  TURPENTINE  IN  SECONDARY 
SYPHILIS,  AND  IN  PHAGEDENIC  SORES 
FOLLOWING  FEVER. 

By  Deputy  Insp. -General  BRINSLEY  NICHOLSON,  M.D. 


The  experiences  of  this  most  useful  medicine  which  have 
befallen  me  in  these  two  classes  of  disease  may  prove  of 
interest  to  at  least  some. 

1.  Having  taken  over  charge  of  a  depot  hospital,  I 
found  in  it  two  exactly  similar  cases.  Both  had  had  syphilis, 
and  both  had  returned  to  hospital  with  syphilitic  plaques — 
induration  of  the  skin  and  subcutaneous  tissue  above  and 
below  Poupart’s  ligament.  Both  had  apparently  recovered 
under  iodide  of  potassium  and  rest,  and  both  had  quickly 
come  back  to  hospital  with  relapses  of  the  same.  When 
1  took  charge  they  were  again  under  the  iodide  and  con¬ 
fined  to  bed  ;  indeed,  they  moved  as  1‘  lamiters  ”  and  with 
difficulty.  The  treatment  was  continued,  merely  adding 
local  compression  by  means  of  leaden  plates  and  bandages. 
They  appeared  to  improve,  and  in  a  reasonable  time  one 
seemed  to  be,  and  pronounced  himself,  quite  well ;  but,  in 
view  of  his  previous  history,  he  was  retained  a  little  longer 
under  treatment,  and  then  returned  for  a  while  to  conva¬ 
lescence  and  light  duty.  Very  shortly,  however,  he  came 
back  as  bad  as  ever ;  so,  recurring  to  the  same  local  treat¬ 
ment,  I  put  both  him  and  the  other  case  on  turpentine,  in 
doses,  if  I  remember  rightly,  of  a  drachm  twice  a  day  made 
into  an  emulsion  with  liquor  of  potass  and  two  ounces  of 
water.  Both  were  quickly  cured,  and,  being  discharged, 
did  not  return. 

Some  year  or  two  afterwards,  at  the  Cape,  two  cases  were 
brought  before  me  by  a  brother  medical  officer — one  of 
syphilitic  plaque,  by  no  means  so  extensive  as  those  just 
spoken  of,  but  which  had  resisted  all  treatment ;  the  other 
of  similarly  obstinate  orchitis,  I  think  syphilitic.  I  nar¬ 
rated  my  experiences  of  turpentine,  as  given  above,  but 
said  that  I  could  suggest  nothing  beyond  strapping  for  the 
orchitis,  as — building  on  my  success  in  syphilitic  plaques 
- — I  had  tried  turpentine  in  orchitis  from  different  causes,  in 
syphilitic  buboes  (suppurating  and  non-suppurating),  and 
in  other  ■swellings,  but  without  the  slightest  success.  My 

'  (d)  . Report  of  a  controversy  in  the  Paris  Academie  de  Medecine  ( Daily 
Telegraph  for  August,  6,  1883). 


friend’s  cases  turned  out  conformably — the  plaque  was- 
cured,  the  orchitis  was  not. 

2.  In  West  Australia  I  found  occasional  cases  of  an  ap¬ 
parently  endemic  and  peculiar  continued  fever,  generally  of' 
a  mild  type,  and  never,  in  my  experience  of  three  years,, 
fatal.  A  civilian,  whose  children,  though  apparently  well 
nourished  and  well  formed,  did  not  to  a  practised  eye  show 
very  healthy  constitutions,  called  me  in  to  a  son  of  about 
ten  or  over.  This  fever  had  attacked  him  in  a  rather  more- 
severe  form  than  was  usual,  but  one  could  not  call  it  severe. 
He  went  through  it  apparently  successfully,  but  it  lingered? 
on  him  longer  than  usual,  and  his  convalescence  threatened 
to  resemble  that  perpetual  ill-health  which  sometimes^ 
follows  on  typhoid  fever.  In  its  course  he,  being  still  con¬ 
fined  to  bed,  was  unexpectedly  attacked  with  a  couple  of' 
slowly  progressing  phagedsenic  and  ashy-coloured  sores,  one 
circular  and  more  superficial  over  the  right  trochanter,  the- 
other  more  longitudinal  and  deeper  in  the  middle  front 
of  the  upper  part  of  the  left  thigh.  The  former  even¬ 
tually  left  the  tendinous  surface  exposed,  but  unaffected. 
In  the  latter,  when  at  its  worst,  by  lifting  a  yet  healthy 
but  flabby  and  loose  piece  of  flesh  still  attached  by 
its  lower  part,  a  little  above  an  inch  in  length  of  the- 
femur  could  be  laid  bare,  besides  that  smaller  portion 
which  was  already  bare  above  it.  The  local  remedies-- 
used  were  (the  edges  of  the  ulcers  being  swollen) — compres¬ 
sion  by  leaden  plates  and  bandages  re-applied  every  third 
day,  and  the  use  at  the  same  time  of  lotions  or  unguents,  or- 
of  nitrate  of  silver  and  sulphate  of  copper,  and  more  espe¬ 
cially  of  a  lotion  of  kino  (or  catechu)  and  myrrh,  this  (the- 
tinctures  being  more  or  less  diluted  with  water)  being  a 
favourite  application  of  mine  in  syphilitic  or  other  unhealthy 
sores,  care  being  taken  that  if  kino  were  used  it  should  give- 
a  red  and  not  a  brown-red  colour  when  so  diluted.  Such 
treatment  was  clearly  of  service  in  restraining  the  unhealthy, 
and  in  some  slight  degree  restoring  healthy  appearance  and 
action.  But  all  alterative  and  tonic  treatment  seemed  use¬ 
less,  until  I  began  with  twenty  minims  of  turpentine  twice 
a  day ;  and  even  then  the  improvement  was  very  slow  and. 
gradual.  At  last,  however,  I  had  more  hope ;  the  swollen 
appearances  at  the  margins  diminished,  the  exposed  surfaces- 
became  more  healthy,  and  the  healing  process  progressed: 
favourably.  In  every  way,  in  fact,  the  sores  looked  well, 
and  seemed  advancing  to  a  speedy  cure.  Unfortunately,  I 
was  called  away  by  duty  to  another  part  of  the  colony  for 
about  a  week  or  so,  and  had  to  give  over  the  case  for  that 
time  to  another  practitioner.  On  my  return  all  was  worse 
the  old  state  and  appearances  had  returned,  and,  though  the- 
sores  bad  not  fallen  back  to  their  former  size,  healing  had 
more  than  ceased.  The  statement  I  got  was  this — that  they 
had  become  so  healthy-looking,  and  were  advancing  so 
favourably,  that  my  substitute  had  left  off  the  compression 
and  omitted  the  turpentine.  The  result  was,  the  cure  was 
stopped,  and  though  under  a  recurrence  to  the  same  treat¬ 
ment  the  trochanter  sore  at  length  healed,  it  was  some- 
months  before  that  on  the  thigh  did,  and  then  the  child  was- 
yellowish,  pale,  sickly-looking,  emaciated,  lame  from  the 
large  loss  of  flesh  about  the  thigh-ulcer,  and  only  able  to  go 
about  in  a  perambulator.  At  that  time,  my  period  of  duty 
in  the  colony  having  expired,  I  left,  and  afterwards  heard 
that  my  patient  had  died,  though  I  received  no  particulars- 
of  his  illness  or  death. 

Whether  I  tried  turpentine  in  this  case  as  a  local  applica¬ 
tion,  I  cannot  now  distinctly  remember.  If  I  did  not,  it  was,. 
I  think,  a  regrettable  omission. 


Administration  of  Iodide  and  Bromide  of  Potas¬ 
sium  and  Salicylate  of  Soda. — According  to  Dr.  Seguin 
these  salts  are  best  exhibited  in  slightly  alkaline,  natural  or 
artificial,  carbonated  waters.  Given  in  this  way  they  are- 
less  irritating  to  the  mucous  membrane  of  the  stomach,  the 
disagreeable  taste  is  very  much  masked,  and  the  salts  are 
more  quickly  and  thoroughly  absorbed.— Phil.  Med.  Rep., 
July  28. 

The  Poison  of  Lizards.— Drs.  Weir  Mitchell  and 
Reichert  find  that  the  full-grown  lizard  will  bite  and  cause- 
a  wound  that  may  prove  fatal.  Unlike  that  of  other  reptiles, 
its  saliva  is  alkaline,  not  acid.  A  little  injected  into  a  pigeon, 
caused  the  death  of  the  bird  (which  was  strong,  fat,  and 
plump)  in  less  than  nine  minutes.— New  York  Med.  Record > 
August  4.  ... 


Medical  Times  and  Gazette. 


IMEDICAL  AND  SUEGICAL  PEACTIOE. 


Sept.  1,  1883.  235 


REPORTS  OF 

HOSPITAL  PRACTICE  IN  MEDICINE 
AND  SURGERY. 


8AMAEITAN  EEEE  HOSPITAL  FOE  WOMEN 
AND  CHILDEEN. 


DERMOID  OVARIAN  TUMOURS. 

(Under  the  care  of  Mr.  KNOWSLEY  THORNTON.) 

( Continued  from  page  383  of  last  volume.) 

.Before  proceeding  to  give  brief  notes  of  the  dermoid  ovarian 
•cysts  which  I  have  removed  by  ovariotomy  at  the  Samaritan 
Hospital,  I  have  to  add  two  cases,  which  I  had  overlooked, 
do  the  list  of  malignant  dermoids  already  described. 

(Case  2-17  in  Ovariotomy  Tables— not  yet  published.) 

The  first  was  that  of  a  woman,  aged  thirty-nine,  married 
twenty-two  years,  and  mother  of  one  child  aged  twenty- 
•one.  The  patient  had  always  enjoyed  good  health,  but 
was  of  a  phthisical  family.  She  had  only  noticed  the  en¬ 
largement  for  six  months,  and  during  the  whole  time  had 
suffered  very  severe  and  unusual  pain  in  the  left  side  at 
The  monthly  periods. 

I  performed  ovariotomy  on  June  29,  1881,  and  removed  a 
-sarcomatous  dermoid  of  the  left  ovary,  with  such  intimate 
adhesion  to  the  omentum  and  small  intestine,  that  I  had 
regularly  to  carve  a  coil  of  the  latter  out  of  the  wall  of  the 
"tumour,  and  the  intestine  for  some  distance  on  each  side  of 
the  adhesion  was  evidently  infiltrated  with  new  growth. 
The  right  ovary  was  healthy.  In  places  the  cyst-wall  was 
two  inches  thick,  pink  and  fleshy  when  cut,  and  there  was 
a  considerable  growth  of  long  black  hair  in  its  interior. 
It  is  worthy  of  note  that  the  patient  was  fair,  with  fresh 
complexion  and  brown  hair. 

She  made  a  rapid  recovery,  but  died  of  recurrence  in  the 
abdomen  in  the  following  May,  1882.  Dr.  McWilliam,  of  the 
Temperance  Hospital,  kindly  informed  me  of  her  death,  and 
-also  that  the  new  growth,  which  was  chiefly  in  the  right  iliac 
fossa,  began  to  grow  six  months  after  the  ovariotomy.  She 
had  six  months’  good  health,  and  then  cachexia  was  rapidly 
•developed. 

(Case  242  in  Ovariotomy  Tables — not  yet  published.) 

The  other  case  was  that  of  a  young  woman  of  thirty-one, 
married  ten  years,  and  mother  of  four  children.  She  ap¬ 
peared  to  be  in  very  good  health  when  admitted  into  the 
Hospital.  Had  first  noticed  a  “  throbbing  lump  ”  in  the  left 
iliac  region  two  years  and  a  half  ago,  and  just  after  her 
last  confinement.  Growth  was  rapid  at  first  for  some 
months.  Then  she  had  a  miscarriage  and  lost  much  blood, 
-and  after  this  the  tumour  seemed  hardly  to  grow  at  all. 

I  performed  ovariotomy  on  June  2,  1881,  and  removed  a 
semi-solid  dermoid  tumour  of  the  right  ovary,  with  the 
pedicle  twisted  one  and  a  half  turns,  so  as  greatly  to  obstruct, 
but  not  stop  the  circulation.  This  condition  doubtless  dated 
from  the  miscarriage,  and  explained  the  cessation  of  growth. 
There  was  a  great  deal  of  free  fluid  in  the  peritoneum.  The 
^uterus  was  healthy,  but  the  other  ovary  was  large.  The 
tumour  was  a  sarcoma,  with  bone,  hair,  etc.,  scattered  in 
small  portions  throughout  the  solid  parts,  just  as  in  another 
■of  the  cases  already  described.  The  mass  weighed  ten 
pounds. 

The  patient  made  a  rapid  recovery,  and  went  home  on 
fhe  twenty-first  day  after  the  operation.  I  have  just  heard 
from  Dr.  Miller,  of  Eye,  who  placed  her  under  my  care, 
that  she  is  well  and  strong,  free  from  any  sign  of  recurrence, 
and  in  better  health  than  for  years  before  the  operation. 
It  is  an  interesting  subject  for  speculation,  how  far  the 
•changed  nutrition  following  the  twisting  of  the  pedicle 
may  have  influenced  the  nature  of  the  tumour. 

Passing  now  to  the  ordinary  dermoid  tumours,  I  shall 
•give  only  very  brief  notes  of  the  individual  cases,  as  they 
are  numerous.  What  I  wish  to  do  is  to  put  side  by  side 
any  facts  which  seem  to  throw  light  on  the  tumours  as 
a  class — first,  their  etiology ;  second,  their  differential 
■diagnosis. 

Case  1  (Case  17  in  Ovariotomy  Tables). 

A.  J.  M.,  thirty-seven ;  no  children.  Menstruation  always 
scanty.  A  big,  strong,  Welsh  woman,  with  full  colour  and 
dark  complexion.  No  family  history  obtainable.  Growth  of 


tumour  rapid.  Had  had  pain  in  left  side  for  eighteen 
months,  and  enlargement  for  about  a  year. 

Ovariotomy,  January  3,1876.  The  tumour  was  chiefly  solid, 
with  large  masses  of  bone,  many  of  them  containing  teeth 
(several  dozen  teeth  of  various  kinds),  and  large  masses  of  hair; 
weight  twenty-six  pounds.  The  other  ovary  was  of  the 
size  of  a  pigeon’s  egg,  and  contained  a  cyst  full  of  fat  and 
hair.  It  was  also  removed.  The  patient  recovered,  and 
remains  in  good  health. 

Case  2  (No.  18  in  Ovariotomy  Tables). 

Mrs.  J.  (not  a  Samaritan  Hospital  case).  I  will  refer 
briefly  to  some  points  in  the  case  in  my  remarks  at  the  end. 

Case  3  (No.  19  in  Ovariotomy  Tables). 

Also  a  private  case. 

Case  4  (No.  45  in  Ovariotomy  Tables). 

E.  W.,  single,  aged  twenty,  a  dark,  delicate-looking  girl, 
with  fresh  colour ;  menstruation  quite  regular.  Had  noticed 
enlargement  in  right  side  of  abdomen  for  four  years.  Never 
any  serious  pain  ;  occasionally  a  little  burning  sensation  in 
right  side.  No  family  history.  Had  been  once  tapped  by 
Mr.  Square,  Plymouth. 

Ovariotomy,  November  21,  1877.  Tumour  of  left  ovary 
removed;  the  right  ovary  and  uterus  healthy;  weight 
twenty-nine  pounds.  Recovered,  and  remains  well.  It 
was  a  large  simple  cyst,  and  inside  it,  and  opposite  the 
site  of  the  pedicle,  there  was  a  secondary  cyst  with 
fatty  contents,  dark  hair,  and  a  bony  mass,  with  an 
incisor  tooth  growing  in  it.  This  smaller  cyst  was  one 
cavity  of  a  multilocular  mass,  in  other  parts  of  which  there 
were  bony  plates. 

Case  5  (No.  60  in  Ovariotomy  Tables). 

E.  A.,  married  four  years,  aged  twenty-nine.  Had  two 
children  before  marriage,  and  a  miscarriage  since.  A  dark 
woman,  with  fresh  colour,  and  not  emaciated.  Menstrua¬ 
tion  regular  and  free.  No  family  history.  Had  noticed  a 
lump  in  the  left  iliac  region  ever  since  a  bad  fall  which  she 
had  two  years  or  more  before  admission. 

Ovariotomy,  February  21,  1878.  Dermoid  cysts  of  both 
ovaries  removed ;  weight  four  pounds.  The  smaller  (left 
side)  tumour  had  growing  from  its  wall  a  lot  of  little  pink 
fleshy  nodules,  which  were  evidently  the  first  buddings  of 
dermoid  structures.  I  have  observed  them  in  several  cases, 
and  shall  refer  to  them  again.  Recovered,  and  remains 
well. 

Case  6  (No.  86  in  Ovariotomy  Tables). 

M.  J.  H.,  aged  twenty-six,  married  two  years ;  no  chil¬ 
dren.  Menstruation  always  quite  regular.  First  noticed 
“  tender  lump  ”  in  right  iliac  region  about  eight  months 
before  admission.  Attributes  the  growth  to  a  bad  fall  on 
the  Crystal  Palace  stairs  just  after  marriage,  when  she  hurt 
the  right  side  very  much,  and  was  in  a  faint  for  nearly  three 
hours.  No  family  history  of  importance. 

I  performed  ovariotomy  on  July  22,  1878,  and  enucleated 
a  dermoid  cyst  of  the  left  ovary.  The  operation  was  one  of 
the  worst  I  have  ever  performed,  and  the  patient  never  re¬ 
covered  consciousness,  and  died  in  thirteen  hours.  The 
tumour  weighed  eighteen  pounds. 

Case  7  (No.  102  in  Ovariotomy  Tables). 

E.  D.,  aged  fifty-three,  and  mother  of  five  children  ; 
blind.  Was  admitted  from  the  Gravesend  Workhouse  in 
March,  1879.  Tumour  made  its  appearance  just  after  the 
menopause  six  years  ago  ( i.e .,  when  she  was  forty-seven). 

I  performed  ovariotomy  on  March  12,  and  removed  a 
dermoid  cyst  of  left  ovary  weighing  twenty  pounds,  and 
another  of  the  right  ovary  weighing  seven  ounces.  The 
latter  had  lost  its  pedicle,  and  become  attached  to  the 
omentum  and  caecum.  The  patient  made  a  good  recovery. 


Case  8  (No.  167  in  Ovariotomy  Tables). 

E.  C.,  single,  aged  forty-seven.  Menstruation  always 
quite  regular.  Disease  of  right  hip,  with  contraction. 
Inflammation  of  bowels  eighteen  years  ago,  and  again  nine 
years  ago.  Family  history  has  no  bearing  on  case. 

Ovariotomy,  March  17,  1880.  A  dermoid  cystic  tumour, 
weighing  twenty  pounds,  was  removed  with  great  difficulty, 
owing  to  the  very  extensive  adhesions  and  encapsulation  of 
its  base  in  the  left  broad  ligament.  -The  tumour  contained 
much  liquid  fat  and  large  masses  of  hair  and  bone.  The 
patient  made  an  excellent  recovery,  and  re  main  a  wall — The 
right  ovary  was  also  removed,  becaitstTflih^  hifcftr ng' 
enlarged  with  fibro-myomata. 

yj-z  ft  .A  0  S' r  h  rVS^" 

.  .. 


236 


Medical  Times  and  Gazette. 


DE.  HUNTER  IN  EGYPT. 


Sept.  1, 18St. 


Case  9  (No.  184  in  Ovariotomy  Tables). 

M.  A.  S.,  single,  thirty- one.  No  previous  bad  health. 
Menstruation  rather  irregular  and  sometimes  too  free. 
Family  history  unimportant.  Had  noticed  increase  of  size, 
■with  some  pain  in  lower  abdomen  for  a  few  months  only. 

Ovariotomy,  May  21,  1880.  Simple  and  rapid  recovery. 
Patient  remains  well.  Thin  cyst  packed  with  little  concre¬ 
tions  of  fat  and  epithelium  ;  also  large  balls  of  hair,  and  at 
one  point  a  little  prominence  with  a  tuft  of  hair  growing 
from  it,  and  young  teeth  just  coming  through. 

Case  10  (No.  200  in  Ovariotomy  Tables — not  yet  published). 

A  private  case,  important  in  the  series  on  account  of  the 
age  of  the  patient,  a  widow  of  sixty-one. 

This  concludes  the  notes  of  all  the  dermoid  tumours  in 
my  first  200  ovariotomies — two  malignant  and  ten  simple, 
i.e.,  6  per  cent,  of  the  cases. 


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efrical  Cimcs  anil  §R}dk, 


SATURDAY,  SEPTEMBEE  1,  1883. 


DE.  HUNTEE  IN  EGYPT. 

A  Parliamentary  paper  has  been  issued,  containing  a  report 
addressed,  on  August  6,  by  Surgeon-General  Hunter  to  Sir  E. 
Malet,  on  the  measures  which  he  has  taken  or  proposed  since 
his  arrival  in  that  country.  “  It  is  simply,”  he  says,  “  an  abuse 
of  words  to  talk  of  sanitation  in  connexion  with  Cairo,  every 
sanitary  law  being  grossly  set  at  defiance.  The  canals  are, 
in  many  instances,  little  better  than  sewers,  and  no  precau¬ 
tions,  at  least  none  deserving  the  name,  are  taken  to  keep 
the  source  of  the  water-supply  from  contamination  by 
excreta  and  filth.  Conditions  for  the  development  and 
spread  of  disease  in  almost  every  form,  epidemic  and  other, 
abound.”  The  work  of  cleansing  the  streets,  which  Dr. 
Hunter  describes  as  a  herculean  task,  was,  however,  being 
vigorously  carried  on,  and  the  city  began  to  assume  a  fairly 
clean  appearance.  But  without  some  permanent  sanitary 
organisation,  which  shall  be  enabled  to  follow  up  these 
temporary  measures  by  a  regular  system  of  scavenging, 
disposal  of  excreta,  provision  and  maintenance  of  pure 
water-supplies  free  from  risks  of  pollution,  supervision  of 
cemeteries,  and  improvement  of  the  quarters  inhabited  by 
the  poorer  classes,  the  results  of  the  present  efforts  will 
be  but  transient  and  illusory.  The  Conseil  Superieuc 


or  Board  of  Health  at  Cairo  at  once  admitted  Dr.  Hunter 
as  a  member,  and  seem  to  have  given  a  willing  ear  to  his 
suggestions  as  to  the  treatment  of  epidemics  of  cholera  on 
the  Indian  plan,  and  the  necessity  for  a  reform  of  the  burial 
customs ;  and  the  President,  Dr.  Salim  Pasha,  together 
with  the  other  members,  accepted  Dr.  Hunter’s  suggestion 
to  organise  a  sanitary  service  composed  of  eight  Indian 
surgeons,  and  forty-eight  hospital  assistants  (Indian  Mussul- 
men).  These  are  probably  already  arrived  in  Egypt,  and,, 
whether  our  occupation  of  the  country  be  permanent  or  not, 
we  trust  that  this  service  may  become  an  integral  and 
lasting  part  of  the  administration. 

The  Council  appear,  if  Dr.  Hunter  is  not  over-sanguine,, 
to  be  already  convinced  of  the  utter  uselessness  of  sanitary 
cordons  and  such  antiquated  precautions  while  the  sanitary 
condition  of  the  towns  remains  what  it  is.  Happily  the 
epidemic  is  rapidly  subsiding.  How  far  this  is  due  to  the 
measures  adopted,  or  to  the  natural  tendency  of  such  out¬ 
breaks  to  wear  themselves  out,  we  cannot  say.  The  deaths, 
reported  up  to  the  end  of  July  were  12,600,  but  Dr.  Hunter 
is  inclined  to  estimate  their  true  number  at  25,000. 
Whether  the  original  cases  were  imported  from  India  or 
Arabia,  or  not,  we  shall  perhaps  never  know ;  but  this  is 
certain,  that  if  the  sanitary  condition  of  a  country,  espe¬ 
cially  as  regards  the  possible  contamination  of  the  drinking- 
water  and  the  subsoil  of  towns  by  faecal  discharges,  is  bad,, 
cholera  will  find  a  congenial  soil ;  and  if  these  conditions 
be  good,  the  disease,  even  if  imported,  will  not  take  a  firm 
root  in  the  land.  To  this  constant  relation  between  the 
sanitary  conditions  of  a  community  and  the  severity  of  an 
outbreak  of  cholera,  and  to  no  other  cause,  can  one  attri¬ 
bute  the  decreasing  intensity  of  each  successive  epidemic  in 
our  own  country.  Exclusion  is  desirable  if  it  be  practicable,, 
but  it  is  a  minor  matter  compared  with  the  other.  We  may 
safely  assume  that  cholera  will  never  arise  de  novo  under  the 
climatic  and  sanitary  conditions  of  Europe — at  least,  of 
Central  and  Western  Europe;  but  in  Egypt,  with  a  sub¬ 
tropical  climate  and  insanitary  conditions  equalling  or  ex¬ 
ceeding  in  their  abominable  character  anything  met  with 
in  India,  it  would  be  rash  to  deny  the  possibility  of  its. 
development  when  circumstances  such  as  those  attending 
a  recent  campaign  intensify  existing  evils. 

While  fully  admitting  the  specificity  of  zymotic  diseases, 
we  must  also  take  account  of  the  doctrine  of  evolution, 
which  we  believe  will  ere  long  be  recognised  as  playing  an 
important  part  in  the  origination  of  the  less  sharply  dif¬ 
ferentiated  of  specific  diseases — those,  we  mean,  which,  like 
cholera,  diphtheria,  and  enteric  fever,  stand  in  a  certain 
relation  to  other  and  non-specific  or  less-specific  forms. 
We  cannot  conceive  of  the  origination  de  novo  of  small¬ 
pox,  for  examplejunder  any  circumstances  with  which  we 
are  familiar ;  but,  given  the  conditions  favouring  the  evo¬ 
lution  of  the  higher  from  the  lower  bacterial  forms,  it  may 
be  that  those  producing  septic  inflammations  of  the  pharynx 
may  develope  into  those  of  diphtheria,  and  diarrhoeas  of 
pythogenic  origin  assume  more  and  more  of  a  specific  cha¬ 
racter  until  we  get  an  epidemic  of  genuine  cholera  such  as 
that  under  consideration.  The  probability  of  this  is  the 
latest,  and  we  venture  to  think  the  most  important  and 
practical,  outcome  of  the  doctrine  which  will  ever  be 
associated  with  the  honoured  name  of  the  far-sighted 
philosopher  Darwin. 


PEOFESSOE  EEB  ON  THE  ETIOLOGY  OF 
TABES  DOESALIS. 

In  1881,  Professor  Erb  published  his  first  series  of  100  eases 
of  tabes  dorsalis,  showing  the  frequency  of  previous  syphilis 
in  this  disease.  In  88  of  these  cases  there  had  been  previous 


Medical  Times  and  Gazette. 

. . : i 


ERRORS  IN  DRESS:  A  CAUSE  OF  SCROFULOSIS. 


Sept  1,1833.  237 


syphilis,  in  12  there  had  been  none.  Since  that  date, 
Fournier,  in  his  work  on  Locomotor  Ataxia  of  Syphilitic 
Origin  (1882),  gives  the  percentage  of  cases  in  which  there 
has  been  previous  syphilis  as  93;  Vogt,  a  former  opponent 
of  syphilitic  tabes,  in  his  latest  statistics,  gives  the  per¬ 
centage  as  81'4.  The  Berliner  Klinische  Wochenschrift, 
No.  32  of  this  year,  contains  a  paper  by  Erb  giving  a  second 
series  of  100  cases  of  tabes  dorsalis.  Out  of  this  series,  9 
only  of  the  cases  had  had  no  syphilis,  while  91  had  had 
previous  syphilis.  Of  these  91  cases,  62  had  undoubted 
secondary  syphilis,  29  had  primary  sores,  but  no  secondary 
symptoms  were  noticed.  Of  these  29  cases,  5  had  true  hard 
sores,  10  were  treated  with  mercury  and  iodide  of  potassium, 
and  in  14  the  treatment  and  the  nature  of  the  sore  are 
not  noted.  The  tabes  dorsalis  manifested  itself  at  the  fol¬ 
lowing  periods  after  infection  with  syphilis  : — 13  cases 
occurred  between  the  first  and  fifth  years,  31  between  the 
sixth  and  tenth,  25  between  the  eleventh  and  fifteenth,  15 
between  the  sixteenth  and  twentieth,  5  between  the  twenty- 
first  and  twenty-fifth,  1  between  the  twenty-sixth  and 
thirtieth,  and  in  1  case  the  period  was  unknown.  Thus 
69  of  the  91  cases  occurred  during  the  first  fifteen  years 
after  infection,  15  in  the  period  between  fifteen  and  twenty 
years,  and  6  still  later.  As  a  check  observation  Professor 
Erb  ascertained  that  of  1500  patients  who  attended  his 
clinic,  who  were  not  tabetic,  77'25  per  cent,  had  never  had 
syphilis,  and  that  22-75  per  cent,  had  been  infected.  Of 
these  latter  10-25  had  suffered  from  secondary  symptoms, 
and  12-50  from  chancres  only.  Erom  these  observations 
he  concludes  that  syphilis  is  such  an  important  factor  in 
the  etiology  of  tabes  dorsalis,  that  scarcely  anyone  who  has 
not  had  syphilis  or  a  chancre  has  a  chance  of  becoming 
tabetic.  As  to  the  other  factors  in  the  etiology  of  tabes 
(viz.,  heredity,  catching  cold,  fatigue,  sexual  excesses,  and 
injury),  he  considers  them  of  much  less  importance :  of  the 
100  cases  of  the  present  series  he  gives  in  36  cases  syphilis 
as  the  only  assignable  cause,  in  17  cases  syphilis  and  cold, 
in  8  syphilis  and  fatigue,  in  7  syphilis  and  excesses,  in  2 
syphilis  and  injury,  in  15  syphilis,  cold,  and  fatigue,  in  4 
syphilis,  cold,  and  excesses,  in  3  syphilis,  fatigue,  and 
excesses,  in  1  syphilis,  excesses,  and  injury  as  the  assign¬ 
able  causes,  and  in  3  cases  cold  alone,  in  2  cases  fatigue 
alone,  in  1  case  excesses  alone,  and  in  1  injury  alone. 
Syphilis  is  thus  the  most  frequent  and  important  change 
of  condition  that  favours  the  development  of  tabes,  the 
other  factors  generally  acting  in  company  with  syphilis. 

The  frequent  paralysis  of  ocular  muscles,  the  affection  of 
the  pupils,  the  presence  of  symptoms  pointing  to  syphilitic 
affections  of  the  cerebral  nervous  system  (viz.,  hemiplegia, 
apoplexy,  epileptiform  attacks,  and  frequent  headache) ;  the 
presence  of  syphilitic  affections  of  the  skin,  the  mucous 
membranes,  and  the  bones  ;  the  fact  that  in  cases  of  tabes 
occurring  late  in  life  the  patients  have  usually  acquired 
syphilis  late  in  life  (in  one  case  the  patient  acquired  syphilis 
at  the  age  of  forty-eight,  and  became  tabetic  at  the  un¬ 
usually  late  age  of  fifty-eight ;  in  another  case  the  patient, 
who  had  acquired  syphilis  at  the  age  of  thirty-eight,  became 
tabetic  at  fifty)  ;  the  relative  frequency  of  syphilis  and 
tabes  in  men  and  women  (being  in  each  disease  as  ten  to 
one),  the  relative  frequency  of  tabes  and  syphilis  in  women 
of  the  lower  classes,  the  relative  rarity  of  both  in  women  of 
the  higher  classes  ; — these  facts  Erb  considers  of  great  im¬ 
portance  in  assigning  syphilis  as  the  most  important  factor 
in  the  etiology  of  tabes.  The  occurrence  of  previous  syphilis 
in  tabetic  women  he  considers  not  at  all  infrequent,  for,  of 
13  cases  of  tabes  in  women,  6  had  a  clear  history  of  syphilis, 
4  had  no  history,  and  in  3  cases  the  history  was  doubtful. 
From  these  statistics  Professor  Erb  holds  that  syphilis  is 
one  of  the  most  important,  if  not  the  most  important,  cause 


of  the  occurrence  of  tabes.  That  tabes  is  a  specific  disease, 
a  late  manifestation  of  syphilis,  he  does  not  consider  to  be 
proved,  though  he  thinks  it  extremely  probable. 


ERRORS  IN  DRESS  :  A  CAUSE  OF  SCROFULOSIS. 
In  the  production  of  all  forms  of  strumous  disease  there 
occur  a  series  of  factors,  in  addition  to  that  of  hereditary 
tendency,  which  may  be  classed  as  preventable.  The  chief 
of  these — foul  air  and  insufficient  or  inappropriate  food — 
have  of  late  received  the  lion’s  share  of  attention  at  the 
hands  of  the  apostles  of  hygiene ;  and  great  changes  have 
been,  and  are  being,  made  in  the  domestic  life  and  economy 
of  the  poorer  classes,  which  must  eventually  tend  to  reduce 
the  formidable  array  of  deaths  and  diseases  due  to  prevent¬ 
able  causes  which  at  present  confronts  us.  But  while 
attention  has  thus  been  given  to  the  regulating  of  the  pul¬ 
monary  and  gastric  functions  of  the  scrofulously  inclined, 
a  third,  and  almost  as  important  a  function,  has  been 
allowed  to  pass  with  but  scanty  notice. 

The  importance  of  the  skin  as  an  excretory  organ,  and 
the  extent  to  which,  its  function  is  daily  interfered  with, 
not  only  by  the  sickly,  but  also  by  the  vigorous  and  strong, 
are  points  which  claim  serious  consideration  at  the  hands  of 
physicians  and  hygienists.  In  a  comprehensive  monograph 
on  the  subject,(a)  Dr.  O.  Paulsen,  of  Hamburg,  has  under¬ 
taken  to  show  the  part  which  errors  of  dress,  and  consequent 
interference  with  the  cutaneous  functions,  may  take  in  the 
production  of  scrofulosis,  and  especially  in  the  scrofulous 
conditions  of  the  organs  of  special  sense.  The  large  pro¬ 
portion  of  water  which  the  skin  daily  excretes  has  been  over 
and  over  again  observed  and  noted  by  physiologists,  and  the 
results  of  artificial  suppression  of  the  excretion  by  envelop¬ 
ing  the  human  body  in  india-rubber,  and  the  bodies  of 
small  animals  in  an  equally  impervious  coat  of  varnish, 
have  proved  tbe  importance  of  the  function  as  the  regulator 
of  body-temperature.  The  amount  of  perspiration  from 
any  surface  is  to  some  extent  a  measure  of  the  fulness  of 
the  bloodvessels  supplying  it.  Influences,  therefore,  which 
hinder  the  occurrence  of  the  sweating  must  likewise  affect 
the  condition  of  the  bloodvessels.  Such  influences  are 
exercised  by  anything  which  tends  to  check  the  due  evapo¬ 
ration  of  the  cutaneous  moisture.  In  an  atmosphere  over¬ 
charged  or  nearly  saturated  with  aqueous  vapour  this 
evaporation  is  diminished,  and  the  same  thing  must  of 
necessity  happen  where  the  clothing  of  the  body  is  of  such 
a  nature  as  to  prevent  evaporation  from  taking  place  with 
sufficient  rapidity.  In  almost  all  grades  of  society  the  choice 
of  materials  for  clothing  has  been  determined  hitherto  more 
by  the  dictates  of  custom,  tradition,  or  present  fashion 
than  by  any  consideration  of  furthering  or  hindering  the 
natural  function  of  the  skin.  Numerous  experiments  have 
been  from  time  to  time  carried  out  by  von  Pettenkofer, 
Brieger,  and  others,  with  a  view  to  determining  the  relative 
value  of  various  materials  from  this  point  of  view.  The 
results  obtained  prove  that  the  permeability  of  flannel  and 
woollen  stuffs  is  nearly  double  that  of  linen,  and  more  than 
double  that  of  silk.  In  confirmation  of  these.  Dr.  Paulsen 
himself  conducted  a  series  of  experiments  by  observing  the 
degree  of  moisture  in  his  own  bed  during  a  number  of 
nights,  each  time  being  covered  by  bedclothes  of  different 
material.  His  observations  showed  that  whilst  sleeping 
under  a  woollen  cover  the  increase  of  moisture  was  5° 
over  that  of  the  external  air ;  under  a  linen  coverlet  the 
increase  rose  to  12°,  and  under  a  feather  quilt  from  30°  to  40°. 
The  excretion  of  carbonic  acid  gas  he  found  to  be  hindered 
under  every  form  of  cover,  with  the  exception  of  the  woollen 

(al  “  On  the  Causes  and  Treatment  of  Scrofulosis,”  by  Dr.  O.  Paulsen 
Hamburg.  Berlin:  Aug.  Hirschwald.  1883.  Pp.  39. 


233 


Medical  Times  and  Gazette. 


THE  WEEK. 


Sept.  1, 1883. 


one.  A  rise  of  temperature  also  was  noticed  to  be  produced 
and  similarly  an  increased  frequency  of  pulse  and  respira¬ 
tion  was  observed.  That  such  conditions  are  unfavourable 
from  a  hygienic  point  of  view  needs  no  emphasising.  How, 
then,  do  they  affect  those  persons  predisposed  to  strumous 
affections  ?  Depending,  as  they  chiefly  do,  on  disturbed  nutri¬ 
tion  and  insufficient  assimilation  of  food,  the  circulation  in 
such  cases  is  sluggish,  and  liable  to  give  rise  to  congestion  in 
lymphatic  channels  and  glands.  With  the  diminished  activity 
of  the  cutaneous  vessels,  the  increased  action  of  the  heart  and 
lungs,  and  the  rise  of  temperature,  this  congestion  becomes 
increased,  and  general  nutrition  still  further  interfered  with. 
Regarding  the  marked  tendency  which  some  of  the  organs 
of  special  sense  evince  to  become  affected  with  strumous 
disease.  Dr.  Paulsen  calls  attention  to  the  fact  that  the  head 
and  neck  being  alone  uncovered  are  liable  to  extreme  sweat¬ 
ing,  perhaps  vicariously,  and  by  the  excessive  evaporation 
the  cutaneous  vessels  are  cooled,  and  thus  congestion  of 
deeper-lying  vessels  is  set  up.  To  what  extent  this  is  true 
it  is  difficult  to  determine,  but  it  is  a  striking  characteristic 
of  all  the  so-called  strumous  affections  of  the  organs  of 
special  sense  that  they  givG  evidence  of  imperfect  nutrition. 
In  the  clothing  of  babies  and  young  children  the  claims 
of  the  skin  for  liberty  of  action  are  perhaps  more  flagrantly 
disregarded  than  at  any  other  period  of  life.  Not  only  do 
children  sleep  by  night  for  a  greater  number  of  hours  than 
adults,  often  under  the  most  impermeable  forms  of  covering, 
but  even  by  day  an  absurd  regard  for  custom  frequently 
condemns  them  to  a  casing  of  various  layers  of  linen  and 
even  silk,  in  which  free  evaporation  is  as  impossible  as  its 
prevention  is  injurious.  That  persons  of  all  ages,  from  baby¬ 
hood  to  manhood,  may  maintain  health  under  such  unfavour¬ 
able  hygienic  conditions  cannot  be  denied,  but  that  the 
same  conditions  are  factors  in  the  production  and  main¬ 
tenance  of  those  forms  of  impaired  nutrition  comprised 
under  the  head  of  scrofulosis  is  equally  certain.  Hence  in 
the  treatment  of  such  cases  this  factor  must  always  be  taken 
into  consideration.  In  the  treatment  of  strumous  disease 
of  the  nose,  ears,  and  eyes.  Dr.  Paulsen  claims  to  have 
obtained  success  by  attention  to  this  element  of  checked 
perspiration  in  numerous  cases  where  the  ordinary  local  and 
dietetic  treatment  have  failed  without  it.  The  means  to  be 
adopted  are  simple.  No  alteration  in  the  shape  or  style  of 
clothing  need  be  insisted  on  ;  the  use  of  materials  through 
which  evaporation  can  take  place,  in  preference  to  those 
through  which  it  cannot,  forms  the  simple  and  efficient 
means  of  avoiding  the  dangers  which  a  checked  cutaneous 
perspiration  must  always  present  to  those  predisposed  to 
strumous  disease. 


THE  WEEK. 

TOPICS  OP  THE  DAT. 

Just  before  the  close  of  the  session,  a  deputation,  represent¬ 
ing  nine  suburban  local  boards  and  sanitary  authorities  and 
150,000  inhabitants,  essayed  the  task  of  interviewing  the 
Home  Secretary,  to  complain  of  the  obstacle  to  providing 
their  own  water  presented  by  Section  52  of  the  Public 
Health  Act,  which  hands  them  over  entirely  to  the  existing 
water  companies.  Mr.  Wright,  of  Ealing,  explained  that 
their  sole  object  was  to  suggest  the  repeal  of  an  Act  which 
prohibited  local  boards  from  having  any  waterworks  in  a 
district  where  a  water  company  was  in  possession  of  the 
land.  They  did  not  desire  to  establish  any  opposition,  but 
only  to  acquire  what  might  be  termed  a  domestic  supply  by 
means  of  their  own  works  in  their  own  territory.  Of  course, 
suburban  boards  could  not  buy  up  the  enormous  existing 
companies,  but  he  contended  that  they  ought  not  to 
be  deprived  of  the  power  of  utilising  local  supplies  of 


water  for  their  domestic  purposes.  For  instance,  in  his 
own  district  of  Ealing  there  would,  he  knew,  be  no  difficulty 
in  obtaining  an  effective  supply  for  such  requirements.  In 
reply.  Sir  W.  Harcourt  admitted  that  the  prohibition  re¬ 
ferred  to  was  a  very  great  hardship,  but  he  thought  it  would 
be  a  very  difficult  thing  to  get  over  an  Act  of  Parliament 
passed  so  recently  as  the  year  1875;  he  was  perfectly  at  a 
loss  to  understand  how  such  a  prohibition  came  to  be  in¬ 
serted  in  the  Act,  since  it  was  certainly  not  fair  that  a 
district  should  be  compelled  to  take  its  water  from  a  par¬ 
ticular  trading  company,  when  it  might  get  its  water  better, 
and  perhaps  cheaper,  elsewhere  for  itself.  He  thought  this 
matter  was  somewhat  different  from  the  general  question 
of  the  metropolitan  water-supply,  and  it  was  one  deserving 
of  very  careful  consideration.  He  could  not,  however,  at 
that  time  give  any  definite  answer  on  the  subject,  but  he 
assured  the  deputation  that  he  would  take  every  pains  to 
consider  if  there  was  any,  and  if  so  what,  remedy  to  meet 
the  case.  We  venture  to  think  that  Sir  W.  Harcourt  might 
have  arrived  at  a  solution  of  the  problem  which  so  puzzled 
him  by  a  very  little  consideration  of  the  way  in  which  Acts 
have  been  rushed  through  Parliament  at  the  end  of  the 
session  just  closed. 

The  annual  rate  of  mortality  in  twenty-eight  great  towns 
of  England  and  Wales  averaged,  according  to  the  return  of 
the  English  Registrar-General  for  the  week  ending  August  18 
last,  20'2  per  1000  of  their  aggregate  population.  The  six 
healthiest  places  were  Halifax,  Norwich,  Bristol,  Hull, 
Cardiff,  and  Bradford.  In  London,  during  the  same  period, 
2652  births  and  1437  deaths  were  registered.  Allowing  for 
increase  of  population,  the  births  were  27  and  the  deaths 
149  below  the  average  numbers  in  the  corresponding  week 
of  the  last  ten  years.  The  annual  rate  of  mortality  from  all 
causes,  which  had  steadily  declined  in  the  four  preceding 
weeks  from  23-5  to  l7-3  per  1000,  rose  again  this  week  to  19  0. 
During  the  seven  weeks  of  the  current  quarter  to  the  18th  ult. 
the  death-rate  averaged  20 '5  per  1000,  against  23-6  and  18'6  in 
the  corresponding  periods  of  1881  and  1882.  The  1437  deaths 
included  2  from  small-pox,  70  from  measles,  35  from  scarlet 
fever,  9  from  diphtheria,  26  from  whooping-cough,  2  from 
typhus,  9  from  enteric  fever,  1  from  an  ill-defined  form  of 
continued  fever,  119  from  diarrhoea  and  dysentery,  and  1 
from  simple  cholera,  making  altogether  274  deaths  attri¬ 
butable  to  zymotic  diseases,  or  137  below  the  corrected 
average  number  in  the  corresponding  weeks  of  the  last  ten 
years.  The  deaths  referred  to  diarrhoea  and  dysentery,  which 
had  steadily  declined  in  the  four  previous  weeks  from  350 
to  94,  rose  again  to  119  during  this  week,  but  were  116 
below  the  corrected  average — 110  were  of  children  under 
five  years  of  age,  including  86  of  infants  under  one  year. 
The  Registrar-General’s  Return  for  the  week  ending 
August  25  shows  that  in  London  the  annual  rate  of  mor¬ 
tality  from  all  causes  declined  again  to  17’9.  The  1356 
deaths  registered  during  the  week  included  1  from  small¬ 
pox,  52  from  measles,  49  from  scarlet  fever,  19  from  diph¬ 
theria,  27  from  whooping-cough,  10  from  enteric  fever,  3 
from  ill-defined  forms  of  continued  fever,  63  from  diarrhoea 
and  dysentery,  2  from  simple  cholera,  and  not  one  from 
typhus,  the  total  of  deaths  referred  to  these  causes  (viz., 
233)  being  145  below  the  corrected  average  number.  The 
deaths  attributed  to  diarrhoea  and  dysentery  fell  to  63,  being 
152  below  the  corrected  average ;  49  were  of  infants  under 
one  year  of  age.  The  deaths  of  two  adults  were  referred 
to  choleraic  diarrhoea  and  to  simple  cholera.  In  the  Outer 
Ring  27  fatal  cases  of  diarrhoea  were  registered. 

The  grievances  of  the  officers  of  the  Indian  Medical 
Service  have  been  frequently  made  the  subject  of  questions 
in  the  House  of  Commons  lately,  and  the  replies  given  by 


Medical  Times  and  Gazette. 


THE  WEEK. 


Sept.  1,  1883.  239 


the  Under  Secretary  for  India  have  not  been  satisfactory. 
They  have  not  been  inaccurate,  but  have  been  cleverly 
framed  to  represent  that  all  is  really  quite  right,  and  that, 
whatever  little  difficulties  there  [may  be,  they  are  merely 
temporary,  and  are  being  remedied.  On  the  last  occasion  of 
being  questioned  on  the  matter,  just  before  the  end  of  the 
session,  Mr.  Cross  showed  some  impatience  with  querists 
who  would  not  be  satisfied,  and  intimated  that  no  additional 
steps  would  be  taken  to  remedy  the  grievances  especially 
complained  of,  by  the  junior  officers  of  the  Service.  But  it 
appears  that  the  Secretary  of  State  for  India  adopts 
a  rather  different  tone  in  an  official  communication  to 
the  Chairman  of  the  Parliamentary  Bills  Committee  of 
the  British  Medical  Association.  A  statement  of  the 
grievances  of  the  Service  had  been  laid  by  that  Committee 
before  the  Secretary  of  State,  and,  in  reply  to  it,  he  says 
that  the  general  question  of  the  organisation  of  the  Indian 
Medical  Service  is  at  the  present  moment  under  the  im¬ 
mediate  consideration  of  the  Government  of  India,  with 
the  view  of  removing,  as  far  as  possible,  the  inconvenience 
found  to  exist  under  the  present  system.  “Inconvenience  ” 
is,  we  suppose,  an  official  dilution  of  a  “  grievance/’  and 
the  use  of  it  may  really  be  taken  as  an  admission  that 
grievances  do  exist.  We  may  have  something  more  to  say 
on  that  matter  soon,  but  one  of  the  greatest  of  possible 
grievances  that  any  service  can  suffer  is,  that  its  organisa¬ 
tion  should  be  frequently  under  the  consideration  of  the 
Government. 

The  annual  general  meeting  of  the  governors  of  the 
Chelsea  Hospital  for  Women  was  recently  held  in  the  new 
portion  of  the  building,  Mr.  Debac,  the  treasurer,  presiding, 
in  the  unavoidable  absence  of  Mr.  Anthony  W.  Biddulph. 
Amongst  those  present  were  Mr.  Frank  Marshall,  Dr.  Bobert 
Barnes,  Dr.  Fancourt  Barnes,  Dr.  Edis,  Dr.  Landon,  Mr.  E. 
Moreland,  etc.  The  Secretary  having  read  the  report,  on 
the  motion  of  the  Chairman,  seconded  by  Mr.  Moreland, 
the  same  was  unanimously  adopted.  The  governors  then 
confirmed  the  election  of  the  following  additional  staff : — 
Physician,  Dr.  Fancourt  Barnes  ;  Assistant-Physicians,  Drs. 
Horrocks,  Travers,  Dickinson,  and  Mackern  ;  Pathologist, 
Dr.  Burnet ;  Anaesthetist,  Dr.  Fenton- Jones.  The  Board  of 
Management  was  re-elected,  with  the  addition  of  Sir  Algernon 
Borthwick.  The  Treasurer,  Mr.  Debac,  was  also  re-electedj 
and  the  following  ladies  were  added  to  the  Ladies’  Com¬ 
mittee  : — The  Countess  Cadogan,  Countess  St.  Germains, 
Lady  Borthwick,  and  Lady  Codrington. 

The  1st  of  September  has  been  fixed  upon  for  this  year’s 
collection  of  the  so-called  working  men’s  contribution 
to  the  funds  of  the  London  hospitals — in  fact.  Hospital 
Saturday.  We  are  informed  that  to  15,000  different  esta¬ 
blishments  connected  with  the  industrial  life  of  London  an 
appeal  has  been  made  for  a  better  response  than  has  as  yet 
been  elicited  from  the  London  workmen.  During  the  ten 
years  of  its  existence  the  Hospital  Saturday  Fund  has,  it  is 
stated,  contributed  about  .£50,000  to  the  hospitals  and  dis¬ 
pensaries  of  the  metropolis,  and  it  is  rightly  thought  that 
the  working-classes  should  subscribe  much  more  liberally 
towards  the  support  of  these  institutions,  by  which  they 
certainly  benefit  the  most.  Every  legitimate  effort  to  in¬ 
crease  the  funds  of  the  London  hospitals  should  be  en¬ 
couraged  in  every  way,  but  we  must  again  point  out  the 
manifest  incorrectness  of  crediting  the  London  workmen 
with  the  whole  of  the  subscriptions  collected  on  these  Hos¬ 
pital  Saturdays.  To  begin  with,  the  street  collections, 
supervised  by  1200  ladies,  are  swelled  by  donations  contri¬ 
buted  by  others  than  working  men,  according  to  the  common 
acceptation  of  that  term ;  and  if,  as  is  publicly  announced, 
collections  are  to  be  made  at  the  Fisheries  Exhibition,  Covent 


Garden  Theatre,  etc.,  the  amount  realised  is  hardly  likely  to 
be  subscribed  by  workmen.  We  venture  to  think  that  the 
basis  of  this  Hospital  Saturday  collection  is  incorrect :  the 
London  workmen,  as  was  recently  suggested  by  one  of  their 
number,  should  be  able,  by  a  uniform  subscription  of  six¬ 
pence  or  a  shilling  each,  once  a  year,  to  raise  a  sum  which 
would  even  surpass  the  total  realised  from  the  wealthier 
members  of  society  on  a  Hospital  Sunday,  and  they  might 
then  with  reason  object  to  any  extraneous  aid  being  called 
in  to  supplement  their  efforts  in  this  direction.  Meanwhile, 
there  would  not  be  the  slightest  objection  to  an  annual  col¬ 
lection  for  our  deserving  and  sorely  pressed  metropolitan 
hospitals  from  the  peripatetic  and  travelling  portion  of  the 
community — say  Hospital  Wednesday — when  all  the  rail¬ 
ways  and  steamboats,  theatres,  and  exhibitions  might  be 
asked  to  co-operate  for  such  a  praiseworthy  object.  But, 
under  its  present  conditions,  we  are  compelled  to  maintain 
that  the  coupling  of  Hospital  Saturday  with  the  name  of 
the  working  man  only  is  a  palpable  absurdity. 

The  Bill  introduced  by  Government  to  make  better  pro¬ 
vision  for  the  prevention  of  outbreaks  of  formidable  epi¬ 
demic,  endemic,  or  infectious  diseases,  gives  to  the  local 
sanitary  authorities  in  England  and  Ireland  greater  powers 
for  borrowing  money,  if  necessary,  for  the  carrying  out  of 
regulations  made  for  the  following  purposes: — For  the 
speedy  interment  of  the  dead  ;  for  house-to-house  visitation  ; 
for  the  provision  of  medical  aid  and  hospital  accommoda¬ 
tion;  for  the  promotion  of  cleansing,  ventilation,  and  dis¬ 
infection  ;  and  for  guarding  against  the  spread  of  disease. 
The  Public  Health  (Ireland)  Act,  1878,  is  also  amended  so 
as  to  enable  the  Local  Government  Board  to  direct  urban 
sanitary  authorities  to  see  to  the  execution  of  any  regulations 
made  by  the  Board,  either  independently  or  jointly  with  the 
Poor-law  guardians. 

A  special  meeting  of  the  Northampton  Town  Council  was 
held  on  Saturday  evening  last  to  consider  the  question  of 
the  water-supply.  The  Town  Clerk  stated  that  twelve 
months’  notice  was  necessary  before  the  Council  could 
purchase  the  present  water  company’s  works.  The  chair¬ 
man  of  the  Water  Committee  said  that  some  time  must 
elapse  before  a  full  supply  could  be  obtained.  The  Council 
eventually  passed  a  resolution,  calling  on  the  water  com¬ 
pany  to  flush  the  sewers  and  water  the  streets  without  delay. 
Water  for  this  purpose  might,  they  added,  be  obtained  from 
the  river.  The  proposed  purchase  of  the  company’s  works 
was  referred  to  a  committee. 

The  Managers  of  the  Metropolitan  Asylums  District 
having  found  that  the  hospital  accommodation  is  insufficient 
for  the  needs  of  the  metropolis,  have  decided,  subject  to  the 
sanction  of  the  Local  Government  Board,  to  erect  a  large 
hospital  for  fever  cases  at  Upton  Cross,  West  Ham.  The 
scheme,  however,  meets  with  much  opposition  in  the 
neighbourhood. 


SANITARY  PRECAUTIONS  IN  HACKNEY. 

The  house-to-house  inspection  of  dustbins  and  of  drainage 
arrangements,  instituted  in  the  district  of  Hackney  by  Dr. 
Tripe  and  the  Sanitary  Committee,  is  nearly  completed. 
About  30,000  houses  have  been  inspected,  an  extra  staff  of 
men  having  been  engaged  for  the  work,  and  it  is  said  that  the 
sanitary  authorities  of  the  district  have  not  been  so  busily 
employed  since  the  year  1866.  The  better  classes  of  houses, 
not  hitherto  included  in  the  inspections  by  the  ordinary  staff, 
are  said  to  have  been  found  sadly  defective  as  regards  sani¬ 
tary  arrangements.  Great  attention  is  being  paid  to  the 
water-supply,  particularly  in  houses  erected  before  1856,  in 
which  the  use  of  modern  appliances  is  being  enforced. 


240 


Medical  Times  and  Gazette. 


THE  WEEK. 


Sept.  1, 1883. 


NAVAL  MEDICAL  DEPARTMENT. 


At  the  competition  for  commissions  in  the  Medical  Service 
of  the  Eoyal  Navy,  held  on  August  13  and  following  days, 
in  the  Hall  of  the  University  of  London,  Burlington  - 
gardens,  the  undermentioned  gentlemen  were  the  successful 


candidates  :  — 

Marks 

F.  J.  Lea . 

2,150 

T.  C.  Rowland  .  .  . 

2,125 

E.  J.  Morley  .  .  . 

2,035 

H.  W.  Macnama  .  . 

2,025 

L.  H.  Whelan  .  .  . 

2,010 

P.  W.  Bassett-Smith  . 

2,000 

H.  Canton 

i 


L.  P.  J.  Coolican  .  . 

Marks. 

1,945 

R.  W.  Doyne  .  .  . 

1,885 

E.  R.  Dimsey  .  .  . 

1,815 

J.  R.  McDonnell  .  . 

1,795 

D.  W.  Donovan  .  . 

1,780 

H.  Meikle  .... 

1,725 

THE  DISCOVERT  OF  DEAD  BODIES  OF  INFANTS  IN 
BERMONDSEY. 

The  discovery  of  a  number  of  dead  bodies  of  infants  upon 
the  premises  of  a  local  undertaker  has  caused,  naturally, 
great  excitement  and  disgust.  The  Southwark  police-officers 
appear  to  have  received  information  which  led  them  to 
make  an  investigation  of  the  premises  of  an  undertaker 
named  Camden,  in  Long-lane,  Bermondsey,  and  under  a 
recess  in  the  staircase  they  found  a  large  shell,  from  which 
a  most  offensive  smell  proceeded.  On  opening  it  they  found 
three  coffins,  which  contained  the  bodies  of  eleven  infants 
in  a  very  advanced  state  of  decomposition.  On  an  exami¬ 
nation  by  Dr.  Alexander,  the  divisional  surgeon,  he  ex¬ 
pressed  the  opinion  that  they  were  the  bodies  of  stillborn 
infants,  and  further,  that  they  must  have  been  secreted  in 
the  coffins  for  several  months.  It  is  stated  that  a  very 
small  charge  is  made  for  the  interment  of  such  bodies,  and 
that,  unless  the  system  of  keeping  them  until  some  number 
had  accumulated  was  adopted,  the  fee  charged  would  be 
totally  inadequate.  Whether  this  be  true  or  not,  it  is  per¬ 
fectly  evident  that  such  an  outrage  to  public  decency  can¬ 
not  be  justified  on  any  grounds  conceivable.  Mr.  Payne 
(the  Coroner),  who  held  an  inquiry  upon  two  of  the  bodies, 
remarked  that  it  was  a  horrible  thing  that  such  a  disgusting 
occurrence  should  have  taken  place,  and  that  the  lives  of 
people  should  have  been  endangered  by  a  man  who  took  money 
to  bury  the  bodies  and  failed  to  do  so.  He  understood  that 
the  police  magistrate  had  no  jurisdiction  in  the  matter — a 
fact  admitted  by  Mr.  Slade  at  the  Southwark  Police-court, 
to  whom  an  application  on  the  subject  had  been  made,— 
and  if  the  sanitary  authorities  would  not  prosecute,  he  hoped 
an  application  would  be  made  direct  to  the  Home  Secretary, 
so  that  some  prosecution  might  be  instituted  against  the 
undertaker;  or  perhaps  he  might  be  sued  in  the  county 
court  for  the  sums  of  money  that  had  been  paid  to  him.  But, 
on  the  whole,  the  magistrate  appeared  not  to  know  of  any 
charge  that  could  be  brought  with  success  against  the 
man.  Meanwhile,  the  undertaker  has  had  to  shut  up  his 
shop  and  keep  out  of  the  way,  to  escape  the  rough-and- 
ready  justice  which  the  lower  orders  were  prepared  to 
inflict  upon  [him  and  his  property.  The  eleven  bodies 
of  the  infants  were  placed  in  the  mortuary  of  St. George’s 
Parish,  Southwark,  till  a  difficulty  raised  as  to  their  in¬ 
terment  could  be  got  over.  The  St.  Saviour’s  Union  re¬ 
lieving  officer  undertook  to  pay  the  expense  of  the  inter¬ 
ment  of  the  two  bodies  belonging  to  his  district,  and  upon 
which  Mr.  Payne  had  held  an  inquest;  but  Mr.  Payne’s 
authority  didnotextend  to  Bermondsey,  to  which  parish  the 
parents  of  the  other  children  belonged.  However,  in  the 
end,  the  Bermondsey  local  authorities  agreed  to  recoup  the 
coroner’s  officer’s  expenses  if  he  would  obtain  their  burial  at 
Ilford  Cemetery ;  and  Dr.  Waterworth,  the  Medical  Officer  of 
Health  for  St.  George’s,  and  one  of  the  sanitary  inspectors 
of  the  Vestry,  obtained  an  order  for  the  removal  of  the 
bodies  from  St.  George’s  mortuary.  So,  after  much  parade 


of  officialism  and  law,  in  the  way  of  obstruction,  the  infant 
bodies  have  received  decent  burial,  and  an  offensive  and 
dangerous  nuisance  has  been  removed.  But  it  is  abun¬ 
dantly  clear,  from  this  and  other  scandalous  difficulties  of  a 
like  character  lately,  that  some  reform  of  the  Burial  Act  is 
imperatively  called  for ;  and  perhaps  also  some  enactment 
for  the  registration  of  stillborn  children. 


HOSPITAL  ESTABLISHMENTS  IN  FRANCE. 

The  Gazette  Hebdomadaire  states  : — From  a  very  recent 
inquiry  instituted  by  the  Assistance  Publique,  it  results  that 
there  are  1563  hospital  establishments,  of  which  364  are 
hospitals,  789  hopitaux-hospices,  and  410  hospices,  or,  accord¬ 
ing  to  the  population,  one  establishment  for  24,000  inhabi¬ 
tants.  The  personnel  charged  with  the  service  of  these 
1563  establishments  consists  of  28,676  persons,  viz.,  2787 
physicians  and  surgeons,  3050  employes,  11,287  religieuses, 
and  11,553  servants.  The  1563  establishments  dispose  of 
164,955  beds,  of  which  71,192  are  devoted  to  patients,  54,245 
to  the  infirm,  the  aged,  or  the  incurable,  10,1 50  to  enfants 
assistes,  and  23,450  to  the  personnel  of  the  various  institu¬ 
tions.  In  regard  to  what  relates  to  the  hospitals  proper — 
that  is,  establishments  in  which  accidental  diseases  are 
treated — there  are  admitted  360,000  persons  per  annum, 
and  as  a  mean  there  remain  under  treatment  40,000  from 
one  year  to  another.  The  proportion  of  persons  treated  in 
hospitals  is  90  per  10,000  inhabitants. 


HABITUAL  DRUNKARDS. 

The  third  report  of  the  Inspector  of  Retreats  under  the 
Habitual  Drunkards  Act,  1879,  has  been  issued  as  a  Parlia¬ 
mentary  paper.  The  report  deals  with  the  year  1882,  during 
which  Cannock  Retreat  was  re-opened  for  the  reception  of 
such  patients  under  a  new  licence;  and  more  recently  a 
licence  has  been  granted  by  the  St.  Albans  magistrates  to 
another  retreat,  near  Rickmansworth,  for  the  reception  of 
sixteen  male  patients. 


THE  RICHMOND  WATER-SUPPLY. 

The  deputation  of  the  inhabitants  of  Richmond,  who  waited 
upon  the  President  of  the  Local  Government  Board,  on 
Monday  last,  to  represent  the  sufferings  of  Richmond  from 
want  of  water,  owing  to  the  shortcomings — to  say  the  least 
— of  the  Local  Authority,  met  with  a  sympathetic  and  very 
sensible  listener.  Sir  Charles  Dilke  remembered,  it  may  be 
suspected,  that  there  are  two  sides  to  every  shield,  and  he 
possibly  suspected  that  there  might  be  a  little  exaggeration 
in  the  accounts  given  of  the  scarcity  of  the  water-supply  in 
Richmond.  At  any  rate,  he  said  he  should  be  very  happy  to 
help  the  good  people  if  he  could,  but  that  any  real  action 
that  the  Board  could  take  would  be  too  slow  to  meet  the 
present  emergency;  and  he  offered  them  the  advice  and 
aid  of  Colonel  Bolton,  the  Official  Examiner  of  the  Metro¬ 
politan  Water-Supply.  As  a  result  of  this.  Colonel  Bolton 
has  visited  Richmond  on  behalf  of  the  Local  Government 
Board,  and  made  inquiries  at  the  principal  hotels  and 
of  various  large  consumers  with  reference  to  the  water- 
supply.  At  one  well-known  hotel  on  the  hill  the  pro¬ 
prietor  stated  that  he  always  had  plenty  of  water,  and  was 
in  a  position  to  start  his  fountain  with  a  jet  of  water 
twenty-five  feet  in  height  at  any  moment.  Colonel  Bolton 
noticed  that  the  drinking-fountains  in  the  streets  were 
flowing  continuously,  and,  it  is  stated,  came  to  the  conclu¬ 
sion  that  the  statements  with  regard  to  the  great  dearth 
of  water  in  the  town  had  been  exaggerated,  although  he 
advised  the  Vestry  to  connect  their  service  with  the  main 
of  the  Southwark  and  Vauxhall  Company  for  use  in  case 
of  emergency.  After  due  consideration  the  chairman  (Major 


Medical  Times  and  Gazette. 


THE  WEEK. 


Sept.  1,  1883.  241 


Bull),  on  behalf  of  the  Vestry,  ordered  the  work  to  be  carried 
out.  Several  officials  and  a  gang  of  men  employed  by  the 
Southwark  and  Vauxhall  Company  set  to  work  to  unite  the 
two  mains,  and  on  Tuesday  night  the  public  baths  were 
supplied  principally  from  the  new  source.  The  parish  has 
been  supplied  with  a  daily  service  for  the  past  ten  days  from 
the  old  sources  of  supply,  owing,  it  is  stated,  to  the  fact 
that  there  were  good  spring  tides  at  the  beginning  of  last 
week,  and  a  consequent  increase  in  the  quantity  of  water  in 
the  well  at  Petersham  Meadows,  adjoining  the  river. 


'THE  HEALTH  OF  FOREIGN  AND  COLONIAL  CITIES  FOR  THE 
JUNE  QUARTER  OF  1883. 

A  summary  of  the  weekly  returns  furnished  to  the  Regis¬ 
trar-General  by  various  local  authorities  abroad  shows  that 
the  average  annual  death-rate  during  the  quarter  ended 
June  last  in  twenty-seven  colonial  and  foreign  cities,  having 
an  aggregate  population  of  nearly  fourteen  millions,  was 
■equal  to  29T  per  1000.  The  average  rate  in  the  twenty-one 
European  cities  was  30-5  per  1000,  against  21-5  in  twenty- 
eight  of  the  largest  English  towns.  The  lowest  death-rates 
among  the  twenty-seven  colonial  and  foreign  cities  were 
16’3  in  Christiania,  20-7  in  Baltimore,  21‘9  in  Philadelphia, 
and  22T  in  Brooklyn  ;  the  rates  ranged  upwards  in  the  other 
towns  to  351  in  Munich,  36'3  in  Buda-Pesth,  36’4  in  St. 
Petersburg,  and  42' 4  in  Prague.  The  fatal  cases  of  small¬ 
pox  in  Paris,  which  had  been  101  and  154  in  the  two  preced¬ 
ing  quarters,  further  rose  to  181  in  the  second  quarter  of  the 
present  year;  the  deaths  from  measles  also  showed  a  consider¬ 
able  further  increase  upon  the  numbers  returned  in  second 
quarters.  The  deaths  referred  to  typhoid  fever  in  Paris, 
which  had  been  1571  and  582  in  the  two  previous  quarters, 
further  fell  to  523  last  quarter,  which  were,  however,  equal 
to  an  annual  rate  of  2-94  per  1000,  against  but  0T4  from 
the  same  disease  in  London.  The  fatal  cases  of  small-pox 
in  St.  Petersburg,  which  in  the  two  preceding  quarters  had 
been  279  and  232,  further  declined  to  129.  In  Bombay, 
Madras,  and  Rotterdam  small-pox  was  severely  epidemic 
during  the  quarter.  Diphtheria  caused  486  deaths  in 
Berlin,  306  in  St.  Petersburg,  253  in  New  York,  and  218  in 
Philadelphia.  Measles  showed  increased  prevalence  in 
Berlin,  St.  Petersburg,  Munich,  Prague,  and  New  York;  and 
typhoid  fever  was  also  fatally  prevalent  in  St.  Petersburg, 
Buda-Pesth,  New  York,  and  Philadelphia. 


CHARGE  AGAINST  A  MEDICAL  OFFICER. 

At  a  meeting  of  the  Greenwich  Board  of  Guardians  last 
week,  the  Dispensary  Committee  reported  that  Dr.  Kavanagh 
<the  public  vaccinator  for  Deptford)  had  brought  a  charge 
against  Mr.  Fisher,  one  of  the  district  medical  officers,  of 
falsely  certifying  that  several  children  were  suffering  from 
syphilis,  and  that  the  syphilitic  disease  was  communicated 
through  vaccination.  Dr.  Kavanagh  further  stated  that  the 
■children  in  question  (four  in  number)  had  been  vaccinated 
along  with  seventeen  others  on  July  23,  and  that  all  the 
latter  had  presented  arms  of  a  normal  character  at  the  end 
of  a  week.  Of  the  other  four,  one,  specified  by  Mr.  Fisher 
as  suffering  from  syphilitic  eczema,  had  a  general  erup. 
tion  all  over  the  body,  which  was  completely  cured  after 
four  days’  treatment.  Dr.  Kavanagh  had  laid  the  cases 
before  the  Local  Government  Board,  and  had  received 
from  their  inspector  a  letter,  in  which  he  said,  “  I 
think  his  (the  district  medical  officer,  Mr.  Fisher)  con- 
-duct  truly  scandalous,  and  he  is,  in  my  opinion,  on  that 
ground  alone,  totally  unfit  to  hold  his  present  office,  not  for 
his  siding  with  anti-vaccinators,  which  he  has  a  perfect 
right  to  do  if  he  likes,  but  for  his  statement  respecting  the 
infant  whose  disease  he  entered  as  syphilis.  This  was  either 


knowingly  false,  or  believed  to  be  true.  If  the  latter,  his 
ignorance  shows  him  to  be  quite  unfit  for  his  post ;  if  the 
former,  dismissal  is  not  enough  punishment.”  Supposing 
that  the  statements  made  by  Dr.  Kavanagh  are  facts,  it 
would  be  difficult  to  exaggerate  the  gravity  of  the  offence 
committed  by  Mr.  Fisher ;  and,  in  such  circumstances,  the 
condemnation  of  the  Local  Government  Board  inspector  is 
not  worded  one  whit  too  strongly. 


THE  PARIS  WEEKLY  RETURN. 

The  number  of  deaths  for  the  thirty-third  week  of  1883, 
terminating  August  15,  was  977  (528  males  and  449  females), 
and  of  these  there  were  from  typhoid  fever  38,  small-pox 
3,  measles  21,  scarlatina  2,  pertussis  19,  diphtheria  and 
croup  23,  dysentery  2,  erysipelas  4,  and  puerperal  infec¬ 
tions  5.  There  were  also  49  deaths  from  tubercular  and 
acute  meningitis,  161  from  phthisis,  17  from  acute  bron¬ 
chitis,  54  from  pneumonia,  158  from  infantile  athrepsia  (59 
of  the  infants  having  been  wholly  or  partially  suckled),  and 
41  violent  deaths  (36  males  and  5  females).  The  deaths  are 
still  less  than  in  the  preceding  week,  and  call  for  no  remark, 
except  that  those  from  athrepsia  have,  increased  unduly, 
viz.,  from  136  to  158.  The  births  for  the  week  amounted  to 
1140,  viz.,  575  males  (435  legitimate  and  140  illegitimate) 
and  565  females  (445  legitimate  and  120  illegitimate)  :  63 
infants  were  either  born  dead  or  died  within  twenty-four 
hours,  viz.,  35  males  (27  legitimate  and  8  illegitimate)  and 
33  females  (21  legitimate  and  12  illegitimate). 


the  action  of  saline  cathartics. 

Dr.  Matthew  Hay  concludes  the  report  of  his  investiga¬ 
tion  into  the  action  of  saline  cathartics  as  follows  ( Journal  of 
Anatomy  and  Physiology,  July,  1883) : — They  all  tolerably 
closely  agree  in  the  ultimate  effect  they  have  on  the  ali¬ 
mentary  canal  and  the  body  generally.  They  cause  no  irrita¬ 
tion  or  inflammation  of  the  canal;  stimulate  but  in  the 
smallest  degree  the  secretion  of  the  more  important  digestive 
juices,  as  the  gastric,  the  pancreatic,  and  the  biliary ;  have, 
under  ordinary  circumstances,  little  action  on  the  blood ; 
and  mainly  act  by  increasing  the  intestinal  secretion,  and 
by  hindering  the  absorption  of  the  intestinal  fluid.  Their 
purgative  action  is  therefore  extremely  simple.  They  sweep 
out  the  contents  of  the  alimentary  canal  with  the  least 
possible  disturbance  of  the  digestive  system  and  of  the  other 
systems  of  the  organism.  Few  other  purgatives,  if  any, 
have  so  simple  an  action.  The  value,  therefore,  which  has 
long  been  assigned  to  them  in  the  treatment  of  the  occa¬ 
sional  disturbances  of  digestion,  to  which  almost  everyone  is 
at  times  subject,  and  where  the  indication  seems  to  be  to 
empty  the  canal  ‘  cito,  tuto,  et  jucunde,’  is  quite  justified  by 
the  results  of  this  investigation.” 


THE  COOMBE  LYING-IN  HOSPITAL,  DUBLIN. 

The  seven-years’  period  of  office  of  the  Master  of  this  bene¬ 
volent  institution.  Dr.  George  Hugh  Kidd,  expired  on  July 
22,  and  in  the  ordinary  course  an  election  to  the  vacant 
post  should  have  taken  place  before  that  date  in  order  to 
avoid  an  interregnum.  But  the  guardians  and  directors 
have  resolved  to  take  a  step,  the  propriety  of  which  is  cer¬ 
tainly  a  matter  of  question.  The  charter  of  the  Hospital 
disti  nctly  provides  that  the  period  of  office  of  each  Master 
shall  not  exceed  seven  years,  and  that,  consequently,  no 
one  person,  however  deserving — and  this  Dr.  Kidd  un¬ 
doubtedly  is, — shall  be  capable  of  being  elected  Master  of 
the  Hospital  who  has  been  Master  for  seven  years,  either  suc¬ 
cessively,  or  at  different  times  amounting  in  the  whole 
to  seven  years.  Notwithstanding  this  strict  provision 


242 


Medical  Times  and  Gazette. 


THE  WEEK. 


Sept.  1,  1883. 


in  the  charter,  the  guardians  and  directors  have  applied  to 
the  Lord  Lieutenant  by  memorial  for  a  Queen’s  Letter  to 
permit  them  to  reappoint  Dr.  Kidd  for  a  period  of  three 
years.  This  proceeding  is  likely  to  cause  a  good  deal  of 
comment  and  dissatisfaction,  more  particularly  as  there  is 
no  lack  of  eligible  candidates  for  the  Mastership  among  the 
ex-Assistant  Masters  of  the  Hospital,  to  whom,  in  accordance 
with  the  terms  of  the  charter,  a  preference  must  be  given  in 
all  elections  for  the  Mastership.  It  does  not  appear  that 
there  is  any  precedent  in  the  case  of  either  the  Kotunda 
Lying-in  Hospital  or  the  Coombe  for  the  course  which  the 
authorities  of  the  latter  institution  have  on  the  present 
occasion  seen  fit  to  pursue. 


INDIAN  MEDICAL  SERVICE. 


Appended  is  a  list  of  the  candidates  for  Her  Majesty’s 
Indian  Medical  Service  who  were  successful  at  the  competi¬ 
tive  examination  held  at  Burlington  House  on  August  13, 
1883,  and  following  days.  Twenty-one  candidates  competed 
for  five  appointments.  All  were  reported  qualified  : — 


M  Q  pllQ 

J.  J.  Pratt  ;  .  .  .  2,475 

E.  Shore . 2,410 

H.  Thomson  .  .  . 


Marks. 


C.  I.  Sarkies  .  .  .  2,341 

W.  B.  Bannerman  .  2,230 
.  .  .  2,015  marks. 


HEALTH  OF  TOWNS  IN  SCOTLAND. 

The  death-rate  in  the  eight  principal  towns  of  Scotland 
during  the  week  ending  Saturday,  August  25,  1883,  was 
21 T  per  1000  of  estimated  population.  This  rate  is  IT 
above  that  for  the  corresponding  week  of  last  year,  and  09 
above  that  for  the  previous  week  of  the  present  year.  The 
lowest  mortality  was  recorded  in  Perth,  viz.,  1P9  per  1000  j 
and  the  highest  in  Paisley,  viz.,  307  per  1000.  The  mor¬ 
tality  from  the  seven  most  familiar  zymotic  diseases  was  at 
the  rate  of  3'4  per  1000,  or  0'4  below  the  rate  for  the  previous 
week.  Diarrhoea,  scarlet  fever,  and  whooping-cough  were 
the  most  prevalent  of  the  epidemic  diseases,  the  mortality 
therefrom  being  most  marked  in  Glasgow,  where  6  deaths 
from  diphtheria  were  also  registered.  Acute  diseases  of 
the  chest  caused  67  deaths,  or  5  less  than  in  the  previous 
week.  The  mean  temperature  was  58 ’4°,  being  P4°  above 
that  of  the  week  immediately  preceding,  and  2‘8°  above  that 
of  the  corresponding  week  of  1882. 


A  STANDAED  FOE  POETEE. 

At  the  late  Co.  Antrim  Assizes,  Mr.  James  Dempsey, 
brewer,  Belfast,  had  an  action  for.  libel  against  Dr.  C.  A. 
Cameron,  of  Dublin,  public  analyst  for  the  county  of  Down. 
The  action  arose  out  of  an  analysis  of  porter  which  the 
defendant  had  made  so  far  back  as  June,  1881.  This  porter 
was  sent  by  the  constable  acting  as  food  inspector  at  Holy- 
wood,  co.  Down,  to  Dr.  Cameron,  who  reported  that  it  was 
a  debased  article.  The  vendor  was  fined  £5  by  the  magis  - 
trates  at  petty  sessions.  Mr.  Dempsey,  who  brewed  the 
porter,  was  examined  for  the  defence,  and  induced  the 
defendant  to  appeal  to  quarter  sessions,  and  to  require 
Dr.  Cameron’s  attendance.  After  some  adjournments  the 
case  was  heard  in  January,  1882,  at  Downpatrick,  and  the 
County  Court  Judge  confirmed  the  conviction.  Dr.  Cameron 
reported  the  case  to  the  Grand  Jury  in  March,  1882,  and 
again  in  18S3.  He  incidentally  referred  to  it  by  stating 
that  the  samples  of  porter  analysed  during  the  year  were 
superior  “  to  the  debased  article  which  formed  the  subject 
of  a  trial  at  Downpatrick,”  etc.  For  these  reports  and  for 
describing  the  porter  as  a  debased  article  the  action  was 
brought.  For  the  plaintiff  it  was  contended  that  the 
porter  was  a  fair  article.  An  excise  officer  and  two 
brewers’  assistants  supported  the  plaintiff’s  evidence,  which 


admitted  the  defendant’s  analysis,  but  not  his  inference 
therefrom.  Dr.  Cameron  pi’oved  that  he  condemned  the 
porter  because  it  contained  only  3-85  per  cent,  of  extract, 
5  per  cent,  of  alcohol  by  volume,  or  4  per  cent,  by  weight, 
and  that  it  was  made  largely  from  molasses  or  some  kind  of 
cane  sugar.  Dr.  Tichborne  coincided  with  the  defendant’s 
opinion,  and  said  that  porter  should  contain  at  least  5  per 
cent,  of  extract,  and  6  per  cent,  of  alcohol.  Dr.  Cameron 
swore  that  from  his  twenty  years’  experience  as  analyst 
— and  he  was  public  analyst  for  twenty-three  counties — 
he  could  say  that  Irish  porter  contained  from  6  to  O 
per  cent,  of  'extract,  and  from  5  to  10  per  cent,  of 
alcohol  by  volume.  He  would,  however,  not  certify  that 
porter  was  adulterated  unless  it  contained  less  than  4  per 
cent,  of  extract,  and  less  than  41  per  cent,  of  alcohol  by 
weight.  He  calculated  that  the  porter  in  question  was 
brewed  from  a  wort  of  1045  gravity.  The  jury  found  for 
the  defendant,  with  costs.  Three  courts  have  now  esta¬ 
blished  that  porter  should  contain  at  least  4  per  cent- 
of  extract,  and  4  per  cent,  of  alcohol. 


CONVEYANCE  OF  MEDICINES  BY  EUEAL  LETTER-CARRIERS. 

On  Thursday  last  week,  in  reply  to  a  question  from  Mr.. 
Waddy,  the  Postmaster-General  stated  that  so  many  appli¬ 
cations  had  reached  him  from  different  parts  of  the  country 
in  favour  of  rural  letter-carriers  being  allowed  to  carry  light 
packets  of  medicines,  as  they  had  been  in  the  habit  of  doing 
before  the  introduction  of  the  Parcels  Post,  that  he  had 
gladly  been  able  to  decide  to  grant  permission  for  the  con¬ 
tinuance  of  the  practice;  and  instructions  to  that  effect 
would  be  given  immediately.  Mr.  Fawcett  has  been  very 
considerate  in  this  matter,  which  is  one  of  much  importance- 
in  country  districts.  It  is  obvious  that  the  boon  thus 
granted  may  be  abused ;  but,  should  this  happen,  punish¬ 
ment  will  follow,  and  rightly,  though,  unhappily,  the 
guilty  and  the  innocent  would  alike  suffer.  Mr.  Fawcett 
gave  clear  warning  on  this  point.  He  should  regret  ex¬ 
tremely,  he  said,  if  the  permission  given  should  be  in  any 
way  abused  by  sending  as  packets  of  medicine  articles  which, 
are  not  medicine,  because  such  proceedings  would  make  it 
necessary  to  withdraw  the  permission. 


THE  LICENSING  OF  PLUMBERS  BY  MUNICIPALITIES. 

The  Town  Council  of  Bradford  have  just  adopted  by¬ 
laws  for  securing  the  laying,  fixing,  and  fitting  of  pipes  for 
the  distribution  and  supply  of  water  and  gas  at  houses  and 
other  buildings  and  places  within  the  borough  in  a  satis¬ 
factory  and  efficient  manner.  In  addition  to  laying  down 
regulations  as  to  the  method  of  doing  work  of  this  nature^ 
the  by-laws  provide  that  no  person  shall  act  as  a  plumber 
within  the  borough  who  is  not  duly  licensed  by  the  Corpora¬ 
tion  for  the  purpose.  A  strong  representation  was  made 
against  a  system  of  licensing  any  body  of  tradesmen,  and 
it  was  pointed  out  that  licences  might  as  well  be  required 
for  masons,  joiners,  and  slaters  ;  but  the  by-laws  were 
carried  by  a  large  majority. 


DISEASED  MEAT. 

In  one  of  the  principal  thoroughfares  in  Glasgow,  a  butcher, 
named  Graham,  has  been  fined  the  modified  penalty  of  £5 
for  having  sold  and  had  exposed  in  his  shop  for  sale  a 
quantity  of  meat  which  was  unsound  and  unfit  for  human 
food.  Evidence  disclosed  that  sulphate  of  lime  is  used  in  the 
trade  “to  make  meat  beautiful  and  pleasant  to  the  eye.”' 
It  was  further  stated  by  Dr.  Bussell  that  the  preparation  was 
known  in  the  trade  as  “Madame  Bachel.”  The  complain¬ 
ant  stated  that  the  smell  from  the  “  sausages  ”  (the  form  in 


Medical  Times  and  Gazette. 


THE  WEEK. 


Sept.  1, 1883.  243 


which  the  meat  was  sold)  when  placed  on  the  fire  was  so 
disgusting  and  disagreeable  that  it  was  impossible  to  stay  in 
the  house.  The  defendant  gave  as  excuse  that  the  blame 
rested  on  a  strange  shopman,  who  used  too  much  of  the 
<e  seasoning,”  at  the  same  time  attempting  to  screen  his  man 
by  stating  that  the  weather  was  very  much  against  keeping 
such  kinds  of  meat  fresh. 


TIDY  AND  WIGNER  ON  MAMMARY  FERMENT(?). 

We  have  on  several  occasions  referred  to  the  use  of  “  oleo¬ 
margarine  ”  in  the  manufacture  of  butterine,  and  in  the 
production  of  a  “  double  ”  cheese  from  milk  from  which  the 
butter  fats  have  been  previously  withdrawn.  In  regard  to 
the  latter,  we  have  been  inclined  to  speak  favourably  of  the 
manufacture  as  turning  out  really  a  more  nutritious  food 
than  would  have  been  the  case  had  the  addition  of  the  fat 
not  been  made.  We  have,  when  discussing  butterine  from 
the  analytical  standpoint,  pointed  out  that  by  some  means 
the  manufacturers  had  succeeded  in  preventing  the  crystal¬ 
line  structure,  which  was  formerly  considered  sufficient  of 
itself  to  distinguish  the  factitious  from  the  genuine  butter, 
and  that,  in  fact,  the  only  positive  indication  of  the  pre¬ 
sence  of  foreign  fats  was  now  to  be  found  in  the  determina¬ 
tion  of  the  melting-point.  Messrs.  Tidy  and  Wigner  have 
recently  reported  to  the  Society  of  Public  Analysts  the 
results  of  some  experiments  on  the  action  of  the  mammary 
tissue  of  the  cow  on  mutton  fat,  which  tend  to  show 
that  some  ferment  therein  contained  possesses  the  power 
of  assimilating  these  fats  more  or  less  to  those  of  butter,  by 
converting  the  insoluble  into  soluble  fatty  acids  ;  and  doubt¬ 
less  milk  itself,  containing,  as  it  does,  epithelium  and  other 
derivatives  from  the  mammary  ducts,  contains  also  some  of 
“the  ferment  in  question.  Oleo-margarine  contains  more 
olein  and  less  stearin  than  the  fat  from  which  it  is  made, 
the  higher  melting-point  of  the  stearin  permitting  of  its 
separation  under  moderate  pressure  and  heat ;  but  it  would 
seem  that,  whether  the  inventor  of  butferine,  M.  Mege,  was 
quite  conscious  of  what  he  was  doing,  or  not,  the  incorpora¬ 
tion  of  a  certain  quantity  of  milk  with  the  oleo-margarine 
brings  about  those  changes  in  the  fatty  acids  which  Tidy 
and  Wigner  obtained  by  means  of  mammary  tissue  or  its 
alcoholic  extract :  and  which  very  probably  take  place  in  the 
■gland  as  a  physiological  process  in  the  natural  secretion  of 
milk,  analogous  to  the  conversion  in  the  stomach  of  albumen 
into  peptons. 

The  distinction  of  the  Boyal  Eed  Cross,  conferred  by  Her 
Majesty,  was  received  on  Friday  last  week  at  Chatham,  for 
presentation  to  Miss  J.  King,  Nursing  Sister  at  Fort  Pitt 
Hospital,  in  recognition  of  the  special  devotion  and  com¬ 
petency  displayed  by  that  lady,  and  her  unwearied  attention 
in  nursing  the  sick  and  wounded  during  the  Egyptian 
Campaign.  _ 

At  the  recent  examination  at  the  Apothecaries’  Hall, 
London,  for  the  prizes  in  Materia  Medica  and  Pharmaceu¬ 
tical  Chemistry,  the  successful  candidates  were :  (1)  Arthur 
Pearson  Luff,  student  of  St.  Mary’s  Hospital — gold  medal ; 
(2)  Augustus  Frederick  Dimmock,  student  of  King’s  College, 
London— silver  medal  and  a  book. 


At  a  meeting  of  the  Aberdeen  University  Court,  on 
August  28,  Dr.  Matthew  Hay,  Assistant  to  the  Professor 
of  Materia  Medica  in  the  University  of  Edinburgh,  was 
appointed  to  the  Chair  of  Medical  Jurisprudence,  Aberdeen, 
in  the  place  of  Dr.  Ogston,  resigned. 

The  next  session  of  the  Medical  Society  of  London  will 
open  on  October  29,  with  a  paper  by  Professor  Lister. 


The  opening  address  at  the  London  Hospital  Medical 
College  will  be  delivered  by  Professor  Huxley,  F.E.S.,  on 
Tuesday,  October  9,  at  8  p.m.,  instead  of  October  1,  as 
previously  announced.  A  conversazione  will  be  held  after¬ 
wards,  to  which  all  past  and  present  students  are  invited. 


Mr.  Andrew  Carnegie,  of  New  York,  who  has  been 
munificent  in  his  gifts  to  Dunfermline,  his  native  city,  has 
subscribed  £1000  to  the  fund  for  completing  the  new  build¬ 
ings  of  the  University  of  Edinburgh. 


An  “  Old  English  Fayre  ”  was  held  in  Harwich  last  month, 
for  the  purpose  of  providing  funds  for  the  erection  of  a 
‘moderately  large  cottage  hospital  in  connexion  with  that 
town.  The  “  Fayre,”  which  was  opened  by  the  Countess  of 
Dalkeith,  proved  very  successful,  the  receipts  having  ex¬ 
ceeded  =£1200. 

A  fatal  football  accident  occurred  at  Arbroath  on  the 
25th  ult.  A  man  named  James  Gordon,  while  playing  in  a 
match  between  the  Arbroath  and  the  South-Western  of 
Glasgow  Clubs,  received,  accidentally,  a  severe  injury  to¬ 
wards  the  end  of  the  contest,  and  died  on  the  following 
Tuesday.  The  cause  of  death  was  rupture  of  the  liver. 


According  to  the  last  official  report  of  the  Metropolitan 
Board  of  Works,  the  open  spaces,  parks,  commons,  etc., 
which  are  under  the  Board’s  management  and  control  com¬ 
prise  a  total  of  1769J  acres,  which  have  been  acquired  for 
the  use  of  the  public  in  perpetuity. 


Mr.  W.  F.  Bock  promised  some  time  ago  <£1000  towards 
the  Canon  Millar  Memorial  Hospital,  if  £5000  were  raised 
in  a  similar  manner.  Mrs.  Payne  (sister  of  Mr.  Eock),  Mr. 
Evelyn,  Mrs.  Penn,  and  Messrs.  Penn  and  Co.  have  each 
promised  £1000.  _ 

Mrs.  Lovegrove,  of  Park-street,  Grosvenor-square,  has 
sent  a  cheque  for  £500  to  tbe  hospital  at  Weston-super- 
Mare,  in  which  place  she  has  a  marine  residence. 


Early  Tubercular  Disease  in  Infants. — Dr.  Lewis 
Smith,  in  a  paper  read  at  the  New  York  Pathological 
Society,  observed  that  the  tubercles,  being  widely  dissemi¬ 
nated  in  the  system  of  tuberculous  children,  do  not  ordinarily 
give  rise  to  any  prominent  local  symptoms  till  they  produce 
inflammation  around  them.  Hence  the  difficulty  of  making 
a  positive  diagnosis  at  an  early  stage,  the  presence  of 
tubercles  being  inferred  from  the  general  condition— wasting, 
loss  of  appetite  and  strength,  and  the  cough— it  not  being 
possible  to  state  positively,  as  in  the  adult,  that  tuberculosis 
is  present  until  this  is  pretty  well  advanced.  “  Whenever  I 
am  called  to  a  young  child  with  a  chronic  cough  and  wasting, 
I  do  not  wait  for  a  more  accurate  diagnosis  ;  but,  if  there  be 
no  diarrhoea  to  contraindicate  it,  prescribe  cod-liver  oil  with 
the  hypophosphites,  frequently  adding  the  syrup  of  the 
iodide  of  iron,  since  the  strumous  cachexia  is  apt  to  be 
present,  with  possibly  caseous  substance  in  some  parts. 
(Dr.  Smith  regards  caseous  foci  resulting  from  unresolved 
inflammatory  products  as  the  commonest  source  of  tubercle 
in  children.)  Such  a  case  requires  the  utmost  attention  to 
the  hygienic  management — pure  air,  nutritious  and  easily 
digested  diet,  into  which  milk  enters  largely,  and  the  juice  of 
meats  or  meat-broths  prepared  at  a  temperature  of  100°  so 
as  not  to  coagulate  the  albumen.  A  favourite  prescription 
in  two  of  the  asylums  of  this  city  for  infants  with  chronic 
cough  and  wasting,  whether  or  not  tuberculosis  be  diagnosti¬ 
cated,  is  the  following,  to  be  taken  between  the  doses  of 
cod-liver  oil :— £.  Ammon,  carb.  ferri  et  ammon.  cit.  al 
gr.  xxiv.,  syi'upi  §iij. ;  a  teaspoonful  for  a  child  a  year  old, 
every  two  or  three  liours. — Aew  York  Med.  Record ,  May  12. 


Medical  Times  and  Gazette . 


FROM  ABROAD. 


Sept.  1,  1883. 


244 


MEDICAL  MATTERS  IN  PARLIAMENT. 


House  of  Commons — Thursday,  August  23. 

Mr.  Labouchere  gave  notice  that  next  session  he  would 
move  for  a  Select  Committee  to  inquire  into  the  causes 
which  have  led  to  the  serious  diminution  of  water  in  the 
Thames  between  Teddington  Lock  and  London,  and  into  the 
best  method  of  remedying  this  evil. 

An  Alleged  Vaccination  Disaster. — In  reply  to  a  question 
from  Mr.  Hopwood,  Mr.G.  Russell  said:  The  child  mentioned, 
Emily  Agnes  Henning,  was  vaccinated  on  July  25,  by  Mr. 
Niall,  who  is  not  a  public  vaccinator,  and  was  not  attacked 
with  symptoms  of  blood-poisoning  within  three  days  after 
vaccination.  The  vaccination  ran  the  normal  course,  and 
the  result  on  the  eighth  day  was  regarded  as  satisfactory  by 
Mr.  Niall.  One  of  the  vesicles,  however,  became  broken  by 
being  rubbed  by  a  piece  of  muslin,  and  following  on  this  a 
blush  of  the  nature  of  erysipelas  appeared  on  the  arm.  This 
was  on  the  ninth  day  after  vaccination.  The  erysipelas 
spread,  and  the  child  died  three  weeks  after  vaccination.  It 
appears  that  death  was  due  to  absorption  of  some  septic 
matter  by  the  surface  of  the  broken  vesicle,  and  not  from 
the  vaccination.  In  these  circumstances  the  Local  Govern¬ 
ment  Board  consider  that  the  statements  in  the  certificate 
of  death,  that  the  primary  cause  was  erysipelas,  and  the 
secondary  cause  convulsions,  are  correct. 

Workmen’s  Dwellings. — In  reply  to  Mr.  Broadhurst,  Sir 
W.  Harcourt  said  he  should  be  glad  to  give  every  attention 
to  any  scheme  placed  before  him  for  providing  better  ac¬ 
commodation  for  working  people  in  the  great  towns.  Mr. 
Broadhurst  said  he  would  call  attention  to  the  subject  next 
Session. 

Saturday,  August  25. 

The  Royal  Assent  was  given,  by  commission,  to  the  Trial 
of  Lunatics  Act  and  the  Cholera  Hospitals  (Ireland)  Act, 
among  other  measures ;  and  Parliament  was  prorogued  till 
November  12. 


FROM  ABROAD. 

“Before  or  After  Meals?” 

Under  this  title  a  very  useful  article  appeared  in  the 
number  of  the  Philadelphia  Med.  News  for  July  7,  in  which 
it  is  stated  that  it  is  a  question  to  which  the  doctor  has  not 
always  his  answer  ready.  One  general  principle  will  em¬ 
brace  many  cases — viz.,  that  an  organ  in  a  state  of  irritation 
requires  to  be  shielded. 

“  Medicines  that  are  irritating  should  be  given  after  meals 
when  the  stomach  is  full,  unless  the  chemical  changes  which 
must  then  occur  will  destroy  their  qualities.  Mineral  reme¬ 
dies,  as  the  salts  of  copper,  zinc,  iron,  and  arsenic,  should  be 
given  after  meals,  unless  local  conditions  require  their  ad¬ 
ministration  in  small  quantity  before  meals.  Of  the  latter, 
arsenic  affords  a  capital  illustration.  Large  doses,  acting  as 
an  irritant,  should  follow  food,  which  protects  the  mucous 
membrane ;  but  small  doses,  intended  to  act  upon  the 
stomach  terminals  of  the  vagi,  must  be  given  when  the 
organ  is  empty.  Chemical  reasons,  also,  influence  the  ques¬ 
tion  of  the  time  for  administering  mineral  irritants.  Thus, 
oxide  and  nitrate  of  silver,  intended  for  local  action,  should 
appear  in  the  stomach  during  its  inactivity,  lest,  at  other 
times,  chemical  reactions  destroy  the  special  attributes  for 
which  these  remedies  are  prescribed.  Iodine  and  the  iodides 
further  illustrate  this  point.  Given  on  an  empty  stomach, 
they  promptly  diffuse  into  the  blood ;  but  if  digestion  is 
going  on,  the  acids  and  starch  form  products  of  inferior 
activity,  and  thus  the  purpose  which  they  were  intended 
to  subserve  is  defeated.  Substances  prescribed  to  have  a 
local  action  on  the  mucous  membrane,  or  for  prompt  diffu¬ 
sion  unaltered,  are  preferably  given  before  meals.  It  should 
not  be  forgotten  that  the  liver  is  a  great  sieve,  which  retains 
in  its  structure  for  a  time,  and  then  excretes,  many  noxious 
substances ;  hence  it  is,  in  part,  that  the  subcutaneous  ad¬ 
ministration  of  many  remedies  is  more  effective  than  the 
stomachal.  The  condition  of  the  stomach-veins  after  meals 
is  such  as  to  lessen  the  activity  of  diffusion  of  poisons,  and 
hinder  their  passage  through  the  liver.  It  follows  that 
active  medicines,  in  doses  near  the  danger  line,  are  more 
safely  administered  after  meals. 


“  Probably  the  most  important  questions  connected  with 
the  period  of  administration  of  remedies  are  those  affecting- 
the  acidity  and  alkalinity  of  the  blood  and  urine.  Here  we 
have  to  do  with  chemical  facts  that  afford  small  opportunity 
for  differences  of  opinion ;  and  yet  how  diverse  the  views  of 
practitioners — how  much  more  diverse  the  practice  !  They 
must  be  considered  separately.  First,  as  to  acids.  When 
prescribed  with  the  view  to  check  the  excessive  forma¬ 
tion  of  the  acids  of  the  gastric  juice,  when  should  they 
be  administered  ?  A  moment’s  consideration  given  to  the 
laws  of  osmosis  will  decide  this  question.  As  the  blood  is 
a  compound  fluid  with  an  alkaline  reaction,  but  which  fur¬ 
nishes  to  the  gastric  glands  the  materials  for  an  acid  secre¬ 
tion,  it  is  obvious  that  an  acid  taken  into  the  stomach  before 
digestion  begins  will  determine,  by  the  laws  of  osmosis,  a. 
flow  through  the  intervening  membrane  of  the  alkaline 
constituents.  Hence,  when  there  is  an  excess  in  the  forma¬ 
tion  of  the  acid  constituent  of  the  gastric  juice,  an  acid 
may  be  given  before  meals  to  check  the  osmosis  stomach- 
ward  of  the  acid-forming  materials.  When  the  alkaline 
condition  of  the  blood  and  urine  is  alike  in  excess,  when 
shall  acids  be  administered?  Obviously,  in  the  interval 
between  the  digestive  acts ;  for  then,  the  stomach  being 
empty  and  the  veins  flaccid,  the  most  favourable  conditions 
for  the  diffusion  of  acid  into  the  blood  exist.  An  alkaline 
fluid  on  one  side  of  the  animal  membrane,  and  an  acid  fluid 
(the  medicament)  on  the  other,  are  the  conditions  most 
favourable  to  osmosis.  Then  the  acid  diffusing  into  the 
blood,  and  out  again  from  the  kidneys,  changes  the  reactions 
of  these  fluids  from  alkaline  to  acid.  Alkalies  require  dif¬ 
ferent  handling.  When  an  excess  of  acid  exists,  as  during 
the  progress  of  digestion,  how  may  alkalies  be  used  ?  It  is 
a  matter  of  quite  common  observation  that  an  alkali,  as  the 
bicarbonate  of  soda,  will  quickly  relieve  the  excess  of  acid, 
by  neutralising  it ;  but  it  is  equally  true,  although  not  so 
clearly  recognised,  that  the  relief  thus  purchased  is  at  the 
expense  of  a  continually  increasing  recurrence  of  the  same 
malady.  It  may  then  be  affirmed,  as  a  rule  of  practice, 
that  the  habitual  use  of  alkalies  to  relieve  an  excess  of  acid 
is  unwise  and  hurtful.  Alkalies  are  used  to  increase  the 
formation  of  acid,  when  the  gastric  glands  perform  this 
duty  inadequately.  An  alkaline  given  before  meals  diverts 
to  the  gastric  glands,  by  the  laws  of  osmosis,  those  materials 
in  the  blood  out  of  which  the  acid  constituent  of  the  gastric 
juice  is  elaborated.  There  are  two  periods  when  alkalies  ( 
may  be  used  to  lessen  the  acidity  of  the  urine— just  before 
meals,  when  the  acid-forming  materials  in  the  blood  diffuse 
into  the  stomach-glands,  and  the  alkaline  medicament  dif¬ 
fuses  into  the  blood  and  outwards  into  the  urine ;  and  after 
digestion  is  completed,  when  the  alkalies  diffuse  directly 
into  the  blood,  without  interference  from  the  contents  of 
the  stomach. 

“  The  effect  of  the  remedy  on  the  stomachal  digestion 
must  also  be  taken  into  consideration  in  deciding  upon  the 
time  of  its  administration.  For  example,  an  alkali  taken 
during  the  time  when  the  reaction  of  the  stomach-juices 
should  be  strongly  acid,  must  necessarily  hinder,  if  not 
arrest,  the  digestive  process  for  the  time  being.  The 
metallic  salts — notably  corrosive  sublimate, — alcohol,  tannin, 
and  some  other  agents,  impair  or  destroy  the  ferment,  or 
digestive  power,  of  pepsin.  Whenever,  then,  it  is  necessary 
to  preserve  the  integrity  of  the  stomachal  digestion,  the' 
administration  of  the  offending  substance  must  precede  or 
follow  the  meals  at  a  considerable  interval.  Again,  there 
are  remedies  which  should  be  given  with  the  meals,  such  as 
food  adjimcts,  and  medicines  required  in  the  process  of 
tissue-construction.  Wine  that  is  intended  to  act  as  a  food 
is  most  beneficial  when  taken,  slowly,  during  the  course  of 
the  meal.  The  objection  above  stated  as  regards  the  ill- 
effect  of  alcohol  on  pepsin  is  not  applicable  here,  except 
to  the  stronger  spirituous  wines  in  large  quantity,  for  the 
ordinary  medicinal  wines  do  not  have  sufficient  alcoholic 
strength  to  injure  this  ferment.  Iron,  phosphates,  cod-liver 
oil,  malt,  and  similar  agents  should,  as  a  rule,  go  with  food 
through  the  digestive  process,  and  with  the  products  of 
digestion  enter  the  blood. 

“  It  results  from  the  foregoing  observations  that  the  rela¬ 
tion  of  medicine- giving  to  food-taking  is  not  merely  a 
question  of  taste,  convenience,  or  expediency.  There  are 
rules  capable  of  exact  application,  and  hence  the  adminis¬ 
tration  of  any  medicament  may  be  accurately  adjusted  to 
the  requirements  of  the  function  of  digestion.” 


Medical  Times  and  Gazette.  MEDICAL  REPORTS  TO  THE  LOCAL  GOVERNMENT  BOARD. 


Sept.  1, 1883.  245 


MEDICAL  REPORTS  TO  THE  LOCAL 
GOVERNMENT  BOARD. 


Me.  Spear  on  Fever  and  Diphtheria  in  the  Dartfoed 

Sub-district. 

At  the  commencement  of  the  present  year  Mr.  John  Spear 
Was  deputed  by  the  Local  Government  Board  to  report  upon 
a  sustained  prevalence  of  enteric  fever  and  of  diphtheria,  in 
the  registration  sub-district  of  Dartford.  At  the  outset  of 
his  inquiry  he  found  that  this  district  is  seldom  entirely  free 
from  enteric  fever,  but  in  the  years  1879  and  1880  there  was 
comparative  absence.  In  the  latter  year  no  deaths  were 
recorded  from  it,  and  only  some  half-dozen  cases  came  under 
the  notice  of  the  Medical  Officer  of  Health.  In  the  beginning 
of  1881,  however,  a  series  of  cases  occurred,  and  during  that 
year  there  were  sixty-five  attacks  with  seven  deaths  ;  whilst 
during  the  first  nine  months  of  1882  there  were  thirty-eight 
cases,  of  which  seven  proved  fatal.  The  first  case  of  the 
present  prevalence  occurred,  it  is  believed,  in  November, 
1880  ;  the  sufferer,  a  boy  employed  at  the  paper-mills,  occu¬ 
pied  with  his  family  one  of  a  block  of  six  small  cottages, 
having  common  yard-space,  privy  accommodation,  and  water- 
supply.  The  yard-space  was  confined,  and  the  surface  most 
dilapidated;  the  privies  were  of  the  deep  cesspit  class, 
dilapidated,  extremely  foul,  and  situated  within  a  few 
feet  of  the  back  doors  and  windows  of  the  dwellings  ; 
whilst  the  water-supply  was  derived,  at  the  time  of  the 
occurrence,  from  a  shallow  well  sunk  close  to,  and  receiving 
soakage  from,  privies  and  drains — so  that,  as  the  Medical 
Officer  of  Health  described,  “the  water  from  the  well  was 
flavoured  with  the  carbolic  acid  used  to  disinfect  the  excre¬ 
ment  in  the  privies.”  In  all,  sixteen  cases  of  well-marked 
enteric  fever  occurred  in  this  block  of  six  cottages,  and  two  of 
the  sufferers  died.  TJp  to  this  point  the  evidence  as  to  the 
causation  of  fever  in  Dartford  was,  Mr.  Spear  found,  of  the 
most  commonplace  description,  but  pointing  very  clearly  to 
excremental  pollution,  by  ordinary  means,  of  soil  and  atmos¬ 
phere,  and  especially  of  local  wells.  Further  inquiry  elicited 
the  fact  that  in  1880-81  a  system  of  sewers  was  being  con¬ 
structed  throughout  the  town,  and  in  order  to  avoid  flooding 
of  the  sewer  trenches,  considerable  pumping  operations  had 
to  be  resorted  to.  The  conditions,  in  fact,  were  those  which 
have  before  been  found  to  be  associated  with  outbreaks  of 
enteric  fever,  viz.,  a  rapid  falling  of  ground-water  pre¬ 
viously  standing  at  a  high  level  in  a  sewage-polluted  soil. 
“  Herein,”  says  Mr.  Spear,  “  lies  the  only  satisfactory 
explanation  discoverable  of  certain  of  the  more  marked 
phenomena  of  the  recent  fever-prevalence  in  Dartford ;  and 
if  the  explanation  be  accepted,  the  further  question  arises, 
whether  the  connexion  between  the  two  occurrences — the 
fall  of  the  subsoil-water  and  the  outbreak  of  fever — be  that 
direct  one  which  Professor  Pettenkofer  believes  in,  or 
whether  it  be  not  simply  referable  to  the  special  facilities 
afforded  by  the  sinking  of  the  ground-water  for  the  convey¬ 
ance  of  impurities  from  the  surrounding  soil  into  surface 
wells.”  An  improved  system  of  sewerage  and  water-supply 
has  now  been  provided,  which  will,  the  report  observes, 
greatly  conduce  to  the  health  of  the  locality,  although  it  is 
to  be  regretted  that  these  works  were  not  undertaken  before. 
With  regard  to  the  prevalence  of  diphtheria  in  the  Rural 
District,  it  is  necessary,  the  report  says,  that  the  sanitary 
history  of  the  locality  during  the  last  few  years  should  be 
studied,  in  order  to  understand  the  recurring  outbreaks  of 
the  disease,  and  the  summary  of  an  inquiry  held  by  Dr. 
Thorne  Thorne,  in  1879,  on  diphtheria  in  Swanscombe  parish 
is  quoted,  to  show  how  defective  were  all  the  sanitary 
arrangements  of  the  district  at  that  time.  So,  in  fact,  they 
continue  to  the  present  day ;  no  efficient  action  has  been 
taken  for  the  removal  of  old  nuisances  and  conditions 
dangerous  to  health.  Mr.  Spear  visited  Swanscombe,  and, 
after  a  diligent  search,  found  only  a  well  or  two  closed,  and 
a  drain  ventilating  pipe  or  two  put  up.  Dr.  Thorne  in  his 
report  had  signalised  one  particular  house  in  the  Swanscombe 
parish  that  had  been  invaded  by  diphtheria,  pointing  to  it  as 
the  sort  of  house  likely  to  be  so  invaded,  and  as  showing  the 
very  defects  it  was  the  duty  of  a  sanitary  authority  to  remedy. 
Mr.  Spear  visited  this  house,  and  found  everything  in  exactly 
the  same  state  as  when  inspected  by  Dr.  Thorne  four  years 
previously.  In  the  face  of  such  want  of  action  on  the  part 


of  the  authorities  it  is  not  surprising  to  learn  from  the 
present  report  that  the  outbreak  of  diphtheria  of  1881-82: 
bears  in  many  respects  a  close  resemblance  to  that  of  1879' 
investigated  by  Dr.  Thorne,  and  is  perhaps  to  be  looked  upon 
as  little  more  than  a  continuation  of  the  earlier  occurrences. 
The  disease  made  its  appearance  at  a  spot  previously  infected,, 
and  appears  then  to  have  spread  under  circumstances  very* 
similar  to  those  of  the  earlier  visitation.  There  are,  as; 
usual,  recommendations  appended  to  this  report,  but  it 
would  seem,  from  previous  experiences,  that  the  chance  of 
their  being  carried  out  is  but  small. 

Mr.  Power  on  Diphtheria  in  the  Hendon  Sanitary 

District. 

On  account  of  a  sudden  outbreak  of  diphtheria  at  Hendon;,, 
which  occurred  in  January  of  the  present  year,  Mr.  W.  H. 
Power  was  deputed  to  institute  an  inquiry  on  behalf  of 
the  Local  Government  Board.  On  the  5th  of  the  month, 
fourteen  cases  in  six  houses  were  simultaneously  brought  to* 
the  notice  of  Dr.  Cameron,  the  Medical  Officer  of  Health  for 
the  District  (one  case  being  in  his  own  house),  and,  as  a 
result  of  the  investigation  he  at  once  made,  the  milk- 
supply  was  suspected.  No  fault  was  found  with  the  milk 
examined  at  the  dairy  implicated,  but  the  pond-water 
used  for  farm  and  dairy  purposes  was  found  to  be  fouled 
to  a  large  extent  by  sewage  matter,  and  to  contain  in 
abundance  animalculac  visible  to  the  naked  eye,  and  the 
use  of  this  was  ordered  to  be  discontinued.  It  was  at  this 
point  that  Mr.  Power  commenced  his  inquiry,  and  it  may 
be  said  that  he  at  once  endorsed  the  view  taken  by  Dr. 
Cameron.  The  invaded  houses  were  some  of  the  best  in  the- 
locality,  and  their  sanitary  condition  was  irreproachable,  but 
patient  inquiry  elicited  the  fact  that  in  the  invaded  house¬ 
holds  it  was  the  large  consumers  of  milk  who  were 
attacked,  and  that  in  certain  families,  where  the  milk  was 
habitually  boiled  before  use,  the  children  wholly  escaped  ill¬ 
ness.  Singular  confirmation  of  the  milk  theory  was  obtained 
in  the  course  of  the  investigation  :  it  was  ascertained  that  the 
implicated  dairy,  in  addition  to  supplying  families  in  Hendon 
with  milk,  had  also  a  limited  number  of  customers  in  the 
adjoining  district  of  Finchley,  and  it  was  argued  that  if 
diphtheria  was  to  be  traced  to  this  cause  in  Hendon,  it  should 
also  be  found  to  have  affected  families  in  the  latter  place. 
To  test  this,  therefore,  inquiry  was  made  of  Dr.  Turle,  Health 
Officer  of  Finchley,  and  of  certain  private  medical  men  in  the 
place,  with  the  result  of  learning  that  the  Finchley  customers 
of  this  particular  dairy  had  not  been  exempt.  Altogether 
nearly  a  dozen  cases  in  four  families  had  been  treated  for 
sore-throat,  and  although  only  one  of  the  cases  was  defined 
as  diphtheria,  several  had  been  regarded  as  diphtheritic, 
and  all  had  been  of  sufficient  gravity  to  come  under  medical 
treatment.  Further,  it  appeared  that  these  Finchley  cases 
were  separated  into  two  groups,  one  occurring  at  the  end  of 
November  or  beginning  of  December,  coincidently  with  the* 
earlier  attacks  in  Hendon  associated  with  the  particular 
milk,  though  not  then  traced  to  it,  and  the  second  m 
January,  coincidently  with  the  notable  outbreak  of  diphtheria, 
in  Hendon  which  formed  the  subject  of  the  present  inquiry. 
Thus  not  only  was  there  in  the  Finchley  experience  corrobo¬ 
ration  of  the  already  inferred  relation  between  the  particular 
milk  service  and  diphtheria,  but  there  was  also  strong- 
suggestion  that  this  milk  had,  at  two  distinct  periods  sepa¬ 
rated  by  an  interval  of  several  weeks,  possessed  the  faculty 
alike  in  Hendon  and  Finchley  of  bringing  about,  in  persons; 
consuming  it,  throat-illness  of  a  diphtheritic  sort.  Mr.  Power 
in  his  report  next  proceeds  to  discuss  the  method  in  which, 
the  milk  acquired  the  infective  property,  and  offers  some  sug¬ 
gestions  thereon  which  the  limits  of  the  present  notice  will 
not  permit  us  to  append.  In  bringing  his  report  to  a  con¬ 
clusion,  however,  he  considers  it  necessary  to  make  a  few 
remarks  upon  the  Hendon  sewage  system.  This,  he  says,  is- 
confessedly  fragmentary,  insufficient,  and  inefficient.  In 
addition,  it  is  by  many  residents  believed  to  be  dangerous  to 
health,  and  much  of  the  occasional  diphtheria  that  has  con¬ 
tinued  to  arise  in  the  district  is  locally  freely  ascribed  to 
defects  of  the  sewerage.  Upon  this  point  Mr.  Power  observes, 
that,  given  a  sewer  origin  of  diphtheria,  the  circumstances  of 
sewerage  in  Hendon  are  likely  to  foster  it,  and  that,  for  this 
and  other  reasons,  no  time  should  be  lost  by  the  Sanitary 
Authority  in  adopting  and  carrying  out  some  such  compre¬ 
hensive  scheme  of  sewerage  and  sewage  disposal  as  that 
already  prepared  by  the  Authority’s  surveyor. 


246 


Medical  Times  and  Gazette. 


A  NEW  EOEM  OF  CLOSED  SEWEE. 


Sept.  1, 1883. 


Mr.  Power  on  Diphtheria  at  Pirbright,  near 
Guildford. 

On  November  27  last  the  Guildford  Eural  Sanitary 
Authority  applied  to  the  Local  Government  Board,  through 
its  Health  Officer,  Mr.  Joseph  Smith,  for  advice  respecting 
•diphtheria  prevalence  in  Pirbright,  which  it  was  believed 
was  in  some  measure  due  to  the  operations  of  the  National 
School  there.  Mr.  Smith  stated  that  since  May,  1882,  this 
school  had  on  several  separate  occasions  been  closed,  and 
•each  time  for  several  weeks,  on  account  of  diphtheria 
amongst  the  children ;  and  that  diphtheria  in  the  parish 
Laving  undergone  diminution  or  cessation  during  each 
interval  of  school  closure,  re-appeared,  and  mainly  amongst 
school  children,  each  time  that  the  school  re-commenced 
•operations.  In  consequence,  Mr.  W.  H.  Power  was  directed 
to  inquire  into  the  circumstances,  and  in  the  beginning  of 
this  year  he  carried  out  a  most  minute  investigation.  The 
parish  of  Pirbright  is  situated  about  five  miles  from  the 
town  of  Guildford,  and  its  sanitary  condition  is  above  the 
•average  :  few  dwellings  are  overcrowded,  and  almost  without 
•exception  they  have  garden  ground  or  other  space  about 
them.  The  most  searching  inquiry  failed  to  show  either  in 
the  physical  or  sanitary  circumstances  of  Pirbright  any  ready 
•explanation  of  diphtheria  prevalence.  For  instance,  from  the 
wide  dispersion  of  dwellings,  households  had  had,  for  the  most 
part,  but  little  intercommunication,  while  as  regards  other 
sanitary  details,  they  were  commonly  exceptionally  separate 
•one  from  another.  Nevertheless,  Mr.  Power  quickly  learnt 
•that,  in  addition  to  definite  diphtheria,  there  had  been  in  the 
parish  a  large  prevalence  of  sore-throat,  much  of  which  had 
not  come  under  medical  observation,  and  that  frequently  chil- 
•dren  who  had  had  what  their  parents  regarded  as  trivial  sore- 
throat,  suffered  later  on  from  paralyses  of  the  sort  that  are  apt 
to  follow  diphtheria.  This  information  was  only  acquired  by 
means  of  a  house-to-house  inquiry ;  in  the  course  of  which  it 
was  ascertained  that  the  first  cases  of  diphtheria  in  Pirbright 
•dated  back  to  the  beginning  of  1882,  but  could  not  be  satis¬ 
factorily  accounted  for,  and  that  the  principal  victims  were 
•children  between  the  ages  of  three  and  twelve.  So  far,  it 
must  be  admitted,  the  facts  appeared  to  press  hardly  upon 
the  school,  since  no  doubt  could  be  entertained  that  the 
•condition  of  school  attendance  had  played  an  important 
part  in  the  spread  of  illness.  But  the  school-house  on 
■examination  was  found  to  be  a  modern  building,  in  the 
■erection  of  which  unusual  forethought  had  apparently  been 
brought  to  bear;  its  sanitary  condition,  in  every  respect, 
being  superior  to  that  of  buildings  in  other  parts  *of  the 
parish.  It  has,  moreover,  to  be  noted  that  Dawney  Hill,  the 
locality  in  which  it  is  situated,  had  suffered  from  throat- 
illness  and  diphtheria  to  a  greater  extent  and  for  a  longer 
dime  than  other  localities,  and  that  five-ninths  of  its  first 
•sufferers  had  not  at  the  date  of  their  seizure  recently  at¬ 
tended  the  school.  Altogether,  Mr.  Power  observes,  the 
Investigation  has  failed  in  giving  definite  reply  to  the  main 
question  as  to  the  nature  of  the  school  influence.  In  con¬ 
cluding  his  report,  Mr.  Power  says,  in  the  investigation  of 
the  incidence  of  throat-illness  upon  families,  both  he  and 
Mr.  -  Smith  were  struck,  and  independently  of  one  another,  by 
the  apparently  different  ability  of  the  disease  in  different 
instances  to  extend  itself  in  families  invaded.  Not  infre¬ 
quently  severe  and  fatal  diphtheria  appeared  well-nigh 
destitute  of  power  to  infect  other  children  living  along  with 
it,  while,  on  the  other  hand,  cases  of  very  trivial  sore-throat 
or  “  cold,”  that  were  perhaps  only  heard  of  by  close  ques¬ 
tioning,  often  preceded,  and  were  seemingly  responsible  for, 
after  occurrences  of  true  and  fatal  diphtheria  in  the  family. 
Especially  was  this  apparent  potency  of  mere  sore-throat 
for  breeding  malignant  diphtheria  noticeable  in  regard  of- 
families  comprising  many  young  children. 


Moss  as  a  Dressing  for  Wounds. — At  the  Berlin 
Surgical  Congress,  Dr.  Hagedorn,  of  Magdeburg,  reported 
that  from  a  trial  which  he  had  made  during  six  months  of 
fresh-dried  moss  ( sphagnum )  as  an  application  to  all  kinds 
of  wounds,  he  was  enabled  to  speak  most  highly  in  its  favour. 
It  possesses  no  disinfecting  power,  but  is  used  in  conjunction 
with  weak  sublimate  solution.  It  is  cheap,  very  absorbent, 
elastic,  and  convenient  of  application.  In  these  respects  he 
regards  it  as  superior  to  turf,  which  has  recently  been  much 
used,  and  was  highly  spoken  of  at  the  discussion  which 
followed  the  paper. — Central./.  Chirurgie,  No.  23,  Beilage. 


A  NEW  EOEM  OF  CLOSED  SEWEE. 

It  is  well  known  that  when  the  sewage  of  a  town  flows 
rapidly  along  an  open  channel,  such  as  those  conducting 
it  to  sewage  farms,  little  or  no  smell  is  perceptible ;  and 
nearly  the  same  result  may  be  obtained  by  the  free  ventila¬ 
tion  of  a  sewer,  provided  it  be  so  well  laid  that  no  deposit 
of  solid  matter  occurs  in  its  course.  Sewer-air,  as  dis¬ 
tinguished  from  sewer-gas,  is  comparatively  inodorous,  and 
any  stench  indicates  stagnation,  deposit,  and  putrefaction  of 
the  solids  of  the  sewage.  As  a  matter  of  fact,  few  systems 
of  sewers  are  so  perfect  as  to  be  free  from  such  deposit,  and 
in  too  many  instances  the  gases  thus  generated  are  ex¬ 
tremely  foul.  It  is  no  doubt  better  that  even  such  should 
escape  into  the  streets  than  that  they  should  be  forced  into  the 
houses,  as  will  certainly  happen  if  the  house-drains  are  not 
disconnected,  unless  the  sewers  are  freely  ventilated.  But, 
again,  the  light  sewer-gases  are  so  affected  by  temperature 
and  atmospheric  pressure  that  their  dilution  is  not  pro¬ 
portioned  to  the  number  of  outlets  provided,  for  under 
varying  circumstances  these  will  act  as  inlets  or  as  outlets, 
and  a  concentrated  sewer-gas  may  be  discharged  in  large 
volumes  in  a  narrow  street  or  crowded  thoroughfare,  pure 
air  entering  the  sewer  where  the  escape  of  the  foul  was 
most  to  be  desired. 

To  remedy  these  evils  Mr.  Harris  Beeves  has  patented, 
and,  as  he  believes,  perfected,  a  scheme  whereby  the  sewers 
are,  as  regards  the  air  contained  in  them,  divided  into 
sections,  the  flow  of  the  sewage  continuing  uninterruptedly  ; 
to  each  section  there  is  attached  an  apparatus,  worked  by 
every  fluctuation  of  the  level  of  the  sewage  (even  by  the 
sudden  discharge  of  the  contents  of  a  bath  or  slop-pail) 
in  such  a  manner  that,  the  section  being  accurately  sealed, 
on  the  least  rise  of  the  sewage  the  gases  pass  out  through 
a  purifier,  this  being  formed  of  a  double  circular  midfeather 
trap,  the  inner  section  of  which  contains  a  disinfecting  fluid, 
and  the  outer  water,  which,  by  washing  the  passing  air,  re¬ 
moves  the  odour  of  the  disinfectant.  When,  on  the  other 
hand,  the  level  of  the  sewage  falls,  air  is  admitted  to  the 
sewer  through  an  automatic  valve,  responding  to  a  pressure 
so  slight  that  the  seals  of  house-traps  and  purifiers  are 
not  broken.  We  have  not  seen  this  system  in  operation,  and 
we  must  confess  to  a  fear  that  the  latter  part  might  get 
out  of  order ;  but  the  action  of  the  purifiers  is  vouched  for 
by  Professor  Tuson  and  medical  men  who  have  inspected 
its  working  on  the  esplanade  and  streets  in  Shanklin,  and 
who  affirm  that  the  sewer-gas,  which,  when  it  escaped 
in  its  natural  condition,  had  a  sickening  odour,  might 
be  seen  bubbling  into  the  streets  through  the  purifiers 
absolutely  devoid  of  smell. 

There  are,  however,  serious  objections  to  all  such  elaborate 
apparatus,  and  especially  so  in  the  case  of  large  towns.  The 
real  remedy,  we  believe,  is  to  be  found  in  prevention  rather 
than  cure — in  better  construction,  that  is,  of  the  sewers 
themselves ;  and  that  it  is  possible  to  prevent  all  deposit  is 
proved  by  the  example  of  Frankfort,  where  the  engineers 
not  having  old  sewers  to  patch,  but  beginning  de  novo,  have 
been  so  successful  that  it  has  never  been  necessary  to 
employ  manual  labour  for  the  removal  of  silt  or  sludge. 


Glasgow  Eoyal  Infirmary  School  of  Medicine. — 
Dr.  Barlow,  lately  teacher  of  Physiology  in  Anderson’s 
College,  has  been  appointed  to  fill  a  similar  position  in  the 
Glasgow  Eoyal  Infirmary  School,  in  the  vacancy  made  by 
the  resignation  of  Dr.  William  James  Fleming.  As  yet  only 
one  applicant  has  come  forward  for  the  vacancy  in  Anderson’s 
College,  namely.  Dr.  Joseph  McGregor  Eobertson,  who  is 
at  present  Demonstrator  of  Physiology  in  the  Glasgow 
University. 

Fracture  of  the  Lower  End  of  the  Fibula.— 
Of  such  frequent  occurrence  is  this  accident,  that  Prof. 
Trelat,  of  the  Necker  Hospital,  lecturing  upon  it,  observed 
that  if  it  occurred  as  often  in  the  other  hospitals  as  it  did 
in  his  own  wards  there  would  be  in  the  twenty-one  great 
surgical  services  of  the  Paris  hospitals  1000  cases  per 
annum ;  and  if  to  these  were  added  the  number  of  cases 
observed  and  treated  en  ville  the  cases  would  easily  amount 
to  between  5000  and  6000. — Gazette  des  Hop.,  May  24. 


Medical  Times  and  Gazette. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


Sept.  1,1883.  247 


REVIEWS  AND  NOTICES  OF  BOOKS. 


A  System  of  Human  Anatomy,  including  its  Medical  a.nd 
Surgical  Relations.  By  Harrison  Allen,  M.D.,  Pro¬ 
fessor  of  Physiology  in  the  University  of  Pennsylvania. 
Section  I.  Histology.  Section  II.  Bones  and  Joints. 
Section  III.  Muscles  and  Fasciae.  London :  Henry 
Kimpton.  1882. 

The  aim  of  the  author  has  been,  as  he  tells  us  in  his  intro¬ 
duction,  to  produce  “  a  book  which  will  be  at  once  accurate 
in  statement  and  concise  in  terms  ;  which  will  be  an  accept¬ 
able  expression  of  the  present  state  of  the  science  of  ana¬ 
tomy  ;  which  will  exclude  nothing  that  can  be  made  applic¬ 
able  to  the  medical  art,  and  which  will  thus  embrace  all  of 
surgical  importance,  while  omitting  nothing  of  value  to 
clinical  medicine.”  The  object  aimed  at  is  one  to  which  we 
can  take  no  exception,  and  if  we  may  judge  of  what  the  suc¬ 
ceeding  volumes  will  be  like  from  the  three  that  are  before 
us,  we  think  the  author  will  be  fairly  entitled  to  claim  that 
he  has  succeeded  in  attaining  to  the  goal  which  he  set  before 
himself.  It  is  not  possible  in  the  limited  space  at  our  com¬ 
mand  to  do  more  than  make  a  few  general  remarks  on  this 
work ;  anything  like  a  detailed  examination  of  it  would 
require  to  be  very  lengthy.  The  first  volume,  or  section, 
is  on  Histology,  and  is  written  by  Dr.  Shakespeare.  The 
various  tissues  are  described  in  order  at  some  length,  and 
the  writer’s  views  agree  closely  with  those  generally  adopted 
in  this  country ;  and  he  has  evidently  taken  care  to  make 
himself  acquainted  with  the  most  recent  work  both  here 
and  on  the  Continent.  This  section  is  illustrated  by  twelve 
plates  of  steel  engravings,  and  between  fifty  and  sixty 
woodcuts.  The  latter  are  mostly  taken  from  well-known 
authors,  such  as  Carpenter,  Banvier,  Frey,  Strieker,  Gray, 
etc.  Of  the  former,  several-  are  after  Banvier  or  Klein. 
The  plates  do  not,  on  the  whole,  come  up  to  the  standard 
of  excellence  attained  by  Klein  and  Noble  Smith  in  their 
"  Atlas  of  Histology  but  they  are  good,  and  in  most 
instances  exhibit  the  structures  they  were  designed  to 
show,  with  sufficient  clearness  for  all  practical  purposes. 
Section  II.  is  devoted  to  Bones  and  Joints.  To  show  the 
author’s  method  we  give  a  brief  sketch  of  the  way  in  which 
he  deals  with  the  spine.  He  commences  with  some  general 
remarks  about  the  vertebral  column,  such  as  the  degree  of  mo¬ 
bility  between  its  different  parts,  the  antero-posterior  curva¬ 
tures,  the  influence  of  weight  in  producing  lateral  curvature, 
the  intervertebral  foramina  and  spinous  processes;  then  he 
speaks  of  the  cervical  vertebrse  as  a  whole,  and  of  the  atlas 
axis  and  seventh  cervical  in  detail ;  and  then  he  considers  the 
dorsal  and  lumbar  vertebral  individually  and  collectively,  and 
concludes  with  a  table,  taken  from  Holden,  of  the  relative 
positions  of  the  spines  of  the  vertebrse  to  certain  thoracic 
or  abdominal  viscera.  One  of  the  objects  of  the  author  is 
to  make  the  study  of  anatomy  more  interesting  to  those  en¬ 
gaged  in  the  practice  of  their  profession,  and  the  para¬ 
graphs  on  the  skull  as  a  whole  show  how  he  has  tried  to 
fulfil  this  object,  viz.,  by  pointing  out  the  functions  of  the 
canine  teeth  and  malar  and  zygomatic  processes  in  receiving 
and  conducting  shocks,  and  by  considering  the  structure  of 
the  skull  with  especial  reference  to  the  effects  of  injury ; 
the  distribution  of  the  spongy  and  compact  tissue,  and  the 
disposition  of  the  cranial  bones  and  their  sutures,  being 
the  points  to  which  attention  is  chiefly  directed.  In  the 
description  of  a  bone,  after  its  surfaces,  borders,  angles,  and 
processes  have  had  th.eir  share  of  attention,  and  the  attach¬ 
ments  of  the  muscles  and  grooves  for  vessels  or  nerves  have 
been  given,  the  author  gives  a  paragraph  on  the  structure  of 
the  bone  :  we  quote  one,  taken  quite  at  random,  to  show  the 
care  which  has  been  bestowed  on  the  work  :  “  The  scapula 
presents  the  strongest  arrangement  of  the  cancelli  at  the 
neck.  The  lines  here  radiate  from  the  glenoid  cavity  toward 
the  vertebral  border.  They  are  intersected  by  a  number  of 
lamina;  that  are  more  or  less  concentric  with  the  plane  of 
the  articular  surface.  When  it  is  remembered  that  no 
weight  is  borne  by  the  scapula,  the  arrangement  of  cancelli 
of  the  neck  can  have  relations  with  forces  exerted  from 
below  only,  namely,  from  the  humerus.  The  pressure  of  the 
head  of  the  last-named  bone  against  the  lower  half  of  the 
glenoid  cavity  is  very  great  when  the  arm  is  elevated  by 
the  deltoid  and  the  supra- spinatus  muscles.  The  object  of 
the  cancelli  in  the  scapular  neck  is  to  receive  and  distribute 


through  the  scapula  the  results  of  such  pressure.  Spongy 
tissue  is  also  seen  in  the  coracoid  process,  acromion,  and 
spine,  and  at  the  borders  and  inferior  angle  of  the  bone. 
The  greater  part  of  the  supra-  and  infra-spinous  fossse  are 
thin  and  diaphanous.”  This  section  contains  no  less  than 
thirty  plates,  many  of  them  being  devoted  to  the  ligaments, 
which  are  well  represented.  The  bones  have  been  drawn  of 
a  sufficient  size  to  permit  of  attention  being  directed  to  all 
their  points  of  interest.  The  attachments  of  the  muscled 
are  marked  out  by  dotted  lines,  and  in  most  instances  the 
name  of  the  muscle  has  been  written  on  the  bone  at  the  site 
of  its  attachment.  The  names  of  the  muscles,  grooves,  etc., 
are  all  printed  in  a  legible  type.  But  we  think  it  is  a  pity 
the  author  has  not  adopted  Holden’s  plan  of  marking  the 
origins  and  insertions  of  muscles  in  different  colours,  as- 
that  is  of  decided  advantage  to  the  student.  The  third 
section  treats  of  the  Muscles  and  Fasciae :  the  former  are 
described  in  a  systematic  manner  throughout,  the  order  taken 
being  as  follows : — the  origin  of  the  muscle  is  given,  then 
the  general  course  and  direction,  including  any  additional 
slips  it  may  receive ;  then  its  point  or  points  of  insertion, 
then  its  use,  nervous  supply,  and  lastly,  any  variations  re¬ 
garding  it  that  are  at  all  common  ;  and  where  it  seems 
necessary,  its  relationships  to  contiguous  structures.  In 
regard  to  the  actions  of  the  various  muscles,  we  are  pleased 
to  notice  how  frequently  the  name  of  Duchenne  is  quoted ; 
his  method  of  determining  the  function  of  a  muscle  was  at 
once  the  most  simple  and  most  reliable — viz.,  to  put  it  into 
action  by  itself  by  passing  an  induced  current  through  it. 
Dr.  Allen  has  acted  wisely  in  taking  him  as  a  guide  in  regard 
to  the  use  of  the  muscles.  The  plates  in  this  section  are 
well  executed,  and  would  prove  of  much  assistance  to  a 
student  in  reading  up  a  part  after  he  has  already  dissected  it. 
The  section  concludes  with  a  few  remarks  on  displacements 
in  fracture. 

As  we  said  at  the  outset  of  this  notice,  we  consider  that 
the  instalment  that  is  before  us  gives  good  promise  that  the 
whole  work,  when  completed,  will  be  of  great  value,  and 
will  take  rank  amongst  the  standard  works  on  anatomy. 


Die  Allgemeine  Electrisation  des  menschlichen  Korpers  ( The 

General  Electrisation  of  the  Human  Body).  By  Sigmund- 

Theodor  Stein,  M.D.,  Ph.D.,  Frankfort-on-Main.  Second 

Edition.  Halle :  W.  Knapp.  1883.  Pp.  136. 

It  is  a  common  characteristic  of  almost  all  the  methods  of 
treatment  which  have  been  suggested  for  that  most  vague  of 
all  conditions,  “  nervous  debility,”  that  they  should  for  a  time- 
fall  into  disrepute  owing  to  their  indiscriminate  adoption  by 
ignorant  practitioners  or  designing  charlatans.  The  work 
before  us  may  be  described  as  an  attempt  to  bring  back 
into  respectability  a  branch  of  therapeutic  art  which,  from 
the  want  of  precise  knowledge  as  to  its  mode  of  action,  has 
long  lain  under  the  ban  of  “  quackery.”  That  this  attempt 
has  met  with  due  recognition  in  Germany  is  evidenced  by 
the  speedy  call  for  a  second  edition  of  the  work  in  rather  less 
than  six  months. 

The  author  has  dealt  with  his  subject  mainly  from  the 
practical  side,  showing  in  what  cases  good  results  may  be 
hoped  for,  and  in  what  manner  such  results  may  best  be 
brought  about. 

In  the  present  edition  a  very  full  account  is  given  of  the 
use  of  the  bath  as  a  means  of  applying  faradism  or  gal¬ 
vanism  either  generally  or  locally.  Premising  that  a  large 
volume  of  water,  as  in  an  ordinary  bath,  offers  greater 
resistance  to  an  electric  current  than  does  the  body  reclining 
in  it,  the  author  simply  passes  his  current  from  point  to 
point  through  the  (insulated)  bath  in  whatever  direction  he 
desires  it  to  travel  through  the  body.  The  superiority  of 
this  method  over  that  of  Holst  and  of  Seligmiiller,  in  which 
the  current  was  made  to  travel  directly  from  the  one  pole 
held  in  the  hand,  to  the  other  which  was  maintained  in  con¬ 
nexion  with  the  metal  bath  itself,  is  fully  discussed.  Of 
the  class  of  cases  to  which  treatment  by  general  electrisa¬ 
tion  seems  to  have  been  found  beneficial,  it  may  be  said 
that  they  are  for  the  most  part  those  disorders  of  the  nervous 
system  of  which  we  are  ignorant  of  the  actual  pathology. 
In  the  disorders  of  sensation,  local  and  general.  Dr.  Stein 
has  made  several  crucial  experiments  with  Franklinic  elec¬ 
tricity,  which  deserve  attention.  He  points  out  that  just 
as  a  marked  difference  exists  in  the  thex-apeutic  action  of  the 
induced  and  the  continuous  current  respectively,  so  also  there 


248 


Medical  Times  and  Gazette. 


KEVIEWS  AND  NOTICES  OF  BOOKS. 


Sept.  1, 1883. 


appear  to  be  in  static  electricity  qualities  which  cannot  be 
■discovered  in  either  of  the  other  two  forms.  That  a  condi¬ 
tion  of  general  electric  stability  is  an  essential  condition  for 
a  healthy  nervous  system  has  been  generally  recognised 
since  the  days  of  Franklin,  and  finds  illustration  in  the 
nervous  disturbance  so  frequently  induced  during  thunder¬ 
storms.  The  author  recognises  in  many  so-called  hysterical 
■cases  a  condition  of  unstable  electrical  equilibrium,  which 
he  looks  to  the  employment  of  static  electricity  to  relieve. 
The  methods  of  treatment  and  the  instruments  used  are 
very  fully  given  and  amply  illustrated.  Although  it  does 
not  bring  to  light  any  new  theory  of  importance.  Dr.  Stein’s 
-work  may  be  classed  as  a  useful  link  in  the  chaih  of  honest 
work,  which,  it  is  hoped,  will  one  day  lead  us  to  a  correct 
understanding  of  the  various  disorders  to  which  our  complex 
nervous  organisation  is  subject. 


'Rheumatism,  Gout,  and  some  Allied  Disorders.  By  Maurice 
Longstreth,  M.D.,  one  of  the  Attending  Physicians  of  the 
Pennsylvanian  Hospital ;  Lecturer  on  Pathological  Ana- 
homy  at  the  Jefferson  Medical  College,  Philadelphia. 
London :  Sampson  Low,  Marston,  Searle,  and  Eivington. 
1883.  8vo,  pp.  276. 

After  a  short  chapter  on  the  forms  and  varieties  of  rheu¬ 
matism,  Dr.  Longstreth  proceeds  to  consider  its  causes, 
and  as  he  devotes  a  considerable  amount  of  space  to  the 
buestion  of  heredity,  and  holds  views  on  this  subject 
•different  to  those  usually  adopted  in  this  country,  we  will 
quote  some  extracts  to  show  the  general  line  of  thought 
"he  follows  : — “  The  determination  of  the  hereditary  nature 
•of  a  disease,  especially  the  proof  of  the  negative  proposition, 
is  a  matter  of  great  difficulty,  but  I  think  it  will  be  found 
-that  a  very  much  larger  number  of  people  whose  parents 
•suffered  from  it  escape  rheumatic  affections  than  become 
rheumatic  themselves,  and  I  believe  the  converse  of  the  pro¬ 
position  is  also  true.”  “  On  the  question  of  the  greater  or 
less  strength  of  the  supposed  hereditary  tendency  of  rheuma¬ 
tism,  the  unsupported  opinion  of  most  writers  is  that  there 
exists  a  strong  hereditary  tendency  in  its  development.” 
“  Now  I  have  no  notes  of  my  own  with  which  to  substantiate 
or  disprove  the  correctness  of  the  law  of  transmission.  In 
my  earlier  notes  of  cases  the  matter  was  carefully  inquired 
into,  but  later  the  inquiry  has  been  abandoned,  partly  from 
my  alteration  of  views  in  relation  to  the  hereditary  trans¬ 
mission  of  diseases  in  general,  partly  from  it  becoming 
■obvious  to  me  that,  at  least  among  hospital  and  out-patient 
cases,  the  replies  were  incorrect  or  confused,  and  partly 
because  I  found  that  inquiries  as  to  hereditary  diseases  in 
general  developed  the  fact  that  rheumatism  in  the  parent 
was  quite  as  often  absent  in  the  offspring  as  parent.”  “  The 
"histories  ©f  families,  even  many  instances  within  my  own 
knowledge,  afford  as  numerous  examples  of  the  failure  in 
transmission  as  the  reverse,  and  it  would  be  just  as  un¬ 
fair  to  argue  its  non-transmissibility  from  this  fact  as  to 
attempt  to  affirm  its  opposite  character  from  similar  facts.” 
■“  The  question  needs  to  be  studied  by  methods  as  yet 
unused  for  its  decision.  Hitherto  its  hereditary  tendency 
lias  been  concluded  by  collecting  the  answers  of  a  set  of 
people  who,  as  a  rule,  are  ignorant,  unobserving,  and  per¬ 
haps  prejudiced  in  favour  of  the  one  view  of  the  question, 
and  who,  to  increase  the  magnitude  of  their  suffering,  are 
•capable  of  wilfully  distorting  facts.  It  is  not  surprising, 
therefore,  that  sufficient  evidence  has  been  collected  to  pro¬ 
duce  a  strong  impression  in  favour  of  the  hereditary  cha¬ 
racter  of  rheumatism.  I  believe  there  would  be  a  very 
different  showing  produced,  supposing  that  the  statistical 
method  of  proof  has  any  considerable  value  in  deciding  the 
question,  if  we  were  to  ascertain  how  many  descendants  of 
rheumatic  patients  escaped  the  disease,  or  determine  how 
many  of  those  patients,  now  classed  as  rheumatic  by 
Heredity,  were  born  prior  to  their  parents  suffering  from  the 
disease.  And  while  I  believe  that  such  inquiries  would 
■show  a  different  result,  or  would  change  our  opinions  from 
what  are  at  present  held,  I  do  not  think  we  should  be  any 
more  certain  of  the  true  characteristic  of  rheumatism  in 
this  respect  than  we  are  at  present.” 

Dr.  Longstreth  takes  syphilis  as  the  type  of  an  inherited 
■disease,  and  considers  that  a  disease  when  inherited  should 
appear  in  the  offspring  in  very  early  life.  Judged  by  this 
standard,  tubercle  has  no  better  claim  to  be  ranked  as 
hereditary  than  rheumatism.  It  seems  to  us  that  the 


author  has  entirely  overlooked  the  tendency  to  disease,  or 
“diathesis,”  which  we  on  this  side  of  the  water  are  accus¬ 
tomed  to  consider  as  having  a  real  existence  and  playing  an 
important  part  in  many  diseases.  In  the  chapter  on  the 
pathology  of  rheumatism  the  author  discusses  the  local  or 
inflammatory  theory,  the  vascular  theory,  the  nervous  and 
vaso-motor  theories,  the  chemical  theory  (lactic  acid),  and 
lastly,  the  infectious  theory,  giving  the  arguments  in 
support  of  and  against  each  with  impartiality  and  much 
acumen.  If  he  has  any  leaning  towards  any  it  would  appear 
to  be  in  favour  of  the  last-mentioned  theory.  The  author 
deals  in  the  same  way  with  the  subject  of  treatment,  and 
shows  himself  to  be  thoroughly  conversant  with  the  most 
recently  received  ideas  both  in  this  country  and  on  the 
Continent.  Dr.  Longstreth  has  in  the  work  before  us  shown 
not  only  that  h«  is  a  careful  and  scientific  observer,  but  that 
he  can  examine  the  writings  of  others  with  courtesy  and 
impartiality.  _ 


Lectures  on  Cataract :  its  Causes,  Varieties,  and  Treatment . 

Six  Lectures  delivered  at  the  "Westminster  Hospital.  By 

George  Cowell,  F.E.C.S.  London:  Macmillan  and  Co. 

1883. 

Without  any  claim  to  originality,  these  lectures  give  a 
very  good  account  of  all  the  ordinary  varieties  of  cataract 
and  of  the  different  methods  of  operation  for  their  removal. 
The  usually  recognised  causes  of  cataract  are  mentioned, 
but  we  would  take  exception  to  the  author’s  opinion  that 
“  straining  of  accommodation  by  continuous  work  at  minute 
objects  is  a  common  cause.”  In  soft  cataract  Mr.  Cowell 
trusts  to  repeated  needling,  and  considers  the  suction  opera¬ 
tion  dangerous.  The  linear  extraction  as  here  described  for 
such  cases  would,  we  think,  be  attended  by  still  greater  risks. 
An  excellent  description  is  given  of  a  modified  linear  ex¬ 
traction  operation  for  senile  cataract.  Our  author  protests 
against  shutting  up  cataract  patients  for  a  week  or  so  after 
the  operation  in  a  dark  room,  as  then  “  the  vital  processes  of 
the  body  cannot  be  performed.”  He  asserts  that  the  great 
proportion  of  lamellar  cataracts  are  non-progressive,  and 
recommends  iridectomy  down  and  in  as  the  most  satisfac¬ 
tory  operation  in  such  cases.  The  book  is  neatly  got  up, 
and  the  accompanying  illustrations  are  excellent. 


A  Dictionary  of  Domestic  Medicine  and  Household  Surgery. 
By  Spencer  Thomson,  M.D.  Seventeenth  Edition,  by 
J.  C.  Steele,  M.D.,  assisted  by  the  Author.  London: 
Charles  Griffin  and  Co.  1883. 

The  popularity  of  this  work  is  abundantly  testified  to  by 
the  fact  that  sixteen  editions  have  been  exhausted  during 
the  last  thirty  years.  In  that  time  the  work  has  only  been 
revised  once,  in  1864,  or  nearly  twenty  years  ago,  so  that  the 
progress  made  since  then  has  naturally  afforded  sufficient 
material  for  another  revision.  In  the  hands  of  Dr.  Steele 
no  important  additions  to  our  knowledge  have  been  allowed 
to  pass  unnoticed,  whilst  at  the  same  time  the  original  aim 
and  object  of  the  work  has  been  kept  constantly  in  view. 
The  present  edition  is  well  got  up,  and  the  diagrams  and 
woodcuts  are  well  executed.  We  have  no  doubt  that  this 
volume  will  prove  as  popular  as  its  predecessors. 


The  Bristol  Medico-Chirurgical  Journal,  No.  1.  Edited  by 
J.  Greig  Smith,  M.A.,  F.E.S.E.  Bristol.  July,  1883. 
The  first  half  of  this  number  is  occupied  by  two  papers  on 
the  doctrine  of  the  contagiousness  of  phthisis.  Dr. 
Shingleton  Smith  writes  on  the  “  Proofs  of  the  Existence 
of  Phthisical  Contagion,”  and  Dr.  Markham  Skerritt  on 
“  Clinical  Evidence  against  the  Contagiousness  of  Phthisis.” 
Dr.  Smith  says  he  has  been  led  to  the  following  conclusions 
regarding  phthisis  or  tubercle,  viz. : — “  1.  That  tubercle  is  a 
true  zymotic  disease  of  specific  nature  in  the  same  sense  as 
typhoid  fever,  etc.  2.  That,  like  these  diseases,  tubercle 
never  originates  spontaneously,  but  is  perpetuated  solely  by 
the  law  of  continuous  succession.  3.  That  the  tuberculous 
matter  itself  is  (or  includes)  the  specific  morbific  matter  of 
the  disease,  and  constitutes  the  material  by  which  phthisis 
is  propagated  from  one  person  to  another,  and  disseminated 
through  society.”  Dr.  Skerritt’s  conclusions  are — “1.  That 
evidence  derived  from  experiments  upon  the  lower  animals 
must  be  received  with  caution  ;  and  that  it  does  not  follow 
that  a  disease  which  is  contagious  in  these  animals  is  conta- 


Medical  Times  and  Gazette. 


FOREIGN  CORRESPONDENCE. 


Sept.  1, 1883.  249 


gious  also  in  man.  2.  That  it  has  not  been  conclusively 
proved  that  the  bacillus  is  the  cause  rather  than  associated 
with  it  as  a  secondary  phenomenon ;  and  further,  that  if  the 
disease  be  shown  to  be  the  bacillus,  even  then  it  is  not 
necessarily  contagious,  as  malarial  fever  is  not  contagious 
although  it  has  been  induced  by  inoculation  of  an  associated 
organism.  3.  That  clinical  experience  is  strongly  opposed 
to  the  theory  that  phthisis  is  a  contagious  disease  in  the 
ordinary  sense  of  the  term.  4.  That  there  is  not  sufficient 
evidence  of  the  actual  occurrence  of  phthisis  in  man  by 
contagion.”  We  fancy  that  the  majority  of  practitioners 
will  agree  with  Dr.  Skerritt  that  the  contagiousness  of 
phthisis  is,  as  yet,  not  proven.  Amongst  the  other  contribu¬ 
tions  to  this  number  are  a  short  article  on  the  use  of  the 
cardiograph  in  medicine,  by  Mr.  Munro  Smith  ;  some  notes 
from  the  surgical  out-patient  room,  by  Mr.  Harsant;  two 
cases  of  compression  of  the  spinal  cord  by  sarcomatous 
growths  from  the  soft  membranes,  by  Dr.  E.  Long  Eox  ;  a 
case  of  ulcerative  endocarditis  of  the  tricuspid  valve,  by  Dr. 
J.  E.  Shaw  ;  and  some  interesting  or  rare  cases  by  the  Editor 
and  others.  The  book  is  nicely  got  up  as  regards  type  and 
paper,  and  we  are  glad  to  notice  that  a  goodly  number  of 
practitioners  in  the  neighbourhood  have  become  subscribers. 
The  Bristol  Medico-Chirurgical  Journal  has  made  an  excel¬ 
lent  start  under  favourable  auspices  ;  we  hope  it  may  “  live 
long  and  prosper.” 


FOREIGN  CORRESPONDENCE. 


EGYPT. 


(From,  a  Correspondent.) 

Cairo,  August  18. 

An  epidemic  developed  at  Damietta  in  the  latter  half  of 
July  last ;  from  thence  it  spread  itself  over  all  Lower  Egypt 
and  Cairo,  where  there  have  been  as  many  as  480  deaths  in 
a  day.  Now  Cairo  is  almost  free,  but  the  epidemic  prevails 
still  in  Upper  Egypt  and  Alexandria.  There  was  much 
controversy,  at  the  first,  about  the  nature  of  the  disease : 
some  medical  men  called  it  a  gastro-enteritis,  with  cerebral 
symptoms;  others  regarded  it  as  a  kind  of  pernicious  fever 
from  malaria;  and  others  again  thought  that  it  must  be  a 
disease  of  a  quite  new  kind  :  but  at  last  the  general  opinion 
agreed  that  it  was  true  Asiatic  cholera,  the  same  that  has 
been  seen  in  Egypt  on  other  occasions. 

There  cannot  be  the  slightest  doubt  of  the  nature  of  the 
disease  in  the  mind  of  anyone  who  has,  even  once  only,  seen 
cholera,  as  both  the  symptoms  in  the  patients  and  the 
anatomo-pathological  alterations  found  in  the  dead  body 
have  been  the  same  that  are  generally  described  and  seen 
in  true  cholera. 

The  question  as  to  its  origin  is  more  difficult  to  resolve. 
Thus,  the  opinions  that  have  always  divided  the  medical 
world  about  the  origin  of  epidemics  arose  in  this  instance. 
Has  the  disease  come  from  without,  brought  by  travellers  or 
goods  coming  from  India?  or  has  it  developed  from  bad  local 
conditions  ?  The  origin  of  cholera  in  any  epidemic  has  been 
constantly  discussed,  and  with  little  profit;  and  the  question 
is  still  one  to  be  solved.  This  time  also  there  are  the  con- 
tagionists  and  the  epidemiologists,  the  believers  in  rigorous 
quarantine  measures,  and  the  upholders  of  sanitary  works  to 
improve  the  conditions  of  the  country.  In  this  state  of 
things  is  it  not  better  to  have  recourse  to  both  kinds  of 
measures,  with  the  view  of  better  preventing  the  diffusion  of 
the  disease  ? 

There  is  no  doubt  that  the  sanitary  conditions  of  Egypt 
are  very  bad,  and  at  a  level  lower  than  the  apparent  degree 
of  civilisation  of  the  country  would  lead  anyone  to  suppose. 
No  drainage,  no  system  of  sewers,  bad  habitations,  bad 
feeding  among  the  lower  classes,  general  dirtiness,  foul  water 
for  drinking,  bad  exhalations  of  every  kind,  and  especially 
from  dead  bodies,  both  human  and  animal, — these  are  all 
conditions  that  explain  the  facility  and  rapidity  with  which 
any  epidemic  disease  would  spread.  But  as  to  whether  the 
germ  of  the  disease  must  have  been  brought  from  without, 
or  remains  hidden  in  the  soil  waiting  the  opportunity  for 
developing  itself,  is  a  problem  less  easy  of  solution.  There 
is  no  doubt  that  in  Egypt  in  the  first  half  of  the  year  a 
dreadful  epizoic  prevailed  among  the  cattle,  and  that  the 
dead  bodies  were  principally  thrown  into  the  Nile  and  its 


canals,  and  that  this  was  the  cause  of  the  bad  condition  of 
water  that  obtained  in  the  summer — in  fact,  the  micro¬ 
scopical  examination  of  the  deposit  of  the  Nile  water  never 
showed  such  large  numbers  of  dead  bodies  of  daphnie,  with 
bacteria  and  micrococci,  as  were  seen  this  year  about  the 
beginning  of  July,  when  the  Nile  water  was  to  be  compared 
to  the  water  of  a  stagnant  pool.  Add  the  consequences 
of  the  insurrection  and  war,  and  you  will  confess  that 
the  best  conditions  for  giving  rise  to  an  epidemic  have 
been  present.  Certainly  we  have  no  facts  sufficient  to  prove 
that  cholera  had  never  left  Egypt  since  the  epidemic  of 
1865,  and  that  it  can  be  considered  as  endemic  in  the 
country.  But  we  cannot  deny  that  Egypt  offers  conditions 
very  like  those  of  India,  and  that  there  is  nothing  more; 
probable  than  that  the  germs  of  cholera  may  find  here  as. 
good  a  soil  to  maintain  themselves  and  develope  as  in  the 
valley  of  the  Ganges.  There  are,  indeed,  many  points  of 
resemblance  between  India  and  Egypt.  Both  countries- 
belong  to  hot  climates  ;  in  both  we  have  large  classes  of 
persons  who  live  in  defiance  of  the  commonest  rules  of 
hygiene,  especially  as  regards  cleanliness  and  choice  of  food ; 
both  are  traversed  by  large  rivers,  into  which  is  thrown 
every  kind  of  organic  matter  in  a  state  of  decomposition, 
and  from  such  sources  especially  the  lower  classes,  and 
animals  generally,  derive  their  drinking-water;  and  both 
countries  have  many  parasitical  diseases  in  common.  All 
this  shows  the  necessity  in  Egypt  for  resorting  to  sanitary 
works  such  as  those  which  have  succeeded  in  improving 
the  state  of  health  of  many  towns  of  India.  To  obtain 
this  it  is  necessary  to  reform  the  sanitary  administration, 
to  render  it  quite  independent  of  the  local  government,  and 
to  put  at  its  head  a  man  of  sufficient  energy  to  triumph 
over  the  natural  inertia  and  passive  opposition  of  the  native 
administrators. 


OBITUARY. 

- ♦ - 

ROBERT  BOYD,  M.D.  Edin.,  F.R.C.P.  Lond.,  M.R.C.S- 

Dr.  Robert  Boyd,  whose  sad  but  noble  death,  at  the  age 
of  seventy -five,  we  have  already  briefly  recorded,  was  one  of 
the  most  indefatigable  and  eminent  workers  in  psycho¬ 
logical  medicine  ;  and  his  death  will  be  deeply  regretted  as  a 
great  loss  to  the  public,  to  the  profession,  and  especially  to 
that  department  of  it  to  the  advancement  and  practice  of 
which  he  devoted  his  talents  and  industry. 

Dr.  Boyd  became  a  Member  of  the  Royal  College 
of  Surgeons  of  England  in  the  year  1830,  and  in  the 
following  year  he  graduated  as  Doctor  of  Medicine  in 
the  University  of  Edinburgh.  In  1836  he  became  a 
Licentiate  of  the  Royal  College  of  Physicians,  London, 
and  in  1852  was  elected  to  the  Fellowship  of  the  College. 
He  filled,  with  great  success  as  a  practical  physician, 
and  with  remarkable  industry  and  energy  as  a  worker  at 
pathology,  and  a  careful  collector  of  statistics,  several 
important  appointments.  He  was  for  some  time  Resident 
Physician  at  the  Marylebone  Workhouse  Infirmary;  after¬ 
wards  Physician  and  Superintendent  of  the  Somerset  County 
Lunatic  Asylum  ;  and  then  proprietor  and  manager  of  the 
Southall  Park  Private  Asylum;  and  he  never  failed  to  use¬ 
fully  his  opportunities  for  original  research.  He  held  strongly 
the  opinion  that  the  workhouse  infirmaries,  as  established 
under  the  Metropolitan  Poor-Law  Act  of  Mr.  G.  Hardy 
(now  Lord  Cranbrook),  afforded  great  opportunities  of  study 
to  junior  qualified  medical  men  and  students.  And  in  his 
Presidential  address  to  the  Medico- Psychological  Associa¬ 
tion,  in  1870,  he  insisted  on  this,  remarking  that  that  Act 
recognised  the  admission  of  students  to  the  infirmaries, 
and  added— “A  student  will  therefore  have  an  oppor¬ 
tunity  of  observing  cases  as  they  are  met  with  in  pri¬ 
vate  practice ;  and,  from  the  mortality  resulting  from 
the  great  number  of  aged  and  infirm  persons  in  such 
institutions,  he  will  have  an  excellent  opportunity  of 
acquiring  a  knowledge  of  morbid  anatomy.  The  wards 
set  apart  for  lunatics  would  also  be  most  useful,  as  in  some 
degree  supplying  a  deficiency  in  medical  education,  namely, 
the  study  of  insanity — a  knowledge  of  which  is  so  essential 
in  practice,  amongst  the  poor  especially.”  That  Dr.  Boyd 
practised  with,  great  diligence  what  he  thus  recommended  — 
viz.,  the  earnest  use  of  all  opportunities  of  study  that  came 
in  his  way— is  proved  by  his  very  numerous  contributions  to- 


250 


Medical  Times  and  Gazette. 


OBITUARY. 


Sept.  1. 1883. 


the  literature  of  pathology  and  psychological  medicine.  He 
published  annual  “  Reports  on  the  Pauper  Lunatics  ”  at  the 
St.  Marylebone  Infirmary  and  the  County  Somerset  Asylum ; 
and  was  the  author  of  “  Pathological  Contributions  ”  to  the 
Royal  Medical  and  Chirurgical  Transactions,  vols.  xxiv.  and 
xxxii.,  and  to  the  Edinburgh  Medical  Journal,  vols.  lv.  to 
Ixxii. ;  of  “  Tables  of  the  Weights  of  the  Human  Body  and  In¬ 
ternal  Organs,”  published  in  the  Philosophical  Transactions ; 
and  of  a  paper  on  “The  Weight  of  the  Brain  at  Different 
Ages  and  in  Various  Diseases,”  read  before  the  British  Medi¬ 
cal  Association  in  1875.  Papers  from  him  on  “  Vital  Statis¬ 
tics,”  on  ‘'“Insanity,”  on  “Diseases  of  the  Nervous  System,” 
and  on  cognate  subjects,  also  appeared  in  other  journals; 
but  the  larger  number  of  his  contributions  were  published 
in  the  pages  of  the  Journal  of  Mental  Science.  The  most 
important,  perhaps,  and  most  valuable  of  all  his  contribu¬ 
tions  to  medical  science  is  his  article  on  General  Paralysis 
of  the  Insane,  published  in  the  Journal  of  Mental  Science 
in  May  and  October,  1871.  He  made  most  careful  post¬ 
mortem  examinations  in  the  cases  of  155  deaths  from  that 
affection  in  the  Somerset  County  Asylum,  examining  the 
condition  of  the  spinal  cord,  as  well  as  of  the  brain  and 
other  organs,  microscopically  as  well  as  by  the  naked  eye  ; 
and  through  these  laborious  examinations  he  largely  ad¬ 
vanced  our  knowledge  of  the  pathology  of  the  disease. 
To  the  same  journal  he  contributed  a  paper  on  “  Tumours  of 
the  Brain,”  one  of  the  results  of  1039  post-mortem  examina¬ 
tions  made  in  the  St.  Marylebone  Infirmary,  and  875  made 
in  the  Somerset  County  Asylum ;  and  papers  on  the  “  Care 
and  Treatment  of  the  Insane  Poor,”  on  “  Causes  of  Death  in 
Chronic  Insanity,”  and  many  other  subjects.  All  his  works 
bore  the  stamp  of  conscientious  care  and  labour,  and  close, 
accurate  observation ;  and  he  carried  the  same  conscientious¬ 
ness  and  thoroughness  into  all  his  actions  ;  he  was  trust¬ 
worthy  and  trusted  as  practitioner  and  friend.  It  will  be 
remembered  that  he  lost  his  life  through  his  eagerness  and 
anxiety  to  save  all  those  under  his  care  in  Southall  Park 
House.  It  is  said  that  he  and  his  son,  Mr.  W.  Boyd,  who 
perished  with  him,  had  been  engaged  in  directing  and  aiding 
the  escape  of  some  of  the  patients  by  means  of  a  ladder 
kept  attached  to  the  outside  of  the  house  for  the  purpose, 
and  might  have  saved  themselves  in  the  same  way,  but 
they  heard  sounds  as  of  some  one  knocking  inside  the 
Rouse,  and  ran  back  into  the  burning  room  to  give  assistance, 
when  the  roof  fell  in,  and  they  were  buried  in  the  ruins. 


JOHN  HENRY  LOFTIE  STONEY,  M.D.,  Q.U.I., 
F.R.C.S.  Ire. 

Almost  suddenly.  Dr.  Loftie  Stoney  passed  away  on  the 
afternoon  of  Sunday,  August  26.  Until  the  Thursday  pre¬ 
ceding  his  death,  he  was  in  the  enjoyment  of  his  usual  good 
health :  a  violent  hsemoptysis  then  set  in  unexpectedly, 
which,  although  checked  bv  the  measures  adopted  by  his 
devoted  and  skilful  medical  attendants,  left  him  so  prostrate 
that  he  sank  quickly  when  the  bleeding  unfortunately  re¬ 
curred  on  Saturday  night.  The  source  of  the  htemorrhage 
is  supposed  to  have  been  an  aneurysm. 

Dr.  Loftie  Stoney,  although  a  comparatively  yon  rig  man, 
had  made  his  mark  as  an  anatomist,  and  as  an  ophthalmic  and 
aural  surgeon.  He  graduated  in  1861  as  Doctor  of  Medicine 
of  the  Queen’s  University  in  Ireland,  and  in  the  same  year 
he  became  a  Licentiate  of  the  Royal  College  of  Surgeons  in 
Ireland,  proceeding  to  the  Fellowship  of  that  body  in  1867. 
For  many  years  he  filled  with  distinction  the  post  of  Oph¬ 
thalmic  and  Aural  Surgeon  to  the  City  of  Dublin  Hospital, 
and  in  1879  he  was  elected  Lecturer  on  Anatomy  in  the 
Carmichael  College  of  Medicine,  Dublin.  His  untimely 
decease  has  caused  deep  sorrow  to  his  many  friends. 


JOHN  ISMAY  ATKINSON,  M.R.C.S.  Eng.,  L.S.A.  Lond. 
Mr.  John  Ismay  Atkinson,  who  died  at  his  residence  in 
Wylam-on-Tyne,  on  August  23,  in  his  sixty-eighth  year, 
will  be  long  and  deeply  regretted  throughout  a  very  wide 
■district  of  Tyneside.  Mr.  Atkinson,  who  was  a  man  of  good 
general  education,  received  his  medical  education  in  Edin¬ 
burgh,  settled  down  in  practice  in  Wylam  some  forty- 
four  years  ago,  and  continued  to  labour  there,  and  through¬ 
out  all  parts  of  the  country  round,  to  the  time  of  his  death. 
He  commanded  great  reputation  as  a  skilful  and  successful 
practitioner  in  the  three  great  departments  of  the  profession 


— medicine,  surgery,  and  midwifery;  and  in  innumerable 
homes  he  was  a  trusted  and  valued  friend,  confidant,  and 
adviser.  In  April  last,  Mr.  Atkinson’s  patients  and  friends 
presented  him  with  a  brougham  and  a  silver  inkstand ;  and 
an  illuminated  address,  stating  that  the  testimonial  was 
presented  to  him  “  as  a  token  of  their  high  appreciation  of 
his  eminent  abilities  as  a  medical  practitioner  of  forty-four 
years’  standing  in  Wylam  and  the  surrounding  district  of 
Tyneside,  who,  by  his  many  excellent  qualities  as  a  pro¬ 
fessional  friend  and  adviser,  his  unwearying  exertions  for  the 
comfort  and  well-being  of  his  numerous  patients,  and  his 
warm-hearted  sympathy  on  all  occasions  of  difficulty  and 
danger,  together  with  his  benevolent  attention  to  the  wants  of 
the  necessitous  poor  of  the  locality,  has  earned  for  himself  the 
general  respect  and  admiration  of  the  community,  amongst 
whom  his  name  is  become  familiar  as  a  household  word.” 
In  thanking  his  friends,  Mr.  Atkinson  employed  phrases 
that  have  proved  mournfully  prophetic — “  I  cannot  but 
look,”  he  said,  “  upon  the  testimonial  as  one  of  the  ‘  mile¬ 
stones  on  the  track  of  time,’  which  remind  me  of  the  length 
of  the  way  that  has  been  travelled,  and  of  the  shorter 
portion  of  the  journey  left  to  be  traversed.”  But  four 
months  have  passed,  and  Mr.  Atkinson’s  journey  in  time  is 
ended ;  but  it  will  be  long  before  his  fame  fades  from  out 
the  Tyneside,  or  his  memory  out  of  the  hearts  of  his  friends 
and  patients. 


SURGEON  PETER  MACPHERSON  GRANT, 
M.B.,  C.M.  Edin.,  B.Sc. 

This  deserving  young  officer,  at  the  age  of  thirty-four,  has 
fallen  an  early  victim  to  the  recent  outbreak  of  cholera  in 
India.  In  the  district  of  Western  Malwah,  where  Dr.  Grant 
was  stationed  as  Medical  Officer  to  the  First  Central  India 
Horse,  the  disease  had  made  its  appearance  by  the  beginning 
of  July,  at  which  time  there  seemed  to  be  little  indication 
of  the  outbreak  assuming  a  serious  form.  On  the  16th  of 
that  month  he  was  called  on  to  attend  a  case  occurring  in 
the  regiment,  while  he  himself  was  suffering  from  the  effects 
of  an  attack  of  malarial  dysentery,  and  on  the  following 
day  he  experienced  some  of  the  premonitory  symptoms  of 
cholera.  These  symptoms  for  a  while  passed  off,  but  re¬ 
curred  with  renewed  violence  on  the  morning  of  the  18th, 
and  death  took  place  early  on  the  morning  of  the  22nd. 

Dr.  Grant  had  been  in  the  Indian  Medical  Service  since 
1877,  and,  during  his  short  career,  had  earned  for  himself 
in  a  high  degree  the  respect  and  affection  of  his  fellow- 
officers  and  of  the  men  of  the  various  regiments  to  which  he 
had  been  attached,  as  much  on  account  of  the  untiring 
attention  he  bestowed  on  those  under  his  care,  whether 
native  or  European,  as  on  account  of  his  professional  skill 
and  attainments.  He  received  his  education  at  the  Uni¬ 
versity  of  Edinburgh,  in  which  city,  after  taking  the  degrees 
of  M.B.  and  C.M.  in  1870,  he  held  various  hospital  appoint¬ 
ments.  He  afterwards  spent  some  time  in  Berlin  and 
Vienna,  in  order  to  perfect  his  knowledge  of  the  diseases  of 
the  larynx,  with  the  view  of  devoting  himself  specially  to 
that  department  of  medical  science.  He  was,  however, 
subsequently  induced  to  turn  his  attention  to  the  Indian 
Medical  Service,  into  which  he  gained  admission  in  1876, 
ranking  high  in  the  list  both  at  the  entrance  examination 
and  at  Netley.  Before  leaving  for  India  he  took  the  B.Sc. 
degree  in  Public  Health  at  Edinburgh  in  1877.  His  first 
station  in  India  was  at  Mian  Mir,  and  towards  the  end  of 
1877  he  accompanied  the  troops  against  the  Jowaki  Afridis, 
when  he  served  with  distinction.  On  the  cessation  of  hostilie 
ties  he  took  duty  on  the  Cashmere  frontier,  among  the  fugi¬ 
tives  from  the  famine  at  that  time  existing  in  the  Cashmere 
Valley,  and  while  engaged  on  this  service  contracted  typhus 
fever,  to  which  he  nearly  succumbed.  On  his  recovery  he  was 
attached  to  the  Central  India  Horse,  and  in  1880,  during 
the  war  in  Afghanistan,  served  for  some  time  as  surgeon  on 
General  Roberts's  staff,  and  afterwards  received  the  respec¬ 
tive  medals  for  this  and  for  the  Jowaki  campaign.  During 
his  career  in  the  Service,  Surgeon  Grant  had  the  happiness 
of  gaining  the  esteem  and  affection  of  those  with  whom  he 
was  brought  in  contact,  for  his  genuine  goodness  of  heart 
and  never-failing  considerate  attention  to  all. 


Apothecaries’  Hale,  London. — The  examination  in 
Arts  for  registration  of  medical  students  takes  place  on 
Thursday,  Friday,  and  Saturday,  September  13,  14,  and  15. 


Medical  Times  and  Gazette. 


MEDICAL  NEWS. 


Sept.  1,1883.  25 1 


MEDICAL  NEWS. 

-  •+.. - - 

University  of  London. — The  following  is  a  list  of 
candidates  who  passed  at  the  recent  examinations : — 

Intermediate  Examination  in  Medicine. 

ENTIRE  EXAMINATION. 

First  Division. — Charles  Edward  Adams,  University  College ;  Samuel 
King  Alcoek,  St.  Bartholomew’s  Hospital ;  Frank  Hugh  Barendt,  Royal 
Infirmary  School  of  Medicine  and  University  College,  Liverpool ;  John 
Oglethorpe  "Wakelin  Barratt,  B.Se.,  Mason  and  Queen’s  Colleges,  Bir¬ 
mingham  ;  William  Leonard  Braddon,  Guy’s  Hospital ;  Albert  Carless, 
Kings  College;  Eustace  Rhodes  St.  Clair  Corbin,  University  College; 
William  Kelynack  Dale,  King’s  College;  Arthur  Frederick  Davenport, 
University  of  Edinburgh  and  University  College;  Edmond  Lucien  de 
Ohazal,  University  College  ;  Leonard  Maurice  Gabriel,  St.  Bartholomew’s 
Hospital;  Edwin  Goodall,  Guy’s  Hospital ;  William  John  Gow,  St.  Bar¬ 
tholomew’s  Hospital ;  John  Power  William  Gray,  King’s  College;  George 
Ezra  Halstead,  B.A.,  B.Se.,  Guy’s  Hospital;  Franke  Chamberlain  Hart- 
Smith,  University  College ;  Frank  Hichens,  London  Hospital ;  J ohn 
Stuart  Hutton,  St.  Thomas’s  Hospital;  Raymond  Johnson,  University 
College;  Sydney  Harold  Jones,  St.  Thomas’s  Hospital;  Hugh  Cameron 
Kidd,  St.  Thomas’s  Hospital ;  Frederic  Charles  Larkin,  Royal  Infirmary 
School  of  Medicine  and  University  College,  Liverpool;  Frederick  Lever, 
Guy’s  Hospital ;  George  Hyde  Melson,  Queen’s  and  Mason  Colleges,  Bir¬ 
mingham;  Alfred  Edward  Price,  Guy’s  Hospital;  Frederick  Osmund 
Stedman,  Charing-cross  Hospital ;  George  Stevenson,  St.  Bartholomew’s 
Hospital;  Edgar  Herbert  Thane,  University  College ;  John  Wychenford 
Washbourn,  Guy’s  Hospital;  Robert  Briggs  Wild,  Owens  College ;  William 
Alfred  Wills,  Westminster  Hospital. 

Second  Division— William  Arthur  Aikin,  Guy’s  Hospital ;  William 
Henry  Bailey,  St.  Bartholomew’s  Hospital ;  Sidney  Barwise,  Queen’s  and 
Mason  Colleges,  Birmingham;  Eustace  Frederick  Bright,  University 
College ;  James  Calvert,  B.  A.,  St.  Bartholomew’s  Hospital ;  Letterstedt 
Frederick  Childe,  Guy’s  Hospital ;  Joseph  Clegg,  Owens  College  ;  Frederick 
Edge,  Owens  College  ;  Frederick  Gault  Finley,  Owens  and  McGill  Colleges  ; 
Henry  Willoughby  Gardner,  St.  Bartholomew’s  Hospital ;  Edward  Wil- 
berforce  Goodall,  Guy’s  Hospital ;  Joseph  George Harsant,  Guy’s  Hospital; 
Francis  Heatherley,  Guy’s  Hospital ;  Robert  Lawson,  St.  Thomas’s  Hos¬ 
pital  ;  Priestley  Leech,  Owens  College;  John  Marriott,  Charing-cross 
Hospital ;  Frederick  William  Morison,  St.  Bartholomew’s  Hospital ; 
Edward  Pain  Mourilyan,  Guy’s  Hospital ;  Charles  Drummond  Muspratt, 
Guy’s  Hospital;  Francis  Horatio  Napier,  St.  Bartholomew’s  Hospital; 
Patrick  Moriarty  O’Brien,  Royal  Infirmary  School  of  Medicine  and  Uni¬ 
versity  College,  Liverpool ;  Mary  Elizabeth  Pailthorpe,  London  School  of 
Medicine  for  Women  and  Royal  Free  Hospital;  Samuel  Esmond  Prall, 
Guy’s  Hospital;  Alfred  Martin  Sutton,  Guy’s  Hospital ;  Benjamin  Wilfred 
Thomas,  Charing-cross  Hospital ;  Alfred  William  Hinsley  Walker,  Owens 
College ;  Frank  Joseph  Wethered,  Bristol  Medical  School ;  Patrick  Watson 
Williams,  Bristol  Medical  School. 

EXCLUDING  PHYSIOLOGY. 

First  Division. — Walter  Essex  Wynter,  Middlesex  Hospital. 

Second  Division.— Charles  Kingsley  Ackland,  King’s  College  ;  Edward 
Roberts.  Guy's  Hospital ;  Charles  Henry  Taylor,  King’s  College ;  Reginald 
Muzio  Williams,  St.  Thomas’s  Hospital. 

PHYSIOLOGY  ONLY. 

First  Division. — Freeland  John  Freeland,  King’s  College. 

Second  Division. — George  Alfred  Carpenter,  St.  Thomas’s  Hospital ; 
Alfred  Owen  Lankester,  St.  Bartholomew’s  Hospital ;  William  Herbert 
Lister  Marriner,  St.  Thomas’s  Hospital. 

Examination  eor  Honours. 

ANATOMY. 

First  Class. — Edgar  Herbert  Thane  (Exhibition  and  Gold  Medall,  Uni¬ 
versity  College;  Raymond  Johnson  (Gold  Medal),  University  College; 
John  Wychenford  Washbourn,  Guy’s  Hospital. 

Second  Class.—  Edward  Wilberforce  Goodall,  Guy’s  Hospital,  and  Franke 
Chamberlain  Hart-Smith,  University  College,  equal ;  Robert  Briggs  Wild, 
Owens  College  ;  John  Power  William  Gray,  King’s  College;  George  Ezra 
Halstead,  B.A.,  B.Se.,  Guy’s  Hospital ;  William  Alfred  Wills,  Westminster 
Hospital. 

Third  Class. — Arthur  Frederick  Davenport,  University  of  Edinburgh 
and  University  College ;  Sydney  Harold  Jones,  St.  Thomas’s  Hospital. 

MATERIA  MEDICA  AND  PHARMACEUTICAL  CHEMISTRY. 

First  Class. — Raymond  Johnson  (Exhibition  and  Gold  Medal),  Univer¬ 
sity  College;  Edgar  Herbert  Thane, (a)  University  College;  James 
Calvert, (a)  B.A.,  St.  Bartholomew’s  Hospital,  Albert  Carless, (a)  King’s 
College,  Eustace  Rhodes  St.  Clair  Corbin,  (a)  University  College,  equal  ; 
Frederick  Gault  Finley,  Owens  and  McGill  Colleges,  Henry  Willoughby 
Gardner,  St.  Bartholomew’s  Hospital,  William  John  Gow,  St.  Bartholo¬ 
mew’s  Hospital,  and  George  Stevenson,  St.  Bartholomew’s  Hospital, 
equal ;  William  Leonard  Braddon,  Guy’s  Hospital,  Arthur  Frederick 
Davenport,  University  of  Edinburgh  and  University  College,  Robert 
Briggs  Wild,  Owens  College,  and  William  Alfred  Wills,  Westminster 
Hospital,  equal. 

Second  Class.— Frank  Hichens,  London  Hospital,  Priestley  Leech.  Owens 
College,  Charles  Drummond  Muspratt,  Guy’s  Hospital,  and  J  ohn  Wychen¬ 
ford  Washbourn,  Guy’s  Hospital,  equal;  Letterstedt  Frederick  Childe, 
Guy’s  Hospital. 

Third  Class.  —  Frederick  Osmund  Stedman,  Charing-cross  Hospital; 
Frank  Hugh  Barendt,  Royal  Infirmary  School  of  Medicine  and  Univer¬ 
sity  College,  Liverpool,  and  Frederick  Lever,  Guy’s  Hospital,  equal. 

ORGANIC  CHEMISTRY. 

First  Class.— John  Wychenford  Washbourn  (Exhibition  and  GoldMedal), 
Guy’s  Hospital  ;  Frank  Hichens,  (b)  London  Hospital,  and  George 
Stevenson, (b)  St.  Bartholomew’s  Hospital,  equal. 

Second  Class.  George  Ezra  Halstead,  Guy’s  Hospital ;  William  Leonard 
Braddon,  Guy’s  Hospital. 


(a)  Obtained  the  number  of  marks  qualifying  for  the  Exhibition  and 
Medal. 

(b)  Obtained  the  number  of  marks  qualifying  for  a  medal. 


PHYSIOLOGY  AND  HISTOLOGY. 

First  Class. — Robert  Briggs  Wild  (Exhibition  and  Gold  Medal),  Owena 
College ;  Edgar  Herbert  Thane  (Gold  Medal),  University  College. 

Second  Class.—  Eustace  Frederick  Bright,  University  College  ;  Frederick 
Gault  Finley,  Owens  and  McGill  Colleges  ;  William  Leonard  Braddon, 
Guy’s  Hospital ;  William  John  Gow.  St.  Bartholomew’s  Hospital ;. 
Raymond  Johnson,  University  College;  Priestley  Leech,  Owens  College. 

Third  Class.— Frederick  Lever,  Guy’s  Hospital;  Patrick  Moriarty 
O’Brien,  Royal  Infirmary  School  of  Medicine  and  University  College,. 
Liverpool ;  Frederick  Edge,  Owens  College. 

Intermediate  Science  and  Preliminary  Scientific  (M.B.)  conjointly, 

INORGANIC  CHEMISTRY. 

First  Class.—  Ernest  Henry  Starling  (Prel.  Sei.),  [Exhibition,]  Guy’s  Hos¬ 
pital ;  Frederick  Henry  Hatch  (cl  (Int.  Sc.),  University  College  ;  William 
Popplewell  Bloxam  (Int.  Sc.),  King’s  College  ;  John  Lloyd  Roberts  (Prel. 
Sci.),  Guy’s  Hospital. 

Second  Class.—  G.  Whitefield  Sutherland  (B.A.  Syd.,  Prel.  Sci.),  Uni¬ 
versity  of  Edinburgh  and  University  College  ;  Hugh  Richard  Jones  (Int. 
Sc.),  Liverpool  Institute  and  St.  John’s  College,  Cambridge;  Otto 
Christopher  Overbeck,  J.G.L.  (Int.  Sc.),  University  College. 

Third  Class.—  Percy  Ashworth  (Prel.  Sci.),  Owens  College,  George  Black 
(Prel.  Sci.),  Guy’s  Hospital,  and  Frederick  Howard  Taylor  (Prel.  Sci.), 
London  Hospital  and  private  study,  equal ;  Evelyn  Oliver  Ashe  (Prel.  Sci.),. 
Owens  College,  Cecil  Whitehall  Cooke  (Prel.  Sci.),  St.  Thomas’s  Hospital, 
and  George  Edward  Rennie  (B.A.  Syd.,  Prel.  Sci.),  University  College, 
equal ;  Walter  Harris  (Int.  Sc.),  Bradford  Grammar  School  and  private 
tuition;  Alfred  Ernest  Field  (Int.  Sc.),  Trinity  College,  Oxford;  Philip- 
Henry  Hensley  (Prel.  Sci.),  King’s  College. 

EXPERIMENTAL  physics. 

First  Class. — John  Buchanan  (Int.  Sc.),  [disqualified  by  age  for  the- 
Arnott  Exhibition  and  Medal],  University  and  King’s  Colleges ;  Ernest 
Henry  Starling  (Prel.  Sei.),  Guy’s  Hospital. 

Second  Class.— John  Lloyd  Roberts  (Prel.  Sci.),  Guy’s  Hospital ;  Edward 
George  Baker  (Int.  Sc.),  private  study. 

Third  Class.—  John  Maxwell  Finnegan  (Int.  Sc.),  Queen’s  College, 
Belfast,  and  private  tuition;  Mary  Madeline  Adamson  (Int.  So.),  Bedford 
College,  London,  and  Jesse  Mary  Chambers  (Int.  Sc.),  private  study,  equal 
Hugh  Richard  Jones  (Int.  Sc.),  Liverpool  Institute  and  St.  John’s  College, 
Cambridge;  Percy  Ashworth  (Prel.  Sci.),  Owens  College;  Henry  Edward 
Whitehead  (Prel.  Sci.),  St.  Bartholomew’s  Hospital. 

BOTANY. 

First  Class. — Robert  William  Boyce  (Prel. Sci.),  [Exhibition],  University- 
College;  Ernest  Henry  Starling(c)  (Prel.  Sci.),  Guy’s  Hospital;  Charles 
Hermann  Fernau  (Prel.  Sci.).  University  College. 

Second  Class.— Llewellyn  William  Powell  (Prel.  Sci.) ,  University  College  ; 
James  Edward  Huxley  Blake  (Prel.  Sci.),  Mason  College,  Birmingham-, 
John  Gardiner  (Prel.  Sci.),  Owens  College  ;  Edward  George  Baker  (Int. 
Sc.),  private  study. 

Third  Class.—  Edwin  Birchall  Hastings  (Prel.  Sci.),  University  College. 

ZOOLOGY. 

First  Class.— George  Edward  Rennie  (Prel.  Sci.),  University  Colleger 
Charles  Hermann  Fernau  (Prel.  Sci.),  University  College. 

Second  Class.— Albert  Edward  Brindley  (Prel.  Sci.),  Owens  College ;  John 
Gardiner  (Prel.  Sci.),  Owens  College. 

Third  Class.— Arthur  Ellis  Durham  (Prel.  Sci.),  University  College,  and 
Frank  Lomas  Wood  (Prel.  Sci.),  Owens  College,  equal. 


University  of  Aberdeen. — During  the  past  year- 
the  following  candidates  received  degrees  in  Medicine  and’ 
Surgery :  — 

The  Degree  of  M.D. 

John  Barratt,  M.B. ,  C.M.,  P.  and  O.  Service;  Harry  Arthur  Benham, 
M.B.,  C.M.,  Dundee  Royal  Asylum ;  Algernon  Aaron  Cohen,  M.B.,  C.M., 
Burwash,  Sussex;  Alexander  Downie  Diaek,  M.B. ,  C.M.,  Fort  Beaiifort, 
Cape  Colony;  John  Murray  Gibbea,  M.B  ,  O.M. ;  8kene  Gordon,  M.B., 
C.M.,  South  Africa;  Alexander  Hill  Griffith,  M.B.,  C.M.,  Royal  Eye- 
Hospital.  Manchester;  Robert  Harvey,  M.B.,  C.M.,  Professor  of  Mid¬ 
wifery,  Medical  College  of  Beogal,  Honorary  Surgeon  to  H.E.  the  Viceroy 
of  India ;  Frederick  Mortimer  Hawkins,  M.B.,  C.M.,  London ;  George- 
Robert  MacGregor,  M.B.,  C.M  ,  Bingley;  Charles  Mitchell  MacQuibban, 
M.B.,  C.M.,  Aberdeen:  John  Ramage,  M.B.,  C.M.,  British  Seamen’s- 
Hospital,  Cronstadt ;  William  Reid,  M.B.,  C.M.,  Kensington,  London; 
Charles  Boards  Richardson,  M.B. ,  C.M.,  Brighton;  John  Ruxton,  M.B.* 
C.M.,  Blackpool,  Lancashire;  William  Dyne  Steel,  M.B.,  C.M. .  Aber¬ 
gavenny ;  David  Tulloch,  M.B.,  C.M  *  Winnipeg,  Canada;  John  Michael 
Augustus  Wallis,  M.B.,  C.M.  Whittingham,  Preston;  Charles  Lindsay 
Wattie,  M.B.,  C.M..  Inverkindie  ;  Alexander  JohnWillcocks,  M.B.,  C.M.,. 
Bulandshaler,  N.W.P.  India. 

The  Degrees  of  M.B.  and  C.M. 

John  Baker,  Aberdeen  ;  Robert  Milne  Beaton,  Aberdeen ;  Alfred  Brown  * 
M. A.,  Welshpool;  George  Buchan,  Aberdeen ;  Sylvester  John  Cole,  Free- 
town,  Sierra  Leone;  Henri  Cook,  Greenock;  Alexander  Cowley,  Dublin 
George  Forsyth  Ashley  Da  Costa,  Kingston,  J amaica ;  Francis  Falconer , 
M.A.,  Aberdeen;  James  Thomson  Fraser,  Longsight,  Manchester  ;  John 
Gerard,  M.A.,  Aberdeen;  Henry  Gibbons,  Kurrachee,  India;  John  Gordon, 
Aberdeen:  George  Grant,  Keith ;  John  Gregory,  Bridge  of  Don  ;  Andrew 
Hosie,  Aberdeen  ;  John  Inglis,  M.  A.,  Aberdeen  ;  David  Ireland,  Brechin  , 
Charles  Jeffrey,  Tarland;  George  Johnston,  Fintray;  Thomas  Mair 
Johnstone,  Ellon  :  Louis  Joseph,  Colombo,  Ceylon ;  John  BamfordKerr, 
Crawshawbooth,  Manchester ;  Alexander  Walker  Knox,  Aberdeen  ;  James 
Logie,  Huntly ;  James  Francis  Macdonald,  Aberfeldy ;  John  Norman 
Emslie  Maclennan,  Lumphauan;  Cyril  James  Mansfield,  Ryde,  Isle  oi 
Wight;  John  Matheson,  M.A.,  Plockton,  Ross-shire ;  Frederic  Maude,. 
Highgate,  London  ;  John  M’Corabie,  Oxton,  Morayshire  ;  Wm.  McKenzie, 
M  V  ,  Fochabers ;  Grenville  Edwin  Moffett,  Calcutta ;  Jame3  Moir,  bt, 
Kilda,  Victoria ;  John  Drew  Moir,  St.  Kilda,  Victoria;  William  Moir,. 
Aberdeen;  James  Murray,  Naira;  Alexander  Nicoll,  Rhyme;  David 
Petty,  Montrose  ;  David  Prain,  M.A.,  Fettercairn;  James  Robert  Purdy,, 
Morpeth;  Richard  Rees,  Aberdovey ;  James  Robertson  Reid,  Aberdeen  ; 


(c)  Obtained  the  number  of  marks  qualifying  for  the  exhibition  or  prize-. 


252 


Me  iieal  Times  and  Gazette. 


MEDICAL  NEWS, 


Sept.  1,  1883. 


Alexander  Rennie,  M.A.,  Wester  Fintray;  Janies  Taylor  Robb,  Keith; 
James  Alexander  Ross,  Aberdeen  ;  William  Scott,  Auchairn,  Keith  ;  John 
■George  Scroggie,  Aberdeen  ;  William  John  Henderson  Sinclair,  Dunbeath, 
Wick;  Alexander  Gillespie  Smith,  M.A.,  Torphins ;  James  Lawrence 
Smith,  Aberdeen ;  William  Allan  Stewart,  Buxburn,  Newhills ;  George 
Gardno  Still,  Aberdeen;  James  Struthers,  Aberdeen  ;  James  Taylor,  M.A., 
New  Deer;  James  Longmore  Taylor,  M.A.,  Cullen;  Alexander  Philip 
Thom,  Durris,  Kincardineshire ;  George  John  Kemp  Turner,  Ellon ;  John 
Turner,  Portsmouth ;  George  Vincent,  Bedfont,  Middlesex ;  Robert 
Walford,  Colchester;  Arthur  Meredith  Whitehead,  Nottingham. 

Of  the  above-named  candidates,  David  Prain,  M.A.» 
received  his  degrees  in  Medicine  and  Surgery  with  highest 
academical  honours ;  John  G-erard,  M.A.,  David  Ireland, 
James  Francis  Macdonald,  Alexander  Rennie,  M.A.,  and 
William  Scott  received  their  degrees  in  Medicine  and 
Surgery  with  honourable  distinction.  At  the  same  time, 
Charles  Alexander  Butchart,  William  Kelty,  William 
Barclay  Livermore,  Alexander  Reid,  William  Ledingham 
Buxton,  and  Arthur  Greatorex  Smith  were  certified  as 
having  passed  all  the  examinations,  but  did  not  graduate  ; 
and  the  following  candidates  are  now  declared  to  have  passed 
the  First  Division  of  the  First  Professional  Examination : — 

James  Richardson.  Anderson,  Henry  Angus,  Charles  Arthur  Arnold, 
Thomas  Charles  Bennett,  John  Fairbaim  Binnie,  Peter  Cameron,  Arthur 
Wilson  Chapman,  Alexander  Forbes  C.  Clark,  Frank  Lang  Collie,  Ernest 
George  Coward,  Alexander  W.  Dalgarno,  William  Alfred  Season,  Thomas 
Einlayson  Dewar,  William  Diack,  George  Hubert  Ede,  William  Boucher 
Evaftis?  George  Findlay,  Alexander  Forbes,  Arthur  Daniell  Forbes,  Charles 
Frederick  Forbes,  Henry  Farquharson  Forbes,  James  Fraser,  James 
Winton  Fraser,  Thomas  Henderson  Fyfe,  George  Henry  Grant,  William 
GffeiA  Alexander  N.  Grieve,  James  Hall,  Alexander  G.  R.  Ingram, 
Alexander  Innes,  Alexander  Seymour  Jameson,  Donald  G.  G.  Macdonald, 
George  B.  D.  Macdonald,  Alfred  Maekay,  Leslie  Samuel  Manning,  Edmund 
Thomas  Martin,  William  Milligan,  Alexander  Milne,  Robert  Morrison, 
Stephen  Morison,  James  Nicol,  Patrick  John  Nicoll,  Alexander  A.  Philip, 
Gharles  Reid,  George  Marr  Reid,  John  Russell,  William  Corke  Sheard, 
Robert  Smith,  Charles  Henry  J.  Souter,  John  Souter,  Robert  B.  Tydd 
Stephenson,  Herman  B.  T.  Symons,  John  Taylor,  James  Thomson, 
William  Donald  TJrquhart,  Frederick  William  Walker,  Cresswell  Fitz- 
herbert  White,  George  Williamson,  George  Nicol  Wilson,  Adolph  Zimpel. 

The  following  candidates  to  have  completed  the  First 
Professional  Examination  :  — 

Alexander  de  Wet  Allan,  John  Barclay,  Alfred  Tennyson  Brown, 
William  Robert  Cheves,  John  Duncan,  Frederick  Arthur  Foy,  Thomas 
Best  Gibson,  James  William  M.  Gunn,  Philip  James  Lumsden,  John 
Mackenzie,  Archibald  D.  Mackinnon,  John  Maclean,  John  Malcolm, 
George  Leslie  H.  Milne,  Thomas  George  Paterson,  David  Taylor. 

The  following  candidates  to  have  passed  the  Second 
Professional  Examination : — 

Francis  Alexander  Bennet,  James  Wilson  Bett,  John  Harley  Brooks, 
Gregor  Burgess,  James  Forsyth  Craig,  Henry  M.  Cyril  Dalton,  Alexander 
Gordon  Davidson,  James  Steel  Dickie,  Alexander  Gordon  Davidson, 
James  Steel  Dickie,  Alexander  Gray  Duguid,  John  Charles  D.  Irvine, 
William  Leith,  Andrew  Anderson  Maclennan,  Donald  McLeod,  George 
Milne,  James  Mitchell,  Irvine  Kempt  Reid,  Alfred  Ernest  Roberts, 
William  Robertson,  John  Russell,  James  Savege,  William  Booth  Skinner, 
Leslie  Fyfe  Walker,  James  Will,  James  Martin  Young. 


Apothecaries’  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday, 
August  23  : — 

Abbott,  Frederick  Ernest,  The  Manse,  Penrith. 

Alsop,  Clement,  Teignmouth. 

Cheves,  James  Trelawny,  Millbrook,  Devonport. 

Gibbon,  Frederick  William,  Seaham,  co.  Durham. 

Larkin,  Arthur  Ernest,  St.  Thomas’ s-terrace,  Southwark. 

Rhabha,  Rev.  Shapurji  Dadabhai,  Q,ueen’s-road,  Norland-square,  W. 
Robinson,  Louis,  Saddlescombe,  Sussex. 

Smithwick,  Thomas,  Middleton,  Cork. 

The  following  gentlemen  also  on  the  same  day  passed  their 
Primary  Professional  Examination  : — 

Roberts,  George  Augustus  Edward,  Middlesex  Hospital. 

Simpson,  George  Augustus  Garry,  London  Hospital. 


DEATHS. 

Bartlett,  Joseph  James  Henry,  L.R.C.P.,  at  35,  Ladbroke-gardens 
Notting  Hill,  on  August  25,  in  his  44th  year. 


VACANCIES. 

In  the  following  list  the  nature  of  the  office  vacant,  the  qualifications  re¬ 
quired  in  the  candidate,  the  person  to  whom  application  should  be  made 
and  the  day  of  election  (as  far  as  known)  are  stated  in  succession. 

Central  London  Ophthalmic  Hospital,  Gray’s-inn-road,  W.C. — 
Assistant-Surgeon.  Candidates  must  be  Fellows  or  Members  of  the 
Royal  College  of  Surgeons  of  London,  Edinburgh,  or  Dublin,  and  must 
produce  certificates  of  having  attended  the  practice  of  some  ophthalmic 
institution  for  at  (least  six  months.  Testimonials  to  be  sent  to  the 
Secretary,  on  or  before  September  8. 

General  Infirmary  at  Gloucester  and  the  Gloucestershire  Eye 
Institution.— House-Surgeon.  Salary  at  the  rate  of  £103  per  annum, 
with  board,  lodging,  and  washing.  Candidates  must  possess  a  medical 
and  surgical  qualification  and  be  registered.  Applications,  with  testi¬ 
monials,  to  be  forwarded  to  the  Secretary  on  or  before  September  1. 


General  Lying-in  Hospital,  York-road,  Lambeth,  S.E.  —  House- 
Physician.  Salary  at  the  rate  of  £50  per  annum,  with  board  and 
residence.  The  post  is  tenable  for  four  months.  Applications  and 
testimonials  tobe  addressed  to  the  Secretary,  at  the  Hospital,  on  or  before 
September  7. 

Hospital  for  Women,  Soho-square,  W.— House-Physician.  [For  par¬ 
ticulars  see  Advertisement.) 

Huntingdon  County  Asylum.— House-Surgeon.  [For  particulars  see 

Advertisement.) 

J ersey  Public  Lunatic  AsYuf-i  —Superintendent  Medical  Officer.  [Fo 
particulars  see  Advertisement.) 

Western  Ophthalmic  Hospital,  155,  Marylebone-road,  W.— Surgeon. 
Candidates  must  be  Members  or  Fellows  of  the  Royal  College  of  Sur¬ 
geons  of  England,  and  have  attended  ophthalmic  practice  for  twelve 
months.  Address,  Secretary,  at  the  Hospital,  on  or  before  September  1. 


UNION  AND  PAROCHIAL  MEDICAL  SERVICE. 

***  The  area  of  each  district  is  stated  in  acres.  The  population  is 
computed  according  to  the  census  of  1881. 

RESIGNATIONS. 

Bedford  Union. — Mr.  Robert  Gibbs  has  resigned  the  Harold  District : 
area  11,004  ;  population  2944 ;  remuneration  by  fees. 

Ormskirk  Union. — Mr.  George  Pilkington  has  resigned  the  North  Meols 
District :  area  14,831 ;  population  43,767  ;  salary  £60  per  annum. 

APPOINTMENTS. 

Abergavenny  Union. — Wm.  D.  Steel,  C.M.,  M.D.,  to  the  Llanarth District. 

Bridport  Union. — Wm.  A.JE.  Hay,  M.R.C.S.  Eng.,  L.S.A.,  to  the  Fourth 
District. 

Skirlaugh  Union.— James  R.  Forrest,  M.R.C.S.  Eng.,  L.S.A.,  to  the 
Brandes  Burton  District. 


How  to  Sleep  in  a  Railway  Carriage. — Many 
weary  persons  have  tried  to  solve  this  problem,  and  have 
tossed  about  for  hours  in  restless  disappointment.  Dr. 
Outten,  a  German  physician,  has  applied  the  laws  of  physi¬ 
ology  to  the  matter,  and  announces  ( Allg .  Central.  Zeitung) 
a  satisfactory  solution.  If  a  person  lies  down  with  the  feet 
towards  the  engine,  the  movement  of  the  train  tends  to 
draw  the  blood  from  the  brain  towards  the  feet,  and  cerebral 
anaemia  is  produced,  and  then  sleep.  If  he  lies  with  his 
head  nearer  the  locomotive  (as  is  the  custom  in  Germany), 
the  movement  of  the  train  produces  a  cerebral  hyperaemia 
incompatible  with  sweet  repose.  Dr.  Outten  has  verified 
his  views  by  many  experiments.  His  directions  are  hardly 
needed  in  America,  where  the  berths  of  sleeping-cars  are 
generally  made  up  so  that  the  position  is  as  indicated  by 
physiology  and  our  German  confrere.  In  this  connexion, 
however,  we  would  say  that  many  persons  are  unaware  of 
the  fact  that  additional  comfort  and  better  sleep  in  travelling- 
can  often  be  obtained  by  judiciously  using  the  bromides. — 
New  York  Medical  Record,  August  4. 


APPOINTMENTS  EOR  THE  WEEK. 


September  1.  Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  1 J  p.m. ;  King’s  College,  1J  p.m. ;  Royal 
Free,  2  p.m.;  Royal  London  Ophthalmic,  11  a. m. ;  Royal  Westminster 
Ophthalmic,  ljp.m.;  St.  Thomas’s,  l^p.m.;  London,  2  p.m. 

3.  Monday. 

Operations  at  the  Metropolitan  Free,  2  p.m.;  St.  Mark’s  Hospital  for 
Diseases  of  the  Rectum.  2  p.m.;  Royal  London  Ophthalmic,  11  a.m.; 
Royal  Westminster  Ophthalmic,  li  p.m. ;  Hospital  for  Women,  2  p.m. 

4.  Tuesday. 

Operations  at  Guy’s,  1J  p.m. ;  Westminster,  2  p.m. ;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  lj  p.m.  ;  West 
London,  3  p.m. _ 

5.  Wednesday. 

Operations  at  University  College,  2  p.m. ;  St.  Mary’s,  If  p.m. ;  Middlesex! 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew’s,  1J  p.m.  ;  Great  Northern, 

2  p.m. ;  Samaritan,  2j  p.m. ;  Royal  London  Ophthalmic,  11  a.m. ; 

Royal  Westminster  Ophthalmic,  lj  p.m. ;  St.  Thomas’s,  1J  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m. ;  National  Orthopaedic,  Great 
Portland-street,  10  a.m. _ 

6.  Thursday. 

Operations  at  St.  George’s,  1  p.m. ;  Central  London  Ophthalmic,  1  p.m.; 
Royal  Orthopaedic,  2  p.m.;  University  College,  2  p.m.;  Royal  London 
Ophthalmic, 11  a.m. ;  Royal  Westminster  Ophthalmic,  1  j  p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m.;  Hospital  for  Women,  2  p.m.; 
Charing-cross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  2i  p.m. 

7.  Friday. 

Operations  at  Central  LondonOphthalmic,  2  p.m.;  Royal  London  Ophthal¬ 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminster 
Ophthalmic,  ljp.m. ;  St.  George’s  (ophthalmic  operations),  11  p.m.; 
Guy’s,  11  p.m. ;  St. Thomas’s  (ophthalmic  operations),  2  p.m. ;  King’s 
College  (by  Mr.  Lister),  2  p.m. 


Medical  Times  and  G» cette. 


NOTES,  QUERIES,  AND  REPLIES. 


Sept,  1, 1883.  253 


VITAL  STATISTICS  OF  LONDON. 

Week  ending  Saturday,  August  25,  1883. 


BIRTHS. 

Total  births . 

Corrected  weekly  average  in  the  10  years  1873-82 

DEATHS. 


2450 

2608-9 


Males. 

Females. 

Total. 

Deaths  during  the  week . 

699 

657 

1356 

Weekly  average  of  the  ten  years  1873-82,  » 
corrected  to  increased  population  ...  J 

795-1 

7142 

1509-3 

Deaths  of  peopleaged  80  and  upwards 

... 

... 

58 

DEATHS  IN  SUB-DISTRICTS  FROM  EPIDEMICS. 


Enumerated 

Population, 

1881 

(unre  vised). 

Small-pox. 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

Whooping- 

cough. 

Typhus. 

Enteric  (or 
Typhoid) 
Fever. 

Simple 

continued 

Fever. 

Diarrhoea.  1 

West . 

669633 

6 

4 

3 

6 

2 

8 

North 

905947 

10 

11 

1 

8 

9 

1 

14 

Central 

282238 

4 

3 

3 

1 

5 

East . 

692738 

... 

13 

22 

4 

4 

4 

18 

South . 

1265927 

1 

20 

9 

8 

8 

... 

1 

2 

18 

Total . 

3816483 

1 

53 

49 

19 

27 

... 

16 

3 

63 

METEOROLOGY. 

From  Observations  at  the  Q-reenwich  Observatory. 

Mean  height  of  barometer  . 30 '023 

Mean  temperature  . 

Highest  point  of  thermometer 
Lowest  point  of  thermometer 
Mean  dew-point  temperature 
General  direction  of  wind 
Whole  amount  of  rain  in  the  week  . 


m. 

64-0° 

85-1° 

44-8° 

55-7° 

Variable. 
O'Ol  in. 


BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  the 
Week  ending  Saturday,  August  25,  in  the  following  large  Towns : — 


Cities 

and 

Boroughs. 

i 

1  Estimated  Population  to 

middle  of  the  year  1883. 

Births  Registered  during 
the  week  ending  Aug.  25. 

|  Deaths  Registered  during 
|  the  week  ending  Aug.  25. 

Annual  Rate  of 
Mortality  per  1000  living, 
from  all  causes. 

Temperature 
of  Air  (Fahr.) 

Temp, 
of  Air 
(Cent.) 

Rain 

Fall. 

Highestduring 
the  Week. 

Lowestduring 
the  Week. 

Weekly  Mean  of 
Daily  MeanYalues 

Weekly  Mean  of 
Daily  Mean 
Values. 

In  Inches. 

In  Centimetres. 

London 

... 

3955814 

2450 

1356 

17-9 

85-1 

44-8 

64-0 

17-78 

001 

0-C3 

Brighton  ... 

... 

111262 

67 

39 

18-3 

77-0 

62-0 

62-5 

16-95 

000 

o-oo 

Portsmouth 

131478 

91 

49 

19-4 

Norwich 

... 

89612 

58 

31 

18-1 

Plymouth  ... 

74977 

44 

20 

139 

71-0 

45-0 

59-3 

15-17 

o-oo 

o-oo 

Bristol . 

... 

212779 

114 

53 

13-0 

736 

460 

59-1 

15T6 

0-00 

o-co 

Wolverhampton  . 

77557 

63 

36 

24-2 

754 

43-1 

58-5 

14-72 

o-co 

o-oo 

Birmingham 

... 

414846 

276 

171 

2f5 

Leicester  ... 

129483 

100 

41 

165 

75-0 

46-0 

59-6 

15  34 

0-00 

0-00 

Nottingham 

... 

199349 

138 

76 

199 

76-2 

41-2 

59-4 

1522 

0-00 

0-00 

Derby . 

... 

85574 

64 

30 

18-3 

Birkenhead 

... 

88700 

62 

26 

15-3 

Liverpool  ... 

•  •• 

666763 

406 

260 

230 

76  0 

45-0 

59-2 

15-ii 

0-00 

0-00 

Bolton . 

... 

107862 

76 

35 

169 

Manchester 

... 

339252 

244 

155 

23-8 

Salford 

190465 

125 

79 

216 

Oldham 

... 

119071 

80 

52 

228 

Blackburn  ... 

108460 

96 

36 

17  3 

Preston 

98564 

70 

57 

30-2 

73-0 

51-0 

59-2 

1511 

0-01 

0-03 

Huddersfield 

84701 

43 

21 

129 

Halifax 

... 

75591 

42 

21 

14-5 

Bradford  ... 

... 

204807 

112 

52 

132 

73-3 

49-4 

59-4 

15  22 

0-03 

0-C8 

Leeds  . 

321611 

202 

134 

21-7 

74-0 

50-0 

60-0 

15-56 

014 

0-36 

Sheffield 

... 

295497 

194 

127 

22-4 

76-0 

45-0 

59-2 

1511 

0-00 

o-oo 

Hull  . 

176296 

147 

62 

154 

75-0 

45-0 

597 

15-39 

0-00 

o-oo 

Sunderland 

•  •• 

121117 

104 

37 

15-9 

81-0 

50-0 

62-8 

17-12 

0-00 

o-oo 

Newcastle  ... 

•  •• 

149464 

87 

79 

27-6 

... 

Cardiff . 

... 

90033 

77 

34 

19-7 

... 

... 

... 

... 

... 

... 

For  28  towns... 

6620975 

6622 

3149 

191 

85-1 

412 

60- 1 

15-62 

o-oi 

0-03 

Edinburgh ... 

•  •• 

235946 

148 

71 

15-7 

69-9 

46-5 

681 

1450 

0-00 

o-oo 

Glasgow 

... 

515589 

373 

247 

250 

69-0 

44-2 

57-6 

14-23 

0-00 

o-oo 

Dublin . 

... 

349685 

176 

142 

21-2 

72-4!  42-3 

57-5 

1417 

001 

003 

At  the  Royal  Observatory,  Greenwich,  the  mean  reading 
of  the  barometer  last  week  was  80-02  in. ;  the  lowest  read¬ 
ing  was  29’91  in.  on  Monday  afternoon,  and  the  highest 
30- 11  in.  on  Friday  morning. 


NOTES,  QUERIES,  AND  REPLIES. 

- o- - 

H*  t|mt  qutstioiutjj  mucjj  s|jaU  learn  rnurlj. — Bacon. 


The  Amur  Doctor’s  Consolation. 

Tired,  worn  out,  and  weary, 

They  sat  when  their  work  was  done. 

And  their  tone  was  almost  cheery, 

In  spite  of  Egyptian  sun  : 

And  they  prattled  of  praise  to  follow 
The  work  they  had  striven  to  do. 

Alas  !  for  the  hope  so  hollow,  — 

How  little  the  Doctors  knew ! 

They  took  up  the  London  papers, 

And  read  with  alarmed  surprise, 

They  had  cut  all  their  little  capers 
In  the  sight  of  the  great  world’s  eyes  ; 

For  the  Press  had  listened  to  tattle, 

And  pandered  to  itching  ears, 

Which,  after  the  roar  of  battle, 

Were  agog  for  scandal  and  sneers. 

For  taxation  never  is  funny ; 

And  the  foeman  who  runs  away, 

If  he  leaves  behind  him  no  money, 

Of  course  leaves  “  the  devil  to  pay”  : 

Somebody’s  got  to  suffer, 

Somebody’s  got  to  hang, 

And  the  Doctor ’s  the  sort  of  buffer 
To  receive  the  indignant  bang. 

“Mad  dog !  ”  is  a  cry  of  power, 

To  startle  a  thoughtless  throng  ; 

Now  ’tis  the  Doctor’s  hour, 

Hurry  the  scandal  along : 

Colonel  Jones  never  got  his  clyster  ! 

Private  Brown  was  deprived  of  lint ! 

Sergeant  Smith  had  a  scandalous  blister  I 
And  Corporal  Trim,  no  splint ! 

The  golden  youth  of  the  “  Household,” 

Though  ever  prepared  to  die, 

Were  the  first  to  whimper  and  outseold. 

When  they  couldn’t  get  pudding  or  pie  ’ 

No  one  could  sleep  for  the  vermin, 

No  one  could  rest  for  the  fleas. 

And  the  General’s  staff  determine 
To  “  show-up  ”  such  Doctors  as  these  1 

“  A  lazy,  proud  set  of  beggars, 

Eating  and  drinking  all  day ; 

Soda  and  brandy  peggers, 

Though  none  of  it  came  our  way  : 

Calling  themselves  Commanders ! 

Before  they  knew  how  to  drill 
As  soldiers ;  salute-demanders, 

When  they  didn’t  know  how  to  kill  1 

“Fellows  with  souls  apathetic, 

Who  denied  the  patients  grog, 

And  gave  vile  tartar  emetic, 

To  the  soldiers  who  wanted  prog  ! 

Stir  up  the  public  opinion  ! 

Demand  a  Committee  at  once  ! 

Woe  to  the  medical  minion  ! 

Woe  to  the  surgical  dunce  !  ” 

Alas  for  the  combatant  “Bumble,” 

The  Committee  just  simply  explain. 

The  Doctors  did  duty,  if  humble, 

And  are  ready  to  do  it  again  : 

Beg  pardon  ?  Pride  scorns  it !  No  matter, — 

Wrong  must  happen  of  course  now  and  ilien. 

To  all  who  can  work,  but  not  flatter, 

Nor  tout  for  the  praises  of  men.  J.  T.  W.  B. 

Dr.  G.  Graham,  Richmond,  Victoria,  Australia. — Letter  and  enclosure 
received  with  thanks. 

Alleged  Butter  Adulteration  The  Summons  Dismissed. — A  summons,  taken 
out  by  the  Urban  Sanitary  Authority,  Gravesend,  against  a  grocer  of 
West-street,  in  that  town,  on  the  charge  of  vending  adulterated  butter, 
came  on  again  last  week  on  adjournment  at  the  Court  House.  The 
borough  analyst,  on  the  first  hearing,  deposed  that  the  sample  of  butter 
in  question  was  composed  chiefly  of  animal  fat.  On  the  other  hand, 
Mr.  Robert  Harland,  F.C.S.,  of  London,  contended  he  had  found,  on. 
analysis,  the  sample  was  pure  butter,  produced  from  the  milk  of  the 
cow.  On  this  evidence  a  sample  of  the  butter  was  sent  for  analysis  to 
Somerset  House.  After  the  reading  of  the  Government  report,  the 
Bench  dismissed  the  summons,  allowing  the  analyst’s  fee  of  five  guineas, 
and  three  guineas  for  the  solicitor,  and  also  ordering  that  a  certificate  be 
granted  to  the  vendor  of  the  butter. 

Impure  Well-  Water :  Important  Decision.— The  W est  Hartlepool  magistrates- 
have  had  before  them  the  case  of  an  owner  of  property  who  had  a  house 
supplied  with  well-water.  The  water,  on  being  tested,  was  pronounced 
impure  and  unfit  for  human  consumption.  The  Local  Authority  con¬ 
sequently  applied  for  an  order  for  the  permanent  closing  of  the  well. 
The  defence  set  up  was  that  the  well  was  now  covered  over,  and  com¬ 
munication  cut  off ;  but  the  Bench  decided  that  this  was  not  a  permanent 
closing,  and  gave  the  order  applied  for.  An  appeal  is  to  be  made 
against  this  decision. 


.  -m 

^/FvAOe’OFiU 


Medical  Times  and  Gazette. 


Sept.  1,  1?83. 


254 


NOTES,  QUERIES,  AND  REPLIES. 


«  The  Marine  Store  Dealer,"- The  Kensington  Vestry  has  received  a  letter 
from  the  Metropolitan  Board  of  Works  in  reply  to  a  communication 
from  the  Vestry— already  noticed  in  these  pages— requesting  the  Board 
to  consider  as  to  the  desirability  of  the  business  of  a" marine  store 
■dealer,”  who  took  in  putrid  animal  matter,  being  declared  an  offensive 
(business  under  the  provisions  of  the  Metropolis  Slaughterhouses  Act. 
The  central  authority  points  out  that  the  businesses  to  which  the  Act 
referred  included  processes  of  manufacture,  and  it  did  not  appear  to 
the  Board  that  the  mere  collection  of  a  mass  of  refuse  matter  into  one 
iplace  was  a  “  business  ”  within  the  meaning  of  the  third  section  of 
the  Act.  We  are  glad  to  add,  the  Board  did  not  stop  here,  but  went  on 
to  advise  that  such  houses  as  the  one  in  question  come  under  the 
Nuisances  Removal  Acts,  which  were  intended  to  apply  to  like  cases. 

•Churton.— By  the  law  a  penalty  of  £5  may  be  imposed  on  any  householder 
who  refuses  to  have  his  dust  removed  by  the  dustman;  but,  according  to 
our  experience,  the  difficulty  is  to  get  the  dustman  to  come  and  empty 
the  dustbin :  the  householder  is  willing  enough  to  let  it  go. 

'The  New  Diseases  Prevention  ( Metropolis )  Act.— One  of  our  daily  contem¬ 
poraries  says  that  the  passing  of  this  Act  is  the  subject  of  considerable 
agitation  and  dissatisfaction,  in  consequence  of  the  additional  powers  it 
confers  upon  the  Local  Government  and  Metropolitan  Asylums  Boards 
in  respect  to  the  provision  of  hospital  accommodation,  and  the  isolation 
and  treatment  of  persons  suffering  from  cholera  and  infectious  diseases. 
The  inhabitants  of  Camberwell  are  prominent  in  their  protest  against 
-the  Act,  believing  great  injustice  will  be  done  to  the  parish  at  large  if, 
in  the  event  of  an  outbreak  of  cholera  in  the  metropolis,  the  Asylums 
Board  should  use  the  small-pox  hospital  in  the  Old  Kent-road  for  the 
reception  of  patients  from  all  parts  of  the  metropolis,  as  they  are  em¬ 
powered  to  do  under  the  provisions  of  the  new  Act.  It  is  urged  that  as  a 
small-pox  hospital  the  establishment  has  had  a  very  prejudicial  effect 
upon  the  value  of  the  property  immediately  surrounding  it. 

Apropos  of  Coroners'  Juries.-  Mr.  Commissioner  Kerr  remarked  the  other 
day  that  “  a  jury  is  at  all  times  the  most  incompetent  tribunal  known 
to  the  law  of  England.” 

Hygiene. — Yes';  chemical  experts  have  estimated  that  the  cost  of  London’s 
winter  smoke  and  fog  is  £5,000,000  annually.  That  is  to  say,  constituents 
of  coal  to  this  value  escape  unconsumed,  and  assist  in  forming  the  sooty 
vapour. 

/Death-rate,  South  Hornsey— Dr.  Jackman,  Medical  Officer  of  Health  for 
the  South  Hornsey  Local  Board  district,  lately  reported  to  the  Board  a 
largely  increased  death-rate.  In  one  road  it  was  in  the  proportion  of 
one  death  to  every  four  houses,  and  in  another  road  even  higher.  He 
recommended  that  a  house-to-house  visitation  should  be  ordered,  and 
other  measures  adopted  to  improve  such  an  unsatisfactory  state  of 
things ;  and  the  General  Purposes  Committee  were  instructed  to  carry 
out  his  recommendations. 

A  Gastronomic  Novelty.-— An  evening  contemporary  informs  the  public 
that  it  is  now  stated  that  the  flesh  of  the  whale  is  both  nutritious  and 
palatable.  Large  quantities  of  it  are  eaten  every  fishing  season  by  the 
men  engaged  in  the  capture  of  the  fish,  but  still  larger  quantities  are 
wasted.  A  Norwegian  speculator  was  struck  with  the  fact  that  some 
■of  the  immense  mass  of  food  thus  annually  thrown  away  might  be 
profitably  preserved  and  utilised  for  consumption  on  shore.  Acting  on 
this  idea,  he  arranged  with  several  whaling  captains  and  two  meat- 
preserving  firms,  and  recently  he  gave  a  dinner  by  which,  he  believes, 
'he  has  demonstrated  that  whale  flesh  may  be  cooked  in  various  ways, 

•  and  that  it  forms  a  delicious  as  well  as  a  wholesome  article  of  diet. 
Some  parts  of  the  fish  supply  materials  for  an  excellent  imitation  of 
turtle  soup,  others  resemble  beef,  and  others  are  almost  as  while  and 
quite  as  tender  as  chicken.  The  meat  can  be  sold  for  about  half  the 
price  of  our  colonial  tinned  beef. 

'The  London  Hospital  and  the  Mile  End  Old  Town  Guardians.— A  letter 
from  the  Hospital,  charging  the  Board  with  2s.  6d.  incident  to  an  opera¬ 
tion  made  at  the  Hospital  on  the  eye  of  one  of  the  inmates  of  their  work- 
house,  was  discussed  at  the  last  meeting  of  the  Board.  It  appeared 
that  the  patient  in  question  had  taken  his  discharge  from  the  infirmary, 
believing  that  the  operation  would  be  better  performed  at  the  Hospital. 
A  question  was  thus  opened  as  to  whether  or  not  the  guardians  were 
liable  for  the  charge  made  by  the  Hospital.  It  was  thought  that  the 
matter  involved  an  important  point,  and  it  was  decided  to  refer  it  to 
the  Medical  Committee. 

A  Morgue  at  Pome.—  It  has  been  decided  by  the  Municipality  of  Rome  to 
construct,  upon  the  model  of  the  establishment  in  Baris,  a  morgue,  or 
deadhouse,  for  the  reception  of  the  bodies  of  persons  found  dead  in 
public  places,  in  order  to  facilitate  their  identification. 

A -Fatality  from  Drinking  Soda-Water.— A  clerk  at  the  Northampton  Gas 
Works,  before  leaving  the  works  a  few  days  since,  being  thirsty,  drank 
a  quantity  of  soda-water  from  a  bottle,  and  was  taken  ill  and  conveyed 
home.  He  continued  ill  for  twenty-six  hours  and  then  expired.  A 
post-mortem  examination  of  the  body  disclosed  acute  inflammation  of 
the  bowels,  the  cause  of  which  was  found  in  a  small  opening  in  the 
intestine,  close  to  the  stomach,  at  the  side  of  an  old  ulcer  which  had 
been  covered  by  a  thin  membrane,  and  had,  it  was  supposed,  given  way 
-under  the  distension  caused  by  the  soda-water.  The  coroner’s  jury 
returned  the  verdict,  “  Died  from  natural  causes.” 


The  Dundee  Poyal  Lunatic  Asylum. — The  directors  have  decided,  for  the 
purpose  of  devising  means  to  relieve  the  institution  in  its  present 
embarrassed  condition,  that  an  appeal  be  made  to  the  public,  both  for 
donations  and  applications  for  debentures,  to  be  secured  by  way  of  bond 
over  the  Asylum  property.  A  debt  of  £50,000  was  secured  over  the  pro¬ 
perties  of  the  old  and  the  new  Asylums,  and,  in  addition,  there  are  float 
ing  debts  unsecured  of  fully  £10,000. 

Official  Solicitude.— The  Local  Government  Board,  in  assenting  to  the  pro¬ 
posal  of  the  Leicester  Board  of  Guardians  to  provide  a  fish  dinner  for 
the  inmates  of  the  workhouse  every  alternate  Tuesday,  impressed  upon 
the  Guardians  the  necessity  of  taking  suitable  precautions  to  prevent 
the  children  from  swallowing  the  fish-bones ! 

Imprisonment  not  a  Deterrent.— A  woman,  a  milk-seller  and  butcher  at 
Hanley,  on  being  convicted  of  having  unwholesome  meat  in  her  posses¬ 
sion,  and  fined  £10,  gave  notice  of  appeal.  Two  days  afterwards  she 
abandoned  the  appeal,  and,  in  default  of  paying  the  amercement,  was 
committed  to  prison  for  two  months.  The  defendant  was  only  recently 
liberated  from  prison,  convicted  of  being  concerned  in  the  illicit  manu¬ 
facture  of  whisky. 

Female  Suicides,  Berlin. — The  Times  correspondent,  writing  on  the  22nd 
ult.,  says,  Apropos  of  the  numerous  female  suicides  of  late  in  London,  it 
may  be  mentioned  that  within  the  last  few  days  the  morgue  in  Berlin 
has  received  the  bodies  of  no  fewer  than  six  young  women  who  had  all 
poisoned  themselves  in  consequence  of  loss  of  character. 

Worthy  of  Observation.— The  British  Consul  at  Bordeaux,  in  his  last 
report,  states  “  Low-priced  genuine  Bordeaux  wines  must  be  regarded 
as  non-existing.  If  the  well-known  Bordeaux  wines  are  advertised  for 
sale  at  the  same  prices  as  used  to  be  charged  ten  or  fifteen  years  ago,  or 
in  times  of  exceptional  abundance,  such  wines  are  not  the  growth  of 
the  vineyard  under  the  name  of  which  they  are  offered  for  sale.  The 
prices  of  the  commonest  class  of  Modoc  wines  [via  ordinaire)  have  in¬ 
crease  75  to  100  per  cent,  during  the  last  decade.  To  buy  pure  genuine 
Medoc,  or  other  well-known  wines  of  this  district,  a  far  higher  price 
must  be  paid  for  them  than  has  been  obtained  for  some  years.  The 
quantity  of  adulterated  and  falsified  (so  called)  ‘Bordeaux  wine’ 
exported  at  present  annually  is  very  considerable.” 

A  Hint  from  Philadelphia. — The  Chief  Commissioner  of  Highways  in  this 
city,  in  an  appeal  to  the  public,  says  “  For  the  purpose  of  preserving 
the  good  sanitary  condition  in  all  sections  of  the  city,  it  will  be  necessary 
for  citizens  to  aid  in  preserving  the  cleanliness  of  the  highways  as  well 
as  their  own  premises,  by  daily  sweeping  their  gutters,  courts,  alleys, 
and  all  surface  water  courses,  and  collecting  vegetable  and  animal 
matter  for  the  garbageman  to  remove.” 

An  Outcome  of  the  Action  of  Dobbs  v.  The  Grand  Junction  Waterworks 
Company. — The  Camberwell  Y estry  have  instructed  their  Law  and  Parlia¬ 
mentary  Committee  to  inquire  into  the  question  of  the  water  companies 
charges  in  the  parish. 

COMMUNICATIONS  have  been  received  from— 

The  Secretary  of  the  Apothecaries’  Society,  London;  The  Sanitary 
Commissioner  of  the  Punjaub,  Lahore ;  The  Director-General  of 
the  Medical  Department  of  the  Admiralty,  London  ;  Dr.  Manning, 
New  South  Wales;  Dr.  Heberstanz,  Vienna;  Lord  E.  Fitzmaurice, 
London;  The  Military  Secretary  of  the  India  Office,  London;  Dr. 
R.  Boustead,  Pitlochry;  The  Warden  of  the  London  Hospital 
Medical  School,  London;  The  Secretary  of  the  Local  Government 
Board,  London;  Mr.  J.  Chatto,  London  ;  Dr.  J.  W.  Moore,  Dublin; 
Dr.  H.  Sonsino,  Cairo;  Dr.  Balthazar  Foster,  Birmingham;  The 
Registrar-General  for  Scotland,  Edinburgh ;  Mr.  J.  H.  Johnson, 
Lineoln’s-inn-fields  ;  Mr.  James  Death,  London;  Dr.  H.  Sutherland, 
London ;  Dr.  W.  H.  Peabse,  Plymouth ;  Messrs.  Maclachlan  and 
Stewart,  Edinburgh. 

BOOKS,  ETC.,  RECEIVED  - 

A  Review  of  the  Scientific  Progress  of  Dental  Surgery,  by  C.  Spence  Bate, 
F.R.8. — Notes  on  Diphtheria,  by  Dr.  Eade — Nineteenth  Report  of  the 
Trustees  of  the  City  Hospital,  Boston — The  Next  Step  for  the  Medical 
Profession  of  the  United  States,  by  D.  B.  St.  John  Roosa,  M.D.,  LL.D. 
—The  Amount  of  Protection  afforded  by  Vaccination,  by  Hy.  Tomkins, 
M.D.,  B  Sc.— Annual  Report  of  the  Borough  of  Huddersfield  for  the 
Year  1882— The  Outbreak  of  Cholera  in  Egypt,  by  G.  V.  N.-  Diagram  of 
Pathogenic  Organisms,  etc.— The  New  Sydenham  Society’s  Lexicon,  by 
Henry  Power,  M.B.,  and  Leonard  W.  Sedgwick,  M.D. — Illustrated 
Medicine  and  Surgery,  vol.  ii.,  No.  3 — The  Diseases  of  the  Nervous 
System,  by  James  Ross,  M.D.,  LL.D.,  vols.  i.  and  ii. — Diseases  of 
Women,  by  R.  J.  Nunn,  M.D.,  Savannah — The  Life  and  Work  of  St. 
Paul,  by  F.  W.  Farrar,  D.D.— The  Prophylactic  Power  of  Copper  in 
Epidemic  Cholera,  by  Arthur  De  Noe  Walker,  M.D. 

PERIODICALS  AND  NEWSPAPERS  RECEIVED— 

Lancet— British  Medical  Journal— Medical  Press  and  Circular — Ber¬ 
liner  Klinische  Wochenschrift— Centralblatt  fur  Cbirurgie — Gazette 
des  Hopitaux — Gazette  Mddicale— Revista  de  Medicina — Bulletin  de 
1’ Academiede  Mddecine — Pharmaceutical  Journal — W iener  Medi cinische 
Wochenschrift— Revue  M6dicale— Gazette  Hebdomadaire —Nature — 
Boston  Medical  and  Surgical  Journal — Louisville  Medical  News — 
Centralblatt  fur  Gyniikologie — Le  Concours  Medical— Centralblatt  ftir 
die  Medicinischen  Wissenschaften— Centralblatt  fiir  Klinische  Medicin 
— Philadelphia  Medical  News— Le  Progres  Medical — Ciencias  Medieas  — 
Sunderland  Daily  Echo,  August  21— Revue  D’ Hygiene— Staffordshire 
Sentinel,  August  23— Collective  Investigation  Record — Indian  Medical 
Gazette— New  York  Medical  Journal — Friendly  Greetings  — Boy’s  Own 
Paper -Sunday  at  Home— Girl’s  Own  Paper — Leisure  Hour— Students’ 
Journal  and  Hospital  Gazette  -  Polyclinic— Society — Maryland  Medical 
Journal,  August  11  and  18— Ophthalmic  Review. 


Medical  Times  and  Gazette 


SUTHERLAND  ON  INSANITY. 


Sept.  8, 1883.  255 


LECTURES  ON  INSANITY. 

Delivered  at  the  Westminster  Hospital,  June,  1883. 

By  HENRY  SUTHERLAND,  M.D., 

Physician  to  Otto  House  and  Blacklands  House  Lunatic  Asylums,  etc. 

Lecture  I. 

THE  DEFINITION,  CLASSIFICATION,  AND  CAUSES 
OF  INSANITY. 

Gentlemen, — In  commencing  this  short  coarse  of  lectures 
en  Mental  Diseases,  I  shall  state,  as  I  have  done  on  previous 
occasions,  that  the  remarks  I  shall  make  in  this  room  are 
intended  to  be  of  a  really  practical  character,  and  of  a  kind 
to  afford  you  assistance  in  the  ordinary  labours  of  your 
medical  career. 

I  shall  therefore  avoid  all  theoretical  ground,  and  en¬ 
deavour  to  lay  before  you  as  clearly  as  possible  the  symp¬ 
toms  of  those  diseases  of  the  mind  which  you  will  actually 
be  called  upon  to  treat  in  after  life. 

Whether  you  undertake  the  duties  of  superintendent  of  a 
public  asylum,  of  private  asylum  proprietor,  of  family  doctor, 
of  physician  to  a  workhouse  or  any  similar  institution  ; 
whether  you  reside  in  the  house  of  a  wealthy  Chancery 
patient,  or  travel  abroad  in  his  company ;  whether  you  are 
in  the  Army  or  the  Navy,  whether  you  are  at  sea  or  on 
shore, — you  can  never,  as  medical  men,  be  free  from  the 
chance  of  being  some  day  called  upon  to  treat  both  medi¬ 
cinally  and  legally  a  person  of  unsound  mind. 

In  the  first  place,  then,  let  us  inquire.  What  is  insanity  ? 
The  answer  to  this  question  is  more  difficult  than  might  at 
first  sight  be  supposed.  I  cannot  commence  these  lectures 
more  profitably  than  by  warning  you  never  to  attempt  to 
give  a  definition  of  insanity,  more  especially  if  you  are 
placed  in  a  position  in  which  you  may  be  called  to  account 
for  having  done  so,  as,  for  instance,  in  the  witness-box  in  a 
court  of  justice. 

Perhaps  the  best  definition  of  insanity  that  has  yet  been 
attempted  is  that  of  Dr.  Maudsley,  who  tells  us  it  is  “  dis¬ 
order  of  brain  producing  disorder  of  mind.”  But  if  we 
examine  this  definition  we  find  that  it  expresses  both  too 
much  and  too  little.  Can  we  always  prove  that  disorder  of 
brain  is  present,  as  proved  by  post-mortem  examination  ? 
Undoubtedly  not.  In  many  cases  where  the  symptoms  have 
been  most  violent  and  most  acute  during  life,  the  brain  is 
found  to  be  perfectly  healthy  after  death.  Again,  can  we 
say  that  disorder  of  mind  is  peculiar  to  insanity  and  to  no 
other  disease  ?  We  must  answer  this  question  also  in  the 
negative,  as  we  know  that  alcoholic  excess,  blood-poisoning, 
the  poison  of  fever,  a  blow  on  the  head,  sunstroke,  syncope, 
and  all  agencies  producing  coma  or  other  minor  disturb¬ 
ances  of  the  cerebral  circulation,  bring  about  precisely  the 
same  mental  symptoms  as  are  met  with  in  insanity.  So  that 
in  this  last  section,  as  well  as  in  the  first,  the  definition 
breaks  down. 

A  description  of  insanity,  although  of  more  practical 
value  than  a  definition,  is  open,  but  in  a  less  degree,  to  the 
same  objections,  namely,  that  it  expresses  either  too  much 
or  too  little.  Nevertheless,  that  we  may  have  some  starting- 
point  in  common,  I  shall  endeavour  to  give  a  description 
of  insanity,  as  the  subject  may  be  new  to  some  of  you. 

Insanity  may  be  described  as  being  a  disorder  of  the 
mind,  generally  supposed  to  be  due  to  disorder  of  the  brain, 
u,nd  characterised  by  peculiar  acts,  feelings,  and  delusions, 
no  one  of  which,  however  eccentric,  would  alone  constitute 
insanity. 

With  regard  to  insane  acts,  the  motive  for  performing 
the  act  should  always  be  considered. 

With  regard  to  insane  feelings,  the  extent  to  which  the 
feeling  influences  the  patient  relatively  to  the  cause  must 
be  estimated. 

And  with  regard  to  delusions,  careful  inquiry  should 
always  be  made  as  to  whether  or  no  there  are  any  real 
grounds  for  such  delusions. 

Classification. 

In  all  professions  certain  technical  terms  are  employed 
which  express  a  great  deal  in  the  shortest  possible  way,  and 
which  bring  to  the  mind  of  the  skilled  workman  a  great 
many  facts  condensed  into  one  word.  As  might  be  expected, 

Yol.  II.  1883.  No.  1732. 


the  study  of  insanity  necessitates  the  use  of  some  such 
technical  terms,  which,  however,  have  been  multiplied  to 
an  inordinate  degree  by  the  pedantry  of  those  who  wished 
it  to  be  thought  they  knew  more  of  the  subject  than  other 
people. 

Briefly  speaking,  it  may  be  said  that  the  numerous  classi¬ 
fications  (forty  or  fifty)  which  have  appeared  from  time  to 
time  have  been  founded  upon  one  of  the  three  following 
principles : — 

I.  According  to  the  Functions  of  Mind  supposed  to  be 
affected.  Examples:  Intellectual  Insanity,  Emotional  In¬ 
sanity. 

II.  According  to  the  Mental  Symptoms.  Examples : 
Mania,  Melancholia. 

III.  According  to  the  Bodily  Diseases  or  conditions  asso¬ 
ciated  with  the  mental  disturbance. 

At  present  we  shall  deal  only  with  the  last  two  modes  of 
classification. 

The  second  one  (according  to  the  mental  symptoms)  is  the 
one  adopted  by  the  compilers  of  the  Nomenclature  of 
Diseases  drawn  up  by  a  Committee  of  the  Royal  College  of 
Physicians  ;  and  is,  moreover,  the  only  classification  recog¬ 
nised  by  the  Commissioners  in  Lunacy.  It  includes  nine 
forms,  the  details  of  which  will  be  given  later  on.  They  are .- 

1.  Mania. 

2.  Melancholia. 

3.  Monomania. 

4.  Dementia. 

5.  Paralysis  of  the  Insane.  (Synonym,  General  Paralysis.) 

6.  Idiotcy  (Congenital). 

7.  Imbecility  (Congenital). 

8.  Cretinism. 

9.  Puerperal  Mania. 

These  are  defined  and  subdivided  as  follows  : — 

1.  Mania. 

Definition  :  Disorder  of  the  Intellect  with  Excitement. 

a.  Acute  Mania. 

b.  Chronic  Mania. 

2.  Melancholia. 

Definition :  Disorder  of  the  Intellect  with  Depression, 
often  with  suicidal  tendency. 

3.  Note  :  Cases  of  so-called  Monomania  are  to  be  classed 
under  Chronic  Mania  or  Melancholia  according  to  their 
character. 

4.  Dementia. 

Definition  :  Disorder  of  the  Intellect  characterised  by  Loss 
or  Feebleness  of  the  Mental  Faculties. 

a.  Acute  Dementia. 

b.  Chronic  Dementia. 

5.  Paralysis  of  the  Insane. 

(Synonym,  General  Paralysis.) 

6.  Idiotcy  ( Congenital ). 

7.  Imbecility  {Congenital) . 

8.  Cretinism. 

(This  is  placed  next  Rickets  and  Scrofula  in  the  Nomen¬ 
clature.)  Definition  :  A  condition  of  Imperfect  Development 
and  Deformity  of  the  whole  body,  especially  of  the  head,  occur¬ 
ring  in  the  valleys  of  certain  mountainous  districts,  and 
attended  by  feebleness  or  absence  of  the  mental  faculties 
andspeciaJ  senses,and  often  associated  with  goitre.  Varieties : 

a.  Complete  Cretinism.  (Synonym,  Incurable  Cretinism.) 
Definition :  Complete  Cretinism,  characterised  by  idiotcy, 
deaf -dumbness,  deficiency  of  general  sensibility,  and  absence 
of  the  reproductive  power. 

b.  Incomplete  Cretinism.  (Synonym,  Curable  Cretinism.) 
Definition :  A  degree  of  Cretinism  in  which  the  mental 
faculties,  though  limited,  are  capable  of  development,  the  head 
is  moderately  well  formed  and  erect,  the  special  senses,  the 
faculty  of  speech,  and  the  reproductive  powers  are  present. 

9.  Puerperal  Mania. 

a.  Connected  with  Parturition. 

b.  Connected  with  Lactation. 

Without  making  any  comment  on  this  classification,  I 
now  pass  on  to  give  one  more  system  of  nomenclature —that 
proposed  by  the  late  Dr.  Skae.  This  has  given  rise  to  much 
controversy,  but  as  it  is  the  one  recognised  by  the  Medico- 
Psychological  Association,  in  the  competition  for  the  Hack 


256 


Medical  Times  and  Gazette. 


SUTHERLAND  ON  INSANITY. 


Sept.  8, 1883. 


Tube  Prize,  it  is  necessary  that  you  should  be  acquainted  at 
least  with  its  outlines. 

It  is  founded  chiefly  on  the  third  principle  mentioned 
previously,  that  is,  according. to  the  bodily  diseases  or  con¬ 
ditions  associated  with  the  mental  disturbance. 

It  includes  thirty-five  forms.  They  are : 


Idiocy  )  Intellectual. 
Imbecility  j  Moral. 
Insanity  with  Epilepsy. 
Insanity  of  Pubescence. 
Insanity  of  Masturbation. 
Hysterical  Insanity. 
Amenorrhceal  Insanity. 
Post-connubial  Insanity. 
Puerperal  Insanity. 
Insanity  of  Lactation. 
Insanity  of  Pregnancy. 
Climacteric  Insanity. 
Ovarian  Insanity. 
Hypochondriacal  Insanity. 
Senile  Insanity. 

Phthisical  Insanity. 
Metastatic  Insanity. 
Traumatic  Insanity. 
Rheumatic  Insanity. 


Podagrous  Insanity. 
Syphilitic  Insanity. 

Delirium  Tremens. 
Dipsomania. 

Insanity  of  Alcoholism. 
Malarious  Insanity. 
Pellagrous  Insanity, 

Post- febrile  Insanity. 
Insanity  of  Oxaluria. 

Anaemic  Insanity. 

Choreic  Insanity. 

General  Paralysis  with  In¬ 
sanity. 

Insanity  from  Brain  Disease. 
Hereditary  Insanity  of  Ado¬ 
lescence. 

Idiopathic  )  Sthenic. 
Insanity.  )  Asthenic. 


In  my  humble  opinion  the  classification  of  diseases  of  the 
mind  should  be  as  simple  as  possible,  and  should  be  founded 
chiefly  upon  prognosis  in  insanity,  the  diagnosis  and  treatment 
being  usually  easy  as  compared  with  the  prognosis,  which  is 
moreover  the  most  important  of  these  three  elements  of 
mental  derangement  in  many  cases. 

Whatever  classification  may  be  adopted  by  any  author,  it 
is  evident  that  there  are  four  states  of  mind,  and  four  only, 
which  deviate  from  the  normal  standard.  And  I  should 
divide  my  second  division  of  mental  diseases,  if  necessary, 
under  one  of  these  four  heads. 

First  to  mention  my  classification,  arranged  in  the  order 
of  the  various  ages  at  which  the  individual  is  likely  to 
suffer  from  them,  I  would  have  these  divisions : — (1),  Idiocy ; 
(2),  Simple  Insanity;  (3),  General  Paralysis;  (4),  Epileptic 
Insanity. 

Simple  Insanity  might,  if  necessary,  be  subdivided  into — 
a.  Simple  Insanity  with  Excitement  (equivalent  to  Mania) ; 
i.  Simple  Insanity  with  Depression  (Melancholia) ;  c.  Simple 
Insanity  with  Exaltation  (Monomania  ?) ;  d.  Simple  Insanity 
with  Fatuity  (Dementia). 

It  will  be  observed  that,  roughly  speaking,  the  second  of 
these  divisions.  Simple  Insanity,  is  the  one  in  which  the 
largest  proportion  of  cases  are  likely  to  get  well,  as  compared 
with  any  other  three  divisions. 

Epileptic  Insanity  is  next  most  favourable  as  regards  the 
outlook,  many  cases  of  this  form  recovering  if  the  first 
attack  takes  place  at  puberty,  although  the  termination  of 
this  disorder  is  almost  always  fatal  if  it  occur  after  middle 
age.  The  proportion  of  idiots,  too,  who  are  sufficiently 
restored  to  mental  health  to  enable  them  to  earn  a  liveli¬ 
hood  is  remarkably  small,  and  general  paralysis  is  in¬ 
curable.  Thus  it  will  be  seen  that  this  simple  attempt  at 
classification  is  founded  upon  the  prognosis  in  cases  of 
mental  disease.  Let  us  first  consider 


Epileptic  Insanity  we  would  simply  place  by  itself  as  a- 
matter  of  convenience  to  asylum  superintendents.  Such 
patients  require  special  kinds  of  treatment  and  appliances- 
They  are  usually  more  dangerous  than  those  suffering  from 
insanity  not  complicated  with  this  nervous  disorder,  and  in 
many  asylums  they  are  treated  in  wards  by  themselves. 
The  prognosis  is  also  very  unfavourable  in  epileptic  insanity,. 
unless  it  occur  either  as  convulsions  at  dentition,  with 
mental  aberration,  or  in  connexion  with  the  trials  of  puberty- 

The  Causes  of  Insanity. 

Most  frequently  insanity  is  produced  by  several  causes, 
acting  at  different  periods  upon  the  individual  previous  to- 
the  attack.  To  say  that  one  influence  has  caused  the  attack 
is  almost  always  erroneous,  although  it  is  true  that  one 
cause  generally  stands  forward  more  prominently  than  the 
rest  in  the  history  of  the  case.  Causes  have  been  divided 
into  predisposing  and  exciting.  They  have  also  been  divided 
into  physical,  moral,  and  mixed.  The  terms  need  no- 
explanation. 

1.  Those  affecting  the  human  race  generally,  or  particular 
classes.  2.  Those  affecting  the  individual. 

A  few  of  these  causes  may  be  here  alluded  to,  although 
their  name  is  legion,  and  it  is  impossible  to  enumerate  them 
exhaustively. 

Season .-  Hot  weather  undoubtedly  is  a  potent  cause  of 
insanity,  the  month  of  June  being  the  one  in  which  the 
admissions  to  asylums  are  most  numerous.  Civilisation :: 
Humboldt  has  stated  that  there  is  no  insanity  amongst 
savages.  Some  authors  believe  that  modern  civilisation 
has  increased  it.  But  the  truth  of  the  matter  is  that  it  is  the 
abuse  and  not  the  use  of  the  advantages  of  civilisation 
which  has  added  to  the  admissions  to  our  asylums.  Impure 
Water :  The  presence  of  lime  and  magnesia  in  water  is  an 
undoubted  cause  of  cretinism.  Poverty :  Dr.  Thurnam 
has  shown  us  in  his  statistics  that  poverty  is  a  most  power¬ 
ful  agent  in  the  production  of  insanity.  The  five  counties 
which  possess  the  greatest  number  of  paupers  in  proportion 
to  the  population  are — (1)  Wiltshire,  (2)  Dorset,  (3)  Oxford,. 
(4)  Gloucester,  and  (5)  Berks.  The  five  counties  which 
have  the  greatest  number  of  insane  paupers  in  proportion 
to  the  total  paupers  are — (1)  Wiltshire,  (2)  Gloucester, 
(3)  Oxford,  (4)  Berks,  and  (5)  Dorset.  Age :  Insanity  (ex¬ 
clusive  of  idiocy)  is  rare  before  ten,  more  frequent  between 
ten  and  twenty,  and  most  common  between  twenty-five  and 
forty;  but  the  admissions  to  asylums,  if  re-admissions  are 
also  included,  have  then  maximum  between  the  ages  of  forty 
and  fifty.  Sex  :  The  proportions  of  men  and  women  attacked 
differs  in  different  places.  More  males  become  insane  than 
females  in  England ;  more  females  than  males  in  France.. 
But  more  females  are  attacked  than  males  in  London,  and 
more  males  than  females  in  Paris.  Occupation :  The  effects 
of  occupation  are  difficult  to  estimate.  It  may  be  briefly" 
said  that  head- workers  are  more  liable  to  insanity  than  are- 
hand-workers.  Overwork  alone  is  seldom  a  cause  unless 
other  influences  are  connected  with  it. 

The  causes  affecting  the  individual  may  be  conveniently 
divided  into  those  occurring — I.  Before  birth  ;  II.  At  birth  ;. 
III.  In  infancy;  IY.  In  youth;  Y.  In  adult  life;  VI.  In 
old  age. 

I. — Hereditary  Influence. 


Simple  Insanity. 

It  may  be  objected  that  this  division  is  too  comprehensive, 
but  who  is  there  amongst  us  who  can  tell  that  a  patient  who 
is  melancholic  to-day  may  not  be  maniacal  to-morrow,  and 
demented  the  next  day  ?  Therefore,  it  is  surely  a  more 
stable  term  to  apply  to  a  case  than  is  the  word  mania, 
melancholia,  or  dementia. 

Idiocy,  to  our  thinking,  is  a  good  term.  The  College  of 
Physicians  places  the  word  congenital  after  idiocy  and  im¬ 
becility.  But  this  is  wrong.  Dr.  Langdon  Down  has  shown 
me  many  examples  of  idiocy  which  were  not  congenital, 
but  were  the  result  of  scarlatina,  accident,  or  other  causes 
in  early  childhood. 

General  Paralysis  undoubtedly  stands  by  itself  as  a  form 
of  mental  disease.  Attempts  have  been  made  at  different 
times  to  divide  it  into  varieties ;  but,  in  our  opinion,  such  a 
course  is  to  be  deprecated  as  likely  to  lead  to  confusion  in 
the  minds  of  the  profession,  and  to  encourage  the  relations 
of  the  victims  of  this  form  to  indulge  in  false  hopes  of 
the  patient’s  recovery. 


Out  of  fourteen  authors  who  have  given  statistics  on  this 
point,  Parchappe  states  that  15  per  cent,  of  cases  are  caused 
by  hereditary  taint.  Burrows  puts  it  as  high  as  84.  Bucknill 
agrees  with  Parchappe,  and  places  it  at  15.  Thurnam,  the 
most  careful  of  statisticians,  gives  30  per  cent,  as  the  figure. 
The  number  of  persons  going  mad  whose  ancestors  have- 
suffered  from  hereditary  insanity  or  other  nervous  diseases 
should  not,  in  my  opinion,  be  placed  at  less  than  50  per  cent.; 
75  per  cent,  would  possibly  be  nearer  the  mark.  Baillarger 
tells  us  that  the  insanity  of  the  mother  is  more  likely  to 
affect  the  children  than  is  the  insanity  of  the  father,  (a) 
He  also  believes  that  the  mother’s  insanity  is  most  likely 
to  affect  the  girls  of  the  family,  and  that  the  father’s  is 
most  likely  to  affect  the  boys.  Heredity  may  be  “  direct” 
or  “  collateral.”  Direct  heredity  refers  backwards  to  lineal 
ancestors  only — that  is,  to  parents  and  grandparents.  Col¬ 
lateral  refers  to  the  insanity  of  one’s  own  uncle,  own  aunt,, 
brother,  or  sister.  The  insanity  of  cousins  is  not  included 
under  the  head  of  collateral  heredity,  as  the  introduction 


(a)  See  the  Commissioners’  tables,  mentioned  later  on. 


Medical  Times  and  Gazette. 


SUTHERLAND  ON  INSANITY. 


Sept.  8,1883.  257 


of  fresh  blood  by  marriage  may  have  caused  the  taint. 
Epilepsy  and  other  nervous  disorders  in  the  parents  often 
appear  as  insanity  in  the  children. 

The  connexion  of  phthisis  with  insanity  in  the  same 
family  is  an  undisputed  fact.  Syphilis  and  drunkenness  in 
the  parents  are  often  the  causes  of  idiocy  in  the  child  or  of 
insanity  in  the  adult  offspring. 

Any  physical  injury  or  moral  shock  to  the  pregnant 
mother  may  produce  idiocy  in  the  infant. 

II. — Causes  Operating  at  Birth. 

These  may  be  briefly  summed  up  under  these  two  heads  : 
1.  A  too  small  pelvis  on  the  part  of  the  mother.  2.  A  too 
large  head  on  the  part  of  the  child.  Either  of  these  two 
impediments  to  natural  labour,  or,  indeed,  any  element  by 
which  the  process  of  parturition  is  unusually  prolonged, 
are  very  frequent  causes  of  idiocy  in  the  offspring.  Hence 
late  marriages  on  the  part  of  the  female  should  be  dis¬ 
couraged  if  the  mental  health  of  the  next  generation  is  to 
be  considered. 

In  exceptional  cases  an  injudicious  use  of  the  forceps, 
causing  injury  to  the  head  of  the  child,  has  been  known  to 
produce  asymmetry  of  the  head,  and  consequent  idiocy. 

III. — Causes  Operating  in  Infancy. 

All  ignorant  treatment  of  the  ailments  of  childhood,  as 
by  drugging  with  opium  and  spirits,  are  potent  causes  of 
idiocy  or  the  insanity  of  early  life.  Injuries  to  the  head 
are  equally  injurious.  Idiocy  also  sometimes  follows  the 
exanthemata,  whooping-cough,  or  convulsions  at  dentition  ; 
and  it  is  said  that  the  milk  of  an  insane,  anaemic,  or 
syphilitic  wet-nurse  may  also  affect  the  mental  health  of  the 
-child. 

IY. — Causes  Operating  in  Youth. 

Any  brutality  on  the  part  of  parents  or  relations,  and,  on 
the  contrary,  any  over-indulgence  during  childhood,  may 
result  in  mental  disease  in  adult  life.  The  insane  tempera¬ 
ment  is  a  very  usual  form  of  mental  disorder  in  those  who 
have  been  “  spoilt  ”  by  well-meaning  parents  in  early  life. 
The  advent  of  puberty  is  an  event  which  not  unfrequently 
causes  alienation  in  girls.  The  epileptic  insanity  found  in 
both  sexes  at  this  age,  contrary  to  that  of  advanced  life, 
is  a  form  of  disorder  which  gives  a  large  percentage  of 
recoveries.  Masturbation,  in  both  sexes,  is  said  to  produce 
insanity,  but  it  is  difficult  to  distinguish  between  premonitory 
symptoms  and  causes  in  many  of  these  cases. 

Y. — Causes  Operating  in  Adult  Life. 

Sexual  excess  in  the  male  or  the  female,  amongst  both 
the  married  and  the  single,  is  perhaps,  next  to  heredity,  the 
most  potent  cause  of  insanity.  Under  this  head  also  may 
be  included  the  troubles  of  the  female  at  the  periods  of  men¬ 
struation,  pregnancy,  parturition,  lactation,  and  the  change 
of  life,  as  well  as  the  disorders  attending  the  catamenial 
function,  and  all  other  diseases  of  the  uterus  and  ovaries. 

Next  may  be  placed  alcoholic  excess  ;  and  it  is  said  the 
abuse  of  tobacco,  opium,  bhang,  and  other  sedatives  produces 
a  small  percentage  of  cases  of  insanity. 

Injuries  and  blows  to  the  head  are  also  dangerous  to 
mental  health,  the  prognosis  in  such  cases  being  more 
favourable  if  the  symptoms  come  on  suddenly  than  if  they 
are  insidious  in  their  approach.  Unnatural  sexual  desire 
is  a  frequent  concomitant  of  insanity  produced  by  these 
causes. 

Mental  disease  also  frequently  follows  fevers,  ague,  gout, 
rheumatism,  erysipelas,  and  other  diseases.  It  is  sometimes 

metastatic/’  which  means  that  it  results  from  the  suppres¬ 
sion  of  any  discharge  which  has  existed  for  any  length  of 
time,  such  as  that  from  an  old  ulcer,  the  blood  from  chronic 
piles,  or  from  a  cessation  of  the  catamenia  at  the  climacteric. 

Insanity  has  also  a  subtle  connexion  with  other  nervous 
•disorders,  more  especially  with  epilepsy,  hysteria,  chorea, 
and  the  various  forms  of  paralysis. 

Moral  influences  undoubtedly  play  their  part  in  its  pro¬ 
duction,  such  as  pecuniary  losses,  religious  anxiety,  over¬ 
work,  and  emotional  excitement ;  the  French  nation,  how¬ 
ever,  contributing  a  larger  number  of  cases  attributable  to 
this  last  element  than  we  do  on  this  side  of  the  Channel. 

YI. — Causes  Operating  in  Old  Age. 

Simple  decay  from  old  age  may  produce  complete  loss  of 
the  mental  faculties.  Such  cases  are  classed  under  the  head 


of  Senile  Dementia,  a  more  important  form  of  insanity  than 
might  at  first  sight  be  supposed.  It  is  at  this  age  and  in 
this  state  of  mind  that  old  men  are  induced  by  designing 
people  to  make  wills  and  execute  documents  by  which  their 
nearest  relatives  are  excluded  from  the  reversionary  inte¬ 
rest  of  property  they  have  all  their  lives  expected  to  enjoy. 
This  form  of  insanity  is  not  hereditary,  and  the  children  of 
a  parent  whose  intellect  has  yielded  to  simple  old  age  need 
not  fear  that  they  inherit  any  tendency  to  mental  alienation. 

The  results  of  apoplexy,  epilepsy,  and  other  disorders  in 
old  age  may  also  incapacitate  a  man  from  undertaking  the 
management  of  himself  or  his  affairs. 

These  remarks  upon  the  etiology  of  insanity  cannot  be 
brought  to  a  close  more  appropriately  than  by  bringing 
before  you  the  following  table  of  causes  drawn  up  by  the 
Commissioners  in  Lunacy  in  their  Eeport  for  1878. 


Table  of  Percentages  of  Causes  of  Insanity  (from  the  Thirty  - 
third  Report  of  the  Commissioners  in  Lunacy,  1879). 


Male. 

Female. 

Total. 

Physical — 

Unknown... 

22-9 

22-6 

22-8 

Hereditary  influence  . 

163 

18-8 

17-5 

^Intemperance  in  drink  . 

213 

7-9 

146 

Previous  attacks . 

11T 

14-8 

13-0 

Other  bodily  diseases  or  disorders 

9-9 

10-2 

10-1 

Congenital  defect  ascertained... 

5-9 

3-7 

4-8 

Old  age  ... 

35 

4-1 

3-8 

Parturition  and  the  puerperal  state  ... 

... 

7-0 

3-5 

Accident  or  injury  . 

50 

1-1 

31 

Change  of  life  ...  . 

•  •• 

3-7 

1-8 

Other  ascertained  causes  . 

2-7 

•6 

1-6 

Privation  and  starvation 

1-5 

1-6 

1-5 

Uterine  and  ovarian  disorders... 

.  .  . 

2-8 

1-4 

Sunstroke... 

2-4 

•2 

1-3 

Self-abuse  (sexual) 

23 

•2 

1-2 

^Intemperance  (sexual) . 

14 

■8 

11 

Over-exertion 

•9 

•8 

•9 

Lactation...  . 

... 

1-9 

*9 

Fevers 

•8 

•7 

•7 

Venereal  disease... 

•9 

•4 

•6 

Pregnancy 

1-1 

•5 

Puberty  ... 

•1 

*6 

*3 

Moral — 

Domestic  trouble 

3-8 

9-8 

6-8 

Mental  anxiety  and  worry 

6-8 

50 

5-9 

Adverse  circumstances... 

7-2 

32 

5-2 

Eeligious  excitement  .  ... 

23 

2-4 

2-4 

Love  affairs  (including  seduction)  ... 

•6 

30 

1-8 

Fright  and  nervous  shock 

1-2 

20 

1-6 

*  Note. — The  proportion  of  cases  of 

general  paralysis  produced  by — 

Intemperance  in  drink  is  . 

25-8 

15-0 

23-7 

And  by  Sexual  intemperance . 

4-8 

4-5 

•  4-8 

The  attention  of  the  student  is  directed  to  the  proportion 
of  cases  of  all  forms  of  insanity  caused  by  intempei’ance  in 
drink  and  sexual  excess  as  compared  with  the  percentage  to 
cases  of  general  paralysis  produced  by  the  same  causes. 
This  mil  be  again  alluded  to  under  the  head  of  General 
Paralysis  of  the  Insane. 

He  may  also  draw  useful  conclusions  from  the  figures 
placed  against  “  hereditary  influence,”  “  previous  attacks,” 
“accident  or  injury,”  and  “love  affairs,”  as  showing  the 
different  liability  of  the  sexes  to  the  influence  of  certain 
causes  producing  insanity. 


To  Stop  Hiccough. — Dr.  Shaw,  of  Cincinnati,  states 
that  he  has  often  succeeded  in  this  by  following  Dr. 
Kinnaird’s  procedure.  “His  method  was  to  place  the  tips 
of  the  fingers  of  both  hands  in  the  position  of  complete 
supination  against  the  abdominal  muscles,  at  the  lower  and 
outer  junctions  of  the  epigastric  with  the  hypochondriac 
regions.  With  the  finger-tips  in  this  position,  firm  and 
very  gradual  pressure  is  made  backward  and  upward 
against  the  diaphragm.  This  pressure  should  be  continued 
for  some  little  time  after  the  diaphragm  has  ceased  its 
spasmodic  contractions,  when  the  fingers  should  be  very 
I  gradually  withdrawn.”— New  York  Med.  Record,  July  21. 


258 


Medical  Times  and  Gazette. 


RIVINGTON’S  presidential  address. 


Sept.  8, 1883. 


PRESIDENTIAL  ADDRESS 

DELIVERED  AT 

THE  HUNTERIAN  SOCIETY 

On  February  28,  1883. 

By  WALTER  RIVINGTON,  M.S.  Lond.,  F.R.C.S.  Eng., 

Surgeon  to  the  London  Hospital. 

( Concluded  from  page  228.) 

The  history  of  medicine  shows  that  before  the  perfecting 
of  anatomy  and  physiology,  chemistry  and  physics,  the 
science  of  medicine  was  largely  composed  of  unverified 
hypotheses,  false  principles,  and  pseudo-science.  Galen  could 
write  an  elaborate  treatise  on  the  pulse,  full  of  the  most 
subtle  distinctions,  giving  twenty-seven  varieties  of  pulse  as 
to  fulness,  and  twenty-seven  as  to  rapidity,  without  acquaint¬ 
ance  with  the  circulation  of  the  blood  or  the  true  cause  of 
the  phenomenon.  To  a  certain  extent,  doubtless,  his  dis¬ 
tinctions  were  practically  useful,  and  enabled  him  to  interpret 
the  “prognostics”  or  the  course  of  diseases  aright,  but 
scarcely  can  such  a  treatise  be  termed  scientific.  A  scien¬ 
tific  account  of  the  pulse  could  not  be  written  until  the  ana¬ 
tomy  of  the  heart  and  arteries  was  thoroughly  worked  out ; 
until  Harvey  had  discovered  and  placed  on  the  immovable 
foundation  of  anatomy,  reason,  and  experiment  the  circula¬ 
tion  of  the  blood;  until  physiology  had  taught  how  the 
heart  and  arteries  were  regulated  and  controlled  by  nerves 
and  ganglia;  until  pathology  had  displayed  the  various 
diseased  conditions  of  the  valves  and  the  cavities  of  the 
heart  and  the  coats  of  the  arteries  by  which  the  pulse 
might  be  modified — and  not  even  then,  perhaps,  until  the 
stethoscope  could  reveal  to  us  the  heart  actually  at  work, 
regular  or  intermittent,  embarrassed  or  free,  hypertrophied 
or  weakened,  sound  or  degenerated ;  and  until  physiology, 
again  and  ever  by  experiment,  had  interpreted  the  causes 
of  the  sounds  of  the  heart  and  described  the  phenomena 
of  blood-pressure  and  arterial  tension,  and  given  us  the 
sphygmograph  as  a  graphic  method  of  registering  what  the 
touch  could  but  imperfectly  appreciate.  As  it  has  been 
with  the  heart  and  arteries,  so  it  has  been  with  the  diseases 
of  all  the  organs  of  the  body.  The  practitioner  might  meet 
with  and  recognise  different  varieties  of  derangement  of 
individual  organs  by  the  careful  exercise  of  his  unaided 
senses,  and,  with  little  help  from  science,  find  out  a  good  deal 
concerning  their  course  and  issue,  and  even  arrive  at  a  ra¬ 
tional  method  of  treatment,  but  not  until  the  present  century, 
and  in  years  very  recent,  has  it  been  possible  for  him  to  under¬ 
stand  them  scientifically.  Not  until  the  minute  anatomy  of 
the  liver  and  kidneys  was  unfolded,  until  physiology  had 
described  their  functions,  and  chemistry  had  analysed  their 
products, — not  until  pathology,  which  is  the  physiology  of 
disease,  with  the  aid  of  chemistry  and  the  microscope,  had 
rearedits  fabricon  the  foundation  of  the  knowledge  furnished 
by  anatomy  and  physiology,  could  the  clinical  physician 
approach  these  diseases  from  a  scientific  standpoint.  Do 
not  let  it  be  supposed  that,  whilst  insisting  on  the  value  of 
the  services  rendered  by  anatomy  and  physiology  to  medi¬ 
cine,  I  ignore  the  aid  rendered  by  medicine  to  anatomy  and 
physiology.  W ere  I  inclined  to  do  so,  the  name  of  my  dis¬ 
tinguished  predecessor  would  remind  me  that,  in  regard  to 
the  localisation  of  the  functions  of  the  brain  and  spinal  cord, 
he  had,  by  observation  of  the  phenomena  of  individual  cases, 
and  comparison  of  the  symptoms  with  the  parts  of  the  nervous 
system  found  affected  after  death,  anticipated  some  of  the 
observations  made  by  experiment  on  healthy  living  animals. 
Disease  is  of  the  nature  of  experiment,  as  it  shows  the 
effects  both  of  irritation  and  of  deprivation  of  parts  of  the 
body,  and  therefore  physiology  and  pathology  shed  a  com¬ 
bined  light  upon  function,  confirming  and  strengthening 
one  another.  All  scientific  medical  knowledge  is  obtained, 
as  in  other  sciences,  by  the  accurate  observation  of  phe¬ 
nomena,  the  collection  of  a  large  number  of  facts  by  dif¬ 
ferent  observers,  the  comparison  of  these  facts  with  one 
another  for  the  recognition  of  those  features  which  are 
common  to  the  whole,  and  those  which  are  accidental  or 
peculiar.  This  method  has  to  be  applied  to  every  one  of  the 
countless  ills  of  humanity  before  safe  general  conclusions 
or  principles  can  be  deduced :  and  if  medicine  cannot  boast 


of  the  discovery  of  any  universal  law  like  the  law  of  gravi¬ 
tation,  more  limited  generalisations  have  been  or  are  in 
process  of  being  reached,  which  may  possibly  be  comparable 
to  the  discoveries  of  Kepler,  that  the  planets  move  in 
elliptical  orbits,  having  the  sun  for  their  common  focus ; 
that  the  planets  describe  equal  areas  in  equal  times ;  and 
that  the  squares  of  the  periodic  times  of  the  planets  are  as 
the  cubes  of  their  mean  distance  from  the  sun, — out  of  which 
Newton  was  able  to  evolve  the  law  of  gravitation.  Among 
general  discoveries  stamping  medicine  as  a  science  are  the 
elucidation  of  the  whole  class  of  parasitic  diseases,  with  the 
migrations  and  changes  of  the  parasites  themselves,  the 
protection  afforded  by  vaccination  and  its  later  extension 
by  Pasteur,  and  the  relations  of  micro-organisms  or  microbes 
(the  bacterium,  bacillus,  micrococcus,  and  spirillum)  to  fevers; 
and  other  infectious  diseases. 

So  far,  therefore,  as  the  natural  history  of  disease  is  con¬ 
cerned,  the  materials  appear  to  be  abundant  to  prove  that 
medicine  is  a  science.  Its  progress  may  have  been  slow, 
but  it  has  kept  pace  with  the  progress  of  civilisation,  and 
has  at  once  made  use  of  every  advance  in  the  sciences  on 
which  it  is  based  and  in  physical  science  generally.  The 
science  of  modern  medicine  had  to  wait  for  its  development 
for  the  subsidence  of  the  waves  of  barbarism  which  swept 
away  the  civilisation  of  Rome,  for  the  abolition  of  the  feudal 
system  which  made  history  but  the  record  of  “  battle  and 
murder  and  sudden  death,”  and  for  the  restoration  of  some 
of  the  ancient  knowledge  through  the  agency  of  the  Crusades, 
which  helped  to  spread  the  Arabian  literature  (scarcely  an 
equivalent  for  the  burning  of  the  Alexandrian  Library),  and 
through  the  capture  of  Constantinople,  which  insured  the 
return  of  precious  manuscripts  to  Italy,  where  the  lamp  of 
medical  science  was  first  relumed.  It  had  to  wait  for  the 
gradual  destruction  of  the  belief  in  supernatural  agencies  as 
the  cause  of  disease,  for  the  overthrow  of  superstition,  mys¬ 
ticism,  and  astrology,  and  reliance  upon  magic  and  spiritual 
influences  as  the  means  of  cure.  It  had  to  wait  for  the 
divorce  of  medicine  from  the  church,  the  separation  of  its- 
practitioners  from  barbers,  blacksmiths,  and  grocers,  for  its 
constitution  as  a  distinct  calling,  and  for  its  elevation  into  a 
learned  profession.  It  had  to  wait  for  the  foundation  of 
universities  and  colleges  by  the  favour  of  Royalty,  and  the 
origin  of  academies,  learned  societies,  and  associations- 
through  the  scientific  ardour  of  the  most  enlightened 
members  of  the  community.  It  had  to  wait  for  the  emanci¬ 
pation  of  the  human  mind  from  the  bondage  of  opinion  and 
authority,  largely  effected  by  means  of  the  reformation  in 
religion,  the  concurrent  diffusion  of  the  art  of  printing, 
and  the  formation  of  public  libraries  and  museums.  It  had 
to  wait  until  chemistry  had  been  freed  from  the  swaddling 
clothes  and  emerged  from  the  cradle  of  alchemy,  and,  having 
abandoned  the  infantile  occupation  of  the  search  after  the 
philosopher’s  stone,  had  entered  upon  the  wonderful  career 
of  discovery,  analysis,  and  synthesis  which  have  lightened 
the  darkness  of  the  laboratory  of  the  living  body.  It  had 
to  wait  for  the  establishment  of  the  practice  of  dissection 
of  the  human  body,  by  which  current  errors  could  be 
corrected,  and  free  and  independent  inquiry  undertaken,  for 
physiology  to  unfold  by  experiment  and  observation  the 
laws  of  the  healthy  animal  economy,  and  for  pathological 
anatomy  to  reveal  the  structural  alterations  effected  by 
disease.  It  had  to  wait  for  the  abandonment  of  hypotheses 
and  occult  causes,  and  for  the  general  acceptation  and  prac¬ 
tice  of  the  principles  of  the  inductive  philosophy.  Curiously 
enough,  the  first  man  who  shook  the  fabric  reared  by  Galen 
was  a  man  described  by  Zimmerman  as  “  living  like  a  hog, 
looking  like  a  carter,  and  writing  only  when  drunk,”  and 
who  himself  professed  to  have  discovered  the  elixir  vitei 
His  full  name  was  Philippus  Aureolus  Theophrastus  Bom- 
bastes  von  Hohenheim,  commonly  known  by  the  title  of 
Paracelsus.  Extravagant  as  were  some  of  his  own  opinions, 
and  intemperate  as  was  his  language  and  conduct,  he  very 
effectually  disposed  of  the  humours,  the  hot  and  cold  diseases, 
and  the  multifarious  remedies  used  in  a  single  prescrip¬ 
tion.  Assuming  the  air  of  a  great  reformer  of  medicine,  and 
in  imitation  of  Luther  burning  the  Bull  of  Leo  X.  in  1520, 
Paracelsus  commenced  his  Professorship  of  Physic  and 
Surgery  in  the  University  of  Basle  by  committing  the  works 
of  Galen  and  Rhazes  to  the  flames.  Probably  there  never 
were  two  men  more  dissimilar  than  the  mountebank 
Paracelsus,  and  the  present  refined  and  cultured  President 
of  the  Clinical  Society;  and  yet  there  are  one  or  two 


Medical  Times  and  Gazette. 


RIVINGrTON’S  PRESIDENTIAL  ADDRESS. 


Sept.  8, 1883.  259 


points  of  parallelism  between  their  views.  Thus  we  find 
Paracelsus,  when  inveighing  against  the  humoral  pathology, 
which  had  so  long  held  sway  in  the  profession,  saying, 
“  What  you  call  humours  are  not  diseases ;  that  is  the 
disease  which  makes  these  humours.  How  can  a  physician 
think  to  discover  the  disease  in  the  humours,  when  the 
humours  spring  out  of  the  disease  ?  It  is  not  the  snow 
which  makes  the  winter,  but  the  winter  the  snow ;  for, 
although  the  snow  is  gone,  the  winter  remains.  You  mistake 
"the  product  of  disease  for  disease  itself.”  On  the  other 
hand,  the  President  of  the  Clinical  Society  has  uttered  an 
•eloquent  protest  against  morbid  anatomy  and  experimental 
pathology  mistaking  the  structural  changes  found  after 
death  (which,  I  take  it,  is  a  description  of  solidism)  for  the 
disease  itself.  Dr.  Clark  observes — “  But  the  true  relation 
is  not  this ;  it  is,  in  fact,  the  converse  of  it.  For  the  struc¬ 
tural  change  is  not  disease,  it  is  not  co-extensive  with  disease  ; 
and  even  in  the  cases  where  the  alliance  appears  the  closest, 
the  statical  or  anatomical  alteration  is  but  one  of  other 
•effects  of  physiological  forces,  which,  acting  under  rm- 
physiological  conditions,  constitutes  by  this  new  departure 
"the  essential  and  true  disease.  For  disease  in  its  primary 
condition  and  intimate  nature  is,  in  strict  language,  dynamic. 
It  precedes,  underlies,  evolves,  determines,  embraces,  trans¬ 
cends,  and  rules  the  anatomical  state.”  In  both  epochs, 
"the  products  of  disease  are  mistaken  for  the  disease  itself  ; 
but  I  am  not  sure  that  in  either  the  true  nature  of  disease 
has  been  grasped,  or  is  perfectly  comprehensible  from  the 
descriptions  of  their  authors.  The  disease  of  Paracelsus  was 
an  immaterial  entity  generated  out  of  three  co-efficients — 
salt,  sulphur,  and  mercury ;  the  disease  of  Dr.  Clark  is  the 
dynamic  offspring  of  physiological  forces  acting  under  un- 
physiological  conditions,  and  seems  in  its  nature  to  be 
nebulous  and  intangible.  One  great  notion  of  Paracelsus 
was  that  of  a  threefold  unity  in  nature,  or  mystic  harmony 
with  the  Trinity  in  Unity.  Man  consisted  of  body,  soul,  and 
spirit ;  the  world  of  three  elements — water,  air,  and  earth  ; 
•and  disease,  as  already  mentioned,  was  an  immaterial  entity 
generated  out  of  three  co-efficients — salt,  sulphur,  and 
mercury.  One  of  the  first  lectures  which  I  had  the  pleasure 
of  listening  to  at  the  London  Hospital  Medical  College  was 
an  introductory  lecture  by  Dr.  Andrew  Clark,  on  Triune 
Man,  composed  of  body,  soul,  and  spirit ;  but  here  the 
parallel  ends,  for  it  is  difficult  to  determine  an  affinity 
between  his  dynamic  pathogenesis  and  the  immaterial  entity 
of  Paracelsus,  generated  out  of  salt,  sulphur,  and  mercury. 

The  thunders  of  Paracelsus  were  insufficient  to  overthrow 
the  fabric  which  Galen  had  reared,  for  his  system  was  as  un¬ 
satisfactory  and  as  speculative  as  that  which  it  sought  to 
replace.  Before  the  reign  of  authority  and  mere  speculative 
hypothesis  could  be  brought  to  an  end,  a  philosopher  of 
learning  and  reputation  was  needed,  who  could  analyse  the 
■errors  and  illusions  to  which  the  human  mind  is  subject, 
expose  the  folly  of  founding  systems  on  preconceived 
notions  and  assumption  of  axioms,  and  point  the  true  way 
to  the  knowledge  of  the  external  world  by  accurate  observa¬ 
tion  of  natural  phenomena,  verification  of  facts,  and  interro¬ 
gation  of  nature  by  experiment.  Such  a  philosopher  was 
Francis  Bacon,  the  great  expounder,  though  not  the  originator, 
•of  the  inductive  philosophy.  Hippocrates  had  practised  its 
principles  ;  Aristotle  had  laid  them  down  and  followed  them  ; 
and  the  Chancellor’s  namesake  and  predecessor,  the  cele¬ 
brated  Roger  Bacon  (Doctor  Mirabilis),  had  pursued  physical 
science  in  a  kindred  spirit.  Bacon  started  with  the  aphorism 
that  “  man,  the  servant  and  interpreter  of  nature,  does  and 
understands  so  far  as  he  may  have  observed  respecting  the 
order  of  nature  in  things  or  in  his  mind ;  and  further,  he 
has  neither  knowledge  nor  power.”’  Man  was  to  come  as  a 
little  child  to  nature,  conscious  of  his  ignorance  and  anxious 
to  be  taught.  The  testimony  of  the  senses  was  to  be  his 
guide.  With  regard  to  medicine.  Bacon  insisted  on  the 
necessity  of  employing  all  the  powers  of  nature  for  the 
relief  of  the  bodily  ills  of  the  human  race,  approved  of  ex¬ 
periments  on  the  lower  animals  but  not  on  living  men,  and 
insisted  that  the  footsteps  of  disease  and  their  devastation 
of  the  inward  parts  ought  to  be  “  exactly  observed  by  multi¬ 
tudes  of  anatomies  and  the  contributions  of  men’s  several 
experiences,  and  carefully  set  down  both  historically  accord¬ 
ing  to  the  appearances,  and  artificially  with  reference  to  the 
diseases  and  symptoms  which  result  from  them,  in  case 
where  the  anatomy  is  of  a  defunct  patient,  whereas  now 
they  are  passed  over  slightly  and  in  silence.”  Bacon  is 


extremely  wroth  against  Galen,  and  seems  to  have  been  the 
originator  of  the  bag-and-baggage  policy — “  Let  him,”  he 
says,  “then  be  dismissed  and  take  along  with  him  the 
whole  train  of  his  associates — these  compensatory  compilers 
from  the  Arabians  who  have  shown  such  folly  in  their 
theories,  and  from  their  supine  and  jejune  conjectures 
amass  together  such  a  heap  of  promises  instead  of  real 
helps  from  vulgar  remedies.”  He  is  also  indignant 
at  the  idea  of  diseases  being  pronounced  incurable.  “  A 
work,”  he  says,  “is  wanting  upon  the  cures  of  reputedly 
incurable  diseases,  that  physicians  of  eminence  and  reso¬ 
lution  may  be  excited  and  encouraged  to  pursue  the 
matter  ’  so  far  as  the  nature  of  things  will  permit,  since  to 
pronounce  diseases  to  be  incurable  is  to  exhibit  ignorance 
and  carelessness,  as  it  were,  by  law,  and  screen  ignorance 
from  reproach.”  Lastly,  Bacon  points  out  the  deficiency 
of  physic  in  authentic,  specific,  positive  remedies,  and  ad¬ 
vocates  the  compilation  of  a  work  setting  forth  the  approved 
and  experienced  medicines  in  particular  diseases,  with  the 
careful  collection  of  all  well-established  cures.  Whilst 
Bacon  was  writing  about  the  interrogation  of  nature  by 
observation  and  experiment,  for  which  he  was  himself  un¬ 
fitted,  Harvey  was  putting  his  method  independently  into 
practice ;  and  when  Bacon  died,  Boyle,  the  father  of  experi¬ 
mental  philosophy  and  the  reformer  of  chemistry,  arose  to 
investigate  natural  phenomena  in  accordance  with  the 
methods  of  Bacon.  By  the  application  of  the  same  prin¬ 
ciples  Haller  became  the  father  of  physiology.  Rejecting 
metaphysical  ideas,  which  were  but  the  cloak  of  ignorance, 
and  all  mathematical  and  chemical  theories,  he  set  himself 
to  ascertain  general  facts  by  observation,  and  to  place  the 
foundation  of  physiology  on  human  and  comparative  ana¬ 
tomy  and  experiments  on  the  lower  animals.  Of  the  other 
men  who,  by  following,  consciously  I  or  unconsciously,  the 
principles  of  the  Baconian  philosophy  and  the  method  of 
Hippocrates,  helped  to  rear  the  fabric  of  scientific  medicine, 
time  and  space  only  permit  reference  to  a  few.  There  was 
Sydenham — medicus  in  omne  cevum  nobilis — who  earned  the 
title  of  the  English  Hippocrates.  There  was  Cullen,  who, 
avoiding  the  plan  of  Boerhaave  of  collecting  the  opinions  of 
others,  pursued  the  method  of  induction  and  generalisation, 
“  disclaimed  all  hypotheses  and  theories  not  derived  from 
facts,  and  made  it  his  business  to  collect  by  actual  observation 
the  materials  from  which  he  might  deduce  his  general  prin¬ 
ciples.”  There'  was  Bonet,  the  founder  of  pathological 
anatomy,  followed  by  Manget,  Yalsalva,  and  Morgagni,  whose 
chief  woi’k  was  translated  by  the  revered  founder  of  this 
Society,  Dr.  William  Cooke.  Jenner  must  not  be  passed 
over  in  silence,  and  with  the  pupil  must  be  named  the 
master  (John  Hunter),  who  wrote  the  aphorism  which  maybe 
commended  to  the  attention  of  our  legislators — “If  you  check 
experiment  you  stop  discovery,” — and  who  combined  at  once 
in  the  highest  degree  the  power  of  collection  and  classifica¬ 
tion,  the  power  of  investigation,  and  the  power  of  thought. 
His  praise  is  in  all  the  schools,  in  every  place,  in  every  time, 
on  every  tongue.  Under  the  sanction  of  his  honoured 
name  we  meet  to  contribute  our  mites  to  the  treasury  of 
knowledge  and  truth,  steadfastly  believing  that  medical 
science  possesses  in  the  future  almost  boundless  possibilities 
of  progressiveness,  unlimited  capacity  for  new  observations 
and  new  discoveries  which  will  be  turned  to  the  great  end 
of  all  our  labours  —the  use  and  advantage  of  man. 


A  Singular  Variety  oe  Charlatanism. — We  read 
in  the  Union  MSdicale  that  a  mysterious  kind  of  personage 
installed  himself  as  a  doctor  in  the  most  frequented  part  of 
the  Faubourg  Montmartre.  Admission  could  only  be  gained 
to  his  presence  after  infinite  questionings.  His  name  was  a 
foreign  one,  and  all  his  servants  were  bound  over  to  secrecy. 
His  consultation-room  was,  in  consequence  of  all  this,  besieged 
from  morning  to  night,  until  at  last  the  attention  of  the 
police  was  attracted.  A  commissaire  called  upon  him  and 
demanded  an  inspection  of  his  diplomas,  expecting  to  find 
him  pale  and  trembling  at  the  request.  Nothing  of  the  kind. 
The  suspected  practitioner,  all  smiles,  opened  a  drawer  of  his 
bureau,  and  exhibited  to  his  visitor  documents  which  were 
perfectly  authentic.  "  And  now  that  you  have  quite  assured 
yourself,  M.  Commissaire,”  said  the  doctor,  “  pray  do  not 
betray  me ;  for  if  my  patients  only  get  to  know  that  I  am  a 
mere  Doctor  of  the  Medical  Faculty  of  Paris,  I  shall  see  no 
more  of  them.” — Presse  Med.  Beige. 


260 


Medical  Times  and  Gazette. 


CHEYERS  OJST  THE  ORDINARY  DISEASES  OF  INDIA. 


Sept.  8, 1883. 


PRACTICAL  NOTES  ON 

THE  ORDINARY  DISEASES  OF  INDIA, 

ESPECIALLY  THOSE  PREVALENT  IN  BENGAL. 

By  NORMAN  CHEYERS,  C.I.E.,  M.D., 

Late  Senior  Physician  and  Professor  of  Medicine,  Medical  College 
and  Hospital,  Calcutta. 

( Continued,  from  page.  234.) 

CHOLERA  ASIATICA  MALIGNA — Continued. 

The  following  data — most  of  which  are  recognised  by 
many,  if  not  by  all,  physicians  of  Indian  experience — may 
be  taken  as  applicable  to  our  present  threatened  position  in 
Europe.  All  of  these  conclusions  are  based  upon  many 
more  facts  than  can  be  given  here. 

If  a  strong  epidemic  wave  rises  among  us,  its  destructive 
effects  will  not  be  wholly  avoidable.  In  India,  good  Hygiene 
is  generally  a  great  protective.  English  officers  and  mer¬ 
chants,  their  wives  and  children,  are  comparatively  rarely 
attacked,  their  good  Hygiene  being  their  main  safeguard  ; 
but,  in  two  Indian  epidemics,  within  my  knowledge,  the 
officers  suffered  greatly.  So,  in  one  of  the  worst  small-pox 
visitations  which  I  watched  in  Calcutta,  persons  whose  faces 
were  seamed  by  a  previous  attack  fell  victims. 

Whatever  treatment  may  be  adopted,  a  very  large  percent¬ 
age  of  those  first  attached  will  probably  die.  It  is  a  fact> 
noticed  always  and  everywhere  in  India,  that  at  the  first 
outset  of  an  epidemic,  and  when  an  endemic  first  sets  in, 
the  loss  of  life  among  those  attacked  is  terrible,  the  disease 
having  an  intensity  which,  in  a  majority  of  cases,  defies  all 
treatment.  Later,  when  the  outbreak  is  on  the  decline, 
there  is  usually  a  strong  tendency  to  recovery.  This  law  in 
the  disease  has  repeatedly  led  inexperienced  practitioners 
into  a  very  transparent  mistake.  One  who  has  recently  come 
to  the  country  frequently  makes  this  observation  :  “  When 
cholera  appeared,  in  February,  I  tried  all  the  old  remedies, 
but  found  them  useless.  Being  almost  in  despair,  in  May,  I 
gave  Album  Grsecum  in  three-grain  doses  every  quarter  of  an 
hour,  and  cured  60  per  cent,  of  my  patients  !  ”  The  fallacy 
only  becomes  apparent,  even  to  the  discoverer  himself,  when 
he  comes  to  employ  his  specific  at  the  commencement  of  the 
next  outbreak.  This  law  receives  some  indirect  illustration 
from  the  fact,  given  by  Dr.  Macpherson,  that,  in  an  analysis 
of  1354  cases  of  cholera  in  Europeans  in  Calcutta,  “'the  rate 
of  mortality  during  the  hot  or  cholera  months  was  56 '2  per 
cent.,  and  45’2  during  the  others.” 

The  following  data,  also  given  by  Macpherson,  are  still 
more  explicit:— In  the  outbreak  at  Kurrachee,  in  Scinde,  of 
the  first  100  admissions  79  died;  second,  66;  third,  50; 
fourth,  40. 

In  Cholera  outbreaks,  he  who  enters  the  Epidemic  or  En¬ 
demic  Area  encounters  special  danger.  In  India,  no  one  can 
be  considered  safe  on  first  entering  a  cholera-impested  area. 
Thus,  when  I  looked  around  my  cholera  ward,  the  native 
patients  generally  had  much  the  appearance  of  Calcutta 
people ;  but,  on  inquiry,  it  was  almost  always  found  that 
they  were  outsiders  who  had  not  been  many  days  in  the  city. 
It  was  hoped  that  the  introduction  of  an  excellent  water- 
supply  would  put  an  end  to  this,  but  it  did  not— in  my  time. 
All  travellers,  Europeans  and  natives,  from  Up  Country 
incur  thi3  Lability.  It  is  a  common  saying,  among  natives, 
that  everyone  who  enters  Calcutta  is  liable  to  bowel  com¬ 
plaint  ;(a)  and  I  am  confident  that  no  one  who  arrives  in 
Calcutta  from  Europe  can  regard  himself  as  being  perfectly 
free  from  danger  of  an  attack  until  he  has  passed  through 
a  cholera  season.  The  Europeans  who  die  of  this  disease  in 
Calcutta  are  mostly  sailors,  lately  arrived  in  port,  and  other 
new-comers.  Hence  the  necessity  for  moderate  care  in  living 
during  the  early  months  of  residence  in  India. 

The  works  of  Dr.  John  Macpherson,  the  “  Annals  of 
Cholera  ”  and  “  Cholera  in  its  Home,”  which  may,  at  this 
crisis,  be  studied  throughout  with  the  greatest  interest  and 
profit  by  every  medical  man  in  this  country,  contain  impor¬ 
tant  illustrations  of  this  law,  among  the  most  striking  of 
which  is  the  following(b)  : — 

(a)  So  also  it  was  observed  by  a  medical  officer,  long  resident  there  pre  - 
vious  to  the  Mutiny— I  thiftk  Dr.  John  Balfour,— that  the  water  of  Delhi 
was  so  bad  that  nearly  every  European  who  went  there  was  attacked  with 
some  disorder  of  the  bowels. 

(b)  “  Cholera  in  its  Home,”  page  36. 

V 


“  A  first-class  ship  arrived  in  the  Hooghly  in  the  early 
days  of  January.  There  was  no  cholera  in  the  vessel 
coming  up  the  river,  or  during  the  month  after  its 
arrival.  There  was  very  little  in  the  city  of  Calcutta.” 
[Still,  there  is  generally  a  brief  cholera  season  at  about 
that  time  in  Calcutta. — N.  C.]  “A  party,  consisting  of 
a  gentleman  and  his  wife,  a  European  nurse,  a  young 
lady,  and  two  children,  landed  from  the  ship  in  perfect 
health  on  a  Sunday.  They  went  to  a  house  in  which  there: 
had  been  no  cholera  for  several  years — not,  however,  in  a 
good  situation  (Circular- row,  opposite  to  Elysium-row),  and 
small  for  the  party  that  was  received  in  it.  After  their 
arrival,  there  was  a  total  of  eight  adults  and  ten  children 
in  the  house.  Of  these,  two  adults  and  three  children  were? 
residents,  two  adults  and  three  children  were  arrivals  from 
up-country,  and  the  rest  were  the  new  arrivals.  Five  of  the 
new  arrivals  occupied  a  small  room  on  the  upper  flat — that 
is,  three  females  and  two  children, — they  had  one  bathing- 
room  off  it.  The  rest  of  the  occupants  of  the  house  were- 
partly  upstairs  and  partly  down.  The  nurse  and  children 
appear  to  have  had  slight  diarrhoea  during  the  week,  and 
the  young  lady  ate  on  Saturday  some  indigestible  food. 
The  children,  having  slight  diarrhoea,  got  a  dose  of  Gregory’s: 
powder  from  the  mother  on  Sunday  morning.  I  was  sent 
for  at  8  p.m.  of  that  day,  and  found  one  child  far  gone  in 
cholera ;-  she  died  at  half-past  twelve  at  night.  The  other 
child  was  in  the  earlier  stage  of  the  disease.  About  mid¬ 
night  the  father  had  an  attack,  which  was  checked  ;  and, 
towards  morning,  the  nurse  was  seized.  She  was  sent  to 
the  General  Hospital  close  by  at  7  a.m-,  and  died  at  7  p.m. 
All  who  could  possibly  leave  the  house  (all  but  its  resident 
occupants)  were  ordered  out  of  the  house.  The  young  lady, 
who  had  been  in  devoted  attendance  on  the  children,  went 
to  Wilson’s  Hotel.  There  she  was  seized  on  Monday  night, 
and  died  at  4  p.m.  on  Tuesday.  The  second  child  eventually 
recovered.  One  of  the  occupants  of  the  room  downstairs 
was  at  the  time  suffering  from  chronic  diarrhoea,  but  he  was 
not  attacked.  No  more  cases  occurred  in  the  house  or  in  the 
servants’  outhouses.” 

Here,  as  Dr.  Macpherson  observes,  the  sufferers  had  j  usk 
arrived  from  sea ;  and  it  may  again  be  just  worthy  of  notice 
that,  almost  precisely  as  happened  in  Mr.  Macnamara’s  case, 
where,  of  nineteen  persons  who  swallowed  water  polluted  by 
cholera  excreta,  five  were  attacked  with  cholera,  so,  of  the 
eighteen  inmates  of  this  house,  five  were  also  attacked. 

A  very  few  days  after  the  19th  Regiment  arrived  in 
Calcutta,  early  in  the  Mutiny,  my  friend  Professor  Longmore, 
of  Netley,  took  me  to  the  bedside  of  an  officer  who  had  gained 
remarkable  distinction  in  the  Crimea,  and  was  known  as 
“  the  Boy  Colonel.”  Colonel  R.  landed  his  regiment  about 
Christmas  time  (when,  as  we  have  seen,  there  is  always  a 
tendency  to  a  brief  cholera  outbreak).  In  his  first  arrange¬ 
ments  for  his  men,  he  had  great  mental  anxiety  and  bodily 
fatigue.  He  sank  in  a  few  hours  in  the  collapse  stage. 

“  The  incidence  of  Cholera  will  always  be  heaviest  upon 
the  most  insanitary  localities.”  I  have  endeavoured  to  state- 
this  generally  recognised  law  in  the  words  used  by  that 
great  sanitarian,  Mr.  Edwin  Chadwick,  at  a  meeting  of  the- 
Epidemiological  Society  on  the  4th  of  July  last. 

As  I  have  already  mentioned,  well-to-do  ladies  and  gentle¬ 
men,  who  have  resided  for  more  than  a  year  in  Calcutta, 
or  elsewhere  in  India,  are  rarely  attacked.  When  they 
are,  it  is  usually  found  that  they  inhabit  certain  notorious 
spots — such  as  Lall  Bazar  and  its  vicinity  (the  unhealthy 
quarter  most  frequented  by  sailors),  the  old  town  around 
Tank-square,  and  the  site  of  an  old  filled-up  tank  in 
Chowringhee.  My  friend.  Dr.  Wilson,  kept  in  his  study 
a  map  showing  every  house  in  the  place,  on  which  he  marked 
the  houses  where  cases  occurred  within  his  experience.  It 
was  in  such  localities  as  the  above  that  his  black  marks 
lay  thickest.  We  inhabited,  for  some  months,  a  house 
which,  at  first  sight,  appeared  to  be  delightfully  situated, 
but  which  I  soon  found  to  be  surrounded  with  insanitary 
influences.  When  I  left,  on  the  occurrence  of  a  case  of 
grave  remittent  fever,  I  was  told  that  the  house  was  notorious 
for  cholera  ;  and  I  know  that,  in  the  course  of  a  few  years, 
two  well-to-do  Europeans  died  in  one  of  the  rooms. 

Dr.  Macpherson  mentions(c)  an  instance  which  was  known 
to  every  medical  man  in  Calcutta.  Many  years  ago,  certain 
large  palatial  houses  in  Middleton-row  were  almost  deserted. 


(c)  “  Cholera  in  its  Home,”  page  22. 


Medical  Times  and  Gazette. 


PHILLIPS  OH  ETHEE  NAECOSIS. 


Sept.  8,  1883.  261 


being  considered  a  hot-bed  of  Cholera.  The  site  had  been 
•occupied  by  a  large  tank  in  Sir  Elij  ah  Impey’s  park,  which 
had  been  filled  in,  doubtless  after  the  old  manner  in  Calcutta, 
with  every  kind  of  filth  and  refuse. 

Next  we  have  the  well-established  fact  that  it  is  dangerous 
to  travel  in  the  Cholera  area.  Hence  it  is  that  pilgrims, 
who  endure  the  most  terrible  exposure,  privation,  and  fatigue, 
appear  so  prominently  in  the  history  of  Indian  Cholera. 
The  natives  have  a  saying  that  the  widow  who  goes  upon  a 
pilgrimage,  performs  as  great  a  sacrifice  as  she  who  is  burnt 
on  her  husband’s  pyre.  Those  who  are  well  lodged  and  in 
comfortable  circumstances  have  a  great  prospect  of  escape,  if 
they  remain  at  home.  Well-to-do  Europeans,  resident  in 
Calcutta,  suffer  very  little  from  cholera,  but  travellers  undergo 
•great  peril  of  that  disease,  even  when  there  is  but  little 
fatigue,  privation,  or  exposure.  A  late  venerable  archdeacon, 
who  had  enjoyed  good  health  for  many  years  in  the  Cholera 
atmosphere  of  Calcutta,  went  up-country  on  visitation,  and 
died  of  Cholera  at  Ghazipur.  The  only  member  of  our 
rather  large  European  community  who  suffered  when  Epi¬ 
demic  Cholera  visited  Chittagong,  in  1849,  was  the  chaplain. 
He  came  in  from  Tipperah,  when  Cholera  was  raging  in  my 
jail,  ate  a  hearty  dinner,  went  to  bed,  and  was  almost 
immediately  attacked.  His  was  a  very  severe  and  typical 
•case,  and  recovery  was  difficult.  The  following  case  also 
came  within  my  own  notice.  Two  young  married  ladies 
arrived  at  Calcutta  by  the  same  ship  in  the  cold  season. 
One  of  them  remained  in  Calcutta  nearly  three  months,  and 
then  accompanied  her  husband  from  our  house  at  Howrah, 
in  high  health  and  spirits,  to  the  barracks  at  Chinsurah. 
This  was  early  in  the  Cholera  season.  Meeting  the  other 
lady  in  the  neighbouring  town  of  Hooghly,  she  accompanied 
her  friend  to  church  on  the  first  Sunday  after  her  arrival. 
Both  were  attacked  with  cholera  on  that  day,  and  both  died. 
A  year  or  two  subsequently  to  this,  a  lady,  long  resident  at 
•Chinsurah,  came  down  on  a  visit  to  a  relation  living  in  one 
of  the  best  situated  houses  in  Calcutta.  She  was  imme¬ 
diately  attacked  with  fatal  cholera.  This  lady’s  husband 
subsequently  left  Chinsurah,  and  was  stationed,  for  a  short 
time,  in  Burmah.  He  died  of  cholera  on  his  return  to 
Calcutta.  Such  cases  are  known  to  every  officer  of  Indian 
experience. 

Within  the  last  few  months,  I  heard  of  a  case  illustrating 
this  law.  A  wealthy  lady  had  made  a  tour  through  India, 
and,  having  come  down  to  Calcutta  from  the  Upper  Pro¬ 
vinces,  invited  a  friend  of  mine,  who  called  on  her  arrival, 
to  luncheon  on  the  following  day.  Previous  to  that  time 
she  was  fatally  attacked  by  cholera. 

In  old  times,  within  my  recollection,  occurrences  like 
the  following  were  frequent  in  India.  A  party  of  healthy 
European  soldiers  would  be  embarked  early  in  the  morning 
at  Chinsurah  on  a  well-found  troop-boat,  towed  by  a  steamer. 
On  arriving  at  Fort  William,  Calcutta,  at  midday,  several 
men,  dying  of  cholera,  would  have  to  be  landed  and  taken  to 
the  General  Hospital.  Again,  a  vessel,  conveying  coolies  to 
the  Mauritius,  would  leave  Calcutta  with  all  on  board  healthy. 
Cholera  almost  inevitably  appeared,  with  more  or  less  severity, 
before  the  vessel  passed  the  Sand  Heads,  110  miles  down  at 
the  mouth  of  the  Hooghly,  and  ceased  when  she  was  once 
fairly  at  sea.  When  it  was  customary  to  send  European 
soldiers  up-country  from  Bengal  on  country  boats — which, 
when  not  overcrowded  (as  they  too  often  were),  were  comfort¬ 
able  and  wholesome, — the  results  were  frequently  most 
calamitous.  An  account  of  one  of  the  latest  and  most  disas¬ 
trous  instances— that  of  H.M.’s  87th  Royal  Irish  Fusiliers, 
in  1849— is  detailed  in  my  work  “  On  the  Means  of  Preserving 
the  Health  of  European  Soldiers  in  India.” (d)  Between 
September  and  the  following  March,  this  fine  regiment, 
1036  strong,  lost,  on  their  way  up,  from  cholera,  dysen¬ 
tery,  and  fever,  217,  exclusive  of  1  officer,  and  29  women 
out  of  a  strength  of  73,  and  29  children  out  of  103.  In  the 
above-mentioned  work  are  cited  at  length  several  instances 
illustrative  of  the  law  that  native  troops,  when  embarked  on 
•country  boats,  were  almost  invariably  attacked  with  Cholera, 
as  in  the  case  of  the  8th  Native  Infantry,  who,  on  the  voyage 
from  Cawnpore  to  Benares,  at  the  end  of  August  and  begin¬ 
ning  of  September,  1856,  lost,  in  seventeen  days,  42  men  out 
of  a  strength  of  1115.  Nearly  all  authorities  agreed  that 
these  outbreaks  of  cholera,  among  Hindoo  troops,  were  de¬ 
pendent  mainly  upon  the  use  by  the  men  of  ill-cooked  nutri¬ 


ment — such  as  chobanee  (parched  rice)  and  soaked  gram 
(horse  beans).  I  feel  confident,  however,  that  these  parties 
merely  fell  under  a  law  in  Cholera  to  which  men  of  all  habits 
and  races  are  alike  subject.  Raw  rice  and  beans  could  not 
cause  cholera,  they  could  only  excite  it ;  and  we  see  that 
European  soldiers,  to  whom  these  articles  of  native  diet  were 
unknown,  suffered  precisely  as  the  natives  did. 

Here  we  come  upon  a  concurrent  law,  the  explanation  of 
which  has  perplexed  many.  Whenever  Cholera  attacks  a 
barrack  or  jail,  the  surest  means  of  staying  the  pest  is  to 
remove  those  who  are  still  well  to  a  judiciously  chosen  camping 
ground.  We  did  this  when  my  jail  at  Chittagong  was  very 
severely  attacked  by  epidemic  cholera  in  1849.  Not  a  single 
case  occurred  after  the  prisoners  were  promptly  removed  to 
camp.  Mackinnon  gives  an  instance  in  which.  Cholera  having 
broken  out  in  a  Queen’s  regiment  in  Fort  William,  part  of 
the  wing  of  the  regiment  was  moved  to  Chinsurah  Barracks, 
with  the  best  effect.  Upon  this  interesting  point  Dr.  John 
Murray’s  paper  “On  Removal  in  Epidemic  Cholera ”(e) 
should  be  consulted.  It  is  mainly  due  to  native  recognition 
of  this  law  that  so  many  ruined  villages  are  noticed  in  tra¬ 
velling  through  the  swampy  districts  of  Lower  Bengal ;  and 
that  every  large  city,  like  Dacca,  is  observed  to  be  environed 
by  a  wide  belt  of  hut  foundations. 

f  To  he  continued .) 


NOTES  ON  ETHEE  NAECOSIS. 

By  LESLIE  PHILLIPS,  M.D. 

Having  had  not  inconsiderable  experience  in  ether  adminis¬ 
tration,  I  may  be  pardoned  for  bringing  the  following  few 
observations  before  the  profession,  hoping  that  some  who 
have  not  had  much  opportunity  of  giving  ether  may  be 
benefited. 

Mr.  Teale  made  a  valuable  suggestion  when  he  said 
that  ether  should  be  given  in  a  curve  of  harmonic  pro¬ 
gression,  as  may  be  well  done  by  a  Clover’s  inhaler,  begin¬ 
ning  with  air,  and  gradually  increasing  the  dose  of  ether 
till  the  patient  breathes  nothing  but  ether  vapour.  This  is  the 
best  possible  way  to  avoid  struggling  and  to  give  courage  to 
the  timid.  I  would  add  this  fact,  that  the  longer  a  patient 
has  been  narcotised,  the  less  ether  he  requires  to  keep  up 
the  narcosis.  The  drug  has  a  kind  of  cumulative  action, 
probably  from  the  tissues  becoming  saturated  with  the 
vapour.  At  any  rate,  it  is  a  fact  that,  in  order  to  be  kept 
under,  a  strong  man,  for  example,  will  require  to  respire 
unmixed  ether  vapour  till  three  or  four  ounces  have  been 
inhaled ;  then,  and  not  till  then,  may  the  administration 
be  a  little  relaxed,  and  an  occasional  breath  of  air  be  allowed  : 
say  on  every  fourth  inspiration  the  inhaler  may  be  removed. 
To  state  it  as  an  aphorism — “  The  more  ether  taken,  the 
less  is  required  to  prolong  the  narcosis.” 

The  best  way  to  observe  the  conjunctival  reflex  is  by  the 
associated  action  of  the  other  orbicularis  palpebrarum. 
Touch  the  right  cornea,  and  watch  the  left  eye ;  if  the  left 
orbicularis  does  not  respond,  suspend  ether.  It  must  be 
observed,  however,  that  from  natural  causes  the  conjunctiva 
in  some  patients  becomes  under  ether  very  dry,  and  then 
loses  to  a  great  extent  its  sensibility,  so  that  its  reflex 
cannot  be  elicited.  This  fact  must  be  borne  in  mind ;  for, 
if  not,  we  may  be  apt  to  think  that  our  patient  is  deeply 
narcotised,  when  such  is  not  the  case. 

Ether  acts  as  a  respiratory  stimulant,  and,  when  the 
patient  is  once  asleep,  diminution  in  the  force  of  the  respira¬ 
tory  acts  generally  means  that  the  patient  is  coming  from 
under  the  influence  of  the  anaesthetic.  If  the  inhaler  be 
removed,  or  if  there  be  no  ether  in  it,  the  breathing  may 
become  so  feeble  as  to  be  almost  imperceptible,  more  especially 
since  it  is  contrasted  with  the  previous  vigorous  breathing 
during  inhalation.  In  this  way,  alarm  at  the  patient’s  con¬ 
dition  may  be  caused;  but  the  pulse  is  good,  and,  more 
easily  observed  still,  the  eye-reflex  will  be  found  much  more 
easily  elicited  than  before.  In  a  few  moments,  unless  more 
ether  is  given,  the  patient  will  move  and  come  round. 

During  ether  narcosis,  ankle-clonus  may  generally  be 
easily  obtained.  The  danger  of  administering  ether  in 
Bright’s  disease  is  admitted,  and  on  one  occasion  the  wisdom 
of  the  observation  forced  itself  upon  my  notice.  Prolonged 


(e)  Transactions  of  the  Epidemiological  Society,  1879-E0. 


(d)  Indian  Annals  of  Medical  Science,  No.  x.,  page  706. 


262 


Medical  Times  and  Gazette. 


MEDICAL  AND  SURGICAL  PEACTICE. 


Sept.  8, 1883. 


suppuration  from  a  necrosed  humerus  had  caused  a  cloud 
of  albumen  to  appear  in  the  urine.  It  was  proposed  to 
amputate  at  the  shoulder- joint.  Ether  was  given  at  the 
request  of  the  surgeon.  Narcosis  was  easily  induced  ;  the 
conjunctivas  were  much  more  anaesthetic  than  is  usual 
with  the  quantity  of  ether  used,  the  face  was  bluish,  and 
altogether  the  coma  was  alarming.  An  occasional  breath  of 
the  anaesthetic  sufficed  to  keep  the  youth  under.  This 
suggests  that  if  ether  be  given  in  albuminuria  its  action 
should  be  suspiciously  watched,  and  its  quantity  minimised. 
In  the  above  case  two  ounces  kept  up  the  anaesthesia  for 
half  an  hour. 

The  usual  rule  observed  during  the  inhalation  of  ether  is 
that  the  surface  of  the  body,  especially  of  the  face,  neck, 
and  upper  part  of  the  trunk,  gets  hyperaemic,  and  feels  hot 
to  the  touch.  This  is  more  noticed  in  hot  weather.  It  is 
to  be  observed,  therefore,  that  the  patient  should  be  covered 
as  much  as  possible  with  blankets  to  prevent  chill,  which 
is  likely  to  easily  take  place  in  such  condition.  After  the 
inhalation  has  been  continued  for  a  time  we  frequently 
observe  that  the  surface  becomes  very  cold  to  the  touch  and 
bedewed  with  moisture.  This  is  probably  due  to  shock,  and 
though  likely  to  cause  some  alarm  to  the  inexperienced,  it 
is,  in  my  observation,  of  not  much  significance. 

For  patients  who  are  very  anaemic,  from  long-continued 
disease  or  from  haemorrhage,  ether  is  the  appropriate  anaes¬ 
thetic,  but  even  it  must  be  used  with  much  skill  and  caution. 
Such  patients  easily  become  narcotised,  and  are  easily  kept 
under.  At  first  the  pulse  and  general  condition  seem  to 
improve,  but  this  will  not  last  long,  and  signs  of  failure 
will  very  soon  be  observed,  notably  failure  of  wrist-pulse. 
No  rallying  power  is  manifested,  the  heart  gradually  fails, 
the  lungs  fill  up,  and  the  patient  dies  without  recovering 
consciousness.  The  lessons  which  such  circumstances  should 
teach  are — Firstly,  the  anaesthetist  should  use  the  minimum 
quantity  of  the  drug,  not  attempting  to  produce  complete 
coma.  Secondly,  the  anaesthetist  himself  should  see  that 
the  patient  is  surrounded  with  hot  bottles  and  blankets 
during  the  operation.  Thirdly,  the  surgeon  should  perform 
the  operation  as  though  the  patient  were  not  under  the  in¬ 
fluence  of  an  anaesthetic ;  he  should  think  he  was  operating 
in  1843.  Fourthly,  when  it  is  obvious  that  the  patient  has 
not  rallying  power,  and  it  is  plain  that  he  is  dying  from 
anaemia,  it  is  my  opinion  that  the  introduction  of  a  saline 
fluid  into  a  vein  should  on  no  account  be  omitted. 

Birmingham. 


Carrying  Clinical  Thermometers. — Dr.  Clark,  of 
Rackford,  writes  : — “  The  most  convenient  way  to  guard  a 
clinical  thermometer  against  accident  that  I  have  ever 
tried  or  heard  of  is  simply  to  carry  it  in  the  pantaloon 
pocket,  just  as  a  knife  is  carried.  I  usually  devote  the  left- 
hand  pocket  to  this  purpose.  Let  any  physician  try  this 
plan,  and  he  will  prefer  it  to  every  other.” — New  York  Med. 
Record,  August  18. 

The  Faeces  of  Starch- Fed  Infants. — At  the 
Philadelphia  College  of  Physicians,  Dr.  Randolph  read  a 
paper  ( Boston  Medical  Journal,  July  19)  in  corroboration 
of  the  conclusions  of  Dr.  Keating  ( Medical  Times  and  Gazette, 
August  18)  that  starchy  foods  are  digestible  by  young  in¬ 
fants.  He  tested  the  stools  of  twenty-four  starch-fed  infants, 
varying  in  age  from  forty-five  days  to  eighteen  months.  He 
found  that  the  presence  of  starch  was  exceptional,  and  not 
dependent  on  the  age  of  the  child.  The  stools  of  eighteen 
contained  either  no  starch  or  but  a  trace — that  is,  not  more 
than  is  frequent  in  the  healthy  evacuations  of  a  healthy 
adult  on  a  mixed  diet.  In  many  cases  the  broken  and 
empty  cellulose  envelopes  of  the  starch  granules  were 
clearly  discernible.  The  six  infants  in  whose  evacuations 
a  noteworthy  amount  of  starch  was  present  were  aged 
three,  four,  ten,  thirteen,  fourteen,  and  seventeen  months. 
The  eldest  two  were  in  very  bad  health.  Dr.  Randolph 
concludes : — 1.  That  many  infants  of  under  three  months 
can  digest  starchy  food.  2.  That  the  individual  variations 
in  this  regard  are  so  numerous  that  no  broad  and  general 
statement  can  be  made  as  to  the  period  at  which  infants 
legin  to  digest  starch.  3.  Absolute  knowledge  that  a  fari¬ 
naceous  diet  is  beneficial  to  a  young  infant  can  only  be 
attained  by  an  examination  of  the  dejecta  under  such  diet. 
In  one  instance  Dr.  Randolph  found  10  per  cent,  of  fat  in 
the  faeces  of  a  child  who  was  receiving  two  inunctions  of 
„  cod-liver  oil  daily.. 


REPORTS  OF 

HOSPITAL  PRACTICE  IN  MEDICINE- 
AND  SURGERY. 

- ♦ - 

EAST  LONDON  HOSPITAL  FOR  CHILDREN. 


SUBMERSION  —  PLEURISY— EMPYEMA—  INCISION 

—COUNTER  -  OPENING— PERITONITIS— DEATH- 

AUTOPSY. 

(Under  tlie  care  of  Dr.  H.  DONKIN.) 

[For  these  notes  we  are  indebted  to  the  kindness  of  Mr.  F.  W.  S.  Stone  , 
Senior  Resident  Clinical  Assistant.  ] 

William  T.,  aged  six,  was  admitted,  under  the  care  of  Dr. 
Donkin,  on  June  22,  1883.  The  boy  was  said  to  have  been 
always  delicate  and  to  have  had  winter  cough.  “He  could 
never  play  about  like  other  children.'”  He  had  scarlet  fever- 
in  May,  1881,  and  measles  in  December,  1882.  His  father 
died  of  phthisis,  at  twenty-seven  years  of  age ;  his  mother 
is  alive  and  well,  and  now  aged  thirty-one  ;  her  family  are- 
all  healthy.  She  has  had  five  children,  of  which  two  have- 
died — one  of  pneumonia,  and  one  of  scarlet  fever. 

Present  Illness. — This  commenced  four  months  ago — he- 
was  thrown  into  a  pond  of  water  by  some  of  his  schoolfellows,, 
and  remained  in  his  wet  clothes  for  three  hours.  Two  days 
after  this  he  had  three  rigors,  each  being  followed  by¬ 
profuse  sweating  and  by  vomiting.  He  refused  his  food,, 
saying  thaff  “  he  felt  sick  and  queer  all  over.”  He  has  been 
very  thirsty.  There  has  been  slight  hacking  cough,  but  no¬ 
sputa  and  no  haemoptysis.  Breathing  has  been  painful. 
Taken  to  a  doctor,  he  was  said  to  have  pleurisy,  and  hot 
fomentations  to  the  side  were  ordered.  Subsequently  a 
blister  was  applied  to  the  chest.  He  has  continued  under 
this  doctor  for  the  past  eight  weeks. 

State  on  Admission. — The  boy  is  much  wasted.  His  abdo¬ 
men  is  prominent  .  The  breathingis  markedly  diaphragmatic. 
The  whole  of  the  left  side  of  chest  is  distended  and  immov¬ 
able.  There  is  marked  cardiac  pulsation  in  the  epigastric 
region.  In  the  left  subclavicular  space  there  is  a  prominent 
semiglobular  swelling,  the  maximum  prominence  of  which 
corresponds  with  the  second  rib.  It  fluctuates  freely  ;  skin 
is  slightly  reddened  and  infiltrated.  There  is  complete  dul- 
ness  on  percussion  over  the  whole  of  the  left  side  of  the- 
chest,  back  and  front,  extending  anteriorly  a  little  beyond  the 
mid-sternal  line;  and  over  this  area  breath-sounds  are  com¬ 
pletely  absent.  The  heart  is  felt  beating  one  inch  and  a  half- 
internal  to  the  right  nipple.  On  the  right  side  there  is  some 
harsh  breathing,  with  coarse  crepitation,  and  clicking  sounds- 
at  the  extreme  base.  The  fingers  and  toes  are  markedly 
clubbed.  All  the  superficial  thoracic  veins  are  distended,, 
and  the  face  is  considerably  cyanosed. 

A  free  incision  was  made  into  the  fluctuating  swelling; 
just  described  by  Mr.  Battams,  the  Resident  Medical  Officer, 
and  two  quarts  and  a  half  of  yellowish  pus,  slightly  offen¬ 
sive,  were  evacuated,  with  immediate  relief  to  the  dyspnoea. 
A  large  drainage-tube  was  put  in.  The  abscess-cavity  is- 
very  extensive  in  all  directions. 

June  23. — The  boy  has  been  easier  since  his  chest  was 
evacuated.  He  slept  well  during  last  night,  but  had  two  fits; 
of  coughing,  which  caused  great  pain.  Bowels  were  opened 
twice  during  night.  Cyanosis  of  face  has,  to  a  large  extent, 
disappeared.  The  cavity  was  irrigated  with  warm  weak 
carbolic  solution  (one  in  100),  and  a  quantity  of  shreddy 
material  came  away.  The  discharge  is  still  slightly  offen¬ 
sive.  The  boy  lies  on  the  right  side,  with  his  knees  flexed, 
and  the  thigh  drawn  up  on  to  the  abdomen,  which  latter  is. 
tender  all  over,  and  distended. 

24th. — There  is  a  considerable  discharge  from  the  chest, 
and  the  pus  is  markedly  offensive.  Temperature  rose  during, 
the  night  to  100  8°  Fahr.  There  is  slight  cough,  but  no- 
sputa  and  no  haemoptysis.  The  face  is  very  sallow,  and  the 
eyes  are  sunken.  He  is  very  thirsty. 

25th. — The  abdominal  pain  has  increased.  The  whole- 
surface  of  the  belly  is  tender  on  the  slightest  pressure,  with 
great  pain  during  urination  or  defaecation ;  there  is  also- 
tenesmus.  Pulse  120,  wiry ;  respirations  (thoracic)  32°, 
painful.  The  urine  has  a  specific  gravity  of  1024  ;  is  loaded 
with  urates,  but  no  albumen. 

29th. — There  is  great  increase  in  the  abdominal  pain; 
opium  fomentations  were  ordered  to  the  abdomen.  The  boy 
is  now  lying  on  his  back,  with  thighs  and  legs  flexed.  He- 
cries  on  the  slightest  movement.  Temperature  102°  Fahr. 


Medical  Times  and  Gazette. 


MEDICAL  EDUCATION. 


Sept.  8, 18S3.  263 


The  skin  is  dry  and  hot ;  the  face  flushed.  Respirations  40, 
markedly  thoracic.  He  was  sick  twice  last  night.  The 
abdomen  is  much  distended,  and  with  slight  dulness  in  the 
flanks.  The  tongue  is  dry,  coated,  and  clammy. 

July  1. — A  counter-opening  was  made  in  the  eighth  inter¬ 
costal  space  below  the  angle  of  the  scapula,  and  a  large 
Tube  introduced;  a  quantity  of  slightly  offensive  pus  was 
thus  evacuated.  The  pleural  sac  is  irrigated  twice  daily  with 
•Condy’s  fluid  and  water.  The  abdominal  symptom  remains 
the  same ;  no  further  vomiting. 

2nd. — There  is  now  slight  dulness  at  right  posterior 
•extreme  base,  with  pleuritic  friction.  Temperature  last 
night  102-8°  Fahr.  Ordered  tinct.  aconiti  TffJ.  every  two 
hours  till  the  temperature  falls. 

3rd. — Temperature  10P20  Fahr.  last  night.  There  is 
much  less  abdominal  pain  this  morning. 

6th. — The  aconite  to  be  discontinued.  Abdomen  still  a 
little  tender,  but  the  urgent  peritonitic  symptoms  seem  to 
have  passed  off.  There  has  been  no  further  vomiting. 
Bowels  are  opened  two  or  three  times  daily  :  motions  highly 
offensive,  containing  flakes  of  mucus.  The  wounds  in  the 
chest  are  still  irrigated  night  and  morning ;  they  discharge 
•a  fairly  healthy  pus.  The  lung,  covered  by  its  thickened 
visceral  pleura,  bulges  with  each  inspiration  against  the 
-chest-wall.  The  dulness  at  right  base  is  increasing. 

10th. — Diarrhoea  has  been  present  since  the  7th;  each 
-action  is  attended  with  severe  abdominal  pain.  The  tem¬ 
perature  rose  last  night  to  105 *4°  Fahr.,  falling  this  morning 
to  98°  Fahr.  He  was  sick  three  times  during  last  night. 
Pulse  160,  very  weak  and  irregular;  respirations  72,  not 
painful,  purely  thoracic.  Tongue  is  covered  Avith  a  thick 
brown  fur.  There  is  marked  increase  of  dulness  in  the 
flanks.  The  patient  is  in  a  condition  of  collapse.  The 
•extremities  are  nearly  cold  and  the  face  pale.  The  skin  is 
covered  with  a  cold,  clammy  sweat.  He  was  sick  four  times 
•during  early  morning.  Hiccough  has  troubled  him  these 
last  two  days.  He  is  slightly  delirious. 

11th. — Death  in  collapse. 

Post-mortem  Examination  (by  Mr.  Stone). — The  whole 
interior  of  the  left  pleural  sac  is  much  roughened  by  in¬ 
flammatory  deposit.  Several  thick  adhesions  at  lower 
posterior  part ;  each  adhesion  is  recent  and  vascular.  The 
pleural  surface  of  the  diaphragm  is  covered  with  the  same 
Lind  of  inflammatory  lymph;  an  irregular  opening  can  be 
traced  along  the  left  crus  of  the  diaphragm,  leading  into 
the  abdominal  cavity,  but  behind  the  peritoneum.  The 
whole  of  the  cellular  tissue  covering  the  anterior  lamella  of 
the  transversalis  fascia  is  much  infiltrated  with  pus  and 
lymph.  The  peritoneal  cavity  contains  eight  ounces  of 
sticky  sero-purulent  material ;  the  peritoneal  surface  of 
intestines  is  deeply  congested.  No  bands  of  adhesion ; 
no  ulceration  of  intestine.  Two  ounces  of  serum  in  the 
right  pleural  sac.  Kidney,  liver,  and  spleen  normal. 

Remarks. — The  boy’s  submersion,  and  his  subsequent  three 
hours’  chilling  from  his  wet  clothes,  would  amply  explain  the 
onset  of  his  pleurisy.  The  symptoms  seemed  to  have  been 
well  recognised  by  the  medical  man  under  whose  care  he 
was  previous  to  his  admission  into  hospital.  It  is  unfor¬ 
tunate  that  suitable  treatment  was  not  adopted  much  earlier 
in  the  disease.  To  wait  for  an  empyema  to  discharge  itself 
is  not  quite  in  keeping  with  modern  teaching.  Early  aspira¬ 
tion  might  or  might  not  have  sufficed  to  cure  the  patient ;  in 
any  case,  free  incision  would  have  offered  a  better  chance  of 
recovery  if  it  had  been  practised  t\vo  or  three  weeks  pre¬ 
viously  ;  while  the  lung  would  have  had  a  greater  chance  of 
re-expansion,  and  there  would  have  been  less  risk  of  the  pus 
getting  beneath  the  diaphragm  into  the  abdomen.  The 
occurrence  of  peritonitis  was  interesting,  although  there  was 
no  direct  communication  between  the  pleural  and  peritoneal 
•cavities.  It  has  doubtless  the  same  pathological  significance 
as  pericarditis  occurring,  as  it  not  infrequently  does,  under 
•similar  circumstances.  The  spontaneous  opening  of  the  pleura 
occurred,  as  it  does  in  the  great  majority  of  cases,  in  the  upper 
part  of  the  chest  wall,  and  not,  as  would  d  priori  perhaps  be 
expected,  in  a  more  dependent  part.  In  such  cases  it  is  well 
>to  utilise  the  opening  which  nature  makes  for  evacuation, 
but  it  is  generally  necessary,  as  Avell  as  desirable,  to  make 
a  counter-opening  lower  down.  In  this  instance  the  boy’s 
•condition  was  so  low  that  the  second  opening  was  not  made 
until  some  days  had  elapsed  after  the  first  operation ;  the 
discharge  of  pus  was  materially  aided  thereby.  Death  took 
place  from  peritonitis  and  exhaustion. 


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SATURDAY,  SEPTEMBER  8,  1883. 


MEDICAL  EDUCATION. 

Evert  year,  as  October  comes  round,  the  thoughts  of  a  large 
proportion  of  the  profession  are  turned  towards  the  subject 
of  medical  education  ;  and  year  by  year  a  feeling  of  uneasi¬ 
ness  spreads  and  deepens  among  parents  and  guardians,  and 
indeed  among  all  thoughtful  men,  as  the  number  of  subjects 
increases  of  which  medical  students  have  to  show  a  com¬ 
petent  knowledge,  and  as  the  amount  of  acquaintance  with 
each  subject  which  is  considered  as  competent  knowledge 
comes  to  be  measured  by  a  higher  standard.  Already  the 
amount  of  learning  of  every  kind  which  has  to  be  acquired 
in  the  four  short  years  of  the  minimum  medical  curriculum 
is  so  great  that  the  percentage  of  rejections  at  most  of  the 
examinations  increases  year  by  year.  There  can  be  no  doubt 
that  this  increase  results  from  no  general  deterioration  in 
the  ability  or  industry  of  the  students,  but  from  increased 
stringency  in  the  examinations.  We  do  not  blame  the  exa¬ 
miners  for  this  result.  They  give  effect  to  the  general 
feeling,  both  of  the  profession  and  the  public,  that 
the  continued  advance  of  the  general  stock  of  knowledge 
of  disease  and  its  treatment  shall  be  reflected  in  the  con¬ 
tinual  increase  of  the  knowledge  demanded  from  each  indi¬ 
vidual  who  is  licensed  to  treat  the  sick.  Hence,  as  Mr. 
Hutchinson  says,  “  an  extension  of  the  period  of  study,  a 
well-considered  limitation  of  its  subjects,  and  lastly,  a 
careful  development  of  its  methods,  are  the  three  measures 
which  severally  suggest  themselves  ”  to  remedy  this  con¬ 
dition  of  things.  But  besides  these  alternatives  there  is  a 
third  course,  the  arguments  for  which  deserve  attention — to 
abolish  altogether  the  restrictive  regulations  as  to  time,  and 
allow  the  student  to  present  himself  for  examination  Avhen- 
ever  he  feels  himself,  and  is  considered  by  his  tutors,  com¬ 
petent  for  the  trial.  By  fixing  a  time  at  which  the  student 
may  present  himself,  the  intention  was  no  doubt  to  say  in 
effect  that  this  period  was  the  shortest  in  Avhich  the  neces¬ 
sary  knowledge  could  be  acquired, 
that  that  inference  was  suggested, 


264 


Medical  Times  and  Gazette. 


MEDICAL  EDUCATION. 


Sept.  8,  1888. 


involved.  If  the  supreme  authority  fixes  this  time  for  the 
acquisition  of  the  necessary  knowledge,  then  this  time 
is  sufficient,  and  to  fail  in  presenting  oneself  for  exami¬ 
nation  after  the  prescribed  time  has  been  spent  in  study 
is  clearly  a  neglect  of  duty  towards  one’s  parents  and 
oneself.  This  is  the  light  in  which  probably  the  majority 
of  students  regard  the  regulation  of  the  period  of  study! 
and  if  they  are  rejected  after  having  spent  this  period  in 
honest  work,  they  have  a  bitter  feeling  that  the  examining 
body  has,  as  it  were,  broken  faith  with  them.  The  feeling 
may  or  may  not  be  irrational,  but  it  exists,  and  it  is  worth 
taking  into  account.  Moreover,  the  disheartening  effect  of 
rejection  on  a  young  and  sensitive  mind  is  far  greater  when 
it  is  officially  declared — or  at  the  least  suggested — that  the 
candidate  might,  could,  or  should  have  passed  after  so 
much  time  spent  in  study.  If,  on  the  other  hand,  the  regu¬ 
lation  were  done  away  with,  the  student  would  not  feel  him¬ 
self  bound  to  go  up  on  a  certain  date,  whether  he  were  ready 
or  whether  he  were  not,  but  would  either  wait  until  he  could 
go  up  with  a  reasonable  chance  of  passing,  or,  if  rejected, 
would  attribute  his  failure  to  miscalculation  of  the  time  re¬ 
quired,  and  would  set  to  work  again  with  a  good  heart. 
Again,  no  officially  declared  time  being  fixed  at  which  a 
student  must  either  go  up  for  examination  or  be  content  to 
be  considered  an  inferior  man,  both  he  and  his  tutor  would 
pay  more  attention  to  the  calculation  of  his  chance  of 
passing,  and  be  less  eager  to  cry  double  or  quits  with  destiny. 
If  this  reform  were  made,  another  measure  of  liberty  might 
be  granted  at  the  same  time,  and  compulsory  attendance  on 
lectures  be  abolished.  Granting  that  the  lecture  is  the  best 
possible  mode  of  imparting  and  receiving  instruction,  none 
the  less,  it  is  said,  is  compulsory  attendance  a  mistake.  In 
the  first  place,  it  is  needless.  Students  are  not  the  in¬ 
tellectual  infants  that  these  regulations  suppose  them  to  be  ; 
they  are  old  enough  to  discern  the  methods  by  which  they 
learn  most  easily  and  most  thoroughly.  Good  lectures  are  in¬ 
variably  well  attended;  students  flock  to  them,  crowd  to  them, 
even  when  they  are  under  no  obligation  whatever  to  attend. 
Indifferent  lectures  may,  under  the  compulsory  system, 
have  an  audience,  but  no  compulsion  will  make  the  audience 
attentive.  Students  who  are  compelled  to  attend  a  lecture 
in  which  they  cannot  find  interest  will  occupy  themselves 
in  whispered  conversation,  or  in  furtive  employments  of 
a  less  legitimate  kind,  and  will  not  only  derive  no 
benefit  themselves  from  the  lecture,  but  will  distract 
the  attention  of  those  who  might  profit  by  it.  The  belief 
that  compelling  a  student  to  sit  in  the  same  room  in  which 
a  lecture  is  being  delivered,  for  an  hour  at  a  time 
so  many  times  in  the  year,  will  induce  him  to  imbibe 
one  iota  of  knowledge,  is  a  delusion  ;  and  the  sooner  it  is 
abandoned  the  better.  It  would  be  better  for  the  licensing 
bodies  to  leave  the  task  of  regulating  the  studies  of  the 
students  to  the  various  medical  schools,  which  will  regulate 
them  in  accordance  with  the  individual  qualities  of  their 
teachers  and  the  individual  wants  of  their  students,  while 
the  licensing  bodies  should  confine  themselves  to  ascer¬ 
taining  very  thoroughly  whether  the  candidates  who  come 
before  them  possess  a  competent  knowledge  of  their  several 
subjects,  without  inquiring  too  curiously  how  that  know¬ 
ledge  was  obtained.  If  their  processes  are  trustworthy,  and 
their  examiners  efficient,  they  ought  to  be  able  to  sift  those 
who  have  been  practically  taught  from  those  who  have 
been  crammed,  without  asking  the  hospital  authorities  to 
send  up  this  information  on  schedules.  It  is  the  business 
of  the  licensing  bodies  to  discover  whether  the  candidate  has 
been  efficiently  taught,  and  the  very  fact  of  their  requiring 
a  quantity  of  written  information  on  this  point  from  the 
schools  is  a  confession  of  weakness,  a  confession  that  they 
are  unable  or  unwilling  to  discover  the  whole  for  themselves. 


The  arguments  which  we  have  presented  in  the  foregoing: 
remarks  have  by  themselves  great  force.  But  in  the  affairs- 
of  life  it  constantly  happens  that  what  is  called  compromise- 
is  the  best  course.  We  say  what  is  called  “  compromise,’'’ 
because  that  word,  in  its  literal  meaning,  denotes  a  sacrifice 
or  surrender  of  principle;  whereas,  in  the  present  case,  a 
system  intermediate  between  the  courses  required  for  the 
practical  carrying  out  of  two  opposite  principles  may  not 
involve  sacrifice  of  either,  but  rather  the  preservation  of 
the  essential  points  of  each.  We  have  just  summarised 
opinions  which  are  those  held  by  many,  probably  most, 
students.  We  do  not  think  it  needful  to  oppose  them  from 
the  teachers’  point  of  view ;  for  the  teachers  have  in  their 
own  hands  ample  power  of  effecting  whatever  changes  they 
think  desirable.  But  from  the  point  of  view  of  the  public, 
we  wish  to  make  some  remarks  upon  the  subject. 

First,  the  absolute  liberty  which  some  desire  :  the  liberty 
to  students  to  get  their  knowledge  where  they  like,  and  how 
they  like,  and  come  up  for  examination  when  they  like, 
would  at  once  open  the  door  to  unlimited  personation.  At 
present,  when  a  man  is  obliged  to  get  his  education  at  a 
regular  medical  school,  where  there  are  many  other  students, 
along  with  whom  he  works,  and  with  whom  he  presents, 
himself  for  examination,  it  is  scarcely  possible  for  him  to- 
pass  by  proxy ;  but  were  men  allowed  to  come  up  without 
certificates,  when  they  like,  what  is  to  prevent  a  man  pass¬ 
ing  two  or  three  times  over,  in  the  names  of  different, 
persons  unable  to  get  through  themselves  ?  With  the  present, 
nineteen  licensing  bodies,  this  would  be  the  simplest  fraud 
conceivable ;  and  even  with  an  examining  board  for  each 
division  of  the  kingdom,  it  would  be  so  difficult  of  detection 
that  great  temptation  to  it  would  arise.  This  is  so  obvious, 
that  we  need  say  no  more  on  the  subject. 

Supposing,  however,  that  an  efficient  means  of  preventing 
personation  has  been  discovered,  under  the  system  pro¬ 
posed  the  only  security  that  none  but  proper  persons  will 
be  registered  is  the  examination.  If  examiners  were  infal¬ 
lible,  and  could  thoroughly  test  and  correctly  judge  each 
candidate  coming  before  them,  the  examination  would  be 
sufficient.  B  ut  they  are  not ;  scarcely  an  examination  is 
held  without  its  happening  that  some  of  the  rejected  are 
known  to  be  superior  to  some  of  the  passed.  On  the  average 
we  have  no  doubt  the  examiners  gauge  the  competence  of 
candidates  pretty  accurately.  But  an  examination  is  not, 
and  cannot  be  made,  an  investigation  of  such  thoroughness 
and  accuracy  as  to  be  a  test  that  can  be  relied  upon  alone. 
The  compulsory  attendance  on  lectures  (especially  when, 
as  now,  the  candidate  has  to  produce  certificates  that  he 
has  attended  to  the  lecturers’  satisfaction)  represents  the 
recognition  by  the  examining  boards  of  the  need  of  sup¬ 
plementing  the  examinations  by  reference  to  the  opinion 
of  the  teachers.  No  one  can  so  well  judge  of  the  fitness 
of  a  student  to  be  entrusted  with  the  responsibilities  of 
medical  practice  as  his  teachers ;  those  whose  opinion  is 
based,  not  on  ten  minutes’  questioning,  but  on  months  or 
years  of  close  observation  of  his  conduct.  If  the  persons- 
for  whom  we  had  to  legislate  were  simply  intellectual 
machines,  whom  neither  personal  interest  nor  sympathetic, 
feeling  could  influence,  there  could  be  no  doubt  that  the  best 
course  would  be  to  empower  the  teachers  at  each  medical 
school  to  grant  (in  their  collective  capacity)  certificates  to- 
those  of  their  pupils  who  they  think  deserve  such,  stating 
the  competence  to  practise  of  those  who  received  them, 
and  for  the  Medical  Council  to  accept  such  certificates  as- 
entitling  the  holders  to  registration.  There  could  (the  pos¬ 
tulate  being  granted)  be  no  doubt  of  the  excellence  of  such 
an  arrangement,  for  the  examiners  at  present  are  drawn 
almost  entirely  from  the  teachers  at  the  schools,  and  the 
effect  of  the  suggested  change  would  be  that  instead  of  each 


Medical  Times  and  Gazette. 


SEWAGE  DISPOSAL  AT  BERLIN. 


Sept.  8,  1883.  265 


examiner  giving  his  decision  as  to  his  colleagues’  pupils,  of 
whom  he  knows  nothing,  he  would  express  his  judgment  upon 
his  own,  whom  he  knows  thoroughly.  But  the  objections  to 
such  a  Utopian  scheme  as  this  are  too  evident  to  need  much 
exposition.  The  teachers  at  the  medical  schools  are  men  of 
flesh  and  blood,  possessing  the  usual  frailties  of  human 
nature.  Close  acquaintance  brings  with  it  not  only  know¬ 
ledge  as  to  competence  and  character,  but  often  a  feeling  of 
strong  friendship  in  some  cases,  of  repulsion  in  others — 
feelings  which  bias  the  judgment.  Besides  this,  the  pecu¬ 
niary  interests  of  the  teachers,  both  as  private  practitioners 
and  as  the  recipients  of  profits  earned  by  the  medical 
school  to  which  each  is  attached,  would  be  largely  affected 
by  their  readiness  or  otherwise  to  grant  qualifying  certifi¬ 
cates.  To  put  upon  the  teachers  the  responsibility  of  de¬ 
ciding  as  to  their  pupils’  fitness  to  practise,  would  be  to 
expose  them  to  most  unfair  temptation. 

Although  to  burden  the  teachers  with  this  weighty  and 
invidious  responsibility  would  be  quite  impracticable,  yet 
we  have  dwelt  upon  it  because  it  seems  to  us  that  in  the 
arrangements  which  may  be  made  in  the  future  for  securing 
that  none  but  fit  persons  shall  be  placed  on  the  register,  the 
co-operation  of  the  teachers  must  be  provided  for.  Their 
assistance  is  necessary  not  only  for  the  solution  of  the  mere 
police  question  of  preventing  personation,  but  because  their 
judgment  as  to  a  candidate’s  acquirements  is  better  than 
anybody  else’s  possibly  can  be.  A  model  tribunal  should 
unite  their  full  knowledge  with  the  impartiality  of  examiners 
who  are  entire  strangers  to  the  candidates.  In  the  present 
undecided  state  of  the  medical  licensing  laws  it  is  not 
worth  while  to  go  into  details  upon  the  matter  ;  we  there¬ 
fore  simply  ask  attention  to  these  considerations,  and  leave 
the  subject  for  the  present. 


SEWAGE  DISPOSAL  AT  BERLIN. 

Berlin  has  a  population  of  about  a  million  and  a  quarter ; 
it  stands  on  a  perfectly  level  plain,  and  is  intersected  by  the 
river  Spree,  one  of  the  most  sluggish  streams,  perhaps,  in 
all  Europe.  Until  recently  the  sewers  here,  as  everywhere 
else,  discharged  themselves  directly  into  the  river,  which 
naturally  surpassed  in  foulness  the  Thames  of  twenty  or 
thirty  years  ago.  Under  these  circumstances,  it  may  well 
be  imagined  that  the  problem  of  dealing  with  such  a  mass 
of  sewage  presented  almost  insurmountable  difficulties ; 
indeed,  at  one  time  the  abandonment  of  the  site,  and  the 
removal  of  the  capital  to  a  more  eligible  position,  was 
even  suggested  as  a  dire  necessity.  But  within  the  last 
ten  years  the  Germans  have  been  undertaking  the  sewer¬ 
age — or,  as  they  call  it,  canalisation — of  their  large  towns 
with  praiseworthy  energy,  and  the  engineer  whose  genius 
had  made  Frankfort  one  of  the  healthiest  cities  of  its 
size  in  Europe  was  invoked  to  purge  the  Spree.  The 
authorities  determined  on  adopting  the  system  of  irri¬ 
gation,  and  for  that  purpose  the  Municipality  obtained 
possession  of  a  number  of  estates  to  the  north,  east,  and 
south  of  the  city,  those  at  Falkenburg  and  Burknersfeld 
covering  2000  acres,  and  those  at  Osdorf,  Friederikenhof, 
Heinersdorf,  and  Grossbeeren  over  5000  acres.  Between 
these  the  sewage  was  pretty  equally  divided,  but  for  some 
time  only  700  acres  of  the  former  and  1400  of  the  latter 
were  adapted  for  irrigation.  By  adaptation  the  engineers 
mean  the  division  into  a  number  of  areas,  at  the  highest 
point  of  each  of  which  is  a  sluice  communicating  with  a 
branch  of  the  main  culvert,  where  the  sewage  is  always 
under  some  degree  of  pressure.  When  the  sluice  is  opened, 
the  sewage  flows  into  feeders,  from  which  it  disappears  in 
the  soil ;  the  more  inclined  parts  are  turned  into  meadows. 


and  the  lowest  levels  into  vegetable  gardens.  The  channels 
for  the  discharge  of  the  effluent  water  are  deep  dykes,  dug 
in  the  lowest  outlying  parts  of  each  area,  and  having  no 
direct  communication  with  the  irrigation  fields  or  feeders . 
Into  them  the  water  percolates  through  the  sandy  soil,  or  is 
conveyed  by  drainage  pipes.  Finally  it  is  discharged  into 
the  tributaries  of  the  Spree,  the  Wuhle,  the  Panke,  and 
the  artificial  Grenzgraben.  When  the  sewage  was  found 
to  be  in  excess  of  the  capabilities  of  the  land,  which  was 
especially  the  case  in  winter,  it  was  stored  in  reservoirs, 
varying  in  size  from  five  to  ten  acres  surrounded  by  low 
embankments.  From  these  it  disappeared  in  three  or  four 
months,  when  they  were  sown  with  rye-grass,  the  first  crop 
of  which  was  ready  for  cutting  in  a  few  weeks.  So  long  as 
so  small  a  proportion  of  the  land  was  adapted  for  irrigation, 
recourse  was  had  to  these  reservoirs  to  an  extent  never 
contemplated  by  the  engineers,  who  intended  them  only 
as  temporary  and  occasional  expedients.  As  Osdorf,  for 
example,  there  were  twenty  such  basins,  covering  together 
some  300  acres,  the  exhalations  from  these  “  lakes  ”  poison¬ 
ing  the  air,  while  the  sewage-sodden  soil  lost  its  depurative 
power.  The  question  was  referred  to  a  Royal  Commission, 
in  whose  report  it  was  pointed  out  that  the  nuisances  justly 
complained  of  were  the  results  of  a  defective  execution, 
excusable,  however,  considering  the  vast  scale  of  the  experi¬ 
ment,  and  in  no  way  to  be  laid  to  the  charge  of  the  system 
itself,  in  which  they  expressed  their  entire  confidence.  On 
their  recommendation  the  central  authority  insisted  on  the 
Corporation  extending  the  process  of  adaptation,  enlarging 
the  effluent  channels,  and  acquiring  fresh  land  until  the 
proportion  one  acre  to  every  hundred  of  the  population  should 
be  attained.  All  this  was  accomplished  more  than  a  year 
ago,  but,  as  might  have  been  expected,  the  owners  of  pro¬ 
perty,  especially  of  suburban  villas,  were  alarmed  at  the  ex¬ 
tension  of  the  sewage  farms  to  the  enormous  area  of  10,000 
acres ;  and  the  local  authority  of  Pankow,  backed  by  the 
representations  of  Dr.  Fuhrmann,  the  Kreisphysikus  (medical 
officer  of  health) ,  obtained  in  N ovember,  1882,  from  the  Govern¬ 
ment  of  the  province  of  Potsdam,  an  injunction  against 
the  Municipality  of  Berlin,  restraining  them  from  discharging 
their  effluent  into  the  Panke.  In  the  following  February 
the  Ministers  of  the  Interior,  Public  Works,  Agriculture* 
and  Medicine,  on  an  appeal  from  the  Corporation,  and  acting 
on  the  advice  of  the  Imperial  Board  of  Health,  annulled  the 
injunction,  and  called  on  the  members  of  the  last-named 
(with  whom  was  associated  the  eminent  chemist.  Professor 
Tiemann)  to  institute  a  microscopic,  bacterioscopic,  and 
chemical  examination  of  the  sewage,  the  effluents,  and  the 
waters  of  the  Spree  above  and  below  the  outfall  of  the 
Wuhle,  Panke,  and  Grenzgraben,  as  well  as  of  the  water 
supplied  to  the  city  by  the  company’s  works.  Dr.  Tiemann 
having  examined  the  water  at  fourteen  different  points  in 
its  course  from  the  filtering  beds  to  the  Spree,  concludes  that 
the  effluent,  though  efficiently  filtered,  has  not  under  present 
conditions  been  deprived  of  the  whole  of  its  ammonia,  nor 
have  its  organic  impurities  been  completely  converted  into 
inorganic  matter,  or  into  organic  bodies  giving  but  a  feeble 
reaction  with  potassium  permanganate,  such  as  are  met  with 
in  natural  •  and  not  specially  polluted  rivers.  But  experi¬ 
ments  and  analyses  prove  that  these  changes  are  completed 
in  the  Wuhle  and  Grenzgraben,  for  water  taken  from  the 
outfalls  of  these  gives  the  same  feeble  reaction  as  that  of  the 
Spree  at  higher  points,  and  as  that  of  Lake  Rummelsburg, 
whence  the  supply  of  the  city  is  drawn,  and  which  is  protected 
against  all  pollution  from  without.  In  fact,  the  water  of  the 
Spree  is  in  no  appreciable  degree  affected  by  receiving  that  of 
the  Wuhle,  etc.  These  conclusions  confirm  what  we  maintained 
some  time  ago,  when  discussing  the  question  of  sewage  treat¬ 
ment  by  irrigation,  viz.,  that  though  the  effluent  is  itself  unfit 


266 


Medlca1  Times  and  Gazette. 


THE  WEEK. 


Sept.  8, 1883. 


for  domestic  use,  and  it  would  not  be  safe  to  take  a  supply 
immediately  below  the  outfall,  or  from  a  very  small  stream 
receiving  such  effluent,  yet  a  few  miles  lower  down  the  com¬ 
bined  effects  of  dilution  and  oxidation  by  exposure  to  air  and 
the  action  of  vegetation  efface  all  appreciable  pollution  and 
difference  in  composition  between  the  water  of  the  river  re¬ 
ceiving  such  effluent  and  others.  The  process  adopted  by 
Dr.  Koch  for  the  bacterioscopic  examination  of  water,  and 
quantitative  estimation  of  its  real  character  as  regards  pota¬ 
bility,  is  so  novel,  so  ingenious,  and  seems  so  full  of  promise, 
that  we  shall  on  another  occasion  describe  it  in  detail.  In 
conclusion  we  may  remark  that  it  is  as  yet  premature  to 
judge  of  the  results  of  the  Berlin  scheme,  since  a  conflict  of 
authorities  on  legal  points  will  delay  its  completion  for  some 
time ;  but  it  is  of  the  highest  interest,  as  being  the  first  at¬ 
tempt  to  dispose  in  this  manner  of  the  sewage  of  a  popula¬ 
tion  exceeding  a  million,  and  that  under  physical  conditions 
not  the  most  favourable. 


SECLUSION  OF  THE  INSANE. 

The  American  Psychological  Journal  for  July,  1S83,  says, 
“We  copy  entire  the  article  from  the  Medical  Times  and 
Gazette  with  the  above  title,”  and  goes  on  to  offer  some 
criticisms  which  are  not  unkindly,  but  which  are  based 
upon  an  erroneous  interpretation  of  the  article  in  question- 
By  a  curious  oversight  the  article  (which  appeared  in  our 
columns  on  July  7  last)  is  not  reproduced  in  our  American 
contemporary.  Had  it  been  copied  as  averred,  much  of  the 
criticism  would  have  been  seen  to  be  forestalled  by  reserva¬ 
tions  and  conditions  in  the  article  itself,  and  we  should  have 
been  spared  the  task  of  repudiating  opinions  which,  though 
not  expressly  attributed  to  us,  any  reader  of  the  criticism 
in  question  would  naturally  infer  that  we  are  responsible 
for.  As  it  is,  even  the  title  is  erroneously  given,  our  article 
being  headed,  with  definite  meaning,  “  The  TJse  of  Seclu¬ 
sion  of  the  Insane,”  in  order  to  draw  attention  to  the  dis¬ 
tinction  that  we  insisted  on  between  its  use  and  its  abuse. 
“  The  dark  cell  and  bread  and  water  as  the  only  diet  ”  have 
never  been  advocated  by  this  paper,  nor,  as  far  as  we  know, 
by  any  sane  person  during  the  last  half-century,  as  legiti¬ 
mate  aids  to  the  treatment  of  insanity.  “  Quiet  — removal 
from  all  exciting  scenes  and  sounds — is  a  desideratum  in  the 
treatment  of  many  diseases,  and  especially  those  affecting 
the  brain  and  other  nerve-centres.  It  is  often  essential  to 
recovery,  and  we  see  no  reason  why  it  may  not  be  specially 
ndicated  in  some  forms  of  insanity/5  The  doctrine  which 
the  Psychological  Journal  expresses  in  the  foregoing  terms 
is  a  paraphrase  of  that  which  was  advocated  in  these 
columns.  Under  the  circumstances  of  a  patient  becoming 
suddenly  violent,  noisy,  or  troublesome  in  a  ward  containing 
a  score  or  more  of  insane  persons,  it  would  seem  wise,  our 
contemporary  admits,  to  separate  him  till  the  violence  of  the 
paroxysm  passes  off ;  but  it  goes  on  to  say,  “  separation  does 
not  necessarily  imply  seclusion.”  Here  we  must  emphati¬ 
cally  join  issue.  According  to  the  meaning  authoritatively 
attached  to  it  in  this  country,  seclusion  is  “  compulsory 
isolation  in  the  daytime,”  and  it  matters  not  whether  the 
patient  is  isolated  in  a  cell  six  feet  square  or  in  a  twenty- 
acre  field :  if  he  is  compulsorily  isolated  from  other  human 
beings  he  is  in  seclusion.  This  legal  meaning  of  the  term 
is  not  as  well  known  as  it  ought  to  be,  even  on  this  side  of 
the  water,  and  we  cannot,  therefore,  be  surprised  if  our 
American  confreres  are  ignorant  of  it.  Few  even  of  our 
asylum  superintendents  are  aware  that  when  they  turn  a 
troublesome  patient  out  into  a  spacious  airing  court  alone, 
they  are  under  a  legal  obligation  to  enter  him  in  the 
“  medical  journal”  as  secluded. 


THE  WEEK. 

TOPICS  OP  THE  DAT. 

A  considerable  amount  of  typhoid  fever  is  stated  to  exist 
at  the  present  time  in  the  parish  of  St.  Pancras.  Since  the 
15th  ult.  twenty-seven  cases  have  been  reported  to  the 
parochial  officials,  and  of  these  some,  being  paupers,  have 
been  removed  to  the  Homerton  Fever  Hospital ;  whilst  eight 
or  nine  paying  patients  have  been  persuaded  to  assent  to  the 
adoption  of  a  similar  course.  Dr.  Stott,  who  is  acting  for 
the  medical  officer  of  health  for  the  parish  (Dr.  Murphy),  is 
of  opinion  that  the  crisis  has  now  been  reached,  and  that 
the  epidemic  is  subsiding.  Two  cases  of  the  fever  were 
reported  on  the  same  day  from  Greenland-place,  which 
leads  immediately  off  the  High-street,  Camden  Town, 
and  cannot  certainly  be  called  a  “  slum,55  although  occu¬ 
pied  by  the  poorer  classes.  On  an  inspection  of  this 
locality  by  the  sanitary  officers,  most  of  the  houses 
were  found  to  be  very  clean,  and  but  few  defects  were 
discovered.  The  house  from  which  the  fever  patients  were 
removed  was  found  to  be  somewhat  overcrowded,  and  a 
notice  was  served  to  remedy  this  evil.  Dr.  Stott  ascertained 
that  the  commencement  of  the  outbreak  of  typhoid  dated 
from  the  3rd  or  4th  ult. ;  and  as  some  of  the  cases  occurred 
in  houses  of  the  best  class  in  the  locality,  the  milk-supply 
was  investigated,  more  especially  that  furnished  by  one 
particular  dealer.  Most  of  the  evil  was  found  to  have  been 
done  during  a  few  days  about  three  weeks  ago,  and  it  was 
ascertained  that  about  that  time  a  man  left  the  dairy  suffer¬ 
ing  from  congestion  of  the  kidneys,  and  afterwards  developed 
typhoid  fever;  after  he  left,  two  other  persons  in  the  same 
employ  were  prostrated  by  the  fever — the  latest  only  a 
fortnight  since.  It  may  be  hoped,  therefore,  that  if  the 
source  of  the  infection  has  been  correctly  traced,  the  present 
outbreak  will  shortly  be  stamped  out. 

We  last  week  briefly  alluded  to  the  recent  report  of  the 
Inspector  of  Retreats  under  the  Habitual  Drunkards  Act, 
1879.  The  report  states  that  during  the  past  year  as  many 
visits  as  were  necessary  were  paid  to  the  two  retreats  regis¬ 
tered,  viz..  Hall  Court,  Cannock,  and  Tower  House,  West- 
gate-on-Sea.  An  investigation  of  the  complaints  made  by 
the  patients  elicited  the  fact  that  they  were  mostly  trivial 
in  character ;  but  those  made  by  the  licensees,  though 
not  numerous,  were  more  serious,  and  the  inspector 
was  obliged  in  some  instances  to  warn  the  delinquents 
that  a  repetition  of  the  offence  would  probably  lead 
to  prosecution.  The  general  condition  of  both  the  re¬ 
treats,  and  also  the  health  of  the  patients,  was,  on  the 
whole,  very  good,  and  the  results  obtained  by  treatment 
satisfactory.  The  detailed  returns  showed  that  in  one 
case  three  out  of  the  five  patients  admitted  during 
the  year  received  decided  benefit,  whilst,  in  the  other 
case,  nine  out  of  twenty  are  spoken  of  as  “  certain  or 
probable  cures.55  Both  licensees  agree  that  a  shorter 
period  than  twelve  months’  detention  in  a  retreat  is  insuffi¬ 
cient  for  permanent  cure  in  the  majority  of  cases.  As 
regards  the  utility  of  the  Act,  the  report  gives  the  follow¬ 
ing  opinion  of  one  of  the  present  licensees,  who  says: — 
“  Having  had  experience  in  the  management  of  an  esta- 
blishm  ent  for  a  similar  purpose  prior  to  obtaining  a  licence 
under  the  Act,  I  feel  justified  in  asserting  that  it  is  scarcely 
possible  to  conduct  a  retreat  for  dipsomaniac  patients  in  a 
satisfactory  manner  without  the  aid  afforded  by  the  Act.55 
The  total  number  of  patients  under  treatment  on  December  31 
last  was  fourteen. 

At  a  recent  Local  Government  Board  inquiry,  in  reference 
to  an  application  of  the  Acton  Local  Board  for  sanction  to 
borrow  <£75,000  for  the  carrying  out  of  a  drainage  scheme 
for  the  district,  Major  Tulloch,  the  inspector,  stated  that 


Medical  Times  and  Gazette. 


THE  WEEK. 


Sept.  8,  1883.  267 


the  residents  of  Bedford  Park  and  the  owners  of  several 
estates  in  Acton  had  memorialised  the  Local  Government 
Board  to  declare  the  Acton  Local  Board  a  defaulting  autho¬ 
rity,  through  failing  to  provide  a  sufficient  supply  of  sewers. 
It  was  elicited  in  evidence  at  the  inquiry  that  there  were 
nine  houses  on  one  estate  in  regard  to  which  the  Local  Board 
had  not  provided  any  means  of  disposing  of  the  sewage,  and 
the  question  arose  whether  that  amounted  to  default.  The 
inspector  held  that  even  if  the  Local  Board  failed  to  provide 
means  of  sewage  disposal  in  the  case  of  one  house  there  was 
default,  but  the  Local  Government  Board  always  considered 
the  special  circumstances  of  these  cases.  Strong  opposition 
was  manifested  against  the  scheme  for  which  this  ,£75,000 
was  sought  to  be  borrowed,  the  opinion  being  that  it  is  un¬ 
necessarily  expensive ;  and  Major  Tulloch,  in  compliance 
with  an  urgent  request,  resolved  to  recommend  that  the 
inquiry  should  be  adjourned  till  October  in  order  to  give  the 
ratepayers  an  opportunity  of  being  heard  on  the  subject. 

The  different  metropolitan  parishes  have  lost  no  time  in 
endeavouring  to  secure  an  improved  sanitary  condition,  in 
view  of  the  probabilities  of  the  introduction  of  cholera  into 
the  country.  Upon  the  advice  of  Dr.  Griffiths,  their 
Medical  Officer  of  Health,  the  Sanitary  Committee  of 
Clerkenwell  have  instituted  an  examination  of  the  houses 
in  sixteen  different  courts  and  passages.  In  one  instance 
an  underground  kitchen  was  found  illegally  occupied  as  a 
sleeping  apartment ;  in  another  a  family  of  nine  were  found 
residing  in  a  single  room  with  a  cubical  capacity  of  2040 
feet,  and  notices  were  served  upon  the  owners  for  immediate 
remedial  measures.  The  local  inspectors  have  also  been 
employed  in  house-to-house  visitation,  and  the  gratuitous 
distribution  of  disinfectants  has  been  largely  carried  out. 
The  sanitary  authorities  of  the  parish  of  Shoreditch  have 
issued  a  notice  to  the  inhabitants,  calling  attention  to  the 
fact  that  there  is  a  public  mortuary  in  the  parish  church¬ 
yard  to  which  a  corpse  can  at  any  time  be  removed,  and 
urging  the  parishioners  during  the  summer  and  autumn 
heat  to  promote  such  removal,  especially  from  small  crowded 
dwellings.  In  some  of  the  smaller  cottages  of  the  parish  it 
has  been  found  that  residents  occupy,  to  the  number  of 
four  or  five,  the  rooms  where  dead  bodies  lie;  and  other 
insanitary  conditions  render  the  removal,  as  suggested,  im¬ 
peratively  necessary,  though  the  authorities  have  no  power 
to  compel  it. 

The  monthly  return  of  the  Eegistrar- General  for  Scotland 
for  July  last  shows  that  during  that  period  there  were  regis¬ 
tered  in  the  eight  principal  towns  of  North  Britain  the 
births  of  3735  children,  and  the  deaths  of  2179  persons  ;  the 
latter  number  was  166  under  the  average  for  the  month 
during  the  last  ten  years,  allowing  for  increase  of  popula¬ 
tion.  A  comparison  of  the  deaths  registered  in  the  eight 
towns  shows  that  during  this  month  the  mortality  was  at 
the  annual  rate  of  13  deaths  per  thousand  persons  in  Perth, 
14  in  Aberdeen,  17  in  Edinburgh,  18  in  Leith,  20  in  Dundee, 
22  in  Paisley,  23  in  Greenock,  and  25  in  Glasgow.  The  mias¬ 
matic  order  of  the  zymotic  class  of  diseases  proved  fatal  to 
386  persons,  and  constituted  17'7  per  cent,  of  the  mortality  . 
this  rate  was,  however,  exceeded  in  Glasgow,  Greenock,  and 
Paisley.  Fever  caused  22  deaths ;  of  these  8  were  tabulated  as 
typhus,  13  as  enteric,  and  one  as  simple  continued  fever.  Six 
deaths  from  typhus  were  registered  in  Glasgow,  and  1  each  in 
Edinburgh  and  Leith.  Whooping-cough  was  the  most  fatal 
epidemic,  having  caused  97  deaths,  or  4‘5  per  cent,  of  the 
whole.  The  mortality  from  measles  (92)  was  nearly  as 
great,  Glasgow  and  Greenock  furnishing  the  highest  death- 
rates  from  this  disease.  The  deaths  from  inflammatory 
affections  of  the  respiratory  organs  (not  including  consump¬ 
tion,  whooping-cough,  or  croup)  amounted  to  398,  or  18’3 
per  cent.  Those  from  consumption  alone  numbered  298,  or 


13-7  per  cent.  Three  males  and  five  females  were  aged 
ninety  years  and  upwards,  the  oldest  of  whom  was  a  retired 
farmer  ninety-eight  years  of  age. 

An  outbreak  of  small-pox  has  been  reported  from  Leicester, 
introduced  from  Birmingham  in  the  following  manner  : — A 
young  woman  working  at  Leicester  went  to  Birmingham  to 
visit  her  mother,  who  is  engaged  as  a  nurse  at  the  small-pox 
hospital  there.  During  the  visit  the  mother  gave  her 
daughter  a  dress  which  she  had  worn  whilst  engaged  in 
the  hospital ;  the  daughter  took  the  dress  back  to  Leicester 
and  began  to  unpick  it,  but  before  she  had  completed  her 
task  she  became  ill,  and  as  she  was  found  to  be  suffering 
from  small-pox  she  was  removed  to  the  Leicester  small-pox 
hospital,  where  she  eventually  died.  A  few  days  after¬ 
wards  two  other  cases  of  the  disease  occurred  in  the  house 
where  the  deceased  had  lived.  The  sufferers  were  promptly 
removed  to  the  small-pox  hospital,  and  as  a  precautionary 
measure  all  the  remaining  inmates  of  the  house  were 
induced  to  go  into  quarantine  at  the  hospital,  where  they 
are  to  be  provided  with  all  necessaries  and  amusements  for 
fourteen  days.  It  is  hoped  that  these  measures  will  prevent 
the  further  spread  of  the  disease.  Owing  to  the  prevalence 
of  small-pox  in  Birmingham  and  the  surrounding  district  - 
the  whole  of  the  police  of  Aston,  including  the  Birmingham 
division,  numbering  about  one  hundred  men,  have  been  re¬ 
vaccinated.  The  authorities  have  erected  a  number  of  tents 
to  serve  as  small-pox  hospitals  outside  the  cemetery  at 
Wilton,  a  long  distance  from  any  houses,  and  to  these 
persons  suffering  from  small-pox  are  immediately  removed. 

The  Hospital  Saturday  collection  was  duly  made  on 
Saturday  last,  and,  so  far  as  is  known  up  to  the  present 
time,  the  amounts  realised  would  appear  to  be  again  in 
excess  of  any  former  contributions.  It  may  be  mentioned, 
in  support  of  the  remarks  we  recently  made  on  this  subject, 
that  a  note  for  £5  and  a  cheque  for  a  like  amount  were 
found  in  one  of  the  street  collecting  boxes — scarcely  dona¬ 
tions  to  be  looked  for  from  any  working-man ;  whilst  the 
Times  says  that  “  the  boxes  from  the  West-end,  though  not 
lighter  than  usual,  indicated  that  September  is  badly 
chosen  for  a  street  collection  in  the  West,  the  wealthier 
people  of  the  district  being  for  the  most  part  absent  from 
town/’ 


THE  CHOLERA  MORTALITY  IN  EGYPT. 

The  total  cholera  returns  in  Egypt  up  to  the  end  of  August 
show  that  altogether  the  deaths  in  Lower  and  Upper  Egypt 
amounted  to  26,900.  In  the  Army  of  Occupation  there  were 
138  deaths.  The  Artillery  had  21  fatal  cases,  the  Cavalry  8, 
the  Engineers  1,  the  Eoyal  Sussex  33,  the  Duke  of  Corn¬ 
wall’s  Eegiment  5,  the  Black  Watch  8,  the  Eifles  20,  the 
Gordons  13,  the  Camerons  10,  the  Hospital  Corps  15,  and 
other  corps  4.  _ 

THE  EIRE  IN  SOUTHALL  PARK  LUNATIC  ASYLUM. 

On  Thursday  last  week  Dr.  Diplock  opened  an  inquest  on  the 
body  of  E.  E.  Howe,  aged  sixteen  years,  who  had  been  a 
housemaid  in  the  Southall  Park  Lunatic  Asylum,  and  who 
had  died  from  the  effects  of  injuries  received  in  escaping  from 
that  house  when  it  was  burnt  on  August  14.  It  appeared 
that  the  girl,  together  with  two  other  servants,  got  on  to  the 
roof,  and  that  the  deceased  getting  frightened,  and  indeed 
scorched,  by  the  approaching  flames,  jumped  from  the  roof 
on  to  a  gravel  walk,  instead  of  to  the  roof  of  the  west  wing 
of  the  house,  which  was  immediately  below.  There  was 
ample  evidence  as  to  the  cause  of  death ;  but  the  jury 
desired  to  discover,  if  possible,  the  origin  of  the  fire ;  and  at 
any  rate,  influenced  and  guided  by  their  foreman,  were  deter¬ 
mined  to  learn  from  the  Commissioners  of  Lunacy  whether 
they  had  not  made  any  by-laws  or  regulations  with  respect  to 


268 


Medical  Times  and  Gazette. 


THE  WEEK. 


Sept.  8,  1883. 


provision  against  fire  in  lunatic  asylums.  The  foreman  was 
very  earnest  in  urging  that  the  Commissioners  must  have 
some  regulations  with  regard  to  means  of  escape  in  case 
of  fire,  and  as  to  provisions  against  fire ;  and  in  the  end 
the  inquest  was  adjourned  for  a  week,  in  order  that  a 
representative  from  the  Lunacy  Commissioners  might 
attend.  W e  confess  that  we  sympathise  largely  with  the 
foreman  of  the  jury,  and  think  that  he  has  rendered  good 
service  in  insisting  that  the  Commissioners  should  have  an 
opportunity  of  stating  in  public  what  measures,  if  any,  they 
require  or  recommend  to  be  taken  in  order  to  insure,  so 
far  as  may  be,  the  safety  of  lunatics  in  case  of  fire. 


THE  ASYLUMS  BOARD’S  PROVISIONS  FOR  AN  OUTBREAK  OF 

CHOLERA. 

At  the  meeting  of  the  Managers  of  the  Metropolitan 
Asylums  Board  held  on  Saturday  last,  a  communication  was 
read  from  the  Local  Government  Board,  explaining  the  provi¬ 
sions  of  the  new  Diseases  Prevention  (Metropolis)  Act.  The 
report  of  the  General  Purposes  Committee  was  then  brought 
up.  This  dwelt  at  length  upon  the  previous  history  of  the 
Board  in  connexion  with  cholera,  and  concluded  by  sug¬ 
gesting  the  addressing  of  letters  to  the  boards  of  guardians 
and  hospital  authorities  in  London,  stating  that  in  the 
event  of  cholera  spreading  to  this  country  the  Managers 
would  probably  be  called  Upon  by  the  Local  Government 
Board  to  make  a  certain  [and  defined  provision  for  the 
treatment  of  persons  of  both  sexes  suffering  from  the 
disease,  such  provisions  to  be  so  distributed  throughout 
the  metropolis  as  to  be  uniformly  available  for  all  cases. 
With  the  object  of  carrying  out  the  views  of  the  Legisla¬ 
ture,  the  Managers  desired,  as  a  preliminary  step,  to  enter 
into  negotiations  with  the  several  boards  of  guardians  and 
metropolitan  hospital  authorities,  in  order  to  ascertain 
whether  they  would  be  willing  to  place  at  their  disposal,  for 
a  time,  a  certain  number  of  beds  for  the  treatment  of 
patients  suffering  from  cholera.  Sir  E.  H.  Currie,  Chairman 
of  the  General  Purposes  Committee,  in  moving  that  the 
letter  and  report  be  adopted,  observed  that  it  should  be 
distinctly  understood  that  the  Managers  did  not  purpose  to 
find  accommodation  for  the  whole  of  the  metropolis.  But 
the  Board  wished  to  see  what  provision  might  be  obtained 
in  case  of  a  great  epidemic  of  cholera  occurring  here,  and 
they  therefore  wished  to  send  out  this  letter.  It  must  be 
made  known  that,  although  the  Board  were  prepared  to 
make  general  provision  for  London,  yet,  in  case  of  a  distinct 
epidemic  breaking  out  in  any  one  district,  that  district 
must  deal  with  the  epidemic.  The  report  and  the  letter 
were  eventually  ordered  to  be  adopted. 


AN  UNSUCCESSFUL  NEPHRECTOMY. 

The  operation  of  nephrectomy  was  performed  in  Dublin  last 
month  by  Dr.  Kidd,  Master  of  the  Coombe  Lying-in 
Hospital,  on  a  woman,  aged  twenty-eight.  She  was  first 
admitted  into  the  Coombe  Hospital  in  February,  1882, 
when  she  gave  the  following  history  : — In  October,  1880,  she 
suffered  from  a  severe  wetting,  and  from  that  time  men¬ 
struation,  previously  regular  and  normal,  had  recurred  at 
fortnightly  intervals,  being  profuse  and  accompanied  by 
rather  severe  pain  referred  to  the  hypogastrium.  From  the 
sa  me  date  the  patient  has  suffered  from  great  irritability  of 
the  bladder,  being  unable  to  retain  urine  for  more  than  ten 
minutes  at  a  time,  whilst  micturition  was  constantly  accom. 
panied  by  very  severe  scalding  or  cutting  pain  referred  to  the 
external  orifice  of  the  urethra.  The  urine  was  then  healthy, 
and  no  cause  could  be  found  either  in  the  urinary  or  genital 
tracts  to  account  for  the  pain.  Some  time  afterwards  the 
urine  became  distinctly  purulent,  and  the  mucous  membrane 


|  of  the  bladder,  examined  by  means  of  the  endoscope,  was 
!  seen  to  be  very  red  and  vascular.  The  passage  of  a  sound 
into  the  bladder  gave  rise  to  great  suffering,  and  therefore 
a  permanent  vesico-vaginal  fistula  was  established  by  opera¬ 
tion,  without,  however,  being  followed  by  the  expected  relief. 
In  May  of  the  present  year  the  patient  again  came  under 
notice,  suffering  from  the  same  symptoms  as  formerly,  but 
a  movable  tumour  was  now  felt  in  the  right  hypochon- 
drium,  in  general  shape  and  consistency  resembling  an  en¬ 
larged  kidney.  In  the  situation  of  this  tumour  the  patient 
complained  of  much  pain,  aggravated  by  lying  on  either  side. 
The  diagnosis  was  made  of  a  right  kidney  enlarged  by 
abscesses.  In  consequence  of  the  severe  pain  and  the  irre¬ 
gular  hectic,  and  wasting  of  the  patient.  Dr.  Kidd  decided 
on  removing  the  kidney,  and  the  operation  was  carried  out, 
under  bichloride  of  methylene,  on  July  12,  and  lasted  alto¬ 
gether  about  an  hour  and  a  half.  The  incision  was  made 
through  the  anterior  abdominal  walls  over  the  length  of  the 
tumour.  The  peritoneum  was  adherent  over  the  front  of  the 
kidney,  and  there  were  several  firm  adhesions  posteriorly 
also.  There  were  a  great  number  of  separate  abscesses 
found  in  the  substance  of  the  kidney.  Hempen  ligatures 
were  used  to  tie  the  pedicle,  which  consisted  of  the  renal 
vessels,  ureter,  etc. ;  and  the  pedicle  was  then  dropped  back 
into  the  abdomen,  a  glass  drainage-tube  inserted,  the  peri¬ 
toneal  cavity  carefully  cleansed,  and  the  wounds  closed  up. 
The  patient  at  first  seemed  to  rally  well  from  the  operation, 
but  died  twenty-four  hours  afterwards  from  collapse,  with¬ 
out  any  hemorrhage  having  taken  place. 


CARMICHAEL  COLLEGE  OF  MEDICINE,  DUBLIN. 

Dr.  Francis  Thomas  Heuston  has  been  elected  Lecturer 
on  Anatomy  in  this  flourishing  school  of  medicine,  in  suc¬ 
cession  to  the  late  Dr.  Loftie  Stoney,  whose  almost  sudden 
death  we  recorded  last  week.  Dr.  Heuston  had  served  for 
the  past  three  years  as  Senior  Demonstrator  in  the  Ana¬ 
tomical  Department,  to  be  the  head  of  which  he  is  now 
promoted.  He  graduated  as  Doctor  of  Medicine  and  Master 
of  Surgery  in  the  Queen’s  University  in  Ireland  in  1878, 
having  become  a  Licentiate  of  the  Eoyal  College  of  Surgeons 
in  Ireland  in  the  previous  year. 


alkali  works. 

Dr.  Angus  Smith,  Chief  Inspector,  has  presented  his  nine¬ 
teenth  annual  report  upon  the  alkali  works  of  the  United 
Kingdom  to  the  Local  Government  Board.  This  inspection 
has  an  exclusively  sanitary  object ;  and  the  report  shows 
how  widely  spread  are  the  various  chemical  industries,  and 
how  important  is  their  effect  upon  the  public  health.  Dr. 
Smith  has  experienced  considerable  difficulty  in  bringing  all 
the  establishments  included  in  the  statutes  under  direct 
inspection.  There  are  over  a  thousand,  and  in  many  instances 
they  are  small  and  isolated.  So  far  as  regards  the  escape  of 
acid  in  the  smoke  from  chimneys,  the  maximum  prescribed 
is  not  now  being  exceeded.  Condensing  machinery  has  of 
late  years  been  so  greatly  improved  that  the  various  works, 
and  especially  those  manufacturing  on  a  large  scale,  have 
no  difficulty  in  complying  with  the  present  legal  obligations, 
notwithstanding  their  stringency.  He  directs  special  atten¬ 
tion  to  the  “  waste  heaps  ”  (alkali  waste)  which  disfigure  the 
towns  of  St.  Helen’s  and  Widnes,  and  which  have  for  many 
years  been  a  perplexing  sanitary  problem.  The  nuisance  is 
so  serious  that  he  feels  disinclined  to  prolong  the  responsi¬ 
bility  of  withholding  the  compulsory  clauses  of  the  Act, 
and,  without  reservation,  expresses  the  opinion  that  the 
Local  Government  Board  should  bring  the  matter  to  an 
early  issue. 


Medical  Times  and  Gazette. 


THE  WEEK. 


Sept.  8,  1883.  269 


THE  PUBLIC  HEALTH. 

The  Registrar-General’s  return  for  the  week  ending  Sep¬ 
tember  1  shows  that  the  annual  rate  of  mortality  in  twenty- 
eight  great  towns  of  England  and  Wales  averaged  19*8  per 
1000  of  their  aggregate  population.  The  six  healthiest 
places  were  Halifax,  Norwich,  Bristol,  London,  Derby,  and 
Hull.  In  London  the  annual  rate  of  mortality  from  all 
causes,  which  had  been  equal  to  19-0  and  17'9  per  1000  in 
the  two  preceding  weeks,  declined  to  17'0  last  week.  The 
1292  deaths  included  4  from  small-pox,  57  from  measles, 
40  from  scarlet  fever,  19  from  diphtheria,  27  from  whooping- 
cough,  1  from  typhus,  21  from  enteric  fever,  1  from  an  ill- 
defined  form  of  continued  fever,  74  from  diarrhoea  and 
dysentery,  and  9  from  simple  cholera.  Thus,  253  deaths 
were  referred  to  these  diseases — 95  below  the  corrected 
average  number  in  the  corresponding  weeks  of  the  last  ten 
years.  The  deaths  from  diarrhoea  and  dysentery  were  111 
below  the  corrected  average ;  63  were  of  infants  and  children 
below  five  years  of  age.  The  deaths  of  7  infants  and  children, 
.and  of  2  adults,  were  referred  to  simple  cholera  or  to  chole¬ 
raic  diarrhoea.  In  the  Outer  Ring  29  deaths  from  diarrhoea 
were  registered. 


INTOXICATING  LIQUOR  DRINKING. 

The  report  of  the  Commissioners  of  Inland  Revenue  shows 
that  during  the  year  ending  March  31  last  the  revenue  from 
excise  duties  upon  spirits  decreased  £62,296,  and  upon  beer 
,£130,451.  The  quantity  of  spirits  consumed  as  a  beverage 
decreased  in  England  by  294,270  gallons,  and  in  Scotland 
by  46,254  gallons,  but  in  Ireland  there  was  an  increase  of 
.245,667  gallons ;  thus  the  net  decrease  for  the  United 
Kingdom  was  94,857  gallons.  The  Commissioners  remark 
on  the  decrease  in  the  consumption  in  England  and  Wales 
that  it  appears  comparatively  small,  “  but  it  becomes  more 
significant  of  altered  habits  when  considered  in  connexion 
with  the  natural  increase  which  must  have  taken  place  in 
the  population.  There  cannot  be  any  doubt  that  in  some 
localities  the  spread  of  temperance  principles  has  already 
-caused  a  marked  diminution  in  the  consumption  of  intoxi¬ 
cating  liquors,  and  the  tendency  is  still  increasing.  On 
the  other  hand,  it  is  remarkable  to  find  in  Ireland,  in 
spite  of  an  estimated  decrease  of  population,  an  increased 
consumption  of  245,667  gallons.” 


THE  MORBID  ANATOMY  OF  PLUMBISM. 

The  importance  of  lead  as  a  therapeutic  agent  and  as  a 
•cause  of  disease  appears  to  justify  the  repetition  of  experi¬ 
mental  observations  of  its  effect  on  animals.  Maier  has 
accordingly  undertaken  the  investigation  of  this  question, 
and  the  results  of  his  observations,  which,  as  far  as  they  have 
gone,  relate  to  the  stomach  and  intestine  only,  are  recorded 
in  Virchow's  Archiv,  xc.,  page  455,  and  Centralblatt  f.  d. 
rued.  Wiss.,  1883,  page  358.  Maier  dosed  rabbits  and  guinea- 
pigs,  either  continuously  or  intermittently,  with  0'2  grammes 
.of  acetate  of  lead  daily,  and  determined  the  occurrence  of  the 
usual  symptoms  of  plumbism,  which  we  need  not  describe. 
On  post-mortem  examination  of  the  alimentary  canal,  the 
effects  of  lead  were  found  to  extend  to  all  the  structures 
composing  its  walls.  The  epithelium  of  the  surface  and  of 
the  glands  was  granular  and  swollen,  or  actually  fatty  in 
the  more  chronic  cases.  The  muscular  and  adventitious 
coats  of  the  middle-sized  and  small  arteries  were  pervaded 
by  leucocytes,  which  were  undergoing  degeneration ;  small 
aneurysms  formed;  and  haemorrhages  and  superficial  ulce¬ 
rations  were  the  results,  with  secondary  clotting  in  the 
veins  and  further  softening.  The  intestinal  vessels  pre¬ 
sented  less  severe  lesions  than  did  the  gastric,  from  the 
more  free  anastomosis  between  the  former.  Especially 


important  were  the  changes  in  the  nervous  structures  of  the 
alimentary  canal.  The  ganglia  were  found  to  be  sclerosed, 
the  cells  atrophied,  and  even  the  nerve-fibres,  though  more 
resistant,  became  diseased  ;  the  whole  condition  suggesting 
an  explanation  of  the  colic  characteristic  of  the  action  of 
lead.  Lastly,  the  connective  tissues  throughout  the  gastro¬ 
intestinal  wall  presented  evidence  of  active  growth,  as  they 
did  in  the  kidneys,  liver,  and  central  nervous  system  of  the 
same  animals.  The  question  is.  Which  of  the  associated 
changes  is  to  be  considered  the  primary  effect  of  lead — the 
connective-tissue  growth,  or  the  disturbance  of  the  nutri¬ 
tion  of  the  protoplasmic  structures,  represented  by  granular 
and  fatty  metamorphosis?  Maier  appears  to  regard  the 
protoplasmic  change  as  the  first  event,  the  connective 
tissue  hyperplasia  as  the  result  of  this ;  at  the  same  time,  he 
considers  that  the  resulting  cirrhosis  or  sclerosis  gives  rise 
to  further  atrophy  of  the  active  protoplasmic  elements,  in¬ 
cluding  the  muscular  fibres.  The  ultimate  effects  of  vascular 
lesions,  in  the  shape  of  ulceration,  hsemorrhage,  etc.,  are 
obvious. 


THE  ENGLISH  REGISTRAR-GENERAL’S  RETURN,  JUNE 
QUARTER,  1883. 

The  quarterly  return  of  the  English  Registrar- General  for 
the  second  or  June  quarter  of  the  present  year  shows  that 
the  number  of  births  registered  in  England  and  Wales 
during  that  period  was  228,703.  The  annual  birth-rate, 
which  was  equal  to  34  3  per  1000  of  the  estimated  popula¬ 
tion,  was  T6  below  the  mean  rate  in  the  ten  preceding  cor¬ 
responding  quarters,  and  showed  a  further  decline  from  the 
rates  recorded  in  recent  corresponding  quarters.  The  lowest 
country  birth-rates  were  27'8  in  Herefordshire,  28'8  in 
Devonshire,  and  29T  in  Dorsetshire ;  the  highest  rates  were 
38'9  in  Nottinghamshire,  39’2  in  Staffordshire,  and  40' 7  in 
Durham.  In  the  twenty-eight  great  towns  the  birth-rate 
averaged  352  per  1000,  and  was  0  9  above  the  general 
English  rate.  The  rate,  which  did  not  exceed  34-2  in  London, 
averaged  36T  in  the  twenty-seven  provincial  towns.  In 
these  provincial  towns  the  rates  ranged  from  27'7  in  Hud¬ 
dersfield,  and  30'2  both  in  Plymouth  and  Halifax,  to  38-9  in 
Leicester,  40-5  in  Blackburn,  41-3  in  Nottingham,  and  42  3 
in  Sunderland.  The  natural  increase  of  the  population  of 
England  and  Wales,  or  the  excess  of  births  over  deaths, 
which  had  been  104,492  and  102,351  in  the  second  or  June 
quarters  of  1881  and  1882,  declined  to  94,920  in  the  quarter 
under  notice.  During  this  second  quarter  of  1883,  133,783 
deaths  were  registered  in  England  and  Wales,  and  were 
equal  to  an  annual  rate  of  20T  per  1000  of  the  estimated 
population.  This  death-rate  was  0'3  below  the  average  rate 
in  the  ten  preceding  corresponding  quarters,  but  exceeded 
by  1'5  and  IT  respectively  the  exceptionally  low  rates 
in  the  second  quarters  of  1881  and  1822.  This  increase 
in  the  death-rate  would  appear  to  have  been  due  to 
the  unseasonably  low  temperature  that  prevailed  in  March, 
rather  than  to  the  prevalence  of  a  lower  sanitary  condition, 
insomuch  as  the  death-rate  from  zymotic  diseases  was  ex¬ 
ceptionally  low.  Thus,  the  total  number  of  deaths  ascribed 
to  these  latter  causes  was  12,632— equal  to  an  annual  rate 
of  1-89  per  1000,— which  was  O' 51  below  the  average  rate 
in  the  ten  preceding  corresponding  quarters.  The  zymotic 
rate  of  this  June  quarter  was,  in  fact,  lower  than  that 
recorded  in  the  second  quarter  of  any  year  since  1870, 
except  in  1881,  when  the  rate  was  only  1-87.  Whooping- 
cough,  measles,  and  scarlet  fever  were  the  most  fatal  of  this 
class  of  diseases,  and  small-pox  was  the  lowest  on  the  list, 
with  only  224  deaths.  Of  these,  30  occurred  in  London 
and  its  Outer  Ring  of  suburban  districts,  14  in  the  Home 
and  Eastern  Counties,  51  in  Staffordshire,  9  in  Birming¬ 
ham,  13  in  Lancashire,  8  in  Leeds,  45  in  Durham, 


Medical  Times  and  Gazette. 


THE  WEEK. 


Sept.  8,  1883* 


270 

and  23  in  Newcastle-upon-Tyne.  The  number  of  un¬ 
certified  deaths  during  this  quarter  showed  a  slight  de¬ 
cline  on  that  recorded  in  recent  quarters.,  being  5303,  or 
4'0  per  cent,  of  the  total  mortality.  The  proportion  of  un¬ 
certified  deaths  did  not  exceed  IT  per  cent,  in  London, 
whereas  it  averaged  -To  per  cent,  in  the  rest  of  England 
and  Wales.  Excessive  proportions  of  uncertified  deaths 
have  almost  invariably  been  recorded  in  Oldham  and  Halifax 
in  recent  quarters,  as  also  in  Wales.  During  the  period 
under  notice  the  numbers  were  11 T  n  South  Wales,  and 
1T4  in  North  Wales.  The  number  of  hours  of  bright  sun¬ 
shine  recorded  at  Greenwich  during  the  quarter  was  474-6, 
and  was  4'5  above  the  average  number  recorded  in  the  six 
preceding  corresponding  periods. 


THE  PARIS  WEEKLY  RETURN. 

The  number  of  deaths  for  the  thirty-fourth  week  of  1883, 
terminating  August  22,  was  1051  (563  males  and  488  females), 
and  of  these  there  were  from  typhoid  fever  49,  small-pox 
4,  measles  20,  scarlatina  2,  pertussis  19,  diphtheria  and 
croup  28,  erysipelas  5,  and  puerperal  infections  4.  There 
were  also  34  deaths  from  acute  and  tubercular  meningitis, 
183  from  phthisis,  25  from  acute  bronchitis,  38  from  pneu¬ 
monia,  143  from  infantile  athrepsia  (49  of  the  infants 
having  been  wholly  or  partially  suckled),  and  40  violent 
deaths  (33  males  and  7  females).  The  return  for  this  week 
notably  exceeds  that  of  the  preceding,  and  is  also  above  the 
weekly  mean  of  the  preceding  four  weeks,  which  is  981. 
The  increase  is  chiefly  due  to  typhoid  fever,  the  deaths  from 
which  increased  from  38  to  49,  to  phthisis  (183  in  place  of 
161),  and  to  diseases  of  the  cerebro- spinal  apparatus  (109 
instead  of  79).  The  births  for  the  week  amounted  to 
1319,  viz.,  662  males  (477  legitimate  and  185  illegitimate) 
and  657  females  (474  legitimate  and  183  illegitimate)  :  95 
infants  were  either  born  dead  or  died  within  twenty-four 
hours,  viz.,  49  males  (32  legitimate  and  17  illegitimate)  and 
46  females  (34  legitimate  and  12  illegitimate). 


LOCALISATION  OE  MOTOR  AREAS  IN  THE  BRAIN. 

Under  the  above  heading  at  page  616  we  noticed  the  first 
of  a  series  of  papers  by  MM.  Charcot  and  Pitres  on  the  non¬ 
motor  districts  of  the  cerebral  cortex.  In  their  second  com¬ 
munication  ( Revue  cle  Medecine,  June,  1883)  they  take  into 
consideration  destructive  lesions  of  the  motor  area,  the 
object  being  to  prove  that  these  always  produce  permanent 
paralysis,  and  lead  ultimately  to  contracture  of  the  paralysed 
muscles  and  secondary  degeneration  of  the  spinal  cord. 
The  conclusions  of  their  paper  may  be  summarised  as 
follows:  — 1.  Cortical  lesions  capable  of  giving  rise  to  total 
permanent  hemiplegia  are  always  situated  in  the  motor 
area,  and  they  occupy  the  whole  or,  at  any  rate,  a  good 
part  of  the  surface  of  this  motor  area.  2.  Lasting  para¬ 
lysis  of  the  arm  and  leg  on  one  side,  the  face  being 
unaffected,  is  due  to  lesion  of  the  upper  half  of  the 
cortical  motor  area  of  the  opposite  hemisphere.  3.  Para, 
lysis  of  the  face  and  arm  on  the  same  side,  the  leg  being 
unaffected,  denotes  a  lesion  of  the  lower  half  of  the  cortical 
motor  area  of  the  opposite  hemisphere.  4.  The  cortical 
motor  centre  which  governs  voluntary  movements  of  the 
face  is  situated  at  the  lower  end  of  the  opposite  ascending 
frontal  convolution.  5.  The  cortical  centre  governing  move¬ 
ments  of  the  arm  is  situated  at  the  middle  third  of  the 
ascending  frontal  convolution,  or  perhaps  a  little  above 
this.  6.  The  paracentral  lobe  is  the  seat  of  the  centre  for 
movements  of  the  leg ;  and  7.  Destructive  lesions,  even 
■when  very  extensive,  if  situated  in  the  non-motor  area, 
never  give  rise  to  secondary  degenerations,  whilst  destruc¬ 
tive  lesions  of  the  motor  area  are  always  accompanied  after 


the  lapse  of  a  certain  period  of  time  by  descending  changes 
in  the  pyramidal  tract.  In  a  subsequent  communication 
(August)  to  the  same  periodical  the  authors  study  the 
relations  of  partial  epilepsy  with  cortical  lesions.  The  follow¬ 
ing  extracts  will  sufficiently  express  their  views  : — “When 
during  the  interval  between  his  attacks  a  patient  who 
suffers  from  epileptiform  convulsions  shows  no  signs  of 
any  permanent  paralysis,  the  lesion  is  either  quite  super¬ 
ficial,  or  else  it  is  situated  in  the  neighbourhood  of  the 
motor  area.  When,  on  the  other  hand,  the  patient  during 
the  interval  between  his  seizures  is  permanently  hemiplegic 
or  monoplegic,  we  should  infer  that  there  is  situated  in  the 
motor  cortical  area  a  more  or  less  limited  destructive  lesion. 
From  the  standpoint  of  diagnosis  we  must  not  take  into 
account  those  transient  post-epileptic  paralyses  which  come 
on  immediately  after  a  seizure,  last  from  some  minutes  to 
a  few  days,  disappear  spontaneously  at  the  approach  of  a 
fresh  seizure,  and  are  far  from  being  uncommon.  They 
appear  to  be  the  result  of  temporary  exhaustion,  of  fatigue 
of  the  nerve-elements  after  the  exaggerated  activity  whicli 
has  provoked  the  attack,  and  have  no  diagnostic  value  as 
regards  the  locality  of  the  cortical  lesion  determing  the  con¬ 
vulsions.  ...  It  is,  then,  the  paralysis  which  must  determine 
the  diagnosis.  .  .  .  The  existence  of  epileptiform  convul¬ 
sions  of  the  Jacksonian  type  ought  to  make  us  think  of  a, 
cortical  lesion,  and  the  coexistence  or  absence  of  any  per¬ 
manent  paralysis  ought  to  tell  us  whether  or  not  the  lesion, 
is  situated  in  the  area  of  the  motor  convulsions.” 


SANITARY  PROSECUTIONS  IN  GLASGOW. 

The  Sanitary  Department  of  the  city  of  Glasgow  last  week 
obtained  a  conviction  at  the  Central  Police-court  against 
a  woman  whom  they  charged  with  having  contravened 
Rule  12  of  the  regulations  respecting  lodging-houses,  by 
failing  to  properly  wash  the  floors  of  every  apartment-  in 
her  house.  The  accused  pleaded  guilty,  and  a  fine  of  5s-. 
was  imposed,  failing  which  she  should  undergo  four  days' 
imprisonment.  On  the  South  Side  of  the  city  a  proprietor 
was  charged  with  allowing  the  drainage  in  his  property  to 
be  in  a  defective  state.  The  defendant,  it  was  stated  in 
court,  absolutely  refused  to  carry  out  the  necessary  repairs 
which  had  been  suggested  on  a  previous  occasion.  The 
magistrate  before  whom  the  case  came  gave  instructions  for 
a  suitable  party  to  report  on  the  state  of  the  drainage,  and 
to  state  what  repairs  were  found  necessary.  In  another 
case  a  “  factor  ”  was  fined  a  guinea  for  a  similar  offence.  At 
present  fever  (typhus  and  typhoid)  are  very  prevalent  in 
Glasgow,  and  it  is  a  serious  matter  for  the  inhabitants  when 
proprietors  and  agents  refuse  to  keep  their  properties  in  a 
proper  state  of  repair  or  to  assist  the  sanitary  officers  in 
their  arduous  duties  in  doing  what  they  can  in  conserving; 
the  health  of  the  community. 


THE  LONDON  WATER  EXAMINER’S  REPORT  FOR  THE  MONTH 
OF  JULY,  1883. 

The  agitation  on  the  subject  of  the  water-supply  of  the 
metropolis,  which  has  now  been  going  on  for  some  years,, 
must  sooner  or  later  produce  results  which  will  be  bene¬ 
ficial  to  the  public  in  more  ways  than  one.  It  may  be 
accepted  as  a  good  sign  that  some  feeling  of  this  kind  has 
evidently  influenced  the  official  mind,  since  the  monthly 
report  of  Colonel  Bolton  for  July  last  commences  with  a 
very  valuable  piece  of  information  never  before  given;  this 
is  no  less  than  a  detailed  statement  of  the  sources  from 
whence  the  various  metropolitan  water  companies  derive 
their  supply  of  water,  and  the  proportion  furnished  by  each 
of  them.  For  the  month  of  July  last,  the  report  informs  us^ 
these  proportions  were  nearly  as  follows From  the  river 


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Medical  Times  and  Gazette. 


THE  WEEK. 


Sept.  8, 1883.  271 


Thames  and  certain  springs  in  the  Thames  valley  about  fifty 
parts  of  the  whole  ;  from  the  river  Lea  and  certain  springs 
in  the  Lea  valley,  about  thirty-eight  parts  of  the  whole;  from 
the  eight  wells  in  the  north  of  London,  about  six  parts  ;  and 
from  the  ten  chalk  wells  in  the  south  of  London,  also  about 
six  parts.  It  will  thus  be  seen  that  at  the  present  time  no 
less  than  88  per  cent,  of  the  metropolitan  supply  is  river- 
water,  and  some  idea  may  be  formed  of  the  importance  of 
keeping  our  two  great  sources  of  supply  as  free  from  pollu¬ 
tion  as  possible.  During  the  month  of  July,  Colonel  Bolton 
says,  the  Thames  water,  previous  to  filtration,  was  good  in 
quality  on  every  day  but  two  (the  5th  and  6th),  when  it  was 
bad.  The  intakes  are  closed  as  much  as  possible  to  avoid 
taking  in  water  during  the  floods,  but  the  Southwark  and 
Vauxhall  Water  Company,  being  unprovided  with  reservoirs 
for  subsidence,  have  to  draw  from  the  river  at  all  times,  and 
consequently  their  filter-beds  soon  become  choked  up.  It 
may  be  remarked  that  Colonel  Bolton  has  been  calling  atten¬ 
tion  to  this  fact  in  each  monthly  report  issued  by  him  for  a 
long  time  past ;  but  presumably  he  has  no  power  to  take 
any  action  in  the  matter,  or  such  a  state  of  things  would, 
before  this,  have  been  remedied.  The  present  report  further 
■contains  a  copy  of  the  regulations  made  under  the  Metro¬ 
polis  Water  Act,  1871,  and  points  out  that  if  the  portion 
relating  to  cisterns  and  waste-pipes  was  more  strictly 
followed  out,  many  of  the  evils  now  complained  of  would  be 
prevented.  As  usual,  the  report  of  Dr.  Frankland,  F.B.S., 
on  the  quality  of  the  water  after  filtration,  is  added  to  that 
of  Colonel  Bolton.  The  samples  analysed  by  him  are  not  fur¬ 
nished  direct  by  the  different  companies,  but  are  drawn  at 
certain  fixed  points  within  the  radius  of  each  one’s  supply. 
He  remarks  that  during  July  the  Thames  water  supplied  by 
the  Chelsea,  West  Middlesex,  Southwark,  Grand  Junction, 
and  Lambeth  Companies  was  again,  for  river-water,  un¬ 
usually  free  from  organic  matter,  and  the  water  was  in 
each  case  efficiently  filtered  before  delivery.  The  water  ab¬ 
stracted  from  the  river  Lea  and  sent  out  by  the  New  Biver 
and  East  London  Companies  was  also  exceptionally  free 
from  organic  impurity,  and  superior  to  any  of  the  Thames 
waters  ;  whilst  the  deep-well  water  distributed  by  the  Kent 
and  Colne  Valley  Companies  and  by  the  Tottenham  Local 
Board  of  Health  was  of  its  usual  excellent  quality  for 
drinking,  and  in  freedom  from  organic  matters  surpassed 
any  of  the  river-waters  examined. 


ON  THE  SUTURE  AND  TRANSPLANTATION  OF  NERVES. 

Dr.  E.  G.  Johnson,  of  Stockholm,  in  a  long  and  interesting 
paper  in  a  recent  number  of  the  Nordislct  MedicinsM  Arhiv, 
after  referring  to  the  literature  of  the  above  subject,  gives 
the  results  of  his  own  experiments  made  in  the  laboratory 
of  the  School  of  Medicine  at  Stockholm.  In  sixteen  cases 
be  reunited,  by  means  of  a  catgut  suture,  the  entirely 
divided  ends  of  the  sciatic  nerve.  The  re-establishment  of 
the  nervous  influence  by  the  cicatrix  was  observed  on  the 
fortieth  day  in  the  experiments  on  rabbits,  on  the  thirty-first 
day  in  those  on  dogs,  and  on  the  twenty-fifth  on  fowls.  In 
twenty  experiments  on  rabbits  the  two  ends  of  the  sciatic 
nerve  were  not  reunited,  and  the  passage  of  the  nervous  in¬ 
fluence  by  the  cicatpix in  these  cases  was  not  observed  till  after 
sixty  days.  The  presence  or  absence  of  this  influence  was 
indicated  by  the  excitation  of  the  nerve,  above  the  cicatrix, 
by  means  of  a  weak  induction  current  or  by  mechanical 
■excitation.  In  the  experiments  on  rabbits,  microscopical 
examination  showed  on  the  fortieth  day  in  cases  of  suture 
of  the  nerve,  and  on  the  sixtieth  day  in  those  of  simple 
section,  bundles  of  amyelinic  nervous  fibres  passing  across 
the  cicatrix  from  the  central  extremity  of  the  nerve  to  its 
peripheral  parts.  In  reference  to  the  transplantation  of 


nerves.  Dr.  Johnson  has  succeeded  in  inserting,  in  the 
deficient  intervals  of  the  sciatic  nerve  of  two  fowls,  portions 
of  the  sciatic  nerve  of  other  fowls,  and  in  the  sciatic  nerve 
of  a  third  fowl  a  portion  of  the  sciatic  nerve  of  a  rabbit. 
The  first  two  fowls  were  killed  at  the  end  of  twenty-eight 
days  and  thirty-four  days  respectively,  and  the  third  after 
twenty-three  days.  The  portions  of  the  transplanted  nerve 
were  perfectly  grafted  on  the  original  nerve,  but  the 
nervous  influence  through  the  cicatrix  did  not  exist  in  any 
of  the  cases.  Microscopical  examination  exhibited  a  very 
evident  contrast  between  the  portion  of  the  central  nerve 
where  the  degeneration  was  but  slight,  the  intermediate 
portion  where  the  myeline  was  very  much  subdivided,  and 
the  peripheric  portion  where  scarcely  any  traces  of  myeline 
were  to  be  found. 


SOCIAL  SCIENCE  ASSOCIATION. 

The  programme  of  the  forthcoming  Congress  of  this  Asso¬ 
ciation,  to  be  held  at  Huddersfield  from  October  3  to  10, 
is  complete  as  regards  the  “  special  questions  ” — i  e.,  the 
questions,  of  which  there  are  three  in  each  department, 
formulated  by  the  Council  for  special  discussion.  Among 
these,  in  the  Depression  of  Crime  Section,  papers  will  be 
read  by  Mr.  C.  Meymott  Tidy,  M.B.,  and  Mr.  G.  Lathom 
Browne,  on  the  question,  “  Can  the  law  regulating  the  sale 
of  poisons  be  amended  so  as  more  effectually  to  prevent 
their  employment  for  criminal  purposes  ?  ”  In  the  Health 
Department,  the  question,  “  Is  the  modern  system  of  edu¬ 
cation  exerting  any  deleterious  influence  upon  the  health 
of  the  country  ?  ”  will  be  introduced  by  Dr.  Clifford  Allbutt 
and  Mr.  J.  Hepburn  Hume.  The  desirability  of  taking 
any,  and  if  any  what,  further  measures  to  prevent  the 
spread  of  zymotic  diseases  through  the  milk-supply  of  our 
towns,  will  be  dealt  with  in  papers  by  Mr.  Francis 
Yacher,  F.B.C.S.,  Dr.  Britton,  and  Mr.  Ernest  Hart;  and 
Dr.  Norman  Kerr  and  Mr.  Samuel  Knaggs,  M.B.C.S.,  will 
read  papers  on  the  question,  “  Is  it  desirable  to  amend  or 
extend  the  Habitual  Drunkards  Act,  and,  if  so,  in  what 
direction  ?  ” 


BACTERIOSCOP1C  EXAMINATION  OF  WATER. 

Some  time  ago  Dr.  B.  Koch  suggested  the  application  of  the 
method  of  pure  cultivations  to  the  detection  of  bacteria  in 
water,  but  since  he  found  them  always  present,  and  in  enor¬ 
mous  numbers,  it  seemed  as  if  little  practical  good  would  come 
of  it.  He  has,  however,  succeeded  in  giving  it  a  quantitative 
character,  and,  in  the  recent  inquiry  into  the  alleged  de¬ 
terioration  of  the  waters  of  the  Spree  by  the  effluent  of  the 
Berlin  sewage-farms,  has  shown  that  valuable  inferences 
may  be  drawn  from  its  indications.  After  a  preliminary 
examination  of  the  water  in  question,  firstly  with  a  power 
of  100  diameters,  and  then  with  one  of  500,  he  evaporates 
a  drop  on  a  glass  cover,  stains  it  with  methyl  blue,  and 
mounts  with  Canada  balsam.  Having  thus  formed  a  rough 
notion  of  the  relative  abundance  of  bacteria,  he  takes  a 
quantity  varying  from  ten  drops  of  distilled  water  down 
to  jjJjg  drop  (obtained,  of  course,  by  dilution)  in  the  case  of 
the  foulest  sewage,  and  intimately  mixes  it  with  one  cubic 
centimetre  of  his  gelatinous  cultivating  fluid,  which,  having 
been  sterilised  by  boiling,  is  not  yet  cooled  down  quite 
to  the  solid  state.  This  is  then  spread  out  on  a  part 
marked  out  on  a  glass  slide,  previously  exposed  to  a  flame, 
where  it  sets  into  a  thin  film.  The  slide,  covered  by  a 
bell-glass  enveloped  in  moistened  blotting-paper,  is  kept 
in  a  warm  room  for  thirty  to  sixty  hours.  Every  bacillus 
or  micrococcus  capable  of  development  will  be  by  this  time 
found  to  have  given  rise  to  a  separate  colony,  unless  the 
original  germs  were  in  actual  contact, — these  colonies 
appearing  as  cavities  of  various  sizes  and  hues  in  the  solid 


A. 


(I/,/- owl 


A 


272 


Medical  Times  and  Gazette. 


THE  WEEK. 


Sept.  8,  1883. 


gelatine,  which  at  these  points  has  been  liquefied  by  their 
vital  action.  A  glass  cover,  ruled  in  square  centimetres,  is 
laid  over  the  gelatine,  the  number  of  vacuities  in  several  of 
the  spaces  counted  with  the  help  of  a  glass  of  about  thirty 
diameters,  and  the  mean  taken.  It  is  then  easy  to  reckon, 
first  the  number  of  viable  bacilli  in  the  sample  drop,  and 
next  in  a  cubic  centimetre  of  the  original  water.  A  few 
examples  will  show  the  practical  employment  of  the  process. 
A  cubic  centimetre  of  pure  distilled  water  was  estimated  to 
contain  four  to  six,  derived  from  the  air  or  admitted  by 
other  accident ;  water  taken  direct  from  the  sewer,  38,000,000 ; 
the  effluent  from  the  filtering-beds,  87,000 ;  the  same  mixed 
with  that  of  the  Wuhle  (in  which  chemical  analysis  showed 
it  to  have  undergone  considerable  oxidation)  at  the  point 
where  this  stream  discharges  itself  into  the  Spree,  52,000 ; 
the  Spree  above  this  point,  115,000,  and  below,  118,000 ;  the 
water  at  the  Stralau  pumping-station,  before  filtration, 
125,000,  and  after  filtration,  120 ;  that  of  the  Rummels- 
burgerSee  (another  of  the  water-supplies  of  the  city), 
before  filtration,  32,000,  and  after,  100;  and,  lastly,  good 
spring-waters,  50  to  80.  Of  course  the  examination  does 
not  reveal  anything  as  to  the  virulence  or  otherwise  of  the 
bacteria  themselves;  but,  knowing,  as  we  do,  that  they 
live  and  multiply  in  and  at  the  expense  of  organic  matter 
— in  which  they  set  up  all  putrefactive  changes,  including 
nitrification, — we  can  appreciate  the  meaning  of  the  reduc¬ 
tion  effected  in  their  number  by  filtration,  in  the  case  of  the 
sewage  from  38,000,000  to  87,000,  and  of  the  potable  water 
at  Stralau  from  125,000  to  120.  Dilution  of  the  effluent 
with  the  water  of  the  Wuhle  and  its  course  therewith  for  a 
few  miles  still  further  reduced  them  from  87,000  to  52,000. 
Even  before  this  the  effluent  contained  fewer  than  the  water 
of  the  Spree,  on  which  it  had  no  appreciable  effect.  The 
number  (32,000)  in  the  Rummelsburger  See,  a  natural  lake 
preserved  from  external  pollution,  presents  a  striking  con¬ 
trast  to  that  of  120  in  the  filtered  river- water  at  Stralau. 
And  we  may  conclude  that  water  used  for  drinking  should 
not  contain  a  number  much  greater  than  this.  All  these 
indications,  we  may  add,  were  borne  out  by  the  chemical 
analysis. 


VITAL  STATISTICS  OF  IRELAND  FOR  THE  SECOND  QUARTER 

OF  1883. 

In  the  quarterly  return  for  Ireland,  published  by  authority 
of  the  Registrar- General  for  that  country,  it  is  shown  that 
during  the  three  months  ended  June  30  last  there  were 
registered  in  the  800  registrars’  districts  31,953  births  (a 
number  equal  to  an  annual  birth-rate  of  25*5  in  every  1000 
of  the  estimated  population)  and  27,288  deaths  (represent¬ 
ing  an  annual  rate  of  21  *8  per  1000) .  In  England,  during 
the  same  quarter,  the  birth-rate  was  34*2  in  every  1000 
of  the  estimated  population,  and  the  death-rate  20*0  per 
1000.  The  birth-rate  in  Ireland  for  the  quarter  under 
notice  was  slightly  under  the  rate  for  the  corresponding 
quarter  of  1882,  and  also  under  the  average  for  the  second 
quarter  of  the  five  years  1878-82.  The  deaths  were  above 
those  registered  in  the  corresponding  quarter  of  1882, 
to  the  extent  of  4414 ;  the  death-rate  was  3*8  per  1000 
above  the  rate  for  that  quarter,  and  1*8  over  the  average 
for  the  second  quarter  of  the  five  years  1878-82.  The 
increase  in  the  death-rate  for  this  June  quarter,  as  com¬ 
pared  with  the  average  of  the  corresponding  quarter  of  the 
last  five  years,  is,  the  return  says,  due  to  the  excessive 
mortality  amongst  the  old,  the  excess  over  the  average  in 
the  deaths  at  all  ages  being  1260,  and  the  increase  in  deaths 
at  sixty  years  and  upwards  amounting  to  1289.  The  deaths 
from  one  or  other  of  the  principal  zymotic  diseases  amounted 
to  2062,  being  131  under  the  number  for  the  preceding  three 
months,  but  296  over  the  number  for  the  June  quarter  of  last 


year.  The  annual  rate  per  1000  of  the  population,  represented 
by  the  deaths  from  these  causes,  was  1*6,  against  1*7  in  the 
preceding  quarter,  and  1*4  in  the  second  quarter  of  1882. 
Ten  deaths  from  small-pox  were  registered  in  Belfast,  and  2  in 
Glennamaddy  Union,  but  none  in  any  other  locality.  Measles 
was  prevalent  throughout  the  greater  part  of  the  country, 
but  on  the  whole  the  mortality  was  comparatively  light,  the 
total  number  of  deaths  recorded  being  225.  The  mortality 
from  whooping-cough,  exceptionally  heavy  in  the  preceding 
quarter,  showed  but  a  slight  decrease,  as,  although  the 
disease  declined  in  many  parts  of  the  country,  it  was  very 
prevalent  in  portions  of  the  province  of  Connaught,  and  was 
altogether  responsible  for  491  deaths.  During  the  fourth 
quarter  of  1882  there  were  409  deaths  registered  from  scarlet 
fever ;  in  the  following  quarter  the  number  fell  to  342,  and 
for  the  quarter  under  notice  it  slightly  declined  to  337.  The 
total  number  of  deaths  from  typhus  recorded  in  this  second 
quarter  showed  no  appreciable  variation  from  that  for  the 
preceding  three  months,  or  from  the  number  for  the  second 
quarter  of  last  year,  and  is  returned  as  282.  The  deaths 
from  diphtheria,  enteric  fever,  and  diarrhoea  were  under  the 
average  for  the  June  quarter,  markedly  so  in  the  case  of  the 
first-named  ;  and,  as  usual,  a  few  deaths — 5  in  all — were 
attributed  to  simple  cholera.  According  to  the  returns 
of  vaccination  received  for  the  second  quarter  of  1883, 
there  were  34,838  persons  successfully  vaccinated ;  in  2539' 
cases  the  operation  was  postponed,  and  74  children  were 
reported  as  insusceptible  of  vaccination.  The  deaths  of 
1735  unvaccinated  children  under  three  months  old  were 
registered  during  the  quarter,  making  a  total  of  39,186 
children  with  regard  to  whom  particulars  as  to  vaccination 
were  obtained.  The  return  points  out  that  as  children  in 
Ireland  under  three  months  old  are  not  required  by  law  to 
be  vaccinated,  the  number  of  vaccinations  performed  in 
any  particular  quarter  must  not  be  expected  to  agree  with 
the  number  of  births  registered  during  that  quarter. 


THE  HOLDING  OF  WAKES. 

At  the  Athlone  Petty  Sessions,  on  Saturday,  September  1,  a 
man  named  Michael  Brazil  appeared  on  a  summons  issued 
at  the  suit  of  the  Sanitary  Authority  for  permitting,  con¬ 
trary  to  Section  142  of  the  Public  Health  Act,  1878,  a  wake 
to  be  held  at  his  residence  in  Chapel-lane  over  the  body  of 
his  child,  who  had  died  of  an  infectious  disease.  Evidence 
was  given  that  the  man  had  been  officially  warned  not 
to  allow  a  wake  to  be  held,  as  it  was  an  infectious  disease 
but  the  police  afterwards  found  a  number  of  persons, 
in  the  house.  Another  child  of  Brazil’s  died  from  the 
same  cause,  and  he  had  allowed  a  wake  to  be  held.  Dr. 
White  deposed  that  the  children  died  of  an  infectious 
disease.  The  Chairman  (Mr.  Potts)  explained  the  serious 
nature  of  the  offence,  and  said  the  full  penalty  of  the  Act 
was  A5,  but  as  it  was  the  first  prosecution  of  the  kind  in 
Athlone,  the  Court  would  inflict  the  mitigated  penalty  of 
10s.  It  is,  we  think,  to  be  regretted  that  so  small  a  penalty 
was  inflicted  in  this  case.  The  man  had  been  fully  warned 
not  to  allow  a  wake  to  be  held,  and  deserved  to  be  mulcted, 
in  a  much  heavier  fine  than  10s.  The  magistrates,  in  their 
misplaced  leniency  towards  the  culprit,  showed  very  little 
consideration  for  those  who  may  suffer  through  his  wilful 
and  wanton  disobedience  to  the  law. 


It  is  said  there  is  reason  to  believe  that  both  the  street 
and  the  workshops  collections  for  the  Hospital  Saturday 
Fund  will  considerably  exceed  those  of  last  year.  Judging 
by  the  increased  value  of  the  amount  received  from  some 
sources,  it  is  conjectured  that  the  street  collection  will  pro¬ 
duce  at  least  .£3000,  and  the  workshops  collection  <£7000. 


Medioal  Times  and  Gazette. 


FROM  ABROAD. 


Sept.  8, 1883.  27S 


The  London  Fever  Hospital  is  now  connected  with  the 
Telephone  Exchange.  Every  facility  is  thus  afforded  with 
perfect  safety  for  making  inquiries  as  to  friends  in  the  Hos¬ 
pital,  and  for  communicating  with  the  officials  when  the 
ambulance  is  required.  The  telephone  number  of  the 
Hospital  is  6637. 

The  Mason  Science  College  has  made  very  good  progress. 
During  the  three  years  that  it  has  been  open  the  number 
of  students  increased  from  95  (65  males  and  30  females) 
entered  in  the  first  session,  to  366  (229  males  and  137  females) 
registered  in  the  session  recently  ended. 


The  Duke  of  Devonshire  has  just  presented  a  public 
block  to  the  Buxton  Hospital  at  a  cost  of  about  <£500. 


FROM  ABROAD. 


Extirpation  of  Bronchocele. 

At  the  twelfth  congress  of  the  German  Society  of  Surgery, 
held  recently  at  Berlin  ( Beilage  zum  Centralblatt  fur 
Chirurgie ),  there  were  several  papers  read  relating  to  this 
subject.  Prof.  Kocher,  of  Bern,  in  his  contribution,  stated 
that  according  to  the  statistics  of  the  operations  to  1850, 
including  his  own  operations,  there  had  been  70  excisions 
with  a  mortality  of  41  per  cent. ;  to  1877  there  had  been 
146  operations  with  21  per  cent,  mortality ;  and  to  1883, 
240  operations  with  only  11  per  cent,  mortality.  Since  the 
58  cases  of  his  own,  which  he  had  formerly  published,  he 
had  performed  43  operations,  with  a  mortality  of  5  per  cent, 
in  non-malignant  and  25  per  cent,  in  malignant  broncho¬ 
cele,  the  fatal  cases  not  having  been  directly  dependent 
upon  the  operation,  but  upon  complications  due  to  paralysis 
of  the  larynx  prior  to  the  operation,  to  accompanying  disease 
of  the  aorta,  and  to  preceding  pyaemia.  No  example  had 
occurred  amongst  his  last  43  cases  of  death  from  haemor¬ 
rhage  or  septicaemia.  The  execution  of  the  operation  has, 
in  fact,  become  so  perfected  that  even  in  great  bronchoceles 
all  considerable  haemorrhage  or  injury  to  the  recurrent 
nerve  may  be  avoided.  All  ligatures  en  masse  are  to  be 
discountenanced,  and  not  merely  the  chief  arterial  vessels  are 
to  be  exposed  and  tied  separately,  but  the  principal  venous 
trunks  are  also  to  be  ligatured  before  they  are  divided.  It 
is  indeed  obvious  from  injections  that  the  arteries  and  veins 
of  thethyroidare  byno  means  so  irregular  in  their  distribution 
as  is  often  supposed ;  and  some  of  the  principal  veins  are  as 
certain  to  be  found  as  the  chief  arteries  are.  In  most  of 
the  cases  chloride  of  zinc  was  used,  and  bismuth  was  em¬ 
ployed  as  an  antiseptic.  Tracheotomy  should,  as  far  as 
possible,  be  avoided,  even  when  the  difficulty  of  breathing 
is  great ;  for  it  is  an  impediment  to  the  carrying  out  of  the 
antiseptic  treatment,  and  to  the  restoration  of  the  normal 
form  of  the  compressed  trachea.  The  removal  of  one-half 
of  the  bronchocele  has  been  followed  by  very  favourable 
ultimate  results ;  twenty-nine  of  the  patients  so  operated 
upon,  who  have  been  seen  and  exactly  reported  upon,  having 
remained  quite  well.  The  remaining  half  of  the  tumour  has 
only  exceptionally  increased  in  size,  and  even  when  it  had 
attained  a  considerable  size  it  had  caused  no  trouble  after 
the  removal  of  the  other  half.  Of  the  twenty-four  cases  of 
total  extirpation,  the  results  were  satisfactory  only  in  those 
cases  in  which  the  operation  had  been  executed  after  the 
growth  of  the  body  had  been  entirely  completed.  In  all 
those  which  were  operated  upon  prior  to  this  period  (with  the 
exception  of  two  cases  in  which  relapse  took  place)  a  remark¬ 
able  form  of  progressive  cachexia  was  induced,  which  may 
be  termed  cachexia  strumipriva.  It  is  characterised  by  great 
anaemia,  tumefaction  (especially  of  the  face),  and  a  diminu¬ 
tion  of  intellectual  activity — furnishing  a  display  of  symp¬ 
toms  resembling  those  of  cretinism.  The  observation  of  the 
Cretinoid  changes  which  take  place  after  the  total  excision 
of  bronchocele  in  young  individuals  exhibits  for  the  first 
time  the  conditions  of  dependency  between  cretinism  and 
the  thyroid  gland. 


Dr.  A.  Wolfler  reported  on  sixty-eight  cases  of  non- 
malignant  bronchocele  which  had  occurred  in  Prof,  von 
Billroth’s  clinic  with  a  mortality  of  7  3  per  cent.  He  pre¬ 
fers  total  extirpation,  which  is  not  more  dangerous  than 
unilateral ;  and  he  has  met  with  none  of  the  [symptoms  of 
cachexia  described  by  Prof.  Kocher  in  any  of  seven  children 
who  were  operated  upon  fully  three  to  four  years  since. 
Tracheotomy,  as  causing  many  disadvantages,  he  thinks, 
should  be  performed  as  seldom  and  as  late  as  possible. 
Although  in  most  of  Billroth’s  cases  tracheotomy  was  ab¬ 
stained  from,  there  occurred  in  none  of  them  the  stenosis 
of  the  trachea  which  Kocher  states  he  has  sometimes  met 
with.  In  one  case  death  took  place  immediately  from  the 
entrance  of  air  into  one  of  the  veins  of  the  neck.  Especial 
care  should  be  taken  in  tying  the  lower  thyroid  vein,  as  it 
springs  from  below  the  thyroid.  Temporary  dysphagia  and 
aphonia  were  not  infrequent  temporary  occurrences  after 
the  operation.  After  the  sixty-eight  extirpations,  tetanus 
was  observed  in  seven,  always  appearing  during  the  first 
week.  These  all  occurred  in  women,  five  recovering  and! 
two  terminating  fatally.  i 


Bleeding  in  Local  Inflammation. 

Dr.  Nancrede,  at  the  fourth  meeting  of  the  American 
Surgical  Association,  held  at  Cincinnati  under  the  presi¬ 
dency  of  Prof.  S.  D.  Gross,  read  a  paper  on  the  question, 
“  Have  we  any  Therapeutic  Means,  as  proven  by  Experi¬ 
ment,  which  directly  affect  the  Local  Process  of  Inflamma¬ 
tion  ?  ”  According  to  the  report  in  the  Phil.  Med.  Times  for 
June  2 — 

44  From  a  series  of  experiments  on  the  local  vascular  and 
blood  changes  following  the  application  of  irritants  to  the 
web  of  a  frog's  foot,  and  the  effects  upon  this  traumatic 
inflammation  of  the  abstraction  of  blood,  he  was  able  to- 
arrive  at  positive  conclusions,  and  to  answer  the  question  in 
the  affirmative — that  local  bleeding  offers  advantages  in  the 
treatment  of  local  inflammation  unequalled  by  any  magis¬ 
tral  remedy.  He  formulated  his  conclusions  as  follows  : — 

1.  During  the  stage  of  dilated  arteries,  with  increasing 
rapidity  of  the  current,  but  little  danger  of  capillary 
changes  with  exudation  need  be  apprehended;  and  here 
perhaps  ergot,  certainly  arterial  sedatives,  do  good,  either 
directly  or  indirectly,  without  blood-letting,  by  reducing 
the  size  of  the  arteries  and  the  rapidity  of  the  current,  thus 
allowing  the  veins  of  the  obstructed  area  time  to  empty 
themselves  even  of  an  unaccustomed  amount  of  blood. 
Thus,  if  vascular  pressure  changes  have  taken  place,  the 
vessels  have  an  opportunity  of  returning  to  the  norm. 

2.  After  stasis  has  occurred,  or  is  occurring,  weakening  of' 
the  heart’s  action,  and  a  diminished  volume  of  the  current,, 
bleeding  can  do  nothing  but  harm  to  the  inflamed  area,, 
although,  for  the  reasons  given,  it  may  prevent  extension  of 
the  inflammation  in  the  circumjacent  parts,  which  are  merely 
in  the  earliest  stages  of  congestion.  3.  The  results  to  be¬ 
sought,  and  which  are  secured  by  local  blood-letting,  are- 
removal  of  the  blood  on  the  venous  side,  so  that  the  vessels; 
can  not  only  empty  themselves,  but  a  certain  amount  of  vis. 
a  f route — i.e.,  aspiration — is  invoked.  This  secondarily 
results  not  only  in  a  temporary  return  to  the  normal  on 
the  arterial  side,  but  an  increased  rapidity,  and— here  is; 
an  important  point — lessened  force  of  the  circulation. 
The  acceleration  of  rate,  without  weakened  force  of  the 
circulation,  would  further  damage  the  vessels ;  instead 
of  which  the  increased  rate  of  the  current  merely  serves  to- 
sweep  out  the  accumulated  red  blood-cells,  the  cause  of  the 
excess  of  oxygen,  and  the  consequent  cell-infiltration.  The 
vehement  current  also  induces  a  rapid  resorption  of  the 
effused  liquor  sanguinis,  at  once  the  stimulator  to  growth 
and  the  food  of  the  cells.  The  latter  advantage  is  not 
founded  on  theory  alone,  for  it  is  a  matter  of  common- 
observation  that  the  mere  amount  of  blood  abstracted  pro¬ 
duces  no  sensible  effect  on  an  inflamed  breast,  for  instance, 
but  in  a  few  hours  the  skin,  if  carefully  examined,  has 
become  wrinkled,  and  the  whole  organ  shrunken.  This 
effect  is  secondary  to  the  loss  of  blood,  and  chiefly  results 
from  the  absorption  of  the  inflammatory  exudate.  4.  Arterial 
sedatives  in  the  latter  stages  are  usually  inadmissible, except, 
as  succedanea  to  blood-letting,  as  far  as  the  focus  of  inflam¬ 
mation  is  concerned.  The  surrounding  parts,  which  are 
merely  congested,  may  be  benefited  by  their  exhibition. 
After  bloodletting  they  act  favourably,  because,  when  the 


274 


Medical  Times  and  Gazette. 


ANEURISM  OF  THE  AORTA  IN  CHINA. 


Sept.  8,  1883. 


stasis  has  been  overcome,  they  lessen  intravascular  pressure*  | 
and  thus  permit  the  bloodvessels  to  recover  their  normal 
condition.  They  also  alleviate  pain  by  lessening  the  bulk 
of  blood  in  the  part — i.e.,  they  relieve  nerve-pressure/’ 


Eae.lt  Operations  poe  Moebid  Geowths. 

At  the  same  meeting.  Prof.  Gross  read  a  paper  “  On  the 
Value  of  Early  Operations  in  Morbid  Growths.”  The  object 
of  the  paper  was  stated  to  be  the  placing  the  value  of  early 
operations  for  the  removal  of  morbid  growths  in  a  stronger 
and  clearer  light  than  any  in  which  it  had  hitherto  been 
presented.  The  reasons  for  early  removal  are  (1)  the  less 
risk  of  shock  and  haemorrhage ;  (2)  the  more  effectual  rid¬ 
dance  of  the  diseased  structures;  (3)  the  diminished  pro¬ 
bability  of  septicaemia  or  blood-poisoning  ;  (4)  the  avoidance 
of  unsightly  scars ;  and  (5)  the  less  risk  of  recurrence  of 
morbid  action,  either  at  the  seat  of  operation  or  in  other 
parts  of  the  body.  The  local  origin  of  morbid  growths  is 
now  generally  admitted,  but  an  hereditary  tendency  to  the 
development  of  such  neoplasms  was  recognised  not  only  as 
xegards  malignant,  but  also  in  benign  growths,  such  as 
warts  and  sebaceous  cysts,  which  have  been  observed  in  three 
generations.  Morbid  growths,  tumours,  and  neoplasms  are 
the  products  of  perverted  nutrition,  in  which  a  comparatively 
few  cells  native  to  the  part  are  replaced  by  colonies  of  new 
■cells,  of  which  the  product,  or  new  growth,  is  mainly  com¬ 
posed.  He  states  that  “  all  morbid  growths  are  developed, 
directly  or  indirectly,  under  the  influence  of  inflammatory 
action,  the  result  of  external  injury,  or,  as  is  more  frequently 
the  case,  of  some  mechanical  obstruction,  causing,  in  the 
first  instance,  congestion  of  the  part,  and  this  in  turn  in¬ 
citing  action  and  inflammation  ;  both  leading,  sooner  or  later, 
to  abnormal  cell-growth,  cell-formation,  or  cell-development. 
It  is  in  this  way,  and  this  way  alone,  that  we  can  satisfac¬ 
torily  explain  these  morbid  growths,  both  benign  and  malig¬ 
nant,  which,  as  the  phrase  goes,  arise  without  any  assignable 
-cause.  One  of  the  most  simple  of  all  tumours,  the  sebaceous,  is 
formed  under  the  irritating  influence  of  itsown  natural  secre¬ 
tion  retained  by  the  closure  of  its  natural  outlet.  Obstruc¬ 
tion  of  a  lacteal  duct  is,  there  is  no  doubt,  a  frequent  start¬ 
ing-point  of  scirrhus  of  the  mammary  gland.  There  is  not 
a  surgeon  of  any  experience  anywhere  who  has  not  occasion¬ 
ally  met  with  eases  of  carcinoma  which  are  due,  directly  or 
indirectly,  to  the  effects  of  local  injury.”  With  these 
fundamental  principles  in  view,  the  importance  of  early 
■operation  is  manifest,  and  experience  shows  its  necessity. 

Referring  to  the  difficulty  of  diagnosis,  the  advice  was 
given,  in  cases  of  doubt,  to  seek  consultation  rather  than  to 
allow  the  growth  to  develope,  thus  increasing  the  danger  to 
the  patient.  In  a  case  of  carcinoma  of  the  breast  especially 
was  the  surgeon  warned  against  the  waiting  for  the  develop¬ 
ment  of  secondary  growths  in  the  axilla,  and  till  involvement 
of  the  general  health  occurs.  Patients  should  be  taught 
the  risk  of  delay.  Not  only  should  growths  be  removed  early, 
hut  the  extirpation  should  be  done  as  thoroughly  as  possible. 
If  this  cannot  be  done,  it  will  be.  better,  in  advanced 
•cases  of  carcinoma  particularly,  not  to  meddle  with  the 
growths  at  all,  except  to  remove  actr>  offensive  ulcerating 
mass,  and  to  substitute  for  it  a  clean  wound.  The  longer 
the  knife  is  withheld,  the  greater  danger  will  there  be  that 
■some  of  the  cancer-cells  will  be  left  behind,  which  will  sub¬ 
sequently  serve  as  new  centres  of  morbid  action.  Sarcomata 
•are  especially  apt  to  return  in  the  internal  organs,  and  the 
worst  form  is  the  round-celled.  Any  rapidly  growing 
tumour  is,  as  a  law,  a  bad  subject  for  successful  surgical 
interference.  Even  benign  growths  of  rapid  development 
cannot  be  extirpated  too  soon.  As  illustrations  of  this 
principle  may  be  adduced  cystic  growths  of  the  ovary, 
chondromous  fibromas,  and  osteomas,  and,  as  analogous 
illustrations,  stone  in  the  bladder  and  pneumonia,  in  which 
fhe  contrast  between  early  and  late  treatment  is  very  marked. 


Eczema  of  the  Scalp  in  Infants. — Dr.  Lassar 
employs  the  following  formula : — Salicylic  acid  one,  tincture 
of  benzoin  two,  and  vaseline  fifty  parts.  A  certain  quantity 
of  this  is  smeared  over  the  scalp  two  or  three  times  a  day, 
after  having  washed  the  infant’s  head  with  soap-and- water. 
To  soften  the  crusts  and  facilitate  the  cleansing  of  the  scalp 
Hr.  Lassar  recommends  the  employment  of  oil  containing 
2  per  cent,  of  salicylic  acid. — Gaz.  Med.,  August  18. 


ANEURISM  OF  THE  AORTA  IN  CHINA. 

De.  P.  Manson’s  Report  on  the  Health  of  Amoy  for  the 
half-year  ended  September  30,  1881,  contains  the  following 
cases,  with  curious  and  instructive  information  on  the 
frequency  of  aneurism  of  the  aorta  among  foreigners  in 
China. 

Aneurism  of  the  Ascending  Aorta. — The  first  of  the  follow¬ 
ing  cases  of  aneurism  occurred  in  the  person  of  a  member 
of  the  Customs  outdoor  staff,  who  had  recently  arrived  from 
Hankow.  Some  weeks  after  his  arrival  he  consulted  me  about 
a  chronic  irritation  of  the  fauces  which  had  troubled  him  for 
about  two  years,  and  for  which  he  had  been  trying  a  variety  of 
local  applications.  He  also  complained  of  slight  attacks  of 
what  he  called  asthma,  coming  on  especially  at  night,  and  of 
some  breathlessness  experienced  on  going  upstairs.  I  failed 
to  detect  any  disease  in  his  throat,  and  repeatedly  examined 
his  chest,  with  the  possibility  of  aneurism  present  to  my 
mind,  but  could  detect  no  objective  symptoms  whatever. 
On  May  22,  feeling  perfectly  well,  he  went  out  riding  with 
some  friends.  He  had  ridden  but  a  little  way,  and  got 
about  one  hundred  yards  in  advance  of  his  party,  when  he 
was  seen  suddenly  to  drop  from  the  saddle  and  fall  on  his 
face  in  the  sand.  He  breathed  heavily,  his  face  became 
black,  and  in  a  few  minutes  he  died. 

A  post-mortem  examination  was  made  about  four  hours 
after  death.  The  pericardium  was  distended  with  blood-clot 
and  serum.  An  aneurism — sacculated,  and  with  a  large 
opening  into  the  artery,  extending  from  the  semilunar  valves 
nearly  as  far  as  the  origin  of  the  innominate — had  burst  into 
the  pericardium  by  a  minute  rent  behind  the  appendix  of 
the  right  auricle.  The  aneurism — about  the  size  of  a  small 
orange— sprang  from  the  lower  and  back  part  of  the  artery, 
and  pressed  slightly  on  the  trachea  just  above  its  bifurcation, 
but  had  caused  no  erosion  or  ulceration.  There  were  many 
patches  of  atheroma  along  the  aorta ;  these  could  easily  be 
turned  out  with  the  finger-nail  after  stripping  off  the  inner 
coat.  The  patches  increased  in  number,  size,  and  degree  of 
degeneration  in  proportion  to  their  nearness  to  the  aneurism. 
The  inner  surface  of  this  was  rough  and  irregular  from 
atheromatous  deposits,  some  of  which  were  much  eroded, 
and  in  their  ragged,  ulcerated-looking  centres  presented  a 
dark  red  staining.  In  some  places  this  process  had  so 
weakened  the  walls  of  the  tumour  that  small  subsidiary 
aneurisms  had  formed — little  pouches  with  narrow  openings 
hardly  admitting  the  tip  of  the  little  finger.  There  were  at 
least  three  such  baby  aneurisms,  two  of  them  adherent  to 
the  auricle  or  pericardium.  The  rent  in  the  wall  of  the 
aneurism  was  very  small;  but,  besides  that  which  had 
caused  death,  there  was  a  second,  much  more  extensive,  not, 
however,  penetrating  all  the  walls  of  the  sac,  but  dissecting 
them  up  to  a  considerable  extent.  There  were  no  laminated 
coagula,  nor,  beyond  a  certain  amount  of  thickening  in  the 
tissues  around  the  tumour,  any  attempt  at  spontaneous 
cure.  The  origin  of  the  innominate  was  barely  involved. 
The  heart  was  quite  healthy  ;  lungs  somewhat  emphyse¬ 
matous  ;  liver  large  and  full  of  blood.  The  dissection 
proceeded  no  further.  This  man,  though  considerably  over 
forty,  was  active,  in  good  general  health,  very  temperate, 
and  he  told  me  he  had  never  had  syphilis. 

Aneurism  of  the  Transverse  Aorta. — A  sailor,  aged  about 
thirty-one,  active,  muscular,  and  temperate,  consulted  me 
early  in  March  about  a  cough  that  had  troubled  him  for 
some  time.  He  said  he  caught  a  bad  cold  early  in  January ; 
that  towards  the  end  of  that  month,  once  or  twice,  when 
exerting  himself,  his  wind  failed  him  ;  that  during  February 
he  had  several  similar  attacks  of  breathlessness ;  that  pre- 
viouslyhe  had  been  treated  for  specific  disease — had  had  iritis, 
and  some  periostitis  about  the  sternum  and  ribs;  and  that 
last  year  he  suffered  much  from  pains  in  the  head  and  rheu¬ 
matism.  Just  before  my  examination  he  had  been  walking 
up  a  rather  steep  road,  and  I  observed  that  his  breathing 
was  much  oppressed.  There  was  no  expectoration  with  the 
cough.  Examination  failed  to  elicit  any  distinct  sign  of 
thoracic  disease,  although,  owing  to  my  suspicion  of  aneurism, 
this  was  made  with  the  greatest  care.  I  saw  him  again 
about  a  week  later,  and  then  heard  for  the  first  time  a  dis¬ 
tinct,  soft,  systolic  bruit  over  the  second  and  third  inter¬ 
costal  spaces,  just  to  the  left  of  the  sternum.  At  the  begin 
ning  of  April  I  saw  him  again.  He  told  me  that  he  had 


Medical  Times  and  Gazette. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


Sept.  8, 1883.  275 


had  several  very  severe  attacks  of  dyspnoea  while  at  sea, 
and  had  been  much  troubled  at  times  with  paroxysms  of 
coughing,  unaccompanied  by  expectoration.  It  was  possible 
now  to  diagnose  thoracic  tumour,  probably  an  aneurism. 
Pressure  symptoms  had  developed  ;  he  had  difficulty  in  swal¬ 
lowing,  pain  behind  left  shoulder,  and  a  husky,  raucous  voice 
and  breathing.  Slight  dulness  on  percussion  could  be  made 
out  over  the  second  left  cartilage ;  bruit  was  audible  here 
also,  and  could  be  traced  along  the  course  of  the  vessel,  and 
could  also  be  made  out  posteriorly.  There  was  a  slight 
heaving  movement  of  the  sternal  end  of  the  left  clavicle  and 
one  or  two  of  the  upper  ribs;  and  in  addition  to  these 
symptoms  the  breath-sounds  of  the  left  lung  were  decidedly 
feebler  than  those  of  the  right. 

The  man  was  sent  to  bed,  and  kept  as  much  as  possible  in 
the  recumbent  position.  His  food  was  restricted,  and  only 
a  very  small  allowance  of  fluid  permitted;  and  iodide  of 
potassium,  in  doses  rapidly  increased  to  a  drachm,  was  taken 
three  times  a  day.  Great  relief  followed  this  treatment. 
By  the  middle  of  June  cough  had  entirely  ceased,  the  diffi¬ 
culty  in  swallowing  and  pain  in  the  shoulder  had  dis¬ 
appeared,  and  the  heaving  at  the  sternal  end  of  the  left 
clavicle  could  hardly  be  detected.  Before  this,  however,  he 
had  hawked  up  on  three  or  four  successive  mornings  small 
quantities  of  rusty  bloody  mucus.  He  was  so  well  that 
arrangements  were  made  to  send  him  home,  with  the  view 
of  continuing  the  treatment  there  among  his  relatives.  But 
ten  days  before  his  death  a  severe  attack  of  coughing  was 
brought  on  by  a  piece  of  bread  “  going  the  wrong  way,”  and 
next  day  I  observed  that  throbbing  and  heaving  had  re¬ 
turned.  Three  days  afterwards  his  voice  became  very 
husky,  and  he  had  an  alarming  attack  of  orthopnoea.  These 
attacks  recurring  frequently,  and  provoked  by  the  slightest 
movement,  as  even  by  swallowing,  brought  about  his  death 
by  exhaustion  on  July  2. 

On  post-mortem  examination,  an  aneurism  the  size  of  a 
goose’s  egg,  with  an  orifice  the  size  of  half-a-crown,  was 
discovered  springing  from  the  under  and  back  part  of  the 
distal  half  of  the  transverse  aorta.  The  orifices  of  the  in¬ 
nominate  and  left  carotid  and  subclavian  were  not  involved. 
The  walls  of  the  aneuaism  were  strengthened  everywhere 
by  an  extensive  deposit  of  laminated  dirty  yellow  fibrine, 
which  could  be  peeled  off  in  long  strips,  and  was  intimately 
connected  with  the  vessel.  In  some  places  it  was  quite  three- 
quarters  of  an  inch  in  thickness.  Its  inner  surface  was  very 
irregular,  and  stained  with  blood.  Half  an  inch  above  the 
bifurcation  an  aneurismal  mamilla  projected  into  the  lumen 
of  the  trachea.  The  little  tumour  appeared  to  be  covered 
by  mucous  membrane  only.  It  was  rough,  blood-stained, 
and  looked  as  if  on  the  point  of  rupture.  There  was  some 
fibrine  strengthening  it,  but  this  appeared  to  be  the  weakest 
point  in  all  the  aneurism.  About  three-quarters  of  an  inch 
above  this  mamilla  was  another  but  smaller  projection  the 
size  of  a  B.B.  shot;  its  surface  was  smooth  and  much 
healthier-looking  than  the  other.  There  was  great  abun¬ 
dance  of  atheroma  in  the  arch  of  the  aorta.  The  lungs 
were  healthy.  None  of  the  other  viscera  were  examined. 

Notwithstanding  the  fatal  issue  of  this  case,  the  rapid 
amelioration  of  symptoms  and  the  extensive  deposit  of 
fibrine  have  impressed  me  very  favourably  with  the  iodide 
of  potassium  treatment  of  aneurism. 

Remarks. — As  a  result  of  a  good  many  years’  experience 
and  more  than  one  unpleasant  surprise,  I  have  formulated 
for  myself  two  rules  which  I  can  confidently  commend  to 
anyone  commencing  practice  among  foreigners  in  China. 
First,  given  a  non-febrile  case  in  which  persistent  symptoms 
(no  matter  how  trifling)  point  to  disease  in  the  chest  (espe¬ 
cially  if  there  is  laryngeal  irritation),  and  the  cause  for 
which  cannot  be  readily  made  out,  suspect  aneurism  of 
the  aorta,  and  carefully  and  repeatedly  examine  for  this. 
Secondly,  given  a  febrile  case  of  some  standing  in  which 
symptoms  (no  matter  how  trifling)  point  to  disease  in  the 
abdomen,  the  exact  nature  of  which  cannot  readily  be  dia¬ 
gnosed,  suspect  abscess  of  the  liver,  and  carefully  and  re¬ 
peatedly  examine  for  this.  Those  who  have  practised  in 
China  for  any  length  of  time  become  thoroughly  impressed 
with  the  extreme  frequency  of  aneurism  of  the  aorta  and 
abscess  of  the  liver  among  foreigners,  and  hardly  ever  ap¬ 
proach  the  diagnosis  of  an  obscure  case  without  being  on 
their  guard  about  these  two  diseases.  But,  unless  impressed 
by  some  such  rule  as  I  have  formulated,  the  novice,  with 
only  European  experience  to  guide,  or  rather  mislead,  him. 


is  very  apt  to  overlook  these  important  possibilities,  and 
may  have  them  afterwards  very  unpleasantly  impressed  on 
him.  A  pulsating  tumour  bulging  out  from  the  thorax,  or  a 
fluctuating  swelling  in  theregion  of  theliver,  are  easily  recog¬ 
nised  and  diagnosed ;  but  it  is  seldom  indeed,  unless  when 
disease  has  advanced  so  far  that  treatment  has  become 
entirely  hopeless,  that  the  aneurism  or  the  abscess  declares, 
itself  so  openly. 


REVIEWS  AND  NOTICES  jF  BOOKS. 

- ♦ - — 

Traite  Pratique  des  Par  le  Dr.  A.  Char¬ 

pentier,  Professeur  sgrege  &l  a  Faeulte  de  Medecine  de 
Paris,  ex-Chef  de  Clinique  d’Accouchements  de  la  Faeulte. 
Tome  premier.  Avec  une  planche  chromo-lithographee 
et  333  figures  intercalges  dans  letexte.  Paris,  1888.  Pp. 
1056. 

Practical  Treatise  on  Midwifery.  By  Dr.  A.  Charpentier, 
etc.,  etc.  Vol.  I.  With  a  chromo-lithograph  and  33 J 
illustrations. 

This  book  we  believe  is,  at  the  time  we  write,  the  latest 
complete  treatise  on  the  subject.  It  has  a  distinct  character 
of  its  own.  Briefly,  we  may  say  that  we  do  not  know  any 
work  which  contains  such  an  amount  of  information  as  to 
the  literature  of  the  subject,  and  the  different  opinions, 
which  have  been  and  are  held  upon  controverted  topics.  It 
is  scarcely  possible  for  one  man  to  write  a  book  which  shall 
contain  a  notice  of  every  contribution  to  our  knowledge  that 
has  been  made ;  and  in  this  elaborate  work  the  French 
School  is,  as  one  might  have  expected,  more  fully  repre¬ 
sented  than  any  other.  But  the  labour  of  compilation  is, 
on  the  whole,  so  thoroughly  done  that  the  book  is  one  which 
every  teacher  of  midwifery  should  have  on  his  shelves. 
The  defect  of  the  book  is  that  the  richness  of  his  material 
appears  to  have  been  almost  too  much  for  the  author’s  power 
of  digestion ;  the  reader  is  too  much  left  to  take  his  choice 
between  opposing  views ;  rows  of  figures,  sometimes  seeming 
to  contradict  one  another,  are  quoted  without  much,  if  any, 
attempt  to  estimate  their  relative  value  or  explain  their 
want  of  exact  agreement.  These  faults  make  the  treatise  less, 
suitable  for  a  beginner  or  for  the  busy  practitioner ;  but  the 
abundance  of  quotation  and  reference  makes  the  book  ex¬ 
tremely  valuable  for  one  who  has  the  leisure  and  inclination 
to  study  the  subject  with  the  view  not  simply  of  satisfying- 
examiners  and  meeting  the  requirements  of  every-day 
practice,  but  of  thoroughly  mastering  all  that  is  yet  known 
about  it. 

We  confine  our  remarks  at  present  to  the  first  volume, 
although  both  are  now  published.  The  author  conforms  to 
the  usual  custom  in  beginning  with  a  minute  description, 
occupying  sixty-nine  pages,  of  the  anatomy  of  the  pelvis 
and  genital  organs.  We  are  inclined  to  think  that  disserta¬ 
tions  of  this  kind  are  more  appropriately  left  to  those  con¬ 
versant  with  anatomical  research ;  and  that  in  a  treatise  on 
midwifery  it  is  enough  to  describe  the  parts  concerned  purely 
from  an  obstetrical  point  of  view.  The  next  thirty-nine 
pages  are  taken  up  with  the  physiology  of  the  unimpregnated 
organs.  We  doubt  whether  it  is  quite  exact  to  state  that 
the  rupture  of  the  Graafian  follicle  is  analogous  to  the 
bursting  of  an  acute  abscess  (page  71).  Dr.  Charpentier 
carefully  avoids  committing  himself  to  any  opinion  as  to  the 
significance  of  the  differences  in  size,  etc.,  of  the  corpus 
luteum,  or  as  to  the  precise  changes  in  the  mucous  mem¬ 
brane  of  the  uterus  during  menstruation.  The  conflicting 
views  of  various  investigators  are  given,  not  very  fully, 
but  the  author  goes  no  further.  We  have,  however, 
a  very  minute  account  of  the  structure  and  development  of 
spermatozoa,  a  subject  which  some  might  have  thought  it 
scarcely  necessary  to  include.  The  next  section  of  the  work 
deals  with  pregnancy,  and  comprises  207  pages.  The  de¬ 
scription  of  the  changes  which  take  place  in  the  uterus  i& 
very  good.  The  views  of  Bandl  and  others  as  to  the  beha¬ 
viour  of  the  cervix  during  pregnancy  and  labour  are  very 
lucidly  given.  The  distinction  between  the  contractility  and 
the  retractility  of  the  uterus  is  clearly  defined.  The  chromo¬ 
lithograph  to  which  reference  is  made  on  the  title-page  illus¬ 
trates  the  state  of  the  breasts  during  pregnancy,  but  it  is 
not  one  of  the  best  that  we  have  seen.  Dr.  Charpentier 
accepts  the  view  of  Tarnier,  as  to  the  existence  of  a  physio¬ 
logical  fatty  degeneration  of  the  liver  during  pregnancy. 


276 


Medical  Times  and  Gazette. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


Sept.  8,  1883. 


The  development  of  the  ovum  is  described  at  great  length. 
Here  again.  Dr.  Charpentier  follows  the  almost  universal 
precedent.  But  so  few  persons  engaged  in  the  practice  of 
midwifery  are  able  to  combine  with  it  a  pursuit  requiring  so 
•much  time  and  special  knowledge  and  manual  dexterity  as 
that  of  embryology — the  work  of  which  is  mainly  histologi¬ 
cal — that  we  cannot  but  think  that  elaborate  descriptions  of 
the  process  of  development,  and  the  different  views  held  as  to 
different  steps  of  the  process,  are  out  of  place  in  works 
on  practical  obstetrics.  The  anomalies  of  the  umbilical  cord 
are  very  fully  described.  The  author  enumerates  certain 
symptoms  occurring  during  pregnancy  and  labour,  which 
he  states  indicate  abnormal  shortness  of  the  cord.  Among 
these  are  pain  about  the  fundus  uteri,  slow  progress  of  the 
first  stage  of  labour,  hardness  of  the  uterus  in  the  intervals 
of  pains.  He  candidly  says  that  these  signs  are  “  hypo¬ 
thetical,”  and  we  are  ourselves  inclined  to  doubt  the  ad¬ 
vantage  of  printing  wholly  imaginary  symptoms  such  as 
these.  The  causes  which  determine  the  position  of  the  foetus 
in  utero  are  elaborately  discussed,  the  views  of  different 
theorists  being  recapitulated  and  compared;  but  between 
many  of  them  the  differences  seem  to  be  merely  verbal. 
The  diagnosis  of  the  foetal  position  by  abdominal  palpation — 
a  recent  improvement  in  practice  which  is  not  yet  so  widely 
known  as  it  deserves  to  be — is  very  thoroughly  given.  The 
fourth  of  the  books  into  which  this  volume  is  divided,  deals 
with  natural  labour,  and  comprises  236  pages.  The  symp¬ 
toms,  signs,  and  mechanism  of  the  process  are  described  at 
great  length,  and,  as  throughout  the  book,  the  opinions  of 
different  theorists  are  quoted  and  compared.  It  does  not 
seem  to  us  that  the  author  is  quite  so  successful  in  his 
criticisms  of,  or  in  his  attempts  at  harmonising,  divergent 
views  as  to  mechanism,  as  he  is  when  the  question  with  which 
he  deals  is  one  of  clinical  observation.  The  alterations  in 
the  shape  of  the  head,  which  have  been  observed  to  result 
from  the  pressure  to  which  it  is  subject  during  labour,  are 
minutely  specified.  Here,  as  in  most  of  the  mechanical 
questions,  the  author  quotes  and  compares,  but  has  not 
much  light  of  his  own  to  throw  upon  the  matter.  As  an 
•example  of  the  kind  of  work  in  which  he  is  at  his  best,  we 
would  point  to  the  directions  (page  397)  for  diagnosis 
between  the  foot  and  other  parts  of  the  foetus.  The 
advantage  of  supporting  the  perineum  is  a  question 
upon  which  all  accoucheurs  are  not  agreed.  Our  author, 
we  think  rightly,  regards  the  prevention  of  too  sud¬ 
den  escape  of  the  head  as  the  essential  object  of  such 
support.  We  cannot,  however,  agree  with  him  when 
he  says  that  in  those  positions  in  which  the  occiput 
enters  the  pelvis  posterior,  and  does  not  rotate  forward, 
it  is  only  with  the  forceps  that  rotation  can  be  effected. 
Rectification  can  often  be  effected  with  the  hand,  and  we 
are  inclined  to  regard  this  method  as  the  safer.  In  face 
presentations  with  chin  behind.  Dr.  Charpentier  advocates 
rotation  of  the  chin  forwards  with  the  forceps  ;  and  from 
this  we  would  also  differ,  for  the  same  reason.  The  different 
methods  of  extraction  in  difficult  breech  cases  are  very  well 
discussed.  The  author  objects  strongly  to  the  so-called 
■Crede  method  of  managing  the  third  stage  of  labour,  the 
main  ground  of  his  opposition  being  the  haste  which  some 
have  counselled.  To  express  the  placenta  three  or  four 
minutes  after  the  birth  of  the  child  is,  in  our  author’s 
opinion,  to  anticipate  the  contractility  of  the  uterus, 
which,  after  expelling  the  child,  requires  a  longer  in¬ 
terval  of  rest.  In  this  objection  we  believe  he  is  sup¬ 
ported  by  facts,  and  we  have  noticed  in  this  journal 
(volume  ii.  1880,  page  598)  observations  showing  an  ex- 
oessive  frequency  of  secondary  post-partum  haemorrhage 
as  the  result  of  the  immediate  expression  of  the  placenta. 
The  use  of  anaesthetics  during  labour  is  exhaustively  dis¬ 
cussed,  and  the  author’s  conclusions  seem  to  us  sound  and 
practical.  The  effect  of  the  early  and  late  ligature  of  the 
umbilical  cord,  and  the  subject  of  the  asphyxia  of  new¬ 
born  children,  with  the  methods  of  artificial  respiration, 
are  fully  gone  into.  The  remainder  of  the  first  volume  is 
•occupied  with  the  pathology  of  pregnancy.  The  course  of 
•different  diseases — the  eruptive  fevers,  pneumonia,  etc., — 
when  complicated  with  pregnancy,  and  their  effects  upon 
pregnancy  and  labour,  are  described  with  care.  Much  in¬ 
dustry  has  been  given  to  this  part  of  the  work,  which  is 
indeed  a  most  valuable  and  useful  compilation.  The  weak¬ 
ness  of  it,  speaking  generally,  seems  to  us  to  be  that 
is  too  much  importance  attached  to  mere  nume¬ 


rical  statements,  the  general  considerations  which  go  far 
to  explain  the  figures  being  apparently  not  clearly  enough 
perceived.  Still,  we  do  not  know  any  systematic  work 
which  is  such  a  storehouse  of  information  on  these  subjects 
as  the  one  before  us.  The  quotations  do  not  always  seem 
to  us  selected  with  judgment — e.g.,  at  page  625  we  have  a 
page-long  extract  from  a  communication  by  a  Dr.  Leven, 
a  clinical  sketch  which  seems  to  us  imaginary  and  incorrect, 
and  from  which  Dr.  Charpentier  expresses  his  dissent. 
Why,  then,  quote  it?  We  are  surprised  also,  seeing  how 
wide  is  the  range  of  our  author’s  reading,  that  in  the  sec¬ 
tion  upon  the  complication  of  pregnancy  with  heart  disease, 
we  find  no  mention  of  the  admirable  work  by  Dr.  Angus 
Macdonald  upon  this  subject.  Our  author  rejects  absolutely, 
we  are  glad  to  see,  the  accouchement  forcd.  The  diseases  of 
the  placenta  and  membranes  and  of  the  foetus  are  especially 
fully  gone  into.  The  chapter  on  retroversion  of  the  gravid 
uterus,  on  the  pther  hand,  is  poor.  We  may  point  out  by 
the  way  what  is  doubtless  a  clerical  omission :  in  the 
section  on  eclampsia  we  have  numerous  quotations  of 
much  interest  from  the  writings  of  Peter;  but  we  have 
looked  in  vain  for  a  reference  which  would  enable  us  to 
study  this  author’s  researches  for  ourselves.  Dr.  Mahomed, 
of  Guy’s  Hospital,  if  he  should  look  into  this  work,  will 
doubtless  be  amused  to  find  himself  quoted  under  the  name 
of  “Mohammed”  (page  673).  The  names  of  English 
authors  are,  indeed,  very  often  incorrectly  given  ;  thus  we 
have  “  Ramsbootham  ”  passim.  We  have  not  space,  how¬ 
ever,  to  continue  a  detailed  examination  of  this  valuable 
work.  It  is,  as  we  have  said,  one  which  every  teacher  of 
midwifery  should  have  on  his  shelves.  If  we  cannot  in¬ 
variably  agree  with  the  author’s  judgment,  we  can  throughout 
admire  and  wonder  at  the  amount  of  labour^which  he  has 
put  into  the  book. 


Handbuch  der  gesammten  Arzneimittellehre  ( Comprehensive 

Handbook  of  Pharmacology).  By  Dr.  Th.  Httsemann, 

Professor  in  Gottingen.  Second  Edition,  in  two  volumes. 

Berlin  :  J.  Springer.  1883. 

The  appearance  of  a  new  edition  of  a  national  Pharma¬ 
copoeia  is  in  due  course  followed  by  revision  of  the  various 
works  on  Materia  Medica  or  Therapeutics,  which  of  neces¬ 
sity  take  their  origin  from  it.  The  work  before  us  is 
designed  to  form  a  medical  commentary  to  the  latest  edition 
of  the  Pharmacopoeia  Germanica,  just  as  the  first  edition 
of  the  same  work  formed  a  companion  to  the  first 
Pharmacopoeia  of  the  German  Empire. 

Two  bulky  volumes  hardly  suffice  to  contain  all  the  material 
which  so  ambitious  a  scheme  demands,  and  the  title  of  “  Hand¬ 
book  ”  becomes  a  misnomer,  but  as  a  complete  guide  to  the 
science  of  Pharmacology  the  book  deserves  a  prominent 
place  amongst  standard  works  of  reference  on  medical 
subjects. 

Following  the  custom  of  other  writers  on  this  subject,  the 
author  devotes  the  earlier  part  of  his  work  to  the  considera¬ 
tion  of  the  theories  of  physiological  action  of  drugs  and  the 
therapeutic  peculiarities  of  individual  groups.  An  exhaustive 
account  of  the  various  means  of  administering  or  applying 
internal  and  external  remedies  concludes  the  first  part.  To 
obtain  a  thoroughly  satisfactory  classification  of  the  vast 
array  of  “  materia  medica  ”  has  always  been  a  difficulty  with 
writers  on  the  subject.  Objections  more  or  less  valid  may 
be  raised  to  any  of  the  arrangements  that  have  hitherto  been 
adopted,  and,  in  the  present  instance,  the  author,  recognis¬ 
ing  the  difficulties  which  must  beset  any  attempt  at  more 
precise  classification,  has  arranged  his  work  in  what  he 
terms  “pharmacological  ”  order — which  may  be  interpreted 
as  a  combination  of  the  physiological  with  the  clinical  and 
chemical  methods.  The  excellent  index  with  which  the  whole 
work  is  provided  renders  the  exact  classification  of  only  minor 
importance.  To  review  in  detail  the  sections  of  so  large  a 
work  would  trespass  far  beyond  the  limits  of  our  available 
space,  and  it  must  suffice  that  we  record  the  completeness 
and  comprehensiveness  of  the  work,  dealing,  as  it  does,  not 
only  with  the  recognised  and  officinal  preparations,  but  also 
the  very  numerous  collection  of  general  and  special  remedies 
which  are  becoming  known  and  employed  by  physicians  and 
physiologists  of  repute.  Short  quotations  from  the  writings 
of  the  latter,  the  names  being  always  mentioned,  add  to  the 
value  of  the  book  as  a  standard  of  reference. 

With  very  few  exceptions,  there  appears  some  account  o 


Medical  Times  and  Gazette. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


Sept.  8,  1883.  277 


all  the  new  discoveries  and  experiments  in  pharmacology 
np  to  the  end  of  the  year  1882. 

A  useful  chapter  on  antidotes  finds  a  place  in  the  first 
volume.  Besides  a  general  review  of  the  rationale  of  the 
treatment  of  poisoning,  there  is  contained  in  it  a  valuable 
discussion  of  the  relative  value  of  certain  lines  of  treatment. 
Both  in  this  section  and  in  that  devoted  to  the  subject  of 
emetics,  the  use  of  apomorphia  is  warmly  recommended. 
Its  value  has  been  far  more  widely  recognised  in  G-ermany 
than  has  hitherto  been  the  case  in  this  country.  Especially 
useful  will  he  found  the  exhaustive  accounts  of  many  of  the 
newly  introduced  alkaloids.  Notably,  the  description  of 
pilocarpin,  its  physiological  action,  and  the  objections 
attending  its  use,  gives  information  which  may  fairly  be 
called  complete  to  the  present  date. 

As  a  thoroughly  practical  and  comprehensive  work,  bearing 
every  indication  of  trustworthiness,  Dr.  Husemann’s  book 
will  prove  a  valuable  addition  to  the  standard  works  of 
reference  in  every  medical  library  in  which  it  may  find  a 
place.  _ 


Homoeopathy  in  its  Relation  to  the  Diseases  of  Females,  or 
Gynaecology.  By  Thomas  Skinner,  M.D.,  London. 
Second  Edition.  London :  The  Homoeopathic  Publishing 
Company.  1883. 

This  is  a  work  written  by  a  homoeopath,  and  for  the  public ; 
and  such  .  books  we  do  not  commonly  review.  But  as  the 
homoeopaths  are  constantly  saying  that  the  reason  that 
“  allopaths  ”  remain  in  their  blindness  is  that  they  do  not 
read  homoeopathic  literature,  we  have  thought  it  our  duty  to 
read  this  and  see  if  we  could  pick  up  any  hints  from  it.  The 
author  professes  himself  able  to  treat  all  the  diseases  to 
which  women  are  subject  without  local  treatment  of  any 
hind.  If  he  can  show  us  how  to  do  this,  he  will  be  indeed  a 
benefactor ;  so  we  read  eagerly,  hoping  to  learn.  After  a 
good  deal  of  egotistical  verbiage,  we  came  at  length  to  some 
cases.  Of  one  of  them  we  read — “bodily  and  mental  suffer¬ 
ings  which  were  really  something  awful.  In  my  twenty- 
seven  years  of  practice  I  have  never  come  across  a  worse 
case.  I  may  have  cobbled  them  before,  I  never  could  cure 
them  until  now.”  We  studied  tbis  to  see  what  might  be  the 
nature  of  the  worst  case  that  Dr.  Skinner  had  seen.  These 
were  the  symptoms — menorrhagia,  whites,  headaches,  pains 
like  labour ;  a  sinking  empty  exhausted  feeling  ;  nocturnal 
salivation ;  ill  humour  loth  before  and  during  menses ; 
dull  stupid  feeling  in  head;  photophobia,  worse  by  sunlight ; 
quick  nervous  temperament ;  sensation  as  of  the  movements 
of  a  foetus ;  accumulation  of  mucus  in  her  trachea  all  day, 
but  always  worse  at  night.  (The  italics  throughout  are  the 
author’s.)  This  is  precisely  the  kind  of  case  in  which  we 
should  have  expected  that  homoeopathy,  or  any  “  pathy  ” 
that  pleased  the  patient,  would  have  cured;  and  if  this 
mixture  of  hysteria  and  hypochondriasis  is  the  worst  case 
that  the  author  has  seen,  we  do  not  wonder  at  his  success. 
From  the  reports  of  such  cases  we  do  not  get  aid  in  treating 
the  real  and  serious  maladies  about  which  we  are  consulted. 


Artificial  Anaesthesia  and  Anesthetics.  By  Henry  M. 
Lyman,  A.M.,  M.D.,  Professor  of  Physiology  and  of 
Diseases  of  the  Nervous  System  in  Push  Medical  College, 
Chicago,  etc.  London :  Sampson  Low  and  Co.  1882. 
Pp.  338. 

This  work  may  be  broadly  divided  into  two  parts — one 
which  deals  with  anaesthesia  in  general,  the  other  with 
particular  anaesthetics  taken  seriatim.  The  first  part  begins 
with  a  full  account  of  the  history  of  anaesthesia,  from  which 
it  clearly  appears  that  the  claim  of  Simpson  to  the  gratitude 
of  mankind  is  not  that  of  the  discoverer  of  anaesthesia,  or 
even  of  chloroform.  Simpson  popularised  chloroform ;  he 
did  nothing  more.  Dr.  Lyman’s  history  of  the  subject  is 
clear,  interesting,  and  contains  the  fruit  of  much  research. 
Then  we  have  a  general  account  of  the  phenomena  of 
anaesthesia,  with  their  physiological  explanations.  These 
chapters,  it  appears  to  us,  would  have  been  better  had  the 
differences  in  the  effects  of  the  different  substances  used 
been  more  emphasised.  Although  the  author  generally  uses 
language  in  a  scientific  way,  we  sometimes  come  across 
popular  phrases  which  should  have  been  avoided.  We 
ought  not  to  be  told,  in  a  scientific  treatise,  that  “the  brain 
seethes”  (page  9)  when  an  anaesthetic  is  administered. 
Literally,  of  course,  the  statement  is  absurd :  as  a  popular 


metaphor  it  has  no  exact  meaning.  The  administration  of 
anaesthetics  is  next  described.  The  author  declares  strongly 
against  complicated  apparatus  :  a  simple  towel  or  bit  of  lint 
he  considers  as  safe  as  anything,  and  far  simpler,  easier, 
and  more  cleanly.  In  this  we  entirely  agree  with  him. 
Several  inhalers  are  described ;  but,  probably  from  the  un¬ 
favourable  opinion  which  Dr.  Lyman  has  of  them,  his  cata¬ 
logue  of  these  instruments  is  far  from  complete.  We  miss, 
for  instance,  Ormsby’s  ether  inhaler — the  one  to  which,  in 
this  country,  many  give  the  preference.  The  practical 
directions  given  are  very  good.  The  section  on  the  acci¬ 
dents  of  anaesthesia  is  not  so  satisfactory ;  for  the  author 
does  not  distinguish  the  kind  of  accident  special  to  each 
anaesthetic,  and,  when  he  theorises,  is,  like  so  many  of  his 
compatriots,  apt  to  think  that  when  he  has  put  together  a  fine 
phrase  he  has  explained  something.  Here  is  an  example  of 
“words  with  outknowledge  which  darken  counsel”: — “  Death 
from  syncope  is  the  result  of  a  certain  specific  disturbance 
of  the  nervous  equilibrium  which  should  be  maintained 
between  the  different  nervous  centres  of  the  body.”  There 
is  given,  however,  a  useful  collection  of  cases  illustrating 
these  accidents,  and  separate  sections,  which  contain  excel¬ 
lent  practical  directions  on  anaesthesia  in  midwifery  and  in 
dentistry.  We  then  find  an  account  of  the  different  substances 
which  have  been  used  to  procure  local  anaesthesia.  The  risk 
of  anaesthesia  is  next  discussed.  Dr.  Lyman,  putting  together 
such  statistical  statements  as  he  can  find,  comes  to  the  fol¬ 
lowing  estimate  of  the  danger  of  anaesthesia : — Ether,  1  death 
in  16,542 ;  chloroform,  1  in  5860.  This  result,  however,  he 
candidly  states,  is  little  better  than  guesswork.  The  last 
division  of  the  first  of  the  two  sections  into  which  we  have 
said  the  work  may  be  divided,  is  a  valuable  resume  of  the 
medico-legal  aspects  of  anaesthesia.  The  second  part  of  the 
work  consists,  as  we  have  said,  of  chapters,  in  which  each  of 
the  different  substances  that  have  been  employed  to  produce 
anaesthesia  is  considered  separately.  This  forms  the  larger 
part  of  the  volume,  and  is  not  less  interesting  and  useful, 
than  that  which  precedes  it.  Considering  the  work  as  a 
whole,  we  may  say  that,  while  it  does  not  show  any  great 
originality  either  in  research  or  in  thought,  it  is  a  careful 
and  full  compilation  of  facts  relating  to  the  subject,  put 
together  in  a  readable  fashion,  and  connected  by  remarks 
which  show  the  author  to  be  a  physician  of  extensive  know¬ 
ledge  and  sound  judgment. 


The  Alienist  and  Neurologist,  July,  1883. 

The  editor  of  this  journal.  Dr.  Hughes,  of  St.  Louis,  leads 
off  with  an  excellent  article  on  Simulation  of  Insanity  by 
the  Insane,  an  occurrence  by  no  means  so  rare  as  might  be 
supposed.  Although  the  insane  are,  contrary  to  popular 
notions,  often  well  aware  of  their  own  insanity,  yet  often  they 
are  not  so,  and  when  they  are  not,  and  have  committed  some- 
insane  act,  which  they  well  know  has  brought  them  within 
the  grasp  of  the  criminal  law,  they  will  occasionally  feign 
some  manifestations  of  insanity  over  and  above  those  that 
properly  belong  to  their  malady,  in  order  to  secure  them¬ 
selves  from  its  retaliation.  Those,  too,  who  are  insane,  and 
know  themselves  to  be  so,  will  occasionally,  under  similar 
circumstances,  feign  more  aggravated  symptoms  in  order  to 
place  the  existence  of  their  insanity  beyond  a  doubt.  And 
finally,  just  as  there  are  lunatics  who  will  determinedly 
conceal  their  mental  defects  for  lengthened  periods,  in  order 
to  secure  the  privileges  of  the  sane,  so  there  are  other 
lunatics  who  will  with  equal  determination  feign  for  long 
periods  defects  which  they  do  not  actually  suffer,  in  order  to 
secure  certain  privileges  and  immunities  of  the  insane.  The 
detection  of  simulated  insanity  in  a  person  who  is  really 
insane,  and  the  distinction  of  the  sham  from  the  real  affec¬ 
tion,  is  a  triumph  of  expert  skill  which  has  been  several  times 
effected,  and  which  speaks  highly  for  the  present  state  of 
the  practical  estimation  of  insanity.  Dr.  Workman,  of 
Toronto,  continues  his  translation  of  Professor  Golgi’s 
investigations  into  the  Minute  Anatomy  of  the  Brain — a 
translation  which  is  often  too  literal  to  be  intelligible.  The 
indefatigable  Dr.  Spitzka  has  a  long  critical  digest  of  the 
evidence  given  by  the  medical  witnesses  for  the  prosecution 
in  the  case  of  the  wretched  Guiteau.  If  this  report  is  an 
accurate  one,  the  answers  of  these  witnesses,  upon  whose 
evidence  the  man  was  hanged,  are  simply  amazing  ;  and 
one  can  only  wonder  where  and  how  the  prosecuting  counsel 
contrived  to  find  a  group  of  persons  pretending  to  a  know- 


278 


Medical  Times  and  Gazette . 


REVIEWS  AND  NOTICES  OF  BOOKS. 


Sept.  8, 1883. 


ledge  of  insanity  who  could  make  such,  statements  as  the 
following : — “  I  do  not  know  what  an  irresistible  impulse 
is.  That  is  something  I  do  not  understand.  I  cannot  con¬ 
ceive  of  an  irresistible  impulse.”  “People  who  are  known 
as  eccentric  ....  or  illy-balanced  (sic)  are  not  as  liable  to 
outbreaks  of  insanity  as  those  who  are  more  steady  and 
staid  in  habits  and  character.”  “  The  existence  of  insane 
cousins,  uncles,  or  aunts  would  have  no  bearing  whatever 
on  the  question  as  to  whether  there  was  any  hereditary 
tendency  in  a  family.”  “There  is,  I  think,  no  difference 
between  an  illusion,  a  delusion,  and  an  hallucination.”  “  I 
never  knew  a  case  of  hereditary  insanity  where  the  disease 
itself  was  transmitted.  Disease  is  never  transmitted.”  It 
is  difficult  to  believe  that  this  report  is  correct,  but  if  it  be 
correct,  and  if  the  criminal  was  convicted  on  this  evidence, 
it  would  be  as  erroneous  to  speak  of  his  being  executed  as 
ho  speak  of  his  victim  in  the  same  terms.  We  repeat,  that 
if  he  was  convicted  on  such  evidence  as  this,  his  death  was 
not  an  execution,  but  a  murder.  Syphilis  in  its  Eelations  to 
Progressive  Paresis  is  the  title  of  a  paper  by  Dr.  Kiernan, 
who  concludes  that  neither  from  a  clinical,  a  therapeutical, 
nor  a  pathological  standpoint  can  progressive  paresis  of 
non-syphilitic  origin  be  demarcated  from  that  of  syphilitic 
origin,  and  that  the  value  of  antisyphilitic  treatment  will 
depend  on  the  stage  at  which  the  syphilis  is  found.  A  good 
paper  on  Concealed  Insanity,  by  Dr.  Brower,  of  Chicago, 
concludes  the  original  articles,  which  are,  on  the  whole, 
well  up  to  the  usual  standard  of  the  Alienist  and  Neurologist. 
We  have  again  to  acknowledge  with  much  cordiality  the 
highly  appreciative  terms  in  which  this  journal  is  referred 
to  by  our  Transatlantic  contemporary. 


■Guy’s  Hospital  Reports.  Edited  byH.  G.  Howse,  M.S.,  and 
Frederick  Taylor,  M.D.  Vol.  XLI.  London  :  J.  and  A. 
Churchill.  1883. 

Unquestionably  the  most  important  contribution  to  this 
volume  is  Dr.  Pye-Smith’s  “  Case  of  Idiopathic  Amemia  of 
Addison,  with  a  Commentary.”  The  case  in  question  was  a 
typical  example  of  the  disease  that  has  lately  been  re-named 
pernicious  anaemia,  but  which  was  recognised  as  a  separate 
morbid  condition  more  than  thirty  years  ago  by  Addison,  and 
•described  by  him  under  the  name  of  idiopathic  anaemia. 
The  extract  which  Dr.  Pye-Smith  gives  from  Addison’s 
original  account  of  the  disease  leaves  no  doubt  that  “to 
Addison  belongs  the  credit  of  recognising  and  describing 
this  remarkable  morbid  condition.”  Having  traced  the 
history  of  the  disease,  the  author  proceeds  to  discuss  its 
relation  to  other  forms  of  anaemia,  and  then  considers  the 
pathology  of  anaemia,  arriving  at  the  following  opinion : — 
On  the  whole,  although  we  cannot  fully  explain  the  patho¬ 
logy  of  idiopathic  anaemia,  we  may  believe  that  it  depends 
not  upon  diminished  gains  or  increased  losses  to  the  Flood 
as  a  whole,  nor  upon  any  affection  of  the  cytogenic  organs 
-or  of  the  leucocytes,  but  upon  too  rapid  and  extensive 
destruction  of  the  red  blood-corpuscles.”  Idiopathic  anaemia 
is  a  disease  of  early  adult  life.  It  appears  not  to  be  confined 
to  the  inhabitants  of  large  cities,  but  is  probably  most  fre¬ 
quent  amongst  peasants.  The  causes  which  predispose  to  it 
are  still  very  obscure.  The  symptoms,  course,  duration,  and 
prognosis  all  receive  careful  consideration  in  the  paper.  As 
regards  the  morbid  anatomy,  we  do  not  seem  to  know  much 
more  than  Addison  did.  He  recognised  the  fatty  degenera¬ 
tion  of  the  heart,  and  we  have  no  other  constant  lesion  to 
add  now,  if  we  except,  perhaps,  retinal  hsemorrhages  and 
submucous  hsemorrhages  in  the  alimentary  canal.  The 
paper  concludes  with  a  very  complete  bibliography,  including 
a  table  of  the  102  cases  hitherto  recorded,  and  constitutes 
the  [most  important  monograph  on  the  disease  in  this 
country.  Dr.  Wilks’s  paper  on  Hemiansesthesia  will  be  read 
with  interest  by  all  physicians.  Practically,  it  is  a  paper  on 
hysterical  hemiansesthesia,  for,  though  he  does  not  deny 
that  loss  of  sensation  may  be  the  result  of  cerebral  lesion, 
he  says :  “  What  I  have  not  yet  found,  and  am  in  search  of, 
is  a  case  of  pure  and  simple  hemiansesthesia  due  to  a  cerebral 
lesion.”  We  venture  to  think  that  many  neurologists  would 
be  obliged  to  admit  that  on  several  occasions  they  had  met 
with  such  cases,  though,  no  doubt,  hemiansesthesia  of  cerebral 
origin  is  infinitely  less  common  than  the  hysterical  form.  In 
order  to  explain  this  latter  condition.  Dr.  Wilks  suggests  that 
one  hemisphere  of  the  brain  ceases  to  functionise.  He  says : 


“  If  I  am  right,  we  have  only  to  suppose  a  cessation  of  action 
of  half  of  the  brain,  or  a  part  of  it  — say  the  middle  and  pos¬ 
terior  lobes — to  account  for  the  loss  of  perception  of  all  kinds, 
just  as  we  may  suppose  an  implication  of  the  anterior  part 
to  result  in  a  loss  of  power”,-  and  he  then  proceeds  to 
explain  how  this  theory  will  be  found  at  least  as  satisfactory 
1  as  others.  As  regards  his  remarks  on  “  metallo-therapie,” 
we  fancy  that  most  Englishmen  will  fully  agree  with  him, 
as  also  in  the  necessity  for  a  little  wholesome  neglect  in 
the  treatment  of  these  cases,  the  success  of  which  is  well 
illustrated  in  the  treatment  of  one  of  his  own  cases ;  but  one 
is  tempted  to  ask  why  the  treatment  was  not  adopted 
sooner.  Dr.  Goodhart  contributes  some  cases  of  Saturnine 
Lunacy.  We  cannot  say  he  has  proved  that  the  cerebral 
symptoms  seen  in  these  cases  were  due  to  lead-poisoning  in 
all  of  them ;  indeed,  in  one  case  (the  last)  the  evidence  of 
such  connexion  is  so  slight,  judging  from  the  somewhat 
meagre  report  given  of  it,  that  the  paper  would  not 
have  been  weakened  by  its  omission.  The  remarks  on 
the  mode  of  action  of  lead  as  a  poison,  and  on  the  re¬ 
semblance  between  lead  and  alcoholic  poisoning  are,  how¬ 
ever,  full  of  interest,  and  more  than  counterbalance  any 
lack  of  completeness  in  the  cases.  There  is  another  paper 
on  lead  poisoning  by  Dr.  Stevenson,  dealing  with  the 
absorption  of  lead  by  water  from  standing  in  leaden  pipes, 
and  referring  to  the  two  cases  at  Huddersfield  and  Keighley, 
which  came  into  the  law  courts ;  and,  lastly,  containing  an 
analysis  of  the  only  instance  of  murder  by  the  administra¬ 
tion  of  sugar  of  lead  that  has  yet  been  known,  viz.,  the  trial 
and  conviction  of  Louisa  Jane  Taylor  for  the  murder  of 
Mrs.  Tregelles.  Dr.  Stevenson  also  contributes  a  short 
report  on  the  Lamson  Case,  with  some  remarks  on  poisoning 
by  aconitine.  It  seems  fitting  that  the  Keports,  which  a 
quarter  of  a  century  ago  contained  such  an  exhaustive 
analysis  of  the  trial  of  Palmer,  should  now  contain  the  best 
account  of  certainly  one  of  the  foulest  deeds  that  has  since 
then  been  perpetrated.  Dr.  Hilton  Eagge  records  a  case  of 
Poisoning  by  Phosphorus  successfully  treated  by  oil  of  tur¬ 
pentine  ;  and  Dr.  Savage  gives  a  short  account  of  three  cases 
of  Exophthalmic  Goitre  with  Mental  Disorder,  in  which  he 
arrives  at  the  opinion  that  “among  the  insane  Graves’s 
disease  is  more  common  than  among  the  sane,”  and  “  that 
with  this  disease  the  mental  symptoms  are  of  a  melancholic 
type.”  Mr.  Bryant  opens  the  volume  with  a  brief  Memoir 
of  Mr.  Joseph  Towne,  who  was  for  fifty-three  years  modeller 
to  the  Hospital ;  it  constitutes  a  somewhat  tardy  recognition 
of  one  to  whose  life-long  labours  the  world-wide  reputation 
of  the  Guy’s  Hospital  Museum  is  so  largely  due.  Mr. 
Bryant  also  contributes  a  paper  on  Surgical  Affections  of 
the  Tongue,  including  therein  notes  of  cases  of  some  rare 
conditions,  e.g.,  hydatid  cyst,  tubercular  ulceration,  and 
ichthyosis ;  the  paper  is  profusely  illustrated.  Mr.  W. 
Arbuthnot  Lane  records  five  cases  of  Empyema  treated  by 
removal  of  a  portion  of  rib.  We  find  nothing  in  the  reports 
of  the  cases  to  show  that  this  line  of  treatment  was  neces¬ 
sary  or  even  indicated,  and  the  results  were  certainly  not 
in  any  way  more  satisfactory  than  what  we  are  accustomed 
to  see  after  other  modes  of  treatment.  Want  of  space  pre¬ 
vents  us  from  doing  more  than  mentioning  that  Mr.  Davies- 
Colley  has  a  paper  on  Acute  Gonorrhoeal  Eheumatism,  Mr. 
Jacobson  one  on  the  Minute  Anatomy  and  Origin  of  the 
Enchondromata  of  the  Salivary  Glands,  Mr.  Golding  Bird 
one  on  various  forms  of  Talipes,  Dr.  Frederick  Taylor  one  on 
Paralysis  of  the  Abductors  of  the  Vocal  Cords,  and  Dr. 
Brailey  one  on  the  Vitreous  Body  in  its  relation  to  various 
Diseases  of  the  Eye.  The  present  volume  fully  maintains 
the  traditions  of  its  predecessors. 


Proposed  Orphan  Agricultural  Colonies  in 
Algeria. — The  Paris  Assistance  Publique  proposes  to  esta¬ 
blish  in  Algeria  one  or  several  orphan  agricultural  colonies, 
in  which  may  be  placed  with  advantage  the  deserted  chil¬ 
dren  who  are  daily  taken  charge  of  by  the  Administration. 
A  special  commission  has  been  nominated  by  the  Conseil 
Generale  de  la  Seine  for  the  purpose  of  investigating  this 
interesting  question,  and  for  that  purpose  sailed  for  Algeria 
on  September  1,  having  in  Mew  the  examination  of  the 
various  localities  where  it  is  proposed  to  establish  these 
orphan  institutions.  A  sum  of  10,000  fr.  has  been  placed  at 
the  disposal  of  the  commission  to  cover  its  expenses. — Union 
Med.,  August  2S. 


Medical  Times  and  Gazette. 


NEW  INVENTIONS  AND  IMPROVEMENTS. 


Sept.  8, 1883.  279 


GENERAL  CORRESPONDENCE. 

- <© - 

THE  CHAIR  OF  PHYSIOLOGY  IN  ANDERSON’S 
HOSPITAL. 

Letter  from  Dr.  J.  McGregor-Robertson. 

[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sir, — In  last  Saturday’s  issue  of  the  Medical  Times  and 
Gazette  it  is  stated  that  I  am  an  applicant  for  the  chair  of 
Physiology  in  Anderson’s  College,  vacant  by  Dr.  Barlow’s 
removal  to  the  Royal  Infirmary.  This  is  an  entire  mistake. 
I  have  not  at  any  time  contemplated  becoming  a  candidate, 
and  have  not  even  made  the  inquiry  invited  concerning  ,c  the 
terms  of  the  appointment.” 

If  you  will  be  good  enough,  therefore,  to  correct  the 
statement  in  your  next  issue,  I  shall  be  obliged. 

I  am,  &c., 

J.  McGregor-Robertson. 

Physiological  Laboratory,  Glasgow  University, 

September  3. 


NEW  INVENTIONS  AND  IMPROVEMENTS. 


ABSORBENT  COTTON-WOOL  TISSUE. 

We  have  received  from  Messrs.  Robinson  and  Son,  of  Wheat 
Bridge  Mills,  Chesterfield,  samples  of  a  material  which  they, 
at  the  suggestion  of  Mr.  Sampson  Gamgee,  have  produced 
for  surgical  dressings,  and  to  which  they  have  given  the 
name  of  Absorbent  Cotton- Wool  Tissue.  This  consists  of 
beautifully  fine  and  pure  cotton  between  two  layers  of  fine 
absorbent  gauze.  It  is  very  light,  perfectly  soft  and  smooth, 
very  absorbent,  and  elastic ;  and  it  may  be  obtained  in  rolls 
of  various  widths,  or  in  sheets  of  different  sizes.  It  can 
consequently  be  applied  to  any  surface,  and  surgeons  will  at 
once  recognise  that  it  will  be  highly  useful.  It  makes  an 
excellent  absorbent  dressing  for  wounds,  and  a  capital  pad¬ 
ding  for  splints ;  and  Mr.  Sampson  Gamgee  has  found  it  a 
useful  and  light  material  for  the  foundation  of  plaster-of- 
Paris  splints.  The  tissue  is  sold  by  Messrs.  Southall  and 
Barclay  also  impregnated  with  antiseptic  solutions. 


BENGER’S  PEPTONISED  BEEF- JELLY. 
Benger’s  Preparations  of  the  Natural  Digestive  Ferments, 
which  are  manufactured  by  Messrs.  Mottershead  and  Co., 
Exchange-street,  Manchester,  have  deservedly  a  very  high 
reputation,  and  are  all  largely  used.  The  Peptonised  Beef- 
Jelly  is  a  delicately  flavoured,  concentrated,  and  partially 
digested  beef-tea.  It  contains  much  of  the  fibrine  or  flesh¬ 
forming  elements  of  the  beef  in  a  soluble  condition,  and 
may  be  recommended  as  a  really  valuable  form  of  concen¬ 
trated  food.  It  may  be  taken  cold,  by  teaspoonfuls,  as  a 
quick  restorative ;  or  it  may  be  used,  in  the  proportion  of 
two  or  three  teaspoonfuls  in  a  teacupful  of  hot  water,  as  a 
ready  way  of  making  beef -tea. 


BENGER’S  LIQUOR  PEPTICUS. 
BENGER’S  LIQUOR  PANCREATICUS. 

The  first  of  these  preparations  is  a  concentrated  solution 
of  the  natural  digestive  principles  of  the  gastric  secretions. 
It  is  singularly  free  from  all  disagreeable  smell  or  taste  ;  is 
clear  and  bright ;  and  is  a  remarkably  active  fluid  prepara¬ 
tion  of  pepsine.  It  is  worthy  of  all  praise  as  a  skilled  pre¬ 
paration,  and  its  high  value  as  a  digestive  agent  has  been 
well  proved  by  large  experience. 

The  Liquor  Pancreaticus,  which  contains  the  digestive 
principles  of  the  pancreas,  is  also,  from  all  points  of  view, 
an  admirable  and  most  satisfactory  preparation.  Students 
of  “  Quain’s  Dictionary”  will  remember  that  Dr.  W. 
Roberts,  in  his  article  on  peptonised  foods,  speaks  very 
highly  of  this  liquor  pancreaticus;  and  there  can  be  no 
doubt  that  it  is  found  to  be  of  great  service  in  the  ready 
preparation  of  artificially  digested  foods.  Medical  men  can 
easily  explain  to  patients  or  nurses  the  method  of  employin  g 
the  preparation,  and  will  gladly  welcome  the  services  of  so 
easily  employed  and  trustworthy  an  aid  to  nutrition. 


BENGER’S  SELF-DIGE STI YE  FOOD. 

This  preparation  also,  which  may  be  described  as  a  pep¬ 
tonised  farinaceous  food,  deserves  a  few  words  of  warm, 
praise  as  an  agreeable  and  highly  nutritive  food  for  infants 
and  invalids.  It  consists  of  carefully  prepared  wheaten 
flour,  impregnated  with  the  natural  digestive  principles ; 
and,  when  mixed  with  hot  milk,  the  starch  and  the  albu¬ 
minoids  of  the  flour  and  the  milk  are  acted  upon  by  the  pan¬ 
creatic  extract,  and  gradually  converted  into  an  easily 
assimilable  nutriment.  It  may  therefore  be  well  understood 
that  the  preparation  is  valuable  in  conditions  of  defective- 
digestive  power. 


URINARY  TEST  PAPERS. 

From  Messrs.  Wilson  and  Son,  pharmaceutical  and  opera¬ 
tive  chemists,  Harrogate,  we  have  received  some  samples  of 
Dr.  Oliver’s  Albumen  and  Sugar  Test  Papers,  as  prepared  by 
them.  They  supply  for  albumen  precipitants  both  simple 
and  compound  papers.  The  simple  papers  are  impreg¬ 
nated  with  potassio-mercuric  iodide,  potassium  ferrocyanide, 
potassio-mercuric  iodo-cyanide,  or  sodium  tungstate ;  and 
citric  papers  accompany  each  kind  of  these  tests.  The  com¬ 
pound  papers  are  impregnated  with  picric  acid  and  citric 
acid,  sodium  tungstate  with  citric  acid,  or  potassio-mercuric 
iodide  with  citric  acid.  The  papers  for  testing  for  sugar 
are  the  indigo-carmine  test.  All  the  papers  are  prepared,, 
with  great  care,  according  to  Dr.  Oliver’s  directions  in  every 
particular,  and  will  be  found  very  efficient  and  handy.  They 
are  supplied  in  neat,  stout  little  cardboard  boxes,  an  inch 
deep  and  slightly  more  than  an  inch  in  length,  taking  up 
but  little  room*  in  the  waistcoat  pocket.  Some  carbonate 
of  soda  papers  are  supplied  with  each  box  of  the  indigo- 
carmine  sugar- test  papers,  as  it  has  been  found  that  the 
power  of  the  test  is  greatly  amplified  by  using  also  a  paper- 
charged  definitely  with  carbonate  of  soda. 


OBITUARY. 

- ♦ - 

FREDERIC  COBB,  M.D.  Edin.,  F.R.C.P.  Lond. 
Dr.  Cobb,  formerly  Physician  to  the  London  Hospital,  died 
at  his  residence  at  Frensham,  Surrey,  on  September  2,  in  his 
eighty-eighth  year.  He  had  retired  from  practice  so  long 
ago  that  probably  there  are  not  many  members  of  the 
profession  living  who  remember  much  about  him,  and  wo 
learn  the  following  particulars  as  to  his  career  from 
the  Roll  of  the  Royal  College  of  Physicians.  He  was 
born  at  Throwly,  in  Kent,  and  received  his  preparatory 
education  at  the  King’s  School,  Canterbury.  He  com¬ 
menced  the  study  of  medicine  at  the  London  Hospital,, 
and  in  1818  was  appointed  Demonstrator  of  Anatomy  in 
the  School  of  Medicine  of  the  Hospital.  He  next  went  to 
Edinburgh,  studied  there  for  three  years,  and  took  the  M.D. 
degree  of  the  University  on  August  1, 1822.  Returning  then 
to  London,  and  settling  there  in  practice,  he  became  a  Licen¬ 
tiate  of  the  Royal  College  of  Physicians  in  March,  1823,  and 
was  admitted  a  Fellow  of  the  College  in  September,  1839. 
On  September  5,  1827,  he  was  elected  Assistant-Physician 
to  the  London  Hospital,  and  full  Physician  on  February  17, 
1841.  The  latter  office  he  held  until  1854,  and  shortly  after¬ 
wards  he  retired  from  practice,  and  withdrew  to  his  estate  in 
Surrey,  where  he  died.  While  in  London  he  lived  in  St. 
Helen’ s-place,  in  the  City. 


French  Brandy. — In  a  recent  return  of  the  French- 
Minister  of  Agriculture  on  the  wines  of  1882.  it  appears  that 
the  vineyards  of  the  two  Charentes,  which  alone  supply  the 
genuine  wine-brandy,  are  irretrievably  ruined.  These  two- 
departments,  which  were  almost  entirely  devoted  to  grape- 
culture,  gave  311,000,000  gallons  of  wine  in  1875.  Last  year 
they  only  gave  one-eighth  of  that  quantity,  being  a  falling  off 
of  273,000,000  gallons ;  and  the  quality  was  execrable.  The 
condition  of  Charente  proper,  which  produced  the  true 
cognac,  is  even  worse  :  for  the  vintage— if  it  can  still  bo 
called  so — only  gave  the  twenty-second  part  of  the  yield  of 
1875,  and  the  ravages  of  the  phylloxera  are  each  successive 
year  going  from  bad  to  worse.  In  fact,  the  pest  has  now' 
utterly  destroyed  throughout  France  nearly  two  million  acres, 
of  vineyards. — Phil.  Med.  Reporter,  August  11. 


Medical.Times  and  Gazette. 


MEDICAL'  NEWS, 


Sept.  8, 1883. 


28  0 


MEDICAL  NEWS. 

- - - 

Apothecaries’  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday, 
August  30  : — 

Davies,  Henry  Havelock,  Snainton,  Yorkshire. 

Dodd,  Arthur  Herbert,  Canonbury,  N. 

Gent,  George  Sidney,  Chaleot-erescent,  Regent’ s-park. 
Turnbull,  William,  Oosforth,  Newcastle-on-Tyne. 

The  following  gentleman  also  on  the  same  day  passed  the 
Primary  Professional  Examination  : — 

Greenwood,  Cecil  Danforth,  King’s  College  Hospital. 


BIRTH. 

Cooped— On  September  5,  at  9,  Henrietta-street,  Cavendish-square,  the 
wife  of  Alfred  Cooper,  F.R.C.S.,  of  a  daughter. 


DEATHS. 

Bond,  Henby  John  Hayles,  M.D.,  late  Regius  Professor  of  Medicine  in 
the  University  of  Cambridge,  at  his  residence,  Regent-street,  Cambridge, 
on  September  3,  aged  82. 

Cobb,  Frederic,  F.R.C.P.,  formerly  of  St.  Helen’ s-place,  London,  at 
Frensham,  Surrey,  on  September  2,  in  his  88th  year. 

Highmore,  William,  M.D.,  at  Greenhill,  Sherborne,  Dorset,  on  August 
28,  aged  67. 

Hunt,  Benjamin,  M.D.,  at  60,  George-road,  Edgbaston,  on  September  3. 

Master,  Alfred,  F.R.C.S.,  J.P.  of  Norwich,  on  September  3,  aged  67. 

Wellings,  Richard,  M.R.C.S.,  L.S.A.,  at  The  Limes,  Waterloo,  Hamp¬ 
shire,  on  August  23,  aged  71. 

White,  William  Todd,  F.R.C.S.,  at  The  Orchard,  Penzance,  on  August 
27,  aged  64.  e 


VACANCIES. 

In  the  following  list  the  nature  of  the  office  vacant,  the  qualifications  re¬ 
quired  in  the  candidate,  the  person  to  whom  application  should  be  made 
and  the  day  of  election  (as  far  as  known)  are  stated  in  succession. 

Central  London  Ophthalmic  Hospital,  Gray’s-inn-road,  W.C. — 
Assistant-Surgeon.  Candidates  must  be  Fellows  or  Members  of  the 
Royal  College  of  Surgeons  of  London,  Edinburgh,  or  Dublin,  and  must 
produce  certificates  of  having  attended  the  practice  of  some  ophthalmic 
institution  for  at  .least  six  months.  Testimonials  to  be  sent  to  the 
Secretary,  on  or  before  September  8. 

■General  Infirmary,  Leeds.— House-Physician.  Salary  £100  per  annum, 
with  board,  residence,  and  washing.  Candidates  must  possess  a  medical 
degree  in  a  British  university,  or  be  members  or  licentiates  of  a  British 
college  of  physicians.  Copies  of  testimonials  to  be  sent  to  Dr.  T.  Clifford 
Allbutt,  The  Infirmary,  Leeds,  on  or  before  September  12. 

Hospital  eor  Women,  Soho-SQUAbe,  W. — House-Physician.  [For  par¬ 
ticulars  see  Advertisement.) 

Kent  County  Ophthalmic  Hospital,  Maidstone. — House-Surgeon. 
Salary  £100  per  annum,  with  furnished  rooms,  light,  fire,  and  attendance. 
Candidates  must  be  Members  of  the  Royal  College  of  Surgeons  of 
London,  and  Licentiates  of  the  Apothecaries’  Company,  or  possess  an 
equivalent  qualification  duly  registered  under  the  Act  of  Parliament. 
Applications  and  testimonials  to  be  sent  on  at  once,  or  personal  applica¬ 
tions  may  be  made,  to  Matthew  A.  Adams,  F.R.C.S.,  Surgeon  to  the 
Hospital. 

Royal  United  Hospital,'  Bath.— House-Surgeon.  [For  particulars  see 
Advertisement.) 

St.  George’s,  Hanover-square,  Provident  Dispensary,  59,  Mount- 
street,  W.— Resident  Medical  Officer.  Salary  and  allowance  last  year 
£212  2s.  9d.  Candidates  must  be  doubly  qualified,  and  duly  registered 
under  the  Medical  Act,  and  about  thirty  years  old.  Unmarried  candi¬ 
dates  preferred.  Applications  and  testimonials  as  to  character,  etc.,  to 
be  sent  to  the  Secretary,  G.  H.  Leah,  jun.,  73,  Park-street,  W.  (from 
whom  all  further  particulars  may  be  obtained),  not  later  than  Sept.  29. 

St.  Peter’s  Hospital  for  Stone  and  Urinary  Diseases,  etc., 
Henrietta-street,  Covent-garden,  W.C. — House-Surgeon.  Honora¬ 
rium  twenty-five  guineas  ;  board,  lodging,  and  washing.  The  appoint¬ 
ment  is  for  six  months.  Candidates  must  be  M.R.C.S.,  and  have  held 
the  position  of  house-surgeon  at  a  public  institution.  Applications, 
with  testimonials,  to  be  sent  to  the  Secretary,  Walter  E.  Seott,  on  or 
before  September  25. 


UNION  AND  PAROCHIAL  MEDICAL  SERVICE. 

***  The  area  of  each  district  is  stated  in  acres.  The  population  is 
computed  according  to  the  census  of  1881. 

RESIGNATIONS. 

Buckingham  Union. — Mr.  T.  J.  Denton  has  resigned  the  Marsh  Gibbon 
District :  area  13,830 ;  population  2568 ;  salary  £105  per  annum. 

APPOINTMENTS. 

Boston  Union. — Marmaduke  Pittard,  M.R.C.S.  Eng.,  L.S.A.,  to  the 
Swineshead  District. 

Bramley  Union. — James  B.  Brereton,  L.K.&Q.C.P.  Ire.,  L.R.C.S.  Ire., 
to  the  Gildersome  District. 

Holleach  Union. — James  E.  Smith,  M.R.C.S.  Eng.,  L.S.A.,  totheLutton 
District. 

Boss  Union. — Prancis  W.  B.  Jones,  M.B.,  C.M.  Edin.,  to  the  Fourth 
District. 


APPOINTMENTS  EOE  THE  WEEK. 


September  8.  Saturday  (this  day). 

Operations  at  St.  Bartholomew’s,  1 J  p.m. ;  King’s  College,  1£  p.m. ;  Royal 
Free,  2  p.m.;  Royal  London  Ophthalmic,  11  a. m. ;  Royal  Westminster 
Ophthalmic,  1J  p.m. ;  St.  Thomas’s,  Is  p.m.;  London,  2  p.m. 


10.  Monday. 

Operations  at  the  Metropolitan  Free,  2  p.m.;  St!  Mark’s  Hospital  for 
Diseases  of  the  Rectum.  2  p.m.;  Royal  London  Ophthalmic,  11  a.m.; 
Royal  Westminster  Ophthalmic,  1J  p.m. ;  Hospital  for  Women,  2  p.m. 


11.  Tuesday. 

Operations  at  Guy’s,  1£  p.m. ;  Westminster,  2  p.m. ;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  1J  p.m.  ;  West 
London,  3  p.m. 


12.  Wednesday. 

Operations  at  University  College,  2  p.m. ;  St.  Mary’s,  11  p.m. ;  Middlesex, 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew’s,  1J  p.m. ;  Great  Northern, 

2  p.m. ;  Samaritan,  2|  p.m. ;  Royal  London  Ophthalmic,  11  a.m. ; 
Royal  Westminster  Ophthalmic,  lj  p.m. ;  St.  Thomas’s,  1£  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m. ;  National  Orthopaedic,  Great 
Portland-street.  10  a.m. 


13.  Thursday. 

Operations  at  St.  George’s,  1  p.m. ;  Central  London  Ophthalmic,  1  p.m. ; 
Royal  Orthopaedic,  2  p.m.;  University  College,  2  p.m.;  Royal  London 
Ophthalmic,  11  a.m. ;  Royal  Westminster  Ophthalmic,  li  p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m. ;  Hospital  for  Women,  2  p.m. ; 
Charing-cross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  2i  p.m. 


14.  Friday. 

Operations  at  CentralLondonOphthalmic,  2  p.m.;  Royal  London  Ophthal¬ 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminster 
Ophthalmic,  ljp.m.;  St.  George’s  (ophthalmic  operations),  If  p.m.; 
Guy’s,  If  p.m. ;  St. Thomas’s  (ophthalmic  operations) ,  2  p.m.;  King’s 
College  (by  Mr.  Lister),  2  p.m. 


The  Bufatini  Prize. — Conforming  to  the  last  wishes 
of  the  late  Prof.  Bufatini,  the  Minister  of  Public  Instruc¬ 
tion  in  Italy  has  published  the  conditions  of  an  international 
competition  for  the  best  essay  on  the  “  Application  of  the 
Experimental  Methods  to  Science.”  Manuscripts,  written 
in  the  Italian  or  Latin  languages,  will  be  received  until 
October,  1884,  by  the  Secretary  of  the  Medical  Faculty  at 
Florence.  The  prize  amounts  to  5000  fr. — Phil.  Med.  News, 
August  11. 

Cremation  and  the  Cholera. — The  Council  of 
Public  Health,  for  the  Department  of  the  Seine  has  adopted 
a  report,  presented  by  M.  Brouardel,  against  the  institution 
of  cremation  in  times  of  epidemics.  M.  Brouardel  alleges 
that  this  means  of  disposing  of  the  dead  would  be  fraught 
with  danger  to  the  interests  of  justice,  especially  during  an 
outbreak  of  cholera.  The  Council  afterwards  nominated  a 
commission,  instructed  to  inquire  whether  it  would  not  be 
advisable,  as  an  experiment,  to  permit  the  cremation  of 
bodies  which  have  been  used  for  anatomical  studies. 

Glasgow  Maternity  Hospital. — A  vacancy  in  this 
Hospital  will  soon  require  to  be  filled,  in  consequence  of 
Dr.  Hugh  Miller’s  term  of  office  as  Physician  having  expired. 
Already  three  candidates  have  been  spoken  of,  viz.,  Drs.  W. 
Loudon  Reid,  J.  Stirton,  and  Murdoch  Cameron.  It  is  all 
but  certain,  however,  that  others  will  come  forward,  for  in 
such  cases  the  supply  is  generally  in  excess  of  the  demand. 

Zona  of  the  Mouth. — Dr.  Deshayes  related,  at  the 
meeting  of  the  French  Association  for  the  Advancement  of 
Science,  an  interesting  case  of  zona  of  the  mouth,  limited. to 
the  regions  supplied  by  the  lingual  nerve  and  the  inferior 
dental  nerve,  a  branch  of  the  inferior  maxillary.  The 
tonsils,  floor  and  roof  of  the  mouth,  tongue,  gums,  the 
incisors,  canines,  and  molars,  the  lower  lip,  and  a  portion  of 
the  skin  of  the  chin  were  the  seat  of  the  pains,  which,  as 
regards  the  soft  .parts,  were  soon  followed  by  the  eruption. 
The  teeth  are  at  the  present  time— a  year  after  the  disease 
— entirely  exempt  from  erosion,  and  no  disturbance  in  the 
function  of  taste  has  taken  place.  The  only  probable 
cause  of  the  affection  was  exposure  to  damp  and  cold.  The 
patient  was  somewhat  of  a  nervous  subject,  but  exempt 
from  any  diathesis.  The  interest  of  the  case  especially  re¬ 
sides  in  the  fact  that  zona  may  affect  several  branches  of  a 
nervous  trunk  to  the  exclusion  of  others. — Union  Med., 
August  28. 


Medical  Times  and  Garette. 


NOTES,  QUEEEES,  AND  EEPLIES. 


Sept.  8, 1883.  281 


VITAL  STATISTICS  OF  LONDON. 


Week  ending  Saturday,  September  l,  1883. 


BIRTHS. 

Births  of  Boys,  1249;  Girls,  1199;  Total,  2448. 

Corrected  weekly  average  in  the  10  years  1873-82,  2574"6. 


DEATHS. 


Males. 

Females. 

Total. 

Deaths  during  the  week . 

693 

699 

1292 

Weekly  average  of  the  ten  years  1873-82,  i 
corrected  to  increased  population  ...  j 

756'6 

7179 

1474-6 

Deaths  of  people  aged  80  and  upwards 

... 

... 

44 

DEATHS  IN  SUB-DISTRICTS  FROM  EPIDEMICS. 


Enumerated 

Population, 

1881 

(unrevised). 

Small-pox. 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

la 

&£ 
o  g 

O 

Typhus. 

M _ 

3J5  . 

.2  §  » 
> 

u  p,  m 
•g  KPh 

Simple 

continued 

Fever. 

Diarrhoea.  1 

West . 

669633 

3 

2 

... 

3 

1 

4 

1 

9 

North 

906947 

3 

9 

10 

6 

3 

... 

13 

... 

21 

Central 

282238 

3 

1 

•  •• 

4 

... 

1 

•  •• 

4 

East . 

692738 

•  •• 

16 

9 

3 

6 

... 

1 

... 

14 

South . 

1265927 

1 

26 

18 

10 

11 

... 

2 

... 

26 

Total . 

3816483 

4 

67 

40 

19 

27 

1 

21 

1 

74 

METEOROLOGY. 


From  Observations  at  the  Greenwich  Observatory. 


Mean  height  of  barometer 

Mean  temperature  . 

Highest  point  of  thermometer  ... 
Lowest  point  of  thermometer 
Mean  dew-point  temperature 

General  direction  of  wind  . 

Whole  amount  of  rain  in  the  week  ... 


...  29-685  in. 
...  62-5° 

...  78-4= 

...  491° 

...  55-8° 

s.w.  &  w. 

...  0'36  in. 


BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  the 
Week  ending  Saturday,  Sept.  1,  in  the  following  large  Towns:— 


Cities 

and 

Boroughs. 

Estimated  Population  to 
middle  of  the  year  1883. 

Births  Registered  during 
the  week  ending  Sept.  1. 

|  Deaths  Registered  during 
the  week  ending  Sept.  1. 

Annual  Rate  of 
Mortality  per  1000  living, 
from  all  causes. 

Temperature 
of  Air(Fahr.) 

Temp, 
of  Air 
(Cent.) 

Rain 

Fall. 

Highest  during 
the  Week. 

!  Lowest  during 
|  theWeek. 

Weekly  Mean  of 
Daily  MeanVaiues 

Weekly  Mean  of 
Daily  Mean 
Values. 

In  Inches. 

|  In  Centimetres. 

London  . 

3955814 

2448 

1292 

17-0 

78-4 

49-1 

625 

16-95 

0-36 

0-91 

Brighton  . 

111262 

65 

57 

267 

709 

56-1 

6C9 

16-61 

0-28 

0-71 

Portsmouth 

131478 

95 

56 

22-2 

... 

... 

... 

... 

... 

... 

Norwich  . 

89612 

59 

23 

13-4 

,, 

... 

... 

... 

... 

Plymouth  . 

74977 

39 

36 

25-1 

67-6 

54-5 

59-5 

15-28 

0-54 

1-37 

Bristol . 

212779 

96 

61 

15-0 

65-4 

551 

58-7 

14-83 

0-35 

0-89 

Wolverhampton  . 

77557 

56 

30 

20-2 

68-4 

51-0 

58-2 

14-55 

0-42 

V07 

Birmingham 

414846 

257 

169 

2C3 

... 

... 

... 

... 

... 

Leicester  ...  ,.. 

129483 

82 

67 

27-0 

... 

... 

... 

... 

Nottingham 

199349 

154 

81 

21-2 

71-5 

51-8 

60-0 

15-56 

0-17 

0-43 

Derby . 

86574 

39 

28 

171 

... 

... 

... 

... 

Birkenhead 

88700 

57 

36 

21-2 

... 

... 

... 

... 

Liverpool  . 

566753 

348 

269 

24-8 

70-2 

50-0 

58-7 

14-83 

0-30 

0-76 

Bolton . 

107862 

77 

45 

21-8 

... 

•  •• 

... 

... 

... 

Manchester 

339262 

219 

184 

28-3 

... 

... 

... 

... 

... 

... 

Salford  . 

190465 

123 

91 

249 

... 

... 

... 

... 

... 

... 

Oldham  . 

119071 

73 

43 

18-8 

... 

... 

... 

... 

... 

Blackburn . 

108460 

72 

42 

20-2 

... 

... 

... 

... 

... 

... 

Preston  . 

98564 

61 

52 

27-5 

72-C 

51-0 

591 

1506 

0-09 

0-23 

Huddersfield 

84701 

31 

34 

209 

... 

•  •• 

... 

... 

... 

Halifax  . 

75591 

41 

19 

131 

... 

... 

... 

... 

Bradford  . 

204807 

113 

74 

18-9 

74-2 

4S-5 

59-5 

15-28 

0-56 

1-42 

Leeds . 

321611 

222 

124 

20-1 

69  4 

54-3 

60-3 

15-73 

0-08 

0-20 

Sheffield  . 

295497 

206 

143 

25-3 

68-4 

52-6 

58-8 

1489 

0-56 

1-42 

Hull  . 

176296 

138 

68 

172 

74-0 

60-0 

58-5'  14-72 

0-51 

1-30 

Sunderland 

121117 

101 

45 

19-4 

82-0 

45-0 

37-0 

12-78 

1-00 

254 

Newcastle . 

149464 

104 

83 

29-0 

... 

•  •• 

... 

... 

... 

Cardiff . 

90033 

70 

36 

20-9 

... 

... 

... 

... 

... 

For  28  towns... 

5620975 

5446 

3278 

19-8 

82-0 

45-0 

57-9 

1439 

0-40 

1-02 

Edinburgh . 

!  235946 

112 

82 

181 

72-8 

45-5 

56  9  13  83 

'  0-66 

1-68 

Glasgow  . 

1  515589 

378 

267 

27-0 

65-0 

|  4S  0 

57  4  1411 

0-94 

239 

Dublin . 

i  3496851  1S1 

157 

23-4 

71-0 

42-0 

(57  "8  14-34 

1-40 

3-66 

At  the  Royal  Observatory,  Greenwich,  the  mean  reading 
of  the  barometer  last  week  was  29’69  in. ;  the  highest  read¬ 
ing  was  29-96  in.  on  Sunday  morning,  and  the  lowest  28'93  in. 
at  the  end  of  the  week. 


NOTES,  QUEEIES,  AND  EEPLIES. 

■  ■■♦ - 

lit  qucstihtulk  mnrfr  sfesll  learn  mncfr. — Bacon. 

“The  Genu-pectoral  Position.” 

TO  THE  EDITOR  OF  THE  MEDICAL  TIMES  AND  GAZETTE. 

Sir, — From  my  perch  in  the  house  of  my  confinement  I  have  observes 
from  time  to  time  a  manifest  tendency  on  the  part  of  some  of  the  more- 
evolved  of  my  fellow-creatures — the  gynaecologists— to  study  posture  in 
its  manifold  physiological  and  pathological  bearings.  There  are  some  in 
this  country  whose  keen  vigilant  eyes  have  not  left  unobserved  the  advan¬ 
tages  connected  with  the  adoption  of  proper  and  fitting  postures  under 
certain  circumstances.  Far  more,  however,  have  these  advantages  been 
appreciated  by  our  relatives  in  America— for  few  here  have  paid  even  a 
slight  attention  to  this  subject,  while  on  the  other  side  of  the  Atlantic  the- 
generality  of  practical  gynsecoloeists  regard  posture  as  one  of  the  most 
valuable  implements  (if  I  may  so  call  it)  in  their  armamentarium.  This 
is,  however,  more  especially  true  of  those  postures  called  genu-pectoral 
and  knee-elbow. 

I  cannot  help  regarding  the  new  discovery  of  the  value  of  these  positions 
as  an  indication  of  great  importance  -  pointing,  as  it  unquestionably  does,, 
to  the  fact  that  Dame  Nature  committed  a  serious  blunder  in  the  evolu¬ 
tion  of  the  Bimana.  It  has  been  left  to  the  mechanical  school  of  uterine 
pathologists,  and  indeed  to  the  most  advanced  of  them,  to  make  this 
grand  discovery,  and  to  establish  it  by  evidence  which  appears  to  be  incon¬ 
trovertible.  It  is  hardly  necessary  for  me  to  enumerate  the  various  facts- 
which  go  to  complete  this  evidence  ;  suffice  it  to  mention  the  frequency 
with  which  displacements  of  the  uterus  are  met  with  in  those  who  in  the 
course  of  the  progress  of  evolution  have  assumed  the  erect  posture,  and 
the  efficacy  of  frequent  recourse  to  the  genu-pectoral,  knee-elbow,  or  all- 
fours  posture  for  the  relief  and  cure  of  these  troublesome,  painful,  sterility¬ 
generating,  and  obstinate  pathological  conditions.  Indeed  the  frequency 
with  which  these  disorders  are  met  with  in  the  highest  evolved  members- 
of  the  race,  according  to  the  best  accounts,  threatens  its  extinction  by  in¬ 
suring  general  sterility,  andin  this  wayto  verify  the  old  adage,  “Vaulting- 
ambition,  etc.”  The  re-discovery,  however,  of  the  knee-elbow  position, 
which  can  only  be  the  recurrence  of  an  ancestral  idea,  if  carried  into 
practice  generally  and  without  delay,  may  save  the  race  from  such  an. 
extinction.  Avoidance  of  the  erect  posture,  and  an  immediate  and  universal 
return  to  a  more  primitive  mode  of  progression— all-fours— misht,  and  I 
believe  would,  not  only  preserve  the  race,  but  also  insure  a  healthy  state- 
of  the  generative  organs.  It  would  not  only  insure  fecundity,  but,  in 
addition,  painless  and  healthy  performance  of  function.  The  confession 
of  error  involved  in  such  a  proceeding— for  some  would  call  it  retrograde 
—  would  of  course  be  painful,  but  the  advantages  which  would  follow  it 
would  amply  compensate  for  any  sentimental  pain  it  may  cause.  The 
mechanical  school  of  gynaecologists  have  made  a  great  and  valuable  dis¬ 
covery  ;  let  them  stick  to  it  and  treasure  it,  and  I  pray  them  for  the  sake 
of  the  race  not  to  shirk  its  legitimate  and  logical  outcome. 

Monkey  House  in  the  Zoo.  I  am,  &c.,  The  Bare-faced. 

H.  C.  Fox. — No  case  of  genuine  Asiatic  cholera  is  known  to  have  occurred 
in  England  this  year. 

Proposal  to  the  Powers  to  hold  a  Conference  in  Rome  on  Cholera  Regulations. 
—  Signor  Mancini,  the  Italian  Minister  of  Foreign  Affairs,  according  to- 
a  morning  contemporary,  proposes  a  conference  to  draw  up  sanitary 
regulations  against  the  cholera.  Several  of  these  have  assented  in 
principle  to  the  proposal. 

Street  Noises.— The  Town  Council  of  Luton  have  passed  a  by-law  to  pro¬ 
hibit,  under  a  fine  of  40s.,  “  shouting,  singing,  howling,  or  playing  upon 
any  drum,  tambourine,  trumpet,  cornet,  or  other  noisy  instrument, 
(whether  in  procession  or  otherwise) .”  The  by-law  is  made  under  Section 
23  of  the  Municipal  Corporation  Act,  1882. 

L.R.C.P.  Lond.  —  Dr.  Bisset  Hawkins  is  the  son  of  John  Adair  Hawkins,, 
and  must  be  about  eighty-seven,  seeing  he  was  bom  in  1796. 

Vermotologist.—  Yes;  it  is  quite  true  that  Sir  Erasmus  Wilson  is  leaving 
Henrietta-street,  but  the  house  is  not  to  let,  Marshall  and  Snelgrove 
having  purchased  it  in  order  to  increase  their  already  large  premises. 

Grocers'  Licences.— At  the  Brewster  Sessions  for  the  borough  of  Burnley, 
after  two  days  occupied  in  dealing  with  grocers’  licences,  out  of  149  off 
licences  in  the  town,  ninety  were  renewed  and  fifty  refused.  The  police 
objected  to  all  these  licences,  and  a  largely  signed  and  influential 

petition  was  presented  to  the  Bench  in  favour  of  their  abolition. - At- 

Accrington  the  result  of  a  poll  on  the  question  of  these  licences  was 
that  four-fifths  of  the  householders  voted  against  their  renewal.  The- 
licensing  magistrates  were  astonished  at  this  expression  of  opinion, 
and,  in  deference  thereto,  adjourned  the  licensing  session  in  order  to 
permit  of  notices  of  objection  being  given  to  holders  of  off  licences. 

The  Sunderland  Theatre  Disaster.— The  Mayor  convened  a  private  meeting 
for  the  purpose  of  considering  the  subject  of  the  proposed  convalescent 
home  in  connexion  with  the  fund  now  being  raised  in  consequence  of 
the  disaster.  After  some  discussion,  a  committee,  composed  chiefly  of 
medical  men,  was  formed  to  prepare  a  report  as  to  the  advantages  and 
requirements  of  a  convalescent  home.  Steps  have  been  taken  to  collect 
further  subscriptions,  and  a  meeting  of  the  general  committee  will  be¬ 
held  shortly  to  sanction  such  measures  as  may  be  advised  for  the 
promotion  of  the  object  in  view. 

Paternal  Solicitude—  The  Municipality  of  Genoa  has  determined  to  give 
gratis  to  all  persons  who  present  themselves  at  the  offices  to  register 
the  birth  of  a  child  a  small  pamphlet  containing  brief  directions  for  the 
1  healthy  rearing  of  the  infant. 


282 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES 


Sept.  8, 1=83. 


Wasp  Stings. — A  correspondent  states  that  another  death  (the  second  in 
less  than  a  fortnight)  has  just  occurred  in  the  neighbourhood  of  Bishop’s 
Stortford,  the  deceased  being  a  Mrs.  Horsnell,  aged  sixty-three,  who 
Aept  a  confectionery  shop,  and  whilst  cleaning  the  window  a  wasp 
settled  on  the  nape  of  her  neck  and  stung  her.  She  had  sense  enough 
~to  call  to  her  son  to  bring  the  oil  bottle  and  rub  the  spot  with  oil.  He  did 
so,  when  she  exclaimed  she  was  going,  and  fainted.  A  medical  man 
was  called  in,  but  she  never  recovered  consciousness,  expiring  within 
twenty  minutes  after  receiving  the  injury. 

A  People’s  Park,  America. — The  most  recent  big  thing  is  a  public  park  of 
3673  acres.  It  is  situated  in  Wyoming. 

•Collett.— Up  to  the  beginning  of  August  the  Berlin  Hygiene  Exhibition 
had  been  visited  by  about  half  a  million  persons.  The  receipts  up  to 
that  date  had  exceeded  350,000  marks. 

Centenarians. — The  undermentioned  centenarians  lived  and  died  in  the 
parish  of  Ilfracombe ;  their  remains  are  deposited  in  the  churchyard  :— 
John  Bile,  died  May  17,  1784,  aged  100  years;  Sarah  Williams,  died 
January  13,  1788,  aged  107  years ;  William  Soaper,  died  November  6, 
1804,  aged  103  years  ;  John  Davies,  died  March  4,  1810,  aged  102  years. 
Elizabeth  Brooks,  died  January  10,  1840,  aged  100  years  ;  Nanny  Vaggs 
(widow),  born  June  19,  1768,  died  October  6,  1869  ;  Jane  Richards,  died 
June  13, 1875,  aged  101  years. 

Cn  Pit. — Acting  on  the  hint  thrown  out  by  the  Home  Secretary,  it  is 
stated  that  some  great  capitalists  are  already  engaged  in  taking  the 
preliminary  steps  for  the  formation  of  a  financial  corporation  to  supply 
the  metropolis  with  water  from  one  pure  source,  and  at  rates  much 
under  the  present  charges. 

Small-pox,  Sydney.— The  small-pox  scare,  two  years  ago,  entailed  a  large 
expense.  Claims  for  compensation,  expenditure  for  buildings,  food, 
etc.,  amounted  to  £84,000. 

A\Sad  Fatality .—  On  the  night  of  the  28th  ult.,  Mr.  Edmund  Knowles, 
surgeon,  12,  Newmarket-road,  Cambridge,  whilst  walking  upstairs  at 
bis  own  residence,  slipped  and  fell  backwards,  dislocating  his  neck. 
Death  was  instantaneous.  TJntil  lately  he  was  one  of  the  medical 
officers  of  the  Union.  An  inquest  on  the  body  has  been  held,  and  a 
verdict  of  accidental  death  returned. 

Marriage  of  First  Cousins. — It  is  reported  that  the  Society  of  Friends  in 
England  has  just  repealed  the  prohibition  of  the  marriage  of  first 
cousins,  which  has  been  in  force  in  that  body  for  nearly  two  hundred 
years. 

Public  Vaccinators:  Battle  Union. — At  the  Battle  Petty  Sessions,  last  week, 
nine  cases  of  default  of  parents  to  have  their  children  vaccinated  were 
heard.  The  evidence  was  in  several  of  the  cases  fully  gone  into,  the 
result  being  the  dismissal  of  the  summonses.  It  was  shown  that  the 
public  vaccinators  had  neglected  to  fill  in  and  return  the  necessary  cer¬ 
tificates.  Ultimately,  all  the  nine  charges  were  dismissed,  the  Bench 
animadverting  strongly  on  the  neglect  shown  by  the  doctors  in  question. 

Cremation  in  England. — Dr.  Cameron  has  given  notice  in  the  House  of 
Commons  of  his  intention  on  an  early  day  next  session  to  introduce  a 
Bill  legalising  cremation. 

The  Withdrawal  of  the  Medical  Act  Amendment  Bill. — A  Scotch  contem¬ 
porary  thus  concludes  an  article  on  this  subject “  Now  that  the  Bill 
is  out,  it  must  never  come  in  again  on  the  same  lines,  and  this  the  Scotch 
and  Irish  bodies  ought  effectually  to  see  to.  If  Lord  Carlingford  and 
Mr.  Mundella  still  feel  sufficiently  interested  in  the  matter  to  move  in 
it  again,  let  them  be  guided  by  the  views  and  welfare  of  the  profession 
■of  the  United  Kingdom,  and  not  merely  by  a  few  doctors  in  London, 
whether  writers  in  the  Strand  or  fashionable  consultants  in  the  West- 
end  of  the  town.” 

i Female  Physicians,  United  States. — According  to  a  statistical  return  there 
are  no  less  than  2432  female  physicians. 

A  Jerry  Builder.— A.  builder,  who  was  recently  fined  nearly  £100  by  the 
Highgate  magistrates  for  using  garden  mould  instead  of  mortar  in  the 
erection  of  two  houses  at  Highgate  New  Town,  applied  last  week  for 
leave  to  appeal  against  the  magistrates’  decision,  but  this  the  Bench 
refused.  Several  severe  accidents  and  two  fatalities  have  lately  occurred 
in  the  suburbs  by  the  falling  of  portions  of  parapets  and  gutters  which 
were  made  of  defective  materials,  and  dangerously  constructed  and 
erected. 

Bibliopole,  Greenwich.—  The  library  of  the  Royal  College  of  Surgeons  was 
closed  cn  the  1st  inst.,  and  will  not  be  reopened  until  Monday,  the 
1st  prox. 

In  her  123 rd  Bear.— The  Paris  Temps  asserts  that  there  is  a  woman  living 
in  the  village  of  Auberire-en-Royans,  in  the  department  of  the  Isdre, 
who  was  born  on  March  18,  1761,  and  is  consequently  in  her  123rd  year. 
Her  name  is  Marie  Durand,  she  was  born  at  St.  J ust-de-CIaire,  was 
married  on  December  30,  1783,  to  Claude  Girard,  who  was  bom  in  1749, 
and  she  has  been  a  widow  for  ninety-six  years, 
i Dr.  Morrison. — Competitors  for  the  Jacksonian  Prize  must  be  members 
of  the  College  of  Sturgeons ;  the  essays  must  be  sent  in  on  or  before 
Saturday,  December  31.  The  subject  for  it  is  “  The  Pathology,  Dia¬ 
gnosis,  and  Treatment  of  Obstruction  of  the  Intestines  in  its  various 
forms  in  the  Abdominal  Cavity.” 


Statistical  Comparisons  between  the  British  and  German  Capitals. — London 
covers  an  area  of  over  five  and  a  half  German  square  miles,  Berlin  of 
only  one.  The  average  number  of  inhabitants  per  house  is  eight  in 
London  and  no  less  than  sixty-one  in  Berlin.  The  annual  income  value 
of  all  dwelling-houses  in  'London  is  calculated  to  be  141  marks  (or  shil¬ 
lings)  per  head  of  the  total  population,  in  Berlin  148  shillings.  During 
the  year  1882,  the  proportion  of  all  births  in  London  was  34'3  per 
thousand,  in  Berlin  37'9,  while  that  of  deaths  was  21'4  and  25'9  respec¬ 
tively.  It  will  thus  be  seen  that  while  the  natural  increase  is  slightly 
greater  in  the  German  capital,  its  death-rate  is  also  higher  than  that  of 
the  British  metropolis.  During  the  past  year  the  total  increase  of  the 
population  was  62,047  in  London,  and  36,691  in  Berlin.  The  ideas  of 
cleanliness  seem  to  be  much  more  developed  in  England  than  Berlin,  for 
while  the  annual  consumption  of  water  from  the  public  mains  is  136 
litres  per  person  in  London,  it  is  only  61  litres  in  Berlin,  but  then  a 
great  quantity  of  water  is  also  taken  from  private  wells  in  Berlin. 

Workhouse  Fish  Dinners. — The  occasional  substitution  of  fish  for  meat  as 
an  article  of  diet  is  gaining  rather  rapid  recognition  by  workhouse 
authorities,  and  generally  the  change  appears  to  have  been  appreciated 
by  the  inmates.  Moreover  the  experiment  is  found,  in  other  respects 
financially  especially,  to  work  satisfactorily,  and  the  Local  Government 
Board  has  readily  accorded  its  sanction  to  the  change. 

Urban  and  Rural  Sanitary  Improvements. — The  Stevenston  Local  Authority 
have  instructed  an  engineer  to  prepare  a  modification  of  the  Glen  water- 
supply  scheme,  suitable  for  the  requirements  of  Stevenston  parish, 

including  the  Saltcoats  part  of  the  parish. - The  Wednesbury  Local 

Board  have,  after  considerable  discussion,  adopted  the  proposal  that  the 
sewage  should  be  purified  by  precipitation,  overflowing  tanks,  and,  if 

required,  by  filtration. - The  new  waterworks  at  Clandon,  to  supply 

Woking  and  the  district  adjoining  with  water,  have  just  been  opened. 
They  are  situated  in  a  field  on  the  hills  of  Clandon,  several  miles  from 
the  chalk  formation  of  the  hills.  Besides  the  requisite  pumping 

machinery,  there  is  a  capacious  reservoir. - Staines  :  The  members  of 

the  J oint  Infectious  Diseases  Hospital  Board  have  now  agreed, upon  the 
plan  for  a  proposed  hospital,  subject  to  the  approval  of  the  Local 

Government  Board. - Yeovil :  The  Town  Council  have  adopted  plans 

for  the  new  public  baths. - The  Suffolk  Convalescent  Home  at  Felix¬ 

stowe  is  about  to  be  enlarged  by  the  addition  of  an  east  wing  accommo¬ 
dating  twenty-four  male  patients  ;  estimated  cost  about  £2360. - The 

newly  constituted  Joint  Main  Sewerage  Board  for  Godaiming  have 
instructed  their  surveyor  to  submit  plans  for  the  main  drainage  of  the 

district. - The  Local  Board  of  Loughborough,  Leicestershire,  have 

under  consideration  plans  for  an  adequate  water-supply. - The 

Sanitary  Committee  of  the  Town  Council  of  Tiverton  have  several 
designs  before  them  for  the  disposal  of  the  sewage.  — Burnham : 
The  Rural  Sanitary  Authority  of  the  Maldon  Union  have  decided 
to  carry  out  a  complete  system  of  sewerage  for  the  town  of  Burnham, 

and  to  extend  the  drainage  of  Southminster  in  their  district. - The 

main  drainage  scheme  for  the  united  districts  of  Market  Harborough 
and  Great  Bowden  in  Leicestershire,  and  Little  Bowden  in  Northampton¬ 
shire  is  now  completed.  The  cost  has  been  over  £16,000. - The  South¬ 

ampton  Corporation  have  decided  to  filter  the  water-supply  of  the 
borough,  which  is  drawn  from  the  river  Itchen.  The  estimated  cost  is 
£5000.  This  decision  is  the  outcome  of  a  report  prepared  by  Dr.  De 
Chaumont,  Professor  of  Military  Hygiene  at  Netley  Hospital. 

Dr.  Young,  Song-kong,  China. — Letter  and  enclosure  received  with  thanks. 

COMMUNICATIONS  have  been  received  from — 

Messrs.  Cassell  and  Co.,  London;  Mr.  H.  C.  Fox,  London;  The 
Secretary  of  the  Apothecaries’  Society,  London;  Dr.  Henry  Davy, 
Exeter ;  Mr.  J.  McCarthy,  London  ;  Dr.  Willoughby',  London  ;  Dr. 
Herman,  London  ;  Mr.  J.  Chatto,  London  ;  Dr.  J.  Mcgregor 
Robertson,  Glasgow;  Dr.  J.  W.  Moore,  Dublin;  Dr.  A.  T.  Thomson, 
Glasgow ;  The  Secretary  of  the  Social  Science  Association, 
London;  The  Registrar-General  for  Scotland,  Edinburgh;  Mr. 
T.  M.  Stone,  London;  Dr.  Mercer,  Dartmouth. 

PERIODICALS  AND  NEWSPAPERS  RECEIVED— 

Lancet— British  Medical  Journal— Medical  Press  and  Circular — Ber¬ 
liner  TCI  ini  ache  Wochenschrift — Centralblatt  fur  Chirurgie— Gazette 
des  Hopitaux — Gazette  Medicale— Revista  de  Medicina— Bulletin  de 
1’ AcadCmie  de  Medecine— Pharmaceutical  Journal — W iener  Medicinische 
Wochenschrift — Revue  Medicale— Gazette  Hebdomadaire— Nature- 
Boston  Medical  and  Surgical  Journal— Louisville  Medical  News — 
Centralblatt  fiir  Gynakologie— Le  Concours  Medical— Centralblatt  fur 
die  Medicinischen  Wissenschaften — Centralblatt  fiir  Klinische  Medicin 
— Philadelphia  Medical  News — Le  Progres  Medical — British  Workman — 
Revue  de  Medecine— Revue  de  Chirurgie— Band  of  Hope  Review— 
L’Imparziale— Veterinarian— New  York  Medical  Journal — Montlhy 
Homoeopathic  Review— Edinburgh  Medical  Journal — Archives  Generales 
de  .Medecine— L’Impartialite  Mtedicale— Glasgow  Medical  Journal — 
Sanitary  Journal,  Toronto— Birmingham  Medical  Review— Morningside 
Mirror,  July  16  and  August  15 — Revue  Mensuelle  de  Laryngologie,  etc. 
— New  York  Medical  Record. 

BOOKS,  ETC..  RECEIVED - 

On  the  Cause  and  Treatment  of  Phthisis,  by  H.  Armstrong  Rawlings, 
M  .R.C.S.,  L.R.C.P.,  etc.— Imperial  Maritime  Customs,  China :  Catalogue 
of  the  Chinese  Collection  of  Exhibits  for  the  International  Fisheries 
Exhibition — Imperial  Maritime  Customs,  China:  Medical  Reports  for 
the  Half-year  ended  September  30, 1882— Utilisation  of  Town  Refuse, 
by  Lawson  Tait,  F.R.C.S.—  Thirty-seventh  Report  of  the  Commissioners 
in  Lunacy  to  the  Lord  Chancellor— Case  of  Adeno-Sarcoma  of  Mamma, 
b  y  James  Whitson,  M.D.,  etc. — History  of  Rome,  by  Victor  Duruy. 


THE  STUDENTS’  NUMBER 

OF  THE 

MEDICAL  TIMES  AND  GAZETTE 

FOR 

1883-84. 


THIS  number  of  tbe  Medical  Times  and  Gazette  is  for  the  most  part  specially  devoted  to  the  supply  of  needful  informa¬ 
tion  to  parents,  guardians,  and  intending  medical  students  old  enough  to  judge  for  themselves  as  to  what  course 
they  must  pursue  in  seeking  to  enter  the  medical  profession.  It  is  not  often,  however,  that  such  inquirers  are  left 
entirely  to  such  guidance.  Everyone  knows,  or  his  friends  know,  some  medical  practitioner  willing  to  give  aid  and 
assistance,  often  sadly  needed,  on  the  subject ;  for  very  many  circumstances  which  cannot  here  be  indicated  enter  into 
the  questions  to  be  determined,  with  regard  to  an  intending  student  of  medicine.  Foremost  amongst  these  is  the 
selection  of  a  school,  which,  however,  is  often  practically  determined  by  convenience,  or  even  by  the  question  of  fees ; 
but  the  amount  of  money  to  be  paid  is  not  in  reality  the  most  important  point  to  be  settled.  Large  fees  no  more 
predicate  good  teaching  and  training  than  a  smaller  sum  means  that  the  teaching  is  bad.  More  important  than  fees — 
in  many  cases,  at  least —is  the  character  of  the  school  for  industry  or  idleness,  for  expensive  or  economical  (which  does 
not  of  necessity  imply  slovenly)  habits ;  in  short,  what  constitutes  the  whole  tone  of  a  school.  For  the  character  of  a 
medical  school  is  only  less  important  than  that  which  pervades  a  public  school,  after  which  parents  so  anxiously  inquire. 
Matters  of  this  kind  cannot  be  discussed  in  books,  papers,  or  advertisements,  though  in  certain  respects  they  are  even 
more  important  in  a  medical  than  in  a  public  school.  In  the  former  the  students  are  only  kept  in  restraint  during  a  few 
hours  in  the  day,  whereas  in  the  latter  the  supervision  is  more  or  less  constant. 

In  seeking  the  advice  of  medical  men,  however,  the  inquirer  must  not  forget  that  there  is  a  strong  esprit  de  corps 
among  the  different  schools,  and  that  for  the  most  part  every  man  thinks  his  own  the  best.  This  spirit  we  should  be 
the  last  to  condemn,  were  it  not  that  it  arises  in  a  way  which  is  hardly  creditable  to  the  various  hospital  and  school 
authorities  themselves.  Such  things  as  allied  hospital  sports,  cricket  and  football  clubs,  and  so  on,  are  now  gradually 
breaking  down  the  walls  of  separation  which  formerly  existed  between  different  schools,  and  which  were  on  purpose  kept 
up  by  making  all  schools  self-sufficing,  and  still  more  by  the  positive  discouragement  even  now  given  to  students  passing 
from  one  school  to  another. 

We  purpose,  therefore,  to  lay  before  our  readers  as  fully  as  possible  the  materials  whereby  they  may  arrive  at  a 
sound  judgment  for  themselves,  aided  or  unaided,  as  to  what  is  necessary  to  be  done  by  the  intending  student,  where 
the  knowledge  demanded  of  the  pupil  at  his  qualifying  examinations  may  be  obtained,  and  at  what  cost.  Moreover,  as 
in  the  meantime  the  requirements  of  the  various  qualifying  bodies  as  regards  attendance  on  classes,  etc.,  differ  among 
themselves,  we  have  given,  as  fully  as  need  be,  the  various  rules  and  regulations  enforced  by  each  of  these. 


Medical  Council  have  provided  for  this  by  insisting  that 
every  examination  which  they  will  recognise  shall  com¬ 
prehend  the  following  subjects  : — 1.  English  Language, 
including  grammar  and  composition,  (a)  2.  English  History. 
3.  Modern  Geography.  4.  Latin,  including  translation  from 
the  original  and  grammar.  5.  Elements  of  Mathematics, 
comprising— (a)  Arithmetic,  including  vulgar  and  decimal 
fractions;  (0)  Algebra,  including  simple  equations;  (7) 
Geometry,  including  the  first  two  books  of  Euclid,  or  the 
subjects  thereof.  6.  Elementary  Mechanics  of  solids  and 
fluids,  comprising  the  elements  of  statics,  dynamics,  and 
hydrostatics. (b)  7.  One  of  the  following  optional  subjects  : 
—(a)  Greek,  (fi)  French,  (7)  German,  (5)  Italian,  (e)  any 
other  modern  language,  (Q  Logic,  (ji)  Botany,  (0)  Elementary 
Chemistry. 

Some  bodies  specially  insist  on  Greek ;  and  care  should  be 
taken  to  comply  with  this  demand,  if  possible,  at  the  time 
of  the  Preliminary  Examination,  even  should  it  be  optional 
to  postpone  it  to  a  later  season,  which  in  all  probability  will 

(a)  The  General  Medical  Council  will  not  consider  any  examination  in 
English  language  sufficient  that  does  not  fully  test  the  ability  of  the  can¬ 
didate  (1 )  to  write  sentences  in  correct  English  on  a  given  theme,  attention 
being  paid  to  spelling  and  punctuation  as  well  as  to  composition  ;  (2)  to 
write  correctly  from  dictation ;  (3)  to  explain  the  grammatical  construc¬ 
tion  of  sentences ;  (4)  to  point  out  the  grammatical  errors  in  sentences 
ungrammatically  composed,  and  to  explain  their  nature  ;  and  (5)  to  give 
the  derivation  and  definition  of  English  words  in  common  use. 

(b)  This  subject  may  be  passed  either  as  preliminary,  or  before  or  at 
the  First  Professional  Examination, 

Vol.  II.  1883.  No.  1733. 


I.— PRELIMINARY  EDUCATION. 


REGISTRATION  AS  A  MEDICAL  STUDENT. 

It  is  universally  conceded  that  the  establishment  and  enforce¬ 
ment  of  an  examination  in  matters  of  ordinary  education  has 
done  much  to  raise  the  status  of  the  medical  practitioner.  It 
has  especially  tended  to  elevate  him  above  the  dull  level 
which  he  formerly  occupied,  and  to  raise  him  in  the  social 
scale.  Moreover,  it  has  at  once  choked  off  (if  we  may  use 
the  expression)  a  great  number  of  men  obviously  unfitted 
for  the  profession,  at  the  very  commencement  of  their  would- 
be  career,  and  induced  them  to  turn  their  attention  to  other 
occupations  better  suited  to  the  bent  of  their  genius.  All 
are  agreed,  we  repeat,  as  to  the  utility  of  this  examination, 
but  all  are  not  of  the  same  mind  as  to  its  scope  and  purport. 
In  these  utilitarian  days  the  test  of  all  things  is,  too  often, 
Will  it  pay  ?  And  to  this  end  some  would  have  the  future 
medical  practitioner  trained  up,  so  to  speak,  from  his  very 
cradle,  with  a  view  to  his  ultimate  destination  in  life.  How 
often  such  intentions  are  frustrated  we  need  hardly  say ; 
and  it  is  a  terrible  thing  to  contemplate  a  mind  cramped  and 
confined  in  a  single  groove  through  life.  Rather  we  would 
demand  in  preliminary  education  what  will  give  breadth 
and  power  to  the  character  and  intellect,  in  the  shape  of 
that  tincture  of  letters  which  is  useful  to  all  men,  and  to 
none  more  than  to  the  medical  practitioner.  The  General 


284 


Medical  Times  and  Gazette. 


PRELIMINARY  EDUCATION. 


Sept.  15,  1883. 


be  found  not  to  be  so  convenient.  We  would  specially  | 
impress  on  all  who  seek  to  attain  to  the  higher  grades  ( 
of  the  profession  to  take  a  degree  in  Arts,  if  possible,  before 
entering  on  their  strictly  professional  studies  ;  and  this  can 
be  done  nowadays  at  Cambridge  much  more  easily  than  would 
be  supposed.  Two  examining  bodies  disregard  the  possession 
of  a  degree  in  Arts.  Thus,  the  University  of  London  will  only 
accept  its  own  Matriculation  Examination,  whilst  the  Royal 
College  of  Physicians  include  in  their  examination  for  the 
membership  questions  in  Greek,  Latin,  French,  and  German. 
Otherwise  there  is  an  increasing  tendency  to  accept  the 
certificates  of  any  respectable  institution  whose  examina¬ 
tions  comprehend  the  subjects  insisted  on  by  the  General 
Medical  Council.  This  body  now  accepts  the  testamur  of 
any  one  of  the  following  certificates  about  to  be  enumerated  ; 
and,  generally  speaking,  what  is  accepted  by  the  Medical 
Council  will  be  accepted  elsewhere,  with  the  exceptions 
above  mentioned.  The  following  is  the  list  of  bodies  whose 
testimonials  of  proficiency  are  received  and  acknowledged 
by  the  Medical  Council : — 

EXAMINING  BODIES  WHOSE  EXAMINATIONS  FULFIL  THE  CONDITIONS  OF  THE 
MEDICAL  COUNCIL  AS  REGARDS  PRELIMINARY  EDUCATION. 

I. —  Universities  in  the  United  Kingdom. 

Oxford. — Junior  Local  Examinations,  certificate  to  include  Latin  and 
Mathematics,  and  also  one  of  the  following’  optional  subjects : —Greek, 
French,  German,  Natural  Philosophy,  including  mechanics,  hydrostatics, 
and  pneumatics.  Senior  Local  Examinations,  certificate  to  include  Latin 
and  Mathematics ;  Eesponsions ;  Moderations  ;  Examination  for  a  degree 
in  Arts. 

Cambridge.— Junior  Local  Examinations,  certificate  to  include  Latin 
and  Mathematics,  and  also  one  of  the  following  optional  subjects  : — 
Greek,  French,  German,  Natural  Philosophy,  including  the  elements  of 
statics  and  hydrostatics.  Senior  Local  Examinations,  certificate  to  include 
Latin  and  Mathematics  ;  Higher  Local  Examinations ;  Previous  Exa¬ 
mination  ;  Examination  for  a  degree  in  Arts. 

Durham.  -  Junior  Local  Examinations,  certificate  to  include  Latin 
and  Mathematics,  and  also  one  of  the  following  optional  subjects  :— Greek, 
French,  German,  Natural  Philosophy,  including  mechanics,  hydrostatics, 
and  pneumatics.  Senior  Local  Examinations,  certificate  to  include  Latin 
and  Mathematics ;  Registration  Examination  for  medical  students  ;  Exa¬ 
mination  for  students  at  the  end  of  their  first  year ;  Examination  for  a 
degree  in  Arts. 

London. —Matriculation  Examination;  Preliminary  Scientific  (M.B.) 
Examination ;  Examination  for  a  degree  in  Arts  or  Science. 

Edinburgh. — Local  Examinations  (Junior  certificate),  certificate  to 
include  English  Literature,  Arithmetic,  Algebra,  Geometry,  and  also  one 
of  the  following  optional  subjects  :— Greek,  French,  German.  Natural 
Philosophy;  Local  Examinations  (Senior  certificate),  certificate  to  include 
English  Literature,  Arithmetic,  Algebra,  Geometry,  Latin,  and  also  one 
of  the  following  optional  subjects  : — Greek,  French,  German,  Natural 
Philosophy  ;  Preliminary  Examination  for  graduation  in  Science  or  Medi¬ 
cine  and  8urgery ;  Examination  for  a  degree  in  Arts. 

Aberdeen. — Local  Examinations  (Honours  certificate),  certificate  to 
include  English  Literature,  Arithmetic,  Algebra,  Geometry,  Latin,  and 
also  one  of  the  following  optional  subjects Greek,  French,  German, 
Natural  Philosophy  ;  Preliminary  Examination  for  graduation  in  Medi¬ 
cine  or  Surgery  ;  Examination  for  a  degree  in  Arts. 

Glasgow. — Local  Examinations  (Senior  certificate),  certificate  to  include 
English  Literature,  Arithmetic,  Algebra,  Geometry,  Latin,  and  also  one 
of  the  following  optional  subjects Greek,  Erench,  German,  Natural 
Philosophy;  Preliminary  Examination  for  graduation  in  Medicine  or 
Surgery ;  Examination  for  a  degree  in  Arts. 

St.  Andrews. — Local  Examinations  (Honours  certificate),  certificate  to 
include  English  Literature,  Arithmetic,  Algebra,  Geometry,  Latin,  and 
also  one  of  the  following  optional  subjects  :  — Greek,  French,  German, 
Natural  Philosophy  ;  Preliminary  Examination  for  graduation  in  Medi¬ 
cine  or  Surgery  ;  Examination  for  a  degree  in  Arts. 

Dublin. — Public  Entrance  Examination ;  Examination  for  a  degree  in 
Arts. 

Royal  University  in  Ireland. —Local  Examinations  for  Men  and  Women, 
certificate  to  include  all  the  subjects  required  by  the  General  Medical 
Council  as  set  forth  in  Recommendation  4  ;  Entrance  or  Matriculation 
Examination;  Previous  Examination  for  B.A.  degree;  Examination  for 
a  degree  in  Arts. 

Oxford  and  Cambridge  Schools’  Examination  Board,  (c)  -  Certificate  to 
include— Arithmetic  (including  vulgar  and  decimal  fractions),  Algebra 
(including  simple  equations),  Geometry  (including  the  first  two  books  of 
Euclid),  Latin  (including  translation  and  grammar),  also  one  of  these 
optional  subjects : — Greek,  French,  German,  mechanical  division  of 
Natural  Philosophy. 

II. —  Other  Bodies  named  in  Schedule  (A)  to  the  Medical  Act. 

Apothecaries’  Society  of  London. — Examination  in  Arts. 

Royal  College  of  Physicians  and  Surgeons,  Edinburgh.— Preliminary 
Examination  in  General  Education,  conducted  by  a  Board  appointed  by 
these  two  Colleges  combined. 


(c)  The  English  is  provided  for  by  the  following  resolution  of  the 
Executive  Committee That,  as  every  candidate  for  the  certificate  of 
the  Oxford  and  Cambridge  Schools’  Examination  Board  is  required  to 
answer  questions  in  such  a  manner  as  to  satisfy  the  examiners  that  he  has 
an  adequate.  knowledge  of  English  Grammar  and  Orthography,  this  shall 
'  be  held  as.  cofife  tuning  to  the  requirements  of  the  Medical  Council  in 
reference  to  English-Language,” 


Faculty  of  Physicians  and  Surgeons  of  Glasgow. — Preliminary  Exami¬ 
nation  in  General  Education. 

Royal  College  of  Surgeons  in  Ireland. — Preliminary  Examination  ; 
certificate  to  include  Mathematics. 

Apothecaries’  Hall  of  Ireland. — Preliminary  Examination  in  General 
Education. 

III. — Examining  Bodies  in  the  United  Kingdom  not  included  in  Schedule  (A) 
to  the  Medical  Act  (1858). 

College  of  Preceptors.  —Examination  for  a  First  or  Second  Class  Certifi¬ 
cate,  provided  that,  in  the  case  of  the  latter,  the  candidate  has  passed  in 
the  First  or  Second  Division,  and  has  taken  Algebra,  Euclid,  Latin,  and  a 
modern  language. 

Examiners  for  Commissions  and  Appointments  in  Her  Majesty’s  Ser¬ 
vice,  Military,  Naval,  and  Civil.— Certificate,  including  all  the  subjects 
required  by  the  Council’s  4th  Recommendation. 

IV. — Indian ,  Colonial,  and  Foreign  Universities  and  Colleges. 

Universities  of  Calcutta,  Madras,  and  Bombay. — Entrance  Examination ; 
certificate  to  include  Latin. 

Universities  of  M’Gill  College,  Montreal;  Bishop’s  College,  Montreal; 
Toronto  ;  Trinity  College,  Toronto ;  Queen’s  College,  Kingston ;  Victoria 
College,  Upper  Canada ;  Frederickton,  New  Brunswick ;  Medical  Col¬ 
lege,  Halifax,  Nova  Scotia;  Melbourne;  Sydney;  Adelaide;  Michigan 
College  of  Medicine.— Matriculation  Examination. 

University  of  Manitoba.— Previous  Examination. 

University  of  King’s  Co'lege,  Nova  Scotia.  —Matriculation  Examination ; 
Responsions. 

Tasmanian  Council  of  Education.— Examination  for  the  degree  of 
Associate  of  Arts ;  certificate  to  include  Latin  and  Mathematics. 

University  of  the  Cape  of  Good  Hope. -Matriculation  Examination; 
Examination  for  a  degree  in  Arts. 

University  of  Otago.— Preliminary  Examination. 

University  of  New  Zealand.  -  Entrance  Examination. 

Christ’s  College,  Canterbury,  New  Zealand.— Voluntary  Examinations  ; 
certificate  to  include  all  the  subjects  required  by  the  Council’s  4th  Recom¬ 
mendation. 

Codrington  College,  Barbadoes. — English  Certificate  for  Students  of  two 
years’  standing,  specifying  subjects  of  examination ;  Latin  Certificate. 

South  Australian  Institute. —Preliminary  General  Examination;  First 
Class  Certificate. 

Ceylon  Medical  College. — Preliminary  Examination  (Primary  Class). 

Germany  and  other  Continental  Countries.— Gymnasial  Abiturienten 
Examen  in  Germany,  and  the  corresponding  Entrance  Examination  to 
the  Universities  in  other  continental  countries. 

We  have  already  pointed  out  that  the  University  of 
London  insists  on  all  its  would-be  members  passing  its  own 
Matriculation  Examination.  This  is  undoubtedly  severe ; 
but,  when  passed,  it  gives  a  man  a  certain  stamp,  which  is 
always  of  value.  Moreover — and  this  is  very  important — 
this  University  counts  no  medical  study  until  this  examina¬ 
tion  has  been  passed,  so  that  even  if  a  man  has  gone  through 
a  complete  medical  curriculum,  and  should  yet  desire  the 
University  of  London  degree,  he  would  have  to  go  back  to 
the  very  beginning  over  again  to  attain  the  object  of  his 
ambition. 

University  oe  London. — The  following  are  the  parti¬ 
culars  relating  to  the  Matriculation  Examination  : — ■ 

Matriculation. — There  shall  he  two  examinations  for 
Matriculation  in  each  year — one  commencing  on  the  second 
Monday  in  January,  and  the  other  on  the  third  Monday  in 
June.(d) 

No  candidate  shall  be  admitted  to  the  Matriculation  Examination 
unless  he  have  produced  a  certificate(e)  showing  that  he  has  com¬ 
pleted  his  sixteenth  year.  This  certificate  shall  be  transmitted  to  the 
Registrar  at  least  fourteen  dciys  before  the  commencement  of  the  exa¬ 
mination.  A  fee  of  £2  shall  be  paid  at  matriculation.  No  candi¬ 
date  shall  he  admitted  to  the  examination  unless  he  have  previously 
paid  this  fee  to  the  Registrar,  (f)  The  examination  shall  he  conducted 
by  means  of  printed  papers ;  but  the  examiners  shall  not  be  precluded 
from  putting,  for  the  purpose  of  ascertaining  the  competence  of  the 
candidates  to  pass,  viva  voce  questions  to  any  candidate  in  the  sub¬ 
jects  in  which  they  are  appointed  to  examine.  Candidates  shall  not  be 
approved  by  the  examiners  unless  they  have  shown  a  competent  know¬ 
ledge  in  each  of  the  following  subjects,  according  to  the  details  specified 
under  the  several  heads 1.  Latin.  2.  Any  two(g)  of  the  following 
languages  :  Greek,  French,  German,  and  eittier  Sanskrit  or  Arabic,  (h ) 

3.  The  English  Language,  English  History,  and  Modem  Geography. 

4.  Mathematics.  6.  Natural  Philosophy.  6.  Chemistry. 


(d)  These  examinations  may  be  held,  not  only  at  the  University  of 
London,  but  also,  under  special  arrangement,  in  other  parts  of  the  United 
Kingdom,  or  in  the  colonies. 

(e)  A  certificate  from  the  Registrar-General  in  London,  or  from  the 
Superintendent  Registrar  of  the  district,  or  a  certified  copy  of  the  bap¬ 
tismal  register,  is  required  in  every  case  in  which  it  can  possibly  be  obtained. 
In  other  oases  the  best  evidence  procurable  is  admitted.  The  certificate 
of  each  candidate  is  returned  to  him  when  he  inscribes  his  name  on  the 
Register  of  the  University.  Information  respecting  the  time  for  doing 
this  will  be  sent  to  each  candidate  when  the  receipt  of  his  certificate  of 
age  is  acknowledged. 

(f )  The  fee  must  be  paid  when  the  candidate  inscribes  his  name  on  the 
Register  of  the  University. 

(g)  No  credit  will  be  given  for  more  than  two  of  these  languages. 

(h)  Candidates  who  desire  to  be  examined  in  either  Sanskrit  or  Arabic 
must  give  at  least  two  calendar  months’  notice  to  the  Registrar,  and  must 
mention  the  other  optional  language  which  they  select. 


/ 


/ 


Medical  Times  and  Gazette. 


SCIENTIFIC  EDUCATION. 


Sept.  15, 1883.  285 


The  following  are  the  particulars  relating  to  the  foregoing 
subjects  of  examination  for  the  year  1883  : — 

Languages. — In  Latin  the  following  authors  have  been  selected:— 
January,  18S2 — Horace:  Odes,  Books  I.  and  II.  June — Livy :  Book  II. 
The  paper  in  Latin  shall  contain  passages  to  he  translated  into  English, 
with  questions  in  history  and  geography  arising  out  of  the  subjects  of 
the  book  selected.  Short  and  easy  passages  shall  also  be  set  for  translation 
from  other  books  not  so  selected.  A  separate  paper  shall  be  set  containing 
questions  in  Latin  grammar,  with  simple  and  easy  sentences  of  English  to 
be  translated  into  Latin,  (i)  InGreek(k) January,  1882— Xenophon  :  Ana¬ 
basis,  Book  VI.  June  -Homer:  Iliad,  Book  XVII  t.  The  paper  in  Greek 
shall  contain  passages  to  be  translated  into  English,  with  questions  in 
grammar,  (1)  and  with  questions  in  history  and  geography  arising  out 
of  the  subjects  of  the  book  selected.  Short  and  easy  passages  shall  also 
be  set  for  translation  from  other  books  not  so  selected.  French— The 
paper  in  French  shall  contain  passages  for  translation  into  English,  and 
questions  in  grammar,  limited  to  the  Accidence.  German— The  paper  in 
German  shall  contain  passages  for  translation  into  English,  and  questions 
in  grammar,  limited  (except  when  German  is  taken  as  an  alternative  for 
Greek)  to  the  Accidence.  Sanskrit;  Arabic— The  paper  in  Sanskrit  and 
the  paper  in  Arabic  shall  contain  passages  for  translation  into  English, 
and  questions  in  grammar.  The  English  Language,  English  History, 
and  Modern  Geography  -  Orthography ;  writing  from  dictation;  the 
grammatical  structure  of  the  language.  History  of  England  to  the 
end  of  the  seventeenth  century ;  with  questions  in  modern  geography. 

Mathematics—  Arithmetic :  The  ordinary  rules  of  arithmetic;  Vulgar 
and  Decimal  Fractions ;  Extraction  of  the  Square  Boot.  Algebra : 
Addition,  Subtraction,  Multiplication,  and  Division  of  Algebraical  Quan¬ 
tities  ;  Proportion  ;  Arithmetical  and  Geometrical  Progression ;  Simple 
Equations.  Geometry  :  The  First  Four  Books  of  Euclid,  or  the  subjects 
thereof. 

Natural  Philosophy .(m) — Mechanics  :  Composition  and  Besolution  of 
Statical  Forces ;  Simple  Machines  (Mechanical  Powers)  — Batio  of  the 
Power  to  the  weight  in  each ;  Centre  of  Gravity ;  General  Laws  of  Motion, 
with  the  chief  experiments  by  which  they  may  be  illustrated  ;  Law  of  the 
Motion  of  Falling  Bodies.  Hydrostatics,  Hydraulics,  and  Pneumatics  : 
Pressure  of  Liquids  and  Gases,  its  equal  diffusion  and  variation  with  the 
depth ;  Specific  Gravity,  and  modes  of  determining  it ;  the  Barometer, 
the  Syphon,  the  Common  Pump  and  Forcing  Pump,  and  the  Air  Pump. 
Optics :  Laws  of  Beflection  and  Befraction ;  formation  of  Images  by 
Mir  rors  and  Simple  Lenses.  Heat :  its  Sources ;  Expansion  ;  Thermometers 
—relations  between  different  Scales  in  common  use ;  difference  between 
Temperature  and  Quantity  of  Heat ;  Specific  and  Latent  Heat— Calori¬ 
meters  ;  Liquefaction  ;  Ebullition ;  Evaporation ;  Conduction ;  Convection ; 
Badiation. 

Chemistry. — Chemistry  of  the  Non-metallic  Elements,  including  their 
compounds  as  enumerated  below,  their  chief  physical  and  chemical  cha¬ 
racters,  their  preparation,  and  their  characteristic  tests.  Oxygen,  Hydrogen, 
Carbon,  Nitrogen ;  Chlorine,  Bromine,  Iodine,  Fluorine  ;  Sulphur,  Phos¬ 
phorus,  Silicon.  Combining  Proportions  by  weight  and  by  volume  ; 
General  Nature  of  Acids,  Bases,  and  Salts  ;  Symbols  and  Nomenclature. 
The  Atmosphere  its  constitution ;  effects  of  Animal  and  Vegetable  Life 
upon  its  composition.  Combustion  ;  structure  and  properties  of  Flame  ; 
nature  and  composition  of  ordinary  fuel.  Water  :  Chemical  peculiarities 
of  Natural  Waters,  such  as  rain-water,  river-water,  spring-water,  sea¬ 
water.  Carbonic  Acid ;  Carbonic  Oxide ;  Oxides  and  Acids  of  Nitrogen ; 
Ammonia ;  Olefiant  Gas  ;  Marsh  Gas  ;  Sulphurous  and  Sulphuric  Acids, 
Sulphuretted  Hydrogen.  Hydrochloric  Acid,  Phosphoric  Acid,  and  Phos- 
phuretted  Hydrogen ;  Silica. 

ENTRANCE  ON  PROFESSIONAL  STUDIES. 

In  all  cases  the  period  of  medical  studies  is  supposed  to 
extend  over  four  years,  or  more  exactly  forty-five  months  ; 
and  in  Scottish  universities  this  is  rigidly  enforced,  but  in 
England  the  curriculum  is  so  arranged  in  all  hospital  schools, 
that  three  winter  and  two  summer  sessions’  attendance 
suffices  for  school  work.  This  leaves  an  odd  year,  which 
may  be  spent  in  attendance  on  a  hospital  which  has  no 
school  attached,  provided  it  complies  with  certain  conditions, 
or  with  a  private  medical  man  holding  certain  appointments. 
This  extra-scholastic  period  may  likewise  be  spent — and  is 
usually  best  spent,  especially  by  those  seeking  the  higher 
qualifications  -  in  clinical  work  in  the  school  to  which  the 
student  belongs,  after  he  has  completed  his  stated  cur¬ 
riculum.  But  the  odd  year  may  also  be  taken  before 
entering  on  medical-school  life,  thus  to  a  certain  extent 
simulating  the  ancient  system  of  apprenticeship.  Some 
would  like  to  see  the  old  system  revived  in  some  modified 
form.  With  this  view  we  are  not  altogether  in  accord, 
but  we  freely  admit  that  under  the  old  system  a  student 
earned  something  of  the  aspect  of  drugs  and  of  their 
properties  ;  and  he  was  taught  to  read,  write,  and  com¬ 
pound  a  prescription ;  while  nowadays  he  learns  little 
or  nothing  of  all  this.  Every  hospital  has  its  own  pharma- 


(i)  Special  stress  is  laid  on  accuracy  in  the  answers  to  the  grammar 
questions,  and  on  the  correct  rendering  of  English  into  Latin. 

(k)  Candidates  may  substitute  German  for  Greek. 

(l)  Special  stress  is  laid  on  accuracy  in  the  answers  to  the  questions  in 

Greek  grammar.  • 

(m)  The  questions  in  Natural  Philosophy  will  be  of  a  strictly  elementary 
character. 


copoeia,  and,  for  the  purpose  of  saving  time,  prescrip¬ 
tions  are  ordinarily,  and  as  far  as  possible,  written  in 
accordance  with  this.  But  the  knowledge  thus  conveyed 
to  the  student,  except  he  refer  directly  and  on  all  occasions 
to  the  book  in  question,  is  infinitesimal ;  whilst  to  the  style 
of  hospital  dispensing  the  same  remark  applies.  The 
period  assigned  to  apprenticeship,  which  was  commonly 
five  years,  was,  however,  far  too  long ;  and  one  year  spent 
in  this  way,  after  a  student  has  passed  through  his  cur¬ 
riculum,  will  do  as  much  good,  if  not  more,  than  the 
five  under  the  old  system.  Again,  it  is  true  that  a  student 
who  has  served  some  kind  of  an  apprenticeship  starts  on  his 
curriculum  with  certain  advantages  not  possessed  by  those 
who  come  more  directly  from  school ;  but  they  do  not,  as  a 
rule,  long  maintain  this  lead,  and,  too  frequently,  have  to 
submit  to  that  most  tedious,  troublesome,  and  disagreeable 
of  tasks — the  unlearning  of  many  things,  more  especially 
with  regard  to  the  true  methods  of  study  and  investigation. 
On  the  whole  it  is  best,  we  believe,  for  students  to  come  to  a 
medical  school  with  a  good  fair  mental  culture  of  the  broadest 
kind,  and  something  more  than  a  smattering  of  Physics, 
Chemistry,  Botany,  and  Zoology. 

REGISTRATION. 

As  soon  as  the  student  has  passed  his  preliminary  exa¬ 
mination,  and  provided  he  desires  to  enter  on  his  studies  at 
once,  so  as  to  make  time  count,  he  must  register  his  cer¬ 
tificate  at  the  office  of  the  General  Medical  Council,  299, 
Oxford-street,  W.,  or  at  that  of  the  Branch  Registrar  for 
Scotland  (Archibald  Inglis,  33,  Albany-street,  Edinburgh), 
or  for  Ireland  (W.  E.  Steele,  35,  Dawson-street,  Dublin),  as 
the  case  may  be,  which  will  save  him  all  further  trouble  as 
regards  preliminary  education.  This  is  necessary,  if  the 
student  desires  to  spend  the  first  year  with  a  general  prac¬ 
titioner  or  at  a  country  hospital,  so  as  to  enable  the  time 
thus  spent  to  be  included  in  the  period  of  medical  study. 
But  when  the  student  begins  by  entering  a  medical  school, 
he  must  register  the  actual  commencement  of  his  hospital 
studies  as  being  likewise  the  date  of  the  commencement  of 
medical  studies.  It  is  now  the  practice  for  the  return 
required  by  the  General  Medical  Council  to  be  sent  in  by 
the  school  authorities.  All  registration  must  in  any  case 
take  place  within  fifteen  days  of  the  beginning  of  medical 
studies,  at  whatever  time  that  may  be  ;  no  time  previous  to 
this  counting.  _ 


II— SCIENTIFIC  EDUCATION. 


As  matters  now  stand,  instruction  in  medical  and  scientific 
knowledge  is,  during  the  student’s  first  year,  inextricably 
mixed,  as  far  as  the  latter  subjects  are  in  most  schools 
taught  at  all.  Thus,  on  entering  a  school  the  student  is 
set  to  work  at  once  on  Chemistry,  Anatomy,  and  Physi¬ 
ology  ;  whilst  in  summer,  Botany,  Practical  Chemistry,  and 
Materia  Medica  are  taught  simultaneously.  It  would  be 
far  better  if  the  student  came  to  the  study  of  medicine 
ready  prepared  in  the  scientific  subjects  already  named, 
for  the  strictly  scientific  subjects  clash  with  the  purely 
medical,  and  are  never  greatly  relished  by  the  student, 
whilst  Physics  and  Zoology  are  hardly  ever  efficiently 
taught  in  a  purely  medical  school.  Great  inducements 
are  held  out  by  the  College  of  Physicians  of  London  for 
students  to  master  certain  branches  before  entering  on  their 
professional  education.  Thus,  in  Botany,  Chemistry,  Phar¬ 
macy,  and  Materia  Medica  no  regular  class  certificates  are 
required,  but  only  certificates  of  having  received  instruc¬ 
tion,  which  anyone  may  give.  In  most  large  public  schools, 
cience  is  now  well  taught  -  sometimes  muAxffieWij 

\'V  "s//*  > 

'  R  A  D  F  C  ft  Dy 


A 


286 


Medical  Times  and  Gazette. 


PROFESSIONAL  EDUCATION. 


Sept.  15,  1883. 


medical  schools :  the  teachers  are  specially  selected  for 
their  scientific  acquirements  and  their  powers  of  communi¬ 
cating  instruction,  and  not  in  accordance  with  hospital 
rules,  by  which  too  often  the  round  stick  is  found  in  the 
square  hole,  and  a  capital  teacher  in  Medicine  or  Surgery  is 
allowed  to  waste  his  energies  in  working  at  an  uncongenial 
subject.  At  such  a  school  as  Epsom,  Physics,  Chemistry, 
Botany,  and  Zoology  are  now  well  and  efficiently  taught, 
and  a  hoy  on  leaving  should  have  little  difficulty  in  pass¬ 
ing  the  greater  part  of  his  First  Examination  at  the  Col¬ 
lege  of  Physicians,  which  may  be  done  immediately  after 
registration. 

The  University  of  London,  as  usual,  takes  its  own  course 
independently  of  all  others,  and  holds  a  special  Preliminary 
Scientific  Examination  of  its  own.  We  would  again  urge  on 
all  intending  graduates  to  get  this  over  as  early  as  possible, 
for  with  much  sadness  we  have  often  seen  men  grinding  at 
these  preliminary  subjects  at  a  period  of  their  career  when 
they  should  have  been  engaged  in  strictly  professional  work. 
The  following  is  a  synopsis  of  the  regulations  and  of  the 
subjects  on  which  the  questions  are  put : — 

Preliminary  Scientific  (M.B.)  Examination. 

No  candidate  shall  be  admitted  to  this  examination  (which  takes  place 
on  the  third  Monday  of  July)  until  he  shall  have  completed  his  seven¬ 
teenth  year,  and  shall  have  either  passed  the  Matriculation  Examination 
or  taken  a  degree  in  Arts  in  one  of  the  Universities  of  Sydney,  Melbourne, 
Calcutta,  or  Madras  (provided  that  Latin  was  one  of  the  subjects  in  which 
he  passed)  ;  nor  unless  he  have  given  notice  of  his  intention  to  the  Begis- 
trar  at  least  fourteen  days  before  the  commencement  of  the  examination. 

The  fee  for  this  examination  shall  be  £5. 

No  candidate  shall  be  admitted  to  the  examination  unless  he  have  pre¬ 
viously  paid  this  fee  to  the  Begistrar.(n)  If,  after  payment  of  his  fee,  a 
candidate  withdraws  his  name,  or  fails  to  present  himself  at  the  examina¬ 
tion,  or  fails  to  pass  it,  the  fee  shall  not  be  returned  to  him  ;  but  he  shall 
be  allowed  to  enter  for  any  too  subsequent  Preliminary  Scientific  (M.B.) 
Examinations  without  the  payment  of  any  additional  fee,  provided  that 
he  give  notice  to  the  Begistrar  at  least  fourteen  days  before  the  commence¬ 
ment  of  the  examination ;  such  notice,  in  respect  to  the  privilege  afore¬ 
said,'  being  considered  equivalent  to  entry. 

Candidates  shall  be  examined  in  the  following  subjects  :(o)  — 

inorganic  chemistry. 

Differences  between  mechanical  mixture,  solution,  and  chemical  combi¬ 
nation  ;  outlines  of  crystallography  ;  formation  of  crystals ;  dimorphism  ; 
isomorphism;  conditions  on  which  the  melting-point  and  the  boiling- 
point  of  a  substance  depend ;  difference  between  elementary  and  com¬ 
pound  substances  ;  laws  of  chemical  combination ;  equivalent  weights 
of  the  elements ;  multiple  proportions  ;  the  atomic  theory ;  atomic  value 
(quantivalence)  ;  molecules  ;  molecular  weights  ;  relation  between  the 
density  of  a  gas  and  its  molecular  weight ;  abnormal  densities ;  Avogadro’s 
hypothesis ;  combination  of  gases  by  volume ;  compound  radicals  ;  atomic 
and  molecular  combination.  Meaning  of  chemical  symbols,  formulae,  and 
equations ;  calculation  of  quantities  by  weight  and  by  volume ;  chemical 
changes,  and  the  conditions  under  which  they  occur ;  combination  ;  de¬ 
composition  ;  double  decomposition ;  nature  of  acids,  bases,  and  salts ; 
capacity  of  saturation  of  acids  and  bases ;  nomenclature.  Belation 
between  atomic  weight  and  specific  heat ;  Faraday’s  electrolytic  law ; 
principles  of  spectrum  analysis ;  diffusion  of  gases.  Hydrogen,  chlorine, 
bromine,  iodine,  fluorine  ;  the  combination  of  the  last  four  elements  with 
hydrogen.  Oxygen  ;  ozone ;  water  and  peroxide  of  hydrogen ;  the  oxides 
and  oxyacids  of  chlorine ;  chlorates  and  hypochlorites.  Sulphur ;  sul¬ 
phuretted  hydrogen ;  the  oxides  of  sulphur ;  sulphuric  acid  and  the 
sulphates ;  sulphurous  acid  and  the  sulphites ;  chlorosulphuric  acid. 
Nitrogen ;  the  atmosphere  and  its  relations  to  animal  and  vegetable  life  ; 
ammonia ;  ammonium  and  its  salts ;  the  oxides  of  nitrogen  ;  nitric  acid 
and  nitrates  ;  nitrous  acid  and  nitrites.  Phosphorus ;  phosphoretted 
hydrogen  ;  the  oxides  of  phosphorus  ;  phosphoric  acid  and  the  phosphates ; 
chloride  and  oxychloride  of  phosphorus.  Arsenic  and  its  oxides  ;  arseniu- 
retted  hydrogen ;  arsenious  acid  and  its  salts ;  arsenic  acid  and  its  salts ; 
the  sulphides  of  arsenic ;  detection  of  arsenic.  Antimony,  its  oxides  and 
sulphides  ;  antimoniuretted  hydrogen ;  chlorides  of  antimony ;  compounds 
of  antimonic  oxide ;  detection  of  antimony.  Boron ;  boracic  acid  and 
the  borates.  Carbon  ;  carbonic  oxide  and  carbonic  acid ;  the  carbonates ; 
carbon  oxysulphide ;  sulphocarbonic  acid ;  marsh-gas  ;  ethylene ;  com¬ 
bustion  ;  structure  of  flame ;  coal-gas ;  Davy  lamp  ;  principles  of  illumi¬ 
nation.  Silicon ;  siliciuretted  hydrogen ;  silicon  chloride ;  silicon  chloro¬ 
form;  silica  and  the  silicates.  Potassium;  sodium;  silver.  Calcium; 
strontium;  barium.  Aluminium.  Magnesium;  zinc;  cadmium.  Lead. 
Manganese;  iron;  cobalt;  nickel;  chromium.  Bismuth;  copper;  mer¬ 
cury;  gold;  tin.  Platinum.  The  chief  compounds  of  these  metals  with 
the  more  important  acid  radicals  ;  the  detection  of  these  metals  and  their 
compounds,  in  powder  or  in  solution. 


(n)  The  fee  must  be  paid  when  the  candidate  inscribes  his  name  on  the 
Begister  of  the  University.  Information  respecting  the  time  for  doing 
this  will  be  sent  to  each  candidate  with  the  acknowledgment  of  his  notice. 

(o)  Candidates  who  shall  pass  in  all  the  subjects  of  the  Preliminary 
Scientific  (M.B.)  Examination,  and  shall  also  pass  at  the  same  time  in  the 
Pure  Mathematics  of  the  first  B.Sc.  examination,  or  who  shall  have  pre¬ 
viously  passed  the  first  B.A.  examination,  shall  be  admissible  to  the 
second  B.Sc.  examination.— The  attention  of  such  candidates  is  directed 
to  the  fact  that,  under  the  new  regulations  for  the  B.Sc.  degree,  this  degree 
may  be  obtained  by  passing  at  the  second  B.Sc.  examination  in  the  three 
biological  subjects  only. 


EXPERIMENTAL  PHYSICS. 

[Candidates  will  be  expected  to  show  a  general  acquaintance  with  the 
methods  and  apparatus  by  which  the  leading  principles  of  Physics  as 
enumerated  below  can  be  illustrated  and  applied.] 

Units  of  measurement.  The  laws  of  motion  considered  experimentally . 
The  chief  forces  of  nature.  The  general  properties  of  solids,  liquids,  and 
gases.  The  nature,  intensity,  and  transmission  of  fluid  pressure  in  general. 
The  pressure  of  liquids  in  equilibrium  under  the  action  of  gravity.  The 
equilibrium  of  solids  floating  or  entirely  immersed  in  gravitating  fluids. 
The  specific  gravities  of  substances,  with  the  ordinary  modes  of  deter¬ 
mining  them.  Measurement  of  the  pressure  of  the  atmosphere  and  of 
the  elastic  force  of  gases.  Diffusion  of  liquids  and  gases.  Definition  of 
work  and  energy :  conservation  and  transmutation  of  energy. 

Acoustics.—  Production  and  mode  of  propagation  of  sound  ;  intensity, 
pitch  and  quality.  Velocity  of  sound  in  air.  Influence  of  temperature 
and  density.  Velocity  of  sound  in  other  media.  Laws  of  reflection  and 
refraction.  Nature  of  musical  sounds.  Longitudinal  vibrations  of  rods 
and  of  columns  of  air.  Transverse  vibrations  of  strings  ;  variation  in 
their  rate  of  vibration  by  changes  in  their  tension,  length,  thickness,  and 
substance. 

Heat.— Definitions  of  heat  and  temperature.  Construction  of  instruments 
for  the  measurement  of  temperature.  Expansion  of  solids,  liquids,  and 
gases  under  heat.  Change  of  state ;  tension  of  vapours ;  latent  heat. 
Badiant  heat;  its  reflection  refraction,  and  absorption.  Conduction; 
definition  of  thermal  conductivity.  Convection.  Specific  heat ;  mechanical 
equivalent  of  heat.  _  . 

Magnetism. — Properties  of  magnets  ;  induction — magnetic  relations  of 
iron  and  steel.  Terrestrial  magnetism.  , 

Electricity . — Two  electrical  states,  and  their  mutual  relations.  Con¬ 
duction  and  insulation.  Induction.  Electric  attraction  and  repulsion. 
Distribution  and  accumulation  of  electricity  on  conductors.  Electric  dis¬ 
charge.  Voltaic  electricity;  the  various  batteries.  Electro-motive  force, 
strength  of  currents,  resistance ;  Ohm’s  law.  Heating  and  chemical  effects 
of  electric  currents  ;  action  between  currents  and  magnets ;  electro-mag¬ 
netism.  Induced  currents ;  magneto- electricity.  Thermo-electricity. 

Optics.—  Laws  of  propagation  of  light ;  measurement  of  velocity  of  light ; 
photometry.  Laws  of  reflection  and  refraction  of  light.  Befleetion  at 
plane  and  at  spherical  surfaces.  Befraction  at  plane  and  at  spherical 
surfaces.  Befraction  through  lenses,  including  the  formation  of  images. 
Chromatic  dispersion. 

BOTANY  AND  VEGETABLE  PHSSIOLOGY.(p) 

Structure,  functions,  and  life-history  of  simple  unicellular  plants,  such 
as  Protococcus  and  Saccharomyces  (yeast),  as  types  of  vegetable  life. 
Structure,  functions,  and  life-history  of  Penicillium,  Mucor ,  or  some  other 
simple  fungus.  Structure,  functions,  and  life-history  of  Chara  or  Nitella. 
Morphology,  histology,  and  history  of  the  reproduction  of  a  fern.  Morpho¬ 
logy  and  histology  of  a  flowering  plant ;  structure  of  a  flower  ;  homologies 
of  leaves  and  floral  organs  ;  histology  of  ordinary  vegetable  tissues,  such 
as  epidermis,  parenchyma,  fibro-vascular  tissue,  and  their  arrangement  in 
the  stem  and  leaves.  General  principles  of  vegetable  nutrition  ;  food  of 
plants ;  action  of  green  parts  of  plants ;  nature  and  flow  of  sap.  Growth 
of  a  flowering  plant ;  formation  of  wood  and  bark  ;  nature  of  cambium. 
Beproduction  of  a  flowering  plant ;  structure  of  ovule ;  methods  of 
fertilisation ;  development  of  ovule  into  seed ;  distinctive  characters  of 
gymnosperms.  Distinctive  characters  of  the  principal  British  natural 
orders,  viz., — Dicotyledons,  Banunculacese,  Cruciferse,  Caryophylleee, 
Leguminosee,  Bosaceee,  Umbelliferee,  Compositee,.  _  Scrophulariacese, 
Labiatse,  Amentacese  ;  Monocotyledons,  Orchidese,  Liliace8e_,  Cyperaceee, 
Gramineae  ;  A  cotyledons,  Eilices,  Musci,  Lichens,  Algae,  Fungi.  (Descrip¬ 
tion  in  technical  language  of  specimens  of  flowering  plants  fo  be  provided 
by  the  examiners.)  Derivation  and  meaning  of  the  following  terms,  and 
demonstration  of  their  application  on  specimens  (provided  by  the  exa¬ 
miners)  : — Thalamifloral,  calycifloral,  corollifloral ;  hypogynous,  perigy- 
nous,  epigynous ;  monandrous,  diandrous,  etc. ;  individual,  variety,  species, 
genus,  order,  class,  kingdom. 

ZOOLOGY. 

General  structure  and  life-history  of  the  following  animals,  as  types  of 
some  of  the  principal  divisions  of  the  animal  kingdom : — Amoeba, 
paramoecium,  hydra,  teenia,  leech,  mussel,  snail,  centipede,  insect, 
lobster,  frog.  Comparative  structure  of  the  digestive  apparatus  (in¬ 
cluding  the  teeth)  in  the  dog,  sheep,  pig,  and  rabbit.  Comparative 
structure  and  actions  of  the  circulating  and  respiratory  organs  in  the 
animals  enumerated  in  the  first  paragraph,  and  also  in  each  of  the  verte- 
brated  classes.  Essential  structure  of  secretory  organs ;  principal  varieties 
in  the  structure  of  the  liver  and  kidney.  General  plan  of  the  nervous 
system  in  mollusca,  arthrozoa,  and  vertebrata.  Proportionate  develop¬ 
ment  of  the  spinal  cord  and  of  the  several  encephalic  centres  in  the 
ascending  series  of  vertebrata.  Bespective  functions  of  those  centres. 
Modes  of  reflex  action.  Outlines  of  the  comparative  history  of  embryonic 
development  in  frog,  bird,  and  mammal. 


III.— PROFESSIONAL  EDUCATION. 


It  is  clear  that  the  main  object  sought  to  be  attained  by 
every  scheme  of  medical  education  should  be  the  prepara¬ 
tion  of  the  student  for  the  duties  of  professional  life.  But 
it  is  equally  clear  that,  with  the  short  time  at  our  disposal, 
it  is  impossible  to  do  more  than  lay  a  solid  foundation  for 
the  future  acquisition  of  knowledge.  It  is  not  possible  for 
a  student  during  his  short  scholastic  career  to  see  every 
form  of  disease  and  to  master  the  mode  of  treating  it. 
Were  it  so,  clinical  Medicine  and  Surgery  might  well  be 
the  only  subjects  taught ;  but  much  must  be  taken  for 


(p)  Candidates  for  this  and  other  botanical  examinations  are  expected 
to  bring  with  them  a  pocket-lens  or  simple  microscope  of  two  powers,  and 
also  a  sharp  penknife. 


Medical  Times  and  Gazette. 


BROFESSIONAL  EDUCATION. 


86pf.  15, 1883.  287 


granted  which  has  never  been  seen — hence  the  necessity 
for  systematic  books  and  lectures.  For  the  same  reason, 
bedside  teaching  should  as  much  as  possible  assume  the 
shape  of  training  in  method,  especially  as  regards  the 
various  steps  to  be  taken  in  coming  to  a  correct  diagnosis  ; 
whilst  experience,  or  the  guidance  of  others,  direct  or 
indirect,  must  teach  the  best  means  of  remedying  the  dis¬ 
eased  condition.  But  before  entering  on  the  practice  of 
his  profession  the  young  medical  man  must  procure  some 
form  of  qualification  which  will  admit  him  to  registration 
as  a  medical  practitioner.  At  the  present  time  there  are 
no  fewer  than  nineteen  bodies  whose  diploma  or  licence 
entitles  the  owner  to  registration.  Moreover,  the  value  of 
these  various  qualifications,  as  indicated  by  the  curriculum 
demanded  and  the  character  of  the  examination,  is  far 
from  being  uniform.  Hence  it  is  that  a  great  cry  has  gone 
out  for  reform  in  this  respect,  especially  as  regards  the 
lowest  qualifications  granted.  And  this  reform  will  un¬ 
doubtedly  come,  though  the  time  is  not  yet.  Meanwhile, 
the  different  licensing  bodies  exist,  and  exact  very  different 
amounts  of  class  attendance,  hospital  practice,  and  even 
months  of  study.  Hence  it  is  that  we  must  enter  on 
the  rules  and  regulations  of  the  various  licensing  bodies 
in  some  detail,  counselling  the  student  to  make  his  course 
of  professional  study  as  broad  and  comprehensive  as  pos¬ 
sible,  lest  at  any  time  he  should  change  his  mind  and 
seek  another  diploma  in  addition  to,  or  instead  of,  that  he 
had  originally  in  view. 

The  following  is  a  list  of  the  various  licensing  bodies, 
with  the  regulations  attaching  to  each : — 

(A.) 

REGULATION'S  OF  BODIES  GRANTING  THE 
DEGREE  OF  DOCTOR  OF  MEDICINE. 


1.  UNIVERSITY  OF  OXFORD. 

DEGREES  IN  MEDICINE. 

Every  student  wishing  to  graduate  in  Medicine  must  have 
resided  as  a  University  student  for  three  years,  and  have 
passed  the  examinations  for  the  degree  of  B.A. ;  and  can 
reckon  the  time  of  his  medical  study  only  from  the  final 
examination  for  Arts. 

1.  Candidates  for  the  degree  of  B.M.  are  required  to  pass 
two  examinations,  each  of  which  is  held  yearly  in  the  end 
of  the  summer  or  Trinity  Term,  due  notice  being  given,  in 
the  usual  manner,  by  the  Regius  Professor  of  Medicine. 

The  subjects  of  the  first  examination  are  Human  Anatomy 
and  Physiology,  Comparative  Anatomy  and  Physiology  to  a 
certain  extent,  and  those  parts  of  Mechanical  Philosophy, 
Botany,  and  Chemistry  which  illustrate  Medicine.  The 
subjects  of  the  second  examination  are  the  Theory  and 
Practice  of  Medicine  (including  Diseases  of  Women  and 
Children),  the  Materia  Medica,  Therapeutics,  Pathology, 
the  Principles  of  Surgery  and  Midwifery,  Medical  Jurispru¬ 
dence,  and  General  Hygiene.  Every  candidate  at  this 
second  examination  will  be  examined  in  two  of  the  ancient 
authors,  Hippocrates,  Aretseus,  Galen,  and  Celsus  ;  or  in  one 
of  those  four,  and  in  some  more  modern  author  approved 
by  the  Regius  Professor,  as  Morgagni,  for  instance, 
Sydenham,  or  Boerhaave,  or  some  German  or  French 
medical  author. 

Before  a  candidate  is  admitted  to  the  first  of  these  two 
examinations,  he  must  have  spent  two  years  in  professional 
studies  after  having  passed  the  examinations  required  for 
the  degree  of  B.A.,  unless  he  was  placed  in  the  first  or  second 
class  in  the  School  of  Natural  Science,  in  which  case,  if  he 
received  from  the  public  examiners  a  special  certificate  of 
his  attainments  in  Physics,  Mechanical  Philosophy,  Chemis¬ 
try,  or  Botany,  he  may  be  admitted  to  this  examination  at 
once,  and  need  not  then  be  examined  again  in  any  science 
specified  in  such  certificate.  Nor,  indeed,  is  he,  by  recent 
decree,  re-examined  in  Physics  or  Chemistry  if  he  has  passed 
the  Natural  Science  school.  If  he  bring  evidence  of  a  first 
or  second  class  in  Biology,  he  may  be  admitted  in  the  same 


way.  But  he  is  equally  examined,  nevertheless,  in  every 
case,  in  Anatomy  and  Physiology. 

Before  a  candidate  is  admitted  to  the  second  examination, 
he  must  have  completed  sixteen  terms  from  the  date  of  the 
same  testamur,  and  two  years  from  the  date  of  his  testamur 
in  the  first  medical  examination,  and  must  deliver  to  the 
Regius  Professor  satisfactory  evidence  of  his  attendance  at 
some  first-class  hospital. 

No  one  from  another  University  can  be  incorporated  as  a 
graduate  in  Medicine  without  passing  these  two  examina¬ 
tions,  as  well  as  having  previously  passed  all  examinations 
for  the  B.A.  degree  at  his  own  University. 

An  examination  in  State  Medicine  and  Public  Health  is 
held  annually.  Candidates  must  have  taken  the  degree  of 
B.M.  at  Oxford. 

2.  A  Bachelor  of  Medicine  wishing  to  proceed  to  the 
degree  of  Doctor  is  required,  three  years  after  taking  the 
B.M.,  to  read  publicly  within  the  precincts  of  the  Schools  , 
in  the  presence  of  the  Regius  Professor,  a  dissertation  com¬ 
posed  by  himself  on  some  medical  subject  approved  by  the 
Professor,  and  to  deliver  to  him  a  copy  of  it. 


2.  UNIVERSITY  OF  CAMBRIDGE. 

Cambridge  is  now  a  complete  school  of  medicine,  and  all 
the  lectures  and  hospital  practice  required  by  the  various 
licensing  authorities  may  be  attended  here.  A  student  may 
live  as  cheaply  as  in  London,  and  there  are  a  vast  number 
of  science  scholarships  to  help  him  on  his  way. 

REGULATIONS  EOR  DEGREES  IN  MEDICINE  AND  SURGERY. 

Degree  of  Bachelor  of  Medicine. — A  student  intending 
to  graduate  in  Medicine  must  have  resided  nine  terms 
(three  academical  years)  in  the  University  as  a  member 
of  a  college  or  as  a  non-collegiate  student,  and  have  gra¬ 
duated  in  Arts,  or  have  passed  the  Previous  Examina¬ 
tion.  This  latter  may  be  passed  in  the  first  term  of 
residence,  or  through  the  “  Local  Examinations  ”  or  the 
“  Oxford  and  Cambridge  School  Board  Examinations,” 
before  coming  up  to  the  University.  By  the  last  course 
time  is  saved,  and  the  student  is  able,  in  his  first  October 
term,  to  join  the  Natural  Science  and  Medical  classes  at 
the  commencement  of  the  several  courses,  and  at  the  com¬ 
mencement  of  the  academical  year.  In  this  case,  instead  of 
graduating  in  Arts,  he  may  pass  out  in  one  of  the  Honour 
Triposes. 

Five  years  of  medical  study  are  required,  unless  the 
student  has  graduated  with  honours  as  Bachelor  of  Arts,  in 
which  case  four  years  of  medical  study  are  deemed  sufficient. 
There  are  three  examinations  for  M.B. 

The  first  examination  is  in — 1.  Chemistry  and  other 
branches  of  Physics;  2.  Botany.  Before  presenting  him¬ 
self  for  it  the  student  must .  have  attended  lectures  on 
Chemistry,  including  manipulations,  and  on  Botany. 

The  second  examination  is  in — 1.  Elements  of  Com¬ 
parative  Anatomy;  2.  Human  Anatomy  and  Physiology; 

3.  Pharmacy.  The  student  must  have  completed  two  years 
of  medical  study,  and  must  also  produce  certificates  of 
attendance  on  lectures  on  the  Elements  of  Comparative 
Anatomy,  on  Human  Anatomy  and  Physiology,  and  on 
Pharmacy ;  and  of  one  year’s  hospital  practice,  and  of  one 
season’s  dissections. 

The  third  examination  is  in — 1.  Pathology  and  Practice 
of  Physic  ;  2.  Clinical  Medicine  ;  3.  Medical  Jurisprudence ; 

4.  Principles  of  Surgery  ;  and  5.  Midwifery.  The  candidate 
must  have  completed  the  course  of  medical  study,  and  must 
produce  certificates  of  attendance  on  one  course  of  lectures 
on  each  of  the  following  subjects  : — Pathological  Anatomy, 
Principles  and  Practice  of  Physic,  Clinical  Medicine,  Clini¬ 
cal  Surgery,  Medical  Jurisprudence,  and  Midwifery,  with 
attendance  on  ten  cases  of  Midwifery;  and  of  having 
attended  the  medical  practice  of  a  hospital  during  three 
years,  and  the  surgical  practice  during  one  year ;  and  of 
having  been  clinical  clerk  for  six  months  at  a  recognised 
hospital,  or  of  having  had  special  charge  of  hospital,  dis¬ 
pensary,  or  union  patients  under  a  qualified  medical  practi¬ 
tioner  ;  and  of  having  acquired  proficiency  in  Vaccination. 

The  third  examination  is  divided  into  two  parts— one 
including  Midwifery  and  the  Principles  of  Surgery,  the 
other  Pathology  and  the  Practice  of  Medicine  and  Medical 
Jurisprudence  ;  and  candidates  are  allowed  to  enter  the 
two  parts  of  th  examination  at  separate  times. 


288 


Medical  Times  and  Gazette. 


PROFESSIONAL  EDUCATION. 


Sept.  15,  1883. 


After  the  third  examination  an  Act  has  to  he  kept,  which 
consists  in  reading  an  original  thesis,  followed  by  a  viv d  voce 
examination  on  the  subject  of  the  thesis,  as  well  as  on 
other  subjects  of  the  Faculty. 

The  Degree  of  Doctor  of  Medicine  may  be  taken  three 
years  after  M.B.  An  Act  has  to  be  kept,  with  viva  voce 
examination,  and  an  essay  has  to  be  written  extempore.  A 
Master  of  Arts  of  four  years’  standing  can  proceed  direct  to 
M.D.  provided  he  produces  the  same  certificates  and  passes 
the  same  examinations  as  for  M.B. 

Degree  of  Bachelor  of  Surgery. — The  candidate  must 
have  passed  all  the  examinations  for  the  degree  of  Bachelor 
of  Medicine,  and  have  attended  the  surgical  practice  of  a 
recognised  hospital  for  two  years,  have  acted  as  Dresser  or 
House-Surgeon  for  six  months,  and  have  gone  through  a 
course  of  instruction  in  Practical  Surgery.  The  subjects  of 
the  examination  are — 1.  Surgical  Operations  and  the  Ap¬ 
plication  of  Surgical  Apparatus  ;  2.  The  Examination  of 
Surgical  Patients. 

Degree  of  Master  in  Surgery. — The  candidate  must  have 
passed  all  the  examinations  for  the  degree  of  Bachelor  of 
Surgery  two  years  previously.  The  subjects  of  the  examina¬ 
tion  are — 1.  Pathology  and  the  Principles  and  Practice  of 
Surgery  ;  2.  Clinical  Surgery  ,•  3.  Surgical  Anatomy  and 
Surgical  Operations. 

All  the  examinations  for  medical  degrees  take  place  in  the 
Michaelmas  and  Easter  Terms. 

For  additional  information  respecting  graduation  in 
Cambridge,  see  the  “  Student’s  Handbook  to  the  University” 
and  the  ‘‘Student’s  Guide  to  the  University,”  published  by 
Messrs.  Deighton,  Cambridge,  price  Is.  6d.  each. 


3.  UNIVERSITY  OF  LONDON. 

BACHELOR  OF  MEDICINE. 

This  University  grants  degrees  both  in  Medicine  and 
Surgery,  and  certificates  in  subjects  relating  to  Public 
Health.  Those  available  for  young  students  are  the 
Bachelorships  of  Medicine  and  Surgery. 

Every  candidate  for  the  degree  of  Bachelor  of  Medicine 
shall  be  required — 

1.  To  have  passed  the  matriculation  examination  in  this 
Unizersity. 

2.  To  have  passed  the  preliminary  scientific  examination 
(see  page  286).  (Candidates  for  the  degree  of  M.B.  are 
strongly  recommended  by  the  Senate  to  pass  the  preliminary 
scientific  examination  before  commencing  their  regular 
medical  studies.) 

3.  To  have  been  engaged  in  his  professional  studies  during 
four  years  subsequently  to  matriculation,  at  one  or  more  of 
the  medical  institutions  or  schools  recognised  by  this  Uni¬ 
versity  ;  one  year,  at  least,  of  the  four  to  have  been  spent  in 
one  or  more  of  the  recognised  institutions  or  schools  in  the 
United  Kingdom. 

4.  To  pass  two  examinations  in  Medicine. 

INTERMEDIATE  EXAMINATION  IN  MEDICINE. 

The  examination  shall  take  place  once  in  each  year,  and 
shall  commence  on  the  last  Monday  in  July. 

No  candidate  shall  be  admitted  to  this  examination  unless 
he  have  passed  the  preliminary  scientific  examination  at 
least  one  year  previously,  and  have  produced  certificates  to 
the  following  effect : — 

1.  Of  having  completed  his  nineteenth  year. 

2.  Of  having,  subsequently  to  having  passed  the  matricu¬ 
lation  examination,  been  a  student  during  two  years  at 
one  or  more  of  the  medical  institutions  or  schools  recog¬ 
nised  by  this  University ;  and  of  having  attended  a  course  of 
lectures  on  each  of  three  of  the  subjects  in  the  following 
list : — Descriptive  and  Surgical  Anatomy,  Physiology 
and  Histology,  Pathological  Anatomy,  Materia  Medica 
and  Pharmacy,  General  Pathology,  General  Thera¬ 
peutics,  Forensic  Medicine,  Hygiene,  Obstetric  Medi¬ 
cine  and  Diseases  peculiar  to  Women  and  Infants, 
Surgery,  Medicine. 

3.  Of  having,  subsequently  to  having  passed  the  matricu¬ 
lation  examination,  dissected  during  two  winter  sessious. 

4.  Of  having,  subsequently  to  having  passed  the  matricu¬ 
lation  examination,  attended  a  course  of  Practical  Che¬ 
mistry,  comprehending  practical  exercises  in  conducting  the 
more  important  processes  of  general  aud  pharmaceutical 


chemistry ;  in  applying  tests  for  discovering  the  adultera¬ 
tion  of  articles  of  the  Materia  Medica,  and  the  presence  and 
nature  of  poisons ;  and  in  the  examination  of  mineral  waters, 
animal  secretions,  urinary  deposits,  calculi,  etc. 

5.  Of  having  attended  to  Practical  Pharmacy,  and  of 
having  acquired  a  practical  knowledge  of  the  preparation  of 
medicines. 

The  fee  for  this  examination  shall  be  £5. 

Candidates  shall  be  examined  in  the  following  subjects :  — 
Anatomy,  Physiology  and  Histology  (candidates  may  be 
required  to  show  their  acquaintance  with  such  parts  of 
Comparative  Anatomy  and  Physiology  as  are  included  in 
the  Examination  in  Zoology  at  the  preliminary  scientific 
examination), (a)  Materia  Medica  and  Pharmaceutical 
Chemistry,  Organic  Chemistry. 

M.B.  EXAMINATION. (b) 

No  candidate  shall  be  admitted  to  the  second  M.B.  exami¬ 
nation  within  two  academical  years  of  the  time  of  his  passing 
the  intermediate  examination,  nor  unless  he  have  produced 
certificates  to  the  following  effect : — 

1.  Of  having  passed  the  intermediate  examination  in 
Medicine. 

2.  Of  having,  subsequently  to  having  passed  the  inter¬ 
mediate  examination,  attended  a  course  of  lectures  on  each 
of  two  of  the  subjects  comprehended  in  the  list  given  above, 
and  for  which  the  candidate  had  not  presented  certificates 
at  the  intermediate  examination. 

3.  Of  having  conducted  at  least  twenty  labours.  (Certi¬ 
ficates  on  this  subject  will  be  received  from  any  legally 
qualified  practitioner  in  medicine.) 

4.  Of  having  attended  the  surgical  practice  of  a  recognised 
hospital  or  hospitals  during  two  years,  with  clinical  instruc¬ 
tion  and  lectures  on  Clinical  Surgery. 

5.  Of  having  attended  the  medical  practice  of  a  recognised 
hospital  or  hospitals  during  two  years,  with  clinical  instruc¬ 
tion  on  and  lectures  on  Clinical  Medicine.  N.B. — The 
student’s  attendance  on  the  surgical  and  on  the  medical 
hospital  practice  may  commence  at  any  date  after  his  passing 
the  preliminary  scientific  examination,  or  three  subjects 
thereof,  and  may  be  comprised  either  within  the  same  year 
or  within  different  years ;  provided  that  in  every  case  his 
attendance  on  surgical  and  medical  hospital  practice  be 
continued  for  at  least  eighteen  months  subsequently  to  his 
passing  the  intermediate  examination.  Attendance  during 
three  months  in  the  wards  of  a  lunatic  asylum  recognised  by 
the  University,  with  clinical  instruction,  may  be  substituted 
for  a  like  period  of  attendance  on  medical  hospital  practice,  (c) 

6.  Of  having,  after  having  attended  surgical  and  medical 
hospital  practice  for  at  least  twelve  months  subsequently  to 
passing  the  intermediate  examination,  attended  to  Practical 
Medicine,  Surgery,  or  Obstetric  Medicine,  with  special  charge 
of  patients,  in  a  hospital,  infirmary,  dispensary,  or  parochial 
union,  during  six  months,  such  attendance  not  to  be  counted 
as  part  of  either  the  surgical  or  the  medical  hospital  practice 
prescribed  in  Clauses  4  and  5. 

7.  Of  having  acquired  proficiency  in  Vaccination.  (Certi¬ 
ficates  on  this  subject  will  be  received  only  from  the 
authorised  vaccinators  appointed  by  the  Privy  Council.) 

The  candidate  shall  also  produce  a  certificate  of  moral 
character  from  a  teacher  in  the  last  school  or  institution  at 
which  he  has  studied,  as  far  as  the  teacher’s  opportunity  of 
knowledge  has  extended. 

The  fee  for  this  examination  shall  be  £5. 

Candidates  shall  be  examined  in  the  following  subjects: 
— General  Pathology,  General  Therapeutics  and 
Hygiene,  Surgery,  Medicine,  Obstetric  Medicine, 
Forensic  Medicine. 


(a)  Any  candidate  shall  be  allowed,  if  he  give  notice  at  the  time  of  regis¬ 
tration,  to  postpone  his  examination  in  Physiology  and.  Histology  from 
the  first  M.B.  examination  at  which  he  presents  himself  for  examination 
in  the  remaining  subjects  until  the  first  M.B.  examination  in  the  next 
or  any  subsequent  year;  but  such  candidate  shall  not  be  admitted  to 
compete  for  honours  on  either  occasion  ;  and  he  shall  not  be  admitted 
as  a  candidate  at  the  second  M.B.  examination  until  after  the  lapse  of  at 
least  twelve  months  from  the  time  of  his  passing  the  examination  in 
Phy.-iology  and  Histology. 

(b)  Any  candidate  for  the  second  M.B.  examination  who  has  passed  the 
first  M.B.  examination  under  the  former  regulations  will  be  required  to 
have  also  passed  the  examination  in  Physiology  at  some  previous  first 
M  B.  examination  carried  on  under  the  present  regulations;  at  which 
examination  he  shall  not  be  allowed  to  compete  for  honours. 

(c)  the  Senate  regard  it  as  highly  desirable  that  candidates  for  tho 
decree  of  M.B.  should  practically  acqua  nt  themselves  with  the  different 
forms  of  insanity  by  attendance  in  a  luna'ic  asylum. 


Medical  Times  and  Gazette. 


PROFESSIONAL  EDUCATION.  sept.  is,  tsss.  289 


The  examinations  shall  include  questions  in  Surgical  and 
Medical  Anatomy,  Pathological  Anatomy,  and  Pathological 
Chemistry. 

BACHELOR  OF  SURGERY. 

No  candidate  shall  he  admitted  to  the  examination  for 
the  degree  of  Bachelor  of  Surgery  unless  he  have  produced 
certificates  to  the  following  effect :  — 

1.  Of  having  passed  the  second  examination  for  the  degree 
of  Bachelor  of  Medicine  in  this  University. 

2.  Of  having  attended  a  course  of  instruction  in  Operative 
Surgery,  and  of  having  operated  on  the  dead  subject. 

The  fee  for  this  examination  shall  be  =£5. 

Candidates  are  examined  in  Surgical  Anatomy  and  surgical 
operations,  by  printed  papers  ;  examination  and  report  on 
cases,  of  surgical  patients ;  performance  of  surgical  operations 
upon  the  dead  subject ;  application  of  surgical  apparatus  ; 
viva,  voce  interrogation. 

MASTER  IN  SURGERY. 

No  candidate  shall  be  admitted  to  this  examination  unless 
he  have  produced  certificates  to  the  following  effect : — 

1.  Of  having  taken  the  degree  of  Bachelor  of  Surgery  (d) 
in  this  University. 

2.  Of  having  attended,  subsequently  to  having  taken  the 
degree  of  Bachelor  of  Surgery  in  this  University — a.  To 
Clinical  or  Practical  Surgery  during  two  years  in  a  hospital 
or  medical  institution  recognised  by  this  University,  b.  Or 
to  Clinical  or  Practical  Surgery  during  one  year  in  a  hospital 
or  medical  institution  recognised  by  this  University ;  and  of 
having  been  engaged  during  three  years  in  the  practice  of 
his  profession,  c.  Or  of  having  been  engaged  during  five 
years  in  the  practice  of  his  profession,  either  before  or  after 
taking  the  degree  of  Bachelor  of  Surgery  in  this  University. 
(One  year  of  attendance  on  Clinical  or  Practical  Surgery,  or 
two  years  of  practice,  will  be  dispensed  with  in  the  case  of 
those  candidates  who  at  the  B.S.  examination  have  been 
placed  in  the  first  division.) 

3.  Of  moral  character,  signed  by  two  persons. 

The  fee  for  the  degree  of  Master  in  Surgery  shall  be  <£5. 

The  subjects  of  examination  are — Logic  and  Psychology, 
by  printed  papers.  Surgery:  a  commentary  on  a  case  in 
Surgery,  by  printed  papers  ;  Surgical  Anatomy  and  Surgery, 
by  printed  papers ;  examination  and  report  on  cases  of 
surgical  patients  in  the  wards  of  a  hospital  ,•  dissection  of  a 
surgical  region  or  performance  of  surgical  operations  ;  viva 
voce  interrogation. 

Any  candidate  who  has  taken  the  degree  either  of  B.A., 
B.Sc.  (provided  that  Mental  and  Moral  Science  was  one 
branch  of  his  examination),  or  M.D.  in  this  University,  is 
exempted  from  the  examination  in  Logic  and  Psychology ; 
and  any  candidate  who  has  passed  the  second  M.B.  exami¬ 
nation  may  at  any  subsequent  M.S.  examination  present 
himself  for  Logic  and  Psychology  alone,  if  he  so  prefer ; 
thereby  gaining  exemption,  if  he  should  pass,  from  examina¬ 
tion  in  that  subject  when  he  presents  himself  to  be  examined 
for  the  degree  of  Master  in  Surgery. 

DOCTOR  OF  MEDICINE. 

No  candidate  shall  be  admitted  to  this  examination  unless 
he  have  produced  certificates  to  the  following  effect : — 

1.  Of  having  passed  the  second  examination  for  the  degree 
of  Bachelor  of  Medicine  in  this  University. 

2.  Of  having  attended,  subsequently  to  having  taken  the 
degree  of  Bachelor  of  Medicine  in  this  University — a.  To 
Clinical  or  Practical  Medicine  during  two  years  in  a  hospital 
or  medical  institution  recognised  by  this  University,  b.  Or 
to  Clinical  or  Practical  Medicine  during  one  year  in  a 
hospital  or  medical  institution  recognised  by  this  University ; 
and  of  having  been  engaged  during  three  years  in  the 
practice  of  his  profession,  c.  Or  of  having  been  engaged 
during  five  years  in  the  practice  of  his  profession,  either 
before  or  after  taking  the  degree  of  Bachelor  of  Medicine  in 
this  University.  (One  year  of  attendance  on  Clinical  or 
Practical  Medicine,  or  two  years  of  practice,  will  be  dispensed 
within  the  case  of  those  candidates  who  at  the  second  M.B. 
examination  have  been  placed  in  the  first  division.) 

3.  Of  moral  character,  signed  by  two  persons. 

(d)  Candidates  who  have  obtained  the  degree  of  Bachelor  of  Medicine 
previously  to  1866  will  be  admitted  to  the  examination  for  the  degree  of 
Master  in  8urgery  without  having  taken  the  degree  of  Bachelor  in  Sur¬ 
gery  ;  and  in  the  case  of  such  candidates,  the  attendance  on  surgical 
practice  may  c.  mmence  from  the  date  of  the  M.B.  degree. 


The  fee  for  the  degree  of  Doctor  of  Medicine  shall  be  £5.(e) 

The  subjects  of  examination  are — Logic  and  Psychology, 
by  printed  papers.  Medicine  :  a  commentary  on  a  case  of 
Medicine  or  Obstetric  Medicine,  at  the  option  of  the  candi¬ 
date,  by  printed  papers ;  Medicine,  by  printed  papers ; 
examination  and  report  on  cases  of  medical  patients  in  the 
wards  of  a  hospital ;  viva  voce  interrogation  and  demonstration 
from  specimens  and  preparations. 

Any  candidate  who  has  taken  the  degree  either  of  B.A., 
B.Sc.  (provided  that  Mental  and  Moral  Science  was  one 
branch  of  his  examination),  or  M.S.  in  this  University, 
is  exempted  from  the  examination  in  Logic  and  Psychology  ; 
and  any  candidate  who  has  passed  the  second  M.B.  exami¬ 
nation  may  at  any  subsequent  M.D.  examination  present 
himself  for  Logic  and  Psychology  alone,  if  he  so  prefer  ; 
thereby  gaining  exemption,  if  he  should  pass,  from  exami¬ 
nation  in  that  subject  when  he  presents  himself  to  be 
examined  for  the  degree  of  Doctor  of  Medicine. 


4.  UNIVERSITY  OF  DURHAM. 

FACULTY  OF  MEDICINE. 

There  are  two  licences  and  three  degrees  conferred—viz., 
a  Licence  in  Medicine  and  a  Licence  in  Surgery,  and  the 
degrees  of  Bachelor  in  Medicine,  Master  in  Surgery,  Doctor 
in  Medicine. 

Attendance  at  the  College  of  Medicine,  Newcastle-on- 
Tyne,  for  one  year  is  considered  equivalent  to  one  year  of 
residence  at  Durham  for  the  degree  of  B.A. 

A  certificate  of  proficiency  in  Sanitary  Science  is  also 
awarded. 

REGULATIONS  FOR  LICENCES  AND  DEGREES. 

For  the  Licences  in  Medicine  and  Surgery  the  same  regu¬ 
lations  must  be  complied  with  as  for  the  degree  of  Bachelor 
in  Medicine,  except  that  no  extra  Arts  examination  is 
required.  The  first  and  second  examinations  for  the  licences 
are  each  held  twice  yearly  at  the  same  time  as  those  for  the 
degree  of  Bachelor  in  Medicine.  The  subjects  of  each 
examination  are  the  same  as  of  the  corresponding  examina¬ 
tion  for  the  degree.  For  the  Licence  in  Surgery  the  second 
examination  is  directed  more  particularly  to  Surgery.  The 
final  examination  for  the  licences  may  be  passed  at  the  same 
time. 

For  the  Degree  of  Bachelor  in  Medicine,  evei’y  candidate 
must  be  not  less  than  twenty-one  years  of  age,  and  must 
produce  certificates  of  age,  of  registration  as  a  student  in 
Medicine  in  the  books  of  the  General  Medical  Council,  of 
good  moral  conduct,  and  of  attendance  on  such  lectiires  and 
hospital  practice  as  the  Warden  and  Senate  require.  (See 
next  page.) 

In  addition  to  the  certificate  of  registration,  the  candidate 
must  produce  one  or  other  of  the  following  certificates : 
—(a)  A  certificate  of  graduation  in  Arts  at  one  of  the 
following  Universities,  viz.  Oxford,  Cambridge,  Durham, 
Dublin,  London,  Queen’s  (Ireland),  Edinburgh,  Glasgow,  St. 
Andrews,  Aberdeen,  Calcutta,  Madras,  Bombay,  the  McGill 
College  (Montreal),  and  Queen’s  College  (Kingston) ;  or 
(b)  a  certificate  of  having  passed  the  preliminary  or  extra¬ 
professional  examination  for  graduation  in  Medicine  at  one' 
of  the  following  Universities,  viz. -.—London,  Edinburgh, 
Glasgow,  St.  Andrews,  Aberdeen,  and  Royal  (Ireland) ; 
or  (c)  a  certificate  of  having  passed  the  preliminary  examina¬ 
tion  in  Arts,  which  until  18S1  qualified  for  the  Fellowship 
of  the  Royal  College  of  Surgeons  of  England,  or  that  now 
qualifying  for  the  membership  of  the  Royal  College  of  Phy¬ 
sicians  of  London  ;  or  (d)  a  certificate  of  having  passed  the 
preliminary  examination  in  Arts  for  the  degrees  in  Medicine 
of  the  University  of  Durham.  This  examination  is  held 
twice  yearly,  in  April  and  September,  at  the  same  time 
as  the  registration  examination.  Application  for  admission 
must  be  made  at  least  one  month  before  the  examination. 
The  fee  will  be  £1,  payable  to  A.  Beanlands,  Esq.,  at  the 
University,  Durham.  Candidates  who,  at  the  commence¬ 
ment  of  their  professional  education,  passed  the  Arts  exa¬ 
mination  for  registration  only,  may  pass  in  the  extra  subjects 
required,  either  before  or  after  presenting  themselves  for 
the  first  examination  for  the  degree,  but  must  do  so  before 
presenting  themselves  for  the  second  examination. 

(e)  This  fee  will  continue  to  be  £10  to  all  such  as,  having  taken  their 
M.B.  degree  under  the  former  regulations,  shall  not  have  paid  the  fee  of 
£5  at  the  Preliminary  Scientific  Examination. 


290 


Medical  Times  and  Gazette. 


PROFESSIONAL  EDUCATION. 


Sept.  15,  1883. 


Each,  candidate  must  have  been  engaged  in  medical  and 
surgical  study  for  four  years  from  the  date  of  his  registration 
as  a  student  of  Medicine.  It  is  necessary  that  one  of  the 
four  years  of  professional  education  shall  be  spent  in  atten¬ 
dance  at  the  College  of  Medicine,  Newcastle-upon-Tyne. 
During  the  year  so  spent,  the  candidate  must  attend  at  least 
two  courses  of  lectures  in  the  winter  session,  and  two  in  the 
summer  session,  together  with  the  class  and  test  examina¬ 
tions  held  in  connexion  with  those  classes,  and  must  also 
attend  medical  and  surgical  hospital  practice,  and  clinical 
lectures  on  Medicine  and  Surgery,  at  the  Infirmary.  Can¬ 
didates  may  fulfil  this  portion  of  the  curriculum  at  anytime 
before  they  present  themselves  for  the  second  examination 
for  the  degree.  They  are  not  required  to  reside  at  Durham. 
They  may  spend  the  other  three  years  of  the  curriculum 
either  at  Newcastle-upon-Tyne,  or  at  one  or  more  of  the 
schools  recognised  by  the  licensing  bodies  named  in  Schedule 
(A)  of  the  Medical  Act,  1858. 

The  course  of  attendance  on  lectures  and  hospital  practice 
before-mentioned  is  the  same  as  that  required  for  the  mem¬ 
bership  of  the  Royal  College  of  Surgeons  of  England, 
together  with  the  following  extra  courses,  viz. : — Botany  and 
Therapeutics,  each  one  course  of  three  months5  duration ; 
Public  Health  and  Medicine,  each  one  course  of  six  months’ 
duration ;  medical  hospital  practice  and  clinical  lectures  on 
Medicine,  each  one  winter  and  one  summer  session. 

There  are  two  professional  examinations — the  first  being 
held  twice  yearly,  viz.,  in  October  and  April ;  and  the  second 
twice  yearly,  in  June  and  December.  The  subjects  of  the 
first  examination  are — Anatomy,  Physiology,  Chemistry,  and 
Botany. 

The  subjects  of  the  second  examination  are — Medicine, 
Surgery,  Midwifery  and  Diseases  of  Women  and  Children, 
Pathology,  Medical  Jurisprudence,  Materia  Medica  and 
Therapeutics,  and  Publie  Health. 

The  first  examination  will  commence  on  October  8,  1883, 
and  on  April  21,  1884.  The  second  examination  will  com¬ 
mence  on  December  3,  1883,  and  on  June  23,  1884. 

Candidates  for  the  first  examination  (for  which  they 
should  present  themselves  at  the  end  of  their  second  winter 
session)  must  produce,  in  addition  to  the  registration  and 
Arts  certificates  above  mentioned,  certificates  of  attendance 
on  two  courses  of  lectures  on  Anatomy,  one  on  Physiology, 
one  on  Theoretical  and  one  on  Practical  Chemistry,  and  one 
on  Botany,  of  twelve  months’  dissection,  and  of  attendance 
on  a  course  of  Practical  Physiology  of  not  less  than  thirty 
demonstrations. 

The  successful  candidates  for  the  first  and  second  exa¬ 
minations  for  the  degree  of  Bachelor  in  Medicine  will  be 
arranged  in  three  classes,  in  the  first  and  second  (honours) 
according  to  merit,  and  in  the  third  (or  pass)  in  alphabetical 
order. 

N.B. — Candidates,  who  have  completed  part  of  their  cur¬ 
riculum  elsewhere,  may  pass  their  first  examination  previous 
to  entering  at  Newcastle,  and  are  recommended  to  commence 
their  year  of  residence  at  Newcastle  at  the  beginning  of  the 
winter  session. 

For  the  Degree  of  Doctor  in  Medicine ,  candidates  must  be 
of  not  less  than  twenty -four  years  of  age,  must  have  obtained 
the  degree  of  Bachelor  in  Medicine,  and  must  have  been 
engaged  for  at  least  two  years  subsequently  to  the  date  of 
acquirement  of  the  degree  of  Bachelor  in  Medicine,  in 
attendance  on  the  practice  of  a  recognised  hospital,  or  in 
the  Military  or  Naval  Services,  or  in  medical  and  surgical 
practice. 

Each  candidate  must  write  an  essay,  based  on  original 
research  or  observation,  on  some  medical  subject,  selected  by 
himself  and  approved  by  the  Professor  of  Medicine,  and 
must  pass  an  examination  thereon,  and  must  be  prepared 
to  answer  questions  on  the  other  subjects  of  his  curriculum 
so  far  as  they  are  related  to  the  subject  of  the  essay.  A 
gold  medal  will  be  awarded  to  the  candidate  who  presents 
the  best  essay  (provided  that  the  essay  is  judged  to  be  of 
sufficient  merit).  The  successful  candidate  will  be  permitted 
to  publish  his  essay.  The  essays  will  be  retained  by  the 
Faculty  of  Medicine. 

F or  the  Degree  of  Master  in  Surgery,  candidates  must  have 
passed  the  examination  for  the  degree  of  Bachelor  in  Medi¬ 
cine,  and  must  have  attended  one  course  of  lectures  on 
Operative  Surgery.  Each  candidate  will  have  an  additional 
paper  on  Surgery,  and  will  have  to  perform  operations  on 
the  dead  body,  and  to  explain  the  use  of  instruments. 


The  examinations  for  the  licences  and  degrees  above- 
named  are  conducted  at  the  College  of  Medicine,  and  in  the 
Infirmary  at  Newcastle.  Candidates  are  examined — 1.  By 
printed  papers  of  questions  ;  2.  Practically;  3.  Vivci  voce. 

Every  candidate  who  intends  to  present  himself  for  any 
of  the  above-named  examinations  must  give  at  least  twenty- 
eight  days’  notice  to  the  Registrar  of  the  College,  and  must, 
at  the  same  time,  send  the  fee,  <£5,  and  the  necessary  certi¬ 
ficates.  If,  after  payment  of  the  fee,  a  candidate  withdraw 
his  name,  or  fail  to  present  himself  at  the  examination,  or 
fail  to  pass  it,  he  shall  not  receive  back  the  fee,  but  shall 
be  allowed  to  enter  for  one  subsequent  examination  of  the 
same  kind  without  the  payment  of  any  additional  fee. 

The  Degree  of  Doctor  of  Medicine,  for  Medical  Practi¬ 
tioners  of  Fifteen  Years’  Standing,  without  Residence. — The 
Warden  and  Senate  of  the  University  of  Durham,  with  the 
view  of  affording  to  practitioners  of  fifteen  years’  standing 
an  opportunity  of  obtaining  the  degree  of  Doctor  of  Medicine, 
have  instituted  a  special  examination,  under  the  following 
regulations  : — 

1.  That  the  candidate  shall  be  registered  by  the  General 
Council  of  Medical  Education  and  Registration  of  the  United 
Kingdom. 

2.  That  the  candidate  shall  have  been  in  the  active  prac¬ 
tice  of  his  profession  for  fifteen  years  as  a  qualified  practi¬ 
tioner. 

3.  That  the  candidate  shall  not  be  under  forty  years  of  age. 

4.  That  the  candidate  shall  produce  a  certificate  of  moral 
character  from  three  registered  members  of  the  medical 
profession. 

5.  That  if  the  candidate  shall  not  have  passed,  previous  to 
his  professional  examination  (in  virtue  of  which  he  has  been 
placed  on  the  Register),  an  examination  in  Arts,  he  shall  be 
required  to  pass  an  examination  in  Classics  and  Mathematics. 
The  subjects  for  this  examination  shall  be  as  follows : — a. 
An  English  essay.  (A  short  essay  on  some  subject  to  be 
specified  at  the  time  of  the  examination.)  h.  Arithmetic. 

c.  Euclid — Books  I.  and  II.  d.  Latin — Translation  from 
Virgil,  “  iEneid,”  Books  I.  and  II.,  together  with  grammati¬ 
cal  questions,  e.  One  of  the  following  subjects  : — (i.)  Greek 
— Translation  from  Xenophon’s  “Memorabilia,”  Books  I., 
II.,  with  grammatical  questions.  (ii.)  French— Transla¬ 
tion  from  Voltaire’s  “  Charles  XII.,”  with  grammatical 
questions,  (iii.)  German — Translation  from  Goethe’s  “  Dich- 
tung  und  Wahrheit,”  Book  I.,  with  grammatical  ques¬ 
tions.  (iv.)  Elements  of  Mechanics,  Pneumatics,  and 
Hydrostatics,  (v.)  Some  treatise  on  Moral,  Political,  or 
Metaphysical  Philosophy. 

6.  That  if  the  candidate  shall  have  passed,  previous  to  his 
professional  examination  (in  virtue  of  which  he  has  been 
placed  on  the  Register),  a  preliminary  examination,  he  shall 
be  required  to  translate  into  English  passages  in  any  of  the 
parts  specified  below  of  any  one  of  the  Latin  authors  men¬ 
tioned — Caesar,  “  De  Bello  Gallico,”  first  three  books ;  Virgil, 
first  three  books  of  the  “  iEneid  ” ;  Celsus,  first  three  books. 
The  candidate  shall  have  an  opportunity  of  showing  pro¬ 
ficiency  in  Greek,  Moral  Philosophy,  or  some  modern 
Language. 

7.  That  the  candidate  shall  be  required  to  pass  an  exa¬ 
mination  in  the  following  subjects  :■ — a.  Principles  and 
Practice  of  Medicine,  including  Psychological  Medicine  and 
Hygiene,  b.  Principles  and  Practice  of  Surgery,  c.  Mid¬ 
wifery,  and  Diseases  peculiar  to  Women  and  Children. 

d.  Pathology,  medical  and  surgical,  e.  Anatomy,  medical 
and  surgical.  /.  Medical  Jurisprudence  and  Toxicology. 
g.  Therapeutics. 

8.  That  the  fee  shall  be  £52  10s. 

9.  That  if  the  candidate  shall  fail  to  satisfy  the  examiners 
the  sum  of  <£21  shall  be  retained  ;  but  that  if  he  shall  again 
offer  himself  for  the  examination  the  sum  of  £42  only  shall 
then  be  required. 

An  examination  in  accordance  with  the  above  regulations 
will  commence  on  December  3,  1883,  and  on  June  23,  1884, 
in  the  College  of  Medicine,  Newcastle-upon-Tyne. 

Gentlemen  intending  to  offer  themselves  as  candidates  are 
requested  to  forward  their  names  to  Dr.  Luke  Armstrong, 
Registrar  of  the  University  of  Durham  College  of  Medicine, 
Newcastle-upon-Tyne,  on  or  before  November  1,  1883,  or 
May  1, 1884,  together  with  the  fee  and  the  before-mentioned 
certificates. 

FEES. 

For  registration  esamination,  £1  ;  extraordinary  regis- 


Medical  Times  and  Gazette. 


PROFESSIONAL  EDUCATION. 


Sept.  15,  1S8\  291 


t-ration  examination,  £2 ;  preliminary  Arts  examination  for 
degrees,  £1 ;  examination  for  first  year  students,  10s. ;  each, 
public  examination  for  a  licence  or  degree  in  Medicine  or  in 
Surgery,  £5 ;  a  licence  in  Medicine,  <£3 ;  a  licence  in  Sur¬ 
gery,  <£3 ;  a  degree  of  Master  in  Surgery,  £Q ;  a  degree  of 
Bachelor  in  Medicine,  <£6 ;  a  degree  of  Doctor  in  Medicine, 
<£6,  and  for  practitioners  of  fifteen  years’  standing,  =£52  10s.  ; 
a  certificate  in  Sanitary  Science,  £5  5s.,  and  for  Medical 
Officers  of  Health,  =£10  10s. 

The  Registrar  or  Secretary  will  be  happy  to  give  any 
information  either  to  students  or  their  friends.  Applications 
with  regard  to  examinations  should  be  made  to  the  Regis¬ 
trar,  Dr.  Luke  Armstrong,  Clayton-street  West,  Newcastle- 
upon-Tyne;  all  others  to  the  Secretary,  Mr.  Henry  E. 
Armstrong,  College  of  Medicine,  Newcastle-upon-Tyne. 


SCOTTISH  UNIVERSITIES. 

5.  UNIVERSITY  OF  ST.  ANDREWS. 

ORDINARY  DEGREES. 

The  degrees  in  Medicine  granted  by  the  University  of 
St.  Andrews  are  those  of  Bachelor  of  Medicine  and  Master 
in  Surgery  (M.B.and  C.M.)  and  Doctor  of  Medicine  (M.D.). 

The  preliminary  examination  and  professional  curriculum 
and  examinations  for  these  degrees  are  generally  the  same 
as  those  of  the  Universities  of  Edinburgh,  Aberdeen,  and 
Glasgow.  The  following  regulations,  however,  for  candi¬ 
dates  for  the  degree  of  Bachelor  of  Medicine  and  Master  in 
Surgery  present  some  difference  : — 

No  one  shall  be  received  as  a  candidate  for  the  degree  of 
Bachelor  of  Medicine  and  Master  in  Surgery  unless  two 
years  at  least  of  his  four  years  of  medical  and  surgical  study 
shall  have  been  in  one  or  more  of  the  following  universities 
and  colleges,  viz.: — The  University  of  St.  Andrews;  the 
University  of  Glasgow ;  the  University  of  Aberdeen ;  the 
University  of  Edinburgh ;  the  University  of  Oxford  ;  the 
University  of  Cambridge;  Trinity  College,  Dublin  ;  Queen’s 
College,  Belfast  ;  Queen’s  College,  Cork ;  and  Queen’s 
College,  Galway. 

The  remaining  years  of  medical  and  surgical  study  may 
be  either  in  one  or  more  of  the  universities  'and  colleges 
above  specified,  or  in  the  hospital  schools  of  London,  or  in 
the  School  of  the  College  of  Surgeons  in  Dublin,  or  under 
such  private  teachers  of  medicine  as  may  from  time  to  time 
receive  recognition  from  the  University  Court. 

Attendance  on  the  lectures  of  any  private  teacher  in 
Edinburgh,  Glasgow,  or  Aberdeen  shall  not  be  reckoned  for 
graduation  in  St.  Andrews  if  the  fee  for  such  lectures  be  of 
less  amount  than  is  charged  for  the  like  course  of  lectures 
in  the  University  of  Edinburgh,  of  Glasgow,  or  of  Aberdeen, 
according  as  the  teacher  lectures  in  Edinburgh,  Glasgow, 
or  Aberdeen. 

Fees  for  Graduation. — For  the  degree  of  Bachelor  of 
Medicine  and  Master  in  Surgery  £7  in  respect  of  each  of 
the  three  divisions  of  the  examination  on  professional  sub¬ 
jects  ;  and  every  candidate  for  the  degree  of  Doctor  of  Medi¬ 
cine,  who  has  previously  obtained  the  degree  of  Bachelor 
of  Medicine  and  Master  in  Surgery,  shall  pay,  in  addi¬ 
tion  to  the  fees  paid  by  him  as  a  candidate  for  that  degree, 
a  fee  of  <£5  5s.,  exclusive  of  any  stamp  duty  which  may  for 
the  time  be  exigible. 

SPECIAL  DEGREES. 

The  degree  of  Doctor  of  Medicine  may  be  conferred  by 
the  University  of  St.  Andrews  on  any  registered  medical 
practitioner  above  the  age  of  forty  years,  whose  professional 
position  and  experience  are  such  as,  in  the  estimation  of  the 
University,  entitle  him  to  that  degree,  and  who  shall,  on 
examination,  satisfy  the  medical  examiners  of  the  sufficiency 
of  his  professional  knowledge  ;  provided  always,  that  degrees 
shall  not  be  conferred  under  this  section  to  a  greater  number 
than  ten  in  any  one  year. 

Regulations  regarding  the  Examination  of  Registered  Medi¬ 
cal  Practitioners  above  the  Age  of  Forty  Years. — The  exa¬ 
minations  are  held  yearly,  towards  the  end  of  April.  The 
graduation  fee  is  <£52  10s.  Candidates,  whose  certificates 
are  approved  of  by  the  Medical  Faculty,  are  enrolled  for 
examination  in  order  of  application,  provided  they  have 
complied  with  the  undermentioned  regulations  as  to  certi¬ 
ficates  and  deposit.  Candidates  for  graduation  shall  lodge 
with  the  Professor  of  Medicine  the  following  certificates 


and  deposit,  along  with  their  application  for  admission  to 
examination: — 1.  Certificate  of  age  from  parish  registrar, 
or  by  affidavit  before  a  magistrate.  2.  At  least  three  cer¬ 
tificates  from  medical  men,  of  such  acknowledged  reputation 
in  the  profession,  or  of  such  standing  in  the  medical  schools, 
as  shall  satisfy  the  Senatus  of  the  professional  position  and 
experience  of  the  candidate.  3.  A  certain  portion  (viz., 
<£10  10s.)  of  the  graduation  fee  shall  be  forfeited  should  the 
candidate  fail  to  appear  at  the  time  appointed  for  examina¬ 
tion,  or  should  he  fail  to  graduate.  4.  The  examination 
shall  be  conducted  both  in  writing  and  viva  voce,  and 
shall  include  the  following  subjects  : — (1)  Materia  Medica 
and  General  Therapeutics ;  (2)  Medical  Jurisprudence : 
(3)  Practice  of  Medicine  and  Pathology ;  (4)  Surgery ; 
(5)  Midwifery,  and  Diseases  of  Women  and  Children. 


6.  UNIVERSITY  OF  EDINBURGH. 

Three  medical  degrees  are  conferred  by  the  University  of 
Edinburgh,  viz..  Bachelor  of  Medicine  (M.B.),  Master  in 
Surgery  (C.M.),  and  Doctor  of  Medicine  (M.D.).  The 
degree  of  Master  in  Surgery  is  not  conferred  on  any  person 
who  does  not  at  the  same  time  obtain  the  degree  of  Bachelor 
of  Medicine.  All  candidates  for  these  degrees  must  give 
evidence  of  having  obtained  a  satisfactory  general  education. 

PRELIMINARY  EXAMINATION  IN  GENERAL  EDUCATION. 

I.  The  preliminary  branches  of  extra-professional  educa¬ 
tion  are  English,  Latin,  Arithmetic,  the  elements  of  Mathe¬ 
matics,  and  the  elements  of  Mechanics ;  and  the  proficiency 
of  students  in  these  branches  is  ascertained  by  examination, 
prior  to  the  commencement  of  their  medical  study. 

II.  No  candidate  is  admitted  to  a  professional  examination^ 
who  has  not  passed  a  satisfactory  examination  on  at  least 
two  of  the  following  subjects  (in  addition  to  the  subjects 
mentioned  above) : — Greek,  French,  German,  higher  Mathe-  - 
matics.  Natural  Philosophy,  Logic,  Moral  Philosophy ;  and 
the  examination  on  these  latter  subjects  also  takes  place 
before  the  candidate  has  entered  on  his  medical  curriculum. 

III.  A  degree  in  Arts  (not  being  an  honorary  degree)  in 
any  one  of  the  universities  of  England,  Scotland,  or  Ire-  - 
land,  or  in  any  colonial  or  foreign  university  specially 
recognised  for  this  purpose  by  the  University  Court,  exempts 
from  all  ^preliminary  examination ;  and  an  examination  in 
Arts  by  any  corporate  body,  whose  examination  has  been 
recognised  as  qualifying  for  entrance  on  medical  study  by 
resolution  of  the  General  Medical  Council  of  the  United 
Kingdom,  provided  the  said  examination  by  the  said  cor¬ 
porate  body  shall  be  also  approved  by  the  University  Court,, 
shall  exempt,  pro  tanto,  from  preliminary  examination  in 
Arts,  on  the  subjects  comprised  in  the  said  examination  of 
the  said  corporate  body. 

PROFESSIONAL  EDUCATION  AND  EXAMINATION. 

IV.  No  one  is  admitted  to  the  degrees  of  Bachelor  of  Medi¬ 
cine  and  Master  in  Surgery  who  has  not  been  engaged  in 
medical  and  surgical  study  for  four  years — the  medical  session 
of  each  year,  or  annus  medicus,  being  constituted  by  at  least’ 
two  courses  of  not  less  than  one  hundred  lectures  each,  or  by. 
one  such  course,  and  two  courses  of  not  less  than  fifty  ’ 
lectures  each  ;  with  the  exception  of  the  clinical  courses,  in  ’ 
which  lectures  are  to  be  given  at  least  twice  a  week  during*' 
the  prescribed  periods. 

V.  Every  candidate  for  the  degrees  of  M.B.  and  C.M.- 
must  give  sufficient  evidence  by  certificates  (a) — 

1.  That  be  has  studied  each  of  the  following  departments  of  medical 
science— viz.,  Anatomy,  Chemistry,  Materia  Medica,  Institutes  of  Medicine 
or  Physiology,  Practice  of  Medicine,  Surgery,  Midwifery  and  the  Diseases 
peculiar  to  Women  and  Children  (two  courses  of  Midwifery  of  three 
months  each  being  reckoned  equivalent  to  a  six  months’  course,  provided 
different  departments  of  Obstetric  Medicine  he  taught  in  each  of  the 
eourses),  General  Pathology  (or,  in  schools  where  there  is  no  such  course, 
a  three  months’  course  of  lectures  on  Morbid  Anatomy,  together  with  a 
supplemental  course  of  Practice  of  Medicine  or  Clinical  Medicine),  during 
courses  including  not  less  than  one  hundred  lectures  ;  Practical  Anatomy, 
a  course  of  the  same  duration  as  those  of  not  less  than  one  hundred  lectures 
above  described ; (b )  Practical  Chemistry,  three  months;  Practical  Mid- 


fad  No  course  of  lectures  will  be  allowed  to  qualify  unless  the  lecturer 
certifies  that  it  has  embraced  at  least  one  hundred  lectures,  or  fifty  lec¬ 
tures  in  conformity  with  the  requirements  of  this  sec  ion.  Tfiree  months’ 
courses  on  Materia  Medica,  Pathology,  and  Midwifery  do  not  qua  ify. 

(b)  Certificates  of  attendance  on  Practical  Anatomy  must  express  not 
only  tbe  number  of  months  engaged  in  dissection,  but  the  names  of  the 
parts  dissected,  and  the  degree  of  care  with  which  the  dissections  have 
been  made.  Students  are  recommended  not  to  appear  for  an  examina¬ 
tion  in  Anatomy  with  a  view  to  a  degree  until  they  have  dissected  the 
human  body  at  least  once. 


292 


Medical  Times  and  Gazette. 


PROFESSIONAL  EDUCATION. 


Sept.  15, 1883. 


wifery,  three  months  at  a  midwifery  hospital,  or  a  certificate  of  attend¬ 
ance  on  six  cases  from  a  registered  medical  practitioner ;  Clinical  Medi¬ 
cine,  Clinical  Surgery,  (c)  courses  of  the  same  duration  as  those  of  not  less 
than  one  hundred  lectures  above  prescribed,  or  two  courses  of  three 
months’  lectures  being  given  at  least  twice  a  week  Medical  J urisprudence, 
Botany,  Natural  History  (including  Zoology),  during  courses  including  not 
less  than  fifty  lectures. 

2.  That  he  has  attended  for  at  least  two  years  the  medical  and  surgical 
practice  of  a  general  hospital  which  accommodates  not  fewer  than  eighty 
patients,  and  possesses  a  distinct  staff  of  physicians  and  surgeons. 

3.  That  he  has  attended  during  a  course  of  not  less  than  fifty  hours’ 
instruction  the  class  of  Practical  Materia  Medica  in  the  University  of 
Edinburgh,  or  a  similar  class  conducted  in  a  university  or  recognised 
school  of  medicine,  or  a  similar  class  conducted  by  a  teacher  recognised 
by  the  University  Court ;  or  that  he  has  been  engaged,  for  at  least  three 
months,  by  apprenticeship  or  otherwise,  in  compounding  and  dispensing 
drugs  at  the  laboratory  of  a  hospital,  dispensary,  member  of  a  surgical 
college  or  faculty,  licentiate  of  the  London  or  Dublin  Society  of  Apothe¬ 
caries,  or  a  member  of  the  Pharmaceutical  Society  of  Great  Britain. 

4.  That  he  has  attended  for  at  least  six  months,  by  apprenticeship  or 

otherwise,  the  out-practice  of  a  hospital,  or  the  practice  of  a  dispensary, 
physician,  surgeon,  or  member  of  the  London  or  Dublin  Society  of 
Apothecaries,  (d)  ' 

YI.  The  studies  of  candidates  for  the  degrees  of  Bachelor 
of  Medicine  and  Master  in  Surgery  are  subject  to  the 
following  regulations  :  — 

1.  One  of  the  four  years  of  medical  and  surgical  study,  required  by 
Section  IV.,  must  be  in  the  University  of  Edinburgh. 

2.  Another  of  such  four  years  of  medical  and  surgical  study  must  be 
either  in  the  University  of  Edinburgh,  or  in  some  other  university  entitled 
to  give  the  degree  of  Doctor  of  Medicine. 

3.  Attendance  during  at  least  six  winter  (months  on  the  medical  or 
surgical  practice  of  a  general  hospital  which  accommodates  at  least  eighty 
patients,  and,  during  the  same  period,  on  a  course  of  Practical  Anatomy, 
may  be  reckoned  as  one  of  such  four  years,  and  to  that  extent  shall  be 
held  equivalent  to  one  year’s  attendance  on  courses  of  lectures  as  above 
prescribed. 

4.  One  year’s  attendance  on  the  lectures  of  teachers  of  Medicine  in  the 
hospital  schools  of  London,  or  in  the  school  of  the  College  of  Surgeons  in 
Dublin,  or  of  such  teachers  of  Medicine  in  Edinburgh  or  elsewhere  as  shall 
from  time  to  time  be  recognised  by  the  University  Court,  may  be  reckoned 
as  one  of  such  four  years,  and  to  that  extent  shall  be  held  as  attendance 
on  courses  of  lectures  as  above  prescribed. 

5.  Candidates  may,  to  the  extent  of  four  of  the  departments  of  medical 
study  required  by  Section  V.,  Sub-section  1,  attend  in  such  year  or  years  of 
their  medical  and  surgical  studies,  as  may  be  most  convenient  to  them,  the 
lectures  of  the  teachers  of  Medicine  specified  in  the  foregoing  Sub-section  4. 
Students  of  Medicine  in  the  London  Schools  and  in  the  School  of  the 
College  of  Surgeons  in  Dublin  can  obtain  there  two  anni  medici  out  of  the 
four  required  for  the  Edinburgh  degrees  in  Medicine.  Courses  of  lectures 
in  these  schools  are  regarded  as  equivalent  to  lectures  on  the  correspond¬ 
ing  subjects  in  this  University,  except  Materia  Medica  and  Midwifery, 
which,  being  only  three  months’  courses  in  them,  are  not  equivalent.  One 
annus  medicus  may  be  constituted  by  attendance  on  Practical  Anatomy 
and  Hospital  Practice  during  the  winter  session.  Another  annus  medicus 
by  attending  either  (a)  full  winter  courses  on  any  two  of  the  following 
subjects  Anatomy,  Physiology,  Chemistry,  Pathology,  Surgery,  Medi¬ 
cine,  Clinical  Surgery,  Clinical  Medicine ;  or  (6)  on  one  such  course  and 
two  three  months’  courses  on  any  two  of  the  following  subjects — Botany, 
Practical  Chemistry,  Natural  History,  Medical  Jurisprudence.  If  the 
student  selects  the  arrangement  prescribed  in  (a),  attendance  on  a  third 
course,  although  unnecessary  to  constitute  an  annus,  will  also  be  accepted. 
The  other  subjects,  and  the  additional  courses,  not  given  in  London  or 
Dublin,  necessary  for  the  degrees  of  the  University,  will  require  to  be 
attended  at  this  University.  In  provincial  schools,  where  there  are  no 
lecturers  recognised  by  the  University  Court,  a  candidate  can  have  only 
one  annus  medicus,  and  this  is  constituted  by  attendance  on  a  qualified 
hospital  along  with  a  course  of  Practical  Anatomy.  (Butin  a  provincial 
school  'where  there  are  two  or  more  lecturers  recognised  by  this  Univer¬ 
sity,  a  second  annus  medicus  may  be  made  by  attendance  on  at  least  two 
six  months’,  or  one  six  months’  and  two  three  months’  recognised  courses.) 

6.  All  candidates  not  students  of  the  University  availing  themselves  of 
the  permission  to  attend  the  lectures  of  extra-academical  teachers  in  Edin¬ 
burgh  must,  at  the  commencement  of  each  year  of  such  attendance,  enrol 
their  names  in  a  book  to  be  kept  by  the  University  for  that  purpose,  pay¬ 
ing  a  fee  of  the  same  amount  as  the  matriculation  fee  paid  by  students  of 
the  University,  and  having,  in  respect  of  such  payment,  a  right  to  the  use 
of  the  library  of  the  University. 

7.  The  fee  for  attendance  on  the  lectures  of  an  extra-academical 
teacher  in  Edinburgh,  with  a  view  to  graduation,  must  be  of  the  same 
amount  as  that  exigible  by  medical  professors  in  the  University. 

8.  No  teacher  is  recognised  who  is  at  the  same  time  a  teacher  of  more 
than  one  of  the  prescribed  branches  of  study,  except  in  those  cases  where 
professors  in  the  University  are  at  liberty  to  teach  two  branches. 

9.  It  is  not  necessary  for  any  teacher,  attendance  on  whose  lectures 
was  recognised  before  1861  for  the  purposes  of  graduation  in  the  Uni¬ 
versity,  to  obtain  a  new  recognition  from  the  University  Court;  and 
attendance  on  the  lectures  of  every  such  teacher  will  continue  to  be 
recognised  as  heretofore. 

10.  It  is  in  the  power  of  the  University  Court,  if  they  shall  see  cause, 
at  any  time  to  withdraw  or  suspend  the  recognition  of  any  teacher  or 
teachers. 

VII.  Every  candidate  must  deliver,  before  March  31  of  the 
year  in  which  he  proposes  to  graduate,  to  the  Dean  of  the 
Faculty  of  Medicine — 

1.  A  declaration,  in  his  own  handwriting,  that  he  has  completed  his 
twenty-first  year  (or  that  he  will  have  done  so  on  or  before  the  day  of 
graduation),  and  that  he  will  not  be,  on  the  day  of  graduation,  under 


(c)  Tbe  Faculty  of  Medicine  recommend  that  medical  students  should 
not  attend  clinical  surgery  during  their  first  six  months’  attendance  on 
clinical  medicine. 

(d)  Practical  Pharmacy,  dispensary,  hospital  practice,  and  vaccination 
are  not  reckoned  as  classes  in  making  up  an  annus  medicus. 


articles  of  apprenticeship  to  any  surgeon  or  other  master.  (This  declara¬ 
tion,  along  with  a  statement  of  studies,  is  appended  to  the  schedule  for 
the  final  examination,  and  must  be  signed  before  the  schedule  is  given  in.) 

2.  A  statement  of  his  studies,  as  well  in  Literature  and  Philosophy  as  in 
Medicine,  accompanied  with  proper  certificates. 

VIII.  Each  candidate  is  examined,  [both,  in  writing  and 
v ivci  voce — first,  on  Chemistry,  Botany, and  Natural  History; 
secondly,  on  Anatomy,  Institutes  of  Medicine,  Materia  Medica 
(including  Practical  Pharmacy),  and  Pathology;  thirdly,  on 
Surgery,  Practice  of  Medicine,  Midwifery,  and  Medical  Juris¬ 
prudence  ;  fourthly,  clinically  on  Medicine  and  on  Surgery 
in  a  hospital.  The  examinations  on  Anatomy,  Chemistry, 
Institutes  of  Medicine,  Botany,  Natural  History,  Materia 
Medica,  and  Pathology  are  conducted,  as  far  as  possible,  by 
demonstrations  of  objects  placed  before  the  candidates. 

IX.  Students  who  profess  themselves  ready  to  submit  to 
an  examination  in  the  first  division  of  these  subjects,  at  the 
period  of  examination  immediately  preceding  their  second 
winter  session  of  professional  study  may  be  admitted  to 
examination  at  that  time :  provided  always,  that  students 
who  commence  their  medical  studies  in  the  summer  session 
shall  not  be  admitted  to  a  degree  in  Medicine  unless  their 
course  of  study,  subsequent  to  the  completion  of  the  sum¬ 
mer  session  in  which  they  commence  their  medical  studies, 
shall  not  be  less  than  the  minimum  course  of  four  years 
prescribed  in  Section  IY. 

X.  Students  who  have  passed  their  examination  on  the 
first  division  of  these  subjects  may  be  admitted  to  examina¬ 
tion  on  the  second  division  at  the  end  of  their  third  year. 

XI.  The  examination  on  the  third  and  fourth  divisions 
cannot  take  place  until  the  candidate  has  completed  his 
fourth  annus  medicus. 

XII.  Candidates  may,  if  they  choose,  be  admitted  to  exa¬ 
mination  on  the  first  two  of  these  divisions  at  the  end  of  their 
third  year,  or  to  the  four  examinations  at  the  end  of  their 
fourth  year. 

XIII.  If  any  candidate  at  these  examinations  be  found 
unqualified,  he  cannot  be  again  admitted  to  examination 
unless  he  has  studied,  during  another  year,  two  of  the 
prescribed  subjects,  either  in  the  University  or  in  some  other 
school  of  medicine. 

The  degree  of  Doctor  of  Medicine  may  be  conferred  on  any 
candidate  who  has  obtained  the  degrees  of  Bachelor  of  Medi¬ 
cine  and  Master  in  Surgery,  and  is  of  the  age  of  twenty-four 
years,  and  produces  a  certificate  of  having  been  engaged, 
subsequently  to  his  having  received  the  degrees  of  Bachelor 
of  Medicine  and  Master  in  Surgery,  for  at  least  two  years  in 
attendance  on  a  hospital,  or  in  the  Military  or  Naval  Medi¬ 
cal  Services,  or  in  medical  and  surgical  practice ;  provided 
always  that  the  degree  of  Doctor  of  Medicine  shall  not  be 
conferred  on  any  person,  unless  he  be  a  graduate  in  Arts  of 
one  of  the  universities  of  England,  Scotland,  or  Ireland, 
or  of  such  other  universities  as  are  above  specified,  or 
unless  he  shall,  before  or  at  the  time  of  his  obtaining 
the  degrees  of  Bachelor  of  Medicine  and  Master  in  Sur¬ 
gery,  or  thereafter,  have  passed  a  satisfactory  examination 
in  Greek,  and  in  Logic  or  Moral  Philosophy,  and  in  one  at 
least  of  the  following  subjects — namely,  French,  German, 
higher  Mathematics,  and  Natural  Philosophy ;  and  provided 
also  that  the  candidate  for  the  degree  of  Doctor  of  Medicine 
shall  submit  to  the  Medical  Faculty  a  thesis,  certified  by 
him  to  have  been  composed  by  himself,  and  which  shall  be 
approved  by  the  Faculty,  on  any  branch  of  knowledge  com¬ 
prised  in  the  professional  examinations  for  the  degree  of 
Bachelor  of  Medicine  and  Master  in  Surgery,  which  he  may 
have  made  a  subject  of  study  after  having  received  those 
degrees.  The  candidate  must  lodge  his  thesis  with  the 
Dean  on  or  before  April  30  of  the  year  in  which  he  proposes 
to  graduate.  ‘  No  thesis  will  be  approved  by  the  Medical 
Faculty  which  does  not  contain  either  the  results  of  original 
observations  in  Practical  Medicine,  Surgery,  Midwifery,  or 
some  of  the  sciences  embraced  in  the  curriculum  for  the 
Bachelor’s  and  Master’s  degrees ;  or  else  a  full  digest  and 
critical  exposition  of  the  opinions  and  researches  of  others 
on  the  subject  selected  by  the  candidate,  accompanied  by 
precise  references  to  the  publications  quoted,  so  that  due 
verification  may  be  facilitated. 

Candidates,  settled  for  a  period  of  years  in  foreign  parts, 
who  have  complied  with  all  the  regulations  for  the  degree  of 
M.D.  (under  the  new  statutes),  but  who  cannot  appear  per¬ 
sonally  to  receive  the  degree,  may,  on  satisfying  the  Senatus 
to  that  effect,  by  production  of  sufficient  official  testimonials, 
have  the  degree  conferred  on  them  in  absence. 


Medical  Times  and  Gazette. 


PROFESSIONAL  EDUCATION. 


Sept.  15, 1883.  293 


Persons  who  began  their  medical  studies  before  February  4, 
1861,  are  entitled  to  graduate  under  the  system  in  force  before 
or  after  that  date,  according  as  they  may  comply  with  the 
regulations  in  force  in  the  University  before  or  after  that  date. 

The  fees  are— for  the  degree  of  M.B.  and  C.M.,  ,£22 ; 
for  the  degree  of  M.D.,  £5  5s.  additional  to  that  for  M. B., 
exclusive  of  £10  Government  stamp.  The  fees  for  M.D.  are 
required  to  be  paid  on  or  before  July  15  in  the  year  of 
graduation.  Total  fees  and  stamp  for  graduating  as  M.D. 
only,  by  regulations,  for  students  commencing  before  Feb¬ 
ruary,  1861,  £26.  The  above  fees  include  all  charges  for 
the  diplomas. 

RIGHTS  OF  THE  MEDICAL  GRADUATES  OF  SCOTLAND 
ACCORDING  TO  THE  MEDICAL  ACT. 

Before  the  passing  of  the  Medical  Act  of  1858,  the  degree 
of  Doctor  of  Medicine,  granted  by  the  universities  of  Scot¬ 
land  (as  the  possessor  underwent  a  complete  education  and 
examination  in  all  departments  of  Physic  and  Surgery), 
qualified  the  graduate  to  practise  every  branch  of  the 
medical  profession  throughout  Scotland.  One  principal 
purpose  of  the  Medical  Act  was  to  extend  local  rights  of 
practice  over  the  whole  of  Her  Majesty’s  dominions.  But, 
according  to  the  hitherto  accepted  reading  of  a  dubious 
clause  in  the  Act,  no  one  can  practise  both  Medicine  and 
Surgery  without  possessing  two  distinct  diplomas — one  for 
Medicine,  and  another  for  Surgery.  The  universities  were 
thus  compelled,  in  justice  to  their  graduates,  to  give  them 
the  additional  title  of  Master  in  Surgery,  not  as  implying 
any  additional  study  or  examination,  but  as  declaring  more 
distinctly  their  qualifications,  and  to  permit  registration  as 
regularly  qualified  practitioners  in  the  whole  field  of  their 
professional  education.  The  Secretary  for  War  some  time 
ago  issued  an  order  that  candidates  for  admission  into  the 
Medical  Service  of  the  Army  should  obtain  their  qualifica¬ 
tions  in  Physic  and  Surgery  from  two  different  sources  ;  the 
effect  of  which  would  have  been  to  prevent  any  one  univer¬ 
sity  from  qualifying  for  this  purpose.  The  Scottish  Uni¬ 
versities’  Commissioners,  recognising  the  serious  evils  of 
such  a  system,  followed  up  a  remonstrance  which  had  been 
offered  on  the  part  of  the  University  of  Edinburgh,  and 
obtained  the  rescinding  of  all  restrictions  in  the  source  of 
qualification.  Consequently,  any  single  university  in  Scot¬ 
land  can  now  qualify  candidates  for  the  military  service  as 
well  as  for  any  other  public  medical  service  in  the  country. 

ARRANGEMENTS  FOR  THE  PRELIMINARY  EXAMINATIONS  IN 
GENERAL  EDUCATION. 

The  preliminary  examinations  in  general  education  are 
held  in  the  Upper  Library  Hall,  and  students  matriculated 
for  the  academic  year  (November  to  November)  are  admitted 
on  presenting  their  matriculation  tickets  at  the  door.  Stu¬ 
dents  matriculated  for  the  summer  only  and  non-matricu- 
lated  students  pay  a  fee  of  10s.  each,  and  are  admitted  on 
showing  their  receipts.  Those  who  pay  the  fee  in  March 
will  be  admitted  to  the  examination  in  October  without 
further  payment.  Payment  in  October  does  not  exempt 
from  payment  in  March.  The  academic  year  is  reckoned 
from  November  1  to  November  1. 

Candidates  are  required  to  enter  their  names  in  full,  and 
at  the  same  time  to  mention  the  subject  or  subjects  in  which 
they  offer  themselves  for  examination.  They  are  also  required 
to  state  whether  they  have  appeared  for  any  preliminary  or 
professional  examinations  at  this  University. 

Any  candidate  who  cannot  appear  personally  at  the  time 
fixed  to  enter  his  name  and  pay  the  fee,  must  complete  the 
schedule  required  for  the  purpose,  and  transmit  it  with  an 
order  for  the  fee  to  the  Clerk  of  the  University. 

In  conformity  with  Section  I.  of  the  statutes,  examinations 
on  the  preliminary  branches  of  extra-professional  education 
will  take  place  on  Tuesday,  Wednesday,  Thursday,  and 
Friday,  October  2,  3,  4,  and  5,  1883 ;  and  on  Tuesday,  Wed¬ 
nesday,  Thursday,  and  Friday,  March  14, 15, 16,  and  l7, 1884. 

Examination  on  Tuesdays. — Arithmetic,  9  to  11  a.m. ; 
Mathematics  (Euclid,  Algebra),  11.30  a.m.  to  1.30  p.m. ;  and 
Higher  Mathematics,  2  to  4  p.m. 

Examination  on  Wednesdays. — English,  9  to  11  a.m. ; 
Natural  Philosophy,  11.30  a.m.  to  1.30  p.m.  Mechanics, 
2  to  4  p.m. 

Examination  on  Thursdays. — Latin,  9  to  11  a.m. ;  Logic, 
11.30  a.m.  to  1.30  p.m. ;  Moral  Philosophy,  2  to  4  p.m. 

Examination  on  Fridays. — Greek,  9  to  11  a.m. ;  French, 
11.30  a.m.  to  1.30  p.m. ;  German,  2  to  4  p.m. 


7.  UNIVERSITY  OF  GLASGOW.— FACULTY  OF 
MEDICINE. 

Three  medical  degrees  are  conferred  by  this  University, 
viz. Bachelor  of  Medicine  (M.B.) ;  Master  in  Surgery 
(C.M.) ;  and  Doctor  of  Medicine  (M.D.)  ;  all  of  which  are 
recognised  by  the  Medical  Act  as  qualifying  for  practice 
throughout  the  British  dominions. 

The  degrees  of  Bachelor  of  Medicine  and  Master  in 
Surgery,  which  must  be  taken  together,  may  be  obtained  by 
candidates  of  the  age  of  twenty-one  years  who  have  complied 
with  the  regulations  as  to  education  and  examination.  The 
degree  of  Doctor  of  Medicine  may  be  conferred  on  candidates 
of  not  less  than  twenty-four  years  of  age  who  have  obtained 
the  Bachelorship  two  or  more  years  previously,  and  have 
fulfilled  certain  conditions  to  be  afterwards  mentioned. 

The  medical  curriculum  is  as  nearly  as  possible  the  same 
as  that  in  the  University  of  Edinburgh. 

By  an  order  of  Her  Majesty  in  Council,  dated  August  13, 
1877,  the  following  are  the  arrangements  for  Professional 
Examinations : — 

1.  Every  candidate  for  the  degrees  of  Bachelor  of  Medicine 
and  Master  in  Surgery  shall  be  examined  both  in  writing 
and  viva,  voce — first  on  Chemistry,  Botany,  and  Natural 
History  ;  second,  on  Anatomy  and  Physiology ;  third,  on 
Regional  Anatomy,  Materia  Medica  and  Pharmacy,  and 
Pathology;  and  fourth,  on  Surgery,  Clinical  Surgery, 
Medicine,  Clinical  Medicine,  Therapeutics,  Midwifery,  and 
Medical  Jurisprudence.  The  examination  in  Chemistry 
shall  include  Practical  Chemistry  ;  and  the  examinations  in 
Anatomy  and  Physiology  shall  include  Practical  Anatomy, 
Histology,  and  Practical  Physiology ;  and  the  examination 
in  Surgery  shall  include  Operative  Surgery. 

2.  Students  may  appear  for  examination  in  the  first  of  the 
foregoing  divisions  of  subjects  who  have  completed  their 
attendance  on  the  required  courses  during  one  winter  and 
two  summer  sessions,  or  during  one  summer  and  two  winter 
sessions. 

3.  Students  who  have  passed  the  first  examination  may 
appear  for  examination  in  the  second  division  of  subjects 
after  having  completed  their  attendance  on  the  requisite 
courses  (including  those  of  the  subjects  of  examination), 
and  after  the  lapse  of  two  winter  and  three  summer  sessions, 
or  of  three  winter  and  two  summer  sessions,  from  the  time 
of  the  commencement  of  their  studies. 

4.  Students  who  have  passed  the  two  previous  examina¬ 
tions  may  appear  for  examination  in  the  third  division  of 
subjects  at  any  of  the  terms  fixed  for  examinations  by  the 
Senate,  after  the  conclusion  of  the  third  winter’s  session  of 
attendance  upon  medical  classes  (including  those  of  the 
required  subjects). 

5.  Students  who  have  passed  the  examinations  in  the 
subjects  of  the  three  previous  divisions  may  appear  for  exa¬ 
mination  in  the  subjects  of  the  fourth  division  at  the  first 
term  for  the  final  examination  after  the  conclusion  of  their 
curriculum  of  study. 

DEGREE  OF  DOCTOR  OF  MEDICINE. 

The  degree  of  Doctor  of  Medicine  may  be  conferred  on  any 
candidate  who  shall  produce  evidence — a,  that  he  is  not  less 
than  twenty-four  years  of  age ;  b,  that  he  has  obtained  the 
Bachelorship  two  or  more  years  previously  ;  c,  that  he  pos¬ 
sesses  a  degree  in  Arts,  or  has,  in  addition  to  the  preliminary 
examination  in  general  education  required  for  the  Bachelor¬ 
ship,  also  passed  an  examination  in  Greek,  and  Logic  or 
Moral  Philosophy,  together  with  any  one  of  the  other 
optional  subjects  included  in  the  second  part  of  the  subjects 
of  general  education  ;  d,  that  he  has  been  engaged  in  pro¬ 
fessional  study  or  avocation  for  two  years  after  having  ob¬ 
tained  the  Bachelorship.  He  must  also  lodge  an  inaugural 
dissertation,  certified  by  him  to  have  been  composed  by 
himself,  on  any  subject  included  in  the  branches  of  knowledge 
embraced  in  the  professional  curriculum.  Theses  for  the 
degree  of  M.D.  must  be  lodged  with  Mr.  Moir,  the  Assistant 
Clerk  of  Senate,  on  or  before  March  20,  June  20,  or  October  20. 
No  thesis  will  be  approved  unless  it  gives  evidence  of  original 
observation,  or,  if  it  deals  with  the  researches  of  others, 
gives  a  full  statement  of  the  literature  of  the  question,  with 
accurate  references  and  critical  investigation  of  the  views  or 
facts  cited ;  mere  compilations  will  in  no  case  be  accepted. 

The  fees  for  degrees  are  the  same  as  in  Edinburgh. 

The  examinations  in  General  Education  take  place  twice 
yearly — viz.,  in  October  and  March.  The  examinations  for 


294 


Medical  'nine*  and  Gazette. 


PROFESSIONAL  EDUCATION. 


Sept.  15,  1883. 


session  1883-84  will  be  held  on  Wednesday,  Thursday,  Friday, 
and  Saturday,  October  10,  11,  12,  and  13, 1883,  and  Wednes¬ 
day,  Thursday,  Friday,  and  Saturday,  March  26,  27,  28,  and 
29,  1884.  Those  who  intend  to  present  themselves  for  either 
of  these  examinations  are  required  to  send  in  their  names  to 
the  Assistant  Clerk  of  Senate  on  or  before  September  26  or 
March  14.  Those  who  are  not  matriculated  students  of  the 
University  pay  a  fee  of  10s.  on  first  entering  their  names  for 
this  examination. 

The  Professional  Examinations  are  held  at  the  following 
periods,  viz. : — The  first,  second,  and  third  in  October  and 
April  (in  1883-84,  beginning  on  October  15  and  April  4)  ; 
and  the  fourth  in  June  and  July  (beginning  on  June  10, 1884 


8.  UNIVERSITY  OF  ABERDEEN. 

The  following  are  the  degrees  in  Medicine  granted  by  this 
University — namely,  Bachelor  of  Medicine  (M.B.),  Master  in 
Surgery  (C.M.),  and  Doctor  of  Medicine  (M.D.). 

The  preliminary  examination  and  professional  curriculum, 
and  examination  for  the  degrees  of  M.B.,  C.M.,  and  M.D., 
being  in  conformity  with  the  Ordinances  of  the  Scotch  Uni¬ 
versities  Commissioners,  are  nearly  the  same  as  those  of  the 
Universities  of  Edinburgh,  Glasgow,  and  St.  Andrews. 

The  studies  of  candidates  for  the  degrees  of  Bachelor  of 
Medicine  and  Master  in  Surgery  are  subject  to  these  regula¬ 
tions  : — 

One  at  least  of  the  four  years  of  medical  and  surgical  study 
must  be  in  the  University  of  Aberdeen. 

Another  of  such  four  years  must  be  either  in  this  University 
or  in  some  other  university  entitled  to  give  the  degree  of 
Doctor  of  Medicine. 

FEES  FOE  GRADUATION. 

Each  candidate  for  the  degrees  of  M.B.  and  C.M.  shall  pay 
a  fee  of  £5  5s.  in  respect  of  the  first  two  professional  examina¬ 
tions,  and  a  fee  of  =£10 10s.  in  respect  of  the  third  professional 
examination — each  such  fee  of  £5  5s.  and  ,£10 10s.  respectively 
being  payable  at  the  time  at  which  the  candidate  comes 
forward  to  be  examined  in  that  division  in  respect  of  which 
it  is  payable. 

And  every  candidate  for  the  degree  of  Doctor  of  Medicine 
shall  pay,  in  addition  to  the  fees  paid  by  him  for  the  degree 
of  Bachelor  of  Medicine,  a  fee  of  £5  5s.,  exclusive  of  any 
stamp-duty  which  may  for  the  time  be  exigible. 

EXEMPTION  FROM  THE  FOREGOING  REGULATIONS. 

Students  who  shall  have  begun  their  medical  studies  before 
the  first  Tuesday  of  November,  1861,  are  entitled  to  appear 
for  examination  for  the  degree  of  M.D.  after  four  years’ 
study,  one  of  which  must  have  been  at  the  University  of 
Aberdeen. 


IRISH  UNIVERSITIES. 


9.  UNIVERSITY  OF  DUBLIN. 

DEGREES  AND  LICENCES  IN  MEDICINE  AND  SURGERY. 

The  degrees  and  licences  in  Medicine,  Surgery,  and  Mid¬ 
wifery  granted  by  the  University  are — 1.  Bachelor  of  Medi¬ 
cine  ;  2.  Doctor  of  Medicine ;  3.  Bachelor  in  Surgery  ; 
4.  Master  in  Surgery ;  5.  Master  in  Obstetric  Science ;  and 
Licences  in  Medicine,  Surgery,  and  Obstetric  Science. 
Besides  these  degrees  and  licences,  the  University  also 
grants  a  qualification  in  State  Medicine.  All  students  in 
the  School  of  Physic  intending  to  practise  Physic  must  be 
matriculated. 

UNIVERSITY  DEGREES. 

1.  Bachelor  in  Medicine. — A  candidate  for  the  degree  of 
Bachelor  in  Medicine  must  be  a  graduate  in  Arts,  and  may 
obtain  the  degree  of  Bachelor  in  Medicine  at  the  same  com¬ 
mencements  as  those  at  which  he  receives  his  degree  of  B.A.  ; 
or  at  any  subsequent  commencements,  provided  the  requi¬ 
site  medical  education  shall  have  been  completed,  and  the 
necessary  examinations  passed.  The  medical  education  of 
a  Bachelor  in  Medicine  is  of  four  years’  duration,  and  com¬ 
prises  attendance  on  one  course  of  lectures  on  each  of  the 
following  subjects Winter :  Anatomy,  Practical  Anatomy, 
Theoretical  Surgery,  Chemistry,  Institutes  of  Medicine 
(Physiology),  Practice  of  Medicine,  Midwifery.  Summer : 


Botany,  Institutes  of  Medicine  (Practical  Histology),  Com¬ 
parative  Anatomy,  Materia  Medica,  Medical  Jurisprudence, 
Practical  Chemistry.  Term  Courses :  Michaelmas  Term — 
Heat ;  Hilary  Term — Electricity  and  Magnetism.  Six 
months’  Dissections  are  also  required,  and  one  month’s 
instruction  in  Vaccination. 

Hospital  attendance  includes — 1.  Three  courses  of  nine 
months’  attendance  on  the  clinical  lectures  of  Sir  Patrick 
Dun’s  or  other  metropolitan  hospital  recognised  by  the 
Board  of  Trinity  College.  2.  A  certificate  of  personal 
attendance  on  fever  cases,  with  names  and  dates  of  cases. 
The  following  hospitals,  in  addition  to  Sir  Patrick  Dun’s 
Hospital,  are  recognised  by  the  Board: — Meath  Hospital, 
House  of  Industry  Hospitals.  Dr.  Steevens’s  Hospital,  Jervis- 
street  Infirmary,  City  of  Dublin  Hospital,  Mercer’s  Hospital, 
St.  Vincent’s  Hospital,  Adelaide  Hospital,  Mater  Miseri- 
cordise  Hospital,  St.  Mark’s  Ophthalmic  Hospital,  the 
National  Eye  and  Ear  Infirmary.  Students  who  shall  have 
diligently  attended  the  practice  of  a  recognised  county 
infirmary  for  two  years  previous  to  the  commencement  of 
their  metropolitan  medical  studies  are  allowed,  on  special 
application  to  the  Board  of  Trinity  College,  to  count 
those  two  years  as  equivalent  to  one  year  spent  in  a  recog¬ 
nised  metropolitan  hospital.  N.B.— The  recognition  of 
these  schools  and  hospitals  is  conditional  on  their  students 
being  furnished  with  bond  fide  certificates  of  an  amount  of 
regular  attendance  equivalent  to  that  required  by  the 
University — viz.,  three-fourths  of  the  entire  number  of 
lectures  in  each  course. 

The  qualifying  course  of  Practical  Midwifery  consists  of 
six  months’  instruction,  including  clinical  lectures.  Certi¬ 
ficates  of  Practical  Midwifery  are  received  from  (1)  the 
Rotunda  Hospital,  (2)  the  Coombe  Hospital,  (3)  Sir  Patrick 
Dun’s  Hospital  Maternity,  and  (4)  Dr.  Steevens’s  Hospital 
Maternity. 

DEGREE  EXAMINATIONS. 

1.  Bachelor  in  Medicine. — The  candidate  for  the  M.B; 
examination  must  have  previously  passed  the  Previous 
Medical  Examination  in  all  the  subjects  ;  and  have  lodged 
with  the  Medical  Registrar,  on  a  certain  day  to  be  duly 
advertised  before  the  examination,  certificates  of  attendance 
upon  all  the  courses  of  study  prescribed  in  the  preceding 
curriculum.  Candidates  are  then  required  to  pass  a  final 
examination  in  the  following  subjects  : — Physiological  Ana¬ 
tomy,  Practice  of  Medicine,  Surgery,  Midwifery,  Medical 
Jurisprudence,  Institutes  of  Medicine  (Pathology  and 
Hygiene),  Therapeutics,  Clinical  Medicine.  The  fee  for  the 
Liceat  ad  Examinandum  is  £5.  The  fee  for  the  degree  of 
M.B.  is  £11. 

2.  Doctor  in  Medicine. — A  Doctor  in  Medicine  must  be  a 
Bachelor  in  Medicine  of  three  years’  standing,  or  have  been 
qualified  to  take  the  degree  of  Bachelor  in  Medicine  for 
three  years.  He  must  also  read  a  thesis  publicly  before  the 
Regius  Professor  of  Physic,  or  must  undergo  an  examina¬ 
tion  before  the  Regius  Professor  of  Physic,  according  to 
regulations  to  be  approved  by  the  Provost  and  Senior 
Fellows.  Total  amount  of  fees  for  this  degree,  £13. 

3.  Bachelor  in  Surgery. — A  Bachelor  in  Surgery  must  be 
a  Bachelor  in  Arts,  and  have  spent  four  years  in  the  study 
of  Surgery  and  Anatomy.  He  must  also  have  passed  the 
M.B.  examination  before  presenting  himself  at  the  B.Ch. 
examination.  The  curriculum  comprises  the  following,  in 
addition  to  the  complete  course  for  the  degree  of  Bachelor 
in  Medicine : — Operative  Surgery,  one  course  ;  Dissections, 
two  courses  ,•  Ophthalmic  Surgery,  one  course.  Candidates 
are  required  to  perform  surgical  operations  on  the  dead 
subject,  and  will  also  be  examined  in  Bandaging  and  Minor 
Surgery,  and  in  Surgical  Pathology.  Fee  for  the  Liceat 
ad  Examinandum,  £5.  Fee  for  the  degree  of  Bachelor  in 
Surgery,  £5. 

4.  Master  in  Surgery. — A  Master  in  Surgery  must  be  a 
Bachelor  in  Surgery  of  three  years’  standing,  or  have  been 
qualified  to  take  the  degree  of  Bachelor  in  Surgery  for  three 
years  ;  and  must  read  a  thesis  publicly  before  the  Regius 
Professor  of  Surgery,  or  undergo  an  examination  before  the 
Regius  Professor,  according  to  Regulations  to  be  approved 
by  the  Provost  and  Senior  Fellows.  Fee  for  the  degree  of 
Master  in  Surgery,  £11. 

5.  Master  in  Obstetric  Science. — A  Master  in  Obstetric 
Science  must  have  passed  the  M.B.  and  B.Ch.  examinations 
and  produce  certificates  of  having  completed  the  following 


Medical  Tiroes  and  Gazette- 


PROFESSIONAL  EDUCATION. 


rSept.  15,  1893.  295 


curriculum 1.  One  winter  course  in  Midwifery.  2.  Six 
months’  practice  in  a  recognised  lying-in  hospital  or  mater- 
tity.  3.  A  summer  course  in  Obstetric  Medicine  and  Surgery. 
4.  Two  months’  practice  in  the  Cow -pock  Institution.  Exist¬ 
ing  graduates  in  Medicine,  of  the  standing  of  M.D.,  are  en¬ 
titled  to  present  themselves  for  examination  without  comply¬ 
ing  with  Regulations  3  and  4.  Fee  for  the  degree  of  Master 
In  Obstetric  Science,  <£5. 

UNIVERSITY  LICENCES. 

Candidates  for  the  licences  in  Medicine,  Surgery,  or 
Obstetric  Science  must  be  matriculated  in  Medicine,  and 
must  have  completed  two  years  in  Arts,  and  four  years  in 
medical  studies. 

1.  Licentiate  in  Medicine. — The  medical  course  and  exa¬ 
mination  necessary  for  the  licence  in  Medicine  are  the  same 
as  for  the  degree  of  M.B.  A  Licentiate  in  Medicine,  on 
completing  his  course  in  Arts,  and  proceeding  to  the  degree 
■of  B.A.,  may  become  a  Bachelor  in  Medicine  on  paying  the 
degree  fees  without  further  examination  in  Medicine.  Fee 
•for  the  Liceat  ad  Examinandum,  £5.  Fee  for  the  licence 
In  Medicine  £5. 

2.  Licentiate  in  Surgery. — The  surgical  course  and  exa¬ 
mination  necessary  for  the  licence  in  Surgery  are  the  same 
as  for  the  degree  of  Bachelor  in  Surgery.  Fee  for  the  Liceat 
ad  Examinandum,  £5.  Fee  for  the  licence  in  Surgery,  £5. 

3.  Licentiate  in  Obstetric  Science. — The  course  and  exami¬ 

nation  for  the  licence  in  Obstetric  Science  are  the  same  as 
for  the  degree  in  Obstetric  Science.  Fee  for  the  licence  in 
Obstetric  Science,  £5.  _ 

10.  ROYAL  UNIVERSITY  OF  IRELAND. 

The  regulations  concerning  the  degrees  in  Medicine,  Sur¬ 
gery,  etc.,  granted  by  the  University  are  as  follow  : — 

The  Degree  of  Bachelor  of  Medicine  (M.B.). 

The  course  for  this  degree  shall  be  one  of  at  least  four 
years’  duration. 

All  candidates  for  the  degree  shall,  in  addition  to  attend¬ 
ing  the  lectures  and  complying  with  the  other  conditions  to 
be  from  time  to  time  prescribed,  be  required  to  pass  the 
following  examinations  : — The  Matriculation  Examination  ; 
the  First  University  Examination ;  the  First  Examination 
in  Medicine ;  the  Second  Examination  in  Medicine ;  the 
Degree  Examination. 

A  medical  student  from  one  of  the  Queen’s  Colleges,  the 
Queen’s  University,  or  any  other  institution  approved  by  the 
Senate,  matriculated  therein  before  October  1,  1881,  who 
has  completed  at  least  one  year  of  the  medical  curriculum 
in  any  of  said  Colleges,  or  in  said  University  or  institution, 
shall  be  entitled  to  credit  for  a  year’s  course  in  this  Uni¬ 
versity  without  passing  the  First  Examination  in  Arts. 

The  course  of  medical  studies  shall  extend  over  at  least 
four  years,  and  shall  be  divided  into  periods  of  at  least  two 
years  each,  during  which  periods  the  students  shall  attend 
such  courses  of  lectures  and  hospital  instruction,  and  comply 
with  such  other  conditions,  as  the  Senate  shall  from  time  to 
time  order.  Until  further  order — 

The  first  period  shall  comprise  attendance  on  the  following 
courses  of  medical  lectures: — Chemistry,  one  course  of  at 
least  six  months ;  Practical  Chemistry,  a  course  of  at  least 
three  months’  work  in  a  chemical  laboratory ;  Botany,  with 
Herborisation  for  practical  study,  and  Zoology;  Anatomy 
and  Physiology;  Practical  Anatomy ;  Materia  Medica. 

The  second  period  shall  comprise  attendance  on  the 
following  courses  of  medical  lectures  : — Anatomy  and  Physi¬ 
ology,  including  Histology ;  Practical  Anatomy ;  Theory 
and  Practice  of  Surgery  ;(a)  Midwifery  and  Diseases  of 
Women,  a  six  months’  course  ;  Theory  and  Practice  of 
Medicine ;  Medical  Jurisprudence. 

Candidates  are  further  required  to  have  attended  during 
the  first  period — 

Medico-Chirurgical  Hospital  (recognised  by  the  Senate), 
containing  at  least  sixty  beds;  together  with  the  clinical 
lectures  therein  delivered,  at  least  two  each  week,  during  a 
winter  session  of  six  months. 

And  during  the  second  period — 

Medico-Chirurgical  Hospital  (recognised  by  the  Senate), 
containing  at  least  sixty  beds ;  together  with  the  clinical 
lectures  therein  delivered,  during  eighteen  months,  including 


either  three  winter  sessions  of  six  months  each,  or  two 
winter  sessions  of  six  months  each  and  two  summer  sessions 
of  three  months  each.  The  certificate  of  such  hospital 
attendance  must  show  that  the  student  has,  during  a  period 
of  three  months  of  his  hospital  attendance,  attended  either  a 
fever  hospital  of  repute,  or  the  fever  wards  of  a  general 
hospital. 

Practical  Midivifery. — The  candidate  must  also  produce  a 
certificate  of  having  attended  at  a  recognised  midwifery 
hospital,  where  clinical  instruction  in  Midwifery  and  Dis¬ 
eases  of  Women  and  Children  is  given,  for  a  period  of  six 
months ;  or  of  having  attended  for  six  months  at  a  mid¬ 
wifery  dispensary  where  similar  clinical  instruction  is  given. 
The  certificate  in  each  case  to  state  that  the  candidate  has 
attended  at  twenty  labours. 

In  addition  to  the  above-mentioned  certificates  of  attend¬ 
ance  at  hospitals,  candidates  will  be  also  required  before 
presenting  themselves  for  the  Degree  Examination  to 
produce  the  following  certificates : — (i.)  A  certificate  of 
personal  attendance  on  at  least  ten  fever  cases,  such  certifi¬ 
cate  to  be  signed  by  the  physician  under  whose  superin¬ 
tendence  the  cases  were  attended.  (ii.)  A  certificate  of 
having  compounded  medicine  under  an  apothecary  or 
pharmaceutical  chemist  for  at  least  three  months,  (iii.)  A 
certificate  of  having  received  practical  instruction  in  Vac¬ 
cination,  to  be  signed  by  a  public  vaccinator,  (iv.)  A  cer¬ 
tificate  of  having  attended  for  three  months  in  a  recognised 
lunatic  asylum,  where  clinical  instruction  on  Mental  Diseases 
is  given. 

The  Senate  further  recommend  that  students  should  avail 
themselves  of  opportunities  of  attendance  on  lectures  on 
Diseases  of  the  Eye,  Ear,  and  other  special  departments 
of  Medicine  and  Surgery. 

Candidates  for  Honours  must  satisfy  the  examinera  at  the 
Pass  Examinations  before  they  can  be  permitted  to  compete 
for  Honours  ;  and  their  answering  at  the  Pass  Examinations 
will  be  taken  into  account  in  determining  the  class  of 
Honours  which  shall  be  awarded  to  them. 

THE  FIRST  EXAMINATION  IN  MEDICINE. 

Students  shall  be  admitted  to  this  examination  after  the 
lapse  of  one  academical  year  from  the  time  of  their  matri¬ 
culation.  Candidates  may  pass  this  examination  at  the 
same  time  as  the  First  University  Examination. 

The  subjects  of  this  examination  shall  be : — Zoology ; 
Botany  ;  a  Modern  Language.  Candidates  who  have  passed 
in  a  Modern  Language  at  the  First  University  Examination 
in  Arts  are  exempt  from  again  presenting  this  subject,  ex¬ 
cept  as  a  qualification  for  admission  to  compete  for  Honours ; 
the  answering  of  the  candidate  in  the  three  subjects  men¬ 
tioned  being  taken  into  account  in  awarding  Honours. 

Before  being  admitted  to  this  examination,  each  candi¬ 
date  must  produce  satisfactory  evidence  of  having  completed 
the  prescribed  courses  of  study  in  the  subjects  of  examination. 

The  examination  in  Zoology  will  consist  of  questions  on 
the  anatomy  and  classification  either  of  the  vertebrate  or 
invertebrate  animals — the  selection  between  these  two 
groups  to  be  made  by  the  candidates  at  the  time  of  examina¬ 
tion.  They  are  recommended  to  read  Huxley’s  “  Manuals 
of  the  Anatomy  of  Vertebrate  and  Invertebrate  Animals,” 
Macalister’s  “Vertebrata  and  Invertebrata,”  Nicholson’s 
“  Zoology,”  and  Mivart’s  “  Common  Frog,  or  Elementary 
Anatomy  and  for  the  higher  portions  of  Zoology — 
G-egenbauer’s  “  Comparative  Anatomy,”  Macalister’s  "  Com¬ 
parative  Anatomy,”  and  Huxley’s  “  Comparative  Anatomy.” 

The  examination  in  Botany  will  comprise  the  general 
principles  of  the  structure  and  classification  of  plants. 
They  may  use  as  text-books  Oliver’s  “Lessons  in  Ele¬ 
mentary  Botany,”  and  Thome’s  “  Structural  and  Physiological 
Botany”;  and  they  may  usefully  refer  to  Prantl’s  work  on 
Botany. 

THE  SECOND  EXAMINATION  IN  MEDICINE. 

Students  shall  be  admitted  to  this  examination  after  the 
lapse  of  one  academical  year  from  the  time  of  passing  the 
First  Examination  in  Medicine,  provided  they  have  com¬ 
pleted  the  first  period  of  the  course  of  medical  studies. 

The  subjects  for  this  examination  shall  be: — Anatomy; 
Physiology  ;  Materia  Medica ;  Chemistry. 

THE  EXAMINATION  FOR  THE  DEGREE  OF  M.B. 

Students  shall  be  admitted  to  this  examination  after  the 
lapse  of  one  academical  year  from  the  time  of  passing  the 


And  after  the  year  '  883,  Operative  Surgery,  a  three  months’  course. 


296 


Medical  Times  and  Gazette. 


PROFESSIONAL  EDUCATION. 


Sept.  15, 1883- 


Second  Examination  in  Medicine,  provided  they  have  com¬ 
pleted  the  second  period  of  the  course  of  medical  studies. 

The  subjects  for  this  examination  shall  be  (b) — Anatomy; 
Physiology;  Surgery;  Midwifery  and  Diseases  of  Women 
and  Children ;  Theory  and  Practice  of  Medicine ;  Medical 
Jurisprudence. 

Candidates  intending  to  present  themselves  at  any  one  of 
the  above  examinations  must  give  notice,  in  writing,  to  the 
Secretaries  of  their  intention  to  present  themselves,  and 
must  pay  the  prescribed  fee  at  least  one  month  previous  to 
the  examination,  and  must  at  the  same  time  furnish  evidence 
of  having  completed  the  course  of  studies  prescribed  by 
the  Senate  for  the  second  period  of  the  course  of  medical 
studies. 

The  fee  for  the  first  examination  is  £1 ;  for  the  second 
examination,  =£1 ;  and  for  the  third,  <£3. 

The  Degree  of  Doctor  of  Medicine  (M.D.). 
Candidates  may  be  admitted  to  this  degree  after  the  lapse 
of  two  academical  years  from  the  time  of  obtaining  the 
degree  of  M.B.  All  persons  who  were  students  in  Medicine 
in  the  Queen’s  University  at  the  date  of  its  dissolution  shall 
be  entitled,  if  they  so  desire,  to  obtain  the  degree  of  M.D., 
instead  of  the  degree  of  M.B.,  upon  passing  the  examination 
for  the  M.B.  Degree. 

Candidates  must  give  notice  in  writing,  to  the  Secretaries, 
of  their  intention  to  present  themselves,  and  must  pay  the 
prescribed  fee  of  £5,  at  least  one  month  previous  to  the 
examination,  and  must  at  the  same  time  produce  a  certificate 
of  having  been,  for  at  least  two  years,  engaged  in  hospital 
or  private  medical  or  surgical  practice,  or  in  the  Military  or 
Naval  Medical  Service. 

Every  candidate  shall  be  examined  at  the  bedside,  and 
required  to  diagnose  at  least  six  cases,  medical  and  surgical, 
and  prescribe  treatment ;  to  write  detailed  reports  on  at 
least  two  cases  to  be  selected  by  the  examiners,  and  to 
discuss  all  the  questions  arising  thereon. 

Every  candidate  shall  submit  to  the  Medical  Examiners, 
for  their  approval,  a  thesis  certified  by  him  (or  her)  to  have 
been  composed  by  himself  (or  herself).  No  thesis  shall  be 
approved  which  does  not  contain  some  original  or  personal 
observations  in  Practical  Medicine,  Surgery,  Midwifery,  or 
in  some  of  the  sciences  embraced  in  the  curriculum,  or  else 
a  full  digest  and  critical  exposition  of  the  opinions  and  re¬ 
searches  of  others  on  the  subject  selected  by  the  candidate, 
accompanied  by  precise  references  to  the  publications  quoted. 

Candidates  who  have  been  settled  for  a  period  of  two  years 
in  the  colonies  or  foreign  countries  may,  on  satisfying  the 
Senate  to  that  effect,  and  in  lieu  of  the  examination  above 
required  to  be  passed  by  persons  residing  in  this  country, 
upon  furnishing  papers  on  medical  subjects  written  by 
them,  or  official  reports  dealing  with  subjects  of  medical 
science,  with  evidence  of  the  papers  or  reports  being  their 
own  original  composition,  have  the  degree  conferred  on 
them  in  absence. 

It  shall,  for  three  years,  be  in  the  power  of  the  Senate, 
in  the  case  of  medical  students  who,  previous  to  their  matri¬ 
culation  in  the  University,  have  received  a  medical  and  Arts 
education  in  institutions  approved  by  the  Senate,  to  give 
such  students  credit  for  the  education  in  Arts  which  they 
have  received  therein,  if  they  shall  be  satisfied,  from  the 
report  of  the  Medical  Examiners,  of  their  proficiency  in  the 
subjects  of  the  medical  course  of  the  University. 

It  shall  also,  for  the  same  period,  be  in  the  power  of  the 
Senate,  in  cases  where  a  complete  course  in  Arts  and  Medi¬ 
cine  has  been  passed  by  a  student  in  such  institutions  as 
aforesaid,  according  to  the  system  of  such  institutions,  to 
allow  him  to  present  himself  for  the  examination  for  the 
Degree  of  M.B.,  and  to  obtain  such  degree,  if  found  qualified, 
upon  the  same  terms  as  ordinary  medical  students  of  this 
University. 

The  Degree  of  Master  in  Surgery  (M.Ch.). 

This  degree  shall  be  conferred  only  on  graduates  in  Medi¬ 
cine  of  the  University,  (c) 

Candidates  must  give  notice,  in  writing,  to  the  Secretaries 
of  their  intention  to  present  themselves,  and  must  pay  the 

(b)  After  1883  all  candidates  forthe  degree  of  M.B.  will  be  required  to  ex¬ 
hibit  proficiency  in  the  use  of  the  ophthalmoscope  and  the  laryngoscope. 

(c)  After  1S83  all  candidates  for  the  degree  of  M.Ch.  will  be  required 
to  produce  a  certificate  of  having  attended  a  three  months’  course  in 
Operative  Surgery ;  they  will  also  be  required  to  pass  a  special  written 
examination. 


prescribed  fee  of  £5  at  least  one  month  previous  to  the' 
examination. 

The  examination  for  this  degree  shall  comprise  the 
Theory  and  Practice  of  Surgery,  including  Operative  and 
Clinical  Surgery. 

The  Diploma  in  Obstetrics. 

This  diploma  shall  be  conferred  only  on  graduates  in 
Medicine  of  the  University. 

Candidates  must  give  notice,  in  writing,  to  the  Secretaries 
of  their  intention  to  present  themselves,  and  must  pay  the- 
prescribed  fee  of  £2  at  least  one  month  previous  to  the- 
examination. 

The  examination  for  this  diploma  shall  comprise  the- 
Theory  and  Practice  of  Midwifery,  and  the  use  of  obstetrical 
instruments  and  appliances. 

Exhibitions. — The  following  exhibitions  may  be  awarded 
annually  by  the  Senate : — At  the  First  Examination  in  Medi¬ 
cine,  two  first-class  at  £30,  and  two  second-class  at  £15-. 
At  the  Second  Examination  in  Medicine,  two  first-class  at  £40, 
and  three  second-class  at  £20.  At  the  M.B.  Degree  Examina¬ 
tion,  two  first-class  at  £50,  and  three  second-class  at  £25. 
Provided  that  an  exhibition  shall  not  be  awarded  to  any 
candidate  at  the  First  Examination  in  Medicine  if  a  longer 
interval  than  three  academical  years  shall  have  elapsed  from 
the  time  of  matriculation  ;  or  at  the  Second  Examination 
in  Medicine  if  a  longer  interval  than  two  academical  years 
shall  have  elapsed  from  the  time  of  passing  the  First  Exa¬ 
mination  in  Medicine  ;  or  at  the  M.B.  Degree  Examination 
if  a  longer  interval  than  three  academical  years  shall  have 
elapsed  from  the  time  of  passing  the  First  Examination 
in  Medicine. 

Prizes. — A  sum  of  £95  may  be  placed  annually  at  the 
disposal  of  the  Examiners  in  Medicine  to  be  awarded  in 
prizes  for  superior  answering  in  special  subjects,  at  their- 
discretion. 


(B.) 

BODIES  GIVING  LICENCES  OR 
OTHER  FORMS  OF  QUALIFICATION  NOT 
BEING  DEGREES  IN  MEDICINE. 


A.— England. 

1.  THE  ROYAL  COLLEGE  OF  PHYSICIANS, 
LONDON. 

The  licence  of  this  College  is  a  qualification  to  practise' 
Medicine,  Surgery,  and  Midwifery,  and  is  recognised  by  the 
Local  Government  Board  as  a  qualification  in  Surgery  as 
well  as  in  Medicine. 

The  College  will,  under  its  charter,  grant  licences  to  prac¬ 
tise  Physic,  including  therein  the  practice  of  Medicine, 
Surgery,  and  Midwifery  (which  licences  are  not  to  extend  to 
make  the  Licentiates  Members  of  the  Corporation),  to  persons 
who  shall  conform  to  the  following  by-laws. 

I. — Every  candidate  for  the  College  licence  (except  when 
otherwise  provided  by  the  by-laws)  who  commenced  pro¬ 
fessional  study  after  March  25,  1880,  will  be  required,  at 
the  times  prescribed  in  Section  II.  for  the  respective 
examinations,  to  produce  satisfactory  evidence — 

1.  Of  having  passed,  before  the  commencement  of  professional  study, 
one  of  the  preliminary  examinations  on  subjects  of  general  education 
recognised  by  the  General  Medical  Council. 

2.  Of  having  been  registered  as  a  medical  student  in  the  manner  pre¬ 
scribed  by  the  General  Medical  Council,  at  least  forty-five  months  pre¬ 
viously  to  admission  to  the  third  or  final  examination,  unless  specially 
exempted.  Note  A.— Professional  studies  commenced  before  registration, 
except  in  the  cases  of  Chemistry,  Materia  Medica,  Botany,  and  Pharmacy, 
will  not  be  recognised. 

3.  Of  having  been  “engaged  in  professional  studies  at  least  forty- five 
months,  during  which  not  less  than  three  winter  sessions  and  two  summer 
sessions  shall  have  been  passed  at  one  or  more  of  the  medical  schools 
recognised  by  the  College.  One  winter  session  and  two  summer  sessions 
may  be  passed  in  one  or  more  of  the  following  ways a.  Attending  the 
practice  of  a  hospital,  infirmary,  or  other  institution  duly  recognised  as 
affording  satisfactory  opportunities  for  professional  study,  l>.  Receiving 
instruction  as  a  pupil  of  a  legally  qualified  practitioner  having  oppor¬ 
tunities  of  imparting  a  practical  knowledge  of  Medicine,  Surgery,  or  Mid¬ 
wifery.  c.  Attending  lectures  on  one  or  more  of  the  required  subjects  of 
professional  study  at  a  duly  recognised  place  of  instruction. 

4.  Of  having  received  instruction  in  Chemistry,  including  Chemical 
Physics,  meaning  thereby  heat,  light,  and  electricity. 

5.  Of  having  received  instruction  in  Practical  Chemistry. 

6.  Of  having  received  instruction  in  Materia  Medica. 

7.  Of  having  received  instruction  in  Botany. 

8.  Of  having  received  instruction  in  Practical  Pharmacy.  NoteB. — By 


Medical  Times  and  Gazette 


PROFESSIONAL  EDUCATION. 


Sept.  15,  1883.  2  9  7 


this  is  meant  instruction  in  Practical  Pharmacy  by  a  registered  medical 
practitioner,  or  by  a  member  of  the  Pharmaceutical  Society  of  Great 
Britain,  or  in  a  public  hospital,  infirmary,  or  dispensary. 

9.  Of  having  attended  a  course  of  lectures  on  Anatomy. 

10.  Of  having  performed  Dissections  during  not  less  than  twelve  months. 

11.  Of  having  attended  a  course  of  lectures  on  General  Anatomy  and 
Physiology. 

12.  Of  having  attended  a  separate  practical  course  of  General  Anatomy 
and  Physiology. 

13.  Of  having  attended  a  course  of  lectures  on  the  Principles  and 
Practice  of  Medicine. 

14.  Of  having  attended  a  course  of  lectures  on  the  Principles  and 
Practice  of  Surgery. ' 

15.  Of  having  attended  a  course  of  lectures  on  Midwifery  and  Diseases 
peculiar  to  Women.  A  certificate  must  also  be  produced  of  attendance  on 
not  less  than  twenty  labours,  which  certificate  must  be  signed  by  one  or 
more  legally  qualified  practitioners. 

16.  Of  having  undergone  systematic  practical  instruction  in  the  depart¬ 
ments  of  Medicine,  Surgery,  and  Obstetric  Medicine.  Note  O.— Under 
this  clause  the  candidate  will  be  required  to  show  that  he  has  been  per¬ 
sonally  exercised  in  practical  details,  such  as— (1)  The  application  of 
anatomical  facts  to  the  investigation  of  disease;  (2)  the  methods  of 
examining  various  organs  in  order  to  detect  the  evidence  of  disease  or  the 
effects  of  accidents ;  (3)  the  employment  of  instruments  used  in  diagnosis 
and  treatment ;  (4)  the  examination  of  normal  and  diseased  structures, 
whether  recent  or  in  a  museum ;  (51  the  chemical  examination  of  morbid 
products:  (6)  operations  on  the  dead  body ;  (7)  post-mortem  examinations. 

17.  Of  instruction  and  proficiency  in  the  practice  of  vaccination.  NoteD. 
— The  certificate  must  be  such  as  will  qualify  its  holder  to  contract  as  a 
public  vaccinator  under  the  regulations,  at  the  time  in  force,  of  the  Local 
Government  Board. 

18.  Of  having  attended  a  course  of  lectures  on  Pathological  Anatomy. 

19.  Of  having  attended  demonstrations  in  the  post-mortem  room  during 
the  whole  period  of  attendance  on  clinical  lectures  (see  Clause  22) . 

20.  Of  having  attended  a  course  of  lectures  on  Forensic  Medicine. 

21.  Of  having  attended,  at  a  recognised  hospital  or  hospitals,  the  prac¬ 
tice  of  Medicine  and  Surgery  during  three  winter  and  two  summer 
sessions.  Note  E—  No  metropolitan  hospital  is  recognised  which  contains 
less  than  150,  and  no  provincial  or  colonial  hospital  which  contains  less 
than  100  patients.  A  three  months’  course  of  clinical  instruction  in  the 
wards  of  a  recognised  lunatic  hospital  or  asylum  may  be  substituted  for 
the  same  period  of  attendance  in  the  medical  wards  of  a  general  hospital. 

22.  Of  having  attended  during  nine  months  clinical  lectures  on  Medi¬ 
cine,  and  also  during  nine  months  clinical  lectures  on  Surgery ;  and  of 
having  been  engaged  during  a  period  of  three  months  in  the  clinical  study 
of  Diseases  peculiar  to  Women. 

23.  Of  having  discharged  the  duties  of  a  medical  clinical  clerk  during 
six  months,  and  of  a  surgical  dresser  during  other  six  months.  Note  F. — 
These  duties  may  be  discharged  at  a  general  hospital,  infirmary,  or  dispen¬ 
sary,  or  parochial  or  union  infirmary,  duly  recognised  for  this  purpose,  or 
in  such  other  manner  as  shall  afford  sufficient  opportunity  for  the  acquire¬ 
ment  of  practical  knowledge. 

The  certificates  of  attendance  on  the  several  courses  of 
lectures  must  include  evidence  that  the  student  has  attended 
examinations  in  each  course. 

II. — Professional  Examinations. — There  are  three  profes¬ 
sional  examinations,  called  the  First  Examination,  the 
Second  Examination,  and  the  Third  or  Final  Examination, 
each  being  partly  written,  partly  oral,  and  partly  practical. 
These  examinations  will  be  held  in  the  months  of  January, 
April,  J uly,  and  October,  unless  otherwise  appointed. 

The  First  Examination. — The  subjects  of  the  First  Exa¬ 
mination  are — Chemistry  and  Chemical  Physics,  meaning 
thereby  heat,  light,  and  electricity;  Materia  Medica,  Medical 
Botany,  and  Pharmacy;  Osteology.  (Schedules  indicating 
the  range  of  subjects  in  the  examinations,  in  Chemistry  and 
in  Materia  Medica,  Medical  Botany,  and  Pharmacy,  may  be 
obtained  together  with  the  regulations.)  A  candidate  will 
he  admitted  to  the  First  Examination  on  producing  evidence 
of  having  been  registered  as  a  medical  student  by  the  General 
Medical  Council,  and  of  having  complied  with  the  regula¬ 
tions  prescribed  in  Section  I.,  Clauses  4,  5,  6,  7,  and  8.  The 
fee  for  admission  to  the  First  Examination  is  £5  5s.,  being 
part  of  the  entire  fee  for  the  licence ;  and  if  a  candidate  be 
rejected,  he  will  be  required  to  pay  an  additional  fee  of 
£3  3s.  before  re-admission  to  the  examination.  A  candidate 
rejected  in  the  First  Examination  will  not  be  re-admitted  to 
examination  until  after  the  lapse  of  three  months  from  the 
date  of  rejection. 

The  Second  Examination. — The  subjects  of  the  Second 
Examination  are  Anatomy  and  Physiology.  (A  schedule 
indicating  the  range  of  subjects  in  the  examination  in 
Physiology  may  be  obtained  with  the  regulations.)  A 
candidate  will  be  admitted  to  the  Second  Examination  on 
producing  evidence  of  having  passed  the  First  Examination, 
of  having  completed,  subsequently  to  registration  as  a 
medical  student,  eighteen  months  of  professional  study  at  a 
recognised  medical  school  or  schools,  and  of  having  complied 
with  the  regulations  prescribed  in  Section  I.,  Clauses  9,  10, 
11,  and  12.  The  fee  for  admission  to  the  Second  Examina¬ 
tion  is  £5  5s.,  being  part  of  the  entire  fee  for  the  licence ; 
.and  if  a  candidate  be  rejected,  he  will  be  required  to  pay  an 
additional  fee  of  ,£3  3s.  before  re-admission  to  the  examina¬ 
tion.  A  candidate  rejected  in  the  Second  Examination  will 


not  be  re-admitted  to  examination  until  after  the  lapse  of 
not  less  than  three  months  from  the  date  of  rejection. 

The  Third  or  Final  Examination. — The  subjects  of  the  Final 
Examination  are — Medical  Anatomy  and  Pathology,  and  the 
Principles  and  Practice  of  Medicine  and  Therapeutics; 
Surgical  Anatomy  and  Pathology,  and  the  Principles  and 
Practice  of  Surgery ;  Midwifery,  and  Diseases  peculiar  to 
Women.  Forensic  Medicine,  Public  Health,  and  Therapeu¬ 
tics  are  subjects  included  in  the  Final  Examination.  A 
candidate  will  be  admitted  to  the  Third  or  Final  Examination 
on  producing  evidence — (1)  Of  being  twenty-one  years  of 
age ;  (2)  of  moral  character ;  (3)  of  having  passed  the  Second 
Examination ;  (4)  of  having  studied  Medicine,  Surgery,  and 
Midwifery  in  accordance  with  the  regulations  prescribed  in 
Section  I.,  Clauses  3  and  13  to  23.  The  fee  for  admission  to 
the  Third  or  Final  Examination  is  =£5  5s.,  being  part  of  the 
entire  fee  for  the  licence,  and  if  a  candidate  be  rejected,  he 
will  be  required  to  pay  an  additional  fee  of  £3  3s.  before 
re-admission  to  the  examination.  A  candidate  rejected  in 
the  Third  or  Final  Examination  will  not  be  re-admitted  to 
examination  until  after  the  lapse  of  six  months  from  the 
date  of  rejection. 

The  fee  for  the  licence  is  .£15  15s. 

Any  candidate  who  shall  produce  satisfactory  evidence  of 
having  passed  an  examination  on  any  of  the  subjects  of  the 
First  Examination,  conducted  at  a  university  in  the  United 
Kingdom,  in  India,  or  in  a  British  colony,  will  be  exempt 
from  re-examination  on  those  subjects  in  which  he  has  passed. 

Any  candidate  who  shall  produce  satisfactory  evidence  of 
having  passed  an  examination  on  Anatomy  and  Physiology, 
conducted  by  the  Royal  College  of  Surgeons  of  England,  or 
the  Royal  College  of  Surgeons  of  Edinburgh,  or  the  Royal 
College  of  Surgeons  in  Ireland,  or  the  Faculty  of  Physicians 
and  Surgeons  of  Glasgow,  after  a  course  of  study  and  an 
examination  satisfactory  to  the  College,  will  be  exempt  from 
re-examination  on  those  subjects. 

Any  candidate  who  shall  produce  satisfactory  evidence  of 
having  passed  an  examination  on  Anatomy  and  Physiology 
required  for  a  degree  in  Medicine  or  Surgery  at  a  university 
in  the  United  Kingdom,  in  India,  or  in  a  British  colony,  after 
a  course  of  study  and  an  examination  satisfactory  to  the  Col¬ 
lege,  will  be  exempt  from  re-examination  on  those  subjects. 

Any  candidate  who  shall  have  obtained  a  degree  in  Surgery 
at  a  university  in  the  United  Kingdom,  after  a  course  of 
study  and  an  examination  satisfactory  to  the  College,  will  be 
exempt  from  re-examination  on  Surgical  Anatomy  and 
Pathology,  and  on  the  Principles  and  Practice  of  Surgery. 

Any  candidate  who  shall  have  passed  the  examination  on 
Surgery  conducted  by  the  Royal  College  of  Surgeons  of 
England,  or  the  Royal  College  of  Surgeons  of  Edinburgh,  or 
the  Royal  College  of  Surgeons  in  Ireland,  or  the  Faculty  of 
Physicians  and  Surgeons  of  Glasgow,  after  a  course  of  study 
and  an  examination  satisfactory  to  the  College,  will  be 
exempt  from  re-examination  on  Surgical  Anatomy  and 
Pathology,  and  on  the  Principles  and  Practice  of  Surgery. 

Any  candidate  who  shall  have  obtained  a  foreign  qualifi¬ 
cation  which  entitles  him  to  practise  Medicine  or  Surgery  in 
the  country  where  such  qualification  has  been  conferred, 
after  a  course  of  study  and  an  examination  equivalent  to 
those  required  by  the  regulations  of  the  College,  shall,  on 
production  of  satisfactory  evidence  as  to  age,  moral  character, 
and  proficiency  in  vaccination,  be  admissible  to.  the  Pass 
Examination,  and  shall  be  exempt  from  re-examination  on 
such  subjects  as  shall  in  each  case  be  considered  by  the 
Censors’  Board  to  be  unnecessary. 


2.  THE  ROYAL  COLLEGE  OF  SURGEONS,  ENGLAND. 

REGULATIONS  RESPECTING  THE  DIPLOMA  OF  MEMBER 
OF  THE  COLLEGE. 

Section  I. — Preliminary  General  Education  and  Examination. 

By  far  the  most  important  qualification  in  this  country  is 
that  of  the  Royal  College  of  Surgeons  of  England,  inasmuch 
as  almost  all  English  and  many  Scottish  and  Irish  students 
become  candidates  for  the  Membership  of  that  body.  The 
College  consists  of  two  grades— Fellows  and  Members.  The 
Fellowship  is  still  partly  honorary,  sometimes  being  con¬ 
ferred  on  Members  of  a  certain  standing,  but  is  now  only 
obtainable  by  examination.  The  Membership  is  the  quali¬ 
fication  sought  by  students  leaving  their  hospitals ;  hence  the 
'  "portancHoFilm  following  regulations 


298 


Medical  Times  and  Gazette. 


PROFESSIONAL  EDUCATION. 


Sept.  15, 1883. 


I.  Candidates  are  required,  before  the  commencement  of 
their  professional  education,  to  pass  a  preliminary  examina¬ 
tion  recognised  by  the  General  Medical  Council,  and  to 
obtain  a  certificate  of  having  been  registered  by  that  Coun¬ 
cil.  N.B. — In  the  case  of  any  colonial,  Indian,  or  foreign 
student,  not  registered  by  the  General  Medical  Council,  the 
conditions  of  admission  to  the  professional  examinations 
for  the  diploma  will  be  determined  by  the  Council  of  the 
College. 

Section  II. — Professional  Education. 

I.  The  following  are  recognised  modes  of  commencing 
professional  education :  — 

1.  Attendance  on  the  practice  of  a  hospital  or  other  public  institution 
recognised  by  this  College  for  that  purpose. 

2.  Instruction  as'  the  pupil  of  a  legally  qualified  surgeon  holding  the 
appointment  of  surgeon  to  a  hospital,  general  dispensary,  or  union  work- 
house,  or  where  such  opportunities  of  practical  instruction  are  afforded 
as  shall  be  satisfactory  to  the  Council. 

3.  Attendance  on  lectures  on  Anatomy,  Physiology,  or  Chemistry,  by 
lecturers  recognised  by  this  College. 

II.  Candidates,  prior  to  their  admission  to  the  first  or 
primary  examination  on  Anatomy  and  Physiology,  will  be 
required  to  produce  the  following  certificates,  viz. :  — 

1.  Of  having,  prior  to  the  commencement  of  professional  study,  been 
registered  by  the  General  Medical  Council. 

2.  Of  having  attended  lectures  on  Anatomy  during  two  winter  sessions. 

3.  Of  having  performed  Dissections  during  not  less  than  two  winter 
sessions. 

4.  Of  having  attended  lectures  on  General  Anatomy  and  Physiology 
during  one  winter  session. 

5.  Of  having  attended  a  practical  course  of  General  Anatomy  and  Physio¬ 
logy  during  another  winter  or  a  summer  session,  consisting  of  not  less  t  han 
thirty  meetings  of  the  class. 

Note  A. — By  the  practical  course  referred  to  in  Clause  5,  it  is  meant  that 
the  learners  themselves  shall,  individually,  be  engaged  in  the  necessary 
experiments,  manipulations,  etc.  ;  but  it  is  not  hereby  intended  that  the 
learners  shall  perform  vivisections. 

Note  B. — The  certificates  of  attendance  on  the  several  courses  of  lectures 
must  include  evidence  that  the  student  has  attended  the  practical  instruc¬ 
tions  and  examinations  of  his  teacher  in  each  course. 

III.  Candidates,  prior  to  their  admission  to  the  second  or 
pass  examination  on  Surgical  Anatomy  and  the  Principles 
and  Practice  of  Surgery,  Medicine,  and  Midwifery,  will  be 
required  to  produce  the  following  certificates,  viz. : — 

1.  Of  being  twenty-one  years  of  age. 

2.  Of  having  been  engaged,  subsequent  to  the  date  of  registration  by 
the  General  Medical  Council,  during  four  years,  or  during  a  period  extend¬ 
ing  over  not  less  than  four  winter  and  four  summer  sessions,  in  the 
acquirement  of  professional  knowledge. 

3.  Of  having  attended  lectures  on  Surgery  during  one  winter  session. 

4.  Of  having  attended  a  course  of  Practical  Surgery  during  a  period 
occupying  not  less  than  six  months  prior  or  subsequent  to  the  course 
required  by  the  preceding  Clause  3. 

Note  C. — The  course  of  Practical  Surgery  referred  to  in  Clause  4  is 
intended  to  embrace  instruction  in  which  each  pupil  shall  be  exercised  in 
practical  details,  such  as  in  the  application  of  anatomical  facts  to  surgery, 
on  the  living  person,  or  on  the  dead  body.  The  methods  of  proceeding  aud 
the  manipulations  necessary  in  order  to  detect  the  effects  of  diseases  and 
accidents,  on  the  living  person,  or  on  the  dead  body.  The  performance, 
where  practicable,  of  tbe  operations  of  surgery  on  the  dead  body.  The 
use  of  surgical  apparatus.  The  examination  of  diseased  structures,  as 
illustrated  in  the  contents  of  a  museum  of  morbid  anatomy,  and  otherwise. 

5.  Of  having  attended  one  course  of  lectures  on  each  of  the  following 
subjects,  viz. Chemistry,  Materia  Medica,  Medicine,  Forensic  Medicine, 
Midwifery  (with  practical  instruction,  and  acertificate  of  having  personally 
conducted  not  less  than  ten  labours) ;  Pathological  Anatomy  during  not 
less  than  three  months. 

Note  D. — The  course  of  lectures  on  Chemistry  included  in  Clause  5  will 
not  be  required  in  the  case  of  a  candidate  who  shall  have  passed  a  satis¬ 
factory  examination  in  this  subject  in  his  preliminary  examination. 

6.  Of  having  studied  Practical  Pharmacy  during  three  months. 

7.  Of  having  attended  a  three  months’  course  of  Practical  Chemistry 
with  manipulations),  in  its  application  to  medical  study. 

8.  Of  instruction  and  proficiency  in  the  practice  of  Vaccination. 

Note  E. — The  certificate  of  instruction  in  Vaccination  must  be  such  as 
will  qualify  its  holder  to  contract  as  a  public  vaccinator  under  the 
regulations  at  the  time  in  force  of  the  Local  Government  Board. 

Note  F. — The  certificates  of  attendance  on  the  several  courses  of  lectures 
must  include  evidence  that  the  student  has  attended  the  practical  instruc¬ 
tions  and  examinations  of  his  teacher  in  each  course. 

9.  Of  having  attended,  at  a  recognised  hospital  or  hospitals,  the 
practice  of  Surgery  during  three  winter(a)  and  two  summer(b)  sessions. 

10.  Of  having  been  individually  engaged,  at  least  twice  in  each  week, 
in  the  observation  and  examination  of  patients  at  a  recognised  hospital 
or  hospitals,  under  the  direction  of  a  recognised  teacher,  during  not  less 
than  three  months. 

Note  G. — It  is  intended  that  the  candidate  should  receive  the  instruction 
required  by  Clause  10  at  an  early  period  of  his  attendance  at  the  hospital. 

11.  Of  having,  subsequently  to  the  first  winter  session  of  attendance  on 
surgical  hospital  practice,  attended,  at  a  recognised  hospital  or  hospitals, 
clinical  lectures  on  Surgery  during  two  winter  and  two  summer  sessions. 

12.  Of  having  been  a  dresser  at  a  recognised  hospital,  or  of  having,  sub¬ 
sequently  to  the  completion  of  one  year’s  professional  education,  taken 


(a)  The  winter  session  comprises  a  period  of  six  months,  and,  in 
England,  commences  on  October  1,  and  terminates  on  March  31. 

(b)  The  summer  session  comprises  a  period  of  three  months,  and,  in 
England,  commences  on  May  1,  and  terminates  on  July  31. 


charge  of  patients  under  the  superintendence  of  a  surgeon  during  not  less- 
than  six  months,  at  a  hospital,  general  dispensary,  or  parochial  or  union 
infirmary  recognised  for  this  purpose,  or  in  such  other  similar  manner  as, 
in  the  opinion  of  the  Council,  shall  afford  sufficient  opportunity  for  the 
acquirement  of  Practical  Surgery. 

13.  Of  having  attended,  during  the  whole  period  of  attendance  on  sur¬ 
gical  hospital  practice  (see  Clause  9),  demonstrations  in  the  post-mortem 
rooms  of  a  recognised  hospital. 

14.  Of  having  attended,  at  a  recognised  hospital  or  hospitals,  the  prac¬ 
tice  of  Medicine,  and  clinical  lectures  on  Medicine,  during  one  winter  and 
one  summer  session. 

N.B.  — Blank  forms  of  the  required  certificates  may  be  obtained  onappli 
cation  to  the  Secretary,  and  all  necessary  certificates  will  be  retained  at¬ 
tire  Collage. 

SPECIAL  NOTICE. 

I.  Candidates  commencing  tlieir  professional  studies  on  or 
after  October  1,  1882,  and  pursuing  those  studies  in  recog¬ 
nised  medical  schools  in  England,  will  be  required,  before 
presenting  themselves  for  the  Primary  or  Anatomical  and 
Physiological  Examination  for  the  diploma  of  Member  of 
the  College,  to  produce  certificates  of  having  passed  an. 
examination  in  Elementary  Anatomy  and  Physiology,  such 
examination  to  be  conducted  by  their  teachers  at  the  several 
medical  schools. 

1.  The  periods  at  which  the  examination  shall  be  held  will  be  deter¬ 
mined  by  the  teachers  at  the  several  medical  schools,  provided  that  an 
interval  of  not  less  than  six  months  shall  elapse  between  the  date  at 
which  the  candidates  shall  have  passed  the  examination,  and  the  date  of 
their  presenting  themselves  for  tbe  Primary  Examination  at  the  College. 

2.  It  shall  be  left  to  the  teachers  at  the  several  medical  schools  to 
determine  the  nature  and  extent  of  the  examination  in  Elementary 
Anatomy  and  Physiology. 

II.  Candidates  commencing  tlieir  professional  education 
on  or  after  October  1,  1882,  will  not  be  admitted  to  the 
second  or  Pass  Examination  until  after  the  expiration  of  two- 
years  from  tbe  date  of  their  passing  the  Primary  or  Ana¬ 
tomical  and  Physiological  Examination  for  such  diploma, 
except  in  the  following  cases,  viz. : — 

1.  When  a  candidate,  before  presenting  himself  for  the  primary  exa¬ 
mination,  shall  possess  a  recognised  degree  or  diploma  in  Medicine  or 
Surgery,  or  shall  have  completed  the  curriculum  of  professional  education 
for  the  diploma. 

2.  In  the  case  of  a  candidate  who,  being  desirous  of  obtaining  the  Fel¬ 
lowship,  shall  fail  to  present  himself  for  the  primary  examination  for  the 
Membership  at  the  end  of  his  second  year  of  professional  study,  but  who 
shall  pass  at  the  end  of  his  third  winter  session  the  primary  examination, 
for  the  Fellowship,  it  being  required  in  such  case  that  not  less  than  one 
year  of  attendance  on  the  Surgical  Practice  of  a  recognised  hospital  shall 
intervene  between  the  date  of  his  passing  the  primary  examination  for 
the  Fellowship  and  the  date  of  his  presenting  himself  for  the  second  or 
pass  examination  for  the  diploma  of  Member. 

3.  In  the  case  of  a  candidate  who,  having  commenced  his  professional 
studies  by  attendance  on  the  practice  of  a  recognised  provincial  or  colonial 
hospital,  and  having  completed  a  year  of  such  attendance,  shall  fail  to- 
pass  the  primary  examination  at  the  end  of  his  second  winter  session  of 
attendance  at  a  recognised  medical  school,  provided  that  in  his  case  not, 
less  than  one  year  shall  elapse  between  the  date  of  his  passing  the  primary 
examination  and  the  date  of  his  presenting  himself  for  tbe  second  or  pass 
examination  for  the  diploma  of  Member. 

4.  When  a  candidate,  owing  to  illness  duly  certiled  by  one  or  more  of 
the  teachers  of  his  medical  school,  shall  be  prevented  from  presenting- 
himself  for  the  primary  examination  on  the  completion  of  his  second 
year  of  professional  study. 

5.  And  in  the  case  of  a  candidate  who,  from  some  unforeseen  circum¬ 
stances.  shall  fail  to  present  himself  for  the  primary  examination  on  the 
completion  of  his  second  year  of  professional  study,  it  being  left  to  the 
Court  of  Examiners  to  determine  whether  in  such  case  the  candidate- 
shall  or  shall  not  be  required  to  comply  with  the  regulation. 

Section  III. 

I.  Certificates  will  not  be  received  on  more  than  one- 
branch  of  science  from  one  and  the  same  lecturer;  but 
Anatomy  and  Dissections  will  be  considered  as  one  branch 
of  science. 

II.  Certificates  will  not  he  recognised  from  any  hospital 
in  the  United  Kingdom  unless  the  surgeons  thereto  be 
members  of  one  of  the  legally  constituted  Colleges  of  Sur¬ 
geons  in  the  United  Kingdom  ;  nor  from  any  school  of 
Anatomy  and  Physiology  or  Midwifery,  unless  the  teachers 
in  such  school  be  members  of  some  legally  constituted  Col¬ 
lege  of  Physicians  or  Surgeons  in  the  United  Kingdom ;  nor 
from  any  school  of  Surgery,  unless  the  teachers  in  such 
school  he  members  of  one  of  the  legally  constituted  Colleges, 
of  Surgeons  in  the  United  Kingdom. 

III.  No  metropolitan  hospital  will  be  recognised  by  thi  j 
College  which  contains  less  than  150,  and  no  provincial  or 
colonial  hospital  which  contains  less  than  100  patients. 

IY.  The  recognition  of  colonial  hospitals  and  schools  is 
governed  by  the  same  regulations,  with  respect  to  number 
of  patients  and  to  courses  of  lectures,  as  apply  to  the  recog¬ 
nition  of  provincial  hospitals  and  schools  in  England. 

Y.  Certificates  of  attendance  upon  the  practice  of  a 


Medical  Times  and  Gazette. 


PROFESSIONAL  EDUCATION. 


Sept.  15, 1883.  299 


recognised  provincial  or  colonial  hospital,  unconnected  with, 
or  not  in  convenient  proximity  to,  a  recognised  medical 
school,  will  not  he  received  for  more  than  one  winter  and 
■one  summer  session  of  the  hospital  attendance  required  by 
the  regulations  of  this  College ;  and  in  such  cases  clinical 
lectures  will  not  be  necessary,  but  a  certificate  of  having 
acted  as  dresser  for  a  period  of  at  least  six  months  will  be 
required. 

VI.  Those  candidates  who  shall  have  pursued  the  whole 
of  their  studies  in  Scotland  or  Ireland  will  be  admitted  to 
•examination  upon  the  production  of  the  several  certificates 
required  respectively  by  the  College  of  Surgeons  of  Edin¬ 
burgh,  the  Faculty  of  Physicians  and  Surgeons  of  Glasgow, 
and  the  College  of  Surgeons  in  Ireland  from  candidates  for 
their  diploma,  together  with  a  certificate  of  instruction  and 
proficiency  in  the  practice  of  vaccination,  and  satisfactory 
evidence  of  having  been  occupied,  subsequently  to  the  date 
of  registration  by  the  General  Medical  Council,  at  least  four 
years,  or  during  a  period  extending  over  four  winter  and 
four  summer  sessions,  in  the  acquirement  of  professional 
knowledge ;  and  in  the  case  of  candidates  who  shall  have 
pursued  the  whole  of  their  studies  at  recognised  foreign  or 
colonial  universities,  upon  the  production  of  the  several 
certificates  required  for  their  degree  by  the  authorities  of 
such  universities,  together  with  a  certificate  of  instruction 
and  proficiency  in  the  practice  of  vaccination,  and  satisfac¬ 
tory  evidence  of  having  been  occupied,  subsequently  to  the 
date  of  passing  the  preliminary  examination,  at  least  four 
years,  or  during  a  period  extending  over  four  winter  and 
four  summer  sessions,  in  the  acquirement  of  professional 
knowledge. 

VII.  Members  or  licentiates  of  any  legally  constituted 
College  of  Surgeons  in  the  United  Kingdom,  and  graduates 
in  Surgery  of  any  University  recognised  for  this  purpose  by 
this  College,  will  be  admitted  to  examination  on  producing 
their  diploma,  licence,  or  degree,  together  with  proof  of  being 
twenty- one  years  of  age,  a  certificate  of  instruction  and 
proficiency  in  the  practice  of  vaccination,  and  satisfactory 
■evidence  of  having  been  occupied,  subsequently  to  the  date 
•of  registration  by  the  General  Medical  Council,  at  least  four 
years,  or  during  a  period  extending  over  four  winter  and 
four  summer  sessions,  in  the  acquirement  of  professional 
knowledge. 

VIII.  Graduates  in  Medicine  of  any  legally  constituted 
College  or  University  recognised  for '  this  purpose  by  this 
College  will  be  admitted  to  examination  on  adducing, 
together  with  their  diploma  or  degree,  proof  of  being 
twenty-one  years  of  age,  a  certificate  of  instruction  and 
proficiency  in  the  practice  of  vaccination,  and  satisfactory 
•evidence  of  having  been  occupied,  subsequently  to  the  date 
-of  registration  by  the  General  Medical  Council,  at  least  four 
years,  or  during  a  period  extending  over  four  winter  and 
four  summer  sessions,  in  the  acquirement  of  professional 
knowledge. 

Section  IV. — Professional  Examination. 

This  examination  is  divided  into  two  parts. 

1.  The  first  or  primary  examination,  in  Anatomy  and  Physiology,  is 
partly  written  and  partly  demonstrative  on  the  recently  dissected  subject, 
and  on  prepared  parts  of  the  human  body. 

2.  The  second,  or  pass  examination,  on  Surgical  Anatomy  and  the 
Principles  and  Practice  of  Surgery,  Medicine,  and  Midwifery,  (c)  is  partly 
written,  partly  oral,  and  partly  on  the  practical  use  of  surgical  apparatus, 
and  the  practical  examination  of  patients. 

3.  The  primary  examinations  are  held  in  themonths  of  January,  April, 
May,  July,  and  November,  and  the  pass  examinations  generally  in  the 
■ensuing  week,  respectively,  (d) 

4.  Candidates  will  not  be  admitted  to  the  primary  examination  until 
after  the  termination  of  the  second  winter  session  of  their  attendance  at  a 

(c)  Candidates  can  claim  exemption  from  examination  in  Medicine  and 
Midwifery  under  the  following  conditions,  viz. : — (1.)  The  production  by 
the  candidate  of  a  degree,  diploma,  or  licence  in  Medicine  and  Midwifery 
entitling  him  to  register  under  the  Medical  Act  of  1858 ;  or  a  degree, 
diploma,  or  licence  in  Medicine  and  Midwifery  of  a  colonial  or  foreign 
university  approved  by  the  Council  of  the  College.  (2.)  A  declaration 
by  the  candidate,  prior  to  his  admission  to  the  pass  examination,  that  it  is 
his  intention  to  obtain  either  of  the  qualifications  in  Medicine  and  Mid¬ 
wifery  mentioned  in  the  foregoing  paragraph,  in  which  case  the  diploma 
■of  the  College  will  not  be  issued  to  him  until  he  shall  produce  either  the 
said  qualification  or  proof  of  having  passed  the  several  examinations 
entitling  him  to  receive  the  same. 

(d)  The  required  certificates,  whether  for  the  primary  or  pass  exa¬ 
mination,  must  be  forwarded  through  the  post  not  less  than  fourteen  clear 
days  prior  to  the  date  of  each  examination ;  except  in  the  case  of  a 
referred  candidate  whose  term  of  additional  study  will  not  expire  until 
the  date  of  the  examination,  in  which  case  a  written  application  must  be 
sent  in  by  him  fourteen  clear  days  before  the  date  of  the  examination  in 
lieu  of  the  certificates,  such  certificates  to  be  produced  the  day  before  the 
examination. 


recognised  school  or  schools ;  nor  to  the  pass,  or  surgical  examination,  until 
after  the  termination  of  the  fourth  year  of  their  professional  education. 

5.  The  fee  of  £5  5s.,  paid  prior  to  the  first  admission  to  the  primary 
examination,  is  retained  whether  the  candidate  pass  or  fail  to  pass  the 
examination,  but  is  allowed  as  part  of  the  whole  fee  of  £22  payable 
for  the  diploma.  A  candidate,  after  failure  at  any  primary  examination, 
is  required,  on  admission  to  any  subsequent  primary  examination,  to 
pay  a  further  fee  of  £3  3s.,  which  is  retained,  whether  he  pass  or  fa5l  to 
pass  the  examination,  and  which  further  fee  is  not  allowed  as  part  of  the 
whole  fee  of  £22  for  the  diploma. 

6.  The  fee  of  £16  15s.  is  payable  prior  to  each  admission  to  the  pass 
examination;  but  on  each  occasion  of  failure  the  balance  of  £11  10s.  is 
returned  to  the  candidate. 

7.  A  candidate  having  entered  his  name  for  either  the  primary  or  pass 
examination,  who  shall  fail  to  attend,  will  not  be  allowed  to  present 
himself  for  examination  within  the  period  of  three  months  from  the  date 
at  which  he  shall  have  so  failed  to  attend. 

S.  A  candidate  referred  on  the  primary  examination  is  required,  prior 
to  his  admission  to  re-examination,  to  produce  a  certificate  that  he  has 
pursued,  to  the  satisfaction  of  his  teachers,  his  anatomical  and  physiolo¬ 
gical  studies  in  a  recognised  medical  school  during  not  less  than  three 
months  subsequently  to  the  date  of  his  reference.(d) 

9.  A  candidate  referred  upon  the  primary  examination,  who  shall  not 
obtain  more  than  half  of  the  total  minimum  number  of  marks,  is  not 
re-admitted  to  examination  until  after  the  lapse  of  six  months,  and  is 
then  required  to  produce  a  certificate  of  the  performance  of  dissections 
during  not  less  than  three  months,  and  of  having  pursued,  to  the  satis¬ 
faction  of  his  teachers,  his  anatomical  and  physiological  studies  in  a 
recognised  medical  school  during  six  months  subsequently  to  the  date  of 
his  reference. (d) 

10.  A  candidate  referred  on  the  pass  examination  is  required,  unless 
the  Court  of  Examiners  shall  otherwise  determine,  to  produce,  prior  to 
liis  admission  to  re-examination,  a  certificate  of  at  least  six  months’ 
further  attendance  on  the  surgical  practice  of  a  recognised  hospital, 
together  with  lectures  on  Clinical  Surgery,  subsequently  to  the  date  of 
his  reference. (d) 

11.  A  candidate,  referred  on  the  pass  or  surgical  examination  for  the 
diploma  of  Member,  who  shall  have  exhibited  such  extreme  ignorance  in 
the  examination  as,  in  the  opinion  of  the  Court  of  Examiners,  to  render 
it  desirable  that  he  should  be  referred  for  a  longer  period  than  six  months, 
is  required,  before  his  admission  to  re-examination,  to  produce  a  certifi¬ 
cate  of  having  attended  the  surgical  practice  and  clinical  lectures  on  sur¬ 
gery  of  a  recognised  hospital  for  a  further  period  of  nine  or  twelve 
months,  as  the  Court  shall  determine,  (d) 


3.  SOCIETY  OF  APOTHECARIES  (ENGLAND). 

Every  candidate  for  a  certificate  of  qualification  to  prac¬ 
tise  as  an  apothecary  will  be  required  to  produce  testimonials 
— 1.  Of  having  passed  a  preliminary  examination  in  Arts,  as 
a  test  of  general  education.  2.  Of  having  attained  the  full 
age  of  twenty-one  years.  3.  Of  good  moral  conduct.  4.  A 
certificate  of  three  months’  Practical  Pharmacy  from  some 
recognised  hospital  or  dispensary,  or  from  a  qualified  medical 
practitioner.  5.  Of  having  pursued  a  course  of  medical  study 
in  conformity  with  the  regulations  of  the  Court. 

The  course  of  medical  study  must  occupy  at  least  four 
years,  of  which  not  less  than  three  winter  and  two  summer 
sessions  must  be  passed  at  a  recognised  school  or  hospital. 

Course  of  Study.— Every  candidate  must  attend  the  follow¬ 
ing  lectures  and  medical  practice  :  each  winter  session  to  con¬ 
sist  of  not  less  than  six  months,  to  commence  on  October  1 ; 
each  summer  session  to  commence  on  May  1. 

First  Year.— Winter  Session:  Chemistry;  Anatomy  and 
Physiology,  including  dissections  and  demonstrations.  Sum¬ 
mer  Session:  Botany;  Materia  Medica  and  Therapeutics; 
Practical  Chemistry. 

Second  Year.— Winter  Session  :  Anatomy  and  Physiology, 
including  dissections  and  demonstrations ;  Principles  and 
Practice  of  Medicine  ;  Clinical  Medical  Practice.  Summer 
Session  :  Midwifery  and  Diseases  of  Women  and  Children  ; 
Forensic  Medicine  and  Toxicology  ;  Clinical  Medical  Practice. 

Third  Year. — Winter  Session  :  Principles  and  Practice  of 
Surgery ;  Clinical  Medical  Lectures  ;  Morbid  Anatomy  ; 
Pathology  and  Clinical  Medical  Practice.  Summer  Session  : 
Practical  Midwifery  and  Vaccination;  Morbid  Anatomy; 
Clinical  Medical  Practice. 

No  certificates  of  lectures,  or  of  anatomical  instructions 
delivered  in  private  to  particular  students  apart  from  the 
ordinary  classes  of  recognised  public  medical  schools,  can  be 
received  by  the  Court  of  Examiners. 

Examination  in  Arts. — This  examination  will  be  held  at 
the  Hall  of  the  Society  on  Thursday,  Friday,  and  Saturday, 
January  10,  11,  and  12,  1884;  April  3,  4,  and  5  ;  September 
11,  12,  and  13. 

SYLLABUS  OF  SUBJECTS  FOB  EXAMINATION  IN  ARTS. (a) 

1.  The  English  Language— Including  grammar  and  composition ;  writing 

(a)  The  examiners  recommend  the  study  of  one  of  the  following : 
English  :  Angus’s,  Adams’s,  or  Mason’s  Grammar,  and  Earle’s  Philology. 
English  History:  Bright’s  History  of  England,  and  Green’s  “Short 
History  of  the  English  People.”  Mechanics:  Wormell’s  or  Newths 
Natural  Philosophy,  or  Girdlestone’s  Mechanics.  Chemistry :  Roscoe’s 
Elementary  Chemistry. 


300 


Medical  Times  and  Gazette. 


PROFESSIONAL  EDUCATION. 


Sept.  15,  1883, 


sentences  in  correct  English  upon  a  given  theme  ;  -writing  correctly  from 
dictation;  explaining  the  construction  of  sentences;  pointing  out  the 
grammatical  errors  in  sentences  ungrammatically  expressed ;  giving  the 
derivation  and  definition  of  words  in  common  use. 

2.  English  History— From  the  accession  of  James  I.  to  the  death  of 
Cromwell. 

3.  Modern  Geography  —  Including  the  elements  of  physical  geography. 

4.  The  Latin  Language— Including  translations  from  the  original,  and 
grammar.  January  Examination  :  Cicero— “De  Amicitia.”  April  Exa¬ 
mination  :  Horace’s  Odes,  Books  I.  and  II.  September  Examination : 
Livy — Book  XXI. 

5.  Mathematics— Arithmetic,  including  vulgar  and  decimal  fractions. 
Algebra,  including  simple  equations.  The  First  Two  Books  of  Euclid, 
or  the  subjects  thereof,  (b) 

6.  Elementary  Mechanics  —Of  solids  and  fluids,  comprising  the  elements 
of  Statics,  Dynamics,  and  Hydrostatics. 

7.  (a)  Greek  -  Lucian :  “Somnium.”  Grammatical  questions,  (h)  French 
—  Emile  Souvestra  :  “  Un  Philosophe  sous  les  Toits.”  Translation  from 
English  into  French.  Grammatical  questions,  (c)  German— Goethe  ; 
“ Knabenjahre  1749-1759 ”  (Pitt Press  Edition).  English  into  German. 
Grammatical  questions.  ( d )  Elementary  Chemistry — Inorganic. 

Professional  Examinations. — The  Court  of  Examiners  meet 
in  the  Hall  every  Wednesday  and  Thursday,  where  candi¬ 
dates  are  required  to  attend  at  4.30  p.m.  Every  candidate 
intending  to  offer  himself  for  examination  must  give  seven 
days’  notice  previous  to  the  day  of  examination,  and  must  at 
the  same  time  deposit  all  the  required  certificates,  with  the 
fee,  at  the  office  of  the  Beadle,  where  attendance  is  given 
daily,  from  ten  to  four  o’clock  (Saturdays  excepted). 

The  examination  of  candidates  is  divided  into  two  parts, 
and  is  conducted  partly  in  writing  and  partly  viva  voce. 

The  first  examination,  which  may  be  passed  after  the 
second. winter  session,  embraces  the  following  subjects: — 
Physicians’  Prescriptions  and  Pharmacy  ;  Anatomy  and 
Physiology ;  General  and  Practical  Chemistry,  conducted  in 
the  Laboratory  at  the  Hall  of  the  Society ;  Materia  Medica 
and  Botany ;  Histology. 

Testimonials  required  of  Candidates  for  the  First  Examina¬ 
tion. — Of  having  passed  an  examination  in  Arts,  recognised 
by  the  Medical  Council ;  of  having  completed  the  curriculum 
of  study  to  the  close  of  the  second  winter  session  ;  of  having 
attended  three  months’  Practical  Pharmacy ;  and  of  good 
moral  conduct.  Any  candidate  who  presents  himself  for  the 
first  examination  and  is  rejected  may  be  admitted  to  re¬ 
examination  at  the  expiration  of  three  calendar  months. 

The  Second  Examination. — At  the  termination  of  the 
medical  studies  :  Principles  and  Practice  of  Medicine, 
including  an  examination  on  the  living  subject ;  Pathology 
and  Therapeutics  ;  Midwifery,  including  the  diseases  of 
women  and  children  ;  Forensic  Medicine  and  Toxicology  ; 
Microscopical  Pathology. 

Certificates  required  of  Candidates  for  the  Second  or  Pass 
Examination. — Of  having  completed  four  years’  medical 
study,  including  the  period  spent  at  the  hospital ;  of  being 
twenty-one  years  of  age ;  and  of  good  moral  conduct.  Of 
having  passed  the  first  examination.  Of  having  completed 
the  prescribed  curriculum  of  study,  including  a  personal 
attendance  of  twenty  cases  of  Midwifery  (a  certificate  of 
which  will  be  received  from  any  registered  practitioner)  ; 
and  of  having  received  instruction  in  practical  Vaccination, 
and  vaccinated  not  less  than  twenty  cases  (this  certificate 
must  be  obtained  from  a  public  vaccinator  recognised  by  the 
Local  Government  Board).  Of  having  served  the  office  of 
clinical  clerk  at  a  recognised  hospital  during  the  period  of 
six  weeks,  at  least.  Of  having  been  examined  at  the  class 
examinations  instituted  by  the  various  lecturers  and  pro¬ 
fessors  of  their  respective  medical  schools  and  colleges.  No 
rejected  candidate  for  the  licence  can  be  re-examined  until 
the  expiration  of  six  calendar  months  from  his  former 
examination. 

Modified  Examinations. — 1.  All  graduates  in  Medicine  of 
British  universities  will  be  admitted  to  a  clinical  and  prac¬ 
tical  examination  in  the  Practice  of  Medicine,  Pathology, 
and  Midwifery.  2.  Licentiates  of  the  Eoyal  College  of 
Physicians,  London ;  of  the  Eoyal  College  of  Physicians, 
Edinburgh;  of  the  Eoyal  Colleges  of  Physicians  and  Sur¬ 
geons,  Edinburgh ;  of  the  King  and  Queen’s  College  of 
Physicians,  Ireland ;  of  the  Faculty  of  Physicians  and  Sur¬ 
geons,  Glasgow ;  and  of  the  Apothecaries’  Hall,  Dublin, 
will  be  admitted  to  a  clinical  and  practical  examination  in 
the  Practice  of  Medicine,  Pathology,  Midwifery,  Forensic 
Medicine,  and. Toxicology.  3.  Any  candidate  who  has  passed 
his  first  examination  for  the  Licence  of  the  King  and  Queen’s 


(b)  Euclid  s  Axioms  will  be  required,  and  no  proof  of  any  proposition 
will  be  admitted  which  assumes  the  proof  of  anything  not  proved  in 
preceding  propositions  in  Euclid. 


College  of  Physicians,  Ireland ;  the  joint  Licence  of  the  Eoyal 
Colleges  of  Physicians  and  Surgeons,  Edinburgh  ;  or  for  the 
single  Licence  of  the  College  of  Physicians,  Edinburgh  ;  the. 
Licence  of  the  Faculty  of  Physicians  and  Surgeons,  Glasgow;, 
the  first  professional  examination  for  the  degree  of  M.B.,  or 
Master  in  Surgery,  in  the  Universities  of  Oxford,  Cambridge, 
London,  or  Durham ;  or  the  second  part  of  the  professional 
examination  for  the  degree  of  M.B.,  or  Master  in  Surgery,  in 
the  Universities  of  Edinburgh,  Aberdeen,  St.  Andrews,  and 
Glasgow ;  or  the  first  and  second  examination  for  medical  and 
surgical  degrees  in  the  Irish  universities  ;  or  the  first 
examination  for  the  Licence  of  the  Apothecaries’  Company, 
Dublin ;  or  the  first  and  second  examinations  of  the  Eoyal 
College  of  Physicians  of  London ;  the  first  of  the  Eoyal 
College  of  Surgeons,  England,  together  with  the  first  exami¬ 
nation  of  the  Eoyal  College  of  Physicians,  London,  will  be 
admitted  to  a  single  examination  in  Anatomy  and  Materia 
Medica  (to  those  candidates  who  have  not  undergone  an. 
examination  in  those  subjects).  Practice  of  Medicine  (in¬ 
cluding  Clinical  Medicine),  Pathology,  Therapeutics,  Mid¬ 
wifery,  Forensic  Medicine,  and  Toxicology,  which  examina¬ 
tion  will  be  partly  written  and  partly  viva  voce.  4.  Members, 
of  the  Eoyal  College  of  Surgeons,  England;  Licentiates  of 
the  Eoyal  College  of  Surgeons,  Edinburgh  ;  and  Licentiates 
of  the  Eoyal  College  of  Surgeons,  Ireland ;  and  all  candidates, 
who  have  passed  the  first  anatomical  examination  of  the 
Eoyal  College  of  Surgeons,  London ;  the  Eoyal  College  of 
Surgeons,  Edinburgh ;  and  the  Eoyal  College  of  Surgeons, 
Ireland,  will  have  to  undergo  the  two  examinations,  but  will 
be  exempt  from  writing  on  Anatomy  and  Physiology  in 
their  first  examination. 

5.  The  cases  of  graduates  of  colonial  and  foreign  colleges 
or  universities  will  be  considered  on  their  respective  merits. 

The  examination  of  candidates  for1  certificates  of  qualifi¬ 
cation  to  act  as  Assistant  in  compounding  and  dispensing- 
medicines  will  be  as  follows  : — In  translating  physicians’ 
prescriptions  ;  in  the  British  Pharmacopoeia ;  in  Pharmacy, 
Pharmaceutical  Chemistry,  Materia  Medica,  and  Medical 
Botany.  No  rejected  candidate  as  an  Assistant  can  be  re¬ 
examined  until  the  expiration  of  three  calendar  months  from 
his  former  examination. 

Fees. — For  a  certificate  of  qualification  to  practise,  £6  6s., 
half  of  which  is  retained  in  case  of  rejection,  to  be  accounted 
for  at  a  subsequent  examination.  For  the  first  examination, 
£3  3s.,  which  sum  is  retained  in  case  of  rejection,  and  ac¬ 
counted  for  subsequently  ;  for  the  second  examination, 
<£3  3s.;  for  an  Assistant’s  ^certificate,  £2  2s.,  which  sum  is 
retained  in  case  of  rejection,  and  accounted  for  subsequently. 

Prizes  are  annually  offered  for  proficiency  in  the  know¬ 
ledge  of  Materia  Medica  and  Pharmaceutical  Chemistry. 
The  prizes  consist  of  a  gold  medal  awarded  to  the  candidate 
who  distinguishes  himself  the  most  in  the  examination ;  and 
a  silver  medal  and  a  book  or  books  to  the  candidate  who  does 
so  in  the  next  degree.  Also  two  prizes  for  proficiency  in  the 
knowledge  of  Botany,  consisting  of  a  gold  medal  to  the 
candidate  who  distinguishes  himself  the  most  in  the  exami¬ 
nation  ;  and  a  silver  medal  and  a  book  or  books  to  the 
candidate  who  does  so  in  the  next  degree. 

Medical  and  Surgical  Scholarships. — Each  Scholarship  is  of 
the  annual  value  of  £100,  and  is  tenable  for  two  years  on 
certain  conditions.  It  is  open  to  all  students  of  the  medical 
profession  whose  standing  at  the  time  of  the  examination 
is  not  less  than  four  and  not  more  than  five  years  from 
the  date  of  their  registration,  and  who  have  obtained  and 
possess  an  English  medical  qualification. 


B.— Scotland. 

In  Scotland,  besides  the  Universities,  there  are  three 
licensing  bodies,  viz. : — 

4.  EOYAL  COLLEGE  OF  PHYSICIANS,  EDINBURGH 

5.  EOYAL  COLLEGE  OF  SURGEONS,  EDINBURGH  ; 

6.  FACULTY  OF  PHYSICIANS  AND  SURGEONS  OF 

GLASGOW. 

The  first  alone  can  give  a  qualification  in  Medicine ;  the 
two  latter  can  give  only  Surgical  qualifications.  But  each 
of  the  surgical  licensing  bodies  has  joined  with  the  College 
of  Physicians  of  Edinburgh,  so  that  a  candidate  can,  through 
a  single  set  of  examinations,  obtain  a  qualification  both  in 
Medicine  and  in  Surgery.  We  give  the  regulations  to  be 


Htcdical  Times  and  Gazette. 


PROFESSIONAL  EDUCATION. 


Sept.  15, 1883.  301 


observed  by  candidates  for  the  double  qualification  of 
Edinburgh,  as  there  is  but  little  difference  between  these 
and  the  regulations  required  for  the  other  above-named 
qualifications. 

ROYAL  COLLEGES  OF  PHYSICIANS  AND  SURGEONS, 

EDINBURGH. 

The  Royal  College  of  Physicians  of  Edinburgh,  and  the 
Royal  College  of  Surgeons  of  Edinburgh,  while  they  still 
continue  to  give  their  diplomas  separately,  under  separate 
regulations,  have  made  arrangements  by  which,  after  one 
series  of  examinations,  the  student  may  obtain  the  diplomas 
of  both  Colleges.  The  general  principle  of  this  joint  exa¬ 
mination  is,  that  it  shall  be  conducted  by  a  board  in  which 
each  body  is  represented  in  those  branches  which  are  common 
to  both  Medicine  and  Surgery ;  but  that  the  College  of 
Physicians  shall  take  exclusive  charge  of  the  examination 
in  Medicine,  and  the  College  of  Surgeons  of  the  examination 
in  Surgery.  The  object  of  the  joint  examination  is  to  give 
to  students  facilities  for  obtaining  from  two  separate  bodies, 
and  at  less  expense,  a  qualification  in  Medicine  and  a  quali¬ 
fication  in  Surgery.  Students  passing  that  examination 
successfully  will  be  enabled  to  register  two  qualifications 
under  the  Medical  Act — Licentiate  of  the  Royal  College  of 
Physicians  of  Edinburgh,  and  Licentiate  of  the  Royal  Col¬ 
lege  of  Surgeons  of  Edinburgh.  The  arrangement  for  thus 
conferring  a  double  qualification  by  the  co-operation  of  the 
two  Colleges  is  in  conformity  with  Section  XIX.  of  the 
Medical  Act,  and  received  the  special  sanction  of  the  General 
Council  of  Medical  Education  and  Registration. 

Every  candidate  must  have  completed  the  age  of  twenty- 
one  years,  and  must  have  followed  his  course  of  study 
in  a  university ;  or  in  an  established  school  of  medicine,  as 
defined  below ;  or  in  a  provincial  school  specially  recognised 
by  the  Colleges  of  Physicians  and  Surgeons  of  that  division 
of  the  United  Kingdom  in  which  it  is  situate. 

All  candidates  must  have  passed  the  complete  examina¬ 
tion  in  general  education,  and  have  had  their  names  inscribed 
in  the  Register  of  Medical  Students  instituted  by  the  General 
Medical  Council, — at  the  commencement  of  their  professional 
studies. 

Candidates  commencing  professional  study  after  Septem¬ 
ber  16,  1866,  must  have  been  engaged  during  forty-five 
months  after  passing  the  examination  in  general  education 
in  professional  study,  which  period  shall  include  not  less 
than  four  winter  sessions’  or  three  winter  and  two  summer 
sessions’  attendance  at  a  recognised  medical  school,  and 
must  have  completed  the  following  curriculum  : — 

Anatomy,  two  courses  of  lectures  in  distinct  sessions,  six 
months  each,  and  Practical  Anatomy,  twelve  months  ;  or,  at 
the  option  of  the  candidate.  Anatomy,  one  course,  six 
months,  and  Practical  Anatomy,  eighteen  months. 

Chemistry,  one  course,  six  months. 

Practical  or  Analytical  Chemistry,  one  course,  three 
months. 

Materia  Medica,  one  course,  three  months. 

Physiology,  not  less  than  fifty  lectures. 

Practice  of  Medicine,  one  course,  six  months. 

Clinical  Medicine,  one  course,  six  months. 

Medicine  (a  third  course,  which  may  either  be  Practice  of 
Medicine  or  Clinical  Medicine,  at  the  option  of  the  student), 
•one  course,  six  months. 

Principles  and  Practice  of  Surgery,  one  course,  six  months. 

Clinical  Surgery,  one  course,  six  months. 

Surgery  (a  third  course,  which  may  either  be  Principles 
■and  Practice  of  Surgery,  or  Clinical  Surgery,  at  the  option 
of  the  student),  one  course,  six  months. 

Midwifery  and  Diseases  of  Women  and  Children,  one 
•course,  three  months. 

Medical  Jurisprudence,  one  course,  three  months. 

Pathological  Anatomy,  one  course,  three  months. 

The  candidate  must  also  produce  the  following  certifi- 
•eates : — 

a.  Of  having  attended  six  cases  of  labour  under  the  super¬ 
intendence  of  the  practitioner  who  signs  the  certificate,  who 
must  be  a  registered  medical  practitioner. 

b.  Of  having  attended,  for  three  months,  instruction  in 
Practical  Pharmacy.  The  certificate  to  be  signed  by  the 
teacher,  who  must  be  a  member  of  the  Pharmaceutical 
Society  of  Great  Britain,  or  a  chemist  and  druggist  recognised 
by  either  College  on  special  application,  or  the  superin¬ 
tendent  of  the  laboratory  of  a  public  hospital  or  dispensary. 


or  a  registered  practitioner  who  dispenses  medicine  to  his 
patients. 

c.  Of  having  attended  for  twenty-four  months  a  public 
general  hospital  containing,  on  an  average,  at  least  eighty 
patients. 

d.  Of  having  attended  for  six  months  the  practice  of  a 
public  dispensary  specially  recognised  by  either  College,  or 
of  having  been  engaged  for  six  months  as  visiting  assistant 
to  a  registered  practitioner. 

e.  Of  having  been  instructed  in  Vaccination.  The  certi¬ 
ficate  to  be  signed  by  the  teacher,  who  must  be  a  registered 
practitioner. 

Students  are  strongly  recommended  to  avail  themselves 
of  any  opportunities  which  they  may  possess  of  attending, 
in  addition  to  the  courses  of  instruction  which  are  absolutely 
required,  lectures  on  Ophthalmic  and  Mental  Diseases,  also 
on  Natural  History  and  Comparative  Anatomy,  and  of 
obtaining  practical  instruction  in  the  use  of  the  Microscope. 

There  are  two  professional  examinations,  each  partly  in 
writing  and  partly  oral.  The  first  embraces  Anatomy, 
Physiology,  and  Chemistry;  and  no  candidate  can  be  ad¬ 
mitted  to  it  before  the  end  of  his  second  winter  session. 
The  second  embraces  Medicine,  Surgery  and  Surgical  Ana¬ 
tomy,  Midwifery,  Pathological  Anatomy,  Materia  Medica 
and  Pharmacy,  and  Medical  Jurisprudence.  No  candidate 
can  be  admitted  to  it  sooner  than  forty-five  months  after 
passing  the  examination  in  general  education,  or  before  he 
has  attained  the  age  of  twenty-one  years. 

Candidates  who  have  passed  the  First  Professional  Exa¬ 
mination  in  Anatomy,  Physiology,  and  Chemistry,  at  any 
of  the  licensing  boards  recognised  by  the  Medical  Act,  will 
be  admissible  to  the  Second  Professional  Examination  on 
producing  certificates  of  the  whole  course  of  study  prescribed, 
of  having  passed  their  Preliminary  and  First  Professional 
Examinations,  and  of  having  been  registered.  If  any  of 
the  three  subjects  of  the  First  Professional  Examination 
have  been  omitted,  such  candidates  will  have  to  undergo  an 
examination  on  the  omitted  subjects  ;  and  none  of  the  sub¬ 
jects  of  the  Second  Examination  will  be  omitted  even  if 
some  of  them  should  have  formed  part  of  the  First  Exa¬ 
mination  by  another  board. 

In  addition  to  the  written  and  oral  examinations,  all 
candidates  shall  be  subjected  to  practical  clinical  examina¬ 
tions  in  Medicine  and  Surgery,  which  shall  include  the 
examination  of  patients,  physical  diagnosis,  the  use  of  the 
microscope,  surgical  appliances,  bandages,  etc. 

No  candidates  shall  be  admissible  to  examination  who  has 
been  rej  ected  by  any  other  licensing  board  within  the  three 
preceding  months. 

ROYAL  COLLEGE  OF  PHYSICIANS,  EDINBURGH 

AND  FACULTY  OF  PHYSICIANS  AND  SURGEONS 

OF  GLASGOW. 

Candidates  passing  the  examination  for  the  double  quali¬ 
fication  of  these  two  bodies  will  be  entitled  to  register  two 
qualifications  under  the  Medical  Act,  namely — Licentiate 
of  the  Faculty  of  Physicians  and  Surgeons  of  Glasgow,  and 
Licentiate  of  the  Royal  College  of  Physicians  of  Edinburgh. 
The  curriculum  of  study  embraces  a  course  of  Medicine,  in 
addition  to  the  subjects  requiredfor  a  diploma  of  the  Faculty. 


C.— Ireland. 

7.  KING  AND  QUEEN’S  COLLEGE  OF  PHYSICIANS 
IN  IRELAND. 

This  body  consists  of  Fellows,  Members,  and  Licentiates 

THE  LICENCE  IN  MEDICINE. 

The  regulations  relating  to  Licentiates  are  as  follows  : — 
Candidates  must  produce — 1.  Evidence  of  having  been 
engaged  in  the  study  of  Medicine  for  four  years.  2.  A 
certificate  of  having  passed  the  preliminary  examination 
of  one  of  the  recognised  licensing  corporations  before  the 
termination  of  the  second  year  of  medical  study.  3.  Certi¬ 
ficates  of  having  studied  at  a  school  or  schools  recognised 
by  the  College,  the  following  subjects,  viz. : — Practical  Ana¬ 
tomy,  two  courses  ;  and  Physiology  or  Institutes  of  Medicine, 
Botany,  Chemistry,  Practical  Chemistry,  Materia  Medica, 
Practice  of  Medicine  and  Pathology,  Surgery,  Midwifery, 
Medical  Jurisprudence,  one  course  each.  4.  Certificates  of 
having  attended  a  medico-chirurgical  hospital  in  which 
regular  courses  of  clinical  lectures  are  delivered,  together 


302 


Medical  Times  and  Gazette. 


SCIENTIFIC  EDUCATION. 


Sept.  15, 1883. 


with  clinical  instruction,  for  twenty-seven  months.  5.  Of 
having  been  in  attendance  during  at  least  three  months  on 
a  clinical  hospital  which  contains  wards  for  the  treatment 
of  infectious  fevers,  and  of  having  daily  recorded  observa¬ 
tions  on  at  least  five  cases  of  fever.  6.  Of  having 
attended  Practical  Midwifery  and  Diseases  of  Women  for 
six  months  at  a  lying-in  hospital  or  maternity  recognised  by 
the  College ;  or,  where  such  hospital  attendance  cannot 
have  been  obtained  during  any  period  of  the  student’s 
course  of  study,  of  having  been  engaged  in  Practical  Mid¬ 
wifery  under  the  supervision  of  a  registered  practitioner 
holding  public  appointments  ;  the  certificate  in  either  case 
to  state  that  not  less  than  twenty  labour  cases  have  been 
actually  attended.  6.  Certificates  of  character  from  a 
Fellow  of  the  College,  or  from  two  registered  practitioners. 

A  candidate  who  has  already  obtained  a  medical  or 
surgical  qualification  recognised  by  the  College  is  only 
required  to  produce  his  diploma  or  certificate  of  registration, 
a  certificate  of  Practical  Midwifery,  evidence  of  the  study 
of  fever,  and  testimonials  as  to  character. 

Examination  for  the  Licence  in  Medicine. — The  examination 
consists  of  two  parts.  The  subjects  of  the  first  part,  or  pre¬ 
vious  examination,  are — Anatomy,  Physiology,  Chemistry, 
and  Materia  Medica.  The  subjects  of  the  second  part, 
or  final  examination,  are — Practice  of  Medicine,  Medical 
Jurisprudence,  Midwifery,  Clinical  Medicine,  Pathology, 
Hygiene,  and  Therapeutics. 

Examinations  in  the  first  part  are  held  quarterly,  in 
January,  April,  July,  and  October.  Examinations  in  the  final 
or  second  part  are  held  monthly  (except  in  August  and  Sep¬ 
tember)  in  the  week  following  the  first  Friday  of  each  month. 

All  candidates  for  the  second  or  final  examination  (with 
the  exception  below  specified)  (a)  are  examined  in  the 
Practice  of  Medicine  at  the  bedside  in  one  of  the  hospitals  of 
Dublin,  and  in  the  College  by  means  of  printed  questions 
and  orally  in  all  the  subjects  of  examination.  Candidates 
may  be  examined  in  the  subjects  of  the  first  part  at  the  end 
of  the  second  year  of  study,  or  on  the  completion  of  their 
medical  studies.  No  one  can  be  examined  in  the  subjects  of 
the  first  and  second  parts  in  the  same  month. 

Candidates  qualified  as  follows  are  required  to  undergo 
the  second  part  of  the  professional  examination  only,  viz. : — 
1.  Graduates  in  Medicine  of  a  university  in  the  United 
Kingdom,  or  of  any  foreign  university  approved  by  the 
College.  2.  Fellows,  Members,  or  Licentiates  of  the  Eoyal 
College  of  Physicians  of  London  or  Edinburgh,  who  have 
been  admitted  upon  examination.  3.  Graduates  or  Licen¬ 
tiates  in  Surgery.  4.  Candidates  who,  having  completed 
the  curriculum  above  mentioned,  have  passed  the  previous 
professional  examination  or  examinations  of  any  of  the 
licensing  corporations  in  the  United  Kingdom. 

THE  LICENCE  IN  MIDWIFERY. 

Candidates  who  are  not  licentiates  in  Medicine  may  be 
admitted  to  examination  on  the  following  qualifications  : — 
1.  The  degree  or  licence  in  Medicine  from  any  University  or 
College  of  Physicians  in  the  United  Kingdom.  2.  Testi¬ 
monials  as  to  character.  3.  Certificates  of  having  attended 
(a)  a  course  of  lectures  on  Midwifery  in  a  school  recognised 
by  the  College ;  (6)  Practical  Midwifery  as  in  Section  6  of 
the  regulations  for  the  Licence  in  Medicine. 

Candidates  already  qualified  in  Medicine  or  Surgery  may 
apply  for  permission  to  be  examined  for  the  licence  in 
Midwifery.  The  certificates  required  to  be  lodged  are  the 
same  as  those  required  from  qualified  candidates  for  the 
Licence  to  practise  Medicine. 

Examinations,  by  printed  questions  and  orally,  for  the 
Licence  in  Midwifery  are  conducted  on  the  Thursday 
following  the  first  Friday  of  each  month  except  August 
and  September. 

Fees. — Fee  for  the  licence  in  Medicine,  .£15  15s.  Fee  for 
licences  in  Medicine  and  Midwifery,  if  taken  out  within  an 
interval  of  a  month,  <£16  16s.  Fee  for  the  licence  in  Mid¬ 
wifery,  ,£3  3s.  N.B. — The  fee  for  the  Licence  in  Medicine 
to  graduates  in  Arts  and  Medicine  of  any  university  in  the 
United  Kingdom  is  £5  5s. 

MEMBERSHIP. 

The  qualification  of  Member  is  conferred  only  on  those 
who  are  already  Licentiates  of  some  standing  ;  consequently 
it  does  not  fall  within  the  scope  of  our  abstract  of  regulations. 

(a)  Candidates  who  are  registered  practitioners  of  five  years’  standing 
are  exempted  from  the  written  portion  of  tie  examination. 


FELLOWSHIP. 

The  election  for  Fellowship  takes  place  twice  a  year, 
viz.,  on  the  first  Friday  in  April  and  on  St.  Luke’s  Day 
(October  18).  Candidates  (who  must  be  Members  of  the 
College  of  one  year’s  standing)  must  be  proposed  and 
seconded  three  months  previously.  Fee  £3  5,  and  <£25 
stamp-duty.  _ 


8.  EOYAL  COLLEGE  OF  SUEGEONS,  IEELAND. 

The  following  regulations  apply  to  students  who  com¬ 
menced  their  studies  subsequently  to  May  1,  1882  : — 

No  student  can  be  admitted  as  a  candidate  to  any  exami¬ 
nation  for  the  Letters  Testimonial  unless  he  shall,  before 
commencing  his  medical  studies,  have  passed  a  Prelimi¬ 
nary  Examination  recognised  by  the  Medical  Council,  and 
have  been  registered  as  a  student  by  that  Council. 

The  Letters  Testimonial  of  the  College  will  not  be  granted, 
to  any  candidate  at  an  earlier  period  than  forty-five  months 
subsequent  to  registration  as  a  medical  student,  nor  to  any 
one  who  has  not  attained  the  age  of  twenty-one  years. 

EXAMINATIONS. 

Every  candidate  shall  be  required  to  pass  a  Preliminary- 
Examination  and  four  Professional  Examinations. 

The  Preliminary  Examinations  are  held  quarterly,  viz.,  on 
the  third  Wednesday  in  January,  April,  July,  and  October- 
in  each  year. 

PROFESSIONAL  EXAMINATIONS. 

The  First,  Second,  and  Third  Professional  Examinations 
shall  be  held  in  the  July  and  October  of  each  year.  The 
examination  of  each  year  must  be  passed  before  a  new 
session  can  be  entered  on. 

First  Professional  Examination. 

Candidates  are  required,  before  admission  to  the  First 
Professional  Examination,  to  produce  evidence  of  having- 
been  engaged  in  study  for  at  least  nine  months  subsequent 
to  registration. 

The  examination  shall  include  the  following  subjects,  viz.  s 
— Physics,  if  not  passed  at  the  Preliminary  Examination  ; 
the  elements  of  Chemistry ;  Botany  (elementary) ;  Anatomy- 
(human  osteology) ;  Practical  Pharmacy  (elementary).  The- 
examination  lasts  two  days,  and  is  written  and  oral. 

Second  Professional  Examination. 

Candidates  are  required,  before  admission  to  the  Second 
Professional  Examination,  to  produce  evidence  of  having 
passed  the  First  Professional  Examination,  also  certificates 
of  having  subsequently  attended — Medico-Chirurgical  Hos¬ 
pital,  nine  months.  Winter  courses  :  Practical  Anatomy, 
with  demonstrations  and  dissections ;  Physiology  ;  Surgery  ; 
Chemistry  (unless  attended  in  first  year).  Summer  Courses, 
three  months  :  Practical  Chemistry ;  Practical  Physiology;. 
Materia  Medica. 

Candidates  shall  be  examined  in :  Anatomy — bones,  joints, 
muscles,  and  topographical  anatomy  of  the  viscera  of  the 
chest,  abdomen,  and  pelvis.  Histology ;  and  the  physiology- 
of  the  circulatory,  respiratory,  and  digestive  systems.  Sur¬ 
gery — the  signs,  terminations,  and  treatment  of  inflamma¬ 
tion;  wounds;  haemorrhage;  burns  and  scalds;  ulcers; 
bandaging.  Chemistry.  Materia  Medica. 

The  examination  lasts  two  days,  and  is  oral  and  practical- 

Third  Professional  Examination. 

Candidates  are  required,  before  admission  to  the  Third 
Professional  Examination,  to  produce  evidence  of  having, 
passed  the  Second  Examination,  also  certificates  of  having 
subsequently  attended — Medico-Chirurgical  Hospital,  nine- 
months  as  an  extern  pupil,  or  six  months  as  a  resident  pupil* 
Winter  courses :  Demonstrations  and  dissections ;  Practical 
Anatomy  (unless  attended  in  the  first  year)  ;  Surgery ; 
Medicine.  Summer  Course,  three  months :  Medical  Juris¬ 
prudence. 

Candidates  shall  be  examined  in — Anatomy ;  Physiology  ; 
Surgery  (not  including  Operative,  Clinical,  and  Ophthalmic 
Surgery,  which  are  reserved  for  the  Final  Professional  Exa¬ 
mination)  . 

The  examination  lasts  three  days,  and  is  written,  oral,  and 
practical. 

Fourth  and  Final  Professional  Examination. 

The  Fourth  Professional  Examination  shall  be  held  ini 
July  and  October,  and  in  the  following  April. 


Medical  Times  and  Gazette. 


ENGLISH  SCHOOLS. 


Sept.  15, 1883.  303 


Candidates  are  required,  before  admission  to  the  Final 
Examination,  to  produce  evidence  of  having  passed  the  Third 
Professional  Examination,  also  certificates  of  having  subse- 
■quently  attended — Medico-Chirurgical  Hospital,  nine  months 
as  extern  pupil  (or  six  months  as  resident  pupil,  unless  a 
certificate  to  that  effect  has  been  accepted  in  the  third  year) . 
Winter  Courses:  Dissections  and  demonstrations;  Midwifery. 
Certificates  will  also  be  required  of  having  attended  a  mid- 
wifery  hospital  or  maternity  for  six  months,  and  of  having 
been  present  at  thirty  labours ;  Clinical  Ophthalmology, 
three  months ;  Operative  Surgery ;  practical  instruction  in 
Vaccination. 

Candidates  shall  be  examined  in — Surgery  (Clinical,  Oph¬ 
thalmic,  and  Operative,  with  Surgical  Anatomy) ;  Medicine  ; 
Midwifery  and  Diseases  of  Women  ;  Medical  Jurisprudence. 

The  examination  will  last  four  days— one  day  written,  one 
oral,  one  clinical,  and  the  fourth  practical  (opei’ative) . 

The  fee  for  each  of  the  four  Professional  Examinations 
is  <£5  5s. 

The  College  also  grants  a  diploma  in  Midwifery,  for 
which  the  following  are  the  regulations  : — 

Qualifications  of  Candidates  for  the  Diploma  in  Midwifery . — Any  Fellow 
•or  Licentiate  of  the  College  shall  be  admitted  to  an  examination  for  the 
diploma  in  Midwifery  upon  laying  before  the  Council  the  following 
documents  :  —  a.  A  certificate  showing  that  he  has  attended  one  course  of 
(lectures  on  Midwifery  and  Diseases  of  Women  and  Children,  delivered  by  a 
professor  or  lecturer  in  some  School  of  Medicine  or  Surgery  recognised  by 
The  Council,  h.  A  certificate  showing  that  he  has  attended,  during  a 
period  of  six  months,  the  practice  of  a  lying-in  hospital  recognised  by  the 
Council ;  or  the  practice  of  a  dispensary  for  lying-in  women  and  children 
recognised  by  the  Council  and  devoted  to  this  branch  of  Surgery  alone, 
c.  A  certificate  showing  that  he  has  conducted  thirty  labour  cases,  at  least. 

Fees  to  he  paid  hy  Candidates  for  the  Diploma  in  Midwifery .  —  The 
•candidate  pays  £1  6s.  for  the  Midwifery  diploma,  provided  he  takes  it  out 
within  one  month  from  the  date  of  his  letters  testimonial ;  after  that  date 
ithe  fee  will  be  £2  2s. 


9.  THE  APOTHECARIES’  HALL  OF  IBELAND. 

This  body  grants  a  licence  to  practise  Medicine  and 
Pharmacy  on  the  following  conditions : — 

1.  Of  having  passed  an  examination  in  Arts  before  one  of 
the  recognised  public  boards  previously  to  entering  on 
professional  study. 

2.  Of  having  been  registered  in  the  Students’  Medical 
Register. 

3.  Of  being  at  least  twenty-one  years  of  age,  and  of  good 
■moral  character. 

4.  Of  pupilage  to  a  qualified  apothecary,  or  of  having  been 
otherwise  engaged  in  practical  pharmacy  for  a  period  of 
twelve  months  subsequent  to  having  passed  the  examination 
in  Arts. 

5.  Of  having  spent  four  years,  or  forty-five  months,  in 
professional  study  from  the  date  of  registration  in  the 
Students’  Eegister. 

6.  Of  having  attended  the  following  courses,  viz. Che¬ 
mistry,  during  one  winter  session ;  Anatomy  and  Physiology, 
during  one  winter  session ;  Demonstrations  and  Dissections, 
during  two  winter  sessions ;  Botany  and  Natural  History, 
during  one  summer  session ;  Practical  Chemistry  (in  a 
recognised  laboratory),  during  three  months ;  Materia 
Medica,  during  three  months ;  Principles  and  Practice  of 
Medicine  and  Therapeutics,  during  one  winter  session ; 
Midwifery  and  Diseases  of  Women  and  Children,  during  six 
months ;  Practical  Midwifery  at  a  recognised  hospital 
-(attendance  upon  twenty  cases) ;  Surgery,  during  one  winter 
session ;  Forensic  Medicine,  during  one  summer  session ; 
instruction  in  the  practice  of  Vaccination. 

7.  Of  having  attended,  at  a  recognised  hospital  or  hospitals, 
the  practice  of  Medicine  and  clinical  lectures  on  Medicine, 
during  two  winter  and  two  summer  sessions ;  also  the  practice 
•of  Surgery  and  clinical  lectures  on  Surgery,  during  one 
winter  and  one  summer  session. 

8.  Of  practical  study,  with  care  of  patients,  as  appren¬ 
tice  pupil,  assistant,  clinical  clerk,  or  dresser,  in  hospital, 
dispensary,  or  with  a  registered  practitioner. 

9.  Of  having  performed  the  operation  of  vaccination  suc- 
-cessfully  under  a  recognised  public  vaccinator. 

The  examination  for  the  licence  to  practise  is  divided  into 
two  parts  : — The  first  part  comprehends  Chemistry,  Botany, 
Anatomy,  Physiology,  Materia  Medica,  and  Pharmacy  ;  the 
second — Medicine,  Surgery,  Pathology,  Therapeutics,  Mid¬ 
wifery,  Forensic  Medicine,  and  Hygiene. 

The  professional  examinations  will  be  held  quarterly,  and 
will  commence  on  the  first  and  second  Mondays  in  the  months 
of  January,  April,  July,  and  October. 


LONDON  HOSPITALS  AND  MEDICAL 
SCHOOLS. 


ST.  BARTHOLOMEW’S  HOSPITAL. 


MEDICAL  AND  SURGICAL  STAFF. 


Consulting  Physicians. 

Sir  Ci.  Burrows,  Bart.,  D.C.L.,  F.B.S.,  Dr.  Farre,  Dr.  Harris,  Dr.  Martin. 


Consulting  Surgeons — Sir  J.  Paget,  Bart.,  D.C.L.,  F.B.S., 


Physicians. 

Dr.  Andrew. 

Dr.  Church. 

Dr.  Gee. 

Dr.  Duckworth. 

Assistant-Physicians. 

Dr.  Hensley. 

Dr.  Brunton,  F.B.S. 

Dr.  Legg. 

Physician- A  ccoucheur. 

Dr.  Matthews  Duncan. 

Assistant  Physician- Accoutheur. 

Dr.  Godson. 


Mr.  Holden. 

Surgeons. 

Mr.  Savory,  F.B.S. 

Mr.  Thomas  Smith. 

Mr.  Willett. 

Mr  Langton. 

Mr.  Baker. 

Assistant- Surgeons. 

Mr.  Marsh. 

Mr.  Butlin. 

Mr.  Walsham. 

Mr.  Cripps. 

Mr.  Shuter. 

Ophthalmic  Surgeons. 

Mr.  Power. 

Mr.  Vernon. 


Casualty  Physicians — Dr.  Steavenson,  Dr.  Herringham,  Dr.  King. 
Dental  Surgeon — Mr.  Coleman. 

Assistant  Dental  Surgeons — Mr.  Lyons,  Mr.  Ewbank. 
Administrator  of  Chloroform — Mr.  Mills. 


LECTURES. 


Botany — Bev.  George  Henslow. 
Chemistry  and  Practical  Chemistry 
— Dr.  Bussell,  F.  K.S 
Clinical  Medicine — Dr.  Andrew,  Dr. 

Church,  Dr.  Gee,  Dr.  Duckworth. 
Clinical  Surgery — Mr.  Savory,  Mr. 
Thomas  Smith,  Mr.  Willett,  Mr. 
Langton,  Mr.  Baker. 

Comparative  Anatomy — Dr.  Moore. 
Dental  Anatomy  and  Surgory — Mr. 
Coleman. 

Descriptive  and  Surgical  Anatomy 
— Mr.  Langton  and  Mr.  Marsh. 
Public  Health  and  Hygiene — Dr. 
Thorne. 


Forensic  Medicine— Dr.  Southey. 

General  Anatomy  and  Physiology, 
with  Histology  —  Mr.  Morrant 
Baker  and  Dr.  Klein. 

Materia  Medica — Dr.  Brunton. 

Medicine  —  Dr.  Andrew  and  Dr. 
Gee. 

Mental  Diseases — Dr.  Claye  Shaw. 

Midwifery  and  the  Diseases  of 
Women  and  Children — Dr.  Mat¬ 
thews  Duncan. 

Ophthalmic  Medicine  and  Surgery 
— Mr.  Power. 

Pathological  Anatomy — Dr.  Legg. 

Surgery — Mr.  Savory. 


DEMONSTRATIONS. 


Aural  Surgery— Mr.  Cumberbatch. 
Chemistry— Dr.  Armstrong. 

Diseases  of  the  Eye — Mr.  Vernon. 
Diseasesof  the  Larynx— Mr.  Butlin. 
Diseases  of  the  Skin— Dr.  Legg. 
Mechanical  and  Natural  Philosophy 
— Mr.  Womack. 

Orthopaedic  Surgery — Mr.  Walsham. 

Medical  Tutor- 


Morbid  Anatomy  —  Dr.  Norman 
Moore. 

Practical  Anatomy  and  Operative 
Surgery — Mr.  Bruce  Clarke,  Mr. 
Edwards,  and  Mr.  Lockwood. 
Practical  Physiology — Dr.  V.  Harris. 
Practical  Surgery — Mr.  Butlin  and 
Mr.  Walsham. 

-Dr.  S.  West. 


This  Hospital  comprises  a  service  of  710  beds,  of  which  676 
are  in  the  Hospital  in  Smithfield,  and  34  are  for  convalescent 
patients  at  Lauderdale  House,  Highgate. 


SCHOLARSHIPS  AND  PEIZES. 

Open  Scholarships  in  Science,  founded  1873;  subjects  of  examination : 
— Physics,  Chemistry,  Botany,  Physiology,  aud  Zoology.  These  scholar¬ 
ships,  of  the  value  of  £130  each,  tenable  for  one  year,  will  be  competed 
for  on  September  26  and  following  days. 

Preliminary  ScientiSc  Exhibition,  founded  1873 ;  subjects  of  examina¬ 
tion— Physios,  Chemistry,  Botany,  and  Zoology.  This  exhibition,  of  the 
value  of  £50,  is  awarded  in  October. 

Lawrence  Scholarship  and  Gold  Medal,  of  the  value  of  £40,  founded  in 
1873,  by  the  family  of  the  late  Sir  W.  Lawrence. 

Bracxenbury  Scholarship  in  Medicine,  and  Brackenbury  Scholarship 
iu  Surgery,  founded  in  1873  by  the  will  of  the  late  Miss  Hannah 
Brackenbury,  who  left  £2000  for  this  purpose. 

Senior  Scholarship  of  the  value  of  £50 — Anatomy,  Physiology,  and 
Chemistry. 

Juaior  Scholarships  of  the  value  of  £50,  £30,  and  £20  are  awarded  after 
an  examination  iu  the  subjects  of  study  of  the  first  year  at  the  end  of  the 
summer  and  winter  sessions. 

The  Jeaffreson  Exhibition,  of  the  value  of  £50,  is  awarded  at  the  com 
mencement  of  each  winter  session,  after  open  competition,  on  the  same 
days  as  the  Science  Scholarships  in  Clas.-ics,  Mathematics,  and  Modern 
Languages. 

The  Wix  Prize  is  awarded  for  the  best  essay  on  the  following  subject: — 
*'  Willis.” 

Hicheus  Prize  :  subject  of  examination — Bishop  Butler’s  Analogy. 

Bentley  Prizes  (two),  for  the  best  report  of  Surgical  and  Medical  Cases 
occurring  in  the  wards  of  the  Hospital  during  the  previous  year.  It  is 
expected  that  the  reports  will  comprise  the  histories,  progress,  treatment, 
and  results  of  not  less  than  twelve  cases,  with  observations  thereupon. 

Foster  Prize:  subject  of  examination — Practical  Anatomy,  senior. 

Treasurer’s  Prize  :  subject  of  examination — Practical  Anatomy,  junior. 

Kirkes  Gold  Medal :  subject  of  examination— Clinical  Medicine. 

Harvey  Prize  :  subject  of  examination— Practical  Physiology. 

FEES. 

Whole  fee  for  attendance  on  lectures  and  hospital  practice 
£138  12s.,  payable  by  instalments — first  winter  £42,  first 
summer  £48  6s.,  second  summer  £48  6s. — or  a  single  payment 
of  £131  5s.  Payment  in  either  of  these  ways  entitles  to  a 
perpetual  ticket. 


304 


Medical  Times  and  Gazette. 


ENGLISH  SCHOOLS. 


Sept.  15,  1883. 


A  College  for  resident  students  exists  in  connexion  with,  the 
Hospital;  Warden,  Dr.  Norman  Moore,  from  whom  students 
will  obtain  information  respecting  rooms  in  the  College,  or  will 
he  advised  regarding  residence  out  of  the  Hospital. 

All  communications  to  be  addressed  to  the  Warden  of  the 
College,  St.  Bartholomew’s  Hospital,  E.C. 


CHARING-CROSS  HOSPITAL. 


MEDICAL  AND  SURGICAL  STAFF. 


Consulting  Physician — Sir  Joseph  Fayrer,  M.D.,  K.C.S.I.,  F  R.S.,  F.R.C.P. 
Consulting  Surgeons — Mr.  E.  Canton,  F.K.C.S  ,  and  Mr.  F.  Hird,  F.R.C.S. 


Physicians. 

Dr.  A.  .T.  Pollock. 

Dr.  T.  H.  Green. 

Dr.  J.  Mitchell  Bruce. 

Assistant-Physicians . 

Dr.  John  Abercrombie. 

Dr.  Montagu  Lubhuck. 

Dr.  F.  Willcocks. 

Physician- Accoucheur. 

Dr.  J.  Watt  Black. 

Assistant  Physician- Accoucheur. 
Dr.  Amand  Routh. 
Physician  for  Shin  Diseases. 
Dr.  A.  Sangster. 

Medica  l  Registrar. 

Dr.  Murray. 


Surgeons. 

Mr.  R.  Barwell. 

Mr.  E.  Bellamy. 

Mr.  J.  Astley  Bloxam. 

Assistant- Surgeons. 

Mr.  J.  Cantlie. 

Mr.  J.  H.  Morgan. 

Mr.  Stanley  Boyd. 

Dental  Surgeon. 

Mr.  John  Fairbank. 

Chloroformists. 

Mr.  Woodhouse  Braine. 
Mr.  G.  H.  Bailey. 

Surgical  Registrar. 

Mr.  W.  I.  Roeckel. 


LECTURERS  AND  TEACHERS. 


Anatomy— Mr.  Edward  Bellamy. 
Minor  Surgery — Mr.  James  Cantlie. 
Botany — Dr.  F.  Willcocks. 
Chemistry  &  Practical  Chemistry — 
Mr.  C.  W.  Heaton  ;  Demonstrator, 
Mr.  A.  Vasey. 

Clinical  Medicine— Dr.  Pollock,  Dr. 

Greeu,  and  Dr.  Bruce. 

Clinical  Surgery — Mr.  Barwell,  Mr. 

Bellamy,  and  Mr.  Bloxam. 
Ophthalmic  Surgery — The  Staff  of 
the  Royal  Westminster  Ophthal¬ 
mic  Hospital. 

Comparative  Anatomy — Mr.  J.  G. 
Garson. 

Demonstrations  and  Dissections — 
Mr.  James  Cantlie. 

Dental  Surgery—  Mr.  John  Fairbank. 
Diseases  of  Children— Dr.  Montagu 
Lubbock. 

Forensic  Medicine -Dr.  John  Aber¬ 
crombie. 

Physics— Mr.  H.  B.  Shaw. 


Materia  Medica  and  Therapeutics  — 
Dr.  J.  Mitchell  Bruce. 

Mental  Diseases— Dr.  L.  S.  Forbes 
Winslow. 

Practical  Surgery — Mr.J.  A.  Bloxam 
and  Mr.  J.  H.  Morgan. 

Practical  Medicine— Dr.  Montagu 
Lubbock. 

Pathology  and  Morbid  Anatomy — 
Dr.  T.  Henry  Green. 

Physiology — Dr.  Wolfenden. 

Physiology,  Practical — Dr.  Wolfen¬ 
den;  Demonstrator,  Mr.  H.  B.  Shaw. 

Principles  and  Practice  of  Medicine 
—Dr.  A.  J.  Pollock. 

Principles  and  Practice  of  Mid¬ 
wifery  and  Diseases  of  Women — 
Dr-  J.  Watt  Black; 

Principles  and  Practice  of  Surgery 
— Mr.  R.  Barwell. 

Skin  Diseases— Dr.  A.  Sangster. 

Surgical  Pathology  —  Mr.  J.  H. 
Morgan. 


SCHOLABSHIPS,  MEDALS,  AND  PBIZES. 

Two  Entrance  Scholarships,  of  the  value  of  £30  and  £20  respectively, 
tenable  for  one  year,  will  be  awarded  annually  in  October,  after  a  com¬ 
petitive  examination  in  the  following  subjects  : -Compulsory  :  English, 
Latin,  French  or  German,  Mathematics.  Optional  (only  one  of  winch 
may  be  selected):  Chemistry,  Mechanics,  Germ m  or  French.  The  sub¬ 
jects  (as  regards  extent  and  the  authors  selected)  will  be  the  same  as 
those  chosen  for  the  Matriculation  Examination  of  the  University  of 
London  in  the  June  immediately  preceding  Candidates  must  give 
notice  of  their  intention  to  compete  on  or  before  Wednesday,  September  20, 
1882.  The  successful  candidates  will  be  required  to  enter  for  their  medical 
education  at  Charing-cross  Hospital. 

The  Llewellyn  Scholarship  of  £25  is  open  to  all  matriculated  students 
who  have  just  completed  their  second  academical  year.  The  examina¬ 
tion  is  held  at  the  end  of  the  second  summer  session,  and  includes  the 
following  subjects: — Descriptive  and  Surgical  Anatomy,  Physiology, 
Materia  Medica,  Medicine,  Surgery,  Midwifery. 

The  Golding  Scholarship  of  £15  is  open  to  all  matriculated  students  who 
have  just  completed  their  first  academical  year.  The  examination  is 
held  at  the  end  of  the  first  summer  session,  and  includes  the  following  sub¬ 
jects  : — Descriptive  Anatomy,  Physiology,  Materia  Medica,  and  Chemistry. 

The  Pereira  Prize  of  £5  is  open  to  all  matriculated  students  who  shall 
have  completed  their  third  academical  year.  It  is  awarded  to  the  author  of 
the  best  Clinical  Reports  of  Cases  in  the  Hospital  during  the  preceding 
year,  Medical  and  Surgical  Cases  beiQg  selected  in  alternate  years. 

Each  candidate  must  produce  a  certificate  of  good  conduct  from  the 
Dean  of  the  Medical  School,  at  the  time  of  giviDg  in  his  name  as  a  com¬ 
petitor;  and  the  names  of  the  candidates  for  Scholarships  are  to  be  de¬ 
livered  to  the  Librarian  one  week  before  the  first  day  of  the  examination. 

The  Governors’  Clinical  Gold  Medal.— The  competition  for  this  medal 
is  open  to  matriculated  students  who  shall  have  completed,  at  the  end 
of  the  current  session,  their  attendance  on  the  Medical  and  8urgical 
Practice  of  the  Hospital.  Candidates  are  examined  on  the  subjects  of 
Clinical  Lectures  delivered  during  the  session,  and  on  Medical  and 
Surgical  Cases  in  the  wards  of  the  Hospital. 

Silver  Medals. — Silver  Medals  are  awarded  in  all  the  classes. 

Bronze  Medals. — Where  two  sessions’ attendance  on  a  course  are  required, 
a  Bronze  Medal  is  awarded  in  the  junior  class,  in  addition  to  the  Silver 
one  in  the  senior  class. 

Certificates  of  Honour  are  awarded  to  both  senior  and  junior  students 
who,  not  being  the  most  proficient,  have  yet  attained  a  marked  degree  of 
excellence. 

V  FEES. 

Total  fees,  £99  15s.,  payable  by  instalments  (subject  to  an 
abatement  of  8  per  cent,  if  paid  on  joining),  if  entered  for  the 
full  period  of  study— October  (on  joining),  £30  9s.,  including 
matriculation  fee;  May  (following),  £21;  October,  £22  Is.; 


May,  £15  15s.;  October,  £10  10s.  Dental  Students:  October 
(on  joining),  £22  2s.,  including  matriculation  fee  ;  October 
(following),  £20 — total,  £42  2s. 

Students  are  admitted  to  tbe  Medical  and  Surgical  Practice- 
for  tbe  full  period  required  by  the  University  of  London,  the 
Royal  College  of  Physicians,  the  Royal  College  of  Surgeons, 
and  the  Society  of  Apothecaries  (including  the  clinical  courses 
in  both  departments),  on  payment  of  £31  10s.  Non-matricn- 
lated  students  are  admitted  on  payment  of  the  following  fees  r 
— Either  Medical  or  Surgical  Practice  (including  the  clinical 
lectures)  :  Three  months,  £6  6s. ;  six  months,  £10  10s. ;  twelve 
months,  £15  15s.;  full  period,  £21.  Both  Medical  and  Sur¬ 
gical  Practice  (including  the  clinical  lectures)  :  Three  months, 
£10  108.;  six  months,  £15  15s.;  twelve  months,  £21;  full 
period,  £31  10s.  Eor  a  longer  period,  £5  5s.  for  each  addi¬ 
tional  winter,  and  £3  3s.  for  each  additional  summer  session. 

Special  classes  for  the  Preliminary  Scientific  and  first  M.B. 
Examinations  of  the  University  of  London  are  held  during 
each  winter  and  summer  session. 

The  hours  of  lectures  have  been  specially  re-arranged  to- 
suit  the  convenience  of  Dental  Students.  Charing-eroaa 
Hospital  is  within  three  minutes’  walk  of  the  Dental  Hospital 
of  London. 

For  further  particulars  apply  to  the  Dean,  at  the  Hospital. 


ST.  GEORGE’S  HOSPITAL. 

MEDICAL  AND  SURGICAL  STAFF. 

Consulting  Physicians— Sir  Henry  A.  Pitman,  Dr.  Ogle,  Dr.  Barclay. 


Consulting  Surgeons. 

Mr.  Caesar  Hawkins,  F.R.S.,  Sir  Prescott  G.  Hewett,  Bart.,  F.R.S., 
Mr.  Pollock,  Mr.  H.  Lee. 


Physicians. 

Dr.  Wadham. 

Dr.  Dickinson. 

Dr.  Whipham. 

Dr.  Cavafy. 

Assistant-Physicians. 
Dr.  Ewart. 

Dr.  Isambard  Owen. 


Surgeons. 

Mr.  Holmes. 

Mr.  Rouse. 

Mr.  Pick. 

Mr.  Haward. 

Assistant-Surgeons. 
Mr.  Bennett. 

Mr.  Dent. 


Obstetric  Physician — Dr.  Barnes. 

Assistant  Obstetric  Physician — Dr.  Champneya. 

Ophthalmic  Surgeon — Mr.  Brudenell  Carter. 

Assistant  Ophthalmic  Surgeon — Mr.  Frost. 

Aural  Surgeon— Mr.  Dalby.  Dental  Surgeon — Mr.  A.  Winterbottonr. 


LECTURERS. — WINTER  SESSION. 


Chemistry  &  Physics— Mr.  Donkin. 

Clinical  Lectures  on  Diseases  of 
Women— Dr.  Barnes. 

Clinical  Medicine  —  Drs.  Wadham 
and  Cavafy. 

1  Clinical  Surgery — Messrs.  Holmes 
and  Haward. 

Descriptive  and  Surgical  Anatomy — 
Mr.  Bennett. 

Histology — Mr.  Compton. 

Morbid  Anatomy — Mr.  D.  M.  Ross. 

SUMMER 

Aural  Surgery — Mr.  Dalby. 

Botany — Mr.  G.  Murray. 

Clinical  Demonstrations  of  Diseases 
of  the  Skin — Dr.  Cavafy. 

Clinical  Medicine — Dr.  Whipham. 

Clinical  Surgery — Mr.  Rouse. 

Comparative  Anatomy — 

Dental  Surgery— Mr.  Winter  bottom. 

Materia  Medica — Dr.  Owen. 


Ophthalmic  Surgery — Mr.  Brude¬ 
nell  Carter. 

Pathology — Dr.  Whipham. 

Physiological  Chemistry— Dr.  Wm. 
Ewart. 

Physiology  and  Minute  Anatomy; — 
Dr.  Ewart. 

Principles  and  Practice  of  Physic — 
Dr.  Dickinson. 

Principles  and  Practice  of  Surgery; — 
Messrs.  Rouse  and  Pick. 

SESSION. 

Medical  Jurisprudence — Dr.  Wm. 
Wadham. 

Midwifery  and  Diseases  of  Women 
and  Children — Drs.  Barnes  and 
Champneys. 

Practical  Chemistry — Mr.  Donkin. 

Practical  Medicine— Dr.  Whipham. 

Practical  Surgery — Mr.  Dent. 

Psychological  Medicine— Dr.  Blands 
ford. 


EXHIBITIONS  AND  PHIZES. 

The  William  Brown  Exhibition,  of  £100  per  annum,  tenable  for  two- 
years,  to  be  competed  for  by  perpetual  pupils  who  have  recently  obtained 
their  diploma. 

The  William  Brown  Exhibition,  of  £40  per  annum,  tenable  for  three 
years,  to  be  competed  for  by  students  during  their  fourth  year  of  study. 

The  Brackenbury  Prizes  of  £35  each  in  Medicine  and  Surgery,  awarded 
annually  after  a  competitive  examination. 

The  Treasurer’s  Clinical  Prize  of  £10  19s.,  the  gift  of  the  Duke  of 
Westminster,  to  be  competed  for  annually. 

Sir  Charles  Clarke's  Prize  for  Good  Conduct :  The  interest  of  £205 
Consols,  to  be  awarded  annually  to  the  student  of  the  Hospital,  “  wbo,. 
by  reason  of  his  general  good  conduct  during  the  preceding  year,  should! 
be  considered  the  most  deserving.” 

The  Thompson  Medal  :  A  silver  medal  to  be  awarded  annually  for  the 
best  clinical  report  of  Medical  and  8urglcal  Cases  observed  in  the  Hospital 
during  the  preceding  twelve  months. 

Sir  Benjamin  Brodie’s  Clinical  Prize  in  Surgery  will  be  awarded  to  the, 
pupil  of  tne  Hospital  who  shall  have  delivered  to  the  Surgeons  the  best 
report  of  not  more  than  twelve  surgical  cases  which  have  occurred  in  the 
Hospital  during  the  preceding  twelve  months. 

Dr.  Acland’s  Clinical  Prize  in  Medicine  will  be  awarded  to  the  pupil  of 
the  Hospital  who  shall  produce  the  best  report  of  not  more  than  twelve 
medical  cases  which  have  occurred  in  the  Hospital  during  the  preceding 
twelve  months. 

The  Pollock  Prize  in  Physiology  (value  £18)  will  be  awarded  to  the 


Medical  Times  and  Gazette. 


ENGLISH  SCHOOLS. 


Sept.  15, 1883.  305 


second  year’s  student  who  shall  exhibit  the  greatest  proficiency  in  Physi¬ 
ology,  Pnysiological  Chemistry,  and  Histology.  The  examinati  m  or 
this  prize  will  be  held  at  the  commencement  of  the  summer  session. 

The  Henry  Charles  Johnson  Memorial  Prize  in  Anatomy  will  be  awarded 
to  that  pupil  who  shall,  in  the  judgment  of  tne  Medical  School  Committee, 
exnibit  the  greatest  proficiency  in  Practical  Anatomy. 

General  Proficiency  Prizes  :  To  pupils  in  their  first  year,  £10  10s. ;  to 
pupils  in  their  second  jear,  £10  10s.;  to  pupils  in  their  third  year, 
£10  10s. 

PEES. 


Perpetual  pupils  pay  £45  iu  their  first  year,  £45  in  their 
second  year,  and  £40  in  their  third  year  of  study,  or  £125  on 
entrance. 

Gentlemen  are  admitted  to  the  hospital  practice  and  lectures 
required  for  the  licensing  bodies  on  payment  of  the  following 
fees— viz.,  £45  for  the  first  year  of  study,  £45  for  the  second 
year  of  study,  £20  for  the  third  year  of  study,  and  £15  for 
each  succeeding  year.  These  are  not  perpetual  pupils. 

Dental  pupils  are  admitted  to  the  required  courses  on  pay¬ 
ment  of  £30  for  their  first  year,  and  £25  for  their  second  year, 
including  Practical  Chemistry. 

Pupils  may  also  enter  to  the  hospital  practice  and  lectures 
separately. 

For  further  particulars  apply  to  Dr.  ‘Wadham,  Dean  of  the 
School. 


GUY’S  HOSPITAL. 

MEDICAL  AND  SURGICAL  STAFF. 

Consulting  Physicians—  Sir  William  Gull,  Bart.,  Dr.  G.  Owen  Rees. 
Consulting  Obstetric  Physicians — Dr.  Henry  Oldham,  Dr.  J.  Braxton  Hicks. 
Consulting  Surgeons — Mr.  E.  Cock,  Mr.  Birkett. 

Consulting  Ophthalmic  Surgeon — Mr.  Bader. 


Physicians. 

Dr.  S.  Wilks. 

Dr.  F.  W.  Pavy. 

Dr.  W.  Moxon. 

Dr.  C.  Hilton  Fagge. 


Surgeons. 

Mr.  Thomas  Bryant. 
Mr.  Arthur  Durham. 
Mr.  H.  G.  Howse. 

Mr.  N.  Davies-Colley. 


Assistant-Physicians. 

Dr.  P.  H.  Pye-Smith. 

Dr.  Frederick  Taylor. 
Dr.  J.  F.  Goodhait. 

Dr.  F.  A.  Mahomed. 

Obstetric  Physician. 

Dr.  A.  L.  Galabin. 

Assistant  Obstetric  Physician. 
Dr.  Horrocks. 

Medical  Registrar. 

Dr.  Carrington. 


Assistan  t-  Surgeons. 
Mr.  R.  Clement  Lucas. 
Mr.  C.  H.  Golding-Bird. 
Mr.  W.  H.  A.  Jacobson. 
Mr.  C.  J.  Symonds. 

Ophthalmic  Surgeons. 
Mr.  C.  Higgens. 

Dr.  W.  A.  Brailey,  Asst 
Dental  Surgeon. 

Mr.  H.  Moon. 

Aural  Surgeon. 

Mr.  W.  Laidlaw  Purves. 


Curator  of  the  Museum. 
Dr.  Gooahart. 


Surgical  Registrar. 
Mr.  J.  Poland. 


Pean— Dr.  F.  Taylor. 


WINTER  COURSES. — LECTURES. 


Anatomy, Descriptive  andSurgical  — 
Mr.  Howse  and  Mr.  Davies-Colley. 
Chemistry —  Dr.  Stevenson  and  Mr. 
Groves. 

Clinical  Medicine — Dr.  Wilks,  Dr. 

Pavy,  Dr.  Moxon,  and  Dr.  Fagge. 
Clinical  Surgery — Mr.  Bryant,  Mr. 
Durham,  Mr.  Howse,  and  Mr. 
Davies-Colley. 


Clinical  Lectures  on  Midwifery  and 
Diseases  of  Women — Dr.  Galabin. 
Medicine— Dr.  Pavy  and  Ur.  Moxon. 
Physiology — Dr.  Pye-Smith. 
Surgery  —  Mr.  Bryant  and  Mr. 
Arthur  Durham. 

Experimental  Physics — Prof.  A.  W. 
Remold. 


DEMONSTRATIONS. 


Cutaneous  Diseases  —  Dr.  Pye-  ,  Practical  Anatomy— D-. White,  Mr. 

Smith.  Lane,  and  Mr.  Price. 

Morbid  Anatomy — Dr.  Goodhartand  [  Practical  Physiology— Mr.  Golding- 
Dr  Mahomed.  ]  Bird. 

Practical  Surgery— Mr.  Lucas.  |  Surgical  Classes— Mr.  Jacobson. 


SUMMER  COURSES. — LECTURES. 


Botany — Mr.  Bettany. 

Clinical  Medicine — Dr.  Pye-Smith, 
Dr.  F.  Taylor,  Dr.  Uoedhart,  and 
Dr.  Mahomed. 

Clinical  Surgery — Mr.  Clement 
•Lucas,  Mr.  G'  doing-  Bird,  Mr. 
Jacobson,  and  Mr.  Symonds. 
Clinical  Lectures  on  Diseases  of 
Women — Dr.  A.  L.  Galabin 
C  .mparative  Anatomy  &  Zoology — 
Dr.  Brailey. 


Dental  Surgery — Mr.  Moon. 
Hygiene — Mr.  George  I'u'ner 
Materia  Medica  and  Therapeutics- 
Dr.  Taylor. 

Medical  Jurisprudence — Dr.  Stevtn- 
son. 

Mental  Diseases — Dr.  Savage. 
Midwifery  and  Diseases  of  Women 
—  Dr.  Galabin  and  Dr.  Horrocks. 
Ophthalmic  Surgery  — Dr.  Higgens. 
Pathology  — Dr.  Fagge. 


DEMONSTRATIONS. 

Morbid  Histology— Mr.  Symonds.  I  Practical  Chemistry — Mr.  Groves. 
Operative  Surgery -Mr.  Lucas.  |  Surgical  Classes — Mr.  Jacobson. 

This  Hospital  contains  695  beds. 


OPEN  SCHOLAESHIPS. 

An  open  Scholarship  of  the  value  of  £131  5s.  in  Classic?,  Mathematics, 
and  Modern  Languages. 

An  open  Scholarship  of  the  value  of  £131  6s.  in  Science. 


PRIZES. 

Por  First  Year’s  Students  — At  the  end  of  the  summer  session,  in  Ana¬ 
tomy,  Physiology,  Chemistry,  Materia  Medica,  Botany,  and  Comparative 
Anatomy :  Prizes,  £50  and  £25. 


For  Second  Year’s  Students. — In  the  winter  session,  the  Michael  Harris 
Prize  of  £10  in  Anatomy.  Summer  session,  examination  In  Anatomy  and 
Physiology.  £25  and  £10.  The  Sands-Cox  Scholarship  of  £15  per  annum, 
tenable  for  three  years— subject,  Physiology. 

For  Third  Year’s  Stdeunts.— Medical  and  Surgical  Anatomy,  Operative 
and  Minor  Surgery,  Midwifery,  Therapeutics:  First  Prize  £25,  Second 
Prize  £10. 

For  Fourth  Year’ s  Students. — Summer  session,  examination  in  Medicine, 
Surgery,  Diseases  of  Women,  and  Medical  Jurisprudence:  Prizes,  £25 
and  £10. 

For  Senior  Students. — The  Treasurer’s  Gold  Medal  for  Clinical  Medicine; 
the  Treasurer’s  Gold  Medal  for  Clinical  Surgery  ;  the  Gurney  Hoare  Prize 
of  £25  for  Clinical  Medicine  and  Surgery.  The  Beaney  Scholarship  of 
£31  10s.  for  Pathology.  The  Mackenzie  Bacon  Prize  of  £10  10s.  for 
Ophthalmoscopy. 

FEES. 

The  fees  for  hospital  practice  and  lectures  are  as  follows  : — 
A  perpetual  ticket  maybe  obtained — (1.)  By  the  payment  of 
£131  5s.  on  entrance.  (2.)  By  two  payments  of  £66,  at 
the  commencement  of  the  first  winter  session  and  the  following 
summer  session.  (3.)  By  the  payment  of  three  annual  instal¬ 
ments,  at  the  commencement  of  the  sessional  year :  First  year 
£50 ;  second  year,  £50  ;  third  year,  £37  10s.  Materials  used 
in  practical  courses  are  charged  extra. 

For  further  information  apply  to  the  Dean,  Dr.  F.  Taylor. 


KING’S  COLLEGE  HOSPITAL. 


MEDICAL  AND  SURGICAL  STAFF. 


Consulting  Physicians— Dr.  Arthur  Farre,  Dr.  W.  A.  Guy, 
Dr.  W.  O.  Priestley,  Dr.  A.  B.  Garrod. 


Physicians. 

Dr.  George  Johnson. 
Dr.  Lionel  8.  Beale. 
Dr.  Alfred  B.  Duffin. 
Dr.  William  Playfair. 
Dr.  J.  Burney  Yeo. 
Dr.  T.  C.  Hayes. 

Dr.  David  Ferrier. 
Dr.  E.  B.  Baxter. 

Dr.  John  Curnow. 


Surgeons. 

Mr.  John  Wood. 

Mr.  Joseph  Lister. 

Mr.  Henry  Smith. 

Mr.  H.  Royes  Bell. 

Assistant-Surgeons. 

Mr.  William  Rose. 

Mr.  W.  W.  Cheyne.  • 

Rental  Surgeon. 

Mr.  S.  Hamilton  Cartwright. 


Ophthalmic  Surgeon — Mr.  M.  M.  McHardy. 

Aural  Surgeon— Dr.  Urban  Pritchard. 

Vaccinatoi — Mr.  R.  W.  Dunn. 

Pathological  Registrar — Vacant. 

Chloroformist — Mr.  Charles  Moss. 

Sambrooke  Registrars — Dr.  N.  Dalton  and  Mr.  W.  G.  Evans. 


PROFESSORS. 


Anatomy,  Descriptive  and  Surgical 
—Dr.  John  Curnow  ;  Mr.  A.  S. 
Kenuy,  Demonstrator. 

Botany — Mr.  Robert  Bentley. 
Chemistry  and  Practical  Chemistry 
— Mr.  C.  L.  Bloxam ;  Mr.  J.  M. 
Thomson,  Demonstrator;  Mr.G.S. 
Johnson,  Assist. -Demonstrator. 
Clinical  Medicine— Dr.  G.  Johnson. 
Clinical  Surgery — Mr.  John  Wood, 
Mr.  Joseph  Lister. 

Comparative  Anatomy — Mr.  F. 

Jeffrey  Bel). 

Dental  Surgery — Mr.  S.  Hamilton 
Cartwright. 

Forensic  Medicine— Dr.  D.  Fender. 
Hygiene— Dr.  Charles  Kel'y. 
Materia  Medica  and  Therapeutics— 
Dr.  E.  B.  Baxter. 

Ophthalmology — Mr.  M.  M.  McHardy 


Obstetric  Medicine,  and  the  Diseases 
of  Women  and  Children — Dr.  W. 
Playfair. 

Pathological  Anatomy— Dr.  A.  B. 
Dufifin. 

Physiology  and  Practical  Physi¬ 
ology— Dr.  Gerald  F.  Yeo ;  Mr. 
J.  W.  Groves  and  Mr.  W.  T. 
Brooks,  Demonstrators. 
Psychological  Medicine — Dr.  Edgar 
Sheppard. 

Principles  and  Practice  of  Medicine 
— Dr.  L.  S.  Beale. 

Principles  and  Practice  of  Surgery 
— Mr.  Henry  Smith. 

Surgery  and  Practical  Surgery— Mr. 
Henry  Smith  ;  Mr.  H.  Royes  Bell, 
Mr.  W.  Rose,  and  Mr.  W.  W. 
Cheyne,  Demonstrators. 


Pean  of  the  Faculty  —Professor  Curnow. 
Sub-Pean  and  Medical  Tutor— Dr.  N.  I.  C.  Tirard. 


SCHOLAESHIPS,  EXHIBITIONS,  AND  PRIZES. 

Warneford  Scholarships  :  “For  the  encouragement  of  the  previous 
education  of  medical  students,”  two  scholarships  of  £75  each  ;  and,  “for 
the  encouragement  of  resident  medical  students.”  one  scholarship  of  £50. 

Medical  Scholarships :  The  following  are  offered  every  year  to  matri¬ 
culated  students  1.  One  of  £80,  open  to  students  of  the  third  and 
fourth  years ;  2.  One  of  £30,  open  to  students  of  the  secoud  year ; 
3.  Three  of  £20  each,  open  to  students  of  the  first  year. 

Daniell  Scholarship :  One  of  £40,  open  to  every  student  who  has  worked 
in  the  laboratory  for  at  least  six  months. 

Sambrooke  Registrarships  :  Two  of  £50  each  every  year. 

Science  Exhibitions  :  Two  annually ;  one  of  £100  and  one  of  £50,  for 
proficiency  in  Mathematics,  Mechanics,  Physics,  Chemistry,  Botany,  and 
Zoology. 

Sambrooke  Exhibitions  :  Two  annually,  one  of  £60,  and  one  of  £40,  for 
proficiency  in  English,  Elementary  Physics,  Inorganic  Chemistry,  Botany, 
Zoology,  Mathematics,  and  Languages. 

Leathes  Prizes :  Bible  and  Prayer-book,  annually,  to  two  matriculated 
medical  students. 

Warneford  Prizes :  £40  is  expended  annually  in  the  purchase  of  medals 
and  books  as  prizes  to  two  matriculated  medical  students. 

Class  Prizes  are  awarded  annually  of  the  value  of  £3  in  each  subject 
of  study. 

Two  Medical  Clinical  Prizes,  one  of  £3  for  the  winter  session,  and  the 
other  of  £2  for  the  summer  ses-ion,  and  two  Surgical  Clinical  Prizes  of 
the  same  value,  are  given  annually  for  attendance  at  the  Hospital. 


306 


Medical  Times  and  Gazette. 


ENGLISH  SCHOOLS. 


Sept.  15,  1883. 


Todd  Medical  Clinical  Prize  :  This  prize  was  founded  in  memory  of  the 
late  Dr.  Todd,  and  is  awarded  annually.  It  consists  of  a  bronze  medal 
and  books  to  the  value  of  £4  4s. 

Tanner  Prize :  Of  the  value  of  £10  in  each  year,  for  proficiency  in  the 
study  of  Obstetric  Medicine,  and  in  Diseases  of  Women  and  Children. 

Carter  Prize  :  This  piize  is  awarded  annually  for  proficiency  in  Botany, 
and  consists  of  a  Gold  Medal  and  Books,  of  the  joint  value  of  £15. 

FEES. 

The  fees  for  perpetual  attendance  amount  to  £125  if  paid 
in  one  sum  on  entrance ;  or  £130  if  paid  in  two  instalments — 
viz.,  £70  on  entrance  and  £60  at  the  commencement  of  the 
second  winter  session;  or  £135  if  paid  in  three  instalments — 
viz.,  £60  on  entrance,  £50  at  the  beginning  of  the  second 
winter  session,  and  £25  at  the  beginning  of  the  third  winter 
session. 

For  further  information  apply  to  Professor  Curnow,  Dean 
of  the  Medical  Faculty. 


LONDON  HOSPITAL  AND  MEDICAL  COLLEGE. 

MEDICAL  AND  SURGICAL  STAFF. 

Consulting  Physicians — Dr.  Herbert  Davies  and  Dr.  Ramskill. 
Consulting  Surgeons — Mr.  Curling,  F.R.S.,  and  Mr.  Jonathan  Hutchinson, 

F.R.S. 


Physicians. 


Sir  Andrew  Clark,  Bart. 

Dr.  Langdon  Down. 

Dr.  Hughlings-Jackson,  F.R.S. 
Dr.  Sutton. 


Dr.  Fenwick. 

Dr.  Stephen  Mackenzie. 
Dr.  A.  E.  Sansom. 

Dr.  F.  Charlewood  Turner. 


Assistant-  Physicians. 

Dr.  Gilbart  Smith.  I  Dr.  F.  Warner. 


Dr.  C.  H.  Ralfe. 


Surgeons. 

Mr.  Couper.  I  Mr.  Jas.  Adams. 

Mr.  Rivington.  |  Mr.  Waren  Tay. 

Mr.  McCarthy. 

Assistant- Surgeons. 

Mr.  Reeves.  I  Mr.  C.  W.  Mansell-Moullin. 

Mr.  Frederick  Treves.  |  Mr.  Hurry  Fenwick. 

Obstetric  Physician — Dr.  G.  E.  Herman. 
Surgeon-Dentist— Mr.  Ashley  W.  Barrett. 

Surgeons  to  the  Ophthalmic  Department — Mr.  James  Adams  and 
Mr.  Waren  Tay. 

Surgeons  to  the  Aural  Department— Dr.  Edward  Woakes  and 
Mr.  T.  Mark  Hovell. 

Physician  to  the  Skin  Department — Dr.  Stephen  Mackenzie. 

LECTURES. 


Anatomy  and  Pathology  of  the 
Teeth — Mr.  Ashley  W.  Barrett. 

Botany — Dr.  Warner. 

Chemistry — Dr.  C.  Meymott  Tidy. 

Comparative  Anatomy— Mr.  C.  W. 
Mansell-Moullin. 

Descriptive  and  Surgical  Anatomy 
— Mr.  Walter  Rivington. 

Diseases  of  the  Throat  and  Use  of 
the  Laryngoscope  —  Dr.  Morell 
Mackenzie. 

Forensic  Medicine— 1.  Toxicology, 
Dr.  C.  Meymott  Tidy ;  2.  Medical 
Jurisprudence  and  Public  Health 
— Dr.  A.  E.  Sansom. 

Materia  Medica  and  General  Thera¬ 
peutics— Dr.  M.  Prosser  James. 

Medicine — Dr.  Stephen  Mackenzie. 

Warden — Mr. 


Midwifery  and  Diseases  of  Women 
— Dr.  G.  E.  Herman. 

Pathology  and  Demonstrations  of 
Morbid  Anatomy — Dr.  H.  G. 
Sutton. 

Practical  Anatomy — Mr.  Frederick 
Treves. 

Practical  Chemistry — 

Practical  Histology,  and  Use  of  the 
Microscope — Mr.  McCarthy. 
Physiology  and  General  Anatomy 
• — Mr.  McCarthy. 

Ophthalmic  Surgery — Mr.J.  Adams. 
Operative  Surgery— Mr.  J.  Adams. 
Practical  Surgery — Mr.  Reeves. 
Surgery— Mr.  J.  Adams. 

Aural  Surgery — Dr.  Edwd.Woakes. 

Munro  Scott. 


SCHOLARSHIPS  AND  PRIZES. 


The  following  scholarships  will  be  offered  for  competition  during  the 
ensuing  winter  and  summer  sessions : — 

Two  Entrance  Scholarships  in  Natural  Science,  of  the  value  of  £60  and 
£40  respectively,  will  be  offered  for  competition  at  the  end  of  September. 
The  subjects  will  he  Physics,  Botany,  Zoology,  and  Inorganic  Chemistry. 

The  two  Buxton  Scholarships  will  be  awarded  in  September  to  the  stu¬ 
dents  who  distinguish  themselves  most  in  the  subjects  appointed  by  the 
General  Council  of  Medical  Education  and  Registration  as  the  subjects  of 
the  preliminary  examinations.  1.  A  Scholarship,  value  £30,  to  the  student 
placed  first  in  the  examination.  2.  A  Scholarship,  value  £20,  to  the 
student  placed  second  in  the  examination. 

A  Scholarship,  value  £20,  will  be  awarded  to  the  first-year  student  who 
shall  pass  the  best  examination  in  Human  Anatomy  and  Physiology. 

A  Scholarship,  value  £25,  will  he  awarded  to  the  first-year  or  second- 
year  student  who  shall  pass  at  the  end  of  the  winter  session  the  best 
examination  in  Anatomy,  Physiology,  and  Chemistry. 

A  Hospital  Scholarship,  value  £20,  for  proficiency  and  zeal  in  Clinical 
Medicine. 

A  Hospital  Scholarship,  value  £20,  for  proficiency  and  zeal  in  Clinical 
Surgery. 

A  Hospital  Scholarship,  value  £20,  for  proficiency  and  zeal  in  Obstetrics 
(awarded  at  the  end  of  June,  1883). 

The  Letheby  Prize,  value  £30,  for  proficiency  in  Chemistry. 

The  Duckworth-Nelson  Prize,  value  £10,  will  be  awarded  by  competi¬ 
tion  biennially,  and  will  be  open  to  all  students.  The  subjects  of  exa¬ 
mination  will  he  Practical  Medicine  and  Surgery. 

Money  Prizes,  to  the  value  of  £60  per  annum,  are  awarded  by  the  House 
Committee  to  the  most  meritorious  of  the  Dressers  in  the  out-patient 
rooms  who  have  passed  their  first  College  examination. 


The  Hospital  contains  nearly  800  beds,  and  the  number  of 
in-patients  last  year  amounted  to  7171,  exclusive  of  627  re¬ 
maining  under  treatment  at  the  commencement  of  the  year. 

Owing  to  the  great  size  of  the  Hospital,  the  appointments 
are  necessarily  numerous  and  most  valuable.  They  are  all 
free  to  full  students  without  additional  fee. 

The  resident  appointments  consist  of  five  House-Physi- 
cianeies,  five  House-Surgeoncies,  and  one  Accoucheurship,each 
being  tenable  for  six  months,  and  renewable  for  two  further 
periods  of  three  months  each.  The  holders  of  these  appoint¬ 
ments  are  provided  with  board  and  lodging  free  of  expense. 
Two  of  the  Dressers  and  two  of  the  Maternity  Assistants  also 
reside  in  the  Hospital. 

Attached  to  the  Pathological  Department  of  the  London 
Hospital  is  a  laboratory,  under  the  supervision  of  Dr.  Sutton, 
which  contains  a  large  number  of  microscopic  sections,  care¬ 
fully  indexed  and  recorded. 

FEES. 

Perpetual  fee  for  attendance  on  all  the  lectures  with  two 
years’  Practical  Anatomy,  and  for  attendance  on  medical  and 
surgical  practice,  qualifying  for  examination  at  most  of  the 
medical  and  surgical  hoards,  £94  10s.  if  paid  in  one  sum,  or 
£105  in  three  instalments  of  £47  5s.,  £42,  and  £15  15s.,  at  the 
commencement  of  the  first,  second,  and  third  years  respectively; 
composition  fee  for  gentlemen  entering  at  or  before  the  begin¬ 
ning  of  their  second  winter  session,  their  first  year  having  been 
spent  at  a  recognised  medical  school  elsewhere,  £73  10s.  if 
paid  in  one  sum,  or  £78  15s.  in  two  instalments  of  £47  5s. 
and  £31  10s. ;  perpetual  fee  for  lectures  alone,  £52  10s. ; 
perpetual  fee  for  hospital  practice  alone,  £52  10s.  Extra  fees  : 
Practical  Chemistry  (for  apparatus,  etc.),  £2  2s. ;  Practical 
Physiology  do. ,  £1  Is. ;  subscription  to  the  library,  £1  Is. 

Students  in  Arts  of  Universities  where  residence  is  required, 
who  have  attended  lectures  in  Anatomy,  Physiology,  Che¬ 
mistry,  Botany,  or  Comparative  Anatomy,  and  have  obtained 
signatures  for  such  attendance,  fulfilling  the  requirements  of 
the  Examining  Boards,  may  become  pupils  of  the  London 
Hospital,  eligible  for  all  hospital  appointments,  on  payment 
of  the  fee  of  £52  10s.  for  practice  at  the  Hospital.  This 
payment  does  not  give  the  right  to  signatures  for  courses  of 
lectures  at  the  Medical  College. 

Students  who  have  passed  the  Preliminary  Scientific  Exa¬ 
mination  at  the  University  of  London,  and  have  obtained 
signatures  for  lectures  on  Botany,  Zoology,  Chemistry,  and 
Practical  Chemistry,  shall  have  the  fees  for  the  same,  amount¬ 
ing  to  £18  18s.,  remitted  on  entering  as  full  students  at  the 
London  Hospital;  and  students  who  have  attended  the  above 
courses  elsewhere,  and  have  obtained  signatures  for  the  same 
previous  to  their  entrance  at  the  London  Hospital,  shall  also 
have  these  fees  remitted,  provided  they  pass  the  Preliminary 
Scientific  Examination  within  eighteen  months  of  their  entry 
as  full  students. 

For  the  convenience  of  students  a  Club  has  been  established 
in  the  Hospital  grounds,  where  meals  can  he  obtained  at 
moderate  charges. 

Communications  should  be  addressed  to  Mr.  Munro  Scott, 
the  Warden,  at  the  London  Hospital  Medical  College,  Turner- 
street,  Mile-end,  London,  E. 


ST.  MARY’S  HOSPITAL. 


MEDICAL  OFFICERS. 


Consulting  Medical  Officers. 

Dr.  Chambers,  Mr.  S.  A.  Lane,  Mr.  Spencer  Smith,  Mr.  J.  R.  Lane, 
Mr.  White  Cooper. 


Physicians. 

Dr.  Handheld  Jones,  F.R.S. 
Dr.  Sieveking. 

Dr.  Broadbent. 

Dr.  Cheadle. 

Physicians  in  charge  of  Out-Patients. 
Dr.  Shepherd. 

Dr.  David  Lees. 

Dr.  S.  Phillips. 


Surgeons. 

Mr.  Haynes  Walton. 

Mr.  Norton. 

Mr.  Edmund  Owen. 

Surgeons  in  charge  of  Out-Patients. 
Mr.  Herbert  W.  Page. 

Mr.  Pye. 

Mr.  Pepper. 


Physician- Accoucheur — Dr.  Alfred  Meadows. 

Physician- Accoucheur  in  Charge  of  Out-Patients — Dr.  Wiltshire. 

In  charge  of  the  Department  for  Diseases  of  the  Skin — Mr.  Malcolm  Morris. 
Ophthalmic  Surgeon — Mr.  Anderson  Critchett. 

Junior  Ophthalmic  Surgeon — Mr.  H.  E.  Juler. 

Surgeon  in  charge  of  the  Department  for  Diseases  of  the  Throat — Mr.  Norton. 
Aural  Surgeon — Mr.  G.  Field. 

Surgeon-Dentist — Mr.  Howard  Hayward. 

Post-mortem  Examinations — Dr.  Sileock. 

Instructor  in  Vaccination — Mr.  W.  A.  Sumner. 


Medical  Times  and  Gazette. 


ENGLISH  SCHOOLS. 


Sept.  15,  1863.  307 


LECTURES. — WINTER  SESSION. 


Anatomy— Mr.  Owen. 

Clinical  Medicine — Dr.  Handfield 
Jones,  Dr.  Sieveking,  and  Dr. 
Broadbent. 

Clinical  Surgery  —  Mr.  Haynes 
Walton,  Mr.  Norton,  and  Mr. 
Owen. 

Chemistry  and  Natural  Philosophy 
— Dr.  C.  R.  A.  Wright. 


Dental  Surgery-  Mr.  Howard  Hay¬ 
ward. 

Medicine— Dr.  Broadbent  and  Dr. 
Cheadle. 

Pathology — Dr.  Shepherd. 
Physiology — Mr.  Pye. 

Practical  Physiology — Dr.  Nall. 
Practical  Surgery — Mr.  Pepper. 
Surgery — Mr.  Norton  and  Mr.  Page. 


SUMMER  SESSION. 


Aural  Surgery — Mr.  G.  Field. 
Botany — Rev.  J.  M.  Crombie. 
Comparative  Anatomy — Mr.  St. 

Geoi'ge  Mivai-t,  F.R.S. 

Diseases  of  the  Skin — Mr.  Malcolm 
Morris. 

Medical  Jurisprudence — Dr.  Randall 


Materia  Medica— Dr.  Lees. 
Midwifery — Dr.  Meadows  and  Dr. 
Wiltshire. 

Ophthalmic  Surgery — Mr.  Anderson 
Critchett. 

Practical  Chemistry — Dr.  C.  R.  A. 
Wright. 


The  Hospital  contains  200  beds — 88  medical,  and  112 
surgical.  There  are  special  departments  for  the  Diseases  of 
Women  and  Children,  and  for  Diseases  of  the  Eye,  the  Ear, 
the  Skin,  and  the  Throat. 


SCHOLARSHIPS,  PRIZES,  ETC. 

Four  Scholarships  in  Natural  Science,  each  of  the  value  of  £50.  These 
are  awarded  by  open  competitive  examination  at  the  commencement  of 
the  winter  session. 

Three  Scholarships,  of  the  value  of  £20,  £25,  and  £30,  will  be  given  at 
the  end  of  the  first,  second,  and  third  years  to  the  students  of  those 
years  respectively.  Candidates  for  these  scholarships  will  be  examined 
in  all  the  class- subjects  studied  by  them  during  those  years,  as  required 
by  the  several  examining  bodies. 

A  Demonstratorship  in  Pathological  Anatomy,  of  the  value  of  £15,  and 
tenable  for  six  months,  will  be  given  by  competitive  examination  in 
Pathology  and  Morbid  Anatomy,  among  those  students  who  have  com¬ 
pleted  their  third  winter  session.  The  holder  of  the  scholarship  will 
assist  the  Pathologist  in  the  discharge  of  his  duties  in  the  museum  and 
dead-house.  For  this  purpose  he  will  be  required  to  attend  at  least  three 
hours  daily  between  the  hours  of  12  and  5  p.m.,  and  to  employ  that  time 
either  in  assisting  at  the  post-mortem  examinations,  or  in  preparing 
specimens  for  the  museum,  as  directed  by  the  Pathologist,  and  in 
making  such  specimens  as  may  be  required  for  the  demonstrations  by 
the  Lecturer  on  Pathology. 

A  Clinical  Assistant  will  be  appointed  from  among  the  students  pos¬ 
sessing  one  qualification,  with  an  honorarium  of  £20.  His  duties  will 
be  to  assist  both  the  Clinical  Clerks  and  Dressers  in  the  taking  and  record¬ 
ing  of  the  cases.  This  appointment  will  be  held  for  six  months,  and  the 
holder  will  be  eligible  for  re-election. 

Two  Prosectors  of  Anatomy  and  two  Assistant-Demonstrators  of  Phy¬ 
siology  are  appointed  annually,  and  receive  a  certificate  and  £5  each  for 
satisfactory  service  in  their  respective  departments. 

There  are  five  Resident  Medical  Officers,  four  of  whom  are  appointed 
for  twelve  months,  and  one— the  Obstetric  Officer — for  six  months;  all 
of  whom  live,  free  of  every  expense,  in  the  Hospital.  The  money  value 
of  these  appointments  far  exceeds  that  of  as  many  scholarships  of  £50 
each,  whilst  their  professional  advantages  cannot  be  over-rated. 

Examinations  for  prizes  are  held  at  the  termination  of  each  session  in 
the  various  classes  for  students  of  the  first,  second,  and  third  year. 

FEES. 

The  entrance  fee  may  he  paid  in  instalments  by  arrange¬ 
ment  with  the  Dean  of  the  School.  Students  who  have  kept 
the  two  years’  course  at  the  University  of  Cambridge  are 
admitted  as  perpetual  pupils  on  payment  of  £72  9s.,  and 
those  who  have  kept  a  portion  of  the  course  elsewhere  at  a 
proportionate  reduction.  A  fee  of  £1  Is.  is  required  to  be 
paid  to  the  library  and  reading-room.  Instruction  in  vacci¬ 
nation  can  be  obtained  ;  fee  £1  Is. 

Further  information  may  be  obtained  from  Mr.  George 
Eield,  Dean  of  the  School;  or  from  the  Medical  Superintendent, 
at  the  Hospital. 


MIDDLESEX  HOSPITAL. 

MEDICAL  AND  SURGICAL  STAFF. 

Consulting  Physicians — Dr.  Goodfellow,  Dr.  Henry  Thompson, 
Dr.  Green  how. 

Consulting  Surgeons— Mr.  Shaw,  Mr.  Nunn. 
Consulting  Dental  Surgeons — Mr.  Tomes,  Mr.  J.  S.  Turner. 


g Physicians . 

Dr.  Cayley. 

Dr.  Sidney  Coupland. 
Dr.  Douglas  Powell. 


Surgeons. 
Mr.  Hulke. 
Mr.  Lawson. 
Mr.  Morris. 


LECTURES.— WINTER  SESSION. 


Chemistry— Mr.  Wm.  Foster. 

Clinical  Lectures  on  Medicine  and 
Surgery — The  Physicians  and 
Surgeons. 

Clinical  Lectures  on  Diseases  of 
Women  and  Children — Dr.  J. 
Hall  Davis. 

Descriptive  and  Surgical  Anatomy 
—Mr.  Hensman. 

Pathological  Anatomy — Dr.  Coup¬ 
land. 

SUMMER 

Botany — Dr.  Biss. 

Clinical  Lectures  on  Medicine  and 
Surgery — The  Physicians  and 
Surgeons. 

Clinical  Lectures  on  Diseases  of  the 
Eye — Mr.  Lang. 

Comparative  Anatomy  and  Zoology 
— Mr.  J.  B.  Sutton. 

Diseases  of  the  Skin — Dr.  Robert 
Liveing. 

Materia  Medica  and  Therapeutics — 
Dr.  Thorowgood. 

Midwifery  and  Diseases  of  Women 
and  Children— Dr.  Arthur  W. 
Edis. 


Physiology  and  General  Anatomy— 
Mr.  B.  Thompson  Lowne. 

Practical  Demonstrations  on  Dis¬ 
eases  of  tho  Eye— Mr.  Lang. 

Practical  Surgery  —  Mr.  Andrew 
Clark. 

Principles  aud  Practice  of  Medicine 
— Dr.  Cayley. 

Principles  and  Practice  of  Surgery 
— Mr.  Henry  Morris. 

SESSION. 

Medical  Jurisprudence — Dr.  D.  W. 
Finlay. 

Practical  Demonstrations  on  Dis¬ 
eases  of  Women  and  Children — 
Dr.  Arthur  Edis. 

Practical  Demonstrations  on  Dis¬ 
eases  of  the  Larynx  and  Ear— 
Mr.  Hensman. 

Practical  Physiology  and  Histology 
— Mr.  B.  Thompson  Lowne. 

Practical  Chemistry  —  Mr.  Wm. 
Foster. 

Psychological  Medicine — Mr.  Henry 
Case,  Supt.  Leavesden  Asylum, 

Public  Health — Dr.  D.  W.  Finlay. 


This  Hospital  contains  310  beds,  of  which  190  are  for 
surgical  and  120  for  medical  cases.  There  is  a  special  depart¬ 
ment  for  Cancer  cases,  affording  accommodation  for  thirty- 
three  in-patients,  whose  period  of  residence  in  the  Hospital 
is  unlimited.  Wards  are  also  appropriated  for  the  reception 
of  cases  of  Uterine  Disease  and  of  Syphilis,  and  beds  are  set 
apart  for  patients  from  Diseases  of  the  Eye.  There  are  special 
out-patient  departments  for  Diseases  of  the  Skin,  the  Throat, 
the  Eye  and  Ear. 


PRIZES  AND  SCHOLARSHIPS. 

Two  Entrance  Scholarships  of  the  annual  value  of  £25  and  £20,  tenable 
for  two  years,  are  afforded  for  competition  at  the  commencement  of  the 
winter  session.  (The  successful  candidates  will  be  required  to  become 
general  students  of  the  school.) 

An  Entrance  Science  Scholarship  of  the  value  of  £50  will  be  offered  for 
competition  at  the  commencement  of  the  winter  session  18S3-84.  (The 
successful  candidate  will  be  required  to  become  a  general  student  of  the 
school.)  Examination  in  Inorganic  Chemistry,  Botany  and  Vegetable 
Physiology,  Zoology,  and  Experimental  Physics.  The  schedule  of  these 
subjects  will  be  that  of  the  Preliminary  Scientific  Examination  of  the 
University  of  London,  and  there  will  be  a  practical  examination  in  the 
first  three. 

Two  Broderip  Scholarships  of  the  annual  value  of  £30  and  £20,  tenable 
for  two  years,  are  annually  awarded  to  those  students  who  pass  the  most 
satisfactory  examination  at  the  bedside,  and  in  the  post-mortem  room. 

The  Murray  Scholarship  is  open  to  all  general  students,  and  will  next 
be  awarded  in  1886.  Examinations  in  Medicine,  Surgery,  and  Midwifery. 

The  Governors’  Prize  of  £21  is  awarded  annually  to  the  student  who  at 
the  end  of  his  third  winter  session  shall  pass  the  best  clinical  examina¬ 
tion  and  have  been  most  diligent  in  the  wards  aDd  post-mortem  room. 

The  Lyell  Medal,  value  about  £5  5s.,  is  awarded  annually  to  second 
year’s  students. 

An  Exhibition  in  Anatomy  and  Physiology,  value  £10  10s.,  is  given  at 
the  end  of  the  first  winter  session  to  the  student  who  shall  pass  the  best 
practical  and  written  examination. 

FEES. 

The  fee  for  attendance  on  the  hospital  practice  and  lectures 
required  by  the  Colleges  of  Physicians  and  Surgeons  and  the 
Society  of  Apothecaries  is  £94  10s.  if  paid  in  advance,  or  £40 
on  entrance,  £40  at  the  beginning  of  the  second  winter  session, 
£20  at  the  beginning  of  the  third  winter  session,  and  £5  at 
the  beginning  of  the  fourth  winter. 

Dental  students  who  intend  to  become  Licentiates  in  Dental 
Surgery  of  the  Eoyal  College  of  Surgeons  are  admitted  to 
attend  the  requisite  courses  of  lectures  and  hospital  practice 
on  payment  of  a  fee  of  £42,  either  in  one  payment  or  hv 
instalments  of  £30  on  entrance,  and  £15  at  the  beginning  of 
the  second  winter  session. 


ST.  THOMAS’S  HOSPITAL. 

MEDICAL  AND  SURGICAL  STAFF. 


Assistant-Physicians. 
Dr.  David  Finlay. 

Dr.  J.  K.  Fowler. 

Dr.  C.  Y.  Biss. 


Assistant-Surgeons. 

Mr.  Andrew  Clark. 
Mr.  A.  Pearce  Gould. 


Obstetric  Physician— Dr.  Hall  Davis. 

Physician  to  Skin  Department — Dr.  Robert  Liveing. 
Assistant  Obstetric  Physician — Dr.  Arthur  Edis. 
Ophthalmic  Surgeon — Mr.  William  Lang. 

Aural  Surgeon— Mr.  Arthur  Hensman. 

Dental  Surgeon — Mr.  Storer  Bennett. 

Assistant  Dental  Surgeon— Mr.  Claude  Rogers. 
Curator  of  Museum  and  Pathologist — Dr.  J.  K.  Fowler. 
Registrars— Dr.  J.  J.  Pringle  and  Mr.  W.  Roger  Williams. 
Resident  Medical  Officer — Mr.  E.  A.  Fardon. 
Chloroformist — Mr.  G.  Everitt  Norton. 


Honorary  Consulting  Physicians — Dr.  Barker,  Sir  J.  Risdon  Bennett. 
Honorary  Consulting  Surgeons— Mr.  F.  Le  Gros_  Clark,  Mr.  Simon,  C.B. 
Consulting  Ophthalmic  Surgeon — R.  Liebreich,  Esq. 


Physicians. 

Dr.  Bristowe. 

Dr.  Stone. 

Dr.  Ord. 

Dr.  Harley. 

Obstetric  Physician. 
Dr.  Gervis. 
Assistant-Physicians. 
Dr.  Payne. 

.  Dr.  Sbarkey. 

Dr.  Gulliver. 


Assistant  Obstetric  Physician. 
Dr.  Cory. 

Assist.-Phys.  for  Dis.  of  Throat. 
Dr.  Semon. 

Resident  Assistant-Physician. 
Dr.  Percy  Smith. 
Surgeons. 

Mr.  Sydney  Jones. 

Mr.  Croft. 

Sir  William  Mac  Cormac. 
Mr.  Mason. 


308 


Medical  Times  and  Gazette. 


ENGLISH  SCHOOLS. 


Sept.  15,  1883. 


Ophthalmic  Surgeon. 
Mr.  Nettleship. 

Assistarit-Surg.  ons. 
Mr.  A.  O.  MacKellar. 
Mr.  H.  H.  Clutton. 
Mr.  W.  Anderson. 

Mr.  B.  Pitts. 


Dental  Surgeon. 

Mr.  W.  6.  Ranger. 

Assistant  Dental  Surgeon. 
Mr.  ,C.  E.  Truman. 

Resident  Assistant-Surgeon. 

Mr.  G.  H.  Matins. 


Anaesthetists— Mr.  S.  Osborn  and  Mr.  W.  Tyrrell. 
Electrician—  Mr.  Kilner,  M.B. 

Demonstrators  of  Morbid  Anatomy —Dr.  Sharkey  and  Dr.  Hadden. 
Analytical  Chemist  of  the  Hospital—  Dr.  Albert  J.  Bemays. 
Curator  to  the  Museum— Mr.  C.  Stewart. 

Apothecary— Mr.  Plowman. 

Medical  Registrar —Mr.  Hadden. 

Surgical  Registrar  —Mr.  W.  H.  Battle. 

Secretary  to  the  Medical  School— Mr.  G.  Rendle.  Dean — Dr.  Ord. 


LECTURES  AND  DEMONSTRATIONS. 


Medicine— Dr.  Bristowe  and  Dr. 
Ord. 

Clinical  Medicine  —  Dr.  Bristowe, 
Dr.  Stone,  Dr.  Ord,  and  Dr. 
Harley. 

Obstetric  Clinical  Medicine— Dr. 
Gervis. 

Surgery— Mr.  Sydney  Jones  and 
Sir  Wm.  Mac  Cormac. 

Clinical  Surgery— Mr.  S.  Jones,  Mr. 
Croft,  Sir  Wm.  Mac  Cormac,  and 
Mr.  Mason.  Special  Course  :  Mr. 
Croft. 

Descriptive  Anatomy— Mr.  R.  Reid 
and  Mr.  Anderson. 

General  Anatomy  and  Physiology — 
Dr.  John  Harley  and  Mr  Stewart.. 
Practical  Physiology —  Dr.  T.  C. 
Charles. 


Ophthalmic  Surgery— Mr.  Nettle- 
ship. 

Chemistry  and  Practical  Chemistry 
-Dr.  Bernays. 

Midwifery  and  the  Diseases  of 
Women  and  Children— Dr.  Gervis. 

Thysics  and  Natural  Philosophy — 
Dr  Stone. 

M  iteria  Medica  and  Therapeutics  — 
Dr.  Stone. 

Forensic  Medicine — Mr.  Clutton  and 
Dr.  Cory. 

Pathological  Anatomy — Dt  Payne 
and  Dr.  Sharkey. 

Botany — Mr.  A.  W.  Bennett. 

C  mparative  Anatomy  —  Mr.  C. 
Stewart. 

Mental  Diseases — Dr.  H.  Rayner. 

State  Medicine— Dr.  A.  Carpenter. 


TEACHERS  OF  PRACTICAL  SUBJECTS  AND  DEMONSTRATORS. 


Practical  Chemistry — Dr.  Bernays. 
Practical  and  Manipulative  Surgery 
— Mr.  Mason  and  Mr.  MacKellar. 
Demonstrations  in  Anatomv — Mr. 
R.  Reid,  Mr.  Anderson,  Dr.  Taylor, 
Mr.  Ballance,  and  Assistants. 
Demonstrations  in  Microscopical 
Anatomy — Mr.  Rainey. 
Demonstrations  in  Morbid  Anatomy 
— Dr.  Sharkey  and  Dr.  Hadden. 


Demonstrations  in  Physiology — Dr. 
T.  D.  Acland. 

Demonstrations  in  Practical  Physi¬ 
ology  Dr.  T.  D.  Acland. 

Diseases  of  the  Eye — Mr.  Net.tleship. 
Diseases  of  the  Skin — Dr.  Payne. 
Diseases  of  the  Throat — Dr.  Semon, 
Diseases  of  the  Ear — Mr.  Clutton. 
Diseases  of  the  Teeth  -Mr.  W.  G. 
Ranger  and  Mr.  C.  E.  Truman. 


PRIZES  AND  APPOINTMENTS. 

Entrance  Scholarships  of  £100  and  £60,  awarded  after  an  examination 
in  Physics  and  Chemistry,  with  either  Botany  or  Zoology. 

First  Year's  Prizes. — Winter  :  The  Wm.  Tite  Scholarship  of  £30  ;  College 
Prizes— £20  and  £10.  Summer  Prizes  :  £15  and  £10. 

Second  Year's  Prizes.  —  Winter:  The  Peacock  Scholarship  of  £42,  tenable 
Tor  two  year* ;  College  Prizes— £20  aud  £10.  Summer  Prizes :  £15  and  £10. 

Third  Year's  Priz-s. — -Winter:  £20,  £15,  and  £10.  Summer:  £15  and 
£10.  The  Cheselden  Medal,  awarded  after  a  special  examination  in  Sur¬ 
gical  Anatomy  and  Surgery.  The  Mead  Medal,  awarded  after  a  special 
examination  in  Practical  Medicine,  Pathology,  and  Hygiene.  The  Solly 
Medal,  biennially,  with  a  prize  of  at  least  £10  10s.,  for  a  collection  of 
surgical  reports.  The  Treasurer’s  Gold  Medal,  for  general  proficiencv 
during  the  entire  course  of  study.  The  Grainger  Testimonial  Prize,  of 
the  value  of  £20.  will  be  awarded  biennially  to  the  third  or  fourth  year’s 
students  for  a  physiological  essay,  to  be  illm-trated  by  preparations. 

The  Dresserships  and  the  Clinical  aud  Obstetrical  Clerkships  are  open  to 
students  who  have  passed  the  primary  examinations  at  the  Royal  College 
of  Surgeons,  without  extra  charge. 

FEES. 

Gentlemen  are  informed  that  the  admission  fees  to  practice 
and  to  all  the  lectures  may  be  paid  in  one  of  three  ways, 
entitling  to  unlimited  attendance — 1st,  £125,  paid  on  entrance, 
entitle  a  student  to  unlimited  attendance;  2nd,  £135  in  two 
payments,  of  £75  on  entrance  and  £60  at  beginning  of  next 
year;  3rd,  by  three  instalments,  of  £65  the  first  year,  £50  the 
second,  and  £30  the  third.  Special  arrangements  are  made 
for  students  entering  in  second  or  subsequent  years,  and  for 
Dental  students  ;  and  separate  entries  may  be  made  to  any 
•course  of  lectures,  or  to  the  hospital  practice. 

There  are  special  departments  for  Diseases  of  the  Eye,  Dis¬ 
eases  of  Women  and  Children,  Vaccination,  Diseases  of  the 
skin,  Diseases  of  the  Teeth,  and  Mental  Diseases. 

For  further  information,  apply  to  G.  Rendle,  Esq.,  M.R.C.S., 
Secretary  to  the  Medical  School,  St.  Thomas’s  Hospital,  S.E. 


UNIVERSITY  COLLEGE  AND  HOSPITAL. 


MEDICAL  AND  SURGICAL  STAFF. 

Consulting  Physicians , 

Dr.  Walter  H.  Walshe,  Dr.  J.  Russell  Reynolds,  Sir  William  Jenner,  Bart 


Physicians. 

Dr.  Wilson  Fox. 

Dr.  Sydney  Ringer. 

Dr.  H.  Charlton  Bastian. 
Dr  F.  T.  Roberts. 

Dr.  W.  R.  Gowers. 

Dr.  G.  V.  Poore. 


Obstetric  Physicians. 

Dr.  Graily  Hewitt. 

Dr.  John  Williams. 

Physician  to  the  Skin  Department. 
Dr.  Radcliffe  Crocker. 

Assistant-Physician. 

Dr.  T.  Barlow. 


Consulting  Surgeons. 

Mr.  Richard  Quain. 

Mr.  J.  Eric  Erichsen. 
Sir  Henry  Thompson. 
Mr.  T.  Wharton  Jones. 
Mr.  G.  A.  Ibbetson. 

Surgeons. 

Mr.  Marshall. 

Mr.  Berkeley  Hill. 

Mr.  Christopher  Heath. 
Mr.  Marcus  Beck. 


Assistant-Surgeons . 

Mr.  A.  Barker. 

Mr.  R.  J.  Godlee. 

Ophthalmic  Surgeon. 

Mr.  J.  F.  Streatfeild. 

Assistant  Ophthalmic  Surgeon. 
Mr.  J.  Tweedy. 

Dental  Surgeon. 

Mr.  S.  J.  Hutchinson. 


Assistant  Professors  of  Clinical  Medicine — Dr.  W.  R.  Gowers  and 
Dr.  T.  Barlow. 

Assistant  Professor  of  Clinical  Surgery — Mr.  A.  Barker. 
Assistant  Professor  of  Midwifery — Dr.  John  Williams. 


LECTURES. — WINTER  SESSION. 


Chemistry— Dr.  Williamson. 

Clinical  Medicine— Dr.  W.  Fox,  Dr. 
S.  Ringer, Dr.  Bastian ,  Dr.  Roberts, 
Dr.  Barlow,  Dr.  Gowers. 

Clinical  Midwifery — Dr.  G.  Hewitt, 
Dr.  John  Williams. 

Clinical  Surgery — Mr.  Erichsen, 
Mr.  Marshall,  Mr.  B.  Hill,  Sir  H. 
Thompson.  Mr.  C.  Heath,  Mr. 
Streatfeild,  Mr.  Beck,  Mr.  Barker. 
Dental  Surgery — Mr.  8.  J.  Hutchin- 
Surgery— Mr.  Marshall.  [son. 

Skin  Diseases — Dr.  R.  Crocker. 


Descriptive  Anatomy — Mr.  Thane ; 
Demonstrations— Mr.  Rickman  J. 
Godlee,  Mr.  David  Collingwood. 
Medicine — Dr.  Sydney  Ringer. 
Practical  Surgery — Mr.  B.  Hill,  Mr. 

M.  Beck,  Mr.  E.  A.  Barker. 
Physiology  and  General  Anatomy 
— Mr.  Schafer;  Demonstrator,  Dr. 
J.  A.  McWilliam. 

Zoology  and  Comparative  Anatomy 
— Mr.  E.  R.  Lankester  ;  Demon¬ 
strators,  A.  G.  Bourne  and  W.  B. 
S.  Benham. 


SUMMER  SESSION. 


Botany — Professor  Oliver. 

Forensic  Medicine— Dr.  G.  V.  Poore. 
Histology  and  Practical  Physiology 
— Mr.  achafer. 

Hygiene — Dr.  Corfield. 

Materia  Medica — Dr.  F.  T.  Roberts. 
Midwifery — Dr.  Graily  Hewitt,  Dr. 
John  Williams. 

Operative  Surgery — Mr.  M.  Beck. 


Morbid  Anatomy  and  Pathology- 
Dr.  H.  C.  Bastian. 

Natural  Philosophy — Prof.  G.  C. 
Foster. 

Ophthalmic  Surgery  —  Mr.  John 
Tweedy. 

Practical  Chemistry — Dr.  William¬ 
son. 

Practical  Pharmacy — Mr.  Gerrard. 


SCHOLARSHIPS  AND  EXHIBITIONS. 

The  Atkinson-Morley  Surgical  Scholarship,  £45  per  annum,  tenable  for 
three  years,  is  awarded  every  year  for  proficiency  in  the  theory  and 
practice  of  Surgery. 

The  Atchison  Scholarship,  value  about  £55,  tenable  for  two  years,  for 
general  proficiency. 

Tbe  Sharpey  Physiological  Scholarship,  of  about  £105  a  year,  for  pro¬ 
ficiency  in  Biological  Science. 

The  Filliter  Prize  of  £30,  for  proficiency  in  Pathological  Anatomy. 

Dr.  Fellowes’  Clinical  Medals,  one  gold  and  two  silver,  each  winter  and 
summer  session,  aod  certificates  of  honour,  for  reports  and  observations 
on  the  MedicabCases  of  tbe  Hospital. 

The  Liston  Gold  Medal,  and  certificates  of  honour,  for  reports  and  ob¬ 
servations  on  the  Surgical  Cases  in  the  Hospital. 

The  Alexander  Bruce  Gold  Medal,  for  Pathology  and  Surgery. 

Tbe  Uluff  Memorial  Prize,  awarded  every  other  year  lor  proficiency  in 
Anatomy,  Physiology,  and  Chemistry. 

The  Erichsen  Prize,  awarded  every  year  to  the  student  of  the  class  of 
Practical  Surgery  who  shall  most  distinguish  himself  by  manipulative 
skill 

Gold  and  Silver  Medals,  as  well  as  certificates  of  honour,  are  awarded 
as  class  prizes. 

The  Jews’  Commemoration  Scholarship  of  £15  a  year,  tenable  for  two 
years,  for  general  proficiency  in  tbe  Faculty  of  Arts  or  of  Science,  for 
students  of  one  year's  standing ;  tbe  Tuffnsll  Scholarship,  £100,  tenable 
for  two  years,  for  proficiency  in  Chemistry  ;  and  the  Cloth  workers’  Ex¬ 
hibition  for  Chemistry  and  Physics,  of  £50  a  year,  tenable  for  two  years, 
may  be  held  by  students  who,  after  obtaining  it,  enter  the  Medical 
Faculty. 

The  Morris  Bursary  of  £25,  tenable  for  two  years. 


ENTRANCE  EXHIBITIONS. 

Three  Entrance  Exhibitions,  of  the  respective  value  of  £100,  £60,  and 
£40  per  annu  n ;  subject — Science,  as  in  London  Preliminary  Scientific 
Examination. 

FEES. 

For  the  lectures  and  hospital  practice  for  the  licences  of 
the  Royal  College  of  Physicians,  Society  of  Apothecaries, 
and  M.R.C.S.,  £131  5s.  if  paid  in  one  sum;  or  first  year, 
£63  ;  second  year,  £52  10s  ;  third  year,  £21. 

Further  information  and  detailed  prospectuses  may  he 
obtained  from  the  College,  Gower-street,  W.C. 


WESTMINSTER  HOSPITAL. 


HOSPITAL  STAFF. 


Consulting  Physicians — Dr.  Radcliffo.  Dr.  Finoham. 
Consulting  Surgeons  —  Mr.  Barnard  Holt,  Mr.  Holthouse. 


Physicians. 

Dr.  Sturges. 

Dr.  Allchm. 

Dr.  H.  Donkin. 

Assistant-Physicians. 

Dr.  De  Havilland  Hall. 
Dr.  Hughes  Bennett. 
Dr.  Murrell. 


Surgeons. 

Mr.  Cowell. 

Mr.  Richard  Divy. 
Mr.  Maenamara. 

Assistant-Surgeons. 
Mr.  T.  Cooke. 

Mr.  T.  Bond. 

Mr  Boyce  Barrow. 


Obstetric  Physician — Dr.  Potter. 

Assistant  Obstetric  Physician— Mr  Grigg. 
Dental  Surgeons— Mr.  Walker  and  Mr.  Morton  Smale. 
Aural  Surgeon— Mr.  Keene. 


„<?  - 

i 


)  < 


Stedical  Times  and  Gazette. 


ENGLISH  SCHOOLS. 


Sept.  15, 1883.  309 


Surgeon  in  charge  of  the  Ophthalmic  Department — Mr.  Cowell. 
Surgeon  in  charge  of  the  Orthopcedic  Department — Mr.  R.  Davy. 
Physician  in  charge  of  the  Skin  Department— Dr  T.  C  -lcott  Fox. 
Physician  in  charge  of  the  'throat  Department — Dr.  Hall. 


LECTURES. 


Anatomy— Mr.  Black;  Demonstra¬ 
tor,  Dr.  Sanderson 
Aural  Surgery— Mr.  Keene. 

Botany — Mr.  Worsley-Benison. 
-Chemistry-Dr.  Dupr6,  F.R.S.,  Mr. 
O.  Hehner. 

Clinical  Medicine — Dr.  Sturges,  Dr. 

Allcbin,  Dr.  Donkin. 

-Clinical  Surgery— Mr.  Cowell,  Mr. 

Davy,  Mr.  Macnamara. 
Comparative  Anatomy — Dr.  Leslie 
Ogilvie. 

Dental  Surgery — Dr.  Walker. 
Diseases  of  the  Skin — Dr.  C.  Fox. 
Experimental  Pnysics— Dr.  George 
Ogilvie. 

Forensic  Medicine  and  Hygiene— 
Dr.De  Havilland  Hall,  Dr.  Dupre. 


Materia  Medica  and  Therapeutics- 
Dr.  Murrell. 

Medicine— Dr.  Sturges,  Dr.  Allchia. 

Midwifery  and  Diseases  of  Women 
— Dr.  Potter. 

Ophthalmic  Surgery— Mr.  Cowell. 

Pathology  and  Morbid  Anatomy- 
Dr.  Allchin. 

Physiology — Dr.  Heneage  Gibbes 

Practical  Surgery  —  Mr.  Richard 
Davy. 

Practical  Chemistry— Dr.  Dupr-5. 

Practical  Physiology  and  Histology 
— Dr.  Heneage  Gibbes. 

Psychological  Medicine — Dr.  Henry 
Sutherland. 

Surgery  —  Mr.  Cowell,  Mr.  Mac¬ 
namara. 


Treasurer  of  the  School— Mr.  Cowell. 

Dean  of  the  School— Dr.  Ue  Havilland  Hall.  Sub- Dean— Dr.  Heneage  Gibbes. 
Tutors— Dr.  De  Havilland  Hall  and  Mr.  Boyce  Barrow. 
Pathologist  and  Curator  of  the  Museum. -Dr.  Hebb. 

In  addition  to  the  practice  of  the  Hospital,  which  contains 
"201  beds,  and  has  lately  been  enlarged  and  improved,  the 
general  students  of  this  school  are  admitted  to  the  practice 
of  the  Royal  Westminster  Ophthalmic  Hospital,  and  to  tha 
•of  the  National  Hospital  for  Epilepsy  and  Paralysis. 


PRIZES. 

Entrance  Scholarships  (next  October) :  The  Houldsworth,  £40  a  year 
•for  two  years;  and  one  other,  va'ne  £44.  Subjects — Latin,  Mathematics, 
French  or  German,  Chemistry,  and  Natural  Philosophy.  The  Latin  books 
-the  same  as  the  June  examination  of  the  University  of  London  Matricu¬ 
lation — OviJ,  Metamorphoses.  Book  II.  ;  and  Epistolae  Ex  Ponto,  Book  I. 

There  are  also  the  Treasurer’s  Prize,  an  Exhibition,  value  £10  10s  ,  for 
first  year’s  men ;  the  President’s  Prize,  a  Scholarship  in  Anatomy  ana 
Physiology,  value  £21,  for  secon  i  year’s  men  ;  Prizes  for  Clinical  Medicine 
and  Surgery  of  £5  each  ;  the  Frederic  Bird  Medal  and  Prize,  value  £15  ; 
the  Chadwick  Prize  for  general  proficiency,  value  £21 ;  numerous  dresser- 
tships  and  clerkships  ;  the  posts  of  Pathologist  and  Curator  of  the  Museum, 
with  £52 10s.  a  year ;  Medical  and  Surgical  Registrar,  each  with  £40  a  year ; 
cf  House-Physicians  (two),  House-Surgeon,  Resident  Obstetric  Assistant, 
and  Assistant  House-Surgeon. 

FEES. 

The  entry  fee  to  lectures  and  hospital  practice  required  by 
the  College  of  Physicians  and  Snrgeons  and  the  Society  of 
Apothecaries  may  be  paid  in  one  sum  of  £100  ;  in  two  pay¬ 
ments  of  £52  10s.  each,  at  the  commencement  of  the  first  two 
years;  or  in  five  payments  of  £23  each,  at  the  commence¬ 
ment  of  the  first  five  sessions.  The  fees  for  Dental  Students 
•are  £50  in  one  sum,  or  £32  10s.  and  £20  respectively  at  the 
■commencement  of  each  academic  year. 

Pull  particulars  as  to  the  preliminary  scientific  and  tutorial 
-classes,  the  courses  of  lectures  and  mode  of  instruction,  will 
be  found  in  the  published  Calendar,  and  any  further  infor¬ 
mation  may  be  obtained  by  personal  application  to  Dr.  De 
Havilland  Hall,  the  Dean  of  the  School. 


PKOVINCIAL  MEDICAL  SCHOOLS. 

OXFORD. 


ADDENBROOKE’S  HOSPITAL,  CAMBRIDGE. 

This  Hospital  contains  120  beds. 


MEDICAL  AND 
Physicians. 

Dr.  Paget. 

Dr.  Latham. 

Dr.  Bradbury. 


SURGICAL  STAFF. 

Surgeons. 
Dr.  Humphry, 
Mr.  Carver. 
Mr.  Wallis. 
Mr.  Wherry. 


Clinical  Lectures  by  the  Physicians  and  Surgeons. 

Fees  for  attendance  upon  the  practice  (medical  and  surgical), 
£15  15s.  for  an  unlimited  period  ;  £10  10s.  for  one  year;  £8  8s. 
for  six  months. 


DOWNING  COLLEGE,  CAMBRIDGE. 

Every  alternate  year  an  election  to  a  Fellowship  takes  place,  the  holder 
of  which  must  be  engaged  in  the  active  pursuit  of  the  studies  of  Law  or 
Medicine.  These  Fellowships  are  of  the  annual  value  of  from  £100  to  £200, 
and  are  tenable  for  seven  years.  They  are  not  vacated  by  marriage,  and  the 
Fellows  are  not  required  to  reside.  Foundation  Scholarships  of  £50  per 
annum  (in  some  cases  with  rooms  and  commons)  are  offered  annually  for 
distinction  in  Natural  Science,  tenable  until  the  B.  A.  degree,  and  in  cases 
of  special  merit  for  three  years  longer.  Minor  Scholarships  of  £40  to  £70 
per  annum,  tenable  until  their  holders  are  of  standing  to  compete  for  a 
Foundation  Scholarship,  are  offered  each  year  for  competition  before 
entrance,  and  one  or  more  of  these  is  awarded  for  proficiency  in  Natural 
Science. 


THE  QUEEN’S  COLLEGE,  BIRMINGHAM. 


WINTER 

Chemistry— W.  A.  Tilden,  D.Sc. 
Lond.,  F.R.S. 

Demonstrations  on  Practical  Ana¬ 
tomy — Mr.  Bennett  May  and  Mr. 
Henry  Eales. 

Descriptive  and  Surgical  Anatomy 
— Professor  Thoma3. 

SUMMER 

Botany — Professor  W.  Hillhouse, 
B.A.  Cantab.,  F.L.S. 

Dental  Mechanics— Prof.  C.  Sims. 
Dental  Metallurgy— Professor  W.  A. 

Tilaen,  D.Sc.  Lond,,  F.R.S. 

Dental  Anatomy  and  Physiology — 
Professor  F.  R.  Batchelor. 

Dental  Surgery — Prof.  Howkins, 
Diseases  of  Women  and  Children — 
Professors  Berry  and  R.C.  Jordan. 
Materia  Medica — Professor  Sawyer. 

Honorary  Curator  of  Mi 
Medical  Tutors—  Dr.  C.  W. 


SESSION. 

Medicine — Professor  B.  Foster. 

Pathology — Professor  Rickards. 

Physiology — Professor  John  Berry 
Haycralt,  M.B.,  B  Sc.  Edin. 

Surgery  —  Professors  Pemberton 
and  Fumeaux  Jordan. 

SESSION. 

Forensic  Medicine  and  Toxicology 
—Professors  J.  St.  S.  Wilder 
and  Hill. 

Midwifery  —  Professors  Clay  an 
Bassett. 

Ophthalmic  Surgery  —  Professor 
Solomon. 

Practical  Chemistry — Professor  W. 
A.  Tilden,  D.Sc.  Lond.,  F.R.S. 

Operative  Surgery — Professors  Pem¬ 
berton  and  Jordan. 

seum — Dr.  A.  H.  Carter. 

Suckling  and  Dr.  Haslam. 


SCHOLARSHIPS  AND  PRIZES. 

The  Sands  Cox  Prize.  — A  prize  of  the  value  of  £20  is  given  annually  in 
the  Medical  Department,  in  accordance  with  the  Act  of  Parliament,  “i 
commemoration  of  the  exertions  of  Mr.  William  Sands  Cox  in  founding 
and  supporting  the  College.  This  prize  is  open  to  students  who  have 
completed  their  curriculum,  and  is  awarded  after  examination  in  Medi¬ 
cine,  Surgery,  and  Midwifery.  Every  candidate  is  required  to  produce  a 
certificate  of  good  conduct  from  the  Warden.  The  examination  for  this 
prize  wifi  be  held  in  the  third  week  in  March, 

The  Ingleby  Scholarships. — Two  Ingleby  Scholarships,  founded  in 
memory  of  the  late  Dr.  iDgleby,  formerly  Professor  of  Midwifery  in  this 
School,  will  be  awarded  annually,  after  examination  in  Obstetric  Medi¬ 
cine  and  Surgery  and  Diseases  of  Women  and  Children.  These  scholar¬ 
ships  are  open  to  students  who  have  completed  the  first  two  years  of 
their  curriculum  in  this  College. 

Sydenham  Scholarships.— Given  by  vote  of  Council. 

Queen’s  Scholarships.— Given  as  result  of  examination. 

Class  Prizes. — Medals  and  certificates  of  honour  are  awarded  annually 
in  eacn  class  alter  examination. 


There  is  no  School  of  Medicine  at  Oxford. 


CAMBRIDGE. 

The  following  is  a  list  of  the  classes  and  lectures  in  the 
Cambridge  University  School  of  Medicine : — 


WINTER 

Anatomy — Professor  Macalister  and 
the  Demonstrator  (Mr.  Hill). 

Superintendence  of  Dissections  by 
the  Professor  of  Anatomy  and 
Demonstrators. 

•Chemistry— Professor  Liveing. 

Materia  Medica — Professor  Latham. 

Medicine— Professor  Paget. 

Surgery— Professor  Humphry. 

SUMMER 

Botany— Professor  Babington. 

Chemistry  and  Practical  Chemistry 
— Prof.  Liveing  and  Mr.  Hicks. 

Comparative  Anatomy,  Dissections 
by  the  Demonstrator. 

Med.  Jurisprudence — Dr.Anningson 

Pathology — Dr.  Bradbury. 

Practical  Histology — Mr.  Hill. 


COURSES. 

Practical  Surgeiy — Mr.  Wherry. 

Physics — Professor  Lord  Rayleigh. 

Practical  Chemistry  —  Professor 
Liveing  and  Mr.  Hicks. 

Physiology— Dr.  Michael  Foster. 

Zoology  and  Comparative  Anatomy 
—  Professor  Newton.  Demonstra¬ 
tions  by  the  Demonstrator. 

Animal  Morphology— Mr.Sedgwiek. 

COURSES. 

Midwifery  and  Practical  Midwifery 
— Dr.  Ingle. 

Classes  in  Surgery — Dr.  Humphry. 

Practical  Surgery— Mr.  Wherry. 

Human  Osteology— Professor  Mac- 
alister. 

Practical  Physiology— Dr.  Michael 
Foster  or  his  Assistant. 


THE  GENERAL  AND  QUEEN’S  HOSPITALS,  BIRMINGHAM. 


GENERAL  HOSPITAL  STAFF. 


Consulting  Physician— Dr.  Bell  Fletcher. 

Consulting  Surgeons — Mr.  D.  W.  Crompton  and  Mr.  A.  Baker. 


Physicians. 

Dr.  Russell. 
Dr.  Wade. 

Dr.  Foster. 
Dr.  Rickards. 


Surgeons. 

Mr.  Oliver  Pemberton. 
Mr.  T.  H.  Bartleet. 

Mr.  Robert  Jolly. 

Mr.  Chavasse. 


Assistant-Physicians . 
Dr.  R.  Saundby. 
Dr.  Simon. 


Assistant-Surgeons. 

Mr.  W.  G.  Archer. 
Mr.  Haslam. 


Obstetric  Physician — Dr.  Malins 
Resident  Medical  Officei — Dr.  Hond. 
Resident  Surgeon  and  Surgical  Tutoi — Dr.  Barling. 
Registrar  and  Pathologist — Dr.  Windle. 


QUEEN’S  HOSPITAL  STAFF. 


Consulting  Surgeon— Mr.  S.  Gamgee. 
Consulting  Obstetric  Surgeon  —  Mr.  Berry. 


Physicians. 
Dr.  Sawyer. 
Dr.  Carter. 


A 


V  A  ui2R.«.,  ,Y  /.  J 


Surgeons. 

Mr.  Furneaux  Jordan. 
Mr.  J.  St.  S.  Wilders. 
Mr.  Bennett  May. 

Mr.  Jordan  Lloyd. 


310 


Medical  Times  and  Gazette. 


ENGLISH  SCHOOLS. 


Sep\  15,  18S3- 


Physician  for  Oat-Patients. — Dr.  Suckling. 

Casualty  Surgeons— Mr.  A.  F.  Hawkins  and  (vacant). 

Obstetric  Surgeon — Mr.  Jobn  Clay. 

Ophthalmic  Surgeon— Mr.  Priestley  Smith. 

Dental  Surgeon — Mr.  Charles  Sims. 

Souse-Physicians — Dr.  Sanders  and  Dr.  Pratt. 

House-Surgeons— Mr.  Clay  and  Mr.  North. 

CLINICAL  PRIZES. 

The  following  prizes  will  be  given  annually Senior  Medical  Prizes,  for 
third  or  fourth  year  students  :  First  Prize,  £5  5s.  Senior  Surgical  Prizes  : 
First  Prize,  £5  5s.  J unior  Medical  Prizes,  for  second  year  students  : 
First  Prize,  £3  3s.  Junior  Surgical  Prizes:  First  Prize,  £3  3s.  Mid¬ 
wifery  Prize,  £4  4s. 

The  examination  for  the  above-mentioned  prizes  will  be  conducted  by 
the  Clinical  Board,  and,  together  with  various  resident  hospital  ap¬ 
pointments,  will  be  open  for  competition  to  all  students  registered  by 
the  Clinical  Board. 


BRISTOL  SCHOOL  OF  MEDICINE. 

COURSES  OF  LECTURES. — WINTER  SESSION. 


Chemistry — Mr.  Thomas  Coomber. 
Descriptive  and  Surgical  Anatomy 
— Mr.  F.  Richardson  Cross. 
Medicine — Dr.  William  H.  Spencer 
aud  Dr.  E.  Markham  Skerritt. 

SUMMER 

Botany — Mr.  Adolph  Leipner. 
Comparative  Anatomy — Professor 
W.  J.  Sollas. 

Materia  Medina  and  Therapeutics — 
Dr.  John  E.  Shaw. 

Medical  Jurisprudence — Dr.  Regi¬ 
nald  Eager  and  Dr.  Alfred  J. 
Harrison. 

Midwifery  and  Diseases  of  Women— 
Dr.  Joseph  G.  Swayne  and  Dr.  A. 
E.  Aust-Lawrenee. 


Surgery — Mr.  Nelson  C.  Dobson. 
Physiology — Dr.  R.  S.  Smith. 
Practical  Anatomy— Demonstrator : 

Mr.  William  H.  Harsant. 
Hygiene— Mr.  David  Davies. 

SESSION. 

Operative  Surgery  and  Surgical 
Pathology — Mr.  W.  Powell  Keall. 
Pathology  and  Morbid  Anatomy- 
Dr.  William  H.  Spencer  and  Dr. 
E.  Markham  Skerritt. 

Practical  Chemistry— Mr.  Thomas 
Coomber. 

Practical  Physiology  and  Histology 
— Mr.  George  P.  Atcbley.  De¬ 
monstrator  :  Mr.  G.  Munro  Smith. 
Pr-ictical  Surgery — Mr.  Arthur  W. 
Prichard. 


BRISTOL  ROYAL  INFIRMARY. 

MEDICAL  AND  SURGICAL  STAFF. 

Honorary  and  Consulting  Physicians — Dr.  Alexander  F.-urbrother, 

Dr.  Frederick  Brittan,  and  Dr.  Edward  Long  Fox. 

Honorary  and  Consulting  Surgeons — Mr.  John  Harrison  and 
Mr.  Augustin  Prichard. 

Physicians. 

Dr.  William  H.  Spencer.  I  Dr.  Henry  Waldo. 

Dr.  R.  Shingleton  Smith.  |  Mr.  John  E.  Shaw. 

Surgeons. 

Mr.  Edmund  C.  Board.  I  Mr.  Arthur  W.  Prichard. 

Mr.  Christopher  H.  Dowson.  |  Mr.  F.  Richardson  Cross. 

Mr.  J.  Greig  Smith. 

Assistant-Surgeon. — Mr.  William  H.  Harsant. 

Medical  Superintendent — Mr.  J.  H.  Lee  Macintire. 

House-Surgeon — Mr.  J.  Paul  Bush. 

House-Physician — Mr.  J.  Fenton  Evans. 

This  Infirmary  was  founded  in  the  year  1735,  and  is  one  of 
the  largest  provincial  hospitals  in  England.  It  contains  264 
beds. 

PRIZES. 

Suple’s  Medical  Prize,  consisting  of  a  gold  medal  of  the  value  of  £5  5s. 
and  about  £7  7s.  in  money,  is  given  annually  to  the  successful  candidate 
in  an  examination  held  by  the  Physicians.  The  examination  comprises 
reports  of  cases  in  the  medical  wards,  and  the  preparation  of  morbid 
specimens  illustrative  of  disease,  accompanied,  if  possible,  by  micro- 
copic  and  chemical  illustrations,  besides  written  replies  to  questions  in 
Medicine. 

Suple’s  Surgical  Prize  corresponds  in  value  and  character  to  the  medical 
one  described  above.  In  this  case  the  examination  is  conducted  by  the 
Surgeons,  and  comprises  surgical  subjects  only. 

Clark’s  Prize. — The  interest  of  £500,  bequeathed  by  the  late  Henry 
Clark,  Esq.,  Consulting  Surgeon  to  the  Infirmary,  will  be  given  annually 
to  the  most  successful  student  of  the  third  year  at  the  examination  held 
at  the  Medical  School,  provided  he  has  attended  his  hospital  practice  at 
the  Bristol  Royal  Infirmary,  aud  can  produce  certificates  of  good  moral 
character. 

Tibbits’  Memorial  Prize. — A  prize,  founded  by  public  subscription  in 
memory  of  the  late  R.  W.  Tibbits,  Esq.,  Surgeon  to  the  Infirmary,  being 
the  interest  of  £315,  will  be  offered  for  .competition  annually  to  the  ad¬ 
vanced  students  for  the  greatest  proficiency  in  Practical  Surgery. 

Crosby  Leonard’s  Prize. — The  interest  of  £300  will  be  awarded  annually 
for  the  best  reports  of  Surgical  Cases. 

Pathological  Prize.— The  Pathological  Clerk  at  the  expiration  of  his 
term  of  office  will  receive  a  prize  of  the  value  of  £3  3s.  if  his  duties  have 
been  performed  to  the  satisfaction  of  the  Faculty. 

FEES. 

An  entrance  fee  of  £2  2s.  to  the  Infirmary,  and  subscription 
of  £1  Is.  per  annum  to  the  Library.  Medical  or  Surgical 
Practice,  £7  7s.  for  six  months,  £12  12s.  for  one  year,  £21 
perpetual ;  Medical  and  Surgical  Practice  together,  in  one 
payment,  £21  for  one  year,  ,£36  15s.  perpetual.  The  above 
fees  include  Clinical  Lectures.  Clinical  Clerkship,  £5  5s.  for 
six  months,  =£8  8s.  for  one  year ;  Dressership,  £5  5s.  for  each 
six  months ;  Obstetric  Clerkship,  £3  3s.  for  each  three  months. 
All  fees  are  paid  to  the  Secretary,  at  the  Infirmary. 


BRISTOL  GENERAL  HOSPITAL,  (a) 

MEDICAL  AND  SURGICAL  STAFF. 

Honorary  and  Consulting  Surgeons — Mr.  Robert  W.  Coe,  Mr.  W.  Michell 
Clarke,  Dr.  Henry  Marshall,  Mr.  George  F.  Atcbley. 

Honorary  ancl  Consulting  Physician-Accoucheur — Dr.  Joseph  G.  Swayne. 

Srirgeons. 

Mr.  F.  Poole  Lansdown. 

Mr.  Nelson  C.  Dobson. 

Mr.  William  P.  Keall. 

Mr,  Charles  F.  Pickering. 

House-Surgeon. 

Mr.  W.  J.  Penny. 

Assistant  House-Surgeon . 

Mr.  J.  R.  Woolby. 

Dentist — Mr.  T.  C.  Parson. 

SCHOLARSHIPS  AND  PRIZES. 

Martyn  Memorial  Entrance  Scholarship. — This  scholarship,  of  the 
value  of  £20,  founded  by  public  subscription,  in  memory  of  the  late  Dr. 
Samuel  Martyn.  Physician  to  the  Hospital,  is  awarded  annually  at  the 
commencement  of  the  winter  session,  after  a  competitive  examination  in 
subjects  of  general  education. 

Clarke  Scholarship.  —  A  Surgical  Scholarship  of  £15,  founded  by  H.  M. 
Clarke,  Esq  ,  of  London,  is  awarded  annually,  at  the  end  of  the  winter- 
session,  after  an  examination  in  Surgery. 

Sanders  Scholarship. — A  scholarship,  founded  by  the  late  Jobn  Nash 
Sanders,  Esq. ,  and  consisting  of  the  interest  of  £500,  is  awarded  annually, 
at  the  end  of  the  winter  session,  after  examinations  in  Medicine,  Surgery 
and  Diseases  of  Women. 

Lady  Haberfield  Prize. — This  prize,  founded  by  the  late  Lady  Haberfield, 
and  consisting  of  the  interest  of  £1000,  is  awarded  annually,  at  the  end 
of  the  winter  session,  after  examinations  in  Medicine,  Surgery,  and 
Diseases  of  Women. 

The  Martyn  Memorial  Scholarship  and  the  Lady  Haberfield  Prize,  when 
not  awarded  as  above,  are  available  for  the  remuneration  of  a  Museum 
Curator,  to  be  appointed  from  amongst  the  students  after  a  competitive 
examination  in  subjects  bearing  upon  the  duties  of  the  office. 

The  rules  relating  to  the  several  scholarships  may  be  bad  on  application. 

FEES. 

Medical  or  Surgical  Practice,  £6  for  six  months;  £10  for 
one  year ;  £20  perpetual.  Extra  fee  for  Clinical  Clerk  or 
Dresser,  £5  5s.  for  six  months.  Extra  fee  for  Obstetric 
Clerk,  £3  3s.  for  three  months.  Library  fee,  £1  Is.  per  annum. 

Further  particulars  respecting  the  Infirmary  may  be  known 
on  application  to  the  Dean  of  the  Infirmary  Faculty,  Mr.  F. 
Richardson  Cross ;  respecting  the  Hospital,  on  application  to 
the  Dean  of  the  Hospital  Faculty,  Dr.  Markham  Skerritt. 
Information  regarding  the  Medical  School  will  be  afforded 
by  the  Honorary  Secretary  of  the  School,  E.  Markham  Skerritt, 
M.D.,  Medical  School,  University  College,  Tyndall’s  Park, 
Bristol. 


UNIVERSITY  OF  DURHAM  COLLEGE  OF 
MEDICINE. 

The  winter  session  will  be  opened  on  Monday,  October  1, 
when  the  prizes  will  he  presented  by  Joseph  Cowen,  Esq.,  M.P. 

The  College  of  Medicine  has  been  considerably  enlarged. 
Another  Dissecting-room,  sixty  feet  long,  has  been  built,  in 
addition  to  that  lately  constructed.  The  Library  and  Museum 
have./ been  removed  and  remodelled,  and  larger  rooms  have 
been  set  apart  for  the  students  and  teachers,  and  the  Medical 
Theatre  has  been  extended  so  as  to  accommodate  250  students. 
There  are  well-fitted  laboratories  for  the  study  of  Practical 
Chemistry,  and  special  arrangements  for  students  desirous  of 
working  at  Practical  Physiology.  Operative  Surgery  is  taught 
practically  during  the  summer. 

The  Infirmary  contains  230  beds.  There  are  special  wards 
set  apart  for  Diseases  of  the  Eye,  for  Look  Cases  (male  and 
female),  and  for  Children. 

Clinical  lectures  are  delivered  by  the  Physicians  and  Sur¬ 
geons  in  rotation  three  times  a  week.  Pathological  demon¬ 
strations  are  given  as  opportunity  offers  by  the  Pathologist. 
Practical  Midwifery  can  be  studied  at  the  Newcastle  Lying- 
in  Hospital,  where  there  is  an  outdoor  practice  of  about’500 
cases  annually,  available  for  students  without  fee.  At  the 
Infirmary  there  are  special  departments  for  the  instruction  of 
students  in  Ophthalmology,  Gymecology,  Dermatology,  Dis¬ 
eases  of  the  Throat  and  Ear,  and  Bandaging  and  Minor 
Surgery. 

SCHOLARSHIPS,  ETC. 

A  University  of  Durham  Scholarship,  of  the  value  of  £25  a  year  for 
four  years,  for  proficiency  in  Arts,  awarded  annually  to  full  students  in 
their  first  year. 

The  Dickinson  Scholarship,  value  £15  annually,  for  Medicine,  Surgery, 
Midwifery,  and  Pathology. 

The  Tulloch  Scholarship,  value  £20  annually,  for  Anatomy,  Physiology, 
and  Chemistry. 


Physicians. 

Dr.  George  F.  Burder. 

Dr.  E.  Markham  Skerritt. 
Dr.  Alfred  J.  Harrison. 

Physician- Accoucheur. 

Dr.  A.  E.  Aust-Lawrence. 

Physician’s  Assistant. 

Mr.  C.  N.  Cornish. 


(a)  No  return. 


ENGLISH  SCHOOLS. 


Sept.  15,  1883.  311 


Medical  Times  and  Gazette. 


The  Charlton.  Scholarship,  value  £35  annually,  with  (in  addition)  a  gold 
medal,  for  Medicine. 

The  Gibb  Scholarship,  value  £25  annally,  for  Pathology. 

The  Goyder  Memorial  Scholarship,  value  £16  annnally,  at  the  In¬ 
firmary,  for  Clinical  Medicine  and  Cliaical  Surgery. 

At  the  end  of  each  session  a  silver  medal  and  certificates  of  honour  are 
awarded  in  each  of  the  regular  classes. 

An  Assistant  Curator  of  the  Museum  is  appointed  annually  from  among 
the  senior  students,  and  receives  an  honorarium  of  £12  for  tne  year. 

Four  Assistant  Demonstrators  of  Anatomy,  receiving  each  an  honorarium 
of  £5,  two  Assistants  to  the  Lecturer  on  Practical  Physiology,  and  two 
■or  more  Prosectors  are  appointed  yearly. 

Four  times  in  the  year,  two  Resident  Medical  Assistants,  two  Resident 
Surgical  Assistants,  three  Non-resident  Clinical  Clerks,  and  sixteen 
Non-resident  Dressers  (eight  for  the  In-patients,  and  eight  for  the  Out¬ 
patient  Department),  are  nominated  by  the  Medical  Board,  and,  if  ap¬ 
proved,  are  appointed  by  the  House  Committee  for  three  months. 

Assistants  in  the  Pathological  Department,  and  two  Assistants  to  the 
Dental  Surgeon,  are  appointed  in  March  and  October. 

FEES  FOR  HOSPITAL  PRACTICE  AND  LECTURES. 

1.  A  composition  ticket  for  the  complete  course  of  lectures 
at  the  College  may  be  obtained  (1)  by  the  payment  of  £63  on 
entrance ;  (2)  by  two  payments  each  of  ,£36  15s.  at  the  com¬ 
mencement  of  the  first  and  second  winter  sessions  ;  (3)  by  the 
payment  of  three  annual  instalments,  the  first  of  £31  10s.,  the 
second  of  £26  5s.,  and  the  third  of  £21,  at  the  commencement 
•of  each  sessional  year. 

2.  Fees  for  attendance  on  Hospital  Practice : — Three  months, 
£5  5s. ;  six  months,  £8  8s. ;  one  year,  £12  12s. ;  perpetual, 
£26  5s. ;  or  by  instalments  at  the  commencement  of  the  ses¬ 
sional  year,  viz. : — First  year,  £12  12s. ;  second  year,  £10  10s.; 
third  year,  £6  6s.;  or  by  two  instalments,  viz. : — First  year, 
£14  14s. ;  second  year,  £12  12s. 

3.  Single  courses  of  lectures  or  tutorial  classes  ,  £5  5s. 

Further  particulars  may  be  obtained  from  Dr.  Luke  Arm¬ 
strong,  Registrar,  Clayton-street  West ;  or  Mr.  Henry  E. 
Armstrong,  Secretary,  6,  Went  worth-place,  Newcastle-upon- 
Tyne. 

STAFF  OF  THE  COLLEGE. 


Anatomy— Dr.  W.  P.  Mears. 

Physiology — Dr.  D.  Drummond 
and  Mr.  G.  E.  Williamson. 

Medicine— Prof.  G.  H.  Philipson. 

Surgery— Dr.  G.  Y.  Heath  and  Dr. 
W.  C.  Arnison. 

Chemistry  -  Prof.  Bedson,  assisted 
by  Mr.  J.  T.  Dunn. 

Dissections— Dr.  W.  P.  Mears. 

Public  Health,— Mr.  H.  E.  Arm¬ 
strong. 

Diseases  of  Women  —Dr.  C.  Gibson. 

Midwifery— Dr.  T.  C.  Nesham. 


Medical  Jurisprudence— Mr.Fredk. 
Page. 

Botany — Dr.  J.  Murphy. 
Therapeutics —Dr.  T.  W.  Barron. 
Materia  Medica— Di\  8.  McBean. 
Pathology— Dr.  C.  J.  Gibb  and  Dr. 
Drummond. 

Operative  Surgery — Dr.  L.  Arm¬ 
strong. 

Practical  Physiology— Dr.  T.  Oliver. 
Psychology— Mr.  R.  H.B. Wickham. 
Medical  Tutor— Dr.  W.  P.  Mears. 
Tutor  in  Arts— Rev.  J.  Bulmer. 


The  Infirmary  contains  nearly  300  beds.  There  are  special 
wards  for  the  treatment  of  Uterine  and  other  Diseases  of 
Women. 

The  Medical  and  Surgical  Tutors  give  practical  instruction 
in  case-taking  and  clinical  observation  generally  every  morning 
in  the  wards. 

The  Lock  Hospital,  adjoining  the  Infirmary,  contains  sixty 
beds. 

SCHOLARSHIPS  AND  PRIZES. 

Roger  Lyon  Jones  Scholarships. — One  Lyon  Jones  Scholarship  (£21 
for  two  years)  will  be  awarded  in  October  to  the  applicant  who  has  taken 
highest  place  in  Honours  at  the  matriculation  examination  of  the  London 
University.  In  the  absence  of  any  candidate  fulfilling  these  conditions, 
this  Scholarship  will  be  awarded  by  written  examination  in  English, 
Classics,  Mathematics,  Modern  Languages,  and  Physics,  in  September 
next.  Successful  candidates  must  become  composition  ticket-holders  of 
the  School.  Another  Lyon  Jones  Scholarship  (£21  for  two  years)  is 
awarded  to  second-year  students  for  proficiency  in  Anatomy,  Physiology, 
Chemistry,  Botany,  Materia  Medica,  and  Practical  Chemistry. 

The  Derby  Exhibition  (£15  for  one  year)  is  awarded  annually  by  com¬ 
petitive  examination  to  third  or  fourth  year  students. 

A  Lyon  Jones  Gold  Medal  will  be  awarded  to  the  senior  student  who 
passes  the  best  examination  in  Medicine,  Surgery,  Pathology,  and  Mid¬ 
wifery,  provided  a  sufficiently  high  standard  of  merit  be  attained. 

Torr  Medal.  —  A  gold  medal  for  Anatomy  and  Phy.-iology,  presented  by 
Mr.  John  Torr,  M.P.,  is  awarded  to  the  first  student  iu  the  second  year 
subjects. 

Bligh  Medal. — This  gold  medal,  which  is  presented  annually  by  Dr. 
John  Bligh,  Liverpool  (also  for  the  encouragement  of  the  study  of 
Anatomy  and  Physiology),  is  awarded  to  the  first  student  in  the  first- 
year  subjects. 

Many  other  medals  and  prizes  are  also  awarded. 

FEES. 

Composition  Fee. — A  payment  of  £63  on  entrance  or  in 
two  equal  instalments  (one-half  on  entrance,  and  the  re¬ 
mainder  within  twelve  months),  entitles  the  student  to  attend¬ 
ance  on  all  the  lectures  and  demonstrations  required  for  the 
Membership  of  the  Royal  College  of  Surgeons,  the  Licence  of 
the  College  of  Physicians  and  the  Apothecaries’  Society.  Per¬ 
petual  hospital  fee,  £42. 

The  new  Physical  Laboratories,  under  the  charge  of  Pro¬ 
fessor  Lodge,  are  now  open ;  and  also  the  new  Zoological 
Laboratories,  under  the  charge  of  Professor  Herdman. 

For  prospectuses  and  all  further  information,  apply  to  the 
Dean  of  the  Medical  Faculty,  Dr.  Caton,  18a,  Abercromby- 
square,  Liverpool. 

LIVERPOOL  NORTHERN  HOSPITAL. 

MEDICAL  AND  SURGICAL  STAFF. 


NEWCASTLE-UPON-TYNE  INFIRMARY. 

MEDICAL  AND  SURGICAL  STAFF. 

Physicians — Dr.  Philipson,  Dr.  Drummond,  and  Dr.  Oliver. 
Surgeons — Dr.  Amison,  Dr.  Armstrong,  Dr.  Hume,  and  Mr.  Page. 
Assistant-Surgeons — Mr,  G.  E.  Williamson  and  Mr.  T.  A.  Dodd. 


MEDICAL  FACULTY  OF  UNIVEESITY  COLLEGE, 

LIVERPOOL. 


ROYAL  INFIRMARY  SCHOOL  OF  MEDICINE. 

PROFESSORS  AND  LECTURERS. 


Medicine— Dr.  A.  T.  H.  Waters. 
Surgery — Mr.  Rushton  Parser. 
Anatomy — Mr.  W.  Mitchell  Banks. 
Physiology — Dr.  Richard  Caton. 
Pathology — Dr.  A.  Davidson: 
Ophthalmology — -Mr.  T.  S.  Walker. 
Chemistry — Dr.  J.  C.  Brown. 
Experimental  Physios— Dr.  O.  J. 
Lodge. 

Midwifery  and  Gynaecology — Dr.  J. 
Wallace. 

Comparative  Anatomy- 


Clinical  Medicine— Dr.  A.  T.  H. 
Waters,  Dr.  T.  R.  Glynn,  and  Dr. 
A.  Davidson. 

Clinical  Surgery  —  Messrs.  E.  R. 
Bickersteth,  Reginald  Harrison, 
and  W.  Mitchell  Banks. 

Diseases  of  Children — Dr.  R.  Gee. 
Materia  Medica — Dr.  W.  Carter. 
Medical  Jurisprudence— Dr.  Ewing 
Whittle. 

Botany— Dr.  George  Shearer. 

-Dr.  Herdman. 


DEMONSTRATORS . 

Histology  and  Practical  Physiology  I  Practical  Anatomy — Mr.  Barron. 
— Mr.  Mott.  I  Chemistry— Mr.  Snape. 

Physics — Mr.  Clark. 


ROYAL  INFIRMARY,  LIVERPOOL. 

Consulting  Physician — Dr.  Turnbull. 

Consulting  Surgeon — Mr.  Hakes. 

Physicians — Dr.  Waters,  Dr.  Glynn,  and  Dr.  Davidson. 
Surgeons—  Mr.  Bickersteth,  Mr.  Harrison,  and  Mr.  Banks. 
Obstetric  Physician — Dr.  Wallace. 

Assistant-Surgeon — Mr.  Parker.  Pathologist — Dr.  Rich. 

Medical  Tutor — Dr.  Greves.  Surgical  Tutoi — Mr.  Paul. 
Dental  Surgeon — Mr.  Phillips. 

Surgeons  to  the  Lock  Hospital — Dr.  Bernard,  Mr.  F.  W.  Lowndes, 


Physicians— Dr.  E.  H.  Dickinson  and  Dr.  R.  Caton. 

Surgeons — Mr.  Manifold,  Mr.  Puzey,  and  Dr.  McF.  Campbell. 

House-Physician—  Dr.  Logan. 

House-Surgeon  —Dr.  Orr.  Assistant  House-Surgeon — Mr.  Davy. 

House-Surgeon' s  Assistant  and  Ambulance  Surgeon — Mr.  Horrocks. 

The  Hospital  contains  146  beds  (including  special  Children’s 
Ward). 

Fees  for  hospital  practice  and  clinical  lectures — Perpetual, 
£26  5s.;  one  year,  £10  10s. ;  six  months,  £7  7s.;  three 
months,  £4  4s.  Students  can  enter  to  Medical  or  Surgical 
Practice  separately  on  payment  of  half  the  above  fees.  Prac¬ 
tical  Pharmacy,  £2  2s.  for  three  months. 

Attendance  on  the  practice  of  this  Hospital  qualifies  for  all 
the  examining  boards. 

For  further  particulars,  apply  to  the  House-Surgeon. 

LIVERPOOL  ROYAL  SOUTHERN  HOSPITAL. 

MEDICAL  AND  SURGICAL  STAFF. 

Physicians—  Dr.  Cameron,  Dr.  Carter,  and  Dr.  Williams. 

Consulting  Surgeons— Mr.  Higginson  and  M r.  Nottingham. 

Surgeons — Mr.  Hamilton,  Dr.  Little,  and  Mr.  Paul. 

Dental  Surgeon — Mr.  R.  E.  Stewart. 

Senior  House-Surgeon — Dr.  Davison. 

Junior  House-Surgeons— Mr.  Sellers  and  Mr.  Fitzpatrick. 

There  are  200  beds  in  this  Hospital. 

Clinical  lectures  given  by  the  Physicians  and  Surgeons 
during  the  winter  and  summer  sessions.  Clinical  clerkships 
and  dresserships  open  to  all  students.  Special  wards  for 
Accidents  and  Diseases  of  Children.  Rooms  for  a  limited 
number  of  resident  students. 

Fees  for  hospital  practice  and  clinical  lectures — Perpetual, 
£26  5s. ;  one  year,  £10  10s. ;  six  months,  £7  7s. ;  three  months, 
£4  4s. 

The  practice  of  the  Hospital  is  recognised  by  all  the 
examining  bodies.  Further  information  can  be  obtained  from 
the  Senior  House-Surgeon. 


312 


Medical  Times  and  Gazette. 


ENGLISH  SCHOOLS. 


Sept.  15,  1883. 


VICTORIA  UNIVERSITY,  MANCHESTER  (MEDICAL 
DEPARTMENT). 

PROFESSORS  AND  LECTURERS. — WINTER  SESSION. 


Chemistry— Dr.  Hy  .E.  Roscoe,  F.  R.  S. 
Comparative  Anitomy  —  Dr.  A. 
Miiaes  Marshall. 

Descriptive  and  Practical  Anatomy 
— Dr.  Morrison  Watson. 

General  Pathology  and  Morbid 
Anatomy — Dr.  Julius  Dreschfeld. 
Hospital  Instruction — Physicians 
and  Surgeons  to  Royal  Infirmary. 
Clinical  Medicine  —  Dr.  William 
Roberts,  F.R.S. 


Principles  and  Practice  of  Medicine 
—  Dr.  J.  E.  Morgan. 

Organic  Chemistry  — Mr.  C.  Schor- 
lemmer,  F.  K.S. 

Physiology  and  Histology  —  Dr. 

Arthur  Gamgee,  F.R  S. 

Surgery— Mr.  Edward  Lund 
Practical  Surgery  —  Mr.  Thomas 
Jones. 

Surgical  Pathology— Mr.  Alfred  H. 
I  Young. 


SUMMER  SESSION. 


Botany — Mr.  W.C.  Williamson,  F.R.S 
Diseases  of  Children— Dr.  Henry 
Ashby. 

Embryology — Dr,  A.  Milues  Mar¬ 
shall. 

Hygiene  and  Public  Health — Dr. 
Arthur  Ransome. 

Materia  Medica  and  Therapeutics, 
and  Pharmacy — Dr.  Leech;  As¬ 
sistant,  Mr.  W.  Elborne. 

Medical  Jurisprudence — Dr.  C.  J. 
Culling  worth. 

Mental  Diseases — Mr.  G.  W.  Mould. 


Midwifery  and  Diseases  of  Women 
— Dr.  J.  Thorburn. 

Operative  Surgery  —  Mr.  Thomas 
Jones 

Ophthalmology — Dr.  D.  Little. 
Practical  Chemistry— Dr.  Henry  E. 
Roscoe. 

Practical  Morbid  Histology  —  Dr. 
J.  Dreschfeld. 

Practical  Surgical  Pathology— Mr. 

.Alfred  H.  Youug. 

Practical  Physiology  and  Histology 
—  Dr.  Arthur  Gamgee. 


Demonstrator  in  Physiology — Mr.  W.  H.  Waters,  M  A. 
Demonstrators  in  Anatomy  —  Ufa.  A.  Fraser  and  Mr.  J.  Collier. 

Regislrat — Mr.  J.  Holme  Nicholson,  M.  A. 

Dean  of  the  Medical  School — Professor  Gamgee,  M.D.,  F.R.S. 


SCHOLARSHIPS  AND  PRIZES. 

A  Turner  Scholarship  of  £25  fur  fourth  year’s  students.  Prizes  in  books 
or  instruments  varying  from  £3  3s.  to  £5  5s.  will  be  offered  for  competition 
in  the  several  classes. 

Robert  Platt  Physiological  Scholarships. — Two  Scholarships  of  £50  each, 
tenable  for  two  years,  one  of  which  is  offered  annually,  are  open  to  the 
competition  of  all  persons  (whether  students  of  the  College  or  not)  whose 
age  on  January  1  preceding  the  examination  shall  not  be  under  eighteen 
nor  over  twenty-five  years. 

Robert  Platt  Exhibitions.— Two  Exhibitions  of  the  value  of  £15  ear-h 
are  offered  for  the  competition  of  first  and  second  years’  students  m 
Physiology. 

Dumville  Surgical  Prize,  value  £20  :  The  prize  will  consist  of  books  or 
surgical  instruments  at  the  option  of  the  winner. 

Dauntesey  Medical  Scholarship.— The  Scholarship  is  of  the  value  of 
about  £100,  and  is  tenable  for  one  year. 

Gilchrist  Scholarships. -Three  of  £50  each,  tenable  for  three  years, 
one  of  which  is  annually  awarded  to  the  candidate  who  shall  stand 
highest  at  the  Matriculation  Examination  of  the  University  of  London 
in  June,  provided  he  pass  in  the  honours  divhdou,  and,  failing  such,  two 
of  £25  each  will  he  given  to  the  two  candidates  who  stand  highest  in 
the  first  division. 

FEES. 

A  composition  fee  of  £63,  payable  in  two  sums  of  £31  10s. 
each  at  the  commencement  of  the  first  and  second  years  of 
studentship,  admits  to  the  four  years’  course  of  study. 
Students  desirous  of  repeating  attendances  on  any  class  after 
the  expiration  of  the  four  years’  course,  will  he  allowed  to  do 
so  on  paying  for  each  class  attended  one-third  of  the  fee 
payable  by  students  who  do  not  compound.  A  student,  how¬ 
ever,  who  desires  to  continue  his  study  of  Practical  Anatomy 
beyond  two  sessions,  will  be  required  to  pay  at  the  rate  of 
£2  2s.  for  a  three  months’  or  £3  3s.  for  a  six  months’  course. 

Extra  fees  are  charged  for  attendance  on  the  practical  classes 
in  Botany  and  in  Comparative  Anatomy,  and  for  Operative 
Surgery.  Tutorial  classes  are  held  in  Anatomy  and  Physi¬ 
ology  (fee  £2  2s.),  and  in  Chemistry,  Zoology,  and  Botany  (fee 
10s.  6d.  for  each  class). 

A  charge  of  £1  Is.  is  also  made  for  the  chemicals  used  in  the 
class  of  Practical  Chemistry. 


MANCHESTER  ROYAL  INFIRMARY. 


MEDICAL  AND  SURGICAL  STAFF. 


Consulting  Physicians — Dr.  R.  F.  Ainsworth,  Dr.  Frank  Renaud, 
Dr.  Henry  Browne,  and  Dr.  William  Roberts. 

Consulting  Surgeons—  Mr.  George  Bowriog  and  Mr.  Edward  Lund. 


Physicians. 

Dr.  Henrv  Simpson. 
Dr.  John  E.  Morgau. 
Dr.  Daniel  J.  Leech. 
Dr.  Julius  Dreschfeld. 

Assistant- Physicians. 
Dr.  James  Ross. 

Dr.  Graham  Stetll. 

Obstetric  Physician. 

Dr.  John  Thorburn. 


Surgeons. 

Mr.  F.  A.  Heath. 

Mr.  Walter  Whitehead. 
Mr.  Thomas  Jones. 

Mr.  James  Hardie. 

Assistant-Surgeons. 

Mr.  F.  Armitage  Southara, 
Mr.  G.  A.  Wright. 

Ophthalmic  Surgeon. 

Dr.  Little. 


Dental  Surgeon — Mr.  G.  W.  Smith. 

Resident  Medical  Officei — Dr.  David  Grant. 

Resident  Surgical  Officer — Mr.  Bilton  Pollard. 

Medical  Supt.  of  the  Royal  Lunatic  Hospital  at  Cheadle  —  Mr.  G.  W.  Mould. 


Medical  and  Surgical  Registrar — Mr.  A.  H.  Young. 

Pathological  Registrar — Dr.  R  Maguire. 

General  Superintendent  and  Secretary— Mr.  W.  L.  Saunder. 

STUDENTS’  FEES. 

Medical  Practice. — Three  months,  £4  4s. ;  six  months,  £8  8s. ; 
twelve  months,  £12  12s. ;  full  period  required  by  the  examining 
board,  £18  18s. 

Surgical  Practice. — Three  months,  £6  6s. ;  six  months, 
£9  9s. ;  twelve  months,  £18  18s. ;  full  period  required  by 
the  examining  board,  £31  10s. 

Composition  Fee. — The  fees  for  the  full  period  required  by 
the  examining  boards  of  both  medical  and  surgical  practice 
may  be  paid  by  a  composition  fee  of  £42  on  entrance,  or  by 
two  instalments  of  £22  each  at  an  interval  of  twelve  months. 

In  addition  to  the  practice  of  the  Infirmary,  the  Monsall 
Fever  Hospital  and  the  Barnes  Convalescent  Home  will  also 
be  open,  under  certain  regulations,  to  students  for  the  purposes 
of  instruction. 


LEEDS  SCHOOL  OF  MEDICINE. 


CLA8SES  AND  LECTURES. 


Descriptive  Anatomy — Mr.  John  A. 
Nunueley,  Mr.  Edmund  Robin¬ 
son,  and  Mr.  A.  F.  McGill. 
Demonstrators  of  Anatomy — Mr.  A. 
W.  M.  Robson,  Dr.  J.  B.  Hellier, 
Mr.  R.  N.  Hartley,  Mr.  W.  H. 
BrowD,  Mr.  F.  P.  Flood,  and  Mr. 
H.  Rowe. 

Physiology— Mr.  C.  J.  Wright  and 
Dr.  E.  H.  Jacob. 

Practical  Physiology  and  Histology 
— (vacant). 

Demonstrator  of  Physiology— Dr. 
A.  G.  Barrs. 

Medicine — Dr.  T.  Clifford  Allbutt 
and  Dr.  John  Edwin  Eddison 
Mental  Diseases — Dr.  H.  C.  Major. 
Surgery  and  Practical  Surgery— Mr. 
T.  R.  Jessop,  and  Mr.  Edward 
Atkinson. 

Clinical  Medicine— Dr.  T.  Clifford 
Allbutt,  Dr.  John  Edwin  Eddison, 
and  Dr.  Tnomas  Churtou. 


Clinical  Surgery— Mr.  C.  G  Wheel- 
house,  Mr.  T.  P.  Teale,  Mr.  T.  R. 
Jessop,  and  Mr.  Edward  Atkinson. 

Forensic  Medicine — Mr.  Thomas 
Scattergood. 

Midwifery — Mr.  W.  N.  Price,  and 
Dr.  James  Braithwaite. 

Materia  Medica  and  Therapeutics — 
Dr.  Thomas  Churton. 

Pathology  and  Morbid  Anatomy — 
Mr.  A.  W.  M.  Robson. 

Practical  Morbid  Histology  —  Dr. 
Ernest  H.  Jacob. 

Chemistry  (at  the  York  shire  College) 
—Prof.  T.  E.  Thorpe. 

Practical  Chemistry  (at  the  YTork- 
shii e  College) — Prof.  T.  E.  Tbo-pe, 
assisted  by  Mr.  C.  H.  Bothamley. 

Botany  (at  the  Yorkshire  College) — 
Prof.  L.  C.  Miall. 

Comparative  Anatomy  and  Zoology 
(at  the  Philosophical  Hall)— Pro£ 
L.  C.  Miall. 


Resident  Curator — (not  yet  appointed). 


LEEDS  GENERAL  INFIRMARY. 


MEDICAL  AND  SURGICAL  STAFF. 
Consulting  Physician — Dr.  Charles  Chadwick. 
Consulting  Surgeon— Mir.  Samuel  Hey. 


Physicians. 

Dr.  T.  Clifford  Allbutt. 
Dr.  John  Edwin  Eddison. 
Dr.  T.  Churion. 


Surgeons. 

Mr.  C.  G.  Wheelhouse. 
Mr.  T.  Pridgin  Teale. 
Mr.  T.  R.  Jessop. 

Mr.  Edward  Atkinson. 


Assistant-Surgeons— Mr.  A.  F.  McGill  and  Mr  A.  W.  Mayo  Robson 
Surgeons  to  the  Ophthalmic  and  Aural  Department— Mr.  John  A.  Nunneley 
and  Mr.  Hewetson. 

Dental  Surgeon— Mr.  T.  Carter. 


SCHOLARSHIPS  AND  PRIZES. 

The  H  trdwick  Clinical  Prize.— Candidates  for  this  prize  must  be  in 
attendance  on  the  lectures  of  the  Leeds  School  of  Medicine,  and  must 
have  completed  their  first  year’s  course  there,  they  must  be  In  let¬ 
tered  attendance  upon  the  medical  practice  of  the  Hospital,  and  hive 
served  the  office  of  Clinical  Clerk,  or  he  holding  that  office  at  the  time  of 
competition.  The  prize  is  given  annually  for  the  best  set  of  reports  •  f 
medical  cases  in  the  Hospital  during  the  winter  session,  subject  to  such 
regu'ations  as  may  be  laid  down  at  the  commencement  of  the  session. 
I's  value  is  £10  in  money.  Should  the  funds  admit,  a  second  prize  may 
be  given. 

The  Surgeons’  Clinical  Prizes. — Three  prizes  of  the  value  of  £8.  £5,  an  1 
£3  in  money  are  offered  annually  by  the  Surgeons  of  the  Hospital, subject 
to  conditions  similar  to  those  relating  to  the  Hardwick  Prize. 

The  Thorp  Prize  in  Forensic  Medicine.— A  sum  of  £20  (founded  by  a 
former  Lecturer  and  present  honorary  member  of  the  Council)  is  awarded 
at  the  close  of  each  summer  session,  in  one  or  more  prizes,  subject  to  such 
regulations  as  may  be  made  from  time  to  time,  of  which  due  notice  will 
be  given. 

Competitive  CDss  Examinations.— At  the  close  of  each  session,  com¬ 
petitive  examinations  are  held,  when  silver  and  bronze  medals,  books, 
and  certificates  of  honour  are  awarded  according  to  merit ;  but  in  no  case 
will  a  prize  be  awarded  unless  a  reasonable  standard  of  merit  has  been 
attained. 

Prosectors. — Three  prosectors  are  selected  annually  from  the  senior 
students  to  prepare  the  necessary  dissections  or  lectures,  and  to  assist 
the  Demonstrators  of  Anatomy  and  Resident  Curator. 


FEES. 

The  fees  for  school  lectures  and  for  hospital  practice  (which 
includes  clinical  lectures)  are  distinct,  and  are  paid  separately. 

Students  may  enter  for  single  courses  of  lectures,  or  pay  a 
composition  fee.  All  students,  however,  mu&t  pay  an  entrance 
ee  of  „£1  Is.,  which  confers  the  privilege  of  using  the  library 
and  reading-room. 

The  composition  fee  is  .£52  10s.,  if  paid  in  one  sum  on 


Meiical  Times  and  Gazette. 


SCOTTISH  SCHOOLS. 


Sept.  15,  1S83.  313 


entrance ;  or  <£ 27  6s.  on  entrance,  and  the  same  amount  at 
the  expiration  of  twelve  months. 

This  composition  fee,  when  the  payment  is  completed, 
entitles  a  student  to  attend  all  the  school  lectures  required  for 
the  examinations  for  the  licence  of  the  Royal  College  of  Phy¬ 
sicians  of  London,  the  membership  of  the  Royal  College 
of  Surgeons  of  England,  and  the  licence  of  the  Society  of 
Apothecaries.  It  also  gives  admission  to  one  course  of  the 
lectures  and  demonstrations  on  Mental  Diseases,  but  not  to 
the  lectures  on  Comparative  Anatomy. 

The  fee  of  10s.  6d.  is  charged  to  students  attending  the 
demonstrations  of  Morbid  Histology,  for  the  use  of  reagents 
and  apparatus. 

Fees  for  medical  practice  and  clinical  lectures  :  — One  summer 
session,  £6  6s. ;  one  winter  session,  £7  7s. ;  twelve  months, 
£12  12s.;  eighteen  months,  £15  15s.;  three  years,  £21; 
perpetual,  .£26  5s. 

Fees  for  surgical  practice  and  clinical  lectures : — One 
summer  session,  .£6  6s. ;  one  winter  session,  £7  7s. ;  twelve 
months,  .£12  12s.;  eighteen  months,  .£15  1 56. 5  three  years, 
.£21 ;  perpetual,  .£26  5s. 

Instruction  in  vaccination,  as  required  by  the  College  of 
Surgeons  and  by  the  Poor-law  Board,  is  given  by  one  of  the 
Public  Vaccinators — fee  £l  Is.  Students  must  attend  on 
Tuesdays,  at  3  p.m.,  for  six  weeks. 

All  further  information  may  be  obtained  from  the  Honorary 
Secretary,  Dr.  ChurtoD,  35,  Park-square,  Leeds. 


SHEFFIELD  SCHOOL  OF  MEDICINE. 

LECTURES.— WINTER  SESSION. 


Anatomy,  Descriptive  and  Surgical  I 
— Mr.  E.  Skinner,  Mr.  Snell 

Demonstrations  of  Anatomy— The 
Tutor. 

Physiology  -  Dr.  Dyson,  Dr.  Sinclair 
White. 

Principle-*  and  Practice  of  Medicine 
-  Dr.  Bartolome,  Dr.  Banharn, 
Dr.  Thomas. 

Principles  and  Practice  of  Sur¬ 
gery— Mr.  Arthur  Jackson. 

Tutor— Mr. 

SUMMER 

Midwifery  and  Diseases  of  Women 
— Dr.  Hime. 

Materia  Medica  and  Therapeutics 
— Dr.  Young. 

Medical  Jurisprudence  and  Toxi¬ 
cology — Mr.  J.  W.  Harrison. 

Botany — Mr.  Birks. 


Chemistry— At  Firth  College. 

Clinical  Medicine— The  Physicians 
at  the  Infirmary  and  Public  Hos¬ 
pital  and  Dispensary. 

Clinical  Surgery — The  Surgeons  at 
the  Infirmary  and  Public  Hos¬ 
pital  and  Dispensary. 

Practical  Surgery — The  House-Sur¬ 
geon  at  the  Infirmary. 

Practical  Pnysiology — Mr.  R.  J. 
Pye-Smith. 

H.  B  Lee. 

SESSION. 

Practical  Chemistry — At  Firth  Col¬ 
lege. 

Demonstrations  of  Pathology  and 
Microscopy — Toe  House-Surgeon 
of  the  Infirmary. 

Public  Medicine — Dr.  Drew. 

Ophthalmic  Surgery — Mr.  Snell. 


SHEFFIELD  GENERAL  INFIRMARY. 

MEDICAL  AND  SURGICAL  STAFF. 

Consulting  Physicians — Dr.  F.  Branson  and  Dr.  Elam. 

Physicians.  Surgeons. 

Dr.  BartolomA  Mr.  Barber. 

Dr.  Law.  Mr.  Favell. 

Dr.  Banham.  Mr.  A.  Jackson. 

Ophthalmic  Surgeon — Mr.  Snell. 
House-Surgeon — Mr.  Charles  Atkin. 

Assistant  House-Surgeon — Vacant. 

The  Infirmary  contains  180  beds  for  in-patients. 

SHEFFIELD  PUBLIC  HOSPITAL  AND  DISPENSARY. 

Consulting  Physicians — Dr.  Law  and  (vacant). 
Consulting -Surgeons— Dr.  Hunter  and  Mr.  Arthur  Jackson. 

Surgeons. 


Physicians. 

Dr.  Dysou. 

Dr.  W.  R.  Thomas. 
Vacant. 


Dr.  Keeling. 

Mr.  Thorpe. 

Mr.  Pye-amith. 

House-Surgeon— Dr.  Sinclair  White. 

Assistant  House-Surgeons— Me.  Jackson  and  (vacant). 

This  Hospital  contains  110  beds.  Recognised  by  the  Royal 
College  of  Surgeons. 

JESSOP  HOSPITAL  FOR  DISEASES  OF  WOMEN. 

CONSULTING  MEDICAL  OFFICERS. 

Dr.  Aveling,  Dr.  E.  Jackson,  Dr.  Hime. 

MEDICAL  OFFICERS. 

Dr.  Keeling,  Mr.  Woolhouse,  Mr.  R.  Favell,  Mr.  Laver. 

FEES. 

Physiology,  first  course,  £3  3s. ;  second  course,  £2  2s.  Ana¬ 
tomy  (including  Demonstrations),  first  course  £4  4s.;  second 
course,  £2  2s.  Practice  of  Medicine,  first  course,  £4  4s. ;  second 
course,  £2  2s.  Practice  of  Surgery,  first  course,  £4  4s.  Che¬ 
mistry,  first  course,  £4  4s.  Midwifery  and  Diseases  of  Women, 
first  course,  £3  3s.  Materia  Medica,  first  course,  £3  3s. 
Medical  Jurisprudence,  first  course,  £3  3s.  Botany,  first  course) 


£3  3s.  Practical  Chemistry,  first  course,  £3  3s.  Practical  Physi¬ 
ology,  £3  38.  Practical  Surgery,  £3  3s.  Tutor’s  fee,  £2  2s. 

Perpetual  fee  for  attendance  on  all  the  lectures  required! 
by  the  Royal  College  of  Surgeons  and  the  Apothecaries’  Hall, 
£45. 

One  fee  admits  to  the  practice  of  the  Infirmary  and  of 
the  Public  Hospital  and  Dispensary — for  the  summer  session,. 
Medicine  and  Surgery  £3s  3s.  each ;  for  the  winter  session, 
£6  6s. 

All  further  information  may  be  obtained  on  application  to 
the  Hon.  Secretary,  Arthur  J ackson  ,Wilkinson-street,  Sheffield. 


SCHOOLS  AND  HOSPITALS  IN  SCOTLAND. 


UNIVERSITY  OF  EDINBURGH.— FACULTY 
OF  MEDICINE. 


session  1S83-84. 

Principal — Sir  Alexander  Grant,  Bart.,  LL.D. 
winter  session. 


The  session  will  he  opened  on  Tuesday,  October  23,  1883. 


‘Anatomy— Prof.  Turner. 
‘Anatomical  Demonstrations — Prof. 
Turner. 

•Chemistry — Prof.  Crum  Brown. 
Clinical  Medicine — Profs.  Maclagan, 
Grainger  Stewart,  T.  R.  Fraser, 
and  Greenfield  (Prof.  Simpson 
on  Diseases  of  Women.) 

Clinical  Surgery — Prof.  Annandale. 
•Genl.  Pathology — Prof.  Greenfield. 


•Institutes  of-  Medicine  or  Physi¬ 
ology — Prof.  Rutherford. 

•Materia  Medica— Prof.  T.R.  Fraser. 
‘Midwifery  and  Diseases  of  Women, 
and  Children— Prof.  Simpson. 
Practical  Natural  History  —  Prof. 
Ewart. 

•Practice  of  Physic— Prof.  Grainger 
Stewart. 

•Surgery— Prof.  Chiene. 


winter  and  summer  session. 


•Anatomical  Demonstrations — Prof. 
Turner. 

•Bandaging  aud  Surgical  Appliances 
— Prof.  Chiene. 

•Operative  Surgery — Prof.  Chiene. 
•Obstetrical  aud  Gynaecological  Ope¬ 
rations — Prof.  Simpson. 

*  In  University 


•Practical  Physiology,  including: 
Histology,  Chemical  Physiology, 
and  Experimental  Physiology- 
Prof.  Rutherfoid. 

•Practical  Anatomy — Prof.  Turner. 
•Practical  Chemistry— Prof.  Crum, 
Brown. 

New  Buildings. 


summer  session. 


Practical  Instruction  in  Mental 
Diseases  at  an  Asylum  —  Dr. 
Clouston,  Lecturer. 

Practical  Natural  History  —  Prof. 
Ewart. 

Practical  Morbid  Anatomy  and 
Pathology— Prof.  Greenfield. 
Practical  Botany— Prof.  Dickson. 

During  the  summer  session 
following  subjects  :  — 
Anatomical  Demonstrations— Prof. 
Turner. 

Botany— Prof.  Dickson. 

Chemistry — Prof.  Crum  Brown. 
Clinical  Medicine— Profs.  Maclagan, 
Grainger  Stewart,  T.  R.  Fraser, 
and  Greenfield.  (Prof.  Simpson 
on  Diseases  of  Women.) 


Vegetable  Histology — Prof.  Dickson-.. 

Tutorial  Class  of  Clinical  Medicine- 
in  the  Wards  of  the  Royal  Ii>- 
firmary  by  the  Clinical  Tutor,  Dr. 
Jas.  Murdoch  Brown. 

Diseases  of  the  Eye— D.  Argyll 
Robertson,  M.D. 

lectures  will  be  given  on  thee 

Clinical  Surgery— Prof.  C.  Annandale, 

Mental  Diseases,  with  Practical  In¬ 
struction  at  Morningside  Asylum- 
— Dr.  Clouston,  Lecturer. 

Medical  Jurisprudence— Prof.  Mac- 
lagan. 

Natural  History — Prof.  Ewart. 

Obstetrical  and  Gynaecological 
Operations — Prof.  Simpson. 


Information  relative  to  matriculation  and  the  curricula  of 
study  for  degrees,  examinations,  etc.,  will  be  found  in  the- 
University  Calendar,  and  may  be  obtained  on  application  to. 
the  Secretary  at  the  College. 

During  the  summer  session  the  following  means  are  afforded, 
for  practical  instruction  : — 

The  Dissecting  Rooms  are  open  daily,  under  the  Superin¬ 
tendence  of  the  Professor,  assisted  by  Arthur  Thomson,  M.B., 
W.  Bannerman,  M.B.,  C.M.,  and  other  assistants. 

The  Royal  Edinburgh  Asylum  is  open  to  members  of  the 
class  of  Medical  Psychology  exclusively  for  practical  instruc¬ 
tion  in  Mental  Diseases  by  the  Physician-Superintendent,  Dr. 
Clouston. 

Chemical  Laboratories. — The  laboratory  for  instruction  in 
Analytical  Chemistry  and  for  chemical  investigation,  under 
the  superintendence  of  the  Professor,  assisted  by  R.  M.  Morri¬ 
son,  D.Sc.,  John  Gibson,  Ph.D.,  and  Leonard  Dobbin,  Ph.D., 
is  open  from  ten  to  four.  The  Laboratory  for  Instruction  in 
Practical  Chemistry,  under  the  superintendence  of  the  Professor, 
assisted  by  R  M.  Morrison,  D.Sc. 

The  Physiological  Laboratory  is  open  daily  for  physiological 
investigation,  under  the  superintendence  of  the  Professor,, 
assisted  by  John  Lockhart  Gibson,  M.B. 

The  Physical  Laboratory  is  open  daily  from  ten  to  three ^ 
under  the  superintendence  of  Professor  Tait. 

The  Medical  Jurisprudence  Laboratory  is  also  open  daily 
from  ten  to  three,  under  the  superintendence  of  the  Professor,, 
assisted  by  James  Allan  Gray,  M.D. 


314 


Medical  Times  and  Gazette. 


SCOTTISH  SCHOOLS. 


Sept.  15, 1863. 


The  practice  of  Obstetrical  and  Gynaecological  Operations  is 
carried  out  in  the  Obstetrical  Museum,  under  the  superin¬ 
tendence  of  the  Professor,  assisted  by  A.  H.  Barbour,  M.A., 
M.B.,  C.M. 

The  Natural  History  Laboratory  is  open  daily,  under  the 
superintendence  of  Professor  Ewart,  assisted  by  J.  T.  Cun¬ 
ningham,  B.A. 

The  Natural  History  Museum  in  the  Museum  of  Science  and 
Art,  Chambers-street,  is  accessible  to  the  students  attending 
the  Natural  History  Class. 

The  Loyal  Botanic  Garden,  Herbarium,  and  Museum  are 

■open  daily. 

MEDICAL  FELLOWSHIPS,  SCHOLARSHIPS,  BURSARIES,  ETC. 

Fellowships. 

The  Falconer  Memorial  Fellowship,  value  £100,  tenable  for  two  years. 
It  is  for  the  encouragement  of  the  study  of  Palaeontology  and  Geology, 
and  is  open  to  graduates  in  Science  or  Medicine  of  the  University  of  not 
■more  than  three  years’  standing. 

The  Syme  Surgical  Fellowship,  value  about  £100,  tenable  for  two  years, 
open  to  competition  among  Bachelors  of  Medicine  of  not  more  than  three 
years’  standing,  who  shall  present  the  best  thesis  on  a  surgical  subject, 
giving  evidence  of  original  research. 

The  Leckie-Mactier  Fellowship,  consisting  of  the  free  annual  proceeds 
■of  £2000,  open  to  competition  to  Bachelors  of  Medicine  of  not  more  than 
three  years’  standing.  The  Fellowship  to  be  tenable  for  three  years,  and 
the  next  award  will  be  in  November,  1882.  The  examination  will  com¬ 
prise  written  reports  and  commentaries  on  three  medical  cases,  three 
-surgical  cases,  and  one  gynecological  case  in  the  University  wards  in  the 
Royal  Infirmary ;  a  written  examination  in  Midwifery,  Medical  Juris- 
tprudenee,  and  Public  Health ;  and  an  oral  examination  in  Medicine, 
Surgery,  Midwifery,  Medical  Jurisprudence,  and  Public  Health. 

Scholarships. 

The  Sibbald  Scholarship,  value  about  £40,  tenable  for  three  years. 

A  Hope  Prize  Scholarship,  value  about  £30,  will  be  awarded  in  March, 
■1884,  to  the  most  distinguished  junior  student  in  the  chemical  laboratory 
•during  the  winter  session. 

The  Thomson  Scholarship,  of  the  value  of  £40  yearly,  tenable  for  four 
years,  will  be  awarded  in  October.  1886;  the  subjects  of  examination 
Botany,  Zoology,  and  Elementary  Mechanics.  Candidates  to  be  matri¬ 
culated  students  about  to  commence  their  first  winter  session  in  the 
Medical  Faculty ;  a  preference  to  be  given  to  candidates  of  the  names  of 
Thomson  or  Traquair,  or  to  natives  of  the  town  or  county  of  Dumfries, 
or  of  the  city  of  Edinburgh. 

Vans  Dunlop  Scholarships :  Six  scholarships,  of  the  annual  value  of 
£100,  tenable  for  four  years-one  to  be  awarded  in  March,  18S4,  to  the 
candidate  who,  at  the  preliminary  examination  in  March  or  the  preceding 
October,  shall  have  obtained  the  highest  total  number  of  marks  required 
to  enable  him  to  appear  for  a  professional  examination  ;  one  in  J uly,  1884, 
to  the  candidate  who  obtains  the  highest  marks  in  Botany,  Zoology, 
Chemistry,  and  Anatomy ;  one  in  March,  1884,  for  the  highest  marks  in 
Physiology  and  Surgery  ;  the  other  three  to  be  awarded  to  the  students 
who,  at  the  end  of  the  third  winter  session,  shall  obtain  the  highest 
number  of  marks  in  an  examination,  specially  conducted  for  the  purpose, 
on  Anatomy,  Physiology,  Materia  Medica,  and  Pathology — one  scholar¬ 
ship,  to  be  awarded  in  April,  1883,  another  in  April,  1S84,  the  third  in 
April,  1885,  and  so  on  in  each  successive  year. 

The  Vans  Dunlop  Scholarships  in  Chemistry  and  Chemical  Pharmacy, 
and  in  Natural  History,  including  Botany  and  Geology. — These  Scholar¬ 
ships  a-e  of  the  value  of  about  £100,  and  are  tenable  for  three  years. 

The  Coldstream  Memorial  Medical  Missionary  Scholarship,  consisting 
of  the  free  annual  proceeds  of  at  least  £400,  is  open  to  students  of 
Medicine  who  intend  to  prosecute  their  studies  in  the  University  of 
Edinburgh,  and  who  propose  to  devote  their  lives  to  the  calling  of  a 
Medical  Missionary.  The  Scholarship  is  tenable  for  four  years,  and  the 
next  award  may  be  made  in  October,  1883. 

The  Buchanan  Scholarship,  consisting  of  the  annual  proceeds  of  £1000, 
•will  be  awarded  yearly,  on  the  day  of  medic  il  graduation,  for  profi¬ 
ciency  in  Midwifery  and  Gynaecology.  The  award  wid  be  based  upon 
the  results  of  competitive  examinations  in  the  class  of  Midwifery  and 
Diseases  of  Women  and  Children,  upon  the  character  of  the  records  kept 
of  cases  treated  in  the  gynaecological  section  of  the  class  of  Clinical 
Medicine,  and  upon  the  appearance  made  by  the  candidate  at  the  final 
graduation  examination. 

The  Murchison  Memorial  Scholarship,  tenable  for  one  year,  and  con¬ 
sisting  of  the  annual  proceeds  of  about  £1000,  will  be  awarded  in  alternate 
years  in  London  and  Edinburgh,  for  proficiency  in  Clinical  Medicine. 
Candidates  to  be  registered  medical  students  in  attendance  for  not  less 
than  four  nor  more  than  six  years  at  hospitals  and  classes  in  London  and 
Edinburgh,  recognised  by  the  College  of  Physicians  of  London,  or  the 
University  of  Edinburgh.  The  competition  will  take  place  in  London 
in  April,  1884,  and  the  next  will  take  place  in  Edinburgh  in  April,  1885. 

The  James  Scott  Scholarship  in  Midwifery,  consisting  of  the  annual 
.proceeds  of  £1005.  The  Scholarship  is  held  for  one  year,  but  may,  in 
special  circumstances,  be  continued  for  another  year.  The  next  award 
will  be  made  in  August,  1884. 

The  Robert  Mackay  Smith  Scholarships  in  Natural  Philosophy  and 
•Chemistry,  each  consisting  of  one-half  of  the  annual  proceeds  of  £2500, 
are  open  to  students  who  have  attended  at  least  one  session  in 
the  class  of  Natural  Philosophy  or  in  the  class  of  Chemistry  in  this 
University,  and  are  tenable  for  two  years,  during  one  of  which  the  suc- 
■cessful  candidates  shall  be  bound  to  attend  in  this  University  in  the 
department  of  Natural  Philosophy  or  Chemistry.  They  cannot  be  held 
along  with  any  other  scholarship,  fellowship,  or  bursary,  in  any  Scottish 
university.  The  next  competition  in  this  University  will  take  place  at 
the  end  of  the  winter  session,  1886-87. 

Bursaries. 

The  Abercrombie  Bursary  of  £20,  tenable  for  four  years,  is  open  to 
students  who  have  been  brought  up  in  Heriot’s  Hospital  during  their 
medical  curriculum. 

The  Sibbald  Bursaries  are  open  to  the  sons  of  duly  registered  medical 
men  practising,  or  who  may  have  practised  in  Scotland,  and  to  the  sons 
of  parents  who  are,  or  who  may  have  been,  householders  in  Edinburgh. 


They  are  of  the  value  of  £30  each,  tenable  for  four  years,  and  available  for 
the  Faculty  either  of  Arts,  Law,  Medicine,  or  Divinity. 

Eight  Thomson  Bursaries,  value  £25  each,  tenable  for  four  years  ;  one 
to  be  competed  for  each  March  and  October,  at  the  preliminary  examina¬ 
tions  required  from  candidates  for  graduation  in  Medicine.  Candidates 
shall  be  those  about  to  commence  their  medical  curriculum,  who  shall 
attend  the  said  preliminary  examination,  and  who  shall  pass  in  a  sufficient 
number  of  subjects  to  enable  them  to  appear  for  a  professional  examina¬ 
tion  ;  a  preference  to  be  given  to  candidates  of  the  names  of  Thomson  or 
Traquair,  or  to  natives  of  the  town  or  county  of  Dumfries,  or  of  the  city 
of  Edinburgh.  Information  as  to  the  Thomson  Bursaries  and  Scholarship 
may  be  got  from  Messrs.  Traquair,  Dickson,  and  Maclaren,  W.S.,  11,  Hill- 
street,  Edinburgh. 

Four  Grierson  Bursaries  of  £20  a  year. 

One  Tyndall-Bruce  Bursary  of  £25,  tenable  for  one  year,  to  be  competed 
for  by  students  who  have  reached  the  end  of  their  third  winter  session- 
subjects  of  examination,  to  be  Materia  Medica  and  Pathology.  Competi¬ 
tors  for  the  above  bursaries  must  have  studied  the  subjects  of  examina¬ 
tion  at  the  University  of  Edinburgh  ;  and  these  are  not  to  be  held  along 
with  any  other  bursary  or  fellowship. 

Two  Dr.  John  Aitken  Carlyle’s  Medical  Bursaries,  of  the  value  of  £25 
each,  tenable  for  one  year,  to  be  awarded  at  the  end  of  each  winter 
session — one  to  a  first  year’s  student  for  proficiency  shown  in  the  ordinary 
class  examinations  in  Anatomy  and  Chemistry;  one  to  a  second. year’s 
student  for  proficiency  shown  in  the  ordinary  class  examinations  in 
Anatomy  and  Physiology. 

Two  Mackenzie  Bursaries,  consisting  of  the  proceeds  of  £1000,  to.be 
awarded  annually— one  to  the  student  in  the  junior  class  of  Practical 
Anatomy,  and  one  to  the  student  in  the  senior  class  of  Practical.  Anatomy, 
who  shall  respectively  display  the  greatest  industry  and  skill  in  their 
Practical  Anatomy  work  during  the  winter  session. 

Prizes. 

The  Ettles  Medical  Prize  is  awarded  annually  to  the  graduate  in  Medicine 
whom  the  Medical  Faculty  may  consider  the  most  distinguished  of  the 
year.  Value  about  £40.  The  Beaney  Prize  will  be  awarded,  annually  to 
the  candidate  for  the  degrees  of  M.B.  and  C.M.  who,  after  having  attended 
within  the  University,  courses  of  Anatomy,  Surgery,  and  Clinical 
Surgery,  qualifying  for  graduation,  shall  obtain  the  highest  number  of 
marks  in  those  subjects  during  his  examination  for  these  degrees.  Value 
about  £40. 

The  Hope  Chemistry  Prize,  opeu  to  all  students  of  the  University  of 
not  more  than  twenty-five  years  of  age,  who  have  worked  for  eight 
months,  or  for  two  summer  sessions,  in  the  Chemical  Laboratory  of  the 
University.  Value  £100. 

The  Neil  Arnott  Prize,  of  about  £40.  is  awarded  to  the  candidate  who 
shall  pass  with  the  greatest  distinction  the  ordinary  examination  in 
Natural  Philosophy  for  the  degree  of  M.A.  Candidates  must  have  been 
medical  students  of  this  University  during  either  a  summer  or  a  winter 
session,  and  the  successful  candidate  muse  continue  a  medical  student 
of  this  University  during  the  winter  session.  No  student  can  appear 
for  examination  after  the  completion  of  his  third  annus  medicus ;  no 
candidate  shall  be  allowed  to  offer  himself  more  than  once. 

The  Ellis  Prize  for  the  best  essay  “An  Original  Research  in  any  depart¬ 
ment  of  the  subject  of  Animal  Heat,”  is  open  to  students  or  graduates  of 
five  years’  standing.  Value,  proceeds  of  the  sum  of  £500  accumulated 
for  three  years.  The  next  award  may  be  in  18S5. 

The  Goodsir  Memorial  Prize  of  £60  is  awarded  triennially  for  the  best 
essay  containing  results  of  original  investigations  in  Anatomy  or  in 
Experimental  Physiology.  H ext  award  in  August,  1884. 

The  Wightman  Prize  is  awarded  to  the  student  of  the  class  of  Clinical 
Medicine  who  shall  write  the  best  report  and  commentary  on  cases  treated 
in  the  University  clinical  wards  during  the  academic  year. 

The  Cameron  Prize,  consisting  of  the  free  income  of  £2000,  to  be  given 
yearly  to  the  member  of  the  medical  profession  who  shall  be  adjudged 
to  have  made  the  most  valuable  addition  to  Practical  Therapeutics  during 
the  year  preceding  the  award. 

The  DoObie-Smith  Gold  Medal  in  Botany  is  open  for  competition  on 
each  alternate  year  to  all  matriculated  students  of  the  year  of  award,  for 
an  essay  on  a  botanical  subject. 

The  Medical  Faculty  Prizes.— Gold  medals  are  given  on  the  day  of 
graduation  to  Doctors  of  Medicine  whose  theses  are  deemed  worthy  of 
that  honour. 

Lectureship. 

The  Swiney  Lectureship  on  Geology,  value  £144,  tenable  for  five  years, 
is  open  to  Doctors  of  Medicine  of  the  University  of  Edinburgh.  It  is  in 
the  patronage  of  the  trustees  of  the  British  Museum. 

MINIMUM  COST  OP  ATTENDING  THE  MEDICAL  CLASSES,  WITH 
THE  ORDER  OF  STUDY. 

Whilst  there  is  no  authorised  order  of  study,  the  usual  course  is  given 
below — Preliminary  Examination  in  Arts  to  be  taken  in  the  month  of 
March  or  October,  before  entering  medical  classes.  By  order  of  the 
General  Medical  Council,  all  medical  students  require  to  be  registered  as 
such  within  fifteen  days  after  the  commencement  of  thesession.  Students 
are  recommended  to  commence  their  medical  studies  by  attending  the 
summer  session. 

First  Summer  Session.—  Preliminary  examination  fee,  10s. ;  matriculation 
fee,  10s.  ;  Botany  (garden  fee,  5s.),  £4  4s. ;  Natural  History,  £4  4s. ;  total, 
£9  8s. 

First  Winter  Session.—  Matriculation  (for  whole  year),  £1  ;  Anatomy, 
£4  4s. ;  Practical  Anatomy,  £3  3s. ;  Chemistry,  £4  4s.  ;  hospital,  £6  6s. 
(perpetual  ticket,  £12) ;  total,  £18  17s. 

Second  Summer  Session. — Botany  or  Natural  History,  if  not  attended 
previously  ;  Practical  Chemistry,  £3  3s.  ;  examination  m  Botany,  Natural 
History,  and  Chemistry,  in  October  following,  £5  5s.  ;  total,  £8  8s. 

Second  Winter  Session. — Matriculation,  £1 ;  Institutes  of  Medicine,  £4  4s.; 
Surgery,  £4  4s.  ;  hospital,  £6  6s. ;  examination  in  Botany,  Natural  History, 
and  Chemistry,  in  April,  if  not  previously  passed ;  total,  £15  14s. 

Third  Summer  Session.—  Practical  Pharmacy,  £3  3s.;  hospital;  total, 
£3  3s. 

Third  Winter  Session. — Matriculation,  £1 ;  Materia  Medica,  £4  4s.  ; 
Pathology,  £4  4s. ;  Clinical  Surgery,  £4  4s.  ;  hospital ;  examination  in 
Anatomy,  Physiology,  Materia  Medica,  Pathology,  in  April  or  July,  £5  5s. ; 
total,  £18  17s. 

Fourth  Summer  Session. — Medical  Jurisprudence,  £4  4s. ;  outdoor  dis¬ 
pensary,  £2  2s. ;  hospital  and  clinical  lectures;  total,  £6  6s. 


Medicai  Times  and  Gazette. 


SCOTTISH  SCHOOLS. 


Sept.  15, 1883.  315 


Fourth  Winter  Session. — Matriculation,  £1 ;  Practice  of  Medicine,  £4  4s.  ; 
Midwifery,  £4  4s.  ;  Practical  Midwifery,  £1  Is. ;  Clinical  Medicine.  £4  4s. ; 
Vaccination,  £1  Is. ;  outdoor  dispensary,  £1  Is.  :  hospital ;  total,  £16  15s. 

Fifth  Summer  Session. — Hospital;  final  examination  for  M.B.  and  C.M., 
£10  10s.  ;  total  minimum  expenses  for  M.B.  and  C.M.,  £107  18s. 

Only  one  course  of  instruction  on  each  subject  is  here  stated,  that  being 
the  minimum. 

Fees  for  Degrees. — Examination  in  Botany,  Chemistry,  chemical  testing, 
and  Natural  History,  £5  5s.  ;  examination  in  Anatomy,  Institutes  of 
Medicine,  Materia Medica,  Pathology,  £5  5s.  ;  final  examination  in  Surgery, 
Midwifery,  Practice  of  Physic,  Clinical  Medicine,  Clinical  Surgery,  Medical 
Jurisprudence,  and  prescriptions,  during  last  summer  session,  £10  10s.  ; 
registration  fee,  £1;  total  fees  for  M.B.  diploma,  £22.  Additional  fee  for 
M.D.  diploma,  £5  5s.  ;  Government  stamp-duty  (for  M.D.  only),  £10. 

Note. — Total  fees  and  stamp  for  graduating  as  M.D.  only,  by  regulations 
for  students  commencing  before  February,  1861,  £25 ;  registration,  £1. 

N.B. — The  above  fees  include  all  charges  for  the  diplomas. 

Further  information  as  to  the  classes,  courses  of  lectures, 
etc.,  may  be  obtained  on  application  to  Thomas  It.  Fraser, 
M.D.,  Dean  of  the  Faculty  of  Medicine ;  or  from  the  University 
Calendar,  published  by  James  Thin,  Edinburgh. 

The  new  buildings  intended  for  the  Faculty  of  Medicine  to 
the  University  are  now  sufficiently  advanced  to  admit  of  the 
departments  of  Chemistry  and  Materia  Medica  being  removed 
there  for  the  ensuing  winter  session,  in  addition  to  the  depart¬ 
ments  of  Anatomy,  Surgery,  Practice  of  Physic,  Midwifery, 
Physiology,  and  Pathology,  which  were  carried  on  there  during 
the  past  session. 

KOYAL  INFIRMARY,  EDINBURGH. 

For  information  apply  to  the  Secretary  to  the  Royal 
Infirmary. 


SCHOOL  OF  MEDICINE,  EDINBURGH. 

On  Monday,  October  1,  the  Practical  Anatomy  Rooms  and 
Chemical  Laboratories  will  be  opened.  The  courses  of  lec¬ 
tures  will  be  commenced — winter  session,  October  24  ;  summer 
session,  May  1. 

WINTER  SESSION. 


Anatomy  :  Practical  Anatomy, 
Course  of  Lectures,  Course  of  De¬ 
monstrations — Mr.  J.  Symington 
and  Mr.  Charles  W.  Cathcart. 

Chemistry ;  Lectures,  Practical 
Chemistry,  Analytical  Chemistry 
— Dr.  Stevenson  Macadam,  Mr. 
J.  Falconer  King,  Mr.  Ivison 
Macadam,  Dr.  Drinkwater,  and 
Mr.  Buchanan. 

Practice  of  Physic — Dr.  John  Wyllie, 
Dr.  J.  O.  Affleck,  and  Dr.  Byrom 
Bramwell. 

Pathology  and  Morbid  Anatomy — 
Dr.  J.  B.  Buist. 

Surgery — Mr.  Duncan,  Mr.  A.  G. 
Miller,  and  Dr.  C.  VV.  MacGillivray. 

Midwifery  and  Diseases  of  Women 
and  Children  —  Dr.  Charles  Beil 
and  Dr.  Peter  Young. 

Clinical  Medicine  (Royal  Infirmary) 
— Drs.  Claud  Muirhead,  Braken- 
ridge,  and  Wyllie,  Dr.  ADgus 
Macdonald  (Diseases  of  Women). 

Clinical  Surgery(Royal  Infirmary) — 
Mr.  Joseph  Bell. 


Institutes  of  Medicine  and  Practical 
Physiology — Dr.  James  and  Mr. 
James  Hunter. 

Medical  Jurisprudence  and  Public 
Health— Dr.  Littlejohn. 

Materia  Medica  and  Therapeutics — 
Dr.  Francis  W.  Moinet  and  Dr. 
William  Craig. 

Practical  Materia  Medica,  including 
Practical  Pharmacy  —  Dr.  Wo. 
Craig. 

Diseases  of  the  Ear  —  Dr.  Kirk 
Duncanson. 

Diseases  of  the  Eye  — Dr.  John 
Robertson. 

Vaccination  (Royal  Dispensary) — 
Dr.  Husband. 

Diseases  of  Children — Dr.  James 
Andrew  and  Dr.  Jas.  Carmichael. 

Pxactical  Midwifery — Dr.  Angus 
Macdonald  and  Dr.  Charles  Bell. 

Practical  Midwifery  and  Clinical 
Gynaecology — Dr.  Peter  Young. 

Practical  Gynaecology — Dr.  Halliday 
Croom  and  Dr.  David  Berry 
Hart. 


SUMMER  SESSION. 


Practical  Anatomy,  Course  of  De¬ 
monstrations — Mr.  J.  Symington 
and  Mr.  C.  W.  Cathcart. 

Practical  Chemistry,  Analytical  Che¬ 
mistry — Dr.  Stevenson  Macadam, 
Mr.  J.  Falconer  King,  Mr.  Ivison 
Macadam,  Dr.  Drinkwater,  and 
Mr.  Buchanan. 

Materia  Medica  and  Therapeutics — 
Dr.  Francis  W.  Moinet  and  Dr. 
William  Craig. 

Practical  Materia  Medica,  including 
Practical  Pharmacy  —  Dr.  W. 
Craig. 

Midwifery  and  Diseases  of  Women 
and  Children— Dr.  Angus  Mac¬ 
donald,  Dr.  Halliday  Croom,  Dr. 
Charles  Bell,  Dr.  Peter  Young, 
and  Dr.  David  Berry  Hart. 

Medical  Jurisprudence  and  Public 
Health— Dr.  Littlejohn. 

Practical  Physiology — Mr.  James 
Hunter. 

Practical  Pathology  —  Dr.  J.  B. 
Buist. 

Natural  History,  Zoology,  and  Com¬ 
parative  Anatomy— Dr.  Andrew 
Wilson. 


Clinical  Medicine  (Royal  Infirmary) 
— Drs.  Claud  Muirhead,  Braken- 
ridge,  and  Wyllie,  Dr.  Angus 
Macdonald  (Diseases  of  Women). 

Clinical  Surgery  (Royal  Infirmary) 
— Mr.  Joseph  Bell. 

Practical  Medicine  and  Diagnosis — 
Dr.  Byrom  Bramwell. 

Diseases  of  the  Bye— Dr.  J.  Robert¬ 
son  and  Mr.  George  Berry. 

Diseases  of  the  Ear — Dr.  Kirk 
Duncanson  and  Dr.  P.  McBride. 

Vaccination — Dr.  Husband. 

Diseases  of  Children— Dr.  James 
Andrew  and  Dr.  Jas.  Carmichael. 

Insanity — Dr.  J.  Batty  Tuke. 

Diseases  of  the  Skin — Dr.  Allan 
Jamieson. 

Practical  Surgery— Mr.  Duncam 

Operative  Surgery  and  Surgical 
Anatomy— Mr.  A.  G.  Miller  and 
Dr.  C.  W.  MacGillivray. 

Practical  Midwifery — Dr.  Charles 
Bell. 

Clinical  Gynaecology  and  Clinical 
Midwifery-  Dr.  Halliday  Croom. 

Practical  Midwifery  and  Clinical 
Gynajcology — Dr.  Peter  Young. 


The  lectures  qualify  for  the  University  of  Edinburgh  and 
the  other  Universities  ;  the  Royal  Colleges  of  Physicians  and 
Surgeons  of  Edinburgh,  London,  and  Dublin ;  and  the  other 
medical  and  public  Boards. 


FEES. 

For  a  first  course  of  lectures,  £3  5s. ;  for  a  second,  £2  4s. ; 
perpetual,  £5  5s.  To  those  who  have  already  attended  a  first 
course  in  Edinburgh  the  perpetual  fee  is  £2  4s.  Practical 
Anatomy  (six  months’  course),  £3  3s. ;  course  of  demonstra¬ 
tions,  £2  28.;  perpetual,  £4  4s.  Practical  Anatomy,  with 
course  of  demonstrations,  £4  4s.  Practical  Chemistry,  £3  3s. ; 
Analytical  Chemistry,  £2  a  month,  £5  for  three  months,  or  £10 
for  six  months.  Practical  Materia  Medica  (including  Practical 
Pharmacy),  Diseases  of  the  Ear,  Diseases  of  the  Skin,  and 
Diseases  of  Children,  each  £2  2s.  Vaccination,  £1  Is.  For 
summer  courses  of  Clinical  Surgery  and  Clinical  Medicine, 
each  £2  4s. ;  Practical  Anatomy  (including  anatomical  demon¬ 
strations),  Operative  Surgery,  and  Practical  Medicine  and 
Medical  Diagnosis,  each  £2  2s. ;  Insanity,  £1  Is. 

The  minimum  cost  of  the  education  in  this  School  of 
Medicine  for  the  double  qualification  of  Physician  and  Surgeon 
from  the  Royal  Colleges  of  Physicians  and  Surgeons,  including 
the  fees  for  the  joint  examination,  is  £95,  which  is  payable 
by  yearly  instalments  during  the  period  of  study ;  whilst  the 
minimum  cost  for  the  single  qualification  of  either  Physician 
or  Surgeon,  including  the  fee  for  examination,  is  £85. 


UNIVERSITY  OF  GLASGOW.— FACULTY  OF 
MEDICINE. 


LECTURES  AND  CLASSES. — WINTER  SESSION. 


Anatomy,  Junior;  Anatomy,  Se¬ 
nior  ;  Practical  Anatomy — Prof. 
Cleland  and  Demonstrators. 
Chemistry,  Chemical  Laboratory 
— Prof.  Ferguson. 

Clinical  Medicine — Prof.  McCall 
Anderson  and  Prof.  Gairdner. 
Clinical  Surgery  —  Prof.  George 
Buchanan  and  Prof.  Macleod. 


Materia  Medica — Prof.  Charteris. 
Midwifery — Prof.  Leishman. 
Pathology — The  Pathologists  cf  the 
Infirmaries. 

Physiology— Physiological  Labora¬ 
tory  :  Prof.  McKendrick. 

Practice  of  Physic — Prof.  Gairdner. 
Surgery — Prof  Macleod. 

Zoology — Professor  Young. 


SUMMER  SESSION. 


Botany,  Botanical  Demonstrations 
— Prof.  Bayley  Balfour. 

Clinical  Medicine — Prof.  McCall 
Anderson  and  Prof.  Gairdner. 

Clinical  Surgery — Prof.  Buchanan 
and  Prof.  Macleod. 

Embryology,  and  Demonstrations 
on  Anatomy,  Elementary  Ana¬ 
tomy,  Practical  Anatomy — Prof. 
Cleland  and  Demonstrators. 

Forensic  Medicine— Prof.  Simpson. 

Lectures  on  the  Eye — Dr.  T.  Reid. 


Operative  Surgery — Prof.  Macleod. 
Pract.  of  Medicine — Prof.  Gairdner. 
Practical  Chemistry,  Organic  Che¬ 
mistry,  Chemical  Laboratory — 
Prof.  Ferguson. 

Practical  Materia  Medica  —  Prof. 
Charteris. 

Practical  Physiology — Prof.  McKen¬ 
drick. 

Zoological  Laboratory — Prof.  Young. 
Diseases  of  Women— Prof.Leishman. 
Insanity — Dr.  Yellowlees. 


CLASS  FEES. 

Fee  for  each  course,  £3  3s.,  except  lectures  on  the  Eye, 
£1  Is.  ;  lectures  on  Insanity,  £2  2s. 

In  addition  to  the  University  courses,  the  following  Hos¬ 
pitals  and  Dispensaries  afford  ample  means  for  practical 
instruction  in  the  various  departments  of  Medicine  and 
Surgery :  — 

WESTERN  INFIRMARY. 


This  Hospital  contains  400  beds  for  medical  and  surgical 
patients,  with  wards  for  skin  diseases  and  for  diseases  of 
women. 


MEDICAL  AND  SURGICAL  STAFF. 


Physicians. 

Prof.  W.  T.  Gairdner. 

Prof.  T.  McCall  Anderson. 
Dr.  James  Finlayson. 

Dr.  Gavin  P.  Tennent. 


Surgeons. 

Prof.  George  H.  B.  Macleod. 
Prof.  George  Buchanan. 

Dr.  Alexander  Patterson. 

Dr.  Hector  O.  Cameron. 


Assistant-Physician— Dr.  Joseph  Coats. 

Diseases  of  Women — Prof.  W.  Leishman. 

Dispensary  Physicians — D.  O.  McVail,  M.  B.,  Dr.  8.  Gemmell,  and 
Dr.  James  Christie. 

Extra  Dispensary  Physician— Dr.  Wm.  G.  Dun. 

Dispensary  Surgeons — D.  N.  Knox,  M.B.,  J.  C.  Benton,  M.B.,  and 
Dr.  G.  J.  Beatson. 

Extra  Dispensary  Surgeons — Dr.  David  Newman  and  Dr.  A.  E.  Maylard. 
Pathologist — Dr.  Joseph  Coats.  _ 

Consulting  Physician- Accoucheur—  Professor  Leishman,  M.D. 
Outdoor  Physicians- Accoucheur — Dr.  Robert  Kirk,  Dr.  W.  L.  Reid,  and 
Dr.  Murdoch  Cameron. 

Dispensary  Surgeon  for  Diseases  of  the  Ear — Thomas  Barr,  M.D. 
Surgeon-Dentist— Mr.  James  Rankin  Brownlie,  L.D.S. 

Medical  Superintendent — Dr.  Alexander. 

Lady  Superintendent — Miss  E.  Clyde. 

Secretary — Henry  Johnston,  11,  Bothwell-street. 


The  hour  of  visit  is  9  a.m. 


FEES. 


The  fees  for  admission  to  the  practice  of  this  Infirmary  are 
— First  year,  £10  10s.;  second  year,  £10  10s. ;  afterwards 
free.  The  fees  for  clinical  lectures  are  included  in  the  fore¬ 
going. 


316 


Medical  Times  and  Gazette. 


SCOTTISH  SCHOOLS. 


Sept.  15, 1883. 


GLASGOW  ROYAL  INFIRMARY  SCHOOL  OF 
MEDICINE. 


The  winter  session  commences  on  October  30,  and  the 
summer  session  on  May  1.  Lectures  are  delivered  on  the 
subjects  necessary  for  qualifying,  and  extra  courses  are  given 
on  practical  subjects  now  required  by  examining  boards. 
During  summer,  lectures  on  Insanity  will  be  given  by  Dr. 
A.  Robertson,  Physician-Superintendent  of  the  City  Parochial 
Asylum. 

LE  CTURES. 


Anatomy — Mr.  H.  F.  Clark. 
Chemistry — Mr.  John  Clark,  Ph.D. 
Clinical  Medicine  and  Clinical  Sur¬ 
gery — The  Physicians  and  Sur¬ 
geons  of  the  Hospital. 

Dental  Surgery—  Dr.  J.  C.  Woodburn. 
Diseases  of  the  Bar — Dr.  Macfie. 
Diseases  of  the  Bye— Mr.  H.E.  Clark. 
Forensic  Medicine— Mr.  Glaister. 


Materia  Medica— Dr.  JohnDougall. 
Medicine— Dr.  J.  W.  Anderson. 
Mental  Diseases-  Dr.  A.  Robertson. 
Midwifery — Dr.  J.  Stirton. 
Pathology — Dr.  D.  Newman. 
Physiology— Dr.  Barlow. 

Practical  Physiology  <fe  Op.  Surgery 
— Dr.  Barlow  and  Dr.  Macewen. 
Surgery— Dr.  W.  Macewen. 


The  Royal  Infirmary  contains  532  beds.  Of  these  214  are 
for  medical  and  318  for  surgical  cases,  with  special  wards  for 
the  treatment  of  venereal  disease  in  males  and  diseases  of 
women.  Diseases  of  the  ear  and  throat  and  skin  are  specially 
treated  at  the  outdoor  department. 


MEDICAL  AND  SURGICAL  STAFF. 


Physicians. 

Dr.  Perry. 

Dr.  Maclaren. 

Dr.  Wood  Smith. 

Dr.  Charteris. 

Dr.  Scott  Orr. 

Physician  for  Diseases  of  Women. 
Dr.  Stirton. 

Surgeons. 

Dr.  Morton. 

Dr.  Macewen. 

Dr.  E.  Watson. 

Dr.  Dunlop. 

Mr.  Clark. 

Dispensary  Physicians. 

Dr.  J.  W.  Anderson. 

Dr.  Dougall. 

Extra  Dispensary  Physicians. 
Dr.  Middleton. 

Dr.  Henderson. 

Dr.  Campbell  Black. 

Dr.  Macphee. 


Dispensary  Surgeons. 

Dr.  Lothian. 

Dr.  Fleming. 

Extra  Dispensary  Surgeons. 
Dr.  Barlow. 

Dr.  Jas.  A.  Adams. 

Dr.  Muir. 

Dr.  Shaw. 

Vaccinator. 

Dr.  TannahilL 

Pathologist. 

Dr.  Newman. 

Diseases  of  the  Throat, 
Dr.  Eben  Watson. 

Diseases  of  the  Skin. 

Dr.  James  Provan. 

Aural  Surgeon. 

Dr.  Macfie. 

Dental  Surgeon. 

Dr.  J.  C.  Woodburn. 


APPOINTMENTS. 

There  are  five  Physicians’  and  five  Surgeons’  Assistants, 
who  are  boarded  and  lodged  in  the  Hospital  free  of  charge, 
and  who  perform  all  the  duties  of  House-Physicians  and 
House-Surgeons.  These  appointments  are  held  for  twelve 
months — six  in  the  medical,  and  six  in  the  surgical  wards — 
and  are  open  to  those  students  of  the  Infirmary  who  have 
completed  their  curriculum  and  passed  all  their  examinations 
except  the  last,  or  who  have  a  qualification  in  Medicine  or 
Surgery,  the  latter  being  preferred. 

Clinical  Clerks,  Dressers,  and  Dispensary  Clerks  are  selected 
from  the  students  without  any  additional  fee ;  and  from  the 
large  number  of  accident  cases  and  cases  of  acute  disease 
received  into  the  wards,  these  appointments  are  numerous, 
and  invaluable  to  the  student.  Attendance  at  the  Dispensary 
for  the  treatment  of  out-patients,  and  admission  to  the  Patho¬ 
logical  Museum,  also  free. 

FEES. 

For  each  course  of  lectures,  first  session,  £2  2s  ;  second 
■ditto,  and  perpetual,  £1  Is. 

The  Anatomy  Class  fees  are — first  session,  £4  4s. ;  second 
■ditto,  £4  4s. ;  afterwards,  £1  11s.  6d.  per  annum  for  Practical 
Anatomy ;  Practical  and  Systematic  Pathology,  £3  3s. 


HOSPITAL  FEE. 

The  fee  for  perpetual  attendance  on  the  practice  of  the 
Infirmary  and  on  the  courses  of  clinical  instruction  and 
lectures  is  £21. 

Prospectus  can  be  obtained  from  Dr.  Thomas,  the  Super¬ 
intendent  of  the  Hospital. 


ANDERSON’S  COLLEGE,  GLASGOW.— FACULTY  OF 

MEDICINE. 

The  winter  session  begins  on  Tuesday,  October  30,  1883, 
and  closes  on  Thursday,  March  27,  1884  ;  and  the  summer 
session  begins  on  the  first  Tuesday  of  May,  and  closes  about 
the  middle  of  July. 


WINTER  SESSION. 


Chemistry— Professor  Dittmar. 
Surgery— Professor  Dunlop. 

Junior  Anatomy,  Senior  Anatomy, 
Practical  Anatomy — Professor  A. 
M.  Buchanan  and  Demonstrator. 
Institutes  of  Medicine  (Physiology) 
h  Practical  Physiology — (vacant). 
Materia  Medica— Professor  Morton. 


Practice  of  Medicine — Professor 
Gemmell. 

Ophthalmic  Medicine  and  Surgery 
and  Clinical  Instruction  at  Oph¬ 
thalmic  institution — Dr.  J.  R. 
Wolfe. 

Dental  Mechanics  and  Metallurgy 
— Mr.  W.  S.  Woodburn,  L.D.S. 


SUMMER  SESSION. 


Operative  Surgery — Prof.  Dunlop. 

Surgical  Anatomy,  Dissection,  Os¬ 
teology — Prof.  A.  M.  Buchanan 
and  Demonstrator. 

Midwifery — Prof.  A.  Wallace. 

Ophthalmic  Medicine  and  Surgery 
and  Clinical  Instruction  at  Oph¬ 
thalmic  Institution — Dr.  J.  R. 
Wolfe.' 

Aural  Surgery — Dr.  Thomas  Barr. 


Dental  Anatomy — Dr.  David  Taylor, 
L.D.S. 

Dental  Surgery— Mr.  J.R. Brownlie, 
L.D.S. 

Medical  Jurisprudence — Professor 
Alex.  Lindsay. 

Public  Health  —  Dr.  J ames  Christie. 
Practical  Medical  Chemistry— Prof. 
Dittmar. 

Botany— Professor  Wilson. 


CLASS  FEES. 

For  each  of  the  above  courses  of  lectures  (Anatomy  and 
Dental  lectures  excepted),  first  session,  £2  2s. ;  second  session, 
£1  Is. ;  afterwards  free. 

Anatomy  Class  Fees. — First  session  (including  Practical  Ana¬ 
tomy),  £4  4s. ;  second  session  (including  Practical  Anatomy), 
£4  4s.;  third  session,  and  perpetual,  £1  Is.;  summer  fee 
(including  Practical  Anatomy), £1  11s.  6d. ;  Practical  Anatomy 
only,  £1  Is.;  Osteology,  £1  Is. 

Dental  Fees. — £2  2s.  each  course. 

Students  who  have  attended  classes  at  other  schools,  but 
who  desire  to  pursue  their  studies  at  Anderson’s  College,  will 
be  admitted  to  such  classes  as  they  may  have  attended  else¬ 
where  at  the  reduced  fees. 

Royal  Infirmary. — Fees. — Hospital  practice  and  clinical  in¬ 
struction,  first  year,  £10  10s. ;  second  year,  £10  10s. ;  after¬ 
wards  free.  Six  months,  £6  6s.  ;  three  months,  £4  4s. 
Vaccination  fee,  £1  Is. 

Dental  Hospital. — Fee  for  the  two  years’  hospital  practice 
required  by  the  curriculum  for  the  Dental  Licence,  £10  10s. 

Ophthalmic  Institution. — Students  of  Anderson’ s  College  are 
admitted  to  the  practice  of  this  Institution  on  paying  a  matri¬ 
culation  fee  of  5s. 

The  fees  for  all  the  lectures  and  hospital  practice  required 
of  candidates  for  the  diplomas  of  Physician  and  Surgeon 
amount  to  £48.  This  is  not  payable  in  one  sum,  but  students 
simply  fee  their  classes  as  they  take  them  out. 


UNIVERSITY  OF  ST.  ANDREWS. 

There  is  no  proper  Faculty  of  Medicine  in  this  University, 
but  it  is  possible  for  the  student  to  make  an  annus  medicus  by 
attendance  on  certain  of  the  courses — as  Natural  History, 
Professor  Nicholson,  M.D. ;  Chemistry,  Professor  Heddle, 
M.D. ;  and  Anatomy  and  Medicine,  Professor  Pettigrew,  M.D. 


UNIVERSITY  OF  ABERDEEN.— FACULTY  OF 
MEDICINE. 


LECTURES. — WINTER  SESSION. 


Anatomy— Professor  Strothers. 
Chemistry — Professor  Brazier. 
Institutes  of  Medicine— Professor 
W.  Stirling. 

Materia  Medica — Prof.  Davidson. 
Medical  Logic  and  Medical  Juris¬ 
prudence— Professor  M.  Hay. 
Midwifery  and  Diseases  of  Women 
and  Children — Prof.  Stephenson. 


Practical  Anatomy  and  Demonstra¬ 
tions — Professor  Strothers  and 
Assistants. 

Pathological  Anatomy  —  Professor 
Hamilton. 

Practice  of  Medicine  —  Professor 
Smith-Shand. 

Surgery — Professor  Alex.  Ogston. 
Natural  History— Prof.  Nicholson. 


SUMMER  SESSION. 


Botany — Professor  Trail. 

Practical  Pharmacy —Prof.  Davidson 
and  Assistant. 

Practical  Midwifery  and  Gynaeco¬ 
logy,  and  Clinical  Diseases  of 
Children — Professor  Stephenson. 

Practical  Chemistry — Prof.  Brazier. 

Practical  Anatomy  and  Demonstra¬ 
tions— Professor  Strothers  and 
Assistants. 


Practical  Pathological  Anatomy — 
Professor  Hamilton. 

Practical  Physiology  —  Professor 
Stirling. 

Natural  History— Professor  Nichol¬ 
son. 

Practical  Natural  History— Profes¬ 
sor  Nicholson. 

Operative  Surgery— Professor  Alex. 
Ogston. 


The  Anatomical  Course  in  summer  includes  instruction  in 
Histology  and  in  the  use  of  the  microscope ;  and  instruction 
in  Osteology  for  beginners. 

FEES. 

Matriculation  fee  (including  all  dues)  for  the  winter  and 
summer  session,  £1 ;  for  the  summer  session  alone,  10s. 

Practical  Ophthalmology,  Dr.  A.  D.  Davidson.  Practical 


Medical  Times  and  Gazette. 


IRISH  SCHOOLS. 


Sept.  15,  1883.  3  1  7 


Toxicology,  Dr.  F.  Ogston,  jun.  Dental  Surgery  (in  summer), 
Dr.  Williamson. 

The  regulations  relative  to  the  registration  of  students  of 
Medicine,  and  the  granting  of  degrees  in  Medicine  and  Sur¬ 
gery,  may  be  had  of  Professor  Brazier,  Dean  of  the  Faculty  of 
Medicine. 

Full  information  regarding  the  classes  and  degrees  in  the 
Faculties  of  Arts,  Law,  and  Divinity,  and  in  regard  to  Bur¬ 
saries  and  Scholarships,  will  be  found  in  the  University 
Calendar,  published  by  Messrs.  A.  King  and  Co.,  Upper  Kirk- 
gate,  Aberdeen,  by  post  2s.  2d. 


ABERDEEN  ROYAL  INFIRMARY. 

The  Aberdeen  Royal  Infirmary  contains  about  200  beds. 

MEDICAL  AND  SURGICAL  STAFF. 

Consulting  Physician — Dr.  A.  Harvey. 


Physicians. 

Dr.  J.  W.  F.  Smith-Shand. 
Dr.  R.  Beveridge. 

Dr.  Angus  Fraser. 

Resident  Assistant-Physician. 

David  R.  Mackinnon,  M.B.,  C.M. 


Surgeons. 

Mr.  A.  Ogston. 

Mr.  J.  O.  Will. 

Mr.  R.  J.  Garden. 

Mr.  John  Hall. 

Resident  Assistant-Surgeon. 
Jas.  Taylor,  M.B.,  C.M. 


Ophthalmic  Surgeon — Dr.  Alex.  D.  Davidson. 
Dental  Surgeon — Dr.  W.  H.  Williamson. 
Chloroformist — Dr.  P.  B.  Smith. 

Resident  Superintendent  and  Apothecary ~{v acant). 
Curator  of  Museum — Dr.  J.  Rodger. 
Treasurer  and  Secretary — Mr.  W.  Carnie. 


SCHOOLS  AND  HOSPITALS  IN  IRELAND. 


UNIVERSITY  OF  DUBLIN.— SCHOOL  OF  PHYSIC. 

The  School  of  Physic  is  under  the  conjoint  superintendence 
of  the  University  authorities  and  those  of  the  King  and 
Queen’s  College  of  Physicians. 


LECTURES  AND  CLASSES. 


Anatomy  and  Chirurgery — Vacant. 
Botany — Dr.  E.  Pereival  Wright. 
Chemistry— Dr.  J.  E.  Reynolds, 
F.R.S. 

Comparative  Anatomy — Vacant. 
Institutes  of  Medicine — Dr.  J.  M. 
Purser. 

Materia  Medica  and  Pharmacy — 
Dr.  Walter  G.  Smith. 

Midwifery — Dr.  J.  R.  Kirkpatrick. 


Medical  Jurisprudence— Dr.  Robert 
Travers. 

Natural  Philosophy— Mr.  Fitzgerald, 
F.T.C.D. 

Operative  Surgery — Dr.  Richard  G, 
Butcher. 

Practice  of  Medicine— Dr.  J.M.  Finny 
Surgery — Dr.  Edward  H.  Bennett. 
University  Anatomist— Dr.  Thomas 
E.  Little. 


Winter  Session,  1883-84. — The  winter  session  commences  on 
October  1.  Lectures  will  commence  on  November  1.  The 
dissecting-room  will  be  opened  on  October  1. 


SCHOLARSHIPS  AND  PRIZES. 

Two  Medical  Scholars  are  elected  annually,  by  the  Board  of  Trinity 
College,  at  an  examination  held  at  the  end  of  June— subject  to  conditions 
stated  in  the  College  Calendar.  Each  scholarship  is  worth  £20  per  annum, 
and  is  tenable  for  two  years. 

A  Travelling  Prize  in  Medicine  and  Surgery  is  offered  in  each  alternate 
year,  subject  to  certain  conditions ;  the  value  of  each  prize  is  £180.  Par¬ 
ticulars  may  be  obtained  from  the  Medical  Registrar. 

SIR  PATRICK  DUN’S  HOSPITAL. 


MEDICAL  AND  SURGICAL  STAFF. 

Consulting  Physician — Dr.  John  T.  Banks. 
Consulting  Surgeon — Dr.  W.  Colles. 


Clinical  Physicians. 
Dr.  JohnMalet  Purser. 
Dr.  W.  G.  Smith. 

Dr.  J.  Magee  Finny. 

Midwifery  Physician. 

Dr.  J.  R.  Kirkpatrick. 


Clinical  Surgeons. 

Dr.  Thomas  E.  Little. 

Dr.  Edward  H.  Bennett. 
Dr.  Charles  B.  Ball. 

Lecturer  in  Operative  Surgery. 
Mr.  Richard  G.  Butcher. 


Resident  Surgeon— Mr.  James  Chute. 


PEES. 

Clinical  Lectures  and  Hospital  Attendance. — The  payment  of 
£12  12s.  entitles  a  student  to  the  benefits  of  hospital  attendance 
and  clinical  teaching  for  the  winter  and  summer  sessions,  com¬ 
mencing  October  2.  Fee  for  winter  session  only,  £8  8s.;  fee 
for  summer  session  only,  £5  6s. 

Practical  Midwifery . — Students  desirous  of  entering  for  twelve 
months’  instruction  in  Practical  Midwifery  are  required  to  pay 
a  maternity  fee  of  £3  3s.  each.  Students  of  Trinity  College 
are  not  liable  to  any  other  payment  for  instruction  in  Prac¬ 
tical  Midwifery.  Other  students  are  required  to  pay  £3  3s. 
each  to  the  King’s  Professor  for  twelve  months’  practical 
instruction,  in  addition  to  the  Hospital  maternity  fee.  Students 
who  have  paid  the  Hospital  maternity  fee  are  entitled  to 
attend  the  demonstrations  in  Obstetric  Surgery  given  by  the 
King’s  Professor.  Total  fees  for  College  Students,  £3  3s.  ; 
total  fees  for  Extems,  £6  6s. 


PRIZES. 

Clinical  Medals. — The  Governors  of  the  Hospital  award  a  Silver  Clinical 
Medal  in  Medicine  to  the  student  who  shall  pass  the  best  examination  on 
the  medical  cases  treated  in  the  Hospital  daring  the  year ;  and  a  Silver 
Clinical  Medical  in  Surgery  to  the  student  who  shall  pass  the  best  exa¬ 
mination  on  the  surgical  cases  treated  in  the  Hospital  during  the  year. 


QUEEN’S  COLLEGE,  BELFAST. 


Anatomy  and  Physiology — Dr.  P. 
Redfern. 

Chemistry— Dr.  E.  A.  Letts. 
Materia  Medica — Dr.  J.  S.  Reid. 
Medical  Jurisprudence — Dr.  J.  F. 
Hodges. 

Midwifery — Dr.  R.  F.  Dill. 


Natural  Philosophy  —  Dr.  J.  D. 
Everett. 

Practice  of  Medicine— Dr.  James 
Cuming. 

Practice  of  Surgery— Dr.  A.  Gordon. 
Zoology  and  Botany — Dr.  R.  O. 
Cunningham. 


The  demonstrations  in  Anatomy  are  delivered  by  Dr. 
Anderson.  The  lectures  in  Midwifery,  six  months’  course, 
will  commence  on  February  1,  and  the  lectures  in  Medical 
Jurisprudence  and  the  courses  of  Botany  and  Practical 
Chemistry  will  commence  in  May. 


FEES. 

Anatomy  and  Physiology — First  course,  £3  ;  each  subsequent 
course,  £2.  Anatomical  Demonstrations  and  Practical  Anatomy 
— each  course,  £3.  Practical  Chemistry,  £3.  Other  medical 
lectures — first  course,  £2;  each  subsequent  course,  £1. 

SCHOLARSHIPS. 

Two  Medical  Scholarships  are  awarded  to  the  students  of  each  year  of 
the  medical  course.  The  examinations  commence  on  October  23. 


BELFAST  GENERAL  HOSPITAL. 

Clinical  Instruction — A  winter  session,  £5  5  s.  A  summer 
session,  £2  2s.  Perpetual  fee,  payable  in  one  sum  of  £10  10s.  ^ 
or  two  instalments  of  £5  5s.  each  on  entering  for  the  first  and 
second  years.  Hospital  fee,  10s.  6d.  each  winter  or  summer 
session. 

ULSTER  HOSPITAL  FOR  DISEASES  OF  WOMEN  AND  CHILDREN 
AND  MIDWIFERY  DISPENSARY,  11,  FISHER  WICK-PLACE. 

Fee  for  winter  six  months,  <£3  3s. 

BELFAST  LYING-IN  HOSPITAL. 

Fee  for  the  session,  £2  2s. 

BELFAST  DISTRICT  LUNATIC  ASYLUM. 

Fee  for  course,  <£3. 


QUEEN’S  COLLEGE,  CORK.— FACULTY  OF 
MEDICINE. 


LECTURERS. 


Anatomy  and  Physiology — Dr.  J.  J. 
Charles. 

Chemistry  and  Practical  Chemistry- 
— Dr.  Maxwell  Simpson. 

Materia  Medica — Dr.  M.  O’Keefe. 
Midwifery —  (vacant). 

Natural  Philosophy  —  Prof.  John 
England. 


Practical  Anatomy — The  Professor, 
assisted  by  Demonstrators. 
Practice  of  Medicine — Dr.  D.  C. 
O’Connor. 

Practice  of  Surgery — Dr.  Stephen 
O’Sullivan. 

Zoology  and  Botany— Professor  M. 
Hartog. 


SCHOLARSHIPS. 


Eight  Scholarships  are  awarded  to  students  in  Medicine,  if  qualified — 
viz. ,  two  scholarships  of  £25  each  to  students  commencing  their  first, 
second,  third,  and  fourth  years.  Clinical  Medicine  and  Surgery  at  the 
North  and  South  Infirmaries,  and  Clinical  Midwifery  at  the  Lying-in 
Hospital. 


QUEEN’S  COLLEGE,  GALWAY.— FACULTY  OF 
MEDICINE. 

LECTURERS. 


Anatomy  and  Physiology,  and  Prac¬ 
tical  Anatomy — Dr.  J.  P.  Pye. 

Botany  and  Zoology — Dr.  W.  King. 

Chemistry— Dr.  T.  H.  Rowney. 

Logie  and  Mental  Philosophy— Dr. 

T.  W.  Moffett. 

Materia  Medica— Dr.  N.  W.  Colahan. 

Practice  of  Surgery — Dr.  J.  V.  Browne. 

The  County  Galway  Infirmary,  Town,  and  Fever  Hospitals 
are  in  the  immediate  vicinity  of  the  Queen’s  College. 


Medical  Jurisprudence — Dr.  R  J. 
Kinkead. 

Midwifery  and  Diseases  of  Women 
and  Children— Dr.  R.  J.  Kinkead. 
Natural  Philosophy— Dr.  Joseph 
Larmor. 

Practice  of  Medicine — Dr.  John  I. 
Lynham. 


SCHOLARSHIPS  AND  EXHIBITIONS. 

Eight  Scholarships  of  the  value  of  £25  each,  and  Exhibitions  varying  in 
value  from  £12  to  £16,  are  appropriated  to  students  pursuing  the  course 
for  the  degree  of  M.D. 

FEES. 

Anatomy  and  Physiology,  £3  first  session  ;  afterwards  £2. 
Practical  Anatomy,  £3 ;  Practical  Chemistry,  £3 ;  Operative 
Surgery,  £3  ;  other  classes,  £1  for  each  course  extending  over 
one  term  only,  £2  for  each  coarse  extending  over  more  than 


318 


Medical  Times  and  Gazette. 


IRISH  SCHOOLS. 


Sept.  15,  1883. 


one  term,  and  £1  for  each  re-attendance  on  the  same. 
Hospitals,  £4  4s. 

For  further  information,  application  may  be  made  to 
Professor  Townsend,  M.A.,  D.Sc.,  Registrar. 


THE  ADELAIDE  MEDICAL  AND  SURGICAL 
HOSPITALS,  PETER-STREET,  DUBLIN. 


MEDICAL  AND  SURGICAL  STAFF. 


Physicians. 

Dr.  Henry  H.  Head. 
Dr.  Janies  Little 

Obstetric  Physician. 

Dr.  It.  D.  Purefoy. 

Assistant- Physician. 

Dr.  Wallace  Beatty. 

Further  particulars  can 
the  medical  staff. 


Surgeons. 

Mr.  John  K.  Barton. 

Mr.  Kendal  Franks 

Ophthalmic  Surgeon. 

Dr.  Rosborough  Swanzy. 

Dental  Surgeon. 

Dr.  R,  Theodore  Stack. 

be  obtained  from  any  member 


of 


DR.  STEEVENS’  HOSPITAL,  DUBLIN. 


MEDICAL  AND  SURGICAL  STAFF. 


Consulting  Physicians—  Dr.  H.  Freke  and  Dr.  Grimshaw. 
Consulting  Surgeons — Mr.  S.  G.  Wilmot  and  Sir  G.  H.  Porter. 


Physicians. 

Dr.  H.  J.  Tweedy. 
Dr.  R.  A.  Hayes. 

Obstetric  Physician. 
Dr.  A.  Duke. 


Siirgeons. 

Mr.  W.  Colies. 

Mr.  E.  Hamilton. 
Mr.  R.  M'Donnell. 

Resident  Surgeon. 

Mr.  T.  Myles. 


FEES. 


Hospital  Practice,  nine  months,  £12  12s. ;  ditto,  six  months, 
£8  8s. 

Further  particulars  may  he  learned  from  the  Resident 
Surgeon  at  the  Hospital ;  or  from  Dr.  R.  A.  Hayes,  Hon. 
Sec.,  32,  Merrion-square  South. 


ST.  VINCENT’S  HOSPITAL,  DUBLIN. 


Physicians. 

Dr.  Francis  J.  B.  Quinlan. 
Dr.  M.  F.  Cox. 


HOSPITAL  STAFF. 


Surgeons. 

Mr.  Edward  D.  Mapother. 
Mr.  J.  S.  McArdle. 


Gynaecologist — Dr.  J.  A.  Byrne. 
Ophthalmic  Surgeon— Mr.  Redmond. 
Surgeon-Dentist— Mr.  William  J.  Doherty. 
Souse-Surgeon — Mr.  D.  P.  Kenna. 
Apothecary — Mr.  C.  T.  Boland. 


FEES. 

Winter  and  summer  session,  £12  12s.;  separately,  £8  8s. 
and  £5  5s. 

Further  particulars  may  be  learned  ou  application  to  the 
Secretary  of  the  Medical  Board,  Dr.  Cox,  97,  Stephen’s-green 
S.,  Dublin,  or  at  the  Hospital  during  the  hours  of  attendance. 


JERVIS-STREET  HOSPITAL,  DUBLIN. 

MEDICAL  AND  SURGICAL  STAFF. 


Physicians. 

Dr.  Stephen  M.  MaeSwiney.  |  Dr.  William  Martin. 


Dr.  J.  Stannus  Hughes. 
Mr.  Austin  Meldon. 

Mr.  James  Edward  Kelly. 


Surgeons. 


Mr.  J.  V.  Lentaigne. 


Dr.  W.  Stoker. 

Dr.  J.  J.  Cianny. 

Dr.  Robert  MacDonnell. 


This  Hospital,  which  is  at  present  being  rebuilt  upon  an 
■extensive  scale,  is  most  central  in  situation.  From  its  proximity 
to  the  quays  and  principal  factories  it  presents  unrivalled 
opportunities  to  the  students  of  seeing  every  form  of  surgical 
injury.  An  extensive  Dispensary  for  out-door  patients  is 
attached  to  the  Hospital,  at  which  the  students  are  allowed  to 
perform  minor  operations,  under  the  guidance  of  the  Surgeon 
•on  duty,  and  are  rendered  familiar  with  the  details  of  dispensary 
practice. 

Instruction  is  given  by  the  Physician  and  Surgeon  on  duty 
on  alternate  mornings,  between  nine  and  eleven  o’clock,  at  the 
bedside,  when  the  nature,  progress,  and  treatment  of  each  case 
are  explained.  Two  clinical  lectures  are  delivered  each  week 
on  the  most  important  cases  under  treatment,  when  patho¬ 
logical  specimens  are  exhibited.  Surgical  instruments  and 
appliances  of  all  kinds  are  constantly  made  the  subject  of 
.special  instruction. 

Surgical  Operations  are  performed  on  Tuesday  mornings, 
at  ten  o’clock,  except  in  cases  of  emergency,  when  due  notice 
is  given,  if  possible. 

Practical  Pharmacy  is  taught  under  the  superintendence  of 
the  Apothecary. 


Resident  Pupils  and  Dressers  are  selected  from  among  the 
most  attentive  of  the  advanced  students,  without  payment  of 
any  additional  fee.  Two  Interns  are  appointed  each  half-year, 
and  are  provided  with  apartments,  etc.,  free  of  expense. 
Special  Certificates  are  given  to  the  Resident  Pupils  and 
Dressers  who  have  performed  their  respective  duties  to  the 
satisfaction  of  the  Physicians  and  Surgeons. 

Certificates  of  attendance  are  recognised  by  all  the  licensing 
bodies  and  examining  hoards  in  the  United  Kingdom. 


CARMICHAEL  SCHOOL  OF  MEDICINE,  DUBLIN. 

LECTURES. 


Surgery — Dr.  J.  K.  Barton  and  Dr. 
A.  H  Corley. 

Ophthalmic  Surgery— Dr. C.  E.  Fitz¬ 
gerald. 

Practical  Anatomy— Vacant. 
Systemic  Anatomy— Dr.  Francis  T. 
Heuston. 

Physiology — Mr.  J.  A.  Scott. 
Practice  of  Medicine— Dr.  Moore. 


Midwifery— Mr.  W.  B.  Jennings 
and  Mr.  A.  V.  Macan. 

Chemistry — Dr.  0.  R.  C.  Tichborne. 
Pathology — Dr.  S.  Woodhouse. 
Zoology  and  Botany— Dr.  W.  R. 
McNab 

Materia  Medica— Dr.  G.  F.  Duffey. 
Medical  Jurisprudence — Mr.  Hugh 
Auchinleck. 


SCHOLABSHIPS  AND  PEIZES. 

Prizes  to  the  value  of  £67  on  the  foundation  of  the  late  Richard 
Carmichael,  Esq.,  the  Mayne  Scholarship,  value  £15.  and  two  Carmichael 
Scholarships,  value  £15  and  £10  respectively  (a  second  prize  of  £5  being 
awarded  with  each  scholarship),  are  awarded  annually. 

For  further  particulars  apply  to  the  Registrar  at  the  School. 


CATHOLIC  UNIVERSITY  SCHOOL  OF  MEDICINE, 
CECILIA-STREET,  DUBLIN. 


LECTURES  AND  CLASSES. 


Anatomy  and  Physiology  —  Dr. 
Nixon  and  Dr.  Coppinger. 

Anatomical  Demonstrations  —  The 
Professors  of  Anatomy  and  Phy¬ 
siology. 

Practical  Histology— The  Professors 
of  Anatomy  and  Physiology. 

Botany— Dr.  Sigerson. 

Chemistry — Dr.  Campbell. 

Dissections  —  Messrs.  Redmond, 
McDonnell,  McCullagh,  McArdle, 
Chance,  and  O’Carroll. 

Materia  Medica — Dr.  Quinlan. 


Medical  Jurisprudence — Dr.  Mae¬ 
Swiney. 

Natural  Philosophy — The  Very  Rev. 
Dr.  Molloy. 

Pathology— Dr.  Lyons. 

Practical  Chemistry — Dr.  Campbell. 

Theory  and  Practice  of  Medicine— 
Dr.  Lyons. 

Theory  and  Practice  of  Midwifery — 
Dr.  Byrne 

Theory  and  Practice  of  Surgery — 
Mr.  Hayes. 

Ophthalmology — Dr.  D.  D.  Red¬ 
mond. 


FEES. 

For  each  course  £3  3s.,  excepting  Dissections  and  Practical 
Chemistry,  which  are  £5  5s.  Parents  and  guardians  are  re¬ 
commended  to  forward  all  fees  directly,  by  cheque  or  order, 
to  the  Registrar,  Professor  Campbell,  at  the  School. 

Further  particulars  may  he  learned  from  the  Secretary, 
Professor  Campbell.  _ 


CITY  OF  DUBLIN  HOSPITAL,  UPPER  BAGGOT- 

STREET. 

Consulting  Physicians— Dr.  James  Apjohn  and  Dr.  John  T.  Banks. 
Consulting  Surgeon — Mr.  Joliffe  T.  Tufnell. 

Physicians — Dr.  Hawtrey  Benson  and  Dr.  George  F.  Duffey. 
Surgeons — Mr.  Henry  Gray  Croly,  Mr.  William  I.  Wheeler,  and 
Dr.  Henry  Fitzgibbon. 

Ophthalmic  and  Aural  Surgeon— Vacant. 

Gynaecologist— Dr.  William  J.  Smyly. 

Fees. — Nine  months’  hospital  attendance,  £12  12s.;  six 
months,  £8  8s. ;  three  months,  £5  5s. 

For  further  particulars  apply  to  Mr.  Wheeler,  27,  Lower 
Fitz  william-street. 


MATER  MISERICORD LE  HOSPITAL,  ECCLES- 
STREET,  DUBLIN. 


MEDICAL  AND  SURGICAL  STAFF. 


Physicians. 

Dr.  Christopher  J.  Nixon. 
Dr.  Joseph  Redmond. 

Dr.  Michael  Boyd. 


Surgeons. 

Mr.  Patrick  J.  Hayes. 
Mr.  Charles  Coppinger. 
Mr.  Malachy  Kilgarriff. 


Assistant-Physician. 

Dr.  John  Murphy. 


Assistant- Surgeon. 
Mr.  Kennedy. 


Obstetric  Physician— Dr.  T.  M.  Madden. 
House-Surgeon — Mr.  Francis  J.  Cruise. 
Dental  Surgeon — Mi-.  D.  Corbett. 


This  Hospital  contains  250  beds,  including  fifty  beds  for 
fever  and  other  contagious  diseases. 

Certificates  of  attendance  upon  this  Hospital  are  recognised 
by  all  the  licensing  bodies  in  the  United  Kingdom. 


PEIZES. 

Two  Clinical  prizes  (the  “  Leonard  Prizes  ”)  of  £15  each,  one  medical 
and  one  surgical,  will  be  given  at  the  end  of  the  winter  session. 

Fee  for  nine  months,  £12  12s.;  six  winter  months,  £8  8s.; 
I  three  summer  months,  £5  5s. 


Medical  Times  and  Gazette. 


IRISH  SCHOOLS. 


Sept.  15, 1833.  319 


Further  particulars  may  be  learned  by  application  to  Mr. 
Hayes,  Secretary  to  the  Medical  Board,  18,  Merrion-square, 
or  to  any  of  the  other  medical  officers. 


MEATH  HOSPITAL  AND  COUNTY  DUBLIN 
INFIRMARY. 


MEDICAL  AND  SURGICAL  STAFF. 


Physicians. 

Dr.  Arthur  Wynne  Foot.  | 

Surgeons. 

Sir  George  H.  Porter. 

Mr.  James  H.  Wharton. 

Mr.  Philip  Crampton  Smyly. 


Dr.  John  William  Moore. 

Mr.  Rawdon  Macnamara. 
Mr.  Lambert  H.  Ormsby. 
Mr.  William  J.  Hepburn. 


The  ensuing  -winter  session  -will  commence  on  October  1, 
and  the  course  of  clinical  lectures  on  the  first  Monday  in 
November. 

Clinical  lectures,  of  -which  four  will  be  delivered  weekly, 
and  instructions  in  Medicine  and  Surgery,  will  be  given  on 
alternate  days. 

The  Physicians  and  Surgeons  on  duty  will  visit  the  Hospital 
at  9  a.m.,  so  as  to  allow  the  members  of  the  class  to  be  in 
attendance  at  their  respective  Schools  of  Medicine  at  1 1  a.m. 

The  Hospital,  which  contains  120  beds  for  the  reception  of 
medical  and  surgical  cases,  and  to  which  an  extensive  dis¬ 
pensary  (open  daily),  lending  library,  and  physical  laboratory 
are  attached,  is  within  a  few  minutes’  walk  of  the  University, 
the  Royal  College  of  Surgeons,  the  Carmichael  College  of 
Medicine  and  Surgery,  and  the  Ledwich  School  of  Medicine. 

An  additional  ward  has  been  erected  for  the  reception  of 
children,  in  which  the  pupils  will  have  an  opportunity  of 
studying  that  highly  important  subject — infantile  disease. 

Certificates  of  attendance  at  this  Hospital  are  recognised  by 
all  the  universities,  colleges,  and  licensing  bodies  in  the  United 
Kingdom. 

Prizes  will  be  given  at  the  termination  of  the  winter  course 
to  the  best  answerers  in  their  respective  classes. 

The  office  of  Resident  Pupil  is  open  to  pupils  as  well  as 
apprentices. 

Further  information  may  be  obtained  on  application  to 
Mr.  W.  J.  Hepburn,  Hon.  Sec.,  31,  Upper  Merrion-street, 
Dublin ;  or  at  the  Hospital. 


MERCER’S  HOSPITAL,  WILLIAM-STREET, 
DUBLIN. 

STAFF. 

Physicians — Dr.  T.  P.  Mason  and  Dr.  Charles  Frederick  Knight. 
Surgeons — Mr.  E.  8.  O’Grady,  Mr.  F.  Alcoek  Nixon,  and  Mr.  M.  A.  Ward. 

This  Hospital,  one  of  the  first  founded  in  Dublin,  is  situated 
in  a  central  position,  and  is  in  close  proximity  to  the  Schools 
of  the  Royal  College  of  Surgeons,  the  Carmichael  College  of 
Medicine  and  Surgery,  Catholic  University,  and  the  Ledwich. 

Fees  for  the  winter  and  summer  session  (nine  months) 
£12  12s. ;  for  the  six  winter  months,  £8  8s. ;  for  the  three 
summer  months,  £5  5s. 

Further  information  can  be  obtained  from  any  of  the 
medical  officers  of  the  Hospital,  or  from  Dr.  James  Shaw, 
Secretary  to  the  medical  staff. 


ROTUNDA  HOSPITALS,  RUTL AN D - S Q.UARE, 
DUBLIN. 

Master — Mr.  Arthur  V.  Macau. 

Consul  ting  Physician — Dr.  James  Little. 

Consulting  Surgeon — Dr.  William  Colles. 

Assistant- Physicians — Dr.  Richard  Henry  and  Mr.  John  Lilly  Lane. 

Pathologist— Dr.  G.  F.  Duffey. 

This  institution  consists  of  two  distinct  Hospitals,  namely, 
the  Lying-in  Hospital,  into  which  1200  labour  cases  are  on  au 
average  admitted  annually,  and  the  Auxiliary  Hospital,  set 
apart  for  the  reception  and  treatment  of  patients  suffering 
from  the  various  forms  of  uterine  and  ovarian  disease;  about 
500  patients  are  received  into  this  Hospital  during  each  year. 

There  is  also  in  connexion  with  the  Hospital  a  large  extern 
Maternity  (1500  patients  were  in  the  past  year  attended  at 
their  own  homes),  and  a  Dispensary  for  diseases  peculiar  to 
women,  which  is  open  daily. 

Pupils  are  admitted  to  the  practice  of  all  these  departments. 

Clinical  instruction  in  Midwifery  and  the  Diseases  of  Women 
is  given  daily,  and  lectures  are  delivered  regularly  during  the 
session  on  these  subjects. 

The  diploma  from  this  Hospital  is  granted  to  pupils  on 
their  passing  an  examination  before  the  Master  and  Assistants, 
after  a  period  of  six  months’  attendance  on  the  practice  of  the 


Hospital.  It  is  recognised  by  the  Local  Government  Board  as 
a  qualification  in  Midwifery  for  all  hospitals  and  dispensaries 
under  their  control.  _  T..~Z 

Accommodation  is  provided  for  a  limited  number  of^intera 
pupils.  Pupils  can  enter  at  any  time. 

TEEMS  OP  ATTENDANCE. 

Intern  pupils — For  six  months  £21,  three  months  £12  12s. r 
two  months  £9  9s.,  one  month  £6  6s.  Extern  pupils — For 
six  months  £10  10s.,  three  months  £6  6s. 

Application  to  be  made  to  the  Master  or  Assistant-Physi¬ 
cians,  at  the  Hospitals,  Rutland-square, Dublin. 


ROYAL  COLLEGE  OF  SURGEONS  IN  IRELAND. 
SCHOOL  OF  SURGERY. 


LECTURES. — WINTER  SESSION. 


Anatomy  and  Physiology — Professor 
Mapother. 

Systemic  and  Descriptive  Anatomy 
— Professor  Thornley  Stoker  and 
Professor  Cunningham. 

Chemistry — Professor  Cameron. 


Midwifery  and  Gynaecology— Pro¬ 
fessor  Roe. 

Surgery— Prof.  J.  Stannus  Hughes 
and  Professor  Stokes. 

Practice  of  Medicine  —  Professor 
A.  W.  Foot. 


SUMMER  SESSION. 


Materia  Medica — Prof.  Macnamara. 
Medical  Jurisprudence— Prof.  Davy. 
Botany — Professor  Minchin. 
Hygiene — Professor  Cameron. 


Practical  Chemistry  —  Professor 
Cameron. 

Ophthalmic  and  Aural  Surgery — 
Professor  Jacob. 


A  public  course  of  lectures  on  Comparative  Anatoiny  will 
be  delivered  by  the  Professor  of  Anatomy  and  Physiology,  at 
the  commencement  of  the  session,  and  additional  lectures  on 
the  same  subject  will  be  delivered  during  the  winter. 

The  dissections  are  under  the  direction  of  the  Professor  of. 
Anatomy,  assisted  by  the  demonstrators,  who  will  daily  attend 
to  give  instruction  and  to  assist  the  students. 

The  fee  for  each  course  of  lectures  is  £3  3s.,  excepting 
Descriptive  Anatomy,  which  is  £8  8s.,  Practical  Chemistry* 
which  is  £5  5s.,  and  Ophthalmic  and  Aural  Surgery  and 
Hygiene,  which  are  free. 


RICHMOND,  WHITWORTH,  AND  HARDWICKE 
HOSPITALS. 


MEDICAL  AND  SURGICAL  STAFF. 


Surgeons. 

Mr.  William  Stokes. 

Mr.  William  Thomson. 

Mr.  W.  Thornley  Stoker. 

Mr.  A.  Corley. 

Consulting  Obstetric  Surgeon — Dr.  Kidd. 

Assistant  Physician—  Dr.  Woodhouse. 

Ophthalmic  Surgeon — Dr.  A.  Jacob. 

Clinical  instruction  will  commence  on  October  1.  These 


Physicians. 

Dr.  J.  T.  Banks. 
Dr.  B.  G.  M'Dowel. 
Dr.  S.  Gordon. 

Dr.  R.  D.  Lyons. 


Hospitals  contain  312  beds— 110  for  surgical  cases,  82  for 
medical  cases,  and  120  for  fever  and  other  epidemic  diseases. 
Premiums  will  be  awarded  in  Clinical  Medicine  and  Surgery. 
The  Richmond  Institution  for  the  Insane,  containing  over 
1200  patients,  adjoins  these  Hospitals. 


FEES. 

For  the  winter  and  summer  session  (nine  months),  £12  12s.  ; 
for  the  six  winter  months,  £8  8s.  ;  for  the  three  summer 
months,  £5  5s.  Resident  clinical  clerks,  £21  for  the  winter 
session,  £15  15s.  for  the  summer  session,  including  certificate 
of  attendance. 


Apothecaries’  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday, 
September  6  : — 

Fisher,  Walter  Mulrea,  Angel-road,  Hammersmith. 

Hadley,  Wilfred  James,  Clapham  Common. 

Hart,  Arthur  Herbert,  The  Hall,  Harborne,  Staffordshire. 
Humphreys,  Charles  Evan,  Llanfair,  near  Welshpool. 

Linnell,  Edward,  Falmouth-road,  8.E. 

Praeger,  Emil  Arnold,  Walsworth-road,  Hitehin. 

The  following  gentleman  also  on  the  same  day  passed  the 
Primary  Professional  Examination  : — 

Taaffe,  John  Ferdinand  Hugh,  Mercer’s  Hospital,  Dublin. 


University  College,  London. — A  dinner  for  old  and 
present  students  of  the  Faculty  of  Medicine  will  be  held 
on  the  1st  of  October,  at  the  Freemasons’  Tavern,  Mr. 
Erichsen  will  preside,  and  there  will  doubtless  be  a  large 
gathering  on  the  occasion.  Dinner  tickets  may  be  had  of 
the  honorary  secretaries.  Dr.  Poore,  30,  Wimpole-street, 
or  Mr.  Stoneham,  28,  University-street,  W.C.  Application 
must  be  made  before  September  25. 


320  MediCai  Times  and  Gazette.  FEES  FOE  HOSPITAL  LECTURES  AND  ATTENDANCE.  Sept,  is,  issa. 


TABLE  OF  FEES  FOR  HOSPITAL  LECTURES  AND  ATTENDANCE. 


( The  letter  “i.”  denotes  Single  Course;  “ii.,”  Two  Courses,  Perpetual  or  Unlimited  Attendance.) 


St.  Bartholo¬ 
mew’s. * 

Charing 

Cross. 

St. 

George’s. 

Guv’s. 

King’s 

College. 

London. 

St. 

Mary’s. 

Middlesex. 

St. 

Thomas’s. 

Anatomy.  .  . 

i.  £9  9s. 

i.  £6  6s. 

i.  £7  7s. 

i.  £7  7s. 

i.  £9  9s. 

i.  £5  5s. 

i.  £7  17s.  6d. 

i.  £8  8s. 

i.  £7  7s. 

ii.  £13  2s.  6d. 

ii.  £8  18s.  6d. 

ii.  £12  12s. 
(inc.  Pr.  An.) 

ii.  £8  8s. 

ii.  £12  12s. 

ii.  £10  10s. 

Demonst.  and 

i.  £7  7s. 

1st  yr.  £4  4s. 

i.  £3  3s. 

i.  £7  7s. 

i.  £7  7s. 

i.  £5  5s. 

i.  £1  15s. 

i.  £6  6s. 

3  mos.  £4  4s. 

Dissections  . 

2nd  yr.  £3  3s. 

ii.  £8  8s. 

ii.  £8  8s. 

6  mos.  £6  6s. 

ii.  £10  10s. 

Theoret.  Physi- 

i.  £9  9s. 

i.  £6  6s. 

i.  £7  7s. 

i.  £7  7s. 

i.  £8  8s. 

i.  £4  4s. 

i.  £4  4s. 

i,  £6  6s. 

i.  £7  7s. 

ology 

ii.  £13  2s.  6d. 

ii.  £8  18s.  6d. 

ii.  £11  lls. 

ii.  £6  6s. 

ii.  £8  8s. 

ii.  £10  10s. 

Practical  Phy- 

i.  £7  7s. 

i.  £4  4s. 

i.  £3  3s. 

i.  £7  7s. 

i.  £6  6s. 

i.  £3  3s. 

i.  £4  4s. 

i.  £4  4s. 

i.  £6  6s. 

siology  .  . 

ii.  £8  8s. 

ii.  £4  4s. 

Histology  .  . 

i.  £2  12s.  6d. 

... 

i.  £3  3s. 

... 

... 

i.  £3  3s. 

... 

•  •• 

... 

Chemistry  .  . 

i.  £6  16s.  6d. 

i.  £5  5s. 

i.  £6  6s. 

i.  £7  7s. 

i.  £8  8s. 

i.  £7  7s. 

i.  £6  16s.  6d. 

i.  £6  6s. 

i.  £7  7s. 

ii.  £9  9s. 

ii.  £7  17s.  6d. 

ii.  £11  lls. 

ii.  £10  10s. 

ii.  £8  8s. 

ii.  £10  10s. 

Practical  Che- 

i.  £3  3s. 

i.  £4  4s. 

i.  £4  4s. 

i.  £7  7s. 

i.  £6  6s. 

i.  £2  2s.,  or 

i.  £4  4s. 

i.  £3  3s. 

i.  £6  6s. 

mistry 

ii.  £8  8s. 

£5  5s. 

Botany  .  .  . 

i.  £4  4s. 

i.  £3  3s. 

i.  £3  13s.  6d. 

i.  £5  5s. 

i.  £4  4s. 

i.  £3  3s. 

i.  £4  4s. 

i.  £4  4sJ 

i.  £4  4s. 

ii.  £5  5s. 

ii.  £4  14s.  6d. 

ii.  £6  6s. 

ii.  £4  4s. 

ii.  £5  5sJ 

ii.  £5  5s. 

Com.  Anatomy 

i.  £2  12s.  6d. 

i.  £3  3s. 

£4  4s. 

i.  £5  5s. 

i.  £4  4s. 

i.  £3  3s. 

i.  £2  12s.  6d. 

i.  £3  3s. 

i.  £4  4s. 

ii.  £4  4s. 

ii.  £6  6s. 

ii.  £4  4s. 

ii.  £5  5s. 

Medicine.  .  . 

i.  £6  16s.  6d. 

i.  £6  6s. 

i.  £7  7s. 

i.  £7  7s. 

i.  £8  8s. 

i.  £5  5s. 

i.  £5  5s. 

i.  £6  6s. 

i.  £7  7s. 

ii.  £9  9s. 

ii.  £8  18s.  6d. 

ii.  £9  9s. 

ii.  £6  6s. 

ii.  £8  8s. 

ii.  £10  10s. 

Practical  Med. 

... 

i.  £2  2s. 

i.  £4  4s. 

... 

... 

... 

... 

... 

Surgery  .  .  . 

i.  £6  16s.  6d. 

i.  £6  6s. 

i.  £7  7s. 

i.  £7  7s. 

i.  £8  8s. 

i.  £5  5s. 

.  £5  5s. 

i.  £6  6s. 

i.  £7  7s. 

ii.  £9  9s. 

ii.  £8  18s.  6d. 

ii.  £9  9s. 

ii.  £6  6s. 

ii.  £8  8s. 

ii.  £10  lCs. 

Practical  Sur- 

i.  £6  16s.  6d. 

i.  £2  2s. 

i.  £4  4s. 

i.  (Op.)  £5  5s. 

i.  £3  3s. 

i.  £3  3s. 

i.  £4  4s. 

i.  £6  6s. 

i.  £6  6s. 

gery 

ii.  £9  9s. 

(Prac.)  £4  4s. 

ii.  £5  5s. 

Operative  Surg. 

i.  £3  3s. 

... 

i.  £2  2s. 

... 

... 

i.  £3  3s. 

i."£5  5s. 

i.  £5  5s. 

Midwifery  .  . 

i.  £6  16s.  6d. 

i.  £3  3s. 

i.  £4  14s.  6d. 

i.  £7  7s. 

i.  £5  5s. 

i.  £4  4s. 

i.  £5  5s. 

i.  £4  4s. 

i.  £5  5s. 

ii.  £7  17s.  6d. 

ii.  £5  15s.  6d. 

ii.  £6  6s. 

ii.  £6  6s. 

ii.  £5  5s. 

ii.  £6  6s. 

Pathology  .  . 

i.  £2  12s.  6d. 

i.  £3  3s. 

i.  £3  3s. 

i.(Dem.)£7  7s. 

i.  £3  3s. 

i.  £3  3s. 

i.  £4  4s. 

i.  £4  4s. 

i.  £4  4s. 

ii.  £4  4s. 

(Lect.)  £3  3s. 

ii.  £4  4s. 

ii.  £5  5s. 

ii.  £5  5s. 

Materia  Medica 

i.  £6  16s.  6d. 

i.  £3  3s. 

i.  £4  14s.  6d. 

i.  £5  5s. 

i.  £5  5s. 

i.  £3  3s. 

i.  £5  5s. 

i.  £4  4s. 

i.  £4  4s. 

ii.  £7  17s.  6d. 

ii.  £5  15s.  6d. 

ii.  £6  6s. 

ii.  £4  4s. 

ii.  £5  5s. 

ii.  £5  5s. 

Forensic  Medi- 

i.  £4  4s. 

i.  £3  3s. 

i.  £4  14s.  6d. 

i.  £5  5s. 

i.  £5  5s. 

i.  £3  3s. 

i.  £4  4s. 

i.  £4  4s. 

i.  £4  4s. 

cine 

ii.  £5  6s. 

ii.  £5  15s.  6d. 

ii.  £6  6s. 

ii.  £4  4s. 

ii.  £5  5s. 

ii.  £5  5s. 

Public  Health  . 

i.  £2  12s.  6d. 

••t 

i.  £3  3s. 

i.  £1  Is. 

i.  £3  3s. 

... 

i.  £3  3s. 

i.  £2  2s. 

ii.  £4  4s. 

ii.  £3  3s. 

Onhth.  Surgery 

i.  £2  12s.  6d. 

••• 

i.  £2  2s. 

i.  £2  12s.  6d. 

•». 

i.  £2  2s. 

ii.  £4  4s. 

ii.  £3  3s. 

ii.  £3  3s. 

Dental  Surgery 

i.  £2  12s.  6d. 

... 

£2  2s. 

i.  £2  12s.  6d. 

i.  £2  2s. 

ii.  £4  4s. 

ii.  £3  3s. 

Mental  Dis.  . 

i.  £2  12s.  6d. 

i.  £3  3s. 

i.  £3  3s. 

i.  £2  2s. 

ii.  £4  4s. 

Bach  winter. 

ii.  £3  3s. 

Library  .  .  . 

1  year,  10s. 

£1  Is. 

10s.  6d. 

... 

£1  Is. 

£1  Is. 

£1  Is. 

£1  Is. 

Comp,  fee  £2 

Hospital  Prac- 

Medical. 

Med.  or  Surg. 

Medical. 

Med.  or  Surg. 

Med.  or  Surg. 

Perp.  £52  10s. 

Medical. 

Med.  or  Surg. 

Med.  and  Surg. 

tice 

3  mos.  £10 10s. 

3  mos.  £6  6s. 

1  yr.  £10 10s. 

3  mos.  £10 10s. 

1  sum.  £5  5s. 

6  mo.  £5  6s. 

Perp.  £15  15s. 

3  mos.  £15 

6  mos.  £15 15s. 

6  mos.  £10 10s. 

2  yrs.  £21 

6  mos.  £15 15s, 

1  win.  £9  9s. 

6  mos.  t£lO  10/ 
12  „  *£1515/ 
Unlim.  J£26  5/ 

Surgica  l. 

12mo.  £10 10s. 

1  yr.  £8  8s. 

6  mos.  £26 

2yrs.£2312s.  6d. 

12  mo.  £15 15s. 

Perp.  £31 10s. 

1  yr.  £24  3s. 

1  yr.  £12  12s. 

Unlim.  £21 

6  mos.  £5  5s. 

9  mos.  £35 

Unlimited, 

Full  period  £21 

Perp.  £31 10s. 

Perp.  £31 10s. 

12  mos.  £40 

£33  Is  6d. 

Surgical. 

Surgical. 

Med.  and  Surg. 

Perp.  £55 

Surgical. 

Med.  and  Surg. 
3  mos.  £10 10s. 

1  yr.  £10  10s. 

2  yrs.  £21 

Med.  and  Surg. 
3  mos.  £15 15s. 

Med .  and  Surg. 
1  sum.  £8  8s. 

6 mos.  §£10  10/ 
12  „  ||  £15 15/ 
18  „  1£21 
Unlim. H £26  5/ 

6  mo.  £5  5s. 

12  mo.  £10 10s. 
Unlim.  £21 

Perp.  £26  5s., 
or  £10  10s.  at 

3  mos.  £13  2s.  6d. 

6  mos.  £15 15s. 

Perp.  £31  10s. 

6  mos.  £24  3s. 

1  win.  £14  14s. 

beginning  of 

6  mos.  £19 19s. 

12  mos.  £21 

1  yr.  £31  10s. 

1  yr.  £18  18s. 

1st  and  2nd 

12  mos.  £26  5s. 

Full  period, 

Perp.  £47  6s. 

Perp.  £42 

Obstetric. 

Med.  and  Surg. 

years,  and 

Unlimited, 

£31 10s. 

1  year  £4  4/ 

6  mos.  £8  8s. 

£5  5s.  each 

£33  Is.  6d. 

Incl.  Lee.  £6  6/ 

12  mo.  £15  16s 

subsequenl 

Unlim.£3615s. 

year. 

Gen.  fee  £10 10/ 

6  mos.  £7  7s. 

*  No  return.  t  Including  three  months’ Clinical  Clerkship.  t  Including  six  months’ Clinical  Clerkship. 

\  Including  three  months'  Dressership.  ||  Including  six  months’  Dressership.  ‘f  Including  nine  months’  Dressership. 


We  have  endeavoured  to  make  this  table  as  complete  and  correct  as  possible,  but  from  imperfect  returns  and  deficient 
information,  perfect  accuracy  cannot  be  vouched  for.  > 

Many  classes  which  to  outside  students  are  chargeable  in  heavy  sums  are  gratuitous  to  the  regular  students  of  the 
various  schools. 

Totals  cannot  here  be  given  for  the  same  reason,  and  because  many  classes  are  extra. 

Information  as  to  the  mode  of  paying  fees,  and  their  amount,  is  appended  to  the  notice  of  each  school. 


Medical  Times  and  Gazette. 


FEES  FOR  HOSPITAL  LECTURES  AND  ATTENDANCE. 


Sept.  15,  1S83.  321 


TABLE  OF  FEES  FOR  HOSPITAL  LECTURES  AND  ATTENDANCE. 


( The  letter  “  i.”  denotes  Single  Course ;  “  ii.,”  Two  Courses,  Perpetual  or  Unlimited  Attendance!) 


University 

College. 

Westminster. 

Owens  Coll., 
Manchester. 

Queen’s  Coll. 
Birmingham.* 

Leeds. 

Liverpool. 

Bristol.* 

Newcastle. 

Sheffield. 

Anatomy  .  . 

Demonst.  and 
Dissections 

(  i.  £11 11s.  ' 
l  ii.  with  3  1 
<  yrs.  Pract.  > 

1  Anatomy,  l 

V  £16  16s.  ) 

1st  c.  £7  7s. 
subs.  c.  £2 2s. 

3  mos.  £5  5s. 

6  mos.  £8  8s. 

i.  £5  5s. 

6  mos.  £3  3s. 

3  mos.  £2  2s. 

i.  £6  6s. 

i.  £5  5s. 

i.  £6  6s. 

2cs.  ea.  £5 5s.; 
3,  £2  12s.  6d. 

i.  £3  3s. 

i.  £5  5s. 

ii.  £8  8s. 

i.  £5  5s. 

1  c.  £4  4s. 

2  C.  £2  2s. 

Inc.  in  above  * 

Physiology  .  . 

Practical  Phy¬ 
siology 

i.  £8  8s. 

ii.  £10  10s. 

i.  £8  8s. 
add.  c.  £2  2s. 

1st  c.  £6  6s. 
subs.  c.  £2  2s. 

c.  £7  7s.;  either 
division,  £3  3s. 

i.  £5  6s. 

i.  £5  6s. 

i.  £6  6s. 

i.  £6  6s. 

i.  £6  6s. 

1  &  2  cs.  each 
£5  6s. ; 

3,  £2  12s.  6d. 

i.  £5  5s. 

ii.  £8  8s. 

i.  £3  3s. 

ii.  £5  5s. 

i.  £5  5s. 

1  c.  £3  3s. 

2  c.  £2  2s. 

i.  £3  3s. 

Chemistry  .  . 

i.  £7  7s. 

ii.  £9  9s. 

1st  c.  £6  6s. 
subs.  cs.  £2  2s. 

i.  £3  10s. 

Org.  i.  £3  10s. 

i.  £5  6s. 

i.  £4  4s. 

1  c.  £5  5s. ; 
2  and  3,  each 
£2  12s.  6d. 

i.  £5  5s. 

ii.  £7  7s. 

i.  £5  5s. 

#•* 

Practical  Che¬ 
mistry 

i.  £5  5s. 
sec.  c.  £3  3s. 

1  c.  £4  4s. 

i.  £4  4s. 

i.  £4  4s. 

i.  £3  3s. 

i.  £4  4s. 

i.  £3  3s. 

ii.  £5  5s. 

... 

i.  £3  3s. 

Botany  .  .  . 

i.  £3  13s.  9d. 

ii.  £5  5s. 

1  c.  £4  4s. 

2  cs.  £5  5s. 

i.  £2  12s.  6d. 

i.  £4  4s. 

i.  £4  4s. 

1  c.  £4  4s.  ; 
2  and  3,  each 
£2  2s. 

i.  £3  3s. 
ii.  £5  5s. 

i.  £5  5s. 

i.  £3  3s. 

Com.  Anatomy 

i.  £6  6s. 

ii.  £8  8s. 

1  e.  £3  3s. 

2  cs.  £5  5s. 

i.  £2  12s.  6d. 

i.  £3  3s. 

i.  £1  Is. 

£2  per  term ; 
£3  the  course 

i.  £4  4s. 

... 

... 

Medicine  .  . 

i.  £9  9s. 

ii.  £11  11s. 

1st  c.  £6  6s. 
subs.  c.  £2  2s. 

L  £5  5s. 

i.  £6  6s. 

i.  £5  5s. 

1  and  2  c.  each 
£5  5s. ; 

3,  £2  12s.  6d. 

i.  £5  5s. 

ii.  £8  8s. 

i.  £5  5s, 

1  c.  £4  4s. 

2  c.  £2  2s, 

Surgery  .  .  . 

i.  £7  7s. 

ii.  £8  8s. 

1st  c.  £6  6s. 
subs.  c.  £2  2s. 

i.  £5  5s. 

i.  £6  6s. 

i.  £5  5s. 

1  c.  £5  5s. 
2&3,ea.£l  Is. 

i.  £5  5s. 

ii.  £8  8s. 

i.  £5  5s. 

i.  £4  4s. 

Practical  Sur¬ 
gery 

i.  £6  6s. 
sec.  c.  £4  4s. 

1st  c.  £3  3s. 
subs.  c.  £2  2s. 

i.  £4  4s. 

... 

... 

1  c.  £4  4s.; 
2&3,  £2  2s. 

i.  £4  4s. 

ii.  £6  6s. 

... 

i.  £3  3s. 

Surgical  Path.  . 

... 

... 

i.  £4  4s. 

... 

... 

... 

... 

... 

... 

Operative  Surg. 

i.  £5  5s. 

... 

i.  £4  4s. 

... 

... 

... 

... 

... 

Midwifery  .  . 

i.  £6  6s. 

ii.  £7  7s. 

1  c.  £4  4s. 

2  cs.  £5  5s. 

i.  £4  4s. 

ii.  £5  5s. 

i.  £5  5s. 

i.  £4  4s. 

le.£55s.;2&3, 
ea.  £2 12s.  6d. 

i.  £4  4s. 

ii.  £6  6s. 

i.  £5  5s. 

i.  £3  3s, 

Pathology  .  . 

i.  £6  6s. 

ii.  £7  7s. 

1  c.  £3  3s. 

2  cs.  £4  4s. 

i.  £4  4s. 

... 

i.  £3  3s. 

1  c.  £3  3s.  ;  2 
and  3,  each 
£1  11s.  6d. 

i.  £3  3s. 

ii.  £4  4s. 

i.  £5  5s. 

Materia  Medica 

i.  £6  6s. 

ii.  £7  7s. 

1  c.  £3  3s. 

2  cs.  £4  4s. 

i.  £4  4s. 

i.  £4  4s. 

i.  £4  4s. 

le.£44s.;2&3, 
each  £2  2s. 

i.  £4  4s. 

ii.  £5  5s. 

i.  £5  5s. 

i.  £3  3s, 

Pharmacy  .  . 

... 

... 

i.  £3  3s. 

... 

... 

... 

... 

... 

Forensic  Medi¬ 
cine 

i.  £5  5s. 

ii.  £6  6s. 

1  c.  £3  3s. 

2  cs.  £4  4s. 

... 

i.  £4  4s. 

i.  £4  4s. 

lc.£44s.;2&3, 
each  £2  2s. 

i.  £3  3s. 

ii.  £5  5s. 

i.  £5  5s. 

i.  £3  3s. 

Med.  Juris,  and 
Hygiene 
Ophth.  Surgery 

i.  £2  2s. 

1  c.  £1  Is. 

i.  £4  4s. 

i.  £3  3s. 

i.  £3  3s. 

... 

1  c.  £1  is. 

... 

•  •• 

Dental  Surgery 

... 

1  c.  £2  2s. 

... 

i.  £3  3s. 

... 

1  c.  £3  3s. 

... 

... 

... 

Mental  Dis. 
Public  Health  . 
Library  .  .  . 

i.  £2  2s, 

1  c.  £1  Is. 

£1  is. 

i.  £1  11s.  6d. 

... 

£1  Is’." 

i.  10s.  6d. 

ii.  £1  Is. 

£1  Is.’ 

;;; 

... 

Hospital  Prac¬ 
tice 

Med.  and  Surg. 
Perp.  £36  16s. 

1  yr.  £21 

Med.  or  Surg. 
3  mos.  £6  6s. 

6  mos.  £10 10s. 
Each  subseqnt 
6  mos.  £5  5s. 

3  yrs.  £24  3s. 

Med.  and  Surg. 
3  mos.  £10  10s. 
6  mos.  £14  14s. 
Each  subseqnt 
6 mos.  £7  7s. 

3  yrs.  £36 15s. 

Royal  Infirm. 
Full  per.  £42 ; 
or  2  instal¬ 
ments,  £22 

Medical. 

3  mos.  £4  4s. 

6  mos.  £8  8s. 
12  mo.  £12 12s. 
Full  period, 

£18  18s. 

Surgical. 

3  mos.  £6  6s. 

6  mos.  £9  9s. 

12  mo.  £18 18s 
FuUp.  £31 10s. 

General  and 
Queen’s 
Hospitals. 

4  yrs.  £42,  or 
in  two  equal 
sums 

1  yr.  £21 

6  mos.  £14 

Infirmary . 
Med.  or  Surg. 

1  win.  £7  7s. 

1  sum.  £6  6s. 
12  mo.  £12 12s. 
18  mo.  £15 15s. 
3  yrs.  £21 
Perp.  £26  15s. 

1 

Royal  Infirm. 
Perp.  £42 

Medical. 

3  mos.  £3  15s. 
6  mos.  £6  6s. 
12  mos.  £7  7s. 

Surgical. 

3  mos.  £5  5s. 

6  mos.  £7  7s. 
12  mo.  £10 

Royal  Infirm. 

Medical. 

6  mos.  £8 

1  yr.  £15 

18  mos.  £20 
Perp.  £20 

Surgical. 

1  yr.  £12  12s. 

2  yrs.  £21 

3  yrs.  £26  6s. 

General  IIos. 
Med.  or  Surg. 
6  mos.  £6 

12  mos.  £10 
Perp.  £26 

Infirmary. 

3  mos.  £5  5s. 

{6  mos.  £8  8s. 

12  mo.  £12 12s. 

Perp.  £26  5s. ; 
or  1st  year 
£12  12s.,  2nd 
yr.  £10  10s., 
3rd  yr.  £6  6s.; 
or  1st  year 
£1414s.,  2nd 
year  £12  12s. 

Gen.  Infirm., 
or  Public  Hos. 
sum.  ses.  £3  3s. 
win.  ses.  £6  6s, 

*  No  returns  have  this  year  been  received  from  these  institutions. 


We  have  endeavoured  to  make  this  table  as  complete  and  correct  as  possible,  but  from  imperfect  returns  and  deficient 
information,  perfect  accuracy  cannot  be  vouched  for. 

Many  classes  which  to  outside  students  are  chargeable  in  heavy  sums  are  gratuitous  to  the  regular  students  of  the 
various  schools. 

Totals  cannot  here  be  given  for  the  same  reason,  and  because  many  classes  are  extra. 

Information  as  to  the  mode  of  paying  fees,  and  their  amount,  is  appended  to  the  notice  of  each  school. 


322 


Medical  Times  and  Gazette. 


ADVICE  TO  STUDENTS. 


Sept.  15, 1S83. 


ADVICE  TO  STUDENTS. 

A  certain  distinguished  living  Professor,  when  ashed 
whether  he  would  not  desire  to  inaugurate  a  new  session  of 
medical  study  with  an  introductory  lecture,  replied  that  he 
had  nothing  to  say  by  way  of  introduction  to  those  entering 
the  profession  that  could  not  be  expressed  by  the  three 
words,  “  You  must  work.”  Work,  and  nothing  but  work, 
can  pave  the  way  to  success  in  the  profession ;  and  although 
success  may,  through  circumstances,  be  denied  to  some  of 
those  who  have  worked,  on  the  other  hand  failure  is 
absolutely  certain  to  those  who  have  idled. 

The  prospect,  therefore,  is  at  the  outset  clearly  to  be 
scanned  by  all  who  propose  to  climb  the  hill  of  medical 
•study  with  a  view  to  reaching  the  goal  of  success  at  its 
•summit,  and,  difficult  as  the  ascent  appears,  we  have  the 
disturbing  thought  in  addition  that  the  amount  of  labour 
required  to  accomplish  it  is  ever  tending  to  increase,  whilst 
the  allotted  time  remains  as  short  as  ever. 

Let  it  then  be  clearly  understood  by  all  aspirants  for  success 
in  Medicine  that  work,  and  work  alone,  can  bring  about  fulfil¬ 
ment  of  their  desire.  But,  with  this  understanding  at  the  out¬ 
set,  we  have  to  consider  in  what  way  the  work  may  best  be 
directed  so  as  to  produce  the  best  results  in  the  short  four 
years  that  are  allowed  for  preparation  for  the  great  event 
■of  his  life,  which  converts  the  irresponsible  boy  into  the 
responsible  man,  the  medical  student  into  the  qualified 
student  of  Medicine,  viz.,  the  passing  of  bis  qualifying 
•examination.  In  most  of  the  too  numerous  schools  of  Medi¬ 
cine,  prospectuses  containing  advice  to  junior  and  senior 
students  are  published,  which  supply  them  with  all  the 
details  of  work  that  the  customs  of  the  various  hospitals 
have  established ;  and  in  every  instance  they  may  with 
safety  abide  by  the  directions  and  advice  contained  therein. 
Thus,  the  commencing  student  will  find  out  when  it  is  that 
the  various  courses  of  study,  lectures,  demonstrations, 
practical  work,  etc.,  may  best  be  undertaken,  and  in  what 
•order.  Up  to  a  certain  point  in  his  course  of  medi¬ 
cal  study  he  must  go  through  a  definite  course  of  in¬ 
struction,  be  his  special  inclinations  what  they  may. 
His  difficulty,  however,  is  to  distinguish  the  wheat  in 
such  a  course  from  the  chaff,  to  separate  in  his  mind  the 
'fact  which  he  must  learn  and  know  from  the  illustration  or 
•experiment  employed  to  convey  it.  As  he  advances  in  his 
study  he  will  learn  to  his  cost  that  unless  he  can  so  distin¬ 
guish  and  separate  he  will  find  himself  compelled  to  go  over 
and  over  again  the  weary  round  of  which  he  had  thought 
himself  complete  master,  and  so  be  occupying  with  this  re- 
•capitulation  the  very  time  in  which  he  should  be  employing 
his  previous  knowledge  and  experience  to  gain  still  more. 
Unfortunately,  until  they  come  to  be  combined  with  higher 
and  wider  knowledge,  the  cardinal  facts  of  Chemistry,  Ana¬ 
tomy,  and  Physiology  must  be  regarded  as  dry,  and,  to  render 
them  more  palatable,  teachers  and  writers  must  resort  to 
some  means  of  maintaining  the  learner’s  interest,  while  they 
convey  to  him  the  information  that  he  needs,  almost  without 
his  discovering  that  he  has  imbibed  it.  The  device,  how- 
-ever,  is  a  dangerous  one,  and  in  the  case  of  Physiology  too 
•often  leads  to  a  superficial  knowledge  of  a  vast  range  of  in¬ 
genious  experiments,  to  the  complete  exclusion  of  the  facts 
nnd  theories  which  such  experiments  were  destined  to  teach 
or  to  illustrate.  But  it  is  exactly  these  cardinal  facts  that 
are  the  backbone  of  knowledge,  whether  it  be  required  for 
reproduction  over  an  examination-table,  or  for  practical  use 
at  the  bedside.  In  almost  all  the  qualifying  examinations, 
and  still  more  in  the  examinations  for  degr  ees  at  the  older 
universities,  the  knowledge  which  the  examiners  desire 
to  find  in  the  possession  of  the  candidates  is  a  sound  know¬ 


ledge  of  the  well-ascertained  facts,  whether  of  Medicine 
and  Surgery,  or  of  the  preliminary  sciences  with  which 
medical  men  are  required  to  make  themselves  acquainted. 
Amongst  students  this  truth  is  too  little  recognised.  The 
occasional  introduction  of  debatable  matter  into  the  ques¬ 
tions  asked  by  certain  examining  bodies  has  had  a  perni¬ 
cious  effect  in  establishing  in  the  student  mind  a  horrible 
foreboding  that  he  may  be  required  to  be  acquainted 
with  the  views  of  Professor  So-and-So  in  opposition  to 
those  expressed  by  the  learned  Doctor  von  Somebody ;  and  a 
terrible  amount  of  valuable  working  time  is  lost  in  the  tem¬ 
porary  acquirement  of  this,  to  him,  wholly  useless  informa¬ 
tion.  As  far  as  the  higher  examinations  are  concerned,  the 
student  may  rest  assured  that  if  he  can  confidently  give 
to  the  examiners  a  straightforward  answer,  conveying 
nothing  but  facts,  he  may  look  forward  with  equal  confidence 
to  the  appearance  of  his  name  in  a  list  of  successful  candi¬ 
dates,  ranked  in  first  or  second  class,  as  the  case  may  be. 

Nor  is  it  alone  at  the  critical  time  of  examination 
that  this  confident  knowledge  of  simple,  well-ascertained 
facts  must  command  success.  In  medical  and  surgical  prac¬ 
tice,  whether  in  private  or  in  the  bustling  work  of  hospitals, 
the  successful  worker  is  he  who  has  attained  to  the 
most  complete  knowledge  of  the  groundwork  of  his  pro¬ 
fession.  Without  a  good  foundation  neither  buildings  nor 
knowledge  can  stand  the  stress  of  weather  which  time  will 
bring  to  them.  A  house  built  on  too  narrow  a  foundation 
may  stand  for  a  time,  but  it  cannot  be  added  to  without  the 
necessity  of  props  and  supports  to  supply  the  place  of  the 
broad  and  solid  basis  which  it  lacks ;  and,  in  like  manner,  a 
knowledge  of  Medicine  and  Surgery  founded  on  an  insufficient 
basis  of  physiological  and  anatomical  knowledge  is  but  a 
tottering  contrivance  after  all,  and  cannot  be  added  to  with 
safety,  nor  indeed  used  with  confidence,  without  some  such 
artificial  means  of  support  as  may  be  afforded  by  constant 
reference  to  the  handbooks,  digests,  and  vade-mecums 
with  which  our  profession  is  so  liberally  supplied.  The 
acquirement,  then,  of  the  A,  B,  C  of  professional  know¬ 
ledge,  the  leading  facts  upon  which  the  whole  of  after¬ 
knowledge  is  based,  becomes  the  really  important  considera¬ 
tion  for  the  commencing  student.  How  can  it  best  be 
acquired  ?  To  become  acquainted  with  the  recognised  text¬ 
books  in  each  subject  would  occupy  too  much  time,  and 
would,  even  if  feasible,  make  an  unreasonable  demand  upon 
the  partly  trained  memory,  with,  in  all  probability,  disastrous 
results.  But  in  some  departments  of  study  it  is  necessary 
that  the  larger  text-books  should  be  used,  in  preference  to 
the  numerous  "  Aids  to  (?  Idle)  Students  ”  in  circulation. 
More  especially  in  Anatomy  and  Physiology  the  student 
should  beware  of  the  fascination  of  short  cuts  and  easy 
paths.  The  hard-beaten  track,  uninteresting  as  it  may 
appear  at  first,  is  the  only  one  to  be  trodden  with  safety  in 
these  subjects.  But  in  Anatomy  neither  text-books  nor 
waistcoat-pocket  “  aids  ”  are  of  any  avail  without  the  steady 
and  persevering  work  at  dissection,  doubly  useful  as  it  is  in 
teaching  the  practical  knowledge  of  the  most  practical  of 
sciences,  and  in  educating  the  hand  to  guide  the  knife 
amongst  the  delicate  structures  with  which  it  may  have 
to  deal,  in  days  to  come,  with  greater  delicacy  still. 

A  common  thought  amongst  students  is  this — that, 
having  once  “  got  through  ”  the  period  of  preliminary  study, 
work  in  the  wards  and  out-patient  rooms  will  be  not  only 
interesting  but  easy.  That  it  will  be  interesting  there  can 
be  no  doubt ;  but  all  students  may  take  this  truth  to  heart, 
that  it  will  be  easy  or  difficult  to  them  in  exact  pr  oportion 
to  the  amount  of  real  knowledge  which  they  possess  of  the 
preliminary  sciences,  which  in  the  study  and  treatment  of 
disease  they  have  to  be  constantly,  and  often  unconsciously, 
employing. 


Medical  Times  and  Gazette. 


CHANGES  IN  THE  LONDON  HOSPITALS  AND  SCHOOLS. 


Sept.  15,  1883.  3  2  3 


With  the  beginning  of  the  second  part  of  medical  study 
the  question  constantly  arises,  what  book  or  books  shall  be 
read ;  and  different  courses  of  action  are  often  adopted,  with 
equally  satisfactory  results.  Let  it  be  remembered  that  for 
practical  use  only  the  accepted  facts  of  medical  or  surgical 
science  are  required.  Hence  any  text-book  written  by  an 
author  who  commands  general  respect  may  be  safely  fol¬ 
lowed,  even  though  in  small  points  or  in  matters  of  theory 
his  views  may  not  coincide  with  those  of  other  text-book 
writer's  of  the  day.  But  in  thus  accepting  the  teachings  of 
a  single  author,  and  pinning  faith  to  them,  it  must  be  borne 
in  mind  that  more  than  a  superficial  knowledge  of  them 
must  be  acquired. 

Of  the  many  systems  of  study  in  vogue,  there  are  few 
more  really  useful  than  that  of  abstracting  a  work  by  short 
notes,  systematically  following  out  each  subject  in  order. 
The  process  has  the  double  effect  of  fixing  the  abstracted 
matter  in  the  note-book  of  the  mind,  as  well  as  in  that  of 
the  pocket,  and,  when  completed,  it  forms  a  useful  “  abridged 
■edition  ”  of  the  larger  work,  edited  by  its  happy  possessor, 
and  forming  a  pleasant  memorial  of  good  work  well  done. 
The  sound  knowledge  thus  collected  forms,  with  the  pre¬ 
viously  acquired  foundation  of  the  preliminary  sciences,  a 
solid  structure,  to  which  large  and  elaborate  additions  of 
special  knowledge  may  be  made  without  fear  of  endangering 
the  safety  of  the  whole. 

Of  late  years  this  question  of  the  study  of  special  subjects 
has  become  of  serious  importance.  Specialisms  are  multi¬ 
plying,  and  examinations  are  gradually  embracing  them, 
and  students  have  the  additional  incubus  thrown  upon  their 
preliminary  studies  that  these  also  have  to  be  provided  for. 
Experience  shows  every  day  that  special  branches  of  study 
are  learned  with  far  greater  ease,  accuracy,  and  rapidity  by 
the  senior  students,  and  especially  by  those  who  have  ob¬ 
tained  good  preliminary  knowledge.  Such  an  experience 
suggests  the  view  that  the  study  of  special  subjects 
should,  at  the  earliest,  only  be  taken  up  during  the  last 
year  of  studentship,  and  many  of  them,  making  no  very 
great  demand  upon  time,  might  be  taken  during  the  period 
of  senior  clerkship  or  dressership.  As  practical  workers 
who  have  to  get  through  a  large  amount  of  work  in  a  short 
time,  medical  students  must  look  facts  in  the  face,  and  con¬ 
sider  what  does  or  does  not  “  pay  ”  in  the  methods  which 
they  may  seek  to  adopt.  We  would  only  give  them  this 
piece  of  advice — it  undoubtedly  does  “  pay  ”  to  work  steadily, 
systematically,  and  not  for  too  long  a  time  continuously.  It 
pays  to  work  at  the  preliminary  subjects  till  they  are 
thoroughly  mastered.  It  does  not  pay  to  attempt  to  acquire 
a,  knowledge  of  the  higher  branches  of  study,  and  espe¬ 
cially  the  special  branches,  until  the  earlier  part  of  the 
prescribed  course  of  study  can  be  left,  with  the  confident 
feeling  that  it  has  become  the  absolute  property  of  its 
possessor. 


TABLE  SHOWING  THE  DAYS  AND 
HOURS  OP  THE  INTRODUCTORY  LECTURES  AT 
THE  METROPOLITAN  MEDICAL  SCHOOLS. 


Hospital. 

Lecturer. 

Date  and  hour. 

St.  George’s . 

.Mr.  W. H.  Bennett... 

Oct. 

l. 

4 

p.m. 

King’s  College . 

.Dr.  H.  W.  Acland  ... 

J) 

2, 

4 

p.m. 

London . 

.Professor  Huxley  ... 

yy 

9, 

8 

p.m. 

St.  Mary’s  . 

.Dr.  H.  Jones  . 

yy 

1. 

3.30 

p.m. 

Middlesex . 

.Mr.  A.  P.  Gould . 

y> 

1, 

3 

p.m. 

St.  Thomas’s  . 

.Mr.  Le  Gros  Clark  ... 

yy 

1, 

3 

p.m. 

University  College.. 

.Professor  J.  Tweedy 

yy 

L 

4 

p.m. 

Westminster  . 

.Mr.  Boyce  Barrow... 

yy 

l, 

3 

p.m. 

CHANGES  IN  THE  STAFFS  OF  LONDON 
HOSPITALS  AND  SCHOOLS. 


At  St.  Bartholomew’s  Hospital,  Dr.  Dyce  Duckworth  has 
become  Physician/in  place  of  Dr.  Southey,  resigned.  The 
vacancy  amongst  the  Assistant-Physicians  has  not  yet  been 
filled  up.  Drs.  Herringham,  Steavenson,  and  King  have 
been  elected  Casualty  Physicians,  and  Dr.  Steavenson  has 
been  placed  in  charge  of  the  Electrical  Department.  The 
Lecturership  on  Forensic  Medicine  is  vacant  through  the 
resignation  of  Dr.  Southey. 

At  the  Charing-cross  Hospital,  Dr.  Frederick  Willcocks 
has  been  elected  Assistant-Physician  in  place  of  Dr.  Mitchell 
Bruce,  whose  election  to  the  post  of  Physician  we  noticed 
last  year;  and  there  is  now  a  vacancy  for  an  Assistant- 
Physician  through  the  resignation  of  Dr.  Colquhoun.  Dr. 
Amand  Routh  has  been  elected  to  the  newly 'created  post  of 
Assistant-Physician  Accoucheur.  In  the  School,Dr.  Mitchell 
Bruce  succeeds  Mr.  Hird  as  Dean,  and  Mr.  James  Cantlie  is 
Sub-Dean ;  Dr.  Willcocks  lectures  on  Botany  in  place  of 
Dr.  Colquhoun,  and  Mr.  J.  G.  Garson  on  Comparative 
Anatomy  in  place  of  the  late  Mr.  W.  A.  Forbes.  The  post 
of  Demonstrator  of  Morbid  Anatomy  is  vacant. 

At  St.  George’s  Hospital,  Dr.  Isambard  Owen  has  succeeded 
Dr.  Herbert  Watney  as  Assistant-Physician.  In  the  School 
there  have  been  several  changes :  Mr.  Ross  has  been 
appointed  Demonstrator  of  Morbid  Anatomy  in  place  of 
Dr.  Owen;  Dr.  Ewart  takes  the  class  in  Physiology  and 
Minute  Anatomy ;  Dr.  Champneys  is  joint-Lecturer  with 
Dr.  Barnes  on  Midwifery  and  the  Diseases  of  Women  and 
Children ;  and  the  Lecturership  ’on  Comparative  Anatomy 
is  vacant. 

At  Guy’s  Hospital,  Dr.  Galabin  has  become  Obstetric 
Physician,  Dr.  Braxton  Hicks  having  retired ;  and  Dr. 
Horrocks  has  been  elected  Assistant  Obstetric  Physician. 
In  the  School,  Mr.  Groves  lectures  on  Chemistry  with  Dr. 
Stevenson,  and  Dr.  Galabin  succeeds  Dr.  Hicks  as  Lecturer 
on  Midwifery.  Dr.  Hale  White  and  Mr.  J.  A.  Lane  have 
been  appointed  Demonstrators  of  Anatomy. 

At  King’s  College  Hospital  there  have  been  no  changes 
either  in  the  Hospital  staff  or  amongst  the  lecturers  and 
teachers  in  the  School. 

At  the  London  Hospital,  Mr.  Jonathan  Hutchinson,  F.R.S., 
has  been  appointed  Consulting  Surgeon,  and  Mr.  McCarthy 
is  now  full  Surgeon  ;  Mr.  Hurry  Fenwick  has  been  elected 
Assistant-Surgeon.  Dr.  Herman  is  Obstetric  Physician  in 
place  of  the  late  Dr.  Palfrey,  and  he  has  also  succeeded  to 
the  Lecturership  on  Midwifery  and  the  Diseases  of  Women. 
There  is  a  vacancy  for  an  Assistant  Obstetric  Physician. 
Dr.  Sansom  lectures  on  Medical  Jurisprudence  and  Public 
Health;  and  the  post  of  teacher  of  Practical  Chemistry  is 
vacant. 

At  SI.  Mary’s  Hospital,  Dr.  Cheadle  has  become  Physician, 
and  Dr.  S.  Phillips  Assistant  Physician  with  charge  of  out¬ 
patients.  Mr.  Henry  Juler  has  been  appointed  Assistant 
Ophthalmic  Surgeon.  In  the  School,  Dr.  Nall  has  been 
elected  teacher  of  Practical  Physiology,  and  Mr.  Pepper 
teacher  of  Practical  Surgery.  Mr.  George  Field  is  now 
Dean  of  the  School  in  place  of  Dr.  Shepherd. 

At  the  Middlesex  Hospital,  Mr.  A.  Pearce  Gould  has  suc¬ 
ceeded  the  late  Mr.  R.  W.  Lyell  as  Assistant-Surgeon.  In 
the  School,  Mr.  Sutton  lectures  on  Comparative  Anatomy  in 
place  of  Mr.  Hensman. 

At  St.  Thomas’s  Hospital,  Mr.  B.  Pitts  has  been  elected 
Assistant-Surgeon,  Mr.  Ranger  has  succeeded  Mr.  Elliott 
as  Dental  Surgeon,  and  Mr.  C.  E.  Truman  has  been  ap¬ 
pointed  Assistant  Dental  Surgeon.  There  have  been  no 
changes  of  importance  in  the  School. 


324 


Medical  Times  and  Gazette. 


DENTAL  SURGERY. 


Sept.  15, 1883. 


At  University  College  Hospital,  Mr.  S.  J.  Hutchinson  suc¬ 
ceeds  Mr.  G.  A.  Ibbetson  as  Dental-Surgeon.  In  University- 
College,  Mr.  Schafer,  lately  Assistant-Professor,  has  been 
appointed  Jodrell  Professor  of  Physiology  in  place  of  Dr. 
Burdon  Sanderson,  elected  to  the  new  Waynflete  Chair  of 
Physiology  in  the  University  of  Oxford  ;  and  Dr.  J.  A. 
McWilliam  succeeds  Mr.  Schafer  as  Assistant-Professor  and 
Demonstrator;  and  Mr.  Hutchinson  lectures  on  Dental  Sur¬ 
gery  in  place  of  Mr.  Ibbetson. 

At  the  Westminster  Hospital,  Dr.  Fincham  has  been  made 
Consulting  Physician,  Dr.  H.  Donkin  succeeds  him  as  Phy¬ 
sician,  and  Dr.  Murrell  has  been  elected  to  the  vacant 
Assistant-Physicianship  ;  Mr.  Boyce  Barrow  has  succeeded 
Mr.  Gould  as  Assistant- Surgeon  ;  Mr.  Morton  Smale  has  been 
appointed  one  of  the  Dental  Surgeons,  and  Dr.  T.  Colcott  Fox 
has  taken  charge  of  the  Skin  Department.  In  the  School, 
Mr.  Black  lectures  on  Anatomy  in  place  of  Mr.  Gould,  and 
Dr.  Heneage  Gibbes  lectures  on  Physiology  in  succession  to 
Dr.  Allchin.  Dr.  de  Havilland  Hall  is  a  joint-Lecturer  with 
Dr.  Dupre  on  Forensic  Medicine.  Dr.  Hall  also  succeeds 
Dr.  Allchin  as  Dean  of  the  School,  and  Dr.  Heneage  Gibbes 
has  been  appointed  Sub-Dean. 


DENTAL  SURGERY. 


REGULATIONS  RELATING  TO  THE  DIPLOMA 
IN  DENTAL  SURGERY. 

ROYAL  COLLEGE  OF  SURGEONS  OF  ENGLAND. 

EDUCATION. 

Candidates  are  required  to  produce  the  following  certifi¬ 
cates  : — 

1.  Of  being  twenty-one  years  of  age. 

2.  Of  having  been  engaged  during  four  years  in  the 
acquirement  of  professional  knowledge. 

3.  Of  having  attended,  at  a  school  or  schools  recognised  by 
this  College,  not  less  than  one  of  each  of  the  following  courses 
of  lectures,  delivered  by  lecturers  recognised  by  this  College, 
namely: — Anatomy, Physiology,  Surgery, Medicine, Chemistry, 
and  Materia  Medica. 

4.  Of  having  attended  a  second  winter  course  of  lectures  on 
Anatomy,  or  a  course  of  not  less  than  twenty  lectures  on  the 
Anatomy  of  the  Head  and  Neck,  delivered  by  lecturers 
recognised  by  this  College. 

5.  Of  having  performed  dissections  at  a  recognised  school 
during  not  less  than  nine  months. 

6.  Of  having  completed  a  course  of  chemical  manipulation, 
under  the  superintendence  of  a  teacher  or  lecturer  recognised 
by  this  College. 

7.  Of  having  attended,  at  a  recognised  hospital  or  hospitals 
in  the  United  Kingdom,  the  practice  of  Surgery  and  clinical 
lectures  on  Surgery  during  two  winter  sessions. 

8.  Of  having  attended,  at  a  recognised  school,  two  courses 
of  lectures  upon  each  of  the  following  subjects,  viz. Dental 
Anatomy  and  Physiology  (human  and  comparative),  Dental 
Surgery,  Dental  Mechanics,  and  one  course  of  lectures  on 
Metallurgy,  by  lecturers  recognised  by  this  College. 

9.  Of  having  been  engaged,  during  a  period  of  not  less  than 
three  years,  in  acquiring  a  practical  familiarity  with  the 
details  of  Mechanical  Dentistry,  under  the  instruction  of  a 
competent  practitioner.  In  the  cases  of  qualified  surgeons, 
evidence  of  a  period  of  not  less  than  two  instead  of  three 
years  of  such  instruction  will  be  sufficient. 

10.  Of  having  attended  at  a  recognised  dental  hospital,  or 
in  the  dental  department  of  a  recognised  general  hospital, 
the  practice  of  Dental  Surgery  during  the  period  of  two 
years. 

[Note. — All  candidates  who  shall  commence  their  profes¬ 
sional  education  on  or  after  July  22,  1878,  will,  in  addition 
to  the  certificates  enumerated  in  the  foregoing  clauses,  be 
required  to  produce  a  certificate  of  having,  prior  to  such  com¬ 
mencement,  passed  a  preliminary  examination  in  general 
knowledge  recognised  by  the  General  Medical  Council,  all 
inquiries  with  respect  to  which  should  be  addressed  to  the 
Registrar  of  that  Council,  299,  Oxford-street,  London,  W.] 

Candidates  who  were  in  practice  as  dentists,  or  who  had 
commenced  their  education  as  dentists  prior  to  September, 
1859 — the  date  of  the  Charter — and  who  are  unable  to  produce 
the  certificates  required  by  the  foregoing  regulations,  shall 


furnish  the  Board  of  Examiners  with  a  certificate  of  moral 
and  professional  character,  signed  by  two  members  of  this 
College,  together  with  answers  to  the  following  inquiries : — 
Name,  age,  and  professional  address.  If  in  practice  as  a 
Dentist,  the  date  of  the  commencement  thereof.  Whether 
member  or  licentiate  of  any  College  of  Physicians  or  Surgeons 
of  the  United  Kingdom  ;  and,  if  so,  of  what  College.  Whether 
graduate  of  any  University  in  the  United  Kingdom ;  and,  if 
so,  of  what  University  ;  and  whether  graduate  in  Arts  or 
Medicine.  The  date  or  dates  of  any  such  diploma,  licence,  or 
degree.  Whether  member  of  any  learned  or  scientific  society ; 
and,  if  so,  of  what.  Whether  his  practice  as  a  Dentist  is 
carried  on  in  connexion  with  any  other  business  ;  and,  if  so, 
with  what  business.  Whether  since  July  22,  1876,  he  has 
employed  advertisements  or  public  notices  of  any  kind  in  con¬ 
nexion  with  the  practice  of  his  profession.  The  particulars  of 
professional  education,  medical  or  special.  The  Board  of 
Examiners  will  determine  whether  the  evidence  of  character 
and  education  produced  by  a  candidate  be  such  as  to  entitle 
him  to  examination. 

N.B. — In  the  case  of  candidates  in  practice  or  educated  in 
Scotland  or  Ireland,  the  certificate  of  moral  and  professional 
character  may  be  signed  by  two  Licentiates  of  the  Royal 
College  of  Surgeons  of  Edinburgh,  or  of  the  Faculty  of 
Physicians  and  Surgeons  of  Glasgow,  or  of  the  Royal  College 
of  Surgeons  in  Ireland,  as  the  case  may  he. 

EXAMINATION. 

The  examination  is  partly  written  and  partly  oral.  The 
written  examination  comprises  general  Anatomy  and  Physio¬ 
logy,  and  general  Pathology  and  Surgery,  with  especial 
reference  to  the  practice  of  the  dental  profession.  The  oral 
practical  examination  comprises  the  several  subjects  included 
in  the  curriculum  of  professional  education,  and  is  conducted 
by  the  use  of  preparations,  casts,  drawings,  etc.  Members  of 
the  College,  in  the  written  examination,  will  only  have  to  answer 
those  questions  set  by  the  section  of  the  Board  consisting  of 
persons  skilled  in  Dental  Surgery;  and  in  the  oral  examination 
will  be  examined  only  by  that  section.  A  candidate  whose 
qualifications  shall  be  found  insufficient  will  be  referred  back 
to  his  studies,  and  will  not  be  admitted  to  re-examination 
within  the  period  of  six  months,  unless  the  Board  shall  other¬ 
wise  determine.  Examinations  will  be  held  in  February, 
June,  and  October.  The  fee  for  the  diploma  is  £10  10s.,  over 
and  above  any  stamp  duty. 

[Note. — A  ticket  of  admission  to  the  museum,  to  the  library, 
and  to  the  College  lectures  will  be  presented  to  each  candidate 
on  his  obtaining  the  diploma.] 


ROYAL  COLLEGE  OF  SURGEONS  OF  EDINBURGH. 

BEGULATIONS. 

Every  candidate  for  the  Dental  Diploma  must  have  attended 
the  general  lectures  and  courses  of  instruction  required,  at  a 
university  or  an  established  medical  school,  recognised  by  the 
College  as  qualifying  for  the  diploma  in  Surgery.  The 
special  courses  of  instruction  may  have  been  followed  in  a 
recognised  dental  hospital  or  school,  or  by  teachers  recognised 
by  the  College. 

Candidates  must  produce  evidence  of  having  attained  the 
age  of  twenty-one  years,  and  will  require  to  produce  a  cer¬ 
tificate  of  having  passed  the  preliminary  examination  in 
general  education  required  for  the  ordinary  licence  in  Surgery, 
or  an  examination  equivalent  to  this,  and  recognised  by  the 
General  Medical  Council, — except  in  the  case  of  candidates 
who  shall  have  commenced  their  professional  education  previous 
to  August  1,  1878. 

Candidates  will  also  be  required  to  produce  certificates  of 
having  been  engaged  during  four  years  in  the  acquirement  of 
professional  knowledge,  and  of  having  been  during  that 
period,  or  at  some  time  previous  to  their  examination,  engaged 
for  not  less  than  three  years  in  the  acquirement  of  a  practical 
knowledge  of  Mechanical  Dentistry  with  a  practitioner 
registered  under  this  Act. 

The  following  lectures  and  other  courses  of  instruction  must 
have  been  attended  by  candidates,  and  the  number  of  lectures 
in  each  of  the  general  courses  must  correspond  with  those 
required  for  the  surgical  diploma  of  the  College: — Anatomy, 
one  winter  course;  Dissection  and  Demonstrations,  nine 
months,  or  Dissection,  nine  months,  and  Anatomy  of  Head 
and  Neck,  one  course  of  twenty  lectures ;  Physiology,  one 
course  of  not  less  than  fifty  lectures ;  Chemistry,  one  winter 


Medical  Times  and  Gazette. 


DEGREES  AND  QUALIFICATIONS  IN  PUBLIC  HEALTH.  sept.iB.i888.  3  2  5 


-course  ;  Surgery,  one  winter  course ;  Medicine,  one  winter 
•course ;  Materia  Medica,  one  course  of  three  months ;  Practical 
Chemistry  and  Metallurgy,  one  course  of  three  months ; 
clinical  instruction  in  Surgery  at  a  recognised  hospital,  one 
course  of  six  months,  or  two  courses  of  three  months. 

In  addition  to  these,  candidates  will  require  to  have  attended 
the  following  special  courses  of  lectures  and  instruction : — 
Dental  Anatomy  and  Physiology,  Dental  Surgery  and  Patho¬ 
logy,  Dental  Mechanics,  one  course  of  each;  and  produce 
evidence  of  two  years’  attendance  at  a  dental  hospital,  or  the 
dental  department  of  a  general  hospital  recognised  by  the 
College. 

Candidates  who  are  licentiates  of  this  College,  or  who  may 
be  registered  medical  practitioners,  will  be  required  to  produce 
certificates  of  attendance  on  the  special  subjects  only,  and 
will  be  examined  in  these  only  for  the  Dental  Diploma. 

EXAMINATIONS. 

The  Dental  Examinations  shall  be  both  written  and  oral,  and 
be  conducted  in  the  same  manner  as  the  ordinary  surgical 
examinations.  The  examinations  shall  consist  of  two  separate 
sittings,  and  be  held  subsequent  to  each  period  of  the  ordinary 
examinations,  on  such  days  as  the  College  may  appoint. 
Candidates  must  apply  to  the  Secretary  of  the  College  on  or 
before  the  Saturday  preceding  the  ordinary  examinations,  and 
must  then  produce  all  the  required  certificates  of  having 
passed  the  preliminary  examination,  and  of  having  attended 
the  lectures  and  other  prescribed  courses  of  instruction. 

The  fee  for  the  dental  diploma  shall  be  ten  guineas. 

EXAMINATIONS  SINE  CURRICULO. 

Candidates  who  were  in  practice  before  August  1,  1878,  or 
those  not  in  practice  but  who  had  commenced  their  apprentice¬ 
ship  as  Dentists  before  August  1, 1875,  and  who  are  unable  to 
furnish  the  Board  of  Examiners  with  the  certificates  of  lectures 
and  hospital  attendance  required  by  the  foregoing  regulations, 
shall  fill  in  the  schedule  of  application  as  follows  : — 

1 .  Eull  name,  age,  and  address  of  candidate. 

2.  Certificate  of  moral  and  professional  character,  signed  by 
two  registered  medical  practitioners. 

3.  The  date  of  commencing  practice  or  apprenticeship  as  a 
Dentist,  and  whether,  if  in  practice,  such  practice  has  been 
carried  on  in  conjunction  with  any  other  business,  and  if  so, 
with  what  business. 

4.  Whether  he  has  any  degree  or  diploma  in  Medicine  or 
Surgery,  and  if  so,  from  what  College  or  University,  or  other 
body,  and  at  what  time  it  was  obtained. 

5.  The  particulars  of  professional  education. 

The  President’s  Council  shall,  on  such  information  being 
afforded  them,  determine  whether  or  not  the  candidate  may  be 
admitted  to  examination  for  the  Dental  Diploma,  and  such 
examination  shall,  with  the  exception  of  the  preliminary  exa¬ 
mination,  and  the  exemptions  in  favour  of  registered  medical 
practitioners,  as  before  explained,  be  passed  on  the  same  sub¬ 
jects  and  in  the  same  manner  as  is  required  for  other  candidates, 
and  will  confer  the  same  privileges. 


DENTAL  HOSPITAL  OF  LONDON  MEDICAL 
SCHOOL. 


HOSPITAL  STAFF. 

Consulting  Physician— Sir  J.  Risdon  Bennett,  M.D. 
Consulting  Surgeon— Mr.  Christopher  Heath. 

Consulting  Dental  Surgeons — Mr.  S.  Cartwright  and  Mr.  John  Tomes. 
Dental  Surgeons. 


Mr.  D.  Hepburn. 
Mr.  R.  Woodhouse. 
Mr.  Gregson. 


Mr.  Hutchinson. 
Mr.  Moon. 

Mr.  A.  Hill. 


Assistant  Dental  Surgeons. 


Mr.  P.  Canton. 

Mr.  A.  S.  Underwood. 
Mr.  Claude  Rogers. 


Mr.  G.  Parkinson. 
Mr.  Storer  Bennett. 
Mr.  Truman. 


Chlorof or  mists— Mr.  Braine,  Mr.  Bailey,  Mr.  T.  Bird,  and  Mr.  Mills. 
Medical  Tutor—  Mr.  Morton  Smale. 

Demonstrators  —Mr .  John  Ackery  and  Mr.  W.  Hern. 
House-Surgeon— Mr.  J.  0.  Butcher. 

Assistant  House-Surgeon — Mr.  Pillin. 

The  winter  session  will  commence  on  Monday,  October  1. 


LECTURES. — WINTER  SESSION. 

Mechanical  Dentistry — Dr.  Walker. 

LECTURES. — SUMMER  SESSION. 

Dental  Surgery  and  Pathology — Mr.  Alfred  Coleman. 

Dental  Anatomy  and  Physiology  (Human  and  Comparative)— Mr.  C.  S. 

Tomes. 


SCHOLARSHIPS  AND  PRIZES. 

The  Saunders  Scholarship  of  £20  per  annum,  and  Prizes,  are  open  for 
competition. 


ITSlEjS* 

Fee  for  special  lectures  required  by  the  curriculum,  £15  15s.; 
fee  for  two  years’  hospital  practice  required  by  the  cur¬ 
riculum,  £15  15s.  Fees  for  lectures  and  practice,  £31  10s. 
Additional  fees  for  a  general  hospital  for  the  two  years  to 
fulfil  the  requirements  of  the  curriculum  vary  from  £40  to  £50. 

For  further  particulars,  apply  to  Mr.  T.  F.  Ken  Underwood, 
Dean. 


DEGREES  IN  SCIENCE  IN 
THE  DEPARTMENT  OF  PUBLIC  HEALTH. 


UNIVERSITY  OF  CAMBRIDGE. 

EXAMINATION  IN  STATE  MEDICINE. 

An  examination  in  so  much  of  State  Medicine  as  is  com¬ 
prised  in  the  functions  of  Officers  of  Health  will  be  held  in 
Cambridge,  beginning  on  the  first  Tuesday  in  October,  and 
ending  on  the  following  Friday. 

Any  person  whose  name  is  on  the  Medical  Register  of  the 
United  Kingdom  may  present  himself  for  this  examination 
provided  he  is  in  his  twenty-fourth  year.  The  examination 
will  be  in  two  parts,  and  will  be  oral  and  practical  as  well  as 
in  writing. 

Part  I.  will  comprise  : — Physics  and  Chemistry.  The  prin¬ 
ciples  of  Chemistry,  and  methods  of  analysis  with  especial 
reference  to  analyses  of  air  and  water.  Application  of  the 
microscope.  The  laws  of  heat,  and  the  principles  of  pneu¬ 
matics,  hydrostatics,  and  hydraulics,  with  especial  reference  to 
ventilation,  water-supply,  drainage,  construction  of  dwellings, 
disposal  of  sewage  and  refuse,  and  sanitary  engineering  in 
general.  Statistical  methods. 

Part  II.  will  comprise: — Laws  of  the  realm  relating  to 
Public  Health.  Origin,  propagation,  pathology,  and  prevention 
of  epidemic  and  infectious  diseases.  Effects  of  overcrowding, 
vitiated  air,  impure  water,  and  bad  or  insufficient  food.  Un¬ 
healthy  occupations,  and  the  diseases  to  which  they  give  rise. 
Water-supply  and  drainage  in  reference  to  health.  Nuisances 
injurious  to  health.  Distribution  of  diseases  within  the  United 
Kingdom,  and  effects  of  soil,  season,  and  climate. 

Candidates  may  present  themselves  for  either  part  sepa¬ 
rately,  or  for  both  together,  at  their  option  ;  but  the  result  of 
the  examination  in  the  case  of  any  candidate  will  not  be 
published  until  he  has  passed  to  the  satisfaction  of  the  exa¬ 
miners  in  both  parts.  Every  candidate  will  be  required  to  pay 
a  fee  of  £4  4s.  before  admission  to  each  part  of  the  examina¬ 
tion.  Every  candidate  who  has  passed  both  parts  of  the 
examination  to  the  satisfaction  of  the  examiners  will  receive  a 
certificate  testifying  to  his  competent  knowledge  of  what  is 
required  for  the  duties  of  a  Medical  Officer  of  Health. 

All  applications  for  admission  to  this  examination,  or  for 
information  respecting  it,  should  be  addressed  to  Professor 
Liveing,  Cambridge. 

Candidates  who  desire  to  present  themselves  for  examination 
in  October  next  must  send  in  their  applications  and  transmit 
the  fees  on  or  before  September  28. 


UNIVERSITY  OF  LONDON. 

EXAMINATION  IN  SUBJECTS  RELATING  TO  PUBLIC  HEALTH. 

A  special  examination  shall  be  held  once  in  every  year  in 
subjects  relating  to  Public  Health,  and  shall  commence  on  the 
second  Monday  in  December. 

No  candidate  shall  be  admitted  to  this  examination  unless 
he  shall  have  passed  the  second  examination  for  the  degree  of 
Bachelor  of  Medicine  in  this  University  at  least  one  year 
previously  ;  nor  unless  he  shall  have  given  notice  of  his  inten¬ 
tion  to  the  Registrar  at  least  two  calendar  months  before  the 
commencement  of  the  examination. 

The  fee  for  this  examination  shall  be  =£5. 

Candidates  shall  be  examined  in  the  following  subjects  : — 

1.  Chemistry  and  Microscopy,  as  regards  the  examination 
of  air,  water,  and  food. 

2.  Meteorology,  as  regards  general  knowledge  of  meteorologi¬ 
cal  conditions,  and  the  reading  and  correction  of  instruments. 

3.  Geology,  as  regards  general  knowledge  of  rocks,  their 
conformation  and  chemical  composition,  and  their  relation 
to  underground  water,  and  to  drainage  and  sources  of  water- 
supply. 

4.  Physics  and  Sanitary  Apparatus.  The  laws  of  heat,  me¬ 
chanics,  pneumatics,  hydrostatics,  and  hydraulics,  in  relation 


326  Medical  Times  and  Gazette.  DEGREES  AND  QUALIFICATIONS  IN  PUBLIC  HEALTH.  Sept.  15,  1883. 


(for  sanitary  purposes)  to  the  construction  of  dwellings,  and 
to  the  principles  of  warming,  ventilation,  drainage  and  water- 
supply,  and  to  forms  of  apparatus  for  these  and  other  sanitary 
uses.  And  the  reading  of  plans,  sections,  scales,  etc.,  in 
regard  of  sanitary  constructions  and  appliances. 

5.  Vital  Statistics,  as  regards  the  methods  employed  for  de¬ 
termining  the  health  of  a  community ;  birth-rate ;  death- 
rate  ;  disease-rate ;  life-tables ;  duration  and  expectancy  of 
life.  Present  amount  of  mortality  at  the  various  ages,  and  its 
causes  indifferent  classes  and  communities.  Practical  statistics 
of  armies,  navies,  civil  professions,  asylums,  hospitals,  dispen¬ 
saries,  lying-in  establishments,  prisons,  indoor  and  outdoor 
paupers,  friendly  societies,  sick  clubs,  medical  and  surgical 
practice,  towns. 

6.  Hygiene,  including  the  causation  and  prevention  of  dis¬ 
ease,  in  which  branch  of  examination  reference  shall  be  had 
to  such  matters  as  the  following  : — 

Parentage,  as  influencing  the  individual  expectation  of  health ;  tem¬ 
peraments  ;  morbid  diatheses ;  congenital  diseases  and  malformations ; 
effects  of  close  inter-breeding.  Special  liabilities  of  the  health  at  par¬ 
ticular  periods  of  life ;  physical  regimen  of  different  ages.  Earth  and 
climate  and  changes  of  season  in  their  bearing  on  the  health  of  popula¬ 
tions  ;  dampness  of  soil ;  malaria.  Conditions  of  healthy  nourishment : 
dietaries  and  dietetic  habits ;  stimulants  and  narcotics  in  popular  use  ; 
dietetic  privation,  excesses,  and  errors,  as  respectively  causing  disease ; 
drinking-water,  and  the  conditions  which  make  water  unfit  for  drinking  ; 
adulterations  of  food.  Conditions  of  healthy  lodgment :  ventilation  and 
warming,  and  the  removal  of  refuse-matters,  in  their  respective  relations 
to  health;  filth  as  a  cause  of  disease;  sanitary  regimen  of  towns  and 
villages ;  “  nuisances  ”  (as  defined  by  law)  with  regard  to  the  sanitary 
bearing  and  the  removal  of  each  ;  trade  processes  causing  offensive  effluvia ; 
common  lodging-houses  and  tenement  houses.  Conditions  of  healthy 
activity  :  work,  over- work,  rest,  and  recreation ;  occupations  of  different 
sorts  in  relation  to  the  health  of  persons  engaged  in  them — e.g.,  factory 
work  in  general,  occupations  which  produce  irritative  lung-disease,  occu¬ 
pations  which  promote  heart-disease,  occupations  which  deal  with  poisons, 
etc.  Hygiene  of  particular  establishments  and  particular  classes  of  popu¬ 
lation  :  factories  and  workplaces  ;  schools ;  workhouses  ;  asylums ;  hos¬ 
pitals  ;  prisons.  Disease  as  distributed  in  England :  classifications  of  dis¬ 
ease  for  various  purposes  of  medical  inquiry  ;  excesses  of  particular 
diseases  and  injuries  at  particular  places  and  at  particular  times.  Par¬ 
ticular  diseases,  as  regards  their  intimate  nature,  causation,  and  pre- 
ventability:  e.g.,  enteric  fever,  cholera,  typhus,  small-pox,  scarlatina, 
diphtheria,  erysipelas,  pyaemia,  tubercular  diseases,  rheumatism,  ague, 
cretinism,  ophthalmia,  porrigo,  venereal  diseases,  scurvy,  ergotism,  leprosy, 
insanity.  Processes  of  contagion  in  different  diseases ;  incubation  in  each 
case;  particular  dangers  of  infection — at  schools,  workplaces,  etc.,  and 
from  laundries,  dairies,  etc.  Disinfectants  and  establishments  for  dis¬ 
infection.  Quarantine.  Hospitals  for  infectious  disease.  Conveyance 
of  the  sick.  Vaccination:  existing  knowledge  as  to  its  protectiveness; 
re  vaccination;  precautions  which  vaccination  requires;  arrangements 
for  public  vaccination  in  town  and  country ;  natural  cow-pox.  Prostitu¬ 
tion  as  regards  the  public  health.  Diseases  of  domestic  animals  in  relation 
to  the  health  of  man  :  rabies ;  farcy  and  glanders ;  anthrax ;  parasites, 
especially  trichina  and  the  tseniadee  ;  aphtha ;  tubercle ;  meat  and  milk 
of  diseased  animals.  Diseases  of  the  vegetable  kingdom,  and  failures  of 
vegetable  crops,  inrelation  to  the  health  of  man ;  famine-diseases.  Poisons 
in  manufacture  and  commercial  and  domestic  use — e.g.,  arsenic,  lead, 
phosphorus,  mercury ;  poisonous  pigments. 

7.  Sanitary  Law,  as  regards  the  leading  purposes  of  the  fol¬ 
lowing  statutes,  and  the  constitution  and  modes  of  procedure 
of  the  respective  authorities,  and  any  existing  orders,  regula¬ 
tions,  or  model  by-laws  of  the  Local  Government  Board  in 
sanitary  matters.  The  Public  Health  Act,  1875.  The  Vac¬ 
cination  Acts.  The  (Rivers’  Pollution  Prevention  Act,  1876. 
The  Sale  of  Food  and  Drugs  Act,  1875.  The  Artisans  and 
Labourers’  Dwellings  Improvement  Act,  1875.  The  Acts 
regulating  the  medical  profession.  The  Acts  regulating  the 
practice  of  pharmacy.  The  Acts  relating  to  factories  and 
workplaces,  and  to  the  detention  and  care  of  lunatics. 


UNIVERSITY  OF  DURHAM. 

STATE  MEDICINE. 

The  Warden  and  Senate  of  the  University  of  Durham,  in 
recognition  of  the  importance  of  the  fact  that  Medical  Officers 
of  Health,  or  those  seeking  appointments  as  such,  should  pos¬ 
sess  a  proof  of  their  special  acquirements,  have  instituted 
examinations  in  State  Medicine,  by  which  the  successful  can¬ 
didates  will  be  entitled  to  receive  a  certificate  of  proficiency  in 
Sanitary  Science. 

For  the  certificate  of  proficiency  in  Sanitary  Science  it  is 
required; — 1.  That  the  candidate  shall  be  a  registered  medical 
practitioner.  2.  That  the  candidate  shall  have  attended  one 
course  of  lectures  on  Public  Health  at  the  College  of  Medicine, 
Newcastle-upon-Tyne,  extending  over  one  winter  session. 

3.  That  the  candidate  shall  pass  an  examination  on  the  following 
subjects  :  — 

1.  Physics. — Laws  of  light,  heat,  hydro- dynamics,  and 
pneumatics. 

2.  Chemistry. — As  applied  to  the  detection  of  noxious  gases 
and  atmospheric  impurities ;  analysis  of  air,  water,  and  food. 


3.  Sanitary  Legislation. — Knowledge  of  the  Acts  of  Parlia¬ 
ment  in  force  for  the  preservation  and  protection  of  health. 

4.  Vital  Statistics. — Rates  of  births,  deaths,  and  marriages  ; 
methods  of  calculation,  classification,  and  tabulation  of  returns 
of  sickness  and  mortality ;  data  and  conclusions  deducible 
therefrom. 

5.  Meteorology,  Climatology,  and  Geographical  Distribution 
of  Diseases  in  the  United  Kingdom, 

6.  Sanitary  Medicine,  more  especially  in  relation  to  epidemic, 
endemic,  epizootic,  and  communicable  diseases ;  diseases  attri¬ 
butable  to  heat,  cold,  or  damp  ;  insufficiency  or  impurity  of  air, 
food,  or  drink ;  habitation,  occupation,  over-exertion,  intem¬ 
perance,  heredity;  preventive  measures — vaccination,  isolation, 
disinfection;  the  regulation  of  noxious  and  offensive  manufac¬ 
tures  and  trades ;  the  removal  of  nuisances. 

7.  Practical  Hygiene,  in  reference  to  site,  materials,  construc¬ 
tion,  lighting,  ventilation,  warmth,  dryness,  water-supply  aud 
refuse-disposal  of  dwellings,  schools,  hospitals,  and  other 
buildings  of  public  or  private  resort ;  action  with  respect  to- 
nuisances  and  outbreaks  of  disease.  Other  duties  of  a  Medical 
Officer  of  Health. 

The  examination  shall  be  by  written  papers,  and  practical 
and  viva  voce  examination,  and  will  commence  on  October  8, 
1883,  and  on  April  21,  1884. 

In  the  practical  examination  the  candidate  will  be  required 
(1)  to  report  on  the  condition  of  some  actual  locality ;  (2)  to- 
analyse  liquids  and  gases ;  (3)  to  explain  the  construction  and 
use  of  instruments  used  in  Meteorology;  (4)  to  make  micro¬ 
scopic  examinations.  The  fee  for  the  examination  will  be 
£5  5s. 

A  special  certificate  of  proficiency  in  Sanitary  Science  may 
be  obtained  by  Medical  Officers  of  Health  of  five  years’  stand¬ 
ing  who  have  obtained  a  registrable  qualification  before 
January  1,  1878,  on  condition  that  the  candidate  is  not  under 
thirty  years  of  age,  that  he  passes  the  examination  for  the 
certificate  detailed  above,  and  that  he  writes  an  essay  on 
some  practical  sanitary  subject,  upon  which  he  may  also  be 
examined.  The  fee  will  be  £10  10s. 


UNIVERSITY  OF  EDINBURGH. 

In  consequence  of  the  great  demand  which  now  exists  for 
Medical  Officers  of  Health,  and  the  importance  to  the  public- 
of  some  means  of  ascertaining  that  members  of  the  medical 
profession  have  specially  studied  the  subject  of  Public  Health, 
Science  Degrees  in  the  Department  of  Public  Health  have 
been  instituted  by  the  University  of  Edinburgh  under  the 
following  conditions :  — 

1.  Candidates  for  graduation  in  Science  in  the  Department 
of  Public  Health  must  be  graduates  in  Medicine  of  a  British 
University,  or  of  such  foreign  or  colonial  Universities  as  may 
be  specially  recognised  by  the  University  Court. 

2.  He  must  be  matriculated  for  the  year  in  which  he 
appears  for  examination  or  graduation. 

3.  Candidates  who  have  not  passed  an  annus  medicus  in  the- 
University  of  Edinburgh  must,  before  presenting  themselves 
for  examination,  have  attended  as  matriculated  students  in 
the  University  at  least  two  courses  of  instruction,  scientific  or 
professional,  bearing  on  the  subjects  of  the  examinations. 

4.  There  are  two  examinations  for  the  degree  of  Bachelor 
of  Science  in  the  Department  of  Public  Health.  Candidates 
who  have  passed  the  first  examination  may  proceed  to  the 
second  at  the  next  or  at  any  period  fixed  for  this  examination. 

5.  Candidates  must  produce  evidence  that,  either  during 
their  medical  studies  or  subsequently,  they  have  attended  a 
course  of  lectures  in  which  instruction  was  given  on  Public 
Health,  and  that  they  have  studied  Analytical  Chemistry 
practically  for  three  months  with  a  recognised  teacher. 

6.  The  examinations  are  written,  oral,  and  practical,  and 
are  conducted  by  University  examiners  selected  by  the- 
University  Court. 

7.  The  subjects  of  the  examinations  for  the  degree  of 
Bachelor  of  Science  in  the  Department  of  Public  Health  are 
as  follows : — 

PIEST  EXAMINATION. 

1.  Chemistry. — Qualitative  analysis ;  analysis  of  air,  detection 
of  gaseous  emanations  and  other  impurities  in  the  atmosphere ; 
analysis  of  waters  for  domestic  use,  and  determination  of  the- 
nature  and  amount  of  their  mineral  and  organic  constituents  ; 
detection,  chemical  and  microscopical,  of  adulterations  in 
articles  of  food  and  drink,  and  in  drugs :  practical  examina¬ 
tion,  including  at  least  two  analytical  researches. 


Medical  Times  and  Gazette. 


DEGREES  AND  QUALIFICATIONS  IN  PUBLIC  HEALTH.  sept,  is,  ism.  327 


2.  Physics. — Elements  of  experimental  physics  ;  hydraulics 
and  hydrostatics,  in  reference  to  water-supply,  drainage,  and 
sewerage ;  pneumatics,  in  reference  to  warming  and  ventila¬ 
tion  ;  meteorology,  and  method  of  making  meteorological 
observations. 

An  oral  examination  and  an  examination  in  Practical 
Chemistry  in  the  laboratory  will  take  place  a  few  days  after 
the  written  examination. 

SECOND  EXAMINATION. 

1.  Medicine. — Origin,  nature,  and  propagation  of  epidemic 
and  contagious  diseases  ;  prevention  of  contagion  and  infec¬ 
tion  ;  endemic  diseases  and  the  geographical  distribution  of 
disease ;  insalubrious  trades ;  overcrowding  ;  epizootics,  in¬ 
cluding  pathological  changes. 

2.  Practical  Sanitation. — Duties  of  aHealth  Officerin  reference 
to  water-supply ;  insalubrious  dwellings  and  public  buildings ; 
removal  and  disposal  of  sewage  and  other  refuse  and  impuri¬ 
ties  ;  cemeteries ;  nuisances  from  manufactories,  etc. :  bad  or 
insufficient  supplies  of  food ;  outbreaks  of  zymotic  diseases ; 
quarantine ;  disinfectants  and  deodorisers ;  construction  of 
permanent  and  temporary  hospitals. 

3.  Sanitary  Law  and  Vital  Statistics. — Knowledge  of  the 
leading  sanitary  Acts  of  Parliament.  Knowledge  of  statistical 
methods  and  data  in  reference  to  population,  births,  marriages, 
and  deaths. 

4.  Mensuration  and  Mechanical  Drawing. — Plans  and  sections 
of  public  and  private  buildings,  mines,  waterworks,  and 
sewers.  The  candidate  will  be  expected  to  make  figured 
■sketches  from  models,  and  to  have  such  a  knowledge  of 
mechanical  drawing  as  will  enable  him  fully  to  understand 
engineering  plans,  sections,  and  elevations. 

Every  candidate  is  required  before  graduation  to  pay  the 
registration  fee  (£1)  as  a  member  of  the  General  Council  of 
the  University,  now  made  compulsory  by  Act  of  Parliament. 

The  written  examinations  will  take  place  in  October,  1883, 
and  March,  1884.  Candidates  who  intend  to  present  them¬ 
selves  for  examination  are  required  to  lodge  with  the  Secre¬ 
tary  of  the  Senatus  proof  of  their  being  eligible,  and  to  pay 
the  fee  on  or  before  September  28,  1883,  or  March  14,  1884. 

DOCTOR  OE  SCIENCE. 

A  Bachelor  of  Science  in  the  Department  of  Public  Health 
may,  after  the  lapse  of  one  year,  proceed  to  the  degree  of 
Doctor  in  the  same  department  on  producing  evidence  that 
he  has  been  engaged  in  practical  sanitation  since  he 
received  the  degree  of  Bachelor  of  Science,  and  on  pre¬ 
senting  a  thesis  on  some  subject  embraced  in  the  Department 
■of  Public  Health.  Every  such  thesis  must  be  certified  by  the 
candidate  to  have  been  composed  by  himself,  and  must  be 
approved  of  by  the  examiners. 

The  candidate  for  the  degree  of  D.Sc.  must  lodge  his  thesis 
with  the  Dean  of  the  Medical  Faculty  on  or  before  January  31 
in  the  year  in  which  he  proposes  to  graduate.  No  thesis  will 
be  approved  which  does  not  contain  either  the  results  of 
■original  observations  on  some  subject  embraced  in  the  exa¬ 
mination  for  B.Sc.,  or  else  a  full  digest  and  critical  exposition 
of  the  opinions  and  researches  of  others  on  the  subject  selected 
by  the  candidate,  accompanied  by  precise  references  to  the 
various  publications  quoted,  so  that  due  verification  may  be 
facilitated. 

The  fees  for  the  degrees  in  Science  in  the  Department  of 
Public  Health  shall  be — For  the  First  B.Sc.  in  Public  Health 
examination,  £5  5s. ;  for  the  Second  B.Sc.  in  Public  Health 
examination,  £5  5s. ;  for  the  degree  of  D.Sc.  in  Public  Health 
£5  5s. ;  Registration  fee,  £1 — total,  £16  15s. 

The  following  are  recommended  as  books  to  be  studied  in 
preparation  for  the  above  examinations: — E.  Parkes’  “Prac¬ 
tical  Hygiene  ”  ;  George  Wilson’s  “  Handbook  of  Hygiene  ”  ; 
Edwd.  Smith’s  “Manual  for  Public  Officers  of  Health  ”  and 
“ Handbook  for  Inspectors  of  Nuisances”  ;  Michael,  Corfield, 
and  Wanklyn’s  “  Manual  of  Public  Health,”  edited  by  E. 
Hart;  Eassie’s  “Healthy  Houses”;  Baldwin  Latham’s 
Sanitary  Engineering”  ;  Fleeming  Jenkin’s  “Healthy 
Houses”  ;  Henry  Law’s  “Rudiments  of  Civil  Engineering ” ; 
George  Monro’s  “The  Public  Health  (Scotland)  Act  ”  ;  Alex. 
Buchan’s  “  Introductory  Text-book  of  Meteorology.” 


UNIVERSITY  OF  GLASGOW. 

THE  QUALIFICATION  IN  PUBLIC  HEALTH. 

A  special  examination  will  be  held  once  in  every  year  in 
subjects  relating  to  Public  Health,  and  will  commence  on  the 


second  Tuesday  in  April.  The  examination  will  consist  of 
two  divisions,  viz. : — First  Division,  embracing  Physics, 
Chemistry,  Meteorology,  Geographical  Distribution  of  Dis¬ 
eases.  Second  Division,  embracing  State  Medicine,  Sanitary 
Law,  Vital  Statistics.  Fee  for  each  division  of  the  examina¬ 
tion,  £4  4s.  _ 

ROYAL  COLLEGE  OF  PHYSICIANS  OF  EDINBURGH. 

GENERAL  REGULATIONS. 

Candidates  shall  be  already  on  the  Medical  Register,  and  be 
entered  there  as  possessing  a  qualification  in  Medicine.  Can¬ 
didates  shall  not,  in  the  meantime,  be  required  to  attend  any 
special  courses  of  instruction ;  but  their  attention  is  directed 
particularly  to  courses  of  lectures  on  State  Medicine,  and  to 
the  practice  of  Analytical  Chemistry.  Candidates  shall  be 
subjected  to  two  examinations.  Such  examinations  may  be 
taken  simultaneously,  or  with  an  interval  not  exceeding 
twelve  months.  The  examinations  shall  be  written,  oral,  and 
practical.  The  examinations  shall  be  held  in  the  Physicians’ 
Hall,  or  elsewhere  if  found  more  convenient.  Rej  ected  can¬ 
didates  shall  not  be  admitted  for  re-examination  till  after  the 
expiry  of  six  months.  Fees  will  not  be  returned,  except  in 
the  case  mentioned  in  the  paragraph  relating  to  fees  given 
below. 

EXAMINATIONS. 

I.  The  First  Examination  shall  embrace — 1.  Physics: 
Especially  pneumatics,  hydrostatics,  hydraulics,  and .  engi¬ 
neering  in  relation  to  sanitary  operations,  including  a 
knowledge  of  architectural  and  other  plans,  sections,  etc. 
2.  Chemistry :  Especially  analysis  of  air,  water,  food,  including 
the  biology  of  putrefaction  and  allied  processes.  3.  Meteor¬ 
ology:  Including  climate,  topographical  and  seasonal  in¬ 
fluences  in  relation  to  health  and  disease. 

II.  The  Second  Examination  shall  embrace — 1.  Epidemi¬ 
ology  and  Endemiology :  Including  the  corresponding  depart¬ 
ments  in  the  diseases  of  animals  and  plants  contagious 
diseases ;  diseases  of  periods  of  life,  professions,  trades, 
seasons,  and  climates.  2.  Practical  Hygiene :  Duties  of  a 
health  officer ;  food ;  water-supply  ;  sewerage  and  drainage  ; 
construction  of  hospitals,  public  buildings,  dwellings ;  manu¬ 
factories;  cemeteries;  nuisances.  3.  Sanitary  Law  and  Vital 
Statistics. 

Meetings  for  both  examinations  shall  be  held  annually  in 
April  and  October.  The  first  examination  shall  be  held  on 
the  second  Tuesday  of  the  month,  and  shall  occupy  one  day ; 
the  second  examination  on  the  immediately  succeeding  Wednes¬ 
day  of  the  same  week,  and  shall  occupy  one  day.  Candidates 
may  enter  for  both  examinations  in  the  same  week,  or  for  one 
only.  The  examinations  must  be  passed  in  their  order,  first 
and  second.  Candidates  must  appear  for  the  second  exami¬ 
nation  not  later  than  twelve  months  after  having  passed  the 
first.  A  candidate  remitted  at  his  second  examination  will  be 
allowed  to  come  up  again  after  a  further  period  of  six  months  ; 
but  if  he  then  fail  to  pass,  he  will  be  required  again  to  undergo 
the  first  as  well  as  the  second  examination  before  obtaining 
the  certificate. 

FEES. 

No  one  shall  be  recognised  as  a  candidate  till  he  has  paid 
the  fee  for  the  first  examination.  The  fees  for  examinations 
must  be  paid  at  least  a  week  before  the  day  of  examination. 
The  whole  charges  by  the  College  for  the  certificate  amount  to 
£10  10s.  The  fee  for  the  first  examination  is  £3  3s. ;  the  fee 
for  the  second  examination  is  £3  3s. ;  the.  fee  payable  before 
receiving  the  certificate  is  £4  4  s.  Candidates  forfeit  the  fee 
for  the  examination  which  they  have  been  unsuccessful  in 
passing.  If  a  candidate  who  has  offered  himself  for  both 
examinations  fail  to  pass  the  first,  he  shall  not  be  allowed  to 
present  himself  for  the  second,  and  his  fee  for  the  second  shall 
be  returned  to  him.  _ _ _ 

ROYAL  UNIVERSITY  OF  IRELAND. 

THE  DIPLOMA  IN  SANITARY  SCIENCE. 

This  diploma  will  be  conferred  only  on  graduates  in 
Medicine  of  the  University.  . 

Candidates  must  give  notice,  in  writing,  to  the  Secretaries 
of  their  intention  to  present  themselves,  and  must  pay  the 
prescribed:  ee  of  £2  at  least  one  month  previous  to  the 
examination. 

The  examination  will  embrace  the  following  subjects 
1  Climate  :  A  general  knowledge  of  meteorological  conditions ; 


323 


Medical  Times  and  Gazette. 


PHARMACEUTICAL  CHEMISTRY. 


Sept.  15, 1882. 


the  reading  and  correction  of  instruments,  and  tabulating 
the  results  of  meteorological  observations.  Chemistry: 
Constitution  of  the  atmosphere  ;  pure  and  impure  waters  ; 
food.  Geology :  The  character  and  structure  of  roots  with 
reference  to  water-supply  and  drainage.  Physics :  Laws  of 
heat ;  mechanics,  pneumatics,  hydrostatics,  and  hydraulics, 
or  sanitary  engineering.  The  construction  of  dwellings, 
barracks,  hospitals,  schools,  factories,  etc.,  in  accordance 
with  the  principles  of  warming,  ventilation,  drainage, 
water-supply,  etc.  Vital  Statistics.  Hygiene,  including 
the  causation  and  prevention  of  disease.  Sanitary  Law. 

The  examination  in  Chemistry  will  include  a  practical 
part  on  the  chemical  and  microscopical  examination  of  air, 
water,  food,  poisonous  substances  used  in  manufactures,  etc. 

The  examination  in  Physics  will  embrace  the  reading  of 
plans,  sections,  scales,  etc.,  in  connexion  with  buildings, 
sanitary  constructions,  etc. 


UNIVERSITY  OF  DUBLIN. 

Doctors  of  Medicine,  or  graduates  in  Medicine  and  Sur¬ 
gery,  who  wish  to  obtain  from  the  University  a  certificate 
in  State  Medicine  can  do  so  on  passing  an  examination 
in  a  limited  course  of  the  following  subjects : — 1.  Law  ; 
2.  Engineering;  3.  Morbid  Anatomy ;  4.  Vital  and  Sanitary 
Statistics  ;  5.  Chemistry;  6.  Meteorology;  7.  Medical  Juris¬ 
prudence  ;  8.  Hygiene.  Candidates  must  send  in  their 
names  to  the  Medical  Registrar  at  the  least  a  wqek  before 
the  first  day  of  examination. 


KING  AND  QUEEN’S  COLLEGE  OF  PHYSICIANS 
IN  IRELAND. 

THE  CERTIFICATE  IN  SANITARY  SCIENCE. 

Every  candidate  for  the  certificate  in  Sanitary  Science 
must  be  a  Licentiate  in  Medicine  of  the  College,  and  must 
return  his  name  to  the  Registrar  of  the  College  a  week 
before  the  examination,  and  lodge  with  him  a  testimonial 
of  character  from  a  Fellow  or  Member  of  the  College,  or 
from  a  Fellow  of  the  Royal  Colleges  of  Physicians  or 
Surgeons  of  London,  Edinburgh,  or  Dublin.  The  examina¬ 
tion  comprises  the  following  subjects  : — 1.  Etiology  and 
Prevention  of  Disease :  epidemiology  ;  infection  ;  heredi¬ 
tary  influence ;  accommodation  and  conveyance  of  the 
sick ;  hospitals,  and  their  management.  2.  Engineering :  in¬ 
cluding  hospital  and  house  construction  ;  sewage ;  drainage  ; 
ventilation;  water  supply.  3.  Law:  The  Acts  relating  to 
public  health ;  duties  of  health  officers.  4.  Chemistry :  with 
special  reference  to  air,  water,  and  food.  5.  a.  Meteorology 
and  Climatology ;  b.  Vital  Statistics. 

Stated  examinations  for  the  certificates  in  Sanitary 
Science  are  held  quarterly  on  the  Thursday  and  Friday 
following  the  first  Friday  of  the  months  of  January,  April, 
July,  and  October. 

The  fee  for  the  examination  is  £5  5s. 


PHARMACEUTICAL  CHEMISTRY. 


PHARMACEUTICAL  SOCIETY  OF  GREAT  BRITAIN  • 
SCHOOL  OF  PHARMACY. 

The  session  will  commence  on  October  1,  1883,  and  extend 
to  July  27,  1884. 

Lectures  on  Chemistry  and  Pharmacy  will  be  delivered  by 
Professor  Redwood  on  Monday,  Tuesday,  and  Wednesday 
mornings  at  nine  o’clock,  commencing  on  Monday,  October  1. 
The  course  consists  of  sixty  lectures,  comprising  an  exposition 
of  the  leading  principles  and  doctrines  of  the  science  of 
Chemistry,  and  of  those  branches  of  allied  physical  science, 
the  applications  of  which  are  involved  in  the  highest  qualifica¬ 
tions  required  for  the  practice  of  Pharmacy.  There  will  be 
two  of  these  courses  during  the  session — the  course  which 
commences  in  October  and  ends  in  February  being  repeated, 
with  additions,  in  the  following  five  months.  Each  course 
will  be  complete  in  itself,  and  will  include  a  description  of  all 
the  most  important  chemical  and  Galenical  preparations  used 
in  medicine,  which  will  be  fully  illustrated  with  experiments, 
diagrams,  and  specimens.  With  the  view  of  connecting  the 
instruction  provided  at  the  lectures  with  the  practical  teaching 
in  the  laboratories,  the  Demonstrator  of  Practical  Chemistry 
will  conduct  the  after-lecture  examinations. 

Lectures  on  Botany  and  Materia  Medica  by  Professor 


Bentley,  on  Thursday,  Friday,  and  Saturday  mornings  at 
nine  o’clock,  commencing  Friday,  October  5.  Daring  the 
session  two  courses  of  lectures  will  be  delivered,  each  con¬ 
sisting  of  sixty  lectures.  The  first  course,  extending  from 
October  to  the  end  of  February,  will  comprise  Botany  and 
Materia  Medica,  with  especial  reference  to  Structural  Botany,, 
and  the  use  of  the  microscope  in  distinguishing  the  various 
drugs;  and  the  second  course,  which  commences  in  March 
and  extends  to  the  end  of  July,  will  also  comprise  Botany 
and  Materia  Medica,  with  especial  reference  to  Systematic 
and  Practical  Botany.  Each  course  will  be  complete  in  itself, 
although  each  will  have  a  definite  object  in  view.  Tim 
portion  of  the  second  course  on  Systematic  and  Practical 
Botany,  consisting  of  twenty  lectures,  commences  in  May  and 
ends  in  July.  Separate  entries  may  be  made  for  this  portion. 

The  Laboratories  for  the  study  of  Practical  Chemistry  will 
be  opened  on  Monday,  October  1,  at  10  a.m.,  under  the  direc¬ 
tion  of  Professor  Attfield,  assisted  by  the  Demonstrator  of 
Practical  Chemistry,  Mr.  Wyndham  R.  Dunstan,  F.C.S.,  and 
an  Assistant-Demonstrator,  Mr.  F.  W.  Short.  The  Labora¬ 
tories  are  fitted  up  with  every  convenience  for  the  study  of 
the  principles  of  Chemistry  by  personal  experiment.  They 
are  specially  designed  for  the  study  of  Pharmacy,  but  are  also 
well  adapted  for  the  acquirement  of  a  knowledge  of  Chemistry 
in  its  application  to  manufactures,  analysis,  and  originaL 
research.  There  is  no  general  class  for  simultaneous  instruc¬ 
tion,  each  student  following  an  independent  course  of  study 
always  determined  by  his  previous  knowledge ;  pupils  can 
therefore  enter  for  any  period  at  any  date.  A  complete  course 
of  instruction,  including  the  higher  branches  of  Quantitative 
Analysis,  occupies  ten  full  months,  and  dates  from  the  day  of 
entry  to  that  day  twelvemonth.  The  Laboratories  are  open 
daily.  Vacation  months,  August  and  September. 

Prospectuses  and  farther  particulars  may  be  had  of  the 
Professors  or  their  assistants,  17,  Bloomsbury-square,  W.C. 


EDUCATIONAL  VACCINATION  STATIONS- 

In  order  to  provide  for  the  granting  of  those  special  certifi¬ 
cates  of  proficiency  in  vaccination  which  are  required  to  be 
part  of  the  medical  qualification  for  entering  into  contracts, 
for  the  performance  of  Public  Vaccination,  or  for  acting  as 
deputy  to  a  contractor,  the  following  arrangements  are 
made  : — 

1.  The  Vaccination  Stations  enumerated  in  the  subjoined  list  are  open, 
under  certain  specified  conditions,  for  the  purpo-es  of  teaching  and 
examination. 

2.  The  Public  Vacjinators  officiating  at  these  stations  are  authorised, 
to  give  the  required  certificates  of  proficiency  in  vaccination  to  persons 
whom  they  have  sufficiently  instructed  therein  ;  and 

3.  The  Pnblic  Vaccinators  whose  names  in  the  subjoined  list  are 
printed  in  italic  letters  are  also  authorised  to  give  such  certificates,  after 
satisfactory  examination,  to  persons  whom  they  have  not  themselves 
instructed : — 

London. — Principal  Station— Surrey  Chapel,  Blackfriars-road  :  Dr. 
Robert  Corg,  who  attends  on  Tuesday  and  Thursday,  at  2  p.m.  North¬ 
west  Stations -Marylebone  General  Dispensary,  77,  Welbeck-street 
Mr.  William  A.  Sumner,  on  Tuesday,  at  2  p.m. ;  Hall  of  the  Working- 
Men’s  Christian  Association,  Omega-place,  Alpha-road :  Mr.  William 
A.  Sumner,  on  Wednesday,  at  10  a.m.  West  Station— 9.  St.  George's- 
road,  Pimlico,  S.W.  :  Mr.  Edward  Lowe  Webb,  on  Thursday,  at  10  a.m. 
East  Station  —Eastern  Dispensary,  Leman-street :  Mr.  Charles  T.  Black¬ 
man,  on  Wednesday,  at  11  a.m.  North  Station— Tottenham-court 
Chapel.  Tottenham-court-road :  Mr.  William  Edwin  Grindley  Pearse, 
on  Monday  and  Wednesday,  at  1  p.m.  South-west  Station — 2,  Regent- 
place,  Horseferry-road :  Mr.  William  Edwin  Grindley  Pearse,  on  Tuesday, 
at  2  p.m.  Strand  Station -14,  Rnssell-street,  Covent-garden  :  Mr.  Robert 
William  Dunn,  on  Thursday,  at  11  a.m.  South-east  Station— Vestry  Hall, 
St.  John’s,  Horselydown  :  Mr.  John  Gittins,  on  Monday,  at  2  p.m.  St. 
Thomas’s  Hospital:  Dr.  Robert  Cory,  on  Wednesday,  at  11  30  a.m. 

Birmingham. — St.  Jude’s  School-room,  Hill-street,  near  SmalToank- 
street,  on  Monday,  at  11  a.m. ;  the  Assembly  Rooms,  103,  Constitution- 
hill,  opposite  Bond-street,  on  Tuesday,  at  llam.;  the  Wesleyan  Methodist 
Infant  School-room,  Monument-road,  on  Wednesday,  at  11  a.m.  ;  the- 
Wesleyan  School-room,  Peel-street,  Winsou-green-road,  on  Wednesday, 
at  2  p.m.;  and  “  The  British  Workman”  Reading  Rooms,  Sherborne- 
street,  near  Grosvenor-street,  on  Thursday,  at  11  a.m.  :  Dr.  Edmund. 
Robinson. 

Bristol. — The  Public  Vaccination  Station,  Peter-street :  Mr.  Henry 
Lawrence,  on  Wednesday,  at  10  a.m. 

Exeter. — The  Dispensary,  Castle-street:  Mr.  William  A.  Budd,  on 
Thursday,  at  3  p.m. 

Leeds. — Heed-street :  Mr.  Frederick  Holmes,  on  Tuesday,  at  2.30  p.m. 

Liverpool. — St.  Mary’s  School-room,  Edgehiil,  West  Derby  :  Mr.  Roger 
Parker,  on  Thursday,  at  2.30  p.m. 

Manchester. — 72,  Rochdale-road :  Mr.  Ellis  Southern  Quest,  on  Monday, 
at  2  p.  m. 

Newoastle-ttpon-Tvnk. — The  Central  Vaccination  Station,  21,  Nun- 
street  :  Mr.  John  Hawthorn,  on  Wednesday,  at  3  p.m. 

Sheffield. —The  Public  Vaccination  Station,  Tow  ahead-street :  Mr. 

William  Skinner,  on  Tuesday,  at  3  p.m. 

•  Edinburgh.— Bpyal  Dispensary:  Dr.  William  Husband,  on  Wednesday 


Medical  Times  and  Gazette. 


SPECIAL  INSTRUCTION. 


Sept.  15,  1883.  329 


and  Saturday,  at  12.  The  New  Town  Dispensary :  Dr.  James  0.  Affleck, 
on  Wednesday  and  Saturday,  at  1. 

Glasgow. — The  Hall  of  the  Faculty  of  Physiciins  and  Surgeons:  Dr. 
Hugh  Thomson,  on  Monday,  at  12.  The  Royal  Infirmary  :  Dr.  Robert 
Dunlop  Tannahill,  on  Monday  and  Thursday,  at  12.  The  Western  In¬ 
firmary  :  Dr.  David  Caldwell  McVail,  on  Monday,  at  1  p.m. 

Candidates  for  the  Certificate  by  Examination  are  recom¬ 
mended  to  communicate  some  days  beforehand  with  the 
Examiner  at  whose  station  they  propose  to  attend. 


SPECIAL  INSTRUCTION. 


SCHOOLS  AND  OTHER  PLACES  OF  GENERAL 
AND  SPECIAL  INSTRUCTION. 


Besides  the  regular  Schools  with  their  various  departments, 
there  are  many  other  institutions — devoted,  some  of  them,  to 
special  purposes — where  students  and  practitioners  may  acquire 
a  sound  knowledge  of  various  subjects  which  hardly  enter  into 
the  ordinary  curriculum.  We  have  already  indicated  that  in 
the  plan  of  studies  the  student  may  avail  himself  of  a  year  at 
the  beginning  or  at  the  end  for  such  purposes.  If  at  the 
beginning,  we  could  not  do  better  than  advise  him  to  take  a 
session  at  the  Royal  School  of  Mines  (now  the  Natural 
Science  Department  at  South  Kensington),  studying  especially 
Chemistry  and  Natural  History,  the  value  of  which  we  have 
already  inculcated.  If  he  takes  the  year  at  the  end,  then  such 
special  studies  as  Eye  Diseases,  Skin  Diseases,  Lunacy,  Diseases 
of  Women  and  Children,  may  well  engage  his  attention.  These 
may,  as  a  rule,  be  studied  in  connexion  with  his  school ;  or,  if 
a  wider  field  is  desired,  in  some  one  or  other  of  the  following 
institutions  :  — 

Preliminary. 


NORMAL  8CH00L  OF  SCIENCE  AND  ROTAL  SCHOOL  OF  MINES. 
Department  of  Science  and  Art. 

During  the  session  1883-81,  which  will  commence  on  October  l,the 
following  courses  of  lectures  and  practical  demonstrations  will  be  given  : 


Mechanics — Mr.  Goodeve. 
Chemistry — Dr.  E.  Frankland. 
Geology— Mr.  John  W.  Judd. 


Metallurgy — Mr.  W.  Chandler  Ro¬ 
berts. 

Biology— Professor  T.  H.  Huxley. 


Physics — Dr.  Frederick  Guthrie. 

The  lecture  and  laboratory  fees  are  as  follows : — Chemistry,  Part  I  , 
lectures  £4,  laboratory  £13  ;  Part  II..  lectures  and  laboratory,  £15;  Part 
III.,  lectures  and  laboratory,  £15.  Physics,  Part  I.,  lectures  £5,  labora¬ 
tory  £12  ;  Part  II.,  lectures  and  laboratory,  £12  ;  Part  III.,  lectures  and 
laboratory,  £12.  Biology  with  Botany,  Part  I.,  lectures  £4,  laboratory  £8  ; 
Part  II.,  lectures  and  laboratory,  £8  ;  Part  III.,  lectures  and  laboratory, 
£4  ;  Part  IV.,  lectures  and  laboratory,  £8.  Geology  (Parts  I.,  II.,  and 
III.)  with  Mineralogy,  Part  I.,  lectures  £4,  (a)  laboratory  £8  ;(a)  Part  IV., 
lectures  and  laboratory,  £8.  Mechanics,  Part  I.,  lectures  £4,  laboratory 
£6  ;  Part  II.,  lectures  and  laboratory,  £8  ;  Part  III.,  lectures  and  labora¬ 
tory,  £8.  Metallurgy,  Part  I.,  lectures  £2,  laboratory  £' 3 ;  Part  II., 
lectures  and  laboratory,  £15. 

Students  who  do  not  wish  to  attend  the  lectures  are  admitted  for  short 
periods  to  the  laboratories,  at  the  discretion  of  the  Professors.  The  fees 
for  the  laboratories  are  £4  per  month.  Admission  is  granted  to  persons 
desirous  of  attending  certain  courses  of  the  lectures  without  the  labora¬ 
tory  instruction,  on  payment  of  the  lecture  fees. 


SOUTH  LONDON  SCHOOL  OF  CHEMISTRY  AND  PHARMACY, 
325,  Kennington-road,  and  Central  Public  Laboratory, 
Kennington-cross,  S  E.— Director — Dr.  Muter. 

FOURTEENTH  SESSION— If 83-84. 

Daily  lectures  in  Classics,  Chemistry,  Physics,  Botany,  Mateiia  Medica. 
and  Pharmacy.  Laboratory  open  for  Practical  Chemistry  from  ten  till 
five.  Special  instruction  for  Medical  Officers  of  Health  in  Water,  Air, 
Gas,  and  Food  Analysis.  For  fees,  etc.,  apply  to  W.  Baxter,  Secretary, 
Laboratory,  Kennington-cross,  S.E. 


LONDON  SCHOOL  OF  MEDICINE  FOR  WOMEN, 

30,  Henrietta-street,  Brunswick-square,  W.C. 

(In  Association  with  the  Royal  Free  Hospital,  Gray’s-inn-road.) 


LECTURERS. 


Anatomy— Mr.  Stanley  Boyd. 
Physiology — Dr.  Augustus  Waller. 
Chemistry — Mr.  Heaton. 

Botany — Dr.  P.  H.  Stokoe. 

Materia  Medica— Dr.  Samuel  West 
Practice  of  Medicine  — Dr.  H.  Don¬ 
kin  and  Mrs.  Garrett- Anderson, 
M.D. 

Midwifery  and  Diseases  of  Women 
—Dr.  Ford  Anderson  and  Dr. 
Louisa  Atkins. 

Forensic  Medicine  —  Dr.  Dupr<5, 
F.  R.S  ,  and  Mr.  Bond. 

Surgery— Mr.  A.  T.  Norton. 


[  Clinical  Medicine — Dr.  Cockle  and 
Dr.  Buchanan  Baxter. 

Hygiene — Dr.  Sophia  Jex  Blake  and 
Dr.  Edith  Pechey. 

1  Clinical  Surgery— Mr.  F.  J.  Gant 
and  Mr.  W.  Rose. 

Ophthalmic  Surgery— Mr.  J.  Adams. 

Mioor  Surgery — Mr.  James  Shuter, 
M.B. 

Tutorial  Class  for  Auscultation  and 
Percussion — Dr.  Samuel  West. 

Pathology  — Dr.  Allen  Sturge. 

Mental  Pathology— Dr.  Sankey. 

Comparative  Anatomy — Dr.  Murie. 


Dean  of  the  School— Mrs.  Garrett- Anderson,  M.D. 

(a)  These  fees  include  also  those  for  Parts  II.  and  III.  of  Geology. 


The  Winter  Session  of  1883-84  will  commence  on  October  1,  and  will 
comprise  classes  in  Anatomy,  Physiology,  Chemistry.  Practice  of  Medicine, 
Midwifery  and  Diseases  of  Women,  and  Practical  Anatomy  with  Demon¬ 
strations.  Clinical  instruction  will  be  given  at  the  Royal  Fiee  Hospital, 
and  will  include  lectures  on  Clinical  Medicine,  Clinical  Surgery,  Hospital 
Attendance,  and  Pathological  Demonstrations.  Separate  eliniques  are 
held  for  the  treatment  of  the  Diseases  of  Women  under  Dr.  W.  Hayes,  and 
for  Ophthalmic  Surgery  under  Mr.  Grosvenor  Mackinlay.  Dressers,  Clinical 
Clerks,  and  a  Pathological  Registrar  will  be  selected  from  among  the  senior 
students. 

The  Royal  Free  Hospital  contains  150  bads.  The  staff  ar e— Physicians, 
Dr.  Cockle  and  Dr.  B  Baxter ;  Assistant-Physician,  Dr.  Samuel  West ; 
Surgeons,  Mr.  Gant  and  Mr.  W.  Rose  ;  Assistant-Surgeon,  Mr.  J.  Shuter; 
Physician  for  Di-eases  of  Women.  Dr.  T.  C.  Hayes ;  Ophthalmic  Surgeon, 
Mr.  G.  Mackinlay;  Pathological  Demonstrator,  Dr.  S.  West. 

An  Entrance  Scholarship,  value  £30,  is  competed  for  annually. 

Fees  for  ordinary  curriculum  of  uon-clinical  lectures  £80,  or  £40  the 
first  year,  £30  the  second,  and  £15  the  third.  Fees  for  clinical  instruction 
and  lectures  for  four  years  £41,  or  £20  the  first  year,  £15  the  second  year, 
and  £15  the  third,  the  fourth  being  free.  Apply  for  information  to  the 
Dean,  or  to  the  Hon.  Sec.,  Mrs.  Thorne. 


MR  THOMAS  COOKE'S  SCHOOL  OF  ANATOMY,  PHYSIOLOGY 
AND  SURGERY. 

This  School  is  intended  to  meet  the  requirements  of  two  distinct  classes 
of  students— i.e.  (1)  advaaced  students  and  qualified  practitioners,  who 
may  wish  either  to  extend  their  knowledge  of  the  foregoing  subjects,  or 
to  recall  to  mind  what  they  once  knew  and  have  since  forgotten ,  (2)  be¬ 
ginners  entering  upon  their  medical  studies  by  a  short  term  of  apprentice¬ 
ship.  For  the  former,  rapid  advanced  classes,  complete  in  three  months, 
but  still  thoroughly  practical,  are  provided;  and  for  the  latter,  when 
required,  more  elementary  classes  of  six  months’  duration.  For  pro¬ 
spectus  of  particulars  and  terms,  apply  to  Mr.  Thomas  Cooke’s  private 
address,  16,  Woburn-place,  Russell-square,  W. 


THE  MASON  SCIENCE  COLLEGE,  BIRMINGHAM. 

This  College  has  been  appointed  a  local  centre  for  the  following  exami¬ 
nations  required  by  the  University  of  London:  viz.,  for  the  Intermediate 
Examinations  in  Arts  and  Science,  aud  the  Preliminary  Scientific  (M.B.). 

SCIENCE  DEPARTMENT. 

Pure  and  Applied  Mathematics.—  The  subjects  taught  in  the  several 
classes  will  meet  the  requirements  of  the  Matriculation,  the  Intermediate 
Pass  Examination  in  Science,  and  the  B.Sc.  (Branches  1  and  2)  Examina¬ 
tion  of  the  University  of  London. 

Also  in  Physics,  Chemistry,  Organic  Chemistry,  Zoology,  Comparative 
Anatomy  and  Botany,  candidates  for  the  Intermediate  Examination  in 
Science,  Preliminary  Scientific  (M.B.),  and  B  Sc.  Examination  of  the 
University  of  London  will  be  able  to  obtain  the  instruction  necessary. 
Courses  of  lectures  are  given  on  Human  Physiology,  including  Microscopic 
Anatomy.  Practical  Physiology  is  trught  in  the  summer  term.  Each 
student  tests  for  the  most  important  constituents  of  the  blood,  biie, 
urine,  milk,  etc. ;  and  is  taught  the  practical  use  of  some  of  the  more 
important  physiological  apparatus,  such  as  the  cardiograph,  spbygmo- 
graph,  ophthalmoscope,  and  laryngoscope. 

All  information  as  to  classes,  fees,  etc.,  can  be  obtained  by  application 
to  the  Secretary  at  the  College. 


LONDON. 

General  Hospitals. 

GREiT  NORTHERN  HOSPITAL, 

Caledonian-road. 

Consulting  Surgeon  -Mr.  F.  Le  Gros  Clark,  F.R.S. 

Physicians — Dr.  Cholmeley,  Dr.  R.  Bridges,  Dr.  Cook,  Dr.  Burnet, 
Dr.  Clifford  Beale. 

Obstetric  Physician— Dr.  Gustavus  C.  P.  Murray. 

Assistant  Obstetric  Physician — Dr.  Fancourt  Baines. 

Diseases  of  the  Eye— Mr.  R.  Jennings  Milles. 

Surgeons— Mr.  Gay,  Mr.  W.  Adams,  Mr.  W.  Spencer  Watson, 
Mr.  J.  Macready,  Mr.  C.  B.  Lockwood. 

Aural  Surgeon — Mr.  A.  E.  Cumberbatch. 

Dental  Surgeon — Mr.  E.  Keen. 

Chloroformist— Mr.  G.  Eastes.  House-Surgeon— Mr.  H.  G.  Ashwell. 

Junior  Resident  Medical  Officer — Mr.  Gandevia. 

Dispenser — Mr.  Marks. 


WEST  LONDON  HOSPITAL, 
Hammersmith-road,  W., 

By  a  recent  enlargement  has  now  100  beds.  In  1882  (47  beds),  678  in¬ 
patients,  13,503  out-patients.  There  are  two  appointments  of  House- 
Surgeon,  each  tenable  for  six  months,  salary  £80  per  annum  (no  board); 
a  new  one  of  Registrar,  honorarium  £25  per  annum;  also  appointment 
for  a  limited  number  of  Clinical  Assistants. 

Consulting  Physician — Dr.  Henry  Maudsley. 

Consulting  Physician  Accoucheur — Dr.  W.  O.  Priestley. 
Consulting  Surgeons— Mr.  Samuel  Armstrong  Lane,  Mr.  William  Bird, 
Mr.  William  F.  Teevan. 

Physicians — Dr.  G.  Goddard  Rogers,  Dr.  J.  C.  Thorowgood, 

Dr.  D.  W.  C.  Hood. 

Physician  for  Diseases  of  Women — Dr.  Alfred  Wiltshire. 
Surgeons— Mr.  Alfred  Cooper,  Mr.  C.  B.  Keetley.  Mr.  F.  Swinford  Edwards. 
Surgeon  for  Diseases  of  the  Eye— Mr.  B.  J  Vernon. 
Assistant-Pnysicians  -  Dr.  P.  D.  Drewitt,  Dr.  W.  P.  Herringham.  (b) 
Assistant-Physician  for  Diseases  of  Women — Dr.  A.  J.  Venn. 
Assistant-Surgeons— Mr.  W.  Bruce  Clarke,  Mr.  A.  Boyce  Barrow, 

Mr.  C.  A.  Ballance. 

Surgeon-Dentist — Mr.  A.  S.  Underwood. 

Administrator  of  Anse-thetics— Mr.  T.  Gunton  Alderton. 
Resident  Medical  Officers— Mr.  Harfid  Hendley,  Mr.  H.  H.  Tayler. 
Secretary — Mr.  R.  J  Gilbert. 

(bi  An  election  for  one  Assistant- Physicianship,  now  vacant,  will  take 
place  on  October  1. 


330 


Medical  Times  and  Gazette. 


SPECIAL  INSTRUCTION. 


Sept.  15, 1883. 


SEAMEN’S  HOSPITAL  (late  Dreadnought),  GREENWICH,  S.E. 

Consulting  Physicians— Dr.  Robert  Barnes,  F.R.C.P., 
and  Dr.  Richard  Quain,  F.  R.C.P. 

Visiting  Physicians  — Drs.  John  Curnow,  F.R.C.P., 
and  R.  E.  Carrington,  M. R.C.P. 

Consulting  Surgeon — Mr.  George  Busk,  F. R.C.S.,  F.R.S. 
Visiting  Surgeon— Mr.  G.  Robertson  Turner,  F.R.C.S. 
Medical  Officer,  Well-street  Dispensary— Mr.  E.  Muirhead  Little. 
Principal  Medical  Officer — Mr.  W.  Johnson  Smith,  F.R.C.S. 
Secretary — Mr.  W.  Thomas  Evans. 


VICTORIA  HOSPITAL  FOR  CHILDREN, 
Queen’s-road,  Chelsea  ;  and  Churehfields,  Margate. 


Physicians — Dr.  Julian  Evans  and 
Dr.  T.  Ridge  Jones. 

Physicians  to  Out-Patients  —  Dr. 
Grigg,  Dr.  A.  Venn,  Dr.  T.  Cfficott 
Fox,  Dr.  F.  Dawtrey  Drewett. 
Surgeon — Mr.  George  Cowell. 


Surgeons  to  Out-Patients— Mr.  F. 

Churchill,  Mr.  Walter  Pye. 
Dental-Surgeon— Mr.  Francis  Fox. 
Registrar — Mr.  T.  F.  Hugh  Smith. 
House-Surgeon — Mr.  J.  Alexander 
Shaw. 


Secretary — Captain  Blount,  R.  N. 


Special  Hospitals. 

CITV  OF  LONDON  HOSPITAL  FOR  DISEASES  OF  THE  CHEST, 

Victoria-park. 

Honorary  Consulting  Physician— Sir  J.  Risdon  Bennett,  M.D.,  F.R.S. 
Consulting  Physicians — Dr  E,  L.  Birkett,  Dr.  J.  Andrew,  and 
Dr.  J.  C.  Thorowgood. 

Consulting  Surgeon— Mr.  John  Eiic  Erichsen. 

Physicians— Dr.  Eustace  Smith,  Dr.  J.  B.  Berkart,  Dr.  J.  M.  Fothergill, 
and  Dr.  Samuel  West. 

Assistant-Physicians— Dr.  G.  A.  Heron,  Dr.V.  D.  Harris,  Dr.  J.  A.Ormerod, 
Dr.  E.  Clifford  Beale,  Dr.  Jas.  Anderson,  and  Dr.  B.  Fenwick. 
Resident  Medical  Officer— Mr.  Theodore  H.  Waller,  M.R.C.S.,  L.R.C.P. 


HOSPITAL  FOR  CONSUMPTION  AND  DISEASE3  OF  THE  CHEST, 

BROMPTON. 

(Number  of  beds,  192 ;  and  137  in  new  Extension  Building.) 

Consulting  Physicians— Dr.  C.  J.  B.  Williams,  Dr.  W.  H.  Walshe, 

Dr.  Richard  Quain,  and  Dr.  James  E.  Pollock. 

Consulting  Surgeon — Prof.  John  Marshall 
Physicians — Dr.  E.  Symes  Thompson,  Dr.  C.  Theodore  Williams, 

Dr.  R.  Douglas  Powell,  Dr.  John  Tatham,  Dr  Reginald  E.  Thompson,  and 
Dr.  Frederick  T.  Roberts. 

Assistant-Physicians— Dr.  T.  H.  Green,  Dr.  J.  M.  Bruce.  Dri  J.  Kingston 
Fowler,  Dr.  Percy  Kidd,  Dr.  Cecil  Y.  Biss,  and  Dr.  David  King. 
Pathologist — Dr.  Percy  Kidd 
Dental  Surgeon— Mr.  Charles  J.  Noble. 

Resident  Medical  Officer — Mr.  Frederick  J.  Hicks,  M.B.,  M.  A.,  F.C.S. 
Secretary— Mr.  Henry  Dobbin. 

The  clinical  practice  of  this  Hospital  is  open  to  students  of  Medicine 
and  practitioners.  Fee  for  three  months,  £3  3s.  ;  six  months,  £5  5s.  ; 
perpetual,  £10  10s. 

A  course  of  clinical  instruction  in  Auscultation  will  be  given  by  the 
medical  officers. 

Certificates  of  attendance  on  the  medical  practice  of  this  Hospital  are 
recognised  by  the  University  of  London,  the  Apothecaries’  Society,  and  by 
the  Army,  Navy,  and  Indian  Boards. 


HOSPITAL  FOR  DISEASES  OF  THE  THROAT  AND  CHEST, 
32,  Golden -square,  W. 

Outpost — 7,  Newington-butts,  S.E. 

Physicians— Dr.  Morell- Mackenzie,  Dr.  Semple,  Dr.  Prosser  James, 
and  Dr.  W.  MacNeiil  Whistler. 

Surgeons— Mr.  Edward  Woakes  and  Mr.  T.  Mark  Hovell. 
Dental  Surgeon — Mr  Oakley  Coles. 

Resident  Medical  Officer — Mr.  Edward  Law. 

Secretary— G.  C.  Witherby. 


BELGRAVE  HOSPITAL  FOR  CHILDREN 
79,  Gloucester-street,  Warwick- square,  S.W. 


HONORARY  MEDICAL  STAFF. 

Consulting  Physician— Sir  W.  W.  Gull,  Bart.,  M.D. 
Physicians  -  Dr.  W  Hope  and  Dr.  W.  Ewart. 
Surgeons— Mr.  W.  Bennett  and  Mr.  C.  Dent. 
House-Surgeon— Mr.  A.  Grayling. 


EAST  LONDON  HOSPITAL  FOR  CHILDREN 
DISPENSARY  FOR  WOMEN, 
Shadwell,  E. 


AND 


Consulting  Physicians — Dr.  Barnes 
and  Sir  Andrew  Clark,  Bart. ,  M.  D. 
Physicians— Dr.  Eustace  Smith  and 
Dr.  Horatio  B.  Donkin. 
Assistant-Physicians— Dr.  Warner 
and  Dr.  Crocker. 

Administrator  of  Anaesthetics— Mr. 
Thomas  Bird. 


Consulting  S  urgeon — Mr.  B.  Shillitoe. 
Consulting  Ophthalmic  Surgeon — 
Mr.  George  Cowell. 

Surgeons— Mr.  A,  Caesar.  Mr.  H.  A. 

Reeves,  and  Mr.  R.  W.  Parker. 
House-Surgeon  —  Mr.  J.  Scott 
Battams. 

Secretary— Ashton  Warner. 


The  Hospital  contains  92  beds,  besides  10  beds  in  an  Infirmary  for 
nurses  and  children  who  require  isolation.  The  Hospital  is  open  free  to 
patients.  _ 


THE  ROYAL  HOSPITAL  FOR  CHILDREN  AND  WOMEN, 
Watei'loo-bridge-road. 

Consulting  Physicians — Dr.  Samuel  Wilks,  Dr.  John  Williams,  and 
Dr.  G.  Vivian  Poore. 

Consulting  Surgeons— Mr.  J.  Cooper  Forster  and  Mr.  Edwin  Canton. 


Physicians  — Dr.  William  Park,  Dr. 
George  Roper,  and  Dr.  George 
Gulliver. 

Surgeon-Dentist— Mr.  W  alter  White- 
house. 


Surgeon — Mr.  W.  H.  A.  Jacobson. 
Assistant-Surgeo  n — Mr .  E.  O  v  er man 
Day 

Resident  Medical  Officer— Mr.  J.  F. 
Briscoe. 


Secretary— Mr.  R.  G.  Kestin. 


THE  HOSPITAL  FOR  WOMEN, 

Soho-square,  W. 

Physicians— Dr.  Protheroe  Smith,  Dr.  Hey  wood  Smith,  Dr.  Carter, 
Dr.  R.  T.  Smith. 

Surgeon — Mr.  Henry  A.  Reeves. 
Assistant-Physicians— Dr.  Holland,  Dr.  Mansell-Moulliu, 

Dr.  Bedford  Fenwick. 

Surgeon-Dentist -Mr.  Frederic  Canton. 
Administrator  of  Anaesthetics— Mr.  Thomas  Bird. 
Pathologist  and  Curator  of  Museum— Dr.  Bedford  Fenwick. 
Secretary— David  Cannon. 


CENTRAL  LONDON  THROAT  AND  EAR  HOSPITAL, 
Gray’s-inn-road,  W.O. 

Consulting  Surgeon — Mr.  Sydney  Jones  F.R  C.S. 
Surgeons— Mr.  Lennox  Browne,  Dr.  Llewelyn  Thomas, 
Mr.  Francis  Hamilton. 

Assistant-Surgeons — Dr.  Arthur  Orwin,  Dr.  Dundas  Grant. 
Defects  of  Speech -Mr.  William  Van  Praagh. 

Dental  Surgeon— Mr.  George  Wallis. 
Chloroformist — Dr.  James  Murray. 

Registrar  and  Pathologist — Mr.  Percy  Jakins. 
Secretary— Mr.  Richard  Kershaw. 


THE  HOSPITAL  FO 
48  and  49,  Great  Ormond-street,  W. 

Physicians — Dr.  Dickinson,  Dr. 

Gee,  and  Dr.  W.  B.  Cheadle. 
Assistant-Physicians  —  Dr.  R.  J. 
Lee,  Dr.  O.  Sturges,  Dr.  Thomas 
Barlow,  Dr.  D.  B.  Lees,  Dr. 
Lubbock. 

Surgeons — Mr.  Thomas  Smith  and 
Mr.  Howard  Marsh. 

125  beds.  In-patients,  1882, 1025. 
practice  of  the  Hospital,  in  both  in- 
at  nine  every  morning. 


I  SICK  CHILDREN, 

1,  and  Cromwell  House,  Highgate. 

Assistant-Surgeons — Mr.  Edmund 
Owen  and  Mr.  J.  H.  Morgan. 
Ophthalmic  Surgeon— Mr.R.  Marcus 
Gunn. 

Surgeon-Dentist— Mr.  Alex.  Cart¬ 
wright. 

Secretary — Samuel  Whitford. 

Out-patients  attending,  12,900.  The 
id  out-patient  departments,  is  open 


EVELINA  HOSPITAL  FOR  SICK  CHILDREN, 
Southwark- bridge-road. 

Consulting  Physician —Dr.  W.  S.  Playfair. 

Consulting  Surgeons— Sir  Prescott  G.  Hewett  and  Mr.  W.  Morrant  Baker. 


Physicians  —  Dr.  Frederick  Taylor 
and  Dr.  Jas.  F.  Goodhart. 
Physicians  to  Out-Patients  —  Dr. 
Nestor  Tirard  and  Dr.  Frederick 
Willcocks. 

Surgeons  —  Mr.  H.  G.  Howse  and 
Mr.  R.  Clement  Lucas. 

Dental  Surgeon— Mr.  Isidore  Lyons. 


Surgeons  to  Out-Patients — Mr.  R. 
Clement  Lucas  and  Mr.  Charters 
J.  Symonds. 

Ophthalmic  Surgeon — Dr.  W.  A. 
Brailey. 

House-Surgeon — Mr.  W.  H.  C. 
Newnham,  B.A. 

Secretary— Mr,  T.  Sands  Chapman. 


QUEEN  CHARLOTTE’S  LYING-IN  HOSPITAL, (c) 

191,  Marylebone-road,  London,  N.W. 

Physicians  to  the  In-patients— Dr.  Wm.  Hope  and  Dr.  W.  C.  Grigg. 
Physician  to  the  Out-patients — Dr.  Percy  Boulton. 
House-Physician — Mr.  Norman  Dalton. 


BRITISH  LYING-IN  HOSPITAL, 

Endell-street,  St.  Giles’s,  W.  C. 

Consulting  Physician— Dr.  Priestley. 

Consulting  Surgeon— Sir  T.  Spencer  Wells,  Bart.,  F.R.C  S. 
Physicians — Dr.  Hey  wood  Smith,  Dr.  Fancourt  Barnes,  and  Dr.  J.  Phillips. 
Matron— Miss  Freeman. 

Secretary — FitzRoy  Gardner,  Esq. 


ROYAL  LONDON  OPHTHALMIC  HOSPITAL, 
Blomfield-street,  Moorfields,  E.C. 

Consulting  Surgeons— Mr.  J  Dixon,  Mr.  G.  Critchett,  Mr.  W.  Bowman, 
Mr.  J.  Hutohinsoa,  and  Mr.  J.  C.  Wordsworth. 

Surgeons— Messrs.  Wordsworth,  Streatfeild,  J.  W.  Hulke,  G.  Lawson, 
J.Couper.Waren  Tay,  J.  Adams,  J.  Tweedy,  E.  Nettleship,  and  B.  M.  Gunn. 
House-Surgeons — Messrs.  M.  A.  Symons  and  W.  O.  Maher. 
Operations  daily  at  11  o’clock.  In-patients  in  1882, 1868 ;  Out-patients, 
22,150.  Students’  fee — six  months,  £3  3s. ;  perpetual,  £5  5s. 


ROYAL  WESTMINSTER  OPHTHALMIC  HOSPITAL, 

King  William-street,  Charing- cross. 

The  Hospital  contains  thirteen  wards  with  fifty  beds,  and  the  patients 
(10,000  new  cases  annually)  are  seen  daily  at  1  p.m.,  and  operations  per¬ 
formed  at  2  p.m.  The  following  are  the  days  of  attendance  of  the  Surgical 
Staff : -Monday  and  Friday,  Mr.  Power;  Monday  and  Thursday,  Mr. 
Maenamara  ;  Tuesday  and  Saturday,  Mr.  Rouse ;  Wednesday  and  Satur¬ 
day,  Mr.  Cowell.  Assistant-Surgeons:  Wednesday  and  Saturday,  Mr. 
Henry  Juler ;  Tuesday  and  Saturday,  Mr.  Hartridge ;  Monday  and 
Thursday,  Mr.  Frost. 

The  practice  of  the  Hospital  is  open  to  students.  Fees— for  six  months, 
£3  3s.  ;  perpetual,  £5  5s. 

Secretary —Mr.  Geo.  C.  Farrant. 

(c)  No  return. 


Medical  Times  and  Gazette. 


SPECIAL  INSTRUCTION. 


Sept.  15,  1883.  331 


HOSPITAL  FOR  DISEASES  OF  THE  SKIN, 

52,  Stamford-street,  Blaekfriars,  S.E. 

Surgeons — Mr.  Jonathan  Hutchinson  and  Mr.  Waren  Tay. 
Assistant- Surgeons — Mr.  Wyndham  Cottle  and  Dr.  J.  F.  Payne. 
Secretary  —  Samuel  Hay  man. 


BRITISH  HOSPITAL  FOR  DISEASE!  OF  THE  SKIN, 

West  Branch,  61,  Great  Marlborough-st.,  W. ;  East  Branch,  1'2a,  Finsbury- 
square,  E. 0.  ;  and  South  Branch,  5,  Newington-butts,  S.E. 
Surgeons— Mr.  Balmanno  Squire  and  Mr.  George  Gaskoin. 
Honorary  Secretary— E.  Morton  Daniel,  Esq. 


ST.  PETER’S  HOSPITAL  FOR  STONE  AND  GENITO-URINARY 

DISEASES, 

Henrietta-street,  Covent-garden,  W.O. 

Surgeons — Mr.  Walter  J.  Coulson  ani  Mr.  W.  F.  Teevan. 
Surgeons  to  the  Out-Patient  Department — Mr.  F.  R.  Heycock, 

Mr.  F.  S.  Edwards,  and  Mr.  W.  Bruce  Clarke. 
House-Surgeon —Mr.  Hugh  Micnamara. 

Secretary— Mr.  Walter  E.  Scott. 


LONDON  FEVER  HOSPITAL,  ISLINGTON. 

Consulting  Physicians — Dr.  A.  Tweedie,  Dr.  Broadbent,  and 
Dr.  G.  Buchanan. 

Physicians — Dr.  Cayley  and  Dr.  F.  A.  Mahomed. 
Assistant-Physicians — Dr.  Thomas  Barlow  and  Dr.  George  Gulliver. 
Consulting  Surgeon — Mr.  W.  S.  Savory. 

Surgeon  -  Mr.  A.  J.  Pepper. 

Resident  Medical  Officer -Dr.  E.  O.  Hopwood; 

Assistant,  Mr.  R.  M.  0.  C.  Owen  Fowler. 

Secretary — Mr.  E.  Burn  Callander. 

This  Hospital  is  recognised  by  the  Royal  University  of  Ireland,  and 
certificates  of  attendance  given  by  the  Resident  Medical  Officers  are 
accepted.  These  certificates  are  also  accepted  by  the  King  and  Queen’s 
College  of  Physicians,  Ireland. 


ST.  LUKE’S  HOSPITAL  FOR  LUNATICS, 
Old-street,  E.C. 

Honorary  Consulting  Physician— Dr.  Henry  M  mro. 
Physician — Dr.  William  Wood. 

Surgeon — Mr.  Alfred  Willett. 

Resident  Medical  Superintendent— Dr.  George  Mickley. 


NATIONAL  HOSPITAL  FOR  THE  PARALYSED  AND  EPILEPTIC, 
Queen-square,  Bloomsbury. 

Physicians— Drs.  Ramskill,  Radcliffe,  Hughlings- Jackson,  Buzzard. 
Physicians  for  Out-patients— Drs.  Charlton  Bastian,  Gowers,  Ferrier. 
Assistant-Physicians— Drs.  Ormerod  and  Beevor. 

Surgeon— W.  Adams,  F.R.C.S. 

Resident  Medical  Officer  and  Registrar— N.Rushworth,M.R.C.S.,L.R.C.P. 


PROVINCIAL. 

BATH  ROYAL  UNITED  HOSPITAL. 

Honorary  Consulting  Physicians— Dr.  Davies  and  Dr.  Coates. 

Physicians — Dr.  Goodridge,  Dr.  Cole,  and  Dr.  Fox. 

Surgeons — Mr.  Stockwell,  Mr.  Fowler,  and  Mr.  Freeman. 

Assistant -Surgeons  -  Mr.  Green,  Mr.  Scott,  and  Mr.  Ransford. 
Honorary  Medical  Officers  for  Out-Patients — Dr.  Field,  Mr.  Cowan,  and 

Mr.  Craddock. 

Dental  Surgeon — Mr.  Gaine. 

Pathological  Registrar  and  Curator — Mr.  H.  Culiiford  Hopkins. 

The  Hospital  contains  120  beds,  is  recognised  by  the  General  Medical 
Council,  and  licensed  for  dissection.  It  has  a  good  library,  and  an  excel¬ 
lent  museum  containing  a  large  number  of  interesting  specimens,  both 
in  Pathology  and  Comparative  Anatomy. 

A  year  spent  at  the  Hospital  counts  as  one  out  of  the  four  required 
before  qualifying  for  practice. 

Fees  for  attending  the  hospital  practice— Six  months,  £5  5s. ;  twelve 
months,  £10  10s.  Instruction  in  Pharmacy,  £5  5s. 

Pupils  entering  in  October  can,  if  desired,  be  instructed  in  the  sub¬ 
jects  required  for  the  First  Professional  Examination  of  the  Royal  College 
of  Physicians,  which  can  be  passed  during  the  year  spent  at  the  Hospital. 
The  subjects  are— Chemistry  and  Chemical  Physics,  Materia  Medica  and 
Pharmacy,  Medical  Botany,  and  Osteology. 

For  further  particulars,  apply  to  the  Registrar  and  Curator. 


NORFOLK  AND  NORWICH  HOSPITAL. 

Physicians — Dr.  Eade,  Dr.  Bateman,  and  Dr.  Taylor. 
Surgeons — Mr.  Cadge,  Mr.  Crosse,  and  Mr.  Williams. 
Assistant-Surgeons — Dr.  Beverley  and  Mr.  Robinson. 
Resident  Medical  Officer— Mr.  D.  D.  Day. 


WOLVERHAMPTON  AND  STAFFORDSHIRE  GENERAL  HOSPITAL. 

Medical  Officers— Dr.  Millington,  Dr.  Totherick,  Mr.  Vincent  Jackson, 
Mr.  J.  O’B.  Kough,  Mr.  F.  E.  Manby. 

Physician  to  Out-Patients — Dr.  H.  Malet. 

Fees  for  hospital  practice— For  six  months,  £6  6s.;  for  one  year,  £10 10s. ; 
perpetual,  £22  Is.  Some  members  of  the  honorary  staff  receive  resident 
pupils.  _ 

GENERAL  INFIRMARY,  NORTHAMPTON. 

Physician — Dr.  Buszard. 

Surgeons— Mr.  Kirby  Smith  and  Mr.  G.  H.  Percival. 
House-Surgeon — Mr.  J.  Oswald  Lane. 

Assistant  House-Surgeon— W.  Winworth  Smith. 


ROYAL  DISPENSARY,  EDINBURGH,  (d) 

Consulting  Physician-Accoucheurs— Dr.  Keiller  and  Dr.  Bell. 
Medical  Officers— Dr.  W.  Husband,  Dr.  James  Andrew,  Dr.  D.  Wilson, 
Dr.  F.  W.  Moinet,  Dr.  A.  J.  Sinclair,  Dr.  Ootterill,  Dr.  Waller, 

Dr.  Jamieson,  Dr.  Spence,  Dr.  Peter  Young,  Dr.  Dyce  Fraser,  and 

Dr.  Black. 

Midwifery  Department— Dr.  Andrew  and  Dr.  Young. 
Vaccination — Dr.  Husband. 

Apothecary — Mr.  J.  Nicol. 

Secretary  to  Medical  Officers— Dr.  Andrew. 


ROYAL  HOSPITAL  FOR  SICK  CHILDREN,  MEADOWSIDE  HOUSE, 

EDINBURGH. 

Consulting  Physicians — Drs.  Charles  Wilson,  Graham  Weir, 

George  W.  Balfour,  and  R.  Peel  Ritchie. 

Consulting  Surgeon— Professor  Annandale. 

Pathologist— Dr.  Woodhead. 

Ordinary  Physicians— Drs.  Dunsmure,  Andrew,  Underhill,  Carmichael. 
Surgeon- Dentist — Dr.  Smith. 

Ophthalmic  Surgeon — Dr.  Argyll  Robertson. 

Resident  Physician— Dr.  Spence. 

Honorary  Secretaries— Messrs.  Henry  and  Scott,  20,  St.  Andrew-square. 
Treasurer— Mr.  W.  H.  Cook,  1,  Albyn-place. 


EDINBURGH  DISPENSARY  FOR  DISEASES  OF  THE  EAR, 

6,  Cam  bridge-street,  Lothian-road. 

Surgeon — Dr.  J.  J.  Kirk  Duucanson. 

Annual  patients,  upwards  of  600.  Open  Mondays,  Thursdays,  and 
Saturdays,  12  noon.  _ 

GLASGOW  HOSPITAL  AND  DISPENSARY  FOR  DISEASES  OF 

THE  EAR, 

239  and  241,  Buchanan-street. 

HONORARY  MEDICAL  STAFF. 

Senior  Consulting  Physician— Dr.  P.  Stewart. 

Senior  Consulting  Surgeon -Dr.  James  Morton. 

Consulting  Dental  Surgeon  — Dr.  J.  Edwin  Woodburn. 
Physicians— Dr.  A.  K.  Irwine,  Dr.  A.  L.  Kelly,  Dr.  J.  Gardner. 

Aural  Surgeon  and  Lecturer  on  Aural  Surgery— Dr.  James  P.  Cassells. 
Clinical  Assistant— Dr.  James  Erskine. 


GLASGOW  EYE  INFIRMARY, 

170,  Berkeley-street,  and  76,  Charlotte-street. 

Senior  Surgeon — Dr.  Thomas  Reid. 

Surgeons— Dr.  T.  S.  Meighan,  Mr.  H.  E.  Clark,  Dr.  J.  Crawford  Renton. 
Assistant-Surgeons — Mr.  D.  N.  Knox.  Dr.  Johnston  Macfie,  and 
Mr.  A.  Freeland  Fergus. 

House  Surgeon — Dr.  A.  Maitland  Ramsay. 

Consulting  Surgeon  —Dr.  George  Buchanan. 

Secretary — George  Black,  88,  West  Regent-street. 


ST.  MARK’S  OPHTHALMIC  HOSPITAL  AND  DISPENSARY  FOR 
DISEASES  OF  THE  EYE  AND  EAR, 

Lincoln-place,  Dublin. 

Surgeon — John  B.  Story,  M.B.,M.Ch.,  F.R.C.S. I. 
Assistant-Surgeon  — Arthur  H.  Benson,  M.B.C.C.D.,  F.R.C.S. I. 
Resident  Surgeon— Sayer  Hasbrouck,  M.D.  Boston. 


APPOINTMENTS  FOR  THE  WEEK. 


September  15.  Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  14  p.m.;  King’s  College,  14  p.m. ;  Royal 
Free,  2  p.m.;  Royal  London  Ophthalmic,  11  a.m. ;  Royal  Westminster 
Ophthalmic,  14  p.m. ;  St.  Thomas’s,  14  p.m.;  London,  2  p.m. 

17.  Monday. 

Operations  at  the  Metropolitan  Free,  2  p.m.;  St.  Mark’s  Hospital  for 
Diseases  of  the  Rectum.  2  p.m.;  Royal  London  Ophthalmic,  11  a.m.; 
Royal  Westminster  Ophthalmic,  14  p.m. ;  Hospital  for  Women,  2  p.m. 

18.  Tuesday. 

Operations  at  Guy’s,  1J  p.m.  ;  Westminster,  2  p.m. ;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  14  p.m.;  West 
London,  3  p.m. 

19.  Wednesday. 

Operations  at  University  College.  2  p.m. ;  St.  Mary’s,  lj  p.m.  ;  Middlesex, 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew’s,  14  p.m.  ;  Great  Northern, 

2  p.m.;  Samaritan,  24  p.m.;  Royal  London  Ophthalmic,  11  a.m.; 
Royal  Westminster  Ophthalmic,  14  p.m. ;  St.  Thomas’s,  14  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m. ;  National  Orthopaedic,  Great 
Portland-street,  10  a.m. 


20.  Thursday. 

Operations  at  St.  George’s,  1  p.m. ;  Central  London  Ophthalmic,  1  p.m.; 
Royal  Orthopaedic,  2  p.m.;  University  College,  2  p.m.;  Royal  London 
Ophthalmic, 11  a.m. ;  Royal  Westminster  Ophthalmic,  14  p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m. ;  Hospital  for  Women,  2  p.m. ; 
Charing-eross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  24  p.m. 


21.  Friday. 

Operations  at  Central  London  Ophthalmic  ,2p.m.;  Royal  London  Ophtha!  - 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminster 
Ophthalmic,  14  p.m.;  St.  George’s  (ophthalmic  operations),  li  p.m.; 
Guy’s,  14  p.m.  ;  St. Thomas’s  (ophthalmic  operations),  2  p.m. ;  King’s 
College  (by  Mr.  Lister),  2  p.m.  _ 


(d)  No  return. 


332 


Medical  Times  and  Gazette. 


THE  PUBLIC  SERVICES. 


Sept.  15,  1883. 


THE  PUBLIC  SERVICES. 


ARMY  MEDICAL  DEPARTMENT. 

No  candidate  to  exceed  the  age  of  twenty-eight  years  on 
appointment  as  a  Surgeon  on  probation. 

He  must  be  registered  under  the  Medical  Act  in  force  at 
the  time  of  his  appointment,  as  possessing  two  diplomas  or 
licences  recognised  by  the  General  Medical  Council — one  to 
practise  Medicine,  and  the  other  Surgery — -in  Great  Britain 
and  Ireland. 

Candidates  will  be  examined  by  the  Examining  Board  in 
Anatomy  and  Physiology;  Surgery;  Medicine,  including 
therapeutics,  and  the  diseases  of  women  and  children  ;  Che¬ 
mistry  and  Pharmacy,  and  a  practical  knowledge  of  drugs. 

The  ranks  and  rates  of  pay  of  Officers  will  be  as  follows  : — 


Surgeon- General 

After  25  years’  service 
„  30  years’  service 

„  35  years’  service 

At  Head- quarters 
Deputy  Surgeon-General 
After  25  years’  service 
„  30  years’  service 

„  35  years’  service 

At  Head-quarters 
Brigade  Surgeon 

After  5  years  in  the  rank 
At  Head-quarters 
Surgeon-Major 

After  15  years’  service  . 

„  5  years’  service  as  such 

„  20  years'  service  . 

„  25  years’  service  . 

At  Head-quarters 
Surgeon  .... 

After  5  years’  service  . 

„  10  years’  service  . 
Surgeon  on  probation 


Officers  of  the  Army  will  be  as  follows :  — 

Surgeon  and  Surgeon-Major 
After  10  years’  service 
„  15  years’  service 

„  18  years’  service 

Surgeon-Major  : 

After  12  years’  service 
„  15  years’  service 

„  20  years'  service 

„  25  years’  service 

„  30  years’  service 

Brigade-Surgeon  : 

After  20  years’  service 
„  30  years’  service 

Deputy  Surgeon-General 
After  20  years’  service 
„  25  years’  service 

„  30  years’  service 

Surgeon-General 

After  20  years’  service 
„  25  years’  service 

„  30  years’  service 

Temporary  Saif -pay. 

A  Medical  Officer,  under  5  years’  service 
„  „  after  5  years’  service 

„  ,,  ,,  10  years’  service 

„  „  „  15  years’  service 

Candidates  for  commissions  in  the  Army  proceed  to  the 
Army  Medical  School  at  Netley  to  go  through  a  course  of 
study  after  passing  the  examination  in  London. 


£ 

s. 

d. 

daily 

2 

15 

0 

— 

> » 

yearly 

1,300 

0 

0 

daily 

2 

0 

0 

U 

— 

' 

>> 

yearly 

900 

0 

0 

daily 

1 

10 

0 

>> 

1 

13 

0 

yearly 

750 

0 

0 

daily 

1 

0 

0 

1 

2 

6 

>> 

n 

1 

5 

0 

>> 

1 

7 

6 

yearly 

650 

0 

0 

5) 

200 

0 

0 

250 

0 

0 

daily 

0 

15 

0 

>> 

0 

8 

0 

alf-pay, 

for  Medical 

£ 

s. 

d. 

gratuity  1,250 

0 

0 

1,800 

0 

0 

2,500 

0 

0 

daily 

— 

>» 

— 

>> 

1 

0 

0 

J  5 

1 

2 

6 

>> 

1 

5 

0 

1 

7 

6 

1 

10 

0 

1 

15 

0 

>> 

— 

>> 

>? 

>> 

2 

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13 

6 

INDIAN  MEDICAL  DEPARTMENT. 

The  rules  for  admission  to  the  above  department  are 
identical  with  those  for  the  Army  Medical  Department.  The 
rates  of  pay  are  as  follows : — 


Brigade-Surgeon. 
Surgeon -Major 

Years’  service. 
(Not  yet  fixed.) 

25 

Per  mensem. 

K.  A.  P. 

.  888  12  0 

>>  >> 

20 

.  852 

3 

7 

15 

.  677 

6 

11 

12 

.  640 

14 

6 

Surgeon 

10 

.  410 

9 

5 

» 

6 

.  392 

5 

2 

5 

.  304 

14 

2 

»>  •  • 

.  under  5 

.  286 

10 

0 

The  salaries  of  the  principal  administrative  and  military 
appointments  are :  — 


its.  per  mensem. 


Surgeon- General,  Bengal  ..... 

„  „  Madras ..... 

„  „  Bombay  .... 

Deputy  Surgeon-General  {  ftt ;  *  ; 

Brigade-Surgeon.  (Not  yet  fixed.) 
Surgeon-Major  of  20  years’  service  and  upwards 
in  charge  of  Native  Regiments 
Surgeon -Major  in  charge  of  ditto 
Surgeon  above  5  years’  full -pay  service  in  charge 
of  ditto  ........ 

Surgeon  under  5  years’  ditto  .... 


2700 

2500 

2500 

2250 

1800 


1000 

800 

600 

450 


Candidates  for  commissions  in  the  Indian  Medical  Service 
proceed  to  the  Medical  School  at  Netley  to  go  through  a 
course  of  study  after  passing  the  examination  in  London. 


The  following  are  the  regulations  for  the  examination  of 
candidates  for  the  appointment;  of  Surgeon  in  Her  Majesty’s 
Service,  in  the  Indian  Medical  Service,  and  in  the  Navy  : — 

All  natural-born  subjects  of  Her  Majesty,  between  twenty- 
one  and  twenty-eight  years  of  age  at  the  date  of  the  examina¬ 
tion,  and  of  sound  bodily  health,  may  be  candidates.  They 
may  be  married  or  unmarried.  They  must  possess  a  diploma 
in  Surgery,  or  a  licence  to  practise  it,  as  well  as  a  degree  in 
Medicine;  or  a  licence  to  practise  it,  in  Great  Britain  or  Ireland, 
as  well  as  a  certificate  of  registration  in  the  Medical  Register. 
Candidates  for  the  British  Army  and  the  Naval  Medical  Ser¬ 
vices  must  also  declare  that  their  parents  are  of  unmixed 
European  blood.  And  candidates  for  the  Indian  Service  must 
have  attained  the  age  of  twenty-two.  All  candidates  are 
examined  as  to  physical  fitness  by  a  Board  of  Medical  Officers. 
All  these  conditions  being  satisfied,  candidates  are  admitted 
to  a  competitive  examination. 

Candidates  are  examined  in  the  following  compulsory  sub¬ 
jects,  and  the  highest  number  of  marks  attainable  will  be 
distributed  as  follows  : — a.  Anatomy  and  Physiology,  1000 
marks;  b.  Surgery,  1000  ;  c.  Medicine,  including  Therapeutics, 
the  Diseases  of  Women  and  Children,  1000  ;  d.  Chemistry  and 
Pharmacy,  and  a  practical  knowledge  of  drugs,  100  marks. 

(The  examination  in  Medicine  and  Surgery  will  be  in  part 
practical,  and  will  include  operations  on  the  dead  body,  the 
application  of  surgical  apparatus,  and  the  examination  of 
medical  and  surgical  patients  at  the  bedside. ) 

The  eligibility  of  each  candidate  for  the  Indian  Medical 
Service  will  be  determined  by  the  result  of  the  examinations 
in  these  subjects  only. 

Candidates,  who  desire  it,  will  be  examined  in  French, 
German  (and  Hindustani  for  the  Indian  Service),  Comparative 
Anatomy,  Zoology,  Natural  Philosophy,  Physical  Geography, 
and  Botany,  with  special  reference  to  Materia  Medica. 

The  number  of  marks  gained  in  these  subjects  will  be  added 
to  the  total  number  of  marks  obtained  in  the  obligatory  part 
of  the  examination  by  candidates  who  shall  have  been  found 
qualified  for  admission,  and  whose  position  on  the  list  of 
successful  competitors  will  thus  be  improved  in  proportion  to 
their  knowledge  of  modern  languages  and  natural  sciences. 

The  maximum  number  of  marks  allotted  to  the  voluntary 
subjects  will  be  as  follows:— French,  German,  and  Hindustani 
(150  each),  450;  Natural  Science,  300. 

After  passing  the  preliminary  examination,  candidates  will 
be  required  to  attend  one  entire  course  of  practical  instruction 
at  the  Army  Medical  School,  before  being  admitted  to  exa¬ 
mination  for  a  commission,  on — (1)  Hygiene,  (2)  Clinical 
and  Military  Medicine,  (3)  Clinical  and  Military  Surgery, 
(4)  Pathology  of  Diseases  and  Injuries  incident  to  Military 
Service. 

(These  courses  are  to  be  of  not  less  than  four  months’  dura- 


Medical  Times  and  Gazette. 


THE  WEEK. 


Sept.  15,  1883.  3  3  3 


tion ;  but  candidates  who  have  already  gone  through  a  course 
at  Netley  as  candidates  for  the  Army  or  Navy  Medical  Service 
may,  if  thought  desirable,  be  exempted  from  attending  the 
school  a  second  time.) 

Daring  the  period  of  his  residence  at  the  Army  Medical 
School,  each  candidate  will  receive  an  allowance  of  8s.  per 
diem,  with  quarters,  or,  when  quarters  are  not  provided,  with 
the  usual  lodging  and  fuel  and  light  allowances  of  subalterns, 
to  cover  all  costs  of  maintenance ;  and  he  will  be  required  to 
provide  himself  with  uniform  —viz. ,  the  regulation  undress 
uniform  of  a  Surgeon  of  the  British  Service,  but  without  the 
sword. 

At  the  conclusion  of  the  course,  candidates  will  be  required 
to  pass  an  examination  on  the  subjects  taught  in  the  School. 
The  examination  will  be  conducted  by  the  Professors  of  the 
School. 

(The  Director-General,  or  any  medical  officer  deputed  by 
him,  may  be  present  and  take  part  in  the  examination.  If 
the  candidate  give  satisfactory  evidence  of  being  qualified  for 
the  practical  duties  of  an  Army  Medical  Officer,  he  will  be 
eligible  for  a  commission  as  Surgeon.) 

The  examinations  for  admission  to  the  three  Services 
usually  take  place  twice  a  year,  viz.,  in  February  and  in 
August. 

All  candidates  desirous  of  entering  the  Indian  Medical 
Service  should  obtain  from  the  India  Office  the  “  Memorandum 
regarding  the  Position  of  Medical  Officers  to  be  appointed  to 
Her  Majesty’s  Indian  Forces,”  as  well  as  the  ‘‘  Regulations  ” 
for  candidates  for  the  Service. 


ARMY  MEDICAL  SCHOOL. 

President  of  the  Senate. — T.  Crawford,  M.D.,  Director-General 
of  the  Army  Medical  Department. 

Members  of  the  Senate. — Surgeon-General  Sir  Joseph  Fayrer, 
M.D.,  K.C.S.I.,  F.R.S.,  Physician  to  the  Council  of  India; 
the  Principal  Medical  Officer,  Royal  Victoria  Hospital  ( ex 
oficio)  ;  and  the  Professors  of  the  Army  Medical  School. 

Professors. — Surgeon-General  T.  Longmore,  C.B.,  Professor 
of  Military  Surgery  ;  Inspector-General  W.  C.  Maclean,  M.D., 
C.B  ,  Professor  of  Military  Medicine ;  William  Aitken,  M.D., 
F.R.S.,  Professor  of  Pathology  ;  Surgeon-Major  F.  S.  B.  F.  De 
Chaumont,  M.D.,  F.R.S.  Professor  of  Military  Hygiene. 

Assistant-Professors. — Surgeons-Major  R.  Tobin  (Military 
Surgery),  W.  Cherry  (Military  Medicine) ;  Surgeon-Major 

S.  Moore,  M.B.  (Military  Hygiene) ;  and  Surgeon-Major 

T.  R.  Lewis,  M.B.  (Pathology). 

Surgeons  on  probation  for  the  British  Army  and  for  the 
Queen’s  Indian  Service  proceed  to  Netley  after  passing  the 
examination  in  London.  At  Netley  they  attend  the  medical 
and  surgical  practice  of  the  Royal  Victoria  Hospital,  and  learn 
the  system  and  arrangements  of  military  hospitals.  During 
four  months  they  attend  the  lectures  given  by  the  Professors 
and  Assistant-Professors,  and  go  through  a  course  of  practical 
instruction  in  the  hygienic  laboratory  and  microscopical  room. 


NAVAL  MEDICAL  DEPARTMENT. 

Candidates  will  be  examined  by  the  same  Examining  Board 
and  in  the  same  subjects  as  candidates  for  the  Army  Medical 
Service. 

Every  candidate  for  admission  into  the  Medical  Department 
of  the  Royal  Navy  must  be  not  under  twenty-one  nor  over 
twenty-eight  years  of  age  on  the  day  on  which  he  presents 
himself  for  examination.  He  must  produce  an  extract  from 
the  register  of  the  date  of  his  birth  ;  or,  in  default,  a  declara¬ 
tion,  made  before  a  magistrate,  from  one  of  his  parents  or 
other  near  relative  stating  the  date  of  birth.  He  must  also 
produce  a  certificate  of  moral  character,  and  a  recommendation 
signed  by  a  clergyman  or  magistrate  to  whom  he  has  been 
for  some  years  personally  known,  or  by  the  President  or  Senior 
Professor  of  the  College  at  which  he  was  educated.  He  must 
*  be  registered  under  the  Medical  Act  in  force  at  the  time  of  his 
appointment  as  possessing  two  diplomas  or  licences  recognised 
by  the  General  Council,  one  to  practise  Medicine,  and  the 
other  Surgery,  in  Great  Britain  and  Ireland.  He  must  sign  a 
declaration  that  he  is  a  British  subject,  the  son  of  parents  of 
unmixed  European  blood,  that  he  labours  under  no  mental  or 
constitutional  disease  or  weakness,  or  any  other  imperfection 
or  disability  which  may  interfere  with  the  most  efficient 
discharge  of  the  duties  of  a  medical  officer  in  any  climate  ; 
and  that  he  does  not  hold,  and  has  never  held,  any  commission 
or  appointment  in  the  public  services.  He  must  also  declare 


his  readiness  to  engage  for  general  service  at  home  or  abroad 
as  required.  He  must  be  free  from  organic  or  other  disease, 
and  his  physical  fitness  will  be  determined  by  a  Board  of 
Medical  Officers,  who  are  to  certify  that  his  vision  comes  up  to 
the  required  standard,  which  will  be  ascertained  by  the  use 
of  Snellen’s  test-types. 

Every  candidate,  immediately  after  passing  the  entrance 
examination,  will  receive  a  commission  as  a  Surgeon  in  the 
Royal  Navy,  and  will  undergo  a  course  of  practical  instruction 
in  Naval  Hygiene,  etc.,  at  Haslar  Hospital. 

The  rates  of  full  pay  and  half  pay  are  somewhat  higher 
than  in  the  Army  Medical  Service ;  but  for  full  information 
on  these  points,  on  retirement,  and  on  gratuities  and  retired 
pay,  as  well  as  with  regard  to  promotion,  etc.,  intending  candi¬ 
dates  should  apply  to  the  Secretary  of  the  Admiralty,  White¬ 
hall,  S.W  ,  for  the  “  Regulations  for  Eatry  of  Candidates  for 
Commissions  in  the  Medical  Department  of  the  Royal  Navy.” 


The  foregoing  is  a  brief  summary  of  the  main  points  to  be 
considered  by  students  in  choosing  a  career  in  the  public 
services.  All  details  and  information  are  procurable  on 
application  (by  letter)  to  the  Secretaries  of  the  different 
departments. 


TERMS  OF  SUBSCRIPTION. 


( Free  by  post.) 


British  Islands . 

Tivelve  Months 

.  £1 

8 

0 

yy  yy  ..... 

Six 

yy 

0 

14 

0 

The  Colonies  and  the  United 
States  of  America  .  .  . 

•  Twelve 

yy 

1 

10 

0 

yy  yy  yy 

Six 

yy 

.  0  15 

0 

India  (vid  Brindisi)  .  . 

Twelve 

yy 

1 

12 

6 

yy  ... 

Six 

y> 

0 

16 

6 

Foreign  Subscribers  are  requested  to  inform  the  Publishers  of 
any  remittance  made  through  the  agency  of  the  Post-office. 
Single  Copies  of  the  Journal  can  be  obtained  of  all  Booksellers 
and  Newsmen,  price  Sixpence. 

Cheques  or  Post-office  Orders  should  be  made  payable  to  Mr. 
James  Lucas,  11,  New  Burlington-street,  W. 


TERMS  FOR  ADVERTISEMENTS. 

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Each  additional  line  (10  words)  .  .006 

Half-column,  or  quarter-page  .  .  .15  0 

Whole  column,  or  half-page  .  .  .  2  10  0 

Whole  page . 5  0  0 

For  the  future.  Births  and  Marriages  must  be  paid  for. 
Deaths  of  Medical  Men  are  inserted  Free  of  Charge. 

The  Medical  Times  and  Gazette  is  published  on  b'riday 
morning :  Advertisements  must  therefore  reach  the  Pub¬ 
lishing  Office  not  later  than  One  o’clock  on  Thursday. 


SATURDAY,  SEPTEMBER  15,  1883. 

- « - 

THE  WEEK. 

THE  EIRE  IN  SOUTHALL  PARK  LUNATIC  ASYLUM. 

The  inquiry  into  the  circumstances  of  the  death  of  Elizabeth 
E.  Howe,  who  died  on  August  29,  from  the  effects  of  injuries 
received  in  escaping  from  the  fire  at  the  private  lunatic 
asylum  at  Southall  Park  on  August  14,  was  resumed,  and 
brought  to  a  conclusion,  on  Thursday,  the  6th  inst.  Mr. 
William  Edward  Frere,  one  of  the  Commissioners  in  Lunacy, 
attended  on  behalf  of  the  Commissioners  for  the  purpose  of 
giving  evidence  as  to  what  regulations  the  Commissioners 
make,  and  what  precautions  they  insist  upon  to  guard  against 
fires  in  asylums,  and  to  provide  means  of  escape  should  a  fire 
take  place.  Mr.  Frere  was  not  a  happily  selected  witness. 
He  did  not  show  that  the  sympathies  of  the  Commissioners 
are  always  and  chiefly  with  the  lunatics ;  but  rather,  we  think, 
dwelt  on  the  difficulties  of  the  proprietors  and  managers  of 
asylums,  and  adopted  the  high-and-dry  official  tone.  The 
jury  were  not  satisfied  with  his  explanations,  and  to  the 
verdict  that  the  deceased  died  from  injuries  received  during 


334 


Medical  Times  and  Gazette. 


VITAL  STATISTICS. 


Sept.  15,  1883. 


her  escape  from  the  burning  house,  they  added  the  follow¬ 
ing  rider: — “  And  the  jury  unanimously  record  their  opinion 
that  the  laws  which  give  power  to  confine  lunatics  should 
provide  efficient  means  for  their  protection  from  fire ;  and 
that  the  Commissioners  in  Lunacy  should  have  exercised 
greater  vigilance  in  causing  adequate  provision  to  he  made 
at  the  Southall  Park  Asylum.”  We  shall  have  more  to  say 
on  this  subject  next  week. 

THE  INTERNATIONAL  MEDICAL  CONGRESS,  AMSTERDAM. 

The  International  Medical  Congress  at  Amsterdam  opened 
its  proceedings  on  the  6th  inst.  The  attendance  was  very 
large,  comprising  delegates  from  almost  every  civilised 
country  in  the  world.  The  representatives  of  this  country 
included  Sir  Joseph  Fayrer,  Dr.  Barclay,  Dr.  Duckworth, 
and  Dr.  Scriven,  of  London  ;  Professors  De  Chaumont 
and  Lewis,  of  the  Army  Medical  School,  iSTetley  ;  Dr. 
Ewart,  of  Brighton  ;  Dr.  Sydney  Jones,  of  New  South 
Wales  ;  and  Professor  Norman  Chevers.  The  Congress  was 
opened  by  Professor  Stockvis,  of  Amsterdam  University, 
and  the  Burgomaster  of  Amsterdam,  who  heartily  wel¬ 
comed  the  Congress  on  its  assembly  in  the  Dutch  capital. 
Amongst  the  Honorary  Presidents  of  the  Congress  are  Sir 
Joseph  Fayrer,  Professors  De  Chaumont  and  Lewis,  and 
Dr.  Sydney  Jones.  The  inaugural  address  was  delivered 
by  Professor  Stockvis,  after  which  the  Congress  proceeded 
to  its  more  special  work  under  its  appointed  sections. 

THE  POLLUTION  OE  THE  MEDWAY. 

The  pollution  of  the  river  Medway  at  Maidstone  by  the 
paper  manufacturers  on  its  banks  is  just  now  exciting  con¬ 
siderable  attention,  and  it  is  asserted  that  never  since  the 
pollution  began  (twenty  years  since)  has  it  been  so  bad  and 
so  continuous  as  it  now  is.  Twenty  years  ago  the  water  of 
the  Medway  was  noted  for  its  purity  :  it  was  so  clear  that 
frequently  it  was  possible  to  see  the  bed  of  the  river ;  and 
barge  captains  were  accustomed,  before  sailing,  to  secure  a 
supply  of  it  for  drinking  purposes.  Even  at  the  present 
time,  after  a  cessation  of  the  pollution  for  two  or  three  days 
the  stream  becomes  remarkably  clear.  The  pollution  com¬ 
plained  of  is  of  a  twofold  character.  The  less  harmful  is 
that  which  turns  the  water  of  a  coffee  colour  for  two  or  three 
miles,  and  covers  the  surface  with  floating  patches  of  filthy 
froth.  The  more  objectionable  discharges  are  those  of 
alkaline  liquid,  which  kill  the  fish,  and  cause  them  to 
become  a  great  nuisance  when  floating  on  the  top  of  the 
water  in  an  advanced  stage  of  decomposition.  It  is  con¬ 
tended  that,  if  proper  precautions  were  taken,  the  system  of 
converting  a  remarkably  pure  river  into  a  common  sewer 
might  be  avoided ;  and  the  complaints  have  at  length  become 
so  serious  that  the  Corporation  have  appointed  a  committee 
to  confer  with  the  mill-owners,  and  to  report  on  the  legal 
remedies  which  it  may  become  necessary  to  invoke. 


TO  CORRESPONDENTS. 

We  beg  to  return  our  best  thanks  to  the  Registrars  and 
Secretaries  of  the  various  Universities,  Colleges,  and 
Schools,  for  their  prompt  replies  to  our  Circular,  and  for 
the  trouble  they  have  taken  in  supplying  the  latest 
Regulations  of  the  Institutions  with  which  they  are 
connected. 

As  this  number  is  almost  entirely  devoted  to  matter  mainly 
concerning  Students,  many  important  communications  and 
contributions  unavoidably  stand  over. 

We  have  here  given  everything  of  importance  for  the 
entering  Student  to  know;  for  any  further  details  he 
should  apply  for  a  prospectus  to  the  authorities  of  the 
School  he  may  select. 


....  -  — 

VITAL  STATISTICS  OF  LONDON. 


Week  ending  Saturday,  September  8,  1883. 


BIRTHS. 

Births  of  Boys,  1214;  Girls,  1220;  Total,  2434. 

Corrected  weekly  average  in  the  10  years  1873-82,  2627 "S. 

DEATHS. 


Males . 

Females. 

Total. 

Deaths  during  the  week . 

653 

604 

1257 

Weekly  average  of  the  ten  years  1873-82,  1 
corrected  to  increased  population  ...  ) 

754-2 

663-0 

1417-2 

Deaths  of  people  aged  80  and  upwards 

... 

34 

DEATHS  IN  SUB-DISTRICTS  FROM  EPIDEMICS. 


Enumerated 

Population, 

1881 

(unrevised). 

Small-pox. 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

•9d 

ft  to 

o  o 
^  o 

Typhus. 

Enteric  (or 

Typhoid) 

Fever. 

Simple 

continued 

Fever. 

Diarrhoea. 

West  .. 

669633  ... 

1 

... 

2 

... 

1 

11 

North 

905947  1 

3 

10 

4 

1 

27 

... 

21 

Central 

282238  ... 

1 

6 

3 

2 

l 

1 

... 

East . 

692738  ... 

4 

14 

2 

4 

1 

... 

14 

South . 

1265927  ... 

10 

13 

5 

13 

5 

... 

41 

Total . 

3816483  1 

19 

43 

14 

22 

l 

35 

... 

87 

METEOROLOGY. 


From  Observations  at  the  Gh-eer.wich  Observatory. 


Mean  height  of  barometer 

Mean  temperature  . 

Highest  point  of  thermometer 
Lowest  point  of  thermometer 
Mean  dew-point  temperature 
General  direction  of  wind 
Whole  amount  of  rain  in  the  week  . 


...  29"538  in. 
...  547“ 

...  67-1° 

...  41'5° 

...  5f2’ 

...  S.W. 

...  0'81  in. 


BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  the 
Week  ending  Saturday,  Sept.  8,  in  the  following  large  Towns : — 


Cities 

and 

Boroughs. 

Estimated  Population  to 
middle  of  the  year  1883. 

j  Births  Registered  during 
the  week  ending  Sept.  8. 

Deaths  Registered  during 
the  week  ending  Sept.  8. 

Annual  Rate  of 
Mortality  per  1000  living, 
from  all  causes. 

Temperature 
of  Air(Fahr.) 

Temp, 
of  Air 
(Cent.) 

Rain 

Fall. 

Highest  during 
the  Week. 

!  Lowest  during 
the  Week. 

Weekly  Mean  of 
Daily  MeanValues 

Weekly  Mean  of 
Daily  Mean 
Values. 

In  Inches. 

In  Centimetres. 

London 

3955814 

2434 

1257 

16-6 

67-1 

41-5 

547 

12-61 

0-81 

2-06 

Brighton  ... 

111262 

57 

65 

30-5 

67-0 

44-0 

55-9 

13-28 

076 

t-93 

Portsmouth 

131478 

95 

58 

23-0 

... 

... 

... 

... 

... 

Norwich 

89612 

60 

38 

22-1 

... 

... 

... 

... 

... 

Plymouth  ... 

74977 

47 

38 

26-4 

64-1 

46 '8 

55-4 

13-00 

1-69 

4-29 

Bristol . 

212779 

139 

73 

17-9 

67-0 

45-4 

54-8 

12-67 

1-08 

274 

Wolverhampton  . 

77557 

62 

36 

24-2 

6L8 

40-1 

51-8 

11-01 

0-43 

1-09 

Birmingham 

414346 

271 

207 

26-0 

... 

... 

... 

... 

... 

Leicester  ... 

129483 

84 

52 

21-0 

... 

... 

... 

... 

... 

Nottingham 

199349 

143 

75 

19'6 

66-1 

42-0 

54-2 

12-33 

0-96 

2-44 

Derby . 

85574 

54 

23 

14-0 

... 

... 

... 

... 

... 

... 

Birkenhead 

88700 

60 

30 

17-6 

... 

... 

... 

Liverpool  ... 

566753 

344 

238 

21-9 

60-2 

46-5 

52-9 

11-61 

1-52 

3-86 

Bolton . 

107862 

84 

5b 

28-5 

60-1 

41-6 

511 

10-62 

1-61 

4-09 

Manchester 

339252 

231 

D2 

28'0 

... 

... 

... 

... 

... 

Salford 

190465 

127 

84 

23  0 

... 

... 

... 

... 

... 

... 

Oldham 

119071 

83 

32 

14-0 

... 

... 

... 

... 

... 

... 

Blackburn  ... 

108460 

83 

47 

22  6 

... 

... 

... 

... 

... 

... 

Preston 

98564 

71 

54 

28-6 

64-0 

47-0 

54-6 

12  50 

1-74 

4-42 

Huddersfield 

84701 

-47 

32 

19'7 

... 

... 

... 

... 

Halifax 

75591 

41 

32 

22-1 

Bradford  ... 

204807 

111 

76 

19-4 

63-9 

46-2 

53-6 

1201 

0-58 

1-47 

Leeds  . 

321611 

223 

151 

24-5 

65  0 

47-0 

54-9 

1272 

0-91 

2-31 

Sheffield  ... 

295497 

182 

129 

22-8 

64-0 

43'0 

53-6 

12-01 

0-62 

1-57 

Hull  . 

176296 

108 

64 

189 

... 

... 

... 

... 

... 

... 

Sunderland 

121117 

101 

65 

28-0 

... 

... 

... 

... 

... 

Newcastle  ... 

149464 

94 

78 

27-2 

... 

... 

... 

... 

... 

... 

Cardiff . 

90033 

69 

30 

17'4 

... 

... 

... 

... 

... 

... 

For  28  towns 

S62C975 

5495 

3305 

20-0 

67-1 

40-1 

54-0 

1222 

1-06 

2-69 

Edinburgh  ... 

235946 

113 

76 

16-6 

... 

... 

... 

... 

Glasgow 

515589 

361 

231 

23-4 

618 

43-0 

55-0 

12-78 

G’49 

1-24 

Dublin . 

... 

349685 

176 

164 

24-5 

62-8 

39-7 

53-3 

11-84 

0-69! 

1-75 

At  the  Royal  Observatory,  Greenwich,  the  mean  reading 
of  the  barometer  last  week  was  29-51  in. ;  the. lowest  reading 
was  28-62  in.  on  Sunday  afternoon,  and  the  highest  29'91  in. 
at  the  end  of  the  week. 

/  . . 


a; 

jkt  -H  Arii-  -m 


S. 


V  * 


1,1  "'V^icn 


/*» 


X 


'cal  Tidies  and  Gazette? 


POWER  ON  THE  LACRIMAL  APPARATUS  OF  THE  EYE. 


LECTURES 

ON 

THE  PROTECTIVE  AVD  LACRIMAL 
APPARATUS  OF  THE  EYE. 

Delivered  at  the  Royal  College  of  Surgeons. 

By  HENRY  POWER,  M.B.  Lond.,  E.R.C.S.  Eng., 

Arris  and  Gale  Lecturer  at  the  College  ;  Senior  Ophthalmic  Surgeon,  and 
Lecturer  on  Ophthalmic  Surgery,  St.  Bartholomew’s  Hospital. 

Lecture  I. 

The  Arris  and  Gale  Lectureship,  which  I  have  the  honour 
■of  holding,  was  instituted  for  the  advancement  of  anatomical 
and  physiological  knowledge. 

I  purpose  in  this  and  the  two  following  lectures  to  give  an 
account  of  the  protective  and  especially  of  the  lacrimal 
•apparatus  in  animals  and  man,  and  I  have  been  induced 
to  take  up  this  subject,  first,  on  account  of  the  great  in¬ 
terest  that  attaches  to  it  in  that  department  of  surgery 
which  I  practise;  secondly,  because  the  lacrimal  appa¬ 
ratus  is  not  well  represented  in  this  museum,  of  which 
we  are  all  so  proud;  and,  thirdly,  because  it  is  a  subject 
which,  alike  in  regard  to  its  anatomy,  histology,  and  physi¬ 
ology,  has  been  rather  neglected  in  this  country,  as  may  be 
seen  by  anyone  who  will  take  the  trouble  to  turn  to  our  best 
treatises — to  Gray,  Quain  and  Sharpey,  and  Ellis,  to  Foster, 
Carpenter,  and  Mr.  Baker’s  edition  of  “  Kirkes’  Physiology”; 
for  these  give,  in  the  compass  of  a  single  page  or  a  little 
more,  all  that  it  is  thought  requisite  the  student  should 
learn. 

In  treatises  devoted  to  histology,  the  statement  is  generally 
made,  that  the  lacrimal  gland  belongs  to  the  type  of  acinous 
.glands,  and  little  or  no  mention  is  made  of  the  gland  of  Harder, 
or  of  the  structure  of  the  canaliculi  or  naso-lacrimal  tube. 
And  this  is  somewhat  remarkable  when  we  reflect  how 
large  a  space  the  pathology  of  the  lacrimal  apparatus  occu¬ 
pies  in  every  treatise  on  ophthalmic  surgery.  How  fre¬ 
quently  abnormal  conditions  of  this  apparatus  occur  in 
practice,  amounting  to  at  least  5  per  cent,  of  all  cases,  and 
Row  difficult  they  are  to  treat !  yet  it  would,  I  imagine,  be 
acknowledged  on  all  hands  that  sound  treatment  must  de¬ 
pend  on  accurate  anatomical  and  physiological  knowledge. 
Cases  of  obstruction  of  the  lacrimal  passages  seem  indeed 
to  be  the  despair  of  many  ophthalmic  surgeons,  when  we 
remember  that  they  have  led  to  the  suggestion,  and  even  to 
the  adoption  in  practice,  of  such  formidable  operations  as 
the  excision  of  the  lacrimal  gland,  the  obliteration  of  the 
lacrimal  sac  by  the  glowing  iron,  and  the  preposterous  pro¬ 
ceeding  of  punching  a  hole  through  skin  and  bone  and 
mucous  membrane  from  the  eye  to  the  nose  with  an  instru¬ 
ment  like  a  shoemaker’s  punch.  If  Mr.  Bowman  had  no 
other  claim  to  the  esteem  of  the  profession  than  that  which 
is  due  to  him  for  the  simple  and  scientific  method  of  treating 
these  cases  which  he  has  proposed,  even  though  it  may  not 
in  all  instances  be  attended  with  perfect  success,  he  would 
still  take  high  rank  amongst  those  who  have  done  most  to 
advance  and  improve  the  surgical  treatment  of  diseases  of 
the  eye. 

But  if  the  information  to  be  gained  from  English  woi’ks 
is  somewhat  bald  and  imperfect,  in  France  and  Germany 
many  monographs  have  been  written— some  dealing  with  the 
lacrimal  gland  and  the  lacrimal  passages  in  man ;  others 
with  the  special  gland  associated  with  the  nictitating  mem¬ 
brane  in  animals  ;  others  with  the  process  of  development 
of  the  whole  apparatus ;  and  others  again  with  the  physi¬ 
ology  both  of  the  secretions  themselves,  and  with  the 
mechanism  of  the  apparatus  by  which  these  secretions  are 
conveyed  away.  These  original  papers  form  collectively 
rather  a  large  literature,  and  I  venture  to  hope  that  in  these 
lectures  I  may  have  collected  from  various  sources  and  be 
able  to  place  before  you  information  that  is  otherwise  widely 
scattered  and  is  not  familiar  to  the  ordinary  English  reader. 
Most  of  the  dissections  which  will  illustrate  the  remarks  I 
have  to  make  have  been  executed  by  William  Pearson, 
whose  skill  in  this  direction  is  known  to  all  of  us  by  the 

Vol.  II.  1883.  No.  1734. 


Sept.  22,  1683.  335 


I  beautiful  dissections  in  the  museum,  and  without  whose  aid 
I  it  would  have  been  impossible  for  me  to  have  added  so  many 
specimens  to  the  museum.  I  have  to  thank  him  also,  as  well 
as  my  son  and  some  other  friends,  for  many  sections. 

In  considering  how  1  could  best  deal  with  the  materials  in 
my  possession,  it  seemed  to  me  that  it  would  be  advisable  to 
consider  the  lacrimal  apparatus  in  Amphibia,  Reptiles,  and 
Birds  in  my  first  lecture ;  in  my  second  to  describe  its 
characters  in  detail  in  Mammals  and  in  Man;  and  in  my 
third  lecture  to  discuss  the  physiology  of  the  secretion  of 
tears  and  the  functional  significance  of  the  several  parts, 
adding,  if  time  is  sufficient,  a  few  observations  of  a  practical 
nature. 

There  are  no  lacrimal  glands  in  any  of  the  Invertebrata. 
In  the  highest  Arthropods  the  facetted  corneal  surface  of 
the  eyes  is  hard,  horny,  bright,  and  polished,  and  particles 
of  dust  are  removed  by  a  brushing  movement  of  the  fore 
legs — an  action  that  is  familiar  to  all  in  the  fly,  bee,  ant, 
and  beetle,  which  carefully  clean  their  eyes.  The  higher 
Mollusca  live  in  water,  and  the  surface  of  the  eyes  is  kept 
clean  by  the  currents  of  this  fluid ;  or  if,  as  in  the  case  of 
the  snail,  they  are  terrestrial,  they  are  carefully  protected 
by  being  retracted  in  the  long  tentacles.  In  the  cuttle-fish 
a  glandular  apparatus  surrounds  the  eye,  and  there  is  a 
circular  fold  in  the  species  brought  home  by  Ross,  with  a 
sphincter  which  can  cover  the  cornea  and  protect  it  from 
spicula  of  ice. 

Amongst  the  Yertebrata  the  presence  of  lids  and  of  a 
glandular  apparatus  connected  with  them  is  limited  to  the 
Amphibia,  Reptiles,  Birds,  and  Mammals.  Eyelids  and  their 
associated  glands  are  absent  amongst  Fishes.  Living  in 
water,  the  surface  of  their  eyes  is  continually  washed  with 
the  circumambient  fluid,  and  it  is  only  in  the  highest  forms, 
as  the  Sharks,  that  some  rudiments  of  the  lids  appear,  with, 
in  one  family,  the  Carchariidse,  sharks  chiefly  inhabiting  the 
warmer  seas  of  the  tropics,  a  nictitating  membrane.  The 
nictitating  muscle  is  stated  by  von  Carus  not  to  lie,  as  in  the 
higher  classes,  upon  the  eye,  but  behind  the  orbit,  and  to 
arise  from  the  side  of  the  skull.  In  the  orbit  of  one  Fish 
alone,  according  to  Gunther — Chorismodentex — an  organ  has 
been  found  which  can  be  compared  to  a  saccus  lacrimalis.  It 
is  a  round,  blind,  wide  sac  of  the  size  of  a  pea,  situated 
below  the  anterior  corner  of  the  orbit,  between  the  maxillary 
bone  and  the  muscles  of  the  cheek,  communicating  by  a 
rather  wide  foramen  with  the  orbital  cavity.  The  membrane 
by  which  it  is  formed  is  continuous  with  that  lining  the 
orbit. 

In  the  lower  division  of  the  Amphibia,  represented 
by  the  TTrodela  or  tailed  Amphibia,  of  which  the  Newt 
or  Eft,  the  Salamander,  and  Proteus,  are  typical  examples, 
it  is  found  that  in  the  Proteus,  which  inhabits  the  waters 
of  the  dark  underground  caves  of  Styria  and  Carinthia, 
the  eyes,  no  longer  required,  with  all  their  accessory  appa¬ 
ratus,  have  (apparently  from  disuse)  undergone  degeneration, 
have  become  extremely  small,  and  are  covered  by  a  pro¬ 
longation  of  the  skin,  which  either  presents  no  eyelids  at 
all,  or  at  most  only  a  rudimentary  circular  fold. 

In  the  Salamander,  however,  the  eyes  are  large,  and  there 
are  valve-like  folds  of  the  skin  which  present  some  approxi¬ 
mation  to  true  eyelids  ;  yet  even  here  the  skin,  after  forming 
the  lid-folds,  is  continued  over  the  eye,  becoming  trans¬ 
parent  at  its  central  part.  No  lacrimal  apparatus  is  known 
to  exist  in  these  creatures,  and  there  do  not  appear  to  be 
any  channels  by  which  the  products  of  their  secretion,  if 
present,  could  be  conveyed  away. 

In  the  higher  division,  or  Anoura,  represented  by  the 
various  genera  of  Frogs  and  Toads,  and  which  spend  much  of 
their  time  out  of  water,  the  presence  of  lids  and  a  lacrimal 
apparatus  becomes  a  necessity  for  their  protection.  rJ  here 
is  only  one  genus  in  which  no  lids  exist — that  is  in  the  Pipa, 
or  Surinam  toad,  so  interesting  on  account  of  the  female 
incubating  the  eggs  on  her  back,  and  in  which  the  eyes  are 
very  small  and  placed  quite  in  ;  he  fore  part  of  the  head. 
In  all  the  rest  of  the  Anoura  there  is  an  upper  and  lower 
eyelid,  which  has  a  free  border  that  resembles  a  membrana 
nictitans.  In  the  Bufonidse,  but  not  in  the  other  genera, 
a  rudimentary  lower  eyelid  exists.  The  upper  eyelid  is 
always  adherent  to  the  globe  of  the  eye,  and  follows  its  move¬ 
ments.  According  to  Ecker,  it  contains  no  muscular  tissue. 
The  cleansing  of  the  surface  of  the  eye  is  essentially  effected 
by  a  kind  of  membrana  nictitans,  which  is  of  considerable 
size,  and  appears  here  for  the  first  time  with  its  own  proper 


Sept.  22,  ISSo, 


336  Medical  Times  and  Gazette1  POWER  ON  THE  LACRIMAL  APPARATUS  OF  THE  EYE. 


or  Harderian  gland.  It  is  a  transparent  membrane,  desti¬ 
tute  of  pigment  except  at  its  free  border,  and  presenting 
the  characters  of  skin,  with  nerves,  vessels,  and  cutaneous 
glands,  though  the  latter  are  more  sparsely  scattered  than 
in  the  skin  itself.  It  can  be  rapidly  drawn  up  over  the 
anterior  surface  of  the  eye  by  the  action  of  a  special  muscle. 
When  refracted,  its  free  border  embraces  the  lower  segment 
of  the  globe  ;  but  when  the  muscle  contracts,  it  rises  and 
covers  the  greater  part  of  the  surface  of  the  eye.  It  is 
essentially  the  free  border  of  the  lower  lid  in  the  Frogs,  but 
in  Bufonidse  there  is  a  rudiment  of  a  special  lower  lid. 

The  precise  mode  in  which  the  movement  of  this  mem¬ 
brane  is  accomplished  is,  however,  not  very  perfectly 
known.  Duges  has  described  (a)  two  muscles  amongst  the 
extrinsic  muscles  of  the  eye,  having  for  their  function  the 
elevation  of  the  lower  eyelid.  These,  he  believes,  constitute 
portions  of  the  strong  retractor  bulbi,  from  which  they 
are  only  separated  and  prolonged  anteriorly.  The  outer, 
which  he  names  the  oculo-palpebral  posterieure,  is  some¬ 
what  more  completely  separated,  or  is  separated  to  a  rather 
greater  extent  backwards,  than  the  inner,  which  he  names 
the  oculo-palpebral  anterieure.  These  two  slips,  he  thinks, 
draw  the  eyelid  over  the  eye,  at  the  same  time  that  the 
retractor  bulbi  draws  the  eye  backwards  and  downwards. 

Manz,(b)  however,  believes  that  he  is  able  to  demonstrate 
that  the  free  border  of  the  membrana  nictitans,  which  is 
usually  characterised  by  a  special  deposit  of  pigment,  passes 
on  either  side  into  a  thin  tendinous  band,'whieh  runs  through 
a  pulley  attached  to  the  periosteum  of  the  orbit,  and  is  then 
joined  by  connective  tissue  to  the  retractor  muscle,  so  that 
a  ring  is  formed,  having  the  membrana  nictitans  in  front, 
whilst  the  posterior  half,  crossing  the  fibres  of  the  retractor 
bulbi  at  right  angles,  is  intimately  connected  with  them. 
The  inner  part  of  the  tendinous  band  lies  beneath  the  gland 
of  Harder,  and  the  disposition  of  the  whole  is  such,  that  as 
the  globe  of  the  eye  is  retracted  the  membrana  nictitans 
rises,  the  tendon  rolling  through  the  pulley.  The  depres¬ 
sion  of  the  membrana  nictitans  is  effected,  according  to  Manz, 
by  a  small  special  muscle  arising  near  the  external  angle 
of  the  eye,  which  he  has  named  the  musculus  palpebree 
inferioris.  The  whole  length  of  the  tendinous  ring  in  frogs 
of  moderate  size  is  estimated  at  about  nine  to  ten  milli¬ 
metres,  or  nearly  half  an  inch.  Nuhn  simply  says  the 
muscular  apparatus  of  the  nictitating  membrane  resembles 
that  of  Birds,  except  that  the  musculus  quadratus  is  absent, 
and  a  tendinous  fasciculus  of  the  musculus  pyriformis  passes 
to  the  outer  extremity  of  the  upper  eyelid. 

There  is  no  true  lacrimal  gland  in  Frogs  and  Toads  ;  that 
is,  there 'is  no  gland  situated  at  the  upper  and  outer  part  of 
the  orbit  discharging  a  clear  watery  fluid,  though  they 
possess  a  well-developed  naso-lacrimal  duct.  A  gland, 
however,  is  found  at  the  inner  canthus,  which  pours  its 
secretion  into  the  space  between  the  nictitating  membrane 
and  the  globe  of  the  eye.  This  is  the  first  appearance  of 
the  Harderian  gland — a  gland  that  we  shall  hereafter  see  is 
constantly  associated  with  the  nictitating  membrane.  It  is 
particularly  well  developed  in  the  Toad.  It  is  of  pyriform 
shape,  and  is  composed  of  a  number  of  acini  united  into 
lobules  and  lobes  by  fine  fibrillar  connective  tissue,  which 
forms  a  strong  investment  to  the  whole  gland.  The  alveoli 
have  a  diameter  of  l-300th  or  l-400th  of  an  inch,  and  they 
present  a  canal  and  a  wall.  The  canal  of  the  acinus  be¬ 
comes  smaller  as  it  runs  towards  the  excretory  duct.  The 
wall  is  composed  of  a  layer  of  columnar  and  finely  granular 
cells,  with  ill-defined  cell-walls,  resting  on  a  delicate  and 
homogeneous  membrana  propria.  In  preparations  macerated 
in  Muller’s  fluid,  the  nuclei  are  spherical  and  pale,  and  lie 
near  the  membrana  propria,  like  the  cells  of  the  salivary 
glands.  The  excretory  ducts  are  lined  by  a  single  layer  of 
columnar  cells,  which  are  shorter  and  smaller  than  those 
lining  the  alveoli,  and  the  walls  of  the  larger  ducts  are 
strengthened  by  connective  tissue.  The  gland,  as  a,  whole,  is 
very  vascular,  every  alveolus  being  surrounded  by  a  plexus 
of  bloodvessels.  The  secretion  is  oily,  and  resembles  that 
of  the  Meibomian  follicles. 

No  eyelids  exist  in  Ophidia,  which  gives  the  stony  aspect 
to  their  physiognomy,  and  contributes  to  the  fascination  of 
their  steady  gaze. 

(a)  Bronn,  “Thier  Reich,”  vol.  vi.,  page  302. 

(b)  “Ueber  den  Mechanismus  der  Nickbautbewegung  beim  Froscb.” 
Her.  ub.  die  Verhand.  der  Nalurf.  Gesells.  zu  Freiberg ,  vol.  i.,  page  391. 
1862. 


In  Snalces,  the  lacrimal  apparatus  consists  of  a  lacrimal 
gland,  the  conjunctival  sac,  and  the  lacrimal  duct  or  pas¬ 
sage.  The  lacrimal  gland  is  of  remarkable  size,  being  at 
least  as  large  as  the  globe  of  the  eye.  It  is  situated  behind' 
the  eye  and  the  post-orbital  ligament,  and  is  often  pro¬ 
longed  posteriorly  to  a  considerable  distance  beneath  the 
anterior  temporal  muscle.  It  attains  its  greatest  size  in  the 
Colubers,  Pythons,  and  other  Constrictors,  and  in  these  con¬ 
tributes  its  secretion  to  that  of  other  sources  of  lubrication 
of  the  mouth  during  the  long  and  difficult  act  of  deglutition. 
It  is  generally  less  developed  in  the  venomous  snakes.  It  is. 
in  contact  anteriorly  with  the  conjunctiva,  through  which, 
membrane  its  numerous  excretory  ducts  pass.  It  presents 
the  characters  of  an  acinous  gland,  and  is  invested  by  a 
delicate  layer  of  connective  tissue.  Its  secretion  is  poured 
into  the  conjunctival  sac,  which  is  large,  extends  far  back 
into  the  orbit,  and  has  no  opening  corresponding  to  the 
palpebral  fissure  of  the  higher  animals.  It  has,  however, 
at  its  anterior  and  lower  part  a  small  single  opening  or 
pore — the  punctum  lacrimale , — which  in  the  Python  is  large 
enough  to  admit  a  bristle.  The  punctum  leads  to  a  delicate 
membranous  duct,  which  is  the  lacrimal  canal,  and  which 
communicates  with  the  mouth  behind  the  premaxillary 
bone.  The  canal  runs  downwards  and  forwards,  grooves 
the  lacrimal  bone,  and  arrives  at  the  outer  wall  of  the 
nasal  fossa,  where  it  forms  a  large  pouch,  named  by  Cloquet 
the  intermaxillary  sac.  In  the  Viper  and  other  venomous 
serpents  the  lacrimal  sac  opens  into  the  nasal  meatus. 
But  in  the  non-venomous  serpents  the  intermaxillary  sac  is 
situated  on  each  side  of  the  head,  between  the  maxillary 
and  palatine  branches  of  the  superior  maxillary  bone.  The 
walls  of  the  sac  are  very  thin,  and  those  of  opposite  sides 
communicate  in  front.  Behind,  it  is  prolonged  between 
the  skin  and  the  muscles,  and  terminates  in  a  cul-de-sac _ 
Lastly,  it  communicates  below  with  the  cavity  of  the  mouth 
by  a  narrow  orifice.  In  some  venomous  snakes  the  mouth 
communicates  directly  with  an  analogous  reservoir,  but  this- 
sac  does  not  appear  to  have  any  communication  with  the- 
lacrimal  sac.(c) 

Many  Saurians,  as  the  Grecko,  have  no  eyelids ;  others,  as 
the  Lizards,  possess  them ;  and  we  are  indebted  to  Leydig 
and  Weber  for  the  best  account  of  the  lacrimal  and  acces¬ 
sory  apparatus  of  the  eye  in  Lizards  and  their  allies.  In 
these  animals  the  eyelids  are  fairly  well  developed,  and  by 
their  apposition  can  close  the  conjunctival  cavity.  The 
upper  lid  is  supported  by  a  dermal  ossicle,  the  lamina  super- 
ciliaris,  which  may  be  compared  with  the  so-called  tarsal  car¬ 
tilage  of  Man.  The  lower  lid  is  strengthened  by  cartilage,, 
which  was  first  noticed  by  Duges.  The  corium  of  each  lid 
presents  a  curiously  laminated  structure.  The  cells  of 
the  cartilage  are  small,  pointed,  and  resemble  connective- 
tissue  corpuscles.  The  lymph-like  tissue  is  very  peculiar. 
It  exists  not  only  in  the  upper  and  lower  lids,  but  beneath 
the  conjunctiva.  The  spaces  are  filled  with  finely  granular 
material,  making  the  whole  resemble  gland  tissue.  Leydig 
dwells  upon  the  oedematous  character  that  the  lid  presents 
in  Man,  and  suggests  that  lymphatic  spaces  of  a  similar 
character  may  exist  there.  The  cartilage  which  succeeds  to- 
the  lymphoid  tissue  is  covered  with  epithelium  which  rests 
directly  on  the  cartilage.  There  is  a  large  quantity  of  un- 
striated  muscular  tissue  arising  circumferentially,  and  run¬ 
ning  towards  the  lids,  just  beneath  the  skin.  These  fibres 
form  a  strong  band  at  the  anterior  angle  of  the  eye.  Here 
also  there  is  a  smooth  muscle  which  arises  from  the  cartila¬ 
ginous  septum  of  the  orbits,  and  is  lost  in  front  of  the- 
superior  oblique  muscle  in  the  upper  lid,  the  membrana 
nictitans,  and  the  gland  of  Harder.  A  strong  band  of  this 
smooth  musculature  runs  from  below  into  the  third  lid.  I 
have  mentioned  these  muscular  fibres  because  Leydig  is  of 
opinion  they  have  nothing  to  do  with  the  movements  of  the 
lids,  but  have  for  their  function  the  evacuation  of  the 
glandular  secretions. 

Leydig  gives  a  good  description  of  the  membrana  nictitans 
in  Lizards.  He  points  out  that  the  external  surface  pre¬ 
sents  two  ridges  of  semilunar  form,  which  are  not  mere 
folds,  but  persistent  formations.  The  first  belongs  to  the 
anterior  border  of  the  lid,  and  is  a  strong  two-lipped 
ridge,  rather  darkly  pigmented.  The  second  is  placed 
further  back,  but  is  likewise  arched  and  equally  darkly 
pigmented.  Quite  different  from  these  are  a  number  of 


(o)  Milne  Edwards,  vol.  xii.,  pages  115  to  119;  vol.  vi.,  page  224. 


Medical  Times  and  Gazette. 


POWER  ON  THE  LACRIMAL  APPARATUS  OF  THE  EYE. 


Sept.  22,  1883.  337 


little  wrinkles  which,  occur  near  the  posterior  portion  of  the! 
membrane,  where  it  passes  into  the  connective  tissue  around ' 
the  eye  in  the  retracted  condition.  The  membrana  nictitans 
possesses  also  a  cartilage  which,  both  in  its  form  and  in  its 
histological  characters,  differs  greatly  from  that  of  the  lower 
lid.  It  is  a  hook  or  clasp-like  rod  which  supports  the  lid 
like  the  rod  of  a  curtain.  Its  structure  is  that  of  pure 
hyaline  cartilage.  It  extends  from  the  membrana  nictitans 
into  the  gland  of  Harder.  It  is  free  at  its  two  extremities. 
The  inner  surface  of  the  nictitating  membrane  is  lined  with 
epithelium,  characterised  by  the  presence  of  a  large  number 
of  goblet-cells.  The  fundamental  connective  tissue  is  very 
rich  in  fine  elastic  fibres.  The  membrana  nictitans  is  con¬ 
nected  at  its  lower  border  with  a  long  cord-like  tendon, 
which  winds  round  the  posterior  part  of  the  globe  of  the  eye, 
close  to  the  optic  nerve.  Where  this  tendon  is  continuous 
with  the  membrana  nictitans  it  loses  its  cord-like  character, 
expands  into  a  kind  of  hollow  cone,  and  runs  into  the  two 
arched  ridges  just  described,  which  constitute  the  real 
points  of  attachment  of  the  tendon.  Posteriorly,  near  the 
optic  nerve  it  passes  through  a  muscular  loop  resembling 
the  quad  rat  us  muscle  of  Birds,  and  which  is  named  by  Weber 
( Archiv  f.  Naturgeschichte,  1877)  the  musculus  bursalis,  and 
then  passes  on  to  be  attached  to  the  wall  of  the  orbit  on  its 
inner  or  nasal  side,  and  indeed  to  the  frontal  bone.  It 
surrounds  three-fourths  of  the  circumference  of  the  globe. 
It  is  supplied  by  the  sixth  nerve. 

The  musculus  bursalis  of  Weber  arises  just  above  the 
groove  for  the  retractor  oculi,  or  musculus  choanoides,  and 
forming  a  long,  flat  belly,  proceeds  towards  the  eyeball 
parallel  with  the  fibres  of  the  retractor,  but,  instead  of 
being  wholly  inserted  into  the  globe,  a  part  of  its  fibres, 
amounting  to  about  two-thirds,  suddenly  curve  round  the 
tendon  of  the  nictitator  muscle,  forming  a  complete  loop, 
through  which  that  tendon  passes.  The  bursalis  muscle  is 
therefore  quite  different  from  the  musculus  quadratus  of 
Birds.  Huxley,  examining,  probably,  another  species, 
describes  a  fibrous  lamina  as  existing  at  this  spot;  and 
Weber  says  there  is  a  connective-tissue  cushion  within  the 
loop.  The  fasciculus  of  muscle  which  becomes  detached, 
which  is  about  one-third  of  the  whole  muscle,  runs  upwards 
•over  the  tendon  of  the  nictitator,  and  acts  as  a  retractor, 
compensating  for  the  unilateral  action  of  the  retractor 
proper.  The  two  actions  of  protraction  of  the  nictitating 
membrane  and  retraction  of  the  globe  are  necessarily 
coincident. 

Two  glands  are  present  in  Lizards,  a  lacrimal  and  an 
Harder ian  gland. 

The  lacrimal  gland  lies,  as  usual,  at  the  external  or  pos¬ 
terior  angle  of  the  eye,  and  is  very  small  as  compared  with 
the  Harderian  gland.  It  consists  of  short  tubes  bifurcated 
at  their  extremity,  which  do  not  unite  to  form  a  single  duct, 
but  form  groups  discharging  themselves  by  several  open¬ 
ings.  The  conjunctiva  in  the  vicinity  of  the  lacrimal  gland 
contains  layers  of  smooth  muscle.  It  is  supplied,  according 
to  Weber  ( Archiv  fiir  Naturgeschichte,  1877),  by  the  fifth 
nerve,  and  not  by  the  first,  but  by  the  second  branch  to  the 
upper  lid. 

The  Harderian  gland,  or  gland  of  the  nictitating  mem¬ 
brane,  is  situated  at  the  anterior  or  inner  angle  of  the  eye,  and 
is  very  large.  It  embraces  the  lower  and  posterior  segment 
of  the  globe,  the  major  portion  of  the  gland  forming  its  upper 
and  back  part.  This  gland  has  only  one  excretory  duct, 
which  Leydig  states  that  he  has  followed  for  some  distance 
towards  the  nasal  cavity,  but  without  being  able  to  satisfy 
himself  of  the  precise  spot  where  it  terminates.  Weber 
states  that  it  is  supplied  by  the  branch  of  the  fifth  to  the 
lower  lid,  which  also  comes  from  the  second  branch  of  the 
fifth. 

Two  canaliculi  exist  in  Lizards  at  the  inner  angle  of  the 
■eve.  They  may  be  best  exposed  by  sharply  and  cleanly 
excising  the  nictitating  membrane,  by  which  means  their 
lumina  are  exposed  lying  in  juxtaposition.  They  are  lined 
with  epithelium,  which  is  rich  in  goblet-cells,  and  in  this 
respect  resembles  that  of  the  conjunctiva.  The  canaliculi 
are  surrounded  with  bloodvessels,  and  a  bristle  inserted  into 
•either  of  them  may  be  passed  into  the  nose. 

In  regard  to  the  lacrimo-nasal  canal,  an  opening  exists 
in  the  oslacrimale,  which  dilates  into  a  wide  lacrimal  canal, 
formed  by  the  lacrimal  and  prefrontal  bones,  and  then  by 
the  superior  maxillary,  which  forms  the  outer  wall,  situated 
externally  to  the  cartilaginous  framework,  and  bounded  by 


the  upper  jaw,  which  opens  into  the  external  wall  of  the 
nasal  passage  near  its  communication  with  the  throat.  These 
bony  ducts  contain  the  proper  tear-ducts.  The  puncta  are 
slit-like,  and  open  into  canaliculi,  which  lie  close  together, 
and  run  parallel  to  the  bony  opening,  separated  by  connec¬ 
tive  tissue,  and  lined  by  goblet-cells.  The  superior  canaliculus 
is  the  largest.  After  uniting  they  form  the  ductus  lacrimo- 
nasalis,  which  is  short  and  does  not  exhibit  any  sac. 

The  superior  rectus  is  a  fiat  muscle,  arising  from  the  floor 
of  the  orbit  by  a  musculo-tendinous  origin,  and,  running 
forward,  is  partly  inserted  into  the  sclerotic,  and  partly  passes 
into  the  substance  of  the  upper  eyelid,  blending  with  the 
fibres  of  the  internal  oblique  muscle. 

The  internal  oblique  muscle,  also  flat,  arises  from  the  floor 
of  the  orbit  by  a  muscular  origin,  and  after  running  obliquely 
forwards  for  about  the  space  of  three-quarters  of  an  inch, 
also  divides  into  two  parts— one,  more  internal  or  anterior  and 
superficial  than  the  other,  joins  with  the  superficial  part  of 
the  superior  rectus,  and  is  apparently  partly,  like  it,  inserted 
into  the  sclerotic,  and  partly  runs  into  the  substance  of  the 
upper  eyelid;  the  other,  more  external  and  deeper,  passes 
beneath  the  superior  rectus,  and  is  inserted  into  the  upper 
and  outer  quadrant  of  the  eyeball. 

The  internal  rectus  is  a  round  muscle.  It  arises  from  the 
back  of  the  orbit  at  a  point  intermediate  to  the  superior 
rectus  and  internal  oblique,  and  running  forwards  between 
the  globe  and  Harderian  gland,  appears,  like  the  superior 
rectus,  to  be  partly  insertedinto  the  sclerotic,  and  partly  into 
the  dense  tissue  of  the  eyelid  near  the  inner  canthus,  upon 
which  the  Harderian  gland  rests. 

Now  turning  the  eye  half-way  round,  so  as  to  obtain  a  view 
from  below,  a  second  oblique  muscle  is  seen,  which  may  be 
termed  the  external  oblique ;  it  arises  from  the  floor  of  the 
orbit,  below  the  Harderian  gland,  and  is  inserted  into  the 
sclerotic  at  its  inferior  part,  about  one-third  of  an  inch  from 
the  cornea,  in  company  with  the  inferior  rectus. 

The  inferior  rectus  arises  from  the  same  groove,  but  a 
little  posterior  to  the  internal  oblique,  and  just  external 
to  the  superior  rectus,  and  is  inserted  with  the  external 
oblique. 

The  external  rectus  is  thin,  round,  and  small ;  it  arises 
from  a  deep  groove  at  the  back  of  the  orbit,  and  is  inserted 
into  the  external  part  of  the  sclerotic.  *■ 

And  now  there  is  a  large  retractor  bulbi,  which,  arising 
again  from  the  floor  of  the  orbit,  covers  the  outer  and  upper 
and  lower  parts  of  the  optic  nerve,  around  the  entrance  of 
which  into  the  globe  it  is  inserted.  Below  and  in  front  of 
this  is  a  singular  thin  muscle,  which  runs  forwards  between 
the  retractor  and  the  external  rectus.  This  muscle  divides 
into  two  portions  anteriorly — one  j  oins  the  external  rectus 
at  its  insertion :  the  other  runs  to  the  external  canthus  of 
the  eyelid,  which  it  must  serve  to  pull  outwards,  and  perhaps 
to  raise  a  little. 

The  nictitator  arises  from  the  inferior  and  inner  part  of  the 
globe,  just  beneath  the  Harderian  gland,  and  runs  upwards 
and  outwards  close  to  the  globe  till  it  reaches  the  upper 
border  of  the  optic  nerve,  from  which  it  is  separated  by 
the  retractor.  It  here  divides  :  the  nictitator  proper  runs 
downwards  and  then  upwards  to  the  inferior  border  of  the 
nictitating  membrane  ;  the  other  part  ascends  suddenly,  and 
passes  to  the  outer  canthus  of  the  eye.  The  relation  of  this 
to  the  duct  of  the  large  lacrimal  gland  is  very  peculiar. 

The  eyelids  of  the  Turtle  are  heavy  folds  of  skin,  the  inner 
surface  of  which  is  lined  by  a  mucous  membrane.  The 
lower  lid  is  the  larger  of  the  two,  and  its  general  structure 
is  that  it  presents  a  corium  with  subjacent  lymph  spaces. 

There  is  also  a  membrana  nictitans,  which  advances  from 
the  inner  corner  of  the  eye  at  the  same  time  that  the  inferior 
eyelid  rises  and  the  globe  of  the  eye  is  retracted.  This 
triple  movement  is  provided  for  by  the  very  remarkable 
arrangements  of  the  muscles.  Besides  the  usual  six  muscles 
attached  to  the  globe  of  the  eye,  there  is  a  large  and  power¬ 
ful  muscle  which  arises  more  anteriorly  than  the  retractor 
muscle,  and  to  the  inner  side  of  the  optic  nerve  by  a  broad 
origin.  The  fibres  run  outwards  above  the  optic  nerve,  and 
almost  immediately  form  two  fasciculi,  which  diverge  from 
each  other.  One  of  these  curves  sharply  round  the  optic  nerve, 
and  then,  widening  beneath  it,  runs  to  the  inner  extremity 
of  the  membrana  nictitans ;  when  it  contracts,  the  membrana 
nictitans  rises.  The  other  fasciculus  runs  outwards  and 
somewhat  upwards,  then  curves  downwards,  and  is  attached 
to  the  outer  border  of  the  lower  lid ;  when  it  contracts,  the 


338 


Medical  Times  and  Gazette. 


POWER  ON  THE  LACRIMAL  APPARATUS  OF  THE  EYE. 


Sept.  22, 18®3. 


lower  lid  rises.  When  the  protractor  membrana  nietitantis 
acts,  it  is  probable  that  the  retractor  bulbi  also  contracts,  and 
prevents  injurious  pressure  on  the  eye,  whilst  it  still  aids  iu 
shielding  the  eye  from  injury. 

A  short  but  good  account  of  the  lacrimal  gland  of  the 
Common  Turtle  has  been  furnished  by  C.  Stewart,(d)  who 
observes  that,  in  dissecting  the  head  of  the  common  turtle 
(Chelone  midas),  it  is  impossible  not  to  be  struck  by  the 
great  relative  and-absolute  size  of  the  lacrimal  gland.  The 
large  size  of  this  organ  is  the  more  remarkable  since,  in  the 
water-dwelling  animals,  it  is,  as  we  have  seen,  either  alto¬ 
gether  absent  or  but  slightly  developed,  the  surrounding 
fluid  answering  the  purposes  of  its  secretion  in  protecting 
the  eye  from  dust,  desiccation,  or  loss  of  the  transparency 
of  the  conjunctiva  and  cornea.  He  further  remarks  that 
the  necessity  for  at  least  an  occasional  abundant  lacrimal 
secretion  in  these  animals  is  perhaps  found  in  the  fact  that 
at  certain  times,  especially  during  the  breeding  season,  they 
leave  the  water,  and  remain  for  some  time  on  the  hot  sandy 
banks  on  which  their  eggs  ar  laid. 

In  the  Turtle  the  gland  occupies  the  outer  or  posterior 
part  of  the  base  of  the  orbit,  and  is  covered  and  protected 
by  the  posterior  frontal  bone,  which  forms  so  large  a  part  of 
the  false  roof  of  the  cranium  that  exists  in  this  genus  and  in 
Cbelydra.  The  gland  is  about  three  times  the  size  of  the 
globe  of  the  eye.  It  is  composed  of  numerous  closely  packed 
lobules,  which  are  irregularly  flattened  and  cleft,  and  sur¬ 
round  a  central  cone  of  connective  tissue.  Each  lobule  is 
conical  in  form,  the  apices  of  the  various  lobuli  converging 
to  a  central  duct.  This  duct  is  lined  by  columnar  epithe¬ 
lium,  with  a  layer  of  smaller  cells.  Tubular  acini  proceed 
directly  outwards,  which  repeatedly  branch  and  become 
reduced  in  size  as  they  pass  to  the  surface  of  the  lobules. 
These  acini  are  lined  by  a  layer  of  a  remarkable  variety  of 
columnar  epithelium,  the  cells  being  in  no  place  in  contact 
with  each  other,  but  being  separated  by  a  clear  space.  Each 
cell  has  also  deep  grooves  running  along  its  sides,  and  at  its 
attached  end  presents  numerous  delicate  root-like  processes. 
A  section  which  grazes  the  surface  of  an  acinus  accordingly 
shows  a  number  of  dots  corresponding  with  the  transverse 
sections  of  these  root-like  processes.  If  it  be  a  little  deeper, 
each  cell  appears  like  a  minute  star ;  whereas,  if  the  centre 
of  the  acinus  be  struck,  a  true  side-view  of  the  cells  will  be 
obtained. 

Each  of  the  lobules  of  the  lacrimal  gland  of  the  Turtle 
presents  the  character  of  a  t.ubuliferous  gland.  The  tubules 
commence  at  the  periphery  of  the  gland-lobule  by  a  slightly 
dilated  extremity,  which  abuts  upon  the  surrounding  con¬ 
nective  tissue  investment  of  the  lobule.  It  runs  without 
changing  its  diameter  as  a  cylindrical  tubule  for  some  dis¬ 
tance,  then  gradually  widens,  and  then,  without  anasto¬ 
mosing,  appears  to  open  into  wider  tubes. 

Many  irregular  pigment  corpuscles  may  be  seen  in  the 
intermediate  connective  tissue. 

The  gland  of  Harder  in  the  Turtle  is  not  nearly  so  per¬ 
fectly  developed  a  gland  as  the  lacrimal ;  it  consists  of  a 
large  quantity  of  connective  tissue  with  acini  sparingly 
scattered  amongst  them.  It  gives  one  the  idea  of  a  gland 
undergoing  degeneration  from  disuse. 

In  the  Crocodile,  the  structure  of  the  eyelids,  according  to 
Hoffmann,  (e)  differs  considerably  from  that  of  the  Lizard. 
There  is  no  tarsal  cartilage,  the  lamination  of  the  corium  is 
not  perceptible,  and  the  large  lymphatic  sinuses  are  absent. 
There  is  a  depressor  of  the  lower  lid.  The  upper  eyelid  is 
supported  at  its  base  by  the  superciliary  bone  and  its  own 
levator  muscle.  The  membrana  nictitans  is  strongly  deve¬ 
loped,  but  in  C.  porosus  it  is  not  provided  with  a  cartila¬ 
ginous  rod.  The  muscle  moving  it  arises  above  and  in  front 
of  the  optic  nerve  by  a  broad  and  very  thin  origin,  then  courses 
round  the  posterior  part  of  the  globe  of  the  eye  lying  in  close 
apposition  to  it,  and  then,  descending  slightly,  terminates 
by  a  short  aponeurosis  in  the  lower  extremity  of  the  posterior 
border  of  the  membrana  nictitans. 

The  lacrimal  gland  is  small,  narrow,  and  elongated,  with 
its  long  diameter  in  the  axis  of  the  orbit.  It  is  so  closely 
united  with  connective  tissue  that  it  is  not  easily  dis¬ 
coverable. 

The  Harderian  gland  is  large,  and  can  be  easily  dissected  out . 
It  is  triangular  in  form,  with  rounded  angles,  and  concavo- 


(d)  Monthly  Microscopical  Journal ,  1877,  page  241. 

(e)  Bronn,  “Thier  Beichs,”  vol.  vi.,  page  799. 


convex  surfaces  fitting  on  the  globe.  Fromits  forward  and  out¬ 
ward  directed  basis  issue  a  few  serially  arranged  ducts,  which 
open  in  the  sinus  between  the  membrana  nictitans  and  the 
globe  of  the  eye.  The  puncta  lacrimalia  are  remarkable. 
Hoffmann  found  only  one  in  C.  porosus,  but  they  vary, 
according  to  Eathke,  from  three  to  eight  in  different  species 
of  Crocodiles  and  Alligators.  Thus,  there  are  three  in  Alli¬ 
gator  lucius,  four  in  Crocodilus  vulgaris,  five  in  Gavialis 
Schlegelii,  six  in  Alligator  punctulatus,  and  six  to  eight  in 
Alligator  sclerops.  They  are  situated  on  the  inner  surface 
of  the  lower  lid,  near  the  anterior  canthus  of  the  eye.  Each 
leads  into  a  small  elongated  oval  sac,  lying  just  beneath 
the  connective  tissue,  which  is  again  continuous  with  a 
narrow  membranous  tube.  These  tubes  run  forwards  and 
downwards,  and  open  successively  into  a  far  wider  canal 
which  runs  close  to,  and  nearly  parallel  with,  the  free  border 
of  the  lid,  and  then  inclines  away  from  it  to  enter  the  open¬ 
ing  which  is  situated  at  the  posterior  part  of  the  lacrimal 
bone.  Eathke  was  unable  to  find  any  puncta  in  the  upper 
eyelid,  nor  was  Hoffmann  more  successful  in  C.  porosus. 
As  soon  as  it  has  entered  the  lacrimal  bone  it  expands,  and 
then  forms  what  Eathke  terms  the  saccus  naso-lacrimalis, 
which  appears  to  be  a  special  organ  of  secretion.  It  is  com¬ 
posed  of  mucous  membrane  and  a  strong  connective  tissue 
investment,  which  contains  pigment-cells  and  is  vascular. 
Between  the  mucous  membrane  and  the  fibrous  tissue  is  a 
closely  arranged  layer  of  glandular  cauliflower-like  follicles, 
which  have  a  yellowish  colour,  and  resemble  in  their  glisten¬ 
ing  aspect  fat-cells,  but  which  yet  contain  no  fat. 

Besides  these  there  is  still  a  third  kind  of  gland  in  Croco¬ 
diles,  situated  at  the  fold  of  the  inferior  palpebral  sinus, 
namely,  scattered  acinous  glands. 

The  necessity  that  exists  in  Birds  for  extremely  clear 
and  distinct  vision,  in  order  that  they  may  obtain  their 
food,  has  occasioned  their  eyes  to  be  highly  developed,  and 
they  have  all  the  accessory  organs  that  are  required  to  keep 
the  surface  of  the  cornea  bright  and  polished,  and  in  the 
highest  state  of  efficiency.  They  have,  therefore,  well- 
developed  upper  and  lower  lids,  both  of  which  are  movable, 
and  a  nictitating  membrane,  and  they  possess  both  a  lacri¬ 
mal  and  a  Harderian  gland.  Ho  Bird  is  destitute  of  eyes  or 
has  even  imperfectly  developed  eyes. 

The  lacrimal  gland  in  Birds  is  smaller  than  the  Harderian. 
It  lies  in  its  usual  position  at  the  upper  and  outer  or  posterior 
and  external  part  of  the  globe.  According  to  Owen,(f)  in 
the  Goose  it  is  of  flattened  form,  about  the  size  of  a  pea, 
and  discharges  its  secretion  by  a  short  wide  duct  upon  the 
inside  of  the  outer  canthus  of  the  eyelids.  In  the  Vulture 
it  appears  as  a  small  pale  pink-  or  rose-coloured  body, 
situated  at  the  upper  or  outer  part  of  the  globe,  granular 
in  aspect,  oval  in  form,  and  running  off  to  a  point  towards 
the  outer  canthus  of  the  eye,  where  it  terminates  by  be¬ 
coming  continuous  with  a  single  duct.  Its  structure  does 
not  appear  to  present  any  remarkable  features. 

The  gland  of  Harder  in  Birds  presents  peculiarities  of 
structure,  which  have  been  carefully  observed  and  described 
by  Jules  McCleod  in  the  Duck.(g) 

In  this  animal  the  gland  measures  l-5  ctm.  in  length,  and 
1’6  to  l-8  ctm.  in  width,  with  a  thickness  of  0-2  to  5  ctm.,  and 
is  therefore  of  considerable  size.  The  gland  is  flattened 
between  the  globe  of  the  eye  and  the  osseous  wall  of  the 
orbit,  and  is,  so  to  speak,  moulded  on  these  two  parts.  The 
osseous  surface  is  convex,  the  bulbar  concave.  The  general 
form  of  the  gland  is  crescentic,  the  concavity  being  in  front 
and  the  convexity  behind.  The  bulbar  face  presents  near 
its  middle  a  deep  transverse  fissure,  slightly  oblique  from 
above  downwards  and  from  before  backwards.  The  orbital 
face  presents  an  analogous  fissure,  nearly  vertical  in  direc¬ 
tion,  which  runs  upwards  from  the  central  part  of  the  con¬ 
cave  border.  The  bulbar  face  presents  a  number  of  small 
fissures  limiting  polygonal  eminences.  The  orbital  face 
presents  analogous  fissures,  but  much  less  marked.  The 
difference  is  perhaps  due  to  the  surface  on  which  it  is 
moulded. 

This  gland  discharges  its  product  at  the  internal  angle  of 
the  eye  at  the  base  of  the  nictitating  membrane,  and  the 
duct  is  accompanied  nearly  to  its  orifice  by  glandular 
elements. 

In  structure  the  Harderian  gland  of  the  Bird  differs 


(i)  “Anatomy  of  Vertebrates,”  vol.  ii.,  page  114. 
(g)  Archives  de  Biologic,  1830,  page  15. 


Medical  Times  and  Gazette. 


POWER  OH  THE  LACRIMAL  APPARATUS  OF  THE  EYE. 


Sept.  22,  1883.  339 


remarkably  from  the  same  gland  in  Mammals.  In  the  latter 
it  is  a  compound  acinous  gland,  but  in  Birds,  as  in  the 
Duck  and  Book,  it  is  a  compound  tubular  gland,  presenting 
this  character  in  a  remarkably  typical  manner  in  the  Duck. 

It  is,  in  fact,  here  formed  of  a  number  of  small  glandular 
tubes,  opening  by  groups  into  common  excretory  ducts, 
around  which  they  are  disposed  in  whorls. 

McCleod  applies  the  term  primary  tube  to  each  of  the 
small  simple  tubes,  and  secondary  tube  to  each  of  the  tubes 
around  which  the  primary  tubes  are  arranged,  and  into 
-which  they  discharge  their  products.  These  terms  cor¬ 
respond  to  those  of  acini,  primary  lobuli,  etc.,  ordinarily 
•employed  in  the  description  of  the  acinous  glands. 

The  entire  gland  is  invested  by  a  layer  of  connective 
tissue,  which  is  sometimes  of  considerable  thickness,  which 
sends  septa  between  the  secondary  tubes.  These  septa, 
in  their  turn,  give  off  others  of  less  thickness  between  the 
primary  lobules. 

The  arrangement  of  the  primary  and  secondary  tubes 
varies  somewhat  according  to  the  part  of  the  gland 
examined,  so  that  two  regions  may  be  distinguished  in  the 
gland,  between  which  there  is  no  well-defined  limit,  but 
which  pass  gradually  into  each  other. 

The  primary  tubes  are  arranged  in  a  radiating  manner 
around  a  common  excretory  duct,  into  which  they  open  at 
a  right  angle,  and  are  so  numerous  that  from  forty  to  fifty  \ 
are  seen  in  a  single  section. 

The  form  of  the  tubes  presents  some  variations,  according 
to  whether  the  upper  or  the  lower  portion  of  the  gland  is 
examined.  In  the  lower  region,  which  is  the  largest,  the 
tubes  have  a  straight  direction ;  when  they  bifurcate,  the 
divisions  remain  parallel ;  they  only  to  a  slight  extent  over¬ 
lap  or  interlace,  and  are  only  slightly  tortuous.  In  pro¬ 
portion  as  they  reach  the  point  of  discharge  they  become 
more  and  more  sinuous  and  interlace  more  and  more. 
The  tubes  are  rendered  prismatic  by  mutual  pressure,  and 
measure  on  the  average  25  to  35  p  in  diameter ;  their  length 
varies  too  much  to  allow  of  any  average  being  stated.  The 
tubes  are  very  closely  connected  together.  Their  wall  is 
formed  of  a  layer  of  connective  tissue  common  to  two  adja¬ 
cent  tubes.  They  are  lined  by  glandular  epithelium,  which 
presents  different  characters  according  to  the  part  of  the 
primary  tube  that  is  examined,  and  these  differences  are 
^associated  with  differences  in  the  connective  tissue  of  the 
wall. 

In  the  deep  part  the  connective  tissue  of  the  wall  is  much 
reduced.  The  gland  cells  are  cylindroid  ;  the  free  extremity, 
or  that  turned  towards  the  lumen  of  the  tube,  is  generally  a 
little  enlarged,  so  as  to  resemble  the  form  of  cell  sometimes 
termed  calyciform.  The  deep  or  attached  extremity  of  the 
•cell  is  usually  single,  but  occasionally  double.  It  maybe  as 
long  as  the  cell,  and  usually  forms  an  angle  with  it.  These 
processes  are  imbricated.  They  may  even  interlace  so  that 
they  give  more  surface  of  adhesion  for  the  cell,  and  more 
■strength  and  solidity  to  the  wall.  Similar  cells  have  been 
found  by  Banvier  in  the  cells  of  the  stomach  of  the  Frog, 
and  in  the  cells  of  the  lacrimal  glands  of  Mammals.  These 
cells  are  inserted  obliquely  in  or  on  the  connective  tissue 
wall,  and  are  inclined  towards  the  end  of  the  tube  in  the 
secondary  tube. 

The  limits  of  the  cells  are  well  defined  in  the  deeper  or 
attached  part,  but  are  much  less  distinct  on  the  free  surface. 
When  seen  en  face,  the  gland  epithelium  presents  itself 
under  the  form  of  a  pretty  regular  mosaic  :  and  on  lowering 
the  focus,  polygonal  areas  are  first  seen,  which  correspond  to 
the  limits  of  the  cells ;  and  at  a  still  lower  point  the  cell 
boundaries  disappear,  and  nuclei  are  only  seen  distributed 
through  a  mass  of  protoplasm.  The  nuclei  are  sometimes 
so  closely  approximated  as  to  become  flattened,  and  then 
present  a  polygonal  or  hexagonal  optical  section.  Usually, 
however',  they  have  a  rounded  form.  When  treated  with 
l-10th  per  cent,  of  chromic  acid,  the  contents  of  the  cells 
present  a  large  number  of  large,  highly  refracting  granula¬ 
tions,  with  some  smaller  ones.  With  absolute  alcohol  the 
contents  are  finely  granular. 

When  treated  with  a  1  per  cent,  solution  of  osmic  acid, 
the  cells  seem  to  contain  a  network  with  large  meshes,  the 
matter  composing  which  is  refractile ;  though  the  appear¬ 
ances  might  also  be  explained  on  the  theory  of  their  being 
corpuscles  rendered  polyhedric  by  mutual  pressure,  and 
placed  at  a  little  distance  from  each  other  in  a  refracting 
medium.  Treatment  with  osmic  acid  also  renders  the  cell 


contour  crenulated,  the  projections  or  the  grooves  being  few 
in  number,  and  most  distinctly  marked  in  the  deep  part  of  the 
cell.  Near  its  free  extremity  they  gradually  but  completely 
disappear. 

The  nucleus  is  situated  in  the  deepest  part  of  the  cell, 
which  is  often  at  this  point  a  little  swollen.  It  is  rounded 
or  oval  in  form,  and  in  some  instances  fills  the  whole  cavity 
of  the  cell  at  this  point.  In  this  case  the  nuclei  are  flattened 
by  mutual  pressure,  which  explains  the  appearances  above 
alluded  to.  The  nucleus  sometimes  occupies  the  axis  of  the 
cell  and  is  sometimes  excentric.  When  treated  with  absolute 
alcohol,  the  nucleus  appears  finely  granular,  and  when  with 
chromic  acid  of  l-10th  per  cent.,  it  presents  one  or  several 
granules  larger  than  the  others,  which  may  be  termed 
nucleoli.  Under  the  influence  of  a  1  per  cent,  solution  of 
osmic  acid,  the  nuclei  present  great  diversities  of  aspect, 
some  being  homogeneous,  others  granular,  perhaps  cor¬ 
responding  to  different  phases  of  a  process  of  division,  or  to 
variations  in  the  activity  of  the  secretory  process,  or  to  their 
age. 

Near  the  point  where  the  primary  tubes  open  into  the 
secondary,  the  connective  tissue  is  much  thicker  than  in  the 
deep  region  of  the  tube.  It  attains  its  maximum  thickness 
at  its  embouchure,  and  the  cells  differ  from  those  already 
described  in  the  following  points  : — Their  transverse  dia¬ 
meter  is  less.  Their  contours  are  better  defined,  especially 
at  the  free  surface.  They  are  arranged  more  vertically  to 
the  membrane.  They  stain  more  deeply  with  colouring 
agents,  especially  with  hsematoxylin. 

Secondary  Tubes. — In  the  lower  part  of  the  gland  eight 
or  ten  of  these  tubes  may  be  met  with  in  one  section. 
They  are  disposed  in  two  layers.  They  are  separated  by 
connective-tissue  septa  proceeding  from  the  envelope  of 
the  gland.  This  separation  is  complete  and  very  well 
marked.  But  at  the  upper  part  of  the  organ  the  number 
of  these  tubes  is  considerably  reduced — in  fact,  they  unite 
to  form  two  or  three.  At  the  same  time  the  connective- 
tissue  septa  have  become  much  less  conspicuous,  and  no  longer 
completely  separate  the  several  secondary  tubes  from  each 
other.  The  lumina  of  the  secondary  tubes  almost  deserve  the 
name  of  sinuses  or  confluents  rather  than  of  ducts,  since  these 
walls  are  made  up  of  the  walls  of  the  primary  tubes  modi¬ 
fied  at  their  embouchure  as  above  stated,  and  presenting  a 
very  irregular  form ;  on  section  they  present  septa,  which 
are  prolongations  of  the  walls  of  the  primary  tubes.  The 
secondary  tubes  unite  ultimately  to  form  a  single  tube,  which 
opens  at  the  superior  and  anterior  part  of  the  gland. 

Harder’s  gland  in  Birds,  then,  according  to  McCleod,  is 
typically  a  compound  tubular  gland,  even  more  so  than  the 
poison-glands  of  some  snakes,  for  these  do  not  present  such 
regularity  of  structure. 

The  gland  of  Harder  in  the  Duck  is  a  compound  tubular 
gland  formed  of  gland-tubes  disposed  in  whorls  around 
common  trunks,  which  thus  form  secondary  tubes.  The 
form  of  the  primary  tubes  and  the  disposition  of  the  se¬ 
condary  tubes  permits  the  discrimination  of  two  regions  in 
this  organ — a  superior  region,  in  which  the  primary  tubes 
are  convoluted,  the  secondary  few  in  number  and  incom¬ 
pletely  separated ;  and  an  inferior,  in  which  the  primary 
tubes  are  straight,  the  secondary  numerous  and  completely 
separated  by  septa  of  connective  tissue. 

In  the  primary  tubes  two  regions  can  be  distinguished 
owing  to  differences  in  the  characters  of  the  gland-cells. 

The  gland  of  Harder  in  Birds  resembles  that  of  Beptiles  in 
its  structure,  but  differs  completely  from  that  of  Mammals, 
which  is  an  acinous  gland. 

In  some  instances  transitional  forms  of  gland  are  found. 

In  the  Y ulture  the  lacrimal  gland  is  a  small  pale  pink-  or 
rose-coloured  body  situated  at  the  upper  and  outer  part  of 
the  globe.  It  is  granulated  on  the  surface,  oval  in  form, 
running  down  to  a  point  towards  the  outer  can  thus,  where 
it  terminates  by  becoming  continuous  with  the  duct,  which 
opens  apparently  by  a  single  aperture  in  the  conjunctival 
fold  at  this  part. 

The  gland  of  Harder  is  nearly  circular  in  form,  occupies 
the  usual  position  below  the  inferior  oblique  muscle,  and  has 
a  deep  fissure  running  along  it  from  before  backwards,  from 
which  secondary  fissures  run  at  right  angles.  It  is  flattened, 
of  purplish  tint,  and  the  duct  opens  between  the  nictitating 
membrane  and  the  globe. 

The  nictitating  membrane  of  Birds,  by  the  neatness  of  the 
mechanism  in  operation  when  it  is  drawn  across  the  eye,  has 


340 


Mellca1  Times  and  Gazette. 


SONSINO  ON  FILARIA  SANGUINIS  PARASITISM. 


Sept.  22,  1883.. 


been  carefully  described  by  several  authors  who  have  written 
upon  this  class  of  animals,  and  has  been  a  favourite  example 
of  design  when  naturalists  adopted  the  teleological  mode  of 
explaining  adaptation  of  structure  to  function;  and  it  is 
difficult  to  give  a  satisfactory  solution  of  its  mode  of  de¬ 
velopment  on  the  theory  of  evolution.  Two  muscles  are 
engaged,  the  musculus  quadratus  and  the  pyramidalis ;  the 
object  of  the  former  being  clearly  to  prevent  the  tendon  of 
the  pyramidalis  from  pressing  on  the  optic  nerve  during  its 
contraction.  The  arrangement  of  the  parts  is  the  following  : 
A  pyramidal  muscle  arises  from  the  sclerotic,  below  and  to 
the  outer  side  of  the  entrance  of  the  optic  nerve.  It  ends 
in  a  long  tendon,  which  terminates  in  the  membrana  nic- 
titans.  The  position  of  the  tendon  is  such,  that,  on  con¬ 
traction  of  the  pyramidalis,  the  tendon  would  compress  the 
optic  nerve.  To  avoid  this  contingency  a  second  muscle — 
the  quadratus — is  developed  above,  which,  arising  from  the 
sclerotic  above,  descends  towards  the  tendon  and  ends  in  a 
loop.  Through  this  loop  the  tendon  of  the  pyramidalis 
passes ;  and  it  is  obvious  that,  by  the  coincident  contraction 
of  the  two  muscles,  the  membrana  nictitans  is  drawn  up 
and  across  the  eye,  and,  on  the  other  hand,  that  its  tfendon 
is  prevented  from  pressing  on  the  optic  nerve.  We  may 
suppose,  on  the  doctrine  of  evolution,  how  many  sports  or 
efforts  of  nature  must  have  been  made  before  this  ingenious 
piece  of  mechanism  can  have  been  perfected. 

The  membrana  nictitans  in  Birds — as  in  the  Sparrow 
— is  stated  by  Leydig  to  be  composed  of  elastic  fibres  rather 
than  of  connective  tissue.  Some  bloodvessels  and  nerves 
are  also,  though  sparingly,  distributed  to  it.  The  black 
pigmented  border  is  due  to  the  presence  of  pigment-cells. 

It  may  just  be  remarked  that  there  are  no  Meibomian 
follicles  in  Birds,  or,  if  any— as  possibly  in  Strix, — they  are 
very  small. 

The  fluids  excreted  by  the  lacrimal  and  Harderian  glands 
are  conveyed  away  from  the  conjunctiva  by  two  small  open¬ 
ings  which  lead  into  a  common  duct  that  opens  into  the 
nasal  cavity. 


A  Model  Medical  Witness. — In  an  excellent  lecture 
“  On  Medical  Evidence  and  Medical  Witnesses 55  ( Boston 
Medical  Journal,  July  26),  Dr.  Draper,  Lecturer  on  Forensic 
Medicine  at  the  Harvard  Medical  School,  thus  sums  up  the 
“  qualities  of  a  successful  and  creditable  medical  witness  ” : — 
“  He  possesses  (1)  the  faculty  of  accurately  observing  all 
things  about  him,  (2)  a  retentive  memory,  (3)  sincerity  of 
purpose  and  a  mind  unprejudiced,  (4)  a  well-balanced  tem¬ 
perament  that  will  remain  unmoved  under  circumstances  of 
great  provocation,  and  (5)  skill  in  expressing  tersely  and 
intelligibly  what  his  mind  desires  to  impart. 

Absence  of  the  Uterus.— The  St.  Petersburg  Med. 
Woch.,  August  25,  refers  to  an  account  given  in  a  Russian 
journal  by  Dr.  Tschernogubow  of  a  woman  in  good  health, 
aged  twenty-four,  in  whom  the  breasts  and  labia  were  well 
developed,  but  in  whom  the  clitoris  was  exceedingly  small. 
The  urethra  was  so  dilated  that  the  forefinger  could  be 
easily  passed  into  the  bladder,  but  the  vagina  consisted  of 
a  blind  sac  half  a  centimetre  in  length.  An  examination 
made  through  the  abdominal  walls  and  the  bladder  and 
rectum  proved  that  no  trace  of  a  uterus  could  be  found. 
Neither  menses  nor  vicarious  haemorrhage  had  ever  occurred, 
and  the  woman  was  devoid  of  sexual  passion.  She  had  been 
married  six  years,  and  her  husband  had  often  tried  to  intro¬ 
duce  the  penis  into  the  urethra,  causing  much  pain.  In  all 
other  respects  the  woman  was  quite  well. 

Macroglossa  treated  by  Paquelin’s  Cautery. — 
Helferich,  in  1879,  employed  ignipuncture  with  successful 
results  in  the  treatment  of  macroglossa,  and  now  Dr. 
Weizsacker  relates  an  equally  successful  case  which  occurred 
in  Bran’s  clinic  at  Tubingen.  The  greatly  enlarged  tongue 
of  a  girl,  five  years  of  age,  projected  constantly  out  of  the 
mouth,  and  greatly  embarrassed  respiration.  Fourteen 
punctures  were  made  with  a  Paquelin,  from  above  down¬ 
wards,  at  about  a  centimetre  from  each  other,  and  five  in  a 
transverse  direction,  without  a  drop  of  blood  being  lost.  On 
the  third  day,  secondary  haemorrhage  occurred  from  the 
intercommunication  of  three  of  the  punctures,  but  this  was 
arrested  by  chloride  of  iron.  The  tongue  gradually  dimi¬ 
nished  in  size,  was  withdrawn  within  the  mouth,  and  all 
embarrassment  of  respiration  ceased. — Centralb.f.  CMrurgie, 
August  18. 


a  new  series  of 

CASES  OF  FILARIA  SANGUINIS  PARASITISM 
OBSERVED  IN  EGYPT; 

WITH  THE  RESULTS  OF  EXPERIMENTS  ON  FILARIATEI> 
SUCTORIAL  INSECTS,  (a) 

By  PROSPERO  SONSINO,  M.D.  (Pisa). 


Part  I. 

Since  my  previous  paper  on  Filaria  sanguinis  hominis(b) 
was  sent  to  the  London  Epidemiological  Society,  last  year, 
I  have  collected  a  certain  number  of  new  cases,  and  made 
other  observations  about  the  passage  of  the  embryos  into 
gnats  and  other  suctorial  insects,  so  as  to  allow  me  to  send' 
another  note  on  a  subject  which,  as  it  is  said  by  Dr.  Manson 
in  his  last  “  Notes  on  Filaria  Disease,”  “  is  a  new  and  an 
expanding  one,  and  one  concerning  which  fresh  information, 
no  matter  how  crude  and  imperfect,  may  therefore  prove 
useful  and  suggestive.” 

As  with  the  previous  paper,  I  begin  by  giving  a  synopsis 
of  the  new  cases  observed  from  March  of  last  year  to  the 
present  time. 

Taking  together  the  22  cases  observed  till  now,(c)  it 
appears  that  in  not  less  than  13  individuals  lymphuria  was 
observed  actually  (Cases  3,  4,  7,  8,  9,  14,  16,  18,  20),  or  was 
reported  to  have  existed  previously  (Cases  12,  15,  17,  19). 
The  new  series  shows  even  more  clearly  the  frequent  con¬ 
nexion  that  exists  between  lymphuria  and  the  presence  of 
Filaria  sanguinis  in  the  human  body. 

Cases  of  Hoemorrhage  associated  with  Filaria. — In  my 
previous  communication  I  concluded  that  the  principal 
characteristic  of  the  disorders  produced  by  filaria  consisted 
in  an  obstruction  of  the  lymphatics  giving  place  to  a  kind 
of  extravasation  of  lymph,  or  to  external  lymphorrhagia.  It 
is  true  that  in  my  first  series  of  cases  with  lymphous  urine 
it  happened  to  me  to  observe  some  cases  in  which  there  was 
some  blood  mixed  with  it,  viz.,  cases  of  hsematolymphuria, 
but  the  presence  of  the  blood  was  not  the  principal  disorder, 
nor  a  constant  one.  If  I  had  two  cases  (1st  and  10th)  of 
simple  hsematuria,  these  were  to  be  referred  to  another 
parasite  equally  detected — I  mean  bilharzia.  But  in  the 
new  series  I  have  had  cases  of  hsematuria  that  could  not 
be  referred  to  bilharzial  origin.  Thus,  I  wish  now  to  dwell 
on  the  fact  of  hsematuria  or  other  kinds  of  haemorrhage  as 
a  consequence  of  filaria  without  bilharzial  disease.  How¬ 
ever,  such  cases  are  more  rare  than  those  of  lymphuria,  and 
may  be  considered  as  exceptions,  yet  from  their  importance 
cannot  pass  unnoticed.  I  will  refer  particularly  to  Cases  11 
and  15,  which  illustrate  better  than  any  other  such  a  fact. 

Case  11. — A  woman  of  Maltese  origin,  about  fifty-five 
years  of  age,  who  had  lived  for  a  long  time  in  Egypt,  had 
been  always  careless  about  the  water  she  drank.  She  had 
suffered  for  many  months  from  abundant  hsematuria  of  un¬ 
known  origin,  and  without  relief  from  the  remedies  given 
her,  when,  in  March  of  last  year.  Dr.  Ambron,  who  was 
treating  her,  sent  to  me  her  bloody  urine  to  be  examined 
microscopically  for  the  purpose  of  searching  for  bilharzia 
eggs.  The  first  examination  gave  a  negative  result  as  to^ 
parasitism ;  the  urine,  which,  when  examined,  was  begin¬ 
ning  to  putrefy,  had  an  alkaline  reaction,  and  I  could  only 
ascertain  a  phosphatic  deposit.  But  in  the  second  exami¬ 
nation,  made  on  March  23,  the  urine  being  fresh,  I  found, 
indeed,  no  bilharzia  eggs,  but,  instead,  many  embryonal 
filariae,  several  of  which,  still  living,  were  detected  especially 
in  the  bloody  clot  deposited  by  the  urine.  In  a  third  exami¬ 
nation  (March  28)  the  urine  was  still  bloody,  with  alkaline 
r  eaction.  I  found  again  living  filariae  both  in  the  bloody  clots 
and  in  the  liquid.  On  April  5  the  urine  gave  no  microscopical 
appearance  of  blood ;  it  was  yellow,  but  a  little  smoky  ;  reac¬ 
tion  feebly  acid.  Crystals  of  phosphates,  and  other  rectangular 
crystals  (uric  acid  ?),  were  found  in  small  flocculi,  with  a  brown 
matter  like  pigmental  matter.  The  urine  gave  afterwards 
a  deposit  in  which  were  found  leucocytes,  red  corpuscles, 
but  no  filarial  embryos.  After  this  examination  I  received 
no  more  urine,  as  the  hsematuria  had  ceased  entirely.  At 

(a)  Communicated  to  the  Epidemiological  Society. 

(b)  “  On  Filaria  Sanguinis  Homing,  Lymphocele,  Lymphuria,  and  other 
Associated  Morbid  Disorders,  etc.”  Published  in  the  Medical  Times  and 
Gazette,  May,  1882  :  abstract  in  the  Transactions  of  the  Epidemiological 
Society,  new  series,  vol.  i. 

(c)  See  also  the  Synopsis  appended  to  the  previous  paper  at  page  149  of 
the  above-cited  Tiansactions,  etc. 


Medical  Times  and  Gazette. 


SONS  I  NO,  ON  FILARIA  SANGUINIS  PARASITISM. 


Sept.  22,  1863.  341 


the  end  of  June,  1882,  having  been  called  in  by  the  same 
patient,  I  found  that  after  the  cessation  of  the  hsematuria  she 
had  suffered  from  dysentery,  which  was  at  an  end,  although 
she  was  still  in  a  state  of  great  weakness,  with  anaemia,  but 
no  functional  disorder  or  pain  in  any  part  to  indicate  disease 
of  any  viscus,  except  a  certain  sensibility  in  the  epigastrium. 

I  gave  her  ethereal  tincture  of  perchloride  of  iron  and  quin¬ 
quina,  and  I  asked  for  an  examination  of  the  blood  with  a 
view  of  ascertaining  the  presence  or  no  of  the  filarial 
embryos.  This  examination  was  made  about  9  p.m.  on  the 
■evening  of  July  1,  with  a  drop  taken  from  a  finger  and  spread 
on  six  slides,  and  several  (not  many)  embryo  filariae  were 
■detected.  Thus  I  myself  ascertained  that  the  parasitism 
was  still  present.  After  some  days  my  patient  left  Cairo 
and  Egypt,  and  lived  many  months  abroad,  during  the 
general  exodus  caused  by  the  insurrection ;  and  when  she 
had  returned,  being  in  pretty  good  condition,  I  thought  it 
mot  advisable  to  ask  for  another  examination  of  her  blood. 

Case  15. — In  the  following  case  the  origin  of  hsema¬ 
turia  was  not  well  ascertained,  and  the  absence  of  other 
•causes  led  me  to  suspect  that  it  was  due  to  the  filarial 
parasitism.  A  native  Jew,  thirty- two  years  of  age;  lymph- 
uria  many  years  ago,  latterly  ventral  hsematocele.  This 
very  interesting  case  deserves  to  be  related  with  every 
particular.  On  September  3  of  last  year  I  was  called  to 
visit  this  man,  who  lay  in  bed  with  fever,  and  pain  in  the 
belly.  I  found  the  presence  of  a  swelling  in  the  middle 
hypogastric  region,  extending  more  to  the  right  than  to  the 
left  side.  On  inspection,  the  abdomen  presented  just  the 
appearance  of  the  abdomen  of  a  woman  at  her  fifth  month 
of  pregnancy.  There  was  dulness  on  percussion,  but  the 
swelling  gave  neither  the  resistance  of  a  solid  tumour  nor 
the  sense  of  fluctuation.  The  pain  extended  to  all  the 
circumference  of  the  belly,  as  in  the  case  of  peritonitis.' 
The  percussion  at  the  lower  sides  of  the  belly  was  tympa¬ 
nitic.  No  connexion  of  the  swelling  with  the  liver.  There 
was  some  enlargement  of  the  glands  in  the  groins.  It 
was  a  case  that  puzzled  me  much  at  the  first  examination. 
On  inquiry,  the  patient  told  me  that  he  was  well  till 
about  three  months  before,  when  he  began  to  suffer  with 
the  present  illness,  consisting  principally  of  pain  in  the 
belly  with  recurrent  attacks  of  fever.  Then  he  began  to 
perceive  something  wrong  in  the  belly,  and  at  the  same  time 
to  lose  flesh  and  to  grow  pale.  Asking  for  a  further  history, 
he  assured  me  he  had  in  past  time  enjoyed  pretty  good 
health,  save  that  many  years  ago  (he  could  not  say  precisely) 
he  for  some  time  passed  urine  like  milk,  which  soon  became 
solid.  When  I  got  this  last  information  I  began  to  suspect  I 
had  discovered  the  clue  to  the  present  rather  puzzling  form 
■of  disease.  I  asked  the  patient  to  allow  me  to  examine  his 
blood,  to  which  he  agreed  ;  and  on  September  6,  at  6.30  a.m., 
I  drew  a  drop  of  blood  from  a  finger  and  spread  it  on  seven 
slides,  in  which  were  found  several  living  embryonal  filarise. 
I  then  inferred  that  probably  this  man  had  a  disease  caused 
by  parasitism,  arguing  that  an  internal  lymphorrhagia, 
whether  from  a  mesenteric  gland  or  from  some  other 
obstructed  lymphatic  vessel,  had  taken  place  into  or  behind 
the  peritoneal  cavity,  giving  rise  to  an  inflammatory 
process,  and  forming  as  a  final  result  an  encysted  morbid  col¬ 
lection.  To  prove  my  diagnosis  it  would  have  been  neces¬ 
sary  to  examine  the  contents  of  the  swelling,  but  having 
said  to  the  patient  that  it  was  necessary  to  examine  the 
•contents  by  aspiration,  he  refused,  and  preferred  to  recur 
to  a  native  medical  man,  who  contented  himself  with  treating 
him  by  ointments  and  purgatives.  The  man  continued  in 
the  same  bad  state  until  about  the  end  of  January  last, 
when  he  called  in  Dr.  Ahmet  Bey  Hamdy,  the  Inspector  of 
Health  in  Cairo,  who  proposed  tapping.  I  was  sent  for  to 
be  present,  and  on  January  30  I  found  that  the  swelling  in 
the  belly  was  much  more  voluminous,  but  it  did  not  offer 
such  prominence  and  definite  form  as  it  had  in  Septem¬ 
ber.  The  parietal  veins  were  very  visible,  and  two  rather 
large  ones  were  seen  through  the  skin  going  towards  the 
■epigastrium.  No  fluctuation.  Tapping  was  performed  at 
the  middle  point  of  the  line  between  the  navel  and  the  iliac 
spine  ;  but  only  blood  coming  by  the  canula,  the  latter  was 
at  once  withdrawn.  Another  tapping  on  the  other  side  gave 
a  like  result.  The  few  ounces  of  blood  extracted  had  the 
appearance  of  common  venous  blood,  and  showed  some  white 
specks  which  turned  out  to  be  only  fibrinous  clots.  At  the 
microscopical  examination,  a  large  part  of  the  blood  cor¬ 
puscles  were  unaltered,  and  I  found  some  filarise  still  living 


and  in  full  activity.  I  detected  also  some  oval,  pale,  granu¬ 
lated  corpuscles,  with  their  breadth  of  the  diameter  of  the 
blood  corpuscles,  and  the  outlines  well  marked  but  not 
regular.  I  could  not  ascertain  what  they  were  if  not  lym¬ 
phatic  corpuscles,  or  cells  resulting  from  the  disintegration 
of  the  dead  filarise.  To  finish  with  the  history  of  the 
case,  I  will  add  that  I  have  seen  this  man  several  times 
more  lately.  He  has  not  suffered  from  the  tapping,  but 
his  condition  is  rather  worse,  as  the  belly  is  still  enlarging, 
and  the  dulness  reaches  now  to  the  epigastrium.  He 
gets  thinner  and  thinner,  and  more  feeble,  and  often  has 
attacks  of  fever.  Notwithstanding,  he  still  can  attend  to 
his  business  a  little,  he  has  a  good  appetite,  and  the  diges¬ 
tive  functions  are  not  much  interfered  with.  In  this 
case  it  seems  to  me  that  there  is  no  doubt  that  there 
is  an  encysted  collection  of  blood  into  or  behind  the  peri¬ 
toneal  cavity ;  that  this  collection  has  formed  slowly,  so 
to  say,  drop  by  drop,  and  still  continues  to  grow,  from 
rupture  of  some  small  vessels,  if  not  capillary  ones.  That 
the  collection  was  constituted  only  of  blood  was  shown  by 
the  tapping,  that  gave  exit  to  pure  blood  only.  The  haemor¬ 
rhage  has  taken  place  slowly,  otherwise  it  would  not  have 
happened  without  giving  rise  to  symptoms  of  acute  anaemia 
and  its  consequences.  That  there  is  still  bleeding  I  argue 
from  the  blood  not  being  much  modified,  as  it  is  in  old 
collections,  and  from  the  embryo  filariae  being  still  living. 
It  is  true  that  the  presence  of  filarise  in  the  blood  extracted 
from  the  belly  is  not  sufficient  of  itself  to  justify  the  con¬ 
clusion  that  the  extravasation  must  be  ascribed  to  the 
filarial  parasitism,  as  any  haemorrhage  in  a  filarious  indi¬ 
vidual  must  contain  filarise,  if  it  happen  at  a  time  when  the 
embryos  circulate  with  the  blood.  But  in  this  case  there 
had  been  no  traumatism,  and  the  want  of  any  other  cause 
to  which  to  ascribe  a  dropping  haemorrhage  renders  it  likely 
that  the  parasitism  is  the  only  true  one.  Thus  I  am  led 
to  think  that  the  filarial  parasitism  may  in  some  circum¬ 
stances  give  rise  to  hsematuria  or  to  some  other  haemorrhage, 
just  as  in  more  frequent  cases  it  gives  rise  to  lvmphuria  or 
some  other  kind  of  lymphorrhagia.  But  what  the  exact 
condition  is  that  gives  rise  to  haemorrhage  rather  than  to 
lymphorrhagia  will  be  elucidated  in  future  time  only,  when 
the  anatomo-pathological  lesions  consequent  on  filarial  in¬ 
fections  have  come  to  be  better  known.  It  is  permissible 
to  argue,  however,  that  in  some  cases,  though  not  fre¬ 
quently,  the  adult  filariae  may  emigrate  to  some  blood¬ 
vessel  instead  of  continuing  to  abide  in  the  lymphatic 
system.  This  supposition  is  the  more  likely  if  we  refer  to 
Dr.  Lewis’s  first  detection  of  the  adult  worm  in  a  blood- 
clot(d)  from  a  lymph-scrotum  which  had  been  removed  by 
operation. 

It  is  surprising  that  Dr.  Lewis,  who  has  observed  so  many 
individuals  with  filarial  parasitism,  has  not  yet  met  with 
cases  of  filarial  hsematuria.  From  this  he  is  inclined  to 
suspect  that  there  is  a  difference  between  the  parasite 
as  observed  by  him  in  India,  and  that  observed  in  Brazil  and 
Africa,  since  the  parasite  in  India  has  been  observed  by  him 
to  give  rise  only  to  lymphuria.(e) 

Other  Cases  with  Hcematuria. — For  the  sake  of  brevity,  I  will 
not  give  the  full  history  of  the  other  cases,  it  being  sufficient 
to  note  only  some  interesting  features  of  them.  In  Case  12 
the  hsematuria  had  probably  been  caused  by  bilharzia,  the 
appearance  of  an  old  egg  being  found  in  the  deposit,  and 
symptoms  of  alteration  of  the  bladder  being  present,  as  are 
often  associated  with  the  bilharzial  disease.  Hsematuria 
from  bilharzial  disease  had  existed  previously  in  Case  13, 
having  been  witnessed  by  myself  in  1874  ;  and  even  in  this 
year  (1883),  though  the  hsematuria  has  apparently  ceased,  I 
have  detected  once  in  a  little  deposit  of  the  urine  a  bilharzia 
egg  with  the  embryo  still  living.  In  Case  21  hsematuria 
had  existed  long  ago,  and  from  the  story  of  the  patient, 
whom  I  had  not  visited  during  the  presence  of  that  com¬ 
plaint,  I  argue  that  it  originated  from  bilharzia  rather 
than  from  filaria,  the  blood  being  present  only  in  the  last 
drops  of  urine.  In  Case  22  I  could  not  find  any  eggs  of 
bilharzia  in  the  deposit  of  bloody  urine  ;  but  this  case 
having  only  recently  come  under  my  observation,  I  have  not 
yet  well  ascertained  if  there  is  filarial  parasitism  only,  or 

(d)  See  the  Lancet,  September  29,  1877 :  “  Filaria  Sanguinis  Hominis 
(Mature  Form)  found  in  Blood-Clot  in  Nsevoid  Elephantiasis  of  the 
Scrotum,”  by  T.  Lewis,  M.B. 

(e)  See  “The  Nematoid  Hmmatozoa  of  Man.”  by  T.  It.  Lewis,  M.B., 
in  the  Quarterly  Journal  of  Microscopical  Sciences,  vol.  xix.,  new  series, 
page  2,6. 


342 


Medical  Times  and  Gazette. 


CHEVERS  ON  THE  ORDINARY  DISEASES  OE  INDIA. 


Sept).  22,  18SS. 


filarial  and  bilharzial  combined,  tbougb  the  character  of  the 
haematuria  was  at  the  beginning  that  of  bilharzial  disease. 
Indeed,  from  what  I  saw,  I  can  say  that  the  exit  of  blood 
with  the  last  drops  of  urine  only  is  a  sign  rather  of  bilharzia 
than  of  filaria,  and  the  abundant  and  abrupt  hsematuria  is 
rather  a  reason  for  suspecting  its  filarial  origin. 

Other  Leading  Particulars  about  the  Cases  of  the  New 
Series. — As  for  the  cases  associated  with  lymphuria,  in  Case 
12  lymphuria  had  preceded,  and  the  patient  assured  me 
that  he  had  suffered  from  it  or  from  hsematuria  intermit¬ 
tently  for  twenty  years.  But  when  I  visited  the  man  at  the 
Diaconess  Hospital  in  Alexandria  in  April,  1882,  there  was 
present  only  hsematuria  with  a  largely  developed  elephan¬ 
tiasis  scrotalis.  In  this  case  the  embryo  filarise  had  already 
been  detected  by  Hr.  Murison  (then  assistant-physician  in 
that  hospital,  now  surgeon  of  the  Victoria  Hospital  in  Cairo) 
a.  the  blood  from  the  scrotum,  and  I  found  them,  in  a  new 
examination  made  at  7-45  a.m.,  both  in  the  blood  from  the 
scrotum  and  from  the  finger,  and  in  another  examination, 
at  9.30  p.m.,  in  the  blood  from  the  finger  only.  The  bad 
condition  of  the  patient  did  not  allow  Dr.  Varenhorst  Bey 
to  remove  the  big  scrotum.  Notwithstanding,  I  hear  that 
the  man  is  still  living  and  can  attend  to  his  business.  In 
Case  14,  lymphuria  had  appeared  about  a  month  before  the 
patient  came  to  me,  as  a  second  attack  ;  the  first  having 
happened  only  some  months  before.  It  is  important  to  note 
that  in  Case  15  the  man  with  ventral  hsematocele  assured 
me  he  had  suffered  many  years  before  from  lymphuria  with¬ 
out  relapse.  In  Case  16,  a  man  thin  and  emaciated,  the 
attack  of  lymphuria  observed  by  me  in  last  October  had 
begun  in  the  summer  before,  when  the  man  was  at  Malta 
during  the  insurrection,  and  was  the  first  attack.  In  Case 
17  the  deposition  of  the  man  is  that  he  had  suffered  only 
once  from  lymphuria,  many  years  ago,  while  afterwards 
he  enjoyed  good  health,  as  he  does  now,  notwithstanding 
that  in  an  examination  of  his  blood  made  in  last  October  at 
9.30  p.m.,  when  he  came  up  to  me  with  his  cousin  attacked 
with  lymphuria,  I  found  a  great  number  of  living  filarise. 
In  Case  18,  according  to  the  patient's  account,  he  had 
suffered  from  several  attacks  within  these  last  three  years. 
He  told  me  he  had  used  copaiba  with  some  advantage.  But 
in  the  last  attack  he  was  cured  by  me  with  yellow  santhal  oil 
(from  twenty  to  twenty-five  drops  three  times  a  day),  and 
the  man  says  that  he  was  never  cured  so  quickly  as  this  time 
with  the  last  medicine.  But  although  the  attack  of  lymph¬ 
uria  has  ceased  and  his  general  health  has  a  little  improved, 
the  filarial  infection  is  still  persisting,  as  I  ascertained  by 
an  examination  of  his  blood  performed  at  10  p.m.  of  May  20. 
Case  19  (the  mother  of  the  man  of  the  preceding  case)  is 
singular,  in  that  she  asserts  that  she  has  suffered  from 
lymphuria  only  once,  about  twenty-five  years  ago.  The 
great  distance  in  time  from  the  attack  of  lymphuria  to  the 
date  of  the  detection  of  the  embryo  filarise  leads  me  to  think 
that  the  adult  filaria  can  live  a  very  long  time.  But  we  cannot 
be  sure  that  in  some  cases  successive  infections  of  new  worms 
may  not  have  happened,  and  to  judge  better  of  the  possible 
length  of  the  filaria’s  life  it  would  be  necessary  to  observe 
how  long  an  infected  individual  offered  the  embryo  filarise 
after  having  emigrated  to  a  country  where  a  new  infec¬ 
tion  was  not  possible.  Case  20  would  be  interesting  if  I 
could  be  sure  of  what  is  asserted  by  the  father  of  the  girl, 
that  the  lymphuria  began  seven  years  ago,  and  that  there 
has  been  perhaps  not  an  interval  of  a  week  in  which  the 
girl  has  not  presented  the  milky  urine.  But  I  must  give 
the  account  of  this  case  with  much  circumspection,  as  I 
could  not  visit  and  interrogate  the  patient  herself,  her  urine 
only  having  been  handed  to  me  by  her  father,  who  assures 
me  that  the  girl  is  much  attenuated  and  that  she  suffers 
from  menorrhagia.  Another  assertion  of  the  father  would 
be  very  singular,  and  not  in  accordance  with  the  generality 
of  the  cases  observed  by  me ;  it  is  that  her  urine  is  gene¬ 
rally  more  milky  in  the  morning  hours,  and  that  strong  milky 
urine  is  passed  in  the  afternoon  only  when  the  girl  has 
been  at  rest  in  the  morning.  Is  it  possible  that  the 
recumbent  position  may  in  this  case  facilitate  the  escape  of 
the  lymph  from  the  ruptured  lymphatics  ? 

[To  be  continued.) 


A  collecting -box  of  the  Hospital  Saturday  Fund, 
from  the  Mino:ies,  was  found  to  contain  no  fewer  than 
385  farthings. 


PRACTICAL  NOTES  ON 

THE  ORDINARY  DISEASES  OF  INDIA,. 

ESPECIALLY  THOSE  PREVALENT  IN  BENGAL. 

By  NORMAN  CHE  VERS,  C.I.E.,  M.D., 

Late  Senior  Physician  and  Professor  of  Medicine,  Medical  College- 
and  Hospital,  Calcutta. 

( Continued  from  page  261.) 

CHOLERA  ASIATICA  MALIGNA — Continued. 

Those  European  and  Indian  observers  who  contend  that  a 
Cholera  patient  is  a  focus  whence  the  disease  will  radiate  by 
the  admixture  of  Cholera  dejecta  with  drinking-water  or  with. 
dust,  urge  that  seamen  and  pilgrims,  coming  from  Cholera- 
impested  places,  convey  the  disease  to  healthy  localities,, 
having  “  followed  the  great  routes  of  trade,”  which,  they 
consider.  Cholera  especially  besets.  This  opinion  is  assailable- 
on  various  grounds.  Take  the  following.  We  know  that  the 
Cholera  endemic  becomes  very  grave  in  Calcutta  at  about 
the  middle  of  February.  Let  us,  for  the  sake  of  argument,, 
assume  the  possible  case  that  epidemic  Cholera  will  begin  to- 
prevail  in  England  at  precisely  the  same  time.  John  Smith, 
sailor,  arrives  from  Alexandria,  which  is  impested  by 
Cholera,  at  Southampton,  or  at  any  other  English  port,  on 
February  12.  Wherever  he  arrives,  he  will  be  said  to  have 
“  followed  one  of  the  great  routes  of  trade,”  as  probably 
ships  from  Alexandria  arrive  every  week  at  several  English, 
ports.  His  brother,  Thomas  Smith,  sailor,  arrives,  also  from 
Alexandria,  on  the  same  day,  in  the  port  of  Calcutta.  Both, 
men  drink  and  knock  about  on  shore,  are  attacked  with 
Cholera,  and  die.  On  the  following  day,  Cholera  breaks  out 
at  both  ports.  Now,  we  of  Indian  experience  can  trace 
perfectly  *the  sequence  of  events  in  the  case  of  Thomas.. 
He  also  ‘'followed  one  of  the  great  routes  of  trade.”  But 
no  Calcutta  medical  man  will  dream  of  asserting  that  he 
brought  the  endemic  pestilence  into  that  city.  All  will  imme¬ 
diately  agree  in  declaring  that  he  fell  a  victim  to  the  Cholera 
poison,  which  he  found  there,  just  as  a  dog  dies  when  he  is 
thrown  into  the  Grotto  del  Cane  and  is  choked  by  its  gas. 
Why  does  his  death  precede  by  a  day  or  two  any  Cholera 
death  among  the  fixed  inhabitants  of  Calcutta  ?  He  falls  a 
victim  to  the  law,  illustrated  by  a  multitude  of  facts  like 
those  of  the  cases  of  Colonel  R - ,  and  of  the  persons  at¬ 

tacked  in  the  Circular-roadhouse  (given  in  last  chapter), that, 
in  India,  the  gravest  and  speediest  incidence  of  a  Cholera  out¬ 
break  is  always  upon  those  newly  arrived  in  the  Cholera  area,. 
especially  if,  as  is  generally  the  case,  they  be  exhausted  by 
fatigue,  or  be  very  imprudent,  immediately  upon  arrival. 
Our  opponents  will  unhesitatingly  declare  that  John  Smith 
brought  the  epidemic  Cholera  from  Egypt  to  England.  We 
“  non-propagationists  ”  will  reply,  as  steadfastly,  that,  it 
awaited  his  arrival  in  England,  and  that  both  men  died, 
under  one  and  the  same  law  of  disease. 

In  the  February  of  any  year,  a  Calcutta  medical  man, 
addressing  the  sailors  newly  arrived,  would  say,  “  Some  of 
you  will  be  attacked  with  Cholera  before  this  month  is  out, 
unless  you  are  unusually  prudent  and  careful.”  At  a  time 
like  the  present,  our  port  authorities  ought  to  have  all 
recently  arrived  sailors  duly  warned  and  instructed  where- 
they  can,  with  the  utmost  ease  and  readiness,  obtain  medi¬ 
cine  gratis,  whenever  they  are  attacked  with  bowel  disorder. 

Exciting  Causes  of  Cholera. 

Principal  among  these  are  all  causes  tending  to  produce 
nervous  depression  and  exhaxostion — want,  excess,  exposure, 
fatigue,  panic, — and  everything  which,  in  popular  language, 
“  disagrees  ”  with  the  stomach.  A  circumstance  which  almost 
invariably  attends  cholera,  dysentery,  and  the  gravest  forms 
of  diarrhoea  in  India  is  that,  immediately  the  morbid  process 
sets  in,  the  stomach  signally  fails  in  its  power  to  digest,  and 
that  more  or  less  suspension  of  digestive  power  frequently 
continues  far  into  convalescence.  Hence  the  fact  that,  in 
cases  of  subacute  (commonly  termed  “  chronic  ”)  dysentery, 
when  the  patients  are  imprudent,  as  they  mostly  are,  nearly 
every  kind  of  undigested  food  may  be  looked  for  in  the 
stools.  The  Chaplain  of  Chittagong,  whose  attack  I  have 
already  alluded  to  as  having  occurred  soon  after  he  had 


Medical  Times  and  Gazette. 


CHEVERS  ON  THE  ORDINARY  DISEASES  OF  INDIA. 


Sept.  22,  1883.  3  43 


dined  and  gone  to  bed  on  returning  from  a  journey,  while  ] 
epidemic  cholera  was  raging  in  the  station,  vomited  his 
plentiful  meal  of  beef  and  potatoes  entirely  undigested, 
.although  there  had  been  quite  time  enough  for  digestion. 

I  carefully  examined  the  vomit :  meat  and  vegetable,  which 
had  been  bolted  hungrily  in  great  masses,  appeared  quite 
•unchanged.  It  appeared  astonishing  that  keen  appetite  could 
•have  existed  in  such  a  condition  of  the  system.  We  gene¬ 
rally  dine  late  in  India,  but  those  who  are  prudent  never  eat 
fruit  at  night.  This  is  best  taken  at  breakfast.  All  ex¬ 
perience  shows  that  Europeans  are  generally  attacked  with 
•Cholera  at  night  or  in  the  “small  hours,”  and  natives  after 
a  full  meal. (a) 

I  have  already  alluded  to  the  fact  that  most  of  the 
inmates  of  my  cholera  ward  in  Calcutta  were  strangers, 
■attacked  shortly  after  their  arrival  in  Calcutta.  It  was 
•believed  that  their  disease  was  excited  by  drinking  foul  water 
from  filthy  tanks,  in  their  ignorance  of  better  sources  of 
supply.  The  majority  of  European  cases  in  that  institu¬ 
tion  were  sailors  lately  arrived  in  port,  who  had  been  impru¬ 
dent  on  landing,  and  who  were  frequently  known  to  have 
■drunk  Hooghly  water,  taken  up  over  the  ship’s  side,  which 
is  often  brackish,  and  which  is  always  contaminated  with 
•every  kind  of  city  filth,  probably  including  cholera  excreta. 

I  have  already  mentioned  that  an  officer  told  me  that  he 
■and  a  brother  officer,  having  duty  in  an  Up-Country 
•bazaar,  became  so  much  heated  and  fatigued  that  they 
went  into  the  shop  of  a  native  dealer,  and  asked  for 
two  pint  bottles  of  ale.  His  companion  emptied  his  at 
a  draught.  That  which  was  poured  out  for  my  friend 
■was  so  horribly  decomposed  that  he  rejected  it,  and 
.asked  the  other  how  he  could  swallow  such  stuff.  The 
■reply  was,  “  I  was  so  thirsty  that  I  could  have  swallowed 
anything.”  The  poor  fellow  was  attacked  with  cholera 
■on  his  return  to  quarters,  and  died.  An  administra¬ 
tive  medical  officer,  when  travelling  from  the  plains  to  a  hill 
•station,  suffered  much  from  thirst  and,  unguardedly,  drank 
milk  not  long  after  drinking  beer.  He  was,  soon  afterwards, 
fatally  attacked  with  cholera.  A  very  healthy  gentleman 
and  his  wife,  friends  of  mine,  were,  during  part  of  the 
Mutiny,  shut  up  in  the  fort  at  Allahabad,  the  sanitary 
(Condition  of  which  was  then  most  evil,  where  they  endured 
•considerable  privation.  As  the  danger  lessened,  the  refugees 
were  removed  to  neighbouring  places  in  detachments.  Mr. 

H - and  his  wife  were  separated,  and  died  of  cholera  in  a 

few  days,  neither  hearing  of  the  other’s  fate.  Here  this 
disease,  which  prevailed  sadly  among  the  refugees,  was 
attributed  to  to6  great  freedom  in  eating  meat,  fruit,  and 
vegetables,  of  which  they  obtained  large  supplies.  One  of 
the  few  cases  of  European  ladies  who  were  attacked  with 
•cholera  in  Calcutta  during  my  long  residence  there,  was  one 
who  lived  in  a  distant  suburb,  Alipore,  and  whose  seizure 
followed  a  rather  fatiguing  morning  shopping  in  the  town, 
.after  which  mangoes  were  eaten  freely. 

I  attended  with  a  brother  officer  the  fatal  case  of  an 
.English  lady  attacked  during  her  first  cholera  season  in 
Calcutta,  after  having  breakfasted  upon  corned  ox-tongue. 

A  European  man  recovered,  in  my  ward,  from  cholera  caused, 
as  he  believed,  by  eating  corned  beef.  It  was  thought  that 
the  lower  class  of  butchers  employ  arsenic  in  “  curing  ” 
tainted  meat.  Strong  purgatives,  especially  Epsom  Salts  or 
other  hydrogogue  cathartic  salines,  are  so  notorious  as  ex- 
•citing  causes  of  cholera,  that  I,  throughout  my  career,  never 
gave  salts  or  seidlitz  powder.  According  to  Indian  usage,  I 
never  gave  any  purgative  at  night.  I  was  called  by  a  medical 
man  to  visit  his  mother,  who  was  attacked  with  cholera  after 
taking  a  dose  of  sulphate  of  magnesia.  One  of  my  last  fatal 
.cases  in  the  country  was  that  of  a  poor  European  woman,  in 
whom  the  attack  was  excited  by  a  dose  of  well-known  “anti- 
bilious  ”  pills. 

Variation  in  the  Types  of  Cholera. 

It  is  needless  in  the  present  day,  with  the  works  of  such 
.observers  as  Macpherson,  Goodeve,  and  Macnamara  before  us, 
to  enter  into  a  description  of  the  common  and  unmistakable 
symptoms  of  Malignant  Cholera — the  stage  of  Premonitory 
Diarrhoea,  when  it  is  present ;  the  Stage  of  Algide  Collapse  ; 
and  the  stage  of  Reaction,  -\yith  its  perils  from  arrest  of 
hepatic  and  renal  excretion.  As  I  emphatically  observed  of 
Indian  Fevers  that  the  type  changes  incessantly ,  so  it  is  with 
Cholera.  I  always  noticed  a  distinctly  marked  variation,  not 


only  in  the  type  of  each  outbreak,  but  also  in  the  condition  of 
each  patient— every  man’s  case  has  its  own  distinct  indi¬ 
viduality.  Consequently,  no  disease  stands  more  in  need 
than  Cholera  does  of  special  treatment  according  to  the 
peculiarities  and  exigencies  of  every  case. 

This  is  a  law  which  every  observant  man  will  be  able  to 
read  clearly  soon  after  the  disease  comes  before  him,  and 
which  is  laid  down  by  Dr.  Macpherson  in  the  following  pithy 
words  : — “  In  all  essentials  the  disease  is  the  same  as  when 
it  first  broke  out  ”j  but  then  “  all  observers  are  agreed  that 
the  cholera  of  one  season  varies  from  that  of  another,  just 
as  the  character  of  fever  changes.  Some  of  the  most  strik¬ 
ing  variations  are  the  degree  of  blueness  of  the  skin,  the 
early  occurrence  of  collapse,  the  amount  of  vomiting  and 
purging,  or  of  cramps,  the  frequency  of  consecutive  fever, 
the  degree  in  which  the  disease  is  amenable  to  treatment.” 
To  these  variations  may  be  added  an  appearance  of  bile  or 
blood  in  the  stools,  great  differences  in  the  condition  of  the 
mucous  membrane  and  follicles  of  the  ileum,  especially  as 
regards  vascularity  and  exudation,  a  tendency  to  the 
formation  of  ante-mortem  clots  in  the  right  heart.  In  one 
outbreak  there  will  be  a  prevalence,  as  we  begin  to  hope 
that  our  patients  are  safe,  of  sloughing  of  the  cornea,  which 
first  becomes  dull  and  sunken,  evidently  from  arrest  of  nutri¬ 
tion.  On  another  occasion  there  will  be  a  tendency  to  slough¬ 
ing  of  the  scrotum.  We  cannot,  at  first,  judge  whether  the 
occurrence  of  the  stage  of  reaction  will  be  early  or  late. 
In  one  autumnal  outbreak,  patients  remained  collapsed  for 
three  days.  The  tendency  to  serious  head-complication  in 
the  stage  of  consecutive  fever  varies  greatly  ;  so  also  does 
the  disposition  to  retention  of  the  first  urine  when  the 
bladder  is  full.  Cholera  spasm  or  cramp  is  not  very  common 
or  excessive  in  the  weak-muscled  natives  of  Lower  Bengal 
(who  endure  tetanus  much  better  and  longer  than  Europeans 
generally  do)  or  in  women.  I  have  often  thought  that  the 
fatal  result  was  determined,  in  strong  European  sailors,  by 
the  severity  of  the  cramps.  I  had  two  sailors  lying  side  by 
side — one  a  perfect  picture  of  healthy  athletic  muscu¬ 
larity;  the  other  sickly-looking  and  meagre.  I  could  only 
account  for  the  death  of  the  finer  man  and  the  recovery  of 
his  comrade  upon  this  ground.  I  did  not  see,  in  Bengal, 
that  muscle-tearing  cramp  which  has  occurred  in  England. 

I  cannot  quite  understand  with  what  view  the  authorities, 
in  1840,  added  to  the  Bengal  Medical  Return  the  disease 
Cholera  Biliosa.  By  this  they  may  have  intended  to  desig¬ 
nate  a  form  of  malignant  Cholera  in  which  the  stools  are 
bile-tinged.  I  saw  one  of  these  fatal  cases  in  Calcutta,  and 
heard  of  another— the  two  examples  occurring  more  than 
twenty  years  apart.  Dr.  Morehead  found  these  cases  rare. 
I  do  not  think,  however,  that  it  was  intended  to  set  apart 
this  very  exceptional  form  of  the  disease,  because,  I  repeat, 
it  is,  self-evidently,  true  algide  Cholera  wherever  it  occurs. 

The  separate  heading  was,  doubtless,  intended  for  those 
cases  of  violent — but,  in  my  experience,  always  safe  and 
transient — Bilious  Flux,  perhaps  attended  with  vomiting, 
which  are  frequent  among  Europeans  at  the  end  of  the  Cold 
Weather,  just  as  the  Cholera  Season  is  setting  in.  The 
liver,  having  been  rather  congested  during  the  cold  weather, 
suddenly  relieves  itself  by  an  enormous  flow  of  bile,  which 
produces  considerable  prostration,  and  still  more  alarm. 
The  first  case  I  saw  was  treated  by  a  native  Sub-Assistant- 
Surgeon,  who  gave  a  scruple  of  calomel  and  the  same 
quantity  of  soda.  After  taking  this,  the  patient  went  to 
sleep,  and  was  nearly  well  in  the  morning.  After  this 
I  used  to  give  the  soda  without  the  calomel ; — indeed,  the 
disease  relieves  itself.  I  used  to  notice  that  one  of  these 
thorough  purgations  generally  left  a  peculiarly  clean  tongue, 
not  raw,  but  perfectly  moist  and  healthy.  Many,  when  I  first 
went  to  India,  called  this  “  Bilious  Cholera,”  and  I  suspect 
that  many  of  these  cases — all  of  which  were  "  cured  ” — were 
included  under  the  head  of  "  Cholera  ”  in  the  old  returns, 
previous  to  1840,  with  serious  detriment  to  the  accuracy  of 
their  Cholera  death-rate. 

Cholera  is  often,  but  not  always,  ushered  in  by  Premonitory 
Diarrhoea.  This  can  generally  be  arrested  and  an  attack  of 
cholera  prevented  by  the  timely  use  of  opium.  Wherever 
cholera  was  prevalent  in  an  out-district,  we  used  to  send  to 
all  the  police  thannas  large  stocks  of  “  Cholera  Pills  ”  of 
which  my  friend  Dr.  Waring  gives  the  prescription  in  his 
excellent  work  on  “  Bazaar  Medicines  ” — opinm,  black  pep¬ 
per,  and  assafoetida,  of  each  twenty  grains  ;  beat  them  well 
together  and  divide  into  twelve  pills  :  of  these  one  was  the 


(a)  Macpherson. 


344 


Medical  Times  and  Gazette. 


CHEVEES  ON  THE  OEDINARY  DISEASES  OF  INDIA. 


Sept.  22,  1883; 


dose,  repeated  every  hour  if  required.  With  a  view  to 
speedy  solution,  we  used  to  give  these  broken  up  in  a  table¬ 
spoonful  of  brandy-and-water.  These  pills  used  to  be  in  high 
repute. ...  I  generally  gave  twenty  minims  of  laudanum  in  a 
draught  with  chloric  ether,  sesquicarbonate  of  soda,  chalk 
mixture,  and'cinnamon-water.  Omum  W ater,  distilled  from 
the  seeds  of  Carum  (Ptychotis)  Ajowan—  (Waring), — is  much 
used  as  a  carminative  vehicle  in  the  Madras  Presidency. 

Cholera  Simplex 

Is  readily  distinguishable  in  a  country  like  England,  where 
malignant  cholera  does  not  appear  except  as  an  epidemic, 
save  when  a  not  unquestionable  sporadic  case  occurs  once  or 
twice  in  a  lifetime  ;  but  in  Bengal,  where  true  Cholera  is 
constantly  endemic,  it  is  sometimes  hard  to  differentiate  the 
two  maladies  save  upon  a  retrospective  view.  We  are  told 
that  a  patient  is  dying  of  cholera,  and  we  find  him  with  or 
without  vomiting,  and  passing  thin,  copious,  and  almost 
colourless  stools.  He  is  greatly  alarmed,  nearly  algid,  and 
very  low  ;  has  a  thread-like  pulse,  and  complains  of  spasms. 
At  first  sight,  this  may  be  a  case  of  cholera.  We  give  a  dose 
of  opium — thepatient  sleeps,  and  does  well.  It  is  noticed  in 
these  cases  that  there  are  never  the  characteristic  rice-water 
evacuations  of  cholera.  The  radial  pulse  is  not  arrested  for 
hours,  and  there  is  never  true  collapse.  An  elderly  man  of 
great  scientific  eminence,  retired  from  long  and  very  arduous 
service  in  India,  suffered  from  most  intractable  chronic 
white  diarrhoea,  which  was  probably  true  Hill  Diarrhoea.  He 
remained  for  upwards  of  two  years  and  a  half  in  a  healthy 
midland  English  town,  very  slowly  but  decidedly  losing 
strength.  He  was  certainly  not  careful  as  regarded  his  diet, 
and  he  travelled  a  good  deal.  In  his  second  summer  at  home, 
the  weather  being  very  hot,  I  received  a  telegram  saying 
that  he  was  dangerously  ill.  I  could  not  reach  his  house 
until  after  midnight.  He  was  lying  on  his  side,  as  those 
about  him  thought,  in  calm  sleep,  but  was  dead.  I  was  con¬ 
vinced,  upon  inquiry,  that  he  had  been  attacked  with  English 
cholera,  under  which  his  exhausted  powers  sank. 

Persons  subject  to  chronic  diarrhoea  and  subacute 
(“  chronic  ”)  dysentery,  and  those  who  are  said  to  have 
“  irritable  bowels,’’  are  especially  liable  to  be  attacked  with 
cholera. 

The  History  of  Cholera ,  in  India  and  elsewhere,  has  found 
a  most  able  illustrator  in  my  friend  Dr.  John  Macpherson. 
Here  it  will  be  sufficient  to  mention  that  its  first  great  epi¬ 
demic  outbreak,  in  modern  times,  commenced  at  Jessore,  in 
Lower  Bengal,  in  the  year  1817,  which,  as  I  have  already 
shown,(b)  was  a  season  of  singular  zymotic  activity  through¬ 
out  the  Peninsula  of  India.  Thenceforward  it  has  been 
constantly  endemic  in  the  Gangetic  Delta,  rarely,  but  dis¬ 
tinctly,  appearing  as  an  epidemic  in  that  locality,  as  in  1849. 
As  I  have  shown  in  a  previous  work,(c)  the  Endemic  Cholera 
of  Calcutta  is  most  severe  in  the  Hot  Season,  which  extends 
from  about  the  middle  of  February  until  the  commencement 
of  the  Rains  (about  June  20).  But  the  statistical  data  which 
I  have  there  cited  show  that  the  disease  is  very  destructive 
throughout  the  year  in  Lower  Bengal.  I  believe  that  Cal¬ 
cutta  never  has  a  day  unmarked  by  a  Cholera  death.  Now 
and  then  there  is  a  rather  severe  outbreak  at  about  the 
close  of  the  Rains,  and  another  very  marked  but  less  exten¬ 
sive  one  at  Christmas  time.  In  the  North-Western  Provinces, 
Cholera  begins  to  prevail  when  it  is  on  the  decline  in  Bengal. 
In  the  former,  the  disease  prevails  most  in  June,  July, 
August,  and  September, — July  and  August  being  the  worst 
months.  In  the  N.W.  Provinces  the  disease  can  scarcely 
be  said  to  be  endemic.  There  a  severe  epidemic  is  to  be 
looked  for  about  once  in  three  years. 

It  is  well  known  that  the  late  Dr.  James  Lumsdaine 
Bryden  devoted  many  years  of  most  careful  observation  to 
the  investigation  of  the  habits  of  Indian  Cholera.  In  pur¬ 
suing  his  inquiry,  he  had  the  singular  advantage  of  being 
able  to  trace,  in  the  office  of  the  Sanitary  Commissioner,  every 
movement  made  by  Cholera  in  India  during  the  lengthened 
period  of  his  quest ;  and  there  cannot  be  a  doubt  that  one 
placed  as  he  was,  with  the  whole  of  the  past  history  of  the 
movements  of  epidemic  Cholera  tabulated  before  him,  and 
in  constant  receipt  of  official  intimation  of  every  outbreak  of 
the  disease  throughout  the  wide  field  of  his  supervision,  would 
be  able,  as  he  was,  to  predicate  with  considerable  accuracy 
the  probability  of  the  appearance  of  the  disease,  at  a  stated 

(b)  “  Annals  of  Cholera.” 

(c)  “Means  of  Preserving  the  Health  of  European  Soldiers  in  India.” 


period,  in  any  given  locality,  and  thus  to  afford  valid  advice 
with  regard  to  timing  the  movement  of  troops,  the  necessity 
for  special  sanitary  precautions,  etc. 

Bryden’s  views,  as  far  as  he  had  endeavoured  to  lay  them 
before  the  profession  when  his  valued  life  was  brought  to  a 
premature  close,  may  be  studied  in  the  Annual  Reports  of 
the  Sanitary  Commissioner  with  the  Government  of  India  j 
in  a  Blue  Book  by  Brigade- Surgeon  J.  Marston,  1878,  Ap¬ 
pendix  No.  12,  page  300 ;  and  in  his  own  “  Suggestions 
for  the  Systematic  Study  of  the  History  and  Relations  of 
Cholera,”  in  the  Indian  Medical  Gazette  for  October  1, 1866. 

Next  to  Fever,  Cholera  is  the  most  destructive  of  all 
Indian  diseases.  Sir  Joseph  Fayrer  shows  that,  in  the  year 
1879,  there  were  270,552  deaths  from  this  cause,  out  of 
4,975,042  registered  deaths  from  all  causes. 

I  have  said  that  in  Lower  Bengal  the  great  endemic  season 
is  from  the  beginning  of  the  hot  weather  in  February  until 
the  setting-in  of  the  Rains  in  the  third  week  of  June.  There 
is  generally  stormy  weather  at  about  the  end  of  the  second 
week  of  March  ;  this  almost  always  sends  in  a  batch  of  cholera 
cases,  palkee  (palanquin)  bearers  and  other  poor  creatures  - 
whom  the  rough  weather  has  chilled ;  then  there  are  a  few 
days  of  cool  weather,  in  which  there  are  very  few  cholera  ad¬ 
missions  ;  and  then  great  heat  sets  in,  and  with  it  come  a 
crowd  of  cholera  patients .  My  cholera  ward  held  twelve  beds, 
and  the  cases  usually  came  in  so  fast  during  the  epidemic 
season  that  it  occurred  to  me  nearly  every  year  that!  should 
have  to  find  extra  accommodation  ;  but  the  necessity  for  this 
always  happened  to  be  prevented  by  the  rapidity  with 
!  which  patients  died  and  left  beds  vacant. 

When,  during  the  very  hottest  weather,  and  when  the 
prevalence  of  cholera  is  at  its  height,  a  storm  cools  the 
atmosphere,  it,  as  I  have  already  said,  chills  and  endangers 
those  who  are  most  exposed ;  but  such  a  change  almost  cer¬ 
tainly  abates,  for  a  little  time,  the  severity  of  the  outbreak. 
Thus,  I  have  before  me  a  report  in  which  it  is  stated  that, 
not  long  since,(d)  the  population  of  Manilla  was  being  de¬ 
cimated  by  cholera,  when  at  the  end  of  October  (1882?) 
a  tremendous  hurricane  swept  over  the  island,  almost  en¬ 
tirely  destroying  the  town.  In  less  than  an  hour  from  the 
commencement  of  the  storm  not  a  single  native  house  was 
left  standing.  But  on  the  following  day  not  a  single  case 
of  cholera  occurred,  and  not  one  had  been  reported  since. 
Here  we  inquire — how  long  since  ?  In  Calcutta  the  chota 
bursat  (little  rains)  occur  at  the  height  of  the  cholera  season, 
at  about  the  beginning  of  the  last  week  in  May.  They  in¬ 
fluence  the  endemic  in  the  manner  which  I  have  described  •, 
but,  during  the  twenty  days  of  intense  hea't  which  generally 
follow  them,  cholera  is  very  prevalent.  When  the  Rainy 
Season  sets  in  steadily,  about  June  20,  we  almost  invariably 
have  reason  to  consider  that  “  the  Cholera  Season  ”  is  over. 

With  regard  to  Measures  of  Prevention,  I  am  in  accord 
with  the  believers  in  the  communicability  of  Cholera,  in 
maintaining  that,  on  the  arrival  of  Cholera  cases  in  ships, 
they  ought  to  be  treated  apart.  But  I  would  do  this  not  as 
a  sanitary  precaution,  but  as  a  means  of  testing  the  question 
— did  these  people  bring  Cholera  into  the  country  ?  I  think 
it  is  certain  that  the  segregation  of  those  members  of  a 
household  who  may  be  attacked  ought  to  be  strongly  recom¬ 
mended,  but  ought  not  to  be  made  compulsory  when  the 
other  members  of  the  family  are  energetic  and  courageous, 
or  when  due  assistance  is  obtainable.  When  such  removal 
is  voluntary,  it  is  advisable,  not  as  a  means  of  preventing 
the  spread  of  Cholera,  but  upon  the  consideration  that  a  well- 
managed  Cholera  hospital  is  the  best  place ;  as,  there,  due 
attendance  is  available  night  and  day.  In  a  private  house, 
the  services  of  four  persons — a  day  and  a  night  nurse,  duly 
instructed,  and  two  strong  men  to  apply  friction — would  be 
absolutely  needful,  (e)  Soiled  clothing  and  bedding  should  be 
burnt,  because  they  are  hopelessly  nasty ;  not  because  they 
are  fomites  of  propagation.  Cholera  excreta  should  be 
promptly  removed  and  buried — for  the  same  reason.  The 
very  best  drinking-water,  procurable  at  any  cost,  should  be 
filtered  and  boiled  and  drunk  as  weak  tea,  not  because  we 


(d)  I  have  not  the  precise  date. 

(e)  A  European  officer,  attacked  with  Cholera,  had,  what  is  very  unusual 
in  India,  three  adult  and  active  ladies  constant  in  their  attendance.  1 
said,  “  If  each  of  you  will  alone  attend  him  for  a  given  time,  you  will  be 
most  useful ;  but,  if  you  all  continue  to  surround  his  bed  night  and  day, 
you  will  all  break  down  in  a  few  hours.”  They  positively  would  continue 
to  attend  in  this  manner,  and  all  speedily  failed.  One  of  the  chief  uses  of 
a  cholera  hospital  is  the  service  afforded  to  the  sick  by  its  competent  body 
of  resolute  trained  attendants. 


Medical  Times  and  Gazette . 


MEDICAL  AND  SURGICAL  PRACTICE. 


Sept.  22,  1883.  345 


have  to  fear  the  presence  in  it  of  a  cholera  germ,  but  because 
bad  and  dirty  water  is  a  powerful  exciting  cause  of  cholera. 
So  are  all  purgative  and  aperient  medicines,  especially 
salines.  At  most,  two  drachms  of  castor  oil  with  the  same 
quantity  of  compound  tincture  of  rhubarb,  in  cinnamon- 
water — taken  in  the  morning— will  suffice.  Fruits  and  jams 
containing  fruit-seeds  should  be  avoided.  So  also  should 
potatoes,  which  are  certainly  hurtful,  almost  poisonous,  in 
dysentery.  The  diet  should  be  plain,  but  very  good.  Boast 
and  boiled  and  broiled  fresh  beef,  mutton,  and  chicken — 
nothing  corned  or  salted  or  smoked  ;  well-cooked  cruciferous 
vegetables ;  stale  white  bread  (home-made  if  possible)  and 
really  genuine  fresh  butter  ;  cold  tea  or,  in  great  modera¬ 
tion,  weak  spirit-and-water.  All  the  generally  accepted 
rules  of  good  sanitation,  Civic,  Household,  and  Personal, 
should  be  observed  with  absolute  strictness. 

Every  member  of  the  community  may  be  bold  in  the  con¬ 
fidence  that  his  chances  of  suffering  from  the  disease  are 
small;;  and  are  only,  if  he  be  courageous  and  prudent,  those 
which  he  shares  with  everyone  else ;  and  that  his  danger  is 
not,  in  the  very  least,  increased  by  the  occurrence  of  cases 
in  his  household,  or  by  visitation  or  attendance  upon  the 
sick.  To-day  (August  17),  as  I  write  this,  I  see  it  announced 
in  the  papers  that,  yesterday,  the  Khedive  inspected  all  the 
Alexandrian  Hospitals — sure  evidence  that  his  advisers  did 
not  consider  that  this  humane  act  was  attended  with  danger. 

[To  be  continued .) 


Keeping  Hypodermic  Syringes  in  Order.  —  In 
answer  to  the  question  how  this  is  to  be  done,  a  corre¬ 
spondent  of  the  New  York  Medical  Record  (September  1) 
observes: — “Of  course  the  best  way  with  any  and  all  in¬ 
struments  is  to  use  them.  Next  to  that,  inspect  them 
regularly,  once  a  month — not  only  look  at  them,  but  look 
at  them  with  an  oiled  rag  and  piece  of  chamois  skin,  more 
carefully  in  summer  than  in  winter.  In  considering  hypo¬ 
dermic  syringes,  aspirators,  etc.,  the  instruments  should  be 
regarded  in  two  parts — the  barrels  and  pistons,  which  re¬ 
quire  the  wet  treatment;  and  the  needles  and  wire,  the 
trocar  and  canula,  which  require  the  dry  treatment.  If  the 
piston-leather  is  old  and  worn  out,  it  should  be  renewed  ; 
but  if  only  dried  and  loose  from  non-use,  draw  a  little  warm 
water  into  the  syringe,  then,  placing  the  finger  over  its  end, 
slowly  press  the  piston  downwards  through  the  water,  which 
will  be  seen  to  pass  between  the  piston  and  sides  of  the 
syringe.  The  water  will  now  be  both  above  and  below  the 
piston,  and  will  cause  its  leather  to  swell  quickly  and  make 
a  tight  joint.  In  order  to  "keep  it  so,  discharge  the  water 
from  both  ends  of  the  syringe,  and  treat  in  the  same 
manner  with  glycerine,  which,  being  hygroscopic,  keeps  the 
piston-leather  in  good  condition.  Moreover,  pure  glycerine 
will  not  become  rancid,  as  will  oil,  etc. ,  nor  will  it  interfere 
with  any  chemicals  used  hypodermically.  In  the  larger 
syringes  a  harder  fat  like  mutton-tallow  will  often  cause 
the  piston  to  work  better  than  oil  or  glycerine.  If  the 
piston  should  have  become  so  tight  that  it  is  impossible  to 
make  the  glycerine  pass  above  it,  invert  the  syringe  in 
glycerine,  or  put  a  few  drops  around  the  piston-rod,  and 
then  press  it  slowly  downwards.  The  glycerine  will  follow 
into  the  upper  chamber,  and  will  ply  back  and  forth  with 
the  piston,  and  keep  it  in  order.  The  test  for  a  tight  piston 
is  to  put  the  finger  over  the  end  of  the  syringe  and  quickly 
pull  up  the  piston-rod,  when,  if  tight,  a  vacuum  will  be 
formed,  and  the  piston  return  to  fill  it.  The  dry  treatment 
for  the  needle  consists  in  blowing  out  all  liquid  by  several 
quick  strokes  of  the  piston  while  the  needle  points  up¬ 
wards,  so  that  no  fluid  from  the  syringe  enters  it.  If  used 
but  seldom,  let  this  be  done  in  the  hot,  dry  air  just  above 
the  lamp  or  gas.  After  removing  the  needle  from  the 
syringe,  replace  the  wire.  Should  the  morphia  gradually 
form  a  crust  upon  the  inside  of  the  needles,  hot  water  may 
be  drawn  through  them ;  or  a  quicker  and  more  thorough 
way  is  to  get  a  yard  of  uncut  hypodermic  wire,  fasten  one 
end,  thread  the  needle  upon  the  other,  and  then  with  a  few 
long  strokes  it  is  quickly  cleansed.  When  one  allows  his 
patient  to  suffer  ten  or  fifteen  minutes’  extreme  pain  while 
fixing  his  hypodermic  syringe,  or,  as  I  have  seen,  a  patient 
almost  lose  his  life  because  his  physician’s  stomach-pump 
would  not  work,  it  seems  a  duty,  and  but  little  trouble,  to 
inspect  for  a  few  minutes,  the  first  day  of  each  month,  those 
instruments  which  ought  to  be  kept  in  order.” 


REPORTS  OF 

HOSPITAL  PRACTICE  IN  MEDICI 
AND  SURGERY. 


LIVERPOOL  ROYAL  INFIRMARY.''  ”  „ 

_  Vtf,  \.  L '  0  ft  A  :■ 

SERIES  OF  BONE  AND  JOINT  O^E'S.i,:  /, 

(Under  the  care  of  Mr.  RUSHTON  PARKER.) 

[Continued  from  page  38.) 

Case  6. — Fracture  of  Leg,  Thigh,  and  Clavicle,  Sprained 
Wrist,  and  Scalp  Wound  stripping  the  Bone. 


George  W.,  aged  thirty-eight,  a  brewer’s  drayman,  was 
admitted  on  June  10,  1881,  shortly  after  having  been 
run  over.  The  left  tibia  and  fibula  were  broken  about  the 
middle,  and  the  shaft  of  the  left  femur  in  its  lower  third — 
all  oblique  fractures,  between  which  the  leg  was  much  con¬ 
tused.  The  right  clavicle  was  broken  about  the  middle,  and 
there  was  on  the  left  side  a  scalp  wound  two  or  three  inches 
long,  flap-shaped,  and  partly  stripping  the  bone.  The 
fractured  lower  limb  was  put  up  in  Thomas’s  long  knee- 
splint,  as  used  ordinarily  in  bed ;  and  the  scalp  wound  well 
carbolised,  and  treated  from  the  bottom  with  boracic  oint¬ 
ment  and  boracic  lint,  without  sutures,  eventually  healing 
without  complication. 

After  a  day  or  two  the  leg  fracture  was  separately  fixed 
between  two  sheet-iron  lateral  splints,  padded  with  boiler 
felt  and  boracic  lint  (next  the  skin),  in  addition  to  the  splints 
of  the  same  material  enveloping  the  thigh.  Around  the  leg' 
a  stout  bandage  was  thus  safely  hitched  without  directly 
compressing  the  injured  tissues,  and  extension  made  upon 
the  thigh  fracture  as  the  whole  limb  lay  in  Thomas’s  splint,, 
the  counter-pressure  being  made  upon  the  perineum  by 
the  padded  ring  of  the  splint.  Previously  side  plasters 
had  been  fixed  to  the  ankle  and  lower  half  of  the  leg,  but 
had  to  give  place  to  the  above  modification  which  worked 
much  better. 

Over  the  extensive  ecchymosis  a  few  bullae  formed,  that 
were  covered  with  boracic  lint,  into  which  some  of  their  fluid 
escaped,  with  the  effect  of  simple  eventual  healing  under 
perfectly  aseptic  conditions.  After  the  ecchymosis  was 
gone  a  subcutaneous  fluid  collection  remained  about  the 
front  tibial  edge,  feeling  and  looking  like  a  flaccid  abscess. 
It  was  aspirated  and  found  to  be  serous.  The  fractured 
clavicle  was  let  alone,  the  patient  lying  on  his  back,  and 
the  arm  of  that  side  being  confined  to  his  side  by  a  draw- 
sheet  used  as  a  binder,  but  the  hand  and  forearm  left  free 
for  his  use. 

The  left  wrist  being  found,  at  the  first  visit,  to  be  quite 
disabled  and  painful,  was  kept  straight  and  still  in  a  splint 
composed  of  two  daily  newspapers  folded  together  and 
applied  closely  as  a  trough,  and  bandaged  to  the  hand  and 
forearm.  This  injury  was  thus  at  once  rendered  painless, 
and  continued  so  during  the  week  or  ten  days  required  for 
its  complete  recovery.  The  fractured  clavicle  united  well 
and  speedily,  though  not  without  obvious  deformity,  which 
it  was  not  convenient  to  take  energetic  precautions  to  pre¬ 
vent,  owing  to  the  very  helpless  situation  that  the  entire 
confinement  of  that  limb  would  have  imposed. 

Before  July  31  sound  union  was  found  to  exist  in  all  the 
fractures,  and  the  patient  was  now  permitted  to  get  up, 
wearing  a  Thomas’s  walking  knee-splint,  to  which  the 
weight  of  the  body  (that  would  otherwise  have  been  borne 
on  the  recently  fractured  limb)  was  thus  transferred  during 
the  hardening  of  the  osseous  union,  for  several  subsequent 
months. 

During  the  first  week  or  two  the  patient  was  necessarily 
rather  helpless,  having  only  the  right  lower  limb  entirely 
free  from  injury.  But  the  arms  were  partly  available-^-the 
left  above  the  elbow,  and  the  right  below  that  joint, — so  that 
he  was  not  entirely  debarred  from  righting  and  assisting 
himself  as  he  lay  on  his  back.  After  the  preliminary  sore¬ 
ness  and  tenderness  had  passed  off,  he  was  able  to  be  propped 
up  in  bed  in  the  sitting  posture — a  position  permitted  by 
this  method  of  treating  fractured  femur  without  interfering 
in  the  least  with  the  proper  position  of  the  knee,  and  a  great 
addition  to  the  patient’s  liberty. 

There  was  only  about  an  inch  of  shortening  on  the  reco¬ 
very  of  the  patient,  who  resumed  his  occupation  as  drayman. 
He  was  seen  one  day  in  the  following  year,  busily  engaged 


346 


Medical  Times  and  Gazette. 


THE  WALTHAMSTOW  MURDER. 


Sept.  22, 1883. 


outside  a  public-house,  delivering  barrels  of  beer  from  his 
dray^  and  said  he  was  none  the  worse  for  his  injuries. 

Case  7. — Fracture  of  Pelvis  and  Thigh  (Upper  Third ) — Union 

— Return  to  Work,  and  Second  Fracture  of  same  Thigh 

(Middle  Third )  four  months  after  previous  Accident,  etc. 

Anthony  K.,  aged  fifty-six,  a  bricklayer’s  labourer,  was 
Injured  in  some  building  operations  on  January  27,  1883, 
and  was  brought  to  hospital  during  the  visit.  He  com¬ 
plained  of  his  hip  and  thigh,  chiefly,  on  the  left  side,  where, 
on  examination,  there  was  found  much  tenderness,  with 
moderate  swelling,  and  complete  disablement  of  the  lower 
limb.  Further  manipulation  of  the  pelvis  revealed  distinct 
mobility  and  crepitus  at  the  back  of  the  left  ilium  and  in 
the  ilio-pubic  region  in  front.  The  thigh,  moreover,  did 
not  seem  all  right,  and  was  found  (not  without  some  little 
difficulty  under  the  circumstances)  to  be  also  broken  at  or 
just  below  the  great  trochanter.  The  limb  lay  everted  and 
a  little  shortened,  but  could  be  placed  in  the  normal  anato¬ 
mical  position,  from  which,  however,  it  fell  away  when  unsup¬ 
ported.  There  was  also  a  scalp  wound,  which  healed  without 
need  of  further  comment.  The  patient  was  put  up  in 
Thomas’s  hip-splint,  and  the  pelvis  was  bound  up  in  a  draw- 
sheet  firmly  pinned.  After  a  day  or  two,  side  plasters  were 
put  upon  the  thigh,  and  tied  to  the  lower  end  of  the  hip- 
splint,  after  pulling  the  limb  out  to  its  fullest  length.  The 
shoulder-brace  was  removed  to  permit  of  the  dead-weight 
extension  thus  promoted ;  for  under  most  circumstances  the 
absence  of  the  shoulder-brace  is  followed  by  a  gradual 
slipping  of  the  hip-splint  towards  the  foot.  This  tendency 
can  thus  be  utilised  in  resisting  shortening  in  fracture  of 
the  upper  third  of  the  femur,  and  even  of  the  neck  when 
unimpacted.  It  had  at  first  been  also  intended  to  actively 
keep  up,  by  additional  means,  such  extension  as  might  at 
first  be  necessary  to  counteract  the  shortening ;  but  the 
intention  was  abandoned  for  fear  of  delaying  the  union  in 
either  pelvis  or  thigh,  though  the  fear  appeared  afterwards 
to  have  been  groundless. 

So  the  shortening  was  accepted,  and  the  case  got  well 
without  complication.  There  was  loss  of  movement,  too,  in 
the  anterior  muscles  of  the  leg,  shown  by  persistent  drop  of 
the  foot  in  the  pointed-down  extended  position.  This  even¬ 
tually,  though  very  slowly,  disappeared.  By  the  beginning 
of  March  he  was  allowed  to  get  up,  still  wearing  the  splint, 
bearing  his  weight  on  the  uninjured  leg,  elongated  by  a 
simple  wooden  clog  about  two  inches  thick  on  his  boot,  and 
using  a  pair  of  crutches.  The  patient  was  kept  as  long  as 
practicable  in  hospital  and  in  the  convalescent  institution, 
eventually  returning  to  work  at  the  end  of  May,  having  a 
shortening  of  an  inch  and  a  half  or  less.  On  May  29  he  fell 
off  a  scaffold,  and  was  admitted  into  hospital  with  a  fracture 
of  the  same  thigh.  This  time  the  middle  of  the  shaft  was 
affected,  and  all  found  sound  at  the  sites  of  the  previous 
accident.  He  was  at  once  put  up  in  Thomas’s  knee-splint, 
with  hollow  sheet-iron  splints  padded  with  boiler-felt  and 
covered  with  boracic  lint  (next  the  skin)  well  surrounding 
the  thigh.  An  uninterrupted  recovery  took  place,  and  by 
the  end  of  June  good  union  had  resulted,  without  any 
shortening  in  the  last  fracture.  He  was  then  allowed  up, 
wearing  a  knee-splint  a  little  longer  than  the  limb.  This 
was  discarded  in  August,  in  the  last  week  of  which  he  was 
again  sent  to  the  convalescent  institution,  still  using  crutches, 
but  no  splint. 

Remarks. — It  is  impossible  to  exaggerate  the  comfort  and 
convenience,  combined  with  an  extreme  degree  of  liberty  of 
motion,  procured  to  patients  treated  in  the  manner  above 
described.  They  can  be  rolled  over  in  bed,  can  place  them¬ 
selves  upon  the  bed-pan,  and  in  the  case  of  the  knee-splint 
can  even  sit  up  in  bed,  while  a  fracture  of  the  femoral  shaft 
is  still  proceeding,  without  impairing  the  mechanical 
efficiency  of  the  treatment. 

(For  further  particulars  and  illustrations  see  the  second 
volume  of  “  Transactions  of  the  International  Medical  Con¬ 
gress,”  1881,  or  “  Surgical  Cases  and  Essays,”  by  the  same 
writer.) 


Vaginitis  in  Aged  Women.— Dr.  Despres  drew  the 
attention  of  his  class  to  some  cases  of  vaginitis  in  old 
women  which  are  not  referred  to  in  books.  These  he  has 
found  to  depend  upon  the  urine,  highly  charged  with  urates, 
obtaining  access  tojthe  vagina,  owing  to  incontinence  from 
partial  paralysis  of  the  neck  of  the  bladder. — Gaz.  des  Hop. 


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lleMcal  (Lillies  antt  Incite. 


SATURDAY,  SEPTEMBER  22,  1S83. 


THE  WALTHAMSTOW  MURDER. 

The  facts  of  this  case  are  very  simple.  The  convict, 
William  Gouldstone,  who  is  now  lying  under  sentence  of 
death,  has  been  a  sober,  steady  workman,  a  good  husband, 
and  an  affectionate  father.  He  is  but  twenty-six  years  of 
age,  and  his  wife  had  already  borne  him  three  children, 
when  on  August  1  last  she  gave  birth  to  twins.  After  this 
event — a  very  serious  one  to  a  man  whose  earnings  were 
only  25s.  a  week — his  disposition  and  habits  underwent 
a  change.  He  left  his  work,  at  which  he  had  always  been  ex¬ 
tremely  regular,  and  remained  at  home  in  a  lethargic  state. 
He  would  sit  still,  and  when  spoken  to  would  not  answer. 
He  complained  of  pains  in  his  head.  On  one  occasion  he  was 
seen  crying.  Several  times  he  talked  about  committing 
suicide.  A  week  after  the  birth  of  the  twins,  he  came  home 
earlier  than  usual,  went  into  his  wife’s  bedroom  and  con¬ 
versed  quietly  with  her,  took  one  of  his  children  out  of  bed, 
went  into  the  kitchen,  and  drowned  the  lad  in  a  cistern. 
He  then  drowned  his  two  other  sons  in  the  same  way,  went 
back  into  his  wife’s  bedroom,  and  struck  each  of  the  twins 
on  the  head  with  a  hammer,  so  that  they  died  a  few  hours 
afterwards.  He  made  no  attempt  at  secrecy  or  concealment. 
There  were  several  other  people  in  the  house  at  the  time ; 
and  the  midwife  was  actually  in  the  bedroom  when  he 
entered,  but  left  it  in  the  belief  that  the  husband  wished  to 
have  some  private  conversation  with  his  wife.  After  the 
murders,  the  convict  expressed  no  concern,  no  regret,  was  un¬ 
affected  by  the  distress  of  his  wife,  the  reproaches  of  the  nurse, 
and  the  presence  of  the  policeman,  but  seemed  to  experience 
a  feeling  of  relief.  His  expressions  all  convey  the  same 
notion — that  he  had  now  at  length  got  eased  from  a  load 
that  he  had  been  suffering  under  and  had  found  too 
hard  to  bear.  To  his  wife  he  said,  “  I  have  killed  the  chil¬ 
dren  ;  I  am  happy  now.”  To  the  policeman  who  arrested 
him  he  said,  “  I  have  done  it ;  now  I  am  happy.”  In  the  cell 
he  said,  “  I  have  had  an  extra  drop  of  drink  to-day  to  accom¬ 
plish  the  job.  There  are  five  of  them  gone  to  glory,  and  a 


Medical  Times  and  Gazette. 


THE  WALTHAMSTOW  MURDER. 


Sept.  22,  1883.  3  4  7 


good  job  too.”  Not  knowing  whether  the  twins  were  dead 
or  not,  he  said  to  a  constable  while  in  the  cell,  “  I  wish  I  had 
killed  the  little  ones  out  of  the  way.  I  don’t  know  if  I  hit 
them  once  or  twice.  I  have  had  this  playing  [preying  ?]  on 
my  mind  for  a  long  time.”  It  was  further  adduced  in  evi¬ 
dence  at  the  trial  that  there  was  insanity  in  the  families  of 
both  his  parents.  His  mother  has  been  insane  for  eighteen 
years,  and  was  so  at  the  time  of  the  convict’s  birth.  Her 
sister  also  is  insane.  A  second  cousin  of  the  convict,  on  the 
father’s  side,  likewise  is  insane. 

The  man  is  mad,  of  course.  No  one  who  has  any  acquaint¬ 
ance  with  insanity  will  have  a  shadow  of  a  doubt,  after 
reading  the  foregoing  account,  that  he  was  suffering  from  an 
attack  of  acute  melancholia  at  the  time  that  he  committed 
the  murders.  The  matter  is  clear  and  certain  beyond  all 
question.  The  case  would  be  an  excellent  typical  example  to 
quote  in  a  text-book  for  students.  To  argue  the  matter 
would  be  as  superfluous  as  to  argue  whether  the  sun  is 
shining  or  not.  It  will  be  useful,  however,  in  view  of  the 
fact  that  the  jury  arrived  at  a  different  conclusion,  to  point 
out  how  abundant  and  incontrovertible  are  the  proofs  of  his 
insanity.  The  family  history  we  may  leave  out  of  conside¬ 
ration.  The  facts  that  the  convict’s  mother  and  mother’s 
sister  are  both  at  the  present  time  insane,  that  the  former 
was  insane  at  the  time  of  his  birth,  and  that  there  is  a  taint 
of  insanity  on  the  father’s  side  also,  are  of  course  facts  of 
the  highest  significance.  They  show  that  the  convict  must 
necessarily  have  inherited  a  tendency  to  insanity,  which 
was  likely  to  be  called  into  activity  by  any  adverse  circum¬ 
stances  in  his  life ;  and  if  the  direct  evidence  of  insanity 
were  doubtful  or  imperfect,  it  would  be  proper  to  bear  this 
tendency  in  mind,  and  to  attach  to  it  very  considerable  sig¬ 
nificance.  In  the  present  case,  however,  evidence  of  this 
character  is  not  needed,  save  as  it  renders  more  irrefragable 
a  conclusion  that,  even  without  it,  is  sure  ;  and  as  it  gives 
to  the  case  a  certain  academic  rotundity  and  completeness. 
The  conduct  and  demeanour  of  the  convict  before  the 
crime  may  also  be  put  on  one  side,  and  left  out  of 
account,  although,  had  the  crime  never  been  committed, 
a  competent  alienist  would  have  found  no  difficulty  from 
these  circumstances  alone  in  certificating  the  unfortunate 
man  and  sending  him  to  an  asylum.  When  a  man  who  has 
always  been  cheerful,  industrious,  sober,  and  regular  in  his 
habits,  leaves  his  work  without  assigning  any  reason,  sits 
moping  all  day,  not  answering  when  spoken  to,  crying  at 
times,  complaining  of  pains  in  his  head,  and  repeatedly 
speaks  of  his  death — wishes  he  were  dead,  mentions  several 
ways  in  which  he  might  kill  himself,  and  shows  by  numerous 
expressions  of  this  nature  what  is  passing  in  his  mind, — the 
merest  tyro  in  psychiatric  practice  knows  that  there  is  but 
one  safe  place  for  such  a  man,  and  that  that  place  is  a 
lunatic  asylum.  It  scarcely  needs  a  knowledge  of  insanity 
to  predict  that  such  a  man  is  on  the  brink  of  a  terrible 
disaster,  and  that  nothing  but  promptly  placing  him  under 
supervision  will  save  him  from  a  speedy  end.  Putting  aside, 
however,  all  considerations  of  this  kind,  leaving  out  of 
account  the  ominous  family  history  and  the  unmistakable 
symptoms  of  insanity  that  preceded  the  crime,  ignoring  every 
consideration  but  the  circumstances  of  the  crime  itself,  and 
the  demeanour  and  expressions  of  the  patient  after  its  com¬ 
pletion,  we  say  positively  that  the  act  itself  was  an  insane 
act,  and  that  the  whole  conduct  of  the  convict  on  the  day  of 
the  murder  is  abundant  and  superabundant  evidence  that  he 
was  insane.  A  sober  and  previously  well-conducted  man,  who 
has  had  no  quarrel  with  his  wife,  or  with  anyone  else,  comes 
home  one  afternoon,  and,  after  a  few  minutes  of  quiet  con¬ 
versation  with  his  wife  upon  indifferent  matters,  he  kills  his 
five  children.  There  is  no  anger,  no  passion.  He  was  not 
such  a  father  as  Francesco  Cenci ;  on  the  contrary,  he  was 


very  fond  of  his  wife,  and  used  to  be  happy  playing  with  and 
amusing  his  children.  He  does  not  benefit  in  any  way  by 
their  death;  on  the  contrary,  he  says  immediately  after¬ 
wards  that  he  shall  be  hanged.  There  is  no  attempt  at 
concealment ;  the  midwife  is  passing  to  and  fro  between  the 
two  rooms,  and  the  twins  are  killed  in  the  very  sight  of  the 
wife  he  so  dearly  loved.  If  this  is  a  sane  act,  there  is  no  such 
thing  as  insanity.  The  learned  counsel  for  the  Crown  laid 
stress  upon  the  contention  that  the  prisoner  had  an  adequate 
motive  for  the  act,  and  the  existence  of  an  adequate  motive  is 
prima  facie  evidence  of  sanity.  The  prisoner,  according  to  his 
own  confession,  was  appalledat  the  additional  burden  thrown 
upon  him.  Five  children  in  three  and  a  half  years  was  an 
accumulation  of  responsibilities  that  he  was  unable  to  bear. 
There  were  three  courses  open  to  him.  He  might  have 
struggled  bravely  with  the  world,  and  laboured  to  support 
them,  as  many  a  man  under  similar  circumstances  has  done 
before ;  but  this  he  felt  he  could  not  do.  He  gave  up  the 
struggle  in  despair ;  he  was  certain  that  he  could  never  sup¬ 
port  them.  What  would  a  sane  man  do  under  the  circum¬ 
stances  ?  What  do  many  sane  but  unprincipled  men  do  on 
like  occasions  ?  They  elude  their  responsibilities  by  flight, 
and  leave  their  wife  and  children  to  the  tender  mercies  of 
the  workhouse.  Such  a  course  never  occurred  to  Gouldstone. 
His  children  were  more  than  he  could  support.  If  they  were 
dead,  they  would  not  need  to  be  supported,  and  he  would 
be  free  from  the  responsibility.  He  would  kill  them,  then, 
and  his  mind  would  be  at  ease.  This  is  the  motive  that  the 
counsel  for  the  Crown  imputed  to  him,  and  imputed  cor¬ 
rectly,  there  is  no  doubt.  And  because  the  motive  was 
clear  and  unmistakable,  and  the  act  was  done  with  delibe¬ 
ration,  and  with  full  knowledge  of  the  consequences,  there¬ 
fore,  said  Mr.  Poland,  the  prisoner  is  sane.  But  is  it  not 
.  manifest  that  the  motive  was  an  insane  motive,  and  was 
itself  sufficient  proof  of  insanity  ?  The  man  feared  that  he 
would  not  be  able  to  support  his  children.  He  feared  they 
would  starve ;  and  he  killed  them  to  escape  the  responsi¬ 
bility  of  letting  them  die !  Is  this  a  sane  motive  ?  He 
knew  that  he  would  be  hanged,  and  said  so  repeatedly, 
but  the  dread  of  the  doom  impending  over  him,  and 
the  awful  responsibility  that  he  had  incurred,  were  no¬ 
thing  in  comparison  with  the  inexpressible  relief  he  felt 
at  the  comparatively  trifling  responsibility  that  he  had 
eluded.  That  he  knew  “  the  nature  and  quality  of  the  act  ” 
that  he  was  committing  is  certain.  He  knew  he  was  killing 
his  children,  he  knew  it  was  legally  wrong  to  do  so,  and  he 
knew  the  penalty  that  inevitably  awaited  him.  So  far  his 
reasoning  carried  him.  What  he  was  not  able  to  do  was  to 
balance  the  responsibility  that  he  was  incurring  against  the 
responsibility  that  he  was  escaping,  and  to  realise  how 
enormously  the  former  outweighed  the  latter.  And  this 
inability  to  reach  this  plain,  patent,  and  obvious  conclusion 
— the  absorption  of  his  whole  mind  in  the  contemplation  of 
the  one  set  of  circumstances,  so  that  the  other  set,  al¬ 
though  known  and  of  almost  infinitely  greater  importance, 
were  utterly  unappreciated — this  it  was  that  constituted  his 
insanity.  When  a  man  has  several  courses  open  to  him,  and 
deliberately  chooses  that  which  is  palpably,  and  manifestly, 
and  far  beyond  all  comparison,  the  worst  for  himself,  and 
for  all  that  he  loves,  the  universal  practice  of  mankind 
is  to  regard  him  as  insane ;  and  this  was  the  action  of  the 
convict  Gouldstone.  Whether  he  had  a  delusion ;  whether 
he  knew  right  from  wrong ;  whether  he  could  appreciate  the 
nature  and  quality  of  his  act:  these  are  questions  which 
have  a  certain  speculative  interest ;  but  they  fade  into  in¬ 
significance  beside  the  practical  question — Was  he  or  was  he 
not  insane  ?  To  this  question  there  can  be,  it  seems  to  us, 
but  one  answer,  and  we  anticipate  with  confidence  that  the 
Home  Secretary  will  modify  the  sentence  accordingly. 


348 


Medical  Times  and  Gazette. 


ENTHUSIASM  AND  QU AGREE Y. 


Sept.  22,  1883. 


ENTHUSIASM  AND  QUACKERY. 

When  a  new  means  of  combating  disease  is  introduced  it  is 
almost  always  the  case  that  its  benefits  are  at  first  over¬ 
estimated.  It  is  unavoidable  that  it  should  be  used  in  a 
great  many  cases  for  which  it  is  not  suited ;  for  it  is  impos¬ 
sible  that  its  limits  of  utility  should  be  ascertained  except 
by  largely  employing  it  in  an  experimental  fashion.  It  is 
obvious  also  that  the  man  who  urges  upon  patients  the  use 
of  treatment  which  turns  out  to  be  useless  or  injurious,  may 
lay  himself  open  to  the  imputation  of  having  been  actuated 
by  motives  not  wholly  unselfish.  It  is  true  that  the  system 
of  gratuitous  medical  relief  enables  those  attached  to  hos¬ 
pitals  to  test  new  plans  of  treatment  under  conditions  which 
do  not  give  colour  to  the  imputation  of  pecuniary  motives. 
But  the  value  of  treatment  cannot  be  always  settled  by 
observations  upon  hospital  patients  ;  and  too  often  patients 
and  their  friends — sometimes  even  their  medical  advisers — 
are  ungenerous  enough  not  to  give  credit  for  good  intentions 
to  the  man  who  has  advised  a  costly  and  prolonged,  and  to  all 
appearance  useless,  treatment.  There  is  in  this  point  little 
apparent  difference  between  honest  enthusiasts  and  quacks ; 
it  is  sometimes  exactly  the  same  for  the  patient,  whether  he 
fall  into  the  hands  of  the  one  or  the  other  :  the  treatment  is 
alike  useless  and  expensive.  The  difference  lies  in  the 
motive ;  and  the  motive  imputed  will  depend  largely  upon 
the  charity  of  the  critic,  guided  partly,  no  doubt,  by  the  re¬ 
putation  already  enjoyed  by  the  person  whose  conduct  is 
the  subject  of  censure.  Useless  new  treatment  is,  after  all, 
no  worse  than  useless  old  treatment ;  so  that  a  harsh  judgment 
is  not  invariably  deserved  because  treatment  is  unsuccessful. 
The  quack  lives  by  kindling  hope.  When  patients  learn 
from  their  more  honest  advisers  the  pitiful  truth  that  their 
malady  is  one  for  which  art  does  not  afford  a  remedy,  what 
wonder  is  it  that  when  the  quack  promises  with  assurance 
of  manner,  boldness  of  speech,  and  a  glib  reference  to 
similar  cases  cured  after  all  ordinary  doctors  had  pro¬ 
nounced  them  hopeless,  the  patient  should  say  to  himself — 
“  This  man  promises  relief  ;  all  others  admit  that  they  can 
do  nothing.  I  will  let  this  man  try,  and  if  he  fail  I  shall 
be  no  worse  off  than  I  should  have  been  had  I  not  gone  to 
him  ”  ?  The  quack,  of  course,  professes  to  employ  a  novel 
means.  The  characteristic  which  distinguishes  him  from 
the  honest  enthusiast  is,  that  he  knows  quite  well  that  his 
remedy  is  worthless  and  that  his  patients  do  not  get  well, 
and  that  he  uses  the  fears  and  hopes  of  the  patient  for  his 
own  enrichment.  But,  broad  as  is  the  difference  between  the 
cunning  which  uses  the  last  hope  of  the  despairing  for  its  own 
ends,  and  the  enthusiast  whose  sanguine  spirit  leads  him  to 
expect  more  than  he  attains,  the  broad  result  to  the  superfi¬ 
cial  observer  is  much  the  same.  Too  often  the  “  long-necked 
geese  of  the  wcrld  that  are  ever  hissing  dispraise”  fling 
taunts  of  quafikery  at  the  honest  enthusiast;  while  the  public, 
credulous  as  well  as  generous,  do  not  see  in  the  most  un¬ 
blushing  of  medical  pretenders  anything  more  than  too  great 
self-confidence.  The  difference  is  the  less  easily  perceived,  be¬ 
cause  the  quack  imitates  in  his  style,  as  much  as  he  can,  the 
genuine  man  of  science.  The  cleverer  and  more  dangerous 
the  charlatan,  the  closer  does  he  succeed  in  making  the  re¬ 
semblance.  The  profession  knows  only  too  well  that  there 
are  quacks  on  the  Medical  Register  as  well  as  off  it,  and  the 
former  do  the  more  harm,  because  their  proceedings  impair 
public  confidence  in  our  profession.  We  are  told  that  a 
certain  person  sometimes  assumes  the  form  of  an  angel  of 
light ;  and  we  do  not  see  how  we  can  prevent  the  quack 
being  sometimes  mistaken  for  an  honest  man.  But  we 
think  it  a  grievous  tiring  that  the  honest  enthusiast  should, 
from  his  indiscreet  but  philanthropic  haste,  be  suspected  of 
charlatanry ;  and  therefore  we  would  offer  some  remarks  on 


the  essential  difference  between  the  real  and  the  sham 
pioneer  of  medicine. 

This  difference,  to  our  mind,  is  a  very  broad  and  simple 
one.  It  is,  that  one  tells  the  whole  truth  whil  e  the  other 
does  not.  In  the  advertisements  even  of  the  most  notorious 
quacks  there  is  a  grain  of  truth.  Anyone  who  will  look  at 
the  advertisement  columns  of  most  religious  newspapers  and 
magazines  will  see  abounding  in  them  the  advertisements 
of  quack  doctors.  These  advertisements  commonly  consist, 
first,  of  a  general  statement,  in  more  or  less  unctuous 
phraseology,  of  what  the  advertised  nostrum  will  do,  and 
then  follow  reports  of  a  number  of  cases,  with  each  of  which 
is  given  a  name,  a  date,  and  an  address ;  the  name  being 
often  that  of  a  person  occupying  a  prominent  position 
in  his  own  locality — very  frequently  that  of  a  clergyman 
or  a  dissenting  minister:  and  these  cases  report  striking 
cures  which  the  advertiser’s  treatment  has  wrought.  Now, 
there  is  no  reason  whatever  for  supposing  that  these  cases 
are  untrue.  We  have  no  doubt  that  they  are  perfectly  cor¬ 
rect,  being  some  of  them  cases  in  which  the  remedy  was  suit¬ 
able  and  did  good,  others  examples  of  mistakes  in  diagnosis, 
and  consequently  in  prognosis,  made  by  medical  men — cases, 
for  instance,  of  bronchitis  taken  for  phthisis,  and  pro¬ 
nounced,  in  consequence,  to  be  incurable  and  certainly  fatal, 
but,  under  the  influence  of  summer  weather,  recovering, 
notwithstanding  the  quack  medicine.  The  falsehood  of  the 
quack’s  advertisement  consists,  not  in  his  saying  the  thing 
which  is  not,  but  in  his  suppressing  the  thing  which  is.  He 
trumpets  abroad  the  few  dozen  cases  that  have  improved, 
but  he  says  nothing  about  the  hundreds  who  took  his  stuff 
and  remained  ill  or  got  worse.  Statements  of  this  kind,  we 
are  sorry  to  say,  are  not  confined  to  the  advertisement 
columns  of  religious  newspapers.  They  sometimes  appear 
as  original  communications  in  medical  journals,  and  in  books 
issued  by  respectable  publishers.  The  promulgators  of  such 
statements  are  sometimes  men  essentially  quacks,  although 
shielded  by  a  diploma,  and,  it  may  be,  claiming  confidence 
on  the  ground  of  high  position  in  the  profession,  here,  or — 
as  has  been  more  frequently  the  case — across  the  Atlantic. 
Sometimes  they  come  from  honest  enthusiasts,  lacking  in 
judgment  and  in  knowledge  of  scientific  method,  who  believe 
and  say  what  is  not  true  only  because  they  judge  hastily,  not 
understanding  how  difficult  it  is  to  decide  correctly  a  ques¬ 
tion  concerning  the  effect  of  remedies.  It  is  because  thera¬ 
peutic  literature  by  the  last-mentioned  class  of  authors  is  so 
common  that  we  have  thought  it  desirable  to  call  atten¬ 
tion  to  the  close  resemblance  between  the  lying  assertions 
of  quacks,  and  the  loose  and  exaggerated  statements  of 
well-meaning  but  injudicious  enthusiasts.  We  ask  atten¬ 
tion  to  this  that  we  may  point  out  how  to  avoid  any  such 
discreditable  resemblance.  It  is  to  bear  in  mind  that  in 
reporting  upon  a  new  means  of  treatment  every  case  should 
be  recorded.  It  must  be  remembered  that  patients  who 
think  themselves  benefited  like  to  go  on  with  treatment 
which  seems  to  do  good,  while  those  who  are  not  often  say 
nothing  but  go  elsewhere.  Hence,  without  the  most  scru¬ 
pulous  care  in  seeking  out  results — not  merely  taking  those 
which  are  brought  to  his  notice — the  enthusiast  is  likely  to 
go  wrong,  to  make  statements  which  others  will  subse¬ 
quently  show  to  be  inaccurate,  and  which  will  therefore  bring 
discredit  upon  the  author,  will  certainly  damage  his  reputa¬ 
tion  for  sound  judgment,  and  may  lead  to  the  imputation  of 
dishonesty.  There  are  no  questions  in  medical  science  so 
difficult  to  solve  as  those  of  therapeutics.  Those  most  con¬ 
versant  with  pathology  know  how  many  fallacies  beset  the 
interpretation  of  morbid  appearances  :  and  yet  the  problems 
of  morbid  anatomy  are  simple  compared  with  those  of 
diagnosis  and  treatment,  for  the  pathologist  can  take  in  his 
hand  the  subject  of  controversy,  can  weigh,  dissect,  test. 


Sedical  Times  and  Gazette. 


THE  FIRE  AT  SOUTHALL  PARK  :  WHO  IS  TO  BLAME  ?  sept  22,  uses.  349 


analyse,  examine  with  microscope  or  spectroscope,  and  so  on, 
the  altered  structure.  The  practitioner  who  has  to  pro- 
tounce  on  its  nature  while  the  patient  is  alive  can  do  none 
<f  these  things,  and  has  to  form  his  judgment  without  their 
|elp.  If  we  go  further,  and  attempt  to  define  the  effect  of  a 
aemedy,  the  imperfections  of  pathology  and  the  uncertain¬ 
ties  of  diagnosis  are  ever  present  to  qualify  our  confidence  in 
,he  therapeutic  conclusions  we  think  we  have  reached.  Some 
diseases,  of  course,  are  simpler  than  others ;  but,  as  a  general 
rule,  we  think  it  may  be  said  that  the  value  of  any  means 
-)f  treatment  can  only  be  safely  estimated  by  watching  its 
results  in  a  large  number  of  cases.  It  is  rare  for  one  man 
ho  be  able  to  treat,  observe,  and  record  a  very  large  number 
.»f  similar  cases,  and  therefore  rare  that  one  man  has  it  in 
Ms  power  to  establish  the  value  of  a  remedy.  He  may  go  a 
ong  way  towards  doing  so,  but  he  will  only  do  it  by  taking 
scrupulous  pains  to  avoid  all  unconscious  bias  in  the  selection 
<i>f  cases  for  report.  He  must  publish  the  whole  truth.  If  he 
thinks  that  in  his  seemingly  unfavourable  cases  there  were 
special  features  which  explained  the  want  of  effect  of  the  new 
<ure,  he  should  put  candidly  before  the  profession  the  cases 
and  the  explanation,  and  not,  as  is  sometimes  done,  suppress 
them,  and  publish  only  those  which  turned  out  well.  He 
may  be  sure  of  this — that  disease  is  pretty  much  alike  the 
whole  world  over.  If  he  will  plainly  and  without  reserve 
publish  the  whole  facts,  he  may  be  sure  that,  when  others 
follow  him  on  the  same  line,  their  observations  will  only 
Corroborate  his,  strengthen  his  conclusions,  and  add  to  his 
reputation.  “A  lie  which  is  half  a  truth  is  ever  the  worst 
Of  lies.”  That  it  is  told  with  an  honest  intention  does  not 
make  it  less  mischievous ;  and  those  who  do  not  know  the 
author  may  possibly  not  give  him  credit  even  for  this  much. 


THE  FIRE  AT  SOUTHALL  PARK:  WHO  IS  TO 

BLAME  P 

How  that  the  inquest  on  the  body  of  the  unfortunate  girl 
who  perished  from  the  effects  of  the  fire  at  Southall  Park  is 
finished,  it  will  be  proper  to  make  comments  upon  the  occur¬ 
rence  which  we  have  hitherto  withheld.  The  mode  of  manage¬ 
ment,  and  therefore  the  persons  responsible  for  failures  in  the 
management,  of  lunatic  asylums,  varies  considerably  with  the 
kind  of  asylum  and  with  the  part  of  the  country  in  which  it 
is  situated.  County  and  borough  asylums  are  managed  by 
committees  of  visitors,  who  alone  are  responsible  for  the 
whole  of  the  arrangements  in  these  institutions,  and  the 
power  of  the  Commissioners  in  Lunacy  with  respect  to  such 
-asylums  is  limited  to  advice  and  suggestion  and  recom¬ 
mendation  :  if  their  advice  is  not  followed,  they  are,  how¬ 
ever,  powerless  to  enforce  it.  Licensed  houses  in  all  parts 
of  the  kingdom,  save  the  Metropolitan  District,  are  licensed 
by  the  justices  at  quarter  sessions,  a  committee  of  whom  are 
the  Visitors  of  the  house,  and  have  power,  not  indeed  directly 
to  manage  the  house,  but  to  make  such  recommendations 
.as  they  see  fit,  and  if  these  recommendations  are  not  attended 
to  they  can  refuse  to  renew  the  annual  licence,  or  can  even 
recommend  the  Lord  Chancellor  to  revoke  it.  With  respect 
to  these  houses  the  Commissioners  in  Lunacy  have  equal 
powers  with  the  Visitors  to  recommend  to  the  Lord  Chan¬ 
cellor  the  revocation  of  the  licence ;  and  the  responsibility 
for  the  management  of  such  institutions  lies  therefore 
primarily  on  the  licensee,  but  ultimately  is  pretty  equally 
divided  between  the  Visiting  Justices  and  the  Commissioners 
in  Lunacy.  Licensed  houses  which,  like  that  at  Southall 
Park,  are  within  the  Metropolitan  District,  stand  upon  a 
different  footing.  Such  houses  have  no  committee  of  visitors. 
They  are  licensed  by  the  Commissioners  in  Lunacy,  who 
alone,  after  the  licensee,  are  responsible  for  their  proper 
management,  and  who.e  power,  backed  as  it  may  be  by  a 


recommendation  to  the  Lord  Chancellor  to  revoke  a  licence, 
is  plenary.  It  is  enacted  that  every  such  house  shall  be  visited 
by  two  of  the  Commissioners  four  times  every  year,  and  in 
addition  by  at  least  one  Commissioner  twice  a  year,  making  six 
visits  in  all.  They  have  therefore  ample  opportunity  of  making 
themselves  acquainted  with  the  structure  and  management 
of  these  institutions ;  and  they  are  invested  by  the  Legislature 
with  the  special  duty  of  seeing  that  the  structure  is  appro¬ 
priate  for  the  reception  and  care  of  lunatics,  and  that  the 
management  is  properly  carried  out.  The  destruction  of 
Dr.  Boyd’s  private  asylum  and  the  loss  of  seven  lives  is  a 
frightfully  forcible  commentary  upon  the  manner  in  which 
this  duty  has  been  performed.  The  evidence  of  Mr.  Frere, 
who,  we  are  glad  to  say,  is  not  one  of  the  Medical  Com¬ 
missioners,  was  remarkable,  to  say  the  least.  Although  the 
fire  had  occurred  more  than  three  weeks  before  Mr.  Frere’s 
appearance ;  although  the  inquest  had  been  adjourned  for 
seven  days  on  purpose  to  secure  the  presence  of  a  repre¬ 
sentative  of  the  Commissioners  ;  and  although,  therefore, 
Mr.  Frere  had  ample  time  to  acquaint  himself  with  the 
facts  of  the  case,  yet  when  he  appeared  before  the  jury,  he 
was  unable  to  answer  questions  of  the  most  elementary 
character,  and  such  as  he  must  have  known  would  be  put 
to  him.  When  was  Southall  Park  visited  last  ?  asked 
the  Coroner. — I  cannot  answer  that  question.  Was  any 
special  report  made  with  regard  to  the  provisions  that 
should  be  taken  against  fire  in  that  asylum  ? — There  were 
certain  regulations  made  in  1869  to  guard  against  an  out¬ 
break  of  fire.  Have  you  any  copy  of  those  regulations? — 
They  were  printed.  I  have  no  copy  of  them  at  all.  The 
Visitors  would  malce  an  entry  in  the  visitors’ ho  oh,  which  was 
destroyed  in  the  fire.  The  italics  are  ours ;  and  we  ask,  is 
it  possible  that  Mr.  Frere  is  ignorant  of  the  duty  imposed 
by  statute  on  the  proprietor  or  superintendent  of  every 
licensed  house  to  forward  to  the  Commissioners  in  Lunacy, 
within  three  days  after  their  visit,  copies  of  the  entries 
made  by  the  Visiting  Commissioners  in  the  visiting-book  ? 
Was  such  a  copy  of  the  regulations  sent  to  the  Commis¬ 
sioners,  or  was  it  not  ?  If  it  was  not,  how  came  the  Com¬ 
missioners  to  overlook  so  gross  a  breach  of  the  law  ?  If  it 
was,  what  is  the  value  of  Mr.  Frere’s  statement  that  he 
had  no  copy  of  them  at  all;  and  that  the  visitors’  book 
was  destroyed  in  the  fire  ?  The  foreman  of  the  jury — evi¬ 
dently  a  man  of  intelligence,  and  of  considerable  perti¬ 
nacity — complained  that  some  of  the  questions  put  by  him 
to  the  Commissioner  were  fenced.  This  does  not  seem  at  all 
too  strong  an  expression  to  apply  to  such  answers  as  the 
foregoing,  when  the  fact,  which  the  foreman  was  scarcely 
likely  to  know,  that  the  Commissioner  ought  to  have  been 
in  possession  of  a  copy  of  the  regulations  in  question,  is 
taken  into  consideration.  Another  statement  of  Mr.  Frere’s 
attracts  attention.  “If  a  small  bucket  of  water,”  he  is 
reported  to  have  said,  “  will  not  put  out  a  fire,  the  attend¬ 
ants  have  quite  enough  to  do  to  get  the  patients  to  a  place 
of  safety.  That  is  all  we  feel  ourselves  concerned  in ;  the 
safety  of  the  building  matters  very  little.”  If  this  be  so 
we  should  have  expected  that  the  Commissioners,  in  their 
inspection  of  asylums,  would  have  made  a  point  of  ascer¬ 
taining  what  arrangements  were  in  force — what  regulations 
had  been  made — for  removing  the  patients  to  a  place  of 
safety  in  the  event  of  a  fire,  and  that  they  would  have 
regarded  the  integrity  of  the  building  as  a  secondary  affair- 
But  when  we  turn  to  their  last  Report,  just  issued,  we  do 
not  find  that  this  is  the  case.  We  find  that  they  have 
inquired  in  many  asylums  as  to  the  means  of  extinguishing 
fires,  as  to  the  disposition  of  the  hydrants,  the  serviceable¬ 
ness  of  the  engines,  and  the  duties  laid  upon  the  attendants, 
and  several  times  they  have  had  the  fire  drill  performed 
in  their  presence ;  but  we  do  not  find  that  the  Commis- 


350 


Medical  Times  and  Gazette. 


THE  WEEK. 


Sept.  22, 18Sa 


sioners  have  ever  alluded  in  the  most  distant  way  to  the 
removal  of  the  patients  from  the  scene  of  the  fire  as  forming 
a  part  of  those  duties,  nor  can  we  ascertain  that  a  single 
question  has  ever  been  asked  on  this  point,  which  Mr. 
Frere  says  is  “  all  that  the  Commissioners  feel  themselves 
concerned  in.” 

On  the  whole,  Mr.  Frere’ s  evidence  was  decidedly  unsatis¬ 
factory,  and  the  same  must  be  said  of  the  state  of  affairs  that 
it  discloses  as  to  the  internal  arrangements  of  the  Commis¬ 
sion.  That  such  a  dreadful  occurrence  as  this  fire  at  Southall 
Park  should  be  possible  in  any  asylum,  and  most  of  all  in  an 
asylum  belonging  to  a  class  that  is  more  than  any  other 
under  the  direct  supervision  and  management  of  the  Com¬ 
missioners  in  Lunacy,  must  tend  to  produce  a  very  uneasy 
state  of  feeling,  not  only  as  to  the  possibilities  of  such  occur¬ 
rences  in  other  asylums,  but  as  to  the  efficiency  of  the 
supervision  that  is  exercised  by  the  Board  of  Commissioners. 


THE  WEEK. 

TOPICS  OP  THE  HAT. 

The  Board  of  j  Works  for  the  Wandsworth  District  recently 
addressed  a  complaint  to  the  Local  Government  Board  on 
the  subject  of  the  quality  of  the  water  supplied  to  that 
portion  of  the  metropolis  by  the  Southwark  and  Yauxhall 
Water  Company.  They  have  now  received  a  reply,  enclosing 
an  explanation  from  the  Company  in  question,  stating  that 
the  water  supplied  to  the  district  is  of  exceptionally  good 
quality,  and  leaves  little  to  be  desired.  It  would  appear 
that  the  absence  of  storage  reservoirs,  to  which  we  have 
often  called  attention  when  dealing  with  the  monthly 
reports  of  the  Metropolitan  Water  Examiners,  formed  a 
portion  of  the  complaint  of  the  Wandsworth  Board,  since 
the  Southwark  and  Yauxhall  Company  explain  that,  while  in 
no  way  admitting  that  the  want  of  these  reservoirs  has  been 
detrimental  to  the  quality  of  their  supply,  they  have  only 
deferred  the  construction  of  additional  works  until  they 
could  avail  themselves  of  the  experience  of  a  system  of 
underground  filtration  recently  carried  out  by  the  Grand 
Junction  Company,  and  they  have  now  signed  a  contract  for 
the  construction  of  similar  works,  whereby  they  believe 
that  they  will  be  rendered  independent  of  the  conditions  of 
the  river,  and  have  at  all  times  an  ample  supply  of  pure 
water,  without  any  risk  of  the  filter-beds  being  affected  by 
floods  or  any  other  contingency.  This  work,  they  state, 
has  already  been  commenced. 

Dr.  Sutton,  Medical  Officer  of  Health  for  the  parish  of 
Shoreditch,  recently  reported  to  the  Yestry  of  that  parish 
that  the  death-rate  of  the  district  for  the  month  of  August 
had  been  22'6  per  1000  of  the  population,  which  was  above 
the  average  of  the  past  five  years.  The  death-rate  for  the 
corresponding  period  of  last  year  was  19'6  per  1000,  or  2-6 
below  the  average  of  the  preceding  quinquennial  period. 
Mr.  Adams  having  called  attention  to  what  he  termed  the 
“  unsavoury  smells  ”  of  the  parish,  arising  from  the  drains, 
Mr.  Waynforth  explained,  on  behalf  of  the  Sanitary  Com¬ 
mittee,  that  every  gully  in  the  parish  had  been  flushed,  but 
what  was  really  needed  was  a  proper  ventilation  of  the 
sewers.  On  this,  Mr.  Turner,  the  Shoreditch  member  of 
the  Metropolitan  Board  of  Works,  urged  that  before  the 
V estry  proceeded  to  take  steps  to  ventilate  the  sewers  by 
means  of  air-shafts  they  should  think  twice.  Sir  Charles 
Dilke,  the  President  of  the  Local  Government  Board,  had 
stated  distinctly  that  no  competent  engineer  was  satisfied 
with  any  plan  that  had  as  yet  been  proposed  for  the  accom¬ 
plishment  of  the  better  ventilation  of  the  sewers  of  the 
metropolis.  Mr.  Waynforth  further  added  that  the  sanitary 
staff  of  Shoreditch  parish,  which  had  been  augmented  for 
the  summer  work,  had  sedulously  attended  to  the  promotion 


of  the  public  health,  and  would  be  prepared  with  a  satisfac¬ 
tory  report,  which  would  bear  comparison  with  any  otlnr 
East-end  parish. 

The  sanitary  authorities  of  St.  Pancras  have  lost  no  time 
in  dealing  with  the  outbreak  of  typhoid  fever  in  Camdei 
Town ;  a  largely  augmented  staff  of  officers  have  been  ei- 
gaged  for  some  days  in  making  a  partial  house-to-house  in¬ 
spection.  Their  inquiries  have  elicited  the  fact  that  tie- 
epidemic  has  been  more  widely  spread  than  was  at  first 
imagined,  and  that  the  published  statements  respecting  ii, 
instead  of  being  exaggerated,  have  been  considerably  belov 
the  mark.  At  a  special  meeting  recently  held  by  the  Sanitarr 
Committee,  Mr.  Robinson,  the  chairman,  said  he  was  sorry  t> 
have  to  state  that  it  was  found  that  no  less  than  250  persons 
had  been  attacked  by  the  epidemic  in  that  parish,  and,  s> 
far,  the  number  of  fatal  cases  had  been  thirty.  Througt- 
out  the  district,  however,  it  might  be  said,  he  thought,  that 
the  epidemic  had  Been  successfully  checked,  and  as  withix 
the  last  few  days  there  had  been  no  fresh  cases,  it  was 
considered  that  there  was  now  no  danger  of  any  renewed 
outbreak.  Mr.  Robinson  further  stated  that  it  was  that 
intention  of  the  Medical  Officer  of  Health,  Mr.  Shirley 
Murphy,  when  he  had  completed  his  inquiries  and  felt 
himself  in  a  position  to  make  a  statement,  to  issue  a  report 
which  would  make  the  public  acquainted  with  the  course: 
of  the  epidemic,  and  the  source  whence  it  had  originated. 

Mr.  W.  J.  Payne,  the  Coroner  for  the  Borough,  has 
apparently  taken  upon  himself  to  do  away  with  the  long- 
established  custom  of  “  viewing  the  body  ”  in  all  cases  of 
inquests.  It  must  be  assumed  that  he  has  assured  himself 
of  the  legality  of  the  innovation  thus  introduced ;  but  if  so, 
it  is  strange  that  he  should  have  spoken  of  the  custom  as 
one  “  required  by  the  law.”  Briefly,  the  circumstances  were 
as  follows : — At  an  inquest  held  on  the  body  of  Elizabeth 
Weller,  aged  thirty-eight,  the  husband  stated  that  his 
wife  had  been  ailing  for  some  time  past,  and  had  been  an 
out-patient  at  the  Royal  Free  Hospital.  A  few  days  ago, 
witness,  who  had  been  in  the  country,  returned  home  in 
consequence  of  a  telegram  informing  him  that  his  wife  was. 
dangerously  ill.  He  found  her  in  a  dying  state,  and  she- 
expired  a  few  hours  after  his  arrival.  A  medical  man  de¬ 
posed  that  he  had  seen  the  deceased  shortly  before'  her 
death,  and  considered  that  she  died  from  an  ulcer  in  the 
stomach.  The  Coroner  remarked  that  in  this  case  the  hus¬ 
band  had  declined  to  allow  the  body  to  be  removed  to  the 
mortuary,  consequently  the  jury  had  been  unable  to  view 
the  remains  as  they  were  required  to  do  by  law.  If  they 
thought  it  necessary  that  they  should  see  the  body  they 
would  have  to  make  a  long  journey  to  the  house  where  the 
deceased  was  lying,  and  he  (the  Coroner)  could  see  no  occasion 
for  that.  It  was  quite  time  the  absurd  custom  of  viewing  the: 
body  was  dispensed  with.  Years  ago,  when  medical  evidence 
was  not  forthcoming,  and  the  jury  had  to  depend  upon  the 
state  of  the  body  for  grounds  upon  which  to  base  their  ver¬ 
dict,  the  custom  of  viewing  the  body  was  likely  to  be  pro¬ 
ductive  of  some  good ;  but  things  were  different  now,  and 
he  had  no  hesitation  in  saying  that  the  custom  ought  forth¬ 
with  to  be  abolished.  Eventually  the  jury  decided  to  return 
a  verdict  in  accordance  with  the  medical  evidence. 

A  case  of  reckless  exposure  of  a  person  suffering  from 
small-pox  was  recently  brought  to  notice  at  the  Chester 
Police-court.  Job  Moss,  landlord  of  the  “  Blomfield  Arms,” 
Bishopsfield,  Chester,  was  charged,  under  Section  126  of  the 
Public  Health  Act,  with  extreme  negligence  by  travelling 
with  his  son  while  the  latter  was  suffering  from  small¬ 
pox.  Dr.  McCann,  surgeon,  of  Liverpool,  deposed  that 
on  August  6  last,  defendant’s  son,  whom  he  had  been 
attending  at  Liverpool,  was  suffering  from  small-pox,  and 


Kedical  Times  and  Gazette. 


THE  WEEK. 


Sept.  22,  1883.  351 


witness  advised  the  defendant  to  remove  him  to  the 
Workhouse  or  to  the  Mill-road  Hospital;  but  the  defen¬ 
dant  having  made  up  his  mind  to  take  him  home, 
brought  him  to  Chester  by  train  with  other  passengers,  and 
from  the  station  to  his  house  in  a  cab.  No  special  precau¬ 
tions  whatever  were  taken  to  avoid  infecting  other  pas¬ 
sengers,  the  defendant  simply  stating  that  he  smoked 
a  pipe  in  the  train.  The  son  had  since  died,  and  the  defen¬ 
dant’s  wife  was  now  seriously  ill,  having  caught  the  disease. 
It  wras  stated  that  the  cab  in  which  defendant’s  son  was 
taken  from  the  station  at  Chester  had  been  thoroughly  dis¬ 
infected,  the  lining  having  been  taken  out  and  burnt,  and 
the  cab  removed  off  the  stands.  The  presiding  magistrate 
remarked  on  the  gravity  of  the  offence,  and  inflicted  a  fine 
of  20s.  and  costs — a  punishment  not  likely  to  make  either 
the  culprit  or  the  public  believe  that  he  had  committed  any 
very  serious  offence. 

The  return  issued  by  the  Registrar-General  for  the  week 
ended  on  the  8th  inst.  shows  that  the  annual  rate  of  mor¬ 
tality  in  twenty-eight  great  towns  of  England  and  Wales 
averaged  20  per  1000  of  their  aggregate  population.  The 
six  healthiest  places  were  Oldham,  Derby,  London,  Cardiff, 
Birkenhead,  and  Bristol.  In  London  2434  births  and  1257 
-deaths  were  registered.  The  annual  rate  of  mortality  from 
all  causes,  which  had  been  equal  to  17'9  and  17  per  1000 
in  the  two  preceding  weeks,  further  declined  during  the 
week  under  notice  to  166,  a  lower  rate  than  has  prevailed 
in  any  week  since  the  end  of  September,  1881.  During 
the  first  ten  weeks  of  the  current  quarter  the  death-rate 
averaged  19-5  per  1000,  against  2T6  and  18’6  in  the  corre¬ 
sponding  periods  of  1881  and  1882.  The  1257  deaths  included 

1  from  small-pox,  19  from  measles,  43  from  scarlet  fever,  14 
from  diphtheria,  22  from  whooping-cough,  1  from  typhus, 
35  from  enteric  fever,  87  from  diarrhcea  and  dysentery,  and 

2  from  simple  cholera;  thus  224  deaths  were  referred  to 
these  diseases,  being  72  below  the  corrected  average  number 
in  the  corresponding  weeks  of  the  last  ten  years.  The  deaths 
attributed  to  diarrhoea  and  dysentery,  which  had  been  63 
and  74  in  the  two  previous  weeks,  further  rose  to  87  in  this 
week,  but  were  then  no  fewer  than  57  below  the  corrected 
average ;  81  were  of  infants  and  children  under  five  years  of 
age.  For  the  week  ending  September  15  the  annual  rate  of 
mortality  in  London  was  again  16 '6  per  1000.  There  was 
no  very  marked  difference  in  the  number  of  deaths  attri¬ 
buted  to  any  one  cause.  No  death  was  registered  from 
typhus ;  31  were  attributed  to  enteric  fever,  and  62  to 
•diarrhoea  and  dysentery,  58  of  the  62  having  been  deaths  of 
infants  and  children  under  five  years  of  age. 

It  is  authoritatively  stated  that  there  has  been  a  rapid 
and  remarkable  increase  of  insanity  in  New  York,  and 
much  consideration  is  being  given  to  the  treatment  of 
lunatics  in  consequence.  On  the  last  day  of  December,  1871, 
there  were  1535  insane  persons  confined  in  asylums  in  the 
city.  In  the  course  of  eight  years  the  number  had  doubled, 
and  in  the  current  year  it  has  reached  3600.  In  seven 
months  there  has  been  an  increase  of  121  patients  in  the 
male  asylum  on  Ward’s  Island,  and  of  110  patients  in  the 
female  asylum  on  Blackwell’s  Island.  There  is  one  lunatic 
in  every  360  inhabitants  in  the  city,  while  in  the  whole 
nation  the  average  is  one  to  779  of  the  population.  The 
increase  of  insanity  in  the  whole  country  has  been  60  per 
cent,  in  ten  years,  the  population  having  increased  only  26 
per  cent,  in  the  same  time.  The  ratio  of  increase  in  the  city 
is  thus  more  than  double  what  it  is  in  the  nation,  but  there 
are  special  reasons  which  partially  account  for  this.  Many 
lunatics  in  the  neighbouring  towns,  and  even  states,  are 
shipped  into  New  York  and  abandoned  in  the  streets,  and  as 
their  former  places  of  abode  cannot  be  traced,  it  falls  to  the 
lot  of  the  municipality  to  provide  for  them.  Great  com¬ 


plaint  is  made  of  this,  as  the  city  not  only  cares  for  all  its 
own  insane,  but  at  the  same  time  is  made  to  pay  nearly 
one-half  the  expense  of  maintaining  the  State  asylums,  to 
the  population  of  which  it  contributes  not  a  single  patient. 

The  twentieth  annual  meeting  of  the  British  Pharmaceu¬ 
tical  Conference  was  opened  at  Southport  on  the  18th  inst., 
under  the  second  year’s  presidency  of  Professor  Attfield, 
F.R.S.,  by  whom  the  address  was  delivered.  It  will  be 
remembered  that  this  Conference  is  usually  held  so  as 
to  terminate  with  the  opening  of  the  meeting  of  the 
British  Association,  by  which  means  its  members  are 
enabled  to  attend  the  Chemical  Section  of  the  Associa¬ 
tion.  The  object  of  the  Conference  is  to  increase  the 
common  stock  of  pharmaceutical  knowledge,  and  to  pro¬ 
mote  a  friendly  intercourse  among  those  engaged  in 
pharmacy.  Members  are  encouraged  to  make  original 
investigations  during  the  year,  and  to  forward  the  results  in 
the  form  of  papers  to  the  annual  meeting.  In  some  cases 
grants  of  money  are  made  to  assist  in  defraying  the  cost  of 
materials  used  in  making  investigations.  The  proceedings 
of  the  Conference  are  printed  in  a  year-book,  which  also 
contains  reports  on  the  progress  of  pharmacy,  materia 
medica,  therapeutics,  and  chemistry,  notices  of  new  prepara¬ 
tions  and  processes,  and  useful  formulas  published  at  home 
and  abroad  during  the  year. 

At  the  Greenwich  Police-court,  recently,  some  occupiers 
of  houses  in  Brandram-road,  Lee,  were  summoned  by  the 
Plumstead  Board  of  Works  to  show  cause  why  an  order 
should  not  be  made  upon  them  to  stop  up  a  certain  well  and 
accumulation  of  impure  water,  polluted  with  sewage  and 
injurious  to  health.  Previous  to  and  in  March  last  there 
was  a  prevalence  of  typhoid  fever  in  the  part  of  Lee  where 
these  houses  are  situated,  and  the  daughter  of  one  of  the 
defendants  died.  Through  their  medical  officer  the  Board 
were  then  able  to  trace  the  origin  of  the  fever  to  a  well  used 
by  the  inhabitants  of  three  houses  in  Brandram-road.  Mr. 
Wigner,  President  of  the  Society  of  Public  Analysts,  had 
declared  that  the  water  contained  organic  impurity  and  was 
highly  dangerous.  The  Board  had  endeavoured  to  get  the 
landlords  of  the  houses  to  have  the  public  water-supply  laid 
on,  but  they  repudiated  the  liability.  The  magistrate  made 
an  order  for  the  well  to  be  closed  within  fourteen  days,  and 
advised  the  defendants,  in  the  meantime,  to  have  the  water 
they  drank  boiled  and  filtered. 

COMPLAINTS  AGAINST  THE  DRAINAGE  OF  TWICKENHAM. 

It  is  rumoured  that,  as  a  result  of  the  recent  visit  of  Sir 
Charles  Dilke  to  the  Twickenham  Drainage  Works,  a 
preliminary  communication  from  the  Local  Government 
Board  has  been  forwarded  to  the  Urban  Authority  of  that 
town,  inquiring  the  number  of  houses  at  present  connected. 
The  sudden  visit  of  Sir  Charles  (which,  it  is  understood, 
was  made  in  consequence  of  serious  complaints  from 
influential  residents),  together  with  various  extraordinary 
rumours  which  have  since  been  in  circulation,  have  created 
some  uneasiness  in  the  minds  of  the  ratepayers.  It 
has  been  alleged  that  the  effluent  water  at  present  dis¬ 
charged  into  the  Thames  is  either  impure,  or  that  sewage 
from  the  houses  is  still  allowed  to  flow  into  the  river 
to  a  considerable  extent ;  also  that  sickness  has  broken 
out  in  the  neighbourhood  in  consequence  of  the  offensive 
smells  arising  from  the  drainage.  These  charges  are, 
however,  denied,  and  it  is  claimed  for  the  sewage  works 
that  they  are  a  thorough  success.  With  regard  to  the 
purity,  or  otherwise,  of  the  effluent  water,  it  is  stated  that 
the  inspector  of  the  Thames  Conservancy  has  inspected  the 
same  from  time  to  time,  and  has  expressed  his  satisfaction 
with  the  quality  of  the  water.  The  whole  matter  is  expected 
to  be  discussed  at  an  early  meeting  of  the  Local  Board. 


352 


Mel'cal  Times  and  Gazette. 


THE  WEEK. 


Sept.  22,  18S3. 


THE  HOUSES  OF  THE  LABOURING  CLASSES. 

In  connexion  with  the  movement  recently  inaugurated  by 
the  Labourers’  Union  in  favour  of  the  appointment  of  a 
Royal  Commission  to  inquire  into  the  sanitary  condition  of 
the  houses  of  the  labouring  classes  of  London,  a  meeting 
was  held  on  Saturday  last  at  the  Mission  Rooms,  Manor- 
place,  Walworth,  for  the  purpose  of  forming  a  representa¬ 
tive  committee  to  co-operate  with  the  Labourers’  Association 
in  their  efforts  to  remedy  the  evils  complained  of.  The 
chairman  of  the  meeting  pointed  out  that  while  much  had 
been  done  in  recent  years  to  improve  the  dwellings  of  the 
working  classes,  the  work  was  not  half  completed.  A  num¬ 
ber  of  unhealthy  houses  had  undoubtedly  been  removed, 
but  sufficient  accommodation  had  not  been  provided  for  the 
people  dispossessed,  and  the  result  was  that  the  evil  of  over¬ 
crowding  had  become  intensified  in  other  insanitary  dis¬ 
tricts,  where  the  poor  might  be  found  herding  like  cattle. 

A  resolution  was  eventually  adopted,  approving  the  appoint¬ 
ment  of  a  committee  to  organise  a  deputation  to  the  Home 
Secretary  on  the  subject. 

SCHOOL  BOARD  SCHOOLS  AND  HOME  LESSONS. 

There  has  been  an  agitation  lately,  at  Bradford,  against 
the  overworking  of  School  Board  children  by  means  of 
home  lessons,  and  a  legal  opinion  has  been  taken  on  the 
subject.  In  the  opinion  thus  obtained,  it  appears  that  from 
one  of  the  sections  of  the  Education  Act  of  1876  the  infer¬ 
ence  is  drawn  that  the  several  Acts  do  not  interfere  with  the 
common-law  right  of  a  person  to  dispose  of  the  time  and 
occupation  of  his  child  between  school  hours  as  he  may 
please;  and  that  a  teacher  who  punishes  a  child  for  neglect¬ 
ing  to  prepare  home  lessons  by  command  of  his  father,  is 
acting  outside  the  scope  of  his  authority,  and  would  be  liable 
to  a  civil  action,  or  might  be  summoned  before  a  magistrate 
and  fined  for  an  assault,  or,  in  a  flagrant  case,  an  indictment 
might  be  prepared. 

THE  PARIS  WEEKLY  RETURN. 

The  number  of  deaths  for  the  thirty-fifth  and  thirty-sixth 
weeks  of  1883,  terminating  August  29  and  September  6,  were 
respectively  1040  (561  males  and  479  females)  and  929  (518  I 
males  and  411  females);  and  of  these  there  were  from  typhoid 
fever  54and40,small-pox3  and  2,  measles  22andl7,  scarlatina 
none  and  1,  pertussis  25  and  15,  diphtheria  and  croup  23  and 
27, erysipelas  8  and  5,  and  puerperal  infections  2  and  5.  There 
were  also  38  and  43  deaths  from  acute  and  tubercular 
meningitis,  206  and  175  from  phthisis,  9  and  13  from 
bronchitis,  58  and  37  from  pneumonia,  135  and  154  from 
infantile  athrepsia  (43  and  48  having  been  wholly  or  partially 
suckled),  and  32  (29  males  and  3  females)  and  20  (15  males 
and  5  females)  violent  deaths.  There  is  nothing  remarkable 
in  the  return  of  deaths  for  the  thirty-fifth  week,  while  the 
numbers  for  the  thirty-sixth  week  are  exceptionally  low ; 
infantile  athrepsia,  however,  furnishing  in  the  latter  a 
large  number  of  deaths  (154),  being  two  and  a  half  times 
greater  than  in  January,  when  the  mean  number  of  deaths 
was  64  per  week.  This  is,  however,  always  observed  to  be 
so  at  the  end  of  the  summer  in  Paris,  and  it  is  yet  more 
visible  in  the  South  of  France.  The  births  for  the  thirty- 
fifth  week  amounted  to  1279,  viz.,  681  males  (503  legitimate 
and  178  illegitimate)  and  859  females  (451  legitimate  and 
147  illegitimate)  ;  those  for  the  thirty-sixth  week  amounted 
to  1147,  viz.,  583  males  (439  legitimate  and  144  illegitimate) 
and  564  females  (413  legitimate  and  151  illegitimate). 
During  the  thirty-fifth  week  97  infants  were  either  born 
dead  or  died  within  twenty-four  hours,  viz.,  50  males  (29 
legitimate  and  21  illegitimate)  and  47  females  (33  legitimate 
and  14  illegitimate);  and  during  the  thirty-sixth  week  there 
were  79  such  births,  viz.,  47  males  (34  legitimate  and  13  ille¬ 
gitimate)  and  32  females  (23  legitimate  and  9  illegitimate) . 


IN  MEMORIAM. — CANADA. 

Mr.  George  Stephen,  President  of  the  Canadian  Pacific 
Railway,  has  presented  the  sum  of  $50,000  to  the  General 
Hospital,  in  Montreal,  to  be  expended  in  erecting  one  of  the 
proposed  new  wings  in  memory  of  the  late  Dr.  CampbelL 
Dean  of  the  Medical  Faculty  of  McGill  University.  The 
Medical  Endowment  Fund,  or  Campbell  Memorial,  of  the 
University  (which  was  set  on  foot  at  the  semi-centennial 
banquet  of  the  Medical  Faculty  last  October  by  the  generous 
offer  of  the  Hon.  D.  A.  Smith  of  $50,000,  provided  an  equal 
amount  could  be  raised  by  subscription),  has  now  become  an 
actuality ;  and  the  sum  named  is  stated  to  have  been  handed 
over  to  the  University  by  the  hon.  gentleman. 

THE  CHOLERA  IN  EGYPT. 

We  have  received  from  the  Foreign.  Office  a  copy  of  the 
further  report  by  Surgeon- General  Hunter  on  the  cholera, 
epidemic  in  Egypt.  Dr.  Hunter  speaks  in  no  measured 
terms  of  the  utter  neglect  of  the  commonest  sanitary  pre¬ 
cautions  which  came  under  his  notice  in  the  towns  and 
villages  along  the  Damietta  branch  of  the  Nile.  One  place 
(Tanta)  alone  excepted,  he  found  the  hospitals  “  in  a  more  or 
less  tumble-down,  dirty  condition,  impregnated  with  foul 
odours,  and  containing  beds  filthy  in  the  extreme,  .... 
noisome  places  utterly  unfit  for  the  reception  of  human 
beings.”  Dr.  Hunter  has  ascertained  beyond  all  doubt  that, 
cases  of  cholera  occurred  in  Damietta  as  early  as  April  last, 
and  that  cases  had  occasionally  been  seen  for  many  years, 
past,  but  these  were  mostly  called  “  cholerine  ”  by  the  local 
practitioners — a  distinction  in  the  name  without  any  corre¬ 
sponding  difference  in  the  disease.  The  report  contains  a. 
letter  from  Dr.  Sierra  to  Dr.  Sonsino ;  the  report  of  Dr., 
Dutrieux,  who  had  been  employed  by  Shereef  Pacha  t» 
inquire  into  the  cause  and  origin  of  the  epidemic ;  and  also 
the  report  of  Ahmet  Chaffey  Bey  and  Salvatore  Ferrari,  who 
commenced  their  labours  in  the  confident  belief  that  they 
were  going  to  prove  that  the  disease  had  been  imported, 
from  India  by  a  stoker  of  the  steamship  Timor,  and  were 
compelled  to  accept  the  evidence  that  they  themselves  had 
compiled,  that  there  was  no  need  to  seek  outside  Damietta. 
for  a  cause  of  the  outbreak.  But  we  must  defer  to  a  future 
day  any  detailed  consideration  of  the  report  itself  and  its 
enclosures. 

BRITISH  PHARMACEUTICAL  CONFERENCE. 

On  Tuesday,  the  18th  inst.,  the  twentieth  annual  meeting 
of  the  British  Pharmaceutical  Conference  was  opened  at. 
Southport,  under  the  presidency  (for  the  second  year)  of 
Professor  J.  Attfield,  Ph.D.,  F.R.S.  The  President  com¬ 
menced  the  proceedings  by  an  address  on  the  future 
supply  of  drugs  to  the  p  ublic.  He  contended  that  a  crisis 
in  pharmacy  is  fast  approaching.  The  aim  of  the  Act  of 
1868— viz.,  the  proper  supply  of  trustworthy  drugs — was, 
he  said,  being  seriously  thwarted.  The  Act  declared  that 
no  person  should  assume  the  title  of  “chemist  and  druggist” 
and  practise  under  it  unless,  after  satisfying  State  exa¬ 
miners  that  he  was  properly  qualified,  his  name  was 
duly  enrolled  on  a  State  register.  But  it  was  never¬ 
theless  quite  possible,  and  did  happen,  that  unregistered, 
and  even  utterly  unqualified  persons,  might  act  as 
chemists  and  druggists.  Drugs  of  nearly  all  kinds,  simple 
and  compound,  excepting  the  few  more  virulent  scheduled 
in  the  Pharmacy  Act,  were  being  sold  by  shopkeepers  of  all 
sorts — by  barbers,  booksellers,  chandlers,  drapers,  grocers,, 
hairdressers,  oilmen,  publicans,  etc., — and  to  supply  these 
retail  tradesmen,  wholesale  houses  had  arisen  of  whose  com¬ 
petence  there  was  no  guarantee.  These  unqualified  drug 
dealers  sell  the  drugs  at  a  very  small  profit,  or  even  at 
cost  price,  as  bait  to  catch  customers.  But  the  educated 
and  qualified  chemist  and  druggist  must  charge  not  only  the. 


Medical  Times  and  Gazette. 


THE  WEEK. 


Kept.  22,  1883.  353 


fair  price  for  the  drugs,  but  also  for  his  knowledge  and 
skill,  chemical,  botanical,  and  pharmaceutical.  The  public 
could  not  protect  themselves  against  bad  drugs  ;  they  were 
not  protected  by  the  Food  and  Drugs  Act,  for  nature  yields 
drugs  varying  much  in  quality,  and  analysts,  as  such,  could 
not  be  familiar  with  the  conditions  of  their  purity  and 
strength  j  the  public  could  not  control  the  importers,  growers, 
wholesale  dealers,  or  the  manipulators;  and,  finally,  the  Phar¬ 
macy  Act  is  incomplete.  Dr.  Attfield  dwelt  very  fully  on  his 
subject,  showing  the  various  and  great  evils  arising  to  the 
public  and  to  pharmacy  from  the  existing  state  of  things ; 
and,  in  conclusion,  pointed  out  the  remedy  for  these  evils, 
viz.,  an  extension  of  the  principle  and  letter  of  the  Pharmacy 
Act.  “  A  score  of  medicinal  substances,”  he  said,  “  were 
deemed  poisons,  and  were  to  be  sold  retail,  as  a  rule,  only  by 
registered  chemists  and  druggists.  Let  that  list  be  consider¬ 
ably  extended,  saving  all  rightful  interests.  Let  the  retail 
sale  in  open  shop  of  most  of  the  simple  and  compound  medi¬ 
cines  of  the  British  Pharmacopoeia  be  carried  on  only  by  regis¬ 
tered  chemists  and  druggists.  The  machinery  of  the  Pharmacy 
Act  is  ample  if  inspectors  be  employed  to  see  that  unqualified 
traders  do  not  infringe  it.  In  sparsely  populated  districts 
let  drugs  be  sold  by  unregistered  persons  in  secured  pack¬ 
ages,  but  only  as  agents  for  responsible  and  registered 
chemists.”  Dr.  Attfield’s  address  contains  a  large  amount 
of  carefully  gathered  information,  and  deserves  to  be 
thoughtfully  read  by  everyone.  In  the  more  part  of  what 
he  says  we  entirely  agree  with  him  ;  but  unless  the  public 
at  large  can  be  seriously  aroused  to  a  recognition  of  the  evils 
he  points  out,  it  will  be  to  the  last  degree  improbable  that 
the  present  Government  will  trouble  themselves  about  the 
matter. 


TYPHOID  FEVER  IN  PARIS. 


Dr.  Bertillon  has  just  communicated  to  the  Commission 
for  the  Sanitary  Improvement  of  Paris  the  annual  number 
of  deaths  from  typhoid  fever,  which  have  occurred  in  Paris 
during  the  years  1865-82  (with  the  exclusion  of  the  abnormal 
years  1870  and  1871).  There  were  in — 


1865  . 

.  ...  1,161  or  64 

1866  . 

.  ...  967  „ 

53 

1867  . 

.  ...  925  „ 

50 

1868  . 

.  ...  988  „ 

53 

1869  .. 

.  ...  1,080  „ 

57 

1872  . 

.  ...  1,007  „ 

54 

1873  . 

.  ...  1,021  „ 

54 

1874  .. 

.  ...  823  „ 

43 

1875  .. 

.  ...  1,048  „ 

53 

1876  .. 

.  ...  2,032  „ 

102 

1877  .. 

.  ...  1,201  „ 

59 

1878  .. 

.  ...  855  „ 

41 

1879  .. 

.  ...  1,119  „ 

52 

1880  .. 

.  ...  2,120  „ 

97 

1881  .. 

.  ...  2,121  „ 

96 

1882  .. 

.  ...  3,403  „ 

150 

99 

99 


SANITARY  EXHIBITION  IN  GLASGOW. 

The  allocation  of  space  in  the  Burnbank  Drill  Hall  for  the 
exhibition  in  connexion  with  the  Congress  of  the  Sanitary 
Institute  of  Great  Britain  was  concluded  on  Saturday  last 
week.  In  addition  to  the  Hall  itself,  which  is  190  ft.  long 
by  83  ft.  wide,  a  pavilion,  83  ft.  by  27  ft.,  has  been  provided 
at  one  end,  and  an  annexe,  100  ft.  by  27  ft.,  in  front.  Con¬ 
siderable  quantities  of  appliances  have  already  been  received 
from  British  and  French  exhibitors,  and  nearly  all  the  others 
are  expected  to  be  forwarded  during  the  course  of  the  week. 
The  judges  are  to  make  a  preliminary  inspection  some  time 
this  week,  and  the  opening  ceremony  will  be  performed  by 
Lord  Provost  Ure  on  the  25th  inst.,  and  the  Exhibition 
continued  until  the  20  th  prox. 


THE  INSANE  AS  WITNESSES. 

The  United  States  Supreme  Court  have  recently  decided 
that — “  A  lunatic  or  person  affected  with  insanity  is  admis¬ 
sible  as  a  witness  if  he  have  sufficient  understanding  to 
apprehend  the  obligation  of  an  oath,  and  to  be  capable  of 
giving  a  correct  account  of  the  matters  which  he  has  seen 
or  heard  with  reference  to  the  questions  at  issue ;  and 
whether  he  have  that  understanding  is  a  question  to  be 
determined  by  the  Court  upon  examination  of  the  party 
himself,  and  any  competent  witnesses  who  can  speak  to  the 
nature  and  extent  of  his  insanity.” 


PROFESSOR  CHEVREDL. 

The  Union  Medicale,  writing  of  this  distinguished  savant  on 
September  4,  observes: — ,CM.  Chevreul,  Member  of  the 
Academie  des  Sciences,  and  Director  of  the  Museum 
d’Histoire  N aturelle,  enters  to-day  on  his  ninety-eighth 
year.  In  spite  of  his  great  age  he  assumes  the  modest  title 
of  doyen  des  etudiants,  in  which  he  glories ;  but  we  may 
term  him  far  more  justly  the  doyen  des  maitres,  for  sixty 
years  of  the  exceptional  labours  and  services  which  he  has 
rendered  constitute  one  of  the  highest  renowns  of  France. 
Born  at  Angers  in  1786,  he  entered  the  Ecole  Centrale  of 
that  town  in  his  seventeenth  year,  having  Beclard  as  a 
fellow-student.  In  1811,  after  some  remarkable  investiga¬ 
tions,  he  was  nominated  aide-naturaliste  at  the  Museum, 
and  in  the  course  of  some  years  he  became  Examiner  at  the 
Ecole  Polytechnique,  Professor  of  Mathematics  at  the 
Lycee  Charlemagne,  and  the  Director  of  the  Dye  Works- 
and  Professor  of  Chemistry  at  the  Gobelins.  In  1826  he 
succeeded  M.  Proust  in  the  Section  of  Chemistry  in  the 
Academie  des  Sciences,  and  his  great  reputation  became 
confirmed  by  his  work  on  fatty  bodies  of  animal  origin. 
This  important  work  procured  for  him  the  Argenteuil  Prize 
of  12,000  fr.  He  then  became  the  Director  of  the  Museum, 
in  which  post  he  has  rendered  great  services ;  and  in  1875 
he  received  the  Grand  Cross  of  the  Legion  of  Honour.  One 
of  the  most  active  members  of  the  Institute  and  of  the 
Society  of  Agriculture,  M.  Chevreul  still  delivers  his  lec¬ 
tures  at  the  Jardin  des  Plantes,  and  directs  a  portion  of  the 
works  at  the  Gobelins.” 


LESIONS  OF  PERIPHERAL  NERVE-TRUNKS. 

Under  this  heading  Dr.  Weir  Mitchell  describes  some  cases 
of  considerable  interest,  especially  with  reference  to  treat¬ 
ment  ( American  Journal  of  Medical  Science,  July,  1883). 
The  most  important  is  that  of  a  woman,  aged  forty,  who  had 
noticed  at  first  numbness  in  the  palm  of  the  right  hand, 
which  she  attributed  to  milking,  as  it  was  only  during  this 
act  that  it  was  at  first  perceived.  The  numbness  was  suc¬ 
ceeded  by  pain,  and  this  gradually  spread  to  the  fingers,  and 
the  pain  was  so  great  as  to  prevent  her  doing  anything  with 
her  hand.  Later  on  (after  the  lapse  of  about  two  years)  an 
herpetic  eruption  appeared  on  the  back  of  the  hand,  but 
there  were  no  other  nutritive  disturbances,  e.g.,  muscular 
atrophy,  joint  affection,  glossy  skin,  or  marks  on  the  nails. 
Ultimately  a  small  abscess  formed  at  the  spot  where  the 
herpes  came,  leading  to  the  formation  of  an  open  sore. 
Internal  remedies  having  failed  to  give  any  permanent 
relief,  the  continuous  current  was  tried,  one  pole  being 
placed  over  the  median  or  musculo-spiral  nerve,  the  other 
over  the  sore  on  the  hand,  but  without  any  marked  benefit. 
The  median  nerve  was  then  stretched,  and  finally  a  portion 
of  the  radial  nerve  excised,  after  which  the  eruption  and 
sore  disappeared  and  the  pain  was  much  relieved,  but  the 
area  of  impaired  sensation  was  increased  rather  than  other¬ 
wise.  The  case  is  illustrated  by  diagrams  of  the  hand, 
showing  the  area  of  impaired  sensation  before  operation. 


FIRES  IIST  LUNATIC  ASYLUMS. 


Sept.  22,  1883. 


^  5  I  Medical  Times  and  Gazette. 

after  the  stretching  of  the  median  nerve,  and  again  after 
the  division  of  the  radial.  After  each  operation  there  was 
an  extension  of  the  area  of  impaired  sensation,  which  did 
not,  however,  follow  the  distribution  of  any  one  of  the  three 
nerves  supplying  the  hand,  hut  invaded  the  territory  of  each 
in  part.  As  regards  the  exact  nature  of  the  nerve  lesion  in 
this  case,  Dr.  Mitchell  does  not  put  forward  any  suggestions, 
and  the  omission  is  the  more  remarkable  because  he  had  the 
•opportunity  of  carefully  examining  the  portion  of  radial 
nerve  excised — an  opportunity  which,  it  cannot  be  doubted,  he 
availed  himself  of ;  but  no  mention  is  made  of  the  results  of 
that  examination.  Of  the  other  cases,  one  was  neuralgia  of 
the  fifth  nerve,  and  another  neuralgia  of  the  inferior  dental 
nerve.  In  this  latter  case  he  tried  the  experiment  of 
plugging  the  inferior  dental  canal  with  dental  cement,  to 
prevent  the  possibility  of  reunion  of  the  nerve  after  division. 


The  Earl  of  Leicester,  as  President,  has  just  added  to 
the  permanent  fund  of  the  Norfolk  and  Norwich  Hospital 
the  princely  donation  of  £15,000. 

We  regret  to  learn  that  Dr.  Louis  Thuillier,  one  of  the 
principal  members  of  M.  Pasteur’s  commission  to  investi¬ 
gate  the  pathology  and  etiology  of  cholera  in  Egypt,  has 
fiallen  a  victim  to  that  disease.  He  was  attacked  in  Alex¬ 
andria  on  the  18th  inst.,  and  died  next  morning,  at  the  age 
•of  twenty-seven. 

The  examination  for  Certificates  in  Sanitary  Science  by 
the  University  of  Cambridge  will  begin  on  Tuesday,  Octo¬ 
ber  2.  The  names  of  candidates,  who  must  be  on  the 
Medical  Register  of  the  United  Kingdom,  should  be  sent  to 
Professor  Liveing,  Cambridge,  on  or  before  September  28. 

Dr.  Hughes,  Superintendent  of  the  Hamadryad  hospital- 
ship,  Cardiff,  has  received  a  first-class  gold  medal  of  honour 
from  the  French  Government,  in  recognition  of  his  devoted 
services  to  French  seamen  who  had  been  brought  to  that 
vessel  from  time  to  time. 

The  Library  and  the  Museum  of  the  Royal  College  of 
Surgeons  will  both  be  reopened  on  Monday,  October  1. 

Tjhe  buildings  of  Dundee  College  are  nearly  ready  for  the 
opening  ceremony,  which  takes  place  on  October  5.  Large 
numbers  of  inquiries  are  being  made  by  students,  and  a  good 
attendance  is  expected  at  the  opening  of  the  classes.  The 
attendance  at  the  chemistry  classes,  it  is  anticipated,  will 
be  a  large  one,  as  the  chemical  laboratory  which  is  being 
•erected  will  be  the  most  complete  in  Scotland.  With  the 
view  of  interesting  working  men  in  the  College,  a  popular 
scientific  lecture  will  be  delivered  on  the  evening  of  the 
opening  day. 

At  a  quarterly  meeting  of  the  Governors  of  the  Dundee 
Royal  Infirmary,  Dundee,  held  on  the  18th  inst.,  it  was 
reported  that  Mr.  Thomas  Bell,  manufacturer,  had  given 
1000  guineas  for  the  children’s  ward  ;  and  it  was  mentioned 
that  arrangements  were  being  made  to  have  the  children’s 
ward  opened  as  soon  as  possible. 

Three  children  living  in  Saltcoats,  Ayr,  after  eating  some 
pods  of  the  laburnum  tree,  were  attacked  with  symptoms  of 
poisoning  of  rather  a  serious  nature.  Severe  and  persistent 
vomiting  was  succeeded  by  deep  sleep.  Steps  were  at  once 
taken  for  their  relief,  which  happily  proved  successful.  The 
three  cases  recovered,  although  at  one  period  the  recovery 
of  one  of  them  appeared  extremely  doubtful. 

The  Library  of  the  Royal  Medical  and  Chirurgical  Society 
was  reopened  on  Thursday,  the  13th  inst. 


Mrs.  M.  W.  T.  Cumberland  has  given  a  donation  of 
,£700  to  the  Warneford  Hospital,  in  memory  of  her  late 
husband.  Colonel  Cumberland.  The  interest  of  this  sum — 
which  has  been  invested — is  to  be  applied  to  the  mainten¬ 
ance  of  one  bed  in  the  women’s  ward. 


EIRES  IN  LUNATIC  ASYLUMS. 


The  recent  disaster  at  Southall  Park  has  brought  promi¬ 
nently  before  public  notice  the  great  risk  that  there  is  of 
the  occurrence  of  fires  in  lunatic  asylums,  and  the  terrible 
consequences  to  which  these  institutions,  more  than  any 
others,  are  liable.  In  addition  to  the  risks  to  which  all 
inhabited  buildings  are  subject,  there  is  one  which  is  pecu¬ 
liar  to  lunatic  asylums,  and  constitutes  a  constant  source 
of  danger  to  them  ;  we  refer  to  the  mischievous,  careless, 
or  imbecile  habits  of  their  inmates.  How  easily  the  neglect 
of  a  servant  may  cause  a  fire  in  an  ordinary  dwelling-house 
is  matter  for  common  remark;  but  a  very  much  less  degree 
of  carelessness — a  momentary  relaxation  of  the  sleepless 
vigilance  that  is  required  from  asylum  attendants — may  be 
the  origin  of  a  far  more  disastrous  catastrophe  than  can 
occur  in  any  ordinary  dwelling-house.  Many  lunatics  in 
public  asylums  are  permitted,  and  very  properly,  to  visit  the 
neighbouring  towns  and  make  purchases  for  themselves. 
What  could  be  more  easy  than  for  them  to  include  a  box  of 
matches  in  their  purchases  ?  Now  let  a  careless  attendant 
neglect  to  make  the  customary  search  of  clothing,  etc., 
before  the  patient  goes  to  bed,  and  the  opportunity  for 
a  terrible  disaster  is  ready  to  hand.  Many  and  many 
a  patient,  either  from  ignorance,  or  curiosity,  or  an  impish 
spirit  of  mischief,  or  from  a  desire  to  make  a  sensation, 
would  rejoice  in  the  opportunity  of  setting  his  curtains  or 
bedclothes  on  fire ;  and,  a  fire  once  started,  the  risks  to  the 
inmates  of  an  asylum  is  out  of  all  comparison  greater  than 
that  to  the  inmates  of  any  other  building  or  institution 
whatever.  For,  in  the  first  place,  the  doors  are  all  locked. 
Many  patients  are  locked  by  themselves  in  single  rooms  ; 
others  in  dormitories  containing  from  three  or  four  to,  it 
may  be,  ninety  or  a  hundred  patients.  Not  only  are  the 
doors  locked,  but  the  windows  also  are  secured.  Either 
they  are  stopped  by  battens  so  that  they  will  open  only  a 
few  inches,  or  they  are  made  in  immovable  iron  frames 
whose  interstices  are  purposely  made  too  small  to  permit 
the  passage  of  a  human  being.  Add  to  this  that  when  the 
patients  are  liberated  (granting  that  they  could  be  liberated) 
many  of  them  are  hopelessly  incapable  of  understanding  or 
following  any  directions,  and  must  be  “  personally  con¬ 
ducted  ”  to  a  place  of  safety,  at  whatever  loss  of  time  and  of 
opportunity  of  liberating  others  (for,  if  not  so  conducted, 
they  might  as  well  be  left  in  durance,  as  they  would  perish 
with  equal  certainty).  Add  that,  even  if  there  has  been,  as 
there  ought  to  be,  a  properly  organised  fire  drill,  a  consider¬ 
able  number  of  the  attendants  will  be  drafted  off  to  the 
special  duties  in  connexion  with  the  fire-engine,  and  a 
correspondingly  diminished  number  left  to  take  care  of  the 
patients  and  to  see  to  their  removal, — and  it  becomes  evident 
that  scarcely  any  accident  contains  within  itself  so  many 
conditions  for  the  production  of  a  disaster  of  the  very 
utmost  gravity  as  a  fire  in  a  lunatic  asylum. 

When  these  considerations  are  realised  it  becomes  the 
obvious  duty  of  every  committee  of  visitors  and  of  every 
asylum  superintendent  to  make  it  the  object  of  their  first 
care  to  provide  precautions  against  fire,  and  means  of  coping 
with  it  should  it  unhappily  occur.  When,  however,  we  examine 
the  recently  issued  Report  of  the  Commissioners  in  Lunacy, 
we  find  that  arrangements  for  this  purpose  are  lamentably 
and  almost  universally  defective.  In  some  asylums  there 
are  hydrants  inside,  but  none  outside  the  building;  in  others 
there  are  hydrants  outside,  but  none  inside  ;  in  others  again 
there  are  hydrants,  but  no  hose  to  attach  to  them— an 
arrangement  which  is  about  as  efficient  as  a  bucket  without 
a  bottom.  In  some  asylums  there  is  no  fire  drill;  in  others 
the  attendants  and  patients  are  exercised  in  working  a  fire- 


Medical  Times  and  Gazette. 


FROM  ABROAD. 


Sept.  22, 1883.  355 


engine  that  is  practically  useless;  in  few  is  there  an  effi¬ 
cient  fire-alarm.  These  things  ought  to  he  remedied,  and 
remedied  at  once.  We  would  urge  it  with  the  most  earnest 
insistence  upon  every  medical  superintendent  to  investi¬ 
gate  with  the  utmost  thoroughness  the  precautions  that 
are  in  existence  in  his  asylum  against  fire,  and  the  appli¬ 
ances  for  dealing  with  such  an  event.  By  so  doing,  and 
bringing  the  matter  under  the  notice  of  his  committee,  he 
will  at  least  relieve  himself  from  a  terrible  load  of  responsi¬ 
bility,  and  will  in  the  majority  of  cases  bring  about  a  most 
important  and  urgent  reform.  The  appliances  necessary 
are  few  and  comparatively  simple.  They  ai’e  no  doubt 
expensive,  but  in  such  a  matter  expense  ought  not  to  be, 
must  not  be,  reckoned.  There  are  things  that  should  be 
done  at  any  cost,  and  this  is  one  of  them.  The  main  requi¬ 
sites  are  as  follows  : — Hydrants,  running  from  the  ground 
floor  to  the  highest  floor,  should  be  placed  at  frequent 
intervals— not  greater  than  100  feet— throughout  the  build¬ 
ings.  By  preference  they  should  be  on  or  near  staircases. 
Each  hydrant  should  be  tapped  on  every  floor,  and 
beside  the  tap  should  hang  the  spanner  and  enough  hose 
to  reach  at  least  two-thirds  of  the  distance  between 
this  hydrant  and  the  next.  A  similar  series  of  hydrants 
should  also  be  placed  at  intervals  outside  the  building,  at 
a  few  yards  distance  from  it ;  and  in  convenient  places, 
but  not  necessarily  at  every  hydrant,  should  be  kept  the 
spanners  and  a  coil  of  hose  wound  on  a  reel  upon  wheels. 
So  much  for  the  distribution ;  but  this  is  of  little  use  if  the 
head  of  water  or  motive  power  is  insufficient.  When  this  is 
obtained,  as  in  the  Metropolitan  District  Asylums,  from  a 
water-tower  considerably  higher  than  the  highest  roof  of 
the  buildings,  gravity  alone  will  be  sufficient,  but  in  all 
other  cases  it  is  necessary,  and  even  in  this  it  is  advisable, 
that  the  hydrants  should  be  served  by  a  steam-pump.  Such 
pumps  are  now  made  at  a  comparatively  small  cost,  in  which 
steam  may  be  got  up  and  a  powerful  stream  of  water  obtained 
in  a  very  few  minutes ;  and  no  committee  can  be  considered 
to  have  discharged  its  duty  fully  until  it  has  added  one  of 
these  engines  to  the  asylum  under  its  management.  Of 
the  advisability  of  securing  abundance  of  staircase- exit 
from  the  upper  floors  of  asylums,  we  need  not  speak,  since 
this  is  a  very  serious  item  in  construction,  and  can  only  be 
properly  dealt  with  when  a  new  asylum  is  to  be  built ;  but, 
in  all  asylums  sufficiently  large  to  employ  an  engineer,  the 
provision  of  an  ample  supply  of  hydrants  and  an  efficient 
steam-pump  is  so  obviously  and  urgently  necessary,  and  can 
be  effected  at  a  cost  so  moderate  in  proportion  to  the  advan¬ 
tage  gained,  that  we  cannot  too  strongly  advocate  its 
adoption.  In  smaller  establishments,  and  where  no  such 
officer  is  employed,  a  steam-pump  would  obviously  be  out 
of  place ;  but  the  hydrants  and  a  water-supply  at  high 
pressure  ought  to  be  provided ;  and  an  “  Extincteur  ”  on 
each  floor  is  an  admirable  and  very  ready  means  of  promptly 
extinguishing  fire.  Finally,  in  every  asylum  there  ought  to 
be  a  fire  watch  on  duty  every  night. 


Alloa  County  Hospital. — On  the  10th  inst.  the 
annual  meeting  of  the  subscribers  to  this  Hospital  was  held, 
and  the  Treasurer’s  and  Committee’s  reports  were  submitted 
and  approved.  The  Committee  reported  that  the  Hospital 
was  free  of  debt,  and  at  the  close  of  1882  there  was  a  balance 
of  over  A100  in  bank.  At  the  close  of  the  previous  year 
there  remained  a  debt  of  ,£120 ;  but  through  the  liberality  of 
the  executors  of  the  late  Mr,  C.  Miller,  in  handing  over  to 
the  Hospital  the  sum  of  £200  out  of  a  general  bequest  made 
by  that  gentleman  towards  local  charities,  that  has  been 
cleared  off,  and  a  substantial  balance  to  the  good  remains. 

Aknison  Memorial.- — A  stained  glass  memorial  window 
has  just  been  erected  in  the  parish  church  of  Allandale, 
Northumberland,  as  a  record  of  the  life-labours  of  one  of 
the  oldest  medical  practitioners  in  the  North  of  England, 
the  late  William  Campbell  Arnison,  born  1797,  died  1883. 
The  inscription  on  the  brass  at  the  foot  describes  him  as 
“  for  upwards  of  fifty  years  surgeon  in  this  and  the  adjoining 
parishes.”  It  also  commemorates  his  fifty-two  years’  wife, 
Jane,  and  a  deceased  son  who  died  in  infancy.  The  window 
is  in  the  decorated  style,  of  two  lights.  The  subjects  illus¬ 
trated  are  the  journey  of  Abraham  with  Isaac  to  offer  the 
required  sacrifice  on  Mount  Moriah  (Gen.  xxii.),  and  the 
burial  of  Sarah  in  the  Cave  of  Machpelah.  Messrs.  Powell 
Brothers,  of  Leeds,  are  the  artists  of  the  memorial. 


FROM  ABROAD. 

Le  Comte  de  Chambord. 

The  last  number  of  the  Gazette  Hebdomadaire  is  almost 
entirely  occupied  by  a  narrative  (extending  over  more  than 
twenty  columns)  by  Prof.  Vulpian  concerning  the  last  illness 
of  the  Count  of  Chambord.  He  observes  that  it  had  been 
resolved  between  himself  and  Drs.  Drasche  and  Mayr  that 
no  account  of  the  illness  should  appear  from  them  during 
the  life  of  the  illustrious  patient ;  and  he  even  confesses  to 
a  little  subterfuge  in  characterising  it.  “  It  had  been  agreed,” 
he  says,  “  that  we  should  designate  it  as  acute  catarrh  of  the 
stomach  of  extreme  intensity,  and  this  term  has  been  re¬ 
produced  in  most  of  the  journals.  Now,  this  designation 
did  not  faithfully  represent  our  manner  of  viewing  the 
case.  We  readily  admitted  the  existence  of  a  catarrh  of 
the  stomach,  but  we  were  of  opinion  that  to  this  was 
joined  a  far  more  serious  condition  of  this  organ,  and 
in  our  opinion  the  disease  would  terminate  fatally  at  no 
distant  period.  It  is  this  view  which  we  would  not  render 
public  until  the  end,  and  we  never  departed  from  our 
reserve.”  And  even  after  death  had  changed  the  situation 
entirely.  Prof.  Vulpian  abstained  from  all  publication  until 
he  had  consulted  the  personages  immediately  surrounding 
the  Count,  and  the  Princes,  his  near  relations.  From  them 
he  received  authority  to  make  known  all  that  can  interest 
the  medical  public.  “  If  there  are  any  inexactitudes  in  the 
ensuing  narration,  these  have  arisen  solely  from  a  want  of 
precision  in  some  of  the  recollections.  I  should  mention  oh 
this  point  that  I  only  saw  the  Prince  during  a  few  days,  from 
August  15  to  18,  and  that  consequently  I  have  only  learned 
the  various  circumstances  from  the  commencement  to  the 
termination  of  the  disease  from  hearsay.” 

We  must  refer  our  readers  to  the  minute  narrative  which 
follows,  and  have  only  to  observe  that  the  Countess  do 
Chambord  peremptorily  forbade  any  autopsy  being  made,  in 
conformity  with  the  wishes  of  the  deceased,  several  times 
expressed,  so  that  the  medical  attendants  who  had  watched 
the  case  with  such  prolonged  anxiety  were  reduced  to 
attain  what  knowledge  they  could  get  by  the  glimpses 
afforded  them  during  the  process  of  embalmment,  which 
was  executed  by  Prof.  Kundrat,  of  Vienna,  fifty  hours  after 
death.  It  was  found  that  the  tumour,  which  had  given 
rise  to  so  much  speculation  during  life,  consisted  of  greatly 
thickened  mesentery,  loaded  with  fat,  and  containing  in  its 
substance  a  large  number  of  hypertrophied  lymphatic 
glands.  On  opening  the  oesophagus,  its  lower  fifth  was 
found  to  be  occupied  with  numerous  ulcers  of  a  rounded 
form  and  varying  size.  The  stomach  exhibited  the  well- 
known  appearance  of  gastric  catarrh,  and  near  the  pylorus 
were  several  small  ulcerations.  The  examination  had  to  be 
performed,  in  the  presence  of  servants  of  the  Countess,  with 
the  greatest  haste,  so  that  it  was  impossible  to  investigate 
with  the  necessary  attention  the  lesions  observed.  At  all 
events,  one  thing  was  incontestable,  that  an  error  in  dia¬ 
gnosis  had  been  made,  and  the  cancer  expected  to  be  found 
in  the  epigastric  region  had  no  existence;  but  all  present  at 
the  examination  agreed  that  the  error  was  unavoidable,  and 
in  a  similar  case,  having  the  same  clinical  characters,  would 
be  repeated.  The  ulcers  of  the  oesophagus  were  never  sus¬ 
pected  during  life,  and  consisted  in  simple  loss  of  substance, 
several  of  the  ulcers  showing  the  commencement  of  cica¬ 
trisation.  After  referring  to  the  relapse  of  the  symptoms, 
which  he  suspects  may  have  been  somewhat  due  to  incau¬ 
tious  feeding.  Prof.  Vulpian  thus  speculates  upon  a  possible 
recovery : — 

Supposing  this  relapse  of  August  9  had  not  occurred,  was 
recovery  possible  P  That  is  a  question  to  which  no  decided 
answer  can  be  given,  in  the  ignorance  we  are  in  as  to  the 
causes  of  these  ulcerations  of  the  oesophagus  and  stomach. 
First,  we  must  admit  that  these  lesions  were  perhaps  due 
to  a  morbid  process  progressing  slowly  (arterial  alterations) , 
and  that,  if  ’ this  was  the  case,  relapse  might  necessarily 
occur  at  any  moment.  If  the  attack  of  acute  catarrh  of 
the  stomach  and  oesophagus  were  only  in  question,  a  re¬ 
lative  cure  might  take  place  ;  but  under  the  state  in  which 
these  portions  of  the  digestive  canal  would  in  future*  be, 
and  the  conditions  which  the  arteries,  the  heart,  and  the 


356 


Medical  Times  and  Gazette. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


Sept.  22,  1883. 


kidneys  presented,  there  could  only  be  a  short  and  miserable 
survival.  The  digestive  functions  would  be  carried  on  in  a 
painful  and  probably  an  incomplete  manner  ;  strength 
would  be  recovered  with  great  difficulty  and  very  slowly ; 
and,  even  supposing  relapse  did  not  occur,  life  could  not 
last  long,  menaced  as  it  would  incessantly  be  by  the  acci¬ 
dents  which  atheroma  of  the  arteries  or  fatty  degeneration 
of  the  heart  might  give  rise  to. 

“  En  re-sume,  the  disease  of  the  Comte  de  Chambord 
was  characterised,  in  the  anatomical  point  of  view,  by 
ulcerations  of  the  mucous  membrane  of  the  stomach,  and 
especially  of  the  mucous  membrane  of  the  oesophagus,  and, 
in  the  clinical  point  of  view,  by  an  assemblage  of  symptoms 
which  must  inevitably  lead  to  the  admission— at  the  very 
least,  as  highly  probable — of  the  existence  of  cancer  of  the 
stomach.  We  have  to  do,  therefore,  with  a  case  that  is  of 
extreme  rarity,  and,  if  I  do  not  deceive  myself,  of  great 
interest ;  and  it  is  for  this  reason  that  I  have  thought  fit  to 
publish  its  narration.” 


THE  SANITARY  CONDITION  OF  THE 
WANDSWORTH  DISTRICT. 


The  Wandsworth  District  comprises  within  its  area  several 
important  parishes,  notably  East  and  West  Battersea, 
Clapham,  Putney,  and  Streatham — including  Balham  and 
Tooting, — with  a  population  amounting  to  212,492;  its 
sanitary  condition  must  consequently  be  of  no  mean  im¬ 
portance  and  interest.  The  combined  report  of  the  medical 
officers  of  health  for  the  year  1881  shows  that  during  the 
greater  part  of  that  period  the  district  was  affected  by  the 
epidemic  of  small-pox  which  prevailed  generally  throughout 
the  whole  metropolis ;  scarlet  fever,  whooping-cough,  and 
measles  were  also  extensively  prevalent,  and  the  latter 
was  attended  with  unusual  fatality :  yet,  notwithstand¬ 
ing  these  adverse  influences,  the  rate  of  mortality  for 
1881  is  the  lowest  recorded  since  the  Wandsworth  Board 
■of  Works  assumed  jurisdiction  over  this  extensive  and 
important  suburb.  The  average  annual  death-rate  of 
the  ten  years  1871-80  was  18-06  per  1000;  for  1881  it 
was  17T6,  or  3 '75  lower  than  the  rate  for  all  London, 
which,  with  the  exception  of  that  of  the  year  1850,  was 
the  lowest  recorded  within  the  annals  of  registration. 
Even  adding  the  deaths  of  the  sixty-three  inhabitants 
of  the  district  who  died  in  public  hospitals  out  of  its  con¬ 
fines,  the  rate  would  still  be  but  17'45  per  1000,  or  only  0'45 
higher  than  the  zero  in  Dr.  Farr’s  health-scale,  above  which 
deaths  are  held  to  be  preventable  in  urban  districts.  The 
report  concludes  by  remarking  that  the  facts  disclosed  by 
the  statistical  information  it  affords,  whether  considered  in 
relation  to  the  lowness  of  the  death-rate,  the  high  birth¬ 
rate,  the  diminution  of  the  fatality  from  epidemic  diseases, 
the  resistance  to  the  pressure  of  a  severe  epidemic,  or  the 
other  exponents  of  the  state  of  the  public  health,  lead  to 
the  irresistible  conclusion  that  the  Wandsworth  District  en¬ 
joyed  a  high  sanitary  status  during  the  year  1881.  The 
medical  officers  further  express  a  hope  that  the  same  measures 
which  have  been  so  successfully  adopted  in  the  repression 
of  outbreaks  of  contagious  disease  (especially  those  which 
relate  to  the  disinfection  of  houses,  in  which  they  have  great 
confidence)  may  be  continued,  since  it  is  scarcely  to  be  ex¬ 
pected  that,  in  a  constantly  increasing  population,  so  low  a 
rate  of  mortality  as  that  recorded  in  1881  can  be  maintained 
without  a  persistent  employment  of  such  measures,  together 
Avith  a  continuous  and  persevering  application  of  all  those 
minor  details  of  preventive  sanitation,  which,  in  the  aggre¬ 
gate,  constitute  the  real  sanitary  defences  of  the  public 
health. 


South  London  School  of  Pharmacy. — The  following 
prizes  were  presented  to  the  successful  competitors  at  the 
last  session,  on  Wednesday,  the  12th  instant: — Senior 
Chemistry — medal,  Albert  Ivatt;  certificate,  Herbert  H. 
Presbury.  Junior  Chemistry — medal,  C.  M.  Adams;  certi¬ 
ficate,  J ohn  Dickson.  Materia  Medica — medal,  David  Jones  ; 
certificates,  Messrs.  Dickson  and  Atkinson.  Botany — 
medal,  John  Dickie;  certificates,  Messrs.  Atkinson  and 
Adams.  Pharmacy— medal,  C.  M.  Adams  ;  certificate,  F.  W. 
Doubleday.  Extra  certificates  of  merit— Messrs.  Stafford, 
Harding,  Barnes,  Milton,  Capper,  Peck,  Farm  an,  and  Parker 


REVIEWS  AND  NOTICES  OP  BOOKS. 


The  Mineral  Waters  of  Europe.  By  C.  R.  C.  Tichborne, 
LL.D.,  M.R.I.A.,  F.C.S.,  and  Prosser  James,  M.D. 
London  :  Bailliere  and  Co.  18S3.  Small  8vo,  pp.  234. 
This  handy  little  book,  replete  with  sound  and  useful  in¬ 
formation,  will  be  welcomed  not  only  by  the  physician  who 
may  have  to  select  a  spa  for  such  of  his  patients  as  can 
afford  the  luxury  of  continental  travel,  but  as  well,  and 
even  more,  by  the  great  mass  of  practitioners  who  desire  to 
avail  themselves  of  the  same  waters  in  the  home  treatment 
of  patients,  who  for  various  reasons  are  debarred  from  the 
accessory  benefits  undoubtedly  to  be  derived  from  the  change 
of  air,  scene,  and  other  accompaniments  of  life  at  a  foreign 
watering-place. 

The  chemistry  and  the  therapeutics  of  each  class  of 
waters  are  given  by  the  authors  in  alternate  chapters,  of 
which  the  chemical  are  specially  valuable.  Many  of  the 
published  analyses  ordinarily  attached  to  the  bottles  con¬ 
taining  mineral  waters  are  very  incorrect,  partly  on  ac¬ 
count  of  the  defective  methods  employed  when  they  were 
made  perhaps  twenty  or  thirty  years  ago,  and  partly  from 
the  fact  that  mineral  waters  in  the  course  of  a  few 
years  undergo  great  alterations  in  their  composition.  The 
Friedrichshall  water,  for  example,  as  noiv  sold,  contains 
50  per  cent,  more  of  mineral  constituents  than  when 
analysed  by  Liebig,  though  Sir  Henry  Thompson  evi¬ 
dently  had  that  analysis  before  him  when  he  dilated  on 
the  remarkable  energy  of  salts  in  natural  solutions.  The 
fact  that  a  drachm,  we  will  say,  of  sulphate  of  magnesia 
in  this  form  is  more  active  than  a  like  dose  from  the  drug¬ 
gist’s  shop  is  due  not  to  any  mysterious  power  possessed 
by  the  spring,  but  partly  to  the  quantity  of  water,  especially 
hot  water,  in  which  it  is  taken,  and  partly  to  the  influence 
on  absorption  and  elimination,  on  digestion  and  tissue 
change,  exerted  by  the  numerous  other  salts  accompanying 
it.  Again,  Dr.  Tichborne  shows  that,  contrary  to  a  generally 
received  opinion,  these  combinations  cannot  be  imitated  by 
art,  for  we  really  do  not  know,  even  after  the  most  careful 
analysis,  in  what  mutual  combinations  the  various  bases  and 
acids  exist ;  each  can  be  estimated,  but  the  arrangement  of 
them  is  a  matter  of  individual  conj  ecture.  An  important 
observation,  which  we  do  not  remember  having  seen  before, 
is  that  the  so-called  sulphurous,  or,  as  Dr.  Tichborne  would 
rightly  call  them,  sulphurated,  waters  often  owe  their  dis¬ 
tinctive  character  to  the  presence  of  large  quantities  of 
organic  matter;  in  fact,  they  differ  little  from  dilute  sewage. 
And  though  we  can  bear  testimony  to  the  value  of  calcium 
sulphide  in  the  treatment  of  boils,  etc.,  which  he  seems  in¬ 
clined  to  discredit,  there  can  be  no  doubt  that  the  use  of 
such  a  water  as  he  describes  must  be  injurious.  Even 
some  other  waters,  as  the  Pullna  and  Mattoni’s  Royal  Hun¬ 
garian,  give,  in  the  presence  of  albuminoid  ammonia, 
nitrates  and  nitrites,  evidence  of  organic  pollution,  which 
attention  to  the  local  conditions  might  easily  obviate. 
Happily,  the  Hunyadi,  Friedrichshall,  and  iEsculap  are  per¬ 
fectly  free  from  organic  matters,  and  so  is  the  Harrogate 
among  the  sulphurated  waters.  Apropos  of  the  iEsculap, 
Dr.  Tichborne  calls  attention  to  a  ludicrous  error  in  the 
labels,  viz.,  that  it  contains  salicylic  acid — a  mistake  for 
silicic  ! 

The  authors  divide  mineral  waters  into  saline,  alkaline, 
chalybeate,  suphurated,  special,  and  table-waters,  the  latter 
including  such  as  seltzer  and  Apollinaris,  and  containing  no 
more  active  salts  than  may  be  largely  and  habitually  taken 
without  injury.  But  it  must  be  by  inadvertence  that  in 
the  introduction  1000  grains  per  gallon  is  given  as  a  pro¬ 
portion  not  as  a  rule  to  be  exceeded,  the  more  so  as  later 
on  waters  with  500  to  600  are  said  to  scarcely  fall  under  the 
denomination.  The  saline  waters  are  again  divided  into 
bitter  waters ,  in  which  sulphates  of  magnesia  or  of  soda,  or 
both,  are  the  chief  ingredients,  and  the  haloids,  owing  their 
special  characters  to  the  chlorides.  Among  special  waters 
are  included  the  arsenical,  iodine,  and  bromine  springs,  but 
of  the  therapeutic  value  of  these — i.e.,  in  virtue  of  their 
special  ingredients — Dr.  James  is  justly  incredulous.  Only 
a  disciple  of  Hahnemann  could  attach  much  value  to  a 
quarter  of  a  grain  of  iodide  or  bromide  of  potassium,  or  to 
infinitesimal  doses  of  arsenic;  the  Kreutznach  waters,  for 
example,  come  more  strictly  under  the  head  of  haloid  salines, 


Medical  Times  and  Gazette. 


KEVIEWS  AND  NOTICES  OF  BOOKS. 


Sept.  22,  1883.  357 


and  the  iodine  may  well  be  ignored.  In  a  short  supplemen¬ 
tary  chapter  on  artificial  waters.  Dr.  Tichborne  again  shows 
up  the  absurdity  of  attempted  imitations,  however  honestly 
undertaken,  and  the  worse  than  worthlessness  of  many 
fraudulent  substitutes  for  seltzer,  expressing  a  hope  that 
the  demand  for  these  will  be  too  small  to  encourage  the 
trade. 

We  have  perused  the  work  with  much  pleasure,  but  may 
be  allowed  to  suggest  that,  in  any  future  edition.  Dr. 
Tichborne,  of  whose  skill  as  an  analyst  we  have  a  high 
opinion,  might  with  profit  pay  more  attention  to  elegance 
of  style,  or  at  least  to  grammatical  correctness. 


Geschichte  der  epidemischen  Krankheiten.  Yon  Heinrich 
Haeser.  Dritte  Bearbeitung.  Jena  :  Yerlag  von  Gustav 
Fischer.  1882.  S.  995. 

A  History  of  Epidemic  Diseases.  By  Heinrich  Haeser. 
Third  Edition. 

This  history  forms  the  third  and  concluding  volume  of  the 
author’s  History  of  Medicine.  He  divides  the  work  into  three 
parts.  In  the  first,  the  Epidemics  of  Ancient  History,  in  the 
second,  those  of  the  Middle  Ages,  and  in  the  third,  those 
of  Modern  Times,  are  described.  The  last  period  occupies 
the  greater  part  of  the  work,  and  200  pages  suffice  for  the 
first  and  second  periods  in  consequence  of  the  compara¬ 
tively  scanty  records  of  the  epidemics  of  ancient  times.  In 
sacred  and  profane  literature  there  are  allusions  to  pesti¬ 
lences  which  were  regarded  as  Divine  punishments  for  the 
sins  of  the  people  or  their  rulers ;  but  before  the  time  of 
Thucydides  we  have  no  clear  description  of  any.  He  has 
given  a  full  account  of  the  plague  which  prevailed  in  Athens 
430  b.c.,  from  which  he  himself  suffered.  There  is,  however, 
much  difference  of  opinion  as  to  the  nature  of  the  disease. 
Scarlatina,  yellow  fever,  typhus,  the  plague,  and  small-pox, 
have  been  suggested  ;  but  Haeser  thinks  that  most  probably 
it  was  typhus.  Diodorus  Siculus  has  described  the  plague 
which  prevailed  in  the  Carthaginian  camp  before  Syracuse 
in  395  b.c.  In  this,  small-pox  and  typhus  appear  to  have 
been  the  prevalent  diseases.  The  antiquity  and  origin  of 
small-pox  have  been  the  subject  of  much  investigation,  and 
our  author  has  diligently  collated  the  opinions  which  have 
been  expressed,  and  the  evidence  on  which  they  are  based, 
with  the  result  that  no  positive  conclusion  can  be  formed 
on  the  subject.  The  first  part  of  the  work  concludes  with 
an  account  of  “the  plague  of  Justinian”  (531-580  a.d.), 
which  surpassed  all  that  preceded  it  in  virulence.  It  lasted 
with  some  remissions  for  fifty  years,  and  caused  such  fearful 
mortality  that  populous  cities  were  left  waste,  and  wild 
beasts  made  their  lair  where  human  beings  had  formerly 
dwelt.  There  were  probably  many  different  epidemics  during 
this  period  ;  but  the  plague  undoubtedly  predominated. 

In  the  middle  ages  Europe  was,  to  a  large  extent  covered 
with  forests  and  marshes;  the  towns  were  small,  and 
built  with  regard  to  defence  and  economy  of  space  rather 
than  sanitary  considerations.  These  conditions,  with  intra¬ 
mural  interment,  an  enforced  diet  of  salt  meat  without 
vegetables  during  the  winter,  and  constantly  recurring 
dearth  and  famine  arising  from  bad  tillage  and  imperfect 
communication,  were  very  favourable  to  disease.  Leprosy 
was  endemic,  small-pox,  scarlatina,  and  measles,  which 
were  classed  by  the  medical  skill  of  the  time  as  varieties 
of  the  same  disease,  were  very  prevalent ;  and  the  plague 
frequently  recurred.  Of  all  the  epidemics  of  this  period, 
the  black  death  was  the  most  formidable.  Commenc¬ 
ing  in  the  East,  it  spread  during  the  fourteenth  century 
over  the  then  known  world,  and  its  victims  have  been 
estimated  by  Hecker  at  25,000,000.  The  native  Irish 
escaped  its  ravages  to  a  great  extent,  but  their  exemption 
was  probably  due  to  their  isolation  on  the  hills  rather  than 
to  their  nationality.  But  little  is  known  of  the  nature  of 
this  epidemic,  notwithstanding  the  abundant  literature  on 
the  subject,  to  which  Boccaccio  and  Petrarch  (whose  Laura 
was  among  the  victims)  contributed.  Medical  treatment 
was  powerless  against  it,  and  the  people  in  despair  had  re¬ 
course  to  self-flagellation  and  persecution  of  the  Jews  as 
the  best  means,  in  their  opinion,  of  propitiating  the  Divine 
favour.  Of  the  part  of  this  work  devoted  by  the  author  to 
epidemics  of  modern  times,  syphilis  occupies  a  large  portion, 
although  its  most  virulent  period  certainly  belongs  to  the 
middle  ages.  There  is  the  usual  discussion  as  to  its  origin 
and  antiquity,  and  the  usual  result — complete  uncertainty. 


The  disease  was  formerly  known  by  many  names,  but  the 
most  usual  was  morbus  gallicus,  or  some  equivalent  transla¬ 
tion  thereof.  It  has  been  suggested  that  “  gallicus  ”  was 
not  originally  used  with  any  geographical  meaning,  but 
was  formed  from  “  gale,”  the  itch  ;  or  from  “  galle,”  an  oak- 
apple,  from  some  resemblance  in  certain  syphilitic  eruptions. 
Again,  there  is  an  old  Saxon  word,  “  gale,”  lasciviousness, 
which  would  be  an  appropriate  derivation.  If  this  be 
correct,  the  subsequent  geographical  application  of  the 
word,  from  an  etymological  blunder,  would  resemble  the 
clerical  (in  a  twofold  sense)  error  by  which  gonorrhoea  was 
for  a  time  transformed  into  gomorrhoea,  and  regarded  as  a 
legacy  bequeathed  to  posterity  by  the  inhabitants  of  the  Cities 
of  the  Plain.  Whatever  its  origin  or  antiquity  may  have  been, 
it  was  unquestionably  most  virulent  in  Europe  during  the 
fifteenth  and  sixteenth  centuries.  After  the  Crusades  the 
general  immorality  was  very  great,  and  the  clergy  seem  to 
have  been  especially  culpable.  Haeser  thinks  that  this  may 
have  been  partly  due  to  the  humoral  pathology  of  the  time, 
according  to  which  retention  of  the  seminal  fluid  was  con¬ 
sidered  dangerous  to  health  and  even  life.  Thus  in  the 
fourteenth  century  Magninus  wrote : — Periculum  est,  si  per 
coitum  non  expellatur  sperma,  quod  putrefit  et  ad  aliquid 
simile  veneno  convertetur,  et  caussabit  pessimas  aegritudines 
et  tandem  mortem  ”;  and  V alescus  of  Taranta,  in  reference  to 
the  clergy,  wrote,  “  Venerabiles  hoc  non  facient  causa  delec- 
tationis  sed  ut  superfiuitates  emittantur.”  In  consequence  of 
this  immorality  syphilis  pervaded  all  ranks  with  terrible 
results,  until  fear  produced  a  reformation  of  morals  which 
other  considerations  had  failed  to  effect.  Fashion,  as  well 
as  morality,  was  influenced  by  it,  if  it  be  correct  that  the 
customs  of  wearing  perukes  and  of  using  scents  were  adopted 
in  order  to  conceal  the  effects  of  this  disease.  In  the  sixteenth 
century  the  virulence  of  syphilis  considerably  diminished, 
probably  because  the  people  had  become  generally  syphilised. 
The  epidemics  of  the  nineteenth  century  compare  favourably 
with  those  of  former  times  as  regards  mortality.  Many 
causes  have  contributed  to  this — partly  improvement  in 
medical  diagnosis  and  treatment,  but  chiefly  better  drainage 
and  cultivation  of  the  soil,  and  greater  attention  to  hygienic 
conditions. 

This  volume  is  an  excellent  conclusion  to  a  valuable  and 
instructive  work,  and  the  author’s  diligence  in  compiling 
information  deserves  the  highest  praise.  One  point  is,  how¬ 
ever,  fairly  open  to  unfavourable  criticism.  Haeser  attributes 
great  influence  in  epidemics  to  atmospheric  conditions  due 
to  earthquakes  and  volcanic  eruptions.  Earlier  historians 
have  carefully  noted  that  outbreaks  of  pestilence  have  been 
accompanied  or  preceded  by  earthquakes,  etc.  When  pesti¬ 
lence  was  believed  to  be  of  supernatural  origin  this  associa¬ 
tion  of  ideas  was  intelligible.  Seismology  as  a  science  is  as 
yet  in  its  infancy.  But  modern  investigations  tend  to  prove 
that  any  connexion  between  such  natural  disturbances  and 
disease  is  as  void  of  foundation  as  was  the  influence  which 
comets  and  meteors  were  supposed  formerly  to  have  on 
famine  and  drought.  More  especially  the  researches  of 
Honiger  seem  to  clearly  prove  that  the  assumed  extraordinary 
atmospheric  conditions  did  not  prevail  in  the  pestilences  of 
former  times  to  the  extent  that  has  been  asserted,  and  that 
there  is  no  evidence  for  any  “  conspiracy  of  nature  with 
malevolent  elements  against  the  human  race.” 


Du  Diagnostic  de  VEctopie  Renale.  Par  le  Dr.  Fredk. 

Buret.  Paris :  aux  Bureaux  du  Prog  res  Medical,  et 

Delahaye  et  E.  Lecrosnier.  1883. 

To  make  known  the  various  symptoms  produced  by  a  dis¬ 
placed  kidney  is  the  object  of  the  pamphlet  before  us,  in 
which  the  author  discusses  the  differential  diagnosis  of  this 
affection  from  every  other  form  of  abdominal  tumour.  As 
he  very  justly  observes,  the  chief  object  in  recognising  the 
affection  is  not  so  much  to  attempt  to  cure  it,  as  that  we  may 
abstain  from  a  useless  if  not  positively  injurious  line  of 
treatment.  The  author  briefly  reports  fifty  cases  which  he 
has  been  able  to  collect,  many  of  them  illustrating  points  in 
diagnosis,  and  he  sums  up  the  results  of  his  labours  in  the 
following  conclusions : — 

1.  Displacement  of  the  kidney  is  relatively  a  tolerably 
common  malady. 

2.  It  s  apparent  rarity  is  owing  to  the  fact  that  its  existence 
is  not  always  recognised. 

3.  To  prevent  mistakes  in  diagnosis,  we  must  realise  the 


358 


Medical  T^mes  and  Gazette. 


GENERAL  CORRESPONDENCE. 


Sept.  22, 1883. 


possibility  that  the  kidney  may  be  displaced,  and  we  must 
be  quite  familiar  with  the  various  symptoms  which  this 
affection  may  present. 

4.  And  lastly,  in  any  doubtful  case,  we  must  limit  ourselves 
to  trying  to  relieve  the  sufferings  of  the  patient,  and  be 
especially  cautious  not  to  interfere  unless  the  diagnosis 
clearly  justifies  it,  ever  bearing  in  mind  the  old  adage,  which 
cannot  be  repeated  too  often,  “  Primo  non  nocere.” 


Manual  des  Injections  sous-cutandes.  Par  Bourneville  et 

Bricon.  Paris  :  Delahaye  et  Lecrosnier,  et  Librairie  du 

Progres  Medical.  1883. 

The  administration  of  drugs  by  the  hypodermic  method  is 
one  that  has  steadily  increased  in  favour  with  the  profession 
ever  since  its  first  introduction,  and  there  are  good  reasons 
why  this  should  be  so.  In  most  instances  we  can  be  certain 
by  this  method  of  promptly  producing  the  effect  which  we 
wish  to  secure — a  result  which  can  seldom  be  attained  satis¬ 
factorily  by  the  ordinary  administration  by  the  mouth.  It 
is  not  likely,  however,  that  the  latter  method  will  ever  be 
entirely  superseded  by  it — at  least  not  for  a  long  time  to 
come.  The  association  of  recovery  from  illness  (or  cure,  as 
they  would  put  it)  with  the  taking  of  physic  is  much  too 
firmly  engrafted  in  the  minds  of  the  public  to  be  easily  up¬ 
rooted  :  one  can  hardly  picture  to  oneself  an  out-patient 
coming  up  to  the  hospital  without  a  pint  bottle  sticking  out 
of  his  pocket. 

The  volume  before  us,  which  has  suggested  these  general 
reflections,  contains  in  the  introduction  a  description  of  the 
different  kinds  of  syringes  in  use,  and  of  the  mode  of  operation. 
The  remarks  about  the  necessity  of  determining  the  exact 
quantity  used  are  to  the  point,  and  the  suggestion  to  deter¬ 
mine  the  weight  of  the  quantity  injected,  and  thus  judge  of 
its  strength,  is  a  good  one.  We  should  have  hardly  thought  it 
necessary  to  give  a  caution  against  injecting  under  the  skin 
of  the  nose  or  eyelids ;  but  perhaps  they  do  things  differently 
on  the  other  side  of  the  Channel.  We  agree  with  the  authors 
as  to  the  importance  of  performing  the  injection  slowly.  The 
drugs  that  are  used  hypodermically  are  treated  of  in  alpha¬ 
betical  order,  the  best  modes  of  making  the  solution  are 
detailed,  and  an  account  added  of  the  physiological  and 
therapeutic  effects  of  each.  The  only  remarks  we  would 
offer  at  present  are  that  atropine  has  been  found  useful 
sometimes  in  diphtheritic  paralysis,  and  that  we  think  the 
dismissal  of  cod-liver  oil  in  a  single  line  rather  unjust, 
seeing  the  amount  of  space  given  to  quinine,  or  even  that 
allotted  to  distilled  water. 


The  Liverpool  Medico-Chirurgical  Journal,  No.  5,  July,  1883. 
This  number  contains  several  papers  of  great  merit.  The 
first,  on  infarctions  and  embolisms  of  various  organs,  by 
Professor  Hamilton,  is,  to  our  thinking,  the  most  im¬ 
portant.  The  object  of  his  paper  will  be  shown  by  the 
following  quotation,  where,  speaking  of  Cohnheim’s  work, 
he  says : — “  He  thus  arrives  at  the  conclusion  that,  as 
a  result  of  embolic  obstruction  of  the  splenic  or  renal 
artery,  a  mass  of  haemorrhage  takes  place  into  the  sub¬ 
stance  of  these  organs,  which  he  calls  a  haemorrhagic  in¬ 
farction  ;  and  further,  he  seems  to  think  that  these  wedge- 
shaped  masses  in  spleen  and  kidney  are  similar  in  their 
origin  to  the  ‘  haemorrhagic  infarction  ’  of  the  lung — 
viz.,  that  both  are  embolic.  I  may  simply  here  repeat 
what  I  have  previously  stated — that  I  have  never  seen  such 
a  haemorrhagic  infarction  from  uncomplicated  occlusion  of 
a  branch  of  the  splenic  or  renal  artery  as  he  describes; 
and  if  he  means  to  indicate  that  such  are  of  constant 
occurrence  in  embolic  occlusion  of  the  renal  artery,  I  must 
conclude  that  he  is  labouring  under  a  misapprehension. 
Such  a  body  as  he  describes  is  of  constant  occurrence  in  the 
lung  along  with  yelloiv  infarctions  in  the  spleen  and  kidney  ; 
the  morbid  process  in  the  second  and  last  organs  being,  as  I 
.shall  show,  of  quite  a  different  character  from  the  liasmor- 
rhagic  block  in  the  first.”  In  speaking  of  haemorrhagic 
infarction  of  the  lung,  he  says  he  has  never  been  able  to  dis¬ 
cover  the  occluded  branch  of  artery  leading  to  the  infarct, 
and  does  not  believe  that  anyone  else  has  succeeded  in  doing 
so.  We  read:  “  I  am  firmly  convinced  that  the  wedge- 
shaped  haemorrhages,  known  as  haemorrhagic  infarctions  of 
the  lung,  have,  as  a  rule,  nothing  to  do  with  embolism  of 
the  pulmonary  artery.  They  are  simply  pulmonary  apo¬ 
plexies  situated  at  the  periphery  of  the  lung,  and  moulded 


into  a  wedge-shape  by  the  shape  of  the  bronchus  and  air- 
vesicles  into  which  the  effused  blood  is  poured.”  We  fully 
expect  that  these  views  will  be  corroborated  by  future 
observers. 

Dr.  James  Barr  contributes  a  long  article  on  the  pathology 
and  treatment  of  tubal  nephritis,  evidently  the  outcome  of 
much  thought  and  careful  observation.  Dr.  Dyce  Duckworth 
has  a  paper  on  hemiglossitis.  Dr.  Carter  contributes  some 
notes  on  therapeutics,  and  Dr.  Oliver  pleads  in  favour  of  the 
reality  of  the  existence  of  reflex  paraplegia.  Dr.  Campbell 
gives  an  account  of  four  cases  of  prolapse  of  the  uterus 
treated  by  Alexander’s  operation,  and  Dr.  Rawdon  describes 
the  removal  by  abdominal  section  of  a  large  renal  tumour 
from  an  infant  aged  sixteen  months.  Mr.  Rushton  Parker 
contributes  some  remarks  on  imperforate  rectum,  with  two 
cases  successfully  treated.  Mr.  G.  A.  Woods  commences 
what  promises  to  be  a  valuable  communication  on  the 
anatomy,  etc.,  of  the  sixth  nerve. 

We  wish  to  protest,  in  conclusion,  in  the  strongest  manner 
possible,  against  the  very  objectionable  practice  of  insert¬ 
ing  advertisements  amongst  the  communications.  It  con¬ 
stitutes  a  blot  which,  being  quite  avoidable,  is  therefore 
quite  inexcusable. 


GENERAL  CORRESPONDENCE. 

- o- - 

METAPHYSICS  IN  PATHOLOGY. 

Letter  prom  Dr.  C.  Mercier. 

[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sir, — I  am  greatly  obliged  to  Mr.  Kenneth  Millican  for 
drawing  my  attention  to  his  paper  on  the  Etiology  of  the 
Acute  Specific  Diseases,  which  I  have  read  with  much 
interest.  In  that  paper  the  doctrine  of  the  origin  of 
species  by  evolution  is  definitely  applied  to  the  ease  of  the 
specific  diseases,  and  had  I  had  the  advantage  of  reading  it 
before  publishing  the  article  on  Metaphysics  in  Pathology 
I  should  certainly  have  credited  Mr.  Millican  with  the  views 
that  he  so  clearly  expresses.  I  am,  &c., 

September  5.  Charles  Mercier. 


TINNED  PROVISIONS. 


[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sir, — In  Cassell’s  Family  Magazine  for  September  there  is 
an  article  on  the  Rabbit  Pest  in  Australia.  There  is  one 
!  passage  in  it  which  appears  to  me  to  require  clearing  up  in 
the  interest  both  of  Australian  settlers  and  the  English 
public.  It  seems  that  the  enormous  loss  caused  by  the 
rabbit  plague  is  partly  compensated  by  the  export  of  the 
dead  animals  to  England  in  the  shape  of  food,  and  it  is 
stated  that  100,000  rabbits  were  sent  home  in  one  year  by 
the  New  Zealand  Meat  Preserving  Company.  But,  says  the 
author,  “  Eor  my  own  part  I  should  seriously  object  to  eating 
New  Zealand  rabbits,  considering  that  the  cure  now  in  vogue 
is  wholesale  poisoning  by  means  of  grain  saturated  with 
c  phosphorus.’  ” 

There  are  others  besides  the  author  who  would  like  to 
know  if  phosphorus  in  this  form  “  may  prove  beneficial  to 
human  beings.”  I  am,  &c.,  Caution. 


FISH  DIETARY. 

Letter  from  Mr.  W.  Trenerrv. 


[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sir, —  For  nearly  two  months  past  the  patients  of  the  Bristol 
Royal  Infirmary  have,  with  the  sanction  of  the  Faculty,  been 
given  a  “  fish  dinner  ”  once  a  week  as  an  experiment.  Up 
to  the  present  time  the  change  has  been  most  agreeable, 
satisfactory,  and  highly  appreciated  by  the  patients.  The 
saving  in  money  is  also  considerable — nearly  £4  daily  in 
favour  of  fish  as  against  butcher’s  meat. 

For  the  information  of  other  institutions,  I  should  like  to 
state  that  the  weight  of  fish  to  be  provided  should  be  twice 
that  of  meat — that  is  to  say,  should  the  diet  list  demand 
150  pounds  of  butcher’s  meat,  then  300  pounds  of  fish  should 
be  ordered.  We  find  that  the  change  gives  no  additional 
trouble  in  the  cooking  department — in  fact,  rather  the  re¬ 
verse.  I  am,  &c.,  W.  Trenerry,  Secretary. 

Bristol  Royal  Infirmary,  September  18. 


M 1  dical  Times  and  Gazette. 


MEDICAL  NEWS. 


Sept.  22,  1883.  359 


MEDICAL  NEWS. 

- ♦ - 

Apothecaries’  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday, 
September  13  : — 

Greenwood,  Cecil  Danforth,  Offerton-road,  Clapham. 

Honan,  Lynton  Michael,  Hieh-street,  Clapham. 

James,  Henry  Daniel,  Woodland-terrace,  Babbicombe,  S.  Devon. 

Passmore,  Geo.  Shapland,  North  Radnorthy,  North  Molton,  N.  Devon. 

Richards,  William,  Bath-row,  Birmingham. 

The  following  gentlemen  also  on  the  same  day  passed  their 
Primary  Professional  Examination  : — 

Dovaston,  Milward  Edward,  University  College  Hospital. 

Lewis,  Jenkyn,  London  Hospital. 

Vernon,  Frederick  William,  London  Hospital. 

At  the  Preliminary  Examination  in  Arts,  held  at  the  Hall 
of  the  Society,  on  September  13,  14,  and  15,  128  candidates 
presented  themselves;  of  whom  85  were  rejected,  and  the 
following  43  passed,  and  received  certificates  of  proficiency 
in  General  Education.  (Those  candidates  whose  names  are 
marked  with  an  asterisk  [#]  have  also  passed  in  Elementary 
Mechanics.)  In  the  First  Division,  none.  In  the  Second 
Division,  in  alphabetical  order,  viz. : — - 

*Edward  Buller  Allan,  Valentine  Evelyn  Barrow,  *Louis  Beckett, 
*Dabiel  Booth,  Ivan  John  Howard  Boyton,  *Graham  Wilmot  Brooke, 
*Frank  Calder,  Percy  Tranto  Carpenter,  William  Burwell  Darroll, 
Frederick  Arundel  Dene,  *George  Tolcher  Eccles,  *William  Henry 
Frederick  Godwin.  *Arthur  Stephen  Hanson,  Henry  Hamilton,  *William 
Edmund  Hardy,  Richard  McDonnell  Hawker,  *Geo.  Herbert  Humphreys, 
Smith  Cyril  Ireland,  Theophilus  Nicholas  Kelynack,  *Frederick  William 
Lewitt,  *Emest  Andrew  Long,  *Stouppe  McChance,  Matthew  Lovell 
Mackintosh,  *Edward  Charles  Mahany,  Charles  Reginald  Morley,  Horace 
Young  Nutt,  John  Griffiths  Owen,  *Kilham  Roberts,  Cyril  Walrond  Shaw, 
Alexander  Sharman,  Gilbert  Arthur  Sumner,  *Jenan  George  Thomas, 
Nigel  Alan  Allison  Trenow,  *Basil  Riddell  Trevelyan,  *  Arthur  Turner, 
*Charles  Stuart  Vines,  *Charles  Frederick  Myers  Ward,  William  Timmins 
Ward,  *John  Houghton  White,  John  James  Winn. 

The  following  passed  in  Elementary  Mechanics  alone  :  — 

Edwin  Thomas  Larkam,  Henry  Nichol,  Reginald  Field  Walker. 


DEATHS. 

Bertier,  Dr.  Francis,  at  Aix-les-Bains,  on  September  8,  aged  36. 

Browne,  Charles  Frederick,  M.R.C.S.,  late  of  Tulse  Hill,  London,  at 
Ships ton-on-Stour,  Worcestershire,  on  September  6,  aged  72. 

Clouston,  Charles  Stewart,  M.D.,  of  Gunnersbury,  London,  W.,  at 
Sandwick  Manse,  Orkney,  on  September  16. 

Footman,  John,  M.D.,  on  September  9,  aged  51. 

Hardy,  Frederic,  M.D.,  of  Southport,  at  Rock  House,  Pembrey,  South 
Wales,  on  September  5,  aged  77. 

Hodgson,  Frketh  Foster,  M.R.C.S.,  at  St.  Bartholomew’s  Hospital,  on 
September  7,  aged  31. 

Iles,  Francis  Henry  Wilson,  M.D.,  at  Watford,  Herts,  on  September 
18,  aged  48. 

Martin,  John,  M.R.C.S.,  at  Oxford,  on  September  7,  aged  82. 

Merry,  Robert  Rosier,  M.R.C.S.,  L.R.C.P.,  atMarlowes,  Hemel  Hemp¬ 
stead,  on  September  4,  aged  43. 

Ridoct,  Charles  Lyon,  Staff-Surgeon  of  H.M.S.  Tourmaline,  at  Mauritius, 
on  August  24,  in  his  38th  year. 

Satchell,  William  Carrol,  M.R.C.S.,  -late  of  Tunbridge  Wells,  at 
Hastings,  on  September  10. 

Twining,  Frank  Theed,  M.A.,  M.B.,  at  the  Eastern  District  Hospital, 
on  September  14. 


VACANCIES. 

In  the  following  list  the  nature  of  the  office  vacant,  the  qualifications  re¬ 
quired  in  the  candidate,  the  person  Co  whom  application  should  be  made 
and  the  day  of  election  (as  far  as  known)  are  stated  in  succession. 

Queen’s  College,  Belfast. — Professor  of  Anatomy  and  Physiology. 
(for  particulars  see  Advertisement.) 

Royal  Hospital  for  Diseases  of  the  Chest,  City-road,  E.C.— Assistant - 
Physician,  etc.  (For  particulars  see  Advertisement.) 

Royal  London  Ophthalmic  Hospital,  Blomfield-street,  Moorfiblds, 
E.C. — House-Surgeon.  (For  particulars  see  Advertisement.) 

St.  George’s,  Hanover-square,  Provident  Dispensary,  59,  Mount- 
street,  W.  —  Resident  Medical  Officer.  Salary  and  allowance  last  year 
£212  2s.  9d.  Candidates  must  be  doubly  qualified,  and  duly  registered 
under  the  Medical  Acc,  and  about  thirty  yews  old.  Unmarried  candi¬ 
dates  preferred.  Applications  and  testimonials  as  to  character,  etc.,  to 
be  sent  to  the  Secretary,  G.  H.  Leah,  jun.,  73,  Park-street,  W.  (from 
whom  all  further  particulars  may  be  obtained),  not  later  than  Sept.  29. 

St.  Peter's  Hospital  for  Stone  and  Urinary  Diseases,  etc., 
Henrietta-street,  Covent-gahden,  W.C. — House-Surgeon.  Honora¬ 
rium  twenty-five  guineas  ;  board,  lodging,  and  washing.  The  appoint¬ 
ment  is  for  six  months.  Candidates  must  be  M.R.C.S.,  and  have  held 
the  position  of  house-surgeon  at  a  public  institution.  Applications, 
with  testimonials,  to  be  sent  to  the  Secretary,  Walter  E.  Scott,  on  or 
before  September  25. 


UNION  AND  PAROCHIAL  MEDICAL  SERVICE. 

***  The  area  of  each  district  is  stated  in  acres.  The  population  is 
computed  according  to  the  census  of  1881. 

RESIGNATIONS. 

Bingham  Union. — Mr.  Charles  Rowland  has  resigned  the  Workhouse : 
salary  £30  per  annum. 

Birkenhead  Union.— The  offices  of  Medical  Officer  for  the  Second  District, 
the  Workhouse,  and  the  Schools  at  Tranmere  are  vacant  by  the  death  of 
Dr.  W.  G.  Laidlow  :  area  1139 ;  population  34,882 ;  salary  £100  per 
annum;  salary  for  Workhouse  £50  per  annum;  salary  for  Schools  £20 
per  annum. 

Oatherington  Union. — The  office  of  Medical  Officer  for  the  Union  is 
vacant  by  the  death  of  Mr.  R.  Wellings:  area  12,901;  population  2769; 
salary  £60  per  annum. 

Crediton  Union. — Mr.  A.  M.  Bredon  has  resigned  the  Cheriton  Fitzpaiue 
District:  area  10,980;  population  1478 ;  salary  £45  per  annum. 

Ellesmere  Union. — Mr.  Edward  Sandford  has  resigned  the  Middle 
District:  area  7584 ;  population  1245  ;  salary  £22  10s.  per  annum. 

Pontardawe  Union. — Mr.  Thomas  Morgan  Andrews  has  resigned  the 
Workhouse:  salary  £15  per  annum. 

Woodstock  Union.— Mr.  Frederick  Taylor  has  resigned  the  Woodstock 
No.  2  District  and  the  Workhouse:  area  10,758;  salary  £52  10s.  per 
annum ;  salary  for  Workhouse  £35  per  annum. 

APPOINTMENTS. 

Abingdon  Union.— Sidney  A.  Hayman,  M.R.C.S.  Eng.,  L.R.C.P.  Lon3., 
to  the  First  District. 

Bodmin.— John  J.  Beringer,  F.C.S.,  an  Analyst  for  the  Borough. 

Bridlington  Union.— Donald  Morison,  B.M.  and  M.C.  Glasg.,  to  the 
Fourth  District. 

Gockermouth  Union. — Isaac  C.  Hodgson,  M.B.  and  C.M.  Glasg.,  to  the 
Workington  District. 

Crediton  Union.—  Charles  H.  Hay  croft,  M.R.C.S.  Eng.,  L.S.A.,  to  the 
Coldridge  District. 

Greenwich  Union. — Jas.  Dixon,  L.R.C.S.  Ire.,  L.A.H.  Dub.,  as  Assistant 
Medical  Officer  and  Dispenser  of  Medicines  at  the  Infirmary  and  the 
Workhouse. 


The  Dublin  Artisans’  Dwellings  Company. — The 
fourteenth  ordinary  general  meeting  of  this  Company  was 
held  on  Monday,  the  10th  inst.  The  report  showed  that  the 
entire  revenue  of  the  Company  for  the  half-year  ending 
June  30,  1883,  amounted  to  £3354  4s.  7d.,  which,  after  pro¬ 
viding  for  all  expenses,  leaves  a  balance  of  £1580  13s.,  out 
of  which  the  directors  recommend  a  dividend  at  the  rate  of 
4  per  cent,  per  annum,  absorbing  £1319  7s.,  and  leaving  a 
balance  of  £261  6s.,  which  they  recommend  should  be 
carried  to  the  reserve  fund.  The  buildings  of  the  Company 
now  accommodate  536  families,  with  2500  inhabitants. 
There  bad  been  28  deaths,  being  at  the  rate  of  23  per  1000 
per  annum  as  compared  with  35  per  1000,  the  average  over 
the  whole  city.  There  were  13  deaths  of  children  under  five 
years  of  age  — a  class  which  forms  one -fifth  of  the  entire 
population.  The  mortality  of  that  class  in  the  city  and 
suburbs  was  87  per  1000,  while  in  their  houses  it  was  only 
49  per  1000.  The  report  was  unanimously  adopted. 

Professor  Virchow  and  the  “  Swiss  Pill.” — Prof. 
Virchow  has  fallen  under  the  displeasure  of  the  Congress 
of  German  Physicians,  a  society  which  meets  annually  to 
take  cognisance  of  medical  ethics  and  allied  matters.  He 
has  been  charged  with  giving  a  testimonial  to  a  secret 
remedy — the  pilules  Helveticce  of  a  Dr.  Brandt,  of  Schaff- 
hausen ;  and  doubtless  many  of  our  readers  have  themselves 
received  the  laudatory  notices  which  accompany  these 
famous  pills,  the  distribution  of  which  has  not  been  limited. 
Virchow,  in  a  letter  to  the  Berliner  Klin.  Wochen.,  marvels 
at  the  amount  of  displeasure  which  he  has  apparently 
incurred.  He  says  that  he  received  some  of  the  pills  last 
winter,  with  a  letter  from  Dr.  Brandt  asking  him  to  give 
them  a  trial.  Some  time  afterwards  came  another  appeal, 
and,  being  in  need  of  such  a  remedy,  he  tried  their  effect 
upon  himself.  The  result  was  so  satisfactory  that  he  penned 
a  few  lines  to  the  inventor,  which  the  latter  published 
without  Virchow’s  sanction — pleased,  no  doubt,  when  such 
testimony  came  from  so  high  a  quarter.  From  that  time 
Virchow  has  had  no  peace  —letters  and  circulars,  signed  and 
unsigned,  have  been  addressed  to  him,  complaining  that  he 
was  violating  the  ethical  law  in  giving  a  testimonial  to  a 
secret  remedy;  and  this  has  culminated  in  the  remonstrance 
addressed  by  the  Chairman  of  the  Committee  of  the  Aerzte- 
vereinsbund.  The  Committee  also  produced  an  official 
analysis  of  the  pills,  which,  however,  only  went  to  show  that, 
their  composition  was  nothing  very  extraordinary.  Virchow 
denies  that  he  ever  gave  a  testimonial  at  any  time  for  these 
or  any  other  pills.  He  withdraws  from  the  Bund,  and 
appeals  from  its  arbitrary  action  to  his  medical  brethren  at 
large  to  pass  a  judgment  free  from  the  paltry  and  narrow 
trades-unionism  which  characterises  this  act. — New  York 
Med.  Record,  August  4.  [We  doubt  whether  the  Professor’s 


360 


Medical  Times  and  Gazette. 


VITAL  STATISTICS. 


Sept.  22,  1883. 


appeal  will  be  responded  to.  When  will  the  great  ones  of 
the  earth  learn  that  their  names  and  reputations  are  too 
sacred  a  possession  to  be  lightly  put  at  the  disposal  of 
mercantile  adventurers  ?] 

Aberdeen  Eoyal  Infirmary  and  Lunatic  Asylum. 
— A  quarterly  meeting  of  the  managers  of  this  institution 
was  held  on  Monday,  in  the  Infirmary  Hall,  under  the 
presidency  of  the  Lord  Provost,  when  a  number  of  subscrip¬ 
tions  were  intimated,  including  one  of  ,£1000  from  Dr. 
Francis  Edmond.  In  reference  to  the  sum  of  <£2068  be¬ 
queathed  by  the  late  Miss  Allan,  of  Potterton,  for  the  ex¬ 
tension  of  the  Infirmary  buildings,  the  Provost  remarked 
that  they  were  all  alive  to  the  great  good  that  was  being 
done  in  the  community  by  the  institution;  but,  like  other 
institutions,  the  circumstances  outgrew  the  accommodation, 
and  it  would  be  necessary  at  an  early  date,  no  doubt,  to  re¬ 
organise  the  Infirmary  in  accordance  with  the  most  recent 
discoveries  in  science,  and  the  best  arrangement  of  such  in¬ 
stitutions  in  regard  to  the  treatment  of  the  sick.  It  is  most 
encouraging  to  find  that  they  have  in  hand  £3000  for  en¬ 
largement  and  improvement ;  and  when  the  time  comes,  the 
charity  and  benevolence  of  those  who  take  great  interest  in 
such  institutions  will  be  equal  to  the  occasion.  At  the  same 
meeting.  Dr.  Thomas  Collins,  of  Elgin,  was  appointed  Super¬ 
intendent  of  the  institution.  There  were  no  fewer  than 
seventeen  candidates  for  the  vacant  office. 

Sugar  as  an  Antiseptic  Dressing. — Dr.  Fischer 
states  that  Prof.  Lucke,  of  Strasburg  (Centralblatt  f.  Chir., 
August  25),  has  since  May  last  been  making  trials  of  sugar 
as  a  pulveriform  antiseptic.  He  has  used  it  mixed  with 
equal  parts  of  naphthaline  or  with  a  fifth  part  of  iodoform, 
enclosing  it  in  gauze  bags,  which  are  fixed  over  the  wound 
after  the  application  of  sutures.  When  the  skin  is  defective, 
the  sugar  is  strewed  over  the  wounded  surface.  The  wound 
has  been  disinfected  during  the  operation  by  means  of  a  1  per 
cent,  sublimate  solution.  The  dressing  may  remain  on  the 
part  from  a  week  to  a  fortnight,  until  the  sugar  becomes 
dissolved,  the  secretions  from  the  wound  diffusing  themselves 
equally  throughout  the  sugar.  If,  however,  the  sugar  is  applied 
too  thickly  ( i.e .,  more  than  half  a  centimetre)  it  forms  into 
lumps.  The  wounds  thrive  under  the  sugar,  the  dressing 
emitting  no  bad  smell  nor  exhibiting  bacteria.  The  granu¬ 
lations  are  well  developed,  having  no  inclination  to  bleed, 
and  cicatrisation  proceeds  rapidly.  In  wounds  united  by 
suture,  primary  union  has  always  been  obtained.  The  ex¬ 
perience  thus  far  gained  justifies  the  recommendation  of 
further  trials  of  a  remedy  so  easy  to  obtain. 


APPOINTMENTS  FOE  THE  WEEK. 


September  22.  . Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  1J  p.m. ;  King’s  College,  1£  p.m. ;  Royal 
Free,  2  p.m.;  Royal  London  Ophthalmic,  11  a.m. ;  Royal  Westminster 
Ophthalmic,  11  p.m. ;  St.  Thomas's,  11  p.m.;  London,  2  p.m. 


24.  Monday. 

Operations  at  the  Metropolitan  Eree,  2  p.m.;  St.  Mark’s  Hospital  for 
Diseases  of  the  Rectum.  2  p.m.;  Royal  London  Ophthalmic,  11  a.m.; 
Royal  Westminster  Ophthalmic,  11  p.m. ;  Hospital  for  Women,  2  p.m. 


25.  Tuesday. 

Operations  at  Guy’s,  11  p.m. ;  Westminster,  2  p.m. ;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  11  p.m.  ;  West 
London,  3  p.m. 


26.  Wednesday. 

Operations  at  University  College,  2  p.m. ;  St.  Mary’s,  If  p.m. ;  Middlesex, 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew’s,  11  p.m.  ;  Great  Northern, 

2  p.m.;  Samaritan,  21  p.m.;  Royal  London  Ophthalmic,  11  a.m.; 
Royal  Westminster  Ophthalmic,  11  p.m. ;  St.  Thomas’s,  11  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m. ;  National  Orthopaedic,  Great 
Portland-street,  10  a.m. 


27.  Thursday. 

Operations  at  St.  George’s,  1  p.m. ;  Central  London  Ophthalmic,  1  p.m. ; 
Royal  Orthopaedic,  2  p.m.;  University  College,  2  p.m.;  Royal  London 
Ophthalmic, 11  a.m. ;  Royal  Westminster  Ophthalmic,  11p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m. ;  Hospital  for  Women,  2  p.m. ; 
Charing-cross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  21  p.m. 


28.  Friday. 

Oparaiiorasat  Central  London  Ophthalmic,  2  p.m.;  Royal  London  Ophthal¬ 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminster 
Ophthalmic,  11  p.m.;  St.  George’s  (ophthalmic  operations),  If  p.m.; 
Guy’s,  14  p.m. ;  St. Thomas’s  (ophthalmic  operations),  2  p.m. ;  King’s 
College  (by  Mr.  Lister),  2  p.m. 


VITAL  STATISTICS  OF  LONDON. 

Week  ending  Saturday,  September  15,  1883. 

BIRTHS. 

Births  of  Boys,  1256;  Girls,  1232;  Total,  2488. 

Corrected  weekly  average  in  the  10  years  1873-82,  258P6. 

DEATHS. 


Males. 

Females. 

Total. 

Deaths  during  the  week . 

661 

599 

1260 

Weekly  average  of  the  ten  years  1873-82, 1 
corrected  to  increased  population  ...  ) 

711-4 

669-3 

1380-7 

Deaths  of  people  aged  80  and  upwards 

... 

... 

35 

DEATHS  IN  SUB-DISTRICTS  FROM  EPIDEMICS. 


Enumerated 

Population, 

1881 

(unrevised). 

Small-pox. 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

1 

a* . 

.9  £i 

o  p 

O  o 

rCl  O 

Typhus. 

Enteric  (or 

Typhoid) 

Fever. 

Simple 

continued 

Fever. 

Diarrhoea.  1 

West . 

669633 

5 

6 

3 

6 

1 

4 

North 

905947 

X 

5 

8 

5 

7 

20 

15 

Central  ... 

282238 

1 

2 

2 

2 

t 

3 

East . 

692738 

5 

21 

6 

2 

... 

4 

15 

South . 

1265927 

... 

8 

13 

5 

13 

... 

4 

... 

25 

Total . 

3816483 

1 

24 

48 

21 

30 

... 

31 

... 

62 

METEOROLOGY. 


From  Observations  at  the  Greenwich  Observatory. 


Mean  height  of  barometer 

Mean  temperature  . 

Highest  point  of  thermometer 
Lowest  point  of  thermometer 
Mean  dew-point  temperature 
General  direction  of  wind 
Whole  amount  of  rain  in  the  week 


29"900  in. 
57-8° 

73'1° 

41'6° 

54'2° 

Variable. 
1'52  in. 


BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  the 
Week  ending  Saturday,  Sept.  15,  in  the  following  large  Towns : — 


I 

Cities 

and 

Boroughs. 

Estimated  Population  to 
middle  of  the  year  1883. 

]  Births  Registered  during 
|  the  week  ending  Sept.  15. 

|  Deaths  Registered  during 

the  week  ending  Sept.  15. 

Annual  Rate  of 
Mortality  per  1000  living, 
from  all  causes. 

Temperature 
of  Air  (Fahr.) 

Temp, 
of  Air 
(Cent.) 

Rain 

FaU. 

Highest  during 
the  Week. 

Lowest  during 
the  Week. 

Weekly  Mean  of 
Daily  MeanValues 

Weekly  Mean  of 
Daily  Mean 
Values. 

In  Inches. 

In  Centimetres. 

London 

3955814 

2488 

1260 

166 

73-1 

41-6 

57-8 

14-34 

1-52 

3-86 

Brighton  ... 

... 

111262 

66 

48 

22-5 

70'0 

45-S 

57-7 

14-28 

0-94 

239 

Portsmouth 

... 

131478 

80 

54 

21-4 

4, 

Norwich 

... 

89612 

66 

35 

20-4 

Plymouth  ... 

... 

74977 

51 

27 

18-8 

66-1 

42  5 

55-1 

1284 

0-74 

1-88 

Bristol . 

... 

212779 

140 

57 

14-0 

66-4 

46-0 

56'2 

13-44 

1-06 

269 

Wolverhampton . 

77557 

47 

33 

222 

65-4 

37-4 

53-8 

12-12 

1-08 

2  74 

Birmingham 

... 

414846 

259 

169 

213 

... 

... 

... 

Leicester  ... 

129483 

85 

47 

18-9 

68-5 

42-0 

56-2 

1344 

0-95 

2-41 

Nottingham 

... 

199349 

144 

65 

170 

69-5 

38-6 

55-3 

12-95 

0-94 

2-39 

Derby . 

... 

85574 

71 

24 

14-6 

-ft 

Birkenhead 

... 

88700 

64 

35 

20-6 

Liverpool  ... 

... 

566753 

377 

268 

24-7 

68-1 

48-0 

56-o:  13-33 

0-3S 

0-97 

Bolton . 

... 

107862 

64 

36 

174 

67-9 

4P6 

54-4 

1244 

0-67 

1-70 

Manchester 

... 

339262 

252 

175 

26-9 

... 

Salford 

... 

190465 

128 

95 

26-0 

Oldham 

119071 

90 

44 

19-3 

.  .  . 

Blackburn  ... 

... 

108460 

75 

52 

25  0 

... 

Preston 

98564 

72 

42 

22-2 

67-C 

50-0 

56-5 

1361 

0-23 

0-58 

Huddersfield 

84701 

44 

3S 

23-4 

Halifax 

75591 

41 

24 

16-6 

Bradford  ... 

... 

204807 

121 

52 

13-2 

66-7 

441 

54-9 

1272 

0-75 

1-90 

Leeds  . 

321611 

199 

150 

24-3 

68-0 

45-0 

55-9 

13-28 

0-41 

1-04 

Sheffield 

... 

295497 

211 

12S 

22-8 

67-0 

43-0 

55-2 

1289 

0-94 

2'39 

Hull  . 

176296 

121 

61 

181 

67-0 

40-0 

556 

13-12 

1-38 

351 

Sunderland 

121117 

98 

62 

26-7 

6S-0 

47-0 

53-2 

11-78 

0-85 

216 

Newcastle  ... 

149464 

92 

67 

23-4 

Cardiff . 

... 

90033 

71 

35 

203 

... 

... 

... 

... 

... 

... 

For  28  towns 

... 

8620975 

5617 

3184 

19-3 

73-1 

37-4 

55-6 

13-12 

0-86 

2-18 

Edinburgh  ... 

235946 

123 

62 

13-7 

Glasgow 

... 

515589 

358 

243 

246 

64-0 

35-0 

53-6 

1201 

0-46 

1-17 

Dublin . 

... 

349685 

170 

184 

27-5 

64-6 

35-0 

51-7 

10-95 

0-02 

0-05 

At  the  Eoyal  Observatory,  Greenwich,  the  mean  reading 
of  the  barometer  last  week,  was  29'90  in. ;  the  lowest  reading 
was  29-75  in.  on  Monday  afternoon,  and  the  highest  30’09  in. 
on  Thursday  morning. 


Medical  T  mes  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES. 


Sept.  22, 1883.  361 


NOTES,  QUERIES,  AND  REPLIES. 

- .> - 

De  qurstioneQ  rntujj  sfeall  learn  nwlj. — Bacon. 


The  Closing  of  Hospitals  for  Cleaning ,  etc. — A  working-man’s  letter  calls 
the  attention  of  the  managers  of  oar  metropolitan  hospitals  to  what 
he  considers  “  an  unfair  and  most  uncharitable  custom,”  namely, 
closing  the  accident  wards  whilst  the  building  is  being  cleansed,  painted, 
etc.  A  case,  he  says,  occurred  some  days  previously,  of  a  poor  young 
man,  a  stonemason,  employed  on  a  high  building  near  the  Northumber- 
land-avenue,  Charing-cross,  falling  from  a  scaffold.  He  was  at  once 
taken  to  the  Charing-cross  Hospital,  but  on  application  for  admission 
his  comrades  were  informed  the  Hospital  was  closed.  He  was  forth¬ 
with  conveyed  to  King’s  College  Hospital,  which,  fortunately,  was  not 
closed  against  such  cases.  He  protests  against  any  hospital  being 
entirely  shut  against  cases  of  accident  during  the  time  of  cleansing,  etc., 
and  concludes :  “  I  earnestly  appeal  to  all  who,  like  myself,  have 
willingly  contributed  my  donation  to  the  Sunday,  as  also  to  the  Satur¬ 
day,  Hospital  Funds,  that  they  should  do  all  in  their  power  to  urge  upon 
our  hospital  authorities  that  no  cases  of  accident  should  be  excluded  at 
any  time.” 

Hospital  for  Poor  Italians  in  London.— The  Chevalier  Ortelli,  of  Hatton- 
garden,  has  generously  provided  a  hospital  for  the  poorer  Italians  of  the 
metropolis.  The  Chevalier  has  purchased  a  commodious  house  in 
Queen-square,  Bloomsbury,  has  adapted  it  for  a  hospital,  furnished  it 
with  every  necessary  for  the  sick,  and  presented  it  for  the  benefit  of  his 
poor  fellow-countrymen  in  London.  The  hospital  is  open  for  the  recep¬ 
tion  of  patients. 

Tobacco  and  Snuff  for  Workhouse  Paupers. — A  letter  from  the  Local 
Government  Board,  approving  of  the  auditor’s  surcharging  the  cost  of 
tobacco  and  snuff,  given  out  to  the  inmates  without  direct  orders  from 
the  medical  officer,  was  the  subject  of  some  discussion  at  the  last  meet¬ 
ing  of  the  Liverpool  Workhouse  Committee.  The  Committee  took  ex¬ 
ception  to  this  sanctioning  of  the  surcharge,  and  instructed  their  clerk 
to  prepare  a  statement  in  reply,  to  be  forwarded  to  the  central 
authority. 

Taken  to  Task. — “It  seems,”  says  a  contemporary,  “  to  be  the  function  of 
certain  medical  journals  to  try  and  frighten  people  who  are  so  unwise 
as  to  pin  their  faith  on  the  dicta  which  they  enunciate  every  week. 
Regularly,  as  Saturday  comes  round,  we  are  favoured  with  a  great  deal 
of  what  looks,  at  first  sight,  like  sage  advice— regarding  the  risk  we  run 
from  this  danger,  or  from  that.  Now  it  is  drains  which  are  to  decimate 
the  foolish  ones,  who  decline  to  have  them  inspected  by  a  fussy  personage, 
whose  aim  it  is  to  impress  us  with  a  sense  of  his  importance,  by  turning 
everything  upside  down  and  converting  the  entire  neighbourhood  into 
a  particularly  odorous  locality.  Then  it’s  the  water-supply,  etc.”  The 
writer  adds,  “  What  we  object  to  is  the  fussiness  of  those  who,  by  terri¬ 
fying  timid  folk,  conduce  to  the  very  mischief  it  is  their  ostensible  aim 
to  avoid.” 

Penalties  for  Selling  Adulterated  Spirits,  Australia. — For  the  first  offence  a 
fine  of  £25  is  imposed  ;  for  the  second,  £50  ;  and  then  imprisonment. 

An  Inquest  Incident. — When  the  jury  were  about  to  be  sworn  on  an  in¬ 
quest  held  at  the  “Lord  Clyde,”  Wotton-road,  Deptford,  Mr.  Carttar, 
the  West  Kent  Coroner,  opened  the  book  which  was  supplied  by  the 
landlord  of  the  house  for  the  purpose  of  administering  the  oath  to  the 
jurymen,  and  found  it  to  be  a  copy  of  “  Tristram  Shandy.”  After  some 
delay  the  New  Testament  was  forthcoming. 

The  Grand  Junction  Canal. — The  condition  of  this  canal,  particularly  in 
relation  to  its  effect  upon  the  health  of  the  patients  in  the  adjacent  St. 
Mary’s  Hospital,  is  receiving,  not  too  soon,  necessary  attention.  When 
the  basin  near  the  Hospital  was  recently  being  “  cleaned,”  and  the  water 
run  off,  Mr.  St.  George  Mivart  experienced  an  abominable  stench,  and 
found  the  corridors  and  wards  of  the  Hospital  impregnated  with  the 
same  nauseous  odour.  The  officials  state  that  a  similar  offensive  smell 
is  of  frequent  occurrence,  especially  at  night,  though  not  so  bad  as  in 
the  instance  in  question.  The  Medical  Superintendent,  Dr.  Stewart 
Brown,  found  that  during  the  two  or  three  days  following  this  “  clean¬ 
ing”  several  cases  of  tonsillitis  occurred  among  the  patients  in  the 
Hospital,  while  one  poor  woman,  who  had  undergone  a  serious  surgical 
operation,  and  had  been  making  favourable  progress  for  upwards  of 
a  week,  had  since  shown  symptoms  of  blood-poisoning,  and  had  been 
in  serious  danger  of  her  life. 

Physical  Effects  of  the  Ischia  Earthquake  on  Survivors. — Professor  E.  Fazio 
has  been  making  notes  in  Ischia  as  to  the  impressions,  etc.,  made  upon 
the  victims  before  and  after  the  calamity.  He  has  ascertained  that  in 
general  those  who  were  excavated  alive  were  stupefied,  their  organic 
functions  paralysed,  their  sight  weakened  or  altogether  suspended  for 
some  time;  most  had  felt  extreme  thirst  while  under  the  masonry, 
but  all  asserted  that  they  had  never  lost  the  hope  of  being  saved. 

Damp  Houses.— A  correspondent  asks:  “If  dampness  is  the  sole  cause 
of  the  unhealthiness  of  new  houses,  why  are  not  tents  unhealthy  in  wet 
weather  l  I  have,”  he  adds,  “  seen  a  good  deal  of  tent  life,  and 
always  found  it  agree  with  me.” 


Making  the  Best  of  the  Animal. — A  publican  of  Calverton,  Bucks,  was 
charged  before  the  Northampton  Bench  with  exposing  beef  for  sale  unfit 
for  human  food,  at  Cottonend.  The  animal,  which  belonged  to  the 
Duke  of  Grafton,  went  mad,  and  his  Grace’s  steward  ordered  defen¬ 
dant  to  kill  it,  and  make  the  best  of  the  carcase.  He  brought  it  to 
Northampton  and  sold  it  for  five  guineas.  The  sentence  of  the  Bench 
was  one  month’s  imprisonment  without  the  option  of  a  fine,  and  an 
order  to  pay  £3  2s.  6d.  costs. 

Dr.  Thompson,  Liverpool.— He  was  a  great  political  writer,  as  was  the 
celebrated  Dr.  Shebbeare,  who  was  condemned  to  stand  in  the  pillory 
at  Charing-cross  for  publishing  “  An  Eighth  Letter  to  the  People  oS 
England.” 

J.  Tremearne,  Esq.,  Creswick,  Victoria,  Australia.— 'Letter  and  enclosure 
received  with  thanks. 

The  Relation  of  the  Teeth  to  the  Brain.  —  The  recent  discussion  in  the  French 
medical  journals  on  the  relation  of  the  teeth  to  the  brain,  and  their 
conclusions,  are  of  importance  to  all  brain  workers.  Dr.  Championniere 
recommends  that  parents  and  guardians  should  pay  close  attention  to 
the  condition  of  the  teeth  of  those  under  their  care,  and  should,  when 
any  signs  of  premature  decay  are  noticeable,  give  their  charges  a  holiday. 

Champagne  or  Claret  ? — The  circumstance  about  which  you  inquire  occurred 
as  long  ago  as  1652.  Mr.  Vizetelly  informs  us  in  his  work  on  Cham¬ 
pagne,  that  a  young  medical  student  in  France,  at  a  loss  for  a  subject 
for  his  inaugural  thesis,  advanced  the  bold  theory  that  the  wines  of 
Burgundy  were  preferable  to  those  of  Champagne,  the  latter  being  irri¬ 
tating  to  the  nerves  and  conducive  to  gout.  The  Faculty  of  Medicine  at 
Rheims  were,  of  course,  at  once  in  arms  in  defence  of  their  local  crd,  and 
many  learned.disquisitions  did  they  publish,  setting  forth  the  wonderful 
purity  and  other  merits  of  the  wines  of  Sillery,  Rheims,  and  Epernay. 
The  dispute  assumed  a  very  excited  form.  The  entire  medical  profes¬ 
sion  took  part  in  it ;  and  it  continued  down  to  1778,  when  the  Faculty  of 
Paris  put  an  end  to  the  discussion  by  giving  a  formal  verdict  in  favour 
of  the  wines  of  Champagne . 

Narrow  Escapes.— The  published  report  of  a  benevolent  society  says :  ‘  ‘  Not 
withstanding  the  large  amount  paid  for  medicine  and  medical  attend¬ 
ance,  very  few  deaths  occurred  during  the  year.” 

The  Stratford-on-Avon  Infirmary. — From  the  last  annual  report  it  appears 
that  the  regulations  requiring  each  in-patient  to  pay  a  registration  fee- 
of  two  shillings  upon  admission,  and  each  out-patient  one  shilling  on 
presentation  of  ticket,  had  worked  very  satisfactorily,  and  the  funds 
of  the  charity  had  been  increased  in  consequence. 

A  District  Auditor  s  Officiousness. — The  district  auditor  has  made  various-- 
surcharges  on  members  of  public  bodies  in  Kent,  several  of  which  have 
been  reversed  by  the  Local  Government  Board.  He  recently  surcharged 
three  town  councillors  of  Faversham  with  the  sum  of  £8  6s.  9d.,  on  the 
ground  that  their  payment  of  that  sum  for  expenses  incurred  by  the 
medical  officer  in  the  purchase  of  a  disinfecting  apparatus  for  public 
purposes  was  not  a  legal  expenditure. 

A  Sanitary  Medical  Organisation,  New  York. — This  organisation  is  com¬ 
posed  of  fifty  physicians,  whose  duty  it  is  during  the  hottest  weather  to- 
make  a  house-to-house  visitation  of  all  the  tenement-houses  in  the  city. 
It  is  stated  that  this  work  has  been  in  operation  for  several  years,  and 
has  had  good  results — it  has  lowered  the  death-rate,  and  improved  the 
sanitary  condition  of  these  (the  most  crowded)  districts.  Dr.  Jones,  the- 
Assistant  Sanitary  Superintendent,  says,  in  his  report  of  last  summer’s 
operations:  “It  is  the  general  belief  that  a  gradual  improvement  is 
being  made  in  the  sanitary  condition  of  the  premises  visited,  as  evidenced 
by  less  sickness  and  fewer  violations  of  sanitary  law.  The  apparent 
result  of  several  years’  experience  is  that  this  service  becomes  year  by 
year  more  popular ;  visits  are  received  with  increasing  confidence  and 
interest,  and  the  advice  given  carefully  followed.” 

Protest  against  the  Site  of  a  Temporary  Hospital  for  Small-pox  Patients. 
This  hospital,  for  the  reception  of  patients  from  the  Aston  district, 
Birmingham,  which  has  been  in  course  of  construction  at  the  corner  of 
Rocky-lane  and  Chester-street,  has  evoked  a  protest  at  two  public- 
meetings  in  respect  to  its  site ;  and  resolutions  have  been  passed  that 
the  attention  of  the  Local  Government  Board  should  be  called  to  the 
matter. 

The  late  Dr.  Bertier.—  Touching  the  death  of  Dr.  Bertier  fils,  at  the  early 
age  of  thirty-seven  years,  a  correspondent  at  Aix-les-Bains  states : 
“  The  deceased  was  much  appreciated  by  the  numerous  English  visiting 
the  place  for  the  baths,  and  was  well  known  in  England  by  many  patients 
who  had  been  treated  by  him,  and  to  whom  he  was  recommended  as 
much  by  his  kindly  social  qualities  as  by  his  medical  knowledge.” 

London  Children  Suffocated.— Dr.  G.  Danford  Thomas,  Coroner  for  Central 
Middlesex,  in  addressing  the  jury  at  an  inquest  on  the  body  of  a  child 
sixteen  weeks  old,  found  dead  in  bed  by  the  side  of  its  parents,  said 
that  every  year  he  held  over  120  inquests  on  children  who  had  died  under 
similar  circumstances  from  suffocation. 

A  House-hunter.— We  believe  a  book,  “  Hints  to  House-hunters  and  House¬ 
holders,”  will  give  you  the  information  you  require.  It  is  published  by 
Messrs.  Batsford,  of  High  Holborn. 


362 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES. 


fiept.  *2,  1883. 


The  Wolverhampton  and  Staffordshire  Hospital. — At  the  half-yearly  meeting 
of  the  Board  the  chairman  announced  the  receipt  of  a  donation  of  £1000 
from  Mr.  J.  E.  Briscoe,  to  provide  homes  for  persons  connected  with  the 
institution.  An  invitation  to  inspect  the  Briscoe  Home  for  Nurses, 
which  is  admirably  fitted  Up  for  the  sleeping  accommodation  of  twelve 
of  the  staff,  was  accepted. 

From  the  Time  of  the  Norman  Conquest." — The  Totnes  Rural  Sanitary 
Authority  having  had  their  attention  drawn  to  the  very  insanitary  state 
of  Stoke  Gabriel,  Dr.  Cape,  Medical  Officer  of  Health,  admitted  that 
Stoke  Gabriel  was  in  a  bad  sanitary  condition.  It  was  saturated  with 
sewage,  in  consequence  of  the  filthy  habits  of  the  people  from  the  time 
of  the  Norman  Conquest  down  to  the  present.  This  remark  was  met 
with  a  smile,  but  what  caused  it  is  left  to  conjecture.  However,  the 
matter  was  referred  to  a  committee  for  consideration  and  report. 

The  Ballot  in  the  Election  of  Local  Boards. — Mr.  Rylands,  M.P.,  will  move 
next  session — “  That,  in  the  opinion  of  this  House,  it  is  desirable  that 
provision  should  be  made,  at  the  earliest  practicable  period,  for  the 
adoption  of  the  ballot  in  the  election  of  local  boards,  town  improvement 
commissioners,  and  boards  of  guardians.” 

Publicans’  Responsibilities. — At  Stockton,  the  licensing  justices  have  warned 
the  holders  of  licences  that  they  are  bound  to  supply  tea  and  coffee  and 
solid  refreshments  when  they  are  asked  for.  “  The  word  victual,”  said 
the  Chairman  of  the  Bench,  “  means  food,  and  not  merely  beer  and 
spirits,  which  to  some  persons  are  nothing  less  than  poisons.” 

Pauper s’  Snuff:  An  Alternative. — The  medical  officer  reported  at  the  last 
meeting  of  the  South  Dublin  Union  Guardians  that  he  had  directed  that 
eight  pounds  of  snuff  should  be  served  out  to  the  inmates.  A  guardian 
thereupon  observed  that  he  was  glad  of  this,  because  the  old  women  took 
ashes  when  they  could  not  get  snuff,  and  the  old  men  ground  up  stones 
and  mixed  them  with  clay  for  the  same  purpose,  both  of  which  injured 
their  health. 

Unhealthy  Houses:  An  Owner  within  the  Meaning  of  the  Act. — By  order  of 
the  Hampstead  Vestry,  two  summonses  were  taken  out  at  the  police- 
court  against  Enoch  Maggs,  for  allowing  a  nuisance  injurious  to  health 
to  exist  on  premises  Nos.  8  and  9,  Goldsmith’s-place,  Kilburn.  The 
premises  were  in  a  very  foul  and  filthy  condition,  and  in  bad  repair 
through  his  default  as  “  owner.”  An  order  to  repair  and  improve  five 
other  houses  in  Goldsmith’s-place,  which  were  in  a  similar  insanitary 
state,  was  made  on  the  defendant  a  fortnight  previously,  and  was  being 
complied  with.  The  defendant  in  the  present  case  again  ass  erted  that 
he  was  not  the  “owner,”  and  handed  a  letter  to  the  Bench  from  another 
agent  of  the  property.  The'sanitary  inspector  proved  the  unhealthi¬ 
ness  of  the  houses  in  question,  observing  that  the  defendant  was  the 
“  owner  ”  within  the  meaning  of  the  Act,  as  he  received  the  rents,  and 
he  (the  inspector)  asked  for  an  order  to  be  made  on  the  defendant  to 
do  the  work  that  was  necessary.  The  order  was  granted— the  work  to 
be  completed  within  one  month. 

■Shameless  Quacks. — Two  men,  named  respectively  ‘Wallace  and  Clark,  have 
been  brought  up  at  the  Lerwick  Sheriff  Court,  charged  with  contraven¬ 
ing  the  Medical  Act  by  assuming  the  title  of  “  doctors.”  The  accused 
had  publicly  announced  that  Drs.  Wallace  and  Clark  would  deliver 
lectures  at  the  Lerwick  Market  Cross,  and  had  there,  after  lecturing  on 
diseases  of  the  human  body,  prescribed  and  furnished  medicines  for 
them.  When  lecturing,  Wallace  stated  that  he  had  been  surgeon  on 
board  Her  Majesty’s  ship  Lincoln,  and  that  he  had  stood  close  to  the 
University  gates  in  Edinburgh,  vending  his  medicines,  with  the  consent 
of  certain  professors,  whose  names  he  gave  as  a  guarantee  of  his  pro¬ 
fessional  standing.  The  Sheriff  characterised  the  accused  as  two  of  the 
most  impudent  quacks  he  had  ever  come  across,  and  sentenced  Wallace 
to  a  fine  of  £5  and  36s.  costs  ;  but,  as  Clark  was  only  a  subordinate,  he 
found  the  charge  against  him  not  proven. 

Meat  for  Paupers. — This  question  has  been  the  subject  of  discussion  by 
the  Guardians  of  the  City  of  London  Union.  The  master  of  the  Bow 
Workhouse  complained  that  the  contractor  had  sent  in  four  carcases  of 
sheep  that  had  been  frozen  and  were  in  a  bad  condition,  and  con¬ 
sequently  he  sent  them  back,  charging  the  difference  in  the  price  to  the 
contractor’s  account.  The  alleged  bad  condition  of  the  meat  was  not 
substantiated,  and  the  Board  generally  approved  of  frozen  meat  as  an 
article  of  diet.  It  was  stated  that  the  foreign  frozen  meat  was  not  only 
good,  but  commanded  a  very  extensive  sale  among  the  well-to-do 
classes.  The  Board  decided  that  American-killed  beef  and  Australian 
mutton  may  be  included  in  the  supply  to  the  workhouse.  The 
Guardians  obtain  these  meat-supplies  for  their  paupers  at  7d.  per  lb. 
There  is  no  doubt  these  importations  from  abroad  have  the  effect  of 
very  considerably  reducing  the  market  prices  of  meat,  and  that  the 
food  is  both  wholesome  and  nourishing. 

A  Chinaman  and  Chinese  Women  Doctors. — Mr.  Tong  Sing,  a  Chinese 
gentleman,  has  sent  £10  to  the  London  School  of  Medicine  for  Women. 
He  says  it  would  be  a  blessing  if  Chinese  ladies  were  taught  medicine. 

H.  It.,  Hemel  Hempstead. — The  late  Dr.  Robert  Willis,  the  biographer  of 
William  Harvey,  was  the  first  librarian  of  the  Royal  College  of  Sur¬ 
geons.  He  was  for  some  time  editor  of  the  London  Medical  Gazel 
many  years  past  incorporated  in  this  journal. 


A  Female  Guardian  on  Workhouse  Fish  Dinners, — On  the  motion  coming 
on  for  discussion  at  the  Paddicgton  Board  of  Guardians,  last  meeting, 
that  the  inmates  of  the  workhouse  be  supplied  with  a  fish  dinner  once  a 
week,  Mrs.  Charles  said  that  fish  was  not  fit  food  for  paupers,  because  it 
was  brain  food  containing  phosphorus,  which  was  excellent  for  brain 
workers.  Paupers  did  not  require  it,  as  they  did  not  use  their  brains. 
The  motion  was,  however,  we  are  glad  to  say,  carried,  notwithstanding 
the  lady’s  opinion. 

The  Removal  of  House  Refuse:  An  Experiment. -The  Sub-Committee 
appointed  by  the  Poplar  District  Board  of  Works  to  consider  the  col¬ 
lection  of  dust,  etc.,  and  to  supply  receptacles  for  it,  reported  that  they 
had  resolved  to  recommend  that  one  thousand  houses  in  a  block  in  each 
parish  be  supplied  with  dust-pails,  as  an  experiment,  and  that  the 
receptacles  be  emptied  twice  in  each  week.  The  recommendation  was 
adopted. 

COMMUNICATIONS  have  been  received  from — 

The  Treasurer  of  Guy’s  Hospital,  London;  Dr.  Henry  W.  Williams, 
Boston,  U.S.A. ;  The  Secretary  of  the  Apothecaries’  Society, 
London;  Dr.  Henry  Sutherland,  London;  Mr.  J.  T.  W.  Bacot, 
Seaton;  Dr.  C.  Mercier,  Dartford ;  Dr.  B.  Nicholson,  South  Norwood; 
Mr.  T.  M.  Stone,  London;  Dr.  Norman  Chevers,  London;  Dr.  G.  E. 
Herman,  London ;  Mr.  J.  Chatto,  London ;  Mr.  R.  Parker,  Liverpool ; 
Mr.  R.  J.  W.  Oswald,  London  ;  The  Secretary  of  the  Sanitary 
Institute  of  Great  Britain,  London  ;  Messrs.  Powell  Brothers, 
Leeds ;  Dr.  Bushell  Anningson,  Cambridge ;  Dr.  Kelly,  London ; 
Dr.  Warne,  London;  Dr.  Workman,  Toronto:  Dr.  A.  T.  Thomson, 
Glasgow;  Dr.  J.  W.  Moore,  Dublin  ;  The  Secretary  of  the  Bristol 
Royal  Infirmary,  Bristol ;  Mr.  Munro  Scott,  London ;  Professor 
Attfield,  London;  Mr.  W.  Watson  Cheyne,  London:  Dr.  Crichton 
Browne,  London :  Mr.  T.  V.  Lister,  London  ;  Mr.  T.  H.  Killick, 
Hungerford;  Dr.  R.  Norris  Wolfendf.n,  Southport;  The  Registrar- 
General  for  Scotland,  Edinburgh;  Dr.  H.  Donkin,  London;  The 
Secretary  of  St.  Thomas’s  Hospital,  London. 

BOOKS.  ETC.,  RECEIVED  - 

Report  on  the  Sanitary  Condition  of  the  Parish  of  St.  Mary,  Islington , 
for  1882 — Notes  on  Books,  by  Messrs.  Longmans  and  Co.— Remarks  on 
Hydrophobia,  by  Charles  W.  Dulles,  M.D.  -  Medical  Communications 
of  the  Massachusetts  Medical  Society,  vol.  xiii.,  No.  11,  1882 — Bulletins 
et  Mdmoires  de  la  Societe  Medicale  des  Hopitaux  de  Paris— Insanity, 
by  E.  C.  Spitzka,  M.D. —Diseases  of  the  Ear.  by  O.  D.  Pomeroy,  M.D. 
— Sexual  Impotence  in  the  Male,  by  W.  A.  Hammond,  M.D. —Syphilis 
and  the  Genito-Urinary  Diseases,  by  E.  N.  Otis,  M.D. — Annual  Report 
of  the  Colony  of  Mauritius  Lunatic  Asylum  for  1882  — Healthy  Brain 
and  Mental  Development  in  an  Infant,  by  P.  Warner,  M.D.,  M.R.C.P. 
— A  Method  and  Apparatus  for  obtaining  Graphic  Records  of  various 
kinds  of  Movements,  etc.,  by  E.  Warner,  M.D.  -  Annual  Report  of  the 
Urban  Sanitary  District  of  Featherstone  for  1882— Asiatic  Cholera,  by 
Charles  Moore  Jessop,  M.R.C.P.— Artificial  Infant  Alimentation,  by 
Hugh  Hamilton,  M.D.  (University  of  Pennsylvania) —Tenth  Annual 
Report  of  the  Gloucestershire  Combined  Sanitary  District  for  the  Year 
1882— Ueber  die  Drehung  des  Vorderarms,  von  Prof.  Dr.  Jacob  Heiberg 
— Du  Traitement  des  Maladies  Tropioales  dans  les  Climats  TetnpSres, 
par  Sir  Joseph  Fayrer,  M.D.,  etc.,  et  Joseph  Ewart.  M.D.,  E.R.C.P. — 
On  Shock,  by  W.  H.  Meyers,  M.D.,  Fort  Wayne — Preservation  de  la 
Syphilis  par  la  Vaccine,  etc.,  par  le  Docteur  W.  H.  Van  der  Heijden— 
Report  on  the  London  Water  Supply— Engineering  Education  at  Home 
and  Abroad,  by  Edward  Mitchell  —  Transactions  of  the  Medical  Society 
of  the  State  of  Pennsylvania— Phthisis,  by  John  Parkin,  M.D  —Club 
Foot,  by  De  Forest  Willard,  M.D. — Transactions  of  the  College  of 
Physicians,  Philadelphia —Transactions  of  the  Academy  of  Medicine  in 
Ireland— Ambulance  Service  in  Philadelphia,  by  De  Forest  Willard, 
M.D. — Congenital  Phimosis,  by  De  Forest  Willard,  M.D. 

PERIODICALS  AND  NEWSPAPERS  RECEIVED  — 

Lancet— British  Medical  Journal — Medical  Press  and  Circular — Ber¬ 
liner  Klinische  Wochensohrift— Centralblatt  fiir  Chirurgie — Gazette 
des  Hopitaux — Gazette  Medicale— Revista  de  Medicina — Bulletin  de 
1’AcaddmiedeMfidecine— Pharmaceutical  Journal — Wiener  Medicinische 
Wochensehrift — Revue  Mddicale— Gazette  Hebdomadaire— Nature — 
Boston  Medical  and  Surgical  Journal— Louisville  Medical  News— 
Centralblatt  fiir  Gynakologie — Le  Concours  Medical— Centralblatt  fur 
die  Medicinischen  Wissenschaften— Centralblatt  fiir  Klinische  Medicin 
— Philadelphia  Medical  News— Le  Progres  Medical — Bible  Light— 
Philadelphia  Medical  Times  -  Students’  Journal  and  Hospital  Gazette — 
Weekblad — Denver  Medical  Times— Popular  Science  News  and  Boston 
Journal  qf  Chemistry — Revista  Medico-Quirurgica  — New  York  Medical 
Journal — Physician  and  Surgeon— Maryland  Medical  Journal,  August 
25  and  September  1 — New  York  Medical  Record— Journal  of  Cutaneous 
and  Venereal  Diseases— Archives  de  Neurologie— Chemist  and  Druggist 
— Western  Medical  Reporter —  Detroit  Lancet— Journal  of  the  Vigilance 
Association— Journal  of  the  British  Dental  Association— Journal  of 
Nervous  and  Mental  Disease— Canada  Lancet  — Canadian  Practitioner — 
American  Journal  of  Obstetrics— Therapeutic  Gazette— Practitioner — 
Analyst. 


Inhalation  of  Oxygen  in  Poisoning  by  Illumi¬ 
nating  Gas. — Dr.  Alonzo  Clark  related  two  cases  to  the 
New  York  Medical  and  Surgical  Society  (New  Yorlc  Medical 
Journal,  August  11),  which  he  believes  to  be  the  first 
examples  of  poisoning  by  gas  being  treated  by  inhalation 
of  oxygen.  A  woman,  forty  years  of  age,  and  her  daughter, 
aged  twelve,  slept  in  a  room  filled  with  the  fumes  of  escaping 
gas,  and,  after  being  exposed  to  these  during  fifteen  hours, 
were  found  in  a  state  o'f  insensibility.  They  were  brought 
to  the  hospital  in  an  unconscious  and  exhausted  state,  but 
after  inhalation  of  oxygen  had  been  administered  during 
three  hours,  consciousness  returned,  and  both  eventually 
^recovered. 


Medical  Times  and  Gazette. 


POWER  ON  THE  LACRIMAL  APPARATUS  OP  THE  EYE. 


Sept.  29,  1883.  3  6  3 


LEC  TU  RES 

ON 

THE  PEOTECTIVE  AND  LACRIMAL 
APPARATUS  OF  THE  EYE. 

Delivered  at  the  Royal  College  of  Surgeons. 

By  [HENRY  POWER,  M.B.  Bond.,  F.R.C.S.  Eng., 

Arris  and.  Gale  Lecturer  at  the  College  ;  Senior  Ophthalmic  Surgeon,  and 
Lecturer  on  Ophthalmic  Surgery,  St.  Bartholomew’s  Hospital. 


Lecture  II. 

lN|the  great  majority  of  Mammals  the  surface  of  the  eye 
is  kept  bright  and  polished  by  the  play  in  a  vertical  direc¬ 
tion  of  two  eyelids,  both  of  which  are  movable,  both  of 
which  contain  muscular  fibres,  and  the  movements  of  which 
are  facilitated  by  the  secretion  of  a  lacrimal  gland.  Like 
Birds,  they  have  an  additional  means  of  protection  provided 
for  these  organs,  in  the  form  of  a  third  eyelid,  or  membrana 
nictitans,  which  has  its  own  gland,  named  the  Harderian 
gland,  connected  with  it,  and  which  sweeps  across  the 
cornea  in  a  horizontal  direction  beneath  the  other  two. 

In  Man  and  many  of  the  higher  Quadrumana  the  mem¬ 
brana  nictitans,  perhaps  correlatively  with  the  development 
of  the  fore-limb  as  an  organ  of  protection,  becomes  reduced 
to  a  mere  rudiment,  the  plica  semilunaris  ;  and  the  Harderian 
gland  altogether  disappears. 

The  Eyelids,  to  the  description  of  which  a  whole  lecture 
might  easily  be  devoted,  may  be  regarded  as  two  folds  of  skin, 
the  inner  surfaces  of  which  are  lined  by  mucous  membrane. 
Between  the  skin  and  the  mucous  membrane  is  a  web  of 
connective  tissue,  with  a  layer  of  pale  and  delicate  muscular 
fibres. 

Without  entering  into  minute  details,  these  parts  maybe 
briefly  described.  The  skin  is  fine  and  soft,  loosely  connected 
with  the  subjacent  parts,  transversely  wrinkled,  provided  with 
hairs  of  a  pubescent  character,  sebaceous  and  sweat  glands. 
The  deeper  parts  even  in  Man  contain  pigment  cells,  espe¬ 
cially  abundant  in  dark-complexioned  individuals.  Beneath 
the  skin  is  loose  connective  tissue,  the  meshes  of  which  becom¬ 
ing  filled  with  effusion  accounts  for  the  swelling  in  various 
inflammatory  affections. 

The  muscular  fibres  of  the  orbicularis,  to  which  I  shall 
have  occasion  to  revert,  occupy  the  middle  part  of  the  section 
of  the  lid,  and  are  composed  of  many  fasciculi,  which  run 
transversely.  One  particular  fasciculus,  situated  near  the 
free  border  of  the  lid,  has  received  the  name  of  the  muscle 
-of  Riolanus. 

Beneath  the  muscular  layer  is  a  thin  layer  of  loose  con¬ 
nective  tissue  which  intervenes  between  it  and  the  proper 
foundation  of  the  lid,  named  the  tarsus,  or  improperly  the 
tarsal  cartilage.  This  lamina  is  composed  of  a  dense  and 
homogeneous  layer  of  connective  tissue.  Posteriorly,  the 
tarsus  of  the  upper  lid  has  inserted  into  it  the  tendinous 
fibres  of  the  levator  palpebrse  muscle ;  anteriorly,  the  tarsus 
terminates  insensibly  in  the  connective  tissue  of  the  free 
border  of  the  lid.  It  is  separated  from  the  conjunctiva  by 
-a  fine  band  of  fibres. 

In  both  lids  some  muscular  fibres  of  the  unstriated  kind 
extend  from  the  conjunctival  retrotarsal  fold  to  the  upper 
and  lower,  or  rather  to  the  posterior,  margins  of  the  tarsal 
cartilages. 

The  glands  associated  with  the  eyelids  are,  according 
to  Waldeyer — (1)  the  Meibomian  glands ;  (2)  the  normal 
sudoriparous  glands;  (3)  the  modified  sudoriparous  glands 
of  the  free  border  and  of  the  lacrimal  caruncle  or  glands  of 
Moll;  (4)  the  tubular  glands  of  the  conjunctiva;  (5)  the 
acino-tubular  glands  of  Krause;  and  (6)  the  glands  of  Manz. 

Besides  ordinary  sudoriparous  glands  distributed  over  the 
surface  of  the  lid,  Waldeyer  has  described  some  specially 
modified  sudoriparous  glands  which  he  has  seen  on  the  free 
border  of  the  lid  and  on  the  caruncle.  Each  opens  into  the 
mouth  of  a  sebaceous  follicle  between  the  opening  of  the 
Meibomian  follicles  and  the  point  of  implantation  of  the 
•cilia,  and  when  traced  back  forms  a  long  and  sinuous  cul-de- 
sac,  lined  by  a  single  layer  of  columnar  cells,  and  containing 
finely  granular  substance  and  spherical  corpuscles  analogous 
to  a  drop  of  albumen. 

You.  II.  1883.  No.  1735. 


The  glands  of  Manz  are  described  as  consisting  in  Man 
and  Animals  of  a  small  sac  having  a  fine  aperture,  with 
epithelial  cells,  free  nuclei,  small  round  cellules,  and  some 
detritus.  Waldeyer  (a)  is,  however,  inclined  to  regard  them 
as  accidental  productions  composed  of  paquets  of  epithelial 
cells  in  a  plexus  of  connective  tissue  analogous  to  the  tartric 
glands  of  the  gums,  and  which  are  occasionally  met  with 
in  the  skin. 

The  acino-tubular  glands  of  Krause  are  found  in  the  retro¬ 
tarsal  fold  of  the  conjunctiva, chiefly  near  its  nasal  part ;  but 
also  on  and  in  the  substance  of  the  tarsus.  Krause  usually 
counted  sixteen  to  eighteen,  though  once  as  many  as  forty- 
two,  in  the  upper  lid,  and  from  six  to  eight  in  the  lower  lid. 
The  tubuli  of  these  glands,  as  well  as  their  terminalvesicles, 
are  large,  and  are  filled  with  tolerably  clear  epithelium. 

The  Meibomian  follicles  are  glands  that  especially  belong 
to  Mammals.  They  are  not  found  in  Fishes,  Reptiles,  or 
Birds.  Their  absence  in  Birds  is  somewhat  remarkable. 
The  vigilance  of  these  animals  is  almost  proverbial,  and  it 
might  have  been  anticipated  that  the  oily  secretion  produced 
by  these  glands,  the  object  of  which  seems  to  be  to  prevent 
adhesion  of  the  lids  during  sleep,  would  have  been  found 
in  them. 

The  Meibomian  glands  may  be  regarded  as  composed  of 
an  excretory  duct,  around  which  are  disposed,  in  whorls,  not 
primary  tubes  as  in  the  Harderian  gland  of  Birds,  but  true 
acini.  The  epithelium  of  the  duct  is  arranged  in  a  triple 
layer,  the  middle  layer  of  cells  being  very  distinctly  ribbed. 
The  internal  surface  of  the  acini  is  lined  by  cubical  epi¬ 
thelium,  which  towards  the  lumen  of  the  tube  passes  into 
the  sebaceous  mass.  This  mass  appears  to  be  formed  by  the 
fatty  degeneration  of  the  cells.  It  is  doubtful  whether  the 
acini  have  a  membrana  propria.  The  general  arrangement 
of  the  parts  is  very  similar  in  Animals,  the  chief  differences 
being  in  the  amount  of  connective  tissue  between  the  acini. 

The  use  of  the  Meibomian  glands  is  clearly  to  prevent 
adhesion  of  the  lids  during  sleep,  and  to  prevent  the  flow 
of  the  tears  over  the  cheek. 

The  best  description  of  the  Lacrimal  gland  in  Man  that 
has  been  given  is  by  Sappey,  whose  account  I  shall  follow, 
and  whose  illustrations  are  excellent. 

The  position  of  the  gland  in  Man,  as  in  most  Animals,  is 
at  the  upper  and  outer  or  posterior  part  of  the  globe  of  the 
eye — a  position  that,  on  the  doctrine  of  evolution,  it  might 
almost  have  been  predicted  that  it  would  occupy,  because 
the  discharge  of  its  secretion  in  the  form  of  tears  would  here 
act  to  the  greatest  advantage  in  carrying  away  foreign 
bodies  that  may  have  accidentally  entered  between  the  lids. 

In  Man  it  consists  of  two  portions,  differing  considerably 
in  their  form  and  situation,  though  they  are  continuous 
with  each  other  and  secrete  the  same  kind  of  fluid.  The 
upper  or  orbital  portion,  sometimes  called  the  glandula 
lacrimalis  superior,  or  G.  innominata  of  Galen,  is  familiar  to 
everyone ;  whilst  the  inferior,  palpebral  portion,  or  G.  congre- 
gata  Monroi,  is  less  generally  known.  They  are  separated 
from  each  other  by  a  fibrous  lamina.  The  orbital  portion 
of  the  gland  is  an  ovoid  mass,  the  long  axis  of  which  is 
directed  downwards  and  outwards.  It  is  of  firm  con¬ 
sistence,  and  occupies  the  fossa  at  the  outer  and  anterior 
part  of  the  orbit,  just  within  the  external  orbital  process. 
Its  external  convex  surface  is  in  contact  with  the  periosteum 
of  the  bone,  to  which  it  is  adherent  by  tolerably  strong 
fibro-cellular  bands.  The  inferior  surface  is  smooth  and 
slightly  concave,  and  rests  on  the  levator  palpebrse  and  ex¬ 
ternal  rectus  muscles.  The  lacrimal  nerve  and  artery  enter 
at  the  posterior  margin.  The  anterior  border  is  parallel  to 
the  margin  of  the  orbit,  beneath  which  it  may  be  sometimes 
felt.  This  margin  may  be  seen  on  division  of  the  broad  liga¬ 
ment.  The  upper  or  internal  extremity  corresponds  to 
the  elevator  of  the  lid,  and  the  inferior  or  outer  extremity 
to  the  middle  portion  of  the  external  rectus. 

The  inferior  accessory  or  palpebral  portion  of  the  gland  is 
flattened  and  irregularly  quadrilateral.  It  is  covered  through¬ 
out  its  whole  extent  by  the  orbito-palpebral  muscle,  which 
separates  it  from  the  anterior  border  of  the  orbital  portion, 
so  that,  when  looked  at  from  above  and  in  front,  the  two 
portions  of  the  gland  are  separated  by  a  deep  fissure.  The 
under  surface  of  the  palpebral  portion  rests  on  the  external 
rectus  and  on  the  conjunctiva.  Posteriorly  it  is  continuous 
with  the  orbital  portion  of  the  gland.  Its  anterior  border  is 


(a)  Page  19,  Wecker  and  Landolt, 


Medical  Times  and  Gazette. 


POWER  OjST  THE  LACRIMAL  APPARATUS  OF  THE  EYE. 


Sept.  29, 1883. 


364 


parallel  to  the  attached  border  of  the  upper  tarsal  cartilage, 
from  which  it  is  separated  by  an  interval  of  a  sixth  of  an 
inch.  The  upper  and  lower  borders  are  irregular  in  outline, 
and  a  few  detached  lobules  may  sometimes  be  seen  resting 
on  the  outer  surface  of  the  inferior  tarsal  cartilage,  and 
opening  by  a  common  duct  on  the  inner  surface  of  the  lower 
lid  immediately  below  the  external  angle  of  the  lid. 

Excretory  Ducts. — Much  difference  of  opinion  has  existed 
in  regard  to  the  number,  and  indeed  in  regard  to  the  very 
existence,  of  excretory  ducts.  Haller  and  the  anatomists 
who  preceded  him— such,  for  example,  as  Zinn,  Santorini, 
and  Morgagni — were  unable  to  inject  them  ;  and  the  credit  of 
being  the  first  to  effect  this  is  given  to  Monro,  who,  in  175S, 
injected  two.  Subsequently,  Hunter,  Scarpa,  and  many 
others  were  equally  successful,  though  their  accounts  want 
precision.  The  points  to  be  determined  are,  what  ducts 
belong  to  the  principal  gland,  which  to  the  accessory  gland, 
what  course  do  they  pursue,  and  what  relation  have  they  to 
each  other  ?  M.  Gosselin,  in  1843,  was  the  first  to  resolve 
these  points.  He  found  that  the  orbital  portion  possesses  two 
excretory  canals,  whilst  the  palpebral  portion  has  six  or 
eight,  all  of  which  run  independently,  and  open  separately 
on  the  conjunctiva. 

Sappey,  in  1853,  demonstrated  to  the  Societe  de  Biologie 
that  the  number  of  ducts  belonging  to  the  orbital  portion 
varies  from  three  to  five.  They  commence  in  the  substance 
of  the  gland  from  each  of  the  glandular  grains  by  as  many 
fine  branches,  which  converge,  unite,  and  form  trunklets, 
and  finally  a  main  trunk.  The  main  trunks  run  towards 
the  concave  surface  of  the  gland,  and  pass  from  this  face 
towards  its  anterior  border.  Having  arrived  at  this  plane, 
they  penetrate  the  palpebral  portion,  running  from  behind 
forwards,  and  open  four  or  five  millimetres  above  the  tarsal 
cartilage  of  the  upper  lid  in  front  of  the  angle  of  reflection 
of  the  conjunctiva.  The  lowest  of  these  orifices  is  situated 
at  the  level  of  the  horizontal  diameter  of  the  globe  of  the 
eye,  immediately  behind  the  external  angle  of  the  eyelids  ; 
and  as  the  conjunctiva  is  tense  and  adherent  at  this  spot,  it 
is  not  in  general  difficult,  though  the  orifice  is  invisible,  to 
introduce  the  point  of  a  fine  injection-tube.  The  openings 
of  the  other  ducts  are  placed  at  distances  of  about  three 
millimetres  from  each  other,  forming  a  curved  line,  the 
concavity  of  which  looks  downwards. 

All  these  ducts  are  parallel,  rectilinear,  and  very  uniform 
in  diameter.  They  do  not  anastomose,  and  have  a  thickness 
varying  from  a  third  to  half  a  millimetre  when  injected  with 
mercury. 

In  regard  to  the  ducts  of  the  palpebral  portion,  it  may  be 
noted  that  this  portion  of  the  gland  consists  of  a  variable 
number  of  lobules,  sometimes  of  fifteen  to  twenty  only,  whilst 
in  some  subjects  as  many  as  thirty,  thirty-five,  or  forty 
may  be  counted.  From  each  of  these  a  small  duct  arises, 
but  these  do  not  open  directly  and  separately  on  the  con¬ 
junctiva  ;  they  open  into  the  excretory  ducts  of  the  orbital 
portion,  on  which  they  are  disposed  like  the  barbs  of  a  pen 
on  the  quill.  When  the  lobules  which  form  the  palpebral  por¬ 
tion  of  the  gland  are  very  numerous,  some  are  found  to  be 
placed  outside  the  course  run  by  these  canals.  These,  of  course, 
are  at  the  margins  of  the  main  group.  The  small  ducts 
emanating  from  these  behave  in  the  following  manner : — the 
posterior  ones  unite  and  form  a  small  trunklet,  which  is  di¬ 
rected  towards  the  conjunctiva  in  a  direction  parallel  to  the 
ducts  of  the  orbital  portion.  Into  this  trunklet  all  the  ducts 
of  the  neighbouring  lobules  discharge  themselves,  so  that  it 
gradually  increases  in  size,  and  ultimately  does  not  differ 
from  that  of  the  principal  ducts  in  any  sensible  degree.  Near 
the  upper  border  of  the  palpebral  portion  two  of  these 
accessory  ducts  may  in  general  be  observed.  At  the  lower 
border  often  one  only  is  visible,  and  even  this  may  be  absent. 
The  openings  of  the  excretory  ducts  of  the  lacrimal  gland 
are  very  easily  demonstrated  in  the  Calf,  and  also  in  the 
Sheep,  in  which  animal  there  are  only  two  ;  but  when  an 
attempt  is  made  to  find  them  in  Man,  the  orifices  are  at  first 
concealed  from  the  most  attentive  consideration :  various 
means  have  therefore  been  suggested  to  discover  them. 
Winslow  recommended  insufflation  with  a  tube  of  small 
diameter;  many  observers  have  employed  a  bristle ;  others, 
and  M.  Cruveilhier  in  particular,  recommended  that  the  parts 
in  question  should  be  immersed  in  water  tinted  with  ink  or 
carmine  :  but  none  of  these  methods  are  of  much  service.  It 
is  best  to  employ  mercury  as  the  injecting  substance,  and  by 
diligently  searching  to  find  the  conjunctival  opening  of  the 


ducts  after  removing  the  upper  eyelid.  The  eyes  of  children 
of  six  or  eight  years  of  age  are  best  adapted  for  experiment. 
The  first  duct  being  discovered,  the  rest  may  be  found  in 
succession.  It  is  not  necessary  that  the  tube  should  be  very 
fine,  but  it  should  be  conical,  so  that  the  duct  may  fit  lightly 
upon  it  when  introduced,  and  thus  oppose  the  reflux  of  the 
metal.  As  soon  as  the  metal  enters  the  duct  it  quickly 
spreads  over  the  whole  of  the  lobules  belonging  to  it. 

Sappey’s  observations  have  led  him  to  the  following  conclu¬ 
sions  : — That  a  division  may  be  made  into  chief  and  accessory 
ducts.  That  the  chief  ducts  are  from  three  to  five  in  number*, 
spring  from  the  orbital  portion,  and  receive  in  traversing 
the  palpebral  portion  all  the  canaliculi  of  the  lobules  situ¬ 
ated  in  their  course.  That  the  accessory  ducts  to  the  number 
of  two  or  three  come  exclusively  from  the  palpebral  portion. 

It  hence  appears  that  the  two  portions  of  the  gland  are 
closely  connected  and  associated  with  each  other,  and  are 
not,  as  Gosselin  and  Tillaud  were  of  opinion  from  their 
experiments,  independent  of  each  other.  The  latter  observer 
used  tartaric  acid,  which  produces  illusions  by  acting  on 
the  nerves,  arteries,  and  ducts  alike. 

In  its  structure  the  lacrimal  gland  belongs  to  the  type  of 
acinous  glands  in  all  Mammals. 

The  disposition  of  the  lacrimal  gland  is  peculiar  in  the 
Cetacea.  Hunter  states  that  the  tunica  conjunctiva,  where 
it  is  reflected  from  the  eyelid  to  the  globe  of  the  eye,  is  per¬ 
forated  all  round  by  small  orifices,  which  are  the  openings, 
of  the  ducts  of  a  circle  of  glandular  bodies  lying  behind  it. 

Rapp,(b)  whose  work  on  Whales  is  a  standard  one,  states 
that  although  the  Whales  are  said  to  have  no  lacrimal 
gland,  yet,  both  in  the  Delphinus  delphis  and  D.  phocaena, 
he  found  a  granular  lacrimal  gland  which  was  disposed  in  a 
circular  manner  around  the  eye.  The  ducts  opened  by 
numerous  very  distinct  apertures  on  the  inner  surface  of  the 
upper  and  lower  eyelids.  He  was  unable  to  discover  any 
puncta  or  any  lacrimo-nasal  duct.  In  this  respect  the  Seals 
and  the  Walrus  agree  with  the  Whales.  The  eyelids  of 
Cetacea  have  no  tarsus  nor  Meibomian  glands.  They  have,, 
however,  an  Harderian  gland. 

The  Harderian  gland  of  Mammals  demands  special  con¬ 
sideration.  It  may  be  truly  termed  the  gland  of  the  nicti¬ 
tating  membrane,  for  it  is  always  situated  in  close  relation 
with  this.  Its  only  secretion  is  poured  forth  by  one  or  more 
ducts  opening  in  the  fold  between  it  and  the  globe  of  the 
eye,  or  on  the  inner  surface  of  the  nictitating  membrane 
itself ;  and  when,  as  in  the  higher  Quadrumana  and  Man, 
the  nictitating  membrane  is  absent,  the  Harderian  gland 
also  disappears. 

It  is  present,  according  to  Owen,  in  the  Marsupials,  in- 
regard  to  which  he  remarks  that  in  Marsupials  the  Harderian 
gland  and  retractor  oculi  co-exist,  as  usual  in  Mammalia, 
with  the  nictitating  eyelid.  This  is  always  largely  developed, 
and  the  conjunctiva  covering  its  free  margin  is  stained  black. 
In  speaking  of  the  Monotremes,  he  only  says  both  Mono- 
tremes  have  a  well-developed  membrana  nictitans ;  but  no 
mention  is  made  of  an  Harderian  gland. 

It  is  interesting  to  notice  that,  according  to  Leydig,  in  the 
Mole  the  eye  beneath  the  skin  is  in  relation  with  a  very 
large  sebaceous  gland,  which  in  size  and  position  corres¬ 
ponds  to  an  Harderian  gland. 

The  Harderian  gland  presents  its  highest  development  in 
the  Rodents  and  their  allies,  and  two  excellent  monographs 
have  been  devoted  to  the  elucidation  of  the  histology  of 
these  glands  in  the  Rodents  by  Wendt  and  by  Kamocki,(c) 
to  which,  so  far  as  the  histology  is  concerned,  little  remains 
to  be  added.  Wendt  lays  down  the  general  proposition  that 
the  size  and  development  of  the  Harderian  and  of  the  lacri¬ 
mal  glands  bear  an  inverse  ratio  to  each  other,  so  that 
where,  as  in  many  Rodents,  the  Harderian  glands  are  largely 
developed,  the  lacrimal  are  inconspicuous ;  whilst  in  other 
cases,  where  the  lacrimal  glands  are  large,  the  Harderian 
glands  are  only  to  be  discovered  with  difficulty. 

The  situation  of  the  Harderian  gland  is  in  all  instances 
at  the  inner  anterior  or  nasal  part  of  the  orbit.  It  is  in 
contact,  in  most  instances,  with  the  bony  wall  of  the  orbit, 
as  in  the  Hare,  Rabbit,  Guinea-pig,  Rat,  Mouse,  and  Hedge¬ 
hog  ;  or  it  is  embedded  in  a  mass  of  fat,  as  in  the  Sheep,  Ox, 
and  Pig.  Its  outer  surface  is  in  relation  with  the  globe  of 

(b)  “  Die  Cetaceen,”  1837,  8  93. 

(c)  Wendt,  “  Ueber  die  Hardersche  Driise  der  Saugethiere,”  1877. 
Kamocki,  “  Ueber  die  sogenannte  Hardersche  Driise  der  Nager ’’  (Archiv 
f.  Biolog.,  Bandii.,  1883,  8.  709). 


'Medical  Trn«s  and  Gazette. 


POWER  OX  THE  LACRIMAL  APPARATUS  OF  THE  EYE. 


Sept.  29, 1883.  365 


the  'eye,  to  the  inner  and  posterior  surface  of  which  it  is 
accurately  adapted.  It  is  further  closely  connected  with  the 
membrana  nictitans ;  and  indeed,  in  many  animals,  as  the 
Sheep,  the  cartilage  of  the  membrana  nictitans  is  prolonged 
into  the  substance  of  the  gland  in  the  form  of  a  broad,  flat 
plate.  The  investment  of  the  gland  is  directly  continuous 
•with  the  posterior  surface  of  the  nictitating  membrane,  and 
more  externally  with  the  conjunctiva,  the  submucous  layer 
of  which  is  continuous  with  the  anterior  part  of  its  tunica 
propria.  Wendt  observes  that  if  we  divide  the  fold  of  con¬ 
junctiva  between  the  globe  of  the  eye  and  the  third  eyelid, 
and  divide  also  the  membrane  which  is  attached  to  the  bones 
■of  the  orbit,  proceeding  from  the  membrana  nictitans,  the 
whole  gland  may  be  dragged  out  by  traction  on  the  mem¬ 
brana  nictitans.  In  Oxen,  Sheep,  and  Pigs,  however,  the 
•quantity  of  fat  present  renders  a  careful  dissection  necessary. 

The  Harderian  gland  of  the  Hare  and  Rabbit  is  remarkable 
for  being  composed  of  two  parts,  an  inferior  larger  rose- 
coloured  mass  (the  pars  rosea,  or  pars  rubicunda  major),  and 
a  superior  smaller  and  whitish  mass  (the  pars  alba,  or  pars 
albescens  minor,  as  they  were  called  by  Trapp) .  Other  Rodents 
only  exhibit  a  single  gland  in  this  situation.  The  two 
parts  can  be  separated  from  each  other  with  facility.  The 
•consistence  of  the  pars  rosea  is  doughy  and  slightly  elastic, 
That  of  the  pars  alba  is  firmer.  The  rosy  gland  when  viewed 
in  section  with  the  naked  eye  is  porous  and  spongy,  whilst 
the  white  is  more  compact  and  granular,  and  presents 
granules  of  intense  whiteness.  According  to  Kamocki,  the 
two  halves  of  the  gland  have  only  a  single  excretory  duct 
■common  to  both,  which  extends  to  near  the  free  border  of 
the  membrana  nictitans,  and  receives  several  ducts  from 
each  gland. 

The  external  surface  of  each  gland  is  invested  by  a  thin 
and  almost  hyaline  membrane.  This  corresponds  to  the 
■dense  investing  membrane  of  other  glands,  which  is  usually 
termed  the  capsule  or  tunica  propria.  It  is  composed  of 
loose  connective  tissue,  the  fibres  of  which  are  intermingled 
with  wavy  bands  and  bright  cords  of  elastic  tissue,  the  whole 
forming  a  felted  elastic  membrane,  with  numerous  elongated 
and  rounded  cells  containing  nuclei  in  their  interior,  and 
giving  off  processes  from  their  surface.  Prom  this  external 
membrane,  trabeculae  are  given  off,  which  penetrate  in  the 
form  of  broad  bands  into  the  interior  of  the  gland,  breaking 
it  up  into  large  lobules ;  and  these  again  are  subdivided  by 
more  slender  trabeculae  into  smaller  rounded  lobules;  and  so 
on  till  we  arrive  at  the  granules,  acini,  alveoli,  or  follicles 
which  compose  the  gland.  The  amount  of  connective  tissue 
between  the  acini  is  often  so  small  that  they  appear  to  be  in 
actual  contact  without  losing  their  generally  rounded  form. 
The  size  of  the  follicles  varies,  but  they  may  be  round  or 
oval,  or  pear-shaped,  or  figure-of-eight,  or  polyhedric,  with 
irregular  bulgings,  which  are  particularly  conspicuous  in 
“the  white  part. 

As  the  interstitial  tissue  is  very  loose,  and  has  at  the  same 
•time  a  strong  tendency  to  imbibe  water,  whilst  the  proper 
parenchyma  of  the  gland  swells  in  fluid  with  difficulty,  the 
follicles  of  the  gland  become  separated  by  the  swollen  hyaline 
•connective-tissue,  and  the  lobular  composition  of  the  gland 
is  very  beautifully  shown.  Hear  the  surface  of  the  gland  the 
lobules  present  a  slight  convexity,  whilst  internally  they  are 
flattened  against  each  other,  and  near  the  anterior  border 
where  the  excretory  duct  is  given  off  and  the  bloodvessels 
enter  the  lobules,  assume  a  pyramidal  form. 

Examinations  of  the  structure  of  the  gland  may  be  well 
made  in  fresh  glands  macerated  in  alcohol,  and  subsequently 
stained  with  picrocarmine  and  with  hsematoxylin. 

According  to  Kamocki,  there  is  a  certain  distinction 
between  true  acinous  glands,  such  as  the  parotid,  submaxil¬ 
lary,  pancreas,  and  lacrimal,  and  the  Harderian  gland  of  the 
Rabbit,  Guinea-pig,  and  Rat,  in  the  circumstance  that  there 
is  no  narrowing  of  the  excretory  duct  at  the  point  of  tran¬ 
sition  between  the  acinus  and  the  duct.  Kamocki,  follow¬ 
ing  the  main  excretory  duct  backwards,  describes  it  as 
extending  from  the  opening  near  the  free  border  of  the 
membrana  nictitans  to  the  gland,  and  lying  on  the  inner 
surface  of  the  cartilage.  On  reaching  the  gland  it  begins 
to  branch,  and  gives  off  several  trunks  to  each  part  of  the 
gland — the  pars  alba  and  pars  rosea.  These  subdivide  into 
wide  tubules,  which  proceed  to  the  terminal  lobules.  But 
these  last  do  not  represent  simple  or  compound  vesicles  or 
acini  seated  on  the  terminal  branches  of  the  excretory  ducts, 
but  are  relatively  long  and  wide,  frequently  branching 


looped  tubules,  with  lateral  pullulations.  The  lumen  of  the 
proper  gland-tubes  is  indeed  somewhat  larger  than  that  of 
the  peripheral  extremity  of  the  excretory  ducts.  Moreover, 
the  proper  gland-cells  immediately  succeed  to  the  epithelial 
cells  of  the  excretory  duct  at  the  point  of  transition,  but  the 
dilatation  of  the  lumen  is  effected  quite  gradually.  The 
histological  features  of  the  gland,  therefore,  in  the  animals 
mentioned  (Rabbit,  Guinea-pig,  and  Rat)  assimilate  it  to 
the  mucous  glands  of  the  oral  cavity,  oesophagus,  trachea, 
pylorus,  and  Brunner’s  glands,  and  to  the  sublingual  gland, 
and  it  constitutes  a  transitional  form  between  true  acinous 
and  tubular  glands. 

The  chief  excretory  duct  of  the  Harderian  gland  is  lined 
in  Rabbits,  near  its  opening,  with  a  many-layered  transitional 
epithelium  resembling  that  of  the  membrana  nictitans,  and 
a  few  of  the  superficial  cells  may  be  observed  to  have  under¬ 
gone  transformation  into  goblet-cells.  Hear  its  termination 
a  few  scattered  acini  of  small  serous  glandulse  open  into  it, 
the  structure  of  these  acini  agreeing  with  that  of  the 
lacrimal  gland.  Exactly  similar  serous  glands  are  found 
in  much  larger  numbers  near  the  posterior  border  of  the 
cartilage  of  the  membrana  nictitans,  beneath  its  investing 
mucous  membrane,  and  their  excretory  ducts  open,  quite 
independently  of  the  excretory  duct  of  the  Harderian  gland, 
on  that  surface  of  the  membrane  which  is  directed  inwards. 
The  laminated  epithelium  of  the  first  part  of  the  excretory 
duct  of  the  gland  is  replaced  more  internally  by  a  single 
layer  of  cubical  epithelium.  In  the  middle-sized  branches 
of  the  duct,  columnar  cells  are  found,  with  rounded  nuclei 
situated  near  the  attached  extremity,  and  having  finely 
granular  protoplasm  in  their  interior.  At  the  extremity  of 
the  duct,  cubical  cells  reappear,  with  a  nucleus  situated  at 
their  centre.  The  sudden  transition  to  the  quite  distinctly 
characteristic  gland-cells  is  most  marked  in  the  red  gland. 

The  characters  of  the  acini  themselves  have  been  so  care¬ 
fully  described  by  Wendt  that  little  remains  to  be  added  by 
subsequent  observers;  and  Kamocki’s  account  is  only  con¬ 
firmatory  of  the  exactness  of  his  statements. 

Minute  examination  of  the  acini,  Wendt  says,  shows  that, 
as  in  other  instances,  they  are  hollow  sacculi,  composed  of 
an  investing  membrane  lined  by  epithelium,  the  products  of 
secretion  being  discharged  into  the  cavity.  The  investing 
membrane  is  hyaline,  and  apparently  structureless,  except 
for  the  occasional  distribution  in  it  of  a  nucleus.  The  cells 
form  a  single  layer,  and  have  been  variously  described  as 
pyramidal,  short  columnar,  or  truncated  conical  form.  They 
are  so  delicate  that  no  investing  membrane  can  be  shown, 
and,  when  fresh,  are  so  completely  filled  with  fat  that  no 
details  of  their  structure  can  be  ascertained.  Yet  there  is 
this  difference  in  the  disposition  of  the  fat-drops  in  the  rosy 
and  in  the  white  glands,  that  in  the  cells  of  the  rosy  gland 
the  fat  appears  in  large  drops,  whilst  in  that  of.  the  white 
gland  it  is  in  the  form  of  white  molecules,  which  hardly 
give  the  impression  of  fat.  A  similar  material  fills  the 
cavity  of  the  acini  of  the  white  part,  giving  to  this  portion 
of  the  gland  the  aspect  of  colloid  thyroid.  In  very  young 
Rabbits  this  contained  mass  is  absent,  and  Wendt  has  not 
been  able  to  fix  the  exact  period  when  it  is  developed.  He 
found  that  on  chemical  examination  the  molecules  presented 
the  characters  of  fat.  The  size  of  the  follicles  is  on  the 
average  0'3 — 0'4  mm.,  or  about  T;jgth  of  an  inch,  though 
it  may  vary  considerably,  the  larger  ones  being  usually 
situated  near  the  centre  of  the  lobule.  .  .  . 

If  the  cells  of  the  pars  alba  present  a  certain  similarity  to 
the  elements  of  the  sebaceous  glands,  the  cells  of  the  pars 
rosea  resemble  those  of  the  mammary  gland  in  the  stage  of 
lactation,  except  that  in  the  latter .  the  disposition  of  the 
fat-drops  in  the  interior  of  the  cells  is  less  regular  and  their 
size  is  much  less  uniform. 

If  the  fat  be  removed  by  chemical  means,  the  cells  of  the 
white  part  appear  to  consist  of  granular  protoplasm,  often 
with  a  distinct  cell-wall  and  an  excentric  basally-placed 
nucleus.  The  cells  of  the  rosy  part,  on  the  other  hand, 
after  similar  treatment,  present  a  network  or  plexus  in  their 
interior,  the  meshes  of  which  correspond  with  the  removed 
fat-corpuscles.  The  reticulum  is  sometimes  granular,  some¬ 
times  striated,  according  to  the  mode  in  which  the  gland  has 
been  treated,  whilst  in  other  instances  it  is  homogeneous 
and  bright.  The  reticulum  of  the  pars  alba  is  stated  by 
Kamocki  to  be  much  more  delicate,  but  still  apparent. 
There  is  also  a  plexus  which  results  from  the  presence  of  an 
intercellular  cement-work,  but  there  are  no  intercellular 


366 


Medical  Times  and  Gazette. 


POWER  OjST  THE  LACRIMAL  APPARATUS  OF  THE  EYE. 


Sept.  29,  1883. 


ducts  like  those  of  the  liver.  The  size  and  number  of  the 
large  fat- drops  in  the  red  gland  differ  with  the  stage  of 
secretion  and  with  the  age  of  the  animal.  In  young  animals 
smaller  droplets  are  present,  and  these  are  for  the  most  part 
deposited  near  the  free  or  central  extremity  of  the  cells.  The 
coalescence  into  large  drops  occurs  only  in  older  animals. 

In  regard  to  the  connective  tissue  of  the  Harderian  gland., 
there  is,  according  to  Kamocki,  a  layer  of  dense  connective 
tissue  with  numerous  elastic  fibres  beneath  the  epithelium 
of  the  chief  excretory  duct.  In  the  middle-sized  ducts  and 
in  the  finer  ducts  there  is  a  layer  of  transversely  arranged 
nuclei,  probably  belonging  to  the  propria.  The  parenchy¬ 
matous  connective  tissue  between  the  gland-ducts  is  very 
weakly  developed.  It  is  very  loose,  poor  in  cell-elements, 
in  lymphoid  structures,  and  so-called  plasma-cells.  It  is 
only  strongly  developed  around  the  larger  vessels  and  coarser 
ducts,  and  there  is  also  a  larger  quantity  of  elastic  tissue. 
The  distribution  of  the  bloodvessels  is  free. 

Kamocki  has  made  a  careful  examination  of  the  relations 
of  the  lymphatics  and  of  the  nerves,  but  has  nothing  of 
special  interest  to  communicate  in  regard  to  them,  particu¬ 
larly  in  the  Eat.  He  has,  however,  never  been  successful  in 
finding  any  ganglia  in  the  gland. 

The  Harderian  gland  of  the  Guinea-pig  presents  the  same 
characters  as  the  pars  rosea  of  the  gland  of  the  Eabbit.  It 
is  difficult  to  discover  its  very  small  excretory  duet,  since 
there  is  only  a  rudimentary  membrana  nictitans  in  the  form 
of  a  semilunar  fold.  The  small  opening  lies  internal  or 
posterior  to  the  caruncle.  The  excretory  ducts  and  their 
ramifications  resemble  those  of  the  Eabbit,  except  that  their 
lumen  is  smaller,  and  that  they  are  more  uniform  in  diameter. 
The  droplets  in  the  gland-cells  are  more  equal  in  size. 

The  Harderian  gland  of  the  Eat  resembles  the  pars  alba 
of  the  Eabbit,  and  contains  in  its  secretion,  according  to 
Kamocki,  a  large  quantity  of  red  colouring  matter,  which 
is  not  changed  by  the  action  of  alkalies  or  of  dilute  acetic 
acid,  remains  undissolved  in  alcohol,  ether,  or  clove  oil,  but 
bleaches  in  weak  mineral  acids,  and  is  decomposed  by  strong 
mineral  acids.  Its  presence  in  the  lumen  of  the  ducts 
renders  then*  injection  superfluous,  and  shows  very  distinctly 
in  sections  of  hardened  glands  that  they  are  composed  of 
branched  tubes.  The  cells  contain  no  large  fat-drops,  but 
only  a  mist  of  granules.  There  are  no  pigment-granules  in 
the  cells,  though  some  are  visible  in  the  secretion  contained 
in  the  lumen  of  the  tubes.  The  fat  in  the  cells  is  strongly 
disposed  to  crystallise.  The  same  feature  is  observable  in 
the  House-Mouse  and  in  the  Hamster :  in  the  latter  the 
secretion  is  destitute  of  pigment. 

The  account  of  the  Harderian  gland  above  given  answers 
fairly  well  for  all  Mammals, 

Cartilage  of  the  Nictitating  Membrane. — Many  Mammals 
possess  a  peculiar  rod  of  cartilage  at  the  base  of  the  nicti¬ 
tating  membrane,  which  dips  into  the  gland  of  Harder, 
and  forms  a  support  for  it.  It  has  been  carefully  de¬ 
scribed  by  Jules  McCleod  in  the  Sheep,  in  which  animal 
it  has  the  form  of  a  long  flattened  bar,  enlarging  as  it 
extends  towards  the  deeper  part  of  the  gland,  and  stop¬ 
ping  at  a  distance  of  only  two  or  three  millimetres  from 
its  extremity.  It  is  composed  of  typical  hyaline  cartilage. 
The  corpuscles — rounded,  ovoid,  or  elongated — are  irregu¬ 
larly  distributed.  In  the  central  part  they  measure  15  to 
25  /x.  There  is  no  indication  of  proliferation.  Near  the 
periphery  the  capsules  become  flattened,  and  are  disposed 
in  layers  parallel  to  the  surface,  and  the  cells  they  contain 
pass  insensibly  into  the  flat  cells  of  the  perichondrium,  just 
as  in  other  hyaline  cartilages. 

The  perichondrium  presents  nothing  peculiar  in  its  struc¬ 
ture,  but  gives  off  numerous  septa,  which  traverse  the  gland 
and  aid  in  dividing  it  into  lobules,  the  septa  proceeding  from 
the  investing  membrane  of  the  gland. 

Leydig  says  that  the  cells  of  this  cartilage  are  filled  with 
fat  in  the  Eat  and  Eabbit.  The  rod  represents  in  a  normal 
and  regularmanner  the  pathological  conversion  of  connective 
tissue  into  cartilage,  such  as  may  be  seen  in  some  tendons. 

The  secretions  discharged  by  the  lacrimal  and  Harderian 
glands  of  Mammals,  after  having  discharged  their  functions, 
are  conducted  by  two  canaliculi,  or  rarely  by  a  single  canali¬ 
culus,  to  the  lacrimal  sac,  and  by  this  to  the  nasal  cavity, 
the  lower  opening  being  situated  near  the  posterior  opening 
of  the  nares  in  some,  and  close  to  the  anterior  opening  of  the 
nares  in  others. 

The  lacrimal  bone  is  wonderfully  constant  throughout 


the  Mammalia,  being  absent  only  in  Whales,  Seals,  and  the 
Walrus.  It  varies,  however,  considerably  in  point  of  size, 
and  in  the  extent  to  which  it  encroaches  on  the  face.  It 
rarely  coalesces  with  the  other  bones  of  the  face.  In  the 
adult  Pangolin,  however,  no  sutures  can  be  detected.  In, 
by  far  the  larger  number  the  lacrimal  bone  is  perforated  by* 
the  canal  for  the  canaliculi,  and  this  opening  appears  to 
be  double  in  the  Kangaroo,  Pig,  and  some  of  the  Phalangers- 
In  the  Hyrax,  Lemurs  and  Monkeys,  and  Man,  the  foramen 
lacrimale  superior,  or  upper  orifice  of  the  naso-lacrimal  pas¬ 
sage,  is  formed  by  both  the  lacrimal  bone  and  by  the  superior- 
maxillary.  In  a  large  number  of  cases  the  opening  for  the 
lacrimal  canal  is  within  the  orbit,  but  in  some  it  is  just  ab. 
the  margin  of  the  orbit,  or  orbito-facial,  whilst  in  others 
again  it  is  entirely  facial.  Good  examples  of  the  orbito- 
facial  position  of  the  opening  is  seen  in  the  Phalangers,, 
Opossums,  Wombat,  and  Kangaroo,  whilst  the  facial  position 
of  the  opening  is  seen  in  the  Sloth  and  Deer. 

It  does  not  appear  that  any  great  importance  can  be. 
attached  to  the  position  of  the  opening,  since  in  animals  so 
nearly  allied  as  the  Sheep  and  Deer  the  position  is  different, 
in  the  Deer  being  facial,  whilst  in  the  Sheep  it  is  quite 
orbital.  The  size* of  the  lacrimal  bone  is  immense  in  these* 
animals. 

The  position  of  the  lacrimo-nasal  canal  in  the  bones  differs 
considerably,  and  in  some  animals  is  very  characteristic. 
The  Seals  and  Walrus  do  not  appear  to  have  any,  nor  is  there 
any  in  the  Whale,  where  the  lacrimal  bone,  if  present  at  all, 
is  only  a  thin  wedge  of  bone.  In  all  Australian  and  American 
Marsupials  it  is  facial ;  in  the  Edentata,  subfacial  j  in  the 
Carnivora  it  is  generally  orbital. 

The  lacrimal  bone  is  small,  thin,  and  concave  in  the 
Primates,  and  merits  its  name  of  os  unguis ;  but  in  the  Indris, 
a  genus  of  Lemurs  inhabiting  Madagascar,  it  is  large  and. 
thick,  and  bent  in  the  middle  part,  where  it  forms  a  part  of 
the  border  of  the  orbit,  and  extends  largely  upon  the  cheek. 

A  small  bone  is  frequently  found  at  the  lower  part  of  the 
lacrimal,  between  it  and  the  superior  maxillary  bone,  a  thin 
transparent  ossicle  of  squareform,presentingmany  foramina,, 
which  is  not  described  in  any  of  our  text-books  except  Gray’ s ;. 
but  which  was  described  by  Dr.  Emile  Eousseau,  in  1828, 
under  the  name  of  petit  unguis,  or  petit  lacrimal.  It  is., 
largely  developed  in  some  of  the  lower  animals. 


Extirpation  of  the  Larynx. — At  a  meeting  of  the* 
Philadelphia  College  of  Physicians  (Medical  News,  July  7),. 
Dr.  Silas  Cohen  read  a  paper  upon  the  question,  “  Does 
excision  of  the  larynx  tend  to  the  prolongation  of  life  P  ” 
He  has  had  no  personal  experience  in  the  operation  or  its- 
results,  his  opinions  being  founded  solely  on  the  considera¬ 
tion  of  the  sixty-five  cases  of  total  extirpation  that  have  been 
published.  Four  of  these  operations  were  performed  for 
non-malignant  disease,  two  proving  fatal.  Of  the  sixty-one 
remaining  cases,  in  four  sarcoma  was  the  cause  of  the  ope¬ 
ration  ;  and  Dr.  Cohen  observes  that  “  taking  for  granted, 
as  we  are  bound  to  do,  that  death  was  imminent  in  these 
five  cases  when  the  operation  was  resorted  to,  we  have  a 
considerable  prolongation  of  life  in  every  instance,  and  a 
remarkable  prolongation  in  two  (the  patients  being  still 
alive  and  well  six  and  two  years  respectively  after  the  ope¬ 
ration),  or  in  40  per  cent.  As  far  as  these  limited  statistics 
go,  therefore,  the  operation  in  hopeless  cases  of  sarcoma  is. 
worthy  of  the  serious  consideration  of  the  surgeon.”  The 
account  of  the  remaining  fifty-six  operations  for  carcinoma- 
is  far  less  favourable.  Death  is  recorded  in  forty  of  these 
cases  :  in  seventeen  it  occurred  within  three  days,  and  in  five 
more  within  eight  days,  usually  from  subsequent  pneumonia 
— a  disease  which  Dr.  Cohen  has  frequently  met  with  in  opera¬ 
tions  upon  the  neck,  in  which  the  air-passages  have  not  been 
opened.  In  two  cases  recurrence  took  place,  after  three  and 
seven  months  ;  and  in  fourteen  neither  death  nor  recurrence 
has  been  reported.  The  general  conclusion  Dr.  Cohen 
arrives  at  is,  that  in  carcinoma  excision  does  not  tend  to  the 
prolongation  of  life — the  prolonged  existence  of  a  very  few 
cases  not  compensating  for  the  shortened  existence  of  many 
others.  The  greatest  good  for  the  greatest  number  appears, 
better  secured  by  dependence  on  the  palliative  operation  of 
tracheotomy.  This  produces  little  shock,  very  slight  danger 
of  pneumonia,  and  much  less  risk  of  septic  infection.  Life 
is  not  likely  to  be  sacrificed  in  any  instance,  and  existence  is 
much  more  comfortable  after  it  than  after  laryngectomy. 


Medical  Times  and  Gazette. 


SONSINO  ON  FILARIA  SANGUINIS  PARASITISM. 


Sept.  23,  1883.  367 


A  NEW  SERIES  OF 

CASES  OF  FILARIA  SANGUINIS  PARASITISM 
OBSERVED  IN  EGYPT; 

WITH  THE  RESULTS  OF  EXPERIMENTS  ON  FILAR  IATED 
SUCTORIAL  INSECTS,  (a) 

By  PROSPERO  SONSINO,  M.D.  (Pisa). 

(Continued  from  page  342.) 

Part  I. — Concluded. 

In  two  cases  (13  and  21)  I  found  filariae  associated  with 
lung  disease.  In  the  first  the  symptoms  are  of  a  chronic 
pulmonary  catarrh  with  bronchiectasis,  and  the  other  I 
.suspect  to  be  a  case  of  tubercles  extended  to  the  larynx.  It 
is  then  clear  that  in  both  the  cases  the  lung  disease  is 
only  a  simple  association.  In  Case  13,  in  which  simple 
purulent  sputa  without  blood  were  seen,  I  could  not  find 
any  filarise  in  them.  But  in  Case  21,  where  the  sputa  were 
•abundantly  bloody,  the  first  detection  of  embryo  filarise 
was  made  in  them,  and  the  successive  examination  of  the 
blood  taken  from  a  finger  at  7  a.m.  confirmed  the  filarial 
infection.  The  embryo  filariae  detected  in  the  sputa  were 
.not  living. 

No  Detection  of  Distoma  Ringeri. — By  the  way,  I  may  say 
that  on  examining  the  bloody  sputa  of  this  last  case,  as  of 
other  hsemoptical  patients,  I  had  always  in  mind  Dr. 
Manson’s  discovery(a)  of  a  parasitical  haemoptysis  due  to  a 
mew  fluke.  Distoma  Ringeri,  but  till  now  I  have  not  detected 
the  characteristic  eggs  of  that  fluke.  It  is  possible  that  the 
geographical  distribution  of  it  does  not  extend  to  Eo-vnt 
and  Africa.  ° 

I  am  disappointed  that  I  cannot  complete  the  history  of 
'Case  22,  which  I  mention  only  as  regards  the  hsematuria, 
that  is  still  under  treatment;  whilst  the  patient  offers 
some  interesting  conditions  as  to  which  I  cannot  determine 
whether  they  have  or  have  not  direct  connexion  with  filaria. 
The  young  man  called  on  me  asking  for  relief  from  an 
•enlargement  of  the  right  testis,  but  I  perceived  that  he 
offered  also  two  hard  masses  not  larger  than  a  walnut  along 
the  spermatic  cord,  that  were  independent  of  the  testis  and 
seemed  to  be  some  cystic  productions.  He  had  had  a 
long  time  before  a  perineal  abscess,  and  last  summer  a  little 
abscess  in  the  scrotum.  There  is  also  a  hydrocele  on  the 
left  side.  The  enlargement  of  the  testis  has  now  ceased,  but 
as  for  the  cysts,  we  have  not  yet  determined  (Dr.  Vernoni, 
who  also  visited  the  patient  with  me,  and  myself)  how  to 
treat  them. 

In  no  filarious  individuals  did  I  get  so  large  a  number  of 
■embryos  in  a  single  drop  as  in  the  woman  of  Case  19,  from 
whom  I  took  the  blood  at  10  p.m.  of  February  8  of  this 
year.  Having  spread  the  drop  on  four  slides,  one  of  these 
■offered  me  as  many  as  ten  individuals  under  the  field  at 
x  100. .  The  gnats  and  bugs  taken  from  this  woman  were, 
of  the  insects  examined,  even  more  charged  with  embryos. 
This  woman,  about  fifty-five  years  of  age,  looks  very  pale, 
weak,  and  older  than  she  is,  but  she  says  that  she  suffers 
•from  no  complaint,  and  I  could  find  nothing  but  an  evident 
state  of  anaemia.  I  tried  to  hinder  the  evaporation  of  the 
filarious  blood  of  some  preparations,  by  putting  some  wax 
round  the  edge  of  the  covering  glass,  and  I  could  by  this 
■contrivance  maintain  living  filarise  for  some  days.  Once 
in  a  preparation  of  the  blood  taken  at  10  p.m.  from  the 
woman  of  Case  19  I  succeeded  in  keeping  living  filarise  till 
the  seventh  day,  and  one  of  the  embryos  was  still  living 
even  on  the  eighth  day  after  the  extraction  of  the  blood. 

No  Detection  of  Filaria  Eggs  in  Lymphous  Urine. — In  the 
examination  of  the  lymphous  urine  of  my  patients  I  had 
never  detected  any  kind  of  eggs  that  may  be  considered 
filaria  eggs,  as  Dr.  Manson  happened  to  observe  in  two 
■of  his  cases. (b)  Dr.  Manson’s  newl  theory  on  the  diseases 
originated  by  filaria  is  based  upon  the  fact  of  the  miscarriage 
of  the  eggs  from  the  body  of  the  mature  female  worm,  which 
seem  viviparous.  New  observations  only,  and  especially 
anatomo-pathological  ones,  as  Dr.  Manson  judiciously  says, 

(a)  “Distoma  Ringeri  and  Parasitical  Haemoptysis,”  by  P.  Manson, 
M.D.  (reprinted  from  the  Customs  Medical  Reports). 

(b)  “  Note  on  Filaria  Disease,”  by  Patrick  Manson,  M.D.,  in  the  Customs' 
Medical  Reports. 


will  decide  on  this  ingenious  theory,  against  which  I  have 
not  to  oppose  any  positive  fact.  Yet  it  seems  to  me  rather 
probable  that  the  obstruction  of  the  lymphatic  vessels  caused 
by  plugging  with  miscarried  eggs  may  happen  only  as  an  ex¬ 
ceptional  fact,  and  that  more  often  the  adult  worm  itself  may 
be  the  cause  of  the  obstruction  and  irritation.  Dr.  Manson 
himself,  who  had  explained  the  absence  of  embryo  filarise 
in  some  patients  suffering  from  chyluria  by  admitting  the 
presence  of  adult  filarise  of  one  sex  only,  must  then  admit 
that  lymphuria  and  other  allied  diseases  may  have  often  an 
origin  different  from  that  which  is  now  sustained  by  him. 
But  as  to  the  eventual  presence  of  eggs  of  filaria  in  the 
lymphous  urine,  I  argue  that  this  fact  may  be  the  conse¬ 
quence  of  the  death  of  the  parent  worm,  and  the  destruction 
of  its  body,  more  probably  than  of  miscarriage,  which,  if 
happening  frequently,  would  be  rather  considered  as  a 
normal  fact,  and  as  the  consequence  of  the  worm  being 
ovoviviparous  instead  than  viviparous.  I  add,  too,  that 
the  characteristic  of  the  filaria  eggs  to  adapt  their  form  to 
the  external  pressure,  as  Dr.  Lewis  had  described,  does  not 
render  them  the  more  likely  to  produce  obstruction,  as  is  the 
case  with  other  firmer  eggs,  like  those  of  bilharzia. 

Cases  of  Disease  in  which  Embryo  Filarice  were  not  present. 
— In  my  previous  paper  I  related  a  case  of  lymphuria  in 
which  no  filaria  was  found,  though  an  accurate  research 
had  been  made  several  times  at  different  hours.  I  have 
now  to  relate  two  new  cases  with  the  same  negative  result, 
in  one  of  which  the  filaria  was  searched  for  only  some  time 
after  the  cessation  of  the  attack  of  lymphuria ;  in  the  other 
when  the  complaint  was  still  present. 

(a.)  A  native  Jewess,  about  thirty-five  years  of  age,  thin, 
and  of  feeble  constitution,  called  me  in,  in  June  of  last 
year,  and  told  the  following  history  : — Four  years  ago  she 
suffered  from  a  large  and  deep  abscess  near  one  knee,  from 
which  she  recovered  without  bad  consequences.  Eight 
months  ago  she  began  to  suffer  from  milky  urine,  and  the 
attack  lasted  for  about  six  months,  viz.,  till  two  months 
previous  to  my  visit.  The  attack  left  her  feeble  and 
amemic  ;  and  soon  she  began  to  suffer  from  pain  in  the  left 
side  of  the  chest,  with  difficulty  of  respiration  and  some 
cough.  The  doctor  treated  her  for  a  pleuritic  effusion.  At 
the  moment  of  my  visit  the  pain  in  the  left  side  was  not  at. 
all  ameliorated,  but  was  also  extending  down  towards  the 
renal  region,  and  was  felt  about  the  epigastrium.  I  per¬ 
ceived  a  certain  feebleness  of  the  respiratory  sound,  with  a 
little  dulness  on  percussion.  The  examination  of  a  drop 
of  blood  taken  from  a  finger  at  9  p.m.  did  not  offer  any 
embryo  filarise.  I  prescribed  some  tonics,  and  I  ceased  to 
visit  the  woman  a  few  days  afterwards  on  account  of  her 
departure,  and  had  no  opportunity  of  examining  her  after 
her  return. 

(b.)  On  January  of  this  year  Dr.  Mackie,  of  the  Diaconess 
Hospital  of  Alexandria,  sent  to  me  a  patient,  desiring  me  to 
examine  his  milky  urine,  as  he  (Dr.  Mackie)  had  repeatedly 
done  so  without  discovering  any  filarise  microscopically. 
The  patient,  a  native  employed  in  the  railway  administra¬ 
tion,  was  thin  and  emaciated;  presented  no  hydrocele,  but 
only  a  certain  degree  of  swelling  along  the  left  spermatic 
cord.  He  was  suffering,  for  only  a  few  days,  from  a  third 
attack  of  lymphuria,  with  some  pain  in  the  right  renal 
region.  The  first  attack  happened  eight  years  ago,  and,  like 
the  second,  lasted  for  several  months;  and  he  remembers 
well  that  in  the  second  the  urine  offered  often  the  white 
jelly-like  coagulum,  but  never  blood.  The  present  attack 
does  not  offer  coagulum  in  the  urine,  this  being  not  much 
charged  with  lymph.  That  emitted  in  my  presence  was 
yellow,  opaque,  and  coagulated  both  with  nitric  acid  and 
heat,  as  well  as  with  rectified  alcohol.  Ether  separated  from 
it  some  oily  matter.  But  I  did  not  find,  at  the  microscopical 
examination,  any  embryo  filaria;,  though  I  spent  much  time 
in  searching  for  them  in  several  samples  of  the  urine.  I 
thought  it  well,  too,  to  search  for  them  in  the  patient’s  blood. 
But  three  examinations  of  blood  taken  from  a  finger,  and 
made  on  January  16,  17,  and  20,  at  respectively  9.30  p.m., 
10  p.  m.,  and  7  a.m  ,  were  equally  negative  as  to  the  presence 
of  embryo  filarise  in  the  body. 

But  these  two  cases  of  lymphuria  without  filaria,  as  well 
as  the  first,  of  which  I  gave  the  full  history  in  my  previous 
paper,  may  be  explained  by  the  hypotheses  that  I  suggested 
in  that  paper— either  that  the  adult  filariae  had  previously 
passed  out  with  the  lymphous  urine,  or  had  died  and  decom¬ 
posed  in  the  body  of  the  host ;  or  that  the  patient  had  been 


368 


Medical  Times  and  Gazette. 


SONSINO  ON  FILARIA  SANGUINIS  PARASITISM. 


Sept.  29, 1883. 


Synopsis  of  the  Second  Series  of  Cases  of  Individuals  affected  by  Filaria  Sanguinis  observed  in  Egypt . 


Years 
of  the 
observa¬ 
tion. 

"Where  observed. 

Origin,  profession,  state,  etc. 

Age 

(years 

pre¬ 

sumed). 

Disorders  and  diseases  associated. 

Where  embryonal  filarise  were 
found. 

11 

1882 

Private  practice,  Cairo 

Woman,  Maltese,  since  many 
years  in  Egypt 

65 

Hsematuria,  weakness,  renal  pain 

In  the  bloody  urine,  and  in  the- 
blood  from  a  finger  after  the  ces¬ 
sation  of  hsematuria. 

12 

1882 

Diaeoness  Hospital,  Alex¬ 
andria 

Native  Mohammedan,  a 
butcher 

45 

Hsematuria,  elephantiasis  scroti; 
before  suffered  from  lymphuria 

In  the  blood  taken  from  the- 
scrotum  and  from  the  finger. 

13 

1882-83 

Private  practice,  Cairo 

Jew,  native  of  Jaffa,  since 
many  years  in  Egypt 

25 

Hsematuria  from  bilharzia  (ob¬ 
served  in  1874),  now,  apparently 
recovered  ;  at  present  lung  dis- 

In  the  blood  from  the  finger— not 
in  the  mucous  purulent  sputa. 

14 

1882 

Private  practice,  Cairo 

Native  Copt,  clerk  in  the 
Cavastre  Administration 

22 

Lymphuria  . 

In  the  blood  from  the  finger. 

15 

1882-83 

Private  practice,  Cairo 

Native  Jew,  clerk  . 

32 

Lymphuria  many  years  ago ;  now, 
ventral  hsematoeele,  emaciation 

In  the  blood  from  the  finger  and1 
in  the  blood  from  the  ventraS 
hsematoeele. 

16 

1882 

Private  practice,  Cairo 

Native  Jew,  merchant  ...  ... 

30 

Lymphuria,  weakness,  ansemia... 

In  the  blood  from  the  finger  and- 
in  the  milky  urine. 

17 

1882 

Private  practice,  Cairo 

Native  Jew,  merchant,  cousin 
of  the  preceding  one 

30 

Lymphuria  long  ago  ;  at  present 
no  disorder,  but  good  and  robust 
health 

In  the  blood  from  the  finger. 

18 

1882-83 

Private  practice,  Cairo 

Native  Jew,  a  broker  . 

32 

Lymphuria,  ansemia,  weakness ... 

In  the  blood  from  the  finger  and! 
in  the  milky  urine. 

19 

1883 

Private  practice,  Cairo 

Native  Jewess,  mother  of  the 
preceding  one 

55 

Lymphuria  twenty- five  years  ago ; 
no  relapse ;  weak  and  anaemic 

In  the  blood  from  the  finger. 

20 

1883 

Private  practice,  Cairo 

Mohammedan  girl . 

15 

Lymphuria  . 

In  the  milky  urine.  Not  exa¬ 
mined  the  blood. 

21 

1883 

Private  practice,  Cairo 

Native  Jew,  exchange  broker 

27 

■ 

Long  ago,  hsematuria  (probably 
from  bilharzia) ;  now,  chronic 
disease  of  the  lung 

In  the  bloody  sputa,  and  subse¬ 
quently  in  the  blood  from  the 
finger. 

22 

1883 

Private  practice,  Cairo 

A  native,  but  of  Italian 
parentage 

30 

Hsematuria,  ansemia,  enlarge¬ 
ment  of  one  testis  and  of  sper¬ 
matic  cords 

In  the  blood  from  the  finger. 

the  host  of  adult  filarise  of  one  sex  only.  The  probability  of 
the  first  hypothesis  can  now  receive  confirmation  from  the 
result  of  the  interesting  case  which  happened  in  the  London 
Hospital  under  Dr.  S.  Mackenzie,  in  which  the  patient,  who 
for  a  long  time  offered  the  embryos  in  the  blood  and  in  the 
urine,  ceased  to  offer  them  two  months  previous  to  his 
death,  (g) 

Even  a  case  related  by  Dr.  Manson  (Case  63  in  his  last 
“  Notes  on  Filaria  Disease  ”),  of  an  abscess  in  the  thigh,  in 
which  some  fragments  of  a  mature  female  worm  were  found, 
and  in  which  case  the  previous  examination  of  some  milky 
lymph  extracted  from  an  enlarged  gland  was  negative  as 
regards  embryos,  confirms  the  probability  that  in  some  cases 
of  disease  the  embryo  filarias  cease  to  be  present  because 
of  the  death  of  the  parent  worm. 

I  think  I  may,  without  hazarding  much,  suppose  that,  in 
the  woman  of  whom  I  spoke  just  before,  it  is  possible  that 
the  symptoms  of  pleuritic  effusion  may  have  been  connected 
in  some  manner  with  an  emigration  and  death  of  the  mature 
worm,  though  fortunately  the  accident  had  not  a  fatal  result 
for  the  host  of  the  parasite. 

(c.)  A  case  again  in  which  the  search  for  embryo  filarise 
was  negative  was  offered  by  an  old  man,  whom  I  saw  at 
the  Greek  Hospital  in  Alexandria  in  April  last  year,  and 
who  had  elephantoid  disease  both  of  the  legs  and  scrotum, 
but  with  anasarca  and  ascites.  I  was  informed  afterwards 
that  the  man  died  some  days  after  my  visit,  and  that  Dr. 
Kartulis  at  the  post-mortem  examination  had  not  succeeded 
in  finding  either  embryonal  filarise  or  the  adult  worm, 
although  he  had  searched  for  them  in  the  vessels  of  the 
scrotum  and  in  the  inguinal  glands,  as  well  as  in  the  ductus 
thoracicus.  But  there  were  many  pathological  lesions  of 
important  organs,  and  principally  atheroma  of  the  aorta, 
cirrhosis  of  the  liver,  and  nephritis  ;  and  thus  it  is  possible 
that  in  this  case  the  elephantiasis  had  had  its  origin  in 
obstructions  of  a  different  kind  from  those  produced  by 
filaria. 

(d.)  On  June  8  of  last  year  I  saw  too  a  fellah  of  Mohallet- 
el-Kebeer  (in-patient  at  Kasr-el-Ain  Hospital)  with  a  large 
elephantiac  scrotum,  which  was  complicated  with  some  fis¬ 
tulous  tracts  in  its  posterior  part.  I  was  permitted,  through 
the  kindness  of  Dr.  Fouzee  Bey,  to  take  a  drop  of  blood  from 
the  scrotum,  and  a  drop  of  serum  from  a  knot  in  the  hyper¬ 
trophied  scrotum.  The  extraction  of  the  blood  was  made  at 
8.30  a.m.,  and  the  result  was  negative  as  regards  embryo 
filarise.  But,  though  I  have  not  examined  this  case  tho¬ 
roughly,  I  have  the  conviction  that  it  was  rather  a  case  of 
spurious  elephantiasis  due  to  urinary  fistula,  as  it  is  seen  fre¬ 
quently  in  Egypt,  than  a  case  of  true  elephantiasis  Arabum. 

(c)  See  rt  ports  of  the  London  Pathological  Society  in  the  Lancet  of 
May  27,  183.'. 


Conclusions  about  my  Observations  on  Filaria  Parasitism 
in  Egypt. — From  the  knowledge  gained  from  the  twenty-two- 
cases  of  filaria  parasitism  till  now  observed,  I  think  I  am 
authorised  to  conclude 1.  That  filariated  individuals  may 
live  long  without  presenting  disorders  of  importance,  and 
even  enjoy  good  health.  2.  But  that  during  their  infection 
they  are  liable  to  attacks  of  lymphorrhagia,  and  especially 
of  lymphuria,  the  lymphorrhagia  in  some  cases  assuming 
the  form  of  lymphocele.  The  occurrence  of  the  one  or  thn 
other  complaints,  I  contend,  depends  upon  the  seat  of  the 
adult  worms.  3.  That  haemorrhage,  and  especially  haema- 
turia,  may  also  be  the  sequel  of  the  filarial  parasitism,  but 
exceptionally  ;  and  probably  they  are  the  consequence  of  the 
passage  of  mature  filarise  into  the  bloodvessels.  4.  That,  in 
Egypt,  hsematuria  even  in  filariated  patients  is  generally  due 
to  the  co-existence  of  bilharzial  disease. 

Gravity  of  Filarial  Infection,  and  Prognosis. — If  I  might 
judge  from  only  the  twenty-two  cases  of  filarial  infection  ob¬ 
served  by  myself  in  Egypt,  J  ought  to  infer  that  filarial  infec¬ 
tion  is  not  so  grave  as  to  immediately  endanger  life,  for  out 
of  twenty-two  cases,  in  many  of  which  I  can  argue  that  the 
time  of  infection  mounted  back  to  many  and  many  years  ago, 
there  has  happened  up  to  now  the  death  of  one  patient  only 
(Case  2  of  the  first  series),  and  this  was  not  apparently 
caused  by  the  filarial  disease.  Of  the  other  cases,  save  three 
individuals,  whom  I  have  altogether  lost  view  of,  I  can  assert 
that  they  are  all  living,  and,  with  the  exception  of  one,, 
offer  no  immediate  danger.  Yet,  for  the  reasons  given  in 
my  previous  communication,  and  in  accordance,  too,  with 
the  result  of  the  observations  made  in  other  countries,  I 
must  still  consider  the  worm  as  a  dangerous  parasite  which: 
may  eventually  cause  the  death  of  its  host.  I  will  add  that, 
if  I  recall  many  cases  of  obscure  disease  with  fatal  result, 
which  it  happened  to  me  to  observe,  either  in  my  practice' 
or  in  that  of  other  practitioners,  there  are,  in  my  opinion, 
several  in  which,  if  search  for  embryo  filarise  had  been  made,, 
the  detection  of  them  would  very  probably  have  afforded  the 
key  to  the  origin  of  the  process  of  the  disease,  which  now 
rests  a  mystery  hidden  in  the  burial-ground. 

Treatment. — It  is  rather  vexing  to  have  dwelt  so  much 
upon  a  pathological  condition  without  being  able  to  add  any¬ 
thing  new  about  what  is  the  first  aim  of  the  practitioner — 
how  to  cure.  But  this  is  my  position  with  the  filarial  disease. 
I  cannot  modify  what  I  have  said  in  the  previous  paper — 
viz.,  that  we  have  no  means  at  our  disposal  for  procuring  or 
facilitating  the  favourable  event  of  the  exit  of  the  parasite 
from  the  body,  with  the  exception  of  surgical  means,  when 
the  adult  filaria  is  found  in  a  part  of  the  system  that  may  be 
removed.  But,  as  respects  lymphuria  especially,  I  can  now 
suggest  the  yellow  santhal  oil  as  being  better  than  any  other 
balsam  as  a  remedial  agent;  as  it  has  seemed  to  me  to 


■Medical  Time*  and  Gazette. 


CHEVEES  ON  THE  ORDINARY  DISEASES  OF  INDIA. 


Sept.  29,  1883.  369 


possess  some  efficacy  in  checking  the  morbid  discharge, 
'whatever  may  be  its  mode  of  action. 

But  if  the  means  of  treatment  of  the  infection  at  our  dis¬ 
posal  are  so  deficient,  we  can  rejoice  that,  as  regards  preven¬ 
tion,  we  have  attained  all  the  progress  that  we  could  aim  at, 
.as  by  the  discovery  of  the  intermediate  host  of  the  parasite 
it  is  still  more  confirmed  that  human  beings  catch  the 
parasite  from  drinking  water,  and  that  the  use  of  boiled  or 
filtered  and  well-preserved  water  can  assure  impunity  from 
the  filarial  infection.  And  it  is  better  to  prevent  than  to 
Bave  to  cure. 

( To  le  continued .) 


PEACTICAL  NOTES  ON 

THE  ORDINARY  DISEASES  OF  INDIA, 

ESPECIALLY  THOSE  PREVALENT  IN  BENGAL. 

By  NOEMAN  CHEVEES,  C.I.E.,  M.D., 

ligate  Senior  Physician  and  Professor  of  Medicine,  Medical  College 
and  Hospital,  Calcutta. 


( Continued  from  page  345.) 

"CHOLEEA  ASIATICA  MALIGNA — Continued.* * 
Treatment  of  Cholera. 

The  states  of  the  Liver  and  Kidneys  in  cholera  are  so  full  of 
interest  and  importance  pathologically,  and  still  more  in  a 
therapeutic  point  of  view,  that  it  is  surprising  that  they 
have  never  yet  been  made  the  subjects  of  thorough  clinical 
investigation.  Algide  cholera,  being  more  remarkable  than 
.any  disease  with  which  we  are  acquainted  for  the  almost 
entire  absence  of  x°^h  bile,  from  the  evacuations  during  its 
worst  stage,  that  of  collapse,  we  should  approach  more 
clearly  to  descriptive  precision  if  we  called  it  Acholia,  and 
•to  pathological  accuracy  if  we  termed  it  Asiatic  Pernicious 
Fever,— thus  wholly  separating  it  in  our  ideas,  as  it  is  abso¬ 
lutely  distinct  in  reality,  from  several  disorders  of  the  bowels 
with  which  it  is  still  unhappily  confused,  (a) 

As  a  general  rule,  exceptions  to  which  are  rare,  bile  pig¬ 
ment  is  not  positively  detectable  in  the  stools  and  vomited 
"matter  of  the  algide  stage,  during  which  it  appears  that  the 
excretive  functions  of  the  liver  are,  in  the  large  majority  of 
oases,  arrested  as  absolutely  as  those  of  the  kidneys  are 
in  all  cases.  Dr.  Edward  Goodeve  found  that  “nitric  acid 
occasionally  gives  red  reaction  in  the”  [rice-water]  “liquid. 
This  is  probably  due  to  a  small  quantity  of  bile  mixed  some¬ 
how  with  the  evacuations,  but  it  is  not  certain  what  it  is.” 
_It  is  here  to  be  remarked  that  any  bile  which  may  appear  in 
•vomited  matter  and  alvine  evacuations,  whether  during  the 
collapse  stage  or  early  in  the  stage  of  reaction,  must  not  be 
viewed  as  positive  evidence  that  hepatic  action  is  not  abso¬ 
lutely  arrested,  as  its  source  may  be  the  gall-bladder.  Tanner 
says  that  cholera  stools  contain  only  a  trace  of  biliary 
matter.  During  the  epidemic  of  1868,  Dr.  Thudichum 
•observed,  in  death  during  the  stage  of  collapse,  that  the 
secretion  of  bile  was  completely  arrested  ;  and  that,  in  ex¬ 
treme  cases,  a  clear  white  fluid  percolates  through  the 
hepatic  ducts,  free  from  bile,  colouring  matter,  and  albumen. 
It  seems  to  be  simply  water,  with  a  trace  of  alkali  and  a 
vestige  of  mucus.  In  some  instances  the  fluid  was  coloured, 
but  contained  no  bile-acids.  Placing  cases  of  acute  bilious 
diarrhoea  or  hepatic  flux  entirely  aside,  cases  do  occasionally 
•occur  in  which  the  vomited  fluid  and  the  dejections,  during 
the  algide  stage,  are  distinctly  coloured  by  bile.  This  hap¬ 
pened  in  the  case  of  an  administrative  medical  officer  who 
Hied  in  Fort  William,  Calcutta,  about  twenty-six  years  ago  ; 
and  again,  in  1874,  among  the  constantly  varying  types  of 
true  cholera  which  occurred  in  Calcutta,  there  was  one  in 
which  the  fluids  ejected  during  collapse  were  distinctly 
coloured  by  bile.  In  March,  1875,  I  had,  in  my  ward,  a 
European  woman  who  was  attacked  with  Asiatic  cholera 
after  having  taken  a  well-known  “  antibilious  ”  purgative 
on  the  night  of  February  27.  She  died  on  March  4,  at  about 
eleven  o’clock  a.m.,  never  having  rallied  from  the  collapse 

(a)  The  active  mischievousness  of  this  antiquated  name  is  displayed  in 
the  fact  that  even  so  modem  a  writer  as  Dunglison  says  that  it  is  derived 
from  x°^’h  hile,  and  ptu,  to  flow,  because  it  arises  principally  from  a 
superabundance  of  acrid  bile.  This,  in  true  Asiatic  Cholera,  is,  of  course, 

•  precisely  the  reverse  of  the  fact. 


stage,  and  never  having  passed  urine.  She  continued,  up  to 
two  o’clock  on  March  3,  to  vomit  a  bilious  fluid,  the  quantity 
of  bile  voided  being  far  too  large  to  allow  the  suspicion  that 
it  came  merely  from  the  gall-bladder.  Stools  ceased  on  the 
afternoon  of  the  1st.  They  were  from  six  to  seven  in  the 
twenty-four  hours,  and  were  markedly  coloured  by  bile. 
The  severity  of  this  case  was  much  aggravated,  and  the 
evacuating  treatment  interfered  with  by  a  tendency  to  abort, 
the  poor  woman  being  in  the  second  month  of  pregnancy. 
In  1874  there  was  a  great  and  very  unusual  tendency  to 
bilious  vomiting  in  the  reaction  stage  and  at  the  beginning 
of  convalescence  from  true  cholera. 

The  ordinary  and  most  favourable  type  of  alvine  evacua¬ 
tion,  after  reaction  has  become  established,  is  a  free  and 
perfectly  fluid  fseculent  and  very  bilious  stool,  of  a  warm 
brown  colour,  of  which  there  should  be  some  five  or  six 
during  the  twenty-four  hours.  Not  unfrequently  the  first 
evidence  of  improvement  is  the  passing  of  what  are  locally 
known  as  “Calcutta  mud”  stools,  fromtheir  close  resemblance 
to  the  dirty  greyish  mud  of  the  Hooghly. 

The  behaviour  of  the  Kidneys  in  cholera  is,  of  course,  far 
more  open  to  clinical  observation  than  that  of  the  liver  is. 
As  a  general  rule,  there  is  a  considerable  excess  of  bile- 
pigment  in  the  first  urine  passed  in  cholera,  and  even  far 
on  in  convalescence  traces  of  biliary  matter  are  frequently 
present  in  this  excretion. 

It  is  almost  needless  to  say  that,  exceedingly  as  the  types 
of  cholera  vary  from  year  to  year,  and  even  from  week  to 
week,  there  is,  in  every  case,  complete  suppression  of  urine 
during  the  algide  stage  ;  and  that,  however  distinct  the  sub¬ 
sequent  reaction  may  be,  we  are  never  satisfied  that  the 
danger  of  collapse  is  over  until  urine  has  been  passed  ;  and  that 
we  can  never  feel  confident  that  our  patient’s  second  great 
peril,  the  danger  of  uraemia,  is  over  untilthe  free  excretion  of 
perfectly  healthy  urine  is  re-established. 

Dr.  Begbie  found  that  the  first  urine  is  of  diminished 
density,  and  generally  contains  albumen  and  bilious  colour¬ 
ing  matter,  with  the  ordinary  salts,  but  little  or  no  urea. 

In  his  article  on  Cholera,  in  “  Eeynolds’s  System  of  Medi¬ 
cine,”  Dr.  Goodeve  wrote  :  “  At  first  it  ”  [the  urine]  “  comes 
scantily,  high-coloured,  and  an  ounce  or  two,  with  a  strong 
and  peculiar  animal  smell,  deficient  in  urea  perhaps,  but 
not  in  all  animal  principles,  generally  albuminous,  with 
many  transparent  casts.  The  albumen  or  allied  compound, 
when  present,  is  not  always  detected  by  nitric  acid,  though 
often  by  heat,  giving  a  deposit  not  dissolved  by  nitric  acid 
when  the  nitric  acid  test  alone  failed  to  detect  it.  The  urine 
often  turns  pinkish  with  nitric  acid.” 

In  the  cholera  season,  extending  from  February  to  June, 
1868,  I,  with  the  aid  of  my  very  able  House-Physician, 
Baboo  Eaj  Mohun  Banerjee,  commenced  a  series  of  observa¬ 
tions  upon  the  specific  gravity  of  cholera  urine,  which,  with 
an  interruntion  of  twenty  months,  I  continued  until  I  left 
India  at  the  end  of  March,  1876.  The  general  result  of  very 
numerous  observations  was  that  the  first  urine  usually  owes 
its  high  colour  chiefly  to  the  presence  of  bile-pigment. 

I  Blood  has  not  been  detected.  The  fluid  is  turbid.  The 
specific  gravity  is  generally  high,  from  1020  to  1026.  The  re¬ 
action  is  generally  acid.  There  is  commonly  a  sediment  of 
epithelium  desquamated  from  the  renal  tubes.  Albumen  is 
probably  always  present,  most  frequently  in  small  quantity. 
Such  urine  may  be  passed  (the  catheter  has  to  be  used  once 
or  twice  in  many  cases)  twice  or  thrice,  generally  with  a 
high,  but  l'educed,  specific  gravity,  as  1019.  The  case  ad¬ 
vancing  in  progress  to  another  very  distinct  stage,  the  flow 
of  urine  is  more  free,  the  fluid  is  usually  transparent  and 
pale,  and  the  specific  gravity  is  low — from  1012  even  down  to 
1102.  Bile-pigment  is  generally  present,  and  may  fre¬ 
quently  be  detected  up  to  the  time  of  the  patient’s  discharge ; 
it  usually  out-stays  the  albumen.  When  the  case  does  well 
the  albumen  usually  disappears  in  from  one  to  three  days, 
but  I  have  found  it  as  late  as  the  twelfth  day.  Eenal  epi¬ 
thelium  has  been  noticed  as  late  as  the  thirteenth  day. 
During  tardy  convalescence  phosphates  often  appear  in  the 
urine.  Whenever,  in  cholera,  there  are  albumen  and  bile- 
pigment  in  urine  of  a  very  low  specific  gravity,  what  is  now 
generally  called  uraemia,  or,  as  it  appears  more  correct  to  term 
it,  cholo-urcemia,  is  to  be  apprehended  and  resisted. 

The  following  abstracts  of  cases,  taken  from  many,  fairly 
illustrate  these  principles  :  — 

Charles  S.,  admitted  collapsed  March  6,  1868,  at  noon. 
Eeaction  commenced  in  forty-six  minutes. 


370 


Medical  Times  and  Gazette. 


CHEYEES  ON  THE  OBDINAKY  DISEASES  OF  INDIA. 


Sept.  29,  1SS3. 


First  urine  passed  on  the  morning  of  the  7th — scanty, 
high-coloured,  specific-gravity  1024,  traces  of  albumen. 

8th. — Bowels  free ;  no  vomiting  j  urine  free,  specific 
gravity  1012 ;  no  head  symptoms. 

9th. — Vomited  once;  two  stools;  urine  copious,  specific 
gravity  1102,  traces  of  albumen.  Towards  the  evening 
evidences  of  cholo-urmmia  appeared,  he  became  delirious 
and  restless,  was  constipated,  and  vomited  several  times. 

10th. — Specific  gravity  of  urine  1020,  traces  of  albumen 
and  phosphates,  bile-pigment.  The  head  symptoms  passed 
off  and  vomiting  ceased. 

11th. — Doing  well. 

17th. — Discharged. 

Charles  M.,  admitted  in  a  state  of  collapse  July  19, 
1868.  Reaction  took  place  on  the  following  day. 

The  first  urine  was  passed  on  the  21st;  specific  gravity 
1021,  scanty,  turbid,  acid. 

22nd.— Urine  profuse,  limpid,  specific  gravity  1004,  traces 
of  albumen.  There  were  now  symptoms  of  cholo- uraemia — 
dulness,  drowsiness,  constipation,  and  vomiting.  Gentle 
purgation,  sinapisms,  and  fomentations  over  the  loins. 

23rd. — Bowels  moved  several  times ;  vomiting  ceased ; 
urine  free,  specific  gravity  1008,  traces  of  albumen ;  no 
head  symptoms. 

24th. — Urine  contained  traces  of  albumen,  specific  gravity 
1017.  In  other  respects  doing  well. 

25th. — Traces  of  albumen,  specific  gravity  1014. 

26th. — Doing  well.  No  albumen  in  the  urine,  specific 
gravity  1020. 

29th. — Discharged,  well. 

Shiboo,  admitted  collapsed  November  25.  Reaction 
towards  evening. 

26th. — No  urine  ;  head  symptoms,  dulness,  vomiting,  con¬ 
stipation,  laboured  respiration,  with  thickly  coated  tongue 
and  congested  eyes ;  bowels  constipated.  Conjee-water 
injection ;  mustard  poultice  to  loins. 

27th. — No  urine;  uraemic  symptoms;  purgatives,  dry 
cuppiDg  over  the  loins,  fomentation. 

28th. — Urine  scanty,  specific  gravity  1026,  slightly  albu¬ 
minous,  and  with  bile-pigment. 

30th. — Urine  1004,  slightly  albuminous  ;  head  symptoms, 
vomiting,  constipation,  gentle  purgation. 

December  1. — Urine  free,  specific  gravity  1012,  albu¬ 
minous  ;  bowels  open  ;  no  head  symptoms. 

2nd. — Urine  specific  gravity  1016,  traces  of  albumen. 
Doing  well. 

3rd. — Urine  1016,  no  albumen.  Doing  well. 

4th.  — Urine  free,  1018,  no  albumen. 

5th. — Urine  free,  specific  gravity  1022.  Doing  well. 

9th. — Discharged,  well. 

The  following  case  is  singularly  remarkable  for  the  ex¬ 
tremely  low  specific  gravity  of  the  urine,  which  continued 
far  into  convalescence.  At  first  the  urine  was,  as  is  usual, 
of  high  specific  gravity ;  thenceforward,  up  to  the  time  at 
which  he  was  discharged,  apparently  quite  well,  on  the  forty- 
first  day,  its  specific  gravity  did  not  rise  higher  than  1011. 
Moderate,  but  marked,  symptoms  of  cholo-ursemia  were 
observed — drowsiness  on  the  eleventh  day ;  restlessness 
(jactitation)  on  the  third  day ;  and  insomnia  on  the  fourth 
and  sixteenth  nights ;  and  severe  headache  on  the  thirty- 
eighth  day,  when  the  urine  had  the  (in  this  case)  unusually 
high  specific  gravity  of  1011. 

The  continued  presence  of  albumen  in  the  urine  up  to  the 
twelfth  day,  of  epithelium  up  to  the  thirteenth,  and  of  bile 
up  to  the  date  of  his  discharge  on  the  forty-first  day,  taken 
together  with  these  symptoms,  kept  up  constant  apprehen¬ 
sion  of  cholo-urasmia. 

James  W.,  admitted  March  30, 1874,  in  a  state  of  collapse. 
Reaction  took  place  on  the  31st,  and  urine  was  passed  on 
this  day,  specific  gravity  1022,  without  sediment,  but  with 
albumen  and  bile,  bilious  vomiting,  and  purging. 

April  1. — Bladder  relieved  by  catheter  cf  twenty-nine 
ounces  of  urine  of  acid  reaction,  albumen  about  one-sixth, 
and  bile  present,  no  sediment,  specific  gravity  1019. 

During  the  next  six  days  he  made  water  freely ;  stools 
loose. 

On  April  8  (tenth  day)  the  specific  gravity  was  1020,  acid, 
with  slight  traces  of  albumen. 

On  the  9th  (eleventh  day  of  illness)  tliero  was  a  tendency 


to  vomit ;  there  were  five  brownish-yellow  stools.  The 
urine  was  1010,  slightly  albuminous,  and  it  is  noted  that  he 
was  somewhat  drowsy. 

On  the  10th  the  urine  was  of  the  same  specific  gravity, 
with  a  slight  trace  of  albumen. 

11th.  — Specific  gravity  1012,  no  albumen. 

13th.— Specific  gravity  1006,  reaction  alkaline. 

The  urine  continued  to  be  alkaline  until  April  21  (twenty- 
third  day),  when  it  became  slightly  acid,  with  a  specific 
gravity  of  1011. 

Thenceforward  the  reaction  continued  to  be  acid. 

The  stools  were  frequent  and  thin  up  to  the  fourteenth 
day.  On  the  sixteenth  day  there  were  only  two  semi- solid 
stools  and  no  vomiting,  and  the  specific  gravity  of  the  urine 
was  as  low  as  1004 ;  insomnia  was  complained  of.  On  the 
seventeenth  day  there  was  only  one  stool,  no  vomiting,  the 
specific  gravity  of  the  urine  was  still  1004 ;  the  patient  had 
slept  well.  On  the  eighteenth  day  there  had  been  a  stool  in 
the  night,  and  there  was  another  late  in  the  day ;  the  specific 
gravity  of  the  urine  was  only  1002.  On  the  following  day 
also  there  were  two  stools ;  no  vomiting  ;  he  had  slept  well  ; 
the  specific  gravity  of  the  urine  was  1004.  On  the  seven¬ 
teen  succeeding  days  on  which  the  urine  was  examined,  the- 
range  of  specific  gravity  was  1010,  1009,  1010,  1006, 1010, 
1007,  1005,  1006,  1008,  1010,  1011,  1010,  1009,1010,1010, 
1011,  1008.  During  the  whole  of  this  latter  period  the  rule 
was  one  stool  in  the  twenty-four  hours,  and  the  appetite  was 
generally  good. 

This  case  shows  that,  while  a  very  low  specific  gravity  of 
the  urine  after  cholera  is  always  to  be  viewed  as  an  indica¬ 
tion  for  extreme  watchfulness  of  the  patient’s  condition,  and 
for  caution  in  treatment  and  dieting,  it  is  not  by  any  means 
invariably,  as  regards  prognosis,  an  extremely  grave  sign. 
Still  it  will  be  noticed  that,  on  the  tenth  day  of  the  illness, 
there  was  urine  of  the  specific  gravity  of  1020,  with  slight 
traces  of  albumen ;  on  the  following  day,  the  urine  being 
still  albuminous,  the  specific  gravity  suddenly  fell  to  1010; 
and  drowsiness  was  observed ;  the  bowels  were,  however, 
free.  Again,  when,  on  the  sixteenth  day,  there  were  only  two 
semi-solid  stools  without  vomiting,  the  specific  gravity  cf 
the  urine  being  so  low  as  1004,  there  was  insomnia. 

When  I  first  assumed  my  charge  at  the  Medical  College* 
Hospital,  in  the  cholera  season  of  1862,  1  found  that  my 
colleagues  had  an  established  system  of  treating  the  collapse 
stage  of  cholera.  Their  leading  objects  were  : — 

1st.  To  arrest  Vomiting  and  Purging. — The  rice-water 
evacuations  were  regarded  as  being,  potentially,  haemor¬ 
rhage.  This  was  to  be  checked  by  styptics,  principally 
acetate  of  lead ;  but  opium  and  other  narcotics  were  to  be 
avoided  as  tending  to  produce  uraemia,  in  the  reaction  stage, 
by  locking  up  the  excretions. 

2ndly.  To  obtain  Reaction. — Diffusible  stimulants,  espe¬ 
cially  aromatic  spirit  of  ammonia,  were  given  steadily  every 
quarter  to  half  an  hour  until  reaction  set  in.  The  body 
and  limbs  were  rubbed  with  dry  ginger  powder  by  relays 
of  active  ward  coolies — one  to  each  limb.  Large  sinapisms 
were  applied  to  the  praecordial  region  and  abdomen. 

I  then  adopted  and  generally  adhered  steadily  (except 
when  new  plans  of  treatment,  which  appeared  to  deserve 
trial,  failed  in  my  hands)  to  my  colleagues’  therapeutic- 
principles  in  treating  the  collapse  stage ;  but  I  made  some; 
changes  in  the  details  of  their  treatment.  In  choosing  a 
styptic,  I  preferred  tannic  acid  (ten  grains  after  the  first, 
and  five  grains  after  every  subsequent  rice-water  evacuation, 
whether  by  stool  or  vomiting)  to  acetate  of  lead,  which,  if 
absorbed,  was  likely  to  act  as  a  depressant.  To  ammonia  I 
objected  on  account  of  its  affinity  to  urea,  and  I  always  pre¬ 
ferred  chloric  ether  as  a  diffusible  stimulant.  I  ordered  dry 
ginger  friction  only  to  the  trunk  of  the  body,  considering 
that  rubbing  the  extremities  could  only  tend  to  increase  the- 
already  excessive  congestion  of  the  vessels  of  the  great 
cavities.  I  therefore  had  eight  hot-water  bottles,  frequently 
changed,  in  bags  of  thick  flannel  applied  to  the  limbs  and 
trunk  in  every  case,  and  had  recourse  to  strong  shampooing 
(kneading)  of  the  limbs  only  when  cramp  was  present. 

Sydenham  gave  Opium  in  cholera,  and  specially  thanked' 
Providence  for  the  gift ;  but  Copland  tells  us  that  Frank 
and  Sclimidtmann  justly  acknowledged  the  importance  of 
Sydenham’s  observation  that,  when  opium  “is  given  too  early,, 
much  disorder  of  the  bowels  and  abdominal  organs,  with) 
1  more  or  less  fever,  continues  afterwards  to  be  complained  of,. 


Aledical  Times  and  Gazette. 


CHEVERS  OX  THE  ORDINARY  DISEASES  OF  INDIA. 


Sept.  29,  18E3.  371 


evidently  owing  to  the  arrest  of  a  salutary  effort,  and  the 
retention  of  morbid  secretions.”  How,  then,  would  these 
authorities  have  explained  the  undoubted  good  which  opium 
effects  in  absolutely  arresting  the  premonitory  diarrhoea  P 
Macpherson  gives  opium  in  the  premonitory  diarrhoea,  and 
considers  that,  in  the  invasion  of  cholera,  opium  (laudanum) 
“  is  still  our  chief  remedy  for  a  time.”  When  collapse  is 
accompanied  with  a  tendency  to  stupor,  violent  vomiting 
and  purging  having  ceased,  he  takes  it  for  granted  that 
opium  will  have  been  given  up.  I  certainly  would  not  give 
opium  where  vomiting  and  purging  were  not  exhausting  the 
patient,  and  where  stupor  was  threatened.  Macnamara 
gives  opium  in  the  early  stages,  but  not  in  collapse,  even 
when  frequent  purging  and  vomiting  continue.  Drs.  Aitken 
and  Fergus  maintain  that  opium  is  only  to  be  given  “  if  the 
evacuations  are  still  bilious,  the  pulse  fair,  and  the  skin 
warm,”  and  insist  that  “  when  vomiting,  rice-water  purging, 
and  cramp  set  in,  it  is  then  too  late  for  opium.”  In  my 
hospital  practice  I  scarcely  ever  saw  a  case  of  cholera  which 
had  not  advanced  at  least  to  this  latter  stage  ;  and  it  was 
then  that,  in  respectful  non-concurrence  with  authority, 
I  gave  opium.  I  long  eschewed  its  use,  except  in  pre¬ 
monitory  diarrhoea;  but,  as  my  views  regarding  cholo- 
urannia  became  clear,  I  gave  laudanum  a  cautious  trial  in 
the  collapse  stage,  and  afterwards  generally  used  it.  I 
think  that  it  aids  the  tannic  acid  in  arresting  the  gastric 
and  alvine  evacuations,  every  one  of  which  reduces  the 
patient’s  vital  powers  distinctly  a  step  lower.  It  aids  the 
stimulant  action  of  the  chloric  ether ;  and  if  it  does,  as  I 
believe  it  does,  assist  our  first  therapeutic  triumph,  the  esta¬ 
blishment  of  reaction,  we  have  no  reason  whatever  to  assume 
that  it  interferes  with  the  restoration  of  the  functions  of  the 
liver  ’and  kidneys.-  Even  if  it  be  assumed  that  it  does  so, 
there  lies  before  us  the  necessity  of  bringing  about  reaction, 
and  we  have  at  our  command  a  clear  line  of  treatment  for 
the  cholo-ursemia. 

The  patients  were  well  watched,  the  laudanum  was  given 
cautiously,  and  was  not  continued  after  the  rice-water 
evacuations  had  ceased.  Thus  used,  I  never  saw  it  cause 
stupor  or  any  other  evil  effect. 

Although  there  may  be  no  great  power  of  absorbing  drugs 
into  the  system  during  the  algide  stage,  astringents,  stimu¬ 
lants,  and  opium  certainly  do  appear  to  act.  It  has  been 
observed  that,  in  most  great  outbreaks  of  pestilence,  persons 
die  suddenly,  almost  without  symptoms.  They  fall,  perhaps 
in  the  streets,  struck  down  and  overwhelmed  by  the  con¬ 
centrated  intensity  of  the  poison.  I  know  of  cases  of 
cholera  in  which  death  occurred,  without  vomiting,  after 
one  or  two  gelatinous  stools.  At  the  commencement  of 
cholera  outbreaks,  when  the  natural  tendency  to  death  is 
at  its  maximum,  we  shall,  I  fear,  always  lose  patients  in  the 
stage  of  collapse,  but  many  patients  are  brought  out  of  a 
state  of  pulseless  collapse  by  the  treatment  described  above. 

We  have  shown  that  the  first  urine  passed  after  an  attack 
of  Asiatic  cholera  is  generally  acid  and  turbid  from  inflam¬ 
matory  products  or  organic  debris,  and  contains  albumen 
and  bile-elements.  Its  specific  gravity  is  high,  apparently 
only  in  consequence  of  the  presence  of  the  above  products. 

As  the  urine  becomes  limpid,  its  solid  matters  as  well  as 
the  albumen  and  bile-elements  diminish,  and  the  specific 
gravity  is  almost  always  low.  When  it  is  slow  in  losing  its 
albumen,  and  remains  of  a  specific  gravity  between  1002  and 
1010,  and  there  is  a  tendency  to  constipation,  cholo-ursemic 
danger  must  be  apprehended,  and  vigilantly  and  actively 
guarded  and  fought  against. 

That  dangei'ous  complication  which,  setting  in  rather  late 
in  the  algide  stage,  or  almost  at  any  period  before  the  excre¬ 
tive  functions  of  the  kidneys  and  liver  have  become  re¬ 
established,  destroys  multitudes  of  cholera  patients  by  blood- 
poisoning  (constituting  the  second  and  last  great  peril  of 
cholera,  collapse  being  the  first)  is  generally  called  urcemia. 
To  be  understood  etiologically  and  to  be  treated  with  success, 
it  must,  however,  be  recognised  and  dealt  with  as  Cholo- 
JJrcemia ,  because  in  it  we  have,  in  the  bile-pigmented  albu¬ 
minous  urine  of  very  low  specific  gravity,  and  also  in  the 
absence  of  the  free  bilious  stools,  which  latter  are  essential 
to  recovery  from  cholera.,  evidences  that  the  terrible  condi¬ 
tion  of  blood-poisoning,  with  which  we  have  to  grapple,  is 
due  to  failure  equally  of  Hepatic  and  Renal  elimination. 

When  the  renal  and  hepatic  tissues  have  been  previously 
healthy, the  uraemia  and  chohemia  of  cholera  are  attributable, 
first,  to  congestion  of  the  kidneys  and  liver,  and,  secondly,  to 


lack  of  fluid  in  the  system.  Cholo-uraemia  can  be  best  guarded 
against  by  the  use  of  large  and  repeated  sinapisms  over  the 
liver  and  kidneys,  by  dry-cupping  over  the  kidneys;  the 
steady  application  of  a  pillow-case  half -filled  with  hot  dry 
bran,  in  which  the  patient  lies ;  large  hot  linseed-meal  or 
soojee  cataplasms  to  follow  the  sinapisms  over  the  liver  and 
loins  ;  and  the  free  use  of  nature’s  own  diuretics,  water  and 
milk.  Dr.  Goodeve  says  “  water  is  the  best  diuretic.”  After 
cholera  I  have  never  dared  to  irritate  the  kidneys  by  more 
stimulating  direct  diuretics.  These  organs  can,  at  this  most 
critical  period,  only  be  solicited  by  the  use  of  bland  demul¬ 
cent  fluids,  supplying  the  place,  of  that  which  the  cholera 
flux  has  almost  completely  drained  the  system  of.  Attempts 
to  compel  them  to  act  can  only  tend  to  produce  arterial  con¬ 
gestion  and  uraemia.  Still,  even  in  the  present  day,  there 
are  some  otherwise  judicious  practitioners  who,  becoming 
impatient  at  the  slowness  with  which  the  congested  serum- 
exuding,  desquamating  kidneys  begin  to  act,  while  yet 
unsupplied  with  that  water  without  which  urine  cannot  be 
made,  are  unable  to  refrain  from  goading  these  already  suffi¬ 
ciently  over-burthened  organs  into  premature  action.  One 
thinks  that  “  a  few  doses  of  benzoate  of  ammonia”  will  act 
as  a  gentle  diuretic, — as  if  the  kidneys  were  not  already  suffi¬ 
ciently  troubled  in  a  struggle  to  void  urea  !  Another  uses 
“  solutions  of  the  chlorate  of  potash  and  the  like”;  and  a 
third  is  only  satisfied  when  he  has  added  fire  to  fire  by 
administering  the  tincture  of  cantharides  ! 

In  his  remarks  upon  the  treatment  of  the  diarrhoea  which 
follows  cholera,  a  modern  writer  tells  us  that — “  In  those 
cases  that  are  connected  with  defective  secretion  of  urea, 
turpentine,  either  by  the  mouth  or  applied  externally,  is 
very  useful.”  We  are  not  surprised  to  find  that  he  adds — 
“  Cases  of  this  nature  are  very  obstinate,  often  continuing 
for  months,  and  generally  requiring  change  of  air  to  the 
seaside,  or  a  long  sea-voyage  to  complete  the  cure.”  This- 
recalls  the  case  of  congestion  of  the  posterior  part  of  the- 
liver,  which  I  have  cited  in  a  previous  chapter,  in  which  we 
are  told  that,  although  the  patient  was  bled  three  times  to* 
deliquium,  recovery  was  tardy ! 

In  treating  cholera  I  have  always,  on  chemical  grounds,, 
avoided  the  use  of  ammonia  in  any  form  ;  and  have,  in  con¬ 
sideration  for  the  state  of  the  kidneys,  interdicted  the  use  of' 
cantharides  blisters,  and  have  even  refrained  from  the  use 
of  turpentine  stupes. 

[To  be  continued .) 


Tuberculosa  Dolorosa. — After  giving  an  account  of 
a  case  operated  upon  by  Prof.  Genzmer,  Dr.  Eohrschneider 
refers  to  the  other  cases  that  have  been  recorded  of  pain¬ 
ful  subcutaneous  tumours.  These  he  found  to  be  60  in 
number,  35  having  occurred  in  females  and  24  in  males 
(the  sex  in  one  case  not  stated).  As  to  the  situation 
of  the  tumours,  this  was  on  the  lower  extremities  in 
29,  on  the  upper  in  23,  on  the  back  in  2,  on  the  chest 
in  2,  on  the  head  and  scrotum  each  in  1.  In  only  three 
cases  were  they  multiple ;  and  their  course  was  chronic, 
without  any  essential  disposition  to  increase  (the  Dauer- 
geschwiilste  of  Virchow).  Their  structure  exhibits  no  ana¬ 
tomical  identity,  and  they  have  been  met  with  as  true  and 
false  neuroma,  enchondroma,  fibroma,  and  erectile  tumour, 
especially  angioma.  The  case  operated  upon  by  Genzmer 
related  to  a  woman  thirty  years  of  age,  who  suffered  from 
violent  pain  due  to  a  tumour,  the  size  of  a  hempseed,  in  the 
temporal  region.  After  its  excision  this  tumour  was  found 
to  consist  of  a  cavernous  structure,  without  any  trace  of 
nervous  tissue. —  Oentralblatt  fur  Chirurgie,  August  18. 

Obligatory  Vaccination  in  French  Schools. — The 
Prime  Minister,  M.  Ferry,  has  just  addressed  the  following 
circular  to  the  rectors  of  French  lyceums  and  colleges : — 
“  In  a  recent  discussion  at  the  Hospital  Medical  Society,  the 
excellent  results  which  have  attended  the  enforcement  of 
obligatory  vaccination  at  the  Lycee  Louis-le- Grand  were 
brought  forward  and  made  the  ground  of  a  request  to  me 
that  my  administration  should  render  this  procedure  general 
in  all  the  establishments  connected  with  the  State.  Since 
revaccination  has  become  obligatory  for  every  new  pupil 
entering  the  Lycee  Louis-le-Grand,  no  case  of  variola  or 
varioloid  has  occurred.  Persuaded  that  the  measure  de¬ 
manded  by  the  Society  can  only  be  productive  of  beneficial 
results,  I  have  decided  that  revaccination  shall  be  made 
obligatory  for  all  boarding  pupils  at  the  lycees  and  colleges.” 


372 


Medical  Times  and  Gazette. 


MEECIER  ON  RESPONSIBILITY  IN  LAW. 


Sept.  29,  1883. 


RESPONSIBILITY  IN  LAW. 

By  CHARLES  MEECIER,  M.B. 

In  the  recent  trial  of  William  Gouldstone  for  the  murder  of 
his  children,  the  counsel  for  the  prosecution  and  the  learned 
judge  who  tried  the  case  differed  materially  in  their  state¬ 
ment  of  the  law  with  regard  to  the  responsibility  of  a 
criminal,  and  both  of  them  differed  from  the  interpretation 
given  by  Mr.  Justice  Stephen.  Mr.  Poland  told  the  jury 
that  “  if  the  prisoner  knew  the  nature  and  quality  of  the 
act  he  was  committing,  and  that  it  was  a  crime,  he  was 
responsible  to  the  law  for  that  act.”  Mr.  Justice  Day 
charged  them  that  ‘‘if  they  found  that  the  prisoner  knew 
the  nature  and  quality  of  the  act  when  he  killed  his  children, 
and  that  he  was  not  of  unsound  mind,  they  must  find  him 
guilty.”  Mr.  Justice  Stephen,  in  his  “History  of  the 
Criminal  Law,”  lays  down  that  “  no  act  is  a  crime  if  the 
person  is,  at  the  time  when  it  is  done,  prevented  [either  by 
defective  mental  power  or]  by  any  disease  affecting  his 
mind — (<x)  from  knowing  the  nature  and  quality  of  his  act, 
or  (&)  from  knowing  that  the  act  is  wrong  [or  (c)  from  con¬ 
trolling  his  own  conduct,  unless  the  absence  of  the  power  of 
control  has  been  produced  by  his  own  default].”  The  parts 
included  in  brackets  are  given  as  doubtful. 

Ho  one  who  has  had  any  experience  in  insanity  can,  I 
think,  doubt  that  Gouldstone  is  insane.  1  do  not  inteud  to 
argue  the  case — and,  fortunately,  it  is  so  plain,  that  argu¬ 
ment  is  not  needed, — but,  assuming  that  he  is  insane,  it 
may  be  interesting  to  inquire  which  of  the  three  statements 
of  law  given  above  will  most  completely  cover  the  facts  of 
the  case,  and  which  will  be,  from  the  point  of  view  of  the 
alienist,  the  most  satisfactory. 

If  Mr.  Poland’s  statement  of  the  law  is  correct,  the  man 
was  justly  convicted,  for  it  is  certain  that  he  “knew  the 
nature  and  quality  of  the  act  he  was  committing,  and  that 
it  was  a  crime.”  According  to  the  hypothesis  that  the  man 
is  insane,  this  is,  therefore,  not  a  complete  statement  of  the 
law ;  and,  when  it  is  examined,  the  expression  is  found  to  be 
nothing  more  than  a  new  rendering  of  the  old  test  of  the 
“knowledge  of  right  and  wrong,” — a  test  which  has  long  been 
discredited,  exploded,  and  rejected. 

According  to  the  first  two  of  the  criteria  of  Mr.  Justice 
Stephen  (the  only  criteria  that  he  regards  as  certain),  the 
conviction  was  just,  for  these  are  substantially  the  same  as 
those  given  by  Mr.  Poland.  Even  if  we  give  the  prisoner 
the  benefit  of  the  doubt  that  rests  on  the  third  criterion,  it 
does  not  seem  of  any  service  to  him,  for  it  is  very  difficult  to 
know  what  is  meant  by  “the  power  of  controlling  his  own 
conduct,”  and  still  more  difficult  to  say  in  such  a  case  as 
that  of  Gouldstone  how  far  he  did  or  did  not  possess  this 
power.  The  expression  was,  it  appears,  intended  to  cover 
the  rare  cases  of  sudden  and  uncontrollable  impulse,  and 
would  scarcely  be  allowed  to  apply  to  an  act  deliberately 
undertaken. 

There  remains,  then,  the  very  comprehensive  statement 
of  Mr.  Justice  Day;  but  this  statement,  as  reported  in  the 
Times,  admits  of  more  than  one  interpretation.  “  If,”  said 
the  learned  judge,  “  the  jury  found  that  the  prisoner  knew 
the  nature  and  quality  of  the  act  when  he  killed  his 
children,  and  that  he  was  not'  of  unsound  mind,  they  must 
find  him  guilty.”  The  words  that  I  have  italicised  maybe 
understood  in  two  senses.  They  lhay  be  taken  as  merely 
expressing  over  again  the  idea  Contained  in  the  previous 
sentence.  It  may  be  that  the  learned  judge  intended  the 
jury  to  understand  that,  “  if  they  found  that  the  prisoner 
knew  the  nature  and  quality  of  his  act,  which  was  legally 
equivalent  to  saying  that  he  was  not  of  unsound  mind,  they 
must  find  him  guilty.”  Against  this  reading  must  be  set 
the  fact  that  judges  are  not  accustomed  to  express  them¬ 
selves  in  this  loose  and  tautologous  manner;  and  it  is  ex¬ 
tremely  unlikely  that  in  an  important  trial  for  murder  a 
judge  would  state  the  law  to  the  jury  in  such  ambiguous 
terms.  It  seems  clear  that  the  words  are  to  be  understood 
in  their  logical  and  literal  and  unstrained  meaning,  as 
stating  a  second  issue  to  the  jury.  To  find  the  prisoner 
guilty,  they  must  find,  first,  that  he  knew  the  nature  and 
quality  of  the  act;  in  addition  to  this  they  must  find  that 
he  was  not  of  unsound  mind ;  and  unless  they  were  satisfied 


on  both  these  points  they  must  bring  in  a  verdict  of  not 
guilty.  The  two  issues  are  by  no  means  equivalent ;  they 
are,  in  fact,  widely  different.  A  sane  man  may  commit  a 
crime  without  knowing  the  nature  and  quality  of  his  act, 
as  has  occurred  in  some  cases  of  somnambulism ;  and  the 
inmates  of  lunatic  asylums  are  very  frequently  guilty  of 
acts  that  in  the  outer  world  would  be  called  criminal, 
knowing  full  well  the  nature  and  quality  of  those  acts.  If 
Mr.  Justice  Day’s  charge  to  the  jury  is  to  be  under¬ 
stood  in  this  sense,  it  is  the  most  important  departure  that 
has  been  taken  in  the  criminal  jurisprudence  of  insanity 
since  the  memorable  case  cf  McNaughten  ;  and  it  seems  to 
me  the  most  thoroughly  satisfactory  interpretation  of  the 
law  that  has  yet  been  given.  Mr.  Justice  Stephen’s  state¬ 
ment  is  a  great  advance  upon  everything  that  has  gone 
before ;  but  this  last  interpretation  is  much  better,  not  only 
because  it  is  more  comprehensive,  which  is  very  important, 
but  because  it  sets  up  no  rigid  test  of  insanity,  which  is 
more  important  still.  To  the  legal  mind  this  will  appear  a 
disadvantage,  and  if  there  were  any  prospect  that  juries 
would  take  an  unconscientious  or  even  a  latitudinarian  view 
of  their  duties,  no  doubt  it  would  be  so.  But  there  is  no 
such  danger.  Juries  have  never  shown  themselves  eager  to 
admit  the  plea  of  insanity  in  criminal  cases.  On  the  con¬ 
trary,  their  reluctance  to  admit  this  plea  is  extreme,  and 
even  excessive.  From  the  year  1863  to  18S2  the  number  of 
prisoners  acquitted  on  the  ground  of  insanity  was  116, 
while  the  number  of  those  who  were  convicted  and  after 
conviction  were  certified  to  be  insane  was  no  fewer  than  641. 
Part  of  this  discrepancy  is  owing,  no  doubt,  to  the  present 
state  of  the  law ;  but  when  juries  have  been  prejudiced 
against  the  law,  they  have  rarely  failed  to  bring  in  verdicts 
of  acquittal  even  against  the  clearest  evidence  and  in  the 
teeth  of  the  most  positive  ruling  of  the  judges ;  and  the 
figures  given  above  are  of  themselves  sufficient  to  show  that 
the  rigidity  of  the  law  with  regard  to  the  insanity  of  crimi¬ 
nals  may  be  considerably  relaxed  without  any  danger 
of  exceeding  the  wide  margin  of  safety  that  at  present 
lies  beyond  it.  The  view  which  regards  every  man  who 
commits  a  crime  as  ipso  facto  insane  appears  to  me  fanatical 
and  untenable ;  but  since  the  law  admits  that  a  madman 
should  not  be  punished  for  a  crime  arising  out  of  his  mad¬ 
ness,  it  is  but  logical  and  consistent  to  desire  that  the 
application  of  the  law  should  be  efficient,  which  cannot,  I 
think,  be  said  of  it  at  present.  In  almost  every  case  in 
which  the  plea  of  insanity  has  broken  down,  and  yet  the 
prisoner  has  been  afterwards  admitted  to  be  insane — and 
such  cases  are  not  very  uncommon, — the  plea  has  been 
rejected  because  the  prisoner  failed  to  satisfy  the  test  of 
insanity  that  the  law  or  its  interpreters  imposed.  As  this 
has  happened  in  cases  in  which  the  insanity  of  the  criminal 
was  beyond  all  question,  and  was  admitted  to  be  so  by  his 
reprieve  and  his  committal  to  an  asylum,  the  onus  of  the 
failure  of  justice  lies,  it  is  evident,  upon  the  test ;  indeed, 
this  has  been  practically  admitted  by  the  variations  in  the 
test  that  have  from  time  to  time  been  made.  Every  test 
that  has  yet  been  proposed  has  broken  down  in  practice  and 
has  had  to  be  modified.  Even  Mr.  Justice  Stephen  proposes 
a  modification  for  his  own  test,  and  then  is  doubtful  about  the 
propriety  of  the  modification.  If  so  learned  a  lawyer  and 
so  able  a  man  as  Sir  James  Stephen  is  unable  to  propound 
a  test  that  is  satisfactory,  we  may  well  believe  that  the  task 
is  impossible,  at  any  rate  at  present ;  and  this  is  the  conclu¬ 
sion  to  which  the  facts  appear  to  me  imperatively  to  point. 
So  long  as  the  test  of  the  knowledge  of  right  and  wrong, 
or  that  variation  of  it  which  is  at  present  in  vogue,  must 
be  satisfied  by  the  lunatic  criminal,  so  long  cases  of  great 
injustice  will  from  time  to  time  occur  in  the  future  as  they 
have  occurred  in  the  past.  It  must  be  admitted,  on  the 
medical  side,  that  no  satisfactory  test  of  insanity  has  yet 
been  discovered ;  and  it  is  surely  better  to  admit,  on  the 
legal  side,  that  no  test  at  all  is  better  than  one  which  breaks 
down  in  practice,  which  leads  to  terrible  mistakes,  and  which 
even  its  author  is  obliged  to  modify. 

If,  then,  every  individual  test  is  declared  to  be  insufficient 
and  to  leave  a  certain  number  of  cases  to  which  it  does  not 
apply,  lawyers  have  a  right  to  ask  what  alternative  is  pro¬ 
posed.  The  alternative  is  that  propounded  by  Mr.  Justice 
Day,  and  the  course  that  he  took  seems  to  me  not  only  more 
in  accordance  with  our  knowledge  of  insanity,  but  even  better 
adapted  to  the  forms  of  legal  procedure  than  the  method 
1  which  I  hope  it  will  displace.  The  verdict  of  the  jury  in 


Medical  Times  and  Gazette. 


MEDICAL  AND  SUEGICAL  PEACTICE. 


Sept.  29,  1883.  3  73 


cases  of  lunatic  criminals  is  not "  Guilty,  but  he  did  not  know 

right  from  wrong  ”;  it  is  not  “  Guilty,  but  he  did  not  know 
the  nature  and  quality  of  his  act  it  is  not  “  Guilty,  but 
he  did  not  know  that  he  was  committing  a  crime,”— it  is 
“  Guilty,  but  insane.”  Why  should  not,  then,  the  two  issues 
be  left  to  the  jury — Did  this  man  do  the  act  ?  and.  Was  he 
sane  at  the  time  he  did  it  ?  They  would  not  then  have  to 
find  whether  the  man  was  capable  of  forming  this  or  that 
particular  judgment— a  finding  that  can  never  be  hiore  than 
a  guess ;  for  which  safe  guidance  can  rarely  be  obtained,  the 
facts  bearing  on  it  being  necessarily  few  and  equivocal; 
a  finding  which,  when  found,  is  not  a  trustworthy  criterion 
of  his  sanity.  They  would  have  to  conclude,  not  merely  from 
the  opinion  of  experts,  but  from  the  entire  mass  of  evidence 
before  them,  whether  the  man  was  sane  or  insane.  Should  it 
be  said  that  such  a  finding  would  relax  too  much  the  rigour 
of  the  law,  and  that  all  insane  people  are  not  irresponsible 
upon  all  points,  it  would  be  easy  to  add  a  limitation.  Let 
it  be  left  to  the  jury  to  say  whether  the  man’s  mind,  as  a 
whole,  was  so  disordered  that  the  crime  he  is  charged  with 
can  fairly  be  considered  the  result  of  his  insanity.  Such  an 
issue  would  surely  satisfy  the  requirement  of  the  law,  that 
no  guilty  person  shall  escape  conviction  ;  and,  on  the  other 
hand,  it  would  to  a  large  extent  provide  against  the  occur¬ 
rence,  which  is  a  reproach  to  our  legal  system,  of  a  convic¬ 
tion  followed  by  the  admission  that  the  criminal  was  insane 
when  tried.  A  minor  advantage  would  be  that  it  would 
relieve  expert  witnesses  from  the  heavy  responsibility  of 
saying  that  a  prisoner  can  in  all  probability  distinguish 
right  from  wrong,  and  in  so  saying  being  understood  to 
make  the  admission  that  he  is  sane,  when  their  opinion 
may  be  most  positive  that  he  is  mad. 


Rumination  by  Lunatics. — In  a  communication  to 
the  Societe  des  Sciences  Medicales  de  Lille,  Dr.  Bouchoud 
observed  that  rumination  in  man  has  been  hitherto  regarded 
as  a  pathological  rarity ;  but,  in  fact,  it  is  not  uncommon,  at 
least  in  lunatic  asylums.  Thus,  at  the  asylum  at  Lommelet, 
fourteen  patients  who  ruminated  were  met  with — viz.,  eleven 
idiots  among  100,  and  three  among  570  lunatics.  Several  of 
these  individuals  ruminated  before  presenting  any  signs  of 
insanity,  so  that  this  feature  may  possess  some  prognostical 
importance. — Revue  de  Therapeutique,  September  1. 

The  New  Hypnotic,  Paraldehyde. — This  is  a  poly¬ 
meric  modification  of  aldehyde.  What  is  aldehyde  ?  This 
is,  in  brief,  alcohol  deprived  of  its  hydrogen,  and,  although 
a  generic  term  applied  to  a  group,  means  in  this  connexion 
acetic  aldehyde.  Paraldehyde,  being  merely  the  same  sub¬ 
stance  in  respect  to  its  number  of  atoms,  but  which  are 
arranged  differently,  may  be  suspected  to  have  analogous 
properties.  Pot-  medicinal  administration  the  dose  ranges 
from  half  a  drachm  to  two  drachms  and  a  half,  and  it  is 
said  that  the  best  results  are  attained  from  the  maximum 
dose.  In  the  trials  that  have  been  made,  paraldehyde  has 
proved  to  be  an  admirable  hypnotic,  possessing  most  of  the 
qualities  and  none  of  the  dangers  of  chloral.  It  acts  first 
on  the  cerebral  hemispheres,  and  causes  torpor  without  the 
preliminary  excitement  so  common  in  the  action  of  the 
sleep-producing  class.  After  the  hemispheres  the  action 
extends  to  the  medulla  oblongata,  and  then  to  the  cord. 
A  lethal  dose  suspends  the  functions  of  the  medulla  and  the 
respiratory  centre,  and  the  action  of  the  heart  ceases  after 
the  respiration.  In  respect  to  the  effect  on  the  heart,  par¬ 
aldehyde  is  far  safer  than  chloral.  Indeed,  it  appears  to  be 
free  from  the  danger  which  renders  the  administration  of 
chloral  in  large  doses  so  doubtful  an  expedient.  Its  effect 
as  a  hypnotic  is  not  so  persistent  as  that  of  chloral,  but  it 
may  be  maintained  by  the  repetition  of  sufficient  doses.  No 
ill-effects  of  any  kind — no  after-nausea,  or  depression,  or 
headache — have  been  observed  to  follow  its  very  free  ad¬ 
ministration.  It  may  be  prescribed  as  a  hypnotic  in  fevers, 
rheumatism,  gout,  prurigo,  etc.  It  is,  however,  in  mental 
and  nervous  disorders  that  it  will  probably  be  most  used. 
By  the  Italians  it  has  been  prescribed  with  very  marked 
success  in  acute  mania,  in  the  wakefulness  of  dementia 
paralytica,  in  hysterical  paroxysms,  and  in  insomnia  arising 
under  ordinary  conditions.  They  have  found  it  especially 
useful  in  the  form  of  wakefulness  caused  by  the  fear  of 
inability  to  sleep.  Surely,  if  these  statements  be  confirmed, 
an  important  remedy  has  been  discovered  iff  paraldehyde .  — 
Phil.  Med.  News,  July  28. 


REPORTS  OF 

HOSPITAL  PRACTICE  IN  MEDICINE 
AND  SURGERY. 

- • - 

EAST  LONDON  HOSPITAL  FOE  CHILDREN. 

ACCIDENTAL  INGESTION  OF  BELLADONNA- 
SYMPTOMS— RECOVERY. 

(Under  the  care  of  Dr.  EUSTACE  SMITH.) 

[From  notes  by  Mr.  F.  S.  Stone,  Resident  Clinical  Assistant.] 
Grace  B.,  aged  three  years,  was  admitted  into  the  hospital 
on  July  13,  1833.  She  was  said  to  have  swallowed  a  quantity 
of  a  mixture  of  extract  of  belladonna  and  of  glycerine  (which 
her  mother  was  using  to  arrest  lactation),  in  the  proportion 
of  one  part  of  the  extract  to  four  of  glycerine.  Her  fingers 
and  face  and  clothes  were  smeared  with  it  when  she  was 
admitted,  about  half-andiour  later.  The  child’s  friends  stated 
that  she  had  vomited  twice  since,  bringing  up  each  time  about 
two  ounces  of  dark  brown  (grumous)  material. 

On  admission  the  following  note  was  made : — There  is 
(at  12.40  p.m.),  a  bright  red  flush  on  the  face,  upper  half  of 
trunk  (specially  the  right  lateral  region),  and  legs,  which 
disappears  on  pressure.  It  had  appeared  first  about  a 
quarter  of  an  hour  before  she  was  brought.  The  child’s 
utterance  is  distinctly  impaired.  She  complains  of  thirst, 
and  says  she  cannot  see  her  mother  plainly.  The  eyes  are 
prominent  and  sparkling,  and  the  pupils  widely  dilated; 
they  do  not  act  to  light  either  directly  or  indirectly.  The 
skin  is  dry  and  hot.  Pulse  120,  regular,  but  feeble.  Respira¬ 
tions  40,  shallow  and  painless. 

Treatment. — -An  emetic,  consisting  of  eight  grains  of 
sulphate  of  copper  with  a  tablespoonful  of  mustard-flour, 
was  given. 

The  child  vomited  about  five  minutes  afterwards.  The 
ejected  material  smelt  strongly  of  belladonna  ;  it  contained 
also  undigested  food  and  gastric  mucus. 

12.50  p.m. — The  stomach  was  then  well  washed  out  with 
warm  water  by  the  aid  of  a  stomach-pump  until  the  water 
returned  quite  clear.  Subsequently  a  teaspoonful  of  animal 
charcoal  was  given,  suspended  in  mucilage  and  water. 

1  p.m. — She  is  quite  delirious;  “fancies  she  is  playing  at 
school  ”;  occasionally  tosses  her  arms  about.  If  anything 
is  placed  in  either  hand  it  is  immediately  dropped.  There 
is  general  muscular  flaccidity.  The  breathing  is  stertorous; 
alse  nasi  working.  Respirations  34,  shallow  and  painless ; 
pulse  128,  weak  and  irregular. 

1.10  p.m. — Passed  two  ounces  of  pale  brown  urine  in  the 
bed.  On  attempting  to  give  her  a  drachm  of  brandy  in  a 
cup  of  hot  coffee  it  was  found  she  had  considerable  difficulty 
in  the  pharyngeal  part  of  deglutition,  some  of  the  liquid 
passing  out  of  the  nostrils ;  she  was  therefore  fed  by  the 
oesophageal  tube.  The  coffee  and  brandy  was  retained. 

2  p.m. — The  child  is  quite  unconscious;  her  pupils  are 
widely  dilated,  and  the  cornese  insensitive.  The  legs  feel 
cold.  Temperature  in  axilla  98-2°  Fahr. 

3p.m. — Consciousness  appears  to  be  returning.  She  was 
fed  with  three  ounces  of  beef-tea  through  the  oesophageal 
tube  ;  this  was  retained.  There  is  slight  internal  squint  on 
the  left  side. 

4  p.m. — Passed  a  large  motion  in  the  bed ;  it  was  normal, 
containing  neither  blood  nor  mucus. 

During  the  evening  the  power  of  swallowing  gradually 
returned,  so  that  she  took  a  little  milk  from  time  to  time. 
During  the  earlier  part  of  the  night  there  was  muttering 
delirium.  She  was  very  thirsty  all  through  the  night. 

July  14. — At  2  a.m.  she  passed  four  ounces  of  dark-brown 
urine,  which,  on  examination,  was  found  to  be  acid  and  free 
from  albumen  and  casts.  By  6  a.m.  the  scarlet  rash  had 
quite  disappeared. 

9  a.m. :  Has  almost  completely  recovered  the  power  of 
swallowing.  She  has  taken  some  beef-tea,  and  not  been  sick 
after  it.  The  pupils  do  not  act  to  light  freely.  She  seems 
quite  sensible,  and  talks  rationally.  A  dose  of  castor-oil  was 
ordered.  She  complained  throughout  the  day  of  thirst,  and 
preferred  water  to  milk. 

15th. — She  appears  quite  recovered,  and  is  playing  with 
her  toys. 

16th.— Was  discharged. 

Remarks.— The  case  can  scarcely  be  called  one  of  bella- 


374 


Medical  Times  and  Gazette. 


THE  WALTHAMSTOW  MURDERS. 


Sept.  29.  1883. 


donna-poisoning,  seeing-  how  slightly  the  specific  symptoms 
attributed  to  over-doses  of  this  drug  were  present.  Never¬ 
theless,  we  can  hardly  doubt  that  the  child  took  in  much 
more  of  the  drug  than  the  maximum  our  Pharmacopoeia 
allows.  Fortunately,  she  came  under  observation  very 
shortly  after  having  partaken  of  the  drug,  the  inherent 
emetic  action  of  which  had  even  then  rid  the  system  of 
much  of  what  had  been  swallowed.  This,  together  with  a 
thorough  washing  out  of  the  stomach,  saved  the  child  from 
the  baneful  effects  which  might  otherwise  have  followed. 
Although  children  show  a  great  tolerance  for  the  drug, 
especially  when  given  in  gradually  increasing  doses,  yet  a 
limit  is  soon  reached  beyond  which  it  is  not  safe  to  go.  It 
will  be  noticed  that  the  drug  was  already  beginning  to  show 
its  effects,  although  but  a  very  short  time  had  elapsed,  and 
notwithstanding  that  she  had  vomited  up  a  considerable  part 
of  what  had  been  swallowed.  As  arule,  symptoms  do  notcome 
on  for  some  hours ;  their  early  appearance  in  this  case, 
therefore,  was  possibly  due  to  a  special  receptivity  which 
some  individuals  are  found  to  manifest. 


UNIVERSITY  COLLEGE  HOSPITAL. 


“SMASH”  OF  BOTH  UPPER  EXTREMITIES  BY 

RAILWAY  ENGINE --AMPUTATION  OF  BOTH 

ARMS -SURGICAL  SCARLET  FEVER— RECOVERY. 

(Under  the  care  of  Mr.  GODLEE. 

Henry  S.,  aged  twenty-one  years,  a  platelayer  by  occupa¬ 
tion,  was  admitted  into  University  College  Hospital  on 
July  1,  1880.  He  gave  the  following  account  of  himself  : — 
He  was  returning  home  from  Kilburn,  after  visiting  a  friend. 
He  was  not  intoxicated,  though  he  admits  that  he  is  a  mode¬ 
rate  drinker.  Arrived  at  Willesden  Junction,  he  had  to 
cross  the  line  from  one  level  to  another.  While  doing  so, 
he  saw  and  heard  an  engine  coming ;  but  all  of  a  sudden 
“  he  felt  as  if  he  had  been  tied,  and  could  not  move.”  He 
then  became  unconscious,  and  remembers  nothing  further. 
He  has  never  had  a  fit  in  his  life,  and  he  is  not  aware  that 
any  of  his  relations  have  ever  suffered  from  fits.  He  had 
been  walking  about  a  good  deal  that  day,  and  the  day  was 
warm. 

On  recovering  his  consciousness,  he  found  both  his  arms 
gone.  He  walked  about  a  hundred  yards  to  a  friend’s 
house,  where  he  was  taken  in.  Subsequently  his  friends 
removed  him  to  the  station,  where  a  tourniquet  was  placed 
on  each  arm.  He  was  then  brought  on  to  the  hospital, 
where  he  arrived  about  midnight. 

Mr.  Godlee,  having  been  sent  for,  found  him  quite  con¬ 
scious.  The  right  arm  was  gone  ;  the  left  was  hanging  on 
by  a  flap  of  skin  only.  Amputation  was  performed  at  the 
junction  of  the  upper  with  the  middle  third,  the  flap  being 
shaped  to  meet  the  requirements  of  the  case  The  operation 
was  carried  out  with  strict  Listerian  precautions. 

July  1. — The  arms  were  re-dressed  about  6  p.m. 

3rd. —Re- dressed  at  11.30  a.m.  There  was  a  slight  sero- 
sanguineous  discharge  from  each.  Wounds  looked  well. 

6th. — Re-dressed.  The  old  dressing  was  quite  sweet; 
very  little  discharge.  One  or  two  of  the  stitches  were  cut 
to  relieve  tension,  and  slight  gaping  of  the  edges  of  the 
wound  occurred. 

8th. — Patient  was  not  quite  so  comfortable  to-day ;  he 
had  not  slept  well,  owing,  he  said,  to  a  “  jumping  ”  sensa¬ 
tion  in  the  stumps.  There  were  some  raised  patches  of 
erythema,  with  well-defined  borders,  on  his  knees  and  other 
parts  subjected  to  pressure.  He  had  bleeding  also  from 
the  nose.  His  temperature  has  gone  up  from  99°  to  101°. 

10th.— Temperature  99'6°.  No  bleeding  from  nose  since 
last  note.  The  erythema  has  almost  disappeared. 

11th. — Re-dressed.  Stumps  looking  healthy.  Temperature 
normal. 

13th. — Antiseptic  dressings  discontinued  from  left  arm. 
All  remaining  stitches  removed.  Erythema  quite  gone. 

15th.- — Antiseptic  dressing  discontinued  from  right  arm. 
The  left  arm  is  now  quite  cicatrised;  the  right  one 
nearly  so. 

21st. — The  right  arm  was  not  quite  cicatrised  just  at  one 
extremity  of  the  line  of  incision.  He  was  discharged. 

Remarks.— The  interesting  points  in  this  case  are — first, 
the  small  amount  of  shock  and  the  rapid  recovery,  con¬ 
sidering  the  severity  of  the  injury;  secondly,  the  difficulty 


of  understanding  how  it  was  possible  for  the  man  to  suffer 
amputation  of  both  arms  above  the  middle  without  at  the 
same  time  sustaining  any  injury  to  the  head;  and,  thirdly, 
the  fact  that,  although  the  stumps  remained  typically 
aseptic,  he  suffered  from  a  well-marked  attack  of  what  is 
known  as  surgical  scarlet  fever.  After  the  stumps  were 
healed,  he  was  provided  with  two  artificial  arms,  with  both 
of  which,  when  last  seen,  he  could  execute  a  considerable 
variety  of  movements. 


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SATURDAY,  SEPTEMBER  29,  1883. 


THE  WALTHAMSTOW  MURDERS. 
There  is  unquestionably  a  strong  and  growing  feeling  in 
the  medical  profession  that  there  may  have  been  a  serious 
miscarriage  of  justice  in  the  case  of  William  Gouldstone, 
who  still  lies  under  sentence  of  death  in  Her  Majesty’s  prison 
at  Chelmsford  for  the  murder  of  his  five  children,  and  that 
we  are  yet  in  danger  of  witnessing  again  the  painful  spectacle 
of  the  execution  of  a  lunatic,  and  thus  adding  another  stain 
of  blood-guiltiness  to  the  already  deeply  incarnadine  criminal 
annals  of  the  country.  A  great  authority  on  criminal  juris¬ 
prudence — perhaps  the  greatest  now  living — has  said,  when 
treating  of  trials  for  murder  in  which  the  defence  of  in¬ 
sanity  is  set  up,  that  a  jury  “are  reluctant  to  convict  if 
they  look  upon  the  act  itself  as  upon  the  whole  a  mad  one, 
and  to  acquit  if  they  think  it  was  an  ordinary  crime.”  But 
this  rule  does  not  seem  to  have  held  good  in  the  trial 
at  the  Central  Criminal  Court  on  the  14th  inst.,  for  there 
the  jury,  if  they  were  men  of  ordinary  discernment,  must 
have  perceived  that  the  act  of  the  prisoner  before  them  was 
a  mad  one  in  every  aspect ;  and  yet  they  manifested  no  re¬ 
luctance  to  send  him  to  the  scaffold,  for  they  deliberated  on 
their  verdict  only  for  fifteen  minutes.  Is  it  an  ordinary  occur¬ 
rence  for  a  doting  father  to  kill  his  five  children  P  Is  it 
consonant  with  our  knowledge  of  human  nature  that  a  sober, 
industrious  man  should  perpetrate  a  deed  of  this  kind,  in  no 
heat  of  passion,  but  with  calm  deliberation,  with  no  hope  of 
gain,  but  with  the  certainty  that  he  was  forfeiting  his  own 
life  ?  Surely  so  unusual  and  gratuitous  a  crime  bears  on 


Medical  Times  and  Gazette. 


THE  WALTHAMSTOW  MURDERS. 


Sept.  29,  1883.  3  7  5 


its  face  tlie  strange  expression  of  insanity ;  and  surely 
the  first  impression  of  its  character,  thus  obtained,  is  con¬ 
firmed  when  it  is  discovered  that  the  criminal  is  the  son  of 
a  mad  mother,  and  that  he  has  been  marked  by  his  fellow- 
workmen,  long  before  he  imbrued  his  hands  in  blood,  as  a 
crazy  mortal  outside  the  pale  of  rational  calculation.  That 
the  jury  who  tried  William  Gouldstone  did  not  realise  all 
this  must  be  attributed  to  the  mystification  to  which  they 
were  subjected  in  court — a  mystification  no  doubt  practised 
with  the  best  intention,  and,  as  it  is  thought,  in  the  interests 
of  justice,  but  which  is  sadly  inimical  to  a  clear  scientific 
view  of  things.  The  evidence  of  insanity  was  sufficient 
and  convincing,  but  it  was  of  a  cumulative  character,  and 
so,  of  course,  the  separate  items  of  which  it  was  composed 
— which,  fagotted  together,  were  irrefragable— were  taken 
singly  and  easily  snapped  asunder.  The  fact  that  a  second 
cousin  of  the  prisoner’s  father  was  insane  was  received  with 
ridicule,  and  yet  this  fact  was  most  significant  as  showing  a 
strain  of  madness  on  the  father’s  side,  which,  uniting  with 
that  derived  from  the  mother,  would  intensify  the  tendency 
to  the  disease  an  hundredfold.  Then,  of  course,  the  medical 
witnesses  were  not  permitted  to  say  outright  what  they 
thought  of  the  prisoner’s  mental  condition.  They  might 
beat  about  the  bush  as  much  as  they  liked,  but  they  could 
not  be  allowed  to  say  plainly  that  they  thought  the  prisoner 
an  irresponsible  lunatic  :  that  was  the  question  for  the  jury. 
They  might  state  any  number  of  premises,  but  were  forbidden 
to  draw  any  conclusion  ;  and  the  consequence  was,  as  we  now 
learn  fr&m  a  letter  to  a  daily  paper  by  “  One  of  the  Jury,” 
that  the  conclusion  drawn  from  their  premises  by  the  jury 
was  just  that  which  they  should  have  avoided.  Because  Dr. 
Savage  said,  under  cross-examination,  that  he  could  not, 
from  anything  observed  during  his  one  interview  with 
William  Gouldstone,  have  certified  him  as  a  lunatic,  and 
that  he  believed  he  knew  he  was  committing  murder  when 
he  killed  his  children,  the  jury  handed  the  man  over  to 
the  hangman.  But  it  appears  from  a  humane  letter  which 
Dr.  Savage  has  addressed  to  the  Times  that  he  regards 
Gouldstone’s  as  “  a  typical  case  of  insanity,”  and  it  is  now 
clear  either  that  Dr.  Savage  had  not  an  opportunity  of  laying 
before  the  court  that  whole  truth  on  the  matter  in  question 
which  he  had  sworn  to  deliver  to  them,  or  that  he  some¬ 
how  failed  to  do  so.  When  he  said  that  he  could  not  from 
his  personal  observations  have  certified  Gouldstone  insane, 
he  should  have  added  that  neither  could  he  have  certified  him 
sane ;  and  when  he  said  that  Gouldstone  knew  he  was 
committing  murder  when  he  killed  his  children,  he  should 
have  amplified  the  statement  to  the  effect  that  he  merely 
knew  he  was  committing  what  is  technically  called  murder, 
but  what,  he  was  persuaded,  owing  to  the  disorder  of  his 
mind,  was  a  humane  and  necessary  sacrifice,  and  what  he 
was  impotent  to  refrain  from  committing  owing  to  enfeeble- 
ment  of  his  will.  Dr.  Savage  seems  to  have  been  somewhat 
awed  by  the  solemnity  of  the  grove  of  horsehair  wigs  in 
the  midst  of  which  he  found  himself,  and  to  have  spoken 
in  rather  uncertain  terms ;  and  even  the  supplementary 
evidence  that  he  has  offered  in  the  columns  of  the  Times  is 
not  altogether  satisfactory.  He  says  of  Gouldstone,  “  He 
•has  done  his  work,  which  was  purely  mechanical  ”;  and 
that  phrase  is  apt  to  mislead,  by  revealing,  as  it  were,  an 
attempt  to  carry  the  irresponsibility  of  the  convict  too 
far.  Proceedings  such  as  his  cannot  be  called  mechanical. 
He  drowned  his  three  eldest  children,  after  considerable 
resistance,  in  a  cistern  containing  only  fourteen  inches 
of  water,  having  previously  tied  a  string  round  the  neck  of 
one  of  them ;  and  he  beat  in  the  heads  of  the  two  infants 
with  a  hammer,  having  watched  for  his  opportunity  in  the 
absence  of  the  nurse ;  and,  after  this  group  of  murders,  he 
•exhibited  in  several  expressions  an  appreciation  of  what  he 


had  done,  and  a  foresight  of  the  consequences  to  himself. 
Now,  no  automaton  has  yet  been  invented  to  go  through 
such  a  performance  as  that.  Not  even  instinct  is  equal  to  it, 
for  it  involved  reasonable  preparation,  the  adaptation  of 
means  to  ends,  the  modification  of  processes  according  to 
varying  conditions,  and  a  just  anticipation  of  remote  effects. 
To  speak  of  such  processes  as  mechanical,  and  thus  to 
represent  Gouldstone  as  a  sort  of  human  alarm-clock, 
wound  up  to  run  down  at  wholesale  murder  at  a  certain 
time,  is  very  apt  to  excite  a  suspicion  that  there  cannot 
be  much  of  real  weight  to  be  adduced  in  maintenance  of 
a  case  that  is  supported  by  such  exaggeration.  William 
Gouldstone  was  no  automaton,  but  a  madman,  when  he 
slaughtered  his  children — deprived,  no  doubt,  to  a  great 
extent  of  his  power  of  self-control,  and  swayed  unduly  by 
the  suggestions  of  his  disordered  fancy, — but  still  retaining 
many  of  the  essential  attributes  of  manhood.  He  was 
melancholic,  not  mechanical;  irresponsible,  but  not  dead 
altogether  to  human  motives.  Dr.  Savage  seems  subse¬ 
quently  to  awaken  to  all  this,  for  he  remarks  that  Gould¬ 
stone’s  act  depended  on  ‘c an  insane  feeling  of  misery”;  and 
it  can  be  scarcely  necessary  to  point  out  that  feeling  is  not 
one  of  the  mechanical  forces. 

And  there  is  another  feature  in  Dr.  Savage’s  letter  to  the 
Times  which  requires  explanation.  He  ends  by  saying,  “  I 
am  not  one  who  is  in  the  habit  of  defending  criminals  on 
the  plea  of  insanity.”  Now,  we  venture  to  assert  that 
there  are  no  medical  men  who  are  in  the  habit  of  defending 
criminals  on  the  ground  of  insanity,  and  that  the  distinc¬ 
tion  which  Dr.  Savage  claims  for  himself  is  illusory. 
We  suppose  that  what  Dr.  Savage  meant  was  that  he 
is  not  one  of  those  who  take  an  extreme  view  as  to  what 
constitutes  insanity  sufficient  to  exempt  from  punishment 
— a  statement  which  those  who  remember  his  evidence  in 
the  Taylor  case  will  readily  believe, — but  it  is  unfortunate 
that  he  did  not  make  his  meaning  less  ambiguous,  and 
emphasise  the  truth  that  a  medical  man  is  not  concerned 
either  to  defend  or  prosecute,  but  to  set  forth  scientific 
facts. 

The  check  imposed  on  medical  men  in  giving  their 
evidence  in  cases  in  which  insanity  is  the  question  at  issue, 
to  which  we  have  referred,  and  which  prevents  them  from 
stating  explicitly  the  judgment  they  have  formed,  is,  we 
believe,  a  fertile  source  of  error  and  confusion.  When  they 
are  asked  by  counsel  whether  they  consider  the  prisoner 
at  the  bar  insane,  the  judge  invariably  intervenes  with  the 
remark  that  that  is  the  question  for  the  jury,  and  not  for  the 
witness.  Now,  we  venture  to  suggest  that  that  is  not  the 
question  for  the  jury,  but  for  medical  experts.  The  jury  are 
practically  called  upon  to  say  whether  a  man  is  responsible 
or  irresponsible,  not  whether  he  is  sane  or  insane.  Insanity 
is  a  disease,  and  an  occult  and  obscure  disease,  and  the 
jury  are  quite  incompetent  to  decide  as  to  its  presence 
or  absence.  That  is  a  question  for  those  who  have  made 
a  special  study  of  the  subject.  It  would  take  a  jury  years 
of  laborious  study  to  determine  for  themselves  whether  a 
specimen  of  water  that  was  the  subject  of  litigation  con¬ 
tained  or  did  not  contain  albumenoid  ammonia.  On  a  point 
like  that  they  are  bound  to  take  the  opinion  of  chemists ; 
and  a  chemist,  in  bearing  testimony  regarding  it,  would 
never  be  prevented  from  definitely  stating  the  fact  that  he 
had  found  albumenoid  ammonia  in  the  water.  And  so, 
with  reference  to  insanity,  a  jury  should  be  bound  to  take 
the  opinion  of  the  medical  witnesses  on  a  point  which  they 
have  not  the  skill  or  knowledge  to  decide  for  themselves; 
and  these  witnesses  should  be  entitled  to  state  whether  or 
not  they  have  found  insanity  in  the  mind  which  they  have 
analysed.  Of  course,  where  a  difference  of  opinion  exists 
between  different  medical  men  the  jury  must  determine 

* 


376 


Medical  Times  and  Gazette. 


THE  ENDOWMENT  OF  KESEAKCH. 


8ept.  29,  1883. 


which  way  the  balance  of  probability  inclines  ;  but,  where 
no  difference  of  opinion  arises,  they  should  receive  as  con¬ 
clusive  the  medical  evidence  as  to  the  existence  of  insanity, 
and  then,  with  the  assistance  of  the  judge,  consider  whether 
the  degree  of  insanity  is  such  as  wholly  or  partially  to 
exempt  from  criminal  responsibility.  Now,  it  is  to  be  ob¬ 
served  that  in  the  case  of  Gouldstone  there  was  no  differ¬ 
ence  of  opinion  amongst  the  medical  men  examined.  Dr. 
Savage  thought  him  insane.  Dr.  Sunderland  gave  corrobora¬ 
tive  testimony,  and  it  now  comes  out  that  the  medical  officer 
of  the  House  of  Detention,  who  had  him  under  observation 
immediately  after  the  crime — but  who,  strange  to  say,  was 
not  examined  at  the  trial, — also  regarded  him  as  a  lunatic. 
Under  these  circumstances  it  was  the  duty  of  the  jury  either 
to  accept  the  medical  testimony  submitted  to  them,  or  to 
insist  upon  having  more  medical  testimony ;  and  in  adopt¬ 
ing  the  latter  course  they  would  have  been  setting  an 
admirable  precedent,  and  calling  attention  to  a  weak  point 
in  our  judicial  system,  which  allows  a  prisoner,  whose  life  is  at 
stake  and  whose  insanity  is  suspected,  to  be  brought  to  trial 
without  any  steps  having  been  taken  to  test  and  ascertain 
the  state  of  his  mind.  The  jury  did  not,  however,  adopt 
this  course,  but  went  on  in  the  old  hum-drum  way,  and  now 
the  necessity  arises  to  obtain  additional  evidence  in  an 
informal  manner — evidence  the  mere  procurement  of  which 
reflects,  as  it  were,  some  discredit  on  the  court. 

Since  this  article  was  in  type,  the  Home  Secretary  has,  we 
are  glad  to  add,  signified  the  Queen’s  command  that  the 
sentence  of  death  passed  on  William  Gouldstone  be  respited 
until  Monday,  October  8,  in  order  that  inquiry  may  be  made 
as  to  the  prisoner’s  sanity.  The  man  is  not  yet  out  of 
danger  ;  but  we  cannot  ourselves  doubt  that  the  judgment 
of  the  experts  will  be  to  find  that  Gouldstone  is  insane,  or 
at  least  was  so  when  he  committed  the  crimes  for  which  he 
was  tried. 


THE  ENDOWMENT  OF  RESEARCH. 

Among  the  various  addresses  delivered  by  the  Presidents  of 
Sections  at  the  recent  meeting  of  the  British  Association, 
the  address  given  by  Professor  Ray  Lankester  in  the  Sec¬ 
tion  of  Biology  stands  prominently  out  as  dealing  with  a 
subject  of  general  interest  and  wide  importance,  and  as 
giving  information  that  can  be  fully  understood  by, 
and  deserves  thoughtful  consideration  from,  all  educated 
persons.  Professor  Lankester  took  for  his  theme  the  en¬ 
dowment  of  research,  especially  in  biology,  and,  point¬ 
ing  out  that  it  had  in  the  past  produced  discoveries  of 
the  highest  service  to  humanity,  urged  the  establishment  in 
England  of  such  State-endowed  institutions  for  the  pro¬ 
secution  of  research  as  those  which  have  been  so  fruit¬ 
ful  in  Germany.  The  Professor  pointed,  among  other 
illustrations  of  his  argument,  to  the  immense  proportions 
and  importance  of  what  we  may  call  bacterial  pathology, 
which  has  all  grown  out  of  the  assiduous  studies  of  biologists 
provided  with  laboratories  and  maintenance  by  continental 
States.  It  is  true  that  our  countryman  Lister  gave  immense 
impetus  and  importance  to  the  labours  and  discoveries  of 
Ehrenberg,  Theodore  Schwann,  and  Pasteur,  by  his  anti¬ 
septic  method  of  the  treatment  of  injuries  and  wounds ;  but 
those  discoveries,  and  the  studies  of  Koch  and  others  in  the 
same  direction,  of  the  causation  and  prevention  of  diseases, 
have  been  made  in  continental  laboratories.  We  do  not  propose, 
however,  to  enlarge  upon  this  part  of  Professor  Lankester’s 
address.  There  was  nothing  in  it  that  is  not  well  known  to 
all  our  readers;  and  our  object  here  is  to  draw  attention  to 
the  information  given  in  the  address  in  question  to  the 
wretchedly  poor  encouragement  given  to  research  in  England 
as  compared  to  that  afforded  by  the  State  in  continental 


countries,  and  especially  in  Germany.  The  Professor  laid  it 
down  as  a  general  proposition  that  scientific  discovery  had 
only  been  made  by  one  of  two  classes  of  men,  viz. :  (1)  those 
whose  time  could  be  devoted  to  it  in  virtue  of  their  possess¬ 
ing  inherited  fortunes ;  and  (2)  those  whose  time  could  be 
devoted  to  it  in  virtue  of  their  possessing  a  stipend  or 
endowment  especially  assigned  to  them  for  that  purpose : 
and  he  described  very  fully  the  magnificent  provision  made 
in  Germany  for  the  prosecution  of  scientific  discovery  as 
compared  with  that  which  exists  in  our  own  country.  He 
declared  that  whether  you  ask  the  zoologist,  the  botanist, 
the  physiologist,  or  the  anthropologist,  you  get  the  same 
answer :  it  is  to  Germany  that  he  looks  for  new  infor¬ 
mation  ;  it  is  in  German  workshops  that  discoveries,  each 
small  in  itself,  but  gradually  leading  up  to  great  conclu¬ 
sions,  are  daily  being  made.  English  students  flock  to 
Germany  to  learn  the  methods  of  scientific  research ;  and  to 
such  a  state  of  weakness  is  English  science  reduced,  for  want 
of  proper  nurture  and  support,  that  even  on  some  of  the  rare 
occasions  when  a  fully  capable  investigation  of  biological 
problems  has  been  required  for  the  public  service,  it  has  been 
necessary  to  obtain  the  assistance  of  a  foreigner  trained  in 
the  laboratories  of  Germany.  In  that  empire  there  are 
twenty-one  universities ;  and  each  university  has,  in  addi¬ 
tion  to  its  other  arrangements  for  the  study  and  teaching  of 
all  branches  of  learning  and  science,  five  institutes  devoted 
to  the  prosecution  of  researches  in  biological  science,  namely, 
the  physiological,  zoological,  anatomical,  pathological,  and 
the  botanical  institutes  or  establishments.  In  a  university 
of  average  size,  each  of  these  institutes  consists  of  a  spacious 
building,  containing  many  rooms  fitted  as  workshops,  pro¬ 
vided  with  instruments,  a  museum,  and,  in  the  case  of 
botany,  an  experimental  garden.  And  all  this  is  provided 
and  maintained  by  the  State.  It  is  the  business  of  the 
professor  in  each  department,  in  conjunction  with  his 
assistants,  and  the  advanced  students,  who  are  admitted  to 
work  in  the  laboratories  free  of  charge,  to  carry  on  investiga¬ 
tions,  to  create  new  knowledge.  For  this  he  receives  his 
stipend,  and  on  his  success  in  this  field  of  labour  depends 
his  promotion  from  the  university  to  a  more  important  or 
better  paid  post  in  another.  And,  in  addition  to,  and  irre¬ 
spectively  of  this  part  of  his  duties,  each  professor  is  charged 
with  the  delivery  of  courses  of  lectures  and  of  elementary 
instruction  to  the  general  students  of  the  university ;  and 
for  this  he  is  allowed  to  charge  to  each  student  a  certain 
fee,  which  belongs  to  himself.  “There  are  in  Germany 
more  than  one  hundred  such  institutes,  carried  on  at  an 
annual  cost  to  the  State  of  about  =£80,000,  equal  to  about 
<£160,000  in  England,  providing  posts  of  graduated  value  for 
300  investigators — some  of  small  value,  sufficient  to  carry 
the  young  student  through  the  earlier  portion  of  his 
career,  while  he  is  being  trained  and  acting  as  the  assistant 
of  more  experienced  men ;  and  others  forming  the  sufficient 
but  not  too  valuable  prizes  which  are  the  rewards  of  con¬ 
tinuous  and  successful  labour.”  This,  even,  is  not  a  com¬ 
plete  list  of  all  the  posts  of  value  and  importance  open  to 
scientific  investigators  in  Germany,  nor  does  it  take  into 
account  the  large  number  of  educational  establishments — 
as  polytechnic  schools,  technical  colleges,  etc., — which  offer 
posts  of  emolument  to  not  a  few  biological  students.  We 
cannot  afford  space  to  point  out  with  anything  like  com¬ 
pleteness  how  utterly  miserable,  compared  with  the  state  of 
things  in  Germany,  is  the  amount  of  endowment  of  research 
in  England ;  and,  indeed,  there  is  no  need  to  dwell  on  it — 
it  is  a  matter  of  common  knowledge,  though  Professor 
Lankester’s  detailed  description  of  our  shortcomings  may 
be  studied  with  profit.  He  does  more,  however,  than 
criticise  and  expose  our  faults — he  plans  out  the  remedy ; 
and  here  he  is  as  clear,  definite,  and  outspoken  as  in  the 


Medical  Times  and  Gazette. 


THE  CHOLERA  IN  EGYPT. 


Sept. ‘29,  1683.  377 


rest  of  his  address.  There  is  no  escape,  he  says,  from  the 
necessity  of  providing  stipends  and  laboratories  for  the 
purpose  of  creating  new  knowledge ;  and  he  will  not  be 
content  with  anything  short  of  placing  England  on  a  level, 
or  about  on  a  level,  with  Germany.  For  this  purpose  there 
would  be  required,  in  England  alone,  forty  new  biological 
institutes,  distributed  among  the  five  branches  of  physi¬ 
ology,  zoology,  anatomy,  pathology,  and  botany.  He  will 
admit  that,  taking  one  place  with  another,  fifteen — more  or 
less  imperfect— such  institutes  may  be  reckoned  as  already 
existing,  and  the  forty  required  are  to  be  in  addition  to 
these.  He  is  not  extravagant,  certainly,  in  his  estimate  of 
the  cost :  he  estimates  the  cost  of  the  required  buildings  at 
only  ,£160,000— an  average  of  <£4000  for  each  institute  ;  and 
the  average  cost  of  stipends  for  the  director,  assistants, 
and  maintenance  he  calculates  at  <£1500  for  each,  or 
<£60,000  for  the  forty — equal  to  a  capital  sum  of  <£2,000,000. 
The  institutes  are  to  be  distributed  in  groups  of  five 
throughout  the  country — in  London,  Bristol,  Birmingham, 
Nottingham,  Leeds,  Newcastle,  Cardiff,  and  Plymouth ; 
one,  in  fact,  “  in  each  of  the  great  towns  of  the  kingdom 
where  there  is  at  present,  or  where  there  might  be 
with  advantage,  a  centre  of  professional  education  and 
higher  study.”  The  cost  of  such  a  scheme  would  be  con¬ 
siderably  greater,  we  suspect;  but  suppose  it  required  a 
capital  of  <£3,000,000 — that,  really,  as  a  matter  of  expense 
only,  would  be  very  easily  borne  by  such  a  country  as 
England.  Professor  Lankester  thinks  that  were  the  facts 
known  to  public  men,  in  reference  to  the  expenditure  incurred 
by  foreign  States  in  support  of  scientific  inquiry,  they  would 
be  willing  to  do  something  in  this  country  of  a  sufficient 
and  statesmanlike  character.  We  suspect  it  is  necessary  for 
this  purpose  to  educate  the  public,  rather  than  public  men, 
up  to  a  proper  appreciation  of  the  value  and  necessity  of 
scientific  inquiry.  Were  our  Ministers  and  our  legislators 
once  convinced  that  the  endowment  of  research  would  be 
popular,  there  would  be  no  difficulty  in  carrying  out  such  a 
scheme  as  that  which  Professor  Lankester  has  propounded ; 
and  we  will  hope  that  his  address  to  the  public,  through  the 
British  Association,  may  do  something  in  promoting  that 
desirable  public  education. 


THE  CHOLERA  IN  EGYPT. 
Surgeon-General  Hunter’s  further  Report  on  the  cholera 
epidemic  in  Egypt  calls  for  a  rather  fuller  notice  than  our 
space  last  week  allowed.  This  officer  has,  with  the  help 
of  a  special  railway  service,  visited  a  number  of  towns  and 
villages.  In  every  one  of  them  he  found  the  grossest  viola¬ 
tion  of  all  sanitary  laws.  The  rivers  and  canals,  he  says, 
“  are  ordinarily  made  use  of  as  the  easiest  and  readiest  means 
of  disposing  of  all  dead  animals,  excreta,  and  refuse  and  filth 
of  every  kind  and  description.”  “If  a  small  factory  be 
erected  on  the  banks  of  the  river,  the  privies,  as  a  matter  of 
course,  are  built  over  the  stream.”  From  the  Damietta  branch 
of  the  Nile,  568  carcases  of  cattle  which  had  died  of  typhus 
were  removed,  beside  numerous  portions  of  others  in  a  more 
or  less  advanced  state  of  decomposition.  French  observers, 
subsequently  to  be  referred  to,  speak  of  “  thousands  ”  of 
dead  bodies  in  the  river.  The  stench  arising  from  these 
bodies  in  the  process  of  burial  was  so  intense  as  not  infre¬ 
quently  to  cause  attacks  of  fainting  among  the  burying 
parties.  The  cemeteries.  Dr.  Hunter  says,  “  cannot  but  be 
prolific  sources  of  disease.”  The  dead  are  put  into  hollow 
structures,  about  six  feet  by  four,  made  of  sun-dried  bricks 
and  mud,  the  floor  being  on  the  ground  level.  Into  these 
the  dead  bodies  are  thrust,  one  after  another,  as  occasion 
arises,  until  the  place  is  full.  “  In  the  daytime,  with  a  hot 
sun  pouring  on  them,  they  can  be  little  better  than  ovens, 


and  the  stench  given  off  may  be  imagined,”  At  Benha  a 
cemetery  of  this  kind  is  close  to  the  town,  and  a  couple  of  these 
so-called  graves  are  within  fifty  yards  of  the  hospital.  “  The 
hospitals,”  says  the  Report,  are  “  in  a  more  or  less  tumble- 
down,  dirty  condition,  impregnated  with  foul  odours,  and 
containing  beds  filthy  in  the  extreme  ;  in  fact,  noisome  places, 
utterly  unfit  for  the  reception  of  human  beings.”  From 
these  strictures  Tanta,  which  is  under  the  administration  of 
Dr.  Sidki  Bey,  is  to  be  excepted.  What  Dr.  Hunter  by 
courtesy  calls  “  the  medical  administration  ”  “is  simply 
deplorable.”  “  It  is  quite  rare  and  exceptional  for  a  person 
suffering  from  disease  to  be  seen  during  life  by  a  medical 
man,  unless  it  be  a  few  of  the  better  classes.”  The  village 
barber  is  the  registrar,  and  he  never,  except  by  chance,  sees 
a  sick  person  during  life.  After  the  patient’s  death,  he 
enters  what  from  the  statements  of  the  friends  he  thinks  was 
the  cause  of  death,  and  grants  a  permit  for  burial.  “  It  is  on 
such  a  system,”  adds  Dr.  Hunter,  “  that  the  vast  majority 
of  the  mortuary  returns  of  the  country  is  based  !  ”  From 
the  details  which  we  have  quoted,  two  general  inferences 
will  at  once  be  apparent— first,  that  if  it  be  assumed  th  at, 
under  suitable  conditions,  there  may  take  place  new 
developments  of  the  germs  of  those  epidemic  maladies  of 
which  the  spread  is  undoubtedly  favoured  by  dirt  and  over¬ 
crowding,  then  those  conditions  exist  in  perfection  in  Egypt ; 
second,  that  statements  as  to  the  presence  or  absence  of  any 
particular  disease  in  Egypt  based  on  the  ordinary  mortuary 
returns  of  the  country  are  absolutely  worthless.  Seeing  how 
untrustworthy  these  mortuary  returns  were.  Dr.  Hunter 
made  cautious  inquiries  from  medical  men  and  others  long 
resident  in  Egypt,  and  he  found  that  for  a  long  time  cases 
of  “  cholerine,”  as  they  were  euphemistically  termed,  had 
been  seen  occasionally.  He  satisfied  himself  that  these 
cases  presented  characters  identical  with  those  of  true 
cholera.  He  found  also  that  in  the  early  part  of  this  year 
an  epidemic  of  typhus  had  existed.  With  these  facts  before 
him.  Dr.  Hunter  thinks  it  “  hardly  worth  while  to  discuss 
the  oft  repeated  and  as  often  refuted  story  of  the  importation 
of  the  disease  from  India  into  Egypt.”  He  appends,  how¬ 
ever,  a  very  able  report  by  Ahmed  Chaffey  Bey  and  Salvatore 
Ferrari,  two  medical  gentlemen,  who,  “  firmly  convinced  of 
the  importation  of  the  disease  into  Egypt  from  India,  insti¬ 
tuted  an  inquiry  into  the  matter,  with  the  full  anticipation 
of  obtaining  a  confirmation  of  their  opinions.  Instead  of 
this,  they  are  forced  to  the  conclusion  that  the  disease  had 
not  been  so  imported,  and  that  there  existed  in  the  deplorable 
insanitary  condition  of  Damietta  itself  sufficient  cause,  as 
they  believe,  for  the  origin  and  development  of  the  disease.” 
To  their  report  is  added  an  appendix  on  the  chemical  and 
microscopical  examination  of  the  water  at  Damietta,  which 
shows  that  the  water  drunk  by  the  inhabitants  has  been  in 
a  state  of  putrefaction. 

After  discussing  these  facts.  Dr.  Hunter  briefly  mentions 
observations  of  another  kind,  which  are  of  much  interest. 
It  will  be  remembered  that  in  the  cholera  epidemic  which 
visited  this  country  in  the  autumn  of  1866,  Mr.  Glaisher 
drew  attention  to  an  atmospheric  phenomenon  which  he 
called  the  “cholera  mist.”  Mr.  Borg,  H.M.  Vice-Consul 
in  Cairo,  tells  Dr.  Hunter  that  “  when  cholera  was  at  its 
height  in  1865  in  the  capital,  the  sky  was  lead-coloured, 
the  atmosphere  oppressive,  so  as  to  render  breathing  rather 
difficult  at  times,  and  the  town  of  Cairo,  as  seen  from  the 
Mokattan  Hills,  seemed  to  be  enveloped  in  a  spherical  cloud 
of  thick  mist  during  three  consecutive  days.  He  also  ob- 
*  served  that  the  sparrows  deserted  the  town,  and  did  not 
return  until  the  epidemic  was  on  the  decline.”  Dr. 
McDowell,  A.M.D.,  Sanitary  Officer  of  the  Cairo  District, 
reports  that  “  when  the  (present)  epidemic  was  at  its  height 
on  July  23,  a  very  peculiar  condition  of  the  atmosphere  was 


378 


Mjdlcal  Times  and  Gazette. 


THE  WEEK. 


Sept.  29,  1883. 


observed — a  yellowness  of  the  air,  somewhat  of  the  nature 
of  a  fog ;  and  it  was  quite  calm.  The  sparrows,  it  was 
noticed,  had  deserted  the  place,  and  did  not  return  until 
July  26.”  Dr.  Hunter  adds,  ffIt  is  curious  to  note  that  the 
Arabic  phrase  for  cholera  is  *  the  yellow  air/  and  that  the 
fact  of  birds  deserting  a  place  at  such  periods  has  also  been 
remarked  by  the  natives.”  Detailed  meteorological  observa¬ 
tions  by  Dr.  Kirker,  of  H.M.S.  Iris,  and  by  Dr.  McDowell, 
are  appended  to  the  Eeport.  Dr.  Hunter  abstains  from 
drawing  inferences  from  these  facts,  and  contents  himself 
with  merely  recording  them. 

To  summarise  the  purport  of  Dr.  Hunter’s  Eeport:  he 
is  satisfied  with  the  evidence  (1 )  of  typhus  before  the  out¬ 
break  of  cholera;  (2)  of  cholera  prior  to  the  outbreak  at 
Damietta ;  and  he  entertains  grave  suspicions  of  cholera 
having  been  epidemic  in  Egypt  since  the  epidemic  of  1865. 


A  PEEPETUAL  DANGEE, 

There  are  some  forms  of  danger  that  seem  to  have  a  dire 
and  unaccountable  fascination  for  great  numbers  of  people- 
Most  of  us  perhaps  have  felt  more  or  less  strongly  the 
tremulous  pleasure  of  walking  as  near  as  possible  to  the 
edge  of  a  precipice,  and  have  withstood  the  feeling,  half 
dread  and  half  desire,  that  prompts  us  to  cast  ourselves 
down.  The  daily  papers.are  continually  reporting  instances 
of  persons,  usually  considered  sane,  who  point  firearms  at 
their  friends,  “  in  fun  ”;  who  say,  playfully,  “  I’ll  shoot 
you”;  who  pull  the  trigger,  and,  by  one  momentary  act 
of  incomprehensible  folly,  blast  their  own  lives  and  destroy 
that  of,  it  may  be,  their  dearest  friend.  It  would  be  going 
too  far,  perhaps,  to  ascribe  to  some  such  self-destructive 
impulse  the  conduct  of  those  medical  men  who,  in  spite 
of  the  warnings  that  appear  from  time  to  time  in  the 
papers,  in  spite  of  the  most  obvious  pleadings  of  common 
sense,  in  spite  of  the  imperative  demands  of  the  instinct  of 
self-preservation,  still  venture  to  attend  women  profession¬ 
ally  in  the  absence  of  any  third  person  ;  but  it  seems  some¬ 
thing  like  it.  The  danger  of  such  a  course  is  sufficiently 
obvious  without  illustration,  but  if  illustration  were  needed, 
it  could  not  be  supplied  more  forcibly  or  with  more  brutal 
plainness  than  by  the  case  of  Davies  v.  Davies  and  Eichards, 
which  was  reported  in  the  Times  not  long  ago.  The  peti¬ 
tioner,  John  Davies,  sought  the  dissolution  of  his  marriage 
on  the  ground  of  the  adultery  of  the  respondent  with  her 
medical  attendant.  The  co-respondent  was  honourably 
acquitted  of  the  charge  of  adultery,  but  the  case  is  memor¬ 
able,  not  only  because  such  a  charge  was  made,  not  only 
because  the  charge  grew  oxxt  of  the  professional  attendance 
of  the  co-respondent,  not  only  because  it  was  supported 
by  the  direct  affirmative  evidence  of  the  respondent ;  but, 
also,  because  of  the  character  of  the  correspondence  that 
had  passed  between  the  wife,  and  the  husband  who  prayed 
for  a  divorce.  In  one  of  the  letters  which  she  wrote  to  her 
husband,  admitting  and  asserting  and  reiterating  her  guilt, 
there  occurred  this  remarkable  passage :  “  I  saw  in  the 
paper  about  another  doctor,  a  job  like  mine,  and  the  doctor 
pison  hisself,  and  there  is  another  case  to  come  off  again — 

Dr. - ;  an  old  paper  as  I  got  now  where  it  cost  Dr. - 

<£500. ”  If  there  are  any  of  our  readers  who  have  not 
already  taken  to  heart  the  lesson  taught  by  such  cases  as 
this,  and  that  of  the  unfortunate  Dr.  Edwardes,  we  beg 
them  to  give  this  extract  their  most  serious  consideration. 
Any  medical  man  who  professionally  attends  a  woman,  and  is 
so  incautious  as  to  neglect  to  secure,  if  feasible,  the  presence 
of  some  third  person  during  his  visit,  renders  it  possible 
for  a  depraved  and  abandoned  woman  to  blast  his  character 
and  ruin  his  life.  And  it  appears  from  the  cases  that  occa¬ 
sionally  come  to  light  that  such  women  are  not  far  to  seek. 


They  are  evidently  fully  awake  to  the  possibility  of  extort¬ 
ing  money  by  this  infamous  means,  and  are  eager  to  avail 
themselves  of  any  opportunity  that  may  be  thrown  in  their 
way,  or  that  they  can  contrive  to  secure.  Against  such 
designs  there  is  but  one  safeguard,  and  that  is  at  once 
simple  and  certain.  It  lies  in  the  strict  observance  of  two 
rules — first,  never,  under  any  circumstances,  to  visit  alone 
a  woman  whose  character  is  in  the  least  degree  doubtful ;  and 
secondly,  to  doubt  almost  everyone.  Of  course,  emergencies 
will  occasionally  arise  which  necessitate  an  infraction  of 
the  first  rule,  but  such  occasions  need  be  but  rare,  and  it 
will  nearly  always  be  possible  to  keep  some  one  (if  only  one’s 
own  coachman)  within  hearing.  The  people  by  whom  such 
charges  are  made  commonly  live  in  associated  cottages  or 
tenement-houses,  and  the  services  of  a  neighbour  can  almost 
always  be  secured.  If  this  cannot  be  obtained,  and  if  circum¬ 
stances  necessitate  a  tSte-d-tete,  then  the  interview  should 
be  extremely  brief.  There  is  nothing  absolutely  unpractical 
in  these  suggestions.  A  short  observance  of  them  makes 
their  practice  so  habitual  that  it  is  deprived  of  all  effort, 
and  does  not  add  appreciably  to  the  already  onerous  duties 
of  the  doctor.  On  the  other  hand,  how  utterly  disastrous 
the  neglect  of  such  precautions  may  be  was  exemplified  in 
the  deplorable  case  of  Dr.  Edwardes.  And,  as  was  also 
shown  by  that  case,  it  is  by  no  means  necessary  for  a  charge 
of  this  nature  to  be  proved  or  even  to  be  remotely  probable. 
The  mere  fact  that  it  is  made,  apart  from  every  considera¬ 
tion  of  its  truth  or  probability,  or  even  possibility,  is  capable 
of  doing  a  man  infinite  damage ;  and  it  behoves  every 
medical  man,  and  more  especially  that  large  majority  of 
medical  men  whose  duties  compel  them  to  visit  much 
amongst  the  poor,  to  give  the  second  of  our  rules  the  most 
liberal  interpretation,  and  to  observe  the  first  with  the 
most  scrupulous  exactness. 


THE  WEEK. 

TOPICS  OF  THE  DAT. 

The  condition  of  the  Paddington  Canal  Basin  having  been 
prominently  brought  to  notice  through  complaints  in  several 
quarters,  the  Paddington  Vestry  have  at  length  determined 
to  take  some  action  in  the  matter.  According  to  the  report 
of  the  Sanitary  and  Public  Health  Committee,  the  com¬ 
plaints  had  been  referred  to  Dr.  J.  Stevenson,  the  Medical 
Officer  of  Health  for  the  district,  to  be  dealt  with  in  whatever 
manner  he  might  see  fit ;  and  he  had  also  received  instruc¬ 
tions  to  take  proceedings  against  all  persons  detaining 
manure  on  the  wharves  on  the  banks  of  the  canal  imme¬ 
diately  after  the  expiration  of  time  allowed  by  the  statute, 
viz.,  twelve  hours.  This  insanitary  condition  of  the  Padding¬ 
ton  Canal  is  certainly  not  of  recent  growth ;  so  far  back  as 
1874  the  late  Dr.  Hardwicke,  then  Medical  Officer  of  Health 
for  Paddington,  reported  that  during  the  whole  period  of 
his  official  career,  as  well  as  during  that  of  his  predecessor, 
every  attempt  to  improve  the  condition  of  the  canal  basin 
had  failed ;  that  the  Grand  Junction  Company,  whilst  ex¬ 
pressing  itself  as  willing  to  take  any  steps  that  might  be 
suggested,  contented  itself  with  occasionally  changing  the 
water  and  partially  removing  the  mud,  but  had  never 
adopted  any  effectual  method  of  regulating  the  noxious 
trades  carried  on  upon  its  banks.  Dr.  Stevenson  also  con¬ 
firmed  this  view  on  taking  up  his  duties  in  the  year  1875, 
and  pointed  out  what  steps  might  be  taken  with  advantage 
to  mitigate  the  evils  complained  of,  but  nothing  of  impor¬ 
tance  seems  really  to  have  been  done.  It  is  to  be  hoped, 
however,  that  with  the  impetus  that  has  of  late  been 
given  to  sanitary  details  by  the  possibility  of  a  cholera 
invasion,  and  the  remonstrances  of  the  authorities  of  St. 
Mary’s  Hospital,  the  Vestry  will  at  length  be  forced  into 


Medical  Times  and  Gazette. 


THE  WEEK. 


Sept.  29,  1883.  379 


■securing  for  the  inhabitants  of  that  particular  locality  a 
more  healthy  condition  of  affairs.  It  may  be  pointed  out 
'that,  in  consequence  of  representations  recently  made  to  the 
Eegent’s  Canal  Company  by  Dr.  Tripe,  the  Medical  Officer 
•of  Health  for  Hackney,  as  to  the  insanitary  condition  of  that 
portion  of  the  canal  which  is  in  the  jurisdiction  of  the 
Hackney  district,  the  necessary  cleansing  was  at  once  carried 
out ;  and  it  is  presumed  that  what  can  be  done  by  one  canal 
■company  can  be  done  by  all  of  them. 

It  is  stated  that  a  series  of  investigations  into  the  origin 
of  yellow  fever  has  just  been  made  by  Dr.  Domingas 
Frieze,  a  Brazilian  physician.  Dr.  Frieze  claims  to  have 
discovered  that  the  blood  of  yellow-fever  patients  contains  a 
parasite  which  appears  as  a  minute  point,  and  in  one  form 
or  another  continues  its  existence  after  the  death  of  the 
patient.  As  he  considers  this  fact  to  be  satisfactorily 
established,  he  recommends  that  the  bodies  of  all  those  who 
succumb  to  the  disease  should  be  burnt.  In  further  experi¬ 
menting  it  was  shown  that  the  injection  of  a  little  of  the 
tainted  blood  into  the  veins  of  a  rabbit  caused  death  in 
fifteen  minutes.  This,  Dr.  Frieze  admits,  might  only  seem 
like  ordinary  blood-poisoning,  were  it  not  for  the  fact  that 
the  blood  of  the  dead  rabbit  was  found  to  be  filled  with  the 
peculiar  organisms  referred  to.  Moreover,  a  guinea-pig 
kept  closely  upon  earth  taken  from  a  yellow-fever  cemetery 
died  in  five  days,  and  the  same  peculiarity  also  appeared  in 
its  blood;  from  which  the  experimenter  argues  that  all 
such  burying-places  are  constantly  liable  to  distribute  the 
disease. 

The  monthly  return  of  the  Registrar-General  for  Scotland 
for  August  last  shows  that  during  that  period  there  were 
registered  in  the  eight  principal  towns  of  North  Britain 
(the  births  of  3544  children,  and  the  deaths  of  2204  persons. 
Allowing  for  increase  of  population,  the  latter  number  is 
•51  below  the  average  for  the  month  during  the  preceding 
ten  years.  A  comparison  of  the  deaths  registered  in  the 
eight  towns  shows  that  during  the  month  under  notice  the 
mortality  was  at  the  annual  rate  of  15  deaths  per  1000 
persons  in  Perth,  16  in  Aberdeen,  Leith,  and  Dundee,  17  in 
Edinburgh,  25  in  Glasgow,  26  in  Greenock,  and  27  in  Paisley. 
The  miasmatic  order  of  the  zymotic  class  of  diseases  proved 
fatal  to  410  persons,  and  constituted  186  per  cent,  of  the 
mortality.  This  rate  was,  however,  exceeded  both  in 
Glasgow  and  Greenock,  in  both  which  places  diarrhoea  was 
fatally  prevalent.  Diarrhoea  was,  in  fact,  the  most  fatal 
epidemic  of  the  month,  having  caused  141  deaths,  or  6-4  per 
cent,  of  the  whole.  The  deaths  from  inflammatory  affec¬ 
tions  of  the  respiratory  organs  (not  including  consumption, 
whooping-cough,  and  croup)  amounted  to  290,  or  13  T  per 
cent. ;  those  from  consumption  alone  numbered  261,  or  11-8 
per  cent.  Three  females  were  aged  ninety  years  and 
upwards,  the  oldest  of  whom  was  a  nurse  ninety-seven  years 
of  age. 

On  Saturday  last  a  meeting  of  the  Governors  of  the 
Norfolk  and  Norwich  Hospital  was  held  in  the  board-room 
•of  that  institution,  for  the  purpose  of  receiving  a  highly 
satisfactory  report  from  the  committee  appointed  to  arrange 
a  bazaar  recently  held  in  connexion  with  the  opening  of  the 
new  building  by  the  Duke  and  Duchess  of  Connaught.  The 
report  stated  that,  after  providing  for  all  expenses,  the 
bazaar  had  resulted  in  an  addition  to  the  building  fund  of 
<£5779,  which,  it  was  hoped,  would  be  sufficient  to  cover  the 
entire  cost  of  fitting  and  furnishing  the  Hospital,  the 
balance,  if  any,  to  be  available  for  defraying  any  small  ex¬ 
penses  still  left  outstanding  on  the  fabric  itself.  Before  the 
close  of  the  proceedings  a  letter  was  read  from  the  Duke  of 
Connaught,  expressing  the  great  pleasure  which  the  success 
of  the  bazaar  had  afforded  him  as  well  as  the  Duchess  of 
(Connaught. 


The  returns  of  the  late  Hospital  Saturday  collection,  made 
up  to  Saturday  last,  the  22nd  inst.,  show  that  the  amount 
paid  into  Messrs.  Hoare  and  Co.’s  bank  is  at  least  ,£1100  in 
excess  of  what  had  been  collected  and  paid  in,  up  to  the 
corresponding  date  of  last  year.  It  is  further  stated  that 
the  workshop  collection  shows  not  only  a  large  advance  in 
the  sums  contributed,  but  also — what  is  more  important — a 
considerable  increase  in  the  number  of  firms  subscribing : 
many  extensive  business  establishments,  which  never  pre¬ 
viously  contributed  to  the  fund,  have  this  year  joined  the 
movement  with  marked  advantage  to  its  prosperity.  And  it 
is  undoubtedly  in  this  direction  that  the  promoters  should 
push  their  efforts,  if  they  honestly  desire  that  the  Saturday 
collection  for  the  London  hospitals  should  be  prominently 
identified  with  the  working  classes  of  the  metropolis. 

A  singular  example  of  the  difficulties  which  surround  the 
wisest  legislation,  where  the  interpretation  is  left  to  the 
ignorant,  was  afforded  in  ‘the  evidence  adduced  at  an 
inquest  recently  held  on  a  bricklayer  at  Tuxford.  The  man 
is  reported  to  have  “  found  himself  somewhat  unwell,”  and 
to  have  stated  his  intention  of  taking  “a  sup  of  laudanum.” 
Having  none  in  the  house,  he  sent  over  to  a  neighbour  to 
borrow  a  “  teacup  full.”  The  messenger  returned  with 
about  three  teaspoonfuls,  and  the  invalid’s  wife,  finding  the 
quantity  so  small,  administered  only  a  third  of  this,  telling 
her  husband  “not  to  take  the  remainder  just  then.”  It  is 
needless  to  remark  that  the  man  died ;  and,  when  being 
examined  before  the  coroner,  the  wife  not  only  admitted 
having  administered  the  dose,  but  declared  that  she  would 
not  have  believed  that  her  husband  could  have  taken  any 
harm  if  she  had  given  him  the  whole  of  the  quantity  bor¬ 
rowed.  The  facilities  for  purchasing  poisons  in  the  neigh¬ 
bourhood  of  Tuxford  must  be  so  great,  and  the  custom  of 
keeping  laudanum  in  the  labourers’  cottages  so  common, 
that  it  would  be  as  well  if  the  local  authorities  were  to 
institute  an  inquiry  into  the  matter. 

A  small  cottage  hospital  has  recently  been  opened  in  the 
North  of  London,  where  accommodation  for  the  sick  of  the 
district  is  much  needed.  The  new  building,  which  is  in¬ 
tended  for  the  reception  of  about  thirty  patients,  has  been 
built  and  furnished  at  the  sole  cost  of  a  lady  in  the  locality, 
in  memory  of  her  son,  who  was  accidentally  killed,  and  it 
has  been  conveyed  by  her  to  the  trustees  of  the  Conference 
Hall,  Mildmay  Park,  adjoining  which  building  the  new 
hospital  is  situated.  The  internal  arrangements  are  very 
complete,  and  great  pains  have  been  taken  to  make  the 
decorations  of  the  wards  bright  and  attractive.  Consider¬ 
able  progress  has  already  been  made  in  raising  an  endow¬ 
ment  fund.  Four  small  rooms  in  the  building  have  been 
set  apart  as  private  wards  for  the  use  of  those  who  are  able 
to  contribute  towards  the  expenses  of  the  hospital. 

The  recent  novelty  of  introducing  fish  as  an  article  of 
diet  in  our  workhouses  has  called  forth  several  comments 
from  the  London  press.  The  Daily  Nevjs,  in  remarking 
upon  various  stupid  objections  urged  by  the  officials  of  a 
number  of  workhouses  to  this  innovation,  insists  that  soft 
food  like  fish,  savoury  and  well  cooked,  is  the  diet  that 
will  keep  the  old  and  infirm  in  the  best  possible  health,  in 
preference  to  heavy  messes  of  butcher’s  meat.  It  further 
observes  that,  “to  give  these  inactive  old  folks  butcher’s 
meat  every  day  is  to  load  their  system  with  waste  products 
— with  material  which  is  virtually  poisonous.”  It  seems  a 
sad  pity  that  all  this  wisdom  and  knowledge  has  been  hitherto 
withheld  from  vestrymen  and  boards  of  guardians.  Why 
could  not  the  Daily  News  have  taken  up  its  parable  sooner  P 
Our  contemporary  goes  on  to  say,  “  The  addition  of  fish  to 
a  pauper’s  diet  leads  not  only  to  a  saving  of  workhouse 
expenses,  but  to  the  increased  bodily  comfort  of  the  pauper 


380 


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THE  WEEK. 


Sept.  29, 1S83. 


himself.  It  does  not,  we  admit,  traverse  the  objection  of 
‘'the  master/  which  the  Kensington  Guardians  regarded 
as  insuperable,  namely,  that  in  their  workhouse  the  new 
diet  ‘  would  be  neither  cleanly  or  economical,  besides  being 
a  trouble  to  the  cook/  We  cannot,  of  course,  get  rid  of 
that  objection,  unless  we  get  rid  of  both  the  master  and  the 
cook,  and,  peradventure,  of  the  guardians  also/’ 


BIOLOGICAL  NOTES  AT  THE  BRITISH  ASSOCIATION  AT 
SOUTHPORT. 

In  the  Biology  Section  some  interesting  papers  have  been 
read.  Dr.  Carpenter,  F.R.S.,  in  a  contribution,  “  The  Germ 
Theory  of  Disease  from  a  Natural  History  Point  of  View,” 
attempted  to  show  that  disease-germs  belonging  to  the 
very  lowest  types  of  life  are  capable  of  a  very  considerable 
amount  of  transmutation,  and,  instead  of  always  developing 
in  one  particular  mode,  and  giving  rise  to  one  fixed  type 
of  morbid  action,  the  different  forms  of  bacilli,  micro¬ 
cocci,  or  bacteria — the  germs  of  the  different  species  of 
zymotic  disease, — are  capable  of  modification  according 
to  the  conditions  they  are  surrounded  by  ;  and  no¬ 
where  is  this  more  evident  than  in  the  simplest  fungi 
(moulds  and  blights),  to  which  schizomycetous  disease- 
germs  are  most  nearly  related.  Such  diseases  as  exanthe¬ 
mata  have,  according  to  this  view,  obtained  a  fixity  of 
type  by  a  process  of  evolution.  A  ship,  having  on  board 
malarial  fever,  was  described  as  suddenly  developing  yellow 
fever.  Typhoid  and  typhus  were  instanced  as  probably 
dependent  on  the  same  germs,  developing  with  different  in¬ 
tensity  ;  [cholera  and  autumn  diarrhoea  probably  passing 
insensibly  one  into  the  other,  the  same  germ  becoming  at 
one  time  innocuous,  at  another  time  virulent.  Dr.  Carpenter 
condemned  the  tendency  amongst  pathologists  to  regard  the 
varieties  of  zymotic  disease  as  specifically  distinct.  Different 
telluric  and  atmospheric  conditions  were  one  factor  in  develop¬ 
ing  a  mild  or  a  virulent  character  of  the  same  disease-germ. 
In  the  discussion  that  followed,  exception  was  taken  to  the 
idea  of  great  interchangeability  among  the  lower  forms  of 
vegetal  life,  by  botanists  of  repute  present ;  and  Dr.  Sydney 
Vines  made  the  decided  statement  that  amongst  the  Fungi 
and  in  the  Schizomycetes  there  was  no  such  thing  known  as 
one  vegetal  organism  taking  on  the  characters  of  another. 
Professor  Thiselton  Dyer,  F.R.S.,  objected  to  such  an 
amount  of  plasticity  being  claimed  for  the  lower  orders 
of  life,  which  was  not  possessed  by  higher  types.  Dr. 
C.  A.  McMunn  read  a  paper,  in  which  he  claimed  to 
have  discovered  chlorophyll,  in  every  respect  resem¬ 
bling  plant-chlorophyll,  in  the  intestines  of  invertebrata, 
synthetically  built  up  by  the  protoplasm.  Several  inte¬ 
resting  papers  have  been  read,  showing  the  continuity 
of  the  protoplasm  through  the  cell-walls  in  plants ;  and  it 
was  suggested  by  Professor  Hillhouse  that  these  threads 
of  connecting  protoplasm  might  serve  to  transmit  im¬ 
pulses  from  one  cell  to  another.  These  papers  are  im¬ 
portant,  as  showing  the  unity  of  the  whole  plant  indi¬ 
vidual,  and  the  power  of  the  whole  for  working  together. 
Professor  McKendrick  (Fullerian  Professor  in  the  Royal 
Institution)  delivered  an  interesting  lecture  tc  the  public 
on  the  subject  of  “  Galvani  and  Animal  Electricity.”  He 
remarked  that  electrical  currents  obtained  from  muscles 
were  one  index  of  the  amount  of  chemical  change  taking 
place,  that  they  were  evanescent  and  feeble,  and  bad  no 
relation  to  the  general  well-being ;  consequently,  all  at¬ 
tempts  to  influence  the  living  body  by  magnets  had  no 
rational  basis.  With  reference  to  currents  produced  in 
the  living  man,  Dr.  McKendrick  thought  them  to  be 
skin  currents,  and  not  currents  from  the  muscles.  Dr. 
W .  H.  Stone  read  a  paper  on  “  The  Electrical  Resistance 
of  the  Human  Body,”  in  which  he  stated  that  this  resist¬ 


ance  had  been  much  exaggerated,  and  was  not  more  than 
1000  ohms  (about)  from  hand  to  foot.  This,  for  instance,  in 
one  subject  measured  1100  ohms  at  a  temperature  of  98°^ 
and  in  the  same  subject  (human)  after  death  1200  ohms.  In 
a  case  of  hemiplegia,  instead  of  being  increased,  it  was 
diminished  to  730  ohms.  With  temperature  increase,  the 
resistance  rises  till  at  105°  it  reaches  4000  ohms,  and  in  one 
case  nearly  5000  ;  as  the  temperature  diminishes  the  resist¬ 
ance  falls.  Skin  resistance  has  been  enormously  exagge¬ 
rated.  The  statements  of  resistances  reaching  13,000  ohms, 
were  utterly  devoid  of  foundation. 


THE  PARIS  WEEKLY  RETURN. 

The  number  of  deaths  for  the  thirty-seventh  week  of  1883,. 
terminating  September  13,  was  910,  and  of  these  there  -were 
from  typhoid  fever  36,  small-pox  5,  measles  16,  scarlatina 
none,  pertussis  11,  diphtheria  and  croup  25,  dysentery  1„ 
erysipelas  1,  and  puerperal  infections  2.  There  were  also- 
37  deaths  from  acute  and  tubercular  meningitis,  167  from, 
phthisis,  16  from  acute  bronchitis,  28  from  pneumonia,  145 
from  infantile  athrepsia  (50  of  the  infants  having  been  par¬ 
tially  or  wholly  suckled),  and  33  violent  deaths.  The  mor¬ 
tality  returns  continue  to  decrease,  being  even  fewer  than 
last  week  (929),  which  had  the  smallest  amount  of  deaths- 
during  the  present  year.  Infantile  athrepsia  is  the  only 
disease  which  does  not  diminish  in  fatality.  Of  the  145- 
deaths  caused  by  it,  in  only  16  were  the  infants  above  one- 
year  of  age.  There  were  1174  births  (596  males  and  578- 
females),  and  the  legitimate  births  were  872,  the  illegitimate- 
302. 


extract  op  piscidia  as  a  hypnotic. 

Dr.  Otto  Seifert  writes  in  the  Berliner  Klin.  Woch.. 
(No.  29)  on  Piscidia  erythina,  or  Jamacia  dogwood,  which 
belongs  to  the  order  Leguminosse.  The  dogwood  is  a  native  of 
the  West  Indies  and  of  the  dry  mountainous  districts  of  the 
Antilles,  but  occurs  principally  in  Jamacia.  Towards  the 
end  of  the  last  century  the  rind  of  the  root  was  used  (in  the- 
form  of  a  decoction)  for  its  narcotic  effects  by  the  natives,  of 
America,  and  also  employed  as  a  poison  for  fish.  Professor- 
Ott,  of  Philadelphia,  has  recently  made  some  physiological 
experiments,  chiefly  on  rabbits,  with  this  drug.  He  finds 
that  the  extract  of  piscidia  is  a  narcotic,  not  only  for  the 
higher  but  also  for  the  lower  animals ;  that  it  is  a  mydriatic 
it  increases  the  respiration,  produces  salivation  and  perspi¬ 
ration,  reduces  the  action  of  the  heart,  and  in  large  doses- 
may  cause  general  paralysis  and  death  from  asphyxia.  The- 
liquid  extract  of  the  rind  of  the  root  is  recommended  for 
cases  of  “  spinal  irritation,”  and  for  the  treatment  of  chronic 
severe  cough  where  opium  cannot  be  prescribed.  Von  Firth 
has  found  the  extract  of  value  in  patients  suffering  from 
delirium  tremens,  even  where  other  narcotics,  such  as  chloral 
bromide  of  potassium,  and  opium,  have  failed.  Seifert  gave 
some  to  healthy  individuals,  and  found  that  it  was  followed 
by  marked  soporific  effects,  and  some  dilatation  of  pupil ;  but 
no  change  was  observed  in  the  pulse  or  temperature,  nor 
was  there  any  salivation  or  increase  of  perspiration.  Severe 
coughing  at  night  in  cases  of  phthisis  was  greatly  relieved 
by  the  administration  of  ’25  of  a  gramme  of  the  solid  extract.. 


the  royal  albert  asylum  for  idiots. 

In  his  annual  report  for  the,  year  1882,  Dr.  G.  E.  Shuttle- 
worth,  the  Medical  Superintendent  of  the  Royal  Albert. 
Asylum  for  Idiots  and  Imbeciles  of  the  Northern  Counties, 
which  is  situate  at  Lancaster,  states  that,  for  the  first 
time  in  the  history  of  the  institution,  two  patients  have 
been  returned,  in  the  form  required  by  the  Lunacy  Com¬ 
missioners,  as  “  recovered,”  it  being  considered  that  their- 


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Sept.  29,  1883.  381 


mental  condition  would  fairly  bear  comparison  with  that  of 
persons  deemed  by  society  as  responsible  for  their  actions. 
The  first  of  these  was  a  girl  aged  twenty,  who  had  suffered 
in  consequence  of  a  fall  on  the  head  in  childhood  ;  and  the 
■other  was  a  lad,  who  had  . been  afflicted  with  hydrocephalus 
of  a  severe  form  in  infancy.  The  health  of  the  Asylum 
during  the  past  year  is  considered  to  have  been  satisfactory, 
whilst  the  mortality  was  equal  to  an  annual  death-rate  of 
-2 '2  percent,  computed  upon  the  average  number  resident,  or 
T9  per  cent,  computed  upon  the  aggregate  number  under 
■care  and  training.  Attention  is  called  to  the  fact  that  these 
percentages  are  lower  than  any  recorded  since  1871,  and 
below  the  average  death-rate  of  the  institution  since  its 
■opening,  which  for  eleven  completed  years  is  given  as  3-8 
per  cent,  upon  the  average  number  resident,  and  3 '2  upon 
the  aggregate  number.  The  comparatively  low  mortality  of 
the  year  under  notice  is,  the  report  says,  no  doubt  mainly 
flue  to  the  mildness  of  the  winter  of  1881 — the  feeble  consti¬ 
tutions  of  the  children  possessing  but  little  resisting  power 
to  cold.  As  usual,  more  than  two-thirds  of  the  deaths  were 
■due  to  phthisis  and  scrofulous  disease.  Towards  the  close  of 
the  year  four  cases  of  scarlet  fever  occurred,  but  prompt 
removal  to  the  Lancaster  Fever  Hospital  stayed  any  further 
progress ;  and  although  in  the  spring  of  the  year  measles 
was  extensively  prevalent  in  the  neighbourhood  of  the 
Asylum,  happily  the  infection  was  not  communicated  to  the 
inmates  of  it. 


NEW  MEDICAL  SCHOOL  AT  BEYROUT. 

The  Progres  Medical  announces  that  France  now  possesses 
an  additional  medical  school,  namely,  at  Beyrout,  in  Syria. 
A  sum  of  150,000  fr.  has  been  already  expended  in  the 
■construction  and  preparation  of  the  lecture-rooms,  complete 
laboratories  of  physics  and  chemistry,  etc.  Everything  is 
now  ready,  and  the  lectures  will  commence  in  October.  The 
professors  are  chosen  from  among  the  doctors  of  the  French 
faculties,  and  will  receive  investiture  from  the  French 
<Government. 


DISSEMINATED  SCLEROSIS  IN  CHILDREN. 

The  absence  of  any  mention  of  this  affection  in  the  leading 
text-books  on  the  diseases  of  childhood  has  induced  M.  Marie 
to  investigate  the  literature  of  the  subject,  and  the  result  of 
that  inquiry  is  the  collection  of  fourteen  published  cases  in 
which  a  diagnosis  of  disseminated  cerebro-spinal  sclerosis  had 
been  made  in  children.  The  majority  of  these  have  been 
recorded  in  this  country;  a  large  proportion  of  them  will  be 
found  in  our  pages  during  the  years  1877  to  1879.  The 
.characteristic  symptoms  are  the  same  as  in  adults,  the  most 
important  being  trembling  on  voluntary  movement,  usually 
first  noticed  in  the  legs,  and  generally  accompanied  by  exag¬ 
geration  of  the  tendon  reflexes.  Strabismus  and  nystagmus 
were  frequently  present;  and  affections  of  speech  were  almost 
•constant,  the  speech  becoming  slow,  monotonous,  and  mea¬ 
sured  ;  occasionally  trembling  of  the  tongue  was  noticed.  A 
-certain  amount  of  mental  disturbance  was  usually  present, 
• e.g .,  irritability  of  temper,  impaired  memory,  or  weakened 
understanding.  Epileptiform  or  apoplectiform  seizures  were 
present  in  some  of  the  cases.  Affections  of  common  sensation 
were  but  seldom  present.  In  most  of  the  cases  the  disease 
came  on  quite  early  (about  the  age  of  four  years),  and  in  one 
•or  two  may  have  been  congenital.  We  should  exclude  M. 
'Chareot’s  patient  altogether,  as  the  patient  was  fourteen 
before  any  symptoms  were  recognised,  and  it  therefore  cannot 
fairly  be  grouped  with  cases  in  which  the  disease  commenced 
in  childhood.  In  several  instances  the  disease  seemed  sta¬ 
tionary,  in  some  was  slowly  progressive  ;  in  one  instance  the 
patient  completely  recovered,  but  had  a  relapse  afterwards 
consequent  upon  a  fright.  In  only  one  case  did  death  occur. 


The  patient  in  this  instance  was  a  girl  of  fourteen,  who  had 
first  presented  symptoms  of  nerve  disorder  seven  years  pre¬ 
viously,  strabismus,  diplopia,  and  left  facial  paralysis  being 
the  first  indications.  Two  years  later,  paralysis  came  on,  and 
became  general,  but  was  not  persistent.  Mental  changes 
commenced  about  the  same  period,  and  from  this  time  the 
intellect  progressively  deteriorated.  There  was  marked  in¬ 
coordination  of  movements  before  her  death,  but  no  evident 
muscular  wasting.  On  examination  there  was  found  in¬ 
creased  resistance  of  the  brain  substance,  due  to  affection 
of  the  central  parts,  and  not  of  the  cortex,  the  whole  of  the 
corona  radiata  being  involved  and  altered  in  consistence ; 
the  crura  cerebri,  crura  cerebelli,  and  pons  were  also  more 
resistant  than  natural,  and  this  was  more  marked  on 
the  right  side  than  the  left.  In  the  spinal  cord  the 
posterior  columns  were  most  affected,  and  next  the  lateral. 
Microscopically,  a  process  of  sclerosis  was  found  to  be  going 
on  in  the  affected  areas,  and  it  was  especially  noted  that  the 
changes  were  most  obvious  around  the  bloodvessels,  which 
themselves  had  undergone  some  cell-infiltration.  The  writer 
is  of  opinion  that  the  irregular  distribution  of  these  patches 
of  sclerosis  justifies  him  in  considering  the  case  to  be  one  of 
disseminated  rather  than  diffuse  sclerosis.  M.  Marie  has 
endeavoured,  in  the  paper  we  have  been  analysing  ( Revue  de 
MSdecine,  July),  to  show  that  disseminated  cerebro-spinal 
sclerosis  may  occur  in  children  with  the  same  symptoms  and 
pathology  as  in  adults.  We  feel  bound  to  confess  that  we  do 
not  think  he  has  succeeded  in  proving  his  position.  Out  of 
the  fourteen  cases  he  has  collected,  only  one  proved  fatal,  and 
there  was  found  a  diffuse,  or  at  any  rate  a  widespread, 
irregular  sclerosis  of  the  white  matter  of  the  brain  and 
spinal  cord,  the  grey  matter  apparently  being  uninvolved. 
This  is  not  quite  in  accordance  with  what  is  usual,  nor  do 
we  consider  that  the  symptoms  and  course  of  the  disease  in 
many  of  the  cases  were  such  as  would  exactly  tally  with  a 
case  of  disseminated  sclerosis.  These  cases,  however,  appear 
to  us  all  to  belong  to  the  same  group,  but  we  consider  that 
further  pathological  evidence  is  required  before  they  should 
be  classed  as  of  the  same  nature  as  disseminated  sclerosis  in 
adults. 


THE  HOWARD  MEDAL. 

The  usual  annual  competition  for  the  “  Howard  Medal” 
(1884)  of  the  Statistical  Society  will  take  place  subject  to  the 
rules  and  conditions  of  former  years.  The  essays  must  be 
sent  in  on  or  before  June  30,  1884.  The  Council  have  again 
decided  to  grant  the  sum  of  ,£20  to  the  writer  who  may  gain 
the  “  Howard  Medal.”  The  subject  for  next  year  is  “  The 
Preservation  of  Health,  as  it  is  affected  by  Personal  Habits, 
such  as  cleanliness,  temperance,  etc.”  (The  candidates  to 
be  referred  to  Howard’s  account  of  his  own  habits,  as  well 
as  to  his  opinions,  as  set  forth  in  the  text  and  foot-notes  of 
his  two  works  on  “Prisons”  and  “  Lazarettos.’  )  Further 
particulars  or  explanations  may  be  obtained  from  the 
Assistant- Secretary,  at  the  office  of  the  Society  in  the 
Strand. 


VITAL  STATISTICS  OE  SCOTLAND  FOR  THE  JUNE  QUARTER, 

1883. 

In  noticing  briefly  the  quarterly  return  of  births  and  deaths 
registered  in  Scotland  during  the  second,  or  J une,  quarter 
of  1883,  published  by  authority  of  the  Registrar-General 
for  that  portion  of  the  kingdom,  it  has  to  be  recorded  that 
during  that  period  32,420  births  and  20,386  deaths  were 
officially  noted.  For  every  10,000  of  estimated  population 
the  annual  birth-rate  was  340,  or  3'40  per  cent.  ;  whereas 
the  average  rate  during  the  corresponding  quarter  of  the 
ten  preceding  years  was  3'652  per  cent.  Glasgow  returns 
show  a  birth-rate  of  409  per  10,000 ;  Greenock,  40/ 


382 


Medical  Times  and  Gazette. 


THE  WEEK. 


Sept.  29,  t8S3c 


Paisley,  381 ;  Aberdeen  and  Leith,  359  each ;  Dundee, 
342 ;  Edinburgh,  306 ;  and  Perth,  305.  Of  the  32,420 
births,  2530,  or  7'8  per  cent.,  were  illegitimate,  and 
the  proportion  of  boys  to  girls  was  as  104’2  of  the 
former  to  100  of  the  latter,  the  average  number  of  births 
on  each  day  of  the  quarter  being  356-3.  The  deaths  regis¬ 
tered  in  Scotland  during  this  quarter  were  at  the  annual 
rate  of  214  in  every  10,000  inhabitants,  which  is  a  higher 
rate  than  that  recorded  in  the  second  quarter  of  any  year 
since  1878.  The  number  of  deaths  registered  in  England 
and  Wales  during  the  same  quarter  was  133,783,  and  the 
death-rate  was  201  in  every  10,000  inhabitants.  In  Glasgow 
the  death-rate  was  320  per  10,000 ;  in  Dundee  and  in 
Greenock,  273 ;  in  Paisley,  255 ;  in  Leith,  227 ;  in  Perth, 
221 ;  and  in  Edinburgh  and  in  Aberdeen,  195.  The  average 
number  of  deaths  registered  on  each  day  of  the  quarter 
was  224.  The  natural  increase  of  population  during  the 
quarter,  calculated  from  the  preceding  figures,  was  12,034, 
irrespective  of  emigration  and  immigration.  As  regards 
the  latter,  there  are  no  means  of  forming  a  reliable 
estimate,  but  from  the  Board  of  Trade  Returns  it  would 
appear  that  the  number  of  Scotch  emigrants  during  the 
quarter  was  11,795,  and  this  number  deducted  from  the 
excess  of  births  over  deaths  gives  239  as  the  computed  in¬ 
crease  of  population  for  the  period  under  notice.  The  return 
remarks  that  this  very  small  estimated  increase  is  to  be  ex¬ 
plained  by  the  fact  that  the  death-rate  for  the  quarter  was 
very  large, exceeding  that  of  the  corresponding  quarter  of  1882 
by  2093,  while  the  birth-rate  for  the  same  period  is  smaller 
by  926 ;  the  number  of  Scotch  emigrants  at  the  same  time 
being  great.  The  deaths  from  zymotic  diseases  during  this 
quarter  numbered  1626,  or  about  19'5  per  cent,  of  all  deaths 
referred  to  specified  causes.  Only  one  death  was  registered 
from  small-pox  in  April,  but  the  mortality  from  measles  was 
521,  and  from  whooping-cough  466.  As  regards  the  weather 
of  the  second  quarter  of  the  present  year,  it  is  to  be  gathered 
from  the  return  that  April  was  a  fine  month  of  its  order, 
with  high  barometric  pressure,  rather  greater  mean  tempera¬ 
ture,  less  humidity,  less  number  of  rainy  days,  less  depth  of 
rainfall,  less  strength  of  wind,  and  rather  less  both  of  north 
and  east  in  the  direction  of  the  wind  than  usual.  The 
characteristics  of  May  were — slightly  less  barometric  pres¬ 
sure,  mean  temperature,  humidity,  and  rainfall,  but  more 
wind  and  with  a  prominent  direction  from  the  north-west. 
June  was  on  the  whole  cold  and  dry,  and  characterised  by 
an  extra  amount  of  east  wind. 


Elsewhere  in  our  columns  will  be  found  a  paper  on  the 
Bncovenanted  Medical  Service  of  India,  which  we  strongly 
recommend  to  the  notice  and  consideration  of  our  readers. 
The  Service  is  one  that  not  a  few  of  the  young  medical  men 
who  enter  our  crowded  profession  every  year  might  find  very 
tempting,  and  very  suitable  to  their  temperaments  and 
gifts  ;  but  it  is  a  Service  that  is  but  little  heard  of  in 
England,  and  about  which  it  is  by  no  means  easy  to  gain 
any  clear  and  accurate  information  ;  and  all  that  Surgeon- 
General  Francis  says  about  it  may  be  most  fully  accepted. 


At  a  meeting  of  the  Governors  of  St.  Bartholomew’s 
Hospital  on  Thursday,  September  27,  Dr.  Norman  Moore 
was  elected  to  the  vacant  post  of  Assistant-Physician. 


The  Secretary  of  the  London  Fever  Hospital  writes  to 
suggest  that  the  public  would  give  the  authorities  of  the 
Hospital  valuable  help  by  sending  a  supply  of  toys  for  the 
numerous  children  being  now  received  into  the  typhoid 
wards.  ■  “A  few, shillings,”  he  says,  “  invested  in  this  direc¬ 
tion,  would  give  no  end  of  pleasure  to  our  little  patients.” 


We  are  informed  that  a  petition,  signed  by  over  3Sf> 
Fellows,  has  been  forwarded  to  Mr.  Cadge,  for  presentation 
to  the  Council  of  the  Royal  College  of  Surgeons,  in  support 
of  Mr.  Cadge’s  motion  in  favour  of  non-personal  voting  at 
the  election  on  the  Council  of  the  College. 


The  President  of  the  Sanitary  Institute  of  Great  Britain, 
Professor  Humphry,  in  the  course  of  his  opening  address, 
advocated  the  institution  of  a  Sanitary  Department  in  the 
Legislature,  distinct  from  the  Local  Government  Board,  and 
under  the  direction  of  a  Minister  of  Sanitary  Affairs.  He 
could  scarcely  conceive  of  anything  more  likely  than  this  to 
promote  the  well-being  of  the  people,  and  their  success 
in  everything  they  undertook,  whether  it  were  literary, 
scientific,  commercial,  or  military. 


The  financial  position  of  the  Middlesex  Hospital  was  the 
subject  of  congratulation  at  the  usual  quarterly  meeting  of 
the  governors,  held  lately.  Towards  the  necessary  expense 
of  the  proposed  new  building  ,£5000  had  been  realised,  and 
legacies  had  been  bequeathed  to  the  amount  of  =£11,000. 


It  is  probable  that  the  Right  Hon.  G.  J.  Goschen  may 
deliver  the  opening  address  of  the  forthcoming  winter 
session  at  the  Edinburgh  Philosophical  Institution. 


At  the  quarterly  board  meeting  of  the  Bristol  Royal 
Infirmary,  held  on  Tuesday  last,  the  chairman  stated  that 
the  introduction  of  fish  dinners  had  been  attended  with 
very  great  success  and  saving  to  the  charity.  They  ob¬ 
tained  the  fish  direct  from  Great  Grimsby  at  the  rate  of  2d. 
and  2^d.  a  pound,  and  the  dinners  had  been  approved  by  the- 
patients  and  the  staff. 


The  War  Department  has  leased  twenty  acres  of  land 
abutting  on  the  sea-wall  at  Sheerness,  to  the  Sheerness 
Local  Board  of  Health,  for  the  use  of  the  inhabitants  as  a 
recreation  ground. 

We  learn  that  the  Sanitary  Institute  of  Great  Britain 
have  transferred  their  office  to  the  Parkes  Museum,  74a, 
Margaret-street,  W.  We  understand  also  that  Mr.  E.  White 
Wallis,  F.S.S.,  for  some  years  past  the  Secretary  of  the 
Sanitary  Institute,  has  become  the  Secretary  and  Curator  of 
the  Parkes  Museum  also.  We  are  glad  to  notice  this  evidence 
of  the  harmonious  working  of  two  societies  with  kindred 
aims. 


Medical  Charities. — The  late  Miss  Caroline  Hutton, 
of  Eastgate,  Lincoln,  amongst  other  liberal  bequests,  has 
bequeathed  £500  to  build  a  fever  ward  in  connexion  with 
the  Lincoln  County  Hospital,  a  similar  amount  to  the 
Lincoln  General  Dispensary,  £300  to  the  Eastwood  Idiot 
Asylum,  and  £200  to  the  Samaritan  Free  Hospital.  The 
Very  Rev.  Archibald  Boyd,  Dean  of  Exeter,  leaves  £250' 
each  to  the  Devon  and  Exeter  Hospital,  the  Cheltenham 
General  Hospital,  and  St.  Mary’s  Hospital,  Paddington ;  £200 
each  to  the  Exeter  Dispensary,  the  Exeter  Eye  Infirmary,, 
and  Deaf  and  Dumb  Institution. 

Curious  Crushing  Injury.— The  Prague  correspon¬ 
dent  of  the  Philadelphia  Med.  News  (August  11)  mentions 
the  following  curious  result  of  a  crushing  accident — “  the 
man’s  thorax  being  caught  between  the  bumpers  of  two  cars 
as  he  was  coupling  them.  At  the  autopsy  no  external  injury 
was  visible.  Several  ribs  on  each  side  were  broken,  and  the 
heart  was  found  free  in  the  abdomen,  it  having  been  torn, 
from  its  attachments  to  the  great  vessels,  and  forced  through 
a  rent  which  was  made  in  the  diaphragm.  It  is  rather 
difficult  to  understand  how  the  violence  could  have  acted 
so  as  to  produce  this  result.  Most  probably  the  man  was 
stooping  slightly  forward  when  caught.” 


Medical  Times  and  Gazette. 


THE  UNCOVEN  ANTED  MEDICAL  SERVICE  OF  INDIA. 


Sept.  29,  1883.  383- 


THE  UNCOVENANTED,  OE  CIVIL  MEDICAL, 
SERVICE  OE  INDIA. 

By  Surgeon-General  CHARLES  R.  FRANCIS,  M.B. 

It  is  much  to  be  regretted,  considering  how  many  sub¬ 
stantial  advantages  it  offers,  that  so  little  is  known,  out  of 
the  country,  of  the  ITncovenanted  Medical  Service  of  India- 
And  yet  it  is  a  service  which  the  Government  there  wishes 
to  see  developed.  Beyond  the  publication  of  its  rules  in  the 
Government  Gazette — rules  which  may  be  obtained  in  India 
— no  steps  have  been  taken  to  promulgate  a  knowledge  of 
the  subject  elsewhere.  An  abstract  of  the  rules  may  indeed 
be  seen  in  the  “  India  List,”  published  half-yearly  by  Messrs. 
W.  H.  Allen  and  Co.,  13,  Waterloo-place,  London;  but  this 
is  a  rather  expensive  publication. 

As  the  name  implies,  there  is  no  covenant  between  the 
Government  and  the  medical  men  of  this  service.  These 
gentlemen  are  “picked  up,”  as  it  were,  in  a  hap-hazard  sort' 
of  way ;  and  if  they  satisfy  a  board  of  examiners,  consisting 
of  the  senior  medical  officers  on  the  spot,  as  to  their  know¬ 
ledge  of  tropical  disease  and  its  treatment,  they  are  admitted 
into  the  medical  portion  of  the  Uncovenanted  Service.(a) 
But  there  is  no  uniform  standard,  and  the  examination 
may  be  searching  or  otherwise.  The  candidates  must 
possess  a  recognised  diploma  or  licence,  as  a  guarantee  of 
their  general  professional  acquirements.  In  enlisting  men 
under  these  conditions,  the  object  of  the  Government 
originally  was  to  supplement  the  regular  service,  and 
to  create  a  permanent  source  from  which  to  supply  the 
smaller  civil  stations.  Subsequently,  however,  they  went 
further ;  and,  about  fourteen  years  ago,  it  was  proposed,  at 
a  medical  conference  in  Calcutta,  to  reduce  the  strength  of 
the  regular  establishment,  and  to  increase  that  of  the  un¬ 
covenanted  body;  but  the  proposal  was  never  carried  out. 

There  are,  generally,  a  few  medical  men  who  have  got  to 
India  in  various  ways,  and  who  are  looking  out,  in  the  presi¬ 
dency  towns  and  elsewhere,  for  employment.  From  this 
uncertain  source  the  Uncovenanted  Medical  Service  is,  at 
present,  for  the  most  part  recruited  ;  but,  in  the  absence  of 
any  organised  system  of  supply,  and  of  a  uniform  standard 
of  professional  qualification,  the  result  is  not,  and  never  can 
be,  thoroughly  satisfactory.  The  medical  officers  who  com¬ 
pose  this  service  are  variously  qualified.  Some  are  able 
physicians  and  surgeons,  and,  both  by  nature  and  acquire¬ 
ments,  are  fitted  to  shine  in  any  community.  Many  excellent 
men  go  abroad  for  two  or  three  years  as  surgeons  to  ships, 
in  view  to  seeing  something  of  life,  to  becoming  bronzed  and 
rubbing  off  the  fresh  bloom  of  youth— a  juvenile  appearance 
being  a  barrier,  as  a  rule,  to  success  in  practice  at  home — 
and  to  acquiring  a  knowledge  of  the  world.  It  occasionally 
happens  that  one  from  this  class,  if  he  be  not  bound  to 
accompany  his  vessel  home,  or,  being  bound,  if  he  can  pro¬ 
vide  a  substitute,  remains  in  India — induced  thereto  by  the 
offer  of  a  partnership  in  one  of  the  well-to-do  firms  of 
chemists.  In  Calcutta  these  firms  are  almost  entirely  com¬ 
posed  of  qualified  practitioners,  and  some  of  them  have,  in 
the  past,  realised  very  comfortable  independences  compara¬ 
tively  early  in  life.  Shipping  practice  often  yields  a  hand¬ 
some  addition  to  the  yearly  income  ;  and  it  usually  falls  into 
the  hands  of  these  gentlemen.  The  owners  of  every  vessel 
that  comes  into  harbour  without  a  surgeon  give  a  stipu¬ 
lated  sum  monthly  to  the  practitioner  who  will  take  medical 
charge  of  her  whilst  she  is  in  port.  He  is  expected  to  go  on 
board  every  morning,  and  treat  what  cases  will  admit  of  it. 
But,  there  being  no  sick-bay  in  these  vessels,  all  serious  cases 
are  sent  as  soon  as  possible  to  one  of  the  presidency  hospitals. 
The  emoluments  from  this  source  frequently  amount  to 
between  Rs.  1500  and  Rs.  2000  a  month.  Or,  the  quondam 
ship  surgeon  may  become  a  “  planter’s  doctor  ” — often  a 
comfortable  and  lucrative  position.  Or  he  may  enter  the 
railway  service,  and,  constantly  travelling  up  and  down  over 
his  “  beat”  of  some  two  hundred  miles  at  all  seasons  of  the 
year,  then  realise  what  hard  work  practically  means.  Or  he 
may  be  attached  to  a  factory,  or  to  a  Nuwab  or  Rajah,  and 

(a)  Sometimes  a  superior  member  of  the  apothecary  class  is  raised  to  the 
rank  of  uncovenanted  medical  officer,  and  appointed  to  a  small  civil 
station;  a  position  which  is  much  valued  by  this  class,  who  recognise,  in 
the  prospect  of  one  day  attaining  to  it,  a  stimulus  to  exertion. 


have  medical  charge  of  two  or  three  dispensaries.  I  occe 
met  with  a  shrewd  medical  adventurer,  who,  failing  succes¬ 
sively  in  London,  Canada,  and  Teneriffe,  endeavoured  to 
establish  himself  at  the  Cape  of  Good  Hope.  Meeting 
there  with  an  Indian  administrative  officer,  who  had  been 
sent  to  the  Cape  on  medical  certificate  on  account  of  an 
attack  of  insolation  when  on  a  sporting  expedition  in  the 
month  of  May,  he  contrived  to  ingratiate  himself  into 
the  officer’s  favour  in  a  way  that  led  to  his  permanent  ad¬ 
vancement.  The  officer  made  him  his  “  body  surgeon  ”  on 
a  salary  of  =£600  a  year,  took  him  to  India,  and  there  obtained 
for  him  an  appointment  that  provided  for  him  for  life. 

The  Government  Service,  in  spite  of  many  desagremens, 
is,  by  reason  of  the  regular  and  fairly  sufficient  pay  and 
pension,  always  attractive ;  but,  however  desirous  the  Govern¬ 
ment  may  be  to  secure  efficient  and  estimable  men,  many 
enter  it  who  may  emphatically  be  classed  amongst  the  oi  iroWct 
of  medical  society.  Instances  have  occurred,  where  adven¬ 
turers,  having  accepted  service  and  not  found  it  to  their 
fancy,  or  in  the  hope  of  bettering  themselves,  have  simply 
deserted  their  posts.  The  appointment  of  men  of  “  low 
degree  ”  to  stations  where  high-born  and  delicate  ladies  are 
located  is  fraught  with  much  vexation  and  expense;  for,, 
sooner  than  consult  them,  they  who  could  afford  it  would 
seek  medical  aid  elsewhere,  even  though  at  some  cost.  It  is  in> 
the  interest  of  unfortunate  communities  thus  situated,  and 
of  the  Government  of  India,  that  I  write  these  lines. 

When  a  man  has  passed  the  prescribed  age  (twenty- eight) 
he  is  no  longer  eligible  for  admission  into  the  regular,  or 
Indian  Medical,  Service.  For  admission  into  the  Uncove¬ 
nanted  Service  there  is  no  limit  as  to  age. 

The  pay  of  an  uncovenanted  medical  officer  for  the  first 
five  years  is  Rs.  350(b)  a  month,  which  is  increased  by 
periodical  increments,  at  intervals  of  five  years,  till  the 
maximum — Rs.  700  a  month — is  attained.  This  occurs 
after  fifteen  years’  service.  The  executive  charge  of  the 
gaol  in  civil  stations  yields  a  further  income  according  to- 
the  number  of  the  prisoners.  It  is  a  capitation  allow¬ 
ance,  and  varies  from  Rs.  50  to  R3.  150  a  month.  Private- 
practice  may  still  further  increase  the  income ;  but,  as 
the  stations  to  which  uncovenanted  medical  officers  are- 
appointed  are  comparatively  small,  much  must  not  be 
expected  from  this  source.  There  are  very  few  European 
Government  officers  in  these  stations,  and  remuneration 
can  only  be  claimed  for  professional  attendance  upon  their 
families.  But  a  practice  may  be  made  amongst  the  natives. 
If  the  civil  surgeon  has  a  reputation  for  surgical  skill,  be  he 
convenanted  or  uncovenanted,  patients  suffering  from  every 
conceivable  form  of  disease  or  injury,  requiring  the  use  of 
the  knife,  will  be  brought  from  long  distances.  The  days 
are  past  when  a  medical  officer  received  a  set  of  gold  instru¬ 
ments  as  a  keepsake  from  a  grateful  monarch,  but  handsome 
fees  are  still  given  occasionally  by  wealthy  native  patients. 
European  medical  practitioners  of  repute  have,  in  my  own 
time,  received  Rs.  50,000  for, going  from  Calcutta  to  operate 
upon  patients  in  the  provinces ;  and  it  is  not  at  all  unusual 
for  the  civil  surgeon  himself  to  receive  a  large  sum  for  a 
successful  operation.  I  was  well  acquainted,  when  in  India, 
with  uncovenanted  medical  officers  whose  annual  income 
from  all  sources  was  at  least  ,£1200  a  year,  and  they  were 
living  upon  less  than  half  of  it. 

At  the  end  of  fifteen  years  an  uncovenanted  medical  officer 
may,  on  the  production  of  a  certificate  showing  that  his- 
health  will  no  longer  allow  of  his  serving  in  the  country, 
retire  upon  a  pension  which  equals  a  third  of  the  average 
salary  that  he  had  been  drawing  during  the  previous  five 
years,  or,  say,  from  Rs.  2000  to  Rs.  3000  a  year.  But,  either 
from  inability  to  produce  the  necessary  certificate,  or  from 
unwillingness  to  give  up  so  good  a  service,  few  retire  so 
early.  After  twenty-five  years  the  retiring  pension  is  half 
the  last  five  years’  average  salary,  or,  say,  from  Rs.  4000  to 
Rs.  5000  a  year. 

The  leave  regulations  are  not  illiberal.  After  twenty 
years’  service  an  uncovenanted  officer  may  have  two  years’ 
-furlough,  three  after  twenty -five,  four  after  thirty', 
and  five  after  thirty-five  years’  service  ;  all  these  several 
periods  being  allowed  to  count  as  service.  This  kind  of 
leave  is  independent  of  privilege,  and  subsidiary,  leave — 
the  former  being  reckoned  at  one  month  in  twelve,  and 

(b)  In  palmier  days  the  Indian  rupee  was 
at  the  rate  of  exchange  which  has  prevailed 
varies  from  Is.  64d.  to  Is.  9£d. 


Medical  Times  ani  Gazette. 


FROM  ABROAD. 


Sept.  29, 1883. 


384 


the  latter  according  to  requirements.  It  is  given  to 
allow  of  an  incumbent  joining  an  appointment,  or  to  enable 
him  to  prepare  to  leave  India  on  furlough. (c)  Then,  by 
subscribing  to  the  Uncovenanted  Family  Pension  Fund — a 
fund  distinct  from  the  Indian  Service  Family  Pension  Regu¬ 
lations,  under  the  operation  of  which  officers  of  the  staff  corps, 
of  the  Indian  Medical  Service,  and  chaplains,  are  compelled 
to  subscribe  towards  a  fund  for  the  benefit  of  their  families 
—provision  may  be  made  for  the  widow  and  orphan.  The 
Uncovenanted  Family  Pension  Fund  has  been  hitherto 
exceedingly  well  managed,  and  is  looked  upon  as  an  institu¬ 
tion  of  great  value  to  the  uncovenanted  body. 

The  cost(d)  of  living  will,  of  course,  depend  upon  personal 
habits,  the  dearness  or  otherwise  of  provisions,  and  upon  the 
individual’s  condition — whether  he  be  married  or  single.  I 
strongly  recommend  all  who  intend  to  make  India  the 
land  of  their  adoption  not  to  remain  single  in  that  country. 
With  a  good  wife,  life  at  a  civil  station  in  India  is  very 
enjoyable  :  without  one,  there  is  probably  no  quarter  of  the 
world  that  so  conduces  to  dyspepsia  and  low  spirits.  The 
uncovenanted  surgeon  has  one  great  advantage  over  his 
covenanted  confrere — he  is  never  wanted  for  military  employ. 
He  may,  if  he  likes,  continue  throughout  his  entire  service 
in  one  station,  and  thus  escape  the  expense  attendant  upon 
long  journeys,  the  risk  of  selling  his  property  at  a  sacrifice, 
and  the  delay  which  must  inevitably  occur  before  he  can 
acquire  a  professional  reputation  in  a  fresh  sphere. 

With  regard  to  taking  a  wife  to  India  in  the  first  instance, 
the  intending  settler  will  probably  act  according  to  his  in¬ 
clination  ;  but  the  step  is  scarcely  wise.  Both  would  be 
ignorant  of  the  language,  and  neither  could  tell  how  the 
country  would  agree  with  them.  Communication  with 
'home  is,  nowadays,  comparatively  easy :  and  I  should, 
therefore,  recommend  the  lady  to  remain  where  she  is, 
■whilst  her  husband,  or  intended,  as  the  case  may  be,  goes 
to  reconnoitre. 

I  believe  that  the  climate  of  India  is  not  so  inimical  to  the 
European  constitution  as  is  generally  supposed,  and  that 
very  much  of  the  sickness  that  is  attributed  to  it  is  pre¬ 
ventable.  Still,  it  does  not  suit  everyone,  and  some  never 
become  acclimatised,  stay  as  long  as  they  may. 

A  medical  man  could  not  be  expected  to  make  the  experi¬ 
ment  at  his  own  expense ;  but '  I  venture  to  think  that  the 
liberal  regulation,  instituted  by  the  East  India  Company, 
of  allowing  its  officers  to  retire  upon  a  small  pension  at  the 
-end  of  three  years,  upon  the  production  of  a  medical  certifi¬ 
cate  showing  that  it  was  impossible  for  them  to  live  in  the 
country,  might  be  applied  to  uncovenanted  medical  officers, 
with  whom  the  Government  could,  so  far,  enter  into  a 
covenant.  The  term  “  uncovenanted,”  as  at  present  under¬ 
stood,  conveys  a  sense  of  inferiority,  and  very  frequently 
•causes  heart-burnings  and  jealousies.  “  Civil  Medical  Ser¬ 
vice  ”  would  be  a  far  more  satisfactory  title. 

Army  medical  officers  are  required  to  go  through  a  special 
course  of  instruction  for  military  service  in  India ;  and  for 
that  purpose  remain  four  months  at  Netley.  A  fortiori,  the 
medical  man  who  is  to  be  placed  in  charge  of  a  civil  station 
in  that  country  should  have  similar  instruction  ;  for  he  will 
be  completely  isolated,  and  unable,  in  the  moments  of  diffi¬ 
culty  which  occur  to  all  during  the  first  year  or  two,  to  con¬ 
sult  those  who  are  more  experienced  than  himself  in  the 
management  of  tropical  disease. 

This  service  is  capable  of  much  advantageous  develop¬ 
ment,  advantageous  alike  to  the  State  and  to  the  medical 
officers,  who,  unsuccessful  at  home,  and  with  the  doors  of 
■entrance  into  other  public  services  closed  against  them,  may 
find  a  suitable  footing  for  themselves  and  their  families  in 
this  one  ,•  and,  whilst  providing  for  the  future  of  both — a 
provision  to  the  absence  of  which  in  England  our  benevo¬ 
lent  institutions  too  abundantly  testify — he  will,  if  wisely 
-selected,  be  a  fit  representative  of  the  noble  fraternity  which, 
in  various  ways,  is  contributing  so  largely  to  the  welfare  of 
India. 

If  these  few  lines  succeed  in  drawing  attention  to  this 
important  service,  I  shall  not  have  written  them  in  vain. 

(c)  Leave  on  medical  certificate  is  granted  within  certain  limits,  a  portion 
■being  allowed,  as  with  general  furlough  leave,  to  reckon  as  service  for 
pension.  An  officer  may  have,  at  one  time,  two  years  to  Europe  on 
medical  certificate— to  be  extended,  if  necessary,  to  three.  During  these 
•various  leaves  pay  is  given  according  to  a  fixed  scale. 

(d)  For  a  stationary  bachelor  Its.  250,  and  for  a  married  man  without 
■children  Rs.  350,  a  month  ought  to  be  sufficient.  These  sums  are  intended 
to  include  a  very  moderate  allowance  of  malt  liquor. 


FROM  ABROAD. 

Prolonged  Retention  of  a  Fcetos. 

Prof.  Sappet,  at  a  recent  meeting  of  the  Academie  des 
Sciences  ( Comptes-Rendus ,  August  27,  and  Union  Medicate, 
September  1),  read  an  “Account  of  a  Fcetus  which  remained 
for  Fifty-six  Years  in  the  Abdomen  of  its  Mother,  without 
undergoing  any  alteration  or  causing  any  inconvenience 
beyond  that  resulting  from  its  weight  and  size.” 

When  a  foetus,  he  observes,  encounters  an  obstacle  which 
prevents  its  expulsion,  it  dies,  and  becomes,  in  the  vast 
majority  of  cases,  the  cause  of  accidents  to  the  mother 
which  prove  fatal.  In  some  exceedingly  rare  cases,  however, 
the  foetus  comports  itself  as  a  simple  foreign  body,  to  which 
th.e  surrounding  organs  so  well  habituate  themselves  that  a 
new  pregnancy  may  even  occur,  and  follow  its  natural  course. 
These  exceptional  cases  have  excited  much  attention,  and 
were  especially  investigated  by  Morand  in  the  middle  of  the 
last  century.  All  the  instances  of  very  prolonged  retention  on 
record  have  presented  identical  conditions,  the  foetus  having 
been  found  rolled  up  on  itself  and  enclosed  in  a  cyst  of  bony 
hardness  ;  and  this  cyst,  deprived  of  all  traces  of  organisa¬ 
tion,  separated  the  foetus  so  completely  from  the  neigh¬ 
bouring  organs,  that  its  organic  connexions  with  the  mother, 
once  so  intimate,  no  longer  existed.  But  these  conditions 
afford  little  explanation  of  why  the  foetus  so  placed  did  not 
undergo  putrefaction.  This  was  attempted  to  be  explained 
by  the  petrifaction  of  the  foetus ;  but  the  facts  failed  to  show 
the  reality  of  this,  and  the  views  of  Morand,  that  the  pre¬ 
servation  of  the  foetus  was  due  to  the  drying-up  of  its 
tissues,  and  the  incrustation  of  the  air-tight  cyst  in  which 
it  was  enclosed,  were  generally  accepted. 

All  the  instances  heretofore  known  of  a  foetus  having  been 
retained  in  the  abdomen  for  many  years,  conformed  to  this 
explanation  :  but  the  case  now  brought  before  the  Academy  is 
completely  opposed  to  it ;  for  this  fcetus,  which  remained  in 
the  abdomen  of  its  mother  for  fifty-six  years,  and  which 
ought  to  have  been  more  dried  up  than  any  of  its  prede¬ 
cessors,  was,  in  fact,  not  desiccated  at  all,  its  various  parts 
retaining  their  normal  consistency.  The  mother  of  this 
foetus  became  pregnant  at  twenty-eight  years  of  age,  and 
having  reached  the  age  of  eighty-four  (in  the  enjoyment  of 
tolerable  health),  she  was  brought,  in  1845,  to  the  Hospice 
of  Quimperle,  where  she  died  soon  after  from  an  affection 
of  the  respiratory  organs.  At  the  autopsy,  M.  Beaugendre 
found  that  the  tumour  which  had  existed  for  so  many 
years  was  placed  at  the  outer  side  of  the  uterus,  in 
the  course  of  the  right  Fallopian  tube.  It  was  covered 
all  over  with  calcareous  deposits  and  incrustations,  pre¬ 
senting  the  appearance  of  a  cyst  with  an  unequal  and 
mammelonated  surface,  of  a  bony  consistence,  and  adhering 
at  some  points  to  neighbouring  organs.  Of  an  irregularly 
ovoid  form,  it  measured  eighteen  centimetres  along  its  great 
axis,  its  walls  having  a  thickness  of  from  two  to  three  milli¬ 
metres.  On  the  cyst  being  sawn  into  two  equal  parts,  great 
was  the  surprise  of  all  present  at  finding  in  this  inclosure, 
apparently  of  a  mineral  nature,  a  foetus  which,  during  its 
prolonged  captivity,  had  undergone  no  chaDge  whatever. 
It  lay  in  the  ordinary  foetal  attitude,  with  its  limbs  folded 
on  the  trunk  and  its  head  inclined  upon  the  thorax.  The 
two  completely  formed  pupillary  membranes  attested  that  it 
was  of  an  age  from  the  sixth  to  the  seventh  month.  The 
superficial  organs,  the  viscera  contained  within  the  great 
cavities  of  the  body,  all  the  muscles,  and  all  the  other  soft 
parts,  had  preserved  their  consistence,  their  suppleness,  and 
their  normal  colour.  The  hairy  scalp  was  covered  with 
hairs  that  were  already  very  long.  The  two  eyelids  con¬ 
cealed  the  globe  of  the  eye,  and  on  the  free  border  was 
placed  a  double  row  of  well-formed  eyelashes.  The  foetus, 
in  fact,  conveyed  to  those  present  the  idea  of  a  sleeping 
infant. 

The  drying-up  theory  having  to  be  abandoned,  and  the 
influence  of  the  exclusion  of  air,  to  which  Morand  attached 
deserved  importance,  having  to  be  modified  in  the  light  of 
Pasteur’s  experiments  (which  prove  that  pure  air  is  not 
provocative  of  putrefaction  in  organic  bodies),  Prof.  Sappey 
thus  formulates  what  he  terms  the  new  theory: — “The 
foetus  which,  after  its  death,  is  preserved  for  an  indefinite 
period  in  the  abdomen  of  its  mother  owes  its  preservation 


Medical  Times  and  Gazette. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


Sept.  20*  1888.  385 


to  the  physical  conditions  of  its  imprisonment,  which  have 
the  advantage  of  sheltering  it  from  the  action  of  atmos¬ 
pheric  germs.”  This  “  Quimperle  foetus,”  by  which  name 
it  will  be  henceforth  known,  after  having  been  carefully 
examined,  was  placed  in  slightly  diluted  alcohol,  and  as  this 
gradually  become  turbid,  M.  Beaugendre,  to  avoid  the  trouble 
of  its  frequent  renewal,  unfortunately  determined  to  expose 
the  foetus  to  the  air  for  the  purpose  of  desiccating  it.  This 
he  accomplished,  and  irretrievably  spoiled  the  preparation, 
and  incurred  Prof.  Sappey’s  sharp  reproaches,  which  he 
received  with  due  penitence.  Such  as  it  is,  it  has  at  last 
been  presented  to  the  Academie  ;  but  Prof.  Sappey  gives  no 
explanation  of  the  long  delay  that  has  elapsed  between  the 
discovery  (in  1845)  of  this  remarkable  and  unique  case,  and 
the  publicity  now  given  to  it. 


Herniotomy  and  Antiseptic  Treatment. 

At  the  recent  Congress  of  German  Surgeons  ( Centralblatt 
fur  Chirurgie,  Beilage),  Dr.  Benno  Schmidt,  of  Leipzig, 
read  a  paper  upon  “  The  Eesults  of  Herniotomy  since  the 
introduction  of  Antiseptic  Treatment.”  For  the  purpose  of 
replying  to  the  question  as  to  how  far  the  results  of  herni¬ 
otomy  have  improved  since  the  introduction  of  the  Listerian 
method,  Dr.  B.  Schmidt  has  had  compiled  the  histories  of  a 
number  of  cases  that  have  been  treated  in  German  hospitals 
and  clinics  between  1877  and  1881,  and  has  thus  collected 
accounts  of  363  operations,  of  which  308  were  performed  for 
strangulated  hernia,  and  55  for  the  radical  cure  of  non- 
strangulated  hernia;  while,  prior  to  Lister’s  procedure,  the 
mortality  from  herniotomy  amounted  to  45 '8  per  cent. 
Of  these  308  cases  113  proved  fatal,  furnishing  a  mortality 
of  36'6;  the  improvement,  therefore,  only  amounting  to  9'2 
per  cent.  Several  fatal  cases  were  due  to  intercurrent  or 
complicating  diseases  which  did  not  influence  the  condition 
of  the  wound,  peritoneum,  etc. ,  but,  after  abstracting  these 
cases,  the  mortality  remained  at  30'9  per  cent.  Of  249 
patients  there  died  77  from  septic  causes,  and  but  a  few  from 
perforating  peritonitis.  These  results  will  take  many  by 
surprise,  if  they  do  not  bear  in  mind  that  in  an  operation 
for  strangulated  hernia  there  cannot  be  a  question  of  an 
antiseptic  operation  as  generally  understood.  The  sub¬ 
stance  of  the  inflamed  intestine  is  pervious,  and  its  vicinity 
very  soon  after  the  commencement  of  the  strangulation  takes 
on  a  septic  condition.  That  this  is  the  case  will  be  seen  from 
the  results  of  the  operation  (Petit’s)  external  to  the  sac,  for 
which  cases  of  short  duration,  and  presumably  with  a  better 
condition  of  the  contents  of  the  sac,  are  always  chosen  ;  and 
yet,  of  the  16  cases  so  , operated  upon,  4  proved  fatal  from 
septic  peritonitis.  The  other  cases  were  ranged  in  four 
categories — (1)  herniotomy,  with  return  of  the  intestine, 
with  a  mortality  of  27'4 ;  (2)  excision  of  the  omentum,  and 
the  same,  222;  (3)  excision  of  the  intestine,  and  return  of  the 
sutured  gut,  76T  ;  and  (4)  the  formation  of  an  artificial  anus, 
80' 5.  Septic  peritonitis  was  the  cause  of  death  in  50  per 
cent,  of  the  first  category,  66'6  of  the  second,  87'5  of  the 
third,  and  50  of  the  fourth  category. 

Of  the  55  cases  of  operation  for  the  radical  cure  of  non- 
strangulated  hernia,  11  proved  fatal,  septic  peritonitis  being 
the  cause  of  death  in  one-half  of  the  cases. 

From  the  above  statistical  statement  Dr.  Schmidt  draws 
the  following  conclusions  1.  The  results  of  operations  for 
strangulated  hernia  are  not  capable  of  attaining  the  same 
improvement  by  means  of  the  antiseptic  procedure  as  are 
operations  executed  on  healthy  parts,  because  they  are  per¬ 
formed  on  parts  already  septically  infiltrated.  2.  These 
results,  however,  would  probably  be  better  if  we  limited  our¬ 
selves  more  to  the  strict  necessity  of  the  case  by  the  removal 
of  what  immediately  endangers  life,  viz.  : — (a.)  In  opera¬ 
tions  in  which  the  return  of  the  intestine  is  only  in  question, 
we  should  not  add  to  this  an  operation  for  the  radical  cure 
of  the  hernia.  (6.)  When  there  is  a  co-existing  descent  of 
unreturnable  omentum,  we  should  confine  ourselves,  as  a 
general  rule,  to  the  return  of  the  liberated  intestine,  in  place 
of  always  proceeding  to  excise  the  omentum,  (c.)  When  we 
meet  with  a  gangrenous  condition  of  the  intestine,  not  only 
in  doubtful  cases,  but  in  all  cases,  we  should  abstain.from 
at  once  proceeding  to  the  excision  and  suture  of  the  gut— 
facilitating  the  passage  of  the  contents  of  the  canal,  and 
leaving  the  gut  at  rest  outside  until  the  cleansing  of  the 
wound  allows  of  the  application  of  the  sutures.  3.  The 
operation  for  the  radical  cure  of  non- strangulated  hernia 


should  only  be  performed  in  those  instances  in  which  the 
urgency  of  the  case  outweighs  its  danger. 

Prof.  Gussenbauer,  of  Prague,  stated  that  his  experience, 
derived  from  between  140  and  160  operations  for  strangu¬ 
lated  hernia,  led  him,  in  opposition  to  the  views  of  Dr. 
Schmidt,  to  attribute  a  remarkably  favourable  effect  to  the 
antiseptic  procedure.  He  also  regarded  the  basis  on  which 
Schmidt  had  founded  his  statistics  as  faulty,  as  it  enabled 
no  account  to  be  taken  of  the  peculiarities  of  the  different 
cases  operated  on .  And  yet  it  exerts  an  essential  influence 
on  the  result  of  a  replacement  of  a  strangulated  hernia, 
with  or  without  operation,  whether  peritonitis  is  or  is  not 
already  present.  Statistics  which  do  not  take  this  point 
into  consideration  possess  no  general  validity. 


REVIEWS  AND  NOTICES  OF  BOOKS. 

- ♦- - 

The  Principal  Southern  and  Swiss  Health-Resorts :  their 
Climate  and  Medical  Aspect.  By  William  Marcet,  M.D., 
F.E.C.P.  Lond.,  F.E.S.,  late  Senior  Assistant-Physician, 
to  the  Westminster  Hospital,  and  the  Hospital  for  Con¬ 
sumption  and  Diseases  of  the  Chest,  Brompton,  etc- 
London  :  J.  and  A.  Churchill.  1883.  8vo,  pp.  400. 

Dr.  Marcet,  who  spent  three  winter  seasons  at  Nice,  and 
six  at  Cannes,  engaged  in  medical  practice,  has  in  this 
volume  given  the  public  and  the  profession  the  benefit  of 
his  experience  of  the  value  of  southern  climates  for  in¬ 
valids.  He  hopes  his  book  will  be  “not  altogether  wanting" 
in  medical  and  public  utility”;  and  we  are  sure  it  will 
be  found  very  useful  both  by  medical  men  who  desire  to- 
know  all  they  can  gather  about  foreign  health-resorts, 
and  by  those  of  the  public  who  have  to  leave  home  in  search 
of  health.  The  first  and  second  chapters  of  the  book  give 
general  and  special  advice  to  invalids  about  to  winter  on  the- 
Eiviera;  deal  with  the  important  subjects  of  dress  and 
food,  and  that  of  hotels,  boarding-houses,  apartments,  etc.  p 
and  of  social  life.  Then  follows  a  chapter  on  “  The  Natural 
Laws  of  Climate”;  and  one  on  “Winds  and  Weather  on 
the  Mediterranean  ”;  and  “  Pursuit  of  Health  from  a 
Mediterranean  Cruise.”  The  rest  of  the  work  treats  of  the 
special  health-resorts  along  the  French  and  Italian  Ei  viera  j. 
of  Algiers,  Pau,  Pisa,  Eome,  Naples,  Palermo,  and  Egypt ; 
of  the  principal  health-resorts  in  Switzerland;  and  of  the 
island  of  Madeira,  and  the  island  of  Teneriffe. 

Dr.  Marcet  does  not  give  any  new  information  as  to  the- 
remedial  value,  and  the  medical  drawbacks,  of  these  foreign 
health-resorts  generally — who  could  ? — but  Teneriffe  is  but 
little  known  as  yet.  Dr.  Marcet  has  not  much  to  say  about 
it  from  his  own  experience,  as  he  was  in  the  island  only  a. 
very  few  weeks,  and  the  more  part  of  that  time  was  occupied 
in  ascending  and  bivouacking  on  the  Peak,  of  which  he- 
gives  a  very  interesting  account.  But  he  learned  a  good 
deal  about  the  climate  of  the  island  from  a  physician 
in  practice  there,  and  from  other  sources;  and  as  the 
result  of  all  he  says — “I  am  inclined  to  believe  that 
Teneriffe  will  eventually  become  a  favourite  station  for 
consumptive  invalids ;  and,  even  at  present,  those  who  can 
put  up  with  fair,  though  not,  perhaps,  luxurious  accommoda¬ 
tion,  may  find  acceptable  quarters  at  Puerto  Orotava  and  the 
Villa  Orotava,  while  there  are  pretty  good  houses  to  be  had 
at  Laguna.  I  do  not  think  the  English  would  quite  like 
the  Spanish  hotel  accommodation  at  Santa  Cruz,  but  I 
believe  comfortable  houses  can  be  had  in  the  town ;  it  will 
be  necessary,  however,  to  put  up  with  Spanish  cooking  and 
Spanish  attendance.” 

Dr.  Marcet’s  book  is  freely  and  well  illustrated,  and  well 
brought  out. 

A  Treatise  on  the  Diseases  of  the  Nervous  System.  By  James 
Eoss,  M.D.,  LL.D.  Second  Edition.  Two  Volumes.- 
London  :  J.  and  A.  Churchill.  1883. 

The  fact  that  a  work  consisting  of  2000  pages  on  a  special 
subject  should  have  reached  a  second  edition  in  less  than 
three  years  is  probably  almost  unparalleled  in  the  annals  of 
medical  literature,  and  affords  the  most  striking  proof  of 
the  state  of  public  opinion  on  the  .book.  Such  being  the 
case  we  shall  only  call  attention  to  the  author’s  views  on  a 
few  of  the  more  disputed  points,  leaving  our  readers  to  refer 
to  the  work  itself  for  further  information. 

The  exact  nature  of  the  knee-reflex  is  discussed  at  length 


•386 


Medical  Times  and  Gazette. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


Sept.  29,  1883. 


and  with,  much  care,  the  question  being,  of  course,  whether 
the  contraction  of  the  quadriceps  is  due  to  direct  irritation 
from  the  blow,  or  whether  it  he  due  to  a  true  spinal  reflex. 
After  quoting  Dr.  De  Watteville’s  experiments  he  concludes  : 
,c  It  would  appear  certain  that  the  knee-jerk  is  not  caused 
by  reflex  but  by  direct  action,  and  that  it  is  due,  as  was  at 
first  supposed  by  Westphal,  to  the  sudden  stretching  of  the 
muscular  substance  itself.  It  is  at  the  same  time  of  great 
importance  to  notice  that  the  integrity  of  the  reflex  loop  is 
necessary  to  its  production,  and  that  the  reaction  is  readily 
abolished  by  disease  of  the  spinal  centres,  or  of  the  afferent 
or  efferent  nerve-paths.  It  would  seem  that  the  reaction 
does  not  take  place  unless  a  certain  degree  of  tonus  is 
maintained  in  the  muscle,  and  that  the  reflex  influence  is 
necessary  for  the  maintenance  of  this  condition.” 

The  fact  that  conjugate  deviation  of  the  eyes  and  rotation 
of  the  head  and  neck  in  cases  of  hemiplegia  is  usually 
transient,  is  probably  well  known  to  all  physicians,  and  Dr. 
Boss  offers  a  sensible  and  simple  explanation  of  it.  The 
nucleus  of  one  third  nerve  is  connected  with  the  nucleus  of 
the  opposite  sixth  nerve  by  commissural  fibres,  and  thus 
becomes  connected  with  the  cortex  of  the  hemisphere  on  its 
own  side.  It  is  by  means  of  these  fibres  that  the  lateral 
movements  of  the  eyes  are  carried  out.  But  the  third 
nerve  nucleus  is  also  connected  with  the  cortex  of  the 
■opposite  hemisphere,  and  when  the  common  path  is  inter¬ 
rupted  by  disease,  the  disused  communication  between  the 
third  nerve  nucleus  and  the  cortex  of  the  opposite  side 
commences  to  transmit  impulses,  then  the  commissural 
fibres  to  the  opposite  sixth  nerve  gradually  get  opened  up, 
and  thus  by  degrees  the  paralysis  disappears. 

The  important  subject  of  diagnosis  of  diseases  of  the 
nervous  system  Dr.  Boss  treats  of  under  three  heads — viz.. 
Clinical,  Topographical,  and  Pathological,— and  of  these  the 
topographical  is  divided  into  peripheral,  spinal,  and  en¬ 
cephalic  lesions,  the  pathological  diagnosis  including  vas¬ 
cular,  inflammatory,  and  degenerative  lesions,  and  the  new 
formations.  The  definitions  given  of  these  different  forms  are 
■concise,  and  at  the  same  time  sufficiently  full. 

Enable  to  feel  satisfied  with  the  existing  theories  of  optic 
neuritis.  Dr.  Boss  puts  forward  his  own  views  in  the  follow¬ 
ing  words : — “  The  relation  subsisting  between  the  ganglia 
of  the  posterior  roots  of  the  spinal  nei’ves  and  the  afferent 
nerves  is  well  known.  The  structure  of  the  external  geni¬ 
culate  bodies  lends  countenance  to  the  view  that  they  are  the 
homologues  of  the  ganglia  of  the  roots  ;  and  if  so,  they  will 
bear  a  similar  relation  to  the  nutrition  of  the  optic  nerves 
that  the  spinal  ganglia  do  to  the  sensory  spinal  nerves. 
Irritation  of  the  external  geniculate  bodies  may,  therefore, 
be  supposed  to  give  rise  to  trophic  changes  in  the  optic 
nerves ;  and  if  the  position  of  these  bodies  near  the  edge  of 
the  tentorium,  and  in  the  angle  formed  by  the  crura  and 
corpora  quadrigemina  with  the  posterior  lobes  of  the  cerebrum, 
be  taken  into  account,  it  will  be  seen  that  irritation  would 
be  very  liable  to  be  produced  by  various  diseases  of  the  brain, 
and  especially  by  diseases  like  tumour,  which  are  likely  to 
cause  displacements  of  the  relative  positions  of  the  different 
parts  of  the  encephalon.”  It  seems  to  us  that  a  grave 
objection  to  this  theory  is  that  it  ignores  one  of  the  chief 
facts  in  regard  to  optic  neuritis — viz.,  that  microscopical 
examination  of  the  affected  nerves  points  strongly  to  the 
belief  that  the  perineurium  is  the  primary  seat  of  the  disease, 
and  that  in  the  early  stages  the  inflammation  is  more 
marked  at  the  periphery  than  in  the  central  portion  of  the 
nerve.  Should  subsequent  investigation  prove  the  correct¬ 
ness  of  these  observations,  the  theory  of  a  descending 
cerebritis  will  be  untenable. 

Dr.  Boss  inclines  to  adopt  Friedrich’s  views  on  the  mode  of 
production  of  palpitations  in  exophthalmic  goitre,  according 
to  which  paralysis  of  the  vasomotor  nerves  of  the  sym¬ 
pathetic  is  followed  by  dilatation  of  the  coronary  arteries, 
increased  flow  of  blood  to  the  muscular  walls  of  the  heart, 
and  increased  excitement  of  its  ganglia.  This  hypothesis 
removes  the  necessity  for  presupposing  that  a  permanent 
lesion  could  be  set  up  by  continuous  irritation  without  any 
paralysis  resulting. 

Dr.  Boss  describes  and  figures  an  accessory  nucleus  of 
the  hypoglossal  nerve,  which  consists  of  a  large  number 
of  very  small  caudate  cells.  The  position  of  this  nucleus 
does  not  appear  to  be  quite  constant,  but  it  is  almost 
entirely  limited  to  one  side,  although  faint  traces  of  it  may 
occasionally  be  observed  in  the  opposite  side.  It  is  scarcely 


recognisable  on  either  side  of  the  medulla  at  the  ninth 
month  of  embryonic  life.  Dr.  Boss  has  not  yet  noted  on 
which  side  of  the  medulla  it  is  found,  but  he  surmises  that 
it  may  be  connected  with  the  third  left  frontal  convolution, 
and  may  have  to  do  with  the  regulation  of  the  movements 
of  articulation. 

In  the  former  edition  of  this  work  Dr.  Boss  expressed  the 
opinion  that  in  pseudo-hypertrophic  paralysis  the  nervous 
system  was  primarily  at  fault,  but  he  has  since  met  with  a 
case,  which  he  publishes  in  detail,  in  which  no  lesion  could 
be  detected  either  in  the  spinal  cord  or  in  the  sciatic  nerve, 
or  in  that  portion  of  the  brachial  plexus  which  supplied 
affected  muscles  in  the  arms.  He  has  therefore  abandoned 
his  former  view,  and  now  accepts  the  theory  of  a  primary 
affection  of  the  muscles  themselves.  In  connexion  with 
this  subject  Dr.  Boss  suggests,  with  much  probability,  that 
the  cases  of  progressive  muscular  atrophy  where  the  spinal 
cord  has  been  found  healthy  may  have  been,  in  reality, 
irregular  cases  of  pseudo-hypertrophic  paralysis. 

Speaking  of  the  clonic  spasms  which  sometimes  precede 
hemiplegia,  and  are  known  by  the  name  of  prgehemiplegic 
hemichorea.  Dr.  Boss  suggests  two  explanations.  One  is 
that  an  interruption  has  occurred  in  the  fibres  connecting 
the  cerebrum  and  cerebellum,  so  that  the  normal  balance 
between  these  two  organs  is  disturbed;  and  the  other  theory 
is  that  the  damaged  fibres  all  belong  to  the  pyramidal  tract, 
and  that  those  which  suffer  most  are  related  to  the  more 
fundamental,  and  not  to  the  more  special  functions.  “  Partial 
injui’y  done  to  the  fundamental  motor  mechanism,  while  the 
accessory  one  is  left  unaffected,  would  be  very  likely  to  cause 
the  phenomena  of  hemichorea.  In  such  an  event  the  usual 
tonic  contractions  and  exaggerated  tendon  reactions  would 
result  from  injury  of  the  pyramidal  tract,  while  the  appa¬ 
ratus  of  the  more  voluntary  and  special  actions,  although 
still  uninjured,  would  act  in  an  irregular  manner  owing  to 
the  damage  done  to  the  fundamental  apparatus.” 

This  doctrine  of  a  fundamental  and  accessory  apparatus 
is  applied  to  the  explanation  of  almost  every  disease,  and 
we  shall  have  occasion  to  allude  to  it  again. 

The  spastic  paraplegia  occasionally  met  with  as  a  con¬ 
genital  defect  in  young  children  is  due,  according  to  Dr. 
Boss’s  views,  to  a  parencephalic  defect  of  the  cerebral  centres 
rather  than  to  an  arrested  development  of  the  lateral  columns 
of  the  cord,  which  he  admits  would  explain  the  rigidity;  and, 
to  our  way  thinking,  seems  the  more  probable  cause,  as  it 
is  by  no  means  uncommon  in  these  cases  to  have  no  cerebral 
symptoms  present  whatever. 

In  regard  to  the  diagnosis  of  tubercular  meningitis,  we 
read  :  “  Examination  of  the  retina  may  throw  light  on  the 
nature  of  the  affection.  When  general  miliary  tuberculosis 
exists,  tubercles  of  the  choroid  are  frequently  found,  but 
they  are  absent  in  tuberculosis  affecting  the  pia  mater  alone.” 
We  have  only  two  remarks  to  offer  on  this  passage — first, 
that  if  the  tubercles  affect  the  pia  mater  alone,  it  is  obvious 
that  they  will  not  be  present  in  the  choroid;  and,  secondly, 
that  cases  in  which  tubercles  can  be  recognised  in  the  choroid 
at  a  sufficiently  early  period  of  the  disease  to  be  of  any 
diagnostic  value  are  quite  the  exception. 

Another  passage  to  which  we  would  likewise  take  excep¬ 
tion  is  that  referring  to  the  etiology  of  congenital  hydro¬ 
cephalus,  in  which  he  says,  “  congenital  syphilis  is  probably 
the  most  important  predisposing  cause,  and  it  is  possible 
that  too  much  importance  has  been  attributed  to  rickets  in 
its  production.”  Now,  if  the  hydrocephalus  be  really  con¬ 
genital — which  we  very  much  doubt — it  is  clear  that  rickets 
can  have  nothing  to  do  with  its  production;  but  we  should 
be  glad  to  know  what  sort  of  evidence  Dr.  Boss  can 
bring  forward  in  support  of  its  syphilitic  origin  :  our  own 
belief  is  that  in  the  majority  of  instances  there  has  been  a 
preceding  attack  of  basic  meningitis. 

In  the  article  on  Tetany  we  find  no  mention  of  rickets  as 
a  factor  in  children ;  nor  of  the  presence  of  facial  irrita¬ 
bility,  which  is  almost,  if  not  quite,  constant ;  nor  of  the 
effect  on  the  spasm  of  the  administration  of  chloroform  to 
the  patient, — all  of  which  are  very  important  points  in  the 
disease. 

In  a  fatal  case  of  chorea,  in  which  he  had  an  oppor¬ 
tunity  of  examining  the  nervous  centres  microscopically. 
Dr.  Boss  found  spots  of  necrotic  softening  in  the  corpora 
striata,  and  marked  changes  in  the  anterior  and  antero¬ 
lateral  arteries  of  the  cord,  and  also  a  shrivelled  granular 
state  of  the  accessory  motor  cells  in  the  anterior  cornua  of 


Medical  T.'mes  and  Gazette. 


GENERAL  CORRESPONDENCE. 


Sept.  29, 1883.  38P 


the  cord — changes,  so  far  as  the  bloodvessels  are  concerned, 
closely  resembling  those  described  by  Dickinson  some  years 
since.  Dr.  Eoss,  however,  does  not  show  any  good  reason 
why  these  changes  should  be  regarded  as  the  cause  of  the 
disease  rather  than  as  the  result.  Surely,  if  such  central 
changes  as  are  here  mentioned  were  the  cause  of  the  symp¬ 
toms  in  chorea,  we  should  not  find  that  recovery  would  be  so 
complete  as  it  invariably  is,  and  fatal  cases,  instead  of  being 
exceedingly  rare,  would  be  by  no  means  uncommon.  Basing 
his  views  chiefly  on  the  fatal  case  already  alluded  to.  Dr. 
Eoss  arrives  at  the  opinion  that  chorea  is  a  “  widely  dis¬ 
tributed  disease  of  the  nervous  centres,  in  which  the  cerebro¬ 
spinal  motor  functions  and  mechanisms  are  specially  affected, 
the  accessory  functions  and  structures  being  affected  at  an 
earlier  period  and  more  profoundly  than  the  fundamental 
functions  and  structures,”  and  he  considers  that  three 
factors  contribute  to  its  production — first,  anaemia  of  the 
nervous  centres  leading  to  excessive  irritability;  second, 
a  profound  mental  impression,  usually  fright ;  thirdly,  an 
inherent  instability  of  the  nervous  system.  Whilst  we 
agree  with  Dr.  Eoss  in  rejecting  the  embolic  theory  of  the 
origin  of  chorea,  we  cannot  follow  him  in  putting  rheu¬ 
matism  on  one  side,  ‘'inasmuch  as  the  disease  may  occur  in 
the  absence  of  a  history  of  active  rheumatism.”  If  amongst 
the  children  of  the  poor  we  are  to  wait  for  a  history  of  active 
rheumatism  before  calling  an  affection  rheumatic,  we  shall 
very  soon  arrive  at  the  conclusion  that  rheumatism  is  a 
disease  from  which  childhood  is  nearly  exempt — the  very  re¬ 
verse  of  the  fact.  The  fact  that  parents  give  no  history  of 
rheumatism  must  be  taken  for  what  it  is  worth,  and  nothing 
more — i.e.,  that  they  do  not  know  that  their  child  has  suf¬ 
fered  from  rheumatism.  What  the  association  between 
chorea  and  rheumatism  is,  does  not  at  present  concern  us, 
but  that  it  is  present  in  a  large  majority  of  cases,  a  not  in¬ 
considerable  experience  has  satisfied  us.  Another  factor, 
not  mentioned  by  Dr.  Eoss,  but  one  which  plays  as  im¬ 
portant  a  part  as  fright,  in  London  at  any  rate,  is  the 
mental  overstrain  induced  by  the  School  Board  examinations. 

We  ought  to  add  that  both  volumes  are  profusely  illus¬ 
trated  with  woodcuts,  and  that  references  are  given  in  foot¬ 
notes  to  the  works  of  authors  whose  opinions  or  writings 
are  quoted,  the  references  being  so  numerous  as  to  consti¬ 
tute  a  valuable  bibliography.  The' work  fully  deserves  the 
success  it  has  met  with. 


Formulaire  des  Maladies  des  Voies  TJrinaires.  Par  F. 

Mallez.  Paris :  Adrien  Delahaye.  1883.  Pp.  292. 
Formulary  for  Diseases  of  the  Urinary  Organs.  By  F. 

Mallez. 

Dk.  Mallez  has  for  many  years  enjoyed  a  reputation  in  this 
special  department  of  practice ;  and  a  book  in  which  are  col¬ 
lected  the  various  formulae  which  experience  has  taught  him 
are  useful  in  urinary  diseases  will  doubtless  prove  useful  to 
the  general  practitioner.  In  the  first  place  the  author  dis¬ 
cusses  diet;  this  is  of  prime  importance  unquestionably. 
Then  come  various  drugs,  such  as  opium,  belladonna,  ;phos- 
phorus,  ergot,  cantharides,  balsams,  and  others.  The  action 
of  mineral  waters  comes  next,  and  the  various  forms  of 
purgative  and  diuretic  medicines.  In  the  second  part  of  the 
book,  external  medication  is  discussed ;  and,  in  addition,  some 
hints  on  the  mode  of  use  of  the  more  important :  as  the 
author  says,  “  Why  speak  of  vesical  injections  unless  we 
indicate  their  mode  of  administration,  and  the  method  of  ren¬ 
dering  this  little  operation  as  harmless  as  it  is  efficacious  F  ” 
The  work  finishes  with  a  series  of  tables  in  which  the 
systematic  treatment  of  the  various  diseases  is  laid  down  in 
a  short  and  concise  manner.  The  book  will  prove  more 
useful  to  practitioners  than  to  students,  for  a  previous  know¬ 
ledge  of  the  diseases  of  which  it  treats  is  essential  to  the 
selection  of  the  remedy  best  suited  to  the  individual  case. 

American  Journal  of  Neurology  and  Psychiatry,  May,  1883. 
Dr.  Spitzka  is  represented  in  this  number  by  no  less  than 
three  papers — one  on  Insane  Delusions ;  one  (which,  we  are 
told,  is  a  chapter  in  a  forthcoming  work  on  Insanity)  on 
How  to  Examine  the  Insane  ;  and  a  lengthy  communication 
containing  Contributions  to  Encephalic  Anatomy,  which  are 
more  curious  than  important.  Mr.  Howard  has  a  paper  on 
the  Somatic  Etiology  of  Crime,  which  does  not  call  for 
notice  ;  and  the  remainder  of  the  number  is  occupied  by 
comments  on  the  Medical  Jurisprudence  of  the  State  of 
New  York,  which  are  of  local  interest  only. 


GENERAL  CORRESPONDENCE. 

- <• - 

METAPHYSICS  IN  PATHOLOGY. 

Letter  prom  Dr.  E.  Satjndby. 

[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sir, — Ido  not  think  anyone  can  claim  as  his  own  "the- 
application  of  the  doctrine  of  the  origin  of  species  to  the 
case  of  specific  diseases.”  Certainly  the  idea  has  been 
familiar  to  me  since  early  student  days,  and  I  obtained  it 
from  Niemeyer  (“  Text-book  of  Practical  Medicine,”  trans¬ 
lated  from  the  eighth  German  edition,  1871,  vol.  ii.,  pp.. 
605-6).  But  this  familiarity  by  no  means  lessened  the 
pleasure  with  which  I  read  Dr.  Creighton’s  able  address. 

I  am,  &c., 

September  22.  Eobert  Satjndby. 


ST.  JOHN'S  HOUSE,  NOEFOLK-STEEET. 

Letter  prom  Mr.  G.  W.  Bell. 

[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sir, — In  reply  to  many  inquiries,  I  beg  you  to  permit  me' 
thus  to  announce  to  the  professional  friends  of  St.  John’s 
House  the  fact,  which  has  already  appeared  in  the  usual 
advertisements,  that  there  has  been  no  cessation  in  the- 
nursing  work  of  this  institution. 

Skilful  medical  and  surgical  nurses  can  be  obtained  on 
application  to  the  Lady  Superior,  personally  or  by  letter. 
The  hospital  work  at  King’s  and  at  Charing-cross  is  con¬ 
tinued  as  heretofore.  I  may  add  that  the  Lady  Superior 
can  recommend  two  very  good  nurses  ready  to  go  abroad. 

I  am,  &c., 

George  William  Bell,  Hon.  Secretary. 

St.  John’s  House,  7  and  8,  Norfolk-street,  Strand,  W.C. 


NEW  INVENTIONS  AND  IMPROVEMENTS. 


DEAINAGE-TUBE  FOE  EMPYEMA. 

The  increasing  use  of  a,  double  drainage-tube  for  cases  of 
empyema  has  induced  Messrs.  Mayer  and  Meltzer,  of  Great 
Portland-street,  W.,  to  make  a  special  form  of  drain,  as  re¬ 
presented  in  the  woodcut.  It  has  the  advantage  of  being. 


in  one  piece,  very  pliable,  with  tubing  which  can  be  cut  to 
any  required  length.  Surgeons,  we  think,  are  now  agreed 
that  a  chest  drains  better  with  a  double  opening  into  it,  on 
the  principle  that  the  discharge  cannot  get  out  unless  air 
gets  in.  By  making  one  free  opening,  and  putting  in  such 
a  tube  as  is  here  represented  (in  actual  use  one  of  the  tubes 
should  be  a  little  longer  than  the  other),  the  double  opening 
is  practically  obtained.  We  can  speak  well  of  its  value  from 
personal  observation  of  cases  in  which  this  fo  rm  of  tube 
has  been  used. 

NEW  SUEGICAL  NEEDLE  AND  THEEAD. 

By  John  Ward  Cousins,  M.D.  Lond.,  F.E.C.S., 
Surgeon  to  the  Royal  Portsmouth  Hospital. 

A  very  simple  innovation,  in  which  the  ordinary  steel 
needle  is  superseded  by  converting  the  end  of  the  wire  into 
a  needle.  The  wire  is  cut  into  equal  lengths,  and  each  piece 
is  separately  reduced  by  drawing,  with  the  exception  of  an 
inch  or  two  at  one  extremity.  The  end  is  then  converted 
into  a  convenient  needle  by  pointing  and  burnishing. 

The  invention  is  intended  to  secure  several  novel  and  im¬ 
portant  advantages  in  practice.  The  needle  is  always  new  and 


388 


Medical  Times  and  Gazette. 


MEDICAL  NEWS. 


Sept.  29,  1883. 


clean,  and  it  can  be  used  for  only  a  limited  number  of  sutures. 
It  requires  no  preparation  or  threading,  and  the  continuity 
of  the  needle  and  the  ligature  prevents  the  delay  in  intro¬ 
duction  which  often  occurs  with  the  ordinary  needle  from 
kinking  or  twisting  at  the  eye.  The  point  is  always  perfect, 
so  that  the  pain  of  penetration  is  consideraby  reduced. 

The  needle  can  be  obtained  from  Messrs.  Maw,  Son,  and 
Thompson,  and  it  is  made  both  in  silver  and  in  steel.  The 
silver  needle  can  be  bent  by  the  surgeon  to  any  shape  suit¬ 
able  for  the  purpose  for  which  it  is  to  be  applied. 


PORTABLE  IRRIGATOR  AND  ENEMA  APPARATUS. 

Messrs.  Allen  and  Son,  of 
Marylebone-lane,  have  added 
to  their  long  list  of  sanitary 
appliances  a  small,  convenient 
irrigator  for  dressing  wounds, 
washing  out  the  chest,  etc. 
The  apparatus  can  be  used  also 
as  an  enema  or  as  a  vaginal 
douche  by  substituting  one 
nozzle  for  another,  according 
to  the  needs  of  the  case.  The 
advantages  of  all  such  instru¬ 
ments  over  syringes  will  be 
obvious  to  everyone,  apart  from 
the  facts  that  the  current  is 
constant  and  its  force  can  be 
regulated  to  a  nicety  by  the 
height  at  which  the  small  cis¬ 
tern  is  placed.  We  think  it 
will  prove  useful.  The  sub¬ 
joined  illustration  will  explain  its  size  and  appearance. 


MEDICAL  NEWS. 

- ♦ - 

Apothecaries’  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday, 
September  20  : — 

Bateman,  Frederick  Augustus  Newton,  Pall-mall,  S.W. 

Habgood,  William,  Wimborne,  Dorset. 

James,  James  Prytherch,  Eastlake-road,  Loughborough. 

Little,  Andrew  Johnston,  Belfast. 

Lockwood,  Harry,  Gudcliffe  Vale-road,  Sheffield. 

Marsden,  James  Aspinall,  Paulet-road,  Camberwell. 

Smith,  Joseph  Spilsbury,  Free  Town,  Sierra  Leone. 


APPOINTMENTS. 

***  The  Editor  will  thank  gentlemen  to  forward  to  the  Publishing-office, 
as  early  as  possible,  information  as  to  all  new  Appointments  that  take 
place.  - 

Browse,  ArthurBancks.M.D.  Lond.,F.R.C.S.  Eng. -Assistant-Physician 
for  the  Out-Patient  Department  of  the  Bristol  Royal  Infirmary. 


DEATHS. 

Balding,  James,  M.R.C.S.,  at  Barkway,  Herts,  on  September  25,  aged  86. 
Finch,  Henry,  M.D.,  at  Colchester,  on  September  19. 

Hewan,  Archibald,  M.D.,  at  9,  Chester-square,  on  September  20, 
aged  61. 

Hodge,  Benjamin  Terry,  M.R.C.S.,  L.R.C.P.,  L.S.A.,  at  Sidmouth,  on 
September  20,  aged  65. 

Holman,  J.  R.,  M.D.,  R.N.,  Deputy  Inspector- General  of  Hospitals  and 
Fleets  (retired),  at  Gipsy  Hill,  on  September  19,  aged  59. 

Yarde,  William,  M.D.,  late  Staif-Surgeon  of  H.M.  Navy,  at  Fairlea, 
Beechin  Cliff,  Bath,  on  September  19,  aged  47. 


VACANCIES. 

In  the  following  list  the  nature  of  the  office  vacant,  the  qualifications  re¬ 
quired  in  the  candidate,  the  person  to  whom  application  should  be  made 
and  the  day  of  election  (as  far  as  known)  are  stated  in  succession. 

-Joint  Counties  Asylum,  Abergavenny. — Senior  Assistant  Medical 
Officer.  Salary  £150  per  annum,  with  board,  lodging,  and  washing. 
Candidates  must  be  duly  qualified.  Applications,  with  not  more  than 
three  testimonials,  to  be  sent  to  the  Medical  Superintendent  on  or 
before  October  1. 

St.  George’s,  Hanover-squabe,  Provident  Dispensary,  59,  Mount- 
street,  W.— Resident  Medical  Officer.  Salary  and  allowance  last  year 
£212  2s.  9d.  Candidates  must  be  doubly  qualified,  and  duly  registered 
under  the  Medical  Act,  and  about  thirty  years  old.  Unmarried  candi¬ 
dates  preferred.  Applications  and  testimonials  as  to  character,  etc.,  to 
he  sent  to  the  Secretary,  G.  H.  Leah,  jun.,  73,  Park-street,  W.  (from 
whom  all  further  particulars  may  be  obtained),  not  later  than  Sept.  29. 


UNION  AND  PAROCHIAL  MEDICAL  SERVICE. 

***  The  area  of  each  district  is  stated  in  acres.  The  population  is 
computed  according  to  the  census  of  1881. 

RESIGNATIONS. 

Chepstow  Union—  Dr.  S.  W.  A.  Napier  has  resigned  the  Tintern  District : 
area  13,993  ;  population  2841 ;  salary  £40  per  annum. 

Downham  Union.—  Dr*  W.  B.  Hunter  has  resigned  the  South  Welney 
District:  area  1814;  population  368  ;  salary  £10  per  annum. 

Leigh  Union.—  Mr.  Thomas  D.  Paradise  has  resigned  the  Leigh  District 
and  the  Workhouse :  area  3364 ;  population  14,48?  ;  salary  £70  per 
annum  ;  salary  for  Workhouse  £30  per  annum. 

Oundle  Union.— Mr.  William  F.  Smith  has  resigned  the  Weldon 
District :  area  8980  ;  population  1497  ;  salary  £50  per  annum. 

APPOINTMENTS. 

Brecknock  Union. — David  V.  Rees,  M.R.C.8.  Eng.,  L.R.C.P.  Lend.,  to 
the  Llangorse  District. 

Cockermouth  Union.— James  Little,  M.R.C.S.  Eng.,  M.D.  Edin.,  L.S.A. 
Lond.,  to  the  Maryport  District. 

Coventry. — Alfred  B.  Hill,  M.D.,  as  Analyst  for  the  City,  vice  Dr.  Swete, 
resigned. 

OrmsMrk  Union.— Frederick  F.  Moore,  L.R.C.S.  Ire.,  L.R.C.P.  Edin.,  to 
the  Second  District. 


Royal  College  of  Surgeons. — Tlie  Museum  and 
Library  of  tbis  institution  will  be  re-opened  on  Monday 
next,  the  1st  prox.  The  new  Calendar  of  the  College  will 
show  a  good  increase  in  the  number  of  its  Fellows,  now 
amounting  to  1166,  including  nearly  600  who  have  obtained 
this  honour  by  examination.  There  appear  to  be  only  five 
elected  under  Section  5  of  the  Charter  of  15th  of  Victoria — 
viz.,  Mr.  E.  R.  Bickersteth,  of  Liverpool ;  Sir  Joseph  Fayrer, 
E.R.S.,  of  Wimpole-street,  W. ;  Professor  T.  H.  Huxley, 
E.R.S.,  of  Marlborough-place,  N.  W. ;  Mr.  Oliver  Pemberton, 
of  Birmingham ;  andMr.  John  Tomes,  P.R.S.,  of  Caterham. 
There  are  three  gentlemen  who  are  ad  eundem  Fellows 
— viz.,  Mr.  A.  E.  J.  Barker,  of  Harley-street,  and  Sir 
William  Mac  Cormac,  of  Harley-street,  Fellows  of  the  Irish 
College  ;  and  Mr.  K.  King,  of  Hull,  of  the  Edinburgh  College 
of  Surgeons.  The  oldest  Fellow  of  the  College  appears  to 
be  Mr.  James  Moncrieff  Arnott,  E.R.S.,  a  former  President, 
who,  seeing  he  was  admitted  a  Member  so  long  ago  as 
April  4,  1817,  when  it  was  necessary  to  be  twenty-two  years 
of  age,  must  now  be  in  his  eighty-ninth  year. 

Water  for  Infants. — Under  this  heading  the  New 
York  Med.  Record  for  August  18  has  the  following  observa¬ 
tions  : — “'With  the  exception  of  tuberculosis,  no  disease  is 
so  fatal  in  infancy  as  intestinal  catarrh,  occurring  especially 
during  the  hot  summer  months,  and  caused,  in  the  great 
majority  of  cases,  by  improper  diet.  There  are  many  upon 
whom  the  idea  does  not  seem  to  have  impressed  itself  that 
an  infant  can  be  thirsty  without,  at  the  same  time,  being 
hungry.  When  milk,  the  chief  food  of  infants,  is  given  in 
excess,  acid  fermentation  results,  causing  vomiting,  diar¬ 
rhoea,  with  passage  of  green  or  yellowish-green  stools, 
elevated  temperature,  and  the  subsequent  train  of  symp¬ 
toms  which  are  too  familiar  to  need  repetition.  The  same 
thing  would  occur  in  the  adult  if  drenched  with  milk.  The 
infant  needs  not  food,  but  drink.  The  recommendation  of 
some  writers,  that  barley-water  or  gum-water  he  given  to 
the  little  patients  in  these  cases,  is  sufficient  explanation  of 
their  want  of  success  in  treating  this  affection.  Pure  water 
is  perfectly  innocuous  to  infants,  and  it  is  difficult  to  conceive 
how  the  seeming  prejudice  to  it  ever  arose.  Anyone  who 
has  ever  noticed  the  avidity  with  which  a  fretful  sick  infant 
drinks  water,  and  marks  the  early  abatement  of  febrile  and 
other  symptoms,  will  be  convinced  that  water,  as  a  beverage, 
a  quencher  of  thirst,  a  physiological  necessity,  in  fact, 
should  not  he  denied  to  the  helpless  member  of  society. 
We  have  often  seen  an  infant  which  had  been  dosed  ad 
nauseam  for  gastro-intestinal  irritability  assume,  almost  at 
once,  a  more  cheerful  appearance  and  rapidly  grow  better 
when  treated  to  the  much-needed  draught  of  water.  If  any 
prescription  is  valuable  enough  to  he  used  as  routine  practice, 
it  is — c  Give  the  babies  water.’  ” 

Sulphate  of  Atropia  in  Coryza. — Atropia  possessing 
the  property  of  diminishing  the  nasal  secretion.  Dr.  Gentil- 
homme  determined  to  try  its  effect  in  coryza.  In  several 
very  bad  cases,  with  abundant  secretion,  fever,  and  embar¬ 
rassment  of  respiration,  engendering  in  some  true  attacks 
of  asthma,  a  pill  containing  half  a  milligramme  of  the  sul¬ 
phate,  given  at  the  commencement  of  the  inflammatory 
period,  has  arrested  the  coryza.  In  cases  of  confirmed 
coryza  the  sulphate  also  gives  relief,  hut  its  effect  is  less 
decided  than  when  given  at  the  commencement  of  the 
affection. — Union  Med.,  September  4. 


Medical  T.mes  and  Gazette, 


NOTES,  QUERIES,  AND  REPLIES 


Sept.  29, 1883.  389 


VITAL  STATISTICS  OF  LONDON. 

Week  ending  Saturday,  September  22,  1883. 

BIRTHS. 

Births  of  Boys,  1258;  Girls,  1212;  Total,  2470. 

Corrected  weekly  average  in  the  10  years  1873-82,  2592'4. 

DEATHS. 


Males. 

Females. 

Total. 

Deaths  during  the  week . 

659 

627 

1286 

Weekly  average  of  the  ten  years  1873-82,  | 
corrected  to  increased  population  ...  ) 

725-1 

685-7 

1410-8 

Deaths  of  people  aged  80  and  upwards 

... 

... 

48 

DEATHS  IN  SUB-DISTRICT3  FROM  EPIDEMICS. 


Enumerated 

Population, 

1881 

(unrevised). 

Small-pox. 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

.9x5 

P<  bn 

2  ° 
r 

Typhus. 

Enteric  (or 
Typhoid) 
Fever. 

Simple 

continued 

Fever. 

Diarrhoea.  | 

West . 

669633 

3 

4 

6 

5 

3 

3 

North 

905947 

1 

2 

10 

8 

7 

... 

15 

... 

11 

Central 

282238:  ... 

5 

2 

2 

... 

3 

... 

4 

East . . 

692738 

4 

19 

3 

11 

... 

2 

... 

11 

South . 

1265927 

1 

6 

17 

7 

6 

... 

2 

... 

25 

Total . 

3816483 

2 

15 

55 

26 

31 

... 

25 

... 

54 

METEOROLOGY. 


From  Observations  at  the  Greenwich  Observatory. 


Mean  height  of  barometer  ... 

Mean  temperature  . 

Highest  point  of  thermometer 
Lowest  point  of  thermometer 
Mean  dew-point  temperature 
General  direction  of  wind 
Whole  amount  of  rain  in  the  week 


29-798  in. 
58-4° 

77-1“ 

48-1° 

63-6° 

Variable. 
0’24  in. 


BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  the 
„  Week  ending  Saturday,  Sept.  22,  in  the  following  large  Towns : — 


Cities 

and 

Boroughs. 

Estimated  Population  to 
middle  of  the  year  1883. 

Births  Registered  dining 
the  week  ending  Sept.  22. 

Deaths  Registered  during 
the  week  ending  Sept.  22. 

Annual  Rate  of 
Mortality  per  1000  living, 
from  all  causes. 

Temperature 
of  Air  (Fahr.) 

Temp, 
of  Air 
(Cent.) 

Rain 

Fall. 

Highest  during 
the  Week. 

Lowest  during 
the  Week. 

Weekly  Mean  of 
Daily  MeanValues 

Weekly  Mean  of 
Daily  Mean 
Values. 

In  Inches. 

In  Centimetres. 

London 

3955814 

2470 

1286 

17  0 

77-1 

48-1 

58-4 

14-66 

0-24 

0-61 

Brighton  ... 

... 

111262 

53 

47 

220 

690 

50-0 

59-0 

15-00 

0-54 

1-37 

Portsmouth 

... 

131478 

86 

48 

183 

... 

... 

... 

... 

... 

... 

Norwich 

89612 

57 

38 

221 

... 

... 

... 

... 

... 

... 

Plymouth  ... 

74977 

42 

35 

24-4 

689 

48'2 

57-4 

1411 

0-57 

145 

Bristol . 

212779 

131 

64 

15-7 

73-5 

4S-5 

58' 1 

14-50 

0-42 

1-07 

Wolverhampton  . 

77557 

56 

30 

20-2 

70-5 

42-3 

557 

1317 

0-66 

1-68 

Birmingham 

... 

414846 

269 

175 

220 

... 

... 

... 

... 

... 

... 

Leicester 

r.. 

129483 

77 

38 

15-3 

... 

... 

... 

... 

... 

Nottingham 

... 

199349 

188 

76 

199 

73-8 

41-8 

57-8 

1434 

0-59 

1-50 

Derby . 

85574 

52 

24 

146 

... 

... 

... 

... 

... 

... 

Birkenhead 

88700 

50 

30 

17-6 

... 

... 

... 

... 

... 

... 

Liverpool  ... 

566763 

384 

287 

26-4 

... 

... 

... 

... 

... 

Bolton . 

107862 

68 

43 

20-8 

72-3 

47  6 

56-7 

1372 

0-74 

1'83 

Manchester 

... 

339262 

232 

151 

232 

... 

... 

... 

... 

... 

... 

Salford 

190465 

111 

79 

21-6 

... 

... 

... 

... 

... 

... 

Oldham 

_ 

119071 

96 

43 

18-8 

... 

... 

... 

... 

... 

... 

Blackburn  ... 

108460 

78 

54 

26-0 

... 

... 

... 

... 

... 

Preston 

98564 

74 

41 

21-7 

69-0 

51-0 

58-6 

14-78 

0-65 

1*65 

Huddersfield 

84701 

53 

33 

20-3 

... 

... 

... 

... 

... 

Halifax 

75591 

45 

22 

15-2 

... 

... 

... 

Bradford  ... 

204807 

84 

79 

20-1 

68-7 

49-2 

57-2 

14  00 

0-58 

147 

Leeds  . 

321611 

203 

146 

23-7 

72  0 

48-0 

58-1 

1450 

0-58 

1-47 

Sheffield 

295497 

201 

118 

20-8 

70-0 

45-0 

567 

1372 

0-45 

114 

Hull  . 

176296 

125 

69 

204 

72-0 

42-0 

55-8 

1323 

0-40 

1-02 

Sunderland 

121117 

103 

54 

23-3 

... 

... 

... 

... 

... 

... 

Newcastle  ... 

149164 

98 

83 

29-0 

... 

... 

... 

... 

... 

... 

Cardiff . 

... 

90033 

85 

44 

255 

... 

... 

... 

... 

... 

... 

For  28  towns 

... 

8620975 

5569:3235 

19-6 

771 

4P8 

57-5 

1417 

0-54 

1-37 

Edinburgh  ... 

235946 

111 

74 

16-4 

... 

... 

••• 

... 

... 

... 

Glasgow 

515589 

331 

230 

23-3 

70-0 

43-8 

55-1 

1284 

115 

2-92 

Dublin... 

... 

349685 

185 

167 

24-9 

69-0 

41-7 

55-4 

13-00 

027 

0-69 

At  the  Royal  Observatory,  Greenwich,  the  mean  reading 
of  the  barometer  last  week  was  29-80  in. ;  the  highest  read¬ 
ing  was  30-05  in.  on  Monday  morning,  and  the  lowest 
29A9  in.  on  Saturday  morning. 


NOTES,  QUERIES,  AND  REPLIES. 

- » - 

lit  tfcat  qntstionetb  mnc{r  s(tall  learn  mntlj. — Bacon. 


“  TJteeine  Displacements.” 

TO  THE  EDITOR  OF  THE  MEDICAL  TIMES  AND  GAZETTE. 

Sir,— Your  correspondent,  “  The  Bare-Faced  Monkey,”  betrays  his 
pithecoid  origin,  not  to  say  ignorance,  in  confusing  two  perfectly  different 
postures— the  genu-pectoral  and  the  genu-manual.  Not  only  are  these 
postures  different,  but  their  indications  are  not  to  be  confused.  It  is 
sufficient  to  point  out  that  either  may  be  indicated  according  to  the 
amount  and  direction  of  flexion  or  version  of  the  uterus  ;  in  other  words, 
according  to  the  amount  of  the  angle  formed  between  the  axis  of  the 
brim  (any  deviation  from  which  is  pathological)  and  that  of  the  uterus, 
and  which  should  be  called  the  “angle  of  divergence,”  or  the  “utero- 
pelvic  angle.” 

It  must  also  be  remarked  that  the  “  Bare-Faced  Monkey’s  ”  loose  talk 
about  “flexions,”  as  if  they  were  all  alike,  casts  discredit  on  the  writer, 
and  shows  no  signs  of  the  increasing  interest  with  which  these  important 
maladies  are  being  regarded,  and  indeed  measured.  The  time  is  perhaps 
not  far  distant  when  the  required  posture  may  be  absolutely  indicated  by 
a  mathematical  formula  depending  on  the  angle  of  flexion  or  version. 

It  is  needless  to  point  out  that  the  genu-pectoral  and  genu-manual 
positions  are  adapted  only  for  retro-  versions  and  -flexions  ;  in  ante- versions 
and  -flexions  the  proper  position  would  be  one  in  which  the  spine  was 
downwards,  and  the  head  lower  than  the  pelvis,  the  body  resting  on  the- 
scapulae,  and  the  pelvis  elevated  by  an  inclined  plane.  Such  a  position 
would  be  difficult  to  describe  in  a  word  analogous  to  “  genu-pectoral”;  it 
might  be  inconvenient  at  first,  but  the  patient  who  once  felt  the  relief  it 
would  afford  her  would  be  foolish  to  quarrel  with  it  on  grounds  of  aesthetic 
dislike. 

In  conclusion,  I  may  point  out  that, although  the  “genu-pectoral”  may- 
be  described  as  a  posture,  progression  in  this  attitude  is  plainly  impossible, 
without  at  least  such  mechanical  aid  as  would  be  afforded  by  a  small  trolly- 
on  wheels  placed  beneath  the  breast. 

Finally,  that  Nature,  when  man  assumed  an  erect  position,  contemplated 
a  possible  return  to  the  genu-manual,  is  rendered  probable  by  the  absence- 
of  hair  from  the  two  terminal  phalanges  of  the  fingers. 

I  am,  &e.,  “  Fiat  Rkpositio  Uteri,  iujat  Ccelum.” 

An  Anxious  Parent,  Liverpool.— AM  inquiries  with  respect  to  recognised 
preliminary  examinations  should  be  addressed  to  the  Registrar  of  the- 
General  Medical  Council,  299,  Oxford-street,  London,  W. 

Brewster  Sessions  Items. — At  the  first  licensing  session  at  Rotherham  since 
the  creation  of  the  Borough  Commission  of  the  Peace,  held  a  few  days 
since,  the  magistrates  reduced  the  licences  from  seventy-seven  to  forty- 

five. - At  Salford  twenty-eight  off  licences  have  been  refused. - At 

Merthyr  Tydfil  the  magistrates  made  the  announcement  that  it  might 
be  the  duty  of  the  Bench  at  the  next  licensing  sessions  to  reduce  the 

number  of  licences  issued. - At  Lincoln  the  magistrates  refused  to  grant, 

any  new  licences,  on  or  off,  but  renewed  the  old  licences,  except  where 
the  holders  had  been  convicted  of  misconducting  the  houses. 

A  'Homoeopathic  Hospital  for  Diphtheria  Patients,  St.  Petersburg .—  The 
Emperor  of  Russia  has  ordered  a  hospital  to  be  opened  in  St.  Petersburg 
for  diphtheria  patients,  where  the  homoeopathic  treatment  only  will  be 
adopted.  A  matron  and  eight  nurses  have  been  sent  by  the  Red  Cross 
Society. 

“  Our  Boys.”— An  M.R.C.S.  writes  “  I  am  a  professional  man  with  a 
good  income,  but  I  have  a  large  family  of  daughters,  and  two  sons. 
Knowing  how  precarious  are  the  chances  of  success  in  any  of  the  learned, 
professions,  I  have  j  ust  apprenticed  my  youngest  son,  aged  sixteen  years, 
to  a  builder.  Of  course,  he  has  to  work  at  the  bench,  and  go  out  with, 
the  workmen  ‘  on  jobs,’  but  he  is  happy,  and  his  time  well  employed. 
When  he  is  twenty-one  he  will  have  become  master  of  his  trade,  and,, 
being  a  well-educated  lad,  and  sharp  to  boot,  a  very  few  pounds  would 
start  him  in  one  of  the  colonies,  on  the  high  road  to  competency.  This 
is  what  I  do  with  ‘our  boys’— that  is,  for  those  who  are  handy  with 
their  tool-chest,  and  most  English  lads  are.  The  silly  pride  of  parents 
is  the  chief  drawback  to  their  sons’  success  in  life.” 

Psychologist.— It  was  Defoe  who,  alluding  to  our  mixed  origin,  in  his 
“True-born  Englishman,”  says  ironically  : — 

“With  easy  pains  you  may  distinguish 
Your  Roman,  Saxon,  Danish,  Norm  au-English.” 

“  When  Analysts  Differ.” — A  baker,  of  Monkton,  was  charged  before  the- 
Ramsgate  magistrates  with  adulterating  bread  with  alum.  The  proceed¬ 
ings  were  taken  on  the  certificate  of  Mr.  Adams,  the  county  analyst, 
who  certified  that  the  sample  submitted  to  him  contained  twelve  grains 
of  alum  to  a  four-pound  loaf.  The  defendant  produced  another  certificate 
from  Mr.  Sidney  Harvey,  public  analyst,  Canterbury,  who  certified  that 
the  bread  sent  to  him  was  “  pure  and  un-alumed.”  The  third  portion  of 
the  loaf  taken  by  the  officer  was  subsequently  submitted  to  the  Somerset 
House  analysts,  who  pronounced  that  the  bread  was  pure. 

Spirit-drinking  in  India  by  European  Soldiers.  A  great  decrease  appears- 
to  have  taken  place,  by  the  last  published  returns,  in  the  consumption 
of  strong  drinks  by  the  European  soldiers  in  India,  and  there  is  a  corre¬ 
sponding  spread  of  sobriety  among  the  rank  and  file  of  the  army  there.. 
In  1877-78  the  total  consumption  of  rum  among  the  British  troops  in 
India  was  253,254  gallons,  but  in  1881-82  it  fell  to  141,801  gallons.  In 
comparing  the  same  years,  as  regards  beer-drinking,  the  figures  are- 
respectively  76,942  and  74,747  hogsheads. 


390 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES 


Sept.  29,  1883. 


Barber-  Chirurgeon.— Captain  H.  R.  Skey,  the  Common  Crier  in  the  City  of 
London,  is  a  son  of  the  late  Mr.  F.  C.  Skey,  of  St.  Bartholomew’s  Hos¬ 
pital,  who  filled  the  office  of  President  of  the  Royal  College  of  Surgeons 
in  1863.  The  salary  of  Captain  Skey  is  £325  per  annum,  that  of  Dr. 
Sedgwick  Saunders  £800,  and  that  of  Mr.  W.  Collingridge,  Medical 
Officer  of  the  Port,  £500  per  annum. 

Precautions  against  Fire  :  Netley  Hospital. — The  Admiralty  authorities, 
realising  their  responsibility  in  the  protection  of  this  institution  against 
.fire,  have  taken  steps  to  provide  an  additional  steam  fire-engine,  to  be 
kept  on  the  premises. 

Purchasing  Spirits  for  Analysis :  The  New  Pharmacy  Bill. — The  Chemists 
and  Druggists’  Trade  Association  of  Great  Britain  have  held  a  special 
meeting  at  Birmingham,  which  was  attended  by  representatives  from 
London,  Manchester,  Leeds,  Sheffield,  Liverpool,  Glasgow,  Edinburgh, 
and  other  parts  of  the  kingdom.  Inter  alia,  a  deputation  was  appointed 
to  wait  upon  the  Inland  Revenue  Board  to  urge  the  advisability  of 
issuing  an  order  making  it  compulsory  on  excise  officers,  when  pur- 
■chasing  spirit  for  analysis,  to  leave  with  the  seller  a  portion  of  the 
article  purchased.  It  was  also  decided  that  chemists  and  druggists 
generally  should  be  united  in  the  support  of  a  Pharmacy  Bill  before  it 
was  submitted  to  the  Government  or  introduced  into  Parliament.  It  is 
proposed  to  arrange  an  interview  between  a  deputation  from  the 
Association  and  the  Council  of  the  Pharmaceutical  Society. 

A  Workhouse  Unfit  for  Habitation. — The  workhouse  of  the  Bridge  Union, 
Canterbury,  appears  to  be,  with  the  exception  of  the  casual  ward, 
totally  unfit  for  use.  The  infirmary  is  low,  narrow,  and  badly  venti¬ 
lated,  and  ought  to  have  been  condemned  years  ago.  By  an  arrange¬ 
ment,  which  has  been  allowed  to  exist  for  nearly  fifty  years,  the  inmates, 
however  old  and  infirm,  have  to  pass  from  the  day-rooms  into  the  open 
air,  and  then  to  ascend  a  steep  ladder,  in  order  to  reach  the  dormitories. 

'Totally  Inadequate  Fines. — Two  builders  have  been  called  upon  to  answer 
before  the  Stratford  Bench  charges  of  infringing  one  of  the  by-laws 
of  the  Leyton  Local  Board.  The  by-law  in  question  requires  builders 
to  give  notice  to  the  surveyor  of  the  Board  of  the  completion  of  each 
building,  in  order  that  he  may  inspect  the  premises  and  see  that  they 
are  fit  for  habitation.  This  notice  the  defendants  had  failed  to  give. 
The  drainage  was  not  connected  with  the  sewers  in  either  case,  and  in 
one  a  tenant  had  been  allowed  to  enter  upon  the  premises  and  occupy 
them  for  some  time  while  this  serious  defect  existed.  The  surveyor, 
on  inspecting  the  house,  “  found  the  sink  and  back  yard  saturated  with 
stinking  water,  etc.,  most  injurious  to  health”;  and  when  the  Local 
Authority  come  to  connect  the  drains  with  the  sewers,  they  will  en¬ 
counter  an  accumulation  of  sewage.  With  this  evidence  before  them, 
the  Bench  imposed  fines,  respectively,  of  50s.  and  60s. 

Fitzjames.— The  Metropolitan  Open  Spaces  Act,  1881,  empowers  vestries 
to  take  over  burial-grounds,  to  lay  them  out  as  public  gardens,  and  to 
make  by-laws  for  their  superintendence. 

How  to  Waste  Food :  Islington  Workhouse  School. — The  Islington  Board  of 
Guardians  have  held  a  discussion  on  an  alleged  waste  of  food  in  the  work- 
house  school.  In  the  course  of  this  discussion,  Dr.  Cotton,  the  medical 
officer  of  the  school,  remarked  that  he  had  come  to  the  conclusion  that  the 
bread  allowed  by  the  new  table  of  diet  was  at  least  two  ounces  per  child 
per  day  more  than  it  should  be,  and  the  pudding  four  ounces  too  much. 
Dr.  Willis  (a  guardian)  stated  there  was  another  source  of  waste,  and 
it  was  in  the  cook.  ’On  one  occasion  when  he  visited  the  school  with  the 
chairman,  after  each  child  had  been  served  there  remained  two  whole 
puddings  and  a  half,  weighing  together  about  30  lbs.(!)  On  inquiring 
of  the  master  what  would  be  done  with]  them,  he  was  told  they  would 
be  thrown  into  the  dustbin.  He  contended  that  if  the  cook  could  not 
draw  the  line  nearer  than  this,  the  sooner  she  was  discharged  the 
better.  Eventually  the  subject  was  referred  to  the  School  Committee 
to  take  immediate  steps  to  stop  the  waste. 

A  Factory  Surgeon.— The  statute  passed  in  the  last  session  extends  the 
prohibition  of  paying  of  wages  in  public-houses  to  all  workmen,  and 
directs  that  no  wages  be  paid  to  a  workman  at  a  public-house,  beer- 
shop,  or  place  for  the  sale  of  spirits,  wine,  cider,  or  other  spirituous  or 
fermented  liquor,  or  any  office,  garden,  or  place  belonging  thereto,  or 
occupied  therewith.  An  exception  is  made  as  regards  the  workmen 
bond  fide  employed  by  the  owner  or  occupier  of  a  public-house.  The 
maximum  penalty  for  infringing  the  Act  is  £10.  All  labourers,  ser¬ 
vants  in  husbandry,  journeymen,  artificers,  handicraftsmen,  and  all 
other  persons,  of  whatever  age,  engaged  in  manual  labour,  are  included 
in  the  Act. 

School  Instruction,  England  and  Wales. — The  report  of  the  Committee  of 
Council  on  Education  shows  that  during  the  year  the  day-schools  in 
England  and  Wales  provided  accommodation  for  4,538,320  scholars,  and 
had  the  names  of  4,189,612  children  on  the  registers,  35,444  certificated 
teachers  being  employed  in  their  instruction.  Cooking  is  taught  in  347 
schools,  an  increase  of  forty- eight  on  the  year,  and  it  is  stated  that 
“  arrangements  are  being  made  in  various  parts  of  the  country  by 
school  boards  and  voluntary  associations  for  giving  girls,  in  the  last 
year  of  their  stay  at  school,  some  practical  instructions  in  this  subject, 
a  knowledge  of  which  is  so  necessary  for  them  in  after  life.”  This 
official  recognition  of  the  importance  of  the  question  is  satisfactory. 


Sanitary  Aid  Committees. — It  is  stated  that  in  one  quarter  of  London  sani¬ 
tary  aid  committees  are  being  organised.  It  is  pointed  out  that  occupiers 
of  tenement-houses  usually  endure  all  kinds  of  sanitary  evils  in  their 
homes  rather  than  complain  to  the  landlord  or  local  authorities,  for 
fear  of  a  notice  to  quit  or  an  increase  of  the  rent.  A  sanitary  aid 
committee  goes  to  them,  and  offers  to  make  complaints  for  them  to  the 
local  authorities  without  disclosing  the  names  of  the  informants.  It  is 
urged  that  were  such  committees  established  in  every  town  in  the 
kingdom,  one  probable  result  of  their  action  would  be  that  the  dwellings 
of  the  working  classes  would  pass  into  the  hands  of  a  better  class  of 
landlords. 

COMMUNICATIONS  have  been  received  from — 

The  Secretary  of  the  Apothecaries’  Society,  London;  Mr.  F.  Lb 
Gros  Clark,  F.R.S.,  London ;  Dr.  Ward  Cousins,  Portsmouth  ;  Dr. 
McKendrick,  Glasgow ;  Mr.  W.  H.  Bennett,  London ;  Messrs.  Francis 
and  Co.,  London;  Dr.  Saundby,  Birmingham;  The  Sanitary  Commis¬ 
sioner  for  the  Punjaub,  Lahore;  Mr.  Watson  Chbyne,  London; 
Mr.  Tweedy,  London  ;  Dr.  P.  Kavanagh,  Brockley ;  Dr.  W.  Domett 
Stone,  London ;  The  Secretary  of  St.  Mary’s  Hospital  Medical 
School,  London  ;  The  Secretary  of  St.  John’s  House,  London;  The 
Secretary  of  the  Obstetrical  Society,  London ;  The  Secretary  of 
the  Statistical  Society,  London;  The  Secretary  of  King’s  College, 
London  ;  The  Secretary  of  the  Royal  Albert  Asylum,  Lancaster  ; 
Dr.  Norris  Wolfenden,  London ;  The  Secretary  of  University 
College  Hospital,  London;  Mr.  J.  Chatto,  London;  Mr.  T.  M. 
Stone,  London. 

BOOKS,  ETC.,  RECEIVED— 

Sanitary  Principles,  by  Surgeon  S.  J.  Thomson,  S.Sc.C.  Camb.,  etc. — 
The  Topographical  Relations  of  the  Female  Pelvic  Organs,  by  A.  L. 
Ranney,  A.M.,  M.D. — Interesting  Cases  in  Private  Practice,  by  Joseph 
H.  Warren,  A.M.,  M.D. — Massage,  by  Dr.  Douglas  Graham— Announce¬ 
ment  of  the  Philadelphia  Polyclinic — Annual  Report  of  the  Murray 
Royal  Asylum,  Perth — Complicirten  Luxationen  und  deren  Behandlung, 
von  Dr.  August  Schreiber — De  la  Folie  a  Double  Forme,  par  le  Docteur 
Amb.-E.  Mordret— La  Medicacion  Fosforo-Cilcica  de  Almera. 

w'  PERIODICALS  AND  NEWSPAPERS  RECEIVED— 

Lancet — British  Medical  Journal — Medical  Press  and  Circular — Ber¬ 
liner  Klinische  Wochenschrift— Centralblatt  fiir  Chirurgie — Gazette 
des  Hopitaux— Gazette  Medicale— Revista  de  Medicina— Bulletin  de 
1’ Academie  de  Medecine— Pharmaceutical  J ournal — W iener  Medicinische 
Wochenschrift— Revue  Mddicale— Gazette  Hebdomadaire— Nature — 
Boston  Medical  and  Surgical  Journal— Louisville  Medical  News— 
Centralblatt  fiir  Gynakologie — Le  Concours  Medical— Centralblatt  fiir 
die  Medicinischen  Wissenschaften — Centralblatt  fiir  Klinische  Medicin 
— Philadelphia  Medical  News — Le  Progress  Medical — Dublin  Journal 
of  Medical  Science— Dublin  Evening  Mail,  September  15— Cambridge 
Chronicle  and  University  J  ournal — Revue  de  Hygiene — Revue  de  Mede¬ 
cine— Revue  de  Chirurgie— South-Eastern  Herald— Greenwich  and 
Deptford  Chronicle,  September  21 — Medical  Record,  New  York— 
Australasian  Medical  Gazette — Students’  J  ournal  and  Hospital  Gazette. 


APPOINTMENTS  POE  THE  WEEK. 


September  29.  Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  1 J  p.m. ;  King’s  College,  1J  p.m. ;  Roya* 
Free,  2  p.m.;  Royal  London  Ophthalmic,  11  a.m. ;  Royal  Westminster 
Ophthalmic,  1J  p.m. ;  St.  Thomas’s,  l^p.m.;  London,  2  p.m. 


October  1.  Monday. 

Operations  at  the  Metropolitan  Free,  2  p.m.;  St.  Mark’s  Hospital  for 
Diseases  of  the  Rectum. 2  p.m.;  Royal  London  Ophthalmic,  11  a.m.; 
Royal  Westminster  Ophthalmic,  1^  p.m.  ;  Hospital  for  Women,  2  p.m. 


2.  Tuesday. 

Operations  at  Guy’s,  1J  p.m. ;  Westminster,  2  p.m. ;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  Is  p.m.;  West 
London,  3  p.m. 


3.  Wednesday. 

Operations  at  University  College,  2  p.m. ;  St.  Mary’s,  1|  p.m. ;  Middlesex, 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew’s,  1£  p.m.  ;  Great  Northern, 

2  p.m. ;  Samaritan,  2j  p.m. ;  Royal  London  Ophthalmic,  11  a.m. ; 
Royal  Westminster  Ophthalmic,  1£  p.m. ;  St.  Thomas’s,  1£  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m.;  National  Orthopaedic,  Great 
Portland-street.  10  a.m. 

Obstetrical  Society  of  London,  8  p.m.  Specimens  will  be  shown  by 
Dr.  Mansell-Moullin,  Dr.  W.  A.  Duncan,  and  others.  Papers  :  Dr. 
S wayne,  “  Gangrene  of  the  Thigh  durrng  the  Seventh  Month  of  Preg¬ 
nancy.”  Dr.  Henry  Bennet,  “  The  Anatomy,  Physiology,  and  Pathology 
of  the  Os  Uteri  Internum.”  Dr.  E.  S.  Tait,  “  Observations  on  Puerperal 
Temperatures.” 


4.  Thursday. 

Operations  at  St.  George’s,  1  p.m. ;  Central  London  Ophthalmic,  1  p.m. ; 
Royal  Orthopaedic,  2  p.m.;  University  College,  2  p.m.;  Royal  London 
Ophthalmic, 11  a.m. ;  Royal  Westminster  Ophthalmic,  li  p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m. ;  Hospital  for  Women,  2  p.m. 
Charing-cross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  2£  p.m. 


5.  Friday. 

Operations  at  CentralLondonOphthalmie,  2  p.m.;  Royal  London  Ophthal¬ 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminster 
Ophthalmic,  ljp.m.;  St.  George’s  (ophthalmic  operations),  li  p.m.; 
Guy’s,  14  p.m. ;  St. Thomas’s  (ophthalmic  operations),  2  p.m.;  King’s 
College  (by  Mr.  Lister),  2  p.m. 


Medical  Tfange  and  Gazette. 


INAUGURAL  ADDRESS 

DELIVERED  IN 

KING’S  COLLEGE,  LONDON, 

On  October  2,  18S3. 

-By  HENRY  W.  ACLAND,  M.D.,  LL.D.,  F.R.S., 
iRegius  Professor  of  Medicine  in  the  University  of  Oxford. 


In  the  year  1847  the  first  Professor  of  Surgery  in  King’s 
■College,  in  concluding  the  Hunterian  Oration,  thus  addressed 
a  highly  critical  audience  in  the  theatre  of  the  Royal  College 
of  Surgeons  of  England  “  By  the  institution  and  protec¬ 
tion  of  seminaries  of  learning,  in  which  is  cultivated  Science 
anterior  to  the  Sciences,  as  the  Sciences  to  the  especial  Pro- 
-fessions,  may  we  best  insure  the  growth  and  increase  of 
professions  united  in  their  attachment  to  all  ancient  institu¬ 
tions,  and  in  all  the  hereditary  loves,  loyalties,  and  reverences 
that  have  ever  been  the  precious  birthright  of  an  English 
gentleman — professions  united  with  each  other,  and  in  union 
-with  the  National  Church.” 

Joseph  Henry  Green  never  addressed  an  audience  which 
he  did  not  hold  bound  as  by  a  spell.  He  rarely  addressed 
one  which  he  did  not  convince  by  his  logic.  His  biographer, 
one  also  of  the  ornaments  and  lights  of  King’s  College, 
relates  that  on  this  occasion  the  meeting  showed  signs  of 
.dissent.  A  feeble  minority  began  to  groan  and  to  hiss.  An 
overwhelming  majority  shouted  applause,  and  for  a  moment 
discord  seemed  to  be  impending — when  the  orator,  writes 
Mr.  Simon,  “  by  one  stately  movement  of  head  and  hand 
silenced  the  whole  meeting  so  that  a  pinfall  could  have  been 
heard,  repeated  his  words  with  an  emphasis  so  resolute  and 
yet  so  conciliative  that  not  one  murmur  resented  them,  and 
-then,  in  language  which  might  have  been  Plato’s,  concluded 
his  sentence  and  oration,  f  with  the  National  Church  .... 
-as  the  universal  organ  according  to  the  Idea,  for  educing, 
harmonising,  and  applying  all  those  elements  of  moral 
..cultivation  and  intellectual  progress,  of  which  Religion 
prescribes  the  aim  and  sanctifies  the  use.’”(a) 

The  occasion  of  the  distribution  of  prizes  in  a  Medical 
School  may  scarce  seem  a  fit  occasion  for  recalling  to  mind 
this  pregnant  utterance,  and  this  remarkable  scene.  But 
reflection  will,  I  think,  show  the  occasion  to  be  not  inapt, 
and  of  all  Schools  this  the  fittest. 

The  time  is  not  come,  nor  can  it  ever  come,  when  the 
distribution  of  prizes  in  a  great  Medical  School  can  lose  its 
interest  for  thoughtful  men.  There  is  something  in  the 
occupation  of  the  student  of  Medicine  which  touches  every 
well-constituted  mind  with  singular  force.  In  many  voca¬ 
tions  in  life  a  certain  self-interest,  aiming  at  success,  is  the 
mainspring.  Though  this  success  depends  generally,  and 
ought  always  to  depend,  upon  the  right  performance  of  duty 
undertaken,  whether  in  profession  or  in  trade,  still  self- 
interest  is  and  will  be  the  chief  motive. 

But  in  the  life  of  a  Student  of  Medicine  this  is  not,  or  at 
least  need  not  be,  the  case.  There  is  no  corner  of  human 
nature  which  he  may  not  one  day  or  other  be  destined  to 
explore.  He  may  perchance  be  fitted  intellectually  for  the 
study  of  some  one  of  the  Sciences  with  which  Medicine  is 
connected,  and  may  be  devoted  to  it.  His  progress,  in  that 
•case,  is  watched  with  interest  only  in  reference  to  the  Science 
in  question.  Competent  observers  note  how  much  he  adds 
tfo  the  mere  knowledge  of  fact  or  of  law  in  the  world ;  and 
they  estimate  him  accordingly.  But  in  reference  to  the 
practical  work  of  his  future  profession,  men  take  measure 
of  his  whole  character,  as  fitted  by  sympathy  and  singleness 
of  purpose,  as  well  as  by  scientific  knowledge,  to  relieve  the 
varied  sufferings  and  sorrows  of  afflicted  humanity. 

"What  therefore  is  to  be  the  true  aim  of  those  who  seek  to 
influence  the  medical  education  of  the  future  should  be  made 
clear.  Is  it  to  fit  average  men  exclusively  or  chiefly  for 
amassing  knowledge  ;  or  is  it  to  make  them  fit  to  relieve  the 

[a)  Simon,  Life  of  Green,  vol.  i.,  page  44. 

Yckl.  II.  1883.  No.  1736. 


Oct.  6,  1883.  391 

■ - 

sick  and  the  suffering  by  every  known  means  of  knowledge, 
of  goodness,  of  unselfish  practical  care  P 

Mr.  Green,  of  whom  personally  I  shall  presently  have  more 
to  say,  told  a  great  scientific  and  professional  audience  that 
the  groundwork  of  professional  education  was  a  high  general 
culture  with  scientific  discipline,  and  that  these  two  should 
be  in  union  with  Religion. 

In  King’s  College  no  uncertain  sound  on  this  matter  has 
yet  been  given.  King’s  College  originally  laid  down  certain 
principles  to  guide  her  destiny  as  a  great  seat  of  education. 
Were  her  principles  right?  Do  they  need  revision?  or 
change  ? 

To  these  difficult  questions  I  purpose,  with  much  diffidence, 
to  devote  the  short  time  at  my  disposal.  Neither  my  brevity 
nor  the  limits  of  my  insight  can  be  the  measure  of  the 
seriousness  of  the  inquiry  or  of  its  necessity  at  the  present 
hour. 

Everywhere,  as  in  the  highest  periodical  literature,  so  in 
the  less  refined  journals,  there  is  a  demand  for  secular,  to 
the  exclusion  of  religious,  education.  A  protest,  not  less 
loud  and  strong,  is  made  against  such  demand  as  illiberal 
and  mistaken,  and  as  injurious  to  the  best  interests  of 
human  society  in  the  future.  The  demand  and  the  protest 
are  not  confined  to  one  country  or  one  language.  Wherever 
active  though  t  and  public  life  have  fair  play  the  discussion 
is  carried  on  with  warmth. 

King’s  College  was  originally  founded  in  the  year  1829. 
It  was  laid  down  as  “  essential,  to  maintain  indissolubly  the 
connexion  between  sound  religion  and  useful  learning  ”  (I 
quote  the  words)  and,  “  in  King’s  College,  instruction  in 
the  doctrines  and  duties  of  Christianity,  as  taught  by  the 
Church  of  England,  should  be  for  ever  combined  with  other 
branches  of  useful  education.”  By  an  Act  which  received 
the  Royal  assent  in  May  of  last  year,  1882,  it  was  enacted 
that  the  “  College  shall  continue  as  a  body  politic  for  the 
purpose  of  giving  instruction  in  the  various  branches  of 
Literature  and  Science,  and  the  doctrines  and  duties  of 
Christianity  as  the  same  are  inculcated  by  the  Church  of 
England.” 

Into  the  history  of  the  circumstances  which  led  in  1829 
to  the  adoption  of  this  clause,  or  into  any  statement  of  the 
precise  limitation  of  .the  doctrines  which  may  be  held  with 
integrity  within  the  pale  of  the  Church  of  England,  this 
certainly  is  not  the  time  to  enter.  It  is  only  to  be  noted 
that  the  energetic  and  devoted  persons  who  founded  this 
College,  in  what  it  is  now  the  fashion  to  describe  as  a  narrow, 
if  not  intolerant  spirit,  did  so  fully  aware  of  the  great  social 
movements  of  the  period — of  Catholic  Emancipation  which 
took  place  in  the  same  year,  of  the  agitation  whereby  the 
extension  of  the  suffrage  was  to  be  secured  in  1832,  and 
of  the  general  tendency  of  the  time  to  sweep  away  all  so- 
called  restrictions  as  fatal  to  the  healthy  growth  of  scientific 
knowledge  and  of  political  freedom. 

In  the  midst  of  this  general  ferment,  at  a  notable  epoch 
of  our  constitutional  history,  the  founders  laid  down  that 
the  educational  system  “  was  to  comprise  religious  and  moral 
instruction,  classical  learning,  history,  modern  languages, 
mathematics,  natural  philosophy,  medicine  and  surgery, 
chemistry,  jurisprudence,  etc.,  to  be  so  conducted  as  to  pro¬ 
vide  in  the  most  efficient  manner  for  the  two  great  objects 
of  education — the  communication  of  general  knowledge,  and 
specific  preparation  for  particular  professions.” 

“  General  knowledge,  and  specific  preparation  for  par¬ 
ticular  professions.”  What  is  general  knowledge  ?  and  what 
is  the  specific  preparation  for  the  Profession  of  Medicine  ? 
Is  it  better  that  this  preparation  should  be,  in  modern 
phraseology,  wholly  secular  and  physical;  or  should  it  be,  as 
the  founders  of  King’s  College  provided,  a  mixed  training, 
secular  and  religious  ? 

I  have  neither  the  power  nor,  to-day,  the  time  to  tho¬ 
roughly  answer  this  question.  But  it  is  one  that  has  to  be 
met,  and  speedily.  One  of  Bacon’s  prayers  was  that 
“  human  things  may  not  prejudice  such  as  are  divine ; 
neither  that  from  the  unlocking  of  the  gates  of  sense,  and 
the  kindling  of  a  natural  light  anything  of  incredulity,  or 
intellectual  night,  may  arise  in  our  minds  towards  divine 
mysteries.  But  rather,  that  by  our  mind  being  thoroughly 
cleansed  and  purged  from  fancy  and  vanities,  and  yet  sub¬ 
ject  and  perfectly  given  up  to  divine  oracles,  there  may  be 
given  unto  Faith  the  things  of  Faith.”  This  conflict  between 
the  things  of  Faith  and  the  things  of  Sight  is  as  old  as 
Socrates.  I  am  glad  to  think  it  is  now  as  sturdy  as  ever. 


OPENING  ADDRESS  AT  KING’S  COLLEGE. 


392  Medical  Times  and  Gazette.  OPENING  ADDRESS  AT  KING’S  COLLEGE.  0*6.6,188?. 


It  is  often  assumed  that  the  old  culture  of  the  Universities 
and  the  yearning  for  the  Spiritual  Life  were  to  be  swept  away 
as  relics  of  the  dark  ages,  and  that  “useful  knowledge5’ 
(this  was  the  phrase)  alone  was  the  proper  subject-matter 
for  training  a  robust  mind.  But  a  reaction  is  setting  in. 
Men  begin  to  ask  whether,  after  all,  a  great  and  noble  life 
cannot  be  lived  without  endeavouring  to  provide  that  the 
largest  mass  of  fact  with  which  an  educational  artillerist 
has  loaded  the  young  instrument,  shall,  on  a  given  day,  be 
discharged. 

“  But  the  old  simple  life  has  passed  away,”  it  is  said.  I 
is  only  knowledge  of  things  which  is  real  in  this  world, 
though  we  are  not  quite  sure  what  constitutes  knowledge. 
All  things  cognisable  are  Material  ;  behind  Matter  nothing 
is  ascertained  or  ascertainable,  though  we  are  not  quite 
sure  yet  whether  Matter  be,  or  be  not.  If  there  be  aught  else, 
then,  to  veil  our  ignorance  as  to  what  that  is,  we  will  call 
it  Force.  Of  anything  beyond  in  nature,  of  Will,  human  or 
superhuman,  we  know  not,  and  therefore  take  no  account. 
We  are  in  an  age  of  fact  and  a  practical  age.  We  trust 
our  senses,  untrustworthy  as  they  are,  and  that  which  they 
can  verify  by  experiment.  Of  all  things  else,  of  the  “  things 
of  Faith,”  we  so  doubt,  that  we  consider  most  of  them  to 
be  Vanity,  or  Falsehood,  and  would  dismiss  them  as  poison 
from  the  youth  of  the  future,  who  shall  have  none  of  them. 

Doubtless,  authority,  if  it  override  investigation,  is  of 
little  worth.  When  we  approach  in  our  day  a  discussion  as 
to  the  nature  of  Man,  it  is  something  to  believe  that  we  are, 
in  the  main,  at  one  with  Plato,  with  Aristotle,  and  with 
Galen — with  Dante  and  Fra  Angelico — with  Linnaeus,  with 
Newton,  Galileo,  Kepler,  Herschel — with  Butler  and  Kant, 
in  whom  the  precise  study  and  lifelong  contemplation  of  the 
material  world  and  of  human  nature  produced  the  convic¬ 
tion,  that  as  there  is  a  finite  Human  Will,  so  there  is,  though 
known  only  by  analogy,  an  Infinite  Will,  an  absolute,  super¬ 
human,  intellectual  Power — the  supreme  idea  of  all  perfect¬ 
ness,  interwoven  with  all  Good — to  be  inferred,  wheresoever 
the  feeble  powers  of  the  creature  can  scan  the  manifestation 
of  the  work,  as  of  a  Creator  and  Preserver. 

“  Yes,”  it  is  said,  “but  all  these  men  whom  you  quote 
pertained  to  the  days  of  ignorance.  We,  the  true  ancients 
of  the  world,  have  outlived  their  infancy ;  we  have  seen  one 
by  one  the  weakness  of  these  men  of  the  dawn  exposed  ;  and 
we  at  length  have  the  true  light.  The  poet  of  Israel  was 
deceived  when  he  sang,  c  He  counteth  the  number  of  the 
stars,  and  calleth  them  all  by  their  names.5  He  did  not  per¬ 
ceive,  as  we  now  do,  that  not  fewer  than  some  40,000,000  of 
suns  are  within  the  range  of  our  scientific  calculations.  He 
did  not  see,  as  we  now  see,  how  fatal  it  is  to  the  old  faith 
that  we  have  thus  enlarged  the  conception  of  the  contents 
of  the  physical  universe.  The  few  thousand  stars,  which, 
to  the  unassisted  eye  of  the  Arabian  herdsman,  seemed 
countless,  were  justly  calculated  to  inspire  him  with  awe. 
We  who  read  the  larger  figure,  we,  who  see  or  infer  so  many 
millions,  can  read,  in  the  everlasting  Law  which  pervades 
Infinity,  the  negation  of  Intelligence  and  Will.  We  who 
can  now  note  the  chemistry  of  the  sun,  as  easily  as  Faraday 
read  the  flame  of  the  rushlight,  we  see,  by  this  our  gained 
power,  proof  of  the  incompetence  of  a  superhuman  Power 
to  create,  to  evolve,  to  preserve,  with  intelligence  and  will. 
We  disbelieve  what  we  do  not  understand.  Faith  in  proba¬ 
bilities  and  in  abstract  good  has  perished  with  knowledge. 
In  the  days  of  man’s  infancy  alone  would  an  afflicted  Seer 
cry  out,  *  Lo  !  these  are  parts  of  His  ways  ;  how  small  a 
portion  is  heard  of  Him  ! 5  ” 

But  let  some  one  reply  “  It  is  not  so.  You  mistake  the 
situation.  It  is  not  the  quantity,  but  the  quality  of  modern 
knowledge,  which  constitutes  physical  science.  It  is  this 
quality  which  has  wrought  so  great  change  in  the  interpre¬ 
tation  of  nature.”  Well  then,  let  us  ask  ourselves  more 
closely  —  What  is  the  change  in  quality  of  knowledge, 
which  parts  off  the  ancient  from  the  modern  Idea  of  the 
Universe,  and  gives  the  latter  the  right  to  reject  the  conclu¬ 
sions  of  ancient  simplicity  ? 

Now,  if  we  reject  the  notion  that  the  quantity  of  acquired 
human  knowledge  is  destructive  of  Faith  in  a  Supreme 
Intelligence,  and  inquire  into  the  bearing  thereon  of  its 
quality,  we  have  to  consider  what  alteration  in  this  respect 
of  quality  has  taken  place  in  modern  times.  The  alteration 
appears  to  lie  chiefly  in  two  points — first,  in  the  enlarged, 
rapid,  and  often  unexpected  application  of  scientific  know¬ 
ledge  to  the  practical  circumstances  of  common  life — us,  for 


example,  the  use  of  chloroform  derived  from  Chemistry,*, 
steam  and  electricity  from  Physics,  and  the  biological  rela¬ 
tions  of  lower  animal  and  vegetable  forms  to  Medicine  and 
Surgery.  Amongst  these,  one  illustration  must  suffice — one 
in  which,  through  Wheatstone  and  Daniel,  King’s  College 
has  a  special  interest.  When  Franklin  and  Galvani  made 
their  experiments  respectively  into  the  currents  of  the 
thunder-cloud  and  the  nerve-tissue  of  the  frog,  how  little 
could  their  wildest  imaginings  realise  the  tremendous  forces 
that  were  to  minister  as  slaves  of  the  every-day  life  of 
man. 

The  world  at  large,  on  the  other  hand,  which  profits  by 
the  results  of  purely  scientific  research,  s(uch  as  is  scoffed,  at 
as  useless,  knows  little  of  the  intellectual  labours  which, 
have  been  gone  through  to  accomplish  such  results*  Here 
also  take  one  instance  only.  In  any  future  great  war  this 
country  will  probably  be  protected  as  well  as  attacked  by 
gigantic  ironclads,  armed  with  huge  guns,  some  weighing' 
100  tons,  which  will  be  fired  by  the  electric  spark.  Fixed 
torpedoes,  a  subtler  foe,  exploded  automatically,  will  under 
certain  circumstances  bring  sure  destruction  on  the  invader. 
These  tremendous  instruments  will  be  watched  by  delicate 
electrical  apparatus  from  forts  upon  the  shore  ;  their  very 
movements  being  attentively  noted  by  the  ear,  and  their 
condition,  below  perhaps  an  angry  sea,  carefully  noted* 
through  the  telephone. 

Now  what  observation  has  been  here  !  what  experiments 
devised  by  imagination  succoured  by  science  !  what  search 
after  abstract  truth  !  what  induction  of  law  !  what  applica¬ 
tion  of  mathematical  method,  of  mechanical  ingenuity,, 
chemical  science  and  skill,  in  relation  to  the  inorganic 
world,  to  the  kingdoms  of  life  and  organisation,  to  the  arts 
of  peace! — before  this  one  strange  power  could  thus  be 
brought  to  bear  on  the  protection  of  a  nation,  on  the 
destruction  of  human  life  ! 

The  mind  becomes  dazzled  when  it  scans  such  results. 
Man  seems,  to  the  unreflecting,  as  if  he  were  the  creator  off 
forces  which  he  is  but  marshalling  for  his  own  ends.  Yet 
man  himself  in  his  specialised  nature  may  be  none  the 
greater  for  all  these  things.  Many  a  heart  in  Csesar’s  legions 
beat  as  true  as  ours,  or  thrilled  as  deeply  with  tribal  despera¬ 
tion  among  the  resisting  Britons,  near  two  thousand  years, 
ago — perhaps  at  the  very  spot  where  these  fiery  contests 
may  one  day  rage. 

Will  anyone  dare  to  say  either  that  such  applied  science 
in  itself  raises  or  lowers  all  who  personally  profit  by  itS- 
conditions  ?  Will  he  not  rather  admit  at  once  that  Caesar 
or  Alexander,  Gustavus  Adolphus  or  Napoleon,  Clive,  Henry 
Lawrence,  or  Havelock,  or  other  great  commanders  who- 
will  wield  the  tremendous  forces  of  future  warfare,  were' 
what  they  were,  or  will  be  what  they  may  be,  despite  of  the 
scientific  epoch  in  which  they  have  been  or  may  happen  to- 
be  placed  ?  that  there  is  something  outside  and  beyond  the 
application  of  science  to  the  arts  of  life,  which  helps  him  on- 
towards  his  highest  goal  ?  that  it  is  a  delusion  to  suppose 
that  the  best  faculties  of  man  are  or  can  be  called  out  by  his 
material  surroundings  alone,  or  by  a  knowledge  of  their 
nature?  and  that  men  feel,  now  as  ever,  a  yearning  for 
light  and  good  which  no  material  surroundings  supply  ?  As 
we  dismissed  the  idea  that  the  quantity  of  modern  know¬ 
ledge  has  altered  the  conception  of  the  Idea  of  the  Universe, 
and  of  its  moral  government,  so  we  may  reject  the  thought 
that  this  quality  of  practical  utility  in  applied  science  has 
directly  wrought  any  such  result;  though  it  may  have  so 
done  by  fostering  luxury,  frivolity,  or  love  of  ease. 

It  is,  then,  some  other  quality,  if  any,  in  knowledge  or  in 
science  that  has  changed  men’s  conception  of  the  Universe. 

This  may  be  stated  briefly  because  it  is  known  to  all.  It 
is  the  conception  or  hypothesis  that  the  whole  material 
frame  of  the  Universe  is  the  outcome  of  necessary  Law,  and’ 
that  this  Law  allows  no  room  for  any  Power  other  than  is: 
necessarily  inherent  in  Matter. 

Volumes  would  be  needed  to  record  either  the  con¬ 
sequences  which  follow  from  this  conviction,  or  a  tithe  of 
the  arguments  which  have  been  written  for  or  against  it.. 
Suffice  it  now  to  remark  that  many  are  from  this  dogma  led 
to  accept  as  proved  that  the  evidence  of  Design  in  the- 
Universe  is  manifestly  false— that  there  is  no  analogy 
between  the  constitution  and  course  of  Nature  (so-called) 
and  Religion — that  there  is  no  evidence  of  the  possibility 
that  the  individual  human  soul  is  guided  by  a  Being  whose 
highest  attributes  are  infinite  Goodness  and  Love — and  that 


Medical  Times  and  Gazette. 


OPENING  ADDRESS  AT  KING’S  COLLEGE. 


Oct.  6, 1883.  393 


there  is  no  clear  boundary  line  between  Man  and  the  “  beasts 
that  perish.” 

As  I  have  now  said,  the  arguments  for  or  against  this 
view  of  the  Universe,  sharply  and  absolutely  fatal  to 
Christianity,  are  so  voluminous  and  so  intricate  as  to  be 
far  beyond  my  power  or  my  time  now  to  summarise.  But 
addressing  my  fellow-students  as  man  to  man,  in  the  midst 
of  the  wordy  strife,  I  may  be  allowed  to  say  a  few  words  of 
counsel  and,  I  hope,  of  peace. 

Men  may  accept  that  some  sort  of  Evolution  of  the  present 
order  of  things  is  true ;  no  one  ought  now  to  doubt.  We 
may  now  all  believe  this  earth  was  “  without  form  and  void  ” 
— that  the  land  was  divided  from  the  waters — that  life 
appeared  in  sentient  and  non-sentient  forms — that  original 
forms  have  both  endured  and  have  perished  through  ages 
uncounted  and  uncountable — that  man  appeared  late,  per¬ 
haps  latest,  on  the  planet — that  our  race  has  existed  for  a 
period  far  exceeding  the  mere  suspicions  of  philosophers 
fifty  years  ago — that  man  is  divisible  into  various  races — 
that  these  races  have  many  differences  in  respect  of  ten¬ 
dency  to  modification,  of  resistance  to  external  conditions, 
of  evolution  towards  the  highest  standard  of  intellectual 
gifts,  of  conviction  of  relations  to  a  supreme  Euler  of  the 
Universe. 

Further  it  has  to  be  noted  that  in  this  century  the  precise 
investigation  into  the  material  condition  of  our  planet,  of 
our  solar  system,  of  the  Universe,  has  brought  fruit  such  as 
the  giants  of  the  race — as  Aristotle,  Galileo,  Kepler,  Newton, 
Haller — did  not  and  could  not  foresee.  Yet  while  allowing 
this  we  are  bound,  notwithstanding  the  modern  telescope, 
spectroscope,  microscope,  and  analytical  and  synthetical 
chemistry,  to  marvel  at  the  knowledge  and  sagacity  as  well 
as  the  prudence  and  reserve  of  our  forefathers,  and  our 
indebtedness  to  them. 

All  this  admitted,  one  is  forced  to  say,  but  in  no  dogmatic 
spirit,  that  many  of  the  inferences  of  Materialists  (I  use  the 
term  as  one  of  designation,  not  of  criticism)  are  the  result 
of  too  narrow  data  and  too  hasty  generalisation.  So,  in  past 
times,  the  faith  of  Eeligionists  throughout  the  world’s 
history  has  been  often  founded  on  ignorance  and  superstition, 
and  has  been  supported  as  well  by  the  credulity  of  the 
masses  as  by  the  evil  passions  of  rulers.  But  are  these  sad 
pages  in  the  history  either  of  Eeligion  or  of  Science  to 
prejudice  us  against  the  one  or  the  other  ?  Can  we  not  both 
seek  with  confidence  further  knowledge  of  the  Universe 
which  the  present  age  lays  bare  for  us,  and  also  strive  for 
the  development  of  the  spiritual  yearning  after  the  pure  and 
the  true,  which,  nearly  1900  years  ago,  was  kindled  in  man 
by  showing  him  his  true  relation  to  the  Supreme  Good. 

It  is  no  doubt  more  than  probable  (1)  that  from  infinitely 
minute  matter,  widely  diffused,  were  formed  incandescent 
masses,  of  which  our  planet  is  among  the  least;  (2)  that 
they  cooled  into  the  condition  in  which,  as  far  as  we  can 
judge,  the  life  and  sensation,  whereof  we  are  conscious  in 
ourselves  and  infer  in  others,  became  as  they  exist  now  in 
man  ;  (3)  that  successive  changes  occurred  through  myriads 
of  years  in  these  codling  masses  before  life  appeared,  have 
occurred  since  life  appeared,  and  are  occurring  still — as 
witnessed  the  catastrophe  in  Java  but  the  other  day,  an 
awful  phenomenon  which  recalls  pristine  modes  of  local 
geological  evolution ;  (4)  that  the  evolution  from  inorganic 
to  organic,  and  within  the  organic  from  the  simpler  to  the 
higher  forms,  has  been,  upon  the  whole,  progressive  to  a 
higher  moral  and  intellectual  type,  with  breaks,  hindrances, 
cataclysms,  variations,  causes,  of  which  many  are  unex¬ 
plained,  and  many  unknown  ;  (5)  that  as  yet  there  is  no 
certain  evidence  from  analogy  or  direct  observation  of  the 
existence  of  similar  or  analogous  life  in  worlds  other  than 
•our  own. 

Many  general  considerations  of  a  like  kind  might  be  added 
to  these  ;  but  these,  as  they  are  here  stated,  seem  sufficient 
to  suggest  certain  lessons  for  us  all : — the  first,  that  the 
greatly  extended  knowledge  of  the  physical  universe  gained 
in  the  last  half-century  is  such  as  to  require  a  revision  of 
our  interpretation  thereof;  secondly,  that  notwithstanding 
"the  marvellous  discoveries  in  that  time  of  geologists,  physi¬ 
cists,  and  biologists,  this  knowledge  is  still  fragmentary 
and  incomplete  ;  and  thirdly,  that  the  nature  and  growth  of 
the  spiritual  life  in  man,  as  he  has  been  since  the  revelation 
of  Christianity,  is  little  if  at  all  affected  by  the  consideration 
of  the  material  steps  by  which  the  evolution  of  this  planet, 
.■as  a  whole,  has  been  carried  on. 


I  will  here  add  a  very  few  words,  in  passing,  specially  for 
the  student  preparing  for  the  medical  profession. 

Do  not  allow  yourselves  to  be  perplexed  or  dazzled  by 
the  controversies  as  to  the  relation  between  Physical 
Science  and  Eeligion.  Of  all  discussions  they  are  the  most 
fruitless,  unless  we  except  purely  metaphysical  specula¬ 
tions.  Scientific  acquirement  is  the  result  of  patient  in¬ 
dustry  and  careful  self-education,  not  of  controversy. 
Eeligion  is  the  fruit  of  self-mastery  and  reverence,  not  of 
doubt  and  of  wavering.  The  student  of  Medicine  has,  of 
all  men,  under  conditions,  the  greatest  opportunities,  if 
he  has  received  a  good  education  before  his  hospital  days, 
of  forming  a  true  judgment  of  the  Nature  of  Things. 
There  is  no  department  of  precise  knowledge,  whether  of 
Physics,  of  Chemistry,  of  Biology,  that  is  not  open  to  him. 
All  the  fascination  that  the  material  world  can  display  is 
his.  His  senses  are  open  as  many  other  men’s  are  not.  He 
sees  daily  in  the  facts  before  him  the  blessing  of  virtue,  the 
evil  of  vice,  the  curses  of  ignorance.  He  notes  in  these  at 
once  the  bane  and  the  antidote.  To  him  pure  research  and 
abstract  science,  as  Pasteur  and  Lister  have  shown  him, 
bring  the  rich  fruit  of  applied  and  practical  remedy.  The 
all-embracing  inquiries  of  Hunter  and  of  the  guardians  of 
his  treasure  displayed  in  Lincoln’s-inn-fields,  satisfy  both 
his  craving  for  the  highest  biological  truth  as  to  the  origin 
and  evolution  of  things,  and  his  desire  to  know  the  causes 
and  laws  of  disease,  of  decay,  and  of  death,  and  the  mode 
of  averting,  healing,  soothing  the  sufferings  of  mankind. 
To  him  all  this  is  practical,  and  not  mere  work  of  the  closet. 
His  is  a  life  of  observation,  of  action,  of  experiment.  These 
are  to  him  not  abstract  questions  only,  they  have  a  definite 
beneficent  end.  He  cannot  pursue  in  detail  every  branch 
of  a  growth  so  widespread  as  is  his  profession,  but  he 
learns  enough  to  take  interest  for  life  in  every  advance 
of  every  science  related  to  it.  Through  the  more  recent 
aims  and  newer  modes  of  Biological  inquiry,  there  is  in 
Histology  and  Embryology  a  field  of  fact  virtually  with¬ 
out  limit.  In  the  last  century  discoveries  in  these  direc¬ 
tions  were  to  be  reckoned  by  hundreds  or  by  thousands. 
It  is  far  otherwise  now.  For  instance,  the  species  of  living 
and  extinct  organisms  now  known  (whatever  species  may 
mean)  exceed  half  a  million.  The  idea  of  Evolution  has 
raised  questions  of  the  origin  and  development  of  all  of  these, 
and  of  their  affinities  and  differences  at  every  stage  of  their 
formation.  The  mode  of  investigation,  as  you  are  well  aware, 
demands  and  obtains  individual  sections  of  perhaps  a  thousand 
to  an  inch  in  the  same  adult — nay,  even,  it  may  be,  in  the 
same  embryo.  The  number  which  will  be  so  examined  can¬ 
not  now  be  estimated.  Individual  organs  will  be  in  many 
cases  similarly  studied.  The  abnormities  of  each,  and  the 
relations  of  the  abnormities  in  classes  and  races,  will  be  alike 
tracked  out  and  described,  both  in  respect  of  their  causes  and 
of  their  laws,  and  in  regard  to  the  modes  of  their  prevention. 
The  more  important  of  them  all  will  be  described  by  Photo¬ 
graphy,  or  by  the  Graver,  in  one  or  other  of  over  five  hundred 
journals  of  different  nations.  The  prospect  is  boundless  in  the 
region  of  Morphology  alone.  I  have  not  even  hinted  here 
at  the  abstruser  relations  of  advancing  Physiology,  and 
the  special  directions  in  which  it  impinges  on  the  domain 
of  Mind  on  the  one  hand,  and  on  the  problems  of  inorganic 
science  on  the  other,  and  the  experiments  it  proposes  in 
both.  Though  all  these  facts,  advanced  within  these  walls 
during  the  early  days  of  Physiology  in  this  country,  by 
Todd,  Bowman,  and  Beale,  and  on  which  I  have  so  lightly 
touched  as  bearing  on  the  evolution  of  our  race,  are  allied 
to  the  daily  work  of  the  Medical  Student,  yet  his.  main 
interest  must  centre  in  the  sufferings  of  man  and  their  alle¬ 
viation  ;  in  the  sufferings  of  the  individual  and  of  the  race ; 
in  the  prevention  and  alleviation  of  those  sufferings  in  the 
individual,  in  rural  and  urban  societies,  in  nations,  in  the 
world.  From  these  neither  Teachers  nor  Examiners  nor 
his  own  tastes  must  draw  him  away.  I  could  say  much 
more,  but  I  prefer  to  quote  a  passage  from  one  of  the 
greatest  clinical  teachers  this  metropolis  has  ever  produced. 
This  will  tell  you  the  temper  in  which  you  may  best  master 
your  scientific  studies  and  stand  related  to  your  fellow- 
men. 

“  Diseases  are  not  abstractions ;  they  are  modes  of  acting, 
different  from  the  natural  and  healthy  modes — modes  of 
disorganising,  modes  of  suffering,  and  modes  of  dying ;  and 
there  must  be  a  living,  moving,  sentient  body  for  all  this. 

“This  body  must  be  your  study,  and  your  continual  care 


394 


Medical  Times  and  Gazette. 


OPENING  ADDRESS  AT  KING’S  COLLEGE. 


Oct.  6,  1883. 


— your  active,  willing,  earnest  care.  Nothing  must  make 
you  shrink  from  it.  In  its  weakness  and  infirmities,  in  the 
dishonours  of  its  corruption,  you  must  still  value  it — still 
stay  by  it — to  mark  its  hunger  and  thirst,  its  sleeping  and 
waking,  its  heat  and  its  cold ;  to  hear  its  complaints,  to 
register  its  groans. 

“  And  is  it  possible  to  feel  an  interest  in  all  this  ?  Ay, 
indeed  it  is ;  a  greater,  far  greater,  interest  than  ever 
painter  or  sculptor  took  in  the  form  and  beauties  of  its 
health. 

Whence  comes  this  interest  ?  At  first, 'perhaps,  it  seldom 
comes  naturally :  a  mere  sense  of  duty  must  engender  it ; 
and  still,  for  awhile,  a  mere  sense  of  duty  must  keep  it  alive. 
Presently,  the  quick,  curious,  restless  spirit  of  science 
enlivens  it ;  and  then  it  becomes  an  excitement,  and  then  a 
pleasure,  and  then  the  deliberate  choice  of  the  mind. 

“  When  the  interest  of  attending  the  sick  has  reached  this 
point,  there  arises  from  it,  or  has  already  arisen,  a  ready 
discernment  of  diseases,  and  a  skill  in  the  use  of  remedies. 
And  the  skill  may  exalt  the  interest,  and  the  interest  may 
improve  the  skill,  until,  in  process  of  time,  experience  forms 
the  consummate  practitioner. 

“  But  does  the  interest  of  attending  the  sick  necessarily 
stop  here  ?  The  question  may  seem  strange.  If  it  has  led 
to  the  readiest  discernment  and  the  highest  skill,  and  formed 
the  consummate  practitioner,  why  need  it  go  further  ? 

“  But  what  if  humanity  shall  warm  it  ?  Then  this  inte¬ 
rest,  this  excitement,  this  intellectual  pleasure,  is  exalted 
into  a  principle,  and  invested  with  a  moral  motive,  and 
passes  into  the  heart.  What  if  it  be  carried  still  further  ? 
What  if  religion  should  animate  it  ?  Why,  then  happy 
indeed  is  that  man  whose  mind,  whose  moral  nature,  and 
whose  spiritual  being,  are  all  harmoniously  engaged  in  the 
daily  business  of  his  life;  with  whom  the  same  act  has 
become  his  own  happiness,  a  dispensation  of  mercy  to  his 
fellow-creatures,  and  a  worship  of  God/’ 

To  these  thoughts  of  Latham  I  would  add  no  other  words 
than  these — that  as  Latham  spoke  and  taught,  so  he  lived 
and  died. 

It  will  have  been  noted  that  no  attempt  has  now  been 
made  to  give  a  definition  as  to  what  is  to  be  included  under 
the  term  <c  Religion,”  or  what  is  the  method  to  be  pursued 
in  a  religious  as  distinguished  from  a  secular  education. 
The  disputes  of  Christendom  alone  have  rendered  it  impos¬ 
sible  to  accept  Religion  and  Theology  as  synonymous  terms. 

Unhappily  for  mankind,  here  as  elsewhere,  the  Human 
element  too  often  overshadows  the  Divine.  The  form  is 
sometimes  made  to  seem  of  more  importance  than  the  sub¬ 
stance.  Yet  the  essentials  of  the  spiritual  life  are  simple 
enough.  They  may  be,  and  are,  hard  to  teach  and  hard  to 
attain.  They  are  taught  chiefly  by  example,  which  implies 
individual  attainment.  They  are  acquired  by  practice, 
which  means  individual  self-sacrifice.  They  are  summed  up 
in  the  weighty  words,  fieravoia,  tticttis  uydirr] .  These  gifts, 
we  are  told,  are  not  self-originated, — having  life,  they  are 
born  of  other  life,  6  Kaprbs  tou  ■Ki'evfxa.Tos. 

Any  system  of  education  which  has  not  seriously  brought 
before  the  student  some  considerations  concerning  the 
spiritual  life  thus  faintly  pourtrayed,  has  been,  for  him, 
faulty  and  inadequate,  and  is  behind  the  Science  of  the  day. 
Any  scheme  of  the  Universe  condemns  itself  which  leaves 
out  of  sight  all  that  can  be  learnt  of  the  character  of  a 
Heavenly  Father  from  the  study  of  the  moral  Nature  of 
Man.  No  amount  of  acquirement  in  positive  knowledge 
of  physical  science  can  remedy  the  deficiency  incident  to  a 
wholly  secular  and  materialistic  education. 

For  reasons  which  I  need  not  here  relate,  the  Medical 
Council  has  abstained  from  entering  upon  this  stormy  topic 
in  its  recommendations  on  general  education.  Nor  would  I 
presume  to-day  to  examine  even  in  the  briefest  review 
the  countless  speculations  which  are  variously  designated 
Materialistic  or  Agnostic  or  the  like.  Modern  literature 
teems  with  these.  They  are  of  singular  diversity  in  respect 
of  their  force  and  their  value.  Some  are  the  production 
of  earnest,  sober,  patient  seekers  after  truth.  Some  would 
seem  to  be  the  dialectic  exercises  of  literature.  Many  im¬ 
press  the  reader  by  their  vagueness,  many  by  their  un¬ 
warranted  assumptions,  many  by  the  inconclusiveness  of 
their  facts  and  of  arguments.  Some  few  rise  to  the  height 
of  pathetic  and  noble  despair.  Here  and  there  one  claims 
to  serve  as  a  guide  to  a  higher  earthly  life,  and  is  moved  by 
a  profound  desire  to  lessen  and  to  solace,  if  by  any  means. 


the  sorrows  of  mankind  and  the  sufferings  with  which  “  the 
whole  creation  groaneth  together  until  now.”  Any  attempt 
to  describe  these  various  kinds  of  thought  would  but  waste 
your  time,  and  bring  us  to  no  conclusion.  I  would,  on  the 
contrary,  take  the  opportunity  of  saying  a  few  words  of 
profound  respect  and  sympathy  for  all  efforts  which,  under 
these  circumstances,  have  been  and  are  now  made  for 
improved  secular  and  specialised  instruction,  whether  lite¬ 
rary,  scientific,  or  technical,  which  are  not  in  their  aim  and 
intention  antagonistic  or  aggressive.  The  importing  religion 
into  scientific  teaching  is  fraught  with  danger  both  to  Reli¬ 
gion  and  to  precise  knowledge.  It  seldom  brings  good  to  either. 
It  exposes  the  teacher  of  Science  to  the  risk  of  weakness  and 
timidity.  It  disposes  the  half -informed  Religionist  to  rely 
on  broken  reeds  of  material  evidence,  and  not  on  the  im¬ 
pregnable  armour  of  Faith  and  Love.  It  seems  to  me  that 
the  day  is  come  when  each  should  support  the  other  in  the 
pursuit  of  his  special  vocation.  The  one  should  be  encouraged 
in  the  fearless  investigation  of  fact  and  cause  and  law  in  the 
material  world ;  the  other  in  the  seeking  to  foster  and  com¬ 
prehend  the  evolution  of  the  spiritual  life  in  the  individual 
and  the  race.  W e  seem  to  descry  the  dawn  of  a  happier 
period.  Already,  God  be  thanked  !  many  strong  men,  whe¬ 
ther  devoted  by  profession  to  the  quest  after  physical  truth 
or  to  the  promotion  of  pure  morality  and  the  religious  life, 
see  that  the  love  of  specialising,  however  necessary,  has  its 
own  dangers,  and  that  the  physicist  and  the  religionist  have 
each  more  hope  of  looking  rightly  upon  the  deep  secret  of 
the  Universe  by  union  and  sympathy  than  by  misunder¬ 
standing  and  discord. 

In  the  life  of  more  than  one  of  the  Professors  of  King’s 
College,  all  this  has  been  fully  set  forth  to  the  world  ;  but  in 
the  life  of  one  especially — Frederick  Denison  Maurice.  He 
had  lived  in  Guy’s  Hospital  among  medical  students  philo¬ 
sophical  and  simple.  He  loved  them,  cared  for  them, 
understood  them.  To  the  poor  and  the  sick  he  gave  his 
powers,  his  life,  his  holiness.  He  studied  human  nature 
among  all  these.  He  came  and  did  good  work  for  years 
among  you.  For  opinions  deemed  inconsistent  with  the 
dogmas  of  the  Anglican  Church  you  lost  from  among  you 
the  brightness  of  his  character,  contact  with  the  profound 
depth  of  his  solemn  convictions,  the  sympathy  of  his  loving 
nature.  But  he  and  Joseph  Henry  Green  will  stand  out 
while  English  literature  endures,  as  types  of  strong  men 
who,  having  approached  education  from  very  different 
standpoints,  came  to  the  same  conclusion. 

Mr.  Green,  from  the  side  of  consummate  knowledge  of  the 
material  and  spiritual  organisation  of  man  ;  of  man  as  part 
of  the  animal  creation ;  of  man  as  the  object  of  scientific, 
philosophical  and  aesthetic  study ;  of  suffering  man,  to  be 
cared  for  by  the  highest  skill  and  sympathy,  through  the 
advanced  surgery  of  his  time — tells  you  that  the  groundwork 
of  education  is  to  be  found  in  the  elements  of  moral  cultiva¬ 
tion  and  of  intellectual  progress,  of  which  Religion  prescribes 
the  aim  and  sanctifies  the  use. 

Mr.  Maurice  scanned  with  historical  insight  the  light  as 
well  as  the  cloudland  of  metaphysical  inquiry,  from  its  dawn 
among  the  Greeks  and  Arabians  to  the  mazy  consummation 
of  the  most  modern  thought-painters.  He  read  with  wide 
sympathy  the  teaching,  false  or  fair,  of  all  the  religions  of 
the  world.  He  tells  the  same  tale,  the  result  of  a  philo¬ 
sophic  life  in  part  spent,  as  I  have  said,  in  the  walls  of  a 
great  hospital,  near  the  laboratory  and  the  dissecting-room , 

And  lest,  to  some,  these  references  to  the  philosophical 
biologist  and  surgeon  and  to  the  liberal  divine  may  seem 
too  narrow,  to  savour  too  much  of  the  closet,  too  little  of  the 
world ;  lest  you  blame  me  for  not  referring  to  more  great 
names  from  your  own  roll  (and  how  many  living  and  not 
living  I  might  now  name !),  I  will  quote  from  the  senior 
member  of  your  own  Council,  himself  a  chief  force  in 
modern  progress — the  Prime  Minister  of  England.  To  him 
we  owe  some  exquisite  lines,  in  which  he,  great  master 
of  modern  speech,  has  translated  into  the  ancient  tongue  of 
the  Western  Church  words  which  express  the  result  of  his 
own  strong  keen  scrutiny  into  the  phenomena  of  human- 
life,  its  aspirations  and  hopes,  in  their  world-wide  and 
world-long  relations : 

“Scis  te  lassum  ?  scis  languentem  1 
Luctu  contristaris  ? 

Audin’  ‘  Veni  veniensque 
Pace  perfruaris.’ ; 

*  #  *  *  * 


Medical  Times  and  Gazette. 


OPENING  ADDRESS  AT  UNIVERSITY  COLLEGE. 


Oct.  6, 1883.  395 


“  Persistentem,  perluctantem 
Certus  est  beare  ? 

Yates  quisque,  Martyr,  Virgo, 

Angelus  testare !  ” 

You  in  this  Institution,  so  steadily  progressive  in  every 
•department  of  human  thought,  for  either  sex,  for  all  pro¬ 
fessions — you  possess  the  heritage  of  these  and  many  other 
great  names.  To  you  here,  in  this  vast  Metropolis,  the 
centre  of  liberty,  of  progress,  of  science,  the  seat  as  of 
deepest  suffering  so  too  of  warmest  good-will  to  man,  has 
been  consigned  by  Parliament  the  precious  national  duty 
of  maintaining  the  Unity  of  human  thought,  secular, 
scientific,  and  spiritual,  to  be  the  method  and  basis  of  the 
highest  education. 

Secular — all  the  Humanities,  History,  and  Art. 

Scientific — all  organised  knowledge  based  on  observation, 
experiment,  and  induction  in  the  Material  World. 

Spiritual — all  that  pertains  to  the  higher  nature  of  Man, 
and  his  relation,  by  faith,  to  Supreme  Good. 

And  here  I  will  end  these  few  words  on  a  great  subject 
which  affects  all  your  young  lives.  Believe  that  no  narrow 
distrust  of  Knowledge,  no  want  of  sympathy  with  the  most 
unrestrained  progress  of  Research,  give  any  bias  to  my 
utterance.  Believe  rather  that  the  deep  conviction  of  my 
life  is  that  the  way  to  the  true  understanding  of  the  Material 
world,  to  one  part  of  which  you  address  yourself  in  your 
Biological  studies,  is  the  way  which  has  been  trodden  by 
.great  men  from  Aristotle  to  Faraday — a  way  in  which 
Penetration  has  not  cast  out  Reverence,  and  wherein  human 
insight  has  seen  in  the  far-off  gloom  the  mystery  of  a  Light 
•which  it  counts  to  be  Divine. 


INAUGURAL  ADDRESS 

DELIVERED  IN 

UNIVERSITY  COLLEGE,  LONDON, 

On  October  1,  1883. 

By  JOHN  TWEEDY,  F.R.C.S., 

Professor  of  Ophthalmic  Medicine  and  Surgery  in  University  College. 

'Gentlemen, — As  the  spokesman,  for  the  nonce,  of  the 
Medical  Faculty  of  this  College,  my  first  duty  is  to  give  you 
all  a  hearty  welcome;  not  less  to  you,  old  friends,  who, 
mindful  of  the  happy  associations  of  former  years,  grace 
these  proceedings  by  your  presence,  nor  you  who  are  the 
•actual  participators  of  our  current  labours,  than  to  you, 
young  scions  of  a  hopeful  race,  who  are,  here  and  now,  to  be 
engrafted  upon  an  ancient  and  honourable  stock.  It  is, 
indeed,  to  celebrate  your  initiation  into  the  medical  pro¬ 
fession  that  we  are  chiefly  gathered  together ;  and  custom 
has  prescribed,  and  good-fellowship  enjoins,  that  the  occa¬ 
sion  should  not  be  allowed  to  pass  without  our  giving  you 
the  assurance  that  you  have  here  friends  to  greet  you,  hands 
to  help  you,  and  willing  hearts  to  serve  you.  Let  me,  then, 
congratulate  you  on  the  choice  you  have  made  of  the  profes¬ 
sion  of  medicine  as  the  sphere  of  your  labours,  and  of  this 
College  as  the  place  of  your  studies. 

Whatever  may  have  been  the  considerations  which  have 
led  you  to  enter  the  medical  profession — whether  the  accident 
of  birth,  social  relationships  and  family  ties,  or  the  exercise 
of  a  deliberate  choice — it  is  not  likely  that  you  and  your 
friends  have  selected  this  College  without  some  thought  and 
inquiry.  This  circumstance  might  seem  to  render  it  un¬ 
necessary  for  me  to  attempt  to  add  strength  to  your  con¬ 
victions  ;  but  I  cannot  forbear  from  dwelling  upon  some  of 
the  special  advantages  which  I  believe  will  accrue  to  you 
from  studying  in  this  place.  No  vindication  is  needed  of 
the  general  scope  and  character  of  the  education  that  Uni¬ 
versity  College  affords.  The  continued  and  unvaried  success 
■of  half  a  century  is  a  sufficient  testimony  to  its  efficacy  and 


its  worth.  Scarcely  a  city,  town,  or  village  throughout  the 
British  Empire  but  cherishes  one  or  more  of  her  sons.  They 
sit  in  seats  of  honour  in  high  places  ;  Royalty  calls  in  their 
aid  ;  the  State  avails  itself  of  their  knowledge  and  acumen  ; 
Science  applauds  their  genius ;  Learned  Societies  award  them 
enviable  honours  ;  and  Schools  of  Learning  accept  their  co¬ 
operation  with  delight.  The  practical  sagacity  and  the  true 
political  insight  of  the  founders  of  this  College,  the  energy 
and  enthusiasm  of  our  predecessors,  and  the  enlightened 
enterprise  of  our  executive  body,  have  furnished  many  of 
the  elements  of  our  success.  Our  museums,  laboratories, 
class-rooms,  and  libraries  afford  facilities  of  observation, 
study,  and  research  which  in  their  entirety  are  unsurpassed 
by  those  of  any  medical  college  in  the  world.  Our  hospital 
has  supplied  the  material  of  the  public  experience  of  some 
of  the  greatest  teachers  and  practitioners  of  this  agp.  It 
has  been  the  scene  of  the  clinical  and  scientific  achievements 
of  Elliotson,  of  Anthony  Todd  Thompson,  of  Robert  Cars¬ 
well,  and  of  Samuel  Cooper;  and,  among  those  happily  still 
living,  of  C.  J.  B.  Williams,  of  Walshe,  of  Jenner,  and  of 
Reynolds ;  of  Richard  Quain,  of  Erichsen,  of  Henry  Thomp¬ 
son,  and  of  Wharton  Jones.  Here,  too,  Liston  performed 
those  marvellous  feats  of  surgical  skill  and  daring  that 
made  him  the  wonder  and  delight  of  his  contemporaries, 
the  envy  and  despair  of  his  successors.  But  it  is  not  only 
in  the  practical  departments  of  medicine  and  surgery  that 
University  College  has  been  renowned.  From  this  College 
and  Hospital  have  emanated  some  of  the  most  famous  and 
permanent  contributions  to  medical  literature.  The  Encyclo¬ 
paedic  Surgical  Dictionary  of  Samuel  Cooper,  the  classical 
treatise  of  Erichsen  on  the  Science  and  Art  of  Surgery, 
that  fund  of  clinical  record  blended  with  philosophical 
reflection  in  Walshe’s  works  on  Diseases  of  the  Heart  and 
the  Lungs,  and  Quain’s  copious  and  authoritative  Text-book 
of  Anatomy,  had  their  birth  and  have  received  most  of 
their  nurture  within  this  fold.  Nor  have  we  been  behind¬ 
hand  in  the  higher  departments  of  scientific  thought  and 
investigation.  This  College  has,  from  its  very  foundation, 
been  distinguished  from  most  other  medical  schools  by  the 
plan  and  method  of  its  studies.  Its  guiding  principle  has 
been  to  teach  by  great  authorities,  by  specialists  and  experts 
in  their  particular  departments  of  learning.  This  has  given 
to  its  teaching  a  thoroughness,  reality,  and  dignity  that  have 
enabled  a  large  proportion  of  its  pupils  not  only  to  excel 
as  practitioners,  but  also  to  attain  distinction  as  students 
of  science.  Nor  have  these  results  been  casual  or  fortuitous; 
they  have  been,  rather,  the  anticipated  culmination  of  a 
sagacious  and  well-regulated  system. 

There  is  a  collateral  advantage,  amounting  almost  to  a 
privilege,  which  the  medical  student  in  this  College  may 
enjoy.  This  institution  is  not  a  medical  school  only;  it  is  a 
large  educational  establishment,  embracing  also  the  Faculties 
of  Science  and  Arts,  and  employing  the  services  of  men  emi¬ 
nent  in  every  department  of  thought.  Its  range  of  studies 
is  therefore  wide  and  encyclopaedic,  and  exhibits  many  of 
the  social  and  intellectual  characteristics  of  a  university. 
Though  a  student  cannot,  of  course,  pursue  every  subject 
that  is  open  to  him,  even  in  his  own  Faculty,  and  still  less 
in  other  Faculties,  he  cannot  fail  to  be  a  gainer  by  living 
among  those  who  represent  the  entire  circle  of  knowledge. 
He  breathes  an  intellectual  air,  and  profits  by  traditions 
which  are  independent  of  particular  teachers.  Though  the 
relationships  between  the  students  in  the  medical  and  other 
faculties  have  not  always  been  so  close  and  so  harmonious 
as  might  have  been  wished,  there  are  real  and  substantial 
benefits  to  be  gained  by  a  freer  intercourse  and  a  closer 
intercommunication.  In  the  Faculties  of  Science,  and  of 
Arts  and  Law,  you  will  find  many  earnest  and  anxious 
toilers  after  truth,  who  are  doubtless  destined  to  take  high 
places  among  the  thinkers  and  the  workers  of  the  im¬ 
mediate  future ;  and  it  is  to  your  intellectual  and  moral 
advantage,  to  say  nothing  of  your  social  interest,  to  make 
the  acquaintance  of  such,  and  to  grow  up  in  friendly 
communion  with  them. 

Though  I  have  given  precedence  to  your  connexion  with 
University  College,  I  would  not  have  you  suppose  that  I 
regard  this  as  the  permanent  order  of  relative  importance. 
While  I  wish  you  to  cherish  sentiments  of  affection  and 
loyalty  to  this  College,  I  am  not  so  devoid  of  the  sense  of 
relativity  as  to  place  this  institution  in  the  forefront  of  your 
thoughts.  It  is  Medicine,  its  aims  and  aspirations,  that 
is  to  be  the  absorbing  passion  of  your  lives.  You  are  to  be 


396 


Medical  Times  and  Gazette. 


OPENING  ADDRESS  AT  UNIVERSITY  COLLEGE. 


Oct.  6,  1883- 


medical  men  first.,  and  University  College  men  afterwards. 
To  this  end  it  is  necessary  that  you  should  have  clear  notions 
of  what  Medicine  is,  in  order  that  you  may  comprehend  its 
character,  be  faithful  to  its  traditions,  and  zealous  for  its 
honour  and  advancement. 

What,  then,  is  Medicine  P  To  most  of  you  it  may  at 
present  seem  nothing  more  than  the  art  of  diagnosing  disease 
and  prescribing  remedies.  It  is  this ;  but  it  is  something 
more.  Medicine  is  essentially  the  science  of  health.  So 
long  as  the  idea  of  medicine  was  limited  to  the  study  and 
treatment  of  disease,  its  progress  was  slow  and  uncertain, 
and  its  place  in  the  hierarchy  of  intellectual  pursuits  doubt¬ 
ful  and  ill-defined.  Now,  however,  the  medical  profession 
would  still  retain  the  most  important  part  of  its  duties,  and 
all,  or  more  than  all,  its  present  share  of  honours,  if  every  drug 
in  the  Pharmacopoeia  were  to  become  extinct.  The  credulous 
faith  in  the  efficacy  of  drugs  is,  and  always  has  been,  the 
secret  of  the  success  of  every  form  of  charlatanism.  Medicine, 
then,  being  not  merely  the  art  of  healing,  but  the  science  of 
life  in  its  organic  relations,  the  duty  of  studying  and  in¬ 
vestigating  the  phenomena  and  conditions  of  health  becomes 
paramount.  It  was  the  recognition  of  this  truth  that  raised 
Hippocrates  and  his  school  out  of  the  region  of  mere 
empiricism.  Before  his  time,  medicine  in  Greece  had  been 
cultivated  in  the  priestly  schools  of  the  Asclepiadm,  and 
had  remained  a  mere  technical  craft,  based  upon  hereditary 
experience.  But  Herodicus,  who  is  said  to  have  instructed 
Hippocrates  in  the  use  of  gymnastics  in  the  treatment  of 
diseases,  sought  to  fix  the  rules  of  a  scientific  promotion 
of  health.  Inquiry  was  instituted  into  the  influence  of 
various  nutriments  and  ways  of  life,  and  thus  was  created 
a  new  art,  which  had  reference,  not  to  the  treatment  of 
particular  diseases,  but  rather  to  the  invigoration  and  pre¬ 
servation  of  the  human  organism  as  a  whole.  The  efforts 
of  Hippocrates  and  his  followers  were,  however,  rather  to 
promote  the  health  of  individuals,  whereas  the  aim  of  modern 
medicine  is,  in  addition,  to  conserve  and  protect  the  health 
of  communities.  Imagine  the  condition  of  a  large  city  like 
London,  with  four  millions  of  persons  congregated  upon  the 
comparatively  small  area  of  a  hundred  and  twenty  square 
miles,  without  the  sanitary  and  other  resources  which 
medical  science  has  bestowed  upon  civilisation.  What  a 
light  has  hygiene  thrown  upon  the  relations  existing  between 
the  character  of  the  soil,  drainage,  light,  ventilation,  food, 
water,  clothing,  and  occupation,  and  the  origin  and  spread 
of  disease !  Consumption,  pneumonia,  typhus  and  typhoid 
fevers,  various  epidemic  and  endemic  diseases,  malaria, 
dysentery,  gout,  and  paralysis  of  many  forms,  are  now 
known  to  depend  upon  preventable  physical  conditions. 
Small-pox,  which  up  to  the  beginning  of  the  present  century 
inflicted  such  ravages,  and  even  now  makes  frightful  havoc 
upon  unprotected  communities,  has  been  rendered  practically 
ei’adicable  by  the  means  of  vaccination.  Cholera,  as  we  have 
lately  had  experience,  has  not  for  us  the  terrors  which  it 
had  for  our  fathers  ;  its  conditions  have  been  ascertained,  its 
secret  discovered,  and  its  malignancy  disarmed.  The  ex¬ 
perimental  investigations  of  pathologists — and  among  them 
those  of  our  Holme  Professor  of  Clinical  Medicine,  Dr. 
Wilson  Fox,  have  an  honoured  place, — aided  by  the  beau¬ 
tiful  microscopical  researches  of  Koch,  are  elucidating  the 
causes  and  origin  of  consumption,  and  have  already  kindled 
eager  hopes  of  its  effectual  prevention. 

The  scope  of  medicine  is  therefore  far-reaching,  and,  in 
order  to  comprehend  the  whole  science  of  medicine  in  the 
sense  just  defined  as  the  art  of  treating  disease  and  the 
science  of  health,  it  is  necessary  to  premise  the  study  of  the 
natural  behaviour  of  living  matter — that  is,  of  physiology. 
Strange  as  it  may  appear  to  uninitiated  minds,  the  grandest 
discovery  and  generalisation  of  modern  medicine  is  that 
disease  is  healthy  action  gone  wrong,  or,  as  Mr.  John  Simon 
has  described  it,  “  Pathology  consists  in  the  science  of  life 
under  other  conditions  than  those  of  ideal  perfection.”  Physi¬ 
ology  is  therefore  the  true  foundation  of  medicine.  This  may 
seem  heterodoxy  to  those  who  have  been  brought  up  under 
the  influence  of  the  older  doctrine  that  anatomy  is  the  basis 
of  medicine.  True,  anatomy  is  indispensable  to  the  study 
of  physiology ;  but  anatomy  is  notoriously  incapable  of 
solving  the  simplest  biological  problem.  Dr.  Daremberg,  in 
his  learned  history  of  the  medical  sciences,  has  observed  that 
an  examination  of  the  history  of  medicine  shows  that  the 
fate  of  pathology  is  bound  up,  scientifically  and  historically, 
with  the  fate  of  physiology ;  and  that  anatomy  has  not  only  at 


all  times  failed  to  reform  physiology,  but  that  ancient  physi¬ 
ology,  which  was  for  the  most  part  only  a  tissue  of  &  priori 
speculations,  has  not  unfrequently  contributed  to  corrupt 
anatomy.  Modern  physiology  has,  however,  amended  itself  by 
the  experimental  method,  and  henceforth  is  not  likely  either 
to  miss  its  own  way  or  to  allow  anatomy  to  go  astray.  On  the 
contrary,  it  has  opened  up  for  anatomy  new  paths,  and  has, 
at  the  same  time,  furnished  more  solid  basis  of  support  for 
the  reform  of  pathology.  Do  not  mistake  my  meaning ;  I  da 
not  wish  to  say  anything  that  can  in  the  smallest  degree  be' 
construed  as  depreciating  the  absolute  value  of  anatomy.  I 
merely  protest  that  its  relative  rank  needs  to  be  readjusted. 
Anatomy  is  of  primary  importance  to  the  study  and  practice' 
of  medicine;  it  is  the  very  ABC,  without  which  no  real 
progress  can  be  made.  As  without  an  acquaintance  with  the 
alphabet  there  can  be  no  literary  culture,  so  without  anatomy 
there  can  be  no  medical  attainments.  Were  it  not  for  this; 
and  for  the  help  which  a  knowledge  of  topographical  ana¬ 
tomy  renders  to  the  operating  surgeon,  the  educational 
value  of  human  anatomy,  consisting  as  it  does  almost  ex¬ 
clusively  of  the  observation  and  remembrance  of  unrelated' 
facts,  would  be  extremely  small,  while  its  utility  as  a  means 
of  intellectual  culture  is  absolutely  nil.  It  is  only  when 
anatomy  takes  on  a  synthetic  character,  and  becomes  com¬ 
parative  in  its  method,  that  it  first  assumes  the  quality  of  a 
science.  Nevertheless,  anatomy  is  indispensable  in  a  medical 
education,  and  to  be  of  any  service  it  must  be  almost  ex¬ 
clusively  practical.  Now, practical  anatomy  means  dissection,, 
and  this  study  is,  to  a  beginner,  revolting  and  disgusting. 
No  man  of  nice  feeling  can  at  first  take  any  pleasure  in  dis¬ 
secting  a  human  corpse.  To  remain  unmoved  in  the  pre¬ 
sence  of  death  indicates  a  callous  rather  than  a  courageous 
disposition.  I  envy  not  that  man  who  enters  a  dissecting- 
room  for  the  first  time  without  an  “  inward  horror.”  Mem 
who  have  afterwards  become  enamoured  of  the-anatomy,  and1 
acquired  authority  in  it,  have  recorded  their  first  repugnances' 
to  dissection.  Aristotle,  the  founder  of  comparative  ana¬ 
tomy,  and  who  is  said  to  have  dissected  as  many  as  five, 
hundred  different  kinds  of  animals  with  his  own  hands, 
expresses  the  repugnance  that  he  felt  at  the  sight  of  the 
primordia  of  the  human  body.  Haller  observes  that  the 
<c  nature  of  death  impresses  us  with  horror,”  and  that  “  there- 
is  nothing  sadder  than  a  deadhouse.”  George  Henry  Lewes,, 
distinguished  alike  as  an  anatomist,  physiologist,  and  phi¬ 
losopher,  has  eloquently  described  the  repugnance  which 
human  dissection  creates,  and  the  fascination  by  which  it 
can  alone  be  suppressed.  “  The  fascination  must,”  he  says,, 
“  be  strong,  for  the  disgust  is  powerful.  Our  senses  are 
affected  by  the  sickening  scent  of  a  corrupting  body,  by  the 
painful  sight  of  blood-stained  instruments,  and  the  scattered, 
shreds  of  a  dismembered  corpse.  There  is  also  a  deeper 
moral  disgust,  peculiarly  affecting  to  imaginative  minds. 
The  spectacle  of  death  is  always  accompanied  by  a  certain* 
awe.  At  the  bedside  or  on  the  battlefield  no  gazer  remains' 
unmoved ;  pity,  and  a  sense  of  community  in  death,  steal 
over  every  mind  when  unshaken  by  violent  emotions.  How 
much  more  painful  the  dissecting-room,  where  the  corpse  is 
untended  by  affection,  and  unpitied  by  strangers  !  none  of 
the  sanctity  of  death  surrounds  it ;  none  of  the  tenderness* 
of  love  watches  over  it ;  none  of  the  ceremonials  of  respect 
defend  it.  There  it  lies,  naked,  and  alien  alike  from  affec¬ 
tion  and  respect,  flung  upon  the  table  in  oblivious  disregard 
of  its  having  once  been  the  temple  of  a  human  life.  It  is  no- 
longer  that  temple  ;  it  is  not  even  a  corpse  ;  it  has  become 
a  subject.  Yet  all  these  sources  of  repulsion  have  been,  and 
daily  are,  overcome.  Men  sit  patiently  for  many  hours, 
inhaling  the  nauseous  odours,  exploring  with  their  scalpel 
the  winding  intricacies  of  vein  and  nerve — steadfast,  patient, 
victorious.  They  have  suppressed  the  suggestions  of  the 
scene  by  firmly  fixing  their  minds  on  the  object  of  their  task. 
It  is  not  because  their  sensibilities  have  become  obtuse,  but 
because  their  power  of  abstraction  has  overcome  the  solici¬ 
tations  of  suggestion.  They  have  not  become  hardened; 
they  have  simply  learned  to  concentrate  their  thoughts  upon 
a  definite  pursuit.  Were  it  not  for  this  we  might  wonder 
that  men  did  not  consent  to  remain  for  ever  unenlightened 
on  the  marvels  of  their  organisation,  rather  than  acquire  the 
knowledge  by  so  repulsive  a  route.”  But  when  the  prejudice 
against  it  is  finally  overcome  by  the  passion  for  knowledge, 
anatomy  even  intensifies  the  finer  sensibilities  of  our  nature. 
Bossuet,  of  whom  it  has  been  said,  “  he  is  not  so  much  a. 
man  as  a  human  nature  with  the  temperance  of  a  saint,  the 


Medical  Times  and  Gazette. 


OPENING  ADDRESS  AT  UNIVERSITY  COLLEGE. 


Oct.  6,1883.  397 


justice  of  a  bishop,  the  prudence  of  a  doctor,  and  the 
might  of  a  great  spirit  Bossuet,  with  all  his  delicate 
and  tender  sympathies  for  everything  that  was  pure, 
noble,  and  refined,  was  not  repelled  from  the  study  of 
anatomy,  and  even  wrote  a  tractate  upon  it;  and  Goethe, 
though  a  practised  anatomist,  could  not  look  upon  the 
body  of  Schiller  dead. 

While  anatomy  furnishes  the  material  substratum  of 
physiology,  there  are  other  studies  equally  necessary  in  the 
investigation  of  the  phenomena  of  living  matter.  Botany 
and  chemistry  are  only  second  in  importance  to  anatomy ; 
and  though  it  is  the  fashion  nowadays  to  decry  botany  and 
dx>  advocate  its  abolition  from  medical  studies,  I  entertain  a 
very  strong  opinion  that  in  the  whole  range  of  natural 
science  there  is  no  subject  so  well  adapted  for  initiating  a 
student  into  the  Inductive  Method.  It  encourages  observa¬ 
tion,  it  affords  the  opportunities  of  generalisation,  and,  at 
a  very  small  expenditure  of  time  and  money,  enables  the 
student  to  gain  an  insight,  pure  and  experimental,  into 
the  operations  of  living  matter.  Standing,  as  it  does,  mid¬ 
way  between  the  animal  and  vegetable  worlds,  botany,  it  has 
been  observed,  indicates  their  relation  to  each  other,  and  at 
-different  points  touches  the  confines  of  both.  It  throws 
great  light  on  the  functions  of  nutrition  and  on  the  laws 
mf  development ;  while,  from  the  marked  analogy  between 
animals  and  vegetables,  there  is  every  reason  to  hope  that 
its  further  progress,  assisted  by  that  of  electricity,  will  pre¬ 
pare  the  way  for  a  comprehensive  theory  of  life,  to  which  the 
resources  of  our  knowledge  are  still  unequal,  but  towards 
which  the  movements  of  modern  science  are  manifestly 
tending.  Botany,  it  is  true,  may  not  now  be  of  the  same 
technical  value  to  the  practitioner  as  formerly,  but  its  edu¬ 
cational  value  to  the  student  has  correspondingly  increased. 
It  will  be  an  evil  day  for  medicine  when  all  its  studies  are 
regulated  only  by  considerations  of  utility.  This  word 
“  utility  ”  is  the  bane  of  modern  education.  It  is  tending  to 
-eliminate  all  culture  from  scientific  pursuits.  It  is  an  ignis 
fatuus  that  is  leading  us  into  a  bog  of  stolid  dulness.  Those 
-who  cannot  see  any  relation  between  a  liberal  education  and 
the  requirements  of  practical  life  are  constantly  clamouring 
for  the  substitution  of  technical  instruction  in  the  place  of 
•classical  and  literary  studies.  The  pernicious  influences  of 
the  doctrine  of  utilitarianism  have  not,  perhaps,  made  such 
havoc  in  England  as  they  have  in  America,  but  they  threaten 
sooner  or  later  to  confound  us.  Over  fifty  years  ago  Long¬ 
fellow  raised  an  eloquent  protest  against  the  absorbing  utili¬ 
tarianism  of  the  age.  “  With  us/’  he  says,  “  the  spirit  of 
the  age  is  clamorous  for  utility;  for  visible,  tangible  utility ; 
for  bare,  brawny,  muscular  utility.  We  would  be  roused  to 
action  by  the  voice  of  the  populace  and  the  sounds  of  the 
crowded  mart,  and  not c  lulled  asleep  in  shady  idleness  with 
poets’  pastimes.’  We  are  swallowed  up  in  schemes  for  gain, 
-and  engrossed  in  contrivances  for  bodily  enjoyment,  .... 
as  if  this  particle  of  dust  were  immortal,  as  if  the  soul 
needed  no  aliment,  and  the  mind  no  raiment.”  We  too 
often  limit  the  application  of  the  word  utility  to  those 
acquisitions  and  pursuits  which  are  of  immediate  and  visible 
profit  to  ourselves  and  the  community,  regarding  as  compara¬ 
tively  or  utterly  useless  many  others  which,  though  more 
remote  in  their  effects  and  more  imperceptible  in  their  ope¬ 
ration,  are,  notwithstanding,  higher  in  their  aim,  wider  in 
their  influence,  more  certain  in  their  results,  and  more 
intimately  connected  with  the  common  weal.  “  The  word 
‘  utility,’  ”  continues  Longfellow,  ”  has  a  wider  signification 
than  this;  it  embraces  in  its  proper  definition  whatever 
contributes  to  our  happiness,  and  thus  includes  many  of 
those  arts  and  sciences,  many  of  those  secret  studies  and 
•solitary  avocations,  which  are  generally  regarded  as  useless 
nr  as  absolutely  injurious  to  society.  Not  he  alone  does 
service  to  the  State  whose  wisdom  guides  her  councils  at 
home,  nor  he  whose  voice  asserts  her  dignity  abroad.  A 
thousand  little  rills  springing  up  in  the  retired  walks  of  life 
go  to  swell  the  rushing  tide  of  national  glory  and  prosperity ; 
and  whoever,  in  the  solitude  of  his  chamber,  and  by  even  a 
single  effort  of  his  mind,  has  added  to  the  intellectual  pre- 
-eminence  of  his  country,'  has  not  lived  in  vain,  nor  to  him¬ 
self  alone.”  In  the  medical  profession,  the  greatest  and  the 
best  have  usually  been  the  most  cultured  and  the  least 
tainted  by  this  spirit  of  utilitarianism.  Hippocrates,  Galen, 
Linacre,  Boerhaave,  Haller,  Mead,  Freind,  Francis  Adams, 
and  Daremberg,  were  all  scholars  ;  and  even  among  the  men 
,o£  the  greatest  practical  skill,  not  a  few  have  been 


distinguished  by  their  attainments  in  elegant  and  polite  ■ 
learning. 

As  to  the  way  in  which  you  are  to  pursue  your  studies, 
there  is  little  for  me  to  say.  Of  advice  you  have,  no  doubt, 
already  had  as  much  as  you  care  for,  and,  despite  any  sug¬ 
gestions  or  recommendations  I  might  make,  you  are  more 
like  to  fall  in  with  the  traditions  of  the  place,  and  with  the 
practices  of  your  fellows,  than  with  any  theories  of  mine. 
But  take  care  that  the  traditions  you  follow  are  the  best 
traditions.  Do  not  forget  that  diligence  and  industry  will 
make  up  for  many  intellectual  imperfections.  Remember, 
too,  that  your  organisation  is  multiplex,  and  that  you  need  to 
train  your  senses,  your  understanding,  and  your  reason,  and 
have  all  your  faculties  under  the  governance  of  a  resolute  and 
vigorous  will.  “  All  our  knowledge,”  says  Kant,  “  starts 
from  the  Senses,  goes  on  from  them  to  the  Understanding, 
and  ends  with  Reason,  than  which  nothing  higher  is  found 
in  us,  either  to  work  up  the  material  which  we  derive  from 
the  intuitions  of  sense,  or  to  evolve  the  highest  unity  of 
thought.”  To  be,  then,  useful  and  accomplished  men,  it  is 
necessary  for  you  to  engage  in  those  exercises  which  will 
train  your  external  senses,  cultivate  your  understanding, 
and  refine  and  ennoble  your  reason.  The  medical  curriculum 
embraces  studies  adapted  to  each  and  all  these  purposes. 
What  they  are  and  how  they  are  to  be  pursued,  I  will  not 
now  stop  to  explain.  But  a  caution  is  needed.  There  are 
two  extremes  to  be  avoided ;  both  equally  dangerous,  though 
in  different  ways.  Working  too  much  is  almost  as  bad  as 
working  too  little ;  perhaps  of  the  two  the  more  grievous 
damage  is  done  by  excess.  The  idle  and  desultory  student 
may,  by  resolute  application,  do  something  to  redeem  the 
follies  of  the  past ;  but  the  student  who,  through  misguided 
zeal  or  over-anxiety,  or  from  fear,  has  lavished  his  strength 
too  prodigally  on  his  task,  to  the  neglect  of  his  physical 
well-being,  may  find  too  late  his  forces  undermined  and  his 
energies  consumed.  Regulate,  then,  your  hours  of  work, 
and  study  so  that  you  may  have  ample  leisure  for  the  needs 
of  recuperation,  recreation,  and  refinement.  Learn  the 
secret  of  losing  time  rationally.  Literature,  music,  the 
drama,  the  fine  arts,  and  the  society  of  persons  of  refined 
though  simple  tastes,  afford  abundant  opportunities  for 
instruction  and  amusement,  and  facilities  for  the  best 
aesthetic  culture.  Outdoor  exercises,  as  walking,  riding, 
boating,  cricket,  and  Volunteering — whether  you  enlist- in 
the  service  of  Mars  or  Hygeia,  to  shoulder  the  rifle  or 
attend  the  ambulance — will  invigorate  your  body,  refresh 
your  mind,  and  repair  the  damage  your  growing  frame 
sustains  in  the  noxious  atmosphere  of  hospital,  laboratory, 
and  dissecting-room.  These  exercises,  too,  supply  the  only 
opportunities  of  witnessing  and  admiring  the  natural  beauty 
of  earth  and  sky  and  sea,  the  variegated  hues  of  gem  and 
flower ;  the  painting  of  insect,  bird,  and  beast ;  the  bright¬ 
ness  of  sunshine,  the  iridescence  of  the  rainbow,  the 
rippling  of  the  shallow  stream,  the  sheen  of  still  water, 
the  flash  and  roar  of  storm  and  tempest.  A  memory 
plenished  from  the  storehouse  of  poet  and  philosopher, 
artist  and  orator,  novelist,  historian,  and  divine ;  a  mind 
that  gives  “  to  forms  and  images  a  breath  and  everlasting 
motion”;  C£an  eye  made  quiet  by  the  power  of  harmony 
and  the  deep  power  of  joy,”  will  soothe  the  tired  brain,  bring 
solace  to  the  careworn  heart,  brace  the  unstrung  nerves,  and 
lighten  the  weary  tread.  Cultivate  the  habit  of  wishing  to 
discover  the  Good  and  the  Beautiful  in  all  that  meets  and 
surrounds  you ;  the  disposition  that 

“  Finds  tongues  in  trees,  books  in  the  running  brooks. 

Sermons  in  stones,  and  good  in  everything.” 

Gentlemen,  no  education  should  be  exclusively  technical 
or  even  intellectual,  and  certainly  not  that  of  a  medical  man. 
Hippocrates  gave  ethical  dignity  to  medical  practice.  No  one 
showed  more  respect  than  he  for  patients,  more  solicitude 
for  their  welfare,  or  at  least  for  their  solace  and  consolation. 
No  one  more  than  he  admired  useful  discoveries,  or  took 
more  trouble  to  perfect  them.  While  maintaining  a  con¬ 
scientious  deference  to  all  his  upright  professional  brethren, 
he  utterly  repudiated  those  practitioners  who  were  careful 
only  for  their  fortune  and  reputation,  making  a  parade  of 
their  knowledge  and  learning,  humouring  the  prejudices  of 
the  vulgar,  and  ruling  their  own  conduct  by  considerations 
of  the  profit  which  they  were  likely  to  receive.  No  one 
has  ever  had  a  nicer  and  more  correct  appreciation  of  tho 
relations  which  should  exist  between  medical  men  them- 


398 


Medical  Times  and  Gazette. 


DONKIN"  ON  POPULAR  AND  RATIONAL  THERAPEUTICS. 


Oet.  6, 1889. 


selves,  and  between  the  medical  practitioner  and  his  patient 
and  the  public.  Guy  of  Chauliac,  who  flourished  in  the  middle 
of  the  fourteenth  century,  was  equally  exalted  in  his  ideals. 
“  A  surgeon/'  he  says,  “  should  be  learned,  expert,  ingenious, 
and  well-mannered ;  he  should  be  bold  when  sure,  cautious  in 
danger ;  kind  to  patients,  gracious  to  colleagues,  modest  in 
giving  an  opinion  ,•  chaste,  sober,  pitiful,  and  merciful,  and 
not  greedy  of  gain/'  These  are  noble  teachings,  which  each 
of  us  may  follow,  however  haltingly  and  afar  off.  Whatever 
may  be  our  ideals,  they  have  only  moral  value  when  they 
amend  our  lives.  Grave  deep  upon  your  hearts  the  moral 
maxims  of  the  master  mind  of  medicine,  and  of  the  illumi¬ 
nator  of  modern  philosophy.  “  With  purity  and  with  holi¬ 
ness  I  will  pass  my  life  and  practise  tny  art,"  was  the  pledge 
demanded  by  Hippocrates  of  every  novitiate  of  medicine ; 
and,  “  Never  act  otherwise  than  so  that  you  can  will  that 
your  maxim  should  become  a  universal  law,"  is  the  unsur¬ 
passable  ethical  dictum  of  Imanuel  Kant.  Inexperienced  in 
the  course  of  the  world,  incapable  of  being  prepared  for  all 
its  contingencies,  ask  yourself :  Can  I  will  that  my  principle 
of  action  shall  be  a  universal  law  for  the  guidance  of  every 
other  man?  Be  not  deceived;  the  study  and  practice  of 
medicine  are  not  of  themselves  refining  or  ennobling  to  the 
natural  man.  Among  those  who  are  engaged  in  the  treat¬ 
ment  of  disease  are  some  of  the  meanest  and  cruellest  of 
their  race.  Quacks  and  pretenders  have  been  the  pests  of 
every  age.  What  elevates  and  ennobles  medicine  is  Science 
— that  “  fair,  effusive  ray  ”  which  Akenside,  himself  a  dis¬ 
tinguished  physician,  invoked  as  the  guiding  principle  of 
his  life : 

“  That  last  best  effort  of  thy  skill. 

To  form  the  life  and  rule  the  will, 

Propitious  power !  impart : 

Teach  me  to  cool  my  passion’s  fires, 

Make  me  the  judge  of  my  desires, 

The  master  of  my  heart. 

“  Raise  me  above  the  vulgar’s  breath, 

Pursuit  of  fortune,  fear  of  death, 

And  all  in  life  that’s  mean  : 

Still  true  to  reason  be  my  plan. 

Still  let  my  actions  speak  the  man. 

Through  every  various  scene.” 

It  is  Knowledge  that  purifies  our  nature ;  it  is  Science 
that  gives  moral  dignity  and  value  to  our  calling.  To  a 
worldly-minded  man,  the  rewards  of  medical  labour  are  not 
worth  the  toil.  The  remuneration  is  not  adequate  to  the 
anxious  and  arduous  cafe  of  professional  life ;  to  the 
struggles  against  opposition,  adversity,  and  disappointment ; 
to  the  lack  of  honours,  luxuries,  and  even  comforts.  But 
to  a  mind  imbued  with  the  modest  and  unselfish  spirit  of 
science,  the  rewards  of  a  good  conscience  and  of  a  sense  of 
duty  properly  performed  are  sufficient.  You,  and  all  of  us, 
are  engaged  in  the  pursuit  of  this  science,  and  in  a  work  of 
humanity  and  love.  We  are  inheritors  of  a  useful  art,  the 
heirs  of  a  noble  learning,  the  depositories  of  godlike  know¬ 
ledge.  On  our  efforts,  collectively  and  individually,  will 
depend  to  a  large  degree  the  character  and  the  influence  of 
our  art  and  our  science  during  the  coming  generations.  The 
way  in  which  we  discharge  our  duties  and  fulfil  our  obliga¬ 
tions  to  the  profession,  to  ourselves,  and  to  the  world,  will 
influence  for  good  or  for  evil  medical  and  social  life  for  years 
to  come.  Higher  than  mere  earthly  honours  and  earthly 
dignities,  the  reward  we  covet  is  that  of  being  numbered 
among  the  true  workers  in  science  and  searchers  after  truth 
— science  that  has  revealed  the  mysteries  of  our  organisa¬ 
tion,  eradicated  superstition  from  our  minds,  extended  wide 
the  bounds  of  knowledge,  and  put  back  the  limits  of  the 
unknown,  abridged  both  space  and  time,  strengthened  our 
intellectual  gaze  till  we  almost  pierce  the  veil  of  Eternity 
and  realise  the  life  beyond.  Gentlemen,  my  task  is  nearly 
done.  I  have  only  to  add  my  own  good  wishes  to  those  of 
my  colleagues  for  your  health,  happiness,  and  success. 


Yellow-Fever  Fungus.— Dr.  Domingo  Frere,  of 
Rio  Janeiro,  the  discoverer  of  the  yellow-fever  fungus. 
Cryptococcus  xanthogenicus,  has  made  the  experiment  of 
transferring  this  fungus  into  the  system  of  animals  by 
injection,  and  has  obtained  satisfactory  confirmation  of  his 
theory.  The  inoculated  animals,  after  a  very  short  time, 
showed  all  the  symptoms  of  yellow  fever,  and  on  dissection 
their  blood  was  found  to  be  full  of  the  germs  of  Cryptococcus 
xanthogeniius. 


POPULAR  AND  RATIONAL 
THERAPEUTICS. 

Introductory  Address  at  the  London  School  of  Medicine 
for  Women ,  October  1,  1883. 

By  H.  DONKIN,  M.B.  Oxon.,  F.R.C.P., 

Joint  Lecturer  on  Medicine  at  the  above  School;  Physician  to  the  West¬ 
minster  Hospital  and  to  the  East  London  Hospital  for  Children. 

On  the  movement  of  which  this  school  is  the  sign  of  success 
I  shall  not  address  you  to-day.  It  is  now  to  be  regarded  as 
an  accomplished  fact,  to  be  ascribed  in  a  paramount  degree 
to  the  doings  and  sayings  and  writings  of  the  lady  whom 
this  institution  is  proud  to  own  as  its  Dean,  and  its  students- 
fortunate  to  have  before  them  as  their  best  example.  The 
continuance  and  extension  of  this  movement  will  now  depend 
mainly  on  the  demand  for  the  material  supplied  by  such  a 
school  as  this.  It  is  to  the  credit  of  the  public,  and  now  at 
last  to  that  of  the  medical  profession  at  large,  that  prejudice 
on  this  question  is  no  longer  wide  or  deep  enough  to  justify 
my  detaining  you  now  with  an  apology  for  ourselves  or  a 
crusade  against  opponents ;  and  it  may  not  be  too  much  to 
hope  that,  with  the  favouring  smile  of  Royalty  upon  you 
when  the  next  International  Medical  Congress  is  held  in 
London,  you  will  no  more  be  a  cause  of  dissension  amongst 
its  councillors. 

The  subject  I  have  chosen  to  speak  upon  to-day,  though 
I  have  already  touched  on  it  elsewhere,  on  an  occasion 
similar  to  this,  is  one  which  appeared  to  me  especially 
suitable,  and  possibly  useful,  to  the  not  wholly  professional 
audience  I  have  before  me  here. 

The  relation  of  patients  to  their  doctors— the  light  in 
which  they  should  regard  them,  and  the  demands  they 
should  make  at  their  hands — is  clearly  a  matter  both  off 
interest  and  importance.  Not  a  few  of  the  shortcomings 
and  faults  of  the  profession  are  due  to  the  ignorance  and 
misconceptions  of  the  public  as  to  the  nature  of  the  science 
and  art  of  medicine ;  and  charlatans  flourish  and  abound  on 
the  joint  results  of  the  superstition,  the  indolence,  and  the- 
obstinacy  of  men  and  women. 

It  is  especially  to  the  still  wide-spread  and  deeply  rooted 
fallacies  concerning  the  nature  and  treatment  of  disease  that 
I  now  call  your  attention,  for  these  it  is  that  constitute  the 
main  hindrance  to  that  rational  understanding  between 
doctors  and  patients  which  ought  to  be  the  boast  of  this 
enlightened  and  scientific  age.  I  would  that  the  profession 
itself  were  entirely  free  from  a  tendency  to  cherish  its  fading 
mysteries ;  but  for  that  happy  time  we  must  wait,  and  wait 
perhaps  for  long,  until  it  be  no  longer  true  to  say  that  the 
people  wills  to  be  deceived. 

The  chief  fallacies  to  which  I  allude  are,  first,  the  assump¬ 
tion,  tacit  or  expressed,  that  to  have  our  diseases  cured  is  a 
kind  of  right — that  it  is  always  and  every  where  a  reasonable 
thing  to  expect ;  and,  secondly,  that  there  is  somewhere  in 
nature  a  drug  for  almost  every  disease — a  kind  of  pre¬ 
ordained  or  cut-and-dried  remedy — if  only  the  doctors  could 
find  it  out.  Yes,  even  in  this  age,  when  biological  science  is 
so  widely  heard  of,  and  men's  minds  are  searching  out 
almost  everything  anew,  the  ignorance  of  the  mass  of  the 
public  as  to  the  meaning  and  nature  of  disease  remains 
profound,  and  the  practical  belief  that  nearly  all  our 
maladies  ought  to  be  cured  by  drugs  is  still  held  by  most,., 
and  is  strong  enough  to  cause  the  evils  which  we  deplore. 

That  the  question  of  the  possibility  and  the  nature  of  the 
treatment  of  disease  must  always  be  of  high  importance  to 
the  human  race  is,  of  course,  obvious.  Such  a  possibility  in 
some  sort,  too,  is  one  of  the  chief  raisons  d’etre  of  the 
physician,  though  even  without  it  his  occupation  would 
not  be  gone.  That  he  has  other  valuable  functions  as 
well  as  those  of  the  healer  is  now  generally  admitted,  and 
need  not  be  insisted  on  here.  Concerning  these,  indeed,, 
there  would  seem  to  be  a  better  general  understanding 
than  as  regards  his  position  as  one  who  tends  or  treats- 
disease.  A  large  debt  is  acknowledged  by  most  enlightened 
people  to  the  advancing  study  of  the  human  body  and  its. 


.'Medical  Times  and’Gasette. 


DOCKIN'  ON  POPULAR  AND  RAATIONAL  THEEPEUTICS. 


Oct.  6, 1883.  399 


-conditions  in  health  and  disease,  and  physiology  and  path¬ 
ology  are  more  or  less  credited  in  the  present  day  with  pro¬ 
viding  us  with  a  body  of  men  who  are  able  to  give  an 
increasingly  certain  opinion  and  forecast  regarding  many 
maladies,  including  some  but  little  known  before,  or  quite 
unrecognised  amidst  a  confusion  of  undifferentiated  signs 
and  symptoms.  But  men  naturally  place  the  subject  of 
treatment  in  a  pre-eminent  position,  and  even  now,  in  the 
minds  of  most,  the  word  "  treatment  ”  stands  for  the  giving 
of  drugs.  Ignoring  or  disobeying  the  clear  teachings  of 
science  as  to  health,  which  are  the  true  medicine,  we  still 
persist  in  demanding  from  our  doctors  unreasonable  and 
impossible  methods  of  cure.  We  will  not  wash  in  Jordan  ; 
but,  even  ad  nauseam,  we  will  gladly  swallow  pills  and 
potions :  we  prefer  the  doctor  who  says  without  hesitation 
that  he  can  cure  disease  by  drugs,  rather  than  by  the  observa¬ 
tion  and  following  of  nature’s  lessons.  The  truth  that 
■  “  prevention  is  better  than  cure  ”  may  be  often  on  our  lips, 
but  in  our  hearts  we  are  far  from  it,  for  we  like  to  keep  our 
cake  and  eat  it  too.  Credulity  and  blind  assumption  seem 
•very  powerful  here ;  tainting  somewhat,  too,  our  great  pro¬ 
fession,  and  causing  some  of  us  to  remain  among  the 
shadows,  or  even  wilfully  to  turn  away  from  the  light. 

We  must  seek  a  little  further  for  an  explanation  of  this 
before  going  on  to  show  that  the  progress  of  the  sciences 
on  which  the  art  of  medicine  or  the  treatment  of  the  body 
in  health,  and  disease  depends,  points  in  a  direction  widely 
separate  from  the  method,  heretofore  so  prominent,  of  the 
universal  administration  of  heterogeneous  materials  known 
"!by  the  collective  name  of  “  drugs.” 

In  the  ages  when  observation  had  no  place  in  the  study 
of  medicine,  all  treatment  was  rooted  in  some  kind  of  super¬ 
stition  or  assumption.  Disease  came  from  the  hands  of  the 
gods  :  from  them  alone,  or  through  their  mediation  with  men, 
must  come  relief.  In  the  earlier  times,  in  fact,  the  pro¬ 
fessions  of  physic  and  divinity  were  one.  And  such  is  the 
strength  of  early  impressions  that  the  stamp  of  unquestion¬ 
ing  faith  in  this  very  important  and  personal  matter  of  the 
treatment  of  disease  is  still  deeply  marked  on  many  minds. 
As  an  immediate  outcome,  perhaps,  of  the  intimate  alliance 
between  theology  and  medicine,  diseases  were  regarded 
as  separate  existences,  to  be  exorcised  or  antagonised  by 
.spiritual  means  or  charms.  The  search  after  causes  had 
mot  begum:  men  took  for  granted  what  they  saw,  without 
•.analysis,  and  in  indolence,  impotence,  and  fear  they  readily 
•assumed  the  interference  of  a  higher  power  in  everything 
that  took  place  beyond  their  own.  As  time  went  on,  this 
notion  of  the  personality  or  independent  nature  of  disease 
remained,  though  men  sought  further  than  charms  for  its 
relief.  Disease  was— and  is,  to  the  minds  of  many,  now — an 
independent  intruder  into  a  body  where  it  has  no  right  to 
be,  and  requires  to  be  met  with  an  extraneous  and  antago¬ 
nistic  remedy.  In  this  way  arose  the  pernicious  and  gratui¬ 
tous  notion  of  the  antidotal  or  specific  treatment  of  disease 
— a  rock  on  which  so  many  good  minds  have  been,  at  least 
partially,  wrecked ;  so  many  impostors  established  them¬ 
selves  securely.  On  this  foundation  has  been  built  up  the 
creed  of  the  drug-treatment  of  disease — not  yet  cast  down, 
but  beginning  to  totter  to  its  fall  under  the  slow  but  sure 
attacks  of  scientific  method. 

Intimately  bound  up  with  this  view  of  the  treatment  of 
•disease,  it  must  be  remembered,  is  the  confusion  of  symptoms 
with  disease  processes,  or  the  taking  of  effects  for  causes. 
Before  analysis  or  the  study  of  causes  engaged  men’s 
minds  in  the  matter  of  our  maladies,  symptoms  alone  could 
be  the  objects  of  attack ;  and  through  many  years  in  the 
bistory  of  medicine  we  look  in  vain  for  true  progress,  while 
the  study  of  symptoms  and  the  search  for  specifics  were 
predominant  in  the  schools.  A  system  such  as  this  is  at 
once  in  theory  exploded  when  the  search  after  causes  begins. 
The  treatment  of  symptoms  was  all  that  was  possible  before ; 
but  how  small  its  scope,  how  constantly  dangerous  and 
blundering  its  method  must  be,  is  as  obvious  now  as  it  is 
demonstrably  unscientific,  and  therefore  untrue.  The  search 
after  the  causes  of  disease,  or  looking  behind  its  symptoms, 
mainly  illustrated  by  the  rise  of  the  study  of  morbid  ana¬ 
tomy,  was  the  first  valuable  advance  towards  better  treat¬ 
ment,  and  gave  the  shock  which  must  one  day  end  in  the  total 
discomfiture  of  any  drug-theory  of  therapeutics  whatever. 

I  may  observe  incidentally  here  that  I  am  not  decrying  the 
treatment  of  symptoms,  even  by  drugs,  as  always  and  every¬ 
where  foolish  or  useless.  Experience,  often  of  the  most  hap¬ 


hazard  nature,  has  shown  that  a  symptom  may  sometimes 
be  relieved  to  the  great  advantage  of  the  patient,  although 
its  nature  and  the  working  of  its  remedy  may  be  alike 
obscure.  Pain  and  other  symptoms  may  sometimes  be  safely 
antagonised,  even  if  their  origin  be  not  fully  explained  ;  and 
even  amongst  many  blunders  there  may  be  some  notable 
successes.  But  it  is  only  the  wilfully  blind  and  unreasoning 
man  who  dares  to  argue  from  this  towards  a  symptomatic 
system  of  treatment.  On  the  occasional  good  results  of  such 
symptomatic  treatment  as  this  rests  the  success  and  im¬ 
munity  from  disgrace  so  often  enjoyed  by  ignoramuses  and 
quacks  in  medicine.  It  is  notorious  that  men  speak  more 
loudly  of  the  triumphs  of  the  homoeopaths  over  colds  in  the 
head,  and  other  maladies  tending  to  rapid  spontaneous  re¬ 
covery,  than  of  their  numerous  errors  of  diagnosis  ;  and 
blazon  abroad  the  marvellous  cure  of  a  stiffened  joint  by  a 
bone-setter,  while  many  of  his  dupes,  unnoticed  by  the 
public,  are  sacrificing  irreparably  injured  limbs  on  the  altar 
of  his  dangerously  little  knowledge. 

The  treatment  of  symptoms,  then,  however  useful  it  may 
be  in  isolated  instances,  can  never  be  satisfactory  or  final 
This  seems  sufficiently  obvious,  though  it  is  not  yet  prac¬ 
tically  admitted  by  the  world  at  large,  or  by  all  those  who 
call  themselves  Healers  of  Men.  Sprung  from  its  primitive 
soil  of  superstition,  the  belief,  I  repeat,  is  still  rife  among 
us,  that  we  have  a  right  to  expect  an  antidote  to  every 
symptom,  that  every  disease  ought  to  be  cured.  Only 
perhaps  when  man’s  true  place  in  nature  shall  be  not  merely 
taught,  but  realised,  will  this  belief  finally  die,  and  be  one  of 
the  signs  of  the  last  struggle  of  Sentiment  for  predominance 
over  Thought.  Diseases  have  been  looked  upon  so  long  as  a 
series  of  enemies  to  man  (for  whom  all  things  were  thought 
to  be  made),  to  be  individually  knocked  down,  that  when  we 
found  we  could  remedy  some  of  our  maladies  by  certain 
means,  as,  for  instance,  by  the  administration  of  drugs,  we 
falsely  argued  ourselves  into  a  universal  practice,  if  not  a 
theory,  of  a  drug-treatment  for  all  diseases.  This  it  is  which, 
without  any  justification  in  nature  or  in  logic,  has  been 
the  bane  of  therapeutics  for  countless  years.  The  public 
have  suffered  from  it  ;  and  quacks  rejoice  in  it.  So 
obstinate  is  this  gratuitous  belief  that  there  is  a  connexion 
in  nature  between  disease  and  extraneous  substances 
called  drugs,  that  we  find  it  cropping  up  where  we  should 
least  expect  it,  and  held,  by  implication  at  all  events,  by 
men  who  appreciate  and  follow  scientific  method  in  their 
investigations.  It  is  not  only  the  great  delusion  and  im¬ 
posture  of  Homoeopathy,  with  its  sublime  neglect  of  Physi¬ 
ology  and  Pathology,  that  has  owed  its  being  to  this  super¬ 
stition  ;  traces  of  it  we  find  as  well  in  the  exaggerated  hopes 
of  advance  in  Therapeutics  along  the  line  of  a  more  scientific 
knowledge  of  the  physiological  action  of  drugs,  held  out  to 
us  by  men  whose  investigations,  taken  by  themselves,  are 
worthy  of  all  regard.  I  do  not  mean  to  undervalue  the 
admirable  work  done  by  many  by  way  of  experiment  with 
regard  to  the  action  of  drugs  on  the  healthy  body,  espe¬ 
cially  that  of  the  vegetable  poisons,  nor  do  I  deny  that 
in  some  few  instances  it  has  led  to  more  or  less  valuable 
therapeutic  results.  What  I  wish  to  make  clear  is,  that 
had  we  even  a  complete  knowledge  of  the  action  of  every 
drug,  past,  present,  and  to  come,  in  the  Pharmacopoeias 
of  the  World,  we  should  probably  be  but  little  nearer  to 
a  scientific  treatment  of  disease.  And  even  if  past  ex¬ 
perience,  apart  from  theory,  had  given  us  good  hopes  of 
any  wide  success  from  the  use  of  drugs,  yet  it  is  obvious 
that  our  knowledge  of  the  causes  and  starting-points  of 
morbid  states  must  be  equally  profound  with  our  knowledge 
of  remedies — I  had  almost  said,  must  be  perfect — if  we  are 
safely  to  use  our  newly  found  weapons,  and  not  continue  to 
attack  a  symptom  as  if  it  were  the  disease  itself. 

Even  though  modern  physiological  research  may  give  us 
definite  means  of  modifying  certain  secretions  and  processes, 
or  antagonising  certain  symptoms,  by  means  of  drugs  intro¬ 
duced  into  the  circulation,  we  must  be  very  sure  of  the 
position,  as  links  in  the  morbid  chain,  of  the  symptoms  we 
attack,  and  have  good  reason  to  believe— a  very  difficult 
matter  indeed — that  the  rest  of  the  economy  will  not  suffer  by 
our  interference,  before  we  can  hope  to  be  anything  more  than 
blunderers  in  applying  our  so-called  remedies  to  any  com¬ 
plex  case  of  disease  as  we  see  it.  There  are  many  symptoms 
of  disease,  inconvenient  in  themselves,  which  it  is  not  always 
desirable  to  neutralise  if  we  can.  I  cannot  here 'enlarge 
upon  this, — it  is  neither  the  time  nor  the  place.  That  an 


400 


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DONKIN  ON  POPULAR  AND  RATIONAL  THERAPEUTICS. 


Oct.  6,  1686'.. 


obvious  symptom  is  always  rightly  attacked  is  the  fallacy 
which  underlies  self-medication  and  most  forms  of  quackery, 
and  explains  the  harm  that  often  results  therefrom.  And 
even  those  from  whom  one  might  hope  better  things  are, 
in  this  day,  found  to  gleefully  hail  as  an  advance  in  thera¬ 
peutics  some  addition  to  the  list  of  drugs  which  may  control, 
say,  the  sweating  in  consumption,  regardless  of  the  fact 
that  often  the  possible  success  of  the  drug  means  increased 
harm  to  the  patient.  Very  valuable,  then,  as  some  of  the 
results  of  the  physiological  study  of  drugs  has  been,  and 
more  valuable  as  we  may  hope  they  may  still  be,  I  would, 
nevertheless,  urge  that  this  is  not  the  main  line  of  advance 
in  therapeutics  which  science  points  out  to  us;  and  that  the 
most  learned  pharmacologist  may  be  as  blundering,  and 
even  dangerous,  in  his  treatment  of  disease,  as  a  plough¬ 
man  would  be  in  endeavouring  to  repair  a  chronometer. 
I  hope  I  have  made  it  clear  that  the  so-called  drug- 
treatment  of  disease  has  certainly  a  considerable  basis 
of  ignorance  and  assumption.  And  I  would  have  you  re¬ 
member  that  it  is  in  response  to  this  credulity  that  most 
of  the  plagues  of  our  profession  have  arisen,  and  that  we 
hear  and  read  so  much  of  the  puffing  doctor  and  his  inti¬ 
mate  ally,  the  over-advertising  chemist.  “  The  incredible 
amount  of  quackery,5’  says  Mr.  Baptist  Crofts,  in  a  most 
interesting  article  on  the  Relation  of  Drugs  to  Medicine,  in 
the  British  Quarterly  Review  for  July,  “  which  flaunts  in  our 
faces  wherever  we  turn,  testifies  more  to  a  speculative  weak¬ 
ness  for  medicine  than  to  the  necessities  of  disease.  People 
laugh  at  it,  satirise  it,  declaim  against  it,  and  fly  to  it  for 
help  in  pain  and  sickness.” 

What,  now,  does  modern  pathology,  or  the  study  of  the 
course  and  causes  of  disease,  teach  us  touching  the  art  of 
treatment,  and  in  what  direction  does  it  point  with  respect 
to  the  use  of  drugs  P  The  answer  to  this  question  alone, 
quite  apart  from  &  priori  or  historical  views,  can  put  the  drug- 
treatment  in  its  proper  place,  high  or  low.  For  it  is  clear 
that  successful  treatment  of  disease,  if  disease  is  to  be  modi¬ 
fied  at  all,  must  depend  on  the  extent  and  accuracy  of  our 
knowledge  of  morbid  causes.  It  may  be  said,  without  fear 
of  contradiction,  that  the  whole  course  of  modern  science 
tends  to  discourage  any  prospect  of  a  royal  road  to  health 
by  means  of  the  systematic  medication  of  disease.  Disease 
is  a  complex  term  including  many  different  notions  and  pro¬ 
cesses.  Morbid  anatomy  has  explained  to  us  how  impossible 
t  is  to  check  the  changes  and  degenerations  of  various 
organs  and  tissues  of  the  body,  which  are  the  accompani¬ 
ments  of  important  classes  of  disease,  and  has  emphasised 
the  lessons  that  our  failures  and  constant  searching  after 
new  remedies  ought  to  have  taught  us  long  ago.  One 
great  dictum  of  Pathology,  to  quote  the  words  of  Dr. 
Creighton’s  recent  suggestive  address  at  the  British  Medi¬ 
cal  Association,  is  that  “  diseased  states  of  the  body 
are  mainly  modifications  of  healthy  states— deviations  from 
the  beaten  track,  perturbations  of  the  normal  life,  short¬ 
comings  of  the  physiological  standard.”  In  other  words. 
Pathology  may  be  looked  upon  as  a  chapter  out  of  the  great 
book  of  Biology.  And  so  we  must  regard  many  diseases 
which  afflict  us,  as  part  of  the  common  lot — as  accidents  of 
development.  Does  not  this  show  us  that  an  intimate  know¬ 
ledge  of  the  body  in  health,  of  its  structure  and  functions, 
is  the  best  approach  to  the  study  of  disease,  and  that  to 
guard,  if  possible,  against  the  changes  which  may  be  called 
the  beginnings  of  disease  must  be  the  right  line  on  which 
to  work.  The  progress  of  science  in  enlarging  our  know¬ 
ledge  of  the  processes  of  life  has  irresistibly  altered  the 
practice  of  Medicine  which  depends  on  it ;  and  Medicine  now 
more  than  ever,  if  a  science  at  all,  deserves  to  be  called  the 
Science  of  Health.  The  treatment  of  disease  in  the  main 
must  now  become  hygienic ;  it  must  be,  as  the  British  Quar¬ 
terly  reviewer  says,  “  the  adaptation  and  modification  of  the 
laws  and  conditions  of  life.”  To  give  even  a  resume  of  the 
advances  made  in  the  treatment  of  disease,  both  preventive 
and  curative,  by  the  scientific  or  mainly  hygienic  method, 
time  does  not  allow.  Once  more  I  would  refer  you  to  the 
admirable  article  I  have  just  quoted.  Great  things  have  been 
done,  and  we  may  rightly  hope  for  greater  still.  The  value 
of  the  apparently  simple  therapeutics  of  air,  warmth,  diet, 
and  exercise  are  but  beginning  to  be  appreciated.  We  have 
no  reason  to  despair  of  advance  in  therapeutics  as  we  give 
up  the  fanciful  notion  of  specific  treatment  by  drugs.  We 
have  been  able  to  antagonise  many  maladies,  in  some  cases 
with  great  success,  as  might  have  been  expected,  by  the 


rational  application  of  natural  means,  such  as  special  foods 
and  atmospheric  conditions,  to  certain  morbid  states  with 
which  by  observation  and  experiment  we  have  become  better 
acquainted. 

Nor  must  we  forget  how  much  we  owe  to  the  scientific 
method  for  helping  us  along  the  path  of  iconoclastic  Thera¬ 
peutics.  The  demolition  of  false  theory  and  the  abandon¬ 
ment  of  bad  practice  in  medicine  form  perhaps  not  the  least 
striking  improvement  that  scientific  knowledge  is  working. 
It  may  be  humiliating  to  confess  this,  but  it  is  at  the  same 
tim  e  encouraging.  Theory  after  theory  set  up  by  our  indolence 
and  conceit  has  been  exploded  by  observation  and  experi¬ 
ment,  and  the  days  of  indiscriminate  bleeding  and  wholesale-; 
drugging  on  the  ground  of  a  flimsy  pathology  have  passed, 
or  are  passing  away.  Day  by  day  fewer  patients  are  killed. 
secundum  artem.  No  better  example  can  be  given  of  this, 
than  the  progress  we  have  made  in  the  treatment  of  fevers, 
and  other  so-called  “acute  ”  disorders.  Though  Sydenham, 
more  than  two  centuries  ago,  saw  and  taught  that  what  was 
called  the  “  hot  regimen  ”  for  fever  patients  was  harmful,  it 
is  but  lately,  and  since  we  have  learnt  more  accurately  from- 
the  use  of  the  thermometer  that  an  excessive  rise  of  tem¬ 
perature  is  probably  in  itself  a  danger  to  life,  that  we  allow 
our  patients  to  be  kept  cool— to  drink  cold  water  when  they 
are  thirsty,  and  even  in  certain  cases  cool  them  down  by  art. 
Surely  even  what  is  sneeringly  called  by  the  druggist  school 
(as  though  drugging  were  synonymous  with  doing  in  medical 
practice)  our  “  masterly  inactivity  ”  in  the  present  day,  in 
many  cases  of  disease  whose  course  we  know,  is  a  great  and 
positive  improvement  when  we  think  of  our  dark  doings  in 
days  gone  by.  Dr.  Waters  said  recently,  at  Liverpool,  that 
we  may  enumerate  among  the  successes  of  medicine  in  the 
present  day  a  large  reduction  in  the  mortality  from  pneu¬ 
monia  (or  inflammation  of  the  lung).  Certainly  we  may ; 
but  he  did  not  emphasise  the  fact  that  the  mode  of  practice 
which,  he  says,  has  robbed  the  disease  of  much  of  its  terror 
has  been  little  else  than  letting  it  alone. 

Have,  then,  drugs  no  place  in  the  treatment  of  disease-?- 
you  will  ask.  I  would  answer  both  No  and  Yes.  In  the 
common  use  of  the  term,  drugs  as  a  class,  including  many- 
substances  quite  alien  to  the  body,  should  be  regarded  as- 
having  no  necessary  relation  to  medicine.  No  one  starting- 
now  de  novo  on  the  scientific  study  of  disease  would  efer 
hit  upon  such  a  theory  or  dream  such  a  fancy  at  all :  no 
notion  would  exist  of  a  series  of  pre-ordained  remedies.  It 
is  obvious  too  that  if  the  results  we  aim  at  in  treatment  cam 
be  attained  without  the  insertion  of  alien  substances  into, 
the  body,  it  is  better  to  do  without  them.  At  the  best  it  is  a 
blundering  and  artificial  method.  But  in  the  course  of  so 
many  years,  when  “  treatment”  has  been  almost  synonymous 
with  drugging,  and  medicine  meant  little  else  than  a  potion,, 
many  valuable  discoveries  have  been  made  in  the  way  of 
remedies.  Of  specifics  we  have,  properly  speaking,  none. 
The  quest  of  them  is  that  of  a  will-o’-the-wisp.  But  there  are 
many  substances,  both  organic  and  inorganic,  which,  though 
generally  as  adjuncts  to  other  treatment,  we  are  thankful 
to  use,  and  often  should  fare  but  ill  without.  Yet  it  may 
be  said  that  most  of  our  valuable  pharmacopoeial  remedies 
(with  a  few  notable  exceptions)  are  those  which  enter  more 
or  less  into  the  composition  of  the  human  body.  The  notable 
exceptions  cannot  be  called  strictly  curative  agents,  and 
a  knowledge  of  them  has  been  arrived  at  for  the  most- 
part  in  a  purely  accidental  manner.  For  these  we  should,  I 
think,  be  very  thankful,  and  should  rather  feel  surprise  at 
our  possession  of  them  than  disappointment  at  the  smallness 
of  their  number. 

Besides  the  administration  of  those  substances  which  can 
be  scientifically  explained,  and  those  few  others  for  whose- 
beneficial  influence  there  is  merely  a  vast  amount  of  direct 
evidence,  I  must  mention  one  other  justification  for  drug¬ 
giving,  which  some  day  may  perhaps  disappear.  The  treat¬ 
ment  of  many  maladies,  especially  those  called  functional,, 
must  include  the  regard  of  what  we  call  the  mind  as  well  as 
what  we  strictly  term  the  body.  Belief  in  drugs,  as  strong 
as  it  is  indefinite,  still  exists  in  many  of  our  patients.  It  is. 
absolutely  necessary  for  their  cure  in  some  cases  to  give, 
or  appear  to  give  them  something  that  they  call  medicine.. 
Some  may  be  educated  to  do  without  it — their  number  will 
doubtless  increase  ;  but  we  must  treat  the  individual  while 
waiting  for  the  improvement  of  the  race.  It  would  indeed 
be  to  many  here  a  startling  revelation  if  some  of  our 
physicians  of  real  “  light  and  leading,”  and  free  from  all 


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MEDICAL  AND  SURGICAL  PRACTICE. 


Oct.  6,  1883.  401 


taint  of  quackery,  were  to  publish,  as  they  well  might  at  the 
close  of  their  active  work,  an  approximate  statement  of  the 
proportion  of  mere  placebos  among  the  prescriptions  they 
have  written. 

It  is  constantly  thrown  in  the  teeth,  of  the  scientific 
physician,  who  wants  a  reason  why,  before  he  gives  a  drug, 
that  he  belongs  to  a  school  of  men  who  do  nothing  for  their 
patients.  This  is  a  superficial,  false,  but  often  damaging 
charge,  brought  by  the  “  believers  in  drugs,”  as  they  call 
themselves,  against  their  more  thoughtful  brethren.  But 
it  seems  clear  that  the  doctor  who  wants  a  reason  for 
what  he  does  need  be  none  the  less  likely  to  use  a  remedy 
which  may  reasonably  be  supposed  to  be  beneficial  than  he 
who  has  a  tendency  to  run  after  every  new  thing,  and  he 
will  certainly  be  less  likely  to  do  his  patients  harm.  Often, 
indeed,  the  practice  of  the  best  men  in  these  two  very 
opposite  schools  is  not  so  very  different ;  but  none  the  less 
is  the  difference  of  their  mental  attitude  a  fundamental  one, 
and  must  in  certain  cases  lead  to  directly  divei'gent  modes 
of  treatment.  There  is  a  danger,  indeed,  of  some  of  the 
followers  of  the  so-called  sceptical  school  becoming  indolent, 
but  there  is  the  far  greater  danger  of  the  credulous  dogma¬ 
tist  becoming  fussy  and  interfering ;  and,  beyond  this,  there 
is  ever  the  temptation  present  to  the  dogmatist  of  over¬ 
stepping  the  lines  of  soberness,  and  becoming,  perhaps  un¬ 
consciously,  a  quack.  The  “  sceptic,”  again,  is  not  likely  to 
forget  to  give  a  prescription,  whether  really  necessary  or 
not — the  patient  will  see  to  that ;  but  the  doctor,  dogmatic 
in  drugs,  will  often  forget  to  impress  upon  the  patient  the 
hygienic  dicta  that  his  Science  should  have  taught  him. 

The  new  direction  given  to  inquiry  by  the  discovery  of 
micro-organisms  in  relation  to  disease  may  perhaps,  by 
placing  certain  diseases  in  a  category  definitely  due  to 
external  causes,  give  us  some  hope  of  antagonising  them  by 
drugs.  We  can  already  do  much,  by  the  direct  application  of 
certain  substances,  in  the  way  of  destroying  parasites,  both 
animal  and  vegetable,  and  it  may  conceivably  be  possible 
hereafter  to  attack  the  minuter  enemies  of  man  in  their 
homes  in  his  blood  and  tissues.  But  the  question  of  the 
part  played  by  germs  in  the  production  of  specific  disease 
is  not  yet  settled;  and  it  has  even  been  suggested  that 
these  maladies  are  but  the  results,  by  long  evolution, 
of  altered  normal  processes  and  departures  from  the  phy¬ 
siological  standard.  Be  this  as  it  may,  however,  it  is  rather 
to  processes  akin  to  vaccination  than  to  antidotal  medica¬ 
tion  that  we  have  to  look  for  the  best  protection  against 
these  diseases. 

There  is  no  reason  why  the  heart  of  physician  or  patient 
should  faint  when  the  voice  of  Science  is  heard  saying  that 
the  cure  of  disease  is  very  often  impossible,  and  that  many 
drugs  have  nearly  had  their  day  and  ceased  to  be.  If  we  at 
last  know  that  we  can  but  rarely  cure  disease,  we  can  treat  it 
far  better  than  of  old.  We  know  more  about  diseases;  we 
must  be  able  to  avert,  and  tend  or  treat  them  better,  if 
any  such  action  be  possible.  Better  practice  should  follow 
on  fuller  knowledge  ;  and  I  would  point  to  two  undertakings 
of  the  present  time  which  give  us  much  hope  of  both  for 
the  future,  and  should  meet  with  the  support  and  encourage¬ 
ment  of  all  interested  in  medicine.  I  allude  to  the  Associa¬ 
tion  for  the  Advancement  of  Medicine  by  Research,  with 
especial  reference  to  Experimental  Physiology,  and  to  the 
no  less  important  Collective  Investigation  Committee  of  the 
British  Medical  Association,  from  which  we  hope  for  great 
things  respecting  the  natural  history  of  disease. 

Doubtless  in  the  present  state  of  our  knowledge  we  are 
glad  to  catch  at  anything  that  may  relieve  our  pains  and 
mitigate  our  many  sufferings,  and  we  doctors  should  be 
thankful  that  we  can  do  much  in  this  direction  ;  but  “  if  it 
be  true,”  as  Mr.  Crofts  says,  “that  the  artificial  treatment 
of  disease  by  drugs  is  a  necessity  of  our  civilisation,  it  is 
surely  one  of  its  ‘barbarisms’  which  a  higher  development 
will  gradually  abolish.  If  the  use  of  drugs  is  practically 
inevitable  in  the  life  of  our  day,  so  much  the  worse  for  our 
life.  Amend  the  life  according  to  biological  laws,  repent  of 
physiological  transgressions,  and  throw  physic  to  the  dogs, 
is  the  monition  of  the  best  medicine  of  to-day.”  Thus  I 
believe  will  Therapeutics  increase,  but  Drugs  will  decrease. 
And  if  it  be  said  that  the  treatment  of  disease  as  indicated 
by  Science  is  disappointingly  simple,  I  would  read  to  you,  in 
conclusion,  what  Sydenham  said  so  long  ago :  “  If  anyone 
objects  that  in  some  things  I  have  not  only  renounced  the 
Pomps  of  Medicine,  but  have  proposed  such  Remedies  as  are 


scarcely  reducible  to  the  Materia  Medica,  so  simple  and 
inartificial  are  they :  in  this  I  suppose  I  shall  only  displease 
unthinking  People  ;  for  the  Wise  know  that  all  things  are 
good  that  are  useful,  and  that  Hippocrates  when  he  proposed 
the  use  of  Bellows  in  the  Iliack  Passion,  and  nothing  for  a 
Cancer,  and  the  like  (which  may  be  seen  almost  in  every 
page  of  his  Writings),  deserved  as  well  for  his  Medical  Art 
as  if  he  had  filled  all  with  pompous  Forms  of  Remedies.” 


REPORTS  OF 

HOSPITAL  PRACTICE  IN  MEDICINE 
AND  SURGERY. 

- - 

GUY’S  HOSPITAL. 


VAGINITIS— SOFTENING  OF  BOTH  HEMISPHERES 
OF  THE  BRAIN— THROMBOSIS  OF  LEFT  COMMON 
CAROTID  AND  INTERNAL  CAROTID  ARTERIES 
—EMBOLISM  OF  MIDDLE  CEREBRAL  ARTERY- 
THROMBOSIS  OF  LEFT  COMMON  ILIAC  VEIN- 
DEATH. 

(Under  the  care  of  Dr.  HILTON"  FAGGE  and  Dr.  F.  TAYLOR.) 

[Reported  by  Mr.  F.  Eastes  and  Mr.  A.  Scott.) 

Emma  G.,  aged  eighteen,  was  admitted  into  Guy’s  Hospital 
on  March  18, 1888,  under  Dr.  Fagge’s  care,  and  subsequently 
passed  under  the  care  of  Dr.  Taylor. 

Family  History. — Her  father  died  of  consumption  at  the 
age  of  forty-seven.  Her  mother  suffers  from  chronic  bron¬ 
chitis.  She  is  one  of  ten  children,  all  of  whom  are  living. 
There  is  no  history  of  cancer,  syphilis,  or  rheumatic  fever  in 
the  family. 

Personal  History. — She  had  measles  when  a  child;  has 
always  been  delicate,  but  very  bright  and  lively ;  and  has" 
neither  had  rheumatic  fever,  nor  scarlatina,  nor  any  injury 
to  the  head,  nor  discharge  from  the  ear  or  nose,  nor  earache. 

Present  Illness. — She  left  her  place  in  service  three  months 
ago,  and  has  been  at  home  since,  because  she  felt  weak  and 
out  of  sorts.  During  this  period  she  has  not  been  nearly 
so  bright  as  she  used  to  be,  and  has  not  talked  much.  She 
remained  in  this  condition  until  March  13,  when  she  felt 
very  ill,  had  a  severe  headache,  and  vomited.  Then  she 
became  unconscious,  and  had  convulsions  of  the  right  arm 
and  leg  only,  the  face  being  drawn  to  the  left,  and  the  left 
eyeball,  according  to  the  mother’s  account,  deviating  to  the 
left.  She  did  not  scream.  The  convulsions  lasted  two- 
minutes,  and  on  recovery  she  had  right  hemiplegia  and 
speechlessness.  Since  then  she  has  not  uttered  a  sound, 
nor  moved  the  right  arm  or  leg.  She  has  been  very  drowsy 
and  stupid,  and  has  understood  but  little.  For  two  or  three- 
days  before  the  fit  she  had  complained  of  the  right  arm 
being  cold,  and  her  mother  felt  it  and  ascertained  that  it 
really  was  colder  than  the  left.  Her  urine  has  been  passed 
into  the  bed,  and  on  the  14th  she  also  passed  motions  into 
the  bed. 

On  Admission. — She  is  a  fairly  well-developed  girl;  looks; 
older  than  her  age;  pale,  with  a  slight  flush  on  each  cheek. 
She  lies  quietly,  sometimes  on  the  back,  sometimes  on  the 
right  side,  rarely  on  the  left.  She  cannot  move  the  right 
arm  or  leg ;  the  mouth  is  drawn  over  to  the  left  side,  and  she 
cannot  shut  the  right  eye  so  forcibly  as  the  left.  When 
told  to  shut  her  eyes  tightly  she  only  stares,  and  she  takes 
scarcely  any  notice  of  questions  and  directions;  but  the 
relative  power  of  the  palpebral  muscles  was  finally  estimated 
from  their  behaviour  during  ophthalmoscopic  examination. 
She  appears  to  have  some  idea  of  how  many  fingers  may  be 
shown  her,  but  she  often  holds  up  a  wrong  number,  and 
seems  to  be  trying  to  think  of  it,  and  then  lets  her  hand  (the 
left)  drop,  and  seems  to  give  up  the  effort.  When  she 
attempted  to  write  with  the  left  hand  an  answer  to  any 
question,  she  made  a  meaningless  scrawl,  and  then  dropped 
the  pencil  and  utter  id  a  dissatisfied  grunt — the  first  sound 
she  had  made  since  admission,  twelve  hours  previously. 
When  asked  to  put  out  her  tongue,  she  only  opens  her 
mouth,  and  the  tongue  remains  within  the  teeth.  On 
laughing,  the  left  corner  of  the  mouth  is  drawn  very  far 
back,  the  right  side  remaining  blank,  and  the  tip  of  the 
tongue  is  then  often  moved  towards  the  left  angle,  but  does 
not  protrude.  There  is  partial  anaesthesia  of  the  right  half 
of  the  body  and  the  right  limbs.  Plantar  reflex  is  good  on 


402 


Medical  Times,  and  Gazette. 


MEDICAL  AND  SURGICAL  PRACTICE. 


Oct.  6,  1883. 


the  left  side,  slight  on  the  right.  Patellar  reflex  is  a  little 
more  than  usual  on  both  sides ;  no  ankle-clonus.  Epigastric 
reflex  good  on  the  left,  slight  on  the  right  side.  The 
optic  discs  are  slightly  pinker  than  usual.  There  is  no 
pain  and  no  wasting  of  any  muscles.  The  bladder  is 
distended,  and  the  urine  runs  away.  The  heart’s  beat 
is  somewhat  forcible,  in  the  fifth  space,  one  inch  within 
the  nipple ;  no  murmurs.  Pulse  100,  full,  soft,  compres¬ 
sible,  regular.  Chest  appears  quite  normal.  No  cough. 
Urine  acid;  specific  gravity  1020  ;  no  albumen;  no  sugar; 
abundant  deposit  of  urates.  The  catamenia  were  present, 
but  scanty,  from  March  3  to  March  10.  Tongue  brown, 
furred;  sordes  on  teeth  and  lips.  Takes  milk  well;  no 
vomiting.  Abdomen  normal.  Ordered  ten  grains  of  iodide 
of  potassium  in  camphor-water  every  four  hours ;  milk 
diet ;  water-bed.  Urine  to  be  drawn  off  thrice  daily. 

March  19. — Has  not  spoken  since  admission,  nor  has  she 
nodded  or  shaken  the  head  in  answer.  Two  or  three  times 
has  made  sounds  expressing  disapproval. 

20th. — This  morning  said  “No”  to  the  nurse.  Dr.  Fagge 
considers  the  heart  perfectly  normal,  and  thinks  there  is 
slight  optic  neuritis  on  both  sides. 

23rd. — Slightly  more  movement  of  right  leg  on  irritation 
by  tickling  or  pricking.  Bowels  not  opened  since  admission. 
Ordered  three  grains  of  calomel  and  a  soap  enema,  which 
resulted  in  a  copious  evacuation. 

24th. — Slight  voluntary  movement  of  right  leg.  Occa¬ 
sionally  says  “  No  ”  when  asked  questions.  Puts  the  tongue 
fairly  out,  the  tip  turning  slightly  to  the  right.  Seems 
happy,  and  frequently  laughs  at  her  attempts  to  speak. 

26th. — Passed  urine  voluntarily. 

27th. — Can  move  the  right  leg  more  freely;  looks  more 
intelligent,  and  answers  “  No  ”  to  everything,  but  differently 
when  she  means  “  Yes.”  Makes  several  attempts  to  say 
other  things,  but  without  result,  and  equally  fails  in  the 
use  of  gesture. 

28th. — Temperature  98-2° ;  pulse  80 ;  respirations  18. 

On  the  day  of  admission  the  temperature  was  100-2°,  but 
for  the  next  week  it  was  between  98°  and  99° ;  the  pulse 
mostly  between  80  and  95.  With  the  transfer  of  the  clinical 
wards  at  the  end  of  the  month,  she  came  under  Dr.  Taylor’s 
care. 

On  April  2  a  change  took  place.  At  8.30  a.m.  she  had  a 
fit,  in  which  she  became  quite  unconscious,  and  was  con¬ 
vulsed.  She  rolled  about  in  bed,  kicking,  moaning,  and 
crying,  with  frothy  saliva  running  from  the  mouth.  She 
continued  so  for  some  hours,  taking  no  notice  when  spoken 
to,  so  that  she  would  not  open  her  mouth,  or  put  out  her 
tongue,  or  take  any  food  whatever.  In  this  condition,  ankle- 
clonus  was  well  marked  on  the  right  side,  and  present,  but 
less  pronounced,  on  the  left.  Plantar  reflex  was  good,  and 
patellar  reflex  excessive,  resulting  in  clcnus  on  the  right 
side. 

April  4. — The  condition  has  continued  the  same.  She 
usually  lies  quite  quietly  on  her  back,  taking  no  notice,  the 
eyes  open,  and  staring  vacantly  before  her.  From  time  to 
time  she  sobs  and  moans,  and  moves  the  legs  about.  Ankle 
and  knee  clonus  are  still  present.  The  urine  is  of  orange 
colour,  cf  specific  gravity  1015,  depositing  lithates,  free  from 
albumen  and  sugar. 

5th. — Patient  still  unconscious  ;  the  breathing  stertorous, 
and  usually  very  rapid.  Deviation  of  head  and  eyes  to  left 
side.  Ankle-clonus  and  patellar  reflex  now  scarcely  percep¬ 
tible,  and  abdominal  reflexes  absent.  Morning  temperature 
98‘4° ;  evening  temperature  99-6°. 

6th. — Morning  temperature  99°;  evening  temperature 
102-4° ;  pulse  120. 

7th. — Slightly  more  conscious.  Follows  moving  objects 
with  her  eyes,  but  makes  no  response  to  questions  ;  will  not 
put  out  her  tongue,  nor  swallow  any  food.  Respiration  is 
entirely  costal,  the  anterior  abdominal  wall  being  retracted 
with  each  respiration.  The  optic  discs  were  rather  more 
generally  red  than  normal,  and  perhaps  the  edge  was  a  little 
blurred.  Dr.  Taylor  thought  the  change  did  not  amount  to 
evidence  of  optic  neuritis.  Temperature  103°  in  the  morn¬ 
ing  ;  107°  in  the  evening.  Nutrient  enemata,  many  of  which 
are  not  retained. 

8th. — Morning  temperature  98-4° ;  evening  temperature 
99-2°. 

9th. — Morning  temperature  99-4°;  evening  temperature 
102-4°. 

10th. — Decidedly  more  conscious.  Took  hold  of  one’s  stetho¬ 


scope  with  the  left  hand,  and  tried  to  pull  it  away.  Slight 
patellar  reflex  on  the  right  side.  Morning  temperature  101° ; 
evening  temperature  101-4° ;  pulse  140  to  160. 

11th. — Uses  the  left  arm  much  more  freely,  putting  the 
hand  to  the  mouth  and  eye,  and  interfering  with  the  thermo¬ 
meter  or  stethoscope  when  used.  She  now  passes  nearly  all 
the  enemata  with  her  motions.  To-day  she  is  fed  with  a 
nasal  tube.  Some  milk  was  placed  in  her  mouth,  but  she 
did  not  make  any  effort  to  swallow  it,  and  it  ran  out.  There 
is  well-marked  tache  cerebrate  on  the  abdomen.  Morning 
temperature  99° ;  evening  temperature  101°. 

12th. — Is  fed  partly  by  the  nasal  tube,  partly  by  enemata. 
The  pulse  and  circulation  have  been  getting  more  and  more 
feeble.  Yesterday  the  right  foot  was  cold  and  blue ;  to¬ 
day  both  right  leg  and  right  hand  are  cold  and  mottled 
with  purple.  Pulse  120  ;  respirations  52  ;  temperature  101-8°. 
Death  at  5  p.m. 

The  following  is  Dr.  Mahomed’s  account  of  the  Post¬ 
mortem  Examination  made  by  him  twenty-one  hours  after 
death  : — Body  rather  spare.  Cranial  bones  not  diseased, 
but  calvaria  very  thin  and  translucent  along  each  side  of 
the  median  line.  Dura  mater  and  sinuses  normal.  No 
disease  of  petrous  bone.  A  considerable  increase  of  the 
cerebro- spinal  fluid,  but  no  signs  of  meningitis  and  no 
tubercle.  No  discharge  from  the  ears.  The  brain  weighed 
forty-eight  ounces.  The  left  temporo- sphenoidal  lobe  and 
the  convolutions  above  the  Sylvian  fissure  and  at  the  base  of 
the  fissure  of  Rolando  felt  soft,  and  on  exposing  the  centrum 
ovale  majus  on  the  left  side,  the  grey  matter  of  the  convolu¬ 
tions  was  softened  in  an  irregular  manner,  especially  that  of 
the  parietal  convolutions,  while  the  frontal  were  but  little 
affected.  At  a  lower  level  the  parietal  convolutions  were  quite 
broken  down  and  diffluent,  and  the  white  matter  was  invaded. 
Transverse  sections  were  now  made  through  the  basal 
ganglia.  These  showed  a  patch  of  softening  in  the  white 
and  grey  matter  of  the  anterior  frontal  convolutions,  and 
from  this  point  a  large  area  of  softening  passed  backwards 
below  the  level  of  the  roof  of  the  lateral  ventricle  in  the 
cerebral  hemisphere.  The  temporo-sphenoidal  lobes,  the 
island  of  Reil,  and  the  lower  part  of  the  ascending  parietal 
convolution  were  almost  diffluent,  and  the  softening  ex¬ 
tended  inwards  through  white  matter  to  reach  and  involve 
the  posterior  part  of  the  extra- ventricular  nucleus  of  the 
corpus  striatum.  Other  parts  of  the  central  ganglia  on 
this  side  escaped,  but  the  only  convolutions  free  were  the 
occipital.  On  the  right  side  the  convolutions  were  healthy, 
except  the  island  of  Reil,  where  a  patch  of  softening  com¬ 
menced,  involving  the  claustrum,  external  capsule,  and  the 
outer  half  of  the  lenticular  nucleus,  where  there  was  a  highly 
vascular,  almost  hemorrhagic  patch,  surrounded  by  yellow 
softening.  Farther  back  the  softening  was  confined  to  this 
area.  The  ventricles  were  not  distended,  and  contained  only 
a  small  quantity  of  fluid.  The  arteries  of  the  left  side  con¬ 
nected  with  the  brain  itself  were  perfectly  healthy  and  free 
from  clot,  but,  on  examining  the  internal  base  of  the  skull, 
the  left  internal  carotid  was  found  to  be  firmly  occluded  with 
ante-mortem  clot.  The  clot  had  obviously  been  divided  in  re¬ 
moving  the  brain,  and  that  in  the  distal  portion  of  the  vessel 
connected  with  the  brain  had  fallen  out.  The  internal  carotid 
through  its  whole  extent  was  full  of  clot,  which  extended  down 
the  common  carotid,  and  appeared  to  reach  as  far  as  the 
aorta.  The  clot  was  firm,  dry,  and  laminated,  slightly  ad¬ 
herent  to  the  vessel-wall,  and  very  clearly  of  some  consider¬ 
able  age.  In  some  places  the  centre  was  softened.  Several 
branches  of  the  external  carotid  were  examined,  and  found 
to  be  free  from  clot.  On  the  right  side  the  middle  cerebral 
artery  at  one-eighth  of  an  inch  from  its  origin  was  com¬ 
pletely  occluded  by  a  firm  ante-mortem  clot.  The  heart 
weighed  seven  ounces,  and  was  quite  normal.  The  valves 
were  perfectly  healthy,  and  there  were  no  relics  of  clot 
in  the  auricles,  such  as  might  have  given  origin  to  emboli. 
Both  the  lungs  were  somewhat  cedematous,  but  otherwise 
healthy,  and  there  were  some  old  pleural  adhesions  at 
the  back  of  the  left  lung.  The  larger  bronchi  were  some¬ 
what  congested,  and  contained  some  blood-stained,  frothy 
secretion.  There  were  yellow  caseous  glands  below  the 
bifurcation  of  the  trachea,  and  some  extended  upwards 
and  along  the  trachea  to  the  neck.  Liver  forty-one  ounces, 
healthy.  Spleen  three  ounces  and  a  half.  Stomach':  Dif¬ 
fused  emphysema  beneath  the  mucous  membrane,  probably 
post-mortem ;  the  lower  part  of  the  ileum  hypersemic,  other¬ 
wise  normal ;  supra-renal  capsules  and  kidneys  healthy,  the 


Medical  Times  and  Gazette. 


SPEECH-DAY. 


Oct.  6. 1883.  103 


latter  weighing  eight  ounces.  There  were  a  few  ecchymoses  of 
the  mucous  membrane  of  the  bladder.  The  vagina  was  very 
hypersemic ,*  the  upper  part  was  coated  with  muco-pus,  below 
which  there  was  intense  hyperemia —  apparently  a  gonorrhoea. 
The  purulent  discharge  continued  on  to  the  os  uteri,  but 
ceased  within  the  lip ;  and  the  cervix  contained  a  jelly- 
like  mucus.  The  vulva  was  examined  after  removal  of  the 
vagina  :  it  was  difficult  to  speak  with  certainty  of  the  con¬ 
dition  of  the  hymen  ;  the  fourchette  and  a  thin  membrane 
in  front  of  it  were  intact,  and  the  ostium  was  of  fair  size. 
Attached  to  a  fold  of  the  broad  ligament,  half  an  inch  from 
the  extremity  of  the  Fallopian  tube  on  each  side,  were  two 
delicate  bands  one  inch  and  five-eighths  long,  from  which 
two  little  cysts  were  suspended,  three-eighths  of  an  inch 
in  diameter.  These  were  perfectly  symmetrical.  The  left 
common  iliac  vein  contained  a  large  thrombus,  one  inch 
long,  filling  it  just  below  the  point  of  bifurcation.  It  was 
pale  and  corrugated  on  the  surface.  The  remainder  of  the 
vessel  and  the  femoral  vein  were  filled  with  recent  black 
clot. 

Remarks  (by  Dr.  Taylor). — The  above  case  is  interesting 
in  many  particulars.  The  symptoms  which  first  appeared 
would  have  been  readily  explained  by  embolism  of  the  left 
middle  cerebral  artery ;  but  the  absence  of  any  source  of  an 
embolus,  the  freedom  from  rheumatism  or  chorea,  and  the 
healthy  condition  of  the  heart,  raised  a  difficulty,  and  led 
one  to  consider  if  other  pathological  conditions  might  not  be 
present.  Even  after  death  it  was  not  clear  to  what  the 
embolism  and  thrombosis  were  due,  for  the  heart  was  quite 
normal,  and  the  only  thing  that  could  be  suggested  as  a 
factor  was  the  extensive  vaginitis,  which  was  not  known  to 
exist  during  life.  Serious  alterations  of  the  blood  are 
possible  in  connexion  with  suppuration ;  and  pyaemia  and 
ulcerative  endocarditis  have  resulted  from  gonorrhoea  in 
the  male ;  while  the  liability  to  thrombosis  in  the  puerperal 
state  is  well  known.  It  therefore  seems  probable  that  the 
vaginitis  was  the  cause  of  an  alteration  of  the  blood,  which 
led  to  its  coagulation  in  the  vessels.  It  will  be  seen  that 
in  the  history  of  her  illness  nothing  was  said  of  any 
trouble  about  the  generative  organs,  but  for  some  time 
previous  to  the  cerebral  attack  she  had  been  unwell,  and  it 
may  be  suggested  that  her  malaise  and  mental  depression 
were  caused  by  the  existence  of  this  local  trouble.  Such  ex¬ 
tensive  clotting  of  blood  in  the  carotid  artery  is  very  unusual, 
but  it  does  not  appear  to  have  led  to  any  special  symptoms 
during  life,  such  as  local  pain,  beyond  those  due  to  the 
obstruction  to  the  cerebral  circulation.  The  vessel  was  not 
specially  examined  with  the  finger,  and  though  the  discovery 
of  an  absence  of  pulsation  would  have  assisted  the  diagnosis, 
one  can  scarcely  expect  that  this  condition  will  be  frequently 
enough  present  to  make  a  systematic  examination  of  the 
carotids  of  great  value  in  diagnosis.  As  to  the  course  of 
the  symptoms,  the  lesion  on  the  left  side  of  the  brain  must 
have  arisen  first,  and  led  to  the  right  hemiplegia  and  aphasia ; 
and  the  fit  of  April  2  was,  no  doubt,  caused  by  the  implica¬ 
tion  of  the  right  side  of  the  brain.  Though  there  was  such 
extensive  softening,  it  is  noticeable  to  what  a  small  extent 
the  motor  centres  and  tracts  were  involved ;  and  it  is  no 
doubt  to  this  that  we  must  ascribe  the  great  improvement 
in  the  use  of  the  right  arm  and  leg  previous  to  the  second 
attack,  and  the  persistence  of  power  in  the  left  limbs  to  the 
end.  No  special  examination  was  made  for  a  local  cause  for 
the  paralysis  of  the  diaphragm. 


Yellow  Fever  in  Mexico. — Yellow  fever  has  been 
causing  fearful  ravages  at  Guaymas,  in  Mexico.  According 
to  a  despatch  dated  September  17,  the  inhabitants  were 
fleeing  from  the  country,  and  the  city  was  a  veritable  city  of 
the  dead.  Medical  assistance  was  being  recruited  from  all 
parts.  The  burying  of  the  victims  of  the  outbreak  was  left 
almost  entirely  to  hired  Indians,  and  it  was  feared  that  many 
of  the  persons  attacked  had  been  removed  to  the  place  of 
interment  before  they  were  actually  dead,  as  it  was  believed 
that  the  Indians  could  not  discriminate  between  the  coma¬ 
tose  state  which  the  patients  are  invariably  in  when  the 
favourable  turning-point  has  arrived,  and  death  itself. 
Yellow  fever  was  also  reported  to  be  raging  at  other  adjacent 
places.  It  was  said  the  ravages  of  the  disease  at  Mazatlan 
were  even  greater  than  at  Guaymas.  All  the  people  who 
could  walk  or  crawl  made  their  way  to  the  mountains,  taking 
with  them  their  bedding  and  whatever  food  they  could  pack. 


TEEMS  OF  SUBSCEIPTION. 


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The  Colonies  and  the  United  7 
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yy  >>  » 

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y> 


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efoical  Crates  anti  §ag#e. 


SATUEDAY,  OCTOBEE  6,  1883. 


SPEECH-DAY. 

The  witty  author  of  “  John  Bull  et  son  He,”  astonished, 
like  other  foreigners,  at  the  survival  of  the  old-world 
pageantry  of  the  Lord  Mayor’s  Show,  concludes,  with  a 
truly  French  audacity,  that  the  English  have  a  special 
affection  for  their  ancient  customs.  That  may,  perhaps, 
be  true  of  the  upper  and  lower  crusts  of  society,  with  their 
Court  ceremonials  and  Foresters’  fetes,  but  it  is  not  true 
of  the  great  middle-class,  whose  cold  puritanism  has  for  so 
many  generations  thrown  its  shadow  over  the  once  rich  and 
joyous  English  life.  Of  them  it  may  be  said  with  truth,  that  if 
they  have  any  love  for  ancient  custom,  it  is  only  after  their 
iconoclastic  hands  have  stripped  it  of  every  vestige  of  pomp 
and  circumstance.  But  with  the  rise  of  the  lower  classes 
into  influence,  and  the  consequent  craving  for  a  more 
emotional  life,  the  pendulum  is  beginning  to  swing  back, 
and,  instead  of  denouncing  ail  pageantry  and  the  feelings 
it  excites  as  childish  things  which  we  are  old  enough  to 
have  put  away,  many  are  inclined  to  admit  that  we  may 
have  dismantled  the  nursery  too  soon,  and  that  toys  may 
still  have  their  uses  even  for  a  nation  so  advanced  in  years 
as  our  own.  It  cannot  be  that  the  ordered  pomp  and 
dignified  ceremony,  which  almost  all  known  nations  and 
tribes  of  earth  have  with  one  accord  religiously  preserved, 
have  no  appropriateness  for  us,  or  that  we,  with  our  still 
large  proportion  of  uncivilised  citizens,  can  afford  to  think 
lightly  of  the  loyalty  and  enthusiasm  which  their  impres¬ 
siveness  may  arouse  or  strengthen.  Kept  within  due 
bounds,  the  magnetic  emotion  induced  in  masses  of  men 
met  together  with  one  common  object  must  have  its  uses  as 
well  as  its  delights ;  and  the  science  of  the  day,  by  reveal¬ 
ing  the  closeness  of  the  tie  that  binds  us  to  men  of  other 
ages  and  other  climes,  should  give  pause  to  our  arrogant 
assumption  of  superiority,  and  warn  us  that  we  have  pos¬ 
sibly  been  too  hasty  in  discarding  time-honoured  and  once 
widely  valued  means  of  moral  edification. 

One  pretence  to  ceremonial  observance,  and  one  only,  does 


404 


Medical  Times  and  Gazette. 


MECHANICAL  DYSMENORRHCEA. 


Oct.  6, 18£3. 


the  medical  profession  in  its  collective  capacity  retain,  namely, 
the  introductory  addresses  at  the  medical  schools.  And,  with 
the  above  general  remarks  in  view,  it  may  be  worth  asking 
whether  it  might  not  have  been  better  for  the  self-respect 
and  solidarity  of  the  profession  if,  instead  of  studiously 
minimising  the  formality  of  our  opening  ceremonial,  or, 
with  a  confessed  inability  to  cope  with  students’  riotousness, 
converting  it  into  a  nondescript  evening  entertainment  with 
a  foreign  name,  an  opposite  policy  had  been  pursued,  and 
every  effort  been  made  to  increase  its  impressiveness  by  a 
calculated  addition  of  dignity  and  circumstance.  That  some 
doubt  of  this  nature  has  been  already  felt  is  evident  from 
changes  which  have  been  recently  initiated  in  connexion 
with  the  October  inauguration  in  more  than  one  London 
school.  But  the  power  of  one  great  name,  be  it  as  widely 
known  as  that  of  the  President  of  the  Royal  Society,  or  the 
President  of  the  Medical  Council,  is  not  in  itself  sufficient 
to  overcome  an  inertia  that  is  the  growth  of  years.  It  needs 
the  enthusiastic  co-operation  and  determination  of  all. 

It  is  possible  to  imagine  a  grave  and  impressive  ceremony, 
where  the  untimely  exuberance  of  youth  should  be  duly 
overawed,  and  the  grave  and  reverend  seniors  of  the  school 
should  file  in  amidst  the  solemn  silent  feeling  of  all  that 
a  function  of  some  meaning  was  being  celebrated  at  that 
hour,  not  only  there,  but  in  every  medical  school  throughout 
the  country.  It  is  possible  to  imagine  the  most  bent  and 
worn  of  past  students  leaving  their  ingle-nook  to  wave  a 
kindly  greeting  to  the  new  generation ;  it  is  possible  to 
imagine  the  most  busy  and  successful  of  past  teachers 
robbing  their  patients  of  this  one  afternoon,  and  putting 
their  school  and  their  successors  under  one  more  obligation 
to  them  ;  it  is  possible  to  imagine  those  successors  looking 
eagerly  forward  to  this  ceremony  as  a  solemn  recognition  of 
past  labours,  and  a  solemn  inauguration  of  labours  to  come. 
Given  all  this,  and  the  students  would  be  quiet  and  reverent 
enough,  for  reverence  is  easy  to  youth  if  it  is  only  shown 
something  to  revere.  Then,  when  the  places  were  all  duly 
taken,  one  might  see  some  veteran,  whose  labours  had 
won  him  wide  respect,  come  gravely  forward  and,  in  a  few 
simple  and  heartfelt  words,  welcome  the  newly  enlisted 
students,  and  felicitate  them  on  their  initiation  into  the 
sacred  art  and  mystery  of  medicine.  Perhaps,  too,  he 
might  go  on,  in  brief  and  unstilted  phrases,  to  remind  them 
of  the  great  dead — of  Hippocrates,  Harvey,  Sydenham, 
Bright,  and  others, — who  still,  in  spite  of  all  change  in 
our  methods  of  research,  remain  the  honoured  exemplars  of 
our  calling.  And  then,  with  a  few  words  on  that  special 
school,  begging  for  it  the  loyalty  and  love  of  all,  he  would 
have  ended,  and  the  assembly  would  disperse  with  a  feeling 
of  seriousness,  if  not  of  awe.  Can  anyone  not  trained  in 
the  school  of  burlesque  doubt  for  a  moment  that  a  ceremony 
of  that  sort  would  knit  together  the  disjointed  members  of 
our  profession,  and  start  them  on  their  year’s  journey  with 
a  new  sense  of  its  honourableness  and  homogeneity  P 
Contrast  it  with  what  we  now  see  every  first  of  October. 
The  students  clamorous,  disrespectful,  and  eager  to  cheer 
the  most  trivial  incident  and  most  threadbare  jest;  the  staff 
too  often  wearied  and  uncomfortable  at  having  to  play  a 
part  in  what  they  honestly  believe  to  be  a  hollow  ceremony ; 
the  lecturer  apologetic,  either  from  a  deep-seated  doubt  as 
to  the  utility  and  reality  of  the  proceedings,  or  from  a  fear 
that  his  remarks,  which  have  been  written  for  readers,  and 
not  for  listeners,  will  fail  of  general  apprehension — every¬ 
one  anxious  that  the  whole  affair  should  be  speedily  over, 
to  make  way  for  the  pleasant  and  unrestricted  greetings  of 
old  friends,  which  now  are  apt  to  form  the  only  redeeming 
feature  of  these  annual  events.  We  are  met  with  com¬ 
plaints  on  every  hand  that  the  profession  is  so  ununited, 
and  has  so  little  momentum  for  its  State  function ;  that  men 


have  such  slight  respect  and  fondness  for  their  Alma  Mater  ; 
while,  as  a  curiously  apt  commentary  on  this  state  of  things, 
the  address  which  excited  more  attention  than  almost  any 
other  that  has  been  delivered  within  the  past  ten  years  was 
one  in  which  the  lecturer  solemnly  condoled  with  the  new 
students  on  having  joined  a  profession  which  has  so  little 
to  offer  them.  Why,  what  can  we  expect  of  our  younger 
brethren  if  we  allow  them  to  see  the  one  most  solemn 
occasion  of  their  career  treated  with  such  cynicism  P  How 
can  we  blame  them  for  regarding  themselves,  and  their  call¬ 
ing,  and  each  other  with  so  little  respect,  if  we  do  not  show 
them  that  we  are  proud  of  the  inherent  dignity  of  the  profes¬ 
sion,  and  determined  to  clothe  that  dignity  with  appropriate 
ceremoniousness  ?  But  dignity  is  impossible  without  faith, 
be  it  but  faith  in  the  increase  of  science  as  an  ideal  good, 
which  Professor  Lankester  has  so  eloquently  lauded ;  and 
if  we  see  the  public  veiling  its  eyes  when  it  scatters  its 
rewards  upon  us,  and  stopping  its  ears  when  we  have  aught 
to  say  to  it,  we  can  hardly  complain,  while  we  ourselves  mani¬ 
fest  such  scepticism  as  to  the  validity  of  our  claims  as  minis¬ 
ters  of  truth,  and  seem  so  little  disposed  to  give  due  weight 
and  impressiveness  to  our  single  ceremonial  observance. 


MECHANICAL  DYSMENOREHCEA. 

We  recently  called  attention  to  the  researches  of  Vedeler(a) 
into  the  supposed  causation  of  painful  menstruation  by 
uterine  flexion.  Bending  of  the  uterus  is,  however,  but  one 
of  the  conditions  which,  it  is  taught,  produce  dysmenorrhcea 
by  mechanically  hindering  the  exit  of  menstrual  blood.  The 
doctrine  has  been  propounded,  that  all  dysmenorrhcea  is  due 
to  obstruction  somewhere,  a  failure  to  find  the  seat  of  the 
obstacle  only  meaning  either  that  the  examination  was 
incomplete,  or  the  examiner  deficient  in  skill  and  acuteness. 
In  the  list  of  causes  to  which  dysmenorrhoea  is  by  these 
theorists  ascribed,  stricture  of  the  cervical  canal,  at  the 
internal  or  external  os,  figures  prominently,  opinions  being 
divided  as  to  which  is  the  more  frequent.  Peculiarities  in 
the  shape  of  the  vaginal  portion  of  the  cervix,  consisting  in 
an  unusually  conical  shape  of  this  part,  combined  with  an 
external  os  which  is  round  instead  of  being  a  slit,  have  been 
pointed  out  as  occurring  in  patients  the  subject  of  the 
disease  under  consideration.  Metrotomes,  at  least  as  big  as 
a  No.  6  or  No.  7  catheter,  have  been  devised  to  be  passed  into 
and  to  cut  the  strictured  internal  os,  but  we  are  not  aware 
that  any  satisfactory  explanation  has  been  given  of  how  it 
is  that  a  canal  which  will  admit  so  large  an  instrument,  yet 
is  insufficient  for  the  transit  of  the  small  quantity  of  blood 
which  forms  the  menstrual  flow.  The  same  criticism  applies 
to  the  treatment  recommended  for  stricture  of  the  os  ex¬ 
ternum.  There  is  this  difference  between  the  two  kinds 
of  stricture  supposed  to  be  so  common.  The  existence  of 
stricture  of  the  internal  os  has  been  by  some  denied  alto¬ 
gether,  except  as  due  to  rare  and  exceptional  causes  ;  whereas 
there  is  no  doubt  that  the  vaginal  portion  of  the  cervix 
uteri  is  not  always  the  same  in  shape,  and  that  the  external  os 
varies  in  size  in  different  women.  It  is  assumed  that  where 
the  os  is  small,  menstruation  is  painful — the  pain  being  due 
to  obstruction  resulting  from  the  smallness  of  the  orifice. 

In  the  communication  of  Y edeler  to  which  we  have  referred, 
he  considers  this  theory.  He  points  out  that,  as  in  the 
subject  of  flexions,  so  with  regard  to  a  small  external  os, 
investigation  has  been  one-sided.  Only  patients  who  were 
suffering  have  been  examined ;  and  because  in  some  of  them 
a  peculiar  conformation  of  the  cervix  uteri  was  observed, 
surgical  gynaecologists  have  jumped  to  the  conclusion  that 
the  pain  resulted  from  the  shape  of  the  cervix.  Before  this 
inference  ought  to  have  been  even  provisionally  accepted,  it 
(a)  Archiv  Jiir  Gyniikologie,  Bd.  xxi  ,  zweiter  Heft. 


•Medical  Times  and  Gazette. 


A  EADICAL  FAULT  IN'  OUE  EEFORMATOEY  SYSTEM. 


Oct.  e,  1883.  405 


deeded  to  be  shown  that  the  state  of  cervix  in  question  was 
not  present  in  women  who  menstruate  without  pain.  No 
attempt  has  been  made  to  do  this,  so  far  as  we  know,  before 
"V  edeler  undertook  his  researches. 

In  investigating  the  subject,  the  first  thing  to  be  decided 
is,  what  is  a  small  os?  Yedeler  took  the  ordinary  uterine 
sounds  in  use,  viz.,  Simpson’s  and  Sims’s.  Of  these 
Sims’s  is  the  smaller,  its  knob  measuring  less  than  three 
millimetres  in  thickness.  He  therefore  assumed  that  an 
external  os  through  which  this  instrument  could  only  be 
passed  with  pressure  might  be  properly  called  “  small.” 
One  that  was  only  of  the  bigness  of  a  pin’s  head  he  deno¬ 
minated  “  very  small.”  These  definitions  being  decided 
upon,  Vedeler  proceeded  to  ascertain  the  frequency  with 
which  a  small  os  externum  exists.  Out  of  252  women,  he 
found  15  cases  (or  about  6  per  cent.)  in  which  the  external 
os  was  small  ,•  in  6  it  was  very  small.  In  none  of  these  was 
there  retention  of  menstrual  blood  or  painful  contraction 
of  the  uterus.  In  100  women  who  menstruated  painfully, 
stenosis  was  present  in  9,  a  slightly  larger  percentage  than 
among  those  who  menstruated  without  pain.  But  the  100 
included  only  18  who  had  borne  children,  while  of  the  252, 
in  92  the  os  externum  had  be  en  enlarged  by  childbearing. 
Deducting  these  in  each  case,  the  figures  stand  :  out  of  82 
nulliparous  women  menstruating  painfully,  there  were  9 
cases  of  stenosis  of  the  external  os,  or  10  per  cent. ;  while 
out  of  160  menstruating  without  any  pain,  there  were  15 
such,  or  9  per  cent.,  an  almost  identical  proportion.  These 
figures,  says  Yedeler,  give  reason  for  doubting  whether 
stenosis  of  the  os  externum  has  any  influence  upon  the 
production  of  dysmenorrhcea.  They  confirm  the  teaching 
of  Duncan,  who  says,  “the  smallest  passage  described, 
*  pin-point  os  uteri,’  as  it  is  called,  is  quite  enough  to  allow 
a  hundred  times  as  much  blood  to  pass  as  there  is  any  occa¬ 
sion  for,  or  as  offers  to  pass.”  This  general  assertion  of 
Duncan’s,  of  course,  might  require  modification  by  facts. 
It  is  quite  conceivable  that  a  small  external  os,  though  itself 
-quite  large  enough  to  permit  all  the  menstrual  blood  to  pass, 
might  yet  be  a  malformation  associated  with  other  modifica¬ 
tions  in  the  genital  system  which  should  make  menstruation 
painful.  Theoretical  propositions  must  always  yield  to  the 
results  of  clinical  observation.  But  at  present,  so  far  as 
we  know.  Dr.  Yedeler’s  is  the  only  attempt  to  investigate, 
according  to  a  scientific  method,  the  relation  of  smallness 
of  the  external  os  to  dysmenorrhcea;  and  his  result  is  to 
show  that  the  two  conditions  are  not  connected.  The  only 
objection,  so  far  as  we  can  see,  that  can  be  made  to  his 
method,  and  therefore  to  his  results,  is  the  smallness  of  the 
numbers.  Let  us  hope  that  others  who  still  think  the 
subject  worth  inquiry  will  continue  the  investigation,  and 
.either  confirm  or  refute  Dr.  Yedeler’s  conclusions. 


A  RADICAL  FAULT  IN  OUR  REFORMATORY 
SYSTEM. 

The  twenty-sixth  Report  of  the  Inspector  of  Reformatory 
and  Industrial  Schools  in  Great  Britain,  which  has  been 
published  recently,  contains  a  large  mass  of  interesting 
information  about  these  institutions;  and  yet  it  does  not 
.enable  us  to  judge  in  a  satisfactory  manner  of  their  condi¬ 
tion,  and  of  the  degree  in  which  they  are  fulfilling  the 
expectations  with  which  they  were  founded  and  are  sup¬ 
ported  at  great  public  expense.  The  Inspector  of  these 
schools,  Lieutenant-Colonel  Inglis,  who  is  responsible  for 
the  Report  and  its  elaborate  appendices,  evidently  discharges 
his  duties  with  the  utmost  zeal  and  assiduity,  and  his  failure 
to  supply  a  full  and  instructive  description  of  the  establish¬ 
ments  under  his  supervision  must  be  attributed  not  to  any 
want  of  disposition  on  his  part  to  do  so,  but  to  the  practical 


impossibility  of  his  accomplishing  more  than  he  already  does, 
and  to  the  lack  of  that  special  training  which  would  enable 
him  to  penetrate  beneath  the  surface,  and  get  at  the  very 
core  of  his  subject.  The  preparation  of  the  Report  which 
lies  before  us  might  in  itself  occupy  no  inconsiderable  por¬ 
tion  of  the  official  year  of  one  inspector ;  but,  in  addition  to 
this,  Lieutenant-Colonel  Inglis  has,  with  the  aid  of  one 
assistant,  to  inspect  211  schools  scattered  over  England  and 
Scotland,  and  containing  24,215  juveniles  under  sentence  of 
detention.  Then  the  inspection  of  these  schools  can  only  be 
thoroughly  and  successfully  carried  out  by  a  medical  man. 
It  becomes  more  and  more  evident  that  juvenile  crime  is 
intimately  connected  with  juvenile  disease,  and  that  the  two 
great  highways  leading  boys  and  girls  to  reformatories  and 
prisons  are  inherited  pathological  tendencies  and  parental 
neglect.  “The  fathers  have  eaten  sour  grapes,  and  the 
children’s  teeth  are  set  on  edge,”  or  the  fathers  are  so  much 
engaged  in  drinking  sour  beverages  that  their  children’s 
teeth  decay  for  want  of  the  commonest  attention.  A  glance 
at  a  group  of  reformatory  or  industrial-school  children  con¬ 
vinces  of  this.  Their  stunted  forms,  misshapen  features, 
unhealthy  complexions,  and  strange  furtive  ways,  bear  the 
stamp  of  degeneration  born  in  the  tissues,  or  wrought  in 
them  by  starvation  and  the  deprivation  of  all  those  influ¬ 
ences  that  are  necessary  to  sound,  vigorous  growth  in  the 
earliest  years.  And  degeneration  of  this  kind  tinctures  and 
taints  the  whole  life  of  the  child,  and  can  only  be  arrested 
and  counteracted  by  careful  regimen  and  treatment,  with¬ 
out  which  discipline  and  education  are  comparatively 
useless. 

The  medical  conception  of  their  situation  is,  we  maintain, 
essential  to  the  profitable  and  humane  management  of 
juvenile  offenders,  and  this  conception  can  never  be  properly 
grasped  or  applied  by  a  layman.  And  upon  this  broad 
ground  we  urge  that  the  houses  in  which  such  crowds  of 
these  are  detained  should  be  under  skilled  medical  inspec¬ 
tion.  No  doubt  the  rejoinder  to  this  plea  will  be  that  these 
houses  are  under  medical  inspection,  each  of  them  being 
visited  by  a  medical  man  who  is  in  practice  in  the  neigh¬ 
bourhood.  But  it  is  not  inspection  of  this  kind,  valuable 
although  it  doubtless  is,  that  we  desiderate.  These  visit¬ 
ing  medical  officers  are  appointed  to  treat  the  children  who 
may  be  reported  sick,  and  to  afford  counsel  in  sanitary 
matters  when  it  may  be  asked  of  them ;  but  they  have  little 
or  no  share  in  the  general  administration  of  the  houses, 
and  any  interference  on  their  part  in  the  regulation  of  these 
educational  and  disciplinary  measures,  in  which  they  might 
perhaps  be  most  useful,  would  be  promptly  resented.  They 
have  to  confine  themselves  to  their  duties,  which  are  of  a 
very  circumscribed  description.  Individual  cases  of  illness 
are  handed  over  to  them,  but  the  universal  malady  is  ex¬ 
cluded  from  their  consideration.  Any  pimple  or  corn 
falls  within  their  province,  but  the  whole  heart  that  is 
sick  and  the  whole  head  that  is  sore  must  be  doctored 
by  clergymen,  taskmasters,  and  retired  military  officers. 
It  is  not  medical  inspection  of  this  kind  that  is  needed, 
and  no  extension  of  it  would  meet  our  requirements. 
What  is  imperatively  demanded  is  inspection  by  a  central 
medical  authority  in  immediate  relation  with  the  Govern¬ 
ment,  free  from  local  influences,  capable  of  taking  a  com¬ 
prehensive  and  scientific  view  of  the  problems  that  arise  in 
connexion  with  the  attempts  made  to  redeem  our  little  waifs 
and  strays,  of  generalising  the  experiences  and  experiments 
of  the  various  institutions  in  which  they  are  confined,  and  of 
exercising  a  healthy  control  over  these  institutions. 

And  the  medical  inspection  of  reformatories  and  indus¬ 
trial  schools,  such  as  we  have  indicated,  would  have  many 
specific  advantages  beyond  those  general  ones  which  have 
been  alluded  to.  It  would  afford,  for  instance,  the  best 


Medical  Times  and  Gazette. 


A  RADICAL  FAULT  IN  OUR  REFORMATORY  SYSTEM. 


Oct.  G,  188?. 


406 


guarantee  that  is  obtainable  for  the  humane  treatment  of 
he  children.  It  is  not,  of  course,  insinuated  that  the 
children  are  not  humanely  treated  at  the  present  time. 
Reformatories  and  industrial  schools  are,  we  believe,  con¬ 
ducted  for  the  most  part  in  a  spirit  of  gentleness  and  kind¬ 
ness  ;  but  recent  investigations  in  London  and  Glasgow 
have  shown  that  terrible  abuses  may  spring  up  in  them,; 
and  go  on  long  undetected,  and  that  the  helpless  children 
shut  up  in  them  may  be  subjected  to  cruelty  which  it  is 
shocking  to  think  of.  These  children  are,  no  doubt,  very  1 
trying  to  those  who  rule  over  them.  They  are  unlovely  to 
look  on,  and  destitute  of  those  winning  ways  which  are  such 
a  shield  against  severity  to  better-born  children.  They  are 
dull  and  stolid,  or  insubordinate  and  incorrigible;  they 
requite  kindness  with  contempt,  and  grow  thorns  and 
thistles  where  good  seed  was  planted.  So  disheartening . 
and  provoking  are  they,  so  difficult  to  govern,  so  wayward 
and  wicked,  that  something  more  than  ordinary  good  nature 
and  self-restraint  are  necessary  to  prevent  those  who  have 
the  charge  over  them  from  becoming  austere  or  irritable, 
and  from  adopting  measures  of  unnecessary  rigour.  Anri 
that  something  is,  we  believe,  the  medical  conception  of 
juvenile  delinquency,  impressed  on  all  those  who  have  to  do 
with  it,  and  made  the  guiding  principle  in  the  establish¬ 
ments  which  are  devoted  to  its  eradication  or  cure.  The 
insane  were  treated  with  cruel  repression  so  long  as  they 
were  under  the  care  of  priests  or  laymen,  and  it  was  only 
when  insanity  was  recognised  as  a  disease,  and  when  the 
treatment  of  the  insane  was  relegated  to  medical  men,  that 
the  modern  humane  system  of  lunatic  asylum  management 
was  inaugurated.  And  so  it  may  be  argued  that  only  when 
the  morbid  element  in  juvenile  delinquency  is  recognised, 
and  when  medical  science  is  brought  to  bear  on  the  train¬ 
ing  of  juvenile  delinquents  to  a  larger  extent  than  it  has 
hitherto  been,  will  that  training  be  truly  humane  and  fully 
successful. 

The  need  of  medical  and  scientific  supervision  of  reforma¬ 
tories  and  industrial  schools  may  be  clearly  perceived  in  the 
Report  of  the  present  Inspector,  where  it  is  dealing  with 
the  conduct  and  discipline  of  these  institutions.  A  medical 
inspector  would  unquestionably’regard  it  as  one  of  his  first 
and  most  important  duties  to  obtain  accurate  and  detailed 
returns  of  all  the  punishments  inflicted  on  the  children ; 
but  the  present  Inspector,  while  never  omitting  to  refer  to 
the  subject  in  his  separate  reports  on  each  reformatory, 
does  so  in  such  vague  and  general  terms,  that  it  is  impos¬ 
sible  to  form  any  estimate  whether  the  punishments  em¬ 
ployed  are  judicious  in  number  and  amount,  or  unjustifiably 
severe  and  numerically  excessive.  In  scores  of  instances  we 
are  told  that  there  had  been  “  a  small  average  of  corporal 
punishments,”  “  that  discipline  is  maintained  without  much 
severe  punishment,”  “  that  the  number  of  punishments  have 
been  considerably  below  the  average,”  "  that  the  record  of 
punishment  is  light  ”;  and,  in  many  cases  on  the  other  hand, 
we  are  told  that  the  record  of  punishments  and  offences 
was  of  “  a  serious  character,”  that  there  had  been  “  too  much 
corporal  punishment,”  or  that ,f  the  record  of  punishments 
was  a  heavy  one.”  But  what  does  all  this  mean  ?  Such 
phrases  convey  little  or  no  meaning  unless  we  know  exactly 
what  the  punishments  are,  and  what  is  considered  an  average 
amount  of  punishment.  A  table  should  be  provided,  showing 
the  number  of  punishments  of  each  description  in  every 
school,  and  the  precise  character  of  the  punishment.  As 
regards  corporal  punishment,  the  public  should  be  informed 
by  whom  it  is  inflicted,  in  whose  presence  it  is  inflicted, 
with  what  instrument  it  is  inflicted,  and  what  number  of 
strokes  are  administered.  The  Home  Office  carefully  pre¬ 
scribes  the  weight  of  the  cat  that  is  used  for  the  flogging 
of  garotters,  and  the  public  is  surely  entitled  to  know  the 


length  of  the  birch  and  the  thickness  of  the  strap  that  are 
employed  in  the  chastisement  of  the  hapless  and  badly" 
nourished  children  of  the  State.  The  public  is  surely  en¬ 
titled  to  know  whether  the  practice  of  flogging  with  a  cane 
on  the  bare  back  (a  most  excruciating  and  sometimes 
dangerous  punishment)  is  still  resorted  to  in  some  reforma¬ 
tories.  But  upon  all  such  matters  nothing  is  said  in  the 
Inspector’s  Report.  The  Inspector  himself  is  evidently  in 
favour  of  leniency,  and  everywhere  recommends  a  system  of 
marks,  and  inculcates  the  superiority  of  moral  influences  to 
physical  coercion.  But  he  does  not  appear  to  be  listened  to 
in  all  quarters,  for  we  obtain  through  his  Report  one  or  two 
rather  disquieting  glimpses  behind  the  scenes.  He  alludes 
to  “  cell  cases  ” — whatever  these  may  be,— to  the  committal 
of  numbers  of  juveniles  to  prison  after  they  have  been 
found  incorrigible  under  reformatory  discipline,  to  out¬ 
breaks  of  mutiny  and  general  disaffection,  and  to  instances, 
of  wholesale  desertion.  In  reporting  on  the  Industrial 
Home  for  Girls  at  Ipswich,  he  says  there  have  been  through¬ 
out  the  year  “  many  cases  of  personal  chastisement  carried 
much  beyond  the  ordinary  limits.  I  strongly  object  to 
severe  and  extraordinary  measures  for  the  repression  of  evil 
in  such  schools  in  dealing  with  girls  of  advanced  age.” 
This  and  other  allusions  which  might  be  quoted  satisfy  us 
that  additional  precautions  are  still  needed  in  the  matter  of 
corporal  punishment,  as  a  first  step  towards  which  a  table- 
of  accurate  returns,  such  as  a  medical  inspector  would  have 
insisted  on  long  ago,  is  essential.  The  precaution  adopted 
by  the  Home  Office— a  very  sensible  one — in  requiring  a 
list  of  punishments  to  be  hung  upon  the  wall  of  the  school¬ 
room  of  every  reformatory  or  industrial  school,  is  not  always- 
complied  with. 

But  it  is  not  merely  in  connexion  with  discipline  and' 
conduct  that  the  desirability  of  medical,  in  addition  to  lay,, 
inspection  of  reformatories  and  kindred  institutions  is- 
apparent.  In  every  department  of  the  Report  which  we  are 
considering,  proofs  are  conspicuous  of  the  need  of  such  a- 
reform.  We  have  turned  over  the  volume  in  vain  in  search 
of  information  as  to  the  offences  for  which  children  admitted 
into  reformatories  and  industrial  schools  had  been  convicted 
— an  elementary,  but  important,  matter  in  measuring  the- 
condition  and  utility  of  these  institutions,  and  a  matter 
which  a  doctor  could  scarcely  have  overlooked.  We  have- 
sought,  equally  in  vain,  in  the  paragraphs  dealing  with  the 
state  of  the  premises  in  each  school,  for  information  as  to 
the  cubic  space  allowed  by  day  and  night  to  each  inmate,  as- 
to  the  dormitory  and  sanitary  arrangements.  And  we  have 
not  been  more  fortunate  in  securing  enlightenment  from 
this  Report  as  to  the  educational  system  pursued  in  these- 
schools,  the  hours  devoted  to  study  and  recreation,  or  as  to 
the  relative  proficiency  of  different  classes  of  children  in 
different  kinds  of  school-work.  As  might  have  been  antici¬ 
pated,  the  information  procurable  about  the  health  of  the- 
children  is  still  more  meagre  and  unsatisfactory.  There  is 
no  tabular  statement  of  the  causes  of  death  in  the  123 
children  who  died  in  the  schools  last  year,  nor  of  the  nature- 
of  the  diseases  which  led  to  the  discharge  of  94  children 
last  year,  nor  of  the  amount  and  kind  of  sickness  that 
prevailed  in  the  schools.  There  is  no  reference  to  the 
dietary  in  the  different  schools,  although  this  seems,  if  we 
may  judge  from  the  sums  of  money  expended  on  food,  to 
vary  greatly  in  different  institutions,  and  to  fall,  in  some 
instances,  short  of  what  physiology  would  sanction ;  for  we 
question  whether,  at  the  present  price  of  meat,  milk,  and 
bread,  a  child  can  be  kept  adequately  nourished  at  a  cost  of 
2Jd.  per  day.  Information  on  these  points,  and  on  many 
others  of  vital  significance  which  we  might  mention,  such  as- 
the  height  and  weight  of  the  children  at  various  ages,  might 
very  well  replace  much  of  the  matter  with  which  the  Report 


Medical  Times  and  Gazette. 


DIPHTHERIA  AND  “BOARDING  OUT. 


Oct.  6, 1883.  407 


is  now  loaded — matter  which  is  simply  dull  and  tedious 
iteration. 

Reformatory  and  industrial  schools  are  still  upon  their 
trial ;  and  hence  the  importance  that  we  should  know  truly 
the  quality  and  quantity  of  the  work  which  they  are  doing. 
They  grow  apace, — at  the  end  of  1864  they  contained  5954 
inmates,  and  at  the  end  of  1882,  24,215, — and  hence  again  the 
importance  of  gauging  their  value  as  reformatory  agencies, 
so  that  we  may  decide  whether  they  are  to  be  permitted 
to  expand,  or  whether  some  new  departure  should  be  tried. 
It  is  by  no  means  an  established  truth  that  the  segregation 
of  herds  of  depraved  children  in  institutions  by  themselves, 
where  they  are  exposed  to  the  general  diffusion  of  vice,  and 
are  deprived  of  all  the  holpening  and  saving  influences  that 
•cluster  round  a  home,  however  humble,  is  the  best  way  to  win 
them  back  to  the  higher  life.  Public  convenience  will  always 
make  it  necessary  to  maintain  this  system  to  a  certain  extent, 
and  for  the  worst  cases ;  but  it  is  quite  another  question 
how  far  it  should  be  permitted  to  extend  and  draw  into  its 
net  not  only  deep-dyed  little  sinners,  but  the  ill-disposed 
offspring  of  idle,  negligent,  and  dissipated  parents,  who  are 
only  too  glad  to  transfer  their  natural  obligations  from  their 
•own  shoulders  to  those  of  the  public. 

It  has  been  our  purpose  to  point  out  the  omissions  and 
shortcomings  which  are  discoverable  in  the  Report  of  the 
Inspector  of  Reformatories  and  Industrial  Schools — omis¬ 
sions  and  shortcomings  which  only  medical  assistance  can 
remove — rather  than  to  dwell  on  its  merits  and  excellences. 
W e  cannot  conclude  our  notice,  however,  without  acknow¬ 
ledging  these.  A  thoroughly  humane  and  wholesome  spirit 
pervades  the  Report,  and  the  Inspector  and  his  assistant 
Rave  evidently  at  heart  the  welfare  and  happiness  of  the 
inmates  of  the  institutions  which  they  supervise.  The  visita¬ 
tion  of  the  individual  institutions  is  carried  out  with  great 
eare  and  minuteness,  and  the  descriptions  given  of  them  are 
lucid  and  instructive.  Many  practical  suggestions  of  great 
value  are  offered,  such  as  those  referring  to  the  admission  of 
reformatory  boys  into  the  Royal  Navy,  and  to  the  custody 
of  children,  more  especially  girls,  on  their  discharge  from 
reformatories  and  industrial  schools.  With  the  addition  of 
one  able  and  well-qualified  medical  inspector  the  department 
of  reformatories  and  industrial  schools  would  be  an  eminently 
■useful  branch  of  the  public  service. 


DIPHTHERIA  AND  “BOARDING  OUT.” 

Eor  many  months  past,  we  are  told,  diphtheria  has  been 
present  in  the  suburban  districts  of  Hendon  and  Mill  Hill. 
No  efforts  seem  to  have  been  spared  to  stamp  out  the  dis¬ 
ease,  every  means  of  prevention  having  been  adopted,  and 
the  Local  Government  Board  having  sent  an  inspector,  in 
January  last,  to  investigate  the  causes  and  centres  of  the 
outbreak.  In  the  Hendon  district  the  widespread  use  of 
milk  from  an  infected  dairy  was  assigned  as  the  cause  of  the 
epidemic,  and  the  measures  adopted  were  so  far  effectual 
that  the  disease  was  obliterated  in  that  locality.  In  Mill 
Hill,  however,  four  miles  distant,  diphtheria,  of  a  more  or  less 
virulent  type,  has  existed,  in  a  sporadic  form,  ever  since. 
Here,  too,  all  efforts  have  been  made  to  efface  it,  but  without 
any  marked  success.  No  valid  explanation  of  this  unusual 
tenacity  of  the  complaint  has  been  given,  and  the  Local 
Government  Board  have  been  requested  to  make  the  matter 
the  subject  of  another  special  inquiry.  So  far,  however, 
this  request  has  not  been  complied  with,  and  at  a  meeting, 
on  September  24,  of  the  Hendon  Local  Board  the  medical 
officer  and  other  members  of  the  Board  professed  themselves 
as  "  baffled  ”  in  tracing  the  origin  of  the  disease.  Up  to 
this  point,  we  can  only  sympathise  with  the  inhabitants  of 
Mill  Hill,  and  with  the  medical  officer,  in  the  failure  of  such 


patient  and  unfruitful  exertions  ;  but,  at  the  meeting  referred 
to,  some  statements  were  made,  and  explanations  offered,  for 
the  persistence  of  the  epidemic,  which  involve  other  issues 
and  call  for  more  extended  remark. 

It  seems  that  the  practioe  has  obtained  of  sending  con¬ 
valescent  patients  from  the  East  London  Hospital  for 
Children,  at  Shadwell,  to  complete  their  recovery  in  the 
cottages  of  the  Mill  Hill  district,  the  expenses  of  their 
board  and  lodging  being  defrayed  by  a  special  fund  for  the 
purpose.  This  plan,  under  proper  precautions,  would  seem 
both  desirable  for  the  patients,  and  innocuous  to  the  neigh¬ 
bourhood  concerned.  We  say  “  under  proper  precautions,” 
and  presume,  in  our  remarks  on  this  head,  that  tjie  most 
complete  and  careful  safeguards  against  the  spread  of  in¬ 
fectious  diseases,  under  skilled  and  responsible  medical 
supervision,  both  in  hospital  and  cottage,  should  be  a  con¬ 
stant  and  essential  part  of  the  system.  No  one  can  doubt 
that  extreme  benefit  would  accrue  to  a  large  number  of 
children,  convalescent  from  a  children’s  hospital,  and  free 
(as  far  as  foresight,  care,  and  precaution  can  go)  from  any 
taint  of  infectious  disease,  from  spending  such  few  weeks 
as  may  be  necessary  to  re-establish  their  health  in  the  pure 
air  and  among  the  good  sanitary  conditions  of  some  rural 
or  suburban  neighbourhood,  where  they  can  be  safely  and 
economically  placed.  No  one  who  has  been  connected  in  any 
way  with  children’s  wards  or  hospitals  but  must  have  felt  how 
incomplete  and  unsatisfactory,  after  all,  was  the  work  done 
when  the  pale  and  emaciated  little  patient  was  discharged 
from  the  hospital  ward — cured,  no  doubt,  so  far  as  medicine 
in  such  surroundings  can  accomplish  cure,  but  still  in  no 
such  condition  as  could  be  described  by  the  term  “  good 
health  discharged,  too,  into  such  close  and  unsavoury 
courts,  to  partake  of  such  meagre  and  unsuitable  food,  and 
to  miss  so  greatly  the  kind  care  and  cleanliness  of  the 
hospital,  that  no  further  improvement,  but  an  actual  dete¬ 
rioration  of  health  will  be  the  most  likely  and  reasonable 
outlook  for  the  future.  Could  every  child  discharged  from 
a  London  hospital  be  drafted  into  such  a  seaside  conva¬ 
lescent  home  as  those  which  do  exist,  though  in  such  insuf¬ 
ficient  numbers,  to  reap  the  rich  hygienic  advantages  which 
such  sanatoria  afford,  many  a  life,  no  doubt,  would  be  saved, 
many  a  relapse  avoided,  many  a  child  restored,  healthier, 
happier,  and  with  more  hopeful  prognosis,  to  its  home. 
But  this  is  an  Utopian  dream  which  is  far  indeed  from 
present  realisation,  an  outlet  and  an  aim  for  charitable 
impulse  and  energy  which  has  commended  itself  but  too 
little  to  the  liberality  of  donors  and  .testators.  So,  appa¬ 
rently,  deemed  the  kind  soul  who  afforded  or  collected  the 
means  for  boarding  out  these  little  patients  in  private 
cottage  homes  in  Mill  Hill  and  elsewhere.  The  good  which 
has  been  so  done  is  incalculable,  but,  from  the  report  of  the 
speeches  at  the  meeting  in  question,  there  seems  to  be 
danger  lest  it  should  be  lost  sight  of. 

Is  there  any  valid  foundation  for  the  outcry  made  by  the 
Hendon  Local  Board  and  their  medical  officer  ?  Has  the 
presence  of  the  epidemic  in  question  been  in  any  way  due  to 
the  importation  of  the  convalescent  children  ?  What  are  the 
facts  of  the  case  ?  Early  in  September  last  a  child  developed 
scarlatina,  two  days  after  having  been  brought  to  Mill  Hill 
from  the  East  London  Hospital ;  and  about  the  same  time 
cases  of  diphtheria  appeared  in  the  district.  No  one,  we 
imagine,  would  contend  that  the  one  could  be  the  cause  of 
the  other,  nor,  we  believe,  does  Dr.  Cameron,  the  health 
officer  of  the  district,  maintain  that  the  scarlatinal  infection 
was  imported  from  the  Children’s  Hospital,  in  which  there 
has  been  no  case  of  the  disease  for  many  weeks.  But  the 
case  seems  to  have  drawn  attention  to  a  possible  channel  of 
contagion,  and  on  inquiry  it  was  found  by  Dr.  Cameron  that 
one  case  of  diphtheria  and  one  of  croup  had  been  sent 


408 


Mjdical  Times  and.  Gazette. 


CHRONICLE  OF  THE  WEEK. 


Ocf.  6, 1S83. 


at  different  times  from  the  East  London  Hospital  to  board 
in  Mill  Hill  cottages.  Much  was  made  of  these  cases,  but 
the  statement  of  the  house-surgeon,  that  the  one  case  had 
been  six  months  and  the  other  three  months  in  hospital 
before  being  sent  out,  appears  somehow  to  have  escaped 
notice  at  the  meeting.  It  is,  however,  a  very  essential 
piece  of  evidence,  and,  unless  we  hold  views  as  to  per¬ 
sistency  of  the  diphtheric  contagion  very  different  from 
those  at  present  current,  is  in  itself  sufficient  to  render 
it  unlikely  a  priori  that  the  epidemic  was  introduced  in 
the  way  hypothesised.  And  when  we  hear  that  it  is  only 
during  the  last  year  that  convalescents  have  been  sent 
from  the  Hospital  to  Mill  Hill,  whereas  diphtheria  has 
been  more  or  less  prevalent  in  the  district  for  nearly  two 
years,  it  is  difficult  to  believe  that  even  Dr.  Cameron  him¬ 
self  can  attach  much  importance  to  this  unlikely  channel  of 
infection.  We  are  afraid  the  Hendon  Local  Board  and  their 
medical  officer  must  try  again.  The  epidemic  appears  to  be 
one  in  which  a  rigorous  scientific  investigation  is  necessary, 
especially  if  it  be  true,  as  stated,  that  one-fourth  of  the 
infant  population  have  died  of  it.  Meanwhile,  it  will  be  well,  if 
only  for  the  sake  of  their  little  patients,  that  the  authorities 
of  the  East  London  Hospital  should,  as  Dr.  Cameron  sug¬ 
gests,  discontinue  the  present  practice  of  boarding  their 
convalescents  among  the  cottagers  at  Mill  Hill. 


CHRONICLE  OF  THE  WEEK. 


The  Medical  Session  has  begun  in  good  earnest  at  the 
English  schools.  It  was  inaugurated  by  addresses  at  all 
the  metropolitan  hospitals  but  Guy’s,  St.  Bartholomew’s, 
and  Charing-cross.  At  the  London  Hospital  the  formal 
ceremonial  does  not  take  place  till  next  Tuesday,  when 
Professor  Huxley  will  deliver  an  address.  The  most  im¬ 
portant  of  the  addresses  already  delivered,  both  in  respect 
to  the  rank  of  the  speaker  and  the  subject-matter  of  his 
remarks,  was  that  delivered  at  King’s  College  on  Tuesday 
by  Dr.  Acland,  which  will  be  found  in  full  in  another 
column.  It  needed  some  courage,  as  Dr.  Acland  himself 
admitted,  to  stand  up  as  the  champion  of  what  is  at  present 
the  unpopular  side,  and  to  put  forward  the  claims  of  the 
spiritual  as  opposed  to  the  agnostic  ideal.  But  there  is  no 
other  member  of  the  profession,  except  perhaps  Sir  James 
Paget,  who  could  have  treated  it  with  equal  authority  and 
tact.  The  King’s  students  have  not  been  so  merciful — so 
comparatively  merciful,  one  had  perhaps  better  say — to  any 
of  their  inaugural  speakers  sinceMr.  Lister,  some  years  ago, 
kept  them  spell-bound  for  three  half-hours  with  a  description 
of  his  researches  on  the  bacterium  lactis. 


At  St.  Mary’s  Hospital,  Dr.  Handfield  Jones  took  a  line 
somewhat  similar  to  that  of  Dr.  Acland,  and  begged  the 
more  cultivated  students,  who  presumably  are  most  exposed 
to  such  a  temptation,  not  to  lightly  adopt  the  prevalent 
scepticism.  The  points  he  chiefly  relied  upon  to  dissuade 
them  from  it  were — that  the  recognition  of  a  Supreme  First 
Cause  is  “  a  necessity  of  thought  that  the  argument  from 
phenomena  implying  intelligent  design  is  accepted  un¬ 
hesitatingly  in  the  case  of  human  works,  and  ought  therefore 
to  be  regarded  as  equally  valid  in  the  case  of  superhuman  ; 
that  force  and  law  require  each  an  antecedent  power ;  that 
miracles  are  no  more  impossible  than  any  other  extraordinary 
event,  and  are  to  be  credited  as  other  events  are,  on 
evidence  sufficient  to  satisfy  a  candid  mind.  Faith,  he 
asserted,  was  able  to  sustain  the  human  spirit  under  the 
most  trying  afflictions,  and  to  irradiate  the  hour  of  death 
with  peace  and  joy.  In  the  evening,  the  past  and  present 
students  of  the  school,  their  friends,  and  the  members  of  the 


staff,  dined  at  Limmer’s  Hotel.  There  were  ,130  present, 
this  large  number  being  probably  due  to  the  popularity  of 
Mr.  Spencer  Smith,  who  occupied  the  chair.  Former 
students  of  the  school  came  in  strong  force  to  support  their 
old  friend  and  teacher,  who,  it  should  not  be  forgotten,  was 
one  of  the  founders  of  St.  Mary’s. 


At  University  College,  Mr.  Tweedy  delivered  an  address 
marked  by  rare  depth  of  thought  and  beauty  of  lan¬ 
guage,  which  will  be  found  at  length  in  another  column. 
The  most  important  part  of  it,  to  our  mind,  was  that  in 
which  he  defined  the  position  of  medicine  as  not  merely 
the  art  of  diagnosing  disease  and  prescribing  remedies, 
but  as  essentially  the  science  of  health.  It  is  interest¬ 
ing  to  compare  Mr.  Tweedy’s  views  on  this  matter  with 
those  so  ably  advocated,  at  the  School  of  Medicine  for 
Women,  by  Dr.  Donkin.  It  is  a  fact  of  some  import,  as 
showing  the  tendency  of  modern  thought  with  respect  to 
drug-treatment,  that  two  of  the  most  able  of  this  year’s 
addresses  should  have  boldly  taken  the  same  ground. 
“  The  medical  profession,”  says  Mr.  Tweedy,  “  would  still 
retain  the  most  important  part  of  its  duties,  and  all,  or 
more  than  all,  its  present  share  of  honours,  if  every  drug  in 
the  Pharmacopoeia  were  to  become  extinct.  The  credulous 
faith  in  the  efficacy  of  drugs  is,  and  always  has  been,  the 
secret  of  the  success  of  every  form  of  charlatanism.”  Dr. 
Donkin’s  position  is  still  more  absolute,  as  his  defence  of  it 
is  more  elaborate.  “  In  the  common  use  of  the  term,”  he 
says,  “  drugs,  as  a  class,  should  be  regarded  as  having  no- 
necessary  relation  to  medicine.”  “  The  so-called  drug- 
treatment  of  disease  has  certainly  a  considerable  basis  of 
ignorance  and  assumption,  and  it  is  in  response  to  this  cre¬ 
dulity  that  most  of  the  plagues  of  our  profession  have 
arisen.”  Both  of  these  addresses  are  worthy  of  most  careful 
reading  and  thinking  over.  The  believers  in  drug- treatment, 
will,  perhaps,  charitably  hope  that  the  practice  of  these 
sceptics  is  better  than  their  creed ;  but  there  can  no  longer 
be  any  doubt  that  the  latter  has  much  to  be  said  for  it. 


The  other  orations  dealt  with  less  vitally  important 
questions.  At  St.  George’s,  Mr.  W.  H.  Bennett  gave  an 
interesting  address  on  the  social  position  of  the  medical 
profession.  He  complained  that  the  estimation  in  which 
our  calling  was  held,  from  a  social  point  of  view,  was  in¬ 
ferior  to  that  of  other  professions.  The  very  great  interest, 
of  the  study  and  the  honourable  character  of  those  who 
practise  medicine  were  acknowledged  with  all  candour  and 
respect  by  men  of  the  world  and  of  high  social  standing ; 
but  there  the  matter  ended.  A  comparison  between  the 
Law  List  and  the  Medical  Register  would  show,  for  in¬ 
stance,  that  law  was  patronised  far  more  freely  by  society  of' 
a  certain  rank  than  their  own  calling.  The  point  in  which 
they  compared  the  least  favourably  with  other  professions 
was  that  of  State  recognition.  There  was  no  State  repre¬ 
sentative  of  the  profession  in  either  House  of  Parliament. 
A  medical  peerage  was  yet  to  be  created;  a  baronetcy- 
was  almost  rare ;  a  knighthood  hardly  more  frequent. 
While  regretting  what  had  come  to  be  called  the  “  political 
powerlessness  ”  of  the  profession,  it  was  but  just  to  mention 
that  the  condition  did  not  exist  by  reason  of  any  want  of* 
agitation  or  importunity  on  their  part ;  otherwise  surely  it 
would  have  been  rectified  long  ago.  The  real  reason, 
without  doubt,  could  be  found  in  the  fact  that  the  public 
even  now  was  lamentably  careless  on  matters  of  health. 
If  they  as  a  profession  were  to  occupy  the  position  which: 
they  ought  to  hold  in  the  political  world,  it  would  only  be,, 
he  firmly  believed,  in  ans  wer  to  the  public  will,  which  n&- 
Legislature  could  resist,  and  without  which  it  was  most 


Medical  Times  and  Gazette. 


CHRONICLE  OF  THE  WEEK. 


Oct.  6,  1883. 


difficult  to  act.  It  stiould  therefore  be  their  first  business 
to  so  educate  the  people  that  the  important  relations  which 
health  in  all  its  branches  must  bear  to  the  welfare  of  the 
country  might  be  fully  understood.  When  once  this  was 
accomplished,  it  followed  as  a  matter  of  necessity  that  the 
profession,  in  whose  hands  the  management  of  the  nation’s 
health  should  be,  must  be  fully  appreciated.  Then,  and 
then  only,  would  they  arrive  at  what  Tully  called  the  Per¬ 
fection  of  Glory,  viz. : — ■**  That  -the  people  love  us,  that 
they  have  confidence  in  us  ;  that,  being  affected  with  a  cer¬ 
tain  admiration  towards  us,  they  think  we  deserve  honour.” 
We  have  not,  we  must  confess,  much  sympathy  with  the 
outcry  for  social  distinction,  believing  that  our  own  self- 
respect  is  a  much  more  important  possession  than  the 
empty  honours  doled  out  to  us  by  the  public  and  the  Crown. 
Each  doctor’s  social  standing  must  depend  on  his  own  in¬ 
dividual  self,  and,  collectively  speaking,  the  social  status 
of  the  medical  profession,  as  distinguished  from  its  political 
weight,  is  probably  as  high  as  it  deserves  to  be.  The  shoe, 
of  course,  is  felt  to  pinch  much  more  severely  in  the  neigh¬ 
bourhood  of  Mayfair  and  Belgravia  than  in  less  aristocratic 
parts,  where  the  doctor  is  quite  as  often  too  good  for  his 
work,  as  the  reverse. 


At  St.  Thomas’s  Hospital  the  address'was  delivered  by 
Mr.  Le  Gros  Clark,  and  its  object  was  to  direct  the  attention 
of  the  students  to  some  natural  laws  in  relation  to  them¬ 
selves,  and  to  indicate  the  share  which  their  own  will  might 
and  ought  to  have  in  accomplishing  the  life-work  before 
them.  Intelligent  intercourse  with  Nature  would  teach 
them  to  trust  her,  and  this  trust  would  ripen  year  by  year 
into  a  more  perfect  confidence.  This  seemed  a  simple  lesson ; 
yet  observation  had  taught  him  that  it  was  not  so.  Nature 
did  not  like  to  be  opposed,  and  opposition  generally  stimu¬ 
lated  resistance;  but,  on  the  other  hand.  Nature  was  as 
beneficent  as  she  was  bountiful,  as  grateful  for  help  as  she 
was  resentful  when  thwarted.  The  lecturer  then  referred 
to  the  moral  laws  by  which  conduct  should  be  influenced  and 
determined.  He  reminded  his  hearers  of  the  distinction 
between  their  intellectual  and  moral  nature,  and  that  mental 
gifts  might  be  employed  to  contravene  and  subvert  the  moral 
law,  and  thus  be  prostituted  to  selfish  and  ignoble  purposes. 
In  commenting  on  the  number  of  subjects  which  claimed 
the  attention  of  the  student  during  the  comparatively  short 
period  of  his  sojourn  at  the  hospital,  Mr.  Le  Gros  Clark  said 
he  was  aware  that  this  necessary  compression  of  so  much 
within  so  small  a  compass  was  consequent  on  the  rapid 
strides  of  natural  science  in  these  later  days  ;  and  he  deplored 
one  result  of  this  needful  stowing  of  the  mind  with  so  many 
facts — namely,  that  education  in  its  highest  sense  was  ne¬ 
glected.  When  they  were  tempted  to  acquire  knowledge 
by  artificial  helps,  or  in  an  unmeaning  or  mechanical  way, 
he  urged  upon  them  to  seek  rather  to  make  the  acquire¬ 
ment  their  own  by  investigating  all  its  relations,  and  not  to 
accept  on  the  authority  of  others  that  which  was  within 
their  reach  to  ascertain  for  themselves.  The  lecturer  con¬ 
cluded  by  exhorting  the  students  to  realise  their  responsi¬ 
bility  while  they  were  young  and  vigorous,  for  age  would 
bring  with  it  sadness  and  remorse  if  they  wilfully  rejected 
the  right  and  chose  the  wrong.  He  urged  them  not  to 
limit  their  aspirations  to  securing  their  own  happiness  and 
the  acquirement  of  knowledge,  but  to  seek  rather  to  realise 
the  still  higher  and  more  noble  purpose  of  their  existence 
in  promoting  the  good  of  others,  and  in  becoming  masters  of 
themselves. 


Me.  Peakce  Gould  opened  his  address  at  the  Middlesex 
Hospital  with  a  brief  allusion  to  medical  politics,  and  the 
withdrawal  of  the  Government  Bill,  in  the  course  of  which 


he  severely  criticised  the  obstructive  tactics  of  individuals 
and  bodies  not  wholly  disinterested  in  the  matter.  It  was 
to  be  hoped  that  the  only  result  of  the  tactics  of  the 
representatives  of  obstructive  corporations  would  be  that 
they  would  obtain  less  generous  terms  when  the  Bill  was 
next  presented  to  Parliament.  Those  particular  corpora¬ 
tions  had  degraded  the  profession  and  deceived  the  public, 
and  were  not  worthy  of  the  sympathy  of  either  of  the  parties 
so  deeply  interested  in  that  question.  Mr.  Gould  then  pro¬ 
ceeded  to  explain  the  methods  by  which  the  students  should' 
pursue  their  investigations.  It  was  very  important  to  study 
the  body  in  health  as  the  essential  groundwork  on  which  all 
their  later  knowledge  and  practice  must  rest.  That  know¬ 
ledge  was  to  be  obtained  by  studying  anatomy  and  physiology 
— sciences  which  ought  to  be  regarded  as  one,  the  student 
seeking  for  the  physiological  equivalent  of  every  anatomical 
fact.  Not  only  was  that  the  true  way  to  study  anatomy,  but 
it  rendered  the  task  much  easier,  for  association  was  the 
greatest  aid  to  memory.  But  he  held  that  additional  im¬ 
portance  attached  to  this  point,  because  the  study  of  ana¬ 
tomy  in  an  improper  manner  soon  wearied  the  mind,  and  it 
either  drove  the  student  to  habits  of  idleness  or  led  him  to 
regard  it  as  an  exercise  of  the  memory  alone.  Then,  as  he 
passed  on  to  his  later  studies,  the  same  habit  of  work  would 
be  continued,  and  facts  be  stored  in  the  memory  without 
any  attempt  being  made  to  explain  them.  Towards  the 
close  of  his  address  Mr.  Gould  commented  strongly  on  the 
prevalent  tendency  towards  specialism  in  medicine,  which 
was  contrary  to  the  generalisation  to  be  seen  in  nature. 
Not  only  had  various  organs,  and  especially  all  the  orifices 
of  the  body,  a  large  number  of  practitioners  professing  to 
be  specially  learned  in  their  affections,  but  it  was  now 
attempted  to  relegate  individual  operations  to  special  sur¬ 
geons.  The  only  claim  to  special  knowledge  possessed  by 
many  so-called  specialists  rested  upon  their  entire  ignorance 
of  everything  outside  that  small  part  of  the  human  frame 
they  had  taken  under  their  charge ;  and  if  his  hearers  were 
to  seek  for  ignorance  of  science,  and  for  the  practice  of  arts 
which  degraded  a  noble  profession  to  the  level  o  f  a  huck¬ 
stering  trade,  it  would  be  in  the  consulting -rooms  o£ 
specialists  that  they  would  find  them. 

At  the  Westminster  Hospital,  Mr.  Boyce  Barrow  delivered 
an  address,  which  was  marked  here  and  there  by  a  certain 
dry  humour  rare  in  introductory  lectures.  “  An  Italian  phi¬ 
losopher  once  said  that  Time  was  his  Estate — a  motto  worth 
adopting.  But  Time  is  a  more  satisfactory  Estate  to  cultivate 
than  a  Landed  Estate,  for  whereas  the  produce  of  the  latter 
deteriorates  after  a  certain  number  of  crops  have  been 
grown  upon  it,  each  crop  produced,  each  work  accomplished,, 
adds  to  the  value  of  time.”  “  As  a  landed  estate  is  not  esti¬ 
mated  by  its  extent,  but  by  its  productiveness,  so  time 
must  be  estimated  by  the  results  of  its  employment,  and  not 
by  its  length.”  “  Before  you  have  spent  many  days  in  the 
study  of  anatomy,  I  venture  to  predict  that  there  will  not  be 
one  of  you  who  will  not  complain  of  his  memory.  If  you 
were  appointed  custodians  of  a  number  of  valuable  treasures, 
you  would  so  arrange  them  that  you  could  inspect  them 
readily,  and  the  frequency  of  your  inspections  would  be  in 
accordance  with  the  fear  you  had  of  losing  them.  In  the 
same  way  you  must  so  arrange  and  associate  in  your  minds 
your  anatomical  treasures  that  you  can  inspect  them  easily 
and  with  a  frequency  proportionate  to  the  defect  of  memory 
of  which  you  complain.”  Mr.  Barrow  did  not  say,  as 
perhaps  he  might  have  done,  that  if  the  student  were 
acute  enough  to  keep  an  eye  on  the  treasures  likely  to  be 
particularly  asked  for  by  the  examiners,  he  might  safely  let 
the  rest  drop  out  of  his  mind,  though  they  were  Pitt- 
diamonds  and  Koh-i-noors. 


410 


Medical  Times  and  Gazette. 


CHBONICLE  OF  THE  WEEK. 


Oct.  6,  1883. 


The  soirde  with  which  Guy’s  Hospital  opened  its  session 
was  as  successful  as  in  previous  years,  between  two  and 
three  thousand  persons,  the  larger  proportion  of  whom 
were  ladies,  having  been  present.  The  whole  of  one  of 
the  large  medical  wards  was  crowded  with  most  varied 
•objects  of  interest,  ranging  from  the  latest  improvements 
in  surgical  instruments  and  the  most  advanced  methods  of 
microscopic  research,  to  specimens  of  Venetian  glass  and 
mechanical  toys.  In  some  of  the  new  class-rooms  there  were 
special  exhibitions  of  telephones,  etc. ;  while  in  the  elec¬ 
trician’s  room  Dr.  Horrocks  very  successfully  entertained 
the  visitors  by  inducing  special  muscular  contractions  in 
.an  individual  endowed  by  nature  with  a  plastic  countenance 
which  lent  itself  with  especial  facility  to  the  familiar  illus¬ 
tration  of  Ziemssen’s  motor  points.  The  distribution  of 
medals  and  prizes  to  successful  students  by  Mr.  Gilliat, 
•one  of  the  governors  of  the  Hospital,  took  place  during 
the  evening. 


The  session  was  opened  at  Liverpool,  on  Saturday  last, 
with  an  address  by  Professor  Herdman,  and  a  distribution  of 
prizes  by  Lord  Derby.  This  is  the  first  year  that  the  Royal 
Infirmary  School  of  Medicine  figures  as  an  integral  part  of 
the  Liverpool  University  College,  and  it  is  hoped  that  before 
-another  year  has  passed  the  College  will  be  affiliated  to  the 
Victoria  University,  so  that  the  students  of  its  new  Medical 
Faculty  will  be  able  to  obtain  their  medical  degrees  at  the 
Victoria  University  on  the  same  terms  as  the  Manchester 
.students.  But  funds  are  needed  to  endow  two  new  chairs 
before  this  affiliation  can  take  place.  The  inaugural  address 
was  mainly  devoted  to  a  vindication  of  the  importance  of 
biology  as  a  portion  of  scientific  training.  Dr.  Herdman 
;spoke  in  terms  of  unbounded  admiration  of  Darwin,  and 
said  that,  happily,  men  of  science  were  now  practically  of 
•one  mind  in  accepting  evolution  in  some  form  or  another, 
and  the  main  object  of  a  biological  investigation  was  to 
establish  the  great  theory  on  a  firmer  foundation,  and  to 
arrive  at  some  definite  knowledge  of  its  working.  Subse¬ 
quently,  Lord  Derby  expressed  his  opinion  that  Darwin  was 
one  of  the  half-dozen  men  of  the  present  century  who  would 
be  remembered  a  thousand  years  hence.  He  had  had  the 
honour  of  knowing  Darwin  personally,  and,  great  as  was  his 
admiration  for  his  work,  he  was  more  impressed  by  his 
•extraordinary  modesty  and  his  dignified  simplicity  of  nature. 
Never  in  any  human  being  was  there  a  more  entire  absence 
of  egotism  and  self-assertion.  They  could  all  imitate 
him  in  that,  although  they  could  not  imitate  him  in  his 
•discoveries. 


The  winter  session  of  the  Army  Medical  School  at 
Netley  commenced  on  Monday,  October  1.  §  The  introduc¬ 
tory  address  was  delivered  by  Dr.  De  Chaumont,  F.R.S., 
Professor  of  Hygiene,  the  principal  subjects  discussed  in 
his  discourse  being  the  recent  epidemic  of  cholera  in  Egypt, 
and  the  questions  it  has  evoked  regarding  the  advantages 
of  a  system  of  quarantine  with  a  view  to  stop  the  entrance 
•of  the  disease  into  other  countries,  compared  with  those  of  a 
system  of  sanitary  preparedness  for  confronting  it ;  or,  in 
other  words,  the  adoption  of  all  such  hygienic  measures  as 
are  calculated  to  prevent  it  from  gaining  a  hold  and  spread¬ 
ing  in  case  of  its  introduction.  The  almost  uniform'failure 
of  quarantine  for  effecting  its  object  was  pointed  out  by 
numerous  illustrations,  while,  on  the  other  hand,  the  lec¬ 
turer  demonstrated  the  positive  gains  which  had  always 
resulted  in  proportion  as  hygienic  measures  had  been  pro¬ 
perly  carried  into  execution.  Professor  de  ^Chaumont  in 
the  early  part  of  his  remarks  congratulated  his  colleague. 
Dr.  Aitken,  who  was  present,  on  his  recovery  from  a  recent 
dangerous  illness,  and  his  congratulations  were  heartily 


responded  to  by  the  staff  of  the  establishment  and  others 
who  were  assembled  in  the  lecture-room.  The  session  is 
being  attended  by  twenty-five  candidates  for  commissions 
in  the  public  services — twenty  for  the  British  Army  Medical 
Service,  and  five  for  the  Indian  Medical  Service. 


At  the  Newcastle  School  the  session  was  opened  on 
Monday  by  Mr.  Joseph  Cowen,  M.P.,  who,  in  the  course  of 
his  remarks  to  the  students,  said  that  the  tendency  of  the 
present  day  was  more  or  less  in  the  direction  of  sameness 
and  uniformity,  which  lay  at  the  root  of  sterility  and  in¬ 
tellectual  weakness.  Medical  students  who  were  called 
upon  to  make  difficult  diagnoses  should  be  able  to  think 
for  themselves.  Mr.  Cowen’s  precept  is  admirable.  Un¬ 
fortunately  for  its  cogency,  his  example  is  a  burlesque  of  it. 


One  noteworthy  point  in  connexion  with  this  year’s  in¬ 
augural  addresses  is  the  small  space  allotted  to  them  in  the 
daily  journals,  as  compared  with  previous  years.  In  all  the 
papers  but  the  Times  and  Morning  Post,  the  abstracts  were 
further  abstracted  and  whittled  down,  until  no  idea  could  be 
gathered  from  them  of  what  the  lecturers  really  said.  That 
this  was  not  due  to  their  want  of  interest  is  sufficiently 
evident,  for  some  of  them  were  well  above  the  average,  and 
really  worthy,  if  anything  that  doctors  say  ever  is  worthy, 
of  public  attention.  And  it  is  equally  evident  that  this 
unfortunate  compression  was  not  due  to  the  pressure  of 
other  events.  May  not  the  true  explanation  be  that  the 
public  are  growing  a  little  weary  of  the  constant  claims  of 
science,  as  a  universal  teacher,  on  their  attention,  and  that 
their  caterers  in  the  press  are  wise  enough  to  perceive  and 
make  allowance  for  this  weariness  P  No  one  will  suspect  us 
of  underrating  the  importance  of  the  medical  education  of 
the  public,  but  the  teacher  who  is  anxious  to  teach  at  all 
hours  will  soon  empty  his  school.  Reaction  is  a  force  that 
always  threatens  the  ardent  proselytiser.  There  is  one 
point,  however,  on  which  the  wooers  of  the  West-end 
may  congratulate  themselves — the  Morning  Post  gives  the 
abstracts  in  full.  _ 

The  session  has  commenced  in  real  earnest  in  the  metro¬ 
politan  dissecting-rooms,  as  the  subjoined  statement  of  the 
number  of  bodies  being  dissected  shows.  Taking  them 
in  numerical  order,  at  St.  Bartholomew’s  27,  at  Guy’s  19, 
at  University  College  18,  at  the  London  Hospital  17, 
at  St.  George’s  Hospital  8,  at  King’s  College  7,  at  the 
Middlesex  6,  and  at  Charing-cross  Hospital  4  bodies  were 
placed  on  the  table  on  October  1.  The  mode  of  preparing 
the  bodies  at  University  College  Hospital  is  as  follows  : — 
The  bodies  are  injected  with  a  solution  of  one  pound  of  crys¬ 
tallised  carbolic  acid  in  half  a  gallon  of  glycerine  and 
half  a  gallon  of  spirit.  Each  body  is  then  sewn  up  in  calico 
and  put  in  a  tank,  and  a  solution,  consisting  of  glycerine 
one  quart,  water  and  spirit  half  a  gallon  each,  and  common 
carbolic  acid  half  a  pint,  poured  over  it.  At  King’s  College 
the  bodies  are  preserved  by  what  is  known  as  the  Edinburgh 
process. 

Addressing  the  students  of  the  Pharmaceutical  Society, 
at  the  opening  of  the  winter  session  on  Wednesday  last. 
Dr.  Michael  Foster  seized  the  opportunity  of  planting  some 
very  well-directed  and  timely  blows  against  the  system 
of  cramming  for  examination.  Diplomas  had  come  to  be 
the  stamp  and  certificate  not  so  much  of  general  ability 
and  skill,  as  of  ability  and  skill  in  passing  an  exa¬ 
mination.  In  many  cases  they  were  even  less  than  that — 
proofs  not  of  the  ability  of  the  candidates,  but  of  the 
skill  of  the  coach.”  Some  coaches,  no  doubt,  gained  their 
ends  by  real  teaching,  but  in  many  cases  they  gave  less 


'ANNOTATIONS. 


Oct.  6, 1883.  411 


Medical  Times  and  Gazette. 


attention  to  the  nature  of  the  study  than  to  “  the  examiner’s 
mind,”  his  whims,  his  fancies,  and  what  answers  would  be 
likely  most  to  tickle  him.  Dr.  Michael  Foster  has  done 
well  to  call  public,  attention  to  this  point,  but  surely  the 
fault  lies  with  the  examiners,  and  not  with  the  coaches.  The 
examiner  has  no  business  to  let  himself  become  the  victim 
of  “  tickling.”  The  simple  fact  is,  that  in  the  struggle 
between  examiners  and  coaches,  the  latter,  being  more  men 
of  the  world,  better  paid,  and  with  a  direct  interest  in 
results,  have  got  the  best  of  it.  The  remedy  is  simple  : 
choose  examiners  rather  for  wisdom  than  for  knowledge,  and 
pay  them  well. 

Me.  Listee  is  enjoying  another  triumphal  progress  on  the 
Continent.  Some  years  ago,  it  will  be  remembered,  he  was 
received  with  immense  enthusiasm  by  the  South  German 
students.  In  Hungary,  where  there  is  a  very  real  and  rapidly 
growing  interest  in  scientific  progress,  his  presence  has 
excited  no  less  interest.  On  Saturday  last  the  Professors  of 
the  Medical  Faculty  of  the  Pesth  University  gave  a  banquet 
in  his  honour,  and  the  students  arranged  one  of  those  torch¬ 
light  ovations  which  they  organise  so  cleverly.  Several 
hundreds  strong,  they  appeared  with  torches  before  the  hotel 
in  which  the  dinner  was  held.  A  deputation  was  sent  up, 
and  Mr.  Lister  and  his  wife,  followed  by  the  Professors,  came 
out  on  the  balcony,  where  they  were  received  with  much 
cheering.  The  students  addressed  Mr.  Lister  in  Hungarian 
and  in  English,  assuring  him  that  they  had  daily  oppor¬ 
tunities  not  only  of  hearing  his  praise  from  their  teachers, 
but  also  of  convincing  themselves  personally  of  the  blessings 
his  activity  had  conferred  on  mankind.  Three  cheers  were 
given  at  the  conclusion  of  the  addresses.  Mr.  Lister  replied 
in  German,  thanking  the  students  for  the  ovation,  and 
adding  that  he  could  not  take  these  manifestations  of  sym¬ 
pathy  and  enthusiasm  as  meant  for  himself,  but  as  an 
ovation  to  their  noble  art.  These  Hungarians  teach  us  a 
lesson  in  reverence. 


The  Obstetrical  Society  of  London  met  on  Wednesday 
evening  last.  Specimens  were  shown  by  Dr.  Mansell- 
Moullin,  Dr.  Edis,  Dr.  W.  A.  Duncan,  and  Dr.  Champneys 
A  paper  by  Dr.  Swayne,  on  a  case  of  Gangrene  occurring 
during  the  Seventh  Month  of  Pregnancy,  was  read ;  and  also 
one'  by  Dr.  Henry  Bennet.  on  the  Anatomy,  Physiology, 
and  Pathology  of  the  Os  Uteri  Internum.  These  papers* 
the  latter  especially,  excited  an  animated  discussion,  the 
position  taken  up  by  Dr.  Bennet  being  one  adverse  to  the 
practice  of  incision  of  the  os  internum,  so  much  in  vogue  in 
America  and  among  some  gynaecologists  in  this  country. 

The  Sanitary  Institute  of  Great  Britain  held  its  annual 
Congress  at  Glasgow  last  week.  The  meeting  was  a  most 
pleasant  and  enjoyable  one.  There  was  throughout  a  spirit 
of  unity  in  considering  the  business  of  sanitation,  each  one 
showing  that  he  was  in  real  downright  earnest  in  the  part 
he  had  to  occupy  in  the  deliberations.  It  must  perhaps  be 
confessed  that  the  members  were  not  treated  to  much  that 
was  really  original,  the  material  for  the  most  part  being 
old  ideas  dressed  up  for  the  occasion  according  to  each 
speaker’s  fancy.  Altogether,  however,  it  was  a  very  suc¬ 
cessful  meeting.  The  Exhibition  is  still  open,  and  will 
continue  so  until  the  20th  of  the  present  month. 


The  Congress  was  opened  by  an  address  from  Professor 
Humphry,  on  the  26th  ult.,  and  to  each  of  its  three  sections 
a  day  was  devoted.  Professor  W.  T.  Gairdner,  of  Glasgow 
University,  delivered  the  presidential  address  in  the  Section 
of  Sanitary  Science  and  Preventive  Medicine.  He  gave  an 
account  of  the  work  carried  oat  in  Glasgow  during  the 


period  from  1863  to  1872,  in  which  he  was  responsible  for 
the  sanitary  administration  of  the  city ;  and  led  up  the 
argument  to  prove  that  “  the  true  preventive  medicine  is  to- 
be  found  chiefly  in  improvements  directed  towards  the  ven¬ 
tilation,  cleanliness,  and  general  comfort  of  the  houses  of 
the  poor.”  Papers  were  afterwards  read  on  the  geographical 
distribution  of  phthisis,  cholera  epidemics,  typhoid  fever,, 
the  disabilities  of  inspectors  of  nuisances,  the  sanitary 
condition  of  Glasgow,  house-sanitation  in  and  around 
Glasgow,  and  the  dangers  threatening  Southport  as  a  health- 
resort.  In  the  everting  a  conversazione  was  held  in  the- 
Corporation  Galleries.  On  Friday,  Dr.  P.  Angus  Smith,, 
the  President  of  the  Section  of  Chemistry,  Meteorology, 
and  Geology,  delivered  an  address  on  “  Air  as  a  Sanitary 
Agent,”  in  which  he  dwelt  at  length  on  the  influence  of  the 
atmosphere  in  promoting  health  and  preventing  disease, 
and  described  the  process  of  putrefaction  and  the  effects  of: 
oxidation.  The  fact  that  oxygen  diminished  the  activity  Of 
the  minute  particles  which  produce  chicken-cholera,  that  it 
rapidly  and  decidedly  arrested  decomposition  in  sewage, 
indicated  the  central  point  in  all  sanitary  reforms — the 
importance  of  pure  air.  Papers  were  read  on  smoke-abate¬ 
ment,  the  comparative  merits  of  fine  and  coarse  flour 
as  an  article  of  food,  disinfection  by  heat,  river-pollution, 
and  the  utilisation  of  town  refuse.  At  the  closing  general 
meeting,  in  the  evening,  it  was  stated  that  circumstances 
had  arisen  which  would  prevent  next  year’s  meeting  being 
held,  as  intended,  at  Cheltenham.  It  was  agreed  to  accede 
to  an  influential  requisition  from  Dublin,  asking  that  the 
Congress  of  1885  should  be  held  in  that  city.  The  cus¬ 
tomary  votes  of  thanks  brought  the  meeting  to  a  close. 
The  members  dined  together  at  night  in  the  St.  Andrew’s; 
Halls,  the  President,  Professor  Humphry,  in  the  chair.  The* 
sittings  of  the  Congress  were  brought  to  a  close  on  Satur¬ 
day.  During  the  day  numbers  of  the  members  of  the  Con¬ 
gress  took  part  in  an  excursion  to  Ardrishaig,  and  in  the- 
evening  Dr.  Alfred  Carpenter  addressed  a  meeting  of  the 
working  classes  in  St.  Andrew’s  Halls  on  public  health. 


ST.  MARY’S  HOSPITAL  MEDICAL  SCHOOL. 

At  this  School  very  extensive  and  important  additions  have- 
been  made,  and  it  now  not  only  possesses  every  modern  re¬ 
quirement  of  a  medical  school,  but  the  accommodation  for 
every  department  of  teaching  is  extremely  good-  An  im¬ 
portant  feature  of  the  new  arrangements  is  the  establish¬ 
ment  of  a  students’  club,  including  a  restaurant  for  lunch¬ 
ing.  The  School  Committee  anticipate  much  benefit  to  the- 
students  by  this  “new  departure,”  and  if  the  club  is- 
well  managed  we  believe  that  their  anticipations  will  bo- 
realised.  _ _ _ 

UNIVERSITY  COLLEGE  HOSPITAL. 

Veey  considerable  improvements,  involving  a  large  outlay, 
have  been  carried  out  during  the  recess  in  the  casualty  and 
out-patient  departments  of  this  Hospital.  The  casualty 
ward  has  been  enlarged,  and  the  space  in  one  wing  of  the- 
building  has  been  rearranged.  A  new  suite  of  rooms  has 
been  constructed,  which  will  serve  for  out-patient  practice 
in  the  daytime,  while  at  night  they  will  be  available  for 
casualty  cases.  What  was  once  the  nurses’  dining-room  has 
been  turned  into  a  srtrgeons’  consulting-room,  and  froin  this 
access  is  had  by  separate  entrances — one  for  women  and  the 
other  for  men — to  compartments  known  as  cubicles,  where* 
wounds  are  dressed,  and  limbs  or  other  portions  of  the  body 
bathed  and  douched.  Three  lady  nurses  have  been  en¬ 
gaged — two  by  day,  and  one  during  the  night— to  attend  on- 
the  female  patients.  One  of  the  chief  results  of  these  new 
arrangements  is  that  a  large  addition  can  be  made  to  the- 


412 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Oct.  6,  1883 


patients  at  present  supplied  with  advice  and  relief ;  while 
the  consulting-room  will  for  the  future  be  much  better 
ventilated  than  it  has  been  hitherto. 


LUND  TESTIMONIAL  FUND. 

The  past  and  present  pupils  of  Edward  Lund,  Esq.,  F.E.C.S., 
Professor  of  Surgery  at  the  Owens  College,  Manchester, 
are  about  to  present  him  with  a  testimonial  on  the  occasion 
of  his  retirement  from  active  service  as  a  Surgeon  at  the 
Manchester  Eoyal  Infirmary.  The  testimonial  is  to  take 
the  form  of  a  portrait,  by  Mr.  J.  H.  Partington,  and  plate. 
As  many  of  Mr.  Lund’s  friends  have  expressed  a  wish  to 
join  in  the  testimonial,  and  as  some  of  his  former  pupils 
may  not  have  received  a  circular,  the  subscription-list  will 
remain  open  for  a  short  time  longer.  Communications  may 
be  addressed  to  F.  A.  Heath,  Esq.,  118,  Portland-street, 
Manchester,  chairman  of  the  testimonial  committee,  or  to 
Hr.  Leech,  Mosley-street,  Manchester,  treasurer  of  the  fund. 


ALLEGED  DEATH  FROM  VACCINATION  AT  DEPTFORD. 

At  a  meeting  of  the  Council  of  the  Poor-Law  Medical  Officers’ 
Association,  held  at  their  rooms,  3,  Bolt-court,  Fleet-street, 
on  October  2,  1883,  it  was  resolved — “  That  this  Council, 
having  read  the  statements  that  have  been  made  relative  to 
a  recent  inquiry  held  at  Deptford,  have  to  express  its  regret 
that  any  erroneous  opinion  should  have  been  given  by 
any  practitioner  concerning  an  eruption  occurring  in  four 
children  out  of  twenty-one  vaccinated  from  the  same  child, 
thereby  leading  to  an  inquest  being  held  on  one  of  the 
children,  wTho  died  two  months  after  vaccination,  from 
pneumonia.  The  Council  begs  to  tender  its  sympathy  with 
Dr.  Kavanagh  on  the  unjust  aspersion  on  his  character 
which  the  rider  to  the  verdict  of  the  coroner’s  jury  con¬ 
veyed.  The  Council  congratulate  Dr.  Kavanagh  on  the 
recognition  of  the  injustice  of  such  rider  by  so  high  an 
authority  as  Dr.  Stevens,  Government  Inspector  of  Vaccina¬ 
tion,  and  trusts  that  the  Medical  Council  will  mark  its  sense 
of  the  impropriety  (if  not  something  worse)  of  the  written 
statement  of  the  medical  man  upon  whose  allegation  a 
coroner’s  inquiry  was  considered  necessary.” 


THE  PARIS  WEEKLY  RETURN. 

The  number  of  deaths  for  the  thirty-eighth  week  of  1883, 
terminating  September  20,  was  942,  and  of  these  there  were 
from  typhoid  fever  35,  small-pox  5,  measles  16,  scarlatina 
none,  pertussis  22,  diphtheria  and  croup  22,  erysipelas  10, 
and  puerperal  infections  2.  There  were  also  44  deaths 
from  acute  and  tubercular  meningitis,  179  from  phthisis, 
16  from  acute  bronchitis,  43  from  pneumonia,  118  from  in¬ 
fantile  athrepsia  (45  of  the  infants  having  been  wholly  or 
partially  suckled),  and  32  violent  deaths.  Although  the 
number  of  deaths  has  somewhat  increased  upon  the  excep¬ 
tionally  small  one  of  last  week  (910),  it  still  continues  very 
low.  Epidemic  diseases  have  scarcely  varied  in  the  two 
last  weeks.  In  neither  of  these  have  there  been  any  deaths 
.from  scarlatina,  and  in  each  only  5  deaths  from  small-pox. 
Athrepsia,  which  mounted  up  the  week  before  to  145,  has 
in  the  present  week  sunk  to  118,  although  the  month  of 
■September  is  usually  so  favourable  to  its  development. 
During  the  week  there  were  1144  births  (in  the  unusual 
proportion  of  544  males  and  600  females),  the  legitimate 
numbering  860,  and  the  illegitimate  284. 


THE  LIVERPOOL  HOSPITALS. 

The  question  of  assisting  voluntary  hospitals  out  of 
municipal  funds  is  at  present  engaging  the  attention  of  the 
JLaverpool  Council.  In  April  last,  after  a  wordy  warfare 


in  the  local  papers  between  the  medical  men  and  Mr. 
Eorwood,  it  was  generally  understood  that  a  grant  of  land  to 
extend  the  Royal  Infirmary  would  be  sanctioned,  and  that 
an  application  to  Parliament  for  power  to  purchase  the 
property  and  to  demolish  the  houses  now  standing  on  the 
ground  would  in  due  course  be  made.  However,  at  a  meet¬ 
ing  of  the  Council  on  September  26,  when  this  scheme  came 
up  for  confirmation,  it  was  found  that  the  Committee  of 
the  Stanley  Hospital  had  sent  in  an  application  for  <£5000  to 
build  a  new  wing  to  their  institution;  that  the  authorities 
of  the  Northern  Hospital  had  applied  for  both  money  and 
ground  to  extend  their  Hospital ;  that  the  President  of  the 
Children’s  Infirmary  had  asked  the  Council  to  again  seek 
sanction  from  Parliament  for  powers  to  grant  them  a  piece 
of  land  which  the  Treasury  refused  to  permit  the  Council 
to  grant  them  in  1881 ;  and  that  the  Council  itself  had 
almost  come  to  the  conclusion  to  build  one  or  more  hospitals 
for  infectious  diseases,  so  as  to  be  able  to  carry  out  more 
effectually  their  warfare  against  fevers.  So  many  hospital 
demands  upon  the  municipal  funds  have  caused  the  Council 
to  pause  in  their  proposed  generosity  to  the  Eoyal  Infirmary, 
lest  a  precedent  should  thereby  be  constituted  that  would 
bring  them  into  troubled  waters,  or,  if  they  conceded  all  that 
was  asked,  would  involve  the  city  in  a  heavy  expense.  In 
spite  of  the  appeals  of  warm  friends  of  the  Infirmary,  the 
Council  appointed  a  committee,  with  authority  to  communi¬ 
cate  with  the  trustees  of  the  institutions  affected,  and  instruc¬ 
tions  to  report  as  to  the  best  method  of  dealing  with  these 
matters  without  imposing  an  unreasonable  burden  on  the 
ratepayers.  The  Infirmary  scheme  is,  therefore,  in  all 
probability  shelved  for  another  year. 


THE  NOTIFICATION  OF  INFECTIOUS  DISEASES  IN 
LIVERPOOL. 

At  a  meeting  of  the  Health  Committee  on  September  21, 
Mr.  Forwood,  the  strongest  advocate  in  the  Council  of  com¬ 
pulsory  notification  of  infectious  disease,  cited  a  number  of 
instances  where  fever  was  allowed  to  spread,  without  any 
intimation  being  given  to  the  medical  officer  of  health  by 
the  medical  men  in  attendance.  Mr.  Stevens,  the  strongest 
opponent  of  compulsory  notification,  alleged  that  notification 
had  nothing  to  do  with  the  matter,  and  that  fever  was 
inseparably  connected  with  certain  streets  and  houses.  He 
carried  a  resolution,  authorising  a  survey  by  the  medical 
officer  of  health  and  the  city  engineer  of  all  unhealthy 
property  where  fever  has  lurked  for  years,  and  directing 
that  a  report  of  the  same  be  made  to  the  Council.  At 
the  next  meeting  of  the  Health  Committee  it  was  found 
to  be  necessary  to  rescind  this  resolution,  because,  under 
the  Sanitary  Amendment  Act  of  1864,  if  the  medical  officer 
reported  any  dwelling  unfit  for  human  habitation  or  in 
a  condition  injurious  to  health,  a  presentment  would  have 
to  be  made,  the  property  would  have  to  be  purchased  at 
the  owner’s  price,  and  the  town  put  to  the  expense  of 
“  hundreds  of  thousands  of  pounds.”  It  was  explained  that 
the  Health  Committee  was  at  present  purchasing  and  clean¬ 
ing  unhealthy  houses  to  the  extent  of  five  hundred  or  so 
yearly,  and,  not  being  forced  to  purchase  any  special  house, 
they  found  they  could  manage  it  more  cheaply  than  if  they 
were  forced  to  clear  out  two  or  three  thousand  houses  at  one 
swoop.  _ 

REGISTRAR-GENERAL’ S  RETURNS  FOR  SCOTLAND. 

The  death-rate  in  the  eight  principal  towns  in  Scotland 
during  the  week  ending  Saturday,  September  29,  was 
20'6  per  1000  of  estimated  population.  This  rate  is  0'4 
b  elow  that  for  the  corresponding  week  of  last  year,  but  0-6 
above  that  for  the  previous  week  of  the  present  year.  The 
lo  west  mortality  was  recorded  in  Leith,  viz.,  17'6  per  1000, 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Oct.  6,  1883.  41 3 


and  the  highest  in  Greenock,  viz.,  24- 7  per  1000.  The  mor¬ 
tality  from  the  seven  most  familiar  zymotic  diseases  was  at 
the  rate  of  40  per  1000,  or  the  same  as  the  rate  for  the 
previous  week.  Diarrhoea  continues  to  be  the  most  fatal 
miasmatic  disease.  In  Glasgow  10  deaths  were  attributed 
to  whooping-cough,  and  9  to  scarlet  fever.  Acute  diseases 
of  the  chest  caused  75  deaths,  or  6  less  than  the  number 
registered  during  the  previous  week.  The  mean  tempera¬ 
ture  was  53-5,  being  0‘7  below  that  of  the  week  immediately 
preceding,  but  P5  above  that  of  the  corresponding  week  of 
1882. 


FACULTY  OF  PHYSICIANS  AND  SURGEONS  OF  GLASGOW. 

The  annual  meeting  for  the  election  of  office-bearers  was 
held  on  Monday,  the  1st  inst.  The  attendance  of  Fellows 
numbered  about  a  hundred.  Dr.  Andrew  Fergus  was  elected 
President,  and  Dr.  Henry  Muirhead  Visitor.  The  new 
Councillors  elected  were — Dr.  Robert  Perry,  Dr.  James 
Christie,  and  Dr.  T.  Lapraik.  Of  the  four  retiring  Examiners, 
two  were  re-elected  without  opposition,  and  the  other  two 
after  a  contest.  Dr.  H.  C.  Cameron  was  re-elected  Exa¬ 
miner  in  Surgery,  and  Dr.  James  Stirton  in  Midwifery. 
For  the  Examinership  on  Anatomy,  Mr.  D.  N.  Knox, 
Lecturer  on  Surgery  in  the  Western  Medical  School,  was 
defeated  by  Dr.  A.  M.  Buchanan,  Professor  of  Anatomy  in 
Anderson’s  College.  The  other  contest  lay  between  Dr.  W.  J 
Fleming,  the  retiring  Examiner  in  Physiology,  and  Dr. 
John  Barlow,  Lecturer  on  the  subject  in  the  Royal  Infirmary 
School.  Dr.  Fleming  obtained  the  appointment.  Four 
Examiners  on  Public  Health  were  appointed — Dr.  J.  M. 
Milne,  Dr.  Eben.  Duncan,  Dr.  J.  B.  Russell,  and  Dr.  James 
Christie. 


A  daily  medical  journal  has  just  been  started  at  Paris. 

The  Working  Men’s  College  will  re-open  on  Monday 
next  with  an  address  by  Sir  James  Paget. 

The  epidemic  of  typhoid  fever  in  St.  Pancras  has  spread 
to  the  Female  Orphanage  in  the  Hampstead-road,  and  has 
prostrated  20  per  cent,  of  the  inmates. 

We  understand  that  Mr.  Butlin  will  deliver  the  intro¬ 
ductory  address  at  the  Abernethian  Society,  at  the  opening 
meeting  on  October  11. _ 

A  movement  is  on  foot  for  affording  relief  to  M  r. 
George  Hind,  F.R.C.S.,  who,  in  his  eighty-first  year,  is  in 
capacitated  from  work  by  serious  illness,  and  is  in  straiten  ed 
circumstances. _ 

We  are  glad  to  be  able  to  state  that,  as  a  result  of  th  e 
examination  and  report  of  Dr.  Orange,  William  Gouldston  e 
has  been  finally  respited,  and  will  be  detained  during  He  r 
Majesty’s  pleasure.  _ 

Dr.  B.  W.  Richardson,  Dr.  W.  Collingridge,  D  r. 
J.  W.  Tripe,  and  Dr.  W.  H.  Corfield  have  been  elect  ed 
honorary  members  of  the  Association  of  Public  Sanitary 
Inspectors. 

Several  of  the  doctors  who  were  sent  out  to  Egypt 
during  the  late  cholera  epidemic  may  be  expected  home  aga  in 
in  the  course  of  next  week.  Surgeon-General  Hunter  has 
already  arrived  in  England.  The  members  of  the  Paste  ur 
scientific  mission  left  Alexandria  on  their  return  to  Fra  nee 
on  the  2nd  inst.  _ 

The  late  Sir  William  Taylour  Thomson,  K.C.M.G.,  C.B., 
for  many  years  Her  Majesty’s  Envoy  Extraordinary  and 
Minister-Plenipotentiary  in  Persia,  has  bequeathed  .£30, 000 


to  the  St.  Andrews  University,  to  found  bursaries  for 
students  of  both  sexes  in  equal  numbers,  and,  in  the  case  of 
females,  to  assist  them,  as  far  as  practicable,  in  qualifying 
themselves  to  enter  the  medical  profession. 

The  Congress  of  the  National  Association  for  the  Pro¬ 
motion  of  Social  Science  was  opened  at  Huddersfield  on 
Wednesday.  In  the  Health  Department,  of  which  Mr. 
Pridgin  Teale  is  president,  the  following  are  the  special 
questions  for  discussion  : — “  Is  the  modern  system  of  edu¬ 
cation  exerting  any  deleterious  influence  upon  the  health 
of  the  country  ?  ”  and,  “  Is  it  desirable  to  take  any,  and 
what,  further  measures  to  prevent  the  spread  of  zymotic, 
diseases  through  the  milk-supply  of  our  towns  ?  ” 

The  St.  Pancras  Vestry  propose  to  utilise  a  portion  of  the- 
enclosed  piece  of  burial-ground  abutting  on  St.  Pancras 
Gardens  and  Cambridge-street  for  the  purpose  of  erecting 
a  public  mortuary  and  coroner’s  court.  The  need  of  a 
public  mortuary  in  all  populous  districts  is  obvious,  and  a 
coroner’s  court  is  a  desideratum  of  scarcely  less  importance. 
It  is  high  time  the  use  of  the  public-house  for  these  in¬ 
quiries  should  be  superseded;  and  if  the  time-honoured 
custom  of  viewing  the  body  is  to  survive,  it  is  as  well  that 
mortuary  and  coroner’s  room  should  be  under  one  roof. 

We  are  requested  by  the  Registrar  of  the  Royal  College 
of  Physicians  to  state  that  the  remains  of  the  illustrious 
Harvey,  now  lying  in  the  vault  under  Hempstead  Church, 
in  Essex,  will  be  removed,  with  the  sanction  of  Harvey’s 
next  of  kin,  to  the  Harvey  Chapel,  and  placed  therein,  in  a 
sarcophagus  provided  by  the  Royal  College  of  Physicians. 
The  ceremony  will  take  place  on  Thursday,  October  18, 
being  St.  Luke’s  Day,  and  Fellows  of  the  College  intending 
to  be  present  on  the  occasion  must  signify  the  same,  on  or 
before  Thursday,  the  11th  inst.,  to  the  Treasurer  or  Regis¬ 
trar  of  the  College,  from  whom  all  necessary  information 
may  be  obtained.  _ 

During  the  coming  season  the  following  books  of 
general  interest  to  the  profession  will  be  published : — “  The 
Creed  of  Science  :  Religious,  Moral,  and  Social,”  by  William 
Graham.  “Voyages  of  Discovery,”  by  Deputy  Inspector- 
General  Robert  McCormick,  R.N.,  F.R.C.S.  “Essays  on 
Diet,”  by  Professor  F.  W.  Newman.  “  The  Laws  con¬ 
cerning  Public  Health,”  by  W.  R.  Smith,  M.D.  “Voice, 
Song,  and  Speech,”  by  Lennox  Browne,  F.R.C.S.E.,  and 
Emil  Behnke.  Vol.  i.  of  “  The  World  as  Will  and  Idea,” 
by  Schopenhauer,  translated  from  the  German  by  R.  B. 
Haldane  and  John  Kemp.  “  The  Vegetable  Materia  Medica 
of  Western  India,”  by  W.  Dymock.  Von  Hartmann’s 
“  Philosophy  of  the  Unconscious,”  translated  by  W.  Dymock. 
“Wild  Adventures  Round  the  Pole,”  by  Dr.  Gordon 
Stables,  R.N.  _ 

A  year  ago  the  Committee  of  the  London  Hospital  com¬ 
menced  the  experiment  of  taking  lady  apprentices  to  learn 
the  art  of  nursing  in  their  extensive  and  well-managed 
wards.  The  ladies  were  admitted  for  short  periods  of  three 
months  on  paying  a  small  entrance-fee,  and  the  Hospital 
obtained  the  advantage  of  their  services  without  being  at 
any  cost  to  provide  them  with  board  and  lodging.  The 
experiment  has  been  attended  with  remarkable  success,  and 
so  numerous  are  the  demands  for  admission  that  another 
house  will  shortly  be  opened  in  addition  to  those  at  present 
in  use.  Every  Wednesday  a  lecture  on  nursing  is  delivered 
to  these  ladies.  The  first  course  is  on  the  general  details  of 
nursing,  by  the  matron ;  the  other  two  courses,  on  medical 
and  surgical  nursing  respectively,  being  delivered  by  Dr . 
Sansom  and  Mr.  Treves. 


Medical  Times.and  Gazette. 


FROM  ABROAD. 


Oct.  6, 1883. 


414 


FROM  ABROAD. 

Cancer  of  the  Breast. 

At  the  late  Congress  of  German  Surgeons  at  Berlin  ( Central - 
tblattfiir  Chir.,  Beilage), Dr .  Kuster,  of  Berlin,  introducing  the 
-question  of  operating  in  cancer  of  the  breast,  observed  that 
although  in  so  many  quarters  the  desirability  of  performing 
the  operation  at  the  earliest  period  and  in  the  most  complete 
manner  had  been  maintained,  yet  nowhere  has  it  been  main¬ 
tained  as  a  principle  (as  may  be  seen  by  the  best  known  text¬ 
books  and  the  most  recent  statistical  publications)  that  the 
■clearing  out  the  glands  of  the  axilla  should  in  all  cases  be  com¬ 
bined  with  the  amputation  of  the  breast.  Taught  by  his  own 
experience,  Kuster  supported  the  plan  of  thus  clearing  out 
the  axilla,  even  when,  as  in  thin  women,  the  glands  could 
be  felt  to  have  undergone  no  abnormal  change.  Up  to  the 
end  of  1882  he  had  operated  in  132  cases  of  cancer  of  the 
breast.  In  15  of  these  the  operations  were  only  partial — 
that  is,  only  the  indurated  portions  were  removed,  or  the 
breast  alone,  or  the  breast  with  only  one  or  two  of  the 
axillary  glands.  In  13  of  these  relapse  quickly  followed, 
and  in  2  (13'33  per  cent.)  the  patients  had  remained 
healthy.  In  the  remaining  117  cases  the  axilla  was  cleared 
out,  although  in  not  a  small  number  of  these  no  trace  of  a 
perceptible  change  could  be  felt.  But,  on  examination  of  the 
rglands  so  removed,  the  commencement  of  cancerous  degene- 
xation  was  detected  in  all  of  them,  with  the  exception  of 
two  cases.  As  to  the  results  of  this  procedure,  measured 
not  only  by  the  mortality,  but  by  the  duration  of  the  free¬ 
dom  from  relapse,  they  may  be  judged  of  by  comparing 
them  with  the  large  statistics  of  cancer  which  have  been 
published  in  recent  years.  These  show  a  mortality  of  from 
23-7  to  7‘63  per  cent.,  or  a  mean  of  15-66  per  cent.  In 
Raster's  132  cases  he  had  20  fatal  results,  or  15T5  per  cent. 
In  relation  to  the  durability  of  the  cure — that  is,  this  having 
lasted  more  than  three  years — it  was  found  in  the  statistics 
to  have  been  observed  in  between  5'59  and  16-19  percent.  In 
60  operations  Kuster  had  met  with  such  definitive  cures  in  13 
cases — i.e.,  2T66  per  cent.  Beckoning  only  those  in  whom  it 
occurred  prior  to  the  end  of  the  second  year,  the  percentage 
is  less,  viz.,  19-75.  This  is  explained  by  the  large  number 
of  women  whose  fate  remains  unknown  ;  and  if  we  wish  to 
■obtain  a  correct  reply  to  the  question  of  the  durability  of 
cures,  we  must  take  into  consideration  the  two  sets  of 
■cases  —those  which  have  proved  fatal,  and  those  in  which  the 
result  remains  unknown.  Deducting  20  on  this  last  account 
from  81  cases  up  to  March,  1881,  there  remain  61,  of  whom 
16,  or  26-22  per  cent.,  remained  well.  And  Kuster  considers 
that  this  result  justifies  the  view  that  primary  removal  of 
the  axillary  glands  under  all  circumstances  is  to  be  regarded 
as  the  sole  proper  operation. 

Prof.  Gussenbauer,  of  Prague,  stated  that  in  his  treatise, 
published  in  1881,  on  the  development  of  secondary  affec¬ 
tions  of  the  lymphatic  glands,  he  had  maintained  the  ne¬ 
cessity  of  removing,  in  operations  for  malignant  tumours, 
all  regional  lymphatic  glands.  In  cancer  of  the  breast,  he 
even  extended  the  recommendation  to  the  supra-clavicular 
glands  ,•  but  at  least  their  entire  removal  from  the  axilla 
should  be  the  general  practice. — Prof.  v.  Langenbeck  had 
always  removed  the  axillary  glands  when  cancerous,  but  did 
not  meddle  with  the  supra-clavicular,  as,  if  these  were  already 
affected,  the  infection  has  almost  always  also  involved  other 
glands  which  are  not  operable. — Prof.  Esmarch,  of  Kiel, 
always  extirpated  the  axillary  glands,  but  when  these  have 
Become  so  united  to  the  large  vessels  and  nerves  that  they 
cannot  be  removed,  it  is,  in  his  opinion,  permissible  to 
disarticulate  the  entire  arm.  In  a  case  in  which  he  so 
operated,  the  patient  recovered,  and  has  remained  free  from 
relapse.— Prof,  von  Langenbeck  believed  that  in  the  worst 
cases  this  indication  would  be  justifiable.  He  himself  had, 
besides  the  glands,  excised  the  diseased  muscles,  nerves, 
and  vessels  in  three  cases.  One  of  these  patients  remains 
well,  another  died  of  relapse,  and  the  third  from  gangrene 
•of  the  arm.  Disarticulation  of  the  arm  would  probably 
in  these  cases  have  furnished  better  results. — Prof.  v.  Berg- 
mann,  of  Berlin,  observed  that,  in  his  experience,  whenever 
the  supra-clavicular  glands  were  diseased,  almost  always 
other  not  operable  metastases  also  exist. — Prof.  Kuster 
stated  that  he  had  brought  the  subject  forward  because  he 
was  well  aware  that  the  procedures  recommended  by  him¬ 
self  and  Gussenbauer  had  not  as  yet  gained  currency  in 


various  surgical  clinics. — Prof.  Gussenbauer  observed  that 
cancer  of  the  breast  seldom  offered  itself  for  early  treat¬ 
ment,  but  whenever  he  had  in  such  cases  examined  regional 
glands  which  were  as  yet  scarcely  enlarged,  he  almost  always 
found  that  they  were  already  carcinomatous.  Hence  his  ad¬ 
vice  that  they  should  always  be  removed. — Prof.  Winiwarter, 
of  Luttich,  observed  that  in  his  work  on  Carcinoma,  pub¬ 
lished  in  1878,  he  had  proffered  the  advice  that  in  every 
case  of  cancer  of  the  breast,  in  which  we  are  not  absolutely 
certain  that  no  infiltrated  glands  are  present  in  the  axilla, 
the  cavity  of  the  axilla  should  be  freely  “  prepared  ”  up 
to  the  large  vessels. — Prof.  v.  Langenbeck  believed  that 
Gussenbauer’s  doctrines  in  relation  to  cancer  of  the  breast 
and  tongue  had  been  generally  received.  He  also  read  a 
letter  which  he  had  received  from  Prof.  v.  Nussbaum,  of 
Munich,  in  which  he  recommended  the  employment  of  the 
thermo-cautery  for  the  removal  of  the  cancerous  tongue  or 
breast,  believing  it  to  be  a  preventive  of  haemorrhage,  and 
of  future  traumatic  fever.  Prof.  v.  Langenbeck  could  not 
agree  to^this  recommendation,  as  a  clean  operation  can  be 
much  better  performed  with  the  knife,  while  cauterisation 
causes  suppuration,  which  again  favours  infection.  In  cases, 
however,  which  did  not  admit  of  operation,  he  had  often 
found  the  actual  cautery  of  good  service  in  relieving  pain. 


REPORT  OF  THE  TYNE  PORT  SANITARY 
OFFICER  FOR  1882. 


Though  the  public  mind  has  ceased  for  the  moment  to 
speculate  on  the  probabilities  of  the  introduction  into  this 
country  of  cholera  from  the  East,  it  is  satisfactory  to  note  from 
the  annual  report  of  the  Medical  Officer  of  Health  to  the  River 
Tyne  Port  Sanitary  Authority  (Mr.  Henry  E.  Armstrong), 
for  the  year  1882,  that  ample  precautions  were  even  then 
in  force  in  this  large  northern  port  for  the  preservation  of 
the  public  health  ashore.  Although  previously  existing,  the 
establishment  of  the  Tyne  Port  Sanitary  Authority  on  a 
permanent  basis  has  only  recently  been  sanctioned  by  Par¬ 
liament  on  the  motion  of  the  Local  Government  Board — 
a  step  which,  it  would  seem,  has  met  with  universal  approval. 
During  the  year  1882  ten  patients  were  admitted  to  the 
floating  hospital  of  the  Authority,  as  compared  with  a 
total  of  thirteen  during  the  previous  year,  amongst  them 
being  four  cases  of  enteric  fever  and  three  of  small-pox ; 
with  one  exception,  all  of  these  were  admitted  to  the  hospital 
directly  from  shipboard.  During  the  whole  year  a  vigilant 
watch  was  kept  on  all  vessels  coming  to  the  Tyne  from  ports 
where  it  was  known  that  infectious  disease  had  been  lately 
prevalent — among  which  may  be  specified  London,  Bouen, 
and  Bilbao  (whence  small-pox  was  introduced  into  the 
district  the  previous  year),  and  Fecamp  (where  it  had  been 
prevalent  during  1882), — and  fortunately  no  small-pox  was 
imported  from  any  of  these  places.  In  the  autumn,  owing 
to  the  prevalence  of  cholera  in  foreign  countries,  and  the 
possibility  of  its  being  brought  thence  to  the  Tyne,  it  was 
considered  desirable  to  request  the  special  attention  of  the 
officers  of  Her  Majesty’s  Customs  to  vessels  arriving  from 
suspected  places ;  strict  attention  was  also  paid  to  such 
vessels  by  the  officers  of  the  Sanitary  Authority,  the  inspec¬ 
tors  willingly  undertaking  partial  Sunday  duty  for  this 
purpose,  there  being  a  large  number  of  Sunday  arrivals  at 
the  time.  Happily,  no  case  of  cholera  occurred.  To  meet 
the  requirements  of  the  daily  increasing  shipping  trade  of 
the  Tyne,  the  Sanitary  Authority  appointed  an  additional 
inspector,  who  entered  on  his  duties  in  May,  18S2,  and,  follow¬ 
ing  the  example  of  the  Port  of  London,  and  to  facilitate  the 
work  of  the  Health  Department,  a  steam  launch  was  also 
purchased  by  the  Authority,  which,  though  inadequate  to 
the  requirements  of  the  Department,  has  been  a  considerable 
help.  The  following  list  of  vessels  inspected  will  give  some 
idea  of  the  importance  of  the  Tyne  as  a  shipping  port : — 
British  steamers,  2448  ;  British  sailing-vessels,  2308  ;  foreign 
steamers,  776  ;  foreign  sailing-vessels,  1091.  The  number 
of  vessels  of  all  kinds  inspected  has  risen  from  2410  in  1879, 
to  6623  during  the  past  year.  One  instance  only  of  complaint 
as  to  the  quality  or  condition  of  food  supplied,  was  made 
during  the  past  year  to  the  officers  of  the  Authority ;  this 
was  by  the  crew  of  a  British  steamer,  respecting  some  beef 
which  was  found  to  be  of  poor  quality,  and  was  changed  for 
better  on  a  suggestion  to  that  effect. 


Medical  Times  and  Gazette. 


MEDICAL  NEWS, 


Oct.  6,1883.  4  1  5 


GENERAL  CORRESPONDENCE. 

- <. - 

UTERINE  DISPLACEMENTS. 

[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sib, — The  interesting  correspondence  on  the  “genu-pectoral 
position”  having  come  under  my  notice  at  my  club,  I  venture, 
with  much  diffidence,  to  point  out  that  it  is  merely  a  case  of 
re-discovery.  The  department  of  knowledge  in  which  we 
naturally  look  for  survivals  of  customs  long  after  their 
meaning  has  been  lost,  is  the  religious.  If  we  gaze  around 
this  department,  we  see  both  the  Hebrew,  the  Mussulman, 
and  the  Parsee  performing  their  devotional  exercises  in  the 
“  genu-pectoral  position  ”!  The  position  still  survives,  while 
the  meaning  has  been  lost.  Can  it  be  doubted  that  this 
points  to  the  time  when  the  “  genu-pectoral  position  ”  was 
universal  ?  Another  instance  is  found  in  Aristophanes,  who, 
no  doubt  unconsciously,  records  a  fact  of  similar  import 
when  he  describes  the  savants  star-gazing  with  their 
“  podices,” — in  other  words,  in  the  “genu -pectoral  position.  ” 
(Aristophanes,  “  Clouds,”  lines  191,  seq.) 

2  r  p  ei]/  id  Sps.  MctdrjT^s. 

2.  3>  'HpdicAeis,  tclvtI  7roSa7ra  ret  9-fjpia  ; 

M.  rl  iOav/xarras  ;  rip  croi  Sokovitiv  ehcivcu  ; 

2.  t o?s  £k  rivAov  A'r)<p9eio‘i  rots  Aa.naiviKo'is. 
ardp  rl  itot’  is  ri/v  yrjv  /3A£irov<nv  ovrod  ; 

M.  Qqrovaiv  ovTot  ra  Kara  yrjs. 

2.  fioAfiovs  &pa 

£r)TOV<n,  p.Tj  VVV  TOUToyl  (ppOVTi^eTS 
£ycc  yap  o!8’  'tv  elcri  pieyaAoi  Kal  naAoi. 
rl  ycip  oiSe  bpwaiv  ot  trtpSSp ’  iyneKvcpdres  ; 

M.  ovroi  8’  £pe/3o8i(pooaiv  virb  tov  T dprapov. 

2.  r (  8rj9’  6  xpaiKrbs  is  rbv  ovpavbv  fiAiirei; 

M.  avrb s  KaO’  avrbv  dorr povo p-eiv  diSdcrKerai. 

Apologising  for  this  intrusion  on  your  space, 

I  am,  &c.,  Theophilus  Philologtjs. 


GOD’S  GIFTS  TO  MAN. 


[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sib, — Last  Monday  I  was  taken,  much  against  my  will, 
by  my  young  granddaughter,  who  proposes  to  join  the 
medical  profession  (also  much  against  my  will),  to  hear  the 
introductory  lecture  at  the  London  School  of  Medicine  for 
Women.  I  was  prepared  to  hear,  and  perhaps  to  be  some¬ 
what  wearied  by,  a  repetition  of  the  sage  advice  and  solemn 
maxims  with  which  the  young  lecturer  has  been  accustomed 
to  entertain  the  young  student.  Imagine  my  surprise,  sir, 
when,  instead  of  all  this,  I  found  a  set  attack  being  made 
on  what  I  still,  after  half  a  century  of  practice,  believe  to 
be  our  most  potent  and  indispensable  weapons  in  the  warfare 
against  disease.  Not  platitude,  for  which  I  was  well  pre¬ 
pared,  but  latitude,  is  the  word  that  best  describes  Dr. 
Donkin’s  lecture ;  and,  to  my  mind,  a  very  dangerous 
latitude.  I  hope  you  will  agree  with  me  that  a  sturdy  stand 
ought  to  be  made  by  everyone  who  has  the  welfare  and  the 
efficiency  of  our  calling  at  heart,  against  this  new  scepticism. 
To  say,  as  Dr.  Donkin  did,  that  the  drug-treatment  of 
disease  is  founded  on  ignorance  and  assumption,  is  to 
give  a  slap  in  the  face  to  all  the  learned  men  and  learned 
bodies  who  have  spent  their  days  in  carefully  investigating 
the  use  of  medicines,  and  in  compiling  laborious  pharma¬ 
copoeias.  If  drugs  are  of  no  avail,  the  Medical  Council  loses 
its  one  great  claim  on  our  gratitude.  I  cannot  but  think 
that  these  junior  practitioners,  who  declaim  so  glibly  against 
the  utility  of  the  materia  medica,  can  have  as  yet  but  small 
experience  of  serious  warfare.  “  He  jests  at  scars  that  never 
felt  a  wound,”  and  he  jests  at  swords  and  pistols  who  was 
never  in  action.  I  hope  I  shall  be  forgiven  for  suggesting 
that  the  treatment  in  hospitals  is  not  a  very  serious  matter 
for  the  physician,  however  serious  it  may  be  for  the  patient. 
It  is  when  one  comes  to  private  practice,  when  one’s  whole 
reputation,  not  to  mention  one’s  bread-and-butter,  depends 
on  one’s  success,  in  perhaps  a  single  case,  that  one  really 
feels  one’s  responsibilities.  It  is  when  you  may  be  called  up 
at  any  hour  of  night  or  day  to  relieve  suffering, — it  is  when 
you  realise  that,  if  you  cannot  relieve  it,  some  one  else 
will  be  called  in  who  can, — that  you  really  begin  to 
yearn  for  remedies  in  which  you  can  have  a  sure  faith. 


Why,  sir,  if  I  had  not  had  a  sure  faith  in,  aye,  and  a  sure 
knowledge  of,  the  efficacy  of  drugs,  I  verily  believe  that  I 
should  have  before  this  ended  my  days  in  a  lunatic  asylum, 
or  at  any  rate  in  a  workhouse.  Instead  of  that— well,  I 
have  no  reason  to  complain.  To  talk  of  hygiene  and  all  that, 
seems  to  me  to  be  like  locking  the  stable-door  when  the 
steed  is  stolen.  Preventive  medicine  is  all  very  well  in  its 
way,  but  it  is  nonsense  and  worse  to  preach  to  a  patient 
about  diet  and  temperance  when  he  has  a  gouty  kidney  or 
hobnail  liver.  The  old  doctors  used  to  call  opium  “  God’s 
gift  to  man.”  I,  believing  that  pain  is  not  the  only  suffering, 
would  go  further,  and  reckon  amongst  His  benefits  not 
only  opium,  but  iron,  quinine,  arsenic,  strychnine,  aloes,  and 
even  assafoetida.  I  am,  &c., 

A  Pbactitioneb  op  Fifty  Years’  Standing. 


METAPHYSICS  IN  PATHOLOGY. 

[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sib, — What  does  Dr.  Saundby  mean  by  the  “  application  of 
the  doctrine  of  the  origin  of  species  to  the  case  of  specific 
diseases  ”?  If  he  means  [merely  the  assertion  that  the  law 
of  evolution  applies  to  the  case  of  specific  diseases  as  well 
as  to  all  other  specificities,  no  one  will  be  disposed  to  dispute 
his  statement.  If  the  doctrine  of  evolution  be  true  at  all, 
it  requires  no  great  acumen  to  see  that  its  application 
must  be  universal.  But  if  Dr.  Saundby  would  imply  that 
Niemeyer  (or  any  other  authority)  has  attempted  to  work 
out,  detail  by  detail,  the  progress  of  the  origin  of  species  as 
affecting  specific  diseases,  to  explain  their  phenomena 
thereby,  to  reconcile  thereby  their  apparent  anomalies  and 
contradictions,  and  to  show  that  that  process  is  now  going 
on  in  our  midst  (not  only,  as  Sir  James  Paget  indicated  in 
his  recent  Bradshawe  Lecture,  in  the  production  of  “  new 
and  rare  diseases,”  but  even  in  the  re-evolution  of  already 
existent  types),  then  I  can  only  ask  him  for  a  more  specific 
reference  to  exact  expressions. 

I  am  tolerably  well  acquainted  with  Niemeyer,  and  have 
had  occasion  to  quote  from  his  work  some  general  state¬ 
ments  in  my  forthcoming  pamphlet  on  the  “  Evolution  of 
Morbid  Germs.”  But  those  statements  merely  suggest  the 
application  of  the  doctrine,  or  rather  its  applicability ;  they 
do  not  apply  it  in  detail,  or  formulate  a  definite  and  har¬ 
monious  theory,  especially  in  the  light  of  the  germ  theory. 

Such  theories  may  stand  or  fall  with  time,  but  they  are 
at  least  the  pioneers  of  knowledge,  and  no  law  of  nature 
can  be  proved  to  be  such  till  it  is  first  formulated  as  a 
theory  on  a  limited  observation,  and  its  truth  tested  after¬ 
wards  by  the  universality  of  its  application. 

I  am,  &c., 

Kineton,  October  2.  Kenneth  W.  Millican. 


MEDICAL  NEWS. 


King  and  Queen’s  College  of  Physicians  in  Ire- 
land. — At  a  special  Examination  Meeting  of  the  College 
held  on  Wednesday,  September  26,  the  Licences  to  practise 
Medicine  and  Midwifery  were  granted  to — 

"Wright,  Robert,  Surgeon  R.N.,  L.R.C.S.  Ire. 


Apothecaries’  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday, 
September  27  : — 

Appleford,  Stephen  Herbert,  Finsbury -circus,  E.C. 

Clayton,  Geoffrey  Sherborne,  Fairfax-road,  N.W. 

Skardon,  Charles  Chapman,  Westbourn  e-park-crescent,  W. 
Wilson,  John  Grant,  Monmouth. 

The  following  gentleman  also  on  the  same  day  passed  the 
Primary  Professional  Examination  : — 

Forden,  George,  Stafford  Infirmary. 


APPOINTMENTS. 

*«*  The  Editor  will  thank  gentlemen  to  forward  to  the  Publishing-office, 
as  early  as  possible,  information  as  to  all  new  Appointments  that  take 

place.  - 

Cooper,  Austin  N.,  L.R.C.S.  Ire.,  House-Surgeon  to  the  House  of  In¬ 
dustry  Hospitals,  Dublin,  in  succession  to  Dr.  A.  Newton  Dickenson, 
resigned. 


416 


Medical  Times  and  Gazette. 


MEDICAL  NEWS. 


Oct.  6,  1883. 


VACANCIES. 

In  the  following  list  the  nature  of  the  office  vacant,  the  qualifications  re¬ 
quired  in  the  candidate,  the  person  to  whom  application  should  be  made 
and  the  day  of  election  (as  far  as  known)  are  stated  in  succession. 
Bristol  Boyal  Infirmary.— Assistant  Eesident  Officer  and  Pathologist. 
(For  particulars  see  Advertisement.) 

Cheltenham  General  Hospital.— Assistant  House-Surgeon.  Salary 
£80  per  annum,  with  board  and  lodging  in  the  Hospital.  Candidates 
must  possess  at  least  one  registered  qualification  and  be  unmarried. 
Applications,  stating  age,  with  testimonials,  to  be  sent  to  the  Hon. 
Secretary,  on  or  before  October  24. 

Chichester  Infirmary.— House-Surgeon  and  Secretary.  Salary  £100  per 
annum,  with  board,  lodging,  and  washing.  Candidates  must  possess 
both  a  medical  and  surgical  qualification  obtained  in  the  United  King¬ 
dom,  and  be  duly  registered.  Applications,  with  testimonials,  to  be  sent 
to  the  Chairman  of  the  Committee,  on  or  before  October  22.  The 
election  will  take  place  on  November  8. 

Chichester  Infirmary. — Assistant  House-Surgeon.  Salary  £20  per 
annum,  with  board,  lodging,  and  washing.  Applications  to  be  sent  to 
the  Chairman  of  the  Committee,  on  or  before  October  22. 

Durham  County  Asylum,  Sedgefield,  near  Ferryhill. — Junior  Assis¬ 
tant  Medical  Officer.  Salary  £100  to  £150.  Applications,  enclosing 
testimonials,  to  be  made  to  Dr.  Smith,  Superintendent. 

Kilburn,  Maida  Vale,  and  St.  John’s  Wood  General  Dispensary, 
N.W.— Resident  Medical  Officer.  Salary  £120  (per  annum,  with 
rooms,  coals,  gas,  and  attendance.  Candidates  must  be  unmarried. 
Applications,  with  qualifications  and  testimonials  as  to  character  and 
professional  ability,  to  be  sent  to  the  Hon.  Secretary,  13,  Kilbum-park- 
road,  Maida  Vale,  W.,  on  or  before  October  10. 

UNION  AND  PAROCHIAL  MEDICAL  SERVICE. 

***  The  area  of  each  district  is  stated  in  acres.  The  population  is 
■computed  according  to  the  census  of  1881. 

RESIGNATIONS. 

Brachley  Union.— Mr.  Walter  Moore  has  resigned  the  Second  District : 
area  14,102 ;  population  2883 ;  salary  £60  per  annum. 

Downham  Union. — Mr.  Alexander  J.  Mackintosh  has  resigned  the 
Wiggenhall  District :  area  18,691 ;  population  3644  ;  salary  £46  per  annum. 

Smallburgh  Union.— Mr.  William  Wilcox  has  resigned  the  Bacton  Dis¬ 
trict  :  area  10,841 ;  population  2416 ;  salary  £40  per  annum. 

APPOINTMENTS. 

Aylesbury  Union.— Charles  E.  Walker,  L.R.C.P.  Edin.,  M.R.C.S.  Eng., 
to  the  Fifth  District. 

Sheffield  Union.— William  Collier,  L.F.P.&S.  Glasg.  and  L.S.A.  Lond., 
to  the  Central  District. 


On  November  6,  Dr.  B.  W.  Richardson,  -will  lecture 
at  the  Victoria  Coffee  Hall  on  "  Food  and  Feeding.”  Entrance 
one  penny. 

There  were  only  sixty-four  deaths  from  cholera  in 
Bombay  city  last  week,  as  compared  to  seventy-four  the 
week  previous.  The  epidemic  in  the  Deccan  districts  also 
is  rapidly  dying  out. 

On  Tuesday  last,  Dr.  Haughey,  a  practitioner  of 
Crewe,  was  thrown  violently  out  of  his  carriage,  and,  falling 
on  his  head,  received  such  serious  injuries  to  his  brain  that 
but  faint  hopes  are  entertained  of  his  recovery. 

At  Guy’s  Hospital  the  open  Scholarship  of  125  guineas 
in  classics,  mathematics,  and  modern  languages  has  been 
awarded  to  Mr.  George  Herbert  Pennell ;  and  that  of  125 
guineas  in  chemistry,  physics,  botany,  and  zoology  to  Mr. 
Ernest  Henry  Starling. 

The  Indian  Government  has  issued  a  notice,  stating 
that  the  cholera  cases  at  present  occurring  in  Bombay  are 
not  of  an  epidemic  character,  and  that  the  health  officer  for 
the  port  will  in  future  grant  clean  bills  of  health.  There 
were  only  ten  deaths  from  cholera  in  the  city  last  week. 

Legacy  to  Glasgow  Charities. — By  the  settlement 
of  the  late  Mrs.  Macnair,  of  Glasgow,  the  residue  of  her 
estate,  amounting  to  close  on  £3000,  has  been  divided  equally 
between  the  Glasgow  Royal  Infirmary,  the  Glasgow  Blind 
Asylum,  and  the  Glasgow  City  Mission. 

New  Inventions  and  Improvements. — We  are  re¬ 
quested  by  Messrs.  C.  Wright  and  Co.,  of  New  Bond-street, 
do  state  that  a  portable  irrigator  and  enema  apparatus, 
similar  to  the  one  noticed  on  page  388  in  the  last  number, 
has  been  made  by  them  for  some  years  past. 

Edinburgh. — At  the  Edinburgh  Police-court,  on 
Monday,  a  butcher  was  fined  £20,  or  sixty  days’  imprison¬ 
ment,  for  exposing  eighty-two  and  a  half  pounds  of  horse¬ 
flesh  which  was  unsound  and  unfit  for  human  food.  Part 
•of  the  meat  was  found  hanging  in  the  shop  beside  good 
meat,  and  other  two  pieces  in  the  back-shop,  while  the 
mincing  machine  was  filled  with  horse-flesh.  The  Bailie 
remarked  that  the  poor  people  in  the  Cowgate  must  be 
protected  as  much  as  the  people  in  the  better  parts  of  the 
city. 


The  committee  of  the  recent  Festival  Choral  Society, 
Wolverhampton,  has  handed  over  to  the  local  Hospital 
=£368  15s.  4d.,  received  from  collections  and  donations 
during  the  musical  festival.  It  is  probable  that  a  further 
sum  on  the  balance  of  the  accounts  will  be  handed  over 
to  the  Hospital. 

University  of  Aberdeen.— The  University  Court  has 
appointed  the  following  to  be  Extra-Professorial  Examiners 
in  Medicine  in  the  University  for  the  ensuing  year,  viz.  : — 
Dr.  John  Alexander,  Glasgow;  Dr.  James  Anderson,  London; 
Dr.  A.  Campbell,  Dundee  ;  Dr.  G.  M.  Edmond,  Stonehaven ; 
Dr.  R.  M.  Wilson,  Old  Deer  ;  Mr.  Fredk.  Treves,  London. 

Aberdeen  Sick  Children’s  Hospital.— This  Hos¬ 
pital,  in  support  of  the  funds  of  which  Princess  Beatrice 
opened  a  bazaar  at  Aberdeen  on  Thursday  week,  was  founded 
in  1877,  mainly  through  the  instrumentality  of  Dr.  Stephen¬ 
son,  Professor  of  Midwifery  in  the  University.  Contribu¬ 
tions  amounting  to  nearly  <£2000  have  recently  enabled  the 
directors  to  set  about  the  work  of  making  provision  for 
additional  accommodation ;  and  they  are  now  negotiating 
for  the  acquisition  of  land  to  the  east  of  the  present  Hos¬ 
pital.  If  the  negotiations  prove  successful,  it  is  intended 
to  erect  a  building,  separate  from  the  Hospital,  for  the 
reception  of  infectious  cases,  for  which  purpose  it  is  estimated 
that  from  £2000  to  £2500  will  be  required. 

Dunoon  Seaside  Homes. — The  annual  meeting  of  the 
donors  and  subscribers  to  the  Convalescent  Homes,  Dunoon, 
was  held  in  Glasgow  on  Monday,  under  the  presidency  of  Sir 
Peter  Coats.  It  was  reported  that  during  the  year  2679 
convalescents  had  been  admitted,  and  of  these  2478  had  been 
perfectly  restored,  while  six  had  died.  The  ordinary  revenue 
of  the  year  had  been  £4701,  while  the  total  expenditure, 
ordinary  and  extraordinary,  amounted  to  £4632.  An  appeal 
was  made  to  the  public  to  enable  the  directors  to  erect  a 
separate  home  for  mothers  and  children.  Resolutions  com¬ 
mending  the  institution  to  the  continued  confidence  and 
support  of  the  community,  and  expressing  thanks  to  sub¬ 
scribers  and  others  who  had  contributed  to  the  efficiency  of 
the  management,  were  adopted. 

University  of  Dublin:  School  of  Physic. — On 
Saturday,  September  29,  the  Provost  and  Senior  Fellows  of 
Trinity  College,  Dublin,  proceeded  to  elect,  in  the  presence 
of  the  President  of  the  King  and  Queen’s  College  of  Phy¬ 
sicians,  a  Professor  of  Anatomy  and  Chirurgery,  in  the  room 
of  Professor  Alexander  Macalister,  recently  appointed  to  the 
corresponding  chair  in  the  University  of  Cambridge.  The 
choice  of  the  electors  fell  upon  Dr.  D.  J.  Cunningham, 
Professor  of  Anatomy  in  the  School  of  Surgery,  Royal 
College  of  Surgeons  in  Ireland,  and  formerly  Senior  De¬ 
monstrator  of  Anatomy  in  Edinburgh  University,  and  Pro¬ 
fessor  of  Physiology  in  the  Royal  Veterinary  College,  Edin¬ 
burgh.  Dr.  Cunningham  may  well  be  congratulated  on  the 
high  position  to  which  his  many  and  varied  talents  have 
enabled  him  to  attain,  and  the  University  of  Dublin  on 
having  secured  so  valuable  an  addition  to  the  staff  of 
teachers  in  the  School  of  Physic. 

First  Aid  to  the  Injured. — Several  interesting 
cases  in  which  “  first  aid  ”  had  been  rendered  by  certificated 
pupils  have  recently  been  reported  to  the  St.  John  Ambu¬ 
lance  Association.  In  the  accident  at  Middlesborough-on- 
Tees,  on  September  19,  when  Mr.  Davison  lost  his  life  by 
the  upsetting  of  a  ladle  of  molten  iron,  several  workmen 
who  were  injured  were  attended  to  by  Police-constable  Salt, 
chief  watchman  at  the  works.  A  few  days  since,  at  Hamp¬ 
stead,  a  milkman,  who,  jumping  from  bis  cart,  fell,  and  cut 
with  a  broken  glass  bottle  the  main  artery  of  the  left  hand, 
was  treated  by  Engineer  F.  Smart,  of  the  Fire  Brigade 
Station,  Heath-street.  At  Worthing,  patients  suffering 
from  double  fracture  of  both  bones  of  the  leg,  poisoning, 
and  fracture  of  the  thigh  respectively,  were  reported  by  a 
local  surgeon  to 'have  been  most  efficiently  treated  pending 
his  arrival.  With  reference  to  the  recent  explosion  at 
Woolwich,  where  the  effects  might  have  been  most  disastrous, 
it  was  mentioned  that  nearly  all  the  Arsenal  Police  had 
undergone  instruction  ;  and  their  proficiency  had  been  com¬ 
mented  on  with  great  satisfaction  by  the  coroner  at  a  recent 
inquest,  at  which  evidence  was  given,  showing  that  two  of 
the  constables,  certificated  pupils,  had  saved  a  life  of  a 
boy  from  their  knowledge  of  how  to  treat  the  apparently 
drowned. 


Medical  Times  and  Gaeette. 


VITAL  STATISTICS';'"^ 

_ _ _ i  .A  MfUA.-A 


VITAINSTATIS 


Oct.  6,  1883.  4  1  7 


OF  LONDON. 


Chloroform  Pomade. — The  following  is  the  formula 
of  Lasegue  and  Regnauld’s  pomade : — chloroform  20  to 
30  parts,  and  vaseline  60  to  80  parts.  It  is  employed  for 
rheumatic  and  neuralgic  pains,  and  in  the  vague  thoracic 
pains  of  tuberculous  patients. — Union  Med.,  September  11. 

According  to  the  latest  report  of  the  Metropolitan 
Fever  Hospitals,  during  the  last  four  weeks  294  patients  had 
been  admitted,  42  had  died,  and  223  had  been  discharged, 
leaving  452  under  treatment,  of  whom  374  were  scarlet- 
fever  patients,  one  was  a  typhus  patient  (in  the  West  of 
London),  75  were  enteric-fever  patients,  while  two  were  de¬ 
scribed  as  suffering  from  “  other  diseases/’  The  numbers 
admitted  and  the  cases  left  under  treatment  showed  a  great 
increase  over  the  figures  last  presented.  In  regard  to  small¬ 
pox,  there  had  been  38  patients  admitted  in  the  four  weeks, 
5  had  died,  and  30  had  been  discharged,  leaving  59  under 
treatment,  or  3  more  than  at  the  last  return. 

At  a  temperance  meeting  in  St.  Petersburg,  Mr.  Sydney 
Buxton  appears  to  have  stated  that  the  average  age  of 
Englishmen  has  lately  increased  by  as  much  as  two  years. 
This  increase  he  attributed  to  the  spread  of  temperance 
principles,  though  he  was  good  enough  to  add  that  the  pro¬ 
gress  of  medical  science  might  have  contributed  something. 
The  next  generation,  he  thought,  would  probably  witness  a 
still  greater  improvement,  for  the  present  age  was  suffering 
from  the  serious  excesses  of  the  past  generation.  Mr.  Buxton 
evidently  does  not  agree  with  biblical  science,  which  makes 
longevity  conditional  on  honouring  one’s  parents.  If  we  want 
to  live  long,  he  contends,  the  last  thing  we  must  do  is  to 
follow  the  example  of  our  progenitors. 


APPOINTMENTS  FOE  THE  WEEK. 

October  6.  Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  1J  p.m.;  King’s  College,  1£  p.m.  5  Royal 
Free,  2  p.m.;  Royal  London  Ophthalmic,  11  a.m. ;  Royal  Westminster 
Ophthalmic,  l^p.m.;  St.  Thomas’s,  l£p.m.;  London,  2  p.m. 


Week  ending  Saturday,  September  29,  1883. 


BIRTHS. 

Births  of  Boys,  1234;  Girls,  1165;  Total,  2399. 

Corrected  weekly  average  in  the  10  years  1873-82,  2610-0. 


DEATHS. 


Males. 

Females. 

Total. 

Deaths  during  the  week . 

662 

595 

1257 

Weekly  average  of  the  ten  years  1873-82,  > 

7192 

6743 

corrected  to  increased  population  ...  j 

Deaths  of  people  aged  80  and  upwards 

48 

DEATHS  IN  SUB-DISTRICTS  FROM  EPIDEMICS. 


Enumerated 

Population, 

1881 

(unrevised). 

o 

p. 

1 

i—e 

*3 

a 

GQ 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

Whooping- 

cough. 

Typhus. 

Enteric  (or 

Typhoid) 

Fever. 

Simple 

continued 

Fever. 

a 

1 

a 

West . 

669633 

1 

1 

5 

3 

2 

... 

... 

T 

North 

906947 

i 

2 

11 

5 

7 

... 

9 

... 

15 

Central 

282238 

... 

2 

... 

1 

... 

1 

... 

4* 

East . 

692738 

l 

9 

12 

3 

2 

••• 

2 

... 

19 

South . 

1265927 

6 

23 

6 

9 

... 

3 

... 

16- 

Total . 

3816483 

2 

18 

49 

19 

22 

2 

15 

... 

61 

METEOROLOGY. 

From  Observations  at  the  Greenwich  Observatory. 


Mean  height  of  barometer  . 

... 

.  ...  29-507  in. 

Mean  temperature  . 

...  57-1° 

Highest  point  of  thermometer  . 

.  ...  69-7° 

Lowest  point  of  thermometer  ... 

...  .. 

.  ...  421° 

Mean  dew-point  temperature  . 

... 

.  ...  50-7* 

General  direction  of  wind  . 

...  • 

...  S.W. 

Whole  amount  of  rain  in  the  week . 

... 

0  92  in. 

BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  thp 
Week  ending  Saturday,  Sept.  29,  in  the  following  large  Towns : — 


8.  Monday. 

Operations  at  the  Metropolitan  Free,  2  p.m.;  St.  Mark’s  Hospital  for 
Diseases  of  the  Rectum. 2  p.m.;  Royal  London  Ophthalmic,  11  a.m.; 
Royal  Westminster  Ophthalmic,  li  p.m. ;  Hospital  for  Women,  2  p.m. 


9.  Tuesday. 

Operations  at  Guy’s,  1&  p.m. ;  Westminster,  2  p.m. ;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  lh  p.m.;  West 
London,  3  p.m. 


10.  Wednesday. 

Operations  at  University  College,  2  p.m. ;  St.  Mary’s,  II  p.m. ;  Middlesex, 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew’s,  1J  p.m. ;  Great  Northern, 

2  p.m. ;  Samaritan,  2J  p.m. ;  Royal  London  Ophthalmic,  11  a.m.  ; 
Royal  Westminster  Ophthalmic,  1£  p.m. ;  St.  Thomas’s,  1£  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m.;  National  Orthopaedic,  Great 
Portland-street,  10  a.m. 

Hunterian  Society  (London  Institution),  (Council  Meeting,  7.15  p.m.), 
8  p.m.  Dr.  Stephen  Mackenzie,  “  On  some  of  the  Rarer  Skin  Diseases.” 


11.  Thursday. 

Operations  at  St.  George’s,  1  p.m. ;  Central  London  Ophthalmic,  1  p.m. ; 
Royal  Orthopaedic,  2  p.m.;  University  College,  2  p.m.;  Royal  London 
Ophthalmic, 11  a.m. ;  Royal  Westminster  Ophthalmic,  li  p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m. ;  Hospital  for  Women,  2  p.m. 
Charing-cross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  2£  p.m. 
Ophthalmological  Society,  8A  p.m.  Address  by  the  President,  Mr. 
Hutchinson,  F.R.S.  Dr.  Stephen  Mackenzie,  “On  some  Cases  of 
Retinal  Haemorrhage.”  Dr.  Sharkey,  “  On  a  Case  of  Homonymous 
Hemianopia  due  to  a  Cortical  Lesion.”  Mr.  Nettleship,  (1)  “  On  a  Case 
of  Homonymous  Hemianopia  due  to  Lesion  of  Chiasma  or  Tract  ” ; 
(2)  “  On  a  Case  of  Sympathetic  Iritis  following  Immediate  Excision  of 
Eye  for  Injury.”  Living  Specimens  at  8  p.m. Dr.  J.  A.  Ormerod— 
Left  Hemiplegia,  with  subsequent  Contraction  of  the  Field  of  Vision  of 
'  the  Opposite  Eye.  Dr.  Brailey — Two  Exceptional  Cases  of  Glaucoma.” 


12,  Friday. 

Operations  at  CentralLondonOphthalmic,  2  p.m.;  Royal  London  Ophthal¬ 
mic,  11a.m.;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminster 
Ophthalmic,  ljp.m.;  St.  George’s  (ophthalmic  operations),  1}  p.m.; 
Guy’s,  14  p.m. ;  St. Thomas’s  (ophthalmic  operations),  2  p.m. ;  King’s 
College  (by  Mr.  Lister),  2  p.m. 

Clinical  Society  op  London,  8J  p.m.  Dr.  Goodhart,  “  On  Three  Cases 
of  Peritoneal  Abscess  in  Children.”  Dr.  Bastian,  (1)  “  On  an  Anoma¬ 
lous  Case  of  Disseminated  Cerebro-Spinal  Sclerosis”;  (2)  “  On  a  Case  of 
Rupture  of  a  large  Aneurysm  in  the  Left  Corpus  Striatum,  with  Intra¬ 
ventricular  Hsemorrhage  and  Extreme  Lowering  of  Rectal  Tempera¬ 
ture  ”;  (3)  “  On  a  Case  of  Apoplexy  in  a  Boy  aged  Fifteen,  with  Intra¬ 
ventricular  Haemorrhage,  Convulsions,  and  Death  in  Four  Hours.” 
Dr.  Althaus,  “On  a  Case  of  Syphilis  of  the  Cerebral  Arteries,  with 
Gummatous  Tumours  permeating  the  Dura  Mater.” 


Cities 

and 

Boroughs. 

Estimated  Population  to 
middle  of  the  year  1883. 

Births  Registered  during 
the  week  ending  Sept.  29. 

Deaths  Registers  d  during 
t  the  week  ending  Sept.  29. 

Annual  Rate  of 
Mortality  per  1CC0  living, 
from  all  causes. 

Temperature 
of  Air  (Fahr.) 

Temp, 
of  Air 
(Cent.) 

Rain 

Fall. 

Highest  during 
the  Week. 

Lowest  during 
the  Week. 

Weekly  Mean  of 
Daily  MeanValues 

Weekly  Mean  of 
rDaily  Mean 
Values. 

In  Inches. 

GO 

9 

■£> 

i 

<a> 

O 

A 

London  . 

3955814 

2399 

1257 

16-6 

69-7 

42-1 

57T 

13-95 

092 

2-3* 

Brighton  ...  ... 

111262 

48 

43 

20-2 

68'0 

47-0 

57-2 

14-00 

1-33 

3'3& 

Portsmouth 

131478 

100 

44 

17-5 

... 

... 

... 

... 

... 

... 

Norwich  . 

89612 

46 

38 

22'1 

... 

... 

... 

... 

... 

... 

Plymouth  . 

74977 

51 

34 

23-7 

66-0 

47  1 

57-1 

1395 

1-93 

4-90- 

Bristol . 

212779 

130 

63 

154 

64-5 

47-0 

55'4 

13-00 

2-03 

518 

Wolverhampton  . 

77557 

56 

27 

18-2 

63-7 

38-0 

52'9 

11-61 

1-76 

4-44 

Birmingham 

414846 

259 

160 

20'1 

... 

... 

... 

... 

... 

Leicester  ...  (.. 

129483 

83 

35 

14T 

... 

... 

... 

... 

Nottingham 

199349 

132 

77 

202 

67-8 

41-2 

54"6 

1256 

1-28 

3-25 

Derby . 

85574 

51 

25 

15"2 

... 

... 

... 

... 

... 

... 

Birkenhead 

88700 

58 

30 

17'6 

... 

... 

... 

Liverpool  . 

566763 

329 

284 

26-1 

64-3 

48-4 

55*6 

13-12 

2-22 

5-64 

Bolton . 

107862 

62 

51 

24-7 

622 

45-8 

53"4 

11'89 

4'14 

10-52 

Manchester 

339262 

225 

163 

25-1 

... 

... 

•••. 

.»• 

... 

... 

Salford  . 

190465 

138 

69 

18-9 

... 

... 

... 

... 

... 

... 

Oldham  . 

119071 

81 

40 

17-5 

... 

... 

... 

... 

... 

... 

Blackburn . 

108460 

63 

39 

18-8 

... 

... 

... 

... 

... 

... 

Preston  . 

98564 

54 

54 

28-6 

... 

... 

... 

... 

... 

... 

Huddersfield  ... 

84701 

47 

25 

15-4 

... 

... 

... 

... 

... 

Halifax  . 

75591 

39 

27 

18-6 

... 

... 

... 

Bradford  ...  ... 

204807 

108 

62 

158 

62-8 

48-8 

54-4 

12  44 

3  86 

9-80 

Leeds  . 

321611 

203 

117 

190 

64-0 

49-0 

55-3 

12-95 

2-54 

6*45- 

Sheffield  . 

295497 

216 

124 

219 

65-0 

46-5 

54-8 

1267 

2-68 

6-81 

Hull  . 

176296 

110 

85 

25'2 

66-0 

42-0 

54-7 

1261 

1-67 

3‘61i 

Sunderland 

121117 

108 

58 

25-0 

... 

... 

... 

... 

Newcastle  . 

149464 

91 

95 

33-2 

... 

... 

... 

... 

... 

... 

Cardiff . 

90033 

71 

28 

162 

... 

... 

... 

... 

... 

... 

For  28  towns ... 

8620975 

6358 

3164 

19T 

69-7 

38-0 

552 

1289 

05  I 
* 

1 

6-56 

Edinburgh . 

— 

235946 

120 

85 

18-8 

... 

... 

... 

1 

... 

Glasgow  . 

>  515589 

363 

220 

223 

63'5 

42-0 

53-8 

1212 

0-84 

2-13 

Dublin . 

!  349685 

178 

159 

23-7 

67-7 

39'S 

54-7 

1261 

1-01 

2-57 

At  the  Royal  Observatory,  Greenwich,  the  mean  reading 
of  the  barometer  last  week  was  29’51  in. ;  the  highest  read¬ 
ing  was  29'91  in.  on  Sunday  morning,  and  the  lowest 
29’0G  in.  by  the  end  of  the  week. 


418 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES 


Oct.  6,  1883. 


NOTES,  QUERIES,  AND  REPLIES. 

- - - 

$U  tjjHi  qrusthmetjj  mntjj  s^all  learn  trnulr. — Bacon. 

■'Hospital  Accommodation  for  Officers.— This  provision  has  been  made  at 
Woolwich,  Dublin,  Devonport,  and  Netley ;  abroad,  at  Malta,  Gibraltar, 
and  Natal— an  arrangement  long  wanted. 

Noteworthy. — In  aid  of  the  objects  of  the  National  Smoke  Abatement 
Institution,  the  Gas  Light  and  Coke  Company  and  the  South  Metro¬ 
politan  Gas  Company  have  each  sent  a  donation  of  £100. 

A  Modem  Dousterswivel. — A  letter  has  been  received  by  a  gentleman 
residing  at  Richmond,  in  which  the  writer  offers  to  find  a  supply  of 
water  for  that  town  and  district  by  means  of  the  divining-rod. 

The  Paris  Morgue. — The  present  building  is  to  be  pulled  down,  and  the 
establishment  will  be  transferred  to  the  Caserne  de  la  CitA  In  t804  the 
Morgue  was  removed  to  the  old  slaughter-house  of  the  Marche  Neuf. 
The  present  Morgue  was  established  in  1864. 

Pr  oposed  International  Sanitary  Code. — It  is  stated  that  all  the  Powers  have 
signified  their  adhesion  to  the  proposal  of  the  Italian  Government  to 
summon  a  conference  at  Rome  with  the  object  of  making  sanitary 
regulations  and  drawing  up  an  international  sanitary  code. 

Their  own  Dust  Collectors. — The  Clerkenwell  Vestry  has  effected  a  saving 
this  year,  as  compared  with  the  expenditure  of  the  previous  year,  of  £260, 
by  itself  undertaking  the  removal  of  dust  and  the  scavenging  and  water¬ 
ing  of  the  parish.  This  work  had  previously  been  done  by  contract. 

Open  Spaces.— Proposals  to  adapt  two  churchyards  in  the  parish  of  Bethnal 
Green— namely,  St.  Matthew’s  Church  and  St.  Bartholomew’s  district 
Church— into  open  spaces  for  the  use  of  the  people,  are  being  considered 
by  the  Vestry.  In  this  densely  crowded  district  the  appropriation  of 
these  burial-grounds  for  the  recreation  of  the  inhabitants  would  be  a 
boon,  which,  no  doubt,  will  be  appreciated. 

< Small  Luxuries  to  Aged  Paupers. — The  Liverpool  Select  Vestry  propose  to 
organise  a  “  monster  deputation  ”  from  boards  of  guardians  to  the 
.President  of  the  Local  Government  Board,  to  remonstrate  with  him  on 
the  present  rigorous  regulations  limiting  the  grant  of  “  small  luxuries  ” 
to  aged  and  infirm  paupers.  This  considerate  proposal  exhibits  a  satis¬ 
factory  contrast  to  the  rigid  economy  in  times  past  of  Poor-law 
guardians. 

failure  of  a  Prosecution  against  a  Chemist  for  Selling  Inferior  Tincture  of 
Quinine. — The  prosecution  by  the  Vestry  of  St.  John’s,  Hampstead, 
against  a  chemist  trading  in  that  district,  for  selling  tincture  of  quinine 
not  containing  the  proper  quantity  (eight  grains  to  the  ounce)  of 
sulphate  of  the  same  material,  has  failed,  the  Government  analysts 
at  Somerset  House  having  certified  that  the  article  in  question  was 
constituted  according  to  the  recognised  standard. 

Improved  Middle- Class  Dwellings. — The  trustees  of  St.  Mary-le-Strand 
Estate,  situate  in  the  Old  Kent-road,  are  prepared  to  receive  offers  for 
a  portion  of  their  estate,  upon  which  to  erect  fifteen  blocks  of  improved 
middle-class  dwellings,  each  to  contain  ten  suites  of  apartments.  At 
>the  request  of  the  Charity  Commissioners  these  dwellings  are  designed 
so  as  to  meet  the  requirements  of  clerks  and  others  of  a  similar  class— a 
description  of  dwellings  which,  it  appears  to  us,  the  metropolis  is  in  much 
want  of. 

Natality  from  Ealing  Diseased  Meat. — At  the  adjourned  inquest  on  the 
body  of  Thomas  Furlong,  one  of  twenty-eight  labourers  who,  it  was 
alleged,  had  been  poisoned  at  Rasagarland,  Wexford,  the  rumour  that 
poison  had  been  put  into  the  water  that  they  drank  was  contradicted ; 
and  it  was  shown  that  a  cow  which  was  suffering  from  splenic  apoplexy 
had  been  killed,  and  the  flesh  given  to  the  labourers  with  some  beer. 
The  deceased,  with  several  others,  was  seized  with  illness,  to  which 
he  succumbed.  Verdict,  “  Died  from  eating  diseased  meat.” 

The  Elementary  Schools. — The  over-pressure  in  these  schools  has  been 
somewhat  freely  discussed,  and,  so  far  as  we  know,  the  balance  of  opinion 
is  decidedly  opposed  to  the  present  system  of  education  in  them.  The 
North  Wales  school-teachers  held  a  meeting  a  few  days  since,  at  Gres- 
ford,  near  Wrexham,  which  resulted  in  a  resolution  strongly  condemning 
the  tendency  of  modern  education  to  unduly  increase  the  subjects  of 
instruction  in  elementary  schools ;  and  asserted  that  the  continual  strain 
in  preparation  is  injurious  alike  to  pupils  and  teachers. 

Street  Accidents :  London. — In  view  of  the  constantly  recurring  running- 
over  accidents  in  the  thoroughfares  of  the  metropolis  by  the  reckless 
driving  of  cabmen,  it  may  be  asked  if  these  men  obtain  their  licences 
without  any  examination  as  to  their  qualifications  for  driving  and  the 
control  of  their  horses  ?  Is  the  licence  granted  merely  upon  previous 
good  character  and  respectability  T  Surely,  before  men  are  licensed  as 
drivers  of  public  vehicles,  not  only  should  their  driving  be  tested,  but 
their  sight  and  hearing  also.  Many  complaints  are  heard  that  cabmen 
appear  at  times  to  deliberately  drive  into  people,  and  it  appears  that 
-such  instances  may  occur  from  defective  sight  or  hearing. 


The  Early  Closing  Movement.— Vie  are  glad  to  observe  that  Mr.  J.  H. 
Stacey,  the  Secretary  to  the  Early  Closing  Association,  has  contradicted 
the  reported  failure  of  the  early  closing  movement.  It  appears  that 
in  the  eastern  and  southern  districts  of  the  metropolis  great  progress  is 
bei  ng  made.  Independent  closing,  in  the  absence  of  any  general  agree¬ 
ment,  is  also  extensively  practised  in  the  North  of  London,  as  well  as  at 
the  West-end.  The  many  years’  persistent  efforts  of  the  Association  on 
behalf  of  shop  employes  is  worthy  of  commendation,  and  of  the  more 
generous  and  unselfish  support  of  employers. 

Cheshire  Dairies. — The  dairy-farmers  of  the  country  will  do  well  to  give 
attention  to  the  report  of  Mr.  Davenport,  the  inspector  to  the  Nantwich 
Rural  Sanitary  Authority.  He  states  that  “  the  exception  in  Cheshire 
is  to  find  any  dairy  sufficiently  far  removed  from  the  piggeries.”  The 
dairies  are  consequently  exposed  to  a  polluted  atmosphere.  Foul  air,  as 
is  well  known,  quickly  and  deleteriously  affects  the  quality  of  the  milk. 
Too  great  precautions  can  scarcely  be  taken  to  protect  it  from  taint, 
considering  how  important  an  article  of  food  milk  is.  Farmers,  as  a 
rule,  exhibit  a  careless  indifference  as  to  their  farm  buildings  being  free 
from  contamination.  The  Nantwich  Board  will,  we  hope,  enforce  the 
necessary  sanitary  improvements  in  the  dairies  under  its  control. 

Cente  narian.— Satisfactory  proof  in  verification  of  extreme  old  age  is  so 
g  enerally  wanting  that  the  following  remarks  are  not  without  interest : 
— The  centenarian  is  usually  poor,  always  in  full  possession  of  his 
faculties,  garrulous  in  the  matter  of  early  recollections,  and  there  is  no¬ 
body  to  contradict  him,  because  he  starts  on  the  basis  of  having  been 
born  a  good  score  of  years  before  his  sceptical  detractors.  What  we 
want  to  hear  of  is,  a  centenarian  who  can  point  to  recorded  evidence  of 
his  birth  and  extraneous  evidence  of  his  identity  with  the  subject  of  the 
recorded  birth— such  evidence,  in  fact,  as  would  stand  the  test  of 
judicial  inquiry  and  procure  a  decree  of  inheritance.  We  are  always 
suspicious  when  the  claim  for  extraordinarily  old  age  is  based  on  the 
centenarian’s  recollection  of  what  occurred  at  any  great  historical  event, 
elaborately  recorded  in  history,  and  supplemented  by  fiction.  The 
imagination  is  as  active  as  the  memory  is  treacherous. 

“  The  Dirtiest  Dustyard  in  London.'’ — The  attention  of  the  Bermondsey 
Vestry  ha3  been  called  by  Dr.  Stirling  to  the  “  dirtiest  dustyard  in 
London.”  Dr.  Stirling,  on  going  to  this  yard,  found  the  dust  formed 
into  a  great  mound  twenty  feet  high,  and  “around  it  an  immense 
quantity  of  ‘  soft  core,’  smelling  as  only  decaying  vegetable  matter  can 
smell.”  No  disinfectants  had  been  used.  The  doctor  paid  a  second 
visit,  which  disclosed  a  far  worse  state  than  he  discovered  on  his  first. 
Several  vestrymen  remarked  upon  this  pestiferous  spot  as  “  an  abo¬ 
mination.”  Some  two  thousand  loads  of  putrefying  refuse  were  heaped 
up  there,  and  green  vegetation  was  sprouting  from  the  top  of  the  horrid 
mass,  “the  stench  being  abominable.”  Ultimately  a  committee  was 
appointed  to  deal  with  the  nuisance,  with  a  view  to  its  abatement.  Ever 
and  anon  are  discovered,  apparently  with  surprise,  such  abominations 
as  this  dustyard.  Yet  to  collect  two  thousand  loads  of  refuse  on  the 
spot  must  have  been  a  work  of  considerable  time,  and  the  fact  seems  to 
involve  want  of  vigilance  on  the  part  of  the  nuisance  inspector  of  the 
district. 

COMMUNICATIONS  have  been  received  from— 

The  Secretary  of  tbe  Social  Science  Association,  London ;  Dr.  F,  A. 
Purcell,  London ;  Mr.  R.  Maguire,  Manchester ;  The  Secretary  of 
the  Pharmaceutical  Society,  London  ;  Mr.  W.  H.  Bennett,  London  ; 
Dr.  Ciiampneys,  London;  The  Secretary  of  the  Apothecaries’ 
Society,  London ;  Dr.  Herman,  London ;  Mr.  A.  P.  Gould,  London  ; 
Dr.  Eardley  Wilmot,  Leamington ;  The  Dean  of  the  Medical 
School  of  St.  Mary’s  Hospital,  London;  Dr.  Acland,  Oxford;  Dr. 
J.  W.  Moore,  Dublin ;  The  Secretary  of  the  London  Homceopathic 
Hospital  Medical  School,  London ;  Mr.  Bartleet,  Birmingham ; 
The  Honorary  Secretary  of  the  Clinical  Society,  London ;  Mr. 
Munro  Scott,  London;  Dr.  A.  T.  Thomson,  Glasgow;  Dr.  K.  W. 
Millican,  Kineton ;  Messrs.  C.  Wright  and  Co.,  London ;  Sir  Henry 
Pitman, London;  Mr.  J.  Chatto,  London  ;  The  Honorary  Secretary 
of  the  Abernethian  Society,  London ;  The  Secretary  of  the 
Faculty  of  Physicians  and  Surgeons,  Glasgow ;  Dr.  Brailey, 
London  ;  The  Editor  of  the  “  Pharmaceutical  Journal,”  London; 
Dr  .Alexander,  Liverpool ;  Dr.  J.  M.  Redmond,  Dublin ;  Dr.  Cholmeley, 
London ;  The  Secretary  of  the  Poor-Law  Officers’  Association, 
London ;  Dr.  W.  Hale  White,  London ;  The  Town  Clerk,  Hastings ; 
Mr.  A.  J.  Pepper,  London;  Mr.  Thomas  Wakley,  jun.,  London: 
The  Secretary  of  the  Army  Medical  School,  Netley  ;  The  Secretary 
of  the  Sanitary  Institute  of  Great  Britain,  London. 

PERIODICALS  AND  NEWSPAPERS  RECEIVED— 

Lancet— British  Medical  Journal— Medical  Press  and  Circular — Ber¬ 
liner  Klinische  Woehenschrift— Centralblatt  fur  Chirurgie— Gazette 
des  Hopitaux— Gazette  Mgdicale— Revista  de  Medicina — Bulletin  de 
1’ Acad^mie de  M^decine— Pharmaceutical  J ournal — Wiener  Medicinische 
Woehenschrift — Revue  M£dieale— Gazette  Hebdomadaire— Nature — 
Boston  Medical  and  Surgical  Journal — Louisville  Medical  News — 
Centralblatt  fur  Gynakologie — Le  Concours  Medical— Centralblatt  fur 
die  Medicinischen  Wissenschaf  ten— Centralblatt  fur  Klinische  Medicin 
— Philadelphia  Medical  News— Le  Progre's  Medical — Daily  Bristol  Times 
and  Mirror,  September  26 — New  York  Medical  Journal — Glasgow 
Medical  Journal — Medical  Temperance  Journal — Physician  and  Surgeon 
—North  British  Daily  Mail,  September  27 — Students’  Journal  and  Hos¬ 
pital  Gazette— Boy’s  Own  Paper — Girl’s  Own  Paper — Sunday  at  Home 
— Leisure  Hour — Friendly  Greetings — Bombay  Gazette — Veterinarian — 
Revue  Mensuelie  de  Laryngologie,  d’Otologie,  etc. — Archives  Generates 
de  Medecine — Monthly  Homoeopathic  Review — El  Ensayo  Medico— 
Toronto  Sanitary  Journal— Birmingham  Medical  Review— Edinburgh 
Medical  Journal — Cassell’s  Saturday  Journal. 


MeaioaJTin^.ndGa.etW  POWER  ON  THE  LACRIMAL  APPARATUS  OF  THE  EYE.  oct.is.issa.  415 

*  - ■ — — - - -  '  ■  - " 


LECTURES 

ON 

THE  PROTECTIVE  NAD  LACRIMAL 
APPARATUS  OF  THE  EYE. 

Delivered  at  the  Royal  College  of  Surgeons. 

By  HENRY  POWER,  M.B.  Load.,  P.R.C.S.  Eng., 

Arris  and  Gale  Lecturer  at  the  College  ;  Senior  Ophthalmic  Surgeon,  and 
Lecturer  on  Ophthalmic  Surgery,  St.  Bartholomew’s  Hospital. 


Lecture  III. 

I  now  proceed  to  consider  the  remarkable  channel  by  which 
the  tears,  having  fulfilled  their  function  of  facilitating  the 
movements  of  the  lids  and  of  cleansing  the  surface  of  the 
cornea  so  that  vision  may  be  clear  and  the  images  of  external 
objects  well  defined  on  the  retina,  are  conducted  to  the  nose, 
and  in  an  inspissated  condition,  and  mingled  with  mucus  and 
impurities,  are  either  discharged  by  the  nostril,  or  pass  back¬ 
wards  along  the  floor  of  the  nose  and  are.  swallowed. 

This  channel  is  bifurcate  above  and  single  below,  thus 
dividing  it  broadly  into  two  parts,  of  which  the  upper 
separate  portions  are  called  the  canaliculi,  the  lower  single 
and  undivided  portion  the  lacrimo-nasal  duct. 

The  canaliculi  commence  at  the  inner  borders  of  the  upper 
and  lower  lid  by  a  minute  orifice,  which  is  constantly  patent, 
termed  the  punctum  lacrimale.  This  is  situated  at  the 
apex  of  a  small  conical  elevation  at  the  junction  of  the  plane 
with  the  rounded  portion  of  the  free  margin  of  the  lid.  It 
is  situated  on  the  same  plane  as  the  openings  of  the  Mei¬ 
bomian  follicles,  and  therefore  near  the  posterior  edge  or  lip 
of  the  free  border.  The  nearest  Meibomian  follicle  is  about 
1  mm.  from  the  punctum.  The  aperture  is  somewhat 
elliptical  in  form,  with  the  long  axis  running  from  before 
backwards.  Its  width  varies  from  0'15  to  0-25  mm.  in. 
to^  in.),  the  lower  being  wider  than  the  upper  one,  in  corre¬ 
spondence  with  the  rather  larger  size  of  the  lower  canaliculus 
as  a  whole.  The  inferior  canaliculus  is  a  little  longer  than 
the  upper,  and  hence  the  punctum  of  the  lower  lid  is  a  little 
more  distant  from  the  inner  angle  of  the  palpebral  fissure. 
The  difference  is  not  more  than  half  a  millimetre,  the  lower 
punctum  being  6'5mm., the  upper6  mm.  from  the  inner  angle. 
Still  it  fulfils  an  important  purpose,  for  it  prevents  the  appo¬ 
sition  of  the  two  orifices  when  the  lids  are  closed,  and  permits 
the  passage  of  some  fluid  down  them  even  during  sleep. 
The  superior  rests  upon  or  against  the  surface  of  the  plica 
semilunaris,  the  inferior  upon  the  free  or  concave  border  of 
this  fold.  Both  orifices  look  a  little  backward,  the  upper 
one  in  addition  downwards  and  outwards,  the  lower  upwards 
and  inwards.  Both  are  endowed  with  remarkable  elas¬ 
ticity,  and  will  admit  the  entrance  of  a  larger  probe  than 
at  first  sight  seems  possible.  The  little  elevation  or  tubercle 
(O' 2  to  0'3  mm.  high)  on  which  the  punctum  is  situated  is 
of  pyramidal  or  triangular  form,  and  though  often6  scarcely 
apparent,  yet,  when  the  lids  are  pulled  outwards  and  the 
muscular  fibres  of  the  orbicularis  are  in  strong  action,  they 
become  very  prominent.  It  is  composed  of  dense  connec¬ 
tive  tissue,  with  some  elastic  tissue  with  horizontal  muscular 
fibres  which  extend  to  near  the  punctum. 

The  canaliculi  extend  from  the  puncta  to  the  lacrimal 
sac,  in  which  they  terminate  by  a  single,  or  occasionally  by 
a  double,  orifice.  Their  course  is  somewhat  oblique,  both 
vertically  and  horizontally,  and  it  is  hence  extremely  diffi¬ 
cult,  and  perhaps  impossible,  to  obtain  a  section  in  the 
adult  which  shall  enable  the  whole  course  of  the  duct  to  be 
seen  at  one  glance.  Gerlach  was,  however,  so  fortunate  as 
to  obtain  one  from  an  embryo  of  the  sixth  month,  in  which 
they  could  be  followed  in  their  entire  length. 

For  convenience  of  description,  the  canaliculi  may  be 
divided  into  several  parts.  English  authors,  as  a  rule, 
merely  refer  to  the  vertical  and  horizontal  portions  ;  but  the 
more  accurate  German  writers,  such  as  Heinlein,  describe 
in  succession  the  infundibulum,  the  arch,  the  diverticula, 
the  horizontal  portion,  and  the  collecting-tube,  or,  as  in  the 
case  of  Gerlach,  whose  account  is  exceedingly  good,  distin¬ 
guish  the  several  parts  of  the  tube  by  their  relation  to 
muscular  tissue— the  first  or  vertical  part  being  surrounded 
Vol.  II.  1883.  No.  1737. 


by  circular  muscular  tissue,  the  horizontal  part  by  longitu¬ 
dinal  muscular  fibres,  and  the  common  or  collecting  tube 
being  free  from  muscular  tissue. 

The  vertical  part  of  the  tube,  taking  it  as  a  whole,  is 
conical  in  form,  with  the  apex  at  the  punctum,  and  is  about 
2^  mm.  in  length.  It  has  been  divided  by  Heinlein  into 
the  infundibulum  and  the  arch.  The  infundibulum  is  the 
intrapapillary  portion  of  the  tube,  and  is  not  more  than 
half  a  millimetre  in  length,  and  its  diameter  at  the  base  a 
trifle  less — 0-4  mm.  According  to  Gerlach,  this  vertical 
part  of  the  tube  contracts  a  little  as  it  descends,  and  then 
widens  again  to  form  the  infundibulum.  At  the  most  con¬ 
stricted  portion  the  diameter  of  the  lumen  does  not  exceed 
0'08  or  01  mm.,  and  this  is  the  narrowest  part  of  the 
whole  canaliculus.  He  therefore  applies  to  it  the  name 
of  angustia  canaliculi  lacrimalis,  on  account  of  its  prac¬ 
tical  importance,  for  it  is  the  part  which  presents  the 
greatest  resistance  to  the  passage  of  a  probe.  Though 
mentioned  by  Foltz,  it  has  been  overlooked  by  all  observers 
subsequent  to  Gerlach,  because  it  is  only  seen  in  trans¬ 
verse  vertical  sections  made  through  the  exact  middle  of 
the  tube.  Physiologically  it  is  of  importance,  since  it  is 
the  point  at  which  circular  muscular  fibres  first  make  their 
appearance. 

The  next  segment  of  the  canaliculus  has  been  termed  by 
Heinlein,  with  considerable  propriety,  the  arch.  It  is  a 
segment  of  a  circle  having  a  radius  of  about  4'5  mm.  The 
convex  side  of  the  upper  canaliculus  looks  upwards  and 
outwards,  that  of  the  lower  downwards  and  outwards.  Its 
length  from  the  base  of  the  cone  to  the  commencement  of 
the  horizontal  segment  is  P2  mm.,  whilst  the  chord  of  the 
arc  measures  0-8  mm. 

There  are  two  diverticula  at  this  point,  which  are  separated 
from  each  other  by  a  slight  constriction.  Those  who  do 
not,  like  Gerlach,  describe  an  arch ,  regard  the  upper  diverti¬ 
culum  as  belonging  to  the  vertical  portion  of  the  tube,  and 
the  lower  one  to  the  horizontal  portion  of  the  tube,  the  con¬ 
striction  between  the  diverticula  marking  the  limit  between 
the  vertical  and  the  horizontal  portions.  It  would  appear 
that  in  adult  life  the  term  ‘f  arch,”  employed  by  Heinlein,  is 
most  correct,  whilst  in  the  embryo  the  tube  is  bent  much 
more  rectangularly.  The  first  diverticulum  is  directed 
outwards  ;  its  lumen  has  a  diameter  of  0'6  mm.  The 
second  diverticulum  is  considerably  larger  than  the  first ; 
it  is  directed  downwards,  or,  in  the  upper  lid,  upwards  ;  its 
lumen  has  a  diameter  of  0'7  or  even  0  8  mm.,  and,  with  the 
exception  of  the  collecting-tube,  is  the  widest  part  of  the 
canaliculus  ;  whilst  the  constricted  part  between  the  diver¬ 
ticular  and  the  horizontal  part  of  the  tube  has  a  general 
diameter  of  0'3  or  0  4  mm.  These  diverticula  appear  to  be 
very  constant,  and  may  have  given  rise  to  the  statement 
of  Hyrtl  (who  injected  them  with  wax)  that  the  tube  was 
spiral. 

The  next  segment  is  the  horizontal.  This  is  the  longest 
part  of  the  tube,  and  extends  from  the  large  diverticulum 
to  the  point  of  junction  of  the  two  tubes,  or  where  they 
open  separately  to  the  lacrimal  sac.  The  term  “  horizontal 
segment  ”  is  not  strictly  accurate ;  for  the  upper  cana¬ 
liculus  inclines  downwards,  the  lower  one  upwards.  The 
length  of  this  segment  depends  on  the  union  or  non-union 
of  the  tubes  to  form  a  collecting-tube,  and  varies  from  2  to 
2'8  mm.  The  lumen  varies  a  little  in  diameter,  ranging 
from  0'3  to  0'4  mm.,  but  does  not  exceed  or  fall  below  these 
measurements.  The  canaliculus  presents  slight  undulations 
in  its  course. 

The  next  part  of  the  tube  has  given  rise  to  much  discus¬ 
sion.  Haller,  writing  in  1772,  said  that  the  canaliculi 
sometimes  opened  by  a  single  aperture  into  the  sac,  some¬ 
times  by  two.  But,  with  this  exception,  most  of  the  older 
German  writers,  as  Krause,  Rosenmiiller,  Weber,  Hildebrandt, 
Serres  and  Bock,  and  others,  held  that  the  presence  of  a 
collecting-tube  was  the  exception.  Huschke  also  (1844) 
states  that  in  eight  cases  only  one  possessed  a  common  tube, 
whilst  in  the  remainder  the  canaliculi  had  separate  apertures. 
The  French  anatomists,  on  the  other  hand,  and  the  more 
recent  German  writers,  have  found  the  presence  of  a  short 
tube  common  to  the  two  tubes  almost  invariable.  Foltz 
never  saw  separate  openings,  though  he  examined  seventy 
eyes.  Bochdalek  and  Lesshaft  regard  the  collecting-tube 
as  normal.  Sappey  states  that  from  his  own  fifteen  dissec¬ 
tions  on  both  sides  he  has  arrived  at  the  conclusion  that  the 
presence  of  a  tube  common  to  both  canaliculi  is  constant 


420 


Medical  Times  and  Gazette. 


POWER  ON'  THE  LACRIMAL  APPARATUS  OF  THE  EYE. 


Oct.  13,  1883. 


Heinlein  found  in  all  his  dissections  only  one  doubtful  case. 
Gerlach  in  twenty  heads  never  found  it  absent.  We  may 
take  it,  therefore,  that  its  presence  or  absence  is  not,  as  has 
been  suggested,  a  racial  or  national  character,  but  that  it  is 
constant,  though  in  some  instances  it  may  be  very  short. 
Moreover,  as  Heinlein  remarks,  the  outer  wall  of  the  sac 
projects  a  little  towards  the  canaliculi ;  so  that  in  doubtful 
cases  it  must  rest  with  the  observer  to  say  whether  there 
is  really  a  collecting- tube  or  only  a  lateral  projection  of 
the  sac  with  two  openings.  The  length  of  the  collecting- 
tube  in  Ileinlein’s  preparations  varied  from  0  8  to  T2  mm. 
Its  diameter  at  the  point  of  junction  of  the  two  canaliculi 
is  06  mm.;  it  then  becomes  a  little  narrower,  and  finally 
dilates  slightly  as  it  opens  into  the  sac.  The  collecting- 
tube  is  horizontal  and  straight ;  it  lies  with  the  sac  in  the 
triangular  space  which  exists  between  the  two  laminae  of 
the  internal  palpebral  ligament  and  the  bony  groove  for 
the  sac.  The  opening  of  the  canaliculi  into  the  sac  is  a 
vertical  slit,  and  sometimes  a  circular  opening.  The  total 
thickness  of  the  wall  of  the  lacrimal  canaliculi  is  O' 3  to 
0'4  mm.  In  regard  to  the  structure  of  the  canaliculi, 
they  possess  a  firm  coat  of  condensed  connective  tissue, 
with  some  elastic  tissue  constituting  a  membrana  or  tunica 
propria.  This  membrane  is  lined  internally  by  epithelium, 
and  is  surrounded  by  transversely  striated  muscular  tissue, 
the  fibres  of  which  are  offsets  of  the  orbicularis  palpebrarum. 
The  epithelium  is  laminated  and  of  considerable  thickness. 
In  a  series  of  sections  Gerlach  counted  ten  superimposed 
layers,  and  in  some  parts  eleven  and  twelve ;  the  thickness 
of  the  epithelium  varies  from  0'12  to  0'13  mm.,  or  one-third 
of  the  total  thickness  of  the  wall.  The  deepest  layer  of  cells 
is  remarkable  for  their  elongated  form  and  large  nuclei; 
the  two  next  layers  are  also  columnar  ;  the  fourth  layer  is 
flattened  and  ribbed,  and  the  most  superficial  cells  are 
tesselated.  There  are  no  cilia.  The  tunica  propria  is 
only  half  the  thickness  of  the  epithelial  layer,  being  on 
the  average  O' 060  mm  (Gerlach),  though  Robin  and  Cadiat 
make  it  as  much  as  018  to  0'28  mm.  in  the  adult. 
It  consists  of  fine  and  closely  compressed  connective- 
tissue  fibres,  which  have  a  general  circular  arrangement. 
These  fibres  are  mingled  with  numerous  fine  elastic  fibres, 
conferring  on  the  ducts  their  elasticity  ;  and  some  rod-shaped 
nuclei  may  be  seen,  which  probably  belong  to  unstriated 
muscular  tissue.  After  removal  of  the  epithelium  the 
surface  of  the  membrane  appears  finely  ribbed.  It  contains 
no  glands  or  papillas.  Numerous  arterioles  and  venules 
ramify  in  the  adherent  face  of  each  canaliculus,  and  run 
both  circularly  and  longitudinally ;  the  capillaries  arising 
from  them  subdivide  into  superficial  plexuses.  From  two  to 
four  nerve-filaments,  having  a  diameter  of  0'02  to  0'06  mm., 
run  at  some  distance  from  each  other  along  the  side  of  each 
canaliculus. 

We  have  now  to  consider  the  relations  of  the  canaliculi  to 
the  musculus  orbicularis  palpebrarum,  and  in  order  that 
these  may  be  understood  it  is  important  that  a  clear  under¬ 
standing  should  be  obtained  of  this  important  and  complex 
muscle.  By  far  the  best  description  of  it  is  that  which  has 
been  given  by  P.  Lesshaft  in  an  elaborate  paper  published 
in  1868  in  Reichert  and  Du  Bois  Reymond’s  Archiv,  which 
contained  the  results" of  careful  dissections  of  fifty-four  heads 
with  104  eyes,  as  well  as  the  heads  of  the  Dog,  Cat,  Rabbit, 
Sheep,  Calf,  and  Horse. 

This  muscle  is  divided  by  most  anatomists  into  an  orbital 
and  a  palpebral  portion,  or  into  an  external  and  internal 
lamina.  A  portion  of  this  latter,  lying  near  the  edge  of  the 
lids,  was  termed  by  Riolan  the  musculus  ciliaris,  and  some 
authors,  as  Thiele,  have  applied  his  name  to  this  band  of 
fibres,  naming  it  the  muscle  of  Riolanus;  but  Merkel, 
Cruveilhier,  and  Hyrtl  apply  the  term  “  muscle  of  Riolanus  ” 
to  the  whole  inner  part  of  the  orbicularis  muscle.  The 
precise  words  of  Riolanus(a)  are  : — There  is  a  muscle  which 
draws  the  superior  eyelid  inwards,  which,  arising  from  the 
bottom  of  the  orbit,  runs  straight  to  the  tarsus  of  the  lid. 
The  lid  is  depressed  by  the  orbicular  muscle,  which,  arising 
from  the  great  angle  and  running  along  the  lower  lid,  the 
width  of  which  it  equals,  turns  round  the  lesser  canthus, 
and  terminates  at  the  same  point  from  which  it  arose.  In 
action  it  depresses  the  upper  lid  at  the  same  time  that  it 
raises  the  lower  lid.  According  to  some  authors  there  is  a 
second  orbicularis  muscle,  which,  arising  from  the  root  of 


the  nose,  surrounds  the  cilium  of  each  eyelid,  and  exactly 
closes  them.  Moll,  whose  diagram  is  well  known,  terms  the 
innermost  band  the  pars  subtarsalis,  and  locates  it  between 
the  Meibomian  glands  and  the  cilia  bulbs  at  the  palpebral 
free  border.  Lesshaft, (b)  who  gave  an  exhaustive  historical 
account  of  the  muscle,  points  out  that  the  orbicularis 
muscle  has  been  divided  into  two,  three,  four,  and  even  five 
parts.  He  states,  correctly,  that  when  the  muscle  is  wholly 
detached  from  its  connexions  it  forms  a  plane  sheet,  so  that, 
physiologically,  it  is  unnatural  to  divide  the  muscle  into 
separate  sheets  and  to  ascribe  an  independent  action  to  each. 
For  the  purposes  of  description,  however,  he  divides  it  into 
a  palpebral  and  a  ciliary  portion. 

The  origin  of  the  palpebral  portion  is  at  the  inner  angle 
of  the  eye,  partly  from  the  tendo  orbicularis,  which  is  attached, 
to  the  crista  lacrimalis  anterior,  and  partly  from  the  inner 
surface  of  the  ascending  process  of  the  superior  maxillary 
bone,  at  about  one-third  of  an  inch  distance  from  the  fronto- 
maxillary  suture. 

Other  fibres  arise  from  a  tendinous  inscription  on  the 
anterior  wall  of  the  lacrimal  sac,  from  a  surface  about  one- 
fifth  of  an  inch  broad,  about  one-eighth  of  an  inch  below 
the  upper  extremity  of  the  sac.  Still  other  fibres  arise  from 
the  anterior  surface  of  the  convex  border  of  the  lacrimal 
canals.  Lastly,  fibres  arise  from  the  whole  anterior  surface 
and  borders  of  the  canaliculi. 

The  tendo  orbicularis  is  flat,  and  presents  an  anterior 
surface  directed  somewhat  upwards,  the  inner  half  of  which, 
is  smooth,  whilst  the  outer  half  is  closely  connected  with 
the  superimposed  skin.  The  posterior  surface  looks  some¬ 
what  downwards,  and  fuses  with  the  tendinous  inscription 
on  the  anterior  wall  of  the  lacrimal  sac. 

All  these  fibres — those  which  arise  from  the  ascending- 
ramus  of  the  superior  maxillary  bone,  from  the  wall  of  the 
sac,  and  from  the  canaliculi — pass  upwards  and  downwards 
to  the  corresponding  lid,  where  the  fibres  which  proceed 
from  the  tendon  lie  somewhat  more  superficially  than  the 
others. 

In  regard  to  their  insertion,  some  fibres  which  lie  near 
the  free  edge  of  the  lid  pass  between  the  Meibomian  glands 
and  the  bulbs  of  the  hairs,  and  terminate  on  the  edges  of 
the  lid  without  reaching  the  external  canthus. 

The  rest  of  the  fibres  reach  the  outer  angle,  and  meet  at 
an  acute  angle  for  a  short  distance,  and  then  decussate, 
attaching  themselves  by  means  of  firm  connective  tissue  to 
the  middle  of  the  internal  surface  of  the  external  border  of 
the  orbit. 

It  is,  I  think,  unnecessary  that  I  should  describe  the 
orbital  portion  of  the  orbicularis.  The  fibres  are  redder 
than  those  of  the  palpebral  portion  ;  they  cover  the  upper, 
outer,  and  lower  borders  of  the  orbit,  and  the  outermost 
fibres  blend  with  those  of  adjoining  muscles. 

There  are,  however,  certain  fasciculi  of  the  palpebral 
portion,  known  as  the  muscle  of  Riolanus  and  Horner’s 
muscle,  which  are  deserving  of  special  description. 

The  Muscle  of  Riolanus  arises  from  the  anterior  surface- 
and  from  the  upper  and  lower  borders  of  the  internal  pal¬ 
pebral  ligament  in  its  outer  fourth,  and,  as  they  run 
outwards,  cross  the  vertical  part  of  the  canaliculi. 

According  to  Gerlach,  the  collecting-tube  is  not  in  rela¬ 
tion  with  muscular  tissue  ;  but  Robin  and  Cadiat  consider 
that  both  the  canaliculi  and  the  collecting-tube  formed  by 
their  junction  are  in  relation,  throughout  their  whole  length 
and  around  their  whole  circumference,  with  muscular  fasci¬ 
culi,  though  they  admit  that  a  little  connective  tissue  and 
adipose  tissue  intervene  between  the  common  tube  and  the 
muscular  fasciculi. 

It  is  certain  that  the  horizontal  and  vertical  portions  ot 
the  canaliculi  are  in  relation  with  muscular  fibres,  and  the 
drawings  of  Gerlach  show  the  relations  very  distinctly.  He 
made  a  series  of  horizontal  sections  of  about  1  mm.  in 
thickness.  The  first  show  that  the  fibres  of  Riolan’s  muscle, 
lying  close  to  the  margin  of  the  lid,  run  entirely  in  front  of 
the  vertical  portion  of  the  canaliculus,  whilst  the  ducts  of 
the  Meibomian  follicles  have  fibres  of  the  muscle  both  in 
front  of  and  behind  them.  Muscular  fasciculi  were  first 
seen  at  the  fifth  section,  situated  between  the  conjunctiva 
and  the  duct.  Vertical  sections  give  the  same  results,  and 
show  that  the  subconjunctival  muscular  tissue  first  becomes 
apparent  at  a  distance  of  O' 5  mm.  from  the  punctum,  whilst 


(a)  Op.  omnia,  1610;  Paris,  Fol.  Anatomie,  page  87. 


(b)  Reichert  and  Du  Bois  Reymond’s  Archiv,  1868,  page  265. 


it  cereal  Timq*  |ind  Gazette. 


SONSINO  ON  FILARIA  SANGUINIS  PARASITISM. 


Oct.  13,1383.  421 


fibres  passing  in  front  of  the  canaliculus  are  found  nearly 
its  far  as  the  punctum.  In  all  horizontal  sections  in  which 
fibres  of  muscle  are  found  in  front  of  and  behind  the  canali¬ 
culus,  fibres  are  found  connecting  the  two,  so  that  the 
canaliculus  is  virtually  surrounded  by  a  sphincter,  though 
there  are  no  true  circular  fibres.  The  musculature  of  the 
horizontal  segment  of  the  canaliculus  is  quite  different  in 
its  behaviour :  part  is  Horner’s  muscle,  part  arises  from  the 
infernal  palpebral  ligament. 

The  Muscle  of  Horner  has  a  somewhat  curious  history, 
well  given  by  Lesshaft,  from  whom  I  borrow  the  following 
particulars.  The  term  scarcely  appears  to  be  appropriate, 
tor  it  was  discovered  and  described  three-quarters  of  a 
century  before  Horner  by  Guischard  Jos.  Duverney,(c)  who 
gave  an  account  of  it  in  1749,  and  again  in  1761,  when  he 
•spoke  of  it  in  these  terms:  "The  orbicular  muscle  being 
reflected,  a  small  muscle  is  brought  into  view,  which  arises 
from  the  anterior  part  of  the  os  planum  of  the  ethmoid,  and 
is  inserted  into  the  inner  part  of  the  internal  tendon, 
opposite  to  the  insertion  of  the  orbicularis  ”(d)  And  in  his 
■"(Euvres  Anatomiques”  (1760), tome  i.,  p.  130,  he  adds, "It is 
a  small  muscle  that  I  have  long  recognised.”  J  Rosenm  tiller 
again  described  it  in  1816,(e)  and  named  it  the  musculus 
sacci  lacrimalis  in  these  words  :  "  But  behind  the  lacrimal 
sac  there  is  the  muscle  of  the  lacrimal  sac,  a  small  muscle 
which  arises  from  the  posterior  margin  of  the  lacrimal 
fossa,  and  is  attached  to  the  posterior  surface  of  the  tarsus.” 
Trasmondi  described  it  in  1823.  (f)  It  may  be  said,  then,  to 
have  been  fairly  known  before  tbe  time  of  Horner,  whose 
paperappeared  inthe  Philadelphia Journal  for  1824.  P. Dubois 
described  it  independently  in  1824 ;  and,  lastly,  Bourjot  St. 
Hilaire  in  1835  named  it  the  "dilatatmr  du  sac.”  This  little 
muscle  has  hence  been  discovered  no  les3  than  six  times  — 
by  Duverney  in  1749,  Bosenmuller  1816,  Horner  1823,  Tras¬ 
mondi  1823,  P.  Dubois  1824,  and  Bourjot  St.  Hilaire  in  1835. 
Lesshaft,  with  Krause  and  Arnold,  regards  it  as  being  un¬ 
doubtedly  an  independent  muscle,  and  names  it  the  musculus 
lacrimalis.  Its  fibres  are  somewhat  paler  than  those  of  the 
orbicularis.  It  arises  from  the  middle  of  the  orbital  surface  of 
the  lacrimal  bone.  The  posterior  border  of  this  attachment  is 
Arcuate,  with  the  convexity  directed  backwards  ;  the  vertical 
.height  of  the  origin  is  from  5  to  7  mm.,  and  the  extent  from 
before  backwards  is  about  3  mm.  Krehbiel  makes  the  muscle 
arise  by  two  origins,  which  decussate ;  and  this,  according 
to  Gerlach,  is  probably  true  so  far  as  the  middle  fibres  of  the 
muscle  are  concerned,  but  not  of  those  near  the  upper  or 
lower  borders.  The  fibres  decussate  at  their  origin,  run 
outwards  and  somewhat  forwards,  forming  a  square  belly, 
the  upper  and  lower  borders  of  which  are  scalloped  at  a 
•distance  of  about  8  mm.  from  the  origin.  The  muscle 
•divides  into  an  upper  and  a  lower  fasciculus,  which  accom¬ 
pany  the  corresponding  canaliculi.  Even  before  the  divi¬ 
sion  of  the  muscle,  some  fibres  are  inserted  into  the  lacrimal 
sac,  and  into  the  posterior  wall  of  the  common  duct. 
After  division,  each  portion  of  the  muscle  covers  the  pos¬ 
terior  wall  and  the  convex  border  of  the  corresponding 
■canal,  and  the  fasciculi  consequently  become  thinner  as  they 
Approximate  the  puncta,  because  they  in  part  terminate  at 
the  borders  of  the  canals  along  their  whole  length.  The 
fibres  are  on  the  whole  about  12  5  to  15  mm.  in  length,  and 
-the  belly  has  a  thickness  of  1  to  P5  mm.  The  muscle  is 
covered  both  in  front  and  behind  by  fibrous  membrane,  as 
has  been  well  demonstrated  by  Tillaux.  The  posterior 
investment  is  derived  from  the  septum  orbitale  ;  the  anterior 
is  Cruveilhier’s  and  Sappey’s  “  tendon  reflechie  du  muscle 
-orbitaire,”  and  is  described  by  Henle  as  the  posterior  layer 
•of  the  internal  palpebral  ligament.  This  layer,  springing 
from  the  posterior  crest  of  the  lacrimal  groove,  passes  as  a 
sheet  of  membrane  outwards  and  forwards,  and,  becoming 
thinner,  blends  with  the  anterior  layer  (which  arises  from 
the  frontal  process  of  the  superior  maxillary  bone)  about  two 
millimetres  before  its  junction  with  the  tarsal  cartilage. 
The  posterior  layer  of  the  internal  palpebral  ligament 
forms,  therefore,  a  complete  septum  between  the  lacrimal 
sac  and  the  musculus  lacrimalis,  and  it  is  so  closely  adherent 
to  the  fibrous  wall  of  the  former  that  they  cannot  be  distin¬ 
guished  even  in  microscopical  sections.  The  lacrimal  sac  lies 
therefore  in  a  triangle  formed  by  the  bone  and  the  anterior 

(c)  Though  this  is  unknown  even  to  French  authors.  See  Duval,  page  25. 

<d)  “L’Art  de  Dissfquer,”  1749,  c.  vi.,  page  37. 

(e)  “  Comp.  Anat.,”  1816,  page  241. 

(Jj  “  Intorno  la  Scop,  di  due  Nervi  de’.l  Occhi  uma  -.a.” 


and  posterior  layers  of  the  internal  palpebral  ligament,  to 
all  of  which  it  is  closely  adherent.  The  outer  surface  of  the 
sac  where  the  tube  common  to  the  two  canaliculi  enters  is 
alone  free.  This  tube  runs  between,  but  is  not  fused  with, 
the  two  layers  of  the  internal  palpebral  ligament,  and  it 
gains  this  position  by  the  two  canaliculi  separately  per¬ 
forating  the  posterior  layer  of  the  internal  palpebral  liga¬ 
ment,  and  immediately  uniting,  after  haring  passed  through 
it,  to  form  the  duct.  The  fasciculi  of  the  musculus  lacrimalis 
accompany  the  canaliculi. 

( To  he  continued .) 


A  NEW  SERIES  OF 

CASES  OF  FILARIA  SANGUINIS  PARASITISM 
OBSERVED  IN  EGYPT; 

WITH  THE  RESULTS  OF  EXPERIMENTS  ON  FILAR IATED 
SUCTORIAL  INSECTS. (a) 

By  PEOSPERO  SONSINO,  M.D.  (Pisa). 


( Concluded  from  page  369.) 


Part  II. 

Result  of  Experiments  on  Filariated  Suctorial  Insects. — 
The  result  of  my  experiments  on  gnats,  of  which  I  gave  an 
account  in  my  previous  communication  (b)  to  the  Epidemio¬ 
logical  Society  of  London,  while  corroborating  the  passage 
of  the  human-blood  embryo  filaria  into  this  variety  of  suc¬ 
torial  insects,  differed  so  much  from  Dr.  Manson’s  as  to  lead 
me  to  think  that  gnats  play  (as  an  intermediary  host)  with 
filarise  a  part  simply  similar  to  that  performed  by  some  birds 
with  vegetable  seeds,  viz.,  that  of  transporting  the  embryos 
from  one  to  another  medium.  But  I  concluded  that  this 
subject  was  one  to  be  studied  again.  Indeed,  referring  to 
the  result  of  my  experiments,  I  perceived  that  they  were  too 
few  in  number,  and  that  some  peculiar  circumstances  may 
perhaps  have  interfered  to  explain  the  differences  between 
my  results  and  Dr.  Manson’s.  Thus  I  found  it  advisable  to 
perform  other  experiments,  and  to  modify  my  processes. 

The  gnats  on  which  I  repeated  the  experiments  were  of 
the  same  kind  as  those  examined  before,  as  they  are  those  of 
the  common  species  found  here  in  every  house.  Some  of  their 
characteristics  were  given  in  my  previous  paper,  from  which 
it  may  be  argued  they  belong  to  the  genus  Culex.  .  But,  as  I 
wished  to  be  certain  what  species  I  was  dealing  with,  I  sent 
a  certain  number  of  them  to  Professor  Adolfo  Targioni 
Tozzetti,  of  the  Museum  of  Florence,  who  had  the  kindness 
to  examine  them  for  me.  He  informed  me  that  there  were 
evidently  among  the  specimens  a  certain  number  of  the 
common  species,  C ulex  pipiens ,  which  has  a  very  large  geo¬ 
graphical  distribution  in  the  world;  but  that  others  were  a 
little  darker,  and  offered  some  slight  differences  which  left 
him  in  doubt  as  to  whether  they  must  be  classified  as  a 
species  very  akin  to  Culex  pipiens,  or  only  as  a  variety  of  it. 
I  can  therefore  say  that  my  experiments  were  made  on  Culex 
pipiens,  or  on  a  culex  very  nearly  akin  to  it.  A  smaller 
species  is  really  found  here,  one  which  it  is  generally  thought 
flies  about  and  stings  the  human  skin  without  making  any 
noise  ;  but  this  species  seems  less  common,  and  I  have  not 
as  yet  been  able  to  procure  any  individual  which  had 
ingested  filariated  human  blood. 

To  fix  the  species  of  the  gnats  experimented  with  was 
a  matter  of  importance,  since  Dr.  Myers’  experiments  in 
South  Formosa  have  left  doubt  whether  all  the  species  of 
mosquitoes  can  act  as  intermediary  host  to  the  parasite,  (c) 

The  conditions  of  my  subsequent  experiments  were  also 
improved  by  putting  the  captured  gnats  in  a  bottle  only 
covered  with  muslin,  and  not  corked,  in  order  not  to  hinder 
the  exchange  of  air,  and  by  putting  some  water  in  the' 
bottle,  just  as  I  learnt  afterwards  had  been  done  by  Dr. 
Lewis.  But  I  wished,  moreover,  to  carry  out  each  series 
of  my  experiments  with  the  temperature  observed  during 


fa)  Communicated  to  the  Epidemiological  Society. 

(b)  “On  Filaria  Sanguinis  Hominis,  Lymphocele,  Lymphuria,  and  other 
Associated  Morbid  Disorders,  etc.”  Published  iu  the  Meaical  Times  and 
Gazette,  May,  1882 ;  abstract  in  the  Transactions  of  the  Epidemiological 

Society,  new  series,  vol.  i.  „ 

(c)  “  Observations  on  Filaria  Sanguinis  Hominis  in  South  I'  ormosa. 
By  W.  W.  Myers,  M.B.,  in  the  Transactions  of  the  Epidemiological  Society 
of  London,  new  series,  vol.  i. 


422 


Medical  Times  and  Gazette. 


SONSINO  ON  FILARIA  SANGUINIS  PARASITISM. 


Oct.  13, 18  3. 


Synopsis  of  the  Result  of  Examinations  of  Filariated  Culex. 


,  .  .  ,  Temperature* 

Date  of  experiment.  (Centigrade). 

Number  of 
culex 
examined. 

Duration  of 
captivity. 

Result. 

1882. 

Min. 

Max. 

Jan.  12  to  Feb.  2  ... 

3-0° 

190“ 

9 

From  a  few  hours 

) 

to  three  days 

1  Embryo  filarise  both  in  the  stomachal  cavity  and  among  the  tissues,  exactly 

Feb.  12-18  . 

2-50 

200 

12 

From  a  few  hours 

|  like  those  directly  extracted  from  the  man,  or  but  very  little  different. 

to  five  days 

May  17-19  . 

12-70 

3525 

3 

Fifty-eight  hours 

Embryo  filarhe  unmodified,  but  dead;  but  the  gnats  too  were  found  dead 

when  taken  for  examination. 

May  20-21  . 

17-80 

39-0 

1 

Twenty-four  hours 

Embryo  filarise  living,  but  still  unmodified. 

June  3-5  . 

16-70 

34-0 

4 

Four  hours  to  more 

In  one  gnat,  examined  the  same  day,  embryo  filarise  unmodified  ;  in  those 

than  fifty  hours 

examined  after  more  than  twenty-four  hours,  I  found  filarise  shorter  and 
thicker  in  the  tissues. 

June  10-11  . 

1530 

3S-E0 

3 

More  than  twenty- 

In  one,  filarise  in  the  stomach  not  transformed;  others  in  the  i issues 

four  hours 

sausage-form;  in  another,  none  in  the  stomach— some  transformed,  and 
some  not,  in  the  tissues. 

1883. 

J an.  23-24  . 

7-0 

19-0 

1 

More  than  twenty- 

) 

four  hours . 

>  No  transformations. 

Jan.  26-28  . 

6-0 

18-0 

1 

Two  days  . 

i 

March  5-7  . 

7-0 

23-0 

2 

Two  days  . 

No  transformations.  In  the  stomach,  some  living,  and  some  dead  and  in 

process  of  disintegration. 

March  5-8  . 

7-0 

31-0 

1 

Three  days . 

One  embryo  filaria  in  full  activity  appears  a  little  shorter  and  thicker  than 
those  taken  directly  from  man. 

) 

March  10-14  . 

9  0 

33-0 

1 

Four  days  . 

March  10-15  . 

8-0 

330 

1 

Five  days 

V  Transformations— sausage-form. 

March  10-16  . 

6-0 

33  0 

1 

Six  days  . 

May  4  . 

May  6  . 

13-0 

21-0 

30-50 

40-0 

1 

1 

A  few  hours 

A  few  hours 

j  No  transformations. 

May  6-7 . 

12 '5 

40-0 

1 

More  than  twenty- 

Large  quantity  of  the  embryos  into  the  stomach  without  modifications,  and 

four  hours 

not  moving ;  some  in  process  of  disintegration ;  three  living,  in  the  tissue 
of  the  thorax. 

May  6-12 . 

11-0 

40-0 

2 

Six  days  . 

Transformations  more  advanced ;  in  some  the  intestinal  tract  distinguishable. 

*  These  minima  and  maxima  of  temperatures  were  obtained  from  the  observations  made  at  the  Laborat,oire-Kh£divial  of  this  town,  and 
published  monthly  by  its  Director,  Mr.  Ismahin.  They  give  then  the  temperature  observed  at  the  Observatory,  and  not  that  particularly  of  the  room 
where  the  gnats  were  under  experiment. 


the  time  of  each  series,  noting  especially  the  minimum  and 
maximum,  as  it  occurred  to  me  that  the  temperature  might 
have  a  strong  influence  in  modifying  the  result  of  the 
rearing  of  the  embyro  filaria  in  the  insect’s  body,  remem¬ 
bering  that  my  first  set  of  observations  had  been  done  in  a 
rather  exceptionally  cold  January. 

I  tabulate  above  the  results  of  my  experiments  made  in 
different  months  comprised  in  the  first  half  of  the  years 
1882  and  1883,  upon  forty-five  gnats,  in  which  were  found 
embryo  filarise,  or  what  were  believed  to  be  their  transforma¬ 
tions.  I  missed  the  opportunity  of  experimenting  in  the 
second  half  of  last  year.  The  synopsis  also  gives  the  mini¬ 
mum  and  maximum  temperatures  corresponding  to  each 
series  of  experiments.  It  appears  from  it  that  both  in 
January  and  February  of  this  and  of  last  year,  with  a 
maximum  temperature  of,  24°  C.,  I  never  found  filaria 
transformations ;  but  that  these  appeared  in  some  of  the 
examinations  made  in  March,  May,  and  June,  with  a  maxi¬ 
mum  temperature  of  between  33°  and  40°  C.  Thus  it  seems 
to  me  to  be  evident  that  the  transformations  of  filarise  take 
place  in  Egypt  only  with  a  certain  degree  of  temperature 
which  does  not  generally  occur  before  the  month  of  March. 

The  metamorphosed  forms  I  have  observed  are  like  those 
verified  by  Manson  and  Lewis.  I  cannot  give  better  drawings 
than  those  of  the  latter  observer. (d)  I  often  saw  trans¬ 
formations  like  those  given  by  Lewis’s  Figs.  6  and  7,  but 
more  frequently  Figs.  9  and  10,  and  these  latter  always  in 
the  tissues  of  the  stomachal  cavity,  and  after  a  certain  time 
of  captivity,  not  less  than  twenty-four  hours.  The  more 
developed  forms  of  transformations  I  saw  in  the  last  set  of 
experiments  after  six  days  of  captivity,  in  which  forms  I 
could  distinguish  the  intestinal  tract  well  formed,  the  point 
of  junction  of  the  oesophagus  with  it,  and  the  beginning  of 
a  buccal  apparatus.  The  specimens  in  which  I  could  dis¬ 
tinguish  these  particulars  did  not  exceed  the  dimensions 
of  those  given  by  Lewis  in  his  Fig.  10,  and  hitherto  I  have 
not  succeeded  in  detecting  forms  of  transformations  so  large 
as  those  of  Lewis’s  Figs.  11,  12,  and  13. 

That  the  observed  transformations  belong  really  to  the 
human  filaria  there  is  every  reason  to  believe,  as  I  never 
found  any  in  a  great  number  of  gnats  taken  at  random  from 
other  sources,  nor  did  I  find  them  in  the  tissues  of  gnats 
examined  soon  after  they  were  brought  to  me  from  filarious 
individuals. 

If  my  inference,  that  it  is  necessary  to  have  a  certain 
degree  of  temperature  to  render  gnats  capable  of  affording 


(d)  “The  Nematoid  Hrematozoa  of  Man.”  By  T.  R.  Lewis.  Reprinted 
from  the  Quarterly  Journal  of  Microscopical  Science,  1878.  See  plate  xii. 


a  suitable  soil  for  the  development  of  embryo  filarise,  so 
as  to  perform  the  part  of  intermediary  host  of  the  parasite, 
should  be  confirmed  by  more  numerous  experiments  per¬ 
formed  in  other  countries,  we  shall  have,  perhaps,  the  key  to 
the  reason  why  the  geographical  distribution  of  filarise  is  not 
precisely  the  same  as  that  of  the  mosquitoes  and  gnats  in 
general.  To  establish  the  influence  of  temperature  on  the 
transformations  of  embryo  filarise  in  the  body  of  gnats  is  a 
matter  of  great  practical  importance.  To  simplify  this 
question,  let  us  speak  only  of  Culex  pipiens.  This  species 
exists  in  many  countries  of  Europe  where  filarial  infection 
has  not  yet  been  observed.  If  in  these  countries  it  is  due  to 
the  absence  of  a  certain  high  temperature  that  Culex  pipiens 
is  not  capable  of  being  the  intermediary  host  to  filaria,  then 
there  is  no  fear  of  seeing  the  filarial  infection  spread  in 
those  countries,  unless  that  temperature  be  reached.  But 
if  neither  that  influence  of  temperature  nor  other  external 
influence  exist,  then  we  may  expect  that,  with  the  ever- 
increasing  intercourse  of  the  inhabitants  of  Egypt  and 
Europe,  Culex  pipiens  will  spread  the  filarial  infection  in 
those  countries. 

It  is  possible,  however,  that  the  conditions  of  the  rearing- 
of  the  filaria  in  the  intermediary  host  are  more  complicated, 
and  that  they  are  in  relation  not  only  with  the  temperature, 
but  also  with  the  hygrometric  state  of  the  air,  of  which  I 
have  not  up  to  this  date  any  confirmation. 

We  may  therefore  conclude  that  a  problem  of  great  prac¬ 
tical  importance  remains  to  be  solved,  and  that  is  :  Is  there 
any  external  influence  that  hinders  Culex  pipiens  and  like 
insects  from  playing  in  certain  countries  the  part  of  inter¬ 
mediary  host  of  filaria,  different  to  what  happens  in  other 
countries,  like  Egypt  ? 

There  is  no  doubt  that  another  element  of  the  diffusion,  or 
of  the  infection,  may  be  searched  for  too  in  the  different 
habits  in  respect  to  drinking-water,  but  this  will  never  act 
as  an  absolute  obstacle  to  the  spread  of  the  infection, 
because  it  must  happen  from  time  to  time  to  some  one  of 
the  inhabitants,  even  of  more  civilised  countries,  to  use 
foul  water,  just  as  the  people  do  generally  in  this  country. 

We  must  not  forget,  moreover,  that  in  the  vital  cycle  of 
filaria  there  seems  to  be  a  stage  of  free  life  in  the  water ;  and, 
as  a  point  of  new  research,  I  may  suggest  that  it  is  possible 
too  that  the  influence  of  a  certain  high  temperature  may 
be  necessary  not  only  to  determine  the  transformations  of 
the  filaria  in  the  insect  body,  but  also  to  maintain  in  favour¬ 
able  conditions  the  life  of  the  parasite  when  it  leaves  the 
insect’s  body  to  pass,  as  we  think,  into  water,  before  being 
reintroduced  into  the  human  body. 

Thus  I  think  I  have  briefly  pointed  out  the  elements  of 


Medical  Times  and  Gazette. 


OSWALD  ON  CARCINOMA  OF  THE  PROSTATE  GLAND. 


Oct.  13,  1893.  423 


inquiry  that  must  be  in  the  mind  of  the  investigator  who 
institutes  new  researches  with  the  view  of  solving  the  ques¬ 
tion  :  What  are  the  conditions  that  determine  and  favour  the 
spreading  of  the  filarial  infection,  and  in  what  manner  may 
this  spreading  be  interfered  with  in  other  countries,  as  those 
of  Europe  ? 

Result  of  the  Examination  of  other  Suctorial  Insects. — I 
think  that  the  result  of  the  examination  made  on  two  other 
suctorial  insects,  though  it  does  not  afford  data  of  great 
importance,  should  be  given  to  complete  what  is  known 
concerning  the  different  manners  of  the  exit  of  the  embryo 
filarial  from  the  human  body.  Of  one,  Pulex  irritans  (the 
common  flea),  I  have  little  to  say,  as  I  succeeded  only  once 
in  catching  a  single  individual  upon  a  man  who  was  infected 
with  filaria,  and  on  the  examination  of  its  stomachal  contents 
I  detected  a  few  embryo  filarise,  which,  however,  were  dead, 
and  presented  an  unmodified  form,  although  I  examined  the 
insect  after  a  day’s  captivity.  I  had  naturally  more  facility 
in  procuring  the  nocturnum  fcetidum  animal  zoologically 
known  under  the  name  of  Cimex  or  Acanthia  lectularia.  How¬ 
ever  disgusting  it  may  be  to  have  to  deal  with  it,  I  could 
not  desist  from  such  examination,  being  inquisitive  as  to 
its  conduct  as  regards  the  human  embryo  filaria. 

I  examined  from  January  last  to  a  quite  recent  date  twenty- 
six  bugs  taken  from  the  beds  of  filariated  persons,  and  in 
many  of  them  I  found  embryo  filarise  in  large  number. 
Once,  in  a  big  specimen  which  measured  more  than  six  milli¬ 
metres  in  length,  and  from  which  a  large  and  fresh  drop  of 
blood  was  obtained,  I  found  such  a  large  number  of  embryo 
filarise  that  I  calculated  that  in  the  whole  drop  there  must 
have  been  several  hundreds  of  them.  I  had  never  so  many 
human  embryo  filarise  under  the  field  of  the  microscope,  and 
their  abundance  was  only  to  be  compared  to  what  I  could 
often  see  in  the  filariated  blood  of  the  crow  ( Corvus  corax). 
But,  to  abridge  the  result  of  my  examination  on  filariated 
cimex,  I  may  say  that  I  found  that  this  insect  is  infected  with 
embryo  filarise  from  man  just  as  easily  as  culex ;  that,  on 
examining  the  cimex  when  full  of  recently  drawn  blood,  the 
filarise  were  found  living ;  but  that  after  twenty-four  hours 
of  captivity  all  the  embryo  filarise  were  not  living,  and  that 
after  more  than  twenty-four  hours  generally  the  filarise  were 
dead,  and  some  of  them  were  found  in  process  of  disintegra¬ 
tion;  that  I  have  found  filarise,  though  in  small  number, 
■even  five  days  after  the  captivity  of  the  insect,  but  not  on 
examination  performed  after  seven  days  of  captivity;  that  I 
never  found  filarise  modified  so  as  to  lead  me  to  believe 
that  such  transformations  occurred  in  the  body  of  cimex  as 
those  in  the  body  of  the  culex ;  that  I  could  not  say  I  had 
found  embryo  filarise  in  the  tissues  out  of  the  stomachal 
cavity,  through  difficulties  in  dissecting— it  is  probable  that 
the  few  specimens  of  filarise  found  out  of  the  stomach  may 
have  been  derived  from  its  contents. 

For  all  that  I  am  inclined  to  conclude  that  filarise  may 
live  some  time  in  the  stomach  of  cimex  simply  because  of  the 
generally  slow  process  of  digestion  of  this  insect,  but  that 
with  time  they  are  digested,  or  else  are  expelled  with  the 
excrement.  In  this  manner  the  embryo  filarise  that  are 
caught  by  cimex  are  drawn  off  from  the  cycle  of  development 
of  the  parasite,  and  cease  to  aid  in  the  maintenance  of  the 
species.  Thus,  as  far  as  concerns  filaria  infection,  Cimex  is 
not  so  dreadful  a  foe  to  man  as  its  rival  Culex. 


A  CASE  OF 

CARCINOMA  OF  THE  PROSTATE  GLAND, 
PROBABLY  SCIRRHOUS, 
OCCURRING  AT  AN  EARLY  AGE. 

By  R.  J.  W.  OSWALD,  L.R.C.P.&S.  Ed.,  M.R.C.S.  Eng. 

W.  H.  R.,  aged  twenty-three  years,  married,  a  farrier  by 
trade,  first  came  under  my  notice  about  the  end  of  September, 
1882.  The  family  history  has  been  good.  His  father  died 
from  chronic  bronchitis ;  his  mother  in  childbirth ;  his 
brothers  and  sisters  have  always  enjoyed  good  health.  There 
was  no  history  of  cancer  on  either  the  father’s  or  the  mother’s 
side.  His  own  history,  up  to  the  time  he  first  noticed 
anything  unusual,  was  good ;  he  was  a  strong,  robust  man, 
and  able  to  work  at  his  trade  without  fatigue.  About  four 
years  ago  he  had  a  severe  kick  from  a  horse  in  the  abdomen. 


which  incapacitated  him  for  a  time  from  his  work  ;  and 
afterwards  several  kicks  in  the  perineum,  and  one  severe 
blow  from  a  shovel.  About  three  years  ago  he  was  attacked 
by  the  following  symptoms  : — Slight  difficulty  in  defla¬ 
tion  and  micturition,  accompanied  by  tenesmus.  He  took 
no  notice  of  them,  but  they  gradually  increased,  until  in 
June,  18S2,  he  was  suddenly  seized  with  diarrhoea,  and 
lost  a  large  quantity  of  blood.  He  was  prescribed  for, 
and  the  attack  abated.  No  local  examination  was  made. 
The  weakness  continued  to  increase,  and  he  was  compelled 
to  give  up  his  work.  He  suffered  very  great  pain  in  the 
epigastric  and  perineal  regions,  especially  when  the  bowels 
were  relieved — so  much  so  that  he  dreaded  that  event. 
Emaciation  was  marked.  He  then  went  to  St.  Thomas’s 
Hospital,  where  he  was  examined,  and  told  that  he  had 
cancer,  but  that  nothing  could  be  done  for  him.  It  was 
immediately  after  this  that  I  first  saw  him. 

His  condition  then  was  one  of  emaciation,  and  he  had 
well-marked  cachexia ;  he  was  scarcely  ever  free  from  pain. 
Micturition  was  still  difficult,  and  defsecation  almost  im¬ 
possible.  On  examination  of  the  rectum,  a  large,  nodulated 
non- elastic  tumour,  very  painful  to  the  touch,  was  detected 
in  the  situation  of  the  prostate  gland,  passing  backwards, 
nearly  to  the  sacrum.  There  was  no  annular  constriction  of 
the  rectum,  and  a  narrow  passage  was  felt  between  the 
tumour  and  the  posterior  wall  of  the  bowel.  I  advised  him 
to  go  to  Charing-cross  Hospital,  where  he  was  admitted  on 
October  4,  under  the  care  of  Mr.  Barwell,  and  where  I  saw 
him  constantly.  Mr.  Barwell  considered  it  advisable  for 
him  to  rest  in  bed  for  a  few  days.  He  was  placed  on  fluid 
nourishment,  and,  to  relieve  the  extreme  pain,  was  ordered 
morphia  suppositories  every  four  hours.  After  an  examina¬ 
tion,  Mr.  Barwell  came  to  the  conclusion  that  the  growth 
was  of  a  cancerous  nature,  and  thought  that  the  only  j  usti- 
fiable  measure  would  be  to  perform  “  colotomy,”  with  the 
object  of  relieving  the  tumour  from  the  constant  irritation  of 
faeces  and  of  mitigating  pain,  and  with  the  hope  of  prolonging 
life.  Accordingly,  twelve  days  after  admission,  Amussat’s 
operation  was  performed.  The  only  noteworthy  feature  was 
that  the  kidney  was  unusually  low,  and  came  in  the  line  of 
operation.  On  passing  the  finger  down  the  lower  segment 
of  the  bowel,  a  hard,  nodular,  irregular  mass  was  felt,  about 
two  inches  from  the  orifice.  The  patient  rallied  well  from 
the  operation.  The  wound,  on  removing  the  dressings, 
looked  healthy ;  the  bowel  acted  well ;  and  the  pain  was  not 
so  severe.  At  his  own  request,  a  fortnight  after,  the  man 
was  removed  to  his  home,  where  he  was  under  my  care  until 
his  death,  on  January  17,  1883. 

His  condition,  from  the  time  of  his  discharge  from  hos¬ 
pital  until  his  death,  was  one  of  almost  uninterrupted  pro¬ 
gressive  prostration  and  emaciation.  Cachexia  became 
much  more  marked,  and  the  pain  again  returned  in  a 
severe  form,  although  he  was  almost  always  under  the 
influence  of  morphia.  Other  symptoms  gradually  deve¬ 
loped.  (Edema  of  the  scrotum  and  lower  extremities  set  in, 
and  micturition  became  frequent  and  painful,  and  only 
possible  in  the  prone  position.  For  thirty-six  hours  before 
death  no  urine  was  passed.  The  pulse  was  small,  quick, 
and  the  tongue  furred ;  and  he  suffered  a  great  deal  from 
flatulence. 

Secondary  growths  three  in  number.  One  over  the 
seventh  rib  (left  side)  -was  non-adherent  to  the  bone,  but 
firmly  attached  to  the  skin ;  very  hard  and  nodulated,  but 
rapidly  growing,  and  becoming  very  red  a  few  days  before 
death.  Another,  at  the  back  of  the  neck,  was  about  the  size 
of  a  cherry,  and  also  of  rapid  growth.  The  third  was  over 
the  left  buttock,  where  there  was  a  considerable  swelling 
of  a  doughy  consistency,  and  non-inflam  mat  ory.  A  dis¬ 
charge  “  per  anum,”  which  began  shortly  after  the  opera¬ 
tion,  increased  in  quantity,  small  portions  of  ddhris  being 
ejected ;  the  whole  of  an  extremely  offensive  character. 

The  treatment  adopted  was  of  a  palliative  and  stimulant 
character.  Suppositories  containing  half  a  grain  of  morphia 
were  given  every  four  or  six  hours,  as  w'ell  as  a  pill  con¬ 
taining  one  grain  of  opium  night  and  morning.  Later  on 
this  quantity  had  to  be  increased,  as  no  effect  was  appre¬ 
ciable.  Soda-water,  milk,  etc.,  were  taken  in  large  quan¬ 
tities.  To  act  as  a  gentle  aperient,  “  Hunvadi  Janos  ”  was 
given  with  advantage.  The  diet  was  of  a  plain,  nutritive  cha¬ 
racter— beef -juice,  beef-tea,  etc.,  with  a  regulated  amount 
of  stimulants.  No  vomiting  occurred  until  nearly  the  close 
of  the  illness. 


424 


Medical  Times  and  Gazette. 


MEDICAL  AND  SURGICAL  PRACTICE. 


Oct.  13,  1883. 


Pathology ,  principally  Histological. — No  post-mortem  exa¬ 
mination  being  allowed,  the  portions  I  obtained  for  inves¬ 
tigation  were  from  the  discharge,  and  a  small  portion  of 
the  tumour  after  death.  The  cells,  under  a  power  of  400 
diameters,  presented  a  great  diversity  of  form — spindle, 
caudate,  unipolar,  large  round  cells  containing  many  nuclei 
and  granular  contents,  pear-shaped,  and  innumerable  small 
cells  filled  with  granular  matter.  With  transmitted  light 
the  cells  presented  a  beautiful  appearance ;  the  cell-wall 
was  clearly  defined,  the  nuclei  and  nucleoli  standing  out 
distinctly,  and  strongly  refracting  the  light.  There  was 
no  appearance  of  pigment  in  any  of  the  cells,  but  some 
seemed  to  have  undergone  fatty  degeneration.  The  large 
round  cells  were  present  in  considerable  numbers,  but  they 
did  not  exhibit  either  the  form  or  size  of  the  multipolar  or 
“  giant  cells  ”  met  with  in  sarcoma.  The  cells  were  packed  in 
alveoli  of  moderate  size,  pressure,  no  doubt,  causing  many 
of  the  above-mentioned  forms.  Pervading  all  parts  of  the 
field  of  vision  were  the  small  cells.  The  stroma  consisted  of 
fibrous  tissue,  containing  connective-tissue  corpuscles.  This 
tissue  was  present  in  large  quantities ;  in  some  parts  it 
appeared  in  a  wavy  arrangement,  enclosing  at  intervals 
groups  of  cells.  At  one  or  two  places  were  dense  portions  of 
fibrous  tissue  with  no  cells  whatever.  This  was  probably 
part  of  the  tumour  that  had  undergone  fibroid  induration. 
The  portions  of  the  tumour  that  came  away  exuded  on  pres¬ 
sure  a  whitish  fluid  rich  in  cells.  The  colour  of  the  pieces 
was  a  dull  white. 

Remarics. — With  the  limited  family  history  at  command, 
presenting  no  trace  of  cancer  or  any  form  of  tumour  what¬ 
ever,  the  origin  of  the  disease  was  plainly  “■traumatic.” 
The  several  severe  blows  in  the  abdomen  and  perineum,  by 
keeping  up  irritation,  no  doubt,  first  started  the  mischief. 
The  majority  of  modern  pathologists  hold  that,  in  cancer, 
constitutional  predisposition  is  the  prime  factor ;  but 
of  late  the  opinion  is  gaining  ground,  and  with  reason, 
that  the  reverse  holds  good.  Mr.  Barwell  was  quite 
of  opinion  that  the  case  was  one  of  “  traumatic  malig¬ 
nancy.”  Cancer  of  the  prostate  is  rare.  Some  autho¬ 
rities  mention  having  seen  several  cases.  Billroth  con¬ 
siders  that  it  is  the  encephaloid  variety  that  always 
occurs,  and  doubts  the  existence  of  scirrhus.  Professor 
Erichsen  mentions  three  cases  of  encephaloid  in  patients 
over  seventy  years  of  age,  and  one  of  scirrhus.  This  parti¬ 
cular  case,  I  venture  to  think,  is  of  the  scirrhous  variety, 
and  for  the  following  considerations : — The  length  of  time 
since  the  commencement  of  the  symptoms — more  than  three 
years;  the  extreme  hardness  of  the  tumour;  its  irregular 
outline,  and  the  facts  that  there  was  no  sense  of  fluctuation, 
and  no  loss  of  blood  since  the  commencement  of  serious 
symptoms  (about  a  year  ago),  although  ulceration  had  been 
going  on  for  some  time,  as  shown  by  the  offensive  discharge; 
and,  lastly,  the  microscopical  evidence.  As  regards  operative 
measures,  even  had  the  growth  been  detected  at  any  early 
date,  no  treatment,  either  locally  or  constitutional,  would 
have  been  of  any  avail.  By  “  colotomy,”  as  advised  by  Mr. 
Barwell,  the  patient’s  life  was  no  doubt  prolonged  (he  lived 
just  three  months  after  the  operation)  ;  he  suffered  less 
pain  for  some  time,  and  appeared  to  gain  strength  in  pro¬ 
portion.  At  the  early  stage  of  the  disease  the  growth  must 
have  been  very  slow,  as  shown  by  the  symptoms.  Cancer 
occurring  in  the  prostate  at  such  an  early  age  (commencing, 
probably,  at  nineteen  years)  is  extremely  rare,  more  especially 
of  the  scirrhous  variety. 


Locomotor  Ataxy  and  Syphilis. — At  the  meeting 
of  the  American  Neurological  Association,  Dr.  Birdsall,  of 
New  York,  read  a  paper  in  which  he  presented  statistics 
with  regard  to  the  relation  between  syphilis  and  locomotor 
ataxy.  He  had  collected  525  cases  of  locomotor  ataxy,  of 
which  225  (43  per  cent.)  had  syphilis.  The  cases  were  from 
Eosenthal,  Bernhardt,  Eemak,  Westphal,  Pusinelli,  Gowers, 
Eournier,  and  Erb,  together  with  42  which  had  come  under 
his  own  observation.  There  was  a  marked  difference  in  the 
percentages  of  syphilis  in  the  cases  reported  by  different 
observers.  For  instance.  Prof.  Erb  in  100  cases  reports 
syphilis  as  present  in  88  per  cent.,  while  in  Dr.  Birdsall’s 
own  cases  (42)  only  4  per  cent,  of  the  patients  had  syphilis. 
Probably  the  differences  were  due  to  accidental  relations. — 
Phil.  Med.  Times,  July  14, 


EEPOETS  OF 

HOSPITAL  PRACTICE  IN  MEDICINE 
AND  SURGERY. 


UNIVERSITY  COLLEGE  HOSPITAL. 


STEANGULATED  TJNDESCENDED  TESTIS -OPEEA- 

TION— BELIEF— SUBSEQUENTLY  CASTEATION — 

EEYSIPELAS  —  SEPTIC  PEEITONITIS  —  DEATH— 

AUTOPSY — EEMAEKS. 

(Under  the  care  of  Mr.  RICKMAN  J.  GODLEE.) 

Walter  H.,  aged  four  months,  was  admitted  into  University 
College  Hospital  on  March  3,  1882. 

Past  History. — The  child  was  very  restless  last  night, 
and  screamed  out  frequently  as  if  in  pain,  but  nothing 
was  noticed  to  account  for  it.  At  10  a.m.  this  morning  (day 
of  admission)  the  mother  noticed  that  there  was  a  hard1 
swelling  over  the  left  external  abdominal  ring,  which  was 
tender,  while  the  rest  of  the  abdomen  was  neither  tender  nor 
swollen.  The  child  has  slept  a  good  deal  during  this  morn¬ 
ing,  but  has  again  been  fretful  this  afternoon.  The  thigh  is 
kept  flexed  on  the  abdomen ;  swelling  about  the  same.  The 
child  is  usually  constipated,  the  bowels  not  acting  for  two  or 
three  days  sometimes ;  they  were  moved  last  evening.  Is 
brought  up  at  the  breast,  but  vomits  frequently,  and  has 
vomited  to-day  even  more  frequently  than  usual.  When 
admitted,  an  anaesthetic  was  administered,  and  an  attempt 
to  reduce  the  swelling  into  the  abdomen  was  made.  Proving 
unsuccessful,  Mr.  Godlee  was  sent  for. 

The  Present  Condition  was  then,  briefly,  as  follows  : — A 
tense,  firm,  irreducible  swelling,  tender  when  handled, 
situated  just  outside  the  external  abdominal  ring  on  the 
left  side.  The  scrotum  was  equally  and  well  developed  on. 
the  two  sides. 

Treatment. — The  child  being  chloroformed,  Mr.  Godlee, 
under  the  spray,  cut  down  on  the  swelling,  as  in  the  operation, 
for  hernia.  After  division  of  the  skin  and  subcutaneous- 
tissues,  the  sac  was  opened,  and  the  contents  were  fully  ex¬ 
posed.  They  consisted  of  a  globular,  hard  mass,  occupying 
apparently  the  external  ring,  on  pulling  down  which  as 
far  as  possible,  a  smaller  lump  of  similar  shape  and  colour 
came  in  sight ;  this  was  at  first  mistaken  for  a  piece  of  half- 
strangulated  gut,  but  its  hardness  negatived  this  idea.  The 
mass  could  neither  be  pulled  down  nor  forced  up  ;  a  broad 
director  was  therefore  passed  through  the  ring  in  front  of 
the  mass,  and  a  constricting  band  was  divided  with  a  blunt- 
pointed  bistoury,  the  incision  being  made  upwards.  The 
tumour  at  once  became  released,  and  could  be  drawn  down, 
into  the  wound.  It  then  became  clear  that  it  was  the  testis, 
the  body  of  which  was  grey,  while  the  smaller  part,  the 
epididymis,  was  much  darker  in  colour.  Both  had  evidently 
been  tightly  constricted,  and  were  indeed  on  the  point 
of  sloughing.  The  lower  part  of  the  vas  deferens  had  also- 
suffered  constriction.  No  gut  was  contained  in  the  sac,  and, 
as  the  parts  were  so  small,  no  attempt  was  made  to  close 
the  canal.  An  attempt  to  get  the  testicle  into  the  scrotum 
failed,  on  account  of  the  shortness  of  the  vessels,  not  from, 
any  deficiency  in  the  length  of  the  vas  deferens.  The  edges- 
of  the  wound  were  drawn  together,  and  a  drainage-tube  was: 
put  in ;  the  wound  was  then  covered  with  iodoform  wool, 
and  a  soft  bandage  applied. 

March  4. — The  patient  has  passed  a  very  restless  night. 
The  wound  was  re-dressed  under  the  spray ;  there  was  con¬ 
siderable  swelling  over  the  external  ring;  edges  of  the 
wound  were  well  together ;  no  redness,  no  bagging. 
Temperature  101 ‘6°  Fahr. 

6th. — Passed  a  quieter  night.  Temperature  this  morning 
has  fallen  to  99‘8°  Fahr.  The  wound  is  looking  better;  less 
redness,  less  swelling.  Iodoform  dressing  is  continued. 

7th. — Good  night  on  the  whole ;  a  little  restless  in  the 
early  morning.  Temperature  99'6°  Fahr.  The  wound  was 
re-dressed.  Some  of  the  sutures  have  cut  through ;  the 
wound  is  gaping,  and  the  testicle  is  exposed ;  it  looks  rather 
inclined  to  slough. 

8th. — It  was  decided  this  morning  to  remove  the  testis, 
its  condition  being  less  satisfactory  even  than  yesterday, 
Mr.  Godlee  passed  a  double  ligature  through  the  cord,, 
tying  one  around  the  vas  deferens,  and  the  other  around  the 
vessels;  the  cord  was  then  cut  through,  and  the  testicle: 


Medical  Time*  and  Gaaatti". 


LIGHT— WHENCE  1  LEADING— WHITHER  % 


Oct.  13,  1883  425 


removed.  The  wound  was  then  plugged  with  boracic  lint, 
and  left  to  granulate.  On  examining  the  testicle,  it  was 
found  gangrenous,  hut  the  epididymis  seemed  fairly  healthy. 

9th.— Child  sent  home. 

10th.— Came  to  the  hospital  to  be  dressed.  Wound  looks 
clean  and  begins  to  granulate.  Temperature  101  '2°  Fahr. 

16th. — Wound  continues  to  granulate ;  scrotum  rather 
oedematous  to-day. 

21st. — The  wound  is  healing  very  well.  No  oedema  of 
scrotum. 

25th. — When  brought  this  morning,  the  child  was  seen  to 
be  less  well.  The  lower  extremities  were  decidedly  cede- 
matous.  The  forehead  also  was  oedematous,  and  pitted  on 
pressure.  A  few  days  ago,  the  mother  relates,  she  first 
noticed  some  redness  and  swelling  on  the  left  thigh  and  leg  ; 
this  then  spread  to  the  right  side.  The  wound,  however,  is 
healing  up  satisfactorily.  Appetite  is  good.  Temperature 
99°.  The  child  seems  in  a  semi-unconscious  condition. 

27th. — Seen  again ;  found  to  be  worse.  The  redness  and 
swelling  on  the  right  side  are  more  marked  than  on  the 
25th.  The  child  was  therefore  re-admitted.  The  incision- 
wound  in  the  groin  is  now  almost  healed ;  the  skin  imme¬ 
diately  surrounding  it  appears  normal.  The  redness  and 
oedema  have  spread  over  the  greater  part  of  the  scalp  and 
face,  and  somewhat  also  on  to  the  forearms  ;  the  neck  and 
chest  are  free. 

April  1. — Child  lies  in  bed  on  the  left  side,  breathing 
quietly  about  thirty-eight  times  a  minute.  At  times  it  utters 
a  feeble  cry.  Temperature  99-6°.  Bowels  are  much  relaxed. 
The  child  is  suckled,  and  has  ten  minims  of  brandy  every 
hour. 

3rd. — The  exhaustion  increased,  and  the  child  died  early 
this  morning,  after  an  attack  of  convulsions  lasting  about 
one  hour. 

Autopsy  (by  Mr.  Stanley  Boyd).— The  body  was  well 
nourished ;  surface  pale ;  some  oedema  on  dorsum  of  feet,  but 
none  elsewhere.  The  forearms  were  oedematous,  as  also  the 
scalp,  especially  about  vertex  and  occiput,  where  the  skin  was 
dull  red.  The  wound  in  the  left  groin  was  quite  healed  in 
its  outer  half,  whilst  the  inner  half  was  occupied  by  an  ulcer 
extending  through  the  thickness  of  the  skin.  On  opening- 
up  the  old  wound,  no  trace  of  the  catgut  ligatures  could  be 
found.  A  probe  passed  through  the  internal  ring  from  the 
abdomen  easily  entered  a  pouch  which  was  more  than  half  an 
inch  long,  and  free  from  inflammation.  Bound  about  the  in¬ 
ternal  ring  the  sigmoid  flexure  was  adherent  by  recent  adhe¬ 
sions  ;  it  could  be  torn  away  with  little  difficulty,  and  in  doing 
this  a  single  point  of  pus,  the  size  of  a  split-pea,  was  found 
between  it  and  the  abdominal  wall.  Just  above  the  bladder 
a  coil  of  small  intestine  was  found  similarly  adherent  to  the 
abdominal  wall.  There  was  a  little  pus  everywhere  in  the 
abdominal  cavity ;  the  intestines  were  all  very  greasy,  but 
there  was  no  injection  of  either  visceral  or  parietal  peri¬ 
toneum,  and  the  coats  of  the  intestine  were  not  swollen  or 
dull.  There  was  no  thrombus  in  the  vena  cava  or  the  iliac 
arteries  to  account  for  the  oedema  of  the  legs.  The  left 
spermatic  vein  was  normal.  Liver,  spleen,  and  kidneys 
were  normal.  Eight  testis  normal.  Thorax  :  Pleura; — left 
normal ;  right  contained  about  one  ounce  of  clear,  rather 
deeply  blood-stained  fluid.  No  lymph  or  adhesions  of  any 
kind.  Lungs :  The  surface  of  the  right  lung  was  markedly 
redder  than  that  of  the  left,  which  was  normal  in  all  respects. 
In  addition  to  its  redness,  the  surface  of  the  right  lung  was 
dotted  over  with  a  number  of  petechise,  chiefly  on  the  lower 
and  middle  lobes.  On  raising  the  lung,  a  considerable  sub- 
pleural  haemorrhage  was  seen  behind  its  root,  and  below  this 
the  branches  of  the  vagus  and  side  of  the  gullet  were  so 
plain  that  they  struck  one  immediately  as  being  bare 
of  pleura.  And,  on  further  examination,  it  was  found 
that  the  pleura  was  absent  on  the  right  side  of  the  gullet 
from  just  below  the  root  of  the  lung  to  just  above  the  dia¬ 
phragm,  at  which  point  its  free  edge  was  at  once  picked 
up,  and  followed  easily  along  the  spine.  Accidentally,  a 
finger  pressed  on  the  oesophagus,  when  a  bubble  of  air 
was  seen  to  escape  through  a  small  opening  in  its  side. 
This,  then,  seemed  to  be  the  source  of  the  fluid  in  the  right 
pleura;  it  was  perfectly  certain  that  no  injury  had  been 
inflicted  on  the  part  during  the  autopsy.  There  were  no 
signs  of  pneumothorax  or  of  fluid  in  the  pleura.  (Eso¬ 
phagus,  when  cut  down,  was  found  to  contain  several  small 
clots  about  one  inch  long,  lying  in  the  furrows  between  its 
rugae  at  a  point  about  midway  between  the  bifurcation  of 


the  trachea  and  the  opening  in  the  diaphragm,  at  which 
place  was  the  opening  previously  alluded  to.  The  mucous 
membrane  around  this  hole  seemed  quite  normal.  Scalp  was 
very  oedematous ;  the  loose  subaponeurotic  tissue  having  its 
meshes  full  of  greenish-yellow  fluid,  which  streamed  away 
when  pressed. 

Remarks  (by  Mr.  Godlee). — The  case  presents  some  points 
of  interest :  first,  from  the  extreme  rarity  of  the  occurrence 
of  strangulation  of  an  undescended  testis  in  a  child; 
secondly,  from  the  consequent  difficulty  of  coming  to  a  cor¬ 
rect  diagnosis ;  and,  thirdly,  from  the  difficulty  of  conceiving 
of  any  cause  which  should  give  rise  to  such  a  strangulation. 
It  was  thought  right  to  give  the  parts  a  chance  of  recovering, 
although  at  the  time  of  operation  it  was  pretty  clear  that  they 
were  already  in  a  state  of  gangrene ;  and  I  do  not  suppose  that 
this  delay  in  their  removal  had  anything  to  do  with  the  un¬ 
fortunate  result.  It  was  interesting  to  observe,  as  has  been 
noticed  by  others,  that  it  was  impossible  to  draw  the  testis 
down  into  its  natural  position — not  from  any  deficiency  of 
the  vas  deferens,  but  because  the  shortness  of  the  spermatic 
vessels  rendered  this  impossible.  I  think  that  death  resulted 
from  a,  so  to  speak,  accidental  attack  of  erysipelas,  and  that 
the  slight  and  recent  peritonitis  was  a  part  of  this  con¬ 
dition,  and  not  a  direct  extension  of  inflammatory  mischief 
from  the  wound ;  for  the  external  wound  itself  was  far  ad¬ 
vanced  towards  healing,  and  the  little  pocket  of  peritoneum 
opposite  the  internal  abdominal  ring  was  free  from  the 
inflammation  which  affected  the  rest  of  the  peritoneal  cavity. 


TEEMS  OF  SUBSCEIPTION. 


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The  Colonies  and  the  United 
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JJ  »  )>  • 

India  (vid  Brindisi)  .  .  . 

99  •  •  • 


Twelve 

Six 

Twelve 

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99 
99 
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♦ 


SATUEDAY,  OCTOBEE  13,  1883. 


LIGHT— WHENCE  ?  LEADING— WHITHEE  ? 

If  one  may  safely  argue  from  one’s  own  impressions  to 
those  of  others,  thousands  of  medical  practitioners  through¬ 
out  the  country  have  had  their  thoughts  and  feelings  stirred 
this  week  by  a  rare  pleasure.  It  is  hardly  too  much  to  say 
that  Dr.  Clifford  Allbutt’s  address  to  the  Leeds  students, 
published  in  full  in  a  contemporary,  is  an  epoch-making 
speech,  which,  if  he  had  never  said  or  written  anything  else, 
would  have  been  sufficient  to  place  him  side  oy  side  with 
the  two  or  three  masters  of  thought  and  eloquence  in  our 
profession.  It  is  true  that  much  that  Dr.  Allbutt  said  is 
what  hundreds  of  us  have  been  dumbly  thinking  these  many 
years  past ;  but  he  managed  to  throw  upon  it  all  such  a 


cirtcal  Crates  trait  m)tiU 


426 


Medical  Times  and  Gazette. 


LIGHT— WHENCE  1  LEADING— WHITHER  ] 


Oct.  13, 1883. 


glow  of  emotion  and  of  warm  human  sympathy,  that  it  will 
he  from  now  that  we  shall  date  its  inception.  For  while 
human  thought  is  ever  advancing  with  the  steady  whirr 
and  tick  of  clockwork,  its  movement  is  often  scarce  noticed 
until  emotion  strikes  the  hour.  Dr.  Allbutt’s  style  may, 
here  and  there,  show  a  lack  of  that  self-restraint  which 
is  seldom  gained  except  by  a  life  spent  in  literature,  and 
which  in  the  case  of  the  present  speech  might  possibly  have 
been  gained  only  at  the  cost  of  its  wonderful  freedom  and 
6lan.  But  in  his  thought  there  is  no  extravagance,  or 
absence  of  restraint.  It  is  equally  far  removed  from  Phi¬ 
listinism  and  priggishness,  and  deserves,  if  anything  written 
in  English  ever  did  deserve  it,  the  praise  of  Mr.  Matthew 
Arnold  for  its  “  lucidity.”  Dr.  Allbutt  has  stepped  outside 
the  walled  circle  of  orthodoxy,  without  straying  into  the 
wilderness  of  paradox,  which  is  the  special  temptation  of 
original  and  imaginative  minds.  The  middle  path  he  has 
chosen  is  the  safest,  if  it  can  only  be  found  and  followed. 
But,  such  is  the  pull  of  bias  towards  one  side  or  the  other, 
such  the  attraction  or  repulsion  exercised  by  the  mass  of 
current  thought,  that  to  find  the  path  is  only  given  to  very 
few,  and  to  fewer  still  to  keep  it.  The  truth  of  one  genera¬ 
tion  is  the  paradox  of  another  ;  and  what  is  decried  as  here¬ 
tical  to-day,  shall,  with  “as  wide  a  throat,”  be  proclaimed 
orthodox  to-morrow.  It  is  the  sign  of  a  lucid  and  courageous 
mind  to  be  able  to  perceive  and  steer  along  the  straight 
and  unbroken  line  of  truth,  uninfluenced  by  the  huge  bulk 
of  opinion  ever  drunkenly  floundering  on  this  side  or  on 
that.  And  yet,  after  all,  it  is  not  so  much  for  its  thought 
that  Dr.  Allbutt’s  address  will  be  remembered,  as  for  that 
emotional,  sympathetic  undertone  which  will  make  it  vibrate 
in  every  heart.  Only  wide  human  sympathies  under  the 
guidance  of  a  powerful  imaginative  insight  can  make  the 
man  who  walks  in  the  pure  air  of  science,  upon  the  hill-tops 
of  success,  feel  with  the  hearts  that  labour  amidst  the  sordid 
pettiness  of  lower  and  darker  levels.  Such  gifts  and  such  a 
use  of  them  are  rare  and  precious.  They  earn  a  love  which 
is  better  than  reverence  or  wonder.  Men  may  still  laud  and 
chucklingly  admire  the  gloomy  and  unhuman  sage  who  told 
them  they  were  mostly  fools,  but  it  is  for  the  simple  and 
large-souled  George  Eliot,  with  her  interest  in  common 
lives  and  her  sympathy  for  lowly  hearts,  that  they  cherish 
the  tenderest  memories. 

If  there  is  one  part  of  Dr.  Allbutt’s  address  which  more 
than  another  is  worth  thinking  over  by  medical  men,  and 
likely  to  make  an  impress  upon  medical  thought,  it  is  that 
in  which  he  defines  the  claims  of  the  profession  to  public 
regard  and  to  political  authority.  If  he  succeeds  as  well  in 
clearing  his  readers’  minds  of  cant  on  this  point,  as  he  has 
cleared  his  own,  he  will  have  worked  a  success  which  even 
iu  these  days  might  be  considered  as  partaking  of  the 
miraculous.  But,  in  spite  of  all  Dr.  Allbutt’s  eloquence, 
there  will  remain  many  minds  who  will  still  be  chiefly 
drawn  to  the  old  ideal  which  has  been  preached  to  us  for  so 
many  years  from  so  many  rostra,  and  which,  like  all  beliefs 
that  have  a  large  following,  must  be  admitted  to  possess 
some  element  of  reasonableness  and  vitality.  Which 
standard  will  the  profession  enrol  itself  under  ?  which  light 
and  which  leading  will  it  follow  ?  That  of  Mr.  Bennett, 
who,  in  proclaiming  last  week  the  time-worn  truth  that 
ours  is  a  noble  profession,  demands  as  its  logical  corollary 
that  we  should  receive  due  patents  of  nobility  ?  or  that 
of  Dr.  Allbutt,  who,  following  the  Poet  Laureate,  finds 
the  true  patent  of  nobility  in  humble  unselfishness,  un¬ 
conscious  of  heroism,  and  who  of  course  cannot  demand 
any  recognition  for  it  because  to  throw  upon  it  the  glare  of 
publicity  would  be  infallibly  to  destroy  it  ?  For  ourselves, 
we  cannot  help  thinking  that  Mr.  Bennett’s  demand  for 
political  power,  not  as  an  end,  but  as  a  means  towards  social 


recognition,  is  of  altogether  too  local  and  artificial  a  character 
to  meet  with  any  wide  sympathy  from  the  profession.  The 
bulk  of  us  must  ever  be  drawn  from  the  sons  of  the  pro¬ 
fessional  classes,  who  form  the  intellectual  as  well  as  the 
moral  backbone  of  the  country.  It  would  weaken  the  pro¬ 
fession,  instead  of  strengthening  it,  to  court  an  invasion 
from  the  younger  offshoots  of  our  “  materialised  aristocracy.” 
They  would  only,  even  on  Mr.  Bennett’s  showing,  be 
tempted  to  join  us  for  the  sake  of  the  loaves  and  fishes,  and 
they  would  come  to  us  with  an  ideal  of  very  different  quality 
from  that  which  now  happily  rules  in  our  ranks.  The  move¬ 
ment,  which  in  the  last  generation  attracted  to  the  College 
of  Physicians  men  of  a  sturdier  and  bolder-minded  stock 
than  the  old  university  graduates,  though  it  undoubtedly 
tended  to  lower  the  social  status  of  medicine,  has  added 
immensely  to  the  height  of  its  ideal  and  the  fervour  of  its 
beliefs.  The  profession  is  now  slowly  recovering  its  due 
social  standing,  and  is  attracting  more  and  more  the  very 
men  we  want — thoughtful  men  of  breeding  and  culture. 
But  to  replenish  our  ranks  from  the  class  for  whom  good 
tone  expresses  the  highest  reach  of  excellence,  and  money 
and  enjoyment  the  main  ends  of  life,  would  be  infallibly  to 
lower  the  self-respect  of  the  profession,  whatever  effect  it 
might  have  in  winning  for  it  the  respect  of  others. 

If,  then,  we  are  to  claim  a  share  of  political  power  with 
any  prospect  of  success,  or  promise  of  benefit  to  ourselves, 
it  must  be  with  a  very  different  aim  in  view  from  that  which 
Mr.  Bennett  holds  before  us.  That  the  State  needs  our 
advice,  and  would  be  the  better  for  hearing  it,  might  seem 
to  most  a  sufficient  justification  of  our  claim  to  give  it  from 
the  place  where  alone  it  can  be  given  with  authority.  But 
Dr.  Allbutt  traverses  this  commonly  accepted  logic.  Public 
medicine,  he  says,  does  not  as  yet  deal  with  very  large 
conceptions,  nor  with  the  higher  aims  of  national  life;  and 
hence  all  cries  for  “  doctors  in  the  House  of  Lords,”  for 
“political  power  for  the  profession,”  appear  to  him  to  be 
based  upon  a  false  and  undignified  idea  of  the  Republic  of 
Science.  By-and-by,  he  promises  us  in  a  sentence  which  seems 
to  look  forward  to  a  socialistic  millennium.  Public  Medicine 
will  be  able  to  claim  a  public  voice,  when  it  has  successfully 
worked  out  “  the  conditions  of  those  great  social  fusions 
which  hereafter  shall  absorb  individual  wills  into  new 
wholes  and  reveal  the  future  of  mankind.”  How  public 
medicine  is  working  out  those  conditions  Dr.  Allbutt  does 
not  tell  us,  but  if  he  really  believes  that  it  is  at  present 
engaged  in  laying  the  foundations  of  a  future  socialistic  re¬ 
public,  he  is  perhaps  wise  in  not  forcing  its  representatives 
into  a  Parliament  composed  almost  exclusively  of  adherents 
of  the  present  order.  Whether  the  conceptions  with  which 
Public  Medicine  deals  are  large  enough  or  not  to  warrant  its 
followers  in  demanding  an  official  place  in  Parliament,  or 
whether  Medical  Science  will  not  make  itself  best  felt  and 
rouse  least  resistance  by  steady  unofficial  pressure,  are  ques¬ 
tions  that  must  be  left  for  future  treatment.  These  are,  after 
all,  minor  matters.  The  real  point  which  the  profession  has 
to  decide  is  this— Will  it,  following  Mr.  Bennett’s  advice, 
strive  for  a  higher  place  at  the  feast,  for  more  honours  from 
the  Queen,  and  more  frequent  mention  in  the  Morning  Post  ? 
or  will  it  continue  to  obey  that  larger  and  more  lovely  ideal 
which  Dr.  Allbutt  describes,  and  seek  its  highest  reward  in 
the  self-respect  and  satisfaction  that  comes  of  humble,  self- 
forgetting  labour  ?  For  ourselves,  we  know  well  which  ideal 
most  appeals  to  us,  for  now  that  the  tendency  of  civilisation 
is  towards  the  effacement  of  conventional  distinctions  of 
rank,  no  ideal  which  rests  on  a  regard  for  those  distinctions 
can  ever  possess  any  strong  or  enduring  vitality.  But  the 
ideal  which  Dr.  Allbutt  recommends  has  had  its  charm 
for  the  best  minds,  apart  from  all  distinctions  of  race  or 
polity ;  it  is  the  one  to  which  the  advance  of  modern  thought 


Medical  Times  and  Gazette. 


EDUCATIONAL  OYER  -  PRESSURE 


Oct.  13,  1883.  427 


and  the  widening  of  human  sympathies  will  ever  give  fresh 
increase  of  strength  ;  and  it  is,  we  are  sure,  the  one  in  which 
the  medical  profession  will  find  its  best  light  and  leading. 


EDUCATIONAL  OYER  -  PRESSURE. 

There  is  evidently  a  good  time  in  store  for  the  spectacle- 
makers  in  this  country,  for  we  have  firmly  determined  to 
follow  the  example  of  Germany,  and  introduce  short-sighted¬ 
ness  on  a  large  scale  amongst  our  children.  We  have 
decided  in  favour  of  mental  muddle  as  against  clear  vision  ; 
and  by  means  of  excessive  book-work  in  schools,  and  the 
severe  strain  on  the  muscles  of  accommodation  and  the  in¬ 
creased  tension  of  the  eyeball  thereby  occasioned,  we  are 
already  reaping  a  rich  harvest  of  myopia.  It  is  of  course 
difficult  for  modern  ophthalmic  surgeons  accurately  to  com¬ 
pare  their  results  with  those  of  their  predecessors,  who  were 
unprovided  with  the  delicate  tests  now  in  use  for  the  detec¬ 
tion  of  errors  of  sight ;  but  the  conclusions  they  have  arrived 
at  cannot,  alas  !  be  shaken  by  the  supposition  that  they 
are  merely  bringing  to  light  defects  which  formerly  escaped 
detection.  The  present  number  of  grave  cases  of  failure  of 
vision,  such  as  must  at  any  period  have  secured  recog¬ 
nition,  is  vastly  in  excess  of  anything  that  we  find  re¬ 
corded  by  the  authorities  of  past  times,  while  the  multi¬ 
plication  of  minor  visual  impairments  is  going  on  under 
the  immediate  observation  of  living  authorities  in  a 
manner  that  admits  of  no  dispute.  All  English  ophthalmo¬ 
logists  are  agreed  that  myopia  is  becoming  daily  more  fre¬ 
quent  amongst  us ;  and  Mr.  Bendelach  Hewetson  and  Mr. 
Edgar  Browne  made  it  abundantly  clear,  at  the  meeting  of 
the  Social  Science  Association  at  Huddersfield  on  the 
4th  insb.,  that  this  increased  prevalence  of  myopia  is  attri¬ 
butable  to  school- work  and  over-employment  of  the  eyes  on 
print  and  stitching  by  children  and  young  persons.  The 
strain  of  the  eyes  in  reading  and  fine  sewing,  required  of 
children  now  to  bring  them  up  to  the  standards  which  they 
have  to  pass,  results  in  deformity  of  these  organs,  which  is 
more  especially  apt  to  occur  when  there  is  an  inherited 
tendency  to  it,  where  general  bodily  nutrition  is  defec  tive 
or  where  the  construction  of  the  school  furniture  and 
distribution  of  the  light  are  faulty. 

Now,  these  facts  as  to  the  spread  of  short-sightedness 
amongst  the  young  are  alone  sufficient  to  prove  that  educa¬ 
tional  over-pressure  exists,  and  in  view  of  them  it  is  in  vain 
for  members  and  officials  of  School  Boards,  who  seem  all  to 
assume  a  pedagogic  infallibility  of  tone,  to  asseverate  that 
the  present  system  is  doing  no  harm,  and  that  the  doctors 
are  simply  foolish  alarmists  because  they  suggest  that  it  is. 
If  education,  as  now  conducted,  is  causing  wholesale  short¬ 
sightedness,  it  ought  to  be  overhauled  and  amended  without 
delay,  for,  in  homely  phrase,  “  the  game  is  not  worth  the 
candle,”  and  an  elementary  knowledge  of  reading,  writing, 
and  arithmetic  is  dearly  purchased  by  the  partial  blocking 
up  of  one  of  the  great  gateways  of  knowledge,  which  ought 
to  remain  the  principal  inlet  of  edification  and  delight  all 
through  life. 

But  these  defects  of  vision  which  have  been  alluded  to  do 
not  exhaust  the  indictment  against  education  in  these  days. 
Worse  remains  behind.  The  children  whose  eyes  fail  them, 
and  who  go  on  groping  over  their  relentless  task  in  dimness 
and  confusion,  complain  of  headaches,  and  hundreds  of  other 
children  whose  sight  remains  good  also  experience  frequent 
pains  in  the  forehead  or  vertex.  In  a  certain  proportion  of 
these  cases  the  headaches  are  relieved  by  the  use  of  appro¬ 
priate  glasses,  but  in  a  large  number  they  persist  in  spite  6f  all 
ophthalmological  efforts,  and  are  shown  to  depend  on  a  state 
of  irritation  of  the  brain.  And  it  is  scarcely  to  be  wondered 
at  that  the  brain  should  suffer  from  processes  which  leave 


their  pernicious  impress  on  the  eye.  The  eye  is  a  delicate 
organ,  but,  compared  with  the  brain,  it  is  what  a  ship’s  cable 
is  to  a  cobweb,  and  it  is  certain  that  any  operations  in 
which  they  are  both  equally  engaged  that  are  detrimental  to 
the  one  will  be  tenfold  more  detrimental  to  the  other.  We 
really  wish  that  our  educationists,  who  habitually  talk  of 
the  brain  as  if  it  were  a  hard  and  stony  structure  that  will 
stand  any  amount  of  chiselling  and  polishing,  could  see  a 
microscopic  section  of  a  shred  of  it.  Looking  at  a  group  of 
its  starry  cells,  with  their  innumerable  branches  lying  in 
their  neuroglia,  “  like  a  swarm  of  fire-flies  tangled  in  a  silver 
braid,”  tracing  out  its  intricate  conduits  and  interlacing 
strands,  learning  that  this  exquisite  complexity  of  tissue 
when  alive  is  of  the  consistence  of  red-currant  jelly,  and 
that  the  “living  splendour”  with  which  it  is  “  burnished  ” 
— its  functional  activity — is  something  as  impalpable  as  the 
bloom  on  a  ripe  plum,  which  can  be  brushed  off  with  a 
touch,  and  can  never  be  reproduced,  they  would  be  more 
chary  thereafter  iu  imposing  burdens  on  it,  and  in  wearing 
it  out  prematurely  by  vexing  toil.  They  would  realise  that 
if  educational  over-pressure  impairs  the  power  of  the  eye 
and ’alters  its  shape,  it  is  likely  to  induce  still  more  serious 
consequences  in  that  supreme  centre  of  which  the  eye  is  but 
the  minister.  And  the  real  truth  would  seem  to  be  that  ex¬ 
cessive  application  to  study  in  early  years  does  set  up  a  sort 
of  intellectual  short-sightedness,  analogous  to  visual  short¬ 
sightedness,  but  much  more  difficult  to  discover  and  measure. 
We  know  that,  in  extreme  cases,  hopeless  imbecility  has 
been  induced  by  the  ruthless  brain-forcing  of  children  ;  and 
we  are  entitled  to  infer  that,  in  a  much  larger  number  of 
cases,  artificial  stupidity,  or  a  blunting  of  the  fine  edge 
of  talent,  has  followed  it  in  those  who  have  been  schooled 
“  not  wisely,  but  too  well.”  The  zealous  teacher,  with  an 
eye  to  payment  by  results,  gets  results  where  he  should 
only  aim  at  preliminaries,  and  finishes  up  at  twelve  the 
evolution  of  a  mind  that  ought  to  have  gone  on  till 
middle  life.  The  school  headaches  which  we  have  adverted 
to,  and  which  are  attracting  anxious  attention  in  Germany,, 
are  very  significant  of  hidden  mischief  and  of  the  risks  we 
are  running.  Headaches  used  to  be  utterly  unknown  in 
children  in  this  country,  except  as  premonitory  of  acute 
hydrocephalus,  or  as  symptomatic  of  organic  disease  of  the 
brain ;  and  now  they  are  of  the  commonest  occurrence 
amongst  town  children,  many  of  whom  bring  them  home 
with  them  from  school  every  day,  while  others  suffer  from 
them  now  and  again,  or  when  the  home-work  has  been  ex¬ 
ceptionally  heavy.  But  these  school  headaches  betoken  an 
irritated  condition  of  the  cerebrum  and  its  membranes,  and 
that  they  do  so  is  shown  by  the  fact  that  they  occasionally 
run  on  into  tubercular  meningitis.  Even,  however,  when 
they  do  not  overstep  the  boundary  of  common  headache,  they 
are  full  of  danger,  and  well  calculated  to  excite  forebodings  : 
for  the  young  brain  cannot  be  irritated  with  impunity,  and 
the  “  headachy  ”  child  is  only  too  likely  to  grow  up  into 
the  dissolute  or  insane  man  or  the  hysterical  woman.  And 
not  less  significant  than  the  school  headaches  of  some 
children  in  these  days  are  the  school  twitchings  of  others. 
Grimacings,  startings,  and  choreic  movements  of  one  kind 
or  another  are  prevalent  amongst  school  children  of  the 
more  affluent  classes,  and  particularly  amongst  girls,  to  an 
extent  that  could  not  be  surmised  by  those  who  had  not 
made  observations  on  the  subject,  and  that  is  ominous  of 
disaster. 

Medical  men  are,  and  ever  have  been,  the  consistent 
advocates  of  education.  None  know  so  well  as  they  the 
hygienic  value  of  training,  of  knowledge,  of  intellectual 
resources,  and  self-control.  But  what  they  desire  is  educa¬ 
tion  in  its  larger  sense,  and  not  mere  schooling.  With¬ 
out  under-estimating  the  utility  of  the  schoolmaster,  it 


428 


Medical  Times  and  Gazette. 


STATE  INTERVENTION  IN  MEDICAL  AFFAIRS. 


Oct.  13,  1883. 


must  be  maintained  that  the  least  important  part  of  educa¬ 
tion  is  that  -which  is  obtained  under  his  auspices.  He 
cultivates  a  corner  of  human  life,  and  makes  it  yield  useful 
produce;  but  its  wide  expanse  teems  with  luxuriant  and 
varied  growth  that  he  has  never  evoked,  but  that  he  may 
do  much  to  blight  and  stunt.  All  nature — sky,  earth,  flood, 
field,  and  flower, — all  the  forces  of  the  universe — the 
stars  in  their  courses,  the  summer  lightning ;  the  winter’s 
frost,  the  dancing  atoms,  the  mysteries  of  hate  and  love, 
— are  ceaselessly  busy  in  teaching  the  child ;  and  shall 
we  allow  a  dull  man  with  a  ferule  in  his  hand  to  take  the 
credit  of  the  result  ?  If  we  do,  and,  accepting  his  exag¬ 
gerated  notions  of  his  own  mission,  permit  him  to  encroach 
too  largely  on  the  domain  of  the  great  primordial  teachers, 
pinning  infants  to  benches  when  they  should  be  roaming 
free,  stuffing  them  with  grammar  when  they  should  be  quaff¬ 
ing  sunshine,  we,  or  those  who  come  after  us,  will  bitterly 
repent  it.  We  shall  become  an  island  full  of  round-backed, 
blear-eyed  bookworms,  poor  of  heart  and  small  of  soul, 
instead  of  a  nation  of  men  and  women  strong  of  limb, 
graceful  in  movement,  nimble-handed,  quick-sighted,  clear¬ 
headed,  tender,  and  true— a  nation  such  as  we  should  all 
wish  the  English  to  become. 

The  penalties  of  educational  over-pressure  of  every  kind 
fall  much  more  heavily  on  the  children  in  urban  than  in 
rural  districts.  Their  nervous  systems  are  more  unstable 
to  begin  with,  and  they  lack  the  benefit  of  those  mighty 
correctives — fresh  air,  sunlight,  and  freedom — which  country 
children  enjoy.  But  on  children  of  all  classes  the  rage  for 
precocity,  which  animates  those  who  have  the  regulation  of 
educational  methods,  is  telling  more  or  less.  The  screw  is 
applied  too  severely,  and  it  has  been  applied  far  too  fast. 
It  should  have  been  remembered  that  the  great  mass  of 
children  gathered  or  driven  into  Board  Schools  have  no 
inherited  aptitude  for  learning,  and  can  only  crawl  painfully 
along  the  path  that  better-born  children  tread  lightly.  If 
it  takes  three  generations  to  make  a  gentleman,  it  takes  at 
least  half  a  dozen  to  make  a  scholar;  and  to  force  sickly 
and  underfed  children,  handicapped  by  a  load  of  inherited 
pathological  tendencies,  to  keep  pace  with  the  strong,  the 
well-nourished,  the  soundly  constituted,  is  both  cruel  and 
wasteful.  School  Boards  had  better  arouse  themselves  to  a 
sense  of  the  true  situation  at  once ;  if  they  do  not  they  will 
be  awakened  to  it  by  the  voice  of  the  country  in  somewhat 
peremptory  and  ungracious  tones  before  long. 


STATE  INTERVENTION  IN  MEDICAL  AFFAIRS. 
On  Tuesday  evening  last,  at  the  London  Hospital,  Professor 
Huxley  delivered  the  address  which  has  been  so  greatly 
looked  forward  to.  He  chose  a  topic  which  nearly  touches 
the  interest  of  every  medical  practitioner  and  student,  and 
he  dealt  with  it  in  his  usual  broad  and  statesmanlike 
manner.  But  there  will  be  many,  in  this  division  of  the 
kingdom  at  least,  who  will  rise  from  the  perusal  of  his 
remarks  with  disappointment.  Lately  we  have  all  had  our 
minds  exercised  on  the  claim  of  Medicine  to  intervene  in  the 
affairs  of  State.  Professor  Huxley  turns  to  us  the  obverse 
of  ;the  medal,  and  draws  attention  to  the  right  of  the 
State  to  intervene  in  the  affairs  of  Medicine.  No  one,  of 
course,  would  expect  Mr.  Huxley  to  sympathise  with  or  to 
uphold  the  view  held  by  some  in  our  ranks — that  the  object 
of  medical  licences  is  to  protect  the  licensees  from  unautho¬ 
rised  opposition.  But  when  he  affirms  that  in  passing  the 
various  Medical  Acts  the  State  had  no  idea  of  protecting  the 
public  from  incompetent  advice,  he  certainly  differs  from 
the  modern  conception  of  the  object  of  a  registrable  diploma. 
What  did  the  State  mean  by  passing  the  Dentists’  Act,  if  it 
was  not  to  give  the  public  a  means  of  determining  between 


competent  and  incompetent  practitioners  ?  Legislative  in¬ 
terference  with  the  dental  profession  could  be  justified  on 
no  single  one  of  Professor  Huxley’s  reasons ;  and  it  is  an 
entirely  gratuitous  assumption  to  suppose  that  the  State 
has  less  care  for  the  lives  of  its  subjects  than  for  their 
teeth.  Professor  Huxley  has  made  a  slip  there,  at  all  events. 

On  the  subject  of  future  medical  legislation.  Professor 
Huxley  again  shows  himself  out  of  harmony  with  current 
medical  opinion.  He  thinks  that  all  the  present  evils  would 
be  mended  if,  first,  no  one  were  placed  on  the  Register  who 
could  not  prove  a  competent  knowledge  of  medicine,  surgery, 
and  midwifery ;  and,  secondly,  if  the  Medical  Council  were 
given  efficient  control  of  the  examinations.  The  Medical 
Council  has  certainly  in  times  past  had  scant  justice  done 
it,  but  if  there  is  one  point  on  which  the  mind  of  the  pro¬ 
fession  is  made  up,  it  is  on  the  absolute  necessity  of  institut¬ 
ing  reforms  in  that  body,  and  bringing  it  more  into  harmony 
with  general  medical  opinion.  The  clause  in  the  abortive 
Medical  Bill  which  provided  for  this  was  the  only  one  in 
which  the  profession  took  a  deep  interest,  and  it  is  to  be 
regretted  that  on  this  point  Professor  Huxley  sympathises 
so  little  with  the  body  to  which  he  still  professes  himself 
proud  to  belong.  If  the  Medical  Council  is  only  the  agent 
of  the  State,  instituted  for  purely  State  convenience,  and 
allowed  to  run  counter,  with  impunity,  to  the  feelings  and 
opinions  of  the  medical  body,  it  is  a  scandalous  and  crying 
evil  that  every  fresh  practitioner  should  be  heavily  taxed  to 
support  it.  That  is  an  old  argument,  but  it  has  never  yet 
been  met  by  the  adherents  of  extreme  views  on  the  auto¬ 
cratic  function  of  the  State. 

Professor  Huxley’s  next  point  is  one  which  touches  vitally 
the  interests  of  teachers  under  the  present  system.  The 
proposal,  which  has  nothing  new  about  it,  is  that  the  funda¬ 
mental  and  elementary  parts  of  medical  education —the 
parts  included  under  the  old  name  of  the  “  Institutes  of 
Medicine,”  together  with  the  collateral  sciences — should  be 
taught  at  two  or  three  large  central  schools,  instead  of  at  a 
number  of  small  schools,  as  at  present.  To  this  he  added 
the  suggestion  that  some  systematic  provision  should  be 
made  for  the  advancement  of  Medicine  as  a  science.  There 
is  at  present  in  London,  he  pointed  out,  scarcely  any  open¬ 
ing  for  a  man  who  wishes  to  devote  himself  to  original 
scientific  research,  without  any  view  of  entering  the  field  of 
practice.  There  is  much  that  is  taking  in  the  idea  of  two 
or  three  large  central  schools,  where  the  students  of  diffe¬ 
rent  hospitals  would  mix  more  freely  than  at  present,  but 
it  is  too  large  a  question  to  go  into  now.  All  that  we  can 
say  here  is,  that  it  is  strange  that  Dr.  Huxley  did  not 
allude  to  what  he  must  know  perfectly  well  to  be  the  real 
justification  of  the  present  system,  viz.,  that,  imperfect  as 
it  is,  we  have  in  it  almost  the  only  aid  to  research  in 
Medicine  that  exists  in  London. 

We  have  a  number  of  small  schools,  each  with  several 
small  lectureships,  held  for  the  most  part  by  young  physicians 
and  surgeons  attached  to  the  corresponding  hospitals,  who 
are  willing  to  take  the  lectureships  for  the  sake  of  the  fees 
attached  to  them,  rather  than  because  it  is  their  intention 
to  devote  themselves  to  the  subject  on  which  they  lecture. 
That  may  not  be  an  ideal  system,  but  at  any  rate  the  income 
so  derived  helps  these  men  to  live,  and  devote  themselves  to 
that  scientific  study  of  disease  by  which  they  hope  eventu¬ 
ally  to  rise  to  fame  and  fortune.  But  for  the  assistance 
given  by  such  appointments,  many  an  able  man  would  have 
been  compelled  either  to  abandon  the  idea  of  consulting 
practice  altogether,  leaving  his  place  to  be  filled  by  the  next 
best  man  who  was  possessed  of  private  means,  or  would  have 
been  itempted  to  devote  himself  to  work  which  was  more 
immediately  remunerative — in  either  case  to  the  detriment 
of  science.  Imperfect  as  the  present  system  may  be,  judged 


Medical  Times  and  Gazette. 


CHRONICLE  OF  THE  WEEK. 


Oct.  13,  1883.  429 


by  the  systems  in  vogue  on  the  Continent,  where  the  State 
subsidises  as  well  as  intervenes,  it  still  remains  almost  the 
only,  certainly  the  most  important,  organisation  which  we 
possess  for  assisting  the  study  of  medical  science  as  dis¬ 
tinguished  from  its  application  in  practice  ;  and  our  autho¬ 
rities  must  weigh  the  consequences  very  carefully  before 
they  give  in  to  the  temptations  of  this  newest  conjoint 
scheme. 


CHOREA  AND  RHEUMATISM. 

The  relation  between  chorea  and  rheumatism,  or  the  de¬ 
pendence  of  the  former  upon  the  latter,  is  a  question  which 
has  been  much  debated  of  late  years  in  our  own  country — 
more  so,  we  fancy,  than  on  the  Continent ;  and  the  fact  that 
it  forms  a  part  of  one  of  the  subjects  selected  by  the  Collec¬ 
tive  Investigation  Committee,  shows  that  the  problem  has 
not  yet  received  a  satisfactory  solution.  It  is  not,  perhaps, 
one  of  the  questions  best  adapted  for  collective  investiga¬ 
tion,  for  the  simple  reason  that  so  much  depends  upon  the 
interpretation  which  the  observer  puts  upon  the  history  given 
him  by  the  patient  or  his  friend :  what  one  man  would 
record  as  “  some  history  of  vague  pains,”  another  would  call 
“subacute  rheumatism/’  But  this  objection,  of  course,  would 
apply  to  all  collective  investigation.  From  the  accumulation 
of  a  large  number  of  statistics,  we  may  certainly  hope  for 
some  decided  results.  In  his  introductory  remarks  on  rheu¬ 
matism  and  its  allies,  at  the  last  meeting  of  the  British 
Medical  Association,  Dr.  Barlow  has  given  a  succinct  and 
impartial  statement  of  what  may  be  taken  to  be  the  views 
that  are  most  in  favour  at  the  present  time.  The  embolic 
theory,  very  seductive  at  the  first  glance,  has  failed  to  fulfil 
the  expectations  that  were  formed  of  it.  Were  it  the  uni¬ 
versal  cause,  we  should  expect  that  heart-disease  would 
always  precede  chorea,  and  that  not  infrequently  some  of 
the  larger  vessels  would  become  blocked,  and  permanent 
damage  result ;  neither  of  which  conditions  is  met  with. 

In  many  cases  no  history  of  rheumatic  attack  can  be 
obtained,  but  we  are  not  justified  in  assuming  that  rheu¬ 
matism  is  thereby  excluded.  We  must  wait  for  events. 
This  was  well  exemplified  in  a  case  that  recently  came 
under  our  observation.  A  little  girl  who  had  twice  had 
chorea,  and  each  time  without  any  (other)  rheumatic  mani¬ 
festation,  came  again  in  a  third  attack,  and  still  presented 
no  proof  of  rheumatism,  but  she  brought  with  her  a  younger 
sister,  also  suffering  from  chorea,  with  decided  evidence  of 
mitral  disease,  and  a  clear  history  of  an  attack  of  subacute 
rheumatism  shortly  before  the  onset  of  the  chorea.  If  the 
patient  has  signs  of  heart-disease,  it  is  almost  needless  to 
search  further  for  evidence  of  rheumatism.  Those  who 
have  had  much  experience  of  children  are  aware  that  endo¬ 
carditis  may,  and  often  does,  commence  when  the  joint 
affection  is  so  slight  as  to  be  hardly  worth  taking  any 
notice  of.  The  subcutaneous  nodules  that  Drs.  Barlow 
and  Warner  described  in  the  “  Transactions  of  the  Inter¬ 
national  Medical  Congress,”  are  now  generally  admitted 
to  be  of  rheumatic  origin,  but,  as  they  are  rarely  present 
without  organic  disease  of  the  heart,  they  cannot  often  have 
much  diagnostic  value.  The  erythema  marginatum  which 
is  sometimes  present  might  be  accepted  as  evidence  of 
rheumatism,  but  it  is  often  transitory,  and  probably  fre¬ 
quently  escapes  the  notice  of  the  patient  or  his  friends. 
Some  few  years  since,  Dr.  Dickinson  discussed  at  some  length 
the  rheumatic  origin  of  chorea,  and  its  dependence  or  not 
upon  endocarditis,  and  he  arrived  at  the  conclusion  that 
chorea  of  rheumatic  origin  was  quite  independent  of  endo¬ 
carditis,  and  was  due  to  rheumatism  of  the  nervous  centres ; 
indeed,  he  went  further  than  this,  for  he  maintained  that 
the  chorea  caused  the  endocarditis,  relying  partly  on  the 


absence  of  rheumatic  antecedents,  and  partly  on  the  fact 
that  endocarditis  often  succeeds  chorea.  These  are  not 
very  powerful  arguments  when  the  latent  character  of  rheu¬ 
matism,  to  which  allusion  has  been  made,  is  taken  into 
consideration.  On  the  whole.  Dr.  Barlow’s  conclusion,  that 
“chorea  occurs  so  frequently  in  connexion  with  rheumatic 
symptoms,  both  in  combination  and  alternation,  that  we  are 
justified  in  provisionally  regarding  it  as  itself  often  a  rheu¬ 
matic  symptom,”  is  warranted  by  the  evidence  he  brings 
forward ;  but,  granting  that  it  be  entirely  proved,  the  whole 
problem  of  chorea  is  by  no  means  yet  solved. 


CHRONICLE  OP  THE  WEEK. 

It  is  one  of  the  greatest  pleasures  of  lesser  minds,  con¬ 
scious  of  their  own  place  and  proportions,  to  watch  a  larger 
mind  dealing  with  a  hackneyed  subject.  On  Monday  last. 
Sir  James  Paget  talked  to  the  working-men,  at  their  College 
in  Great  Ormond-street,  on  “  Recreation,”  and  managed  to 
strike  out  some  sparks  from  even  such  a  worn-out  tinder-box 
as  that.  Here  is  one  of  his  generalisations :  “  Three  things 
seem  to  lie  at  the  basis  of  healthy  recreation — first,  uncer¬ 
tainty;  second,  wonder;  and,  third,  the  exercise  of  skill, 
whether  mental  or  bodily,  in  something  unlike  the  ordinary 
day’s  work.”  If  Sir  James  Paget  means  that  every  form  of 
recreation  includes  these  three  elements,  the  generalisation 
is  somewhat  too  narrow.  The  only  recreation  that  many  of 
us  obtain  in  the  midst  or  at  the  end  of  our  day’s  work — viz., 
a  walk  along  tiresomely  familiar  streets — satisfies  none  of 
his  conditions,  unless  reckless  driving,  hideous  fashions,  and 
the  display  of  skill  necessary  to  avoid  both,  be  considerei 
sufficient  to  bring  it  under  the  general  rule.  Reading, 
again,  the  recreation  of  the  best  minds,  does  not  depend  for 
its  pleasureableness  on  the  exercise  of  skill;  nor  violin¬ 
playing  on  the  element  of  uncertainty — in  the  hands,  at 
least,  of  some  amateurs,  it  is  to  be  hoped.  Still,  of  most 
recognised  recreations  Sir  James  Paget’s  dictum  is  true 
enough,  especially  of  those  included  in  his  second  generali¬ 
sation,  which  was  this  :  “  A  great  part  of  our  recreation  is 
really  the  survival  in  us  of  instincts  and  practices  which 
belong  to  distant  ancestors — such  as  fishing,  hunting,  clear¬ 
ing  forests,  making  roads,  wandering,  and  picnicking.”  Sir 
J ames  Paget  formulated  this  only  as  a  guess,  but,  if  there 
be  any  element  of  truth  in  it,  the  present  generation  of 
athletes  is  “  throwing  back  ”  with  a  vengeance. 


The  Congress  of  the  Social  Science  Association,  which 
was  opened  at  Huddersfield  on  the  3rd  inst.,  continued  its 
sittings  during  the  week.  The  most  important  discussion, 
from  a  medical  point  of  view,  was  that  which  took  place  on 
Thursday  week,  on  the  influence  of  the  Modern  System  of 
Education  on  the  Health  of  the  Country.  The  question 
was  introduced  by  Dr.  Clifford  Allbutt,  who  singled  out  two 
points  in  the  modern  system  for  adverse  criticism,  viz.,  the 
employment  of  pupil  teachers,  and  the  influence  of  the  com  - 
petitive  system.  The  latter  he  condemned  as  uniformly 
baneful.  “  There  is  no  single  agency,”  he  said,  “  com¬ 
parable  to  this  for  straining  and  exhausting  the  brain  and 
nervous  system,  and  it  is  the  most  wasteful  of  work  and 
health  that  could  be  devised.  Its  evil  effects  appear  afresh 
in  the  next  generation,  increasing  the  nervous  affections 
of  children.”  Mr.  E.  A.  Brown,  of  Liverpool,  and  Mr. 
Hewetson,  of  Leeds,  supported  Dr.  Allbutt’s  contention, 
strongly  emphasising  the  evil  result  of  modern  education 
on  the  sight.  Several  medical  practitioners  spoke  to  the 
same  effect,  and  it  was  resolved,  without  serious  opposition, 
that  the  case  was  quite  sufficiently  made  out  to  render  it 


430 


Medical  Times  and  Gazette. 


CHRONICLE  OF  THE  WEEK. 


Oct.  13,  1883. 


desirable  that  the  attention  of  the  Government  should  be 
called  to  the  matter.  We  have  dealt  with  this  subject  at 
great  length  in  an  article,  which  we  believe  will  meet  with 
fairly  unanimous  approval  from  the  medical  profession. 


On  Friday  the  subject  for  discussion  in  the  Health  Section 
was  the  Spread  of  Disease  through  the  medium  of  Milk.  Mr. 
F.  Yacher,  Dr.  Britton  of  Halifax,  and  Mr.  Ernest  Hart 
read  papers  on  the  subject,  and,  after  a  long  discussion,  the 
Section  resolved  unanimously  to  ask  the  Council  of  the 
Association  to  consider  the  desirability  of  recommending  to 
the  Government  the  adoption  of  further  measures  for  pre¬ 
venting  the  spread  of  zymotic  diseases  through  the  milk- 
supply  pf  towns.  Many  authorities  on  epidemiological 
problems  are  beginning  to  question  whether,  in  many  cases, 
epidemics  have  not  been  traced  to  the  milk- supply  without 
a  sufficiently  rigid  scientific  demonstration.  It  is  almost 
impossible  to  believe  that  in  the  fifty-three  epidemics  of 
typhoid  said  by  Mr.  Hart  to  have  been  traced  to  impure 
milk  the  evidence  has  amounted  to  absolute  demonstration. 
Even  in  the  recent  Camden  Town  epidemic,  in  which  there 
is  a  much  larger  and  more  definite  body  of  evidence  point¬ 
ing  to  milk -infection  than  in  the  case  of  many  other  epi¬ 
demics  put  down  to  a  similar  cause,  the  demonstration  by 
no  means  amounts  to  certainty.  But  we  must  defer  com¬ 
ments  on  this  particular  case  till  next  week.  The  simple 
fact  is,  it  has  become  the  fashion  to  condemn  the  dairy 
in  default  of  other  discoverable  cause.  This  is  a  point 
which  needs  guarding  against. 


On  Saturday,  Mr.  George  Smith,  the  well-known  philan¬ 
thropist  of  Coalville,  called  attention  again  to  the  little 
wanderers  by  land  and  water  whom  he  has  taken  under  his 
especial  charge — the  canal-boat  children,  and  the  gipsy  van 
and  show  children.  Amongst  many  other  facts  substantiated 
by  him  in  support  of  his  proposal  for  further  legislation,  he 
stated  that  within  the  last  few  days  small-pox  had  been 
conveyed  to  Ashton  by  a  van,  and  a  score  of  persons  were 
dangerously  ill. 

On  Monday,, Mr.  Pridgin  Teale  delivered  his  address  as 
President  of  the  Health  Section.  It  was  unfortunate  that 
it  was  not  delivered  earlier,  as  it  dealt  with  a  subject  which 
had  been  previously  fully  debated  in  the  section,  viz.,  the 
tendency  of  Modern  Education  to  influence  Physical  Growth 
and  Development.  Mr.  Teale  fully  confirmed  Dr.  Clifford 
Allbutt’s  assertions,  and  on  the  pupil- teacher  question  was 
equally  emphatic.  Speaking  on  this  point,  he  said  that  he  had 
been  simply  horrified  at  the  human  slavery  and  torture  in¬ 
vented  and  carried  out  in  this  country  to  meet  the  demands 
of  an  inexorable  examination.  Mr.  Teale  admitted  that 
hard  work  and  long  hours  did  not  of  themselves  constitute 
over-pressure  in  education  or  overwork  in  life.  It  was  the 
work  done  under  perpetual  worry  and  anxiety,  and  under 
the  compulsion  of  want  of  time,  that  tried  the  health  of 
young  and  old.  It  was  because  we  were  importing  into 
modern  education  hurry,  worry,  and  anxiety,  selfishness, 
competition,  and  a  feverish  desire  for  success,  prize-winning 
and  place-winning — all  tending  year  by  year  to  grow  in 
intensity  and  to  become  more  powerful  agents — that  he 
foresaw  injury  to  health,  degradation  of  intellect,  and  a 
departure  from  a  true  ideal  of  education.  Surely  it  had 
become  the  duty,  and  would  become  the  function,  of  the 
medical  profession  to  raise  its  voice  and  make  itself  heard 
on  the  sanitary  aspect  of  education,  as  it  has  made  its 
influence  tell  in  other  departments  of  sanitary  science. 

On  the  same  day  the  Health  Section  discussed  the  Habitual 
Drunkards  question,  and,  by  a  large  majority,  carried  Dr.  I 


C.  R.  Drysdale’s  resolution— “  That  the  Council  be  recom¬ 
mended  to  impress  upon  the  Legislature  the  importance  of 
removing  the  present  hindrance  to  the  voluntary  admission 
of  dipsomaniacs  into  retreats,  and  also  of  conferring  on 
magistrates,  in  certain  well-marked  cases,  the  power  to 
commit  such  persons  to  such  retreats.”  On  Tuesday,  papers 
were  read  byMr.  Norman  Porritt  on  the  relation  of  Baths  and 
Washhouses  to  the  Social  Well-being  of  the  Lower  Orders, 
by  Dr.  C.  R.  Drysdale  on  Infantile  Mortality  in  various 
European  Countries,  and  by  Dr.  E.  T.  Tibbits  on  the 
position  and  influence  of  Medical  Men  in  Society.  On 
Thursday  the  members  of  the  Congress  separated,  with 
mutual  congratulations  at  the  amount  of  serious  work  they 
had  put  behind  them. 

The  health  of  the  metropolis  still  continues  satisfactory, 
the  recent  short  spell  of  cold  having  apparently  had  little 
effect  upon  the  death-rate.  For  the  last  three  weeks  the 
rate  has  not  exceeded  17  per  1000,  and  the  average  for 
the  whole  quarter  just  ended  was  not  more  than  18-8. 
Scarlet  fever  continues  to  be  the  most  fatal  of  the  zymotic 
diseases ,  and  accounted  last  week  for  63  deaths,  while 
there  were  only  3  deaths  from  small-pox,  and  11  from 
measles.  Seeing  that  this  is  the  season  chiefly  favoured  of 
typhoid,  21  deaths  in  the  week  from  that  disease  cannot 
be  considered  as  an  excessive  number,  though  even  this 
small  death-roll,  especially  when  added  to  the  19  deaths 
caused  by  that  other  judgment  on  filthiness,  diphtheria, 
should  be  sufficient  to  act  as  a  reminder  to  the  sanitary 
conscience.  This  month  is  a  sort  of  neutral  zone  between 
the  catarrhs  of  summer  and  the  catarrhs  of  winter.  The 
deaths  from  the  former  were  54,  including  6  from  simple 
cholera ;  from  the  latter,  191 — still,  in  spite  of  the  anti¬ 
cyclone,  69  below  the  corrected  weekly  average.  In  the 
great  towns  this  week  was  also  exceedingly  healthy. 
In  seventeen  towns  out  of  twenty-eight  the  death-rate 
was  below  20,  and  in  nine  it  was  below  16'0.  Huddersfield 
heads  the  list  with  a  rate  of  12’3,  a  statistic  no  doubt  very 
satisfactory  both  to  the  hosts  and  guests  at  the  Social 
Science  Congress,  to  whom  it  will  be  a  matter  of  interest 
to  determine  whether  it  was  due  to  anything  more  than  a 
coincidence. 


Another  unfortunate  case,  illustrating  the  special  danger 
of  sudden  obloquy  and  loss  of  reputation  to  which  even  the 
most  rigidly  honourable  practitioner  may  be  exposed  through 
spite  on  the  part  of  patients  or  fussiness  on  the  part  of  the  police, 
came  before  the  magistrate  at  Hammersmith  Police-court 
on  Tuesday  last.  Mr.  Haffenden,  a  well-known  practitioner 
of  Kensington,  and  a  female  patient  of  his,  were  arrested, 
and  accused  conjointly,  at  the  instance  of  the  Director  of 
Public  Prosecutions,  of  being  concerned  in  the  performance 
of  an  operation  and  the  administration  of  medicine  for  an 
unlawful  purpose.  The  information  appears  to  have  been 
given  to  the  police  by  an  acquaintance  of  the  patient’s.  It 
was  stated  on  behalf  of  Mr.  Haffenden  that  there  was  a  com¬ 
plete  answer  to  the  charge,  and  until  that  is  heard  the  fewer 
words  on  it  the  better.  It  is  difficult  to  believe  that  so 
highly  respected  a  practitioner  as  Mr.  Haffenden  can,  by  an 
act  of  omission  or  commission,  have  exposed  himself  to  the 
risk  of  a  serious  prosecution  for  malajpraxis,  or  even  worse. 
But  the  only  alternative  is  to  suppose  that  the  Director  of 
Public  Prosecutions  has  been  culpably  careless  in  sifting  the 
evidence,  and  permitting  police  action  in  a  case  in  which 
any  blunder  on  his  part  would  be  nothing  short  of  a  crime. 


It  has  been  decided  by  the  authorities  of  the  Vienna 
University  to  omit  this  year  the  ceremony  with  which  the 
new  Rector  is  usually  installed.  They  have  not  forgotten 


Medical  Times  and  Gazette 


annotations. 


Oct.  13,  1883.  431 


the  lesson  of  the  Ring  Theatre,  and  profess  to  be  afraid  of  a 
similar  disaster  occurring  in  the  time-honoured  theatre  of 
the  University,  should  any  alarm  of  fire  or  panic  of  other 
sort  break  out.  As  the  outgoing  Rector  is  not  very  popular 
with  the  students,  such  an  occurrence  is  thought  to  be  not 
altogether  unlikely.  The  medical  organ  of  Vienna  approves 
of  the  decision,  for  at  this  year’s  ceremonial  the  studentry 
would  include  such  a  large  quantity  of  combustible  material 
as  to  render  an  explosion  and  subsequent  panic  almost 
inevitable.  The  undergraduates  it  is  well  known  are  as 
enthusiastic  in  their  expressions  of  regard  as  they  are 
unmeasured  in  their  demonstrations  of  aversion,  and  there 
is  good  reason  to  fear  that  the  inevitable  explosion  would 
lead  to  such  a  tumult  in  the  theatre  that,  considering  the 
paucity  of  exits,  the  ex-Rector  might  find  it  difficult  to  make 
his  escape. 


The  following  books  have  been  published  in  the  course  of 
the  last  week  in  England  and  abroad  : — “  The  Field  of  Dis¬ 
ease,”  by  Dr.  B.  W.  Richardson;  "My  Patients,  being  Notes 
of  a  Surgeon,”  by  M.  Fenn ;  "  Die  Thierischen  Parasiten  der 
Menschen,”  by  M.  Braun;  "Zur  Entwickelungsgeschichte 
des  breiten  Bandwurmes,”  by  M.  Braun ;  “  Le  Cholera,”  by 
A.  Proust.  The  following  books  are  announced,  but  have 
not  yet  appeared: — "  A  Manual  of  Chemistry,  Organic  and 
Inorganic,”  by  Alphonse  Dupre,  F.R.S.,  and  H.  Wilson 
Hake ;  “  A  Manual  of  Botany,”  by  William  Ramsay  McNab, 
M.D. ;  "  Poisons :  their  Effect  and  Detection,”  forming  the 
second  volume  of  the  re-issue  of  "  Practical  Chemistry,”  by 
A.  Winter  Blyth,  F.C.S.;  "  Kohat,  Kuram,  and  Khost,” 
reminiscences  of  the  late  Afghan  War,  by  Dr.  Gilliam 
Thomsett. 


The  following  is  a  list  of  the  most  noteworthy  papers  in  the 
current  numbers  of  the  chief  foreign  medical  journals  : — Le 
Pr ogres  M6dical  contains,  besides  reports  of  several  societies, 
the  following  articles :  “  Lemons  sur  la  Tuberculose  para- 
sitaire,”  by  M.  Debove ;  "  Sur  quelques  Symptomes  qui 
peuvent  se  montrer  chez  les  Hemiplegiques,  du  Cote  oppose 
a  l’Hemiplegie,”  by  M.  Paul  Dignat ;  “  La  derniere  Maladie 
de  M.  le  Comte  de  Chambord,”  by  M.  Vulpian.  In  the 
Gazette  Medicate  de  Paris — "  Sur  un  Cas  de  Menstruation 
precoce,”  by  M.  Cabade ;  "  Reflexions  cliniques  sur  l’emploi 
du  Corset  de  Sayre  dans  le  Traitement  de  la  Scoliose,”  by 
M.  Lucien  Picque.  In  the  Gazette  Hebdomadaire  de  MSdecine 
et  de  Ghirurgie — "  Formes  et  Pathogenie  du  Purpura,”  by 
M.  P.  Merklen;  "Etude  critique  sur  la  Tuberculose  arti- 
culaire,”  by  M  Mabboux;  "La  Fi&vre  Hysterique,”  by  M. 
Briand.  The  Gazette  des  Hopitaux  for  October  6  contains 
a  lecture  by  M.  Landouzy  on  a  case  of  Hepatic  Typhus ;  and 
that  for  the  9th,  comments  by  M.  Trelat  on  cases  of  Parotid 
Tumour  and  Ovarian  Cysts  operated  on  by  him. 


The  Centralblatt  far  Gynakologie  contains  an  original 
article  on  the  Instrumental  Measurement  of  the  Conjugata 
Vera,  by  Dr.  Kabierske,  jun. ;  and  the  Centralblatt  fur 
Ghirurgie,  one  on  a  New  Form  of  Stretcher,  by  Dr.  P.  Hase, 
Staff-Surgeon.  The  Berliner  Klinische  Wochenschrift  has 
the  first  part  of  an  article  by  Professor  Liebermeister  on 
Recent  Advances  in  Therapeutics ;  a  paper  by  Dr.  Zenker  on 
an  hitherto  undescribed  form  of  Neurosis  from  Occupation 
(viz.,  paralysis  of  legs  and  feet  in  potato- gatherers)  ;  a  case 
of  Diaphragmatic  Pleurisy,  by  Dr.  Jacubasch;  and  one  of 
Echinococcus  in  the  Brain,  by  Dr.  Kuhn.  The  Wiener 
Medizinische  Wochenschrift  contains  a  clinical  study  on 
Unsound  Mind,  by  Dr.  J.  Weiss ;  and  articles  on  the  Suture 
of  Divided  Nerves,  by  Dr.  H.  Schramm,  and  on  the  Origin 
of  Traumatic  Tumours,  by  Dr.  Zesas. 


The  medical  profession  has  lost  heavily  by  death  within 
the  last  week  or  two.  Dr.  Henry  Dunbar,  of  Helensburgh, 
who  died  at  the  age  of  sixty- seven,  was  known  rather  for 
his  literary  than  for  his  medical  achievements,  though 
during  the  Crimean  war  he  rendered  distinguished  service 
in  the  French  Transport  Service,  and  received  a  decoration 
from  the  French  Government  in  recognition  thereof.  He  was 
familiar  to  the  literary  world  as  the  author  of  a  Concordance 
to  the  Odyssey,  published  at  the  Clarendon  Press.  Dr. 
G.  H.  Evans,  who  died  at  a  comparatively  early  age  after 
some  years’  disablement  from  professional  work,  appeared 
at  one  time  to  have  before  him  a  most  promising  career  as 
a  London  physician.  He  came  into  the  profession  late,  and 
brought  to  it  a  wide  general  culture  and  a  very  varied  ex¬ 
perience  of  life.  He  had  a  large  circle  of  friends,  and  his 
disappearance  from  the  ranks  some  six  years  ago  was  the 
subject  of  general  and  deep  regret.  Robert  Harold 
Ainsworth  Schofield,  of  the  China  Inland  Mission,  who 
died  on  August  1  at  his  post  in  North  China,  after  a 
brief  illness,  was  well  known  at  Oxford,  and  subsequently  at 
St.  Bartholomew’s,  as  a  quiet,  unassuming,  and  able  student 
with  an  immense  faculty  for  work.  He  passed  more  exa¬ 
minations  than  almost  any  man  of  his  time.  He  was  a 
Fellow  of  the  Royal  College  of  Surgeons,  a  Bachelor  of 
Science  of  the  University  of  London,  and  a  Bachelor  of 
Medicine  of  the  University  of  Oxford.  He  served  with  dis¬ 
tinction  as  a  surgeon  in  the  Servian  and  Russo-Turkish 
campaigns,  and  subsequently  went  with  enthusiasm  to  bury 
himself  as  a  medical  missionary  amongst  the  Chinese.  To 
these  names  we  may  add  that  of  another  university  man,  also 
an  enthusiast,  who  was  cut  off  some  three  weeks  ago  at 
an  early  period  of  his  professional  career — Frank  Theed 
Twining,  Assistant  Medical  Officer  at  the  Homerton  Fever 
Hospital.  Dr.  Twining  was  a  Cambridge  and  St.  Thomas’s 
man.  He  was  devoted  to  his  work,  and  persevered  in  it  till 
the  very  day  before  his  death.  His  loss  is  deeply  deplored 
by  all  who  came  into  intimate  contact  with  him.  The 
deaths  are  also  announced  of  Mr.  Evans,  of  Cardiff,  and  Dr. 
Haughey,  of  Crewe,  both  suddenly  cut  off  in  the  midst  of 
their  professional  labours. 


SUCCESS. 

At  a  time  when  the  new  student  of  medicine,  in  town  and 
country,  is  entering  upon  the  first  step  of  his  labours,  and 
when  the  whole  subject  of  our  profession,  its  duties  and  its 
prospects,  is  brought  forward  for  its  annual  airing  upon  the 
introductory  platform,  it  may  not  be  uninteresting  to  inquire 
to  what  end  this  striving  crowd,  practitioners  and  students, 
are  pressing  forward,  what  is  the  future  to  which  they  may 
tend,  and  what  the  means  and  qualifications  by  which  their 
dreams  of  future  good  may  perchance  be  realised.  "  I  wish  to 
succeed  in  my  profession,”  each  young  aspirant  will  say  as  he 
takes  his  first  step  into  the  arena  where  so  many  struggle  in 
vain.  But  what  does  this  success  mean,  and  how  may  it  be 
obtained  ?  Its  extent  is,  after  all,  except  to  the  favoured  few, 
most  moderate,  and  it  is  obtained  only  by  a  combination  of 
physical,  mental,  moral,  and  material  advantages  which,  it 
must  be  confessed,  would  produce  a  more  enduring  fame 
and  more  immediately  practical  results  in  many  other 
more  pleasant  and  less  laborious  walks  of  life.  Few,  very 
few,  and  far  between  are  the  chief  prizes  of  our  calling. 
So  few  are  they  as  to  be  out  of  reach  of  all  but  the 
most  visionary  expectations  of  the  student  who  has 
chosen  the  medical  profession  as  his  life-work.  No  man,  it 
is  abundantly  evident,  can  say  to  himself  that,  if  energy, 
ability,  industry,  research,  or  industrious  self-abnegation 
can  achieve  it,  he  will  end  his  days  as  a  rich  man  or  at 
the  top  of  his  profession.  And  this  not  alone  from  the 


4-32  jieciicai  Times  and  Gazette. 


ANNOTATIONS. 


Oct.  13,  1883. 


uncertainty  of;  human  life  or  health,  but  because  the  rare 
union  of  physical,  mental,  and  moral  powers  to  which  each 
man  who  has  ever  so  succeeded  owes  his  success  must  be 
combined  again  with  such  a  train  of  unhoped-for  and  un¬ 
foreseen  circumstances  as  to  be  beyond  the  reach  of  all 
human  calculation  and  device. 

Set  this  aside,  then, — call  this  attainment  of  high  profes¬ 
sional  reputation  and  wealth  not  merely  success,  but  success 
of  the  most  exceptional  order,  which  we  can  by  no  means  take 
into  our  expectations, — and  what  remains  as  an  end  and  aim 
for  the  average  good-class  aspirant  to  look  forward  to  ?  He 
has  come  into  the  profession,  it  has  been  said,  in  which 
there  is  the  greatest  certainty  of  making  a  competence,  and 
the  least  probability  of  making  a  fortune.  He  can  neither 
achieve  the  one,  nor  have  the  slightest  prospect  of  the  other, 
without  a  life  of  toil,  with  much  of  mortification  and  dis¬ 
appointment  to  embitter  it,  and  a  death  probably  in  harness 
at  its  close.  But  why,  if  all  this  be  true,  as  we  believe,  are 
the  ranks  so  constantly  filled  from  below  j  why  is  more 
and  more  capital  year  by  year  invested  in  the  purchase 
or  foundation  of  practices  ?  It  is  not  from  the  tempting 
prospect  of  exceptional  return  for  talents  and  capital 
so  invested,  nor  assuredly  from  the  high  social  estima¬ 
tion  in  which  we  are  held  by  the  world  around.  It 
is,  we  maintain,  from  the  fact  that  in  our  profession 
alone  can  the  possession  of  reasonable  talents,  and  the  ex¬ 
penditure  of  reasonable  capital,  yield  a  life  full  of  interest, 
variety,  and  emulation,  with  such  moderate  but  certain 
pecuniary  returns  as  may  represent  to  the  man  of  average 
ambition  and  content  that  success  which  has  been  his  aim 
from  the  commencement  of  his  career.  Any  man,  let  us  say, 
who,  having  entered  the  medical  profession  by  deliberate 
choice  and  desire,  maintains  himself  and  his  family,  finds 
an  engrossing  and  unmonotonous  occupation,  and  makes 
such  provision  for  those  depending  upon  and  succeeding  him 
as  may  insure  their  start  from  the  same  social  platform  as 
that  which  has  been  their  standpoint  during  his  life,  may 
be  said  to  have  enjoyed  such  measure  of  success  as  he  should 
have  expected,  and  to  be  above  rather  than  below  the 
average  as  a  recipient  of  the  gifts  of  fortune.  The  region 
of  failure  lies  far  below,  the  sphere  of  rank  and  riches 
immeasurably  above,  this  haven  of  average  success  and 
contentment. 

This  success  which  we  have  so  briefly  depicted  as  the 
reward  of  the  great,  the  overwhelming  proportion  of  those 
who  embrace  medicine  as  a  calling,  may  be  obtained,  of 
course,  in  various  ways.  It  may  fall  early,  but  more  often 
comes  late,  to  the  successful  and  distinguished  student  who 
devotes  himself  and  his  talents  to  the  instruction  of  others, 
or  who,  embracing  pure  practice  or  a  specialty,  enters  the 
crowded  ranks  of  metropolitan  or  provincial  consultants. 
It  falls  naturally,  easily,  and  in  due  course  to  the  general 
practitioner,  the  member  of  the  rank  and  file,  the  main 
body  and  power  of  the  profession.  But  in  every  case,  so  far 
as  actual  material  success  may  be  computed,  the  standard 
which  we  have  indicated  above  is  the  one  by  which  it  must 
be  judged.  We  have  not  space  here  to  consider  the 
factors,  which  we  have  said  to  be  physical,  mental,  moral, 
and  material,  by  the  combination  of  which  this  success 
may  be  obtained.  We  can  have  no  wish  to  undervalue 
our  calling,  or  to  favour  any  low  view  of  its  ends 
and  aspirations.  We  wish  merely  to  place  the  probable 
future  fairly  before  those  who  are  now  entering  upon  their 
career  and  studies.  And  if  our  words  have  any  weight  at 
all  with  those  who  are  joining,  or  intend  to  join  our  number, 
let  us  hope  that  the  salutary  effect  may  be  that  of  mode¬ 
rating  hopes  unreasonable  and  unlikely  of  realisation,  and 
not  of  damping  the  ardour  and  energy  of  those  who  have 
become  members  of  our  profession,  not  for  what  it  will  bring, 


but  for  what  it  is.  For  it  is  in  the  rewards  of  self-respect,  of 
successful  work,  of  scientific  research,  of  aid  to  the  progress 
of  knowledge,  that  the  real  end  of  our  desires  should  be 
sought,  and  in  these  alone  can  the  satisfaction  of  the  true 
scientific  ambition  be  found.  Work  we  must,  constantly, 
and  not  always  hopefully,  believing  that  this  work  is,  for 
the  most  part,  its  own  reward,  and  that  it  is,  as  has  been 
truly  said,  “  better  than  what  we  work  to  get.’5 


THE  PROPOSED  MARINE  OBSERVATORY. 

A  proposal  for  the  foundation  of  an  observatory  on  the 
British  coast  for  the  study  of  marine  animals  and  plants  in 
relation  to  fish  and  fisheries  has  just  been  issued,  bearing 
the  signatures  of  Professor  Owen,  Dr.  Carpenter,  Professor 
Burdon  Sanderson,  Professor  Ray  Lankester,  Sir  John 
Lubbock,  Professor  Michael  Foster,  Mr.  Adam  Sedgwick, 
Mr.  Romanes,  Professor  Flower,  Professor  Jeffrey  Bell,  Mr. 
P.  Sclater,  Mr.  H.  N.  Moseley,  Dr.  Milnes  Marshall,  and  other 
scientific  men.  It  is  proposed  that  the  observatory,  says  the 
circular,  would  be  in  charge  of  a  competent  resident  superin¬ 
tendent,  and  fitted  with  aquaria,  laboratories,  and  apparatus, 
and  possessed  of  boats  and  dredging  apparatus.  Two  or 
three  fishermen  would  be  kept  in  the  pay  of  the  observatory. 
The  institution  thus  organised  would  be  frequented  at  all 
times  of  the  year  by  naturalists  desirous  of  carrying  on 
original  investigations  relative  to  the  life-history  and  struc¬ 
ture  of  marine  organisms.  Accommodation  for  as  many  as 
six  such  naturalists  might  be  provided.  It  is  calculated  that 
,£8000  would  be  sufficient  to  secure  a  site  and  erect  and 
furnish  a  suitable  building  ;  whilst  £500  a  year  should  be 
secured  as  a  minimum  income  for  the  purpose  of  paying  a 
salary  of  £250  a  year  to  a  resident  superintendent,  minor 
salaries  to  fishermen  and  attendants,  and  of  meeting  the 
small  current  expenses.  The  income  of  the  institution 
might  be  materially  aided  by  the  payment  of  a  fee  (say  £5 
a  month)  on  the  part  of  those  naturalists  making  use  of  its 
resources.  The  opportunity  for  securing  the  £20,000  neces¬ 
sary  for  the  inauguration  of  such  a  zoological  observatory 
has  presented  itself  in  connexion  with  the  International 
Fisheries  Exhibition.  Should  there  be,  as  there  is  reason 
to  hope,  a  large  surplus  fund  in  the  hands  of  the  Committee 
of  the  Exhibition  at  its  close,  it  is  proposed  to  bring  the 
suggestion  of  the  establishment  of  a  Marine  Zoological 
Observatory  before  the  Committee,  and  to  endeavour  to 
obtain  the  support  of  that  body  for  the  scheme. 


ROYAL  COLLEGE  OF  SURGEONS. 

The  Calendar  of  this  institution  has  just  been  published, 
from  which  it  appears  that  there  are  now  1166  Fellows  of 
the  College,  of  which  number  593  obtained  the  distinction 
by  examination,  3  as  ad  eundem  Fellows  of  the  Irish  and 
Scotch  Colleges,  and  5  elected  to  it  as  members  of  twenty 
years’  standing,  under  Section  5  of  the  Charter  of  15th  Viet. 
Of  Members  there  are  no  less  than  16,258,  making,  with 
the  Fellows,  a  small  army  of  17,424.  There  are  971  Licen¬ 
tiates  i  n  Midwifery,  and  521  Licentiates  in  Dental  Surgery. 
The  annual  income  during  the  collegiate  year  from  July, 
1882,  to  July  last  appears  to  have  been,  from  all  sources, 
the  large  sum  of  £19,374  19s.  2d.,  and  the  expenditure 
£19,446  8s.  5d.  There  appears  the  respectable  balance  at 
the  bankers  at  Midsummer-day  last  of  £2087  10s.  4d.  At 
the  Primary  Examination  for  the  Fellowship  there  were 
122  candidates,  of  which  number  68  passed  and  54  were 
rejected  for  six  months.  At  the  Pass  Examination  there 
were  34  candidates,  17  of  whom  passed,  and  as  many  were 
rejected.  For  the  Membership  there  were  at  the  Primary 
Examination  1119,  of  which  number  795  passed,  289  were 
referred  for  three  months,  and  35  for  six  months.  At  the 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Oct.  13,  1883.  433 


Pass  Examination  for  the  same  distinction  there  were  769 
candidates ;  343  were  admitted  Members,  44  were  referred 
for  three  months,  224  for  six  months,  10  for  nine  months, 
and  3  for  twelve  months,  making  a  total  of  281  who 
had  failed  to  acquit  themselves  to  the  satisfaction  of  the 
Court  of  Examiners.  The  total  number  of  diplomas  issued 
was  435,  as  previous  candidates  rejected  in  Medicine  sub¬ 
sequently  obtained  a  recognised  legal  licence  from  other 
authorities. 

MR.  GEORGE  HIND,  F.R.C.S. 

It  will  be  a  source  of  regret  to  a  large  section  of  the 
members  of  our  profession  to  know  that  this  gentleman, 
after  a  long  and  laborious  career  of  usefulness,  has  been 
compelled,  by  the  pressure  of  advanced  age  and  by  painful 
bodily  illness,  to  abandon  the  courses  of  instruction  in 
anatomy  and  surgery  which  he  has  conducted  to  large 
classes  for  a  great  number  of  years.  In  addition  to  these 
afflictions,  it  is  still  more  sad  to  know  that,  after  a  life  of 
incessant  toil,  he  is  suffering  from  pecuniary  want— a  result 
brought  about  by  no  fault  of  his  own,  but  solely  by  the 
causes  just  referred  to,  which  have  for  several  years  past 
prevented  him  from  the  same  energetic  discharge  of  his 
duties  as  he  formerly  manifested.  Under  these  circum¬ 
stances  many  of  his  friends  and  former  pupils  have  con¬ 
stituted  a  committee  for  his  relief,  comprising  some  of  the 
most  distinguished  members  of  the  profession,  and  the 
first  meeting  was  held  on  Thursday,  the  4th  inst.,  at  the 
Briton  Life  Assurance  Office.  Dr.  B.  W.  Richardson  is  the 
Chairman  of  the  Committee]  Professor  Tweedy,  24,  Harley- 
street,  is  the  Treasurer;  and  the  Messrs.  Coutts,  Strand, 
will  be  ready  to  receive  subscriptions,  to  be  addressed  in 
favour  of  the  “  Hind  Fund.”  Over  ,£200  has  been  already 
received,  as  will  be  seen  from  the  list  published  in  another 
column.  The  object  of  the  Committee  is  twofold,  namely, 
to  provide  for  Mr.  Hind’s  immediate  necessities,  and  to  form 
a  permanent  provision  for  his  declining  years. 


ST.  JOHN  AMBULANCE  ASSOCIATION. 

The  Central  Executive  Committee  bas  just  issued  its  report 
for  the  current  year.  The  number  of  centres  and  branches 
now  established  at  home  and  abroad  amounts  to  190,  while 
in  addition  many  hundreds  of  “  detached  classes  ”  for  both 
sexes  have  been  held  in  the  United  Kingdom,  the  Continent, 
and  the  colonies,  among  the  more  recent  foreign  centres 
being  Gibraltar,  Bombay,  and  the  “  Victoria  Centre,”  Aus¬ 
tralia.  During  the  year  9069  certificates  have  been  awarded, 
of  which  1139  were  to  women  for  the  nursing  course,  3322  to 
women  for  the  “first  aid”  course,  and  4608  to  men — making 
a  grand  total  of  at  least  70,000  certificates  issued  since  the 
institution  of  the  Association  in  1877.  At  one  centre  alone 
(Middlesbrough-on-Tees),  eighteen  classes,  numbering  600 
pupils,  were  examined  in  one  week.  A  noticeable  feature 
in  connexion  with  this  work,  and  one  that  unmistakably 
indicates  its  great  utility,  is  the  support  and  co-operation 
accorded  to  it  by  the  medical  profession,  many  leading 
members  of  which  are  actively  engaged  in  its  extension  both 
at  home  and  abroad.  As  in  previous  years,  it  has  been 
found  that  those  engaged  in  dangerous  occupations,  such  as 
colliers,  miners,  railway  employes,  factory  hands,  firemen, 
etc.,  show  great  eagerness  in  attending  the  classes,  the 
benefits  of  which  have  lately  been  extended  to  the  Police  at 
the  Naval  Dockyards,  the  Mercantile  Marine,  and  the  Metro¬ 
politan  Fire  Brigade.  Amongst  various  items  of  the  year’s 
work,  such  as  the  institution  of  the  "  Egyptian  Relief  Fund,” 
which  culminated  in  the  establishment  of  the  Victoria  Hos¬ 
pital  at  Cairo  by  Viscountess  Strangford,  and  the  formation 
of  a  Transport  Department,  the  report  states  that,  by 
permission  of  the  Commissioner  of  Works,  ambulance 


stations  have  been  formed  at  Hyde-park,  and  litters  and 
materiel  deposited  at  the  lodges  at  the  Marble  Arch  and 
Hyde-park  Corner,  in  charge  of  the  police,  most  of  whom 
have  attended  the  classes.  Attention  is  drawn  to  an  ad¬ 
mirable  plan,  illustrated  by  diagram,  suggested  by  Lady 
Brassey,  and  already  carried  into  effect  at  Battle  and  else¬ 
where,  for  the  grouping  of  neighbouring  villages  and  outlying 
districts  as  the  subsidiary  sections  of  larger  centres  ;  and 
after  an  interesting  statement  as  to  the  issue  of  stores,  the 
value  of  which  for  the  year  has  amounted  to  over  £3000,  and 
an  extract  from  a  report  to  the  Home  Office  by  the  Inspector 
of  Mines  for  Lancashire  urging  the  value  of  the  Association’s 
work,  an  urgent  appeal  is  made  in  conclusion  for  increased 
personal  co-operation  and  pecuniary  support  to  a  movement 
now  essentially  national  in  its  operation  and  usefulness. 


ENTRANCE  SCHOLARSHIPS  AT  THE  LONDON 
HOSPITALS. 

At  St.  Bartholomew’s  Hospital  College,  the  Senior  Scholar¬ 
ship  in  Science,  of  the  value  of  £130,  tenable  for  one  year, 
has  been  awarded  to  Mr.  Major  Brown,  B.A.,  of  Downing 
College,  Cambridge,  and  Mr.  James  George  Ernest  Colby, 
B.A.,  of  Wadham  College,  Oxford — equal;  the  Junior 
Scholarship  in  Science,  of  the  value  of  £130,  tenable  for 
one  year,  to  Mr.  Horatio  George  Adamson  and  Mr.  Frederick 
Frost  Blackman — equal;  and  the  Jeaffreson  Exhibition,  of 
the  value  of  £50,  to  Mr.  John  Wilkie,  B.A.,  of  Trinity 
College,  Cambridge.  The  Scholarship  for  the  most  success¬ 
ful  candidate  from  Epsom  College  at  the  last  Preliminary 
Scientific  Examination  of  the  London  University  has  been 

awarded  to  Mr.  Ludvic  William  Darra  Mair. - At  the 

Charing-cross  Hospital  School  of  Medicine,  the  Entrance 
Scholarship  of  £30  has  been  awarded  to  Mr.  Raymond 
Edward  Fasnacht,  and  that  of  £20  to  Mr.  William  John 
Radford.  Mr.  A.  H.  Hooker,  F.C.S.,  has  been  asked  by 
the  Medical  Society  of  this  Hospital  to  deliver  the  opening 

address  at  the  meeting  of  the  Society  on  the  12th  inst. - 

At  St.  Mary’s  Hospital  Medical  School,  four  Entrance 
Science  Scholarships  of  £50  each  have  been  awarded  re¬ 
spectively  to  Mr.  J.  Bays,  Mr.  N.  C.  Ridley,  Mr.  W.  A. 
Bottomley,  and  Mr.  H.  A.  Kidd;  and  two  Exhibitions  of 

£26  5s.  each  to  Mr.  M.  M.  Bird  and  Mr.  L.  P.  Gibson. - 

At  the  Middlesex  Hospital  Medical  School,  the  Entrance 
Science  Scholarship  of  £50  has  been  awarded  to  Mr.  H.  A. 
Kidd  ;  the  Entrance  Scholarship  of  £25,  tenable  for  two 
years,  to  Mr.  W.  B.  Cockill;  and  the  Entrance  Scholarship 

of  £20,  tenable  for  two  years,  to  Mr.  0.  G.  Matthews. - 

The  Entrance  Scholarship  of  £100  at  St.  Thomas’s  Hospital 
has  been  awarded  to  Mr.  C.  W.  Cooke,  Merchant  Taylors’ 
Exhibitioner,  and  that  of  £60  to  Mr.  Frank  Fawssett. 


GRANTS  FOR  SCIENTIFIC  RESEARCH. 

At  the  last  annual  meeting  of  the  British  Medical  Associa¬ 
tion,  held  at  Liverpood,  it  was  decided,  on  the  recommenda¬ 
tion  of  the  Scientific  Grants  Committee,  to  authorise  the 
Council  to  offer  two  research  scholarships,  of  the  value  of 
£150  each  per  annum,  tenable,  at  the  discretion  of  the 
Scientific  Grants  Committee,  for  three  years.  Application 
should  be  made  at  once,  addressed  to  the  Honorary  Secretary 
to  the  Scientific  Grants  Committee,  in  order  that  they  may 
be  placed  before  the  Scientific  Grants  Committee  at  their 
meeting  on  the  17th  inst.  The  following  scientific  grants 
were  also  made: — Dr.  A.  Waller,  21,  Craven-road,  West- 
bourne-terrace,  W. :  A  grant  of  £20  for  defraying  the  expense 
of  work  being  carried  out  for  Dr.  Waller  by  Messrs.  Elliot, 
for  an  examination  of  certain  points  relating  to  Animal 
Electricity,  more  especially  Electrotonic  Phenomena  and 
Internal  Polarisation.  Dr.  Thin,  22,  Queen  Anne-street, 


434 


Medical  Timet  and  Gazette. 


ANNOTATION'S. 


Oct.  13, 1883. 


W.  :  ,£20  in  aid  of  the  expenses  of  a  research  into 
the  Bacillus  Leprse,  and  its  Transmissibility  to  Animals 
by  Inoculation.  Dr.  A.  Lingard,  49,  Lambeth  Palace-road, 
S.W. :  £50  in  aid  of  an  inquiry  into  the  Pathology  of  a 
Peculiar  Contagious  Ulcerative  Disease  in  Calves,  resem¬ 
bling  Noma  (Gangrenous  Stomatitis  in  the  Human  Being). 
Dr.  Sidney  H.  Martin,  University  College,  Gower-street, 
W.C. :  £5  in  aid  of  a  research  into  the  Action  of  Papain. 
Dr.  Imlach,  16,  Canning-street,  Liverpool :  £50  renewed 
grant  in  aid  of  a  methodical  investigation  on  the  question 
of  Bovine  Tuberculosis  in  Calves  and  other  Young  Animals 
through  the  Milk.  Dr.  Francis  Warner :  £25  renewed 
grant  for  a  research  on  Muscular  Movements  by  means  of 
the  Graphic  Method,  such  movements  being  considered  as 
signs  of  the  Conditions  of  the  Nerve-Centres.  Dr.  Astley 
Cresswell :  £30  for  an  observation  on  the  Temperature  of 
Adults,  under  varying  circumstances,  during  Sea  Voyage. 
Dr.  Heneage  Gibbes :  £20  towards  the  expenses  of  an  in¬ 
vestigation  into  the  Chronic  Change  of  the  Blood  during 
Inflammatory  Action. 

THE  MASTERSHIP  OF  THE  C00MBE  LYING-IN 
HOSPITAL,  DUBLIN. 

In  the  Medical  Times  and  Gazette  for  September  1,  1883, 
allusion  was  made  to  a  movement  then  on  foot  to  have  the 
usual  seven -years’  term  of  office  as  Master  of  this  Hospital 
prolonged  in  the  case  of  the  present  very  popular,  able,  and 
efficient  Master,  Dr.  George  H.  Kidd.  It  was  proposed  to 
effect  the  object  in  view  by  memorialising  the  Lord  Lieu¬ 
tenant,  and  obtaining  a  Queen’s  Letter  to  amend,  or  rather 
to  ride  rough-shod  over,  the  charter  of  the  institution* 
which  provides  that  the  period  of  office  of  each  Master  shall 
not  exceed  seven  years.  The  Irish  Executive  have  refused 
to  grant  a  Queen’s  Letter,  so  that  the  provisions  of  the 
charter  will  be  preserved  intact.  The  Freeman’s  Journal 
comments  as  follows  on  the  matter: — “On  all  sides  the 
decision  of  the  Government  to  preserve  the  Charter  in¬ 
tact  will  be  received  with  extreme  satisfaction.  To  have 
granted  the  Queen’s  Letter  would  have  created  a  feeling 
of  intense  bitterness,  which  could  not  but  be  most  detri¬ 
mental  to  the  best  interests  of  the  institution  and  profession. 
In  opposing  it  ourselves  we  did  not  forget  the  eminent 
abilities  of  the  present  Master  of  the  Coombe  Hospital,  and 
his  title  to  the  highest  trust  and  honour  which  the  institu¬ 
tion  could  confer  on  him.  But  we  felt  it  to  be  singularly 
unfair  that  extra  pains  should  be  taken  to  run  one  of  the 
most  respected  and  successful  practitioners  in  the  city  a 
second  time  for  the  Mastership  against  the  younger  men 
who  were  legally  eligible  for  the  office,  and  who  had  yet  to 
win  their  spurs.” 

EXTENSION  OF  BIRMINGHAM  GENERAL  HOSPITAL. 

The  Committee  of  the  Birmingham  General  Hospital  have 
gratefully  accepted  an  offer  from  Mr.  Jaffray,  who  has  been 
long  associated  with  them  in  their  benevolent  work,  to 
build  a  branch  hospital.  It  has  long  been  felt  by  the 
Committee  and  staff  of  the  General  Hospital  that,  having 
regard  to  the  present  magnitude  of  that  building,  and  the 
crowded  state  of  the  neighbourhood,  no  further  extension  of 
the  actual  premises  was  desirable  or  even  possible  ;  yet  the 
demands  upon  the  charity  are  much  in  excess  of  the  accom¬ 
modation,  and  are  growing  year  by  year.  The  number  of 
inmates  afflicted  with  chronic  disorders  in  this,  as  in  most 
other  hospitals,  is  felt  to  be  a  serious  tax  upon  its  resources, 
and  it  is  in  this  department  that  relief  is  chiefly  needed.  Mr. 
Jaffray’ s  gift  is  specially  designed  as  a  solution  of  this  difficulty. 
He  proposes  to  build  a  suburban  hospital  in  connexion  with 
the  General  Hospital,  in  which  chronic  and  non-contagious 
ases  may  be  treated.  Towards  the  fulfilment  of  this  pur¬ 


pose  he  has  secured  an  eligible  freehold  site  within  easy 
distance  of  the  town,  and  caused  plans  to  be  prepared  for  a 
building  capable  of  accommodating  fifty  male  and  female 
patients,  with  the  requisite  offices  for  attendants  and 
servants,  so  arranged  that  an  extension  can  readily  be  made 
whenever  the  necessity  for  it  shall  arise.  The  land  and  the 
building  to  be  erected  upon  it  he  offers  as  a  free  gift  to  the 
governors  of  the  General  Hospital  in  trust  for  the  public. 
The  cost  of  the  hospital  and  land  is  approximately  estimated 
at  £20,000.  The  Committee,  in  accepting  Mr.  Jaff ray’s  offer, 
subject  to  the  approval  of  the  governors  or  subscribers,  have 
summoned  a  meeting  of  the  latter  for  November  7,  to  receive 
a  report  upon  the  subject.  Since  the  announcement  of  the 
gift,  four  gentlemen  interested  in  the|Hospital  have  promised 
£1000  each  towards  the  endowment. 


THE  PARIS  WEEKLY  RETURN. 

The  number  of  deaths  for  the  thirty-ninth  week  of  1883, 
terminating  September  27,  was  836,  and  of  these  there  were 
from  typhoid  fever  36,  small-pox  4,  measles  5,  scarlatina  4, 
pertussis  12,  diphtheria  and  croup  26,  erysipelas  6,  and 
puerperal  infections  1.  There  were  also  31  deaths  from 
acute  and  tubercular  meningitis,  170  from  phthisis,  19  from 
acute  bronchitis,  39  from  pneumonia,  105  from  infantile 
athrepsia  (26  of  the  infants  having  been  wholly  or  partially 
suckled),  and  35  violent  deaths.  The  deaths  in  Paris  con¬ 
tinue  to  be  extremely  few  in  number,  and  several  years  have 
elapsed  since  so  small  a  number  as  836  has  been  registered. 
The  affections  of  the  chest,  as  acute  bronchitis  of  children 
and  pneumonia,  are  at  about  the  usual  mean  for  the  time  of 
year ;  and  the  athrepsia  of  young  infants  exhibits  a  more 
than  usually  rapid  decrease  on  the  approach  of  autumn. 
During  the  week  there  were  1262  births  (613  males  and  649 
females— those  of  females  thus  still  preponderating),  the 
legitimate  numbering  900,  and  the  illegitimate  362. 


CINCHONA  CULTIVATION  IN  INDIA. 

Dr.  King,  Manager  of  the  Department  for  Cinchona  Cul¬ 
tivation  in  Bengal,  states,  in  his  report  for  the  year  1882-83, 
that  the  total  number  of  cinchona  trees  of  all  sorts  at  the 
close  of  the  year  was  4,711,168,  namely,  red  ( Cinchona  Succi- 
rubra)  3,713,200,  yellow  ( Galisaya  Ledgeriana )  662,998,  hybrid 
unnamed  variety  304,378,  and  other  kinds  30,592.  The 
crop  of  the  year,  the  largest  that  has  yet  been  harvested  on 
the  plantations,  amounted  to  396,980  lbs.  of  dry  bark,  of 
which  372,610  lbs.  were  of  Succirubra,  22,120  lbs.  of  Calisaya 
and  Ledgeriana,  and  2250  lbs.  of  hybrid  bark.  By  far  the 
largest  portion  of  the  produce  was  made  over  to  the  factory 
for  conversion  into  cinchona  febrifuge,  while  about  41,800 
lbs.  of  yellow  and  red  barks  were  sent,  at  the  request  of 
the  Secretary  of  State,  to  London,  to  be  there  converted 
into  various  forms  of  febrifuge,  and  returned  to  India 
for  trials  by  the  Medical  Department.  An  attempt 
has  been  made  by  the  Superintendent  to  introduce  the 
Bemija  plant,  which  is  a  genus  botanically  allied  to 
cinchona.  It  is  said  to  be  less  particular  than  cinchona  as 
to  soil  and  climate,  and  produces  a  quinine-yielding  bark 
under  the  name  of  Cuprea.  This  bark  forms  a  very  large 
proportion  of  the  quantity  of  quinine  bark  imported  into 
Europe.  Although  the  first  attempt  to  grow  the  plant  in 
the  Mungpoo  plantations  has  not  been  quite  successful.  Dr. 
King  entertains  hopes  of  successfully  acclimatising  it  when 
he  is  able  to  procure  a  more  adequate  supply  of  seed.  Dr. 
King  has  eventually  succeeded  in  obtaining  an  analysis  of 
the  bark  renewed  on  Succirubra  trees  that  had  their  original 
bark  removed  by  the  shaving  process  introduced  by  Mr. 
Moens,  the  distinguished  Director  of  Cinchona  Cultivation 
to  the  Dutch  Government.  The  results  are  thus  described 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Oct.  13, 1883.  435 


by  Dr.  King:  — “The  bark  renewed  rather  slowly,  but  the 

analysis  shows  that  it  is  very  rich  both  in  quinine  and  cin- 
chonidine ;  and  there  can  be  no  doubt  that  in  countries 
where  red  bark  trees  are  perfectly  at  home,  and  where  their 
continuance  in  good  health  and  vigour  for  a  long  series  of 
years  can  be  absolutely  counted  on,  this  shaving  process 
must  be  a  very  excellent  one.” 


LUNACY  IN  SCOTLAND. 

The  twenty-fifth  annual  report,  just  issued,  of  the  General 
Board  of  Commissioners  in  Lunacy  for  Scotland,  shows  that 
the  number  of  lunatics  reported  by  them  on  January  1  last 
was  10,050,  of  whom  5606  were  females  and  4904  males — 
1654  being  maintained  from  private  sources,  8793  by  paro¬ 
chial  rates,  and  63  at  the  expense  of  the  State,  in  the 
lunatic  department  of  the  General  Prison,  Perth  ;  203  were 
inmates  of  training-schools  for  imbeciles,  and  of  these  120 
were  supported  by  friends,  and  83  by  parochial  rates.  There 
was  an  increase  in  the  year  of  14  registered  lunatics  in 
private  establishments,  and  an  increase  of  135  pauper 
patients  in  asylums  and  lunatic  wards  of  poor-houses ;  an 
increase  of  1  in  the  General  Prison,  and  of  5  in  the  train¬ 
ing-schools  for  imbeciles.  The  expenditure  for  pauper 
lunatics  was  ,£210,550  13s.  8d.,  and  of  that  £10,211  2s.  lOd. 
was  contributed  by  relatives  and  others,  and  £79,711  17s.  5d. 
by  Government. 

THE]  ADVANTAGES  OF  SANITARY  CO-OPERATION. 

One  of  the  most  valuable  suggestions  made  by  Professor 
Humphry,  in  his  recent  address  to  the  Sanitary  Institute, 
was  that  a  Sanitary  Department,  under  a  special  Minister, 
should  be  instituted.  At  present  there  is  very  little  formal 
co-operation  amongst  the  neighbouring  sanitary  districts ; 
but,  with  the  formation  of  a  central  authority,  all  the  sani¬ 
tary  officers  throughout  the  country  could  be  brought  into 
harmonious  relations  with  one  another  and  with  the  central 
department.  And  not  the  least  of  the  advantages  to  be  ex¬ 
pected  from  such  co-operation  would  be  that  the  wants  of  one 
district  might  be  speedily  communicated  to  others,  and  timely 
preventive  measures  taken  against  the  spread  or  transmission 
of  disease.  In  his  report  on  the  sanitary  condition  of  Cam¬ 
bridge  for  the  year  1882,  Dr.  Bushell  Anningson,  the  Medical 
Officer  of  Health,  illustrates  the  necessity  of  co-operation 
amongst  health  officers  of  different  districts  if  contagious  dis¬ 
eases  are  to  be  kept  in  subjection.  Alluding  to  small-pox,  he 
says  no  death  was  registered  from  this  cause  in  Cambridge 
during  the  whole  year,  neither  did  any  case  occur  so  far  as 
his  information  extended.  But  this  fortunate  immunity 
was  only  secured  through  the  practice  of  extreme  vigilance. 
In  one  instance,  thanks  to  the  prompt  information  conveyed 
to  him  by  telegraph  from  Dr.  Turner,  the  medical  officer 
of  health  for  several  Hertfordshire  authorities,  a  party 
of  tramps  were  intercepted  at  a  common  lodging-house 
on  the  Newmarket-road,  who  had  been  exposed  to  the 
infection  of  small-pox,  and  were  on  their  way  from 
Buntingford  to  Cambridge,  vid  Royston.  Dr.  Anningson 
failed  to  discover  them  at  Royston,  but  when  traced 
to  Newmarket-road  he  found  that  none  of  them  were 
suffering  from  the  disease.  They  were,  however,  kept  under 
observation  until  the  limit  of  incubation  of  the  disease  had 
passed  ;  and  the  policy  of  this  proceeding  was  substantiated 
by  subsequent  information,  which  disclosed  the  fact  that 
both  the  husband  and  father-in-law  of  a  woman  of  the 
party  had  died  of  small-pox  in  the  workhouse  infirmary  at 
Buntingford.  Dr.  Anningson  further  records  an  opinion 
that  scarlet  fever  is  kept  active  in  Cambridge  by  the  migra¬ 
tion  of  persons  attending  the  fairs  which  are  held  in  the 
precincts  of  the  town  on  Midsummer  Common.  During  the 


year  under  notice  there  were  fifteen  deaths  recorded  from 
this  cause — a  larger  number  of  fatal  cases  than  has  been 
returned  in  any  of  the  preceding  seven  years. 


STIMULANTS  IN  PARIS  HOSPITALS. 

The  contract  just  completed  for  six  months’  supply  of  wine, 
and  for  three  months’  of  spirits,  to  the  hospitals  of  the  city, 
are  for  these  periods  1,245,000  litres  of  wine,  20,000  litres 
of  common  spirit,  10,000  litres  of  rum,  and  3000  litres  of 
brandy.  The  different  kinds  of  wine  are  enumerated,  and 
various  quantities  of  each  have  to  be  supplied.  Among 
them  are  red  Bordeaux  of  the  1881  vintage,  white  Bordeau  x 
of  1879,  white  Spanish  wine,  Roussillon,  and  Lapalme. 
These  statistics  have  especial  interest  at  the  present  time, 
from  the  recent  protest  of  an  eminent  French  physician, 
officially  employed,  against  the  excessive  use  of  stimulants 
in  these  hospitals. 

The  German  Cholera  Commission,  headed  by  Dr.  Koch, 
is  now  at  Damietta,  still  continuing  its  investigations. 


Mr.  David  Bogue  will  publish,  on  October  25,  the  first 
number  of  an  illustrated  magazine,  to  be  called  the  Science 
Monthly.  _ 

The  electors  of  Chalons  have  recently  chosen  a  medical 
practitioner.  Dr.  Lorranchels,  as  their  representative  in  the 
French  Chamber  of  Deputies. 


The  Chair  of  Internal  Pathology  in  the  Paris  Faculty  of 
Medicine  has  become  vacant,  owing  to  the  transfer  of  M. 
Jaccoud  to  the  Chair  of  Clinical  Medicine,  recently  held  by 
the  late  M.  Lasegue.  _ 


The  Statistical  Society  announces  as  the  subject  for  the 
Howard  Medal  for  1884— “  The  Preservation  of  Health,  as 
it  is  affected  by  Personal  Habits,  such  as  Cleanliness, 
Temperance,  etc.”  _ 

Dr.  Jackson,  Civil  Surgeon  of  Pachmarree,  Central  Pro¬ 
vinces,  India,  while  out  tiger-shooting,  was  attacked  by 
hornets,  and  received  over  two  hundred  stings.  Erysipelas 
set  in,  and  proved  fatal.  _ 

At  the  quarterly  meeting  of  the  Directors  of  the  Naval 
Medical  Supplemental  Fund,  held  on  the  9th  inst..  Sir 
William  Smart,  K.C.B.,  M.D.,  Inspector- General,  in  the 
chair,  the  sum  of  £68  was  distributed  among  the  several 
applicants.  _ 

The  winter  session  in  the  Edinburgh  University  and  the 
Extra-Academical  Medical  Schools  was  partially  commenced 
on  Monday,  when  the  practical  classes  in  anatomy  opened. 
The  attendance  of  students,  so  far  as  an  opinion  can  yet 
be  formed,  promises  to  be  even  greater  than  that  of  previous 
years.  _ 

The  latest  use  to  which  the  graphic  method  has  been  put 
is  to  obtain  an  exact  representation  of  the  shape  and  size  of 
a  body  in  the  depth  of  a  cavity  which  can  only  be  reached  by 
the  finger,  by  means  of  an  apparatus  attached  to  the  finger, 
with  a  planchette  at  the  back  of  the  hand  communicating 
with  a  pencil,  which  will  trace  out  on  a  piece  of  paper  all 
the  movements  of  the  finger.  Doubtless — though  there  is 
no  mention  of  this— arrangements  have  been  madefor  putting 
in  shading,  etc.,  and  making  the  drawing  generally  lifelike 
The  instrument  which  is  to  perform  this  by  no  means  easy 
feat  is  the  fertile  invention  of  MM.  Mallez  and  Napoli,  and 
goes  by  the  name  of  the  “  surgical  pantograph.” 


436 


and  Gazette. 


PROFESSOR  HUXLEY  AT  THE  LONDON-  HOSPITAL. 


Oct.  13,  1883. 


Mr.  Thomas  Evans,  one  of  the  oldest  practitioners  in 
South  Wales,  died  suddenly  at  Penarth  on  Monday  after¬ 
noon,  while  at  the  house  of  a  patient.  The  deceased  was 
connected  with  many  local  institutions,  and  was  Mayor  of 
Cardiff  in  1868.  He  was  sixty-nine  years  of  age,  and  took 
his  membership  of  the  College  of  Surgeons  in  1837. 


M.  Ramon  de  Luna  brought  before  the  Paris  Academy  of 
Sciences,  on  September  10,  a  memoir,  “  Cholera  from  the 
Standpoint  of  Chemistry.”  He  is  led  by  his  physiological 
studies  to  conclude  that  cholera  is  exclusively  propagated 
through  the  respiratory  organs,  and  his  chemical  inquiries 
convince  him  that  the  only  safe  treatment  is  to  cause  the 
patient  to  inhale,  with  prudence,  hypoazotic  vapour  mixed 
with  air.  _ 

M.  Lancereaux  has  reported  the  occurrence  in  Paris  of 
several  cases  of  undoubted  scurvy.  Most  of  the  individuals 
attacked  were  returned  convicts,  who  had  spent  a  part  of 
their  life  in  prison,  and  so  contracted  a  predisposition  to  the 
disease.  In  his  report  M.  Lancereaux  gives  a  list  of  the 
cases  of  scurvy  observed  since  1871,  and  advises  the  Govern¬ 
ment  to  provide  prisoners  with  a  daily  supply  of  potatoes 
and  fresh  vegetables  throughout  the  year. 


The  Government  of  Honolulu  are  considering  the  ad¬ 
visability  of  establishing  hospitals  in  different  parts  of  the 
island  under  their  control.  There  is  at  present  only  one 
hospital  in  working  order — the  Queen’s  Hospital,  esta¬ 
blished  through  the  instrumentality  of  his  Majesty  Kame- 
hamheha  IY.  and  Queen  Emma.  This  Hospital  is  managed 
by  a  corporation,  and  supported  by  contributions  and  a  tax 
of  $2  levied  on  all  passengers  from  foreign  ports  landing  in 
Honolulu.  _ 

At  the  last  annual  meeting  of  the  Society  of  Medical  Officers 
of  Health  the  following  officers  were  elected  for  the  year 
ensuing: — Dr.  T.  O.  Dudfield,  President;  Dr.  J.  W.  Tripe, 
Dr.  W.  Armistead,  Dr.  J.  Stevenson,  Dr.  G.  P.  Bate,  Vice- 
Presidents  ;  Mr.  S.  R.  Lovett,  Treasurer ;  Dr.  J.  N.  Yinen, 
Mr.  S.  F.  Murphy,  Hon.  Secretaries ;  Council — Dr.  Ashby, 
Mr.  W.  Blyth,  Dr.  Bristowe,  Dr.  Buchanan,  Dr.  Dixon, 
Dr.  Gwynn,  Mr.  Jacob,  Dr.  Rowland,  Dr.  C.  E.  Saunders, 
Dr.  T.  Stevenson,  Dr.  Thursfield,  Mr.  G.  Turner.  The  first 
meeting  of  the  session  will  be  held  on  Friday,  October  19, 
at  7.30  p.m.,  atl,  Adam-street,  Adelphi,  when  the  President, 
Dr.  Dudfield,  will  deliver  an  inaugural  address  entitled, 
“  The  Need  of  Unity  in  Metropolitan  Sanitary  Administra¬ 
tion.” 


The  Public  Health,  Glasgow. — During  the  fort¬ 
night  ending  September  29,  1883,  there  were  449  deaths 
registered,  as  against  470  in  the  fortnight  preceding,  a 
decrease  of  21,  and  representing  a  death-rate  of  23  in  place 
of  24  per  1000  living  (or,  according  to  the  Health  Officer’s 
estimate  of  the  population,  21  in  place  of  23).  The  death- 
rate  in  the  first  week  of  the  fortnight  was  23%  and  in  the 
second  week  22-3.  The  number  of  deaths  below  one  year 
of  age  was  124  in  place  of  123,  and  of  those  aged  sixty  and 
upwards  65  in  place  of  56.  The  proportion  of  deaths  below 
five  years  to  the  total  deaths  was  45  per  cent.  The  number 
of  deaths  from  pulmonary  diseases  was  128  as  compared 
with  142,  representing  a  death-rate  of  6-5  instead  of  7  per 
1000  living,  and  constituting  29  in  place  of  30  per  cent,  of 
the  total  deaths.  The  number  of  deaths  from  diarrhoeal 
diseases  was  33,  a  decrease  of  6,  of  which  number  26  were 
below  five  years  of  age.  The  number  of  deaths  from  fever 
was  14,  an  increase  of  2  ;  viz.,  10  from  enteric  fever,  2  from 
typhus  fever,  and  2  undefined.  The  number  of  deaths  from 
infectious  disease  of  children  was  39,  a  decrease  of  6  ;  of 
which  number  18  were  from  whooping-cough,  17  from 
scarlet  fever,  and  4  from  measles.  The  deaths  from  scarlet 
fever  were  5  fewer  than  in  the  preceding  fortnight. 


PROFESSOR  HUXLEY  AT  THE  LONDON 
HOSPITAL. 

On  Tuesday,  the  9th  inst..  Professor  Huxley,  P.R.S.,  presided 
at  the  distribution  of  the  prizes  to  students  of  the  London 
Hospital  who  had  been  successful  in  examinations  held  at 
the  end  of  the  winter  session  1882-83,  and  the  last  summer 
session ;  after  the  ceremony  Mr.  Huxley  delivered  his  address 
on  the  intervention  of  the  State  in  the  affairs  of  the  medical 
profession.  On  what  grounds,  he  asked,  is  such  intervention 
justifiable  ?  To  what  extent  ought  it  to  go  ?  After  what 
fashion  may  it  be  most  properly  exercised?  The  ground 
of  intervention  is  not  the  protection  of  the  public  against 
incompetence  or  quackery.  If  such  protection  were  advis¬ 
able,  it  is  not  practicable,  as  it  would  be  impossible  to  prevent 
anyone  from  buying  drugs  or  seeking  advice  of  whom  he 
pleased.  The  right  of  the  State  to  intervene  is  based  on 
the  fact  that  it  is  of  great  importance  to  the  community  that 
no  man  shall  die  without  the  cause  of  his  death  being 
formally  certified ;  that  the  law  shall  be  able  to  appeal  to 
recognised  experts  in  civil  and  criminal  cases ;  and  that  the 
Government  shall  have  a  guarantee  of  the  competence 
of  persons  appointed  to  the  numerous  medical  appoint¬ 
ments  at  its  disposal.  It  is  no  interference  with  the 
freedom  of  medical  practice  if  the  Government  says  to 
the  medical  practitioner,  “We  will  not  accept  your  certificate 
of  death,  we  will  not  regard  your  evidence  as  that  of  a 
medical  expert,  and  we  will  not  take  you  into  our  service, 
unless  you  produce  evidence  which  satisfies  us  of  your 
medical  competency.”  The  State  does  really  restrict  itself 
within  these  limits  in  this  country.  Anybody  may  practise 
medicine,  but  a  broad  practical  distinction  is  drawn  between 
the  practitioners  who  are  in  the  State  sense  “  qualified  ” 
and  those  who  are  “  unqualified.”  Practically  the  “  un¬ 
qualified  ”  practitioner  is  very  heavily  handicapped ;  and 
if  the  enforcement  of  penalties  against  those  who,  directly 
or  indirectly,  profess  to  be  qualified  when  they  are  not  so, 
were  somewhat  swifter  and  sharper,  it  does  not  appear  that 
the  present  condition  of  affairs  could  be  improved.  The 
State  has  a  solid  justification  for  its  intervention,  and  that 
intervention  goes  no  further  than  is  absolutely  necessary. 
But  is  this  justifiable  intervention  carried  into  effect  in  the 
best  possible  manner  ?  To  this  question  the  reply  given  by 
common  consent  is  a  very  decided  negative.  Forty  years 
ago  the  State  accepted  any  one  of  certain  university 
degrees,  or  the  diplomas  of  a  given  number  of  medical  cor¬ 
porations,  or  the  licence  of  the  Archbishop  of  Canterbury, 
as  evidence  that  a  medical  practitioner  was  qualified.  Every 
one  of  these  qualifying  authorities,  of  which  there  were 
altogether  twenty-one,  did  exactly  as  it  pleased  in  the  way 
of  testing  the  fitness  of  its  licensees,  and  there  was  no  limit 
to  the  complaisance  of  some  of  them.  No  system  could 
have  been  better  calculated  to  ruin  young  men  during  their 
student  career  or  to  degrade  the  noblest  of  professions.  At 
length  the  scandal  became  too  great,  and  in  1858  the 
present  Medical  Act  came  into  operation,  and  with  it  the 
first  attempt — feeble  enough,  but  praiseworthy — to  give  a 
rational  organisation  to  the  relations  of  the  medical  profes¬ 
sion  with  the  State.  The  Medical  Council  then  appointed 
was  to  |be  a  sort  of  Parliament  of  Medicine,  representing 
the  Government  on  the  one  hand,  and  the  profession  on 
the  other.  From  this  time  onwards  no  candid  observer 
will  deny  that  a  rapid  and  a  vast  improvement  has  taken 
place  in  the  action  of  the  great  majority  of  the  licensing 
bodies,  reduced  by  the  Act  to  nineteen.  But  the  evidence 
laid  before  the  late  Royal  Commission  showed  conclusively 
that  three  grave  defects  remain  to  be  remedied.  In  the  first 
place,  there  are  still  among  the  licensing  bodies  some  which 
tout  for  custom  by  a  low  standard  of  examination  ;  secondly, 
licences  are  still  gained  which  do  not  involve  proof  of  an 
acquaintance  with  all  the  three  great  branches  of  medical  prac¬ 
tice — namely,  medicine,  surgery,  and  midwifery;  thirdly,  the 
present  state  of  the  law  does  not  permit  the  Medical  Council 
to  remove  these  evils  by  enforcing  equality  of  minimum  exa¬ 
mination  and  the  threefold  qualification  before  admitting  a 
medical  practitioner  on  to  the  Register.  The  “  con  j  oint 
scheme,”  upon  which  the  Act  introduced  into  Parliament 
and  dropped  last  session  was  based,  proposes  to  remedy  these 


Medical  Times  and  Gazette. 


MESMERISMU S  CHRONICUS. 


Oet.  IS,  1883.  437 


difficulties.  It  may  be  described  as  a  highly  complex  and 
■cumbrous  machinery,  wholly  untried  and  of  doubtful  efficacy, 
for  the  purpose  of  superseding  universities  and  corporations, 
the  great  majority  of  which  are  at  present  doing  their  work 
extremely  well ;  while  the  end  in  view  might  be  attained 
easily,  and  without  the  least  interference  with  any  of 
the  existing  bodies  which  have  acquired  a  high  status  by 
doing  their  duty,  by  the  addition  of  two  simple  clauses  to 
the  present  Act,  to  the  effect — first,  that  no  person  shall 
be  placed  upon  the  Register  who  fails  to  produce  evidence 
that  he  possesses  a  knowledge,  of  medicine,  surgery,  and 
midwifery ;  and,  secondly,  that  such  evidence  shall  be  the 
certificate  of  any  examining  body,  a  certain  number  of  the 
members  of  which  are  appointed  as  coadjutors  by  the  Medical 
Council.  The  practical  effect  of  this  regulation  would  be 
that,  without  the  least  interference  with  the  prestige  or  the 
income  of  any  existing  licensing  body,  the  threefold  quali¬ 
fication  and  the  equality  of  minimum  examinations  would 
be  thoroughly  secured.  There  is  no  practical  difficulty 
about  carrying  it  out,  and,  in  fact,  the  Scottish  Universities 
do  at  this  present  time  appoint  coadjutor  examiners.  What¬ 
ever  may  be  the  precise  plan  adopted,  the  requirement  of 
the  threefold  qualification  and  the  enforcement  of  a  mini¬ 
mum  standard  of  examination  are  mere  questions  of  time. 
For  other  desiderata  we  must  look  partly  to  the  Medical 
Council,  partly  to  the  spontaneous  action  of  the  medical 
community.  The  course  of  instruction  for  the  ordinary 
student  is  at  present  overloaded.  It  is  practically  impos¬ 
sible  to  extend  the  time  given  to  medical  studies  by  the 
average  student  over  more  than  four  years  and  beyond 
twenty-two — that  is  to  say,  it  cannot  be  extended  forwards  ; 
but  there  is  no  obvious  reason  why  it  should  not  be  extended 
backwards.  If  the  two  years  between  sixteen  and  eighteen 
were  given  to  elementary  physics,  chemistry,  and  biology,  the 
student  would  not  only  know  when  he  comes  up  at  eighteen  a 
great  deal  that  he  has  now  to  learn  during  the  time  which 
ought  to  be  given  to  medical  studies,  but  he  would  be  pre¬ 
pared  for  the  work  before  him  so  efficiently  that  the  four 
years  would  be  worth  five  under  the  present  arrangement. 
A  few  years  ago  the  scientific  instruction  indicated  could 
bardly  have  been  obtained  anywhere  :  now  it  is  to  be  had 
in  all  our  greater  provincial  towns.  If  the  Medical  Council 
were  to  substitute  a  good  examination  in  elementary  phy¬ 
sical  science  for  the  present  futile  examination  in  general 
education,  they  would  work  a  revolution  in  medical  educa¬ 
tion.  Another  important  improvement  would  be  the  re¬ 
organisation  of  the  London  medical  schools,  in  such  a  manner, 
that  while  great  hospitals  remained  as  they  were  at  present, 
the  schools  of  practical  medicine  in  all  its  branches — human 
anatomy  and  physiology,  with  physiological  physics  and 
chemistry — were  restricted  to  two  or  three  central  schools 
of  the  Institute  of  Medicine,  in  which  they  could  be  effi- 
eiently  taught  by  men  who  would  give  their  minds  to 
knowing  these  subjects.  Lastly,  is  nothing  to  be  done  in  a 
systematic  fashion  for  the  advancement  of  medicine  as  a 
science  ?  A  few  medical  societies,  the  lectureships  at  the 
College  of  Physicians  and  the  College  of  Surgeons,  the 
Brown  Institute,  and  the  Society  for  the  Promotion  of 
Medicine  by  Research,  we  have,  but  these  are  not  exactly 
what  is  wanted.  It  is  fortunate  for  us  that  we  have  no 
Claude  Bernard,  no  Ludwig,  in  London  just  at  present ;  we 
should  not  know  what  to  do  with  them.  London  has  a 
University  just  as  Paris  has,  but,  unfortunately,  our  metro¬ 
polis  can  show  nothing  comparable  to  a  Sorbonne  or  a 
College  de  France. 


MESMERISMU S  CHRONICUS. 

It  is  a  matter  of  surprise  to  Mr.  Edmund  Gurney  and  Mr. 
Frederic  W.  H.  Myers,  the  conjoint  authors  of  a  lengthy 
paper  on  Mesmerism  in  the  current  number  of  the  Nine¬ 
teenth  Century,  that  the  subject  which  has  for  them  so  much 
of  interest  and  fascination  should  have  secured  so  little  of 
public  attention  in  recent  years.  The  phenomena  of  mesmer¬ 
ism  are,  they  say,  easy  of  reproduction,  and  are  being  con¬ 
stantly  exhibited  on  publicplatforms,  andyetthe  British  Asso¬ 
ciation,  year  after  year,  takes  no.  notice  of  them,  and  men  of 
science,  who  at  one  time  attempted  to  explain  them  away,  now 
simplyignore  them  altogether.  To  us,  wholook  at  mesmerism 


from  a  different  point  of  view  from  Messrs.  Gurney  and  Myers, 
the  wonder  is  not  that  it  should  have  been  neglected,  but 
that  it  should  be  again  brought  forward  for  discussion,  and 
that  educated  men  should  think  it  worth  their  while  to  ex¬ 
pend  profound  thought  and  precious  time  in  investigating 
its  dilapidated  mysteries.  The  real  reason  why  mesmerism 
sank  into  comparative  oblivion  and  contempt,  was  that 
sensible  men  with  no  pretensions  to  supersensuous  per¬ 
ception  saw  through  it,  and  satisfied  themselves  that  for 
every  ha’p’orth  of  fact  contained  in  the  experiments  per¬ 
formed  to  illustrate  it  there  was  an  intolerable  deal  of 
trickery  and  deception.  But  while  mesmerism  has  descended 
from  the  drawing-room  and  lecture-hall  to  the  kitchen  and 
village  school-room,  and  has  been  so  stultified  that  no  re¬ 
spectable  scientific  body  could  entertain  it  without  discredit, 
it  has  never  lost  its  interest  for  medical  men,  who  have 
always  appreciated  its  morbid  relations.  The  belief  in 
mesmerism,  and  the  manifestations  of  the  so-called  mes¬ 
meric  state,  have  excited  their  curiosity  quite  as  much 
as  the  dancing  manias  of  the  middle  ages,  and  other 
extraordinary  popular  delusions.  They  have  studied  with 
edification  its  rapid  spread  and  epidemic  prevalence  in 
the  days  of  its  founder,  they  have  traced  out  its  occa¬ 
sional  local  outbreaks  in  London  and  other  great  cities, 
when  fresh  virulence  seemed  to  be  imparted  to  it  by 
some  illustrious  victim,  and  they  have  watched  with 
satisfaction  its  subsidence  in  recent  years — that  subsidence 
which  has  filled  Messrs.  Gurney  and  Myers  with  so  much 
regret.  Of  late  we  have  only  had  sporadic  cases  of  mesmeric 
disorder,  and  these  have  been  of  a  mild  type.  The  acute 
stage  of  the  malady  is  past,  and  it  is  now  mesmerismus 
chr onions  that  has  to  be  dealt  with.  It  may  be  feared, 
perhaps,  that  an  acute  exacerbation  will  follow  the  action 
of  the  Psychical  Research  Society  in  bringing  it  again  into 
prominence  ;  but  a  word  of  judicious  warning  may  prevent 
any  evil  of  this  kind,  and  it  is  in  the  hope  of  counteracting 
the  mischievous  tendencies  of  the  renewed  agitation  that 
we  now  refer  to  the  subject. 

In  what  we  have  to  say  regarding  mesmerism  we  shall 
use  plain  language,  even  at  the  risk  of  being  thought  offen¬ 
sive.  If  "  nice  customs  curt’sy  to  great  kings,”  they  must 
fall  prostrate  before  the  Majesty  of  Scientific  Truth,  and 
where  health  and  reason  are  concerned  there  is  no  room 
for  ambiguity  or  circumlocution.  The  results  of  the  medical 
observation  of  mesmerism  must  be  faithfully  set  forth,  even 
should  they  give  pain  to  those  who  have  taught  themselves 
to  regard  it  as  a  sort  of  human  transfiguration,  raising  man 
above  the  prosaic  meanness  of  the  workaday  world,  and 
illuminating  him  with  a  glimpse  of  that  light  that  “  never 
was  on  sea  or  shore.”  Its  real  nature  and  tendencies  must  be 
revealed  even  at  the  risk  of  shocking  those  who  have  become 
intimate  with  it.  And  its  real  nature  and  tendencies  are 
essentially  morbid  and  demoralising.  The  only  genuine  phe¬ 
nomena  in  mesmerism,  which  are  better  described  as  the  phe¬ 
nomena  of  hypnotism,  are  seen  exclusively  in  persons  who 
have  an  inherited  or  acquired  proclivity  to  nervous  or  mental 
disease  ;  and  the  repeated  production  of  these  phenomena  in 
the  same  person  is  calculated  to  increase  the  instability  of 
the  nerve-centres  involved,  and  the  liability,  therefore,  to 
grave  disorder.  Madness,  epilepsy,  and  hysteria  have  fol¬ 
lowed  immediately  on  mesmeric  operations  on  delicate  sub¬ 
jects,  and  a  long  list  of  ailments  might  be  made  out,  in  the 
causation  of  which  they  have  played  some  part.  But  the 
dangers  of  mesmerism  are  not  confined  to  the  subjects 
in  whom  the  phenomena  are  induced.  The  very  belief  in 
it,  in  those  who  are  not  susceptible  to  what  are  spoken 
of  as  mesmeric  influences,  is  often  the  offspring  or  the 
foster-mother  of  morbid  tendencies.  The  healthy  and  well- 
constituted  mind  turns  away  from  mesmerism,  after  a  short 
survey  of  it,  with  ridicule  or  disgust.  It  may  see  in  it  much 
that  it  cannot  explain,  just  as  it  does  in  an  epileptic  fit,  but  it 
scents  its  mawkish  sickliness  and  detects  its  inherent  ab¬ 
surdity.  But  it  is  not  so  with  the  mind  that  is  tinged  with 
that  melancholy  that  is  so  nearly  allied  to  genius,  or  that  is 
afflicted  with  an  unhappy  craving  for  the  second-rate  super¬ 
natural.  It  gloats  over  mesmerism  with  delight,  thrills  at 
its  revelations,  puzzles  out  its  problems,  and  vexes  and 
excites  itself  into  a  state  of  erethism  and  high  tension  that 
is  full  of  danger.  We  generally  find  a  belief  in  mesmerism, 
combined  with  a  belief  in  other  transcendental  trickeries 
and  delusions,  in  persons  of  eccentric  character  or  weakly 
superstitious  disposition.  This  description  does  not,  of 


438 


Medical  Times  and  Gazette. 


MESMERISM!! S  CHRONICUS. 


Oct.  13,  1883. 


course,  apply  to  all  who  accept  Mesmer’s  creed,  or  the  modi¬ 
fications  of  it  which  are  in  vogue.  Strong-minded  men 
have  fallen  into  this  error,  and  vain-minded  men  who  think 
themselves  scientific  when  they  are  simply  silly;  but  most 
medical  men  will  assent  to  the  proposition  that  believers  in 
mesmerism  are,  as  a  rule,  neurotic— are,  in  fact,  persons 
whose  continued  sanity  and  freedom  from  nervous  disease 
could  only  be  insured  at  a  high  premium. 

As  to  the  demoralising  tendencies  of  mesmerism,  they  are 
patent  enough.  It  will  not  be  denied  that  in  public  exhibi¬ 
tions  of  mesmerism  there  is  often  introduced  a  good  deal  of 
what  Messrs.  Gurney  and  Myers  would  call  “  farcical  exagge¬ 
ration,”  but  what  plain  people  would  call  impudent  sham¬ 
ming  ;  and  all  students  of  hypnotism  knowhow  apt  the  hyp¬ 
notic  state  is  to  sap  the  integrity  and  truthfulness  of  those  who 
are  frequently  thrown  into  it.  The  disturbance  of  normal 
cerebral  function  induced  not  rarely  enfeebles  the  will  and 
stimulates  in  an  inordinate  degree  every  furtive  feeling. 
There  is  an  incessant  craving  for  notice,  and  a  cunning  de¬ 
light  in  simulation,  and  the  subject  who  commenced  honestly 
enough  is  soon  converted  into  a  miserable  impostor.  We 
can  conceive  few  surer  ways  of  undermining  the  moral  sense 
in  youths  and  maidens  than  by  submitting  them  to  a  course 
of  hypnotic  experiments.  And,  if  hypnotism  is  hazardous 
to  virtue,  mesmerism,  for  reasons  which  will  be  apparent 
presently,  is  tenfold  more  so. 

The  imperative  duty  of  the  medical  profession  in  relation 
to  mesmerism  is  discharged  when  it  has  clearly  pointed 
out  its  mischievous  tendencies,  which  we  have  just  indi¬ 
cated.  There  is  no  obligation  on  it — as  Messrs.  Gurney 
and  Myers  appear  to  think  there  is — to  be  constantly 
investigating  mesmeric  manifestations.  It  has  made  up 
its  mind  about  these  long  ago,  and  satisfied  itself  that 
they  consist  of  a  small  nucleus  of  genuine  hypnotic  phe¬ 
nomena,  and  of  a  huge  mass  of  wilful  deception  and 
vulgar  buffoonery.  Medical  men  have  enough  to  do  in 
dealing  with  the  sad  realities  of  life  and  in  the  pursuit  of 
legitimate  science,  and  have  no  time  to  waste  on  the  curious 
conundrums  that  may  be  prepared  for  them  by  idlers,  poets, 
and  philosophers,  or  in  the  detection  of  fraud.  Mesmerism 
has  been  exposed  again  and  again,  and  until  it  has  some 
entirely  new  matter  to  submit  it  is  not  deserving  of  serious 
consideration.  And  there  is  certainly  nothing  new  in  the 
matter  which  is  brought  forward  by  Messrs.  Gurney  and 
Myers.  With  an  air  of  extreme  caution  and  scientific  pre¬ 
cision,  these  gentlemen  again  introduce  to  us  all  the  old 
tricks  with  all  the  old  sources  of  fallacy  still  surrounding 
them.  The  unwary  reader  might  imagine  that  every 
possible  source  of  error  had  been  eliminated  from  the  ex¬ 
periments  described  and  that  they  had  been  scrupulously 
surrounded  by  every  safeguard  that  ingenuity  could  suggest ; 
but  the  initiated  will  have  no  difficulty  in  discovering 
their  weak  points  and  unprotected  flanks.  We  cannot 
pretend  to  criticise  adequately  a  vital  experiment  of  which 
only  an  imperfect  description  is  before  us  ;  but  we  can  at 
least  point  out  where  the  description  is  imperfect,  and,  ad¬ 
mitting  for  the  moment  the  accuracy  of  the  statement  of 
facts  offered,  suggest  a  more  common-place  theory  than  that 
of  mesmerism  for  their  explanation. 

Now,  in  the  first  place,  Messrs.  Gurney  and  Myers’  descrip¬ 
tions  are  defective  in  that  they  afford  us  no  clue  to  the 
temperament,  character,  and  antecedent  history  of  the 
subjects  upon  whom  they  have  experimented.  Who  is  Mr. 
G.  A.  Smith,  and  who  is  Master  Wells?  This  gentleman 
and  this  youth  make  large  calls  on  our  credulity,  and  it  is 
but  fair  that  we  should  know  something  about  them  before 
we  honour  their  draughts.  What  are  their  respective  ages, 
social  positions,  and  degrees  of  education  ?  How  did  they 
first  discover  their  uncommon  gifts  ?  Do  they  now  derive 
any  profit  from  the  exhibition  of  them,  or  do  they  give  their 
services  gratuitously  to  the  Psychical  Research  Society? 
Do  they  enjoy  sound  health,  and  from  what  diseases  have 
they  suffered  in  time  past  ?  These  and  a  score  of  other 
questions  we  should  require  to  have  answered  satisfactorily 
before  we  received  with  implicit  faith  as  genuine,  and 
not  illusive,  the  extraordinary  performances  attributed  to 
them.  Some  of  these  performances  can  of  course  be  tested, 
although  we  are  not  sure  that  this  has  yet  been  done 
thoroughly — but  many  of  them  rest,  and  must  rest,  on  the 
good  faith  of  the  performer’s,  and  we  must  therefore  have 
convincing  evidence  that  they  are  not  deceiving  or  self- 
deceived. 


But  it  is  not  merely  in  affording  no  information  about  the 
subjects  of  their  experiments  that  Messrs.  Gurney  and 
Myers’  descriptions  of  them  are  insufficient.  They  often 
fail  to  exclude  very  obvious  sources  of  fallacy,  which,  if 
they  existed,  must  have  vitiated  the  whole  proceedings. 
Let  us  take  an  example.  A  very  full  account  is  given  of  a 
series  of  experiments  belonging  to  the  class  of  mesmeric 
rapport,  and  designed  to  illustrate  community  of  sensation 
between  the  operator  and  subject — the  operator  being  Mr. 
Smith,  the  subject  Master  Wells.  Wells,  in  a  tolerably 
deep  sleep,  was  in  one  room,  and  Mr.  Smith  in  another,  the 
rooms  being  separated  by  very  thick  curtains.  “Perfect 
silence  was  throughout  observed  except  for  the  simple  and 
uniform  question,  ‘  Do  you  feel  anything  ?  ’ — which  it  was 
necessary  Mr.  Smith  should  ask,  as  (according  to  the 
admitted  rule  with  mesmerised  or  hypnotised  subjects) 
Wells  was  deaf  to  every  other  voice. 

“  1.  Upper  part  of  Mr.  Smith’s  left  ear  pinched.  After  the 
lapse  of  about  two  minutes.  Wells  cried  out,  'Who’s  pinch¬ 
ing  me  ?’  and  began  to  rub  the  corresponding  part. 

"  2.  Upper  part  of  Mr.  Smith’s  left  arm  pinched.  Wells 
indicated  the  corresponding  part.” 

And  so  on  through  eight  experiments  in  all.  In  seven  of 
these  Wells  correctly  indicated  the  part  pinched  in  Smith — 
the  left  ear  twice  ;  the  right  ear,  left  arm,  chin,  neck,  and 
calf  of  the  leg,  once  each.  In  one  experiment,  in  which 
the  hair  was  pulled,  he  gave  no  sign. 

Now,  all  this  sounds  very  wonderful  until  we  begin  to 
reflect  that  we  are  left  without  information  on  a  number  of 
points,  a  knowledge  of  which  is  essential  to  enable  us  to  deter¬ 
mine  in  what  manner  Smith  and  Wells  were  en  rapport.  We 
are  not  told  positively  that  the  eight  experiments  described 
included  all  the  experiments  of  that  kind  performed  at  that 
time,  but  we  shall  assume  that  they  did.  We  are  not  told 
who  blindfolded  Wells,  and  how  the  process  was  carried  out. 
We  are  not  told  the  number  and  names  of  the  persons 
in  the  rooms  with  Smith  and  Wells  respectively,  nor  whether 
the  curtains  were  so  drawn  as  absolutely  to  prevent  any 
person  in  the  one  room  having  a  view  of  any  person  in  the 
other.  We  are  not  told  whether  Mr.  Smith  stood  stock-still 
or  made  passes.  We  are  not  told  whether  in  asking  his 
uniform  question  he  employed  a  uniform  tone  of  voice  and 
used  always  the  same  inflection.  We  are  not  told  whether 
during  the  whole  ten  or  fifteen  minutes  occupied  by  the  ex¬ 
periments  Mr.  Smith  ever  coughed,  or  jingled  the  money  in 
his  pocket,  or  blew  his  nose.  W e  are  not  told  who  pinched  Mr. 
Smith,  or  how  the  order  in  which  the  pinches  were  given  was 
determined.  It  is  clear  that  Smith  and  Wells  were  en  rapport, 
but  the  simplest  explanation  of  their  relationship  is  obviously 
the  most  logically  correct,  and  the  very  last  to  be  arrived  at 
is  that  of  community  of  sensation.  Now,  the  simplest  ex¬ 
planation  is  that  Smith  and  Wells  had  a  pre-arranged  code  of 
signals  by  means  of  which  Smith  communicated  to  Wells 
information  as  to  the  part  on  which  he  was  pinched.  The 
human  body  is  only  likely  to  be  pinched  in  a  public  assembly 
in  a  limited  number  of  parts,  so  a  very  simple  code  would 
suffice.  Audible  sign  s  for  right  and  left,  and  for  half  a  dozen 
parts  of  the  body,  would  be  enough  for  a  very  creditable  per¬ 
formance.  The  privity  of  a  third  party  to  the  trick  would,  of 
course,  facilitate  matters  still  further.  The  order  of  pinches  to 
be  given  might  have  been  settled  beforehand  ;  or  an  accom¬ 
plice  in  the  room  with  Wells,  but  seeing  the  pinches  inflicted 
on  Smith,  might  have  conveyed  the  needed  hint  by  visible 
signs  to  the  only  nominally  blindfolded  Wells.  We  are  not 
prepared  to  maintain  that  the  trick  was  played  in  any  of  the 
ways  which  we  have  indicated,  although  Wells’  acute  and  dis¬ 
criminating  sense  of  hearing,  as  shown  in  subsequent  experi¬ 
ments,  makes  it  probable  that  he  received  audible  signs  ;  but 
what  we  do  contend  is,  that  it  was  simply  a  trick  played  with 
more  or  less  cleverness  and  apparent  artlessness.  Any  ave¬ 
rage  conjuror  will  undertake  to  do  all  that  Smith  and  Wells 
did,  and  a  great  deal  more,  for  he  will  convey  to  his  subject 
the  names  of  a  great  variety  of  objects  which  he  touches,  the 
dates  of  coins,  numbers  of  notes,  etc. ;  anduntil  themesmerists 
can  do  something  that  the  conjurors  cannot  accomplish,  we 
shall  refuse  to  credit  them  with  extraordinary  powers.  If 
there  is  under  mesmeric  states  a  community  of  sensation 
between  Smith  and  Wells,  that  community  must  extend  to 
the  nature  of  the  sensation  as  well  as  its  locality;  and  when 
the  latter  is  able,  under  conditions  which  we  could  prescribe, 
to  reproduce  accurately,  both  as  to  place  and  character,  a 
series  of  sensations  experienced  by  the  former  such  as  these 


Medical  Times  and  Gazette. 


ABSTRACTS  AND  EXTRACTS. 


Oct.  13,  1883.  439 


— heat  on  the  second  joint  of  the  left  ring-finger,  cold  on 
the  left  knee-pan,  a  prick  on  the  right  little  toe,  a  draught 
of  wind  on  the  neck,  rubbing  of  the  left  eyelid,  pinching  in 
the  right  arm-pit,  sweetness,  bitterness,  perfume,  etc. — we 
shall  begin  to  think  that  his  accomplishments  are  worthy 
of  a  moment’s  attention. 

In  the  more  complex  experiments  narrated  by  Messrs. 
Gurney  and  Myers,  the  defects  of  description  and  loop-holes 
for  doubt  are  far  more  numerous  than  in  the  comparatively 
simple  ones  that  we  have  selected  for  criticism.  We  cannot 
here  analyse  these  experiments,  although  it  would  beamusing 
to  do  so,  but,  in  connexion  with  one  series  of  them,  we  must 
certainly  express  our  surprise  to  find  an  ardent  anti-vivisec- 
tionist  like  Mr.  Gurney  running  theprongs  of  a  carving-fork 
into  the  fingers  of  “  a  human  boy,”  as  Mr.  Chadband  would 
have  called  him,  and  burning  the  core  of  his  nails  with  a 
lucifer-match. 

It  will  require  a  good  deal  more  evidence  than  the  Psychical 
Research  Society  has  yet  been  able  to  adduce  to  convince 
medical  men  that  water  over  which  mesmeric  passes  have 
been  made  conveys  a  tingling  sensation  to  the  tongue,  that  a 
patient  deaf  to  all  shouting  in  her  ears  hears  a  whisper  in 
the  pit  of  her  stomach,  and  that  another  patient  can  read  a 
book  with  the  palm  of  her  hand  on  the  nape  of  her  neck. 
Such  cases  are  more  suitable  for  discussion  in  the  debat¬ 
ing  society  of  a  lunatic  asylum  than  by  men  who  have 
enjoyed  a  scientific  training.  The  only  circumstance  that 
would  justify  medical  men  in  again  examining  mesmerism 
with  a  view  to  its  refutation  would  be  the  serious  disturbance 
of  the  public  mind  by  the  deliverances  of  the  Psychical 
Research  Society.  Then  it  might  become  their  duty  to 
unmask  the  delusion  once  more  ;  and  for  that  purpose  we 
should  recommend  a  good  working  committee  composed  of 
three  practical  physicians  accustomed  to  the  observation  of 
nervous  diseases,  three  physiologists,  one  professional  con¬ 
juror,  and  an  experienced  police-officer.  We  feel  confident 
that  a  committee  thus  constituted  would  very  speedily 
explode  modern  mesmerism,  and  perhaps  the  Psychical 
Research  Society  also. 


DR.  AIRY  ON  DIPHTHERIA  PREVALENCE 
AT  COGGESHALL,  IN  ESSEX. 


On  the  report  of  Dr.  Abbott,  Medical  Officer  of  Health,  that 
diphtheria  was  epidemic  in  the  parishes  of  Great  and  Little 
Coggeshall,  in  the  Braintree  Rural  Sanitary  District,  Dr. 
Airy  was  deputed  in  November  last  to  investigate  the  cir¬ 
cumstance  up  to  November  3,  1S82.  Fifteen  cases  of  the- 
disease  among  paupers  alone  had  been  reported  to  the  health 
officer  by  the  district  medical  officer,  all  occurring  since  the 
previous  25th  of  October.  As  is  unfortunately  nearly  always 
the  case,  about  the  origin  of  the  epidemic  there  is,  the  report 
says,  a  good  deal  of  obscurity ;  the  earliest  case  that  could  be 
traced  dated  back  to  September  10,  and  from  that  time  to 
the  third  week  in  October,  when  the  disease  became  epidemic, 
several  children,  whose  cases  Dr.  Airy  relates,  died  from 
different  causes,  which,  though  registered  under  other  names, 
he  cannot  help  suspecting  should  have  been  returned  as  diph¬ 
theria.  It  having  been  ascertained  that  all  the  households 
invaded  were  those  which  sent  children  to  the  church  schools. 
Dr.  Abbott  urged  that  these  should  be  closed,  and  his 
recommendation  was  carried  out,  with  the  effect  of  at  once 
checking  the  outbreak.  But,  having  been  closed  seventeen 
days,  they  were  re-opened  on  November  20  without  any  con¬ 
sultation  with  the  sanitary  authority,  the  result  being  that 
several  fresh  cases,  two  of  them  fatal,  were  shortly  afterwards 
reported,  and  the  infection  then  spread  to  families  of  children 
attending  the  chapel  school.  On  December  12  the  Medical 
Officer  of  Health  procured  the  temporary  closure  of  both 
schools.  Dr.  Airy  remarks  that  there  was  no  indication  that 
the  diphtheria  was  spread  by  milk,  nor  was  there  any  reason 
to  think  that  it  was  caused  by  air  escaping  from  defective 
drains.  It  appeared  to  him  that  the  infection  had  probably 
been  brought  into  the  school  by  children  from  the  early 
invaded  families,  and  that  its  subsequent  spread  was  suffi¬ 
ciently  accounted  for  by  personal  contact  of  children  in  and 
out  of  school.  The  type  of  the  disease  on  the  whole  was  not 
very  severe,  but  was  in  many  instances,  the  report  adds,  well 
marked,  the  attack  being  followed  by  nasal  voice  and 


difficulty  of  swallowing ;  the  loss  of  guttural  articulation 
being  made  very  apparent  when  the  children  were  asked  to 
pronounce  the  name  of  their  native  village.  The  previous 
history  of  diphtheria  in  Coggeshall  shows  that  from  1870  to 
1875  there  was  only  one  death  registered  from  it  in  that 
sub-district ;  in  the  autumn  of  1875  there  was  a  severe  out¬ 
break,  which  was  investigated  and  reported  upon  by  Dr. 
Thorne.  In  1876  sixteen  deaths  were  registered  from  this 
cause,  and  five  in  1877 ;  then  followed  another  long  interval 
from  1878  to  the  third  quarter  of  1882  with  only  a  single 
death  registered.  Is  this  sudden  recurrence.  Dr.  Airy  asks, 
due  to  the  presence  of  some  new  or  unusual  conditions,  or  is 
it  due  merely  to  the  chance  of  one  infectious  case  getting 
into  a  crowded  school  and  there  disseminating  the  poison  ? 
It  cannot  be  doubted,  he  says,  that  diphtheria  does  often 
exhibit  a  certain  dependence  upon  local  conditions ;  that  is 
to  say,  it  is  found  in  the  long  run  to  be  much  more  prevalent 
in  one  region  than  in  another.  For  example,  in  the  county 
of  Essex,  during  the  last  twelve  years  the  annual  diphtheria 
death-rates  of  Chelmsford  and  Rochford  have  averaged  3’0 
and  0'8  per  10,000  respectively.  In  the  present  instance  it 
may  be.  Dr.  Airy  goes  on  to  observe,  that  the  general  poverty 
and  insufficiency  of  food  among  the  lower  classes  in  the 
district  contributed,  by  reducing  the  bodily  strength  of  the 
children,  to  render  them  more  susceptible  of  infection.  In 
all  probability  there  was  a  concurrence  of  predisposing  causes, 
such  as  the  nature  of  the  locality,  the  wetness  of  the  autumn 
season  of  1882,  and  the  impaired  health  of  the  children,  which 
had  together  prepared  a  soil  suitable  for  the  reception  and 
development  of  diphtheria. 


ABSTRACTS  AND  EXTRACTS. 

Professor  Pick’s  Treatment  of  Eczema. 

In  a  communication  to  the  New  York  Medical  Record  for 
July  26,  Dr.  Robert  Morison  furnishes  an  account  of  the 
great  success  which  he  had  observed  to  attend  Prof.  Pick’s 
treatment  of  eczema  at  Prague,  contrasting  it  with  what 
he  had  seen  at  Vienna.  There,  tar,  as  employed  by  Hebra, 
is  still  in  the  ascendant,  and,  notwithstanding  its  great 
antiparasitic  and  antiseptic  powers,  proves  a  most  tedious, 
troublesome,  and  dirty  application.  Prof.  Kaposi’s  attempt 
to  supersede  it  by  naphthol  has  not  succeeded ;  for,  in  spite 
of  prolonged  trials  in  other  diseases,  its  employment  is  now 
almost  confined  to  scabies,  and  even  for  this  it  has  to  be  most 
cautiously  used,  owing  to  its  great  liability  to  produce  severe 
inflammatory  action. 

“For  three  months,”  says  Dr.  Morison,  “I  have  been 
studying  closely  and  critically,  through  the  kindness  of 
Prof.  Pick,  his  gelatine  treatment  of  this  disease,  and  I 
have  been  greatly  struck  with  the  simplicity  of  its  applica¬ 
tion,  its  cleanliness,  and  its  most  excellent  results.  Instead 
of  the  troublesome  use  of  powders  and  of  salves,  which  in 
Vienna  must  be  applied  at  least  twice  a  day,  the  patient 
in  Prague  has  immediately  wrapped  over  his  diseased 
parts  linen  bandages  smeared  with  unguentum  saponis 
containing  5  or  10  per  cent,  of  salicylic  acid.  This  is 
applied  at  any  stage,  and  is  left  in  situ  for  a  week.  After 
the  bandages  are  applied,  they  are  covered  with  what  ia 
known  as  tricot,  and  which  is  manufactured  in  various  sizes, 
especially  for  Prof.  Pick,  in  England.  A  patient  so  dressed 
is  able  to  go  about  his  work  with  no  inconvenience  to  himself 
and  no  injury  to  his  clothes.  After  a  week  the  bandage  is 
removed,  and  the  disease  examined.  If  it  is  found  necessary, 
from  the  still  remaining  inflammation  and  induration,  a 
fresh  bandage  is  applied,  and  left  on  for  a  week.  Then  the 
gelatine  is  applied  in  the  following  manner.  A  portion  of 
a  mass  made  by  dissolving  fifty  grammes  of  the.  purest 
gelatine  in  100  grammes  of  distilled  water,  and  which  has 
been  allowed  to  cool  previously,  is  melted  by  putting  it  into 
a  cup,  and  placing  the  cup  in  hot  water.  To  this  is  added 
the  required  strength  of  salicylic  acid  usually  5  per  cent. 
When  sufficiently  cool,  this  mixture  is  painted  upon  the 
diseased  parts  with  a  painter’s  brush  made  of  bristles.  The 
layer  of  gelatine  is  made  about  as  thick  as  a  sheet  of  writing- 
paper,  and,  after  it  has  dried,  is  gently  covered  with  a  mini¬ 
mum  quantity  of  glycerine  spread  with  the  hand.  The  use 
of  glycerine  is  found  to  be  necessary  to  render  the  gelatine 


440 


Medical  Times  and  Gazette. 


REVIEWS. 


Oct.  13,  1883. 


pliable,  and  to  prevent  its  contracting,  -which  it  otherwise 
would  do  with  considerable  force — sufficient  to  irritate  the 
skin.  It  is  also  worthy  of  notice  that  it  is  not  practicable 
to  mix  the  glycerine  with  the  gelatine  before  it  is  applied, 
as  it  prevents  its  hardening  sufficiently,  and  renders  it 
sticky.  It  takes  a  very  small  quantity  only  of  glyce¬ 
rine,  after  the  gelatine  has  dried  on  the  skin,  to  render 
this  soft  and  pliable.  A  few  trials  teach  the  nurse  the 
amount  required.  This  use  of  glycerine  obviates  the  only 
bad  effect  which  the  gelatine  can  possibly  have.  With 
such  a  bandage  a  patient  seldom  feels  the  slightest  itching. 
The  diseased  parts  are  seen  through  the  transparent  layer, 
thus  rendering  the  progress  of  the  disease  visible  without 
the  removal  of  the  application ;  and,  what  is  much  more 
agreeable  to  the  patient,  an  ordinary  bath  removes  all  traces 
of  it.  So  easy  is  this  method  of  treatment  that  the  patient 
can  in  most  cases  make  his  own  applications,  and  there  is 
no  fear  of  a  too  strong  action  being  produced  by  the  drug. 
In  many  cases  of  chronic  eczema  the  application  is  made 
immediately,  without  the  previous  use  of  the  linen  bandages ; 
and  in  acute  eczema,  especially  in  crusta  lactea,  this  rule 
may  often  be  followed.  There  is  no  reason  why  the  medi¬ 
cated  gelatine  may  not  be  immediately  applied  at  any  stage 
of  eczema;  but  experience  has  shown  that  salicylic  acid 
first  applied  in  the  moist  stage  of  acute  eczema  in  the  form 
of  salicylated  soap  ointment,  for  a  period  long  enough  to 
reduce  the  inflammation,  renders  the  use  of  medicated 
gelatine  more  prompt  in  its  results.” 

After  relating  some  of  the  cases  which  he  had  watched. 
Dr.  Morrison  observes :  — "  The  most  satisfactory  results, 
both  to  patient  and  physician,  are  obtained  in  chronic  cases 
which  appear  so  frequently  at  dispensaries.  For  instance, 
in  cases  due  to  varicose  veins,  I  have  seen  the  greatest 
benefit  follow.  Instead  of  taking  the  patient  into  the 
hospital,  he  is  simply  bandaged  and  sent  off,  to  return  in  a 
week’s  time.  Nothing  could  be  simpler,  and  it  is  satisfactory 
in  the  extreme. 

"  In  trying  this  treatment  there  are  a  few  points  in  the 
method  of  application  which  it  is  necessary  to  insist  upon. 
The  salicylic  acid  must  be  thoroughly  well  mixed  with  the 
soap  ointment  while  warm,  and  this  must  be  spread,  when 
at  about  the  consistence  of  butter,  evenly  upon  short  linen 
bandages,  which  should  not  be  more  than  one  inch  and  a  half 
in  width— and  even  much  narrower  when  applied  to  fingers 
and  toes.  The  ointment  should  not  be  in  a  thicker  layer 
than  the  back  of  an  ordinary  table-knife,  and  should  be 
spread  fresh  every  time  it  is  used.  It  is  well  not  to  mix  too 
large  a  quantity,  as  it  hardens  and  is  more  difficult  of 
application.  The  gelatine  should  be  prepared  by  dissolving 
in  distilled  water  and  heating  in  a  porcelain  crucible.  After 
stirring  thoroughly,  it  is  allowed  to  cool,  and  forms  a  cake, 
which  takes  the  form  of  the  crucible.  This  cake  can  be  kept 
for  any  length  of  time  in  paper,  and  the  necessary  quantity 
broken  off  every  time  it  is  to  be  used.  The  salicylic  acid 
must  be  kept  separate  from  it,  and  only  added  to  the 
gelatine  when  it  is  melted.  The  mixture  should  not  be 
painted  on  the  skin  unevenly  or  in  a  thick  layer.  When 
properly  applied,  it  can  be  torn  from  the  skin  in  quite  large 
pieces,  and  it  comes  off  without  pain  to  the  patient  or  irrita¬ 
tion  to  the  disease.  It  sounds  like  the  tearing  of  tissue 
paper  ;  and  when  thus  torn  off,  looks  as  if  the  patient  was 
having  his  epidermis  removed  by  force.  Any  holes  or  rents 
in  the  covering  may  be  repaired  from  time  to  time  by  a  fresh 
application. 

"  After  having  seen  as  many  as  a  hundred  cases  of  eczema 
treated  by  this  method,  I  consider  that  it  fully  equals  the 
old  tar  treatment  in  the  results  obtained,  and  that  it  far 
surpasses  it  in  the  simplicity  of  its  application  and  in  its 
cleanliness — a  quality  which  immediately  recommends  it  to 
the  patient.  With  its  introduction  Prof.  Pick  has  made  a 
great  advance  in  the  treatment  of  this  most  common  of  all 
skin  diseases,  and  it  is  worthy  of  a  most  thorough  trial  at 
the  hands  of  others.” 


Bequests  to  Hospitals. — The  late  Mr.  Henry 
Couchman,  of  Blackheath,  who  died  on  June  30  last,  has 
bequeathed  ,£200  each  to  the  Royal  Kent  Dispensary, 
Greenwich-road  ;  the  London  Hospital,  Whitechapel-road ; 
the  Seamen’s  Hospital,  Greenwich ;  the  Hospital  for  Con¬ 
sumption,  Fulham-road;  the  Cancer  Hospital,  Fulham- 
road  ;  and  the  Charing-cross  Hospital,  Agar-street. 


- i:. . 

REVIEWS. 


Body  and  Will.  By  Henry  Maudsley,  M.D.  Kegan  Paul 
and  Co.  1883.  Demy  8vo,  pp.  333. 

In  this  book  we  find  but  a  small  proportion  of  definite  and 
positive  teaching,  the  main  bulk  of  the  work  being  occupied 
with  a  controversy,  which  is  conducted  with  considerable- 
vehemence,  against  opinions  with  which  the  author  dis¬ 
agrees.  These  opinions  appear  to  be  of  two  sets — those  of 
a  nearly  obsolete  school  of  theologians,  whose  style  of  con¬ 
troversy  Dr.  Maudsley  emulates  at  the  same  time  that  he 
often  goes  far  out  of  his  way  to  abuse  their  tenets ;  and 
those  which  are  held  by,  or  rather  which  Dr.  Maudsley 
attributes  to,  metaphysicians,  by  which  he  appears  to  mean 
those  who  pursue  the  study  of  mind  by  the  introspective 
method — who  look,  as  it  were,  into  their  own  consciousness, 
and  describe  what  they  find  there.  It  is  quite  impossible, 
however,  to  discover  who  it  is  that  Dr.  Maudsley  is  attack¬ 
ing  with  so  much  vigour  of  language  and  with  an  iteration 
and  reiteration  to  which  we  are  sorely  tempted  to  apply 
Falstaff’s  epithet.  The  doctrines  that  he  combats  are,  many 
of  them,  as  Dr.  Maudsley  states  them,  so  foolish  as  to 
justify  anything  that  can  be  said  of  them;  some  are  so 
manifestly  absurd  that  it  is  difficult  to  believe  that  they 
were  ever  entertained,  in  the  form  that  Dr.  Maudsley 
states  them,  by  any  reasonable  being ;  and  it  is  the 
more  important,  therefore,  that  they  should  be  carefully 
authenticated.  But  as  to  their  authorship  Dr.  Maudsley 
never  gives  us  a  hint.  They  are  “  favourite  axioms,”  they 
are  in  “  common  vogue,”  they  are  conclusions  that  we  “  are- 
to  see  ” — that  we  are  “required  to  draw”;  they  are  held  by 
“  some  evolutionists,”  by  “  some  philosophers,”  by  “  the 
introspectionist,”  by  “  our  introspective  psychologist  of  the 
study  ”;  some  person  or  persons  unknown  are  “  wont  ”  to 
uphold  them,  they  “  rush  to  the  conclusions,”  they  are  in 
“  hot  haste  ”  to  reach  them ;  but  who  these  anonymous 
individuals  are,  we  are  left  in  ignorance.  Although  by  far 
the  greater  part  of  the  book  is  taken  up  with  a  refutation 
of,  or  more  correctly  a  violent  attack  upon,  these  doctrines, 
not  one  single  authority  is  adduced  to  show  that  any  one 
of  them  has  ever  been  held  by  any  human  being.  This 
style  of  controversy  is  not  altogether  new ;  it  is  not  diffi¬ 
cult  ;  and  we  fail  to  perceive  that  it  is  of  the  slightest 
interest  or  value.  If  these  opinions  are  really  such  fa¬ 
vourites — are  in  such  common  vogue — as  Dr.  Maudsley 
asserts,  why  does  he  not  adduce  at  any  rate  one  authority 
to  support  his  assertion  ?  The  soundest  doctrine  may  easily 
be  made  to  look  preposterous  when  stated  by  its  adversary, 
and  the  only  fair  way  of  presenting  it  is  to  give  it  as 
stated  by  one  of  its  upholders.  This  Dr.  Maudsley  does  not 
do,  and,  in  the  absence  of  such  a  citation,  the  method  of  his 
book  resembles  nothing  so  much  as  that  of  the  recreation 
that  is  so  much  in  favour  on  racecourses  and  other  places 
of  popular  assemblage — we  refer  to  that  in  which  a  figure 
more  or  less  accurately  resembling  the  human  form  (it  is 
commonly  intended  to  portray  a  member  of  the  softer  sex 
and  of  the  negro  race)  is  set  up  for  the  purpose  of  being 
knocked  down  again  by  the  missiles  of  the  hilarious  popu¬ 
lace.  Dr.  Maudsley’s  verbal  missiles  are  hurled  with  great 
dexterity  ;  they  always  hit  the  object  of  his  marksmanship, 
and  his  success  affords  him  no  little  satisfaction.  But 
whether  his  target  is  a  living  antagonist,  or  a  lay  figure  set 
up  by  himself,  he  alone  can  enlighten  us,  and  this  he. 
studiously  refrains  from  doing.  By  all  kinds  of  ingenious 
periphrases  he  contrives  to  make  us  understand  that  the 
doctrines  he  is  combating  are  held  by  some  one,  but  who  it 
is  that  holds  them  he  never  lets  us  know.  He  objurgates, 
the  doctrines  and  their  holders  with  all  the  vigour  and 
with  all  the  reiteration  of  the  excommunication  service. 
Ernulphus  himself  had  not  a  stronger  or  more  copious 
vocabulary ;  but  when  it  is  all  exhausted  nobody  seems  one 
penny  the  worse.  Occasionally  we  get  a  hint  that  among 
the  shadowy  antagonists  is  to  be  reckoned  Mr.  Herbert 
Spencer.  On  more  than  one  occasion  Dr.  Maudsley,  without- 
mentioning  any  name,  gives  a  paraphrase  of  some  doctrine 
of  Mr.  Spencer’s,  and  dismisses  it  with  a  sneer.  Yet  Dr. 
Maudsley  shows  so  clearly  upon  almost  every  page  of  his 
book  the  influence  of  Mr.  Spencer’s  writings,  that  the  third 
time  he  denies  Mr.  Spencer’s  leadership  we  listen  for  the: 
cockcrow. 


Vedical  Tlroca  and  Oayctte. 


REVIEWS. 


Oct.  13,  188?.  441 


To  judge  Dr.  Maudsley’s  boob  by  the  common  standard, 
and  to  compare  his  views  with  those  of  the  leaders  in  mental 
science,  would  be  fruitless  ;  for  there  is  not  sufficient  common 
ground  between  them  to  allow  of  a  thorough  comparison. 
The  position  that  Dr.  Maudsley  takes  up  is  so  peculiar  as  to 
make  us  feel  that  no  comparison  is  admissible  or  even  pos¬ 
sible,  save  with  himself.  We  will  therefore  take  the  different 
portions  of  his  book,  and  see  how  far  they  harmonise  with  one 
another.  As  has  been  said,  a  very  large  portion  of  the 
work  is  taken  up  by  arguments  against  the  introspective 
study  of  mind.  We  do  not  propose  to  enter  into  this  con¬ 
troversy.  A  method  which  counts  among  its  adherents  such 
names  as  Plato,  Locke,  Berkeley,  Kant,  Leibnitz,  Pascal, 
Descartes,  and  Mill  is  not  likely  to  be  discredited  by  being 
called  nonsense,  absurdity,  and  self-foolery,  even  by  Dr. 
Maudsley,  and  may  be  safely  left  to  take  care  of  itself.  All 
we  can  do  here  is  to  notice  how  far  Dr.  Maudsley’s  practice 
harmonises  with  his  principles.  A  method  for  which  Dr. 
Maudsley  has  so  much  scorn,  and  to  which  he  applies  so 
many  hard  names,  whose  “  fundamental  incompetence  ”  he 
sets  himself  to  prove,  in  which  he  has  “no  proper  faith,” 
and  which  it  is  one  of  the  main  objects  of  his  book  to  dis¬ 
credit,  is,  one  would  think,  the  last  that  he  would  himself 
employ.  It  is  with  some  surprise,  therefore,  that  we  find 
chapters  with  such  headings  as  “  What  Consciousness  tells 
us  concerning  Will,”  “  Concerning  the  Authority  of  Con¬ 
sciousness,”  and“The  Positive  Assurance  of  Consciousness.” 
When  we  examine  the  chapters  thus  entitled,  we  find  that 
this  method,  which  Dr.  Maudsley  repudiates  with  so  many 
bitter  words,  is  nevertheless  employed  by  him  in  investigating 
questions  of  such  profound  importance  and  difficulty  as 
these,  and  that  he  is  quite  content  with  the  results  that 
it  yields  him.  It  is  difficult  to  see  in  what  way  the  dicta 
of  consciousness,  the  assurance  of  consciousness,  and  the 
authority  of  consciousness  can  be  investigated  save  by  turn¬ 
ing  our  attention  to  our  own  consciousness,  and  noting  what 
passes  therein  ;  and  it  is  so  far  satisfactory  to  find  that  even 
Dr.  Maudsley  is  driven  to  adopt  this  method  in  dealing 
with  these  problems.  But  the  question  naturally  presents 
itself,  Which  is  the  most  trustworthy  guide  in  these  most 
obscure  and  almost  inaccessible  regions — he  who  pursues 
patiently  and  devotedly  with  the  labour  of  a  lifetime  a 
method  of  whose  value  he  is  thoroughly  convinced,  or  he 
who  adopts  for  a  special  occasion  a  method  which  he  affects 
to  ridicule  and  despise  ?  So  startling  is  the  discrepancy 
between  Dr.  Maudsley’s  opinions  and  his  practice  in  this 
matter,  that  we  turn  again  to  the  chapters  in  question  to 
see  if  the  method  really  is  the  same,  and  we  are  bound  to 
say  that  there  are  indications  of  a  certain  difference.  It 
appears  that  Dr.  Maudsley  “  considers  the  matter  closely 
he  is  “  fixed  in  resolve  to  question  freely  and  think  sin¬ 
cerely,”  he  “examines  closely  and  without  bias,”  he  “  looks 
calmly  and  frankly  at  the  facts  with  a  sincere  desire 
to  see  them  as  they  are”;  and  it  would  be  no  wonder, 
therefore,  if,  with  such  novel  intentions,  he  arrived  at 
new  conclusions.  The  fact  is,  however,  that  Dr.  Maudsley’s 
doctrine  concerning  free  will  is  by  no  means  a  new  one, 
but  is  slightly,  if  at  all,  different  from  that  which  is  now 
widely  accepted,  and  whose  most  authoritative  exponent 
is  Professor  Bain ;  and  this  confirms  our  suspicions  that  the 
same  pure  intentions  with  which  Dr.  Maudsley  sets  out  may 
have  been  previously  entertained  by  some  one  else.  Dr. 
Maudsley’s  adoption  in  practice  of  the  introspective  method 
of  studying  mind,  after  he  has  rejected  it  in  principle,  is 
but  one  of  the  many  contradictions  in  his  book.  When 
some  person  (unknown)  says  that  “the  highest  evolution  of 
free  will  is  freely  to  lose  its  freedom,”  Dr.  Maudsley  warns 
us  that  “  many  persons  do  not  thoroughly  consider  whether 
they  distinctly  know  their  own  meaning,  but  deceive  them¬ 
selves  in  imagining  that  they  have  any  distinct  meaning  at 
all;  and  that  of  the  two  issues — first,  that  opposites  are 
identical ;  secondly,  that  meaningless  propositions  are  made 
— the  latter  is  the  more  probable.”  This  seems  to  us  a  very 
sound  opinion,  and  it  rises  very  prominently  to  the  mind, 
and  is  repeated  with  emphatic  approval,  when  we  find,  on 
page  38,  reference  made  by  Dr.  Maudsley  to  “  the  secret 
presence,  in  the  background,  of  a  substance  which  is 
not  substance,  being  unsubstantial— immaterial  substance. 
Here  again,”  says  Dr.  Maudsley,  apparently  oblivious  of  the 
opinion  quoted  above,  “  we  strike  upon  one  of  those  expres¬ 
sions  that  seem  to  common  apprehension  to  be  a  contradic¬ 
tion  in  terms,  and  a  mode  of  robbing  language  of  its  definite 


meaning,  but  which  the  mystical  sense  of  high  philosophy 
perceives  to  be  a  conjunction  of  opposites  that  bespeaks  a 
deeper  unity.”  Such  a  passage  comes  rather  oddly  from 
one  who  says  of  “  those  who  are  adepts  in  the  schools  of 
high  mental  philosophy  ”  that  he  is  “  unable  to  use  their  lan¬ 
guage  with  a  satisfactory  sense  of  having  clear  and  definite 
ideas  beneath  its  terms.”  Being  unfortunately  deficient 
in  the  mystical  sense  of  high  philosophy,  and  having  to 
get  on  with  no  better  sense  than  that  which  is  called, 
erroneously,  as  it  appears,  common,  we  are  bound  to  say 
that,  viewed  by  that  humble  but  useful  faculty.  Dr. 
Maudsley’s  expression  appears  sheer  nonsense.  It  is  pro¬ 
bable  that  the  passage  in  question  was  meant  to  foreshadow 
and  prepare  the  way  for  a  very  extraordinary  doctrine  that 
appears  in  another  part  of  the  book.  This  “  most  pregnant 
theory,”  as  it  is  modestly  called  by  its  author,  is  no  less 
than  a  new  theory  of  Mind,  by  which  it  is  supposed  to 
consist  in  vibrations  of  an  “all-pervading  mentiferous 
ether.”  Such  a  doctrine  is  not  exactly  what  we  expect 
from  an  author  who  starts  by  declaring  that  he  has  “  no 
choice  but  to  leave  the  barren  heights  of  speculation  for 
the  plains  on  which  men  live  and  move  and  have  their 
being,”  and  may  be  summarily  dismissed  in  the  terms  that 
he  himself  applies  to  the  operations  of  cerebral  matter 
— “  no  motion  of  its  molecules,  gyratory,  undulatory, 
rotatory,  nor  any  combination  of  such  motions  that  we 
can  imagine,  could  have  any  conceivable  analogy  with  a 
sensation.” 

The  further  we  penetrate  into  this  remarkable  book,  the 
greater  grows  our  wonder  that  an  author  of  such  unques¬ 
tionable  ability  as  Dr.  Maudsley  should  have  involved  him¬ 
self  in  such  a  mass  of  gratuitous  and  uncalled-for  contra¬ 
dictions  and  inconsistencies.  One  of  his  chief  grievances 
against  his  adversaries  “  the  metaphysicians  ”  is  the  ob¬ 
scurity  of  their  language,  yet  he  himself  uses  such  expres¬ 
sions  as  the  following : — Reason  is  “  something  which  comes 
not  miraculously  into  a  man,  but  grows  in  him  by  consum¬ 
mate  development  from  the  not  supreme,”  which  sounds 
like  a  line  out  of  the  popular  opera.  Patience ;  Will  is  “  a 
mighty  tide  of  becoming  that  is  broken  into  so  many  ripples 
of  individual  and  conscious  energies  the  social  tendency 
is  “  the  all-mightiness  of  the  whole  dominating  the  par¬ 
ticular  desires  and  wills  of  the  past  the  form  of  an 
organism  is  “  the  result  of  the  combining  properties  of  the 
simple  and  complex  compounds  that  constitute  the  structure 
in  their  relations  with  the  environment.”  The  following 
profound  counsel  is  given  by  Dr.  Maudsley  to  mankind  in 
general : — “  Let  him  cease,  then,  to  labour  to  know  himself 
in  himself,  and  let  him  strive  diligently  to  know  himself — as 
he  can  only,  properly  speaking,  know  himself— in  nature.” 
“To  say  there  is  an  absolute,  and  call  it  the  unknowable,” 
says  Dr.  Maudsley,  “  is  it  a  whit  more  philosophical  than  it 
would  be  for  a  blue-bottle  fly  to  call  its  extra-relational  the 
unbuzzable  P  ”  This  is  terribly  severe,  and  if  anyone  has 
ever  said  such  a  thing  he  must  no  doubt  feel  himself  anni¬ 
hilated  ;  but  there  is  yet  balm  in  Gilead  even  for  him.  On 
page  203,  Dr.  Maudsley  himself  says  that  “  the  under¬ 
standing  reveals  a  phenomenal  world  standing  forth  from 
a  background  of  the  unperceivable,”  and  again,  on  page 
231,  he  speaks  of  “  sterile  endeavours  to  think  the  un¬ 
thinkable.”  If  it  is  right  and  proper  to  speak  of  the 
unthinkable  and  unperceivable,  it  cannot  be  so  excessively 
unphilosophical  to  speak  of  the  unknowable.  Dr.  Maudsley 
is  very  angry  with  his  adversaries  for  erecting  mental 
abstractions  into  substantial  entities,  and  dealing  with  them 
as  if  they  possessed  independent  activities  of  their  own,  and 
yet  we  find  that  he  himself  originates  such  views  as  these  : 
the  life-principle  of  the  organism  is  “  a  principle  of  con¬ 
tinuity  ;  in  the  living  present  the  incorporate  past  is  active 
and  again,  each  element  of  the  physiological  organism 
“  contains  in  itself,  in  some  secret  and  incomprehensible 
way,  an  abstract  essence  of  the  whole.”  How  Dr.  Maudsley 
can  find  it  necessary  to  strain  out  the  gnat  of  a  special  Will- 
entity  after  swallowing  such  a  metaphysical  camel  as  this, 
passes  our  comprehension.  Not  all  the  mysticism  of  all  the 
schoolmen,  from  John  Erigena  to  St.  Thomas  Aquinas,  con¬ 
tains  a  more  mystic  passage ;  and  the  following  is  not  much 
more  definite  “  The  exercise  of  function  being  the  giving- 
out  or  unloosing  of  those  combined  internal  and  external 
conditions,  the  unfolding  from  within,  by  a  self-disintegra¬ 
tion,  of  the  coincident  conditions  within  and  without  that 
combined  in  the  first  instance  to  form  the  new  variation*  these 


GENERAL  CORRESPONDENCE. 


442 


Medical  Times  and  Gazette. 


Oct.  13,  1883. 


naturally  promote  further  material  embodiments— that  is 
to  say,  further  increase  of  structure.”  Fine  words,  truly,  but 
what  do  they  mean  ?  What  is  the  giving  out  of  a  condition  ? 
What  is  a.self-disintegration,  and  how  does  itdifferfrom  other 
disintegrations  ?  and  how  can  a  self-disintegration  promote 
a  material  embodiment  ?  After  reading  this  passage  it  is 
refreshing  to  hear  from  Dr.  Maudsley  that  we  are  “  not  to 
delude  ”  ourselves  “  with  words  that  mark  no  definite  ideas, 
but  to  have  a  substantial  meaning  in  the  terms”  we  use; 
and  we  can  at  length  find  ourselves  in  agreement  with  him 
when  he  says,  “  The  question  is,  what  are  the  exact  facts 
that  such  general  words  signify ;  and  here  it  must  be  con¬ 
fessed  that  an  aching  void  of  meaning  often  appears.” 

The  passages  that  we  have  quoted  above  are  not  unfairly 
selected;  they  are  a  trustworthy  sample  of  the  kind  of 
writing  in  which  the  book  abounds,  and  we  fail  to  discover 
a  single  new  doctrine  or  original  view  of  any  importance  to 
compensate  for  the  harshness  of  its  style,  or  to  warrant  the 
arrogance  of  its  tone.  The  style  is,  as  may  be  judged  from 
the  foregoing  extracts,  singularly  uncouth,  and  the  text  is 
interspersed  with  obsolete  and  ecclesiastical  forms  of  expres¬ 
sion,  which  appear  out  of  place  in  a  work  claiming  to  be 
scientific,  and  still  more  so  in  one  that  is  largely  occupied 
with  attacking  the  religious  forms  which  are  commonly  ex¬ 
pressed  in  such  language.  Things  don’t  happen  to  Dr. 
Maudsley,  they  come  to  pass,  or  befall.  We  are  drenched  with 
howbeit,  wherefore,  haply,  subtile,  albeit,  cometh,  giveth,  no¬ 
wise,  behold,  and  similar  expressions,  until  we  canimagine  our¬ 
selves  reading  the  Epistle  to  the  Romans,  and  find  the  text 
quite  as  obscure.  The  tone  of  the  book  is,  however,  its 
most  distinctive  feature.  It  is  dogmatic  and  self-assertive 
to  an  extraordinary  degree.  A  doctrine  with  which  Dr. 
Maudsley  disagrees  is  not  merely  erroneous — it  is  “non¬ 
sense,”  “absurd,”  “a  signal  absurdity,”  “a  manifest  ab¬ 
surdity,”  a  “  huge  absurdity  ”;  it  is  “  self -foolery,”  it  is  “  vain 
and  empty,”  “  an  empty  pretence,”  an  example  of  “  extra¬ 
ordinarily  perverse  and  futile  ingenuity,”  and  so  on.  Dr. 
Maudsley  repeatedly  goes  far  out  of  his  way  to  attack 
current  religious  opinions ;  but,  in  spite  of  this,  his  methods 
of  controversy  are  essentially  ecclesiastical.  He  meets  asser¬ 
tion  by  assertion,  and  dogma  by  dogma.  He  betrays  an  in¬ 
tense  odium  antitheologicum,  but,  upon  acquaintance,  it 
appears  to  be  only  the  odium  theologicum  turned  inside  out. 
He  has  all  the  qualities  (and  they  are  neither  few  nor  small) 
that  go  to  make  up  a  first-rate  polemical  theologian ;  but  his 
style  is  unsuited  for  the  ways  of  science.  It  is  not  by  as¬ 
suming  a  papal  infallibility,  and  treating  every  adverse 
opinion  with  majestic  scorn,  that  a  position  can  be  either 
won  or  maintained  nowadays.  If  Dr.  Maudsley  wishes  to  be 
recognised  as  the  ultimate  authority  in  mental  science,  he 
must  climb  down  into  the  arena  and  hold  his  own  against  all 
comers,  and  he  will  then  find  that  a  little  reasoning  is 
worth  an  enormous  deal  of  assertion. 


GENERAL  CORRESPONDENCE. 


METAPHYSICS  IN  PATHOLOGY. 

[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sib, — As  I  gave  an  exact  reference  to  Niemeyer’s  remarks 
on  this  subject,  there  seems  to  me  to  be  no  excuse  for  Mr. 
Millican’s  questions.  He  can,  if  he  likes,  read  the  passage, 
and  judge  for  himself  how  far  the  theories  he  has  lately 
advanced  were  anticipated  by  that  great  German  physician. 

I  am,  &c., 

Birmingham,  October  6.  Robebt  Saundby. 


THE  LATE  MR.  BOAST,  OF  WYMONDHAM, 
NORFOLK. 


[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sib, — This  is  an  appeal  on  behalf  of  the  widow  and  four 
young  children  of  the  above-mentioned  surgeon.  After 
practising  many  years  at  Wymondham,  he  died  last  year, 
leaving  his  family  almost  totally  unprovided  for.  He  had  a 
lingering  illness,  the  expenses  of  which,  including  the  em¬ 
ployment  of  locum  tenens,  etc.,  swallowed  up  a  considerable 
portion  of  what  small  means  he  had.  It  is  to  be  regretted 
that  such  appeals  should  have  to  be  made  ;  every  one,  how¬ 
ever,  is  an  argument  in  favour  of  some  kind  of  provident 


scheme.  I  may  mention  that  the  above-named  case  is 
recommended  by  Mr.  William  Cadge  and  Mr.  Burton,  of 
Norwich,  to  whom  reference  may  be  made.  Subscriptions 
may  be  paid  either  to  myself,  or  to  Mr.  J.  D.  Allman,  care 
of  Messrs.  Hewlett  and  Son,  wholesale  chemists  and  drug¬ 
gists,  40,  41,42,  Charlotte-street,  Great  Eastern-street,  E.C. 
The  following  subscriptions  have  been  promised: — 


£  s.  d. 

Mr.  Wm.  Cadge  .  .  5  0  0 
Mr.  Haynes  Robinson  3  0  0 
Mr.  S.  H.  Burton.  .  200 


£  s.  d 

Dr.  W.  Hughes.  .110 
Mr.  E.  Jackson  ..220 
Mr.  J.  D.  Allman  .  0  10  6 


Further  subscriptions  will  be  acknowledged  in  the  journals. 
Mr.  Burton,  F.R.C.S.  Eng.,  of  Norwich,  will  act  as  secretary 
and  treasurer,  to  whom,  therefore,  subscriptions  may  also 
be  sent.  I  am,  &c.,  Geobge  Jackson. 

1,  St.  George’s-terrace,  Plymouth,  October  6. 


“GOD’S  GIFTS  TO  MAN.” 


[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sib, — Will  you  grant  me  space  to  inform  the  independent 
young  lady’s  grandfather,  who,  in  your  issue  of  to-day,  so 
pitilessly  handles  my  Address  on  Therapeutics  at  the  London 
School  of  Medicine  for  Women,  that  I  quite  agree  with  him 
as  to  the  value  of  the  drugs  he  enumerates  ;  and  to  add  yet 
one  more  to  the  list,  saying  to  the  very  venerable  practi¬ 
tioner  (who  may  well  be  excused  for  having  entirely  forgotten 
most  that  I  said),  “  There’s  rosemary — that’s  for  remem¬ 
brance.”  It  were  useless,  I  think,  now,  to  send  him  to 
Ophelia  for  pansies.  I  am,  &c., 

October  6.  H.  D. 

P.S. — I  would  remind  your  correspondent  that  the  sources 
of  assafeetida  are  not  wholly  Divine,  as  shown  by  its  synonym, 
stercus  diaboli. 


OBITUARY. 

- o- - 

GEORGE  HENRY  EVANS,  M.D.  Cantab.,  M.R.C.P. 
Geobge  Henby  Evans,  who  was  regarded  at  one  time  as 
one  of  the  most  promising  amongst  our  younger  consulting 
physicians,  but  whose  career  was  prematurely  cut  short  some 
few  years  ago  by  the  onset  of  a  hopeless  malady,  died  at 
Isle  worth  on  the  30  th  ult.  He  was  born  at  Norwich  in 
August,  1835,  and  was  the  son  of  a  well-known  barrister  in 
that  city,  who  was  for  many  years  Chancellor  of  the  diocese. 
He  received  his  early  education  as  a  foundationer  at  Eton, 
proceeded  as  a  scholar  to  King’s  College,  Cambridge,  ob¬ 
tained  a  junior  optime  in  the  Mathematical  Tripos  in  1858, 
and  in  due  course  was  elected  Fellow  of  his  college.  Soon 
after  taking  his  degree  he  entered  for  a  time  upon  the  study 
of  medicine  at  Addenbrooke’s  Hospital,  but  circumstances 
shortly  induced  him  to  abandon  physic  for  a  military  career. 
He  obtained  a  commission  in  the  Bedfordshire  Militia,  and 
when  that  regiment  was  incorporated  into  the  line  he 
accompanied  it  to  St.  Helena.  He  remained  with  it  until  it 
was  converted  into  a  West  India  Regiment,  when  he  re¬ 
signed  his  commission  and  came  back  to  England.  Imme¬ 
diately  after  his  return  he  went  into  residence  at  King’s 
College,  and  again  took  up  the  study  of  medicine  at  Adden¬ 
brooke’s,  and  subsequently  at  St.  Thomas’s  Hospital.  He 
graduated  M.D.  in  1871,  and  in  the  same  year  took  the 
membership  of  the  Royal  College  of  Physicians.  After 
passing  some  time  as  clinical  assistant  at  the  Victoria- 
park  Hospital,  he  was,  on  the  completion  of  the  new  St. 
Thomas’s  Hospital  on  the  Albert-embankment,  appointed 
first  Resident  Assistant-Physician.  This  post  he  held  for  a 
year,  resigning  it  on  being  elected  Assistant-Physician  to 
the  Middlesex  Hospital.  His  career  in  London,  though  full 
of  promise,  was  all  too  short  for  achieving  that  success 
which  his  friends  had  every  reason  to  prognosticate  for  him. 
In  1877  the  symptoms  began  to  develope  themselves  of 
that  incurable  disease  which  ultimately  proved  fatal,  and 
though  rest  for  a  time  seemed  to  be  beneficial,  yet  it  was 
evident  to  all  but  himself  that  the  night  had  fallen  upon 
him.  He  passed  quietly  away  on  September  30,  at  the  early 
age  of  forty-eight. 

Dr.  Evans  will  be  remembered,  by  all  who  knew  him  per¬ 
sonally,  as  an  example  of  the  thoroughly  earnest  and  enthusi¬ 
astic  worker,  uninfluenced  by  any  deliberate  purpose  of  self- 


MEDICAL  NEWS, 


Oct.  18, 1883.  443 


Meiioal  Times  and  Gazette. 


advancement.  Whatever  he  took  in  hand  he  carried  out 
with  determination  and  energy,  and  while  resident  at  St. 
Thomas’s  Hospital  he  won  the  confidence  and  esteem  of 
both  his  superiors  and  subordinates.  He  supervised  the 
work  of-  the  House-Physician  and  clinical  clerks,  without 
interfering  with  their  self-respect  or  responsibility,  and  will 
be  held  in  the  memory  of  many  who  profited  by  his  accurate 
clinical  knowledge  and  teaching.  In  observation  and  regis¬ 
tration  of  facts  he  was  untiring ;  and,  owing  to  his  great 
common  sense,  and  what  may  be  called  clinical  insight,  his 
opinion  on  the  nature  and  treatment  of  the  cases  under  his 
care  was  always  listened  to  with  respect  by  the  Visiting 
Physicians.  At  the  Middlesex  Hospital,  during  the  short 
period  of  his  service  there,  he  carried  out  the  promise  of  his 
earlier  career,  and  was  valued  alike  by  his  colleagues  and 
pupils.  Forced,  as  he  was,  by  his  illness  to  resign  the  posts 
he  held  in  London,  the  hospitals  to  which  he  was  attached 
suffered  a  real  loss  in  being  deprived  of  a  man  with  such  a 
combination  of  good  sense,  accurate  knowledge,  and  wide 
general  culture  as  is  not  often  to  be  met  with  in  the  medical 
profession. 


FRANK  THEED  TWINING,  M.B.,  M.A.  Cantab., 

M.R.C.S. 

Dr.  Twining,  whose  death,  on  September  14,  from  phthisis, 
at  the  age  of  thirty-five,  was  recorded  in  a  recent  number  of 
this  journal,  received  his  school  education  at  Christ’s  Hos¬ 
pital.  Thence  he  proceeded  in  due  course  to  Cambridge, 
where  he  took  his  B.A.  degree,  with  honours  in  Natural 
Science.  Whilst  at  Cambridge,  like  many  medical  under¬ 
graduates,  he  devoted  most  of  his  time  to  the  scientific 
subjects  more  or  less  closely  connected  with  medicine, 
putting  in  a  sufficient  number  of  appearances  in  the  wards 
of  Addenbrooke’s  Hospital  to  get  signed  up  for  a  year’s 
hospital  medical  practice.  After  holding  the  valuable  ap¬ 
pointments  of  Resident  Clinical  Assistant  at  Victoria-park 
Chest  Hospital,  and  House-Physician  to  Dr.  Bristowe  at 
St.  Thomas’s,  he  completed  his  medical  education  at  Vienna. 
Having  no  taste  for  private  practice,  and  perhaps  not  being 
fitted  to  play  successfully  the  part  of  a  general  practitioner, 
he  spent  the  remainder  of  his  life  as  Assistant  Medical 
Officer  at  the  Eastern  District  Fever  Hospital  at  Homerton. 
A  good  observer,  well  up  in  his  profession,  shrewd  and 
cautious  in  forming  an  opinion,  and  deeply  interested  in  his 
work,  he  would  certainly,  had  he  been  spared,  have  added 
something  to  our  scanty  knowledge  of  the  pathology  of 
infectious  fevers. 


MEDICAL  NEWS. 

- ©- - 

Cambridge  Sanitary  Science  Certificate. — The 
following  is  a  list  of  those  who  satisfied  the  examiners  in 
both  parts  of  the  examination  : — 


Bartley,  A.  G.,  M.D. 

Cowen.  P„  M.R.C.S. 

Day,  W.  W„  M.D. 

East,  F.  W.  A.,  M.B. 
Finlay,  D.  W.,  M.D. 

Glasier,  C.,  M.B. 

Gripper,  W.,  M.B. 

Herring,  J.  F.,  L  R.C.P.E 

The  examiners  were  Dr. 
Chaumont,  and  Dr.  Alfred 


Hill.  R.  B„  M.D. 

MacRurv,  O.  M.,  L.R.C.E. 
Pearse,  T.  F.,  L.R.C.P. 

Penny,  E.,  M.B. 

Read,  M.,  M.B. 

Richardson,  J.,  M.B. 

Saunders,  G.  .T.  S.,  M.B. 
Sweeting,  R.  D.  R.,  M.R.C.S. 

A.  W.  Barclay,  Professor  F.  de 
Carpenter. 


Apothecaries’  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday, 
October  4  : — 

Beret-ford,  Ralph,  Prince  of  Wales’-road,  Norwich. 

Bullock,  Thomas  Warren,  Spring  Grove,  Iileworth. 

Hutchinson,  Harry,  Oakley-square,  Camden  Town,  N.W. 

Gostling,  J ohn  Harry,  Halesworth,  Suffolk. 

Scott.  Arthur  William,  Coalbournbrook,  Stourbridge. 

Smith,  Albert,  Paris-villas,  Wakehurst-road,  Wandsworth  End,  S.W. 

The  following  gentlemen  also  on  the  same  day  passed  their 
Primary  Professional  Examination  : — 

Bradbrook.  William.  London  Hospital. 

Llewelyn,  Ithel  Penderel.  King’s  College  Hospital. 

Skill,  Geoffrey,  8t.  Thomas’s  Hospital. 


APPOINTMENTS 


riOi 


Eyre,  J.  J.,  L.K.Q.C.P.I.,  L.M.,  and  L.R.eTSM^Medical  Officer- tj/jttife 
Forest  Hill  Dispensary,  iZ./'  "R  A  0  P  ‘  s'  D 

I  G")  [  '  i’ 

L  i  B  H  A  R  v 


Redmond,  Joseph  M.,  Physician  to  the  Mater  Misericordiee  Hospital — 
Joint-Lecturer  on  the  Practice  of  Medicine  and  Pathology  in  the  Ledwich 
School  of  Medicine  and  Surgery. 


DEATHS. 

Adam,  John  Mitchell,  M.B.,  C.M.,  at  Ardentigh,  Port  Bannatyne,  Bute, 
on  September  28,  aged  31. 

Evans,  George  Henry',  M.D.,  at  Isleworth,  on  September  30,  aged  48. 

Everitt,  Herbert,  M.R.C.S.,  at  Tarkastad,  South  Africa,  on  August  24. 

Jervis,  Thomas,  M.D.,  J.P.  for  Middlesex  and  Westminster,  at  32,  Con- 
naught-square,  on  October  3,  aged  73. 

Schofield,  Robert  Harold  Ainsworth,  M.  A.,  F.R.C.S.,  B. Sc.,  etc.,  of 
the  China  Inland  Mission,  at  Tai-Yiien.-Fu,  North  China,  on  August  1. 


VACANCIES. 

Brighton  and  Hove  Dispensary. — Resident  House-Surgeon.  Salary 
£140  per  annum,  with  furnished  apartments,  coals,  gas,  and  attendance. 
Candidates  must  be  Members  of  one  of  the  Royal  Colleges  of  Surgeons 
of  Great  Britain  or  Ireland,  and  Licentiates  of  the  Royal  College  of 
Physicians  of  London,  or  Licentiates  of  the  Society  of  Apothecaries  of 
London,  and  registered  under  the  Medical  Act.  Diplomas,  certificate 
of  registration,  and  testimonials  (under  seal),  to  be  addressed  to  the 
Chairman  of  the  Committee  of  Management,  Brighton  and  Hove  Dis¬ 
pensary,  Q,ueen’s-road,  Brighton,  on  or  before  November  5.  The  election 
will  take  place  on  December  4. 

Cheltenham  General  Hospital. — Assistant  House-Surgeon.  Salary 
£80  per  annum,  with  board  and  lodging  in  the  Hospital.  Candidates 
must  possess  ar.  least  one  registered  qualification  and  be  unmarried. 
Applications,  stating  age,  with  testimonials,  to  be  sent  to  the  Hon. 
Secretary,  on  or  before  October  24. 

Chichester  Infirmary.— House-Surgeon  and  Secretary.  Salary  £100  per 
annum,  with  hoard,  lodging,  and  washing.  Candidates  must  possess 
both  a  medical  and  surgical  qualification  obtained  in  the  United  King¬ 
dom,  and  be  duly  registered.  Applications,  with  testimonials,  to  be  sent 
to  the  Chairman  of  the  Committee,  on  or  before  October  22.  The 
election  will  take  place  on  November  8. 

Chichester  Infirmary.— Assistant  House-Surgeon.  Salary  £20  per 
annum,  with  board,  lodging,  and  washing.  Applications  to  be  sent  to 
the  Chairman  of  the  Committee,  on  or  before  October  22. 

General  Hospital,  Nottingham. — Assistant  House-Surgeon.  Salary  £80 
per  annum,  with  board  and  residence.  Candidates  must  be  doubly 
qualified.  Applications,  with  testimonials,  to  be  addressed  to  the 
Secretary,  on  or  before  October  17. 

Kilbhrn,  Maida  Vale,  and  St.  John’s  Wood  General  Dispensary, 
N.W.— Resident  Medical  Officer.  Salary  £120  per  annum,  with 
rooms,  coals,  gas,  and  attendance.  Candidates  must  be  unmarried. 
Applications,  with  qualifications  and  testimonials  as  to  character  and 
professional  ability,  to  be  sent  to  the  Hon.  Secretary,  13,  Kilbum-park- 
road,  Maida  Vale,  W.,  on  or  before  October  10. 


UNION  AND  PAROCHIAL  MEDICAL  SERVICE. 

***  The  area  of  each  district  is  stated  in  acres.  The  population  is 
computed  according  to  the  census  of  1881. 

RESIGNATIONS. 

Nantwich  Union—  The  Crewe  District  is  vacant :  area  14,709  ;  population 
32,034 ;  salary  £60  per  annum.  m 

Tiverton  Union. — Mr.  A.  8.  Connellan  has  'resigned  the  Bradninch 
District:  area  4830;  population  1825 ;  salary  £35  per  annum. 

APPOINTMENTS. 

Alcester  Union. — George  R.  Green,  L.R.C.P.  Edin.,  M.R.C.S.  Eng.,  to  the 
Inkberrow  District. 

Bedford  Union. — Thomas  R.  C.  Edwards,  M.R.C.S.  Eng.,  L.R.C.P. 
Edin.,  to  the  Harrold  District. 

Oorwen  Union.—  David  T.  Richard,  M.B.  and  C.M.,  to  the  Western 
District. 

Coventry  Union. — John  A.  London,  M.B.,  M.C.  Edin.,  to  the  First 
District. 

Grediton  Union.— Charles  T.  Champneys,  L.R.C.S.  Edin.,  to  the  Cheriton 
Fitzpaine  District. 

Leeds  Union. — Arthur  Hawkvard,  L.R.C.P.,  L.R.C.S.,  and  L.M.  Edin., 
to  be  Assistant  Medical  Officer  at  the  W orkhouse  Infirmary . 

Manchester  Township. — Charles  William  Jones,  M.B.  and  M.C.  Edin., 
to  be  Assistant  Medical  Officer  at  Crumpsall  Workhouse,  and  Resident 
Assistant  Medical  Officer  at  the  Receiving  and  Casual  Wards. 

Mansfield  Union—  Charles  Guthrie  Stein,  M.R.C.S.  Eng.,  M.B.  andC.M. 
Edin.,  to  the  Third  District. 

Pontardawe  Union. — Griffith  Griffiths,  M.R.C.S.  Lond.  and  L.R.C.P. 
Edin.,  to  the  Workhouse. 


Dr.  Uattgttf.v,  of  Crewe,  died  on  Friday  last  from  in¬ 
juries  sustained  by  being  thrown  out  of  his  carriage  on 
Monday  last. 

Death  from  Hydrophobia. — A  domestic  servant  in 
Chelsea,  who  was  bitten  by  a  cat  in  May  last,  has  died  from 
hydrophobia. 

Cambridge  University. — The  Special  Board  for  Bio¬ 
logy  and  Geology  have  published  the  following  list  of  lectures 
for  this  term  Physiology :  Professor  Foster,  elementary; 
Mr.  Lea  (Caius),  Chemical  Physiology,  advanced;  Mr. 
Langley,  Physiology,  advanced  ;  Mr.  Hill  (Downing),  second 
M.B.  class.  Zoology  and  Comparative  Anatomy,  and  Animal 
Morphology:  Professor  Newton  will  lecture  on  Evolution  in 
the  Animal  Kingdom  ;  Mr.  Sedgwick,  Practical  Morphology, 
elementary  and  advanced ;  Dr.  Hans  Gadow,  Morphology  of 


444 


Medical  Times  and  Gazette. 


MEDICAL  NEWS. 


Oct.  13,  1863. 


Ichthyopsida,  advanced.  Botany :  Dr.  Vines  (Christ’s  Col¬ 
lege),  General  Elementary  Course,  and  Advanced  Physiology. 

The  Contagious  DiseasesActs. — Mr.  Stansfeld,  M.P., 
in  a  letter  to  M.  Emile  de  Laveleye,  states  that  it  is  the 
intention  of  himself  and  of  those  who  think  with  him  on  this 
subject,  by  persuasion,  by  encouragement,  and  by  pressure, 
to  endeavour  to  secure  the  introduction  by  Her  Majesty’s 
Government  on  the  first  day  of  next  session  of  a  Bill  intended 
to  be  in  accordance  with  the  resolution  of  the  House  of 
Commons  of  April  20  last,  and  the  discussion  of  such  Bill 
before  the  setting-in  of  the  great  rush  of  party  political 
questions.  They  intended  to  hold  the  House  to  the  spirit  of 
that  resolution,  and  to  oppose  with  all  their  power  Clause  5 
of  the  Government  Bill. 

The  Drainage  of  the  Lower  Thames  Valley.— 
The  sites  proposed  for  the  drainage  works  of  the  Lower 
Thames  Valley  Main  Sewerage  Board  have  now  been  made 
known.  The  one  preferred  by  the  engineers  consists  of 
fifty-five  acres  of  market-garden  land  on  the  Surrey  side  of 
the  Thames,  between  Kew  railway-bridge  and  Mortlake. 
Here  it  is  intended  to  erect  works  for  the  chemical  treat¬ 
ment  of  the  sewage  of  the  whole  district,  which  has  a  popu¬ 
lation  of  nearly  150,000.  Among  the  alternative  sites  is 
some  low-lying  grass  land  south  of  the  Ham  Fields,  near 
Teddington  Lock.  The  works  are  estimated  to  cost  about 
<£300,000. 

Army  Medical  Department. — The  following  changes 
have  been  gazetted  : — Deputy  Surgeon- General  Alexander 
Dudgeon  Gulland,  M.D.,  has  been  granted  retired  pay,  with 
the  honorary  rank  of  Surgeon-General;  Brigade- Surgeon 
Joseph  John  Thompson  to  be  Deputy  Surgeon-General,  vice 
H.  T.  Reade,  V.C.,  retired  on  temporary  half-pay ;  Surgeon- 
Major  William  Gerard  Don,  M.D.,  to  be  Brigade-Surgeon, 
-vice  J.  J.  Thompson;  Surgeon-Major  Edmond  Hoile,  M.D., 
has  been  granted  retired  pay,  with  the  honorary  rank  of 
Brigade- Surgeon ;  Surgeon  Kingston  Dodd  Lloyd  Kirkwood 
has  resigned  his  commission  ;  Surgeon  William  Milward, 
M.B.,  resigns  his  commission. 

Soldiers  of  Unsound  Mind. — From  the  report  of 
Mr.  Parker  Wilson,  medical  officer  of  the  Brixton  Military 
Prison,  it  would  appear  that,  in  the  anxiety  to  augment  the 
number  of  Her  Majesty’s  land  forces,  recruiting- sergeants 
even  neglect  to  draw  the  line  at  mental  infirmity.  Some  of 
the  offenders  undergoing  punishment  at  Brixton  seem,  at 
all  events,  to  be  men  who  could  hardly  be  held  responsible 
for  the  breaches  of  discipline  of  which  they  have  been  con¬ 
victed.  The  class  of  weak-minded  patients  in  such  prisons 
is  not  at  all  uncommon,  and  Mr.  Wilson  says  that  he  can 
call  to  mind  at  least  half  a  dozen  cases  which  have  really 
verged  on  imbecility,  and  were  undoubtedly  in  that  con¬ 
dition  on  enlistment.  At  the  present  time  there  is  in 
hospital  a  patient  who,  previous  to  enlistment,  was  the 
inmate  of  a  lunatic  asylum. 

The  New  Water  Schemes.— The  Municipal  Review 
is  informed  that  the  two  leading  features  of  the  proposed 
water  scheme  for  London,  to  be  considered  by  the  Water  and 
General  Purposes  Committee  of  the  Metropolitan  Board  of 
Works,  are  uniformity  of  rating  throughout  the  whole  of 
the  metropolis,  and  an  unintermittent  supply  to  houses  of 
all  classes.  It  is  proposed  that  the  Committee  shall  make 
a  new  estimate  of  the  value  of  the  property  of  the  water 
companies,  and  it  is  believed  that  the  consideration  of  this 
part  of  the  subject  will  occupy  the  Committee  for  at  least 
two  months.  A  consultation  with  the  Corporation  Com¬ 
mittee  is  also  spoken  of,  for  the  purpose  of  agreeing  on  the 
modus  operandi  between  the  two  bodies.  But  it  is  pointed 
out  that  their  schemes  are  diametrically  opposed  in  one  of  the 
essential  points — the  supply  of  water  by  measurement. 

The  Tubercle  Bacillus.  —  As  the  rssult  of  an 
elaborate  review  of  what  has  been  done,  and  his  own 
investigations.  Dr.  Harold  Ernst  ( Boston  Medical  Journal, 
August  2  and  9)  arrives  at  the  following  conclusions : — 
4‘1.  A  staff-shaped  micro-organism  exists  in  all  forms  of  the 
tuberculous  process,  and  its  presence  has  been  demonstrated 
in  them.  2.  It  is  more  abundant  in  the  rapid  than  in  the 
slow  form  of  the  process.  3.  Its  specific  nature  as  the 
cause  of  tuberculosis  is  claimed  by  Koch  on  the  ground  of 
his  observations.  4.  Its  specific  character  has  not  been 
successfully  refuted  by  trustworthy  observations.  5.  Its 
value  as  diagnostic  evidence  of  tuberculosis  is  very  great. 


although  its  absence  cannot  be  considered  as  excluding  the 
existence  of  that  process.  6.  The  only  observer  who  has 
thus  far  attempted  the  repetition  of  Koch’s  cultivation- 
experiments  is  Prof.  Feltz,  of  Nancy,  who  has  announced 
the  complete  failure  of  his  work.  The  manipulation  is 
such,  however,  that  more  than  one  failure  must  occur  to 
upset  the  testimony  of  complete  and  repeated  successes.” 

The  Hind  Fund. — The  following  subscriptions  have 
been  received  and  paid  to  the  account  of  the  “  Hind  Fund 

Dr.  Rogers  . £2  2 

A.  J.  Pepper,  Esq . 2  2 

G.  B.  Sweeting,  Esq .  2  2 

J.  Tweedy,  Esq.  .  2  2 

Dr.  Domett  Stone  .  2  2 

J.  A.  Gartley,  Esq .  2  2 

Dr.  J.  H.  Lilley  .  2  2 

W.  D.  Dunn,  Esq . 1  1 

A.  J.  Purnell,  Esq . 1  1 

J.  J.  Pope,  Esq.  .  I  X 

John  Messent,  Esq . 1  1 

J.  Brown,  Esq .  1  1 

Surgeon-Major  Spence  ...  1  1 

C.  E.  Whiteford,  Esq.  ...  1  1 

F.  Magnuss,  Esq . 1  1 

T.  M.  Stone,  Esq . 1  1 

Mrs.  Rawsetti . 1  1 

Dr.  Richards .  X  1 

Dr.  Collins  .  1  X 

T.  Cooke,  Esq .  1  1 

Dr.  J.  B.  Ryley . 1  1 

James  T.  Hyatt,  Esq.  ...  X  1 

Dr.  W.  A.  Satchell  .  1  1 

An  Old  Pupil  .  1  1 

T.  Harley,  Esq.,  Haverstock- 

hill  1  1 

Surgeon  R.  W.  Barnes  ...  1  1 

J.  Baines,  Esq.,  Birmingham  1  0 


1  Dr.  Jones  . £21  0 

F.  E.  Webb,  Esq . 21  0 

Messrs.  Coutts  and  Co.  ...  21  0 

Sir  Erasmus  Wilson .  10  10 

R.  Quain,  Esq.  .  10  0 

S.  W.  Rayner,  E»q .  5  6 

Dr.  W.  J.  Bryant  .  5  5 

G.  A.  Critchett,  Esq.  ...  5  6 

Dr.  Watson .  6  0 

Dr.  Luke  .  6  0 

Dr.  Barton  .  5  0 

Thomas  Wakley,  Esq.  ...  5  0 

Dr.  Wakley  .  5  0 

George  Lawson,  Esq.  ...  5  0 

Dr.  F.  J.  Mouat  .  6  0 

J.  C.  Whaley,  Esq .  5  0 

Harman  Visger,  Esq.  ...  3  3 

Miss  Adela  Bosanquet  ...  3  3 

Christopher  Heath,  Esq.  ...  3  3 

Berkeley  Hill,  Esq .  3  3 

Dr.  Horsefall .  3  3 

A  Friend  .  3  3 

Sir  Ed.  Saunders  .  2  2 

T.  Wakley,  jun..  Esq.  ...  2  2 

Dr.  Stiven  .  2  2 

Dr.  Elliot  .  2  2 

Dr.  B.  A.  Duncan  .  2  2 

F.  Simms,  Esq.  .  2  2 

A.  Benthall,  Esq .  2  2 

Subscriptions  may  be  paid  to  Dr.  Richardson,  F.R.S.  (chair¬ 

man),  Manchester-square;  Professor  Tweedy,  F.R.C.S.,  24, 
Harley-street,  Hon.  Treasurer  ;  A.  J.  Pepper,  Esq.,  F.R.C.S., 
122,  Gower-street,  and  T.  Wakley,  j.un..  Esq.,  L.R.C.P., 
96,  Redcliff e-gardens,  Hon.  Secretaries ;  or  to  Messrs.  Coutts, 
Strand. 


APPOINTMENTS  FOR  THE  WEEK. 


October  13.  Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  1£  p.m. ;  King’s  College,  1 J  p.m. ;  Royal 
Free,  2  p.m.;  Royal  London  Ophthalmic,  11  a. ra. ;  Royal  Westminster 
Ophthalmic,  l£  p.m. ;  St.  Thomas’s,  l£  p.m.;  London,  2  p.m. 

15.  Monday. 

Operations  at  the  Metropolitan  Free,  2  p.m.;  St.  Mark’s  Hospital  for 
Diseases  of  the  Rectum, 2  p.m.;  Royal  London  Ophthalmic,  11  a.m.; 
Royal  Westminster  Ophthalmic,  14  p.m. ;  Hospital  for  Women,  2  p.m. 


16.  Tuesday. 

Operations  at  Guy’s,  1J  p.m. ;  Westminster,  2  p.m. ;  Royal  London  OpI- 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  14  p.m.;  West 
London,  3  p.m. 

Pathological  Society,  84  p.m.  Dr.  Carringfon-Lympho-Sarcoma  of 
the  Gastro -Intestinal  Mucous  Membrane.  Dr.  Hadden— Tumour  of 
the  Bladder.  Mr.  George  Lawson  -  Congenital  Growth  in  the  Orbit. 
Mr.  Kesteven— Tumour  of  the  Brain.  Mr.  Hutchinson,  jun.— Gastritis 
in  a  Bear.  Mr.  Poland  -Sebaceous  Cvst  from  Finger.  Dr.  Howard 
Tooth — Congenital  Malformation  of  Heart.  Dr.  Frederick  Taylor — 
Gumma  of  Dura  Mater  and  Syringo-Myelus.  Mr.  Sutton— Rickets  in 
the  Monkey  (three  cases) . 


17.  Wednesday. 

Operations  at  University  College,  2  p.m. ;  St.  Mary’s,  1J  p.m. ;  Middlesex, 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew’s,  14  p.m.  ;  Great  Northern, 

2  p.m.;  Samaritan,  24  p.m.;  Royal  London  Ophthalmic,  11  a.m.; 
Royal  Westminster  Ophthalmic,  14  p.m, ;  St.  Thomas’s,  14  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m. ;  National  Orthopsedic,  Great 
Portland-street.  10  a.m. 

Bromptox  Hospital  for  Coxsumptiov,  stc.,  4  p.m.  Dr.  R.  Douglas 
Powell,  “  On  Cases  of  Aortic  Aneurysm.” 


18.  Thursday. 

Operations  at  St.  George’s,  1  p.m.  ;  Central  London  Ophthalmic,  1  p.m. ; 
Royal  Orthopaedic,  2  p.m.;  University  College,  2  p.m.;  Royal  London 
Ophthalmic,  11  a.m. ;  Royal  Westminster  Ophthalmic,  14  p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m. ;  Hospital  for  Women,  2  p.m. ; 
Charing-cross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  24  p.m. 
Abernethian  Society  (St.  Bartholomew’s  Hospital),  8  p.m.  Dr. 
Herringham,  “  On  Aphasia.”  J 

19.  Friday. 

Operations  at  Central  London  Ophthalmic,  2  p.m.;  Royal  London  Ophthal¬ 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m.  ;  Royal  Westminsttr 
Ophthalmic,  14  p.m.;  St.  George’s  (ophthalmic  operations),  11  p.m.; 
Guy's.  l(  p.m.  ;  St,.  Chomas’s  (ophthalmic  operations),  2  p.m. ;  King’s 
College  (by  Mr.  Lister),  2  p.m. 

Society  of  Medical  Officers  of  Health.  7.30  p.m.  Inaugural  Addres8 
by  the  President,  Dr.  Dudfield,  “  On  the  Need  of  Unity  in  Metropolitan 
Sanitary  Administration.” 


Medical  Times  and  Onr^tte. 


NOTES,  QUERIES,  AND  REPLIES. 


Oct.  18,  1883.  445 


VITAL  STATISTICS  OF  LONDON. 

Week  ending  Saturday,  October  6,  1883. 
BIRTHS. 

Births  of  Boys,  1221;  Girls,  1166;  Total,  2387. 

Corrected  weekly  average  in  the  10  years  1873-82,  2605 '7. 

DEATHS. 


Males. 

Females. 

Total. 

Deaths  during  the  week . 

Weekly  average  of  the  ten  years  1873-82,  I 

637 

759  8 

615 

7C0T 

1252 

1459-9 

corrected- to  increased  population  ...  ) 

Deaths  of  people  aged  80  and  upwards 

... 

... 

41 

DEATHS  IN  SUB-DISTRICTS  FROM  EPIDEMICS. 


1  Enumerated 

|  Population, 

1881 

(unrevised). 

Small- pox. 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

Whooping- 

cough. 

Typhus. 

Enteric  (or 
Typhoid) 
Fever. 

Simple 

continued 

Fever. 

Diarrhoea.  | 

West . 

669633 

1 

1 

2 

3 

,,, 

2 

11 

North 

906947 

2 

2 

12 

5 

2 

•  •• 

7 

9 

Central 

262238 

6 

•  •• 

2 

... 

2 

4 

East . 

692738 

6 

25 

2 

5 

1 

3 

11 

South . 

1265927 

i 

2 

19 

10 

2 

... 

7 

... 

13 

Total . 

3816483 

3 

11 

63 

19 

14 

1 

21 

... 

43 

METEOROLOGY. 


From  Observations  at  the  Greenwich  Observatory. 


Mean  height  of  barometer  ...  ... 

Mean  temperature  . 

Highest  point  of  thermometer  ... 

Lowest  point  of  thermometer  ... 

Mean  dew-point  temperature  ... 

General  direction  of  wind  . 

Wnole  amount  of  rain  in  the  week  ... 


29-631  in. 
47-7“ 

68-3° 

40  3’ 

42-7° 
N.N.W. 
0'66  in. 


BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  the 
Week  ending  Saturday,  Oct.  6,  in  the  following  large  Towns 


Cities 

and 

Boroughs. 

Estimated  Population  to 
middle  of  the  year  1883. 

Births  Registered  during 
the  week  ending  Oct.  6. 

Deaths  Registered  during 
the  week  ending  Oct.  6. 

Annual  Rate  of 
Mortality  per  1000  living, 
from  all  causes. 

Temperature 
of  Air(Fahr.) 

Temp, 
of  Air 
(Cent.) 

Rain 

Fall. 

Highestduring 
the  Week. 

Lowestduring 
the  Week. 

Weekly  Mean  of 
Daily  MeanV  alues 

Weekly  Mean  of 
Daily  Mean 
Values. 

In  Inches. 

In  Centimetres. 

London 

3955814 

2387 

1252 

165 

58-3 

40-3 

47'7 

8-72 

0  66 

1-68 

Brighton  ... 

111262 

48 

30 

14T 

590 

38-0 

46-9 

8-28 

047 

1-19 

Portsmouth 

131478 

79 

39 

155 

•  •• 

... 

... 

... 

... 

•  •  • 

Norwich 

89612 

63 

28 

163 

... 

... 

... 

... 

Plymouth  ... 

74977 

55 

31 

2D6 

58-0 

40'0 

48-9 

939 

0-69 

175 

Bristol . 

212779 

117 

57 

140 

57-0 

360 

47-5 

861 

063 

1-60 

Wolverhampton  . 

77557 

51 

35 

23-6 

62‘S 

33-7 

43' 6 

6-45 

O'o9 

1-50 

Birmingham 

414346 

277 

163 

2045 

... 

Leicester  ... 

129483 

84 

37 

14-9 

57-0 

39-0 

47-4 

8-55 

0-61 

1-55 

Nottingham 

199349 

135 

74 

194 

550 

38T 

46-2 

7-89 

163 

4-14 

Derby . 

85574 

40 

26 

15-9 

... 

... 

... 

... 

... 

Birkenhead 

88700 

71 

27 

159 

... 

... 

... 

... 

Liverpool  ... 

566753 

346 

253 

235 

53-9 

42-0 

48-6 

9-23 

0-98 

2-49 

Bolton . 

107862 

70 

47 

22'7‘ 

55-1 

35-8 

457 

7-61 

0’8S 

2-24 

Manchester 

339262 

242 

172 

265 

... 

... 

... 

... 

... 

... 

Salford 

190465 

125 

74 

20  3 

... 

... 

... 

... 

Oldham 

119071 

74 

35 

153 

... 

... 

... 

... 

... 

Blackburn  ... 

103460 

96 

40 

19-2 

... 

... 

... 

Preston 

98564 

56 

40 

21-2 

56-0 

39-0 

46-9 

828 

0-60 

1-52 

Huddersfield 

84701 

55 

20 

123 

... 

... 

... 

... 

... 

Halifax  ... 

75591 

46 

20 

138 

... 

... 

... 

Bradford  ... 

204807 

111 

77 

19-6 

53-6 

39-5 

46-3 

7'95 

0-30 

0-76 

Leeds . 

321611 

197 

122 

19-8 

55-0 

390 

47-4 

8-55 

0-95 

2-41 

Sheffield 

295497 

222 

107 

18-9 

53  5 

39-0 

46-6 

8-06 

0-85 

2-16 

Hull  . 

176296 

112 

77 

228 

68-0 

38-0 

467 

8-17 

102 

2  59 

Sunderland 

121117 

90 

53 

22-8 

... 

... 

... 

... 

... 

... 

Newcastle  ... 

149464 

98 

82 

28-6 

... 

... 

... 

•  •• 

... 

... 

Cardiff . 

90033 

75 

34 

19'7 

... 

... 

... 

... 

... 

... 

For  28  towns ... 

8620975 

6422 

3054 

18-5 

590 

33-7 

469 

828 

0-78 

1-98 

Edinburgh  ... 

235946 

120 

67 

148 

... 

... 

... 

Glasgow 

615589 

336 

181 

18-3 

56-5 

32-5 

44-6 

8-00 

0-00 

0  00 

Dublin  . 

349-85 

184 

157 

23-4 

68-1 

35-8 

46-9 

8'28 

044 

1-12 

At  the  Royal  Observatory,  Greenwich,  the  mean  reading 
of  the  barometer  last  week  was  29-63  in. ;  the  lowest  read¬ 
ing  was  29‘06  in.  at  the  beginning  of  the  week,  and  the 
highest.  30  21  in.  at  the  end  of  the  week. 


NOTES,  QUERIES,  AND  REPLIES. 

- « - 

t{jHt  questioned  mncjj  sfcall  learn  mncfc. — Bacon. 

Seats  for  Public  Places. — These  seats  might  bear  the  appropriate  inscription, 
“  Never  injure  a  friend.” 

Bournemouth  as  a  Winter  Resort. — The  number  of  large  houses  taken  in 
this  town  for  the  coming  winter  is  unprecedented. 

The  West  London  Hospital.-  In  recognition  of  the  long-continued  kindness 
shown  by  the  members  of  the  Ancient  Order  of  Foresters,  one  of  the 
wards  in  the  new  wing  has  been  named  the  “  Foresters’  Ward.” 

Cholera:  Egypt. — The  disease  has  virtually  ceased  in  Egypt,  a  few  cases 
only  being  reported  from  Upper  Egypt.  The  ordinary  mortality  in 
Alexandria,  however,  is  unusually  heavy,  and  the  returns  are  regarded 
with  some  suspicion. 

Resignation  of  a  Medical  Officer  of  Health. — Dr.  Rygate,  the  Medical  Officer 
of  Health  for  St.  George’s-in-the-East,  has  tendered  his  resignation  to 
the  Vestry,  which  the  Vestry  has  accepted.  Dr.  Rygate  has  held  the 
office  for  seventeen  years.  The  Vestry  expressed  its  regret  at  losing  his 
valuable  services. 

Resignation.— Dr.  Iliff,  one  of  the  representatives  of  the  St.  Saviour’s 
(Borough) Union  at  the  Asylums  Board,  has  resigned  his  seat,  beingunable 
to  devote  sufficient  time  to  the  duties  of  the  office.  The  resignation  has 
been  accepted,  and  a  letter  forwarded  to  Dr.  Iliff,  thanking  him  for 
his  past  services. 

The  Preston  Town  Council  and  Temperance. — The  Council  has  accepted  the 
offers  of  several  persons  to  purchase  on  lease  for  999  years  different 
plots  of  land  in  the  borough,  on  the  usual  covenants  and  building  con¬ 
ditions,  but  “including  restrictions  against  the  sale  of  wines  or 
intoxicating  liquors.” 

The  Leeds  Medical  School  and  the  Yorkshire  College.— Dr.  Clifford  Allbutt, 
on  the  occasion  of  the  opening  of  the  winter  session  of  the  Leeds 
Medical  School,  last  week,  intimated  that  the  fusion  of  this  school  of 
medicine  with  the  Yorkshire  College  was  now  very  near,  and  only  some 
minor  details  remained  to  be  settled. 

University  of  Zurich.—  There  are  now  thirty-one  women  students  in  this 
University,  of  whom  only  seven  are  German.  Twenty  of  these  ladies 
are  studying  medicine.  Zurich  has  conferred  the  doctor’s  degree  on 
thirty  women  during  the  ten  years  the  University  has  been  open  to  both 
sexes  alike.  Twenty-three  of  these  were  Doctors  of  Medicine,  and  seven 
had  the  Ph.D.  degree. 

Hospital  Accommodation  for  Infectious  Patients,  Manchester. — A  memorial 
has  been  presented  to  the  Manchester  Town  Council  from  the  Manchester 
and  Salford  Sanitary  Association,  urging  the  Corporation  to  acquire 
the  right  of  using  the  Ardwick  and  Ancoats  Hospital  as  a  receiving- 
house  for  cases  of  infectious  disease.  This  proposal  is  supported  by  a 
memorial  from  the  Manchester  Board  of  Guardians. 

Anti-Vaccinators'  Goods  Distrained. — Stubborn  disobedience  to  the  law 
provokes  extreme  measures  to  enforce  compliance.  The  plea  of  “  con¬ 
scientious  scruples”  is  futile  and  worthless  as  a  justification  for 
resistance  to  legal  obligations.  At  Wellingborough  six  anti- vaccinators 
have  been  fined,  one  £10,  and  the  remaining  five  £5  each  and  costs,  for 
opposing  the  police  in  the  execution  of  their  duties  in  the  removal  of 
goods  under  distraint  for  not  complying  with  the  Vaccination  Acts. 

Mortality  of  Children:  Climatic  Effects.-  The  Medical  Officer  of  the  City  of 
York,  in  his  report  for  the  month  of  August,  observes  that  “  the  marked 
feature  in  the  death-returns  of  York  was  the  rapidity  with  which  the 
death-rate  for  young  children  was  increased  with  the  slightest  changes 
in  the  temperature,  etc.,  showing  clearly  the  existence  of  a  feeble  popu¬ 
lation,  ready  to  die  whenever  the  climatic  conditions  became  less  favour¬ 
able  to  health.  The  high  mortality  was  confined  chiefly  to  the  crowded 
parts  of  the  city. 

Posthumous  Prescribing.  — A  French  medical  journal  has  been  amusing 
itself  by  prescribing  for  the  ailments  of  illustrious  people  who  have  been 
long  dead,  but  who,  according  to  this  authority,  ought  not  to  have  died 
as  early  as  they  did.  It  seems  that  Moliere  could  have  been  saved  by  a 
few  grains  of  cafeine  ;  Racine’s  neuroses  would  have  yielded  to  bromide 
of  potassium  ;  while  any  modern  doctor  could  have  cured  Napoleon  of 
his  biliousness,  and  altered  the  course  of  history  by  making  the  Great 
Emperor  live  to  a  green  old  age. 

Inquests:  Viewing  the  Body— The  recent  remarks  by  Mr.  Payne,  the 
Coroner,  as  to  viewing  the  body,  have  attracted,  it  appears,  the  attention 
of  one  juryman  at  least.  The  foreman  of  the  jury,  at  an  inquest  held 
last  week  at  Rochester,  raised  the  question  as  to  whether  it  was  neces¬ 
sary  for  the  jury  to  view  the  body  of  the  deceased.  The  Coroner,  on 
citing  the  law  upon  the  question,  stated  that  “  viewing  the  body”  was 
part  of  the  evidence,  without  which  an  inquest  was  liable  to  be  quashed 
Thereupon  the  jury  viewed  the  body,  and  the  inquiry  proceeded  in  the 
usual  manner.  The  superficial  and  proformd  character  of  this  long- 
established  custom  renders  it  of  little  value  as  evidence.  Albeit,  it 
remains  a  requirement  of  the  law,  and  the  legality  of  an  inquest  should 
not  be  jeopardised  by  non-compliance  therewith. 


Medical  Times  and  Gazette. 


446 


Recreation  Grounds,  Paris.— A  large  part  of  the  expenses  of  maintaining 
the  public  squares  and  promenades  in  the  city  is  met  by  the  duties 
paid  to  the  Municipality  by  proprietors  of  establishments  situated  in 
them,  such  as  restaurants,  etc.  An  official  return  shows  that  the  total 
receipts  of  this  kind  for  the  whole  of  the  public  lands  in  Paris  are 
1,843,831  fr.  per  annum.  The  cost  of  maintenance,  on  the  other  hand, 
is  set  down  at  1,600,000  fr.,  including  the  services  of  the  police  officials. 

Anti-Vivisection,  France.—  A  meeting  of  the  League  against  vivisection 
(the  first  of  its  kind)  has  been  held  in  Paris,  and  was  attended,  it  seems, 
by  many  distinguished  members  of  society.  The  tableaux  exhibited 
(aided  by  the  electric  light),  showing  the  different  forms  of  alleged  torture 
which  victims  of  vivisection  have  undergone,  were  received  with  demon¬ 
strations  of  great  enthusiasm.  It  was  argued  with  much  vehemence 
that  “  the  animals  are  tortured,  but  without  result  to  science,  and  there 
is  no  progress  attained  by  vivisection.” 

The  Contagious  Diseases  Act. — By  recent  returns  there  seems  to  have  been 
a  grievous  increase  in  cases  under  treatment  in  the  Royal  Naval  Hos¬ 
pital,  Stonehouse,  and  the  Royal  Military  Hospital,  Stoke,  since  the 
suspension  of  the  Act  in  May  last.  The  type  of  the  disease  is  stated 
to  be  more  serious,  and  the  medical  officers  of  the  hospitals  are  appre¬ 
hensive  that  even  more  severe  types  will  soon  become  more  prevalent  in 
the  community,  and  be  spread  rapidly.  It  may  be  hoped  that  early  on 
the  re-assembling  of  Parliament  the  decision  of  May  last  will  be  reversed 
by  the  restoration  of  the  compulsory  clause. 

A  Female  Guardian  on  Compulsory  Vaccination. — The  vaccination  officer 
addressed  a  letter  to  the  Lambeth  Board  of  Guardians  for  authority  to 
enforce  the  Vaccination  Act  against  four  persons  who  would  not  comply 
with  the  law.  During  a  discussion  on  this  application,  Miss  Lord 
pointed  out  that  several  boards  of  guardians  had  decided  not  to 
prosecute.  She  urged  the  guardians  to  throw  the  responsibility  of 
prosecuting  on  the  Local  Government  Board,  and  moved  that  the  letter 
of  the  vaccination  officer  lie  on  the  table — a  motion  which  was  lost  by 
a  majority  of  two,  thirteen  guardians  being  present. 

First  Aid.— A.  pianoforte  tuner  at  Chester  was  charged  with  attempting 
to  poison  himself  with  laudanum.  On  the  case  being  heard  by  the 
magistrate,  Police-Serjeant  Warburton  (who  had  undergone  a  course 
of  study  with  the  St.  John  Ambulance  Corps)  informed  the  Bench 
that,  the  prisoner  having  taken  laudanum,  he  immediately  gave  him  an 
emetic  of  warm  water  and  mustard,  as  well  as  a  stronger  emetic  which 
he  had  compounded  at  a  neighbouring  chemist’s,  and  walked  him  up 
and  down  the  room  as  rapidly  as  possible.  When  the  prisoner  recovered, 
he  said  to  witness,  “  I  should  have  passed  off  nicely  if  you  had  let  me 
alone.” 

Pawning  Infected  Clothing.— The  Chairman  of  the  Birmingham  Health 
Committee,  referring  to  the  small-pox  epidemic,  said  a  very  serious 
mode  of  propagating  the  disease  had  been  discovered  by  the  vigilance 
of  the  health  authorities.  A  man  with  small  pox  in  his  house  took 
infected  wearing  apparel  to  a  pawn-shop,  where  it  was  taken  in  and 
placed  among  other  bundles  of  clothes.  Fortunately  the  case  was  dis¬ 
covered,  and  the  infected  bundle  and  all  placed  near  it  have  been 
secured  and  disinfected.  Meanwhile,  the  man  is  to  be  prosecuted.  The 
attention  of  pawnbrokers  has  been  officially  called  to  this  case  with  the 
view  to  every  precaution  being  taken  by  them. 

No  Medical  Officer  of  Health.—  The  Sanitary  Committee  of  the  Garrison  at 
Woolwich  have  called  the  attention  of  the  District  Board  of  Works  to 
the  existence  of  diphtheria  in  the  garrison,  and  requested  the  Board  to 
appoint  a  medical  officer  of  health.  It  appears  that  the  present 
arrangement  of  the  Board  was  that  the  twenty-one  local  medical  men 
should  furnish  the  Board  with  information  of  all  cases  of  infectious 
disease,  for  which  they  paid  them  a  small  fee.  It  was  stated  that 
this  plan  worked  much  better  than  having  one  medical  officer.  A  reply 
was  ordered  to  be  given  to  the  Garrison  Committee,  with  a  request  that 
the  military  surgeons  should  furnish  the  Board  with  the  names  and 
addresses  of  all  persons  suffering  from  diphtheria  or  other  infectious 
disease.  It  may  be  asked  whether  this  arrangement  does  not,  in  fact, 
contravene  the  Act  of  Parliament,  as  to  its  requiring  the  appointment 
of  a  medical  officer  of  health. 

A  Protest :  Mats  v.  Dr.  Forbes. — A  meeting  of  ratepayers  of  the  parish  of 
Shoreditch  has  been  held  at  the  Town  Hall,  Old-street,  to  protest 
against  the  payment  of  a  gratuity  of  £315  to  discharge  the  legal 
expenses  of  their  Medical  Officer  of  Health,  Dr.  Forbes.  The  Board  of 
Guardians  and  the  Local  Government  Board  have  had  the  question 
under  consideration,  and  the  decision  of  the  Guardians  to  allow  the 
expenses  has  evoked  a  very  hostile  feeling  in  the  parish.  These 
expenses  were  incurred  by  the  Medical  Officer  of  Health  in  the  trial 
“  Mais  v.  Forbes  ”  —the  matron  of  the  infirmary  against  the  doctor— for 
libel.  The  plaintiff  and  defendant  were  condemned  to  pay  their  own 
costs  ;  and  the  doctor  claimed  of  the  Board  the  costs  he  had  to  pay  out 
of  pocket.  The  Guardians  had  requested  the  central  authority  to 
defray  the  amount,  inasmuch  as  the  report  which  wras  the  subject  of  the 
alleged  libel  was  written  at  the  order  of  the  superior  B  oard.  The 
central  authority  did  not,  however,  admit  their  responsibility,  and  the 
expenses  have  been  thrown  on  the  ratepayers.  Ultimately,  after  much 
heated  discussion,  a  resolution  was  adopted,  condemning  the  action  of 
the  Guardians. 


Oct.  13,  1883. 


Dwellings  of  the  Poor:  France. —  We  were  scarcely  prepared  to  hear  that 
there  are  140,003  houses  in  France  without  that  indispensable  requisite 
—a  window.  Yet  such  seems  to  be  vouched  upon  official  returns.  M. 
Marten  Nadaud,  the  Deputy  for  Creuse,  made  a  statement  to  this  effect 
at  a  recent  meeting  of  the  Trades  Confraternity  in  Paris,  and  he  moreover 
added,  “  In  these  houses,  which  have  no  other  flooring  than  the  soil, 
which  are  without  chimneys  and  without  light,  whole  families  live  with 
the  domestic  animals  for  companions,  and  with  the  pig  as  a  guest.” 
That  such  a  housing  of  the  poorer  classes  is  allowed  to  exist,  is  scarcely 
compatible  with  the  vaunted  exceptionally  high  state  of  civilisation  of 
the  nation.  It  is  a  survival  of  cave  life. 

Decline  of  Russian  Medical  Students  in  Foreign  Universities. — A  correspon¬ 
dent  writes  that  formerly  90  per  cent,  of  Russian  students  in  continental 
universities  confined  their  studies  to  medicine,  but  during  recent  years 
that  faculty  attracts  only  a  small  number.  Philosophy,  chemistry,  and 
mathematics  are  now  the  principal  studies  prosecuted.  The  chief  cause, 
he  believes,  of  the  decline  in  number  of  medical  students  is  the 
severity  of  the  examination  by  the  Russian  faculty  of  medical  men 
holding  foreign  diplomas,  before  licences  to  practise  are  granted. 
Another  reason  is,  perhaps,  that  the  greater  number  of  these  students 
before  entering  foreign  universities  have  simply  finished  the  ordinary 
courses  of  the  Russian  gymnasia  or  polytechnic  schools.  Strange  to  say, 
the  English  universities  appear  to  have  no  attractions  for  the  Russian 
student. 

Alcoholism:  Hackney  Infirmary. — The  Board  of  Guardians  have  been 
somewhat  exercised  on  the  increased  consumption  of  spirits  in  the 
infirmary.  In  the  course  of  a  discussion  on  the  subject,  the  medical 
officer  stated  that  the  spirits  entered  in  the  return  were  consumed  by 
the  sick  poor,  and  not  by  the  officers.  Thereupon  a  guardian 
called  attention  to  the  answer  given  to  the  committee  on  the  same 
question  by  the  doctor  a  short  time  ago,  which  was  to  the  effect  that 
“  there  were  different  views  amongst  medical  men.  He  (the  doctor)  had 
been  brought  up  in  a  certain  school,  and  he  considered  the  amount  of 
spirits  that  he  was  prescribing  was  necessary,  and  that  was  all.”  In 
reply  to  the  remarks  of  the  guardian,  Dr.  Miller  observed  that  “if  the 
doctor  diminished  his  prescriptions  of  spirits  simply  upon  protest  he 
should  say  that  he  was  a  very  dishonest  doctor.  If  he  shortened  the  use  of 
spirits  in  order  to  curry  favour  with  the  guardians  he  was  unfit  for  his 
position.  He  might  order  what  he  considered  necessary  for  individual 
patients,  regardless  of  how  it  might  appear  in  the  aggregate.”  The 
subject  was  then  dropped. 

COMMUNICATIONS  have  been  received  from— 

Dr.  Crichton  Browne,  London  ;  Dr.  R.  Saundby,  Birmingham ;  Mr.  R. 
Catterall,  London ;  Sir  E.  Lechmere,  London :  Dr.  R.  H.  Semple, 
London ;  Dr.  G.  E.  Herman,  London ;  Dr.  H.  Sutherland,  London ; 
Dr.  J.  W.  Barrett,  Melbourne;  Dr.  R.  J.  Anderson,  Belfast;  Mr. 
George  Jackson,  Plymouth ;  Mr.  R.  J.  Godlee,  London;  Mr.  Stone, 
Wimbledon ;  Mr.  W.  T.  Grant,  Birmingham :  The  Secretary  of 
the  University  of  Cambridge  ;  Dr.  Morison,  London  ;  Mr.  George 
Rendle,  St.  Thomas’s  Hospital ;  The  Secretary  of  the  Admiralty 
Department,  Whitehall;  Mr.  J.  Chatto,  London  ;  The  Secretary  of 
the  Pathological  Society.  London ;  The  Secretary  of  the  Society 
of  Medical  Officers  of  Health,  London  ;  The  Secretary  of  the 
British  Medical  Association,  London ;  Mr.  Bartleet,  Birmingham  ; 
Dr.  J.  W.  Moore,  Dublin ;  The  Secretary  of  the  St.  Mary’s 
Hospital  Medical  School,  Loudon. 

BOOKS,  ETC..  RECEIVED  - 

Cholera,  by  John  Chapman,  M.D.— Congress  at  Glasgow:  Inaugural 
Address,  by  Professor  G.  M.  Humphry,  M.D.,  F.R.S.— History  of  Rome, 
by  Victor  Duruy — Manual  of  Surgical  Operations,  by  Joseph  Bell. 
F.R.C.8. — Meeting  of  the  National  Association  for  the  Promotion  of 
Social  Science — A  Guide  to  the  Microscopical  Examination  of  Drinking- 
Water,  by  J.  D.  Macdonald,  M.D.,  R.N.,  F.R.S. — L’Epilepsie,  l’Hystdrie, 
et  l’Idiotie,  par  Bourneville— The  Life  and  Work  of  St.  Paul,  by  Canon 
F.  W.  Farrar,  D.D.— Annual  Report  of  the  Wonford  House  Hospital 
for  the  Insane,  near  Exeter  — Wiesen,  by  A.  T.  Tucker  Wise,  M.D., 
L.R.C.P.,  etc.— The  Physiological  Factor  in  Diagnosis,  by  J.  Milner 
Fothergill,  M.D.— Plant  Analysis,  by  C.  Dragendorff,  Ph.D.— Howard 
Association  Report,  October,  1883— On  Malpositions  of  the  Kidney,  by 
David  Newman,  M.D.,  C.M. —Dr.  Corpus’s  Class— Physical  Diagnosis, 
by  Dr.  E.  T.  Bruen — The  Organs  of  Speech,  by  Georg  Hermann  von 
Meyer -Annual  Report  of  the  Sanitary  Condition  of  Nottingham  for 
1882— Zur  Gesehichte  der  Lehre  von  der  Drehung  der  Hand,  von  Prof. 
Dr.  Jacob  Heiberg— On  the  Immediate  Suture  of  Divided  Nerves,  by 
Henry  E.  Clark— Murray’s  Time-Tables— The  Boy’s  Own  Annual— The 
Girl’s  Own  Annual — Surgical  Applied  Anatomy,  by  Frederick  Treves, 
F.R.C.S. — Elements  of  Surgical  Pathology,  by  A.  J.  Pepper,  M.S.,  M.B. 

PERIODICALS  AND  NEWSPAPERS  RECEIVED— 

Lancet— British  Medical  Journal— Medical  Press  and  Circular — Ber¬ 
liner  Klinische  Wochenschrift — Centralblatt  fur  Chirurgie — Gazette 
des  Hopitaux— Gazette  M6dicale— Revista  de  Medicina—  Bulletin  de 
P  Acad6mie  de  Medecine — Pharmaceutical  J ournal — W iener  Medicinische 
Wochenschrift— Revue  M6dicale— Gazette  Hebdomadaire— Nature — 
Boston  Medical  and  Surgical  Journal — Louisville  Medical  News — 
Centralblatt  fur  Gynakologie — Le  Coneours  Medical— Centralblatt  fur 
die  Medicinischen  Wissenschaf ten— Centralblatt  fur  Klinische  Medicin 
— Philadelphia  Medical  News— Le  Progr^s  Mddical — New  York  Medical 
Journal — Cassell’s  Saturday  Journal — Analyst— Weekblad — American 
Journal  of  Neurology  and  Psychiatry — Maryland  Medical  Journal- 
Popular  Science  News— Polyclinic— L’Impartialitd  Medicale— Students’ 
Journal  and  Hospital  Gazette— Ophthalmic  Review— Indian  Medical 
Gazette— Night  and  Day — Practitioner — An  Ephemeris  of  Materia 
Medica,  etc. — National  Anti-Compulsory  Vaccination  Reporter— New 
York  Medical  Record — North  Carolina  Medical  Journal — Maryland 
Medical  Journal. 


NOTES,  QUERIES,  AND  REPLIES. 


Metfieal  Times  and  Gazette. 


KOCH’S  REPORT  ON  TIIE  CHOLERA.  IN  EGYPT. 


Oct.  JO,  1SS?.  447 


REPORT 

ON  THE 

CHOLERA  IN  EGYPT. 

By  Dr.  KOCH, 

Chief  of  the  German  Scientific  Commission. 

As  the  cholera  epidemic  was  already  rapidly  subsiding  when 
the  Commission  arrived  in  Egypt,  it  was  hardly  to  be  antici¬ 
pated  that  that  country  would  supply  the  material  necessary 
to  complete  the  investigation.  And,  moreover,  as  the  period 
when  an  epidemic  is  on  the  wane  is  hardly  the  best  suited 
for  inquiry  into  its  etiology,  the  original  plan  was  changed, 
and  it  was  decided  to  make  only  the  preliminary  researches 
in  Egypt,  with  the  view,  in  case  the  epidemic  should  extend 
to  Syria,  of  rectifying  them  in  places  which  had  been  but 
recently  attacked  by  the  cholera,  and  which  would  therefore 
be  likely  to  afford  a  favourable  basis  for  the  inquiry. 

The  first  portion  of  this  plan  has  hitherto  been  carried 
out  with  very  satisfactory  results,  for,  during  its  stay  in 
Alexandria,  the  Commission  has  found  opportunity  to  collect 
the  material  necessary  for  preliminary  inquiry.  This  success 
I  owe  chiefly  to  the  courtesy  of  the  physicians  to  the  G  reek 
Hospital,  who,  by  giving  us  rooms  for  our  work,  and  placing 
at  our  disposal  all  cholera  patients  who  were  admitted 
into  the  hospital,  and  the  bodies  of  all  who  died  there 
from  the  disease,  materially  furthered  the  objects  of  the 
expedition. 

At  the  very  beginning  the  Commission  obtained  the  use 
of  two  well-lighted  rooms  adjoining  each  other  on  the  ground 
floor,  one  of  which  was  devoted  to  the  microscopical  researches, 
and  the  other  to  cultivation  experiments.  The  animals  for 
experiment  were  placed  in  both  rooms.  But  as  their  number 
increased,  and  it  seemed  too  dangerous  to  make  researches  in 
the  infectious  matter  in  the  same  rooms  in  which  we  had  to 
spend  almost  the  whole  day,  the  animals  were  removed  into 
•a  completely  isolated  chamber  in  the  old  hospital,  and  there 
the  experiments  on  the  infection  were  carried  out. 

The  material  so  far  used  for  the  research  has  been  obtained 
from  twelve  cholera  patients,  and  from  ten  cadavers  dead  of 
the  disease.  Of  the  patients,  nine  were  under  observation 
in  the  Greek  Hospital,  two  in  the  German,  and  one  in  the 
Arabian.  In  all  cases  the  symptoms  corresponded  in  every 
particular  with  those  of  true  Asiatic  cholera.  Portions  of 
the  blood,  of  the  vomit,  and  of  the  dejections  of  these 
patients  were  examined.  As  it  very  soon  became  evident  that 
the  blood  was  free  from  micro-organisms,  and  the  vomited 
matters  contained  comparatively  few,  while  in  the  dejections 
they  were  found  in  considerable  numbers,  the  last-named 
were  chiefly  used  in  the  inoculation  experiments  on  animals. 

Although  the  quantity  of  post- mortem  examinations  was 
not  large,  we  were  happily  favoured  in  obtaining  from 
them  extremely  valuable  material  for  the  preliminary  in¬ 
quiry.  The  most  varied  nationalities  were  represented 
amongst  the  cadavers  (three  Nubians,  two  Austro-Germans, 
four  Greeks,  one  Turk),  at  the  most  varied  times  of  life 
(two  children,  two  cases  over  sixty  years,  the  rest  between 
twenty  and  thirty-five  years),  and  cases  in  which  the  disease 
had  lasted  very  different  periods.  But  the  most  important 
point  is  that  the  autopsy  was  made  in  most  cases  imme¬ 
diately  after  death,  or  at  the  outside  only  a  few  hours  later. 
The  changes  which  putrefaction  produces  in  the  organs,  and 
with  especial  rapidity  in  the  bowel,  and  which  render  micro¬ 
scopical  examination  of  these  parts  most  extremely  difficult, 
could  under  these  circumstances  be  excluded  with  certainty. 
I  would  lay  especial  stress  upon  this  fact,  because  in  other 
countries  it  would  be  scarcely  possible  to  obtain  material  so 
well  adapted  for  microscopical  examination.  The  patho¬ 
logical  appearances,  like  the  symptoms  during  life,  left  no 
doubt  that  we  had  to  deal  with  true  cholera,  and  not,  as  was 
maintained  in  general  quarters,  with  a  so-called  choleriform 
or  choleroid  disease. 

No  organised  infective  material  could  be  demonstrated  in 
the  blood,  or  in  those  organs  which,  in  the  case  of  other 
infective  diseases,  are  usually  the  seat  of  micro-parasites, 
viz.,  the  lungs,  spleen,  kidneys,  and  liver.  In  some  cases 
bacteria  were  found  in  the  lungs,  but  these,  as  we  saw  from 

Vol.  II.  1883.  No.  1738. 


their  peculiarities  of  form  and  position,  had  nothing  to  do 
with  the  peculiar  disease-process,  but  had  found  their  way 
into  the  lungs  by  the  inspiration  of  ejecta  from  the  stomach. 

The  contents  of  the  bowel  and  the  dejections  of  the 
cholera  patients  contained  extraordinary  quantities  of  micro¬ 
organisms  belonging  to  the  most  different  varieties,  none  of 
which  appeared  in  preponderating  proportion.  There  was 
also  an  absence  of  other  indications  of  a  relationship  to  the 
disease-process. 

The  bowel  itself,  on  the  contrary,  gave  most  important 
results.  In  all  the  cases  except  one,  which  had  died  of  a 
consecutive  disease  several  weeks  after  recovery  from 
cholera,  bacteria  of  a  definite  form  were  found  in  the  coats 
of  the  bowel.  These  bacteria  are  rod-shaped,  and  belong 
therefore  to  the  bacilli ;  in  size  and  shape  they  most  nearly 
resemble  the  bacilli  found  in  glanders.  In  those  cases 
in  which  the  bowel  showed  the  slightest  changes  to  the 
naked  eye,  the  bacilli  were  found  to  have  penetrated  into 
the  follicular  glands  of  the  mucous  membrane,  and  had 
there  given  rise  to  very  considerable  irritation,  as  shown  by 
the  increase  in  the  lumen  of  the  gland,  and  the  collection  of 
many  nucleated  round  cells  in  its  interior.  In  many  cases 
the  bacilli  had  also  penetrated  behind  the  epithelium  of  the 
glands,  and  had  proliferated  between  it  and  the  basement 
membrane  of  the  gland.  They  had,  moreover,  collected  in  con¬ 
siderable  quantities  on  the  surface  of  the  villi,  and  had  often 
penetrated  into  their  substance.  In  the  severe  cases,  which 
had  been  characterised  by  haemorrhagic  infiltration  of  the 
intestinal  mucous  membrane,  the  bacilli  were  found  in  large 
numbers,  and  were  not  limited  only  to  the  interior  of  the 
follicular  glands,  but  had  passed  into  the  surrounding  tissues, 
into  the  deeper  layers  of  the  mucous  membrane,  and  here 
and  there  even  into  the  muscular  coat  of  the  bowel.  The 
villi  were  also  in  such  cases  extensively  invaded  by  the 
bacilli.  The  chief  seat  of  these  changes  is  the  lower  por¬ 
tion  of  the  small  intestine.  Had  not  this  investigation 
been  made  on  quite  recent  cadavers,  the  result  would  have 
been  of  little  or  no  value,  for  putrefaction  is  able  to  pro¬ 
duce  in  the  intestine  exactly  similar  bacterial  growths. 
A  year  ago  I  had  found  these  same  bacilli,  with  a  similar 
distribution,  in  a  choleraic  bowel  which  I  received  direct 
from  India  ;  but  I  had  not  been  able  to  attach  any  value  to 
it  on  account  of  this  very  reason,  for  it  was  always  possible 
that  they  might  be  confounded  with  post-mortem  putrefac¬ 
tive  changes.  Now,  however,  that  any  error  arising  from 
putrefactive  phenomena  can  be  positively  excluded,  this 
earlier  discovery,  made  in  four  different  Indian  cholera  cases, 
acquires  extraordinary  value.  Nor  is  it  an  unimportant 
fact  that  the  agreement  in  the  appearances  of  the  bowel  in 
Indian  and  Egyptian  cholera  furnishes  a  further  proof  of 
the  identity  of  the  two  diseases. 

The  number  of  cadavers  examined  is  certainly  small ;  but, 
as  the  bacilli  were  met  with  in  all  recent  cases  of  cholera, 
while  they  were  absent  in  the  single  case  examined  after  the 
cessation  of  the  cholera-process,  as  well  as  in  several  other- 
cases  dead  from  other  forms  of  disease,  and  examined  with 
special  regard  to  this  point,  there  can  be  no  doubt  that  they 
stand  in  some  sort  of  relation  to  the  cholera  process.  It 
cannot,  however,  as  yet  be  concluded  that  they  are  the  cause 
of  the  cholera.  The  relationship  may  be  quite  the  reverse  ; 
it  being  quite  as  possible  that  the  cholera-process  produces 
such  changes  in  the  intestinal  mucous  membrane  as  to  admit 
the  penetration  into  its  tissues  of  a  definite  bacillus  variety 
of  the  many  parasitic  bacteria  which  are  constantly  met  with 
in  the  bowels.  Which  of  these  two  hypotheses  is  the  correct 
one  —whether  the  infective  process  or  the  bacterial  invasion 
is  the  primary  event -  can  only  be  decided  by  attempting 
to  isolate  the  bacteria  obtained  from  the  diseased  tissues, 
to  cultivate  them,  and  then  to  reproduce  the  disease  by 
inoculation  experiments  on  animals.  For  this  purpose  it  is 
absolutely  necessary  to  have  at  one’s  disposal  animals 
which  are  susceptible  to  the  infective  material  in  question. 
Hitherto,  however,  in  spite  of  every  endeavour,  we  have  not 
succeeded,  in  an  indisputable  manner,  in  conveying  cholera 
to  animals. 

Numerous  experiments  have  been  made  on  rabbits,  por¬ 
poises,  dogs,  cats,  monkeys,  pigs,  rats,  etc.,  but  always  with¬ 
out  success.  The  only  results  of  any  value  in  this  respect 
are  those  of  Thiersch,  who  fed  a  number  of  mice  on  the  con¬ 
tents  of  an  intestine  from  a  cholera  patient,  and  observed 
that  they  were  seized  with  diarrhcea  and  died  This  experi- 
m>  nt  has  been  confirmed  by  trustworthy  investigators,  like 


448 


Medical  Times  and  Gazette. 


HUTCHINSON’S  PRESIDENTIAL  ADDRESS. 


Oot.  20,  1S5S. 


Burdon  Sanderson,  but  it  has  also  been  impugned  by 
others.  Since  it  was  of  the  highest  importance  to  discover 
an  animal  susceptible  of  cholera,  it  was  necessary  to  repeat 
these  experiments.  It  was  very  improbable  that  the  re¬ 
quisite  number  of  mice  could  be  speedily  obtained  in 
Alexandria,  and  fifty  mice  had  already  been  brought  from 
Berlin  for  this  purpose,  and  the  infection  experiments  were 
at  once  commenced  upon  them.  But,  besides  these,  monkeys, 
which  are  the  only  animals  susceptible  of  certain  human  in¬ 
fective  diseases,  such  as  small-pox  and  relapsing  fever,  were 
also  used  for  experiment.  Lastly,  the  attempt  was  also  made 
to  infect  some  dogs  and  chickens.  But,  in  spite  of  every 
endeavour,  these  experiments  have  hitherto  been  entirely 
without  result.  The  most  varied  attempts  were  made,  and 
the  animals  fed  with  the  vomit,  with  the  cholera  dejections, 
and  with  the  contents  of  the  bowel  obtained  post-mortem — 
given  in  some  cases  quite  fresh,  in  others  after  it  had  stood 
for  a  time  in  a  cold  ora  warm  room,  in  others  again  dried, — but 
in  no  case  did  choleraic  symptoms  appear ;  on  the  contrary, 
the  animals  continued  perfectly  well.  Besides  this,  the  bacilli 
found  in  the  contents  of  the  bowels  and  in  the  intestinal 
walls  were  cultivated,  and  animals  were  fed,  and  in  some 
cases  inoculated,  with  the  product.  In  some  cases  septic 
manifestations  followed  inoculation,  but  in  none  was  cholera 
reproduced. 

That  the  materies  morbi  in  an  active  form  is  very  often 
contained  in  the  dejections  of  cholera  patients  is  shown  by 
numerous  facts,  especially  by  the  frequent  infection  of 
washerwomen  who  have  had  to  wash  the  soiled  linen.  A 
case  of  this  kind  occurred  in  the  Greek  Hospital  during  the 
present  epidemic — a  washerwoman,  who  was  exclusively 
employed  on  the  linen  of  cholera  patients,  having  sickened 
of  the  disease. 

It  may  therefore  be  regarded  as  certain,  that  of  the  many 
substances  used  in  the  experiments,  some  at  least  must 
have  contained  infective  material;  and  the  fact  that  no 
result  was  obtained  may  be  attributed  either  to  the  anitnals 
used  being  completely  insusceptible  of  cholera,  or  to  the 
proper  mode  of  infection  having  yet  to  be  discovered.  The 
experiments  shall  be  continued,  and  modified  in  both  direc¬ 
tions,  but  there  is  little  prospect  of  any  result  being  ob¬ 
tained  with  the  material  at  present  at  our  disposal. 

For  it  is  not  very  probable  that  the  reason  of  the  failure 
of  the  infection  experiments  is  to  be  found  in  those  circum¬ 
stances  only.  Thereis  still  a  third  explanation,  for  the  correct¬ 
ness  of  which  there  is  much  to  be  said.  It  is  well  known  that, 
in  any  given  place  attacked  by  cholera,  the  disease  subsides 
long  before  all  the  inhabitants  have  been  affected  by  it ;  and 
although  the  morbid  material  may  be  concluded  to  be  dis¬ 
tributed  widely  over  the  whole  neighbourhood,  yet  fewer 
and  fewer  people  fall  ill,  and  the  epidemic  dies  out  while 
many  individuals  still  remain  capable  of  infection.  This 
phenomenon  is  only  to  be  accounted  for  on  the  hypothesis 
that  towards  the  end  of  the  epidemic  the  infective  material 
declines  in  activity,  or  at  least  becomes  uncertain  in  its 
action.  If,  then,  when  the  epidemic  is  declining,  even 
human  beings  cease  to  be  susceptible  to  the  infection,  it 
is  hardly  to  be  expected  that  the  contrary  should  be  the 
case  with  the  animals  experimented  on,  concerning  whose 
susceptibility  to  cholera  we  as  yet  know  nothing.  In  our 
researches  only  such  subjects  were  available  as  were  to  be 
collected  towards  the  end  of  the  epidemic,  and  their  in¬ 
capability  of  conveying  the  infection  was  to  be  expected 
with  more  or  less  certainty.  It  still  remains  possible  that, 
under  favourable  circumstances — i.e.,  at  the  commencement 
of  an  epidemic, — one  might  succeed  in  infecting  animals, 
and  by  that  means  one  would  at  once  discover  whether  the 
bacilli  which  I  have  shown  to  exist  in  the  intestinal  mucous 
membrane  are  the  true  cause  of  cholera. 

Though,  therefore,  the  results  so  far  obtained  by  the 
Commission  are  still  far  from  completely  solving  the  pro¬ 
blem,  and  though  they  have  little  practical  value  in  the 
struggle  against  cholera,  yet,  considering  the  unfavourable 
circumstances,  and  the  short  duration  of  the  investigation, 
they  may  be  considered  as  very  satisfactory.  They  com¬ 
pletely  answer  the  original  aim  of  the  inquiry,  and,  indeed, 
exceed  it,  inasmuch  as  the  constant  discovery  of  character¬ 
istic  micro-organisms  satisfies  the  first  condition  which 
must  be  fulfilled  in  the  investigation  of  an  infectious  disease, 
and  thus  secure  a  definite  goal  for  further  research. 

From  the  above  statement  it  may  be  gathered  that  in 
Alexandria  the  Commission  will  not  be  able  to  advance 


further  towards  the  solution  of  the  problem  than  it  has: 
hitherto  done. 

[Dr.  Koch  then  states  his  reasons  for  not  advising  that  the 
Commission  should  follow  the  epidemic  in  Upper  Egypt, 
where  the  conditions  would  be  highly  unfavourable  to  the 
investigation,  and  expresses  the  wish  of  himself  and  his 
colleagues  that  they  should  be  allowed  to  continue  their 
researches  in  India,  and  especially  in  Bombay,  where 
a  sudden  cessation  of  cholera  is  not  likely.  He  then 
continues : — ] 

I  have  now  to  communicate,  the  result  of  certain  under¬ 
takings  which  the  Commission  has  found  opportunity  to 
carry  out  concurrently  with  their  investigations  on  cholera. 
Egypt  is  very  rich  in  parasitic  and  infectious  disorders,  and' 
it  was  therefore  not  difficult  to  obtain  appropriate  subjects 
for  research,  partly  with  the  view  of  securing  comparisons 
controlling  the  results  obtained  in  connexion  with  cholera, 
and  partly  with  the  view  of  arriving  at  further  conclusions, 
in  certain  important  general  questions  regarding  infective 
diseases. 

Thus  I  have  so  far  dissected  two  cases  of  dysentery.  In 
the  one,  which  ran  an  acute  course,  there  were  found  in 
the  intestinal  mucous  membrane  certain  peculiar  parasites, 
which  do  not  belong  to  the  group  of  bacteria,  and  were- 
hitherto  imknown. 

Next,  at  the  Arabian  Hospital,  I  dissected  an  Arab  who- 
had  died  of  intestinal  splenic  fever  (Darmmilzbrand).  The 
disease  is  probably  traceable  to  infection  from  sheep,  which 
are  imported  in  great  numbers  into  Egypt  from  Syria,  and 
die  here  largely  of  splenic  fever. 

Further,  I  had  the  opportunity,  at  the  Greek  Hospital,  of 
observing  six  cases  of  bilious  typhus— a  disease  with  a  con¬ 
siderable  resemblance  to  yellow  fever,  and  of  great  interest 
from  having  been  frequently  confounded  with  that  affection. 
Three  of  the  patients  died.  They  have  been  dissected  by 
me,  and  shall  be  thoroughly  investigated. 

Besides  that,  numerous  investigations  have  been  made  as 
to  micro-organisms  in  the  air  and  drinking-water  of  Alexan¬ 
dria  ;  and,  if  I  have  time,  I  intend  to  make  some  observations 
on  Egyptian  ophthalmia. 


ADDRESS 

DELIVERED  BEFORE  THE 

OPHTHALMOLOGICAL  SOCIETY 

OF  THE  UNITED  KINGDOM, 

On  Thursday,  October  11,  1883. 

By  JONATHAN  HUTCHINSON,  F.R.S., 

Consulting  Surgeon  to  the  London  and  the  Eoyal  London  Ophthalmic- 
Hospitals;  President  of  the  Society. 


Gentlemen, — We  begin  to-day  the  fourth  session  of  the- 
Ophthalmological  Society  of  Great  Britain.  In  the  first 
place  I  must  thank  you  very  heartily  for  the  honour  you 
have  done  me  in  electing  me  your  second  President. 
Appreciating  this  honour  most  highly,  I  yet  accept  it  with 
much  misgiving,  more  especially  when  I  remember  who  has 
been  my  predecessor. 

In  Mr.  Bowman  you  have  enjoyed  the  services  of  a  Pre¬ 
sident  of  unequalled  fitness  and  ability — of  one,  indeed, 
who  had  already  conferred  inestimable  benefits  on  ophthalmic 
science.  His  acceptance  of  the  office  of  President  at  once 
secured  the  success  of  our  infant  Society,  and  in  his  recent 
resignation  of  it  we  have  sustained  a  very  heavy  loss — one 
which,  I  am  well  assured,  it  will  be  quite  out  of  my  power,  in 
any  degree,  to  make  you  forget.  The  chief  satisfaction 
which  I  have,  in  venturing  to  accept  your  invitation  to  suc¬ 
ceed  him,  is  the  knowledge  that  he  still  takes  the  warmest 
interest  in  our  affairs,  and  that  I  shall  always  have  the 
advantage  of  his  advice  and  help. 

It  will  be  my  duty  to  mention  to  you  directly,  facts  which 
will  prove  that,  although  Mr.  Bowman  has  resigned  the 
nominal  presidency,  he  still  occupies  in  relation  to  us  an 
almost  paternal  position.  Long  may  he  live  to  do  so ! 

We  meet  this  evening,  as  you  will  have  observed,  in  rooms 
which  have  been  made  much  more  commodious  since  our 
I  last  session,  and  in  connexion  with  this  subject  I  have  to 


Medical  Times  and  Gazette. 


HUTCHINSON'S  PRESIDENTIAL  ADDRESS. 


Oct.  20,  1883.  4  4  9 


give  you  some  important  items  of  information.  The  first  is, 
that  the  Medical  Society  of  London,  whose  tenants  we  are, 
on  entering  upon  their  greatly  improved  premises,  felt 
themselves  obliged  very  materially  to  increase  our  rent. 
There  was  nothing  in  the  least  unreasonable  in  this ;  indeed, 
our  landlords  have  throughout  acted  towards  us  in  a  liberal 
spirit.  The  proposed  increase  was,  however,  in  respect  to 
our  finances,  a  very  heavy  one,  and  as  the  Council  was 
desirous  to  collect  a  library,  and  to  form  a  museum  of  instru¬ 
ments  and  appliances — both  objects  demanding  outlay, — 
we  found  ourselves  for  a  time  in  a  position  of  great 
difficulty.  It  is  almost  certain  that  the  Society  could  not 
have  afforded  to  continue  in  these  rooms  and  develope  itself 
in  the  proposed  directions  had  it  not  been  helped  by  an  act 
of  scientific  beneficence  not  often  surpassed. 

Having  acquainted  himself  with  the  facts,  and  noting  our 
position,  our  ex-President  made  an  offer  to  the  Council  to 
himself  undertake  the  cost  of  purchase  of  all  fittings  neces¬ 
sary  for  the  museum  and  library,  and  further,  to  make  a 
gift  to  the  Society  annually,  for  twenty  years,  of  the  sum  of 
£50,  in  order  to  defray  the  expenses  of  rent  of  rooms.  Need 
I  say  that  the  Council  on  your  behalf  thankfully  accepted 
Mr.  Bowman’s  munificent  offer,  and  I  have  now  the  pleasure 
of  informing  you  that  we  are,  in  all  probability,  rent-free 
for  twenty  years,  and  shall  be  able  to  devote  the  whole  of 
our  income  from  subscriptions  to  the  publication  of  our 
annual  volume.  I  am  sure  that  you  will  receive  this  most 
liberal  gift  of  your  past  President  as  one  in  the  highest 
degree  worthy  not  only  of  praise  in  the  present,  but  of  imi¬ 
tation  in  the  future.  The  pecuniary  advantages  which  it 
confers  upon  us  are  solid,  extensive,  and  durable ;  but, 
warmly  as  we  appreciate  them,  I  believe  I  may  say  that 
those  who  have  been  most  closely  associated  with  the  early 
years  of  our  Society  derive  yet  greater  pleasure  from  the 
Tact,  that  one  so  competent  to  judge,  should  in  so  emphatic 
a  manner  have  crowned  their  efforts  with  his  approbation. 

I  have  next  to  allude  to  a  remarkable  coincidence.  Mr. 
Bowman’s  offer  was  made  only  about  a  month  ago,  and 
quite  unexpectedly  to  us  all,  whereas  for  at  least  three 
months  before  this,  and  wholly  unknown  to  him,  the 
Council  had  had  under  consideration  a  proposal  to  recog¬ 
nise  his  pre-eminent  position  in  respect  to  ophthalmology 
in  Britain,  and  the  invaluable  services  which  he  had  already 
rendered  to  our  Society.  It  was  from  Hr.  Gowers  that  the 
suggestion  had  first  come  that  we  should  found  a  lecture¬ 
ship  to  be  known  as  the  Bowman  Lecture,  but  it  was  no 
sooner  mentioned  than  it  was  received  with  unanimous 
approbation. 

I  am  anxious,  for  reasons  that  will  be  self-evident,  to 
make  it  clear  that  the  Council’s  endeavour  in  this  slight 
manner  to  do  honour  to  Mr.  Bowman,  and  his  liberal 
endowment  of  the  Society,  had  no  connexion  one  with  the 
other,  although  the  two  projects  ripened  about  the  same 
time.  Hr.  Gowers’  proposal  has  been  several  times  dis¬ 
cussed  in  our  Council  meetings,  and  should  it  meet  with 
your  approbation,  as  I  feel  sure  that  it  will,  the  lecture  in 
question  will  be  founded  forthwith.  Without  wishing 
unduly  to  bind  the  executive  in  future  years,  the  present 
proposal  is  that  a  Bowman  Lecturer  shall  be  appointed  each 
year,  and  invited  to  prepare  for  us  a  critical  summary  of  the 
best  extant  information  upon  some  special  subject  to  be 
selected  by  the  Council,  or,  if  not  selected,  approved  by  it. 

This  lecture  will  probably  be  an  annual  one,  and  will  be 
delivered  at  a  meeting  specially  appointed  for  that  purpose. 
We  hope  in  it  not  only  to  permanently  associate  with  our 
Society  the  name  of  a  great  man,  but  also  to  contribute 
each  year  something  real  towards  that  <c  advancement  of 
knowledge  for  the  good  of  man’s  estate,”  which  has  been 
Mr.  Bowman’s  lifelong  aim. 

With  this  statement  I  end,  gentlemen,  the  announce¬ 
ments  which  it  has  been  my  most  pleasing  duty  to 
make  to  you,  but  I  purpose  before  sitting  down  to  tres¬ 
pass  upon  your  attention  with  a  few  further  remarks  on 
our  general  position  and  the  possible  scope  of  our  future 
work. 

I  think  that  we  may  now  fairly  congratulate  ourselves 
that  the  organisation  of  our  Society,  if  we  regard  it  simply 
as  providing  means  for  the  furtherance  of  research  in 
ophthalmology,  is  well-nigh  perfect.  We  shall  have  regular 
meetings  in  commodious  and  central  rooms,  at  which  any 
subject  which  is  brought  forward  will  be  certain  to  receive 
the  attentive  criticism  of  an  audience,  than  which  none 


exists  better  qualified  for  the  task.  We  invite  in  the 
freest  possible  manner  the  production  of  all  new  facts, 
opinions,  and  suggestions,  whether  relating  to  extended 
series  of  observations  or  isolated  cases.  All  that  concerns 
the  Eye,  whether  in  health  or  disease,  concerns  us,  and 
we  shall  be  thankful  alike  for  the  single  case  and  the 
elaborate  paper.  Nor  is  there,  I  am  happy  to  say,  any 
spirit  of  exclusiveness  as  regards  membership  with  us. 
We  shall  willingly  accept  the  help  of  all  who  take  an 
interest  in  our  pursuits.  Those  who  had  the  largest  share 
in  the  formation  of  this  Society  were  careful  that  it  should 
have  a  wide  basis,  and,  thanks  to  their  foresight,  it  has 
now  the  good  fortune  to  include  amongst  its  members 
many  physicians,  surgeons,  and  others  engaged  in  general 
practice  who  are  not,  and  never  have  been,  in  any  sense, 
specialists. 

To  say  nothing  of  the  original  contributions  which  we 
have  had  from  some  of  these,  their  help  in  our  debates  and 
their  services  on  our  committees  have  been,  and  will  be  in 
the  future,  simply  invaluable.  It  is  true  that  we  have  not 
yet  a  library  of  reference,  nor  a  museum.  But  the  first  of 
these  desiderata  will,  I  doubt  not,  soon  be  supplied,  and  the 
other  will  be  put  in  course  of  formation  to  such  extent  as 
may  suitably  come  within  our  lines  of  work.  We  shall 
probably  never  attempt  the  formation  of  a  pathological 
collection,  since  we  have  no  convenience  for  its  preparation 
or  its  display,  and  there  exists,  besides,  at  other  institutions, 
ample  provision  in  this  direction. 

We  do,  however,  contemplate  the  formation  of  a  collec¬ 
tion  of  instruments  and  appliances,  and  to  this  object  Mr. 
Bowman’s  endowment  will,  as  I  have  said,  be  in  part 
devoted.  Probably  also  we  shall  make  gradually  a  collec¬ 
tion  of  drawings  and  other  forms  of  graphic  illustration. 
These  can  be  easily  classified  and  stored  for  reference  in  the 
drawers  of  our  library.  Should  it  occur  to  any  of  our  more 
wealthy  friends  to  emulate  Mr.  Bowman’s  noble  example, 
I  cannot,  for  my  own  part,  think  of  any  object  to  which  a 
second  endowment  could  be  more  usefully  devoted  than  to 
the  formation  of  such  a  collection. 

Morbid  conditions  of  the  eye,  whether  external  or  revealed 
by  the  ophthalmoscope,  lend  themselves  with  peculiar  facility 
to  the  artist’s  skill.  If  we  had  the  funds  I  would  suggest 
that,  under  the  auspices  of  a  committee,  we  should  copy, 
collect,  and  classify,  from  all  available  sources,  private  and 
public,  published  or  otherwise,  all  such  illustrations  of  eye 
disease  as  are  passably  good  as  to  execution,  and  duly  au¬ 
thenticated  and  described.  With  but  few  exceptions  I  would 
leave  aside  all  in  which  the  history  of  the  individual  case  is 
omitted.  If  this  scheme  were  completed  we  should  find,  if  I 
am  not  mistaken,  that  we  were  in  possession  of  a  sort  of 
clinical  museum  which  would  prove  of  very  great  use  alike  to 
students  and  to  all  engaged  in  original  research.  I  certainly 
count  this  object  as  chief  among  the  very  few  desiderata  for 
which  adequate  provision  has  not  yet  been  made. 

Hitherto  I  have  been  speaking  of  our  arrangements  and 
organisation  as  a  Society  for  the  improvement  of  knowledge 
in  our  special  branch.  To  those  who,  with  me,  believe  that 
it  would  not  be  possible,  in  any  material  degree,  to  alter 
these  arrangements  for  the  better,  it  is,  I  may  repeat,  a 
source  of  great  satisfaction  to  know  that  they  have  received 
the  emphatic  imprimatur  of  our  first  President,  than  whom 
there  is  no  man  living  so  well  qualified  to  judge. 

The  improvement  of  ophthalmic  knowledge  is  unques¬ 
tionably  our  first,  and  by  far  our  principal  duty.  I  cannot 
but  think,  however,  that  it  is  possible  that  in  the  future 
such  societies  as  ours  may  find  another  kind  of  work  open  to 
them,  which  is  only  second  in  importance. 

I  allude  to  the  systematic  and  strenuous  endeavour  to 
diffuse  rapidly  amongst  the  profession  at  large,  for  the 
prompt  benefit  of  our  patients  universally,  all  items  of  new 
knowledge  which  may  have  been  obtained. 

There  are  many  directions  in  which  thoughtful  help 
might  be  given  towards  this  end.-  We  may,  in  the  first 
place,  endeavour  to  induce  as  many  as  possible  to  join  us, 
and  attend  our  demonstrations  and  receive  our  volumes. 
We  shall  not,  however,  in  this  way  reach  any  excepting 
London  residents. 

It  is  perhaps  possible  that  something  might  be  done  to 
make  some  of  our  meetings,  and  the  reports  of  them  which 
appear  in  the  journals,  more  valuable  to  the  bulk  of  the 
profession,  by  becoming  less  definitely  special  than  they  now 
are.  We  might,  for  instance,  bring  forward  for  discussion. 


Medical  Times  and  Gazette 


HUTCHINSON’S  PRESIDENTIAL  ADDRESS. 


Oct.  20,  1S88. 


450 


occasionally,  the  commoner  forms  of  eye  disease — such  as 
are  scarcely  likely  to  be  often  made  the  themes  of  original 
communications.  Not  only  would  this  help  others,  but  it 
is  very  desirable  for  our  own  good  that  we  should  occa¬ 
sionally  make  recapitulation  in  public  of  our  knowledge  of 
common  things,  and  thus  ascertain  how  far  our  opinions 
have  advanced  towards  unanimity. 

There  is  another  branch  of  the  same  topic  on  which  I 
incline,  if  you  will  permit  me,  to  enter  into  a  little  more 
detail,  since  it  offers  possibly  a  sphere  for  much  useful  work 
in  the  future  on  the  part  of  societies  like  ours.  It  is  one, 
indeed,  to  which  perhaps  this  Society  in  particular  is  more 
specially  called  than  any  other.  I  refer  to  the  promotion 
of  what  may  be  named  every-day  therapeutics.  It  is 
obviously  quite  possible  that  the  knowledge  of  diseases  of 
the  eye  might  be  cultivated  by  a  few  up  to  a  point  of  very 
high  excellence,  and  with  great  finish  of  detail,  and  yet 
remain  a  possession  of  the  specialist,  and  benefit  but  little 
the  family  practitioner,  and  the  public  his  patients.  In 
some  degree  this  state  of  things  is  unavoidable,  and  in 
some  departments  of  our  practice  we  cannot  hope  to  ever 
escape  it.  Still,  however,  it  will  be  admitted  by  all  to  be  a 
matter  of  regret.  So  far  as  we  can  do  it,  it  is  our  duty  to 
make  such  knowledge  popular — to  diffuse  it  over  an  area 
the  widest  that  we  can  obtain.  A  practical  knowledge  of 
astigmatism  is  not  to  be  expected  from  a  general  prac¬ 
titioner  ;  possibly  not  even  from  all  who  are  engaged  in  the 
treatment  of  eye  diseases  as  a  specialty.  The  attempt  to 
use  the  ophthalmoscope  for  purposes  of  diagnosis,  although 
quite  possible  to  a  large  section  of  the  younger  part  of  the 
profession,  enjoying  constant  opportunities  and  fresh  from 
hospital  training,  would  probably,  to  by  far  the  greater  part, 
prove  to  be  a  source  of  error  rather  than  a  help. 

Skill  in  the  diagnosis  and,  as  a  necessary  consequence,  in 
the  treatment  of  a  not  inconsiderable  group  of  rare  dis¬ 
eases  of  the  eye,  must  always,  despite  any  development  of 
education  which  it  is  reasonable  to  hope  for,  and  any  arti¬ 
ficial  aid  which  ca.n  possibly  be  given,  remain  the  possession 
of  the  specialist  only.  But  it  is  otherwise  in  respect  to  a 
majority.  Almost  all  the  examples  of  the  commoner  forms 
of  eye  disease  come  under  the  care,  in  the  first  instance  and 
often  throughout,  of  those  who  are  not  specialists,  and  have 
perhaps  never  even  had  any  training  in  an  ophthalmic  hos¬ 
pital.  Circumstances  over  which  no  one  has  any  control 
render  this  inevitable.  Whether  or  not  the  surgeons  con¬ 
cerned  desire  it,  they  must  perforce  take  charge  of  “  eye 
cases  ”  as  well  as  of  others.  It  is  in  reference  to  practitioners 
so  placed  that  I  w'Oirld  suggest  that  our  Society  has  possibly 
a  duty  to  perform.  If  I  trouble  you  with  a  few  examples,  I 
shall  probably  be  best  able  to  convey  my  meaning. 

Concerning  the  treatment  of  syphilitic  iritis,  there  is  pro¬ 
bably  but  little  hesitation  or  difference  of  opinion  amongst 
specialists,  and  perhaps  I  could  hardly  mention  another 
disease  respecting'which  the  opinions  of  specialists  are  more 
widely  known  and  accepted.  That  atropine  should  be  used 
from  the  first,  frequently,  freely,  and  in  strong  solution, 
and  that  mercury  and  iodide  of  potassium  are  very  useful 
and  ought  always  to  be  given,  but  in  no  degree  compare  in 
importance  with  mydriatics,  I  take  to  be  the  acknowledged 
canon.  It  would  be  easy  to  prepare  an  explicit  schema  for 
the  treatment  of  this  disease,  giving  the  exact  strength  of 
the  atropine,  the  frequency  of  its  application,  the  precise  dose 
of  the  mercurial,  and  suggesting  a  few  of  the  more  impor¬ 
tant  means  which  help  success,  such  as  a  purgative,  leeches 
to  the  temples,  and  low  diet.  This  might  be  done  in  ten 
lines,  and  so  printed  in  a  visiting-list  or  pocket-book  that  it 
should  be  readily  accessible  to  all.  It  would  be  better  that 
such  a  schema  should  be  propounded  under  the  auspices  of 
a  society  than  that  it  should  come  from  an  individual. 
In  many  parallel  instances,  the  discussion  and  examina¬ 
tion  which  such  schemata  of  treatment  would  receive 
at  the  hands  of  our  Society  would,  no  doubt,  be  of  great 
use  in  perfecting  them,  as  well  as  adding  to  their 
authority. 

I  do  not  doubt  that  there  are,  at  the  present  moment, 
whilst  I  am  speaking  to  you,  in  the  homes,  the  schools,  the 
workhouses,  and  the  hospitals  of  England,  some  thousands 
of  children  who  are  suffering  from  ulcerations  on  the  cornea, 
attended  with  intolerance  of  light,  causing  the  patient  great 
distress  and  annoyance  through  many  months,  and  des¬ 
tined  often  to  leave  disfiguring  and  incapacitating  scars. 
If  my  own  experience  may  be  trusted,  I  believe  that  three- 


fourths  of  these  would  be  almost  well  in  the  course  of  a  fort¬ 
night  under  the  use  of  a  very  weak  yellow  oxide  ointment. 
Many  of  them,  no  doubt,  are  getting  it,  but  a  considerable 
majority  probably  are  not;  for  the  rule  of  treatment  is  not 
yet  universally  acknowledged  amongst  specialists,  and 
certainly  not  very  widely  known  in  the  profession. 

If  this  Society  could,  after  an  examination  of  the  subject, 
determine  upon  the  recommendation  of  an  explicit  formula 
which  would  be  likely  to  result  in  the  prompt  cure  of  these 
very  troublesome  cases,  it  would  confer  an  immense  boon 
upon  the  public.  Such  a  formula,  so  recommended,  would 
be  copied  into  every  medical  journal  and  into  every  manual. 
It  would  be  reprinted  over  and  over  again,  and  would  become 
the  pi’operty  of  the  whole  profession. 

Is  it  not  somewhat  humiliating  to  reflect  that  if  a  quack 
■were  to  bring  out  a  very  weak  Piigenstecher’s  ointment,  give 
it  a  telling  name,  and  push  it  into  notice  as  a  specific  for 
chronic  inflammations  of  the  eye,  he  would  be  a  public 
benefactor  ?  No  doubt  it  would  often  be  used  in  error,  but 
it  would  even  then  do  little  or  no  harm,  and  I  have  not  the 
least  doubt  that  the  balance  of  gain  would  enormously  pre¬ 
ponderate.  My  own  experience  has  been,  that  since  I 
knew  the  virtues  of  this  ointment  I  have  been  able  to 
abandon  almost  entirely  the  use  of  blisters,  setons,  and  like 
painful  measures,  and  to  effect  the  cure  in  a  tenth  of  the 
time.  I  have  reason  to  think  that  a  large  majority  of 
ophthalmic  specialists  have  had  a  like  experience.  Yet  we 
hesitate  to  come  boldly  before  the  general  profession  and 
announce  loudly  an  important  item  of  progress.  We  fear 
to  boast,  we  dread  to  impair  the  scientific  spirit  by  the 
formation  prematurely  of  general  rules ;  and,  seeking  to 
quiet  our  consciences  by  reminding  ourselves  that  after  all 
the  thing  is  no  secret,  we  do  nothing  further  in  the  matter. 
Our  i*eticence  is  a  loss  to  the  nation,  it  is  an  injury  to 
hundreds  and  to  thousands  whom  the  benefits  of  modern 
ophthalmological  science  might  reach  if  we  would  only  con¬ 
sent  to  throw  away  our  scruples.  Is  it  not  a  frequent  failing- 
amongst  the  more  scientific  part  of  our  profession  to  become 
superfine  P  We  dread  the  spirit  of  the  charlatan  and  the 
self-seeker  so  much,  that  we  come,'dike  David  when  in  pre¬ 
sence  of  the  sinner,  to  hold  our  peace  even  from  good.  In 
the  individual,  scrupulous  care  in  these  respects  is  most  meri¬ 
torious  ;  nothing  is  less  to  be  desired  than  that  those  who 
believe  themselves  to  have  made  therapeutic  discoveries 
should  deem  it  their  duty  to  proclaim  them  ostentatiously. 
Let  them  be  brought  forward  in  the  first  instance  quietly, 
and  under  the  cognisance  only  of  those  skilled  to  judge  of 
them. 

But  the  fact  that  it  is  meritorious  in  individuals  to  abstain 
from  pushing  their  favourite  remedies,  only  throws  the  duty, 
to  which  I  have  been  alluding,  the  more  definitely  upon 
public  bodies  like  ourselves.  No  one  could  impugn  our 
motives  or  doubt  our  sincerity,  and  our  verdicts  would  be- 
received  not  certainly  as  final,  but  as  entitled,  at  any  rate, 
to  a  temporary  acceptance. 

Let  no  one  suspect  me  of  wishing  to  stereotype  knowledge 
or  to  damp  the  ardour  of  any  skilled  person  in  the  endeavour 
yet  further  to  improve  our  therapeutic  resources.  There  is 
no  fear  in  that  direction  ;  and  what  I  am  concerned  to  assert 
is  this,  that  nine  out  of  ten  of  the  practising  part  of  the 
profession  would  most  thankfully  receive  from  this  Society 
detailed  schemata  for  the  treatment  of  various  typical 
forms  of  eye  disease.  Let  met urther  add — without,  I  hope, 
hurting  anyone’s  feelings — that  I  feel  sure  the  use  of  them 
would  tend  immensely  to  the  benefit  of  their  patients  as 
compared  with  the  extemporised  prescriptions  now  employed. 
It  is  not  in  the  power  even  of  the  most  laborious  of  those? 
engaged  in  family  practice,  to  keep  their  minds  well  stored 
with  details  respecting  the  management  of  diseases  which, 
although  very  common  with  us,  are  rarities  to  them. 

I  might  easily  mention  a  number  of  'special  types  and 
forms  of  eye  disease— purulent  ophthalmia,  rheumatic  iritis, 
episcleritis,  catarrhal  ophthalmia,  glaucoma,  and  the  like — 
for  which  definite  schemes  of  treatment  could  easily  be  laid 
down.  It  will,  I  have  no  doubt,  be  objected,  that,  after  all, 
successful  treatment  depends  upon  the  correctness  of  the 
diagnosis.  This  statement  is  almost  as  obvious  as  was  the 
famous  injunction  to  “  first  catch  your  hare.”  It  is  [no 
reason  that  because  diagnosis  is  difficult,  therapeutics  should 
be  left  in  a  muddle  also. 

I  might  urge  further  that  I  believe,  working  on  the  same 
lines,  this  Society  might  do  much  to  put  the  diagnosis  of 


BASTIAN  ON  CEREBRO  -  SPINAL  SCLEROSIS.  Oct.  20,1893.  451 


Medical  Times  and  Gazette. 


eye  diseases  more  easily  within  the  reach  of  British  prac¬ 
titioners  in  general. 

There  is  no  one  present  who  has  not  been  pained  over 
and  over  again  by  having  to  treat  cases  of  glaucoma  which 
were  brought  to  him  too  late.  In  spite  of  all  that  has  been 
done  by  specialists,  and  in  spite  of  the  fame  which  iridec¬ 
tomy  cures  have  obtained,  it  is  still  the  fact  that  a  large 
proportion  of  cases  of  acute  glaucoma  are  unrecognised 
during  the  first  fortnight  by  those  under  whose  observation 
the  patients  come.  Practitioners  of  the  most  scrupulous 
care,  of  wide  general  information,  and  the  most  conscientious 
regard  for  their  patients’  good,  are  yet  very  commonly  mis¬ 
led  by  the  acute  congestion  and  severe  constitutional  symp¬ 
toms  which  often  attend  the  early  stages  of  this  disease. 

It  was  my  fortune,  some  years  ago,  to  operate  upon  three 
cases  of  this  kind  in  one  week,  in  all  of  which  the  proper 
time  for  interference  had  been  allowed  to  pass  by,  on  account 
•of  the  patients’  severe  general  illness. 

In  one  instance  I  became  acquainted  with  the  facts  of  a 
-case  in  which  a  benevolent  country  surgeon,  aided  by  two  or 
three  friends,  was  himself  maintaining  a  lady  who  had  lost 
her  sight,  and  consequently  her  occupation,  from  double 
acute  glaucoma.  He  had  himself  attended  her  from  the 
beginning,  and  when  I  gently  hinted  at  the  possibility — to 
me,  a  practical  certainty — that  iridectomy  at  the  proper  time 
would  have  saved  the  lady’s  sight  for  the  rest  of  her  life, 
he  promptly  replied  “that  the  eyes  were  so  much  inflamed 
in  the  first  instance,  and  the  patient  so  ill,  that  he  was  quite 
sure  I  should  never  have  thought  of  operating.”  I  said  no 
more,  for  it  would  have  been  cruel  to  tell  him  that  these 
were  the  very  symptoms  which  denoted  the  necessity  for  an 
-operation. 

Some  years  ago,  in  the  early  days  of  the  keratome,  I  felt 
so  strongly  on  this  subject  that  I  had  some  thoughts  of 
engaging  a  full  page  in  the  Lancet  for  a  big  red-lettered 
anonymous  advertisement,  so  staring  that  all  must  read  it, 
stating  in  a  dozen  words  the  symptoms  and  inevitable  re¬ 
sult  of  glaucoma,  together  with  the  certainty  of  its  cure  by 
operation. 

And  now,looking  back  upon  suchimpulses  of  enthusiasm,  I 
do  deliberately  declare  my  conviction  that  a  society  like  our 
•own  wouldhave  beenmore  than  justified  in  taking  such  a  step. 
At  that  time  acute  glaucoma  probably  had,  on  British  soil 
alone,  its  daily  victim,  whom  it  left  in  irrevocable  blindness. 
In  the  present  day  the  number  has  been  greatly  dimin¬ 
ished,  but  it  is  still,  no  doubt,  very  considerable.  Our  confi¬ 
dence  in  the  remedy  which  we  then  hailed  has  remained 
unshaken ;  and  it  is  most  certainly  a  very  melancholy 
thought,  that  there  are  thousands  now  living  without 
■sight  who  might  have  saved  it  very  easily  had  there 
-existed  any  efficient  means  for  the  rapid  diffusion  of  the 
mew  knowledge. 

I  must  not  trespass  further  upon  your  patience  in  this 
matter.  Briefly,  what  I  desire  to  urge  is  this,  that  we  ought 
not  to  be  content  with  doing  our  utmost  to  make  know¬ 
ledge  perfect,  and  to  secure  its  application  in  our  own  imme¬ 
diate  spheres  of  action,  but  that  it  is  well  worth  a  thought 
whether  societies  like  our  own  have  not  duties  to  perform  in 
respect  to  its  diffusion.  I  will  not  for  a  moment  doubt  that 
a  subject  so  important  will  receive  from  you  such  attention 
as  your  judgments  may  deem  it  entitled  to. 

Is  it  too  much  to  hope  that  something  of  the  nature  of  a 
compendium  of  ophthalmic  therapeutics  may  sometime  be 
prepared,  which  shall  bear  the  authority  of  a  society’s  con¬ 
sensus  ?  Such  a  code  should  of  course  be  destined  to  modi¬ 
fication  from  time  to  time,  but  it  would  probably  from  the 
first  be  a  great  advance  upon  the  statements  of  any  indi¬ 
vidual,  both  in  explicitness,  in  brevity,  and  in  the  amount 
■of  practical  experience  which  it  would  summarise. 

Should  the  Society  see  its  way  in  the  future  to  any  action 
in  this  matter,  much  collateral  advantage  might  be  expected 
by  the  more  detailed  attention  to  therapeutics  which  would 
he  given  by  the  committees  appointed  to  report. 

Had  time  permitted,  I  might  have  ventured  to  bring 
before  you  a  few  other  suggestions  as  to  work  which  the 
Society  might  undertake  collectively — such,  for  instance, 
as  a  systematic  examination  of  symptoms  with  the  object  of 
defining  and  describing  them  more  accurately ;  of  prepar¬ 
ing-  detailed  lists  of  the  more  rare  types  and  forms  of  disease, 
and  giving  to  each  its  concise  description  ;  and  possibly, 
after  this  were  done,  of  preparing  nosological  lists  which 
might  assist  the  labours  of  hospital  registrars. 


AN  ANOMALOUS  CASE  OF  CEREBRO¬ 
SPINAL  SCLEROSIS,  (a) 

By  H.  CHAELTON  BASTIAN,  M.D.,  F.E.C.P.,  F.E.S.,  etc. 

Professor  of  Pathological  Anatomy  at  University  College, 
Physician  to  University  College  Hospital,  etc. 

Joseph  H.  had  been  under  observation  at  University  College 
Hospital  from  time  to  time  since  the  year  1877.  He  died 
on  March  24, 1882,  being  then  sixty-two  years  of  age.  There 
was  a  neurotic  history;  no  syphilis.  In  August,  1868  (then 
aged  forty-nine),  he  fell  down  a  flight  of  stone  steps.  The 
patient  dates  his  illness  from  eighteen  months  after  the 
accident,  when  he  began  to  complain  (1)  of  dragging  of  the 
left  foot  in  walking,  (2)  of  tingling  at  the  tips  of  left  fingers, 
and  (3)  of  deafness  in  left  ear.  After  twelve  months  the  first 
of  these  symptoms  had  disappeared  ;  the  other  two  remained. 
Four  years  and  a  half  later  his  left  leg  again  began  to  be 
weak.  This  was  soon  followed  by  weakness  of  the  right  arm 
and  leg,  and  deafness  on  the  right  side.  From  August,  1876, 
he  became  gradually  worse.  He  was  first  admitted  into  the 
hospital  in  October,  1877.  He  then  suffered  from  paresis  in 
all  limbs ;  tingling  in  both  hands  ;  deafness  and  noises  in 
both  ears ;  giddiness ;  occasional  headache  ;  and  pains  in  the 
eyeballs.  There  was  no  optic  neuritis  now  or  later  on.  There 
was  no  definite  mental  defect,  but  speech  was  indistinct  and 
slow,  with  separate  pronunciation  of  each  syllable.  Motor 
cranial  nerves  not  distinctly  affected.  Deglutition  natural. 
He  stands  and  walks  only  with  much  difficulty.  There  was 
considerable  rigidity  of  both  legs,  and  some  loss  of  power  over 
the  bladder.  Knee-jerk  present,  and  equal  on  two  sides.  No 
tremors,  either  spontaneous  or  on  movement,  in  either  lower 
extremity.  He  left  the  hospital  early  in  1878,  walking 
slightly  better,  but  otherwise  in  much  the  same  condition. 
Early  in  July,  1880,  the  patient  was  again  admitted  under 
my  care.  His  intellect  was  unimpaired;  voice  even  more 
drawling  and  slow ;  deglutition  natural.  The  chief  altera¬ 
tions  in  his  condition  were  these :  — Loss  of  all  power  of  walk¬ 
ing  and  of  standing  without  assistance ;  loss  even  of  power 
of  "raising  feet  from  bed ;  loss  of  power  over  right  hand  (so 
that  he  could  not  feed  himself  or  write  with  it  as  previously), 
with  slightly  increased  force  of  grip  on  left  side  ;  much  more 
paralysis  of  trunk-muscles  ;  the  occurrence  of  the  so-called 
« tache  cerebrale,”  and  of  “  factitious  urticaria,”  after  slight 
and  more  severe  irritation  respectively  of  skin;  burning 
pains  in  trunk  and  limbs.  The  joints  of  the  upper  extremi¬ 
ties  were  now  rigid,  and  the  muscles  were  wasted.  The  right 
leg  wa.s  slightly  flexed  at  the  knee,  the  left  extended  at  all 
joints;  some  rigidity  on  both  sides.  Muscles  irritable  to 
mechanical  stimuli,  and  the  interrupted  current  produced  a 
tetanic  condition  of  the  muscles  of  the  lower  extremities  to 
which  it  was  applied.  Both  ankle-clonus  and  exaggeration 
of  knee-jerk  well  marked,  especially  on  the  left  side.  There 
were  Still  no  spontaneous  tremors  or  fibrillary  twitchings  in 
any  parts,  and  no  tremors  on  movement.  Morning  tem¬ 
perature  often  above,  and  evening  temperature  often  below, 
the  normal— 99-5°  and  97-5°  respectively.  About  this  time, 
too,  the  patient  became  more  emotional,  crying  and  laughing 
frequently,  and  on  slight  provocation.  He  left  the  hospital, 
at  his  own  desire,  on  October  14,  1880,  but  was  again 
admitted  under  my  care  on  January  2,  1S82.  Still  no 
intellectual  impairment ;  speech  and  deafness  as  before ; 
deglutition  still  unimpaired.  Tongue  protruded  in  straight 
line.  No  tremors.  Eight  upper  extremity  rigidly  flexed 
and  motionless  ;  on  left  side  slight  power  of  movement 
at  all  joints.  No  power  of  moving  any  part  of  either 
lower  extremity.  No  control  over  fasces.  Eetention  of 
urine,  with  dribbling  and  some  cystitis.  Breathing  wholly 
diaphragmatic.  Intercostals  almost  completely  paralysed. 
Widespread  numbness,  with  diminution  of  sensibility. 
Superficial  reflexes  all  abolished.  Knee-jerk  exaggerated 
as  before.  Ankle-clonus  easily  obtained  on  left,  absent 
on  right  side,  though  it  returned  two  or  three  weeks  later. 
Factitious  urticaria  still  easily  obtainable.  During  the  next 
two  months  the  patient  suffered  from  frequent  emotional  dis¬ 
turbances— strange  dreams  of  a  terrifying  nature,  and  many 

(a)  Abstract  of  a  paper  read  before  the  Clinical  Society  at  the  meeting 
on  October  12,  1883. 


4.52 


Medical  Times  and  Gazette. 


MEDICAL  AND  SURGICAL  PRACTICE. 


Oct.  20,  1883. 


painful  subjective  sensations.  On  March  15it  was  found  that 
the  patient  had  wasted  considerably  since  the  beginning  of 
January.  About  this  time  his  appetite  failed,  his  tongue 
became  thickly  furred,  and  his  temperature  rose  slightly. 
Fresh  cystitis,  with  blood  in  the  urine,  appeared;  and  bron¬ 
chitis,  from  which  he  had  been  suffering  slightly  for  about 
a  month,  became  gradually  worse.  He  died  asphyxiated  on 
March  25,  having  been  quite  unable  to  expectorate  any  mucus. 

Axdo'psy  (twenty  hours  after  death). — Brain:  Meninges 
healthy;  slight  amount  of  subarachnoid  serum.  On  the 
under  surface  of  the  pons  two  superficial  grey  patches 
were  seen  One  of  them,  a  quarter  of  an  inch  in  diameter, 
was  situated  near  the  middle  line,  contiguous  to  the  ex¬ 
tremity  of  the  left  anterior  pyramid  of  the  medulla,  which 
was  flatter  than  natural,  and  had  a  greyish  tinge  almost 
uniformly  throughout  its  substance.  The  right  anterior 
pyramid  on  section  was  also  found  to  show  much  grey  de¬ 
generation,  though  less  than  its  fellow.  Sections  through 
other  parts  of  the  medulla  and  through  the  pons  showed 
many  greyish-red  patches  of  sclerosis,  varying  in  diameter 
from  a  pea  to  a  mustard-seed.  The  root  of  the  right  auditory 
nerve  for  nearly  half  an  inch  was  distinctly  grey  and  semi- 
translucent.  On  the  left  side  this  was  less  marked  in  the 
superficial  portion  of  the  auditory  root.  The  other  cranial 
nerves  were  apparently  healthy.  The  white  substance  of 
both  cerebral  hemispheres,  but  especially  that  of  the  pos¬ 
terior  half  of  the  left  hemisphere,  showed  small  grey  areas 
here  and  there.  In  one  section,  through  the  region  men¬ 
tioned,  about  fifteen  small  patches  were  seen  within  a  space 
of  about  two  and  a  half  square  inches.  None  of  them  seemed 
to  implicate  the  cortical  grey  matter.  The  lining  membrane 
of  the  lateral  ventricles  was  thickened  and  very  tough,  and 
grey  patches  of  discolouration  were  seen  here  and  there  on 
the  surface  of  the  thalami.  On  section,  similar  patches  were 
found  through  different  parts  of  the  interior  of  both  thalami, 
but  the  corpora  striata  and  the  cerebellum  were  free  from 
them.  Spinal  Cord  :  Meninges  healthy.  Cord  presenting 
no  unnatural  appearances  externally.  When  sections  were 
made,  the  antero-lateral  columns  seemed  to  occupy  an  area 
relatively  smaller  than  natural.  No  distinct  changes  of 
textui’e  were  recognisable  by  the  naked  eye  on  the  cut  sur¬ 
faces  in  the  eight  or  nine  places  in  which  sections  were 
made ;  but  after  the  cord  had  been  immersed  for  some 
time  in  bichromate  of  ammonia,  areas  of  degeneration  were 
easily  recognisable  when  fresh  sections  were  made.  A  well- 
marked  patch  was  seen,  for  instance,  in  the  left  cervical 
region,  implicating  a  large  portion  of  the  lateral  column, 
as  well  as  a  portion  of  the  contiguous  grey  matter.  Smaller 
patches  also  existed  in  this  region,  in  the  lateral  column  of 
the  right  side.  In  the  lower  dorsal  region  a  distinct  tract 
of  sclerosis  occupied  the  central  portions  of  the  posterior 
columns  on  each  side  of  the  middle  line.  In  other  por¬ 
tions  of  the  dorsal,  and  in  the  lumbar  regions,  no  very 
distinct  patches  of  degeneration  were  seen  with  the  naked 
eye,  but  on  subsequent  microscopical  examination  a  dif¬ 
fuse  overgrowth  of  connective  tissue  (not  taking  the  form 
f  f  limited  patches  or  tracts)  was  seen  in  many  parts  of  the 
lateral  and  of  the  posterior  columns.  The  nerve-cells  also, 
but  especially  in  the  lumbar  region,  were  very  notably 
atrophied.  The  central  canal  was  enlarged  throughout  the 
whole  of  the  cord,  and  densely  packed  with  small  round 
cells.  The  patches  of  degeneration  in  the  medulla  and 
« ther  parts  of  the  brain  presented  all  the  typical  characters 
of  a»eas  of  sclerosis  in  nerve-tissue. 

Charcot,  in  his  admirable  account  of  “  disseminated  scle¬ 
rosis,”  says  :  “  It  rarely  shows  itself  after  thirty  years.  The 
age  of  forty  seems,  on  the  other  hand,  to  be  the  outside 
limit  to  which  patients  attacked  with  disseminated  sclerosis 
attain.”  It  is  worthy  of  note,  therefore,  that  in  the  case  of  J.H. 
the  disease  first  showed  itself  when  he  was  over  fifty  years 
of  age,  and  that  the  patient  lived  to  attain  the  age  of  sixty- 
two.  In  regard  to  etiology,  the  only  points  to  attract  atten- 
lion  are— first,  some  evidence  of  a  neurotic  tendency ;  and, 
secondly,  the  fall  over  a  flight  of  steps  eighteen  months 
before  the  first  distinct  signs  of  the  disease.  The  arrest  of 
the  disease  for  four  years  and  a  half,  and  the  symmetry  of 
its  manifestation  after  this  date,  are  interesting  features. 
Although  the  patches  of  degeneration  were  so  numerous  in 
the  medulla  and  in  the  pons,  convulsions  were  absent  from 
fir.-t  to  last.  Again,  it  is  worthy  of  note  that  the  charac¬ 
teristic  tremors  on  movement,  which  so  frequently  constitute 
a  marked  feature  in  this  disease,  were  also  absent  rom  first 


to  last.  The  early  weakening  of  cerebral  control  over  the 
bladder  was  probably  due  to  the  existence  of  an  extreme 
amount  of  disease  in  both  anterior  pyramids.  Although  the 
sclerosis  of  the  anterior  pyramids  (and  especially  of  that  on 
the  left  side)  was  so  marked,  yet  nothing  like  a  secondai’y 
degeneration  existed  in  either  lateral  column  of  the  cord. 
This  is  in  harmony  with  what  might  have  been  expected, 
since  it  is  well  known  that  in  these  patches  of  sclerosis  the- 
axis-cylinders  are  not  commonly  destroyed,  although  they 
are  more  or  less  pressed  upon  and  damaged.  It  could  not 
be  expected,  therefore,  that  the  same  results  would  follow 
from  a  patch  of  sclerosis,  however  well  developed,  involving 
the  anterior  pyramids,  as  might  be  looked  for  from  a  de¬ 
structive  lesion  ( e.g .,  a  traumatic  section  or  a  complete  soft¬ 
ening).  It  seems  probable  that  the  hallucinations  and 
abnormal  sensory  phenomena  which  occurred,  especially 
during  the  last  few  months  of  life,  were  due  to  the  late  de¬ 
velopment  of  patches  of  sclerosis  in  the  thalami  as  well  as 
in  the  white  substance  of  the  posterior  third  of  each  cerebral 
hemisphere.  The  power  of  provoking  in  this  case,  over  a 
period  of  several  years,  both  a  “  tache  cerebrate  ”  and  “  facti¬ 
tious  urticaria ”  are  interesting  facts  in  themselves,  and 
especially  from  the  point  of  view  of  the  pathogenesis  of  this 
latter  condition.  In  regard  to  diagnosis,  it  was  pointed  out 
that  in  the  early  stages  of  this  patient’s  illness  all  the 
symptoms  were  to  be  accounted  for  by  a  disease  of  the 
medulla  oblongata,  and  that  the  evidence  even  at  that  time 
was  clearly  against  the  existence  of  a  tumour,  and  in  favour 
of  disseminated  sclerosis  involving  this  region  in  such  a  way 
as  successively  to  abolish  the  functions  of  the  auditory 
nerves  without  interfering  with  the  portio  dura,  and  again: 
of  impairing  the  power  of  articulation  whilst  it  left  that  of 
deglutition  intact.  The  subsequent  progress  of  the  case  was 
felt  to  strengthen  the  diagnosis  of  disseminated. sclerosis. 


REPORTS  OF 

HOSPITAL  PRACTICE  IN  MEDICINE 
AND  SURGERY. 

- ♦ — - - 

CHARING-CROSS  HOSPITAL. 


REMOVAL  OF  THE  GREATER  PORTION  OF  BOTH 
UPPER  JAW-BONES,  WITHOUT  EXTERNAL  IN¬ 
CISION. 

(Under  the  care  of  Mr.  BELLAMY.) 

[For  the  rotes  of  this  case  we  are  indebted  to  Mr.  B.  “W.  Thomas, 
the  Dresser.] 

The  patient,  a  man  fifty-eight  years  of  age,  was  admitted 
under  Mr.  Bellamy’s  care,  September  27,  1883,  with  ex¬ 
tensive  epithelioma  invading  the  entire  palate,  and,  as  far  as 
could  be  made  out,  both  superior  maxillae. 

The  family  history  of  the  patient  is  good.  There  is  no 
history  of  specific  or  malignant  disease  to  be  obtained. 

History  of  Patient.— He  has  for  the  greater  part  of  his 
life  enjoyed  good  health.  When  ten  years  old  he  “  suffered 
from  typhus  fever,”  and  has  since  had  occasional  attacks  of 
sciatica.  Three  months  ago  he  attended  as  an  out-patient; 
of  this  hospital,  suffering  from  external  haemorrhoids. 
Five  months  ago,  patient  noticed  a  small  swelling  in  the 
roof  of  his  mouth,  lying  behind  the  incisor  teeth  of  the  right 
jaw.  He  saw  a  medical  man,  who  said  it  was  an  abscess, 
and,  on  opening  it  with  a  lancet,  there  was  no  discharge.. 
As  the  sore  in  the  roof  of  his  mouth  appeared  to  be  spread¬ 
ing  fast,  there  being  at  the  same  time  a  foul  discharge,  he 
came  to  this  hospital. 

Condition  on  Admission. — On  examination,  a  large  ulcer 
was  seen  in  the  roof  of  his  mouth,  extending  forwards  to 
the  incisor  teeth,  and  backwards  so  as  to  involve  the  soft 
palate,  outwards  on  the  right  side  to  the  molar  teeth  (several 
of  these  and  one  bicuspid  had  dropped  out  from  the  exten¬ 
sion  of  the  disease).  The  ulcer  extended  also  for  a  slight 
distance  to  the  left  of  the  median  line  ;  the  edges  of  the 
ulcer  were  thickened  and  everted,  and  its  base  was  covered 
with  a  foul  slough.  A  probe  could  be  passed  through  the 
hard  palate  into  the  right  nostril.  Patient  was  unable  to 
breathe  through  his  right  nostril,  from  which  there  was  a 
most  offensive  discharge.  There  was  no  appreciable  en¬ 
largement  of  the  glands  in  the  neighbourhood  of  the  lower 
jaw. 


Med’cnl  Times  and  Oa7:“t*e. 


THE  FEDERATION  OF  THE  LONDON  SCHOOLS. 


Oct.  20,  1S?3.  453 


Operation  (October  4). — Complete  anaesthesia  being  pro- 
educed,  Mr.  Bellamy  extracted  the  teeth  of  the  upper  jaw 
with  forceps  ;  he  then  performed  Rouge’s  operation  of  de¬ 
taching  and  raising  the  upper  lip  and  nose  from  the  superior 
maxillary  bones,  and  so  getting  a  good  view  of  the  anterior 
choanse.  He  next  passed  a  small  stout  saw  into  the  nostril, 
and  divided  the  hard  palate.  This  was  completed  by  nip¬ 
ping  through  it  with  a  pair  of  powerful  Liston’s  forceps. 
The  soft  parts  were  next  dissected  up  from  the  bones.  The 
removal  of  the  rest  of  the  diseased  bone  was  effected  by 
grasping  with  lion  forceps  each  lateral  half  thus  divided, 
wrenching  them  aside,  and  cutting  away  with  the  Lis' on 
forceps  all  the  tissues  which  appeared  to  be  diseased.  Both 
superior  maxilla)  as  far  as  the  orbital  plates  were  thus  re¬ 
moved,  and  the  parts  trimmed  with  strong  scissors  after¬ 
wards;  the  actual  cautery  being  freely  applied  to  all  bleeding 
points.  There  was  little  or  no  haemorrhage  to  speak  of,  and 
the  patient  rallied  very  soon  from  the  operation. 

October  4. — At  6  p.m.  on  the  evening  of  the  operation, 
temperature  rose  to  103  4’,  at  9  p.m.  it  was  102'4°. 

5th. — Patient  passed  r  good  night.  There  was  some 
discharge,  which  he  was  unable  to  expectorate.  Wounds 
looked  healthy.  In  the  morning,  temperature  99'4° ;  in  the 
evening,  temperature  100°. 

6th.  — Patient’s  right  eye  and  cheek  are  a  little  puffy. 
For  the  first  three  days  he  was  fed  entirely  by  eneinata, 
which  were  well  retained. 

8th.— Morning  temperature  100  4°,  evening  101-6°.  Bowels 
were  opened  three  times.  Yesterday  morning  the  patient 
was  for  the  first  time  fed  by  the  mouth. 

9th. — Patient  feels  remarkably  well.  Temperature  and 
pulse  normal . 

Remarks  (by  Mr.  Bellamy).  —  In  all  cases  of  removal  or 
partial  removal  of  the  jaws  it  is,  of  course,  of  the  utmost 
importance  to  avoid  injury  to  the  face.  In  some  instances 
this  is  clearly  impossible  ;  in  others,  such  as  the  present,  it 
was  to  be  attempted.  There  was  no  external  tumour,  and  the 
■contour  of  the  face  was  unaffected  ;  hence  it  might  be  pre¬ 
sumed  that,  by  a  careful  internal  liberation  of  the  parts,  the 
diseased  structures  might  be  removed.  The  adoption  of 
Rouge’s  modification  was  invaluable,  and  the  putting  aside 
of  cutting  instruments,  such  as  knives,  at  an  early  stage, 
saved  haemorrhage.  The  crushing  power  of  forceps  and 
stout  scissors  almost  torsioned  the  bleeding  ends  of  vessels 
of  itself.  I  was  at  first  inclined  to  do  a  prophylactic  trache¬ 
otomy,  and  to  use  Trendelenburg’s  tamponade  apparatus, 
but  did  not  do  so,  though  I  was  prepared  to  perform  the 
operation  at  any  moment ;  this,  however,  from  the  perfect 
way  in  which  the  anesthetic  was  administered,  and  the  rapid 
progress  of  the  operation,  was  unnecessary.  Owing  to  the 
extension  of  the  disease  into  the  soft  palate,  the  preliminary 
steps  of  dividing  the  palate  were  useless ;  and  it  is  some¬ 
what  remarkable  that,  on  the  fourth  day  after  the  opera¬ 
tion,  the  patient  was  able  to  swallow  (he  was  at  first  fed  by 
enemata).  You  may  possibly  remember  a  case  in  which  I 
had  removed  the  half  of  the  lower  jaw,  in  a  girl,  from  within 
the  mouth,  without  wounding  the  face  at  all.  These  are,  of 
course,  fortunate  instances,  but  showing  that  by  careful  in¬ 
ternal  dissection,  and  more  particularly  the  use  of  forceps 
after  the  tissues  have  been  liberated,  these  operations  are 
not  so  difficult  as  may  be  imagined. 


Prof.  Fraektzel  ok  Tuberculosis.— Prof.  Fraentzel, 
•while  giving  all  the  results  of  his  authority  and  experience 
in  favour  of  the  bacillus  theory  of  tuberculosis,  is  of  opinion 
that  the  careful  series  of  experiments  by  Koch  and  Goffky 
decisively  show  the  inefficacy  of  all  inhalation  methods.  It 
would  seem  as  if  the  medicaments  employed  in  this  way  did 
not  reach  the  diseased  parts  of  the  lungs,  since  those  which 
proved  to  be  the  strongest  poisons  against  pure  cultures 
did  not  in  the  least  diminish  the  number  of  the  tubercle- 
bacilli  in  the  sputa.  He  rejects  as  useless,  on  the  other 
hand,  and  as  rather  cruel,  the  direct  application  of  strong 
.anti-bacteric  solutions  (bichloride  of  mercury  !)  to  the  lung- 
tissue,  as  recently  performed  by  means  of  a  Pravaz  syringe 
in  some  clinical  wards.  Bo  we  find  ourselves  restricted  to 
internal  medication,  and  must  try  to  overcome  the  enemy 
in  that  way.  Until  now,  Prof.  Fraentzel  ascribes  the  best 
results  to  the  creasote  treatment,  following  the  formula  of 
Boutliard  and  Groubert,  which  he  adopted  a  couple  of 
years  before  the  germ-theory  appeared. — Phil.  Med.  News, 


TERMS  OP  SUBSCRIPTION. 


British  Islands  .  . 

( Free  by  post.) 

.  .  .  Twelve  Months 

.  all 

8 

0 

>9  y>  •  • 

.  .  .  Six 

99 

0 

14 

0 

The  Colonies  and  the 
States  of  America 

United'  |  Twdve 

99 

l 

10 

0 

99  99  99 

.  Six 

99 

.  o 

15 

0 

India  (vid  Brindisi) 

.  .  .  Twelve 

99 

1 

12 

6 

99 

.  .  .  Six 

99 

0 

16 

6 

Foreign  Subscribers  are  requested  to  inform  the  Publishers  of 
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SATURDAY,  OCTOBER  20,  1883. 


THE  FEDERATION  OF  THE  LONDON  SCHOOLS. 
Though  the  entries  at  the  London  hospitals  this  year  have 
exceeded  all  expectations,  and  have  for  the  moment  relieved 
the  anxiety  of  the  metropolitan  teachers,  there  is  no  doubt 
that  the  latter  must  brace  themselves  up  for  many  further 
and  more  radical  changes  if  they  are  to  contend  successfully 
against  the  growing  competition  of  the  schools  in  Scotland 
and  the  provinces.  The  efforts  which  have  been  made  within 
recent  years,  in  nearly  ail  the  metropolitan  schools,  to  bring 
up  their  education  to  the  requirements  of  the  day,  may  be 
cordially  acknowledged  without  blinding  us  to  the  necessity 
of  still  further  improvement.  Hitherto  the  tendency  has 
been  towards  greater  complexity  and  a  greater  specialisa¬ 
tion  of  function  in  the  educational  machine.  Old  branches 
have  been  split  up,  and  new  branches  introduced,  until  the 
list  of  subjects  and  lecturers  at  our  smallest  school  must 
strike  anyone  with  astonishment  who  compares  them  with 
the  number  of  lecturers  thought  sufficient  for  the  united 
schools  of  Guy’s  and  St.  Thomas’s  in  the  first  half  of  the 
century.  It  is  pretty  certain  that  at  length  the  limits  of  a 
safe  differentiation  of  subjects  have  been  reached,  and  that 
the  time  for  the  contrary  process,  viz.,  the  integration  of 
schools,  is  at  hand.  Some  such  change  is  becoming  neces¬ 
sary  in  the  interests  of  economy,  if  not  of  efficiency ;  it  is 
becoming  necessary  in  order  to  husband  the  resources 
both  of  the  student  and  his  teacher.  On  the  one  hand, 
the  expense  of  maintaining  a  dozen  dissecting-rooms  and 
laboratories,  all  competing  with  each  other  iu  respect  of 
completeness  and  excellence,  forms  a  serious  handicap  on 
medical  education  in  the  metropolis ;  while,  at  the  same 
time,  it  means  a  very  large  deduction  from  the  fee3  avail¬ 
able  to  remunerate  the  teachers.  On  the  other  hand,  as 
Professor  Huxley  has  pointed  out,  dozens  of  men  aie  com¬ 
pelled  to  teach  subjects  in  which  they  are  neither  deeply  in¬ 
terested  nor  thoroughly  instructed  ;  or,  if  their  subject  be 
one  that  they  can  teach  with  love,  they  find  that  they 
have  to  spend  on  a  class  of  twenty  the  effort  that  would 


454 


Mcd'cal  Timos  rnd  Gazette. 


THE  FEDERATION  OF  THE  LONDON  SCHOOLS. 


Oct.  20,  IS  3. 


be  sufficient  for  ten  times  that  number.  It  is  utterly  absurd  I 
that  we  should  have  a  dozen  separate  lecturers  in  London  ! 
on  such  subjects  as  botany,  comparative  anatomy,  and 
forensic  medicine,  when  three  or,  at  the  outside,  four  in, 
each  branch  would  be  sufficient  to  meet  every  requirement. 
As  to  the  value  of  the  teaching  in  these  subjects  in  many 
cases,  the  less  said  the  better.  The  only  argument  in  favour 
of  the  system  is  the  one  advanced  in  these  pages  last  week, 
viz.,  that  it  happens  to  serve  as  an  indirect  endowment  of 
pure  research.  Of  course,  it  is  utterly  illogical,  as  we  well 
know,  to  pay  a  man  for  doing  something  that  he  can  only 
do  indifferently,  in  order  that  he  may  be  able  to  follow  unpaid 
work  that  he  can  do  well,  and  no  one  in  his  senses  would 
have  devised  such  a  system.  But  it  is  there,  it  has  grown 
up  insensibly  amongst  us,  and  before  sweeping  it  away  it 
will  be  well  to  find  another  system  which  will  remove 
its  defects  without  having  the  effect  of  driving  scores  of 
able  and  hard-working  teachers  into  general  practice  or 
quackery. 

With  a  little  enthusiasm,  a  little  self-sacrifice,  and  a  little 
courage,  the  thing  is  to  be  done,  we  are  sure ;  but  if  the 
change  is  to  be  successful  it  must  be  radical.  No  tinkering 
little  amendments  will  avail  to  tempt  to  London  the 
scores  of  students  that  now  flock  to  Edinburgh  from  all 
parts  of  England,  not  to  mention  the  colonies.  Edin¬ 
burgh  is  not,  on  the  whole,  a  pleasanter  town  for  a  student 
to  live  in  than  London ;  it  has  not  better  teachers,  for 
we  seduce  its  best  away  as  soon  as  they  make  a  name ; 
it  has  no  special  diseases  that  will  bear  mention,  nor 
greater  facilities  for  clinical  work.  It  is  simply  a  better 
organised  centre  of  education  ;  its  resources  are  husbanded, 
instead  of  being  frittered  away  over  a  dozen  centres ;  its 
lecturers  work  better  together,  and  the  whole  organisation 
by  its  very  size  and  homogeneity  has  a  greater  attraction 
for  the  student’s  mind  than  any  single  London  hospital. 
Consequently,  when  for  some  cause  or  another  the  London 
entries  suddenly  fall  off  by  a  hundred  and  more,  the 
Edinburgh  entries  still  keep  on  increasing.  It  is  the 
same,  though  in  a  less  degree,  with  the  provincial  schools, 
which  are  rapidly  rising  into  a  position  of  serious  rivalry 
with  those  of  the  metropolis.  The  fault  is  not  in  our 
teachers,  nor  in  our  hospitals,  nor  in  our  supply  of  material, 
nor  in  the  reputation  of  the  metropolis  as  a  seducer  of  youth 
— a  young  man  is  probably  safer  in  London  than  in  a 
provincial  town;  it  is  in  our  system.  Everyone  who  has 
thought  over  the  matter  has  admitted  this  for  years.  It  did 
not  need  Professor  Huxley  to  point  it  out.  Sooner  or  later 
a  change  must  be  made,  and  when  it  comes  it  ought  to 
be  made  on  a  grand  scale.  The  whole  subject  should  be 
reviewed,  and  reorganised  on  the  widest  principles. 

The  changes  we  are  about  to  suggest  may  perhaps  appear 
to  many  far  too  revolutionary.  But  Time  has  a  way  of 
turning  out  of  her  womb  more  terrible  infants  in  the  way 
of  reforms  than  the  most  advanced  dreamer  had  ever  looked 
for ;  and  in  this  matter,  we  are  sure.  Time  is  on  the  side  of 
reform.  The  first  step  necessary  to  secure  economy  of  edu¬ 
cational  effort  is  to  bring  all  the  medical  schools  together 
under  one  central  council,  on  which  each  school  and  each 
examining  body  would  be  duly  represented,  while  each 
would  retain  full  control  of  its  own  local  affairs.  The  ad¬ 
vantages  of  such  a  federation  have  recently  been  sought 
voluntarily  by  the  schools  in  one  point — viz.,  the  distribution 
of  bodies  for  dissecting,  in  proportion  to  the  needs  of  each 
school, — and  it  might  be  hoped  that  a  similar  equilibrium 
between  supply  and  demand  would  be  obtained  in  other 
subjects  than  anatomy  if  there  were  a  central  council  which 
had  the  control  of  the  resources  of  education.  The  next 
step  would  be  to  follow  out  Professor  Huxley’s  proposal,  and 
concentrate  the  teaching  of  everything  which  can  be  taught 


away  from  the  hospital — anatomy,  physiology,  histology,- 
chemistry  and  practical  chemistry,  botany,  materia  mediea,. 
comparative  anatomy,  physics,  forensic  medicine — at  four 
central  schools,  each  provided  with  the  necessary  apparatus- 
of  instruction  in  the  most  complete  manner.  The  pro¬ 
fessor  or  lecturer  on  each  subject  would  be  appointed 
by  the  central  authority,  and  his  post  would  be  of  such 
a  character,  both  from  its  emoluments  and  its  dignity,  as  to- 
attract  the  very  best  talent  to  it ;  while  the  demonstrators- 
and  assistants  in  each  department,  having  such  a  goal  con¬ 
stantly  before  their  eyes,  and  knowing  that  it  was  only  to  be- 
attained  by  intrinsic  merit,  would  be  ever  stimulated  to  fresh- 
exertions,  both  in  the  way  of  teaching  and  research,  instead 
of  living  the  aimless  and  often  hopeless  existence  that  they' 
now  so  frequently  do.  Each  demonstrator  might  in  time- 
hope  to  become  a  professor,  and  he  would  at  any  rate  feel 
certain,  of  what  he  cannot  feel  certain  now — that  if  any¬ 
one  were  appointed  over  his  head,  it  would  be  because  off 
superior  merit  in  that  special  branch,  and  not  because  off 
any  claim  arising  from  the  value  of  services  in  an  entirely 
separate  department.  Hnder  this  new  system  the  expenses', 
of  primary  medical  teaching,  which  are  now  exorbitant,  could 
be  materially  reduced,  and  a  considerable  fund  would  thus  be- 
available  to  pay  the  younger  members  of  the  hospital  staffs 
for  work  in  their  own  special  lines.  Eor,  having  abolished, 
at  least  seven  out  of  every  eleven  chairs  of  primary  medical- 
instruction,  a  large  amount  of  teaching  power  would  be  set 
free,  and  the  best  way  of  utilising  it  would  be  to  employ 
it  in  a  more  systematic  clinical  teaching  in  the  hospital 
wards  and  out-patient  rooms.  If  the  whole  of  the  elemen¬ 
tary  teaching  of  medicine,  surgery,  gynsecology,  and  the- 
specialties  were  entrusted,  as  we  think  it  should  be,  to  men 
of  junior  standing,  the  senior  members  of  each  hospital  staff 
would  be  able  to  devote  themselves,  with  the  greatest  advan¬ 
tage,  to  the  higher  medicine  and  surgery,  which  are  now,, 
except  here  and  there,  almost  entirely  neglected,  because 
the  teacher  finds  his  followers  insufficiently  advanced  to- 
appreciate  their  niceties. 

The  next  reform,  which  would  necessarily  follow  from 
those  already  advocated,  and  which  would  be  less  a  reform 
than  a  revival,  would  be  to  throw  open  the  teaching  and 
the  appointments  at  each  hospital,  general  or  special,  to 
every  student.  By  this  means  the  teacher,  instead  of  having 
a  compulsory  class  ready  made  for  him,  would  have  to  de¬ 
pend  for  a  following  on  the  excellence  of  his  teaching,  and 
for  his  remuneration  on  his  power  of  attracting  students. 
This  would  introduce  competition  amongst  the  teachers,  and 
would  at  once  give  vitality  to  clinical  instruction  throughout 
the  metropolis.  But  before  such  a  reform  could  be  safely 
initiated  it  would  be  absolutely  necessary  to  render  the  exa¬ 
minations  more  frequent,  more  searching,  and  more  prac¬ 
tical.  It  must  be  quite  possible  for  a  painstaking  examiner 
to  inform  himself  from  his  own  inquiries,  without  any  help 
from  the  apparatus  of  schedules,  whether  a  given  student 
knows  his  work  and  will  make  a  safe  practitioner.  A  good 
examiner  can  afford  to  be  entirely  indifferent  to  where,  when,, 
and  how  a  student  has  learnt  his  profession,  provided  only 
that  he  knows  it.  Another  valuable  reform,  though  not  an 
absolutely  necessary  one,  would  be  to  concentrate  all  the 
chief  special  hospitals  into  three  or  four  polyclinics — an. 
innovation  which  would  be  greatly  to  the  advantage  of 
everyone  except  those  specialists  who  cannot  stand  on  their 
own  merits. 

We  are  well  aware  that  some  of  these  suggestions  will 
be  extremely  distasteful  to  many  teachers,  who,  in  their 
modesty,  are  afraid  of  the  results  of  open  competition.  Some, 
too,  perhaps  will  be  found  to  contend  that  the  student  cannot 
be  relied  upon  as  a  competent  judge  of  teaching,  that  adul¬ 
teration  would  infallibly  follow  on  competition,  and  that  the- 


^Medical  Times  and  Gazette. 


DR.  KOCH’S  KESEARCHES  ON  CHOLERA. 


Oct.  20,  18£3.  455 


largest  classes  would  gather,  as  they  have  done  before  now, 
around  the  dogmatist  and  the  brilliant  talker.  But  we  have 
faith  enough  in  our  students  to  believe  that  they  would 
appreciate  earnestness,  energy,  and  enthusiasm  in  the 
teacher,  and  if  the  examinations  were  only  efficient,  they 
would  rapidly  find  out  from  whom  they  could  most  easily 
learn  their  profession.  Then  tHe  best  teachers „  would 
obtain  not  only  the  most  numerous  following,  but  the  best 
clinical  clerks.  Their  cases  would  be  better  studied  and 
reported  than  those  of  less  successful  teachers,  and  their 
task  would  be  immensely  facilitated.  There  may  be  room  for 
difference  of  opinion  in  respect  to  detail,  but  we  are  sure  that 
some  such  scheme  as  we  have  sketched  out  must  be  intro¬ 
duced  if  London  is  to  retain  the  pre-eminence  as  a  centre  of 
medical  education,  which  from  the  size  and  variety  of  its 
'hospitals,  the  wealth  of  its  material,  and  the  excellence  of  its 
teachers,  it  fully  deserves  to  hold. 


DR.  KOCH’S  RESEARCHES  ON  CHOLERA. 

The  report  of  the  head  of  the  German  Scientific  Commission, 
which  we  reproduce  in  another  column,  is  a  model  of  lucid 
and  unexaggerated  statement,  and  well  deserves  careful 
reading,  not  only  for  its  matter,  butfor  its  manner.  It  will 
be  seen  that  Dr.  Koch  clearly  perceives  and  lays  down  the 
exact  limits  of  the  conclusion  deducible  from  his  discovery, 
and  his  anxiety  not  to  strain  it  beyond  the  weight  which  it 
will  legitimately  bear  should  be  a  lesson  to  those  who,  more 
Kochite  than  Koch,  have  been  proclaiming  that,  because 
certain  rod-shaped  bacteria  have  been  found  in  the  intestine 
in  nine  cases  of  cholera,  the  cause  of  the  disease  has 
been  isolated,  and  the  whole  problem  solved.  The  Com¬ 
mission  has  had  a  difficult  and  a  dangerous  task;  its 
members  have  had  to  busy  themselves,  day  after  day, 
with  material  which,  according  to  the  belief  of  many  of 
them,  and  probably  according  to  the  hopes  of  all,  was  the 
wery  essence  of  a  terrible  disease.  They  have  had  to  live  in 
rooms  where  this  material  was  evaporating,  and  to  officiate 
as  purveyors  of  it  to  numerous  animals  whom  they  expected 
to  become  its  victims.  And  their  enthusiasm  has  been  such 
that,  beaten  in  their  attack  on  one  part  of  the  problem  in 
one  place,  they  have  begged  to  be  allowed  to  continue  their 
researches  on  it  in  another,  where;  according  to  their  theory, 
“the  infection  is  still  more  active.  If  an  enthusiastic  driving 
of  evidence  to  support  a  preconceived  theory  is  pardonable 
in  anyone,  it  was  pardonable  in  them,  and,  accordingly.  Dr. 
Koch’s  determination  to  be  bound  strictly  by  the  rules  of 
the  scientific  game  in  the  pursuit  of  his  quarry  deserves 
■every  recognition  from  the  scientific  world. 

The  results  of  the  investigation  may  be  briefly  summarised. 
Micro-organisms  were  looked  for  in  vain  in  the  blood  of 
■cholera  patients  ;  they  were  found  only  in  relatively  small 
amount  in  the  vomit,  but  in  large  quantities  in  the  evacua¬ 
tions.  In  the  cadavers  there  was  no  trace  of  organised 
infective  material  in  the  blood  or  solid  viscera,  and  the 
contents  of  the  bowel,  though  containing  numerous  micro¬ 
organisms,  showed  no  preponderance  of  any  particular 
variety.  The  bowel  itself,  on  the  other  hand,  especially  the 
lower  part  of  the  small  intestine,  was  invariably,  in  recent 
cases  of  cholera,  found  to  be  invaded  by  hosts  of  bacilli,  in  size 
and  shape  resembling  those  met  with  in  glanders.  These 
organisms  were  collected  chiefly  in  and  around  the  follicles, 
where  they  had  evidently  set  up  much  irritation,  and  on  the 
willi,  into  the  substance  of  which  they  had  often  penetrated. 
'The  autopsies  were  made,  fortunately  for  the  scientific  cer¬ 
tainty  of  the  results,  immediately  after  death,  before  any 
putrefactive  changes  had  had  time  to  make  their  appearance 
and  complicate  the  inquiry. 

So  far,  the  success  of  the  investigation  was  beyond  the 


most  sanguine  expectations.  But  the  further  experiments 
which  were  necessary,  in  Dr.  Koch’s  opinion,  to  prove  the 
causal  nexus  between  cholera  and  the  specific  bacteria  dis¬ 
covered,  were  unsuccessful.  The  most  varied  attempts  were 
made  to  infect  animals  of  the  most  different  kinds,  but 
though  some  of  the  subjects  of  the  experiments  died  of 
septicaemia,  in  no  case  was  cholera  reproduced.  This  may 
have  been  due  to  the  fact  that  no  animal  yet  experimented 
on  is  capable  of  taking  the  disease,  or  to  the  fact  that  the 
proper  mode  of  communicating  it  has  yet  to  be  discovered. 
But  Dr.  Koch  inclines  to  a  third  explanation,  which  is, 
that  at  the  time  Avhen  the  investigations  were  made,  cho¬ 
lera  was  losing  it  virulence.  It  was  already  ceasing  to 
affect  man,  and  it  was  hardly  to  be  expected  that,  under 
these  circumstances,  animals,  which  have  always  shown 
a  great  power  of  resisting  the  infection,  should  fall  a 
prey  to  it,  however  strong  the  dose  of  poison  adminis¬ 
tered  to  them.  Acting  on  this  hypothesis.  Dr.  Koch  has 
petitioned  for,  and  obtained,  the  consent  of  his  Government 
to  proceed  to  Bombay,  where  cholera  is  still  very  prevalent, 
there  to  continue  his  investigations,  under  conditions  equally 
favourable  as  far  as  hospital  accommodation  is  concerned, 
and  presumably  more  favourable  in  respect  to  the  infectivity 
of  the  disease.  We  cannot  conclude  this  brief  resumd  without 
expressing  the  opinion  that  both  Dr.  Koch  and  German 
science  in  general  have,  by  the  way  in  which  the  investiga¬ 
tion  has  been  conducted,  added  materially  to  their  repu¬ 
tation,  and  increased  the  debt  which  we  all  owe  them. 


MORS  IN  OLLA? 

Four  hundred  and  thirty-one  persons  disabled  for  many 
weeks,  and  sixty  dead,  is  the  estimated  result  of  the  St. 
Pancras  epidemic.  As  a  rule,  catastrophes  due  to  causes 
acting  silently  and  secretly,  and  developing  their  effects  by 
isolated  and  successive  phenomena,  do  not  produce  the  same 
vivid  impression,  nor  raise  the  tide  of  human  sympathy  to 
such  a  height  as  an  equal  fatality  from  fire,  falls  of  build¬ 
ings,  collisions,  or  shipwreck;  but,  in  this  case,  public  atten¬ 
tion  has  been  much  excited  and  public  emotion  aroused,  and 
we  are  glad  to  receive  and  criticise  the  details  of  the  out¬ 
break  as  set  forth  in  a  special  report  by  Mr.  Murphy. 

On  July  28,  three  households  in  North  and  South- villas 
and  in  Camden-park-road  were  simultaneously  attacked 
with  typhoid  fever,  and  on  almost  each  day  following  up  to 
September  8  fresh  typhoid  centres  developed,  so  that  at  last 
no  less  than  276  households  were  attacked  and  the  number 
and  fatality  already  mentioned  attained ;  July  7,  13,  and  19, 
August  24,  25,  and  27,  were  days  on  which  the  crop  of 
sickness  was  especially  heavy.  The  chief  incidence  of  the 
disease  was  an  area  of  about  half  a  mile  in  diameter,  its 
centre  being  the  “Britannia,”  Camden  Town;  but  a  glance 
at  the  map  accompanying  the  report,  on  which  affected 
houses  are  denoted  by  red  spots,  shows  the  spots  scattered 
at  wide  distances  from  the  chief  focus.  Of  the  431  persons 
attacked,  368,  or  about  85  per  cent.,  derived  their  milk- 
supply  from  a  large  dairy  situated  near  the  “  Britannia,” 
and  therefore  in  the  very  centre  of  the  epidemic  area.  This 
dairy  (referred  to  in  the  report  as  that  of  Mr.  X.)  was  early 
infected,  for  on  August  7,  Mr.  X.’s  partner  and  the  servant 
became  ill  of  typhoid  fever,  and  the  same  disease  on  August 
12,  13,  15,  and  19  attacked  three  of  the  milk-carriers  and 
a  boy,  altogether  more  than  a  third  of  the  employes. 

Mr.  Murphy  next  proceeds  to  exclude  everything  but 
the  milk.  It  was  not  produced  by  the  Regent’s  Canal,  for 
Park  Village,  Albert-road,  and  Augustus-street  were  un¬ 
affected  ;  nor  by  a  polluted  water-supply ;  nor  by  sanitary 
defects  in  the  houses  themselves;  nor  at  Mr.  X.’s  dairy — the 
fever  there  being  considered  a  result  of  infected  milk,  not 


456 


M. 'ileal  Times  and  Gazette. 


CHRONICLE  OF  THE  WEEK. 


Oct.  20,  1883. 


the  cause  of  the  infection.  The  reasoning  by  exclusion 
is  followed  by  calculations  of  the  percentage  of  houses 
attacked.  Taking  the  entire  parish  of  St.  Pancras,  and 
also  the  most  affected  district  of  Eegent’s-park,  Mr. 
Murphy  calculates,  from  data  furnished  by  a  list  of  Mr.  X.’s 
direct  and  indirect  customers,  that  in  the  whole  area  Mr. 
X.’s  natural  share  should  have  been  3*7  per  cent,  of  typhoid 
fever  cases,  whereas  it  is  78'2,  while  in  the  sub-district  it 
should  have  been  7*8  per  cent.,  and  it  is  89  8  per  cent. 

This  reasoning  is  ingenious,  but  not  wholly  free  from 
fallacy :  a  stronger  part  of  Mr.  Murphy’s  case  lies  in  the 
result  of  a  house-to-house  inspection  of  certain  streets.  In 
387  houses  visited,  258  were  supplied  by  other  milk-vendors, 
and  3  only,  or  about  IT  per  cent.,  were  affected ;  while  of 
132  households  supplied  by  Mr.  X.,  37,  or  about  2S  per  cent  ., 
were  attacked.  So  again,  considerable  weight  must  be  given 
to  the  case  of  the  25  female  clerks,  12  of  whom  drank  milk 
at  Mr.  X.’s  shop :  of  these  4  certainly  had  typhoid,  and  2 
others  suffered  from  what  seemed  to  be  a  mild  attack  ;  while 
those  who  did  not  drink  the  milk  escaped.  Again,  in  a  house 
of  business  there  were  17  people  employed  ;  7  drank  beer,  10 
Mr.  X.’s  milk  :  the  beer-drinkers  escaped,  but  7  of  the  milk- 
drinkers  were  attacked.  Attempts  are  next  made  to  trace 
the  infection  backward  to  one  of  the  five  country  sources  of 
the  milk,  four  having  been  satisfactorily  excluded.  The 
milk  suspect  came  from  a  farm  near  St.  Albans.  Porters 
who  probably  drank  it  at  Kentish  Town  Station  sickened 
with  typhoid;  households  on  Mr.  X.’s  own  list,  known  to 
have  been  specially  supplied  with  St.  Albans  milk,  suffered 
la  the  proportion  of  about  11  per  cent,  more  than  those 
not  known  to  have  been  thus  supplied;  and  lastly,  twelve 
persons  living  in  seven  houses  in  St.  Albans,  drinking 
milk  from  the  same  farm,  were  attacked  between  July  28 
and  the  beginning  of  September,  the  milk-supply  being,  it 
is  said,  almost  limited  to  the  households  infected.  At  the 
farm  itself,  one  positive,  a  second  possible,  case  occurred, 
on  August  4  and  6  respectively — -dates  too  late  to  have 
anything  to  do  with  the  July  and,  even  allowing  for  in¬ 
cubation  period,  with  the  August  London  outbreak.  The 
sanitary  arrangements  also  were  not  free  from  danger:  a 
cesspit  attached  to  a  privy  was  but  twenty-nine  feet  from 
the  well,  the  water  of  which  was  used  in  the  dairy.  Analysis, 
however,  did  not  condemn  the  water,  nor  did  experiment 
establish  any  connexion  between  well  and  cesspit. 

This,  then,  we  believe,  is  a  brief  but  fair  summary  of  Mr. 
Murphy’s  investigation,  and  of  his  deductions.  There  is 
nothing  per  se  improbable  in  milk  not  only  playing  the  part 
of  an  infected  garment,  but  also  that  of  what  biologists  call 
“  a  cultivation  liquid’-;  but  there  has  been  of  late  years  too 
great  a  tendency  to  refer  all  outbreaks  of  fever  to  infected 
milk,  though  but  little  of  the  published  evidence  would 
satisfy  a  legal  mind;  and  we  have  marked  in  more  than 
one  instance  a  looseness  of  statement,  an  explanation 
ready  for  every  difficulty,  a  concealment  of  facts  making 
aga:nst,  an  exaggeration  of  those  making  for  the  theory, 
as  though  the  investigator  held  the  brief  of  a  prose¬ 
cuting  counsel.  We  by  no  means  say  that  Mr.  Murphy’s 
report  possesses  these  defects  ;  but  we  do  say  that  we  are 
not  entirely  satisfied.  A  letter  communicated  to  the  Daily 
News  by  Dr.  J.  Murray,  of  St.  Albans,  leads  us  to  suspect 
that  some  very  important  circumstances  have  been  over¬ 
looked  or  suppressed.  Thirteen  visitors  at  the  farm  itself, 
Dr.  Murray’s  own  family,  and  others,  drank  the  milk  regu¬ 
larly,  and  yet  escaped.  Were  the  precautions  taken  at  the 
infected  London  dairy  sufficient  to'  render  it  certain  the 
milk  was  not  partially  and  intermittently  contaminated 
there  ?  Is  the  question  of  simple  coincidence  in  typhoid 
area  due  to  some  local  condition,  and  Mr.  X.’s  arena  of 
milk-supply  operations  completely  settled  P  Is  it  not  a 


fact  that  typhoid  fever  during  August  and  September 
has  been  unusually  rife  in  other  parts  of  the  metropolis  to 
which  Mr.  X.  never  sends  his  carts?  Listly,  is  the  ex¬ 
planation  of  the  supposed  particulate  nature  of  the  typhoid 
contagium  considered  sufficient  to  account  for  so  small  a- 
number,  comparatively,  of  the  persons  who  drank  the  milk 
being  attacked  ?  or,  put  jn  another  form,  i3  it  possible  to 
dispense  for  days  sixteen  gallons  of  dilute  typhoid  poison  in 
pints  and  half-pints  to  such  a  population,  and  only  infect 
some  400  people?  Whether  Mr.  Murphy’s  explanation  of 
the  outbreak  is  correct  or  not,  this  much  is  clear — while  it 
is  possible  for  remote  farms  to  possess  bad  drains,  foul  cess¬ 
pits,  and  polluted  water,  and  yet  be  permitted  to  supply 
the  largest,  richest,  and  most  important  city  in  the  world,, 
all  town  milk  should  be  boiled  before  use.  Two  organisms, 
alone,  the  anthrax  bacillus  and  the  hay  bacillus  in  the  spore 
state,  are  known  to  withstand  for  a  short  time  a  temperature, 
of  212°  :  hence  there  is  every  reason  to  believe  that  by  such 
simple  means  every  family  may  escape  the  possible  mors 
in  olla. 


CHRONICLE  OF  THE  WEEK. 

■ - o - 

Everyone  will  be  astonished  and  delighted  at  the  number 
of  the  entries  this  year  at  the  London  medical  schools. 
When  the  returns  are  complete  it  will  probably  be  found 
that  they  exceed  by  more  than  a  hundred  the  number  of  any 
previous  year,  even  without  including  the  entries^  for  occa¬ 
sional  courses,  which  also  show  a  most;  satisfactory  increase. 
The  very  small  number  of  entries  last  year— the  smallest 
for  a  decade — had  created  considerable  alarm  at  the  hos¬ 
pitals,  especially  at  those  which  have  recently  gone  to  much 
expense  in  fitting  up  elaborate  medical  schools.  It  was  seen 
that  the  number  of  metropolitan  students  was  steadily- 
diminishing,  while  that  of  the  provincial  students  was  as 
steadily  increasing  ;  the  percentage  of  students  registered 
at  the  chief  English  provincial  schools  having  steadily 
gone  up  from  32  8  in  1879  to  42’5  in  1882  If  this  ratio 
were  to  go  on  increasing,  the  average  number  of  students; 
at  each  of  the  seven  great  provincial  schools  would  soon- 
considerably  exceed  the  average  of  the  eleven  London  hos¬ 
pitals.  There  was  therefore  grave  cause  for  anxiety,  and 
the  very  favourable  returns  of  this  October  have  been 
noticed  with  immense  relief. 


We  have  received  returns  from  all  the  London  hospitals 
except  the  Middlesex  and  the  Westminster,  and  the  entries 
for  the  ordinary  curriculum,  even  omitting  those  two  schools, 
are  553,  while  as  many  as  222  students  have  entered  for 
occasional  or  preliminary  courses.  The  following  are  the 
retuims  : — 

Charing-cross  Hospital  .  32  full  entries  ;  15  occasional. 


Guy’s  Hospital  .... 

74 

20 

yy 

King’s  College  Hospital  . 

51 

ff 

21 

yy 

London  Hospital  .  .  . 

64 

yy 

49 

yy 

St.  Bartholomew’s  Hospital  120 

yy 

20 

y> 

St.  George’s  Hospital 

36 

yy 

4 

yy 

St.  Mary’s  Hospital  .  . 

28 

yy 

7 

y> 

St.  Thomas’s  Hospital  . 

65 

yy 

28 

yy 

University  Hospital  .  . 

83 

yy 

58 

yy 

When  one  compares  these  553  entries — which,  when  all  the 
returns  are  made,  will  probably  be  converted  into  over  600  — 
with  the  461  entries  of  1879,  the  468  of  1880,  the  472  of 
1SS1,  and  the  371  of  last  year,  one  cannot  but  congratulate 
the  London  teachers.  It  is  difficult  to  account  for  this 
sudden  ifise  in  the  numbers  entering  the  profession,  except  it 
be  due  to  the  admitted  overcrowding  in  all  other  callings. 
We  may  heartily  welcome  these  new  recruits ;  there  is 


Medical  Times  and  Oarette. 


CHRONICLE  OF  THE  WEEK. 


plenty  of  room  in  the  world  for  them  and  their  work.  Only 
one  provincial  return  has  come  in,  that  of  the  Manchester 
School,  where  sixty  students  have  entered  for  the  full 
curriculum,  and  ten  for  occasional  courses. 


At  the  first  meeting  of  the  Ophthalmological  Society,  on 
Thursday  week,  the  chief  event  was  the  address  of  the  new 
President,  Mr.  Jonathan  Hutchinson,  which  contained  the 
important  announcement  that  Mr.  Bowman,  the  retiring 
President,  had  offered  to  guarantee  to  the  Society  the  sum 
of  A50  per  annum  for  a  term  of  twenty  years  ;  an  offer  which, 
it  is  needless  to  add,  had  been  gratefully  accepted  by  the 
Council,  and  elicited  a  most  hearty  vote  of  thanks  from  the 
meeting.  By  a  curious  coincidence — and  Mr.  Hutchinson 
was  careful  to  explain  to  his  hearers  that  it  was  only  a 
coincidence —the  next  announcement  he  had  to  make  was 
that  the  Council  of  the  Society  had  decided  to  found,  in 
honour  of  Mr.  Bowman’s  presidency,  a  “Bowman  Lecture,” 
to  be  delivered  annually  or  periodically,  on  some  subject 
connected  with  ophthalmology,  by  some  one  nominated  by 
the  Council.  There  were  not  many  communications,  owing 
to  want  of  time.  Dr.  Sharkey’s,  on  homonymous  hemi- 

anopia  due  to  cortical  lesion,  being  the  chief  one. - 

The  Clinical  Society  held  its  first  meeting  on  Friday, 
October  12,  under  the  presidency  of  Sir  Andrew  Clark.  A 
paper  “  On  Peritoneal  Abscess  in  Children,”  by  Dr.  Goodhart, 
gave  rise  to  a  discussion  which,  although  occasionally  stray¬ 
ing  beyond  the  bounds  of  the  subject,  brought  to  light  much 
interesting  clinical  information  upon  peritoneal  abscesses  in 
general.  A  very  complete  and  elaborate  account  of  a  case 
o'f  cerebro-spinal  sclerosis,  in  which  the  characteristic  tremors 
were  absent  throughout,  was  contributed  by  Dr.  Charlton 

Bastian. - At  the  opening  meeting  of  the  Pathological 

Society,  on  Tuesday  last,  the  chief  communications  were — 
Dr.  Carrington,  specimen  of  lympho-sarcoma  of  the  intes¬ 
tine;  Mr.  Lawson,  a  cystic  tumour  springing  from  the 
sphenoid  bone  in  an  infant;  and  Dr.  Frederick  Taylor,  a 
case  of  syringo-myelus,  with  syphilitic  gumma  on  the  spinal 
dura  mater.  Other  specimens  of  interest  were  also  shown, 
and  the  meeting  was  well  attended. 


The  important  remarks  made  by  Sir  Andrew  Clark  at  the 
Clinical  Society  upon  the  subject  of  certain  obscure  cases  of 
severe  illness  following  the  constant  use  of  catheterisation 
will  doubtless  meet  with  earnest  consideration  from  the 
surgical  members  of  the  profession,  in  whose  practice  such 
cases  must  occur  most  frequently.  The  following  may  be 
taken  as  a  type  of  this  class  of  cases  : — A  man,  in  otherwise 
perfect  health,  complains  of  incontinence  of  urine,  and, 
under  the  advice  of  his  physician,  who  finds  him  free  from 
disease  of  any  kind,  seeks  aid  from  a  surgeon.  The  presence 
of  an  enlarged  prostate  is  diagnosed,  catheterisation  is  re¬ 
commended,  and  adopted  without  any  untoward  result. 
Four  days  later  the  patient  becomes  very  ill,  with  rise  of 
temperature  and  other  febrile  symptoms,  but  with  abso¬ 
lutely  no  local  manifestations  sufficient  to  account  for  the 
general  symptoms.  As  the  days  pass  by,  the  condition  gra¬ 
dually  grows  more  grave,  but  still  without  any  definite  signs 
or  other  symptoms  than  those  of  increasing  fever.  Death 
ensues  in  the  course  of  nine  or  ten  days,  and  the  autopsy 
throws  no  light  upon  the  case,  a  slightly  inflamed  bladder 
being  the  only  departure  from  the  normal  condition.  That 
these  cases  should  occur  with  such  frequency  that  a  phy¬ 
sician,  however  large  his  practice,  can  'quote  four  or  five  in 
each  year  from  his  own  experience,  and  that  hitherto  no 
kind  of  explanation  has  been  offered,  seems,  indeed,  an 
anomaly  at  the  present  day,  and  one  which  the  collective 
wisdom  of  the  London  societies  and  the  numerical  power 


Oct.  2\  1883.  4  5  7 

of  the  Collective  Investigation  Committee  ought  speedily  to 
reduce  to  its  true  pathological  position. 


Dr.  B.  W.  Richardson  is  a  man  of  thoughtful  and 
ingenious  mind,  but  it  is  to  be  feared  that  he  sometimes 
allows  his  imagination  to  run  away  with  him,  especially 
where  his  feelings  are  deeply  engaged.  The  supporters  of 
total  abstinence  have  secured  in  him  a  persuasive  but  not  a 
safe  disputant.  Oa  Monday  last  a  crowded  meeting  in  St. 
Panoras  cheered  him  to  the  echo  as  he  cleverly  manipulated 
his  scientific  statistics,  which,  like  Wendell  Holmes’s  spheres, 
rolled  with  facile  movement  wherever  he  wished  them.  In 
the  returns  of  the  revenue  from  alcohol  the  total  abstainers 
have  found  ready  to  their  hands  a  sort  of  barometer,  which 
gives  them  accurate  indications  as  to  the  pressure  their 
efforts  are  exerting  oa  the  public  mind  and  thirst.  During 
the  last  quarter  a  sudden  rise  in  the  drink  returns,  after 
a  steady  preceding  fall,  caused  much  perturbation,  which 
has  required  all  Dr.  Richardson’s  ingenuity  to  allay. 
There  is  no  cause  for  disappointment,  we  hear ;  the  rise 
is  merely  the  result  of  a  simple,  natural,  but  hitherto 
unrecognised  law— viz.,  that  people  are  thirstier  in  hot 
weather.  This  law  is  amply  supported  by  Mitchell  and 
Buchan’s  statistics  as  to  the  mortality  of  different  diseases 
in  different  periods  of  the  year.  The  deaths  from  alcoholic, 
disease  are  below  the  mean  in  February,  March,  and  April,, 
they  rise  rapidly  in  May,  and,  after  rising  and  falling  in 
June,  reach  their  maximum  in  the  third  week  of  July.. 
They  then  begin  to  decline  until  the  end  of  the  year,  when- 
there  is  a  small  rise — due  evidently  to  Christmas  festivities, 
—in  the  beginning  of  January.  According  to  Dr.  Richardson,, 
the  revenue  statistics  accurately  correspond  with  these  mor¬ 
tality  returns.  The  revenue  of  the  nation  and  the  revenue 
of  death,  so  far  as  alcohol  is  concerned,  rise  and  fall  together. 


This  kind  of  scientific  legerdemain  does  very  well  t<3 
amuse  Blue  Ribbon  gatherings,  but  surely  Dr.  Richardson 
might  leave  it  to  some  one  without  a  scientific  reputation. 
It  cannot  do  science  any  good,  and  it  may  do  the  cause  of 
abstinence  a  great  deal  of  harm,  to  trifle  with  figures  in  this; 
way.  Dr.  Richardson  cannot  be  supposed  to  be  under  the? 
delusion  that  drink  is  always  consumed  immediately  after  it 
is  taxed,  or  that  it  always  kills,  like  prussic  acid,  immediately 
after  it  is  consumed,  or  else  takes  some  multiple  of  twelve¬ 
months  to  produce  its  lethal  effect.  Nor,  surely,  can  he 
think  that  the  third  week  in  July  is  invariably  a  time  of 
scorching  and  parching  heat,  or  that  thirstiness  is  the  chief 
cause  of  drinking,  or  that  summer  is  a  necessary  condition 
of  thirstiness.  If  Dr.  Richardson  is  unhappily  the  subject 
of  all  these  delusions,  we  can  understand  his  line  of  argu¬ 
ment,  but  so  long  as  he  retains  amongst  the  public  the  repu¬ 
tation  of  a  scientific  thinker  he  ought  to  be  more  careful  in 
his  statements. 


At  an  inquest  held  in  the  East-end,  yesterday  week, 
on  a  poor  m orphiomaniac,  a  sfatement  was  made  which, 
if  true,  deserves  some  consideration  from  the  medical 
moralist.  The  deceased,  a  female  drunkard  with  cancer 
of  the  gullet,  had  long  been  in  the  habit  of  going  from 
one  doctor  to  another  to  have  morphia  injected,  until 
she  had  ceased  to  be  known  by  her  proper  name,  and  went 
everywhere  by  the  name  of  the  drug  she  lived  on.  It 
was  her  way  to  pester  the  medical  practitioners  whom  she 
visited  until  they  gave  her  her  dose  of  morphia,  to  get  rid  of 
her.  The  drug  was  not  necessary  for  the  relief  of  pain,  but,  as 
in  all  these  sad  cases,  the  morphia-hunger  was  doubtless  as 
agonising  to  her  as  that  form  of  nerve-worry  which  we  have 
agreed  to  call  by  the  name  of  pain.  No  one  can  fail  to  pity 


458 


Medical  Times  and  Gazette. 


CHRONICLE  OF  THE  WEEK. 


Oct.  20,  1883. 


such  poor  wretches,  for  though  there  is  doubtless  in  many  of 
these  cases  a  predisposition  founded  on  mental  defect,  their 
fate  is  one  which,  with  injudicious  treatment,  might  befall  any 
of  us — which  has  in  our  own  profession,  to  everyone’s  know¬ 
ledge,  wrecked  many  a  career  that  promised  well.  Some  of 
our  best  practitioners  have  felt  this  so  strongly  that  the 
morphia-syringe  is  now  seldom  employed  by  them,  and  it  is 
beginning  to  be  acknowledged  that  the  cases  are  very  rare 
in  which  its  use  is  demanded.  But  the  more  difficult  ques¬ 
tion  is  :  What  is  to  be  done  with  the  cases  in  which  its  use 
has  become  almost  a  necessity  of  existence  ?  Is  one  to  refuse 
point-blank  to  administer  to  a  morbid  craving,  and  to  let  the 
patient  pass  into  the  hands  of  others  Vho  will  be  less 
scrupulous  ?  Ought  one  to  refuse  invariably  to  continue 
attendance  on  patients  who  will  not  throw  aside  their 
syringes  and  morphia  solutions  at  one’s  command?  In  the 
East-end,  apparently,  the  problem  has  solved  itself  by 
“  reductio  ad  absurdum,”  for  surely  no  doctor  with  any  self- 
respect  can  allow  himself  to  be  turned  into  a  sort  of  licensed 
victualler,  to  be  ever  at  the  call  of  a  tramp’s  imperious 
cravings.  And  yet,  from  an  ethical  point  of  view,  it  is 
difficult  to  distinguish  between  the  practice  of  the  East  and 
that  of  the  West,  except  that  in  the  one  case  the  f>atient 
visits  the  doctor,  and  in  the  other  the  doctor  visits  the 
patient.  _ 

These  seems  to  be  very  strong  evidence  that  at  Liver¬ 
pool  the  police  have  lighted  upon  one  of  those  cases  of 
systematic  poisoning  for  gain  which  crop  up  every  few 
years,  and  which,  from  their  invariably  tardy  discovery,  give 
one  much  reason  to  fear  that  for  every  such  case  brought  to 
light  there  must  be  many  which  have  remained  unsuspected. 
The  history  is  the  same  in  all.  At  first  the  murderer  is 
careful  and  prudent,  employs  every  precaution  to  avoid 
discovery,  has  no  confederates,  and  waits  a  long  time 
between  each  case.  Then,  as  doctor  after  doctor  is  taken 
in,  and  murder  after  murder  goes  undiscovered,  he 
•gradually  becomes  bolder,  till  at  last  he  appears  abso¬ 
lutely  reckless,  and  carries  out  his  designs  almost  in 
the  light  of  open  day,  either  from  a  spirit  of  bravado 
the  result  of  continued  impunity,  or  because  the  fasci¬ 
nation  of  his  horrible  pursuit  is  such  that  he  can  no 
more  conceal  it  than  one  can  prevent  a  sneeze.  Every 
case  goes  to  prove  that  the  safety  of  the  public  lies  less 
in  the  apparatus  of  death-certificates,  coroners’  inquests, 
and  directors  of  public  prosecutions,  than  in  the  nervous 
instability  of  the  murderer.  A  course  of  poisoning  seems  to 
resemble  one  of  gambling ;  it  robs  the  strongest  brain  of  its 
coolness.  But  it  is  surely  not  very  creditable  to  science  and 
civilisation  that  it  should  invariably  be  the  weakness  of  the 
criminal  rather  than  the  strength  of  the  detective  that  at 
length  brings  these  cases  to  light.  The  possibility  of  them 
ought  to  be  in  the  mind  of  every  doctor  who  has  cases  as 
to  which  he  cannot  form  a  definite  diagnosis.  It  may  be 
admitted  that  there  is  a  strong  temptation  not  to  make 
a  stir  about  a  case  when  the  suspicion  is  only  slight,  for  if 
it  should  turn  out  to  be  unfounded,  or,  though  correct,  can. 
not  be  proved  to  be  so  in  a  court  of  justice,  the  doctor’s 
position  is  not  likely  to  be  a  bed  of  roses.  Then  the  coroner 
is  anxious  to  keep  down  expenses,  and  the  coroner’s  clerk 
perhaps  finds  it  pay  better  to  prevent  an  inquest  than  to 
call  one.  So  the  interest  of  all  the  recognised  detectives 
of  such  crimes  blinds  them  to  their  occurrence,  and  between 
them  all,  no  doubt,  many  a  poisoner  has  gone  unpunished. 

The  following  is  a  list  of  the  most  noteworthy  papers  in 
the  current  numbers  of  the  leading  foreign  medical  journals : 
— Le  Pr ogres  Medical  contains — “  Tuberculose  Testiculaire 
et  Castration,”  by  M.  h.onod;  “  Tumeur  Eibreuse  de 


Filter  us,”  by  M.  Leveque;  and  “  De  la  Dermatite  Exfolia- 
trice  generalisee,”  by  M.  Comby.  The  Gazette  Medicate  de 
Paris  contains — “  Be  la  Doctrine  Microbienne  et  de  la 
Medecine  traditionelle,  au  point  de  vue  de  la  Genese  et  de 
la  Generalisation  du  Tubercule  et  du  Cancer,”  by  Dr.  F. 
de  Pause ;  and  “  Nevrite  traumatique  du  Plexus  Brachial 
Droit,”  by  Dr.  J.  Pozzi.  The  Gazette  Hebdomadaire  contains 
— “  Contribution  a  l’Etude  du  Zona,”  by  M.  Ch.  Deshayes; 
and  “Trois  Cas  de  Scorbut  secondaire,”  by  M.  de  Beurmann. 
The  Gazette  des  Hopitaux  contains — “  Cas  remarkable  de 
Delire  des  Persecutions,”  by  Dr.  Legrand  du  Saulle. 


The  Centralblatt  fur  Klinische  Medicin  contains  abstracts 
of  papers — by  M.  Paul  Bert,  on  Prolonged  Anaesthesia 
obtained  by  means  of  Protoxide  of  Nitrogen,  and  by  MM. 
Chiari  and  Eiehl,  on  Lupus  of  the  Larynx.  The  Centra l- 
blatt  fur  die  Medicinischen  Wissenscliaften  presents  an 
original  paper  on  Micrococci  in  Croupous  Pneumonia,  by 
Salvioli  and  Zaslein  ;  and  abstracts,  amongst  others,  of  papers 
— by  Bernstein,  on  the  Excitability  of  the  Nerve-end  Organs 
in  Muscle;  by  Maly  and  Emich,  on  the  Action  of  the  Bile- 
Acids  on  Albumen  and  Peptone  ;  and  by  Babes,  on  the 
Bacilli  of  Leprosy  and  Chicken-Cholera.  In  the  Centralblatt 
fur  Chirurgie  appears  a  paper  on  the  Treatment  of  Stenosis  of 
the  Trachea,  after  Removal  of  Goitre  ;  Dr.  Kurz,  of  Florence, 
brings  forward  a  new  dilator  for  the  rectum,  urethra,  and 
uterus.  In  the  Centralblatt  fur  GyndJcologie  is  contained 
a  detailed  case  of  Successful  Laparotomy  in  the  eighth  month 
of  extra-uterine  pregnancy,  by  Dr.  Brendel,  in  Montevideo 
In  the  Berliner  Klinische  Wochenschrift ,  Dr.  Hofmeier  dis¬ 
cusses  the  Influence  of  Diabetes  Mellitus  on  the  Female 
Generative  Organs ;  and  a  report  of  an  address  by  Dr.  Pohl- 
Pincus,  on  Alopecia  and  the  Indurative  Processes  of  Disease 
in  general,  also  appears.  The  Wiener  Medizinische  Wochen¬ 
schrift  publishes  a  successful  case  of  Resection  of  Stomach 
by  Dr.  v.  Hacker,  and  a  notice  of  an  Epidemic  of  Parotitis 
at  Ljubinje,  by  Dr.  Bettelheim. 


The  following  books  have  recently  been  published:  — 
“  Hospital  Management :  Authorised  Report  of  a  Con¬ 
ference  on  Hospitals,”  edited  by  J.  L.  Clifford  Smith;  “De 
la  Folie  a  Double  Forme,”  by  Dr.  Ambr.  E.  Mordret— a 
monograph  which  received  a  prize  from  the  Academy  of 
Medicine;  “Des  Formes  diverses d’Epidemies Puerperales,” 
by  Dr.  Charles  Maygrier  ;  “  Die  Elektro-Technik  in  der. 
Praktischen  Heilkunde,”  by  R.  Lewandowski ;  “  Mittheil- 
ungen  aus  dem  Embryologischen  Institute  der  Universitat 
in  Wien,”  by  S.  L.  Schenk,  vol.  ii.,  part  3 ;  “Vorlesungen 
fiber  Pathologie,”  section  iii.,  part  3,  by  S.  Strieker. 


LIVERPOOL  MEDICAL  SOCIETY. 

The  first  meeting  of  the  Liverpool  Medical  Institution  for 
the  session  1883-84  was  held  on  October  11.  The  whole 
suite  of  rooms  was  thrown  open,  and  in  the  upper  gallery 
Dr.  Barron  showed  a  number  of  sections  of  the  human  body 
cut  while  frozen,  with  water-colour  drawings  of  the  same. 
The  sections  were  made  by  Dr.  Barron,  and  the  drawings  by 
Mr.  J.  R.  L.  Dixon.  Mr.  Paul  showed  a  collection  of  skuHs 
that  he  had  prepared  for  the  school  museum.  The  President 
(Mr.  Shadford  Walker)  opened  the  session  with  a  few  words 
of  welcome.  He  hoped  that  the  meetings  of  the  Society 
would  be  characterised  by  harmony  and  goodwill,  and  that 
questions  exciting  to  personal  feelings  would  be  avoided  as 
far  as  possible.  Dr.  Carter  then  showed  some  pathological 
specimens  of  multiple  sarcoma  removed  from  a  patient  who 
during  life  presented  some  symptoms  of  Addison’s  disease, 
I  and  in  whom  after  death  the  semilunar  ganglia  were  found 


Med  al  Times  and  Gazette. 


ANNOTATIONS. 


Oct.  20, 1883.  459 


encroached  upon  by  the  growth.  Dr.  Glynn  showed  draw¬ 

ings  of  a  tumour  of  the  medulla  oblongata.  The  patient 
had  had  syphilis  fourteen  years  before  the  onset  of  the 
nervous  symptoms.  These  were  partial  numbness  of  the  left 
side  of  body  and  of  face,  flow  of  saliva,  dysphagia,  para¬ 
lysis  of  the  vocal  cord  on  the  affected  side,  sickness  and 
nausea,  a  very  dicrotic  pulse,  and  epileptic  attacks  when¬ 
ever  the  patient  was  moved.  The  tumour  pressed 
upon  the  cord  just  below  the  medulla,  affecting  chiefly 
the  spinal  part  of  the  long  pneumogastric  nucleus.  Mr. 
Puzey  then  read  a  short  paper  on  two  cases  of  ligature 
of  the  brachial  artery  for  wounds  of  the  palmar  arch.  In 
one  case,  after  ligature  of .  the  brachial  artery,  the  ulnar 
was  found  to  pulsate,  and  haemorrhage  recurred.  On  tying 
the  vessel  the  haemorrhage  ceased.  In  the  second  case  the 
supposed  brachial  was  ligatured  at  two  points,  and  the 
vessel  cut  between  the  ligatures.  It  was  then  found  that 
the  brachial  really  lay  behind  this  ligatured  vessel,  which, 
from  the  pulse  having  ceased  at  the  wrist,  was  found  to  be  an 
abnormal  radial.  The  brachial  was  then  ligatured,  and  the 
case  did  well.  Mr.  Puzey  advocated  less  searching  for  the 
cut  ends  of  the  wounded  vessel  in  the  palm  of  the  hand,  and 
an  earlier  recourse  to  ligature  of  the  brachial  artery.  After 
ligaturing  this  vessel  a  search  should  be  made  for  an  ab¬ 
normal  branch,  and  it  should  be  ascertained  that  both  the 
radial  and  ulnar  pulsations  have  ceased.  If  either  vessel 
still  pulsates,  that  vessel  should  be  ligatured  at  the  wrist. 
Mr.  Banks,  Mr.  Eushton  Parker,  and  Drs.  Macfie,  Campbell, 
Barron,  and  Alexander  all  agreed  with  the  general  prin¬ 
ciples  enunciated  by  Mr.  Puzey.  Mr.  Paul  said  the  inter¬ 
mittent  bleeding  in  such  cases  arose  from  imperfect  division 
of  the  vessel  and  the  formation  of  false  aneurysm.  In  all 
cases  he  thought  the  vessel  ought  to  be  found  at  the  bleed- 
ing  point ;  and,  in  his  opinion,  the  brachial  artery  should 
never  be  ligatured  for  such  an  injury. 

THE  EDINBURGH  UNIVERSITY  TERCENTENARY. 

On  Wednesday  next  the  University  of  Edinburgh  will 
complete  the  first  three  hundred  years  of  its  existence.  It 
was  founded  by  a  Eoyal  Charter  granted  by  King  James 
VI.  in  1582,  and  the  Faculty  of  Divinity  was  opened  by  the 
first  Regent  on  October  24,  1883  ;  but  it  was  not  until  after 
another  hundred  years  that  the  Medical  Faculty,  which  has 
now  quite  overshadowed  the  others,  was  started.  The  Chair 
of  Botany  dates  from  1676,  and  those  of  the  Institutes  of 
Medicine  and  the  Practice  of  Physic  from  1685.  The  Chair 
of  Anatomy  was  added  in  1705,  and  that  of  Chemistry  in 
1713.  The  medical  profession  was  at  first,  however,  little 
affected  by  the  training  thus  provided  for  its  members.  The 
few  physicians  who  were  trained  received  their  education 
abroad.  The  bulk  were  apothecaries,  who  owed  to  experience 
the  little  skill  they  possessed.  Surgeon-barbers  were  still 
trusted  in  their  double  capacity  in  all  parts  of  the  country. 
A  great  change  came  in  1720  with  the  appointment  of 
Alexander  Monro  primus  as  Professor  of  Anatomy  in  the 
University  of  Edinburgh.  He  was  then  only  twenty-two 
years  of  age  ;  but  his  learning,  his  skill,  and  his  intellectual 
force  commanded  universal  respect  and  confidence.  During 
the  thirty-four  years  of  his  tenure  of  the  chair,  he  gave  an 
immense  impetus  to  the  scientific  study  of  medicine  in  Scot¬ 
land.  His  influence  was  continued  by  his  son,  Alexander 
secundus,  and  his  grandson,  Alexander  tertius,  both  of  whom 
in  succession  occupied  the  same  chair.  The  professorship 
thus  remained  in  the  hands  of  one  family  for  125  years.  It 
was  the  first  Monro,  however,  that  started  the  great  Medical 
School  of  Edinburgh  University  on  its  successful  career.  By- 
and-by  the  curriculum  was  reduced  to  a  system.  The  Eoyal 
Infirmary  was  founded  in  1725,  Monro’s  father,  also  a 
physician,  being  one  of  the  founders,  and  Monro  himself  its 


first  Physician.  Four  new  chairs  were  added  to  the  Faculty 
before  the  close  of  the  century,  and  the  reputation  of  the 
school  was  maintained  and  extended  by  William  Cullen, 
John  and  James  Gregory,  and  Joseph  Black.  Since  the 
beginning  of  the  present  century,  five  chairs  have  been 
added  to  the  Faculty,  and  the  roll  of  famous  Professors  has 
included  the  names  of  Alison,  Goodsir,  Sir  James  Simpson, 
Edward  Forbes,  James  Syme,  and  others  whom  it  is  surely 
unnecessary  to  name. 


GARTNER'S  DUCTS  IN  WOMEN. 

In  a  paper  published  in  a  recent  number  of  the  Archiv  fur 
Gynukologie,  Dr.  J.  Kocks,  of  Bonn,  describes  certain  fine 
canals  which  he  has  been  able  to  find  in  about  80  per  cent, 
of  those  women  in  whom  he  has  searched  for  them,  and 
which  he  believes  to  be  the  remains  of  Gartner’s  ducts. 
These  canals  open  close  to  the  posterior  margin  of  the 
meatus  urinarius,  and  a  probe  of  one  millimetre  (about  one 
twenty-fifth  of  an  inch)  in  thickness  can  be  passed  into  them 
for  a  distance  of  from  half  a  centimetre  to  two  centimetres 
(about  one-fifth  to  four-fifths  of  an  inch).  Their  orifices 
are  often  situated  a  little  distance  behind  the  urethral 
orifice,  so  that  the  canal  has  to  be  held  open  in  order  to  see 
them ;  but  generally,  says  Kocks,  the  openings  are  to  be 
found  at  the  summit  of  the  little  lips  of  mucous  membrane 
which  bound  the  posterior  part  of  the  meatus  to  right  and 
left.  They  are  generally  both  present,  but  one  may  be 
absent.  Dr.  Kocks  compares  their  appearance  to  that  of 
the  lacrimal  puncta.  They  run  in  the  urethro-vaginal 
septum,  and  end  blindly.  They  are  found  most  easily  in 
young  adults.  In  the  newly  born  they  are  relatively  larger, 
but  absolutely  smaller  than  in  adults.  In  old  women  they 
become  obliterated  or  lessened  in  size.  Dr.  Kocks  regards 
them  as  the  homologues  of  the  ejaculatory  ducts  in  the 
male.  In  the  following  number  of  the  same  journal.  Pro¬ 
fessor  C.  Bohm,  of  Vienna,  writes  to  say  that  he,  like 
Kocks,  has  been  able  to  demonstrate  the  presence  of  these 
ducts;  and  further,  that  he  has  seen  cases  of  acute  and 
chronic  inflammation  of  them.  Sometimes  this  inflamma¬ 
tion  is  but  part  of  a  similar  process  affecting  the  vagina, 
vulva,  and  urethra,  but  sometimes  it  exists  by  itself.  In  the 
latter  case,  owing  to  the  presence  of  redness  and  swelling  of 
the  meatus,  discharge  of  pus  from  it,  and  pain  on  making 
water,  the  disease  may  be  taken  for  gonorrhoea.  From  this 
it  is  to  be  diagnosed  by  everting  the  margins  of  the  meatus, 
and  noticing  that  the  pus  issues  from  the  ducts  in  question. 
It  is  to  be  cured  by  applications  of  solid  nitrate  of  silver  to 
the  inflamed  ducts.  Unless  proper  diagnosis  is  made,  and 
this  treatment  employed,  the  disease  may  prove  obstinate. 


THE  SANITARY  CONDITION  OF  TORQUAY. 

The  annual  report  of  the  Medical  Officer  of  Health  for 
Torquay  (Mr.  Paul  Q.  Karkeek)  for  the  year  1882  is  a  most 
satisfactory  one  in  all  that  regards  sanitary  matters.  During 
the  past  twelve  months  the  new  sanatorium  has  been  in 
course  of  construction,  and  by  this  time  should  be  available 
in  the  event  of  any  outbreak  of  infectious  disease.  Some 
progress  has  also  been  made  with  the  new  reservoir,  which 
it  is  hoped  may  be  completed  during  the  current  year.  The 
stock  of  water  for  the  town  will  then  be  three  hundred 
millions  of  gallons,  which  will  enable  the  authorities  to 
provide  a  constant  supply,  without  any  anxiety,  during  the 
driest  of  summers.  The  main  drainage  system  has  likewise 
been  completed,  by  the  construction  of  about  four  hundred 
yards  of  sewer,  whilst  no  opportunity  has  been  lost  of  in¬ 
serting  ventilators  in  the  drains  wherever  they  were  likely 
to  be  of  service.  Constant  and  systematic  inspections  of  the 
whole  town  have  been  made  during  the  period  under  notice 


460 


Medical  Times  an  i  Gazette 


ANNOTATIONS. 


Oct.  2C,  1683. 


and  on  the  whole  the  condition  of  the  houses  may  be  said 
to  be  satisfactory.  The  labouring  classes  of  Torquay  are, 
Mr.  Karkeek  remarks,  generally  speaking,  very  well  housed; 
and  to  this  fact  he  attributes,  to  a  great  extent,  the  free¬ 
dom  which  the  locality  enjoys  from  typhoid  fever  and  other 
outbreaks  of  zymotic  disease.  The  number  of  deaths  re¬ 
corded  during  the  year  was  363,  equal  to  an  annual  death- 
rate  of  14  6  per  1000.  This  is  the  lowest  number  of  deaths 
registered  since  the  year  1874.  Amongst  visitors,  tramps, 
and  others,  62  deaths  took  place, viz. — phthisis,  21;  bronchitis, 
8;  heart  disease,  6  ;  injury,  1 ;  and  general  diseases,  26.  This 
number,  Mr.  Karkeek  says,  is  somewhat  higher  than  usual, 
but  in  a  health-resort  like  Torquay  this  must  always  be  a 
very  fluctuating  item. 


COBONERS  AT  HOME  AND  ABROAD. 

While  we  have  been  recently  engaged  in  discussing  various 
details  of  the  “  crowner’s  quest  law,”  whether  it  is  neces¬ 
sary  to  view  the  body,  or  what  precise  proportion  of  the 
mortal  remains  constitutes  a  body  in  the  coroner's  sense  of 
the  word,  it  is  interesting  to  find  the  Boston  Medical  and 
Surgical  Journal  heading  a  forcible  article  with  the  ominous 
words,  “  The  Coroners  must  go.”  Prom  this  we  learn  that 
in  Massachusetts,  since  1877,  a  medical  examiner  system 
has  been  in  operation.  An  official  is  appointed,  who  has  to 
examine  the  dead  bodies  of  persons  who  “  are  supposed  to 
have  come  to  their  death  by  illegal  means  or  without  the 
recent  attendance  of  a  physician  in  good  standing.”  Wit¬ 
nesses,  one  of  whom  must  be  a  physician,  are  required  to 
attend  this  examination.  This  system  for  insuring  the  de¬ 
tection  of  crime  and  the  protection  of  public  morals  is 
said  to  work  with  unexpected  smoothness  and  efficiency. 
Seeing  that  the  object  of  an  inquest  is  merely  to  determine 
the  cause  of  death,  and  that,  in  spite  of  the  coroner’s  j  uries’ 
verdicts  of  manslaughter  or  murdei’,  conviction  and  punish¬ 
ment  do  not  necessarily  follow,  it  would  certainly  seem  that 
we  might  follow  with  advantage  the  Massachusetts  system, 
and,  while  abolishing  our  present  expensive,  cumbrous,  and 
unsatisfactory  machinery,  substitute  for  it  one  as  capable 
of  supplying  the  necessary  links  for  criminal  prosecutions, 
and  more  likely  to  avoid  derision  by  keeping  clear  of  the 
present  too  frequently  fanciful  style  of  coroners’  verdict. 


A  TOO  HEALTHY  CITY. 

The  report  of  Mr.  David  Davies,  the  Medical  Officer  of 
Health  for  the  city  and  county  of  Bristol,  touching  the 
sanitary  condition  of  his  district  during  the  second  quarter 
of  the  current  year,  exhibits  a  state  of  affairs  which  might 
be  considered  highly  satisfactory.  The  annual  rate  of  mor¬ 
tality  is  given  as  17'4  per  1000,  against  19-2  and  19’9 
respectively  for  the  similar  quarter  of  the  years  1881  and 
1882.  This  result,  Mr.  Davies  says,  is  much  more  favour¬ 
able  than  he  anticipated  ;  but,  considering  the  many  agents 
detrimental  to  health,  common  to  Bristol  and  all  other 
large  towns,  he  is  of  opinion  that  the  present  returns  do  not 
indicate  the  normal  rate  of  mortality  for  the  period  ;  that 
they  are,  in  fact,  too  favourable  to  be  permanent.  In  illus¬ 
tration  of  this  he  points  out  that  only  ninety-four  deaths 
(or  10T  per  cent.)  were  those  of  children  over  one,  but 
under  five  years  of  age,  against  167  (or  16  0  per  cent.) 
during  the  corresponding  quarter  of  the  past  year.  This 
low  mortality  he  attributes  to  the  comparative  immunity 
of  the  locality  from  the  principal  diseases  of  the  zymotic 
class.  He  frankly  admits  that  this  improved  condition  of 
the  district  is  no  proof  that  vigilant  supervision  has  esta¬ 
blished  a  mastery  over  this  dangerous  class  of  diseases  ;  on 
the  contrary,  he  fears  that  the  present  success  increases 
the  danger  in  the  future,  as,  by  the  saving  of  so  many 


lives,  there  is  now  a  large  number  of  young  children  in  the 
city  who  are  unprotected  from  these  diseases  through  not 
having  once  suffered  from  them.  Without  anticipating 
evils,  Mr.  Davies  wishes  it  to  be  understood  that  a  sudden 
outbreak  of,  say,  scarlet  fever  might  escape  all  sanitary 
control,  and  spread  in  a  virulent  form  among  the  large 
number  of  unprotected  children  now  in  the  city,  and  it 
would  then  have  to  be  admitted  that  the  improved  health- 
condition  of  Bristol  was  only  temporary,  and  not  of  a  per¬ 
manent  character.  The  total  deaths  during  the  quarter 
under  notice  from  zymotic  diseases  were  fifty-five,  giving  a 
rate  of  only  DO  per  1000;  this,  Mr.  Davies  observes,  re¬ 
quires  no  comment,  but  he  is  by  no  means  sanguine  as  to 
its  continuance.  Meanwhile,  he  is  to  be  congratulated  on 
such  a  successful  outcome  of  his  professional  labours,  even 
if  the  same  should  not  prove  to  be  permanent. 


“THE  STEED  OF  STEEL.” 

In  his  chatty  and  suggestive  article  in  one  of  the  magazines. 
Dr.  B.  W.  Bichardson  has  lauded  the  “cycle”  as  a  means  of 
healthful  exercise,  but  he  has  said  little  about  it  as  a  means 
of  locomotion  from  the  doctor’s  point  of  view.  The  time  is 
probably  still  far  distant  when  it  may  be  deemed  generally 
consistent  with  the  dignity  of  the  healing  art  for  the  medical 
attendant  to  alight,  red-hot  and  in  athletic  garb,  at  his 
patient's  door.  Even  in  the  level  midlands,  and  in  rural 
districts,  the  “  cycle”  is  still  only  the  recreation  of  the  few, 
and  the  means  of  professional  locomotion  of  almost  none,  of 
our  medical  fraternity.  What  may  be  the  outcome  of  the 
future,  by  what  means  the  powers  of  electricity  maybe  made 
to  subserve  the  exigencies  of  wide-spreading  practice,  may  as 
yet  be  only  guessed  at  by  the  many,  while  confidently  anti¬ 
cipated  by  the  scientist.  For  the  present,  the  cool  head  and 
hand,  the  dress  of  ordinary  life,  and  the  conservation  of 
medical  energy  by  the  employment  of  the  horse's  (not  the 
doctor’s)  muscles  as  a  motive  force,  are  as  customary  as 
desirable.  But  the  “cycle”  may  be  a  good  friend  to  the 
surgeon,  notwithstanding,  and  may  facilitate  practice  in  one 
|  way,  if  not  in  another.  It  would  be  interesting  to  collect  and 
I  tabulate  the  number  and  variety  of  accidents  met  with  in 
the  use  of  the  machine.  Such  a  catalogue  would  surely  cause 
the  hunting  field,  as  a  source  of  danger  and  injury,  to  sink 
into  extreme  insignificance.  From  one  country  town,  in 
one  week,  we  hear  of  a  fracture  of  metatarsal  bones,  a 
double  Colles’  fracture,  a  strain  of  the  recti  muscles,  and  a 
badly  cut  head,  under  simultaneous  treatment.  This  ex¬ 
cludes  another  case  where  the  refractory  tricycle  swerved 
from  the  hands  of  an  inexperienced  rider  into  a  team  of 
dray-borses,  who  promptly  reduced  it  into  whatever  may  be 
the  ferreous  equivalent  of  “  matchwood,”  the  rider  escaping, 
as  by  a  miracle,  with  a  general  shaking  and  some  bruises- 
From  a  surgical  or  financial  point  of  view,  we  may  conclude 
the  “  cycle  ”  is  not  altogether  such  a  “  nuisance  ”  as  the 
doctors,  with  the  rest  of  the  driving  and  riding  public,  are 
apt  so  emphatically  to  affirm. 


ANTHROPOMETRY. 

Some  interesting  facts  were  made  public  at  the  recent 
meeting  of  the  British  Association,  as  the  result  of  the 
labours  of  the  Anthropometric  Committee,  which  was  ap¬ 
pointed  in  1875,  to  collect  and  analyse  information  upon  the 
physical  character  of  inhabitants  of  the  British  Isles.  Sta¬ 
tistics  have  been  collected,  relating  to  53,000  individuals  of 
both  sexes  ;  and  the  results  of  the  labours  of  the  Committee 
are  embodied  in  several  important  and  interesting  tables. 
The  average  height  of  adult  males  in  Scotland  is  68-71  in., 
in  Ireland  67  90,  in  England  6736,  and  in  Wales  66  66.  The 
weight  of  the  average  Scotchman  is  165’3  lbs.,  of  the  Welsh- 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Oct.  2\  1883.  461 


man  158-3,  the  Englishman  155,  and  of  the  Irishman  154  lbs. 
A  Scotchman  weighs  2'40  lbs.  per  inch,  a  Welshman  2'37,  an 
Englishman  230,  and  an  Irishman  2-27  lbs.  One  table  deals 
with  the  relative  stature,  weight,  and  strength  of  arm  of  adult 
English  males  and  females.  The  average  stature  of  males 
is  67'36  in.,  and  of  females  6265  in.  —the  weight  of  the 
former  155  0,  and  of  the  latter  122-8  lbs.  Inhabitants  of 
northern  are  taller  in  stature  than  those  of  other  climates. 
Taking  the  British  people  as  a  nation,  and  comparing 
with  91  peoples,  the  average  stature  of  the  Britisher  is 
2J  in.  more  than  all  except  Polynesians  and  New  Zea¬ 
landers,  who  average  If  in.  more  than  the  Britisher.  It  is 
interesting  to  know  that  the  tallest  Englishmen  are  those 
of  the  professional  classes.  The  ratio  of  weight  to  stature 
is  in  trained  athletes  2 TO  lbs.,  and  in  ordinary  individuals 
2’32  lbs.  per  inch.  A  trained  athlete  of  5  ft.  7  in.  should 
therefore  weigh  10  st.,  and  an  untrained  man  of  the  same 
height  11  st.  Some  very  interesting  measurements  concern¬ 
ing  children  are  tabulated.  At  birth  males  are  j  in.  longer 
and  3  oz.  heavier  than  females — 19-53  to  19-32  in.,  and  7'12 
lbs.  to  6-94  lbs.  respectively.  Growth  in  children  is  most 
rapid  during  the  first  five  years,  and  is  about  the  same  in 
rate  in  both  sexes.  From  5  to  10,  boys  grow  more  rapidly 
than  girls.  From  10  to  15,  girls  beat  boys,  and  at  11|  to 
14f  years  of  age  are  taller  than  boys,  and  at  12J  to  15J 
heavier.  This  is  attributed  to  the  earlier  accession  of  puberty 
in  girls.  From  15  to  20,  boys  again  take  the  lead,  growing 
at  first  rapidly,  then  more  slowly  up  to  23.  Girls  attain  full 
stature  at  20,  boys  not  till  23.  The  strength  of  both  sexes 
increases  up  to  30,  and  then  declines  to  60. 

AN  IDEAL  DRINK. 

After  all  has  been  said  and  done  that  can  be  said  and  done 
in  the  cause  of  total  abstinence  and  on  the  subject  of 
alcoholic  beverages,  after  the  fever  and  fashion  of  this  our 
day  has  changed  and  subsided,  we  believe  that  beer  will  still 
be  found  to  be  the  national  drink  of  the  future,  as  it  has 
been  of  the  past,  in  this  country.  The  reason  of  this  is 
that  it  is,  in  fact,  economically  and  physiologically  a  drink 
combining  so  many  useful  qualities  that  nothing,  it  is  clear, 
can  be  provided  for  the  price  which  is  at  all  likely  to  super¬ 
sede  it.  Tea  and  coffee,  if  universally  drunk — solutions  of 
tannin  with  a  small  and  varying  amount  of  more  or  less 
harmful  alkaloid — would  cause  such  an  increase  of  national 
dyspepsia  and  nervous  troubles  that  a  new  crusade,  with  the 
Dean  of  Bangor  perhaps  as  its  Peter  the  Hermit,  would 
soon  drive  them  from  their  position  as  national  beverages. 
Neither  they  nor  milk  can  be  provided  good  in  sufficient 
quantity  and  at  the  price  required ;  and  milk  is  not 
always  tolerated  by  grown-up  stomachs.  Oatmeal-and- 
water  will  soon  pall  upon  the  most  enthusiastic  palate. 
Sweet  syrups  or  acid  effervescents  can  scarcely  be  habi¬ 
tually  consumed  without  derangement  of  the  gastric  func¬ 
tions.  And  as  for  water— the  ijbest  of  drinks  when  at 
its  best — sanitation  will  have  to  make  very  long  strides 
indeed  before  it  can  be  regarded  as  anything  but  the  most 
perilous  of  thirst- quenchers.  If  a  committee  of  unpreju¬ 
diced  scientific  men  had  been  appointed  to  compound  and 
recommend  a  perfectly  aseptic  drink,  combining  the  qualities 
of  nutrition  and  palatability,  with  such  small  amount  of 
alcohol  as  should  act  as  a  preservative  to  the  fluid  itself,  an 
aid  to  digestion,  and  a  mild  and  innocuous  stimulant  to  the 
whole  system,  it  is  probably  upon  a  light,  bitter  beer,  brewed 
from  good  malt  and  hops,  that  the  seal  of  their  approval 
would  be  placed.  Formed,  as  it  is,  from  wholesome  and 
indigenous  materials,  easily  concocted,  and  at  a  small  cost, 
tonic  and  nutritious,  harmless  except  in  almost  impos¬ 
sible  quantity,  it  is  just  such  an  ideal  drink  as  we  should 
pine  for  if  we  did  not  already  possess  it.  All  ques¬ 


tions  of  adulterated,  fortified,  or  dishonestly  compounded 
malt  liquor,  and  all  question  of  injury  by  excess,  in  this  as 
in  every  other  aliment,  are  beside  the  present  issue. 


THE  ETIOLOGY  OF  PUERPERAL  INVERSION  OF 
THE  UTERUS. 

In  a  paper  by  Fiirst,  published  in  a  recent  number  of 
the  Archiv  fur  Gyn'akologie,  the  author  describes  the  follow¬ 
ing  as  the  conditions  which  predispose  to  the  occurrence  of 
inversion  of  the  uterus  in  the  puerperal  state  : — 1.  Feeble¬ 
ness  of  uterine  action  as  a  result  of  prolonged  labour,  cases 
in  which  delivery  is  often  completed  by  the  forceps.  Out  of 
148  cases  collected  by  Lee,  in  twenty  the  labour  was  ex¬ 
ceptionally  slow,  and  in  twenty-five  very  quick.  2.  Attach¬ 
ment  of  the  placenta  to  the  fundus  uteri.  Considering  the 
large  part  which  want  of  tone  in  the  uterine  muscular  fibre 
plays  in  producing,  or  rather  in  permitting,  inversion  of  the 
organ,  and  having  regard  to  the  exceptional  presence  of  this 
atony  in  primiparse,  Dr.  Fiirst  is  of  opinion  that  the  acci¬ 
dent  occurs  more  frequently  in  first  labours  than  would  be 
expected — a  fact  which  he  attributes  to  the  greater  fre¬ 
quency  of  fundal  implantation  of  the  placenta  in  these  cases, 
as  shown  by  the  comparative  rarity  of  placenta  prsevia  in 
primiparse.  3.  Comparative  rigidity  of  the  vagina,  opposing 
descent  of  the  uterus  in  response  to  downward  pressure  on 
it,  and  thus  favouring  the  production  of  inversion  by  a  force 
acting  on  the  fundus,  this  being  a  condition  also  met  with 
chiefly  in  primiparse.  According  to  Schatz,  the  opposite 
state,  laxity  of  the  vagina,  is  one  of  the  conditions  which 
bring  about  inversion.  4.  Narrowness  of  the  vulva,  pre¬ 
venting  the  easy  exit  of  blood,  so  leading  to  distension 
of  the  uterus,  in  the  sudden  emptying  of  which  inversion 
is  likely  to  occur.  Adhesion  of  the  placenta  is  known  to  be 
frequently  associated  with  inversion.  Thus,  out  of  Lee  s 
148  cases,  in  sixty-seven  the  placenta  was  attached  to 
the  inverted  organ,  its  manual  removal  being  required  in 
fifty-three  of  them. _ 

THE  NEW  GO  VAN  COMBINATION  FEVER  HOSPITAL. 

This  institution,  which  has  been  upwards  of  a  year  in 
building,  is  now  completed,  and  will  be  a  great  adjunct  to 
the  other  hospitals  connected  with  Glasgow.  The  Hospital 
has  been  erected,  at  the  request  of  the  local  authorities 
of  Govan,  Kinning  Park,  Partick,  and  Hillhead,  to  meet 
the  growing  want  of  these  districts.  It  is  a  handsome 
building,  the  cost  of  which  is  estimated  at  <£12,000,  and 
covers  an  area  of  ground  extending  over  three  acres.  The 
building  consists  of  five  separate  blocks,  comprising  a  large 
central  administrative  department  two  storeys  in  height, 
containing  accommodation  for  resident  medical  officer, 
matron,  nurses,  etc.,  with  reception-room  for  visitors,  and 
ample  kitchen  quarters.  In  addition,  there  are  three  large 
separate  pavilions  of  one  storey  each,  which  are  capable  of 
accommodating  in  all  fifty  fever  or  small-pox  patients, 
and  the  cubic  space  allotted  to  each  is  of  a  very  ample 
kind.  Each  pavilion  is  provided  with  separate  accom¬ 
modation  for  day  and  night  nurse,  and  is  supplied  with 
the  latest  improvements  in  sanitary  appliances.  The  re¬ 
maining  block  contains  disinfecting  and  drying  rooms, 
mortuary,  washing  and  coach  houses,  and  other  offices. 
The  whole  building  is  enclosed  by  palings  seven  feet  high, 
and  a  handsome  stone  parapet  and  iron  railings. 


SOCIETY  FOR  THE  RELIEF  OF  WIDOWS  AND 
ORPHANS  OF  MEDICAL  MEN. 

The  usual  quarterly  court  of  the  above  Society  was  held 
at  the  rooms  of  the  Royal  Medical  and  Chirurgical  Society 
on  Wednesday,  October  10,  at  5  p.m.  The  President  (Sir 
George  Burrows,  Bart.)  was  in  the  chair.  The  attendance 

* 


462 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Oct.  20.  1883. 


of  the  directors  was  unusually  large.  One  new  member 
was  elected.  Applications  for  grants  were  considered  from 
fifty-seven  widows,  five  orphans,  and  three  recipients  of 
relief  from  the  Copeland  Fund,  and  it  was  resolved  to 
recommend  that  a  sum  of  ,£1217  should  be  distributed 
among  them  in  January  next.  There  were  no  fresh  applica¬ 
tions  for  relief.  The  Christmas  present,  which  has  now 
been  given  for  many  years,  was  again  voted,  the  funds  ad¬ 
mitting  the  same  sum  as  last  year  to  be  given  to  the 
widows  and  orphans  now  in  receipt  of  grants— viz.,  £5  to 
each  widow,  <£2  to  each  orphan,  and  £4  to  the  three  orphans 
on  the  Copeland  Fund — in  all  a  sum  of  £307. 


SMALL-POX  STATISTICS  FOR  ISLINGTON  IN  1882. 

Dr.  Charles  Metmott  Tidy,  the  Medical  Officer  of  Health 
for  the  parish  of  St.  Mary,  Islington,  in  his  annual  report 
on  the  sanitary  condition  of  the  locality  for  the  year  1882, 
makes  the  following  remarks  upon  small-pox  incidence  in 
that  portion  of  London.  The  epidemic  of  small-pox,  he 
says,  which  had  gradually  subsided  during  the  last  three 
months  of  1881,  did  not  entirely  disappear  with  the  advent 
of  1882,  but  lingered  in  that  neighbourhood  throughout  the 
whole  of  the  year.  During  1882,  142  cases  of  this  disease 
were  recorded,  against  797  in  the  previous  year ;  the  monthly 
numbers  commencing  with  11,  and  increasing  to  43  in 
August  and  38  in  September,  and  diminishing  to  1  in 
December  last.  It  is  only  right  to  add,  he  remarks,  that 
this  dreaded  scourge  has  been  very  quiescent  during  the 
present  year,  only  10  cases  having  been  reported  during 
the  first  six  months.  Such  fortunate  immunity,  however, 
he  reminds  the  authorities,  is  often  followed  by  increased 
activity,  as  is  shown  by  the  previous  history  of  this  disease. 
The  terrible  outbreak  of  1871,  with  its  386  deaths  in  Isling¬ 
ton  alone,  was  preceded  by  a  similarly  peaceful  lull.  He 
therefore  counsels  an  attitude  of  constant  watchfulness,  in 
order  that  the  first  symptoms  of  prevalence  may  be  met  by 
due  precautions.  In  concluding  his  remarks  he  observes  : 
“  Knowing  as  we  do  from  long  experience  the  treacherous 
character  of  this  disease,  its  insidious  working  in  some  secret 
focus,  and  the  swiftness  with  which  it  subsequently  appears 
and  spreads,  it  is  no  small  source  of  satisfaction  to  know 
that  the  Islington  Small-pox  Camp  Hospital  premises  remain 
intact.  The  tents  and  stores  being  apparently  in  good  con¬ 
dition,  we  should,  in  any  sudden  emergency,  have  the 
immense  advantage  of  being  ready  at  a  moment'’ s  notice  to 
face  the  enemy  with  the  best  of  all  weapons — a  sufficiency 
of  hospital  accommodation,  so  much  needed  at  the  com¬ 
mencement  of  an  outbreak  by  the  sufferers  first  attacked.” 


DR.  ROCHARD’S  SUPPOSED  ASSASSIN. 

In  a  paper  inserted  in  the  Gazette  des  Hopitaux  (October  11), 
Dr.  Legrand  du  Saulle  gives  an  account  of  a  remarkable 
case  of  delire  des  persecutions,  which  is  especially  interesting 
inasmuch  as  there  is  every  reason  to  suppose  that  the  sub¬ 
ject  of  it  is  the  author  of  the  attempted  assassination  of 
Dr.  Rochard,  the  Medical  Director  of  the  French  Marine, 
which  has  excited  so  painful  a  sensation  in  Paris.  It  will 
be  recollected  that  Dr.  Rochard,  while  returning  from  the 
Office  of  Marine  to  his  own  house  on  the  evening  of  Sep¬ 
tember  26,  was  shot  in  the  back  by  an  unknown  hand.  It 
was  supposed  that  he  had  been  shot  in  mistake  for  some 
one  else,  and  this  seems  to  have  been  the  case.  A  man, 
Jean  Chabert  by  name,  and  forty-four  years  of  age,  gave 
himself  up  (October  6)  to  the  magistrate  entrusted  with  the 
case,  who  at  once  placed  him  under  Dr.  Legrand  du  Saulle’s 
care  in  order  that  his  mental  condition  should  be  investi¬ 
gated.  It  seems  that  the  man,  after  following  various 
trades,  and  being  somewhat  addicted  to  drink,  obtained 
admission  to  a  hospital  in  1878  under  the  erroneous 


|  allegation  that  he  had  been  poisoned;  and  about  the 
same  time  he  conceived  a  violent  antipathy  to  a  maitre 
d  hotel,  at  whose  hands,  as  well  as  various  other  per¬ 
sons,  he  conceived  himself  the  victim  of  various  perse¬ 
cutions.  Placed  in  an  asylum,  he  considerably  improved, 
but  on  his  discharge  his  delusions  returned,  and  he  was 
again  admitted  into  the  asylum  of  Ville-Evrard,  whence  he 
contrived  to  escape.  For  a  considerable  time  he  remained 
quiet,  and  worked  for  his  living,  but  at  the  end  of  September 
resumed  his  intemperate  habits  and  became  dominated  by 
the  idea  of  persecution.  He  wandered  about  Paris  for  some 
days  without  food,  and  carrying  a  revolver,  and,  standing 
out  of  the  rain  on  the  evening  of  September  26,  he  fired 
at  a  gentleman  who  passed,  the  ball  striking  him  on  the 
back,  just  below  the  umbrella  he  was  holding.  Learning 
from  the  newspapers  that  it  was  Dr.  Rochard  whom  he  had 
shot,  he  addressed  an  anonymous  letter  to  him,  accusing  the 
maitre  d’hotel,  his  former  supposed  persecutor,  of  the  crime. 
He  afterwards,  as  already  stated,  denounced  himself  to  the 
magistrate.  Although,  as  Dr.  Legrand  observes,  he  is 
most  probably  the  author  of  the  crime,  yet  no  one  saw  him 
commit  it.  His  is  not  one  of  those  singular  dispositions  of 
mind  which  lead  to  the  avowal  of  imaginary  crimes,  and  all 
seems  to  concur  in  demonstrating  the  reality  of  this  sad 
action,  but  still  the  absence  of  all  witnesses  imposes  a  certain 
reserve. 

I  CITY  OF  MEDICAL  SOCIETIES. 

The  New  York  Medical  Record  of  September  22  applies  this 
designation  to  New  York,  stating  that  there  are  in  New 
York  city  twenty-seven  registered  working  medical  societies,' 
besides  two  societies  devoted  to  public  health,  one  to  general 
science,  one  to  microscopy,  and  two  to  veterinary  medicine. 
There  are  moreover  four  alumni  associations.  The  majority 
of  the  societies  are  limited  in  membership,  and  hold  their 
meetings  at  the  houses  of  the  members.  Of  the  now  exist¬ 
ing  societies  not  half  a  dozen  existed  before  1860.  “  While 

some  of  these  societies  are  weak  and  inactive,  this  cannot  be 
said  of  the  great  majority,  and  the  general  effect  of  the 
numerous  organisations  has  been  most  excellent.  In  no 
city  can  there  be  found  so  many  physicians  who  are  on  such 
amicable  terms  with  each  other,  nor  does  any  other  city 
produce  so  many  contributors  to  medical  science.” 


THE  PARIS  WEEKLY  RETURN. 

The  number  of  deaths  for  the  fortieth  week  of  1883,  ter¬ 
minating  October  4,  was  937  (539  males  and  398  females), 
and  of  these  there  were  from  typhoid  fever  39,  small-pox  4, 
measles  6,  scarlatina  1,  pertussis  19,  diphtheria  24,  dysen¬ 
tery  1,  erysipelas  5,  and  puerperal  infections  2.  There  were 
also  37  deaths  from  acute  and  tubercular  meningitis,  188 
from  phthisis,  19  from  acute  bronchitis,  44  from  pneumonia, 
111  from  infantile  athrepsia  (43  of  the  infants  having  been 
wholly  or  partially  suckled),  and  36  violent  deaths  (28  males 
and  8  females).  The  mortality  of  Paris,  although  increased 
upon  the  exceptional  amount  of  last  week,  is  still  low,  that 
from  epidemic  diseases  continuing  nearly  stationary.  The 
autumnal  recrudescence  of  typhoid  fever  usually  observed 
has  not  commenced.  The  births  for  the  week  amounted  to 
1202,  viz.,  604  males  (451  legitimate  and  153  illegitimate) 
and  598  females  (412  legitimate  and  186  illegitimate) ;  95 
infants  were  either  bom  dead  or  died  within  twenty-four 
hours,  viz.,  60  males  (40  legitimate  and  20  illegitimate)  and 
35  females  (23  legitimate  and  12  illegitimate). 


A  PROVIDENTIAL  ACCIDENT. 

A  patient  with  locomotor  ataxy  consulted  Dr.  W.  A. 
Hammond,  of  New  York,  who  advised  him  to  go  to  bed,  and 
remain  there  for  at  least  six  months.  The  patient  said  it 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Oct.  20,  1883.  463 


was  impossible  for  him  to  go  to  bed,  and  that  if  that  were 
necessary  he  must  give  up  treatment.  On  leaving  the  con¬ 
sulting-room,  however,  he  luckily  slipped  and  broke  his 
thigh,  and,  being  taken  home,  he  completed  his  good  fortune 
by  calling  in  an  “  irregular  practitioner,”  who  kept  him  in 
bed  for  a  year.  At  the  end  of  that  time  the  patient  arose, 
cured  not  only  of  his  fracture,  but  of  his  ataxy  also,  and 
has  remained  well  ever  since. 

TREATMENT  OF  THE  INSANE  IN  SPAIN. 

Spain  is  sadly  in  want  of  a  Commission  in  Lunacy  like  our 
own.  The  following  state  of  things  is  described  in  the 
Journal  of  Nervous  and  Mental  Diseases  by  Dr.  Seguin,  the 
well-known  American  alienist,  as  existing  in  the  asylum  at 
Valencia: — “Camisoles  and  ordinary  muffs,  wristlets,  etc., 
were  employed,  but  there  was  something  worse.  This  was 
an  iron  belt,  made  in  two  segments  connected  behind  by  a 
hinge,  and  closing  in  front  by  a  nut  and  screw ;  the  belt  is 
two  inches  wide  and  one-eighth  of  an  inch  thick.  On 
either  side,  screwed  by  a  rivet,  is  a  single  oval  chain  link, 
two  inches  long,  supporting  a  manacle  or  bracelet  of  the 
same  iron  as  the  belt  (a  trifle  less  wide),  opening  with  two 
hinges,  and  closed  also  by  a  screw  and  nut.  The  bracelets 
give  play  for  the  arms  (in  semi-flexion,  as  the  wrists  are 
kept  at  waist)  only  on  a  radius  of  some  three  inches.  And 
to  cap  the  climax,  these  iron  parts  are  not  lined  or  protected 
in  any  way.  The  apparatus  weighs  from  four  to  five  pounds . 
Many  of  these  were  in  use  on  male  and  female  patients,  and 
there  were  others  hung  up  in  a  store-room.  During  our 
visit  a  number  of  the  patients  came  forward,  half  holding 
out  their  hands,  begging  piteously  to  be  released.  The 
good  doctor  smilingly  replied,  c  Yes,  by-and-by,’  or  ‘  Yes, 
to-morrow.’  The  most  astounding  part  of  this  barbarity 
was  Dr.  Company’s  satisfaction  with  the  irons,  and  his 
assurance  that  they  were  fso  secure.’  He  showed  me  how 
they  were  managed,  and  took  considerable  trouble  to 
procure  me  permission  from  the  general  authorities  to  take 
one  away  with  me  r  as  a  model,’  which  he  supposed  I  would 
introduce  to  a  grateful  circle  of  alienists  in  America.  But 
the  worst  thing  of  all — a  thing  almost  incredible  at  the 
present  day— was  the  way  in  which  the  filthy  demented 
patients  were  herded  (and  that  is  a  mild  word).  In  one 
long,  narrow,  dismal  room,  I  found  between  thirty  and  forty 
women  squatting  nearly  naked  on  a  wooden  platform,  about 
six  by  twenty- five  feet,  and  raised  one  foot  from  the  floor. 
On  this  platform  was  straw,  and  on  this  sat,  or  kneeled,  or 
sprawled,  or  squatted  these  women,  with  only  a  coarse 
shift,  open  in  all  directions,  exposing  to  view  wrinkled  and 
dirty  arms,  backs,  bosoms,  etc.  Some  were  howling,  others 
moaning,  some  singing,  many  rocking  to  and  fro.  They 
were  so  crowded  as  almost  to  touch  one  another.  On  the 
other  side  of  the  same  hall,  a  yard  away  perhaps,  was 
another  wooden,  raised,  sloping  platform,  extending  the 
whole  length  of  the  room,  covered  with  straw  and  corn 
husks.  Upon  this  the  wretches  were  to  lie  down  side  by 
side  to  pass  the  night.  A  bad-looking  man  had  charge  of 
this  crowd,  assisting  a  woman.  No  doubt  sometimes  extra 
muscular  strength  was  required.  The  filthy  male  patients 
were  treated  in  much  the  same  manner,  only  they  were 
allowed  to  go  about  their  c  patio,’  some  with  irons  on.  They, 
like  the  women,  had  almost  no  clothing,  and,  like  them, 
they  slept  promiscuously  on  straw.  In  these  and  other 
departments  I  noticed  patients  with  bare  extremities  visibly 
suffering  from  the  cold ;  it  was  a  damp,  chilly  air,  and  I 
was  glad  of  my  winter  underclothing  and  a  heavy  autumn 
overcoat.  Dr.  Company  said  of  these  unfortunates,  in  a 
half  apologetic  way,  that  they  were  perfectly  demented  and 
unconscious.  He  added  that  restraint  was  always  ordered 
by  himself  or  his  assistants.” 


THE  HOSPITAL  FOR  WOMEN. 

On  Thursday  last.  Dr.  Heywood  Smith,  after  some  introduc¬ 
tory  remarks  from  Dr.  Protheroe  Smith,  commenced  a  course 
of  clinical  lectures  to  be  delivered  on  alternate  Thursdays, 
at  3.30  p.m.,  in  the  theatre  of  the  Hospital.  His  subject 
is  Cervicitis.  The  first  lecture  was  occupied  chiefly  with 
pathology,  and  some  of  the  causes  of  the  malady ;  the  next 
lecture  (October  25)  will  deal  with  symptoms  and  signs ; 
and  the  third  mainly  with  treatment.  He  will  be  followed 
by  Dr.  Carter,  Dr.  R.  T.  Smith,  and  Mr.  Reeves.  Prac¬ 
titioners  are  welcome  on  the  presentation  of  their  card. 


MEDICAL  WOMEN  IN  INDIA. 

The  education  and  training  of  medical  women  for  India 
was  first  mooted  in  Great  Britain.  In  India  it  was  taken 
up  in  an  unofficial  manner  by  Drs.  Corbyn,  Tomkyns,  and 
Lock,  of  the  Bengal  Army,  as  early  as  1867;  and  in  1872, 
Surgeon- General  Edward  Balfour  submitted  the  subject  to 
the  Madras  Government,  by  which  it  was  adopted.  Mr.  E. 
Balfour,  a  few  months  since,  gave  an  elaborate  account  of 
the  movement  from  its  initiation  in  a  letter  to  the  National 
Indian  Association,  which  showed  that  during  the  past  thirty 
years  considerable  attention  had  been  given  to  the  training 
of  women  in  Madras  as  midwives  and  nurses,  and  the 
Government  in  1854  granted  them  salaries.  The  prejudices 
of  the  native  population  against  the  movement  were,  however, 
so  strong  that  it  made  but  slow  progress  amongst  them.  An 
impetus  seems  lately  to  have  been  given  to  the  study  of 
medicine  by  native  women  of  India,  and  several  have  entered 
the  medical  schools  for  that  purpose.  Moreover,  the  move¬ 
ment  is  rapidly  increasing  in  other  foreign  nations,  under 
official  sanction. 

BACILLUS  IN  CONSUMPTION. 

Db.  Hurd’s  remarks  on  “the  germicide  treatment  ”  of  Con¬ 
sumption  ( Boston  Medical  and  Surgical  Journal,  September 
20)  will  be  most  unwelcome  to  physicians  who  have  been 
anxious  to  treat  consumption  on  antiseptic  principles. 
While  fully  admitting  the  presence  of  the  bacillus.  Dr. 
Hurd  says  there  is  no  evidence  that  inhalations,  sprays, 
atomisations,  or  fumigations  have  any  efficacy  in  destroying 
the  micro-organisms,  whose  multiplication  and  whose  ravages 
are  supposed  to  be  such  important  secondary  factors  in  the 
disease.  He  regards  the  constitutional  diathesis,  which 
allows  of  the  growth  of  the  bacillus,  as  the  primary  factor, 
and  declares  emphatically  that  if  this  be  suitable  there  is  no 
direct  medication  known  to  science  which  will  prevent  the 
l  development,  growth,  and  multiplication  of  the  parasite. 


THE  “EDINBURGH  CLINICAL  AND  PATHOLOGICAL 
JOURNAL.” 

Of  the  multiplication  of  new  medical  periodicals  there  is 
no  end,  and  a  fresh  addition  to  their  already  overcrowded 
ranks  has  just  been  made,  in  the  form  of  a  somewhat  thin 
journal,  intended  to  be  essentially,  clinical  and  patholo¬ 
gical,  and  published  in  Edinburgh  under  the  editorship 
of  Drs.  Graham  Brown,  Cathcart,  and  Berry  Hart.  This 
new-comer  fills  no  gap,  supplies  no  want,  and  has  no  dis¬ 
tinctive  features ;  and  we  venture  to  predict  for  it  a  brief 
and  abortive  career.  The  editors  express  their  surprise  that 
Scotland,  which  possesses  so  many  schools  of  medicine  of 
acknowledged  excellence,  should  have  remained  so  long 
without  a  weekly  organ  in  which  the  views  of  the  profes¬ 
sion  might  be  fittingly  represented,  and  the  busy  practi¬ 
tioner  kept  au  courant  with  the  advances  of  medical 
science.  But  Scotland  and  the  medical  profession  in  that 
part  of  the  kingdom  have  not,  perhaps,  been  left  in  the 
destitute  and  profoundly  ignorant  state  which  the  con¬ 
ductors  of  this  fresh  lamp  of  enlightenment  imagine,  for 


464 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Oct.  20,  1883. 


the  great  national  organs  of  professional  opinion  and  medi¬ 
cal  science,  published  in  London,  have  always  bestowed 
a  fully  fair  share  of  attention  on  Scotch  medical  affairs, 
and  have  weekly  conveyed  to  practitioners  north  of  the 
Tweed  complete  information  as  to  every  advance  in  the 
science  and  art  of  medicine,  not  only  in  the  Scotch  schools, 
but  in  the  schools  of  the  world.  No  more  mischievous 
notion  could  be  indoctrinated  into  the  mind  of  the  pro¬ 
fession  in  Scotland  than  that  of  home-rule  in  medicine  ;  and 
no  more  unfortunate  habit  could  Scotch  practitioners  fall 
into  than  that  of  only  interchanging  their  experiences  with 
their  immediate  neighbours.  Provincialism  is  fatal  to  true 
science.  The  great  social  forces  and  changes  that  have 
made  London  the  sole  literary  centre  of  the  three  king¬ 
doms  are  operative  in  the  case  of  medical  literature,  and 
it  will  be  in  vain  for  the  most  competent  editors  to  con¬ 
tend  against  these,  and  to  attempt  to  carry  on  a  really  first- 
class  journal  anywhere  but  in  the  metropolis.  Writers  in 
this  new  magazine  will  have  the  satisfaction  of  knowing  that 
they  have  an  audience,  fit  perhaps,  but  few  most  undoubt¬ 
edly,  and  that  their  lucubrations  are  read  by  tens,  where 
they  might  have  been  read  by  thousands  if  contributed  to 
more  catholic  and  old-established  periodicals.  And  readers 
of  it  may  console  themselves  with  the  reflection,  that  if 
they  are  somewhat  narrowing  their  minds,  they  are  at 
any  rate  encouraging  native  produce.  Existing  medical 
journals  provide  the  amplest  facilities  for  the  publication  of 
everything  that  is  worth  making  known,  and  local  and 
ephemeral  fly-sheets  are  simply  hurtful,  by  hiding  away,  in 
inaccessible  corners,  observations  and  opinions  that  ought 
to  pass  current  throughout  the  land.  Comparatively  few 
medical  men  have  opportunities  of  visiting  the  great 
libraries  where  all  medical  papers  may  be  consulted,  and 
still  fewer  are  in  a  position  to  lavish  sixpences  on  small 
morsels  of  medical  literature  like  the  Edinburgh  Clinical  and 
Pathological  Journal,  which  is  rounded  off  in  sixteen  octavo 
pages.  The  contents  of  the  first  number  of  this  journal 
cannot  be  said  to  be  above  average  merit. 


THE  COCOANUT  AS  A  FOOD. 

The  Fiji  Times,  in  a  recent  article  on  the  immense  utility 
of  the  cocoanut  as  food  rations,  and  the  valuable  qualities 
which  it  possesses  for  sustaining  nutrition,  narrates  the 
following  instance  of  its  use  as  food  : — A  vessel  left  San 
Francisco  with  400  passengers  for  Sydney,  and  in  conse¬ 
quence  of  running  short  of  stores  had  to  put  in  at  Samsa, 
where  a  large  quantity  of  cocoanuts  were  obtained.  During 
the  remainderof  thepassage — for,  through  stress  of  weather, 
the  vessel  only  reached  Sydney  after  a  perilous  journey  of 
eighty  days — provisions  ran  short,  and  men,  women,  and 
children  were  fed  only  upon  cocoanuts,  being  at  last 
reduced  to  one  per  diem  for  each  adult.  Notwithstanding 
the  diet,  not  a  life  was  lost,  and  not  a  single  case  of  sick¬ 
ness  occurred,  all  the  passengers  landing  in  a  healthy  and 
well-nourished  condition. 


The  Chair  of  Anatomy  in  the  University  of  Berlin  passes, 
with  the  commencement  of  the  present  session,  from  the 
hands  of  Professor  Reichert  into  those  of  Professor  Waldeyer, 
formerly  Professor  of  Anatomy  and  Embryology  at  Strasburg. 

The  testimonial  to  Professor  Bentley  on  his  retirement 
from  the  post  of  Dean  of  the  Medical  Faculty  in  King’s 
College  will  be  formally  presented  to  him  on  October  24,  at 
half-past  four,  by  the  Rev.  Canon  Barry,  in  the  large 
theatre  of  the  College.  The  testimonial  will  consist  of  an 
illuminated  album  containing  an  address  and  a  list  of  the 
subscribers,  together  with  a  purse. 


A  special  private  clinic  will  shortly  be  established  in 
Berlin  for  the  reception  and  study  of  cases  of  skin  diseases 
and  syphilis,  under  the  direction  of  Dr.  Lassar,  who  has 
hitherto  given  instruction,  in  a  smaller  field  of  action,  as 
Docent,  in  the  University.  This  clinic  will  doubtless  be  appre¬ 
ciated  by  foreign  students  in  search  of  special  knowledge. 


The  lectures  of  the  new  session  commenced  in  the 
University  of  Vienna  on  the  15th  inst.  During  the  vacation 
many  of  the  lecture-rooms  have  been  greatly  improved  and 
added  to.  The  new  Pathological  Institute  is  expected  to  be 
completed  in  the  course  of  the  next  few  months.  A  second 
clinic  for  Ophthalmology  is  about  to  be  established  in  the 
Vienna  School,  under  the  professorship  of  Dr.  E.  Jager  von 
Jaxtthal,  hitherto  one  of  the  Extraordinary  Professors. 


We  understand  that  the  Committee  of  Management  of  the 
Farringdon  Dispensary  have  just  established  an  ophthalmic 
department  at  this  institution,  and  that  Mr.  Henry  Juler, 
F.R.C.S.,  of  St.  Mary’s  and  the  Westminster  Ophthalmic 
Hospitals,  has  been  appointed  surgeon  to  the  department. 
There  were  more  than  37,000  attendances  of  patients  last 
year  at  this  Dispensary,  and  the  work  is  rapidly  increasing. 
In  consequence  of  this  increase,  and  also  with  the  view  of 
separating  more  completely  the  medical  from  the  surgical 
cases,  an  additional  physician  is  to  be  appointed. 


At  the  request  of  the  Collective  Investigation  Committee 
of  the  Manchester  district,  Mr.  Jonathan  Hutchinson  has 
promised  to  deliver  an  address  at  the  Owens  College  on 
Thursday  next,  October  25,  at  4.15  p.m.  Dr.  William 
Roberts,  F.R.S.,  will  preside  over  the  meeting,  and  all 
members  of  the  profession  are  invited  to  attend.  We  may 
safely  anticipate  a  most  interesting  address  from  the  dis¬ 
tinguished  orator,  and  we  expect  that  a  very  large  number 
of  the  profession  residing  in  the  neighbourhood  will  avail 
themselves  of  this  opportunity  of  hearing  Mr.  Hutchinson 
on  Collectivism  as  applied  to  Medicine. 


Mb.  Greenwood,  the  “  Amateur  Casual,”  will  have  to 
look  to  his  laurels,  for  his  exploit  in  passing  himself  off  as 
a  tramp  for  a  single  night  has  been  put  quite  in  the  shade 
by  an  American  reporter,  who  had  himself  committed  to  the 
workhouse  as  a  pauper,  and  there  shammed  insanity  in 
order  to  get  transferred  to  the  neighbouring  lunatic  asylum, 
in  which  abuses  were  said  to  exist.  He  was  not  only  suc¬ 
cessful  in  obtaining  his  transference,  but  actually  resided 
in  the  asylum  for  nearly  six  months  without  detection  !  It 
is  difficult  to  believe  that  the  authorities  were  altogether 
without  excuse  in  detaining  him. 


Dr.  F.  Berthier,  of  Aix-les-Bains,  whose  premature 
decease  at  the  early  age  of  thirty-six  has  been  a  source  of 
regret  to  his  many  friends  in  England,  died  from  the  results 
of  typhoid  fever — one  of  the  few  cases  of  the  disease  which 
have  occurred  at  Aix  this  season.  He  was  taken  ill  while 
the  Princess  Beatrice  was  still  under  his  care,  and  for  the 
last  few  days  of  her  stay  in  Aix  was  unable  to  visit  her. 
The  fever  ran  a  comparatively  mild  course,  but  was  followed 
by  parotid  abscess,  which,  much  against  the  advice  of  his 
friends,  he  insisted  on  opening  himself.  Erysipelas  followed, 
and  led  to  the  fatal  result.  Dr.  Berthier  was  well  known  in 
London,  where  he  studied  for  a  time  after  taking  his  degree 
in  Paris.  He  spoke  English  fluently,  was  versed  in  English 
methods  of  practice,  and  will  be  greatly  missed  not  only  by 
his  patients,  but  by  the  many  London  practitioners  who 
were  in  the  habit  of  placing  patients  under  his  care. 


M  ilfcai  Times  and  Gazette 


HOSPITAL  ACCOMMODATION  TOR  OFFICERS. 


Oct.  20,  1893.  4  65 


A  SATISFACTORY  STOCK-TAKING. 


The  forty-fourth,  annual  Report  of  the  Registrar-General  of 
Births,  Deaths,  and  Marriages  in  England  and  Wales  during 
the  year  18S1,  which  has  recently  been  published,  is  a  docu¬ 
ment  highly  gratifying  to  the  medical  profession,  to  whose 
efforts  in  the  past  its  satisfactory  character  is  mainly  due. 
The  Report  is,  according  to  custom,  addressed  to  the  Presi¬ 
dent  of  the  Local  Government  Board,  and  seeks  to  direct 
.attention  to  the  features  considered  important  in  the  vital 
■statistics  of  the  year.  Under  the  head  of  marriages,  many 
of  the  peculiarities  of  the  people  of  Great  Britain  are  noticed, 
•especially  the  objection  which  exists  both  in  England  and 
Scotland  to  marrying  in  the  month  of  May.  The  total 
number  of  births  registered  in  1881  is  shown  to  have  been 
S83,642,  a  proportion  of  33-9  to  each  1000  persons  living. 
This  was  the  lowest  birth-rate  recorded  since  1858,  when  the 
rate  was  33-7.  At  that  period,  however,  it  has  to  be  remem¬ 
bered,  the  registration  of  births  was  not  compulsory,  and 
doubtless  a  considerable  number  were  omitted  from  the 
reckoning.  The  birth-rate  was  at  its  maximum  in  1876,  and 
fell  uninterruptedly  from  that  date,  year  by  year,  in  natural 
-accordance  with  a  corresponding  decline  in  the  marriage- 
rate.  The  illegitimate  births  were  in  the  proportion  of  4'9 
to  every  100  children  born,  a  higher  proportion  than  any  re¬ 
corded  for  six  years  previously,  but  this  is  to  be  explained,  not 
by  any  increase  in  the  illegitimate  births,  but  by  a  falling 
off  in  the  legitimate  births  owing  to  the  decline  in  marriages. 
Thus  the  proportion  of  illegitimate  births  to  every  1000 
persons  living  remained  at  the  same  point  as  it  had  been 
for  the  six  preceding  years  (viz.,  1*7),  and  it  is  satisfactory 
to  note,  the  Report  adds,  that,  notwithstanding  the  long- 
continued  depression  in  the  marriage-rate,  the  illegitimate- 
birth-rate  has  remained  unaffected  throughout,  and  at  its 
lowest  level.  The  deaths  registered  in  1S81  numbered 
491,935,  and,  notwithstanding  the  increased  population, 
were  absolutely  fewer  than  in  any  single  one  of  the  twelve 
preceding  years.  The  death-rate  was  18'9  per  1000  living ; 
a  rate  which  was  no  less  than  7  per  cent,  lower  than  the 
lowest  recorded  in  any  previous  year  since  civil  registration 
began.  In  1877,  when  the  lowestprevious  death-rate  occurred, 
one  person  died  out  of  every  forty-nine  living;  in  18S1  only  one 
died  out  of  every  fifty-three  of  the  population.  The  Regis¬ 
trar-General  is  of  opinion  that  there  is  nothing  in  the  series 
of  annual  reports  issued  by  his  office  that  is  brought  out  more 
distinctly  and  unmistakably  than  the  wonderful  effect  which 
the  sanitary  operations  of  the  last  decade  have  had  in  saving 
life.  The  Public  Health  Act  came  into  operation  in  1872. 
The  average  annual  death-rate  for  the  immediately  preceding 
ten  years — -1862-71 — had  been  22'6,  and  there  were  no  indi¬ 
cations  of  any  tendency  of  the  rate  to  fall  lower.  Indeed, 
in  1871,  the  final  year  of  that  period,  the  rate  was  exactly 
the  average,  viz.,  22'6.  The  Act  in  question  came  into 
force,  and  at  once  the  rate  began  to  fall,  and  continued 
to  fall  year  by  year  with  almost  unbroken  regularity, 
until  in  1881  it  was,  as  previously  stated,  not  more  than 
118 ’9.  Had  this  fall  in  the  death-rate  been  limited  to  a 
single  year,  or  to  two  years,  or  even  to  three,  the  Report 
adds,  it  might  have  been  argued  by  sceptical  persons  that 
the  improvement  was  due  to  a  succession  of  seasons 
favourable  to  health,  or  to  other  causes  unconnected  with 
sanitary  administration,  and  that  the  setting-in  of  the  fall 
coincidently  with  the  coming  into  operation  of  public  health 
■measures  was  no  more  than  casual ;  but  in  face  of  a  fall 
lasting  for  ten  years  in  succession,  and  increasing  each  year 
in  amount,  no  one  can  seriously  maintain  such  a  position. 
The  Registrar- General  is  of  opinion  that  the  saving  effected 
in  life  was  the  direct  product  of  the  large  sums  of  money 
•expended  in  sanitary  improvements ;  and  to  show  what  has 
been  the  return  for  so  much  capital  expended,  he  compares 
the  two  decades  prior  and  subsequent  to  the  passing  of  the 
Public  Health  Act,  and  arrives  at  the  result  that  92,000 
lives  at  least  have  been  saved,  whilst,  speaking  in  round 
■numbers,  there  must  have  been  500,000  fewer  cases  of  illness. 
•One  death  out  of  every  sixteen,  the  Report  says,  fell  into  the 
•class  of  ill-defined  and  not  specified  causes  ;  this  was,  how¬ 
ever,  a  considerable  improvement  upon  the  previous  decade. 
As,  moreover,  the  improvement  in  the  statement  of  causes 
has  been  progressive  for  many  years,  it  is  hoped  that  this 


unsatisfactory  class  will  eventually  be  reduced  to  very 
narrow  limits.  During  the  year  1881  the  causes  of  90'4per 
cent,  of  the  total  deaths  were  certified  by  registered  medical 
practitioners,  and  55  per  cent,  were  certified  by  coroners, 
leaving  4T  per  cent,  uncertified.  The  proportion  of  uncer¬ 
tified  deaths  varied  considerably  in  different  parts  of 
England  and  Wales.  In  the  metropolis  the  proportion  did 
not  exceed  13  per  cent.  Excluding  the  metropolitan 
counties  of  Middlesex  and  Surrey,  the  percentage  did  not 
exceed  0'8  in  Wiltshire,  and  1'7  in  Hampshire,  while  it 
ranged  upwards  to  6-7  in  Huntingdonshire,  7'0  in  Cornwall, 
7-2  in  Durham,  and  7-5  in  Herefordshire.  In  Wales  the 
proportion  was  IPO  per  cent.  The  return  of  4T  per  cent, 
of  these  deaths  is  just  sufficient  to  mark  a  slight  decline  on 
the  two  preceding  years,  when  the  figures  were — 1879,  4‘7 ; 
and  1880,  4'3  per  cent. 


HOSPITAL  ACCOMMODATION  FOR 
OFFICERS. 


A  General  Order  has  been  issued,  notifying, for  the  informa¬ 
tion  of  officers  of  the  Army,  that  hospital  accommodation 
for  officers  is  provided  at  various  home  and  foreign  stations. 
We  acknowledge  the  boon,  and  have  no  intention  of  looking 
the  gift  horse  in  the  mouth,  nor  any  desire  to  criticise'  the 
action  of  the  War  Office.  Sick  officers  once  admitted  into 
hospital  will  have  to  pay  “  stoppages,”  amounting  in  time 
of  peace  to  2s.  61.  per  diem,  or  Is.  in  time  of  war.  The 
stoppage  may  be  too  much  or  too  little  ;  but  that  is  not  the 
matter  which  interests  us.  The  point  to  which  we  wish  to 
draw  attention  lies  concentrated  in  one  little  word,  and  on 
it  hangs  a  great  deal.  Let  us  quote  the  paragraph.  “Sick 
officers,  on  the  recommendation  of  a  medical  board,  may  be 
admitted  for  treatment  into  military  hospitals  where  special 
accommodation  has  been  authorised,  and  on  payment  of  the 
regulated  stoppages.”  The  reader  will  notice  it  is  may — 
not  must,  nor  shall.  We  believe  it  has  for  ages  been 
held  that  a  British  officer  is  entitled  to  treatment  in 
his  own  quarters.  As  a  matter  of  course,  such  a  privilege 
allows  of  an  amount  of  liberty  which  could  not  be  permitted 
in  hospitals  improvised  on  the  battle-field,  or  even  in  “base” 
hospitals;  and  it  is  curious  to  observe,  in  the  evidence  given 
before  Lord  Morley’s  Committee,  that  many  officers  never 
seemed  to  imagine  for  a  moment  that  hospital  discipline 
could  affect  them  for  a  single  instant  longer  than  they  chose 
to  submit  to  it.  Our  readers  may  remember  some  curious 
illustrations  of  this  independence  in  the  story  of  the  Egyptian 
campaign.  One  officer  acknowledged  that  he  walked  in  and 
out  of  hospital  just  as  it  suited  him,  and  refused  to  remain 
for  treatment  on  board  the  Helicon  when  he  saw  a  chance  of 
better  quarters  elsewhere.  A  private  soldier  who  had  so 
behaved  would  undoubtedly  have  been  made  a  prisoner,  and 
on  recovery  would  have  been  tried  by  court-martial ;  but,  for 
anything  we  can  see,  the  officer  in  question  was  quite  within 
his  rights.  He  was  entitled  to  be  treated  in  his  own  quar¬ 
ters,  and  there  the  authority  of  the  doctor  is  greatly 
limited.  Advice  may  be  given,  but  cannot  be  enforced, 
and  all  rules  and  regulations  with  regard  to  diet  may 
be  obeyed  or  neglected  at  the  patient’s  choice.  A  doctor 
can  say  little  more  than,  “If  I  were  you,  my  dear  fellow, 
I  wouldn’t  touch  solid  meat,  and  pray  on  no  account  take 
wine  or  beer.”  As  an  officer  observed  to  the  Committee, 
when  a  patient  “sees  delicacies  under  his  nose”  it  is  hard 
to  refrain,  when  he  knows,  or  thinks  he  knows,  that  they 
would  do  him  good.  With  the  officer  in  quarters  it  is  a 
matter  of  choice  whether  he  obey  the  doctor  or  not.  As  for 
the  doctor  enforcing  an  order  with  regard  to  diet,  the  sick 
officer  in  quarters  scouts  the  idea  where  there  is  a  divided 
opinion  ;  and  when  the  patient  and  the  doctor  are  at  issue  as 
to  whether  the  former  should,  for  instance,  have  champagne 
or  not,  the  combatant  opinion  is  that  “  the  authorities  ought 
to  lay  down  the  rule  in  the  matter”!  We  cannot  help 
thinking  that  some  of  the  complaints  made  by  combatant 
officers  with  regard  to  their  medical  treatment  in  Egypt 
arose  from  the  belief  that  doctors  were  invading  the  privileges 
of  combatant  officers  by  attempting  to  control  their  personal 
habits  when  they  were  admitted  into  hospital.  To  some 
it  must  have  appeared  that  the  doctors  had  no  power 


466 


Medical  Times  and  Gazette. 


MEDICAL  REPOETS  TO  THE  LOCAL  GOVERNMENT  BOARD. 


Oct.  20,  1853. 


to  exercise  control  at  all,  and  that  if  accident  made  it 
necessary  for  an  officer  to  go  into  hospital,  then  the 
hospital  should  he  turned  into  quarters  as  much  as  possible. 
We  do  not  think  this  theory  of  the  combatant  officers  is 
groundless,  for  it  is  based  upon  a  supposed  right  to  be  treated 
in  quarters,  and  to  be  treated  not  by  one  in  authority, 
but  by  a  gentleman  who  is  professionally  employed  to  give 
advice,  but  not  to  enforce  orders.  Of  course,  the  combatant 
officer  would  allow  the  “  authorities  ”  to  interfere,  but  he 
does  not  consider  the  medical  officer  an  authority  at  all.  In 
time  of  peace  we  suppose  that  some  licence  must  be  allowed 
to  combatants.  Perhaps  it  is  not  often  abused,  although  we 
have  known  cases  where  “the  authorities'”  have  had  to  in¬ 
terfere  with  a  strong  hand,  and  remove  officers  from  their  own 
quarters  to  the  military  hospital,  when  it  was  clearly  proved 
that  the  patients  were  too  utterly  contemptuous  of  medical 
advice.  And  we  may  here  remark  that  combatant  opinion, 
in  the  few  cases  where  the  authorities  have  interfered,  was 
dead  against  such  authority ;  and  it  was  openly  said  in  one 
case,  which  occurred  in  India,  that  such  a  step  could  never 
have  been  taken  in  England.  But,  although  we  would  not 
interfere  with  treatment  in  quarters  in  peace  time,  we  gladly 
see  that  when  occasion  arises  the  sick  officer  may  obtain  ad¬ 
mission  into  a  military  hospital ;  we  consider,  however,  that  in 
time  of  war  the  light  to  be  treated  in  quarters  should  be  abo¬ 
lished,  and,  when  the  indulgence  is  conceded,  it  should  be  as 
a  favour  and  after  due  consideration .  The  permission  to  be 
treated  out  of  hospital  should  be  the  exception  to  the  rale 
which  should  prevail  in  war,  that  every  man,  officer  or 
soldier,  should  be  in  hospital  or  at  duty.  Nothing  but  con¬ 
fusion  can  arise  from  officers  absenting  themselves  at  their 
own  will  from  their  men  while  a  campaign  is  going  on. 
They  are  on  the  “  muster  roll,”  sick  or  well,  and  have  no 
right  to  be  absent  without  leave.  It  seems  that  at  present 
it  is  not  necessary  for  officers  to  ask  permission  to  absent 
themselves  from  military  hospitals,  and,  should  they  ask,  it 
is  no  crime  to  take  the  leave  which  has  been  refused  by 
doctors.  We  would  gladly  see  separate  hospital  accom¬ 
modation  provided  for  officers  in  every  campaign  ;  but  where 
circumstances  render  this  impossible,  we  should  prefer  to 
see  officers,  as  a  matter  of  duty,  sharing  the  hospital  accom¬ 
modation  with  their  humbler  comrades.  Officers  and  men 
share  the  same  rations,  the  same  hardships  on  the  march, 
and  the  same  dangers  in  the  fight.  A  wound  or  illness 
relieves  an  officer  from  active  duty,  but  not  from  all  military 
obligations.  He  can  set  a  good  example  in  the  hospital 
wards  as  well  as  on  parade  or  on  the  battle-field,  and  until 
the  campaign  is  over  he  is  not  free  to  study  his  own  ease 
and  convenience.  We  hope  some  day  that  treatment  out 
of  hospital  may  be  the  exception  and  not  the  rale,  and  be 
granted  by  a  board  as  a  boon,  just  as  treatment  in  hospital 
is  conceded  as  a  favour  now. 


MEDICAL  REPORTS  TO  THE  LOCAL 
GOVERNMENT  BOARD. 


Dr.  Page  on  Scarlatina  in  the  Wisbech  Bubal 
Sanitary  District. 

The  Registrar- General’s  returns  for  the  first,  second,  and 
third  quarters  of  1882  showing  a  sustained  and  fatal  pre¬ 
valence  of  scarlatina  in  the  Wisbech  Rural  Sanitary  District, 
and  complaint  being  made  by  the  inhabitants  of  one  of  the 
affected  localities  to  the  Local  Government  Board  as  to  the 
inefficiency  of  the  measures  taken  by  the  Sanitary  Authority 
for  checking  the  spread  of  the  disease.  Dr.  David  Page  was 
instructed,  early  in  the  present  year,  to  report  on  the  general 
sanitary  condition  of  the  district.  Before  proceeding  to 
consider  Dr.  Page’s  report,  we  have  again  to  draw  attention 
to  the  fact  that  within  a  very  few  months  the  Local  Govern¬ 
ment  Board  officials  have  been  called  upon  to  investigate 
unwonted  prevalences  of  diphtheria,  scarlet  fever,  etc.,  in 
several  sanitary  districts  of  the  Fen  country  adjoining  the 
seaboard  of  the  Wash,  and  in  each  instance  it  is  to  be 
gathered,  from  the  reports  rendered,  that  the  peculiar 
formation  of  the  soil  in  that  part  of  England  is  especially 
favourable  to  the  spread  of  pollution  by  means  of  defective 
sewerage  arrangements,  and  careless  disposal  of  slop  refuse. 
In  the  present  instance,  Dr.  Page  says,  fen-land  is  simply 


the  silted  up  and  still  silting  up  coast-line  of  the  Wash  ; 
the  privies  are  constructed  on  the  “  vault  ”  system,  the 
avowed  design  of  the  arrangement  being  to  allow  accumula¬ 
tion  of  excrement  over  a  long  period,  and  soakage  of  the 
liquid  contents  into  the  surrounding  soil.  The  chief  source 
of  water-supply  is  rain-water,  chiefly  caught  on  roofs,  and 
stored  in  cisterns  sunk  in  the  yard  behind  the  houses,  con¬ 
structed  of  cemented  brick-work.  But  the  proximity  of 
these  cisterns  to  the  filth  receptacles  is.  Dr.  Page  observes, 
highly  dangerous,  and  the  cemented  brickwork  is  scarcely 
a  safeguard  against  percolation  from  the  surrounding  pol¬ 
luted  soil.  There  is,  moreover,  a  risk  of  direct  entrance  of 
pollution  by  the  reckless  practice  of  throwing  slops  upon  the 
ground  in  their  vicinity.  Prom  the  beginning  of  the  scar¬ 
latinal  outbreak  in  November,  1881,  until  January  of  the 
present  year,  there  had  been.  Dr.  Page  ascertained  from 
the  lists  furnished  by  medical  practitioners  in  the  neigh¬ 
bourhood,  280  cases  in  107  households,  with  44  deaths.  But 
this  apparently  high  mortality  is  to  be  explained  by  the 
fact  that  numerous  cases  not  only  did  not  come  within  the 
cognisance  of  the  Medical  Officer  of  Health,  but  were  never 
even  treated  by  a  medical  practitioner.  The  spread  of 
infection  throughout  the  whole  series  of  village  outbreaks 
is  attributed  to  the  indiscriminate  and  reckless  intercourse 
maintained  between  infected  and  healthy  households.  It 
was  impossible,  the  report  says,  at  so  late  a  date  as  this 
inquiry,  to  appraise  at  their  respective  values  the  influence 
of  school  attendance  and  of  ordinary  domestic  intercourse 
upon  the  mode  or  rate  of  extension  of  the  outbreak. 
Inquiry  with  such  an  object  in  view  does  not  appear  to  have 
been  undertaken  at  the  outset,  when  evidence  in  this  regard 
might  best  have  been  obtained.  Speaking  with  necessary 
reservation,  the  report  goes  on  :  It  would  appear  that  in  the 
case  of  two  villages,  the  earliest  cases  were  unconnected  with 
school  attendance,  and  that  at  a  later  date  the  opportunities 
of  close  intercourse  amongst  the  children  residing  in  them 
were  nearly  as  frequent  elsewhere  as  at  school.  Dr.  Page 
closes  a  long  report  on  the  sanitary  shortcomings  which  he 
found  to  exist  in  the  Wisbech  district  with  the  usual  recom¬ 
mendations  for  the  guidance  of  the  local  Sanitary  Authority. 
As  will  be  readily  imagined,  these  principally  refer  to  an 
improvement  in  water-supply,  and  method  of  excrement  and 
slop  disposal ;  but  the  fact  cannot  be  overlooked,  that,  until 
it  is  made  compulsory  on  sanitary  authorities  to  carry  out 
such  recommendations,  in  the  majority  of  cases  they  will 
remain  recommendations  only. 


Dr.  Page  on  Scarlatinal  Prevalence  at  Donington. 

In  the  month  of  January  of  the  present  year.  Dr.  David 
Page  was  despatched  by  the  Local  Government  Board  to 
report  on  the  recent  epidemics  of  scarlatina  at  Donington  and 
Moulton,  in  the  Spalding  Rural  Sanitary  District,  in  relation 
to  school  attendance.  Before  proceeding  to  consider  the 
result  of  Dr.  Page’s  inquiries  it  may  not  be  out  of  place  to 
remark  that,  from  the  number  of  outbreaks  of  fever  which 
have  recently  been  reported  on  by  medical  officers  of  the 
Local  Government  Board,  it  is  to  be  gathered  that  the 
sanitary  condition  of  the  whole  fen  district,  which  adjoins 
the  estuary  of  the  Wash,  is  in  anything  but  a  satisfactory 
condition.  The  nature  of  the  soil,  which  is  for  the  most 
part  silt  or  sandy  loam,  is  highly  favourable  for  percolation* 
and  the  system  of  making  vault  privies,  only  emptied  about 
once  in  every  year,  conduces  to  extensive  pollution  of  the 
water-supply,  which  is  obtained  partly  from  underground 
cisterns,  or  other  less  perfect  means  of  storing  rain-water 
caught  on  the  roof,  and  partly  from  wells.  In  the  course  of 
the  present  inquiry  Dr.  Page  found  that  in  the  district  in 
question  there  was  no  system  of  sewerage ;  slops  were 
disposed  of  either  upon  gardens  when  available,  or  into 
porous  cesspools  in  the  back  yards.  Formerly,  he  was  told, 
open  drains,  wide  and  offensive,  traversed  the  main  streets 
of  the  towns,  but  were  replaced  several  years  since  by 
eighteen-inch  brick  culverts.  These,  however,  are  intended 
for  highway  purposes  only.  On  the  other  hand,  the  dwelling- 
houses  of  the  labouring  class  are  mostly  four-roomed,  well 
built  and  ventilated,  and  not  overcrowded.  The  village  of 
Donington  presented  an  appearance  of  neatness  and  good 
order,  a  result,  perhaps,  of  the  frequent  supervision  of  the 
sanitary  officers,  and  the  abatement  of  ordinary  nuisances 
of  the  obtrusive  kind.  The  sanitary  condition  of  Donington 
cannot,  however,  be  pronounced  satisfactory.  Dr.  Page 


Medical  Times  and  Gazett  . 


ABSTRACTS  AND  EXTRACTS. 


Oct.  20,  1883.  467 


observes,  owing  mainly  to  the  need  for  a  proper  system  of 
sewage  disposal.  Prior  to  this  most  recent  outbreak, 
Donington  had  for  three  or  four  years  past  been  free  from 
scarlatina,  the  last  outbreak  having  occurred  in  the  summer 
of  1878 ;  in  the  present  instance,  as  far  as  could  be  ascer¬ 
tained,  the  first  case  occurred  in  the  person  of  a  child  five 
years  old,  medically  treated  on  July  6,  1882,  who  had  been 
attending  the  infant-school  up  to  the  date  of  illness ;  the 
reasons  given  for  the  spread  of  the  disease  may  best  be 
gathered  from  the  summary  appended  to  Dr.  Page’s  report. 
He  says  : — “  Reviewing  the  results  arrived  at  in  the  course 
of  my  inquiries,  the  following  conclusions,  illustrative  of  and 
confirming  previous  experience,  may  be  submitted:  first, 
that  in  relation  to  the  customary  means  of  scarlatinal  spread 
by  personal  intercourse,  elementary  schools  constitute  a  most 
effective  and  frequent  agency ;  second,  that  the  opportunities 
of  school  attendance  of  infected  children,  or  of  children 
belonging  to  infected  families,  are  not,  in  large  measure, 
efficiently  controlled  by  existing  local  sanitary  administra¬ 
tion  ;  third,  that  a  system  of  notification  of  diseases  occurring 
in  connexion  with  children  attending  such  schools  alone 
offers  a  hopeful  solution  of  the  difficulty,  provided  also  that 
the  Local  Authority  has  made  provision  of  those  other 
measures  which  are  peculiarly  the  essentials  of  effective 
action  against  the  spread  of  infection,  namely,  means  of 
isolation  and  of  efficient  disinfection.”  It  maybe  mentioned 
that  during  the  whole  inquiry  nothing  transpired  tending  to 
implicate  the  milk-supply  of  the  district. 


ABSTRACTS  AND  EXTRACTS. 

- 4^ 

Case  op  Hypodermic  Transfusion  op  Blood. 

Dr.  Paladini  relates  the  following  case  in  the  Gazzetta  Med. 
Italiana-Lombardia  for  August  25  A  woman,  forty-eight 
years  of  age,  had  suffered  for  a  long  time  from  menorrhagia, 
which  had  reduced  her  to  a  condition  of  extreme  ansemia. 
When  seen  by  Dr.  Paladini  at  the  beginning  of  August  she 
had  frequent  faintings,  although  in  the  horizontal  position, 
was  unable  to  take  food  of  any  kind,  and,  in  his  opinion, 
transfusion  was  urgently  called  for  on  account  of  her  very 
exhausted  state.  As  the  patient  lived  in  a  remote  village, 
where  appropriate  instruments  could  not  be  obtained,  he 
nesolved  to  perform  hypodermic  injection  by  means  of  a 
syringe  having  a  capacity  of  about  ninety  cubic  centimetres, 
and  a  gum-elastic  tube,  to  which  a  trocar  and  canula  were 
attached.  He  selected  the  skin  of  the  abdomen,  because  this 
was  lax  enough  to  be  raised  in  large  folds  and  to  receive  a 
considerable  quantity  of  blood.  The  woman’s  husband 
having  furnished  about  two  hundred  grammes  of  blood,  two 
syringefuls  were  successfully  injected  into  the  subcutaneous 
tissue,  at  four  fingers’  breadth  to  the  left  of  the  umbilicus,  care 
having  been  taken  to  force  the  trocar  far  enough  in  to  insure 
a  sufficient  space  for  the  reception  of  the  blood.  When  the 
blood  had  been  injected,  a  salient  projection  about  the  size 
of  an  egg  could  be  felt  there.  It  was  calculated  that  at 
least  130  grammes  of  blood  had  been  injected.  Ho  pain  or 
other  inconvenience  was  caused  by  the  operation,  and  in 
about  two  hours  the  tumefaction  had  disappeared.  The  next 
day  the  uterine  flow,  which  had  continued,  in  some  measure 
decreased,  and  the  patient  was  able  to  take  food  and  enjoy 
some  sleep.  The  report  comes  down  to  a  fortnight  after¬ 
wards,  when  the  patient  was  found  to  be  slowly  recovering 
her  strength,  but  only  just  able  to  leave  her  bed,  so  great 
had  been  her  prior  exhaustion.  The  marked  success 
which  attended  the  hypodermic  injection  in  this  case  leads 
Dr.  Paladini  to  hope  that  so  easy  and  innocuous  a  mode  of 
performing  transfusion  will  be  hereafter  frequently  resorted 
to.  If  necessary,  from  120  to  300  or  400  grammes  of  blood 
may  thus  be  promptly  injected  by  means  of  one,  two,  or 
three  punctures. 

Phlyctenular  Disease  op  the  Eye. 

Dr.  Wadsworth,  in  a  paper  read  at  the  annual  meeting  of 
the  Massachusetts  Medical  Society  ( Boston  Medical  Journal , 
August  2),  after  giving  an  excellent  account  of  the  symp¬ 
tomatology  of  this  frequently  occurring  disease  (usually 
teimed  scrofulous  ophthalmia),  goes  on  to  speak  of  its 
treatment  as  follows  : — 

“  What  has  been  said  of  its  etiology  indicates  both  the 
importance  and  direction  of  the  general  treatment.  This 


should  never  be  neglected,  even  in  the  slightest  case.  The 
diet  should  be  easily  digestible  and  nourishing,  and  atten¬ 
tion  to  it  in  detail  is  always  advisable.  Healthy  action  of 
the  skin  is  to  be  promoted  by  frequent  bathing;  and  iron, 
malt,  and  cod-liver  oil  are  to  be  prescribed,  according  to  the 
case.  The  advantage  of  fresh  air  and  light  can  hardly  be 
over-estimated.  Even  in  the  coldest  weather  it  is  usually 
better  that  the  patient,  properly  clothed,  should  be  taken 
out  for  a  time  daily ;  and  this  is  the  more  needed  the  poorer 
the  hygienic  surroundings  of  the  patient  are  at  home. 

“  Blepharospasm,  the  so-called  photophobia, is  to  be  feared, 
not  for  itself,  but  for  the  consequences  it  entails.  The 
violent  action  of  the  orbicularis  irritates  still  more  the 
already  inflamed  cornea,  incites  to  friction  and  consequent 
excoriation  of  the  skin  of  the  lids,  with  the  result  of  increas¬ 
ing  the  general  nervous  excitability,  and  preventing  the  free 
bodily  movement  so  necessary  for  the  preservation  of  health. 
In  considering  the  means  for  its  relief,  we  should  constantly 
remember  that  the  stimulus  which  excites  it  starts  from  the 
irritated  terminations  of  the  trigeminus,  and  not  from  any 
hvpersesthesia  of  the  retina.  It  is  the  irritation  ,of  the 
corneal  nerves  that  chiefly  excites  the  blepharospasm,  and, 
so  far  as  they  are  concerned,  the  local  narcotic  effect  of 
atropine  makes  this  our  most  reliable  agent.  The  alleviat¬ 
ing  effect  of  even  the  first  application  is  sometimes  very 
great.  A  two-grain  solution  may  be  employed  every  other 
day,  or  two  or  three  times  daily ;  and  if  the  case  is  seen 
early  the  spasm  may  thus  be  kept  within  bounds.  But 
should  the  photophobic  habit  be  once  firmly  established, 
relief  is  more  difficult.  When  the  lids  are  persistently  kept 
closed  it  is  commonly  useless,  or  worse  than  useless,  to 
entrust  the  application  of  any  collyriutn  to  the  attendants. 
In  the  efforts  to  force  open  the  lids  of  a  struggling  child 
with  the  fingers,  more  harm  is  likely  to  be  done  than  the 
atropine  will  counteract,  and  the  increased  flow  of  tears 
excited  will  rapidly  remove  the  small  amount  that  has  been 
instilled.  The  elevator  is  hardly  safe  in  untrained  hands. 
The  application  may  perhaps  be  made  when  the  child 
sleeps,  but  otherwise  in  such  cases  it  is  better  left  to 
the  physician.  Sometimes,  however,  reliance  must  be  chiefly 
placed'on  less  direct  treatment.  The  benefit  of  cold  applied 
to  the  lids  has  already  been  referred  to.  All  friction  must 
be  prevented.  Excoriations  of  the  skin  about  the  eyes  may 
be  washed  with  a  solution  of  argenti  nitras,  or  an  ointment 
of  ten  grains  of  zinc  oxide,  or  three  or  four  grains  each  of 
this  and  white  precipitate  to  the  drachm,  may  be  applied. 
Darkness  only  aggravates  the  symptoms.  Within  doors  the 
light  should  be  moderate  and  even,  and  increased  as  the 
condition  improves ;  but  sudden  changes  of  light  are  to  be 
carefully  avoided.  In  the  open  air,  a  dark  shade,  large 
enough  to  protect  both  eyes  though  only  one  be  affected, 
and  arranged  to  stand  out  free  from  them,  with  a  veil  or 
smoked  glasses  if  required,  is  of  use.  It  is  by  attending 
to  details  that  success  is  to  be  attained. 

"  When  the  eruption  is  limited  to  the  conjunctiva,  a  simple 
collyrium  of  borax  in  water  or  camphor-water  is  often  all 
the  local  treatment  needed.  Calomel,  dusted  on  the  con¬ 
junctiva  lightly  from  a  camel’s-hair  pencil  every  day 
or  two  till  congestion  has  disappeared,  seems  to  have  a 
good  effect  in  preventing  relapses.  But  it  must  be  em¬ 
ployed  with  precaution.  It  should  be  pure  and  dry,  only  a 
very  thin  film  being'  allowed  to  form  on  the  conjunctiva; 
and  the  lower  fold  must  be  inspected  after  a  moment  or 
two,  so  that  any  that  has  collected  there  in  a  clump  or 
thread  may  be  removed.  Properly  used  it  is  painless,  and 
I  have  never  seen  any  ill  effects  from  it.  In  general, 
astringents  are  to  be  avoided ;  but  when  the  condition  is 
complicated  with  catarrhal  inflammation  of  the  conjunctiva, 
mild  collyria  of  alum,  zinc,  or  argenti  nitras  are  in  place. 
These  should  be  employed  cautiously,  and  their  action 
watched  if  any  fresh  eruption  exists. 

“  With  an  eruption  on  the  cornea,  I  rely,  with  most  oculists, 
on  the  action  of  atropine.  The  frequency  of  its  application 
is  to  be  governed  in  the  main  by  its  effects  on  the  pupil,  and 
it  is  to  be  continued  until  the  ulceration  is  covered  with 
epithelium.  Here,  also,  calomel  is  apparently  of  benefit, 
but  is,  in  contradiction  to  its  use  in  the  conjunctival  affec¬ 
tion,  only  to  be  applied  after  epithelial  organisation  is  well 
under  way.  Yet  I  would  make  one  exception  to  this  last 
statement.  In  the  fascicular  form  of  keratitis  it  has 
seemed  to  me  that  calomel,  applied  somewhat  freely  during 
the  progress  of  the  band  across  the  cornea,  has  sometimes 


468 


M  dical  Times  and  Gazette. 


NOTICES  OF  BOOKS. 


Oct.  20,  1883. 


checked  its  course.  So  erratic,  however,  is  this  variety,  and 
the  opportunity  for  studying  it  is  so  comparatively  infre¬ 
quent,  that  I  am  willing  to  admit  it  may  have  been  coinci¬ 
dence  rather  tlian  effect  that  I  observed.  With  the  oint¬ 
ment  of  yellow  oxide  of  mercury,  much  used  in  the  same 
condition  as  is  calomel,  my  experience  has  been  limited,  and  it 
has  appeared  to  me,  at  least,  less  agreeable  to  the  patient. 
The  sluggish,  deep  infiltration,  whether  at  the  edge  of  the 
cornea  or  more  central,  showing  little  or  no  tendency  to  the 
formation  of  vessels,  demands,  besides  atropine,  the  applica¬ 
tion  of  hot  fomentations,  continued  for  half  an  hour  or  an 
hour  three  or  four  times  daily.  These  help  to  relieve  the  pain, 
sometimes  considerable,  and  invite  the  vascular  outgrowth 
from  the  conjunctiva  needed  to  furnish  material  for  repair. 
Should  perforation  occur,  pain  usually  ceases  as  if  by  magic, 
and  the  reparative  process  begins.  Many  and  various  have 
been  the  remedies  recommended  to  promote  the  absorption 
of  corneal  opacities  left  by  this  and  other  diseases.  My  own 
belief  is  that  none  of  these  are  of  special  value,  and  that  the 
opacities  are  better  entrusted  to  Nature  to  reduce,  as  she 
certainly  will  in  part.  Our  task,  after  the  immediate  attack 
has  passed,  is  to  see  to  it  that  measures  to  improve  and  pre¬ 
serve  the  general  health  are  continuously  carried  out,  and 
thus  recurrence  prevented.” 


NOTICES  OP  BOOKS. 


An  Atlas  of  Illustrations  of  Pathology.  Fasciculus  V. 

Diseases  of  the  Diver;  with  Pathological  Summary  by  Dr. 

Goodhart.  London  :  The  New  Sydenham  Society.  1883. 
A erections  of  the  gall-bladder  and  larger  bile- ducts  form 
the  subject  matter  of  the  number  before  us.  Of  catarrhal 
inflammation  of  the  gall-ducts  as  an  acute  idiopathic  dis¬ 
ease,  Dr.  Goodhart  has  no  pathological  experience,  and  he 
evidently  does  not  fully  accept  this  explanation  of  those 
causeless  attacks  of  jaundice  to  which  both  children  and 
adults  are  so  subject — a  scepticism  in  regard  to  generally 
received  doctrines  which  we  share  with  him.  The  effects  of 
dilatation  of  the  gall-ducts,  and  of  their  occlusion,  whether  by 
gall-stones  or  in  other  ways,  both  on  the  ducts  themselves 
and  on  the  gall-bladder,  are  considered  at  some  length.  We 
cannot  say  that  Dr.  Goodhart  has  succeeded  in  throwing 
much  light  on  the  nature  of  those  caseous,  bile-containing 
nodules  that  are  almost  constantly  present  in  the  liver  in 
cases  of  general  miliary  tuberculosis  of  some  duration  in 
children,  and  we  consider  that  their  exact  mode  of  formation 
has  still  to  be  demonstrated.  The  plates  are  four  in  number. 
We  doubt  if  many  men  would  be  able  to  say  what  the  two 
latter  were  supposed  to  represent  without  reading  the 
descriptions. 


Indian  Snake  Poisons  :  their  Nature  and  Effects.  By  A.  J. 

Wall,  M.D.  Bond.,  F.E.C.S.  Eng.  London:  W.  H. 

Allen  and  Co.  1883.  Pp.  171. 

Dr.  Wall’s  object  is  to  present  in  a  concise  form  the  chief 
features  of  snake-poisoning ;  and  there  is  no  doubt  that  he 
has  considerable  qualifications  and  has  enjoyed  excellent 
opportunities  for  the  task.  He  takes  up  the  subject  in  a 
practical  manner.  How,  he  asks,  does  snake-poison  kill? 
What  are  the  changes  it  effects  in  the  animal  system  ?  Is 
there  only  one  poison  common  to  all  snakes,  or  are  there 
several  ?  On  the  answer  to  these  questions,  of  course,  hangs 
the  most  important  point  of  all — how  shall  snake-bite  be 
treated  ?  The  first  question  is  answered  partly  by  the  study 
of  cases,  and  partly  by  the  result  of  experimental  investiga¬ 
tion.  The  practical  outcome  is  that  a  difference  does  exist 
in  the  physiological  effects  of  different  snake-poisons,  though 
its  exact  nature  is  still  obscure.  Not  only  is  this  true  of  the 
viperine  and  colubrine  tribes,  it  is  equally  true  that  there 
are  distinct  minor  differences  even  between  snakes  which  are 
closely  allied.  As  to  the  intimate  nature  of  snake-poison, 
nothing  appears  to  be  really  known.  Examined  micro¬ 
scopically,  cobra- venom  is  found  to  consist  of  a  perfectly 
structureless  plasma,  in  which  a  few  bodies  are  to  be  de¬ 
tected,  but  which  do  not  seem  to  be  essential  to  the  activity 
of  the  poison.  Collected  in  quantity  and  treated  with 
certain  reagents,  the  activity  of  the  poison  is  considerably 
modified.  Thus,  the  addition  of  permanganate  of  potash  quite 
destroys  its  power,  so  that  a  solution  of  it  can  be  injected 
into  an  animal  without  producing  any  effects  whatever. 


This  led  to  the  hope  that  permanganate  of  potash  might  be- 
used  successfully  in  the  treatment  of  snake-bites.  Our 
author,  however,  shows  that  permanganate  of  potash  des¬ 
troys  the  poison  by  its  oxidising  power  ;  but  since  it  has  no 
power  of  selecting  one  organic  subject  for  oxidation  rather 
than  another,  when  introduced  into  the  circulation  its  oxi¬ 
dising  power  is  exerted  on  all  the  constituents  of  the  blood 
generally,  instead  of  being  reserved  for  the  cobra-poison  in 
it  alone.  “  If  a  substance  should  be  found  having  the  power 
of  oxidation,  with  a  special  affinity  for  exercising  it  on 
snake-poison,  the  problem  of  the  treatment  of  snake-bite 
would  be  solved  ;  but  potassium  permanganate  has  not  this 
special  power.”  Is  there  no  help,  then,  for  those  who  have 
the  misfortune  to  get  bitten  by  one  of  those  venomous 
beasts  ?  “  When  the  symptoms  have  once  developed,  a  con¬ 
dition  of  appalling  gravity  is  produced,  of  which  little  that 
is  hopeful  can  be  said  here.”  Elsewhere  the  author  says, 
“  I  have  tried  with  care  every  one  [remedy]  that  has  been 
brought  to  my  notice,  and  they  have  been  very  numerous;  it 
is  impossible  to  exaggerate  the  uselessness  of  each  of  them.” 
Our  only  chance  of  successfully  treating  snake-bite  lies  in 
prevention  of  the  absorption  of  the  poison ;  fortunately, 
a  large  proj-'ortion  of  snake-bites  occur  on  the  limbs,  where 
we  can,  in  a  measure,  control  'the  circulation.  Dr.  Wall 
recommends  the  use  of  an  india-rubber  band ;  this  is  to  be 
firmly  and  tightly  bound  round  the  extremity  above  the  seat 
of  injury,  and  should  encircle  the  limb  several  times,  and  it 
should  be  applied  in  all  cases  as  soon  as  possible  after  the 
receipt  of  the  injury.  The  next  step  is  to  remove  the  whole 
of  the  deposited  poison,  and  the  author  describes  how  this  is 
best  done  :  £r  Life  is  not  to  be  saved  by  a  hap-hazard  cutting 
away  of  anything  that  comes  first,  but  by  an  intelligent  and 
careful  dissecting  away  of  the  parts  holding  the  poison.” 
We  have  now  drawn  sufficient  attention  to  this  interesting 
book.  It  is  another  valuable  contribution  to  the  literature 
of  the  subject,  and  can  hardly  fail  to  prove  of  service  to- 
those  whose  practice  takes  them  into  countries  where  snake¬ 
bites  are  common. 


Zur  Lehre  von  den  Complicirten  Luxationen  und  deren 

Behandlung.  Yun  Dr.  August  Schreiber.  Tubingen, 

1883.  Yerlag  der  H.  Laupp’schen  Buchhandlung. 

A  Treatise  on  Complicated  Dislocations  and  their  Treatment . 

By  Dr.  August  Schreiber.  Pp.  106. 

The  author,  whose  Atlas  of  Diseases  of  Joints  was  recently 
reviewed  in  this  paper,  has  now  published  a  treatise  on 
Complicated  Dislocations,  including  therein  not  only  com¬ 
pound  dislocations,  but  also  dislocations,  with  or  without- 
external  wound,  complicated  by  fractures,  ruptures  of  large 
vessels,  nerves,  or  tendons,  or  other  severe  injury  to  adjacent 
structures.  His  reason  for  publishing  it,  as  stated  in  the 
preface,  is  that  these  injuries,  from  their  comparative  infre¬ 
quency,  do  not  receive  sufficient  attention  in  systematic: 
works  on  surgery,  and  are  treated  with  only  cursory  notice.. 
He  cannot  be  charged  with  undue  prolixity,  as  the  whole: 
work  is  comprised  in  106  pages,  of  which  nineteen  are  devoted 
to  prefatory  and  historical  remarks,  and  the  remaining 
eighty-nine  are  chiefly  filled  with  reports  of  cases  compiled 
from  periodicals  and  text-books.  This  brevity,  highly  com¬ 
mendable  in  these  days  of  prolix  writing,  is,  however,  partly 
explained  by  an  intimation  of  the  author’s  intention  to. 
publish  another  work  in  which  the  subject  will  be  treated, 
in  greater  detail. 

History  proves  thatthe  surgical  treatment  of  compound  dis¬ 
locations  has  been  greatly  modified  in  modern  times.  Before 
the  present  century,  surgeons  appear  to  have  been  almost 
unanimous  in  recommending  non-reduction  of  compound 
dislocations  of  any  except  the  smallest  articulations ;  and  am¬ 
putations  and  resections  were  performed  with  an  appalling 
percentage  of  fatal  results.  In  the  last  hundred  years,  how¬ 
ever,  better  treatment  has  become  prevalent,  and  Listerism, 
has  undoubtedly  given  considerable  impetus  to  this.  Still, 
the  cases  recorded  in  this  pamphlet  prove  that,  prior  to  and 
since  the  introduction  of  Listerism,  surgeons  have  success¬ 
fully  treated  cases  of  compound  dislocation,  even  accom¬ 
panied  by  severe  complications,  without  adopting  special 
antiseptic  precautions. 

We  should  think  that  modern  surgeons  have  already 
formed  the  conclusion  as  to  treatment  which  our  author 
draws  from  his  own  experience  and  from  the  recorded  ex¬ 
perience  of  others,  namely,  to  always  reduce  the  dislocation. 


Medical  Times  and  Gazette. 


GENERAL  CORRESPONDENCE. 


Oct.  20,  1883.  469 


where  the  reduction  is  not  contra-indicated  by  special  con¬ 
ditions,  and  to  attempt  by  drainage,  cleanliness,  and  anti¬ 
septics  to  prevent  the  inflammation  and  suppuration  which 
would  otherwise  inevitably  ensue  in  the  majority  of  such  cases. 
If  reduction  be  contra-indicated,  the  question  of  excision  or 
amputation  must  be  decided  by  the  local  and  general  con¬ 
dition  of  the  patient.  Although  these  suggestions  lack 
originality,  the  treatise  is  both  interesting  and  useful,  and 
the  author  deserves  the  gratitude  of  surgeons  for  having 
collected,  from  many  different  sources,  reports  of  most 
instructive  cases,  which  might  otherwise  have  escaped 
notice. 


GENERAL  CORRESPONDENCE. 

- <. - 

THE  PICRIC-ACID  TEST  FOR  SUGAR  IN  THE 

URINE. 


[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sir, — In  conjunction  with  Mr.  J.  B.  Rutland  (Assistant- 
Demonstrator  of  Physiology  in  the  Melbourne  University), 
I  have  been  recently  experimenting  on  the  various  methods 
of  applying  this  test,  and  now  desire  to  make  one  little 
suggestion,  which,  if  adopted,  will  tend  to  simplify  its  use. 

The  estimation  of  the  relative  colour  of  liquids,  as  effected 
by  filling  similar  glass  vessels  to  a  given  height  and  then 
looking  down  them  on  to  a  white  background,  is  a  mode  of 
procedure  which  involves  loss  both  of  urine  and  of  the 
liquids  under  examination. 

The  colour  of  liquids  can  be  much  more  readily  compared 
in  the  following  manner : — Take  a  number  of  graduated 
glass  vessels  of  equal  size,  and  place  them  at  regular  inter¬ 
vals  in  a  wooden  box,  the  anterior  wall  of  which  is  per¬ 
forated  at  corresponding  intervals  by  holes  of  equal  size, 
whilst  the  posterior  wall  is  entirely  removed.  Now  fill  the 
glasses  with  the  coloured  liquids  which  are  to  be  compared, 
and  place  the  box  in  front  of  a  window  or  other  source  of 
white  light,  when  it  becomes  a  very  easy  matter  both  to 
estimate  difference  of  colour  and  to  dilute  the  liquids  till 
their  colours  are  equal. 

The  advantage  of  such  a  simple  contrivance  is  that  it 
only  permits  the  eye  to  take  cognisance  of  equal  bulks  of 
liquid.  Square  glasses  would  be  preferable,  if  procurable, 
since  they  would  not  refract  light  as  much  as  the  round  ones 
do.  I  am,  &c„  James  W.  Barrett,  M.B. 

Melbourne  Hospital,  August  27. 


EDUCATIONAL  OYER-PRESSURE. 


[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sir, — Fresh  from  reading  the  warnings  of  Allbutt  and  Teale 
against  the  cultivation  of  precocity,  feebleness,  and  myopia, 
and  your  own  excellent  articles  on  the  same  subject,  I  wish 
to  point  out  to  you  a  proposal  which  has  recently  been  made 
to  aggravate  the  evils  we  see  arising. 

It  was  lately  determined  by  the  Convocation  of  the  London 
University  that  a  scheme  should  be  drawn  out  for  a  system 
of  local  examinations  similar  to  those  held  by  the  older 
English  and  Scotch  universities,  and  by  the  College  of 
Preceptors. 

I  observe  that  it  has  been  deliberately  proposed  to  copy 
the  evil  example  of  Oxford  and  Cambridge  in  this  matter, 
rather  than  the  good  one  of  the  other  institutions  above 
mentioned,  and  to  fix  limits  of  age  above  which  candidates 
shall  noc  be  admitted. 

The  main  objects  of  such  examinations  are  generally  sup¬ 
posed  to  be  the  encouragement  of  good  schools  and  school¬ 
masters,  and  the  furnishing  a  species  of  passport  to  the 
gates  of  such  occupations  or  professions  as  require  a  certain 
intellectual  status.  Why  they  should  be  so  arranged  as  to 
stimulate  precocity  and  cramming,  and  to  discourage  or 
exclude  slow  (which  is  often  healthiest)  development,  I  fail 
to  comprehend.  Like  many  other  physicians,  I  have  seen 
great  mischief  result  from  the  Cambridge  examinations, 
especially  among  young  girls  intended  for  the  scholastic 
profession.  I  am,  &c., 

John  Beddoe,  M.D.,  &c.,  B.A.  Lond. 

Clifton,  October  14. 


REPORTS  OF  SOCIETIES,  — 

OBSTETRICAL  SOCIETY  OF  EqxiwNi-p- >:  , 


Wednesday,  October  3. 


<Y\  IJ D RAF 


Dr.  Gervis,  President,  in  the  ChaiK^Y' Jr  c  „ 


Hypertrophy  oe  Maym*. 

Dr.  J.  A.  Mansell-Mouldin  showed  a  patient,  aged 
eighteen,  unmarried,  the  subject  of  hypertrophy  of  both 
mammas.  The  patient’s  health  was  otherwise  good.  The 
nipples  were  small,  the  areolos  large. 

Dr.  Champneys  had  seen  a  case  in  Professor  Billroth’a 
clinic  treated  by  rest  in  bed,  the  breasts  being  suspended 
from  above. 

Tumour  op  Clitoris. 

Dr.  W.  A.  Duncan  showed  a  large  fibro-cellular  tumour 
involving  the  clitoris  and  both  nymphse,  which  he  had 
removed. 

Ruptured  Ovarian  Cyst. 

Dr.  W.  A.  Duncan  also  showed  a  multilocular  ovarian, 
tumour,  one  of  the  cysts  of  which  had  ruptured  during  an 
ordinary  examination,  leading  to  fatal  peritonitis. 

A  committee  was  appointed  to  examine  and  report  upon 
the  specimen. 


Arrested  Development  of  One  Fcetus  of  Twins. 

Dr.  Edis  exhibited  a  specimen  of  this  kind.  One  foetus1 
ivas  born  alive  in  the  seventh  month  of  pregnancy ;  the 
other,  expelled  seven  hours  before  it,  was  shrivelled,  and 
its  placenta  atrophied,  apparently  having  died  in  ute.ro- 
about  two  months  previously. 

Dr.  Edis  also  showed  twin  foetuses  at  about  the  fifth 
month  of  development. 

Dr.  Malins  had  seen  a  case  in  which  one  foetus  had  been 
born  living  at  the  eighth  month,  the  growth  of  the  other 
(expelled  at  the  same  time)  having  been  arrested  at  the  fourth 
month.  Cruveilhier  had  illustrated  the  same  condition. 
Such  cases  showed  the  power  of  toleration  possessed  by  the 
uterus,  and  were  also  interesting  in  their  medico-legal 
aspect. 

Placenta  Succenturiata. 

Dr.  Champneys  showed  a  placenta  succenturiata.  It  was 
impossible,  from  an  examination  of  the  afterbirth,  to  dia¬ 
gnose  the  retention  in  utero  of  such'a  body. 

Dr.  Daly  said  these  cases  were  of  medico-legal  interest. 
He  had  been  called  to  a  case  in  which  a  woman  died  from 
haemorrhage,  caused  by  a  piece  of  placenta  left  in  utero.  An 
unqualified  practitioner  had  attended  the  patient,  and  at 
the  coroner’s  inquest  pleaded  that  tbe  retained  piece  was  a 
supernumerary  placenta  ;  a  view  which  was  accepted  by  the 
jury. 

Gangrene  during  Pregnancy. 

Dr.  Swayne  related  a  case  of  gangrene  occurring  during 
the  seventh  month  of  pregnancy.  The  disease  came  on  after 
a  long  journey,  and  attacked  the  integuments  and  muscles 
over  a  space  the  size  of  a  man’s  fist  on  the  upper  and  inner 
third  of  the  right  thigh.  The  symptoms  had  existed  about 
four  days  before  the  occurrence  of  premature  labour,  but 
were  not  very  severe  until  after  delivery,  when  they  became 
much  intensified,  and  proved  fatal  early  on  the  third  day. 
There  was  no  injury,  wound,  or  erysipelatous  inflammation 
to  account  for  the  occurrence. 

Dr.  Burchell  said  that  although  the  case  was  not  clear, 
he  could  not  help  believing  it  to  have  been  one  of  strangu¬ 
lated  femoral  hernia. 

Dr.  Herman  asked  if  the  case  were  not  one  of  gangrenous 
carbuncular  inflammation. 

Dr.  Swayne  thought  the  most  probable  explanation  was 
that  the  gangrene  was  due  to  undue  pressure  on  the  iliac 
vessels,  possibly  from  tight  lacing,  to  which  the  patient  was 
accustomed.  The  situation  of  the  tumour  precluded  the  idea 
of  strangulated  hernia;  the  vesication  and  absence  of  any 
head,  that  of  malignant  carbuncle ;  and  the  absence  of  diffused 
redness  at  the  onset,  that  of  erysipelas. 

On  the  Anatomy,  Physiology,  and  Pathology 
of  the  Os  Uteri  Internum. 

This  paper,  by  Dr.  Henry  Bennet,  was  then  read.  The 
author  had  in  1849  drawn  attention  to  the  existence  of  a 
muscular  sphincter  at  the  os  uteri  internum,  and  this,  like 


470 


Medical  Times  and  Gazette. 


THE  OPHTHALMOLOGICAL  SOCIETY. 


Oct.  20,  1883. 


all  sphincters,  was  closed  when  at  rest.  This  fact  was 
accepted  by  many  at  the  time,  but  now  seemed  to  have 
passed  out  of  mind.  It  had  a  most  important  bearing  on 
uterine  therapeutics.  The  ordinary,  physiological,  closed 
state  of  this  sphincter  offered  resistance  to  the  passage  of 
the  metallic  sound ;  but  a  small  wax  bougie  could  be  passed 
through  it.  By  the  use  of  such  bougies  he  had  in  1846 
•discovered  that  the  cavity  of  the  uterus  was  not  straight, 
but  had  an  anterior  concavity.  This  sphincter  was  no  doubt 
greatly  developed  by  pregnancy.  It  opened  slightly  before, 
during,  and  after  menstruation,  and  probably  during  sexual 
congress.  It  was  relaxed  by  disease,  such  as  fibroids, 
chronic  uterine  inflammation,  endometritis.  The  easy  pas¬ 
sage  of  the  sound  was  therefore  an  indication  of  a  morbid 
rather  than  of  a  healthy  condition  of  uterus.  This  fact  had 
an  important  beai’ing  on  the  theory  and  treatment  of 
sterility.  If  a  closed  os  uteri  were  presumed  to  be  a  morbid 
condition,  then  nearly  all  healthy  young  women  who  were 
examined  would  be  erroneously  considered  to  require  surgical 
treatment. 

Dr.  Galabin  had  no  doubt  of  the  existence  of  a  sphincter 
at  the  os  internum.  This  was  shown  by  the  constriction  often 
seen  at  this  point  in  a  laminaria  tent,  and  by  the  rapid  con¬ 
traction  of  the  os  after  dilatation.  But  he  could  not  agree 
with  Dr.  Bennet  that  it  was  normally  completely  closed. 
Where  the  passage  of  the  ordinary  sound  was  resisted,  a 
smaller  one,  without  a  bulbous  end,  would  often  pass,  if  the 
-direction  of  the  canal  were  hit  upon,  although  a  hitch  was 
sometimes  caused  by  flexion  of  the  canal.  He  thought 
further  evidence  was  much  to  be  desired  as  to  the  cure  of 
sterility  by  incision  or  dilatation  of  the  cervix.  His  impres¬ 
sion  was  that  he  had  seen  a  larger  proportion  of  pregnancies 
follow  dilatation  by  bougies  than  incision.  He  thought  it 
would  be  of  great  value  if  some  of  those  who  performed  the 
-operation  would  give  the  number  of  pregnancies  following 
in  a  complete  series  of  consecutive  cases.  The  only  such 
series  he  remembered  did  not  show  a  greater  number  than 
might  be  accounted  for  by  coincidence. 

The  President  remarked  on  the  interest  and  value  of  Dr. 
Bennet’s  paper.  In  former  years  he  (the  President)  had 
-rarely  incised  the  os  internum.  But  lately,  where  there  was 
■evident  constriction  (a  fact  of  which  he  had  no  doubt),  he 
had  done  so,  and  his  results  had  been  distinctly  better. 
Where  the  os  internum  was  fairly  patulous,  and  the  con¬ 
striction  affected  the  os  externum  alone,  he  was  satisfied 
with  its  division. 

Dr.  Heywood  Smith  protested  against  the  use  of  scissors 
to  divide  the  os  externum,  for  too  extensive  an  incision  was 
thus  made,  and  the  power  of  imbibition  possessed  by  the 
•external  os  destroyed.  The  most  scientific  method  of  doing 
the  operation  was  with  Sims’s  narrow-bladed  knife. 

Dr.  Playfair  believed  very  little  in  stenosis  of  the  os 
internum,  and  not  at  all  in  its  incision  for  the  cure  of  ste¬ 
rility.  Incision  of  the  os  externum  in  well-selected  cases 
was  occasionally  followed  by  pregnancy,  but  he  believed  it 
was  done  far  too  often  and  too  indiscriminately.  He  believed 
it  acted  not  only  by  enlarging  the  os,  but  by  remedying  the 
conical  condition  of  the  cervix,  which  was  more  often  than 
.stenosis  the  cause  of  sterility. 

Dr.  Champneys  pointed  out  that  difficulty  in  the  passage 
•of  the  sound  was  not  proof  of  stenosis  of  the  os  internum. 
Difficulty  might  arise  even  when  the  canal  was  larger  than 
usual,  from  the  instrument  being  passed  in  the  wrong  axis, 
or  from  its  point  catching  in  a  fold  of  mucous  membrane. 
It  was  only  when  the  bulb  of  the  sound  was  gripped  during 
withdrawal  that  stenosis  could  be  inferred. 

Dr.  Aveling  was  sure  that  contraction  of  the  os  internum 
was  a  cause  of  dysmenorrhoea  and  sterility,  and  believed 
that  incision  gave  more  permanent  relief  than  dilatation. 
After  incision  he  did  not  use  a  stem  pessary,  but  passed  the 
sound  daily  for  a  week,  and  then  less  often  till  healing  had 
taken  place. 

Dr.  Edis  thought  there  were  instances  in  which  division 
of  the  internal  as  well  as  the  external  os  was  needed.  Each 
case  must  be  treated  on  its  own  merits,  it  being  impossible 
t.o  lay  down  any  general  rule.  After  incision  he  used  a 
•stem  pessary,  the  patient  being  carefully  watched. 

Dr.  Murray  thought  division  of  the  os  uteri  for  sterility 
Alone  of  doubtful  utility.  He  had  seen  many  cases  in  which 
it  had  been  done  without  good  results.  It  was  not  free  from 
risk  to  life,  and  ought  not  to  be  done  simply  at  the  request 
of  the  patient. 


Dr.  Henry  Bennet  gathered  that  his  views  were  generally 
accepted,  although  some  might  not  go  so  far  as  he  did. 
Deep  division  of  the  cervix  had  been  formerly,  and  he 
believed  was  still,  too  frequently  performed  by  some  prac¬ 
titioners.  The  abuse  of  surgical  treatment  might  be  on  the 
wane  in  England,  but  certainly  was  not  elsewhere.  It  was 
therefore  desirable  to  establish  the  anatomy,  physiology, 
and  pathology  of  the  os  internum  on  a  sound  basis.  Other 
waves  of  opinion  were  setting  in,  equally  exaggerated  in 
their  character ;  as,  for  instance,  in  America,  the  unjustifi¬ 
able  sewing  up  of  the  lacerated  cervix  uteri  for  insignificant 
lesions  easily  cured  by  the  simplest  local  treatment,  and 
with  us  the  abuse  of  pessaries. 


THE  OPHTHALMOLOGICAL  SOCIETY. 

Thursday,  October  11. 


Jonathan  Hutchinson,  F.R.S.,  President,  in  the  Chair. 

Mr.  Hutchinson,  on  taking  for  the  first  time  his  seat  as 
President,  delivered  the  address  which  is  printed  elsewhere 
in  our  pages. 

At  the  conclusion  of  it.  Dr.  George  Johnson  rose  to  pro¬ 
pose,  on  the  part  of  the  Society,  a  hearty  vote  of  thanks  to 
Mr.  Bowman  for  his  munificent  gift,  and  expressed  himself 
as  certain  that  to  all  personally  acquainted  with  Mr.  Bowman 
this  gift  would  be  no  matter  for  surprise. 

The  vote  of  thanks,  having  been  briefly  seconded  by  Mr. 
Wordsworth,  was  carried  by  acclamation,  and  the  Presi¬ 
dent  undertook  to  wait  upon  Mr.  Bowman  and  convey  to 
him  in  person  the  thanks  of  the  Society. 

Contracted  Field  of  Vision  and  Optic  Atrophy  in  a 
Case  of  Hemiplegia. 

Dr.  Obmerod  showed  a  man,  aged  forty-four,  who  had  had 
an  attack  of  left  hemiplegia  fifteen  months  previously.  Since 
May  last,  atrophy  of  the  right  optic  disc  had  been  noticed. 
The  patient  had  had  syphilis.  The  field  of  vision  was  limited 
to  the  lower  and  inner  quadrants.  Since  the  eye  had  been 
fully  under  the  influence  of  atropine,  a  small  detachment 
of  the  retina  near  the  periphery  on  the  outer  side  had  been 
detected,  which  he  imagined  was  a  separate  lesion,  and 
quite  independent  of  the  cerebral  condition. 

Mr.  Fettles  hip  said  that,  on  examining  the  patient,  he 
had  been  strongly  impressed  with  the  idea  that  the  swelling 
of  the  retina  was  due  to  a  sarcoma  of  the  choroid,  and  he 
thought  that  it  was  very  important  that  a  correct  diagnosis 
should  be  arrived  at  without  delay. 

Mr.  James  E.  Adams  also  thought  that  the  case  was  one 
of  sarcoma  of  the  choroid. 

Ultimately,  Mr.  Fettleship  and  Mr.  Adams  were  appointed 
to  form  a  committee  to  report  upon  the  case. 

Glaucoma  following  a  Blow. 

Dr.  Brailey  exhibited  a  boy,  aged  fourteen,  in  whom 
glaucoma  had  supervened  upon  a  blow  with  a  cork.  When 
seen,  eight  days  after  the  accident,  there  was  +  T.  2.  This 
fell  to  normal  after  one  instillation  of  a  four-grain  solution 
of  eserine.  The  fundus  was  not  seen  quite  so  clearly  in  the 
affected  eye,  and  the  disc  was  somewhat  hazy. 

Tumour  at  Sclekocorneal  Junction. 

Mr.  Frederick  Mason  brought  forward  the  woman  whom 
he  had  exhibited  two  years  previously  at  a  meeting  of  the 
Society,  and  whose  case  was  reported  in  the  second  volume 
of  the  Society’s  Transactions.  Since  the  operation  there 
had  been  no  fresh  growth,  the  patient  remaining  very  much 
in  the  same  condition. 

Chronic  Tuberculosis  of  the  Choroid. 

Mr.  W.  H.  Jessop  showed  a  girl,  aged  twelve,  with  phy¬ 
sical  signs  of  phthisis  at  both  apices,  and  a  marked  history 
of  phthisis  in  the  family.  The  child  stated  that  she  had 
never  been  able  to  see  better  with  the  left  eye  than  she 
could  at  the  present  time.  In  the  left  eye,  at  the  yellow-spot 
region  was  a  rounded  swelling,  projecting  one  millimetre, 
of  a  brilliant  white  colour  when  seen  with  the  ophthalmo¬ 
scope,  and  ill  defined  towards  the  periphery.  Between  the 
disc  and  the  swelling  were  eight  small  white  brilliant  spots. 

Homonymous  Hemianopia. 

Mr.  Fettle  ship  read  the  notes  of  the  case  of  a  man  who 
was  blind  with  one  eye,  and  had  hemianopia  with  the  other. 


Medical  Times  and  Gazette. 


THE  CLINICAL  SOCIETY  OF  LONDON. 


Oct.  20,  1883.  471 


from  a  tumour  pressing  on  the  optic  nerve,  chiasma,  and 
tract  on  the  same  side  as  the  blind  eye.  The  patient  came 
under  observation  first  at  the  age  of  thirty  for  recent  failure 
of  the  left  eye.  The  disc  showed  slight  atrophic  changes, 
and  was  said  by  an  earlier  observer  to  have  been  inflamed. 
Subsequently  this  eye  became  nearly  blind,  the  disc  atrophied, 
and  the  patient  lost  the  right  half  of  the  visual  field  in  the 
other  eye,  the  disc  of  which  also  became  atrophic.  The  hemi- 
anopia  was  sharply  defined,  and  the  boundary  line  passed 
through  the  fixation  point.  The  left  third  nerve  also  became 
paralysed.  At  the  same  time  discharge  of  bloody  mucus 
from  the  left  nostril,  defective  smell,  difficulty  in  opening 
the  jaw,  and  the  appearance  of  a  lump  behind  the  jaw  on 
the  left  side,  pointed  to  a  tumour  at  the  base  of  the  skull 
involving  the  optic  nerve,  and  at  a  later  stage  the  tract  and 
third  nerve  on  that  side.  The  man  died  in  September  last, 
seven  years  from  the  time  that  he  first  came  under  observa¬ 
tion,  and  a  large  tumour  was  found,  apparently  growing  from 
the  body  of  the  sphenoid,  and  compressing  but  not  infiltrating 
the  parts  mentioned  as  well  as  the  crus  and  the  pons. 

Hqhonymous  Hemianopia. 

Dr.  Sharkey  read  a  paper  on  a  case  of  homonymous 
hemianopia,  probably  due  to  a  cortical  lesion.  The  patient 
was  a  female,  aged  fifty-one,  who  came  under  Dr.  Sharkey’s 
care  on  July  5,  1883.  The  present  illness  began  two  years 
and  a  half  before,  whilst  the  patient  was  walking  across  a 
hayfield,  when  she  had  the  first  of  a  series  of  “'fits”  of 
exactly  similar  character.  The  order  of  events  in  these 
attacks  was  as  follows  : — Suddenly  there  appeared  “  in  the 
right  eye  ”  a  play  of  all  the  colours  of  the  rainbow,  “  quiver¬ 
ing”  and  “fluttering”  before  her.  Then  the  right  arm 
became  convulsed,  and  the  forearm  and  hand  were  rotated 
inwards.  Soon  the  right  leg  was  rigidly  extended  back¬ 
wards  and  outwards  ;  then  loss  of  consciousness  supervened, 
and  she  bit  her  tongue.  She  remained  unconscious  of  her 
surroundings,  and  when  she  did  recover  her  senses  she  found 
she  had  a  severe  pain  in  the  top  of  her  head,  and  weakness 
of  the  right  arm,  but  none  of  the  right  leg.  Moreover,  she 
could  see  nothing  on  her  right  side  without  turning  her  head 
in  that  direction.  She  had  no  loss  of  sensation  or  of  speech. 
When  first  seen  by  Dr.  Sharkey  she  had  a  painful  area 
on  the  top  of  her  head  posteriorly,  about  two  inches  in 
diameter,  which  was  tender  on  percussion.  There  was 
weakness  of  the  right  hand  and  arm,  and  right  lateral 
homonymous  hemianopia  of  such  a  kind  that  there  remained 
a  considerable  area  of  normal  central  vision  on  all  sides  of 
the  fixation  point.  Colour-vision  was  intact  except  in  the 
blind  portions.  Dr.  Sharkey  thought  that  the  diagnosis  of 
a  lesion  of  the  left  hemisphere  affecting  the  cortical  centre 
for  the  arm  and  its  neighbourhood  was  as  nearly  certain 
as  any  diagnosis  could  be,  which  was  not  subjected  to 
the  test  of  an  autopsy.  The  succession  of  phenomena 
above  described  presented  a  vivid  and  typical  picture  of 
cortical  lesions.  Terrier  long  ago  established  a  connexion 
between  each  hemisphere  and  the  opposite  eye,  and  local¬ 
ised  the  “  visual  centre  ”  in  the  angular  gyrus.  But 
since  then  Munk  has  proved  by  experiment  that  lesions  of 
other  parks  produce,  not  amblyopia  of  the  opposite  eye,  but 
homonymous  hemianopia.  Dr.  Sharkey’s  case  showed  that 
in  such  conditions  central  vision  may  be  unaltered.  This 
being  the  case,  it  proves  that  there  must  be,  to  some  extent, 
a  separation  between  the  area  in  the  cortex  which  receives 
the  peripheral  fibres  of  the  corresponding  halves  of  the 
retinae,  and  that  which  receives  the  central  fibres  of  the 
retina.  The  probabilities  are  in  favour  of  the  “  visual 
centre  ”  being  an  extensive  expansion  of  grey  matter  in  the 
posterior  parts  of  the  hemispheres,  in  which  is  represented 
separately  every  portion  of  the  retinae.  And  probably  great 
variety  will  be  found  in  the  shape  of  visual  defects  in  homo¬ 
nymous  hemianopia  due  to  cortical  lesions.  In  order  to 
represent  the  state  of  our  knowledge,  the  well-known  dia¬ 
gram  of  Charcot  requires  slight  modification.  Leaving  in 
his  diagram  the  crossed  fibres,  as  representing  the  central 
fibres  only  of  each  retina,  let  the  neighbouring  but  some¬ 
what  distinct  cortical  centre  be  added,  from  which  the  peri¬ 
pheral  fibres  to  corresponding  halves  of  the  retinae  start. 
From  this  centre  draw  a  line  running  down  the  optic  tract 
of  its  own  side,  and  bifurcating  at  the  chiasma,  one  portion 
of  the  fibres  passing  to  the  periphery  of  the  temporal  half 
of  the  retina  of  the  same  side,  and  the  other  portion  to  the 
periphery  of  the  nasal  half  of  the  opposite  retina. 


THE  CLINICAL  SOCIETY  OF  LONDON. 

Friday,  October  12. 

Sir  Andrew  Clark,  Bart.,  President,  in  the  Chair. 


The  President,  after  a  few  words  of  welcome  upon  the 
commencement  of  a  new  session,  took  occasion  to  bring  before 
the  Society,  and  especially  its  surgical  members,  the  subject 
of  severe  illness  leading  to  a  fatal  issue  in  cases  of  continued 
catheterisation,  apparently  due  to  that  cause  alone,  and  pre¬ 
senting  no  pathological  changes  beyond  those  of  a  slightly  in¬ 
flamed  bladder.  He  related  the  particulars  of  one  such  case,  in 
which  fever  ensued  four  days  after  the  first  catheterism,  lead¬ 
ing  to  collapse  and  death  in  nine  days.  Similar  cases  having 
occurred  to  him  to  the  number  of  four  or  five  in  a  year,  and 
no  explanation  having  been  found  either  in  contemporary- 
opinion  or  in  the  writings  of  previous  authorities,  he  sug¬ 
gested  that  attention  should  be  drawn  to  such  cases  with  a; 
view  to  investigating  their  true  nature. 

Three  Cases  of  Peritoneal  Abscess  in  Children. 

Dr.  Goodhart  read  notes  of  three  cases  of  peritoneal 
abscess  in  children.  The  first  was  that  of  a  girl,  aged  eleven 
years,  who  was  said  to  have  suffered  from  typhoid  fever- 
four  months  before  she  came  under  treatment.  She  was  in 
bed  for  eight  weeks,  and  in  the  seventh  week  had  chicken- 
pox.  Soon  after  this  an  abscess  formed  at  the  umbilicus,, 
and  opened.  She  was  admitted  into  the  Evelina  Hospital 
with  a  sinus  discharging  pus  copiously  at  the  umbilicus. 
She  was  placed  under  chloroform,  and  Mr.  Howse  made  a 
thorough  examination  with  a  probe.  This  left  no  doubt,, 
from  the  freedom  with  which  it  passed  deeply  in  all  direc¬ 
tions,  that  the  pus  came  from  the  peritoneal  cavity ;  but 
seeing  that  there  was  now  no  febrile  disturbance,  it  was 
decided  to  keep  the  child  in  bed,  feed  her  well,  and  watch 
the  course  of  events.  She  steadily  increased  in  weight,  the- 
discharge  gradually  diminished,  and  after  three  months  had 
all  but  ceased.  She  has  now  been  for  many  months  quite 
well. — The  second  case  was  that  of  a  boy,  aged  eleven  years,, 
who  had  been  quite  well  till  shortly  before  admission.  His 
illness,  attributed  to  getting  wet,  began  with  rigors  and 
vomiting.  When  admitted  he  was  extremely  ill,  and  the- 
case  was  very  obscure,  but  gradually  a  diffused  abdominal 
dulness  became  localised  in  the  hvpogastrium,  and  the 
abdominal  wall  began  to  bulge.  After  he  had  been  in  the 
hospital  a  month,  Mr.  Howse  made  a  small  incision  into  what 
appeared  to  be  an  abscess.  This  was  followed  by  the  escape 
of  a  quantity  of  thin  pus  and  some  feetid  gas.  A  long  probe- 
passed  several  inches  in  all  directions  into  the  peritoneal 
cavity.  A  quantity  of  foetid  pus  continued  to  discharge 
daily,  but  his  condition  did  not  improve,  and  the  opening 
was  therefore  enlarged,  but  neither  did  this  mend  matters,, 
and  shortly  after  an  explanation  of  its  failure  arose  in  the 
fact  that  the  left  pleura  began  to  fill  with  fluid.  The  chest 
was  incised,  and  sixteen  ounces  of  very  foetid  pus  came  away. 
Before  long  it  became  necessary  to  treat  the  left  chest  in  the 
same  way,  and  with  considerable  relief  to  the  child  for  the 
time.  The  lung,  however,  became  consolidated,  and  he 
ultimately  sank.  The  post-mortem  examination  showed, 
that  there  had  been  a  peritoneal  abscess,  for  which  no  cause 
could  be  discovered,  that  this  had  localised  itself  in  each, 
hypochondrium,  and  had  thence  perforated  the  pleurae,  and 
on  the  one  side  had  set  up  a  destructive  pneumonia.  There 
was  no  evidence  of  any  tubercular  disease.  The  viscera 
were  lardaceous  — The  third  case  was  a  female  child,  aged, 
five  years.  Her  illness  began  six  weeks  before  admission, 
with  inflammation  of  the  bowels,  and  she  was  sent  into  the- 
hospital  for  a  supposed  retention  of  urine,  the  abdominal 
swelling  resembling  a  distended  bladder.  As  the  tem¬ 
perature  was  rather  erratic,  at  the  end  of  a  week  an  ex¬ 
ploring  syringe  was  introduced  two  inches  below  the  umbi¬ 
licus,  and  some  thick,  dirty,  feetid  pus  was  withdrawn.  A 
free  incision  opened  a  cavity  which  appeared  to  be  limited 
behind  by  intestine  covered  by  omentum.  A  drainage-tube 
was  inserted  for  a  few  days,  but  the  discharge  soon  dimi¬ 
nished  so  much  as  to  allow  of  its  withdrawal,  and  at  the  end 
of  six  weeks  she  was  well.  Dr.  Goodhart  thought  the  cases 
worthy  of  record,  first,  because  of  their  rarity,  and  secondly, 
because  the  question  of  treatment  is  not  an  easy  one  to  de¬ 
termine  satisfactorily.  On  the  one  hand,  there  is  the  risk 
of  the  pus  gravitating  to  the  hypochondria,  as  actually 


472 


Medical  Times  and  Gazette. 


THE  PATHOLOGICAL  SOCIETY. 


Oct.  20,  1883. 


happened  in  one  case,  if  a  free  opening  be  not  made;  on 
the  other,  there  is  the  difficulty  of  draining  the  cavity  of  the 
peritoneum  if  it  be  made;  though  on  the  whole  the  cases 
point  in  the  direction  of  the  latter  course  as  being  the  most 
advisable.  It  is  probable  that  the  surgeon  might  have  no 
doubt  upon  the  point.  He  would  say  that  free  drainage 
after  abdominal  operations  presents  few  difficulties,  and  cases 
so  treated  are  most  successful ;  but  it  may  be  questioned 
whether  the  conditions  after  operation  are  quite  parallel  to 
those  of  pus  in  the  peritoneum,  and  where  there  is  a 
considerable  tendency  for  the  one  collection  to  become 
distributed  and  to  form  several  separate  abscesses. 

The  President  invited  discussion  on  Dr.  Goodhart’s 
paper,  especially  with  reference  to  the  treatment  of  peri¬ 
toneal  abscesses.  He  related  the  details  of  a  case  in  which 
severe  peritonitis  with  collapse  was  followed  by  the  appear¬ 
ance  of  a  lump  in  the  abdomen,  which  subsequently  was 
found  to  contain  fluid.  The  question  of  operation  then 
became  pressing,  but  eventually  it  was  decided  to  avoid 
surgical  interference.  Three  days  later,  pus  was  evacuated 
from  the  rectum,  with  marked  relief  to  the  patient.  A 
relapse  took  place,  and  a  similar  decision  with  regard  to 
operation  was  followed  by  a  second  discharge  of  pus,  and 
convalescence. 

Mr.  Godlee  mentioned  two  cases  of  discharging  peritoneal 
abscess,  in  one  of  which  an  enlargement  of  the  discharging 
sinus  gave  no  relief,  owing  to  the  presence  of  other  collec¬ 
tions  of  pus  in  the  abdomen.  Although  numerous  cheesy 
masses  were  found,  there  was  no  evidence  of  tubercle,  nor 
were  the  mesenteric  glands  much  enlarged. 

Dr.  Mahomed  thought  that  such  cases  were  not  so  rare 
as  was  supposed,  but  were  frequently  only  noticed  during 
post-mortem  examinations,  and  not  explained.  He  brought 
forward  three  cases,  of  which  one  appeared  to  be  due  to 
suppuration  of  mesenteric  glands,  the  other  two  being  cases 
of  diffuse  suppuration,  not  of  tubercular  origin,  and  not  con¬ 
nected  with  glands.  One  of  the  cases  appeared  as  a  direct 
sequel  of  scarlatina.  He  suggested  that  the  process  might 
not-  improbably  com.mence  in  the  lymphatic  vessels  of  the 
intestine  as  the  result  of  direct  irritation  either  by  unsuit¬ 
able  food  or  by  some  specific  organisms. 

Mr.  Howard  Marsh  called  attention  to  the  fact  that  these 
cases,  and  others  which  result  in  fsecal  fistula,  are  by  no 
means  well  understood.  Two  cases  presenting  at  the  um¬ 
bilicus  recovered  completely  under  simple  drainage,  neither 
being  tuberculous.  A  third  case,  due  in  the  first  onset  to  a 
strain,  discharged  very  freely,  but  was  followed,  after  in¬ 
cautious  purgation,  by  symptoms  of  perforation,  which, 
relieved  for  a  time,  recurred  later  on,  with  fatal  issue. 

Mr.  Barker  gave  details  of  a  case  of  abscess  presenting 
through  the  femoral  opening,  and  apparently  in  the  peri¬ 
toneal  cavity,  but  localised.  He  pointed  out  that  operative 
treatment  in  such  a  case  was  indicated,  to  avoid  danger  of 
intexmal  rupture. 

Dr.  F.  Taylor  agreed  in  the  advisability  of  operative 
treatment  where  the  abscess  could  be  safely  got  at ;  but  in 
the  numerous  cases  of  abscess  following  peritonitis,  no  means 
of  diagnosing  either  the  existence  or  seat  of  such  abscess 
presented  themselves  until  long  after  the  subsidence  of  the 
initial  mischief  In  reply  to  the  President,  he  stated  that 
he  had  never  known  cases  where  the  patient  had  recovered 
after  the  formation  of  pus,  without  some  natural  or  artificial 
opening  having  occurred. 

Dr.  Habershon  pointed  out  that  all  the  cases  referred  to, 
having  origin  in  the  various  forms  of  chronic  peritonitis, 
were  essentially  different  from  those  described  by  Dr. 
Goodhart.  Abscess  in  the  abdominal  parietes  due  to  injury 
might  occasionally  make  its  way  inwards.  Such  cases  were 
not  rare.  Softening  of  blood-clot  effused  during  enteric 
fever  might  also  appear  as  a  cause  of  peritoneal  abscess. 

Dr.  Edis  drew  attention  to  the  occurrence  of  localised 
pelvic  abscess,  of  which  he  related  a  case  successfully  treated 
hy  aspiration  through  the  vagina.  He  believed  that  encysted 
peritoneal  abscess  was  often  overlooked,  and  advocated  the 
employment  of  aspiration  as  a  means  of  treatment. 

Dr.  GooDnART,  in  reply,  maintained  his  view  of  the  com¬ 
parative  rarity  of  the  cases  which  he  had  brought  forward, 
and  showed  that  many  of  the  cases  mentioned  differed  essen¬ 
tially  from  them.  The  treatment  by  evacuation  was  always 
■open  to  risk,  and  no  means  existed  of  determining  whether 
the  abscess  was  single  or  one  of  many. 

The  President  drew  attention  to  the  fact  that,  although 


many  of  the  cases  related  were  associated  with  cheesy  masse 
in  the  abdomen,  none  were  recognised  as  tuberculous. 

Anomalous  Case  of  Cerebro-Spinal  Sclerosis. 

Dr.  Charlton  Bastian  read  an  abstract  of  the  notes  of 
this  case,  which  will  be  found  in  another  part  of  the  present 
issue. 

Dr.  Althaus  remarked  upon  the  absence  of  tremor  in 
the  case,  and  mentioned  one  similar  instance  where  the 
other  symptoms  could  leave  no  doubt  as  to  the  diagnosis. 

Dr.  Longhurst  called  attention  to  the  importance  of 
previous  injury  in  the  production  of  the  disease,  and  men¬ 
tioned  a  case  attributed  to  a  fall  from  a  horse  four  years 
previous  to  the  onset  of  the  symptoms. 

Dr.  Angel  Money  suggested  that  the  absence  of  tremor 
might  be  due  to  the  freedom  from  disease  of  the  corpora 
striata  and  cerebellum. 

Dr.  Bastian,  in  reply,  recorded  the  absence  of  true 
nystagmus  in  the  case,  but  was  inclined  to  attribute  the 
absence  of  tremor  to  the  early  onset  of  the  disease  in  the 
anterior  pyramids,  cerebral  influence  being  thus  cut  off  from 
parts  of  the  spinal  cord. 


THE  PATHOLOGICAL  SOCIETY  OF  LONDON. 

Tuesday,  October  16. 

J.  W.  Hulke,  F.E.S.,  President,  in  the  Chair. 


Lympho-Sarcoma  of  the  Intestine. 

Dr.  E.  E.  Carington  showed  a  portion  of  the  intestine  of 
a  woman  who  had  died  in  Guy’s  Hospital,  under  the  care  of 
Dr.  Goodhart,  from  the  malignant  form  of  Hodgkin’s  dis¬ 
ease.  The  patient  was  aged  fifty  five  years  and  married, 
but  had  had  no  children  and  no  miscarriages.  There  was 
no  history  of  syphilis,  and  no  malaria,  though  she  had  lived 
in  a  damp  house  on  the  banks  of  the  Shannon.  In  June, 
18S2,  she  first  noticed  that  the  glands  in  the  left  side  of  her 
neck  were  swollen,  and  soon  there  ensued  loss  of  appetite 
and  loss  of  flesh.  In  August  her  legs  became  swollen  and 
her  abdomen  enlarged,  and  she  took  to  her  bed  in  Sep¬ 
tember.  After  this  there  were  occasional  periods  of  im¬ 
provement,  but  she  was  unable  to  leave  her  room.  In 
October  she  noticed  a  swelling  in  the  right  side  of  her  neck. 
On  admission  into  the  hospital  she  was  amende  and 
emaciated,  and  there  was  generalised  cedema;  the  cervical, 
submaxillary,  axillary,  and  inguinal  glands  were  enlarged, 
as  also  those  at  the  bends  of  the  elbows ;  there  was  a 
moderate  degree  of  ascites ;  the  liver  could  not  be  made  out, 
but  the  spleen  was  very  greatly  enlarged.  There  were  no 
definite  signs  as  to  thejungs.  The  area  of  cardiac  dulness 
was  increased,  and  the  second  sound  was  reduplicated. 
The  appetite  was  good,  and  the  bowels  regular.  Micturition 
was  frequent,  the  urine  being  of  specific  gravity  1015,  and 
free  from  albumen  or  sugar.  There  were  no  retinal 
haemorrhages.  The  temperature  was  normal,  and  the  blood 
showed  4’ 3  white  corpuscles  per  thousand  red.  After  a 
slightly  febrile  attack  she  gradually  sank  and  died.  At  the 
autopsy  there  was  general  anasarca.  The  brain  and  its 
membranes  were  healthy  ;  the  lungs  normal;  the  heart  was 
small,  its  valves  thickened.  The  cervical  glands  were 
enlarged,  white,  and  brain-like,  containing  a  milky  fluid 
consisting  almost  entirely  of  leucocytes;  the  mediastinal 
glands  were  greatly  enlarged.  The  colon  was  greatly 
distended,  with  medullary-looking  fleshy  nodules  in  it.  The 
glands  were  everywhere  enlarged.  The  peritoneum  was 
healthy.  The  stomach  contained  many  cream-like,  fatty 
tumours;  several  of  them  were  mere  infiltrations  of  the  walls. 
The  pylorus  was  in  a  similar  condition.  The  duodenum  was 
healthy.  The  valvuhe  conniventes  were  swollen,  and  con¬ 
tained  numerous  polypoid  and  cream-like  excrescences 
(many  cf  them  were  ulcerated  on  the  surface),  throughout 
the  small  and  large  intestines,  especially  in  the  latter.  The 
solitary  glands  were  in  a  similar  state.  There  was  no  con¬ 
traction  or  dilatation  of  the  bowel.  The  spleen  weighed 
forty-four  ounces  ;  there  was  a  diffused  soft  growth  through¬ 
out  ;  it  was  not  altered  in  colour.  The  liver  was  healthy  ; 
the  portal  vein  and  hepatic  ducts  were  free  from  obstruction  ; 
the  inferior  cava  was  surrounded  by  enlarged  glands.  The 
growth  in  the  colon  showed  the  structure  of  a  lymphoma. 
He  had  only  been  able  to  find  recorded  in  the  Transactions 
four  cases  resembling  the  present  one. 


MeJical  Times  and  Gazette. 


THE  PATHOLOGICAL  SOCIETY. 


Oct.  20,  1883.  4  7  3 


The  President  remarked  that  it  was  very  unusual  to  find 
the  disease  so  widespread  as  in  the  present  case. 

Dr.  Pye-Smith  referred  to  a  similar  case  which  had  been 
published  in  1S61,  under  the  title  of  “  Leukhsemia  Intes- 
tinalis.” 

Dr.  Coupland  said  that  thei’e  was  a  still  earlier  case  on 
record,  viz.,  that  described  by  Cruveilhier  in  his  Atlas. 

Scirrhus  op  Bladder. 

Dr.  W.  B.  Hadden  exhibited  a  specimen  of  this  disease. 
The  patient,  a  man  aged  sixty-three,  had  been  under  the 
care  of  Sir  William  Mac  Cormac  in  St.  Thomas’s  Hospital. 
The  chief  symptoms  had  been  haematuria,  and  severe  pain 
and  difficulty  in  micturition.  A  large,  firm  mass  could  be  felt 
per  anum  in  the  situation  of  the  prostate.  At  the  autopsy 
the  right  kidney  was  found  to  be  very  small ;  it  contained  a 
few  cysts  and  some  abscesses  ;  its  outer  surface  was  irregular 
and  tuberculated.  There  was  a  soft,  warty-looking  growth, 
made  up  of  granulation  tissue,  attached  to  the  mucous 
membrane  on  the  right  side  of  the  bladder,  just  beyond  the 
neck.  The  anterior  wall  of  the  bladder  was  much  thick¬ 
ened,  white,  and  very  hard.  The  growth,  which  had  infil¬ 
trated  the  wall,  extended  upwards  for  two  and  a  half  inches 
from  a  point  a  quarter  of  an  inch  beyond  the  prostate.  The 
latter  was  not  involved.  There  were  two  or  three  large,  hard 
glands  behind  the  bladder,  but  no  other  secondary  deposits. 
Microscopically,  the  growth  was  found  to  be  scirrhus.  Al¬ 
though  Sir  Henry  Thompson  stated  that  scirrhus  was  the 
most  common  form  of  tumour  of  the  bladder  after  villous 
growth,  only  two  similar  cases  to  the  present  were  recorded 
in  the  Transactions ,  one  by  Dr.  Bastian,  the  other  by  Mr. 
Butlin. 

Congenital  Tumour  of  Orbit. 

Mr.  Lawson  showed  a  drawing  and  narrated  the  case  of 
a  male  infant  who  was  brought  to  him  in  May,  1882,  at 
Moorfields,  when  two  days  old,  suffering  from  complete 
exophthalmos  of  the  right  eye,  which  was  congenital,  and 
evidently  due  to  a  tumour  of  the  orbit.  He  at  once  re¬ 
moved  the  eye.  The  child  went  on  well  until  the  following 
August,  when  convulsions  and  coma  set  in,  and  it  died  after 
two  days’  illness.  On  autopsy,  the  body  was  emaciated, 
and  the  right  orbit  filled  by  a  tumour.  On  the  under  surface 
of  the  brain  the  right  middle  lobe  was  indented  by  a  cystic 
growth  springing  from  the  sphenoid  bone.  There  was  basic 
meningitis  confined  to  the  right  side.  Growing  from  the 
body  of  the  sphenoid  bone  there  was  found  a  solid  tumour 
with  several  multilocular  cysts  embedded  in  it.  On  micro¬ 
scopical  examination  the  growth  contained  patches  of 
hyaline  cartilage,  spherical  or  oblong,  many  of  them  sur¬ 
rounded  by  spindle-cells,  but  with  every  gradation  from 
cartilage-cells.  The  walls  of  the  cysts  were  lined  with  pave¬ 
ment  epithelium  ;  elsewhere  were  seen  masses  of  round  cells 
like  embryonic  tissue. 

The  President  remarked  that  Virchow  had  described  a 
similar  case. 

The  specimen  was  referred  to  the  Morbid  Growths 
Committee. 

Acute  Gastro-Enteritis  in  a  Bear. 

Mr.  J.  Hutchinson,  jun.,  showed  the  stomach  of  a  female 
bear  which  had  been  at  the  Zoological  Gardens  about  four 
years,  and  died  in  February  last  after  one  day’s  illness. 
The  stomach  and  upper  part  of  the  intestines  were  acutely 
inflamed ;  the  rest  of  the  alimentary  canal  was  healthy. 
There  was  no  food,  but  much  exudation,  in  the  stomach  and 
neighbouring  parts  of  the  intestines.  No  torulee,  sarcinse,  or 
micro-organisms  were  found,  but  minute  quantities  of  round 
cells  and  fibrin,  with  altered  blood.  The  uterus,  bladder, 
and  trachea  showed  acute  catarrh.  The  other  viscera  were 
healthy.  Probably  the  disease  was  purely  catarrhal.  It 
was  noteworthy  that  there  was  no  fur  whatever  on  the 
tongue. 

Melanotic  Sarcoma  of  Brain. 

Mr.  Kesteven  showed  this  specimen.  The  patient  was 
an  elderly  lady,  from  whom  Mr.  Gould  had  a  year  previously 
removed  a  melanotic  tumour  of  the  thigh.  At  the  autopsy 
the  meninges  were  healthy.  On  removing  the  dura  mater 
a  dark  patch  was  seen  in  the  region  of  the  upper  part  of  the 
left  superior  frontal  convolution  ;  just  below  this  were  two 
similar  masses — one  in  the  situation  of  the  third  left  frontal 
convolution.  The  masses  had  no  distinct  capsule,  and  the 
brain-tissue  around  was  softened.  There  were  no  tumours 
on  the  surface  of  the  right  hemisphere,  but  there  was  a  large  i 


one  in  the  right  centrum  ovale,  which  communicated  with 
the  lateral  ventricle.  At  the  base  of  the  brain  on  the  left 
side  were  several  tumours— one  large  one  between  the  pons 
Varolii  and  crus  cerebri,  very  soft,  the  brain-tissue  all  round 
being  broken  down.  In  all,  there  were  eleven  tumours,  and 
they  were  all  found  to  be  round- celled  melanotic  sarcomata. 

Sebaceous  Cyst  from  the  Finger. 

Mr.  Poland  related  the  removal  of  a  sebaceous  cyst  from 
the  terminal  phalanx  of  the  ring-finger ;  the  outer  part,  of 
it  seemed  to  be  formed  of  dense  laminrn  of  epidermal  scales. 

Mr.  Godlee  said  that  he  had  removed  three  cysts  of  this 
sort— all,  he  believed,  from  the  ring-finger.  Two  of  them 
followed  some  injury.  He  had  always  been  inclined  to  think 
that  they  might  be  dermoid  cysts  ;  but  he  had  not  made  a 
microscopical  examination  of  the  walls  in  any  of  them.  He 
did  not  see  how  they  could  be  sebaceous  cysts. 

Dr.  Savage  said  that  twenty-three  years  previously  he 
had  had  a  sebaceous  cyst  removed  from  his  ring-finger.  He 
could  not  account  for  its  presence. 

The  President  observed  that  two  of  Mr.  Godlee’s  cases 
were  traumatic.  Several  cases  had  been  recorded  in  which 
sebaceous  cysts  had  formed  in  the  interior  of  the  eye,  espe¬ 
cially  in  the  neighbourhood  of  the  iris  after  a  penetrating 
wound,  where,  presumably,  an  eyelash  had  been  carried  into 
the  eye ;  and  he  thought  that  perhaps  a  similar  occurrence 
might  have  been  the  cause  in  such  cases  as  those  just 
mentioned. 

Mr.  Poland,  in  reply  to  the  question  as  to  the  nature  of 
the  wall  of  the  cyst,  said  that  there  was  no  distinct  wall 
that  could  be  dissected  off. 

Congenital  Malformation  of  Heart.. 

Dr.  Howard  Tooth  showed  the  heart  of  a  boy,  aged 
six  years,  who  had  been  a  patient  of  Dr.  Gee’s  at  St.  Bar¬ 
tholomew’s  Hospital.  The  signs  were  marked  cyanosis, 
especially  of  the  lips  and  tongue,  clubbing  of  the  fingers 
and  toe*.  There  was  bulging  in  the  prmcordial  area,  and  a 
loud  systolic  murmur  all  over,  but  loudest  at  the  apex.  The 
child  was  admitted  for  enteric  fever,  and  died  from  perito¬ 
nitis.  On  autopsy,  the  characteristic  lesions  of  enteric  fever- 
were  found  in  the  intestines.  The  heart  weighed  eight 
ounces  and  a  half.  The  foramen  ovale  was  not  quite  closed. 
The  right  ventricle  was  dilated,  and  the  aorta  arose  from  it, 
and  went  over  to  the  root  of  the  left  lung  as  usual.  The 
septum  between  the  ventricles  was  deficient  at  the  base,  and 
the  space  thus  formed  was  divided  into  two  holes  by  a  columna 
carnea.  The  endocardium  was  thickened  at  the  edge  of  this 
hole.  The  pulmonary  artery,  which  was  of  fair  size,  and 
guarded  by  only  two  sigmoid  cusps,  also  arose  from  the  right 
ventricle.  The  ductus  arteriosus  was  closed.  The  left  auricle 
was  smaller  than  the  right.  The  left  ventricle  was  small, 
and  had  no  vessel  arising  from  it,  and  must  therefore  have 
propelled  the  blood  contained  in  it  into  the  right  ventricle. 
He  believed  that  this  was  a  decidedly  rare  form  of  malforma¬ 
tion  of  the  heart.  The  existence  of  endocarditis  was  a 
further  evidence  of  the  well-known  tendency  to  it  in  these 
cases. 

Gumma  of  Spinal  Dura  Mater  and  Syringo-Myelus. 

Dr.  Frederick  Taylor  showed  this  specimen.  The 
patient  was  a  woman  who  had  had  ulceration  of  the  hard 
palate  and,  about  three  years  previously,  paralysis  of  the 
left  side  of  the  body.  The  arm  and  face  had  recovered. 
One  year  before  she  came  under  observation  she  had  had 
paralysis  of  the  right  leg,  and  this,  as  well  as  that  of  the  left, 
had  persisted,  and  the  limbs  had  become  rigid.  She  was 
pregnant, and  aborted  whilst  under  observation.  After  death, 
the  spinal  meninges  were  found  to  be  thickened  throughout, 
especially  in  the  lower  dorsal  region.  Opposite  to  the  ninth 
dorsal  vertebra  a  spherical  mass  was  found  pressing  on  the 
cord,  which  was  softened  at  this  spot,  and  degenerated  above 
and  below.  Extending  throughout  the  whole  length  of  the 
cord  there  was  a  cavity,  mostly  single,  but  for  a  short  dis¬ 
tance  in  the  dorsal  region  double  in  each  posterior  cornu. 
It  was  behind  the  normal  central  canal,  and  in  the  lower 
part  of  the  cord  was  on  the  right  side  only.  There  was  no 
lining  membrane,  the  tissue  around  it  being  merely  somewhat 
denser  than  elsewhere.  The  contents  were  not  noticed. 
He  had  shown  to  the  Society,  four  years  ago,  a  case  very 
similar  to  this  one.  The  paraplegia,  he  thought,  was  due- 
to  the  gumma,  and  the  syringo-myelus  was  congenital. 


474 


Medical  Times  and  Gazette. 


OBITUARY. 


Oct.  20,  1883. 


Bone  Disease  in  Monkeys. 

Mr.  Sutton  said  that  the  most  prominent  symptoms  of 
rickets  in  a  monkey  were  diminished  activity,  paralysis 
•of  the  lower  limbs  so  that  the  animal  dragged  himself 
along,  using  his  arms  as  crutches,  which  caused  these  to 
bend ;  gradually  the  paraplegia  became  complete;  there 
was  priapism,  and  incontinence  of  urine  and  faeces.  The 
disease  ran  a  very  rapid  course,  and  the  animals  died  in 
three  or  four  months’  time  from  bronchitis  or  broncho¬ 
pneumonia.  In  capuchins  the  chief  signs  were  beaded  ribs, 
softened  and  curved  bones,  enlarged  epiphyses,  deformed 
pelves ;  the  skull  was  remarkably  eroded,  perforated,  and 
slightly  thickened — on  either  side  of  the  foramen  magnum 
was  a  tabetic  patch.  The  shafts  of  the  long  bones  pre¬ 
sented  a  most  remarkable  condition,  the  compact  tissue 
being  split  up  into  longitudinal  lamellae,  separated  by 
tracts  of  richly  cellular  connective  tissue,  which  was  readily 
seen  to  be  continuous  with  the  deeper  layers  of  the  peri¬ 
osteum;  themedullary  cavities  were  filled  with  dark  red 
marrow ;  the  epiphyses  showed  the  condition  he  had  already 
described  as  diffuse  epiphysis,  and  he  was  satisfied  that  the 
•enlarged  epiphyses  met  with  in  rickets  were  due  to  the 
•ossific  matter  being  deposited  in  a  diffuse  and  irregular 
manner.  The  paraplegia  was  due  to  compression  of  the 
spinal  cord  from  overgrowth  and  softening  of  the  vertebrae 
gradually  encroaching  upon  it.  The  nerves  also,  partly  from 
the  same  cause,  and  partly  from  the  weight  of  the  body, 
would  get  pinched  in  the  intervertebral  foramina,  and  thus 
he  would  explain  the  pains  in  the  legs  and  urino-genital 
troubles  which  formed  such  [prominent  symptoms  in  the 
disease.  Examination  of  the  spinal  cord  with  the  microscope 
showed  all  the  changes  found  in  the  cord  in  compression 
from  cancer,  Pott’s  disease,  etc. 

Dr.  Goodhart  asked  for  some  information  relative  to  the 
age  of  these  monkeys.  Last  session  Mr.  Sutton  had  shown 
“these  changes  in  animals  about  the  age  of  four  years ;  and  if 
“these  animals  were  as  old,  the  disease  was  probably  more 
allied  to  “  late  rickets  ”  in  the  human  subject  than  to  ordi¬ 
nary  rickets,  and  therefore  must  be  regarded  as  a  totally 
distinct  disease.  He  also  asked  if  lardaceous  disease  had 
been  present  in  any  of  these  animals. 

Mr.  Sutton,  in  reply,  said  it  was  exceedingly  difficult  to 
estimate  the  age  of  the  monkeys ;  they  were  not  born  in  the 
Gardens,  and  the  state  of  the  epiphyses  was  almost  the  only 
guide,  and  that  not  a  very  reliable  one.  He  had  not  found 
lardaceous  disease  again  since  the  case  reported  last  session. 

Card  Specimens. 

Mr.  Silcock — Tubercular  Hlcer  of  Large  Intestine. 

Dr.  F.  Taylor — Dysentery ;  Abscesses  of  Liver. 


OBITUARY. 

- ♦ - 

JOHN  SULLIVAN,  M.D.,  M.E.C.P.  Lond.,  L.E.C.S.  Edin. 
Dr.  John  Sullivan,  whose  death  we  would,  if  possible, 
have  noticed  earlier,  became  well  known  to  the  readers  of  our 
pages,  in  1877  and  subsequent  years,  through  his  papers  on 
Malarial  Fevers.  He  was  a  typical  example  of  the  energetic 
and  adventurous  medical  man,  to  whom  the  daily  round  of 
general  practice  in  England  is  insufferably  tedious  and  dull; 
and  who  is  consequently  driven  by  natural  temperament 
and  taste  to  seek  practice  in  more  stirring  and  adventure¬ 
bringing  countries.  Born  in  Limerick  in  1818,  he  was  the 
•eldest  of  five  brothers,  who  all  entered  the  medical  profes¬ 
sion,  and  practised  more  or  less  successfully  in  various  parts 
of  the  world.  His  father,  who  was  the  owner  of  considerable 
landed  property  in  Ireland,  died  at  a  comparatively  early  age, 
after  having  given  his  sons  a  good  college  education.  John 
Sullivan  studied  medicine  at  the  Westminster  Hospital  and 
Medical  School,  and  in  Paris.  He  does  not  seem  to  have 
taken  a  medical  degree  in  Paris ;  but  he  studied  under 
Orfila,  and  attended  the  practice  of  the  Paris  hospitals  in 
1833-34-35  ;  and  in  1838  he  took  the  certificate  of  Bachelier 
bs  Lettres  of  Paris,  and  in  the  same  year  became  a  Licen¬ 
tiate  of  the  Society  of  Apothecaries  of  Loudon,  and  of  the 
Royal  College  of  Surgeons  of  Edinburgh.  He  was  offered 
an  appointment  as  Surgeon  in  the  Indian  Army,  having 
thus  the  chance  of  a  career  particularly  well  suited,  one  may 
suppose,  to  his  gifts.  At  this  time,  however,  he  married, 
and  thereupon,  making  the  Indian  appointment  over  to 
one  of  his  brothers,  he  settled  in  Guilford-street,  Eussell- 


square.  After  some  years  of  successful  work  there,  he  dis¬ 
posed  of  his  practice,  and  settled  in  Oxfordshire ;  but  was 
tempted  to  give  up  the  field  of  medical  work  there  for  Cali¬ 
fornia.  The  vessel  in  which  he  went  out  was  detained  for 
some  reason  at  Valparaiso,  South  America,  and  there  he 
elected  to  remain,  visiting  and  practising  also  in  various 
towns  and  cities  along  the  coast.  In  1850  he  returned  to 
England,  and  took  the  Extra-Licentiateship  of  the  Eoyal 
College  of  Physicians  of  London.  Early  in  1851  he  sailed, 
with  his  family,  for  Buenos  Ayres ;  passed  an  examination 
in  medicine  there,  and  obtained  a  licence  to  practise  ;  and 
was  appointed  physician  to  the  well-known  General  Eozas. 
He  quickly  became  the  chief  physician  in  the  city,  and  was 
doing  very  well  when  a  rebellion  broke  out.  The  General 
fled  to  England ;  and  Dr.  Sullivan’s  family  returned  home, 
but  he  himself  remained  in  Buenos  Ayres  till  the  beginning 
of  1853,  when  he  crossed  the  Andes,  and  for  the  next  six 
years  practised  in  Valparaiso,  Iquique,  and  other  cities;  and 
in  1859,  returning  to  England  again,  tried  once  more  home 
practice,  settling  down  this  time  in  Portsmouth.  He  soon 
tired,  however,  of  the  experiment,  and  in  1860  proceeded 
again  to  South  America.  It  would  be  tedious  to  state  in 
detail  the  various  movements  of  Dr.  Sullivan  during  the  next 
sixteen  years;  but  though  he  was  for  some  time  in  the 
island  of  Porto  Eico,  he  spent  the  greater  part  of  the  time 
in  Havana  (where  he  held  for  some  years  the  post  of  Senior 
Physician  to  the  Eoyal  Hospital)  and  in  Cuba.  In  1875 
the  Cuban  insurrection  broke  out,  but  Dr.  Sullivan  remained 
at  his  post  until  April,  1876,  when  he  finally  left  the 
West  Indies,  returned  home,  and  in  1877  was  admitted  a 
Member  of  the  Eoyal  College  of  Physicians.  In  every 
place  in  which  he  settled,  in  South  America  and  in  the 
West  Indies,  his  energy  and  his  professional  acquirements 
and  skill  seem  to  have  been  promptly  recognised  :  in  some 
he  was  appointed  to  high  and  important  posts  ;  and  in  all 
he  acquired  large  and  lucrative  practice.  He  frequently 
returned  to  England,  but .  never  for  long ;  and  even  after 
leaving  Cuba,  in  1876,  his  temperament  would  not  allow  him 
to  rest  at  home.  In  the  latter  part  of  that  year  he  spent  a 
few  months  at  Malaga;  in  1877  he  went  to  Eome,  where  he 
remained  for  some  months,  and  as  a  result  of  his  observa¬ 
tions  he  contributed  to  our  pages  an  article  on  the  Action  of 
Malaria  on  the  Human  Organisation,  in  which  he  set  forth 
the  views  of  Professor  Bacelli  on  the  influence  of  malaria  on 
the  spleen ;  and  in  1878  he  visited  Cyprus,  and  afterwards 
read  a  paper  on  the  peculiar  malarial  fever  of  that  island 
before  the  Medical  Society  of  London.  In  1878,  Dr.  Sullivan, 
through  the  President  of  the  Eoyal  College  of  Physicians  — 
Sir  Eisdon  Bennett — was  appointed  Physician  to  the  British 
Hospital  at  Oporto ;  but  before  the  end  of  the  period  of  three 
years,  for  which  he  had  accepted  the  appointment,  his  health 
gave  way,  and  he  was  compelled  to  return  home.  He  never 
recovered  from  the  effects  of  his  hospital  work  and  private 
practice  in  Portugal ;  and  he  died  at  his  residence  in  Ken¬ 
sington,  in  June  last,  at  the  age  of  sixty-five.  Dr.  Sullivan 
was  a  man  of  good  education,  general  and  professional,  a 
careful  observer,  a  keen  student,  and  an  able  practitioner. 
His  chief  contribution  to  medical  literature  was  a  small 
volume  on  “The  Endemic  Diseases  of  Tropical  Climates, 
with  their  Treatment,”  which  was  published  in  1877 — a 
work  of  considerable  merit;  and  we  understand  that  he  has 
left  the  manuscript  of  a  treatise  entitled  “  A  Comparative 
View  of  Maladies  under  Different  Climates.” 


Health  Aphorisms  by  Dr.  Frank  Hamilton. — 

1.  The  lives  of  most  men  are  in  their  own  hands,  and,  as  a 
rule,  the  just  verdict  after  death  would  be  •  felo  de  se. 

2.  Light  gives  a  bronzed  or  tan  colour  to  the  skin ;  but 
where  it  uproots  the  lily  it  plants  the  rose.  3.  Mould  and 
decaying  vegetables  in  a  cellar  weave  shrouds  for  the  upper 
chambers.  4.  A  change  of  air  is  less  valuable  than  a  change 
of  scene.  The  air  is  changed  every  time  the  direction  of 
the  wind  is  changed.  5.  Calisthenics  may  be  very  genteel, 
and  romping  very  ungenteel ;  but  one  is  the  shadow,  the 
other  the  substance  of  healthful  exercise.  6.  Blessed  is  he 
who  invented  sleep  ;  but  thrice  blessed  the  man  who  will 
invent  a  cure  for  thinking.  7.  Milk  drawn,  from  a  woman 
who  sits  indoors  and  drinks  whisky  and  beer  is  certainly  as 
unwholesome  as  is  milk  from  a  distillery-fed  cow.  8.  Dirt, 
debauchery,  disease,  and  death  are  successive  links  in  the 
same  chain. — Louisville  Med.  News,  August  25. 


M:<  i’-l  Times  and  Gazette. 


MEDICAL  HEWS. 


Oct.  20,  1S83.  475 


MEDICAL  NEWS. 

■ - ♦ - 

The  Royal  University  of  Ireland. — The  Examiners 
in  the  Faculty  of  Medicine  have  recommended  that  the 
following  candidates  shall  be  adjudged  to  have  passed  the 
examinations  for  the  undermentioned  degrees  and  diplomas 
respectively  :  — 

Doctor  of  Medicine. — R.  A.  Barber,  E.  C.  Biggar,  J.  ,T.  Brownlee. 
V/.  Calwell,  A.  A.  G.  Dickey,  J.  Ellisoa,  D.  P.  Gaussen,  J.  Lennox, 
A.  Lindsay,  ,T.  A.  Lynch,  W.  B.  A.  M'Alister,  M.  M’Auley,  J.  M‘Caw, 
J.  M'Nineh,  J.  A..  M.  Macaulay,  II.  Massey,  J.  Meek,  J.  Mitchell,  A.  P.  B. 
Moore,  R.  Sayers,  H.  J.  Taylor,  J.  Taylor,  S.  Wallace,  ah  of  Queen's 
College,  Belfast;  H  C.  Brannigan,  Queen's  College,  Belfast,  and  Edin¬ 
burgh  School ;  B.  Wilson,  Queen’s  College,  Belfast,  and  University  of 
Edinburgh;  R.  Rarry,  W.  Barter,  J.  W.  Bullen,  J.  Cagney,  R.  H. 
Hall.  G.  J.  W.  Johnston,  R.  E.  Kelly,  J.  MacMahon,  W.  J.  Moynahan, 
J.  O’Connell,  D.  O’Mahony.  P.  Quinlivan,  J.  M.  Sheedy,  J.  H.  Swanton, 

E.  C  Ward.  C.  G.  Woods,  all  of  Queen’s  College,  Cork;  R.  W.  Henderson, 
R.  M’Elwaine,  A.  E.  Morris,  W.  H.  Thompson,  P.  B.  White,  all  of 
Queen’s  College.  Gal  wav;  J.  Carroll  and  P.  J.  Doyle,  of  Queen’s  College, 
Galway,  and  Catholic  University  School ;  J.  B.  Jackson,  Queen’s  College, 
Galway,  and  Ledwicli  School;  J.  M‘G)ynn  and  W.  Watters,  of  Queen’s 
Colleges,  Galway  and  Belfast ;  W.  Atterbury,  T.  D.  Kirk,  S.  J.  Moore, 
C.  O’Donel. 

Bachelor  of  Medicine. — D.  Lee,  Queen’s  College,  Cork;  J.  E.  O’Carroll, 
Catholic  University  School. 

Master  of  Suraery.—  'R.  A.  Barber,  E.  C.  Biggar,  W.  Calwell,  W.  Graham 
(Manchester),  J.  Lennox.  J.  A.  Lynch,  W.  R.  A.  M’Alister,  J.  Meek, 
.T.  M.  Orr.  R.  Sayers,  all  of  Queen’s  College,  Belfast:  H.  C.  Brannigan, 
Queen’s  College,  Belfast,  and  Edinburgh  School;  B.  Wilson,  Queen’s 
College,  Belfast,  and  University  of  Edinburgh;  A.  M.  Johnson,  Queen’s 
Colleges,  Belfast  and  Galway,  and  Ledwich  School;  W.  Barter,  H.  E. 
Brown,  J.  W.  Bullen,  J.  Cagney,  R.  H.  Hall,  R.  E.  Kellv,  J.  MacMahon, 
W.  J.  Moynahan,  D.  O'Mahony,  P.  Quinlivan,  J.  M.  Sheedy,  J.  H. 
Swanton,  E.  C.  Ward,  C.  G.  Woods,  all  of  Queen’s  College.  Cork;  J.  A. 
Neslon,  Queen’s  College,  Cork,  and  Carmichael  School ;  R.  W.  Henderson, 
C.  M.  Mitchell,  A.  E.  Morris,  W.  H.  Thompson,  P.  B.  White,  all  of 
Queen’s  College,  Galway ;  J.  Carroll,  Queen’s  College,  Galway,  and 
Catholic  University  School;  J.  B.  Jackson,  Queen’s  College,  Galway, 
and  Ledwich  School ;  W.  Watters,  Queen’s  Colleges  Galway  and  Belfast ; 
,T.  F.  O’Carroll,  Catholic  University  School;  G.  W.  Weir,  Roval  College 
of  Surgeons;  T.  D.  Kirk,  S.  J.  Moore,  T.  Pritchard,  R.  G.  Thompson, 

F.  G.  Tooker. 

Diploma  in  Obstetrics. — J.  J.  Brownlee,  W.  G.  Hanna,  W.  R.  A.  M’Alister, 
all  of  Queen’s  College,  Belfast;  B.  Wilson,  Queen’s  College,  Belfast,  and 
University  of  Edinburgh  :  W.  Barter,  J.  Cagney.  R.  H.  Hall.  G.  ,T.  W. 
Johnston,  R.  E.  Kelly,  W.  J.  Moynahan,  J.  O’Connell,  D.  O’Mahony, 
P.  Quinlivan,  M.  J.  Sexton,  J.  M.  Sheedy,  J.  H.  Swanton,  C.  G.  Woods, 
all  of  Queen’s  College,  Cork  ;  F.  G.  Tooker. 

The  public  meeting  of  the  University  for  the  conferring  of 
degrees  will  be  held  in  the  University  Buildings,  Earlsfort- 
terrace,  Dublin,  on  Thursday,  the  25th  inst. 


King  and  Queen’s  College  of  Physicians  in 
Ireland. — At  the  usual  monthly  examinations  for  the 
Licences  of  the  College,  held  on  Monday,  Tuesday,  Wed¬ 
nesday,  and  Thursday,  October  8,  9,  10,  and  11,  the 
following  candidates  were  successful:  — 

T o  Practise  Medicine. — William  George  Bu’ler,  Bushy  Island,  Limerick  ; 
John  St.  Leger  Clarke.  Dublin :  Constance  Vernev  Fawckner  Hitchcock, 
London  ;  Francis  Octavius  Hodson,  Bishop  Hatford,  Herts :  Jeremiah 
Thomas  Martin,  Clogheen,  cn.  Tipperary  ;  Alphonsus  William  Moloney, 
Dublin;  Thomas  Joseph  O'Donnell,  Consett,  co.  Durham;  William 
Langford  Symes,  Dublin. 

To  Practise  Midwifery.—  J ohn  St.  Leger  Clarke;  Thom  is  Earrelly, 
M.D.R.U.I.,  Bailyborough,  co.  Cavan;  Win.  Gordon  Hanna,  M.D.Q.U.I., 
Magherafelt,  co.  Londonderry  :  Constance  Verney  Fawckner  Hitchcock ; 
Francis  Octavius  Hodson;  James  Macpberson  Lswrie.  M.  B.  Glasg., 
Glasgow  ;  William  Nicholson  McWilliam,  M.D.Q.U.I.,  Banbridge ; 
Alphonsus  William  Moloney;  Tnomas  Joseph  O'Donnell ;  JohuWilgar 
Taylor,  M.D.R.U.I.,  Belfast. 

At  the  quarterly  First  or  Previous  Professional  Examina¬ 
tion,  held  on  Monday,  October  8,  and  following  days,  the 
undermentioned  candidates  were  successful : — 

Clarinda  Boddy ;  Catherine  J ane  Urquhart. 

The  following  Licentiates  in  Medicine  of  the  College, 
having  complied  with  the  by-laws  relating  to  Membership, 
have,  under  the  provisions  of  the  Supplemental  Charter  of 
December  12,  1878,  been  duly  enrolled  Members  of  the 
College: — 

Andrew  Richard  Cowell,  1864,  Rathmines;  George  Henry  Ormsby, 
1869,  High  Barnet;  E^pine  Charles  R.  Ward.  1879,  8nrgeon  A.M.D.; 
William  Crozier,  1877,  Dublin  ;  O’Connell  John  Delahoyde,  1877,  Dublin  ; 
Edward  Bennett,  1878,  Sandymount. 


Apothecaries’  Hall,  London. — The  following  gentle¬ 
man  passed  his  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  his  certificate  to  practise,  on  Thursday, 
October  11 : — 

Bryceson,  Ebenezer,  Shooter's  Hill,  Kent. 


DEATHS. 

Evans,  Thomas,  second  surviving  son  of  the  late  Edward  Evans,  Senior 
Surgeon,  Cardiff,  M.R.C.S  ,  L.S.A.,  J.P.,  Freeman  and  Alderman  of 
the  Borough  of  Cardiff,  aged  69. 

Fasken,  William,  M.D.,  Deputy  Inspector-General  (retired)  of  Hospitals 
and  Fleets,  at  21,  Fairholme-road,  Baron’s  Court,  West  Kensington,  on 
October  11,  in  his  64th  year. 

Hughes,  James  Sheridan,  M.D.,  H.M.  Emigration  Service,  at  Colombo, 
Ceylon,  on  September  6. 

Lenet,  George,  M  R.C.S.,  L.S.A.,  late  of  Maidstone,  at  2,  Bentinck- 
terrace,  Regent’s-park,  on  October  11,  aged  71. 

Osborn,  John,  M.D.,  F.R.C.S.,  of  Longdown  Lodge,  Sandhurst,  on 
October  13. 

Spilsbury,  Thomas,  M.R.C.S.,  at  Highbury,  St.  Leonard’s-road,  East¬ 
bourne,  on  September  10,  aged  43. 


VACANCIES. 

Birkenhead  Bor, high  Hospital. — Junior  House-Surgeon.  Salary  £>0 
per  annum,  with  board,  lodging,  and  washing.  Candidates  must  possess 
registered  medical  and  surgical  qualifications.  Applications,  with 
testimonials,  to  be  sent  to  the  Chairman  of  the  Weekly  Board,  on  or 
before  October  22. 

Birmingham  and  Midland  Ear  and  Throat  Infirmary. — Assistant- 
Surgeon.  [For  particulars  see  Advertisement.) 

Borough  of  Birmingham  Hospital  for  Infectious  Diseases. — Medical 
Superintendent.  ( For  particulars  see  Advertisement.) 

Bradford  Infirmary  and  Dispensary.— Dispensary  Surgeon.  Salary- 
£100  per  annum,  with  board,  residence,  and  washing.  Candidates  must 
be  registered  as  legally  qualified  medical  and  surgical  practitioners. 
Applications,  stating  age,  with  copies  of  recent  testimonials  as  to  moral 
character  and  professional  ability,  to  be  forwarded  to  the  Secretary, 
endorsed  “Dispensary  Surgeon,”  on  or  before  October  25.  The 
election  will  take  place  on  November  2. 

Brighton  and  Hove  Dispensary. — Resident  House-Surgeon.  Salary 
£140  per  annum,  with  furnished  apartments,  coals,  gas,  and  attendance. 
Candidates  must  be  Members  of  one  of  the  Royal  Colleges  of  Surgeons 
of  Great  Britain  or  Ireland,  and  Licentiates  of  the  Royal  College  of 
Physicians  of  London,  or  Licentiates  of  the  Society  of  Apothecaries  of 
London,  and  registered  under  the  Medical  Act.  Diplomas,  certificate 
of  registration,  and  testimonials  (under  seal),  to  be  addressed  to  the 
Chairman  of  the  Committee  of  Management,  Brighton  and  Hove  Dis¬ 
pensary,  Queen’s-road,  Brighton,  on  or  before  November  5.  The  election 
will  take  place  on  December  4. 

Cheltenham  General  Hospital. — Assistant  House-Surgeon.  Salary 
£80  per  annum,  with  board  and  lodging  in  the  Hospital.  Candidates 
must  possess  ar,  least  one  registered  qualification  and  be  unmarried. 
Applications,  stating  age,  with  testimonials,  to  be  sent  to  the  Hon. 
Secretary,  on  or  before  October  24. 

Chichester  Infirmary.— House-Surgeon  and  Secretary.  Salary  £100  per 
annum,  with  board,  lodging,  and  washing.  Candidates  must  possess 
both  a  medical  and  surgical  qualification  obtained  in  the  United  King¬ 
dom,  and  be  duly  registered.  Applications,  with  testimonials,  to  be  sent 
to  the  Chairman  of  the  Committee,  on  or  before  October  22.  The 
election  will  take  place  on  November  8. 

Chichester  Infirm  vry. — Assistant  House-Surgeon.  Salary  £20  per 
annum,  with  board,  lodging,  and  washing.  Applications  to  be  sent  to- 
the  Chairman  of  the  Committee,  on  or  before  October  22. 

Dental  Hospital  of  London  (London  School  of  Dental  Surgery), 
Lkicestur-square,  W. — Lecturer  on  Dental  Anatomy  and  Physiology. 
{Far  particulars  see  Advertisement.) 

North-West  London  Hospital,  K  extish  Town-road,  N.W.— Surgeon. 
Candidates  must  be  Fellows  or  Members  of  a  Royal  College  of  Surgeons 
of  the  United  Kingdom.  Applications,  with  testimonials,  to  be  sent  to 
the  Secretary,  on  or  before  October  23. 

Royal  Berks  Hospital,  Reading.— Assistant  House-Surgeon.  {For 
particulars  see  Advertisement.) 


UNION'  AND  PAROCHIAL  MEDICAL  SERVICE. 

***  The  area  of  each  district  is  stated  in  acres.  The  population  is 
computed  according  to  the  census  of  1881. 

RESIGNATIONS. 

Bridport  Union. — Mr.  H.  E.  Norris  has  resigned  the  Fifth  District :  area 
8670;  population  1738;  salary  £14  per  annum. 

Ely  Union. — Mr.  AY.  B.  Hunter  has  resigned  the  Littleport  District  : 
area  31,0 10;  population  7142 ;  salary  £15  per  anuum. 

Faversham  Union.— Mr.  William  Ernest  Dring  has  resigned  the  Third 
District:  area  12,790  ;  population  3171 ;  salary  £73  per  annhm. 

St.  George' s-in-the-  East  Parish. — Mr.  J.  N.  Cooper  has  resigned  the 
Infirmary  and  the  Workhouse. 

Sheffield  Union. — The  office  of  Resident  Medical  Officer  of  the  Work- 
house  is  vacant  by  the  resignation  of  Mr.  Charles  F.  Coombe.  Salary 
£100  per  annum. 

APPOINTMENTS. 

Ongar  Union.—  Thomas  Spurgin,  M.R.C.S.  Eag.,  L.R.C.P.  Edin.,  to  the 
Fourth  Disti  ict. 

St.  George's  Union.—  Henry  A.  Fotherby,  M.R.C.S.  Eng.,  L.S.A.,  as 
Assistant  Medical  Officer  at  the  Infirmary. 

Woodstock  Union.  —Alexander  H.  Mair,  B.M.  and  M.C.  Aber.,  to  the 
Workhouse.  Thomas  McClure,  F.R.C.S.  Ire.,  L.R.C.P.  Edin.,  to  the 
Second  Woodstock  District. 


Dr.  Francis  Troup  lias  been  appointed  Assistant 
Medical  Officer  of  the  Longmore  Hospital  for  Incurables. 


476 


Medical  Times  an c|Gazette. 


VITAL  STATISTICS. 


a 


Oct.  20,  1883. 


King’s  College,  London. — The  Entrance  Scholarships 
and  Exhibitions  have  been  awarded  as  follows  : — Warneford 
Scholarships — I.  Penny;  H.  C.  Addison  and  H.  B.  Osburn 
(ceq.).  Sanibrooke  Exhibitions — H.  P.  Ward  and  I.  Penny. 
Science  Exhibitions  (Cloth workers’) --E.  B.  Anderson,  C. 
H.  Wordingham ;  E.  W.  Davies  and  E.  Bidewood  (ceq., 
jprox.  acc.). 

Geological  Society  oe  Glasgow.  —  At  the  first 
meeting,  held  on  Thursday  evening  last,  Mr.  John  Young, 
E.G.S.,  exhibited  a  specimen  of  scyelite,  a  new  rock-substance 
from  the  neighbourhood  of  Beay,  in  Caithness-shire,  and  of 
this  important  find  he  gave  an  interesting  account,  with  an 
.analysis,  showing  it  to  consist  of  silica,  ferric  oxide,  and 
magnesia. 

"  Miss  Beatrice  Chigston. — This  lady,  of  convalescent- 
home  celebrity,  has  been  engaged  for  the  past  two  months 
in  going  from  place  to  place,  holding  meetings  for  the  pur¬ 
pose  of  obtaining  aid  for  the  extension  of  Broomhill  Home 
for  Incurables,  Kirkintilloch.  A  wing  is  now  being  added, 
which  will  enable  the  directors  to  receive  special  cases  of  in¬ 
curable  disease.  Miss  Chigston  has  done  so  much  already, 
that  we  can  but  wish  her  success  in  her  charitable  object. 

Glasgow  Medico -Chirurgical  Society. — At  a  meet¬ 
ing  of  the  above  Society  of  Glasgow,  held  in  the  Faculty 
Hall,  the  following  gentlemen  were  appointed  office-bearers 
for  the  session  1883-84 : — President :  Dr.  W.  T.  Gairdner. 
Yice-Presidents  :  Drs.  Alex.  Bobertson  and  Hugh  Thomson. 
Council :  Drs.  Bobert  Forrest,  Lapraik,  D.  McLean,  J.  G. 
Woodburn,  Wm.  Whitelaw  (Kirkintilloch),  W.  A.  Wilson 
(Greenock),  B.  Cowan,  and  J.  A.  Lothian.  Secretaries : 
Drs.  W.  L.  Eeid  and  J.  W.  Anderson.  Treasurer  :  Dr.  Hugh 
'Thomson. 

Bltpture  of  the  Bladder  in  a  Railway  Accident. — 
An  inquest  was  held,  last  week,  relative  to  the  death  of  a 
telegraph  messenger,  aged  fifteen,  who  had  fallen  between 
.a  railway-carriage  and  the  platform  at  King’s  Cross  Station, 
while  the  train  was  still  in  motion.  The  injury  was  not 
recognised  when  the  boy  was  first  seen  at  St.  Bartholomew’s 
Hospital,  as  there  were  then  no  external  signs  of  it ;  but 
the  same  evening  he  was  brought  back  with  evident  rup¬ 
ture  of  the  bladder,  and  an  operation  was  at  once  performed. 
The  boy  died  four  days  later  of  exhaustion. 

Charing-cross  Hospital.— A  grant  of  £350  has  been 
made  by  the  National  Aid  Society  for  the  Belief  of  the 
Wounded  in  War  to  Mr.  Cantlie,  of  Charing-cross  Hospital, 
for  the  equipment  of  an  Ambulance  Company  formed  of  the 
students  of  the  Charing-cross  Medical  School.  The  sum  is 
to  be  expended  in  the  provision  of  the  necessary  ambulance 
material,  and  the  Committee,  in  making  the  grant,  pro¬ 
nounce  this  training  of  medical  students  in  field  hospital 
work  as  a  pastime  to  be  of  the  greatest  importance  in  its 
bearing  on  the  Begular  and  Volunteer  services. 

Eever  in  the  Metropolis. — At  the  meeting  of  the 
Asylums  Board  on  Saturday  last  it  appeared,  from  the  re¬ 
turns  from  the  fever  hospitals,  that  162  cases  had  been  ad¬ 
mitted,  as  against  157  in  the  previous  fortnight,  and  these 
numbers  were  spread  over  the  five  asylums  of  the  Board  in 
all  parts  of  the  metropolis.  During  the  fortnight  21  had 
died,  and  45  had  been  discharged  ;  leaving  54l)  under  treat¬ 
ment,  as  against  452  a  fortnight  ago — an  increase  of  97.  Of 
these  large  numbers,  441  are  scarlet-fever  patients  ;  there  is 
only  1  typhus  case,  and  105  are  cases  of  enteric  fever.  In 
regard  to  small-pox,  during  the  fortnight  20  cases  had  been 
admitted,  6  had  died,  and  19  had  been  discharged ;  leaving 
54  under  treatment,  as  against  59  a  fortnight  ago. 

Ointment  in  Conjunctival  Catarrhal  Ophthalmia. 
— Dr.  Warlomont,  of  Brussels,  recommends  the  following 
formula : — Bed  oxide  of  mercury  five  to  ten  centigrammes, 
balsam  of  Peru  one  drop,  and  vaseline  five  grammes ;  the 
oxide  to  be  thoroughly  well  rubbed  up  with  the  balsam  before 
incorporating  it  with  the  vaseline.  A  portion  the  size  of 
a  small  pea  is  to  be  introduced  at  night  between  the  eyelids, 
when  the  mucus  secreted  by  the  inflamed  conjunctiva  in¬ 
duces  adhesion  of  the  eyelids.  In  very  chronic  cases,  and 
especially  when  the  papillae  of  the  mucous  membrane  are 
engorged  and  give  it  a  velvety  appearance,  the  most  con¬ 
spicuous  parts  should  be  gently  touched  once  a  day  with 
.sulphate  of  copper,  washing  the  part  afterwards  with  cold 
water. — Union  Med.,  October  2. 


VITAL  STATISTICS  OF  LOHDOH. 

Week  ending  Saturday,  October  13,  1883. 
BIRTHS. 

Births  of  Boys,  1280 ;  Girls,  1224 ;  Total,  2504. 

Corrected  weekly  average  in  the  10  years  1873-82,  2647 ‘4. 

DEATHS. 


Males. 

Females. 

Total. 

Deaths  during  the  week . 

758 

680 

1438 

Weekly  average  of  the  ten  years  1873-82, ) 
corrected  to  increased  population  ...  j 

775'5 

73F8 

1507-3 

Deaths  of  people  aged  SO  and  upwards 

... 

... 

58 

DEATHS  IN  SUB-DISTRICTS  FROM  EPIDEMICS. 


1  Enumerated 

Population, 

1881 

(unrevised). 

Small-pox. 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

1 

.9  £ 1 

2  53 

O  o 
^  o 

Typhus. 

Enteric  (or 

Typhoid) 

Fever. 

Simple 

continued 

Fever. 

Diarrhoea.  1 

West . 

669633 

6 

6 

5 

5 

•  •• 

1 

", _ 

2 

North  ... 

905947 

3 

11 

11 

5 

7 

... 

13 

i 

6 

Central  ... 

282238 

4 

3 

•  •• 

... 

1 

2 

1 

East . 

692738 

8 

16 

5 

1 

2 

5 

6 

South . 

1265927 

... 

7 

20 

6 

9 

... 

3 

... 

11 

Total . 

3816483 

3 

32 

57 

24 

22 

2 

23 

3 

26 

METEOROLOGY. 

From  Observations  at  the  Greenwich  Observatory. 


Mean  height  of  barometer  ...  ... 

•  •• 

.  30-012  in. 

Mean  temperature  . 

•  •• 

... 

.  51-4° 

Highest  point  of  thermometer 

... 

... 

.  62-1° 

Lowest  point  of  thermometer 

... 

... 

.  40-6° 

Mean  dew-point  temperature 

... 

.  49-0° 

General  direction  of  wind  . 

-tt 

S.W.  &  S.E. 

Whole  amount  of  rain  in  the  week  ... 

... 

... 

.  0  00  in. 

BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  the 
Week  ending  Saturday,  Oct.  13,  in  the  following  large  Towns 


Cities 

and 

Boroughs 

Estimated  Population  to 
middle  of  the  year  1883. 

Births  Registered  during 
the  week  ending  Oct.  13. 

Deaths  Registered  during 
the  week  ending  Oct.  13. 

Annual  Rate  of 
Mortality  per  1000  living, 
from  all  causes. 

Temperature 
of  Air(Fahr.) 

Temp. ! 
of  Air 
(Cent.) 

Rain 

Fall. 

60 

9 

w 

J3j§ 

ID’S 

w 

Lowest  during 
theWeek, 

Weekly  Mean  oi 
Daily  MeanVaiues 

Weekly  Mean  of 
Daily  Mean 
Values. 

In  Inches. 

|  In  Centimetres. 

London  . 

3955814 

2504 

1438 

19-0 

62-1 

40-6 

51-4 

10-78 

o-oo 

o-oo 

Brighton  . 

111262 

74 

35 

16-4 

61-0 

43-0 

51-3 

10-73 

0-00 

o-oo 

Portsmouth 

131478 

105 

34 

135 

... 

... 

u 

Norwich  . 

89612 

60 

28 

16-3 

... 

... 

... 

Plymouth  . 

74977 

50 

24 

16-7 

62-0 

37-8 

50-6 

10-34 

0-01 

0-03 

Bristol . 

212779 

122 

80 

19-6 

61-0  39  0  51-6 

10-90 

0-00 

o-oo 

Wolverhampton  . 

77557 

46 

36 

24-2 

6F3 

34-3 

48-9 

9-39 

0-21 

0-53 

Birmingham 

414S46 

266 

141 

17-7 

Leicester  ... 

129483 

87 

29 

11-7 

64-2 

39-2 

51-4 

10-78 

O' 16 

041 

Nottingham 

199349 

154 

87 

22-8 

661 

37-3 

50-5 

10-28 

0’14 

0-36 

Derby . 

85574 

61 

21 

12-8 

... 

... 

... 

... 

... 

Birkenhead 

88700 

63 

32 

18-8 

.  .  . 

... 

... 

Liverpool  . 

566763 

363 

256 

23-6 

60-9 

44-7 

52-2 

11-22 

021 

0-53 

Bolton . 

107862 

70 

39 

18-9 

57-4 

38-5 

49-4 

9-66 

0-22 

0-56 

Manchester 

339252 

220 

177 

27-2 

... 

... 

... 

fl. 

... 

Salford  . 

190465 

146 

98 

26-8 

... 

... 

... 

... 

... 

... 

Oldham  . 

119071 

76 

48 

21-0 

.  .  . 

... 

... 

... 

... 

... 

Blackburn . 

108460 

92 

48 

23-1 

... 

... 

... 

... 

•  • . 

Preston  . .- 

98564 

70 

61 

32-3 

... 

... 

... 

Huddersfield  ... 

84701 

47 

30 

18-5 

... 

... 

... 

... 

Halifax  ...  ... 

75591 

49 

22 

152 

... 

... 

... 

Bradford  . 

204807 

95 

74 

1S-9 

62-4 

43-2 

51-4 

1078 

0-04 

0-10 

Leeds  . 

321611 

226 

160 

26-0 

65-0 

37-0 

52-0  11-11 

0-28 

0-71 

Sheffield  . 

295497 

159 

92 

16-3 

6S-0 

32-6 

61-4  10-78 

0-17 

0-43 

Hull  . 

176296 

111 

85 

25-2 

67-0 

34-0 

49-5 

9-72 

0-36 

0-91 

Sunderland 

121117 

102 

41 

17-7 

... 

... 

... 

... 

... 

Newcastle  . 

149461 

121 

85 

29-7 

... 

... 

... 

... 

... 

Cardiff . 

90033 

69 

32 

18-5 

... 

... 

... 

... 

... 

For  28  towns ... 

8620975 

5607 

3333 

20-2 

68-0 

32‘5 

50- £ 

1050 

014 

0-36 

Edinburgh . 

235946 

127 

77 

17-0 

61-0 

^  35'8 

51-1 

:  10-62 

0-3C 

0-76 

Glasgow  . 

515589 

399 

214 

217 

64-0  34-5 

51-2  10-67 

0-20 

0-51 

Dublin . 

349885 

218 

173 

25‘8 

62-0  30-7 

506  10  34 

029 

0-74 

At  the  Boyal  Observatory,  Greenwich,  the  mean  reading 
of  the  barometer  last  week  was  30-01  in. ;  the  highest  read¬ 
ing  was  30-35  in.  on  Monday  morning,  and  the  lowest  29-69  in. 
on  Thursday  afternoon. 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES. 


Oct.  20,  1883.  477 


NOTES,  QUERIES,  AND  REPLIES. 

- o - 

lit  tjjat  qntsftotuQ  mncjj  sfeall  learn  much. — Bacon. 


The  Boast  Fund. 

TO  THE  EDITOR  OF  THE  MEDICAL  TIMES  AND  GAZETTE. 

Sir, — I  shall  feel  obliged  by  your  mentioning  in  your  next  issue  that  I 
have  received  the  following  additional  subscriptions  to  the  above  fund  :  — 
Mr.  J.  Taylor,  £2  2s. ;  Mr.  T.  L.  Lack,  £10;  Mr.  R.  Heald,  £2;  Mr.  H. 
Stear.  £2  2s.  ;  A.  B.  Z.,  10s.  6d.  I  am,  &c„ 

1,  St.  George’s-terrace,  Plymouth,  Oct.  IS.  George  Jackson. 

Metaphysics  in  Pathology. 

TO  THE  EDITOR  OP  THE  MEDICAL  TIMES  AND  GAZETTE. 

Sir,— My  present  access  to  Niemeyer  consists  of  all  the  passages,  copied 
from  his  text-book,  which  appeared  to  me  after  a  careful  search  to  bear 
upon  the  subject  under  discussion  ;  and  a  copv  of  the  seventh  edition,  the 
paging  of  which  does  not  correspond  with  that  of  the  eighth.  In  that 
edition  there  is  nothing  further  than  I  am  well  acquainted  with ;  and  I 
have  at  the  present  moment  no  opportunity  of  consulting  any  other,  and 
am  therefore  compelled  to  depend  upon  my  notes  and  my  memory.  The 
tone  of  Dr.  Saundby’s  letter,  however,  renders  further  discussion  as 
undesirable  as  it  would  be  useless.  I  am,  &c., 

Rineton,  October  14.  Kenneth  W.  Millican. 

Uterine  Displacements. 

TO  THE  EDITOR  OP  THE  MEDICAL  TIMES  AND  GAZETTE. 

Sir,— I  quite  agree  with  your  correspondent,  the  “  Bare- Faced  Monkey,” 
as  far  as  he  goes.  He  is  quite  right  in  considering  the  “  genu-pectoral  ” 
or  “  genu-manual  ”  positions  as  preferable  to  that  commonly  called  the 
erect.  He  is  quite  right,  I  say,  so  far  as  he  goes ;  but  he  does  not  go  far 
enough ;  and,  for  my  part,  if  a  man  has  the  courage  of  his  opinions,  let 
him  follow  them  out  to  their  logical  consequences — I  hate  compromise. 

Now,  the  “genu-pectoral”  position,  or  that  on  “ all-fours,”  is  merely 
a  half-way  house  between  the  “erect”  so-called  (properly,  in  my 
opinion,  the  inverted )  and  the  “inverted”  so-called  (properly,  in  my 
opinion,  the  normal)  position.  This  normal  position  we  Cheiroptera 
have  maintained  unimpaired,  and  what  is  the  result?  Our  females 
are  healthy,  go  through  their  pregnancies  unmurmuring,  and  through 
their  parturition  content !  Who  ever  heard  of  a  bat  complaining 
of  lassitude,  pain  in  the  upper  cervical  or  left  submammary  region, 

“  uterine  dyskinesia,”  or  any  of  the  other  well-known  symptoms  of 
slight  displacement  of  the  uterus,  which  render  many  women’s  lives  a 
burden,  and  subject  them  for  years  to  active  treatment  at  the  hands  of 
their  inverted  brothers  the  gynaecologists  ?  Our  race,  at  any  rate,  is  in  no 
danger  of  extinction  from  sterility,  the  result  of  uterine  distortions  (or 
their  treatment),  and  spaying.  Can  the  inverted  race  which  calls  itself 
the  crown  of  creation  say  as  much  ?  Besides,  if  this  race  knew  their  own 
physiology,  they  would  be  aware  that  Nature  does  her  best  for  them  while 
under  her  safe  control  for  the  first  nine  months  of  their  existence — in 
utero,  or,  as  they  say,  “  before  they  come  out.”  During  this  time  the 
position  of  the  human  embryo  nearly  corresponds  with  that  of  the  adult 
bat.  This  can  be  nothing  else  but  an  instance  of  the  principle  which  the 
late  inverted  philosopher  Darwin  has  pointed  out,  that  embryology  throws 
light  on  the  former  history  of  a  race.  It  is  to  this  dependent  posi¬ 
tion  that  the  head  of  the  human  embryo  owes  its  increasing  specific 
gravity,  and  the  brain  its  development.  The  wisdom  of  the  newly  born 
human  being  contrasts  favourably  with  that  of  the  adult,  for  if  it  cannot 
he  said  to  be  silent,  it  never  speaks.  This  is  again  a  reminiscence  of  the 
Cheiroptera,  and  the  fact  seems  to  be  recognised  by  an  inverted  philo¬ 
sopher,  who  says  “  Speech  is  silvern,  silence  is. golden.” 

Let  those  who  are  debating  the  subject  not  be  content  with  anv  half¬ 
measures.  Their  principles  are  right ;  let  them  carry  them  logically  out. 
They  will  at  least  have  the  satisfaction  of  feeling  that  they  have  returned 
to  the  state  in  which  they  were  created,  and  which  they  were  never 
intended  to  change.  I  am,  &c., 

Bat  House,  Zoological  Gardens.  Topsy-Turvy. 

Resignation  of  a  Medical  Officer. — Dr.  Napier  has  tendered  his  resignation 
of  the  post  of  Medical  Officer  of  the  Tintern  District  of  the  Chepstow 
Union. 

The  Contagious  Diseases  A  cts. — It  is  stated  in  well-informed  naval  circles 
that  the  Admiralty  are  dissatisfied  with  the  result  of  the  suspension  of 
the  Acts,  and  that  a  scheme  which  will  overcome  some  of  the  objections 
of  Mr.  Stansfeld  and  his  friends  will  shortly  come  into  operation. 
Carcinoma,  Liverpool.  —  The  Charity  Commissioners  hold  a  sum  of 
£6507  9s.  9d.  belonging  to  St.  George’s  Hospital  for  the  treatment  of 
certain  cases  of  cancer.  A  piece  of  land  in  the  town  of  Hull,  with 
reversions,  bequeathed,  will,  it  is  expected,  produce  about  £50,000. 

A  Sensible  Prohibition. — The  Faversham  Town  Council  have  decided  to 
henceforth  make  the  “Market”  strictly  a  food  market,  and  to  pro¬ 
hibit  the  selling  of  nostrums  by  “quack  doctors”  and  “cheap  jacks” 
— an  example  which  might  be  usefully  followed  by  other  corporate 
bodies. 

Dr.  Williams.— It  was  at  Hempstead,  in  Essex,  and  not,  as  you  ask, 
at  Hemel  Hempstead,  that  the  celebrated  Harvey  was  buried.  Un¬ 
questionably  the  best  life  of  the  great  man  was  written  by  Dr.  Robert 
“Willis.  The  finest  portrait  of  Harvey  was  engraved  by  Houbraken. 
His  autograph  is  very  rare. 

The  French  Premier  and  Vaccination. — The  circular  of  M.  Jules  Ferry, 
ordering  the  revaccination  of  all  the  scholars  in  French  public  schools, 
is  energetically  protested  against  by  certain  of  the  anti-vaccinationists, 
who  have  sent  a  strongly  worded  address  to  the  French  President  of  the 
Council,  in  which  they  denounce  his  circular  “before  all  civilisations” 
as  an  “inhuman,  retrograde,  unscientific,  and  arbitrary  measure.” 


Hastings. — New  waterworks,  constructed  by  the  Town  Council  at  Filshamv 
near  the  West-end  of  the  borough,  have  just  been  formally  opened.  These 
works  will  insure  the  borough  an  ample  supply  of  deep  well-water  from 
the  greensand.  The  water  has  been  analysed  by  the  borough  analyst*- 
who  pronounces  it  to  be  of  good  quality  and  soft. 

Deaths  from  Excessive  Drinking. — According  to  the  recently  published) 
official  volume  of  judicial  statistics,  447  of  the  inquests  held  in  England 
and  Wales  in  1880  resulted  in  a  verdict  of  “  died  from  excessive  drink¬ 
ing.”  This  was  29  more  than  in  the  previous  year  ;  but,  on  the  other- 
hand,  was  below  the  average  of  the  five  years,  which  was  460. 

Dr .  J ohn  Sykes  writes  : — “  In  1784,  Ray  Beckwith,  who  afterwards  practised 
at  York,  graduated  as  M.D.  at  Edinburgh,  presenting  as  one  of  the 
exercises  for  the  degree  a  thesis,  ‘  De  Morbo  Psoadico.’  As  I  am  unable 
to  find  the  word  psoadicus  in  any  dictionary  within  my  reach,  I  shall 
be  obliged  to  anyone  who  can  tell  me  its  meaning  and  derivation.” 

A  Member.— The  prize  is  open  to  Members  only.  It  was  founded  by  Mr.. 
Samuel  Jackson,  a  Member  of  the  College.  Essays  for  this  year  must  be 
sent  in  omor  before  Monday,  December  31.  The  subject  for  the  prize 
next  year  is  “  The  Surgical  Treatment  of  Uterine  Tumours,  both  Inno¬ 
cent  and  Malignant.”  Members  of  the  Council  of  the  College  cannot 
compete.  Write  to  the  Secretary. 

Parochial  Scavenging. — Local  boards  maybe  encouraged  to  undertake  their 
own  “  dusting,”  etc.,  from  the  official  report  of  the  parish— although  a- 
poor  one — of  St.  Luke’s.  It  shows  that  there  was  sorted  from  the  dust 
and  trade  refuse  of  the  parish  in  the  past  year  the  following  accumula¬ 
tion  of  saleable  articles : — 20  tons  of  glass,  168  dozens  of  bottles,  8  cwt. 
of  zinc,  12  cwt.  of  brass,  14  tons  of  iron,  4  tons  of  bones,  7g  tons  of 
rags,  and  about  the  same  weight  of  paper. 

An  Old  Fellow. — The  annual  election  of  Fellows  into  the  Council  of  the 
College  of  Surgeons,  as  well  as  the  annual  election  of  President  and. 
vice-presidents,  always  takes  place  in  July,  and  it  is  provided  that  if  int 
any  year  one  of  the  three  retiring  members  of  Council  be  President  of 
the  College,  he  does  not  go  out  of  office  until  the  succeeding  year.  The 
election  took  place  in  July  last,  when  Mr.  Marshall  was  elected 
President,  and  Messrs.  Forster  and  Savory  Vice-Presidents  until  next 
July. 

Diphtheria  at  Canterbury.— The  Medical  Officer  of  Health  reports  to  the 
Town  Council  an  outbreak  of  diphtheria.  The  epidemic  prevailed 
between  St.  Dunstan’s  churchyard  and  the  river  Stour.  It  was  sug¬ 
gested  that  the  well-water,  which  is  largely  used  for  drinking  purposes- 
was  polluted  by  water  from  the  churchyard.  The  Medical  Officer 
believed  there  were  cases  of  diphtheria  in  other  parts  of  the  city,  but- 
there  being  no  compulsory  registration  of  infectious  disease,  he  was 
unable  to  trace  them. 

Suffocated  Children.— Dr.  Danford  Thomas,  at  an  inquest  held  a  few  days- 
since  in  St.  Pancras  upon  two  children  found  suffocated  in  bed  with 
their  parents,  remarked— “  If  parents  were  too  poor  to  buy  cots,  then, 
beds  for  their  children  might  be  made  up  in  boxes.  In  Germany,  he 
added,  parents  were  not  allowed  to  have  their  children  in  bed  with  them, 
and  if  such  a  law  were  passed  in  this  country,  cases  like  these  would, 
be  seldom  heard  of.”  According  to  the  coroner’s  estimate,  no  fewer 
than  between  120  and  150  children  are  every  year  suffocated  under 
similar  circumstances.  It  were  time  legislation  dealt  with  this  terrible- 
loss  of  life. 

Colonial  Meat.— The  consignments  of  meat  to  England  from  our  Australian 
colonies  having  attained  such  enormous  proportions,  and  generally  arrived 
here  in  a  good  state  of  preservation  quite  fit  for  consumption,  the  re¬ 
cent  wholesale  seizure  of  mutton  from  New  Zealand  is  to  be  regretted. 
Dr.  William  ColliDgridge,  the  Port  of  London  Medical  Officer,  on  exa¬ 
mining  this  meat,  found  it  to  be  in  such  a  condition  as  to  necessitate  its 
immediate  destruction,  which  was  carried  out  under  an  order  from  the 
police-court.  These  importations  are  of  vast  importance  as  a  matter  of 
food-supply,  and  we  hope  the  seizure  in  question  will  be  a  warning  to- 
the  New  Zealand  importers. 

Water-Supply  Fittings  out  of  Repair,  a  Finable  Offence. — An  application 
was  lately  made  to  the  presiding  magistrate  at  the  Thames  Police-court 
by  the  solicitor  of  the  East  London  Waterworks  Company  for  a  sum¬ 
mons  against  the  owner  of  certain  property  in  Salter-street,  St.  George’ s- 
in-the-East,  because  he  (the  owner)  had  allowed  the  water-fittings  to  bc- 
out  of  repair.  It  appeared  that  Section  32  of  the  Metropolis  Water  Act,. 
1871,  provides  “  that  if  a  person  supplied  with  water  suffers  the  fittings- 
to  be  out  of  repair,  so  that  water  is  wasted,  he  is  liable  to  a  penalty  not 
exceeding  £5  for  each  offence.”  The  occupiers  of  the  houses  in  question 
were  poor  people,  and  the  cutting  off  of  the  water  would  be  a  great  hard¬ 
ship  and  a  danger  to  the  health  of  the  people.  In  the  public  interest, 
it  was  urged  that  the  Company  had  determined  to  proceed  against  the 
owners  of  property  wherever  practicable.  In  reply  to  an  inquiry  of  the 
magistrate  how  the  Company  showed  that  the  owner  was  the  person 
supplied  with  the  water,  the  solicitor  stated  that  he  was  the  person  who- 
paid  the  rates.  The  solicitor  further  explained  that  in  this  case  alone 
the  waste  of  water  was  equal  to  230  gallons  an  hour,  or  equivalent  to 
the  supply  of  384  people  per  day  at  the  statutory  rate  of  ten  gallons  per 
head.  A  summons  was  granted. 


478 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES. 


Oct.  20, 1881. 


Marriages :  Switzerland.— An  analysis,  published  by  the  Statistical  Office 
n  Berne,  of  the  marriages  during  the  year  1881,  shows  that  the  propor¬ 
tion  is  very  low  as  compared  with  other  countries.  The  average  was 
Ti  per  1000  inhabitants.  Out  of  every  100)  men  and  1000  women  of 
marriageable  age,  49  men  and  38  women  were  married.  These  figures 
show  a  falliag  off.  On  the  other  hand,  the  divorces  were  more  numerous 
than  in  any  previous  year.  Religious  differences  are  one  of  the  most 
frequent  causes  of  divorce.  The  mixture  of  races  in  the  Confederation 
is  the  cause  attributed. 

tare  Water  on  Farms  for  Cattle.—  A  suggestion  has  been  made  that 
Government  should  insist  that  holders  of  land  should  in  every  case 
provide  pure  water  for  cattle  to  drink,  and  that  in  no  case  should 
sewage- water,  drainings  from  farmyards  and  other  impure  sources,  be 
allowed  to  run  into  ponds  used  for  drinking  purposes  for  cattle.  Some 
official  supervision  over  the  water-supply  for  the  use  of  cattle  on  farms 
is  a  sanitary  provision  which  is  no  doubt  much  needed,  both  for  the 
well-being  of  man  and  beast.  Milk-pails  are  often  cleansed  with  water 
from  these  farmyard  ponds. 

Stale  Scraps  of  Meat. — The  poor  are  constantly  purchasing  meat  which  is, 
in  fact,  quite  unwholesome  and  unfit  for  human  consumption.  These 
purchases  consist  of  scraps  of  meat,  nearly  all  of  which  are  in  a  state  of 
decomposition.  That  officials,  whose  duty  it  is  to  discover  such  trading, 
often  fail  to  detect  the  offenders,  was  exemplified  in  the  City  of  London 
Court  recently,  when  it  was  shown  that  a  “few  stale  breasts”  of 
meat  sold  in  the  summer  at  the  Central  Meat  Market  to  a  butcher  at 
Battersea  at  2d.  per  lb.  had  become  the  next  morning  “  as  green  as  a 
cabbage.”  Fortunately  the  purchaser  refrained  from  offering  them  for 
sale. 

Obscene  Bills  of  Quack  Doctors. — The  Home  Secretary  has  advised  Her 
Majesty  to  remit  the  remainder  of  the  term  of  a  month’s  imprisonment 
passed  by  the  West  Riding  magistrates  upon  a  man  found  guilty  of 
posting  the  obscene  bills  of  a  quack  doctor.  The  man  had  already  been 
nearly  three  weeks  in  gaol.  The  leniency  thus  shown  to  the  convict 
does  not,  we  should  hope,  indicate  any  indifference  on  the  part  of  Sir 
William  Harcourt  to  the  offence  of  which  he  was  convicted,  but  rather 
(which  we  believe  to  be  the  fact)  that  the  man  was  a  tool  in  the  hands 
of  others,  and  not  the  principal  offender.  The  efforts  made  by  certain 
notorious  medical  quacks  to  advertise  themselves  and  their  pernicious 
■specifics  by  disgusting  handbills  is  injurious  to  the  morality  of  the  com¬ 
munity,  and  perilously  misleading  to  the  unwary  and  ignorant. 

Inflammable  Stores  in  a  Hospital.—  It  appears  that  the  basement  of  the 
Herbert  Military  Hospital  at  Shooter’s  Hill  (one  of  the  largest  hospitals 
of  its  kind  in  England)  is  stored  with  vast  quantities  of  spirits  of  wine, 
turpentine,  oils,  tar,  tow,  wooden  cases,  and  other  highly  inflammable 
-materials,  besides  being  the  depot  of  medical  supplies  for  an  army 
corps,  always  kept  ready  for  shipment  in  case  of  foreign  war.  It  has 
■occurred  to  the  medical  authorities  of  the  Hospital,  since  the  explosion 
at  Woolwich,  to  consider  the  disastrous  results  which  would  arise  if  a 
fire  should  break  out  in  these  stores,  as  the  Hospital  often  contains  501 
flick,  many  of  whom  are  bedridden.  It  is,  consequently,  proposed  to 
have  an  inspection  by  the  officials,  and  it  is  probable  that  before  long 
the  combustible  stores  will  be  removed.  The  value  of  the  drugs  alone, 
which  are  in  the  same  building,  is  estimated  at  upwards  of  £201,000. 

The  Dundee  Customs  Department  and  the  Medical  Officer  of  HeaHh.  —The 
Local  Board  of  Health  have  come  into  collision  with  the  Customs 
authorities  respecting  a  ship  belonging  to  Liverpool.  The  latter  granted 
a  clean  bill  of  health  to  the  ship,  which  the  Medical  Officer  of  Health  has 
■certified  was  infected.  It  appears  there  were  four  cases  of  cholera  on 
Board,  one  of  which  proved  fatal  shortly  after  leaving  Calcutta,  but  as 
there  had  been  no  subsequent  sickness  and  the  effects  of  the  deceased 
■seaman  had  been  destroyed  and  the  ship  disinfected,  the  Customs  granted 
a  clean  bill  of  health,  and  the  vessel  came  into  dock.  The  Medical 
■Officer  of  Health  visited  the  ship,  however,  and  issued  a  certificate  that 
she  was  infected.  The  ship  was  accordingly  ordered  to  the  quarantine 
station,  three  miles  down  the  river.  Without  imputing  to  the  Customs 
officials  the  want  of  due  care  in  satisfying  themselves  under  the  cir¬ 
cumstances  of  the  sanitary  condition  of  the  ship,  we  do  not  doubt  that 
the  Medical  Officer  exercised  a  wise  precaution  in  rendering  quarantine 
indispensable. 

PERIODICALS  AND  NEWSPAPERS  RECEIVED— 

Lancet — British  Medical  Journal — Medical  Press  and  Circular — Ber¬ 
liner  Klinische  Wochenschrift — Centralblatt  fiir  Chirurgie— Gazette 
des  Hopitaux— Gazette  Medicale— Revista  de  Medicina— Bulletin  de 
l’Acad£miedeM0decine—  Pharmaceutical  Journal — Wiener  Medicinische 
Wochenschrift — Revue  Mddicale—  Gazette  Hebdomadaire— Nature  — 
Boston  Medical  and  Surgical  Journal— Louisville  Medical  News  — 
Centralblatt  fiir  Gynakologie — Le  Concours  Medical  — Centralblatt  fiir 
die  Medicinischen  Wissenschaften— Centralblatt  fiir  Klini«che  Medicin 
— Philadelphia  Medical  News— Le  Progres  Medical — New  York  Medical 
Journal — Journal  of  Cutaneous  and  Venereal  Diseases — Dental  Record 
— Revue  des  Sciences  Medicales — Edinburgh  Clinical  and  Pathological 
Journal— Westminster  Review— Students’ Journal  and  Hospital  Gazette 
— Chemist  and  Druggist  -  Canada  Lancet— Detroit  Lancet— New  York 
Medical  Record— Western  Medical  Reporter — Journal  of  the  Vigilance 
Association — The  Christian  Million — Newcastle  Daily  Chronicle,  October 
13— Journal  of  the  British  Dental  Association — Canadian  Practitioner — 
Revue  de  Chirurgie— Revue  de  Medecine. 


V 


BOOKS,  ETC.,  RECEIVED  - 

Abstract  of  Cases,  etc.,  of  the  Monsall  Fever  Hospital,  Manchester — On 
Surgical  Diseases  of  the  Kidney,  and  the  Operations  for  their  Relief,  by 
R.  Clement  Lucas,  B.S.  Lond.,  F.R.C.S. — Report  on  the  Health  and 
Sanitary  Condition,  etc.,  of  Kensington,  from  September  9  to  October 
t\  1833 — Hospital  Management,  by  J.  L.  Cliiford-Smith — Memoir  of 
John  Deakin  Heaton,  M.D.,  by  T.  Wemyss  Reid— Transactions  of  the 
Medical  and  Chirurgical  Faculty  of  the  State  of  Maryland  —  A  Manual 
of  Midwifery,  by  Fancourt  Barnes,  M.D  ,  M.R.C.P. — The  Field  of 
Disease,  by  B.  W.  Richardson,  M  D„  LL.D..F.R.S. — The  Physiological 
Factor  in  Diagnosis,  by  Dr.  Milner  Fothergill— Wiegen  a  Health 
Resort,  by  Dr.  A.  T.  Wise— A  Manual  of  Midwifery  for  Midwives,  by 
Dr.  Fancourt  Barnes -Plant  Analysis,  by  Dr.  G.  Dragendorff — 
Elements  of  8urgical  Pathology,  by  A.  J.  Pepper,  M.S. — Surgical 
Applied  Anatomy,  by  F.  Treves,  F.R.C.S. 

COMMUNICATIONS  have  been  received  from — 

Mr.  Noble  Smith,  London  ;  Mr.  K.  W.  Millicax,  Kineton:  Dr.  John 
Beddoe,  Clifton  ;  Dr.  Francis  Warner,  London;  The  8ecretarv  of 
•i  he  Glasgow  Medico-Chiruhgical  Society,  Glasgow  ;  The  Secretary 
of  the  Apothecaries’  Society,  London;  Mr.  J.  T.  W.  Bacot,  Seaton ; 
Mr.  E.  L.  Hussey,  Oxford ;  Dr.  Mahomed,  London ;  Dr.  Norman 
Chevers,  London ;  Dr.  Gamgek,  Manchester ;  The  Secretary  of  the 
Clinical  Society  of  London;  Dr.  Herman,  London;  The  Dean  of 
St.  Mary’s  Hospital  Medical  School,  London;  The  Dean  of  the 
Medical  Faculty  of  Kino’s  College,  London ;  Dr.  J.  W.  Moore, 
Dublin  ;  Mr.  T.  M.  Stone,  Wimbledon ;  The  Secretary  of  the  Society 
for  the  Relief  of  Widows  and  Orpbans  of  Medical  Men  London  ; 
The  Secretary  of  the  Medical  School  of  Sr.  Thomas’s  Hospital, 
London;  Dr.  A.  T.  Thomson,  Glasgow;  Mr.  G.  F.  Hentsch,  London; 
Dr.  Curnow,  London;  Mr.  William  Crookes,  F.R.S.,  London;  The 
Registrar-General  for  Scotland,  Edinburgh;  The  Secretary  of 
University  College,  London;  Dr.  Wadham,  London;  The  Dean 
of  Guy’s  Hospital  Medical  School,  London;  The  Secretary  of 
Charing-cross  Hospital  Medical  Sohool,  London  ;  The  Warden  of 
the  Guild  of  St.  Luke,  London ;  The  Secretary  of  the  London 
Hospital  Medical  College,  London;  Dr.  Sykes,  Doncaster;  The 
Secretary  of  the  Medical  College  of  St.  Bartholomew’s  Hospital, 
London ;  Dr.  Crichton  Browne,  London  ;  Mr.  J.  Chatto,  London. 


APPOINTMENTS  FOR  THE  WEEK. 


October  20.  Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  14  p.m. ;  King’s  College,  1$  p.m. ;  Roysl 
Free,  2  p.m.;  Royal  London  Ophthalmic,  11  a. m. ;  Royal  Westminster 
Ophthalmic,  14  p.m.;  St.  Thomas’s,  14  p.m.;  London,  2  p.m. 


22.  Monday. 

Operations  at  the  Metropolitan  Free,  2  p.m.;  8t.  Mark’s  Hospital  for 
Diseases  of  the  Rectum. 2  p.m.;  Royal  London  Ophthalmie.il  a.m.; 
Royal  Westminster  Ophthalmic,  14  p.m.  ;  Hospital  for  Women,  2  p.m. 


23.  Tuesday. 

Operations  at  Guy’s,  14  p.m.  ;  Westminster,  2  p.m.;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  14  p.m.;  Wert 
London,  3  p.m. 

Royal  Medical  and  Chirurgical  Society  (Ballot  for  election  of  Secre¬ 
tary,  7g  p.m.),  8-4  p.m.  Dr.  Ferrier,  “On  the  Progress  of  Knowledge 
on  the  Physiology  and  Pathology  of  the  Nervous  System.” 


24.  Wednesday. 

Operations  at  University  College,  2  p.m. ;  St.  Mary’s,  1|  p.m.  ;  Middlesex, 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew’s,  14  p.m.  ;  Great  Northerr, 

2  p.m.  ;  Samaritan,  24  p.m. ;  Royal  London  Ophthalmic,  11  a.m.  ; 
Royal  Westminster  Ophthalmic,  14  p.m. ;  St.  Thomas’s,  14  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m. ;  National  Orthopaedic,  Great 
Portland-street,  10  a.m. 

Bromptox  Hospital  for  Consumption,  etc.,  4  p.m.  Dr.  R.  Douglas 
Powell,  “  Ou  Cases  of  Aortic  Aneurysm.” 

Hunterian  Society  (London  Institution),  8  p.m.  Mr.  Poland — Speci¬ 
mens.  Mr.  McCarthy -1.  “On  a  Case  of  Aneurysm  of  the  Sciatic 
Artery”;  2.  “On  Cases  of  Imperforate  Anus.”  Mr.  Charters  J. 
Symonds,  “  The  Reliable  Signs  of  Fracture  of  the  Neck  of  the  Femur.” 


25.  Thursday. 

Operations  at  St.  George’s,  1  p.m.  ;  Central  London  Ophthalmic,  1  p.m. ; 
Royal  Orthopaedic,  2p.m.;  University  College,  2  p.m.;  Royal  London 
Ophthalmic, 1 1  a.m. ;  Royal  Westminster  Ophthalmic,  14  p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m.;  Hospital  for  Women,  2  p.m.; 
Charing-cross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  24  p.m. 
Abernethian  Society  (St.  Bartholomew’s  Hospital),  8  p.m.  Mr. 
H.  Campbell,  “  On  Habit.” 


26.  Friday. 

Operations  atCentral  LondonOphthalmic,  2  p.m.;  Royal  London  Ophtha’- 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminsttr 
Ophthalmic,  14  p.m.;  St.  George’s  (ophthalmic  operations),  11  n.m.; 
Guy’s,  U  o.m.  ;  St.  Thomas’s  (ophthalmic  operations),  2  p.m. ;  King’s 
College  (by  Mr.  Lister),  2  p.m. 

Clinical  Society  of  London,  84p.m.  Dr.  Bastian— 1.  “On  a  Case  of 
Rupture  of  a  Large  Aneurysm  in  the  Left  Corpus  Striatum,  with  Intra¬ 
ventricular  Haemorrhage  and  extreme  Lowering  of  the  Rectal  Tempera¬ 
ture”:  2.  “  On  a  Case  of  Apoplexy  in  a  Boy  aged  Fifteen,  with  Intra¬ 
ventricular  Haemorrhage,  Convulsions,  and  Death  in  Four  Hours.”  Dr. 
Althaus,  “  On  a  Case  of  Syphilitic  Tumour  of  the  Cerebral  Membranes.” 
Mr.  Golding  Bird.  “  On  a  Case  of  Dislocation  of  the  Jaw,  Reduced  after 
Eighteen  Weeks.”  Mr.  G.  R.  Turner,  “On  a  Case  of  Wound  of  the 
Plantar  Arch  ;  Secondary  Haemorrhage  on  the  Thirteenth  and  Sixteenth 
Days  following  the  Injury.”  Living  Specimen  (8  p.m.) — By  Mr.  G.  R. 
Turner :  A  Case  of  Aphonia  following  a  Head  Injury. 

Medtcal  Society  (Charing-cross  Hospital),  8  p.m.  Dr.  James  Cantlie, 
“  On  Cholera.”  (Visitors  invited.) 


Medical  Times  and  Gazette.  DUDFIELD  OFT  METROPOLITAN  SANITARY  ADMINISTRATION.  Oct.  27,  ism.  479 


METROPOLITAN  SANITARY 
ADMINISTRATION. 

Abstract  of  the  Presidential  Address  delivered  to  the  Society 
of  Medical  Officers  of  Health,  on  Friday,  Oct.  19,  1883, 

By  T.  OB  ME  DUDFIELD,  M.D., 

President  of  the  Society. 

In  taking  this  subjectfor  liis  inaugural  address.  Dr.  Dudfield 
said  that  he  would  consider  it  under  three  heads,  viz.:  — 
{1)  The  need  of  unity  in  sanitary  administration  ;  (2)  How 
such  unity  may  be  brought  about;  (3)  The  probable  benefits 
■of  unity  being  attained.  The  need  of  unity  could  not  admit 
of  question,  when  it  was  considered  that  the  care  of  the  public 
health  in  this  greatest  of  cities  was  committed  to  some  forty 
separate  authorities,  created,  it  was  true,  and  deriving  many 
of  their  powers  from  the  same  Act  of  Parliament,  yet 
practically  independent,  each  in  its  own  district ;  having  no 
bond  of  connexion,  enabling  them  to  combine  for  the  com¬ 
mon  good;  and  rarely  holding  communication  with  one 
•another*,  except  for  some  special  and  local  object.  The 
metropolis  stood  alone  in  this  respect,  being  the  only  city 
that  was  not  at  unity  in  itself.  In  every  other  large  ceutre 
■of  population  there  was  but  one  authority,  deriving  a  power 
under  codified  laws,  and  dealing  with  every  branch  of  public 
health,  and  ordinary  sanitary  administration.  The  ill  effects 
of  sanitary  disunion  in  London  were  not  far  to  seek.  As 
regarded  questions  of  public  health,  affecting  the  public  at 
large,  and  excepting  in  the  case  of  an  emergency,  such  as 
nn  invasion  of  cholera,  when  special  legislation  was  called 
into  operation,  there  were  no  means  of  combining  the 
governing  authorities  for  the  common  defence ;  no,  not 
•even  for  so  necessary  a  purpose  as  concerting  measures  for 
preventing  the  spread  of  a  loathsome  infectious  disease, 
such  as  small-pox.  An  epidemic  might  break  out  in  one 
district,  and  prevail  for  many  days,  without  the  fact  becom¬ 
ing  known  to  the  authorities  in  adjoining  districts,  and 
hence  no  combined  measures  could  be  taken  for  checking 
•or  preventing  its  spread  at  the  onset,  when  alone  a  successful 
result  was  possible.  It  might  be  said,  indeed,  that,  lacking 
‘^compulsory  notification”  powers,  the  authority  of  the 
district  first  invaded  might  itself  remain  but  too  long  in 
ignorance  of  the  outbreak.  This,  however,  only  proved  the 
need  of  unity,  for  Parliament  would  assuredly  give  such, 
and  all  necessary,  powers  to  a  strong  central  authority, 
however  unwilling  to  entrust  them  to  numerous  minor  and 
disunited  sanitary  authorities.  A  significant  illustration  of 
the  need  of  unity  was  furnished  by  the  history  of  the  hos¬ 
pitals  for  infectious  diseases.  Ever  since  1866  the  sanitary 
authorities  had  had  power,  separately  or  collectively,  to 
provide  hospitals  in  their  several  districts,  but  the  power, 
speaking  generally,  had  not  been  exercised.  And  why? 
Because  it  was  felt  that  the  task  was  too  great  to  be  under¬ 
taken  by  each  district  separately,  and  there  existed  no 
means  of  compelling  adjoining  districts  to  combine.  In 
the  following  year  the  question  was  solved  in  a  practical 
way,  but  almost  by  accident,  as  it  were,  viz.,  by  the  enact¬ 
ment  of  a  law  which,  while  providing  for  the  needs  of  paupers 
only,  had  endowed  the  metropolis,  under  a  single  authority, 
with  an  admirable  system  of  hospitals  that  had  become 
available,  and  with  proposed  additions  would  soon  be 
adequate,  for  the  needs  of  all  classes  of  the  population. 
The  fatal  stigma  of  pauperism,  until  lately,  nominally 
attached  to  these  institutions ;  but  here  again,  practical 
common  sense  had  overruled  merely  legal  considerations, 
for  not  only  did  no  actual  disqualification  result  from  relief 
administered  in  the  Asylums  Board  hospitals,  but,  what 
was  more,  the  use  of  them  had  been  greatly  stimulated  by 
the  practically  free  admittance  given  to  all  comers.  The 
experiment  thus  unconsciously  made  had  proved  so  success¬ 
ful,  that  in  the  last  session  a  Government  measure  had  been 
brought  in  and  passed,  by  which  the  sanction  of  law  had 
been  given  to  a  state  of  affairs  that  had  grown  up  contrary 
to  the  provisions  of  law,  and  such  as  had  never  been  con¬ 
templated  by  the  Government  which  introduced,  or  the 
Legislature  which  enacted,  the  Metropolitan  Poor  Act,  1867. 

Vol.  II.  1883.  No.  1739. 


And  so  it  had  come  to  pass  that  the  Society  might  at  length 
be  congratulated  on  the  adoption  by  Parliament  of  a  prin¬ 
ciple  for  which  it  was  the  first,  or  among  the  first,  to  contend, 
viz.,  “  That  the  assistance  afforded  to  the  sick  in  hospitals 
for  the  treatment  of  infectious  diseases  ought  not  to  be  con¬ 
sidered  pauper  relief.”  The  correlative  proposition,  “  That 
the  hospital  treatment  of  infectious  diseases  should  be  dis¬ 
severed  from  any  relation  with  pauperism,”  would  be  adopted 
sooner  or  later.  Meanwhile,  the  Asylums  Board — a  Poor- 
law  authority  in  theory,  admittance  to  its  hospitals  being 
obtainable  only  through  Poor-law  agencies— had  become  a 
sanitary  authority  in  practice,  and  would  become  a  sanitary 
authority  in  law  should  occasion  arise  for  nutting  into 
operation  certain  provisions  of  the  Diseases*  Prevention 
(Metropolis)  Act,  1883,  to  which  they  were  indebted  for 
the  above-mentioned  valuable  concession.  It  was  a  curious 
.feature  in  sanitary  legislation,  that  while  the  most  com¬ 
plete  provision  had  been  made  for  preventing  the  spread 
of  animal  infectious  diseases,  by  notification  of  illness, 
by  isolation  of  the  sick,  and  by  disinfection  rigidly  carried 
out,  no  such  provision  had  been  made  against  the  spread 
of  human  infectious  diseases.  They  had  no  power  to 
enforce  notification  ;  isolation  was  well-nigh  impossible,  ex¬ 
cept  by  voluntary  removal  to  hospitals  ;  whilst  disinfection 
was  only  efficient,  so  far  as  it  was  efficient,  because  sanitary 
officials,  with  the  consent  of  sanitary  authorities,  but  with¬ 
out  legal  obligation,  had  largely  taken  the  matter  into  their 
own  hands.  Given  the  necessary  powers,  a  great  increase 
upon  the  not  inconsiderable  success  of  sanitary  authorities 
in  preventing  the  spread  of  infectious  diseases  would  be 
attained ;  but  those  powers  would  hardly  be  conferred  until 
there  was  a  strong  central  sanitary  authority,  by  which  the 
action  of  the  several  local  sanitary  authorities  could  be 
combined  for  the  common  good.  Even  under  existing  legis¬ 
lation  such  an  authority  would  be  able  to  confer  great 
benefits  on  the  metropolis,  not  to  be  expected  so  long  as 
sanitary  power  remained  scattered  and  divided ;  and  refer¬ 
ence  was  made  to  questions  certain  to  be  dealt  with  by  such 
an  authority,  as,  for  instance,  provision  of  healthy  dwellings 
.  for  the  poor,  viz.,  by  universal  and  stringent  exercise  of 
the  powers  contained  in  the  3-5th  Section  of  the  Sanitary 
Act,  1866,  dealing  with  houses  let  out  in  lodgings,  baths 
and  washhouses,  mortuaries,  disinfecting  chambers,  public 
urinals  and  water-closets  for  both  sexes,  etc. — sanitary 
wants  very  inadequately  supplied  after  more  than  a  quarter 
of  a  century  of  divided  sanitary  government.  A  central 
sanitary  authority  alone  could  make  adequate  provision  of 
these  institutions  suitably  located  for  general  use,  without 
reference  to  local  boundaries.  An  unconscious  striving 
after  unity  had  occasionally  led  to  something  like  conflict  in 
jurisdiction,  of  which  recent  examples  were  cited  in  the 
Slaughter-houses  (Metropolis)  Act,  1874,  dealing  with  offen¬ 
sive  businesses,  and  the  Contagious  Diseases  (Animals)  Act, 
1878,  Section  34,  dealing  with  cowsheds,  dairies,  etc.,  under 
which  the  Metropolitan  Board  of  Works  was  the  “  local 
authority  ”  for  the  metropolis,  the  city  only  excepted.  No 
exception  could  have  been  taken  to  the  action  of  the  Legis¬ 
lature  had  the  Board  been  simply  endowed  with  powers  of 
framing  by-laws  and  general  supervision,  and  had  the  duty 
of  inspection  been  entrusted  to  the  local  sanitary  authorities. 
Nevertheless,  all  drawbacks  notwithstanding,  good  results 
had  followed  the  said  legislation,  resulting  from  a  practical 
co-operation  between  the  Board,  which  had  apparent  juris¬ 
diction,  but  no  qualified  staff,  and  the  vestries,  etc.,  which 
had  a  sanitary  staff,  but  no  defined  jurisdiction.  Had  the 
duty  of  framing  by-laws  been  left  to  the  vestries,  there 
might  have  been  as  many  codes  as  “local  authorities/* 
despite  the  labours  of  the  Society  to  promote  uniformity,  of 
which  the  Board  had  made  such  good  use  in  framing  their 
by-laws  under  both  Acts. 

The  question,  “  How  unity  may  be  brought  about?  ”  was 
next  considered,  and  it  was  said  that  two  courses  were  open  : 
the  existing  sanitary  authorities  might  be  swept  away,  and 
an  entirely  new  central  authority  created  to  rule  over  an 
undivided  London ;  or,  the  present  local  machinery  being 
retained,  a  central  board  might  be  established  to  take  charge 
vof  all  great  questions  affecting  the  metropolis  as  a  whole ;  to 
lay  down  the  principles  on  which  sanitary  administration 
should  be  carried  out,  by  framing  by-laws,  etc.  ;  and,  gene¬ 
rally,  to  exercise  a  supervisory  control  over  the  work  en¬ 
trusted  to  the  vestries  and  district  boards  by  the  Local 
Management  and  other  Acts.  The  central  board,  so  to  say. 


480  Medical  Times  and  Gazette.  DUDFIELD  OX  METROPOLITAN  SANITARY  ADMINISTRATION.  Oct.  27,  18  3. 


would  be  legislative  in  its  functions,  the  local  boards  execu¬ 
tive  ;  and  thus  substantial  uniry  in  principle,  with  uniformity 
in  practice,  would  be  attained  with  a  minimum  of  change. 
Preference  was  expressed  for  the  second  course,  and  it  was 
assumed  that  the  manner  in  which  some  such  a  scheme 
could  be  brought  into  practical  working  might  be  expected 
ere  long  to  engage  the  attention  of  the  Legislature,  it 
being  difficult  to  believe  that  a  system  which  had  worked 
so  well,  and  had  conferred  so  many  benefits  on  the 
metropolis,  would  be  cast  aside,  in  order  to  give  trial  to  a 
new,  a  vast,  and  a  doubtful  experiment,  such  as  was  in¬ 
volved  in  the  adoption  of  the  first  course.  Taking  it  for 
granted  that  the  more  conservative  scheme  would  be  adopted, 
the  constitution,  the  jurisdiction,  and  the  duties  of  the  ex¬ 
isting  governing  bodies — Corporation,  Metropolitan  Board 
of  Works,  vestries  (twenty-three),  district  boards  (fifteen), 
and  Metropolitan  Asylums  Board, — out  of  which  the  new 
machinery  would  have  to  be  evolved,  were  rapidly  passed  in 
review,  occasion  being  taken  to  point  out — (1)  that,  what¬ 
ever  the  defects  of  the  system  of  administration  by  the 
vestries,  the  labours  of  these  much-abused  bodies  had  suc¬ 
ceeded,  in  little  more  than  a  quarter  of  a  century,  in  making 
London  the  best  paved,  the  cleanest,  the  best  drained,  the 
best  lighted,  and  the  healthiest  great  city  in  the  world ; 
and  (2)  that  the  Metropolitan  Board  was,  so  to  speak,  the 
quintessence  of  vestrydom,  its  members  being  vestrymen, 
and  elected  by  the  vestries ;  facts  which,  probably,  few  of 
those  were  aware  who  praised  its  work — exalting  the  greater 
light  at  the  expense  of  the  lesser  lights.  The  continued 
separate  existence  of  the  Corporation  and  the  Metropolitan 
Board  being  held  to  be  incompatible,  the  questions  were 
asked,  Shall  the  Corporation,  endowed  with  enlarged  j  urisdic- 
tion  and  the  necessary  powers,  become  in  fact,  as  in  name,  the 
Corporation  of  London  ?  or.  Shall  the  Metropolitan  Board  of 
Works,  with  similarly  enlarged  powers,  and  under  whatever 
name,  extend  its  sway  over  the  City  ?  Prescription,  historical 
prestige,  etc.,  pleaded  for  the  Corporation  ;  while  the  success 
that  had  attended  the  work  of  the  Metropolitan  Board 
suggested  strong  arguments  in  its  favour.  Whichever  body 
might  be  chosen,  an  opinion  was  expressed  in  favour  of 
election  thereto  by  the  several  vestries,  etc.,  in  the  same 
way  as  members  of  the  Metropolitan  Board  of  Works  are 
elected,  rather  than  by  direct  appeal  to  popular  suffrages, 
as  affording  the  best  prospect  of  London  being  well  and 
wisely  governed.  If,  however,  the  plan  of  direct  election  by 
the  ratepayers  were  chosen,  it  was  to  be  hoped  that  one  of 
the  most  honourable  distinctions  of  the  present  system, 
its  absolutely  non-political  charactei’,  might  be  preserved. 
The  new  authority,  however  constituted,  should  take  over 
the  duties,  with  the  hospitals,  the  ambulances,  etc.,  of  the 
Asylums  Board ;  should  have  power,  and  be  required,  to 
acquire  on  equitable  terms  the  property  of  the  water  com¬ 
panies  ;  should  be  the  vaccination  authority]  should  elect 
coroners  and  registrars  of  births,  deaths,  etc. ;  and  should 
have  the  control  of  cemeteries,  etc.  Such  a  board  need  not 
be  more  numerous  than  the  pi*esent  Corporation,  which  con¬ 
sisted  of  232  members — to  judge  by  the  amount  of  work 
done  by  the  Metropolitan  Board  with  forty-six  members, — 
provided  the  principal  duties  were  handed  over  to  large 
committees,  with  power  to  act,  as  was  the  case  at  the 
Metropolitan  Board.  Officers  in  plenty  were  ready  to 
hand,  and  only  one  entirely  new  department  would  have 
to  be  created,  that  of  Public  Health.  A  principal  medical 
officer  of  health — primus  inter  pares — would  take  charge 
of  the  City — -the  seat  of  government — and  preside  over  the 
department,  to  which  information  would  be  forwarded  daily, 
in  respect  of  the  occurrence  of  specified  infectious  diseases, 
by  loc  d  medical  officers  of  health ;  and  these,  in  return,  would 
be  made  acquainted  with  whatever  it  behoved  them  to  know 
in  regard  to  the  occurrence  of  such  diseases  beyond,  but 
adjacent  to,  their  own  districts.  In  like  manner,  periodical 
statistical  returns,  on  a  uniform  system,  would  be  for¬ 
warded  to  the  central  office,  there  to  be  collated  and  tabu¬ 
lated  for  general  use.  An  annual  report  by  each  local 
medical  officer  of  health,  based  on  an  agreed  plan,  would  be 
prepared,  printed,  and  transmitted,  at  a  specified  time,  to 
the  central  office,  to  become  the  basis  of  a  report  by  the 
principal  medical  officer,  dealing  with  the  metropolis  as  a 
whole.  In  this  way,  and  assuming  compulsory  notification 
to  exist,  medical  officers  would  be  kept  informed  of  the  state 
of  the  public  health,  would  become  speedily  cognisant  of 
the  beginning  of  an  epidemic,  and  thus  they  might  hope  for 


much  success  in  efforts  for  “checking  and  preventing  the- 
spread  ”  of  infectious  diseases,  one  of  the  principal  duties 
assigned  to  them  by  the  Act  to  which  they  owed  their 
official  position.  The  central  authority  being  thus  pro¬ 
vided,  and  unity  in  sanitary  administration  brought  about, 
the  “probable  benefits  to  be  expected  from  such  unity”' 
were  considered.  Codification  of  sanitary  laws  was  put 
in  the  forefront;  next,  compulsory  notification  and  pro¬ 
vision  of  hospitals —the  latter  being  regarded  as  the 
more  important,  because  hospitals  almost  infallibly  led 
to  voluntary  notification,  whereas  even  compulsory  noti¬ 
fication  without  hospitals  was  robbed  of  great  part  of  its 
value.  The  fact  that  hospital  provision  would  soon  be- 
adequate  was  again  referred  to,  and  an  opinion  expressed 
that  the  hospitals  should  come  under  the  control  of  the 
central  sanitary  authority.  For  a  year,  at  least,  under 
Section  7  of  the  Diseases’  Prevention  (Metropolis)  Act,  1883,. 
the  nominal  stigma  of  pauperism  would  not  attach  to  the 
hospitals,  and  the  Society  should  make  an  effort  to  get  those 
provisions  made  permanent,  the  opportunity  being  too  good 
to  be  let  slip,  seeing  that  the  President  of  the  Local  Govern¬ 
ment  Board  was  with  them,  he  having  in  1878,  and  again 
in  1879,  introduced  a  Bill  “  to  remove  disqualification  by" 
medical  relief  for  infectious  diseases.”  By  every  means  the 
sick  should  be  encouraged  to  enter  the  hospitals — often  the 
only  means  of  securing  isolation — even  as  the  Hospitals 
Commission  put  it,  “  by  the  bribe  of  gratuitous  treatment.” 
Increased  powers  of  compulsory  removal  were  necessary  in. 
case  of  persons  not  able  to  be  “safely  isolated”  and  “pro¬ 
perly  treated”  at  home.  The  ambulance  system  was,  or 
shortly  would  be,  perfect ;  a  riverside  wharf  was  in  course 
of  being  acquired ;  an  ambulance  steamer  already  existed  ; 
ship  and  land  hospitals  too  ;  and  soon  a  great  convalescent 
home  would  be  taken  in  hand.  Such  were  some  of  the- 
benefits  qua  infectious  diseases  already  conferred  by  a  single 
authority,  or  to  be  expected  with  the  advent  of  the  new 
Central  Sanitary  Authority. 

Other  branches  of  sanitary  administration  were  succes¬ 
sively  passed  in  review.  The  water-supply  should  be  in 
the  hands  of  the  central  authority,  who  would  provide  an 
abundant  supply  of  potable  water  from  a  pure  source. 
Baths  and  washhouses,  mortuaries,  disinfecting  chambers, 
public  conveniences  for  both  sexes,  etc.,  would  be  provided, 
and  stud  the  metropolis  uniformly,  so  as  to  meet  the  wants 
of  all  classes.  Slaughter-houses  and  cowsheds  would  be  handed 
over  to  the  local  authorities  for  purposes  of  inspection,  the 
central  authority  framing  by-laws  for  regulating  these  and 
other  businesses,  and  private  slaughter-houses  would  in  time 
give  place  to  public  abattoirs..  The  Public  Health  (Dairies, 
etc.)  Bill  would  doubtless  be  re-introduced  next  sessions, 
and  when  the  dairies  and  cowsheds  throughout  the  country 
generally  were  placed  under  the  sanitary  authorities,  they 
might  hope  for  protection  from  milk  endemics,  such  as  had 
lately  afflicted  the  parish  of  St.  Pancras  ;  meanwhile  a  strong- 
effort  should  be  made  by  the  Society  to  get  the  vestries, 
etc.,  constituted  “  local  authorities  ”  in  London,  instead  of 
the  Metropolitan  Board.  Parliament  had,  lately,  once  more 
placed  the  supervision  of  bakehouses  under  these  bodies, 
and  although  the  Factories  and  Workshops  Act,  1883,  qu& 
bakehouses,  was  a  very  imperfect  measure,  they  should 
justify  the  confidence  of  the  Legislature  by  efficient  inspec¬ 
tion  :  the  central  sanitary  authority  should  have  power  to 
frame  stringent  by-laws  for  the  regulation  of  bakehouses. 
Increased  power  of  dealing  with  recurring  nuisances  was 
required,  and  would  doubtless  be  conceded  to  a  strong  central 
authority.  By  means  of  by-laws,  the  authority  would  be  able 
to  deal  effectually  with  the  removal  of  “  refuse  ”  of  all  kinds, 
on  the  lines  laid  down  by  the  Society.  Had  time  permitted,  it 
would  have  been  easy  to  enlarge  still  further  on  the  benefits 
likely  to  accrue  from  unity  in  sanitary  administration — in  the 
shape  of  a  good  building  Aot,  sewer  ventilation,  sewage  dis¬ 
posal,  and  many  another  topic ;  but  he  must  bring  his  remarks 
to  a  close,  and,  in  so  doing,  he  desired  to  repeat,  emphatically, 
his  opinion,  that  in  order  to  good  government  there  was  no¬ 
necessity  for  material  alteration  in  the  constitution  or  in 
the  work  of  the  vestries  and  district  boards.  On  the  con¬ 
trary,  it  might  be  affirmed  that  they,  or  some  practically 
identical,  well-organised  authorities,  would  be  found  neces¬ 
sary  for  local  administrative  purposes,  whatever  the  con¬ 
stitution  of  the  new  central  authority.  London  was  not 
merely  the  greatest  of  cities  :  it  was  a  province  of  houses, 
half  a  million  in  number;  its  population  of  four  millions 


Medical  Times  and  Gazette. 


CHEVERS  ON  THE  ORDINARY  DISEASES  OF  INDIA. 


Oct.  27,  1SS3.  481 


was  greater  than  that  of  some  kingdoms,  the  mere  yearly- 
increase  being  60,000  sonls ;  its  annual  rateable  value, 
twenty-eight  millions,  was  immense ;  whilst  its  area,  ex¬ 
ceeding  120  square  miles,  was  so  vast,  that  any  attempt  to 
•govern  it  from  one  centre,  without  local  aid,  was  but  too 
likely  to  end  in  costly  and  disastrous  failure. 


PRACTICAL  NOTES  ON 

THE  ORDINARY  DISEASES  OF  INDIA, 

ESPECIALLY  THOSE  PREVALENT  IN  BENGAL. 

By  NORMAN  CHEVERS,  C.I.E.,  M.D., 

Late  Senior  Physician  and  Professor  of  Medicine,  Medical  College 
and  Hospital,  Calcutta. 

( Continued  from  page.  371.) 

CHOLERA  ASIATICA  MALIGNA — Concluded. 

Treatment  of  Cholera. 

.Another  ground  for  caution  in  treating  the  renal  compli¬ 
cation  is  the  alleged  fact  that  cholera  is  apt  to  lay  the  founda¬ 
tion  of  kidney  (and  may  we  not  suggest  of  hepatic  ?)  disease. 
Upon  this  point  I  can  say  little.  In  civil  practice,  we  have 
•very  few  opportunities  of  tracing  our  patients’  after-history. 
Officers  of  the  A.M.D.  might  frequently  watch  men  recovered 
from  cholera  for  long  terms,  noting  their  habits  of  life,  and 
examining  the  urine  from  time  to  time.  I  have  known 
people  who  had  suffered  from  cholera  who  appeared  to  enjoy 
fair  health  for  years.  In  one  of  my  voyages,  a  P.  and  O. 
Go/s  steward  came  up  to  me  and  said  that  I  had  brought 
him  through  an  attack  of  cholera.  He  added  that  he  had 
Bright’s  disease,  and  he  apparently  had  it.  Assuredly  he 
never  had  any  diuretic  stronger  than  milk  from  me. 

"When  the  kidneys  first  begin  to  act  we  have  always  to 
watch  the  condition  of  the  bladder,  and,  when  needful,  to 
relieve  it  by  catheter.  Otherwise  it  is  likely  to  be  unable 
to  act  and  to  become  greatly  over-distended. 

As  regards  the  Liver,  there  has  always  been  a  tendency  to 
use  calomel  in  cholera.  When  I  arrived  in  India  in  1848  I 
gave  it  as  others  did,  in  frequent  large  doses,  ten  grains  to  a 
•scruple,  to  compel  the  liver  to  act.  A  few  years  later,  Ayres’s 
plan  of  giving  calomel  in  frequent  small  doses,  with  the 
view  of  soliciting  hepatic  action,  came  into  vogue.  Subse¬ 
quently  I  preferred,  when  the  bilious  stools  were  either 
absent  or  scanty,  or  scanty  bilious  vomiting  took  their  place, 
to  use  free  counter-irritation  by  sinapisms,  followed  by  large 
hot  poultices  over  the  whole  hepatic  region,  front  and  back, 
.and  to  solicit  hepatic  action  by  frequent  gentle  aperient 
doses  and  enemata. 

Dr.  Aitken  says  that,  in  men  of  intemperate  habits,  we 
often  see,  during  the  stage  of  reaction,  obstinate  vomiting 
of  thick,  tenacious,  green  paint-looking  matter,  probably 
bile-pigment  acted  on  by  some  acid  in  the  stomach  or  alimen¬ 
tary  canal.  It  is,  he  considers,  a  symptom  of  evil  omen, 
and  it  often  goes  on  uncontrolled  until  the  patient  dies  ex¬ 
hausted,  and  this,  although  all  other  symptoms  may  promise 
a  favourable  issue.  It  may  last  for  a  week,  resisting  all 
remedies,  and  proving  fatal  when  the  urinary  secretion  has 
been  restored  and  all  cerebral  symptoms  have  subsided. 
In  England,  where  cirrhosis  of  the  liver  and  Bright’s  disease 
are  much  more  common  than  they  are  in  India,  this  irre¬ 
pressible  vomiting,  in  men  of  intemperate  habits,  probably 
depends  mainly  upon  the  presence  of  those  diseases  ;  as  we 
find  in  India  that  where,  in  strong-looking  dysenteric 
patients,  the  stomach  persistently  resists  the  use  of  ipecacu¬ 
anha,  the  liver  is  nearly  always  considerably  diseased.  My 
Indian  experience  gives  me  no  such  terror  of  obstinate 
bilious  vomiting  after  cholera.  Indeed,  I  am  usually  glad 
to  see  bilious  vomiting,  regarding  it  as  a  very  useful  flux, 
only  a  little  in  the  wrong  direction.  Here,  under  the  free 
employment  of  sinapisms  to  the  hepatic  region  and  pit  of 
the  stomach,  the  evidences  of  gastric  irritation  generally 
subside,  and  a  few  salt-and-water  enemata  effectually  solicit 
the  bile  to  take  its  natural  downward  course. 

As  it  is  of  great  importance  that  we  should  view  this 
bilious  vomiting  in  its  true  light,  I  will  quote  what  Dr. 
Goodeve  says  of  vomiting  in  the  reaction  stage : — “Irritability 
-of  the  stomach  may  be  caused  by  some  degree  of  congestion  ' 


of  its  mucous  membrane  approaching  to  subacute' gastritis, 
owing  to  the  frequent  straining  and  vomiting,  and  to  stimu¬ 
lants  incautiously  given.  It  is  not  necessarily  accompanied 
by  feverishness,  but  there  is  generally  thirst  and  burning 
heat  of  oesophagus  and  at  epigastrium.  The  patient  cannot 
retain  nourishment  at  first,  the  smallest  amount  being  at 
once  rejected.  This  condition  often  lasts  several  days,  and 
requires  great  care  and  attention.  I  do  not  remember  to 
have  seen  it  fatal.  When  existing  as  the  only  symptom, 
great  debility  attends  it,  and  convalescence  is  often  delayed 
many  days  by  its  continuance.  Sometimes  it  passes  into  a 
dangerous  state  of  gastro-enteritis.” 

This  description  applies  to  vomiting  which  has  its  origin 
in  congestion  and  irritability  of  the  stomach  itself,  and  not 
to  that  vomiting  which  is  caused  by  a  copious  regurgitant 
flow  of  bile.  Still,  it  fully  confirms  what  I  have  observed, 
that  it  is  generally  within  our  power  to  conduct  the  vomiting 
which  occurs  in  the  reaction  stage  of  Indian  cholera  to  a 
successful  issue. 

My  own  experience  of  the  state  of  the  bowels  in  cholo- 
uriemia  is  that  their  action  is  generally  deficient ;  either 
there  has  been  constipation,  or  the  stools  have  been  few  or 
scanty. 

One  of  our  greatest  difficulties  in  treating  cholera  arises 
from  the  fact  that,  in  Bengal  at  least,  the  type  of  the  disease 
changes,  as  I  have  already  shown,  from  year  to  year,  and 
even  from  week  to  week ;  nay,  carefully  observed,  no  two 
cases  of  cholera  are  precisely  the  same.  Familiar  as  I  was 
with  the  cholera  of  Calcutta,. the  disease  which  I  treated 
during  a  great  part  of  1874  was  of  a  type  altogether  new  to 
me.  It  was,  doubtless,  owing  to  this  variation  in  type  that 
Dr.  Goodeve  wrote — “The  bowels”  [in  cholera  uraemia  J 
“  are  sometimes  relaxed,  sometimes  constipated  ;  the  evacua¬ 
tions  yellow  and  freculent ;  diarrhoea  may  carry  off  some 
urea,  and  should  not  be  checked.”  He  does  not  appear  to 
have  used  purgatives  in  the  cholo-ursemia  of  cholera. 

As  then,  it  is  generally  found  that,  when  cholo-uraemia 
sets  in,  the  bowels  are  more  or  less  confined,  the  prompt  use 
of  castor  oil  in  very  moderate  doses  (two  or  three  drachms), 
and  warm  enemata  of  common  salt  and  conjee  (rice)  water 
relieve  the  head  symptoms  and  produce  five  or  six  more  or 
less  bilious  stools  in  the  twenty -four  hours.  It  cannot  be 
too  emphatically  insisted  on,  that  prolonged  constipation  in 
the  reaction  stage  is  always  a  cause  for  anxiety.  Restoration 
of  the  excretion  of  bile  is  quite  as  important  as  the  renewal 
of  the  excretion  of  urine.  No  fear  whatever  of  relapse,  or 
even  of  moderate  gastric  or  intestinal  irritation,  need  attend 
this  evacuant  treatment,  unless  we  overdo  it.  In  using 
moderate  enemata  we  are  to  bear  in  mind  that  the  lower 
bowel  has  had  little  or  no  concern  in  the  recent  cholera  flux. 
Hence  it  may  be  gently  stimulated  into  action,  with  a  view 
to  a  reflex  impression  upon  the  liver,  without  the  slightest 
danger. 

Indeed,  I  believe  that,  in  cases  where  such  gentle  evacuant 
measures  fail,  stronger  purgation  is  indicated. 

"VYe  have  reason  to  believe  that  there  is  no  hope  of  recovery 
from  cholera  in  cases  where  there  has  previously  existed 
grave  organic  disease  of  the  kidneys  and  liver.  It  is  pro¬ 
bable  that  patients  with  confirmed  Morbus  Brightii  never 
recover  from  cholera. 

In  insisting  that  an  evacuant  system  is  needful  in  the 
cholo-urscmia  of  cholera,  I  in  no  way  subscribe  to  the 
principle  of  the  evacuant  system  of  Johnson,  as  I  have 
recourse  to  it  not  with  a  view  to  driving  out  the  specific 
poison  of  cholera,  but  for  the  purpose  of  disembarrassing 
and  assisting  the  system  in  its  efforts  to  free  itself  from 
accumulated  and  retained  urine  and  bile-elements. 

The  utmost  harm  is  done  in  cholera  by  the  use  of  astrin¬ 
gents,  narcotics,  and  stimulants  after  reaction  has  set  in, 
and  by  irrational  attempts  to  stop  vomiting  and  purging 
in  and  after  the  reaction  stage.  It  is  not  for  us  to  check 
nature’s  own  means  of  clearing  the  system. 

The  clinical  experience  of  several  cholera  seasons  gradually 
established  and  confirmed  in  my  mind  the  conviction  that 
we  can  only  prevent  the  cholo-uramia  of  cholera,  and  suc¬ 
cessfully  treat  it  when  we  find  it  to  be  present,  by  a  full  re¬ 
cognition  of  the  principles  set  forth  above,  and  by  watching 
the  fluctuating  conditions  of  the  nlvine  and  urinary  excreta 
as  narrowly  as  seamen  watch  the  glass  in  threatening 
weather. 

The  vast  importance  of  a  course  of  treatment  which  will 
enable  us  to  control  the  cholo-uramiia  of  cholera  is  shown 


482 


Medical  Times  and  Gazette. 


CH EVERS  ON  THE  ORDINARY  DISEASES  OF  INDIA. 


Oct.  27,  1883. 


by  Dr.  Goodeve’s  statistics  of  deaths  during  the  reaction 
stages.  In  the  great  home  epidemic  of  1853-56,  14  per  cent, 
of  the  deaths  were  from  consecutive  fever.  In  that  of  the 
North-West  Provinces  of  India  in  1861,  22  per  cent,  of  the 
fatal  cases  died  in  the  reaction  stage.  Dr.  John  Macpherson 
shows  that,  during  a  period  of  ten  years,  one-fifth  of  the  fatal 
cases  of  cholera  in  the  Calcutta  General  Hospital  died  after 
the  stage  of  collapse  was  over. 

It  is  always  important  to  bear  in  mind  that  in  Cholera,  as 
in  true  enteric  fever,  the  main  incidence  of  the  disease  is  in¬ 
variably  upon  the  lower  part  of  the  small  intestine.  Here, 
principally,  the  rice-water  stools  are  formed  ;  and,  as  I  men¬ 
tioned  above,  this  part  of  the  bowel  was  absolutely  occluded 
in  the  fatal  cases  which  I  examined  post-mortem  in  the  Bengal 
epidemic  of  1849.  Consequently,  we  should  always  examine 
the  right  iliac  fossa,  and  counter-irritate  there  most  freely, 
especially  if  there  be  fulness  and  tenderness. 

Although  I  regard  Cholera  as  a  Pernicious  Fever,  I  have 
seen  and  heard  nothing  to  show  that  Quinine  has  any  power 
of  commanding  it.  Should  cholera  arise  amongst  us,  every 
member  of  our  community  ought  to  take  a  tonic  dose  of  ! 
quinine  daily.  Thus  the  lives  of  multitudes  would  probably 
be  saved,  the  drug  acting  as  a  nervine  tonic,  promoting 
healthy  digestion.  But,  as  we  have  already  seen  that  quinine 
is  not  specifically  prophylactic  in  averting  marsh  fever,  it 
cannot  be  relied  upon  alone  as  a  certain  means  of  preventing 
cholera  (Macpherson). 

We,  of  course,  give  quinine  as  a  tonic  in  convalescence. 
In  the  outbreak  of  pernicious  fever  at  Deesa  in  1835,  the 
symptoms  of  which  have  been  detailed  above  (page  209), 
quinine  was  pretty  freely  used,  but  “  often  disappointed 
expectations.”  But,  at  that  time,  quinine  was  not  relied 
upon  as  it  deserved  to  be.  In  the  fever  at  Bellary,  in 
1840,  Mr.  Parry,  although  a  strong  believer  in  calomel, 
places  the  following  words  in  italics — '‘During  the  inter¬ 
mission  it”  [calomel]  “ was  frequently  combined  with 
quinine,  and  in  this  combination  it  proved  eminently  ser¬ 
viceable.”  Speaking  of  the  “Malwa  Sweating  Sickness/’ 
Dr.  Murray  wrote — “'Quinine  is  the  sheet-anchor  in  this 
disease,  and  there  are  few  symptoms  that  would  prevent 
my  giving  it.”  Hence  the  importance  of  judging,  in  any 
outbreak  and  in  every  case,  whether  we  have  to  deal 
with  Pernicious  Fever  or  True  Cholera.  “  Cholera,”  says 
Macpherson,  “  is  not  ushered  in  by  rigors  :  the  fluids  ejected 
are  yellow,  green,  or  bilious  in  pernicious  fever  ;  in  cholera 
like  rice-water.” 

All  my  experience  tended  to  show  that  few  things  avail 
more  in  the  management  of  cholera  than  sedulous  care  and 
good  nursing.  I  often  told  my  students  that,  if  I  should  be 
attacked,  I  should  wish  to  be  attended  by  one  who  imagined 
that  he  had  discovered"  a  cure  for  the  disease — no  matter 
what,  unless  it  happened  to  be  croton  or  castor  oil,  nitrate  of 
silver,  or  tincture  of  lytta.(a)  The  discoverer,  when  he  is,  . 
as  he  usually  is,  a  man  of  experience,  science,  and  humanity, 
always  surrounds  his  “  cure  ”  with  so  much  wise  precaution 
and  sedulous  care,  and  such  attention  to  every  turn  of  the 
malady,  that  his  patients  undoubtedly  stand  a  better  chance 
of  recovery  than  do  those  who  come  under  a  routine  system 
of  everyday  treatment.  Whatever  his  plan  of  treatment 
may  be,  he  will,  assuredly,  have  the  largest  amount  of 
success,  even  when  the  outbreak  is  at  the  deadliest  acme  of 
its  destructiveness,  who  treats  every  case  as  a  distinct 
therapeutic  study.  This  law  is  enforced  by  the  fact,  which 
I  have  already  strongly  insisted  upon,  that  no  two  types  of 
cholera — nay,  that  no  two  cases  of  this  disease  are  precisely 
the  same.  Hence  the  necessity  of  not  relying  wholly  ujDon  any 
specific  or  routine  mode  of  treatment,  but  of  treating  every 
case  throughout  in  strict  accordance  with  its  own  particular 
conditions.  On  the  other  hand,  Indian  physicians  are  so 
fully  accustomed  to  the  disappointment  of  losing  nearly  every 
case  at  the  first  outbreak  of  cholera,  that  this  ill-success 
never  shakes  their  confidence  in  what  they  have  proved  to 
be  right  principles  of  treatment.  If  we  treat  our  cases 
steadily,  upon  a  system  proved  by  long  experience  to  be 
rational,  we  shall  probably  find  that,  at  the  end  of  an  out¬ 
break,  at  least  some  40  per  cent,  of  our  cases  have  recovered. 
If  we  change  our  plan  indecisively  every  time  we  lose  a  case, 
we  shall  at  length  come  to  the  decision  that  our  treatment 
has  failed  throughout,  and  that  we  have  left  a  vast  amount 
of  good  undone  in  taking  the  responsibility  which  ought  to 
have  been  held  by  a  man  of  decision. 

(i)  Allot"  which  enjoyed  brief  reputation. 


I  know  of  no  disease  in  which  so  much  benefit  may  be 
obtained  from  good  nursing  as  in  Cholera.  Sensible  nurses 
may  be  readily  trained,  and  need  have  no  apprehension 
whatever  that  this  duty  will,  in  the  very  slightest  degree, 
add  to  the  danger  which  they  share  with  every  other  member 
of  the  community.  In  giving  ice,  in  seeing  that  the  patient 
does  not  incur  the  peril  of  sudden  death  by  syncope  by 
having  his  head  raised,  in  attending  to  the  heat  of  the 
water-bottles  and  in  applying  the  sinapisms,  in  keeping  to 
their  work  the  relays  of  assistants  who  apply  the  dry  ginger 
frictions,  in  feeding,  in  encouraging  the  patient,  and  indeed 
in  carrying  into  effect  every  means  of  relief  and  every  need¬ 
ful  precaution  until  convalescence  is  established,  an  active 
and  experienced  nurse  is  invaluable.  It  was  my  frequent 
remark  in  India,  that  my  leading  measure  in  the  care  of  my 
cholera  patients  was  the  attendance  of  Mrs.  Sheen,  the 
practised  nurse  of  my  cholera  ward. 

I  must  repeat  that,  for  a  considerable  time  before  I  left 
India,  I  considered  that  I  possessed  certain  definite  indica¬ 
tions  which  guided  me  in  the  treatment  of  Cholera. 

I  will  not  boast  that,  from  the  time  at  which  I  first  enter¬ 
tained  these  views,  and  carried  them  unswervingly  into 
practice,  I  achieved  any  marvellous  success  in  the  treatment 
of  the  cholo-ursemic  stage  of  cholera.  I  lost  a  very  few 
patients  from  cholo-ursemia.  I,  however,  felt  that  my 
failures  were  almost  invariably  due  either  to  the  fact  that, 
the  patients  had  faulty  organs,  or  to  the  circumstance  of 
their  having  been  brought  to  hospital  too  late  for  relief. 
Whenever  these  views  had  fair  play,  they  led  to  decided 
success.  I  ceased  to  regard  this  cholo-ursemia  as  a  terrible 
and  irresistible  mystery.  I  felt  that  I  could  generally  either 
prevent  or  encounter  it  successfully  in  a  patient  of  fairly 
sound  constitution,  whom  I  treated  from  the  commencement 
of  the  attack. 

Nourishment  in  Cholera. 

It  is  unquestionable  that  many  deaths  from  Cholera,  whether 
they  occur  in  the  stage  of  collapse  or  in  that  of  reaction  and 
cholo-uraemia,  are,  potentially,  in  a  large  measure  due  to 
starvation.  The  disease,  in  its  early  evacuant  violence  and 
paralysis  of  absorbent  action,  drains  the  blood  of  its  fluid,, 
and  deprives  the  solids  of  the  body  of  all  nutriment.  If,  in 
the  stage  of  collapse,  we  give  milk,  soups,  etc.,  by  the  mouth 
or  rectum,  they  are,  in  my  experience,  immediately  rejected; 
and,  with  each  vomit  and  dejection  thus  excited,  the  patient’s- 
strength  goes  down — as  if,  instead  of  endeavouring  to  feed 
him,  we  bled  him.  As  long  as  the  kidneys  and  liver  are 
absolutely  unable  to  act,  we  can  scarcely  hope  to  do  much 
towards  nourishing  and  supporting  the  patient  by  ordinary 
“feeding.”  We,  of  course,  begin  cautiously  to  give  nourish¬ 
ment  (I  preferred  milk),  in  small  quantities  frequently,  as 
soon  as  we  find  that  it  can  be  retained ;  but  effectual  means- 
of  nourishing  in  Cholera  are  still  an  unattained  desideratum 
in  theraj)eutics.  At  present  our  main  consolation  is  that 
we  have  seen  hundreds  of  patients  “pull  through”  attacks 
of  algide  Cholera,  in  which  it  has  been  evident  that  we  were 
unable  to  effect  much  in  the  way  of  nourishment  until  the 
liver  and  kidneys  had  begun  to  resume  their  functions- 
With  a  heroism  which  has  never  been  wanting  among 
Indian  surgeons.  Dr.  David  Boyes  Smith,  while  acting  for 
me,  some  ten  years  ago,  as  Senior  Physician  of  the  Medical 
College  Hospital  at  Calcutta,  gave  his  blood,  I  believe,  to 
deliquium,  which  was  transfused  into  the  veins  of  a  hospital 
patient  in  the  collapse  stage.  I  understood  that  this  noble 
act  injured  the  physician’s  health  without  materially  bene¬ 
fiting  the  patient.  I  was  told  this  by  our  students— never 
by  Dr.  Smith.  It  is  not  exactly  blood  that  is  wanting  in  the 
vascular  system  of  the  dying  cholera  patient,  who  retains 
his  due  quantity  of  fibrin  and  blood-discs.  This  is  proved  by 
the  fact  that,  in  Indian  cholera,  many  recoveries  take  place 
after  hours  of  algide  collapse,  and  that,  in  these  cases,  dis¬ 
charges  of  haemoglobin  do  not  attend  convalescence  ; 
hence  we  may  consider  that  whatever  injury  the  blood- 
discs  may  sustain  during  the  collapse  stage  is  reparable 
up  to  a  A-ery  late  period.  In  the  present  day,  it  does 
not  occur  in  the  experience  of  everyone  to  see  the  living 
blood  of  a  collapsed  cholera  patient.  Some  years  ago 
it  was  suggested  that  stimulants  should  be  given  during 
collapse,  and  that  then  a  vein  should  be  opened.  By  this 
means,  it  was  conjectured,  the  circulation  would  be  freed 
and  the  heart’s  working  power  restored.  I,  acting  carefully 
upon  this  suggestion,  gave  hot  brandy-and-water,  and  opened 
a  vein  in  the  arm  of  a  fine  young  English  sailor  in  the 


Medical  Times  and  Gazette. 


McCRAITH  OX  THE  PRACTICE  OF  MEDIGIXE  IX  SMYRNA. 


Oct.  27,1883.  4  8  3 


collapse  stage,  his  head  being  kept  low.  The  blood  was  of 
very  good  colour — not  “tarry  ” — bub  it  was  distinctly  thick, 
trickling  down  the  arm,  and  ceased  to  flow  before  two  ounces 
had  escaped.  I  wish  that  it  could  have  been  fully  examined ; 
but,  in  our  concern  for  the  patient,  who  sank  rapidly,  we 
failed  to  preserve  it.  It  appeared  clear  that  this  blood  only 
wanted  serum.  I  believe  that,  in  Cholera,  the  blood-discs 
live  quite  as  long  as  the  man  does,  and  could  receive  and 
benefit  by  a  supply  of  serum  up  to  the  moment  of  the 
article.  What  appears  to  be  wanting  here  is  a  fluid  capable 
of  supplying,  in  every  constituent,  the  place  of  that  which 
has  been  drained  away.  But  the  composition  of  such  a  fluid 
and  the  means  by  which  it  may  be  introduced  into  the 
bloodvessels  have  still  to  be  demonstrated.  The  practice 
of  tranfusing  variously-composed  saline  fluids  had  been 
abandoned,  as  worse  than  useless,  before  I  went  to  India. 
Milk  transfusion  has  appeared  to  afford  some  very  doubtful 
promise ;  but  1  think  that  everyone  who  studies  Dr. 
Benjamin  Ward  Richardson’s  most  suggestive  commentary 
upon  the  whole  of  this  question,  (b)  and  reads  Dr.  T.  M. 
Lownds’s  practical  observations  on  “Feeding  Patients  in 
Cholera  Collapse,” (c)  will  consider  that  the  renewal  of  the 
lost  constituents  of  the  blood  and  the  administration  of 
direct  nourishment  during  the  stage  of  collapse  are  points 
largely  open  to  hopeful  research.  I  believe  that  few  could 
do  more  justice  to  such  an  inquiry  than  the  advocate  of 
peptonised  food  prepared  by  the  pancreatic  method(d) — Dr. 
William  Roberts,  of  Manchester. 

In  closing  this  chapter  I  must  repeat  that  no  system  of 
treating  Cholera  can  be  either  scientific  or  valid  unless 
every  step  be  taken  with  due  regard  to  the  conditions  of  the 
kidneys  and  liver,  (e) 

(To  he  continued.) 


PRACTICE  OF  MEDICINE  IX  SMYRNA: 
OX  POSITION  IX  MIDWIFERY  PRACTICE. 
By  JAMES  McCRAITH,  M.D.,  F.R.C.S., 

Surgeon  to  the  British  Seamen’s  Hospital,  Smyrna. 


.From  experience,  it  would  seem  to  me  that  some  improve¬ 
ments  of  no  small  importance  are  practicable,  with  regard 
ffo  English  practice,  in  this  important  department  of  the 
medical  art.  I  was  called  in  to  a  case  of  hand-presentation 
many  years  since  by  an  old  French  practitioner,  since  de¬ 
ceased.  He,  of  course,  adopted  the  French  position  :  patient 
on  her  back,  head  and  shoulders  raised  and  supported  by 
pillows  or  female  assistants,  with  pelvis  brought  to  edge 
-of  the  bed,  the  thighs  also  supported  by  assistants  at  each 
side,  and  of  course  drawn  up.  The  extremities  of  the  child 
'were  towards  the  abdomen  of  the  mother  in  this  case. 
Our  English  position  in  such  a  case  is  evidently  better  than 
the  French,  and  I  begged  of  my  French  colleague  to  allow 
me  to  deliver  our  patient  in  the  English  position.  He  had 
never  seen  a  patient  delivered  in  such  a  position,  and  he 
willingly  consented,  on  my  explaining  to  him  its  advantages. 
The  delivery  was  easily  and  quickly  effected.  He  quickly 
saw  and  appreciated  the  facility  of  reaching  the  feet  in  this 
position — the  chief  difficulty  to  be  met.  But  he  saw  and 
remarked  that  if  the  feet  were  turned  towards  the  mother’s 
back,  as  often  happens,  then  the  French  position  was 
much  better,  and  that  in  such  cases  the  English  must  be 
about  the  worst  possible  position.  And  it  is  precisely  to 
such  cases  that  I  would  wish  to  draw  the  attention  of  my 
English  colleagues.  Thus  we  have  one  group  of  cases  (the 
feet  of  the  child  being  towards  the  back  of  the  mother)  in 
which  most  certainly  the  English  position  is  the  most  im¬ 
practicable  that  can  be  adopted ;  a.nd  another  (the  feet  of 
the  child  being  towards  the  abdomen  of  the  mother)  in  which 
the  English  is  the  best  of  any.  As  my  French  colleague 

(b)  Medical  Times  and  Gazette,  page  124  et  seq.  of  vol.  ii.  for  1883  :  “  On 
Heeding  by  the  Veins,  and  on  Intraperitoneal  injection  in  the  Collapse  of 
•Cholera.” 

(c)  Lancet ,  page  123,  vol.  ii.  of  1883. 

(d)  “Transactions  of  the  International  Congress  of  1881,”  vol.  i.,  page 
617. 

(e)  Since  I  remarked  upon  the  considerable  immunity  of  patients  in 
the  Calcutta  Medical  College  Hospital  from  cholera,  I  have  called  to  mind 
the  case  of  a  patient  who  was  attacked  in  my  native  male  ward.  He 
recovered. 


observed,  the  French  position,  in  cases  in  which  the  feet  are 
towards  the  mother’s  back,  as  described  above,  is  infinitely 
preferable  to  the  English  (the  worst  position  possible). 
But  there  is  a  position  better  than  the  French,  in  my 
opinion,  and  it  is  the  following : — The  feet  you  are  in 
search  of  are  towards  the  mother’s  back  ;  place  your  patient 
across  the  bed,  on  her  right  side  (the  very  reverse  of  the 
English),  head  and  shoulders  low  ;  bring  the  pelvis  slightly 
over  the  edge  of  the  bed,  legs  and  thighs  well  drawn  up ; 
and  in  this  position  you  can  use  your  good  right  hand, 
with  all  its  tact  and  strength,  in  the  most  favourable  posi¬ 
tion  and  circumstances  for  achieving  the  object  in  view, 
viz.,  “  seizing  a  foot,  turning  the  child,  and  completing  the 
delivery.”  There  is  no  comparison  between  the  facilities 
this  position  gives  you  in  such  cases,  and  the  difficulties  and 
consequent  dangers  you  encounter  in  the  English  position. 
I  remember  reading  or  hearing  somewhere  the  advice  or 
suggestion  “  to  practise  with  your  left  hand  so  as  to  be 
capable  of  using  it  in  such  cases  (in  the  English  position) .” 
Can  anything  be  more  stupid  than  this?  Fiat  experimentum 
in  corpore  vili.  Before  you  can  educate  your  left  hand  to 
make  it  equally  efficient  as  your  right,  how  many  victims 
(mothers  and  children)  you  must  make  !  At  what  risks,  in 
fact,  to  the  lives  entrusted  to  your  care  and  judgment — as 
if  the  English  midwifery  position  were  a  dogma,  one  of  the 
Ten  Commandments,  which  must  not  be  violated  in  the 
slightest  particular !  If  such  were  the  law,  as  those  of  the 
Medes  and  Persians,  then  the  alternative  would  be  to  bring 
up  a  class  of  accoucheurs  with  their  right  hands  on  their 
left  shoulders  for  such  special  cases. 

But  in  the  English  position  in  such  cases  the  difficulty  of 
using  the  right  hand  is  so  great  as  to  suggest  some  such 
advice.  This  of  itself  is  enough  to  condemn  it.  Its  ex¬ 
planation  is  “  tyrant  custom.”  But  surely  in  a  Christian 
country  Mahomet  should  be  brought  to  the  mountain,  not 
the  mountain  to  Mahomet.  I  learned  the  advantages  of 
the  position  I  am  advocating  (patient  on  her  right  side) 
in  these  cases  by  practice.  I  had  adopted  the  French 
position  (patient  on  the  back),  when,  meeting  with  some 
difficulty,  I  ordered  the  attendants  to  pass  patient’s  left 
leg  over,  my  hand  already  passed  into  the  uterus,  and 
to  gently  turn  her  over  on  the  right  side,  which  was  done 
without  my  withdrawing  my  hand.  I  found  such  facility 
in  completing  the  delivery  that  since  then  I  have  adopted 
it,  and  explained  it  to  several  of  my  colleagues,  who  I 
believe  adopt  it.  To  me  this  point  seems  clear,  and  its 
advantages  great.  I  hope  it  will  be  found  so  by  my  masters 
and  superiors  in  this  branch  of  our  profession.  “  Si  quid 
novisti  rectius  istis,  candidus  imparte,  si  non  bis  utere 
mecum.”  To  sum  up :  in  cases  of  turning,  when  the  child’s 
feet  are  towards  the  mother’s  abdomen,  the  English  position 
is  the  best ;  when  the  feet  of  the  child  are  towards  the  back 
of  the  mother,  the  English  is  the  worst  possible  position. 
The  French  is  a  practicable  position,  but  the  best  is,  as 
described  above,  the  patient  on  her  right  side. 

And  now  a  few  remarks  on  forceps  cases — a  very  important 
series  of  cases  indeed.  I  have  no  hesitation  in  asserting  that 
the  French  position  is  by  far  the  best  in  all  forceps  cases. 
Place  the  patient  seated  on  edge  of  bed,  or  rather  in  recum¬ 
bent  position,  head  and  shoulders  slightly  raised,  the  pelvis 
slightly  overhanging  the  edge,  a  female  attendant  at  each 
side  supporting  the  flexed  and  drawn-up  leg  and  thigh  ;  and 
in  such  position  the  passage  of  your  forceps  is  facilitated, 
and  you  can  see  and  judge  clearly  the  progress  and  direc¬ 
tion  in  which  you  are  making  traction,  and  more  easily  adapt 
such  traction  to  the  different  “  axes  ”  you  are  passing.  This 
is  decidedly  better  than  the  English  position,  in  which  you 
lose  the  above  advantages,  and  in  which  the  application  of 
the  right  branch  of  your  forceps  is,  to  say  the  least  of  it, 
awkward  and  inconvenient,  and  in  unpractised  hands  may 
be  mischievous.  In  the  French  position  all  your  proceed¬ 
ings  are  easier  :  you  make  traction  in  any  necessary  direc¬ 
tion  much  more  easily  and  more  surely,  and  therefore  better 
regulated ,-  and  you  see  in  what  direction  to  cut  much 
more  clearly  than  in  the  English  position.  Your  patient 
may  be  covered,  if  she  so  wishes  it,  with  a  sheet.  Nearly 
the  whole  time  when  in  practice  this  is  the  position  I  in¬ 
variably  adopted,  after  I  had  learned  its  advantages  from 
my  colleagues,  educated  in  France,  practising  here.  To 
any  practical  accoucheur,  I  take  it,  this  will  be  evident ;  but 
custom  is  a  very  strong  barrier  to  be  overcome.  “  Nec  neos 
majornm  repudiandus,” — and  an  accomplished  accoucheur 


484 


Medical  Times  and  Gazette. 


MEDICAL  AND  SURGICAL  PRACTICE. 


Oct.  27,  1883. 


will  succeed  against  many  (unnecessary)  difficulties.  But, 
nevertheless,  there  is  an  easier  and  a  more  difficult  way  of 
doing  everything,  and  surely  the  easier  and  safer  should  be 
preferred,  as  every  accoucheur  cannot  be  so  accomplished  as 
to  encounter  any  difficulty  which  may  be  avoided.  To  sum  up 
the  views  put  forward  in  this  paper.  In  all  ordinary  cases 
the  English  position  is  about  as  good  as  any  other,  and  if 
“  supporting  the  perineum  ”  be  accepted  as  useful  or  neces¬ 
sary,  this  support  can  be  given  most  conveniently  and 
effectually  in  the  English  position ;  but  this  “  supporting 
the  perineum  ”  is  a  disputed  doctrine,  and  can  only  be  of 
use  in  very  rare  instances,  when  the  head  is  advancing  too 
quickly  for  safety,  and  the  support  must  be  given  with 
judgment,  lest  greater  evils  than  advantages  result.  It 
can  be  practised  in  the  French  position,  though  not  so 
conveniently  and  effectively  as  in  the  English. 

In  all  cases  of  turning  the  French  position  is  better  than 
the  English ;  and  in  such  cases,  when  the  feet  are  to  the 
back  of  the  mother,  the  English  is  the  worst  possible  ;  the 
French  is  practicable  ;  but  the  position  on  right  side,  as 
advocated  in  this  paper,  is  the  best. 


REPORTS  OF 

HOSPITAL  PRACTICE  IN  MEDICINE 
AND  SURGERY. 


NORTH-EASTERN  HOSPITAL  EOR  CHILDREN. 


SUPPURATION  OF  LEFT  EYEBALL— EXCISION- 

DEATH— AUTOPSY— ABSCESS  IN  PONS  VAROLII 

AND  CEREBELLUM. 

(Under  the  care  of  Mr.  RICKMAN  J.  GODLEE.) 

John  M„  .aged  thirteen  months,  was  admitted  into  the 
hospital  under  the  care  of  Mr.  Godlee  on  April  10,  1883. 

Previous  History. — The  child  has  been  attending,  rather 
irregularly,  as  an  out-patient  since  February  1,  on  account 
of  rickets  and  bronchitis.  The  mother  stated  that  she  had 
lost  one  child  at  six  years  of  age,  and  that  she  has  two  other 
children  at  home,  alive  and  well.  She  has  never  had  mis¬ 
carriages.  The  patient  had  only  six  teeth.  On  February  15 
there  were  rhonchi  over  both  sides  of  the  chest ;  also  left 
facial  paralysis;  there  was  no  otorrhcea;  the  child  had  not 
had  any  fits.  On  March  1  there  was  conjunctivitis,  which 
had  begun  three  days  previously.  The  child  was  taken  to 
Moorfields  Hospital  shortly  afterwards,  and  they  recom¬ 
mended  the  mother  to  try  and  get  him  admitted  into  a 
children’s  hospital. 

State  on  Admission,  April  10. — The  child’s  condition  now 
appeared  very  serious.  The  cornea  was  sloughing,  and  the 
conjunctiva  was  highly  inflamed  and  chemosed.  The  tem¬ 
perature  was  elevated.  The  child  was  much  wasted,  and  in 
a  miserable  condition.  There  was  no  facial  paralysis,  nor 
paralysis  of  the  limbs. 

April  15.— Temperature  continues  to  rise  at  night.  The 
child  vomits  frequently ;  sleeps  badly.  The  eye  appears  to 
be  no  better ;  the  cornea  and  iris  are  blended  in  one  sloughy 
mass. 

21st. — The  condition  being  worse  rather  than  better,  Mr. 
Godlee  excised  the  eyeball.  On  section,  the  eye  showed  pus 
in  the  anterior  chamber ;  the  cornea  was  almost  destroyed. 

May  2. — The  child  died  about  6  a.m. 

After  removal  of  the  globe,  the  orbit  remained  free  from 
inflammation,  and  healing  took  place  with  great  rapidity, 
so  that  at  the  time  of  death,  ten  days  after  the  operation, 
cicatrisation  was  almost,  if  not  quite,  completed.  The 
patient,  however,  showed  no  signs  of  rallying.  On  the 
contrary,  he  vomited  every  day,  and  lay  in  a  stupid  con¬ 
dition,  constantly  crying  out  loudly,  as  if  suffering  from 
-some  cerebral  trouble.  He  was  neither  distinctly  paralysed 
nor  convulsed,  but  appeared  to  die  of  exhaustion. 

Autopsy ,  fifty-six  hours  after  Death. — On  removing  the 
skull-cap  and  dura  mater,  the  convolutions  of  the  brain 
were  found  to  be  much  flattened.  The  lateral  ventricles 
were  considerably  distended  with  clear  fluid.  There  was 
no  evidence  of  meningitis  or  tubercle  at  the  base  of  the 
brain.  The  nerves  all  appeared  healthy.  On  the  left  side 
of  the  pons  there  was  an  abscess-cavity  of  the  size  of  a 
small  walnut.  Close  to  it,  in  the  left  side  of  the  cerebellum. 


there  was  another  cavity  containing  pus,  apparently  having- 
no  connexion  with  the  abscess  in  the  pons.  No  meningitis 
about  the  pons.  The  other  viscera  appeared  normal,  except 
the  right  lung,  which  contained  a  patch  of  consolidation. 

Remarks  (by  Mr.  Godlee). — When  first  seen,  the  case  was 
taken  to  be  one  of  severe  strumous  ophthalmia.  I  had  not 
before  me  the  fact  that  the  child  had  been  previously  under 
medical  treatment  at  the  hospital,  and  had  suffered  from 
facial  paralysis,  so  that  I  did  not  at  that  time  investigate 
the  existence  of  any  cerebral  mischief.  Looking  at  it  from 
the  light  thrown  upon  the  case  by  the  post-mortem,  I 
imagine  that  the  sequence  of  events  was  as  follows  : — First, 
otorrhcea ;  secondly,  cerebral  abscess,  or  rather  abscess  in 
the  cerebellum  and  the  pons  ;  thirdly,  interference  with  the 
fifth  nerve  as  a  result  of  the  abscess  in  the  pons,  and  conse¬ 
quent  conjunctivitis  and  sloughing  of  the  cornea;  fourthly,, 
death  from  the  cerebral  abscess,  the  fatal  tendency  being,  of 
course,  not  at  all  affected  by  the  removal  of  the  eyeball.  I 
have  little  doubt  that  careful  investigation  would  have  dis¬ 
covered  other  signs  of  paralysis  of  the  fifth.  No  note  is  made 
as  to  the  condition  of  the  tympana.  I  believe  they  were 
opened,  and  both  contained  pus  ;  but  this  is  of  such  common 
occurrence  in  children  dying  in  hospital,  that  it  is  an  observa¬ 
tion  of  small  moment.  The  case  is,  I  think,  interesting  and. 
worthy  of  recording,  in  spite  of  the  great  imperfection  of 
the  notes,  because  it  has  been  often  stated  that  cerebral 
abscess  not  unfrequently  follows  removal  of  the  eyeball,  and 
it  has  been  adduced  as  a  somewhat  strong  argument  against 
the  performance  of  the  operation  except  under  the  most 
urgent  circumstances.  This  appeared  to  be  a  case  in  point, 
and  might  easily  have  been  placed  on  record  as  such.  I 
have  very  little  doubt,  however,  that  the  sequence  of  events- 
was  quite  different,  and  that  this  should  be  considered  as  a 
case  of  excision  of  the  eye  following  cerebral  abscess,  rather 
than  one  of  cerebral  abscess  following  excision  of  the  eye. 
It  has  also  been  instructive  to  myself  as  a  warning  to  be- 
more  careful  as  to  inquiry  into  antecedent  circumstances 
whenever  a  case  of  ophthalmia,  especially  if  unilateral,  seems 
rapidly  to  be  leading  to  disorganisation  of  the  globe. 


An  Enormously  Thickened  Peritoneum.— -Dr. 
Jacobi  related  to  the  Society  of  German  Physicians,  New 
York,  the  case  of  a  man,  aged  forty-nine,  who  had  suffered 
from  cirrhosis  of  the  liver  for  some  years,  and,  having  under¬ 
gone  paracentesis  abdominis  since  with  advantage,  died  from 
haemorrhage  of  the  stomach.  At  the  autopsy  the  parietal 
peritoneum  was  found  thickened  by  chronic  inflammation  to 
the  extent  of  an  inch,  and  contained  calcareous  masses,, 
which  had  been  mistaken  during  life  for  intra-abdominal 
growths. — New  York  Medical  Journal,  September  8. 

Statistics  oe  Cancer.- — As  a  contribution  to  this 
subject.  Dr.  Hofmeier  read  a  paper  at  the  Berlin  Obste¬ 
trical  Society,  in  which  he  stated  that  among  10,000  adult 
women  admitted  to  the  Elizabeth  Hospital  during  the 
period  1865-80  there  were  358  cases  of  cancer,  distributed  as 
follows  : — Cancer  of  the  uterus,  169  (47 '2  per  cent.) ;  breast, 
42(1P7);  vagina,  11  (8’07) ;  ovary,  7  (P96) ;  vulva,  2;  clitoris, 
1  ;  stomach  and  liver,  78  (20'3) :  rectum,  17  (4'7);  mesentery, 
8  (2-23)  ;  face  and  epicranium,  8  ;  lungs,  5  (P39) ;  tongue,  4- 
(l'll)  ;  oesophagus,  4 ;  kidneys,  2;  brain,  2;  common  integu¬ 
ment,  2  ;  and  bladder,  1. — Berlin.  Klin.  Woch.,  August  22. 

Cases  of  Hydrophobia  in  Paris.— At  the  meeting 
of  the  Conseil  d’Hygiene  Publique  et  de  Salubrite  oil 
October  12,  Dr.  Ollivier  read  a  report  on  the  case  of  an 
infant,  a  year  old,  who  was  bitten  in  May,  1881.  The  wound, 
was  not  cauterised,  and  the  child  continued  well  until  it  was 
two  years  and  eight  months  of  age,  when  hydrophobic 
symptoms  set  in,  and  it  died  after  thirty-seven  hours  of 
suffering.  Notwithstanding  the  long  period  of  incubation 
(twenty-six  months),  the  reporter  concluded  that  the  child 
diddie  of  hydrophobia. — At  the  same  meeting.  Dr.  Dujardin- 
Beaumetz  reported  the  case  of  a  child  seven  years  of  age, 
who  was  seized  with  hydrophobia  sixty-one  days  after  it  had. 
been  bitten  (the  wound  having  been  only  cauterised  with 
nitrate  of  silver),  and  died  in  two  days. — M.  Leblanc  stated 
that  the  number  of  cases  had  been  somewhat  less  this  year- 
than  in  the  preceding  years,  but  strongly  recommended 
that  there  should  be  no  relaxation  in  the  execution  of 
the  regulations  concerning  wandering  dogs. — Union  Med.,, 
October  20. 


Medical  Times  and  Gazette. 


MURDER  AND  MADNESS  AGAIN.  Oct.  27,  iss3.  4S5 


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SATURDAY,  OCTOBER  27,  1SS3. 


MURDER  AND  MADNESS  AGAIN. 
There  is  some  danger  that  the  case  of  James  Cole,  who  was 
sentenced  to  death  at  the  Central  Criminal  Court  on  the 
18th  inst.  for  the  murder  of  his  child,  will  not  receive  the 
attention  which  it  deserves.  It  follows  very  closely  upon 
the  heels  of  the  Gouldstone  case,  and  the  public  are  apt  to 
grow  impatient  of  medical  interference  between  the  gallows 
and  its  prey,  and  to  take  alarm  lest  the  salutary  effects  of  capi¬ 
tal  punishment  should  be  neutralised  by  the  too  wide  appli¬ 
cation  of  scientific  theories.  An  execution  is  necessary  now 
and  then  “pour  encourager  les  autres,”  and  at  this  moment 
the  new  hangman  is  anxious  to  try  his  hand.  Then  Cole’s 
crime,  although  not  less  savage  than  that  of  Gouldstone,  was 
on  a  much  smaller  scale,  and  is  therefore  less  likely  to 
appeal,  by  its  unusual  proportions,  to  the  popular  imagina¬ 
tion,  which  is  always  impressed  by  the  monstrous  and  gigan- 
tesque,  and  to  secure,  therefore,  careful  official  consideration. 
The  man  Cole,  too,  is  less  deserving  of  sympathy  than  the 
man  Gouldstone,  for,  instead  of  having  been  industrious  and 
steady,  prior  to  the  commission  of  his  crime,  he  was  dissi¬ 
pated  and  quarrelsome.  And  yet  the  evidence  of  insanity  in 
Cole’s  case,  if  the  newspaper  reports  are  to  be  trusted,  was 
■much  stronger  than  it  was  in  that  of  Gouldstone.  Mr. 
Justice  Denman,  who  did  not  exhibit  any  extraordinary 
grasp  of  mind  in  his  conduct  of  the  trial  and  summing-up, 
and  who  was  certainly  not  biased  in  the  prisoner’s  favour, 
was  constrained  to  admit  that  he  had  been  labouring  under 
delusions ;  while  the  prisoner’s  son  and  Dr.  Jackson  of  Croy¬ 
don  made  it  clear  that  these  delusions  were  of  the  very  kind 
that  most  frequently  leads  up  to  crimes  of  violence,  being 
all  connected  with  ideas  of  persecution.  He  imagined  that 
he  was  being  poisoned  and  watched,  and  that  there  were 
men  concealed  in  his  house,  and  it  is  easy  to  understand 
that  he  was  rendered  desperate  by  such  suspicions  when 
he  seized  his  little  child  by  its  legs,  and  so  pounded  its 
head  on  the  wall  and  floor  that  it  died  soon  afterwards  of 
the  injuries  thus  sustained.  The  fierce  vehement  cruelty  of 


the  act  must  itself  create  a  doubt  as  to  the  state  of  mind 
that  made  it  possible.  A  mother  does  not  forget  her  sucking 
babe,  and  even  a  bad  father  will  not  shatter  his  little  child’s 
head  when  there  is  nothing  to  be  got  by  the  operation, 
unless  he  be  brutalised  by  drink  or  disease.  The  evidence 
is  to  the  effect  that  Cole  was  not  drunk  when  he  thus  de¬ 
ported  himself,  and  the  conclusion  is  therefore  unavoidable 
that  he  was  stark  mad.  The  judge  seems  to  have  inclined  to 
the  belief  that  he  was  caught  up  iu  a  sudden  gust  of  im¬ 
petuous  passion,  but  this  is  certainly  not  the  most  probable 
hypothesis,  nor  that  most  creditable  to  human  nature.  It  is 
to  be  recollected  that  the  man  was  subject  to  delusions  well 
calculated  to  make  an  Ishmael  of  him.  Is  it  not  more 
likely  that  he  was  lashed  into  fury  by  these  delusions  when 
he  killed  his  child,  than  that  he  merely  forgot  himself  in  a 
fit  of  common  anger  induced  by  a  dispute  with  his  wife  ? 

Strong  corroboration  of  the  theory  that  Cole  was  insane 
when  he  destroyed  his  child  may  be  derived  from  his  past 
history,  as  brought  out  at  his  trial.  He  is  a  member  of  a 
family  in  which  epilepsy  has  been  prevalent;  he  has  been 
long  addicted  to'  drink,  and  he  has  been  latterly  out  of  work 
and  short  of  food.  He  has  been  exposed,  in  fact,  to  the 
very  etiological  conditions  which  are  most  conducive  to  that 
form  of  insanity  of  which  he  displayed  the  symptoms,  and 
of  which  reckless  violence  is  so  often  a  characteristic.  If  a 
medical  psychologist  were  asked  to  enumerate  the  condi. 
tions  most  certain,  when  acting  in  combination,  to  produce  a 
dangerous  lunatic,  explosive  as  dynamite,  and  as  ruthless  of 
ruin,  he  would  unhesitatingly  name  epileptic  tendencies, 
chronic  alcoholism,  and  inanition.  And  these  ingredients 
of  deadly  madness  have  been  brewing  in  Cole’s  brain  for 
some  time,  and  have  caused  various  petty  discharges  besides 
the  grand  fulmination  that  has  put  his  life  in  peril.  He  has 
been  imprisoned  for  violence  upon  several  occasions,  and, 
while  awaiting  his  recent  trial  in  the  House  of  Detention, 
he  had  to  be  put  in  the  padded  cell  for  violence,  which  did 
not  arise,  it  is  said,  from  unsoundness  of  mind,  but  which 
can  scarcely  have  arisen  from  a  clear  and  rational  conception 
of  his  situation. 

The  surgeon  and  warders  of  the  gaol  in  which  Cole  has 
spent  the  time  between  his  committal  and  trial,  of  course 
gave  evidence  that  they  had  seen  nothing  insane  about  him_ 
They  never  do  see  anything  insane  about  anybody  who  can 
black  his  own  boots,  keep  his  cell  clean,  and  swallow  the 
regulation  allowance  of  victuals.  But  their  empty  denials 
weigh  as  nothing  against  the  positive  statements  of  Dr. 
Jackson,  that  he  discovered  a  large  number  of  delusions  in 
Cole’s  mind,  and  satisfied  himself  that  he  was  a  dangerous, 
lunatic.  Dr.  Jackson  is  not  a  mad  doctor,  and  came  forward 
to  give  his  evidence  out  of  charity  and  a  sense  of  public 
duty,  and  his  testimony  was  therefore  entitled  to  much 
greater  consideration  than  it  seems  to  have  received. 

The  convict  Cole  has  a  bad  record,  and  has  committed  a 
revolting  act,  but  still,  if  he  is  insane,  or  if  he  was  insane 
when  he  destroyed  his  child,  he  should  not  be  left  to  suffer 
the  penalty  of  death.  There  are  perhaps  a  few  cynical 
advocates  of  euthanasia  in  these  days  who  would  argue, 
for  the  sake  of  argument,  that,  mad  or  not  mad,  it  is  ex¬ 
pedient  that  he  should  be  put  out  of  the  way ;  but  the  will 
of  the  nation  is  that  no  infliction  of  man’s  shall  descend  or 
those  who  are  already  borne  down  by  the  bitterest  calamity 
that  can  befall  our  species.  When  insanity  enters  our  own 
households,  or  strikes  down  our  friends,  we  realise  fully  the 
justice  and  wisdom  of  this  rule.  It  would  be  an  agonising 
thought  that  these  loved  ones,  loved  and  lost  awhile  in  the 
wilderness  of  madness,  were  liable  to  ignominious  punish¬ 
ment  for  any  rash  act  into  which  their  frenzy  might  hurry 
them. 

James  Cole’s  mental  condition,  now  and  at  the  time  of 


486 


Medical  Times  and  Gazette. 


COMPENSATION  AFTEE  BAILWAY  ACCIDENT. 


Oet.  27, 1S83. 


the  murder,  should  be  made  the  subject  of  thorough  investi¬ 
gation  by  physicians  skilled  in  probing  the  mind  in  health 
and  disease.  A  man  can  as  readily  read  all  the  lessons  of 
the  ophthalmoscope  at  one  sitting,  and  without  instruction, 
as  decide  on  the  presence  or  absence  of  mental  disease 
without  experience  and  training.  It  is  to  be  hoped,  therefore, 
that  Sir  William  Harcourt  will,  as  he  has  judiciously  done 
on  former  occasions  of  a  like  kind,  send  specialists  to 
examine  this  convict.  If  it  be  shown  that  there  are  or 
were  delusions  in  his  mind,  we  need  not  worry  ourselves 
with  refinements,  such  as  Mr.  Justice  Denman  would  pro¬ 
bably  delight  in,  as  to  whether  these  delusions  were  insu¬ 
lated  or  isolated,  or  transient  or  self-supporting.  Delusions 
of  persecution  compromise  the  whole  mind,  and  deprive 
their  victim  of  any  serviceable  knowledge  of  right  and 
wrong,  as  certainly  as  cataract  deprives  its  victim  of  vision. 


COMPENSATION  AFTER  RAILWAY  ACCIDENT. 
Among  the  many  difficult  problems  which  the.  medical  prac¬ 
titioner  is  called  upon  to  solve,  there  is  no  one  more  perplex¬ 
ing  than  that  of  estimating  the  value  of  health  and  life  after 
accident  or  injury.  With  the  requirements  of  modern  life, 
the  extending  employment  of  machinery,  and  the  facilities 
for  railway  travelling,  there  is  unfortunately  an  increasing 
number  of  victims,  the  result  of  dangers  inseparable  from 
these  advanced  products  of  civilisation.  When  individuals 
are  disabled,  they  naturally  look  to  those  responsible 
for  compensation,  and  the  pecuniary  consolation  accorded 
will  in  great  part  depend  upon  the  nature  and  extent  of 
the  injuries  they  have  received.  This  has  mainly  to  be 
determined  by  the  evidence  of  the  medical  man,  and 
there  is  no  physician  or  surgeon  who  may  not  at  some 
period  of  his  career  be  called  upon  to  form  an  opinion 
on  the  subject.  When  the  calamity  to  the  patient  con¬ 
sists  of  a  broken  bone  or  other  visible  surgical  injury, 
the  estimation  of  the  effects  and  probable  sequels  is  com¬ 
paratively  simple,  and,  moreover,  is  sooner  or  later  con¬ 
firmed  by  the  progress  of  the  case.  A  sufficiently  sound 
judgment  can  then  be  arrived  at,  as  to  the  loss  of  time  and 
money,  or  the  suffering  experienced  by  the  plaintiff.  It 
is  very  different,  however,  when  there  are  no  such  definite 
objective  conditions,  and  when  the  claimant  after  an  acci¬ 
dent  states  that,  although  he  bears  no  external  signs  of 
injury,  his  constitution  is  shattered,  and  he  is  disabled  in 
mind  and  body.  Such  persons  are  said  to  suffer  from  shock 
or  concussion,  the  most  typical  example  of  which  follows 
a  railway  collision.  In  such  an  accident  any  variety  of 
injury  may  occur  to  those  in  the  train,  depending  on  its 
severity  and  the  other  conditions  of  the  situation ;  but  at 
present  it  is  desired  to  direct  attention  more  particularly  to 
that  class  of  cases  in  which  the  traveller  at  the  time  receives 
no  apparent  serious  injury;  and  though  at  first  he  seems 
only  to  be  slightly  shaken,  yet  subsequently  developes  a 
variety  of  symptoms,  of  a  more  or  less  distressing  nature. 

A  man,  for  example,  is  in  a  train  during  a  collision.  He  re¬ 
ceives  a  violent  shock,  is  pushed  about,  and  is  much  alarmed. 
He  soon  finds,  however,  that  no  bones  are  broken,  and  that 
he  is  apparently  unhurt.  After  the  immediate  effects  of  the 
fright  have  passed  off,  he  assists  his  fellow-passengers,  and 
finally  walks  home,  feeling  somewhat  shaken,  and  though 
for  some  days  he  is  not  quite  himself,  he  otherwise  experi¬ 
ences  nothing  of  importance.  He  goes  to  business  as  usual, 
but  feels  indefinite  malaise,  with  loss  of  energy  and  vigour. 
This  continues  for  weeks,  months,  or  even  years,  and  these 
uneasy  sensations  so  increase  that  finally  he  has  to  give  up  his 
occupation,  and  acquires  an  assortment  of  symptoms  which 
cause  him  much  distress.  These  ailments  assume  a  variety 
of  forms,  and  sometimes  simulate  diseases  of  the  most 


serious  character.  The  patient  may  be  bedridden,  unable 
to  attend  to  his  affairs,  and  reduced  to  a  state  of  the  greatest 
misery.  Such  an  individual  and  his  friends  consider,  with 
justice,  that,  under  the  circumstances,  he  is  entitled  to 
compensation  from  the  railway  company.  This  being 
admitted,  the  question  arises  as  to  the  amount  of  such  re¬ 
paration,  and  this  depends  not  only  on  the  social  position 
of  the  claimant,  but  upon  the  nature  of  the  injury,  its 
severity,  and  the  prospects  of  recovery.  These  are  points 
which  the  medical  man  is  called  upon  to  decide.  Assuming, 
then,  that  an  individual  advances  a  compensation  claim  for 
alleged  ill-health  as  the  after-result  of  such  a  railway 
disaster,  the  first  point  to  be  determined  is  the  nature 
and  extent  of  the  disorder  under  which  the  patient 
at  present  actually  suffers,  as  well  as  its  probable  ter¬ 
mination.  In  the  second  place,  it  has  to  be  decided 
what  relation  the  existing  disease  bears  to  the  acci¬ 
dent — whether  it  was  primarily  caused  by  the  collision, 
or  whether  it  was  spontaneous  in  origin.  Both  of  these 
problems  may  sometimes  be  readily  determined ;  more 
generally  their  solution  is  very  difficult.  In  considering  the 
first,  the  disease  may  be  represented  by  an  infinite  variety 
of  forms,  some  of  which  are  easily  recognisable,  others 
extremely  doubtful.  Obvious  functional  conditions  may 
arise  as  the  result  of  emotion  or  fright,  or  grave  symptoms 
may  ensue  which  suggest  serious  organic  degeneration. 
When  the  sequences  of  an  accident  consist,  as  they  fre¬ 
quently  do,  of  these  last — namely,  pain  in  the  back,  paralysis, 
anaesthesia,  loss  of  mental  power,  and  so  on, — the  essential 
point  to  consider  is,  how  far  the  nervous  system  has  become 
impaired.  On  this  subject  two  somewhat  conflicting  views 
are  held.  There  are  those  who  consider  that  the  concussion 
or  shock  sets  up  organic  changes,  often  of  an  inflammatory 
type,  in  the  nerve-centres,  and  that  this  is  the  cause  of  the 
symptoms.  Under  such  a  view  it  is  obvious  that  the 
prognosis  in  advanced  cases  is  very  unfavourable,  and  would 
materially  influence  the  advice  given  by  a  medical  witness 
and  the  decision  of  a  jury.  There  are  others,  however,  who 
maintain  that  such  conditions  do  not  take  place,  or  at  all 
events  are  very  rare.  They  deny  the  fact  that  shock  by 
itself,  without  direct  injury  to  the  spinal  cord,  can  give  rise 
to  inflammation  of  that  centre.  They  consider  that  there 
is  no  evidence  of  this  either  clinically  or  pathologically,  and 
they  find  that  the  train  of  symptoms  in  the  majority  of 
cases  can  be  explained  on  other  grounds  ;  namely,  by  local 
injury  to  the  muscles,  tendons,  and  ligaments,  by  the  effects 
of  simple  fright  or  shock,  and  not  unfrequently  by  the 
exaggeration  or  even  the  manufacture  of  the  invalid 
condition.  The  prognosis  of  all  of  these  states  is  clearly 
more  or  less  favourable. 

The  truth  would  seem  to  lie  somewhere  between  these 
two  extremes.  Hitherto,  the  profession  has  been  inclined 
to  favour  more  exclusively  the  first  of  these  theories,  but 
doubtless  this  belief  has  been  carried  too  far,  and  many  cases, 
supposed  to  be  incurable,  have,  after  receiving  damages,  ulti¬ 
mately  recovered.  As  our  general  experience  of  the  nervous 
system,  and  our  knowledge  of  emotional  and  functional 
disorders  in  particular,  have  advanced,  there  has  been  a  ten¬ 
dency  to  see  that  many  of  such  cases  are  to  be  explained  by 
the  second  hypothesis,  and  that,  although  the  symptoms 
are  for  a  time  apparently  grave,  they  are  not  of  necessity 
hopeless.  While  it  is  admitted  that  organic  inflammatory 
change  in  the  central  nervous  system  after  indirect  injury 
is  rare,  it  is  still  uncertain  as  to  whether  or  not  it  may  take 
place  at  all ;  but  a  few  cases  on  record,  as  well  as  the  experi¬ 
ence  of  general  surgery,  seem  to  show  that  such  a  sequence 
of  events  is  not  impossible. 

The  second  question  is  even  more  difficult  to  settle, 
namely,  the  relation  the  accident  bears  to  the  existing  state 


Medical  Times  and  Gazette. 


THE  SANITARY  ADMINISTRATION  OF  LONDON. 


Oct.  27,  1883.  48  7 


of  the  patient.  In  many  cases  it  may  be  obvious  that  the  two 
are  intimately  associated;  in  others  this  is  not  so  apparent. 
For  example,  an  individual  may  suffer  little  or  nothing  at 
the  time  of  the  disaster,  or  for  weeks  or  even  months  after. 
Should  he  subsequently  develope  a  nervous  disorder,  is  this 
an  independent  disease,  or  was  it  primarily  created  by  the 
collision,  or  only  excited  by  it  in  a  constitution  predisposed 
to  disease  P  Because  a  person  with  a  malady  shows  that 
some  time  previously  he  had  been  involved  in  a  railway 
accident,  and  had  even  been  injured  by  it,  that  is  no  evidence 
that  the  particular  illness  now  complained  of  was  caused  by 
the  collision.  All  chronic  nervous  affections  are  obscure  in 
their  origin,  and  even  where  litigation  is  not  in  question 
they  are  attributed  by  the  patient  to  a  variety  of  causes,  not 
of  necessity  the  true  ones.  For  example,  a  man  strains 
himself ;  he  experiences  pain  in  the  back,  which  may  trouble 
him  for  years.  Should  he  afterwards  be  afflicted  with,  say, 
paralysis  agitans,  it  does  not  follow  that  the  strain,  with  its 
accompanying  pain,  was  the  cause  of  that  disorder,  although 
he  would  probably  connect  the  two  circumstances.  Nor  is  it 
probable  that  the  backache  had  anything  in  common  with 
the  central  lesion,  but  is  simply  a  muscular  or  ligamentous 
affection.  Mistakes  of  this  sort  are  frequently  made,  even 
by  medical  men,  and  are  the  result  of  want  of  experience  or 
deficient  knowledge  of  nervous  diseases. 

To  decide  this,  as  well  as  other  questions  connected  with 
this  difficult  subject,  a  careful  survey  of  all  the  facts  of  the 
case  must  be  made.  The  examination  of  the  claimant 
should  be  conducted  by  able  and  impartial  physicians  or 
surgeons,  as  well  as  by  competent  neurologists  well  skilled 
in  all  the  modern  methods  of  research.  A  thorough  investi¬ 
gation  into  the  legal  and  other  circumstances  of  the  case  is 
required,  and  a  thoughtful  consideration  and  careful  weigh¬ 
ing  of  both  sides  of  the  question  are  essential  to  arrive  at 
a  just  conclusion.  With  all  these  conditions  fulfilled,  and 
every  precaution  taken,  not  unfrequently  the  position  pre¬ 
sents  many  doubts  and  difficulties,  in  which  case  litigation 
will  probably  ensue,  when  it  behoves  the  members  of  our 
profession  to  display  impartiality,  knowledge,  judgment, 
and  temper.  It  unfortunately  too  often  happens  that,  under 
the  circumstances,  these  qualities  are  conspicuous  by  their 
absence  amongst  medical  witnesses,  giving  rise  to  unseemly 
contradictions  and  acrimonious  dissensions.  Such  unneces¬ 
sary  difference  of  opinion  is  probably  in  general  the  result 
of  ignorance,  and  of  employing  incompetent  investigators. 
Let  us  hope  that  less  often  it  is  due  to  partiality  and 
motives  of  interest.  To  arrive  as  nearly  as  possible  at  the 
truth  is  only  to  be  attained  by  the  employment  of  skilful 
and  well-informed  experts,  who,  on  whatever  side  they  may 
be  called,  will  approach  the  question  as  they  would  a  clinical 
case  or  scientific  problem,  and,  without  bias  or  interested 
motive,  give  an  opinion  strictly  in  accordance  with  the  facts 
before  them. 


THE  SANITARY  ADMINISTRATION  OF  LONDON. 

The  need  of  unity  in  the  sanitary  administration  of  the 
metropolis  was  the  subject  chosen  by  Dr.  Dudfield  for  his 
address  to  the  Society  of  Medical  Officers  of  Health,  which 
will  be  found  in  another  column.  By  unity  he  understood 
not  merely  uniformity  of  procedure,  but  identity  of  by-laws 
and  facilities  for  co-operation  among  the  various  local 
authorities.  At  present  there  are  no  fewer  than  thirty-nine 
such  bodies  constituted  by  the  Metropolis  Local  Manage¬ 
ment  Act,  besides  several  so-called  extra-metropolitan  district 
boards,  all  existing  and  acting  in  complete  independence 
one  of  another.  The  only  semblance  of  centralisation  or  com¬ 
bination  is  to  be  found  in  the  Metropolitan  Board  of  Works, 
whose  sanitary  functions  are  almost  limited  to  main  sewer¬ 


age,  and  the  Asylums  Board,  which,  though  properly  a  Poor- 
law  authority,  has  had  a  single  sanitary  function  committed  to 
it  by  a  recent  Act,  in  direct  contravention  of  the  principles  of 
Poor-law  administration.  Such  an  anomalous  state  of  things 
is  not  only  without  parallel  in  the  civilised  world,  but,  as  daily 
experience  shows,  is  highly  detrimental  to  the  public  health. 
Unity  and  co-operation  are  only  attainable  with  a  central 
authority  empowered  to  make  and  alter  by-laws  that  shall 
be  binding  on  all  the  subordinate  members  of  the  combina¬ 
tion,  and  with  a  single  office,  where  statistical  and  other 
information  from  all  parts  of  the  area  shall  be  received, 
collated,  and  registered.  The  arbitrary  and  antiquated  dis¬ 
tinction  between  the  City  of  London  and  the  metropolis  must 
be  abolished,  and  the  whole  of  London  brought  under  a  single 
jurisdiction.  Thus  far  all  are,  we  believe,  agreed  ;  but,  as  Dr. 
Dudfield  pointed  out,  there  are  at  least  two  distinct  methods 
by  which  the  desired  unity  may  be  secured.  The  entire 
government  of  the  metropolis  might  be  vested  in  a  single 
authority,  like  the  corporations  of  Liverpool  and  Birming¬ 
ham;  or,  the  local  administration  being  left  in  the  hands  of 
the  vestries,  the  general  supervision  and  legislation  might 
be  entrusted  to  a  body,  the  members  of  which  should  be 
elected  by,  and  from  among  those  of,  the  local  boards. 
Such  is  the  constitution  of  the  existing  Metropolitan  Board 
of  Works,  and,  in  a  smaller  area,  of  the  Court  of  Aldermen 
and  Commissioners  of  Sewers,  the  sanitary  authority  of  the 
City.  This  alternative  Dr.  Dudfield  very  properly  preferred, 
not  solely  as  being  less  revolutionary,  but  on  the  ground 
that  a  system  of  double  election  is  calculated  to  secure  the 
return  of  a  better  class  of  men  than  direct  popular  repre¬ 
sentation.  It  is  certain  that,  under  whatever  name,  such  a 
body  will  be  provided  by  the  long-talked- of  Metropolitan 
Municipal  Reform  Bill ;  and  we  agree  with  Dr.  Dudfield 
that  under  the  new  administration  the  medical  officer  of 
health  for  the  City  should,  as  primus  inter  pares,  act  as 
director  of  his  brother  officers,  and  as  medical  adviser  to  the 
central  authority. 

But  here  we  must  stop,  and  assert  our  decided  dissent 
from  other  opinions  expressed  by  Dr.  Dudfield.  If  all  ves¬ 
tries  were  as  intelligent  as  his,  and  all  medical  officers  of 
health  as  able  as  himself,  we  might  be  well  content  to  leave 
matters  as  they  are ;  but  there  is  no  shutting  our  eyes  to 
the  fact  that  this  is  not  the  case.  We  feel  strongly  that  the 
functions  of  a  medical  officer  of  health  are,  in  every  sense  of 
the  word,  inspectorial :  he  is  an  inspector  of  every  place, 
thing,  person,  and  act  that  affects  in  any  way  the  health  of 
the  community :  and  he  ought  to  be,  like  other  inspectors, 
independent  of  the  favour  of  those  over  whom  he  has  to 
watch.  The  present  mode  of  appointment  is  as  absurd  as 
if  the  inspectors  of  shipping,  mines,  factories,  etc.,  were  to 
be  appointed  by,  and  removable  at  the  pleasure  of,  the 
owners  of  ships,  collieries,  and  manufactories.  The  very 
class  among  whom  the  chief  obstructors  and  offenders 
against  the  Sanitary  Acts  are  to  be  found— owners  of  un¬ 
healthy  houses,  ‘"jerry”  builders,  unscrupulous  dealers  in 
food,  etc. — can  always  make  their  influence  felt  in  the  deli¬ 
berations  of  vestries  and  local  boards,  though  they  may  not 
be  as  plain-spoken  as  the  town  councillor  of  Sheffield,  who 
maintained  that  they  ought  “  to  be  able  to  kick  their  own 
nigger,”  i.e.,  their  medical  officer  of  health. 

If  the  sanitary  administration  of  London  is  to  be  entrusted 
in  the  future,  as  in  the  past,  to  local  authorities,  it  will  at 
least  be  necessary  that  exclusively  local  interests  should  be 
so  far  as  possible  neutralised  by  the  merging  of  petty 
parishes  in  large  areas  commensurate  with  the  metropolitan 
boroughs,  or,  in  such  parishes  as  Islington,  Kensington,  and 
St.  Pancras,  that  the  medical  officers  of  health  should  be 
precluded  from  the  more  laborious  forms  of,  if  not  from 
all,  private  practice,  and,  of  course,  adequately  paid,  so  as 


488 


Mjdlcal  Times  and  Gazette. 


CHRONICLE  OE  THE  WEEK. 


Oct.  27,  188?. 


to  secure  men  who  intend  to  do  their  duty  and  to  take 
an  active  interest  in  their  work,  instead  of  seeking  the 
office  merely  for  the  sake  of  a  certain  addition  to  their 
incomes ;  and,  lastly,  that  the  appointments  be  not  simply 
approved  on  legal  grounds,  but  inquired  into,  and,  if  found 
to  have  been  “contrary  to  the  evidence”  of  fitness,  reversed 
by  some  higher  authority,  presumably  above  suspicion  of 
partiality  or  interested  motives — say  the  Local  Government 
Board,  acting  on  the  advice  of  its  medical  officer.  That 
some  such  safeguard  is  not  uncalled  for,  and  that  the 
vestries  of  the  largest  may  be  as  incompetent  and  perverse 
as  those  of  the  smallest  parishes,  the  whole  story  of 
Lambeth  and  its  successive  medical  officers  affords  ample 
proof. 


CHRONICLE  OF  THE  WEEK. 

- o- - 

The  inaugural  meeting  of  the  present  session  of  the 
Loyal  Medical  and  Chirurgical  Society  was  held  on  Tuesday 
evening  last,  and  was  very  largely  attended.  The  renewed 
vigour  which  characterised  the  meetings  during  the  past 
session,  under  Mr.  Marshall's  presidency,  showed  no  signs 
of  abatement  on  this  occasion.  This  meeting  was  both  a 
general  and  a  special  one  :  special,  in  order  to  elect  a 
Medical  Secretary  (whpn  the  choice  unanimously  fell  on 
Dr.  Lichard  Douglas  Powell),  in  the  room  of  Dr.  Southey, 
who  resigned  on  receiving  an  appointment  in  the  Govern¬ 
ment  Lunacy  Department;  general,  for  the  ordinary  work 
of  the  Society,  when  Dr.  Perrier,  their  Marshall  Hall  prize¬ 
man,  gave  a  brief  but  lucid  address  on  the  advances  recently 
made  in  neuro-pathology.  As  we  furnish  an  abstract  of 
this  address,  and  the  remarks  to  which  it  gave  rise,  in 
another  part  of  the  journal,  it  will  suffice,  in  this  place,  to 
say  that  the  author  handled  his  subject  en  maitre,  and  more 
than  earned  the  President’s  eulogy,  that  “  not  many  men 
could  have  treated  such  an  intricate  subject  so  briefly  and 
yet  with  such  clearness  and  lucidity,” — a  sentiment  which 
found  universal  acceptance  by  those  present.  Brains  of 
dogs  and  monkeys,  with  the  cortical  centres  mapped  out 
according  to  Hitzig  and  to  Perrier,  were  shown,  as  also 
many  casts  and  photographs  of  brains  illustrating  diseases 
or  lesions  associated  with  loss  or  impairment  of  function. 


The  Society  of  Medical  Officers  of  Health  held  their 
opening  meeting  on  the  19th  inst.,  when  Dr.  Dudfield,  the 
newly  elected  President,  delivered  an  inaugural  address  on 
“  Metropolitan  Sanitary  Administration,”  which  will  be 
found  in  another  column.  All  idea  of  combined  action,  he 
contended,  whether  for  the  general  good  or  the  saving  of 
power,  was  out  of  the  question  so  long  as  the  sanitary 
government  of  London  was  in  the  hands  of  thirty-nine  local 
and  independent  bodies,  besides  two — the  Metropolitan 
Board  of  Works  and  the  Asylums  Board— with  a  more 
general  jurisdiction,  but  the  last  only  a  sanitary  authority 
in  virtue  of  an  accident  or  fictitious  interpretation,  if  not  a 
contravention,  of  the  law.  Dr.  Dudfield  did  not  advocate 
the  supersession  of  the  existing  district  boards  and  vestries 
by  any  new  and  untried  authority,  but,  leaving  the  local  ad¬ 
ministration  in  their  hands,  would  effect  the  desired  unity  of 
action  by  constituting  a  General  Board,  in  which  he  would 
vest  the  supervision  of  the  whole,  and — -what  he  held  to  be 
absolutely  essential — the  unrestricted  power  of  making  and 
altering  by-laws.  The  members  of  this  Board,  whether  it 
took  the  form  of  a  reformed  corporation  representing  the 
whole  metropolis,  or  of  the  Metropolitan  Board  of  Works, 
including  the  City  in  its  j  urisdiction,  should  be  elected  from 
and  by  those  of  the  subordinate  boards,  not  by  the  rate¬ 
payers  at  large.  The  Medical  Officer  of  Health  of  the  City, 


acting  as  medical  adviser  to  the  Board,  should  receive  all 
reports  from  the  local  authorities,  inspect,  collate,  and 
tabulate  them,  and  issue  a  general  report  for  the  metropolis. 


The  anti-vivisectionists  lost  a  great  opportunity  on 
Thursday  week,  when  the  remains  of  William  Harvey — 
the  arch-vivisector — were  ceremoniously  enshrined  in  marble 
by  certain  members  of  the  Association  for  the  Advancement 
of  Medicine  by  Lesearch,  acting  in  their  official  capacity  as 
President,  Censors,  and  Fellows  of  the  Loyal  College  of  Phy¬ 
sicians.  The  whole  ceremony  was  as  much  a  challenge  to  the 
Editor  of  the  Spectator  and  his  friends,  as  an  Orange  proces¬ 
sion  to  the  wearers  of  the  Green,  and  in  less  degenerate  days 
they  would  doubtless  have  set  upon  the  robed  physicians 
with  staff  and  truncheon,  seized  by  force  upon  the  leaden 
shell,  and  scattered  to  the  four  winds  of  heaven  whatever 
dust  or  other  relics  of  mortality  it  contained.  The  anti- 
vivisectionists,  however,  are  wise  in  their  generation  ;  they 
have  discovered  a  better  way  of  wounding  the  living  than 
by  attacks  upon  the  dead.  So  the  physicians  were  allowed 
to  complete  their  curious  mediaeval  ceremony  in  peace. 


There  is  perhaps  in  this  country  no  other  body  but  the 
College  of  Physicians  which  could  have  carried  out  such  a 
function  without  a  loss  of  dignity.  Municipal  pageantry 
invariably  excites  a  smile  or  a  sneer,  for  it  seizes  on  the 
slightest  and  least  appropriate  occasions  to  emphasise  the 
fact  of  its  survival.  But  the  ceremonial  state  of  the  College 
of  Physicians  is  so  seldom  seen  out  of  doors,  that  when  it  is 
at  length  brought  out  for  a  unique  occasion,  the  public  greets 
it  with  sympathy  and  respect.  We  said  a  week  or  two  ago 
that  the  basis  of  dignity  is  faith,  and  the  College  has  not  yet 
felt  the  influence  of  the  nihilistic  attitude  common  amongst 
younger  members  of  the  profession.  The  voice  of  youth  is 
hushed  within  the  portals  of  Pall-mall,  and  when  Sir  William 
Jenner  appears  abroad  in  solemn  state,  bearing  the  very 
caduceus  which  Harvey  must  have  seen,  and  which  we 
suppose  is  but  a  survival  of  the  divining-rod,  the  youngest 
Fellow  of  the  College  feels  that  even  the  most  courteous 
criticism  would  be  out  of  place.  For  our  own  part,  we  love 
these  old  ceremonies,  which  tell  of  the  continuity  of  our 
art,  and  of  our  lineal  descent  from  the  men  who  were  great 
physicians,  though  they  had  only  their  unaided  sight  and 
touch  and  their  good  sound  sense  to  guide  them.  The 
caduceus  is,  after  all,  a  better  emblem  of  medical  art  than 
the  bacillum. 


On  Wednesday  last  a  testimonial,  consisting  of  an  album 
containing  the  signatures  of  the  subscribers,  and  a  cheque 
for  .£200,  was  formally  presented  to  Prof.  Bentley,  who 
has  recently  retired  from  the  office  of  Dean  of  the  Medical 
Faculty  in  King's  College,  after  holding  it  for  a  period  of 
twenty  years.  The  testimonial  was  presented  on  behalf  of 
the  committee  by  Dr.  George  Johnson ;  Mr.  Bowman,  as 
representing  the  Council  of  the  College,  and  the  Lev.  Canon 
Barry,  as  representing  its  academical  staff,  adding  a  few 
words  in  testimony  of  their  regard  for  the  services  and 
character  of  the  retiring  Dean.  Mr.  Bentley  expressed  his 
gratitude  in  a  speech  which  was  frequently  interrupted  by 
the  applause  of  a  crowded  theatre.  It  is  hardly  fair  to  Prof. 
Bentley  to  say  of  him,  as  was  said  at  the  presentation  of  the 
testimonial,  that  he  had  never  made  an  enemy,  for  that  is  a 
form  of  speech  often  applied  to  men  who  but  moderately 
deserve  it.  It  would  be  a  better  compliment  to  say  of  him  that 
no  one  ever  thought  for  a  moment  of  becoming  his  enemy. 
Throughout  his  long  occupation  of  his  place  in  the  Marsden 
Library  he  showed  such  a  sympathetic  insight  into  the  minds 
of  those  with  whom  he  came  in  contact,  and  put  himself  so 
successfully  on  every  occasion  in  their  place,  that  they  would 


Medical  Times  and  Gazette. 


CHRONICLE  OF  THE  WEEK, 


Oct.  27,  1883.  489 


as  soon  have  thought  of  falling  out  with  themselves  as  with 
this  kind  and  single-minded  friend.  It  had  been  his  aim, 
he  said  in  his  speech,  to  be  one  with  the  students  in  their 
joys  and  in  their  sorrows ;  and  he  succeeded  so  well  in  it, 
that  even  the  disgraced  student  passed  out  of  the  College 
with  one  unrancorous  memory. 


The  success  of  Prof.  Bentley  in  his  long  Deanship  may 
suggest  to  other  medical  schools  whether  it  might  not  be  as 
well  to  secure  for  their  dean  one  who,  not  being  embarrassed 
by  the  cares  and  anxieties  of  practice,  or  forced  by  their  in¬ 
creasing  stress  to  resign  his  office  prematurely,  might  enter 
more  fully  into  the  lives  and  interests  of  a  long  succession 
of  students,  and  so  give  increased  solidarity  to  the  sup¬ 
porters  of  the  school.  A  dean,  to  justify  his  name,  should 
represent  the  traditions  and  the  unity  of  the  school  over 
which  he  presides ;  he  should  be  a  more  permanent  officer 
than  the  lecturers,  instead  of  being  less  permanent,  as  he 
often  is  at  many  hospitals  ;  and  his  eye  should  be  fixed  on 
the  success  of  his  hospital,  instead  of  being  liable  to  be  drawn 
away  from  it  by  the  glitter  of  fees.  Busy  as  he  was  in  other 
directions,  Prof.  Bentley  found  time  to  take  an  interest  in 
every  individual  of  a  long  line  of  students ;  and  other  deans 
may  rival  him  in  this,  though  his  other  qualities  may  prove 
beyond  their  powers  of  imitation. 


In  London,  during  last  week,  205  deaths  occurred  from 
preventable  diseases,  and  47  from  more  or  less  preventable 
accidents.  That  is  to  say,  if  our  sanitary  legislation  had 
been  more  satisfactory,  our  sanitary  administration  more 
efficient,  and  individuals  had  been  more  careful  and  sensi¬ 
tive  to  their  responsibilities,  the  death-rate  for  the  week 
might  have  been  under  15-0  instead  of  over  18-0.  These  252 
deaths,  66  of  which  were  from  scarlet  fever,  25  from  measles, 
28  from  diphtheria,  and  24  from  fractures  and  contusions 
the  result  of  negligence  or  accident,  are  mostly  a  real  loss 
to  the  community.  They  represent,  in  many  cases,  healthy 
and  useful  lives,  and  differ  altogether  from  the  other  great 
category  of  mortality — the  252  deaths  from  respiratory 
diseases, — many  of  which,  occurring  in  worn-out  and  weakly 
constitutions,  mean  only  a  salutary  weeding-out  of  the 
population.  Zymotic  disease  pricks  for  death,  blindly ;  and 
negligence  quite  as  often  selects  out  of  existence  the  un¬ 
offending  as  well  as  the  careless.  There  were  during  the 
week,  instead  of  the  usual  allowance  of  six,  only  two  sui¬ 
cides  ;  and  one  of  these,  if,  as  we  imagine,  it  represents  the 
death  of  the  Afghan  student,  would  have  been  prevented  if 
it  could  but  have  been  delayed.  Of  the  twenty-eight  great 
towns  only  eight  had  a  mortality  of  over  20'0.  It  would  be 
interesting  to  inquire  why,  while  Norwich  can  send  in  a 
return  of  11T,  and  Bristol  one  of  15'0,  Brighton  has  a 
mortality  of  21T.  It  cannot  be  right  that  London-on-the- 
Sea  should  have  a  higher  death-rate  than  London-in-the- 
Fogs. 

Dr.  Koch  appears  to  have  been  somewhat  premature  in 
assuming  that  the  cholera  infection  in  Egypt  had  lost  its 
virulence.  Deaths  are  daily  occurring  in  Alexandria,  and 
towards  the  end  of  last  week  a  brisk,  though  limited,  out¬ 
break  was  reported  in  a  village  near  Ramleh,  previously 
passed  over  by  the  epidemic.  It  is  attributed  by  some  to 
the  percolation  of  infective  matter  into  a  small  half- 
stagnant  canal,  which  supplies  the  infected  village  with 
water ;  by  others,  to  the  discontinuance  of  sanitary  precau¬ 
tions  in  the  decline  of  the  epidemic.  That  is  like  leaving 
open  the  stable  door  when  the  thief  has  left  some  steeds 
against  his  next  visit — a  degree  of  folly  which  never  entered 
into  the  calculation  of  the  proverb-maker.  But  the  foolish¬ 
ness  of  Orientals  is  beyond  the  conception  of  the  English 


mind.  The  Minute  in  which  the  Egyptian  Board  of  Health 
has  protested  against  Surgeon- General  Hunter’s  conten¬ 
tion  that  cholera  has  been  endemic  in  Egypt  since  1865, 
is  so  remarkable  for  its.  folly  and  insolence  that  it  is 
worth  reproducing.  “  The  Board  of  Health  declares,  first, 
that  Dr.  Hunter  has  never,  during  his  short  stay  in  some 
portions  of  Lower  Egypt,  been  able  to  make  personal 
observations  which  would  justify  his  expressing  any  such 
opinion,  and  that  it  is  perfectly  certain  that  the  information 
collected  by  him  during  his  voyage  has  come  from  persons 
absolutely  ignorant  of  medicine;  secondly,  that  Drs.  Sonsino, 
Ambron,  and  Seirra,  according  to  declarations  which  they 
have  made  to  the  Board  of  Health,  assert  the  contrary,  and 
that,  according  to  them,  endemic  cholera  has  never  existed 
in  Egypt.”  A  more  satisfactory  item  from  Egypt  is  the 
intelligence  that  Dr.  Crooksliank  has  been  appointed  Medical 
Inspector-General  of  Egyptian  Gaols — a  position  in  which 
he  will  no  doubt  render  able  service. 


There  seems  to  have  been  lately  an  epidemic  of  abortions. 
Whether  the  police  are  more  on  the  alert,  or  the  public  con¬ 
science  is  becoming  less  sensitive  on  the  subject,  it  is  difficult 
to  say ,-  but  it  is  probable  that  at  no  time  within  living 
memory  has  the  trade  of  the  abortionist  been  more  thriving 
— at  any  rate  for  himself — than  at  present.  The  second  of 
the  explanations  given  seems  the  more  likely.  No  doctor  can 
be  blind  to  the  fact  that  in  the  ethics  of  men,  and  certainly  in 
those  of  women,  the  crime  of  abortion  is  not  nearly  so  harshly 
condemned  as  the  law  condemns  it.  Ladies,  the  pattern  of 
strictness  and  propriety  in  all  their  other  dealings,  who  would 
shrink  with  horror  from  the  idea  of  openly  breaking  any  of 
the  commandments,  will  propose  to  their  medical  attendant 
that  he  should  put  an  artificial  end  to  their  pregnancy,  with 
almost  as  much  coolness  as  they  would  ask  him  to  cauterise 
a  wart ;  and  they  will  tell  him  that  not  only  do  they  see  no 
harm  in  it,  but  that,  as  it  would  be  to  the  marked  advantage 
of  their  own  health  and  their  husband’s  temper,  it  must  be 
virtuous  rather  than  the  reverse  to  accede  to  their  request. 
We  have  no  desire  to  comment  on  the  cases  now  before  the 
public,  but  it  seems  rather  important  to  notice  the  dis¬ 
crepancy  between  the  law’s  teaching  and  the  public  con¬ 
science  on  the  subject.  The  medical  conscience  is,  at  any 
rate  in  quarters  which  have  the  slightest  claim  to  respect¬ 
ability,  explicitly  on  the  side  of  the  law,  and  the  question 
is,  whether  the  lawyers  and  doctors  will  have  to  come  down 
to  the  level  of  the  pregnant  woman’s  ethics,  or  raise  hers 
and  a  more  or  less  sympathising  public’s  up  to  theirs.  Equi¬ 
librium  must  be  obtained  in  some  way,  or  we  shall  find  the 
juries  refusing  to  convict,  as  they  have  so  often  done  in  the 
case  of  maternal  infanticide. 

“  Young  man,  if  you  find  no  knife  and  fork  laid  for  you  at 
Nature’s  table,  you  had  better  die.”  These  hard  words  of 
Jeremy  Bentham’s  are  the  comment  of  one  of  the  daily 
papers  on  the  death  of  the  poor  Afghan  student,  who  last 
week  took  prussic  acid,  because  no  one  in  England  would  take 
his  prescriptions,  and  pay  for  them.  But  it  was  not  because 
Nature  had  no  place  for  him  that  the  disappointed  Oriental 
sadly  resolved  to  leave  the  world.  It  was  because  he  had 
not  the  sense  to  see  what  place  Nature  had  kept  open  for 
him,  but,  drawn  away  by  the  glitter  of  Western  civilisation, 
strove  to  take  his  seat  at  a  table  for  which  Nature  never 
meant  him.  If  Mahomed  Khan  had  not  forsaken  men  of  his 
own  colour,  who  are  crying  out  for  skilled  medical  help, 
there  is  little  doubt  that  he  would  have  found  plentiful 
opportunities  of  working  and  feasting  at  Nature’s  expense. 
The  fact  is  constantly  being  proved  to  us  by  repeated 
examples,  that  if  we  try  to  run  an  Eastern  mind  into  a 
Western  mould,  the  former,  supple  and  pliant  as  it  may  be, 

* 


490 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Oct.  27,  1883. 


will  be  inevitably  spoilt,  and  rendered  unfit  for  future  use.  It 
is  a  mistake  to  tempt  men  away  from  India  and  other  Eastern 
countries,  in  order  to  train  them  according  to  a  pattern  con¬ 
trived  for  men  of  sturdier  build.  If  Orientals  are  to  be 
indoctrinated  in  the  sciences — and  science,  like  sunshine,  is 
as  much  for  them  as  for  us, — it  should  be  in  their  own 
country,  by  means  adapted  to  their  different  cast  of  mind, 
and,  if  possible,  by  men  of  their  own  colour.  This  truth  is 
being  borne  in  upon  our  Indian  authorities,  who  find  that 
Western  ideas  must  be,  so  to  speak,  polarised  before  they 
can  be  a  safe  illuminant  to  men  of  Eastern  birth.  The  idea 
that  English  modes  of  thought  must  be  a  heaven-sent 
blessing  to  whomsoever  they  are  communicated,  is  already 
an  exploded  fallacy ;  and  the  story  of  the  dead  Afghan  is  but 
another  proof  of  this. 

No  one  who  has  the  future  welfare  of  our  hospitals  at 
heart  can  fail  to  sympathise  with  the  suggestion  of  Mr. 
Samuel  Morley  and  the  Vice-Presidents  of  the  Hospital 
Saturday  Fund,  that  the  working  men  who  subscribe  to 
that  Fund  should  be  empowered  to  elect  a  life-governor  to 
every  institution  to  which  they  contribute  material  support. 
Many  of  the  present  governors  of  our  hospitals  would,  no 
doubt,  enter  a  strong  protest  against  the  admission  of  any 
representative  of  the  proletariat  to  their  annual  meeting 
They  have  strong  ideas  on  the  inviolability  of  caste,  and 
think  that  they  are  according  the  working  man  quite  suffi¬ 
cient  privileges  in  admitting  him  to  their  wards.  A  few 
years  ago  the  representatives  of  the  large  friendly  societies 
promised  the  committee  of  a  certain  provident  dispensary 
that  they  would  induce  five  thousand  subscribing  members 
to  join  it  on  condition  of  having  two  representatives  on  the 
committee,  but  it  was  found  impossible  to  stomach  this 
proviso ;  the  offer  was  refused,  and  the  societies  formed  a 
provident  dispensary  of  their  own.  The  same  thing  may 
take  place  in  the  not  distant  future  in  the  case  of  our  hos¬ 
pitals,  if  some  such  suggestion  as  that  of  Mr.  Morley  is  not 
adopted.  Our  hospitals  cannot  long  prosper  on  the  present 
hand-to-mouth  system.  The  public  will  soon  grow  weary  of 
amateur  concerts  and  fancy  fairs,  and  then,  as  private  sub¬ 
scriptions  fall  off  more  and  more,  only  two  alternatives  will 
be  left — either  to  introduce  a  provident  system  on  a  grand 
scale,  and  make  the  poor  support  their  own  hospitals ;  or 
else  to  establish  the  continental  system  of  State-supported 
hospitals.  No  one  can  doubt  which  is  the  juster  and 
healthier  arrangement. 

Thebe  are  some  very  noteworthy  articles  in  some  of 
this  week’s  foreign  journals.  The  Revue  de  MSdecine 
contains — -“  Eecherches  experimentales  ayant  pour  but 
de  transformer  le  Tubercule  vrai  ou  infectieux  en  corps 
etranger  inerte,”  by  MM.  J.  Parrot  and  H.  Martin ;  “  Con¬ 
tribution  a  l’Histoire  de  l’Orchite  typhoidique,”  by  M. 
Auguste  Ollivier ;  “Etude  critique  et  clinique  de  la  doc¬ 
trine  des  Localisations  motrices  dans  l’Ecorce  des  Hemi¬ 
spheres  cerebraux  de  l’Homme,”  by  MM.  Charcot  and 
Pitres;  and  “Contribution  a  la  Pathologie  des  Nevroses 
intestinales,”  by  M.  Cherchevsky.  The  Revue  de  Chirurgie 
contains — “La  Maladie  kystique  des  Mamelles,”  by  M.  P. 
Eeclus  ;  “  De  la  Gangrene  gazeuse  foudroyante,”  by 
M.  Trifaud ;  and  “  Note  sur  la  Pathogenie  des  Kystes 
dermoides,”  by  M.  Nicaise.  The  Progres  Medical  contains 
a  lecture  by  M.  Simon,  on  “  Fievres  intermittentes  chro- 
niques,”  and  one  by  M.  Ch.  Monod,  on  “  Tuberculose 
testieulaire  et  Castration,”  and  an  article  by  M.  Rabatoux, 
entitled  “Necrose  des  Os  du  Nez  :  Expulsion  de  la  partie 
centrale  du  sphenoide.”  The  Gazette  Mddicale  de  Paris 
contains  “  IJn  cas  de  recedive  de  Zona.”  The  Gazette  des 
Hojgitaux  contains  an  article  by  M.  Polaillon,  “  Sur 


l’lncertitude  du  Prognostic  de  POvariotomie,”  and  a  review 
on  “  Erytheme  polymorphe  dans  l’lnfection  puerperale.” 

In  the  Centralblatt  fiir  Klinische  Medicin  are  contained 
abstracts  of  papers — by  M.  Afanassiew,  on  Icterus  and  Hsemo- 
globinuria,  artificially  produced;  and  by  Chvostek,  on  the 
Diagnosis  of  Duodenal  Hlcer.  Prof.  Baumgarten,  of  Konigs- 
berg,  contributes  an  account  of  his  researches  into  the 
Pathogenetic  Importance  of  the  Tubercle  Bacillus  to  the 
Centralblatt  fur  die  Medicinischen  Wissenschaften,  which 
contains  also  abstracts  of  papers— on  the  Anatomy  of 
the  Larynx,  by  M.  Simanovsky;  on  the  Etiology  of  Floating 
Kidney,  by  Senator ;  and  on  certain  Microscopic  Changes 
in  the  Middle  and  Internal  Ear  after  Diphtheria,  by  Moos 
and  Steinbrugge.  The  Centralblatt  fur  Chirurgie  presents 
an  original  paper  on  a  case  of  Ossifying  Enchondroma  of 
the  Scalp,  by  Dr.  Baumuller :  abstracts  of  papers — by  MM. 
0.  Heubner  and  J.  A.  Korteweg,  on  Diphtheria  and  Croup ; 
and  by  D.  Bajardi,  on  the  Eegeneration  of  Bone  and  of  Bone- 
Marrow  in  the  Long  Bones — are  also  contributed.  The  Cen¬ 
tralblatt  fiir  Gyndkologie  contains  an  account  of  a  Modifica¬ 
tion  of  Porro’s  Operation,  by  Dr.  Heusner;  and  a  report  of 
a  paper  on  Extra-Uterine  Pregnancy,  read  at  the  late 
meeting  of  the  Association  of  German  Naturalists  held  at 
Freiburg,  with  an  account  of  the  debate  following  it.  In  the 
Berliner  Klinische  Wochenschrift ,  Drs.  Harnack  andMennicke 
discuss  the  respective  activity  of  the  various  preparations  of 
Aconitine  at  present  in  use  ;  Dr.  Wildt  recounts  a  case  of 
Successful  Laparo-Hysterectomy  in  Cairo;  and  Dornig,  of 
Laibach,  gives  the  notes  of  a  case  of  Combined  Scarlatina 
and  Variola.  The  Wiener  Medizinische  Wochenschrift  con¬ 
tains  papers — by  Prof.  Dresche,  on  the  Spread  of  Cholera  by 
means  of  Inanimate  Objects  ;  and  by  Dr.  Pimser,  of  Trieste, 
on  a  series  of  cases  of  Hepatic  Abscess  following  Dysentery. 


RESECTION  OF  THE  PYLORUS. 

This  operation  appears  to  be  gaining  in  favour  at  Vienna, 
and  there  are  at  present  several  cases  in  the  wards  of  the 
General  Hospital,  in  which  it  is  proposed  to  perform  it. 
Hitherto  the  results  have  been  disappointing.  Dr.  Wolfler, 
Professor  Billroth’s  assistant,  recently  attempted  the  opera¬ 
tion  in  an  advanced  case  of  carcinoma,  but  the  adhesions 
were  so  numerous  that  he  was  unable  to  complete  it,  and 
had  to  get  over  the  difficulty  by  making  an  artificial  con¬ 
nexion  between  the  stomach  and  the  small  intestines.  The 
patient,  however,  died  a  few  hours  after  the  operation. 
A  more  satisfactory  record  will  be  found  in  the  Wiener  Medi- 
cinische  Wochenschrift,  Nos.  23  find  24,  which  contain  an 
account  of  a  successful  resection  of  the  pylorus  and  some 
observations  on  a  “  gastroscopic  ”  symptom  of  cancer  of 
the  stomach,  by  Professor  Mikulicz,  of  Cracow.  The 
patient  was  a  peasant,  twenty-five  years  of  age,  the 
mother  of  three  healthy  children.  Hp  to  five  months 
previously  she  had  been  in  perfect  health,  but  since  that 
time  had  suffered  from  bad  appetite,  and  discomfort  and 
pain  in  the  stomach  occurring  some  hours  after  food.  For 
the  last  three  months  she  had,  in  addition,  suffered  from 
repeated  vomiting.  On  admission  into  the  Cracow  Hos¬ 
pital,  on  February  9,  1883,  her  condition  was  as  follows : — 
Nutrition  fairly  good;  skin  and  mucous  membranes  pale ; 
both  breasts  swollen,  red,  and  painful  to  pressure  (the 
patient  having  only  just  weaned  her  last  child),  but  not 
diseased;  abdomen  somewhat  distended;  abdominal  walls 
thin ;  in  the  epigastric  region  a  hard,  apparently  mov¬ 
able  tumour,  the  size  of  a  goose’s  egg  and  painful  to 
pressure,  was  made  out.  The  stomach  was  considerably  dis¬ 
tended,  its  lower  border  reaching  to  three  fingers’  breadth 
below  the  navel.  Bowels  constipated  ;  urine  normal.  The 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Oct.  27,  1883.  491 


diagnosis  of  carcinomatous  stricture  of  the  pylorus  was 
made.  For  the  two  days  preceding  the  operation,  which 
was  performed  on  February  22,  the  patient  had  only  fluid 
diet,  and  immediately  before  it  the  stomach  was  washed  out 
with  warm  water.  The  operation  was  performed  in  the 
usual  manner,  and  lasted  two  hours  and  a  half.  The  tumour 
was  freely  movable.  No  spray  was  used,  and.  iodoform 
dressing  without  drainage  was  employed.  The  portion  re¬ 
moved  measured  three  inches  in  length  ;  and  included,  of 
course,  the  pyloric  opening,  which  was  found  to  be  so 
narrowed  that  a  little  finger  could  scarcely  be  passed 
through  it.  Microscopic  examination  showed  the  growth 
to  be  a  colloid  cancer.  An  enlarged  lymphatic  gland 
removed  at  the  same  time  showed  no  trace  of  cancer  ele¬ 
ments.  There  was  very  little  shock  after  the  operation,  the 
pulse  the  same  evening  being  72,  and  the  temperature  98'5U. 
On  the  evening  of  the  second  day  the  patient  vomited  twice, 
and  several  times  on  the  third,  fourth,  and  fifth  days  ;  but 
on  the  sixth  day  the  vomiting  ceased.  The  vomited  matter 
consisted  each  time  of  mucus  without  any  admixture  of 
bile.  The  pulse  and  temperature  remained  normal  through¬ 
out,  except  on  the  fifth  day,  when  the  temperature  reached 
103-5°  and  the  pulse  112  ;  and  on  the  evening  of  that  day  the 
patient  had  an  offensive  diarrhoea.  During  the  first  five 
days  she  took  cold  water  by  the  mouth,  and  was  fed  by  the 
rectum  with  peptonised  enemata.  On  the  sixth  day  she 
had  soup  and  eggs,  and  on  the  eighth  solid  food.  On  the 
twentieth  day  the  dimensions  of  the  stomach  were  normal, 
and  the  patient  suffered  from  no  gastric  troubles.  On 
March  22,  the  twenty-eighth  day  after  the  operation, 
she  left  the  hospital  in  good  health. 

From  a  consideration  of  the  absence  of  all  signs  of 
peritonitis  in  the  case  ;  from  the  course  which  the  wound 
took,  healing  by  first  intention ;  from  the  considerable 
dilatation  of  the  stomach  that  existed  from  the  third  to  the 
fifth  day;  and  from  the  character  of  the  vomited  matter, 
Mikulicz  considers  that  the  vomiting  was  due  to  a  com¬ 
plete  but  temporary  obstruction  of  the  new  pyloric  orifice. 
The  cause  of  the  obstruction  he  thinks  might  have  been 
due  to  an  inflammatory  swelling  of  the  wound  at  the 
pylorus ;  or  the  dilatation  of  the  stomach  and  the  weak¬ 
ness  of  its  walls  might  be  insufficient  to  propel  the  con¬ 
tents  through  the  new  orifice.  According  to  Mikulicz, 
32  cases  of  resection  of  the  pylorus  have  been  published, 
of  which  24  ended  fatally,  and  8  recovered.  Of  the  8 
successful  cases,  2  were  operated  upon  for  ulcer  of  the 
stomach,  and  6  for  cancer.  Of  the  24  unsuccessful  cases, 
23  were  for  cancer,  and  1  for  ulcer.  In  21  of  the  24  fatal 
cases  the  cause  of  death  is  given:  15  died  of  collapse, 
1  of  inanition,  and  5  of  peritonitis —the  peritonitis  in 
two  cases  being  due  to  perforation  at  the  seat  of  union, 
and  in  two  cases  to  gangrene  of  the  transverse  colon.  These 
four  fatal  cases  of  peritonitis,  and  the  case  of  inanition, 
were  due  to  causes  which  at  the  present  time  might  be 
avoided.  The  large  number  of  cases  which  died  of  collapse, 
Mikulicz  considers  with  Billroth  to  be  due  to  the  general 
marasmic  condition  of  the  patients,  and  to  the  severity  of 
the  operation  in  those  cases  where  the  tumour  was  large 
and  had  formed  adhesions  to  neighbouring  parts.  Only 
cases  where  the  patient  is  well  nourished,  and  the  tumour 
of  moderate. size  and  movable,  are,  he  considers,  suitable  for 
operation.  The  future  of  resection  of  the  pylorus  de¬ 
pends,  he  holds,  on  improvement  in  the  diagnosis  of  cancer 
of  the  stomach  at  an  early  stage,  and  he  looks  to  the 
general  use  of  the  “  gastroscope  ”  as  likely  to  afford  valu¬ 
able  aid  in  that  direction.  In  a  large  number  of  cases  of 
cancer  of  the  stomach  examined  by  him,  he  has  found 
certain  appearances  and  symptoms  which  may  be  of  use  in 
diagnosis.  In  a  healthy  man,  the  pylorus,  examined  “  gastro- 


scopically,”  appears  as  a  longitudinal,  oval,  or  triangular 
slit,  or  as  a  circular  opening  surrounded  by  close,  bright 
red,  mucous  projections  and  folds.  Owing  to  the  irritation 
caused  by  the  instrument  and  to  the  inflation,  the  opening 
is  continually  changing  its  shape,  and  the  folds  moving  with 
each  contraction  of  the  muscular  wall.  The  fundus  of  the 
Btomach,  on  the  contrary,  remains  stationary.  In  cases  of 
cancer  of  the  stomach  he  has  noticed  that  the  coarse  folds  are 
either  entirely  wanting,  the  walls  being  quite  smooth,  or 
are  only  slightly  marked ;  and,  secondly,  that  the  movements 
are  altogether  wanting.  Also  in  certain  cases  he  has  noticed 
considerable  pallor  of  the  pylorus';  in  others  quite  a  dark 
cyanotic  appearance.  In  one  case  the  submucous  veins  were 
dilated,  and  of  a  deep  blue  colour.  No  ulceration  of  the 
cancerous  mass  has  he  ever  seen.  The  explanation  of  these 
changes  he  considers  to  be,  that,  the  walls  of  the  stomach 
being  infiltrated  by  cancer,  the  movable  organ  is  changed 
into  a  comparatively  rigid  tube,  in  which  the  formation  of 
folds  and  the  changes  in  shape  cannot  occur. 


CORTICAL  CEREBRAL  LOCALISATIONS. 

Reference  has  already  been  made  in  previous  numbers 
(vide  Medical  Times  and  Gazette,  page  270,  and  vol.  i. 
1883,  page  616)  to  a  series  of  papers  in  the  Revue  de 
Mddecine  on  Cerebral  Localisations,  by  MM.  Charcot 
and  Pitres.  The  concluding  paper  of  the  series,  which 
appears  in  the  October  number  of  that  journal,  deals  with 
the  cases  that  have  been  brought  forward  during  the  last 
four  years,  as  opposed  to  the  doctrine  of  localisations  in 
the  cortex  of  the  human  brain.  In  entering  upon  this  part 
of  the  subject  they  very  justly  observe  that  those  cases 
alone  can  be  accepted  as  conclusive  which  are  surrounded, 
so  to  speak,  by  certain  guarantees ;  and  the  same  value 
should  not  be  attributed  to  complex  cases,  or  those 
which  have  been  incompletely  studied,  as  to  simple  ones, 
which  have  been  carefully  recorded,  and  are  accompanied 
by  an  exact  and  complete  description  of  the  situation 
of  the  lesions  discovered  on  post-mortem  examination 
They  divide  into  three  groups  the  cases  that  ought  to 
be  rejected.  1.  Cases  of  intracranial  tumour.  The  reasons 
for  excluding  tumours  are  both  numerous  and  weighty : 
most  cerebral  tumours  act  in  different  ways  at  the  same 
time,  i.e.,  they  destroy  one  portion  of  the  brain,  irritate 
another,  and  compress  the  remainder ;  such  cases  are  not, 
therefore,  so  simple  as  they  may  at  first  sight  appear  to  be, 
for  irritative  lesions  always  present  great  difficulties,  and 
the  phenomena  of  compression  are  often  simply  inscrutable. 
Intracranial  tumours,  no  doubt,  are  well  worthy  of  study, 
but  they  can  never  have  the  same  localising  value  as  partial 
limited  destructions,  such,  for  instance,  as  softening.  The 
majority  of  cases  of  cerebral  tumour  are  eminently  complex, 
and  consequently  unsuited  for  the  particular  line  of  research 
under  consideration.  2.  Complex  cases  with  diffuse  or  multiple 
lesions.  It  is  unnecessary  to  dwell  upon  this  group,  for  the 
very  essence  of  a  localising  lesion  is  that  it  should  be  single 
and  well  defined.  3.  Cases  in  which  the  description  is  in¬ 
complete.  In  order  that  a  case  may  be  used  for  purposes  of 
comparison,  it  is  essential  that  the  symptoms  during  life 
shall  have  been  carefully  observed,  and  the  post-mortem 
appearances  well  described.  As  a  general  rule,  the  clinical 
part  of  the  case  is  sufficiently  well  recorded,  for  it  is  easy 
enough  to  recognise  paralysis,  contracture,  or  convulsions, 
but  a  methodical  and  complete  examination  of  the  brain  is 
by  no  means  so  easy.  All  cases  in  which  the  situation  of  the 
lesion  is  indicated  only  in  a  vague  manner  ought,  therefore, 
to  be  rejected.  The  final  outcome  of  their  studies  is  formu¬ 
lated  in  the  following  emphatic  manner  : — “  There  does  not 
as  yet  exist  a  single  accurate  observation  of  a  destructive 
lesion  outside  the  motor  area  having  produced  permanent 


492 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Oet.  27,  1883. 


paralysis ;  nor  does  there  exist  a  single  accurate  observation 
of  a  destructive  lesion  of  any  extent  of  the  ascending  con¬ 
volutions  which  has  not  given  rise  to  permanent  paralysis 
of  the  opposite  side  of  the  body/’ 


“  AN  IDEAL  DEINK.” 

A  “  Hospital  Physician  ”  writes  : — “  As  I  am  in  perfect 
accord  with  your  opinion,  that  beer  will  continue  to  be  the 
English  national  drink,  and  that  a  ‘  light  bitter  beer  brewed 
from  good  malt  and  hops'  is  a  beverage  that  none  need 
fear — and  I  would  add,  that  perhaps  no  doctor  without  a 
crotchet  would  forbid, — allow  me  to  point  out  to  your  readers 
that  it  is  probably  only  those  beers  belonging  to  the  class 
of  porter  which  are  open  to  the  charge  of  being  *  gouty.’ 
It  is  well  known  and  admitted  by  those  who  have 
seen  much  of  poor  man’s  'gout  in  London,  that,  apart 
from  some  hereditary  instances,  nearly  all  the  cases  occur 
in  those  who  drink  inordinately  of  ‘  beer,'  which  means, 
in  London  language,  the  common  dark-coloured  porter. 
Gallons  of  this  are  frequently  drunk  per  diem  by  the 
Thames  lighterman,  the  favourite  victim  of  the  gout. 
Many  writers  on  the  etiology  of  gout,  from  Scudamore  to 
Garrod,  have  laid  stress  on  the  probable  influence  of  porter 
in  its  production.  These  views  are  endorsed  by  Prof. 
Charcot,  who  further  points  out  that  the  German  beers  are 
not  gout-producing.  In  his  book  on  Senile  Diseases  the 
matter  is  well  discussed ;  and  he  adds  to  one  of  his  lectures 
an  interesting  historical  appendix  on  English  beers,  by  Dr. 
Ball,  who  says  that  the  beers  made  use  of  in  the  United 
Kingdom  maybe  divided  into  two  great  classes.  c  Some  are 
rich  in  colour,  but  poor  in  alcohol,  deprived  of  sugar,  and 
ready  to  undergo  acetic  acid  fermentation  ;  they  are,  besides, 
impregnated  with  a  principle  obtained  by  roasting  the  grain 
— a  fact  not  unconnected,  perhaps,  with  their  pathogenic 
properties.  To  this  class  belong  the  drinks  known  under 
the  generic  name  of  porter,  the  use  of  which  is  so  pre¬ 
disponent  to  gout.  The  others,  on  the  contrary,  poor  in 
colour,  are  rich  in  alcohol,  and  contain  no  trace  of  acetic, 
acid.’  It  is  well  for  the  advocates  of  beer  to  be  prepared 
with  a  little  knowledge  on  its  possible  relation  to  gout.  It 
is,  of  course,  not  necessary  that  the  non-gouty  beers  should 
be  rich  in  alcohol,  as  witness  the  drinks  of  the  Yaterland, 
and  our  own  best  f  light  bitters.’  The  more  the  truth  is 
recognised,  that  beer  in  some  sort  must  be,  as  it  has  been 
since  the  days  of  Ina  King  of  Wessex  (who  in  728  promul¬ 
gated  laws  with  reference  to  ale  and  ale-houses),  the  ‘  vin 
ordinaire  ’  of  England,  the  more  likely  we  shall  be  to  have 
supplied  to  our  working-classes  such  a  beer  as  you,  sir,  have 
described.  This  is  the  line,  I  feel  sure,  along  which  broad¬ 
minded  philanthropists  should  work  in  their  desire  to  im¬ 
prove  the  condition  of  the  lower  classes  with  reference  to 
their  drinks,  rather  than  act  in  obedience  to  the  one-eyed 
physiologists  and  doctors,  or  the  short-sighted  moralists, 
who  are  in  no  way  struck  by  the  patent  and  important  fact 
that  the  use  of  some  kind  of  so-called  ‘  stimulant  ’  is  well- 
nigh  universal,  and  that  nearly  everyone  requires  something 
other  than  water  with  his  meals.” 


THE  PAKIS  WEEKLY  KETUKN. 

The  number  of  deaths  for  the  forty-first  week  of  1883,  ter¬ 
minating  October  11,  was  967  (540  males  and  427  females), 
and  of  these  there  were  from  typhoid  fever  43,  small-pox  3, 
measles  6,  scarlatina  1,  pertussis  11,  diphtheria  and  croup 
28,  dysentery  1,  erysipelas  6,  and  puerperal  infection  2. 
There  were  also  43  deaths  from  acute  and  tubercular  menin¬ 
gitis,  187  from  phthisis,  25  from  acute  bronchitis,  47  from 
pneumonia,  117  from  infantile  athrepsia  (36  of  the  infants 
having  been  wholly  or  partially  suckled),  and  41  violent 


deaths  (30  males  and  11  females).  Although  there  is  a 
slight  increase  of  deaths  upon  those  of  the  previous  week 
(30),  the  low  rate  of  mortality  from  epidemic  diseases  con¬ 
tinues  to  prevail.  The  births  for  the  week  amounted  to 
1246,  viz.,  609  males  (440  legitimate  and  169  illegitimate) 
and  637  females  (461  legitimate  and  176  illegitimate)  ;  86 
infants  were  either  born  dead  or  died  within  twenty-four 
hours,  viz.,  49  males  (30  legitimate  and  19  illegitimate)  and 
37  females  (29  legitimate  and  8  illegitimate). 


ACORNS. 

The  rough  autumnal  blast  is  strewing  the  fields  with  an 
unusually  plentiful  crop  of  acorns.  So  thickly  studded  is 
earth’s  grassy  lap  with  this  astringent  harvest,  that  one  is 
tempted  to  inquire  what  purpose  (besides  the  reproduction 
of  the  quercine  genus)  the  acorn  may  serve  in  the  economy 
of  nature — to  what  use,  medicinal  or  dietetic,  it  may  be 
applied  by  man  or  beast.  In  many  parts  of  the  country,  in 
nearly  all  rural  districts,  in  fact,  in  which  we  have  made 
inquiry  on  the  subject,  acorns  are  in  common  use  by  the 
rustic  population  as  a  medicine  in  diarrhoea  from  whatever 
cause.  A  store  of  dried  acorns  forms  part  of  many  a  country 
housewife’s  domestic  pharmacopoeia,  and  the  grated  powder 
is  administered  with  good  effect  in  many  cases  of  intestinal 
flux.  Probably,  since  the  acorn  contains  so  very  large  a 
proportion  of  tannic  and  gallic  acids,  its  operation  in  such 
cases  is  at  least  as  beneficial  as  that  of  any  tinctures  of  kino, 
catechu,  rhatany,  or  other  officinal  astringent,  administered 
by  proper  authority.  Vast  quantities  of  acorns,  as  we  all 
know,  are  also  greedily  eaten  by  pigs,  deer,  and  possibly 
other  animals,  who  become  fat  and  well-conditioned  on  this 
fare.  It  would  be  interesting  if  we  could  learn  from  some 
of  our  veterinary  friends,  how  it  is  that  these  creatures  can 
live  and  thrive  upon  a  diet  which,  though  it  may  contain 
some  nutritive  material,  contains  also  so  overwhelming  a 
share  of  tannic  and  gallic  acids  that  even  the  porcine 
digestive  apparatus  ought  theoretically  to  be  brought  to  a 
dead-lock  by  its  use.  Is  it  the  fact,  may  we  ask,  that  pigs, 
deer,  etc.,  suffer  occasionally  from  costive  or  obstructive 
troubles,  by  the  drying  up  of  the  intestinal  secretions  as  a 
result  of  a  free  diet  of  acorns  at  this  season  P  And  would  it 
be  possible,  may  we  ask  again,  to  make  any  use  of  acorns, 
crushed  or  ground,  as  an  admixture  in  the  food  of  horses, 
especially  those  in  whom  a  constant  looseness  or  “  scouring  ” 
makes  sleek  appearance  and  good  condition  almost  an 
impossibility  ? _ 

THE  INDUCTION  OF  PREMATURE  LABOUR. 

Dr.  Kumpe,  Assistant- Physician  at  the  Marburg  Obstetric 
Clinic,  contributes  to  a  recent  number  of  the  Archiv  fur 
Oyndlcologie  some  interesting  statistics  of  this  operation. 
Professor  Dohrn  in  1877  published  a  number  of  cases 
occurring  in  this  institution.  Dr.  Kumpe  now  relates  in 
detail  14  other  cases  which  have  since  then  been  treated  in 
the  same  way.  Putting  them  all  together  we  have  26  patients, 
who  among  them  had  106  labours.  Of  these,  65  came  on  at 
full  term,  with  a  result  of  53  dead,  and  only  12  living  chil¬ 
dren,  or  an  infantile  mortality  of  81-5  per  cent.  Labour  was 
induced  prematurely  in  41  ;  and  of  the  children,  14  were 
dead,  27  living,  or  a  mortality  of  34  per  cent.  We  should 
mention  that  children  dying  within  the  first  fortnight  after 
birth  are  reckoned  in  these  statistics  as  dead.  The  form  of 
pelvic  deformity  for  which  the  induction  of  labour  was  most 
frequently  undertaken  was  the  generally  narrowed  flat 
pelvis,  with  which  there  were  43  labours.  In  8  of  these  the 
conjugata  vera  measured  less  than  8  centimetres  (3 j  inches), 
and  the  infantile  mortality  was  50  per  cent.  In  28  it  was 
between  8  and  8  5  centimetres  (31  to  33  inches),  and  in  these 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Oct.  27, 1883.  493 


68  per  cent,  of  children  survived.  In  7  the  conjugate  was 
more  than  8‘5  centimetres,  and  in  these  86  per  cent,  of 
children  lived.  The  method  adopted  for  inducing  labour 
was  the  warm  vaginal  douche  (with  1  per  cent,  carbolic  acid 
solution),  used  at  first  three  or  four  times  daily,  and  then 
every  hour  or  two.  If  this  did  not  succeed,  a  bougie  was 
introduced  between  the  membranes  and  the  uterus.  The 
maternal  mortality,  we  are  sorry  to  see,  was  7  per  cent. 


THE  BRAIN  GAUGE. 

Among  the  interesting  minor  points  touched  upon  at  the 
recent  meeting  of  the  British  Association,  was  that  of  the 
relation  and  constant  ratio  existing  between  the  size  and 
capacity  of  the  skull  in  different  races,  and  the  dimensions 
of  the  adult  female  pelvis.  The  conjugate  diameter  of  the 
pelvic  brim  of  the  mother,  it  was  explained,  acts  as  a  gauge 
of  the  potential  brain-power  of  the  offspring,  by  forbidding 
the  passage  into  independent  existence  of  any  child  having 
a  skull,  and  therefore  a  brain,  of  disproportionate  size. 
This  is  a  fair  and  rational  conclusion,  and  is  fully  borne  out 
by  the  facts  and  figures  regarding  still-birth  which  have 
been  placed  on  record  by  various  observers.  Thus  it  was 
shown  by  Sir  James  Simpson  that  the  heads  of  male  children 
measure,  on  an  average,  about  half  an  inch  more  in  circum¬ 
ference  than  those  of  females,  and  that,  in  consequence,  a 
larger  number  of  male  than  of  female  foetal  skulls  are 
denied  passage  by  the  maternal  pelvis,  causing  a  considerable 
numerical  excess  of  male  over  female  still-born  infants.  It 
has  been  shown  also,  with  sufficient  clearness,  that,  broadly 
speaking,  the  size  and  weight  of  the  brain,  and  therefore 
the  external  measurements  of  the  skull  containing  it,  may 
be  taken  as  a  measure  of  the  intellectual  power  of  the  indi¬ 
vidual.  There  is  a  philosophical  interest  attaching  to  these 
conclusions,  which  does  not  perhaps  appear  quite  on  the  sur¬ 
face.  The  bony  frame,  or  diameter  of  the  maternal  pelvis,  is 
thus  made  to  serve  as  a  direct  measure  and  means  of  limita¬ 
tion  of  the  mental  capacity.  It  follows  that  it  is  impossible 
that  any  race  or  family  should  so  develope  exaggerated  or 
phenomenal  brain-power  as  to  cause  a  deterioration  or  puny 
calibre  of  the  osseous  and  muscular  systems.  For,  the  pelvis 
becoming  contracted  and  ill-developed  as  the  brain  and  skull 
became  overgrown,  the  former  would  gradually  exclude  the 
passage  of  the  latter,  and  the  over-intellectual  race,  with 
disproportionate  cerebral  power,  produced  at  the  expense  of 
the  physical  forces,  would  rapidly  become  extinct.  The 
converse  of  this  proposition  would  hold  equally  good,  and 
the  large  maternal  pelvis,  acting,  as  before,  as  the  gauge  of 
the  intellectual  power  of  the  offspring,  the  mother  possess¬ 
ing  the  best  physical  conformation  would  become  the  only 
possible  parent  of  the  son  gifted  with  the  largest  cerebral 
development.  Intelligent  natural  selection  would  lead  thus 
to  the  choice  by  men  of  massive  intellect  (who  might  be 
desirous  of  reproducing  their  mental  attributes  in  their  chil¬ 
dren)  of  wives  in  whom  the  roomy  and  expansive  physical 
type  should  afford  the  best  chance  of  the  large  and  highly 
organised  foetal  brain  passing  the  gauge.  It  is  perhaps  to 
be  regretted  that  the  question  of  the  improvement  of  the 
human  race  by  a  process  of  rational,  as  opposed  to  natural, 
selection  is  one  more  of  theoretical  philosophy  than  of 
practical  possibility.  _ 

THE  TREATMENT  OF  PUERPERAL  CONVULSIONS  BY 
DIAPHORESIS. 

In  a  former  number  of  this  journal  (a)  we  drew  attention  to 
a  paper  by  Dr.  Carl  Breus,  of  Vienna,  on  the  subject  men¬ 
tioned  above.  In  a  recent  number  of  the  Archiv  fiir 
Gyntikologie,  Dr.  Breus  gives  his  further  experience  of  this 
plan  of  treatment,  which  consists,  it  may  be  remembered,  in 


putting  the  patient  into  a  hot  bath,  and  then  wrapping  her 
in  blankets  until  profuse  perspiration  has  taken  place.  The 
paper  we  now  refer  to  relates  eleven  cases  thus  treated.  In 
four  of  them  the  convulsions  came  on  early  in  labour,  in 
two  towards  the  end  of  a  prolonged  first  stage,  in  one  during 
the  second  stage  of  labour,  and  in  the  remaining  four  within 
a  few  hours  after  delivery.  Most  of  them  were  severe  cases. 
Only  one  died  ;  ten  recovered.  Putting  these  with  the  cases 
previously  published  by  Dr.  Breus,  we  have  seventeen  cases 
with  only  two  deaths — a  proportion  of  recoveries  above  the 
average.  The  fatal  case  now  reported  was  that  of  a  syphi¬ 
litic  patient,  who  came  under  treatment  only  after  she  had 
had  many  eclamptic  seizures.  She  died  from  pelvic  cellulitis 
and  peritonitis,  the  convulsions  having  ceased  four  days 
before  her  death,  and  the  symptoms  showing  improvement 
in  the  renal  condition.  Dr.  Breus  does  not  recommend  that 
diaphoresis  should  be  used  to  the  exclusion  of  every  other 
remedy ;  but,  on  the  contrary,  it  should  be  combined  with 
chloroform,  narcotics,  and  such  obstetric  interference  as  the 
case  may  demand.  He  has  not  seen  any  harm  result  from 
the  hot  baths  or  the  subsequent  packing,  even  when  applied 
to  recently  delivered  women.  He  does  not  believe  that  this 
measure  tends  to  provoke  labour ;  and,  in  support  of  this 
opinion,  gives  a  case  of  a  patient  with  Bright’s  disease  (but 
not  convulsions),  who  had  forty-five  baths  while  pregnant, 
without  labour  coming  on.  Dr.  Breus  thinks  it  desirable  to 
employ  this  treatment  in  pregnant  women  who  are  the  sub¬ 
jects  of  dropsy  or  albuminuria,  believing  that  by  it  the  onset 
of  eclampsia  may  possibly  be  prevented.  At  the  end  of  his 
paper  he  gives  an  interesting  quotation  from  Wigand,  who 
recommended  similar  treatment  as  long  ago  as  1820.  But 
this  old  writer  gives  a  caution,  which  we  suppose  Dr. 
Breus  would  not  endorse,  viz  ,  that  the  patient  should  not 
be  allowed  to  sweat  too  much. 


SYPHILIS  IN  THE  METROPOLIS. 

In  his  twenty-sixth  annual  report  to  the  Board  of  Works 
for  the  Holborn  District,  on  the  sanitary  condition  of  that 
locality  for  the  year  1882-83,  Dr.  Septimus  Gibbon,  the 
Medical  Officer  of  Health,  expresses  his  regret  at  having  to 
report  an  increase  in  the  number  of  fatal  cases  of  syphilis 
and  congenital  syphilis,  which  amounted  to  73  and  27  cases 
respectively,  against  52  and  24  in  the  previous  year.  These 
increased  figures,  which,  Dr.  Gibbon  thinks,  very  much 
understate  the  actual  amount  of  the  disease,  are,  in  his 
opinion,  due  rather  to  the  increased  courage  of  the  doctors 
in  recording  its  true  nature  than  to  any  real  increase  of 
this  terrible  plague.  In  fact,  the  deaths  in  the  whole 
metropolis  from  syp  hilis  and  other  venereal  affections  fell 
from  551  in  1881  to  517  in  1882,  a  decrease  of  6'1  per  cent., 
which  must  be  a  source  of  congratulation  to  every  thinking 
person,  and  for  which  we  were  indebted.  Dr.  Gibbon  says,  to 
the  Contagious  Diseases  Acts.  In  the  course  of  a  lengthy 
disquisition  on  this  subject  he  expresses  his  regret  that  these 
Acts,  which  have  done  more  for  the  public  health  than  all 
other  sanitary  legislation  put  together,  should  have  been  un¬ 
constitutionally  repealed  and  abandoned  by  the  Government, 
because,  on  a  single  chance  vote  of  considerably  less  than 
half  the  members  of  the  House  of  Commons,  the  foolishly 
sentimental  resolution  was  carried  to  do  away  with  the 
compulsory  examination  of  women.  “  Inasmuch  as  the  women 
referred  to  are  more  liable  to  contract  the  disease  than  men, 
and  have  elected  to  follow  a  dangerous  trade,  I  do  not  see 
why  they  should  not  be  compelled  to  submit  to  a  personal 
examination,  which  is  made  in  order  to  preserve  their  own 
health  quite  as  much  as  that  of  the  general  community.  As 
a  matter  of  fact,  they  themselves  have  not  objected,  but  in 
two,  if  not  three,  of  the  subjected  towns  have  petitioned  in 


(a)  Medical  Times  and  Gazette,  vol.  ii.  1832,  page  106. 


494 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Oct.  27,  1683. 


vour  of  the  Acts.”  In  conclusion.  Dr.  Gibbon  states  that 
it  is  only  on  account  of  the  immense  practical  injury  to 
t  e  health  of  the  people,  which  he  feels  must  follow  such  a 
disastrous  piece  of  legislation,  that  he  has  been  induced  to 
answer  some  of  the  arguments  brought  forward  in  favour  of 
repealing  the  Acts. 

THE  PROJECTED  MEDICAL  LIBEAEY,  PAEIS. 

ccording  to  the  Union  Mddicale  of  October  16,  the  con¬ 
struction  of  a  medical  library  on  an  unprecedented  scale  of 
magnitude  is  contemplated.  “  As  is  already  known,’5  the 
article  states,  “  the  plan  for  the  entire  reconstruction  and 
enlargement  of  the  Lcole  de  Medecine  comprises  the  creation 
of  a  department  to  be  exclusively  devoted  to  the  library  and 
rooms  for  practical  studies.  In  the  new  library  are  to  be 
assembled  not  only  the  works  which  exist  in  the  present 
library,  but  also  collections  of  all  known  publications  relat¬ 
ing  to  medicine.  Moreover,  it  is  contemplated  forming  there 
a  special  register,  in  which  will  be  inserted  the  names  of 
11  medical  practitioners  legally  pursuing  their  profession 
throughout  the  principal  countries  of  the  world.  The  realisa¬ 
tion  of  so  vast  a  project  has  given  rise  to  a  preliminary 
nvestigation,  which  reveals  figures  of  a  truly  interesting 
character.  From  this  it  appears  (no  references  are  given  as 
to  the  authorities  upon  which  this  statement  is  founded)  that 
the  number  of  medical  practitioners  spread  over  all  parts 
of  the  globe  amounts  to  193,000,  among  whom  11,250  devote 
themselves  solely  to  advanced  medical  study  ( hautes  etudes 
mddicales ).  This  is  the  manner  in  which  these  193,000 
medical  practitioners  are  distributed,  according  to  their 
countries,  viz. :  —  65,000  in  the  United  States,  26,000  in 
France,  32,000  in  Germany  and  Austria,-  35,000  in  Great 
Britain  and  her  colonies,  10,000  in  Italy,  5000  in  Spain, 
etc.  “  If  we  entertain  the  pretension  of  assembling  in  the 
library  of  the  Ecole  de  Medecine  all  that  has  been  written  in 
medicine  to  the  present  time,  this  library  should  contain  more 
than  122,000  volumes,  without  counting  simple  brochures, 
theses,  memoirs,  etc.,  the  number  of  which  must  exceed 
250,000.  In  relation  to  authors  who  have  treated  specially 
on  medical  subjects,  the  United  States  occupy  the  foremost 
place  with  their  2800  authors,  and  then  follow  France  with 
2600,  Germany  and  Austria  each  with  2300,  and  Great 
Britain  with  2000,  etc.  To  accommodate  all  the  documents 
enumerated  above,  an  edifice  eight  times  greater  than  the 
present  library  and  its  dependencies  will  be  required.” 

MILK  EPIDEMICS  IN  DUNDEE. 

Last  week  a  dairyman  at  Dundee  was  heavily  fined  for 
selling  milk  while  harbouring  a  case  of  scarlet  fever  in  his 
house,  whereby  nineteen  cases  of  very  virulent  type,  and 
four  deaths  resulted.  This  little  epidemic  has  now  been 
thrown  into  the  shade  by  an  outbreak  of  typhoid  fever5 
which  has  been  traced  to  a  similar  cause,  and  has  assumed 
alarming  proportions.  From  October  1  up  to  Sunday  last 
no  fewer  than  eighty-five  cases  had  been  reported  to  the 
sanitary  authorities,  and  the  inquiries  which  were  at  once 
instituted  resulted  in  the  discovery  that  of  these  as  many  as 
thirty-six  were  among  the  customers  of  a  single  dairyman 
named  J.  Henderson,  the  remaining  twenty-seven  of  the 
sixty-three  which  had  occurred  since  October  11  being 
supplied  from  eleven  different  dairies.  On  Saturday  last 
three  of  Henderson’s  children  were  certified  to  be  suffer¬ 
ing  from  typhoid  fever,  and  Henderson  then  agreed 
to  have  the  children  removed  to  the  Infirmary,  and  to 
stop  the  sale  of  milk  from  his  premises  until  they  were 
thoroughly  disinfected.  At  half-past  six  o’clock,  however, 
on  Saturday  night,  he  refused  to  allow  his  children  to  be 
removed,-  and  in  consequence  the  Sheriff  has  issued  an 
order  prohibiting  him  from  selling  milk  within  the  burgh 


of  Dundee  for  a  period  of  seven  weeks.  The  epidemic  con¬ 
tinues  to  spread,  and  up  to  noon  on  Wednesday  no  fewer 
than  seventeen  fresh  cases  were  reported,  making  a  total  of 
102  for  the  month. 


THE  FIGHTING  IN  T0NQUIN. 

“We  have  received,”  says  the  Gazette  Hebdomadaire,  “a. 
letter  giving  some  details  of  what  occurred  after  the  combats 
of  August  16  and  17,  when  the  army  was  fighting  while 
retreating  from  an  inundation.  In  these  kinds  of  action, 
which  resemble  coups  de  main  rather  than  regular  battles, 
it  seems  that  the  means  of  transport  did  not  exist  in 
any  more  profusion  than  did  bedding  and  medicines.  The 
wounded,  forty-eight  in  number,  who  were  picked  up  by 
their  comrades  in  the  marshes,  had  leather  straps  attached 
to  their  hands,  and  were  dragged  in  this  way  along  the 
ground  in  order  to  escape  falling  into  the  hands  of  the 
Black  Flags.  All  the  balls  extracted  from  their  wounds  are 
conical.  When  charpie  falls  short,  the  leaves  of  the  banana  or 
of  the  tupa,  which  are  cottony,  are  employed,  camphor  powder 
being  added — but  this  only  in  small  quantity,  as  it  has  to 
be  economised.  Complaint  is  made  of  the  absence  of  carbolic 
acid,  which  is  so  necessary  for  the  dressing  of  the  wounds. 
The  health  of  the  soldiers  is  good,  and  in  this  respect  a  re¬ 
markable  circumstance  has  occurred.  Two  thousand  men 
were  fighting  for  two  days  in  the  water,  and  at  the  date  of 
the  letter  (a  week  afterwards)  there  had  not  been  a  single 
case  of  sickness.” 


Dr.  Bucknill  will  deliver  a  lecture  at  the  London  Insti¬ 
tution  on  “  The  Eelation  of  Madness  to  Crime,”  on  some 
day  in  February  next.  _ 

Mr.  W.  H.  Caldwell,  Fellow  of  Gonville  and  Caius 
College,  Cambridge,  has  been  elected  to  the  Balfour  Student¬ 
ship  ;  and  Mr.  W.  B.  A.  Hansom,  of  Trinity  College,  has 
been  chosen  to  occupy  for  two  months  the  Cambridge  table 
at  the  Naples  Zoological  Station. 

Only  four  of  the  provincial  schools  have  as  yet  sent  in 
returns  of  their  new  entries.  Of  these,  Manchester  comes 
first,  with  60  entries  for  the  full  curriculum,  and  IS  for  occa¬ 
sional  courses  ;  Leeds  stands  next,  with  31  full  entries,  and 
3  partial ;  while  Bristol  and  Newcastle  have,  respectively, 
27  and  25  new  students.  _ 

The  preparation  of  a  new  catalogue  of  the  library  of  the 
Eoyal  College  of  Surgeons  is  under  consideration.  The 
first  catalogue  was  printed  in  1831,  and  since  then  there 
have  been  five  supplementary  catalogues,  the  last  appear¬ 
ing  in  1860.  The  library  now  contains  39,197  volumes,  as 
against  11,000  when  the  catalogue  was  first  printed. 

The  Eegistrar  of  the  General  Medical  Council  requests 
us  to  call  attention  to  the  notices  in  our  advertisement  pages 
with  regard  to  changes  of  address.  It  is  important  to 
everyone  that  the  Medical  Eegister  should  be  as  correct  and 
complete  as  possible — a  result  which  can  only  be  obtained 
by  the  cordial  co-operation  of  every  member  of  the  profession 
with  the  Eegistrar.  _ 

The  total  amount  subscribed  and  promised  to  the 
Hutchinson  Testimonial  Fund  is  now  nearly  =84-00,  and 
the  list  will  be  closed  on  Wednesday  next.  The  presenta¬ 
tion  dinner  will  take  place  at  the  Holborn  Bestaurant  on 
Thursday,  November  29,  at  7  p.m.— chairman,  Sir  Andrew 
Clark,  Bart.  ;  vice-chairman,  Walter  Eivington,  Esq., 
F.E.C.S.  A  general  meeting  of  subscribers  will  be  held 
early  in  November,  to  decide  the  form  the  testimonial  shall 
take  j  and  each  subscriber  will  receive  due  notice  thereof. 


L*  -  J  v  r  .-'  £.rJ 

4<- 


Medical  Times  andWa^eiffcfev 


MESMERISMUS  CHRONICUS 


MESMERISMUS  CHROUICUS. 

In  our  brief  criticism  of  Messrs.  Gurney  and  Myers’  long 
article  on  Mesmerism  in  the  Nineteenth  Century  of  this 
month,  we  had  no  intention  of  conveying  the  impression 
which  Mr.  Gurney  deprecates  in  his  letter  (which  will  be 
found  in  our  columns  to-day) ,  that  he  and  his  friend  base 
their  belief  in  mesmerism  on  the  performances  which  are 
given  under  that  name  on  public  platforms.  We  were 
alive  to  the  fact,  and  had  hoped  to  mate  it  plain,  that  their 
present  fabric  of  opinion  on  this  subject  is  founded  on 
their  own  tedious  experiments ;  but,  at  the  same  time,  we 
thought  it  evident  that  the  platform  phenomena  had  had  a 
good  deal  to  do  with  the  erection  of  the  structure.  From 
hypnotism  and  expectancy,  well  mixed  with  mummery  and 
guile,  Messrs.  Gurney  and  Myers  have  advanced  to  “  specific 
influence”  and  “  physical  effluence,” — from  the  heat  and 
hubbub  of  the  lecture-hall  they  have  retired  to  the  cool 
shades  of  psychical  research.  But  in  the  phenomena  of  the 
platform,  which  they  so  picturesquely  describe,  they  must 
still  feel  some  interest,  and  it  is  in  those  phenomena  alone 
that  we  find  anything  of  scientific  value  in  connexion  with 
their  paper ;  for  while  in  them  there  are  some  traces  of  the 
powerful  influence  of  suggestion  on  a  mind  in  an  allotropic 
state,  there  is  in  the  precise  experiments,  as  far  as  we  can 
judge,  nothing  that  is  genuine  or  above  the  level  of 
juggling.  That  Messrs.  Gurney  and  Myers  had  overlooked 
the  trickery  and  deception  which  mingle  so  largely  with  mes¬ 
meric  exhibitions,  we  neither  hinted  nor  thought  possible ; 
and  that  they  were  sincerely  desirous  of  eliminating  these 
elements  from  their  experiments,  we  never  doubted.  Our 
regret  has  been,  and  is,  that  they  have  as  yet  displayed  so 
little  capacity  for  the  task  they  have  undertaken,  so  little 
skill  in  separating  the  tares  of  falsehood  from  the  wheat 
of  truth;  and  that  in  “strictly  defining”  phenomena  they 
have  stamped  with  their  authority  a  number  of  results 
which  we  regard  as  spurious.  Superstitions  are  doubly 
dangerous  when  they  come  disguised  as  science  ;  and  follies, 
when  patronised  by  men  of  intellect,  are  apt  to  become 
manias. 

Our  remarks  on  the  morbid  and  demoralising  tendencies 
of  hypnotic  experiments  on  those  who  participate  in  them 
can  scarcely  be  twisted  (as  Mr.  Gurney  seems  to  think  pos¬ 
sible)  into  a  reflection  on  the  soundness  of  judgment  of  the 
authors  of  the  paper  in  the  Nineteenth  Century,  whose  con¬ 
spicuous  ability  and  singleness  of  purpose  it  would  have 
been  an  impertinence  on  our  part  even  to  acknowledge.  We 
did  certainly  lament  that  men  of  such  great  mental  power 
should  be  engaged  in  equivocal  and  unremunerative  work 
for  which  they  had  evidently  no  special  gift,  just  as  we 
should  grieve  to  see  Huxley  and  Tindall  lay  aside  their 
proper  pursuits,  and  devote  themselves  to  the  cure  of  dipso¬ 
maniacs  ;  but  our  warnings  were  not  addressed  to  them. 
We  admonished  not  individuals,  but  a  class  ;  not  the  strong- 
minded  men  who  take  up  mesmerism  as  a  crotchet,  but  the 
weak-  and  unstable-minded  people  who  throw  themselves 
into  it  as  a  kind  of  psychical  intoxication.  And  what  we 
said  on  this  point  was  founded  on  observation  and  a  know¬ 
ledge  of  cases.  Of  course,  any  number  of  negative  cases, 
like  those  referred  to  by  Mr.  Gurney,  may  be  quoted, 
in  which  mesmeric  studies  and  practices  carried  far  have 
caused  no  apparent  mischief,  but  these  count  for  little 
against  positive  cases,  in  which  they  have  been  followed  by, 
or  have  merged  into,  mental  or  nervous  disease.  Such 
positive  cases  certainly  do  occur,  and  each  one  of  them  may 
be  taken  to  represent  a  whole  host  of  cases  in  which  minor 
evils  that  do  not  come  under  medical  cognisance  have  been 
wrought  by  mesmerism.  Of  the  demoralisation  for  which 
it  is  responsible  we  have  no  gauge.  And  here  we  should 
perhaps  distinguish  between  hypnotism  and  mesmerism, 
meaning  by  the  latter,  hypnotism  plus  humbug.  The  hyp¬ 
notic  state  implies  in  the  human  subject  a  profound  dis¬ 
turbance  of  brain-function,  presenting  many  of  the  features 
of  dangerous  disease,  and,  as  Messrs.  Gurney  and  Myers  note, 
it  often  leaves  a  headache  behind  it,  and  is  produced  with 
increasing  facility  on  each  occasion  of  its  production.  Can 
it  be  believed  that  such  a  state  can  be  frequently  induced 
without  risk  to  brain-health  ?  and  does  not  the  fact,  which 
can  be  proved,  that  it  has  in  some  instances  hopelessly 


Oct.  27,  1883.  495 


destroyed  this,  suggest  the  inference  that  it  compromises  it 
more  or  less  ostensibly  on  a  much  larger  scale  ?  It  need 
scarcely  be  argued  that  mesmerism,  if  it  involves  deception, 
is  depraving  in  its  influence.  It  must  demoralise  men  and 
women  to  believe  a  lie  ;  and  nothing  need  be  said  as  to  the 
effects  of  systematic  deception  on  those  who  practise  it,  and 
who  draw  into  their  own  vile  duplicity  young  and  impres¬ 
sionable  beings  with  a  thirst  for  notoriety  and  a  love  of 
mystery.  The  statement  that  the  believers  in  mesmerism 
are  for  the  most  part  of  a  neurotic  diathesis,  is  also  founded 
on  observation  and  medical  experience.  That  the  belief  is 
generally  associated  with  a  leaning  to  other  forms  of  mysti¬ 
cism,  the  constitution  of  the  Psychical  Research  Society  suffi¬ 
ciently  attests.  Mr.  Gurney  reminds  us  that  Heidenhain  and 
Hansen  have  found  tall,  vigorous  athletic  subjects  most  suit¬ 
able  for  their  experiments  on  hypnotism  and  mesmerism ;  and 
to  that  we  reply  that  we  do  not  accept  the  experiments  of  these 
observers,  eminent  though  they  are,  as  wholly  trustworthy, 
and  shall  have  something  to  say  about  them  in  these  columns 
shortly.  Of  course,  a  noble  physique  is  not  incompatible 
with  a  low  moral  tone,  and  impostors  may  be  of  any  height 
and  temperament ;  but,  in  this  country,  persons  manifesting 
genuine  hypnotism  have  almost  invariably  borne  the  marks 
of  degenerative  tendencies  of  one  kind  or  another. 

With  reference  to  the  special  set  of  experiments  upon 
which  we  made  some  comments,  Mr.  Gurney  complains 
that  we  have  scarcely  credited  him  with  common  sense. 
We  are  quite  willing  to  grant  that  he  has  a  superabundant 
stock  of  that  somewhat  rare  quality,  but  what  we  maintain 
is,  that  this  is  just  a  case  in  which  common  sense  is  of  no 
avail.  Trained  scientific  insight,  the  detective  instinct,  and 
a  practical  acquaintance  with  the  artifices  of  legerdemain, 
are  necessary  in  testing  results  such  as  he  professes  to  have 
obtained.  The  success  of  a  conjuror  depends  on  his  satis¬ 
fying  common  sense  that  he  has  taken  the  most  elaborate 
precautions  to  make  impossible  the  very  event  which  be 
nevertheless  brings  about  by  his  sleight  of  hand;  and  un¬ 
common  sense  and  acuteness  often  fail  to  perceive  the  one 
point  in  which  the  precautions  failed.  And  so  the  success 
and  credibility  of  mesmeric  experiments,  like  those  described 
by  Messrs.  Gurney  and  Myers,  depend  on  the  scrupulous  care 
taken  to  exclude  deception,  which  may,  however,  still  creep 
in,  even  when  complete  protection  against  it  seems  to  have 
been  secured.  And  therefore  it  was  that,  without  impugning 
the  good  faith  of  the  general  statement  that  signals  between 
the  operator  and  subject  were  impossible  in  these  experiments, 
we  took  occasion  to  point  out  that  we  had  no  detailed  account 
of  the  measures  adopted,  which  would  warrant  that  general 
statement,  and  that  signals  might  have  been  exchanged 
between  the  operator  and  subject,  which  the  bystanders 
had  omitted  to  notice  or  provide  for.  As  Sir  William 
Thompson  said,  in  his  recent  address  at  Birmingham,  “  the 
wretched,  grovelling  superstition  of  animal  magnetism, 
spiritualism,  mesmerism,  or  clairvoyance,  is  the  result  of 
bad  observation  chiefly,  somewhat  mixed  up  with  the  effects 
of  wilful  imposture  on  an  innocent  and  trusting  mind.” 
Now,  our  fear  is  that  the  innocent  and  trusting  minds  of 
the  members  of  the  Psychical  Research  Society  are  not  fully 
awake  to  the  dangers  of  wilful  imposture  and  bad  observa¬ 
tion.  The  power  of  really  good  observation  in  such  matters 
is  an  exceptional  quality  not  included  under  common  sense, 
and  wilful  imposture  is  the  most  subtle  of  beasts,  and  can 
only  be  crushed  effectually  by  relentless  and  uncompro¬ 
mising  scepticism.  Any  real  test  of  mesmerism,  with  a 
view  to  the  exclusion  of  fraud,  must  be  conducted  with 
as  much  scientific  forethought  and  preparation,  and  with 
as  unerring  precision  as  is  the  treatment  of  wounds  under 
Listerism  with  a  view  to  the  exclusion  of  germs.  When  a 
surgeon  in  these  days  finds  that  a  wound  has  become 
putrescent,  he  does  not  resign  himself  to  a  belief  in  spon¬ 
taneous  generation,  but  concludes  that  his  antiseptic  dress¬ 
ings  have  been  faultily  employed.  And  sq,  when  mesmeric 
experiments  like  those  of  Messrs.  Gurney  and  Myers  are  suc¬ 
cessful,  the  reasonable  inference  is  not  that  there  is  “  some 
special  virtue  or  force”  passing  from  one  organism  to 
another,  but  that  vigilance  has  been  outwitted,  and  some 
channel  for  the  passage  of  communications  left  open.  The 
experiment  must  be  repeated  and  varied  again  and  again, 
with  ever-increasing  watchfulness  and  nicety,  until  the 
point  is  reached — as  it  surely  will  be  reached  in  all  such 
experiments — where  ingenuity  is  baffled  and  no  result  is 
obtained.  But  life  is  too  short  for  the  detailed  decapita- 


496 


Medical  Times  and  Gazette. 


TIN  IN  “TINNED”  FOODS. 


Oet.  27,  1883. 


tion  of  hydra-headed  chicanery,  and  all  that  is  necessary  s 
to  expose  its  true  character  by  one  clean  sweep.  If  a  mes¬ 
merist  or  his  subject  is  caught  tripping  in  a  single  instance, 
there  is  no  need  to  insist  on  his  complete  overthrow.  Ex 
ungue  vulpern  !  The  trickster  stands  declared  ! 

The  much  more  detailed  account  now  given  by  Mr. 
Gurney  of  the  manner  in  which  the  particular  set  of  ex¬ 
periments  that  we  criticised  was  carried  out,  does  not 
in  the  slightest  degree  alter  our  opinion  of  the  way  in 
which  they  were  accomplished.  Regarding  each  step  taken 
we  should  have  to  ask  at  least  half  a  dozen  more  questions 
before  we  felt  satisfied  that  the  necessary  precautions  had 
been  observed.  We  have  seen  a  youth  securely  blind¬ 
folded”  looking  down  his  high-bridged  nose,  and  interpreting 
.the  shadows  thrown  on  a  table  by  a  waving  hand  above  him  ; 
and  we  diav.e  heard  a  message  conveyed  when  “  strict 
silence  ”  was  tuaintained  in  a  room  containing  half  a  dozen 
people,  by  changes  in  the  respiratory  rhythm  and  the  almost 
inaudible  creaking  of  a  boot.  And,  if  all  our  questions 
regarding  these  experiments  were  satisfactorily  answered 
by  Mr.  Gurndy,  we  should  still  maintain  that  any  average 
conjuror  could  do  everything  that  Wells  did,  under  the  same 
conditions.  We  should  much  sooner  believe  in  some  defect 
in  our  own  penetration  than  in  any  community  of  sensation 
between  two  men  in  different  rooms.  In  what  we  said 
of  these  experiments  we  merely  touched  them  with  test- 
paper,  but  did  not  analyse  them,  and  we  may  say  now 
that  they  contain  internal  evidence  fatal  to  any  theory  of 
community  of  sensation. 

It  would  be  interesting  and  important  to  know  whether 
we  have  before  us  the  whole  of  the  experiments  in  mesmerism 
and  thought-reading  which  have  been  performed  by  Messrs. 
Smith  and  Wells.  Have  they  ever  failed  in  their  experi¬ 
ments,  and  if  so,  under  what  circumstances  P  Have  their 
performances  been  witnessed  by  any  scientific  men,  biologists 
or  surgeons,  whose  judgment  would  carry  weight  with  the 
medical  profession  ;  and  if  so,  what  conclusion  did  they 
arrive  at  P 

It  was  not  suggested  by  us,  as  Mr.  Gurney  says  it  was, 
that  there  was  any  “  barbarity  ”  in  his  experiments.  All 
that  we  did  was  to  express  our  surprise  that  he,  being 
an  opponent  of  vivisection,  should  claim  for  himself  the 
right  to  perform  on  human  beings  experiments  analogous 
to  those  which  medical  men  are  prohibited  from  per¬ 
forming  on  the  lower  animals.  He  cannot  have  forgotten 
that  a  certificate  and  licence  are  necessary  for  the  per¬ 
formance  of  an  experiment  under  anaesthetics,  which  in¬ 
duce  a  more  indisputable  kind  of  insensibility  than  that 
which  existed  in  the  mesmerised  or  Smithified  youth  whom 
he  punctured  and  scorched.  Then  it  is  to  be  remembered 
that  Mr.  Gurney  could  not,  like  a  physiologist  dealing 
with  a  rabbit,  put  the  subject  of  his  experiment  to  death 
before  the  return  of  consciousness  or  sensibility,  and  that 
Mr.  Wells,  even  supposing  he  did  not  feel  the  carving- 
fork  and  the  burning  match  when  they  were  applied,  must 
have  suffered  considerably  afterwards  from  the  wounds  and 
eschars  which  they  left  on  his  .fingers.  We  did  not  sympa¬ 
thise  with  Mr.  Wells,  but  thought  he  richly  deserved  all  he 
got ;  but  we  desired  to  call  attention  to  the  inconsistency 
between  Mr.  Gurney’s  preaching  and  Mr.  Gurney’s  practice. 

Mr.  Gurney  says  it  would  have  been  more  to  the  purpose 
if,  instead  of  finding  fault  with  the  inhumanity  of  his  ex¬ 
periments,  we  had  accounted  for  the  restricted  sensibility 
which  they  revealed.  Now,  without  actually  seeing  experi¬ 
ments  of  this  class,  we  cannot  undertake  to  criticise  them 
thoroughly,  but  the  impression  left  on  our  mind  by  the 
description  given,  was,  that  no  genuine  insensibility  had  been 
induced  in  Wells,  but  that  he  was  good  at  tholing,  to  use 
a  North-country  word,  and  that  the  pain  actually  caused 
by  the  carving-fork  and  match  was  not,  perhaps,  as  intense 
as  the  bystanders  imagined.  It  may  be  admitted  at  once 
that  the  hypnotic  state  may  be  pushed  to  a  stage  at  which 
sensibility  to  pain  is  abolished,  just  as  it  is  in  catalepsy 
and  other  diseases.  Esdaile’s  Indian  experiments  put  that 
beyond  doubt ;  but  the  anaesthesia  under  such  circumstances 
is  general,  and  not  local,  and  we  hear  with  complete  incre¬ 
dulity  that  a  being  in  an  otherwise  perfectly  normal  state 
can  have  two  fingers  made  temporarily  analgesic  by  a  few 
mesmeric  passes,  while  the  whole  of  the  rest  of  the  surface 
remains  sensitive.  We  prefer  to  believe  that  he  suppressed 
all  outward  manifestations  of  feeling.  Schoolboys  for 
amusement  or  bravado  will  run  pins  deeply  into  their  limbs. 


and  never  start  nor  cease  to  smile ;  and  innumerable  jolly 
tars  have  taken  the  cat  without  wincing.  A  strong  or  highly- 
strung  will  may  inhibit  the  natural  reflexes,  and  preoccupa¬ 
tion  of  mind,  or  a  dominant  and  absorbing  idea  or  emotion, 
may  for  a  time  blunt  feeling,  and  interrupt  its  ordinary 
external  display.  It  is  well  known  that  lunatics  will  mutilate 
and  torture  themselves  without  any  special  exhibitions  of 
suffering,  and  Browning  has  made  use  of  this  fact  in  his 
“  Red  Cotton  Nightcap  Country,”  where  he  tells  us  of 
Miranda : — - 

“  He  had  replaced  the  letters  quietly, 

Shut  coffer,  and  so,  grasping  either  side 
By  its  convenient  handle,  plunged  the  whole  — 

Letters  and  coffer,  and  both  hands  to  boot, 

Into  the  burning  grate,  and  held  them  there. 

‘  Burn,  burn,  and  purify  my  past !’  said  he, 

Calmly,  as  if  he  felt  no  pain  at  all.” 

It  might  be  said  that  there  are  no  means  of  distinguishing 
between  genuine  insensibility  and  the  apparent  insensibility 
which  is  the  result  of  a  strong  voluntary  effort.  We  think 
there  are.  By  the  use  of  instruments  of  precision  and  some 
rather  intricate  devices,  and  in  a  series  of  experiments  which 
Mr.  Wells  would  perhaps  be  scarcely  disposed  to  submit  to, 
genuine  ansesthesia  may  be  differentiated  from  dogged  en¬ 
durance;  but  in  the  case  of  Wells  no  satisfactory  measures 
have  as  yet  been  taken  to  distinguish  the  two,  and  every¬ 
thing  we  are  told  about  the  experiments  points  away  from 
genuine  ansesthesia. 


TIN  IN  “TINNED”  FOODS. 


Tinned  meats,  soups,  vegetables,  and  more  especially  fruits, 
are  all,  without  exception,  contaminated  by  metals  ;  such  is 
the  irresistible  conclusion  of  recent  scientific  investigation. 
In  1878,  Mr.  Albert  E.  Menke  communicated  to  the  Chemical 
News  results  of  analyses  of  a  tin  of  lobster,  one  of  apples,  and 
another  of  pineapple ;  the  latter  contained  tin  dissolved  in 
the  juice  equal  to  1*3  grain  per  pound,  the  lobster  and  apples  a 
much  smaller  quantity.  Mr.  Hehner,  in  1880,  communicated 
to  the  Analyst  the  results  of  a  prolonged  and  thorough  in¬ 
vestigation  of  the  subject.  He  found  tin  in  tinned  French 
asparagus,  American  asparagus,  peas,  tomatoes,  peaches, 
pineapples,  white  cherries,  red  cherries,  marmalade,  corned 
beef  (five  different  brands),  ox-cheek,ox-tongue  (three  kinds), 
collared  head,  tripe,  oysters,  sardines  preserved  in  oil,  salmon, 
lobsters,  shrimps,  curried  fowl  (two  kinds),  boiled  rabbit, 
boiled  mutton,  roast  chicken,  roast  turkey,  soup,  and  in 
three  brands  of  condensed  milk.  The  amount  of  tin  found 
does  not  appear  large — e.g.,  in  the  milk  one-tenth  of  a  grain 
per  pound,  in  one  of  the  soups  half  a  grain  per  pound,  and 
in  a  pound  tin  of  preserved  oysters  seven-tenths  of  a  grain 
per  pound.  On  a  later  research,  Mr.  Wynter  Blyth  has 
found  far  larger  quantities.  In  a  recent  report  to  the  Vestry 
of  St.  Marylebone,  detailing  the  examination  of  twenty-three 
samples  of  tinned  apricots,  tomatoes,  pineapples,  and  cran¬ 
berries,  the  amounts  found  calculated  as  stannous  hydrate 
range  from  T9  grain  to  14  3  grains  per  pound,  the  mean 
amount  being  5-2  grains.  The  juice  and  fruit  in  some  instances 
had  a  metallic  taste.  Several  of  the  tins  showed  signs  of  corro¬ 
sion.  The  older  s  chool  of  toxicologists,  as  represented  by  0  rfila, 
considered  pure  tin  vessels  innocuous if  accidents  occurred, 
they  were  ascribed  with  confidence  to  the  admixture  of  lead 
in  the  alloy,  or  to  arsenic.  The  arsenic  theory  ceased  to  be 
held  when  it  was  found  that  arsenic  was  present  in  so  small  a 
quantity  that  an  adult  would  have  to  spend  more  than  forty 
years  drinking  and  eating  from  tin  vessels  before  he  im¬ 
bibed  a  poisonous  dose ;  and  even  the  explanation  of  lead  so 
often  accompanying  the  tin  has  not  of  late  been  considered 
sufficient,  but  the  question  is  of  some  moment  whether  tin 
in  itself,  present  in  a  soluble  form  contaminating  food,  may 
not  act  injuriously.  All  know  the  toxic  action  of  the  chloride 
of  tin  on  the  one  hand,  and  the  inactivity  of  stannic  oxide 
on  the  other :  it  is  evident  that  in  tinned  foods  we  have  to  do 
with  neither,  but  with  some  form  of  stannous  hydrate.  The 
little  that  is  known  of  the  action  of  stannous  hydrate  may 
be  summed  up  in  a  few  lines.  Doses  of  about  T74  gramme 
per  kilogramme  of  body  weight  cause  in  guinea-pigs  death 
with  signs  of  intestinal  irritation ;  but  with  doses  smaller  than 
T7  to  -2  gramme  the  effects  are  uncertain,  and  the  animals 
generally  recover.  Hence,  supposing  man  to  be  affected  in 


Oct.  27,  1883.  4  9  7 


Medical  Times  and  Gazette*  MEDICAL  EEPOETS  TO  THE  LOCAL  GrOVEENMENT  BOAED. 


the  same  proportion,  he  would  have  to  take  from  three  to 
four  drachms,  or  consume  at  a  meal  ten  pounds  of  the 
most  contaminated  of  Mr.  Wynter  Blyth’s  tinned  fi-uits. 
But  it  is  not  a  question  of  immediate  lethality,  it  is  rather 
one  for  inquiry  as  to  the  action  of  small  repeated  doses 
continued  for  a  long  time.  In  the  summer  season,  some 
families  who  go  yachting,  fishing,  or  travelling  in  remote 
parts  often  carry  a  considerable  supply  of  “tinned ”  pro¬ 
visions,  and  must  take,  in  the  aggregate,  physiologically 
active  doses  of  stannous  hydrate,  possibly  producing  some 
slight  dyspepsia  or  intestinal  irritation.  Prom  time  to  time, 
indeed,  serious  symptoms  are  witnessed  after  eating  tinned 
meats;  but  the  exact  cause  of  such  illness  has  never  been  in 
any  thorough  way  investigated.  It  must  also  be  remembered 
that  certain  sugars  now  in  the  market  contain  tin  in  the  pro¬ 
portion  of  about  half  a  grain  to  the  pound — no  very  great 
quantity  in  itself,  but  the  small  fractions  of  the  metal  found 
in  this  and  that  article  of  food  in  daily  use  may  mount  up 
until  an  active  dose  is  taken.  Physicians  and  medical  men 
generally  will  do  well  to  inquire  closely  into  the  diet  of  their 
patients  suffering  from  obscure  gastric  affections ;  and  it  is 
hoped  that,  in  the  meantime,  experiments  may  be  made  by 
competent  men  on  the  action  of  stannous  hydrates. 


MEDICAL  EEPOETS  TO  THE  LOCAL 
GOYEEHMENT  BOAED. 


De.  Barry  on  the  Sanitary  Condition  of  Barbow- 

on-Soar. 

A  petition  having  been  received  by  the  Local  Government 
Board  from  some  of  the  inhabitants  of  Barrow-on-Soar, 
Leicestershire,  praying  that  an  inquiry  might  be  made  into 
the  sanitary  condition  of  the  locality,  on  account  of  the  con¬ 
tinued  prevalence  of  scarlet  fever.  Dr.  P.  W.  Barry  was 
deputed  in  February  last  to  make  an  investigation.  Barrow- 
on-Soar  is  a  large  village  with  a  population  exceeding  2000 
persons,  chiefly  engaged  in  quarrying  limestone,  which  is 
obtained  from  the  lower  lias  formation,  and  is  used  for 
making  hydraulic  cement ; .  and  in  agriculture.  Its  ivater- 
supply  is  obtained  from  wells,  which,  owing  to  the  filthy 
conditions  of  the  surrounding  soil,  must  be  subject  to 
constant  risk  of  pollution.  It  has  no  system  of  sewerage, 
properly  so-called ;  concerning  the  drains  that  are  in 
existence  the  Sanitary  Authority  have  but  little  information, 
and  that  which  was  communicated  to  Dr.  Barry  by  various 
persons,  official  and  other,  he  found  very  conflicting.  From 
his  own  examination  he  ascertained  that  the  drains  con¬ 
sisted  in  some  cases  of  brick  culverts,  in  others  of  glazed 
sanitary  pipes,  and  in  others  again  of  agricultural  pipes  with 
dry  joints  ;  while  a  large  number  consisted  merely  of  dry 
rubble  walls  with  slate  covers.  The  more  part  of  them 
were  said  to  be  stopped  up,  thus  giving  increased  facilities 
for  percolation  into  the  soil.  The  greater  part  of  the  sew¬ 
age  passes  into  the  river  Soar  by  means  of  two  outlets, 
one  on  each  side  of  the  bridge,  and  the  condition  of  the 
river  banks  in  the  neighbourhood  was  stated  to  be  ex¬ 
tremely  offensive  in  the  summer  months.  A  number  of 
the  houses  visited  were  found  to  have  no  artificial  means 
of  drainage,  the  slops  and  liquid  filth  being  thrown  into 
the  privy  cesspit  or  on  the  surface  of  the  ground.  The 
Sanitary  Authority  of  the  district  does  not  undertake  the 
removal  of  refuse,  consequently  the  inhabitants  have  to 
arrange  with  farmers  and  others  to  remove  it  at  their  con¬ 
venience — a  method  of  procedure.  Dr.  Barry  says,  which 
invariably  leads  to  the  storing  of  large  accumulations  of 
filth.  The  dwelling  accommodation  was  ascertained  to  be 
fairly  good,  though  some  cottages  were  noticed  quite  unfit 
for  human  habitation ;  moreover,  the  means  for  the  venti¬ 
lation  of  bedrooms  was  frequently  defective,  and  in  some 
instances  the  yards  common  to  groups  of  houses  were 
noticed  to  be  very  ill-paved,  and  to  have  slops  and  liquid 
filth  standing  in  holes  and  around  the  drain  inlets,  giving- 
rise  to  considerable  nuisance.  The  Medical  Officer  of  Health 
for  Barrow  informed  Dr.  Barry  that  scarlet  fever  was  intro¬ 
duced  into  the  village  from  Nottingham  in  July,  1882  ;  that 
•eighty-one  cases  were  treated  by  himself  and  the  other  local 
practitioner,  and  that  twenty  of  these  terminated  fatally  ; 
numerous  other  cases  were,  however,  stated  to  have  occurred. 


which  were  not  attended  by  any  doctor.  In  the  absence  of 
any  means  for  isolation  the  only  steps  taken  to  check  the 
progress  of  the  fever  were,  the  distribution  of  disinfectants, 
and  of  carbolised  oil  for  the  purposes  of  inunction  during 
the  process  of  desquamation,  by  the  inspector  of  nuisances. 
As  regards  the  dwellings,  little  beyond  cleansing  and  occa¬ 
sionally  lime-washing  was  practised,  fumigation  having  been 
rarely  resorted  to.  Efficient  disinfection  of  clothing  and 
bedding  by  dry  heat  was  not  possible  in  the  absence  of  the 
necessary  apparatus.  Dr.  Barry  sums  up  his  report  by 
remarking  that  the  water-supply  is  unfit  for  human  con¬ 
sumption  ;  that  the  drainage  is  most  imperfect ;  and  that 
the  means  adopted  for  the  disposal  of  excrement  is  of  the 
worst  description ;  and  he  is  of  opinion  that  the  persistence 

of  scarlet  fever  must,  in  a  measure,  be  att.ribufpd  f,o  tbq _ 

complete  absence  of  any  means  of  isolation  f» 

disinfection,  and  to  crowding  in  ill- ventilated/)^ 

_  f c nY  ft  ^  0  ff*  0 

Mr.  Power  on  Epidemic  Prevalence  W' Vn^b£i^;  A 

Fever  at  Hitchin.  ... . . 

In  February  of  the  present  year  the  Hitchlrh-,,jJrban  ■- 
Sanitary  Authority  applied  to  the  Local  Government  Boa  ret 
for  assistance  in  determining  the  cause  of  prevalence  of 
enteric  fever  in  its  district,  and  Mr.  W.  H.  Power  was 
deputed  to  conduct  an  inquiry.  His  report,  which  shows 
how  carefully  the  investigation  was  conducted,  establishes 
the  fact  that  a  first  outburst  of  the  fever,  beginning  early  in 
December  last,  culminating  about  the  middle,  and  waning 
almost  to  extinction  by  the  end  of  the  month,  was  closely 
followed  in  the  succeeding  January  by  a  second  and  larger 
outburst,  that  waxed,  culminated,  and.  waned  in  very  similar 
fashion  to  the  first.  Want  of  space  compels  us  to  abridge 
considerably  an  account  of  the  means  employed  to  arrive  at 
a  solution  of  the  difficulty,  but  it  must  be  mentioned  that  at 
first  some  suspicion,  as  usual,  attached  to  the  milk-supply, 
for  it  was  observed  that  several  of  the  families  earliest  invaded 
by  the  fever  had  obtained  their  milk  from  a  particular  dairy. 
On  inquiry,  however,  it  was  found  that  this  dairy  had  by 
far  the  largest  milk  business  in  the  town,  so  that  a  prepon¬ 
derance  of  attacks  among  its  customers  had  not  necessarily 
any  significance ;  and  further,  it  was  found  that  of  the 
families  invaded  in  the  first  epidemic  outburst  of  the  fever, 
above  one-half  had  obtained  their  milk  from  other  sources. 
The  public  water-supply,  however,  did  not  prove  on  inquiry 
to  be  so  harmless  ;  although  the  fever  had  had  a  wide  range, 
and  had  fallen  alike  on  high  and  low  lying  quarters  of  the 
town,  there  was  a  notable  limitation  in  its  incidence.  That 
portion  of  the  district  within  the  area  of  the  public  water- 
service  which  still  continued  to  use  well-water  had,  with  few 
exceptions,  escaped  fever,  and  the  exceptions  were  persons 
who,  it  was  proved,  had  drunk  the  public  water  elsewhere  than 
at  home.  Having  established  this  fact,  Mr.  Power  next  set 
to  work  to  ascertain  the  cause  of  the  impurity  of  the  water. 
In  investigating  the  source  of  the  supply  of  this  (which  he 
found  to  be  half  a  mile  south  of  the  centre  of  the  town,  and 
derived  from  a  spring  rising  in  the  chalk),  and  following  the 
.method  by  which  the  water  was  brought  to  the  service 
reservoir  from  which  it  was  distributed,  he  records  many 
risks  existing  of  contamination.  But  the  cause  of  the  spread 
of  the  fever  on  the  two  last  occasions  Mr.  Power  localised 
at  the  pumping  station.  Here  it  was  ascertained  that  an 
eight-inch  overflow  pipe,  contrived  to  convey  surplus  water 
from  the  receiving-tank  and  pumping- well  into  .the  river 
Hiz,  permitted,  on  occasion,  reflux  of  the  river- water  into 
the  tank.  Discovery  of  this  defect  in  January  last  was  not 
only  startling,  but  was,  in  a  way,  satisfactory  to  the  Sani¬ 
tary  Authority,  to  whom  the  waterworks  belong,  since  it 
went  far  to  explain  a  difficulty  that  had  for  some  time 
troubled  the  manager  of  the  works,  viz.,  that,  without 
obvious  cause,  suddenly  and  at  uncertain  intervals,  the  water 
in  the  pumping-well  had  been  apt  to  become  turbid.  The 
river  Hiz,  in  its  course  through  the  town,  is  little  more  than 
a  ditch,  into  which  refuse  of  all  descriptions  is  thrown.  On 
one  inspection  Mr.  Power  himself  saw  diarrhoeal  excrements, 
which  had  been  thrown  out  from  a  neighbouring  dwelling, 
lying  on  the  bank  just  above  the  point  of  entrance  to  it  of 
the  overflow  pipe  from  the  waterworks.  Subsequent  in¬ 
quiry  elicited  the  fact  that  on  December  30  last,  a  day  on 
which  a  heavy  rainfall  of  0  67  inches  was  registered  in 
Hitchin,  very  general  complaint  had  been  made  to  the 
-waterworks  manager  that  the  water  delivered  by  the  public 


498 


Medical  Times  and  Gazette. 


ABSTRACTS  AND  EXTRACTS. 


Oct.  27,  1883. 


mains  was  thick  and  turbid ;  and  an  examination  forth¬ 
with  undertaken  by  the  manager  revealed  the  fact  that 
the  water  in  the  pumping-well  and  the  service  reservoir 
was  in  a  like  condition.  This  pollution  of  the  public  water- 
service  on  December  30,  Mr.  Power  thinks,  was  decidedly 
the  cause  of  the  outbreak  of  fever  in  mid-January,  and, 
that  being  admitted,  it  is  but  fair  to  presume  that  the 
first  outbreak  may  have  had  a  similar  origin.  In  conclusion, 
Mr.  Power  wishes  it  to  be  understood  that  he  does  not  refer 
all  the  fever  which  has  recently  occurred  in  Hitchin  to 
water  causation,  but  he  thinks  the  public  water-service  was 
the  main  factor  in  its  spread  on  the  two  occasions  quoted, 
which  induced  the  Sanitary  Authority  to  seek  for  an  inquiry. 


ABSTRACTS  AMD  EXTRACTS. 
- - 

The  Prevention  of  Ophthalmia  Neonatorum. 

In  a  recent  number  of  the  Archiv  fur  Gynakologie,  Prof. 
Crede,  of  Leipzig,  calls  attention  to  the  prophylactic  treat¬ 
ment  of  the  ophthalmia  of  the  newly-born  which  he  has  in 
former  communications  advocated,  and  which  has  now  been 
tested  by  considerable  experience.  His  view  as  to  the  etiology 
of  the  disease  is,  that  it  is  always  the  result  of  inoculation 
of  gonorrhoeal  virus  from  the  mother,  the  contagious  matter 
coming  into  contact  with  the  infantile  conjunctiva  while  the 
child  is  traversing  the  maternal  passages.  The  form  of 
vaginitis  known  as  “  granular/5  he  regards  as  gonorrhoeal  in 
origin.  In  support  of  this  he  points  to  experiments  by 
Konigstein,  Hausmann,  and  others,  in  which  ordinary 
vaginal  leucorrhoeal  secretion,  transferred  to  the  conjunc¬ 
tiva  of  animals,  failed  to  produce  inflammation.  He  also 
adduces  statistics  to  show  that  ophthalmia  neonatorum 
occurs  more  frequently  in  children  born  after  labours  with 
prolonged  second  stage,  especially  after  these  in  which 
rupture  of  the  membranes  took  place  prematurely,  from  the 
greater  length  of  time  in  which  the  foetal  conjunctiva  was, 
in  such,  exposed  to  the  risk  of  infection ;  and  that  the 
disease  is  more  frequent  in  boys  than  in  girls,  because  labour 
with  boys  is  longer.  These  figures  do  not  seem  to  us  quite 
conclusive,  because  Prof.  Crede  does  not  adduce  for  com¬ 
parison  any  statement  of  the  frequency  of  prolonged  second 
stage,  or  premature  rupture  of  membranes  in  mothers  whose 
children  did  not  suffer  from  ophthalmia;  and  the  excess  of 
boys  affected  over  girls  is  very  slight,  and  might  be  acci¬ 
dental.  The  method  of  prophylaxis  is  the  following  : — After 
the  umbilical  cord  has  been  secured,  the  child  is  washed, 
and  then  the  eyes  are  cleansed  with  a  clean  bit  of  rag  dipped 
in  water.  Each  eye  is  then  held  open,  and  with  a  glass  rod 
a  drop  of  a  2  per  cent,  solution  of  nitrate  of  silver  is  let  fall 
upon  each  cornea.  Nothing  further  is  done.  This  sometimes 
produces  a  little  hyperasmia  of  the  conjunctiva,  with  slight 
increase  of  secretion ;  but  these  results  pass  off  by  the  third 
day.  The  results  obtained  by  Prof.  CredS  are  the  following  : 
— In  the  Leipzig  Hospital,  from  1870  to  1883,  4057  living 
children  were  born,  of  which  318,  or  7'8  per  cent.,  suffered 
from  ophthalmia.  In  1871  and  1877  there  were  between 
6  and  7  per  cent,  affected ;  but  in  the  remaining  years 
between  1870  and  1880  from  12  to  15  per  cent.  In  1880  Prof. 
Crede  introduced  his  prophylactic  treatment,  and  from  that 
time  till  the  present,  out  of  1160  births,  only  four  cases  of 
ophthalmia  have  occurred ;  but  of  these  in  two  the  treatment 
had  not  been  properly  carried  out,  while  in  one  the  disease 
did  not  appear  till  the  ninth  day  after  delivery,  and  therefore 
could  not  be  properly  called  “  ophthalmia  neonatorum/5 
for  the  disease,  to  deserve  that  name,  should  come  on  in  the 
first  five  days.  In  Stuttgart,  according  to  Bayer,  the  per¬ 
centage  of  ophthalmia  in  the  years  1877  to  1880  was  8'7, 
14-3,  12'9,  and  9‘6  per  cent,  respectively.  In  1881  the  treat¬ 
ment  was  adopted,  and  since  then  there  have  been  361  births 
without  a  single  case  of  ophthalmia.  Konigstein  reports  a 
percentage  of  5'44,  sinking,  in  consequence  of  the  treatment, 
to  below  1  per  cent.  It  only  remains  to  be  added,  that 
Prof.  Crede  thinks  the  treatment  of  so  simple  a  character 
that  nurses  may  be  trusted  to  do  it ;  also  that  Horner 
reports  that  throughout  Germany  about  a  third  of  the 
patients  in  asylums  for  the  blind  came  there  through  infan¬ 
tile  ophthalmia  :  so  that  the  importance  of  the  subject  can 
scarcely  be  overrated. 


The  State  of  the  Non-Paralysed  Limbs  in  Hemiplegia. 

The  fact  that  in  ordinary  hemiplegia  due  to  a  destructive 
lesion  in  the  brain,  whether  central  or  cortical,  the  paralysis 
does  not  affect  the  whole  of  one  half  of  the  body,  is  well 
known.  The  regions  that  invariably  escape  are  the  vertebral 
column,  the  neck,  the  larynx,  the  muscles  of  the  abdomen 
and  diaphragm.  The  muscles  which  remain  paralysed  after 
a  destructive  lesion  of  the  motor  area  are  those  of  the  limbs 
and  part  of  the  face  on  the  opposite  side  of  the  body.  What 
is  not  so  generally  known  or  admitted,  is  that,  in  consequence 
of  unilateral  lesions  of  the  brain,  certain  permanent  dis¬ 
turbances  of  motor  power  or  nutrition  may  be  observed  on 
both  sides  of  the  body.  In  the  Progres  Mddical  (Nos.  39, 
40,  41),  M.  Paul  Dignat  has  studied  these  bilateral  pheno¬ 
mena,  and  made  some  general  remarks  upon  the  physiology 
thereof  which  merit  consideration.  In  the  first  place,  in 
hemiplegia  the  other  arm  is  always  obviously  weakened,  but 
there  is  never  any  other  important  functional  disturbance  ; 
it  is  never  the  seat  of  epileptiform  tremor,  nor  of  secondary 
contracture.  In  the  leg,  on  the  other  hand,  there  may  be 
found  not  only  diminution  of  muscular  strength  and  func¬ 
tional  powerlessness,  but  also  the  rapid  formation  of  bed¬ 
sores,  exaggeration  of  the  tendon  reflexes,  epileptiform 
tremor,  and,  in  some  rare  cases,  secondary  contracture. 
M.  Dignat  goes  on  to  say,  “We  have  just  enumerated  the 
leading  symptoms  which  may  appear  in  a  case  of  hemi¬ 
plegia  on  the  side  opposite  to  the  paralysis.  We  must  now 
seek  to  explain  the  mechanism  by  which  a  unilateral  lesion 
of  the  brain  can  affect  both  sides  of  the  body,  and  give  rise 
to  motor  or  nutritive  phenomena,  both  in  the  limbs  on  the 
side  opposite  to  the  cerebral  lesion,  and  also  in  those  on  the 
same  side.  All  the  symptoms  which  we  have  had  under 
consideration  have  not  the  same  pathological  meaning.  Thus 
the  loss  of  strength  in  the  limbs  on  the  same  side  as  the 
lesion  is  probably  the  result  of  a  mere  functional  disturbance 
of  the  central  nervous  system,  the  various  portions  of  which 
are  so  intimately  connected  with  each  other,  that,  of  neces¬ 
sity,  lesion  of  one  part  to  a  certain  extent  hampers  the  action 
of  the  others.  The  bilateral  exaggeration  is  perhaps  also 
the  result  of  a  purely  functional  modification  of  the  spinal 
irritability,  but  the  secondary  contracture  must  certainly  be 
due  to  organic  lesion/5  It  appears  from  the  researches  of 
M.  Pitres  that  secondary  sclerosis  of  the  spinal  cord  is  not 
always  limited  to  the  areas  indicated  by  Turck,  i.e.,  to  the  in¬ 
ternal  part  of  the  anterior  column  on  the  same  side  as,  and  to 
the  posterior  part  of  the  lateral  column  on  the  opposite  side  to, 
the  lesion.  That,  no  doubt,  is  most  commonly  the  case,  but 
sometimes  the  descending  degeneration  resulting  from  a  single 
lesion  occupies  both  the  lateral  columns  of  the  cord  sym¬ 
metrically,  with  or  without  participation  of  the  column  of 
Turck.  The  degeneration  may  or  may  not  be  symmetrical 
on  the  two  sides,  but  it  always  remains  systematic.  Plechsig 
has  shown  that  occasionally  the  decussation  of  the  anterior 
pyramids  does  not  take  place.  M.  Dignat  suggests  that  in 
some  instances  the  anterior  pyramids  send  fibres  to  each 
lateral  column,  and  would  thus  explain  the  existence  of 
bilateral  rigidity  after  a  unilateral  cerebral  lesion. 


The  Moist  Sponge  Dressing  in  Amputations  of  the 

Joints. 

Dr.  McClellan,  Surgeon  to  the  Philadelphia  Hospital, 
relates,  in  the  Phil.  Med.  News  of  August  4,  a  case  of  ampu¬ 
tation  at  the  knee-joint,  with  the  object  of  advocating  more 
frequent  amputations  at  the  joints,  in  order  to  prevent 
the  risk  of  a  second  amputation  being  rendered  necessary 
by  the  propagation  of  disease  along  the  medulla  of  the 
bone.  Another  principal  object  which  he  has  in  view  is  the 
removal  of  an  important  objection  to  the  operation— the 
impression  that  it  implies  extensive  suppuration  and  ex¬ 
haustive  drainage.  He  believes  that  considerable  suppura¬ 
tion  in  this  and  other  wounds  is  mainly  due  to  the  surgical 
dressing  ordinarily  employed ;  and  he  wishes  in  this  case  to 
exhibit  the  superiority  of  moist  sponge,  which  is  of  simple 
application,  and  obviates  the  retention  of  any  discharges  in 
the  wound.  The  patient,  forty-four  years  of  age,  underwent 
amputation  of  the  knee-joint  at  the  end  of  April,  in  con¬ 
sequence  of  the  great  pain  in  the  stump  which  she 
suffered  after  an  amputation  of  the  leg,  performed  at  the 
beginning  of  January,  on  account  of  cancerous  disease, 
which  afterwards  spread  along  the  tibia.  The  edges  of  the 


Medical  Times  and  Gazette. 


Oct.  27,  1883.  49  9 


REVIEWS  AND  NOTICES  OF  BOOKS. 


wound  were  carefully  approximated  with  silver  wire,  and  a 
large,  soft  sponge  (previously  soaked  in  carbolised  water, 
one  part  to  forty)  was  applied  directly  to  the  part,  and  held 
in  position  by  broad  bands  of  adhesive  plaster,  extending 
diametrically  across  the  sponge  and  along  the  thigh,  so  as  to 
exert  equal  compression  upon  the  deep  as  well  as  the  super¬ 
ficial  structures.  The  ligatures  were  brought  out  at  the 
most  convenient  points,  and  their  ends  embraced  in  the 
grasp  of  the  sponge.  There  was  no  external  or  other  dress¬ 
ing  applied,  except  that  a  light  roller  was  run  up  the  thigh  to 
control  muscular  spasm,  and  the  thigh  itself  slightly  elevated 
on  a  pillow  of  oakum.  This  dressing  was  not  disturbed  for 
twenty-four  hours,  when  it  was  removed,  and  afterwards  re¬ 
applied  daily.  One  of  two  sponges  was  used  alternately,  and 
kept  constantly  moistened  with  carbolised  water  (one  to 
forty),  while  the  other  was  soaking  in  the  solution.  At  each 
removal,  all  the  discharges  were  found  within  the  meshes  of 
the  sponge,  and  the  appearance  of  the  wound  was  satisfac¬ 
tory,  except  on  the  fourth  day,  when  it  became  erysipelatous 
(from  contamination  of  an  outbreak  in  the  ward).  This  was 
combated  by  wetting  the  sponge  with  a  solution  of  sulphate 
of  iron  (gr.  x.  ad  3j.),  and  the  progress  of  the  case  was  there¬ 
after  uninterrupted  towards  recovery,  which  was  completed 
with  firm  cicatrisation  and  entire  cessation  of  discharge 
on  May  20,  three  weeks  from  the  date  of  the  operation.  The 
temperature  reached  100°  the  first  night,  and  101°  on  the 
fourth  ;  but,  with  the  subsidence  of  the  erysipelas,  it  fell  to 
the  normal,  and  remained  so  throughout  the  rest  of  the 
treatment.  The  stump  is  firm,  and  well  adapted  for  the 
use  of  an  artificial  limb.  The  patella  remains  between  the 
condyles  of  the  femur,  and  there  is  excellent  forward  motion, 
due  to  the  preservation  of  the  function  of  the  extensor  quad¬ 
riceps  muscle.  Dr.  McClellan  hopes  that  the  narration  of 
this  case  will  induce  others  to  give  the  moist  sponge  appli¬ 
cation,  of  which  he  is  a  warm  advocate,  a  trial. 


The  Semicircular  Canals.— Dr.  Wm.  James,  of 
Harvard  University,  has  made  some  experiments  to  test  the 
modern  theory  that  the  semicircular  canals,  instead  of  being 
connected  with  the  sense  of  hearing,  serve  to  convey  the  feel¬ 
ing  of  movement  of  the  head  through  space,  which,  when 
intensified,  becomes  dizziness.  It  occurred  to  him  that  deaf- 
mutes,  having  their  auricular  organs  injured,  might  afford 
some  corroboration  of  the  theory,  if  it  were  true,  by  showing 
a  smaller  susceptibility  to  dizziness  than  persons  with 
normal  hearing.  Of  519  deaf-mutes  examined  by  subject¬ 
ing  them  to  a  rapid  whirling,  186  were  wholly  insusceptible 
of  being  made  dizzy,  134  were  made  dizzy  in  a  very  slight, 
degree,  and  199  were  normally,  and  in  a  few  cases  ab¬ 
normally  sensitive.  Nearly  200  students  and  instructors 
of  Harvard  College,  supposed  to  have  normal  hearing,  were 
examined  for  the  purpose  of  comparison,  and  but  a  single 
•one  proved  exempt  from  the  vertigo. — Louisville  Med.  News, 
September  1  (from  Weekly  Med.  Review). 

Operations  for  Bronchocele  at  Tubingen.— In 
Prof.  P.  Bruns’  Mittheilungen  a.  d.  Chirurg.  Klinik  zu 
Tubingen,  Dr.  Pischer  states  that  the  Professors  Bruns 
(father  and  son)  have  performed  the  extirpation  of  38  non- 
malignant  bronchoceles,  and  of  5  malignant.  The  former 
occurred  in  36  individuals  (25  males  and  11  females),  of 
whom  12  were  not  more  than  twenty  years  of  age.  In  11 
cases  the  bronchocele  was  parenchymatous,  in  19  paren- 
chymo-cystic,  and  in  8  unilocular — iodine  injections  having 
been  tried  in  vain  in  these  last.  Of  the  38  operations,  6 
(15'8  per  cent.)  proved  fatal — in  3  from  septicaemia,  1  from 
tetanus,  and  1  from  pleuritis  and  pericarditis,  while  in  1 
the  operation  could  not  be  completed,  the  patient  dying 
thirty-two  days  after  from,  some  unascertained  disease.  In 
3  cases  the  number  of  ligatures  rendered  necessary  amounted 
to  120  !  Tracheotomy  had  to  be  resorted  to  only  in  2  cases, 
once  before  and  once  during  the  operation.  In  3  cases 
narrowing  of  the  trachea  had  taken  place  from  the  compres¬ 
sion,  but  in  none  had  its  cartilages  undergone  softening. 
During  the  healing  process,  secondary  haemorrhage  occurred 
in  7  cases.  Of  the  5  operations  for  malignant  bronchocele, 
2  terminated  fatally.  The  disease  was  cancerous  in  4 
cases,  and  sarcomatous  in  1.  In  one  of  the  cases  of  carci¬ 
noma  the  patient  lived  for  three  years  and  a  quarter,  the 
longest  period  that  has  been  survived  after  the  extirpation 
of  a  malignant  bronchocele. — Centralblatt  fur  Chirurgie, 
August  11. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


Injuries  of  the  Spine  and  Spinal  Cord,  without  Apparent 

Mechanical  Lesion,  and  Nervous  Shock,  in  their  Surgical 

and  Medico-Legal  Aspects.  By  H.  W.  Page,  F.R.C.S., 

M.C.  Cantab.,  etc. ;  Surgeon  to,  and  Lecturer  on  Surgery 

at,  St.  Mary’s  Hospital.  London:  J.  and  A.  Churchill. 

8vo,  pp.  374. 

This  book  has  a  twofold  aspect.  On  the  one  hand  it  is  a 
careful  treatise  on  what  is  implied  in  the  title,  while  on  the 
other  it  is,  by  reason  of  the  nature  of  a  great  part  of  its 
subject-matter,  an  attempt  at  a  “clearing-up”  of  the 
various  medical  and  popular  notions  which  obtain  regarding 
the  consequences  of  railway  accidents,  especially  collisions. 
It  is  mainly  on  the  probability  of  the  author’s  views  on  this 
latter  question  that  the  reputation  and  value  of  this  book 
must  rest ;  for  Mr.  Page  says  himself  that  it  is  an  “indirect 
object  of  this  work  to  show  that  with  very  rarest  exception 
the  spinal  cord  is  absolutely  uninjured  in  cases  of  railway 
collision,  shock  or  jar.” 

The  position  taken  is  that  most  of  the  cases  of  pain  in  the 
back  with  subsequent  nervous  symptoms,  so  often  heard  of 
after  railway  accidents,  and  commonly  put  down  to  “  con¬ 
cussion  of  the  spine,”  are  in  reality  cases  of  injury  to  the 
structures  in  the  neighbourhood  of  the  vertebral  column, 
ligamentous  and  muscular,  combined  in  varying  proportion 
with  the  symptoms  of  nervous  shock  ;  and  that  many  cases 
where  there  may  be  no  pain  in  the  back  complained  of  are 
due  to  nervous  shock  alone.  It  is  obvious,  when  the  predomi¬ 
nant  teaching  as  regards  the  possible  and  frequent  results 
of  “  spinal  concussion  ”  is  borne  in  mind,  that  the  opinions 
of  this  author  are  greatly  divergent  therefrom,  and  that, 
in  consequence,  their  substantiation  or  refutation  is  a 
matter  of  considerable  importance,  both  to  the  profession 
and  the  public. 

To  the  widely  received  notion  that  a  shock  suffered  in  a 
railway  collision,  whether  there  have  been  any  violence  to 
the  back  or  no,  may  so  affect  the  cord  by  “  concussion  ”  as 
to  lead  to  its  ultimate  inflammation  and  that  of  its  mem¬ 
branes,  is  opposed  the  statement  that  there  is  no  evidence  of 
primary  or  secondary  changes  having  been  produced  in  the 
spinal  cord  where  there  has  not  been  at  the  same  time  clear 
proof  of  injury  on  or  close  to  the  vertebral  column.  Mr. 
Page,  in  effect,  would  erase  the  words  “  concussion  of  the 
spine  ”  from  medical  terminology. 

He  argues  at  first  by  the  d  priori  method,  and  urges  that 
the  cord  by  its  anatomical  surroundings  is  especially  secured 
from  injury  by  either  direct  or  indirect  violence.  There  is 
no  true  analogy,  he  shows,  between  what  is  understood  as 
concussion  of  the  brain  and  the  so-called  concussion  of  the 
spine — a  point  which  he  discusses  at  some  length ;  and  he 
further  calls  attention  to  the  confusion  implied  in  the  very 
term  “concussion  of  the  spine,”  used,  as  it  often  is,  at  one 
time  for  the  set  of  symptoms  supposed  to  be  due  to  a  shake 
of  the  cord,  and  at  another  as  denoting  the  blow  or  the 
active  cause  of  the  symptoms,  as,  for  instance,  in  the 
phrase,  “below  the  seat  of  the  concussion  of  the  spine.” 
Prom  such  confusion  as  this  misunderstanding  must 
obviously  result.  Yet  another  inaccuracy  is  shown  to  be 
involved  in  the  formula  “  concussion  of  the  spine,”  the 
word  “  spine  ”  being  not  always  definitely  used,  but  allowed 
to  stand  sometimes  for  the  marrow,  and  sometimes  for  its 
bony  case.  The  notion  of  spinal  concussion  is  thus  repre¬ 
sented  as  not  being  a  vera  causa,  or  a  good  working  hypo¬ 
thesis  to  cover  the  facts  and  allegations  which  it  is  called  on 
to  explain. 

The  main  argument,  however,  on  which  the  author  rests 
to  establish  his  contention  that  the  cases  generally  attri¬ 
buted  to  “  concussion  of  the  spine  ”  and  its  alleged  conse¬ 
quences  are  of  quite  a  different  character,  is  an  appeal  to  facts 
and  experience.  And,  as  surgeon  to  one  of  the  largest  railway 
companies,  Mr.  Page  is  able  to  present  his  readers  with  a  very 
considerable  amount  of  material  to  study.  He  first  shows  that 
there  is  no  post-mortem  evidence  of  undoubted  lesion  occur¬ 
ring  in  nervous  centres  when  the  possibility,  or  even  the  pro¬ 
bability,  is  excluded  of  some  traumatic  injury  having  been 
inflicted  at  the  time  of  the  accident;  and  that  the  absence 
of  any  proof  of  myelitis  or  meningitis  taking  place,  in  cases 
where  there  has  been  only  a  supposed  direct  or  indirect  shake 
of  the  spinal  cord,  goes  far  to  render  such  occurrence  of  the 


500 


Medical  Times  and  Gazette. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


Oct.  27,  1883. 


greatest  unlikelihood,  when  the  especial  security  of  the  cord 
from  injury  is  borne  in  mind.  It  is  very  rare,  says  the 
author,  for  direct  blows  on  the  back,  or  falls,  in  ordinary 
practice,  to  cause  any  symptoms  which  could  be  referred 
to  disease  of  the  cord.  Why,  then,  in  cases  of  railway 
accident  should  an  unknown  etiological  quantity  be  called 
in  ? 

It  is  next  contended  that  the  symptoms  so  generally  in¬ 
ferred  to  “  concussion  of  the  spine  ”  can  be  explained  in  other 
ways — -that,  in  fact,  known  causes  can  be  adduced  to  account 
for  them,  without  recourse  to  gratuitous  hypothesis;  and  the 
author  proceeds  to  ascribe  these  symptoms  to  the  general 
category  of  “  nervous  shock.” 

In  the  chapters  of  the  book  entitled  “  Spinal  Injuries  of 
Railway  Collision,”  and  “  Shock  to  the  Nervous  System,” 
Mr.  Page  works  out  and  illustrates  his  contention  that  the 
common  injuries  and  affections  resulting  from  railway  col¬ 
lisions  are,  in  a  large  majority  of  cases,  due  to  sprain  of  the 
muscular  and  ligamentous  structures  of  the  back,  and  to 
nervous  disturbance  resulting  directly  or  indirectly  from  the 
accident.  These  chapters  are  full  of  matter,  and  display 
an  intimate  knowledge  of  the  phenomena  of  nerve-disease, 
and  a  thorough  acquaintance  with  recent  neurological 
research.  They  are,  moreover,  enriched  by  a  constant 
reference  to  cases  in  point,  being,  indeed,  founded  on 
a  large  number  of  observations  made  by  the  author  him¬ 
self,  and  embodied  to  a  great  extent  in  an  elaborate  and 
interesting  table  of  234  unselected  cases  of  railway  injuries, 
which  forms,  as  an  appendix,  a  most  important  feature  of 
the  book.  It  is  shown,  in  an  apparently  incontestable 
manner,  that  a  large  number  of  these  cases,  evincing  the 
symptoms  usually  ascribed  to  “ concussion  of  the  spine,” 
and  held  to  involve  the  probability  of  supervening  structural 
disease,  tend  to  ultimate  and  perfect  recovery,  and  that  they 
are  most  frequently  influenced  for  good,  where  there  has 
been  litigation,  by  a  settlement  of  the  claim  made,  whether 
the  result  be  for  or  against  the  patient. 

A  great  distinction  is  drawn  between  the  mass  of  cases, 
undoubtedly  genuine,  which  are  thought  to  be  due  to  the 
causes  above  mentioned,  and  those  attributable  to  malin¬ 
gering.  An  interesting  chapter  is  devoted  to  this  latter 
subject,  containing  many  hints  of  practical  value ;  and 
the  book  ends  with  some  useful  and  weighty  observations 
on  the  manner  of  examining  cases  of  railway  injuries 
where  litigation  is  involved,  and  of  giving  evidence  in 
courts  of  law. 

The  remarks  on  the  “  electric  test  ”  in  the  examination  of 
patients  are  undoubtedly  true  and  much  to  the  point,  but 
perhaps  require  some  expansion  to  prevent  misunder¬ 
standing.  The  great  diagnostic  value  of  the  use  of  elec¬ 
tricity,  properly  applied,  in  some  cases  is  not  to  be 
underrated,  though,  as  the  author  insists,  this  agent  is 
calculated,  without  due  care,  to  cause  more  confusion  than 
clearness. 

The  constant  reference  to  facts,  and  the  rigidly  logical 
method  which  is  apparent  throughout  this  book,  lend  great 
weight  to  the  inferences  drawn  by  the  author,  whose  field 
for  observation  is  confessedly  large.  Doubtless  his  position 
as  surgeon  to  a  railway  company  renders  him  liable  to  a 
charge  of  unconscious  bias  in  the  formation  of  his  opinions. 
Nevertheless,  it  must  be  said  that  it  is  impossible  to  discover 
a  trace  of  any  such  influence  in  the  whole  course  of  his 
argument.  But,  perhaps  in  the  heat  of  contesting  received 
opinions  and  of  endeavouring  to  establish  other  views,  the 
author  is  occasionally  led  into  a  controversial  style  which  does 
not  harmonise  well  with  the  cool  and  lucid  line  of  argument 
that  he  usually  follows  ;  and  there  is  evinced  here  and  there  a 
seeming  touch  of  acerbity  and  somewhat  uncalled-for  rheto¬ 
ric  in  dealing  with  the  opinions  of  hitherto  acknowledged 
authorities  on  his  subject,  which  we  hope  Mr.  Page  will  see 
fit  to  modify  or  dispense  with  in  a  future  edition.  In  saying 
this  we  have  found  all  the  fault  we  can  with  a  book  which 
evinces  large  experience,  careful  thought,  and  all-round 
medical  knowledge  on  the  part  of  its  author;  and  which, 
if  its  main  contention  prove  to  be  true,  seems  to  go  far  j 
towards  rendering  the  knowledge  of  a  hitherto  obscure 
and  neglected  set  of  clinical  phenomena  part  of  the 
common  property  of  the  practitioner  of  medicine,  and 
helping  us  to  “  escape  from  the  region  of  cloud-land 
when  we  hear  no  more  than  that  a  man  has  been  in  a 
collision  and  had  concussion  of  the  spine  and  become 
paralysed.” 


Lectures  on  the  Localisation  of  Cerebral  and  Spinal  Diseases . 

By  J.  M.  Charcot.  Translated  and  Edited  by  W.  B. 

Hadden,  M.D.  London:  The  New  Sydenham  Society. 

1883.  Pp.  336. 

These  Lectures  were  delivered  at  the  Faculty  of  Medicine  of 
Paris  in  1875,  and  appeared  in  the  Progres  Medical  as  they 
were  given,  and  were  subsequently  issued  in  a  separate  form, 
of  which  the  present  is  the  translation.  Their  aim  may  be 
said  to  be  to  demonstrate  the  importance  of  morbid  anatomy, 
as  compared  with  experimental  physiology,  in  determining 
the  functions  of  the  several  component  parts  of  the  central 
nervous  system.  The  normal  structure  of  the  cortex  and  of 
the  central  ganglia  occupies  several  lectures,  and  affords 
M.  Charcot  an  opportunity  for  pointing  out  the  most  common 
seat  of  cerebral  haemorrhage,  one  of  the  lenticulo-striate 
arteries,  which  he  proposes  to  name  the  “  artery  of  cerebral 
haemorrhage,”  owing  to  its  rupture  being  by  far  the  most 
common  cause  of  this  occurrence.  The  succeeding  lectures 
deal  with  hemianaesthesia,  amblyopia  (including  M. Charcot’s 
well-known  theory  of  the  mode  of  production  of  crossed  am¬ 
blyopia),  and  the  effects  of  lesion  of  the  different  portions  of 
the  internal  capsule.  The  second  part  of  the  volume  relates 
to  the  anatomy,  development,  and  lesions  of  the  spinal  cord. 
The  important  part  played  by  the  pyramidal  tract  in  secondary 
degenerations  is  given  due  prominence ;  and  the  labours  of 
Flechsig  in  this  and  other  matters  are  fully  recognised. 
Several  lectures  are  devoted  to  the  results  of  secondary  de¬ 
generation — e.g.,  late  hemiplegic  contracture,  spasmodic 
infantile  hemiplegia — and  the  true  nature  of  spasmodic  dorsal 
tabes  is  discussed  at  length ;  M.  Charcot  frankly  admitting 
that  cases  he  had  supposed  to  be  of  that  nature  had  subse¬ 
quently  been  proved  to  be  cases  of  disseminated  cerebro¬ 
spinal  sclerosis.  Dr.  Hadden  is  to  be  congratulated  upon 
having  produced  a  translation  of  these  valuable  Lectures 
which,  whilst  faithful  to  the  text,  is  not  marred  by  being 
too  literal. 


Surgical  Cases  and  Essays.  By  Rushton  Barker,  B.S., 

F.R.C.S.,  Professor  of  Surgery  in  University  College, 

Liverpool.  In  Two  Parts.  Liverpool :  Adam  Holden. 

1883.  Pp.  43  and  56. 

This  little  volume  consists  of  two  parts.  In  the  first  are 
collected  a  series  of  reprints  of  papers  on  surgical  subjects, 
including  the  treatment  of  fractures,  of  synovitis  of  the 
knee  by  compression,  cases  of  excision  of  the  tongue,  of 
umbilical  hernia,  and  of  lithotomy.  This  practice  of  collect¬ 
ing  together  papers  scattered  throughout  the  medical  press  is 
very  commendable,  and  might,  we  think,  be  advantageously 
practised  more  widely  than  it  is.  The  cases  are  unusual 
from  one  point  or  another,  and  worthy  of  a  better  fate  than 
to  be  hidden  away  in  the  not  always  readily  accessible  pages 
of  the  weekly  journals. 

Part  II.  deals  with  abdominal  hernia  and  its  treatment. 
In  his  preface  Mr.  Parker  points  out  that  he  does  not  repeat 
indisputable  facts  ;  but  accentuates  certain  points  of  treat¬ 
ment,  etc.,  to  which  he  would  draw  attention.  Thus,  special 
stress  is  laid  on  the  need  for  thorough  and  prompt  “  func¬ 
tional  treatment,”  over  and  above  the  relief  of  strangulation, 
in  all  forms  of  intestinal  obstruction.  Omental  hernia  is 
discussed  in  its  various  bearings,  and  a  somewhat  new  view 
as  to  its  pathological  condition  is  advanced.  The  true  cause 
of  “’collapse”  after  perforation  of  intestine  is  studied,  and 
its  serious  consequences  attributed  to  the  septicremia  which 
it  gives  rise  to,  rather  than  to  the  mere  fact  of  perforation 
per  se,  as  was  formerly  taught.  The  little  volume  is  full  of 
interest,  and  will  add  to  Mr.  Parker’s  reputation'  as  an 
observant  and  practical  surgeon. 


The  Lettsomian  Lectures  on  the  Treatment  of  some  of  the 
forms  of  Valvular  Disease  of  the  Heart.  By  A.  Ernest 
Sansom,  M.D.  London:  J.  and  A.  Churchill.  1883. 
Small  Svo,  pp.  93. 

These  Lectures,  delivered  in  the  early  part  of  the  present 
year,  have  already  appeared  in  our  pages ;  they  deal  solely, 
or  almost  so,  with  diseases  of  the  mitral  valve,  and  may  be 
regarded  as  a  clear  and  concise  statement  of  the  facts  known, 
and  the  views  most  commonly  held  at  the  present  day  in 
regard  to  those  diseases,  by  one  who  has  made  a  special 
study  of  the  subject.  We  have  much  pleasure  in  commend¬ 
ing  to  the  notice  of  our  readers  this  admirable  little  book. 


Medical  Times  and  Gazette. 


GENERAL  CORRESPONDENCE. 


Oct.  27, 1883.  501 


GENERAL  CORRESPONDENCE. 

- « - 

URETHRAL  FEVER. 


[To  tlie  Editor  of  the  Medical  Times  and  Gazette.] 

Sir,- — Tn  your  issue  of  to-day  (page  471)  I  find  it  reported  that 
Sir  Andrew  Clark  lately  submitted  for  investigation  by  the 
Clinical  Society  of  London  a  morbid  condition  which  he  does 
not  find  explained  “  either  in  contemporary  opinion  or  in 
the  writings  of  previous  authorities."’  This  state  has  long 
been  known  to  surgeons  as  Urethral  Fever,  a  very  fully 
illustrated  account  of  which  will  be  found  at  page  367  of 
Fayrer’s  “Clinical  and  Pathological  Observations  in  India.” 
The  effect  of  catheterism  upon  one  who  is  the  subject  of 
morbus  Brightii  or  of  malarious  poisoning  is  often  the  same 
as  that  of  a  chill  or  a  stab  :  it  causes  rigor,  ushering  in 
fever,  which  may  be  deadly.  Sir  Joseph  Fayrer  remarks  : — 
“  Urethral  Fever  is  more  prone  to  occur  in  a  malarious 
climate,  like  that  of  Lower  Bengal,  than  elsewhere.  I  have 
no  recollection  of  ever  having  seen  it  elsewhere  in  such 
marked  and  severe  form  as  in  Calcutta ;  for  not  only  does  it 
sometimes  supervene  here  after  catheterism  in  tight  stric¬ 
tures,  where  the  instrument  is  passed  with  difficulty,  and 
the  patient’s  constitution  is  irritable  from  the  effects  of  the 
disease,  but  in  slighter  cases,  and  sometimes  even  when  there 
is  no  stricture  at  all,  and  the  instrument  has  been  passed 
for  other  reasons.”  Mr.  Stafford  wrote,  many  years  ago,  in 
malarious  London : —“Ague  very  frequently  occurs  from 
local  injury,  when  the  patient  has  previously  had  an  attack 
of  it.  An  injury  to  the  urethra  is  a  good  example  of  this — 
with  which  we  are  all  acquainted.”  I  am,  &c., 

London,  October  20.  Norman  Chevers,  F.R.C.S.  Eng. 


THE  CAMDEN  TOWN  EPIDEMIC. 


[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sir,— The  following  review  of  certain  of  the  facts  connected 
with  the  recent  outbreak  of  typhoid  fever  in  St.  Pancras 
may  serve  to  support  some  of  the  conclusions  suggested  by 
your  leader  of  the  20bh  inst.  Allowing  ten  days  as  the  usual 
incubation  period  for  enteric  fever,  we  might  expect  that, 
had  the  St.  Albans  milk  still  been  infective,  an  increased 
incidence  of  the  disease  would  be  seen  from  September  3 
onwards,  due  to  the  renewal  of  the  supply  from  that  source 
on  August  24.  The  figures  on  page  5  of  the  report  show, 
however,  a  marked  diminution  of  cases  commencing  after 
that  date— only  seven  of  which  the  dates  are  accurately 
known  ;  while  for  the  whole  of  August  the  average  weekly 
number  had  been  about  thirty,  and  in  the  last  fortnight 
110  cases,  or  a  weekly  average  of  fifty-five.  Or,  to  show 
the  same  thing  more  markedly,  there  were  in  the  last 
eight  days  of  August  seventy-two  cases,  and  in  the  first 
eight  days  of  September  only  eighteen  cases.  The  seven 
cases  which  occurred  after  September  3  may  be  due  to  the 
longer  incubation  period,  which,  as  is  known,  may  extend  to 
twenty-one  days.  Hence  the  inference  is  that  the  milk 
supplied  after  August  24  was  free  from  infection.  The  milk- 
supply  from  one  farm  was  never  renewed  after  August  18. 
The  large  increase  in  the  number  of  cases  (forty-eight) 
noticed  by  Dr.  Murphy  as  occurring  from  August  24  to  27, 
may  be  attributed  to  causes  operating  before  August  18. 
Dr.  Murphy’s  report  goes  far  to  prove  a  connexion  between 
the  outbreak  at  St.  Pancras  and  the  milk  from  Mr.  Z.’sfarm, 
but,  as  the  report  says,  the  manner  in  which  the  milk  became 
infected  is  not  clear.  The  theory  that  the  water  was  in¬ 
fected  by  percolation  from  the  cesspit,  though  fitting  best 
the  present  state  of  our  knowledge  of  the  dissemination  of 
typhoid,  is  not  by  any  means  conclusively  proved  ;  for — 

1.  The  analysis  of  the  water  shows  it  to  be  the  purest  of 
all  the  samples  from  the  various  farms  from  which  the 
supplies  were  drawn,  and  free  from  sewage  matter. 

2.  The  water  was  boiled  before  being  used  for  washing 
the  churns  and  pails. 

3.  The  cesspit,  2  ft.  6  in.  deep,  has  many  feet  of  clay 
between  it  and  the  chalk.  Leakage  of  fluid  from  the  cess¬ 
pit  is  said  by  Mr.  Z.  not  to  occur,  and  from  its  structure 
seems  impossible. 

4.  The  experiment  made  by  Dr.  Murphy  (report,  page  20), 
if  not  evidence  against  leakage,  certainly  gives  no  proof 


of  its  existence,  nor,  in  fact,  of  any  connexion  between  the 
cesspit  and  the  well. 

After  carefully  inspecting  the  arrangements,  the  only 
point  on  which  comment  could  be  made  was  the  nearness  of 
the  well  to  the  privy  (24  ft.) ;  and,  as  analysis  of  the  water 
showed  freedom  from  sewage  matter,  I  naturally  concluded 
that  the  water  did  not  suffer  from  the  proximity.  Dr.  Murphy’s 
experiment  upholds  this  opinion.  Judging  from  my  expe¬ 
rience,  the  arrangements  were  as  good  as,  or  better  than,  is 
usual  in  farms  and  country  places. 

That  the  milk  became  infected  for  a  time  is,  I  think,  as- 
nearly  as  possible  proved ;  but  that  it  became  so  through 
the  water,  I  doubt.  I  may  suggest,  that  the  boy  who  was 
staying  in  the  house  became  directly  infected  by  inhalation 
of  the  tainted  air  from  the  cesspit,  and  that  the  clothing  of 
others  using  the  privy  carried  the  infected  air  thence  into 
the  milkshed.  Clearing  out  the  cesspit  removed  this  source 
of  infection.  I  am,  &c., 

J.  Edward  Squire,  M.D.  Lond. 

6,  Orchard- street,  W.,  October  24. 


MESMERISM. 


[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sir, — Your  recent  review  of  an  article  on  Mesmerism,  con¬ 
tributed  by  Mr.  Myers  and  myself  to  the  current  number 
of  the  Nineteenth  Century,  contains  too  much  that  is  true 
and  valuable  for  the  injustice  done  in  it  to  our  own  position 
to  be  a  matter  of  indifference  to  us.  May  I  be  allowed  to 
indicate  some  of  the  points  where  the  writer  has  uninten¬ 
tionally  misrepresented  us,  either  by  direct  statements,  or 
by  the  implication  that  our  views  differ  from  his  own  ? 

1.  It  is  made  to  appear  that  our  belief  in  mesmerism  is 
based  on  the  phenomena  “  constantly  exhibited  on  public- 
platforms.”  Before  reaching  the  point  in  our  paper  where 
we  were  able  to  distinguish  the  phenomena  which  are  from 
those  which  are  not  indicative  of  a  specific  influence,  we 
were  obliged  to  use  the  word  “  mesmerism  ”  generally ;  but 
one  of  our  main  contentions  was  that  the  phenomena  ex¬ 
hibited  on  platforms  as  “  mesmeric,”  even  when  genuine,, 
contain  little,  if  anything,  which  the  theories  of  hypnotism 
and  expectancy  will  not  account  for. 

2.  It  is  said  that  mesmerism  sank  into  contempt  because 
“  sensible  men  satisfied  themselves  that,  for  every  ha’p’orth 
of  facts  contained  in  the  experiments  performed  to  illustrate 
it,  there  was  an  intolerable  deal  of  trickery  and  deception.” 
Even  men  whom  their  critic,  we  fear,  regards  as  not  sensible,, 
have  satisfied  themselves  of  the  same  fact.  Nor,  we  hope, 
will  he  resent  our  complete  agreement  with  his  view  as  to 
the  follies  and  dangers  attaching  to  wonder- mongering 
epidemics  and  the  “  craving  for  the  second-rate  super¬ 
natural.”  It  is  in  that  view  that  we  find  the  strongest 
ground  for  strictly  defining  the  phenomena,  and  subjecting 
the  various  theories  to  the  test  of  precise  experiment. 

3.  Our  critic  obtains  an  argument  against  our  sanity  of 
judgment  by  tracing  a  belief  in  the  reality  of  certain  phe¬ 
nomena  to  the  same  nervous  instability  as  (in  his  opinion) 
favours  the  production  of  them.  He  regards  the  morbid 
state  as  almost  necessarily  infectious  to  those  who  observe 
it ;  and  he  draws  a  gloomy  picture  of  the  base  and  unhealthy 
tendencies  which  hypnotic  experiments  foster  in  the  subjects 
of  them.  His  description  directly  contradicts  our  own  ex¬ 
perience,  and  we  certainly  should  not  employ  any  “  sub¬ 
ject  ”  in  whom  such  tendencies  revealed  themselves.  Our 
“subject”  Wells,  I  may  mention,  is  an  extremely  vigorous 
and  contented  young  tradesman.  But,  if  our  critic  requires- 
further  testimony  to  what  has  been  so  widely  observed,  we 
may  select  a  couple  of  recorded  cases  out  of  a  thousand, 
and  refer  him  to  the  burly  Polish  soldiers  with  whom 
Heidenhain  obtained  some  of  his  best  results;  and  to 
Heidenhain’s  own  brother — undoubtedly  the  most  famous 
“subject”  in  Europe,— described  by  Prof.  Stanley  Hall 
as  “a  tall,  athletic,  duelling  medical  student,  the  picture 
of  health,  and  said  to  be  a  scholar  of  much  promise,” 
who  “had  been  hypnotised,  on  an  average,  two  or  three- 
times  a  day  for  two  months,  and  scoffed  at  the  idea  of 
being  the  worse  for  it.”  Hansen,  the  hypnotist  through 
whose  performances  the  topic  has  lately  received  so  much 
prominence  among  the  leading  German  physiologists,  states 
that  he  “finds  active  muscular  individuals  especially 
adapted  for  his  experiments;  and  hence  prefers  English 


502 


Medical  Times  and  Gazette. 


ROYAL  MEDICAL  AND  CHIRURGTCAL  SOCIETY. 


Oct.  27,  188S. 


students,  who  row,  swim,  and  ride,  to  German  students, 
with  their  prolonged  sedentary  mental  work.’"  So,  too,  the 
honesty  and  directness  of  speech  which  characterise  the 
genuine  hypnotic  state  have  been  again  and  again  the 
theme  of  scientific  comment.  At  the  same  time,  we  fully 
recognise  risks  in  this  class  of  experiment,  which  make  any 
wide  and  unskilled  practice  of  it  extremely  unadvisable.  Of 
these  risks  we  have  elsewhere  spoken  most  unreservedly,  and 
the  very  paper  in  question  contained  an  express  warning  on 
the  subject.  If  we  did  not  there  further  enlarge  on  it,  it 
was  because  the  task  which  we  had  proposed  to  ourselves 
was  a  strictly  limited  one ;  and  in  drawing  attention  to 
certain  phenomena,  producible  by  a  few  exceptional  indivi¬ 
duals,  which  the  hypnotic  theory  so  far  has  failed  to  cover, 
we  could  not  foresee  that  we  should  appear  as  the  reckless 
preachers  of  an  indiscriminate  mesmeric  crusade. 

4.  A  certain  set  of  our  results  was  criticised  at  some 
length,  but  in  a  manner  curiously  illustrative  of  Esdaile’s  re¬ 
mark,  that  no  student  of  mesmerism  “  gets  credit  for  having 
sufficient  common  sense  to  take  the  most  common  precau¬ 
tions  in  making  his  experiments.”  We  avoided  encum¬ 
bering  the  pages  of  a  popular  magazine  with  wearisome 
details,  which  we  thought  might  be  understood  as  included 
under  the  general  statement  that  the  experiments  took  place 
in  private,  and  that  signals  between  operator  and  “  sub¬ 
ject”  were  made  impossible  by  the  interposition  of  opaque 
obstacles  and  the  preservation  of  strict  silence.  The  ob¬ 
jections  which  our  critic  makes  certainly  seem  to  us  incom¬ 
patible  with,  the  trn  th  of  that  general  statement ;  but 
nothing,  of  course,  is  easier  than  to  rebut  them  seriatim. 
The  only  persons  present,  besides  Mr.  Smith  and  Wells, 
were  three  members  of  the  investigating  committee.  Wells 
was  securely  blindfolded  by  one  of  ourselves,  and  was  com¬ 
pletely  separated  from  Mr.  Smith,  first  by  a  large  screen,  and 
then  by  the  curtains ;  which  latter  are  not  ordinary  curtains 
drawn  at  will  between  the  two  rooms,  but  are  so  fastened  as 
to  form  an  extremely  thick  permanent  barrier,  through 
which  not  a  glimmer  of  light  can  pass  even  on  the  brightest 
day.  Mr.  Smith  did  not  make  passes,  or  cough,  or  blow  his 
nose,  or  jingle  the  money  in  his  pocket ;  he  stood  perfectly 
still,  and  under  the  very  closest  scrutiny  throughout.  In 
the  question,  “  Do  you  feel  anything  ?  ”  which  we  described 
as  “  simple  and  uniform,”  the  uniformity  extended  to  the 
tone  as  well  as  to  the  words.  The  pinches  were  applied  by 
one  of  ourselves,  in  his  own  order.  Such  being  the  condi¬ 
tions,  will  our  critic  still  maintain  that  “  any  average  con¬ 
juror,”  in  a  strange  room  and  without  apparatus,  could 
produce  the  same  results  P 

5.  Surprise  is  expressed  at  the  barbarity  of  applying  a 

•carving-fork  and  a  lighted  match  to  a  boyJs  fingers.  The 
point  of  the  experiment  being  the  total  insensibility  of  the 
particular  fingers,  we  do  not  understand  where  the  barbarity 
lay :  we  should  think  it  more  to  the  purpose  if  our  critic 
would  account  for  that  restricted  insensibility — the  factor 
of  expectancy,  it  will  be  remembered,  having  been  excluded 
— on  any  known  form  of  the  “  hypnotic  ”  hypothesis.  He 
may,  perhaps,  refuse  to  criticise  an  experiment  which  he 
has  not  himself  witnessed;  and  such  reluctance,  though 
not  quite  what  his  treatment  of  us  so  far  might  have 
suggested,  would  still  be  reasonable.  Will  he,  then,  let  us 
have  the  pleasure  of  knowing  his  name,  and  accept  our 
invitation  to  witness  the  phenomenon  next  time  it  is  ex¬ 
hibited  in  London  ?  I  am,  &c., 

14,  Dean’s-yard,  S.W.  Edmund  Gurnet. 


An  International  Association  of  Surgical  and 
Orthopjedical  Instrument  Makers. — In  September  last 
•about  150  surgical  instrument  makers,  belonging  to  various 
countries,  held  a  meeting  at  Frankfort,  and  formed  them¬ 
selves  into  an  international  association.  The  principal 
objects  of  the  Association  are — (1)  to  organise  an  opposi¬ 
tion  to  all  imperfect  imitations  of  instruments  of  precision; 
(2)  to  exchange  ideas  and  models  for  the  construction  and 
perfection  of  instruments  and  apparatus;  and  (3)  to  en¬ 
courage  progress  in  the  construction  of  surgical  instru¬ 
ments,  and  to  protect  the  interests  of  those  engaged  in  the 
cccupation.  An  executive  committee  was  formed,  consisting 
of  Leiter,  of  Vienna;  Windier, of  Berlin;  Walter-Biondetti, 
of  Basel ;  Krohne,  of  London ;  Simsky,  of  Konigsberg ; 
Wendschich,  of  Dresden;  Laibach,  of  Liege;  and  Fischer, 
of  Freiburg. — Gaz.  Med.  Lombardia ,  October  13. 


REPORTS  OP  SOCIETIES. 


EOYAL  MEDICAL  AND  CHIRUEGICAL 
SOCIETY. 

Tuesday,  October  23. 


John  Marshall,  F.R.S.,  President,  in  the  Chair. 


The  President,  on  taking  the  chair,  drew  the  attention  of 
the  Fellows  present  to  the  fact  that  this,  the  first  meeting 
of  the  present  session,  was  both  a  special  and  an  ordinary 
meeting  of  the  Society.  It  was  special  in  order  that  the 
Fellows  might  elect  a  Medical  Secretary  in  the  place  of  Dr. 
Southey,  who  had  accepted  an  honourable  post  in  the  Lunacy 
Department.  The  Council  had  taken  into  consideration 
possible  successors  to  Dr.  Southey,  and,  after  deliberation, 
had  decided  to  recommend  Dr.  Douglas  Powell.  It  would, 
however,  be  quite  competent  for  the  meeting  to  nominate 
any  other  physician  being  a  Fellow  of  the  Society.  He 
declared  the  ballot  open  for  one  hour,  and  nominated  as 
scrutineers  Dr.  Duffey  and  Mr.  Langbon.  He  next  referred 
to  a  very  important  discovery  which  had  been  made  since  the 
close  of  their  last  session —that  of  the  special  micro-organism 
of  cholera — by  Dr.  Koch,  of  Berlin.  While  he  could  not  doubt 
that  our  own  surgeons  who  had  been  sent  out  to  Egypt  had 
worked  well  and  done  their  duty  fearlessly,  still  the  honour 
of  the  discovery  of  the  special  germ  of  cholera — a  disease 
which  had  cost  life  for  years  past  to  more  individuals  than 
any  other  disease  known — had  been  made  by  the  Germans. 
He  expressed  the  hope  that  this  germ  might  be  demonstrated 
to  the  Society  during  the  coming  session,  if  not  by  Dr.  Koch 
himself,  at  least  by  one  of  the  assistants  who  had  accom¬ 
panied  him  to  Egypt.  The  President  then  explained  that 
the  Council  had  felt  how  interesting  and  instructive  an 
address  on  the  Progress  of  Neuro-pathology  from  their 
Marshall  Hall  prizeman  would  prove  to  the  Society,  and 
lauded  the  readiness  and  willingness  with  which  Dr.  Ferrier 
had  acted  on  the  hint.  He  then  called  on  Dr.  Ferrier  for 
his  address. 

Marshall  Hall  Prize  Oration. 

After  gratefully  acknowledging  the  honour  conferred  on 
him,  and  paying  a  tribute  to  the  memory  of  Marshall  Hall, 
Dr.  Ferrier  proceeded  to  compare  the  relative  stability  of 
the  work  done  by  Marshall  Hall  and  that  by  Flourens  not 
long  before.  He  sketched  the  position  and  progress  of 
cerebral  physiology  and  pathology  up  to  the  new  departure 
inaugurated  by  the  experiments  of  Fritsch  and  Hitzig. 
Without  dwelling  on  the  early  controversies,  he  went  at 
once  to  the  proceedings  of  the  International  Medical  Con¬ 
gress  here,  where  the  fundamental  question  of  cerebral 
physiology,  localisation  or  no  localisation,  was  brought  to  a 
crisis.  He  described  the  demonstrations,  and,  comparing 
the  facts  with  the  theses  enunciated  by  Prof.  Goltz  and 
other  adherents  of  the  Flourens  system,  held  that  localisa¬ 
tion  of  function  had  been  incontestably  established  before 
the  whole  physiological  world  in  the  case  of  one  vertebrate 
animal  at  least.  He  then  argued  that  the  principle  of 
localisation  must  be  accepted  as  universal,  unless  the  whole 
teaching  of  modern  biology  was  a  fallacy ;  and  proceeded  to 
show  that  such  phenomena  as  were  presented  by  frogs, 
pigeons,  and  Prof.  Goltz’s  dog  could  be  easily  accounted 
for  in  harmony  with  the  fundamental  principle  of  localisa¬ 
tion  of  cerebral  function.  He  dwelt  specially  on  the 
necessity  of  the  study  of  comparative  physiology  in  refer¬ 
ence  to  the  problems  of  cerebral  physiology ;  and  also  on 
the  necessity  of  accuracy  and  completeness  in  establishing 
lesions  where  the  function  of  a  particular  cortical  region  was 
in  question.  The  evidence  of  clinical  medicine  he  did  not 
discuss  at  length,  merely  referring  to  the  facts  in  various 
works  and  journals.  But  the  general  conclusion  was  that 
cerebral  localisation  may  be  assumed  as  having  established 
itself  both  in  physiology  and  medicine.  The  next  point 
discussed  was  whether  the  differentiation  of  function  was  a 
matter  of  accident,  or  whether  it  depended  on  structural 
peculiarities  and  connexions,  which  rendered  the  various 
cortical  centres  rigidly  distinct  from  each  other.  The  various 
facts  and  arguments  on  this  head  were  considered,  and  the 
lecturer  held  that  if  all  the  facts  were  substantiated  in 
reference  to  the  permanency  of  the  effects  of  cortical  lesions. 


Medical  Times  and  Ganettd. 


OBITUARY. 


Oct.  27,  1883.  503 


and  consecutive  degeneration  of  tracts  and  organs,  the 
question  of  the  accidental  or  structural  basis  of  localisation 
would  he  decided  in  favour  of  the  latter.  The  most  impor¬ 
tant  question,  in  a  practical  point  of  view,  was  the  exact 
delimitation  of  the  various  centres.  On  this  he  did  not 
enlarge,  as,  among  other  things,  it  would  necessitate  bringing 
out  much  as  yet  unpublished  work  inopportunely.  He  con¬ 
tented  himself  with  merely  indicating  the  points  on  which 
physiologists  and  physicians  were  at  present  more  or  less  in 
agreement,  or  the  reverse.  Though  the  value  of  scientific 
investigation  was  not  to  be  measured  by  its  practical  utility, 
yet  the  value  of  a  scientific  fact  or  principle  was  enhanced 
when  it  was  useful  as  well  as  true.  He  proceeded  to  test 
the  doctrine  of  localisation  by  the  standard  of  practical 
utility.  So  far  the  benefits  had  been  mostly  absorbed  by 
medical  science  itself,  and  the  various  directions  in  which 
scientific  advance  had  been  made  were  commented  on.  But 
when  the  goal  of  modern  medicine — “localisation,”  according 
to  Yirchow— had  been  reached  as  regards  cerebral  disease, 
was  it  at  all  likely  that  practice  would  not  be  influenced  ? 
He  held  there  was  a  grand  future  for  cerebral  surgery,  and 
advocated  on  various  grounds — among  others,  the  unfailing 
success  of  stringent  antiseptic  precautions — the  treatment  by 
surgery  of  some  of  the  most  distressing  forms  of  intracranial 
disease. 

The  President,  in  thanking  Dr.  Perrier  for  his  address, 
referred  to  the  clearness  and  lucidity  with  which  the  subject- 
matter  had  been  treated.  He  thought  there  were  not  many 
men  who,  handling  such  an  intricate  subject,  would  have 
stated  the  case  so  well  as  he  had  done.  The  President  of 
such  a  Society,  he  said,  was  sometimes  called  upon  to  take 
up  a  subject  and  point  out  the  lines  on  which  it  might  be 
discussed  ;  on  this  occasion,  however,  not  only  was  it  not 
necessary,  it  was  not  even  open  to  him  to  do  so ;  he  could 
see  many  men  present,  physicians,  as  well  as  physiologists, 
who  would  doubtless  have  much  to  say  on  the  points  raised 
by  Dr.  Perrier. 

Dr.  Hughllngs- Jackson  had  listened  with  great  interest  to 
the  paper,  and  he  agreed  with  the  President  that  the  subject, 
considering  its  complexity,  had  been  treated  in  a  very  lucid 
manner.  He  thanked  Dr.  Perrier  for  mentioning  the  work 
which  he  (Dr.  Jackson)  had  done  on  the  question  of  localisa¬ 
tion.  His  views,  however,  at  best,  were  but  guesses  at  truth, 
while  Dr.  Ferrier  had  scientifically  demonstrated  the  abso¬ 
lute  truth  of  the  dotrine.  He  (Dr.  Jackson)  had  held  for  the 
past  nineteen  years  (about),  and  still  held,  the  view  that 
the  localising  centres  lie  in  the  cortex.  Indeed,  he  even 
went  further  than  the  generality  of  thinkers,  in  believing 
that  every  part  of  the  brain  cortex  represents  either  im¬ 
pressions  or  movements.  The  experimental  investigation 
and  demonstration  of  these  facts  was  very  valuable.  They 
were  valuable  to  the  physiologist,  and  they  satisfied  also  the 
requirements  of  the  practical  man.  There  were  a  few  points 
on  which  he  differed  from  Dr.  Perrier ;  but,  on  account  of 
Perrier’s  great  accuracy  and  exactitude,  he  felt  diffidence  in 
his  own  views.  If  envy  of  an  individual  were  ever  permis¬ 
sible,  he  should  certainly  envy  Dr.  Ferrier,  but  with  a  most 
affectionate  kind  of  envy. 

Dr.  Altiiaus  agreed  with  the  President  and  Dr.  Jackson 
as  to  the  general  excellence  of  Dr.  Perrier’s  discourse.  On 
the  whole,  he  would  perhaps  have  preferred  a  little  more 
specialisation.  He  was  sorry  to  miss  any  reference  to  the 
labours  of  Johannes  Muller  in  relation  to  reflex  function, 
which  he  regarded  as  one  of  the  most  important  discoveries 
since  that  of  the  circulation  of  the  blood.  Muller  and  Marshall 
Hall  discovered  the  reflex  function  independently  of  each 
other,  but  Marshall  Hall  was  the  first  to  publish  his  observa¬ 
tions.  There  was,  however,  abundant  evidence  in  the  works  of 
Johannes  Muller  to  show  that  he  had  long  been  acquainted 
with  it,  and  that  he  was  working  out  the  subject  previous 
to  the  publication  of  Marshall  Hall’s  work.  He  quite 
agreed  that  the  controversy  between  Goltz  and  Ferrier  had 
terminated  in  favour  of  the  latter — i.e.,  in  favour  of  localised 
function.  There  were,  nevertheless,  still  many  able  physi¬ 
ologists,  including  Hitzig,  Munk,  and  others,  who  were  at 
variance  in  many  points  with  Perrier ;  but  he  saw  no  reason 
why  these  differences  might  not  be  reconciled,  as  being  pro¬ 
bably  due  to  differences  in  the  modes  of  research.  However 
defective  at  present,  there  was  already  great  improvement  in 
the  diagnosis  of  brain  lesions.  He  was  a  little  disappointed 
with  cerebral  surgery.  In  future  there  was  no  reason  why 
improvement  should  not  take  place.  He  had  been  devoting 


his  attention  to  the  action  of  electricity  on  the  cortex  of  the 
brain,  and  thought  that  good  might  result  in  certain  cases. 

Prof.  Schafer,  as  that  member  of  the  special  committee 
(to  which  Dr.  Ferrier  had  alluded)  to  whom  the  historical 
monkey’s  brain  had  been  referred  for  examination  and 
report,  was  pleased  to  be  able  to  substantiate  Dr.  Ferrier’s 
own  statement,  that  the  motor  areas,  which  he  (Dr.  Perrier) 
had  attempted  to  remove,  really  had  been  completely  re¬ 
moved.  In  fact,  the  lesions  extended  even  deeper,  and 
involved  the  subjacent  white  matter.  There  were  also 
descending  degenerative  changes  in  the  spinal  cord.  The 
experiments  on  monkeys’  brains  were  more  valuable  and 
conclusive  than  on  the  brains  of  dogs.  He  quite  thought 
that  Dr.  Perrier’s  interpretation  is  the  correct  one :  function 
is  doubtless  due  to  the  efforts  of  the  will  in  human  beings, 
while  in  the  lower  animals  it  is  probably  performed  by  lower 
centres. 

Dr.  Sharkey,  in  answer  to  a  call  from  the  President, 
said  he  had,  during  the  past  seven  years,  devoted  much 
attention  to  the  motor  zones  ;  and,  as  far  as  his  own  cases 
allowed  him  to  judge,  the  results  actually  bore  out  Dr. 
Perrier’s  observations.  He  had  published  at  least  six 
clinical  cases,  with  the  autopsies,  representing  lesions  co¬ 
extensive  with  the  whole  motor  area,  in  which  the  symptoms 
noticed  during  life  had  corresponded  accurately  to  those 
described  by  Dr.  Perrier.  Concerning  the  visual  centre, 
he  had  also  published  two  cases,  one  showing  congenital 
absence  of  the  angular  gyrus,  with  extreme  atrophy  of  the 
corresponding  optic  tract — again  supporting  Perrier’s  views. 
Until  quite  recently,  few  observations  had  been  made,  con¬ 
necting  other  parts  of  the  cortex  with  the  retina.  But  the 
most  recent  experiences  of  hemianopia  point  to  the  occi¬ 
pital  lobe  as  being  connected  with  vision ;  a  view  supported 
also  by  experimental  investigation.  He  had  recently  brought 
before  the  Ophthalmological  Society  a  case  in  which  there 
were  epileptic  seizures,  accompanied  by  a  play  of  colours 
in  the  right  field  of  vision  of  each  eye.  The  disease  had 
lasted  two  years  and  a  half,  and  since  the  first  fit  the  patient 
had  had  permanent  paresis  of  the  right  arm  and  of  the  left 
side  of  each  retina.  Mr.  Nettleship  had  carefully  determined 
for  him  the  field  of  vision,  and  found  that  the  peripheral 
parts  of  the  left  half  of  each  retina  were  paralysed,  while 
the  central  parts  and  the  right  halves  were  intact.  If  this 
be  a  cortical  lesion,  as  seems  most  probable,  it  would  show 
that  lesion  of  one  part  of  the  cortex  can  paralyse  the  peri¬ 
pheral  parts  of  the  corresponding  halves  of  the  retime  with¬ 
out  affecting  the  central  parts,  so  that  the  centres  for  the 
two  sets  of  fibres,  though  adjacent,  must  be  separate.  Some 
years  ago,  Perrier  suggested  that  such  cases  might  occur. 
He  thus  found  himself  in  complete  accord  with  Ferrier’s 
teaching. 

Dr.  Mac  fag  an  thought  that  certain  parts  of  the  brain 
were  beyond  the  reach  of  experiment ;  that  is,  the  centres 
of  vital  life.  As  regarded  the  thermic  centre,  he  did  not 
believe  that  hyperpyrexia  was  an  essential  part  of  fever, 
but  rather  an  accident.  Irritation  of  this  centre  was  re¬ 
lieved  by  cold,  not  because  it  reduced  the  heat,  but  because 
it  soothed  the  peripheral  attachments  to  the  thermic  centre. 

Dr.  Perrier  replied.  He  said  he  had  purposely  omitted 
much  that  was  controversial  from  his  paper.  It  would  have 
been  impossible  to  do  justice  to  the  subject  in  the  limited 
time  at  his  disposal,  and  for  this  reason  he  did  not  reply  to 
one  or  two  points  which  had  been  raised. 

The  President,  announcing  the  result  of  the  ballot, 
declared  that  Dr.  Douglas  Powell  had  been  unanimously- 
elected  Medical  Secretary. 

The  meeting  then  adjourned. 


OBITUARY. 

- ♦ - 

THOMAS  JERVIS,  M.D.,  J.P. 

Dr.  Jervis,  of  Connaught-square,  W.,  whose  death  was 
recently  recorded  in  our  columns,  was  born  on  November  6, 
1809.  He  studied  at  St.  George’s  Hospital,  and  took  his 
M.R.C.S.  degree  in  1836.  Ten  years  later  he  graduated 
M.D.  at  the  University  of  St.  Andrews,  and  became  an 
M.R.C.P.  in  1849.  After  a  very  busy  and  active  life  he 
retired  from  the  practice  of  his  profession  in  1863,  and  in 
the  same  year  was  appointed  a  Justice  of  the  Peace  for 
Middlesex  and  Westminster.  He  was  a  member  of  the 


Oct.  27, 1883. 


504 


Medical  Times  and  Gazette. 


MEDICAL  NEWS. 


Yisiting  Committees  of  Feltham,  Hanwell,  Colney  Hatch, 
and  Banstead  Asylums,  and  a  member  of  the  Council  of  the 
Medical  College,  Epsom,  in  all  of  which  institutions  he 
took  a  great  interest.  He  died  on  October  3,  1883. 


MEDICAL.  NEWS. 


Royal  College  of  Surgeons  of  England. — The 
following  gentlemen,  having  undergone  the  necessary  exa¬ 
minations  at  meetings  of  the  Board  on  the  22nd,  23rd,  and 
21th  inst.,  were  admitted  Licentiates  in  Dental  Surgery,  viz. : 

Burton,  H.  Sanford,  Wellington,  Somerset,  student  of  the  Middlesex 
Hospital. 

Dorey,  R.  St.  John,  Brighton,  of  the  Middlesex  Hospital. 

Xmg,  Arthur,  Burton-terrace,  York,  of  the  Charing-cross  Hospital 
Latehmore,  Edward,  Tunbridge  Wells,  of  the  Middlesex  Hospital 
McStay,  John,  King-street,  Belfast,  of  the  Middlesex  Hospital 
Petherbndge,  James,  Buck  fas  tleigh,  Devon,  of  the  Middlesex  Hospital 
Pillin,  H.  Linsell,  Conduit-street,  W.,  of  the  Middlesex  Hospital 
Thomson,  George,  Melbourne,  Australia,  of  the  Middlesex  Hospital. 
Woodhouse,  A.  E.  Clayton,  M.R.C.S.,  Hanover-square,  of  Guy’s  Hospital. 

Three  candidates  were  referred.  The  following  were  the 
questions  submitted  to  the  candidates  at  the  °above  exa¬ 
mination,  viz. Anatomy  and  Physiology:  1.  Describe  the 
antrum  of  Highmore  in  the  human  skeleton;  give  also 
its  arrangement  in  the  living  subject.  2.  What  is  the  com¬ 
position  of  saliva  ?  State  how  the  secretions  of  the  several 
glands  differ  in  composition.  Surgery  and  Pathology: 
1.  Describe  the  different  stages  of  bone  caries,  and  give  the 
treatment.  2.  Describe  the  effects  of  mercurial  salivation 
upon  the  mouth-structnres,  and  contrast  them  with  those  of 
phosphorus.  (The  candidates  were  required  to  answer,  from 
2  to  4  p.m.,  at  least  one  of  the  two  questions,  both  on  Anatomy 
and  Physiology,  and  on  Surgery  aud  Pathology.)— Dental 
Anatomy  and  Physiology :  1.  Describe  and  compare  the 
dentitions  of  (i.)  hyama,  (ii.)  dog,  (iii.)  bear.  State  in 
general  terms  the  characters  which  distinguish  the  denti¬ 
tions  of  the  aquatic  carnivora.  2.  Give  an  account  of  pro¬ 
gnathism  ;  enumerate  the  bones  chiefly  concerned  in  its 
production.  3.  Describe  the  process  of  absorption  of  the 
temporary  teeth.  What  are  the  conditions  which  further  or 
retard  it?  Dental  Surgery  and  Pathology:  1.  What  are 
the  histological  changes  which  occur  in  inflammation  of  the 
pulp  ?  Describe  its  various  terminations.  2.  Under  wliat 
circumstances  should  osteoplasties  be  employed  for  fillino’s 
in  incisor  teeth  ?  Wiiat,  in  general  terms,  is  the  chemical 
composition  of  these  materials  ?  3.  Give  the  chief  forms  of 

perforate  and  cleft  palates.  Discuss  the  relative  advantages 
of  operative  and  mechanical  treatment.  (The  candidates 
were  required  to  answer,  from  5  to  8  p.m.,  at  least  two  out  of 
the  three  questions,  both  on  Dental  Anatomy  and  Physiology 
and  on  Dental  Surgery  and  Pathology.) 

Apothecaries  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday, 
October  18  : — 

Benson,  Christopher  Richmond,  Granville-square,  W  C 
Blacker,  Arthur  Barry,  St.  George’s-road,  S.W. 

Clarke,  James  McFarlane,  Palace-square,  Manchester 
Koettlitz,  Maurice,  Eolkestone-road,  Dover 
Simmons,  Edward  Walpole,  Wallington,  Surrey 


DEATHS. 

Gillies,  Walter,  Surgeon  20th  Punjaub  Native  Infantry,  in  London,  o 
October  15.  ’ 

Littler,  John  Harry,  M.D.,  Surgeon-Major  (retired),  on  October  2, 
aged  74. 

■O  Reilly,  John,  M.D.,  at  15,  Brunswick-road,  Brighton,  on  October  21 
aged  68. 

Shltttleworth,  Robert,  M.R  C.S.,  at  Kensal  Green,  on  October  19. 

Wi;E.WICK<  Richard  Archer,  M.D.,  formerly  of  Richmond,  Surrey,  a 
Teignmouth,  on  October  17,  aged  51 . 


VACANCIES. 

Borough  of  Birmingham  Hospital  for  Infectious  Diseases. — Medical 
Superintendent.  ( For  particulars  see  Advertisement.) 

BRLG^T0N  AND  ■®ov.e  Dispensary. — Resident  House-Surgeon.  Salary 
£140  per  annum,  with  furnished  apartments,  coals,  gas,  and  attendance. 
Candidates  must  be  Members  of  one  of  the  Royal  Colleges  of  Surgeons 
of  Great  Britain  or  Ireland,  and  Licentiates  of  the  Royal  College  of 
Physicians  of  London,  or  Licentiates  of  the  Society  of  Apothecaries  of 
London,  and  registered  under  the  Medical  Act.  Diplomas,  certificate 
ot  registration,  and  testimonials  (under  seal),  to  he  addressed  to  the 
Lfiairman  ot  the  Committee  of  Management,  Brighton  and  Hove  Dis- 
pensary,  Queen’s-road,  Brighton,  on  or  before  November  5.  The  election 
will  take  place  on  December  4. 

Royal  Berks  Hospital,  Beading. — Assistant  House-Surgeon.  [For 
particulars  see  Advertisement.) 


Earringdon  Dispensary  and  Lying-in  Charity. — Honorary  Physician. 
Candidates  must  be  Fellows  or  Members  of  the  Royal  College  of  Phy¬ 
sicians,  London.  Applications,  with  testimonials,  to  be  sent  to  the 
Honorary  Secretary,  17,  Bartlett’s-buildings,  Holborn-eireus,  E.C.,  on 
or  before  November  6. 

Infirmary  for  Consumption  and  Diseases  of  the  Chest  and  Throat, 
26,  Margaret  street,  Cavendish  square,  W. — Visiting  Physician. 
(For particulars  see  Advertisement.) 

Wrexham  Infirmary  and  Dispensary. — House-Surgeon.  Salary  £100 
per  annum,  with  furnished  rooms,  gas,  coal,  and  attendance,  without 
board.  Candidates  must  possess  at  least  one  qualification.  Applica¬ 
tions,  enclosing  testimonials,  etc.,  to  be  addressed  to  the  Secretary, 
J.  Oswell  Bury,  Temple-row,  Wrexham,  on  or  before  November  9. 


University  College,  London. — The  Medical  Entrance 
Exhibitions  of  £100  and  £60  have  been  divided  between 
Mr.  E.  B.  Hastings  and  Mr.  G.  E.  Bennie,  and  that  of  £40 
has  been  awarded  to  Mr.  C.  H.  Eernan. 

Royal  College  of  Surgeons  in  Ireland. — At  a 
meeting  of  the  Council,  held  on  Thursday,  October  18,  the 
following  gentlemen  were  elected  Examiners  in  Dental 
Surgery  for  the  ensuing  year,  viz.  :  —Edward  A.  Stoker, 
Edward  Stainer  O’Grady,  Henry  Gray  Croly,  Henry  G. 
Sherlock,  J.  Daniel  Corbett,  and  Arthur  W.  W.  Baker. 

Dr.  Saunders  reported  on  the  18th  inst.,  at  the  meet¬ 
ing  of  the  Hendon  Board  of  Guardians,  that  there  were 
twenty-seven  cases  of  typhoid  fever  in  the  hamlet  of  Sudbury. 
Six  of  these  broke  out  last  week.  All  available  means  are 
being  taken  to  check  the  spread  of  the  disease.  There  have 
been  no  fresh  cases  within  the  last  few  days.  The  drainage 
of  the  district  is  bad,  hut  the  Board  are  about  to  carry  out  a 
new  system. 

King’s  College. — The  first  meeting  of  the  King’s 
College  Medical  Society  was  held  on  Thursday  week,  when 
the  newly  elected  President,  Prof.  Hamilton  Cartwright, 
took  the  chair.  A  paper  was  read  by  Dr.  John  Phillips 
on  the  social  position  of  the  medical  profession ;  and  a 
scheme  proposed  by  Surgeon-Major  Watts  for  forming  a 
student  ambulance  corps  amongst  the  hospitals  of  London 
was  also  discussed. 

A  PLAN  is  being  matured  in  Cambridge,  under  the 
ausjrices  of  the  Order  of  St.  John  of  Jerusalem,  by  Mr. 
Reynolds  Rowe  (confrere) ,  who,  with  the  cordial  assent  of  the 
Bishop  of  the  diocese,  has  purchased  a  central  site  in  Cam¬ 
bridge,  upon  which  he  intends  to  build  and  endow  a  large 
free  and  open  church,  dedicated  to  St.  John  of  Jerusalem. 
Hospitaller  works  are  contemplated  in  connexion  therewith, 
including  an  infirmary  for  the  use  of  members  of  the  Uni¬ 
versity7,  a  training  school  and  home  for  nurses,  and  an 
ambulance  centre. 

Municipal  Granib  to  the  Dublin  Hospitals. — 
The  Corporation  of  Dublin  recently  appointed  a  committee 
of  their  own  body7  to  visit  and  report  upon  the  hospitals 
receiving  annual  grants  from  the  Municipal  Council.  The 
committee  duly  reported,  and  on  Monday,  October  22,  the 
consideration  of  the  yearly  presentments  for  the  hospitals 
was  proceeded  with  at  a  largely  attended  meeting  of  the 
Corporation.  A  struggle  took  place  as  to  the  amount  of 
the  grant  to  be  made  in  some  instances,  but  in  the  end  the 
amounts  given  last  year  were  again  voted  to  the  several 
institutions,  except  the  Mater  Misericordiie  Hospital,  to 
which  a  grant  of  ,£500  instead  of  £400  was  made.  The 
passing  of  the  presentment  for  the  Rotunda  Lying-in 
Hospital  was  postponed,  to  enable  the  governors  to  attend 
and  explain  away  certain  charges  brought  against  the 
hospital  management  by  Mr.  Thomas  Mayne,  M  P. 

The  Parkes  Museum  of  Hygiene. — The  following 
lectures  will  be  delivered  on  Thursdays  during  the  winter 
session,  1883-84,  at  8  p.m.  each  evening : — November  1 : 
Mr.  Ernest  Hart,  Chairman  of  the  Council  of  the  National 
Smoke  Abatement  Institution,  “  On  Smoke  Abatement/'’ 
November  15:  Dr.  Robert  J.  Lee,  “On  the  Disinfection  of 
the  Atmosphere  ”  (the  lecture  will  be  illustrated  by  experi¬ 
ments  and  demonstrations).  November  22:  Mr,  George 
Murray,  of  the  Natural  History  Department  of  the  British 
Museum,  “  On  the  Potato  Disease”  (the  lecture  will  he 
illustrated  by  microscopical  preparations  and  diagrams). 
November  29  :  Dr.  Charles  Kelly,  Professor  of  Hygiene  in 
King’s  College,  London,  “  Diseases  caused  by  Sanitary 
Defects  in  Houses.”  December  6 :  Dr.  G.  Y.  Pooi’e,  Pro¬ 
fessor  of  Forensic  Medicine  in  University  College,  London, 
“  On  Coffee  and  Tea.”  January  17  :  Mr.  T.  Pridgin  Teale 
of  Leeds),  “Economy  of  Coal  in  Private  Houses.”  The 
lectures  will  be  followed  by  discussions. 


Medical  Tinges  and  CrPtfott*. 


NOTES,  QUERIES,  AND  REPLIES. 


Oct.  27,  1883.  5  05 


VITAL  STATISTICS  OF  LONDON. 


NOTES,  QUERIES,  AND  REPLIES. 


Week  ending  Saturday,  October  20,  1883. 


BIRTHS. 

Births  of  Boys,  1217;  Girls,  1153;  Total,  2370. 

Corrected  weekly  average  in  the  10  years  1873-82,  2723'5. 

DEATHS. 


Males . 

Females. 

Total. 

Deaths  during  the  week . 

722 

686 

1403 

Weekly  average  of  the  ten  years  1S73-S2,  ) 
corrected  to  increased  population  ..  j 

60  J'5 

7130 

1546-5 

Deaths  of  people  aged  80  and  upwards 

... 

... 

58 

DEATHS  IN  SUB-DISTRICTS  FROM  EPIDEMICS. 


|  Enumerated 

[  Population, 

1881 

(unrevised). 

Small-pox.  1 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

Whooping- 
cough.  j 

Typhus. 

Enteric  (or 
Typhoid)  | 
Fever. 

Simple 

continued 

Fever . 

cC 

8 

*1 

s 

West . 

669333 

3 

3 

1  i  2 

1 

1 

North 

905947, 

... 

2 

12 

9  6 

... 

8 

1 

12 

Central 

282238 

... 

.3 

1 

1 

2 

4 

East . 

692738 

... 

7 

23 

5  3 

•  •• 

4 

1 

8 

South . 

1265927 

... 

13 

25 

12  11 

... 

6 

1 

13 

Total . 

3816483|  ... 

25 

66 

28  22 

1 

20 

4 

3S 

METEOROLOGY. 


From  Observations  at  the  Greenwich 

Mian  height  of  barometer  . 

Mean  temperature  . 

Highest  point  of  thermometer  . 

Lowest  point  of  thermometer  . 

Mean  dew-point  temperature  . 

General  direction  of  wind  . 

Whole  amount  of  rain  in  the  week . 


Observatory. 

.  29'551  in. 

.  51'33 

.  64'6° 

.  39  1° 

.  45-2° 

.  S.W. 

.  103  in. 


BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  the 
Week  ending  Saturday,  Oct.  20,  in  the  following  large  Towns : — 


Cities 

and 

Boroughs 

Estimated  Population  to 
middle  of  the  year  1883. 

Births  Registered  during 
the  week  ending  Oct.  20. 

Deaths  Registered  during 
the  week  endirig  Oct.  20. 

Annual  Rate  of 
Mortality  per  1C00  living, 
from  all  causes. 

Temperature 
of  Air  (Fahr.) 

'  Rain 
Fall. 

Highest  during 
the  Week. 

Lowest  during 
the  Week. 

1  Weekly  Mean  of 
|  DailyMeanVaiues 

Weekly  Mean  of 
Daily  Mean 
Values. 

Tn  Inches. 

In  Centimetres. 

London  . 

3955814 

2370 

1408 

18-6 

64-6 

39-1 

5f3  10-73 

103 

2-62 

Brighton  . 

111262 

46 

45 

21  1 

61’0 

41-0 

51-2  10-67 

1-8/ 

4'75 

Portsmouth 

1.31478 

92 

41 

163 

••• 

Norwich  . 

89612 

6i 

19 

111 

•••  ... 

Plymouth  . 

74977 

47 

25 

17-4 

61-0 

453 

52-3  11-28 

2-16 

5-49 

Bristol . 

212779 

111 

61 

io'O 

60-u 

43'0 

50-3  10-17 

1-88 

4-78 

Wolverhampton  . 

77557 

34 

27 

1S'2 

58'5 

34-1 

46-4  8-0J 

1-58 

4-01 

Birmingham 

414946 

261 

153 

19  2 

... 

Leicester  ... 

129483 

99 

48 

19'3 

62-5;  38-8 

48-6,  9-23 

i-io 

279 

Nottingham 

199349 

128 

6s 

17'8 

63‘3 

37-2 

48-6;  9-23 

LOS 

2-74 

Derby . 

85574 

5 

27 

165 

... 

... 

... 

... 

Birkenhead 

88700 

63 

32 

18-8 

...  1 

Liverpool  . 

566?53 

375 

245 

22’6 

58-7 

42-4 

48-3  9-06 

2-45 

6-22 

Bolton . 

107862 

70 

38 

18-4 

66-1 

39-2 

46-7  8’17 

3-42 

8-69 

Manchester 

3  59252 

237 

168 

25'8 

... 

... 

•••  ••• 

,,, 

... 

Salford  . 

190465 

142 

91 

24  9 

. . . 

... 

... 

Oldham  . 

119071 

68 

34 

149 

. .  . 

•••  1  ••• 

... 

... 

Blackburn . 

108460 

81 

54 

26  0 

...  | 

Preston  . 

98564 

7o 

35 

18'5 

58-0 

415 

49-0  9  44 

2-61 

6-63 

Huddersfield 

84701 

45 

28 

17-3 

.  •  . 

... 

...  ••• 

.  .  • 

... 

Halifax 

75591 

32 

20 

1.3-8 

.. 

Bradford  . 

204807 

121 

74 

18-9 

59-5 

40-0 

48-2  9-00 

2-21 

5-61 

Leeds  . 

321611 

222 

165 

26-8 

61  0 

40-0 

49-3  9-61 

1-29 

3-28 

Sheffield  . 

295497 

172 

101 

17-8 

61-0 

39-0 

48-1  8-95 

2-40 

6'lt) 

Hull  . 

176296 

135 

67 

19  8 

62-0 

38  0 

48-2  9-00 

2-23 

5-66 

Sunderland 

121117 

84 

42 

18-1 

.  .  • 

.  .  . 

... 

... 

... 

Newcastle  . 

149164 

104 

84 

29-3 

... 

... 

... 

Cardiff . 

90033 

64 

40 

232 

... 

... 

... 

For  28  towns ... 

862C975 

5395 

3240 

19-6 

64-6 

34-1 

49-0  9  44 

1-95 

4-95 

Edinburgh . 

2  35946 

133 

74 

16  4 

59-0 

33-1 

47  5  8-61 

1-22 

3  10 

Glasgow  . 

515389 

359 

218 

22-1 

69  5  3-r5 

46-6  8  12 

1-75 

4*44 

Dublin . 

349  85 

ro 

156 

233 

58 '8  36'3 

46-2  7'89 

065 

1"65 

At  the  Royal  Observatory,  Greenwich,  the  mean  reading 
the  barometer  last  week  was  29‘55  in. ;  the  lowest  reading 
was  29-12  in.  on  Wednesday  morning,  and  the  highest 
29  95  in.  on  Thursday  evening. 


- - 

tfiat  questioned  mttcjr  a^all  leHrn  moclr. — Bacon. 


The  Boast  Fund. 

TO  THE  EDITOB  OP  THE  MEDICAL  TIMES  AND  GAZETTE. 

Sir,— Please  acknowledge  the  following  additional  amounts  for  the 
above-named  fund.  Amount  already  acknowledged,  £37  9s.  6d.: — A.  B.  Z., 
10s.  6d.  ;  —  Appleford,  Esq.,  Finsbury-circus,  £2  2s. ;  Dr.  M.  Balding, 
St.  Albans.  £1  Is. ;  T.  M.,  10s. ;  Dr.  Clay,  Plymouth,  £1  Is.;  E.  Jackson, 
Esq.,  Jesmond,  10s.;  K.,  £1  Is.;  E.  Softe,  Esq.,  East  Hurling,  10s.  6d.  : 
Dr.  Cufaude,  Acle,  10s.  ;  Francis  Clowes,  Esq.,  Stalham,  £1  is. ;  Hugh 
Taylor,  Esq.,  Cottishall,  10s.  6d.  ;  Fairlie  Clarke,  Esq.,  Southborough, 
£l  Is. ;  Mrs.  E.  P.  Clark,  Wymondham,  £5 ;  Dr.  Eade,  Norwich,  £5  ;  Dr. 
Gairdner,  Glasgow  (per Mr.  Cadge),  £5  ;  C.  Williams,  Esq.,  Norwich,  £33s.; 
Dr.  Burnley,  Norwich,  £2  2s. ;  Dr.  Lomb,  Torquay,  £2  2s  ;  Mrs.  Tallint, 
HiDgham,  £2;  Dr.  Rudge,  Eakenham,  £1  Is.;  Dr.  Alexander,  Wotton, 
£1  is.;  Dr.  Lowe, Wymondham,  £1  Is. ;  J.  Candler, Esq., Hurleston,  £1  is.; 
Dr.  Lowe,  Lynn,  £t ;  Dr.  Hills,  Thorpe,  £1  ;  J.  Brownfield,  Esq.,  Norwich, 
£1 ;  Dr.  Dale,  Lynn,  10s. ;  Bis  Dat  qui  Cito  Dat,  2s.  6d.  I  am,  &c., 

1,  St.  George’s  terrace,  Plymouth,  Oct.  23.  George  Jackson. 

Proposed  Testimonial  to  Dr.  Joseph  Rogers. 

TO  THE  EDITOR  OF  THE  MEDICAL  TIMES  AND  GAZETTE. 

Sir, — Will  you  permit  me  to  draw  the  attention  of  your  readers  to  a 
movement  which  has  been  set  on  foot  with  the  view  of  presenting  to  Dr. 
Joseph  Rogers,  the  President  of  the  Poor-Law  Medical  Officers’  Association, 
a  testimonial  as  a  mark  of  the  esteem  in  which  he  is  held  by  Poor-law 
medical  officers,  and  as  a  recognition  of  his  unwearied  advocacy  of  their 
claims,  his  fearless  exposure  of  injustice  done  to  them,  and  the  able  assist¬ 
ance  and  advice  which  he  has  freely  given  to  such  of  them  as  have  been 
unfortunate  enough  to  be  at  variance  with  their  boards. 

The  unjust  treatment  Dr.  Rogers  has  received  at  the  hands  of  the 
Westminster  Guardians,  will,  I  hope,  shortly  be  brought  before  the  Local 
Government  Board,  but  I  venture  to  suggest  that  no  better  time  than  the 
present  could  be  chosen  for  his  fellow-officers  to  express  th^ir  sympathy 
with  him,  and  that  such  an  expression  from  a  large  number  would  show 
that  they  have  appreciated  his  labours  on  their  behalf,  that  in  a  good 
cause  they  are  capable  of  acting  in  concert,  and  that  they  respect  them¬ 
selves  and  their  office  in  manifesting  respect  for  one  who  has  fearlessly 
doDe  his  duty,  although,  for  doing  it,  he  has  received  the  usual  punish¬ 
ment  accorded  by  guardians  to  parochial  medical  officers. 

The  following  gentlemen  have  kindly  promised  to  receive  subscriptions, 
viz.  -.—Ernest  Hart,  Esq.,  Editor  of  the  British  Medical  Journal ;  C.  Frost, 
Esq.,  Treasurer  Poor-Law  Medical  Officers’  Association,  47,  Ladbroke- 
square,  Notting  Hill,  London;  J.  Wickham  Barnes,  Esq.,  Secretary  Poor- 
Law  Medical  Officers’  Association,  3,  Bolt-court,  Eleet-street,  London. 
Shrewsbury,  October  23.  Iam,  &e.,  Erancis  Whitwell. 

The  Hind  Fund. 

TO  THE  EDITOR  OP  THE  MEDICAL  TIMES  AND  GAZETTE. 

Sir,— The  feeble  response  of  his  old  pupils  to  your  appeal  on  behalf  of 
Mr.  George  Hind  must  make  him  exclaim  with  Shakespeare— 

“  Blow,  blow,  thou  winter  wind  ; 

Thou  art  not  so  unkind 
As  man’s  ingratitude.” 

Surely  when  one  considers  how  many  men  at  the  present  time  owe  their 
position  mainly  to  Mr.  Hind,  and  how  more  than  probable  it  is  that,  had  it 
not  been  for  this  discoverer  of  all  but  a  royal  road  to  learning,  they  would 
have  been  debarred  from  entering  the  profession,  it  is  to  be  hoped  that  the 
apt)eal  for  funds  will  yet  meet  with  a  generous  and  wide  response. 

Let  it  not  be  said  by  Mr.  Hind  that  “  Those  you  make  friends  and  give 
your  hearts  to,  when  they  once  perceive  the  least  rent  in  your  fortunes, 
fall  away.”  I  exhort  my  professional  brethren  therefore  to  “  withhold 
not  good  from  him  to  whom  it  is  due,  when  it  is  in  the  power  of  thine 
hand  to  do  it.”  I  am,  &e.,  W.  Domett  Stone. 

The  following  additional  subscriptions  have  been  received  and  paid  to 
the  account  of  the  “Hind  Fund,”  at  Messrs.  Coutts’  Bank:— Sir  W. 
Jenner,  Bart.,  £5  5s. ;  Sir  E.  Saunders  (additional  donation),  £3  3s.;  Dr. 
Semple.  £3  3s. ;  Dr.  R.  Q,uain,  £3  3s.:  Sir  Spencer  Wells,  Bart.,  £2  2s  ; 
Dr.  R.  Liveing,  £2  2s.;  Prof.  Thane,  £2  2s.;  Timothy  Holmes,  Esq.,  £2  2s.; 
Dr.  Wilson  Fox,  £2  2s.;  J.  Gay,  Esq.,  £1  is.;  Dr.  Walsh,  £t  Is.;  -  Allard, 
Esq.,  £1  Is.  ;  Dr.  Augustus  Brown,  £1  Is.  ;  J.  R.  Walker.  Esq.,  £1  Is. ; 
Irish  Pupil,  £1  ;  Sir  James  Paget,  Bart.,  £5  5s.;  J.  E.  Erichsen,  Esq., 
£5  fis.  ;  William  Adams,  Esq.,  £2  2s.;  Dr.  J.  T.  Powell,  £2  2s.  ;  Dr. 
C.  J.  B.  Williams.  £2  2s. ;  Hunter  Barron,  Esq.,  £1  Is.  ;  Dr.  A.  de  Nod 
Walker,  £1  Is.  ;  H.  G.  S.,  £t  Is.  . 

Subscriptions  may  be  paid  to  Dr.  Richardson,  E.R.S.  (chairman), 
25,  Manchester-square  ;  John  Tweedy,  Esq.,  F.R.C.S.,  24,  Harley-street, 
hon.  treasurer  ;  A.  J.  Pepper,  Esq.,  F.R.C.S.,  122,  Gower-street,  and  T. 
Wakley,  jun.,  Esq.,  L.R.C.R.,  96,  Redcliff  e-gardens,  hon.  secretaries  ;  or 
to  Messrs.  Coutts  and  Co.,  Strand. 

A  meeting  of  the  General  Committee  of  the  fund  will  be  held,  by  the 
kind  permission  of  the  directors,  in  the  Board-room  of  the  Briton  Life 
Offices,  on  Thursday,  November  1,  at  5.30  p.m. 

A  Practical  Estimate  of  Sanitation. — Speaking  at  a  meeting  at  Nottingham, 
the  other  day,  Alderman  Worth  is  reported  to  have  said  that  the  average 
yearly  death-rate  per  thousand  in  Nottingham  was  between  22  and  23,  and 
Dr.  Seaton  had  told  him  that  if  the  sanitary  conditions  were  right  it  would 
be  only  17.  What  did  that  indicate  ?  How  many  people  had  died  who 
would  not  have  died  if  the  conditions  had  been  right  ?  About  600  a  year 
If  500  people  were  embarked  on  a  leaky  vessel,  and  the  ship  went  down, 
there  would  be  an  outcry  from  one  end  of  the  country  to  the  other. 
And  let  them  imagine  that  repeated  year  after  year!  But  here  was  the 
same  thing  going  on  yearly  in  their  midst,  and  yet  when  eiforts  were 
made  to  improve  the  sanitary  condition  of  the  town  they  were  met  with 
this  talk  about  economy.  They  might  talk  about  their  5  per  cent,  for 
their  money ;  they  might  talk  about  their  big  debt ;  but  at  what  estimate 
would  they  put  that  when  they  could  save  500  lives  yearly  ! 


506 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES. 


Oct.  27,  1883. 


Abstainer.  —  The  prohibitory  liquor  amendment  to  the  State  Constitution 
of  Ohio  has  been  defeated  by  a  majority  of  about  76,000. 

Economist. — The  expenditure  of  the  Metropolitan  Asylums  Board  in  1831 
■was  about  £125,000,  and  in  1882  £386,125.  This  increase  chiefly  arose 
from  litigation. 

Wallace,  Marylebone. — There  are  105  churchyards  and  disused  burial 
grounds  in  the  metropolis,  thirty-three  of  which  have  been  laid  out 
or  are  being  adapted  for  recreation  purposes. 

Chester  Infirmary.— The  Duke  of  Westminster  has  just  sent  to  this  Infir¬ 
mary  the  sum  of  £560,  the  proceeds  of  a  small  charge  to  visitors, 
numbering  11,200,  for  inspecting  Eaton  Hall  since  its  re-opening. 


The  Question  of  Quarantine. — The  three  remaining  members  of  the 
Pasteur  Cholera  Commission  have  returned  to  Paris  from  Egypt.  They 
are  of  opinion  that  the  immunity  enjoyed  by  Marseilles  from  cholera  is 
due  to  the  rigorous  enforcement  of  quarantine  regulations,  as  this  is  the 
first  time  that  the  city  has  escaped  the  scourge  when  the  disease  has 
been  raging  at  Alexandria. 

Oxford:  Examination  in  Preventive  Medicine. — An  examination  for  the  cer¬ 
tificate  of  proficiency  in  subjects  bearing  on  preventive  medicine  and 
public  health  will  be  holden  in  the  second  week  of  December.  Intending 
candidates,  who  must  have  passed  all  the  examinations  for  the  degree 
of  Bachelor  of  Medicine  of  this  University,  are  requested  to  send  their 
names  to  the  Begius  Professor  of  Medicine  on  or  before  November  1. 


A  Quack  Doctor:  A  Criminal  Operation. —  At  Ashton-under-Lyne,  a 
coroner’s  jury  has  returned  a  verdict  of  wilful  murder  against  Thomas 
Arthur  Pord,  an  unqualified  medical  practitioner,  for  performing  an 
illegal  operation  on  a  servant-girl,  aged  twenty-four,  who  was  enceinte, 
which  resulted  in  her  death.  A  post-mortem  examination  was  made 
by  Dr.  Maequire,  of  Manchester  Infirmary,  and  Dr.  Julius  Dreschfeld, 
of  Owens  College,  after  which  the  delinquent  was  arrested. 


Scarlet  Fever  in  Dundee. — The  sanitary  authorities  have  for  some  time  past 
been  perplexed  as  to  the  serious  outbreaks  of  scarlet  fever  in  Dundee. 
An  inquiry  into  the  cause  of  these  visitations  has  led  to  the  discovery 
of  nineteen  cases  of  a  very  virulent  type,  four  of  which  were  subse¬ 
quently  fatal,  and  traced  to  milk  supplied  from  a  particular  dairy.  The 
dairyman’s  grandson,  while  suffering  from  the  fever,  was  in  the  room 
where  the  milk  was  sold.  The  case  was  brought  before  the  magistrate, 
and  the  dairyman  was  fined  £5  for  an  offence  which  his  Worship 
designated  as  “  most  serious.” 


The  High  Rate  of  Lunacy,  Birmingham. — The  Local  Government  Board  has 
communicated  with  the  Birmingham  Board  of  Guardians,  with  regard 
to  the  extraordinarily  high  rate  of  lunacy  in  the  town,  and  the  serious 
allegations  against  their  medical  officers.  The  percentage  of  the  pauper 
lunacy  of  the  borough  was  the  highest  in  the  kingdom,  and  about 
double  the  average  rate.  As  to  the  allegations  against  the  medical 
officers,  the  Guardians  had  asked  for  an  explanation  from  them,  but 
only  two  of  them  had  replied— Drs.  Suffield  and  Jackson,— their  letters 
being  to  the  effect  that  on  the  advice  of  their  solicitors  they  declined  to 
give  any  information  which  might  be  used  against  them,  the  Guardians 
being  the  accusing  parties.  They  (the  medical  officers)  had  written  to 
the  central  authority,  soliciting  an  immediate  investigation  of  the 
charges.  The  latter  have  asked  for  further  information  from  the 
Guardians,  and  the  matter  has  been  referred  to  a  committee  for  inquiry 
and  report. 


Medical  Baronets. — From  a  return  issued  this  week,  it  appears  that  the 
baronetcies  conferred  on  “  physicians  and  surgeons  ”  since  1850  were  as 
follows  In  1853,  Henry  Holland,  one  of  Her  Majesty’s  Physicians-in- 
Ordinary  ;  1857,  Charles  Locock,  of  Speldhurst,  Her  Majesty’s  First 
Physician-Accoucheur ;  1859,  Sir  Charles  Nicholson,  of  Luddenham. 
New  South  Wales  ;  1836,  William  Fergusson,  of  Spittlehaugh,  Peebles, 
one  of  Her  Majesty’s  Surgeons  Extraordinary  ;  1836,  James  Young 
Simpson,  of  Strathavon,  Linlithgow,  one  of  Her  Majesty's  Physicians 
in  Scotland;  1863,  Dominic  John  Corrigan,  of  Cappagh,  Dublin,  one 
of  Her  Majesty’s  Physicians-in-Ordinary  in  Ireland;  1866,  Thomas 
Watson,  of  Henrietta-street,  Cavendish-square,  President  of  the 
College  of  Physicians,  and  one  of  Her  Majesty’s  Physicians  Extra¬ 
ordinary  ;  1867,  William  Lawrence,  of  Ealing  Park  and  Whitehall-place, 
one.  of  Her  Majesty’s  Serjeant-Surgeons ;  1868,  William  Jenner,  of 
Harley-street,  Cavendish-square,  one  of  Her  Majesty’s  Physicians-in- 
Ordinary;  1871,  James  Paget,  of  Harewood-place,  Hanover-square, 
Serjeant-Surgeon  to  Her  Majesty  ;  1871,  Bobert  Christison,  of  Moray- 
place,  Edinburgh,  one  of  Her  Majesty’s  Physicians  in  Scotland,  and 
Professor  of  Materia  Medica  in  the  University  of  Edinburgh ;  1872, 
William  Withey  Gull,  of  Brook-street,  Hanover-square ;  1874,  George 
Burrows,  of  Cavendish-square,  President  of  the  Boyal  College  of  Phy¬ 
sicians,  and  one  of  Her  Majesty’s  Physicians-in-Ordinary  ;  1883, 
Thomas  Spencer  Wells,  of  Upper  Grosvenor-street  and  Golder’s  Hill, 
Hampstead,  President  of  the  Boyal  College  of  Surgeons,  and  Surgeon 
to  Her  Majesty’s  Household ;  Andrew  Clark,  of  Cavendish-square, 
M.D. ;  and  Prescott  Gardiner  Hewett,  of  Chesterfield-street,  Hanover- 
square,  Serjeant-Surgeon  Extraordinary  to  Her  Majesty.  Since  1852  the 
honour  of  knighthood  has  been  conferred  on  thirty-two  “  physicians 
and  surgeons  ”  ;  and  between  1863  and  1876  four  received  the  honour  of 
knighthood  from  the  Lord-Lieutenant  of  Ireland. _  _ _ 


x!W'm 

|W/HAQr~S 

U  iy 


The  Asylum  of  the  Barony  { Glasgoio)  Parochial  Board  at  Lenzie. — An  addi¬ 
tion  of  a  farm,  standing  on  the  grounds  of  Woodielee,  has  just  been 
made  to  this  institution.  The  new  building  is  constructed  for  carrying 
on  a  dairy  farm.  It  will  accommodate  fifty  inmates,  twenty-five  of  each 
sex.  These  belong  to  the  harmless  class  of  patients,  and  have  all 
previously  been  engaged  in  farm  work.  The  total  cost,  including  the 
furnishing,  is  estimated  at  about  £10,000. 

Gin  in  Camberwell.—  Dr.  Bernays,  in  his  report  to  the  Camberwell  Yestry, 
states  that  a  specimen  of  gin  was  of  much  higher  standard,  speaking 
aleoholically,  than  required  by  the  law;  it  contained  75,  instead  of  65 
per  cent,  of  proof  spirit.  Certainly  in  the  interest  of  temperance  he 
did  not  regard  it  as  an  advantage,  any  more  than  the  sale  of  slightly 
diluted  spirits.  The  latter  is  not  satisfying,  and  is  sure  to  be  followed 
by  a  second  dose ;  the  former  is  injurious.  The  seller  of  this  gin  evi¬ 
dently  thinks  it  is  safer  to  trade  in  the  article  above,  rather  than  below, 
the  legal  standard. 

COMMUNICATIONS  have  been  received  from — 

Prof.  G.  M.  Humphry,  F.B.S.,  Cambridge;  Dr.  Norman  Kerr,  London; 
Dr.  Crichton  Browne,  London;  The  Secretary  op  the  Boyal  College 
op  Surgeons,  Edinburgh ;  Mr.  P.  Scattergood,  Leeds  ;  Dr.  Skerritt, 
Bristol;  Dr.  H.  E.  Armstrong,  Newcastle-on-Tyne  ;  The  Secretary 
op  the  Apothecaries’  Society,  London;  Mr.  E.  Gurney,  London; 
Dr.  Clifford  Beale,  London;  Dr.  Domett  Stone, London ;  Dr.  Pearse, 
Plymouth  ;  Dr.  J.  W.  Moore,  Dublin ;  The  Editor  op  the  “  Isle  op 
Man  Times”;  Mr.  Noble  Smith,  London ;  The  Secretaries  op  the 
Hutchinson  Testimonial  Fund,  London;  Dr.  Dudfield,  London; 
Mr.  J.  Chatto,  London ;  Mr.  Mark  H.  Judge,  London  ;  Dr.  Dawson 
Williams,  London;  Mr.  T.  M.  Stone,  Wimbledon;  The  Begistrar- 
General  for  Scotland,  Edinburgh ;  The  Secretary  op  the  Local 
Government  Board,  London ;  Mr.  F.  Whitwell,  Shrewsbury ;  Mr.  G. 
Jackson,  Plymouth ;  Mr.  H.  D.  Cole,  Southampton ;  The  Hon. 
Secretary  op  the  West  London  Medico-Chirurgical  Society, 
London. 

PERIODICALS  AND  NEWSPAPEBS  BECEIVED— 

Lancet— British  Medical  Journal— Medical  Press  and  Circular — Ber¬ 
liner  Klinische  Wochenschrift— Centralblatt  fiir  Cbirurgie — Gazette 
des  Hopitaux— Gazette  Medicate— Bevista  de  Medicina— Bulletin  de 
1’  Academic  de  Medecine— Pharmaceutical  Journal — Wiener  Medicinisehe 
Wochenschrift— Bevue  Medicale— Gazette  Hebdomadaire— Nature- 
Boston  Medical  and  Surgical  Journal — Louisville  Medical  News — 
Centralblatt  fiir  Gynakologie — Le  Concours  Medical— Centralblatt  fiir 
die  Medicinischen  Wissenschaf  ten— Centralblatt  fiir  Klinische  Medicin 
— Philadelphia  Medical  News — Le  Progres  Mddical — New  York  Medical 
Journal — Edinburgh  Clinical  and  Pathological  Journal— Students’  Jour¬ 
nal  and  Hospital  Gazette— New  York  Medical  Becoi'd— American  Journal 
of  Obstetrics — Journal  of  Anatomy  and  Physiology— Denver  Medical 
Times— Bevue  d’HvgiSne— Maryland  Medical  Journal — Philadelphia 
Medical  Times— Therapeutic  Gazette— Nottingham  Journal,  October  20 
— Australasian  Medical  Gazette — Bombay  Gazette,  September  15. 


APPOINTMENTS  EOE  THE  WEEK. 


October  27.  Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  l.j-  p.m. ;  King’s  College,  It  p.m. ;  Boyal 
Free,  2  p.m.;  Boyal  London  Ophthalmic,  11  a. m. ;  Boyal  Westminster 
Ophthalmic,  li  p.m. ;  St.  Thomas’s,  lip.m.;  London,  2  p.m. 

29.  Monday. 

Operations  at  the  Metropolitan  Free,  2  p.m.;  St.  Mark’s  Hospital  for 
Diseases  of  the  Beetum.2  p.m.;  Boyal  London  Ophthalmic,  11  a.m.; 
Boyal  Westminster  Ophthalmic,  li  p.m.  ;  Hospital  for  Women,  2  p.m. 
Medical  Society  op  London,  8|  p.m.  Prof.  Lister,  “  On  the  Treatment 
of  Fractures  of  the  Patella. ” 


30.  Tuesday. 

Operations  at  Guy’s,  1J  p.m. ;  Westminster,  2  p.m. ;  Boyal  London  Oph¬ 
thalmic,  11  a.m.;  Boyal  Westminster  Ophthalmic,  li  p.m.  ;  West 
London,  3  p.m. 


31.  Wednesday. 

Operations  at  University  College,  2  p.m. ;  St.  Mary’s,  H  p.m.  ;  Middlesex, 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew’s,  1 J  p.m.  ;  Great  Northern, 

2  p.m.;  Samaritan,  2^  p.m. ;  Boyal  London  Ophthalmic,  11  a.m.; 
Boyal  Westminster  Ophthalmic,  li  p.m. ;  St.  Thomas’s,  li  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m. ;  National  Orthopaedic,  Great 
Portland-street,  10  a.m. 

Brompton  Hospital  for  Consumption,  etc.,  4  p.m.  Dr.  B.  Douglas 
Powell,  “  On  the  Treatment  of  Phthisis  in  its  Advanced  Stages.” 


November  1.  Thursday. 

Operations  at  St.  George's,  1  p.m.  ;  Central  London  Ophthalmic,  1  p.m. ; 
Boyal  Orthopaedic,  2  p.m.;  University  College,  2  p.m.;  Boyal  London 
Ophthalmic,  11  a.m. ;  Boyal  Westminster  Ophthalmic,  li  p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m. ;  Hospital  for  Women,  2  p.m. ; 
Charing-cross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  2-i  p.m. 
Abernethian  Society  (St.  Bartholomew’s  Hospital),  8  p.m.  Mr. 
S.  Paget,  “  On  Burns  and  Scalds.” 

Parkes  Museum  op  Hygiene,  8  p.m.  Mr.  Ernest  Hart,  “On  Smoke 
Abatement .” _ 

2,  Friday. 

Operations  at  Central  London  Ophthalmic,  2  p.m.;  Boyal  London  Ophthal¬ 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Boyal  Westminster 
Ophthalmic,  lip.m.;  St.  George’s  (ophthalmic  operations),  1}  p.m.; 
Guy’s,  li  p.m. ;  St.  Thomas’s  (ophthalmic  operations) ,  2  p.m. ;  King’s 
College  (by  Mr.  Lister),  2  p.m. 

West  London  Medico-Chirurgical  Society.  General  Meeting. 


BENNETT  ON  SPASTIC  PARALYSIS. 


Nov.  3,  1883.  507 


fa?  R.AQPORDXJc 

HBRAHV  A. 

y\dlcal>Yii»eS  and  Gazette... ''Vn  / 


"CLINICAL  LECTURE 


ON 


SPASTIC  PARALYSIS. 


By  A.  HUGHES  BENNETT,  M.D., 

Physician  to  the  Hospital  for  Epilepsy  and  Paralysis,  and  Assistant- 
Physician  to  the  Westminster  Hospital. 


Gentlemen, — I  need  not  remind  you  that  “  Spastic  ”  or 
“  Spasmodic  Paralysis”  is  the  clinical  expression  given  to  a 
■definite  series  of  symptoms,  and  so  called,  because  muscular 
spasm  or  rigidity  is  the  leading  feature  of  the  disorder.  The 
disease  has  also,  from  a  pathological  standpoint,  been  termed 
“  Lateral  Sclerosis,”  as  recent  researches  seem  to  show  that 
it  is  the  result  of  degeneration  of  the  lateral  columns  of  the 
spinal  cord.  I  prefer  to  employ  •  the  former  name,  as  it 
involves  no  theory,  and  is  a  convenient  title  to  indicate  the 
prominent  clinical  aspect  of  the  affection.  In  some  of  its 
forms,  spastic  paralysis  is  extremely  common ;  in  others  it  is 
supposed  to  be  very  rare.  In  some  cases  it  is  due  to  demon¬ 
strable  destructive  disease  of  the  nervous  system  ;  in  others, 
precisely  the  same  symptoms  ensue  without  discoverable 
tissue-change.  In  some  instances  the  disorder  persists  for 
life,  and  is  followed  by  a  fatal  termination ;  in  others  it  is 
succeeded  by  rapid  recovery.  The  diagnosis  and  prognosis 
of  this  condition  are  therefore  of  the  greatest  importance,  and 
I  make  no  excuse  for  directing  attention  to  some  practical 
points  connected  with  it.  The  general  symptoms  have  been 
observed  from  the  earliest  ages,  but  their  true  significance 
has  not  been  determined  till  comparatively  recent  times. 
For  this  we  are  mainly  indebted  to  the  pathological  re¬ 
searches  of  Tiirck,  Vulpian,  Bouchard,  Pitres,  Charcot, 
and  others,  whose  labours  have  thrown  a  flood  of  light  upon 
the  subject,  and  greatly  facilitated  our  conception  of  the 
disease. 

Spastic  paralysis  in  all  its  forms  presents  a  definite  and  cha¬ 
racteristic  clinical  picture.  Without  entering  into  the  symp¬ 
toms  in  detail,  it  may  be  stated  that  these  consist  of  a  chronic 
form  of  paresis,  accompanied  with  rigidity  and  spasm  of 
the  muscles,  contracture  of  the  limbs,  and  exaltation  of  the 
tendon  reflexes.  Associated  with  these,  there  is  no  loss  of 
sensibility,  no  muscular  atrophy,  no  trophic  changes,  no  ab¬ 
normal  electrical  reactions,  and  no  impairment  of  the  functions 
of  the  brain,  rectum,  or  bladder.  Such  are  the  characteristic 
features  of  spastic  paralysis,  a  modification  or  combination 
of  which  determines  that  special  clinical  sequence  of  events 
met  with  in  all  its  forms,  from  whatever  cause  induced. 
This  train  of  symptoms  may  occur  in  two  ways.  It  may 
appear  independently,  and  is  therefore  termed  primary ;  or  it 
may  be  the  result  of  another  lesion,  in  which  case  it  is 
called  secondary.  It  is  to  the  researches  on  the  secondary 
form,  which  is  a  very  common  condition,  that  most  of  our 
knowledge  on  this  subject  is  due,  and  its  anatomical  changes 
after  death,  and  their  relation  to  the  symptoms  during  life, 
have  now  been  very  accurately  determined.  It  has  for  long 
been  known  that  certain  diseases  of  the  brain  and  cord  were 
followed  by  spastic  symptoms,  but  it  was  reserved  for  the 
authorities  already  mentioned  to  demonstrate  the  exact  patho¬ 
logical  changes  which  led  to  this  result.  Both  experiment 
and  pathology  have  shown  that  any  destructive  lesion  of  the 
pyramidal  tract,  extending  between  the  cortex  of  the  brain 
and  the  lower  portion  of  the  spinal  cord,  is  followed  by 
sclerotic  degeneration  of  its  centrifugal  fibres,  and  all  the 
parts  supplied  from  such  affected  portions  are  found  to  be 
in  a  condition  of  spastic  paralysis.  Thus  disease  of  the 
motor  fibres  of  the  corona  radiata,  the  internal  capsule,  the 
crura  cerebri,  the  pons,'  the  medulla,  and  the  lateral 
columns  of  the  cord — in  other  words,  any  part  of  the 
pyramidal  tract— is  invariably  followed  by  secondary  degene¬ 
rative  changes,  and  accompanied  by  the  symptoms  under 
discussion.  It  has  been,  moreover,  determined  that  in  the 
•cortex  of  the  brain  itself  there  exist  certain  localities  which 
“experiment  and  pathology  have  indicated  to  be  associated 
with  voluntary  motion.  In  these  regions,  and  in  these  regions 
only,  there  have  been  found  certain  cell-elements  of  peculiar 
conformation,  and  similar  to  those  found  in  the  anterior 
cornua  of  the  cord.  These  are  believed  to  be  motor  in 
function,  and  to  originate  voluntary  movements.  It  has 
been  further  ascertained,  that  when  this  locality  is  exten- 

Vol.  II.  1883.  No.  1740. 


sively  involved  in  disease  and  these  special  cells  destroyed, 
secondary  descending  sclerosis  in  the  pyramidal  tract 
follows,  and  ultimately  spreads  throughout  its  whole  extent 
to  the  cord.  As  a  rule,  the  disease  is  arrested  at  the  lateral 
columns,  and  does  not  extend  to  the  other  parts  of  the 
spinal  marrow.  The  most  plausible  theory  to  explain  these 
phenomena,  is  that  the  ganglionic  cells  which  exist  in  the 
motor  cortical  convolutions  of  the  brain  act  as  trophic  Centres 
for  the  nerve-fibres  of  the  entire  pyramidal  tract.  When 
these  are  destroyed,  or  severed  from  the  parts  below  by  a 
lesion  in  any  part  of  this  system,  the  centrifugal  fibres  de¬ 
generate,  and  ultimately  induce  what  has  been  termed  lateral 
sclerosis.  This  hypothesis  is  further  supported  by  the  fact 
that  disease  of  no  other  portion  of  the  brain  or  cord  is  followed 
by  secondary  degeneration.  Whatever  theory  we  adopt,  the 
practical  fact  remains,  that  demonstrable  changes  ensue  in  all 
the  motor  fibres,  when  their  origin  in  the  cortex  of  the  brain  is 
destroyed,  or  when  there  is  a  rupture  of  continuity  at  any 
part  of  their  course.  It  is  such  changes  in  the  spinal  cord 
which  lead  to  spastic  paralysis.  Whatever  symptoms  may 
have  originally  existed  as  a  result  of  the  primary  disease, 
when  the  secondary  lesion  follows  there  appear,  in  addi¬ 
tion,  the  muscular  rigidity,  the  contractures,  and  the  in¬ 
creased  tendon  reflexes.  These  are  supposed  to  be  the 
result  of  increased  muscular  tone,  or  augmented  reflex  ex¬ 
citability,  due,  partly  to  the  inhibitory  influence  of  the  brain 
being  intercepted,  and  partly  to  irritation  of  the  spinal  grey 
matter  without  structural  change,  caused  by  the  sclerosis 
of  the  neighbouring  lateral  columns. 

These  pathological  facts,  and  their  association  with  cha¬ 
racteristic  clinical  symptoms,  in  secondary  degenerations 
having  been  determined,  the  existence  of  a  primary  lateral 
sclerosis  has  been  assumed.  This  has  been  more  particu¬ 
larly  insisted  upon  by  Professors  Erb  and  Charcot.  We 
meet  in  practice  with  cases  in  which  all  the  symptoms  of 
spastic  paralysis  are  slowly  developed,  and  generally  from 
below  upwards,  in  which  there  is  no  reason  to  suppose  that 
the  affection  is  consequent  on  pre-existing  disease.  We 
therefore  conclude  that  this  is  idiopathic  or  primary,  and 
that  the  degeneration  began  in  the  pyramidal  tracts  of 
the  cord.  The  symptoms  are  so  perfectly  in  accord  with 
those  which  have  been  proved  to  succeed  sclerosis  of  this 
locality,  as  to  make  our  assumption  in  the  matter  almost 
certain.  Pathological  anatomy  has,  however,  been  sin¬ 
gularly  wanting  in  actual  proof  of  this  belief,  but  there 
is  at  least  one  case  recorded  in  which  the  fact  seems  to  be  de¬ 
monstrated.  In  the  British  Medical  Journal  for  January, 
1881,  there  is  published  a  typical  case  of  Spastic  Paralysis 
by  Drs.  Morgan  and  Dreschfeld,  in  which  post-mortem 
examination  revealed  sclerosis  of  the  crossed  pyramidal 
tracts,  and  of  these  regions  only.  Dr.  Byrom  Bramwell 
likewise  made  sections  of  the  same  tissues,  and  in  his  work 
on  Diseases  of  the  Spinal  Cord  furnishes  an  excellent 
chromo-lithograph  of  the  morbid  appearances.  There  have 
also  been  several  autopsies  in  cases  of  what  Charcot  has 
called  Amyotrophic  Lateral  Sclerosis,  the  first  stage  of 
which  is  practically  primary  spastic  paralysis,  and  is  only 
subsequently  complicated,  as  a  secondary  affection,  with 
atrophic  changes  in  the  muscles.  In  these  it  has  been  de¬ 
monstrated,  that  although  the  motor  cells  of  the  anterior 
cornua  are  degenerated,  the  crossed  pyramidal  tracts  are 
extensively  sclerosed,  and  it  is  probable  that  this  last  is  alone 
accountable  for  the  spastic  symptoms. 

In  most  memoirs  on  the  subject  it  is  stated  that  primary 
spastic  paralysis  is  a  rare  disease ;  but  it  appears  to  me  that 
it  is  more  common  than  is  generally  supposed,  and  that 
hitherto  it  has  been  placed  in  the  category  of  other  nervous 
affections.  In  my  own  limited  experience,  during  the  last 
few  years,  I  have  the  records  of  no  less  than  fourteen 
cases  in  which  the  history,  progress,  and  symptoms  were 
so  characteristic  and  definite  as  to  warrant  me  in  con¬ 
sidering  them  as  specimens  of  this  disease.  Of  these,  seven 
occurred  in  men,  and  seven  in  women,  between  the  ages 
of  fifteen  and  forty.  In  all  the  affection  was  chronic, 
without  apparent  cause,  and  presented  all  the  typical  phe¬ 
nomena.  It  is  more  than  probable,  that  as  a  more  exact 
knowledge  of  the  recent  discoveries  in  nervous  diseases 
is  diffused  amongst  the  profession,  such  conditions  will 
be  recognised  with  greater  accuracy,  and  that  this  special 
disorder  will  be  found  to  exist  in  more  equal  propor¬ 
tion  with  the  other  system-lesions  of  the  cord.  We  know 
that  the  only  two  other  such  diseases  we  are  acquainted 


508 


Medical  Times  and  Gazette. 


POWER  ON  THE  LACRIMAL  APPARATUS  OF  THE  EYE. 


Nov.  3,  1883. 


with— namely,  chronic,  sclerosis  of  the  anterior  cornua  and  of 
the  posterior  columns — are  by  no  means  rare,  and  occur  in 
tolerable  proportion  to  one  another ;  and  there  is  no  d  priori 
reason  to  suppose  that  the  lateral  columns,  which  are  of 
similar  nature,  should  be  specially  exempt  from  like  degene¬ 
rations.  During  the  life  of  the  patient  there  is  always  a  doubt 
as  to  the  primary  nature  of  the  affection,  and  the  existence 
of  this  can  only  be  proved  by  future  pathological  researches. 

In  connexion  with  this  subject  there  is  a  point  of 
great  practical  interest  to  which  I  would  direct  attention. 
Although  it  has  been  determined  that  spastic  paralysis  may 
be  accounted  for  by  disease  of  the  pyramidal  tracts  in  the 
cord,  there  are  numerous  instances  where  exactly  similar 
symptoms  ensue,  in  which  we  have  every  reason  to  believe 
that  no  permanent  changes  exist.  In  certain  cases  of 
Hysteria,  for  example,  we  have  the  typical  picture  of  this 
disorder ;  and  as  some  of  these  under  favourable  circum¬ 
stances  rapidly  recover,  we  assume  that  the  cause  of  the 
symptoms  is  functional,  and  not  organic  in  nature.  I  have 
met  with  many  such  cases,  in  which  paresis,  with  rigidity, 
contracture,  the  characteristic  deformities  of  the  limbs, 
increase  of  tendon  reflexes,  without  impairment  of  sensi¬ 
bility  or  trophic  changes,  has  occurred  in  young  women,  in 
whom  the  symptoms  appeared  insidiously,  and  were  of  such 
a  character  as  in  every  respect  to  simulate  the  disease  under 
consideration.  It  is  true  that  in  many  instances  the  cir¬ 
cumstances  of  the  case  suggest  this  as  being  of  hysterical 
origin,  but  in  many  there  are  no  such  indications.  The 
two  affections  appear  identical,  and  I  know  of  no  single 
point  which  serves  to  diffierentiate  between  them.  The 
proof,  however,  that  there  is  such  distinction  is,  that  the  one 
lasts  for  years  or  for  life,  while  the  other  occasionally  re¬ 
covers  under  circumstances  which  show  that  it  was  of  a 
temporary  nature.  A  decision  on  this  question  is  obviously 
of  the  greatest  practical  importance,  as,  given  a  young  woman 
presenting  such  a  condition,  is  her  state  due  to  organic 
central  change,  or  to  transient  derangement  ?  I  leave 
it  to  others  to  suggest  some  solution  of  this  problem,  as  I 
confess  I  have  met  with  not  a  few  cases  in  which  I  found  it 
impossible  to  come  to  any  decision  on  the  matter.  This  leads 
to  great  embarrassment  on  the  part  of  the  physician,  who, 
not  having  definite  guidance,  treats  the  patient  according 
to  the  view  he  may  take  of  the  question.  Thus  it  happens 
that  many  unfortunate  women  suffering  from  spinal  disease 
are  considered  as  hysterical,  and  others,  who  by  a  vigorous 
regime  might  be  rapidly  cured,  are  incarcerated  for  life  as 
hopeless  invalids.  An  interesting  example  of  this  difficulty 
is  to  be  found  in  a  case  published  by  Professor  Charcot 
in  1865,  under  the  heading  of  “  Sclerosis  of  the  Lateral 
Columns  of  the  Cord  in  a  Hysterical  Woman  suffering  from 
Permanent  Contracture  of  all  Pour  Limbs/5  This  patient 
was  paralysed  for  nine  years  before  she  died,  and  although 
she  may  have  presented  some  symptoms  of  hysteria,  the 
spastic  paralysis  arising  from  the  definite  lesion  discovered 
after  death  could  scarcely  be  placed  in  that  category. 
Therefore,  though  during  life  she  may  have  been  looked 
upon  as  a  hysteric,  the  case  in  reality  was  subsequently 
proved  to  be  one  of  true  primary  lateral  sclerosis. 

It  is  commonly  assumed  that  nothing  is  more  easy  than 
to  distinguish  a  functional  from  an  organic  lesion  ;  but,  as  far 
as  my  experience  goes,  in  many  instances  nothing  is  more 
difficult,  and  this  particular  affection  is  an  illustrative  case 
in  point.  I  have  met  with  several  instances  in  which  the 
most  experienced  physicians,  with  every  care  on  their  part, 
were  at  fault,  much  to  the  disadvantage  of  the  patient,  and 
discomfiture  of  themselves.  As  a  matter  of  fact,  although 
experience  tells  us  that  it  is  possible  for  such  hysterical 
paralyses  to  recover,  as  a  rule  this  condition  is  sufficiently 
grave  to  cause  great  anxiety  and  trouble  to  the  medical  prac¬ 
titioner.  What  the  pathological  representations  of  such 
functional  disorders  are,  we  do  not  know,  but  it  is  interest¬ 
ing  to  observe  that  their  manifestations  follow  exactly  the 
same  order  as  those  resulting  from  structural  disease.  Here 
also  we  find  symptoms  indicating  derangement  of  the 
pyramidal  tracts  in  their  entire  extent,  and  studiously 
avoiding  any  other  systems  in  the  nervous  organisation. 
This  is  evidence  of  the  reality  of  the  disorder,  to  its  in¬ 
dependence  of  the  voluntary  control  of  the  patient,  and 
points  to  some  influence,  of  which  we  are  ignorant,  affect¬ 
ing  the  nervous  system  in  strict  physiological  sequence. 
Various  hypotheses  may  be,  and  have  been,  advanced  to  ex¬ 
plain  these  phenomena.  I  do  not  propose  to  offer  one  for 


your  acceptance,  as  I  consider  those  which  might  be  put 
forward,  if  plausible  in  some  respects,  are  open  to  objection 
in  others.  The  theory  which  appears  to  account  best  for 
the  facts  is  that  which  assumes  that  the  functions  of  the 
voluntary  cortical  centres  are  temporarily  in  abeyance,  and,, 
the  inhibitory  action  of  the  brain  being  thus  removed,  the 
reflex  excitability  of  the  cord  is  in  consequence  augmented,, 
thus  accounting  for  the  paralysis  and  symptoms  of  reflex 
irritation.  It  seems  to  me,  however,  that  it  is  yet  to  be 
proved  that  the  simple  removal  of  cerebral  volition  is; 
sufficient  by  itself  to  cause  such  excessive  and  per¬ 
manent  functional  abnormalities,  as  the  rigidity,  con¬ 
tractures,  and  exaggerated  reflexes.  It  might  also  be 
argued  that  if  the  cortical  centres,  including  the  motor 
ganglion  cells,  are  in  such  a  state  of  inactivity  as  to  induce 
such  symptoms,  the  other  consequences  of  their  deficient 
function  would  follow,  namely,  trophic  changes  in  the 
pyramidal  tracts.  This,  we  know  by  experience,  need  not  of 
necessity  be  the  case.  Whether  a  chronic  functional  de¬ 
rangement  is  capable  of  ultimately  ending  in  actual  struc¬ 
tural  change,  we  do  not  know ;  according  to  this  trophic 
theory,  it  is  possible,  and  the  progress  of  chronic  hysteria 
makes  it  appear  probable,  though  there  is  no  positive  ana¬ 
tomical  evidence  of  the  fact.  We  can  only  say  that,  like 
strychnine,  which  temporarily  causes  somewhat  similar  con¬ 
ditions,  in  hysteria  we  have,  from  unknown  causes  and  for 
unknown  reasons,  some  change  in  a  special  physiological1 
ti'act  of  the  nervous  system,  which,  although  sometimes; 
capable  of  recovery,  is  frequently  permanent,  and  that 
Avithout  apparent  or  necessary  structural  change.  It  is  of 
the  utmost  importance  that  this  should  be  distinguished 
from  the  same  symptoms  due  to  organic  degeneration,  and 
although,  in  the  present  state  of  medical  science,  this  is  a 
problem  of  extreme  difficulty,  Ave  must  hope  that,  as  our 
knowledge  extends,  the  differential  diagnosis  will  be  made 
with  facility  and  precision. 


LECTURES 

ON 

THE  PROTECTIVE  AND  LACRIMAL. 
APPARATUS  OE  THE  EYE. 

Delivered  at  the  Royal  College  of  Surgeons. 

By  HENRY  POWER,  M.B.  Lond.,  E.R.C.S.  Eng., 
Arris  and  Gale  Lecturer  at  the  College  ;  Senior  Ophthalmic  Surgeon,  andl 
Lecturer  on  Ophthalmic  Surgery,  St.  Bartholomew’s  Hospital. 


Lecture  III. — Part  II. 

( Continued  from  page  421.) 

The  lacrimal  sac  is  a  nearly  cylindrical  passage,  occupying" 
the  whole  bony  semi-canal  between  the  crista  posterior  of 
the  lacrimal  bone  and  the  crista  anterior  of  the  ascending 
process  of  the  superior  maxillary  bone.  It  is  situated  im¬ 
mediately  behind  the  tendon  of  the  orbicularis.  Its  length 
from  above  downwards  is  usually  about  half  an  inch,  or 
12  mm.,  but  it  may  be  not  longer  than  11  mm.,  or  as  long 
as  14  mm.  Its  breadth  in  the  middle  is  from  44  to  5  or  even 
6  mm.  BeloAV,  where  it  becomes  continuous  with  the  nasal 

duct,  it  is  from  24  to  34  mm.  Its  direction  is  not  vertical,  but 
slightly  oblique,  downwards,  forwards,  and  outwards.  The 
free  anterior  and  external  part  of  its  Avail  is  somewhat  flat¬ 
tened.  Sappey  describes— 1.  An  antero-external  wall,  which 
corresponds  in  front  to  the  skin  and  to  the  tendon  of  the 
orbicularis,  a  little  further  back  to  the  reflected  portion  of 
the  same  tendon,  and  also  to  the  muscle  of  Horner,  and 
inferiorly  is  in  relation  to  the  obliquus  inferior  of  the 
eye,  the  innermost  fibres  of  which  are  frequently  inserted 
into  this  wall  of  the  sac  ;  2.  A  postero-internal  wall,  Avhicb 
is  in  relation  with  the  bony  wall  of  the  groove,  with  the 
upper  border  of  the  middle  turbinal  bone,  and  lastly  to  the 
highest  point  of  the  middle  meatus.  The  upper  extremity 
of  the  sac  is  formed  by  a  rounded  cul-de-sac.  The  internal 
surface  is  of  pale  rose  tint,  and  when  laid  open  it  presents 
on  its  outer  wall,  at  the  level  of  the  tendon  of  the  orbicularis,, 
and  nearer  to  the  crest  of  the  os  unguis  than  to  this  tendon, 
a  circular  opening,  which  constitutes  the  embouchure  of  the 
common  duct  of  the  canaliculi. 


Medical  Times  and  Gazette. 


Nov.  3,  1883. 


509 


POWER  ON  THE  LACRIMAL  APPARATUS  OF  THE  EYE. 


The  mucous  membrane  lining  the  sac  presents  a  covering 
of  ciliated  epithelium,  and  it  is  supported  externally  by  a 
strong  layer  of  fibrous  tissue,  which  is  almost  limited  to  the 
antero-external  wall.  Elsewhere,  in  all  those  parts  in  which 
the  soft  parts  are  in  relation  with  bone,  the  mucous  mem¬ 
brane  is  only  separated  from  the  thin  periosteum  by  a  thin 
layer  of  connective  tissue,  which,  according  to  Robin  and 
■Cadiat,  is  quite  distinct  in  structure  from  both  the  periosteum 
and  the  membrane.  It  is  characterised  by  its  transparency 
and  by  the  absence  of  any  glands  like  those  seen  throughout 
the  whole  extent  of  the  nasal  fossae.  It  contains  much 
elastic  tissue,  but  is  firm  and  resistant  of  tension.  It  is 
vascular,  containing  both  arteries  and  veins ;  and  the  veins 
are  so  numerous,  except  in  the  thicker  portion  which  forms 
the  outer  free  wall  of  the  sac,  as  to  resemble  cavernous 
tissue. 

The  nasal  duct  is  directly  continuous  with  the  lacrimal 
sac,  and  the  two,  as  Sappey  observes,  constitute  but  one 
canal,  of  which  the  upper  part  lies  in  a  hollow  of  the  inner 
part  of  the  orbit,  and  the  lower  in  a  hollow  of  the  external 
wall  of  the  nasal  fossa.  Its  direction  is  also  continuous 
with  that  of  the  sac,  for  this  sac  has  been  seen  to  be  directed 
downwards,  forwards,  and  outwards;  the  duct  at  first  also 
Tuns  downwards,  but  soon  bends  backwards  without  approxi¬ 
mating  or  receding  perceptibly  from  the  median  plane. 
The  whole  lacrimo-nasal  passage  therefore  describes  a  curve, 
the  convexity  of  which  looks  forwards  and  outwards ;  and  a 
perpendicular  dropped  from  the  middle  of  the  sac  would  fall 
to  the  inner  side  of  the  nasal  opening.  The  whole  length 
of  the  lacrimo-nasal  passage  varies  in  different  subjects  from 
25  to  28  mm.,  and,  speaking  generally,  the  sac  and  the  duct 
each  form  about  one-half  of  the  whole  length.  The  length 
of  the  onter  and  anterior  wall  is  from  4  to  8  mm.  longer 
than  the  inner  and  posterior  wall.  It  is  nearly  cylindrical, 
but  its  diameter  is  smaller  above,  near  the  lacrimal  sac, 
where  it  does  not  exceed  2 1  to  3  mm. ;  below,  it  is  slightly 
wider,  3§  mm. 

The  mucous  membrane  of  the  nasal  duct  has  been  very 
minutely  described  by  Robin  and  Cadiat.  It  has  a  thickness 
of  about  one-thirtieth  to  one-fiftieth  of  an  inch.  Its  sur¬ 
face,  even  when  the  epithelium  is  removed,  is  smooth  and 
even.  In  some  subjects,  indeed,  it  presents  slight  folds  or 
grooves,  but  the  epithelium  lining  them  preserves  its  usual 
characters,  and  in  some  old  people  the  surface  forms  pro¬ 
jections,  and  the  whole  membrane  is  thickened,  which  has 
led  to  its  being  termed  tomentose.  The  subepithelial 
layer  is  made  up  of  laminar  fibres,  of  which  many  are  in 
the  state  of  fibro-plastic  cellules,  and  of  elastic  tissue-fibres, 
forming  plexuses  with  nuclei,  which  occur  either  isolated  or  in 
-small  groups.  Between  this  and  the  epithelium  is  a  limiting 
hyaline  layer  of  amorphous  substance,  free  from  fibres  and 
nuclei.  Externally,  the  membrane  passes  into  loose  fibrous 
tissue.  The  membrane  everywhere  presents  arterioles, 
which  divide  and  form  a  close  superficial  plexus.  There 
are  also  many  nerve-fibres,  the  terminations  of  which  are  con¬ 
cealed.  There  are  no  glands  except  in  the  valvular  fold  at 
the  lower  orifice,  and  even  these  open  into  the  nasal  fossae 
and  present  the  characters  of  those  found  elsewhere  in  the 
nasal  fossae,  being  composed  of  several  minute  lobules ;  yet, 
notwithstanding  the  absence  of  glands,  the  whole  surface 
appears  to  be  capable  of  secreting  mucus. 

The  opening  by  which  the  nasal  duct  opens  into  the 
inferior  meatus  corresponds  sometimes  to  the  summit,  some¬ 
times  to  the  outer  wall.  In  the  latter  case,  which  is  the 
most  common,  it  descends  3  to  4  and  even  5  mm.  below 
the  summit  towards  the  floor  of  the  fossa.  Its  rela¬ 
tions  have  been  particularly  minutely  described  both  by 
Lesshaft  and  by  Sappey.  According  to  Sappey,  the 
diameter  and  form  of  the  orifice  are  subordinate  to  its 
position.  When  the  orifice  is  in  the  vault  of  the  meatus 
it  is  always  very  large,  rounded,  and  infundibuliform, 
so  that  the  tears  then  fall  without  obstruction,  and  by 
their  own  gravity,  on  to  the  floor  of  the  meatus ;  but  if 
the  opening  be  situated  on  the  lateral  and  external  wall 
of  the  meatus  it  is  much  narrower,  it  loses  its  rounded 
form,  and  it  becomes  vertically  or,  as  Lesshaft  states, 
transversely  oval.  The  lower  the  orifice,  the  smaller  is  its 
size,  so  that,  when  it  descends  4  or  5  mm.  below  the 
vault,  it  appears  only  as  a  vertical  fissure  that  is  not 
always  easily  discoverable.  Sappey  states  that  in  four 
instances,  after  having  completely  separated  the  external 
wall  and  washed  the  surface,  he  was  quite  unable  to  per¬ 


ceive  the  inferior  orifice  of  the  canal  by  inspection  or  by 
the  use  of  the  probe,  and  was  only  able  to  demonstrate  it 
by  injecting  the  canaliculus,  when  the  fluid  immediately  ap¬ 
peared  at  a  small  vertical  slit  If  mm.  long  in  the  middle 
of  the  external  wall  of  the  inferior  meatus.  Its  length 
may,  however,  vary  from  If  to  8  mm.,  and  its  breadth 
from  f  to  5  mm.  Its  distance  from  the  floor  of  the  nose 
is  in  some  cases  only  2  mm. ;  from  the  anterior  border  of 
the  bony  opening  of  the  nares  it  is  from  10  to  13  and 
occasionally  17  mm. 

The  lower  part  of  the  internal  wall  of  the  canal  is  not 
bounded  by  bone,  but  by  a  duplicature  of  the  mucous  mem¬ 
brane,  the  lower  free  border  of  which  limits  the  upper  border 
of  the  aperture.  This  fold  was  noticed  and  described  by 
J.  B.  Morgagni; (a)  but  I  shall  have  to  allude  to  the  folds 
of  the  lacrimal  passage  more  particularly  in  considering 
the  physiology  of  these  passages. 

The  lacrimal  gland  receives  its  nervous  supply  from  the 
sympathetic  and  from  the  upper  division  of  the  fifth,  which 
was  formerly  regarded  as  a  purely  sensory  nerve,  but  which 
must  contain  vaso-motor  and  secreto-motory  fibres.  The 
subcutaneus  malse  also  give  branches  to  it.  It  certainly 
contains  fibres  of  different  sizes.  R.  Wagner  noticed  what 
he  considered  to  be  a  large  admixture  of  sympathetic  fibres ; 
whilst  Yolkmann  and  D’Alton(b)  observed  ten  times  as 
many  fine  as  broad  fibres.  Frerichs  states  that  in  a  Lamb 
he  counted  in  a  branch  of  this  nerve  forty  slender  filaments 
and  three  broad  ones,  but  in  another  adjoining  branch  the 
proportion  was  not  so  great. 

Swan,  Magendie,  and  Cruveilhier  state  that  the  fourth 
nerve  gives  off  the  lacrimal  nerve  either  wholly  or  in  part. 
This,  however,  is  only  due  to  the  circumstance  that  the 
fourth  nerve  lies  in  the  outer  wall  of  the  cavernous  sinus  in 
close  contiguity  with  the  ophthalmic  of  the  fifth,  with  which 
it  communicates.  It  is  not,  therefore,  surprising,  as  Longet 
remarks,  that  fibres  of  the  ophthalmic,  previously  applied 
to  the  fourth,  should  detach  themselves  again  and  proceed 
to  the  gland. 

The  lacrimal  nerve  runs  along  the  external  and  upper 
part  of  the  orbit,  and  divides  into  two  branches — a  superior, 
internal,  or  anterior  branch,  and  a  posterior,  inferior,  or  ex¬ 
ternal  branch.  The  former  traverses  the  gland,  and  then 
breaks  up  into  filaments,  distributed  to  the  conjunctiva  and 
upper  eyelid  near  the  outer  canthus.  The  external  branch 
turns  downwards,  and  joins  the  subcutaneus  malse  of  the 
second  branch  of  the  fifth.  From  the  convex  side  of  this 
communication,  branches  proceed  to  the  gland.  This  accounts 
for  the  fact  that  stimulation  both  of  the  lacrimal  and  the 
subcutaneus  malse  may  excite  a  flow  of  tears.  Turner  has 
seen  the  gland  supplied  by  the  zygomaticus  malse  when  the 
lacrimal  has  been  absent. 

The  artery  of  the  lacrimal  gland  is  named  the  lacrimal 
artery,  and  is  a  branch  of  the  ophthalmic  artery.  It  runs 
to  the  gland  between  the  external  and  the  superior  recti 
muscles  along  the  external  Avail  of  the  orbit.  It  sometimes 
arises  from  the  middle  meningeal  artery,  or  from  the 
deep  temporal,  Avith  which  the  lacrimal  artery  sometimes 
anastomoses. 

The  lacrimal  vein  has  the  same  course,  and  runs  into  the 
ophthalmic  vein. 

The  lacrimal  gland  can  be  stimulated  to  secrete  either  by 
direct  or  by  reflex  stimulation. 

We  are  chiefly  indebted  to  Herzenstein  for  the  experi¬ 
mental  evidence  demonstrating  the  particular  nerves  which 
are  distributed  to  the  gland  by  direct  stimulation.  He 
experimented  on  Rabbits,  Cats,  and  Dogs. 

In  the  Rabbit  the  skull  was  opened  and  the  brain  removed, 
the  orbital  plate  of  the  frontal  bone  was  carefully  cut  aAvay 
external  to  the  frontal  nerve,  and  the  lacrimal  nerve  sought 
for,  found,  divided,  and  its  distal  end  stimulated  by  the 
induced  current.  A  copious  flow  of  tears  immediately  took 
place  from  the  glands  of  that  side,  Avhilst  those  of  the 
opposite  side  remained  quiescent ;  and  this  recurred  as  often 
as  the  stimulus  was  applied,  and  ceased  in  the  intervals  of 
the  passage  of  the  current.  The  experiment  often  failed, 
the  animals  dying  during  the  operation.  He  adopted  a  less 
serious  mode  "of  operating  in  the  case  of  Dogs,  in  Avhich 
animals  the  outer  wall  of  the  orbit  is  open,  or  at  least  only 
covered  with  soft  parts.  He  here  made  a  vertical  cut  just 
behind  the  posterior  commissure  of  the  lids,  and  from  the 

(a)  “Ad.  v.  Anat.,”  1  Lugd.  Bat.,  1723,  page  28. 

(b)  “  Handv orterbuch  der  Physiologie,”  Band  ii.,  S.  5SS. 


Medical  Times  and  Gazette. 


POWER  ON  THE  LACRIMAL  APPARATUS  OF  THE  EYE. 


Nov.  3, 1883. 


510 


ends  of  this  made  two  others  passing  backwards  for  two 
inches,  so  that  the  capsule  of  the  orbit  was  exhibited.  On 
dividing  this  carefully,  parallel  to  the  upper  border  of  the 
rectus  externus,  the  nerve  could,  with  a  little  dissection,  be 
made  out.  After  division,  stimulation  of  the  distal  stump 
of  the  nerve  produced  the  same  results. 

In  one  case  bleeding  interfered  with  the  discovery  of  the 
nerve.  He  therefore  sought  another,  and  found  one  at  the 
lower  border  of  the  rectus.  Stimulation  of  this  produced 
apparent  increase  in  the  flow  of  tears.  The  animal  was 
killed,  and  the  nerve  dissected  out ;  it  proved  to  be  nervus 
subcutaneus  males.  Subsequent  experiments,  made  with  a 
view  of  directly  determining  the  influence  of  this  nerve, 
showed  that  it  was  capable  of  inducing  a  secretion  of  tears, 
though  less  abundant  than  when  the  lacrimal  was  itself 
stimulated. 

In  the  course  of  Herzenstein’s  experiments  it  did  not 
appear  that  haemorrhage,  or  otherwise  produced  arrest  of 
circulation  through  the  gland,  interfered  with  the  result, 
and  hence  the  conclusion  may  be  drawn  that  the  action  of 
the  nerves,  as  in  the  case  of  the  salivary  glands,  is  essen¬ 
tially  on  the  secreting  cells  themselves.  From  these  ex¬ 
periments,  then,  it  appears  that  the  gland  may  be  excited 
to  action  by  branches  of  both  the  first  and  second  divisions 
of  the  fifth  pair  of  nerves. 

The  only  other  nerve  that  appears  to  have  a  direct  in¬ 
fluence  on  the  activity  of  the  lacrimal  gland  is  the  sympa¬ 
thetic;  and  this  is  not  easy  to  ascertain,  for  the  sympathetic 
is  often  blended  in  the  Dog  with  the  vagus ;  but  it  appears  that 
after  section  of  the  sympathetic,  when  it  does  happen  to  run 
separately,  though  there  is  increased  flow  of  blood  through 
the  capillaries  of  the  same  side  of  the  head,  there  is  no 
noticeable  increase  in  the  secretion  of  tears.  When,  how¬ 
ever,  the  upper  cut  extremity  is  stimulated,  tears  are 
secreted  in  larger  quantity,  but  still  not  in  quantity  com¬ 
parable  with  what  is  discharged  when  the  lacrimal  nerve  is 
stimulated. 

When  both  sympathetic  and  lacrimal  nerves  have  been 
divided,  an  increased  secretion  of  tears  has  been  observed, 
which  must  be  regarded  as  analogous  to  the  paralytic  secre¬ 
tion  of  the  salivary  glands.  This  statement  is  supported 
by  the  concurrent  testimony  of  Herzenstein,  Wolferz,  and  by 
Demtschenko,  but  Eeich  has  not  been  able  to  satisfy  himself 
of  its  correctness. 

In  regard  to  the  action  of  the  nervous  system  upon  the 
lacrimal  gland,  it  may  be  remarked  that  Hoppe-Seyler 
(though  I  know  not  whether  upon  his  own  authority  or  not) 
states  that,  on  excitation  of  the  trigeminus,  transparent 
tears  are  secreted,  whilst  on  stimulation  of  the  sympathetic 
the  lacrimal  secretion  is  cloudy  and  alkaline. 

Whatever  doubts  there  may  be  on  this  point,  there  can  be 
none  that  the  glands  can  be  stimulated  to  activity  in  a  reflex 
manner  by  various  stimuli  acting  through  different  channels  ; 
and  it  would  appear  that  all  stimuli  act  more  energetically 
in  young  animals  than  in  old.  The  shedding  of  tears  from 
emotional  causes,  so  common  in  the  young,  is  rare  and  feeble 
in  advanced  age.  The  usual  causes  by  which  the  glands  are 
rendered  active  are  undoubtedly  of  a  reflex  nature ;  and  that 
which  is  usually  in  operation  during  the  waking  state,  as 
Landois  observes,  is  a  constant  stimulation  of  the  an¬ 
terior  surface  of  the  bulbus  oculi,  owing  to  the  contact  of 
cold  air,  incipient  dryness  caused  by  evaporation  from  the 
surface  of  the  cornea,  and  the  contact  and  irritation  of 
minute  and  hardly  perceptible  particles  of  dust  or  of  other 
material  floating  in  the  air.  During  sleep,  these  sources  of 
irritation  are  obviated  by  the  closure  of  the  lids,  and  the 
discharge  of  tears  diminishes.  If,  however,  any  foreign  body, 
as  a  particle  of  coke  from  a  furnace,  or  an  insect,  becomes 
embedded  in  or  attached  to  the  cornea,  or  lodged  beneath 
theupperlid,  secretion  is  stimulated,  not  only  of  the  lacrimal, 
but  of  the  mucous  glands  of  the  conjunctiva,  even  during 
sleep ;  and  on  waking,  the  lids  are  found  to  be  firmly  glued 
together  by  the  dried  or  inspissated  secretion.  Certain 
gases  and  vapours,  as  BrCl  and  triethylboron,  B(C2H5)3,  and 
mustard,  provoke  a  discharge  of  tears.  The  flow  of  tears 
may  be  excited  reflectorially  by  stimulating  the  branches 
of  the  fifth  distributed  to  the  Schneiderian  membrane  of 
the  nose,  a  copious  flow  being  readily  produced  by  tickling 
the  inner  surface  of  the  nostrils  with  a  feather ;  and  most 
persons  must  be  aware  that  when  the  irritability  of  the 
nerve  is  heightened  by  a  catarrh,  the  act  of  shaving  will 
cause  free  discharge  of  tears. 


Another  channel  of  reflex  irritation  is  through  the  optic 
nerve ;  and  sudden  exposure  to  a  bright  light,  after  long 
sojourn  in  darkness,  causes  an  abundant  flow  of  tears. 
This  channel  becomes  hypersesthetic  in  certain  forms  of  dis¬ 
ease,  especially  in  those  attacks  of  inflammation  of  the  con¬ 
junctiva  which  were  formerly  called  strumous,  but  which 
are  now  termed  phlyctenular.  In  such  cases  the  intolerance 
of  light  exhibited  by  the  patient  is  often  extreme ;  and  if 
the  child  (for  the  patient  is  usually  young)  is  drawn  away 
from  some  dark  corner  where  he  lies  with  his  head  buried 
in  his  hands,  or  from  his  mother’s  Jap,  and  the  eyelids  are 
forcibly  separated,  a  very  abundant  flow  of  tears  takes 
place,  attended,  apparently,  by  more  or  less  pain.  A  remark¬ 
able  experiment  recently  performed  by  MM.  Yulpian  and 
Journiac(c)  shows  that  the  stimulation  of  the  tympanic 
cavity  by  means  of  a  faradaic  current,  in  Eabbits  under  the 
influence  of  curare,  caused  not  only  activity  of  the  lacrimal 
glands,  but  also  of  the  Harderian  gland,  for  there  was  art 
increased  secretion  of  tears,  and  simultaneously  a  milky 
fluid  welled  up  from  the  inner  angle  of  the  eye.  When 
examined  with  the  microscope,  the  secretion  appeared  as  a 
colourless  fluid,  containing  a  large  number  of  fat-drops. 

The  excitation  of  any  nerve,  if  carried  to  the  point  of' 
producing  pain,  appears  to  be  capable  of  causing  a  flow  of 
tears. 

An  increased  flow  of  blood  through  the  cerebral  vessels 
readily  augments  the  secretion  of  tears.  It  is  seen,  for 
example,  in  loud  and  prolonged  laughter,  or  in  silent  and 
suppressed  laughter,  both  of  which  interfere  with  the  respi¬ 
ratory  acts.  It  is  seen  also  in  the  congestion  of  the  head 
consequent  on  coughing  and  sneezing. 

There  is  yet  one  more  method  by  which  the  secretion  of 
tears  may  be  stimulated — namely,  by  the  subcutaneous  in¬ 
jection  of  certain  drugs,  such,  for  example,  as  pilocarpine. 
This  substance  is  known  to  have  a  powerful  influence  in 
augmenting  the  secretions  of  the  sweat  and  other  glands, 
and  Eeichel(d)  has  recently  employed  it  with  great  advan¬ 
tage  in  his  efforts  to  follow  the  histological  changes  that 
take  place  in  the  lacrimal  gland  of  Dogs  before  and  after 
active  secretion. 

EeicheFs  observations  were  made  under  the  supervision 
of  Heidenhain,  at  Breslau.  He  at  first  attempted  to  apply 
an  electrical  stimulus  to  the  lacrimal  nerve  of  one  side,  and, 
after  thus  exciting  secretion,  to  compare  the  two  glands. 
He  found,  however,  that  in  the  Dog  the  operation  necessary 
to  expose  the  lacrimal  nerve  was  too  severe,  and  too  much 
damage  was  done  to  permit  any  trustworthy  conclusions  tO' 
be  drawn.  He  therefore  adopteda  different  plan.  He  first 
extirpated  the  gland  on  one  side,  and  from  this  gland  con¬ 
trol  preparations  were  made,  after  hardening,  by  section  and 
by  teasing  out  the  parts  with  needles  under  the  microscope. 

He  describes  the  structure  of  the  lacrimal  glands  in  terms: 
similar  to  those  I  gave  in  my  last  lecture,  and  regards  them 
as  belonging  to  the  group  of  acinous  glands,  the  several 
acini  being  separated  from  each  other  by  tolerably  well- 
developed  connective  tissue,  and  filled  with  irregularly 
formed  cells,  which  are  for  the  most  part  provided  with  a 
process  at  their  base.  Every  cell  contains  a  distinct  and 
well-defined  nucleus.  Eeichel’s  sections  were  made  with 
a  microtome,  were  coloured  with  picrocarmine,  and  then 
rendered  transparent  with  glycerine.  It  was  then  seen? 
that  in  the  inactive  gland  each  cell  was  well  defined  and 
distinctly  separated  from  the  adjoining  ones.  Some  were- 
columnar,  some  conical,  and  they  were  only  slightly  gra¬ 
nular.  The  nuclei  of  the  cells  in  the  inactive  or  quiescent 
gland  were  situated  nearer  to  the  base  than  to  the  apex,  and 
coloured  strongly  with  carmine.  Their  form  was  irregular, 
and  they  were  either  smooth,  slightly  toothed,  or  angular  on 
the  surface.  The  active  or  excited  gland,  on  the  other  hand, 
presented  a  very  different  appearance,  for  when  removed 
some  time  after  the  injection  of  the  pilocarpine,  the  first 
aspect  of  the  sections  showed  that  they  were  very  much 
darker.  The  protoplasm  of  the  cells  was  strongly  granular 
and  clouded  with  albuminates.  The  cell  boundaries  were 
much  less  distinctly  marked,  and  were  only  recognisable- 
with  care  as  fine  lines  ;  and  from  this  circumstance,  as  well 
as  in  consequence  of  the  more  close  approximation  of  the- 
nuclei,  the  appearance  of  a  multiplication  of  the  nuclei  was 
often  presented.  The  nuclei  had  also  changed  their  form, 

(c)  Comptes-Rendus,  t.  lxxxix.,  page  393  ;  and  Hofmann  and  Schwalbe, 
Jahresbericht,  1880. 

(d)  Schultze’s  Archiv,  1880,  Band  xvii.,  S.  12. 


Medical  Times  and  Gazette. 


THE  INTERCOLONIAL  MEDICAL  CONGRESS. 


Nov.  3,  1883.  511 


and,  instead  of  being  polygonal,  were  perfectly  spherical. 
The  changes  in  the  lacrimal  gland,  therefore,  which  result 
from  stimulation  are  closely  analogous  to  those  of  the  parotid 
gland. 

f To  be  continued.) 


REPOET  OF  THE  DELEGATES 

OF  THE 

ROYAL  COLLEGE  OF  PHYSICIANS  OF  LONDON 

ON  THE 

INTERCOLONIAL  MEDICAL  CONGRESS, 

Held  at  Amsterdam,  on  Sept.  6,  7,  and  8,  1883. 

By  DYCE  DUCKWORTH,  M.D.,  F.R.C.P.;  and 
JOSEPH  EWART,  M.D.,  F.R.C.P. 

The  Congress  was  opened  on  September  6  by  Prof.  Stokvis, 
the  President,  who  delivered  an  able  address.  In  the  after¬ 
noon  the  following  papers  were  read: — (1)  “Hygiene  des 
Professions,  Cultures  et  Metiers  insalubres  dansles  Colonies/* 
du  Dr.  J.  J.  Da  Silva  Amado,  Professeur  d’Hygiene  a  l’Ecole 
Medicale  de  Lisbonne  ;  (2)  “  Sur  la  Colonisation  Europeenne 
-dans  les  Pays  chauds,”  du  Dr.  G.  Van  Overbeek  de  Meijer, 
Professeur  a  l’Universite  d’ Utrecht;  (3)  “  Acclimatement  et 
Acclimatation,”  du  Dr.  H.  Rey,  Medecin  Principal  de  la 
Marine  Framjaise  a  Toulon.  In  the  discussion  which  fol¬ 
lowed,  Sir  Joseph  Fayrer  expressed  his  concurrence  with 
the  authors  of  the  papers,  as  regai’ds  the  impossibility  of 
colonising  the  plains  of  tropical  countries  by  Europeans. 
Surgeon-Major  Uewis,  of  Netley,  expressed  similar  views, 
and  remarked  that  Europeans  degenerate  in  a  tropical 
climate,  even  when  advantage  is  largely  taken  of  the  hills. 
During  something  like  twenty  years  the  orphan  children  of 
soldiers  in  India  have  been  most  carefully  brought  up  in  special 
asylums  at  elevations  varying  from  3000  to  6000  feet ;  and 
yet  the  moi’tality,  even  under  these  favourable  circumstances, 
has  been  just  double  what  it  is  in  England  amongst  children 
-of  the  same  ages. 

On  the  7th,  in  the  forenoon,  papers  were  read  in  the 
Sections  of  Climatology,  Medical  Geography,  General  Patho¬ 
logy,  and  Hygiene— (1)  “  De  la  Phthisie  dans  les  Colonies 
et  Climats  tropicaux,”  du  Dr.  B.  Carsten ;  (2)  “  Sur  le  mode 
de  Drainage  du  Sol  par  PEucalyptus,”  du  Dr.  Bonnafont, 
Paris  ;  (3)  “  Sur  le  Transport  des  Malades  et  des  Blesses  pas 
les  Voies  ferrees  dans  les  Climats  tropicaux,”  du  Dr.  M.  W.  C. 
Gori,  Professeur  agrege  a  l’Universite  d’Amsterdam ;  (4) “  Sur 
la  Contagion  de  la  Lepre,”  du  Dr.  Chs.  Landre,  a  Bruxelles  ; 
■(5)  “  Sur  r<de  des  Microbes  dans  le  formation  des  Organ- 
ismes  vivants,”  du  Dr.  Van  der  Heyde,  Chef  de  l’Hopital 
et  de  l’Ecole  Medicale  a  Kobe  (Japan). 

In  the  Section  of  Pathology  and  Special  Therapeutics 
papers  were  read— (1)  a.  “  On  the  Management  of  Malarial 
Poisoning  and  Prolonged  Exposure  to  Tropical  Heat**; 
b.  “ Congestion  of  the  Liver*’;  c.  “Abscess  of  the  Liver”; 
d.  “  Malarious  or  Tropical  Anaemia  **;  e.  “  Pernicious 
Anaemia **;  /.  “The  Consequences  of  Coup  de  Soleil  and 
Thermic  Fever  in  Persons  who  have  returned  to  Europe 
after  a  protracted  residence  in  India  or  other  Hot  Climates,” 
by  Sir  Joseph  Fayrer,  K.C.S.I.,  and  Dr.  Joseph  Ewart; 
(2)  “On  the  Treatment  of  Chronic  Dysentery  and  Diarrhoea 
in  those  who  have  returned  to  Europe  after  a  sojourn  in  Hot 
Countries,”  by  Dr.  A.  Le  Roy  de  Mericourt,  of  Paris,  and 
Dr.  A.  Corre,  of  Brest ;  (3)  “  The  Treatment  of  Malarious 
Fevers  by  Subcutaneous  Injection  of  Quinine,”  by  Brigade- 
Surgeon  Scriven. 

In  the  discussion,  Prof.  Stokvis  stated  that  he  preferred  a 
solution  of  quinine  prepared  with  hydrobromic  acid,  and  Dr. 
Dyce  Duckworth  said  that  he  had  recommended  such  a 
preparation  for  use  to  the  medical  officers  of  an  Indian 
railway  with  which  he  is  officially  connected.  Bismuth  often 
failed  to  yield  good  results  in  chronic  diarrhoea  because 
given  in  too  small  doses.  He  recommended  doses  of  thirty 
grains.  Prof.  Stokvis  believed  that  bismuth  exerted  but  a 
topical  soothing  action,  and,  in  view  of  its  costliness,  thought 
that  some  cheaper  and  equally  efficient  substitute  might  be 
found.  With  regard  to  enlargement  of  the  liver  from 
malaria  and  congestion.  Dr.  Duckworth  had  obtained  ex¬ 
cellent  results  from  the  administration  of  large  doses  of 


muriate  of  ammonia.  Sir  Joseph  Fayrer  recommended,  for 
the  treatment  of  chronic  diarrhcea,  a  pure  milk  diet,  with 
or  without  lime-water,  and  repeated,  as  to  quantity  and 
strength,  according  to  the  digestive  and  assimilating  power 
of  the  patient. 

In  the  afternoon,  papers  were  read  in  the  General  Section 
on  the  subject  of  Quarantine — (1)  by  Prof,  de  Chaumont; 
(2)  Dr.  F.  J.  Van  Leent,  Chief  Medical  Officer  of  Nether¬ 
lands  Marine  ;  (3)  Mons.  M.  J.  A.  Ivruyt,  of  Djeddah. 

On  these  papers  a  very  lively  and  somewhat  excited  dis¬ 
cussion  ensued.  The  authors  of  the  two  last  papers,  Prof. 
Amado,  of  Lisbon,  and  M.  de  Mericourt,  of  Paris,  spoke 
warmly  in  favour  of  quarantine  as  a  protective  measure ; 
whilst  M.  Boissevain  characterised  the  system  as  a  “  tyranny 
tempered  by  backsheesh.”  The  author  of  the  first  paper, 
Surgeon-Major  Timothy  Lewis,  Dr.  Joseph  Ewart,  and,  on 
the  following  day.  Sir  Joseph  Fayrer,  were  equally  em¬ 
phatic  in  their  condemnation  of  it.  The  collective  experience 
of  the  three  last-named  speakers  of  cholera  in  India,  both 
in  its  endemic  and  epidemic  forms,  went  to  show  that  the 
malady  was  not  contagious,  and  that,  therefore,  quarantine 
was  not  only  useless,  but  vexatious,  cruel,  and  injurious. 

Surgeon-Major  T.  R.  Lewis,  Assistant  Professor  of  Patho¬ 
logy,  Army  Medical  School,  Netley,  spoke  as  follows  : — It 
is  now  just  fifteen  years  since  the  British  and  Indian  Govern¬ 
ments  honoured  Dr.  Douglas  Cunningham  and  myself  by 
sending  us  to  India  for  the  purpose  of  inquiring  into  certain 
views  regarding  the  causation  of  cholera,  which  were  then 
widely  entertained.  The  results  of  these  investigations 
were  published  from  time  to  time  in  the  Annual  Reports  of 
the  Sanitary  Commissioner  with  the  Government  of  India. 
Whilst  listening  to  the  remarks  which  have  been  made  during 
this  discussion,  I  have  been  struck  with  the  unqualified 
character  of  some  of  the  assertions  regarding  the  contagious 
character  of  cholera.  It  has  been  assumed  that  it  is  readily 
communicable  from  one  man  to  another,  and  that  the  arrival 
of  a  cholera-affected  person  in  any  district,  or  of  a  person 
who  has  recently  been  in  contact  with  the  disease,  is  suffi¬ 
cient  to  give  rise  to  a  widespread  outbreak.  I  do  not  for  a 
moment  find  fault  with  these  speakers  for  entertaining  such 
an  opinion — they  were  but  giving  expression  to  a  very  gene¬ 
rally  accepted  doctrine ;  but  I  beg  leaye  to  be  permitted  to 
record  my  dissent  from  any  such  view.  My  former  colleague. 
Dr.  Cunningham,  and  myself  have  had  considerable  experi¬ 
ence  in  investigating  localised  outbreaks  of  the  disease,  but 
in  no  single  instance  have  we  been  able  to  satisfy  ourselves 
that  ft  was  spread  from  man  to  man.  Until  very  recently 
all  the  most  important  data  regarding  cholera  which  were 
collected  in  British  India  passed  through  my  hands  ;  and  I 
recollect  that,  every  now  and  then,  instances  were  recorded 
which,  atfirst  sight,  seemed  tosupport  such  aconclusion.  The 
evidence  in  these  instances  was  carefully  sifted,  and  I  have 
often  endeavoured  to  find  the  missing  links  which  were  re¬ 
quired  to  complete  the  chain,  but  always  in  vain.  I  am  wel 
aware  that  some  of  the  instances  which  have  been  recorded  in 
Eui’ope  are  exceedingly  puzzling.  These  instances  are  few, 
and  are  known  to  you  all ;  but  even  of  these  it  can  scarcely 
be  said  that  they  have  stood  the  critical  analysis  of  the  re¬ 
nowned  Professor  of  Hygiene  at  Munich,  Prof.  Max  von 
Pettenkofer.  Before  accepting,  therefore,  even  these,  so  to 
speak,  classical  illustrations,  I  -would  urge  upon  you  to  stxxdy 
von  Pettenkofer’s  most  able  papers.  As  already  remarked, 
instances  of  the  supposed  communicability  of  the  disease 
have  been  referred  to  in  this  debate,  but  no  notice  has  been 
taken  of  persons  or  places  which  have  escaped.  When  a 
question  lias  to  be  decided  on  evidence  alone,  both  sides 
have  to  be  considered.  Time  will  not  admit  of  my  entering 
at  any  length  into  this  phase  of  the  subject ;  but  I  should 
like  to  be  allowed  to  refer  to  one  or  two  instances  of  exemp¬ 
tion  from  attack  under  circumstances  exceptionally  favour¬ 
able  so  far  as  contagium  is  concei’ned.  There  are  in  Calcutta 
two  very  large  medical  institutions — the  College  Hospital 
and  the  General  Hospital ;  and  for  many  years  it  was  the 
custom  to  treat  the  numei’ous  cholera  patients  in  each  of 
these  hospitals  in  the  same  building  as  the  other  patients. 
Sir  Josepli  Fayrer  and  Dr.  Ewart,  who  are  now  present,  will 
bear  me  out  when  I  say  that,  during  all  the  years  in  which 
they  were  officially  connected  with  those  institutions,  no  evil 
results  coxxld  be  referred  to  this  custom.  As  regards  the 
General  Hospital,  I  may  mention  that  it  consists  of  three 
buildings,  and  that,  although  until  l’ecently  it  was  the 
custom  to  admit  all  cholera  cases  into  the  central  block. 


THE  INTERCOLONIAL  MEDICAL  CONGRESS.  Nov.3,i883. 


OLu  Medical  Times  a^d  Gazette. 

there  was  not  the  slightest  suspicion  that  any  evil  resulted 
to  the, other  patients  in  it.  It  so  happened  that  all  three 
blocks! had  for  many  years  been  remarkably  exempt  from 
outbreaks  of  cholera.  A  few  years  ago,  however,  several 
cases  occurred  in  two  out  of  the  three  buildings,  but,  strange 
to  say,  it  was  the  central  block  which  escaped.  Again,  as 
an  instance  of  places  which  have  escaped  outbreaks  of  the 
disease,  notwithstanding  frequent  and  early  intercourse  with 
affected  localities,  the  history  of  the  convict  settlement  at 
the  Andaman  Islands,  in  the  Bay  of  Bengal,  may  be  cited. 
This  settlement  is  about  three  or  four  days  by  steamer 
from  Calcutta,  a  city  from  which  cholera  is  never  absent ; 
and  during  the  last  twenty-five  years  the  convicts  for 
transportation  have  been  collected  in  Calcutta  from  all  parts 
of  India,  and,  at  intervals  of  a  few  weeks,  taken  on  to  the 
Andamans.  Nearly  all  the  food  of  the  convicts,  numbering 
about  ten  thousand,  is  likewise  taken  from  Calcutta :  con¬ 
sequently  there  must  have  been  very  free  intercourse  between 
the  two  places  ;  yet,  notwithstanding  all  this,  there  has  not 
been  a  single  outbreak  of  cholera  in  the  settlement.  Had 
the  Government  adopted  a  strict  system  of  quarantine 
during  this  long  period,  the  instance  might,  with  some  show 
of  reason,  have  been  cited  as  an  illustration  of  the  efficacy 
of  quarantine  in  the  protection  of  a  colony ;  but  the  history 
having  been  what  I  have  narrated,  I  can  hardly  imagine 
that  the  most  ardent  advocate  of  the  measure  will  find  fault 
with  the  authorities  for  not  having  adopted  it.  Indeed,  I 
can  hardly  imagine — seeing  that  for  the  last  quarter  of  a 
century  this  great,  so  to  speak,  unplanned  experiment  has 
proved  almost  beyond  dispute  that,  at  least  for  all  practical 
purposes,  cholera  may  be  looked  upon  as  a  non- transportable 
disease— I  can  hardly  imagine  that,  as  regards  the  future, 
they  would  advocate  that  these  convicts  (many  of  them  in 
fetters)  should  be  kept  in  a  crowded  ship  outside  the  harbour 
in  the  fierce  heat  of  a  tropical  sun,  and  this  in  order  that 
they  should  undergo  the  “  regulation  ”  number  of  days 
before  landing,  because  they  have  come  from  an  affected 
place.  As  regards  this  question  of  quarantine  and  cholera, 
the  experience  which  has  been  gained  in  India  is  strongly 
corroborative  of  the  conclusion  which  Prof,  de  Chaumont 
has  arrived  at,  and  which  he  has  so  ably  defended  in  the 
important  paper  just  read  at  this  meeting.  I  warmly  second 
his  recommendation,  that  this  Congress  should  not  lend 
its  support  to  the  introduction  of  any  restrictions  which 
would  so  seriously  interfere  with  personal  liberty,  and  be 
liable  to  be  so  carried  into  effect  as  to  inflict  the  greatest 
hardship,  and  even  cruelty,  on  wholly  innocent  persons. 
It  has  frequently  been  declared  that  the  British  Govern¬ 
ment  objects  to  quarantine  solely  on  mercenary  grounds. 
I  venture  to  think,  however,  that  I  have  shown  that  it 
has  at  least  some  other  reason  for  the  attitude  which  it  has 
assumed  in  this  matter.  The  fact  that  cholera  quarantine 
is  not  only  discountenanced,  but  actually  forbidden  in 
British  India,  shows  that  the  Government  of  that  country  has 
no  faith  in  its  usefulness  ;  and  no  one  will  accuse  it  of  being 
unmindful  of  the  lives  of  its  own  people,  whatever  may  be 
said  of  its  avarice.  The  practice  in  India  is  not  to  establish 
quarantine  cordons,  but  just  the  reverse.  Immediately  on 
the  appearance  of  cholera  the  troops  are  dispersed,  and  en¬ 
camped  on  carefully  selected  sites  away  from  the  locality 
where  the  disease  prevails';  and,  if  necessary,  these  camps 
are  shifted  again  and  again  until  the  disease  disappears. 
This  practice  has  been  followed  by  the  most  marked  success, 
and  it  has  never  been  found  that  these  camping  grounds 
acted  as  foci  for  the  dissemination  of  the  disease.  The  history 
of  the  recent  outbreak  in  Egypt  coincides  in  a  remarkable 
manner  with  what  is  ordinarily  observed  in  India,  though  it 
was  at  first  very  generally  and  very  dogmatically  asserted 
that  the  disease  had  been  brought  by  ships  from  that 
country.  But  what,  so  far  as  is  known,  was  the  history  of 
this  outbreak  ?  Instead  of  breaking  out  at  Suez,  the  place 
in  Egypt  most  generally  frequented  by  Europeans  from 
India,  or  along  the  course  of  the  Suez  Canal,  where  our 
troops,  both  European  and  native,  had  been  congregated, 
it  broke  out  at  Damietta,  a  port  at  which  neither  the  Penin¬ 
sular  and  Oriental  nor  any  other  of  the  ordinary  steamers 
from  India  ever  call.  If  the  disease  had  been  carried  into 
Egypt,  why  was  it  that  it  did  not  start  at  Suez,  Ismailia,  or 
Port  Said,  seeing  that,  as  was  demonstrated  by  after  events, 
there  was  nothing  in  any  of  these  places  inimical  to  the 
occurrence  of  the  disease  among  their  inhabitants  ?  Bear¬ 
ing  all  these  great  facts  in  mind,  I  would  strongly  urge 


upon  the  members  of  this  Congress  the  absolute  necessity 
of  studying  the  question  afresh,  each  one  for  himself,  ancf 
not  remaining  content  to  accept  any  doctrine  as  regards  the 
cause  of  cholera  merely  because  it  may  be  advocated  by  this 
authority  or  by  that.  I  would  not  for  a  moment  have  you 
think  that  I  undervalue  the  labours  of  the  acknowledged 
leaders  of  thought  in  this  matter,  and  I  am  quite  sure  that 
were  the  great  sanitary  authority  of  modern  times,  my  revered 
teacher,  the  late  Dr.  Parkes,  amongst  us,  he,  notwithstand¬ 
ing  his  well-known  extreme  consideration  for  his  co-workers 
and  his  predilection  for  the  opinions  which  are  at  present 
the  most  popular,  even  he  would  be  amongst  the  warmest 
advocates  of  renewed  independent  research  and  of  further 
observation  in  this  matter.  I  would  not  for  a  moment  sug¬ 
gest  that  the  search  for  a  poison  or  germ  of  cholera  should 
cease.  On  the  contrary,  I  would  have  it  carried  to  its  utmost 
limit ;  but,  so  far  as  my  own  observations  have  gone,  I  feel 
bound,  on  an  occasion  like  this,  to  state  that  I  have  not  been 
able  to  collect  any  series  of  facts  in  support  of  the  existence 
of  a  transportable  cholera-poison  of  any  kind,  nor  have  I 
been  able  to  satisfy  myself  that  anyone  else  has  done  so ; 
consequently  it  is,  in  my  opinion,  wholly  illogical  to  frame 
stringent  quarantine  regulations  for  the  purpose  of  keeping 
out  an  entity  which  as  yet  has  not  been  proved  to  exist. 
What  the  essential  cause  of  cholera  may  be,  does  not  fall 
within  the  scope  of  the  present  discussion.  Were  it  so,  I 
venture  to  predict  that  the  sum  and  substance  of  the  remarks 
of  every  speaker  who  had  honestly  studied  the  subject  for 
himself  would  be :  “  I  do  not  know/’ 

Dr.  Joseph  Ewart  said  that,  a  few  months  after  his  arrival 
in  Bengal,  in  1854,  he  was  called  upon  to  deal  with  an  out¬ 
break  of  cholera  at  Barrackpore,  and  later  on,  in  the  same 
year,  at  Dinapore.  Belying  on  the  teaching  of  the  schools 
and  the  standard  works  of  the  day,  he  was  imbued  with 
the  view  that  it  was  highly  contagious.  He  was,  however, 
soon  undeceived.  The  hospital  attendants  and  the  fellow- 
countrymen  of  the  patients  laboured  under  no  such  delu¬ 
sion.  They  nursed  and  waited  upon  the  sick  with  perfect 
impunity.  He  next  saw  the  disease  at  Ajmeer,  Bajputana, 
in  1856.  This  outbreak  was  an  offshoot  of  a  wide-spread 
and  virulent  epidemic  which  affected  most  of  the  important 
towns  of  the  North-Western  Provinces.  Being  still  somewhat 
under  the  dominion  of  the  precepts  inculcated  in  the  London 
schools,  he  recommended  the  adoption  of  quarantine.  The 
advice  was  promptly  acted  upon ;  but  it  soon  became  ap¬ 
parent  that  the  measure  so  intensified  the  scourge  that 
cases  were  admitted  into  hospital  from  all  parts  of  the 
prison,  with  the  exception  of  that  set  apart  for  female  con¬ 
victs.  On  the  realisation  of  this  state  of  affairs,  no  time 
was  lost  in  having  the  prisoners  removed  to  a  series  of  well- 
ventilated  temporary  huts,  situated  two  or  three  miles  to 
windward  of  the  gaol,  on  a  ridge  admitting  of  perfect 
drainage,  and  possessing  every  facility  for  the  maintenance 
of  all  needful  hygienic  and  sanitary  precautions.  The  re¬ 
sult  was  most  satisfactory.  No  fresh  cases  occurred  in  camp, 
and,  as  the  deserted  cells  were  cleansed  and  lime-washed, 
the  epidemic  did  not  extend  to  the  female  department. 
Here,  again,  there  was  no  evidence  to  show  that  the  disease 
was  propagated  by  contagion  or  infection.  Further  experi¬ 
ence  of  cholera  was  gained  at  the  Medical  College  and 
General  Hospitals  at  Calcutta,  between  1863  and  1876,  where 
it  was  constantly  to  be  observed  both  in  its  mildest  and  in  its 
severest  forms.  At  these  institutions,  where  a  great  number 
of  students,  a  full  professional  staff  of  physicians  and  their 
assistants,  nurses,  and  other  attendants,  were  almost  daily 
brought  into  direct  association  with  cholera,  it  was  never 
found  to  prevail  among  them  disproportionately,  or  more 
frequently  than  among  a  corresponding  group  of  the  general 
ponulation.  A  noteworthy  fact  was  also  observed,  viz.,  that 
a  similar  immunity  was  enjoyed  by  the  sweepers  whose  duty 
it  was  to  remove  the  discharges,  and  by  those  persons  who 
washed  the  bed -linen  and  personal  clothing  of  the  patients. 
Such  facts  as  these  have  convinced  most  experienced  phy¬ 
sicians  practising  in  India  that  the  malady  is  not  infectious, 
contagious,  or  catching  from  person  to  person.  Quarantine 
is  therefore  unnecessary,  and  may  prove  very  disastrous  to 
the  individuals  included  within  the  cordon,  as  it  did  in  the 
case  of  the  Ajmeer  Gaol  already  cited.  Those  who  advocate 
quarantine  would  do  well  to  note  the  extreme  difficulty  expe¬ 
rienced  in  completely  isolating  even  a  single  person  pros¬ 
trated  by  disease,  indeed,  when  the  matter  is  carefully 
weighed  in  all  its  bearings,  or  threshed  out,  it  will  be  found 


Medical  Times  and  Gazette. 


THE  INTERCOLONIAL  MEDICAL  CONGRESS 


Nov.  3,  1383.  5  1  3 


to  be  all  but,  if  not  altogether,  impossible.  If  this  be  so, 
how  much  more  impracticable  must  it  be  to  quarantine,  with 
anything  approaching  perfection,  ships  belonging  to  the  navy 
or  to  the  mercantile  marine,  or  a  community  on  land  ?  It  has 
been  stated  that  the  practice  of  removing  troops  in  India  from 
an  affected  to  an  unaffected  locality  is  only  a  modification  of 
quarantine.  But  a  little  consideration  will  suffice  to  show 
that  such  a  notion  is  quite  erroneous.  This  method  of  dealing 
with  cholera  is  simply  the  substitution  of  a  non-epidemic  for 
an  epidemic  area— of  a  healthy  for  an  unhealthy  locality — 
where  the  principles  of  hygienic  and  sanitary  science  can  be 
promotedand  developed  to  the  utmost  extent,  with  the  happy 
result  of  almost  invariably  stopping  the  dissemination  of  the 
disease.  What  is  done  is  to  place  the  sick  and  as  many  of 
the  unaffected  as  possible  in  the  most  favourable  condition 
for  recovery  or  escape  from  attack,  and  to  carry  out  all  mea¬ 
sures  necessary  for  the  maintenance  of  the  strictest  cleanli¬ 
ness  in  all  things.  Quarantine,  which  at  the  best  is  only  a 
poor  apology  for  bad  sanitation,  is  in  no  way  attempted,  be¬ 
cause  experience  in  India,  as  recently  in  Egypt,  has  proved 
it  to  be  as  useless  and  unnecessary  as  it  is  injurious,  cruel, 
and  impossible.  Epidemic  cholera  spreads  somewhat  like 
dengue  or  influenza.  Dengue  is  endemic  in  Calcutta,  but 
occasionally  it  prevails  as  an  epidemic.  When  this  happens, 
as  in  1872,  it  invades  in  a  few  weeks  almost  three-fourths  of 
the  population.  What  the  factor  may  be,  the  absence  of 
which  at  one  time  tends  to  minimise  the  disease  into  an  in¬ 
significant  endemic,  and  the  presence  of  which,  at  another 
period,  exaggerates  it  into  a  widespread  and  disabling  epi¬ 
demic,  we,  it  must  be  candidly  confessed,  do  not  know. 
Neither  do  we  know  anything  very  definite  about  the  influ¬ 
ence  which,  at  certain  seasons,  may  with  fatal  effect  lay 
prostrate  with  influenza  many  members  of  the  community. 
•So  it  is  with  cholera.  We  may  infer  from  its  behaviour 
that  its  diffusion  is  favoured  by  some  powerful  factor  or 
influence,  of  the  nature  of  which  we  are  in  complete 
ignorance,  often  operating,  at  particular  seasons,  with 
great  and  mortal  rapidity,  upon  persons  inhabiting  certain 
areas  of  country.  It  would  therefore  be  about  as  reason¬ 
able  to  attempt  to  quarantine  cholera,  dengue,  or  influenza, 
as  it  would  be  to  quarantine  the  east  wind.  As  regards  the 
uselessness  of  quarantine,  Dr.  Ewart  was  in  full  accord 
with  the  views  enunciated  by  Prof,  de  Chaumont.  and  Dr. 
Lewis.  He  had,  when  at  the  head  of  the  Calcutta  General 
Hospital,  supplied  Drs.  Lewis  and  Cunningham  with  the 
material  for  their  inquiry  into  the  causes  of  cholera.  He 
had  watched  the  progress  of  the  investigation  with  intense 
interest.  These  gentlemen  were  in  direct  contact  with  the 
cholera  discharges  in  their  workroom— often  in  their  private 
apartments — in  all  stages  of  metamorphosis  and  decay ; 
and  that  they  did  all  this  with  complete  impunity  is,  as  far 
us  it  goes — and  it  must  be  admitted  to  go  a  long  way, — in 
favour  of  the  non- contagiousness  of  the  malady.  He  had 
restricted  his  remarks  to  a  plain  statement  of  facts  derived 
from  long  acquaintance  with  endemic  and  epidemic  cholera. 
His  experience,  he  had  good  reason  to  believe,  is  that  of 
most  physicians  in  India,  who  have  seen  the  malady  and 
formed  an  independent  judgment  on  the  question.  It  has 
•been  confirmed  by  what  has  happened  in  Egypt.  He  would, 
in  conclusion,  beg  the  meeting,  constituted  as  it  was  of 
many  distinguished  men  from  different  parts  of  Europe,  to 
pause  before  it  gave  its  sanction  to  quarantine,  or  opposed 
the  enlightened  views  of  Prof,  de  Chaumont,  who,  in  his 
able,  learned,  and  thoughtful  paper,  has  produced  abundant 
evidence  to  convince  the  most  sceptical  that  this  is  cer¬ 
tainly  not  the  way  to  prevent  or  mitigate  the  diffusion  of 
-cholera  with  the  desired  amount  of  success. 

Sir  Joseph  Fayrer  said,  in  continuing  the  discussion  after 
flie  reading  of  Mons.  E.  M.  Van  Lier’s  paper,  “  Sur  la  Genese 
du  Cholera,”  that  he  spoke  with  much  hesitation  on  this 
subject,  but  he  felt  that  it  would  not  be  right  of  any  medical 
officer  who  had  some  twenty-four  years’  experience  in  deal¬ 
ing  with  cholera  to  withhold  communicating  it  on  an  occa¬ 
sion  like  the  present.  Notwithstanding  this  long  experience, 
he  felt  that  he  was  totally  and  absolutely  ignorant  of  the  cause 
of  the  disease.  He  fully  endorsed  all  that  had  been  said 
yesterday  by  Drs.  Lewis  and  Ewart  in  connexion  with  this 
subject.  He  had  himself  seen  hundreds  of  cases  of  sporadic 
and  of  epidemic  cholera,  but  had  seen  nothing  to  make  him 
think  that  there  was  anything  whatever  of  a  contagious 
character  in  connexion  with  the  disease.  He  was  well  aware 
•that  many  of  his  countrymen  thought  otherwise,  but  still 


he  felt  bound  to  make  his  own  confession  of  faith.  A  great 
deal  had  been  heard  of  a  cholera  germ  or  of  a  cholera  poison  ; 
but  neither  had  as  yet  been  discovered,  though  he  did  not 
for  a  moment  deny  that  it  may  exist.  Thus  far  it  is  merely  a 
matter  of  evidence.  The  question  of  quarantine  is  one  of  great 
importance,  and  in  Europe  it  practically  resolves  itself  into 
framing  regulations  for  dealing  with  cholera.  As  regards  the 
hygienic  measures  which  should  be  adopted  in  dealing  with 
the  drinking-water  and  so  forth,  he  would  advocate  their 
adoption  as  strongly  as  the  strictest  believer  in  germs  or  in 
special  water-poison  could  do,  but  he  did  not  do  this  because 
he  believed  that  a  specific  cholera  germ  exists,  but  because 
he  felt  sure  that,  during  a  season  when  cholera  influences 
were  abroad,  any  dietetic  irregularity,  such  as  partaking  of 
unripe  fruit,  or  the  indiscreet  administration  of  a  dose  of 
sulphate  of  magnesia,  might  suffice  to  determine  the  active 
development  of  the  disease.  As  regards  the  theory  pro¬ 
pounded  by  E.  M.  Yan  Lier,  that  cholera  was  due  to  some 
subterranean  volcanic  disturbances,  he  would  point  out  that, 
as  regards  the  parts  of  Bengal  where  the  disease  was  en¬ 
demic,  no  evidence  of  such  influences  had  ever  been  recorded, 
and  that  consequently  he  could  not  accept  the  view  that  had 
been  put  forth.  He  had,  however,  embraced  the  opportu¬ 
nity  which  this  paper  had  furnished  of  enabling  him 
to  continue  yesterday’s  debate  on  quarantine,  of  which, 
owing  to  the  lateness  of  the  hour,  he  could  not  then  avail 
himself. 

On  the  8  th,  in  the  Section  of  Climatology,  etc.  Prof.Norman 
Chevei'3’,  C.I.E.,  learned  paper  was  read,  in  absentia,  by 
Prof.  Stokvis.  It  dealt  with  the  modifications  of  infectious 
and  other  diseases  in  tropical  climates ;  embracing  a  con¬ 
sideration  of  scarlatina,  typhus,  enteric  fever,  and  relapsing 
fever,  filaria  sanguinis  hominis,  erysipelas,  acute  rheumatism, 
gout,  cancer,  struma,  rickets,  scorbutus,  bronchocele,  phthisis 
pulmonalis,  urinary  calculus,  lathyrism,  leprosy,  Delhi  boil, 
Aden  ulcer,  lichen  tropicus,  furunculus  of  the  rainy  season, 
Malabar  and  Burmah  itch.  Communications  to  the  Section 
were  made — (1)  “  Pourquoi  les  Fievres  dites  pernicieuses 
off  rent  plus  de  danger  dans  un  Climat  tropical  que  dans  un 
Climat  modere,”  du  Dr.  Bonnafont,  Paris;  (2)  “  Sur  modi¬ 
fications  apportees  a  la  Syphilis  par  les  Pays  chauds,”  du 
Dr.  Catrin,  d’ Alger ;  (8)  “  Sur  1’ Influence  pbysiologique  et 
therapeutique  du  Climat,”  du  Dr.  Jac.  Baart  de  la  Paqle,  a 
Leeuwarden;  and  (4)  “Sur  la  Genesh  du  Cholera,”  du  Dr. 

E.  M.  Van  Lier.  In  the  Section  on  Pathology,  etc.,  papers 
were  read — (1)  “  Sur  le  Beri-beri,”  du  Prof.  B.  Scheube,  a 
Leipsic  ;  (2)  “  Sur  Diabete  sucre,”  du  Dr.  F.  A.  Eklund,  a 
Stockholm  ;  (3)  "  Sur  quelques  Medicaments  indigenes  des 
Pays  tropicaux,”  du  Dr.  E.  Waring,  a  Londres;  (4)  “  Sur 
l’Elimination  du  Mercure,  introduit  dans  le  corps  par  la 
peau,”  du  Dr.  Schuster,  a  Aix-la-Chapelle. 

In  the  afternoon  the  proceedings  were  concluded  by  the 
reading  of  the  following  papers : — (1)  “  Sur  Education 
speciale  des  Medecins  des  Colonies,”  du  Dr.  Becking  ;  (2) 
another  on  the  same  subject  by  Dr.  Dyce  Duckworth, 
London  ;  and  one  by  Dr.  Catrin,  of  Algiers. 

In  drawing  up  this  imperfect  report  we  have  enumerated 
all  the  papers  in  the  order  in  which  they  were  presented 
and  read,  for  the  purpose  of  showing  the  nature  and  kind 
of  work  done.  We  have  only  referred  briefly  to  some  of  the 
discussions  which  have  ensued.  The  papers  and  the  discus-  • 
sions  will,  doubtless,  be  published  in  full  in  the  forthcoming 
Transactions  of  the  Congress — -the  first  of  its  kind  that  has 
been  held,  and  the  forerunner  of  others,  let  us  hope,  by  the 
medical  profession  of  other  colonial  powers. 

0  ur  mission  was  warmly  welcomed  on  account  of  the  dis¬ 
tinguished  body  who  had  deputed  us  to  attend  the  Congress, 
and  also  because  no  other  British  college  or  scientific  insti¬ 
tution  had  seized  the  opportunity  of  being  similarly  repre¬ 
sented.  This  fact  was  frequently  alluded  to  at  the  meetings, 
and  in  the  complimentary  speeches  and  toasts  at  the  banquets 
and  other  social  gatherings,  and  conspicuously  at  the  banquet 
given  to  the  leading  members  by  Sir  Joseph  Fayrer,  Drs. 
Lewis,  Cutts,  Jones,  Scriven,  and  ourselves. 

On  taking  leave  of  the  President  and  his  colleagues,  we 
most  cordially  thanked  them,  on  behalf  of  the  President 
and  Fellows  of  this  College,  for  the  attention  and  assistance 
which  they  had  rendered  us,  and  assured  them  that  we 
should  not  fail  to  notice  how  highly  and  sincerely  the  action 
and  sympathy  of  the  Royal  College  of  Physicians  had  been 
appreciated  by  the  President,  the  Committee  of  Organisation 
of  the  Congress,  and  the  civic  authorities  of  Amsterdam. 


514 


Medical  Times  and  Gazette. 


MEDICAL  AND  SURGICAL  PRACTICE. 


Nov.  3,  1S8S. 


REPORTS  OP 

HOSPITAL  PRACTICE  IN  MEDICINE 
AND  SURGERY. 

- « - 

ST.  BARTHOLOMEW’S  HOSPITAL. 


CASES  ILLUSTRATING  THE  TREATMENT  OF 
LUMBAR  ABSCESS  BY  FREE  INCISION. 

(Under  the  care  of  Mr.  THOMAS  SMITH.) 

Case  1. — Lumbar  Abscess — Partial  Evacuations — Free  Open¬ 
ing  up  of  Sinuses — Healing  ( from  below)  by  Granulation. 

[For  the  notes  of  this  case  we  are  indebted  to  the  courtesy  of  Mr.  Berrv, 

House-Surgeon .  ] 

Frederick  B.,  aged  nineteen,  admitted  December  16,  1S82. 

Previous  History. — He  had  enjoyed  good  health  previous 
to  the  present  illness,  which  began  about  three  weeks  ago, 
with  rigor  and  headache,  and  shooting  pain  in  the  left 
lumbar  region,  running  into  the  left  leg.  He  has  had  to  J 
keep  his  bed.  Six  years  ago  he  had  a  fall  downstairs  on  to  I 
his  back.  He  now  complains  of  pain  and  weakness  in  the 
back,  and  of  loss  of  power  over  his  left  leg. 

On  Admission,  he  was  found  to  have  what  appeared  to  be 
a  lumbar  abscess.  An  incision  was  made  into  it,  but  no  pus 
was  found.  Antiseptic  precautions  were  taken. 

December  20. — More  pain  in  both  hips,  with  numbness 
in  left  leg. 

21st. — Complains  only  of  pain  in  the  left  leg  ;  sleeps 
rather  badly.  Urine  charged  with  lithates;  contains  no 
albumen;  micturition  about  every  three  hours.  Tendon 
reflexes  all  normal. 

January  4,  1883. — Condition  has  varied  slightly  since  last 
note.  To-day  there  is  more  pain  in  the  back  and  left  leg ; 
it  prevents  his  sleeping.  His  temperature  reaches  103° 
nearly  every  night. 

18th. — Mr.  Smith  let  out  about  one  ounce  of  pus  from 
the  left  lumbar  region  with  an  aspirator. 

23rd. — The  opening  was  enlarged,  and  several  ounces  of 
pus  were  let  out. 

30th. — He  now  sleeps  fairly  well.  There  is  little  discharge. 
February  8. — With  a  view  to  a  freer  discharge,  drainage- 
tubes  were  inserted  into  two  openings ;  they  are  to  be 
syringed  daily.  A  sudden  rise  of  temperature. 

9th. — Had  to  have  sleeping-draught  last  evening.  The 
temperature  this  morning  is  103°  Fahr. 

27th. — A  fresh  collection  of  matter,  situated  above  and 
to  the  right  side  of  the  former  openings,  was  opened  to-day, 
and  about  two  ounces  of  very  foul  pus  were  let  out. 

28th. — Feeling  much  easier. 

March  14. — Still  some  discharge.  He  has  griping  pains 
in  the  abdomen.  Temperature  100°  Fahr.  Takes  his  food 
and  sleeps  well. 

30th. — Since  admission  the  patient  has  been  gradually 
getting  worse.  A  discharge  of  several  ounces  of  pus  takes 
place  every  day  from  four  or  five  sinuses  in  the  left  loin. 
Pressure  on  the  loin  causes  a  quantity  of  matter  to  well  up 
from  the  deeper  parts.  He  appears  to  have  a  large,  deep- 
seated  lumbar  abscess,  the  matter  from  which  can  only  im¬ 
perfectly  make  its  way  to  the  surface.  There  are  no  distinct 
signs  of  spinal  disease ;  there  is  no  tenderness  along  the 
spine.  There  is  some  paralysis  and  numbness  of  the  left  leg 
and  foot.  Chest  normal,  urine  normal.  His  temperature  is 
constantly  above  normal,  and  frequently  rises  as  high  as 
103°  or  104°  Fahr.  His  illness  has  now  lasted  nearly  five 
months. 

April  3. — Under  ether,  a  transverse  incision  about  four 
inches  long  was  made  just  above  the  iliac  crest,  thus  laying 
open  two  sinuses.  Another  sinus  was  then  found  to  extend 
deeply  inwards  beneath  the  erector  spinse  muscle ;  this  was 
laid  freely  open,  so  that  two  fingers  could  be  passed  into  the 
large  abscess-cavity  which  was  found  to  be  present.  The 
sides  of  the  lumbar  vertebrae  could  be  plainly  felt,  but  no 
bare  bone  was  detected.  Another  incision  into  the  abscess 
was  made  on  the  inner  side  of  the  erector  spinse,  and  the 
wounds  were  plugged  from  the  bottom  with  strips  of  oiled 
lint. 

10th. — Only  slight  constitutional  disturbance  followed  the 
last  operation.  The  dressings  have  been  changed  every 
day,  care  being  taken  to  put  the  lint  quite  to  the  bottom  of 
the  wound  on  each  occasion.  To-day  a  large  drainage-tube. 


passing  across  under  the  erector  spinse,  has  been  substituted 
for  the  oiled  lint.  There  is  a  profuse  discharge  of  pus  from 
the  wound. 

May  16. — The  patient  feels  much  better.  There  is  less-- 
discharge  from  the  wound.  The  temperature  has  been 
much  lower  since  the  last  operation ;  it  is  now  very  little 
above  normal. 

June  18. — Continues  to  improve.  Sleeps  well;  takes  his 
food  well ;  has  no  pain.  Less  discharge  from  the  wound  ? 
the  drainage-tube  is  gradually  cutting  its  way  towards  the 
surface  through  the  erector  spinse.  The  left  leg  and  foot 
are  still  partially  paralysed. 

August  2. — A  small  fresh  collection  of  pus  having  formed 
on  the  outer  side  of  the  original  abscess,  an  opening  was 
made  into  it,  and  a  small  tube  inserted. 

September  20. — Is  able  to  get  about  with  the  help  of 
crutches.  Wound  nearly  healed  ;  no  drainage-tube  in  it 
discharge  almost  ceased. 

Case  2. — Disease  of  the  Transverse  Processes  of  the  Vertebrae  — 
Deep  Abscesses — Free  Opening — Recovery. 

[For  these  notes  we  are  indebted  to  Mr.  Trexder,  House-Surgeon.] 
Robert  G.,  aged  twenty-three,  a  miner  by  occupation,  was 
admitted  June  5,  1883. 

Previous  History. — Patient  was  quite  well  until  fourteen 
months  ago,  when  he  fell  backwards  against  a  tub,  which 
struck  him  on  the  loins.  He  continued  with  his  work  for  a 
month  as  usual ;  then  a  lump  appeared  on  the  side  of  the 
lumbar  spine.  At  first  it  was  of  the  size  of  a  walnut,  but 
gradually  enlarged  until  of  the  size  of  a  saucer.  He  went 
to  the  Leicester  Infirmary  after  about  two  months,  during 
which  the  swelling  appeared  stationary ;  the  swelling  was 
then  incised,  and  pus  let  out.  He  remained  in  hospital  for 
about  two  weeks,  and  then  continued  as  an  out-patient  for 
three  months,  after  which  he  was  readmitted.  There  were 
now  several  sinuses,  all  discharging  ;  no  dead  bone  could  be 
detected.  He  continued  in  this  condition  for  some  weeks- 
longer,  and  was  then  admitted  into  St.  Bartholomew’s 
Hospital. 

Present  Condition. — He  has  two  sinuses,  one  above  the 
other,  to  the  right  of  the  spine,  just  above  the  crest  of  the 
ilium.  A  probe  introduced  into  them  goes  in  for  about  two 
inches,  the  upper  sinus  having  rather  a  downward,  the  lower 
an  upward,  direction.  No  dead  bone  can  be  felt.  The  man 
can  run,  walk,  stoop,  or  turn  in  any  direction  as  well  as 
ever  ;  but  if  he  attempts  to  lift  a  heavy  weight  he  seems 
to  have  no  power.  Urine  normal. 

Treatment. — June  12. — Mr.  Smith  opened  up  the  sinuses- 
in  all  directions ;  one  was  found  to  communicate  with  an 
abscess -cavity  immediately  over  the  transverse  processes  of 
one  or  two  of  the  middle  lumbar  vertebrae,  and  between  them 
and  the  fibres  of  the  erector  spinse  muscle.  Drainage-tubes- 
were  then  inserted.  In  the  evening  the  temperature  rose- 
from  99'6°  to  101'8°. 

20th. — For  some  days  past  the  patient  has  complained 
of  pain  about  his  great  trochanter.  There  is  a  rise  of 
temperature. 

August  20. — Fresh  evidence  of  burrowing  of  pus.  The 
patient  was  again  anaesthetised,  and  some  sinuses  opened  up. 

October  20. — The  wounds  have  gradually  closed.  There  has 
been  less  and  less  discharge  up  till  the  present  time.  Now 
there  is  only  a  superficial  wound,  which  is  fast  cicatris¬ 
ing.  The  man  feels  well ;  he  is  gaining  flesh  in  spite  of  a 
troublesome  cough  and  some  expectoration.  His  temperature- 
is  about  normal.  He  is  up  and  about  the  ward. 

Remarks. — In  the  first  of  these  cases  the  disease  seemed 
to  be  making  steady  progress  towards  a  fatal  termination, 
and  it  was  at  Mr.  Berry’s  suggestion  that  the  abscess  was 
treated  by  freely  laying  open  all  sinuses  and  exposing  all 
suppurating  cavities  within  reach.  The  necessary  incisions 
were  numerous,  very  extensive,  and  very  deep,  and  the 
appearance  of  the  lumbar  region  the  day  after  the  operation 
was  such  as  to  cause  some  anxiety  on  account  of  the  very- 
large  wound-surface.  The  treatment,  however,  was  followed 
by  no  serious  disturbance,  and  before  long  there  was  a  very 
appreciable  diminution  in  the  amount  of  discharge,  and  a 
corresponding  improvement  in  the  patient’s  general  health, 
which  has  been  steady  and  progressive.  In  the  second  case, 
it  was  also  necessary  to  make  very  extensive  and  deep  inci¬ 
sions.  In  this  patient  the  recovery  was  more  rapid,  and  un¬ 
attended  with  any  serious  symptoms.  In  neither  case  has. 


Medical  Times  and  Gazette. 


BACTERIA  AND  DISEASE. 


Nor.  3, 1683.  5  1  5 


there  been  any  difficulty  in  healing  the  wounds,  but,  on  the 
contrary,  care  has  had  to  be  taken  to  prevent  too  speedy  a 
•closure  of  the  incisions.  The  routine  treatment  of  lumbar 
•abscess  is  not  so  satisfactory  as  to  forbid  attempts  to  improve 
upon  it,  and  the  progress  towards  recovery  in  the  cases  re¬ 
lated  above  has  been  so  much  more  rapid  than  is  usual,  that 
a  further  trial  of  the  plan  of  free  incision  is  quite  justified. 


TERMS  OF  SUBSCRIPTION. 


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,,  ,,  .....  Six  j, 

The  Colonies  and  the  United ")  ™  7 

States  of  America  .  .  . )  we  ve  ” 

*,  ,,  a  •  Six  ,, 

India  ( vid  Brindisi)  .  .  .  Twelve  „ 

a  ...  Stx  ,, 


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SATURDAY,  NOVEMBER  3,  1883. 

- ♦ - 

BACTERIA  AND  DISEASE. 

It  is  not  surprising  that,  in  its  eagerness  to  apply  all  new 
knowledge  to  the  great  end  of  staying  disease,  the  medical 
profession  should  often  seize  upon  new  discoveries,  and 
make  them  the  basis  of  plausible  theories  tending  to  cura¬ 
tive  measures  long,  before  actual  scientific  knowledge  can 
justify  any  such  proceeding.  The  facts  really  ascertained 
with  regard  to  the  part  played  by  some  bacteria  as  causes  of 
disease  are  continually,  at  the  present  day,  forgotten,  and 
Their  positive  nature  misapprehended,  owing  to  the  readi¬ 
ness  with  which  the  mere  hopes  and  anticipations  arising 
from  the  discovery  of  other  bacteria  in  diseased  states  of 
The  human  body  have  been  misinterpreted  by  over-zealous 
writers,  and  discussed  as  though  they  too  were  de¬ 
monstrable  facts  instead  of  sanguine  hypotheses.  We 
use  the  word  bacteria  to  include  all  forms  known,  as 
bacterium,  micrococcus,  bacillus,  spirillum,  or  vibrio, 
since  it  is  demonstrated  that  in  a  non-parasitic  kind 
,( Bacterium  rubescens)  all  these  forms  may  be  assumed 
by  the  growth  in  turn,  according  to  the  conditions  of  its 
surroundings,  just  as  the  mould  Mucor  racemosus  may  grow 
as  a  filiform  mycelium  or  as  a  pullulating  torula,  according 
as  it  is  exposed  to  atmospheric  oxygen,  or  is  deprived  of 
access  to  that  oxygen  and  provided  with  saccharine  solu¬ 
tion.  The  parasitic  (pathogenic)  bacteria  appear  to  have 
acquired  a  greater  fixity  of  form  than  those  which  live  in 
non-organised  media,  so  that  parasitic  micrococci  are  found, 
when  cultivated  in  various  ways,  always  to  reproduce  them¬ 
selves  as  micrococci ;  just  as  the  beer  yeast,  which  has  for 


centuries  been  cultivated  in  highly  specialised  conditions  by 
brewers,  has  acquired  a  fixity  of  form,  and  cannot  by  any 
change  of  conditions  yet  devised  be  caused  to  revert  to  a 
filamentous  mode  of  growth — a  reversion  which  is  readily 
effected  in  the  case  of  mucor  yeast.  Not  only  is  the  analogy 
of  yeast  instructive  in  relation  to  the  forms  of  bacteria, 
but  it  also  furnishes  important  suggestions  in  relation  to 
their  physiological  activities.  By  change  of  its  conditions 
and  pabulum,  the  non-fermentative  Mucor  racemosus  is 
found  to  assume  the  peculiar  physiological  activity  of  a 
sugar-destroying  alcoholic  ferment ;  so  we  may  expect  that 
it  is  not  improbable  that  bacteria  transferred  from  non- 
organised  media  to  the  tissues  or  fluids  of  an  animal  body 
may  develope  new  physiological  activities  analogous  to  those 
of  a  ferment.  These  new  activities  may  be  injurious  or 
deadly  to  the  organism  in  which  the  bacterium  acquires 
them,  although  the  free-living  stock  from  which  it  is  derived 
possesses  no  such  properties  so  long  as  it  is  in  the  non- 
parasitic  condition.  Of  this  more  will  be  said  below. 

In  reference  to  the  actual  certainties  concerning  the  rela¬ 
tion  of  bacteria  to  disease,  it  is  the  fact  that  only  two 
diseases  have  been  definitely  and  fully  proved  to  be  caused 
by  a  bacterian  parasite.  These  are  the  splenic  fever  of  cattle, 
sheep,  mice,  etc.,  and  the  so-called  cholera  of  fowls.  In 
these  two  cases,  independent  observers  have  found  that  the 
bacteria  associated  with  the  disease  are  (1)  invariably  present 
when  the  disease  is  present ;  (2)  that  they  are  capable  of 
cultivation  on  organic  media  (such  as  broth),  and  when  thus 
cultivated  by  transference  of  minimal  quantities  from  jar  to 
jar — so  as  to  separate  them  absolutely  from  any  other 
material  taken  with  them  from  the  body  of  the  infected 
animal — they  have  been  found  capable,  thus  introduced  in 
a  completely  isolated  condition  into  a  healthy  animal,  of 
producing  the  specific  disease  associated  with  them,  viz., 
splenic  fever  if  the  Bacterium  anthracis  is  the  subject  of 
experiment,  or  “  fowls’  cholera  ”  if  the  bacterium  of  that 
disease  is  the  one  under  study  ;  and  (3)  that  they  are  the 
necessary  accompaniment  of  the  disease,  inasmuch  as  the 
fluids  of  the  diseased  animal,  or  other  fluids  on  which  they 
flourish,  when  separated  from  the  bacteria,  and  injected 
into  a  healthy  animal,  do  not  produce  the  disease.  Of  no 
other  bacteria  associated  with  diseased  conditions  of  men  or 
animals  has  this  series  of  conclusive  facts  been  demon¬ 
strated.  Of  the  many  which,  from  their  presence  in  par¬ 
ticular  diseases,  justify  suspicions  and  even  strong  pre¬ 
sumption  as  to  their  causal  connexion  with  such  diseases 
some  have  been  more,  some  less,  satisfactorily  examined. 

The  bacterium  which,  next  to  the  two  already  mentioned, 
has  claims  to  be  considered  as  a  cause  of  disease,  is 
the  spirillum  form.  Bacterium  Obermeieri,  which  occurs, 
and  has  been  repeatedly  observed,  in  the  human  blood  in 
relapsing  fever.  It  is  abundant  in  the  blood  at  the  febrile 
crisis,  disappears  in  the  intervals,  to  reappear  again  at  the 
crisis.  It  has  been  transferred,  by  inoculation  of  the  blood 
containing  it,  from  men  to  apes,  by  Carter,  with  production 
of  the  fever  in  the  inoculated  animal ;  but  it  has  never  been 
cultivated  so  as  to  obtain  it  free  from  other  material  present 
in  the  blood,  and,  moreover,  it  has  been  found  in  the  blood 
of  men  not  exhibiting  any  signs  of  relapsing  fever  (Lewis). 

The  rod-like  bacterium  found  by  Koch  in  the  sputa  of 
phthisical  subjects  ( Bacillus — or  better.  Bacterium  tubercu¬ 
losis),  and.  in  the  diseased  tissues,  and  since  observed  by  every 
tiro  in  our  hospitals,  has  not  yet  been  shown  to  be  the  invari¬ 
able  accompaniment  of  phthisis.  It  is  not  yet  cer  tain  whether 
such  bacilli  also  occur  in  unhealthy  but  non-phthisical  sub¬ 
jects.  The  cultivation  of  this  organism  outside  the  living  body 
has  been  effected,  but  upon  solid  media,  not  in  fluids ;  and 
accordingly  it  is  less  certain  that  the  organisms  when  sub¬ 
sequently  used  for  inoculation  have  been  entirely  free  from 


516 


MpdfrnI  Times  fiurt  Gazette 


BACTERIA  AND  DISEASE. 


Nov.  3,  1893, 


particles  of  the  diseased  body  from  which  they  were  taken, 
than  would  be  the  case  had  they  been  cultivated  in  fluids.  Ino¬ 
culation  has  been  carried  out  with  the  cultivated  bacilli  upon 
animals ;  but,  inasmuch  as  few  experiments  are  as  yet  re¬ 
corded  of  this  kind,  it  is  not  satisfactorily  proved  that  the 
disease  produced  by  the  inoculation  is  the  same  thing' 
as  the  disease  (phthisis)  supposed  to  be  produced  by  this 
organism  in  men.  Probably,  here,  nothing  short  of  the 
inoculation  of  criminals,  or  of  some  investigator  suffi¬ 
ciently  devoted  to  put  his  own  life  to  the  hazard,  would 
furnish  the  desired  proof  as  to  the  capacity  of  this  bacillus 
to  set  up  true  phthisis,  and  yet  further  resolve  the  ques¬ 
tion  whether  the  disease  follows  necessarily  in  all  cases 
as  a  result  of  the  inoculation,  or  whether  a  particular 
receptivity  is  necessary  on  the  part  of  the  “  inoculee.” 
A  rod-like  bacterium  has  been  detected  constantly  in  the 
morbid  epidermal  tissues  of  lepers  (by  Hansen),  but  no 
inoculation-experiments  exist  to  render  it  even  probable  that 
it  has  a  causal  relation  to  leprosy.  A  bacterium  is  recorded 
by  Klebs  and  Crudeli  as  occurring  in  malaria ;  but  as  yet  it 
has  not  been  isolated,  and  has  not,  after  complete  separa¬ 
tion  from  other  materials,  been  introduced  into  the  blood  of 
healthy  animals.  The  minute  spherical  bacteria  (micrococci) 
found  in  vaccine-lymph  (Cohn),  and  in  the  tissues  of  persons 
dying  of  diphtheria  (Oertel),  have  at  present  no  further  claim 
to  be  considered  as  causes  of  disease  than  is  afforded  by 
their  constant  presence  in  vaccinia  and  diphtheria.  They 
have  not  been  isolated,  cultivated,  and  tested  by  inocula¬ 
tion  when  thus  purified.  Recently,  however,  both  in 
glanders  (Koch)  and  in  erysipelas  (Fehleisen)  a  bacterium 
has  been  detected,  and  has  been  cultivated  on  media  ex¬ 
ternal  to  the  living  body,  and  in  each  case  has  on  inocula¬ 
tion  produced  the  specific  disease  associated  with  it.  In 
both  these  cases,  however,  the  cultivation  and  inoculation 
have  not  as  yet  been  sufficiently  often  repeated  to  warrant  us 
in  accepting  the  activity  of  these  orga  nisms  as  proved  with 
the  same  confidence  which  we  are  justified  in  feeling  in  rela¬ 
tion  to  the  specific  activity  of  the  Bacterium  anthracis  in 
splenic  fever.  Lastly,  we  have  the  rod-like  bacterium,  or 
bacillus,  discovered  by  Koch  in  the  epithelium  of  the  intes¬ 
tine  of  cholera  subjects.  Owing  to  the  fact  that  cholera 
cannot  be  induced  in  animals,  Koch  was  unable  to  test 
the  specific  properties  of  this  bacillus.  Probably,  here 
again,  the  only  satisfactory  method  will  be  to  inoculate  a 
condemned  criminal.  It  was  in  this  way  that,  forty  years 
ago,  the  life-history  of  Taenia  solium  was  definitely  esta¬ 
blished.  Until  such  inoculation -experiments  are  performed, 
we  have  no  justification,  as  Koch  is  the  first  to  point  out, 
for  regarding  it  as  more  than  a  possibility  that  the  bacillus 
discovered  by  him  is  the  cause  of  the  morbid  condition 
known  as  cholera. 

In  regard  to  all  these  untested  cases  of  the  presence 
of  bacteria,  it  must  distinctly  be  remembered  that  there 
is  solid  ground  for  the  conclusion  that  bacteria  may 
and  do  occur  in  living  animal  bodies  (not  perhaps  in  a 
thoroughly  healthy  condition,  except  in  such  open  cavities 
as  the  alimentary  canal  and  bladder)  without  producing 
deadly  mischief,  and  rather  as  the  accompaniments  of  an 
unhealthy  state  than  as  causes  of  it.  Also,  the  judicious 
critic  will  bear  in  mind  that  though  bacteria  may  furnish 
the  explanation  of  a  certain  number  of  zymotic  diseases,  we 
are  not  driven  to  seek  in  them  an  explanation  of  all.  There 
are  other  analogies  than  that  of  parasitic  plants  which  may 
very  possibly  ultimately  furnish  us  with  the  explanation  of 
some  such  diseases.  The  poison  of  snake-bite,  the  infection 
of  sui’rounding  tissues  with  the  properties  of  a  grafted  tissue, 
whether  in  plants  or  in  animals  (skin),  furnish  us  with  evi¬ 
dence  that  particles  forming  the  proper  substance  of  one 
organism  can  modify  the  tissues  of  another  organism  to  which 


they  may  be  transferred,  so  as  to  produce  profound  and  even 
deadly  disturbance.  The  “  affection  ”  in  this  class  of  cases, 
like  that  set  up  by  a  ferment-organism,  is  theoretically 
explained  as  a  propagation  not  of  material  particles  simply,, 
but  of  molecular  vibrations.  Such  possibilities  being  borne 
in  mind,  we  must  in  each  separate  case  wait  for  full  demon¬ 
stration  before  accepting  an  associated  bacterium  as  the 
cause  of  a  disease ;  and  this  though  we  accept  the  demon¬ 
stration  of  the  causal  connexion  in  a  few  well-studied  cases 
of  a  specific  bacterium  with  a  specific  disease. 

One  word  may  be  here  said,  in  conclusion,  as  to  the  sup¬ 
posed  permanency  or  fixity  of  the  pathogenic  property  of 
bacteria  known  to  be  the  cause  of  disease.  Hans  Buchner, 
working  under  the  auspices  of  one  of  the  ablest  and  most 
philosophic  biologists  of  derm  any,  von  Niigeli,  has  adduced 
facts  which  demonstrate,  so  far  as  the  work  of  one  man  can, 
that  the  Bacterium  anthracis  of  splenic  fever  is  the  same 
organism  as  the  Bacterium  subtile  which  flourishes  in  vege¬ 
table  putrefactions.  Buchner  has,  by  a  series  of  cultiva¬ 
tions  in  which  the  conditions  of  pabulum-  and  oxygen-supply 
and  temperature  were  gradually  modified,  converted  the 
B.  anthracis  into  the  harmless  B.  subtile ,  and  has  also 
effected  the  reverse  process.  Koch,  without  repeating  pre¬ 
cisely  Buchner’s  experiments,  refuses  to  admit  his  conclu¬ 
sion,  chiefly  on  theoretical  grounds.  It  is  much  to  be- 
desired  that  Buchner’s  experiments  should  be  minutely  and 
accurately  repeated  by  other  observers. 

Theoretically,  Buchner’s  position  (which  is  that  of  von 
Nageli)  has  an  immense  amount  in  its  favour.  In  these 
days  of  Darwinism  it  does  not  need  any  preface  to  gain 
acceptance  for  the  proposition  that  all  parasitic  organisms- 
are  necessarily  derived  from  closely  allied  non-parasitic 
forefathers.  The  adaptation  to  a  parasitic  life  must  in  all 
cases  have  been  a  gradual  one,  and,  as  there  can  be 
no  doubt  that  parasitic  pathogenic  bacteria  have  been  at 
some  time  or  other  derived  from  non-parasitic  harm¬ 
less  bacteria,  it  would  not  be  surprising  if  we  should 
find  in  these  simple  organisms,  so  closely  allied  to  the 
highly  adaptable  moulds  (mucor,  yeast,  etc.),  some  which 
have  both  a  free  and  a  parasitic  phase  of  life,  according 
to  the  series  of  conditions  into  which  they  may  be  brought- 
Not  only  this ;  but  it  seems  almost  necessary  to  suppose 
that  pathogenic  bacteria  (assuming  that  others  exist  besides 
that  of  splenic  fever  and  of  fowls’  cholera)  have  an  inter¬ 
mediate  phase  of  existence  external  to  their  hosts.  It 
cannot  be  shown,  for  instance,  in  the  case  of  Bacterium 
anthracis,  that  the  bacteria  are  passed  directly  from  host  to 
host;  apparently  they  exist  widely  spread  on  the  surface 
of  the  earth.  In  this  widely  spread  non-parasitic  condition 
it  is  probable  that  they  are  harmless  (as  Bacterium  subtile )„ 
and  that  only  here  and  there,  from  time  to  time,  when 
definite  conditions  recur  (such,  for  instance,  as  the  admix¬ 
ture  of  animal  fluids,  blood,  etc.,  with  the  more  usual  con¬ 
stituents  of  the  soil),  do  they  gradually,  in  those  particular 
spots,  undergo  modification  and  become  adapted  to  take  the 
last  step,  and  enter  on  a  parasitic  and  disease-producing 
phase  of  activity.  This  speculation,  when  applied  to  the- 
case  of  other  diseases  in  which  bacteria  are  suspected, 
acquires  a  very  striking  significance.  It  offers  an  ex¬ 
planation,  which  we  do  not  find  in  the  theory  of  fixity* 
of  specific  physiological  activities  of  bacteria,  of  (1)  the  im¬ 
portance  of  organic  refuse  in  “  breeding  ”  disease ;  (2)  of 
the  apparently  spontaneous  outbreak  of  zymotic  disease 
(really  the  acquirement  of  parasitic  adaptation  by  species  of 
bacteria  present  generally  in  a  harmless  state)  ;  (3)  of  the 
paradox  that,  according  to  the  “  fixity  ”  theory,  millions  of 
these  pathogenic  bacteria  must  everywhere  be  diffused  in  a 
state  ready  for  active  infection,  and  yet  men  and  animals 
are  not  habitually  attacked  by  them,  but  only  at  intervals 


Afodical  Times  and  Gazette. 


MEDICINE  AND  MICRO-BIOLOGY. 


of  time  and  place,  so  as  to  cause  what  are  known,  as 
“  epidemics.”  Of  the  three  elements  in  infection — viz.,  the 
germ,  the  recipient,  and  the  intermediary  vehicle — the  last 
acquires  its  true  significance  and  the  explanation  of  its 
importance  by  the  light  of  the  Nageli-Buchner  exposition 
of  the  etiology  of  splenic  fever.  It  must  not  be  supposed 
that  we  intend  in  the  above  remarks  to  suggest  that  one 
and  the  same  species  of  harmless  bacterium  can  assume  a 
number  of  various  pathogenic  phases  according  to  circum¬ 
stances.  That  would  be  carrying  hypothesis  beyond  the 
limitations  afforded  by  known  facts.  The  hypothesis  is 
simply,  that  as  in  the  case  of  B.  anthracis-subtile,  so  other 
species  of  pathogenic  bacteria  may  have  a  free-living 
harmless  corresponding  phase. 


MEDICINE  AND  MICKO-BIOLOGY. 

The  recent  description  by  Dr.  Koch  of  a  new  form  of 
bacillus  occurring  in  the  intestines  of  cholera  patients  calls 
attention  once  again  to  the  part  played  by  germs  in  the 
production  of  disease.  The  actual  discovery  of  so-called 
“specific”  organisms  in  some  of  those  maladies  where 
their  presence  was  suspected  and  sought  for — the  visible 
manifestation,  as  it  were,  of  the  previously  hypothetical 
seeds  of  infectious  disease — has  naturally  weighed  much 
with  the  medical  mind,  and  it  is  not,  perhaps,  to  be  wondered 
at  that  increasing  light  on  the  subject  seems  at  first  to 
dazzle  as  much  as  illuminate.  But  above  all  things  it  is 
necessary  that  the  doctor  who  would  be  guided  by  the  best 
scientific  knowledge  in  his  practice  should  pause  and  con¬ 
sider  well  before  either  ignoring  or  fully  adopting  the  in¬ 
ferences  drawn  by  many  who  are  making  micro-organisms 
their  study. 

The  chief  facts,  among  many  others,  regarding  the  germ- 
theory  of  disease  that  seem  to  have  impressed  the  profession 
at  large,  which  receives  at  second  hand  the  accounts  of  the  mi¬ 
croscopical  researches  and  the  “  cultivation-”  and  inoculation- 
experiments  of  the  few,  may  be  roughly  stated  as  follows. 
lielapsing  fever  has  been  connected  with  a  peculiar  organism 
— “spirillum” — found  in  the  blood  during  the  paroxysms, 
but  not  clearly  demonstrated  to  be  the  cause  of  the  disease 
it  accompanies.  Malignant  pustule  or  charbon  has  been 
shown  to  result  from  the  inoculation  of  the  purely-culti¬ 
vated  Bacillus  anthracis  into  healthy  animals ;  and  from 
among  the  many  other  micro-organisms  which  have  been  dis¬ 
covered  and  discarded  as  concomitants  or  possible  causes 
of  several  human  diseases,  the  Bacillus  tuberculosis  of 
Koch  stands  out  pre-eminently  as  in  some  very  striking 
way  connected  with  the  disease  (both  in  men  and  animals) 
whence  it  derives  its  name,  and,  by  consequence,  with 
many  forms  of  consumption  of  the  lungs.  It  is  this 
last  bacillus  which  is  of  far  the  greatest  interest  to 
the  profession,  for  many  reasons.  It  is  vouched  for  by  the 
best  observers,  and  has  an  overwhelming  amount  of  evidence 
for  its  special  nature  and  peculiar  habitat.  It  occurs  in 
relation  to  a  disease  whose  fatal  and  widespread  incidence  on 
humanity  has  the  gravest  import,  and  its  causative  influence 
as  the  actual  producer  of  the  malady  is  believed  in  by  many 
who  have  themselves  experimented  with  it.  A  further 
question,  too,  is  obviously  connected  with  this  discovery — a 
question  likely  to  be  asked  at  once  by  everyone,  whether 
medical  or  not,  and  already  answered  all  too  soon  by  the 
thoughtless— “  Is  consumption  catching?”  For ‘hitherto 
it  has  been  in  the  infectious  diseases  that  the  germs  were 
expected  and  sought  for — infection,  indeed,  being  the  very 
scent  on  which  the  germ-hunt  has  mainly  depended.  The 
absorbing  interest  attaching  to  this  subject,  and  the  in¬ 
fluence  it  may  have  on  the  opinions  and  practice  of  us 
all,  renders  necessary  a  clear  understanding  of  what  has. 


Nov.  3,  1883.  5  1  7 

.  1  ,  - -  3 

and  what  has  not,  been  absolutely  settled  in  this  branch 
of  research.  And,  with  regard  to  the  bearing  of  our 
belief  about  germs  on  the  practice  of  to-day,  we  may  take  as 
the  text  of  a  few  words  of  warning  this  very  bacillus  of 
tubercle,  not  only  for  the  reasons  stated  above,  of  the  in¬ 
trinsic  importance  of  its  relations,  but  also  because  it  seems 
at  present  that  tuberculosis  is  almost  the  only  human  disease 
attributed  to  a  germ,  which  has  already  been  regarded  by 
many  in  a  new  light  owing  to  this  recent  hypothesis,  and  may 
thereby  undergo  a  kind  of  pathological  and  therapeutical 
revolution.  The  latest  discovery  of  a  specific  germ  in  the 
case  of  cholera  may  for  the  present  purpose  be  ignored,  as 
not  only  is  it  not  yet  demonstrated  to  be  in  any  sense  the 
cause  of  the  disease,  but  hitherto  also  inoculation-experi¬ 
ments  have  entirely  failed.  The  opinion,  moreover,  of  many 
who  have  had  the  widest  and  closest  experience  of  cholera 
cases  is  strongly  adverse  to  the  notion  of  the  disease  being 
contagious,  as  shown  afresh  by  the  speeches  of  Surgeon- 
Major  T.  Lewis,  Dr.  J.  Ewart,  and  Sir  J.  Fayrer  on  the 
subject  of  quarantine  at  the  late  Intercolonial  Medical 
Congress  at  Amsterdam.  These  gentlemen  expressed  very 
decided  views  on  this  point,  and  pointed  out  that  the  dis¬ 
ease  did  not  spread  among  the  nurses  or  doctors  who 
attended  the  sick,  nor  even  among  those  who  removed  or 
washed  the  soiled  linen ;  and  attention  was  called  to  the  fact 
that  Drs.  Lewis  and  Cunningham,  while  making  their  ex¬ 
periments,  had  been  constantly,  and  with  perfect  impunity, 
in  close  contact  with  cholera  discharges  in  all  stages  of 
metamorphosis  and  decay. 

Let  us  look  for  a  moment  at  the  state  of  belief  about 
phthisis  which  prevailed  before  this  last  discovery,  and 
then  at  the  position  of  the  most  emphatic  advocacy  of  the 
infection  theory,  before  we  decide  how  far  the  real  facts 
underlying  the  latter  will  justify  us  in  largely  rejecting  our 
previous  creeds  and  practice.  Not  long  ago  we  widely 
believed  that  phthisis  was  not  uniform,  nor  always  indeed 
tubercular ;  that  it  was  strongly  hereditary,  and  but  doubt¬ 
fully,  or  not  at  all,  “catching”;  that  it  was  closely  connected 
with  climatic  conditions,  especially  with  dampness  of  soil, 
and  in  a  pre-eminent  degree  occasioned  by  close  confinement 
and  deprivation  of  fresh  air.  We  believed  too,  to  some 
extent,  that  consumption,  in  those  predisposed  to  it,  might 
be  set  up  by  mental  trouble  and  prolonged  anxiety.  For 
most  of  these  notions  there  was  abundant  evidence,  in 
some  cases  amounting  almost  to  demonstration  ;  and  satis¬ 
factory  results  therefrom  in  treatment  have  not  been 
wanting.  But  the  view  that  the  bacillus  is  the  cause  of 
nearly  all  cases  of  so-called  phthisis  is  certainly,  on  the 
face  of  it,  antagonistic  to  these  opinions,  and,  if  esta¬ 
blished,  would  tend  to  invalidate  many  of  them.  And 
it  is  remarkable  that  as  soon  as  several  observers  had  shown 
the  almost  unvarying  concomitance  of  the  bacillus  with 
tuberculosis,  and  its  power  of  producing  the  acute  form  of  the 
disease  in  animals  by  inoculation,  many  were  found  to  not 
only  at  once  conclude  that  the  sole  cause  of  phthisis  was  at 
last  discovered,  but  also  to  loudly  preach  that  the  disease 
was  really  catching,  and  that,  after  all,  it  did  not  run  so 
much  in  families.  In  lectures  and  articles  the  profession 
was  suddenly  taught  that  science  had  decided  that  phthisis 
was  caused  by  a  “  specific”  germ;  that  it  was  consequently 
infectious,  and  might  probably  be  prevented  or  in  some 
cases  cured  by  antiseptic  inhalations.  Although,  moreover, 
the  old-established  notions  about  phthisis  did  not  in  any 
sense  negative  the  probability  of  the  newly  discovered 
organism  being  a  factor  in  the  production  of  the  disease, 
yet  an  undue  eagerness  to  discredit  them  undoubtedly  showed 
that  they  no  longer  suited  the  book  of  the  propagandist  of 
the  novel  doctrines. 

Undoubtedly  the  prevailing  teaching  as  regards  the  origin 


518 


Medical  Times  and  Gazette. 


THE  CONVICT  COLE. 


Nov.  3,  1883. 


of  phthisis  is  not  harmonious  with  the  reception  of  the  ex¬ 
clusively  causative  action  of  the  bacillus.  It  has  already 
been  often  said,  and  still  more  often  thought,  that  if  a 
bacillus  in  the  air  is  the  cause  of  consumption  there  should 
be  but  few  who  escape  from  its  virulent  attack.  And  at 
this  point  it  seems  clear  that  it  is  the  factor  of  a  suitable 
field  for  phthisis  to  develope  in,  which  is  all-important  from 
a  practical  point  of  view.  Even  though  it  be  admitted 
to  the  full  that  the  action  of  the  bacillus  is  absolutely 
necessary  for  the  production  of  phthisis,  and  the  con¬ 
clusion  of  the  purely  scientific  workers  on  the  subject 
be  accepted  without  reserve,  yet  surely  Dr.  Koch  him¬ 
self  would  grant  that,  at  present,  there  is  no  reason 
whatever  for  the  practice  built  on  the  older  views  to  be 
upset  or  disregarded,  as  some  of  his  pseudo-disciples  seem 
to  be  preaching  now.  Though  some  might  think  that  the 
question  as  to  the  suitable  soil  for  the  development  of  the 
tubercle  germ  is  scientifically  subsidiary,  yet  it  is  obvious 
that,  from  the  point  of  view  of  practical  medicine,  it  remains 
an  all-important  one.  In  proportion  as  a  “  specific”  bacillus 
is  regarded  as  the  one  etiological  agent  in  phthisis,  there 
is  but  little  hope  held  out  to  us  for  the  prevention  of  the 
disease ;  for  we  are  told  absolutely  nothing  of  the  source 
from  whence  the  germs  arise,  and  we  may  never  be 
able  to  find  or  attack  them  till  the  disease  has  far  pro¬ 
gressed.  On  the  other  hand,  previous  researches  and 
long-established  experience  have  taught  us  much  that  is 
valuable  touching  the  conditions  which  are  favourable  to 
phthisical  disease.  With  the  exception  of  the  primd  facie 
possibility  of  a  greater  infectious  character  in  phthisis  than 
is  generally  believed  in,  we  have  but  little  of  a  practical 
nature  added  to  our  knowledge  and  treatment  of  consump¬ 
tion,  and  nothing  to  unlearn,  from  these  most  recent  re¬ 
searches  into  its  etiology.  Before  we  receive  into  our 
pathology  and  practice  the  new  teaching  that  some  would 
thrust  upon  us,  we  must  wait  for  more  work  in  the  matter 
■of  micro-biology.  We  must  regard  with  the  deepest  in¬ 
terest  what  scientific  workers  have  to  tell  us  on  this  subject, 
and  hope  for  much  light  from  their  labours  ;  but  must  refrain 
from  rashly  applying  in  the  sphere  of  practical  medicine  the 
result  of  insufficient  inquiries.  The  students  in  this  department 
of  pathology  will  readily  admit  that,  in  default  of  inoculation- 
experiments  on  human  beings,  there  is  much  still  to  be  learnt 
concerning  the  causative  part  played  in  consumption  by  the 
Bacillus  tuberculosis ;  and  it  may  further  be  said  that  the 
whole  question  of  the  really  “  specific  ”  or  stable  nature  of 
the  virulent  germs  of  disease  is  not  yet  entirely  settled.  In 
another  column  the  question  is  discussed  of  the  variability, 
according  to  conditions  of  cultivation,  of  the  lowly  organisms 
known  by  the  name  of  bacteria ;  and  it  will  thence  be  seen 
that  the  matter  of  specificity  of  germs,  quite  apart  from  all 
distracting  relations  with  disease,  cannot  be  regarded  as 
once  and  for  ever  set  at  rest  by  past  or  contemporary  dis¬ 
covery,  For  his  own  sake,  then,  and  that  of  his  patients, 
let  the  Physician  beware  of  rushing  in  where  the  Biologist 
as  yet  but  warily  treads. 


THE  CONVICT  COLE. 

A  letter  from  Dr.  Jackson,  of  Croydon,  which  appeared 
in  the  Times  of  the  23rd  ult.,  supplies  strong  corroboration 
of  the  view  that  the  convict  Cole,  who  now  lies  under  sen¬ 
tence  of  death  for  the  murder  of  his  child,  is  of  unsound  mind, 
and  has  been  so  for  several  years  past.  As  far  back  as  1877 
he  was  received  into  the  Croydon  Workhouse  as  a  wandering 
lunatic,  and  was  certified  as  labouring  under  mental  disease. 
Again,  in  1879  he  was  admitted  there  while  labouring  under 
alienation  of  mind.  Some  working  men  who  have  been  on  terms 
of  intimacy  with  him  for  a  long  period  have  always  regarded 


him  as  a  lunatic.  Witnesses  ready  to  give  evidence  embody¬ 
ing  these  facts  were  in  attendance  during  his  trial  at  the  Old 
Bailey,  but  were  not  called,  although  the  paramount  im¬ 
portance  of  their  testimony  to  the  prisoner’s  defence  was  well 
known  to  the  counsel  for  the  prosecution.  Dr.  Jackson  boldly 
affirms  that  proofs  which  would  have  convinced  the  jury  of 
the  prisoner’s  insanity  were  in  the  possession  of  the  Crown 
at  the  time  of  the  trial,  but  were  wilfully  withheld.  This  is 
a  serious  charge,  falling  very  little  short  of  one  of  judicial 
murder  against  the  Crown  authorities,  and  we  can  only  hope 
that  Dr.  Jackson  has  been  mistaken  in  making  it.  The  matter 
cannot,  however,  rest  where  it  is.  The  charge  must  be 
withdrawn,  repudiated,  or  fully  established.  In  the  latter 
case  some  very  unpleasant  consequences  would  ensue,  as 
the  country  is  in  no  mood  to  stand  wilful  suppression  of 
evidence  on  the  part  of  the  Public  Prosecutor  or  his  emis¬ 
saries.  Blundering  it  may  tolerate  for  a  time,  but  it  will 
not  overlook  an  offence  like  that  which  Dr.  Jackson  alleges 
to  have  been  committed  in  this  case. 

Whether  or  not  Dr.  Jackson  has  been  misled  in  making 
his  accusation  against  the  Crown  authorities,  it  must  be 
admitted  that  his  letter  is  a  very  able  one,  and  contrasts 
favourably,  as  regards  tone,  directness,  and  logical  force, 
with  the  article  to  which  it  is  a  reply.  He  puts  in  a  clear 
light  the  inhumanity,  unwisdom,  and  inutility  of  hanging 
a  lunatic  murderer ;  pointing  out  that  it  would  be  as 
rational  to  punish  a  man  for  displaying  the  symptoms  of 
cardiac  or  renal  disease  as  for  exhibiting  those  of  cerebral 
disease.  To  be  ill  is,  he  says,  no  crime,  but  a  ground  of 
pity  ;  and  it  is  so  equally  whether  the  illness  is  located  in 
the  liver  or  lungs,  or  in  the  brain.  He  vindicates  success¬ 
fully  the  claim  of  medical  science  to  decide  on  the  presence 
or  absence  of  cerebral  disease,  and  exposes  the  fallacy  of  the 
familiar  theory  that  twelve  plain  men  in  a  jury-box  are  as 
good  judges  of  insanity  as  any  doctors  can  be.  The  twelve 
plain  men  are  just  as  capable  of  determining  whether  a  man 
is  atheromatous  or  cancerous,  as  they  are  of  saying  whether 
or  not  he  is  insane.  No  opinion  which  they  can  give  on 
such  a  question  is  worth  anything,  unless  they  have  been 
guided  to  it  by  medical  men,  who  are  not,  at  any  rate, 
behind  the  general  community  in  intelligence,  and  who  have 
devoted  their  lives  to  the  study  of  disease. 

The  extent  of  the  field  of  medical  science  and  the  divi¬ 
sion  of  labour  which  has  thus  taken  place,  has  led  certain 
medical  men  to  apply  themselves  more  particularly  to  the 
study  of  mental  affections,  and  it  is  but  reasonable  to  suppose 
that  they  will  be  better  judges  of  a  man’s  sanity  than  other 
medical  men  who  have  bestowed  no  special  thought  on  these 
affections,  and  infinitely  better  judges  than  a  dozen  men 
chosen  hap-hazard  from  a  jury-list.  Ycu  may  sneer  at  the 
mad  doctors,  remarks  Dr.  Jackson, and  designate  them  “so- 
called  experts  ”  and  “  medical  theorists,”  but  you  practically 
admit  their  superior  skill  every  time  that  you  consult  your 
solicitor  on  law,  your  architect  about  your  house,  or  your 
veterinary  surgeon  about  your  horse  ;  and,  notwithstanding 
all  your  affected  contempt  for  them,  you  would  lose  no  time 
in  flying  to  them  for  aid  did  you  detect  any  disorder  in  your 
own  mental  machinery  or  in  that  of  any  member  of  your 
family!  Dr.  Jackson  marshals  in  an  impregnable  array 
the  evidence  of  the  madness  of  the  man  Cole,  which  seems, 
indeed,  to  have  been  of  the  most  pronounced  type.  He 
laboured  under  delusions  which  must  have  warped  every 
thought  and  feelipg,  and  which  certainly  overpowered  him 
when  he  attacked  his  child.  Sir  William  Harcourt  would 
be  amply  justified  in  sending  him  to  Broadmoor  at  once, 
but  perhaps  an  inquiry  must  take  place  for  form’s  sake. 
There  cannot  be  a  shadow  of  a  doubt  as  to  what  the  issue 
of  that  inquiry  will  be,  if  it  be  undertaken  by  men  who 
have  mastered  the  elements  of  psychological  medicine. 


Medical  Times  and  Gazette. 


CHRONICLE  OF  THE  WEEK. 


Nov.  3, 18:3.  519 


CHRONICLE  OP  THE  WEEK. 

- o - 

The  medical  session  began  last  week  in  Edinburgh  with 
the  usual  introductory  lectures  by  the  various  professors  and 
lecturers,  abstracts  of  which  will  be  found  in  another  column. 
The  most  interesting  were  those  of  Prof.  Grainger  Stewart 
and  Prof.  Rutherford.  Dr.  Grainger  Stewart  gave  the  results 
of  his  experience  at  the  popular  resort  of  the  rheumatic,  Aix- 
les-Bains,  and  advocated  the  addition  of  Zander  machines 
to  the  therapeutic  appliances  already  in  use  at  that  and 
cognate  watering-places.  Dr.  Stewart  did  not  allude  to  it, 
but  the  success  of  both  these  modes  of  treatment  in  rheu¬ 
matism  is  due  to  the  improvement  in  nutrition  which  they 
promote.  The  intimate  pathology  of  rheumatism  is  still  an 
unexplored  field,  but  many  more  cases  are  probably  due  to 
starvation  of  tissue,  the  result  of  overfeeding  and  imperfect 
digestion,  than  to  a  definite  vicious  principle  in  the  blood. 
Prof.  Rutherford  spoke,  of  course,  about  vivisection  and  the 
endowment  of  research.  He  showed  that,  instead  of  the 
use  of  anaesthetics  in  vivisectional  experiments  being  forced 
upon  the  physiologists  by  the  anti-vivisectionist  outcry, 
it  had  been  resolved  upon  by  them  before  that  outcry 
arose.  Another  point  he  made  was  that  in  therapeutics 
experiments  on  animals  were  necessary,  because,  if  we  tried 
new  drugs  on  human  subjects,  without  the  knowledge 
derived  from  previous  vivisectional  experiments,  we  might, 
in  case  of  misadventure,  be  indicted  for  manslaughter. 
That  is  an  argument  which  will  appeal  very  forcibly  to 
those  who  believe  that,  in  Nature’s  bountiful  pharma¬ 
copoeia,  there  is  a  specific  for  every  complaint.  You  put 
Nature’s  book  on  the  shelf  when  you  forbid  vivisection. 
So  the  superstitions  fight  it  out  amongst  themselves,  while 
the  sceptic  stands  by  watching  the  fun.  Each  will  have  its 
martyrs,  of  course.  On  the  one  side  we  shall  see  the  ardent 
therapeutist  writhing  in  the  felon’s  dock  because  he  has  killed 
some  one  in  his  eagerness  to  cure  him  by  a  hitherto  unheard- 
of  remedy;  on  the  other  side  we  shall  see  the  anti-vivisec¬ 
tionist  writhing  in  his  bed  because  of  course  he  will  not 
consent  to  take  advantage  of  drugs,  the  action  of  which  has 
been  determined  by  experiments  on  the  animals  he  loves. 
It  remains  to  the  therapeutic  sceptic  to  suggest  an  ex¬ 
pedient  which  will  work  happily  for  all  parties— men 
and  animals  included.  Let  the  anti-vivisectionist. himself 
take  the  unheard-of  remedy,  and  the  responsibility  of  its 
consequences.  _ 

At  the  Clinical  Society’s  meeting  on  Friday,  October  26, 
papers  were  read  by  Dr.  Charlton  Bastian  on  two  cases  of 
Intraventricular  Haemorrhage  from  Aneurysm  and  from 
Embolism  respectively,  and  by  Dr.  Althaus  on  a  case  of 
Syphilitic  Tumours  of  the  Cerebral  Membranes.  Both 
papers  gave  rise  to  interesting  and  well- sustained  discus¬ 
sions,  especially  with  respect  to  the  diagnosis  of  syphilitic 
lesions  in  cases  where  no  evidence  of  acquired  or  congenital 
syphilis  can  be  brought  forward.  An  interesting  case  of 
dislocation  of  the  jaw,  reduced  after  eighteen  months,  by 
Mr.  Golding  Bird,  was  also  related.  Living  specimens  of 
(1)  aphemia  following  a  severe  injury  to  the  left  side  of  the 
head,  by  Mr.  G.  R.  Turner,  and  (2)  radical  cure  of  femoral 
hernia,  by  Mr.  Berkeley  Hill,  were  exhibited  before  the 
meeting. 

The  111th  session  of  the  Medical  Society  of  London  was 
opened  on  Monday  evening.  Sir  Joseph  Fayrer,  President, 
in  the  chair.  In  welcoming  the  Fellows,  he  briefly  sketched 
the  rise  and  progress  of  the  Society,  which  was  older  than 
any  other  in  London.  It  was  founded  by  men  who  were 
distinguished  in  the  times  when  George  the  Third  was  King. 


Though  venerable  in  years,  it  was  active  in  work.  He  re¬ 
ferred  in  terms  of  satisfaction  to  the  completion  of  their 
new  rooms,  and  to  the  recent  visit  of  the  Prince  of  Wales 
on  the  occasion  of  their  opening.  Among  the  Fellows 
deceased  during  the  preceding  year,  mention  was  made  of 
the  late  Dr.  Boyd  and  his  son,  and  of  their  gallant  attempt 
to  save  the  lives  of  their  patients  at  the  disastrous  fire  which 
wrecked  the  lunatic  asylum  over  which  the  former  presided, 
and  in  which  they  both  lost  their  lives.  Sir  Joseph  congratu¬ 
lated  the  Fellows  present  that  their  session  was  about  to  be 
opened  by  a  paper  from  Prof.  Lister,  whose  name  stands  so 
pre-eminent  as  a  scientific  surgeon  at  the  present  time.  In 
this  paper.  Prof.  Lister  recorded  the  treatment  of  seven 
cases  of  Fracture  of  the  Patella,  which  were  cut  down  upon 
and  wired  together.  The  operation  consists  in  making  a 
longitudinal  incision  over  the  middle  of  the  patella,  clean¬ 
ing  out  of  the  knee-joint  any  blood-clot  which  may  have 
collected,  freshening  the  broken  surfaces  of  the  patella,  and 
then  wiring  them  together.  In  this  manner  bony  union  is 
secured.  The  cases  were  of  two  kinds — recent ;  and  those  in 
which  some  time  had  elapsed  since  the  fracture,  and  where 
there  was  fibrous  union  with  a  greater  or  less  interval 
between  the  fragments.  The  recent  cases  are,  of  course, 
the  more  easy  and  satisfactory  to  treat ;  there  is  no 
difficulty  in  approximating  the  fragments  after  the  blood- 
clot  and  effused  matters  have  been  sponged  out  of  the 
joint.  But,  in  the  older  cases,  the  fragments  are  often 
widely  separated;  possibly  there  is  contracture  of  the 
quadriceps  tendon,  which  must  be  divided ;  or  the  fragments 
of  bone  may  be  atrophied.  Examples  of  these  conditions, 
with  the  result  of  the  operation,  were  exhibited  to  the  meet¬ 
ing.  It  would  be  impossible  to  speak  too  highly  of  the 
results  obtained ;  bony  union  of  the  fragments,  with  almost 
perfect  movement  of  the  joint,  had  resulted  in  every  case. 
We  heartily  congratulate  Mr.  Lister  on  his  results.  The 
discussion  was  postponed  until  next  Monday.  It  would  be 
interesting  if  other  surgeons  were  to  produce  their  cases,  so 
as  to  contrast  the  results  of  treatment  by  the  ordinary  means 
with  the  plan  advocated  by  Lister.  It  is  needless  to  say 
that  these  cases  were  treated  on  the  strictest  antiseptic 
method. 


The  report  of  the  three  surviving  members  of  the  Pasteur 
Mission  is  still  unpublished.  It  is  stated  that  it  will  be 
very  elaborate,  and  will  be  presented  to  the  Minister  of 
Agriculture,  whose  Department  includes  questions  of  public 
health.  Meanwhile  M.  Pasteur  has  been  interviewed,  and 
it  appears  that  he  is  at  once  pleased  and  disappointed  with 
the  results  of  the  expedition.  He  is  disappointed  because 
M.  Thuillier  and  his  colleagues  were  not  able  to  inoculate 
any  animals  with  the  cholera  germ,  apparently  because  they 
did  not  succeed  in  discovering  it ;  but  he  draws  consolation 
from  the  fact  that  the  German  inoculation-experiments 
were  also  without  result.  Indeed,  M.  Pasteur  almost 
despairs  of  final  success  until  he  can  find  some  man  of 
sufficient  public  spirit  to  deliver  himself  over  as  a  subject 
for  experiments  of  this  kind.  Meanwhile,  the  mission  has 
done  much  useful  work,  and  has  limited  the  field  for  future 
inquiries.  In  relation  to  this  subject  we  would  draw 
attention  to  our  two  leading  articles  on  the  connexion  be¬ 
tween  germs  and  disease,  written  respectively  from  the 
view -point  of  the  biologist  and  the  physician. 


One  of  the  evening  journals  has  called  Lord  Salisbury’s 
new  departure  in  respect  to  the  dwellings  of  the  poor  “a  leap 
in  the  dark.”  To  other  people,  and  certainly  to  the  medical 
profession,  it  will  appear  rather  “a  leap  into  the  light.”  In 
this  matter,  however,  leaping  is  not  likely  to  be  of  much 


250 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Nov.  3,  1833. 


use.  It  is  the  steady  upward  climb,  with  eyes  firmly  fixed  on 
the  goal,  and  lured  away  from  it  by  no  dazzling  prospect  of 
party  gain,  that  is  demanded  of  our  statesmen,  if  any  good 
is  to  result  from  their  endeavours.  So  far  we  have  seen 
both  parties  playing  with  sanitation — rivals  in  big  words 
and  trifling  measures.  What  is  wanted  is  courage.  One 
does  not  ask  that  the  State  should  undertake  the  re-housing 
of  the  poor.  That  would  be  perhaps  the  worst — certainly 
it  would  be  the  most  expensive  way  of  doing  it.  But  the 
State  ought  to  put  the  screw  on  the  owners  of  property,  with¬ 
out  remorse,  forcing  them  to  pull  down  their  rookeries,  and 
rebuild  them  under  sanitary  control.  No  one  can  be  deemed 
to  have  a  right  to  exact  from  the  poor  a  rent  in  death  and 
disease  as  well  as  in  money.  The  rights  of  property  have 
no  locus  standi  against  the  rights  of  health.  If  “State 
socialism”  means  decent  dwellings  for  the  poor,  the  medical 
profession  at  least  will  be  on  its  side,  as  well  as  Lord 
Salisbury.  _ _ 

A  curious  illustration  of  the  twist  which  the  possession 
of  vested  interests  is  apt  to  give  to  the  human  mind  will  be 
found  in  a  letter  in  the  St.  James’s  Gazette  for  Tuesday  last. 
The  writer  confesses  to  being  an  owner  of  some  of  the  class 
of  houses  against  which  Lord  Salisbury  has  been  inveighing, 
and  he  finds  it  so  difficult  to  collect  his  rents  that  he  has 
taught  himself  to  regard  them  not  as  interest  on  capital,  but 
as  the  just  remuneration  of  a  very  unpleasant  trade.  To 
him  the  problem  which  has  puzzled  Lord  Salisbury  appears 
easy  of  solution.  Who,  he  asks,  will  benefit  by  the  removal 
of  the  rookeries  ?  Why,  the  surrounding  population,  of 
course,  he  replies ;  and  it  follows,  equally  of  course,  that  it 
is  they  who  ought  to  pay  for  the  improvement.  In  other 
words,  the  landlords  are  to  be  paid  out  of  the  pockets  of  the 
community  for  removing  a  nuisance  which  their  own  neglect 
has  allowed  to  grow  up.  That  is  surely  the  reductio  ad  ab- 
surdum  of  the  rights  of  property.  One  of  the  aphorisms  of 
that  dreadful  monster,  Karl  Marx,  was  “  No  rights,  no 
duties ;  no  duties,  no  rights,” — a  saying  which  the  owners 
of  rookeries  will  do  well  to  take  to  heart. 


The  painful  intelligence  of  the  death  of  Mr.  James  Shuter, 
which  took  place  on  Thursday  morning,  from  an  overdose  of 
morphia,  will  be  received  with  profound  regret  by  all  who 
have  been  at  St.  Bartholomew’s  Hospital  during  the  last 
ten  years.  Having  graduated  in  Arts  and  Law  in  the 
University  of  Cambridge,  Mr.  Shuter  entered  St.  Bartholo¬ 
mew’s  Hospital  in  1869,  where  he  soon  made  his  mark  as 
one  of  the  most  industrious  students  of  his  day.  In  1874 
he  passed  his  final  examination  for  the  M.B.  degree,  and  in 
October  of  that  year  he  became  house-surgeon  to  Mr.  Holden, 
and  subsequently  was  house-physician  to  the  late  Dr.  Black. 
Coincidently  with  this  post,  he  held  the  office  of  Demonstrator 
of  Physiology  in  the  Medical  School,  and  subsequently,  for  four 
years,  was  one  of  the  Assistant-Demonstrators  of  Anatomy. 
Last  year  he  was  elected  Assistant-Surgeon  to  the  Hospital, 
having  for  several  years  previous  held  a  similar  appoint¬ 
ment  at  the  Iioyal  Free  Hospital.  Well  educated,  enthusi¬ 
astically  attached  to  the  profession  of  his  choice,  and  a  man 
of  the  strictest  integrity,  Mr.  Shuter  was  one  of  those 
whom  we  can  ill  afford  to  lose.  No  man  could  have  been 
more  persistent  or  painstaking  with  students  than  he  was, 
or  more  anxious  to  give  every  patient  who  came  under  his 
care  the  benefit  of  his  very  best  advice.  He  wrote  very 
little  indeed,  and  was  not  even  a  contributor  to  the  Hospital 
Reports ;  but,  nevertheless,  the  memory  of  James  Shuter 
will  long  remain  fresh  in  the  hearts  of  those  who  knew  him. 


The  current  numbers  of  the  foreign  journals  are  unusually 
interesting.  In  the  Progres  Medical  there  is  an  Obituary 


Notice  of  M.  Depaul,  besides  articles  on  Lathyrism  and 
Beriberi,  by  M.  Marie,  and  on  Hemiatrophy  of  the  Tongue 
in  Tabes  Dorsalis,  by  M.  Ballet.  The  Gazette  Hebdomadaire 
contains  an  article  on  Ammoniacal  Urine  by  M.  P.  Reclus, 
and  the  conclusion  of  an  article  by  M.  Warlomont  on  the 
Origin  of  Yaccinia.  The  Gazette  des  Hopitaux  contains 
an  article  on  Zona  and  its  Tendency  to  Belapse,  and 
one  on  Sudden  Chilling  of  the  Eyeball  as  a  Cause  of 
Abscess  of  the  Cornea.  The  Centralblatt  fur  Klinische 
Medicin  contains  an  abstract  of  Heubner’s  prize  treatise 
on  Experimental  Diphtheria,  and  of  Sodoweuj’s  investiga¬ 
tions  “Ueber  den  Kefir”;  papers  on  Loss  of  Power  in 
Limbs  in  Cerebral  Hemiplegia,  by  Pitres  and  Fried- 
liinder  respectively,  are  also  contributed.  In  the  Berliner 
Klinische  Wochenschrift,  Dr.  Bidder,  of  Berlin,  discusses 
the  relation  of  the  Alkaline  Salts  in  Food  to  the  Etiology 
of  Tuberculosis ;  Dr.  Schroeder,  of  Stendal,  contributes 
a  paper  on  methods  of  discovering  Simulation  of  Uni¬ 
lateral  Blindness ;  and  Dr.  Goutermann  relates  the  course 
of  a  case  of  Traumatic  Tetanus  treated  by  Injections  of 
Curare.  The  Wiener  Medizinische  Wochenschrift  contains 
a  paper  by  Dr.  Heitler,  of  Vienna,  on  the  diagnostic  and 
prognostic  importance  of  the  Tubercle  Bacillus  in  Sputa ; 
Dr.  Drasche’s  paper  on  the  Spread  of  Cholera,  and  Dr. 
Pinnser’s  article  on  Hepatic  Abscess,  are  respectively  con¬ 
cluded  and  continued. 


MEDICAL  ENTRIES  AT  CAMBRIDGE. 

It  appears,  from  information  furnished  to  the  Cambridge 
Review  by  the  several  tutors  of  colleges,  that  no  less  than 
ninety  of  the  freshmen  this  term  are  intending  to  study 
medicine.  This  large  accession  of  medical  students  makes, 
therefore,  no  small  item  in  the  increase  in  the  number  of 
undergraduates  who  have  matriculated  in  the  present  year 
as  compared  with  former  years ;  and  this  growth  of  the 
Medical  School,  if  continued,  which  we  may  infer  is  likely  to 
be  the  case  from  the  increased  opportunities  for  medical 
study,  and  the  increasing  desire  to  graduate  in  medicine  at 
Cambridge,  will  soon  render  the  Medical  School  of  the  Uni¬ 
versity  one  of  the  largest  in  England.  Indeed,  the  entry 
this  year  is  exceeded,  we  believe,  by  that  of  only  one  of  the 
metropolitan  schools.  The  new  comers  are  distributed 
among  the  several  colleges  (the  number  of  those  who  have 
commenced  as  non-collegiate  students  has  not  been  ascer¬ 
tained),  but  the  largest  entry  (twenty-five)  is  at  Caius,  the 
next  (sixteen)  is  at  Cavendish. 


OPENING  OE  THE  SESSION  AT  ABERDEEN. 

The  medical  session  at  Marischal  College  was  opened  on 
the  24th  ult.,  when  the  various  professors,  with  the  exception 
of  Dr.  Hay,  the  newly  appointed  Professor  of  Medical  Juris¬ 
prudence,  began  the  winter  curriculum  of  study.  Prof. 
Stirling,  in  opening  the  course  of  physiology,  gave  an  address 
upon  the  subject  of  “  Heredity  in  Health  and  Disease,” 
quoting  numerous  instances  of  the  hereditary  transmission 
of  the  external  characters  and  peculiarities  of  the  bony  and 
muscular  and  other  systems  of  the  body.  The  question  as 
to  the  hereditary  transmission  of  the  intellectual  qualities 
was  answered  in  the  affirmative,  the  basis  of  this  reply  being 
the  elaborate  statistical  researches  of  Mr.  Francis  Galton 
in  his  works  on  “  Hereditary  Genius,”  and  “  Inquiry  into 
Human  Faculty.”  The  importance  of  heredity  in  disease 
was  discussed,  and  Dr.  Stirling  advocated  the  adoption  by 
medical  men  of  the  plan  of  “Medical  Family  Registers,” 
recently  suggested  by  Mr.  Galton  in  the  Fortnightly  Review, 
and  he  also  urged  that  the  question  of  heredity  in  disease 
should  be  taken  up  by  the  Collective  Investigation  Com¬ 
mittee  of  the  British  Medical  Association.  It  was  poin  ted 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Nov.  3, 1SS3.  521 


out  that  heredity  was  essentially  a  conservative  agency, 
which  tended  to  perpetuate  in  the  race  variations  occurring 
in  the  species,  evolution  and  heredity  together  playing  a 
most  important  part  in  the  development  and  progress  of  the 
race.  It  is  by  such  means,  along  with  the  changes  produced 
By  the  active  use  of  an  organ,  resulting  in  the  “  functional 
increment,”  as  Herbert  Spencer  observed,  that  the  intel¬ 
lectual  characters  of  the  race  have  undergone  develop¬ 
ment.  Thus  it  happens,  as  Spencer  also  points  out,  that 
faculties  as  of  music,  which  scarcely  exist  in  some  inferior 
races,  become  congenital  in  superior  ones  ;  similarly  from 
savages  speaking  a  language  containing  only  nouns  and 
verbs  arise  at  length  our  Newtons  and  Shalcespeares.  Prof. 
Ogston,  in  opening  the  surgery  class,  ridiculed  the  idea  of 
delivering  introductory  addresses,  declaring  that  in  all  such 
addresses  he  had  ever  read  he  could  not  recall  a  single  senti¬ 
ment  that  was  worth  the  uttering.  The  man  who  could 
write  a  good  introductory  address  to  a  medical  class  had  yet 
to  burst  upon  the  public.  Prof.  Struthers,  in  opening  the 
anatomy  class,  made  no  formal  introductory  address.  He 
referred  at  some  length,  however,  to  the  modern  method  of 
study,  and  to  the  scientific  spirit  with  which  it  was  imbued. 
He  also  referred  to  the  success  of  Scottish  universities  as 
•schools  of  science,  as  well  as  of  medicine,  and  congratulated 
the  students  on  attaching  themselves  to  an  institution  which 
had  made  so  great  a  name  among  medical  schools.  Prof. 
Hamilton,  in  opening  the  pathology  class,  gave  a  synopsis 
of  the  works  of  the  most  eminent  pathologists  of  the  present 
era. 


-ONE  OF  THE  ENGLISH  MISSION  ON  THE  CHOLERA  IN 

EGYPT. 

A  lecture  on  Cholera  was  delivered  on  Friday  evening, 
the  26th  ult.,  before  the  Medical  Society  of  Charing-cross 
Hospital,  by  Mr.  James  Cantlie,  Senior  Assistant-Surgeon 
to  the  Hospital,  who  has  lately  returned  from  Egypt,  where 
he  had  been  engaged  as  one  of  the  Special  Medical  Mission. 
Sir  Joseph  Fayrer,  K.C.S.I.,  occupied  the  chair,  and  there 
were  several  present  who  had  had  large  experience  of 
■cholera  in  India.  Mr.  Cantlie  prefaced  his  remarks  by 
.stating  that  the  present  epidemic  in  Egypt  was  interesting 
as  being  the  first  on  record  in  which  cholera  had  existed  in 
any  country  independently  of  a  simultaneous  epidemic 
in  India.  The  lecturer  then,  in  a  quaint,  amusing,  and 
instructive  manner,  gave  a  lucid  account  of  his  experi¬ 
ences  and  impressions.  The  filthy  state  of  the  town 
in  which  he  was  engaged  was  minutely  entered  into  in 
all  its  details.  The  appearance  of  a  cholera  patient  was 
exactly  drawn  ;  and  of  all  the  drugs  employed  in  treat¬ 
ment,  lead  and  opium,  in  decided  doses  at  the  outset  of  the 
•disease,  were  alone  found  to  be  worthy  of  being  called  suc¬ 
cessful.  For  the  first  time  has  anyone  traced  the  history  of 
the  disease  in  Egypt  as  following  a  particular  course.  Com¬ 
mencing  at  Damietta,  the  lecturer  pointed  out  that  the 
towns  higher  up  the  Damietta  branch  of  the  Nile  were 
attacked  in  succession — first  Shirbeen,  then  Mansourah, 
and  finally  Cairo.  It  there  took  two  courses,  one  up  the 
Nile,  the  other  up  the  Rosetta  branch.  Attacking  Kafr- 
Zayat,  and  then  Rosetta,  it  finally  reached  Damanhour  and 
Alexandria.  The  two  last  towns  being  on  canals  derived 
from  the  Rosetta  branch,  and  consequently  farthest  by  water 
from  the  original  seat  of  the  disease,  were  attacked  last. 
The  possibility  of  the  pollution  of  the  river  by  fish  ascend¬ 
ing  the  stream  was  discussed,  and  a  few  remarks  afterwards 
from  Mr.  A.  H.  Hooker  seemed  to  give  colour  to  the  idea 
■suggested.  The  absurdity  of  the  quarantine  and  cordon 
arrangements  was  dealt  with  in  a  telling  manner,  and  an 
account  of  the  quarantine  arrangements  at  Brindisi,  Malta, 
Suez,  etc.,  was  given.  Sir  Joseph  Fayrer  afterwards  gave 


a  clear  summary  of  his  beliefs  as  to  the  causes,  course,  and 
treatment  of  cholera.  The  simile  of  attempting  to  keep 
back  a  flock  of  locusts  by  a  five-barred  gate,  as  applied  to 
the  prevention  of  cholera  by  quarantine  and  cordons,  was 
a  particularly  happy  one.  Mr.  Bloxam,  Drs.  Longhurst, 
Watson,  and  Cullimore,  gave  their  experience  of  previous 
cholera  epidemics  at  home  and  abroad.  A  vote  of  thanks 
to  the  chairman  closed  the  proceedings. 


SYPHILIS  OR  TUBERCLE  1 

A  question  of  more  than  pathological  interest  was,  perhaps 
unintentionally,  brought  prominently  before  the  members  of 
the  Clinical  Society  at  its  last  meeting.  The  proposition 
may  be  briefly  stated  thus  : — Are  we  justified,  in  the  present 
state  of  pathological  knowledge,  in  pronouncing  certain 
lesions  of  the  brain  and  meninges  to  be  syphilitic,  from  their 
anatomical  characteristics  alone  ?  The  occurrence  of  small 
tumours,  varying  in  size  and  situation,  but  usually  scattered 
about  the  base  of  the  brain,  is  familiar  to  most  pathologists, 
and  these,  when  occurring  in  cases  of  undoubted  syphilis,  have 
been  universally  recognised  and  described  as  syphilitic  lesions. 
Other  tumours  not  unlike  them  are,  however,  found  in  associa¬ 
tion  with  miliary  tubercle,  and  these  have,  in  consequence, 
been  held  to  be  tubercular  in  character,  and,  in  fact,  to  have 
been  foci  of  auto-infection  for  the  acute  disease.  B  ut,  regarded 
from  the  standpoint  of  morbid  anatomy  only,  these  two 
varieties  of  tumour  appear  identical.  Perhaps,  with  the 
improved  and  daily  improving  means  of  identification,  it  will 
be  possible  to  differentiate  the  forms  of  bacteria  which 
respectively  inhabit  them,  and  so  to  tell  with  certainty  the 
tubercular  from  the  syphilitic  nodule.  W e  imagine,  however, 
that  most  of  our  readers  would  feel  disposed  to  agree  with 
Sir  Andrew  Clark  in  his  strongly  expressed  opinion  that  a 
positive  diagnosis  of  such  lesions  is  not  warranted  from  the 
anatomical  appearances  alone,  but  can  only  be  made  by  asso¬ 
ciating  these  appearances  with  the  clinical  history  of  the 
case.  This  opinion,  it  is  true,  is  not  universally  accepted, 
and  some  pathologists  feel  themselves  as  fully  justified  in 
diagnosing  the  syphilitic  nature  of  anatomical  changes  from 
their  appearance  alone,  as  are  the  large  majority  of  physicians 
in  recognising  syphilitic  changes  in  the  skin  and  other 
epidermal  structures  on  similar  grounds.  The  diagnosis  of 
syphilis  as  a  cause  of  anomalous  rashes  on  the  skin  is  made 
every  day,  without  a  tittle  of  evidence  being  adduced  in  it  s 
favour,  beyond  the  appearance  of  the  rash  itself  and  the 
probability  of  its  disappearance  after  specific  treatment. 
That  a  vast  amount  of  moral  injustice  is  thus  done  to  the 
living,  and,  in  the  case  of  post-mortem  appearances,  to  the 
memory  of  the  dead,  is  obvious,  and  for  that  reason,  in 
addition  to  the  scientific  interest  of  the  question,  the  subject 
deserves  more  careful  investigation  at  the  hands  of  patho¬ 
logists  than  has  hitherto  been  the  case.  That  certain 
definite  lesions,  not  differing  anatomically  from  one  another, 
can  be  respectively  associated  with  syphilis  and  with  miliary 
tubercle,  and  may  also  occur  with  complete  independence 
either  of  these,  seems  to  suggest  the  probability  that  a  third 
cause  must  be  at  work,  perhaps  upon  the  vascular  supply 
of  the  parts  affected,  of  which  we  are  at  present  in  complete 
ignorance. 

THE  HEALTH  OF  WEST  SUSSEX. 

The  exhaustive  and  elaborate  report  of  Dr.  Charles  Kelly  on 
the  condition  of  the  Combined  Sanitary  District  of  West 
Sussex,  for  the  year  1882,  is  just  issued.  It  is  a  work  of 
some  volume  (189  pages),  but  we  may  say  that  every  page 
will  repay  perusal,  and  especially  by  all  interested  in  the 
district  dealt  with.  The  statistical  and  other  tables  are 
most  carefully  compiled,  and  every  possible  information 


522 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Nov.  3,  1883. 


regarding  local  sanitary  matters  is  placed  in  a  short  and 
readable  form  before  the  public.  The  Combined  District  in¬ 
cludes  the  rural  localities  of  Steyning,  Horsham,  Petworth, 
Thakeham,  Midhurst,  East  Preston,  and  Westbourne,  and 
the  towns  of  Worthing,  Littlehampton,  and  Arundel — a 
population  of  96,220,  scattered  over  an  area  of  309,078  acres. 
The  population  here  increases  but  slowly,  a  constant  exodus 
taking  place  from  the  agricultural  districts,  whence  the 
young  people  flock  to  the  larger  towns  for  a  living.  Many 
parts  of  West  Sussex  are,  in  fact,  among  the  most  “truly 
rural  ”  of  England.  The  death-rate  is  low,  only  14  per  1000, 
as  against  19-6  for  all  England  and  Wales;  the  zymotic  death- 
rate  being  only  1\35  per  1000,  as  against  2’82  for  England 
and  Wales.  Interesting  particulars  regarding  local  outbreaks 
of  scarlatina,  diphtheria,  and  small-pox  will  be  found  in 
this  report.  The  facts  regarding  the  latter  disorder  we 
recommend  to  the  consideration  of  the  anti- vaccinationists. 
One  variolous  epidemic  was  traced  to  “rag-sorting”  at  a 
paper-mill.  All  local  questions  of  drainage  and  water-supply 
are  concisely  dealt  with,  and  the  meteorological  particulars 
are  unusually  complete.  Such  reports  as  this,  containing  a 
mass  of  condensed  information  of  not  merely  local  but 
national  interest,  should  be  read  by  all  students  of  public 
health.  It  is  from  them  that  the  statistical  particulars  must 
be  drawn,  upon  which  the  etiology  of  preventable  disease, 
and  the  whole  fabric  of  hygiene  as  a  science,  must  be  reared. 
Such  able  and  accurate  observations  as  these  from  West 
Sussex  must  add  materially  to  the  data  upon  which  the 
sanitation  of  the  future  will  be  based. 

THE  FALL  OF  THE  LEAF. 

With  the  universal  prevalence  of  damp  “  muggy”  weather, 
and  the  fall  of  the  leaf,  we  shall  probably  hear  the  more  or 
less  general  tale  of  complaints  which  are  attributed,  rightly 
or  wrongly,  to  the  depressing  effects  of  moisture,  absence  of 
sunshine,  and  decay  of  vegetation.  That  rheumatisms, 
catarrhs,  and  neuralgias  do  trace  their  origin  to,  and  draw 
their  strength  from,  the  climatic  conditions  of  damp  and 
cold  in  air  and  subsoil,  is  a  proposition  whose  truth  few  will 
be  found  to  doubt.  The  elaborate  researches  of  Dr.  Gabbett, 
as  recorded  recently  in  the  Lancet,  tend,  on  the  whole,  to 
strengthen  our  preconceived  ideas  on  the  subject.  The 
“  malarious  ”  origin  of  rheumatic  fever  must  remain  still  in 
the  field  of  etiological  theorisation,  as  difficult  of  demonstra¬ 
tion  as  of  disproof.  But  the  link  between  damp  “  under 
foot,”  rotting  leaves,  and  diphtheria  in  all  its  forms  (from 
the  malignant  type  to  the  “  spreading  quinsy  ”  of  some 
authors)  is  one  towards  the  strengthening  of  which  facts 
and  figures  should  still  be  sought  and  tabulated.  Dr. 
Charles  Kelly,  in  a  succession  of  able  reports,  to  the  last  of 
which  we  have  referred  above,  has  gone  some  way  towards 
showing  that,  in  most  of  the  rather  numerous  epidemics  of 
diphtheria  which  have  occurred  in  his  district  within  the 
last  few  years,  a  clear  connexion  may  be  traced  between 
the  disease  and  the  moist  condition  of  the  air  and  soil. 
Much  of  this  district  of  West  Sussex  lies  in  thickly  wooded 
rural  regions,  with  an  ill-drained  and  impervious  soil  of 
gault  or  weald  clay ;  and  it  is  in  these  parts  that  the  disease 
has  commonly  prevailed.  How  far  the  organic  emanations 
from  decomposing  leaves  and  vegetable  refuse  may  help  to 
supply  a  cause,  and  how  such  emanations  produce  their  dele¬ 
terious  effects,  are  problems  of  great  interest,  upon  which 
further  observations  may  throw  increased  light.  It  is,  at 
least,  possible  that  the  process  of  vegetable  decay  may 
favour  the  production  not  merely  of  new  chemical  com¬ 
pounds,  bub  of  some  disease-producing  micro-organisms,  in 
which  the  germ  of  diphtheritic  contagion  may  hereafter  be 
recognised  and  combated.  We  would  direct  the  energies 
of  observers  in  country  districts  to  these  points. 


ROYAL  COLLEGE  OF  SURGEONS  IN  IRELAND. 

On  Monday,  the  29th  ult.,  the  session  of  1833-84  was  in¬ 
augurated  by  an  address  delivered  by  Dr.  Arthur  Wynne 
Foot,  Professor  of  Practice  of  Medicine  in  the  School  of 
Surgery  attached  to  the  College.  In  the  course  of  the 
address.  Dr.  Foot  referred  to  the  institution  by  the  College 
of  sessional  examinations,  of  which  he  expressed  approval,, 
and  he  dwelt  at  length  on  the  nature  and  scope  of  the  studies 
to  be  pursued  in  each  session  of  the  student-course.  He 
reminded  his  hearers  that  the  course  of  education  on  which 
they  were  entering  was  one  admitting  of  no  delay,  and 
that,  after  all,  four  years  was  but  a  short  time  for  a  mind 
still  immature  to  be  occupied  in  mastering  and  digesting  so 
many  subjects  and  so  many  details.  They  ought  to  aim  at 
perfection.  Although  perfection  in  most  things  was  unat¬ 
tainable,  still  they  who  aimed  at  it  and  persevered,  who 
attacked  their  difficulties  again  and  again,  undaunted  by 
repulse,  would  come  much  nearer  to  it  than  those  whose 
indolence  and  despondency  made  them  give  it  up  as  hope¬ 
lessly  beyond  their  reach.  The  best  help  that  any  of  them 
could  take  advantage  of  was  self-help. 


BREAKING  DOWN  OF  A  UTERINE  FIBROID  DURING 

PREGNANCY. 

It  is  well  known  that  for  sloughing  and  suppuration  of 
uterine  fibroid  to  take  place  during  the  lying-in  period  is 
not  uncommon.  The  great  increase  in  the  vascularity  of 
the  uterus  which  takes  place  during  pregnancy,  usually 
leads,  on  the  contrary,  rather  to  increased  growth,  soften¬ 
ing,  and  oedema  of  these  tumours.  A  case  in  which,  during- 
pregnancy,  suppuration  and  sloughing  of  a  uterine  fibroid 
took  place,  and  which  is  recorded  by  Dr.  G.  Krukenberg, 
of  Bonn,  in  a  recent  number  of  the  Archiv  fur  Gynakologie , 
is  therefore  of  much  interest.  The  patient  was  aged  forty- 
three,  in  her  third  year  of  married  life,  and  pregnant  for 
the  first  time.  On  examining  the  abdomen  at  the  end  of 
the  fourth  month,  two  tumours  were  felt,  one  to  the  left 
(the  pregnant  uterus),  one  to  the  right,  the  fibroid.  A 
smaller  fibroid  was  situated  in  front,  but  as  this  underwent 
no  remarkable  change  we  need  not  again  refer  to  it.  As 
the  pregnancy  went  on,  the  tumour  became  painful,  there 
was  pyrexia  of  irregular  type,  and  the  patient  became 
very  prostrate.  In  the  fifth  month  of  pregnancy  an  ex¬ 
ploratory  incision  was  made,  in  the  belief  that  the  tumour 
on  the  right  might  be  an  abscess  requiring  evacuation  ;  but 
when  the  abdomen  was  opened  the  tumour  was  found  to  be  con¬ 
tinuous  with  the  uterus,  and  therefore  the  wound  was  closed. 
Thirteen  hours  afterwards  labour  came  on,  and  was  com¬ 
pleted  in  four  hours.  The  symptoms  subsequently  became 
more  marked,  the  patient  passed  into  a  typhoid  condition, 
and  died  on  the  sixth  day  after  the  operation.  The  autopsy 
showed  peritonitis :  the  tumour  to  the  right  of  the  uterus 
formed,  with  the  cellular  tissue  adjoining,  a  dirty-greyish, 
semi-fluid,  slimy  mass,  which  communicated  with  the  uterine 
cavity  by  an  opening  about  the  size  of  a  shilling.  Ort 
microscopical  examination,  muscular  fibres  were  found  in  the 
disintegrating  mass.  Dr.  Krukenberg  thinks  the  morbid 
process  probably  began  with  an  effusion  of  blood  between 
the  tumour  and  its  capsule,  cutting  off  its  nutritive  supply,, 
leading  to  sloughing  and  suppuration,  and  the  pus  making 
its  way  into  the  uterine  cavity.  He  has  only  been  able  to  find 
two  cases  on  record  at  all  resembling  this  :  one  reported  by 
Cappie,  in  which  a  subserous  fibroid  became  gangrenous 
during  pregnancy  from  twisting  of  the  pedicle  ;  and  another 
by  Hecker,  in  which,  on  autopsy  of  a  pregnant  woman  who 
died  from  pulmonary  tuberculosis,  and  had  no  other  symp¬ 
toms  than  those  referable  to  this  condition,  a  fibroid  was 
found,  softened  in  its  interior  into  a  reddish  pulp.  It  is 


Medical  Times  and  Gaeette. 


ANNOTATIONS. 


Nov.  3, 1883.  5  2  3 


interesting  to  note  tliat  a  pregnant  woman,  who  nursed  Dr. 
Krukenberg’s  patient,  became  herself  ill,  suffering  from 
irregular  pyrexia  without  apparent  cause.  She,  however, 
bore  a  healthy  child  and  recovered.  Dr.  Krukenberg  gives 
her  illness  the  ingenious  name  of  cryptogenetic  septico- 
pysemia. 


legitimate  and  175  illegitimate)  and  626  females  (454  legiti¬ 
mate  and  172  illegitimate)  ;  84  infants  were  either  born 
dead  or  died  within  twenty-four  hours,  viz.,  51  males  (30 
legitimate  and  21  illegitimate)  and  33  females  (16  legitimate 
and  17  illegitimate). 

PRACTICAL  LECTURES  AT  THE  HOSPITAL  FOR  WOMEN. 


THE  PARIS  NIGHT  SERVICE, 

In  his  report  for  the  quarter  ending  September  30,  Dr. 
Passant  states  (Gaz.  des  Hop.,  October  16)  that  the  total 
number  of  night  visits  paid  was  1659,  being  94  more  than 
those  for  the  same  quarter  in  1832.  Of  these  1659  visits, 
35  per  cent,  were  paid  to  males,  53  per  cent,  to  females,  and 
12  per  cent,  to  children  under  three  years  of  age.  The 
mean  number  of  visits  per  night  was  17'92  per  cent.,  and  in 
44  instances  the  person  was  dead  before  the  arrival  of  the 
medical  visitor.  Among  the  affections  for  which  the  visits 
were  paid,  there  were  84  cases  of  angina,  laryngitis,  and 
pertussis ;  28  of  croup  ;  184  of  diseases  of  the  respiratory 
organs  and  heart ;  85  of  various  forms  of  colic ;  20  of 
strangulated  hernia  ;  23  of  retention  of  urine  ;  338  of  dis¬ 
eases  of  the  nervous  system  ;  68  of  various  forms  of  haemor¬ 
rhage  ;  106  wounds  and  contusions  ;  26  fractures  and  dis¬ 
locations  ;  and  11  poisonings.  Rather  more  than  a  fifth  of 
the  whole  number  of  visits  (314)  were  paid  to  women  in 
labour  or  suffering  from  metritis  or  uterine  haemorrhage. 


THE  DURATION  OF  LABOUR. 

A  recent  number  of  the  Archiv  fur  Gynakologie  contains  a 
paper  by  Dr.  R.  Lumpe,  of  Vienna,  on  the  above  subject. 
He  has  noted  the  duration  of  labour,  counting  from  the  time 
when  the  pains  were  first  felt  by  the  patient,  in  1045  cases  ; 
and  he  finds  that  the  average  duration  of  the  process, 
measured  in  this  way,  was  sixteen  hours  and  a  half — a  result 
not  widely  different  from  that  reached  by  others  who  have 
investigated  the  question  in  the  same  way.  But  the  point 
■of  the  paper  is  this  :  that  in  the  last  week  or  fortnight  of 
pregnancy  there  takes  place,  first,  a  serous  infiltration,  a  kind 
of  oedema  of  the  cervix,  and  then  a  slight,  gradual,  and 
painless  opening  of  the  cervical  canal.  This,  Dr.  Lumpe 
•contends,  should  be  regarded  as  part  of  the  process  of  labour. 
He  gives  a  table  of  fifty  first  labours  observed  by  himself,  in 
which  he  examined  the  patients  during  the  last  fortnight  of 
pregnancy,  and  thus  was  able  to  observe  this  painless  opening 
•of  the  cervix  as  an  initial  sign  of  the  approach  of  labour- 
pains.  He  records  in  the  table  the  dates  at  which  the 
•cervical  canal  was  found  patent  enough  to  admit  the  finger, 
when  the  pains  began  to  be  felt,  and  when  delivery  took  place. 
His  observations  lead  him  to  the  conclusion,  as  wo  have  said, 
that  this  opening  of  the  cervix  begins  from  eight  to  fourteen 
•days  before  the  uterine  contractions  commence  to  be  painful. 
He  considers  that  it  is  effected  by  uterine  contractions  like 
those  which  Dr.  Braxton  Hicks  has  described  as  occurring 
throughout  pregnancy. 

THE  PARIS  WEEKLY  RETURN. 

The  number  of  deaths  for  the  forty-second  week  of  1883,  ter¬ 
minating  October  18,  was  989  (551  males  and  438  females), 
•and  of  these  there  were  from  typhoid  fever  41,  small-pox  3, 
measles  3,  scarlatina  1,  pertussis  12,  diphtheria  and  croup 
35,  erysipelas  2,  and  puerperal  infection  5.  There  were  also 
42  deaths  from  acute  and  tubercular  meningitis,  207  from 
phthisis,  18  from  acute  bronchitis,  49  from  pneumonia, 
•89  from  infantile  athrepsia,  and  34  violent  deaths  (28  males 
and  6  females).  A  very  slight  increase  of  deaths  has  taken 
place  upon  those  of  the  preceding  week,  while  epidemic 
diseases  continue  to  furnish  the  same  low  proportion.  The 
births  for  the  week  amounted  to  1254,  viz.,  628  males  (453 


The  staff  of  the  Soho  Hospital  for  Women  have  organised  a 
course  of  lectures  for  practitioners  and  students,  which,  judg¬ 
ing  from  the  state  of  the  theatre  at  those  which  have  hitherto 
been  given,  promise  to  be  successful.  Dr.  Hey  wood  Smith  is 
lecturing  on  Cervicitis,  its  Causes  and  Treatment,  and  has  one 
more  lecture  to  deliver  on  the  subject.  He  will  be  followed  by 
Dr.  Charles  Carter,  who  will  discourse  on  Ovariotomy ;  and 
the  first  course  will  be  completed  by  Mr.  Reeves  on  Tumours 
of  the  Breast  and  Stricture  of  the  Rectum,  followed  by  Dr. 
R.  T.  Smith  on  Cervical  Fissures  and  Emmet’s  Operation. 
The  subjects  are  all  of  a  practical  nature,  and  cannot  fail  to 
interest  and  instruct  the  practitioners  and  students  for  whom 
they  are  intended. 

CRUELTY  TO  HORSES. 

A  man  was  fined  lately  at  Newcastle  for  docking  a  horse 
Certainly  there  is  very  little  to  be  said  in  favour  of  this 
custom,  but  it  may  be  urged  that  the  pain  thus  inflicted 
is  small  in  comparison  to  that  induced  by  other  prac¬ 
tices  which  are  very  extensively  tolerated.  Far  more 
suffering  is  caused  to  horses  by  tight  bearing-reins 
than  by  docking.  The  discomfort  of  the  latter  may 
last  a  few  days,  whereas  the  intense  irritation  and  pain¬ 
ful  constraint  caused  by  a  bearing-rein  is  in  operation 
whenever  the  horse  is  placed  in  harness.  The  general 
public  are  guided  in  their  estimation  of  animal  suffering  by 
sentiment  rather  than  by  knowledge,  and  they  are  very 
much  impressed  by  the  idea  of  blood  being  spilt.  The 
surgeon,  on  the  other  hand,  who  has  studied  the  nature  of 
pain,  and  whose  whole  life  is  devoted  to  its  removal  or  its 
amelioration,  well  knows  that  the  sensation  caused  by  an 
incision  with  a  knife  is  often  very  trivial  in  comparison  with 
many  other  kinds  of  suffering  in  which  no  blood  is  shed,  and 
which  to  the  uninitiated  may  seem  less  serious.  He  is  also  able 
to  duly  estimate  the  suffering  caused  by  the  cramped  position 
of  horses’  heads  produced  by  tight  bearing-reins — a  universal 
and  useless  form  of  cruelty  which  receives  no  punishment, 
and  is  rarely  even  disapproved.  Many  a  well-meaning 
owner  of  horses  and  carriages  allows  his  animals  to  be 
tortured  for  six  days  in  every  week,  who  would  shudder  at 
the  thought  of  the  decapitation  of  a  frog. 


The  Library  of  the  Obstetrical  Society  of  London  will  be 
open  on  the  evenings  of  the  meetings  of  the  Society  from 
7.15  to  7.45  p.m.  _ 

A  readership  of  .£200  per  annum  is  to  be  attached  to 
the  Professorship  of  Botany  at  Oxford,  now  vacant,  but 
shortly  to  be  filled.  The  emoluments  of  this  chair  will  thus 
be  raised  to  .£500  per  annum. 

The  total  number  of  new  entries  for  the  present  session 
at  the  University  of  Durham  College  of  Medicine,  Newcastle- 
on-Tyne,  is  68,  of  whom  25  are  full  students,  and  43  partial 
students  who  have  entered  for  the  purpose  of  obtaining  the 
degrees  of  the  University. 


It  is  stated  that  Dr.  James  Stannus  Hughes,  the  efficient 
and  courteous  Secretary  to  the  Council  of  the  Royal  College 
of  Surgeons  in  Ireland,  is  about  to  resign  the  post  he  has  so 
long  filled  with  such  credit  to  himself  and  advantage  to  the 
College.  Dr.  Hughes’s  successor  has  not  yet-been  named. 

fM/HADFORDNt 

A  l  i.a  At-,.  .  r 


524 


Medical  Times  and  Gazette. 


OPENING  OF  THE  MEDICAL  SESSION  AT  EDINBURGH. 


Nov.  3, 1883. 


MM.  Charcot,  Aten,  and  Sappey  are  candidates  for  the 
chair  in  the  Medical  Section  of  the  Paris  Academy  of 
Sciences,  left  vacant  by  the  death  of  Baron  Cloquet.  M. 
Jules  Guerin,  who  was  supported  by  a  very  respectable 
minority  at  a  former  election,  has  not  yet  sent  in  his 
application.  _ 

At  Glasgow,  the  winter  session  of  the  medical  schools  of 
the  University,  of  the  Royal  Infirmary,  and  Anderson’s 
College  were  opened  on  the  30th  ult.,  when  inaugural  ad¬ 
dresses  were  delivered  by  Prof.  Young  at  the  University, 
Dr.  James  Stirton  at  the  Royal  Infirmary,  and  Dr.  A. 
Wallace  at  Anderson’s  College. 

The  first  meeting  this  session  of  the  Epidemiological 
Society  of  London  will  be  held  in  the  Council  Room  of 
University  College,  on  Wednesday,  November  7,  at  8  p.m. 
The  President,  Dr.  Norman  Chevers,  C.I.E.,  will  deliver  an 
inaugural  address  on  the  subject  of  “ Medico-Topographical 
and  Health  Histories  for  Districts  and  Towns,”  which  will 
appear  in  full  in  our  next  issue. 

In  our  number  for  August  18,  p.  191,  we  gave  an  account 
of  Prof.  Tarnier’s  remarkable  case  of  ectopia  of  the  heart, 
read  at  the  Academy  of  Medicine,  and  referred  to  a  com¬ 
mittee  of  which  M.  Maury  was  the  reporter.  The  Bulletin 
of  the  Academy  for  October  16  contains  a  long  report  from 
this  observer,  giving  a  detailed  description  of  his  investiga¬ 
tion  of  the  case,  accompanied  by  numerous  traces. 


We  regret  to  learn  that  Sir  Prescott  Hewett  has  retired 
from  practice— a  step  which  will  no  doubt  be  felt  as  a  great 
loss  not  only  in  the  profession,  but  also  amongst  the  general 
public.  His  surgical  skill,  straightforwardness,  and  kindli¬ 
ness  of  manner  endeared  him  and  gave  confidence  to  all  with 
whom  he  met.  It  is  satisfactory  to  hear  that  his  retire¬ 
ment  is  not  due  to  ill-health,  and  we  trust  that  he  may 
have  long  life  and  health  to  enjoy  his  well-earned  rest  from 
the  toils  of  an  arduous  profession. 

It  is  Avith  regret  that  we  have  to  report  the  serious  illness 
of  Dr.  Charteris,  Professor  of  Materia  Medica  in  Glasgow 
University.  At  the  outset  it  was  hoped  that  it  would  be  of 
short  duration,  but  this  hope  has  not  been  realised.  The 
Senatus  Academicus  have  deemed  it  advisable  to  grant  him 
six  months’  leave,  at  the  end  of  which  time  it  is  trusted  that 
he  will  have  regained  his  health.  In  the  meantime  his 
assistant,  Dr.  Alexander  Napier,  has  been  requested  by  the 
Senatus  to  deliver  the  lectures  during  the  winter  session. 

At  the  meeting  of  the  St.  Pan  eras  Yestry  held  on  Wed¬ 
nesday  afternoon,  Mr.  Robinson,  the  chairman  of  the 
Sanitary  Committee,  stated  that  he  Avas  glad  to  be  able  to 
inform  the  public  that  the  epidemic  had  subsided,  and  that 
during  the  past  week  not  a  single  case  from  St.  Pancras 
had  been  admitted  into  the  London  Fever  Hospital.  All 
the  circumstances  of  the  St.  Albans  (Hertfordshire)  cases 
had  been  investigated  by  the  Medical  Officer  of  Health,  Dr. 
C.  E .  Saunders,  who  had  been  absent  during  the  early  part 
of  Dr.  Murphy’s  inquiry,  but  had  since  returned  to  town. 
Dr.  Saunders,  as  the  result  of  his  investigations,  states 
that  he  fully  concurs  in  all  the  conclusions  at  which  the 
Medical  Officer  of  St.  Pancras  had  arrived. 


Hospital  Sunday  at  Brighton. — Last  Sunday  was 
set  apart  as  Hospital  Sunday  in  Brighton,  and  collections 
were  taken  in  nearly  sixty  churches  and  chapels.  This 
is  the  first  time  such  an  idea  has  been  carried  out,  and 
the  result,  according  to  the  returns  received,  was  most 
encouraging. 


THE  OPENING  OF  THE  MEDICAL  SESSION 
AT  EDINBURGH. 

The  winter  session,  both  at  the  University  and  the  School 
of  Medicine,  was  opened  last  week,  when  several  of 
the  professors  and  lecturers  gave  introductory  lectures-. 
There  was  a  crowded  attendance  in  the  Surgery  Class-room 
to  hear  Prof.  Chiene’s  opening  address.  At  the  outset  he 
congratulated  the  students  upon  the  fact  that  they  were 
assembled  in  their  own  class-room.  In  teaching  them,  he 
said,  he  was  not  merely  going  to  collect  all  that  had  been 
done  and  said  by  others,  but  he  was  going  to  try,  after 
studying  the  subject,  to  give  them,  as  far  as  he  could,  the 
best  vieAV  with  regard  to  each  thing.  Of  course  there  Avas 
a  danger  in  this,  that  he  might  be  one-sided.  He  had  to 
take  care  in  trying  to  instil  principles  that  they  were1  self- 
evident  and  true.  One  of  his  endeavours  would  be  to  en¬ 
courage  the  individuality  of  every  student.  The  great 
danger,  owing  to  the  size  of  the  school,  Avas  that  indi¬ 
viduality  might  be  interfered  with.  If,  instead  of  having- 
hundreds,  he  had  only  a  dozen  of  students,  he  could  address 
all  individually.  That  was  impossible  in  a  large  school,, 
and  the  difficulty  could  only  be  overcome  by  very  efficient 
assistants,  and  the  development,  as  far  as  possible,  of  the 
tutorial  system  of  instruction.  Prof.  Chiene  afterwards 
gave  a  short  lecture  on  health  and  disease. 

Prof.  Rutherford  delivered  his  opening  address  in  the  Physi¬ 
ology  Class-room,  on  Human  Life,  its  Condition,  its  Manifesta¬ 
tion,  its  Beginning,  and  its  End.  The  history  of  physiology, 
he  said,  was  wrapped  up  in  that  of  medicine,  and  he  gave  a 
brief  outline  of  it  from  the  days  of  Hippocrates.  During 
Aristotle’s  time,  Alexandria  became  the  birthplace  of  physical 
science ;  and  experimental  science,  starting  from  Alexandria, 
had  enabled  them  to  comprehend  many  great  natural  pheno¬ 
mena.  But,  even  with  that  experience,  it  was  difficult  to  find 
rulers  who  Avould  support  scientific  research.  In  Germany 
there  had  been  many  Ptolemys,  and  the  result  was  that  Ger¬ 
many  was  at  the  head  of  science.  In  this  country  there  were 
signs  of  awakening  in  this  respect,  but  it  came  somewhat*, 
late,  although  not  too  late  in  the  everlasting  day  of  science. 
There  was  no  difficulty  in  finding  men,  filled  with  the 
scientific  spirit,  who  were  Avilling  to  sacrifice  the  luxuries  of 
life  to  the  study  of  science  for  its  own  sake,  but  the  diffi¬ 
culty  was  money.  If  they  had  not  other  means  of  support 
they  must,  as  in  Alexandria,  live  at  the  king’s  expense  or 
upon  the  liberality  of  those  Avho  endowed  research.  Aristotle’s, 
chief  claim  to  their  gratitude  was  in  founding  a  medical 
school  at  Alexandria,  and  in  dissecting  many  animals  and 
recording  his  observations.  Passing  over'.other  discoverers, 
it  became  England’s  turn  to  initiate  something,  and,  through 
the  genius  of  Harvey,  England  contributed  the  greatest  of. 
all  physiological  discoveries — the  truth  as  to  the  circulation, 
of  the  blood.  But  there  were  anti-vivisectors  in  those  days 
who  did  not  hesitate  to  use  opprobrious  epithets.  Physio¬ 
logical  knoAvledge  had  been  obtained  by  the  method  of  ex¬ 
periments  on  animals  and  on  the  human  subject.  The  ex¬ 
perimental  method  had  far  more  power  than  the  method  of 
mere  observation  as  a  means  of  discovery.  Animals  were  used 
for  experiments  which  could  not  be  conveniently  performed 
on  man.  Of  course,  it  must  be  admitted  that  there  were 
many  points  of  specific  difference  between  man  and  other 
vertebrates,  but  the  result  of  experiments  on  animals  Avas 
an  index  of  what  might  be  expected  to  hold  true  in  man. 
It  was  merely  presumptive  evidence  until  its  truth  had  been 
proved,  but  so  well  known  Avas  the  value  of  that  presump¬ 
tive  evidence,  that  if  anyone  tried  on  a  human  being  the 
effect  of  some  new  substance,  he  would  be  indicted  for  man¬ 
slaughter  if  the  patient  died.  That  fact  was  perhaps  as  good 
an  answer  as  any  to  the  idle  talk  of  some  persons.  He  had 
no  sympathy  Avith  those  short-sighted  people  who  imagined 
that  when  once  a  fact  had  been  ascertained  it  was  unneces¬ 
sary  to  repeat  the  experiment.  But,  although  they  could' 
give  no  countenance  to  such  idle  fancies,  they  must  keep  in 
mind  that  they  had  to  deal  with  a  delicate  subject,  and 
that  it  was  desirable  to  avoid  those  experiments  which  in¬ 
volved  pain  unless  they  could  be  done  under  the  influence 
of  anaesthetics — a  course  resolved  upon  by  physiologists, 
before  there  Avas  any  talk  about  vivisection.  In  the  class- 


Medical  Times  and  Gazette. 


OPENING  OF  THE  MEDICAL  SESSION  AT  EDINBURGH. 


Nov.  3,  1833.  52^ 


room  the  experiments  for  teaching  purposes  were  all  pain¬ 
less.  The  lecture  was  illustrated  by  experiments  with  frogs, 
as  showing  the  effects  produced  by  injury  to  particular  parts 
of  the  system. 

Prof.  Greenfield,  in  opening  his  Pathology  Class,  remarked 
that  the  most  recent  pathological  discovery — the  cholera 
bacillus — was  only  a  further  advance  in  a  course  which 
could  not  long  be  delayed ;  and,  however  important  in  its 
results  as  to  public  health,  it  was  not  a  revolution,  but  an 
evolution,  of  the  science.  Pathology,  he  went  on  to  say, 
meant  a  science  of  disease ;  or,  in  other  words,  it  was  the 
science  which  sought  to  record  and  explain  all  that  was 
made  known  about  disease — its  causes,  processes,  and  results. 
Physiologists  just  now  were  rather  fond  of  asserting  that 
pathology  was  only  a  branch  of  physiology ;  but  he  held  that 
physiology  and  pathology  were  sister  sciences,  both  con¬ 
cerned  in  the  study  of  biology,  the  one  under  normal,  and 
the  other  under  abnormal  conditions.  Prof.  Greenfield  then 
adverted  at  some  length  to  the  symptoms  and  causes  of 
various  diseases,  remarking  that  a  great  part  of  the  work 
of  the  students  of  pathology  would  consist  in  observations 
of  simple  facts,  and  indicated  the  course  he  proposed  to 
follow  during  the  session.  He  need  scarcely  enlarge,  he  said, 
upon  the  utility  of  the  science.  Whether  now  or  in  their 
future  career,  their  usefulness  must  largely  depend  on  their 
practical  acquaintance  with  the  laws  of  pathology;  they 
must,  in  fact,  if  they  were  thoughtful  physicians  and 
surgeons,  think  and  act  according  to  their  pathology.  They 
would  speak  the  language  even  if  they  did  not  understand 
the  grammar,  for  pathology  was  the  scientific  basis  of  medi¬ 
cal  and  surgical  science.  Except  as  related  to  pathology, 
of  what  service  was  physiology  ? 

Prof.  Grainger  Stewart  met  his  students  for  the  first  time 
since  he  was  laid  aside  by  illness  early  last  winter  session. 
He  devoted  the  greater  part  of  the  hour  to  an  exposition  of 
the  very  valuable  results  which  he  had  recently  had  such 
excellent  opportunity  of  observing  from  the  treatment  of 
rheumatism  followed  at  Aix-les-Brins.  Commenting  on  the 
method  of  treatment  there  pursued,  he  said  that  the  internal 
use  of  the  waters  was  comparatively  unimportant,  the  great 
reliance  of  the  Aix  doctors  being  placed  upon  the  baths  and 
the  attendant  system  of  shampooing  and  manipulation.  The 
treatment  was,  he  was  convinced,  of  extraordinary  value  in 
the  following  rheumatic  conditions: — (1)  In  the  way  of 
removing  the  joint  thickenings  and  stiff enings  which  so 
often  remained  after  attacks  of  acute  rheumatism ;  (2)  in 
chronic  rheumatism,  where  a  slow  inflammatory  action  was 
going  on  in  and  around  the  joints,  in  removing  the  inflam¬ 
matory  products  and  diminishing  the  tendency  to  renewed 
inflammation ;  (2)  in  alleviating  rheumatic  affections  of  the 
muscles  and  fasciae  and  nerve- sheaths,  as  in  lumbago,  pleu¬ 
rodynia,  and  sciatica ;  (4)  in  counteracting  the  wasting  of 
muscles  which  so  often  occurred  in  connexion  with  rheu¬ 
matic  processes,  by  means  of  the  skilled  manipulation 
and  shampooing,  often  along  with  electrical  stimulation ; 
and  (5)  in  connexion  with  slight  rheumatic  threaten¬ 
ing?,  the  use  of  the  vapour-bath  often  sufficing  to  prevent 
further  development  of  the  disease.  The  facts  as  to  these 
results  were  incontestable,  but  the  explanation  of  their 
cause  was  rather  more  difficult.  Probably,  climate  had 
something  to  do  with  it.  The  chemical  activity  of  the 
water,  which  was  not  great,  could  not  explain  it ;  it 
must  be  the  temperature  of  the  water,  which  ranged 
from  112°  to  114°  Fahr.,  and  the  abundance  of  the  supply, 
that  were  of  special  importance,  combined  with  the  skill  of 
the  bathmen  and  bath  wo  men.  Lastly,  the  skill  and  atten¬ 
tion  of  the  doctors  was  beyond  all  praise.  He  had  two  sug¬ 
gestions  to  offer  in  the  way  of  improvements.  First,  he 
should  require  a  more  simple  and  more  wholesome  dietary 
than  was  now  got  at  some  of  the  hotels.  Were  this  done, 
one  might  confidently  look  for  better  and  more  speedy 
results.  Next,  he  thought  that  a  valuable  improvement 
would  be  brought  about  by  the  establishment  of  Zander’s 
machines  for  effecting  passive  and  active  movements  in  the 
joints,  on  the  plan  followed  at  Stockholm  and  in  London. 
This  plan,  he  was  persuaded,  would  be  advantageously  fol¬ 
lowed  at  Aix-la-Chapelle,  Vichy,  Carlsbad,  Buxton,  Hroit- 
wich,  Harrogate,  and  Bath.  It  would  help  the  waters,  and 
these,  in  turn,  would  render  the  Zander  institutes  more 
efficient  than  they  were  where  no  baths  existed ;  and,  com¬ 
bined,  they  would  afford  a  far  more  satisfactory  means  than 
the  profession  now  possessed  of  treating  this  condition. 


Hr.  Stevenson  Macadam,  in  opening  his  course  of  instruc¬ 
tion  in  the  Surgeons’  Hall,  took  up  the  subject  of  Sanitary 
Chemistry.  The  lecturer  pointed  out  the  great  importance 
of  sanitary  science  as  peculiarly  affecting  the  comfort  and 
the  happiness  of  the  human  race.  Within  the  last  few 
years,  he  said,  sanitary  science  had  made  rapid  progress,  and 
the  result  was  so  marked — a  decreased  mortality  everywhere- 
following  the  introduction  of  sanitary  reform — that  the  sub¬ 
ject  demanded,  and  to  some  extent  was  receiving,  more 
attention  than  it  ever  received  before.  Hr.  Macadam  gave- 
several  striking  illustrations  of  the  beneficial  results  of  the 
adoption  of  sanitary  reform  on  scientific  principles.  Taking- 
first  the  British  Army,  it  had  been  ascertained  that,  before 
the  introduction  of  sanitary  reforms,  the  mortality  in  the 
infantry  was,  generally  speaking,  at  the  rate  of  179  per  1000  ; 
after  the  introduction  of  sanitary  reform  it  fell  to  7'6  per 
1000.  In  the  same  way  the  rate  of  mortality  in  the  case  of' 
the  Foot  Guards  had  fallen  from  20*4  per  1000  to  9T  ;  and  in 
the  case  of  the  Royal  Artillery,  from  13'9  per  1000  to  8-0  per* 
1000.  Taking  towns,  it  had  been  ascertained  that  the 
average  rate  of  mortality  was  about  2S  per  1000  ;  but  after  the 
introduction  of  sanitary  reform  that  rate  came  down  to  21 
per  1000.  In  other  words,  the  difference  lay  in  the  pro¬ 
portion  of  four  to  three  ;  for  four  deaths  that  occurred  before- 
sanitary  science  came  to  be  carried  out  in  practice,  three 
occurred  after  that.  Hr.  Macadam  mentioned  one  curious 
fact  brought  out  by  the  observation  of  the  French  army 
authorities.  At  one  time  there  was  what  might  be  called  an 
enormous  mortality  amongst  the  French  cavalry  horses ;  the 
rate  was  as  high  as  from  180  to  197  per  1000  every  year;, 
various  diseases  were  constantly  breaking  out.  A  change 
was  introduced:  better  stables  were  kept;  more  attention 
came  to  be  paid  to  sanitary  conditions.  The  result  was  that 
the  rate  of  mortality  was  brought  down  to  68  per  1000.  And 
during  the  Italian  war,  when  the  horses  had  little  shelter 
— covered  occasionally  in  inclement  weather,  but  always  in. 
possession  of  plenty  of  fresh  air, — the  rate  of  mortality  fell 
to  the  wonderfully  low  rate  of  one  or  two  per  1000.  All  these 
facts  were  important  as  showing  that  increased  attention, 
to  sanitary  conditions  must  carry  with  it  an  enhancement 
of  the  comfort  and  the  welfare  of  man.  This  led  up  to  the  con¬ 
sideration  of  some  points  connected  with  sanitary  chemistry. 
Hr.  Macadam  pointed  out  the  supreme  importance  to  man 
of  pure  air,  and,  therefore,  the  importance  of  air  as  a  factor 
in  sanitary  matters.  The  water-supply  of  a  house  was  com¬ 
prehended  in  a  comparatively  small  capacity,  and  the  solid 
food  a  man  required  might  be  measured  by  handfuls ;  but. 
of  air  every  man  consumed  1,000,000  cubic  inches  daily,  or 
500  cubic  feet,  or,  to  measure  it  in  another  way,  3000  gallons. 
The  meaning  of  this  was  that  a  man  required  to  inhale 
two  gallons  of  air  every  minute  he  lived.  This  air  was  never 
free  from  dust — the  haze  of  the  atmosphere  and  minute 
particles  of  organic  matter,— and  Hr.  Macadam,  by  a  series 
of  interesting  experiments,  proceeded  to  show  how  the  pre¬ 
sence  of  particles  or  impurities  can  with  ease  and  certainty 
be  demonstrated.  Other  experiments  followed,  the  object¬ 
being  to  show  clearly  the  means  by  which  the  presence  of 
organised  particles  and  poisonous  gases  may  be  detected  in 
the  air,  and  to  impress  on  the  students  the  fact  that  the 
exhalations  of  man  were  always  charged  with  the  poison 
which  was  thrown  off  by  a  burning  candle — carbonic  acid. 

The  Chemistry  Class  was  opened  by  Prof.  Crum  Brown 
within  the  New  University  Buildings.  There  was  a  large 
attendance  of  students,  the  spacious  class-room  being  crowded- 
in  every  part.  The  Professor  said  he  felt  it  would  be  im¬ 
proper  to  enter  upon  their  work  in  this  beautiful  building 
without  in  some  way  expressing  their  obligation  to  those 
who  had  provided  it,  and  their  hope — their  determination,  as 
far  as  it  depended  on  them— that  the  founders’  intention 
should  be  carried  out.  That  intention  was,  that  there  medi¬ 
cine  and  the  sciences  upon  which  medicine  depended  should 
be  studied  in  the  most  thorough,  the  most  practical,  the  most 
successful  manner.  They  naturally  looked  back  on  the  old 
site  which  they  had  left,  and  thought  of  the  memories, 
associated  with  it  and  with  the  two  chemical  class-rooms 
which  one  after  the  other  were  erected  there.  There  lectured 
Cullen,  the  wise  and  scientific  physician  ;  Black,  the  genius 
to  whom  in  great  part  they  owed  the  revolution  which  made 
chemistry  what  it  now  was ;  Hope,  the  clear  and  elegant, 
lecturer ;  the  learned  Gregory ;  and  Playfair,  who,  by  his 
practical  ability  and  remarkable  organising  power,  created 
a  good  teaching  laboratory  under  the  most  unfavourable 


526 


Medical  Times  and  Gazette. 


ABSTRACTS  AND  EXTRACTS. 


Nov.  3, 1883. 


conditions.  When  the  University  buildings  which  they 
had  just  left  began  to  be  occupied,  there  was,  as  now,  a 
crowd  of  medical  students — then,  as  now,  gathered  from  all 
parts  of  the  world.  That  was  a  busy  time  in  the  medical 
schools.  All  Europe  was  inarms,  andpestilence  followedin  the 
footsteps  of  war.  Army  and  navy  surgeons  fell  fast,  and  the 
supply  scarcely  kept  pace  with  the  demand.  Let  them  hope 
that  it  might  be  long  before  such  a  cause  of  prosperity  re¬ 
curred.  After  alluding  to  recent  changes  in  the  constitution 
•of  the  University,  Dr.  Crum  Brown  went  on  to  say  that  though 
a  good  constitution  was  desirable,  there  was  something  far 
more  important.  That  was  the  real  life  of  the  University  — 
■the  work  done  in  it.  In  this  there  had  been  a  change  deeper 
.and  wider  than  any  modification  of  the  form  of  government. 
Formerly  the  teaching  in  their  Faculty  wTas  carried  on  ex¬ 
clusively  by  means  of  lectures.  Gradually  and  slowly  the 
change  was  made.  The  removal  of  difficulties  created  by 
law  rendered  the  class  of  practical  anatomy  possible ; 
practical  teaching  followed,  until  now  there  was  no  branch 
•of  the  medical  curriculum  in  which  a  student  could  not 
obtain  practical  instruction,  and  gain  real  personal  acquaint¬ 
ance  with  the  things  about  which  he  heard  in  the  lecture- 
room.  There  were  some  who  spoke  of  practical  classes  as  a 
new  burden  laid  on  students,  retarding  their  progress,  and 
making  their  work  more  difficult.  He  would  remind  some 
of  those  objectors  to  the  new  modes  of  study  that  what  a 
medical  student  required  was  not  so  much  an  extensive  as  a 
sound  knowledge  of  the  fundamental  sciences.  Practical 
classes  did  not  increase  their  work,  but  rendered  it  easier. 
In  conclusion,  the  Professor  briefly  referred  to  the  applica¬ 
tion  of  the  principles  of  chemistry  to  medicine  and  other 
arts. 

In  opening  his  Class  of  Materia  Medica  in  the  New  Univer¬ 
sity  Buildings,  Prof.  T.  R.  Fraser  remarked  that  he  joined 
■with  his  colleagues,  the  greater  number  of  whom  were  already 
in  possession  of  their  new  rooms  and  laboratories,  in  express¬ 
ing  satisfaction  with  the  beauty  and  excellence  of  their  new 
abode.  He  joined  with  them  also  in  expressing  the  fullest  ap¬ 
preciation  of  the  public-spirited  liberality,  the  intelligent  con¬ 
ception  of  the  value  and  present  scope  of  medical  education, 
and  the  conspicuous  success  in  meeting  their  requirements, 
which  had  resulted  in  the  completion  of  one  of  the  most  im¬ 
portant  undertakings  in  the  city,  and  in  the  history  of  medical 
progress  and  education.  In  these  buildings  there  would  be 
preserved  the  results  of  experience  and  observation,  destined, 
it  was  hoped,  to  be  imparted  to  many  generations  of  disciples. 
The  subject  to  which  that  lecture-theatre  and  adjoining 
rooms  were  henceforth  to  be  devoted  enjoyed  the  singular 
privilege  that,  although  it  was  originated  more  than  2000 
years  ago,  its  name  had  remained  unchanged,  and  the  accep¬ 
tation  of  it  had  received  no  important  modification  to  the 
present  time.  After  adverting  to  the  early  history  of  materia 
medica.  Prof.  Fraser  gave  a  graphic  sketch  of  the  progress  it 
had  made  as  a  branch  of  medical  education  in  Edinburgh. 
At  length  a  science  of  pharmacology  had  been  founded,  and 
its  importance  as  a  branch  of  medicine  was  for  the  first  time 
definitely  acknowledged  in  the  University  in  the  arrange¬ 
ments  of  that  department.  At  present  the  art  of  medicine, 
“the  practice  of  physic  in  its  practical  workings,  was  only 
loosely  associated  with  science.  It  was  protected  from 
crude  fallacies  by  contact  here  and  there  with  a  relatively 
•small  number  of  ascertained  facts  which  controlled  and 
guided  its  doings — much  as  the  two  parallel  walls  of  a  high¬ 
way  controlled  the  erratic  course  of  an  inebriate,  whose  pro¬ 
gress  would  be  altogether  impossible  without  their  assistance. 
In  conclusion,  the  learned  Professor  referred  to  the  increased 
provision  which  had  been  made  for  the  general  teaching  and 
study  of  materia  medica  in  its  several  branches,  which  he 
believed  to  be  in  every  respect  worthy  of  the  educational 
reputation  of  the  University. 


University  of  Cambridge.  —  The  examiners  for 
medical  and  surgical  degrees  for  the  current  academical 
year  are  : — First  M.B. :  Dr.  S.  H.  Vines,  Prof.  Garnett,  and 
Mr.  Pattison  Muir.  Second  M.B. :  Prof.  Paget,  Prof. 
Milnes  Marshall,  Dr.  Gaskell,  and  Mr.  Shuter.  Third 
M.B. :  Prof.  Joseph  Lister,  Mr.  Davies-Colley,  Dr.  Matthews 
Duncan,  Prof.  Paget,  Dr.  O.  Sturges,  and  Dr.  Handheld 
J ones.  B.C.  and  M.C. :  Prof.  Humphry,  Prof.  Joseph  Lister, 
and  Mr.  Davies-Colley.  M.D. :  Prof.  Paget  and  Dr.  Reginald 
Thompson. 


ABSTRACTS  AND  EXTRACTS. 


Chlorate  of  Potash  Poisoning. 

Drs.  Broesicke  and  Schadewald  report  a  case  ( Berliner 
Klinische  Wochensclirift,  No.  42,  1883)  of  rapid  poisoning 
by  chlorate  of  potash  in  a  healthy  young  man,  aged  twenty- 
two.  After  excessive  and  incautious  gargling  with  a  strong 
solution  for  some  trifling  throat  affection,  in  the  course  of 
which  he  had  swallowed  a  considerable  quantity,  the  patient 
complained  on  the  following  day  of  sickness  and  of  pain 
in  the  sides  and  loins.  Signs  of  acute  gastritis  rapidly 
followed ;  nausea  and  severe  pain  in  the  splenic  region  were 
the  chief  symptoms.  Some  enlargement  of  the  spleen 
could  be  detected.  Heart  and  lungs  were  normal ;  but 
distinct  cyanosis,  especially  of  lips  and  extremities,  was 
present.  Two  days  after  the  poisoning,  severe  vomiting 
set  in,  and  lasted  to  the  end.  Icterus  followed,  but  dis¬ 
appeared  before  death.  On  the  fourth  day,  severe  epistaxis 
occurred ;  extreme  praecordial  anxiety  followed,  but  without 
any  notable  signs  in  heart  or  lungs ;  and  some  rigidity  of 
the  muscles  of  the  extremities  was  observed.  Death  took 
place  on  the  eighth  day.  Throughout  the  whole  period 
of  illness  hardly  any  urine  was  passed  ;  the  temperature 
remained  a  little  below  the  normal ;  the  pulse,  however,  was 
of  fair  strength.  The  post-mortem  examination,  made  four 
days  after  death,  revealed  a  brown  discolouration  of  the 
blood  in  the  vessels.  This  blood,  however,  gave  the  normal 
appearance  to  the  spectroscope.  The  spleen  was  very 
greatly  enlarged,  brownish  in  places,  the  capsule  soft.  The 
kidneys  were  also  enlarged,  the  cortical  portions  expanded 
and  of  a  dirty  green  colour.  Microscopically,  the  straight 
and  convoluted  tubules  were  found  filled  with  numerous 
brownish,  irregular-shaped  masses  of  haemoglobin.  The 
stomach  showed  acute  and  chronic  catarrh,  with  a  few  ecchy- 
moses.  The  large  intestine  and  rectum  contained  a  large 
quantity  of  brownish,  watery  fluid,  and  the  mucous  mem¬ 
brane  appeared  cedematous.  Other  organs  normal. 


The  Contractions  of  the  Uterus. 

A  recent  number  of  the  Zeitschrift  fur  Geburtshiilfe  und 
Gvjnalcologie  contains  a  paper  by  Dr.  Richard  Frommel,  of 
Munich,  which  we  may  briefly  mention,  as  it  contains  an  ac¬ 
count  of  an  investigation  carried  on  in  a  method  which 
scientific  workers  in  this  country  are  precluded  from  using — 
viz.,  by  experiments  on  living  animals.  Dr.  From  melts  object 
was  to  throw  light  on  the  physiology  of  uterine  contrac¬ 
tion.  He  employed  an  elaborate  apparatus,  which  it  would 
take  up  too  much  space  for  us  to  describe,  but  the 
essential  parts  of  which  were  tubes  inserted  into  the 
uterine  cornua  of  rabbits,  and  connected  with  a  mano¬ 
meter  and  a  kymograph,  so  that  every  contraction  of 
the  uterus  was  at  once  registered  in  a  graphic  manner. 
With  these  were  combined  various  other  measures,  having 
for  their  object  to  prevent  accidental  conditions,  such  as 
muscular  action,  cold,  etc.,  from  affecting  the  uterus,  and  so 
vitiating  the  experiments.  The  chief  points  of  interest  in 
the  results  obtained  by  Dr.  Frommel  are  these  : — First,  that 
in  rabbits  spontaneous  rhythmical  contractions  of  the  uterus 
occur.  (Similar  contractions,  most  students  are  aware,  have 
been  pointed  out  as  occurring  in  pregnant  women  by  Dr. 
Braxton  Hicks.)  These  contractions  are  stronger  and  more 
regular  in  proportion  to  the  degree  of  development  of  the 
uterus,  being  strongest  in  pregnancy,  least  in  the  infantile 
uterus.  Lowering  of  the  body-heat  causes  the  contractions 
to  occur  more  slowly,  but  does  not  lessen  their  energy. 
Elevation  of  the  temperature  at  first  accelerates  their 
rhythm,  but  a  fever  temperature  causes  them  to  cease 
altogether.  Regular  uterine  contraction  is  therefore  de¬ 
pendent  upon  a  normal  condition  of  the  body-heat.  Altera¬ 
tions  in  the  circulation  also  powerfully  affect  these  contrac¬ 
tions.  They  are  abolished  quickly  by  compression  of  the 
aorta,  and  more  slowly  by  compression  of  the  vena  cava. 
They  are  not  dependent  upon  any  nervous  centre  outside 
the  uterus,  the  ganglia  within  the  organ  itself  supplying 
the  nervous  force  for  their  production,  although  they  may 
be  affected  by  nervous  influences  coming  from  other  centres, 
the  uterine  action  in  this  respect  being  analogous  to  that 
of  the  heart. 


Medical  Times  and  Gazette. 


EE  VIEWS  AND  NOTICES  OF  BOOKS. 


Nov.  3, 1883.  527 


‘'The  Improved  Caesarian  Section.” 

Under  tliis  title  tlie  Philadelphia  Med.  News  for  August  4 
contains  an  article  upon  a  case  which  came  under  the 
care  of  Dr.  Anna  Broom  all.  Professor  of  Obstetrics  in 
the  Women’s  Medical  Hospital.  A  negress,  twenty-two 
years  of  age,  was  admitted  after  being  in  labour  for  twenty- 
four  hours,  during  which  the  forceps  had  been  vigorously 
employed.  It  was  found  that  she  had  a  conjugata°  vera  of 
only  two  inches  and  seven-tenths,  a  very  exaggerated  in¬ 
clination  of  the  pelvis  also  increasing  the  obstruction.  The 
Csesarian  operation  was  resolved  on,  as  the  child  was  still 
living,  and  the  mother’s  condition  not  hopeless,  although 
her  temperature  was  102°,  and  her  pulse  180. 

“  The  main  important  feature  was  the  adoption  of  the 
principle  of  the  Miiller-Porro  operation,  viz.,  the  turning  out 
of  the  uterus  from  the  abdominal  cavity,  keeping  the  edges 
of  the  incision  closely  pressed  against  the  uterine  wall,  and, 
before  incising  the  uterus,  making  constriction  of  the  cervix 
to  prevent  haemorrhage.  This  plan,  first  suggested  by 
Litzmann  of  Kiel,  has  been  carried  out  heretofore  in  a 
few  cases  only,  and  without  success,  by  placing  a  con¬ 
stricting  band  around  the  cervix,  either  a  wire  loop,  or,  as 
urged  by  Garrigues,  an  Esmarch  tube,  tightened  up  until 
arrest  of  circulation  is  effected.  Dr.  Broomall,  however, 
modified  this  part  of  the  operation  in  having  the  cervix 
grasped  by  the  hand  of  an  assistant,  and  securely  com¬ 
pressed  until  the  uterine  wound  was  closed  by  sutures. 
The  hand  was  applied  with  its  palmar  surface  upon  the 
lower  anterior  face  of  the  uterus,  with  the  thumb  and 
fingers  extended,  with  the  commissure  looking  downwards, 
then  slid  rapidly  down  until  the  soft  tissue  of  the 
cervix  could  be  grasped  in  its  embrace — the  head  being 
gently  pressed  upwards  till  the  cervical  tissues  were  entirely 
isolated  from  it.  The  softness  of  the  cervical  walls  rendered 
an  efficient  grasp  quite  easy,  and  the  circulation  was  abso¬ 
lutely  controlled,  there  being  apparently  not  a  drachm  of 
blood  lost  from  the  incision  in  the  uterus.  The  placenta 
was  implanted  anteriorly,  and  had  to  be  cut  through, 
causing,  of  course,  the  loss  of  its  contained  blood.  The 
advantage  of.  this  method  of  constriction  was  seen  to  be 
immense.  First,  there  is  great  saving  of  time,  and  that 
too  at  a  period  of  the  operation  when  every  moment  tells 
upon  the. vitality  of  the  foetus.  The  difficulty  of  passing  a 
cord  or  ligature,  of  any  kind  over  and  behind  the  uterine 
body,  carrying  it. down  between  the  womb  and  the  edges  of 
the  incision  which  have  to  be  kept  closely  in  contact  to 
prevent  the  escape  of  the  intestines, — and  the  care  necessary 
to  prevent  .  loops  of  intestine  and  portions  of  omentum 
being  carried  down  and  grasped  by  the  ligature,  con¬ 
tused  and  perhaps  permanently  injured  by  the  rough  con¬ 
striction,  constitutes  one  of  the  serious  delays  in  Porro’s 
operation ;  and  the  manipulation  necessitated  by  it,  disturb¬ 
ing  the  placental  circulation,  involves  great  danger  to  the 
child.  M  ith  the  manual  grasp,  the  fingers  being  gently  slid 
around  the  cervix  from  in  front,  and  kept  close  to  the 
uterine  wall,  such  precautions  are  unnecessary.  In  Dr. 
Broomall  s  case  it  was  less  than  fifteen  minutes  from  the 
time  the  peritoneal  cavity  was  opened  until  the  uterine 
wound  was  completely  closed,  and  in  ten  minutes  more  the 
abdominal  walls  were  closed  also,  making  only  twenty-five 
minutes  in  all  that  the  abdomen  was  open.  Secondly,  a 
very  important  gain  by  this  procedure  is  in  the  diminished 
risk  of  injury  of  the  uterine  tissues  or  the  broad  ligament 
and  its  appendages  by  their  grasp  in  the  soft  hand,  with  its 
well-regulated,  and  intelligent  pressure,  in  contrast  with 
their  constriction  by  any  mere  machine.  The  hand  would 
not  be  wearied  in  so  short  a  time,  but,  if  it  should  become  so, 
it  could  easily  be  replaced  by  the  other,  with  scarcely  percep¬ 
tible  interval  of  grasp.  .  .  .  The  advantages  of  this  mode  of 
constriction,  and  the  facility  with  which  it  can  be  performed, 
recommend  the  plan  of  Dr.  Broomall  as  a  very  important 
advance  in  the  improved  Caesarian  operation.  The  objec¬ 
tion  urged  by  Carl  Braun  von  Fernwald  to  the  use  of  the 
ligature,  on  the  ground  of  the  head  being  sometimes  im¬ 
pacted  in  the  brim  (a  condition  certainly  extremely  rare  in 
a  pelvis  of  two  inches  and  a  half),  would  not  be  applicable 
to  the  manual  constriction,  as  the  hand  with  its  palmar 
surface  could  efficiently  compress  the  cervical  tissues  against 
the  head  itself,  quietly  raising  it  upwards  till  it  had  cleared 
the  brim,  the  cervix  being  stretched,  and  thus  easily  and 
effectually  grasped.” 


The  condition  of  the  woman  previously,  and  at  the  time 
of  the  operation,  rendered  its  successful  issue  very  unlikely, 
and,  in  fact,  she  died  in  thirty-six  hours ;  but  the  autopsy 
showed  complete  union  of  the  uterine  wound  throughout, 
and  the  abdominal  cavity  was  free  from  all  traces  of  blood. 
There  was  no  inflammatory  action  at  the  surface  of  the 
uterus ;  but  the  intestines  in  the  upper  part  of  the  abdomen, 
above  the  uterus,  were  largely  agglutinated  by  lymph.  The 
child  lived  thirty-two  hours,  and  was  found  to  have  a  large 
clot  beneath  the  membrane  of  the  brain,  with  fracture  of 
the  right  parietal  from  the  compression  at  the  pelvic  brim. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


Note  sur  Vingt-deux’  Operations  de  Goitre.  Par  Jaques- 
Louis  Reverdin,  Professeur  a  la  Faculte  de  Medecine  de 
Geneve,  et  Auguste  Reverdin,  ancien  Assistant  de 
Clinique  Chirurgicale  a  Strasbourg.  Avec  trois  planches- 
phototy piques.  Geneve :  H.  Georg,  Libraire  Editeur, 
Libraire  de  l’Universite.  1883. 

An  Account  of  Twenty-two  Operations  for  Goitre.  With. 

three  photographic  plates.  Pp.  130. 

In  this  pamphlet  the  authors  publish  their  experience  of 
the  surgical  treatment  of  goitre.  They  performed  twenty- 
two  operations  on  twenty-one  patients,  of  whom  nine  were 
male  and  twelve  female,  with  the  result  of  nineteen  re¬ 
coveries  and  two  deaths.  Another  case  died  two  months  after 
the  operation,  from  pneumonia,  which  had  no  connexion 
with  the  original  disease  or  the  operation.  All  the  cases- 
are  fully  reported,  and  the  symptoms,  operations,  and  imme¬ 
diate  and  subsequent  results  are  given  with  minute  detail. 
The  authors  do  not  recommend  anaesthetics  for  the  opera¬ 
tion.  Although  they  in  fourteen  cases  administered  chloro¬ 
form  or  ether  without  any  bad  result,  still  in  their  opinion 
the  risk  of  subsequent  vomiting  is  very  serious,  and  in  seven 
cases  in  which  they  did  not  use  amesthetics  the  patients  did 
not  appear  to  suffer  pain  after  the  cutaneous  incisions  had 
been  made,  while,  if  dyspnoea  supervene,  consciousness  on  the 
part  of  the  patient  is  very  advantageous.  As  to  the  nature 
of  the  operation,  total  extirpation  of  the  gland  insures- 
immunity  from  any  recurrence  of  the  disease,  and  leaves  a 
wound  which,  though  large,  is  composed  of  homologous 
tissues  and  heals  readily.  But  the  operation  is  tedious,  the 
haemorrhage  considerable,  and  very  important  structures 
are  exposed  and  endangered.  Partial  removal  of  the  gland 
is  free  from  these  objections,  but  leaves  the  patient  liable 
to  recurrence  of  the  disease.  They  classify  goitres  into- 
parenchymatous,  lobulated,  and  cystic.  For  the  first  of 
these,  total  extirpation  is  requisite ;  for  the  lobulated 
form,  partial  removal,  if  possible  by  enucleation,  will 
suffice ;  and  for  unilocular  cysts,  incision  with  removal  of 
part  of  the  cyst  and  suture  of  the  remainder  to  the  skin 
produces  good  results.  The  definiteness  of  these  direc¬ 
tions  is,  however,  marred  by  the  admission  that  a  goitre 
is  rarely  simple,  but  usually  a  compound  of  these  varieties. 
Haemorrhage  and  dyspnoea  are  the  chief  difficulties  in  the 
performance  of  the  operation.  In  one  case  the  authors  had 
to  apply  eighty  ligatures ;  and  in  another,  although  they 
commenced  with  a  supply  of  forty  compression  forceps,  they 
had  to  suspend  the  dissection  of  the  tumour  in  order  to- 
ligature  vessels,  and  so  secure  a  continued  supply  of  forceps. 
With  increasing  experience,  however,  they  found  that  by 
cutting  rapidly  down  on  the  large  vessels  which  enter  the 
deep  surface  of  the  gland,  and  by  securing  these  with 
double  ligatures  and  dividing  between  the  ligatures,  the 
loss  of  blood  was  greatly  diminished.  Listerisin  was  care¬ 
fully  employed  in  all  the  cases,  but  a  curious  difference  was- 
observed  between  the  cases  treated  in  the  author’s  private 
clinique  and  those  operated  on  in  the  hospital.  Of  the 
former,  nearly  all  healed  by  first  intention,  with  an  average 
duration  of  treatment  of  seven  days,  and  a  mean  tempera¬ 
ture  of  38T°  C. ;  while  in  the  hospital  cases  all  suppurated, 
the  average  duration  of  treatment  was  twenty-seven  days, 
and  the  mean  temperature  39'6°  C.  As  equal  precautions- 
were  taken  in  all  the  cases,  the  authors  suggest  that  this 
difference  must  have  been  caused  by  the  unfavourable  in¬ 
fluence  of  the  hospital  on  the  general  health  of  the  patients. 
This  explanation,  if  correct,  is  not  very  flattering  to  the 
condition  of  the  hospital.  After  the  operation,  phonation 
and  deglutition  were  usually  affected.  In  most  cases  the 


528 


Mjdieal  Times  and  Gazette. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


Nov.  3,  1883. 


voice  was  hoarse,  and  in  one  case  the  laryngoscope  disclosed 
an  absence  of  parallelism  in  the  vocal  cords.  In  three  cases 
aphonia  resulted,  which  persisted  in  one  case  for  a  few  days, 
in  the  second  for  five  weeks,  and  in  the  third  for  more  than 
six  months.  All  the  patients  experienced  difficulty  in  swal¬ 
lowing  for  from  ten  to  fifteen  days  after  the  operation. 
These  symptoms  were  partly  due  to  the  inevitable  disturb¬ 
ance  of  the  parts  during  the  operation  ;  but  branches  of  the 
recurrent  laryngeal  nerves  must  also  have  been  injured.  In 
three  cases  tetany  was  observed.  These  were  all  females. 
This  accords  with  Billroth’s  experience,  who,  in  sixty-eight 
operations  for  goitre,  had  ten  cases  of  tetany — all  in  females. 
But  Kocher  has  observed  it  once  in  a  young  boy,  from  whom 
the  thyroid  gland  was  removed  for  goitre.  This  affection 
has  hitherto  been  observed  only  in  cases  of  total  extirpation 
of  the  gland ;  and  the  authors,  after  full  consideration  of 
all  possible  causes  for  it,  suggest  that  it  is  most  probably 
a  reflex  phenomenon  due  to  injury  of  branches  of  the 
sympathetic  cord.  It  is  an  unfavourable  symptom,  as  one  of 
these  three  cases  died,  and  of  Billroth’s  ten  cases  two  died. 
In  some  cases,  two  or  three  months  after  the  operation, 
when  the  patients  had  apparently  completely  recovered, 
further  symptoms  appeared.  The  patients  complained  of 
fatigue  after  slight  exertion,  and  of  a  sensation  of  awkward¬ 
ness  and  weakness  in  the  movements  of  the  upper  extremi¬ 
ties.  A  hairdresser  was  unable  to  use  his  scissors,  a  woman 
experienced  difficulty  in  doing  crochet-work,  and  the  husband 
of  another  patient  complained  that  his  wife  broke  a  great 
quantity  of  crockery.  In  two  other  cases  the  trouble  was 
more  marked  on  the  right  side.  The  patients  answered 
questions  slowly  and  with  hesitation,  but  correctly.  The 
intellect  did  not  appear  to  be  impaired,  and  the  authors 
compare  these  cases  to  machinery  in  which,  while  the 
works  are  perfect,  the  wheels  have  become  clogged  with 
oil.  The  only  objective  symptoms  were  puffiness  of  the  face 
and  extremities,  which,  however,  did  not  pit  on  pressure, 
and  an  alteration  in.  the  complexion.  The  patients  acquired 
a  whitish-yellow  colour,  not  that  of  anaemia  or  albuminuria, 
but  similar  to  what  is  seen  in  some  cretins.  These  symp¬ 
toms  occurred  only  in  cases  of  complete  extirpation  of  the 
gland,  and  not  in  all  of  those.  Of  seventeen  cases  in  which 
the  authors  removed  the  entire  gland,  two  died  from  the 
operation,  one  two  months  later  from  pneumonia,  and  two 
could  not  be  traced.  Of  the  rest,  seven  never  suffered  any 
inconvenience.  If,  therefore,  these  symptoms  result  from 
the  absence  of  the  gland,  it  would  seem  that  some  other 
organ  can  vicariously  perform  the  functions  of  the  thyroid 
gland.  These  symptoms  closely  resemble  some  of  those 
noticed  in  cases  of  myxoedema  which  have  been  recorded 
by  Ord,  Hadden,  and  others,  and  the  similarity  is  especially 
noteworthy  from  the  atrophy  of  the  thyroid  gland  which 
has  been  observed  in  these  cases.  Finally,  the  authors  think 
that  the  removal  of  goitre  merely  for  aesthetic  reasons  is 
not  justifiable,  and  that  if  the  tumour  increase  rapidly  or 
cause  any  respiratory  trouble,  partial  removal  should  be 
first  tried,  and  complete  extirpation  only  performed  when 
everything  else  has  failed  to  give  relief. 

The  pamphlet  is  a  very  valuable  contribution  to  our  know¬ 
ledge  of  the  operative  treatment  of  goitre,  and  the  cases  are 
described  and  discussed  with  most  commendable  candour 
and  thoroughness. 


The  Principles  and  Practice  of  Medical  Jurisprudence.  By 
the  late  Alfred  Swaine  Taylor,  M.D.,  F.R.S.  Third 
Edition,  edited  by  Thomas  Stevenson,  M.D.  London  : 
J.  and  A.  Churchill.  1883.  Two  vols.  8vo. 

'Ten  years  have  elapsed  since  the  late  Dr.  Taylor  brought 
•out  the  second  edition  of  this  his  magnum  opus,  and  during 
that  period  the  increase  in  our  knowledge  and  the  accumu¬ 
lation  of  facts  have  not  been  less  rapid  in  regard  to  medical 
jurisprudence  than  in  the  other  branches  of  medical  study. 
It  might  have  been  expected,  therefore,  that  the  new  edition 
would  have  exceeded  its  predecessor  in  bulk  as  much  as  that 
•one  did  its  forerunner.  Such,  however,  is  not  the  case  :  by 
means  of  judicious  pruning,  and  the  substitution  of  new 
matter  for  old,  Dr.  Stevenson  has  contrived  to  keep  the  two 
volumes  of  a  convenient  size.  A  comparison  of  this  edition 
with  the  last  will  show  how  very  thoroughly  the  work  of 
revision  has  been  carried  out :  there  is  not  a  section,  and 
indeed  scarcely  a  page,  but  bears  some  mark  of  Dr. 
.Stevenson’s  work. 

Of  the  many  criminal  trials,  important  in  a  medico-legal 


point  of  view,  that  have  taken  place  since  the  last  edition 
appeared,  a  brief  account  is  in  most  instances  given.  We 
think  the  Lamson  case  might  have  been  detailed  a  little 
more  fully,  for  although  the  facts  are  fresh  in  everybody’s 
mind  at  present,  still  in  a  few  years  they  will  be  so  no  longer, 
and  the  case  is  one  in  some  respects  without  a  parallel  in 
our  country.  The  Tichborne  case  has  been  concluded  since 
the  last  volume,  and  it  is  no  longer  necessary  to  use  any 
reserve  in  pointing  out  the  conclusive  evidence  furnished 
against  the  claimant  by  the  absence  of  certain  scars  and  the 
presence  of  others.  Reports  of  the  Bravo  case  and  the  trial  of 
the  Stauntons  are  amongst  the  additions,  as  well  as  the 
recent  trial  of  the  brothers  Peltzer  for  the  murder  of  Mr. 
Bernays.  We  fail  to  find  any  mention,  however,  of  a 
important  case  of  strychnia-poisoning  which  occurred  about 
two  years  ago  at  Sheffield,  or  of  the  murder  of  President 
Garfield  by  Guiteau— an  omission  the  more  extraordinary,  as 
this  case  is  important  both  from  the  nature  of  the  wound 
and  the  length  of  time  the  patient  survived,  and  also  from 
the  kind  of  evidence  used  to  support  the  plea  of  insanity  by 
the  prisoner. 

The  chapter  on  Ptomaines  is  certainly  one  of  the  chief  addi¬ 
tions  to  the  work,  and  it  contains  the  most  recently  approved 
views  on  the  subject.  Possibly,  many  of  our  readers  had  never 
heard  of  cadaveric  alkaloids  until  the  trial  of  Lamson,  when 
an  attempt  was  made  on  the  part  of  the  defence  to  show 
that  the  alkaloid  obtained  by  Dr.  Stevenson  from  some  of 
the  viscera  and  urine  of  the  deceased  was  probably  the 
result  of  putrefactive  changes — an  attempt  which  failed  most 
signally.  The  latest  test  for  the  presence  of  a  ptomaine  is 
based  on  the  reduction  of  silver  bromide.  “  If  a  piece  of 
photographic  paper  imbued  with  the  bromide  be  written 
upon  with  a  quill  pen  dipped  in  a  solution  of  the  base 
( i.e .,  containing  the  supposed  alkaloid),  and  the  paper  be 
placed  in  a  dark  room,  and  then  washed  successively  with 
sodium  hyposulphite  and  water,  the  characters  traced  upon 
the  paper  will  be  made  manifest  by  reduction  which  has 
occurred  if  a  ptomaine  is  present.”  By  taking  especial 
precautions  in  preparing  and  separating  the  alkaloidal  ex¬ 
tracts  by  Stas’s  process.  Dr.  Stevenson  has  been  able  to 
convince  himself  that  “  the  existence  of  poisonous  cadaveric 
alkaloids  in  human  viscera,  even  when  putrid  and  diseased, 
is,  to  say  the  least,  very  rare.”  Dr.  Stevenson  deserves  the 
thanks  of  the  profession  for  the  admirable  manner  in  which 
he  has  discharged  his  task. 


Sewage  Disposal :  for  the  Guidance  of  Sanitary  Authorities. 

By  Henry  Robinson,  C  E.,  F.G.S.  London:  E.  and  F. 

N.  Spon.  Second  Edition.  1882.  Small  8vo,  pp.  86. 
This  little  book  needs  no  commendation  from  us,  but  we 
feel  it  a  duty  we  owe  to  our  readers  to  call  attention  to  its 
value.  Absolutely  free  from  padding,  with  scarce  a  sentence 
or  word  that  could  be  spared,  it  gives,  in  language  as  clear 
as  it  is  concise,  the  most  recent  state  of  our  knowledge  on 
the  all-important,  the  burning  question  of  the  disposal  of 
sewage  in  the  face  of  injunctions  against  the  pollution  of 
rivers.  Mr.  Robinson  does  not  encumber  his  pages  with 
descriptions  of  the  works  or  machinery  employed  in  the 
several  systems,  for  these  can  be  obtained  from  the  engineers 
of  each  when  the  local  authorities,  guided  by  the  data  here 
supplied,  have  decided  on  the  particular  method  best  adapted 
to  their  circumstances.  Each  of  the  most  successful  plans 
of  treatment,  by  irrigation,  filtration,  chemicals,  or  a  com¬ 
bination  of  the  last  two,  is  discussed  in  its  sanitary,  economic, 
and  financial  aspects,  with  numerous  comparative  analyses 
of  the  several  sewages  and  effluents.  The  author  everywhere 
insists  on  the  necessity  of  dismissing  all  thoughts  of  making 
sewage  disposal  a  commercial  question,  barring  only  excep¬ 
tional  cases  of  sewage  farming.  Pecuniary  considerations, 
as  we  have  always  urged,  must  be  postponed  to  sanitary. 
The  real  question  is,  how  to  dispose  of  the  sewage  at  the 
least  possible  cost,  and  to  obtain  an  effluent  that  may  safely 
be  passed  into  natural  watercourses  which  may  at  other 
points  be  used  as  sources  of  water-supply.  If  the  sewage 
can  be  utilised,  whether  for  crops  or  for  cement,  so  as  to 
reduce  the  expense,  so  much  the  better ;  but  if  not,  it  is  a 
question  of  how  it  can  be  best  and  at  the  least  cost 
destroyed  :  all  idea  of  profit  being  in  either  case  out  of 
place.  There  is  a  fallacy  prevalent  with  regard  to  irri¬ 
gation  that  Mr.  Robinson  effectually  explodes,  viz.,  that 
land  can  be  permanently  enriched  and  its  value  improved 
thereby.  The  organic  matter  of  the  sewage  is  oxidised  in 


Medical  Times  and  Gazette. 


GENERAL  CORRESPONDENCE. 


Nov.  3, 1883.  529 


the  pervious  soil,  and  all  in  excess  of  what  the  vegetation 
can  assimilate  is  thus  destroyed,  instead  of  being,  as  many 
persons  imagine,  stored  up.  If  not  destroyed  it  escapes  in 
the  effluent,  and  the  object  of  the  whole  scheme  is  defeated. 
Soil  that  has  been  for  years  under  irrigation  contains  no  more 
organic  matter  than  it  did  at  first.  Another  point  which 
strikes  us  as  not  generally  known,  though  of  great  practical 
importance,  is  the  action  of  salt  water  on  sewage,  precipitat¬ 
ing  organic  matters  which  would  otherwise  have  remained 
in  suspension,  and  forming  an  adhesive  and  putrescent  ooze 
along  the  foreshore.  Such  is  the  mud  of  the  estuaries  of 
the  Thames  and  Medway,  now  exercising  the  minds  of  the 
Thames  Conservancy  and  the  Metropolitan  Board  of  Works, 
so  much  used  for  making  Portland  cement,  and  which  is 
imitated  in  the  system  of  General  Scott. 

To  analyse  the  contents  of  this  work,  highly  concentrated 
as  they  are,  would  be  an  impossibility  :  suffice  it  to  say,  once 
more,  that  everything  that  a  sanitary  authority  can  need  to 
guide  them  in  fehe  selection  of  that  one  of  the  rival  methods 
best  suited  to  their  particular  case,  whatever  the  quantity 
and  quality  of  their  sewage,  the  extent  and  character  of  the 
land  at  their  disposal,  or  if  there  be  none  available,  will  be 
found  in  this  little  book  so  plainly  that  he  who  runs  may 
read. 


The  Dispensatory  of  the  United  States  of  America.  By  Dr. 
George  B.  Wood  and  Dr.  Franklin  Bache.  Fifteenth 
Edition,  rearranged,  thoroughly  revised,  and  largely  re¬ 
written,  with  illustrations,  by  H.  C.  Wood,  M.D.,  Joseph 
P.  Remington,  Ph.G.,  and  Samuel  P.  Sadtler,  Ph.D., 
F.C.S.  Philadelphia:  J.  P.  Lippincott  and  Co.  London  : 
16,  Southampton-street,  Strand.  1883.  Pp.  1928. 

The  simple  fact  that  this  large  volume  has  reached  a  fifteenth 
edition  is  sufficient  evidence  that  it  meets  a  widely  felt  want. 
We  have  no  hesitation  in  saying  more  than  this  :  that  it  is 
one  of  the  best  treatises  extant  on  pharmacy  and  thera¬ 
peutics.  The  information  given  is  full,  but  is  not  a  mere  col¬ 
lection  of  cuttings  from  miscellaneous  sources  more  or  less 
trustworthy.  On  the  contrary,  the  statements  of  different 
writers  on  therapeutic  subjects  are  weighed,  sifted,  and 
digested,  as  well  as  checked  by  the  large  experience  of  the 
authors  themselves.  The  pharmaceutical  sections  are  very 
clear,  and  their  utility  is  not  limited  to  American  readers  ; 
for  in  most  instances  in  which  the  American  and  British 
preparations  differ,  both  are  given,  and  the  reason  of  the 
difference  is  explained.  We  know  few,  if  any,  works  that 
may  more  safely  be  consulted  than  the  one  before  us. 


GENERAL  CORRESPONDENCE. 

- - 

COMPENSATION  AFTER  RAILWAY  ACCIDENT. 


[To  the  Editor  of  the  Medical  Times  and  Gazette.  1 
Sir, — You  conclude  your  editorial  article  (October  27)  on 
“Compensation  after  Railway  Accident  ”  with  the  remark 
that  “  to  arrive  as  nearly  as  possible  at  the  truth  is  only  to 
be  attained  by  the  employment  of  skilful  and  well-informed 
experts,  who,  on  whatever  side  they  may  be  called,  will 
approach  the  question  as  they  would  a  clinical  case  or 
scientific  problem,  and,  without  bias  or  interested  motive, 
give  an  opinion  strictly  in  accordance  with  the  facts  before 
them.”  In  these  words  you  sum  up  the  whole  desideratum 
in  these  unsatisfactory,  and  too  often  demoralising,  cases. 
My  opportunities  of  familiarising  myself  with  this  class  of 
injuries  has  now  extended  over  some  years ;  and  I  speak  of 
the  cases  as  demoralising,  because  the  mode  in  which  they 
are  conducted  is  such  as  to  tempt  the  public  to  impose  on 
the  companies,  and  to  enlist  witnesses  to  support  claims 
which  ought  never  to  have  been  made. 

Of  genuine  cases  of  shock  from  railway  collision,  my  ex¬ 
perience  has  taught  me  that  only  a  small  proportion  mani¬ 
fest  symptoms  which  justify  the  belief  that  organic  change 
in  the  spinal  cord  has  resulted.  Indeed,  I  have  found 
latterly  that  the  theory  of  spinal  concussion  has  yielded 
very  much  to  that  of  "  general  nervous  shock,”  which  pos¬ 
sesses  the  required  amount  of  indefiniteness  to  supersede 
the  disagreeable  necessity  of  special  pathological  discussions. 

The  railway  companies  are  at  great  disadvantage,  as  their 
medical  witnesses  are  required  to  prove  a  negative  ;  and  the 
temptation  to  exaggeration  or  fraud  is  favoured  by  the 


nature  of  the  symptoms,  which  are  commonly  of  a  character 
to  elude  the  test  of  observation,  being  purely  subjective; 
and  they  are  now  so  popularly  known  that  they  can  be 
readily  assumed  by  the  designing,  or  imagined  by  the 
initiated.  Any  and  every  symptom  the  claimant  fancies  he 
has  or  really  suffers  from,  whatever  the  cause,  is  attributed 
to  this  “  nervous  shock  and  the  medical  witness  for  the 
defence  is  asked  whether  these  symptoms,  as  a  consequence 
of  railway  collision,  are  impossible.  Of  course  he  cannot 
answer  in  the  affirmative,  and  the  counsel  for  the  plaintiff 
does  not  fail  to  make  use  of  such  admission  in  his  address 
to  the  jury.  I  do  not  deny  that  such  shock,  if  genuine, 
may  entail  consequences  which  endure  for  some  time; 
but  in  a  large  proportion  of  these  cases  the  concussion 
produces  only  temporary  inconvenience  and  functional  dis¬ 
turbance — -a  condition  which  would  speedily  disappear  if  the 
patient  were  encouraged,  and  had  not  the  temptation  of  gain 
in  prospect.  But  the  hurt  was  received  on  the  premises  of 
a  railway  company — it  matters  little  whether  on  the  line 
or  elsewhere.  A  claim  has  to  be  made  for  compensation  ;  a 
solicitor  is  consulted  or  tenders  his  services,  and  medical 
advice  is  sought.  Then  the  claimant  is  bidden  to  abstain 
from  all  occupation,  to  keep  quiet,  to  avoid  all  mental 
exercise — in  short,  to  nurse  his  symptoms  until  he  becomes 
mopish,  and  fancies  himself  really  incapable  of  any  exertion ; 
suffering,  not  unnaturally,  from  dyspepsia  and  its  attendant 
miseries  of  disturbed  rest,  dreaming,  headache,  and  nervous 
irritability,  which  are  all  ascribed  to  the  “  nervous  shock,” 
though  really  attributable  to  eating  and  drinking  freely 
(extra  nourishment  is  a  common  item  in  the  claims)  whilst 
all  bodily  and  mental  exercise  is  strictly  prohibited. 

Under  these  circumstances,  what  chance  has  the  railway 
company  of  a  fair  hearing  before  a  jury?  Their  medical 
■witnesses  may  feel  convinced,  from  their  own  observation 
and  from  collateral  evidence,  that  great  exaggeration  or 
even  pure  imposition  is  being  practised.  They  are  even 
offered  the  opportunity,  in  examination  or  cross-examination, 
of  saying  so ;  but  if  they  yield  to  the  temptation,  it  is  with 
the  certain  result  of  exciting  the  assumed  indignation  of 
the  opposing  counsel,  and  the  sympathy  of  the  jury.  They 
may,  often  and  with  perfect  truth,  ascribe  the  nervous 
symptoms  complained  of  to  hysteria — a  noxious  weed  which 
thrives  in  the  hot-bed  of  sympathy  and  enforced  idleness. 
But  the  plea  rarely  avails ;  for  juries  do  not  appreciate  this 
term  in  its  masculine  application,  and  generally  regard  the 
suggestion  as  an  unworthy  loop-hole  framed  for  the  escape 
of  the  railway  company  from  the  penalty  of  heavy  damages. 

That  these  things  are  so  is  well  known  to  those  accus¬ 
tomed  to  deal  with  such  cases;  and  it  is  proverbial  how 
speedily  all  the  symptoms  disappear  as  soon  as  the  com¬ 
pensation  is  obtained,  though  they  may  have  lingered  on 
for  months,  or  even  one  or  two  years,  with  little  or  no 
variation.  It  need,  therefore,  scarcely  excite  surprise  that 
railway  companies  yield  to  demands  which  are  made  on 
them,  in  order  to  save  the  expense  of  litigation  with  the 
prospect,  in  most  instances,  of  an  adverse  verdict,  thereby  en¬ 
couraging  claims  which  they  believe  to  be  greatly  exaggerated 


if  not  inadmissible. 

I  now  take  up  the  subject  where  you  left  it.  Is  there  any 
remedy  for  this  growing  evil  ? — an  evil  which  constantly 
places  members  of  the  medical  profession  in  an  antagonism 
which  is  painful  and  humiliating,  and  defeats  the  ends  of 
justice,  by  presenting  to  the  jury  such  conflicting  evidence 
that  they  feel  the  only  solution  to  their  perplexity  is  a  verdict 
for  the  plaintiff,  on  the  assumption  that  his  statement  is 
true,  and  must  be  accepted  because  the  medical  witnesses 
for  the  company  cannot  prove  its  exaggeration  or  untruth 
fulness.  I  believe  there  is  a  remedy,  and  it  is  this : — -A 
tribunal  of  qualified  medical  men  (three  would  suffice) 
should  be  invested  with  power  to  take  evidence,  previous  to 
the  trial,  respecting  the  nature  of  the  injury  sustained,  and 
also  to  hear  medical  witnesses  on  either  side ;  and  their 
report  on  the  case  should  be  the  only  medical  evi¬ 
dence  admissible  at  the  trial.  The  advantages  of  such 
an  arrangement  would  be  manifold.  Many  cases  would 
be  settled  out  of  court;  in  such  as  went  to  trial  the 
judge  and  jury  would  not  be  perplexed,  but  would  be 
supplied  with  a  trustworthy  estimate  of  the  real  nature 
and  extent  of  the  personal  damage  sustained.  The  time  of 
the  court  would  be  saved  by  the  elimination  of  the  chief 
source  of  entanglement  in  the  case ;  and.,lhe-expenses  of 
the  litigants  would  be  curtailed, 

A/'RADFORD<f\ 


530 


Medical  Times  and  Gazette- 


THE  CLINICAL  SOCIETY  OF  LONDON. 


Nov.  3,  1883. 


medical  witnesses  would  be  superfluous.  Lastly,  though 
not  least  importantly,  genuine  cases  would  have  full  justice 
meted  out  to  them,  whilst  those  which  are  fictitious  would 
be  relinquished,  and  reasonable  compensation  would  be 
accepted  for  a  bruised  arm  or  broken  shin,  as  the  attempt 
to  graft  thereon  a  variety  of  imaginary  ailments  from 
“nervous  shock ”  would  not  be  countenanced  by  such  a 
tribunal  as  I  suggest.  I  am,  &c., 

F.  Le  Geos  Clark. 


REPORTS  OF  SOCIETIES. 

- ■©• - 

THE  CLINICAL  SOCIETY  OF  LONDON. 

Friday,  October  26. 

Sir  Andrew  Clark,  Bart.,  President,  in  the  Chair. 


'The  President  opened  the  meeting  by  presenting  to  the 
Society  the  new  volume  of  its  Transactions ,  remarking  upon 
the  excellence  of  the  contents,  and  calling  attention  to  the 
new  feature  which  it  presents  in  the  descriptions  of  the 
living  specimens  exhibited  during  the  year. 

L  Dr.  Charlton  Bastian  read  the  following  papers  : — 

I. — Case  of  Apoplexy  in  a  Boy  aged  Fifteen— Intra¬ 
ventricular  Hemorrhage,  Convulsions,  and  Death 
in  Four  Hours. 

Wm.  N.,  a  healthy-looking  boy,  aged  fifteen,  admitted 
into  University  College  Hospital  at  7  pan.  on  June  14, 
1883.  Three  years  ago,  according  to  his  parents’  ac¬ 
count,  after  a  "  school  treat,”  he,  on  the  same  night, 
became  violently  convulsed,  and  afterwards  screamed  for 
two  or  three  hours.  This  attack  was  attributed  to  “  sun¬ 
stroke,”  probably  with  no  sufficient  reason.  The  boy  is  said 
to  have  speedily  resumed  his  ordinary  healthy  condition. 
Three  weeks  before  his  death  he  complained  of  pain  in  his 
head,  which  soon  passed  off  after  taking  a  mild  aperient. 
At  1.30  p.m.  on  the  day  of  his  death  he  ate  a  good  dinner, 
and  seemed  in  perfect  health.  About  5  p.m.,  after  some 
flight  exertion  (he  was  on  horseback  at  the  time),  he  com¬ 
plained  of  pain  in  his  head,  and  almost  at  once  lost  con¬ 
sciousness.  He  then  became  rigid,  blue  in  the  face,  and, 
from  the  accounts  that  were  given,  apparently  convulsed. 
He  remained  insensible,  vomited  two  or  three  times,  and 
was  brought  to  the  hospital  about  7  p.m.  There  was  no 
history  of  a  blow  or  fall  upon  the  head.  A  bruit  was  heard 
at  the  apex  of  the  heart,  though  there  was  no  history  of 
rheumatic  or  scarlet  fever.  On  admission  the  patient  was 
in  a  condition  of  stupor,  though  he  put  out  his  tongue  and 
opened  his  eyes  when  told  to  do  so  in  a  loud  voice.  The 
tongue  deviated  slightly  to  the  left  side.  The  pupils  were 
equal,  of  medium  size,  and  sluggish.  He  moved  the  right 
arm  and  leg,  the  left  scarcely  at  all.  Face  somewhat  flushed. 
Pulse  84,  regular ;  respirations  18  per  minute  ;  temperature 
in  rectum  9S-4°.  About  fifteen  minutes  after  admission 
-the  |boy  vomited  some  undigested  food.  A  little  later  he 
became  rigid,  and  the  face  and  extremities  on  both  sides 
were  clonieally  convulsed  for  one  to  two  minutes.  During 
the  brief  remainder  of  his  life  (an  hour  and  three  quarters) 
he  continued  unconscious,  and  became  convulsed  at  short 
intervals.  His  pupils  were  now,  and  remained  till  the  end, 
small  and  quite  insensitive  to  light.  Breathing  at  this  time 
irregular  and  sighing.  Pulse  at  the  same  time  about  40, 
very  slow,  irregular,  and  intermittent.  At  first  the  convul¬ 
sions  just  referred  to  recurred  about  every  five  minutes. 
During  these  attacks  there  was  rigidity  of  both  legs  and 
arms,  as  well  as  slight  opisthotonos.  The  intervals  between 
the  paroxysms  gradually  diminished  from  five  to  two  minutes. 
About  fifteen  minutes  after  the  injection  of  a  solution  con¬ 
taining  thirty  grains  of  chloral  into  the  rectum  the  convulsive 
paroxysms  diminished,  and  eventually  ceased.  The  breath¬ 
ing,  however,  still  continued  of  the  same  irregular  character, 
though  the  pulse  became  frequent  and  regular.  Mucous 
rales  soon  became  audible  all  over  the  front  of  the  chest,  but 
up  to  the  few  moments  immediately  preceding  his  death  the 
patient’s  lips  were  of  good  colour,  his  pulse  was  frequent  (120), 
but  of  fair  quality.  Suddenly  he  became  livid,  and  large  rales 
were  audible  in  the  trachea.  Death  occurred  in  the  course  of  a 
few  minutes  more.  The  rectal  temperature  had  been  taken 
on  three  occasions.  Soon  after  admission  it  was  9S-4°,  but 
before  death  it  had  risen  to  99°.  At  the  autopsy,  seventeen 


hours  after  death,  nothing  unnatural  was  presented  by  the 
dura  mater  or  arachnoid,  though  the  convolutions  over  the 
vertex  were  somewhat  flattened.  A  sub-arachnoid  extrava¬ 
sation  of  blood  was  found  at  the  base,  extending  from  the 
optic  commissure  backwards  over  and  on  each  side  of  the  pons 
and  medulla,  and  thence  upwards  over  the  posterior  border  of 
the  cerebellum.  The  upper  parts  of  both  cerebral  hemi¬ 
spheres  presented  nothing  unnatural,  but  about  one  ounce 
of  blood  was  found  in  each  lateral  ventricle.  The  third  and 
fourth  ventricles  were  also  full  of  blood-clot,  and  from  the 
latter  blood  had  evidently  found  its  way  out  so  as  to  produce 
the  basal  extravasation  above  referred  to.  In  the  nucleus 
lenticularis  of  the  right  corpus  striatum  another  quite  recent 
clot  (about  half  an  ounce)  was  found,  from  which  a  small 
laceration  of  brain-tissue  opened  a  way  for  blood  into  the 
lateral  ventricle.  The  brain-tissue  immediately  around  the 
clot  was  broken  up  and  lacerated.  No  other  lesions  were 
found.  No  aneurysms,  large  or  small,  were  discovered  after 
careful  search.  The  great  vessels  at  the  base  of  the  brain 
were  healthy.  The  heart  was  of  natural  size.  The  free 
edge  of  the  mitral  valve  was  thickened,  opaque,  and  dis¬ 
tinctly  nodular.  Aortic  valves  healthy.  Both  lungs  were 
large,  and  semi-solid  throughout,  the  increased  consistence 
being  apparently  due  to  extreme  congestion  and  oedema. 
This  condition  was  most  marked  in  the  upper  two-thirds 
of  the  left  lung.  Other  organs  healthy.  The  occur¬ 
rence  of  a  rapidly  fatal  apoplexy  from  intra-ventricular 
hsemorrhage  was  a  very  rare  event  in  one  so  young 
as  the  boy  in  question.  No  distinct  exciting  cause  seems 
to  have  existed,  nor  could  any  immediately  determin¬ 
ing  cause  be  discovered.  No  aneurysm  was  found,  there 
was  no  vascular  infiltrating  new  growth,  nor  was  there 
any  appreciable  disease  of  the  great  vessels  at  the  base  of 
the  brain.  There  was  no  evidence  to  show  that  embolism 
had  occurred  as  the  first  event  leading  on  to  hsemorrhage. 
The  thickening  of  the  edge  of  the  mitral  valve  was  chronic, 
and  there  were  no  vegetations  from  which  embolic  masses 
could  have  been  derived,  as  in  a  case  recorded  in  the 
Lancet  of  June  16,  1883,  page  1042,  where  embolism,  and 
adjacent  hsemorrhage,  and  subsequently  fatal  intra-ventri¬ 
cular  hsemorrhage,  occurred  in  rapid  succession  in  a  girl,  also 
aged  fifteen  years.  It  seems  highly  probable  that  at  the 
time  of  his  admission  into  the  hospital  the  patient  was 
suffering  from  hsemorrhage  into  the  right  corpus  striatum, 
that  soon  after  admission  (possibly  as  a  consequence  of  the 
act  of  vomiting)  a  further  bleeding  began  to  take  place  into 
the  ventricles,  with  ultimate  distension  of  the  fourth  ventricle 
and  extravasation  of  blood  over  the  base  of  the  brain.  This 
latter  occurrence  may  have  corresponded  with  the  sudden 
failure  of  pulse  and  respiration  immediately  preceding  death. 
The  amount  of  blood  extravasated  was  here  much  smaller 
than  in  the  case  of  intra-ventricular  haemorrhage  previously 
detailed.  The  rate  at  which  the  blood  was  poured  out  was 
probably  also  much  slower.  Hence  in  the  boy  there  were 
more  signs  of  irritation  of  the  ventricles,  whilst  those  of 
shock  were  far  less  marked.  Tonic  convulsions  were  frequent 
in  this  case,  and  absent  in  the  former.  The  rectal  tempera¬ 
ture  in  the  boy  had  probably  never  been  reduced  to  a  very 
low  point,  seeing  that  at  the  expiration  of  two  hours  from 
the  onset  of  the  attack  it  stood  at  98-43.  Subsequently  the 
tendency  to  lowering  of  temperature  from  a  continuance  of 
the  cerebral  hsemorrhage  was  probably  rather  more  than 
antagonised  by  the  tendency  to  elevation  of  temperature 
due  to  the  frequently  recurring  convulsions,  seeing  that 
just  before  death  it  stood  at  99°. 

II. — Case  of  Bupture  of  a  Large  Aneurysm  in  the 

Bight  Corpus  Striatum,  with  Intra-Yentricular 

Hemorrhage,  and  Extreme  Lowering  of  Bectal 

Temperature. 

Thomas  B.,  aged  sixty-seven,  a  man  of  intemperate  habits, 
was  intoxicated  on  the  night  of  October  18,  1881.  The  fol¬ 
lowing  morning  he  left  his  house  sober  at  7  a.m.,  and  one 
hour  afterwards  was  brought  to  University  College  Hos¬ 
pital  in  an  insensible  condition,  and  admitted  under  my 
care.  He  had  been  seen  to  stagger  and  fall  sideways  in  the 
street,  but  did  not  strike  his  head  in  falling.  On  admission 
he  was  profoundly  comatose.  Breathing  slightly  stertorous, 
slow,  and  regular.  Pulse  65,  soft,  irregular,  and  slow.  Head 
and  extremities  cold ;  skin  pale  and  clammy.  Left  eye  com¬ 
pletely  closed ;  right  eye  partially  so.  Pupils  equal,  insen¬ 
sitive,  very  small.  Slight  rigidity  of  extremities  on  right 


Medical  Times  and  Gazette. 


THE  CLLNTCAL  SOCIETY"  OF  LONDON. 


Nov.  3,  1883.  531 


side.  Left  arm  quite  flaccid,  and  the  left  leg  more  so  than 
the  right.  This  was  the  patient’s  condition  when  he  was 
seen  at  10  a.m.  After  the  application  of  a  hot  flannel 
to  his  cardiac  region  the  pulse  improved,  becoming  72  and 
regular,  and  it  did  not  vary  perceptibly  till  just  before 
the  patient’s  death,  five  hours  after  admission,  when  it 
again  began  to  fail.  At  10.15  the  temperature  in  the  rectum 
was  taken,  and  found  to  be  94-5° ;  at  11  a.m.  it  was  94-5° ; 
at  11.30,  94-4°;  at  12,  94'4° ;  at  12.30,  94’6° ;  and  at  1.15 
(just  after  death),  950°.  The  coldness  and  pallor  of  the 
skin  continued  throughout.  The  pupils  enlarged  slightly 
one  hour  after  admission  (remaining  still,  however,  dis¬ 
tinctly  smaller  than  natural),  and  continued  so  till  death. 
Stertor  increased  slightly  about  forty  minutes  before  death, 
at  1.10.  Some  urine  drawn  off  after  death  was  found  to 
contain  no  albumen.  At  the  autopsy  the  calvaria  was  found 
to  be  extremely  adherent  to  the  dura  mater.  After  efforts 
to  separate  them,  they  were  both  removed  together,  when 
some  clots  and  semi-fluid  blood  welled  up  from  the  base  over 
the  frontal  lobes.  During  the  removal  of  the  brain  itself 
also  semi-fluid  blood  escaped  through  small  rents  in  the 
right  temporo-sphenoidal  and  the  right  orbital  convolutions. 
After  the  removal  of  the  brain  a  quantity  of  blood  was 
found  covering  the  anterior  and  middle  fossae  of  the  skull, 
and  thence  extending  into  the  vertebral  canal.  Over  the 
base  of  the  brain  there  was  a  large  effusion  of  blood  beneath 
the  arachnoid,  extending  from  the  optic  commissure  over 
the,pons,  medulla,  and  hinder  part  of  the  cerebellum.  The 
lateral  ventricles  were  both  very  greatly  distended,  and  full 
of  blood-clot.  When  this  blood  had  been  removed,  the  super¬ 
ficial  portion  of  the  right  corpus  striatum  was  found  to  be 
much  torn  and  shreddy.  At  the  bottom  of  the  space  thus 
formed  a  large  aneurysm  was  found,  about  the  size 
and  shape  of  a  small  chestnut,  three-quarters  of  an 
inch  in  diameter.  In  the  thin  wall  of  this  aneurysm  a 
hole  about  one  line  in  diameter  was  found.  The 
third  and  fourth  ventricles  and  the  passage  between 
them  were  all  distended  with  blood.  The  great  arteries 
at  the  base  of  the  brain  were  not  notably  diseased,  nor, 
after  careful  search  by  Mr.  William  Pasteur,  were  miliary 
aneurysms  found  in  any  part  of  the  brain.  The  kidneys 
were  slightly  granular  on  the  surface ;  their  capsules 
were  thickened,  and  the  cortex  was  wasted  in  each, 
but  to  a  slight  extent.  Other  organs  presented  no  note¬ 
worthy  changes.  Dr.  Bastian  said  tie  did  not  know  of  any 
recorded  case  of  apoplexy  in  which  the  rectal  temperature 
had  fallen  so  low  as  94<-4°,  and  in  which  it  remained  so  near 
to  this  point  for  a  period  of  three  hours.  In  only  two  of 
the  cases  recorded  by  Bourneville  did  it  ever  sink  so  low  as 
96°  Pahr.  (35'4°C.).  It  rarely,  indeed,  sinks  lower  than  9G1 5°. 
The  prognostic  value  of  such  a  sign  is  great,  and  there¬ 
fore  he  has  been  induced  to  place  this  case  on  record.  It 
is,  however,  an  interesting  one  in  other  respects.  He  has 
also  been  unable  to  discover  the  record  of  any  case  in  which 
so  large  an  aneurysm  has  been  found  embedded  within  the 
substance  of  the  brain,  and  formed  upon  one  of  its  smaller 
vessels.  It  is  rare  even  to  find  one  so  large  situated  upon 
the  basilar  or  middle  cerebral  artery.  Yet  this  large  aneu¬ 
rysm  was  evidently  formed  upon  one  of  the  small  arteries  that 
come  off  directly  from  the  first  part  of  the  middle  cerebral 
and  enter  the  nucleus  lenticularis.  The  rupture  of  such  an 
aneurysm,  so  situated,  led  to  the  extravasation  of  an  extremely 
large  quantity  of  blood.  In  this  connexion  it  is  remarkable 
that  the  pulse  and  respiration  should  not  have  been  more 
disturbed.  Probably  some  distinct  increase  of  the  extrava¬ 
sation  already  existing  caused  their  ultimate  sudden  failure. 
The  absence  of  convulsions  in  this  case  is  worthy  of  note  ; 
and  it  is  also  well  to  bear  in  mind  that,  if  ventricular  haemor¬ 
rhage  be  associated  with  a  basal  meningeal  extravasation  of 
blood,  the  pupils  will  be  rather  contracted  than  dilated. 

The  President  inquired  into  the  condition  of  the  heart 
and  arteries  in  the  first  case  related. 

Dr.  Bastian  replied  that  there  was  no  enlargement  of 
the  heart,  and  no  change  visible  to  the  naked  eye  in  the 
vessels. 

The  President  then  called  attention  to  the  fact  that  no 
albumen  had  been  discovered  in  the  urine,  although  the 
kidneys  had  been  found  to  be  granular — a  fact  which,  he 
considered,  afforded  conclusive  proof  that  cases  may  occur 
of  granular  kidney  with  the  urine  full  of  uric  acid,  but  free 
from  casts  or  albumen. 

Dr.  Angel  Money  asked  whether  any  marked  cyanosis 


had  been  present  in  the  first  case.  Some  cases  of  injury  to 
certain  parts  of  the  floor  of  the  fourth  ventricle  had  been 
shown  by  Dr.  Brown-Sgquard  to  be  accompanied  by  lower¬ 
ing  of  temperature,  the  power  of  the  tissues  to  metabolise 
being  annihilated. 

The  President  observed  that  no  case  had  been  recorded 
of  a  lower  temperature  than  96’3°. 

Dr.  Glover  inquired  as  to  the  accuracy  of  the  ther¬ 
mometer,  and  as  to  whether  more  than  one  instrument  had 
been  used. 

Dr.  Charlewood  Turner  asked  whether  the  aneurysm 
was  situated  in  the  substance  of  the  corpus  striatum,  and 
pointed  out  that  it  would  probably  have  produced  symptoms. 
The  condition  of  the  vessels  in  such  cases  was  of  great  im¬ 
portance,  and  in  almost  all  those  examined  by  himself, 
marked  epithelial  changes  had  been  observed.  Some  acute 
changes  always  preceded  aneurysm.  Haemorrhage  into  the 
sheath  of  a  vessel  might  occur,  with  thickening  as  the  only 
result.  Later  on,  a  second  haemorrhage  might  so  far  dilate 
the  thickened  vessel  as  to  form  an  aneurysm  large  enough 
to  give  rise  to  symptoms.  Further  haemorrhage  might 
occur  into  the  tissues  around,  from  the  arterial  wall  thus 
dilated. 

Dr.  Althaus  had  seen  a  case  of  low  temperature  of  95-5°. 
He  called  attention  to  the  fact  that  no  rise  of  temperature 
took  place  in  this  case  subsequently  to  the  extreme  lower¬ 
ing.  Such  a  rise  usually  followed  a  rapid  fall  from  cerebral 
haemorrhage,  and  might  be  generally  taken  to  foretell  a 
fatal  result. 

Dr.  T.  H.  Green  regarded  the  second  case  with  most- 
interest,  owing  to  the  complete  absence  of  any  cause  for 
embolism  which  it  presented.  He  suggested  that  a  careful 
examination  of  the  vessel  should  be  made.  The  contraction 
of  the  pupils  was  common  in  cases  of  haemorrhage  about  the 
base  of  the  brain. 

The  President  mentioned  that  several  writers  had  called 
attention  to  the  occurrence  of  changes  in  vessels,  of  which 
the  exact  pathology  was  not  known.  Sir  James  Paget  had 
suggested  acute  fatty  changes  in  explanation  of  some  of 
these. 

Dr.  Beevor  inquired  into  the  exact  character  of  the 
convulsions. 

Dr.  Bastian,  in  reply  to  the  various  questions  put  to  him, 
stated  that  no  special  cyanosis  had  been  observed,  nor  was 
there  any  noticeable  post-mortem  alteration  in  the  character 
of  the  blood.  The  amount  extravasated  was  very  great,  and 
the  haemorrhage  had  probably  been  continuous  to  the  end. 
This  sufficiently  accounted  for  the  absence  of  subsequent  high 
temperature,  which  only  occurred  after  active  bleeding  had 
ceased.  The  low  temperature  was  probably  due  to  shock. 
The  accuracy  of  the  thermometer  was  undoubted.  Ho  pre¬ 
vious  symptoms  of  paralysis  had  ever  been  noticed.  An 
aneurysm  slowly  developing  might  give  rise  to  no  symptoms. 
Ho  doubt  could  be  entertained  that  the  lesion  in  his  case 
was  aneurysmal.  Slow  haemorrhage  into  the  lateral  ven¬ 
tricles  might  give  rise  to  convulsions  by  irritation  of  their 
walls,  but  in  the  present  case  the  bleeding  had_  been  too- 
rapid. 

Dr.  Althaus  read  the  particulars  of  a 

Case  of  Syphilitic  Tumours  of  the  Cerebral 
Membranes. 

The  patient  was  a  girl,  aged  fourteen,  in  highly  respect¬ 
able  circumstances,  without  any  history  of  congenital  or 
acquired  syphilis.  Her  illness  began  with  gradual  loss  of 
power  in  the  left  side  of  the  body,  and  cessation  of  the 
catamenia,  and  was  diagnosed  as  a  form  of  hysteria,  and. 
treated  with  iron  and  electricity.  The  patient,  however,, 
gradually  got  worse,  and  eventually  sank  into  a  comatose 
condition.  Dr.  Althaus  only  saw  her  once,  in  consultation, 
about  a  week  before  her  death,  and  then  made  the  diagnosis, 
of  tumour  of  the  brain,  and  advised  treatment  by  perchloride 
of  mercury  and  iodide  of  potassium.  The  principal  symp¬ 
tom  which  led  him  to  reject  the  idea  of  hysteria  was  the 
exaggeration  of  tendon  reflexes  in  the  paretic  side  of  the 
body,  which  is  indicative  of  structural  disease  of  the  nervous 
centres,  while  in  hysteria  these  reflexes  may  be  normal,  in¬ 
creased,  or  diminished,  but  are  equal  in  symmetrical  parts  of 
the  body.  In  addition  to  this  there  had  been  headache  and 
vomiting;  the  paralytic  symptoms  had  comeou  gradually,and 
pointed  to  a  lesion  in  the  motor  area  of  the  right  side  of  the. 
brain;  while  a  marked  degree  of  hyperassthesia  which  was  like- 


532 


Medical  Times  and  Gazette. 


NEW  INTENTIONS  AND  IMPROVEMENTS. 


Nov.  3,  18S3. 


wise  present  in  the  affected  side  rendered  it  evident  that  the 
lesion  was  of  an  irritative  character,  and  also  affected  sensory 
areas.  There  had  been  no  convulsive  seizures,  which  are 
common  in  some  forms  of  tumour  of  the  brain,  but  are  not 
a  necessary  sequel  of  the  disease.  There  was  no  choked  disc, 
from  which  it  was  concluded  that  the  intracranial  space  was 
not  materially  reduced,  and  that  the  tumour  was  therefore 
not  of  a  large  size.  The  post-mortem  examination  revealed 
a  multitude  of  small  nodular  growths,  of  a  yellowish-grey 
colour,  permeating  the  pia  mater  and  arachnoid,  which  latter 
were  opaque,  thickened,  and  adherent  to  the  subjacent 
cortex.  Many  of  these  small  tumours  were  disposed  in 
confluent  clusters,  forming  larger  nodulated  masses,  and 
they  were  occasionally  traced  into  the  cortex  and  subjacent 
medulla.  The  lumen  of  the  bloodvessels  was  much  reduced 
by  thickening  of  their  inner  coat,  and  accumulation  of  round 
cells,  occasionally  to  occlusion ;  and  the  bloodvessels  of  the 
cortex  were  unnaturally  engorged.  Dr.  Althaus  discovered 
various  points  in  connexion  with  the  pathology  of  the  case, 
and  remarked,  amongst  others,  upon  a  peculiarly  foetid  smell 
•exhaled  by  the  skin  of  the  patient,  which  is  often  found  in 
syphilis,  and  which  in  doubtful  cases  may  be  of  diagnostic 
importance. 

In  reply  to  the  President,  Dr.  Althaus  stated  that  no 
examination  of  the  thoracic  viscera  had  been  made.  The 
pulse  had  been  100,  and  the  temperature  normal. 

Dr.  Angel  Money  took  exception  to  the  statement  that 
the  absence  of  a  choked  disc  could  be  held  to  indicate  the 
size  of  a  tumour.  Was  cerebral  tumour  invariably  accom¬ 
panied  by  optic  neuritis  ? 

Dr.  Bastian  asked  what  was  the  earliest  period  at  which 
such  tumours  had  been  found  in  cases  of  undoubted  syphilis. 
He  believed  that  not  less  than  five,  and  more  frequently  ten, 
years  was  the  usual  time,  the  changes  being  generally  a 
very  late  sign  of  syphilis.  If  that  were  so,  the  diagnosis  of 
syphilis  in  this  case  became  improbable.  Might  not  other 
conditions  besides  syphilis  tend  to  engender  such  changes  ? 
He  related  a  case  of  a  girl,  aged  twenty,  who  died  from 
tubercular  meningitis,  and  in  whose  skull,  upon  the  inner 
surface  of  the  vertex,  ulcerations  were  present,  which  had  all 
the  characteristics  of  syphilis,  although  there  was  no  other 
reason  to  believe  that  the  patient  had  ever  been  the  subject 
of  the  disease.  Possibly  other  forms  of  cachexia  might  en¬ 
gender  such  lesions.  Might  they  not  be  due  to  some  arterial 
changes  ? 

Dr.  Green  agreed  with  Dr.  Bastian  as  to  the  difficulty  of 
distinguishing  with  certainty  between  tubercular  and  syphi¬ 
litic  lesions  of  that  character. 

Dr.  Glover  considered  that  the  normal  temperature  in 
this  case  rendered  the  diagnosis  of  tubercle  impossible, 
although  cases  did  occur  in  which  only  slight  rises  took 
place.  In  cases  such  as  this,  although  on  moral  grounds  it 
was  highly  desirable  to  avoid  a  diagnosis  of  syphilis  if  pos¬ 
sible,  still  from  the  clinical  standpoint  that  disease  was 
more  amenable  to  treatment  than  any  of  the  other  forms. 

Mr.  Barker  called  attention  to  a  recent  paper  by  Auspitz, 
in  which  it  was  shown  that  the  lesions  described  by  Heubner 
in  the  vessels  in  syphilis  might  be  found  also  in  other  kinds 
of  arteritis. 

Mr.  R.  W.  Parker  mentioned  the  occurrence  of  pachy¬ 
meningitis  in  cases  of  congenital  syphilis.  The  lesion  might 
occur  very  late  in  the  disease. 

Mr.  W.  Smith  referred  to  a  case  of  severe  meningitis  and 
pachymeningitis  in  a  girl  who  had  been  the  subject  of 
interstitial  keratitis. 

The  President  suggested  [that  the  brain  of  Dr.  Althaus’s 
oase  should  be  further  examined.  He  considered  that  a 
diagnosis  founded  upon  the  appearance  of  the  anatomical 
structures  alone,  without  reference  to  the  clinical  history, 
was  insufficient.  Might  not  the  case  have  been  an  anomalous 
form  of  tubercle  ? 

Dr.  Althaus,  in  reply,  pointed  out  that  the  clinical 
features  of  the  case  negatived  the  possibility  of  tubercular 
disease.  His  diagnosis  was  founded  upon  the  post-mortem 
appearances,  and  he  was  not  aware  that  they  occurred  in 
any  other  condition.  Throughout  the  case  there  had  been 
no  cachexia,  no  primary  or  secondary  signs  of  syphilis,  and 
no  probability  of  congenital  syphilis.  He  had  met  with 
similar  pathological  changes  within  two  years  of  the  primary 
infection.  Optic  neuritis  was  not  a  constant  sign  of  tumour 
in  the  brain,  and  usually  only  occurred  with  large  tumours. 


Case  op  Dislocation  op  the  Jaw,  Reduced  apter 
Eighteen  Weeks. 

Mr  C  Hilton  Golding-Bird  related  a  case  of  disloca¬ 
tion  of  the  jaw.  The  patient,  a  sailor,  aged  twenty-two, 
sustained  a  double  dislocation  of  the  jaw  whilst  gaping  on 
May  2,  1883.  Unable  to  obtain  any  relief  where  he  was,  he 
eventually  returned  to  England,  the  dribbling  of  the  saliva 
having  now  ceased,  and  the  jaws  being  closed  to  about 
three-quarters  of  an  inch.  On  August  31  the  first  attempts 
were  made  at  reduction  under  chloroform  by  manipulation 
with  the  thumbs  in  the  mouth  by  pressing  up  the  chin 
forcibly,  the  wedges  being  placed  between  the  molars,  and 
by  Nelaton’s  method  of  pressure  directly  upon  the  coronoid 
processes.  The  position  of  the  jaw  was  not  improved,  but 
adhesions  were  broken,  and  the  jaw  rendered  more  movable, 
though  still  in  the  vicious  position.  A  week  later  (Septem¬ 
ber  2),  Nelaton’s  plan  was  tried  again,  and  after  two  attempts 
the  right  side  was  reduced ;  the  left  was  now  easily  replaced, 
and  direct  pressure  on  the  chin  backwards  brought  the 
lower  front  teeth  into  their  normal  position  behind  the 
upper.  In  a  few  days  the  patient  was  discharged  from 
hospital,  well.  The  author  expressed  his  opinions  that  whilst 
the  coronoid  processes  were  in  contact  with  the  malar  bones, 
yet  the  main  obstruction  to  reduction  lay  in  the  eminentiie 
articulares,  in  spite  of  the  high  opinions  that  were  expressed 
to  the  contrary.  He  believed  the  case  of  eighteen  weeks’ 
standing  to  be,  with  Pollock’s  of  four  months,  the  longest 
after  injury  in  which  reduction  has  been  quite  successful. 

Mr.  Pick  inquired  whether  the  patient  had  been  seen 
since  the  reduction  of  the  dislocation,  and  remarked  on  the 
liability  to  recurrence.  He  quoted  a  case  of  Mr.  Pollock’s, 
in  which  dislocation  was  reduced  by  means  of  the  tourniquet 
and  wedge,  four  months  after  its  occurrence. 

Mr.  Golding  Bird  replied  that  the  patient  had  not  been 
seen  since  his  visit,  a  fortnight  after  the  reduction. 


Two  patients  were  exhibited,  the  one  a  case  of  Aphemia 
following  severe  injury  to  the  left  side  of  the  head,  by 
Mr.  G.  R.  Turner;  the  other,  a  case  of  Radical  Cure  of 
Femoral  Hernia,  by  Mr.  Berkeley  Hill. 


NEW  INVENTIONS  AND  IMPROVEMENTS 

- <► - 

WOOLLEY’S  SANITARY  ROSE  POWDER. 

This  antiseptic  soluble  dusting  powder,  prepared  with 
boracic  acid  according  to  a  suggestion  originating  with 
Mr.  Lund,  of  Manchester,  promises  to  find  a  useful  appli¬ 
cation  in  the  nursery  and  the  sick-room.  We  have  found  it 
to  possess  the  qualities  claimed  for  it.  It  is  soluble,  unirri¬ 
tating,  and  deodorant,  and,  besides  being  a  safe  and  con¬ 
venient.  powder  for  infants,  is  likely  to  prove  advantageous 
in  cases  of  offensive  perspiration  and  of  incontinence  of 
urine,  and  may  be  worth  a  trial  in  pruritus  and  eczema 
pudendi.  This  preparation  may  be  obtained  of  Messrs. 
J.  Woolley,  Sons,  and  Co.,  of  Manchester,  or  through  the 
London  agents,  Messrs.  W.  Edwards  and  Son,  157,  Queen 
Victoria-street,  E.C. 


THE  VAPO-CRESOLENE  VAPORISER. 

This  apparatus,  which  was  introduced  into  this  country 
some  months  ago  by  Messrs.  Allen  and  Hanburys,  of 
Plough-court,  Lombard-street,  E.C.,  for  the  vaporisation 
of  cresolene — a  new  compound  from  coal-tar,  said  to  be 
a  specific  for  whooping-cough — is  very  useful  for  the  dis¬ 
semination  of  other  volatile  substances  which  it  may  be 
deemed  advisable  to  bring  into  contact  with  the  respira¬ 
tory  tract.  Cresolene  in  itself  is  a  good  stimulant  to  the 
laryngeal  and  bronchial  mucous  membrane,  but  any  of  the 
essential  oils  may  be  used  in  the  apparatus,  such  as  the  oil 
of  Sweet  Flag,  Cubebs,  Juniper,  Pinus  Silvestris,  etc.  In  the 
case  of  children,  who  cannot  be  got  to  use  the  ordinary  in¬ 
halers,  this  form  of  vaporiser  will  be  found  very  convenient. 


ALLEN  AND  HANBURYS’  MALT  JELLY. 

This  is  a  very  “ elegant”  preparation  of  Pure  Malt  Extract, 
of  which  it  contains  50  per  cent.,  combined  with  a  matrix 
of  gelatine.  It  can  be  obtained  flavoured  with  Raspberry, 
Malaga,  or  Vanilla,  and  thereby  the  sickly  flavour  of  the 
malt  is  very  successfully  concealed.  The  jelly  is  well  taken 


Medical  Times  and  Gazette. 


MEDICAL  NEWS. 


Nov.  3, 188".  53) 


by  children,  and  will  no  doubt  prove  a  very  excellent  method  I 
of  administering  the  elements  of  malt  to  nursing  mothers 
and  others  whose  stomachs  cannot  tolerate  the  extract  in 
its  undiluted  state. 


MEDICAL  NEWS. 


University  of  Durham  Faculty  of  Medicine. — 
Michaelmas  Teem,  1883. — At  the  First  Examination  for 
degrees  in  Medicine  and  Surgery  at  the  College  of  Medicine, 
Newcastle-upon-Tyne,  held  on  October  8,  9,  10,  11,  and  12, 
the  subjects  of  examination  being  Anatomy,  Physiology, 
Chemistry,  and  Botany,  the  following  gentlemen  passed  : — 

C.  M.  Hendricks  ( Second  Class  Honours),  A.  R.  Aubrey,  W.  R.  Awdrey, 
F.  8.  Barber,  J.  Barker.  G.  N.  Caley,  R.  Crosby,  T.  Carr,  I.  Davis,  C.  R. 
Hodges,  J.  Hindle,  H.  F.  Iliewicz,  C.  E.  Jennings,  W.  F.  Moore,  F.  J. 
Malden,  A.  S.  Nance,  A.  C.  A.  Packman,  J.  E.  Panton,  H.  T.  Platt,  A.  W. 
Rowe,  W.  J.  Ruddock.  W.  J.  8poor,  B.  C.  Simpson,  J.  J.  W.  Stevens,  A. 
Street,  J.  Straughan,  J.  Wilding,  F.  P.  Wigbtwick. 

The  following  satisfied  the  examiners  in  Anatomy,  Physi¬ 
ology,  and  Botany :  — 

J.  E.  Coad,  T.  Harling,  H.  B.  W.  Plummer. 

The  following  satisfied  the  examiners  in  Anatomy,  Physi¬ 
ology,  and  Chemistry : — 

H.  W.  Cross. 

Forty- three  candidates  presented  themselves  for  examina¬ 
tion.  The  examiners  were  James  Murphy,  M.D.,  Thomas 
Oliver,  M.D.,  M.R.C.P.  Bond.,  G.  E.  Williamson,  F.R.C.S. 
Eng.,  P.  P.  Bedson,  D.Sc.  Bond.,  John  Harley,  M.D.,  John 

Curnow,  M.D.  - 

Royal  College  of  Physicians  of  London. — The  fol¬ 
lowing  gentlemen  were  admitted  Members  on  October  25  : — 
Chadwick,  Charles  Montague,  M.B.  Oxon.,  London  Hospital,  E. 

Chapman.  Paul  Morgan,  M.D.  Lond.,  28,  Gordon-square,  W.C. 

Duncan,  Wm.  Archdeckne,  M.D.  Brussels,  65.  Lambeth  Palace-road,  S.E. 
Dutt,  Money  Lall,  L.M.  Bombay,  30,  Guilford-street,  W.C. 

Jones,  Charles  Montague  Handfleld,  L.R.C.P.,  24,  Montague-square,  W. 
Money,  Angel,  M.D.  Lond.,  14,  Langham-place,  W. 

Savill,  Thomas  Dixon,  M.D.  Lond.,  St.  Thomas’s  Hospital,  S.E. 

Suckling,  Cornelius  William,  M.D.  Lond.,  Birmingham. 

The  following  gentlemen  were  admitted  Licentiates  on 
October  25 : — 

Backus,  Lorenzo,  M.B.  Toronto,  46,  Grafton-street,  E. 

Bell,  John,  University  Hospital,  W.C. 

Bolton,  Alfred,  Whitecross.  Warrington. 

Boswell,  John  Irvine,  8,  Guilford- place,  W.C. 

Bowser,  James  Charles,  M.D.  McGill,  2,  Cornwall-road,  Stroud  Green,  N. 
Cahill,  John,  26,  Albert-gate,  S.W. 

Carruthers,  George,  M.D.  McGill,  2,  Cornwall-road,  Stroud  Green,  N. 
Cock,  Morris  Fisher,  Woodville,  South  Molton. 

Cook,  J onathan  Nield,  19,  Arundell-street,  W. 

Cox,  John  Henry,  51,  Doddington-grove,  S.E. 

Dacre,  John,  General  Infirmary,  Leeds. 

Dolsen,  Francis  Jacob,  M.B.  Toronto,  46,  Grafton-street,  E. 

Doyle,  Edward  Angel  Gaynes,  Trinidad. 

Edward's,  George  Frederick,  St.  James’  Green,  Thirsk. 

Evans,  William  George,  King’s  College  Hospital,  W.C. 

Fraser,  James  Alexander,  41,  Finsbury-square,  E.G'. 

Greenwood,  George,  2,  Queen  Anne’s-place,  Bush-hill  Park,  N. 

Harries,  Henry  Jones,  223,  Stanhope-street,  N.W. 

Hooper,  Henry  Walpole,  Souldern,  Sevenoaks. 

Hoople,  Edwin  Manley,  M.B.  Toronto,  46,  Grafton-street,  E. 

Irving,  Duncan  Bell,  White  Hill,  Lockerbie,  Scotland. 

Jalland,  Robert  Wallace,  Horncastle. 

Jenner,  John  Earle,  M.B.  Toronto,  46,  Grafton-street,  E. 

Knaggs,  Robert  Lawford,  111,  Disraeli-road,  S.W. 

Lawrence,  Sidney  Cameron,  116,  Bath-row,  Birmingham. 

Leaver,  Charles  Basil,  24,  Horbury- crescent,  W. 

Merces,  James,  4,  Offley-road,  Brixton,  S.W. 

Miller,  Thomas  Hugh,  10,  Fentiman-road,  S.W. 

Nunnerley,  Philip  Jebb,  11,  Powis-square,  W. 

Oliver,  Vere  Langford,  St.  George’s  Hospital,  S.W. 

Paley,  Frederick  John,  25,  Granville-square,  W.C. 

Robinson,  Henry  Betham,  7,  York-crescent,  Lower  Norwood,  S.E. 

Rook,  Albert  Edward,  Middlesex  Hospital,  W. 

Stewart,  Edward,  16,  Harley-street,  W. 

Stokes,  Francis  Alexander,  21,  Compton-terrace,  N. 

Webster,  William  Frederick,  9,  Victoria-villas,  Kilburn,  N.W. 

Wigg.  Henry  Higham,  18,  Albert-street,  N.W. 

Wood,  Neville  Thorold,  34,  Hill-street,  S.W. 

Apothecaries’  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday, 
October  25 : — 

Draper,  James  William,  Barnsbury-road,  N. 

Forden,  George,  The  Stafford  Infirmary. 

Harris,  John  Henry,  Abertillery,  Mon. 

Winstanley,  Robert  Wyndham,  Victoria  Dock  Dispensary. 

Whish,  Martin  Samuel,  Granby-street,  N.W. 

The  following  gentlemen  also  on  the  same  day  passed  their 
Primary  Professional  Examination  : — 

Becher,  George  John  Dashwood,  Middlesex  Hospital. 

Boobbyer,  Philip,  King’s  College  Hospital. 


APPOINTMENTS. 

Browne,  Valentine,  M.D. -Assistant-Surgeon  to  theMelboume  General 
Hospital. 

Pettigrew,  J.  Bell,  M.D.,  F.R.S.— Medical  Officer  to  Gibson  Hospital, 
St.  Andrews,  N.B.  _ _ 

DEATHS. 

Haefenden,  Dalton  Adolphus,  M.R.C.S.,  at  7,  Bath-place,  Kensington, 
on  October  23,  aged  50. 

Higgins,  Andrew  Henry,  L.R.C.P.,  L.S.A.,  Her  Majesty’s  Certify¬ 
ing  8urgeon  to  Factories,  at  Weston  House,  Southwark,  on  October  27, 
aged  61. 


VACANCIES. 

London  LockHospital  and  Asyluji,  Westbourne-green,  Harrow-road, 
W. — House-Surgeon  in  the  Female  Department.  Salary  £  100  per  annum. 
Applications,  with  testimonials,  to  be  sent  to  the  Secretary  by  Novem¬ 
ber  24. 

National  Hospital  for  the  Paralysed  and  Epileptic,  Queen-square, 
Bloomsbury. W.C. —Medical  Officer  and  Registrar  (non-resident).  Salary 
at  the  rate  of  £100  per  annum.  Candidates  must  be  duly  qualified,  and 
reside  in  the  immediate  neighbourhood  of  the  Hospital.  Applications 
to  be  sent  to  the  Secretary,  38,  Queen-square,  W.  C. ,  ou  or  before  N ovem- 
ber  7.  Further  particulars  may  he  obtained  by  letter,  or  personally 
between  2  and  3  p.m.  (Saturdays  excepted). 

St.  Saviour’s  Union,  Surrey.— Assistant  Medical  Officer  aud  Dispenser. 
[For particulars  tee  Advertisement.) 


UNION  AND  PAROCHIAL  MEDICAL  SERVICE. 

***  The  area  of  each  district  is  stated  in  acres.  The  population  is 
computed  according  to  the  census  of  1881. 

RESIGNATIONS. 

Burton-upon-Trent  Union. — Mr.  Samuel  H.  Warren  has  resigned  the 
Tuthury  District :  area  21,301 ;  population  5917 ;  salary  £58  10s.  per 
annum. 

Dore  Union. — Mr.  Alexander  Lane  has  resigned  the  Madley  District  r. 
area  20,563  ;  population  2936 ;  salary  £70  per  annum. 

Hexliam  Union. — The  office  of  Medical  Officer  for  the  Eastern  District  is 
vacant  :  population  5222  ;  salary  £15  per  annum.  The  office  of  Medical 
Officer  for  the  Western  District  is  vacant :  population  3800  (about)  j 
salary  £15  per  annum. 

Holsworthy  Union. — Mr.  A.  W.  Owen  has  resigned  the  Blacktorrington- 
District :  area  12,569  ;  population  1433  ;  salary  £22  11s.  6d.  per  annum. 

St.  Asaph  Union.—  Mr.  Richard  Humphreys  has  resigned  the  Llanfair- 
talhaiarn  District :  area  37,175;  population  3465 ;  salary  £83  per  annum  . 

APPOINTMENTS. 

Bingham  Union.— Henry  Williams,  M.R.C.S.  Eng.,  L.R.C.P.  Lond.,  to- 
tli6  "W  est  District. 

Bridport  Union. — John  F.  H.  Ellerton,  M.R.C.S.,  L.R.C.P.  Edin.,  to  the 
Second  District. 

Chepstow  Union.— John  T.  Brown,  M.B.  and  C.M.  Glasg.,  to  the  Tintern 
District. 

Droxford  Union. — Herbert  A.  H.  McDougall,  M.R.C.S.  Eng.,  L.R.C.P. 
Edin.,  L.A.H.  Lond.,  to  the  Hambledon  District. 

Bursley  Union. — Abraham  S.  Connellan,  L.R.C.S.  Ire.,  L.A.H.  Dub  ,  to 
the  Third  District. 

Kensington  Parish. — Thomas  O.  Dudfield,  M.D.  St.  And.,  L.R.C.P- 
Lond.,  M.R.C.S.  Eng.,  to  the  South  District. 

Leigh  Union.— Benjamin  Jones,  M.R.C.S.,  L.R.C.P.,  to  the  Pennington 
District  and  the  Workhouse. 

Liverpool  Parish.— James  Pinkerton,  M.D.,  M.Ch.  Queen’s  Univ.,Ire., 
as  Assistant  Medical  Officer  at  the  Brownlow  Hill  Workhouse. 

Oundle  Union.— Arthur  S.  Stokes,  M.R.C.S.  Eng.,  L.R.C.P.  Edin.,  to 
the  Weldon  District. 

Peterborough  Union. — Leonard  Cane,  M.D.  Lond.,  M.R.C.S.  Eng.,  L.S.A-, 
to  the  Workhouse  and  the  Peterborough  District. 

Sleaford  Union.  —  Cyril  John  Williams,  L.R.C.P.  Edin.,  L.R.C.S.  Edin., 
to  the  Blankney  District. 

Warrington  Union.-  Christopher  N.  Spinks,  M.R.C.S.  Eng.,  L.S.A.,  to- 
the  Schools  at  Padgate.  _ 

The  London  Hospital  Medical  College. — The 
Buxton  Scholarship,  of  the  value  of  ,£30,  has  been  awarded 
to  Mr.  H.  E.  Fernandez,  and  that  of  the  value  of  £20  to 
Mr.  A.  Fagan. 

East  London  Hospital  for  Children.— Miss  Cowen, 
the  elocutionist,  is  about  to  give  another  dramatic  enter¬ 
tainment  in  aid  of  the  funds  of  this  Hospital.  Last  year 
about  ,£70  was  realised,  and  it  is  to  be  hoped  that  the 
present  venture  may  not  be  less  successful. 

The  late  Dr.  Ross,  of  Inverness.— On  the  23rd 
ult.,  Dr.  John  Ross,  a  well-known  medical  practitioner  in 
the  northern  counties,  died  at  his  residence  in  Inverness 
after  a  lingering  illness.  Dr.  Ross  was  a  native  of  Suther- 
landshire,  and  had  a  wide  and  extensive  practice.  His 
reputation  as  a  surgeon  was  very  high,  and  as  a  skilful 
medical  adviser  he  occupied  the  foremost  place. 

Anatomy  Appointments  in  Ireland. — It  is  stated 
that  Prof.  Peter  Redfern  has  withdrawn  his  resignation  as 
Professor  of  Anatomy  in  the  Queen’s  College,  Belfast,  and 
continues,  therefore,  for  the  present,  to  fill  that  appointment 
as  before.  There  will,  consequently,  be  no  vacancies,  as  had 
been  anticipated,  in  Cork  or  Galway.  The  election  to  the 
vacant  Professorship  of  Anatomy  in  the  Royal  College  of 
Surgeons  in  Ireland  was  to  be  held  on  Thursday. 


534 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES. 


Nov.  3,  1883. 


The  Medico-Psychological  Association. — The  quar¬ 
terly  meeting  of  this  Association  was  held  at  Bethlem 
Hospital  on  Friday,  October  26,  when  a  paper  was  read 
by  Dr.  Mickle  on  “Rectal  Feeding  and  Medication.”  At 
the  commencement  of  the  meeting,  reference  was  made 
to  the  death  of  Dr.  Boyd  at  the  fire  at  Southall  Park,  and  a 
resolution  of  condolence  with  his  family  was  unanimously 
adopted. 

Fatal  Leap  out  oe  a  Window  by  a  Fever  Patient. 
— A  man,  aged  twenty-eight  years,  residing  in  Govan,  near 
Glasgow,  suffering  from  typhus  fever  with  delirious  symp¬ 
toms,  during  the  temporary  absence  of  his  wife,  opened  the 
window  of  the  room  in  which  he  was,  and  jumped  out  into 
a  hack  court,  a  height  of  two  storeys,  sustaining  injuries 
©f  such  a  nature  that  he  died  a  few  minutes  after  being 
picked  up. 

Hospital  Saturday  Fund. — At  a  meeting  of  the 
hoard  of  delegates  of  this  fund,  held  on  Saturday  evening — 
Mr.  H.  N.  Hamilton-Hoare,  the  hon.  treasurer,  presiding, — 
Mr.  R.  Frewer,  the  Secretary,  stated  that  ,£7000  had  been 
placed  on  deposit  at  the  hank,  as  against  £6000  at  the  cor¬ 
responding  period  of  last  year,  after  £1000  had  been  paid 
in  defraying  necessary  expenses  during  the  year.  The  total 
receipts,  including  the  street  and  workshop  collections, 
would,  he  confidently  anticipated,  reach  £10,000. 

•  The  Sanitary  Institute  of  Great  Britain. — A 
■special  meeting  of  the  signatories  of  an  invitation  to  the 
Sanitary  Institute  of  Great  Britain  to  hold  an  annual  congress 
and  exhibition  in  Dublin  was  held  in  the  King  and  Queen’s 
College  of  Physicians,  Kildare-street,  Dublin,  on  Monday,  the 
29th  ult.  The  meeting  was  largely  and  influentially  attended. 
On  the  motion  of  the  President  of  the  College  of  Physicians, 
seconded  by  the  Registrar- General  for  Ireland,  the  Lord 
Mayor-elect  of  Dublin  took  the  chair.  Mr.  William  Robert 
Maguire,  Honorary  Secretary,  having  made  a  preliminary 
statement,  it  was  agreed,  on  the  motion  of  the  Registrar- 
General  (Dr.  Grimshaw),  seconded  by  Sir  Robert  Jackson, 
C.B.,  that  the  Sanitary  Institute  of  Great  Britain  be  invited 
to  hold  their  congress  in  Dublin  in  1884.  A  local  reception 
committee  was  appointed  to  take  all  steps  necessary  for  the 
■reception  of  the  congress  ;  and  Mr.  John  Bagot,  Alderman 
Tarpey,  and  Mr.  Robert  O’Brien  Furlong  were  requested  to 
act  as  honorary  treasurers  of  a  fund  to  defray  the  expenses 
of  the  congress. 

Academy  of  Medicine  in  Ireland.— The  first  annual 
general  meeting  of  the  Fellows  and  Members  was  held  in 
the  hall  of  the  King  and  Queen’s  College  of  Physicians, 
Kildare-street,  Dublin,  on  the  afternoon  of  Friday,  Octo¬ 
ber  26.  Dr.  J.  T.  Banks,  President  of  the  Academy,  took 
the  chair.  The  ballot  for  the  officers  of  the  coming  session 
resulted  as  follows : — General  Treasurer:  Robert  MacDonnell, 
F.R.S.  General  Secretary  :  William  Thomson.  Council  of 
Medical  Section :  J.  Magee  Finny,  Samuel  Gordon,  T.  W. 
Grimshaw,  Richard  A.  Hayes,  H.  Kennedy,  A.  N.  Mont¬ 
gomery  (Secretary),  J.  W.  Moore,  Christopher  A.  Nixon, 
■George  F.  Duffey,  Walter  G.  Smith.  Council  of  Surgical 
Section :  Wm.  Colies,  Henry  Gray  Croly,  Archibald  H. 
Jacob,  Edward  Dillon  Mapother,  Edward  Stamer  O’ Grady, 
W.  Thornley  Stoker,  Wm.  Stokes  (Secretary),  John  K. 
Barton,  P.  J.  Hayes,  H.  R.  SwaDzy.  Obstetrical  Section: 
President — George  H.  Kidd;  Council  —  Lombe  Atthill, 
Fleetwood  Churchill,  George  Johnston,  J.  Rutherfoord  Kirk¬ 
patrick,  Arthur  Y.  Macan,  Thomas  More  Madden,  W.  Cox 
Neville  (Secretary),  William  J.  Smyly,  John  A.  Byrne,  John 
Denham.  Pathological  Section  :  President— Anthony  H. 
•Corley ;  Council— Pbineas  S.  Abraham,  Ed.  H.  Bennett 
(Secretary),  Charles  Coppinger,  A.  W.  Foot,  T.  E.  Little, 
J.  B.  Story,  J.  Y.  Lentaigne,  J.  M.  Purser,  F.  B.  Quinlan, 
Wm.  Stoker.  A  honorarium  of  £100  was,  after  a  long  and 
stormy  debate,  voted  to  Dr.  William  Thomson,  the  General 
Secretary,  in  appreciation  of  the  very  efficient  manner  in 
which  he  had  discharged  the  arduous  duties  of  his  office 
■during  the  past  year. 

King  and  Queen’s  College  of  Physicians  in 
Ireland. — At  the  annual  stated  meeting  of  the  College, 
held  on  St.  Luke’s  Day,  October  18,  1883,  the  following 
officers  were  elected  for  the  ensuing  year  : — President : 
William  Moore,  M.D.  Vice-President :  Francis  Richard 
Cruise,  M.D.  Censors:  Francis  R.  Cruise,  M.D.,  V.P.; 
Fleetwood  Churchill;  George  Frederick  Duffey,  M.D. ;  John 
Mallet  Purser,  M.D.  Additional  Examiners  :  John  Magee 


Finny,  M.D.  (in  Medicine);  Arthur  Vernon  Macan,  M.D. 
(in  Midwifery) ;  Christopher  John  Nixon,  M.B.  (in  Ana¬ 
tomy)  ;  John  Mallet  Purser,  M.D.  (in  Physiology  and  Histo¬ 
logy)  ;  Francis  J.  B.  Quinlan,  M.D.  (in  Medical  Jurisprudence 
and  Pathology)  ;  Walter  G.  Smith,  M.D.  (in  Chemistry). 
Registrar:  John  William  Moore,  M.D.  Treasurer:  Aquilla 
Smith,  M.D.  Examiners  in  Midwifery :  John  Rutherfoord 
Kirkpatrick,  M.B.,  King’s  Professor  of  Midwifery ;  and 
Stephen  Miles  MacSwiney,  M.D.  Professor  of  Medical 
Jurisprudence :  Robert  Travers,  A.M.,  M.D.  Representative 
on  the  General  Medical  Council:  Aquilla  Smith,  M.D. 
Agent  to  the  Trust  Estate :  Charles  Uniacke  Townshend, 
Esq.  Law  Agents :  Messrs.  Stephen  Gordon  and  Sons. 
The  following  were  elected  to  the  Fellowship  :  —  Michael 
Joseph  Clune,  Licentiate  in  Medicine  and  Member  of  the 
College,  M.D.  Brussels,  Fellow  and  Master  of  Arts  in  the 
University  of  Sydney,  New  South  Wales ;  Effingham  Carroll 
MacDowel,  Licentiate  in  Medicine  and  Member  of  the 
College,  M.D.  Univ.  Dub.  ( stipendiis  condonatis).  Mr. 
Thomas  Henry  Innes  was  elected  Librarian  to  the  College 
on  the  foundation  of  Sir  Patrick  Dun,  Clerk  to  the  College, 
and  Clerk  to  the  Trust  Estates  of  Sir  P.  Dun. 

Hospital  Management. — The  first  meeting  of  the 
enlarged  Committee,  originally  constituted  at  the  Conference 
on  Hospital  Administration  which  took  place  in  July  last, 
under  the  auspices  and  management  of  the  Social  Science 
Association,  was  held  at  No.  1,  Adam-street,  Adelphi,  on 
Thursday  week,  for  the  purpose  of  considering  the  draft  con¬ 
stitution  of  a  proposed  “  Hospitals  Institute,”  which  had 
been  prepared  by  a  sub-committee  appointed  in  July.  Mr. 
Alexander  H.  Ross,  M.P.,  was  in  the  chair,  and  a  large 
number  of  the  Committee,  which  is  constituted  as  follows, 
were  present : — Earl  of  Cork  and  Orrery,  K.P.,  St.  George’s 
Hospital;  Viscount  Powerscourt,  K.P.,  Ireland;  Sir  T. 
Fowell  Buxton,  Bart.,  London  Hospital ;  Sir  Rutherford 
Alcock,  K.C.B.,  Westminster  Hospital;  Sir  Joseph  Fayrer, 
K.C.S.I.,  M.D.,  LL.D.,  F.R.S.,  Charing-cross  Hospital;  Mr. 
H.  W.  D.  Acland,  M.D.,  C.B.,  D.C.L.,  F.R.S.,  Oxford  Uni¬ 
versity;  Mr.  William  Bousfield,  King’s  College  Hospital; 
Mr.  j.  S.  Bristowe,  M.D.,  F.R.S.,  St.  Thomas’s  Hospital; 
Mr.  Henry  C.  Burdett,  Seamen’s  Hospital  and  Home  Hos¬ 
pitals  Association ;  Mr.  J.  H.  Buxton,  London  Hospital ; 
Mr.  Mackenzie  Chalmers,  London  Fever  Hospital ;  the  Rev. 
Canon  Erskine  Clarke,  M.A.,  Bolingbroke  House  Pay  Hos¬ 
pital ;  Dr.  Farquharson,  M.P.,  Scotland;  Captain  Douglas 
Galton,  C.B.,  D.C.L.,  F.R.S.,  University  College  Hospital; 
Mr.  S.  Leigh  Gregson,  Southern  Hospital,  Liverpool ;  Mr. 
Timothy  Holmes,  St.  George’s  Hospital  and  Provident  Dis¬ 
pensaries  ;  Mr.  G.  B.  Lloyd,  General  Hospital,  Birmingham  ; 
Mr.  Charles  Macnamara,  F.R.C.S.,  Westminster  Hospital; 
Mr.  Francis  S.  Powell;  Dr.  Quain,  Consumption  Hospital, 
Brompton ;  Mr.  Alexander  H.  Ross,  M.P.,  Middlesex  Hos¬ 
pital  ;  Dr.  E.  H.  Sieveking,  St.  Mary’s  Hospital :  Dr.  T. 
Gilbart-Smith,  London  Hospital;  Mr.  Joseph  White,  F.R.C.S., 
General  Hospital,  Nottingham  ;  Mr.  John  Wood,  F.R.S. , 
King’s  College  Hospital ;  Mr.  E.  Parker  Young,  St.  Mary’s 
Hospital.  The  Secretary  pro  tem.  to  the  Committee  is  Mr. 
J.  L.  Clifford- Smith. 


NOTES,  QUERIES,  AND  REPLIES. 

- - 

He  tjjat  qtusthmetjj  nuufc  sfeall  learn  mttelj. — Bacon. 


The  Camden  Town  Epidemic. 

TO  THE  EDITOR  OF  THE  MEDICAL  TIMES  AND  GAZETTE. 

Sir, — Referring  to  your  article  of  the  20th  inst.,  to  which  my  attention 
has  just  been  directed,  you  express  yourself  as  “not  entirely  satisfied” 
with  regard  to  some  quality  of  my  report  on  recent  milk-typhoid  in  St. 
Pancras,  and  you  go  on  to  “  suspect  that  some  very  important  circum¬ 
stances  have  been  overlooked  or  suppressed.”  Your  suspicions  are  based 
on  a  letter  to  the  Daily  News  from  Mr.  Murray,  of  St.  Albans,  which 
contains  some  statements  which  would  assuredly  need  critical  exa¬ 
mination  before  their  bearing  on  the  infectiousness  of  Mr.  Z.’s  milk 
could  be  rightly  apprehended.  With  these,  however,  I  am  not  now 
concerned.  I  write  to  object  to  a  “suspicion”  of  “suppression”  of 
facts  expressed  by  tbe  writer  in  your  journal,  who  had  before  him  the 
following  passage  “  Mr.  Z.  has  furnished  me  with  a  list  of  people  who 
came  to  his  farm  during  the  months  of  June,  July,  and  August,  and 
to  these  I  have  written,  asking'  for  information  as  to  their  health ; 
replies  have  not  yet  been  received  from  all,  and  I  do  not,  therefore, 
consider  this  branch  of  the  inquiry  altogether  at  an  end.”  Whatever 
may  be  the  affirmative  evidence  inculpating  the  St.  Albans  milk,  its 
nature  and  validity  may  be  judged  from  the  text  of  the  report.  I  am 
not  concerned  to  defend  its  reasoning.  In  your  issue  of  last  week  I  find 
the  arguments  of  the  report  thus  summed  up  by  Dr.  Edward  Squire, 


M«lical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES. 


Nov.  ?,  18S3.  53 5 


whose  authority  in  the  case  may  help  to  reassure  the  writer  of  your 
article.  The  “report  goes  far  to  prove  a  connexion  between  the  out¬ 
break  at  St.  Pancras  and  the  milk  from  Mr.  Z.’s  farm ;  hut,  as  the 
report  says,  the  manner  in  which  the  milk  became  infected  is  not  clear.” 

October  80.  I  am,  &c.,  Shirley  F.  Murphy. 

[We  are  sorry  that  Dr.  Murphy  should  think  we  accused  him  of  conscious 
and  wilful  suppression  of  evidence,  and  we  hope  he  will  accept  this 
expression  of  regret.  We  think  that  if  he  reads  the  article  again  he 
will  see  that  our  remarks  will  bear  quite  another  interpretation. — Ei> . 
Med.  Times  and,  Gaz.] 

The  Hind  Fund. 

TO  THE  EDITOR  OF  THE  MEDICAL  TIMES  AND  GAZETTE. 

The  following  additional  subscriptions  have  been  received  and  paid 
to  the  account  of  the  “Hind  Fund”  at  Messrs.  Coutts’  Bank:— F.  B. 
Courtenay,  Esq.,  £10  10s. ;  Dr.  H.  Buss,  £5  ;  T.  J.  P.  (per  J.  J.  Pope,  Esq.), 
£5;  Sir  Henry  Pitman,  £3  3s.;  Thomas  Smith,  Esq.,  £3  3s.  ;  Morrant 
Baker,  Esq.,  £3  3s. ;  Sir  Henry  Thompson,  £2  2s. ;  Dr.  G.  Y.  Poore, 
£2  2s. ;  E.  Sandwell,  Esq.,  £2  2s.;  Henry  Stear,  Esq.,  £2  2s.;  E.  H. 
Beaman,  Esq.,  £2  2s. ;  C.  j.  Harris,  Esq.,  £2  2s.;  C.  G.,  £2  2s. ;  Prof. 
Eav  Lankester,  £2 ;  Dr.  John  Williams,  £1  Is. ;  .T.  P.  Holyoake,  Esq., 
£1  Is. ;  W.  H.  Torback,  Esq.,  £1  Is. ;  R.  F.  H.  King,  Esq  ,  £1  Is.  ;  Dr. 
Curnow,  £1  Is.;  Dr.  H.  Allen  Aldred,  £1  Is.;  Edmund  Whitfield,  Esq., 
£1  Is.  :  Duncan  MacArthur,  Esq  ,  £1  Is. ;  Dr.  A.  G.  Cross.  £1  is. ;  H.  J. 
Manning,  Esq.,  £1  Is. ;  John  Bluett,  Esq.,  £1  Is.  ;  Dr.  T.  H.  Moorhead, 
£l  Is. ;  W.  Lee,  Esq.,  £1  Is. ;  Dr.  Fancourt  Barnes,  10s. ;  C.  C.  Balding, 
Esq.,  10s. 

Subscriptions  may  be  paid  to  Dr.  Richardson,  F.R.S.  (chairman), 
25,  Manchester-square ;  John  Tweedy,  Esq.,  F.R.C.S.,  24,  Harley-street, 
Ron.  treasurer  ;  A.  J.  Pepper,  Esq.,  F.R.C.S.,  122,  Gower-street,  or  T. 
Wakley,  jun.,  Esq.,  L.R.C.P.,  98,  Redcliffe-gardens,  hon.  secretaries  ;  or 
to  Messrs.  Coutts  and  Co.,  Strand. 

The  Rogers  Testimonial. 

The  following  subscriptions  have  been  received  : — Ernest  Hart,  Esq., 
£1  Is. ;  Dr.  Whitwell.  Shrewsbury,  £1  Is. ;  S.  Burrows,  Esq.,  Witheridge, 
Devon,  £1  Is. ;  Dr.  O’Connor,  Chatteris.  £1  Is. ;  Dr.  R.  Carpenter.  Stock  - 
well-road,  £1  Is. ;  G.  Pound,  Esq.,  Odiham,  Hants,  £1  Is.;  J.  Breward 
Neal,  Esq.,  Infirmary,  New  Wandsworth,  £1  Is. ;  F.  Hall,  Esq..  1,  Jermyn- 
street,  £i  Is  :  Dr.  Grabb,  Tilsoe  Villa,  Ealing,  £t  Is.  ;  C.  Frost,  Esq., 
F.R.C.S.,  Ladbroke-square,  £1  Is.;  Dr.  Samuel  Smith,  Pershore,  £1  Is.  ; 
Dr.  A.  Godrich,  Fulham,  £1  Is.  ;  Dr.  Gidley  Moore,  Ongar,  10s.  6d.  ;  J. 
Wickham  Barnes,  £1  Is. ;  Dr.  Walter  Smith,  Stanhope-terrace,  Regent 's- 
park,  £1  is. ;  Dr.  Norman  Kerr,  £1  Is. 

The  Bradshaive  Lecture.  -  This  discourse  will  be  delivered,  early  in  the 
present  month,  in  the  Theatre  of  the  Royal  College  of  Surgeons,  by  the 
President,  Prof.  Marshall,  F.R.S. 

Birmingham  Suburban  Hospital. — Eight  donations  of  £IC03  have  been 
made  to  the  endowment  fund  of  the  Birmingham  Suburban  Hospital, 
presented  by  Mr.  Jaffray  to  the  General  Hospital. 

In  Memoriam.  —  It  is  intended  that  the  memorial  to  the  late  Duke  of 
Marlborough  shall  take  the  form  of  additional  buildings  at  the 
Radcliffe  Infirmary,  of  which  he  was  President,  and  it  is  also  proposed 
to  place  a  window  in  the  parish  church  at  Woodstock. 

Mortality,  Croydon.—  The  Medical  Officer  of  Health  for  the  borough  re 
ports  that  the  death-rate  for  the  past  quarter  has  been  less  than  twelve 
per  thousand  of  the  population.  This  is  the  lowest  death-rate  ever 
recorded  in  the  borough. 

At  Last ! — The  Lower  Thames  Valley  Main  Sewerage  Board  has  selected 
the  Mortlake  site  for  the  proposed  sewage  works,  and  their  Chairman 
and  two  other  members  have  been  authorised  to  negotiate  the  purchase . 
We  hope  this  district  will  now  soon  be  provided  with  a  sanitary  require¬ 
ment,  of  which,  by  protracted  opposition  and  conflicting  interests,  the 
inhabitants  have  for  years  been  deprived. 

Impaired  Value  of  the  Reports  of  Medical  Officers  of  Health. — The  Local 
Government  Board  has  had  occasion  to  make  it  known  that  it  appears  to 
the  Board  that  the  value  of  the  reports  of  a  medical  officer  of  health 
on  the  sanitary  condition  of  his  district  must  be  necessarily  diminished  in 
value  if  they  are  not  furnished  until  many  months  after  the  expiration 
of  the  period  to  which  they  relate. 

Small-pox  in.  Lancashire. — An  epidemic  of  small-pox  is  raging  in  Widnes, 
and  a  Government  inquiry  is  to  be  held  in  connexion  with  the  scheme 
for  the  erection  of  a  permanent  hospital  for  the  town.  Dr.  Parsons,  one 
of  the  Local  Government  Medical  Inspectors,  has  visited  the  town  and 
inspected  the  site.  A  large  tent  hospital  has  been  erected  for  the 
purpose  of  isolating  the  worst  cases. 

Medical  Charities.— The  late  Mr.  J.  N.  Mappin,  of  Birchlands,  Sheffield, 
has  left  legacies  of  £10C0  each  to  the  General  Infirmary  and  the  Public 
Hospital  and  Dispensary  of  that  town,  and  a  similar  amount  to  the 

Rotherham  Hospital,  Public  Hospital,  and  Dispensary. - The  late  Mr. 

William  Thomas  Watson,  of  Bristol,  has  left  £2C0  each  to  the  Bristol 
Royal  Infirmary,  the  Bristol  General  Hospital,  and  the  Weston-super- 
Mare  Sanatorium. 

Fever  in  the  Metropolis. — The  Small-pox  and  Fever  Hospital  returns  showed 
that,  with  regard  to  the  former,  during  the  fortnight  ending  Friday, 
October  26, 14  patients  had  been  admitted,  2  had  died,  and  19  had  been 
discharged,  leaving  54  cases  under  treatment— a  decrease  of  6  as  com¬ 
pared  with  the  previous  fortnight.  In  fever  cases  the  returns  showed 
that  during  the  fortnight  152  had  been  admitted,  21  had  died,  and  41  had 
been  discharged,  leaving  549  under  treatment— being  an  increase  of  48  as 
compared  with  the  preceding  fortnight. 


Dens  Sap.,  Middlesex.— There  are  now,  including  the  nine  admitted  last 
week,  530  Licentiates  in  Dental  Surgery  of  the  Royal  College  of  Sur¬ 
geons.  The  Dental  Members  of  the  Board  of  Examiners  are  Messrs. 
Alfred  Coleman,  Augustus  Winterbottom,  and  Charles  Lissmore  Tomes, 
all  of  whom  are  Fellows  of  the  College  by  examination. 

Anti-Vaccination,  Leicester. — This  town  maintains  its  notoriety  in  resisting 
the  Vaccination  Acts.  Twenty-one  persons  were  summoned  last  week 
for  refusing  to  comply  with  the  law.  The  usual  objections  were 
unavailingly  urged.  There  are  several  thousand  unvaccinated  children 
in  the  town,  and  one  thousand  parents,  it  is  stated,  are  to  be  summoned. 

Dr.  Joseph  Rogers.— At  a  meeting  of  the  Dorset  and  West  Hants  Branch 
of  the  British  Medical  Association  held  at  Wareham  on  the  24th  ult., 
the  following  resolution  was  unanimously  passed  “  That  this  Branch 
— having  read  in  the  public  journals  that  Dr.  Joseph  Rogers  has  been 
suspended  from  his  office  as  Medical  Officer  to  the  Westminster  Work- 
house,  ostensibly  on  frivolous  and  vexatious  charges,  but  really  for 
giving  honest  evidence  in  an  inquiry  into  the  conduct  of  the  master, 
and  his  resignation  demanded  ;  whilst  the  master,  against  whom  most 
serious  charges  have  been  established,  has  been  continued  in  office — 
desires  to  enter  a  strong  protest  against  the  manner  in  which  Dr.  Rogers 
has  been  treated,  and  which  materially  affects  the  position  of  every 
Poor-law  medical  officer.  This  Branch  trusts  that  the  action  of  the 
Committee  of  Council  and  of  this  Branch  will  be  supported,  not  only  by 
every  branch  of  the  Association,  but  also  by  the  medical  profession 
throughout  the  United  Kingdom.” 

Medical  Knights. — In  our  last  issue  we  gave  the  names  of  the  members  of 
the  profession  on  whom  baronetcies  have  been  conferred  since  the  year 
1850.  The  following  is  a  list  of  those  on  whom  the  lesser  honour  of 
knighthood  has  been  bestowed  1852,  Charles  Nicholson,  M.D., 
Speaker  of  the  Legislative  Council,  New  South  Wales;  1853  Joseph 
Francis  Oliffe,  M.D.,  Physician  to  the  Embassy  at  Paris;  1853,  John 
Forbes,  M.D.,  Physician  to  the  Royal  Household;  1853.  James  Lomax 
Bardsley,  M.D.,  of  Manchester;  1854,  Henry  Cooper,  M.D.,  Mayor  of 
Kingston-upon-Hull ;  1854,  John  Spencer  Login,  M.D.,  Bengal  Medical 
Service,  Superintendent  to  Duleep  Singh ;  1856,  William  Brooke 
O’Shaughnessy,  Surgeon  Bengal  Army;  1858,  William  Rae,  M.D., 
Inspector  of  Hospitals  and  Fleets  ;  1358,  James  Pryor,  Deputy-Inspec¬ 
tor  of  Hospitals  and  Fleets;  185a,  John  William  Fisher,  Surgeon 
Police  Force  ;  1860,  Jame3  Ranald  Martin,  Physician  to  the  India 
Office;  1863,  James  Coxe,  M.D.,  Commissioner  of  Lunacy  in  Scotland  ; 
1864,  Alexander  Taylor,  M.D. ;  1865,  Edward  Hilditch,  M.D.,  Inspector- 
General  of  Hospitals  and  Fleets ;  1867,  Henry  Thompson,  F.R.C.S  ; 
1868,  William  Carroll,  M.D. ,  Mayor  of  Dublin;  1868,  William  Charles 
Hood,  M.D. ;  1869,  James  Alderson,  M.D.,  President  of  the  Royal 
College  of  Physicians  ;  1872,  John  Rose  Cormack,  M.D.,  Surgeon  to 
the  English  Ambulance  at  Paris ;  1873,  John  Cordy  Burrows,  Surgeon, 
Mayor  of  Brighton  ;  1873,  Alexander  Nisbet,  M.D.,  Inspector-General 
of  Hospitals  and  Fleets ;  1873,  Joseph  Ritchie  Lyon  Dickson,  M.D. ,  Phy¬ 
sician  to  the  Persian  Legation  ;  1878,  James  Salmon,  M.D.,  Inspector- 
General  of  Hospitals  and  Fleets;  1881,  James  Risdon  Bennett,  M.D. , 
F.R.S.,  President  of  the  Royal  College  of  Physicians  ;  1881,  WilliamMac 
Cormae,  Surgeon  and  Lecturer  on  Surgery,  St.  Thomas’s  Hospital ;  1882, 
Oscar  Moore  Passey  Clayton,  F.R.C.S.;  1882,  Erasmus  Wilson,  F.R.S., 
President  of  the  Royal  College  of  Surgeons  of  England  ;  1S83,  Alfred 
Roberts,  Honorary  Secretary  and  Consulting  Surgeon  to  Prince  Alfred 
Hospital,  Sydney,  New  South  Wales  ;  1883,  Henry  Alfred  Pitman,  M.D., 
Registrar  to  the  Royal  College  of  Physicians :  1833,  Edwin  Saunders, 
F.R.C.S.,  Surgeon-Dentist-in-Ordinary  to  Her  Majesty;  T883,  George 
Hornidge  Porter,  Surgeon-in-Ordinary  to  Her  Majesty  in  Ireland.  The 
following  have  received  the  honour  of  knighthood  from  the  Lord  Lieu¬ 
tenant  of  Ireland 186.3,  John  Gray,  M.D.,  on  opening  the  Vartry 
Waterworks;  1864,  William  Robert  Wills  Wilde,  F.R.C.S.,  Surgeon- 
Oeulist-in-Ordinary  to  the  Queen,  for  services  in  connexion  with  the 
Irish  Census ;  1876,  George  Bolster  Owens,  M.D.,  Lord  Mayor  of  Dublin ; 
1876,  William  Miller,  M.D.,  Mayor  of  Derry. 

COMMUNICATIONS  have  been  received  from — 

Prof.  G.  M.  Humphry,  F.R.S.,  Cambridge;  Dr.  George  Johnson,  F.R.S., 
London;  Deputy  Inspector-General  Nicholson,  M.D. ,  Norwood ;  Dr. 
Crichton  Browne,  Manchester ;  Dr.  Althaus,  London ;  The  Secre¬ 
tary  of  the  Royal  Institution,  London ;  The  Registrar  of  the 
Royal  College  of  Physicians,  London;  Dr.  Clifford  Beale, 
London;  The  Sanitary  Commissioner  for  the  Punjaub,  Lahore; 
The  Secretary  of  the  Apothecaries’  Society,  London;  Mr.  J.  T. 
W.  Bacot,  Seaton;  Dr.  W.  P.  Mears,  Newcastle  on- Tyne  ;  The  Hon. 
Secretary  of  the  Odontolooical  Society  of  London:  The  Secre¬ 
tary  of  the  Parkes  Museum  of  Hygiene,  London ;  Mr.  Gurney, 
London;  Mr.  MacAlisteb,  Cambridge;  Mr.  C.  Messent,  London; 
Mr.  G.  F.  Hentsch,  London;  Mr.  Becher,  London;  Dr.  Coates, 
London;  The  Secretary  of  the  Anti-Compulsory  Vaccination 
League,  London ;  Mr.  T.  M.  Stone,  Wimbledon ;  Dr.  Moore, 
Dublin ;  The  Hon.  Secretary  of  the  University  of  Durham 
College  of  Medicine,  Neweastle-on-Tyne ;  The  Hon.  Secretary  of 
the  Obstetrical  Society  of  London  ;  Mr.  J.  Chatto,  London  ;  The 
Hon.  Secretary’  of  the  Med'cal  Society  of  London  ;  Dr.  Sidney 
Coupland,  London  ;  Dr.  A.  T.  Thomson,  Glasgow;  The  Registrab- 
Generalfor  Scotland.  Edinburgh;  Mr.  Wickham  Barnes,  London; 
Mr.  F.  Le  Gros  Clark,  Sevenoaks,  Kent ;  The  Secretary  of  the 
Medico-Psychological  Association.  London:  Dr.  Norman  Chevers, 
London;  Messrs.  Merryweathkb,  London ;  Mr.  George  Scudamore, 
London;  The  Secretaries  of  the  Statistical  Society,  London. 


:,<f  RAt;  y  A)  ?•'?  k)  --V  \ 


I,  I  S3  A.  f-’  -j 


536 


Medical  Times  and  Gazette. 


YITAL  STATISTICS. 


Not.  3, 1883. 


BOOKS,  ETC..  RECEIVED  - 

Clinical  Chemistry,  hy  Charles  Henry  Ralfe,  M.A.,  M.D  .—Clinical  Notes 
on  Cancer,  by  Herbert  L.  Snow,  M.D. — Report  on  the  Berkshire  Com¬ 
bined  Sanitary  Districts. 

PERIODICALS  AND  NEWSPAPERS  RECEIVED— 

Lancet— British  Medical  Journal— Medical  Press  and  Circular — Ber¬ 
liner  Klinische  Wochenschrift — Centralblatt  fur  Chirurgie — Gazette 
des  Hopitaux— Gazette  MSdieale— Revista  de  Medicina— Bulletin  de 
1’ Acad6mie  de  M^decine— Pharmaceutical  J  ournal — W  iener  Medicinische 
Wochenschrift— Revue  M£dicale— Gazette  Hebdomadaire— Nature — 
Boston  Medical  and  Surgical  Journal — Louisville  Medical  News— 
Centralblatt  fiir  Gyniikologie — Le  Concours  Medical— Centralblatt  fur 
die  Medicinischen  Wissenschaften — Centralblatt  fiir  Klinische  Medicin 
— Philadelphia  Medical  News— Le  Progrtts  Medical — New  York  Medical 
Journal — Edinburgh  Clinical  and  Pathological  Journal— Students’  Jour¬ 
nal  and  Hospital  Gazette— New  York  Medical  Record— Modern  Thought 
— Science  Monthly — Yorkshire  Weekly  Post,  October  27 — Philadelphia 
Medical  Times— Veterinarian— Maryland  Medical  Journal — Archives 
Generales  deMedecane. 


APPOINTMENTS  FOE  THE  WEEK. 


November  3.  Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  l£  p.m. ;  King’s  College,  1|  p.m. ;  Royal 
Free,  2  p.m.;  Royal  London  Ophthalmic,  11  a. m. ;  Royal  Westminster 
Ophthalmic,  1^  p.m. ;  St.  Thomas’s,  l^p.m.;  London,  2  p.m. 


5.  Monday. 

Operations  at  the  Metropolitan  Free,  2  p.m.;  St.  Mark’s  Hospital  for 
Diseases  of  the  Rectum, 2  p.m.;  Royal  London  Opbtbalmic.il  a.m.; 
Royal  Westminster  Ophthalmic,  Is  p.m.  ;  Hospital  for  Women,  2  p.m. 

Royal  Institution,  5  p.m.  General  Monthly  Meeting. 

Odontological  Society  op  Great  Britain,  8  p.m.  Casual  communi¬ 
cations  by  Messrs.  Storer  Bennett,  S.  J.  Hutchinson,  and  Henry  Sewill. 
Mr.  Henry  Power,  “  On  the  Relation  between  Diseases  of  the  Eye  and 
Diseases  of  the  Teeth.” 

Medical  Society  op  London  (Council Meeting. 7?  p.m.),  8J  p.m.  General 
Meeting.  Prof.  Lister,  “  On  the  Treatment  of  Fractures  of  the  Patella” 
(adjourned  discussion).  Dr.  Francis  Warner,  “  On  Postures  indicative 
of  the  Condition  of  the  Mind.” 


6.  Tuesday. 

Operations  at  Guy’s,  1A  p.m. ;  Westminster,  2  p.m. ;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  14  p.m.;  West 
London,  3  p.m. 

Pathological  Society,  8$  p.m.  Dr.  Norman  Moore— Multiple  Diver¬ 
ticula  of  Small  Intestine.  Dr.  Hadden — Rupture  of  Heart.  Mr.  Parker 
— Congenital  Talipes  Equino-varus  (two  casesj.  Mr.  A.  Durham- 
Osseous  Tumour  in  a  Cicatrix.  Mr.  Roeckel— Sections  of  Hemor¬ 
rhoids.  Dr.  S.  West  — Obliteration  of  one  Coronary  Artery.  Mr.  Eve 
— Pedunculated  Adeno-Sarcoma  of  the  Skin.  Mr.  Waren  Tay— Living 
Specimens  ten  years  after  Removal  of  nearly  the  whole  of  the  Lower 
Jaw  for  Necrosis.  Dr.  Carrington -Dlcerative  Endocarditis.  Mr.  Eve 
—Hydatid  Cyst  in  Muscles  of  Calf  (card).  Dr.  Lediard— Sarcoma  of 
Lower  Jaw  of  Horse  (card).  Dr.  Burnett  — Sacculated  Aneurysm  of  the 
Aorta  (card). _ 

7.  Wednesday. 

Operations  at  University  College,  2  p.m. ;  St.  Mary’s,  1  j  p.m. ;  Middlesex, 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew’s,  1J  p.m.  ;  Great  Northern, 

2  p.m. ;  Samaritan,  2J  p.m. ;  Royal  London  Ophthalmic,  11  a.m.  ; 
Royal  Westminster  Ophthalmic,  p.m. ;  St.  Thomas’s,  lj  p.m. ;  St. 
Peter's  Hospital  for  Stone,  2  p.m.;  National  Orthopaedic,  Great 
Portland-street,  10  a.m. 

Bbompton  Hospital  for  Consumption,  etc.,  4  p.m.  Dr.  T.  Henry 
Green,  Demonstration  — Cases  of  Commencing  Phthisis. 
Epidemiological  Society,  8  p.m.  The  President  will  deliver  an  Inaugural 
Address,  “  On  Medico-Topographical  and  Health  Histories  for  Districts 
and  Towns.” 

Obstetrical  Society  of  London,  8  p.m.  Specimens  will  be  shown. 
The  following  papers  will  be  read:— "Mr.  Lawson  Tait— 1.  “OnThiee 
Cases  of  Pyosalpinx”;  2.  “  On  a  Case  of  Acute  Gangrene  of  the 
Uterus”;  3.  “  An  Undescribed  Disease  of  the  Fallopian  Tubes.”  Dr. 
E.  S.  Tait,  “  Observations  on  Puerperal  Temperatures.” 


8,  Thursday. 

Operations  at  St.  George’s,  1  p.m. ;  Central  London  Ophthalmic,  1  p.m. ; 
Royal  Orthopeedic,  2  p.m.;  University  College,  2  p.m.;  Royal  London 
Ophthalmic,  11  a.m. ;  Royal  Westminster  Ophthalmic,  U  p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m. ;  Hospital  for  Women,  2  p.m. ; 
Charing-cross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  2)-  p.m. 
Abernethian  Society  (St.  Bartholomew's  Hospital),  8  p.m.  Surgical 
Discussion,  “  On  Recent  Advances  in  the  Surgery  of  the  Urinary 
Organs,”  introduced  by  Mr.  Bowlby. 

9.  Friday. 

Operations  at  Central  London  Ophthalmic,  2  p.m. ;  Royal  London  Ophthal¬ 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminster 
Ophthalmic,  l^p.m.;  St.  George’s  (ophthalmic  operations),  U  n.m. ; 
Guy’s,  14  p.m.  ;  St. Thomas’s  (ophthalmic  operations),  2  p.m. ;  King’s 
College  (by  Mr.  Lister),  2  p.m. 

Medical  Society  of  Charing-cross  Hospital,  8  p.m.  Mr.  Ray  Fletcher, 
11  On  Army  and  Volunteer  Medical  Organisation.”  (Visitors  invited.) 
Clinical  Society  of  London  (Council  Meeting,  7£  p.m.),  8.J  p.m.  Mr. 
G.  R.  Turner — 1.  “  On  a  Case  of  Wound  of  the  Plantar  Arch  ;  Secondary 
Hmmorrhage  on  the  Thirteenth  and  Sixteenth  Days  after  the  Injury  ”; 
2.  “  On  Cases  of  Ununited  Fracture  of  the  Patella  treated  by  Suture.” 
Dr.  Thin,  “On  Cases  of  Thickened  Epidermis  treated  by  Salicylic 
Plaster.”  Dr.  Dawtrev  Drewitt,  “  On  a  Case  of  Myxoedema.”  Living 
Specimens  (8  p.m.):  Dr.  J.  K.  Fowler— Subcutaneous  Nodules  in  an 
Adult  (Male). 


VITAL  STATISTICS  OF  LONDON. 

Week  ending  Saturday,  October  27,  1883. 

BIRTHS. 

Births  of  Boys,  1363;  Girls,  1358;  Total,  2724. 

Corrected  weekly  average  in  the  10  years  1873-82,  271115. 

DEATHS. 


Males. 

Females. 

Total. 

Deaths  during  the  week . 

753 

697 

1450 

Weekly  average  of  the  ten  years  1873-82,  { 

825-9 

766-9 

1592-8 

65 

corrected  to  increased  population  ...  i 

Deaths  of  people  aged  80  and  upwards 

DEATHS  IN  SUB-DISTRICTS  FROM  EPIDEMICS. 


[  Enumerated 

Population, 

1881 

(unrevised). 

Small-pox. 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

Whooping- 

cough. 

Typhus. 

Enteric  (or 

Typhoid) 

Fever. 

Simple 

continued 

Fever. 

as 

8 

Q 

West . 

669633 

3 

6 

1 

3 

2 

5 

North  ... 

905947 

2 

6 

11 

6 

5 

•  •• 

12 

9 

Central  ... 

282238 

.  .. 

2 

6 

1 

2 

... 

2 

.  . . 

1 

East . 

692738 

6 

19 

6 

4 

•  •• 

3 

1 

4 

South . 

1265927 

... 

5 

14 

6 

11 

... 

10 

12 

Total . 

3816483 

2 

22 

56 

20 

25 

... 

29 

1 

31 

METEOROLOGY. 


From  Observations  at  the  Greenwich  Observatory. 


Mean  height  of  barometer  . 

Mean  temperature  . 

Highest  point  of  thermometer 
Lowest  point  of  thermometer 
Mean  dew-point  temperature 

General  direction  of  wind  . 

Whole  amount  of  rain  in  the  week  .. 


29'740  in. 
50'9° 

629° 

36-7° 

47-0° 

S.W. 

016  in. 


BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  the 
Week  ending  Saturday,  Oct.  27,  in  the  following  large  Towns : — 


Cities 

and 

Boroughs 

Estimated  Population  to 
middle  of  the  year  1883. 

Births  Registered  during 
the  week  ending  Oct.  27. 

1  DeathsRegistered  during 
|  the  week  ending  Oct.  27. 

Annual  Rate  of 
Mortality  per  1CC0  living, 
from  all  causes. 

Temperature 
of  Air  (Fahr.) 

Temp, 
of  Air 
(Cent.) 

Rain 

Fall. 

Highestduring 
the  Week. 

Lowestduring 
the  Week. 

Weekly  Mean  of 
Daily  MeanVaiues 

Weekly  Mean  of 
Daily  Mean 
Values. 

In  Inches. 

In  Centimetres. 

London  . 

3355814 

2724 

1450 

19-1 

62-9 

36-7 

509 

10-50 

0-16 

0'41 

Brighton  . 

111262 

69 

43 

20-2 

60-5 

37-0 

49-1 

9-50 

0'26 

0-66 

Portsmouth 

131478 

100 

31 

12-3 

... 

... 

Norwich  . 

89612 

60 

28 

163 

... 

... 

Plymouth  . 

74977 

45 

24 

16-7 

5S-5 

33  5 

49-0 

944 

0-43 

1  09 

Bristol . 

212779 

123 

76 

18-6 

6P0 

36-8 

50-5 

1028 

0  56!  1-42 

Wolverhampton  . 

77557 

61 

25 

16-S 

57-6 

33-8 

46-4 

8 -03 

0-27 

0-69 

Birmingham 

414846 

255 

126 

15-9 

... 

... 

Leicester  ...  ... 

129483 

93 

36 

14-5 

62  2 

37-0 

49-1 

9-50 

0-33 

0-84 

Nottingham 

199349 

148 

74 

19-4 

59'6 

33-2 

47-3 

8-50 

0-33 

0'84 

Derby . 

85574 

61 

32 

19-5 

... 

... 

... 

... 

Birkenhead 

88700 

66 

37 

2P8 

... 

Liverpool  . 

566753 

352 

273 

25- 1 

58-2:  38-1 

48-5 

9-17 

0-96 

2-44 

Bolton . 

107862 

67 

49 

23-7 

56-1 

30-6 

45-1 

7-28 

1-83 

4-65 

Manchester 

339262 

229 

183 

28- 1 

... 

... 

r  •  • 

Salford  . 

190465 

132 

105 

28  8 

... 

... 

... 

... 

... 

Oldham  . 

119071 

92 

45 

19-7 

... 

... 

... 

... 

... 

... 

Blackburn . 

108460 

88 

45 

2P6 

... 

... 

... 

Preston  . 

98564 

72 

42 

222 

56'0 

33-0 

46'2 

7-89 

P47 

373 

Huddersfield  . . . 

84701 

49 

28 

17-3 

... 

... 

... 

... 

,  ,  , 

Halifax  . 

75591 

35 

23 

159 

... 

Bradford  . 

204807 

96 

66 

16’8 

57-4 

33-6 

46-5 

8-C6 

111 

2-82 

Leeds  . 

321611 

216 

162 

26'3 

58-0 

34-0 

46-6 

8-12 

0'68 

1-73 

Sheffield  . 

295497 

203 

107 

18-9 

62-0 

32'0 

48-0 

8-89 

0-74 

1-88 

Hull  . 

176296 

129 

65 

192 

.  .  . 

... 

... 

Sunderland 

121117 

105 

52 

2P4 

... 

... 

... 

... 

Newcastle  . 

149464 

104 

65 

22-7 

.  . . 

... 

... 

... 

... 

Cardiff . 

90033 

53 

37 

2P4 

... 

... 

... 

... 

For  28  towns ... 

S620975 

5827 

3329 

20-2 

62-9 

30-6 

479 

8'83 

070 

1-78 

Edinburgh . 

235946 

99 

89  19-7 

57'0 

326 

46-6 

8-12 

0-54 

1-37 

Glasgow  . 

515589 

339 

258  26-1 

58-5  29’0 

45'f 

7-44 

1-31 

333 

Dublin . 

349c85 

160 

167 

24-9 

5S-0  31-5  46-9 

8-28 

0-82 

2-08 

At  the  Royal  Observatory,  Greenwich,  the  mean  reading- 
of  the  barometer  last  week  was  29’74in. ;  the  lowest  reading 
was  29’ 53  in.  at  the  beginning  of  the  week,  and  the  highest 
30’01  in.  at  the  end  of  the  week. 


CHEYERS  ON  HEALTH  HISTORIES. 


Nov.  10, 1883.  537 


TAOrORD^1 
L!BRA 

'•  ^  Jtpdici^LXiriw^nf  (pfzette. 


MEDICO-TOPOGRAPHICAL  AND  HEALTH 
HISTORIES 

FOR  DISTRICTS  AND  TOWNS. 


Inaugural  Address  delivered  before  the  Epidemiological  Society 
at  the  Opening  of  Session  1883-84,  Nov.  7,  1883, 

By  NORMAN  CHEYERS,  C.I.E.,  M.D., 

President  of  the  Society. 


“Gentlemen, — In  occupying  the  position  to  which  you  have 
.elected  me,  I  have  first  to  perform  the  pleasant  duty  of 
expressing  my  warm  sense  of  the  great  honour  which  you 
have  conferred  upon  me  in  desiring  that  I  should  preside  at 
■our  meetings  during  the  coming  year.  I  feel  the  value  of 
this  distinction  to  be  validly  enhanced  by  the  fact  that,  in 
placing  me  here,  you  pay  a  compliment  and  offer  a  strong 
■encouragement  to  the  medical  officers  of  the  Indian  Army 
•who,  when  toiling  during  a  working  lifetime  in  a  country 
absolutely  remote  from  the  scientific  associations  of  their 
eivil  medical  brethren,  cannot  but  feel  gladdened  by  the 
knowledge  that,  on  their  retirement,  they  will  be  welcomed 
in  a  spirit  of  large  hospitality  and  courtesy  by  the  greatest 
medical  philosophers  of  their  time. 

Since  our  last  Annual  Meeting,  the  scientific  world  and 
this  Society  have,  sustained  a  loss,  which  must  long  be  deeply 
felt,  in  the  death  of  William  Farr,  a  past  President  and  a 
Vice-President  of  our  Association.  I  dislike  much  those 
■eulogies  which  the  little  living  are  wont  to  offer  glibly  to 
the  memory  of  the  great  dead.  I  will  not,  therefore,  pre¬ 
sume  to  record  one  syllable  of  praise  upon  the  tomb  of  the 
esteemed  and  honoured  Brother  who  has  passed  from  amongst 
us.  I  will  only  ask  a  plain  question,  which  will  find  a  reply 
in  all  our  minds.  In  what  position  would  our  knowledge  of 
Vital  Statistics  and  of  Sanitation  have  now  stood  if  England 
had  not  given  birth  to  William  Farr,  whom  she  has  lost, 
■and  to  Edwin  Chadwick,  whom  she  :still  possesses  ? 

The  high  object  of  the  Epidemiological  Society  is,  under 
the  blessing  of  Divine  Providence,  to  find  means  of  protect¬ 
ing  mankind  against  “  the  Pestilence  that  walketh  in  dark¬ 
ness,” — an  inspired  expression  by  which  we  may  be  per¬ 
mitted  to  understand,  not  literally  that  pestilence  which,  like 
■cholera,  notoriously  steals  upon  its  victims  at  the  dead  of 
night,  but  those  pestilential  maladies  which  are  so  dark  in 
their  manifestations  that,  even  up  to  the  present  moment, 
our  best  men  of  science  give  them  directly  opposed  inter¬ 
pretations. 

When  I  had  the  privilege,  a  few  years  ago,  of  beginning 
to  take  an  active  part  in  the  business  of  this  Society,  I  had 
In  my  mind  a  painful  recollection  of  the  fact  that,  in  my 
youth,  the  way  of  physicians  who  sought  to  discover  the  law 
of  pestilence  lay  in  absolute  darkness  beneath  that  lurid 
•cloud  of  odium  theologicum  with  which  the  bitterly  contro¬ 
versial  spirit  of  the  seekers  enveloped  the  object  of  their 
•quest.  But  I  soon  found  that,  although  every  member  of 
This  body  holds  very  strong  opinions,  these  convictions  are 
maintained  in  a  spirit  of  the  broadest  and  most  philosophic 
tolerance.  In  this  place  the  contagionist  meets  the  non- 
contagionist,  not  as  an  irreconcilable  foe  or  even  as  an 
erring  brother,  but  as  a  valued  fellow-worker,  the  fruits 
of  whose  labour  are  shared  and  prized  alike  by  every 
member  of  our  community.  For  my  own  part,  much  as 
I  value  those  epidemiologists  who  think  as  I  do,  I  am 
not  sure  that,  if  they  were  the  sole  occupants  of  these 
chairs,  I  should  come  here  to  meet  them.  I  could  do  that 
equally  well  at  a  Club  or  at  the  Pathological.  Loving,  for 
its  own  precious  sake,  that  knowledge  which  I  trust  will  not 
be  withdrawn  from  me  in  the  place  to  which  I  am  hastening, 
I  come  here  to  collect  gratefully,  from  friends  who  do  not 
think  precisely  as  I  do,  facts  and  opinions  by  which  my  own 
scanty  information  and  narrow  views  may  be  corrected  and 
widened.  In  this  spirit,  I  believe,  we  all  work.  Still,  on  the 
present  occasion,  I  have  chosen  for  this  address  a  subject 
which,  in  its  scientific  aspects,  is  scarcely  open  to  con¬ 
troversy,  in  favour  of  which  I  hope  to  enlist  the  sympathy 
and  co-operation  of  men  of  all  opinions.  I  have  long  been 
desirous  to  re-submit  to  your  j  udgment  the  by  no  means 
novel  suggestion  that  Medico-Topographical  and  Health 

Vol.  II.  1883.  No.  1741. 


Histories  for  Districts  and  Towns,  the  publication  of  which 
was  successfully  conducted  by  the  Government  of  India, 
would  validly  aid  the  great  work  of  Public  Health  which  has 
long  been  in  progress  throughout  the  British  Isles.  I  may 
probably  be  met  here  by  the  objection — the  fact  that,  even 
within  the  term  of  your  own  Indian  Service,  no  such  publi¬ 
cations  were  issued  by  the  Government  of  India,  is  evidence 
that  this  undertaking  proved  a  failure,  and  was  therefore  aban¬ 
doned.  To  this  assertion,  my  reply  would  be — in  India,  as  at 
Home,  the  discontinuance  of  a  great  work  is  by  no  means 
valid  evidence  of  its  failure.  There,  as  here.  Governments 
change  at  brief  intervals,  and  new  men  bring  new  measures. 
There,  too,  it  frequently  happens  that  whatever  was  right 
in  the  government  of  A.  is  wrong  under  the  rule  of  his 
successor  B.  Works  like  the  three  bulky  volumes  on  the 
“  Medical  Topography  and  Statistics  of  the  Madras  Presi¬ 
dency,”  which  I  now  place  before  you,  stand  as  enduring 
monuments  of  the  practicability  of  such  a  measure,  and  as 
evidence  of  its  successful  working. 

Upon  a  plan  suggested  by  the  late  Sir  Ranald  Martin, 
the  Government  of  India  directed,  in  1835,  that  medico- 
topographical  histories  of  Districts  and  Military  and  Civil 
Stations  throughout  British  India  should  be  prepared  by 
medical  men  and  published.  The  result  was  the  promulga¬ 
tion  of  many  hundred  very  useful  pages,  a  few  of  which 
have  escaped  until  now  the  ravages  of  the  white  ants. 
Among  these  histories,  that  in  three  closely  printed  volumes, 
which  now  lie  before  me,  stands  pre-eminent.  Between 
1842  and  1844  the  Medical  Board  of  Madras  published  this 
complete  history  of  the  medical  topography  and  statistics 
of  the  whole  of  the  Madras  Presidency,  founded  upon  reports 
by  local  medical  officers.  The  vast  labour  of  compilation 
was  accomplished  in  three  years  by  the  Board’s  Secretary, 
Dr.  George  Pearse,  most  efficiently  aided  by  Dr.  Lorimer, 
Garrison- Surgeon  of  Fort  St.  George — each  of  these  officers 
performing  at  the  same  time  the  proper  duties  of  his  own 
appointment.  I  particularly  insist  upon  this  fact  as  evidence 
that,  upon  a  well-arranged  plan  and  with  the  aid  of  a  very 
few  well-chosen  men,  the  great,  but  in  no  way  formidable, 
work  of  preparing  a  health-history  for  every  district  and 
town  in  the  United  Kingdom  might  be  carried  out  at  no 
very  heavy  cost,  and  with  an  expedition  commensurate  with 
the  strength  of  the  officers  employed. 

The  Presidency  of  Madras  alone  succeeded  in  fully  giving 
effect  to  the  wishes  of  Government ;  but  much  good  work  in 
this  direction  was  done  by  the  separate  action  of  medical 
officers  in  the  other  two  Presidencies.  Thus  we  have  ex¬ 
ceedingly  valuable  reports  on  the  Medical  Topography  of 
Calcutta,  by  Ranald  Martin,  Duncan  Stewart,  and  Pemble 
Strong ;  of  Upper  Scinde,  by  Kinloch  Kirk  and  J.  Sutherland ; 
of  Meerut,  by  John  Murray,  who,  happily,  is  now  a  leading 
worker  among  ourselves  ;  on  Aj  mere,  by  Irvine ;  on  Oudh,  by 
Donald  Butter ;  on  Sarum,  by  Rankine  ;  on  the  Valley  of  the 
Indus,  by  Percival  Lord  ;  on  Assam,  by  McCosh  ;  on  Kemaon, 
by  Dollard  and  John  McClelland.  Still,  as  I  have  said,  the 
Bengal  and  Bombay  series  were  never  completed.  A  large 
number  of  valuable  minor  topographical  Reports  of  Districts 
and  Stations  in  each  Presidency,  such  as  those  published  in 
the  Bombay  Medical  and  Physical  Transactions  for  1857-58, 
have  appeared  during  the  last  forty  years  in  Indian  medical 
periodicals. 

Here  I  may  remark  that,  old  as  the  whole  of  these  Reports 
are,  they  are  replete  with  facts  and  observations  which,  like 
every  sterling  truth  in  medicine,  are  of  never-dying  value. 
I  have  lately  gone  carefully  through  a  very  large  proportion 
of  these  records,  which  I  never  had  opportunity  of  doing 
in  India ;  and  I  deeply  feel  that  the  result  of  this  pleasant 
exercise  is  that  I  now,  for  the  first  time,  believe  that  I  have 
been  enabled  to  take  a  large  view  of  Indian  disease,  especially 
of  its  geographical  disposition. 

Merely  as  evidence  that  the  undertaking  which  I  am  now 
proposing  is  by  no  means  so  gigantic  or  so  costly  as  to  be 
hopeless,  I  may  mention  that,  in  my  work  on  the  Means  of 
Preserving  the  Health  of  European  Soldiers  in  India,  I  have 
left  a  sketch  of  the  health-history  of  every  station  for 
European  troops  in  that  dependency,  this  being  a  mere 
labour  of  love  carried  out  n  the  spare  moments  of  an  official 
life  which  had  no  proper  leisure.  As  a  proof  that  I  do  not 
mention  this  little  fact  in  a  boastful  spirit,  and  as  a  hint  of 
the  encouragement  which  labourers  in  this  field  may  antici¬ 
pate  from  authority,  I  may  mention  the  criticism  which  my 
labours  received  from  the  Viceroy  of  that  day.  Inquiring 


538 


Medical  Times  and  Gazette. 


CH  EVERS  ON  HEALTH  HISTORIES. 


Nov.  10, 1883. 


of  a  medical  officer  regarding  some  statistical  point,  his 
Lordship  was  asked,  “Have  you  seen  Dr.  Chevers’s  work  ?” 
The  reply  was,  “  Humph  !”  with  a  significant  upraising  of 
the  chin. 

I  need  scarcely  say  that — quite  apart  from  those  pseudo¬ 
medical  histories  in  which,  during  last  century,  were  trum¬ 
peted  the  sanitary  advantages  of  every  English  nook  which, 
by  virtue  of  the  addition  of  a  wheelbarrowful  of  rusty  iron 
to  a  brackish  pool,  had  become  a  “  Spa  ” — the  United 
Kingdom  can  boast  of  some  excellent  medical  topographies. 
Still,  these  are  chiefly  the  work  of  local  ability  and  industry, 
and  they  by  no  means  defend  us  Britons  from  the  charge 
that  we  are  far  behind  India  in  the  work  of  Medical  Topo¬ 
graphy.  The  proposal  which  I  offer  to  your  better  judg¬ 
ment  is,  that  for  each  of  our  districts  and  towns  there 
should  be  prepared  a  concise  but  very  comprehensive  manual, 
illustrated  by  maps,  in  which  would  be  recorded  all  needful 
geological  and  meteorological  data ;  brief  descriptions  of  the 
water-supply  and  systems  of  town  and  land  drainage ;  a 
history  of  all  reported  epidemics,  endemics,  and  epizootics, 
the  dates  of  the  first  appearance  and  of  the  disappearance 
of  the  recent  ones  being  accurately  given  ;  all  that  is  worthy 
of  recollection  as  illustrating  vital  statistics,  especially 
recent  death-rates;  full  health-histories  covering  the  last 
five  years ;  numerical  lists  of  the  prevailing  diseases,  with 
brief  but  clear  accounts  of  those  which  point  to  the  fact 
that  the  land  is  malarious,  or  the  town  air  impure.  In 
short,  these  little  works  should  comprise  every  fact  which 
tends  to  illustrate  the  medical  topography  of  their  localities. 
The  maps  should  especially  define  with  rigid  accuracy  the 
locality  and  original  extent  of  all  extant  or  reclaimed 
lakes,  marshes,  harbours,  bays,  estuaries,  water-courses, 
and  moats.  The  sooner  maps  of  this  kind  are  prepared, 
the  better.  The  work  of  so-called  “  improvement  ”  now 
advances  so  rapidly,  and  the  information  derivable  from 
oral  tradition  is  so  uncertain  and  short-lived,  that  all 
authentic  facts  of  this  kind  should  be  placed  on  record  with 
the  least  possible  delay. 

Pour  hundred  years  ago,  an  encircling  morass  was  in 
some  respects  useful  to  a  town,  forming,  as  it  did,  a  consider¬ 
able  addition  to  its  defences,  and  a  means  for  retreat,  supply, 
and  relief.  In  time  of  peace,  the  marsh  afforded  valuable 
supplies  of  rushes,  reeds,  fish,  and  water-fowl.  So  we  find 
Henry  of  Huntingdon  giving  to  his  native  town  a  recom¬ 
mendation  which  would  scarcely  be  held  attractive  in  these 
times  of  sanitation.  The  town,  he  says,  “  surpassed  all 
others  in  pleasantness,  in  the  beauty  of  the  buildings,  near¬ 
ness  to  the  fens,  and  plenty  of  game  and  fish.” 

In  the  middle  ages,  a  well-preserved  fen  was  a  valuable 
property.  It  is  noticed  by  Whitaker  that,  from  an  inquisi¬ 
tion  taken  in  the  time  of  the  last  Earl  Warren,  it  appears 
that  the  meadow  ground  which  lay  in  open  field  was  worth 
five  shillings  an  acre;  the  pasture-ground  was  enclosed,  and 
worth  only  one-tenth  of  that  sum  ;  and  the  fishery,  a  small 
pond  of  four  acres,  was  worth  almost  one-third  more  per 
acre  than  the  best  meadow  ground.  Writing  in  1650,  Puller 
mentions  that  “  an  acre  of  reeds  on  the  bankside  is  as  bene¬ 
ficial  as  one  of  wheat.”  In  Surrey,  I  have  sat  and  read  by 
the  feeble  light  of  a  peeled  rush  dipped  in  grease,  held  in  a 
simple  apparatus  which  is  represented  in  Chambers’  “  Book 
of  Days.”  Formerly  the  richest  pasture  land  near  London 
was  in  the  Isle  of  Dogs. 

Our  ancestors  were  evidently  proud  of  their  swamps,  and 
were  not  ashamed  to  give  districts  and  towns  their  right 
names,  such  as  Komney  Marsh,  Slough,  Burmarsh,  Wapping- 
on-the-Wose,  Keyingham  Marsh  in  Holderness,  Lambeth 
Marsh,  and  the  like.  Now,  however,  our  Jerry  Builders  are 
more  discreet.  Having,  by  some  subtle  arrangement  with 
Nature,  provided  that  the  whole  of  their  building  sites 
shall  possess  an  inexhaustible  dry  gravel  soil,  they  con¬ 
struct  infinite  Montpelier  Avenues,  Mount  Pleasant  Gar¬ 
dens,  and  Yales  of  Health.  Since  I  returned  from  swampy 
Bengal,  I  have  occasionally  walked  in  some  of  these 
delightful  modern  sanitaria,  and  have  been  astonished  at 
observing  the  manner  in  which,  within  my  own  recollec¬ 
tion,  modern  enterprise  has  “  improved,”  beyond  all  recog¬ 
nition,  sites  which  our  predecessors  deemed  utterly  waste 
and  irreclaimable.  I  may,  without  offence,  mention  one 
or  two  of  these  instances.  Very  lately  I  was  admiring  the 
architectural  beauties  of  a  popular  city  suburb,  when  a 
voice  said  gruffly,  “  A  few  years  ago  you  couldn’t  go  across 
that  plaice  without  leaving  both  your  shoes  !  ”  Some  years 


since,  I,  for  my  sins,  found  myself  enjoying  a  round  of 
watering-place  delights  in  a  beautiful  seaside  resort,  which, 
completely  covers  and  conceals  all  the  little  ineligibilities- 
of  what,  in  my  boyhood,  was  a  dreary  expanse  of  salt 
swamp,  whereon  it  was  evidently  hopeless  to  grow  cab¬ 
bages,  and  which  has  now  lost  its  honest  eight-hundred- 
years-old  English  name  of  the  “  Abbey  Marsh.”  This 
recalls  to  my  memory  “  Pump’s  Marsh,”  which,  now  a  most 
attractive  watering-place,  was  in  my  youth  an  admirable 
field  for  lizard-hunting — its  greatest  drawback  being  that, 
for  those  tired  with  that  noble  sport,  there  was  nothing  to 
drink,  the  whole  of  the  streams  which  guttered  slowly  out 
of  its  sedgy  pools  having  the  appearance,  but  none  of  the 
virtues,  of  the  strongest  black  tea.  Still  again,  I  recollect 
the  site  of  that  long  most  popular  and  fashionable  watering- 
place,  Svveet-Spring-by-the-Sea,  when  it  was  an  utterly 
abandoned  marsh  devoid  of  any  living  thing  standing  higher 
in  creation  than  the  water-rat  and  the  yellow  flag. 

Each  of  these  manuals  should  receive,  annually,  an  appen¬ 
dix  containing  a  brief  but  comprehensive  health-history  of 
the  place,  and  giving  all  needful  particulars  regarding 
outbreaks  of  disease,  fluctuation  in  the  death-rate,  sanitary 
improvements,  and  the  like. 

But  for  your  courtesy,  you  would  perhaps  stop  me  here, 
and  say,  “Your  plan  is  impracticable  !  It  would  please  no 
one  !  ”  But  nearly  all  of  those  whom  I  address  have  long 
since  felt,  and  acted  upon  the  conviction,  that,  in  endeavour¬ 
ing  to  benefit  mankind,  we  must  not  hope  to  please  them. 

I  apprehend  that,  in  recommending  to  town  authorities  the 
adoption  of  this  plan,  which  directly  tends  to  serve  the  best 
interest  of  every  member  of  the  community,  we  shall  find 
the  whole  of  our  auditors,  from  Mister  Mayor  to  Master 
Cobbler,  as  stony- faced  and  as  unappreciative  as  William  the- 
Conqueror  and  Wat  Tyler  would  have  been.  Nay  more,  we 
must  expect  to  be  shouted  down  with  cries  of  “  What !  suffer 
the  publication  of  a  book  giving  a  bad  name  to  our  town,, 
and  pay  for  the  printing !  ”  “  Your  plan  will  raise  our  rates- 
and  impair  the  value  of  everybody’s  property  and  business, 
depriving  us  of  tenants  and  customers.  You  appear  to  wish, 
to  bring  us  all  to  ruin,  and  to  reduce  this  place  to  the  marsh 
which  it  was  when  our  fathers  occupied  it  fifty  years  ago  !  ” 
It  does  not  seem  very  long  since  I  sat  at  a  meeting  of  a 
city  municipality,  and  heard  the  following  observations  by  a 
really  very  fine  and  clever  old  man :  “  This  place  has  done 
very  well  for  a  hundred  and  fifty  years  without  sanitation. 

I  therefore  propose,  Mr.  Chairman,  that  we  resolve  to  defer 
the  question  of  appointing  a  sanitary  establishment  for 
another  hundred  and  fifty  years,  when  it  may  be  again  con¬ 
sidered.”  Here  we  have  enunciated,  in  an  unusually  plain 
and  candid  manner,  the  feeling  which  still  prevails  in  hun¬ 
dreds  of  aldermanic  minds.  I  lately  saw  this  old  gentleman’s 
statue,  subscribed  for  by  his  admiring  fellow- citizens, — it  was 
a  fine  work  of  art.  Every  practical  sanitarian  is,  however, 
proof  against  the  blatant  shallow-minded  logic  of  short¬ 
sighted  boors ;  but  there  is  another  obstacle  which  might 
possibly  meet  us,  but  which  ought  not  to  be  formidable, 
because,  assuredly,  no  one  would  intentionally  place  it  in  our 
way.  Although  I  believe  that  no  representative  of  our  noble 
profession  displays  its  humane  philosophy  with  more  en¬ 
lightenment  and  self-devotion  than  the  Officer  of  Health  does, 
it  has,  in  rare  instances,  appeared  to  me,  when  studying 
some  of  their  reports,  that  a  very  little  of  the  obstructive 
burgher  narrowness  has  insensibly  found  its  way  into  the 
minds  of  a  few  of  these  officials,  and  has  caused  them  to- 
regard  the  sanitary  defects  of  their  localities  (which  they, 
of  all  people,  ought  most  to  abhor  and  protest  against)  with 
overweening  tolerance.  Although  this  is,  unquestionably, 
a  bar  to  improvement,  it  arises  from  an  error  which  is,  in 
itself,  venial  and  natural — the  excessive  development  of  a 
right  feeling  of  admiration  for  that  which  is  our  own;  an 
inclination  to  overlook  and  apologise  for  its  defects,  and  a 
proneness  to  magnify  its  advantages  ;  a  tendency  to  be 
“.  .  .  .  to  its  virtues  very  kind, 

And  to  its  faults  a  little  blind.” 

In  short,  the  foible  of  the  men  of  Little  Pedlington. 

When  I  find  a  health  officer,  professing  to  write  upon  the- 
remarkable  salubrity  of  his  very  badly  situated  district,  pro¬ 
testing  that,  in  the  month  of  August  last,  the  mortality  was 
under  the  annual  rate  of  four  in  the  thousand,  and  overlooking 
the  fact  that,  within  the  past  four  years,  the  place  was  so  dire- 
fully  impested  by  a  Zymosis  as  to  call  for  a  special  inquiry 
by  the  Local  Government  Board ; — when  I  see  it  declared 


Medical  Times  and  Gazette. 


CHEVERS  OH  HEALTH  HISTORIES. 


Nov.  10, 1883.  539 


of  a  town  which  I  know  to  he  full  of  plague-spots,  that,  but 
for  a  visitation  of  diphtheria,  its  mortality-rate  last  year 
would  compare  favourably  with  the  lowest  in  England  ; — 
when,  I  say,  I  find  earnest,  honest-minded  men  contending 
in  this  manner  against  plain  facts,  their  mode  of  arguing 
reminds  me  of  that  of  the  Calcutta  schipper  who,  on  being 
told  that  he  had  made  a  remarkably  slow  voyage  round  the 
Cape,  replied — “  If  you  put  aside  our  loss  of  a  top-mast  and 
do  not  count  the  weeks  in  which  we  were  becalmed,  you  will 
find  that  my  ship  made,  out  and  out,  the  quickest  passage 
of  the  season.” 

I  believe  that  the  establishment  of  the  system  now  proposed 
would  go  far  towards  correcting  this  evil. 

It  is  clear  that  I  need  not  attempt  to  explain  to  an  audi- 
ence  of  eminent  sanitarians  the  uses  which  these  manuals 
would  serve ;  but,  as  my  remarks  may  be  seen  by  others  less 
instructed  and  experienced,  I  will  pray  you  to  bear  with  me 
for  a  few  seconds  while  I  offer  one  or  two  illustrations.  In 
1845,  while  I  professed  to  practise  in  the  parish  of  Lambeth, 
my  father  and  I  suffered  from  dysentery.  I  was  then  con¬ 
cerned  in  the  editorship  of  one  of  London’s  two  weekly  medical 
periodicals ;  I  was  a  member  and  active  frequenter  of  five 
medical  societies  ;  I  spent  some  hours  of  nearly  every  day 
of  my  life  in  communication  with  the  best  men  at  Guy’s 
Hospital :  and  yet,  strange  to  say,  it  was  only  about  two 
months  ago  that  I  became  acquainted  with  the  fact,  that  in 
the  seven  years,  1840-47,  Hr.  Baly  examined  post-mortem 
many  hundred  cases  of  dysentery  in  the  Millbank  Peniten¬ 
tiary,  situated  not  a  mile  from  my  residence.  “Yes,”  you 
may  remark,  “  the  oversights  of  some  people  are  limitless !  ” 
Still,  had  Lambeth  then  possessed  a  health-history,  I  could 
hardly  have  remained  ignorant  for  thirty-eight  years  of  a 
fact  which  interests  me  personally.  Again,  imagine  that  an 
an  outbreak  of  Enteric  Fever  occurs  on  the  twentieth  day  of 
a  given  month  in  Warwick,  and  that  it  is  traced  to  pollution 
cf  the  chief  water-supply  with  sewage-matter :  my  first  step 
in  investigating  this  fact  would  be  to  consult  the  annual 
health-reports  of  the  surrounding  towns  ;  and  if  I  found  that, 
many  days  previously,  at  the  very  beginning  of  that  month. 
Enteric  Fever  had  prevailed  to  an  unusual  extent  in  Worces¬ 
ter,  Birmingham,  Northampton,  Bedford,  Oxford,  and  Glou¬ 
cester,  or  in  more  than  one  of  those  places,  I  should  say  that 
the  fact  tended  to  support  a  heresy  which  I  confidently  main¬ 
tain,  to  the  effect  that  Enteric  Fever  is  of  aerial  epidemic 
•origin,  and  that  Typhoid  stools  and  sewage-filth  are  only 
operative  as  excitants  of  that  disease. 

Again,  should  it  be  reported  that.  Cholera  existing  at 
Alexandria,  a  ship  from  that  port  had  reached  Southampton  | 
on  October  20,  and  had  landed  a  sailor  who  died  of  cholera 
on  the  22nd  of  that  month,  whereupon  the  people  of  South¬ 
ampton  became  impested, — I  should  consult  the  contem¬ 
porary  health-histories  of  the  neighbouring  inland  towns, 
and,  if  I  found  that,  ten  days  previously,  unmistakable  cases 
of  Cholera  had  occurred  in  any  of  these,  it  would  add  another 
fact  to  the  many  whereon  I  ground  the  strong  belief  which 
would  enable  me  to  declare  that  the  sailor  did  not  bring  the 
plague  to  Southampton,  but  that  the  pestilence  awaited  his 
arrival  there,  and  killed  him  under  its  law  that  new-comers 
are  almost  invariably  its  first  victims. 

I  have  no  doubt  that  our  esteemed  colleague.  Hr.  Buchanan, 
has,  in  his  office,  all  data  needful  in  pursuing  an  inquiry  of 
this  kind;  but  is  it  possible  to  obtain  such  information 
^elsewhere  ?  If  so,  I,  for  one,  know  not  where  to  look  for  it. 

I  am  aware  that  a  few  months  ago  Enteric  Fever  raged 
synchronously  in  Paris  and  in  Egypt,  and  I  have  ever  since 
desired  to  know  whether  England  also  suffered  at  all  re¬ 
markably  from  this  pest  at  the  same  time ;  but  I  could  only 
learn  this  with  precision  by  going  about  a  great  deal,  and  by 
giving  needless  trouble  to  over-worked  men.  Under  the  sys¬ 
tem  which  I  propose,  I  should  possess  the  needful  informa¬ 
tion  on  my  study  table.  Again,  I  long  ago  observed  facts  in 
India,  which  led  me  to  believe  that  neurotic  paludal  asthma  is 
aggravated  by  residence  at  the  seaside.  The  great  experience 
-of  Hr.  E.  Headlam  Greenhow  has  convinced  him  that  this  law 
obtains  in  England.  Knowing  that  asthmatics  frequently 
escape  suffering  on  long  voyages,  I  think  that  I  am  justified 
in  inquiring,  are  certain  localities  hostile  to  the  asthmatic 
because  they  are  maritime,  or  because  they  are  paludal,  as 
-so  many  English  watering-places  are  ?  If  I  could  examine 
the  health-statistics  of  all  our  watering-places,  I  might,  nob 
very  improbably,  arrive  at  a  result  useful  to  many  grievously 
afflicted  persons,  by  throwing  great  additional  light  upon  the 


very  important  question  of  finding  breathing-places  for 
asthmatics  ;  but,  at  present,  my  inquiry  is  at  a  standstill. 

Head  with  sufficient  care,  the  periodical  supplementary 
reports  would  afford  to  every  medical  man  in  the  empire  a 
complete  view,  frequently  renewed,  of  the  geographical 
distribution  of  disease  throughout  these  Islands,  and  would 
add  validly  to  his  claim  to  be  considered  as  a  man  of  better 
information  than  the  President  of  the  Epidemiological 
Society  can,  at  present,  hope  to  be.  Properly  carried  out, 
this  work  ought  to  become  an  invaluable  aid  in  fulfilling 
the  noble  objects  of  our  Society. 

Complete  series  ought  to  be  in  the  possession  of  every 
officer  of  health,  and  to  be  available  in  all  public  libraries 
and  museums. 

No  man  living  values  honest  sanitation  or  appreciates  the 
good  which  it  is  very  slowly  effecting  more  warmly  than  I 
do,  but  none  who  have  studied  epidemiology  fairly  can  fail 
to  join  me  in  exclaiming  against  the  fatuous  over-confidence 
of  shallow  people,  who  ought  to  know  better,  who  attribute 
every  temporary  mitigation  in  the  incidence  of  disease  to 
improved  sanitation.  He  who  has  been  tempted  to  declare 
that  he  has  succeeded  in  stamping  out  the  erysipelas  which 
used  to  impest  his  hospital  (a  false  position  which  I  once 
saw  occupied,  to  his  speedy  discomfiture,  by  a  talented 
surgeon),  and  is  shown,  in  the  Health-History,  that  the 
disease  has  lately  attacked  the  neighbouring  hospitals,  and 
sees  that  it  has  now  invaded  his  own,  will  wish  that  he  had 
not  spoken,  and  had  kept  his  short-sighted  exultation  to 
himself. 

I  apprehend  that  some  of  my  friends,  on  hearing  that 
I  recommend  the  publication  of  Health- Histories  of  Towns, 
will  suspect  me  of  preferring  old  facts  to  new  ones.  This, 
however,  is  a  charge  of  which  I  consider  myself  guiltless. 
I  have  never  valued  or  brought  forward  an  antiquated 
medical  fact  unless  I  considered  that  it  threw  distinct  light 
upon  our  daily  professional  work. 

Undoubtedly,  well-chosen  and  judiciously- sifted  historical 
facts  would  claim  a  place  in  the  Health-Histories.  Thus,  in 
describing  a  pleasant  breezy  exercise-ground  for  troops, 
upon  which  multitudes  of  handsome  dwellings  now  abut,  it 
would  have  to  be  stated  that,  a  hundred  years  ago,  men  at 
drill  used  to  be  struck  down  by  the  pestilent  exhalations  from 
a  neighbouring  morass,  which  has  now  been  very  insuffi¬ 
ciently  improved,  but  which  I  remember  in  all  its  pristine 
deadliness.  When  I  had  the  privilege  of  addressing  you  a 
year  ago,  I  spoke  of  the  natural  disadvantages  of  the  site 
upon  which  Southwark  is  built.  When  the  Health-History 
of  that  locality  comes  to  be  written,  the  following  additional 
facts,  standing  two  hundred  and  ninety-nine  years  apart, 
ought  to  be  cited.  Suffolk  Place  and  old  St.  Thomas’s  Hos¬ 
pital  very  nearly  faced  each  other  on  either  side  of  the  great 
highway  at  the  southern  foot  of  Old  London  Bridge.  An 
able  writer,  Mr.  William  Eendle,  has  lately  given  us  (a)  an 
old  medical  case  which  is  most  useful  as  illustrating  the 
sanitary  condition  of  that  locality  early  in  the  sixteenth 
century. 

In  1514,  Charles  Brandon,  Buke  of  Suffolk,  married  Mary 
of  England,  the  French  queen.  They  resided  occasionally 
at  Suffolk  Place,  notably  in  1519  and  1522.  The  writer  tells 
us  that  Southwark  Palace  must  have  been  built  in  an  un¬ 
fortunate  place.  South  of  the  river,  the  fields  were  freely 
intersected  with  small  streams  and  ditches ;  bridges  crossing 
these  streams  are  shown  in  the'earlier  maps,  here,  there,  and 
everywhere.  Not  unfrequently,  the  locality,  being  below 
the  level  of  the  river,  was  flooded.  The  district  was,  of 
course,  unhealthy,  and  was  always  severely  visited  by  the 
various  plagues  which  never  for  long  left  England. 

The  insalubrity  of  the  place  is  most  likely  the  reason  why 
Mary  was  so  little  in  Southwark;  as  it  was,  she  doubtless 
suffered  from  the  marshy  surroundings  of  her  palace. 

“In  1518”  [when  she  was  twenty  years  old]  “someone 
writing  of  her  says,  c  it  has  pleased  God  to  wyesset  her  wyth 
a  nagu’  (ague)  ‘wyche  has  taken  her  Grace  hewarre’  (every) 

<■  third  day/  She  suffers  from  disease  and  pain  in  the  side,  a 
common  result  of  persistent  ague,  but  we  are  pleasantly 
told  that  her  brother’s  kindness  takes  away  a  great  part  of 
the  pain.  .  .  .  The  French  queen  gets  worse  and  worse ; 
physicians  are  consulted,  but  they  do  her  no  good.  Writing 
from  Croydon,  Suffolk  sadly  says  she  has  a.disease  in  her 
side  and  is  very  ill ;  he  has  been  twice  on  his  way  to  the 


(a)  Temple  Bar  for  February,  1882. 


540 


Medical  Times  and  Gazette. 


POWER  ON  THE  LACRIMAL  APPARATUS  OF  THE  EYE. 


Nov.  10, 18S3. 


Court,  where  he,  for  the  time,  seldom  comes,  and  she  sent 
for  him  to  come  hastily  back,  and  will  not  have  him  away. 
She  never  gets  better,  but  finally  dies  in  June,  1533,”  after 
fifteen  years’  suffering  from  paludal  splenic  cachexia.  Then 
in  1813,  giving  an  account  of  old  St.  Thomas’s  Hospital,  Sir 
Gilbert  Blane  described  it  as  situated  on  a  track  of  ground 
which  was,  originally,  swampy,  and  no  doubt  aguish.  In  ten 
years,  192  'cases  of  intermittent  fever  were  admitted  in 
Blane’s  wards  alone;  he,  however,  considered  that  these 
were  not,  principally,  from  the  local  population.  Such 
reports  as  the  following  are  also  noteworthy,  when  well  au¬ 
thenticated.  On  Saturday,  the  23rd  June,  1883,  Sir  William 
Knollys,  TJsher  of  the  Black  Bod,  died  of  Intermittent  Fever 
at  his  official  residence  at  the  House  of  Lords. 

With  a  view  to  obtaining  the  best  information  regarding 
the  Health- Histories  of  districts  and  towns,  it  would  be 
well  to  seek  the  co-operation  everywhere  of  the  clergy, 
archaeologists,  and  librarians. 

I  cannot  doubt  that,  although  the  publication  of  these 
books  would  immediately  encounter  strong  opposition  from 
local  stolidity  and  ignorance,  it  would  not  be  very  long 
before  the  valid  utility  of  the  measure  would,  by  obviously 
enhancing  their  best  interests,  command  the  favourable 
attention  of  the  most  bigoted.  At  starting,  such  an  under¬ 
taking  ought  to  be  received  in  a  friendly  spirit  by  all 
owners  of  healthy  localities ;  while  those  holding  improv¬ 
able  land  and  house-property  would  soon  begin  to  find  that 
the  value  of  their  estates  was  considerably  raised,  under 
reclamation,  by  augmentation  of  their  rents.  Those  who 
absolutely  oppose  reform  may  well  be  allowed  to  howl  until 
public  opinion  or  the  pressure  of  still  higher  authority 
constrains  them  to  stand  out  of  the  way  of  progress.  Be- 
cently.  Dr.  Samelson  has  directed  attention  to  the  fact 
that  Manchester  continues,  in  turn  with  Liverpool,  to  hold 
the  position  of  the  most  unhealthy  town  in  England,  and  has 
shown,  by  official  evidence,  that  the  unsatisfactory  condition 
of  the  dwelling-houses,  new  as  well  as  old,  of  the  mass  of 
the  people  must  be  regarded  as  one  of  the  foremost  causes 
of  ill-health. (b)  To  the  citizens  of  Manchester,  that  time- 
honoured  sanitarian  Edwin  Chadwick  has  also  very  lately 
addressed  arguments(c)  which!  ought  to  awaken  them  to 
their  real  position  as  nothing  else  can  until  the  peal  of  the 
archangel’s  trumpet  strikes  their  ears,  telling  them  that, 
had  they  not  lavished  their  funds  upon  unproductive  works, 
they  might,  ere  now,  have  reduced  their  present  average 
death-rate  by  ten  in  the  thousand.  The  names  of  Chadwick 
and  Samelson  ought  to  have  permanent  reeord  in  the  Health- 
History  of  Manchester  as  standing  prominently  among  those 
who  had  the  courage  to  declare  the  city’s  malady,  and  the 
sagacity  to  demonstrate  its  remedies. 

When  the  sanitary  shortcomings  of  a  place,  and  the 
means  of  remedy,  have  been  for  some  time  clearly  set  forth 
in  a  popular  work  within  the  reach  of  everyone,  it  is  pro¬ 
bable  either  that  the  inhabitants  will  be  shamed  or  con¬ 
vinced  into  reform,  a  healthy  rival  spirit  of  comparison  and 
emulation  arising  between  town  and  town,  or  that  local 
benefactors  will  generously  relieve  them  of  the  work. 

When  the  promulgation  of  these  Histories  shall  have 
accustomed  people  to  the  candid  and  fearless  exposure  of 
sanitary  defects,  we  shall  probably  hear  nothing  more  of 
that  morbid  sensitiveness  which  designates  the  most  friendly 
of  all  criticism  as  libel.  We  might  then  learn  to  offer  a 
public  banquet  and  a  service  of  plate  to  any  chiel  intelligent 
enough  to  spy  a  hole  in  our  civic  coats,  and  to  suggest 
means  for  its  repair. 

If  it  can  once  be  decided  that  a  publication  of  this  kind 
ought  to  be  instituted,  the  manner  of  conducting  it  might 
be  readily  planned.  While  every  district  and  important 
town  would  have  its  “  History,”  these  little  works  would  be 
combined  in  one  or  two  volumes  for  each  of  the  three  King¬ 
doms,  purchasable  at  a  remunerative  price. 

It  appears  clear  that  the  system  which  I  indicate  could 
only  be  successful  under  the  control  of  Government. 

I  think  that  health  officers  and  medical  men  desiring  to 
hold  these  appointments  would  contribute,  nearly  the  whole 
of  the  local  articles,  which,  if  worked  out  with  due  care,  and 
fully  acknowledged,  would  contribute  much  to  the  winters’ 
professional  reputation. 

It  is  probable  that  nearly  the  whole  of  the  needful  Statis- 

(b)  Medical  Times  and  Gazette,  vol.  ii.  for  1883,  page  197. 

(c)  “  On  Sanitary  Administration  and  on  its  Condition  and  Results  in 
Manchester,”  1883. 


tical.  Meteorological,  and  Geological  data  stand  ready  for 
collation. 

I  believe  that  a  director  for  each  Kingdom,  posted  at 
London,  Edinburgh,  and  Dublin,  efficiently  supported  by 
officers  of  health,  and  assisted  by  a  staff  of  about  four 
highly  qualified  assistants,  could  prepare  and  publish  the 
first  edition  of  these  works  within  a  twelvemonth  of  the 
time  of  starting. 

The  cost  of  printing  the  local  histories  is  doubtful ;  but  I 
think  that  the  average  expense  ought  not  to  exceed  <£20. 
The  cost  of  the  annual  supplementary  reports  would  be 
small,  and  two  officers  at  head-quarters  could  edit  them. 
Consequently,  there  would  be  no  heavy  expenditure  after  the 
first  eighteen  months. 

In  the  cause  of  suffering  humanity,  I  should  be  glad  to  see 
this  plan  carried  into  effect  not  only  in  the  United  Kingdom, 
in  India,  and  in  our  Colonies,  but  also  in  America  and  in 
every  country  throughout  the  civilised  world. 


LECTURES 

ON 

THE  PROTECTIVE  AND  LACRIMAL 
APPARATUS  OF  THE  EYE. 

Delivered  at  the  Royal  College  of  Surgeons. 

By  HENBY  POWEB,  M.B.  Lond.,  F.B.C.S.  Eng., 
Arris  and  Gale  Lecturer  at  the  College  ;  Senior  Ophthalmic  Surgeon,  anci 
Lecturer  on  Ophthalmic  Surgery,  St.  Bartholomew’s  Hospital. 

( Concluded  from  page  511.) 

Lecture  III. — Part  III. 

The  influence  of  the  emotions  has  been  carefully  discussed 
by  Darwin.  He  has  pointed  out  that  very  young  children, 
do  not  shed  tears  or  weep,  but  this  is  not  exclusively  due  to 
the  lacrimal  glands  being  as  yet  incapable  of  secreting  tears. 
He  states  that  he  first  noticed  this  fact  from  having  acci¬ 
dentally  brushed  with  the  cuff  of  his  coat  the  open  eye  of 
one  of  his  infants  when  77  days  old,  causing  this  eye  to 
water  freely  ;  and  though  the  child  screamed  violently,  the 
other  eye  remained  dry,  or  was  only  slightly  suffused  with 
tears.  A  similar  slight  effusion  occurred  ten  days  previously 
in  both  eyes  during  a  screaming  fit.  The  tears  did  not  run 
over  the  eyelids  and  roll  down  the  cheeks  of  this  child 
whilst  screaming  badly  when  122  days  old.  This  first 
happened  seventeen  days  later  at  the  age  of  139  days.  I  have, 
however,  noticed  a  case  in  which  an  infant  cried  before  one 
month  was  completed,  the  tears  running  freely  down  the 
cheeks.  In  some  children  observed  for  Darwin,  in  one  the 
eyes  became  slightly  suffused  at  the  age  of  only  20  days ;  in 
another,  at  62  days.  With  two  other  children  the  tears  did 
not  run  down  the  face  at  the  ages  of  84  and  110  days ;  but 
in  a  third  child  they  did  run  down  at  the  age  of  104  days. 
Darwin  was  positively  assured  in  one  case  that  tears  ran 
down  at  the  unusually  early  age  of  42  days.  It  would 
appear,  he  remarks,  as  if  the  lacrimal  glands  required  some 
practice  in  the  individual  before  they  are  easily  excited  to 
action,  in  somewhat  the  same  manner  as  various  inherited 
consensual  actions  and  tastes  require  some  exercise  before 
they  are  fixed  and  perfected.  This  is  all  the  more  likely 
with  a  habit  like  weeping,  which  must  have  been  acquired 
since  the  period  when  man  branched  off  from  the  common 
progenitor  of  the  genus  Homo  and  of  the  non-weeping- 
anthropomorphous  Apes. 

W.  Preyer,  in  his  very  interesting  work  entitled  “  Die 
Seele  des  Kindes,”  in  which  he  records  numerous  and  care¬ 
fully  made  observations  upon  his  own  children,  commencing- 
a  few  minutes  after  birth  and  continued  for  years,  states 
also  that  the  time  of  the  first  appearance  of  tears  varies 
greatly  in  different  children.  In  his  boy  he  observed  a  flow 
of  tears  for  the  first  time  on  the  twenty-third  day  whilst  he 
was  screaming  violently. 

The  glands  are  larger,  according  to  Prerichs,  in  women 
than  in  men — which  is  perhaps  associated  with  their  more 
emotional  proclivities. 

Trousseau — and  Trousseau  alone,  so  far  as  I  know, — whe 
was  one  of  the  acutest  observers,  has  of  late  years  strongly 


Medical  Times  and  Gazette. 


POWER  OIST  THE  LACRIMAL  APPARATUS  OF  THE  EYE. 


Nov.  10, 1883.  541 


insisted  on  the  importance  and  semeiological  value  of  tears 
in  infancy.  W e  may,  according  to  him,  lay  down  the  general 
proposition  that  when  an  infant  weeps  its  disease  or  malady 
is  destitute  of  gravity,  and  that  the  contrary  holds  good 
when  it  no  longer  weeps.  “When  you  find,”  he  says, (a) 

that  in  a  young  subject,  who  has  hitherto  wept,  tears  no 
longer  appear  when  you  irritate  it ;  if  suddenly,  the  condi¬ 
tions  remaining  the  same,  the  eyes  become  dry,  dangerous 
results  may  be  anticipated  of  some  kind  or  other,  in  this 
you  will  never  be  mistaken,  except  of  course  in  those  occa¬ 
sional  cases  where  the  child  does  not  weep  at  all  when  in 
health.  When,  on  the  contrary,  after  having  satisfied  your¬ 
self  of  a  bruit,  of  dulness  of  the  walls  of  the  chest,  an 
hypertrophy  of  the  liver  or  of  the  kidney,  tympanitis,  or 
•other  grave  disease,  you  see  the  infant  shed  tears,  you  may 
give  a  favourable  forecast,  for  it  is  the  indication  of 
approaching  convalescence.” 

The  only  recent  experiments  that  have  been  undertaken 
by  a  skilled  observer  on  the  tears  in  Man  have  been  those 
of  Magaard,(b)  who  had  at  his  disposal  a  case  in  which, 
owing  to  a  deformity  of  the  lid,  the  tears  could  be  obtained 
in  a  pure  state,  and  not,  as  in  previous  experiments,  mingled 
with  the  secretions  of  the  conjunctival  and  Meibomian  glands. 
Magaard’s  case  was  that  of  a  man  aged  fifty,  who  in  1866  had 
nn  attack  of  conjunctivitis  of  the  left  eye.  Six  months  later 
the  right  eye  became  similarly  affected  without  apparent 
■cause,  and  he  applied  for  relief  at  the  Ophthalmic  Hospital 
of  Freiburg.  The  note  then  taken  was  to  the  effect  that 
the  patient  was  suffering  from  ectropion,  with  partial  thick¬ 
ening  of  the  edges  of  the  lids,  and  diffuse  haziness  of  the 
left  cornea.  Sulphate  of  copper  was  employed.  The  left 
•eye  gradually  failed.  The  right  retained  some  vision  ;  but 
when  Magaard  saw  him  there  was  great  eversion  of  both 
lids  of  this  eye,  so  that  the  openings  of  the  lacrimal  ducts 
were  exposed,  and  their  position  could  be  recognised  by  the 
•exudation  of  pearly  drops  of  fluid. 

To  determine  the  reaction  of  this  fluid,  the  whole  surface 
of  the  lids  was  carefully  washed  with  lukewarm  distilled 
water,  until,  indeed,  the  surface  gave  a  neutral  reaction. 
The  ducts  were  then  gently  compressed,  and  the  fluid  which 
•exuded  was  found  to  be  invariably  rather  strongly  alkaline. 

Attempts  were  then  made  to  determine  the  quantity  of 
the  secretion,  first  by  gently  strobing  the  ducts  towards 
their  orifices,  and  then  noting  the  time  which  elapsed 
before  the  reappearance  of  a  pearly  drop  at  their  orifice. 
On  the  first  day,  this  occurred,  on  the  average,  at  the  end  of 
three  minutes.  After  the  introduction  of  a  little  calomel 
in  powder  into  the  eye,  the  secretion  became  more  abun¬ 
dant,  and  the  drops  reappeared  in  two  minutes.  A  few 
days  were  now  allowed  to  elapse,  and,  on  again  timing  the 
rapidity  of  the  secretion,  it  was  found  to  occupy  about 
•one  minute  more  than  before.  On  touching  the  conjunctiva 
with  a  stick  of  alum,  the  drops  appeared  at  the  orifices  of 
the  ducts,  after  their  evacuation,  in  about  two  minutes  and  a 
•quarter  ;  and  when  it  was  touched  with  sulphate  of  copper, 
they  appeared  in  about  one  minute  and  one-third.  Stimula¬ 
tion  of  the  nasal  mucous  membrane  increased  the  rapidity 
of  secretion,  so  that  if,  after  simply  stroking  them,  the  drops 
appeared  after  the  lapse  of  four  minutes  and  a  half,  after  the 
application  of  alum  and  copper  sulphate  they  appeared  in 
two  minutes  and  a  half.  On  the  following  day  various 
vapours  were  applied,  by  means  of  a  roll  of  blotting-paper, 
to  the  nasal  mucous' membrane.  When  sulphuric  ether  was 
used  the  first  drop  appeared  in  three  minutes  and  a  quarter, 
with  caustic  ammonia  after  three  minutes,  and  with  glacial 
acetic  acid  after  three  minutes  and  a  quarter — hence  at 
about  the  same  time  with  each  of  these  reagents.  It  was  of 
no  consequence  whether  the  right  or  the  left  side  of  the 
nose  was  stimulated. 

The  effect  of  stimulating  the  retina  by  the  light  of  the 
sun,  reflected  from  white  and  from  coloured  papers,  was 
then  tried.  The  day  happened  to  be  one  with  a  light  cloud 
•over  the  sky.  Before  exposure  the  droplets  reappeared  in 
about  seven  minutes,  but  after  exposure  to  the  light  re¬ 
flected  from  white  paper  they  appeared  in  five  minutes  ; 
after  exposure  to  rays  passing  through  a  light-green  glass, 
in  three  minutes ;  and  when  a  light-blue  glass  was  held 
Before  the  eye,  in  four  minutes.  With  dark  glasses  the  time 
was  the  same  as  at  first. 

Magaard  proceeded  to  make  some  more  exact  experiments, 

(a)  Gazette  des  Hupitaux,  1848,  page  58. 

(b)  Virchow’s  Archiv,  1882,  page  258. 


in  which  the  amount  of  fluid  secreted  under  different 
conditions  was  determined  by  stroking  the  ducts  towards 
their  orifices  at  the  expiration  of  every  minute,  and 
absorbing  the  fluid  squeezed  out  with  a  small  tube  by 
capillary  attraction.  The  height  of  the  column  was 
precisely  measured,  and  the  contents  were  then  blown  out 
upon  blotting-paper.  Considerable  variations  occurred  from 
minute  to  minute.  Thus  in  these  experiments  the  numbers 
ran  as  follows  :  — 


i.  n.  III. 


After  1  minute 

6  8  mm. 

10  5  mm. 

4  0  mm. 

yy 

2 

yy 

15-2 

yy 

7-5 

yy 

5T  „ 

yy 

3 

yy 

7-9 

yy 

8*5 

yy 

2’3  „ 

yy 

4 

yy 

2-6 

yy 

95 

yy 

15  „ 

yy 

5 

yy 

67 

yy 

7-5 

yy 

2T  „ 

yy 

6 

yy 

2-8 

yy 

5-7 

yy 

0-5  „ 

yy 

7 

yy 

6T 

yy 

1-3 

yy 

8*3  9t 

yy 

8 

yy 

8'9 

yy 

05 

yy 

8-0  „ 

yy 

9 

yy 

4-5 

yy 

20 

yy 

4'2  „ 

yy 

10 

yy 

6T 

yy 

6-7 

yy 

2-0  „ 

59-5 

mm. 

59-7 

mm. 

38’0  mm. 

The  mean  of  six  such  experiments  (each  lasting  ten 
minutes)  gave  the  height  of  the  column  of  41  0  mm.  in  the 
capillary  tube,  which  was  4'26  cm.  long,  and  had  a  capacity 
0023  grammes.  The  4-10  cm.  of  lacrimal  fluid  amounted 
therefore  to  0'0221  grammes  of  fluid.  This  quantity  was 
secreted,  on  the  average,  every  ten  minutes  ;  and  hence,  if 
the  secretion  were  considered  to  be  continuous,  and  if  the 
conditions  remained  the  same,  each  lacrimal  gland  would 
secrete  3-18  grammes,  and  the  two  glands  6'4  grammes  of 
fluid  per  diem. 

It  thus  appears  that  the  activity  of  the  lacrimal,  like  that 
of  other  glands,  is  liable  to  great  variation,  amounting  to 
as  much  as  a  difference  of  O'Ol  to  2-94  mm.  per  minute. 
There  is  no  doubt  that  the  activity  varies  greatly  with 
mental  conditions.  He  observed  some  increase  after  food, 
and  also  after  exercise  had  been  taken.  Even  after  the  act 
of  yawning  the  quantity  was  augmented  for  some  minutes, 
the  augmentation  being  probably  due,  as  he  suggests,  rather 
to  some  change  in  the  circulation  than  to  a  change  in  the 
innervation.  The  quantity  diminished  with  high  temperature 
of  the  surrounding  atmosphere. 

Magaard  made  some  experiments  with  atropine,  which, 
as  is  well  known,  has  a  powerful  influence  on  the  process 
of  secretion.  He  found  that  the  administration  of  atropine 
slowly  caused  diminution  in  the  amount  of  secretion;  whilst 
eserine,  on  the  contrary,  removed  the  inhibitory  influence 
of  atropine,  and  quickly  occasioned  an  increase. 

Stimulation  of  the  cervical  sympathetic  by  the  faradaic 
current  was  not  followed  by  any  very  well-marked  result, 
but,  on  the  whole,  the  quantity  of  the  secretion  seemed  to 
be  somewhat  increased,  and,  in  some  of  the  experiments,  to 
be  rendered  cloudy. 

The  best  analysis  of  the  tears  that  has  been  made  appears 
to  be  that  of  Frerichs,  though  it  is  now  of  somewhat  ancient 
date  (1846).  He  gives  it  as  follows  : — 

One  hundred  parts  of  tears  contain — 


i. 

ii. 

Water 

...  99-06 

98-70 

Solids  . 

0-94 

1-30 

Epithelium 

Albumen  ... 

0'14 

0-08- 

0-32 

010 

Sodium  chloride  ... 

...  \ 

Alkaline  phosphates 
Earthy  phosphates 
Mucus  . 

>  0-72 

0-8S 

Fat...  . 

...  ) 

Hoppe-Seyler,  however,  in  his  “  Physiologische  Chemie,” 
remarks  that  no  satisfactory  analysis  of  the  tears  has  been 
given,  since  it  is  difficult  to  obtain  them  in  sufficient  quanti¬ 
ties  from  Man,  and  still  more  difficult  from  Animals.  In 
all  works,  he  says,  the  analysis  of  Lerch  is  given,  which  is 
insufficient.  Lerch  gives — water,  980;  albumin,  5;  and 
sodium  chloride,  13. 

If  tears,  he  adds,  be  allowed  to  drop  into  water,  a  pre¬ 
cipitate  falls,  which  either  consists  of  mucin  or,  more  pro¬ 
bably,  of  a  globulin.  He  regards  the  secretion  of  tears  as 
being  closely  allied  to  the  saliva. 

Magaard  states  that  on  boiling  tears  some  coagulation 


542  Medical  Times  and  Gazette.  POWER  ON  THE  LACRIMAL  APPARATUS  OF  THE  EYE.  Nov.  10,  1883- 


may  be  observed  to  take  place,  and  be  satisfied  himself  of 
the  presence  of  albumin  and  of  chlorides.  He  was  unable 
to  demonstrate  the  presence  of  phosphates.  Quantitative 
analysis  gave — water,  98-12  ;  organic  compounds,  l-4639 ; 
salts,  0-4161. 

It  is  no  part  of  these  lectures  to  take  up  the  tears  in 
an  historical  point  of  view,  nor  to  tell  how  St.  Thomas 
Aquinas  was  satisfied  that  no  tears  would  be  shed  after  the 
Resurrection ;  that  subsequent  authors  believed  that  the 
tears  were  the  condensed  vapours  of  the  brain,  that  those 
which  passed  off  by  the  upper  canaliculus  came  from  the 
brain  and  the  eyes,  whilst  those  which  passed  away  by  the 
inferior  canaliculus  came  from  grief  and  the  lower  part  of 
the  body  ;  how  Petit  maintained  that  they  were  the  normal 
mode  by  which  the  fluid  that  he  believed  filled  the 
pericardium  was  eliminated  from  the  body;  or  other  curious 
errors  that  have  been  from  time  to  time  promulgated. 

The  secretion  of  the  Harderian  gland  consists,  according 
to  Kamocki,  of  a  clear  fluid  with  large  drops  and  fine 
granules.  A  dark  coagulated  mass  is  seen  in  the  lumen  of 
the  tubes  in  transverse  sections  of  coagulated  glands  that 
have  been  made  clear  by  glycerine,  which  is  finely  granular 
in  the  white  part  of  the  gland,  and  contains  larger  and 
smaller  drops  in  the  pars  rosea.  After  removal  of  the 
fat,  the  previously  dark  contents  clear  up,  and  appear  in  the 
pars  alba  finely  granular,  and  in  the  pars  rosea  in  the  form 
of  a  close  network,  (c) 

In  regard  to  the  mode  of  excretion,  it  would  appear  that 
the  lymphoid  structures  do  not  take  any  active  part  in  the 
formation  of  the  secretion  in  Rodents,  and  that  the  gland- 
cells  themselves  do  not  undergo  any  lively  process  of  pro¬ 
liferation  or  any  fatty  metabolism  and  disintegration,  but 
that  the  cells  of  the  Harderian  gland  are  as  stable  as  in 
other  glands  furnishing  fluid  secretions.  The  secretion  is 
probably  formed  within  the  cells,  and  is  simply  expelled 
from  them  into  the  lumen  of  the  ducts,  without  any  loss  of 
vitality  on  the  part  of  the  cells,  or  any  destruction  of  their 
substance.  On  the  contrary,  each  cell  continues  to  discharge 
its  functions  for  a  period  the  duration  of  which  we  have  at 
present  no  data  for  even  approximately  determining.  The 
mode  of  secretion,  therefore,  resembles  that  of  the  mammary 
gland,  and  is  different  from  that  which  is  observed  in  the 
sebaceous  and  Meibomian  follicles.  In  these  glands  the  lumen 
of  the  acini,  in  well-coloured  and  transparent  sections,  is  seen 
to  be  completely  filled  with  cellular  elements,  in  which  a 
continuous  process  of  disintegration  of  cells  and  nuclei  may 
be  distinctly  perceived,  proceeding  from  the  periphery  towards 
the  centre,  and  onwards  to  the  excretory  ducts.  Moreover, 
in  these  the  layers  of  cells  in  immediate  juxtaposition  to  the 
membrana  propria  exhibit,  when  carefully  examined,  some 
karvolytic  figures. 

Kamocki  has  further  attempted  to  gain  some  insight  into 
the  nature  of  the  secretory  process,  and  especially  to  deter¬ 
mine  whether  the  visible  variations  in  the  quantity  and  size 
of  the  fat-drops  in  the  gland-cells  result  from  varying  stages 
of  rest,  or  of  increased  secretion  occasioned  by  stimula¬ 
tion  of  the  sympathetic,  by  the  subcutaneous  injection  of 
pilocarpine,  and  by  ligature  of  the  excretory  duct  of  the 
Harderian  gland  ;  but  he  does  not  appear  to  have  obtained 
any  satisfactory  results.  After  ligature  of  the  excretory 
duct  there  may  be  observed,  as  consequences  of  the  stasis  of 
the  secretion,  dilatation  of  the  ducts,  flattening  of  the  gland- 
cells  and  disappearance  both  of  the  fat  from  their  interior 
and  of  the  plexiform  arrangement  of  the  protoplasm,  strongly 
granular  metamorphosis  of  the  cells,  great  diminution  in  the 
capacity  for  staining  of  the  nuclei,  infiltration  of  the  paren¬ 
chymatous  connective  tissue  with  lymphoid  cells,  and,  in 
short,  commencing  atrophy  and  inflammatory  degeneration 
of  the  glands.  A  discharge  of  the  pent-up  secretion  by 
rupture  of  the  gland-ducts  into  the  parenchyma  of  the 
gland  is  often  observed.  He  did  not  observe  keratitis  to 
follow  the  arrest  of  the  secretion. 

The  last  point  to  which  I  must  refer  is  that  of  the 
mechanism  by  which  the  tears  flow  from  the  conjunctival 
sac  into  the  nose.  At  first  sight  the  evidence  that  the  tears 
do  really  pass  into  the  canaliculi  is  not  quite  clear,  for,  when 
the  lacrimal  secretion  is  at  all  increased,  the  tears  flow  over 
the  cheeks,  and  it  might  be  supposed  that  the  quantity 
ordinarily  secreted  is  just  sufficient  to  compensate  for  the 
evaporation  from  the  surface  of  the  conjunctiva.  Against 
this,  however,  is  to  be  put  the  fact  that  the  canaliculi  and 
(o)  Kamocki,  loc.  cit.,  page  5  ;  and  Wendt,  lot.  cit.,  page  10. 


nasal  duct  are,  as  we  have  seen,  extraordinarily  constant 
in  position  and  relations  in  all  the  terrestrial  Vertebrates.. 
Secondly,  that  when  from  any  cause  the  nasal  duct  or  the 
canaliculi  are  occluded,  the  same  side  of  the  nose  is  felt  to  be 
remarkably  dry  and  hot;  and,  thirdly,  that  certain  sub¬ 
stances  (such,  for  example,  as  atropin),  when  a  solution  is- 
dropped  into  the  sac,  may  be  recognised  by  the  taste,  or 
produces  dryness  of  the  fauces. 

The  causes  which  lead  to  the  entrance  of  the  fluid  into  the 
canaliculi  have  been  the  subject  of  much  discussion,  and 
several  conflicting  theories  have  been  broached  to  explain 
it.  These  theories  may  be  reduced  to  six — the  siphon  theory,, 
the  exhaustion  theory,  the  capillary  action  theory,  the  mus¬ 
cular  action  of  the  canaliculi,  the  action  of  the  orbicularis,, 
and  the  compression  theory. 

The  older  writers  suggested  that  the  entrance  of  the  fluid 
was  due  to  a  kind  of  peristaltic  action  on  the  part  of  the- 
canaliculi  themselves ;  but  there  do  not  appear  to  be  any 
muscular  fibres  adapted  for  this  purpose — at  least,  there  is- 
no  regular  disposition  of  circular  and  longitudinal  fibres,, 
which  seems  to  accompany  peristaltic  action  in  most 
instances,  even  if  it  is  not  essential  to  it. 

The  syphon  theory  is  stated  to  have  been  proposed  by 
Petit,  but  upon  examining  his  work  I  have  been  unable  to- 
find  any  observation  that  exactly  bears  out  this  statement.. 

Hasner  remarks  that  the  puncta  lacrimalia  are  sur¬ 
rounded  by  contractile  tissue,  which  forms  a  dense  felt  of 
fibres.  These  fibres  by  their  contraction  prevent  the 
entrance  of  large  or  foreign  bodies  into  the  canaliculi, 
though  they  do  not  exactly  form  a  sphincter,  nor,  even  when 
very  strongly  stimulated,  close  the  orifice  entirely.  Hasner 
adds — as  it  appears  to  me,  somewhat  inconsistently — that 
they  have,  indeed,  a  precisely  opposite  function,  for  they 
serve  to  keep  the  puncta  constantly  patent.  They  preserve 
the  puncta  and  canaliculi,  when  covered  by  the  tears,  en¬ 
tirely  passive.  The  entrance  of  the  tears  into  the  canaliculi 
is  exclusively  effected  by  the  action  of  the  orbicularis.  This 
causes  the  canaliculi  to  suck  in  the  tears ;  and  this  action 
is  aided  by  inspiration,  which  rarefies  the  air  contained  in. 
the  passages,  and  causes  the  air  to  stream  in,  carrying  with 
it  the  tears. 

The  exhaustion  theory  has  been  adopted  by  many ;  and 
this  theory,  as  well  as  the  phenomena  of  disease,  and  the- 
occurrence  of  strictures  at  various  points,  has  led  to  the- 
belief  of  the  existence  of  many  valves,  which  have  been  de¬ 
scribed  by  various  authors.  These  are  stated  to  occur  in 
different  parts  of  the  lacrimal  passages,  the  position  of  the 
valves  generally  being  such  as  to  permit  the  tears  to  flow 
downwards,  but  to  resist  regurgitation,  or  the  entrance  of  air 
or  mucus  from  the  nose.  The  descriptions  given  are  often 
detailed,  but  I  shall  not  do  more  than  just  indicate  their 
position,  because  later  researches  have  practically  disproved 
their  existence,  and  because  I  believe  their  functional  im¬ 
portance  to  be  very  small.  The  downward  flow  of  the  tears 
is  well  provided  for,  and  there  seems  no  reason  why  regurgi¬ 
tation  should  take  place,  and  hence  no  physiological  reason 
for  their  presence.  Four  valves  have  been  described — the 
valve  of  Foltz,  the  valve  of  Rosenmuller  or  of  Arnold,  Arifs 
valve,  and  Hasner’s  valve. 

Foltz  placed  a  valve  at  the  bottom  of  the  little  pit  at  the 
tarsal  orifice  of  the  canaliculi,  and  considered  that  it  was 
attached  to  the  outer  wall,  and  opened  downwards. 

Rosenmuller  (1797)  placed  a  valve  at  the  upper  margin 
of  the  opening  common  to  the  two  canaliculi  in  the  lacrimal 
sac,  the  free  margin  of  which  was  therefore  dependent  in 
front  of  the  opening. 

Arnold  admitted  the  existence  of  a  valve  at  the  same 
point,  but  considered  that  its  attached  border  was  at  the 
lower  border  of  the  opening,  and  that  its  free  border  there¬ 
fore  rose  up  in  front  of  the  opening.  Beraud  named  this 
valve  the  valvula  superior  sacci  lacrimalis ;  and  Foltz  went  so 
far  as  to  describe  a  small  knot  in  the  centre  of  its  free  border, 
resembling  the  nodulus  Arantii  of  the  semilunar  valves. 

Arlt  (1850)  described  a  valve  (which  was  subsequently 
named  the  valvula  inferior  sacci  lacrimalis  by  Beraud)  at  the 
point  of  junction  of  the  lacrimal  sac  with  the  nasal  duct. 
The  latter  observer  considered  it  to  be  inconstant. 

Lastly,  Hasner  maintained  the  existence  of  a  valve  at  the 
inferior  or  nasal  orifice  of  the  nasal  duct.  He  considered  it 
to  be  demonstrable  by  removing  the  outer  or  lateral  wall  of 
the  nasal  duct,  when  it  may  be  seen  depending  from  the 
inner  bony  wall  and  covering  the  orifice. 


Medical  Times  and  Gazette. 


MEDICAL  AND  SURGICAL  PRACTICE. 


Nov.  10,  1883.  543 


The  tears  have  not  completed  their  function  when  they 
have  moistened  the  surface  of  the  eyes  and  traversed  the 
lacrimal  canals,  for  the  moisture  which  they  afford  to  the 
nasal  mucous  membrane  subserves  the  important  purpose  of 
■charging  with  watery  vapour  and  warming  the  inspired  air. 

The  development  of  the  Harderian  gland  of  Eodents  com¬ 
mences,  according  to  Kamocki,  coincidently  with  that  of  the 
lacrimal  glands,  immediately  after  the  formation  of  the  lids, 
and  before  their  closure.  It  proceeds,  like  that  of  the  com¬ 
pound  acinous  glands,  from  a  simple  tap-shaped  rudiment,  and 
itsfurther  development  presents  no  special  or  peculiar  charac¬ 
ters.  The  branched  solid  gland  processes  composed  of  cells 
■subsequently  obtain  a  lumen,  probably  through  mucous 
metamorphosis  of  the  central  cell-layers,  whilst  growth  and 
the  formation  of  new  gland-buds  progresses  at  the  periphery. 
After  the  appearance  of  the  lumen  the  ducts  are  lined  by  a 
double  layer  of  cells,  which  subsequently  become  reduced  to 
a  single  layer.  The  protoplasm  of  the  cells  is  very  granular, 
but  does  not  as  yet  contain  any  fat-cells,  which  first  appear 
when  the  gland  begins  to  fulfil  its  function.  The  glands  of 
young  Eats,  which  are  born  blind,  are  not  as  yet  completely 
■developed,  and  contain  no  fat.  The  glands  first  assume 
their  normal  form,  and  their  granular  colouring-matter 
first  appears  in  the  lumen  of  the  ducts,  after  the  opening 
of  the  palpebral  fissure.  The  first  rudiment  of  the  white 
and  red  parts  of  the  gland  of  Harder,  in  the  Eabbit,  is 
undoubtedly  single,  and  not  double. 

The  very  variable  position  of  the  inferior  opening  of  the 
nasal  duct  accounts  for  the  operation  of  catheterisation 
having  become  completely  obsolete  ;  for  if,  when  the  wall  is 
removed  and  examined  with  the  naked  eye,  it  is  sometimes, 
.as  Sappey  states,  almost  impossible  to  discover  it,  it  may 
well  be  imagined  that  any  attempts  to  introduce  a  probe  in 
the  living  subject  are  sure  to  be  attended  with  laceration  of 
'.the  mucous  membrane,  if  not  by  more  serious  effects. 


ON  A  THIED  USE  OF  TURPENTINE. 

By  Deputy  Insp. -General  BEINSLEY  NICHOLSON,  M.D. 

When  re-writing  the  short  article  on  certain  uses  of  this 
drug,  which  appeared  on  September  1  in  No.  1731  of  the 
Medical  Times  and  Gazette,  I  unaccountably  forgot  this  third 
use,  noted  in  the  paper  I  had  first  written  and  mislaid. 

3.  A  soldier  was  affected  with  aneurysm,  as  well  as  I  can 
■remember,  just  where  the  artery  dips  down  into  the  popliteal 
space.  The  regimental  surgeon  being  obliged  to  go  away  on 
three  days’  leave,  I,  from  a  neighbouring  garrison,  was  de¬ 
puted  to  supply  his  place,  as  it  was  feared  that  the  aneurysm 
might  give  way.  On  arrival,  I  found  a  man  of  fairly  made 
frame,  but  looking  rather  thin,  and  pale  and  sunken  about  the 
face.  A  well-fitting  compressor  compressed  the  artery  at  the 
usual  point  in  Scarpa’s  triangle,  and  there  existed  a  pulseless, 
but  fluid,  aneurysm,  about  the  size,  I  think,  of  a  swan’s  egg, 
but  without,  as  I  was  glad  to  find,  any  symptoms  of  giving 
way.  On  inquiry,  I  found  that  the  compressor  had  been  on  for 
at  least  three  weeks — I  believe  nearer  five, — but  without  any 
coagulation  having  been  observed.  His  diet  had  been  low 
and  monotonous — I  think  the  “  low  diet  ”  of  army  hospitals. 
His  pulse  also  was  not  strong.  Thinking  it  better  that  he 
should  have  a  more  generous  supply  of  food,  and  one  con¬ 
taining  more  vegetables,  with  a  little  light  wine,  I  found 
that  he  was  constipated ;  and  therefore,  as  one  of  the 
•quickest  and  least  depressing,  if  not  stimulant,  medicines, 
ordered  him  a  terebinthinate  enema. 

Next  morning,  one  of  the  assistant-surgeons,  earlier  than 
myself,  met  me  with  the  unexpected  news  that  the  aneurysm 
had  solidified,  and,  on  examination,  I  found  it  not  only  solid, 
but  firmly  so.  On  the  third  forenoon,  however,  when  I  left,  it 
liad  become  fluid  in  its  upper  part,  to  the  amount,  say,  of 
rather  more  than  a  teaspoonful.  I  heard  nothing  more  of 
the  case,  except  that  some  time  afterwards  the  limb  was 
amputated  above  the  aneurysm. 

The  coagulating  power  of  turpentine  had  been  known  to 
me,  but,  when  giving  it  inwardly,  I  was  not  prepared  for 
such  and  so  sudden  an  effect  in  an  aneurysm  at  rest.  No 
doubt  I  should  have  followed  up  the  enema  by  giving  tur¬ 
pentine  by  the  mouth,  but  the  result  being  an  apparently 
firm  solidification  of  the  tumour,  and  it  being  to  me  a  wholly 
new  experience,  I  waited  too  long.  I  venture,  however,  to 
■think  that  the  result  is  worthy  of  being  borne  in  mind  in  any 
similar  case,  and  bettered. 


EEPOETS  OF 

HOSPITAL  PRACTICE  IN  MEDICINE 
AND  SURGERY. 

- - 

ST.  BARTHOLOMEW’S  HOSPITAL. 

STEANGULATED  INGUINAL  HEENIA— OPEEATION 
— EECOVEEY. 

(Under  the  care  of  Mr.  HARRISON  CRIPPS.) 

[From  notes  by  the  Dresser,  Mr.  Mathews.] 

Henry  N.,  aged  seventy-five,  was  admitted  October  10, 
1883,  under  the  care  of  Mr.  Langton,  and  transferred  to 
that  of  Mr.  Cripps. 

Previous  History. — Patient  applied  with  an  inguinal 
hernia,  which  had  been  down  five  days.  He  had  been  seen 
by  a  medical  man,  who  had  tried  the  taxis  without  success. 
The  hernia  dated  back  about  nine  years;  it  frequently 
came  down,  but  had  always  been  easily  reduced  on  former 
occasions. 

Present  Condition. — An  aged  man  with  white  hair.  He 
has  a  large  irreducible  hernia  in  the  right  inguinal  (scrotal) 
region.  He  is  vomiting  matters  with  a  distinctly  faecal 
odour.  After  anaesthesia,  Mr.  Cripps  again  tried  the  taxis. 
Failing  to  reduce  the  bowel,  he  cut  down  on  to  the  sac,  but 
without  opening  it.  The  constriction  was  found  to  be  at  the 
external  ring.  After  division  the  bowel  was  reduced.  The 
patient  was  somewhat  collapsed ;  his  pulse  was  weak  and 
intermitting. 

October  11. — The  patient  has  rallied  somewhat;  he  has 
had  a  fairly  good  night.  He  is  fed  with  nutrient  enemata. 
The  wound  dressed;  it  is  looking  healthy. 

12th. — He  has  passed  a  good  night,  and  appears  much 
better.  Hiccough  has  passed  off.  Wound  dressed  ;  there  is 
no  tenderness  over  it  or  over  the  abdomen ;  no  discharge. 
He  is  now  taking  essence  of  beef  by  the  mouth.  No  trouble 
with  his  urine. 

15th. — Mr.  Harding  (the  House-Surgeon)  removed  some 
of  the  sutures.  Wound  looking  healthy.  The  man’s  general 
condition  satisfactory. 

The  patient  continued  to  make  satisfactory  progress  in 
every  way. 

29th. — The  wound  is  quite  healed. 

RemarTcs  (by  Mr.  Cripps). — Aged  patients  appear  to  bear 
the  operation  for  strangulated  hernia  better  than  any  other 
of  the  major  operations.  In  the  case  narrated  the  patient  was 
a  feeble  old  man,  and  had  had  faecal  vomiting  for  four  days  ; 
nevertheless,  he  recovered  without  a  bad  symptom  after  the 
operation.  Doubtless  his  chance  of  life  was  much  increased 
by  its  being  possible  to  replace  the  hernia  without  opening 
the  sac.  A  week  or  two  previous  to  operating  on  Henry  N., 
I  had  operated  upon  an  old  gentleman  of  seventy- six  for  a 
strangulated  bowel.  In  this  case,  not  only  was  the  sac 
opened,  but  the  gut  was  subjected  to  much  handling,  owing 
to  the  difficulty  of  returning  it  into  the  abdominal  cavity, 
the  operation  being  a  prolonged  and  severe  one.  Neverthe¬ 
less,  this  patient,  as  in  the  first  case,  recovered  without 
causing  a  moment’s  anxiety. 

EICKETS— GENU  YALGUM— OSTEOTOMY. 

(Under  the  care  of  Mr.  CRIPPS.) 

[From  notes  by  the  Dresser,  Mr.  Fox.] 

Eliza  M.,  aged  four  years,  was  admitted  on  September  19, 
1883. 

Present  Condition. — The  little  girl  is  very  anaemic  and 
rickety.  She  has  enlargement  of  the  ends  of  the  long  bones, 
most  marked  in  the  radii.  She  has  a  well-marked  genu 
valgum,  the  left  leg  deviating  from  the  mid-line  more  than 
the  right  leg.  When  the  thighs  are  approximated,  there  is 
an  interval  between  the  malleoli  of  about  nine  inches. 

September  22. — Mr.  Harrison  Cripps  performed  MacEwen’s 
operation,  using  a  saw,  however,  instead  of  a  chisel.  The 
two  limbs  were  operated  on  at  the  same  time.  There  was 
no  rise  of  temperature. 

26th. — Wounds  re-dressed  ;  both  look  quite  healthy  ; 
there  is  no  suppuration.  The  child’s  general  condition  is 
excellent. 

October  2. — Going  on  well.  No  pain  ;  no  discharge. 

13th. — Wounds  re-dressed.  That  on  the  right  limb  is 
found  to  be  healed ;  that  on  the  left  has  not  quite  healed. 


544 


Medical  Times  and  Gazette. 


MEDICAL  BULLETIN'S. 


Nov.  10, 1883W 


There  is  an  abundant  deposit  of  callus  about  the  seat  of 
each  fracture. 

25th. — The  splints  removed.  The  wounds  are  cicatrised, 
and  the  genu  valgum  is  quite  overcome. 

29th. — The  child  can  raise  her  legs  without  either  pain  or 
difficulty.  Her  temperature  rose  on  two  or  three  evenings 
to  100°  Fahr.,  but  without  manifest  cause ;  at  the  present 
date  it  is  rather  below  normal,  if  anything 

Remarks  (by  Mr.  Cripps). — A  fine  saw  has  long  been  in  use 
for  subcutaneous  division  of  bones,  notably  by  Mr.  Adams  and 
Mr.  Gant.  It  would  seem,  however,  that  the  chisel  as  used 
by  MacEwen  is  a  more  favourite  instrument  among  London 
surgeons  for  dividing  the  femur  for  genu  valgum.  I  doubt 
whether  it  is  an  improvement  on  the  saw.  The  objection  to 
the  use  of  the  chisel  appears  to  me  to  lie  in  the  difficulty  of 
estimating  the  extent  to  which  it  has  divided  the  bone,  and 
therefore  the  amount  of  force  necessary  for  breaking  through 
the  remaining  portion.  If  the  bone  be  insufficiently  divided, 
and  violence  is  necessary  for  breaking  the  remainder,  there 
is  always  a  risk,  when  the  fracture  occurs,  of  driving  the 
sharp  fragments  into  dangerous  proximity  to  the  vessels 
— an  accident  which  I  have  seen  subsequently  followed  by 
haemorrhage.  With  the  saw,  on  the  other  hand,  it  is  possible 
to  judge  with  greater  accuracy  as  to  the  extent  to  which  the 
bone  is  divided.  The  theoretical  objection  which  might  be 
raised,  that  the  debris  from  the  saw  would  retard  the  heal¬ 
ing  of  the  wound,  I  have  found  to  vanish  in  practice,  for,  in 
all  the  cases  in  which  I  have  used  the  saw,  the  wound  has 
healed  by  first  intention  without  disturbance. 


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SATURDAY,  NOVEMBER  10,  1S83. 


MEDICAL  BULLETINS. 

There  is  not  a.  doubt  that  the  custom  of  publishing 
signed  medical  bulletins  in  the  daily  papers  has  greatly 
extended  during  recent  years.  They  used  to  be  reserved 
for  the  illnesses  of  great  personages,  whose  names  were  in 
everyone’s  mouth,  and  on  whose  lives  great  interests  de¬ 
pended.  Lesser  men  were  allowed  to  glide  quietly  into  the 
oblivion  of  the  tomb,  with  no  more  than  the  customary 
notice  in  the  Times  when  they  were  gone.  All  this  is  changed 


now.  Every  petty  celebrity,  every  insignificant  lordling- 
whose  name  is  scarcely  known  beyond  the  limits  of  his  own 
county  and  coterie,  has  his  illnesses  recorded  down  to  their 
minutest  symptoms.  The  public  are,  as  it  were,  admitted 
into  the  very  sick-chamber,  while  the  doctors  in  attendance- 
stand  by  the  portals  and  courteously  bow  them  in  and  out. 
They  are  shown  the  temperature  chart,  and  allowed  to  put 
their  ear  to  the  chest;  and,  if  the  illness  terminates  in  death* 
they  are  invited  to  crowd  around  the  corpse  and  to  make  an 
inspection  of  its  viscera.  In  other  cases,  where  the  position 
of  the  patient  hardly  warrants  mention  of  his  illness  in  the- 
daily  prints,  a  more  limited  form  of  publicity  is  courted. 
A  young  man,  for  instance,  who  has  never  seen  his  name  in 
type  except  amongst  a  crowd  of  others  in  the  Morning 
Post,  falls  ill,  say,  with  measles  or  pneumonia.  Much  is 
made  of  his  indisposition  :  the  street  is  muffled  with  straw,, 
he  is  prayed  for  at  the  nearest  fashionable  church,  and 
a  commissionaire  is  engaged  to  stand  on  the  doorstep  and 
show  the  latest  of  his  pile  of  bulletins  to  the  queue  of. 
anxious  inquirers.  He  recovers,  and  then  it  is  whispered 
that  there  was  after  all  not  so  very  much  occasion  for  all 
this  excitement.  The  doctors  in  these  latter  cases  are  not  to 
blame — at  least,  not  always.  To  many  of  them  it  must  be- 
highly  distasteful  to  be  thus  forced  into  publicity  ;  but  they, 
are  all  but  helpless.  It  is  the  will  of  the  idlers  of  society 
to  feast  on  the  mysteries  of  the  sick-room.  The  same- 
morbid  curiosity  urges  them  that  brings  the  idlers  of  the- 
street  crowding  round  a  struggling  epileptic,  and  in  either 
case  the  doctor  has  to  put  up  with  their  importunity. 

In  the  case  of  published  bulletins  it  is  different,  for 
there  it  is  probably  quite  as  often  due  to  the  initia¬ 
tive  of  the  doctor  as  to  that  of  the  friends  of  the 
patient  that  the  paragraph  finds  its  way  into  the  papers- 
If  the  profession  could  be  polled  on  this  subject,  a  vast 
majority,  we  believe,  would  avow  their  entire  disapproval. 
of  the  system.  But  at  present  their  lips  are  sealed. 
If  one  of  them  raises  his  voice  against  the  practice,  he  is- 
silenced  by  the  obvious  retort — “  Sour  grapes,  my  dear 
sir  l”  But  it  is  a  low  view  of  professional  right-feeling- 
which  holds  that  no  doctor  would  resist  the  temptation  of' 
having  his  name  published  far  and  wide  as  the  chosen 
attendant  of  this  or  that  lady  or  gentleman  of  fashion.  It 
is  not  only  a  low  view — it  is  a  false  view.  For  there  are 
many  successful  practitioners  who  not  only  do  not  court,  but 
who  absolutely  decline,  this  cheap  means  of  publicity.  The 
fact  that  a  large  number  of  public  characters  are  still  allowed 
to  shuffle  off  then-  mortal  coil  without  any  intimation  of  file¬ 
names  of  the  practitioners  who  assisted  at  the  process* 
shows  that  some  doctors  at  least  can  prevent  such  publica¬ 
tion.  We  know,  as  a  matter  of  fact,  that  the  leading  phy¬ 
sicians  do  their  best  to  keep  their  names  out  of  the  papers,, 
and  not  invariably  without  success.  But  the  question  is* 
whether  all  ought  not  to  make  a  stand  against  this  novel 
custom,  to  discourage  and  to  prevent  it.  It  may  be  argued 
that  the  feeling  which  undoubtedly  exists  in  the  profession 
against  medical  men  advertising  themselves  is  an  anti¬ 
quated  prejudice,  which  is  doomed  to  disappear  as  our 
institutions  become  more  Americanised.  It  may  be  pointed 
out  that  when  the  members  of  other  professions  find 
themselves  in  positions  of  trust  and  eminence,  they  are 
allowed  to  reap  what  little  advantage  may  accrue  to  them 
from  the  fact  of  their  success  being  given  a  wide  publicity. 
No  cause  cdlebre  passes  through  the  law  courts  but  the- 
names  of  the  opposing  counsel  are  trumpeted  aloud  by  the- 
daily  press  ;  no  big  bridge  is  built  or  palace  erected  but  the 
name  of  the  architect  is  in  everyone’s  mouth  ;  college  tutors 
and  private  crammers  ride  into  reputation  on  the  backs  of' 
their  successful  pupils ;  and,  even  in  that  profession  which 
teaches  us  that  fame  is  a  snare,  the  name  of  the  divine- 


Medical  Times  and  Gazette. 


A  DOCUMENT  IN  MADNESS. 


Nov.  10,  1883.  545 


under  whom  Royalty  has  sat  is  duly  announced  each  week, 
and  each  week  a  list  of  preachers  at  the  chief  London 
•churches  appears  in  the  daily  papers.  What  is  not  in 
terdicted  in  these  professions,  it  may  he  argued,  need 
surely  not  be  thought  wrong  in  that  of  medicine.  No 
■one  ever  said  it  was  wrong.  The  utmost  contention 
is  that  it  is  not  expedient.  And  why  ?  First  and  fore¬ 
most,  because  a  large  number  of  practitioners  have  a  very 
strong  objection  to  it,  and,  in  a  matter  like  this,  feeling 
is  a  valid  argument.  Secondly,  there  is  no  public  advan¬ 
tage  to  be  gained  by  it.  The  builder  of  a  palace,  the 
winner  of  a  lawsuit,  the  tutor  of  a  wrangler,  is  tested  by  his 
work ;  he  has  no  other  means  of  making  his  excellence 
known,  and  the  fact  that  he  has  succeeded  well  once  is 
a  very  fair  argument  that  he  will  succeed  equally  well 
again.  It  is  not  so,  however,  in  medicine.  If  practitioners 
-are  content  to  be  judged  by  their  success  or  failure  in  a 
•single  case,  let  them  advertise.  But  no  one  except  a  foci 
condemns  a  doctor  because  a  case  died,  or  pins  his  faith  to 
him  because  a  case  recovered,  while  he  was  in  attendance. 
•Other  professions  have  to  deal  with  the  devices  of  men, 
•and  men  are  the  only  possible  judges  of  their  success.  We, 
■on  the  other  hand,  have  nature  to  deal  with,  and  nature 
for  our  judge.  We  have  to  work  with  forces  that  are  im¬ 
perfectly  understood,  and  to  condemn  us  or  to  extol  us 
for  the  result  in  a  single,  yea,  even  in  a  dozen  cases,  is  like 
passing  or  plucking  a  schoolboy  on  the  strength  of  his 
■succeeding  or  failing  in  construing  a  detached  line  of 
JEschylus. 

The  fact  is  that  the  big  men  in  the  profession  gain  their 
position  not  because  of  their  success  in  individual  illnesses, 
but  because  in  a  long  course  of  hospital  practice  and  research 
"they  have  shown  those  general  qualities  of  mind  from  which 
■one  may  safely  argue  to  their  conduct  in  a  particular 
instance.  As  for  lesser  men,  they  gain  their  position,  as 
many  of  them  would  probably  confess,  by  every  means  but 
intrinsic  medical  merit.  They  have  pleasant  manners,  or  an 
imposing  air,  or  faultless  tact,  or  a  sympathetic  voice,  or 
their  rivals  in  the  neighbourhood  are  devoid  of  these  accom¬ 
plishments.  Whatever  it  is  that  wins  them  success,  it  is 
not  the  broad  philosophic  habit  of  thought  of  the  great 
physician,  which,  perhaps,  scarcely  one  in  a  hundred  of 
"their  patients  would  recognise  in  them  if  they  had  it.  So 
the  fact  that  in  a  single  case  some  hitherto  unknown  practi¬ 
tioner  happens  to  be  in  attendance  has  no  importance  for 
the  general  public ;  it  merely  implies  that  he  has  pleased 
or  gained  the  confidence  of  an  individual,  and  it  is  there¬ 
fore  inexpedient  that  it  should  be  made  known.  We  cannot 
imagine  a  falser  position  for  a  young  doctor  to  be  placed  in 
than  to  have  his  name  constantly  in  the  papers  as  the 
•attendant  on  such  and  such  a  grand  personage.  Sooner  or 
later,  the  lion’s  skin  is  sure  to  be  stripped  off  him  ;  and  even 
if  he  prove  in  the  end  to  have  been  a  lion  after  all,  though  a 
young  one,  it  would  have  been  better  for  him  to  have  waited 
till  his  mane  had  grown.  Thus,  as  the  big  men  need  no 
publicity,  and  the  little  ones  are  only  put  in  a  false  position 
•by  it,  it  were  better  that  the  advertisements  known  as 
medical  bulletins  were  discouraged.  We  have  spoken  out 
boldly  on  this  point,  because  it  is  the  privilege  and 
duty  of  a  journal  to  speak,  when  the  lips  of  individuals 
.are  closed  by  the  fear  of  incurring  a  charge  of  jealousy. 
We  believe  that  we  are  but  giving  voice  to  the  feelings  of 
the  large  majority  of  respectable  and  self-respecting  prac¬ 
titioners,  and  that  the  profession  at  large  would  be  very 
glad  to  see  the  College  of  Physicians  taking  the  initiative 
in  the  matter,  and  publishing  a  formal  disapproval  of  the 
issue  of  signed  bulletins  except  in  the  case  of  patients  of 
the  greatest  eminence,  and  a  condemnation  of  the  publica¬ 
tion  in  the  lay  press  of  the  symptoms  of  any  case  whatever. 


If  a  case  is  of  distinct  clinical  interest,  let  it  be  published, 
without  the  name  of  the  illustrious  patient,  in  a  medical 
journal.  Speaking  for  ourselves,  it  is  our  settled  policy 
never  to  admit  to  these  columns  the  details  of  any  case 
simply  because  it  happens  to  be  that  of  a  personage. 


A  DOCUMENT  IN  MADNESS. 

After  gazing  intently  for  some  time  at  the  portrait  of 
Oliver  Goldsmith  in  Trinity  College,  Dublin,  Carlyle  told 
his  companion  that  he  noticed  in  the  features  that  wild  and 
confused  look  which  is  so  common  in  the  faces  of  Goldsmith’s 
countrymen ;  and  after  scanning  with  some  care  the  Report 
of  the  Inspectors  of  Lunatic  Asylums  in  Ireland,  we  are 
constrained  to  admit  that  we  recognise  in  the  lineaments 
of  that  Blue-book  the  genuine  national  expression  which 
Carlyle  fitly  characterised."  Wildness  and  confusion  stamp 
its  every  page,  and  indeed  impart  to  it  a  peculiar  interest, 
such  as  is  rarely  to  be  found  in  publications  of  its  kind. 
These  are,  as  a  rule,  prim  and  prosaic,  but  this  Irish  Report 
runs  riot  in  stupendous  absurdity,  and  at  once  stimulates 
the  curiosity  of  anyone  who  may  be  compelled  to  dip  into  it. 
For  on  reading  it,  or  attempting  to  read  it,  one  experiences 
a  feeling  of  agonising  wonder  analogous  to  that  felt  when 
watching  the  writhing  performances  of  the  Human  Serpent 
— a  sense  of  half-amused  and  half-horrified  amazement  that 
the  English  language  can  be  thrown  into  such  extraordinary 
and  unimaginable  contortions.  Curiosity  is  piqued  to  get  at 
the  meaning  of  some  particularly  knotty  sentence.  The  idea 
flashes  up  that  a  discovery  has  been  made  of  an  entirely 
new  form  of  aphasia  or  word-blindness.  But  from  all  such 
attempts  and  speculations  we  fall  back,  baffled,  on  the  con¬ 
clusion  that  it  is  simply  Irish  wildness  and  confusion  that  we 
have  to  deal  with. 

Last  it  should  be  thought  that  we  are  exaggerating  the 
Hibernian  disorder  and  perplexedness  of  this  Report,  which 
has  passed  the  Queen’s  printer,  and  been  presented  to  the 
Lord  Lieutenant  and  to  Parliament,  we  cull  from  it  one  or 
two  sentences  which  may  be  taken  as  samples  of  its  style. 
At  its  very  outset  it  thus  launches  forth  :  ct  The  progress 
not  only  of  a  full  accommodation  in  public  institutions  for 
the  mentally  afflicted  in  Ireland,  but  with  it  of  every 
suitable  provision  to  administer  to  all  their  domestic  wants 
and  personal  comforts,  has  been  hitherto  so  sedulously  en¬ 
couraged  and  practically  advanced  by  us  that  we  venture 
to  represent  the  condition  of  the  insane  poor  as  highly 
satisfactory.”  There  is,  of  course,  a  glimmering  of  mean¬ 
ing  through  this  cloud  of  words,  but  what  is  to  be  made 
of  the  following  clotted  composition,  which,  we  gather  from 
a  marginal  note,  is  intended  to  convey  information  as  to  the 
character  of  the  insane  inmates  of  poorhouses  ?  “  The  great 
majority,  save  in  the  few  exceptional  cases  of  acute  mania 
that  occasionally  supervene,  is  composed  of  individuals, 
many  of  them  advanced  in  life,  who  becoming  decrepit  from 
age  in  the  union  have  lapsed  into  dotage — of  epileptics  of 
congenital  idiots— of  imbeciles  physically  ill  developed — of 
persons  broken  down  by  habits  of  dissipation  and  inebriety 
whose  faculties  become  disordered,  of  hopelessly  demented 
who  had  been  sent  from  district  asylums,  and  of  others 
after  long  years  of  employment  elsewhere  when  labouring 
under  debility  both  of  mind  and  body  remitted  home— not 
but  that  English  asylums  harbour  largely  natives  of 
Ireland.”  This  is  indeed  an  extraordinary  and  giddy  flight 
of  rhetoric,  but  it  is  rivalled  or  surpassed  by  many  others 
that  come  before  and  after  it ;  and  indeed,  the  whole  Report 
is  from  beginning  to  end  a  bewildering  enigma,  which, 
however,  it  would  be  scarcely  worth  while  to  endeavour  to 
solve. 


54  G 


Medical  Times  and  Gazette. 


THE  LESS  OBVIOUS  SYMPTOMS  OF  GASTRIC  ULCER. 


Nov.  10,  1883-.. 


It  must  be  obvious  that,  from  a  report  of  the  kind  which, 
we  have  been  indicating,  no  very  cleat  or  comprehensive 
information  can  be  derived  as  to  the  state  of  the  insane  in 
Ireland.  The  statistical  tables,  however,  which  form  the 
appendix,  are  necessarily  more  intelligible,  and  from  them 
we  gather  that  there  were  in  Ireland  on  January  1,  1883, 
13,821  registered  lunatics,  against  13,444  on  the  correspond¬ 
ing  day  of  the  previous  year.  It  thus  appears  that  the 
number  of  registered  lunatics  increased  by  377  in  the  twelve 
months,  and  this  too  although  there  was  a  diminution  in  the 
population  of  the  country  at  large.  The  distribution  of  the 
registered  lunatics  of  Ireland  was  as  follows  at  the  beginning 
of  this  year : — 9271  in  district  asylums,  173  in  the  central 
criminal  asylum,  650  in  private  asylums,  16  in  idiot  asylums, 
and  3711  in  workhouses.  The  district  asylums,  which  are 
twenty-two  in  number,  and  vary  in  size  from  that  at  Carlow, 
which  accommodates  250  patients,  to  that  at  Dublin,  which 
accommodates  1100,  appear  to  be  in  a  sound  and  improving 
condition.  They  are  presided  over  by  medical  superinten¬ 
dents,  with  salaries  ranging  from  =8400  to  =8700  a  year,  and 
with  allowances  which  vary  in  estimated  value  from  =£100 
to  <£229  a  year.  These  allowances  are,  we  think,  set  forth 
with  unnecessary  detail,  as  it  cannot  be  pleasant  to  a  pro¬ 
fessional  man  to  have  it  published  to  the  world  that  he 
receives  two  pounds  of  bread  and  one  stone  of  potatoes  per 
diem,  or  that  he  is  paid  £o  per  annum  for  washing,  and  £2 
for  brushes.  One  medical  superintendent,  we  notice,  has 
the  “keep  of  a  horse,  pig,  and  fowl,”  and  we  can  only 
express  the  hope  that  the  hen  which  is  thus  supported  at 
the  public  expense,  and  reported  to  Parliament,  has  a  due 
sense  of  its  official  responsibility,  and  never  lets  its  chief  run 
short  of  eggs. 

It  must  not  be  supposed,  however,  that  the  statistical 
tables  of  this  Report  are  plain  sailing.  Some  of  them  are  as 
incomprehensible  as  the  text,  notably  that  one  in  which  the 
proportions  of  recoveries  and  deaths  to  the  admissions  and 
average  number  of  patients  resident  in  asylums  are  dealt 
with.  We  are  informed,  for  instance,  that  209  patients 
were  admitted  into  the  Armagh  Asylum  during  the  years 
1880,  1881,  and  1882,  that  89  were  discharged  recovered, 
and  72  died,  the  average  number  daily  resident  having 
been  622  ;  and  from  these  data  the  somewhat  startling  con¬ 
clusion  is  arrived  at,  that  the  recoveries  were  at  the  rate  of 
128  per  cent,  of  the  admissions,  and  that  the  deaths  were 
at  the  rate  of  35  percent,  of  the  average  number  of  patients 
daily  resident.  And  so  on  throughout  the  whole  length  of 
this  table,  only  that  the  results  arrived  at  are,  in  the  case 
of  some  other  asylums,  even  more  remarkable  than  those 
at  Armagh.  Thus  at  Enniscorthy  the  recoveries  reached 
the  unparalleled  height  of  201  per  cent,  of  the  admissions ; 
while  at  Dublin  the  death-rate  mounted  to  44  per  cent,  of 
the  average  number  of  patients  resident ;  and  yet  we  are  not 
informed  that  any  new  and  infallible  cure  had  been  in  opera¬ 
tion  at  Enniscorthy,  or  that  any  fearful  epidemic  had  swept 
over  Dublin.  It  is  clear  that  if  these-  rates  of  recovery  and 
death  can  only  be  maintained  for  a  few  years,  the  functions 
of  the  Inspectors  of  Asylums  will  be  at  an  end,  and  that 
lunatics  will  be  as  scarce  in  Ireland  as  snakes  are  in 
Iceland. 

It  would  be  a  waste  of  time  to  enlarge  further  on  the 
blunders  and  solecisms  of  this  Irish  Blue-book,  or  to  laugh 
at  the  cock-a-hoop  expressions  of  self-satisfied  pride  on  the 
part  of  the  inspectors,  which  are  so  liberally  interspersed 
with  these.  Enough  has  been  said  to  indicate  its  worth¬ 
lessness.  It  is  discreditable  to  the  Irish  Executive  that  such 
a  report  should  have  been  permitted  to  appear.  The  only 
useful  purpose  it  can  serve,  is  to  afford  conclusive  evidence  of 
the  urgent  necessity  that  exists  for  a  radical  reform  in  the 
lunacy  administration  of  the  sister  island. 


CLINICAL  PAPERS.-No.  I. 


The  Less  Obvious  Symptoms  op  Gastric  "Ulcer. 

The  frequency  with  which  ulcer  of  the  stomach  occurs^ 
though  indicated  by  dissections  of  the  dead,  and  taught, 
moreover,  by  several  writers,  is  perhaps  not  duly  realised  j- 
and  it  is  probable  that  from  time  to  time  the  absence  or 
the  want  of  salience  of  some  of  the  well-known  symptoms 
in  this  affection  leads  to  imperfect  observation  of  the  case, 
and  in  consequence  to  erroneous  diagnosis  and  ineffectual 
treatment.  In  the  mass  of  instances,  both  in  hospital  and 
private  practice,  usually  relegated  to  the  large  category  off 
dyspepsia  there  are  many  where  careful  observation  and 
inquiry  into  past  symptoms  suggest  the  probably  causative 
influence  of  gastric  ulcer.  Apart  from  the  significant  occur¬ 
rence  of  rapidly  fatal  perforation,  sometimes  without  any 
premonitory  complaint  whatever,  which  should  have  its  im¬ 
portant  clinical  lesson  for  all,  and  the  frequent  discovery  of 
healed  ulcers  in  the  post-mortem  room,  careful  observation- 
of  symptoms  and  a  little  scientific  use  of  the  imagination 
seem  to  lend  great  force  to  the  teaching  which  emphasises, 
the  part  played  in  so-called  dyspepsia  by  this  curious, 
affection  of  the  stomach. 

It  would  not  appear  necessary  in  these  cases  that  the  com¬ 
plaint  of  severe  pain  should  be  made ;  though  much  stress- 
should  be  laid  on  its  more  or  less  definite  localisation,  and 
time  of  occurrence  in  relation  to  taking  food.  It  would  be 
surprising  to  those  who  may  not  have  paid  much  attention 
to  this  subject  to  learn  that  in  an  extremely  large  number  of 
the  very  common  complaints  of  pain  between  the  shoulders 
at  a  certain  definite  spot,  or,  more  rarely,  of  a  similar  pain  at 
the  epigastrium,  which  are  of  constant  occurrence  in  the 
out-patient  room,  very  definite  and  indubitable  histories  of 
considerable  vomiting  of  blood  can  be  obtained,  though 
often  this  symptom  has  either  been  so  remote  in  time  or,  if 
repeated,  so  slight  in  degree  that  the  patients  do  not 
spontaneously  complain  of  or  report  it.  These  cases  are 
probably  too  frequently  put  down  to  “  gastritis  ”  or  “  gastric 
catarrh,”  and,  even  more  vaguely,  when  the  pain  and  general 
disturbance  are  but  slight,  to  that  refuge  of  diagnostic  doubt, 
“  dyspepsia,”  or  are  looked  upon  as  solely  and  directly  due 
to  improper  feeding. 

It  must  be  remembered  that  the  kind  of  complaint 
under  consideration — the  definite  interscapular  pain,  the- 
“  sinking,”  etc., — although  familiar  to  those  whose  work  is 
among  the  lower  orders,  is  but  rarely  made  by  the  more 
well-to-do,  whose  many  and  variegated  dyspeptic  maladies 
are  directly  traceable  to  what  and  how  they  eat  and  drink. 
Such  cases  of  indigestion,  on  the  other  hand,  and  such 
troublesome  cases— from  the  point  of  view  of  treatment — as 
are  so  often  met  with  among  the  higher  classes,  occur  but 
rarely  among  the  lower,  where,  in  the  few  instances  taking’ 
place  outside  the  circle  of  tea-  and  alcohol-dyspepsia,  and 
often  in  these  as  well,  a  cure  can  generally  soon  be  wrought. 
But  it  is  by  the  lower  classes,  and  by  women  especially, 
that  the  definite  complaint  of  interscapular  or  epigastric 
pain  is  so  often  made ;  and  among  them  too  is  admittedly 
found  the  greatest  incidence  of  gastric  ulcer,  as  evidenced 
by  unquestionably  marked  symptoms  during  life  or  by  exa¬ 
mination  after  death.  It  may  be  interesting,  perhaps,  to 
remember  in  this  context  that  the  greater  frequency  of 
pain  between  the  shoulders  than  “"at  the  pit  of  the  stomach”" 
may  have  some  connexion  with  the  more  favourite  seat  of 
gastric  ulcer  on  the  posterior  aspect  of  the  organ,  and  that 
the  locality  of  the  cause  of  the  pain  may  be  hinted  at  by  the 
frequently  beneficial  effect  of  a  sinapism  placed  in  situ. 

These  remarks  may  be  applied  as  well  to  cases  where  no 
history  of  hsematemesis  can  be  obtained,  or  even  where  it 


Medical  Times  and  Gazette. 


CHRONICLE  OF  THE  WEEK. 


Nov.  10,  18  3.  547 


can  be  excluded.  Many  instances  of  gastric  ulcer  un¬ 
doubtedly  occur  without  haemorrhage,  as  especially  shown 
by  the  rapidly  perforating  ulcers  in  the  anterior  wall  of  the 
stomach,  unchecked  in  their  fatal  course  by  any  adhesion 
to  other  organs.  One  practical  and  additional  aid  in  the 
diagnosis  of  the  obscurer  cases  of  this  affection  is  the  con¬ 
dition  of  the  tongue,  which  is  but  rarely  coated  or  furred 
as  it  would  be  were  the  gastric  affection,  if  accompanied  by 
equal  pain,  either  diffuse  inflammation  or  malignant  growth. 
The  reasonable  hypothesis  of  the  great  clinical  frequency 
of  gastric  ulcer  will  often  lead  to  success  in  treatment  after 
many  dietetic  changes  and  many  drugs  have  failed;  for  it 
points  to  as  near  an  approach  to  perfect  rest  of  the  stomach 
as  possible — to  semi-starvation  sometimes  for  awhile,  or 
even  rectal  feeding,  in  cases  before  any  alarm  of  danger 
arises.  Such  treatment  will  occasionally  work  apparent 
wonders,  and  may  serve  also  to  support  the  diagnosis  in  the 
mind  of  the  doubter,  when  he  finds  that  on  a  speedy  return 
to  ordinary  food  the  patient’s  pain  may  often  be  long  in 
recurring,  or  may  never  be  heard  of  again.  2. 


CHRONICLE  OF  THE  WEEK. 

— - '0“ - 

At  the  Medical  Society,  on  Monday  evening,  the  adjourned 
discussion  on  Mr.  Lister’s  method  of  treating  fracture  of 
the  knee-cap  was  opened  very  appropriately  by  Mr.  Bryant. 
He  began  with  an  eulogy  on  the  system  of  antisepsis  in  sur¬ 
gery,  and  on  the  brilliant  results  to  which  it  had  led.  He 
himself  fully  accepted  the  'principles,  though  he  did  not 
quite  carry  out  the  practice  of  Mr.  Lister.  He  criticised 
the  expression  of  “  being  morally  certain  that  we  do  not 
subject  a  patient  to  risk.”  Could  anyone  say  this,  whatever 
theory  he  adopted,  or  on  whatever  plan  he  carried  it  out  ?  Mr. 
Adams,  who  had  worked  at  this  subject,  said  he  would 
submit  him  self  to  this  operation  at  the  hands  of  Mr.  Lister, 
but  at  no  one  else’s.  Mr.  Bloxam  had  operated  successfully 
in  three  cases,  which  were  shown  to  the  Society.  Mr.  Eoyes 
Bell  had  operated  four  times,  with  complete  success  in 
three  cases,  and  a  failure  in  the  fourth.  Mr.  Gant  praised 
Malgaigne’s  hooks.  Mr.  Morris  spoke  against  the  operation, 
on  account  of  the  risks  involved.  Bony  union  was  not  an 
advantage,  because,  in  cases  of  re-fracture,  it  was  the  bone 
which  gave  way  elsewhere,  and  not  along  the  line  of  the  old 
ligamentous  union.  The  ordinary  treatment  was  free  from 
all  risk,  gave  excellent  resulfsdn  the  hands  of  a  careful  sur¬ 
geon,  and  failure  to  attain  them  depended  not  on  the  method 
but  on  the  surgeon.  Mr.  Lose  had  had  three  cases,  with 
complete  success  in  two,  and  with  success,  but  less  complete, 
in  the  third,  for  there  had  been  a  little  suppuration.  Mr. 
Cheyne  had  examined  the  pus  without  finding  any  bacteria. 
Mr.  Owen  objected  to  the  treatment :  he  always  obtained 
good  results  by  keeping  his  patients  in  bed  for  a  long  time. 
Mr.  Baker  was  opposed  to  the  plan,  on  account  of  the  risks 
involved,  but  chiefly  because  such  excellent  results  could 
be  obtained  by  the  ordinary  method,  if  carefully  carried  out. 

Mr.  Lister  replied  with  great  point  to  the  objections  raised^ 
making  an  evident  impression  on  his  hearers  in  favour  of  the 
whole  question  of  strict  antiseptic  surgery — as  carried  out 
by  himself.  He  was  not,  he  said,  particularly  wedded  to 
carbolic  acid.  He  felt  sure  that  he  would  obtain  satisfac¬ 
tory  results  if  iodine  alone  were  at  his  disposal.  But  it  was 
useless  to  suppose  that  the  best  antiseptic  substance  in  the 
worlcl  would  prove  efficient  unless  efficiently  applied,  and 
in  greater  or  less  quantity  in  proportion  to  its  antiseptic 
power,  its  volatility,  its  solubility,  and  other  attributes.  As 
regards  the  duration  of  treatment,  on  which  so  many 
surgeons  had  laid  stress,  it  was  surely  not  a  matter  of 


indifference  whether  a  case  could  be  cured  in  six  weeks  or 
whether  six  months  should  be  employed.  Finally,  he 
cautioned  his  hearers  against  the  adoption  of  this  method 
unless  they  were  prepared  to  carry  out  a  most  thorough 
system  of  antiseptic  precautions.  It  cannot  be  doubted  that 
Listerian  surgery  will  receive  a  tangible  impetus  from  the 
discussion  of  this  operation,  while  its  author  will  by  it  add 
yet  another  to  his  many  achievements  in  surgical  practice. 
The  time  is  fast  approaching  when  those  who  do  not  carry 
out  Listerian  precautions  will  be  called  upon  to  justify  their 
practice  by  the  publication  of  their  results,  just  as  in  the 
near  past  the  Listerians  have  been  challenged  to  publish 
theirs. 


Hr.  Samuel  West’s  interesting  communication  on  the 
Anastomosis  of  the  Coronary  Arteries,  at  the  meeting  of  the 
Pathological  Society  the  other  evening,  affords  a  good 
instance  of  how  readily  a  mistake  may  be  made,  and  how 
often  it  is  accepted  without  question.  For  many  years,  on  the 
strength  of  Hyrtl’s  assertion,  it  has  been  almost  universally 
taught  and  believed  that  the  blood  did  not  pass  from  one 
coronary  artery  to  another ;  whereas  a  little  extra  trouble 
in  the  method  of  experimenting  would  have  sufficed  to  ex¬ 
plode  this  unfounded  belief  long  ago.  Messrs.  Parker  and 
Shattock  raised  very  important  questions  in  their  communi¬ 
cation  on  the  Causation  of  so-called  Talipes  Equino-varus  and 
other  forms.  So  far  as  one  case  can  do  so,  they  proved  con¬ 
clusively  that  congenital  talipes  does  not  depend  upon  an 
affection  of  the  central  nervous  system.  Mr.  Waren  Tay’s 
case  of  a  boy  who  had  recovered  from  complete  necrosis  of 
the  lower  jaw  was  of  much  interest.  Dr.  W.  B.  Hadden 
showed  two  specimens  of  ruptured  heart ;  Dr.  Norman  Moore, 
a  case  of  stricture  of  the  jejunum,  with  three  diverticula  in 
the  duodenum ;  and  Mr.  W.  J.  Eoeckel  made  a  communication 
on  the  structure  of  hsemorrhoids. 


The  usual  monthly  meeting  of  the  Obstetrical  Society 
was  held  on  Wednesday.  The  time  was  chiefly  occupied  by 
a  paper,  by  Mr.  Lawson)Tait,  on  the  subject  of  Pyosalpinx. 
There  appeared  a  general  feeling  that  Mr.  Tait  was  the 
pioneer  of  a  real  advance  in  the  treatment  of  a  certain  class  of 
cases.  But  it  was  also  made  evident,  both  from  the  remarks  of 
speakers  and  from  Mr.  Tait’s  paper  and  replies  to  questions, 
that  the  operations  he  advocated  were  exceedingly  difficult 
(Mr.  Tait,  indeed,  expressed  himself  as  unable  to  teach 
anyone  else  how  to  perform  them) ;  that  the  diagnosis  of 
the  cases  was  very  obscure  ;  that  it  was  far  from  easy  to 
distinguish  between  hydrosalpinx — an  almost  harmless  con¬ 
dition — and  pyosalpinx — a  much  more  serious  one ;  and  that 
probably  a  number  of  cases  even  of  the  latter  get  well 
without  operation.  While  the  diagnosis  and  the  technique 
of  the  operation  are  in  this  stage,  it  is  plain  that  it  cannot 
be  recognised  as  a  resource  at  the  disposal  of  every  gynae¬ 
cologist.  Far  more  exact  observation  of  cases  is  needed 
before  this  end  can  be  attained. 


The  Medical  School  of  Harvard  University  has  just 
entered,  by  what  is  well  termed  “  a  fortunate  coincidence,” 
upon  its  second  century  of  existence,  and,  at  the  same  time, 
upon  its  occupation  of  the  noble  and  spacious  new  buildings 
which  the  liberality  of  the  American  public  has  provided 
for  its  use.  The  dedicatory  address  was  appropriately  de¬ 
livered,  on  October  17,  by  the  veteran  author,  Dr.  Oliver 
Wendell  Holmes,  whose  name  is  as  much  honoured  and 
works  as  much  appreciated  on  this  side  of  the  Atlantic  as 
on  the  other.  It  is  not,  perhaps,  in  England  so  universally 
recognised  that  the  author  of  the  “  Autocrat  of  the  Break¬ 
fast  Table”  and  "Elsie  Venner”  is  a  member  of  the 
medical  profession,  the  only  living  one  who  has  risen  to  the 

A^V'S  HOV/TS 


M^d’cal  Timos  and  Oazptfe 


CHRONICLE  OF  THE  WEEK. 


Nov.  10,  1883. 


54  8 

highest  rank  in  pure  literature  ;  but  the  fact  remains  that 
we  are  entitled  so  to  claim  and  boast  of  him.  Dr.  Holmes’s 
oration,  an  abstract  of  which  will  be  found  in  another  column, 
will  be  widely  read,  and  with  delight  by  all.  It  is  not  only 
an  interesting  review  of  the  progress  of  medical  and  surgical 
science  within  the  last  two  half-centuries ;  it  is  besides,  as 
we  should  expect  from  the  gifted  author,  so  sparkling  with 
anecdote  and  epigram,  so  graceful  and  felicitous  in  expres¬ 
sion,  as  well  as  valuable  in  matter, — such  a  quaint  mingling 
in  parts  of  the  lofty  and  didactic  with  the  humorous  and 
imaginative,  as  to  form  a  whole  well  worthy  both  of  the 
orator  and  the  occasion.  As  a  review  of  the  past,  and  an 
abstract  of  the  present,  state  of  medicine  and  its  allied 
sciences,  regarded  from  its  most  broad  and  cosmopolitan 
standpoint,  this  address  is  well  worthy  of  attention ;  while, 
as  an  illustration  of  the  peculiar  versatility  of  style  of  the 
writer,  and  of  his  power  of  presenting  the  grave  and  gay  in 
happy  combination,  it  is  equally  remarkable.  The  words  of 
this  most  liberal-minded  of  authors  on  the  subject  of  Medical 
Women  may  be  well  read  as  a  semi-serious,  yet  suggestive, 
context  to  the  Lancet  editorial  article  of  the  past  week. 

One  point  in  the  address  is  especially  worth  picking  out. 
The  lecturer  is  congratulating  his  audience  on  the  size  and 
number  of  the  new  class-rooms.  “If  you  knew,”  he  says, 
“  what  it  is  to  lecture,  and  be  lectured  to,  in  a  room  just 
emptied  of  its  preceding  audience,  you  would  be  thankful 
that  our  arrangements  will  prevent  such  an  evil.  The  ex¬ 
perimental  physiologists  tell  us  that  a  bird  will  live  under  a 
bell-glass  until  he  has  substituted  a  large  amount  of  carbonic 
acid  for  oxygen  in  the  air  therein.  But  if  another  bird  is 
taken  from  the  open  air  and  put  in  with  the  first,  the  new¬ 
comer  speedily  dies.  So,  when  the  class  I  was  lecturing 
to  was  sitting  in  an  air  once  breathed  already,  after 
I  have  seen  head  after  head  gently  declining,  and  one 
pair  of  eyes  after  another  emptying  themselves  of  intel¬ 
ligence,  I  have  said,  inaudibly,  with  the  considerate  self- 
restraint  of  Musidora’s  rural  lover — Sleep  on,  dear  youth ; 
this  does  not  mean  that  you  are  indolent,  or  that  I  am  dull ; 
it  is  the  partial  coma  of  commencing  asphyxia.’  ”  This  is 
no  new  truth,  though  expressed  in  somewhat  novel  form  and 
language.  But  it  is  one  whose  practical  force  is  too  often  lost 
sight  of  in  our  educational  establishments  in  England,  and 
even,  as  we  can  recall,  in  some  of  our  medical  schools.  It 
is  not  a  thing  altogether  unknown  for  the  lecturer  to  meet 
his  class  in  a  room  “  just  emptied  of  its  preceding  audience,” 
and  where  the  air  has  been  further  deteriorated  by  the 
blaze  of  gas  at  the  expense  of  the  already  diminished  supply 
of  oxygen.  Such  a  thing  should  not  be,  and  we  may  hope 
that  the  crisp  utterances  of  Dr.  Wendell  Holmes  may  have 
their  effect  in  enforcing  this  well-worn  truth  in  the  old 
country  as  in  the  new.  Certainly  an  attitude  of  mind  which 
may  be  described  as  the  “  partial  coma  of  commencing 
asphyxia”  can  be  favourable  neither  to  brilliance  in  the 
lecturer  nor  retentiveness  in  the  student. 


The  descriptions  which  the  American  journals  give  of 
the  new  building  show  that  in  other  respects  the  interests 
of  the  students  have  not  been  forgotten.  The  ground  floor 
is  almost  entirely  given  up  to  them.  There  is  a  spacious 
reading-room,  a  library,  a  coat-room,  lavatories,  and — a 
smoking-room.  It  is  indeed  a  new  step  on  the  part  of  the 
authorities  to  recognise  that  the  student  is  a  being  with 
bodily  frailties  like  themselves.  Hitherto,  in  most  medical 
schools  it  appears  to  have  been  an  article  of  belief  that  the 
student  had  no  appetite  or  thirst  that  needed  solacing  or 
quenching ;  that  his  backbone  was  of  iron,  and  his  ischial 
tuberosities  of  adamant ;  that  he  could  see  like  a  bat,  and 
flourish  on  carbonic  acid  like  a  bay-tree.  As  to  his  being 


so  weakly  organised  as  to  need  an  occasional  fillip  from  ex¬ 
cisable  articles,  such  as  tea,  coffee,  alcohol,  or  tobacco,  that 
is  a  notion  to  which  many  authorities  still  remain  blind. 
There  is  another  side  to  the  question,  as  one  of  the  speakers 
at  the  Boston  ceremonial  seemed  to  suspect  when  he  quoted 
the  lines — 

“  Ill  fares  the  land  to  hastening  ills  a  prey, 

Where  wealth  accumulates  and  men  decay.” 

The  appetite  for  comfort  grows  by  what  it  feeds  on,  and 
when  we  find  our  students  lolling  over  their  afternoon  tea*, 
or  cigarettes  in  all  the  luxury  of  a  club-room,  we  may  look 
back  with  regret  to  the  days  when  theatre-benches  were 
hard  and  polished  by  long  sitting,  when  the  pipe  was  a 
surreptitious  open-air  indulgence,  and  tea  was  left  to  women. 

The  return  of  the  Begistrar- General  for  last  week  is 
satisfactory.  The  death-rate  for  the  twenty-eight  chief 
centres  of  population  was  20T — a  rate  which  will  bear  lower¬ 
ing,  but  which  compares  very  favourably  with  that  which 
was  common  before  the  sanitary  era.  The  London  death- 
rate  for  the  week  was  19 '0,  and  for  the  first  five  weeks  of 
the  current  quarter  18'4  per  1000.  Though  zymotic  diseases 
caused  158  deaths  in  the  week,  61  of  which  were  due  to 
scarlet  fever,  this  number  was  79  lower  than  the  ten-years’ 
average  for  the  corresponding  week.  Fifty-one  people  met 
with  violent  deaths,  the  vast  majority  of  which  were  from 
accident  or  negligence.  Twelve  babies  died  from  suffocation 
— a  figure  which  indicates  that  many  mothers  were  either 
overworked  or  careless  of  the  lives  of  their  progeny.  The 
amount  of  infanticide,  whether  from  negligence  or  intent 
is  a  very  fair  index  of  the  social  and  moral  well-being  of  a 
people.  A  hutch-fed  rabbit  will  kill  her  young,  but  no 
animals  that  live  under  healthy  conditions  do  it.  Child- 
murder  nearly  always  implies  either  misery  or  disease. 

The  notion  that  disease-germs  are  modifiable,  and  owe 
their  dangerousness  less  to  their  inherent  specific  characters 
than  to  the  conditions  which  favour  their  development,  as  it 
filters  down  into  the  average  scientific  intelligence,  will, 
probably  have  very  far-reaching  practical  effects.  If  noxious 
germs  always  retain  their  specific  characters,  if  there  is  no 
such  thing  as  evolution  of  them  out  of,  or  devolution  of 
them  into,  innocence,  then  the  practical  way  of  dealing  with 
them  is  to  shut  the  door  upon  them  and  keep  them  out  at 
all  hazards.  But  if  they  are  modifiable,  then  our  effort 
should  be  to  prepare  for  them  conditions  under  which 
the  more  dangerous  forms  can  neither  originate  nor 
thrive.  You  have  a  stinking  water-closet  in  your  house, 
suppose.  Well,  you  can  deal  with  it  in  two  ways.  You 
can  drown  its  odours  with  carbolic  acid,  put  a  double 
door  to  it,  and  keep  its  effluvia  out  of  your  house ;  or  you 
can  have  it  taken  down,  and  one  put  up  that  won’t  smell. 
The  one  treatment  represents  the  action  of  those  who,  in  the 
case  of  diseases  caused  hypothetically  by  germs,  attack  the 
exciting  cause— the  germ ;  the  other  represents  the  action 
of  those  who  fix  their  attention  on  the  predisposing  condi¬ 
tions.  If  dental  caries,  say,  is  due  to  bacteria,  you  may 
attack  it  either  by  antiseptic  washes  and  powders,  or,  recog¬ 
nising  the  futility  of  that  method,  you  may  look  out  for  a 
means  of  so  strengthening  the  tooth-tissue,  that  it  may,  as 
in  our  ancestors,  bid  defiance  to  the  bloodthirstiest  germ. 
Here  it  is  clear  enough  which  is  the  more  rational  pro¬ 
cedure  ;  and  what  is  the  more  rational  in  one  case,  may  quite 
likely  be  the  more  rational  in  all. 

The  two  views  are  seen  in  action  in  respect  to  the  dif¬ 
ferent  means  of  preventing  both  cholera  in  man,  and  foot- 
and-mouth  disease  in  cattle.  “  Lock  the  door  !”  shriek  the 
French  hygienists  and  the  English  farmers  ;  “  keep  out  the 
pest  at  all  costs.”  “Nonsense  !”  reply  the  English  authori- 


Medical  Times  and  Gazette. 


ANNOTATION'S. 


Nov.  10, 1883.  5  49 


ties  in  each  case ;  “  clean  down  your  house,  and  do  your  best 
to  keep  out  the  infection ;  but  for  goodness  sake  don’t  trust 
to  the  feeble  barricade  of  a  door,  and  lull  yourself  into  false 
and  foul  security  behind  it.  There  is  not  a  cordon  known 
yet  which  the  flaming  tongue  of  infection  will  not  pass  if 
there  are  inflammables  on  the  other  side.”  This  attitude  is  as 
yet  but  imperfectly  grasped  either  in  France  or  in  England. 
Here  is  an  instance.  A  writer  in  Tuesday’s  Times  sneers  at 
the  marvellous  discoveries  of  the  microscope,  which  are  to 
make  the  world  believe  that  foot-and-mouth  disease  comes 
from  dirty  ditches,  and  not  from  abroad.  He  is  quite  amused 
at  the  idea  that  sewage-water  is  deleterious  to  cattle.  He 
has,  from  an  experience  of  forty  years,  convinced  himself 
that  farm  animals  do  not  only  derive  no  harm  from  drinking- 
water  consisting  mainly  of  sewage,  but  that  they  even  thrive 
on  it.  In  one  farm  he  knows  of,  the  most  aged  mares  inva¬ 
riably  drink  by  preference  from  that  corner  of  the  pond  into 
which  the  farmyard  directly  drains ;  hence  it  is  needless  to 
provide  pure  water  for  them.  That  represents  the  mental 
attitude  and  the  average  reasoning  faculty  of  the  majority 
of  people  in  England  and  France.  “  The  cannon-shots  have 
not  yet  happened  to  hit  this  particular  magazine  ;  therefore 
let  us  sit  upon  it.”  Why,  the  proverbial  Irishman  took  up 
a  more  sensible  position  than  that ! 

The  current  number  of  Brain  contains,  amongst  others, 
an  article  by  Dr.  Crichton  Browne,  on  the  Pulmonary 
Pathology  of  General  Paralysis,  which  cannot  fail  to  attract 
considerable  attention.  In  a  large  majority  of  cases,  where 
an  autopsy  is  made,  coarse  macroscopical  changes  are  found. 
In  the  first  place,  the  mean  weight  of  the  lungs  is  consider¬ 
ably  increased,  and  this  notwithstanding  the  fact  that  the 
normal  lung  in  general  paralysis  weighs  less  than  in  health. 
This  loss  of  weight  is  probably  dependent  upon  withering 
and  obliteration  of  capillaries  from  diminished  respiratory 
function  and  blood- volume.  Pleurisy  would  appear  to  be 
tolerably  common,  but  the  affections  of  the  lung  itself  are 
of  more  importance.  Of  these,  congestion  is  the  most 
common — much  more  so,  indeed,  than  in  cases  of  death  from 
exhausting  bodily  diseases.  The  lesson  to  be  learned  from 
the  occurrence  of  this  congestion  is  that  the  patient  should 
not  be  left  too  long  in  one  attitude  or  position,  and,  indi¬ 
rectly,  it  furnishes  a  good  plea  against  the  use  of  mechanical 
restraint.  Pneumonia,  which  is  a  frequent  cause  of  death 
in  general  paralytics,  is  regarded  as  probably  due  to  some 
central  nervous  influence  producing  neuro-paralytic  hyper¬ 
emia,  with  possibly  a  suspension  of  healthy  trophic  influ¬ 
ences  superadded.  Phthisis  is  the  cause  of  death  in  a  very 
considerable  proportion  of  general  paralytics,  and,  indeed, 
of  all  the  insane  ;  and  Dr.  Crichton  Browne  regards  this  fact 
as  affording  confirmatory  evidence  of  the  communicability  of 
phthisis,  for,  as  he  justly  remarks,  the  inmates  of  asylums 
are  well  fed,  clothed,  and  housed,  and  live  in  healthy  situa¬ 
tions  and  under  strict  hygienic  regulations,  and  yet  phthisis 
is  more  common  among  them  than  amongst  the  general 
community  at  large ;  and,  further,  phthisis  is  more  common 
amongst  the  females  than  the  males  in  lunatic  asylums — 
which  is  the  reverse  of  what  obtains  amongst  ordinary 
people,  and  is  to  be  attributed  to  the  more  sedentary,  con¬ 
fined  life  that  the  females  live.  The  practical  result  of  this 
view  is  that  Dr.  Browne  suggests  that  patients  suffering 
from  phthisis  should  be  isolated  in  the  infectious  block 
attached  to  most  asylums. 

The  most  important  paper  in  the  French  journals  this 
week  is  Charcot’s  lecture  in  the  Progres  Medical,  entitled, 

“  Des  differentes  formes  de  l’Aphasie:  Aphasie  motrice,” 
The  same  journal  contains  an  article  by  M.  G.  Rivet,  headed, 
“Que  deviennent  les  Varices  chez  les  Femmes  enceintes 


lorsque  le  Foetus  succombe  ”;  and  one  by  M.  E.  Brissaud 
on  “  Le  Pouls  capillaire  visible.”  The  Gazette  Hebdoma- 
daire,  contains  “  Etude  critique  sur  la  Tuberculose  articu- 
laire,”  and  several  reports  from  the  Academy  of  Medicine 
and  the  scientific  societies.  The  Gazette  des  Hopitaux  con¬ 
tains  a  case  by  M.  Verneuil,  “Resection  sousperiostique  de 
l’Humerus  et  des  Os  de  l’Avantbras.”  The  Revue  Mensuelle 
de  Laryngologie,  etc.,  contains  the  following  communications, 
viz.,  “Rhumatisme  articulaire  aigu  a  debut  auriculaire,” 
by  Dr.  Menifere;  “Des  Kystes  du  Larynx,”  by  Dr.  Blanc; 
and  “  De  la  Syphilis  de  l’Oreille,”  by  Dr.  Baratoux. 


This  week’s  number  of  the  Centralblatt  fur  Klinische 
Medicin  contains  abstracts  of  several  papers  of  interest, 
notably  of  papers  by  Schiff,  on  the  Excitability  of  the  Spinal 
Cord  ;  by  Rosenstein,  on  Blood-Pressure  in  Fever ;  by  Barie, 
on  Cardio-Pulmonary  Disturbances,  secondary  to  Gastro¬ 
intestinal  Affections ;  and  by  Arloing,  Cornevin,  Thomas, 
and  Perroncito,  on  the  subject  of  Charbon.  The  Centralblatt 
fur  Chirurgie  continues  the  reports  of  the  Meeting  of 
German  Naturalists  and  Physicians,  giving  a  short  resume 
of  the  debate  following  each  paper.  The  subj  ects  of  Lacera¬ 
tion  of  the  Bladder  and  the  Treatment  of  Goitre  are  of  chief 
interest.  A  paper  by  Gritti  on  the  Surgical  Treatment  of 
Spermatalgia  is  also  to  be  noted.  The  Centralblatt  fur 
Gynukologie  is  also  largely  occupied  by  the  report  of  the 
Gynaecological  Section  of  the  same  meeting.  An  original 
paper  by  Dr.  C.  Brendel,  in  Montevideo,  gives  an  account  of 
a  Successful  Extirpation  of  the  Uterus  through  the  Vagina. 
In  the  Berliner  Klinische  Wochenschrift,  Dr.  Bidder’s  article 
on  the  Relation  of  the  Alkaline  Salts  to  the  Etiology  of 
Tuberculosis  is  continued ;  and  original  papers — by  James 
Israel,  on  a  case  of  Extirpation  of  the  Kidney;  by  Dr. 
Pauli,  on  Diphtheria  with  Inflammation  of  Joints;  and  by 
Dr.  E.  Kurz,  of  Florence,  on  a  case  of  Bilateral  Ovariotomy — 
are  contributed.  The  Wiener  Medicinische  Wochenschrift 
publishes  the  conclusion  of  Dr.  Heitler’s  paper  on  the 
diagnostic  importance  of  Tubercle  Bacilli  in  Sputa,  and  of 
Dr.  Pinnser’s  article  on  Hepatic  Abscess. 


EXPERIMENTS  WITH  SODIUM  NITRITE. 

In  publishing,  and  indeed  in  instituting,  their  reckless  ex¬ 
periments  on  the  effect  of  nitrite  of  sodium  on  the  human  sub¬ 
ject,  Prof.  Ringer  and  Dr.  Murrell  have  made  a  deplorably 
false  move,  which  the  ever-watchful  opponents  of  vivisection 
will  not  be  slow  to  profit  by.  They  cannot  allege  that  they 
were  driven  to  the  experiments  by  the  Vivisection  Act,  for 
they  preface  their  account  of  their  clinical  observations  by  a 
description  of  pathological  observations  on  two  cats,  who 
rapidly  succumbed  to  the  drug.  Nor  have  they  the  excuse 
that  the  effects,  of  nitrite  of  sodium  on  the  human  sub¬ 
ject  were  unknown,  for  Dr.  Ramskill  and  Dr.  Ralfe  have 
placed  on  record  six  cases  in  which  its  administration  was 
attended  by  the  most  serious  consequences— lividity  and 
semi-collapse.  It  is  impossible  to  read  the  paper  in  last 
week’s  Lancet  without  distress.  Of  the  eighteen  adults  to 
whom  Drs.  Ringer  and  Murrell  administered  the  drug  in 
ten-grain  doses,  all  but  one  avowed  they  would  expect  to 
drop  down  dead  if  they  ever  took  another  dose.  One  woman 
fell  to  the  ground,  and  lay  with  throbbing  head  and 
nausea  for  three  hours ;  another  said  it  turned  her  lips 
quite  black,  and  upset  her  so,  that  she  was  afraid  she  would 
never  get  over  it.  The  next  series  of  experiments  was 
with  five-grain  doses.  The  same  results  followed  in  ten 
out  of  sixteen  cases.  One  girl  vomited  for  two  hours  and 
thought  she  was  dying.  Even  in  three-grain  doses  the  drug 
caused  unpleasant  symptoms  in  four  out  of  the  thirteen 
patients  to  whom  it  was  administered.  All  these  observa- 


550 


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ANNOTATIONS. 


Nov.  10,  1883 


tions  are  recorded  with  an  innocent  naivete,  as  though  the 
idea  that  anyone  could  possibly  take  exception  to  them 
were  far  from  the  writers’  minds.  But  whatever  credit 
may  be  given  to  Drs.  Ringer  and  Murrell  for  scientific  en¬ 
thusiasm,  it  is  impossible  to  acquit  them  of  grave  indis¬ 
cretion.  There  will  be  a  howl  throughout  the  country  if  it 
comes  out  that  officers  of  a. public  charity  are  in  the  habit  of 
trying  such  useless  and  cruel  experiments  on  the  patients 
committed  to  their  care,  and  the  whole  profession  will  be 
placed  in  a  false  position.  Thepublic  will  not  understand  that 
such  a  mode  of  conducting  out-patient  practice  is  altogether 
exceptional,  and  would  not  meet  with  the  approval  of  half  a 
dozen  doctors  in  the  metropolis.  It  is  with  the  view,  if 
possible,  of  forestalling  the  outcry  of  the  anti-vivisectionists 
and  counteracting  the  effects  of  this  terribly  false  step,  that 
we  have  felt  ourselves  compelled  reluctantly  to  enter  this 
protest  against  it. 

THE  EFFECT  OF  EXPLOSIONS  ON  THE  MEMBRANA 
TYMPANI, 

An  interesting  letter  from  Mr.  Field,  in  the  Times  of  Satur¬ 
day  last,  draws  attention  to  the  fact,  that  among  the  patients 
seen  at  St.  Mary’s  Hospital,  after  the  recent  explosion  on 
the  Underground  Railway,  three  were  found  to  have  sus¬ 
tained  rupture  of  both  tympanic  membranes,  air  passing 
freely  between  the  mouth  and  outer  ear.  Considering  how 
frequently  this  membrane  is  exposed  to  violent  concussions 
of  air,  it  is  remarkable  how  comparatively  seldom  it  is  rup¬ 
tured  when  in  a  normal  condition.  Its  resisting- power,  how¬ 
ever,  has  been  proved,  both  by  experiment  and  by  clinical 
observation,  to  depend  largely  on  the  patency  of  the 
Eustachian  tube.  Still,  that  it  possesses  great  resisting 
power  in  itself,  is  shown  by  Prof.  Gruber’s  experiments.  In 
every  instance  the  gutta-percha  plug,  which  was  tightly 
wedged  into  the  meatus,  was  expelled.  In  one  experiment, 
air,  compressed  four  or  five  fold  and  suddenly  injected  against 
the  membrane  through  the  external  auditory  meatus,  failed 
to  rupture  it.  Itis  also  well  known  how  comparatively  seldom 
soldiers  suffer  from  ruptured  membranes  when  exposed  to 
heavy  firing,  even  when,  under  the  old  system,  the  gunners 
stood  close  to  the  mouth  of  the  cannon.  Prof.  Gruber,  after 
examining  many  hundreds  of  the  soldiers  who  fought  at 
Konigsgratz,  only  found  one  case  in  which  the  membrane 
was  ruptured.  The  observations  of  Drs.  J.  Green  and  A.  H. 
Smith  have  shown  very  clearly  that  the  greater  or  lesser 
liability  of  the  memfirane  to  rupture  during  explosions  de¬ 
pends  much  on  the  patency  of  the  Eustachian  tube.  Dr. 
Green  examined  a  number  of  the  men  engaged  in  layin  <T  the 
foundations  of  a  bridge,  who  were  working  in  an  atmos¬ 
phere  of  sixty  pounds  to  the  square  inch,  and  discovered 
that  rupture  of  the  membrane  occurred,  first,  where  the 
Eustachian  tubes  were  impervious ;  secondly,  where  there 
was  recent  tubal  catarrh ;  and,  lastly,  among  the  new  hands, 
who  had  not  been  instructed  how  to  inflate  the  tympanic 
cavity  by  Valsalva’s  method  while  working.  These  obser¬ 
vations  only  corroborate  what  had  been  also  noticed  by  von 
Troltsch.  He  says :  “  I  have  found  severe  pharyngeal  catarrh, 
with  diminished  patency  of  the  Eustachian  tube,  remarkably 
often  in  persons  whom  I  have  examined  soon  after  accidents 
to  the  membrane,  arising  from  violent  atmospheric  pressure. 
It  is  in  the  nature  of  the  case  that  during  more  complete 
closure  of  the  tube  any  sudden  condensation  of  the  external 
air  rmrst  tend  to  act  much  more  injuriously  on  the  mem¬ 
brane  thus  impeded  in  its  vibrations,  than  when  the  air 
present  in  the  tympanum  can  escape,  on  any  sudden  con¬ 
cussion  of  the  membrane,  unimpeded  through  the  tube.” 
That  a  slighter  concussion  of  air  is  more  likely  to  rupture 
the  membrane,  where  the  Eustachian  tube  is  from  any 
cause  closed,  than  a  greater  one  where  the  tube  is  patent. 


would  appear  to  be  borne  out  by  such  a  case  as  that  of  an 
actor  rupturing  his  membrane  by  firing  a  pistol  over  his 
shoulder,  as  quoted  by  Roosa.  Mr.  Field,  in  his  letter, 
contends  “that  the  double  amount  of  mischief  caused 
clearly  points  to  the  powerful  nature  of  the  explosive  used.” 
As  the  explosion  occurred  in  a  narrow  tunnel,  it  is  obvious 
that  both  ears  were  probably  equally  exposed  to  the  vio¬ 
lence  of  the  concussion,  and  it  would  have  been  more  re¬ 
markable  if  one  membrane  only  had  been  ruptured.  While 
agreeing,  therefore,  with  Mr.  Field  as  to  the  violence  of  the 
concussion,  we  cannot  quite  follow  him  in  his  conclusion  as 
to  the  importance  of  the  double  rupture  as  clearly  pointing 
to  the  powerful  nature  of  the  explosive  used. 

MILK  AND  TUBERCLE. 

Bovine  tuberculosis  is  not  a  common  disease,  and  fortu¬ 
nately,  when  cows  become  affected,  the  loss  of  health  is  so 
obvious,  and  the  yield  of  milk  so  small,  that  the  milk  pro¬ 
ducer’s  interest  lies  more  in  selling  the  animal  to  the 
butcher  than  in  draining  its  udder.  The  observations  of 
Gerlach,  Klebs,  and  Bollinger,  who  fed  calves,  rabbits,  and 
pigs  with  milk  from  phthisical  cows,  and  successfully  pro¬ 
duced  in  this  way  the  disease,  are  too  well  known  to  be  de¬ 
tailed  ;  but  we  are  glad  to  direct  attention  to  some  experi¬ 
ments  of  Dr.  Ferd.  May,  published  in  the  first  number  of 
the  new  Archiv  fur  Hygiene.  Pieces  of  lung,  infiltrated 
with  tubercle,  were  finely  divided  and  rubbed  up  in  a 
mortar  with  milk.  The  milk  thus  prepared  was  injected  sub¬ 
cutaneously  into  guinea-pigs  ;  tubercle  in  the  majority  of  the 
cases  followed,  but  there  were  many  failures.  In  a  second 
series  of  experiments,  the  milk,  contaminated  as  before,  was 
boiled  from  a  quarter  of  an  hour  up  to  three  hours ; 
but  though  sixteen  animals  were  operated  upon,  no  effeets 
followed.  It  also  seems  established  that  if  the  milk- 
producing  gland  is  itself  infiltrated  with  tuberculous  deposit, 
the  secretion  is  far  mere  dangerous  than  if  derived  from  a 
cow  much  advanced  in  phthisis,  but  with  the  mammary 
gland  unaffected.  It  would  be  interesting  to  know,  from  the 
experience  of  our  veterinary  surgeons,  whether  they  ever 
meet  with  local  tubercle  in  the  udder  of  milch-cows,  the  rest 
of  the  system  being,  comparatively  speaking,  unaffected.  In 
the  light  of  recent  research,  we  cannot  but  admit  that  such 
an  occurrence  would  infect  a  milk-supply,  and  produce  what 
might  be  called  an  “  epidemic  of  consumption.”  If  there  is 
a  difficulty  in  referring  outbreaks  of  scarlatinal  and  enteric 
fevers  to  infected  milk  in  which  the  period  of  incubation  is 
approximately  known,  how  much  more  difficult  to  prove  the 
connexion  between  milk  corrupted  with  tubercle,  and  a 
number  of  cases  of  consumption  which,  from  the  slow,  in¬ 
sidious  nature  of  the  malady,  would  probably  develope  at 
various  dates,  and  be  ascribed  to  various  causes  !  We  recom¬ 
mend  medical  officers  of  health  to  study  closely  the  incidence 
of  tuberculosis  in  young  children,  especially  those  brought 
up  by  hand,  and  repeat  the  advice  given  in  a  former  article, 
namely,  in  the  present  unsatisfactory  state  of  the  milk- 
supply,  to  drink  no  milk  which  has  not  been  boiled. 


SYMBIOSIS  IN  MEN  AND  ANIMALS. 

Last  week’s  Nature  gives  an  abstract  ;of  a  most  interest¬ 
ing  paper  on  Symbiosis  in  the  Animal  Kingdom,  by  Prof. 
Hertwig,  of  Jena.  Symbiosis  is  quite  different  from 
ordinary  parasitism,  in  which  one  organism  flourishes  at 
the  expense  of  another,  for  the  symbiotic  relationship  is 
beneficial,  and  in  some  cases  even-  indispensable,  to  both 
parties  to  the  transaction ;  they  toil  together,  and  to¬ 
gether  enjoy  the  common  fruits  of  their  labour.  Thus 
one  species  of  hermit  crab,  after  taking  up  his  habitation 
in  an  untenanted  shell,  looks  out  for  a  certain  kind  of  sea- 
anemone  as  partner.  The  partner,  when  found,  fixes  itself 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Nov.  10, 1883.  551 


•on  the  shell  with  its  mouth  always  turned  toward  the  head  of 
its  associate.  It  thus  accompanies  the  restless  hermit  on  all 
liis  expeditions,  shares  in  his  plunder,  and,  when  they  are 
threatened  by  reprisals,  shoots  out  its  long  threads,  which, 
being  provided  with  countless  capsules  charged  with  a 
stinging  acid,  form  a  very  efficient  defence  against  invasion. 
.So  thoroughly  does  the  hermit  dread  the  dangers  of  solitude, 
that,  when  he  is  compelled  to  move  into  another  shell,  he 
never  rests  till  his  caustic  little  friend  has  taken  up 
its  post  upon  the  roof  of  his  new  abode.  This  interesting 
instance  of  ego'isme  d  deux  reminds  one  of  a  similar  con¬ 
nexion  not  unknown  in  the  medical  profession.  The  hermit 
«erab  is  like  some  pushing  and  energetic  chemist,  whose  red 
lamp,  coloured  bottles,  and  wide-open  door  tempt  the  impe¬ 
cunious  or  thrifty  invalid  to  make  a  trial  of  counter  advice. 
Mostly  all  goes  well,  and  the  neighbourhood  gets  its  liver 
•cleaned  and  set  agoing  again,  its  blood  purified  and  skin 
cleared  of  rashes,  or  its  coughs  cured,  at  a  most  moderate 
•outlay.  But  sometimes  a  case  goes  wrong,  and  trouble 
threatens ;  then  the  offices  of  the  anemone  are  called  in,  in 
the  shape  of  a  qualified  medical  practitioner,  who  lives  above 
the  shop  or  round  the  corner.  The  blunder  is  rectified,  or 
the  death-certificate  signed,  and,  the  danger  being  averted, 
the  partners  return  to  their  usual  avocations.  The  two  are 
indispensable  to  each  other.  Without  the  chemist,  the 
doctor — perhaps  a  lazy,  drunken  reprobate — would  get  no 
patients  ;  and  without  the  doctor,  the  chemist  would  often 
find  himself  in  danger  of  unpleasant  notoriety.  Together 
success  and  safety  are  assured.  That  the  results  are  not 
quite  so  favourable  to  their  customers  as  to  themselves  only 
adds  to  the  aptness  of  the  analogy.  The  partnership  is  the 
type  of  a  low  form  of  evolution,  beyond  which  the  more  re¬ 
spectable  members  of  the  profession  have  advanced.  Most 
of  us  have  emerged  from  the  stage  of  the  depredator  into 
that  of  the  philanthropist,  and  have  come  to  regard  our 
patients  as  an  ant  regards  a  greenfly,  not  as  our  prey,  but 
as  our  proteges. 

THE  OPENING  OF  THE  MEDICAL  SESSION  IN  DUBLIN. 

On  Wednesday,  the  31st  ult.,  an  inaugural  address  was  de¬ 
livered  at  the  Mater  Misericordi®  Hospital,  Eccles-street, 
Dublin,  by  Dr.  Joseph  M.  Redmond,  one  of  the  Physicians 
to  the  Hospital.  The  chair  was  taken  by  the  President  of 
the  Royal  College  of  Surgeons  in  Ireland,  Mr.  W.  I.  Wheeler. 
The  lecturer  began  by  remarking  on  the  present  position 
of  medicine  as  compared  with  its  past  position.  Once  its 
association  had  been  with  disease,  now  it  was  with  health. 
He  then  briefly  reviewed  the  history  of  the  healing  art 
from  the  earliest  times,  and  concluded  his  address  with 
a  review  of  the  recent  researches  of  Koch  and  Pasteur. 
On  Thursday,  November  1,  Dr.  Banks,  Physician  to  Her 
Majesty  the  Queen  in  Ireland,  gave  the  introductory 
address  for  the  session  1883-84  in  the  theatre  of  the  Rich¬ 
mond  Hospital,  North  Brunswick-street.  On  the  same  day, 
Mr. )  F.  W.  Warren,  P.R.C.S.I.,  Surgeon  to  the  Adelaide 
Hospital,  lectured  in  the  theatre  of  that  institution  before  a 
large  audience  of  students  and  visitors.  In  the  School  of 
Physic,  Trinity  College,  Dublin,  Dr.  D.  J.  Cunningham,  the 
lately  elected  Professor  of  Anatomy  and  Chirurgery,  delivered 
a  formal  lecture  to  inaugurate  the  winter  course  ;  and  Dr. 
Emerson  Reynolds,  E.R.S.,  the  University  Professor  of 
Chemistry,  in  opening  the  chemical  division  of  the  Experi¬ 
mental  Science  School,  pointed  out — in  regard  to  the  present 
phase  of  general  and  technical  education  in  Ireland — the 
scope  of  this  great  branch  of  science,  and  indicated  the  lines 
on  which  experience  had  shown  that  its  teaching  ought  to 
proceed,  to  prove  of  real  value  to  professional  students  and 
those  who  desire  to  engage  in  chemical  industries.  On 
Monday,  the  5th  inst.,  the  last  of  the  “  introductories  ”  was 


delivered  by  Dr.  John  William  Moore,  in  the  theatre  of  the 
Meath  Hospital  and  County  Dublin  Infirmary.  On  this 
occasion  the  lecturer  departed  from  the  beaten  track,  and 
criticised  with  considerable  freedom  the  arrangements  in 
the  extern  department  of  the  Hospital,  as  well  as  the  defects 
in  the  nursing  system  at  present  in  force.  There  was  a 
large  attendance,  principally  of  members  of  the  medical 
profession  and  of  students.  In  the  evening  a  very  successful 
dinner  took  place  in  the  Shelbourne  Hotel,  for  the  reunion 
of  old  past  students  and  governors  of  the  Meath  Hospital 
and  County  Dublin  Infirmary;  under  the  presidency  of  Sir 
George  Porter,  Senior  Surgeon  of  the  institution. 


THE  PARIS  FACULTY  OF  MEDICINE. 

The  fact  of  there  being  at  the  present  time  three  vacancies 
in  this  body,  through  the  deaths  of  Profs.  Lasegue,  Parrot, 
and  Depaul,  naturally  causes  great  excitement  among  the 
professors  and  agr6g6s  of  the  Faculty.  With  respect  to  the 
chair  of  the  Clinic  of  the  Diseases  of  Children,  there  is 
somewhat  of  a  contest  among  the  agreges.  Having  been 
held  by  a  physician  in  the  person  of  Prof.  Parrot,  it  is 
now  claimed  by  the  surgeons  in  their  turn,  who  complain 
that  the  chairs  of  the  Faculty  are  not  fairly  distributed 
between  them  and  the  physicians.  The  diseases  of  children 
are,  they  say,  quite  as  much  surgical  as  medical,  and  there 
can  be  no  reason  why  they  should  be  excluded  from  the 
chair  in  question.  Dr.  De  Ranse,  the  talented  editor  of  the 
Gazette  Mddicale,  however,  objects  to  this  solution,  and  main¬ 
tains  that  the  functions  of  this  chair  cannot  be  efficiently 
performed  either  by  a  physician  or  a  surgeon,  and  that  the 
special  and  extensive  province  of  the  diseases  of  childhood 
requires  for  its  effectual  treatment  that  there  should  be  two 
chairs,  one  filled  by  a  physician,  and  the  other  by  a  surgeon. 
So  also  in  reference  to  filling  up  Prof.  Depaul’s  chair  of 
Clinical  Obstetrics,  Dr.  De  Ranse  thinks  that  the  oppor¬ 
tunity  should  be  taken  for  dividing  it  into  two — the  one  for 
obstetrics  and  the  other  for  gynaecology,  the  latter  branch  of 
medical  science  being  at  present,  he  says,  scarcely  taught 
at  all  at  the  Paris  Faculty. 


MEDITERRANEAN  FEVER. 

In  the  report  on  the  health  of  the  troops  serving  in  the 
Mediterranean  in  1881,  the  officer  in  charge  of  the  station- 
hospital  at  Gibraltar,  Brigade- Surgeon  Fuller,  thus  describes 
his  experience  of  Mediterranean  fever  : — “It  is  characterised 
in  mild  cases  by  ordinary  febrile  symptoms,  with  lassitude, 
debility,  and  slow  convalescence.  In  severe  cases  there  is 
great  prostration,  with  profuse  perspiration.  In  some  the 
lungs  posteriorly  become  rapidly  consolidated  by  engorge¬ 
ment  ;  in  some  there  is  brain-congestion  and  low  mutter¬ 
ing  delirium ;  in  others  there  is  bowel-complication  closely 
resembling  enteric  fever.  Death  may  occur  from  any  of 
these  complications.  The  fever  sometimes  runs  a  very 
protracted  course  unattended  by  any  complication,  cul¬ 
minating  in  an  altered  or  morbid  state  of  the  blood, 
and  a  condition  of  profound  prostration  complicated  with 
purpura.  After  defervescence,  in  a  very  large  number  of 
cases,  a  rheumatic  affection  of  the  fibrous  tissues  around  the 
joints  and  other  parts  supervenes.  The  duration  of  this 
stage  of  the  disease  may  extend  over  an  indefinite  period  ;  in 
some  it  may  be  counted  in  months.  The  cause  and  nature 
of  this  fever  are  still  unknown,  but  it  is  proved  beyond 
doubt  that  it  is  neither  enteric,  malarial,  nor  relapsing. 
My  own  idea  is  that  the  cause  is  to  be  found  in  climatic 
peculiarities.  When  there  has  been  bowel-complication 
there  is  leaden-coloured  congestion  of  the  duodenum  and 
upper  part  of  jejunum.  The  ileum  is  generally  healthy; 
Peyer’s  patches  unaltered.  In  one  case  the  patches  were 


552 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Nov.  10,  1883. 


observed  to  be  very  slightly  swollen,  but  not  sufficiently  to 
be  pronounced  diseased ;  large  intestines  healthy.’5 


GLASGOW  UNIVERSITY. 

The  half-yearly  meeting  of  the  Glasgow  University  Council 
was  held  on  October  31.  The  subjects  discussed  were  the  Uni¬ 
versity  Bill,  the  proposed  new  doctorate  in  arts  and  science, 
presentation  business,  and  the  extension  of  the  Medical  School. 
Prof.  Clelland  pointed  out  to  the  Council  that  the  accommoda¬ 
tion  for  the  Medical  School  should  be  extended.  At  present 
it  was  quite  inadequate  for  the  proper  teaching  of  anatomy 
and  for  making  preparations.  It  is  gratifying  to  notice 
that  the  number  of  medical  students  attending  the  Glasgow 
University  is  yearly  on  the  increase,  and  unless  the  accom¬ 
modation  is  increased,  it  will  be  impossible  to  teach  to  the 
credit  of  the  University  and  with  safety  to  the  health  of 
the  students.  At  present  the  museum  is  only  a  store-room, 
in  which  space  is  so  small  that  specimens  cannot  con¬ 
veniently  be  exhibited.  When  the  buildings  were  designed. 
Prof.  Allen  Thomson,  the  then  Professor  of  Anatomy,  super¬ 
intended  the  allotment  of  space  for  that  department,  and 
it  was  thought  by  many  that  Prof.  Thomson  was  claiming 
too  small  space  for  his  own  department ;  and  he  little 
thought  that  in  so  short  a  time  what  was  considered 
as  very  ample  accommodation  would  be  found  to  be 
too  limited.  A  statement  of  the  Senate  on  the  subject, 
submitted  to  the  meeting,  contained  the  following  : — “It  is 
contemplated  to  build  additions,  which,  while  harmonising 
with  the  other  buildings,  shall  be  free  from  costly  architec¬ 
tural  details,  and  be  as  suitable  as  possible  in  their  internal 
arrangements  for  the  purposes  to  which  they  are  to  be 
devoted.  The  accommodation  most  urgently  required  must 
be  provided  without  loss  of  time,  and  it  is  desirable  that  the 
University  should  be  enabled  to  carry  out  at  once  an  exten¬ 
sion  of  the  buildings  sufficient  to  place  the  Medical  School 
in  a  satisfactory  condition  for  years  to  come.  Sketch  plans 
have  been  obtained,  according  to  which  it  is  estimated  that 
everything  required  may  be  provided  for  =£18,000.  If  such 
a  sum  cannot  be  raised,  then  the  enlargement  absolutely 
necessary  must  be  gone  on  with,  which  will  perhaps  take 
.£3000.”  With  the  increase  of  accommodation,  the  medical 
teachers  seem  determined  to  increase,  or  at  any  rate  to  up¬ 
hold,  their  present  high  standard.  At  a  recent  examination 
they  exemplified  this  by  rejecting  more  than  half  the 
number  of  students  for  examination  in  their  First  Profes¬ 
sional  :  171  went  up,  and  only  eighty-five  got  through. 


THE  PARIS  WEEKLY  RETURN. 

The  number  of  deaths  for  the  forty -third  week  of  1883,  ter¬ 
minating  October  25,  was  939  (510  males  and  429  females), 
and  of  these  there  were  from  typhoid  fever  45,  small-pox  5, 
measles  4,  scarlatina  none,  pertussis  11,  diphtheria  and  croup 
31,  dysentery  1,  erysipelas  2,  and  puerperal  infection  1. 
There  were  also  37  deaths  from  acute  and  tubercular  menin¬ 
gitis,  181  from  phthisis,  31  from  acute  bronchitis,  38  from 
pneumonia,  82  from  infantile  athrepsia  (41  of  the  infants 
having  been  wholly  or  partially  suckled),  and  30  violent 
deaths  (20  males  and  10  females).  The  mortality  has  fallen 
again  to  very  moderate  proportions,  and  epidemics  in  general 
are  rare.  Of  seasonary  significance  are  the  increase  of  deaths 
from  bronchitis  from  18  to  31,  and  of  pneumonia  from  49 
to  58,  and  the  diminution  of  deaths  from  infantile  athrepsia 
from  117  to  89.  The  births  for  the  week  amounted  to  1203, 
viz.,  619  males  (454  legitimate  and  195  illegitimate)  and  584 
females  (437  legitimate  and  147  illegitimate) ;  87  infants 
were  either  born  dead  or  died  within  twenty-four  hours, 
viz.,  41  males  (19  legitimate  and  22  illegitimate)  and  46 
females  (32  legitimate  and  14  illegitimate). 


THE  MEDICAL  DEGREES  OF  THE  VICTORIA  UNIVERSITY, 
MANCHESTER. 

At  a  meeting  of  the  Court  of  Governors,  held  on  the  7th 
inst..  Prof.  Ward  submitted  the  draft  statute  and  regulations 
prepared  in  the  Council  to  give  effect  to  the  supplemental 
charter  enabling  the  University  to  grant  medical  degrees. 
He  stated  that  the  examination  in  Arts  was  designed  to 
insure  that  medical  students  should  have  a  substantial 
degree  of  general  culture.  After  this  came  the  examinations 
which  constituted  the  medical  curriculum,  and  they  were  so 
arranged  that  a  student  might  pass  in  four  years.  These 
four  years  were  the  absolute  requirement  of  the  statute,  and,, 
under  the  terms  of  the  supplemental  charter,  they  must 
be  passed  in  a  college  of  the  University.  There  was  the 
preliminary  examination  in  Science,  the  intermediate  exa¬ 
mination  for  the  Bachelor’s  degree  in  Medicine,  and  the 
final  examination  for  that  degree.  Between  the  inter¬ 
mediate  and  the  final  examinations  two  years  must  elapse,, 
although  a  student  might,  if  he  liked,  take  half  the  final  in 
twelve  months  from  the  intermediate.  It  was  intended  to 
make  the  degree  of  Doctor  of  Medicine  a  really  distinguished 
one,  and  candidates  would  be  required  to  present  an  essay 
or  book  embodying  the  result  of  personal  observation  or 
original  research.  The  further  degree  of  Master  in  Surgery 
was  intended  for  surgical  specialists,  and  an  examination 
would  be  exacted  in  which  candidates  would  be  required  to 
show  evidences  of  surgical  study  which  ordinary  students 
would  not  be  able  to  present.  The  statute,  after  some  discus¬ 
sion,  was  passed.  The  action  of  the  authorities  of  the  Uni¬ 
versity  in  respect  to  their  medical  degrees  has  been  looked 
forward  to  with  some  anxiety.  It  was  feared  that  they  might, 
by  making  their  requirements  comparatively  easy,  seriously 
affect  the  prospects  of  rival  universities,  and  lower  the- 
prestige  of  the  M.D.  degree  in  this  country.  Everyone  will 
be  relieved  to  find  that  they  have  recognised  the  advisability 
of  making  that  degree  a  really  distinguished  one,  and  their 
determination  to  give  it  for  merit  in  personal  observation 
or  original  research,  rather  than  for  success  in  writing 
examination-papers,  will  meet  with  general  approval.  It  is 
felt  by  many  to  be  a  matter  for  regret  that  a  similar  policy 
has  not  been  accepted  at  the  University  of  London. 


FRENCH  HOSPITAL  STATISTICS. 

The  Union  Medicale  of  October  25  furnishes  the  following- 
figures,  without,  however,  stating  the  authority  whence 
they  are  derived There  were  last  year  422,932  patients 
treated  in  the  hospitals  of  entire  France,  and  of  this  number 
376,526  were  discharged  cured,  46,406  remaining  at  the  end 
of  the  year.  It  is  expected  'that  from  400,000  to  410,000 
will  have  been  admitted  during  the  current  year,  this  being 
the  mean  annual  number  of  admissions  of  the  last  ten 
years.  In  the  provincial  portion  of  France,  the  proportion 
of  patients  treated  in  the  hospitals  has  amounted  to  90  per 
10,000  inhabitants ;  but  in  Paris  itself  this  rose  to  400  per 
10,000.  For  entire  France,  the  mean  duration  of  treatment 
in  hospital  was  thirty-five  days  and  a  half  (thirty-one  days 
for  men,  forty  for  women,  and  forty-eight  for  children)  ; 
but  in  Paris  it  was  but  twenty-nine  days.  With  respect  to 
the  issue  of  treatment,  it  was  found  that  78  per  cent,  of  the 
patients  under  treatment  were  cured,  and  9  per  cent,  died — 
giving  a  mean,  therefore,  of  nearly  nine  times  more  recoveries 
than  deaths.  There  were  80  per  cent,  recoveries  in  men, 
75  per  cent,  in  women,  and  74  per  cent,  in  children. 


THE  LAW  CONCERNING  RABID  ANIMALS  IN  FRANCE. 

The  Court  of  Cassation  has  recently  declared  that  a  pre- 
fectorial  or  municipal  order  is  legal  and  obligatory  whichi 
directs  the  destruction  of  all  mad  dogs  or  cats,  as  well  as 


Medical  Times  and  Gazette. 


MESMERISMUS  CHRONICUS. 


Nor.  10, 1883.  553 


of  all  animals  of  the  same  species  that  have  been  bitten, 
•or  are  suspected  to  have  been  bitten,  by  them.  This  judg¬ 
ment,  the  Court  adds,  is  as  applicable  to  dogs  or  cats  kept 
within  the  house  under  the  surveillance  of  their  masters  as 
it  is  to  those  which  are  found  wandering  about  the  streets. 
The  Correctional  Tribunal  of  Lyons  ( Lyon  Medical,  Octo¬ 
ber  28),  putting  this  declaration  of  the  law  into  force,  has 
•condemned  to  a  fine  of  fifty  francs  the  owner  of  a  dog 
which  had  been  bitten  by  a  mad  dog,  for)refusing  to  have  it 
killed. 


The  Library  of  the  Royal  College  of  Surgeons  will  be 
closed  on  Friday,  the  9th  inst.,  for  the  purposes  of  the 
examinations. 

The  treatment  of  foot-and-mouth  disease  by  salicylic  acid 
is  stated  to  have  been  very  successful  in  Germany,  and  also  in 
the  few  cases  in  this  country  in  which  it  has  been  thoroughly 
tried. 

The  will  of  Thomas  Jervis,  M.D.,  of  Connanght-square, 
W.,  a  Justice  of  the  Peace  for  Middlesex  and  Westminster, 
who  died  on  October  3  last,  was  proved  on  the  5th  inst.  by 
Mr.  John  Jervis,  Mr.  Stroud  Cocks,  and  Mr.  Frederick 
Benham,  the  executors.  The  personal  estate  was  sworn 
under  <£63,000. 

Sir  Evelyn  Wool  has  reported  to  Earl  Granville  on 
Dr.  T.  D.  Acland’s  invaluable  services  while  attached  to  the 
Egyptian  army.  He  was  untiring  in  his  attendance  on 
the  sick  Egyptian  soldiers  during  the  cholera  outbreak,  and 
has  since  reorganised  the  entire  medical  hospital  service  of 
the  Egyptian  army.  _ 

The  Chair  of  Physiology  in  Anderson’s  College,  Glasgow, 
is  still  vacant,  but  we  understand  that  Dr.  Christie,  Lecturer 
on  Health,  has  agreed  to  deliver  the  present  course.  It  is 
supposed  that  the  College  would  flourish  better  nearer  the 
University— that  is  to  say,  further  west.  In  its  present 
position  it  is  decidedly  languishing. 


The  funeral  of  Mr.  James  Shuter  took  place  at  Kensal 
Green  Cemetery  on  Wednesday,  the  V en.  Archdeacon  Emery, 
formerly  Mr.  Shuter’s  college  tutor,  officiating.  The  ordi¬ 
nary  lectures  and  classes  at  St.  Bartholomew’s  were  sus¬ 
pended  for  the  day,  and  the  medical  and  surgical  staff,  as 
well  as  a  large  number  of  students  and  of  former  students 
now  in  practice,  were  in  attendance  to  testify  by  their 
presence  and  their  undoubted  grief  to  the  loss  they  had 
sustained.  _ 

Dr.  Alexander  Frazer,  Chief  Demonstrator  of  Anatomy 
in  Owens  College,  Manchester,  was  selected  on  Thursday 
last  by  the  Council  of  the  Irish  College  of  Surgeons  to 
succeed  Dr.  Cunningham  as  Professor  of  Practical  Anatomy 
in  the  College.  Five  candidates  offered  themselves,  viz.  : — 
Dr.  Barton,  of  Trinity  College ;  Dr.  Collingwood,  of  Uni¬ 
versity  College ;  Dr.  Frazer,  of  Owens  College ;  Dr.  Reid, 
of  St.  Thomas’s  Hospital ;  and  Dr.  Thompson,  of  the  Edin¬ 
burgh  University.  _ 

The  inaugural  addresses  delivered  at  the  several  medical 
schools  at  Glasgow  last  week  were,  on  the  whole,  of  a  mild 
type.  Prof.  Young  spoke  on  University  extension.  Dr. 
Wallace,  at  Anderson’s  College,  treated  his  hearers  to  a 
■diatribe  against  the  present  unsuitable  form  of  ladies’  dresses, 
and  some  remarks  on  deformed  children.  Dr.  Stirton,  at  the 
Royal  Infirmary,  was  original,  as  he  chose  amenorrhoea  for 
his  subject;  and  no  doubt  Sir  Charles  Dilke  was  interested 
to  hear  of  the  several  experiments  with  “  fungi  ”  on  the 
uterine  organs. 


James  Cole,  the  Thornton  Heath  murderer,  has  been 
examined,  on  behalf  of  the  Home  Secretary,  by  Drs.  Orange 
and  Gover,  and  in  consequence  of  their  report  the  convict 
has  been  respited,  and  will  be  detained  at  Broadmoor  during 
Her  Majesty’s  pleasure. 

In  consequence  of  the  reported  outbreaks  of  trichinosis  in 
Saxony,  the  French  Minister  of  Commerce,  at  the  instance 
of  the  Committee  of  Public  Health  of  France,  has  despatched 
a  mission  to  the  spot  to  inquire  into  and  report  upon  the  cir¬ 
cumstances.  Dr.  Brouardel  has  been  commissioned  to  preside 
over  the  mission. 

Another  case  in  which  the  Public  Prosecutor  has  laid 
himself  open  to  criticism  came  before  the  magistrate  at  the 
Lambeth  Police-court  on  the  1st  inst.  Two  surgeons, 
Messrs.  Bower  and  Keates,  were  charged  with  having  by 
their  negligence  caused  the  death  of  a  child  whom  they 
attended,  but  though  the  case  had  been  taken  up  by  the 
Public  Prosecutor,  the  magistrate  entirely  exonerated  them 
from  the  charge  and  dismissed  the  case.  Cannot  the  Public 
Prosecutor  find  herbalists  and  abortionists  to  prosecute,  that 
he  must  needs  put  respectable  practitioners  in  the  dock  ? 


MESMERISMUS  CHROUICUS. 


[Third  Article.] 

In  Dr.  Clifford  Allbutt’s  introductory  address,  delivered  at 
the  opening  of  the  Leeds  School  of  Medicine  on  the  1st  of 
October  last,  which  was  fully  reported  in  the  London  medical 
papers,  and  deservedly  received  much  attention,  Mr.  Gurney 
was  bracketed  with  Mr.  Hutton  and  Mr.  Morley  as  “  men 
of  clear  heads  and  profound  humanity,”  whose  arguments 
against  vivisection  deserve  more  consideration  from  the 
medical  profession  than  they  have  yet  received.  As  no 
exception  was  taken  to  this  classification  of  Mr.  Gurney 
with  the  arch-enemy  of  vivisection,  we  cannot  hold  our¬ 
selves  primarily  responsible  for  the  “  damaging  blunder  ” 
of  which  he  now  complains.  It  was  not,  however,  in  re¬ 
liance  on  Dr.  Clifford  Allbutt’s  authority  alone  that  we  de¬ 
scribed  Mr.  Gurney  as  an  opponent  of  vivisection,  for  our 
recollection  of  his  <f  Chapter  on  the  Ethics  of  Pain,”  which 
appeared  in  the  Fortnightly  Review  for  December,  1881, 
was  to  the  effect  that  he  was  not  disposed  to  concede 
to  men  of  science  that  freedom  of  research,  in  connexion 
with  experiments  on  living  animals,  to  which  they  think 
themselves  fairly  entitled.  On  refreshing  our  recollection 
by  a  reference  to  that  article,  as  recommended  by  Mr. 
Gurney,  we  find  that  he  cannot  be  correctly  designated 
either  an  opponent  or  a  supporter  of  vivisection.  He  is 
really  a  mediator  between  the  parties,  and,  as  self-appointed 
mediators  are  apt  to  do,  makes  himself  about  equally  objec¬ 
tionable  to  both  of  them.  The  hallucinated  humanitarians, 
who  see  a  lacerated  rabbit  in  every  doctor’s  brougham,  will 
scarcely  thank  him  for  admitting  that  it  may  be  morally 
lawful,  under  some  circumstances,  to  inflict  suffering  ex¬ 
perimentally  on  animals  ;  and  the  physiologists  will  certainly 
rather  dispense  with  his  advocacy  when  he  argues  that  the 
acquisition  of  knowledge,  apart  from  appreciable  benefits  in 
the  relief  of  suffering  to  be  derived  from  it,  will  never  justify 
painful  experiments  on  the  lower  creatures,  and  suggests 
that  vivisections  in  this  country  should  only  be  permitted 
under  the  sanction  and  superintendence  of  a  board,  composed 
chiefly  of  experts,  but  with  some  amount  of  representation 
of  educated  opinion  outside  professional  ranks,  which  might 
mean  the  educated  opinion  of  irreconeilables  like  Mr. 
Oxenham  and  Mr.  Jesse.  We  should  like  to  ask  Mr.  Gurney 
what  practical  application  of  his  experiments  he  had  in 
view  when  he  applied  the  carving-fork  and  burning  match 
to  Mr.  Wells',  but  the  question  as  to  his  attitude  towards 
vivisection  is,  as  he  says,  remote  from  the  matter  in  hand, 
and  we  can  only  express  our  regret  if  we  have  misrepre¬ 
sented  that  attitude,  and  our  satisfaction  at  knowing  that 
1  is  great  dialectical  skill  is  enlisted  on  the  side  of  scientific 


554 


Medical  Times  and  Gazette. 


A  CENTURY’S  PROGRESS  IN  MEDICINE. 


Nov.  10, 1SS3. 


progress,  and  against  the  “  folly  and  mischievousness  ”  of 
the  ignorant  zealots  who  are  doing  their  best  to  retard  it. 

The  relentless  and  uncompromising  scepticism  which  we 
recommended  when  replying  to  Mr.  Gurney’s  former  letter 
was  to  be  employed  in  the  destruction  of  wilful  imposture, 
and  we  have  never  said  anything  to  justify  the  attribution 
to  us  of  such  staunch  bigotry  as  would  "  under  all  conditions, 
and  to  the  end  of  time,  prefer  the  hypothesis  of  a  defect  in  the 
observer’s  penetration  to  that  of  the  reality  of  a  previously  un¬ 
recognised  fact.”  What  we  did  say  was,  that  even  after  all  the 
questions  which  we  could  suggest  regarding  the  mode  of  per¬ 
formance  of  a  particular  set  of  experiments  by  Messrs.  Smith 
and  Wells  had  been  satisfactorily  answered,  we  should  still 
rather  believe  in  some  defect  in  our  own  penetration  than  in 
community  of  sensation  between  two  men  in  different  rooms. 
It  was  perhaps  unnecessary  to  imagine  so  improbable  a  situa¬ 
tion, — for  our  questions  would  be  numerous  and  searching ; 
but  in  the  event  of  its  occurring,  we  should  still  certainly 
assume  the  position  of  rational  scepticism  which  we  indicated, 
and  which  Mr.  Gurney  converts  into  blind  obstinacy.  The 
human  race  has  been  accumulating  harmonious  testimony  as 
to  the  range  and  limits  of  sensation  for  thousands  of  years,  and 
some  definite  conclusions  on  the  subject  have  been  reached, 
and  a  very  strong  body  of  evidence  will  certainly  be  neces¬ 
sary  to  establish  any  fact  that  directly  contravenes  one  of 
these  conclusions.  Physiologists  have  by  laborious  research 
determined  the  conditions  of  sensation  with  the  utmost 
accuracy,  and  the  contention  that  sensation  may  exist  inde¬ 
pendently  of  these  conditions  will  have  to  be  supported  by 
a  mass  of  proof  of  a  kind  which  the  Psychical  Research 
Society  has  not  yet  contemplated,  before  it  can  be  enter¬ 
tained.  To  found  a  theory  of  community  of  sensation  on 
the  crude  and  rickety  experiments  of  Messrs.  Smith  and 
Wells  is  to  challenge  ridicule  rather  than  to  invite  discus¬ 
sion,  and  he  who  would  accept  such  a  theory,  merely  because 
he  could  not  find  out  how  the  results  of  these  experiments 
were  secured,  must  be  facile  in  faith  or  weak  in  judgment. 
Much  more  astonishing  results  are  obtained  daily  by  pro¬ 
fessed  conjuring  tricks;  and  when  the  modus  operandi  of 
these  cannot  be  discovered,  it  is  more  logical  to  suspect  a 
defect  in  penetration  than  to  invent  a  deus  ex  machind  for 
the  occasion.  Pretensions  to  a  community  of  sensation, 
similar  to  that  now  set  up  for  Messrs.  Smith  and  Wells, 
have  been  again  and  again  advanced  on  behalf  of  other 
interesting  monstrosities,  and  have  been  again  and  again 
exposed  as  fictitious,  and  we  have  no  doubt  that  the  modern 
marvels  of  the  Psychical  Research  Society  will  go  the  way 
of  the  marvels  of  the  past,  and  leave  not  a  rack  behind. 
The  game  is  an  old  one,  and  the  only  pity  is  that  there  is 
still  so  much  childishness  abroad  as  to  enable  it  to  be  played 
with  relish  in  these  days,  and  even  under  brand-new  rules. 

Mr.  Gurney  thinks  it  may  be  well  to  give  a  distinct 
answer  to  our  question  whether  any  scientific  men  whose 
judgment  would  carry  weight  with  the  medical  profession 
have  witnessed  the  performances  of  Messrs.  Smith  and 
Wells,  and,  if  so,  what  conclusion  they  arrived  at.  And 
here  we  are  compelled  to  note  that  Mr.  Gurney  selects  one 
of  three  consecutive  questions  to  which  to  give  an  answer, 
and  that  he  only  answers  that  partially,  if  distinctly. 
Our  questions  were — 1.  Have  we  before  us  the  whole  of 
the  experiments  in  mesmerism  and  thought-reading  which 
have  been  performed  by  Messrs.  Smith  and  Wells  ?  2.  Have 
they  ever  failed  in  their  experiments,  and,  if  so,  under  what 
circumstances  ?  3.  Have  their  performances  been  wit¬ 

nessed  by  any  scientific  men,  biologists  or  surgeons,  whose 
judgment  would  carry  weight  with  the  medical  profession, 
and,  if  so,  what  conclusion  did  they  arrive  at?  And  the 
distinct  answer  to  these  questions  is — “  The  finger  experi¬ 
ment  has  been  witnessed  by  several  gentlemen  (and  will 
soon,  I  hope,  be  witnessed  by  many  more)  to  whom  the 
above  description  applies,  and  the  conclusion  at  which 
they  arrived  was  partly  positive  and  partly  negative.”  But 
our  inquiry  was  not  confined  to  the  finger  experiment, 
but  included  all  experiments  in  mesmerism  and  thought¬ 
reading,  and,  regarding  one  set  of  experiments  in  the  latter, 
we  are  in  a  position  to  state  that  a  party  of  scientific  men 
who  witnessed  them  arrived  at  a  very  positive  conclusion, 
which  was,  that  they  were  carried  on  by  collusion  and  sig¬ 
nalling  ;  a  conclusion  which  was  verified  by  the  fact  that 
the  experiments  failed  utterly  whenever  some  common-place 
precautions  against  collusion  were  adopted — precautions, 
however,  which  the  Psychical  Research  Society  had  appa¬ 


rently  not  thought  of  instituting.  How,  the  general  sym¬ 
pathy  with  which  Mr.  Gurney  has  followed  our  argument  on 
the  subject  of  mesmerism  ought  to  have  led  him  to  perceive 
that  the  fact  that  Messrs.  Smith  and  Wells  were  thus  baffled, 
threw  the  gravest  discredit  on  all  their  previous  and  subse¬ 
quent  performances,  while  his  knowledge  of  scientific  ethics 
ought  to  have  reminded  him  that  their  failures  should  have 
had  a  prominence  given  to  them,  at  least  equal  to  that  which 
has  been  bestowed  on  their  successes.  We  can  quite  believe 
that  it  is  purely  for  convenience  or  through  inadvertence 
that  the  fiascos  have  not  appeared  side  by  side  with  the 
remarkable  achievements ;  but  the  postponement  of  their 
publication  while  kindred  experiments,  but  of  better  omen, 
are  given  to  the  world,  is  calculated  to  shake  confidence  in 
the  strictly  scientific  character  of  the  methods  adopted  by 
the  Society. 

If  we  have  not  accepted  the  invitations  which  have  been 
extended  to  us  to  be  present  at  the  demonstrations  of  the 
Psychical  Research  Society,  it  has  been  from  no  want  of 
appreciation  of  their  courtesy,  but  from  a  conviction  that 
no  good  purpose  could  be  served  by  our  availing  ourselves  of 
them.  We  are  quite  satisfied  as  to  the  real  nature  of  the 
phenomena  which  we  should  behold,  but  we  are  not  at  all 
sure  that  we  should  be  able  to  bring  those  around  us  to  our 
own  way  of  thinking  respecting  them.  One  chilly  sceptic 
can  do  little  to  cool  down  the  heated  atmosphere  of  a  society 
of  ardent  students  of  the  occult ;  and  if  he  fails,  as  fail  full 
well  he  may,  to  make  out  the  ingenious  contrivances  by 
which  the  tricks  are  played,  he  is  apt  to  incur  some  of  the 
guilt  of  one  who  stands  by  consenting  at  the  martyrdom  of 
science,  and  is  liable  to  be  quoted  ever  afterwards  as  a  witness 
of  results  which  he  could  not  account  for  by  recognised  laws. 
If  he  simply  wants  to  be  bamboozled,  he  had  better  go  and 
see  Maskelyne  and  Cooke ;  if  he  is  resolved  to  get  at  the- 
truth,  and  unearth  the  slimy  worms  of  transcendental  per¬ 
fidy,  he  must  take  several  discreet  friends  along  with  him, 
and  carefully  prepare  his  plans  and  prescribe  his  terms. 

We  do  not  think  that  a  primd  facie  case  has  been  made 
out  by  the  Psychical  Research  Society  in  favour  of  any  of 
its  results  such  as  to  warrant  a  reference  to  a  court  of 
scientific  appeal.  We  have  already  adumbrated  the  circum¬ 
stances  which  would,  in  our  judgment,  render  such  a  refer¬ 
ence  desirable,  and  our  notion  as  to  what  the  constitution 
of  the  court  should  be,  and  we  would  only  add  that  the 
inquiry,  it  it  ever  does  take  place,  should  be  arranged  on 
such  conditions  as  would  make  legal  penalties  exigible  from 
any  subject  of  experiment  detected  in  fraudulent  misrepre¬ 
sentation.  A  mesmerist  on  the  treadmill  would  have  a 
most  salutary  effect. 


DR.  WENDELL  HOLMES  ON  A  CENTURY’S 
PROGRESS  IN  MEDICINE. 


The  main  feature  of  the  centennial  celebration  of  the 
foundation  of  the  Medical  School  of  Harvard  University,  on 
October  17,  was  the  oration  delivered  by  the  ex-Professor 
of  Anatomy,  and  author  of  the  well-known  “  Breakfast 
Table”  series.  Dr.  Oliver  Wendell  Holmes.  It  was  devoted 
mainly  to  a  consideration  of  the  most  signal  advances  in 
the  science  and  art  of  medicine  during  the  two  half-centuries 
which  have  passed  since  the  foundation  of  the  School,  and 
throughout  the  second  of  which  Dr.  Holmes  has  been  more- 
or  less  intimately  connected  with  it.  He  began  by  giving 
a  brief  sketch  of  the  founders  of  the  School,  and  by  enu¬ 
merating  the  books  which  were  then  read  by  the  students,, 
comparing  them  with  the  teachers  and  books  of  a  half  a 
century  later,  the  year  in  which  he  himself  left  Boston  to  con¬ 
tinue  his  studies  in  Paris.  After  a  passing  allusion  to  the 
chief  teachers  in  the  latter  city  at  that  time,  he  proceeded 
to  consider  the  progress  that  had  been  made  in  the  half- 
century  then  terminating.  The  chief  advances  had  been,  in 
medical  science,  the  method  of  studying  the  human  body  by 
its  constituent  elements — the  general  anatomy  of  Bichat — 
which  was  a  great  onward  movement,  with  far-reaching 
results  for  physiology  and  pathology ;  next,  the  discoveries 
of  Sir  Charles  Bell  and  Magendie  of  the  distinct  motor  and 
sensitive  functions  of  certain  nerves  and  nerve-root3.  Of 
practical  achievements,  the  most  important  was  the  intro¬ 
duction  of  vaccination,  of  which  most  of  them  would  be 


Moiical  Times  and  Gazette 


A  CENTURY’S  PROGRESS  IN  MEDICINE. 


Nov.  10, 1883.  555 


ready  to  say,  borrowing  Luther’s  words,  that  it  was  a  test 
stantis  vel  cadentis  niedicince.  Laennec’s  invention  of  auscul¬ 
tation,  the  recognition  of  the  affection  of  the  kidneys  known  as 
“  Bright’s  disease,”  and  the  separation  of  the  too  familiar  and 
fatal  malady,  diphtheria,  from  those  with  which  it  was  long 
confounded,  were  other  notable  advances  made  during  the 
period  in  question.  If  we  compared  the  two  half-centuries, 
we  might  balance  the  following  improvements  against  each 
other  Against  the  discovery  of  the  double  nerve  function 
the  extended  knowledge  of  the  reflex  function.  Against 
“  general  anatomy  ”  the  cell  doctrine,  due  to  the  discoveries 
made  by  the  use  of  the  achromatic  microscope,  to  which  we 
also  owed  the  discovery  of  the  minute  organisms,  so  impor¬ 
tant  in  the  history  of  disease.  Against  vaccination  we  might 
-'offset  surgical  anaesthesia.  Against  the  stethoscope  the 
medical  thermometer.  The  honours  of  lithotrity  and  those 
of  ovariotomy  we  must  divide  between  the  two  periods ; 
while  the  beneficent  changes  in  the  treatment  of  insanity, 
effected  by  the  earlier  labours  of  Pinel  and  Esquirol,  had 
been  admirably  carried  on  in  the  more  recent  period. 

But  the  last  fifty  years  had  been  not  less  richly  produc¬ 
tive.  Modern  chemistry  and  physiology  were  practically 
new  sciences;  while  anatomy  had  added  the  more  exact  study 
of  regions  and  of  sections  to  its  earlier  methods  of  investi¬ 
gation.  Operative  surgery  had  of  late  years  achieved  its 
greatest  triumph  in  the  establishment  of  abdominal  section 
as  a  legitimate  and  safe  operation.  First  employed  by  an 
American  surgeon  (Dr.  McDowell,  of  Kentucky)  in  1809,  in 
the  hands  of  Spencer  Wells  and  his  contemporaries  it  had 
rescued  and  was  rescuing  hundreds  of  lives.  Tenotomy  by 
subcutaneous  section  was  another  new  and  valuable  opera¬ 
tion.  Plastic  surgery  had  learned  to  patch  deformities  as  a 
skilful  housewife  patches  a  garment.  Limbs  which  would 
have  been  sacrificed  were  saved  by  improved  methods  of 
dressing,  especially  by  the  use  of  antiseptics.  Eesection  of 
joints  or  of  portions  of  the  shaft  of  a  bone  had  in  many 
cases  taken  the  place  of  amputation.  Lastly,  there  was  the 
operation  of  paracentesis  with  aspiration  of  the  thorax 
in  acute  pleurisy,  as  first  practised  by  Dr.  Bowditch  and 
Dr.  Morrill  Wyman. 

In  the  prevention  of  disease  the  gain  had  been  extraor¬ 
dinary.  The  germ-theory  had  done  much  to  account  for 
the  phenomena  of  many  diseases,  and  to  indicate  the  means 
of  arresting  their  development.  The  recognition  of  domestic 
malaria  as  the  frequent  source  of  disease  was  of  vast  impor¬ 
tance.  The  phrase  “  drain  fever  ”  had  saved  hundreds  of 
lives. 

It  was  harder  to  speak  of  medical  practice — the  treatment 
of  internal  diseases,  fevers,  visceral  inflammations,  and  the 
like.  The  practice  of  drugging  for  its  own  sake — the  fatal 
bequest  of  the  English  apothecary,  or  “  general  practitioner,” 
whose  profit  was  made  on  his  medicines — had  infected  the 
whole  professional  public  of  England  to  a  very  considerable 
extent,  and  through  that  public  introduced  the  over-drugging 
system  into  her  colonial  dependencies,  and  the  States  which 
some  of  these  became.  But  within  recent  decades  great 
changes  have  taken  place.  Bleeding  was  now  an  almost  un¬ 
known  operation;  antimony  had  fallen  from  grace;  and 
calomel,  instead  of  being  next  the  apothecary’s  right  hand, 
had  gone  to  an  upper  shelf,  where  it  might  be  supposed  to 
repent  of  its  misdeeds  like  Simeon  Stylites.,  And  while  old 
drugs  and  old  methods  had  become  obsolete,  new  drugs  and 
new  methods  had  come  in  to  take  their  place.  As  the  over¬ 
employment  of  drugs  gave  way  to  juster  views,  the  hygienic 
conditions  and  personal  attendance  on  the  patient  were 
likely  to  be  better  cared  for  ;  more  attention  was  likely  to  be 
paid  to  air  and  cleanliness  and  comfort,  and  to  the  kind  of 
nourishment  and  the  modes  and  times  of  giving  it.  It  was 
just  in  these  little  unimportant,  all-important  matters  that 
a  good  nurse  was  of  incalculable  aid  to  the  physician ;  and 
the  growing  conviction  of  the  importance  of  thorough  train¬ 
ing  of  young  women  as  nurses  was  one  of  the  most  hopeful 
signs  of  medical  advancement.  He  had  always  felt  that  this 
was  rather  the  vocation  of  women  than  general  medical,  and 
especially  surgical  practice ;  yet  he  himself  had  followed  a 
course  of  lectures  given  by  the  younger  Madame  Lachapelle 
in  Paris,  and  if  here  and  there  an  intrepid  woman  insisted  on 
taking  by  storm  the  fortress  of  medical  education,  he  would 
have  the  gate  flung  open  to  her  as  if  it  were  that  of  the 
citadel  of  Orleans  and  she  were  Joan  of  Arc  returning  from 
the  field  of  victory. 

“I  have  often  wished,”  said  Dr.  Holmes  in  a  charac¬ 


teristic  passage,  “  that  disease  could  be  hunted  by  its 
professional  antagonists  in  couples,— a  doctor  and  a  doctor’s 
quick-witted  wife  making  a  joint  visit  and  attacking  the- 
patient, — I  mean  the  patient’s  malady,  of  course, — with 
their  united  capacities.  Eor  I  am  quite  sure  that  there  is 
a  natural  clairvoyance  in  a  woman  which  would  make  her 
as  much  the  superior  of  man  in  some  particulars  of  dia¬ 
gnosis  as  she  certainly  is  in  distinguishing  shades  of' 
colour.  Many  a  suicide  would  have  been  prevented  if  the 
doctor’s  wife  had  visited  the  victim  the  day  before  it 
happened.  She  would  have  seen  in  the  merchant's  face 
his  impending  bankruptcy,  while  her  stupid  husband  was 
prescribing  for  his  dyspepsia  and  endorsing  his  note ;  she 
would  recognise  the  love-lorn  maiden  by  an  ill-adjusted' 
ribbon,  a  line  in  the  features,  a  droop  in  the  attitude,  a  tone 
in  the  voice,  which  mean  nothing  to  him,  and  so  the  brook 
must  be  dragged  to-morrow.  The  dual  arrangement  of' 
which  I  have  spoken  is,  I  suppose,  impracticable,  but  a 
woman’s  advice,  I  suspect,  often  determines  her  husband’s, 
prescription.  Instead  of  a  curtain  lecture  on  his  own  fail¬ 
ings  he  gets  a  clinical  lecture— on  the  puzzling  case,  it  may 
be,  of  a  neighbour  suffering  from  the  complaint  known  to 
village  nosology  as  c  a  complication  of  diseases,’  which  her 
keen  eyes  see  into  as  much  better  than  his  as  they  would 
through  the  eye  of  a  small-sized  needle.  She  will  find  tha 
right  end  of  a  case  to  get  hold  of,  and  take  the  snarls  out  as 
she  would  out  of  a  skein  of  thread  or  a  ball  of  worsted 
which  he  would  speedily  have  reduced  to  a  hopeless  tangle.’^ 

But  though,  continued  Dr.  Holmes,  attention  to  the  con¬ 
ditions  surrounding  the  patient  was  entitled  to  precedence 
over  all  active  interference  with  the  course  of  disease,  we 
must  not  be  ungrateful  to  the  pharmacist  for  the  useful 
agents,  old  and  new,  which  he  put  in  our  hands.  Opium 
and  cinchona  appeared  in  our  modern  pharmacopoeia  with 
all  their  virtues,  but  freed  by  chemical  skill  of  the  qualities 
which  most  interfered  with  their  utility.  Mercury  was  no- 
longer  considered  a  panacea,  but  it  was  still  trusted  for  im¬ 
portant  special  services.  Most  of  the  remedial  plants  had 
yielded  their  essential  principles  to  chemical  analysis,  and: 
had  got  rid  of  the  useless  portions  which  made  them  bulky 
and  repulsive.  Iodine,  bromine,  salicine,  in  their  various- 
compounds  had,  within  the  present  century,  conferred  in¬ 
estimable  aid  in  the  treatment  of  some  of  the  most  formidable 
diseases.  Many  other  new  remedies,  such  as  carbolic  acid, 
glycerine,  chloral,  had  been  added  to  the  list  of  those  which 
are  of  daily  use  in  combating  particular  symptoms,  or  are 
adapted  to  certain  exceptional  conditions.  The  method  off 
administering  remedies  by  inhalation  had  been  greatly  ex¬ 
tended  ;  the  admirable  invention  of  the  process  of  sub¬ 
cutaneous  injection  had  become,  next  to  etherisation,  the 
most  rapid  and  potent  means  of  subduing  pain  and  other- 
forms  of  suffering ;  and  medical  electricity  had  proved  most 
serviceable  in  the  treatment  of  nervous  and  muscular- 
affections. 

In  the  various  specialties  into  which  the  practice  off 
medicine  had  become  subdivided  within  these  twenty  or- 
thirty  years,  the  ophthalmoscope,  the  improved  ear  spe¬ 
culum,  the  rhinoscope,  the  laryngoscope— held  out  their 
mirrors  to  enlighten  us,  or  opened  their  mouths  to  proclaim 
their  own  value.  Diagnosis  had  reached  a  wonderful  degree- 
of  accuracy ;  prognosis  had  become  a  terrible  kind  of  second- 
sight  which  was  not  always  handled  carefully  enough ; 
treatment  gained  a  little  with  every  decade.  The  history  of 
therapeutics  recorded  a  succession  of  marches  and  counter¬ 
marches,  with  a  slight  onward  movement  as  the  total  result 
of  every  completed  revolution ;  slight,  but  precious  to. 
humanity. 

Having  alluded  to  the  most  encouraging  fact  of  the  growth; 
of  medical  libraries,  and  to  the  work  of  Dr.  Billings  and  his- 
associates.  Dr.  Holmes  spoke  of  the  new  Medical  School,  im 
which,  as  they  trusted,  many  successive  generations  of 
medical  students  were  to  receive  a  large  part  of  their  in¬ 
struction.  As  they  entered  its  doors  and  surveyed  its  halls- 
and  lecture-rooms,  its  laboratories  and  their  appliances,  some 
of  them  might  be  ready  to  exclaim.  What !  AH  this  to  teach 
a  student  to  cut  off  a  limb  or  administer  a  potion  ?  The 
question  was  a  natural  one,  and  the  answer  was  easy.  The- 
Art  of  Healing  was  supported,  advanced,  illuminated,  by 
the  various  kinds  of  knowledge  which  were  recognised  as 
belonging  to  the  Science  of  Medicine.  And  the  Science  of 
Medicine,  like  all  other  kinds  of  classified  knowledge,  was- 
best  taught,  most  easily  and  thoroughly  learned,  when 


556 


Mfdical  Times  and  Gazette 


ABSTRACTS  AND  EXTRACTS. 


Nov.  10,  1883. 


taught  systematically,  because  facts  were  most  clearly  per¬ 
ceived  and  most  firmly  retained  in  the  memory  when  pre¬ 
sented  in  their  serial  relations.  The  teaching  of  the  various 
branches  included  in  a  complete  medical  course  required 
ample  provision  for  its  multiplied  exigencies. 

I  have  referred.  Dr.  Holmes  went  on,  to  the  modern 
achromatic  microscope  as  having  created  a  new  era  in 
medical  science.  I  have  no  time  to  tell  what  it  has  done 
for  anatomy,  physiology,  and  pathology,  besides  its  great 
services  in  other  departments  of  knowledge.  But  to  those 
who  have  never  seen  its  miracles  I  can  give  an  illustration, 
which  they  will  find  it  hard  to  believe  I  did  not  borrow  from 
•some  new  Gulliver’s  Travels  or  from  some  Jules  Verne’s 
imagination.  Yet  what  I  shall  say  is  the  simplest  truth  in 
the  world  to  any  microscopic  expert,  and  may  be  easily 
verified  by  any  sceptic.  If  we  had  to  examine  the  structure 
•of  a  human  body  by  the  naked  eye — or,  as  I  will  venture 
to  call  it,  gymnoscopic  or  rather  \gymnopic  inspection — it 
would  make  a  great  difference  whether  our  subject  were  of 
the  natural  dimensions  or  whether  he  were  a  Liliputian  or 
a  Brobdingnagian.  We  should  lose  sight  of  many  parti¬ 
culars  in  the  structure  of  the  Liliputian  which  we  easily 
detect  in  a  man  of  the  natural  size.  We  should  find  many 
things  plain  enough  in  the  Brobdingnagian  which  we  do 
not  notice  in  the  man  cf  ordinary  dimensions  on  account  of 
their  minuteness.  Thus,  for  instance,  we  should  find  that 
man  is  shingled  all  over,  or  tiled,  if  you  will— covered  with 
scales,  more  literally,  just  as  a  serpent  is.  The  statue  of 
Liberty,  the  statue  of  Carlo  Borromeo  at  Milan,  that  of 
Bavaria,  or  the  new  statue  of  Germania — any  one  of  these 
changed  to  flesh  and  blood  would  be  a  great  source  of  know¬ 
ledge  to  a  gymnopic  anatomist.  You  will  observe  that  the 
naturalist  could  examine  only  a  small  poi'tion  of  one  of  these 
colossal  figures  at  a  time.  Of  course  the  same  thing  is  true 
of  the  microscopic  man  I  am  going  to  describe.  He  must 
be  examined  in  small  fragmentary  portions.  The  individual 
from  whom  we  will  suppose  the  portion  under  examination 
to  have  been  taken  was,  we  will  say,  of  short  stature  ;  a 
little  more  than  5  ft.  2  in.  in  height,  and  weighing  120  lbs. 
Our  microscope,  a  rather  powerful  but  not  extraordinarily 
powerful  one,  magnifies  a  thousand  diameters.  This  frag¬ 
ment,  then,  thus  magnified,  represents  an  individual  just 
one  mile  in  height.  He  would  ten  times  overtop  the  loftiest 
of  the  pyramids,  twenty  times  the  tallest  of  our  steeples. 
His  breadth  and  thickness  being  in  proportion  to  his  height, 
his  weight  would  be  120,000,000,000  lbs.,  equal  to  60,000,000 
tons.  He  could  take  our  State  House  up  as  we  should  lift  a 
paving-stone,  and  fling  it  into  the  waters  beyond  Boston  Light¬ 
house,  cleaning  out  that  palace  of  the  people  by  a  summary 
process  quicker  than  the  praetorian  bands  of  Domitian  or 
■Commodus  would  have  cleaned  out  a  Roman  Senate  Chamber 
that  dared  to  have  an  opinion  of  its  own.  Such  is  the 
microscopic  man  as  we  see  him  piecemeal  in  that  wonderful 
instrument.  It  is  the  telescope  of  the  microcosm — the 
master-key  to  the  portals  of  a  new  universe — and  the  student 
must  be  carefully  taught  how  to  use  it. 

Speaking  of  the  department  of  Anatomy,  over  which  till 
lately  he  presided.  Dr.  Holmes  said  that  the  management 
of  the  difficult,  delicate,  and  all-important  work  of  the 
dissecting-room,  committed  to  the  care  of  a  succession  of 
laborious  and  conscientious  demonstrators,  as  he  had  known 
it  through  more  than  the  third  of  a  century,  had  been  dis¬ 
creet,  humane,  faithful,  and  that  the  record  of  that  depart¬ 
ment  was  most  honourable  to  them  and  to  the  classes  they 
had  instructed. 

"When  the  noble  hall  which  was  to  form  their  museum 
was  filled,  they  might  expect  to  find  there  a  perfect  golgotha 
of  skulls,  and  a  platoon  of  skeletons,  open  to  the  sight  of 
all  comers.  They  would  find  portions  of  every  human 
organ.  They  would  see  bones  softened  by  acid  and  tied  in 
bow-knots  ;  other  bones  burned  until  they  were  as  light  as 
cork  and  whiter  than  ivory,  yet  still  keeping  their  form ; 
sets  of  teeth  from  the  stage  of  infancy  to  that  of  old  age, 
and  in  every  intermediate  condition,  exquisitely  prepared 
and  mounted ;  preparations  that  once  formed  portions  of 
living  beings,  now  carefully  preserved  to  show  their  vessels 
and  nerves ;  the  organ  of  hearing  exquisitely  carved  by 
Drench  artists ;  specimens  of  human  integument,  showing 
its  constituent  parts  in  different  races, — among  the  rest,  that 
of  the  Ethiopian,  with  its  cuticle  or  false  skin,  turned  back 
to  show  that  God  gave  him  a  true  skin  beneath  it  as  white 
as  their  own.  Some  of  these  specimens  were  injected  to  show 


their  bloodvessels;  some  were  preserved  in  alcohol;  some 
were  dried. 

To  one  of  the  great  interests  of  society,  said  Dr.  Holmes 
in  conclusion,  the  education  of  those  who  are  to  be  the 
guardians  of  its  health,  the  stately  edifice  which  opens  its 
doors  to  us  for  the  first  time  to-day  is  devoted.  It  stands 
solid  and  four-square  among  the  structures  which  are  the 
pride  of  our  Hew  England  Venice — our  beautiful  metropolis, 
won  by  well-directed  toil  from  the  marshes  and  creeks  and 
lagoons  which  were  our  inheritance  from  nature.  The 
magnificent  churches  around  it  let  in  the  sunshine  through 
windows  stained  with  the  pictured  legends  of  antiquity. 
The  student  of  nature  is  content  with  the  white  rays  that 
show  her  j  ust  as  she  is  :  and  if  ever  a  building  was  full  of 
light — light  from  the  north  and  the  south ;  light  from  the 
east  and  the  west;  light  from  above,  which  the  great  concave 
mirror  of  sky  pours  down  into  it — this  is  such  an  edifice. 
The  halls  where  Art  teaches  its  lessons  and  those  where  the 
sister  Sciences  store  their  collections,  the  galleries  that  dis¬ 
play  the  treasures  of  painting  and  sculpture,  are  close 
enough  for  agreeable  companionship.  It  is  probable  that 
in  due  time  the  Public  Library  with  its  vast  accumulations 
will  be  next-door  neighbour  to  the  new  domicile  of  our  old 
and  venerated  institution.  And  over  all  this  region  rise  the 
tall  land-marks  which  tell  the  dwellers  in  our  streets  and 
the  traveller  as  he  approaches  that,  in  the  home  of  Science, 
Arts,  and  Letters,  the  God  of  our  Fathers  is  never  forgotten, 
but  that  high  above  these  shrines  of  earthly  knowledge  and 
beauty  are  lifted  the  towers  and  spires  which  are  the  symbols 
of  human  aspiration  ever  looking  upward  to  Him,  the 
Eternal,  Immortal,  Invisible. 


ABSTRACTS  AND  EXTRACTS. 


Iodobobm:  in  Pbob.  Billboth’s  Clinic. 

Fbom  an  interesting  communication  by  Dr.  Jaggard,  study¬ 
ing  in  Vienna,  to  the  Philadelphia  Medical  Times ,  Ho.  410, 
on  “Prof.  Billroth’s  Methods  of  Antiseptic  Surgery,”  we 
extract  the  account  of  the  preparations  of  iodoform  which 
he  employs  : — 

“  Billroth’s  dressing  of  the  wound  after  operations  differs 
from  Lister’s  chiefly  in  the  substitution  for  carbolised  gauze 
of  iodoform  in  the  form  of  powder  or  of  gauze.  Outside 
the  operating-room  iodoform  is  employed  (1)  as  a  powder, 
sprinkled  over  wounds,  as  upon  the  perineum,  by  Wolfler’s 
iodoform-duster,  and  (2)  as  gauze,  which  may  be  either 
(  hydrophile  ’  or  adhesive.  For  the  preparation  of  hydrophile 
iodoform  gauze,  a  coarse,  unbleached  muslin,  which  has 
been  deprived  of  its  fatty  particles,  is  placed  in  a  basin, 
washed  with  carbolic  acid,  and  sprinkled  with  iodoform 
powder  until  the  cloth  assumes  a  yellow  colour.  According 
to  the  thoroughness  of  this  operation,  the  gauze  contains 
from  10  to  20  per  cent,  of  iodoform.  Fifty  grammes  of  iodo¬ 
form  are  sufficient  to  impregnate  six  and  a  half  metres  of 
muslin.  Hydrophile  gauze  costs  in  Vienna  about  eight  cents 
per  metre.  For  the  preparation  of  the  adhesive  iodoform 
gauze  the  muslin  is  saturated  with  a  mixture  of  alcoholic 
solution  of  colophonium  and  glycerine.  The  gauze  is  dried 
carefully,  and  impregnated  with  iodoform  in  the  same 
manner  as  the  hydrophile.  For  six  metres  of  gauze  it  re¬ 
quires  230  grammes  of  iodoform  and  100  grammes  of  colo¬ 
phonium  which  is  dissolved  in  1200  grammes  of  95  per  cent, 
alcohol,  to  which  fifty  grammes  of  glycerine  are  added.” 
This  gauze  costs  about  thirty-two  cents  per  metre.  The 
chief  use  of  adhesive  iodoform  gauze  is  as  a  haemostatic  in 
cases  of  parenchymatous  haemorrhage. 

“  (3)  Iodoform  glycerine :  This  consists  of  from  ten  to 
twenty  parts  of  iodoform  to  100  parts  of  glycerine,  and  is 
employed  for  injection  into  cold  abscesses  after  the  evacua¬ 
tion  of  pus.  (4)  Iodoform  collodium  is  composed  of  one  part 
of  iodoform  to  ten  parts  of  collodium,  and  is  used  in  enor¬ 
mous  quantities  in  the  ambulatorium.  It  is  a  sovereign 
remedy  for  cuts  and  slight  bruises.  (5)  An  ethereal  solution 
of  iodoform  (one  part  iodoform  and  seven  parts  ether)  forms 
a  very  convenient  covering  for  syphilitic  scleroses  and  for 
mucous  patches  in  the  buccal  cavity.  (6)  For  iodoform 
bacilli  the  formula  is — iod.  pulv.  xx.,  gum  acacise,  glycerinse, 
amyli,  Sa  ii. ;  to  be  formed  into  bacilli  of  various  sizes.  The 
value  of  these  cannot  be  overrated  when  fistulous  tracks  or 


Medical  Times  and  Gazette. 


NOTICES  OE  BOOKS. 


Nov.  10,  18S3.  557 


inaccessible  wound-surfaces  have  to  be  treated.  In  endo¬ 
metritis,  cystitis,  pyothorax,  and  certain  urethral  affections, 
the  bacilli  are  of  great  worth.  (7)  Iodoform  vaseline  varies  in 
the  amount  of  the  drug  which  it  contains  (from  20  to  50  per 
cent.),  and  is  used  as  an  application  to  venereal  ulcers.” 


Lupus  op  the  Larynx. 

A  paper  on  this  subject,  by  MM.  Chiari  and  Eiehl,  appears 
in  the  Vierteljahrsschrift  f.  Dermatol,  u.  Syphilis ,  1882,  page 
G63,  and  Centralblatt  f.  Klin.  Medicin,  No.  41,  1883.  A 
review  of  the  present  literature  of  the  subject  goes  to  prove 
that  the  absolute  diagnosis  of  the  condition  is  only  to  be 
made  when  some  affection  of  the  skin  accompanies  it,  and 
when  the  possibility  of  syphilis,  tubercle,  and  carcinoma 
can  be  excluded  with  certainty.  Of  sixty-eight  cases 
(twenty-six  males  and  forty-two  females,  all  suffering  from 
lupus  of  the  skin  or  of  various  mucous  membranes)  investi¬ 
gated  by  the  authors,  only  six  could  be  definitely  diagnosed 
as  lupus  of  the  larynx.  The  following  appears  to  be  the 
most  usual  mode  of  onset.  Small  excrescences  of  the  size 
of  hemp-seeds,  some  isolated  and  others  in  groups,  appear 
upon  the  epiglottis  and,  later,  upon  the  ary -epiglottic  folds. 
Similar  outgrowths  may  form  on  the  vocal  cords,  or  may 
even  extend  into  the  trachea.  These  nodules  are  seated 
upon  a  slightly  hypersemic  mucous  membrane,  and  tend  to 
increase  both  in  prominence  and  in  superficial  area.  They 
may  end  in  resolution,  a  slight  scabbing  taking  place,  fol¬ 
lowed  by  cicatrisation,  with  shallow  depressions  of  the 
mucous  membrane ;  or  ulceration  may  occur,  of  very  long 
duration,  often  accompanied  by  glandular  swellings  in  the 
neck,  and  leading  to  deep  cicatrices,  in  which  fresh  nodules 
are  very  prone  to  recur.  Unlike  lupus  of  the  nose,  there 
appears  to  be  but  little  tendency  for  laryngeal  lupus  to 
attack  the  cartilaginous  structures.  The  symptoms  of  ne¬ 
cessity  depend  upon  the  part  of  the  larynx  invaded. 
Women  would  appear  to  be  more  liable  to  the  affection 
than  men.  Scrofulous  or  tuberculous  diatheses  do  not  seem 
to  have  any  influence  either  upon  the  origin  or  the  course  of 
the  disease.  From  tubercular  disease  of  the  larynx  it  differs 
in  its  proneness  to  attack  the  epiglottis,  and  to  spread  from 
thence  downwards,  and  in  the  scarring  about  the  healed 
nodules  or  ulcers.  From  carcinoma  it  is  distinguished  by 
the  absence  of  the  cachexia  and  by  the  age  of  the  patient, 
and  further,  by  its  tendency  to  disintegration  rather  than 
proliferation.  The  differential  diagnosis  from  the  syphilitic 
affections  is  less  easy.  The  character  of  the  ulcers  them¬ 
selves  forms  the  most  marked  point  of  distinction  ,•  the 
sharply  defined  rounded  edge,  and  the  surface  covered  with 
yellowish  secretion  peculiar  to  the  syphilitic  ulcers,  will 
often  serve  to  determine  their  nature.  In  some  cases,  how¬ 
ever,  the  course  of  the  disease  and  its  amenability  to  treat¬ 
ment  are  the  only  means  of  coming  to  a  correct  diagnosis. 
The  prognosis  must  invariably  be  very  guarded.  Complica¬ 
tions  such  as  perichondritis  or  even  stenosis  of  the  trachea 
have  been  observed,  although  only  in  a  very  small  proportion 
of  the  cases.  Treatment  must  be  general,  especially  by 
cod-liver  oil,  and  local,  by  caustic  remedies  such  as  iodoform 
or  nitrate  of  silver. 


Dr.  Francis  Warner  has  devised  an  apparata  s  for 
measuring  and  recording  in  a  graphic  manner  the  movements 
of  the  hand  and  fingers.  The  apparatus  consists  of  four 
principal  parts,  viz.  : — 1.  An  arrangement  of  rubber  tubes 
to  be  attached  to  the  hand,  one  tube  to  each  finger  or  moving 
part.  From  these  pieces  of  thin  conducting  tubing  carry 
air  to  the  tambours.  2.  A  frame  supporting  the  recording 
tambours  and  electrical  signals.  3.  An  electrical  “  contact¬ 
making  tambour.”  It  is  a  modification  of  the  Marey 
tambour,  adapted  to  the  purpose  of  actuating  an  electrical 
counter.  4.  An  electrical  counter.  A  full  description  of 
the  apparatus  will  be  found  in  the  Journal  of  Physiology, 
vol.  iv..  No.  2.  The  author  believes  that  “  by  this  method 
of  investigation  we  obtain  tracings  of  muscular  movements 
due  to  the  action  of  the  central  nerve  mechanism,  and 
obtain  some  evidence  as  to  the  effects  of  brain  action  in  its 
different  parts  as  indicated  by  muscular  movements.” 
Whether  it  will  satisfactorily  fulfil  the  expectations  formed 
of  it,  time  alone  can  reveal.  Meanwhile,  it  is  impossible  to 
deny  that  Dr.  Warner  has  displayed  great  ingenuity  in 
devising  and  constructing  the  apparatus.  Ni'if'b 


NOTICES  OF  BOOKS. 


A  Manual  of  the  Operations  of  Surgery.  For  the  use  of 
Senior  Students,  House-Surgeons,  and  Junior  Practi¬ 
tioners.  By  Joseph  Bell,  F.R.C.S.  Edin.,  etc.  Illus¬ 
trated.  Fifth  Edition,  revised  and  enlarged.  Edinburgh  : 
Maclachlan  and  Stewart ;  London  :  Simpkin  and  Marshall. 
1883.  Pp.  311. 

It  is  needless  for  us  to  say  much  about  such  a  well-known 
and  obviously  popular  work.  It  makes  no  pretension  to  be  an 
exhaustive  treatise,  and  yet  it  touches  on  most  of  the  more 
usual  operations.  After  such  a  career  as  it  has  enjoyed,, 
and  seeing  that  such  recent  operations  as  gastrostomy  and 
gastrectomy  have  been  added,  we  almost  wish  that  the 
author  had  gone  a  step  further,  and  included  the  operations 
of  nephrotomy  and  nephrectomy,  both  of  which  are  easier 
and  more  successful  than  the  corresponding  operations  on 
the  stomach.  The  chapter  treating  of  operations  on  the 
cranium  and  scalp,  too,  might  advantageously  be  developed 
in  greater  detail.  Cerebral  localisation  is  every  year  be¬ 
coming  more  and  more  a  precise  science,  and  its  teaching 
should  neither  be  forgotten  nor  ignored  by  the  surgeon  who 
is  about  to  trephine.  When  a  new  edition  is  required,  we 
think  our  author  will  do  well  to  add  a  few  cerebral  land¬ 
marks.  Such  an  addition  would  be  highly  appreciated, 
we  are  sure,  by  the  “junior  practitioners.”  Meanwhile,  we 
wish  for  this  fifth  edition  as  favourable  a  reception  as  its 
predecessors  have  met  with. 


A  Guide  to  the  Microscopical  Examination  of  Drinking- 
Water,  with  an  Appendix  on  the  Microscopical  Examination 
of  Air.  By  J.  D.  Macdonald,  M.D.,  F.R.S.  With 
twenty-five  lithographic  plates.  Second  Edition.  London. 
1883. 

To  the  world  of  minute  water-fauna,  an  excellent  introduc¬ 
tion.  In  an  ascending  series  of  twenty-five  good  lithographs 
are  delineated  types  of  all  dead  and  living  things,  from 
earthy  and  organic  debris,  through  desmids,  diatoms,  and 
rhizopods,  up  to  insects,  likely  to  occur  in  wholesome  and 
unwholesome  water.  Some  considerable  labour  has  been 
bestowed  upon  the  classification,  and  the  author  has  trans¬ 
ferred  the  whole  of  the  Flagellata  from  the  Protozoa  to  the 
Protophyta — a  bold  but,  on  the  whole,  justifiable  step. 

Having  reached  a  second  edition,  it  would  not  have  been 
out  of  place  to  have  added  to  each  description  a  scale,  to 
have  given  some  directions  as  to  the  staining  of  bacteria, 
and  to  have  mentioned  Koch’s  method  of  rendering  the 
whips  or  flagella  of  such  bacilli  as  B.  subtilis  and  B.  treriiu- 
lans  visible.  The  clearly  expressed  tqpt  contains  many 
ingenious  hints ;  those  relative  to  the  micro-chemistry  of 
water  and  the  collection  of  floating  particles  from  the  air 
being  specially  valuable.  The  book  deserves  a  place  in  the 
library  not  only  of  health  officers  and  analysts,  but  of  all 
microscopists. 

The  Sanitary  Journal.  Edited  by  Ed.  Platter,  M.D. 

Toronto. 

We  have  received  several  numbers  of  this  periodical,  which 
is  a  popular  publication  in  the  worst  sense  of  the  word. 
Facetiae  of  the  stalest  kind,  clippings  from  unprofessional 
papers,  crude  and  unscientific  assertions,  form  a  large  part 
of  each  number.  We  refrained  a  few  months  ago  from  re¬ 
futing  the  editor’s  illogical  lucubrations  on  small-pox  and 
vaccination,  as  being  unworthy  of  our  notice.  In  the  larger 
part  of  each  number  paste  and  scissors  are  freely  used ;  and 
we  may  refer,  for  instance,  to  the  copious  quotations  from 
our  own  pages,  which  in  the  August  number  reach  one-sixth 
of  the  whole. 


RAD;}  CRDM 


Medical  Guide  to  the  Mineral  Waters  of  France  and  its 
Wintering  Stations.  By  A.  Vintras,  M.D.  London:  J. 
and  A.  Churchill.  1883.  Pp.  320. 

France,  it  seems,  can  boast  altogether  of  about  1000  mineral 
springs,  and  the  aim  of  the  work  before  us  is  to  supply 
information,  especially  to  medical  men,  as  to  the  nature  and 
therapeutic  properties  of  the  more  important  of  these.  Dr. 
Vintras  divides  France  into  six  main  groups,  viz. — 1.  Central 
division :  Here  the  waters  are  chiefly  saline,  containing 


55  8 


Medical  Times  and  Gazette. 


GENERAL  CORRESPONDENCE. 


Nov.  10, 1863. 


bicarbonate,  sulphate,  and  chlorate  of  soda ;  free  carbonic 
acid  is  very  abundant.  2.  Pyrenean  division  :  Here  the 
springs  are  almost  all  characterised  by  the  predominance  of 
the  sulphurous  element.  3.  Southern  division :  Here  the 
springs  are  mostly  ferruginous  or  alkaline,  or  a  combination 
■of  both.  4.  Eastern  division:  Sulphates  of  soda  or  lime, 
and  salts  of  iron,  form  the  most  important  constituents  of 
the  springs  in  this  region.  5.  Northern  division :  The 
springs  here  belong  to  two  classes  only,  the  ferruginous  and 
the  sulphurous,  and,  though  not  numerous,  are  of  consider¬ 
able  importance.  6.  Western  division  :  Here  there  are  only 
■two  springs,  one  sulphuretted,  the  other  ferruginous.  One 
•chapter  is  devoted  to  the  springs  of  Corsica,  and  the  volume 
concludes  with  a  brief  description  of  the  various  wintering 
stations  in  France.  Hr.  Yintras  has  produced  a  work  which 
will  undoubtedly  prove  useful  to  physicians  who  wish  to  send 
their  patients  to  France,  and  who  have  not  the  opportunity 
to  investigate  the  several  watering-places  for  themselves. 


The  Test  Series :  a  New  Series  of  Boolcs  for  Students’  Use  in 
Examinations.  No.  1.  Questions  on  Human  Anatomy,  by 
Samuel  Potter,  M.A.,  M.D.;  with  63  illustrations,  pp.  139. 
No.  2.  A  Compend  of  the  Practice  of  Medicine,  by  Daniel 
Hughes,  M.D.;  Part  I.,  pp.  105.  No.  4.  A  Compend  of 
Human  Physiology,  by  A.  P.  Brubaker,  M.D. ;  pp.  133. 
London  :  Henry  Kimpton.  1883. 

'This  series  of  “'compends”  appears  to  be  an  English  edition 
of  an  American  work  in  course  of  publication.  We  have 
many  times  expressed  our  opinion  on  the  all-but  uselessness 
of  such  cram  books.  For  the  student  they  are  absolutely 
insufficient,  and  more  likely  to  lead  him  astray  than  to  prove 
nsef ul ;  while  for  practitioners  the  bareness  of  the  facts 
recorded  deprives  them  of  any  value  they  might  otherwise 
possess  when  read  in  their  proper  context.  Our  knowledge 
of  practitioners  leads  us  to  think  that  when  they  find  it 
necessary  to  refer  to  their  books  about  any  moot  point  in 
■either  diagnosis,  prognosis,  or  treatment,  it  is  to  the  largest 
■and  amplest  treatises  they  would  look,  rather  than  to  mere 
•“  remembrancers/5  such  as  these. 


A  Poclcet-boolc  of  Physical  Diagnosis.  By  Dr.  Edward  T. 

Bruen.  Second  Edition.  Philadelphia :  Blakiston.  1883. 
This  work,  whose  author  lays  no  “  special  claim  to  origin¬ 
ality  of  matter/5  deals  with  all  the  essential  points  to  be 
noted  in  the  physical  examination  of  the  heart  and  lungs, 
But  does  so  in  a  style  which  robs  it  of  any  value  that  it 
might  otherwise  possess  as  a  guide  to  the  practical  physician 
•or  student.  Simplicity  of  arrangement  and  clearness  of 
diction  are  qualities  which  no  practical  handbook  can  afford 
4o  dispense  with.  The  busy  practitioner  would  pr  obably  be 
tempted  to  transfer  the  book  from  his  pocket  to  his  book¬ 
shelf  on  reading  that  supplementary  breathing  “  is  best 
appreciated  by  contrasting  the  idea  of  the  pulmonary  sub¬ 
stance,  derived  from  the  examination  of  normal  areas,  or  areas 
•of  vicariously  acting  lung,  with  the  changed  elasticity  and 
increased  density  of  truly  pathological  pulmonary  tissue.55 


t Sexual  Impotence  in  the  Male.  By  William  A.  Hammond, 
M.D.  New  York  :  Bermingham  and  Co. 

Ln  the  whole  range  of  medical  literature  it  would  "be  impos¬ 
sible  to  find  the  equal  of  this  book  for  platitude  and  pru¬ 
riency.  No  averagely  well-informed  medical  reader  could 
•extract  from  it  the  smallest  practical  help  ;  for  the  subject- 
matter  is  not  new,  nor  its  handling  fresh  in  anything  but 
obscene  detail.  Whatever  of  truth  or  usefulness  the  book 
may  contain  has  for  long  been  well  and  widely  known.  Its 
jpages  remind  us  of  extracts  we  have  seen  from  that  litera¬ 
ture  of  “  nervous  diseases  55  which,  in  fly-leaf  and  pamph¬ 
let  form,  is  placed  in  the  hands  of  young  men  in  our  streets, 
do  their  infinite  physical,  moral,  and  financial  disaster,  and 
are  full  enough  of  unadorned  obscenity  to  satisfy  the  most 
ardent  patron  of  the  productions  of  Holy  well-street.  On  the 
raison  d’Stre  of  such  a  publication  as  this  we  will  not  venture 
•fco  speculate.  It  is  not  too  much  to  say  that  whatever  readers 
the  book  may  have  will  probably  be  largely  of  the  non-pro¬ 
fessional  class,  to  some  of  whom,  both  in  matter  and  style, 
it  is,  in  appearance  at  least,  adapted.  The  result  of  such 
perusal  would  be  the  production,  rather  than  the  avoidance, 
<©f  the  evils  treated  of. 


The  Journal  of  Nervous  and  Mental  Disease,  July,  1883, 

Is  mainly  occupied  with  reports  of  cases.  Dr.  Seguin  has  a 
paper  on  Spanish  Asylums  for  the  Insane,  from  which  it 
appears  that  in  this,  as  in  most  other  things,  Spain  lags 
behind  the  rest  of  the  civilised  world.  There  is  probably 
no  other  country  in  which  many  patients,  both  male  and 
female,  are  chained  to  the  walls  of  a  lunatic  asylum.  A  case 
of  chronic  myelitis,  of  nineteen  years5  standing,  is  reported 
by  Dr.  H.  Schmidt,  completed  by  an  account  of  the  post¬ 
mortem,  and  of  the  microscopic  appearances  of  the  cord, 
medulla,  and  pons.  The  prominent  pathological  appearances 
are  stated  to  be — (1)  a  congestion  or  degeneration  of  almost 
all  the  bloodvessels ;  (2)  a  “  fibrinous  exudate 55  effused  into 
the  septa  of  the  cord ;  (3)  atrophy  of  the  nerve-fibres  ;  and 
(4)  degeneration  of  the  nerve-cells.  The  microscopic  record, 
which  has  evidently  been  made  with  care  and  industry,  is 
illustrated  by  a  lithograph  engraved  by  the  author  himself, 
which  is  said  by  the  editor  to  be  probably  the  finest  ever 
issued  by  the  journal.  It  is  not,  however,  extraordinarily 
good :  many  of  the  outlines  have  a  degree  of  definition 
which  bespeaks  a  heavy  hand  rather  than  a  good  objective, 
and  the  fasciculi  of  nerve-fibres  look  like  bundles  of  sticks. 
A  large  portion  of  the  journal  is,  as  usual,  occupied  by  the 
reports  of  the  meetings  of  the  American  Neurological 
Association. 


GENERAL  CORRESPONDENCE. 

- o - 

MESMERISM. 


[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sir, — Your  last  article  on  this  subject  compels  me  again 
to  ask  space  for  a  short  reply. 

I  purposely  avoided  commenting  on  the  reference  in  your 
former  paper  to  vivisection ;  simply  because  I  preferred 
leaving  a  somewhat  damaging  blunder  uncorrected,  to  de¬ 
viating  into  a  region  so  remote  from  the  matter  in  hand. 
But  as  the  blunder  is  now  repeated  in  more  precise  terms,  and 
as  it  belongs  to  a  class  peculiarly  apt  to  get  stereotyped  and 
perpetuated,  I  have  no  choice  but  to  state  that  the  position 
apparently  attributed  to  me  is  one  the  folly  and  mischiev¬ 
ousness  of  which  I  have  done  my  very  utmost  to  expose.  If 
my  critic  (whose  courtesy  of  tone  in  this  second  paper  I 
gladly  recognise)  can  ever  find  time  to  peruse  the  very 
moderate  number  of  pages  that  I  have  devoted  to  the 
question,  he  will  see  that  the  sweeping  terms  in  which  he 
describes  me  as  “an  opponent  of  vivisection 55  are  as  unjus¬ 
tifiable  as,  after  the  supposed  perusal,  they  would  be 
wantonly  unjust. 

Putting  aside  this  irrelevant  topic,  he  would,  I  think, 
be  surprised  to  know  with  how  much  general  sympathy  I 
followed  the  rest  of  his  argument.  I  am  puzzled,  I  admit, 
apropos  of  the  series  of  experiments  before  criticised,  at  a 
dark  hint  about  “  internal  evidence  fatal  to  any  theory  of 
community  of  sensation.55  But  curiosity  about  this  may 
fairly  rest  until  some  flaw  has  been  shown  in  the  external 
evidence  on  which  we  relied;  and,  on  the  whole,  the  objec¬ 
tions  now  made  are  not  of  a  sort  that  can  be  profitably 
dealt  with  on  paper.  I  am  well  aware  how  impossible  it  is  to 
believe  that  other  people  have  taken  adequate  precautions, 
and  how  enormous  is  the  strength  of  the  general  presump¬ 
tion  from  the  known  history  of  imposture.  Nothing  would 
be  gained  by  assertions  of  our  own  scepticism  and  detective 
instincts  and  general  lack  of  “  the  innocent  and  trusting 
mind 55  which  our  critic  attributes  to  us,  and  which,  in  these 
inquiries  at  any  rate  and  in  spite  of  his  polite  assurance  to 
the  contrary,  we  must  still  hold  to  be  incompatible  with 
common  sense  ;  nor,  as  he  himself  says,  would  a  further  de¬ 
tailed  description  of  the  precautions  actually  taken  be  any 
more  convincing.  What  we  want,  and  what  he  professes  to 
want,  is  a  large  accumulation  of  harmonious  testimony  ;  and 
I  the  more  regret  that  the  invitation  which  I  addressed  to 
him,  to  take  a  part  in  this  accumulation,  is  not  accepted — 
nay,  even  that  its  acceptance  could  have  no  possible  result ; 
since  what  can  the  utmost  powers  of  investigation  avail 
when  linked  with  such  a  “  relentless  and  uncompromising 
scepticism55  as  would,  under  all  conditions  and  to  the  end  of 
time,  prefer  the  hypothesis  of  a  defect  in  the  investigator’s 
penetration  to  that  of  the  reality  of  a  previously  unrecog¬ 
nised  fact  P  Fortunately,  however,  all  trained  observers  are 


Medical  Times  and  Gazette. 


THE  PATHOLOGICAL  SOCIETY  OF  LONDON. 


Nov.  10,  1883.  55 9> 


not  thus  invincibly  forearmed  against  the  results  -which,  the 
exercise  of  their  faculties  may  reveal  to  them ;  and  this 
brings  me  to  the  one  point  raised  which  both  needs  and 
admits  of  a  short  and  decisive  answer.  I  am  asked  whether 
any  scientific  men  whose  judgment  would  carry  weight 
with  the  medical  profession  have  witnessed  the  perform¬ 
ances,  and,  if  so,  what  conclusion  they  arrived  at.  The 
“  finger ”  experiment  has  been  witnessed  by  several  gentle¬ 
men  (and  will  soon,  I  hope,  be  witnessed  by  many  more)  to 
whom  the  above  description  applies,  and  the  conclusion  at 
which  they  arrived  was  partly  positive  and  partly  negative. 
On  the  one  hand,  not  one  of  them  had  the  slightest  doubt 
that  the  insensibility  was  genuine  ;  on  the  other  hand,  not 
one  of  them  had  the  slightest  idea  how,  on  recognised  laws, 
it  was  to  be  accounted  for.  I  am,  &c., 

14,  Dean’s-yard,  S.W.  Edmund  Gurney. 


“  SYPHILIS  OR  TUBERCLE?” 


[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sir, — In  the  last  number  of  your  journal  there  appears,  & 
propos  of  the  case  of  cerebral  tumour  which  I  brought 
before  the  Clinical  Society  at  its  last  meeting,  an  annotation 
under  the  above  heading  which  may  lead  to  some  mis¬ 
apprehension,  and  which  I  therefore  beg  you  will  allow  me 
to  correct.  I  did  not  bring  the  question  which  was  raised 
by  my  case  “  unintentionally  ”  before  the  Society,  nor  did 
I,  when  called  to  see  the  patient,  make  the  diagnosis  of 
syphilitic  tumour.  It  was  plainly  stated  in  my  paper  that 
I  made  the  diagnosis  of  cerebral  tumour,  and  this  was  fully 
confirmed  by  the  autopsy. 

No  one,  however,  could  have  been  more  surprised  than 
myself  to  find,  when  the  specimen  was  sent  to  me,  that  it 
presented  the  appearances  of  gummata  and  vascular  disease 
which  are  at  the  present  time,  rightly  or  wrongly,  held  to 
be  characteristic  of  syphilis.  I  am  quite  sure  that  you,  sir, 
or  any  of  your  readers  who  are  familiar  with  such  specimens, 
would,  on  seeing  it,  have  at  once  pronounced  for  the  specific 
nature  of  the  lesions.  But  as  no  indications  of  syphilis  had 
existed  during  life,  and  the  clinical  features  thus  showed  a 
complete  discrepancy  with  the  evidence  of  morbid  anatomy, 
I  decided  to  have  another  opinion  on  the  pathological 
significance  of  the  post-mortem  changes,  and  therefore  sent 
the  brain  for  minute  examination  to  Dr.  Bevan  Lewis,  of 
the  West  Riding  Asylum,  without  giving  him  any  indication 
of  the  symptoms  which  had  been  present  during  life,  or  my 
own  notions  concerning  the  specimen. 

Dr.  Lewis,  who  is  deservedly  considered  one  of  the  ablest 
and  most  experienced  observers  in  the  pathological  anatomy 
of  the  nervous  centres,  expressed  himself,  without  any 
hesitation,  for  the  specific  nature  of  the  lesions ;  and  his 
report,  which  is  full  and  explicit,  has  been  incorporated  with 
my  paper. 

I  offered,  during  the  discussion  which  took  place  after  the 
reading  of  my  communication,  to  hand  the  specimen,  if 
still  in  existence,  for  further  examination  to  a  committee  of 
the  Society ;  but  Dr.  Lewis  has  since  written  to  me  to  say 
that  it  has  unfortunately  been  destroyed.  As  far  as  this 
case  is  concerned,  the  matter  is  therefore  at  an  end  ;  but  I 
have  no  doubt  that  such  a  committee,  if  appointed,  could 
only  have  arrived  at  the  same  conclusion  as  Dr.  Lewis  and 
myself.  My  communication  to  the  Clinical  Society  will, 
however,  have  answered  its  purpose  if  it  be  instrumental  in 
drawing  the  attention  of  pathologists  to  a  nicer  discrimina¬ 
tion  between  lesions  which  are  at  present  believed  to  be 
caused  by  the  action  of  one  poison  only — possibly  in  the 
direction  indicated  by  yourself  with  regard  to  a  differentia¬ 
tion  of  bacteria  inhabiting  such  growths. 

I  am,  &c.,  Julius  Althaus,  M.D. 

48,  Harley- street.  Cavendish-square,  W.,  Nov.  3. 


Excision  of  the  Yas  Deferens  in  Excessive  Mas¬ 
turbation. — Dr.  Haynes,  of  Concord,  refers,  in  the  Boston 
Med.  Jour.,  August  9,  to  three  cases  of  desperate  masturba¬ 
tion,  in  which,  in  place  of  castration,  he  performed  excision 
of  the  vas  deferens.  “  An  incision  midway  between  the 
external  inguinal  ring  and  the  testis  laid  bare  the  duct,  from 
which  a  half-inch  was  resected,  and  the  slight  wound  closed 
by  sutures.”  In  each  great  amelioration  in  the  mental  and 
corporeal  condition  of  the  subjects  of  the  operation  ensued. 


REPORTS  OP  SOCIETIES. 

- - — —© - 

THE  PATHOLOGICAL  SOCIETY  OF  LONDON. 

Tuesday,  November  6. 

J.  W.  Hulke,  F.R.S.,  President,  in  the  Chair. 


Diverticula  oe  Small  Intestines. 

Dr.  Norman  Moore  showed  the  intestines  of  a  man,  aged 
forty,  containing  three  diverticula  in  the  first  three  feet  of 
the  small  intestine,  and  a  congenital  structure  at  the  com¬ 
mencement  of  the  jejunum.  The  diverticula  were  each  an 
inch  long,  and  about  as  much  in  diameter,  and  were  on  the- 
mesenteric  side  of  the  intestine.  Their  walls  consisted  of  all 
the  intestinal  coats,  and  they  were  not  mere  hernial  protru¬ 
sions.  They  might,  perhaps,  have  some  relation  to  the 
pyloric  caeca  of  fish.  The  stricture  was  caused  by  an  internal 
ring  of  mucous  membrane,  and  would  but  just  admit  the 
little  finger.  It  was  obviously  a  variety  in  development,  and 
not  due  to  any  morbid  change.  Neither  peculiarity  gave  rise- 
to  symptoms,  and  the  man  died  of  bronchitis.  Such  caeca 
had  been  described,  but  were  very  rare,  while  congenital 
stricture  so  high  up  in  the  small  intestine  was  still  rarer. 

Mr.  P.  Treves  denied  the  rarity  of  such  cases  as  the 
present.  He  had  seen  a  good  many  cases  of  this  kind,  and 
the  diverticula  were  mostly  on  the  mesenteric  side  of  the 
intestine,  and  were  usually  high  up.  Dr.  Moore’s  case 
differed,  however,  from  ordinary  cases  in  that  muscular 
tissue  was  present  in  the  diverticula,  and  also  in  the 
fact  that  there  appeared  to  be  no  history  of  obstruction 
or  distension. 

Mr.  Sutton  said  that  on  examining  the  body  of  an  infant 
that  had  died  on  the  fifth  day  after  birth,  he  had  found,  one 
inch  below  the  pylorus,  a  stricture  forming  a  pouch -like  ter¬ 
mination,  so  that  there  was  no  connexion  with  the  duodenum. 
The  length  of  time  which  the  infant  lived  was  interesting. 

Dr.  Goodhart  was  not  quite  satisfied  as  to  the  absence  of 
distension  in  Dr.  Moore’s  case.  In  one  specimen  in  the 
College  of  Surgeons  there  was  no  definite  history  of  disten¬ 
sion  obtainable.  He  thought  that  there  might  have  been 
some  long-continued  distension  at  a  previous  date,  which 
had  passed  off,  and  that  then  hypertrophy  of  the  muscular 
elements  occurred. 

Dr.  Moore,  in  reply,  said  there  was  no  history  of  obstruc¬ 
tion,  and  no  distension  was  observed,  but  the  points  were  not 
specially  inquired  into.  As  regarded  the  rarity  of  such  cases, 
out  of  3400  examinations  at  St.  Bartholomew’s  Hospital, 
the  present  was  the  only  instance  of  diverticula  on  the 
mesenteric  side,  against  twenty-seven  instances  of  Meckel’s 
diverticula. 

Anastomosis  of  the  Coronary  Arteries. 

Dr.  Samuel  West  read  a  communication  on  the  above 
subject.  After  briefly  referring  to  the  published  cases  of 
obliteration  of  one  coronary  artery,  he  alluded  more  in 
detail  to  a  most  remarkable  instance  of  obliteration  of  both 
coronary  arteries  in  a  patient  aged  fifty-six,  who  died  of 
carcinoma  without  having  presented  any  cardiac  symptoms 
during  life.  Both  coronary  arteries  were  calcified  and 
obliterated  by  a  cretaceous  clot,  which  extended  for  some 
distance  into  the  branches  of  both  vessels.  The  heart  was 
slightly  fatty ;  and  the  narrator  of  the  case  had  not  given 
any  explanation  of  the  manner  in  which  the  nutrition  of 
the  heart  was  kept  up.  His  own  case,  which  he  brought  for¬ 
ward  that  evening,  was  that  of  a  man  aged  fifty,  whose  heart 
was  greatly  dilated  (especially  on  the  left  side)  and  very 
fatty.  The  aorta  was  extremely  calcareous,  especially  behind, 
the  change  extending  even  down  behind  the  cusps ;  but 
these  were  only  slightly  thickened.  The  right  coronary 
artery  was  large,  but  its  mouth  much  narrowed  by  the  cre¬ 
taceous  deposit.  The  orifice  of  the  left  coronary  artery  could 
not  be  seen,  being  completely  obliterated  by  a  calcareous 
plate.  Both  arteries  were  of  normal  size  beyond  their 
orifices.  Other  viscera  natural.  It  was  important  to  note 
that  the  left  coronary  artery  contained  blood,  which  could 
not  have  entered  at  its  orifice.  Passing  on  to  consider  the 
normal  circulation  in  the  coronary  arteries,  he  pointed  out 
that  Hyrtl’s  view,  that  each  coronary  artery  supplied  its 
own  Wlf  of  the  heart  and  nothing  more,  was  contrary  to 
fact — the  cases  to  which  he  had  referred  and  the  speci¬ 
men  he  exhibited  that  evening  affording  a  complete  disproof 


560 


Medical  Times  and  Gazette. 


THE  PATHOLOGICAL  SOCIETY  OE  LONDOK 


Nov.  10,  1833. 


of  it;  and  he  then  alluded  to  some  recent  investigations  of 
his  own  with  injections,  which  showed  in  the  most  unmistak¬ 
able  manner  that  there  was  a  very  free  anastomosis  between 
the  two  coronary  arteries,  so  much  so  that  it  was  necessary 
when  injecting  one  coronary  artery  to  close  the  mouth  of  the 
other  to  prevent  the  injection  running  out,  and  under  inter¬ 
mittent  pressure  the  fluid  escaped  from  the  opposite  artery 
in  jets;  by  a  curious  coincidence  these  experiments  had  been 
conducted  simultaneously  with,  though  perfectly  indepen¬ 
dently  of,  those  referred  to  by  Dr.  Wickham  Legg  in  his  Brad- 
shawe  Lecture.  That  the  injection  should  be  successful  it 
was  necessary  that  the  material  used  should  be  fine  ;  that  the 
heart  should  be  taken  out  not  too  long  after  death ;  and  that 
during  the  experiment  it  should  be  warmed  artificially. 
With  these  precautions  it  was  easy  to  prove  that  the  heart 
could  be  supplied  with  blood  from  one  coronary  artery.  It 
was  very  remarkable  how  large  an  amount  of  obstruction 
there  might  be  to  both  coronary  arteries  without  any  cardiac 
symptoms  during  life,  or  any  gross  pathological  change 
being  recognisable  in  the  muscle  of  the  heart  after  death  ; 
and  he  wished  to  draw  especial  attention  to  the  question  of 
blood-supply  to  the  heart  in  such  cases.  When  only  one 
coronary  artery  was  obliterated,  the  circulation  could  be 
carried  on  by  means  of  the  other  quite  easily,  as  had 
been  shown,  but  the  explanation  of  the  mode  in  which 
the  nutrition  of  the  heart  was  preserved  when  both 
coronary  arteries  were  obliterated  was  not  easy  to  find. 
The  existence  of  accessory  coronary  arteries  naturally  oc¬ 
curred  to  the  mind,  and  it  had  been  suggested  that  the  heart 
might  be  nourished  directly  from  the  ventricle.  Another 
ancl  an  additional  difficulty  was  that  in  these  cases  the  heart 
was  generally  enlarged,  and  therefore  required  an  increased 
supply  of  blood  for  its  nutrition.  When  the  mouths  of  the 
coronary  arteries  were  obstructed,  one  of  two  things  must 
happen — either  the  blood  must  pass  through  the  narrow 
orifices  at  a  greater  speed,  or  for  a  much  longer  time.  The 
latter  might  explain  some  of  the  cases  in  which  the  pulse 
was  very  slow.  The  first  of  these  causes  could  only 
result  from  either  increased  propulsive  power  of  the  heart, 
or  increased  tension  in  the  aorta ;  and  in  either  case  there 
would  be  a  demand  for  an  increased  blood- supply  to  the 
heart.  The  discovery  of  a  collateral  arterial  circulation  of 
the  heart  would  afford  the  most  easy  and  simplest  explana¬ 
tion,  but  he  knew  of  no  evidence  whatever  that  such  a 
condition  existed. 

Mr.  Henry  Morris  was  much  interested  in  Dr.  West’s 
paper,  and  referred  to  some  remarks  he  had  made  at  a 
previous  meeting  of  the  Society.  Some  years  ago,  at  his 
suggestion,  some  injections  had  been  made  in  the  hearts  of 
young  subjects,  and  it  had  been  found  that  a  fine  injection 
always  passed  from  one  coronary  artery  to  the  other;  and 
he  had  thereby  been  quite  satisfied  that  the  right  and  left 
coronary  arteries  freely  anastomosed. 

Mr.  Shattock  thought  that  Hyrtl  had  used  wax  in  his 
experiments,  which  naturally  would  not  pass  through  the 
capillaries.  A  similar  statement  used  to  be  made  in  regard 
to  the  lingual  arteries,  but  a  fine  injection  passed  readily 
from  one  to  the  other. 

Mr.  HujjKe  referred  to  the  assertion  that  used  to  be 
common,  that  injections  could  not  pass  from  the  ligamentum 
teres  into  the  head  of  the  femur  ;  but  a  fine  injection  could 
be  made  to  pass  easily. 

The  Pathology  of  Congenital  Club-Foot. 

Mr.  E.  W.  Parker  and  Mr.  Shattock  showed  specimens 
•of  this  malformation.  In  one  foot  the  muscles  and  nerves 
were  dissected ;  in  the  other  foot  the  shape  of  the  tai-sal 
bones  was  demonstrated.  The  authors  likewise  exhibited 
microscopic  preparations  of  the  spinal  cord,  of  the  nerve 
trunks,  and  of  each  of  the  muscles  of  the  limb.  These 
showed  no  appreciable  deviation  from  the  normal  histo¬ 
logical  standard.  In  the  bones,  however,  certain  changes 
were  described,  but  the  authors  considered  that  these 
changes  were  not  primary,  but  were  the  result  of  the  altered 
position  in  which  they  (the  bones)  had  lain.  They  chiefly 
based  this  view  on  the  fact  that,  though  altered  in  extent, 
the  normal  outlines  of  the  articular  surfaces  could  still  be 
distinctly  traced.  Eeviewing  the  various  theories  of  causa¬ 
tion,  they  rejected  the  nerve-theory  on  the  evidence  of  their 
•own  case ;  for  a  like  reason  the  bone-theory,  which  the  late 
Prof.  Hiiter  had  chiefly  supported,  was  rejected  ;  and  they 
agreed  with  Mr.  W.  Adams  that  these  changes  were  a  result. 


and  not  a  cause.  As  to  whether  talipes  was  only  an  exag¬ 
geration  of  a  physiological  standard,  they  were  undecided, 
because  some  additional  power  was  required  to  bring  about 
a  well-marked  case.  They  believed  that  the  mechanical 
theory  in  some  shape  or  other  best  explained  their  own  case. 
Brief  allusion  was  also  made  to  the  insufficiency  of  the  classi¬ 
fication  into  the  congenital  and  non- congenital  forms.  The 
authors  thought  nerve-lesions  may  exist  in  some  congenital 
cases. 

Mr.  Adams  thought  it  was  much  to  be  regretted  that  the 
hospital  museums  in  London  contained  so  few  specimens  of 
these  affections.  He  had  brought  before  the  Society,  thirty 
years  previously  (and  the  specimen  had  been  recorded  in 
the  third  volume  of  the  Society’s  Transactions'),  a  case 
which  conclusively  proved,  in  his  estimation,  that  the  same 
deviations  which  were  produced  in  the  adult  could  be  found 
present  in  the  newly-born  infant.  Anatomically,  he  fully 
agreed  with  all  that  Mr.  Parker  said,  but,  as  regarded  the 
cause,  he  still  maintained  his  belief  in  the  central  nervous 
origin  of  club-foot,  the  larger  muscles  acting  under  some 
unexplained  cause,  and  drawing  up  the  os  calcis  into  an 
oblique  position.  Club-foot  might  be  found  as  early  as  the 
fourth  month  of  intra-uterine  life,  and  surely  no  mechanical 
cause  could  be  invoked  to  account  for  it  then.  Some  cases 
of  breech  presentation  might,  perhaps,  have  club-foot  of 
mechanical  origin. 

Dr.  Wilks  thought  that  this  was  a  question  which  might 
be  further  developed  by  the  Society  with  great  advantage. 
It  was  the  custom  of  the  present  day  to  attribute  most 
local  lesions  to  a  central  lesion.  He  wished  especially  for 
information  as  to  the  occurrence  of  talipes  in  cases  of  in¬ 
fantile  paralysis.  This  latter  was  stated  to  be  a  common 
cause  of  talipes  in  works  on  surgery ;  but  he  had  never  seen 
a  case  of  infantile  paralysis  in  which  rigidity  subsequently 
appeared,  and  he  wished  to  know  whether  there  was  any 
real  evidence  in  support  of  this  widespread  belief. 

Mr.  Adams  asked  Dr.  Wilks  if  he  believed  in  the  existence 
of  paralysis  anterior  to  birth ;  to  which 

Dr.  Wilks  replied  that  he  had  no  opinion  on  the  subject. 

Mr.  Hulke  thought  that  it  was  probable  that  some  of 
these  cases  were  due  to  pressure,  and  some  to  nerve-lesions. 
He  thought,  however,  that  there  was  not  in  cases  of  talipes 
any  proof  of  paralysis.  As  regarded  the  physiology  of  the 
affection,  Mr.  Parker  had  said  that  there  was  an  exaggera¬ 
tion  of  the  natural  attitude.  For  his  own  part  he  preferred 
to  adopt  the  view  of  an  old  German  writer,  who  regarded 
talipes  as  a  persistence  of  one  phase  of  fcetal  life. 

Dr.  Silcock  thought  that  Mr.  Adams  had  somewhat  mis¬ 
represented  Cruveilhier’s  views  in  assigning  the  talipes  to 
pressure  of  the  uterus  upon  the  foetus.  That  author  had  con¬ 
sidered  pressure  of  one  part  of  the  foetus  against  another  to 
be  the  cause,  and  he  (Dr.  Silcock)  showed  a  specimen  very 
similar  to  Cruveilhier’s  celebrated  one,  in  which  there  was 
talipes  calcaneus  on  one  side,  and  valgus  on  the  other,  both 
due  undoubtedly  to  pressure  against  the  chin. 

Dr.  Longiiurst  asked  whether  the  malformation  was 
common  throughout  the  animal  kingdom,  as  that,  if  the 
case,  would  be  against  the  theory  of  pressure  on  the  foetus 
by  the  uterus. 

Mr.  Parker,  in  reply  to  the  President’s  observations, 
thought  that  a  persistence  of  a  foetal  case  explained  those 
cases  that  died  at  birth,  and  that  an  exaggeration  of  that 
state  would  account  for  the  later  cases.  He  did  not  wish 
to  exclude  a  central  nervous  origin  altogether,  but  the 
occurrence  of  talipes  in  early  fcetal  life  was  strongly  against 
the  nervous  theory,  as  at  that  period  the  nerve-centres  were 
not  fully  developed,  and  the  muscles  therefore  would  have 
no  power. 

Two  Cases  of  Euptured  Heart1 

Dr.  W.  B.  Hadden  showed  these  specimens.  1.  Case  of  a 
boy,  aged  six,  who  had  swelling  of  the  left  foot  two  weeks 
before  admission.  On  examination  there  was  a  large  ulcer 
on  the  outer  side  of  the  left  ankle,  exposing  the  peronei 
tendons  and  the  external  saphena  vein.  There  was  some  pain 
and  tenderness  about  the  right  hip.  The  boy  had  severe 
constitutional  symptoms — cough,  pneumonic  signs,  and  high 
fever.  He  died  suddenly  two  days  after  admission.  There 
was  an  abscess  behind  the  right  hip-joint,  but  not  connected 
with  it.  The  left  calcaneo- cuboid  joint  was  quite  dis¬ 
organised.  There  was  an  abscess,  with  localised  pleurisy, 
in  the  lower  lobe  of  the  left  lung,  besides  numerous  small 
abscesses  in  the  kidneys.  The  pericardium  was  filled  with 


Medical  Times  and  Gazette. 


OBITUARY. 


Nor.  10, 1883.  561 


recent  clot,  which,  had  escaped  from  the  heart  through  a 
rupture  in  the  wall  of  the  left  ventricle  posteriorly,  near  its 
junction  with  the  auricle,  and  just  below  the  coronary  sinus. 
The  external  opening  was  larger  than  the  internal,  ragged, 
and  partially  plugged  with  toughish  clot.  The  internal 
opening,  which  was  smaller  and  more  clearly  defined,  was 
concealed  by  the  posterior  flap  of  the  mitral  valve.  There 
was  very  intense  pericarditis.  The  muscular  fibres  did  not 
appear  unusually  soft.  There  was  no  endocarditis.  The 
case  was  doubtless  one  of  pyaemia.  It  was  probable  that 
there  was  myocarditis  secondary  to  the  pericarditis,  and 
that  the  muscular  walls  gave  way  at  a  spot  naturally  weak 
— viz.,  the  junction  of  the  left  auricle  and  ventricle.  2.  A 
gentleman,  aged  about  fifty,  who  died  very  suddenly  without 
any  previous  symptom.  At  the  autopsy  there  was  a  ragged 
rent,  two  inches  long,  passing  right  through  the  anterior 
wall  of  the  left  ventricle.  The  muscular  fibres  were  found 
on  microscopical  examination  to  be  fatty.  The  heart  itself 
was  surrounded  with  much  fat. 

Sir  W.  Mac  Cormac  had  seen  the  last  patient  referred  to 
during  life,  and  he  had  died  five  hours  after  the  first 
symptom.  He  wished  to  know  how  long  a  man  could  live 
after  rupture  of  the  heart. 

Dr.  Wilks  observed  that  the  rupture  took  place  gradually, 
and  not  all  at  once.  It  was  impossible  to  say  how  long  a 
patient  would  live;  each  case  must  be  judged  on  its  own 
merits. 

Dr.  Moore  referred  to  a  ruptured  bullock’s  heart  that  was 
in  the  museum  of  St.  Bartholomew’s  Hospital. 

Dr.  Hadden  said  that  the  appearances  in  his  first  case 
bore  out  the  idea  that  the  rupture  had  taken  place  slowly. 

Structure  op  Hemorrhoids. 

Mr.  W.  J.  Roeckel,  after  referring  to  the  old  belief  that 
a  haemorrhoid  was  an  angioma,  and  mentioning  that  Ledrun 
had  described  the  structure  of  a  pile  150  years  ago,  gave  an 
account  of  the  microscopical  appearances,  derived  from  the 
examination  of  between  thirty  and  forty  cases.  A  haemor¬ 
rhoid  consisted  of  a  mucous  membrane,  a  muscular  layer, 
and  a  submucous  layer  containing  bloodvessels.  Over  the 
outer  part  the  epithelium  was  squamous,  but  there  were 
no  sweat-glands ;  above  this  it  was  columnar.  The  rnuscu- 
laris  mucosa  was  hypertrophied.  The  veins  were  much  more 
prevalent  than  the  arteries,  and  their  walls  were  thickened. 

Recovery  from  Necrosis  of  the  Lower  Jaw. 

Mr.  Waren  Tay  showed  a  boy  who  had  ten  years  pre¬ 
viously  had  necrosis  of  the  whole  of  his  lower  jaw.  The 
boy  at  that  time  was  aged  four  years,  and  had  typhoid  fever 
with  ulceration  of  gums  ;  this  led  to  exposure  and  ultimate 
necrosis  of  the  whole  of  the  lower  jaw.  In  five  months’  time 
new  bone  could  be  felt,  and  seven  months  from  the  onset  of 
the  disease  he  removed  the  whole  of  the  lower  jaw  except 
the  condyle  on  the  right  side.  The  patient  had,  at  the 
present  time,  a  very  fair  substantial  lower  jaw ;  on  the  left 
side  one  tooth  was  showing.  There  was  no  difficulty  in 
taking  food.  Mr.  Tay  referred  to  cases  published  by  Mr. 
Savory  and  Dr.  Bristowe.  It  was  probable  that  this  was  a 
case  of  phosphorus-necrosis,  as  the  boy  used  to  suck  lucifer- 
matches.  And  he  concluded  by  referring  to  a  case  published 
by  Mr.  Simon,  where  a  man  got  phosphorus-necrosis  by 
sucking  pieces  of  ginger  which  he  kept  in  a  waistcoat  pocket 
along  with  loose  lucifer-matches. 

Card  Specimens. 

Dr.  Sidney  Coupland  :  Ulceration  of  the  Large  Intestine 
ifi'Enteric  Fever. 

Dr.  R.  W.  Burnet  :  Sacculated  Aneurysm  of  the  Aorta. 


King  and  Queen’s  College  of  Physicians  in 
Ireland. — The  following  have  been  appointed  Examiners 
for  the  Membership  and  for  the  Licence  in  Sanitary  Science 
for  the  year  1883- 84.  Membership:  Clinical  Medicine— Drs. 
G.  F.  Duffey  and  J.  M.  Purser;  Principles  of  Medicine, 
Medical  Anatomy  and  Medical  Chemistry— Drs.  Cruise, 
Y.P.,  and  J.  M.  Finny ;  Practice  of  Medicine  and  Principles 
of  Public  Health— Drs.  C.  J.  Nixon  and  F.  J.  B.  Quinlan. 
Sanitary  Science:  Etiology  of  Disease— Dr.  F.  R.  Cruise, 
Vice-President  of  the  College;  Sanitary  Law— George 
R.  Price,  Esq.,  barrister- at-law ;  Sanitary  Engineering— 
Mervyn  Pratt,  C.E.;  Chemistry— Dr.  Walter  G.  Smith; 
Vital  Statistics,  Climatology,  and  Meteorology— Dr.  F.  J.  B. 
Quinlan. 


OBITUARY. 

- ♦ - 

HOTHAM  GEORGE  ORLEBAR,  M.D.,  M.R.C.S. 

Dr.  Orlebar,  whose  untimely  death  from  enteric  fever,  on 
the  1st  inst.,  has  been  heard  with  great  regret  by  all  who 
knew  him,  was  the  youngest  son  of  Admiral  Orlebar,  of  St. 
Leonards-on-Sea.  He  was  born  in  November,  1853,  and  had 
thus  hardly  completed  his  thirtieth  year.  He  received  his 
professional  education  at  St.  Thomas’s  Hospital  and  Aber¬ 
deen,  after  which  he  was  for  three  years  Resident  Medical 
Officer  at  the  Victoria-park  Hospital.  About  two  years  ago- 
he  settled  as  a  general  practitioner  in  the  neighbourhood  of 
Eaton-square,  and  shortly  after  was  elected  one  of  the 
medical  officers  to  the  Royal  Pimlico  Dispensary.  He  entered 
enthusiastically  into  the  work  of  this  institution,  daily 
visiting  a  large  number  of  patients  at  their  own  homes.  He 
was  a  great  favourite  with  all  classes  of  patients,  and  had 
the  prospect  of  a  very  successful  career  before  him.  He  had 
been  out  of  health  for  some  time,  but  his  last  illness  did. 
not  declare  itself  till  the  5th  ult.  He  died  suddenly  at  last, 
but  not  unexpectedly,  from  an  attack  of  hsematemfisis. 


JAMES  MOORE,  M.D.  Edin. 

We  regret  to  announce  the  death  of  this  well-known  surgeon 
and  distinguished  artist.  Dr.  Moore  was  born  in  1819,  studied 
at  Edinburgh,  where  he  graduated  M.D.  in  1842,  taking  his 
Membership  of  the  English  College  of  Surgeons  in  the  same- 
year.  He  was  always  a  clever  draughtsman,  and  when  quite 
a  young  man  prepared  the  illustrations  for  Syme’s  Surgery. 
He  had  a  very  successful  career  as  a  surgeon  in  Belfast,  and 
held  appointments  to  the  Royal  Hospital  in  that  city,  and  to 
the  Ulster  Hospital  for  Diseases  of  the  Eye,  Ear,  and  Throat, 
besides  numerous  minor  honorary  posts.  His  skill  as  an 
artist  was  widely  recognised.  He  received  good  prices  for 
his  pictures,  and  was  elected  an  honorary  member  of  the 
Royal  Hibernian  Academy,  and  an  associate  of  the  Scotch 
Academy.  He  was  also  an  ardent  geologist  and  archaeologist. 
Sir  Charles  Bell  bequeathed  his  case  of  surgical  instruments 
to  Dr.  Moore  as  a  recognition  of  his  proficiency  as  a  surgeon  ; 
Prof.  Goodsir  paid  him  a  similar  compliment  in  leaving 
him  a  silver  case  of  instruments ;  and  Dr.  Thomas  Reade, 
of  Belfast,  likewise  left  him  his  pocket  surgical  case,  with 
the  observation  that  he  knew  no  man  more  competent  to 
use  it. 


PROFESSOR  DEPAUL. 

The  Paris  Faculty  has  sustained  some  serious  losses  during 
the  present  year  in  the  persons  of  Lasegue  and  Parrot,  and. 
now  of  Depaul.  Born  at  Pau,  in  1811,  he  repaired  to  Paris 
at  the  age  of  seventeen,  and  from  that  period  until  his  death 
he  pursued  a  course  of  laborious  and  profitable  industry. 
In  1847  he  became  an  agrdgd  of  the  Faculty,  and  in  1853 
a  hospital  surgeon.  Devoting  himself  to  obstetrics  and 
gymecology,  he  was  one  of  the  favourite  pupils  of  the  cele¬ 
brated  Paul  Dubois  ;  and,  as  his  chef  de  clinique,  assistant, 
frequent  substitute,  and  eventual  successor  in  the  Clinical 
Chair,  he  acquired  an  esteem  for  the  great  accoucheur  which 
almost  amounted  to  veneration.  He  became  a  member  of 
the  Academy  of  Medicine  more  than  thirty  years  ago, 
officiated  for  many  years  as  its  Secretary,  and  in  1873 
was  elected  President.  In  the  numerous  questions  which 
came  before  the  Academy,  relating  to  his  own  branch  of 
the  profession,  he  took  a  prominent  part,  being  an  eloquent 
and  convincing  speaker.  Moreover,  he  did  good  service  in 
that  body  in  his  office  of  Director  of  the  Vaccine  Department, 
which  is  attached  to  the  Academy ;  and  the  firm  hold  which 
the  practice  of  vaccination  has  acquired  in  France  is  due  in 
no  slight  degree  to  his  exposition  of  its  advantages.  One 
of  the  founders,  with  Riyer,  of  the  Biological  Society,  he  also 
set  on  foot,  in  1874,  his  Archives  de  Tocologie.  The  author  of 
numerous  and  important  contributions  to  journals,  societies, 
and  dictionaries,  he  has  left  little  behind  him  in  the  way  of 
substantive  publications.  One  of  these,  however— his  “Traite 
Theorique  et  Pratique  de  l’Auscultation  Obstetricale,”  which 
appeared  at  a  very  early  period  of  ,his  career — was  a  most 
remarkable  production  at  the  time  of  its  publication  in 
1847,  and  has  not  since  been  surpassed  in  exactness  and 
usefulness,  laying  as  it  did  this  important  application  of 
auscultation  on  a  secure  foundation.  Long  ago  he  had 


562 


Medical  Times  and  Gazette. 


MEDICAL  NEWS, 


Nov.  10, 168?,; 


become  the  highest  obstetrical  authority  in  Paris,  and  had 
attained  a  very  large  and  lucrative  private  practice. 
Methodical  in  his  habits,  the  great  amount  of  laborious 
-work  which  he  performed  (having  in  late  years  entered 
even  into  municipal  and  political  life),  never  prevented  his 
strict  fulfilment  of  every  duty  which  he  had  undertaken. 
Whatever  fatigue  he  had  endured,  he  was  always  found  at 
his  clinic  between  seven  and  eight  in  the  morning,  and  at  his 
hospital,  whether  by  day  or  by  night,  he  executed  all  his  opera¬ 
tions  himself.  Possessed  of  herculean  bodily  strength,  which 
allowed  of  his  leading  so  laborious  a  life,  his  friends  only 
perceived  within  the  last  twelve  months  that  his  health 
threatened  to  give  way  ;  and  even  now  he  was  on  the  point  of 
renewing  his  lectures,  after  a  rest  in  his  native  department, 
when  an  attack  of  pneumonia  carried  him  off. 


MEDICAL  NEWS. 


Apothecaries’  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday, 
'^November  1 : — 

Boobbyer,  Philip,  Hillwood,  Hendon,  N.W. 

Taaffe,  John  Ferdinand  Hugh,  Broadstairs. 

Thornton,  Francis  Henry,  Milton-road,  South  Hornsey,  N. 
Waller,  Charles  Brooke,  Ipswich. 


Eoyal  College  of  Surgeons  of  England. — The 
following  gentlemen  passed  their  Primary  Examinations  in 
Anatomy  and  Physiology  at  a  meeting  of  the  Board  of 
Examiners  on  the  5th  inst.,  and  when  eligible  will  be 
admitted  to  the  Pass  Examination,  viz. : — 

Birt,  J.,  student  of  St.  George’s  Hospital. 

Bradshaw,  T.  R.,  Dublin,  of  St.  George’s  Hospital. 

Coad,  J.  E.,  Newcastle,  of  St.  George’s  Hospital. 

Councell,  R.  W.,  Bristol,  of  St.  George’s  Hospital. 

Hamilton,  R.  J.,  Liverpool,  of  St.  George’s  Hospital. 

Jeeves,  F.,  Sheffield,  of  St.  George’s  Hospital. 

Kent,  R.  T.,  of  Guy’s  Hospital. 

Mackay,  W.  B..  of  the  Edinburgh  School. 

Pearce,  F.,  of  Guy’s  Hospital. 

Poonen,  E.,  Madras,  of  St.  George’s  Hospital. 

St.  Romaine,  R.  E.,  Calcutta,  of  St.  George’s  Hospital. 
Sympson,  E.  M.,  of  the  Cambridge  School. 

Traill,  C.  G.,  of  the  Edinburgh  School. 

Two  candidates  were  referred  for  six  months,  and  nine  for 
three  months.  The  following  gentlemen  passed  on  the  6th 
inst.,  viz.  : — 

Ayshford,  G.  R.,  student  of  the  Edinburgh  School 
Baumgartner,  H.  S.,  of  the  Newcastle  School. 

Bewley,  H.  T.,  of  the  Dublin  School. 

Carrol,  J.,  of  the  Dublin  School. 

England,  G.  F.  A.,  of  the  University  of  Cambridge. 

Harvey,  T.  R.  A.,  of  University  College  Hospital. 

Hicks,  E.  H.,  of  St.  Mary’s  Hospital. 

Hubbard,  J.  P.,  of  the  Birmingham  School. 

Mackay,  N.  E.,  of  St.  Thomas’s  Hospital. 

Pringle,  J.  H.,  of  the  Edinburgh  School. 

Sankey,  J.  I.,  of  the  Middlesex  Hospital. 

Scholes,  T.  E.  S.,  of  the  Edinburgh  School. 

Shackleton,  H.,  of  the  Leeds  School. 

Tatham,  E.  J.,  of  the  University  of  Cambridge. 

Tibb,  W.  S.,  of  the  University  of  Cambridge. 

Walker,  E.  H.,  of  the  University  of  Cambridge. 

Seven  candidates  were  referred  for  three  months,  and  one 
for  six  months.  The  following  passed  on  the  7th  inst., 
viz. : — 

Aitkin,  W.  B.,  student  of  the  University  of  Glasgow. 

Brock,  E.  H.,  of  Guy’s  Hospital. 

Brook,  H.  D.,  of  St.  Thomas’s  Hospital. 

Collins,  F.,  of  University  College  Hospital. 

Copeman,  S.  A.  M.,  of  the  University  of  Cambridge. 

Dunn,  P.  H.,  of  St.  Bartholomew’s  Hospital. 

Emmett,  R.,  of  St.  George’s  Hospital. 

Glinn,  C.  F..  of  St.  George’s  Hospital. 

Horner,  C.  J.,  of  St.  Bartholomew’s  Hospital. 

Newbould,  N.  J.,  of  St.  Thomas’s  Hospital. 

Norman,  P.,  of  St.  Bartholomew’s  Hospital. 

Powell,  E.  E.,  of  St.  George’s  Hospital. 

Rigge,  J.  A.,  of  St.  Bartholomew’s  Hospital. 

Sims,  G.  S.,  of  St.  Thomas’s  Hospital. 

Stockton,  H.  S.,  of  the  Charing-cross  Hospital. 

Thomas,  W.  R.,  of  the  London  Hospital. 

Tredennick,  A.  S.,  of  St.  Bartholomew’s  Hospital. 

Walker,  T.  G.,  of  the  London  Hospital. 

Six  candidates  were  referred  for  three  months. 


APPOINTMENTS. 

Buck,  Lewis  A.,  M.R.C.S.,  L.S.A.— House-Surgeon  to  King’s  College 
Hospital. 

Childe,  Charles  P.,  M.R.C.S. — Assistant  House-Surgeon  to  King’s 
College  Hospital. 


Dacre,  John,  M.R.C.S.,  L.R.C.P.  Lond.— Assistant  Medical  Officer  and 
Pathologist  to  the  Bristol  Royal  Infirmary. 

Dent,  Harry  L.  R.,  M.R.C.S.,  L.S.A. — Physician- Accoucheur’s  Assistant 
to  King’s  College  Hospital. 

Lilbubne,  James  T.,  B.A.,  M.R.C.S.,  L.S.A. — Assistant  House-Accou¬ 
cheur  to  King’s  College  Hospital. 

Lynam,  Robert  G.,  M.R.C.S.,  L.S.A.— Physician’s  Assistant  to  King’s 
College  Hospital. 

Russell,  Robert  H.,  M.R.C.S. — House-Surgeon  to  King’s  College  Hos¬ 
pital. 

Short,  Thomas  S.,  M.R.C.S.,  L.S.A.— Assistant  House-Physician  to  King’s 
College  Hospital.  _ 


DEATHS. 

Bell,  George  Coates,  M.D.,  of  Dulwich,  late  Surgeon-Major  Bombay 
Army,  on  October  28,  aged  51. 

Deighton,  John,  M.R.C.S.,  J.P.,  at  Hills-road,  Cambridge,  on  Nov.  3. 

Fbakpton,  Thomas,  M.R.C.S.,  L.R.C.P.,  L.S.A.,  at  62,  Gloucester-terrace, 
Hyde-park,  on  November  5,  aged  66. 

Hilbers,  George  James,  M.D.,  at  8,  Cavendish-place,  Brighton,  on 
Ostober  30,  aged  65. 

Macnaught,  John,  M.D.,  at  15,  Warwick-gardens,  Kensington,  on 
November  3,  aged  90. 

Orlebar,  Hotham  George,  M.D.,  M.R.C.S.,  at  93,  Elizabeth-street,  Eaton- 
square,  on  November  1,  aged  29. 

Soatliff,  J.  Parr,  M.D.,  at  Macaulay  House,  Clapham  Common,  on 
November  6,  aged  64. 

Shuter,  James,  M.A.,  M.B.,  F.R.C.S.,  on  November  1,  aged  37. 


VACANCIES. 

Basford  Union  Rural  Sanitary  Authority.— Medical  Officer  of  Health. 
{For  particulars  see  Advertisement.) 

Gesto  Hospital,  Edinbane,  Skye. — Resident  Medical  Officer.  Salary 
£275,  with  furnished  house,  fire  and  light,  etc.  Applications,  with 
copies  of  testimonials,  to  be  sent  to  J.  MacLennan, 'solicitor,  Portree, 
on  or  before  December  1. 

Great  Northern  Hospital,  Caledonian-road,  N.— House-Surgeon. 
{For  particulars  see  Advertisement.) 

Hospital  for  Sick  Children,  49,  Great  Ormond-street,  W.C.— Surgeon. 

{For  particulars  see  Advertisement.) 

London  Lock  Hospital  and  Asylum,  Westbourne-green,  Harrow-road, 
W.— House-Surgeon  in  the  Female  Department.  Salary  £100  per  annum. 
Applications,  with  testimonials,  to  be  sent  to  the  Secretary  by  Novem¬ 
ber  24.  , 

Queen’s  Hospital,  Birmingham. —  Honorary  Physician.  Candidates 
must  be  graduates  in  medicine  of  a  University,  and  be  Fellows  or 
Members  of  the  Royal  College  of  Physicians  of  London,  or  Fellows  of 
the  King  and  Queen’s  College  of  Physicians,  Ireland,  or  Fellows  of  the 
Royal  College  of  Physicians,  Edinburgh.  The  successful  candidate  is 
prohibited  from  engaging  in  the  practice  of  midwifery,  pharmacy,  or 
surgery  after  his  appointment.  Applications,  testimonials,  and  certi¬ 
ficate  of  registration  to  be  sent  under  cover  to  the  Secretary  (from 
whom  all  further  information  may  be  obtained)  on  or  before  Nov.  26. 

Teignmouth,  Dawlish,  and  Newton  Infirmary  and  Convalescent 
Home. —House-Surgeon  and  Dispenser.  Salary  £71  per  annum,  with 
board  and  lodging.  Candidates  must  be  registered  as  possessing  both 
medical  and  surgical  qualifications,  and  be  unmarried.  Testimonials  of 
moral  character  and  professional  ability  to  be  sent  to  the  Secretary  on 
or  before  November  20. 

Wandsworth  and  Clapham  Union. — Assistant  Medical  Officer.  ( For 

particulars  see  Advertisement.) 


University  of  Edinburgh. — Prof.  Eraser  has  ap¬ 
pointed  Mr.  Atkinson,  M.B.  and  C.M.,  and  Mr.  Stockman, 
M.B.  and  C.M.,  to  be  assistants  in  his  department,  in  room 
of  Dr.  Hay,  now  Professor  of  Medical  Jurisprudence  in  the 
University  of  Aberdeen. 

Army  Medical  Department.  —  Brigade  -  Surgeon 
O.  Barnett,  C.I.E.,  has  been  removed  from  Woolwich  to 
Cork,  iu  anticipation  of  his  promotion  to  Deputy  Surgeon- 
General,  and  charge  of  the  Herbert  Hospital  at  Shooter’s-hill 
has  been  taken  over  by  Surgeon-Major  Mackey,  A.M.D. 

Aberdeen  University. — Prof.  Hay,  who  was  recently 
appointed  to  the  Chair  of  Medical  Jurisprudence  in  Aberdeen 
University,  rendered  vacant  by  the  retirement  of  Prof. 
Ogston,  was  introduced  to  his  class  on  the  29th  ult.  by  Prin¬ 
cipal  Pirie,  and  delivered  bis  first  lecture  on  “  Toxicology.” 

Death  from  Chloroform.— A  death  from  chloroform 
has  occurred  at  the  Seamen’s  Hospital.  The  patient  had  on 
two  previous  occasions  been  operated  on  under  ether,  but  be 
had  suffered  so  much  from  the  effects  of  that  anaesthetic 
that  chloroform  was  administered  instead.  He  died  from 
syncope  before  the  operation  was  begun. 

Sanitary  Institute  of  Great  Britain. — At  an 
examination  of  local  surveyors  and  inspectors  of  nuisances, 
held  on  the  1st  and  2nd  inst.,  ten  candidates  presented 
themselves.  The  Institute’s  certificate  of  competency  to 
discharge  the  duties  of  local  surveyor  was  awarded  to  one 
candidate,  and  the  certificate  of  competency  to  discharge 
the  duties  of  inspectors  of  nuisances  to  five  candidates. 


Medical  Times  and  Gazette. 


VITAL  STATISTICS. 


Nov.  10,  1883.  563 


Roy Aii  Institution  of  Great  Britain. — At  the 
general  monthly  meeting  on  November  5,  Dr.  W.  M.  Ord 
was  elected  a  manager  in  the  room  of  the  late  Mr.  William 
Spottiswoode,  P.E.S. 

The  Edinburgh  Royal  Medical  Society. — The 
146th  session  of  this  Society  was  inaugurated  on  the  2nd 
inst.  by  an  address  delivered  by  Prof.  Chiene.  There  was  a 
large  attendance  of  members  and  medical  students,  the  hall 
of  the  Society  being  quite  full.  Mr.  Chiene  said  that  thelonger 
he  lived  the  more  he  was  confirmed  in  his  impression  that 
it  was  only  by  constant  appeal  to  the  individuality  of  his 
pupils  that  a  teacher  could  encourage  the  growth  and  mental 
development  of  those  whom  he  taught.  In  a  large  school 
like  that  of  Edinburgh  there  was  always  a  danger  of  dog¬ 
matism  and  pulpit  oratory,  which  must  be  guarded  against 
by  each  student  fighting  “for  his  own  hand.”  At  the 
present  day  the  Royal  Medical  Society  was  specially  valu¬ 
able.  This  was  an  age  of  cram,  and  their  Society  was  a 
great  preventive  against  mental  dyspepsia.  Referring  to 
the  Extra-mural  School,  Prof.  Chiene  said  that  to  his  mind 
it  was  one  of  the  great  causes  of  the  continued  success  of 
the  Edinburgh  School  of  Medicine.  The  nursery  was  the 
most  important  room  in  the  house,  and  the  Extra-mural 
School  was  the  nursery  of  the  University.  He  had  once  said 
that  the  Extra-mural  School  was  an  excellent  tonic  to  the 
Professors,  and  he  still  held  to  the  opinion  now  he  was  one 
who  felt  the  benefit  of  the  tonic. 


APPOINTMENTS  EOR  THE  WEEK. 


VITAL  STATISTICS  OF  LONDON. 


Week  ending  Saturday,  November  3,  1883. 


BIRTHS. 

Births  of  Boys,  1310;  Girls,  1313;  Total,  2623. 

Corrected  weekly  average  in  the  10  years  1873-82,  2851 ’9. 


DEATHS. 


Males. 

Females. 

Total. 

Deaths  during  the  week . 

720 

720 

1440 

Weekly  average  of  the  ten  years  1873-82,  i 
corrected  to  increased  population  ...  j 

851-7 

792  5 

1644-2 

Deaths  of  people  aged  80  and  upwards 

... 

... 

56 

DEATHS  IN  SUB-DISTRICTS  FROM  EPIDEMICS. 


Enumerated 

Population, 

1881 

(unrevised). 

Small-pox. 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

1 

&I} 

•2d 

jS  § 

Typhus. 

Enteric  (or 

Typhoid) 

Fever. 

Simple 

continued 

Fever. 

8 

.g 

5 

West . 

669833 

7 

6 

2 

i 

... 

4 

4 

North 

905947 

2 

4 

14 

3 

3 

... 

9 

,,, 

2 

Central  ... 

282238 

1 

4 

... 

2 

... 

2 

... 

1 

East . 

692738 

5 

19 

5 

5 

••• 

5 

1 

4 

South . 

1265927 

1 

6 

18 

3 

3 

1 

4 

1 

6 

Total . 

3816483 

3 

23 

61 

13 

14 

1 

24 

2 

17 

METEOROLOGY. 


November  10.  Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  1 J  p.m. ;  King’s  College,  1£  p.m. ;  Royal 
Free,  2  p.m.;  Royal  London  Ophthalmic,  11  a.m. ;  Royal  Westminster 
Ophthalmic,  li  p.m. ;  St.  Thomas’s,  lj  p.m. ;  London,  2  p.m. 


12.  Monday. 

Operations  at  the  Metropolitan  Free,  2  p.m.;  St.  Mark’s  Hospital  for 
Diseases  of  the  Rectum, 2  p.m.;  Royal  London  Ophthalmic,  11  a.m.; 
Royal  Westminster  Ophthalmic,  1£  p.m. ;  Hospital  for  Women,  2  p.m. 
Medical  Society  of  London,  8g  p.m.  Ordinary  Meeting.  Dr.  F.  de 
Havilland  Hall,  “On  a  Case  of  Malposition  of  a  Tooth  (sequel).” 
Dr.  Stephen  Mackenzie,  “On  Paroxysmal  Hsemoglobinuria.”  Mr. 
Clutton,  “  On  a  Case  of  Fistulee  in  the  Penile  Portion  of  the  Urethra 
Successfully  Treated  by  a  Plastic  Operation  after  Opening  the  Urethra 
n  the  Perineum.” 


13.  Tuesday. 

Operations  at  Guy’s,  ljj  p.m. ;  Westminster,  2  p.m. ;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  li  p.m.;  West 
London,  3  p.m. 

Royal  Medical  and  Chirurgtcal  Society,  S\  p.m.  Mr.  R.  W.  Parker, 
“  On  a  Case  of  Spontaneous  Inguinal  Aneurism  in  a  Boy,  for  which  the 
External  Iliac  Artery  was  Tied;  with  Notes  of  Cases  of  Aneurysm  in 
Young  Persons.” 

14.  Wednesday. 

Operations  at  University  College,  2  p.m. ;  St.  Mary’s,  11  p.m. ;  Middlesex, 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew’s,  li  p.m. ;  Great  Northern, 

2  p.m. ;  Samaritan,  2i  p.m. ;  Royal  London  Ophthalmic,  11  a.m. ; 
Royal  Westminster  Ophthalmic,  li  p.m. ;  St.  Thomas’s,  li  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m. ;  National  Orthopaedic,  Great 
Portland-street,  10  a.m. 

Bbompton  Hospital  foe  Consumption,  etc.,  4  p.m.  Dr.  T.  Henry 
Green,  “  On  the  Treatment  of  Phthisis  in  its  Earlier  Stages.” 
Huntekian  Society  (Council  Meeting,  7i  p.m.),  8  p.m.  Mr.  Charters  J. 
Symonds— A  Recent  Specimen  of  Dislocation  of  Femur,  sequel  to  a 
Case  of  Lupus  of  Foot  (patient  and  microscopic  specimens  to  be  shown'. . 
Dr.  Charlewood  Turner,  “  On  the  Etiology  of  Cerebral  Haemorrhage.” 
Dr.  J.  Herbert  Stowers,  “  On  the  Treatment  of  Acne  Rosacea  and 
Vascular  Hypertrophy  of  the  Nose.” 

Royal  Microscopical  Society,  8  p.m.  Prof.  Abbe,  “  On  the  Relation 
of  Aperture  to  Power  ”  (Part  3) .  Mr.  Crisp,  “  On  Optical  Tube-Length.” 


15.  Thursday. 

Operations  at  St.  George’s,  1  p.m. ;  Central  London  Ophthalmic,  1  p.m. ; 
Royal  Orthopaedic,  2p.m.;  University  College,  2  p.m.;  Royal  London 
Ophthalmic,  11  a.m. ;  Royal  Westminster  Ophthalmic,  li  p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m. ;  Hospital  for  Women,  2  p.m. ; 
Charing-eross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  2£  p.m. 

Medical  Society  of  Charing-cross  Hospital,  8p.m.  Mr.  Garrod,  “On 
a  Visit  to  the  Leper  Hospital  at  Bergen.” 

Parkes  Museum  of  Hygiene,  8  p.m.  Dr.  Robert  J.  Lee,  “On  the  Dis¬ 
infection  of  the  Atmosphere  ”  (the  lecture  will  be  illustrated  by 
Experiments  and  Demonstrations) . 

16.  Friday. 

Operations  at  CentralLondonOphthalmic,  2  p.m.;  Royal  London  Ophthal¬ 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminster 
Ophthalmic,  li  p.m. ;  St.  George’s  (ophthalmic  operations),  If  p.m.; 
Guy’s,  li  p.m. ;  St. Thomas’s  (ophthalmic  operations),  2  p.m.;  King’s 
College  (by  Mr. Lister),  2  p.m. 

Society  of  Medical  Officers  of  Health  (1,  Adam-street,  Adelphi), 
7.30  p.m.  Brigade-Surgeon  Edward  Nicholson,  Army  Medical  Depart¬ 
ment  (retired  list),  “  On  the  Water-Supply  of  Troops  in  India.” 


From  Observations  at  the  Greenwich  Observatory. 


Mean  height  of  barometer  ...  . 

Mean  temperature  . 

Highest  point  of  thermometer 
Lowest  point  of  thermometer 
Mean  dew-point  temperature 
General  direction  of  wind 
Whole  amount  of  rain  in  the  week  . 


...  30051  in. 
...  49  0° 

...  59-8° 

...  429° 

...  46-4“ 

E.  ENE.&ESE. 
...  0  02  in. 


BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  the 
Week  ending  Saturday,  Nov.  3,  in  the  following  large  Towns : — 


Cities 

and 

Boroughs 

Estimated  Population  to 
middle  of  the  year  1883. 

Births  Registered  during 
the  week  ending  Nov.  3. 

1  Deaths  Registered  during 

I  the  week  ending  Nov.  3. 

Annual  Rate  of 
Mortality  per  1000  living, 
from  all  causes. 

Temperature 
of  Air  (Fahr.) 

Temp, 
of  Air 
(Cent.) 

Rain 

Fall. 

Highestduring 
the  Week. 

Lowest  during 
the  Week. 

Weekly  Mean  ol 
Daily  MeanVaiues 

Weekly  Mean  of 
Daily  Mean 
Values. 

In  Inches. 

j  In  Centimetres. 

London  . 

3955814 

2623 

1440 

19-0 

59-8 

42-9  49'0 

9-44 

0'02 

0-05 

Brighton  . 

111262 

55 

32 

150 

57-0 

44-3; 

49-2 

9-55 

0-02 

0-05 

Portsmouth 

131478 

111 

40 

159 

... 

... 

... 

... 

... 

Norwich  . 

89612 

65 

28 

16-3 

... 

... 

... 

... 

... 

Plymouth  . 

74977 

55 

23 

16-0 

594 

487 

52-5 

11-39 

0-57 

1-45 

Bristol . 

212779 

151 

73 

17-9 

57-0 

361 

46-8 

8-23 

007 

o-i» 

Wolverhampton  . 

77557 

66 

23 

155 

58-7 

38-3 

45-7 

7-61 

0-34 

0-85 

Birmingham 

414346 

321 

134 

16-9 

... 

... 

Leicester  ...  ,.. 

1294S3 

92 

49 

19-7 

59-5 

35-8 

46-8 

8-23 

0-22 

0-56- 

Nottingham 

199349 

137 

83 

217 

61-0 

41-2 

48-0  8-89 

o-ii 

0-2S 

Derby . 

85574 

57 

27 

165 

... 

... 

... 

... 

... 

Birkenhead 

83700 

55 

35 

20-6 

... 

... 

... 

Liverpool  . 

566753 

405 

250 

23-0 

569 

41-0 

46-8 

8-23 

0T7 

0-43 

Bolton . 

107862 

71 

51 

24-7 

55-9 

35-7 

454 

7-44 

0-05 

0-13 

Manchester 

339252 

243 

167 

25'7 

•  •• 

... 

... 

... 

... 

Salford  . 

190465 

130 

110 

301 

... 

... 

... 

... 

... 

Oldham  . 

119071 

84 

51 

223 

... 

... 

... 

... 

... 

... 

Blackburn . 

108460 

77 

47 

22-6 

... 

... 

... 

... 

Preston  . 

98564 

71 

57 

30-2 

57-0 

38-0 

47-5 

8-61 

0-06 

015 

Huddersfield  ... 

84701 

61 

36 

22-2 

... 

... 

... 

... 

... 

Halifax  . 

75591 

31 

28 

19-3 

... 

Bradford  . 

204807 

100 

67 

17T 

66-4 

41-0 

47-5 

8-61 

O’ 06 

0-15 

Leeds  . 

321611 

203 

150 

24-3 

59-0 

42-0!  48-4 

9-11 

o-oi 

0-03 

Sheffield  . 

295497 

216 

106 

18-7 

60-0 

39-0 

46-3  7-95 

0-14 

;  0-36 

Hull  . 

176296 

147 

61 

18-1 

60-0 

40-0 

46-9 

8-28 

0-22 

0'56 

Sunderland 

121117 

111 

43 

18-5 

53-0 

40-0 

47-5  8-61 

o-oo 

0-00 

Newcastle  . 

149461 

120 

75 

26-2 

... 

... 

... 

... 

... 

... 

Cardiff . 

90033 

72 

42 

24-3 

... 

... 

... 

... 

... 

... 

For  28  towns... 

5620975 

6930 

3328 

20-1 

61-0 

36-7 

47- e 

8-67 

0T4 

0-35 

Edinburgh . 

235946  194 

86 

19-0 

58-0 

39-2 

47-5 

8-61 

0-03 

0-08 

Glasgow  . 

515589  366 

247 

25-0 

... 

... 

1  - 

... 

1  ••• 

••• 

Dublin . 

1  349-585  174 

189 

28-2 

61-3  36-5149-4  9'66 

lQ-31 

1  0-79 

At  the  Boyal  Observatory,  Greenwich,  the  mean  readin 
of  the  barometer  last  week  was  30’05  in. ;  the  highest  readin 
was  30-27  in.  at  noon  on  Tuesday,  and  the  lowest  29’85  in. 


on  Saturday  morning. 


be  be 


•564 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES 


Nov.  1C,  1883. 


OTES,  QUERIES,  AND  REPLIES. 


•' .V  questinnetlj  mnc^  s^all  learn  mnclj. — Bacon. 

The  Rogers  Testimonial. 

The  following  additional  subscriptions  have  been  received:— C.  H. 
•Cornish,  Esq.,  F.R.C.8.,  Taunton,  £1  Is. ;  Dr.  F.  de  Havilland  Hall, 
46,  Queen  Anne-street,  £1  Is. ;  J.  F.  Churchill,  Esq.,  Chesham,  Bucks, 
£1  is.;  J.  A.  Shaw  Stewart,  Esq.,  71,  Eaton-place  (per  E.  Hart,  Esq.), 
£5 ;  Dr.  Samuel  Benton,  2,  Bennett-street,  St.  James’s  (per  E.  Hart.  Esq.), 
£1  Is. ;  W.  H.  Michael,  Esq.,  64,  Cornwall-gardens,  £2  2s. ;  J.  Raglan 
Thomas,  Esq.,  Llanelly,  £1  Is.;  Dr.  Burchell,  2,  Kingsland-road,  £1  Is.; 
H.  Roberts.  Esq.,  Wickham-terrace,  Lewisham,  £1  Is. ;  Dr.  Eegan,  West- 
combe  Park,  Blackheath,  £1  Is. ;  Dr.  Gay  ton,  Small-pox  Hospital, 
Uomerton,  £1  Is. ;  Dr.  R.  Fowler,  Old  Burlington-street,  £1  Is. :  Dr. 
'Cogswell,  41,  York-terrace,  Regent’s-park,  £6;  Dr.  Rayner,  Middlesex 
Asylum,  Hanwell,  £1  Is. 

The  Hind  Fund. 


A  general  meeting  of  the  subscribers  will  take  place  on  Thursday, 
November  15,  at  the  Briton  Life  Offices,  at  5.30  p.m. 

The  following  additional  subscriptions  have  been  received  and  paid  to 
the  account  of  the  Hind  Fund  at  Messrs.  Coutts’  Bank Dr.  C.  J.  Hare, 
£10  10s. ;  G.  Richmond,  Esq.,  £7 ;  J.  Prince,  Esq.,  £5  5s. ;  Dr.  J.  Hall 
Davis,  £5  ;  F.  D.  Mocatta,  Esq.  (per  Dr.  Archdeckne  Duncan),  £5  ;  T.  W. 
Carmalt  .Tones.  Esq.,  £8s  3s. ;  Three  Friends  at  the  Turkish  Baths,  £3  3s.; 
Dr.  B.  W.  Richardson,  £2  2s. :  Dr.  C.  H.  F.  Routh,  £2  2s. ;  J.  H. 
Callender,  Esq.,  £2  2s.;  A.  H.  Boys, <  Esq.,  £2  2s.;  Dr.  W.  B.  Dalby, 
£2  2s. ;  F.  Le  Gros  Clark,  Esq.,  £2  2s  ;  Major-General  F.  W.  A.  Robson, 
£2;  Dr.  Paul,  £1  Is. ;  G.  Bishop,  Esq.,  £1  Is.;  H.  Taylor,  Esq.,  £1  Is.; 
Malcolm  Morris,  Esq..  £1  Is.;  R.  W.  Dunn,  Esq.,  £1  Is.;  Lennox 
Browne,  Esq.,  £1  Is.;  E.  Bowen,  Esq.,  £1  Is.;  Dr.  Wraith,  £1  Is.;  E. 
Skinner,  Esq.,  £1  Is. ;  C.  D.  Waite,  Esq.,  £1  Is. ;  Dr.  MartindaleC.  Ward, 
£1  Is. ;  Dr.  F.  J.  Corbould,  £1  Is. ;  Samuel  Burrows,  Esq.,  £1  is.;  Dr.  C.  H. 
Browne,  £1  Is.;  “Not  Unmindful,”  £1  Is.:  W.  Davies,  Esq.,  £1  Is.; 

W.  F.  Forsyth,  Esq.,  £1  Is. ;  Dr.  McOscar,  £1  Is. ;  Dr.  Penhall,  £1  Is. ; 
Prof.  R.  Owen,  £1  Is. ;  Sir  W.  Mac  Cormac,  £t  Is. ;  Anatomist,  £1  ts.  ; 
Pupil  (H.).  £1  is.;  W.  B.  Dalby,  Esq.,  £1  :  G.,  £1  ;  Edward  East,  Esq., 
Ws.  fid.  ;  W.  Druitt,  Esq.,  Its.  6d. ;  W.  R.  Dambrill-Davies,  Esq.,  10s.  6d.; 

X.  Y.  Z.,  10s. 

Subscriptions  may  be  paid  to  Dr.  RichardsoD,  F.R.S.  (chairman), 
25,  Manehester-square  ;  .John  Tweedy.  Esq.,  F.R.C.S.,  24,  Harley-street, 
hon.  treasurer  ;  A.  J.  Pepper,  Esq.,  F.R.C.S.,  122,  Gower-street.  or  T. 
Wakley,  jun.,  Esq  ,  L.R.C.P.,  96,  Redcliffe-gardens,  hon.  secretaries  ;  or 
to  Messrs.  Coutts  and  Co..  Strand. 


Eastern  Counties  Idiot  Asylum,  Colchester. — Additions  are  about  to  be 
made  to  this  institution,  at  an  estimated  cost  of  £6900 

Padcliffe  Infirmary,  Cxford.— The  Earl  of  Jersey  has  been  appointed 
president,  vacant  by  the  death  of  the  Duke  of  Marlborough. 

Derby  Infirmary.— The  Committee  announce  that  the  Saturday  collections 
of  the  working  men  have  this  year  amounted  to  upwards  of  £1000. 

London  Water-Supply.— The  Metropolitan  Board  of  Works  have  resolved 
to  introduce  a  Bill  into  Parliament  next  session  in  respect  to  the 
metropolitan  water-supply. 

A.  A.— The  St.  George’s  (East)  Board  of  Guardians  have  decided  that  the 
vacant  office  of  Medical  Superintendent  of  the  Infirmary,  vice  Dr. 
Cooper,  who  has  resigned,  shall  be  open  only  to  married  men  ;  that  the 
age  shall  be  optional:  and  the  salary  £300  a  year,  with  residence,  coals, 
and  gas. 

Unhealthy  Dwellings,  St.  Pancras.—  Dr.  Shirley  Murphy,  Medical  Officer  of 
Health,  reports  that,  after  inspection,  he  found  forty-three  houses 
dangerous  to  health  and  unfit  for  habitation.  The  Yestry  has  referred 
-the  subject  to  the  chief  surveyor. 

Death  from  Snake- Bites.— From  an  official  paper  on  the  number  of  deaths 
from  wild  animals  in  the  Madras  Presidency,  it  appears  they  far  ex¬ 
ceed  that  of  the  previous  year.  The  number  from  snake-bites  alone  is 
given  as  amounting  to  920,  though  there  is  little  doubt  but  that  the 
deaths  from  this  source  are  in  reality  far  more  numerous. 

The  Fisheries  Exhibition.— It  has  been  reported  that  this  Exhibition,  with 
its  annexes,  etc.,  was  undrained,  and  that  several  of  the  Executive 
had  been  ill.  The  buildings,  it  is  further  stated,  are  to  be  properly 
■drained,  and  got  ready  for  the  Food  Exhibition  to  be  held  next  year. 
It  seems  incredible  that  necessary  sanitary  arrangements  should  have 
been  neglected. 

Psoadicus,  psoadic." — Dr.  Robert  Fowler  writes  : — “Dr.  John  Sykes,  who, 
in  your  issue  of  20th  ult.,  seeks  information  about  this  word,  or  these 
words,  will  find  them  respectively  either  in  “  Mayne’s  Expository  Lexi¬ 
con  of  Scientific  Terms,”  or  in  Fowler’s  “  Medical  Vocabulary,”  second 
edition.  The  word  is  derived  from  \l/oa  or  fiha,  pi.  final  or  final,  the 
muscles  of  the  loins  (Liddell  and  Scott),  and  signifies  “  of,  or  belonging 
-to  the  loins,  or  the  psoas  muscles.”  Both  fib*  and  fibai  are  used  by 
Hippocrates. 

Fever  in  Dundee. — The  last  reports  of  the  Medical  Officer  and  the  Sanitary 
Inspector  showed  that  there  was  a  necessity  for  extensive  alterations  and 
improvements  of  several  milk-shops  and  dairies,  also  that  the  measures 
adopted  had  largely  succeeded  in  cheeking  the  fever  epidemic,  as  the 
number  of  cases  was  decreasing,  and  very  few  new  outbreaks  were  being 
reported.  The  present  epidemic  is  a  favourable  opportunity  for  the 
authorities  to  consider  the  question  of  a  new  fever  hospital.  The 
accommodation  for  isolating  epidemic  disease  in  the  city  has  been 
severely  felt— a  deficiency  which  should  unhesitatingly  be  provided  for. 


T.  W.  £?.,  St.  Thomas's  Hospital. — The  unfortunate  gentleman,  Herbert 
Percy  Freund,  who  has  been  so  frequently  charged  at  the  Mansion  House 
with  “brawling”  in  St.  Paul’s  Cathedral,  and  at  last  consigned  by 
the  Lord  Mayor  to  the  City  Lunatic  Asylum,  is  a  son  of  the  late  Dr. 
Freund,  the  founder  of,  and  for  many  years  Physician  to,  the  German 
Hospital. 

Mortality,  Antigua.  — A.  correspondent  writing  from  Antigua  on  the  11th 
ult.,  states  :  — “  During  the  hot  season  the  coloured  population  appears  to 
have  been  literally  decimated.  Making  allowances  for  the  more  healthy 
part  of  the  landward  district  of  St.  John’s  Parish  (the  statistics  being 
made  up  in  parishes),  competent  observers  have  come  to  the  conclusion 
that  the  mortality  of  the  town  of  St.  John’s  is  about  65  per  1000. 
The  explanation  generally  given  is,  that  it  is  infant  mortality,  caused  by 
the  blacks  neglecting  their  offspring.  The  negroes  there  are  not  a 
stalwart  race,  and  are  underfed  and  puny.  The  women  evidently  starve 
their  stomachs  for  the  sake  of  dress  (in  town)  on  Sundays.” 

Primary  Examinations. — The  following  were  the  questions  on  Anatomy  and 
Physiology  submitted  to  the  candidates  for  the  diploma  of  Member  of 
the  Royal  College  of  Surgeons  at  a  meeting  of  the  Board  of  Examiners 
on  the  2nd  inst.,  when  they  were  required  to  answer  four  out  of  the  six 
questions,  both  in  Anatomy  and  Physiology,  viz.  :— Anatomy  (from  one 
to  three  o’clock) :  1.  Describe  the  origin  and  insertion  of  the  muscles  of 
the  orbit,  and  give  their  nervous  supply.  2.  Describe  the  sacrum.  How 
would  you  distinguish  between  the  male  and  female  bone  ?  3.  Describe 
the  dissection  required  to  expose  the  infra-spinatus  muscle.  Give  its 
attachments,  its  blood  and  nerve-supply.  4.  How  would  the  collateral 
circulation  be  carried  on  after  ligature  of  the  third  portion  of  the  sub¬ 
clavian  artery  ?  6.  Describe  the  interior  of  the  larynx.  6.  Give  the 
dissection  required  to  expose  the  profunda-femoris  artery. — Physiology 
(from  four  to  six  o’clock)  :  1.  Name  the  morphological  and  chemical  con¬ 
stituents  of  the  blood.  What  are  the  uses  of  these  constituents  ? 

2.  What  are  the  changes  which  the  food  undergoes  in  the  mouth  ? 

3.  What  is  the  structure  of  a  medium-sized  artery  and  vein  ?  In  what 
way  are  the  arteries  and  veins  concerned  in  the  circulation  of  the  blood  ? 

4.  Describe  the  movements  of  respiration,  and  explain  the  manner  in 

which  the  air  in  the  pulmonary  alveoli  is  renewed.  6.  What  are  the 
chief  ferments  in  the  body  ?  By  what  circumstances  are  their  actions 
facilitated  or  retarded  ?  6.  Describe  the  structure  of  the  iris.  By 

what  nerves  are  its  movements  incited  ?  Mention  the  chief  circum¬ 
stances  which  induce  enlargement  and  contraction  of  the  pupil.  (The 
list  of  successful  candidates  will  be  found  on  another  page.) 

COMMUNICATIONS  have  been  received  from — 

Dr.  Julius  Althaus,  London;  The  Secretary  of  the  Apothecaries’ 
Society,  London;  Mr.  Bacot,  Seaton;  Mr.  T.  H.  Williams,  Denbigh ; 
The  Secretary  of  the  Sanitary  Institute  of  Great  Britain, 
London;  Dr.  Robert  Eowler,  London;  Dr.  Theodor  Puschmann, 
Vienna;  Mr.  H.  Cook,  London;  Dr.  Wynter  Blytb,  Londou ;  The 
Dean  of  the  Medical  Faculty  of  the  University  of  Edinburgh  ; 
Mr.  R.  Brayn,  Woking;  Dr.  Crichton  Browne,  London  ;  Mr.  H.  D. 
Cole,  Southampton;  The  Secretary  of  the  Royal  Institution  of 
Great  Britain,  London;  Mr.  T.  M.  Stone,  Wimbledon;  The  Secre¬ 
tary  of  the  Church  of  England  Temperance  Society,  Loudon  ;  Dr. 
Protheroe  Smith,  London;  The  Secretary  of  the  Paukes  Museum 
of  Hygiene,  Loudon;  Mr.  J.  Chatto,  London;  The  Hon.  Secretary 
of  the  Medical  Society  of  London. 

BOOKS,  ETC..  RECEIVED  - 

The  Patents,  Designs,  and  Trades  Marks  Act,  1883, iby  James  Johnson  and 
J.  H.  Johnson — Charles  Pelham  Villiers  and  the  Repeal  of  the  Com 
Laws— An  Ethical  Symposium,  by  A.  C.  Post,  etc.— A  Summary  of  the 
New  Patent  Act,  1883,  by  W.  Lloyd  Wise -Report  on  the  Health  of  the 
Borough  of  Birmingham  for  the  Quarter  ending  September  29,  1883- 
Army  Medical  Department  Report  for  the  Year  1881— Die  Medicin  in 
Wien,  von  Theodor  Puschmann— Legal  Medicine,  part  ii.,  by  Charles 
Meymott  Tidy,  M.B.,  E.C.S. — Report  on  the  Sanitary  Condition,  etc., 
of  the  Parish  of  St.  Matthew,  Bethnal  Green,  for  the  Year  1882 — The 
Operative  Treatment  of  Intra-Thoraeic  Effusion,  by  Norman  Porritt, 
L.R.C.P.,  M.R.C.S.— Transactions  of  the  American  Otological  Society — 
Good  Remedies  out  of  Fashion,  by  C.  J.  Hare,  M.D.,  etc.— Report  on  the 
Health  of  Bolton  for  18S2— Luther  Commemoration  for  Great  Britain 
and  Ireland— On  Imperfect  Local  Self-Government,  and  its  Results  in 
Manchester,  by  Edwin  Chadwick,  Esq. ,  C.  B.  —Practical  Pathology,  by  G. 
Sims  Woodhead,  M.D.,  E.R.C.P.— The  Sanitary  Chronicles  of  the  Parish 
of  St.  Marylebone,  August  and  September— A  Handbook  of  Hygiene, 
etc.,  by  George  Wilson,  M.A.,  M.D.,  E.R.S.E. — Diseases  of  the  Brain 
and  Spinal  Cord,  by  David  Drummond,  M.A.,  M.D. — Woman  as  a 
Physician,  by  Eugene  F.  Cordell,  M.D.— The  Life  and  Work  of  St.  Paul, 
by  E.  W.  Earrer,  D.D. — Half-Yearly  Report,  etc.,  of  the  Port  of  Loudon 
Sanitary  Committee. 

PERIODICALS  AND  NEWSPAPERS  RECEIVED— 

Lancet— British  Medical  Journal— Medical  Press  and  Circular — Ber¬ 
liner  Klinische  Wochenschrift — Central blatt  fiir  Chirurgie — Gazette 
des  Hopitaux — Gazette  Mddicale— Revista  de  Medicina — Bulletin  de 
1’ Academie  de  M6deeine— Pharmaceutical  J ournal — W iener  Medi cinische 
Wochenschrift — Revue  Mfidicale— Gazette  Hebdomadaire— Nature- 
Boston  Medical  and  Surgical  Journal— Louisville  Medical  News — 
Centralblatt  fiir  Gynakologie — Le  Concours  Medical— Centralblatt  fttr 
die  Medicinischen  Wissenschaften— Centralblatt  fiir  Klinische  Medicin 
— Philadelphia  Medical  News— Le  ProgrSs  Mddieal — New  York  Medical 
Journal — Edinburgh  Clinical  and  Pathological  Journal— Students’  Jour¬ 
nal  and  Hospital  Gazette— New  York  Medical  Record— Edinburgh 
Medical  Journal— Monthly  Homoeopathic  Review  — Glasgow  Medical 
Journal — L’Impartialite  Medicale — Fireside  News — Revue  Mensuelle  de 
Laryngologie.  d’Otologie,  etc.— Boy’s  Own  Paper— Girl’s  Own  Paper — 
Sunday  at  Home— Friendly  Greetings— Leisure  Hour  —  Ophthalmic 
Review— American  Journal  of  the  Medical  Sciences— Brain. 


Medical  Tim 


V^'RAQTOROX7^ 

\\ V  u  BRA  R  y  J*, 


SUTHERLAND  ON  INSANITY. 


Nov.  17, 1S83.  5  65 


JLECTURES  ON  INSANITY. 

Delivered  at  the  Westminster  Hospital,  June,  1883. 

By  HENRY  SUTHERLAND,  M.D., 

iPhysician  to  Otto  House  and  Blacklands  House  Lunatic  Asylums,  etc. 


Lecture  II. 

SIMPLE  INSANITY  AND  ITS  SUBDIVISIONS. 

Premonitory  Synptoms. 

The  premonitory  symptoms  of  insanity  are  so  insidious  in 
their  approach  that  it  is  impossible  for  even  a  skilled 
observer  to  detect  them,  unless  he  may  remember  the  same 
to  have  previously  occurred  before  an  attack  in  the  same 
patient.  Two  instances  have  lately  come  under  my  notice, 
in  which  extraordinary  acts  were  committed  ten  years  before 
the  symptoms  were  sufficiently  developed  to  be  brought 
under  medical  observation.  On  both  occasions  these  symp¬ 
toms  passed  off,  and  the  patient  remained  well  mentally  till 
a  few  weeks  before  the  outbreak.  One  of  these  was  a  case 
of  mania  occurring  regularly  every  spring ;  the  other  was  a 
case  of  general  paralysis. 

These  premonitory  symptoms  are  too  numerous  to  be 
■described  at  length,  but  we  may  mention  three  which 
appear  to  be  common  to  every  form  of  mental  disorder. 
They  are — 

1.  Headache. 

2.  Loss  of  sleep ;  and 
Alteration  of  character. 

1.  Headache  is  due  to  various  causes.  It  may  be  anaemic, 
the  result  of  a  deficiency  of  blood  in  the  brain.  It  may  be 
hypersemic,  caused  by  too  great  fulness  of  the  cerebral 
vessels.  And  it  may  also  depend  upon  an  irregularity  of  the 
blood-supply  to  the  brain.  The  blood  may  also  be  poisoned 
by  alcohol,  by  bile,  or  other  morbid  fluids.  It  may  be,  and  often 
is,  due  to  the  influence  of  several  causes  combined.  To  treat 
this  symptom  successfully  a  careful  inquiry  must  be  made 
into  the  physical  condition  and  previous  habits  of  the  patient. 
For  at  this  stage  the  exhibition  of  appropriate  drugs  may 
actually  avert  an  attack  of  insanity.  And  if  that  is  beyond 
our  skill,  we  may  certainly  make  the  expected  attack  far 
less  violent,  far  shorter  in  duration,  and  consequently  far 
less  expensive  to  the  patient’s  friends. 

2.  Loss  of  sleep  is  a  very  frequent  symptom  in  the  early 
stages  of  insanity.  Like  headache,  it  is  frequently  due  to 
some  disordered  condition  of  the  blood,  as  well  as  to  the 
mental  anxiety  which  often  harasses  the  patient  at  this 
period.  Volumes  might  be  written  upon  this  one  point 
alone,  but  we  shall  here  only  allude  to  the  remarks  of  Dr. 
Mortimer  Granville :  that  healthy  sleep  is  an  aggregation 
■of  several  sleeps — sleep  of  the  muscles,  sleep  of  the  brain, 
sleep  of  the  digestive  and  sexual  organs,  sleep  of  the  special 
senses.  If  one  of  these  items  is  wanting,  sleeplessness  or 
unhealthy  sleep  is  the  result.  The  mere  mention  of  these 
points  suggests  an  endless  variety  of  treatment,  for  which 
we  must  refer  you  to  Dr.  Granville’s  able  works. 

3.  But  it  is  in  alteration  of  character  that  we  have  the 
most  marked  outward  and  visible  signs  of  an  approaching 
attack  of  insanity. 

Forgetfulness  in  the  punctual  man,  irritability  in  the 
kind-hearted,  extravagance  in  the  thrifty,  drunkenness  in 
■the  sober,  sexual  excesses  in  those  who  have  been  remark¬ 
able  for  the  virtuous  aspect  of  their  lives  (these  two  last- 
mentioned  being  often  supposed  to  be  the  causes,  when  they 
are  really  only  premonitory  symptoms) ;  these  and  similar 
contradictory  signs  are  those  which  first  sound  the  note  of 
alarm,  and  which,  in  those  who  have  had  a  previous  attack, 
indicate  that  undoubtedly  a  second  one  may  be  shortly 
expected. 

Delusion. — Passing  over  the  various  premonitory  symp¬ 
toms,  all  of  which  have  caused  more  or  less  anxiety  to  the 
patient’s  friends,  let  us  now  suppose  that  he  has  crossed  the 
line  which  separates  sanity  from  insanity,  and  that  he  has 
become,  legally  speaking,  a  lunatic,  that  he  is  the  victim  of 
one  or  more  delusions. 

Quoting  Dr.  Blandford’s  work  from  memory,  we  may  say 

Vol.  II.  1883.  No.  1742. 


that  the  insane  may  believe  in  what  is  false  in  three  different 
ways,  namely,  by  being  under  a 

Delusion, 

Illusion,  or 

Hallucination. 

A  short  explanation  of  these  terms  may,  perhaps,  be  here 
aporopriate  : 

A  Delusion  is  of  the  Mind. 

An  Illusion  is  of  the  Senses. 

An  Hallucination  is  also  of  the  Senses. 

The  following  definitions  are  slightly  altered  from  Dr. 
Blandford’s  valuable  book : 

A  Delusion  is  an  erroneous,  persistent,  and  absurd  belief 
in  some  fact  which  does  not  exist,  and  which  usually  relates 
to  the  patient  himself.  Example  :  He  is  under  the  delusion 
that  his  nose  is  too  big  to  pass  through  the  doorway. 

An  Illusion  is  an  erroneous  perception  by  some  one  of  the 
senses  of  something  which  has  no  existence,  but  which  there 
are  some  grounds  for  believing  does  exist.  Example  :  He  is 
under  the  Illusion  that  voices  are  whispering  into  his  ear, 
but  in  reality  it  is  only  the  wind  whistling  in  the  chimney. 

An  Hallucination  is  an  erroneous  perception  by  some  one 
of  the  senses  of  something  which  has  no  existence,  and 
which  there  are  no  grounds  for  believing  to  exist.  Example: 
He  hears  voices  talking  to  him  at  night,  when  in  reality 
there  is  no  sound  of  any  kind  to  be  heard. 

Symptoms  op  Insanity. 

I  shall  now  endeavour  to  bring  before  you  some  of  the 
most  common  forms  and  symptoms  of  insanity ;  but  to  make 
a  selection,  and  especially  a  short  selection,  from  the  expe¬ 
rience  of  some  hundreds  of  cases,  is  a  task  of  no  small 
difficulty.  “  Where  is  the  man,”  says  Esquirol,  “  who  would 
dare  to  flatter  himself  that  he  had  observed,  and  could  de¬ 
scribe,  all  the  symptoms  of  mania,  even  in  a  single  case  P 
The  maniac  is  a  Proteus,  who,  assuming  all  forms,  escapes 
the  observation  of  the  most  practised  and  watchful  eye.” 

After  such  a  statement  as  that  from  the  iEsculapius  of 
Psychology,  I  can  do  no  more  than  describe,  as  briefly  as 
possible,  a  few  cases  from  my  own  practice,  illustrating  the 
varieties  of  insanity  enumerated  in  the  Nomenclature  of  the 
College  of  Physicians.  I  shall  also  give  some  hints  for 
treatment,  although  these  must  naturally  vary  in  every 
case. 

I. — Mania. 

This  may  be  Acute,  Acute  Delirious,  Chronic,  or  Recur¬ 
rent.  Acute  is  generally  curable.  Chronic  frequently 
incurable.  The  term  “  Recurrent  ”  is  somewhat  vague, 
as  it  may  be  applied  to  a  patient,  who  is  a  permanent 
resident  in  an  asylum,  who  has  occasional  attacks  of  vio¬ 
lence,  being  quiet  in  the  intervals  ;  or  to  one  who  leaves  the 
asylum,  and  returns  again  the  victim  of  another  attack. 
If  the  patient  is  discharged  “  recovered”  from,  a  first  attack, 
and  again  admitted,  it  ought  to  be  called  a  second  attack. 
If  he  is  discharged  “  relieved,”  or  “not  improved,”  and  is 
again  admitted,  then  the  case  should  be  classed  as  one  of 
Recurrent  Mania. 

Here  is  a  case  of  Chronic  Mania.  A  lady  of  good  educa¬ 
tion,  aged  fifty,  very  handsome,  the  wife  of  a  medical  man. 
At  times  she  recovers,  and  goes  into  society.  Here  she 
picks  up  all  the  scandal  she  can  hear  against  the  officials  of 
the  asylum.  When  she  returns  with  another  attack,  she 
bawls  out  the  most  private  matters  about  the  said  officials 
to  the  other  patients  and  attendants.  She  tears  up  the 
flooring  of  her  room,  blacks  the  eyes  of  all  the  attendants, 
uses  foul  and  blasphemous  language,  runs  barefooted  over 
the  flower-beds,  wears  her  watch  in  her  hat,  passes  fasces 
and  urine  in  her  room,  and  makes  herself  generally  dis¬ 
agreeable.  Sedatives  have  little  or  no  effect  upon  her, 
antimony  in  large  doses  being  the  only  drug  that  is  of  any 
use. 

The  best  sedatives  in  Mania  are  bromide  of  potassium, 
chloral,  bimeconate  of  morphia,  and  tartrate  of  antimony. 
The  bromide  can  be  given  in  beef-tea,  chloral  in  port  wine 
or  beer,  morphia  in  coffee,  and  antimony  is  tasteless  in  any 
liquid. 

I  find  disguising  drugs  is  a  much  pleasanter  mode  of 
administration  than  subcutaneous  injection,  which  often 
causes  a  feeling  of  enmity  between  the  doctor  and  his  patient, 
and  should  only  be  resorted  to  where  medicine  is  refused. 
In  Acute  Mania,  food  and  stimulants  must  be  given  at  fre¬ 
quent  intervals  if  the  case  is  of  the  asthenic  type.  The 


566 


Medical  Times  and  Gazette. 


SUTHERLAND  ON  INSANITY. 


Nov.  17,  1397. 


patient  should  also  be  kept  lying  down  as  much  as  possible. 
As  a  rule,  the  milder  purgatives  are  indicated  in  insanity, 
such  as  citrate  of  magnesia,  syrup  of  senna,  Hunyadi  Janos 
and  vEsculap  waters,  and  rhubarb  pills  for  trustworthy 
patients.  A  powerful  purge  is  often,  however,  of  great 
value  as  a  sedative  measure. 


II. — Melancholia. 

A  gentleman  under  my  care  has  Chronic  Melancholia. 
He  has  the  delusions  that  he  is  suffering  from  hydrophobia, 
and,  in  consequence,  he  constantly  barks ;  that  he  has  been 
changed  at  birth  with  an  attendant  of  the  asylum ;  that 
if  another  patient  puts  his  leg  up  it  causes  him  (the 
melancholiac)  pain  in  the  liver.  He  stands  still  all  day,  but 
will  walk  if  led  by  an  attendant.  He  is  not  suicidal,  this 
being  the  chief  characteristic  of  melancholia.  He  also  takes 
food  well,  which  is  not  common  in  this  disease.  Opium  and 
morphia  are  peculiarly  indicated  in  melancholia.  If  the 
symptoms  are  not  allayed  by  a  soporific  dose,  the  drugs  may 
be  given  during  the  day  with  the  object  of  stupefying  the 
patient  and  making  him  forget  his  woes.  Ether  or  bark 
may  be  added  to  the  tincture  of  opium  or  liquor  morphise 
bimeconatis.  There  is  a  peculiar  form  of  this  disorder 
known  as  Melancholia  Attonita.  The  diagnosis  between 
this  and  Acute  Dementia  is  sometimes  very  difficult.  There 
are  some  cases  which  might  be  classed  under  either  head. 
Melancholia  may  be  subdivided  into  Acute,  Chronic,  and 
Becurrent.  The  great  point  to  remember  about  the  disease 
is  that  most  melancholiacs  have  suicidal  tendencies,  against 
which  we  must  take  proper  precautions. 


III. — Dementia. 


Dementia  may  be  Acute,  Chronic,  Becurrent,  Senile,  or 
Organic. 

Acute  Dementia  is  a  very  peculiar  disease,  in  that,  although 
it  is  called  “  acute,”  yet  there  are  no  febrile  symptoms.  A 
short  table  of  the  distinctions  between  it  and  Melancholia 
Attonita  may  here  be  given. 

Acute  Dementia.  Melancholia  Attonita. 


Cause  none  or  ill-defined. 

In  comparatively  young 
people. 

Not  suicidal. 

Do  not  refuse  food  as  a  rule. 

Sleep  fairly  well. 

Attack  commences  with  ex¬ 
citement. 

Motionless  or  only  automatic 
movements. 

Expression  idiotic. 

Hands  and  feet  blue  with 
cold. 

Chilblains  in  the  summer. 

Wet  and  dirty. 

Fasces  accumulate. 

Transitory  attacks  of  excite¬ 
ment. 

Lethargy  and  anaesthesia. 

Occasional  vomiting. 


Cause  defined. 

In  older  people. 

Suicidal. 

Often  refuse  food. 

Sleep  very  badly. 

Attack  commences  with  de¬ 
pression. 

Frequently  much  motion, 
wringing  of  hands,  etc. 

Expression  of  some  fixed  emo¬ 
tion. 

Hands  hot,  clammy,  or  dry. 

No  chilblains. 

Not  wet  and  dirty. 

Bowels  confined,  but  not  so 
obstinate. 

None. 

Morbid  excitability. 

Vomiting  rare. 


Acute  Dementia  is  also  called  Primary  Dementia,  as 
opposed  to  Chronic  Dementia,  which  often  succeeds  some 
other  form  of  mental  disorder. 

Dementia  may  be  also  recurrent,  or  may  alternate  with 
conditions  of  Mania  and  Melancholia. 

Senile  Dementia  is  a  condition  produced  by  the  natural 
decay  of  the  brain  from  old  age.  It  is  not  a  form  of  insanity 
likely  to  affect  the  patient’s  children,  as  its  existence  is 
only  another  kind  of  “  breaking  up  ”  of  the  organism,  which 
might  possibly  have  made  its  appearance  as  disease  of  the 
lungs,  heart,  or  kidney.  Such  cases  are  important  medico- 
legally,  as  it  is  at  this  period  of  second  childhood  that 
designing  women  often  succeed  in  inducing  old  men  to 
marry  them,  or  to  leave  them  property  to  the  exclusion  of 
deserving  relatives. 

Case  of  Chronic  Dementia. — A  gentleman  under  my  care 
sits  in  a  chair  all  day  with  his  legs  crossed.  One  hand  is 
employed  in  rubbing  the  knee  of  his  trousers,  which  he 
speedily  wears  out;  the  other  holds  an  ivory  paper-knife, 
which  he  perpetually  turns  round  and  round.  He  never 


speaks.  He  is  dressed,  undressed,  and  washed,  but  can  feed1 
himself.  He  walks  out  daily.  There  is  no  loss  of  power- 
He  is  in  good  health. 

IV. — Monomania. 

According  to  Esquirol,  this  is  a  condition  of  mental  exalta¬ 
tion,  in  which  the  patient  is  always  happy.  Under  this- 
head  come  the  insane  kings  and  queens,  the  “  show  cases  ” 
of  asylums.  Their  delusions  are  incompatible  with  their 
actions.  At  Brookwood  there  is  a  male  patient  who  fancier 
he  is  the  Duke  of  Gloucester,  and  is  permitted  to  wear 
Court  dress  in  the  evening  on  festive  occasions.  Neverthe¬ 
less,  he  is  not  above  scrubbing  the  pots  and  pans  in  the 
scullery  during  the  day. 

A  lady  under  my  care  writes  letters  to  all  the  crowned 
heads  of  Europe,  directing  all  the  political  and  military 
matters  of  the  different  countries.  She  is  never  surprised, 
that  she  receives  no  response,  but  goes  on  writing  perpetu¬ 
ally  all  the  same.  This  she  has  done  for  many  years.  The 
exalted  delusions  of  Monomania  differ  from  those  of  General 
Paralysis  in  that  they  are  generally  few  in  number,  and 
stationary,  whereas  those  of  General  Paralysis  are  varied 
and  cumulative.  Such  patients  are  usually  in  good  health,, 
but  their  mental  condition  is  incurable. 

V. — Puerperal  Insanity. 

Puerperal  Insanity  is  of  three  kinds— of  Pregnancy,  of' 
Parturition,  and  of  Lactation.  Half  the  cases  are  due  to 
hereditary  taint.  Esquirol  believes  that  half  are  also  caused 
by  the  birth  of  illegitimate  children.  It  generally  occurs  in 
primiparas,  between  the  ages  of  twenty  and  thirty.  Mental, 
anxiety,  physical  causes,  especially  blood-poisoning,  haemor¬ 
rhage,  and  “  milk  ”  fever  also  act  as  accessory  causes. 

A.  Insanity  of  Pregnancy. — Out  of  155  cases  of  Puerperal 
Insanity,  28  were  those  connected  with  pregnancy  (Batty 
Tuke).  The  form  of  mental  disease  in  such  cases  is  suicidal 
melancholia.  The  prognosis  is  favourable.  Dr.  Blandford 
does  not  think  the  induction  of  premature  labour  justifiable 
as  a  preventive  measure. 

B.  Insanity  of  Parturition. — The  form  in  Insanity  off 
Parturition  is  usually  Mania,  although  Melancholia  and 
Dementia  are  occasionally  met  with.  Of  57  cases  under 
the  care  of  Sir  George  Burrows,  33  were  Maniacs,  26  Melan¬ 
choliacs,  and  8  had  Mania  and  Melancholia  alternately. 
Esquirol  affirms  that  40  per  cent,  of  these  cases  occur  within 
the  first  fortnight. 

Premonitory  Symptoms  :  Bestlessness  ;  diminution  or  sup¬ 
pression  of  the  milk  and  lochia ;  tongue  white ;  bowels 
loaded ;  urine  scanty ;  pulse  rapid,  generally  about  100  (if 
over  100  the  prognosis  is  unfavourable,  if  as  high  as  120  the 
disorder  is  almost  surely  fatal). 

There  is  incessant  talking,  with  occasional  violence,  aver¬ 
sion  to  the  husband  and  child,  angry  gesticulation,  and  very 
obscene  language.  Brierre  de  Boismont  has  remarked  that 
prostitutes  who  are  attacked  by  Puerperal  Insanity  rave 
about  riches  and  ambition,  and  do  not,  as  a  rule,  use  bad 
language.  The  special  senses  become  very  acute,  there  is 
suicidal  tendency,  giddiness,  headache,  and  dilatation  of 
the  pupils. 

In  the  depressed  form  there  is  often  sullen  silence,  and 
in  the  demented  form  confusion  of  thought,  and  loss  of 
memory. 

C.  Insanity  of  Lactation. — Out  of  54  cases  of  this  kind, 
39  were  Melancholiacs,  10  Maniacs,  and  5  Dements  (Batty 
Tuke).  It  is  due  to  nervous  exhaustion  from  over-suckling,, 
and  consequent  supply  of  deteriorated  blood  to  the  nerve- 
centres.  The  Mania  of  this  form  is  severe,  but  evanescent ; 
it  usually  lasts  about  ten  days.  It  is  sometimes  produced, 
by  sudden  weaning.  Dr.  Blandford  has  noticed  exoph¬ 
thalmia  and  bruit  de  diable  in  this  form. 

The  prognosis  is  usually  good  in  Puerperal  Insanity  of  all 
kinds.  Out  of  ninety-two  cases  of  Esquirol’s,  six  only  died. 
It  is,  however,  always  fatal  if  complicated  with  Bright’s 
disease  (Pedler).  Dr.  Webster  has  stated  that  three  out  of 
five  recover  within  the  year.  The  outlook  is  favourable  if 
the  lochia  and  milk  return ;  and,  later  on,  the  accession  of  the- 
catamenia  is  a  good  omen. 

The  Insanity  of  Pregnancy  and  Lactation — both  conditions 
of  asthenia— is  therefore  usually  Melancholia.  The  Insanity 
of  Parturition — a  condition  of  more  or  less  physical  and. 
mental  excitement — is  Mania. 

The  treatment  consists  chiefly  of  a  judicious  selection  off 


Medical  Times  and  Gazette. 


HERMAN  ON  HODGE’S  PESSARY. 


Nov.  17, 1883.  567 


nourishment,  stimulants,  and  sedatives.  A  good  purge  or 
an  injection  should  he  given  at  once.  A  mixture  of  bromide 
•of  potassium  and  tr.  ferri  perchloridi  is  very  appropriate  in 
many  cases.  The  secretion  of  milk  should  be  encouraged  by 
applying  the  child  to  the  breast,  or  by  the  use  of  the  breast- 
pump  ;  and  of  the  lochia,  by  warm  baths,  poultices,  spongio- 
piline  soaked  in  hot  water  and  placed  over  the  vulva,  and 
stimulating  enemata.  Opium  and  morphia  are,  as  a  rule, 
contra-indicated,  and  should  only  be  given  if  chloral  and 
bromide  fail  to  act.  The  room  should  be  kept  dark  and 
quiet,  and  all  unnecessary  visitors  should  be  excluded. 
iSuccus  conii  is  useful  in  cases  accompanied  by  great  mo¬ 
bility,  and  tr.  belladonnse  is  sometimes  appropriate  in  hys¬ 
terical  cases.  A  blister  to  the  nape  of  the  neck  is  sometimes 
useful  to  wake  a  patient  up  in  a  protracted  case  of  Puerperal 
Dementia.  Strong  soups,  beef -tea,  eggs,  milk,  and  wine 
may  be  given ;  but  brandy  should  be  avoided  unless  the 
pulse  be  over  100,  in  which  case  it  may  be  administered 
freely. 

The  patient  should  avoid  mental  anxiety  and  violent 
•exercise  during  pregnancy,  and  should  endeavour  to  improve 
her  bodily  health  in  anticipation  of  the  important  event. 

In  treating  a  case  of  Puerperal  Insanity,  you  must  be 
polite  but  firm  in  your  manner  to  the  patient ;  you  must 
show  her  that  you  are  the  master,  and  that  you  intend  to 
have  your  instructions  carried  out.  You  will  often  find  that 
the  friends  who  appear  to  be  most  distressed  about  the 
patient’s  condition  are  the  very  people  whose  unkindness 
has  caused  her  insanity.  All  such  persons  must  be  rigidly 
•excluded  from  the  sick-room  if  you  wish  your  treatment  to 
be  of  any  avail  in  this  interesting  and  usually  hopeful  class 
•of  cases. 


HODGE’S  PESSARY  AND  ITS 
MODIFICATIONS,  (a) 

By  G.  ERNEST  HERMAN,  M.B.  Bond.,  M.R.C.P.  Bond., 

F.R.C.S.  Eng., 

Obstetric  Physician  to,  and  Lecturer  on  Midwifery  at,  the  London 
Hospital ;  Physician  to  the  Royal  Maternity  Charity ;  Examiner  in 
Midwifery  to  the  Royal  College  of  Surgeons  of  England,  etc. 

All  who  have  paid  attention  to  the  diseases  peculiar  to 
women  are  agreed  that  Hodge’s  pessary  is  a  very  useful 
instrument.  It  has  therefore  been  extensively  used  and 
much  modified.  It  is  indeed  itself  a  modification  of  an  older 
pessary.  Dr.  Hodge  began  with  the  simple  ring,  and  his 
•efforts  to  improve  upon  this  resulted  in  the  pessary  with 
which  his  name  is  connected.  I  propose  to  ask  your  atten¬ 
tion  to  this  instrument — what  it  does,  and  how  it  does  it ; 
and  to  the  advantages  and  disadvantages  of  some  common 
variations  in  its  construction  and  shape. 

Hodge’s  pessary  is  essentially  this :  a  rigid  frame  which 
prevents  inversion  of  the  vagina.  This  effect  is  the  only  one 
it  invariably  produces.  The  great  merit  of  Hodge’s  inven¬ 
tion  appears  to  me  this :  that  he  discovered  the  shape  of 
pessary  which,  without  exerting  undue  pressure  at  any 
point,  keeps  the  walls  of  the  vagina  extended  to  a  greater 
■degree  than  any  other.  There  is  abundant  evidence  to  show 
that  imperfection  of  the  vagina  is  not  by  itself  enough  to 
produce  displacement  of  the  uterus.  But  it  is  also  the  fact 
that  no  displacement  of  the  uterus,  except  flexion,  can  occur 
without  some  change  in  the  shape  of  the  vagina.  Conse¬ 
quently,  if  we  can  prevent  change  in  the  shape  of  the  vagina, 
we  can  greatly  limit  displacement  of  the  uterus. 

In  a  discussion  reported  in  vol.  xxii.  of  the  Transactions 
of  the  Obstetrical  Society  of  London,  Dr.  Graily  Hewitt 
made  the  following  remarks: — “His  own  experience  was 
“that  descent  of  the  uterus  was  almost  universally  present  in 
cases  of  flexion—  it  formed  an  almost  essential  part  of  the 
disorder.”  (b)  My  opinion,  if  I  may  presume  to  add  it  to 
That  of  Dr.  Hewitt,  is  quite  in  accord  with  his  as  to  the 
almost  constant  association  of  descent  of  the  uterus  with 
■flexion  in  the  cases  in  which  the  displacement  gives  rise  to 
symptoms.  I  follow  him  in  believing  that  in  such  cases 
descent  is  “an  essential  part  of  the  disorder.”  But  I  would 


(a)  Read  before  the  East  London  and  South  Essex  district  of  the  Metro¬ 
politan  Counties  branch  of  the  British  Medical  Association. 

,(b)  Page  210. 


go  further,  and  say  that  it  is  the  only  essential  part,  and 
that,  as  a  rule,  whether  the  uterus  is  bent  or  not  is  unim¬ 
portant.  I  would  also  venture  to  differ  from  Dr.  Hewitt  as 
to  the  universality  of  the  association  of  flexion  with  descent, 
although  accepting  his  teaching  as  to  the  importance  of  the 
latter.  His  conclusions  seem  to  me  erroneous,  because  the 
data  on  which  they  are  based  are  one-sided,  consisting  only 
of  observations  of  cases  in  which  flexion  was  associated  with 
symptoms,  and,  unfortunately,  not  also  including  an  in¬ 
vestigation  into  the  frequency  with  which  flexion  of  the 
uterus  occurs  in  health.  Vedeler,  who  has  studied  the  latter 
problem  upon  a  larger  scale  than  anyone  else,  found  that 
in  1504  women  free  from  every  kind  of  uterine  symptom, 
flexion  of  the  uterus,  either  forward  or  backward,  was 
present  in  977,  or  64-3  per  cent.  These  figures  include 
anteflexion,  which,  as  I  think,  is  not  a  morbid  condition,  but 
one  of  the  natural  shapes  which  the  uterus  may  have.  From 
the  evidence  afforded  by  these  and  similar  figures,  as  well  as 
from  observations  of  my  own,(c)  I  believe  that  flexion  of  the 
uterus  often  is  present  without  any  descent,  and  therefore 
without  any  symptoms. 

Putting  aside,  however,  this  controverted  question,  it 
may  be  pointed  out  that  retroversion  of  the  uterus  cannot 
occur  without  displacement  forwards  of  the  upper  end  of 
the  vagina.  When  simple  prolapse  of  the  uterus  takes 
place,  the  vagina  becomes  inverted,  its  upper  part  (with 
the  uterus)  sinks  into  the  lower,  and  this  inversion  in¬ 
creases  with  the  degree  of  the  prolapsus  until  the  vagina 
becomes  turned  inside  out.  If  we  prevent  this  inversion 
of  the  vagina  from  taking  place,  we  prevent  the  uterus 
from  coming  down;  and  if  we  hinder  the  upper  end  of 
the  vagina  from  moving  forwards,  we  hinder  also  the  cervix 
uteri  from  doing  so,  and  thus  prevent  retroversion.  This 
is  the  function  of  Hodge’s  pessary  :  to  prevent  inver¬ 
sion  of  the  vagina,' and  to  prevent  the  upper  end  of  the 
vagina  from  moving  forwards.  It  does  this  by  filling  that 
canal  with  a  relatively  rigid  frame.  This  effect  a  properly 
fitting  Hodge  always  produces  ;  its  effect  upon  the  shape 
and  position  of  the  uterus  is  not  always  the  same,  and  is  in 
many  cases  unimportant. 

But  the  usefulness  of  Hodge’s  pessary  is  not  confined  to 
cases  of  simple  prolapse  or  of  retroversion.  Retroversion  is 
often  combined  with  retroflexion.  In  many  such  cases  we 
are  able,  by  the  use  of  this  instrument,  to  place  and  keep 
the  uterus  in  a  position  of  anteversion ;  and  when  this  is 
done,  the  intra-abdominal  pressure  (which,  when  the  uterus 
was  retroverted,  acted  on  its  anterior  surface,  forced  the 
fundus  lower  down,  and  so  produced  bending  of  the  organ) 
acts  on  the  posterior  surface  of  the  uterus,  and  opposes  the 
continuance  of  the  flexion.  In  this  way  Hodge’s  pessary 
will  often  remove  retroflexion. 

But  this  effect  upon  retroflexion  is  not  invariable.  If  the 
uterine  tissue  be  very  soft,  so  as  to  bend  very  easily,  then 
the  effect  of  the  pessary,  in  pushing  the  posterior  vaginal 
cul-de-sac  upwards  and  backwards,  may  only  be  to  pull  the 
cervix  upwards  and  backwards  without  altering  the  position 
of  the  body.  If  this  be  the  effect,  the  cervix  will  be  drawn 
closer  to  the  body,  the  bend  will  be  made  sharper,  and  the 
end  of  the  pessary  will  enter  the  angle  on  the  concavity  of 
the  flexed  uterus. 

There  are  also  cases  of  retroversion  in  which  Hodge’s 
pessary  fails  to  antevert  the  uterus.  In  some  women  the 
uterus  is  found  lying  in,  or  nearly  in,  the  axis  of  the  pelvic 
outlet,  its  position  appearing  to  be  due  to,  or  at  least  asso¬ 
ciated  with,  unusual  shortness  of  the  vagina.  In  such  cases 
the  instrument  will  somewhat  raise  the  posterior  cul-de- 
sac,  but  will  not  antevert  the  uterus.  Its  posterior  end 
will  press  on  the  upper  part  of  the  cervix  uteri,  sometimes 
even  on  the  lower  part  of  the  body,  slightly  raising  the 
uterus,  but  not  otherwise  altering  its  position. 

The  pessary  under  consideration  was  called  by  Dr.  Hodge  a 
“lever  ”  pessary.  The  only  lever  action  that  I  believe  it 
exerts  is  that  pointed  out  by  Schultze,  and  to  which  attention 
has  been  drawn  in  this  country  by  Dr.  John  Williams,  (d)  The 
uterus  itself  is  the  lever,  the  body  of  it  is  the  weight,  the 
fulcrum  is  the  attachment  of  the  uterus  near  the  internal 
os,  and  the  power  is  applied  through  the  vagina  to  the 
cervix.  It  has  been  said  to  act  as  a  lever  in  another  way — 
viz.,  that  the  pessary  is  the  lever,  “  the  fulcrum  a  trans¬ 
verse  axis,  nearly  through  its  centre,  upon  which  it  is 


(c)  Obstetrical  Transactions,  vol.  xxiii.  (d)  Ibid.,  vol.  xviii. 


Medical  Times  and  Gazette. 


HUSSEY  ON  THE  LAW  OF  CORONERS’  INQUESTS. 


Nov.  17, 1883'. 


568 


Capable  of  oscillating  as  it  is  grasped  by  tbe  vaginal  walls ; 
the  power  is  the  pressure  of  the  anterior  vaginal  wall  upon 
its  anterior  limb,  greatly  increased  during  expulsive  efforts  ; 
the  weight,  or  resistance,  is  the  fundus  uteri,  which  is  pushed 
up  by  the  posterior  limb.”  (e)  Another  writer  says,  still  more 
definitely,  “  the  lower  limb  of  the  instrument  being  carried 
down  as  the  anterior  vaginal  wall  descends  during  the  act  of 
inspiration,  the  upper  limb  ascends  in  the  posterior  cul-de-sac, 
raising  the  fundus  uteri  and  also  pushing  it  forwards.”  (f) 
This  kind  of  lever  action  I  have  not  succeeded  in  observing. 
Usually  I  have  found  that  during  expulsive  efforts  the 
pessary  descends  with  the  vagina  without  any  other  appre¬ 
ciable  alteration  in  its  position.  But  often  the  anterior 
end  descends  more  than  the  posterior,  and  sometimes  the  in¬ 
strument,  besides  descending,  does  alter  its  inclination,  the 
lower  end  moving  slightly  backwards,  and  the  upper  end 
slightly  forwards  ;  but  this  change  in  the  position  of  the 
pessary  is  accompanied  with  descent,  and  does  not,  so  far 
as  my  observations  go,  at  all  tend  to  press  up  the  body  of 
the  uterus.  Hodge’s  own  account  of  it  is  the  following  : 
The  instrument  “operates  as  a  lever  in  elevating  the  fundus 
from  its  malposition  against  the  sacrum  to  its  normal  posi¬ 
tion  behind  the  bladder  ;  that  portion  of  the  pessary  which 
is  posterior  to  the  neck  of  the  organ  being  the  ‘  short  arm/ 
while  all  anterior  to  the  neck  is  the  ‘  long  arm  and  the 
f  fulcrum 5  or  support  is  the  posterior  surface  of  the  vagina. 
As  the  long  arm  or  horn  is  depressed  by  the  finger  of  the 
practitioner,  the  short  arm  rises  and  carries  with  it  the  body 
and  fundus  of  the  uterus.”(g)  I  have  no  doubt  that  Dr. 
Hodge  in  this  passage  describes  correctly  the  change  in  the 
position  of  the  pessary  which  followed  the  manipulation 
mentioned ;  but  before  accepting  it  as  representative  of  the 
effect  of  expulsive  abdominal  effort,  we  need  be  certain  that 
the  pressure  of  the  finger  was  applied  in  exactly  the  same 
direction  as  that  communicated  by  the  anterior  vaginal  wall 
during  effort. 

Whatever  view  be  taken  of  the  lever  action  of  the  instru¬ 
ment,  it  is  certain  that  it  cannot  by  direct  pressure  upon 
the  body  push  a  retroverted  or  a  retroflexed  uterus  into  the 
axis  of  the  pelvic  inlet.  It  can  only  do  this  by  the  mechanism 
described  by  Schultze.  When  the  pessary  does  press  upon 
the  body  of  the  uterus,  the  displacement  is  not  completely 
removed.  The  effect  of  such  pressure  upon  the  patient’s 
condition  depends  upon  the  state  of  the  uterus.  If  the 
uterus  be  congested,  and  therefore  tender,  the  pressure  of  a 
pessary  upon  it  will  generally  make  ,the  patient’s  suffering 
worse.  If  it  be  not  tender,  then  it  is  unimportant  whether 
the  instrument  presses  upon  the  uterus  or  not.  Although 
Dr.  Hodge  did  not  describe  the  mechanical  action  of  his 
pessary  in  the  same  way  as  Schultze  has  done,  he  was  quite 
aware  that  it  ought  not  to  press  directly  upon  the  uterus ; 
and  that  if  it  presses  upon  a  tender  uterus  it  does  harm .  In 
the  quotation  just  given,  the  expression  he  uses  is  that  the 
pessary  “  carries  with  it  ”  the  uterus.  In  describing  the  ad¬ 
justment  of  the  instrument,  he  says,  “  care  must  be  taken  that 
it  does  not  press  against  the  uterus  behind.”  (h)  At  another 
place  he  says,  “  in  retroversion  it  may  turn  up  against  the 
body  of  the  uterus  too  suddenly  ;  indeed,  will  generally  do 
so,  to  the  discouragement  of  all,  if  care  be  not  taken  to 
elongate  the  vagina  and  press  the  instrument  steadily 
between  the  uterus  and  rectum,  so  as  not  to  impinge  ante¬ 
riorly  against  the  uterus.” (i) 

[To  be  continued.) 


REMAKKS  ON  THE 

PROPOSALS  FOR  AMENDMENT  OF  THE 
LAW  OF  CORONERS’  INQUESTS. 

By  E.  L.  HUSSEY, 

Coroner  of  the  City  of  Oxford. 

Many  suggestions  have  been  made  for  amending  the  law  of 
coroners’  inquests — not  the  only  part  of  the  judicial  system 
in  need  of  amendment,  may  be  said,  after  the  Mackonochie 
case,  the  Tichborne  case,  and  the  Belt  libel  case,  ...  to  say 
nothing  of  the  proceedings,  or  want  of  proceeding,  at  the 
fountain-head. _ 

(e)  Galabin,  “Diseases  of  Women,”  first  edition,  page  68. 

(f)  Edis,  ‘‘Diseases  of  Women,”  first  edition,  page  90. 

(g)  ‘‘Diseases  Peculiar  to  Women,”  second  edition,  1868,  page  417. 

(h)  Op.  cit.,  page  422.  (i)  Op.  cit.,  page  429. 


Among  the  changes  proposed,  one  is,  that  the  inquisition 
super  visum  corporis  shall  be  abolished,  and  that,  instead  of 
it,  an  inquiry  into  the  cause  of  death,  without  a  view  of  the 
body,  shall  be  held  by  a  justice  of  the  peace. 

It  has  been  proposed  that  the  view  of  the  body  shall  not 
be  a  necessary  part  of  the  proceedings  before  the  coroner, 
or  that  the  view  shall  be  taken  only  at  the  discretion  of  the 
coroner,  or  at  the  expressed  wish  of  the  jury ;  that  the 
number  of  the  jurors  shall  be  less  than  is  now  required,  and 
that  the  jury  shall  be  taken  from  the  jurors’  book  in  a 
county,  and  from  the  burgess-roll  in  a  borough ;  that  the 
power  of  the  jury  to  put  questions  to  the  witnesses  shall  be 
abolished,  and  that  no  testimony  but  what  is  legal  evidence 
shall  be  admitted  during  the  inquiry ;  that  no  accused 
person  shall  be  tried  upon  an  inquisition  found  against  him  ; 
that  a  qualification  or  evidence  of  professional  fitness  shall, 
be  required  of  all  coroners;  and  that  they  shall  not  be 
elected  by  the  freeholders  in  a  county,  nor  by  the  town 
council  in  a  borough. 

We  have  not  been  told  that  the  justices  of  the  peace, 
generally,  are  willing  to  undertake  the  duty  of  making  the 
inquiry,  or  that  the  friends  of  a  deceased  person  will  find 
the  attendance  at  a  police-court  or  at  petty  sessions  less 
unpleasant  than  at  an  inquiry  before  a  coroner.  The 
attendance,  it  can  hardly  be  doubted,  will  be  more  burden¬ 
some  to  the  family  of  the  deceased,  the  time  given  to  the 
proceedings  will  in  most  cases  be  longer,  and  the  costs  of 
the  inquiry  will  be  greater. 

It  would  be  but  a  slight  alteration  of  the  present  mode  of 
procedure  if  the  coroner — who  is  already  a  conservator  of 
the  peace — should  be  declared  to  have  the  powers  of  a 
justice  of  the  peace,  for  the  purposes  of  the  inquiry.  The 
view,  it  must  be  borne  in  mind,  is  for  the  discovery  and 
for  the  identity  of  the  body.  This  ought  to  be  the  duty  of 
a  recognised  officer.  The  coroner  is  the  officer  to  whom  the 
duty  is  committed;  the  jury  are  the  witnesses  of  the  judicial 
act,  and  neither  they  nor  the  coroner  can  be  excused  from 
the  proper  and  orderly  performance  of  the  duty.  It  is  not 
thought  necessary  that  all  tbe  jurors  should  join  in  the 
view ;  but  the  body  is  present,  and  without  it  the  inquiry, 
as  a  judicial  proceeding,  becomes  worthless.  In  cases  of 
suspicion,  unless  the  cause  of  death  is  found  by  judicial 
inquiry,  a  man  ought  not  to  be  put  on  his  trial  for  homi¬ 
cide  ;  nor,  if  correct  registration  of  the  causes  of  death  is 
desirable,  ought  the  death  to  be  registered  without  it.  If 
the  identity  of  the  body  and  the  cause  of  death  are  not 
found  before  burial  of  the  remains,  the  evidence  can  hardly 
be  found  satisfactorily  afterwards. 

There  is  a  general  concurrence  of  opinion  that  the  coroners, 
for  a  county  should  not  be  elected  by  the  freeholders  at 
large.  But  there  is  not  the  same  agreement  on  the  ques¬ 
tion  how  they  ought  to  be  elected.  It  has  been  proposed 
that  the  appointment  should  be  made  by  the  court  of 
quarter  sessions,  on  the  principle  that  the  local  authority, 
which  makes  the  payment  for  the  work  done,  is  the  proper 
body  for  appointing  the  officer  who  does  the  work. 

In  boroughs,  where  the  town  council  have  the  right  to 
elect  their  more  important  officer,  the  mayor,  there  is  no- 
visible  reason  why  they  should  not  also  continue  to  elect 
the  coroner. 

Upon  the  question  of  qualification,  it  should  be  observed 
that  no  test  of  professional  fitness  is  required  of  a  mayor, 
or  a  justice  of  he  peace,  nor  of  a  sheriff,  or  under-sheriff;, 
that  the  greater  number  of  the  existing  coroners  are  either 
professional  la  vyers  or  medical  practitioners ;  that  the 
deputy  appointc  d  by  a  coroner  for  a  county  must  be  ap¬ 
proved  by  the  Lord  Chancellor ;  and  that  successive  Chan¬ 
cellors  have  laid  down  a  rule  that  the  deputy  must  be  a 
lawyer  or  a  medical  practitioner. 

It  would  be  well,  perhaps,  if  the  same  control  over  the 
appointment  of  a  deputy  by  the  coroner  of  a  borough  was, 
given  to  the  Lord  Chancellor ;  and  also  that  the  coroner  of 
a  borough  should  have  as  full  power  of  acting  by  deputy 
as  the  coroner  for  a  county  has. 

It  was  proposed  by  a  Committee  of  the  House  of  Commons 
that  the  number  of  jurors  to  agree  in  a  verdict  should  be 
nine.  In  some  of  the  colonies,  seven  is  the  number  required. 
In  the  United  States  of  America,  six  is  sufficient.  It  follows, 
of  course,  that  if  less  than  twelve  are  required  to  find  a, 
verdict,  the  inquisition  cannot  be  taken  as  a  bill  of  indict¬ 
ment,  on  which  an  accused  person  should  be  put  on  his-, 
trial. 


Medical  Times  and  Gazette. 


MEDICAL  AND  SURGICAL  PRACTICE. 


Nov.  17,  1883.  569 


No  objection  has  been  raised  to  the  proposal  that  the 
jurors  should  be  taken  from  the  recognised  lists  of  qualified 
persons  ;  provided  the  power  is  continued  of  taking  tales  de 
circumstantibus,  if  necessary.  When  the  time  comes  that 
women  are  admitted  to  what  some  people  tell  us  are  their 
full  rights  of  citizenship,  and  their  names  are  put  on  the 
burgess-roll,  they  can  be  taken  in  their  turn  as  jurors. 

The  suggestions  made  by  the  jury  are  sometimes  useful, 
as  leading  to  the  discovery  of  matters  important  to  the 
inquiry ;  and,  under  due  regulation  by  the  coroner,  are  not 
found  to  be  objectionable  in  practice.  It  may  be  easy  to 
■exclude  what  is  irrelevant  from  the  written  depositions;  but 
it  will  not  be  so  easy  in  the  course  of  the  inquiry  to  hinder 
statements  that  are  extraneous  or  irrelevant  from  being 
made  by  persons  called  to  give  evidence,  when  their  know¬ 
ledge  of  the  facts  and  the  testimony  they  can  give  have 
not  been  previously  sifted  by  a  solicitor. 

The  coroner  should  have  the  power,  when  he  receives  in¬ 
formation  of  a  death,  to  summon  a  medical  practitioner  for 
his  opinion  or  for  information,  and  for  making  a  post-mortem 
■examination,  if  necessary ;  and  he  should  have  power  to  take 
the  testimony  of  the  practitioner,  on  oath  or  otherwise,  as 
he  may  think  best,  before  he  decides  upon  further  proceed¬ 
ings.  In  many  cases  the  necessity  for  summoning  a  jury 
•would  be  avoided  if  the  coroner  could  thus  obtain  informa¬ 
tion  in  an  authoritative  form  from  a  medical  practitioner. 

These  are  some  of  the  questions  which  will  receive  public 
attention  whenever  a  Bill  for  the  amendment  of  the  law  of 
inquests  shall  be  again  submitted  to  Parliament. 

Oxford. 


REPORTS  OF 

HOSPITAL  PRACTICE  IN  MEDICINE 
AND  SURGERY. 

- ♦ - 

ST.  THOMAS’S  HOSPITAL. 


THREE  CASES  OF  CLUBFOOT. 

(Under  the  care  of  Mr.  CROFT.) 

•Case  1. — Talipes  Calcaneo-Varus  ( from  a  Burn) — Plastic 
Operations — Cure. 

.E.  O.,  a  little  girl  aged  two  years  and  three  months,  was 
admitted  under  Mr.  Croft’s  care  in  St.  Thomas’s  Hospital  on 
April  1,  1880,  and  kept  under  treatment  for  about  one  year. 
She  was  admitted  for  a  deformity  of  the  right  foot  and  toes, 
■caused  by  the  effects  of  the  burning  of  her  stocking  about 
eleven  months  previously.  The  deformity  might  be  called 
acquired  calcaneo- varus.  The  foot  had  become  drawn  up 
towards  the  shin  and  inverted,  and  the  great  toe  had  been 
dragged  inwards  alongside  the  inner  border  of  the  foot 
until  its  tip  was  directed  to  the  heel.  The  foot  was,  in  other 
words,  flexed  upon  the  leg  so  far  as  it  could  go,  and  the 
great  toe  was  dislocated  on  its  metatarsal  bone  with  extreme 
adduction  and  flexion.  The  cicatrix  extended  down  the 
middle  of  the  front  of  the  leg  and  ankle,  and  down  the 
inner  side  of  the  foot  to  the  sole.  In  front  of  the  ankle 
the  scar  had  contracted  into  a  firm  band  about  five-eighths 
of  an  inch  in  diameter.  From  the  inner  side  of  the  knee  a 
long  narrow  branch  of  the  scar  reached  upwards  to  the 
thigh.  In  front  of  the  knee  the  scar  began  opposite  the 
upper  edge  of  the  patella.  The  cuticle  of  the  scar  was 
sound,  though  thin  and  shining.  The  back  of  the  leg  and 
the  outer  side  of  the  leg  and  ankle  were  free  from  scar. 
Extension  of  the  foot  on  the  leg  was  impossible  in  any  de¬ 
gree,  and  it  was  equally  impracticable  to  overcome  the  inver¬ 
sion  of  the  foot.  The  foot  formed  with  the  leg  an  angle  of 
40°  instead  of  90°.  In  its  improyed  condition  it  forms  an 
angle  of  95°.  The  woodcuts  (Figs.  1  and  2)  show  the  state 
-of  parts  very  nicely.  They  were  drawn  by  Mr.  Burgess  from 
a  plaster  cast. 

The  treatment  consisted  mainly  of  division  of  the  con¬ 
tracted  cicatrix  in  front  of  the  ankle,  and  of  transplantation 
of  skin  into  the  gap.  This  operation  was  intentionally 
divided  into  two  stages ;  but  the  course  of  events  necessitated 
two  operations,  each  divided  into  two  stages. 

On  May  8,  Mr.  Croft  raised  a  bridge  or  longitudinal  strap 
of  skin  from  the  back  and  inner  side  of  the  calf.  It  measured 
three  inches  and  a  half  in  length  and  one  inch  and  a  half  in 
breadth,  and  included  all  the  subcutaneous  fat  with  the  skin. 


Its  lower  end  remained  attached  to  the  skin  about  the  inner 
side  of  the  foot,  and  its  upper  end  sprang  from  just  below 
the  level  of  the  knee.  This  strap  was  prevented  from 
reuniting  to  the  skin  and  fascia  by  a  layer  of  lint  charged 
with  carbolised  oil. 

Mr.  Croft  had  hoped  that  in  a  fortnight  or  three  weeks, 
when  healing  by  granulation  and  suppuration  had  been  well 
begun,  he  might  have  been  able  to  complete  the  operation ; 
but  little  illnesses,  local  or  general,  caused  him  to  put  off 
the  next  step  until  the  expiration  of  about  seven  weeks 
(until  June  26).  Then  the  bridge  of  skin  was  thick  and 
strong  and  well  nourished,  and  the  sore  beneath  it  had  to  a 
great  extent  healed.  The  great  toe,  being  in  the  way  and  use¬ 
less,  was  dissected  out,  and  its  integument  preserved.  Next, 
the  contracted  scar-tissue  in  front  of  the  ankle-joint  was  cut 
across  by  a  transverse  incision,  commencing  on  the  inner 
side  close  to  the  origin  of  the  strap  about  to  be  transplanted, 
and  ending  an  inch  in  front  of  the  external  malleolus.  The 
tendons  were  exposed.  The  foot  was  extended.  The  edges 
of  the  incision  in  the  scar  were  dissected  up,  towards  the 
leg  particularly,  and  allowed  to  shrink.  A  wide  breach  re¬ 
mained  to  be  filled  in.  The  upper  end  of  the  bridge  was  cut 
across,  the  edges  and  under  surface  freshened,  and  the  strap 
brought  into  the  breach ;  its  free  end  was  attached  by  sutures 
to  the  outer  corner  of  the  breach,  and  a  few  more  sutures 
inserted  to  keep  it  in  place.  This  transplant  was  originally 
long  enough  to  extend  fully  and  without  stretching ;  but, 
being  swollen  and  bulky  from  plastic  matter,  it  could  not  be 
fitted  accurately  into  the  breach.  Of  course,  it  was  twisted 
on  itself  somewhat  at  its  attached  end.  The  wound  was 
dressed  with  lint  charged  with  warm  carbolised  oil,  and  the 
whole  limb  wrapped  in  wool.  The  progress  was  satisfactory 
except  in  one  respect — about  half  an  inch  of  the  free  end 
failed  to  unite. 


Fig.  1.  Fig.  2. 


By  August  6,  or  forty  days  later,  the  wounds  had  all 
healed,  and  the  foot  was  in  better  position.  The  trans¬ 
planted  skin  had  not  stretched  much,  but  remained  pro¬ 
minent  and  ugly  across  the  instep.  Partly  owing  to  the 
failure  on  the  part  of  the  end  of  the  strap  to  unite  and 
take  root  at  its  outer  end,  the  scar  continued  contracted  in 
this  part,  and  the  inversion  of  the  foot  continued.  Mr. 
Croft  therefore  determined  to  raise  a  similar  bridge  of  skin 
from  the  outer  side  of  the  leg,  and  add  another  transplant 
across  the  front  of  the  foot,  inserting  its  free  end  on  the 
inner  side  of  the  foot.  The  parents’  consent  to  this  was 
obtained  after  some  delay. 

On  October  9 — more  than  five  months  after  the  first  step 
of  the  first  operation — this  second  strap  of  skin  was  raised. 
It  was  of  about  the  same  dimensions  as  the  first. 

November  1,  or  about  three  weeks  later,  the  recontracted 
part  of  the  scar  on  inner  side  of  the  foot  was  cut  across,  and 
some  of  the  tissue  dissected  away.  A  bed  was  made  for  the 
new  piece  of  skin,  and  the  transplantation  was  accomplished. 
The  good  progress  after  this  was  marred  by  an  attack  of 
erysipelas.  The  new  transplant  was  allowed  to  contract 
towards  its  attached  end,  and  the  free  end  retracted  from 
the  spot  at  which  it  was  most  wanted— that  is,  the  inner 
border  of  the  foot. 


570 


Medical  Times  and  Gazette. 


MEDICAL  AND  SUEGICAL  PEACTICE. 


Nov.  17,  1883. 


A  month  afterwards,  when  the  child  was  convalescent 
from  the  erysipelas,  she  suffered  from  an  attack  of  jaundice. 
By  the  first  week  of  December  the  wounds  had  healed.  A 
splint  was  now  applied  as  for  talipes  varus,  and,  by  manipu¬ 
lation  regularly  employed,  the  position  of  the  foot  was  very 
much  improved.  The  foot  became  extended  to  a  right  angle, 
but  the  inversion  continued  obstinate. 

There  was  great  difficulty  in  persuading  the  parents,  who 
lived  at  Epsom,  to  leave  the  child  under  treatment,  but,  by 
promising  that  no  further  operation  would  be  performed, 
she  was  allowed  to  remain  until  April  15,  1881,  when  she 
was  discharged,  and  then  lost  sight  of  until  May  31,  1883, 
or  nearly  two  years  later,  when  she  was  found  in  the  very 
improved  condition  which  is  expressed  in  the  accompanying 
drawing,  made  from  a  cast  secured  at  the  time.  The  limb  had 


Fig.  3.  Fig.  4. 

grown  in  good  proportion  with  the  opposite  limb,  and  the 
child  could  walk  and  run  well  in  an  ordinary  boot.  The 
inversion  of  the  foot  was  still  considerable,  but  the  parents 
declined  to  have  anything  done  for  it,  as  the  child  could  run 
and  walk  so  well.  The  first  strap  of  skin  was  fully  three 
inches  long,  and  nearly  two  inches  wide.  It  had  become 
drawn  up  across  the  lower  end  of  the  leg.  The  second 
transplant  measured  two  inches  and  a  half  in  length  and  a 
full  inch  in  width,  and  that  also  had  become  drawn  up  on  to 
the  leg.  Only  the  ends  of  these  transplants  remained  in 
front  of  the  ankle-joint.  The  upper  edge  of  the  incision 
across  the  scar  had  retreated  up  the  leg  a  distance  of  more 
than  two  inches.  The  ankle-joint  was  somewhat  stiff,  only 
allowing  very  slight  extension  and  flexion.  When  the  child 
walked  she  applied  the  sole  of  the  foot  to  the  ground,  and 
the  outer  edge  of  the  foot  was  free  from  corns  or  bursse. 

Remarks. — Although  the  leg  and  foot  are  ugly  to  look  at, 
the  limb  is  now  a  very;  serviceable  one— so  useful  that  the 
parents  would  not  consent  to  any  further  treatment  of  the 
inversion  or  varus.  The  practice  of  transplanting  skin  by 
the  method  described  in  this  case  is  so  seldom  referred  to  in 
print,  and  it  is  so  valuable  in  its  principle,  that  it  seems 
worthy  of  notice.  Mr.  Croft  has  recently  carried  out  this 
principle  of  transplanting  in  a  very  bad  case  of  contracted 
neck.  The  result  has  been  in  every  respect  highly  satis¬ 
factory.  By  adopting  this  method  the  surgeon  may  rely 
upon  the  vitality  of  the  flap  so  long  as  he  does  not  make 
the  strap  too  narrow  in  proportion  to  its  length.  Mr.  Croft 
thinks  the  length  should  not  be  much,  if  any,  more  than 
three  times  the  width.  The  third  week  seems  to  be  the 
suitable  time  for  transplanting.  Nothing  is  gained  for  the 
flap  by  procrastinating  the  transplantation ;  probably  the 
change  of  place  might  be  safely  effected  earlier. 

Case  2. — Talipes  Equino-Varus — Antiseptic  Tarsotomy — Cure. 

J.  B.,  a  girl,  aged  eight  years,  was  admitted  under  Mr. 
Croft’s  care  on  June  22,  1882,  and  discharged  August  12  of 
the  same  year. 

_  The  child  suffered  from  congenital  talipes  varus  on  the 
right  side.  She  had  been  under  treatment  in  various  hos¬ 
pitals,  and  undergone  several  operations.  It  may  be  pre¬ 
sumed  that  she  had  originally  presented  the  condition  of 
equino-varus,  and  that  the  tendo  Achillis  and  several  other 
tendons  had  been  cut,  as  the  case  on  admission  showed  little 


of  the  equinus  variety,  though  the  varus  was  of  an  intract¬ 
able  character.  There  were  scars  about  the  internal  mah 
leolus  where  tenotomies  had  been  performed.  The  ankle- 
joint  was  nearly  stiff,  though  some  movement  was  per¬ 
ceptible  amongst  the  tarsal  joints,  and  the  foot  was  rigidly 
inverted— the  rigidity  not  being  the  result  of  contracted 
tendons.  She  walked  with  a  limp  on  the  outer  side  of  the 
foot,  which  was  thick  and  callous.  The  sole  looked  inwards; 
the  heel  looked  inwards  also.  The  fibula  was  directed  back¬ 
wards.  The  leg  was  two  inches  and  a  half  shorter  than  its- 
fellow,  and  the  muscles  of  the  whole  limb  were  much  wasted. 
When  the  sole  of  the  foot  was  applied  to  the  floor  it  was 
done  at  the  expense  of  considerable  abduction  (or  spurious; 
genu  valgum)  at  the  knee  and  by  advancing  the  leg.  She- 
was  found  to  have  only  four  toes,  the  normal  fourth  being: 
absent.  (See  Fig.  5.)  Under  the  circumstances,  Mr.  Crofc 
decided  that  he  would  not  waste  time  in  trying  splints  or 
tenotomies,  but  proceed  to  excise  a  wedge-shaped  piece  from 
the  tarsus  after  Mr.  Davies-Colley’s  plan. 

The  operation  was  performed  on  July  1  by  the  bloodless; 
method,  and  antiseptically.  No  tendons  were  divided.  The 
immediate  improvement  was  very  marked.  The  progress 
was  perfectly  aseptic ;  extensive  primary  union  took  place. 
In  three  weeks  the  wound  was  soundly  healed,  and  in  four 
weeks  she  was  able  to  apply  the  sole  of  the  foot  flatly  to  the 
floor.  (See  Fig.  6.)  The  improvement  has  since  increased, 
and  she  has  a  firm,  useful  foot,  though  a  short  one.  She  is 
able  to  walk  in  an  inexpensive  high-soled  boot. 


Fig.  5. 

The  piece  removed  consisted  of  parts  of  the  scaphoid  and 
internal  and  middle  cuneiform  bones,  and  the  cuboid  bone- 
It  measured  at  the  cuboidal  edge  one  inch  and  an  eighth, 
and  on  its  opposite  edge  a  trifle  over  half  an  inch,  whilst 
from  side  to  side  it  measured  a  full  inch  and  a  half.  The 
drawings  by  Burgess,  from  plaster  casts,  give  faithful  repre¬ 
sentations  of  the  foot  before  and  after  operation. 

Case  3. — Congenital  Talipes  Equino-Varus — Antiseptic 
Tarsotomy — Cure. 

J.  W.,  a  boy  of  twelve  years  of  age,  was  admitted  under 
Mr.  Croft’s  care  on  May  28,  1883,  and  discharged  August  1. 

He  was  the  subject  of  severe  congenital  talipes  equino- 
varus.  He  had  been  under  treatment  by  other  surgeons 
more  or  less  for  five  years,  but  was  still  a  great  cripple. 
The  foot  was  rigidly  inverted  and  the  heel  raised.  He 
walked  on  the  outer  side  of  the  foot,  where  were  three- 
callous  spots  and  bursa: — one  over  the  external  malleolus, 
another  over  the  peroneal  tubercle,  and  a  third  over  the 
base  of  the  metatarsal  bone  of  the  little  toe.  He  lived  in 
the  country,  belonged  to  very  poor  parents,  wore  a  very 
clumsy,  ill-fitting  boot,  and  had  experienced  difficulty  in 
Obtaining  that. 

In  every  particular  this  was  a  worse  case  than  the  pre¬ 
ceding,  but  the  boy  was  submitted  to  a  similar  operation.  A 
wedge-shaped  piece  was  excised  from  the  tarsus.  This  was 
performed  by  the  help  of  the  bloodless  method  and  anti¬ 
septics.  Immediately  after  the  operation  the  foot  could  be 
brought  into  a  fairly  good  position. 

The  after-progress  was  highly  gratifying.  The  wound 
was  practically  well  in  three  weeks.  A  boot  with  iron  sup¬ 
port  was  supplied  to  him,  that  he  might  have  the  benefit  of 
such  an  appliance  for  about  six  months.  Then,  or  sooner. 


Medical  Times  and  Gnjette. 


EXPERIMENTAL  MEDICATION. 


Nov.  17,  1883.  5  71 


lie  would  be  able  to  wear  a  boot  which  any  bootmaker  would 
be  capable  of  making.  In  both  cases,  in  the  short  space  of 
a  month,  the  wound  was  absolutely  healed,  without  pain  or 
fever.  The  position  of  the  foot  was  so  improved  that  the 
sole  could  be  placed  almost  flat  on  the  floor,  and  the  boot- 
making  had  been  brought  within  the  capabilities  of  an 
ordinary  country  bootmaker. 


'British  Islands 


TEEMS  OF  SUBSCRIPTION. 

( Free  by  post.) 

.  .  .  .  Twelve  Months  .  JS1  8  0 

>i  „  •  •  •  •  .  Six  „  #0  14  0 

The  Colonies  and  the  United )  m  ,  _  ,  _  . 

States  of  America  .  .  .  j  Twelv*  «  .  1  10  0 

,,  33  *  Six  „  .  0  15  0 

India  (vid  Brindisi)  .  .  .  Twelve  ,,  .  1  12  6 

33  ...  SiX  ,,  .0  10  0 

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i?1 


SATUEDAY,  NOVEMBER  17,  1883. 


THE  COLLEGE  OF  SURGEONS  AND  NON¬ 
PERSONAL  VOTING. 

All  the  younger  members  of  the  profession,  and  many  of 
the  older  ones,  will  have  heard  with  gratification  that  the 
Council  of  the  Royal  College  of  Surgeons  has  practically 
adopted  the  principle  of  non-personal  voting  at  elections  to 
the  Council.  One  may  feel  fairly  confident  that  this  accept¬ 
ance  of  a  principle  hitherto  so  persistently  opposed  will  not 
be  allowed  to  remain  the  expression  of  a  mere  “pious 
opinion/5  but  that  steps  will  at  once  be  taken  to  obtain  a 
revision  of  the  College  Charter,  whereby  it  may  be  carried 
into  practical  effect.  Some  such  alteration  in  the  mode  of 
•election  to  the  Council  of  the  Royal  College  of  Surgeons 
has  long  been  urgently  demanded  by  certain  of  the  Fellows, 
and  supported  by  considerations  of  justice  and  expediency. 
That  a  change  was  desired  by  a  large  number  of  the 
Fellows  is  evinced  by  the  presentation  to  the  Council  of 
■a  petition  in  favour  of  non-personal  voting,  with  close  upon 
four  hundred  signatures.  That  fairness  itself  demanded 
a  change,  may  be  gathered  from  the  fact  that  personal 
voting  absolutely  disfranchises  many,  and  practically  dis¬ 
franchises  about  half  the  constituency.  That  this  is  no 
-exaggeration  will  be  seen  by  comparing  the  number  of 
Fellows  of  the  College  with  the  number  who  register  their 
votes  at  any  election.  The  College  of  Surgeons  has  in  times 
past  greatly  influenced  the  surgical  curriculum  and  the 
surgical  examinations,  and  its  influence  will  doubtless  con¬ 
tinue  to  be  felt  in  the  future.  While  London  was  the  only,  or 
■even  the  chief,  centre  of  surgical  knowledge  and  of  surgical 
thought,  it  was  not  unbecoming,  perhaps,  that  a  mode  of 


election  of  its  Council  should  be  employed  which  secured  to 
the  Fellows  resident  in  London  the  whole  management  of 
the  College.  But  at  the  present  time  the  metropolis  neither 
possesses  nor  claims  to  possess  a  monopoly  of  surgical  skill  or 
surgical  enthusiasm,  while  the  existence  of  many  flourishing 
provincial  schools  proves  that  it  has  no  monopoly  in  surgical 
education;  and  we  therefore  congratulate  the  Council  in  that 
it  has  gracefully  acceded  to  a  proposal  which  the  changed 
circumstances  of  the  time  must  necessarily  have  otherwise 
sooner  or  later  forced  it  to  accept.  The  Fellows  of  the  Col¬ 
lege  of  Surgeons  scattered  through  the  country  are  in  some 
respects  representative  men — often  leaders  of  professional 
feeling  and  professional  action  in  their  several  districts ;  and, 
under  any  circumstances,  but  especially  at  the  present  critical 
epoch  in  the  history  of  the  College,  it  would  be  inexpedient  to 
estrange  the  large  and  important  class  of  provincial  Fellows. 
We  trust  that  any  such  feeling  of  estrangement  that  may 
have  existed  will  disappear,  and  that  the  Fellows,  metro¬ 
politan  and  provincial,  will  again  work  harmoniously  together 
for  the  interests  of  the  College  and  of  the  profession. 

Should,  however,  non-personal  voting  at  the  election  of 
the  Council  become  an  accomplished  fact,  we  trust  its  adop¬ 
tion  will  not  be  universal.  We  have  always  felt  that  the 
annual  gathering  at  the  College  was  productive  of  much 
good— old  ties  renewed,  old  friendships  cemented,  old 
haunts  revisited,— and  we  firmly  believe  that  all  who  can 
will  attend  and  register  their  votes  in  person.  The  im¬ 
portant  step  in  reform  about  to  be  taken  by  the  Council  of 
the  College  will  not,  we  trust,  be  at  once  initial  and  final. 
Besides  the  question  of  non-personal  voting,  there  are  many 
others  that  claim  consideration.  The  presence  on  the  Court 
of  Examiners  of  others  than  members  of  the  Council — of  sur¬ 
geons  and  teachers  from  the  smaller  London  and  the  chief 
provincial  schools  ;  the  occasional  election  of  some  eminent 
non-metropolitan  surgeon  to  a  professorship  or  lectureship  in 
the  College;  the  consideration  of  some  plan  by  which  the 
constituents  can  obtain  information  as  to  the  views  on 
important  points  of  policy  of  candidates  soliciting  their 
suffrages,  without  exposing  themselves  to  insult  or  at  the 
least  unmannerly  badinage,— are  all  points  which,  in  the 
interests  of  the  College,  no  less  than  in  the  interests  of  the 
Fellows,  may  well  claim  early  and  complete  investigation. 


EXPERIMENTAL  MEDICATION. 

It  is  almost  a  truism  that  the  decision  between  right  and 
wrong  in  practice  is  a  very  simple  matter  in  comparison 
with  the  difficult  task  of  formulating  an  exhaustive  theory 
of  ethics.  As  a  man  may  talk  prose  all  his  life  without 
knowing  it,  so  he  may  be  true  and  just  in  all  his  dealings 
though  moral  philosophy  be  to  him  as  a  sealed  book.  The 
simpler  the  material  and  the  conditions  in  which  we  work, 
the  easier  it  is  to  act  rightly  without  hesitation,  and  the 
nearer  does  good  practice  come  to  perfect  theory.  Looked 
at  from  this  point  of  view,  the  doctor’s  work  may  be  ex¬ 
pected  to  occasionally  present  some  difficulty,  though  the 
difficulty  is  speculative  rather  than  practical.  For  the 
medical  profession  stands  indeed  apart  from  all  others  in 
the  complexity  of  its  relations,  scientific,  moral,  and  com¬ 
mercial.  It  is  easy  and  common  enough  for  a  physician  to 
be  at  once  scientific,  upright,  and  at  least  fairly  successful ; 
and  it  is  quite  possible  for  him  to  show  all  these  qualities  in 
an  eminent  degree.  It  may  be  less  easy,  however,  to  set 
forth  accurately  where  right  demands  that  some  of  these 
tendencies  should  give  way  to  others.  The  reason  of  this 
difficulty  is  simply  that  the  material  of  the  doctor’s  opera¬ 
tions  is  the  bodies  of  his  fellow-creatures.  Were  it  not  for 
the  moral  duty  implied  in  this  fact,  the  scientific  physician 
might  justifiably  follow  the  spirit  of  research  wherever  it  led 


572 


Medical  Times  and  Gazette. 


EXPERIMENTAL  MEDICATION. 


Not.  17,  1883. 


him,  and  experiment  to  the  top  of  his  bent ;  while  the  more 
worldly-minded  might  be  as  rigid  in  his  business  transactions 
with  every  possible  patient,  with  as  full  a  moral  sanction 
as  is  commonly  extended  to  the  lawyer  or  the  tradesman. 
It  is  perhaps  the  medical  art  alone  which  must  of  moral 
necessity  be  often  exercised  without  reward,  nor  need  we 
labour  to  prove  that  innumerable  instances  arise  where  the 
neglect  so  to  exercise  it  would  be  clearly  culpable.  In 
other  lines  of  business  a  man  may  always  expect  his  definite 
quid  pro  quo,  or  at  least  it  is  not  fair  to  blame  him  if  he  does 
not  freely  give  away  his  stock-in-trade.  What  to  others 
may  be  a  work  of  supererogation  is  often  to  the  doctor  a 
moral  duty  as  a  social  being.  It  is  therefore  good  feeling 
alone  which  so  often  and,  we  believe,  so  generally  prevents 
the  man  and  the  tradesman  from  clashing  in  the  doctor’s 
complex  being.  Although  the  moral  and  the  practical  may 
seem  at  first  sight  to  be  slightly  at  cross  purposes  here,  the 
public  knows  full  well  that  there  are  those  in  the  profession, 
not  few  nor  far  between,  who  fail  not  one  jot  in  their  sacred 
duty  towards  their  fellow-men. 

Now,  with  regard  to  the  relation  of  the  strictly  scientific 
and  the  personally  humane  element  in  the  practice  of  our 
many-sided  profession,  may  not  the  same  be  said  in  other 
words  ?  The  difficulty  of  carrying  out  our  double  duty  of 
at  the  same  time  doing  the  best  for  our  patients  and  of 
endeavouring,  for  the  good  of  humanity  at  large,  to  advance 
medical  knowledge,  is  almost  nil  in  actual  practice.  It  is 
scarcely  e,ver  that  the  physician  who  is  mindful  alike  of 
science  and  humanity  finds  it  necessary  to  pause  and  con¬ 
sider  his  line  of  action.  But,  nevertheless,  though  this 
difficulty  is  so  small,  though  it  is  even  less  than  that  offered 
by  the  occasional  antagonism  of  the  patient’s  interest  and 
the  doctor’s  pocket,  it  is  not  quite  so  simple  a  matter 
rightly  to  define  in  words  the  respective  fields  of  our 
bounden  duty  towards  our  individual  patients  and  that 
towards  the  advancement  of  medical  art  for  the  benefit  of 
all.  A  little  consideration,  however,  will  sufficiently  clear  up 
the  theoretical  aspect  of  that  right  position  which  it  is  never 
difficult  to  practically  take  up  at  once .  Medicine  is  essentially 
an  advancing  study,  and  as  such  its  practice  cannot  always 
rest  on  completely  established  knowledge.  The  physician 
who  works  in  the  most  complicated  field  of  all  (the  human 
body)  is  never  ashamed  to  confess  that  much  of  his  work 
is  carried  out  by  a  very  glimmering  light ;  and  he  can  well 
afford  to  scorn  the  often  and  blunderingly  quoted  gibe  that 
“  doctors  differ.”  He  knows  it  must  be  so.  All  treatment 
of  disease  must  be  largely  experimental,  and  this  element 
is  often  not  lacking  even  in  the  giving  of  the  most  time- 
honoured  drugs  to  various  individuals.  The  exact  result 
cannot  always  be  predicted  ;  sometimes  it  is  widely  different 
from  what  we  have  good  reason  to  expect.  In  every  case 
of  treatment  of  disease  the  best  that  the  best  of  us  can  do 
is  to  act  up  to  our  highest  lights  as  students  of  medicine 
and  social  beings,  never  forgetting  that  by  the  very  force  of 
circumstances  the  patient  (for  the  time  at  least)  trusts,  and 
trusts  implicitly,  in  our  knowledge  and  good  faith.  Obviously 
justifiable  experiment  of  this  kind  plays  no  small  part  in 
medical  treatment ;  and  till  medicine  is  an  exact  science — 
which  it  may  never  be — advance  must  largely  depend  on 
such-like  grounds.  It  is  not  only  in  drug-giving  that  the 
necessity  of  this  method  is  apparent.  No  one,  for  instance, 
would  blame  the  doctors  who  first  experimentally,  and 
with  the  best  intentions,  sent  their  consumptive  patients 
to  winter  among  Alpine  snows.  Such  experiments  as  this, 
for  the  most  probable  good  of  the  patient  and  the  com¬ 
munity  at  large,  is  not  only  allowed  to,  but  actually  required 
of,  the  medical  man.  Not  less  valuable,  clearly— though 
here  the  question  takes  a  fresh  departure, — would  experi¬ 
ments  be  which  were  made  mainly  for  the  advancement 


of  medical  knowledge  without  immediate  regard  to  the- 
individual  patient.  If  we  wished  to  properly  use,  for 
instance,  a  new  and  probably  efficacious  drug,  it  might  occa¬ 
sionally  be  necessary  to  administer  it  experimentally  to 
human  beings.  No  written  rule  of  conduct  seems  to  be 
wanted  here  as  to  on  whom  we  may  and  on  whom  we  may 
not  experiment ;  the  line  which  divides  the  duty  of  the 
advancement  of  the  art  from  that  of  the  faithful  treatment 
of  the  individual  must  surely  be  clearly  seen  in  practice, 
and  a  man  must  never  suffer  for  the  race  at  the  doctor’s 
hands,  whatever  sacrifices  may  be  required  of  him  at  the 
hands  of  nature. 

By  a  process  of  exclusion  it  is  easy  to  see  the  application 
of  this,  and  how  the  field  of  legitimate  experiments  on  the 
human  body  for  objects  other  than  that  body’s  immediate 
welfare  must  be  defined.  It  is  needless  to  say  that  all  so- 
called  experiments  involving  suffering  for  the  purpose  of 
demonstrating  what  is  already  known  are  unjustifiable,  and 
especially  so  in  the  case  of  hospital  patients.  In  this  con¬ 
demnation  we  would  not  include  the  postponement  for  a  few 
days  of  giving  a  supposed  specific  medicine  in  a  case  of  skin: 
disease,  in  order  to  bring  its  action  vividly  before  the  eyes- 
of  students, — a  proceeding  for  which,  not  long  ago,  Mr. 
Hutchinson  was  so  absurdly  attacked,  and  which,  while  doing 
no  harm  whatever  to  the  patient,  might  have  been  of  obvious 
and  far-reaching  usefulness ;  but  to  inject  an  active  drug 
(pilocarpine,  for  instance)  into  a  hospital  patient  for  the 
purpose  of  exhibiting  its  action  to  students  would  at  once  be 
condemned  by  the  moral  sense  of  the  most  ardent  of  experi¬ 
mental  physiologists.  It  is  equally  clear  that  we  must  never- 
withhold  in  any  case  of  suffering  the  course  of  treatment 
which  the  best  experience  has  proved  to  be  for  the  good 
of  the  patient  in  order  to  try  a  new  or  doubtful  method. 
No  consideration  of  possible  advantage  to  the  public  at  large 
should  be  allowed  to  weigh  in  a  case  like  this.  Again,  we 
are  never  justified  in  causing  pain  or  inconvenience  to  any¬ 
one,  whoever  it  may  be,  in  trying  a  new  remedy  for  the 
sake  of  knowledge  alone,  unless  the  object  of  the  experi¬ 
ment  be  made  a  full  party  to  the  transaction,  and  have 
fully  explained  to  him  the  object  in  view.  Still  less,  it  need 
hardly  be  said,  is  such  treatment  justifiable  when  danger, 
however  small,  may  be  involved  in  such  a  trial.  The 
philanthropic  therapeutist  will  doubtless  confine  an  investi¬ 
gation  like  this  to  his  own  person,  or  that  of  an  equally 
enthusiastic  or  enlightened  friend.  All  experiments  in 
treatment  such  as  this,  of  whatever  moment  they  may 
appear  to  be,  should  be  limited  by  the  conditions  indicated  ; 
and  such  conditions  it  is  by  no  means  impossible  or  difficult 
to  obtain.  In  the  case  of  the  trial  of  remedies  which,  though 
in  some  sense  new,  are  yet  demonstrably  harmless,  such 
stringent  precautions  perhaps  need  not  be  observed.  A 
new  preparation,  for  instance,  of  a  well-known  drug,  or 
other  modifications  of  treatment,  maybe  tested  with  respect 
to  their  alleged  greater  efficacy,  in  cases  where  it  is  obvious 
that  no  harm  or  discomfort  can  arise.  In  such  a  case 
proper  feeling  alone  must  be  the  guide ;  and  it  may  not 
be  any  more  necessary  to  enter  into  details  here,  than  it  is 
advisable  to  tell  every  individual  patient  who  is  prescribed 
a  purgative  or  a  narcotic  that  the  drug  may  possibly  fail 
in  its  effect.  This,  however,  is  the  only  exception,  if  ex¬ 
ception  indeed  it  be,  to  the  golden  and  literal  rule  of  always^ 
and  everywhere  doing  our  immediate  best  for  the  person 
under  our  care,  and  keeping  strictly  to  the  sacred  moral 
contract  implied  in  the  relation  of  doctor  and  patient. 

According  to  the  limitations  thus  laid  down,  we  cannot 
but  decide  that  the  administration  of  sodium  nitrite  to 
certain  hospital  patients,  as  reported  in  the  Lancet  for 
November  3,  if  looked  upon  in  the  light  of  experimentation 
with  the  drug,  must  be  pronounced  unjustifiable,  and  as 


Meflicftl  Times  and  Gazette. 


CHRONICLE  OF  THE  WEEK. 


Nov.  17, 18S3.  573 


•deeply  to  be  deplored,  unless  it  can  be  shown  that  in  every 
•case  the  patient  was  a  consenting  party  to  the  transaction, 
and  was  prepared  for  possible  or  even  probable  unpleasant 
•effects.  In  justice  to  Drs.  Ringer  and  Murrell,  it  must  be 
remembered  that  this  drug  had  been  supposed  to  have 
already  been  given  in  far  larger  doses  by  others  without  the 
production  of  toxic  effects,  and  with  alleged  benefit  in  cer¬ 
tain  cases.  The  tentative  administration  of  it,  therefore,  in 
smaller  doses,  when  found  to  be  unexpectedly  active, — pro¬ 
vided  always  the  cases  were  such  as  might  reasonably  be 
expected  to  benefit  therefrom, — might  thus  be  justified  on 
the  ground  of  its  not  being  merely  experimental.  Such 
justification,  however,  cannot  be  extracted  from  the  words 
of  the  Lancet  report,  however  charitably  they  may  be  con¬ 
strued  ;  and  though  we  may  fully  believe  that  one  object 
•  of  the  publication  of  what  the  authors  admit  to  be  "  ex 
periinents”  was  to  warn  others  of  the  newly  discovered 
■  danger  of  the  drug,  we  cannot  acquit  these  gentlemen  of  a 
grave  failure  in  professional  duty  in  thus  prescribing  whole¬ 
sale,  in  such  circumstances  as  they  themselves  detail,  a  drug 
they  well  knew  to  be  most  powerful.  As  a  matter  of  practical 
ethics,  it  must  for  safety's  sake  be  insisted  on  in  no  un¬ 
certain  tone  that  it  is  not  for  one  man,  from  any  motive 
whatever,  to  cause  another  to  suffer  without  his  consent 
:for  the  good  of  the  greatest  number.  A  doctor  who  thus 
■■acts,  especially  in  the  case  of  hospital  patients,  is  really 
false  to  his  unwritten  but  no  less  sacred  contract  with  all, 
and,  by  publishing  his  indiscretions,  both  indirectly  lowers 
the  credit  of  his  professional  brethren,  and  helps  to  retard 
ithe  course  of  legitimate  scientific  inquiry. 


CHRONICLE  OF  THE  WEEK. 

- -o - 

The  past  week  has  been  an  unfortunate  one  for  the 
.medical  profession,  and  in  the  case  of  the  smaller  hospitals, 
with,  their  very  sensitive  subscription-lists,  may  prove 
fis©  have  been  disastrous.  It  was  not  to  be  expected  that 
the  sodium  nitrite  paper,  once  published,  would  escape  the 
hawks’  eyes  of  the  anti-vivisectionists,  and  before  long  it 
will  obtain  a  publicity  on  which  its  authors  scarcely  counted. 
A  few  days  will  see  the  profession  pilloried  on  every  hoard¬ 
ing  ;  for  in  a  case  like  this  no  trouble  will  be  taken  by  our 
opponents  to  discriminate  between  the  offenders  and  their 
Ennocent  brother  practitioners,  but  a  facile  generalisation 
will  be  made  from  this  particular  instance,  and  the  whole 
medical  profession  will  be  denounced  as  inhuman  because 
some  have  forgotten  their  humanity.  Irreparable  harm 
has  been,  done,  and  the  only  hope  of  counteracting  it 
lies  in  giving  as  wide  a  publicity  to  the  “  defence  ”  of  the 
profession  as  has  been  given  to  the  “  indictment.”  No  one 
can  doubt  what  line  that  defence  will  take,  but  it  ought  to 
ihave  been  made  publicly  known  days  ago. 

The  heads  of  the  medical  staff  of  the  two  hospitals  which 
might  be  considered  to  be  incriminated  have  shown  no 
hesitation  in  repudiating  the  experiments  ;  but  if  such  re¬ 
pudiation  was  necessary  for  the  reputation  of  the  hospitals, 
it  is  equally,  if  not  more,  necessary  for  the  reputation  of 
the  profession,  lest  it  should  be  cast  in  our  teeth  that 
our  ethics  are  merely  a  matter  of  pounds,  shillings,  and 
pence,  and  are  put  on  to  hoodwink  the  charitable.  Instead 
of  keeping  silence  on  the  matter,  the  leading  organs  of 
medical  opinion  ought,  in  our  opinion,  to  have  taken 
up  a  courageous  position,  and  spoken  out  the  mind 
of  the  profession.  The  medical  staffs  of  all  the  London 
hospitals  should  have  met  together  days  ago,  and  issued 
such  a  combined  declaration  as  would  have  cleared  them 
■of  all  suspicion,  of  imitating,  or  even  of  sympathising 


with,  the  experiments.  And  it  would  not  have  been  a  super¬ 
fluous  utterance'  of  the  President  of  the  College  of  Physicians 
had  he  come  forward  to  give,  on  the  part  of  the  profession,  an 
authoritative  expression  to  that  opinion  which,  we  are  con- 
vinced,  he  shares  with  all  of  us  who  are  sensitive  to  the 
honour  and  reputation  of  our  calling.  It  is  not  yet  too  late 
for  any  of  these  measures. 


At  the  Clinical  Society’s  meeting  on  Friday,  November  9, 
a  large  number  of  members  attended  to  hear  two  interesting 
papers  on  important  questions  of  surgery,  by  Mr.  G.  R. 
Turner.  On  their  conclusion,  the  President  paid  a  well- 
deserved  compliment  to  the  author,  and  predicted  an  inte¬ 
resting  debate  upon  the  subjects  referred  to,  viz.,  the  treat¬ 
ment  of  wounds  of  the  plantar  and  palmar  arches,  and  the 
operative  treatment  of  fracture  of  the  patella.  A  reference 
to  our  report  will  show  that  this  prediction  was  fully  borne 
out  in  a  debate  prolonged  for  half  an  hour  beyond  the  cus¬ 
tomary  limit.  An  interesting  living  specimen  of  subcuta¬ 
neous  nodules  of  uncertain  origin  was  shown  by  Dr.  J.  K. 
Fowler. 

Two  debates  in  one  week  upon  the  same  subject,  eliciting 
the  opinions  of  many  of  the  leading  surgeons  of  the  day, 
should  result  in  some  definite  conclusion  as  to  the  merits  of 
the  subject  debated.  Although  such  conclusions  can  only 
be  deduced  from  the  pervading  tone  of  opinion,  it  must  be 
evident  that  the  discussions  upon  the  operative  treatment 
of  fracture  of  the  patella,  at  the  Medical  and  the  Clinical 
Societies  respectively,  have  led  to  the  conclusion  that  the 
operation  is  only  justifiable  and  safe  when  it  can  be  under¬ 
taken  as  Prof.  Lister  himself  undertakes  it,  viz.,  with  every 
appliance  of  antiseptic  surgery  at  hand,  and  with  skilled 
assistants  to  superintend  every  detail  of  the  after-treatment. 
The  large  experience  of  hospital  surgeons  of  successful  cases 
treated  without  external  wound,  and  the  apparently  small 
number  of  failures  that  they  are  able  to  record,  cannot  be 
overlooked,  more  especially  when  the  results  obtainable  by 
the  new  method  are,  at  best,  only  as  good  as  the  best  results 
of  the  less  severe  measures.  Everyone  must  admit  that  the 
successful  osseous  union  of  the  two  fragments  of  a  broken 
patella  within  the  space  of  six  weeks  is  a  consummation 
devoutly  to  be  wished  by  surgeon  and  patient  alike,  and  to 
obtain  it  there  are  many  who  would  eagerly  place  themselves 
in  Mr.  Lister’s  hands  in  preference  to  those  of  the  advocates 
of  theolder  method  ;  but,  in  the  face  of  Mr.  Lister’s  strongly 
expressed  views  as  to  the  absolute  necessity  of  employing 
the  most  rigid  antiseptic  precautions,  intending  operators 
with  restricted  means  of  using  such  precautions  will  probably 
decide  in  favour  of  the  safer,  if  more  tedious,  mode  of 
treatment. 

At  the  meeting  of  the  Royal  Medical  and  Chirurgical 
Society,  on  Tuesday,  a  discussion  on  the  pathology  of  spon¬ 
taneous  aneurysm  in  young  subjects  followed  the  reading 
of  a  paper  on  a  spontaneous  aneurysm  in  a  boy  twelve 
years  old.  Mr.  Holmes,  while  unable  to  explain  the  actual 
mode  of  production,  Could  not  but  feel  that  there  must  be 
some  causal  connexion  between  embolism  and  aneurysm  on 
account  of  the  great  frequency  with  which  these  diseases 
are  associated ;  and  he  related  a  case  which  occurred  in  St. 
George’s  Hospital  some  years  ago,  illustrating  this  fact. 
Other  points  supporting  the  view,  such  as  the  occasional 
dilatation  which  is  found  in  arteries  above  the  seat  of  a  liga¬ 
ture,  were  mentioned.  Mr.  Harwell  thought  there  was  no 
necessary  connexion  between  aneurysm  and  embolism, 
because  in  none  of  the  recorded  cases  could  an  embolus 
actually  be  found.  Something  more  than  plugging  would 
be  required  to  explain  an  aneurysm,  for  aneurysms  never 


574 


Medtcal  Times  ar>d  Gazette. 


CHRONICLE  OF  THE  WEEK. 


Not.  17,  1883. 


occurred  after  temporary  obstruction.  Dr.  Goodhart  thought 
the  embolisms  which  gave  rise  to  this  disease  were  not 
vegetations  from  simple  endocarditis,  but  rather  vegetations 
from  a  form  of  fungating  (ulcerative)  endocarditis,  which 
contained  septic  material.  Deposited  in  any  artery,  this 
septic  material  caused  local  softening,  and  thus  predis¬ 
posed  the  arterial  coat  to  yield  to  the  pressure  of  the 
blood-current.  Mr.  Barber  referred  to  the  relative  merits 
of  silk  and  catgut  as  a  ligature  for  arteries  in  their  con¬ 
tinuity  ;  and  advocated  the  former  as  being  thoroughly 
efficient,  if  applied  with  antiseptic  precautions,  and  easy  to 
procure  at  all  times  and  in  all  places.  Mr.  Berkeley  Hill 
mentioned  a  case  in  which  cell-proliferation,  as  demonstrated 
by  the  microscope,  seemed  to  indicate  that  silk  was  not  quite 
so  innocuous  as  Mr.  Barber  imagined.  The  President  in¬ 
quired,  as  to  a  possible  rheumatic  or  syphilitic  origin,  but  the 
author  was  unable  to  give  any  confirmatory  evidence.  The 
discussion  is  reported  at  length  elsewhere.  Preparations 
from  Guy’s,  St.  George’s,  and  St.  Bartholomew’s  Museums, 
and  from  the  College  of  Surgeons,  were  shown,  illustrating 
aneurysms  in  young  subjects. 

On  Tuesday  last  the  Duke  of  Edinburgh  laid  the  founda¬ 
tion  of  a  new  wing  to  the  Croydon  Hospital,  and  was  after¬ 
wards  entertained  at  luncheon  by  the  first  Mayor  of  the  new 
borough,  Mr.  Spencer  Balfour,  M.P.  The  Croydon  Hospital 
has  had  a  short  but  successful  history,  and  it  is  to  be  hoped 
that  its  future  progress  will  be  as  favourable  as  its  past. 
Started  only  some  sixteen  years  ago,  in  a  building  of  the 
old  Croydon  Workhouse,  it  was  transferred  a  few  years  ago 
to  a  roomy  old-fashioned  house  near  West  Croydon  station, 
till  then  occupied  by  a  well-known  Quaker  family.  Some 
of  the  wards,  for  light  and  airiness,  were  everything 
that  could  be  desired,  and  the  position  was  eminently  favour¬ 
able  ;  but  the  accommodation  for  the  out-patients  and  for 
the  resident  officer  was  very  unsatisfactory,  and  it  was 
widely  regretted  at  the  time  that  an  entirely  new  hospital 
was  not  built.  The  construction  of  the  new  wing  will  re¬ 
move  many  of  the  old  inconveniences,  as  well-arranged  out¬ 
patient  rooms  and  casual  wards,  apartments  for  the  House- 
Surgeon,  and  a  spacious  operating-room  will  find  a  place  in 
the  present  addition.  The  authorities  have  wisely  extended 
their  Hospital  in  such  a  direction  that  it  will  not  encroach  on 
the  beautiful  old  garden,  which  is  one  of  the  chief  advantages 
of  the  Hospital.  It  is  no  doubt  a  very  great  boon  to  patients 
to  be  able  to  step  out  of  their  wards  into  the  sunlit  quiet  of 
a  garden;  and  the  surgeons  show  that  they  fully  appreciate 
the  curative  influences  of  pure  air  by  erecting  a  tent  in  the 
summer-time  for  the  treatment  of  suitable  cases.  The  ground 
around  the  Hospital  has  of  late  been  rapidly  covered  by 
houses,  and  it  is  difficult  to  believe  that  so  recently  as  ten 
years  ago  a  herd  of  deer  nibbled  the  herbage  where  now  rows 
of  modern  villas  stand.  Croydon  is  evidently  alive  to  the 
wants  of  modern  civilisation. 


The  “mystery-mongers”  have  enjoyed  a  real  treat  this 
week,  in  the  “  extraordinary  occurrences  ”  which  have  hap¬ 
pened  in  connexion  with  a  certain  young  woman  aged 
thirteen,  and  living  near  Shrewsbury.  The  Psychical 
Research  Society  certainly  failed  in  their  duty  both  to  them¬ 
selves,  to  their  journal,  and  to  the  community  in  not  at 
once  sending  a  deputation  to  report  on  the  case,  and  in 
leaving  it  to  be  unravelled  by  an  unscientific  newspaper 
reporter.  How  was  it  to  be  known  that  the  phenomena 
were  not  extraordinary  and  exceptional  manifestations  of 
psychic  force  ?  Nothing  seemed  to  escape  it.  The  bucket 
in  which  the  girl  was  washing  jumped  about  the  house, 
throwing  water  and  clothes  in  all  directions.  The  family 
Bible  and  other  books  placed  on  a  side  table  did  the 


same,  narrowly  escaping  the  flames.  On  attempting  to- 
pick  them  up,  a  boot  flew  over  the  girl’s  head,  striking 
the  mantelpiece.  Later  on,  the  clothes  she  placed  on 
a  hedge  for  drying,  jumped  over  into  the  road.  On 
arriving  at  her  home,  her  presence  induced  a  lump  of  coal 
to  leap  from  the  fire  across  the  room  to  a  table ;  and  the- 
flowerpots  in  the  window  also  behaved  in  an  extraordinary 
manner.  The  girl  shortly  afterwards  went  out  to  fetch  her 
father,  but  before  proceeding  far  she  became  very  ill,  and 
fell  down  in  the  road.  She  was  conveyed  back  to  her  home, 
and  a  physician  called  in.  The  next  day  there  were  similar 
occurrences,  and  during  the  night  six  panes  of  glass  were- 
broken  in  the  room,  and  outside  the  house  were  strewn 
broken  bricks,  crockery,  glass,  stones,  etc.,  which  could  not 
be  accounted  for  in  any  way.  One  woman  was  struck  with- 
a  stone  150  yards  off;  another,  who  was  in  the  house,, 
received  a  wound  on  the  arm  from  a  knife  passing  her ;  and! 
an  ulster  belonging  to  the  girl  had  every  button  torn  from 
it  in  the  room.  A  number  of  the  Shropshire  constabulary 
visited  the  premises  on  Saturday  to  investigate  the  extra~ 
ordinary  circumstances,  but  were  unable  to  solve  the  mystery. 
The  girl  was  made  to  do  some  household  work,  but  nothiny 
unusual  was  observable.  Dr.  Corke,  of  Baschurch,  was  called 
in  on  Saturday,  and  made  a  close  examination  of  the  girl, 
but  was  unable  to  obtain  much  information  from  her.  He 
stated  that  she  was  in  a  very  excitable  and  nervous  state, 
but  was  not  a  designing  girl.  Since  then  the  patient  has 
been  taken  away  from  her  home,  and  has  confessed,  what 
every  sensible  person  knew,  that  she  was  herself  the  author 
of  all  the  disturbances. 


The  whole  account  is  an  interesting  illustration  of  how 
hysteria  and  imposture  subtly  combined  can  form  the  basis', 
of  a  sensational  story,  when  helped  out  by  a  large  element 
of  hearsay  and  superstition  in  the  report  of  the  alleged 
“  facts.”  It  is  instructive  to  read,  in  connexion  with  the  case, 
the  remark  of  Dr.  Wilks,  that  “  the  strangest  vagaries  of 
human  nature  are  those  which  occur  in  young  females  in 
the  early  stages  of  womanhood.  The  behaviour  is  often 
like  that  of  one  f  possessed  of  a  devil,’  for  the  acts  are  not 
those  of  an  ordinary  criminal  who  has  an  object  in  hig! 
wicked  deeds,  but  are  often  purposeless,  or  for  the  simple- 
love  of  mischief.  When  you  see  a  paragraph  in  the  news 
papers  headed  “  extraordinary  occurrence,”  and  you  read- 
how  every  night  loud  rapping  is  heard  in  some  part  of  the 
house,  or  how  the  rooms  are  being  constantly  set  on  fire,, 
or  how  all  the  sheets  in  the  house  are  torn  by  rats,  you 
may  be  quite  sure  that  there  is  a  young  girl  on  the- 
premises.”  _ 

Tinned  foods  are  so  great  a  boon  to  the  poorer  classes 
that  it  would  be  a  very  great  pity  if  the  case  of  poisoning- 
by  tinned  lobster,  reported  last  week,  should  prejudice  the 
public  against  them.  The  introduction  of  these  preserved 
foods  has  brought  to  the  table  of  all  but  the  very  poorest,  foods 
with  whose  flavour  they  would  otherwise  never  have  a  chance 
of  making  an  acquaintance.  It  is  hardly  too  much  to  say 
that  every  day  the  tinned  lobster  and  the  tinned  salmon 
are  relished  in  thousands  of  artisans’  households,  and  to  stop- 
their  use  would  be  as  great  a  deprivation  to  the  artisan  as 
the  prohibition  of  game  would  be  to  his  master.  It  seems 
fairly  conclusively  proved  by  the  evidence  given  in  the  case 
reported  that  the  tinned  salmon  was  really  the  cause  ofi 
death.  The  alimentary  tract  showed  signs  of  severe  irritant 
poisoning,  and  the  contents  of  the  tin  proved  fatal  to- 
guinea-pigs.  The  exceptional  effect  in  this  case  was  traced 
to  the  fact  that  the  tin  had  been  opened  some  time,  the 
salmon  had  decomposed,  and  the  tin  coating  had  been  largely- 
dissolved.  But  the  danger  is  to  be  avoided  with  common 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Nov.  1*,  1863.  575 


of  papers  by  Petrone  on  the  Miasmatic  Origin  of  Purpura 
are  also  of  interest.  Dr.  Mertnann,  of  Mannheim,  con¬ 
tributes  to  the  Centralblatt  fur  Gyndlcologie  some  Apho¬ 
risms  on  the  Management  of  Midwives.  An  abstract  of  a 
paper  by  Dr.  May,  of  Munich,  on  the  Infectiousness  of  Milk 
from  Cows  with  Bovine  Tuberculosis,  may  also  be  noted. 
The  Berliner  Klinische  Wochenschrift  publishes  in  extenso 
Prof.  Virchow’s  recent  address  on  Congenital  Encephalitis, 
and  the  first  part  of  a  paper  by  Dr.’Felix  Semon,  of  London, 
on  the  Paralysis  of  Individual  Strands  of  the  Inferior 
Laryngeal  Nerve.  In  the  Wiener  Medizinische  Wochen¬ 
schrift,  Dr.  K.  Braun  von  Fernwald  discusses  twelve  cases  of 
Caesarian  Section  with  Hysterectomy;  Dr.  Herz  contributes 
a  critical  sketch  of  the  Modern  Medication  of  Diphtheria ; 
and  Dr.  Schmucker,  a  case  of  Puncture  of  the  Pericardium. 


f  r  •  ' '  rj  A  r*\  <*  ■ 

ANTISEPTICS  AND  HOUSE  SURGEONS.  Iw°('  u‘ :  u 

V  o  «  LIB  ft  )\  f 

While  an  increased  faith  in  the  efficacy  of  strict  antnsep&c--.  _  ' 

■  precautions  must  of  necessity  follow  the  brilliant  resh  %CHgS 
obtained  by  Prof.  Lister  in  his  treatment  of  fractured  patella,  ~~ 
the  remarks  made  by  him  at  the  last  meeting  of  the  Clinical 
Society  on  the  subject  of  attention  to  the  details  of  dressing 
should  be  seriously  taken  to  heart  when  dangerous  operations 
are  undertaken.  The  suggestions  thrown  out — by  one  surgeon, 
that  the  septic  condition  of  a  wound  hitherto  aseptic  might 
have  been  due  to  the  absence  of  the  regular  house-surgeon 
upon  his  holiday;  and  by  another,  that  similar  want  of 
success  might  have  been  the  result  of  a  little  assistance 
rendered  during  the  operation  by  a  colleague  with  unwashed 
hands— are  instructive.  Much  of  the  opprobrium  of  failure 
of  antiseptic  precautions  in  hospital  cases  must  of  necessity 
fall  upon  the  house-surgeon  or  dresser,  if,  as  in  some  large 
hospitals,  the  latter  is  placed  in  responsible  charge  of  his 
cases.  If  a  house-surgeon  is  to  be  thoroughly  versed  in  all 
the  details  of  antiseptic  dressing,  so  as  to  be  equal  to  the 
emergency-practice  of  a  large  hospital,  he  must  have  been 
brought  up,  as  it  were,  in  an  antiseptic  or  Listerian  atmos. 
phere,  and  his  mind  must  be  imbued  with  a  persistent 
enmity  towards  all  sorts  and  conditions  of  germs,  and  accus¬ 
tomed  to  regard  the  homely  poultice  as  a  barbaric  contrivance 
of  a  bygone  age.  But  house-surgeons  and  dressers  must  in 
their  turn  enter  upon  the  general  practice  of  surgery  and  be 
prepared  to  treat  cases  and  to  operate  under  circumstances 
where  antiseptics  cannot  be  applied.  Here  their  knowledge 
of  the  manners  and  customs  of  disease-germs  and  their  con¬ 
tempt  for  the  efficacy  of  the  poultice  will  avail  them  but 
little,  and  patients  may  suffer  in  order  that  their  medical 
attendants  may  theorise.  Until  the  day,  predicted  by  Prof. 

Lister,  arrives  when  rigid  antiseptic  rules  shall  be  univer¬ 
sally  applied,  the  custom  of  restricting  the  student  to  the 
practice  of  one  surgeon  only  will  be  followed,  as  it  frequently 
is  at  present,  by  the  unsatisfactory  consequence  that  the 
general  experience  of  surgical  practice  has  to  be  learnt  at 
last  instead  of  at  first.  But  Mr.  Lister  insists  that  the 
success  of  antiseptic  treatment  depends  largely  upon  the 
antiseptic  training  of  those  who  have  to  carry  it  out.  Per¬ 
haps  the  best  way  out  of  the  difficulty  is  that  suggested  by 
himself,  viz.,  that  surgeons  should  attend  daily  and  see  to 
their  dressings  themselves. 


care.  It  was  recently  shown  in  our  pages  that  the  amount 
of  tin  found  dissolved  in  tinned  foods  freshly  opened  is  com¬ 
paratively  small,  and  though  there  may  be  some  risk  of 
chronic  tin-poisoning  from  the  continued  use  of  such  foods, 
there  is  no  danger  of  acute  poisoning  if  the  food  is  either 
eaten  directly  the  tin  is  opened,  or  is  at  once  transferred  to 
a  glass  or  earthenware  vessel.  It  would  be  well  if  directions 
to  this  effect  were  placed  on  every  tin,  but  the  enforced 
substitution  of  glass  for  tin  vessels  would  probably  double 
the  cost,  and  so  place  the  enjoyment  of  these  foods  beyond 
the  reach  of  the  classes  to  whom  they  are  now  so  great  a 
boon. 


Nothing  can  be  more  reasonable  than  the  contention 
put  forward  by  the  Anti-Beer- Adulteration  Society,  at  the 
meeting  at  Canterbury  on  Saturday  last,  that  brewers  who 
brew  from  other  materials  than  malt  and  hops  should  be 
compelled  to  inform  their  customers  of  the  fact.  It  is  quite 
possible  that  a  safe  and  palatable  drink  may  be  made  from 
beetroot  and  gentian;  and  it  is  not  desirable,  or  indeed 
desired  by  any  enlightened  person,  that  attempts  to  intro¬ 
duce  beverages  of  that  sort  should  be  suppressed.  But 
at  present  the  public  favours  beer  brewed  from  materials 
that  ripen  in  the  full  light  of  the  sun,  in  preference  t<J  the 
concoction  made  from  such  substances  as  mature  their 
sweet  and  bitter  principles  in  the  dark  laboratory  of  the 
earth.  The  very  word  “beer”  implies  the  use  of  malt  and 
hops,  and  until  the  definition  of  the  term  has  been  widened 
by  public  consent  to  include  any  alcoholic  beverage  con¬ 
taining  a  bitter  principle,  the  use  of  anything  except  malt 
and  hops  in  the  brewing  of  beer  may  legitimately  be  de¬ 
nounced  as  an  adulteration.  The  whole  question  ought 
to  be  argued  and  decided  purely  with  regard  to  the  general 
public  weal.  Of  course,  the  growers  of  hops  and  barley  and 
the  manufacturers  of  malt  have  a  direct  personal  interest  in 
the  matter,  but  they  will  injure  a  very  excellent  cause  if 
they  let  their  hand  be  too  plainly  seen  in  the  agitation. 


The  Progres  Medical  this  week  is  entirely  given  up  to  the 
students’  number,  the  medical  year  in  France,  as  our  readers 
are  probably  aware,  commencing  much  later  than  our  own. 
The  Gazette  Hebdomadaire  gives  the  conclusion  of  M. 
Marboux’s  papei;  “  Etude  critique  sur  la  Tuberculose 
articulaire.”  The  Gazette  Medicate  de  Paris  contains  an 
important  paper  by  M.  Dejernie  (whose  researches  on 
diseases  of  the  spinal  cord  are  so  well  known),  headed  “  Sur 
la  Nervo-tabes  peripherique.”  The  Gazette  des  Hopitauxhas 
an  article  entitled  “  Nevrite  sciatique  des  Phthisiques,”  and 
the  Concours  Medical  a  paper  by  M.  Carriere,  “Reflexions 
au  sujet  d’un  cas  de  Tetanos.” 

The  Centralblatt  fur  Klinische  Medicin  contains  an  ori¬ 
ginal  paper  by  Prof.  Ehrlich  on  Sulphodiagobenzol,  a  Re¬ 
agent  on  Bilirubin ;  abstracts  of  several  papers  on  Tubercle- 
Bacilli;  and  of  two  dissertations,  by  Fischer  and  Brecht  of 
Berlin,  respectively,  on  the  Diago  Reaction.  Dr.  Ogneff,  of 
Moscow,  contributes  to  the  Centralblatt  fur  die  Medicinischen 
Wissenschaften  an  original  paper  on  the  Histology  of  the 
Retina.  Amongst  the  numerous  abstracts  the  following  are 
of  interest : — Diising  on  the  Factors  for  the  Determination 
of  Sex;  Pfitzner  on  the  Structure  of  Nuclei;  Kiesselbach 
on  the  Galvanic  Stimulation  of  the  Acoustic  Nerve ;  Wahl 
on  Suture  of  Fractured  Patella;  Francois  Franck  and 
A.  Pitres  on  Epileptiform  Convulsions  of  Cortical  Origin. 
In  the  Centralblatt  fur  Chirurgie ,  Dr.  Kocher,  of  Berne, 
gives  close  details  of  the  method  of  applying  Sutures  in 
the  Resections  of  the  Stomach  and  Intestines.  Dr.  Walz- 
berg,  of  Minden,  contributes  a  paper  on  the  Differential 
Diagnosis  of  Tic-dooloureux  and  Toothache.  Abstracts 


A  GLIMPSE  INTO  THE  FUTURE. 

It  is  a  great  practical  advantage  to  us  English  people  to 
have  constantly  before  our  eyes  a  nation  so  far  in  advance 
of  us  in  every  way  as  the  Americans.  We  can  take  warning 
by  their  example,  following  or  breaking  away  from  them 
according  as  their  pioneering  is  successful  or  the  reverse. 
They  are  to  us  as  the  Beryl-stone  in  Rossetti’s  ballad,  in 


57G 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Nov.  17, 1883 ; 


which  we  can  see  our  future  accurately  depicted  if  we  only 
look  at  it  with  a  faithful  heart.  Here  is  one  of  its  pictures ! 

‘“A  Bloodless  Operation’:  a  Young  Lady’s  Leg  Amputated  at 
the  Buffalo  General  Hospital.— The  clinic  of  Dr.  Roswell  Park  last 
week  consisted  of  a  very  interesting  surgical  operation.  The  new  pro¬ 
fessor  of  surgery  is  fast  winning  friends  among  physicians  and  students 
by  his  genial  ways  and  thorough  understanding  of  his  special  branch  of 
medical  science.  He  is  a  man  conversant  with  the  latest  surgical  litera¬ 
ture,  and  consequently  performs  operations  according  to  Lester’s  (sic)  or 
the  aseptic  or  antiseptic  methods.  The  first  case  at  the  clinic  Wednesday, 
etc.” 

Then  follows  a  full  description  of  the  case.  The  extract 
is  from  a  paper  published  at  Buffalo,  a  city  of  some  two 
hundred  thousand  inhabitants.  The  following  is  from  an 
editorial  in  another  Buffalo  paper,  curiously  enough  an 
admirer  of  the  same  practitioner  : — 

“  During  the  early  part  of  the  summer  a  little  boy  named  Strieker  was 
run  over,  on  an  East-side  street,  by  a  heavily  loaded  beer-waggon.  The 
wheels  passed  over  his  right  leg,  fracturing  it  terribly.  The  child  was  re¬ 
moved  to  the  General  Hospital,  and  for  a  time  it  looked  as  though  the  leg 
would  have  to  be  amputated.  But  the  attending  physicians  worked  hard 
and  the  limb  was  saved.  As  is  usual  in  such  severe  cases,  the  surface 
became  ulcerated,  and  were  (sic)  healing  slowly.  On  Saturday,  before  the 
clinic  class  of  the  University  of  Buffalo,  Dr.  Park  performed  the  opera¬ 
tion  of  skin-grafting,  which  consisted  in  removing  a  small  particle  of 
healthy  skin  from  the  boy’s  leg,  and  after  cutting  this  into  very  minute 
pieces,  scattered  it  on  the  surface  of  the  ulcerated  surface  (sic).  In  a  short 
time  these  little  grafts  will  begin  to  spread  out,  and  a  new  and  healthy 
skin  will  be  formed.” 

What  Beryl-stone  could  tell  us  more  accurately  whither  we 
are  tending  and  where  we  shall  he  landed  if  the  “  medical 
bulletin”  is  allowed  to  develope  itself  in  the  way  that 
newspaper  reporters  wish  ? 


CIVILISATION  THE  RESULT  OF  INTELLECTUAL 
PROGRESS. 

This  was  the  subject  chosen  by  Dr.  Bell  Pettigrew,  the 
Professor  of  Physiology  at  St.  Andrews  University,  for  his 
introductory  lecture  to  his  class  on  the  6th  inst.  The  history 
of  civilisation,  said  the  lecturer,  was  virtually  that  of  intel¬ 
lectual  progress,  and  intellectual  progress,  within  the  his¬ 
torical  period,  might  be  said  to  have  kept  pace  with  brain- 
changes  in  the  human  race  as  a  whole.  It  was  therefore 
necessary,  in  dealing  with  the  subject  of  civilisation,  to 
refer  preliminarily  to  the  nervous  system  not  only  in  man 
but  in  the  lower  animals,  and  especially  to  the  great 
centre  of  the  nervous  system,  the  brain.  Prof.  Pettigrew 
then  proceeded  to  trace  the  nervous  system  from  man 
downwards  to  the  lowest  animal  forms  in  which  it  is  recoar- 
nisable,  referring  also  to  the  great  race  of  sensitive  plants, 
certain  of  which  had  been  shown  by  Darwin  to  display 
an  amount  of  sensitiveness  unknown  even  amongst  the 
highest  animals.  For  every  fresh  increment  of  brain- 
substance  there  was  an  increment  of  brain-power  and  intel¬ 
ligence,  and  that  increased  brain-substance  was  brought  about 
by  cultivation.  The  integrity  of  the  cerebral  hemispheres 
was,  however,  necessary  to  the  production  of  intelligence  and 
will.  When  these  are  defective  or  diseased,  there  follows 
inability  to  discriminate  between  what  is  important  and 
unimportant  in  matters  of  daily  life.  Semi-civilised  nations 
have  smaller  brains  than  Europeans,  and  thus  the  advance 
of  the  arts  in  Europe.  The  lecturer  proceeded  to  prove  his 
case  by  referring  to  the  progressive  development  of  nations 
and  races.  Progress  in  man,  he  said,  proceeds  in  two  direc¬ 
tions — physically  and  mentally.  For  the  last  four  thousand 
years  at  least,  however,  the  body  of  man  has  remained  to 
all  intents  and  purposes  stationary.  It  is  the  mind  which 
during  the  period  in  question  has  made  gigantic  strides. 
The  body  of  the  modern  savage  is  as  perfect  as  that  of  the 
most  civilised  modern  man,  but  the  mind  of  civilised  modern 
man  is  as  much  in  advance  of  the  mind  of  savage  man  as 
the  mind  of  savage  man  is  in  advance  of  that  of  the  gorilla. 
All  modern  improvements  and  discoveries  are  traceable  to 


the  sedulously  cultivated  and  enormously  developed  intellect 
of  man. 


CONGENITAL  ENCEPHALITIS. 

The  valuable  address  of  Prof.  Rudolf  Yirchow,  of  which  we 
publish  an  abstract  in  another  column,  will  be  read  with  much 
interest  in  this  country,  where  the  conditions  of  the  brain, 
of  which  it  treats,  have  received  but  scanty  attention, 
although  probably  familiar  to  most  pathologists.  Occurring, 
as  they  appear  to  do,  with  such  great  frequency,  they  have 
been,  perhaps,  too  readily  accepted  as  normal  conditions. 
The  strongly  expressed  opinion  of  Prof.  Yirchow  to  the 
contrary  will  turn  attention  to  the  subject  and  lead  to  the 
reconsideration  of  the  former  beliefs,  with  the  aid  of  the 
increased  facilities  for  studying  the  pathology  of  the  brain 
which  have  of  late  years  been  introduced. 


THE  PARTNERSHIP  OF  THE  FUTURE. 

“  Great  wits  jump  together,”  says  the  old  proverb,  and 
though  probably  no  “great  wit”  has  been  allotted  to  the 
anonymous  author  of  the  “  Medical  Idyll,”  “  Dr.  Edith 
Romney/’  yet  we  may  remark  that  one  of  the  leading  ideas 
upoij  which  the  tale  turns  is  one  which  has  been  present 
also,  almost  simultaneously,  to  an  undoubtedly  great  mind. 
It  is  that  of  the  intermarriage  of  medical  men  and  medical 
women;  and  we  had  scarcely  recovered  from  the  painful 
effort  involved  in  the  perusal  of  the  novel,  before  we  found 
the  same  point  touched  upon  by  Dr.  Wendell  Holmes  in  his 
Harvard  address.  “  I  have  often  wished,”  says  the  versatile 
author,  introducing,  as  is  his  wont,  a  lighter  passage  among 
his  graver  thoughts,  “  that  disease  could  be  hunted  by  its 
professional  antagonists  in  couples — a  doctor  and  a  doctor’s 
wife.”  May  we  think  that  we  see  the  future  foreshadowed 
in  these  lines,  and  again  in  the  history  of  Dr.  Romney 
aforesaid?  Will  it  hereafter  be  the  aim  of  the  idle  Adonis 
of  the  hospital  (we  all  know  the  type)  to  devote  his  cum¬ 
brous  energies  to  the  captivation  of  a  fair  partner  who  may 
help  him — after  the  agonies  of  examinations  are  over — to  the 
enjoyment  of  that  restful  life  for  which  he  is  best  fitted  ? 
And  may  we  wonder,  with  all  respect,  to  whose  share  in  this 
the  latest  form  of  “  sleeping  ”  partnership  will  fall  the 
harassing  labour  of  the  nightwork  in  the  joint  practice  ?  We 
should  imagine  that  in  this  a  more  fruitful  source  of  con¬ 
jugal  differences  than  any  yet  revealed  may  be  looming  in 
the  future. 

A  PREPARATORY  SCHOOL  OF  MEDICINE  AND 
NATURAL  SCIENCE. 

The  authorities  of  the  West  London  Hospital,  being  anxious 
to  utilise  it  as  a  place  for  medical  education,  have  drawn  up5 
and  are  about  to  carry  into  execution,  a  scheme  for  the  foun¬ 
dation  of  a  preparatory  school  for  medicine  and  for  natural 
science.  The  Hospital  contains  101  beds,  and  is  conve¬ 
niently  near  to  South  Kensington  Museum — i.e.,  ten  minutes 
journey  by  the  District  Railway.  The  objects  aimed  at  are 
stated  as  follows  in  the  prospectus  which  lies  before  us  : — 
1.  To  give,  in  a  more  complete  and  systematic  manner  than 
has  heretofore  ever  been  attempted,  all  the  advantages  of 
a  year’s  pupilage  at  a  first-class  provincial  infirmary  or 
county  hospital.  2.  To  give  thorough  and  practical  instruc¬ 
tion  in  natural  science,  such  to  be  carried  up  to  the  standard 
of  the  Preliminary  Scientific  (M.B.)  Examination  of  the 
London  University.  3.  To  give  intending  medical  students 
an  early  insight  into  medical  work,  so  that  they  may,  without 
needless  loss  of  time  or  money,  be  able  to  judge  whether  or 
not  they  have  chosen  the  right  profession.  To  attain  these 
ends,  courses  of  lectures  are  arranged  for,  which,  as  regards 
advanced  subjects,  such  as  medicine  and  surgery,  will  be, 
the  prospectus  states,  “purely  elementary,  being,  in  fact. 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


IN  OV.  17,  1683.  5  7  7 


adapted  to  excite  an  intelligent  interest  in,  and  to  give  a 
general  idea  of,  hospital  practice.”  But  the  instruction  in 
materia  medica,  osteology,  and  the  subjects  of  the  Science 
School  will  be  more  complete,  it  being  intended  to  prepare 
the  student  for  the  First  Professional  Examination  for  the 
L.R.C.P.  Lond.,  and,  if  he  should  wish  it,  for  the  Prelimi¬ 
nary  Scientific  (M.B.)  of  the  London  University.  The 
“  School  of  Science,”  while  located  at  the  Hospital  and 
worked  in  alliance  with  the  Preparatory  School  of  Medicine, 
appears  to  be  in  a  sense  distinct  from  it,  for  the  former  is 
“  in  connexion  with  the  Science  and  Art  Department  of  the 
Committee  of  Council  on  Education,  South  Kensington,” 
and  under  the  management  of  a  distinct  committee.  The 
subjects  taught  are  mechanical  philosophy,  physics,  che¬ 
mistry,  botany,  zoology,  and,  we  are  glad  to  see,  drawing — 
one  of  the  most  useful  accomplishments  a  medical  student 
can  possess.  The  fees  are  apparently  reasonable  enough, 
and,  for  further  information,  applicants  are  referred  to  “the 
Secretary  of  the  Medical  School,  West  London  Hospital, 
Hammersmith-broadway,”  or  Mr.  C.  B.  Keetley,  20,  Princes- 
street,  Hanover-square,  W. 


THE  PARIS  WEEKLY  RETURN. 

The  number  of  deaths  for  the  forty-fourth  week  of  1883, 
terminating  October  30,  was  932,  and  of  these  there  were 
from  typhoid  fever  30,  small-pox  5,  measles  7,  scarlatina 
none,  pertussis  10,  diphtheria  and  croup  27,  dysentery  1, 
erysipelas  4,  and  puerperal  infection  5.  There  were  also 
53  deaths  from  acute  and  tubercular  meningitis,  202  from 
phthisis,  30  from  acute  bronchitis,  50  from  pneumonia,  69 
from  infantile  athrepsia  (22  of  the  infants  having  been 
wholly  or  partially  suckled),  and  28  violent  deaths.  The 
mortality  continues  at  the  same  low  level  which  it  has 
exhibited  since  September.  Typhoid  fever  has  diminished 
from  the  45  deaths  of  last  week  to  30,  while  the  other  epidemic 
diseases  have  also  diminished  or  are  stationary.  Pertussis, 
which  had  prevailed  epidemically  during  six  months,  has 
much  diminished  during  the  last  four  weeks.  Scarlatina 
has  caused  no  deaths  in  Paris  during  two  successive  weeks. 
During  the  week  there  were  1203  births  (608  males  and  595 
females),  881  legitimate  and  322  illegitimate. 


RESEARCHES  ON  YELLOW  FEVER. 

The  recently  published  volume  of  reports  of  Her  Majesty’s 
Diplomatic  and  Consular  Officers  contain  a  summary  of  the 
results  of  an  inquiry  conducted  under  the  authority  of  the 
Brazilian  Government  by  Dr.  Domingos  Freire  into  the 
causes  of  yellow  fever  and  the  best  means  of  combating  its 
ravages.  Dr.  Freire,  after  a  long  series  of  experiments,  has 
arrived  at  the  conclusion  that  the  disease  is  due  to  the  rapid 
development  and  increase  of  a  special  microbe,  which  he 
calls  Cryptococcus  xanthogenicus.  He  finds  that  all  th 
symptoms  of  yellow  fever  can  be  produced  by  inoculation  ; 
that  where  the  special  micro-organisms  are  present  the  fever 
certainly  follows ;  and  that,  on  the  other  hand,  when  they 
have  been  exposed  to  high  temperatures,  inoculation  with 
the  substance  containing  them  fails  to  produce  fever.  In¬ 
oculation  with  a  drop  of  blood  from  a  person  dead  of  yellow 
fever  caused  the  death  of  a  rabbit  in  a  short  space  of  time. 
A  drop  of  the  rabbit’s  blood  brought  about  the  death  of  an 
inoculated  guinea-pig  ;  and  a  second  guinea-pig  inoculated 
from  the  first,  died  of  the  fever,  and  presented  symptoms 
exactly  like  those  of  yellow  fever  in  man,  whilst  the  autopsy 
after  death  revealed  a  perfectly  similar  alteration  of  the 
tissues  and  internal  organs.  The  organisms  showed  no  sign 
of  losing  their  virulence  by  continuous  transmissions,  for 
nine  transmissions  of  blood,  even  when  diluted  with  water, 
had  unfailingly  caused  death  in  the  animals  inoculated. 


This  persistence  of  virulence  evidently  goes  to  prove  that 
the  agent  of  disease  is  a  living  agent,  and  careful  micro¬ 
scopic  examination  actually  revealed  the  presence  of  minute 
living  organisms  in  different  stages  of  development.  “  But/’ 
continues  Dr.  Freire,  “  if  the  microbes  or  animalcules  are 
really  the  cause  of  yellow  fever,  their  destruction  should 
render  harmless  the  introduction  of  the  organic  liquid  into 
the  circulation.  This  test  was  successfully  obtained.  A 
piece  of  the  arm  of  a  person  who  had  died  of  yellow 
fever  was  triturated  and  mixed  with  water  quite  free  from 
organisms,  and  filtered.  Microscopic  examination  proved 
that  a  drop  of  filtered  liquid  showed  swarms  of  microbes. 
Steps  were  taken  to  subject  a  portion  of  the  infusion  to 
intense  heat,  and  the  resulting  sediment  was  introduced 
into  the  circulation  of  a  guinea-pig  without  producing 
any  injurious  effects,  while  another  portion  of  the  in¬ 
fusion,  not  sterilised  by  heating,  produced  death  within 
two  days.”  Other  experiments  showed  that  the  infec¬ 
tion  could  be  communicated  by  means  both  of  the  air 
and  the  soil,  the  earth  from  a  cemetery  in  which  yellow- 
fever  patients  had  been  buried  having  been  found  to  convey 
the  disease  to  a  guinea-pig  when  introduced  by  suitable 
means  into  its  circulation.  This  is  one  of  the  strongest 
arguments  in  favour  of  cremation  that  we  have  yet  heard. 
But  perhaps  the  most  extraordinary  result  of  the  Brazilian 
Government  inquiry  is  that  Dr.  Freire  professes  to  have 
discovered  other  organisms  which,  being  inoculated  into  the 
system  of  men  and  animals,  prevent  the  subsequent  de¬ 
velopment  of  the  yellow -fever  parasite  j  and  he  mentions 
cases  in  which  guinea-pigs  so  fortified  withstood  the  inocu¬ 
lation  of  the  most  deadly  infusions  of  the  yellow-fever  germ. 
On  this  point,  however,  it  will  be  well  to  keep  an  open 
mind  until  Dr.  Freire’s  results  have  been  repeated  and 
revised  by  other  workers  in  the  same  field. 


A  MEDICAL  VICTORY  AT  LIVERPOOL. 

At  a  meeting  of  the  Liverpool  City  Council  on  November  9, 
it  was  moved  that  the  Insanitary  Property  and  Artisans’ 
Dwelling  Committee  should  consist  of  twelve  members,  only 
one  of  whom  was  a  medical  man.  There  are  three  other 
medical  men  on  the  Council,  and  Mr.  Stephens  at  once 
moved  as  an  amendment  that  the  Committee  should  consist 
of  fifteen  members  through  the  addition  of  these  three 
councillors.  Mr.  Forwood,  the  leading  advocate  of  com¬ 
pulsory  notification  of  infectious  disease,  objected  to  Dr. 
Hamilton,  especially  on  the  ground  that  he  was  antagonistic 
to  notification,  and  therefore  would  not  work  harmoniously 
with  himself  and  the  other  members  of  the  Committee.  On 
a  vote  being  taken.  Dr.  Hamilton  was  added  to  the  Com¬ 
mittee  by  a  majority  of  two  to  one.  Drs.  Cross  and  Bligh 
were  afterwards  appointed  members  of  the  same  Committee. 
The  medical  men  on  the  Liverpool  Council  have  therefore 
asserted  their  right  to  be  heard  on  sanitary  matters,  and 
we  hope  their  example  will  be  followed  by  the  medical  pro¬ 
fession  everywhere.  Hitherto  in  Liverpool  the  medical 
profession  has  had  no  voice  in  these  matters.  Even  the 
Medical  Officer  of  Health  was  restrained  from  reporting 
insanitary  property  except  at  such  times  and  in  such 
localities  as  the  Health  Committee  thought  fit.  By  such  a 
course  the  responsibility  was  kept  from  falling  directly  on 
the  Committee,  and  was  left  on  the  shoulders  of  the  Medical 
Officer  of  Health,  who  occupied  much  the  same  position  to 
the  Health  Committee  as  the  "  whipping  boy  ”  did  to  youth¬ 
ful  but  erring  princes.  The  Liverpool  Medical  Officer  of 
Health  has  been  allowed  to  emerge  from  this  condition  of 
restraint,  and  at  the  last  meeting  of  the  Council  he  reported 
on  fifty-five  houses  as  unfit  for  human  habitation.  A  coun¬ 
cillor  said  he  was  certain  the  medical  officer  had  allowed 


578 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Nov.  17,  1883. 


his  reputation  to  suffer  at  the  hands  of  the  medical  men  of 
the  city  in  consequence  of  his  adherence  to  the  wishes  of 
the  Health  Committee.  May  the  events  here  described 
inaugurate  a  course  of  action  that  will  soon  reduce  the 
number  of  uninhabitable  houses  that  now  abound  in 
squalid  Liverpool. 

AN  UNUSUAL  FORERUNNER  OF  RHEUMATIC  FEVER. 

Most  of  us  are  familiar  with  ear-troubles  as  an  after-result 
of  acute  illness,  and  especially  of  the  exanthemata  in  child¬ 
hood,  but  these  have  not  often  been  observed,  or  perhaps, 
to  speak  more  accurately,  have  not  often  been  recorded,  as 
occurring  amongst  the  prodromata  of  an  acute  illness. 
Such  a  connexion,  however,  between  rheumatic  fever  and 
inflammation  of  the  tympanic  membrane  has  recently 
been  described  by  M.  Meniere,  in  the  Revue  Mensuelle  de 
Laryngologie  for  November.  His  patient  was  a  man  aged 
thirty,  who,  in  consequence  of  a  chill,  complained  of  severe 
lancinating  pain,  with  remissions  and  exacerbations,  in  the 
ear,  and  who  presented  those  changes  in  the  form  and 
colour  of  his  tympanic  membrane  which  commonly  are  the 
precursors  of  an  attack  of  otitis  interna.  On  the  fourth 
day,  however,  rheumatic  fever  declared  itself,  and  the  ear- 
trouble  rapidly  disappeared.  M.  Meniere  considers  that  this 
was  not  a  true  otitis  media  resulting  from  the  chill,  but  a 
peculiar  congestive  attack  without  any  exudation,  and 
closely  associated  with  the  rheumatic  attack.  He  considers 
that  its  occurrence  may  be  regarded  as  evidence  in  support 
of  the  view  (which  is  not,  however,  confirmed  by  histology) 
that  the  tympanic  membrane  is  partly  a  serous  membrane 
and  partly  a  mucous  membrane.  Surely  this  is  very  feeble 
reasoning.  Rheumatism  attacks  fibrous  structures  as  well 
as  serous.  If  we  are  to  base  our  minute  anatomy  on  patho¬ 
logical  theories,  we  shall  arrive  at  a  good  many  strange 
conclusions.  For  instance,  not  to  leave  the  present  subject, 
tonsillar  inflammations  are  exceedingly  common  in  associa¬ 
tion  with  rheumatism,  but  we  have  yet  to  learn  that  the 
tonsils  are  lined  with  a  serous  membrane. 


DEATH  OF  DR.  MARION  SIMS. 

We  regret  to  hear  of  the  death  of  the  distinguished  American 
gynaecologist.  Dr.  Marion  Sims,  which  occurred  suddenly, 
from  heart  disease,  at  New  York,  on  the  13th  inst.  Dr.  Sims 
was  born  in  South  Carolina  on  January  25,  1813.  He  gra¬ 
duated  at  the  South  Carolina  College  in  1832,  and  studied 
medicine  in  Charleston  and  at  the  Jefferson  Medical  College, 
Philadelphia.  He  settled  at  Montgomery,  Alabama,  in 
1836,  and  soon  became  widely  known  for  his  general  surgical 
skill.  It  was  not,  however,  until  some  years  later  that  he 
turned  his  attention  to  the  operation  now  associated  with 
his  name.  In  the  year  1845  he  also  established  a  private 
hospital  for  the  diseases  of  women,  which  he  maintained 
for  some  years  at  his  own  expense.  He  was  successful, 
after  a  protracted  series  of  experiments,  in  substituting 
sutures  of  silver- wire  for  silken  and  other  sutures  in  the 
treatment  of  vesico-vaginal  fistula,  and  he  afterwards  ex¬ 
tended  the  use  of  metallic  sutures  into  every  department  of 
general  surgery.  In  1853,  Dr.  Marion  Sims  removed  to 
New  York,  where,  through  his  efforts,  a  large  temporary, 
and  subsequently  a  permanent,  women’s  hospital  was  esta¬ 
blished  under  his  charge.  In  1861  and  1864  he  visited 
Europe,  and  during  the  war  of  1S70  he  organised  in  Paris  the 
Anglo-American  Ambulance.  Dr.  Sims  was  remarkable  as  an 
operator  of  wonderful  dexterity  and  ingenuity ;  and  these 
qualities,  combined  with  faultless  tact  and  a  most  fascinating 
manner,  gained  him  a  large  and  lucrative  clientele.  Whether 
the  operative  procedures  that  he  devised  will  do  all  that  he 
expected  from  them,  time  and  experience  will  show;  at 


present  it  is  well  known  that  they  are  viewed  by  many  with 
very  qualified  admiration.  But,  be  this  as  it  may,  there 
can  be  but  one  opinion  as  to  the  excellence  of  Dr.  Sims’ 
directions  as  to  the  details  of  manipulation  and  the  other, 
collectively  most  important  although  individually  insigni¬ 
ficant,  matters  upon  which  the  satisfactory  performance  of 
such  operations  depends. 


A  NEW  THEORY  OF  SHOCK. 

In  traumatic  shock,  stupor,  collapse,  apoplexy,  syncope,  etc., 
there  is,  according  to  Brown-Sequard,  a  nervous  inhibition 
of  the  normal  gaseous  interchange  of  the  tissues,  so  that 
venous  blood  becomes  like  arterial — deep  red,  rich  in  oxygen, 
and  poor  in  carbonic  acid.  Any  kind  of  injury  to  the 
nervous  system,  stimulation  of  the  skin  and  mucous  mem¬ 
branes,  poisons  (especially  if  sudden  in  their  action),  etc., 
produce  this  nervous  inhibition.  Asphyxia  differs  from 
this  not  only  in  the  condition  of  the  blood,  but  in  the  absence 
of  convulsion,  the  blood-filling  of  the  left  heart,  and  the 
greater  duration  of  the  irritability  of  the  nervous  and 
muscular  systems. 

“SCARLATINOID.” 

In  his  tenth  annual  report  on  the  sanitary  condition  of  the 
Combined  Gloucestershire  District  for  the  year  1882,  Dr. 
Francis  Bond,  the  Medical  Officer  of  Health  for  the  district, 
explains  at  some  length  his  reasons  for  classing  the  mor¬ 
tality  from  scarlatina,  diphtheria,  and  croup  under  the 
head  of  scarlatinoid  disease.  It  is  not,  he  observes,  that 
typical  scarlatina  and  typical  diphtheria  are  diseases  which 
can  be  compounded  with  one  another  by  any  person  who  has 
once  seen  examples  of  them,  but  that  thei’e  is  so  much 
practical  confusion  in  the  intermediate  links  by  which  these 
separable  types  are  connected  with  one  another,  and  in  the 
tendency  both  of  the  profession  and  the  public  to  call  cases 
of  severe  sorethroat  “  diphtheria,”  though  the  scarlatinoid 
nature  of  such  cases  is  often  not  difficult  to  recognise  when 
searched  for,  that  he  sees  no  alternative  but  to  group  them 
under  one  head,  believing  them  all  to  have  a  more  or  less 
intimate  family  relationship  to  one  another  in  origin,  path¬ 
ology,  and  sanitary  importance.  In  illustration.  Dr.  Bond 
quotes  the  case  of  an  outbreak  which  took  place  at  the 
close  of  last  year,  in  the  parish  of  Westbury-on-Severn, 
where  upwards  of  forty  children  were  suddenly  smitten  by 
an  attack,  the  precise  nature  of  which  it  was  by  no  means 
easy  to  identify.  The  only  invariable  symptom  was  a  more 
or  less  congested  condition  of  the  throat  and  tonsils,  accom¬ 
panied  in  several  cases  with  localised  ulcerations,  and  very 
rarely  with  anything  like  true  diphtheritic  exudation,  though 
with  occasional  croupy  tone  of  voice.  Had  he  seen  the  latter 
samples  of  the  affection  alone.  Dr.  Bond  would  have  classified 
them  as  croup  ;  had  he  seen  those  only  in  which  there  was 
a  tendency  to  exudative  deposit  on  the  tongue  and  fauces, 
he  would  have  been  inclined  to  admit  the  diagnosis  of  a 
medical  friend  who  saw  them  with  him,  and  who  pronounced 
them  diphtheritic.  But  the  absence  in  the  majority  of  the 
cases  of  the  characteristic  symptoms  of  specific  diphtheria, 
the  presence  in  the  district  of  unquestionable  scarlatina, 
the  want  of  any  conditions  to  explain  an  outbreak  of  specific 
diphtheria,  and  the  existence  about  the  same  time  of  similar 
ambiguous  cases  of  the  same  kind  in  other  parts  of  the 
district,  all  pointed  to  the  conclusion  that  this  was  an 
aberrant  and  ill-developed  form  of  scarlatina,  modified  to 
some  extent  by  obscure  local  or  personal  influences.  En¬ 
larged  experience  tends.  Dr.  Bond  says,  to  confirm  in  his 
mind  the  belief  that,  though  scarlatina  generally  originates 
from  direct  personal  infection,  and  though  typical  diphtheria 
often  has  a  purely  local  origin,  these  diseases  are  due  to  an 


Sisdlcal  Time*  and  Gaxette. 


ANNOTATIONS. 


Nov.  17,  1883.  579 


infection  which  in  all  cases  attacks  the  throat,  propagates 
itself  mainly  from  the  throat,  and  which  may,  in  passing 
■from  one  person  to  another,  undergo  such  modifications  as 
will  give  rise  in  one  case  to  a  characteristic  outbreak  of 
scarlatina,  in  another  to  an  equally  characteristic  attack  of 
■diphtheria,  and  in  a  third  to  a  mongrel  type  of  affection 
which  it  is  difficult  to  refer  dogmatically  to  either  of  these 
diseases,  or  identify  by  any  other  name  than  bad  sorethroat, 
nnd  which  is,  in  fact,  a  connecting  link  between  them. 
Practically,  the  outcome  of  this  view  is,  he  thinks,  to 
observe  with  the  greatest  suspicion  any  case  of  sorethroat, 
more  especially  in  young  persons,  and  to  assume  that  it  is 
scarlatinoid  in  nature  unless  good  reason  can  be  shown  for 
regarding  it  otherwise. 


The  Academy  of  Sciences  of  Paris  have  elected  M.  Charcot 
to  the  seat  left  vacant  by  the  death  of  Baron  Cloquet. 


Dr.  Quain  has  been  appointed,  for  a  further  term  of  five 
years,  one  of  the  Crown  Members  of  the  General  Medical 
■Council. 


The  Autumn  Congress  and  Sanitary  Exhibition  of  the 
"Sanitary  Institute  of  Great  Britain  will  be  held  in  Dublin 
In  the  year  1884.  _ 

It  has  been  finally  resolved  that  the  celebration  of  the 
tercentenary  of  the  Edinburgh  University  shall  take  place 
•on  April  16,  17,  and  18  next. 


The  Library  of  the  Eoyal  College  of  Surgeons  will  be 
■closed  on  Friday,  the  16th,  and  Friday,  the  23rd  inst.,  for  the 
purposes  of  the  examinations. 


A  German  translation  of  Dr.  G.  Harley’s  book  on  “  Dis¬ 
eases  of  the  Liver  ”  has  been  published  by  Abel,  of  Leipzig, 
and  has  been  well  received  by  the  German  medical  press. 


The  General  Board  of  Studies  at  Cambridge  has  recom¬ 
mended  that  a  Professor  of  Pathology,  with  a  stipend  of 
US  00  a  year,  should  be  appointed  within  the  course  of  the 
next  six  months.  _ 

The  Professors  of  the  Faculty  of  Medicine  in  Paris  have 
■submitted  for  the  approval  of  the  Minister  of  Public  In¬ 
struction  the  name  of  M.  Pajot  to  succeed  M.  Depaul  in  the 
Chair  of  Midwifery. 

Surgeon- General  Hunter’s  third  report  on  the  recent 
•epidemic  of  cholera  in  Egypt,  which  is  looked  forward  to 
with  so  much  interest,  will  in  all  probability  be  published 
in  the  course  of  next  week. 


There  were  2497  births  and  1556  deaths  registered  in 
U ondon  last  week.  Allowing  for  increase  of  population, 
the  births  were  290,  and  the  deaths  175,  below  the  average 
numbers  in  the  corresponding  week  of  the  last  ten  years. 
The  annual  rate  of  mortality  from  all  causes,  which  had 
Been  19-1  and  19'0  per  1000  in  the  two  preceding  weeks, 
xose  to  20-5.  _ 

A  movement  has  been  on  foot  amongst  his  late  pupils  to 
present  Dr.  Alexander  Maealister,  late  Professor  of  Ana¬ 
tomy  at  Trinity  College,  Dublin,  with  some  slight  evidence 
of  their  respect  and  esteem,  and  to  take  an  early  oppor¬ 
tunity  of  expressing  their  sincere  regret  at  the  loss  of 
his  instruction.  The  movement  originated  spontaneously 
.amongst  the  students,  and  so  far  a  hearty  enthusiasm  has 
been  shown  in  forwarding  its  purpose. 


The  Council  of  the  Eoyal  Society  have  awarded  a  Eoyal 
Medal  to  Prof.  J.  S.  Burdon-Sanderson,  M.D.,  F.E.S.,  for 
the  eminent  services  which  he  has  rendered  to  physiology 
and  pathology,  especially  for  his  investigation  of  the  rela¬ 
tions  of  micro-organisms  to  disease,  and  for  his  researches 
on  the  electric  phenomena  of  plants. 


Football  often  contributes  to  the  material  of  our 
hospitals.  In  Ireland  apparently  they  make  it  contribute 
to  their  support.  At  the  annual  football  match  played  at 
Dublin  on  Saturday  last,  sufficient  gate-money  was  received 
to  render  possible  an  addition  of  over  fifty  guineas  to  the 
Hospital  Sunday  Fund  after  all  expenses  had  been  paid. 


The  question  of  tubercular  disease  of  the  lung  (especially 
with  regard  to  heredity,  contagiousness,  and  curability), 
and  also  of  the  relation  of  pneumonia  to  phthisis,  is  about 
to  be  presented  to  the  Committee  for  Collective  Investiga¬ 
tion  of  Disease  in  Berlin.  Two-and-twenty  medical  societies 
have  put  themselves  in  communication  with  the  Committee, 
and  a  still  greater  number  are  expected  to  join  with  the 
numerous  clinical  teachers  and  hospital  physicians  who  have 
already  combined  for  the  purpose. 


Over  U400  has  been  collected  for  the  Hutchinson  Testi¬ 
monial  Fund.  The  subscribers  (310  in  number)  are  all,  with 
the  exception  of  six  or  seven,  past  or  present  London 
Hospital  students,  the  testimonial  being  essentially  a  local 
one.  A  portion  of  the  amount  collected  will  be  invested  in 
the  names  of  trustees  for  the  foundation  of  a  “  Hutchinson 
Prize”  for  an  essay  on  clinical  surgery,  to  be  awarded  every 
three  years  to  members  of'  the  Hospital  of  not  more  than 
ten  years’  standing.  The  surplus  will  be  devoted  to  the 
purchase  of  a  personal  testimonial,  which  will  be  presented 
at  the  dinner  on  the  29th  inst. 


The  new  Anatomical  Department  in  connexion  with  the 
University  of  Wurzburg  was  formally  opened  on  the  3rd 
inst.  Prof.  Kolliker,  the  head  of  the  Department,  delivered 
an  address  in  which  he  sketched  the  history  of  anatomical  in¬ 
struction  in  Wurzburg.  Dating  originally  from  1719,  the  De¬ 
partment  was  reorganised  in  1788,  when  the  famous  surgeon 
von  Siebold  delivered  the  opening  oration.  The  building  in 
which  instruction  was  given  remained  unaltered  until  within 
quite  recent  times,  and  many  well-known  men  have  been 
connected  with  it,  of  whom  yirchow  and  Kolliker  are  the 
most  famous.  The  increase  in  the  number  both  of  the 
students  and  of  the  branches  of  science  taught  therein  had 
long  rendered  the  construction  of  a  new  anatomical  school 
a  necessity,  and  at  length  a  building  has  been  obtained 
which  answers  in  all  respects  to  the  increased  demands  of 
modern  science.  _ 

The  Athenceum  gives  a  list  of  the  names,  from  Bee  to  Bes, 
to  be  inserted  in  the  “  Dictionary  of  National  Biography.” 
The  list  contains  several  names  which  are  as  household 
words  to  the  medical  profession.  If  any  omission  or  error 
is  noticed,  the  editor  of  the  Dictionary  will  be  glad  if  a 
notice  to  that  effect  is  sent  addressed  to  him  at  Messrs. 
Smith  and  Elder’s,  15,  Waterloo-place,  S.W.  The  following 
selection  from  the  full  list  includes  all  the  names  associated 
with  medicine Begbie,  James  Warburton,  M.D.,  physi¬ 
cian,  1823-76;  Belchier,  John,  F.E.S.,  surgeon,  1706-85; 
Bell,  Benjamin,  surgeon,  1749-1806  ;  Bell,  Sir  Charles,' 
anatomist,  1774-1842 ;  Bell,  James,  physician,  1801 ;  Bell, 
John,  surgeon,  of  Edinburgh,  1762-1820  ;  Bell,  Lady,  widow 
of  Sir  Charles  Bell,  1786-1876;  Bell,  Sir  Thomas,  M.D.,  phy¬ 
sician,  of  Dublin,  1789 ;  Bell,  Thomas,  F.E.S.,  naturalist. 


580 


Medical  Times  and  Gazette. 


EEPOET  OF  THE  AEMY  MEDICAL  DEPAETMENT. 


Nov.  17, 1883 


1792-1880 ;  Bellinger,  Francis,  medical  writer,  1721 ;  Bellot, 
Thomas,  M.R.C.S.,  philologist,  1857 ;  Bennet,  Christopher, 
M.D.,  physician,  1617-55;  Bennett,  John  Hughes,  M.D., 
medical  writer,  1812-75 ;  Bermingham,  Michel,  medical 
writer,  fl.  1750 ;  Bernard,  Francis,  M.D.,  physician  to  James 
II.,  1697.  _ 

Bedstone  Hill,  on  the  Cheshire  side  of  the  Mersey, 
directly  opposite  Liverpool,  is  the  only  elevated  spot 
crowned  with  heather,  and  not  with  houses,  within  many 
miles  of  Liverpool  and  Birkenhead.  It  has  been  a  delight¬ 
ful  and  much  frequented  recreation-ground  for  the  inhabi¬ 
tants  of  both  these  large  cities ;  and  great  was  the  conster¬ 
nation  when  it  was  announced  that  Bedstone  Hill  was  in  the 
market,  and  likely  soon  to  be  in  the  hands  of  jerry  builders. 
Every  association  in  Liverpool  and  Birkenhead  petitioned 
the  Birkenhead  Town  Council  to  retain  the  hill  as  an  open 
space,  and  at  the  last  meeting  of  the  Medical  Institution 
the  following  resolution  was  carried,  and  forwarded  to  the 
Birkenhead  authorities : — “  That  in  the  opinion  of  this 
meeting  it  is  of  primary  importance  to  retain  Bedstone  Hill 
as  an  open  space,  .  .  .  and  the  Corporation  of  Birkenhead  is 
begged  not  to  neglect  the  present  opportunity  of  obtaining 
possession  of  that  property.” 


THE  EEPOET  OF  THE  AEMY  MEDICAL 
DEPAETMENT  EOE  1881. 


[First  Article.] 

The  Blue-book,  generally  known  as  the  Army  Medical  De¬ 
partment  Report,  for  the  year  1881  has  just  been  made 
public,  and  upon  the  present  occasion  will  be  found  to 
possess  rather  more  than  the  average  amount  of  interest. 
Although  the  statistical  portion  is  nearly  two  years  old, 
the  Appendix  bound  up  with  it  contains,  among  other 
matter,  the  Medical  History  of  last  year’s  Egyptian 
War,  by  Sir  John  Hanbury,  K.C.B.,  the  Principal  Medical 
Officer  of  the  expedition ;  the  Sanitary  Report  on  the  cam¬ 
paign,  by  Deputy  Surgeon-General  J.  A.  Marston,  M.D.; 
and  other  interesting  papers.  The  Report  proper  com¬ 
mences  with  the  information  that  the  average  annual 
strength  of  the  troops  serving  at  home  and  abroad  in 
1881,  as  computed  from  the  returns  received  by  the  Army 
Medical  Department,  was  173,331  non-commissioned  officers 
and  men,  exclusive  of  colonial  corps,  which  are  not  re¬ 
cruited  at  home.  The  admissions  into  hospital  in  this 
force  were  198,274,  and  the  deaths  2269.  The  rates 
represented  by  these  numbers  are,  for  admissions  into 
hospital  1115-0,  and  for  deaths  12-85  per  1000  of  the  average 
annual  strength,  the  latter  being  calculated  on  a  strength 
of  176,581,  which  includes  detached  men.  Briefly  glancing 
at  the  records  tabulated  for  the  different  stations  at  home 
and  abroad,  it  will  be  seen  that  during  this  year,  in  the 
United  Kingdom,  the  returns  of  sickness  and  mortality 
amongst  the  troops  were  but  slightly  different  from  those 
for  1880;  in  fact,  the  Report  says  that,  though  the  ad- 
mission-rate  was  greater  than  the  average  of  the  ten 
preceding  years  by  71-5,  the  death-rate  was  less  by 
0'55  per  1000.  The  highest  admission-rate  occurred  in 
the  Eastern  District,  attributable,  according  to  the  report 
of  Deputy  Surgeon-General  Holloway,  to  the  fact  that  in 
the  early  months  of  the  year  there  was  a  large  proportion  of 
admissions  for  chest  affections,  consequent  upon  the  pro¬ 
longed  winter ;  the  lowest  rate  was  in  the  Chatham  District. 
The  highest  death-rate  was  recorded  in  the  Southern  District, 
and  the  lowest  in  the  Chatham  District ;  whilst  the  rate  of 
constantly  sick  was  highest  in  the  Southern  District,  and 
lowest  in  the  Cork  District.  Amongst  causes  of  sickness  it 
had  to  be  noted  that  scarlet  fever  showed  an  increase  upon 
previous  years,  the  number  of  cases  having  been  198  with 
8  deaths ;  Aldershot  alone  had  69  admissions  with  1  death  : 
and  the  Principal  Medical  Officer  there  remarks  that 
although  this  number  exceeded  the  admissions  for  any 


previous  year  since  the  camp  was  established,  it  cannot 
be  accounted  for  on  insanitary  .grounds,  as  the  cases  were 
of  a  sporadic  nature,  and  no  epidemic  of  the  disease 
occurred  among  the  civil  population.  The  total  number 
of  admissions  from  primary  syphilis  was  8593,  and  for 
the  secondary  form  2603,  equal  to  annual  admission-rates 
of  101-4  and  30-7  per  1000  respectively,  the  former  being 
5'6  and  the  latter  fractionally  higher  than  these  rates  in 
the  year  1880.  It  is  certainly  not  satisfactory  to  have  to 
note  any  increase  of  disease  in  this  direction,  but  this  prac¬ 
tically  unimportant  rise  in  the  rates  during  1881  will  be 
utterly  forgotten  when  the  history  of  the  present  year  has 
to  be  written,  and  when  the  solid  testimony  of  statistics 
will  be  found  to  have  confirmed  all  that  has  been  written 
and  said  against  the  folly  of  rendering  nugatory  the  Con¬ 
tagious  Diseases  Acts.  With  respect  to  the  returns  received 
from  the  Mediterranean  Stations,  the  Report  remarks  that 
the  health  of  the  troops  stationed  there  during  1881  may  be 
said  to  have  been  normal.  Mediterranean  fever  prevailed 
more  or  less  throughout  the  year,  but  more  especially  during- 
the  summer  months,  principally  attacking  young  soldiers 
recently  arrived  at  the  stations.  At  Malta  the  admission-, 
death-,  and  invaliding-rates  were  all  higher  than  in  the  pre¬ 
vious  year,  and,  in  comparison  with  the  average  of  ten  years, 
the  admission-  and  death-rates  are  in  excess,  but  the  inva- 
liding-rate  almost  the  same.  During  the  autumn,  dengue 
made  its  appearance  in  an  epidemic  form  over  the  island,  the 
naval  and  civil  population  suffering  more  severely  than  the 
military.  It  is  presumed  that  the  disease  was  imported 
from  Egypt,  where  it  had  been  prevalent  over  the  whole 
country  in  the  month  of  August.  The  returns  from  the 
West  Indies  show  that  yellow  fever  occurred  in  an  epidemic 
form  in  the  island  of  Barbadoes  ;  sixty-six  admissions  and 
forty-one  deaths  are  returned  from  it,  giving  admission- 
and  death-rates  per  1000  of  73 '6  and  45"7l  respectively. 
The  disease  appears  to  have  been  hanging  about  the  island 
for  some  time,  but  it  did  not  develope  itself  among  the 
troops  until  the  month  of  July;  finally  it  was  decided  to 
remove  all  the  European  troops,  and  they  were  therefore 
embarked  for  England.  A  special  report  on  this  outbreak 
by  Surgeon-Major  Edmond  Hoile,  will  be  found  in  the- 
Appendix  at  the  end  of  the  volume.  The  returns  from  other 
foreign  stations  are  of  the  ordinary  kind,  and  do  not  call 
for  special  notice.  In  conclusion  it  may  be  stated  that  this 
Report  for  the  year  1881  fully  maintains  the  character  of  its 
twenty-two  predecessors ;  it  contains  an  immense  amount  of 
information,  which,  if  not  of  great  interest  to  the  general 
reader,  will  nevertheless  be  found  invaluable  for  statistical 
purposes. 

It  is  to  the  Appendix,  however,  that  the  medical, 
reader  will  turn  with  most  interest.  This  contains  in  all 
thirteen  papers  of  various  degrees  of  excellence.  In  three. 
Enteric  Fever  is  discussed,  particularly  with  regard  to  the 
existence  of  two  types  of  the  disease — notably  in  India,, 
where  one  form  is  seen  in  young  soldiers,  which  is  not  to  be 
distinguished  from  the  European  enteric  fever,  while  the 
other  type  is  complicated  with  malaria,  and  observed  in 
those  who  have  been  long  resident  in  India.  The  doubtful 
question  is  also  considered  as  to  the  identity  of  the 
Egyptian  enteric  fever  with  the  Indian  malarial  form. 
Another  paper  which  will  attract  attention  is  a  report 
on  the  Pneumonia  of  the  Punjaub  Frontier,  which  is  de¬ 
scribed  as  a  specific  disease,  quite  different  from  the  acute- 
pneumonia  of  Europe,  and  easily  capable  of  being  com¬ 
municated  by  infection.  The  paper  is  illustrated  by  no  less 
than  six  plates  and  two  temperature-charts,  and  deserves 
careful  study.  There  is  a  report  also  on  the  outbreak  of  Yellow 
Fever  at  Barbadoes,  which  will  repay  perusal.  In  the  Sanitary 
Report  of  the  Egyptian  Campaign  the  remarks  upon  oph¬ 
thalmia  are  of  great  value,  and  we  shall  have  a  word  to  say 
about  them  in  due  time.  At  the  present  time,  however, 
the  most  interesting  paper  in  the  Appendix  is  the  Medical 
History  of  the  War  in  Egypt  in  1882,  by  Sir  J.  A.  Hanbury, 
the  Principal  Medical  Officer  ;  but  we  must  defer  considers^ 
tion  of  this  till  next  week. 


The  Brain  of  Turgenieff. — The  brain  of  the  great 
Russian  novelist  is  said  to  have  weighed  2012  grammes. 
The  average  weight  of  the  human  brain  is  1390  grammes. 
Turgenieff ’s  is  said  to  be  the  heaviest  which  has  yet  been 
weighed. 


Medical  Times  and  Gazette. 


VIRCHOW  OH  ENCEPHALITIS  CONGENITA. 


Nov.  17,  1883.  581 


VIRCHOW  ON  ENCEPHALITIS  CONGENITA. 


An  address  on  the  subject  of  Congenital  Encephalitis  was 
delivered  before  a  recent  meeting  of  the  Berliner  Medi- 
cinische  Gessellschaft  by  Prof.  Rudolf  Virchow,  in  which, 
recalling  certain  observations  made  by  himself  in  the  year 
1865,  he  undertook  to  prove  the  inflammatory  nature  of 
•certain  changes  in  the  brains  of  newly  born  children,  which 
some  subsequent  observers  have  regarded  as  physiological, 
and  not  abnormal.  These  changes,  as  he  at  first  observed 
them,  consisted  in  the  appearance  of  very  numerous 
granular  cells  and  granular  globules,  scattered  chiefly  in 
the  white  substance  of  the  cerebral  hemispheres,  for  the 
most  part  in  very  regular  order  throughout  the  whole  area, 
while  there  was  absolutely  no  change  in  the  appearance 
■of  the  grey  matter.  These  observations  were  published 
•eighteen  years  ago,  and  it  was  then  suggested  that  the 
changes  were  inflammatory;  they  have  been  again  and  again 
•observed  by  other  pathologists,  and  their  frequent  occurrence 
has  led  to  the  opinion  that  they  are  normally  produced  in 
the  development  of  the  brain.  The  extent  to  which  such 
changes  are  congenital,  however,  cannot  be  proved  in  every 
case.  In  the  brain  of  a  child  born  dead,  no  doubt  can  exist ; 
but  in  the  case  of  a  child  which  may  have  lived  only  a  few 
hours,  doubts  may  very  reasonably  be  entertained.  With 
■each  day  of  life  it  becomes  more  and  more  uncertain  how 
far  the  appearances  may  be  regarded  as  congenital. 

The  elements  thus  found  in  the  brain  are  quite  unmis¬ 
takable  granular  cells  and  granular  globules.  As  long  ago 
as  1846,  Prof.  Virchow  drew  out  a  classification  of  the  various 
inodes  in  which  fatty  changes  may  occur  in  cells.  Three 
•different  forms  were  distinguished,  and  they  have  not  since 
been  added  to.  In  the  first  the  fat  within  the  cell  belongs 
properly  to  the  character  of  the  tissue  of  which  it  forms  a 
part ;  in  the  second  the  appearance  of  fat-granules  is  always 
the  forerunner  of  disintegration  of  the  cell  in  which  it 
appears;  in  the  third  the  appearance  of  the  fat  is  only 
transitory.  Erom  the  form  of  fatty  change  alone,  however, 
it  cannot  be  determined  whether  the  change  is  to  be  classed 
as  physiological  or  pathological :  other  considerations  must 
•determine  that  point. 

To  which  of  these  three  classes  of  fatty  change  must  the 
appearance  in  the  newly  born  brain  be  attributed?  To 
assume  the  first  would  be  to  allow  the  possibility  of  the 
occurrence  of  normal  fatty  tissue  in  the  brain.  Putting 
this  aside,  we  must  look  either  to  the  possibility  of  transi¬ 
tory  absorption  of  fatty  matter  or  to  a  process  of  fatty 
degeneration.  As  against  the  former  must  be  placed  the 
truly  fatty  nature  of  the  change — the  absorbed  particles 
are  not  myelin — and  the  absence  of  any  disintegrating 
points  in  the  affected  brains  from  which  granular  material 
could  be  taken  up. 

“  I  am  convinced,”  says  Prof.  Virchow,  “  that  this  condi¬ 
tion  is  a  fatty  metamorphosis  in  the  strictest  sense  of  the 
word,  and  for  this  reason  :  because  all  the  transition  stages, 
from  the  intact  cell  to  the  granular,  from  the  granular  to 
the  globular,  and  at  length  to  the  simple  masses  of  fat,  are 
here  present,  just  as  we  recognise  them  when  occurring  in 
the  fatty  metamorphosis  of  other  organs.  Besides  the  dif¬ 
fuse  form,  however,  of  which  I  have  spoken,  there  is  a 
second  form  appearing  in  a  more  or  less  nodular  manner.” 

The  latter  is  easily  to  be  seen  with  the  naked  eye.  “  One 
notices  in  the  midst  of  the  white  matter  dull  spots,  which 
become  more  and  more  opaque,  and  after  a  time  take  on  a 
faint  yellowish- white  appearance,  and  finally  commence  to 
■soften  at  individual  points,  and  to  become  true  centres  of 
disintegration.  These  centres  are  distinguished  by  a 
peculiar  change  of  the  axis-cylinder  which  they  present,  in 
addition  to  the  excessive  formation  of  granular  cells  and 
globules,  which  consists  in  a  varicose  swelling  and  subse¬ 
quent  falling  apart  of  the  divisions  thus  formed,  so  that 
one  can  demonstrate  long,  varicose,  often  spindle-shaped 
bodies  between  the  fatty  particles.  If  one  now  compares 
a  sufficient  number  of  these  two  categories  of  cases,  the 
diffuse  and  the  circumscribed,  it  becomes  apparent  that 
there  is  by  no  means  an  essential  difference  between  them, 
but  that  the  circumscribed  form  represents  an  exaggerated 
•condition  of  the  same  process  which  i3  found  diffused. 
In  order  to  determine  the  relative  frequency  of  the  occur-  I 


rence  of  these  changes — the  one  point  upon  which  the  theory 
of  their  physiological  nature  has  been  based — Prof.  Virchow 
has  lately  instituted  a  series  of  investigations  of  the  brains 
of  stillborn  and  newly  born  children,  extending  to  44  cases 
in  all.  Of  these  22  were  born  dead,  5  died  during  birth, 
17  lived  for  various  periods  up  to  five  weeks ;  but  of  these 
most  died  during  the  first  day.  Twenty-seven  were  con¬ 
genital  in  the  strictest  sense,  and  of  these  only  11  showed  the 
appearances  described,  abundantly  in  8  cases,  and  sparingly 
in  3.  Of  9  immature  embryos  examined,  only  3  failed  to 
show  the  changes ;  of  those  born  dead  at  full  term,  9  showed 
no  changes,  and  in  only  3  were  they  present.  From  these 
purely  objective  investigations  it  follows  that  the  appearances 
in  the  brain  do  not  occur  with  such  constancy  as  to  warrant 
the  belief  that  they  can  be  of  normal  origin.  Turning, 
now,  to  the  examination  of  those  cases  in  which  death 
took  place  at  varying  periods  after  birth,  only  3  cases  out 
of  17  were  found  to  be  free  from  the  condition.  These 
three  cases  with  normal  brains  were  each  distinguished 
by  all  the  signs  of  inherent  weakness ;  whilst  at  least  eight 
of  those  with  affected  brains  showed  no  predominant  symp¬ 
toms  of  feebleness  whatever.  From  a  careful  consideration 
of  all  the  cases,  it  appears  clear  that  there  is  no  ground  for 
the  supposition  that  this  change  in  the  brain  is  but  a  part 
of  a  general  disturbance  of  nutrition. 

“  I  should  certainly  be  the  last  to  deny  that  such  a  fatty 
metamorphosis  may  be  the  result  of  a  bad  state  of  nutrition, 
and  if  such  a  connexion  could  be  established  I  should  have 
nothing  to  urge  against  it  in  this  case  ;  but,  nevertheless,  I 
must  always  consider  that  it  would  be  a  disastrous  state  of 
affairs  if  general  atrophy  or  want  of  proper  nutrition  were 
always  to  lead  to  this  condition  of  brain.  In  all  those  cases  in 
which,  as  far  as  I  am  aware,  fat  occurs  as  a  consequence  of 
bad  conditions  of  nutrition,  it  appears  to  be  universally 
attracted  to  the  walls  of  the  vessels  in  which  at  any  period 
of  age,  as  a  result  of  impaired  nutrition,  such  changes  may 
occur  in  a  very  marked  manner  even  to  the  smallest  capil¬ 
laries.”  The  granular  cells  previously  described,  however, 
could  be  clearly  demonstrated  to  have  no  connexion  with 
vessels. 

A  challenge  is  thrown  down  to  any  workers  in  the  same 
field  of  investigation  to  prove  the  association  of  these  fatty 
metamorphoses  with  general  conditions  of  impaired  nutri¬ 
tion.  Regarding  these  changes  as  indicative  of  encepha¬ 
litis  due  to  a  condition  of  irritation.  Prof.  Virchow  directs 
attention  to  an  analogous  change  which  is  recognised  in  the 
tissues  of  the  optic  nerve  in  retinitis,  in  which  granular 
globules  appear  in  the  interstitial  tissue,  and  in  which  a  vari¬ 
cose  and  gangliform  alteration  of  the  nerve-fibres  is  induced. 
Although  the  process  in  the  brain  cannot  be  said  to  be  an 
inflammation  in  the  strictest  sense  of  the  word,  it  is,  never¬ 
theless,  an  irritative  process — i.e.,  a  process  in  which  the 
fatty  metamorphosis  is  not  immediately  apparent,  but  in 
which  a  definite  series  of  irritative  changes  lead  to  that 
result. 


Extraordinary  Secretion  oe  Milk. — Prof.  0.  Remy, 
in  the  Archives  Generates,  tells  of  a  young  woman  seen  by 
him  in  Japan,  who  gave  over  twelve  pints  and  a  half  of 
milk  daily ;  and  the  new  Journal  of  the  American  Medical 
Association  quotes  the  following  case  by  Dr.  Gomez  Pamo, 
of  Barcelona,  in  the  Anales  de  Cirurgia : — “  A  woman 
married  at  sixteen  years  of  age,  and  her  menses  (established 
at  fourteen)  continued  without  interruption  until  the  first 
month  of  marriage,  when  she  became  pregnant.  After 
delivery,  lactation  continued  for  twelve  months  without  any 
appearance  of  the  menses.  Becoming  again  pregnant,  she 
weaned  her  child ;  and  this  recurred  fourteen  times  with¬ 
out  any  complication.  She  nursed  each  of  her  fourteen 
children  up  to  the  time  that  she  found  herself  again  preg¬ 
nant.  During  her  pregnancies  the  flow  of  milk  diminished 
somewhat,  but  never  disappeared  entirely.  Immediately 
after  delivery  she  gave  the  breast  to  the  infant.  The  milk 
was  of  good  quality  and  abundant ;  and  during  all  this  time 
— that  is,  from  the  first  month  after  marriage  to  the  present 
time,  seven  years  after  the  birth  of  the  last  child — the  menses 
have  not  reappeared.  She  weaned  her  last  child  five  years 
since,  but  the  flow  of  milk  has  not  diminished,  in  spite  of 
all  treatment.  It  is  abundant  and  of  good  quality,  and  the 
breasts  have  to  be  drawn  frequently  to  relieve  the  pain 
caused  by  tension. — Louisville  Med.  News,  August  4. 


582 


Medical  Times  and  Gazette. 


ABSTRACTS  AND  EXTRACTS. 


Nov.  17, 1883. 


ABSTRACTS  AND  EXTRACTS. 

- - 

Local  Application  op  Vaseline  in  Scarlet  Fever. 

• — Dr.  J.  B.  Johnson,  of  Washington,  writing  to  the  Phil. 
Med.  Reporter,  August  11,  states : — “  I  have  found  nothing  so 
efficient  in  relieving  the  burning  and  itching  sensation  of 
the  eruption  of  scarlet  fever  as  the  inunction  of  the  whole 
body  with  vaseline.  It  is  well  rubbed  upon  the  surface  of 
the  body  with  the  hand,  once  or  twice  a  day,  and  continued 
as  long  as  the  patient  complains  of  the  burning  and  itching. 
These  inunctions  soothe  and  calm  the  patient  in  an  aston¬ 
ishing  manner,  and  are  rarely  required  beyond  two  or  three 
days.'” 

Hydrated  Oxide  op  Iron. — Dr.  Squibb  recommend3 
the  following  as  a  simple  method  of  preparing  hydrated 
oxide  of  iron,  the  antidote  for  arsenic,  one  of  its  chief  ad¬ 
vantages  being  that  its  ingredients  are  always  easily 
obtained:  —  Tr.  ferri  chlor.  §iv.,  aquae  giv. ;  mix  in  a 
vessel  of  twelve-ounce  capacity,  and  add  aquae  ammon.  gij. 
Shake  well,  pour  on  a  large  wet  muslin  drainer,  wring  out 
the  water  and  alcohol,  and  wash  with  fresh  water.  The 
stomach  having  been  evacuated  by  emetics  while  the  anti¬ 
dote  was  preparing,  give  four  fluid  ounces  at  once,  to  be 
followed  by  an  emetic.  Then  give  two  ounces  every  ten 
minutes. — Louisville  Med.  News,  September  1. 

Physiological  Production  of  Pepsin. — It  is  said 
that  a  prominent  manufacturer  of  pepsin  has  applied  to  good 
advantage  the  well-known  physiological  fact  that  the  emo¬ 
tions  awakened  by  the  contemplation  of  appetising  food  not 
only  cause  the  saliva  to  flow,  but  also  stimulate  a  secretion 
of  gastric  juice.  Taking  advantage  of  this  fact,  fasting  pigs 
are  turned  into  a  pen,  where  a  trough  filled  with  hot  mash 
is  covered  with  a  wire  screen  to  prevent  them  from  eating  it, 
and  thus  absorbing  the  pepsin  contained  in  their  peptic 
glands.  They  are  then  in  due  time  killed,  and  the  yield  of 
pepsin  is  said  to  be  greater  than  when  no  such  physiological 
procedure  is  resorted  to. — Boston  Med.  Jour.,  August  16. 

Glycerine  in  Fevers. — Dr.  Semnola  recommends  the 
following  mixture  as  a  good  remedy  in  the  denutrition  of 
fever  patients  : — Pure  glycerine  thirty,  citric  acid  two,  and 
distilled  water  five  hundred  grammes ;  one  or  two  table¬ 
spoonfuls  every  hour.  Glycerine,  which  is  an  economising 
agent  ( agent  d’epargne),  and  a  succedaneum  of  cod-liver  oil, 
may,  according  to  Dr.  Semnola,  be  employed  with  great 
advantage  in  the  treatment  of  fevers  of  prolonged  duration, 
such  as  typhoid,  in  order  to  diminish  febrile  consumption. 
Its  employment  is  especially  indicated  when  there  is  reason 
to  fear  that  alcohol,  used  so  much  at  the  present  time,  may 
cause  excitement  of  the  nervous  centres  capable  of  aggra¬ 
vating  the  disease.' — Gazette  Med.,  September  16. 

Lupus  Erythematosus. — At  the  meeting  of  the 
American  Dermatological  Association,  Dr.  Duhring  l’ecom- 
mended,  in  obstinate  cases  of  this  disease,  a  lotion  of  sulphate 
of  zinc  as  very  efficacious  (zinc,  sulpliat.,  pot.  sulphuret,  aa 
3j-,  aquse  g  iv.). — Dr.  Piffard,  however,  believed  that  a  cure 
cannot  be  effected  without  destroying  the  lupus  either  by 
the  curette  or  scarification. — Dr.  Sherwell  had  used  this 
remedy  with  advantage  in  a  case  ;  and  Dr.  Van  Harlingen 
-bore;  witness  to  its  complete  success  in  one  of  Dr.  Duhring’s 
cases.— Dr/Fox  stated  that  he  had  used  a  combination  of 
salicylic  acid  and  chrysarobin  with  some  success,  but  that  he 
regarded  as  the  best  means  the  painting  of  the  part  with 
pure  carbolic  acid. 

Surgical'"  Cases  in  Vienna. — The  surgery  of  Vienna 
differs  widely  from  that  of  America.  There  is  not  nearly  so 
much  acute  surgery,  if  I  may  be  allowed  the  expression — 
that  is,  fractures,  dislocations,  and  general  mash-ups  are  not 
common.  This  is  due  partly  to  the  fact  that  the  railroads 
are  better  managed  than  with  us ;  the  staging  and  scaffold¬ 
ing  around  buildings  much  more  securely  erected ;  the 
buildings  themselves  more  substantially  built ;  and  partly, 
perhaps,  to  the  fact  that  the  people  themselves  are  naturally 
cautious,  and  that,  as  they  are  punished  for  being  run  over, 
they  take  pains  to  keep  out  of  the  way  of  vehicles.  Tumours 
of  all  kinds,  cancer  and  tuberculous  disease  of  the  bones, 
deformities,  joint-diseases,  and  hernia  are  very  common  — 
Correspondent  of  Maryland  Med.  Jour. 


Maximum  Doses. — M.  Pierre  Vigier,  the  able  phar¬ 
maceutical  contributor  to  the  Gazette  Hebdomadaire  (Sep¬ 
tember  21),  in  reference  to  the  question  whether  a  table  of 
maximum  doses  should  be  inserted  in  the  French  Codex, 
in  imitation  of  most  foreign  pharmacopoeias,  states  that  this, 
is  highly  objectionable,  and  he  succeeded  in  persuading  the 
ministerial  committee,  which  was  appointed  to  consider  the 
matter,  that  it  should  not  be  carried  out  in  the  forthcoming 
edition.  “  Would  it  not,”  he  asks,  “  be  a  dangerous  arm 
in  the  hands  of  magistrates  to  supply  them  with  a  legal 
formulary  in  which  a  quantity  is  inscribed  which  can  only 
be  surpassed  at  our  risk  and  peril?  These  doses  may, 
moreover,  undergo  change  with  the  progress  of  physiological 
discovery,  and  the  tolerance  of  individuals.  What  is  the 
amount  of  morphia  at  which  we  should  stop  ?  It  is  quite 
impossible  to  fix  an  unalterable  basis  for  the  administration 
of  this  drug.  It  is,  however,  needless  to  multiply  examples 
in  order  to  prove  that  while  a  table  of  maximum  doses  is 
indispensable  in  an  ordinary  formula  (such  as  the  successful 
one  of  Jeannel),  it  is  entirely  misplaced,  and  in  certain 
cases  might  be  dangerous,  in  an  official  formulary.” 

The  Origin  op  Vaccine  Virus.— Dr.  Warlomont,  of 
Brussels,  read,  at  a  recent  meeting  of  the  Paris  Academie 
de  Medecine,  a  paper  giving  a  detailed  account  of  numerous 
experiments  on  cattle  and  horses  ( Gazette  Hebdomadaire, 
October  26),  and  terminating  with  these  conclusions  : — 
1.  Neither  the  equine  or  bovine  species  of  animals,  nor 
probably  any  other  animal,  can  be  regarded  as  vaccino- 
genous.  Neither  the  horse  nor  the  ox  can  generate  origi¬ 
nally  (de  toutes  pieces )  the  one  the  horse-pock,  and  the 
other  the  cow-pock.  Both,  in  order  to  furnish  a  crop  of 
vaccinal  matter,  must  first  have  received  its  seed.  2.  The 
original  seed  of  the  vaccine  virus,  in  its  relations  to  the 
horse  and  to  the  ox,  is  nothing  other  than  variola.  Admitted 
into  the  organism  of  these  animals,  it  undergoes  therein 
an  attenuation,  whence  results  what  it  has  been  agreed 
upon  to  term  vaccine  virus.  This  attenuation  is  less  in  the- 
horse  than  in  the  ox ;  and  horse-pock  is  therefore  less  re¬ 
mote  from  variola  than  cow-pock.  4.  The  horse  is  a  bad 
soil  for  the  culture  of  the  vaccine  virus.  Animal  vaccination 
requires  germs  attenuated  to  a  higher  degree  than  those 
which  can  be  derived  from  the  organism  of  the  horse. 
5.  The  artificial  variolic  or  vaccinal  impregnation  in  the 
horse  by  means  of  inoculation  or  intracutaneous  injection, 
seems  to  take  place,  as  in  the  cow,  without  any  external 
manifestation  ;  and  immunity  should  be  the  consequence  of 
such  impregnation. 

Reflex  Area  in  the  Nose. — Dr.  John  Mackenzie, 
of  Baltimore,  terminates  ( American  Journal  of  Medical 
Science  for  July)  a  paper  “  On  Nasal  Cough,  and  the  Exist¬ 
ence  of  a  Sensitive  Reflex  Area  in  the  Nose,”  with  these 
conclusions: — ‘‘1.  That  in  the  nose  there  exists  a  definite> 
well-defined  sensitive  area,  whose  stimulation,  either  through 
a  local  pathological  process  or  through  the  action  of  an  irri¬ 
tant  introduced  from  without,  is  capable  of  producing  an 
excitation,  which  finds  its  expression  in  a  reflex  act,  or  in  a 
series  of  reflected  phenomena.  2.  This  sensitive  area  corre¬ 
sponds,  in  all  probability,  with  that  portion  of  the  nasal 
mucous  membrane  which  covers  the  turbinated  corpora 
cavernosa.  3.  Reflex  cough  is  produced  only  by  stimulation 
of  this  area,  and  is  only  exceptionally  evoked  when  the  irri¬ 
tant  is  applied  to  other  portions  of  the  nasal  mucous  mem¬ 
brane.  4.  All  parts  of  this  area  are  not  equally  capable  of 
generating  the  reflex  act,  the  most  sensitive  parts  being 
probably  represented  by  that  portion  of  the  membrane  which 
clothes  the  posterior  extremities  of  the  inferior  turbinated 
body,  and  that  of  the  septum  immediately  opposite.  5.  The- 
tendency  to  reflex  action  varies  in  different  individuals,  and 
is  probably  dependent  upon  the  varying  degree  of  excita¬ 
bility  of  the  erectile  tissue.  In  some,  the  slightest  touch  is 
sufficient  to  excite  it;  in  others,  chronic  hyperemia  or 
hypertrophy  of  the  cavernous  bodies  seems  to  evoke  it  by 
constant  irritation  of  the  reflex  centres,  as  occurs  in  similar 
conditions  of  other  erectile  organs — as,  for  example,  the 
clitoris.  6.  This  exaggerated  or  disordered  functional  acti¬ 
vity  of  the  area  may  possibly  throw  some  light  on  the 
physiological  destiny  of  the  erectile  bodies.  Among  other 
properties  which  they  possess,  may  they  not  act  as  sentinels 
to  guard  the  lower  air-passages  and  pharynx  against  the 
entrance  of  foreign  bodies,  noxious  exhalations,  and  other 
injurious  agents  ?  ” 


Medical  Time  and  Gazette. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


Clinical  Lectures  on  the  Diseases  of  Women.  Delivered  in 

St.  Bartholomew’s  Hospital.  By  J.  Matthews  Duncan, 

M.D.,LL.D.,  F.R.S.E.,  President  of  the  Obstetrical  Society. 

Second  Edition,  much  enlarged,  with  appendices.  London : 

J.  and  A.  Churchill.  1883.  Pp.  443. 

The  words  "  second  edition,”  which  appear  on  the  title-page 
of  this  book,  mean  much  more  in  this  case  than  they  usually 
do ;  for  at  least  half  of  its  bulk  is  entirely  fresh  matter,  con¬ 
sisting  of  additional  lectures  which,  since  the  publication  of 
the  first  edition,  have  appeared  in  our  columns.  We  need 
not,  therefore,  say  much  about  that  which  our  readers  have 
already  had  before  them.  The  work  is  not,  and  does  not 
claim  to  be,  either  a  treatise  on  gynaecology,  or  a  series  of 
exhaustive  monographs.  It  is  merely  a  statement  of  the 
author’s  opinions  and  practice  concerning  a  certain  number 
of  the  morbid  conditions  met  with  in  women.  From  the 
student’s  point  of  view  we  imagine  that,  besides  its  incom¬ 
pleteness,  the  respect  in  which  the  book  may  fail  to  exactly 
supply  them  with  what  they  think  they  need,  is  in  its  wide 
divergence  from  some  of  the  views  which  at  present  largely 
influence  current  teaching.  Much  that  is  presented  to  stu¬ 
dents  with  deliberate  assertion  and  amplitude  of  detail  Dr. 
Duncan  only  mentions  to  condemn  as  injurious  nonsense.  An 
idea  of  that  which  is  distinctive  in  the  tone  and  purport  of 
the  lectures  may  be  given  if  they  be  described  as  the  some¬ 
what  contemptuous  and  indignant  protest  of  a  scientific 
physician  against  that  current  pathology  which  attributes 
to  the  uterus  the  power  of  causing  symptoms  of  the  most 
diverse  kind  in  the  most  distant  parts,  even  without  itself 
manifesting  any  striking  change ;  which  traces  nearly  all 
symptoms  of  pelvic  disease  to  local  changes  which  to  the 
morbid  anatomist  seem  unimportant,  or  the  very  existence 
of  which  is  doubtful— such,  for  instance,  as  a  patch  of 
redness  on  the  cervix,  an  assumed  excess  of  cervical  mucus, 
an  imagined  (but  not  demonstrated)  stricture,  or  a  trifling 
alteration  in  the  shape  or  position  of  the  uterus, — and  which, 
in  estimating  the  advantages  of  treatment,  quite  forgets 
the  first  maxim  of  caution  to  be  observed :  post  hoc  non 
ergo  propter  hoc.  Dr.  Duncan’s  writings  are  well  known  to 
be  models  of  scientific  precision  in  the  use  of  language,  and 
this  work  does  not  differ  in  this  respect  from  his  former 
ones.  One  aspect  of  Dr.  Duncan’s  teaching,  which  will  be 
quite  novel  to  those  whose  conceptions  of  the  subject  are 
based  only  on  the  popular  text-books,  is  the  importance 
which  he  attaches  to  the  variations  of  pressure  within  the 
abdomen ;  phenomepa,  such  as  the  retention  of  mucus, 
clots,  etc.,  or  the  sudden  expulsion  of  similar  matters,  com¬ 
monly  described  as  the  consequence  of  supposed  strictures, 
or  the  effect  of  powerful  uterine  contraction.  Dr.  Duncan 
conceives  to  be  dependent  upon  the  state  of  the  intra¬ 
abdominal  pressure.  Beyond,  however,  pointing  out  the 
existence  of  this  force  and  its  unquestionable  effects,  he  does 
not  instruct  us  concerning  it ;  we  are  left  still  in  the  dark 
as  to  the  conditions  which  regulate  its  action.  Another  sub¬ 
ject,  little  mentioned  in  the  gynaecological  literature  of  the 
present  day,  but  to  which  Dr.  Duncan  frequently  refers,  is 
the  polarity  of  the  uterus,  a  property  of  that  organ  long 
ago  described  by  Beil,  and  to  which  the  attention  of  the 
profession  has,  within  the  last  few  years,  been  recalled  by  a 
paper  from  the  pen  of  Dr.  Champneys,  published  in  the 
Obstetrical  Journal.  Dysmenorrhoea  and  vaginismus  may 
be  further  instanced  as  subjects  upon  which  Dr.  Duncan’s 
view  is  widely  different  from  that  commonly  accepted,  for 
in  each  of  these  conditions  he  regards  local  morbid  con¬ 
ditions  as  playing  a  quite  minor  part,  the  disorder  being 
essentially  neurotic.  His  views  upon  displacements  are 
well  known,  and  they  find  emphatic  expression  in  the 
work  before  us.  “I  dismiss,”  he  says,  “ without  dis¬ 
cussion  those  extreme  views,  which,  though  prevalent, 
are  not  the  less  untenable  and  highly  injurious.  .  .  .  Were 
such  doctrines  well  founded,  life  for  woman  would  not  be 
worth  having,  for  the  position  of  no  womb  satisfies  those 
who  entertain  them,  and  treatment  has,  as  its  ordinary  con¬ 
sequences,  failure  and  disappointment,  and  sometimes  grave 
disaster.  .  .  .  Thousands  of  blooming,  happy,  fertile  women 
have  displacements.  .  .  Simple  uncomplicated  displacement 
is  not  disease.”  The  lecture  on  pessaries  is  one  of  the  least 
satisfactory  in  the  book,  for  it  deals  almost  entirely  in  nega- 


Nov.  17, 1693.  583 


tives.  Everyone  will  agree  that  there  are  disadvantages, 
which  always  attend  pessaries,  and  that  there  are  cases  in 
which  pessary  treatment  is  undesirable.  What  the  beginner 
wants  to  know  is  how  and  when  pessaries  ought  to  be  used. 
Dr.  Duncan  only  helps  him  here  by  describing  one  or  two 
typical  cases,  but  gives  him  no  rules  for  guidance,  either  in 
identifying  the  case  or  selecting  the  pessary.  The  chief 
thing,  indeed,  that  seems  to  us  to  be  desired  in  these  lectures* 
is  some  concession  to  the  weaker  readers ;  some  explanation^ 
of  the  author’s  reasons  for  dissenting  so  strongly  from  many- 
current  opinions  ;  some  instruction  in  the  practical  applica¬ 
tion  of  the  broad  pathological  generalisations  and  thera¬ 
peutical  precepts  which  the  author  so  epigramatically  lays 
down.  For  the  specialist  they  are  of  the  greatest  value — 
full  of  concentrated  experience,  and  fertile  in  suggestion. 
But  the  student,  or  the  less  highly  educated  general  prac¬ 
titioner,  may  fail  to  gain  as  much  benefit  as  he  would 
receive  from  a  work  written  down  to  a  lower  level. 


De  la  Rachialgia.  Par  Ernest  Lemoine,  Docteur  en  Medi¬ 
cine  de  la  Faculte  de  Paris.  1883.  Pp.  154. 

In  preparing  this  book.  Dr.  Lemoine  has  evidently  taken; 
the  trouble  to  read  all  that  has  been  recently  written  on 
Backache,  and  to  incorporate  in  it  the  results  of  his  reading. 
He  dwells  on  the  frequency  of  the  symptom  as  the  reasons 
for  its  being  regarded  commonly  as  of  slight  diagnostic 
value,  and  draws  attention  to  the  necessity  of  noting  in  all 
cases  both  the  region  and  the  area  affected.  While  defining 
“  backache  ”  as  including  all  cases  in  which  pains  are  re¬ 
ferred  to  the  spinal  column,  or  are  to  be  regarded  as  having 
their  seat  in  the  dorsal  region,  he  gives  a  very  wide  area  for 
the  origin  of  the  pain,  saying  that  it  may  arise  from  morbid 
conditions  of  the  skin,  muscles,  bones,  articulations,  liga¬ 
ments,  as  well  as  the  meninges,  the  cord  itself,  or  the  nerves. 

A  book  beginning  in  this  way  is  obviously  meant  to  be 
most  exhaustive,  but  it  has  the  disadvantage  of  being 
necessarily  very  discursive.  Any  and  every  disease  in  which 
there  is  the  remotest  suspicion  of  pain  in  the  lumbar  or 
dorsal  region  is  sure  to  be  dragged  in. 

Dr.  Lemoine’s  division  of  backache  into  sympathetic, 
symptomatic,  idiopathic,  rheumatic,  and  traumatic  is  suffi¬ 
ciently  useful,  but  somewhat  obvious.  Examples  of  these 
various  forms  are  then  treated  in  detail,  and  go  to  make  up 
the  greater  part  of  the  book. 

Although,  as  a  whole,  very  pleasant  reading  on  a  some¬ 
what  neglected  symptom,  it  appears  to  be  made  unneces¬ 
sarily  lengthy  by  the  adoption  of  the  historical  method. 
For  example,  we  find  six  whole  pages  devoted  to  the 
occurrence  of  this  symptom  in  typhoid  fever,  and  yet  the 
whole  might  have  been  summed  up,  as  in  Murchison’s, 
classic  on  Continued  Fevers,  in  four  lines  or  even  less,  since, 
when  all  is  said,  it  amounts  only  to  this  :  “  Pain  in  the  back 
is  usually  slight,  but  in  rare  instances  there  is  true  rachialgia, 
cervical  or  dorsal  ”  (Murchison).  For  most  readers  the  two 
pages  of  conclusions  at  the  end  of  the  book  will  give  all 
required  for  practical  purposes.  Here  we  find  a  table  by 
means  of  which  this  symptom  may  be  converted  into  one  of 
true  diagnostic  value  by  careful  attention  to  the  precise  seat 
of  the  pain. 

Regarded  purely  as  a  general  store  of  hitherto  somewhat 
scattered  literature,  this  book  will  no  doubt  prove  of  some 
use  to  future  authors.  For  the  busy  practitioner,  hps 
or  for  the  medical  student,  it  is  too  lengthy  and^ 
to  be  of  much  service. 

n,  ; 


iCHf. 


( 


Sanitary  Principles,  more  especially  as  appli^d.td  > 

By  Surgeon  S.  J.  Thomson,  S.Sc.  Camb.,  H.Mx$  Bengal 
Medical  Service.  Calcutta:  Brown  and  Co.  1883.'"-Sm^ll__ 
8vo,  pp.  140. 

This  little  book  is  addressed  to  non-scientific  readers — i.  e., 
to  Europeans,  other  than  medical  officers — resident  in  India; 
and  we  can  safely  say  that  if  every  civilian,  missionary,  and 
planter  were  to  use  his  influence  in  his  own  immediate 
vicinity  in  inculcating  and  carrying  out  its  suggestions,  the 
sanitary  conditions  of  the  native  towns  and  villages  would 
be  improved  to  an  extent  that  no  legislation  alone  could 
achieve.  It  treats  in  a  thoroughly  practical  way  of  the 
conservancy  of  native  towns  and  villages,  the  disposal  of 
sewage,  the  maintenance  of  the  purity  of  water- sources,  the 
burial  of  the  dead,  etc. — showing  in  the  discussion  of  these 


584 


Medical  Times  and  Gazette. 


GENERAL  CORRESPONDENCE. 


Nov.  17, 1883. 


subjects  a  thorough  acquaintance  with  the  habits  and  pre¬ 
judices  of  the  natives,  as  well  as  with  the  practicable  means 
for  remedying  the  evils  indicated.  Purely  scientific  and 
medical  questions  are  wisely  avoided.  We  have  been  able 
to  detect  only  one  real  error — the  reliance  placed  by  the 
author  in  the  indications  of  the  lactometer ;  but  the  accuracy 
■of  the  opinions  and  statements  generally  is  due  to  the  fact 
that,  with  the  exception  of  matters  of  an  exclusively  local 
character,  they  are  copied,  often  verbatim,,  though  without 
any  acknowledgment,  from  the  classical  work  of  Dr.  Parkes, 
which  the  compiler  must  have  had  open  before  him  as  he 
wrote.  This  is  sufficient  guarantee  of  the  value  of  the  matter, 
and  evidence  of  the  good  sense,  though  not  good  taste,  of 
Surgeon  S.  J.  Thomson. 


GENERAL  CORRESPONDENCE. 

- ^ - 

CHOEEIC  COUGH. 


[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sir, — Attention  has  recently  been  directed  to  what  is  called 
“  laryngeal  chorea.”  The  laryngeal  muscles  are  commonly 
implicated  in  the  disorderly  movements  of  chorea  which  has 
■•attained  any  degree  of  development ;  and  there  is  a  well- 
known  form  of  cough  which  is  analogous  in  its  nature  and 
causation  with  the  cough  of  this  new,  or  rather  newly 
•described,  disease— “  laryngeal  chorea.” 

It  is,  however,  with  regard  to  another  form  of  the  same 
nerve-trouble  that  I  ask  your  permission  to  offer  a  few  re¬ 
marks  and  suggestions.  Young  persons  of  either  sex,  but  par¬ 
ticularly  the  female,  are  very  commonly  affected  between 
the  ages  of  fifteen  and  twenty  with  a  cough  which  is  laryn¬ 
geal,  and  characterised  by  a  peculiarly  metallic  ring,  either 
“cracked  ”  or  ‘"whistling,”  during  the  indraught,  and  often 
producing  in  the  intervals  of  the  paroxysm  “  hoarseness,” 
■“squeaking,”  or  “loss”  of  voice.  The  fault  is  irritation  of 
the  recurrent  laryngeal  nerve,  and  it  very  often  happens  that 
the  pneumogastric  is  also  irritated  to  such  an  extent  as  to 
give  rise  sometimes  to  gastric  disturbance,  at  others  to  faint¬ 
ness  from  slowing  of  the  heart-beat,  or  “  palpitation  ”  from 
temporary  suspension  of  the  inhibitory  control  of  the  vagus. 
If  the  trouble  ended  with  this  it  would  be  of  minor  impor¬ 
tance  ;  but  the  gastric  or  cardiac  irritation  set  up,  and  the 
cough,  together,  besides  giving  rise  to  mistake  as  to  the 
general  condition  of  health,  actually,  as  I  believe,  favour 
the  occurrence  of  nutritive  changes  in  the  bronchial  mem¬ 
brane  and  sub-mucous  tissue,  which  induce  a  low  inflam¬ 
matory  action,  and  issue  in  the  exudation  and  deposit  of 
tuberculous  lymph.  Hence  we  get  the  class  of  cases  which 
are  thought  to  have  “  nothing  wrong  with  the  lung”  except 
bronchial  irritation,  but  which  too  often  end  in  rapid 
tuberculisation,  phthisis,  and  death.  They  are,  in  truth, 
cases  of  “  bronchial  irritation  but  the  irritated  structure 
is  the  nerve,  and  consequently  there  is  no  natural  limit 
to  the  disorder  which  may  ensue.  Practitioners  who  have 
much  to  do  with  the  younger  members  of  families  will 
recognise  the  affection  of  which  I  speak. 

Now,  I  believe  there  is  only  one  method  of  treatment 
which  is  quickly  and  completely  successful  in  putting  an 
end  to  the  morbid  state  of  irritability  whence  arise  all  the 
phenomena  that  go  to  make  up  the  misleading  and  mis- 
■chievous  affection  of  “pulmonary  weakness”  or  “throat 
cough”  as  it  occurs  in  the  adolescent.  It  is  not  a  pleasant 
remedy,  nor,  on  the  other  hand,  is  it  a  very  formidable  one. 
It  is  briefly  this  :  to  paint  over  the  course  of  the  pneumo¬ 
gastric  nerve,  or  (which  is  sufficiently  near  for  the  purpose) 
along  the  anterior  margin  of  the  sterno-cleido-mastoid 
muscle,  a  space  extending  from  the  level  of  the  lowest 
margin  of  the  lobe  of  the  ear  to  the  sterno-clavicular 
articulation,  and  about  one-sixth  of  an  inch  in  breadth,  with 
liquor  vesicatorius  or  glacial  acetic  acid.  This  should  be 
done  first  on  one  side,  and,  when  the  blister  has  healed,  on 
the  other  side,  commencing  with  the  side  on  which  there 
may  possibly  be  found  some  indications  of  what  is  fashion¬ 
ably  called  “  lung  weakness.”  If  the  first  application  does 
not  put  an  end  to  the  cough,  another  should  be  made  about 
a  fortnight  afterwards — the  sides  being  blistered  alternately, 
and  the  treatment  continued  until  the  symptoms  entirely 
disappear,  which  will  generally  be  within  two,  or  at  most 
three,  months.  No  medicine  need  be  given  except,  perhaps, 
small  doses  of  cod-liver  oil  if  there  be  any  loss  of  flesh.  In 


this  case  the  dose  ought  not  to  exceed  one  teaspoonful  twice 
or  thrice  daily,  being  taken  about  two  hours  after  a  meal. 
I  would  strongly  urge  those  who  have  to  treat  cases  of  the 
class  to  which  I  refer — namely,  of  choreic  or  “  nervous  ” 
cough — to  try  the  method  described,  which  I  believe  to  be 
in  a  signal  degree  effective.  I  am,  &c., 

J.  Mortimer  Granville. 

16,  Welbeck-street,  Cavendish-square,  W. 


REPORTS  OP  SOCIETIES. 

- o — : - 

THE  CLINICAL  SOCIETY  OF  LONDON. 

Friday,  November  9. 

Sir  Andrew  Clark,  Bart.,  President,  in  the  Chair. 


Case  of  Wound  of  the  Plantar  Arch — Secondary 

Hemorrhage  on  the  Thirteenth  and  Sixteenth 

Days  following  the  Injury. 

Mr.  G.  R.  Turner  read  the  following  case : — E.  S.,  aged 
ten,  a  schoolboy,  was  admitted  into  the  Seamen’s  Hos¬ 
pital,  Greenwich,  under  the  care  of  Mr.  Turner,  on  April  16, 
1883,  with  a  punctured  wound  of  the  sole  of  the  left  foot, 
received  from  a  glass  cut  two  days  previously.  The 
patient  was  a  healthy  boy  and  had  no  haemorrhagic  dia¬ 
thesis.  Bleeding  from  the  wound  was  arrested  by  pressure 
for  ten  days.  On  the  thirteenth  day  after  the  accident, 
haemorrhage  recurred  ;  ether  was  administered,  the  wound 
enlarged  and  explored,  but  no  wounded  vessel  could  be  found. 
The  parts  around  by  this  time  were  sodden  and  rotten,  so  it 
was  decided  to  ligate  the  posterior  tibial  artery,  and,  if 
necessary,  the  dorsalis  pedis.  On  ligaturing  the  first  vessel 
behind  the  inner  malleolus,  the  haemorrhage  ceased  only 
momentarily,  so  the  dorsalis  pedis  was  also  secured. 
Chromic  acid  catgut  was  used  as  a  ligature  in  both  cases. 
Haemorrhage  returned  on  the  sixteenth  day,  three  days 
after  the  proceeding,  and  was  finally  arrested  by  sponge- 
pressure  after  the  application  of  the  actual  cautery.  Mr. 
Turner  thought  the  case  of  interest  as  bearing  on  the  ques¬ 
tion  of  treatment  of  these  injuries.  Should  the  vessel  be 
secured  at  once,  without  taking  heed  of  the  injury  done 
to  the  tendons  of  the  foot  and  other  structures  of  the  sole, 
or  was  it  right  to  first  try  the  effect  of  pressure  ?  Had  the 
actual  cautery  failed  eventually  to  arrest  the  bleeding, 
ligature  of  the  femoral  would  perhaps  have  been  indicated. 

Mr.  H.  Lee,  referring  to  a  discussion  at  Liverpool  on  the 
same  subject,  pointed  out  that  hitherto  no  positive  guide  to 
the  treatment  of  wounds  of  the  palmar  or  plantar  arches 
was  recognised.  He  related  a  case  where  ligature  of  the 
smaller,  and  then  of  the  larger  arterial  trunks,  had  been 
unsuccessfully  practised,  rendering  amputation  necessary. 
This  necessity  he  regarded  as  an  opprobrium  to  the  surgery 
of  the  present  day.  The  employment  of  the  actual  cautery 
he  considered  a  rational  and  simple  procedure,  provided  that 
it  were  undertaken  with  due  regard  to  the  temperature  of 
the  iron  employed.  This  should  always  be  below  that  of 
boiling  water.  With  such  cauteries  no  eschar  was  formed, 
union  by  first  intention  was  not  interfered  with,  and  the  blood 
within  the  artery  was  usually  coagulated  for  a  space  of  two 
inches  at  least.  Where  the  cautery  had  been  thus  properly 
applied  he  had  never  met  with  secondary  haemorrhage. 

Mr.  Christopher  Heath  asked  for  further  details  as  to 
the  dressing  of  the  wound,  the  dates  of  the  changes  of 
the  dressing,  and  the  relation  of  the  haemorrhage  to  those 
changes. 

At  the  request  of  the  President, 

Mr.  Turner  stated  that  the  wound  two  days  after  its 
infliction  had  been  dressed  with  a  pad  of  lint.  This  had  been 
removed  after  a  week  in  consequence  of  the  state  of  the 
tissues  beneath,  and  the  haemorrhage  had  followed  its 
removal. 

Mr.  Heath  considered  that  the  established  faith  in  the 
efficacy  of  pressure  could  not  be  held  to  be  shaken  by  this 
case.  He  advocated  strongly  the  use  of  a  graduated  com¬ 
press  with  firm  bandaging,  and  elevation  of  the  limb.  He 
had  never  seen  it  fail  if  properly  persevered  with  until  com¬ 
mencing  suppuration  rendered  a  change  of  dressing  neces¬ 
sary.  Although  not  an  enthusiast  for  the  employment  of 
the  actual  cautery,  he  agreed  that  the  heat  of  the  instrument 


Medical  Times  and  Gazette. 


THE  CLINICAL  SOCIETY  OF  LONDON. 


Nov.  17, 1883.  585 


used  must  be  moderate.  For  controlling  large  arteries  he 
would  be  unwilling  to  trust  to  it,  owing  to  the  risk  that 
must  attend  the  earlier  or  later  separation  of  the  eschar. 
Ligature  of  the  femoral  artery  for  wound  of  the  plantar 
arch  he  considered  an  unjustifiable  proceeding. 

Mr.  Harrison  Cripps,  while  agreeing  with  Mr.  Heath  as 
to  the  efficacy  of  the  ordinary  treatment,  pointed  out  that  it 
must  of  necessity  be  modified  according  to  the  position  of 
the  wound.  The  preliminary  enlargement  of  the  wound 
would,  in  some  situations,  be  undesirable.  In  such  cases, 
pressure  exercised  upon  the  arteries  where  they  become 
superficial  about  the  ankle-joint  might  be  successful  in 
checking  haemorrhage.  This  treatment  might  be  carried 
out  by  bandaging  over  small  plugs  of  cork,  etc.  But  in  all 
the  cases  bandaging  of  the  limb  on  a  splint  should  be  con¬ 
sidered  essential.  He  related  cases  where,  after  more 
heroic  measures  had  been  adopted,  simple  bandaging  had 
ultimately  checked  the  haemorrhage. 

Mr.  Barker  inquired  whether  the  wound  had  been  kept 
thoroughly  clean  and  aseptic. 

Dr.  Glover  advocated  the  simple  treatment,  and  related 
a  successful  case. 

Mr.  Turner,  in  reply,  stated  that  the  tissues  having 
become  sodden  and  swollen,  removal  of  the  compress  of 
lint  had  been  necessary  at  the  end  of  a  week.  His  experience 
of  cases  of  gangrene  and  tetanus  as  results  of  bandaging 
led  him  to  regard  the  treatment  with  distrust.  He  explained 
that  he  had  used  the  cautery  in  this  case  in  the  way  recom¬ 
mended  by  Mr.  Lee.  The  wound  had  at  first  been  septic, 
but  all  subsequent  treatment  had  been  carried  out  under 
antiseptic  precautions.  Ligature  of  the  femoral  artery 
would  only  be  undertaken  as  the  very  last  resource. 

Case  oe  Ununited  Fracture  of  the  Patella  treated 
by  Suture  of  the  Fragments. 

Mr.  G.  R.  Turner  then  read  the  following  case  : — H.  St.  C., 
aged  thirty-nine,  seaman,  admitted  into  the  Seamen’s  Hos¬ 
pital,  Greenwich,  in  August,  1881,  with  an  ununited  fracture 
of  the  left  patella  of  six  months’  standing.  He  had  broken 
the  bone  first  in  1859,  and  the  fracture  had  been  treated  in 
the  ordinary  way.  The  uniting  medium  gradually  stretched, 
and  early  in  1881 ’he  fell  on  to  the  left  knee,  and  felt  the 
knee-cap  give  way  between  the  pieces  of  bone.  The  frag¬ 
ments,  on  admission  six  months  later  at  Greenwich,  were 
two  and  a  half  to  three  inches  apart.  He  was  helpless, 
and  could  just  hobble  about  with  the  aid  of  a  stick.  On 
October  26  ether  was  given,  and  the  fragments  exposed  by  a 
vertical  incision.  The  lower  one  was  small  and  comminuted. 
To  drill  it  obliquely  would  not  have  been  possible.  Two 
wires  were  passed  through  the  upper  fragment  and  the 
larger  of  the  two  lower  ones,  the  joint  drained  posteriorly 
on  each  side,  after  the  manner  described  by  Prof.  Lister,  and 
the  limb  placed  on  a  posterior  splint.  Strict  antiseptic  pre¬ 
cautions.  The  case  at  first  did  very  well,  the  temperature 
on  the  27th  and  28th  being  normal ;  between  99'2°  and 
100'2°  for  the  next  three  days.  On  November  1  the  patient 
shivered,  and  his  temperature  rose  to  102'8° — the  highest 
point  it  attained.  Freer  exit  was  given  to  the  discharges, 
and  some  pus  evacuated.  His  temperature  for  the  next 
fortnight  ranged  between  100°  and  102°  at  night,  falling  to 
normal  in  the  morning.  There  was  some  burrowing  of 
matter  in  the  ham.  After  November  21  the  discharge  les¬ 
sened,  and  the  wounds  gradually  healed.  Stout  wire  re¬ 
moved  on  February  7 ;  spray  discontinued  on  February  20. 
No  attempt  at  passive  movement  was  made;  the  patient 
refused  it,  saying,  "  all  he  wanted  was  a  stiff  knee.”  He  is 
now  doing  work  as  porter  to  the  hospital.  The  patella, 
enlarged  by  new  osseous  deposit,  can  be  moved  laterally  on 
the  femoral  condyles  to  a  slight  extent.  The  man  is  very 
active,  though  the  knee  is  stiff.  Although  the  case  did  not 
pursue  an  aseptic  course,  the  antiseptic  precautions  largely 
influenced  it  for  good.  It  seems  to  be  a  mistake  to  discard 
them  if  by  any  chance  the  wound  becomes  septic.  The 
fever  in  this  case  was  more  like  slightly  exaggerated  hectic 
fever  as  seen  in  a  negro  than  anything  else.  The  patient, 
once  a  helpless  cripple,  is  now  earning  his  livelihood  as 
hospital  porter,  and  is  more  than  satisfied  with  the  result 
himself.  A  resumd  of  fifty  cases,  the  majority  of  them 
unpublished,  was  then  read,  and  an  analysis  of  them  given, 
as  follows  : — 

Hector  Cameioa:  Old  case,  1. — Thoroughly  useful  joint. 

Lister:  Recent  cases,  5;  old  cases,  2.— All  excellent 


results.  Six  cases  shown  at  the  Medical  Society,  October  29, 
1883. 

Rose  :  Recent  cases,  2 ;  old  case,  1. — The  recent  cases  did 
well  (published).  Old  case  suppurated,  and  anchylosis 
ensued  (not  yet  published). 

Royes  Bell :  Recent  case,  1 ;  old  cases,  3.— In  the  recent 
case  suppuration  and  sloughing  occurred  ;  slight  movement 
eventually.  In  one  old  case  wire  passed  to  inner  side  of 
patella.  Good  results,  old  cases  (one  case  as  yet  published). 

Pye  :  Old  case,  1. — Suppuration  and  burrowing  of  matter 
in  the  thigh  followed,  with  considerable  constitutional 
disturbance ;  anchylosis  ensued. 

Jessop  :  Recent  cases,  2. — Good  movement  in  both  cases. 
One  case,  a  compound  fracture,  suppurated,  and  for  a  time 
there  was  considerable  constitutional  disturbance  (for  nine 
days).  Eventually,  after  the  exercise  of  passive  motion  for 
eight  months,  the  patient  recovered  with  a  nearly  perfect 
joint.  In  the  simple  case,  which  did  well,  no  provision  for 
the  drainage  of  the  joint  was  made.  (Both  cases  published.)* 

Amphlett:  Recent  case,  1. — Anchylosis.  It  is  doubtful 
whether  suppuration  occurred.  The  patient  subsequently 
sustained  a  compound  fracture  of  the  united  patella ;  and 
excision  of  the  joint  was  performed  by  Mr.  W.  Thomson,  of 
Dublin.  (Published.) 

Wheelhouse :  Recent  cases,  2. — Good  movement  in  both. 
One  a  compound  fracture.  No  provision  for  drainage  of  any 
kind  in  this  case.  Did  perfectly  well.  (Published.) 

Johnson  Smith:  Old  cases,  3. — Suppuration  and  anchylosis-- 
ensued.  In  one  case  broncho-pueumonia  caused  by  prolonged 
etherisation  followed  the  operation.  (Not  yet  published.) 

Mansell-Moullin  :  Old  case,  1. — In  this  case  the  operation 
was  abandoned.  After  the  fragments  were  wired  it  was  found 
impossible  to  get  them  together.  The  patient  did  well,  and 
was  no  better  and  no  worse  eventually. 

Jordan  Lloyd:  Old  case,  1. — Partial  movement.  The- 
fragments  could  not  be  brought  nearer  than  one  inch  from 
each  other,  even  after  the  division  of  the  quadriceps,  liga- 
mentum  patellae,  and  lateral  incisions  into  the  aponeures 
of  the  vasti.  The  wound  for  removing  the  wire  suppurated 
without  affecting  the  joint.  (Published.) 

Holmes:  Old  case,  1. — Suppuration  and  anchylosis.  “  A 
colleague  who  helped  me  in  manipulating  the  wires  had  not 
previously  washed  his  hands  in  the  antiseptic  fluid  ”  (Mr. 
Holmes,  St.  George’s  Hospital  Reports,  vol.  x.,  page  496). 

Henry  Smith:  Old  case,  1. —  Use  of  lint.  Recovering^ 
rapidly.  (Published.) 

Teale  :  Recent  case,  1. — Good  result.  Slight  impairment 
of  the  power  of  complete  flexion.  The  lower  fragment  small;* 
so  it  was  found  necessary  to  pass  the  sutures  through  the 
ligamentum  patellae  into  the  cavity  of  the  joint.  (Published.) 

Holderness  :  Old  case,  1.  Rushton  Parker  :  Old  case,  1. — 
Good  results  mentioned  by  Mr.  Jordan  Lloyd,  in  his  paper 
in  the  Birmingham  Medical  Review,  vol.  xiii. 

Howse :  Old  case,  4. — One  patient  operated  on  during  the 
incubative  period  of  syphilis.  Anchylosis,  without  any 
previous  suppuration,  ensued.  Perfect  recovery  in  another 
case.  A  third  case  had  but  little  movement,  and  the  patella 
broke  again  whilst  passive  motion  was  being  employed. 
Eventually  the  patient  recovered,  with  “increased  but  not 
perfect  movement.”  The  fourth  case  is  still  under  treatment, 
doing  well.  (Not  yet  published.) 

Golding  Bird:  Recent  case,  1. — Still  under  treatment; 
doing  well.  Silk  used. 

Oliver  Pemberton:  Old  case,  1. — Fibrous  union.  Firmer 
at  the  end  of  three  months.  The  patient  was  then  going 
about  with  the  knee  in  a  case.  (Not  published.) 

Sydney  Jones:  Old  case,  1. — Partial  movement.  Returned 
to  work  before  passive  movement  was  employed.  Suppura¬ 
tion  occurred. 

Turner  :  Old  case,  1. — Suppuration  and  anchylosis.  Lower- 
fragment  comminuted  and  small.  Wires  passed  right  through 
fragments.  No  passive  movement. 

Davies- Colley :  Recent  cases,  2. — One  case  a  compound 
fracture  ;  one  wire  passed  right  through  both  fragments. 
Fibrous  anchylosis  ensued,  allowing  slight  movement  of  the 
joint.  Passive  movement  not  yet  attempted.  The  other 
case  resulted  in  fibrous  union  of  the  fragments  with  good 
movement.  One  wire  was  passed  through  the  ligamentum 
patellae.  (Not  published.) 

Bloxam :  Recent  cases,  3. — Good  movement.  In  one  case 
there  was  a  slight  purulent  discharge.  No  rise  of  tempera¬ 
ture,  however.  (Not  published.) 


586 


Medical  Times  and  Gazette. 


ROYAL  MEDICAL  AND  CHIRURGICAL  SOCIETY. 


Nov.  17,  1883. 


Wood  :  Old  cases,  3. — In  one,  good  movement  (not  pub¬ 
lished).  In  another,  partial  movement  (not  published). 
The  third  case  died  of  pyaemia  (not  published).  The  risks 
of  the  operation  were  explained  to  the  patient,  who  asked 
for  it  to  be  performed.  The  skin  between  the  patellar 
fragments  adherent  to  the  femur.  Operation  tedious. 
-Quadriceps  and  vasti  divided  before  the  fragments  could  be 
approximated.  Did  well  for  ten  days  or  so.  Was  then 
attacked  with  a  rigor,  the  joint  suppurated,  and  the  patient 
died  about  the  third  week.  Metastatic  abscesses  present. 

Bryant:  Old  case,  1. — Fragments  separated  by  one  inch 
and  three-quarters  ;  uniting  medium  thin.  Operation  per¬ 
formed  January  20,  1882.  The  wound  well  washed  with 
iodine  water  and  dressed  with  terebene  and  oil ;  Leiter’s 
metallic  coil  applied.  Second  day  :  Wound  dressed,  free 
from  discharge  ;  temperature  98-4°.  Sixth  day:  Slight  puru¬ 
lent  discharge ;  temperature  100-4°.  Ninth  day  :  Wound 
healthy ;  temperature  normal.  February  15  :  Some  burrow¬ 
ing  about  lines  of  suture ;  otherwise  doing  well.  March  26  : 
Sutures  removed.  April  29 :  Bavarian  splint ;  very  little 
movement  of  joint ;  good  union  of  patella.  November  2, 1883  : 
■Joint  stiff,  but  very  useful. 

Muler,  of  Utrecht :  Recent  case,  1. — Good  result.  ( Lancet , 
1880.) 

Sir  W.  Mac  Cormac :  Old  case,  1. — The  patient,  a  hard 
drinker,  was  the  subject  of  an  old  ununited  fracture  of  the 
patella,  which  rendered  his  limb  useless  and  his  life  a  burden 
"to  him.  The  fragments  were  separated  by  about  three  inches 
and  three-quarters.  It  was  at  his  own  urgent  request  an 
operation  was  performed.  Quadriceps  had  to  be  divided  to 
■approximate  the  fragments.  The  wound  never  did  well, 
taking  on  an  unhealthy  action  at  once ;  the  joint  suppu¬ 
rated.  Amputation  of  the  thigh  became  necessary,  after 
which  the  patient  rapidly  sank  with  acute  septicaemia  ;  liver 
and  kidneys  fatty.  Previous  to  the  operation  all  sorts  of 
mechanical  contrivances  had  been  found  useless. 

The  cases  of  Prof.  Cooper,  of  San  Francisco,  are  not 
included  in  the  above. 

The  President  congratulated  Mr.  Turner  on  his  paper 
in  very  complimentary  terms.  He  called  attention  to  what 
■■seemed  to  him  an  omission,  viz.,  the  absence  of  any  sta¬ 
tistical  comparison  between  the  various  methods  of  treating 
fracture  of  the  patella. 

Mr.  Turner  explained  that  time  had  not  allowed  him  to 
discuss  that  part  of  his  subject. 

In  response  to  a  call  from  the  President,  i 

Mr.  Lister  observed  that,  having  come  to  the  meeting  in 
trepidation,  lest  he  should  find  that  his  teaching  had,  in 
■other  hands  than  his  own,  been  attended  with  disastrous 
results,  he  was  relieved  to  find  that  it  was  only  in  the  cases 
of  old  ununited  fracture  that  other  than  successful  issues 
had  resulted.  The  paper  well  illustrated  the  difficulties 
which  these  cases  of  long  standing  presented.  Believing 
thoroughly  that  a  time  would  come  when  recent  fractures  of 
the  patella  would  be  universally  treated  by  suture,  it  must 
be  no  less  clearly  recognised  that  whatever  form  of  anti¬ 
septic  treatment  is  adopted,  it  must  be  carried  through  in 
an  absolutely  trustworthy  manner,  and  entrusted  to  com¬ 
petent  hands  only.  He  considered  that  no  man  was  justified 
in  undertaking  the  operation  unless  he  was  either  able  to 
superintend  the  subsequent  dressings  himself,  or  to  depute 
the  superintendence  to  thoroughly  competent  men.  Hence 
the  importance  of  educating  the  younger  men  to  observe 
the  details  of  antiseptic  surgery.  He  deprecated  strongly 
the  custom  prevailing  in  some  hospitals  of  employing  only 
one  house-surgeon  to  carry  out  the  views  and  wishes  of 
-several  surgeons.  Owing  to  the  far  greater  importance  of 
the  after-treatment  of  cases  now  than  formerly,  he  suggested 
that  London  surgeons  might  advantageously  follow  the 
•example  of  some  foreign  operators,  and  visit  their  hospitals 
•every  day.  He  related  a  case  operated  on  a  few  hours  pre¬ 
viously,  in  which  great  difficulty  had  been  met  with,  owing 
to  the  case  having  been  neglected,  and  pathological  changes 
having  commenced  in  the  fragments. 

Mr.  T.  Holmes  drew  attention  to  three  important  points 
with  respect  to  the  operation — first,  its  safety  ;  second,  its 
-application  to  old  and  recent  fractures  respectively ;  third, 
.fits  necessity.  With  respect  to  its  safety,  he  quoted  Prof. 
Lister’s  words  that  the  operation  is  not  justifiable  unless 
the  dressing  be  in  competent  hands.  He  himself  operated 
■an  such  cases  with  a  considerable  sense  of  risk,  and  doubted 
whether  the  procedure  of  opening  the  knee-joint  and  hand¬ 


ling  the  structures  exposed  could  ever  be  undertaken  with¬ 
out  risk.  While  the  operation  might  be  necessary  in  the 
old  cases,  completely  crippled,  it  was  clearly  more  difficult 
in  itself,  and  attended  with  less  satisfactory  results.  But 
in  recent  cases  he  did  not  consider  it  necessary.  Was  it  so 
very  desirable  to  obtain  osseous  union  ?  Were  the  cases  of 
fibrous  union  so  very  unsatisfactory  ?  He  had  lately  held  a 
consultation  with  his  colleagues  as  to  the  operative  treat¬ 
ment  of  a  recent  case,  and  his  own  disinclination  to  operate 
had  been  fully  endorsed  by  the  patient,  who  exhibited  on  his 
other  leg  a  fractured  patella,  healed  with  perfect  success 
by  the  ordinary  means,  some  years  previously.  Many  cases 
thus  treated  were  just  as  well  after  the  fracture  as  before, 
and  until  such  cases  could  be  shown  to  be  in  a  minority 
he  did  not  consider  the  risk  of  operation  justifiable. 

Mr.  Christopher  Heath  thought  that  if  cases  were  more 
skilfully  treated  by  the  older  methods  there  would  be  fewer 
cases  available  for  the  new  operation.  The  notion  that  the 
quadriceps  extensor  caused  the  separation  of  the  fragments 
by  tension  upon  the  upper  was  an  altogether  false  one. 
The  effusion  of  blood  into  the  joint  was  the  real  cause,  and 
he  advocated  the  use  of  the  aspirator  to  empty  the  joint 
when  necessary.  A  plaster-of- Paris  bandage  applied  at 
once,  and  worn  for  six  weeks,  followed  by  the  use  of  a  leather 
case  for  at  least  a  twelvemonth,  was  almost  always  success¬ 
ful.  He  feared  that  the  world-wide  celebrity  of  Prof. 
Lister’s  cases,  lately  published,  would  lead  to  the  loss  of 
many  knees,  if  not  of  many  lives.  In  the  ordinary  practice 
of  the  country  such  precautions  as  Mr.  Lister  himself  held 
to  be  essential  could  rarely  be  observed,  even  by  the  most 
carefully  trained  surgeons. 

Mr.  Bryant  communicated  a  series  of  old  cases  collected 
by  Mr.  J.  Poland  at  Guy’s  Hospital,  all  of  which  had  at 
some  previous  time  been  the  subjects  of  fractured  patella. 
From  the  details  of  these  cases  it  appeared  that  in  a  large 
majority  the  patients  had  been  as  well  able  to  follow  their 
employment  after  as  before  the  injury.  He  considered  that 
with  such  experience  as  that,  the  risk  attending  the  operation 
was  not  warranted. 

Mr.  Bowlby  referred  to  the  treatment  by  division  of  the 
quadriceps  tendon,  and  asked  for  information  as  to  the 
result  of  such  cases.  He  referred  to  a  case  in  which,  after 
division  of  the  tendon,  the  muscle  had  wasted,  and,  although 
the  patella  had  united  by  bony  adhesion,  the  patient 
remained  as  lame  as  before. 

Mr.  Rotes  Bell  referred  to  some  of  the  cases  operated 
on  by  him,  and  gave  details  of  some  of  the  difficulties 
attending  them. 

Mr.  Nunn  believed  that  the  cause  of  retraction  of  the 
upper  fragment  was  to  be  found  in  the  impaired  nutrition 
of  the  quadriceps  muscle  during  the  period  of  complete 
rest,  the  muscle  being  slightly  shortened.  To  obviate  this 
he  would  advocate  the  frequent  shampooing  of  the  muscle 
as  soon  as  the  inflammatory  mischief  in  the  joint  had 
subsided. 

Mr.  H.  Morris  referred  to  the  good  results  obtained  by 
Hawksley’s  apparatus,  which,  while  maintaining  support  to 
the  young  cicatricial  tissue,  allowed  of  gradually  increasing 
movement  of  the  limb.  Referring  to  some  of  Mr.  Lister’s 
results,  he  maintained  that  these  would  not  have  been  con¬ 
sidered  satisfactory  if  they  had  been  obtained  by  the 
ordinary  methods  of  treatment. 

Mr.  Lister  explained  that  the  cases  referred  to  were  none 
of  them  recent  cases. 

Mr.  Turner,  in  reply,  expressed  his  agreement  with  Prof. 
Lister’s  views  as  to  the  treatment  of  recent  cases. 


ROYAL  MEDICAL  AND  CHIRURGICAL 
SOCIETY. 

Tuesday,  November  13. 

John  Marshall,  F.R.S.,  President,  in  the  Chair. 


Spontaneous  Inguinal  Aneurysm  in  a  Boy. 

Mr.  R.  W.  Parker  read  a  paper  on  a  case  of  spontaneous  in¬ 
guinal  aneurysm  in  a  boy  aged  twelve  years  and  eight  months, 
for  which  the  external  artery  was  tied;  with  notes  of  the  other 
recorded  cases  of  external  aneurysm  in  young  persons. 
Frederick  L.,  aged  twelve  years  and  eight  months,  was  ad¬ 
mitted  into  the  East  London  Hospital  for  Children  with  an 


Medical  Times  and  Gazette. 


ROYAL  MEDICAL  AND  CHIRURGICAL  SOCIETY. 


Not.  17,  1883.  587 


aneurysm  in  the  left  inguinal  region,  about  the  size  of  a 
pullet’s  egg.  The  boy  first  experienced  a  pain,  while  asleep 
in  bed,  three  weeks  before  he  came  under  the  author’s  ob¬ 
servation,  after  which  the  aneurysm  gradually  developed. 
He  continued  to  attend  school  until  within  two  weeks  of  his 
admission  into  hospital.  There  was  extensive  aortic  dis¬ 
ease.  After  ten  days’  rest  in  bed,  the  external  iliac 
artery  was  tied  under  strict  Listerian  precautions  :  a  car- 
bolised  silk  ligature  was  used.  The  wound  healed  within 
about  a  week,  and  the  aneurysm  was  cured.  Thirty-four 
days  after  the  operation,  severe  epistaxis  occurred,  and 
recurred,  and  the  boy  died  of  anaemia  and  exhaustion  rather 
suddenly.  At  the  autopsy,  vegetations  were  found  on  the 
aortic  valves,  and  the  aortic  orifice  was  narrowed.  The 
heart  was  hypertrophied.  The  author  then  gave  a  summary 
of  all  the  hitherto  recorded  cases  of  spontaneous  external 
aneurysm  in  persons  under  twenty  years.  The  table  con¬ 
tained  fifteen  cases,  including  his  own.  It  was  shown  that 
in  no  less  than  eight  of  the  fifteen  cases  there  was  disease  of 
the  valves,  in  two  cases  only  was  the  heart  found  healthy, 
while  in  the  remaining  five  cases  its  condition  was  not 
stated.  The  association  of  vegetations  on  the  valves  and 
aneurysm  has  also  been  noticed  in  internal  aneurysms.  The 
views  of  various  authors  on  the  relation  of  embolism  and 
aneurysm  were  quoted  ;  the  author,  while  agreeing  that 
this  must  be  more  than  mere  coincidence,  felt  that  the 
exact  mode  in  which  the  aneurysm  was  brought  about  had 
not  yet  been  satisfactorily  demonstrated,  and  he  invited 
discussion  thereon.  The  object  of  the  criticisms  was  to 
show  that  much  remained  to  be  made  out  even  if  the  embolic 
doctrine  were  accepted. 

The  President,  in  inviting  discussion,  thought  that  the 
value  of  the  paper  was  enhanced  by  being  supplemented 
with  a  table  and  abstract  of  all  the  other  recorded  cases. 
The  subject  was  one  which  required  careful  consideration. 
He  would  ask  ivhether  any  history  of  rheumatism  or  of 
syphilis  had  been  obtained,  and  what  was  the  condition  of 
the  hip- joint,  which  was  stated  to  be  anchylosed.  The  mode 
of  causation  of  aneurysm  in  these  cases  was  obscure.  He 
doubted  whether  there  was  any  sufficient  evidence  on  which 
to  form  an  opinion. 

Mr.  Holmes  agreed  in  the  main  with  the  author’s  con¬ 
clusions.  He  thought  there  must  be  some  causal  connexion 
between  aneurysm  and  embolism  in  the  case  related.  The 
purring  sensation  which  was  reported  as  present  in  the 
arteries  of  the  limbs  seemed  confirmatory  of  this,  although 
no  embolic  clot  was  actually  found.  One  of  the  preparations 
on  the  table,  borrowed  from  St.  George's  Hospital,  showed 
an  aneurysm  of  the  ulnar  artery.  Mr.  Pollock  was  called 
in  consultation  to  see  the  case,  and  pronounced  in  favour  of 
aneurysm.  On  account  of  the  youth  of  the  patient  this 
opinion  was  overruled  by  his  colleagues,  who  thought  it  was 
probably  of  a  cancerous  nature.  In  course  of  time  the 
patient  died,  and  then  the  true  nature  of  the  lesion — an 
aneurysm — was  made  out.  There  could  be  no  doubt  that  in 
early  youth  aneurysms  were  connected  with  heart  disease, 
and  hence  only  two  explanations  seemed  possible.  Either 
they  were  the  result  of  general  disturbance  of  the  circula¬ 
tion,  in  which  case  there  would  be  a  general  fusiform  dilata¬ 
tion  of  the  vessels,  which  practically  did  not  occur ;  or  they 
must  be  caused  by  plugging  of  the  vessels.  The  artery, 
being  plugged,  gave  way  a  few  hours  or  days  later ;  this 
seemed  in  keeping  with  the  dilatation  above  the  seat  of  liga¬ 
ture  which  was  found  in  a  few  cases.  Such  plugging  could 
seldom  be  as  sudden  or  as  complete  as  that  which  followed 
a  ligature ;  partial  obstruction  occurred  first,  and  then 
became  complete.  Of  course,  when  complete  it  more  ade¬ 
quately  explained  the  mode  of  formation  of  the  dilatation. 
In  individuals  where  the  heart  was  diseased  and  hypertro¬ 
phied  the  arteries  also  probably  were  more  brittle  than 
normal,  even  though  changes  could  not  be  detected  by  the 
microscope ;  and  this  would  explain  the  mode  of  production. 
He  (Mr.  Holmes)  was  profoundly  convinced  of  the  causal 
connexion,  and  he  thought  that  anyone  reading  Mr.  Tufnell’s 
case  would  arrive  at  a  similar  conclusion.  The  fact  that  the 
boy  had  an  anchylosed  hip-joint,  and  was  obliged  to  use  a 
crutch,  was  an  additional  point  of  interest.  It  was  possible 
that  the  force  and  weight  of  the  body,  being  largely  borne  on 
the  same  limb  as  the  aneurysm,  had  some  causal  connexion  in 
its  production.  He  agreed  as  to  the  necessity  of  defining 
whatis,  and  what  is  not,  a  traumatic  aneurysm,  for  it  was  pro¬ 
bable  that  mechanical  causes  might  sometimes  be  concerned 


in  spontaneous  aneurysm, though  vital  causes  were  the  initial 
changes  on  which  the  aneurysm  depended.  As  regards  the- 
use  of  silk  for  purposes  of  ligature,  if  used  with  antiseptic- 
precautions,  it  was  no  doubt  a  good  material  for  the  purpose, 
for  it  allowed  an  artery  to  be  occluded  without  division  of  its 
external  coat,  thus  reaching  John  Hunter’s  ideal.  A  draw¬ 
back  had,  however,  been  pointed  out  either  by  Mr.  MacCarthy 
or  Mr.  Treves,  that  the  resulting  obliteration  was  less  com¬ 
plete  than  that  obtained  by  older  methods.  He  himself  had 
recently  shown  a  case  of  aneurysm,  for  which  he  had  per¬ 
formed  the  distal  operation.  The  operation  had  not  run 
quite  an  aseptic  course,  and  the  result  of  the  ligature  was 
the  production  of  a  diaphragm  across  the  lumen  of  the 
vessel;  hence  the  circulation  was  not  obstructed.  This 
method  was  much  less  dangerous  by  the  ligature  not 
cutting  its  way  out,  but  it  was  also  less  efficacious  in 
arresting  the  circulation. 

Mr.  Barwell  said  the  paper  contained  many  matters  of 
great  interest,  which  might  all  be  made  the  subject  of  dis¬ 
cussion,  but,  since  the  time  of  the  Society  was  valuable,  he 
would  confine  his  remarks  to  one  point  only,  viz.,  the  relation 
of  juvenile  aneurysm  to  embolism.  There  was  evidently 
some  connexion  between  that  form  of  endocarditis  which  is 
commonly  called  “  warty  ”  and  aneurysm ;  and,  indeed,  he 
would  concede  without  comment  at  the  present  moment 
that  embolism  of  the  thin-walled  and  unsupported  cerebral 
arteries,  and  occasionally  of  some  visceral  arteries,  was 
directly  traceable  to  embolism,  but  he  could  not  accept  the 
theory  that  systemic  aneurysms — those,  for  instance,  of  the 
limbs — were  due  to  such  a  cause.  The  view  which  would 
attribute  the  arterial  dilatation  to  the  mechanical  effect  of  a 
more  or  less  suddenly  arrested  blood-current  did  not  appear 
to  him  tenable.  Large  vessels  were  frequently  occluded  more 
completely  and  suddenly  than  an  embolus  could  do ;  for 
instance,  the  aorta,  the  iliacs,  femoral,  or  brachial.  This  was 
done  either  for  the  prevention  of  haemorrhage  during  ampu¬ 
tation,  or  for  the  cure  of  an  aneurysm  below  the  point  of 
pressure.  He  was  not  aware  that  aneurysm  ever  followed! 
such  procedure,  unless  in  a  few  cases  when  proximal  com¬ 
pression  of  a  diseased  artery  had  been  so  injudiciously  pro¬ 
longed  as  to  injure  the  coats  of  the  vessel.  Nor  did  deligation 
of  an  artery — an  even  more  perfect  occlusion — produce  aneu¬ 
rysm  save  in  a  very  few  cases,  and  in  them  only  because  the 
internal  and  middle  coats  of  the  vessel  had  been  divided 
by  the  ligature.  The  case  of  Mr.  Tufnell,  already  quoted,, 
did  not  prove  that  an  embolism  could  produce  an  aneurysm 
— indeed,  to  his  mind,  it  went  rather  to  show  the  difficulty  of 
any  such  event.  In  that  case  a  man  suffering  from  acute- 
rheumatism  suddenly  developed  a  pulsating  tumour  in  the- 
popliteal  space.  This  very  rapidly  subsided  as  the  colla¬ 
terals  enlarged,  and  after  death  no  aneurysm,  but  only  a  very 
slightly  dilated  artery  plugged  with  fibrine,  was  found.  A 
theory — due,  he  believed,  to  Dr.  Goodhart — that  the  embolon 
detached  from  inflamed  heart-valves  may  at  its  point  of 
arrest  in  a  systemic  vessel  induce  softening  of  the  valvular 
walls,  rested,  so  far  as  he  (Mr.  Barwell)  knew,  only  on  the- 
case  published  by  him  in  the  Pathological  Transactions.  The 
radial  pulse  of  a  rheumatic  patient  suddenly  stopped,  and 
after  death  the  brachial  artery  was  found  considerably  dilated 
and  filled  with  a  puruloid  fluid ;  but  this  was  not  an  aneu¬ 
rysm,  and  it  was  probable  that,  had  the  patient  lived,  this 
vessel  would  either  have  become  completely  occluded,  or 
that  when  collateral  circulation  had  relieved  the  blood- 
pressure  it  would  have  resumed  its  normal  size  and  func¬ 
tion.  Neither  in  this  case  nor  in  the  preparation  of  air 
ulnar  aneurysm  now  on  the  table  was  there  any  proof  that 
the  condition  was  due  to  the  impaction  of  an  embolus ;  nor, 
as  far  as  he  knew,  was  there  any  reason  to  suppose  that  am 
embolus,  or  a  warty  concretion  detached  from  a  valve,  could 
produce  softening  of  the  parts  against  which  it  came  to  lie. 
In  the  table  of  juvenile  aneurysm,  which  contained  fifteen 
cases,  the  condition  of  the  heart  was  not  noted  in  five  ;  in 
two  it  was  stated  to  be  normal.  Thus,  in  very  nearly  half 
the  cases  the  aneurysm  was  not  deducible  from  embolism,  and 
in  two  was  evidently  independent  of  them ;  moreover,  in  a 
large  proportion  of  the  eight  remaining  cases,  the  cardiac 
affection  was  not  noted  as  being  warty.  He  thought  that 
the  malady,  rheumatic  or  otherwise,  which  produced  the 
heart  disease,  produced  a  condition  of  the  arterial  coats  such 
as  facilitated  the  production  of  aneurysm.  In  the  case- 
brought  before  the  Society  by  Mr.  Parker,  the  boy  had  a 
weak  arterial  system,  as  was  evidenced  by  the  epistaxis  and 


588 


Medical  Times  and  Gazette. 


EOYAL  MEDICAL  AND  CHIRURGICAL  SOCIETY. 


Nov.  17,  1883. 


haematemesis ;  he  also  had  a  greatly  hypertrophied  heart — 
two  conditions  extremely  apt  to  produce  aneurysm.  The 
particular  place  of  its  occurrence  was,  perhaps,  determined 
by  the  fact  that  the  right  hip  being  anchylosed  in  a  bent 
position,  excessive  work  was  thrown  on  the  left  limb,  and 
at  the  moment  of  any  effort  the  over-powerful  heart  would 
throw  into  the  exerted  limb  a  strong  wave,  quite  sufficient  to 
■dilate,  or  perhaps  rupture,  some  of  the  coats  of  a  weakened 
vessel. 

Dr.  Goodhart  said  that,  before  taking  up  the  question  in 
the  main,  he  would  like  to  say  a  word  upon  a  remark  by  Mr. 
Barwell,  that  as  one  reason  against  the  embolic  theory  of 
these  aneurysms,  though  infarctions  occurred  in  the  viscera, 
yet  no  aneurysms  were  found.  This  was  of  course  explained  by 
the  fact  that  aneurysms  did  not  occur  in  the  solid  viscera. 
It  was  from  the  necessity  of  our  arterial  system  running  un¬ 
supported  that  we  were  liable  to  aneurysm;  and  one  of  the 
best  examples  that  could  be  given  of  this  was  the  fact  of  pul¬ 
monary  aneurysm,  which  was  not  liable  to  occur  unless  there 
was  a  cavity  in  the  lung,  when  the  wall  of  the  artery,  weakened 
■on  the  side  next  the  cavity, yielded,  and  an  aneurysm  resulted. 
As  to  the  relation  between  aneurysm  and  embolism,  he  thought 
"there  could  be  no  doubt  that,  as  Mr.  Holmes  said,  there  must 
be  some  causal  connexion  between  the  two;  and  from  what 
Mr.  Parker  said  he  gathered,  not  the  same  impression  as 
Mr.  Barwell,  but  that  the  result  of  his  investigations  was  to 
lead  him  to  the  same  conclusion.  He  really  did  not  see  that 
there  was  any  room  for  doubt,  and  the  strongest  argument 
to  be  found  in  its  favour  lay  in  the  disease  as  it  occurred  in 
the  brain.  Mr.  Barwell  objected  that  in  Mr.  Parker’s  case 
no  embolism  could  be  seen ;  but  that  seemed  to  him,  with  all 
deference  to  Mr.  Barwell,  to  be  no  argument  at  all.  Over 
and  over  again  we  met  with  conditions  in  the  brain  and 
•elsewhere  which  were  certainly  due  to  embolism,  but  in  which 
the  actual  plug  could  not  be  found.  The  other  facts  were 
all  in  favour.  The  aneurysms  were  more  frequent  in  the 
brain  than  elsewhere,  explicable  naturally  by  the  anatomical 
fact  that  the  arteries  were  more  of  a  size  to  catch  embola 
than  the  external  vessels,  which  come  under  the  surgeon’s 
eye  ;  and  further,  that  most  of  those  in  the  brain  did  occur 
on  the  branches  of  the  middle  cerebral  artery,  just  where  an 
embolus  would  be  expected  to  lodge.  The  external  aneu¬ 
rysms,  however,  did  not  support  the  same  view.  There 
were  three  or  four  cases  of  femoral  or  inguinal  aneurysm, 
the  fibres  sticking  on  the  fork,  or  rather  the  aneurysms 
being  situated  at  the  fork.  He  had  himself  elsewhere  recorded 
a  case  of  aneurysm  situated  at  the  bifurcation  of  the  brachial; 
while  seated  near  the  patient,  with  his  finger  on  the  pulse,  at 
the  time,  he  had  felt  the  pulse  stop,  and  had  demonstrated, 
after  death,  the  plugging  of  the  artery  and  the  presence  of  the 
aneurysm.  But  as  to  the  actual  incidence  of  the  embolism, 
how  it  caused  aneurysm,  Mr.  Parker  and  Mr.  Holmes  agreed 
that  there  was  still  very  much  to  be  made  out.  He  (Dr. 
Goodhart)  had  started  a  hypothesis  for  these  cases,  and  was 
on  that  account,  perhaps,  biased  in  its  favour.  All  that  he 
had  seen  since  making  the  suggestion  some  years  ago,  had 
but  tended  to  confirm  him  in  the  notion  that  he  was  not  far 
■off  a  correct  solution  of  the  difficulties.  The  remarks  that  had 
been  made  to-night  afforded  him  material  for  a  very  strong 
argument  in  favour  of  the  view.  In  case  after  case,  almost 
without  an  exception,  these  aneurysms  occurred  in  the  disease 
which  has  been  called  ulcerative  endocarditis — but  which  he 
should  prefer  to  call  fungating  endocarditis,  for  the  disease 
was  not  always  ulcerative.  Very  large  vegetations  seemed 
fio  be  the  most  important  element;  but  they  were  all  of  one 
class  of  cases,  viz.,  excessive  and  severe  endocarditis,  such 
as  was  not  met  with  in  ordinary  rheumatic  disease.  The 
aneurysms  always  occurred  in  these  cases,  and  were  not 
liable  to  result  from  simple  embolism.  If  Mr.  Parker  could 
show  him  that  any  case  had  resulted  from  what  he  would 
call  simple  embolism,  then  he  admitted  a  difficulty,  because 
simple  plugging  was  nearly  parallel  to  ligature.  Mr.  Holmes’s 
suggestion  of  the  occurrence  was  that  the  aneurysm  formed 
behind  the  clot  because  of  this  obstruction,  under  some  cir¬ 
cumstances  ;  yet  aneurysm  was  not  a  risk  that  the  surgeon 
apprehended  when  he  placed  a  ligature  on  the  artery.  Mr. 
Holmes  said  that  aneurysm  did  occur  occasionally  under 
these  circumstances ;  but  he  (the  speaker)  was  disposed 
to  think  that  this  rare  occurrence  would,  if  investigated, 
support  his  view.  He  doubted  whether  this  occurred  much 
in  late  years,  since  suppuration  was  less  extensive  than  for¬ 
merly,  and  he  believed  that  if  such  cases  could  be  examined 


they  would  be  found  to  be  cases  of  inflammatory  soften¬ 
ing  of  the  coats  at  or  above  the  ligature,  and  thus 
really  evidence  in  favour  of  the  process  which  he  believed 
took  place  in  these  aneurysms  from  embolism.  He  thought 
that  the  clot  in  these  cases  was  a  virulent  one,  setting 
up  much  disturbance  in  the  place  in  which  it  lodged, 
and  thus  an  active  inflammatory  softening  of  the  arterial 
coat  resulted ;  and  this,  no  doubt  helped  on  by  the  other 
existing  conditions  of  a  large  heart  and  bad  kidneys,  which 
were  often  co-existent  with  the  fungating  endocarditis,  deter¬ 
mined  the  formation  of  aneurysm.  There  were  many  other 
points  he  would  wish  to  have  taken  up  as  adding  to  the 
strength  of  his  position.  When  aneurysm  occurred  in  a 
young  person,  or  whenever  it  occurred  in  association  with 
heart  disease,  we  knew  of  a  surety  that  we  were  dealing  with 
the  worst  form  of  disease  of  the  valves,  and  that  a  fatal 
result  was  only  too  likely  to  ensue  before  long.  It  was  not 
every  case  of  fungating  endocarditis  that  died,  but  many  did. 
Each  case  must,  of  course,  be  treated  on  its  merits;  but  he 
asked  whether  in  any  case  it  would  be  worth  while  to  attempt 
to  cure  an  aneurysm  by  subjecting  the  patient  to  an  opera¬ 
tion  when  death  was  within  a  three  or  four  weeks’  view. 

Mr.  Arthur  Barker  remarked  that  one  point  connected 
with  the  case  just  recorded  seemed  to  have  fallen  into  the 
background  during  the  interesting  discussion  as  to  the 
causation  of  spontaneous  aneurysms,  which  nevertheless 
seemed  to  be  one  of  some  importance,  and  that  was,  the 
material  used  for  ligature  of  the  vessel.  It  was  worthy  of 
note  that  this  was  one  of  the  few  cases  recorded  in  which 
carbolised  silk,  employed  with  the  completest  antiseptic 
precautions,  had  been  applied  to  an  artery  in  its  continuity, 
cut  short,  and  left  in  the  tissues.  Another  case  had  been 
reported  by  Mr.  Heath  in  the  Transactions  of  the  Society, 
and  those  who  examined  the  preparations  exhibited  would, 
the  speaker  thought,  be  able  to  convince  themselves  of 
the  satisfactory  condition  of  parts  at  the  point  of  liga¬ 
tion.  In  neither  of  these  cases  was  there  the  mere 
thin  diaphragm  either  perfect  or  still  pervious  at  the 
point  of  occlusion,  alluded  to  by  Mr.  Holmes  as  having 
been  found  in  those  cases  in  which  carbolised  catgut 
had  been  used,  but  the  vessel  was  soundly  closed,  and 
surrounded  by  a  firm  material  in  which  the  silk  was 
embedded,  itself  too  producing  an  extra  barrier.  As  one 
who  employed  catgut  largely — of  course  operating  always 
with  all  antiseptic  precautions, — but  who  had  also  used 
carbolised  silk  with  the  same  precautions  in  almost  every 
part  of  the  body,  it  appeared  to  him  that,  as  the  latter 
substance  showed  itself  perfectly  innocuous  in  the  tissues 
when  introduced  in  this  way,  it  might  turn  out  to  be 
the  most  desirable  material  for  ligature  of  arteries  in 
their  continuity,  if  not  for  general  use.  The  speaker  had 
watched  cases  for  years  where  it  had  been  employed,  and  as 
the  wounds  had  been  absolutely  aseptic  to  begin  with,  the 
silk  had  never  made  its  appearance.  Ovariotomists  were 
offering  an  accumulating  mass  of  evidence  upon  this  point 
every  day,  and  as  long  as  there  was  any  uncertainty  about 
the  preparation  of  carbolised  catgut  (and  who  was  there 
who  would  not  admit  this  uncertainty?),  silk  might  be  em¬ 
ployed  with  the  greatest  confidence  not  only  that  its  knot 
would  hold,  but  that,  introduced  in  a  state  of  perfect 
asepticity  into  a  wound,  it  would  remain  quiescent.  It  was 
easier  to  tie,  and  more  easily  procurable  all  the  world  over 
than  catgut,  although  the  latter  was  undoubtedly  valuable 
in  many  ways.  Mr.  Barker  had  tied  the  femoral  artery 
some  months  ago  with  carbolised  silk  under  Listerian  treat¬ 
ment  for  the  cure  of  popliteal  aneurysm,  and  there  had  been 
no  sign  of  the  ligature  since. 

Mr.  Berkeley  Hill  reminded  Mr.  Barker  that  a  con¬ 
siderable  amount  of  exudation  had  been  found  around 
the  ligature  in  Mr.  Heath’s  case ;  and  Mr.  Horseley,  who 
had  made  the  microscopic  preparation,  was  inclined  to 
regard  it  as  of  an  inflammatory  and  irritative  nature.  It 
would  seem,  therefore,  that  carbolised  silk  was  not  quite  so 
innocuous  as  was  generally  believed. 

Mr.  Barker,  in  reply,  said  he  was  quite  familiar  with 
these  appearances  just  described  by  Mr.  Hill ;  but  thought 
that  they  only  showed  the  remains  of  exudation  undergoing 
organisation  into  fibrous  tissue,  but  not  such  degenerative 
changes  as  would  justify  one  in  speaking  either  of  a  trace  of 
pus-formation  or  even  caseation.  The  part,  in  fact,  was 
firmly  and  safely  consolidated. 

The  President  remarked  that  we  were  rather  too  apt  to 


Medical  Times  and  Gazette. 


MEDICAL  NEWS, 


Nov.  17, 1883.  589 


think  that  there  was  only  one  cause  for  any  given  lesion. 
It  was  probable,  however,  that  there  was  more  than  one. 
In  some  cases  an  embolism  might  be  present ;  in  others  it 
might  be  absent.  The  discussion  seemed  to  show  that  in 
the  case  related  there  was  probably  a  combination  of  causes. 
In  physical  science,  phenomena  were  brought  about  by  defi¬ 
nite  causes  ;  but  in  dealing  with  organic  bodies  we  found 
that  similar  effects  could  result  from  many  different  causes. 

Mr.  Parker  briefly  replied.  In  answer  to  the  President’s 
question,  he  stated  that  he  had  failed  to  get  any  history  of 
rheumatism  or  of  syphilis.  On  examining  the  diseased 
hip-joint  after  death,  there  was  some  inspissated  caseous 
pus,  which  suggested  a  strumous  form  of  disease  rather 
than  a  rheumatic  one.  He  thanked  Mr.  Holmes  for  his 
remarks,  and  acknowledged  his  indebtedness  to  his  (Mr. 
Holmes’s)  essay  on  aneurysm,  from  which  he  had  several 
times  quoted.  In  Mr.  Tufnell’s  case,  alluded  to  both  by 
Mr.  Holmes  and  Mr.  Barwell,  at  the  time  of  death  there 
was  no  actual  aneurysm,  only  dilatation  of  the  artery,  while 
lower  down  there  was  obliterative  arteritis. 

Specimens  from  the  museums  of  Guy’s,  St.  Bartholomew’s, 
and  St.  George’s  Hospitals,  and  the  author’s  case  (now  in 
the  College  of  Surgeons),  were  exhibited. 

The  Society  then  adjourned. 


MEDICAL  NEWS. 

- ♦ - 

University  of  Edinburgh. — First  Professional 
Medical  Examination. — The  following  gentlemen  have 
passed  their  First  Professional  Examination  : — 

John  S.  Bell,  C.  N.  Bensley,  E.  G.  Blanc,  A.  E.  Booth.  Alfred  Bourdaile, 
N.  L.  Boxill,  Daniel  Brown,  T.  H.  Bryce,  F.  J.  Butt,  C.  L.  Williams, 
E.  W.  W.  Carlier,  E.  C.  Carter,  J.  T.  Chamberlain,  F.  H.  Clarke,  Arthur 
Clarkson,  J.  H.  Conyers,  R.  J.  Copeland,  A.  J.  W.  Dalzell,  E.  C.  S.  Daniel, 
E.  N.  Darwent.  D.  N.  P.  Datta.  Walter  Denby,  W.  C.  Drew,  E.  W. 
Skinner,  J.  C.  Dunlop,  Alexander  Edington,  W.  J.  Fairlie,  J.  Edmondson, 
M.  Farquharson,  Oliver  Field,  J.  G.  Fletcher,  N.  S.  Fraser,  A.  H.  Frere, 
Thomas  Galbraith,  John  Galletly,  and  L.  D.  Gamble. 

Eoyal  Colleges  of  Physicians  and  Surgeons, 
Edinburgh. — Double  Qualification. — The  following  gen¬ 
tlemen  passed  their  First  Professional  Examination  during 
the  October  sittings  of  the  examiners  : — 

Richard  Basil Morley,  Leeds;  Joseph  George  Garibaldi  Corkhill,  Liver¬ 
pool  ;  William  Ketson  Clayton,  Leeds  ;  Allen  Adair  Dighton,  Gloucester  ; 
Alexander  McKerlie,  Glasgow;  Percy  Henry  Septimus  Mellish,  Sandgate  ; 
Michael  Henry  Taylor,  Dublin ;  Thaddeus  Cachick  Avetoom,  Calcutta  ; 
William  Haines,  County  Cork ;  Charles  William  Reilly,  Nenagh ;  William 
Henry  Roberts,  Dublin;  Thomas  Weir,  Lanarkshire;  Henry  Patrick 
Garvey,  County  Mayo;  James  Knight  Coutts,  London;  William  James 
Van  der  Vyver,  South  Africa ;  Plomer  William  Young,  County  Cork. 

The  following  gentlemen  passed  their  Final  Examination 
and  were  admitted  L.R.C.P.  Edin.  and  L.R.C.S.  Edin. : — 

John  Williams,  Anglesea ;  Asutosh  Mitra,  Calcutta ;  Thomas  Evans 
Franklin,  Carlow ;  Robert  Martin  Fleming,  Suffolk ;  George  James 
Waters  Garnham,  Derbyshire ;  John  Charles  Harris,  Plymouth ;  Alfred 
Bourne,  County  Durham ;  Benjamin  Marshall,  County  Tyrone  ;  Edmond 
Walsh,  Castleterry;  John  Francis  Ryan.  County  Galway  ;  Evans  Jones, 
Cardiganshire  :  George  Brown,  County  Tipperary  ;  John  Albert  Maddox, 
Madras;  Richard  Basil  Morley,  Leeds;  John  Hardman  Cropper, 
Lancashire ;  Edmund  Kemp  Bourne.  Lichfield ;  Robert  Ambrose, 
Newcastle  West;  William  Francis  Miller,  Sydney,  N.S.W.;  Thomas 
Joseph  Patrick  Hartigan,  Aldershot ;  John  Mullin,  Clarinbridge :  Ralph 
Bennett  Sidebottom,  Mottram ;  Ernest  William  Haydon,  Dorsetshire  ; 
James  Edward  Sinclair,  Edinburgh;  James  Malcolm  McKee,  India; 
Arthur  John  Clayton,  Leeds;  James  Hogg,  Lanarkshire;  Mudalitamby 
Eleyatamby,  Ceylon  ;  John  William  Pedroza,  Madras. 

Royal  College  of  Surgeons,  Edinburgh.— During 
the  October  sittings  of  the  examiners  the  following  gentle¬ 
men  passed  their  First  Professional  Examination  :  — 

James  Angus  Higgart,  Malta ;  Robert  Napier  Buist,  India. 

The  following  gentlemen  passed  their  Final  Examination, 
and  were  admitted  Licentiates  of  the  College  : — 

William  Arthur  Shufelt,  Kuowlton;  Edwin  Charles  Warren,  Hamp¬ 
shire;  Thomas  Decimus  Richards.  Cornwall;  Harry  Graham  Smitn, 
Edinburgh  ;  Donald  MacGregor,  Inverness. 

At  the  examination  in  Dental  Surgery,  the  following 
gentleman  passed  his  First  Professional  Examination  ; — 

Ernest  Frank  Cox,  Gloucestershire. 

The  following  gentlemen  passed  their  Final  Examination, 
and  were  admitted  Licentiates  in  Dental  Surgery  :  — 

Edward  Percy  May,  London;  John  Wood,  Dalbeattie;  Ernest  Frank 
Cox,  Gloucestershire. 

Royal  College  of  Surgeons  of  England. — The 
following  gentlemen  passed  their  Primary  Examinations  in 


Anatomy  and  Physiology  at  a  meeting  of  the  Board  of 
Examiners  on  the  8th  inst.,  and  when  eligible  will  be 
admitted  to  the  Pass  Examination,  viz. : — 

Adye,  W.  J.  A.,  student  of  St.  Thomas’s  Hospital. 

Barr,  G.  A.,  of  St.  George’s  Hospital. 

Clarke,  G.  8.,  of  St.  George’s  Hospital. 

Cosens,  W.  B.,  of  the  London  Hospital. 

Dwyer,  H.  de  B.,  of  St.  George’s  Hospital. 

Ewens,  G.  F.  W.,  of  King’s  College  Hospital. 

Ford,  T.  A.  V.,  of  St.  Thomas’s  Hospital. 

Owen,  A.  D.,  of  the  London  Hospital. 

Potts,  F.  R.  H.,  of  Guy’s  Hospital. 

Shadwell,  B.,  of  St.  Bartholomew’s  Hospital. 

Shopoff,  P.  I.,  of  St.  Mary’s  Hospital. 

Sparrow,  J.  E.  P.,  of  King’s  College  Hospital. 

Stacey,  J.  H.,  of  St.  Thomas’s  Hospital. 

Wakeham,  C.  H. ,  of  the  London  Hospital. 

Ward,  S.  E.,  of  St.  Bartholomew’s  Hospital. 

Williams,  G.  R.,  of  St.  Bartholomew’s  Hospital. 

Six  candidates  were  referred  for  three  months.  Of  the 
ninety-four  candidates  who  presented  themselves  for  the 
Primary  Examination,  twenty-eight,  having  failed  to  acquit 
themselves  to  the  satisfaction  of  the  Board  of  Examiners, 
were  referred  to  their  anatomical  and  physiological  studies 
for  three  months,  and  three  for  six  months.  At  the  corre¬ 
sponding  period  last  year  there  were  ninety  candidates  ,- 
sixty-seven  passed,  twenty-two  were  referred  for  three 
months,  and  one  for  six  months. 

The  following  gentlemen,  having  undergone  the  necessary 
examinations  for  the  diploma,  were  admitted  Members  of 
the  College  at  a  meeting  of  the  Court  of  Examiners  on  the 
12th  inst.,  viz. : — 

Alexander,  T.  G.,  M.B.  Glasg.,  Glasgow,  student  of  the  University  of 
Glasgow. 

Barry,  F.  D.  C.,  L.K.&Q..C.P.  Ire.,  Liverpool,  of  the  Liverpool  School. 
Blower,  B.,  L.R.C.P.  Lond.,  Liverpool,  of  the  Liverpool  School. 

Carden,  G.  S.,  M.B.  Edin.,  Bath,  of  the  University  of  Edinburgh.; 

Davies,  H.  A.  B.,  L.R.C.P.  Edin.,  Swansea,  of  Guy’s  Hospital. 

Ellis,  S.,  L.S.A.,  Arundel,  of  King’s  College  Hospital. 

Faulkner,  H.,  L.R.C.P.  Edin.,  Teddington,  of  University  College  Hospital. 
Fenwick,  H.  M.,  L.R.C.P.  Edin.,  Newcastle,  of  the  Newcastle-on-Tyne 
School. 

Giddings,  R.  R..  M.B.  Edin.,  Edinburgh,  of  the  University  of  Edinburgh. 
Gilbertson,  J.  H.,  Hertford,  of  St.  Bartholomew’s  Hospital. 

Hunt,  A.  H.,  L.S.A.,  Birmingham,  of  the  Birmingham  School. 
Hutchinson,  J.  A.,  M.B.  Durh.,  Stockton-on-Tees,  of  the  Newcastle  on- 
Tyne  School.  — 

Johnston,  M.,  L.R.C.P.  Edin.,  Bedford,  of  St.  Bartholomew’s  Hospital. 
Lawrence,  S.  E.,  L.R.C.P.  Lend.,  of  the  Bournemouth  School. 

Lockwood,  H.,  L.S,  A.,  Sheffield,  of  King’s  College  Hospital. 

Macfadyen,  A.,  M.B.  Edin.,  Portobello,  N.B.,  of  the  University  of  Edin¬ 
burgh. 

Manders,  N.,  L.R.C.P.  Lond.,  Marlborough,  of  St.  Mary’s  Hospital. 
Ranson,  W.  E..  L.S.A.,  Stafford,  of  the  Birmingham  School. 

Reid,  G.  M.,  M.D.  Edin.,  Melbourne,  of  the  University  of  Edinburgh. 
Stafford,  W.,  M.B.  Glasg.,  Glasgow,  of  the  University  of  Glasgow. 

Whyte,  J.  M.,  M.B.  Edin.,  Nairn, §N. B. ,  of  the  University  of  Edinburgh. 
Wigmore,  F.  H.,  L.S. A.,  Eccleston-street,  S.W.,  of  St.  Bartholomew’s 
Hospital. 

Wilson,  J.  G.,  L.S. A.,  Monmouth,  of  St.  Bartholomew’s  Hospital. 

One  gentleman  was  approved  in  Surgery,  and  when  qualified 
in  Medicine  will  be  admitted  a  Member  of  the  College  ;  and 
ten  candidates,  having  failed  to  acquit  themselves  to  the 
satisfaction  of  the  Court  of  Examiners,  were  referred  to 
their  professional  studies  for  six  months,  including  one  who 
had  an  additional  three  months.  The  following  gentlemen 
passed  on  the  13th  inst.,  viz.  : — 

Blaxland,  W.,  L.R.C.P.  Lond.,  Sydney,  N.S.W. ,  student  of  the  London. 
Hospital. 

Brown,  J.  H.,  M.B.  Edin.,  Whitby,  of  the  Edinburgh  School. 

Cotton,  J.  M.,  M.B.  Toronto,  Toronto,  of  the  Toronto  School. 

Edmunds,  D.  P.,  L.R.C.P.  Edin.,  Cranbrook,  Kent,  of  Guy’s  Hospital. 
Graham,  G.  H  .L.S.A.,  Anerley,  S.E.,  of  Guy’s  Hospital. 

Hooper,  H.W.,  L.R.C.P.  Lond.,  Sevenoaks,  of  St.  Bartholomew’s  Hospital. 
Moor,  H.  W.,  L.R.C.P.  Edin  ,  Brighton,  of  Guy’s  Hospital. 

Mukerji,  U.  N.,  M.B.  Edin.,  Calcutta,  of  the  Edinburgh  School. 

Rook,  A.  E.,  L.R.C.P.  Lond.,  Forest  Hill,  of  the  Middlesex  Hospital. 
Smith,  M.,  L.R.C.P.  Edin.,  Weston-super-Mare,  of  St.  Bartholomew’s 
Hospital. 

Steedman,  J.  F.,  L  S.A.,  Wellington,  Salop,  of  St.  Bartholomew’s  Hospital. 
Tomson,  W.  B.,  M.B.  Durh.,  Luton,  Beds,  of  St.  Thomas’s  Hospital. 
Turner,  N.  H.,  Redcliffe-gardens,  of  King’s  College  Hospital. 

Vassie,  R.,  M.B.  Edin.,  Lanark,  of  the  Edinburgh  School. 

Williams,  M.  H.,  L.S.  A.,  Tunbridge  Wells,  of  the  Middlesex  Hospital. 
Wood,  J.  W.  A.,  L.R.C.P.  Edin.,  Manchester,  of  the  Manchester  School. 

Seven  gentlemen  were  approved  in  Surgery,  and  when  quali¬ 
fied  in  Medicine  will  be  admitted  Members  of  the  College ; 
and  ten  candidates,  having  failed  to  acquit  themselves  to 
the  satisfaction  of  the  Court  of  Examiners,  were  referred  to 
their  professional  studies — seven  for  six,  two  for  three,  and 
one  for  nine  months.  The  following  gentlemen  passed  on 
the  14th  inst.,  viz.  : — 

Carmichael,  W.,  B.A.  Lond.,  Manchester,  student  of  the  Manchester 
School. 

Crawshaw,  S.,  Wigan,  of  the  Manchester  School. 

Edsall,  S.  B.  A.,  Brixton-road,  of  Guy’s  Hospital. 


Medical  Times  and  Gazette. 


MEDICAL  NEWS, 


Nov.  17,  1883. 


Jefferis,  J.  E.,  Sydney,  N.S.W.,  student  of  University  College  Hospital. 
Salvage,  J.  V.,  Lower  Norwood,  of  Guy’s  Hospital. 

Stevens.  P.  R.,  Biggleswade,  of  St.  George’s  Hospital. 

Swain,  J.,  Mel  bourne-square,  S.W.,  of  the  Westminster  Hospital. 

Syree,  A.  H.,  Canterbury,  of  King’s  College  Hospital. 

Townsend,  S.  A.,  Burleigh-street,  of  St.  Bartholomew’s  Hospital. 

Walker,  C.  P.,  Blackheath,  of  Guy’s  Hospital. 

Eight  candidates  who  passed  in  Surgery  at  previous  meet¬ 
ings  of  the  Court,  having  subsequently  obtained  medical 
qualifications,  were  admitted  Members,  viz. : — 

Greenwood,  C.  D.,  L.S.A.,  Clapham,  student  of  King’s  College  Hospital. 
Howard,  W.,  L.R.C.P.  Edin.,  Littlepool,  of  Guy’s  Hospital. 

Irving,  D.  B.,  L.B.C.P.  Lond.,  Lockerbie,  N.B.,  of  St.  Thomas’s  Hospital. 
Knaggs,  B.  L.,  L.B.C.P.  Lond.,  Putney,  of  Guy’s  Hospital. 

Leaver,  C.  B.,  L.B.C.P.  Lond.,  Bayswater,  of  St.  Bartholomew’s  Hospital. 
Milner,  S.  G.,  L.B.C.P.  Edin.,  Dulwich  Wood,  of  St.  Bartholomew’s 
Hospital. 

Naylor,  J.  H.,  L.B.C.P.  Edin.,  Drighlinton,  of  the  Leeds  School. 
Nunnerley,  P.  J.,  L.B.C.P.  Lond.,  Powis-street,  W.,  of  University  College 
Hospital. 

Three  candidates  passed  in  Surgery ;  ten  were  referred  for 
six  months,  and  three  for  three  months. 


Apothecaries’  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday, 
November  8 : — 

Ellis,  Sidney,  Brecknock-road,  N.W. 

Hasell,  Edward  Suter,  Spring  Grove,  Isleworth. 

Long,  John  William  Francis,  Stamford-street,  S.E. 

Mackay,  Henry,  Normanton-road,  Derby. 


APPOINTMENTS. 

Benson,  Arthur,  M.B.,  F.B.C.S. I.— Ophthalmologist  to  the  City  of  Dublin 
Hospital,  vice  the  late  Dr.  Loftie  Stoney. 

Duncan,  W.  A.,  M.D.,  M.B.C.P.  Lond.,  F.B.C.S. — Obstetric  Physician  to 
the  Boyal  Hospital  for  Children  and  Women,  Waterloo-bridge-road,  S.E. 

Maciver,  Francis  A.,  M.B.,  C.M.— Medical  Officer  to  the  Edinburgh 
Provident  Dispensary. 

Malcolm, fW,  A.,  M.B.  Edin.— House-Surgeon  to  the  Ayr  County  Hospital, 
vice  C.  C.  Scott,  M.B.  Edin.,  resigned. 

Pointon,  James,  L.B.C.P.  Lond.,  M.B.C.S.— Honorary  Medical  Officer 
to  the  North  Dispensary,  Liverpool. 

Bichardson.  H.  E.,  L.B.C.P.,  L.B.C.S.— Junior  House-Surgeon  to  the 
Borough  Hospital,  Birkenhead,  vice  Charles  S.  Brewer,  L.B.C.P.,  etc., 
resigned. 

Turner,  Nathaniel  Henry,  M.E.C.S.E.— Ophthalmic  Clinical  Assistant 
to  King’s  College  Hospital. 

Troup,  Francis,  M.D.  St.  And.,  L.R.C.S.  Edin.— Medical  Officer  to  the 
Edinburgh  Provident  Dispensary. 


MARRIAGES. 

Tibbits— Bussell.— Bowman— Dowell.— OnNovember  10,  at  St.  George’s, 
Hanover-square,  by  the  Bev.  W.  H.  L.  Gilbert,  M.A.,  assisted  by  the 
Bev.E.  Capel-Cure,  M.A.,  rector  of  St.  George’s,  Herbert  Tibbits,  M.D., 
F.R.C.P.E.,  of  Wimpole-street  and  Highgate,  to  Arabella,  widow  of  the 
late  Aubrey  Bussell,  and  eldest  daughter  of  Charles  Dowell ;  and  at  the 
same  time  and  place,  William  Bowman,  of  Lea-road,  Blackheath,  and 
Cullum-street,  City,  to  Florence  Louisa,  youngest  daughter  of  the  above- 
named  Charles  Dowell.  (Indian  and  West  Indian  papers  please  copy.) 


DEATHS. 

Brown,  Charles  Robert,  M.D.,  at  3,  Hartfield-terrace,  Eastbourne,  on 
November  10,  aged  37. 

Hewson,  John  Dale,  M.D. ,  at  Coton  Hill,  Stafford,  onNovember  10 
aged  66.  ’ 

Kain.  William, M. A.,  L.B.C.P.,  at  Kingston-on-Thames,  on  November4 
aged  72.  j 

Orhe,  Campbell,  M.R.C.S.,  of  Bedford  Park,  London,  on  board  Boyal 
Mail  ss.  Minho ,  off  Bio,  on  October  7,  aged  41. 

-Scatliff,  John  Parr,  M.D.,  M.R.C.8.,  formerly  of  Sloane- street,  at 
Macaulay  House,  Clapham,  on  November  6. 

Sims,  J.  Marion,  M.D.,  at  New  York,  on  November  13. 


VACANCIES. 

•Combe  Hospital,  Dublin.— Master.  Applications  to  be  forwarded  on  or 
before  December  13. 

•General  Infirmary,  Northampton. — Assistant  House-Surgeon.  {For 
particulars  see  Advertisement.) 

Great  Northern  Hospital,  Caledonian-road,  N.—  House-Surgeon. 
[For  particulars  see  Advertisement.) 

Hospital  for  Sick  Children,  49,  Great  Ormond-street,  W.C.— Surgeon. 
C For  particulars  see  Advertisement.) 

London  Lock  Hospital  and  Asylum,  Westbourne-green,  Harrow-road, 
W.— House-Surgeon  in  the  Female  Department.  Salary  £100  per  annum. 
Applications,  with  testimonials,  to  be  sent  to  the  Secretary  by  Novem¬ 
ber  24. 

Teignmouth,  Dawlish,  and  Newton  Infirmary  and  Convalescent 
Home. -House-Surgeon  and  Dispenser.  Salary  £71  per  annum,  with 
board  and  lodging.  Candidates  must  be  registered  as  possessing  both 
medical  and  surgical  qualifications,  and  be  unmarried.  Testimonials  of 
moral  character  and  professional  ability  to  be  sent  to  the  Secretary  on 
or  before  November  20. 


Queen’s  Hospital,  Birmingham. —  Honorary  Physician.  Candidates 
must  be  graduates  in  medicine  of  a  University,  and  he  Fellows  or 
Members  of  the  Royal  College  of  Physicians  of  London,  or  Fellows  of 
the  King  and  Queen’s  College  of  Physicians,  Ireland,  or  Fellows  of  the 
Boyal  College  of  Physicians,  Edinburgh.  The  successful  candidate  is 
prohibited  (from  engaging  in  the  practice  of  midwifery,  pharmacy,  or 
surgery  after  his  appointment.  Applications,  testimonials,  and  certi¬ 
ficate  of  registration  to  be  sent  under  cover  to  the  Secretary  (from 
whom  all  further  information  may  be  obtained)  on  or  before  Nov.  26. 

Boyal  Free  Hospital,  Gray’s-inn-road,  W.C. — Assistant-Surgeon. 
[For  particulars  see  Advertisement.) 


UNION  AND  PAROCHIAL  MEDICAL  SERVICE. 

***  The  area  of  each  district  is  stated  in  acres.  The  population  is 
computed  according  to  the  census  of  1881. 

RESIGNATIONS. 

Aysgarth  Union. — Dr.  James  Boss  has  resigned  the  Higher  District :  area 
50,064 ;  population  3196  ;  salary  £40  per  annum. 

Ohapel-en-le-  Frith  Union. — Mr.  Frederick  Stedman  has  resigned  the 
Castleton  District :  area  39,231  ;  population  2463;  salary  £25  per  annum. 

Redruth  Union. — The  office  of  Medical  Officer  for  the  Redruth  District  is 
vacant  by  the  death  of  Mr.  B.  S,  Hudson  :  area  4006  ;  population  9335  ; 
salary  £40  per  annum. 

Sedbregh  Union. — Mr.  Robert  Nunan  has  resigned  the  Dent  District  : 
area  19,603 :  population  1209 ;  salary  £20  per  annum. 

Wangford  Union.— The  Bungay  District  is  vacant  by  the  death  of  Mr. 
Joshua  King  Womersley:  area  15,384;  population  5852;  salary  £90  per 
annum. 

APPOINTMENTS. 

Atcham  Union. — Thomas  C.  Lawson,  M.R.C.S.  Eng.,  L.S.A.,  to  the 
Alberbury  District. 

Bedminster  Union. — William  B.  Edmond,  M.B.C.S.  Eng.,  L.B.C.P.  Edin., 
M.B.  and  M.C.  Edin.,  to  the  Fourth  District. 

Bridport  Union. — William  H.  Kerhey,  M.R.C.S.,  L.S.A.,  to  the  Fifth 
District. 

Denbigh. — William  F.  Lowe,  F.C.S.,  as  second  Analyst  for  the  county. 

Ellesmere  Union.— Cecil  A.  Corke,  F.F.P.&S.  Glasg.,  L.R.C.P.  Edin., 
L.S.A.  Lond.,  to  the  Middle  District. 

Faversham  Union. — Charles  Donkin,  L.B.C.P.  Edin.,  L.F.P.&S.  Glasg., 
to  the  Third  District. 

Hemel  Hempstead  Union. — George  F.  Phillpot,  M.B.C.S.  Eng.,  L.B.C.P. 
Edin. ,  to  the  Boxmoor  District. 

Middlesbrough  Union. — Samuel  Bateman,  M.D.  and  M.C.  Queen’s  Univ. 
Ire.,  to  the  First  District. 


Admiralty  Appointments. — The  following  appoint¬ 
ments  were  made  at  the  Admiralty  on  Saturday :  —  Gerald 
Molloy,  Eleet-Surgeon,  to  Malta  Dockyard,  vice  Lawrenson, 
deceased;  Maxwell  Rodgers,  M.D.,  Fleet- Surgeon,  to  the 
Plymouth  Division,  Royal  Marines ;  Stephen  Sweetnam, 
Eleet-Surgeon,  to  the  Monarch,  vice  Rodgers;  George  H. 
Madeley,  Staff-Surgeon,  to  the  Defence,  vice  Sweetnam. 

A  New  Conjoint  Examination  Scheme  fob  Ire¬ 
land. — At  the  last  meeting  of  the  President  and  Council  of 
the  Royal  College  of  Surgeons  in  Ireland,  the  following- 
resolution  was  adopted,  viz. : — Resolved,  that  with  a  view 
of  reopening  the  negotiations  for  the  giving  of  a  double 
qualification  by  the  Colleges,  a  Committee  be  appointed  to 
confer  with  the  King  and  Queen’s  College  of  Physicians  on 
this  subject,  and  to  report  to  the  Council  as  to  the  terms 
upon  which  this  can  be  carried  out.  The  Committee  to 
consist  of  the  President,  Vice-President,  Secretary  of  the 
College,  and  Drs.  Kidd,  Barton,  Wharton,  and  Corley.” 
The  College  of  Physicians  were  to  meet  to  consider  the 
question  this  week. 

Hospital  Management. — The  third  meeting  of  the 
Committee  appointed  at  the  recent  Hospital  Conference  was 
held  on  Wednesday,  the  7th  inst.  The  draft  constitution  of 
the  proposed  Hospitals  Association  was  provisionally  adopted, 
and  it  was  ordered  that  copies  should  be  issued  at  once  for 
the  consideration  of  the  governing  bodies,  committees  of 
management,  medical  boards,  and  honorary  medical  officers 
of  the  principal  hospitals.  The  objects  of  the  proposed 
Association  are  to  be — first,  to  facilitate  the  consideration 
and  discussion  of  matters  connected  with  hospital  manage¬ 
ment,  and,  where  advisable,  to  take  measures  to  further  the 
decisions  arrived  at ;  and,  secondly,  to  afford  opportunities 
for  the  acquisition  of  a  knowledge  of  hospital  administra¬ 
tion,  both  lay  and  medical.  The  Association,  moreover,  pro¬ 
poses  to  afford  facilities  for  the  reading,  discussion,  and 
publication  of  approved  papers,  for  the  delivery  of  lectures, 
and  for  the  holding  of  conferences  on  hospital  administra¬ 
tion,  hospital  management,  medical  relief,  medical  educa¬ 
tion  in  relation  to  hospitals,  free  and  provident  dispensaries 
and  other  kindred  subjects  ;  and  will  found  a  library,  con¬ 
sisting  of  works  on  hospital  administration,  finance,  and 
statistics.  The  Committee  will  be  called  together  again  in 
December  to  finally  adopt  the  constitution  of  the  new  Asso¬ 
ciation,  which  has  already  received  wide  and  influential 
support. 


Medical  Times  and  Gazette. 


VITAL  STATISTICS. 


Nov.  17, 1SS3.  591 


VITAL  STATISTICS  OF*  LONDON. 

Week  ending  Saturday,  November  10,  1883. 


NOTES,  QUERIES,  AND  REPLIES. 

- - o - 

$Se  tjjat  qatstinttetjr  matji  «(ihII  learn  mac|r. — Bacon. 


BIRTHS. 

Births  of  Boys,  1289;  Girls,  1228;  Total,  2497. 

Corrected  weekly  average  in  the  10  years  1873-82,  2787 ‘4. 


DEATHS. 


Males. 

Females. 

Total. 

Deaths  during  the  week . 

805 

751 

1556 

Weekly  average  of  the  ten  years  1873-82,  J 
corrected  to  increased  population  ...  j 

834-5 

8469 

1731-4 

Deaths  of  people  aged  80  and  upwards 

... 

... 

60 

DEATHS  IN  SUB-DISTRICTS  FROM  EPIDEMICS. 


nd  „ 

<d  a  cr 
oj  .2  _ 

M 

o 

OQ 

■P  • 

o a 

•9x5 

SS’  . 

0) 

<D 

at 

SPSS’S 

|-32g 

■— H 

OQ 

aJ 

•a  s 

go) 

Abfl 
&  3 

A 

& 

.go  S3 

O)  CL  CD 

A 

B 

o 

A 

!§•  § 

a 

s 

'Qt 

£  ° 

H 

CJ  P-l 

5 

.3 

CQ 

s 

CJ 

p 

W 6St  • •  •  •  •  • 

669633 

3 

10 

3 

5 

6 

1 

5 

North 

905947 

l 

5 

13 

4 

5 

1 

9 

7 

Central 

282238 

... 

5 

6 

1 

1 

... 

3 

East . 

692738 

... 

11 

11 

4 

4 

•  •• 

5 

1 

6 

South . 

1265927 

l 

13 

20 

10 

4 

1 

11 

1 

9 

Total . 

3816483 

2 

37 

60 

22 

19 

2 

34 

3 

27 

METEOROLOGY. 


From  Observations  at  the  Greenwich  Observatory. 


Mean  height  of  barometer  . 

Mean  temperature  . 

Highest  point  of  thermometer 
Lowest  point  of  thermometer 
Mean  dew-point  temperature 

General  direction  of  wind  . 

Whole  amount  of  rain  in  the  week  .. 


29'422  in. 
44-1° 

561° 

33  5° 

40'3° 

S.W. 
l’OO  in. 


BIRTH8  and  DEATHS  Registered  and  METEOROLOGY  during  the 
Week  ending  Saturday,  Nov.  10,  in  the  following  large  Towns 


Cities 

and 

Boroughs 

Estimated  Population  to 
middle  of  the  year  1883. 

Births  Registered  during 
the  week  ending  Nov.  10. 

1  Deaths  Registered  during 

1  the  week  ending  Nov.  10. 

Annual  Rate  of 
Mortality  per  1000  living, 
from  all  causes. 

Temperature 
of  Air  (Fahr.) 

Temp, 
of  Air 
(Cent.) 

Rain 

Fall. 

Highest  during 
the  Week. 

Lowestduring 
the  Week. 

Weekly  Mean  of 
DailyMeanValues 

Weekly  Mean  of 
Daily  Mean 
Values. 

In  Inches. 

In  Centimetres, 

London 

3955814 

2497 

1556 

20-5 

53-1 

33-5 

44-1 

6-73 

1-00 

2-54 

Brighton  ... 

... 

111262 

62 

38 

17-8 

585 

36-0 

44-3 

6'84 

111 

2'82 

Portsmouth 

•  •• 

131478 

95 

35 

13-9 

,, 

Norwich  ... 

... 

89612 

48 

24 

14-0 

.. 

... 

... 

... 

Plymouth  ... 

•  •• 

74977 

54 

22 

153 

56-0 

33-8 

45-4 

744 

1-02 

2-59 

Bristol . 

... 

212779 

141 

92 

22-6 

55-0 

31-8 

44-0 

6-67 

097 

246 

Wolverhampton  . 

77557 

45 

27 

18-2 

50-0 

29-5 

39-6 

4-23 

1-68 

4-01 

Birmingham 

•  •i 

414S46 

263 

158 

19-9 

... 

... 

... 

Leicester  ... 

129483 

84 

45 

18-1 

50-0 

33-5 

41-5 

5-28 

1-47 

373 

Nottingham 

•  •* 

199349 

131 

73 

191 

51-5 

307 

41-2 

511 

147 

373 

Derby . 

... 

85574 

60 

22 

13-4 

... 

... 

•  •• 

•  •• 

Birkenhead 

... 

88700 

47 

32 

18-8 

... 

... 

Liverpool  ... 

... 

566753 

370 

268 

24-7 

52-5 

37-3 

43-8 

6-56 

1-01 

2-67 

Bolton . 

... 

107862 

64 

43 

20-8 

48-6 

31-9 

40-8 

4-89 

1-69 

4-29 

Manchester 

339252 

249 

1S1 

278 

... 

... 

.  .i 

Salford 

190465 

125 

81 

222 

... 

... 

Oldham 

t 

119071 

98 

56 

245 

... 

... 

.  .. 

Blackburn  ... 

... 

108460 

70 

50 

24T 

... 

... 

... 

... 

Preston 

98564 

88 

48 

25  4 

52-0 

35-0 

42-2 

5-67 

1-61 

4-09 

Huddersfield 

84701 

60 

34 

20-9 

... 

Halifax 

75591 

36 

33 

228 

,  . 

Bradford  ... 

204807 

99 

76 

19-4 

51-4 

32-5 

42  2 

5  67 

115 

2-92 

Leeds  . 

321611 

220 

173 

28-1 

58-0 

34-0 

43-2 

6-22 

0-85 

216 

Sheffield 

295497 

226 

114 

20-1 

50-0 

32-0 

41-8 

5-45 

1-31 

3-33 

Hull  . 

176296 

125 

83 

24-6 

51-0 

31-0 

41-3 

6-17 

0-80 

2-03 

Sunderland 

121117 

91 

52 

22-4 

... 

... 

... 

... 

... 

Newcastle  ... 

149464 

106 

90 

31-4 

,,, 

... 

... 

Cardiff . 

90033 

71 

41 

238 

... 

... 

... 

... 

... 

... 

For  28  towns 

... 

6620975 

5625 

3547 

21-5 

685 

29-5 

42-5 

5-84 

1-22 

310 

Edinburgh ... 

... 

235946 

133 

100 

221 

52-9 

29-4 

41 T 

5-06 

0-60 

1-52 

Glasgow 

515589 

354 

230 

23-3 

59-5 

29-0 

46-5 

8-06  i 

1-52 

386 

Dublin . 

...1 

349185 

1661 

173! 

25-8 

52-6! 31-3 

4C4 

5-22 

113 

2-87 

At  the  Royal  Observatory,  Greenwich,  the  mean  reading 
of  the  barometer  last  week  was  29-42  in. ;  the  highest  reading 
was  29-93  in.  at  the  beginning  of  the  week,  and  the  lowest 
28’80  in.  on  Tuesday  morning. 


The  Rogers  Testimonial. 

The  following  is  the  third  list  of  subscriptions : — Morell  Mackenzie, 
Esq.,  M.D.,  £5  5s. ;  Septimus  Sibley,  Esq.,  F.R.C.S.,  7,  Harley-street. 
£1  Is. ;  G.  G.  Whitwell,  Esq.,  M.B.  Coll.  Edin.,  £1  Is.  ;  Alfred  Carpenter, 
Esq.,  M.D.,  Croydon,  £1  Is. ;  Douglas  M.  Ross.  Esq.,  M.B.,  9,  Pavilion- 
parade,  Brighton,  £1  is. ;  Dr.  Haward,  9,  Harley-street,  £1  Is.  ;  J. 
Grosvenor  Mackinlay,  Esq.,  16,  Stratford-place,  £1  Is.  ;  J.  Murray 
Lindsay.  M.D.,  Mickleover,  Derby,  £1  Is.  ;  Thomas  Johnston,  Esq.,. 
Belper,  £1  Is. ;  J.  R.  White,  Esq.,  Kelvedon  Hatch,  Brentwood,  10s.  6d.  ; 
C.  T.  Aveling,  Esq.,  M.D.,  Lower  Clapton,  £1  Is. 

The  Boast  Fcnd. 

TO  THE  EDITOR  OP  THE  MEDICAL  TIMES  AND  GAZETTE. 

Sir, — Kindly  acknowledge  the  following  additional  subscriptions  to  the- 
above  fund:-C.  E.  Winckworth,  Esq.,  Shefford,  Bedfordshire,  £1  Is. ; 
Bootle  X.  L.  and  L.  X.,  lid. ;  A.  Potts,  Esq.,  Attleborough,  £1  Is.  ;  Dr. 
Bull,  Hereford,  £1  Is.  ;  Dr.  C.  Aldridge,  Plympton,  10s.  6d.  ;  J.  Wilcoeks,. 
Esq.,  Sylch  House,  Burslem,  10s.  6d. ;  G.,  £1 ;  L.  Lewis.  Esq  ,  Plymouth,. 
5s.  I  am,  &c., 

1,  St.  George’s-terrace,  Plymouth,  Nov.  13.  George  Jackson. 

A  Novel  Suggestion. 

TO  THE  EDITOR  OP  THE  MEDICAL  TIMES  AND  GAZETTE. 

Sir,— In  the  course  of  one’s  midwifery  practice,  cases  occur  in  which 
the  relative  proportions  between  the  size  of  the  fcetal  head  and  the- 
passages  of  the  pelvis  are  such  that,  after  patient  trial  with  the  forceps  or 
attempts  to  turn,  you  are  obliged  to  reduce  the  size  of  the  head  before  the- 
child  can  be  delivered,  i.e.,  by  craniotomy. 

In  performing  this  operation  you  are  advised,  after  perforation,  to  pass 
the  instrument  up  to  the  base  of  the  brain,  that  in  case  the  child  be  living- 
all  traces  of  previously  existing  life  be  destroyed,  so  as  not  to  shock  the- 
friends  by  the  birth  of  a  living  child  with  practically  a  compound  fracture 
of  the  skull,  and  usually  loss  of  brain-substance. 

But  I  would  ask,  are  we  always  justified  in  this  course  ?  Having  pro¬ 
perly  explained  the  state  of  the  case  to  the  friends,  would  it  not  be  possible, 
in  cases  of  minor  disproportion  (the  first  in  Barnes’s  division),  to  favour 
the  birth  of  a  living  child,  and  subsequently  to  treat  the  injury  to  the- 
skull  as  you  would  an  ordinary  case  of  surgery  ?  Surely  we  do  not  con¬ 
sider  a  corresponding  injury  to  the  living  as  hopeless,  nor  do  such  injuries 
of  necessity  lead  to  permanent  impairment  of  the  functions  of  the  brain. 

Never  having  read  of  the  attempt  to  save  life  after  craniotomy,  I  should 
like  to  suggest  that  the  trial  should  be  made  in  a  favourable  case  where- 
the  child  should  be  living,  and  where  the  friends  have  previously  acquiesced 
to  assist  you  in  your  endeavours  to  save  another  life,  when  that  of  the 
mother’s  has  been  rescued  by  the  delivery  by  art,  which  nature  could  not- 
effect  unaided.  I  am,  &e., 

Salisbury,  October.  W.  D.  Wilkes. 

A  Plea  for  Magnanimity. 

TO  THE  EDITOR  OF  THE  MEDICAL  TIMES  AND  GAZETTE. 

Sir,— As  you  were  so  good  as  to  insert  my  former  letter,  I  will  trouble  yous 
with  another,  but  on  a  different  subject.  It  is  a  subject  indeed  that  must 
have  been  in  every  doctor’s  mind  this  last  week.  I  wonder  how  many  of 
us  -  hundreds  perhaps — were  greeted  as  I  was  on  that  unlucky  Friday, 
when  the  Standard  lighted  on  that  unfortunate  paper  in  the  Lancet,— were 
greeted  by  their  patients  with  a  distrustful  look  or  a  mocking  laugh, 
while  the  index  finger  of  scorn  or  triumph  sought  a  letter  and  the  leader 
in  the  crumpled  morning  paper.  I  have  long  retired  from  active  practice, 
but  am  still  able  to  hobble  round  to  a  few  old  patients,  who  cling  to  me 
for  old  times’  sake.  Among  them  are  a  philanthropical  clergyman  and 
his  wife,  both  with  hair  as  white  with  the  snows  of  age  as  my  own. 
Often  have  I  discussed  with  them  the  vivisection  question,  and  upheld  the 
honour  and  humanity  of  my  craft  stoutly  against  all  their  gentle  argu¬ 
ments.  With  a  clear  conscience  I  have  contended  that  the  pursuit  of 
scientific  truth  by  the  method  of  experiment  on  living  creatures  can  have 
no  hardening  effect  on  the  investigator,  but  rather  that  it  softens  his  whole 
moral  being,  and  suffers  it  not  to  be  cruel.  With  a  clear  conscience  I 
have  argued,  with  Bishop  Butler,  that  the  sight  and  even  the  causation 
of  suffering  for  a  worthy  end,  though  it  may  lessen  the  passive  habits  of 
sympathy,  lends  increase  to  the  active  habit  of  helpfulness.  And  when, 
my  friends  have  expressed  a  fear  that  the  experiments  on  living  animals 
may  so  harden  the  investigator’s  sensibilities  that  he  will  transfer  his  ex¬ 
perimental  activity  from  the  physiological  laboratory  to  the  hospital  out¬ 
patient-room,  I  have  pointed  with  a  confident  pride  to  the  noble,  sympa¬ 
thetic,  self-sacrificing  toil  that  is  daily  undertaken  by  hundreds  of  hospital 
doctors,  with  seldom  a  word  of  complaint  from  the  patients.  Sir,  I  can 
boast  no  longer,  and  when  my  friends  point  out  that  what  has  been 
admittedly  done  by  two  members  of  my  profession  may  quite  likely  be 
daily  done  by  hundreds,  I  can  find  no  counter-argument  but  in  my  own 
faith  in  the  rectitude  of  my  fellow-practitioners.  It  is  a  false  and 
humiliating  position  to  be  placed  in,  and  it  has  fallen  to  all  of  us.  But 
my  object  in  writing  to  you  is  to  warn  my  brethren  against  bearing  too- 
hardly  on  those  who  have  brought  discredit  on  us.  One  of  them  at  least- 
is  young,  and  may  be  excused  on  the  score  of  youthful  indiscretion  and 
an  insufficient  appreciation  of  his  responsibilities,  which  the  lapse  of  time 
and  this  terrible  lesson  will  effectually  cure.  Let  us  forgive  him  for  the 
wrong  he  has  done  to  all  of  us.  When  I  think  of  it,  the  words  of  Newton 
rise  to  my  mind,  “  Diamond  !  Diamond  !  thou  little  knowest  the  mischief 
thou  hast  done.”  I  am,  &c., 

November  13.  A  Practitioner  of  Fifty  Years’  Standing. 

A  Double  Artesian  Well.— Selina  has  an  artesian  well  from  which  two- 
separate  streams  of  water  of  entirely  different  properties  flow.  This 
effect  is  produced  by  the  insertion  of  a  two-inch  pipe  within  a  four-inch 
tube.  The  large  pipe  descends  4C0  feet ;  the  water  has  no  mineral 
qualities,  and  is  very  cold.  The  inner  pipe  descends  700  feet ;  the  water 
is  strongly  impregnated  with  sulphur  and  iron,  and,  compared  with  the 
temperature  of  the  twin  stream,  is  quite  warm. 


592 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES. 


Nov.  17,  1883. 


Covetousness.— The  almost  criminal  selfishness  of  a  single  individual  exem¬ 
plifies  how  the  attempts  at  suppression  of  an  epidemic  disease,  after 
great  expense  incurred  by  the  sanitary  authority,  may  be  frustrated. 
At  Bradnineh,  Devonshire,  an  epidemic  of  small-pox  has  prevailed  for 
some  time.  A  man  whose  daughter  died  of  the  disease  assured  the 
sanitary  inspector  that  he  had  destroyed  the  bedding  and  his  daughter’s 
clothes.  It  was,  however,  subsequently  discovered  that  he  had  sold 
them  to  a  rag-dealer  of  Exeter,  who  resold  them  to  another  dealer  in  a 
larger  way  of  business.  Thus  the  neighbourhood  was  endangered  with 
the  risk  of  the  disease  extending.  A  magisterial  inquiry  into  the  cir¬ 
cumstances  of  the  case  resulted  in  a  fine  of  50s.  upon  the  father  of  the 
girl,  and  a  similar  penalty  on  the  dealer  who  purchased  from  him. 

dilapidated  Water- Fittings. — The  summons  taken  out  by  the  East  London 
Waterworks  Company  against  the  owner  of  certain  property  in  Salter- 
street,  St.  George’s-in-the-East,  for  permitting  the  fittings  on  his 
premises  to  be  out  of  repair,  and  thereby  causing  a  waste  of  water,  has 
been  heard  by  the  magistrate.  The  defendant  urged  that  he  was  not 
aware  of  the  condition  of  the  fittings,  and  that  he  ordered  repairs  to  be 
made  as  soon  as  possible  afterwards.  The  magistrate,  however,  reminded 
Turn  that  he  had  allowed  eight  days  to  elapse.  A  fine  of  20s.  and  the 
-costs  of  the  summons  was  inflicted.  Unlike  the  usual  arbitrary  action 
of  water  companies,  these  proceedings  seem  to  have  been  taken  from 
unselfish,  considerate  motives  ;  to  avert,  indeed,  cutting  off  of  the  water- 
supply— an  alternative  which  would  obviously  have  caused  great  incon¬ 
venience,  suffering,  and  probably  disease,  in  a  crowded  neighbourhood. 
Tt  appeared  that  in  this  particular  locality  the  water  company  had  had 
numerous  complaints  of  waste  of  water  lately,  and  they  deemed  it  neces¬ 
sary  to  make  an  example  of  the  defendant,  who  is  a  property-owner,  as  a 
•warning  to  others. 

Surgical  Examinations. — The  following  were  the  questions  on  Surgical 
Anatomy  and  the  Principles  and  Practice  of  Surgery  submitted  to  the 
candidates  at  the  final  examination  for  the  diploma  of  Member  of  the 
Royal  College  of  Surgeons  on  the  9th  inst.,  when  they  were  required  to 
.answer  at  least  four  questions,  including  one  of  the  first  two  (from 
1.30  to  4.30  p.m.),  viz.  : — 1.  Give  the  course,  relations,  and  branches 
•of  that  part  of  the  radial  artery  which  lies  between  the  styloid  process 
of  the  radius  and  the  palm  of  the  hand.  2.  Mention  in  order  the 
several  parts  whose  condition  may  be  ascertained  by  digital  exami¬ 
nation  per  rectum  in  both  sexes.  3.  A  child,  aged  three,  attempted  to 
swallow  some  boiling  water  ;  this  proved  fatal  in  five  hours.  In  such  a 
case  describe  the  symptoms  and  the  appearances  after  death.  4.  Men¬ 
tion  the  several  courses  which  an  abscess  may  pursue,  and  the  circum¬ 
stances  which  determine  them.  5.  What  are  the  disorders  of  the  eye 
which  occur  in  inherited  syphilis  ?  Describe  the  symptoms  of  each. 
6.  State  the  causes  of  epistaxis,  and  describe  the  appropriate  treatment  in 
each  case.— The  following  were  the  questions  on  Midwifery  and  Diseases 
of  Women  submitted  to  the  candidates  on  the  following  day,  when  they 
were  required  to  answer  three  out  of  the  four  questions  from  12.31  to 
2  o’clock  p.m.,  viz.  1.  Describe  the  long  forceps,  and  specify  its  advan¬ 
tage  over  the  short  forceps.  2.  What  are  the  dangers  arising  from 
implantation  of  the  placenta  on  the  lower  segment  of  the  uterus,  and 
.how  would  you  combat  them  ?  3.  What  are  the  conditions  especially 
apt  to  cause  pyrexia  during  the  puerperal  state,  and  how  would  you 
■distinguish  between  them  ?  4.  You  are  consulted  by  a  patient  who  has 
a  swelling  rising  out  of  the  pelvis,  and  reaching  halfway  between  the 
pubes  and  umbilicus.  What  might  such  a  tumour  be,  and  how  would 
you  ascertain  its  nature? -The  following  were  the  questions  on  the 
Principles  and  Practice  of  Medicine  on  the  same  day,  from  2.30  to  4.30 
p.m.,  when  they  were  required  to  answer  three  out  of  the  four  questions^ 
including  No.  4,  viz. 1.  What  are  the  signs,  symptoms,  causes,  pro¬ 
gnosis,  diagnosis,  and  treatment  of  facial  neuralgia  and  sciatica  1  How 
do  you  discover  and  treat  an  empyema  of  the  right  pleural  cavity  ? 
•'3.  What  are  the  signs  and  treatment  of  hydatid  disease  of  the  liver  1 
4.  Give  the  composition  and  doses  of  the  pharmacopoeial  pills  which  are 
•aperient.  (The  names  of  the  successful  candidates  appear  on  another 
page.) 

COMMUNICATIONS  have  been  received  from — 

Messrs.  Collier,  Walthamstow;  Mr.  E.  L.  Hussey,  Oxford ;  Messrs. 
D.  Appleton  and  Co.,  New  York  ;  Mr.  Edmund  Gubney, London  ;  The 
Secbetaey  of  the  Apothecaries’  Society,  London ;  The  Registrar- 
Genebal  fob  Scotland,  Edinburgh ;  The  Sanitary  Commissioner 
fop.  the  Punjaub,  Lahore ;  The  Registrar-General  fob  Ireland, 
Dublin ;  Dr.  Heywood  Smith,  London ;  Dr.  Herman,  London ;  Mr. 
Recheb,  London ;  Dr.  Norris  Wolfenden,  London;  Dr.  Alexander, 
Liverpool ;  Dr.  C.  Browne,  London  ;  The  Secretary  of  the  Parkes 
Museum,  London ;  Dr.  W.  H.  Barlow,  Manchester ;  The  Registrar- 
General  for  Queensland;  Di .  Meyners  Estrey,  Paris ;  The  Secre¬ 
tary  of  the  Sanitary  Institute  of  Great  Britain,  London ;  Mr. 
W.  D.  Wilkes,  Salisbury;  Mr.  J.  Chatto,  London ;  The  Secretary 
of  the  Royal  Microscopical  Society,  London ;  Dr.  Thomson, 
•Glasgow ;  The  Editor  of  the  “  Sanitary  Engineer,”  London ;  Mr. 
Mi  rk  H.  Judge.  London ;  Dr.  J.  N.  Vinen,  London ;  Dr.  J.  W.Moore, 
Dublin;  Dr.  J.  Mortimer  Granville,  London;  The  Hon.  Secretary 
of  the  Medical  Society  of  London  ;  Mr.  T.  M.  Stone,  Wimbledon; 
Dr.  Clifford  Beale,  London ;  Dr.  B.  Kelly,  Bermondsey ;  Mr.  C.B. 
Keetley,  London ;  The  Hon.  Secretary-  of  the  Hutchinson  Testi¬ 
monial  Pund,  London;  Mr.  G.  Meadows,  Hastings  ;  The  Secretary 
of  the  Clinical  Society  of  London;  The  Hon.  Secretary  of  the 
Medical  Society  of  Charing-Cross  Hospital,  London ;  Mr.  Wickham 
Barnes,  London ;  Dr.  Althaus,  London  ;  Mr.  G.  Jackson,  Plymouth ; 
Mr.  J.  G.  Kiernad,  Chicago. 


BOOKS.  ETC..  RECEIVED  - 

Hints  in  Sickness,  by  Henry  C.  Burdett— Habitual  Drunkards  Act,  by 
Samuel  Knaggs,  M.R.C.8. — Annual  Report  on  the  Parish  of  Padding¬ 
ton  for  :1882— Sabbatsbergs  Sjukhus  i  Stockholm  for  1882— Ueber  die 
diagnostische  und  prognostische  Bedeutung  der  Tuberkelbacillen  im 
Auswurfe,  von  Dr.  M.  Heitler— The  History  of  the  Year — Materia 
Medica  and  Therapeutics,  by  Roberts  Bartholow,  M.A.,  M.D.,  etc. — 
Report  on  the  Health,  Sanitary  Condition,  etc.,  of  Kensington,  October 
7  to  November  3— The  Employers’  Liability  Act  (1880),  by  R.  Dacre 
Fox,  F.R.C.S. — Statistical  Tables  of  the  Patients  uuder  Treatment  in 
St.  Bartholomew’s  Hospital  during  1882— Abscess,  by  J.  Stuart  Naime, 
F.F.P.S.— Annual  Report  on  the  Health  of  Salford.  1882— The  Teeth, 
by  Thomas  Gaddes,  L.D.S.— Elements  of  Practical  Medicine,  by  Alfred 
H.  Carter,  M.D. — Note-book  for  Post-mortem  Examinations,  by  Byrom 
Bramwell,  M.D.,  F.R.C.P. 

PERIODICALS  AND  NEWSPAPERS  RECEIVED— 

Lancet— British  Medical  Journal— Medical  Press  and  Circular — Ber¬ 
liner  Klinische  Wochenschrift— Centralblatt  fur  Chirurgie — Gazette 
des  Hopitaux— Gazette  M£dicale— Revista  de  Medicina — Bulletin  de 
l’Aeademie  de  M^decine — Pharmaceutical  Journal — Wiener  Medicinische 
Wochenschrift— Revue  Mddicale— Gazette  Hebdomadaire— Nature — 
Boston  Medical  and  <Surgical  Journal— Louisville  Medical  News — 
Centralblatt  fur  Gynakologie— Le  Concours  Medical— Centralblatt  fur 
die  Medicinischen  Wissenschaften— Centralblatt  fur  Klinische  Medicin 
— Philadelphia  Medical  News— Le  Progres  Medical — New  York  Medical 
Journal — Edinburgh  Clinical  and  Pathological  Journal— Students’  Jour¬ 
nal  and  Hospital  Gazette— New  York  Medical  Record— Edinburgh 
Medical  Journal— Journal  of  Cutaneous  and  Venereal  Diseases — 
Maryland  Medical  Journal— Australian  Medical  Journal— Practitioner — 
Denver  Medical  Times— Gardeners’  Chronicle— Civil  Service  Candidate 
• — Fairplay— Analyst -Fort  Wayne  Journal — Popular  Science  News, 
etc.,  Boston — Nordiskt  Medicinskt  Arkiv — Italian  Times,  November  10 
—The  Planet  -  Montreal  Weekly  Witness — Nottingham  Journal,  Octo¬ 
ber  26  and  November  13— Journal  of  the  Vigilance  Association — Medical 
World— North  Carolina  Medical  Journal — Indian  Medical  Gazette. 


APPOINTMENTS  FOR  THE  WEEK. 


November  17.  Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  14  p.m. ;  King’s  College,  1 J  p.m. ;  Royal 
Free,  2  p.m.;  Royal  London  Ophthalmic,  11  a. m. ;  Royal  Westminster 
Ophthalmic,  14  p.m.;  St.  Thomas’s,  14  p.m. ;  London,  2  p.m. 

19.  Monday. 

Operations  at  the  Metropolitan  Free,  2  p.m.;  St.  Mark’s  Hospital  for 
Diseases  of  the  Rectum. 2  p.m.;  Royal  London  Ophthalmic.il  a.m.; 
Royal  Westminster  Ophthalmic,  14  p.m.  ;  Hospital  for  Women,  2  p.m. 
Medical  Society'  of  London,  84  p.m.  Dr.  Warner,  “  On  Posture  as 
expressing  the  Condition  of  the  Mind.”  Dr.  Milner  Fothergill,  “  On 
some  Nervous  Derangements  of  the  Heart.” 

20.  Tuesday. 

Operations  at  Guy’s,  1J  p.m.  ;  Westminster,  2  p.m. ;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  14  p.m.;  West 
London,  3  p.m. 

Pathological  Society,  84  p.m.  Mr.  Durham— True  Bone  developed 
in  Primary  Tumours  unconnected  with  the  Osseous  System  :  (l)  in 
Epithelioma  of  Cicatrix  ;  (2)  in  Adenoma  of  Breast.  Dr.  Hale 

White— Charcot’s  Joint-Disease.  Mr.  Eve— 1.  Pedunculated  Adeno- 
Sarcoma  of  the  Skin  ;  2.  Hydatid  Cystin  Muscle  of  Calf  (card);  3.  Sar¬ 
coma  of  Lower  Jaw  of  Horse  (card).  Dr.  Money— Necrosis  of  the 
Upper  Jaw  after  Typhoid  Fever.  Dr.  Heneage  Gibbes  and  Mr.  Sutton 
— Tuberculosis  in  Birds.  Dr.  West— 1.  Suppurative  Pericarditis  in 
Pyaemia;  2.  Stomach  from  a  Case  of  Carbolic- Acid  Poisoning  (card). 
Mr.  Symonds— Suppurative  Arteritis.  Mr.  Barker — Tongue  With 
Extensive  Tuberculous  Ulceration.  Mr.  Lunn— Fracture  of  Spine  (card). 

21.  Wednesday. 

Operations  at  University  College.  2  p.m. ;  St.  Mary’s,  11  p.m. ;  Middlesex, 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew’s,  14  p.m.  ;  Great  Northern, 

2  p.m. ;  Samaritan,  24  p.m. ;  Royal  London  Ophthalmic,  11  a.m. ; 
Royal  Westminster  Ophthalmic,  14  p.m. ;  St.  Thomas’s,  lj  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m. ;  National  Orthopaedic,  Great 
Portland-street,  10  a.m. 

Brompton  Hospital  for  Consumption,  etc.,  4  p.m.  Dr.  John  Tatham, 
“  On  Broncho  or  Catarrhal  Pneumonia.” _ 

22.  Thursday. 

Operations  at  St.  George’s,  1  p.m. ;  Central  London  Ophthalmic,  1  p.m. ; 
Royal  Orthopaedic,  2  p.m.;  University  College,  2  p.m. ;  Royal  London 
Ophthalmic,  11a.m. ;  Royal  Westminster  Ophthalmic,  14  p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m. ;  Hospital  for  Women,  2  p.m. ; 
Charing-cross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  24  p.m. 
Abernethian  Society  (St.  Bartholomew’s  Hospital),  8  p.m.  Mr. 
Andrews,  “  On  Ferments.” 

Parkes  Museum  of  Hygiene,  8  p.m.  Mr.  George  Murray,  “  On  the 
Potato  Disease”  (the  lecture  will  be  illustrated  by  Microscopical 
Preparations  and  Diagrams). _ 

23.  Friday. 

Operations  at  Central  LondonOphthalmic,  2  p.m.;  Royal  London  Ophtha’- 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminstir 
Ophthalmic,  14p.m.;  8t.  George’s  (ophthalmic  operations),  1(  p.m.; 
Guy’s,  14  p.m. ;  St.  Thomas’s  (ophthalmic  operations),  2  p.m. ;  King’s 
College  (by  Mr. Lister),  2  p.m. 

Medical  Society  of  Charing-cross  Hospital,  8  p.m.  Mr.  W.  B.  C. 
Treasure,  “  On  Recreation.” 

Clinical  Society  of  London,  84  p.m.  Dr.  Thin,  “  On  Cases  of  Thickened 
Epidermis  treated  by  Salicylic  Plaster.”  Dr.  Dawtrey  Drewitt,  “On  a 
Case  of  Myxoedema.”  Dr.  Cayley,  “On  a  Case  of  Pneumothorax 
occurring  in  the  course  of  Typhoid  Fever.”  Dr.  S.  West,  “  On  a  Case 
of  Complete  Recovery  from  Idiopathic  Pneumothorax  without  Effu¬ 
sion  of  Fluid.”  Living  Specimen  (8  p.m.) ;  Mr.  Mansell-Moullin— 
Thrombosis  of  the  Inferior  Vena  Cava. 


Medical  Ti 


ARKEY  ON  PATHOLOGICAL  HISTOLOGY. 


Nov.  24,  1863.  5  9  3 


INTRODUCTORY  LECTURE 


TO  A  COURSE  OF 

PATHOLOGICAL  HISTOLOGY. 

Delivered  at  St.  Thomas’s  Hospital. 

By  SEYMOUR  J.  SHARKEY,  M.A.,  M.B.  Oxon.,M.R.C.P., 

Assistant-Physician  and  Joint-Lecturer  on  Pathology  at  the  Hospital. 


Gentlemen, — Before  commencing  the  course  of  Patho¬ 
logical  Histology  which  is  to  extend  over  this  winter  session, 
it  will  be  to  our  advantage  if  we  try  to  form  a  clear  idea  of 
the  position  which  this  subject  holds  in  relation  to  other 
parts  of  the  student’s  curriculum,  and  to  the  final  object  of 
all  his  studies— a  sound  knowledge  of  Medicine  and  Surgery. 
"When  a  teacher  proposes  to  lecture  upon  a  subject  which 
his  pupils  are  informed  is  not  compulsory,  it  is  incumbent 
on  him  to  show  clearly  what  advantage  they  will  gain  from 
studying  it  at  all.  So  extensive  and  varied  is  the  knowledge 
which  is  necessary  for  the  medical  man,  that  he  is  justified 
in  declining  to  spend  his  time  on  subjects  which  when  mas¬ 
tered  will  prove  merely  ornamental  accomplishments.  A 
consideration  of  the  matter  will,  however,  convince  you  that 
a  knowledge  of  Pathology  is  essential  to  an  intelligent 
appreciation  of  the  practical  problems  with  which  you  will 
have  to  deal  as  medical  men ;  and  that  it  is  impossible  to 
gain  an  insight  into  Pathology  without  the  study  of  Patho¬ 
logical  Histology. 

The  early  studies  of  a  medical  student  are  intended  to 
make  him  acquainted  with  the  healthy  functions  and  struc¬ 
tures  of  the  human  body.  Hence  he  commences  with  naked- 
eye  anatomy,  and  tries  to  learn  the  forms  and  relative  posi¬ 
tions  of  bones,  muscles,  and  internal  organs,  and  the 
distribution  of  nerves  and  vessels.  The  importance  of  this 
as  a  foundation  both  for  medicine  and  surgery  fully  justifies 
The  time  and  care  which  are  spent  upon  it.  But  even  when 
'this  subject  has  been  well  mastered,  it  leaves  the  student 
with  a  very  limited  knowledge  of  the  functions  of  the  various 
parts.  The  structure  of  the  heart  was  known  long  before 
the  part  it  plays  in  the  circulation  of  the  blood  was  under¬ 
stood;  and  our  present  knowledge  of  the  anatomy  of  the 
brain  is  far  in  advance  of  our  knowledge  of  the  action 
of  its  various  parts.  Knowledge  of  structure,  in  other 
words,  does  not  necessarily  bring  with  it  knowledge  of 
function.  Physiology,  then,  or  the  study  of  function, 
has  to  be  undertaken.  As  soon  as  this  is  attempted  it 
becomes  clear  that  the  knowledge  of  anatomy  attained 
by  dissection  is  quite  inadequate  for  the  purpose.  When 
a  train  remains  motionless  before  the  platform  of  a  station 
until  the  engine  comes  up  and  hurries  it  off,  it  is  evident 
to  the  least  observant  person  that  the  function  of  the 
engine  is  to  draw  the  train  ;  but  it  is  far  from  evident  how 
it  does  so.  No  idea  can  be  formed  of  that  without  a  careful 
-study  of  the  machinery  within  and  of  the  relation  of  one 
part  to  another.  It  is  equally  certain  from  naked-eye 
•anatomy  that  the  liver  secretes  bile  and  the  kidneys  urine. 
But  how  ?  To  ascertain  this  we  have  to  study  histology,  or 
the  minute  anatomy  of  the  body.  This  is  often  wrongly 
termed  physiology.  Human  physiology  is  the  science  of  the 
phenomena  which  occur  in  the  organs  and  tissues  of  the 
healthy  body  during  life  ;  and  as  many  of  the  larger  organs 
are  only  agglomerations  of  smaller  and  microscopical  parts 
having  the  same  structure  and  function,  a  knowledge  of  the 
function  of  the  whole  is  only  ascertained  by  a  study  of  the 
minute  details  of  the  component  parts — that  is,  by  histology. 
The  liver,  for  example,  is  a  very  large  organ,  and  yet  the 
microscope  shows  that  it  is  nothing  more  than  an  aggrega¬ 
tion  of  innumerable  similarly  constructed  lobules,  each 
having  a  like  function ;  and  it  is  only  by  studying  the  in¬ 
dividual  lobules  minutely  that  we  are  in  a  position  to  arrive 
at  any  idea  of  the  physiology  of  the  liver  as  a  whole.  Physi¬ 
ology,  in  fact,  can  no  more  be  learnt  independently  of 
histology,  than  the  way  in  which  steam  makes  an  engine 
move  can  be  understood  without  knowing  the  details  of  the 
machinery  within  the  engine. 

Physiology  being  the  knowledge  of  the  actions  which 
take  place  in  the  various  tissues  of  the  body,  in  what  do  these 
Vol,  II.  1883.  No.  1743. 


actions  consist  ?  They  are,  so  far  as  we  know  at  present, 
chemical  and  physical  changes  occurring  in  living  organic 
matter,  and  for  their  due  appreciation  the  student  must 
apply  himself  to  chemistry  and  physics. 

Such  are  the  subjects  which  it  is  absolutely  necessary 
for  the  student  to  learn  before  he  can  expect  to  have  any 
reasonable  knowledge  of  what  is  meant  by  the  body  in  a 
state  of  health,  and  without  knowing  which  he  can  never 
carry  on  rationally  the  medical  art.  For  how  shall  he  appre¬ 
ciate  disease — that  is  departures  from  health — which  it  will 
be  his  business  to  cope  with,  if  he  does  not  understand 
what  health  is  ? 

The  preliminary  subjects,  then,  which  a  medical  student 
should  have  studied  before  he  proceeds  to  the  investigation 
of  disease  are  as  follows  : — Naked-Eye  Anatomy ;  Histology, 
or  Microscopic  Anatomy ;  Chemistry;  Physics;  Physiology. 
And  to  these  should  further  be  added  Embryology  or  the 
study  of  development.  Quite  apart  from  the  great  interest 
of  this  special  branch  of  Anatomy  and  Physiology,  a  know¬ 
ledge  of  the  various  phases  which  the  human  embryo  goes 
through  up  to  the  time  of  birth,  and  subsequently  up  to  the 
period  of  complete  development,  is  necessary  not  only  for 
the  detection  but  also  for  the  treatment  of  many  abnormal 
conditions.  It  is  only  by  a  knowledge  of  embryology  that 
we  can  understand  such  conditions  as  hermaphroditism, 
cleft  palate,  congenital  heart-disease,  the  presence  of  diver¬ 
ticula  from  the  intestines,  etc. 

The  series  of  subjects  which  I  have  mentioned,  and  a 
knowledge  of  which  I  have  said  to  be  essential  for  a  right 
understanding  of  the  normal  healthy  state  in  man,  has  its 
parallel,  which  is  equally  essential  for  a  knowledge  of  disease. 
It  is  as  follows  : — Morbid  Naked-Eye  Anatomy,  Pathological 
Histology,  Pathology,  Embryology,  Development  of  Morbid 
Conditions. 

As  you  have  studied  the  anatomy  of  the  healthy  subject 
in  the  dissecting-room,  so  you  should  now  study  in  the  post¬ 
mortem-room,  by  comparison,  the  anatomy  of  the  body  which 
disease  has  destroyed.  If  you  make  your  observations  in¬ 
telligently,  and  if  you  have  already  gained  some  knowledge 
of  histology,  you  will  find  your  curiosity  aroused  by  seeing 
many  conditions  of  organs,  many  new  growths,  which  are 
not  present  in  the  healthy  body,  and  which  you  will  find  it. 
impossible  to  understand  or  often  even  to  distinguish  from 
each  other  without  subjecting  them  to  minute  dissection 
and  examination  with  the  microscope.  This  is  the  subject 
— Pathological  Histology — which  I  propose  to  introduce  to 
your  notice  this  session. 

Everything  has  a  beginning  and  as  time  goes  on  is  des¬ 
tined  to  change ;  and  so  it  is  with  disease.  Each  abnormal 
condition  has  a  commencement  and  the  parts  affected  alter 
as  the  disease  developes,  some  more,  some  less  rapidly. 
Every  tumour  or  morbid  growth  has  its  life-history  and 
undergoes  a  series  of  changes.  Without  gaining  a  know¬ 
ledge  from  the  dead  subject  of  the  earliest  conditions  and  of 
the  various  phases  of  disease,  how  can  we  expect  to  detect, 
much  less  to  cure  or  prevent  them  in  the  living  ?  Hence  one 
of  the  most  important  parts  of  pathological  histology  con¬ 
sists  in  tracing  the  gradual  development  of  morbid  condi¬ 
tions.  This  corresponds  to  embryology  in  the  study  of 
healthy  bodies.  If  you  acquire  a  fair  knowledge  of  morbid 
anatomy  and  pathological  histology,  including  the  develop¬ 
ment  of  diseased  conditions,  you  will  be  able  to  follow  and 
understand  the  more  general  questions  of  pathology  which 
are  treated  of  in  the  lectures  of  the  summer  session.  And 
above  all  you  will  be  in  the  most  advantageous  position 
possible  for  studyiug  practical  medicine  and  surgery.  The 
latter  are  the  crowning  studies  of  the  medical  student’s  edu¬ 
cation,  those  which  are  to  be  the  business  of  his  life,  and  for 
the  sake  of  which  he  has  devoted  all  his  previous  time  and 
attention  to  the  subjects  we  have  already  mentioned.  He 
has  a  right  to  demand  that  when  he  has  arrived  at  this 
stage  he  shall  feel  that  all  his  previous  studies  have  been 
necessary  for  that  which  is  now  to  monopolise  his  attention. 
And  this  I  can  promise  him  he  will  feel  if  he  has  really 
acquired  a  knowledge  of  them.  Medicine  and  surgery  con¬ 
sist  simply  in  the  detection  in  the  living  subject  of  unhealthy 
or  pathological  conditions,  and  in  efforts  to  prevent,  cure,  or 
alleviate  them.  For  this  the  student  must  have  made  him¬ 
self  well  acquainted  with  the  facts  of  pathology,  and  to  do 
so  I  have  shown  you  that  a  study  of  morbid  anatomy,  patho¬ 
logical  histology,  and  pathological  development  is  neces¬ 
sary.  I  have  also  pointed  out  that  to  understand  disease 


594 


Medical  Times  and  Gazette. 


SHARKEY  ON  PATHOLOGICAL  HISTOLOGY. 


Nov.  24,  1SSS.1 


one  must  be  familiar  with  the  phenomena  of  health.  The 
latter  can  only  be  learnt  by  Naked-Eye  Anatomy,  Histology, 
Embryology,  Chemistry,  Physics,  and  Physiology. 

The  medical  student’s  curriculum  is  in  fact  framed  with 
the  view  of  leading  him  on  gradually  through  a  well-arranged 
system  of  preliminary  subjects,  until  he  is  in  a  position  to 
study  to  the  greatest  advantage  the  ills  which  afflict  his 
fellow-men,  and  to  treat  them  with  the  greatest  chance  of 
success. 

If  you  have  followed  what  I  have  said  you  cannot  fail  to 
appreciate  the  position  of  pathological  histology,  and  to  see 
how  necessary  a  knowledge  of  it  is  for  the  well-educated 
medical  man.  Neither  is  pathology,  nor  are  any  of  the 
subjects  to  which  I  have  alluded  merely  ornamental,  as 
students  often  seem  to  suppose,  and  unnecessary  for  all 
except  those  who  aspire  to  leading  and  public  positions  in 
the  profession.  True  it  is  that  medicine  and  surgery  can 
be  and  are  practised  by  persons  who  have  but  a  smattering 
of  all,  or  indeed  of ’some  only,  of  the  subjects  which  I  assert 
to  be  essential.  But  this  is  merely  because  the  ignorance 
of  the  public  on  medical  matters  is  so  great  that  they  fre¬ 
quently  cannot  appreciate  whether  a  man  knows  his  busi¬ 
ness  or  not.  His  incapacity  may  escape  detection,  but 
without  a  fair  knowledge  of  most  of  the  subjects  which 
together  form  the  modern  doctor’s  education,  the  latter 
can  neither  duly  appreciate  the  phenomena  of  disease  nor 
the  principles  of  rational  treatment,  nor  can  he  hope  to  add 
anything  to  our  knowledge,  nor  even  to  understand  the 
current  literature  of  his  profession. 

Granted  then  that  pathology  is  a  necessary  and  essential 
factor  in  a  medical  man’s  education,  what  kind  of  changes 
may  he  expect  to  find  occurring  in  diseased  tissues  ?  They 
are  far  more  numerous  than  could  possibly  be  treated  of 
even  in  the  most  cursory  manner  in  the  course  of  one 
lecture.  Some  of  them  consist  in  an  increase,  some  in  a 
decrease  of  healthy  tissues  ;  some  in  destruction  or  altera¬ 
tion  of  them ;  some  in  the  introduction  into  the  organism 
of  structures  which  are  never  present  in  health.  But  what¬ 
ever  the  process  be,  whether  for  evil  or  for  good,  the  student 
will  usually  find  what  are  termed  “  cells  ”  taking  a  promi¬ 
nent  part  in  it.  Nor  should  this  at  all  surprise  him  ;  for  if 
all  tissues  are  not  merely  a  collection  of  modified  cells,  they 
are  at  any  rate  one  and  all  indebted  to  cells  for  their 
existence.  The  ovum  is  a  cell,  and  it  is  by  its  subdivision  and 
re-subdivision  that  numberless  others  are  produced  which  are 
transformed  gradually  during  development  into  the  organs 
and  tissues  of  the  body.  The  blastodermic  layers  are  nothing 
but  collections  of  cells,  and  the  heart  may  be  seen  in  the 
embryos  of  some  animals  to  beat  while  the  individual  cells 
which  form  it  can  still  be  clearly  distinguished  with  the 
microscope.  Such  being  the  importance  of  cells  in  healthy 
bodies,  it  is  no  wonder  that  these  structures  should  play  so 
prominent  a  part  in  the  changes  which  constitute  disease. 
What  then  is  a  cell  ?  How  can  one  define  it  ?  The  earliest 
discovery  of  cells  took  place  in  plants,  and  consequently 
the  earliest  ideas  of  what  was  meant  by  the  term  were  de¬ 
rived  from  the  vegetable  world.  It  was  found  that  here  the 
cell  consisted  of — (1)  an  external  thick  layer  or  “  capsule  ” 
of  cellulose,  that  is  to  say,  of  a  substance  which  contains 
no  nitrogen  and  which  stains  blue  on  the  addition  of  sul¬ 
phuric  acid  and  iodine ;  (2)  within  this  a  very  fine  membrane, 
which  surrounds  (3)  the  “  protoplasm,”  a  nitrogenous  sub¬ 
stance  which  turns  brownish  or  yellowish  on  the  addition 
of  sulphuric  acid  and  iodine;  (4)  a  nucleus;  (5)  a  nucleolus. 

Now  when  a  comparison  was  made  between  these  vege¬ 
table  cells  and  those  which  are  present  in  the  animal 
organism,  it  was  found  that  there  was  a  very  decided  differ¬ 
ence  between  them.  The  cellulose  capsule  is  absent  in  the 
latter.  But  apart  from  this,  cells  are  similar  in  the  two 
kingdoms.  The  animal  cells  which  approach  the  complete 
vegetable  cells  most  nearly  are  those  of  cartilage.  Here  we 
have  a  capsule,  cell-contents  or  protoplasm  surrounded  by  a 
fine  membrane,  a  nucleus,  and  nucleolus.  But  even  so  the 
two  are  not  identical  in  structure,  for  the  capsule  of  the 
cartilage  cell  is  not  non-nitrogenous  like  that  of  vegetables ; 
it  contains  nitrogen.  This  capsule,  however,  is  not  a  part 
of  the  original  cell  at  all,  for  young  cartilage  cells  have  no 
such  structure.  It  is  a  secretion,  if  one  may  say  so,  formed 
by  the  cell.  Thus  setting  aside  these  capsules,  we  have 
left  as  the  component  parts  of  a  typical  cell — (1)  the  external 
membrane  or  cell-wall ;  (2)  protoplasm  or  cell-contents ; 
(3)  nucleus ;  (4)  nucleolus. 


Cells  present  great  variety  of  form — some  being  round  or 
polygonal,  as  in  the  liver;  some  spindle-shaped,  as  in  un¬ 
striped  muscles ;  some  multipolar  or  with  many  processes,  as 
in  the  central  nervous  system ;  and  there  are  many  other  shapes. 
Yet,  notwithstanding  these  variations  in  the  cell,  the  nucleus 
changes  but  little  ;  it  remains  constantly  roundish  or  oval. 
The  nucleus  is  probably  that  part  on  which  depends  the 
growth  and  life  of  cells  rather  than  their  function.  The  latter 
depends  upon  the  protoplasm  or  cell-contents.  Wherever 
growth  is  going  on,  pathologically  or  physiologically,  there 
will  nuclei  be  found ;  and  where  cell-life  is  becoming  extinct, 
there  the  nucleus  may  be  absent.  Thus,  for  example,  in  the 
cells  of  the  external  layers  of  the  epidermis  which  are  con¬ 
stantly  being  shed  there  are  often  no  nuclei.  Similarly,, 
the  cell-membrane  may  be,  and  often  is,  absent — in  white 
blood-cells,  for  instance.  The  latter  are  bodies  which  are 
constantly  active  and  in  their  activity  they  push  forward 
their  protoplasm  in  processes  and  withdraw  it  again,  as  do 
the  amcebce  amongst  unicellular  animals.  In  order  to  exert 
these  free  movements  and  bring  about  such  rapid  changes 
of  form,  the  cell  must  be  soft  and  not  hemmed  in  by  a 
firm,  unyielding  membrane  on  its  periphery.  Such  cells, 
in  fact,  have  no  cell- wall.  Indeed  it  is  probable  that  in 
all  young  cells  there  are  simply  protoplasm  and  nucleus, 
and  that  the  cell- wall  is  only  a  later  development :  just 
as  the  absence  of  a  nucleus,  referred  to  above,  is  not 
the  original  condition  of  any  cells,  but  only  a  phase  in 
the  life-history  of  some.  In  the  early  stages  of  all  cell- 
growth,  however,  one  can  discern  protoplasm  and  nucleus, 
and  generally  nucleolus,  though  the  protoplasm  is  often 
present  only  in  very  small  quantity. 

A  cell  then  you  may  take  to  mean  a  nucleus  surrounded 
by  protoplasm — always  remembering  that  a  cell-wall  or 
membrane  may  develope,  the  nucleus  may  disappear,  and 
the  protoplasm  may  undergo  very  considerable  alterations. 

Wherever  you  find  vital  changes  going  on,  whether  phy¬ 
siological  or  pathological,  there  you  will  meet  with  cells. 
They  are  the  laboratories  wherein  occur  the  molecular 
physical  and  chemical  changes  which  constitute  life. 

A  due  appreciation  of  the  universal  presence  and  great 
importance  of  cells  gave  rise  in  the  hands  of  Yirchow  to  the 
“  Cellular  Pathology,”  which  you  will  constantly  be  reminded 
of  as  we  treat  of  the  pathological  changes  which  occur 
in  man,  and  which  is,  indeed,  the  keystone  to  Modern 
Pathology. 

If  the  cell  comes  so  prominently  to  the  foreground,  and 
if,  as  I  have  given  you  to  understand,  you  are  going  to 
be  constantly  examining  even  swarms  of  them  which  have 
no  existence  in  the  healthy  body,  you  will  naturally  ask 
where  they  come  from.  As  we  study  the  various  diseases 
occurring  in  each  organ  we  shall  also  try  and  form  a  con¬ 
clusion  as  to  the  origin  of  new  cell-growth  in  each  par¬ 
ticular  case.  Here  I  merely  want  to  point  out  to  you  the 
principle  which  holds  good  not  only  in  diseased  but  also 
in  healthy  bodies.  Formerly  it  used  to  be  thought  that  a 
plastic  material,  "  cytoblastema,”  was  formed  in  the  body, 
and  contained  numberless  granules  embedded  in  it.  These 
organic  but  lifeless  granules  were  supposed  to  aggregate 
themselves  into  clumps,  which  became  the  living  cells 
and  their  nuclei.  This  process  corresponds  with  that  which 
is  called  “  generatio  aequivoca,”  or  "  abiogenesis  ”  in  the 
animal  and  vegetable  kingdoms — a  process  by  which  some 
people  assert  that  living  organisms  arise  from  organic 
granules,  and  hold  that  there  is  no  necessity  for  supposing 
that  each  individual  organism  must  have  come  from  a  living- 
parent.  They  say,  in  fact,  that  life  can  originate  de  novo 
from  lifeless  matter.  There  is  but  little  evidence  that 
such  a  process  ever  occurs,  and  you  must  accept  as  your 
guiding  principle,  “  Omnis  cellula  e  cellula  ” — wherever  a 
new  cell  is  developed  there  must  have  been  a  parent-cell. 
As  a  rule  this  reproduction  of  cells  occurs  by  a  process 
called  "  fission,”  or  by  some  modification  of  it.  First  of  all 
a  constriction  in  the  nucleus  is  seen,  which  gradually  grows 
deeper  and  deeper  until  there  are  formed  two  nuclei  in  the 
place  of  the  originally  single  one.  Then  a  similar  process 
commences  in  the  cell  itself,  and  its  protoplasm  gradually 
divides  into  two  halves,  each  appropriating  one  of  the  new 
nuclei.  The  stages  of  this  process  you  will  be  able  to  ob¬ 
serve  and  verify  for  yourselves,  and  nowhei'e  is  it  better  seen 
than  in  cartilage.  The  finer  changes,  however,  which  have 
recently  been  discovered  in  the  nucleus  during  and  previous 
to  its  division  cannot  be  seen  in  sections  prepared  in  the 


Medical  Times  and  Gazette. 


HERMAN  ON  HODGE’S  PESSARY. 


Nov.  24,  1883.  595 


ordinary  way,  but  I  will  endeavour  to  show  you  specimens 
of  them.  The  ovum  itself  is  a  cell  which  divides  and  sub¬ 
divides  as  it  grows  into  innumerable  others.,  so  that  every 
cell  in  the  adult  body  may  be  considered  as  a  direct  descen¬ 
dant  of  that  which  formed  the  ovum.  So  much  then  for 
cells,  which,  together  with  their  modifications,  are  the  truly 
•active  vital  agents  in  .the  body  in  health  as  well  as  in 
disease. 

To  form  organs  cells  require  to  be  aggregated  into 
masses ;  and  this  is  effected  by  means  of  connective  tissue. 
The  latter  generally  consists  of  bundles  of  wavy  fibrils 
running  in  various  directions,  and  leaving  spaces  be¬ 
tween  them  which  are  occupied  by  the  so-called  connective- 
tissue  corpuscles,  which  assume  a  great  variety  of  shapes. 
This  connective  tissue  with  its  various  modifications  you 
will  find  occupying  a  place  in  pathology  only  second  in 
importance  to  cells,  and  I  should  advise  you  to  become  at 
once  familiar  with  its  appearance  under  the  microscope. 
It  is  indebted  to  cells  for  its  existence,  either  directly 
or  indirectly.  There  are  two  views  on  this  subject,  each 
upheld  by  good  observers.  One  is  that  these  fibrils  are 
produced  by  a  fibrillation  in  the  cells  themselves;  the 
other  that  the  cells  remain  unchanged,  but  the  intercellular 
matter  in  which  they  are  embedded  fibrillates.  Whichever 
view  be  the  correct  one,  the  presence  of  connective  tissue 
is  of  the  greatest  importance  in  pathology,  and  its  develop¬ 
ment  always  takes  place  in  connexion  with  cells. 

Next  to  cells  and  connective  tissue  the  most  important 
structures  to  get  familiar  with  are  vessels.  New  tissues 
depend  for  their  existence  on  the  supply  of  nourishment 
brought  to  them  by  vessels,  and  although  some  pathological 
products  are  non- vascular  and  therefore  rapidly  degenerate, 
vessels  are  objects  which  will  be  met  with  at  every  turn 
during  this  course  of  lectures.  When  of  moderate  size  they 
are  not  at  all  difficult  to  recognise,  and  you  should  make 
yourself  familiar  with  the  appearance  of  the  various  coats  of 
the  larger  ones  in  health.  New  capillaries  are  far  more 
frequently  found  in  diseased  growths  than  more  fully  deve¬ 
loped  vessels,  and  they  are  more  difficult  for  the  student  to 
recognise.  This  is  due  to  the  extreme  delicacy  of  their  walls, 
which  consist  simply  ^  of  flat  cells  welded  together,  and 
when  looked  at  under  'the  microscope  one  '  sees  little  more 
than  two  parallel  lines  of  alternately-placed  longish  nuclei 
with  a  space  between  them  forming  a  tube.  I  advise  you, 
therefore,  to  get  immediately  familiar  with  the  appearances 
of  the  various  forms  of  cells,  of  connective  tissue,  and  of 
bloodvessels,  especially  of  the  smaller  ones  as  seen  under 
the  microscope.  If  you  do  this,  and  if  you  have  a  fair 
knowledge  of  the  microscopical  anatomy  of  healthy  struc¬ 
tures,  you  will  have  little  difficulty  in  understanding  the 
diseased.  I  shall  not,  however,  take  for  granted  your  know¬ 
ledge  of  normal  tissues,  but  I  shall  always  recall  to  your 
memory  the  structure  of  the  healthy  organ  before  treating 
of  the  diseases  which  affect  it,  and  you  will  always  find 
under  microscopes,  for  comparison,  sections  of  the  tissues  we 
are  investigating,  as  they  appear  in  a  normal  state. 

You  need  not  expect  learned  discussions  from  me  on 
abstruse  questions  in  pathology.  Simplicity  shall  be  my 
aim,  remembering  that  you  are  commencing  the  study  of 
pathology  and  that  a  sound  knowledge  of  the  subject  de¬ 
pends  upon  the  accuracy  with  which  you  learn  the  elements, 
and  the  ease  with  which  you  retain  the  leading  facts  in  your 
memories,  rather  than  upon  the  quantity  which  I  might  be 
able  to  force  into  a  temporary  occupation  of  your  brains. 

Let  me  bring  these  few  remarks  to  a  close  by  giving  you 
a  piece  of  advice  about  the  use  of  the  sections  of  pathological 
•conditions  which  you  are  going  to  accumulate.  I  have  often 
noticed  what  a  pride  students  take  in  making  prettily  stained 
and  mounted  preparations,  and  when  they  are  made  they 
treat  them  simply  as  studies  in  artistic  colouring.  If  they 
are  asked  what  the  specimen  shows,  they  often  display  abso¬ 
lute  ignorance,  and  seem  to  think  a  knowledge  of  such 
details  a  matter  of  secondary  importance.  The  only  use, 
however,  of  these  specimens  is  to  teach  you  pathology,  and 
the  only  good  of  colouring  them  is  to  enable  you  to  learn  it 
better.  Make,  therefore,  the  best  preparations  you  can, 
because  they  will  show  and  teach  you  most.  But  rather 
spend  your  time  in  studying  a  poor  specimen  than  in  rnount- 
ng  section  after  section,  endeavouring  to  make  one  prettier 
than  the  other,  and  finally  hoarding  them  up  in  a  box,  with 
the  idea  that  having  them  there  is  equivalent  to  having  your 
brains  well  stocked  with  pathology. 


HODGE’S  PESSARY  AND  ITS 
MODIFICATIONS,  (a) 

By  G.  ERNEST  HERMAN,  M.B.  Bond.,  M.R.C.P.  Bond., 

E.R.O.S.  Eng., 

Obstetric  Physician  to,  and  Lecturer  on  Midwifery  at,  the  London 
Hospital ;  Physician  to  the  Royal  Maternity  Charity ;  Examiner  in 
Midwifery  to  the  Royal  College  of  Surgeons  of  England,  etc. 

{.Concluded  from  page  568.) 

In  applying  a  Hodge’s  pessary,  we  want  to  choose  the  one 
which  the  vagina  will  retain,  which  will  extend  the  vagina 
and  carry  its  posterior  cul-de-sac  as  far  backwards  and 
upwards  as  possible,  and  which,  while  efficiently  doing  this, 
will  not  exercise  any  injurious  pressure  upon  any  one  point. 
I  propose  now  to  compare  the  different  varieties  of  Hodge’s 
pessary  from  this  point  of  view. 

The  simplest  and  the  parent  instrument — the  one  with 
which  Hr.  Hodge  started,  and  out  of  which  his  pessary  arose 
— is  the  ring.  A  rigid  ring,  large  enough  to  fill  the  vagina, 
cannot  usually  be  introduced  without  difficulty  and  pain  to 
the  patient,  and  its  pressure  when  in  situ  is  likely  to  be 
injurious.  Therefore  an  elastic  ring,  the  opposite  parts  of 
which  can  be  pressed  together  for  the  purpose  of  introduc¬ 
tion,  and  which  does  not  exert  unyielding  pressure,  is  prefer¬ 
able.  If  the  ring  be  thick,  its  pressure  is  more  diffused,  and 
therefore  less  likely  to  cause  pain  or  ulceration  than  if  it  be 
thin.  A  thick  elastic  ring,  such  as  is  made  of  watch-spring, 
covered  with  india-rubber,  is  therefore  the  best.  This  form 
of  instrument  is  stated  to  have  been  originally  devised 
by  Dr.  Meigs,  of  Philadelphia,  (b)  The  Meigs  ring  is  the 
simplest  and  safest  of  all  vaginal  pessaries.  Assuming  that 
the  case  is  a  suitable  one,  the  only  disadvantageous  mistake 
that  can  be  made  in  the  application  of  such  a  ring  is  the 
choice  of  too  large  a  one.  If  this  error  be  committed,  the 
unsuitability  of  the  instrument  will  soon  be  evident  from 
the  pain  it  will  cause  the  patient.  But  if  the  pessary  be  of 
proper  size— that  is,  big  enough  to  fill  the  vagina,  without 
making  it  tense, — its  thickness  and  elasticity  so  diffuse  the 
pressure  which  it  exerts,  that  it  is  rare  for  any  ulceration  of 
the  vagina  to  be  produced.  I  have  used  these  rings  largely, 
and  have  never  once  seen  ulceration  result  from  them.  The 
ring  pessary,  when  retained,  fulfils  the  main  requirement — 
it  prevents  inversion  of  the  vagina,  and  thus  prevents  pro¬ 
lapsus.  It  carries  the  posterior  cul-de-sac  of  the  vagina 
backwards,  and  thus  in  the  same  manner  as  a  Hodge,  and  in 
most  cases  as  effectually,  prevents  retroversion.  Even  in 
some  cases  where  the  ring  did  not  when  first  introduced 
correct  retroversion,  I  have  found  the  uterus  in  the  natural 
position  after  the  pessary  had  been  worn  a  few  weeks.  The 
thick  elastic  ring  is  especially  useful  where  the  uterus, 
besides  being  displaced  backwards,  is  tender,  or  where  the 
ovaries  are  prolapsed  and  tender ;  for  in  these  cases  the 
thick  elastic  pessary  presses  so  much  more  gently  than  the 
rigid  bar  of  a  Hodge,  that  it  can  be  borne  where  the  latter 
is° not  tolerated.  I  would  venture  to  offer  this  practical 
advice  :  whenever  the  uterus  is  tender,  and  you  are  not  sure, 
after  applying  a  Hodge’s  pessary,  that  the  uterus  is  raised 
into  a  position  of  anteversion,  or  at  least  into  the  axis  of 
the  pelvic  brim,  you  will  do  well  to  substitute  a  Meigs’s  ring 
for  a  Hodge. 

I  may  say,  in  passing,  that  there  are  three  ways  of  ascer¬ 
taining  whether  the  uterus  is  in  or  near  the  axis  of  the 
pelvic°brim.  The  best  and  only  certain  method  is  by 
bi-manual  palpation.  When  the  uterus  is  thus  grasped 
between  the  two  hands,  its  position  is  made  out  beyond 
mistake.  But  in  patients  whose  abdominal  walls  are  fat  or 
rigid  this  may  be  impracticable.  Then  we  are  reduced  to 
(2)  the  use  of  the  sound ;  which,  if  the  uterus  be  in  the  axis 
of  the  brim,  will,  of  course,  easily  pass  up  with  its  eoncavity 
looking  forwards.  If  the  uterus  be  retroflex ed,  it  will  usually 
not  pass  more  than  an  inch  or  an  inch  and  a  half  until  the 
concavity  is  turned  backwards.  This  method  is  not  free 
from  error,  for  I  have  found  the  sound  passed  with  the  con¬ 
cavity  forwards  straighten  out  a  retroflexed  uterus  as  it 
passed  on ;  but  this  is  exceptional.  This  method  may  be 
checked  by  (3)  rectal  examination,  by  which,  if  the  uterus  be 

(a)  Read  before  the  East  London  and  South  Essex  district  of  thejMetro- 
politan  Counties  branch  of  the  British  Medical  Association. 

(b)  Hodge,  “Diseases Peculiar  to  Women,”  second  edition,  1868,  page  401- 


596 


Medical  Times  and  Gazette. 


HERMAN  ON  HODGE’S  PESSARY. 


Nov.  24, 1883. 


still  retroflexed,  its  body  may  be  felt  bent  back  over  the  top  | 
of  the  pessary.  This  is  not  practicable  when  the  instrument 
used  is  a  very  large  one,  for  then  the  finger  may  be  unable 
to  reach  above  it.  It  is  often  stated  that  it  is  necessary, 
for  the  proper  adjustment  of  a  Hodge’s  pessary,  to  first 
replace  the  uterus  with  the  sound.  In  the  cases  in  which 
Hodge’s  or  a  ring  pessary  will  keep  the  uterus  anteverted, 
the  uterus  will  usually  assume  that  position  as  soon  as  the 
instrument  has  been  inserted.  When  the  pessary  does  not 
at  once  antevert  the  uterus,  and  this  is  then  done  with  the 
sound,  sometimes  the  organ  will  remain  in  its  new  position ; 
but  generally  it  falls  back  again  directly  the  sound  is  re¬ 
moved.  The  cases,  therefore,  in  which,  according  to  my 
experience,  replacing  the  uterus  with  the  sound  is  advan¬ 
tageous,  are  very  few. 

Certain  theoretical  objections  are  brought  against  these 
rings.  Hodge  says,  “  Under  the  pressure  from  above,  it 
will,  indeed  must,  remain  parallel  to  the  plane  of  the 
perineum.” (c)  To  see  if  this  were  so,  I  have  carefully 
measured  the  distance  from  the  plane  of  the  perineum,  of 
the  anterior  and  posterior  parts  of  the  ring  pessary,  in 
patients  who  were  wearing  them ;  and  I  have  almost  always 
found  that  the  posterior  end  was  higher  up  than  the  an¬ 
terior,  and  that  therefore  the  ring  was  not  parallel  with  the 
plane  of  the  perineum.  On  a  matter  of  clinical  observation 
I  should  only  with  great  caution  differ  from  so  faithful  an 
observer  as  the  late  Hr.  Hodge  is  shown  by  his  book  to  have 
been,  and  I  have  sometimes  found  the  ring  parallel  with 
the  plane  of  the  perineum ;  but  I  ami  sure  that  it  is  only 
exceptionally  so. 

Another  objection  made  is  that  the  ring  enlarges  the 
vagina  laterally,  and  so  makes  the  last  state  of  the  patient 
worse  than  the  first.  I  think  this  statement  is  based  on  con¬ 
jecture,  and  not  on  observation.  I  do  not  think  that  there 
is  theoretical  ground  for  it,  for,  according  to  Hart  (whose 
statements  are  supported  by  the  evidence  of  sections, 
besides  being,  as  it  seems  to  me,  in  accord  with  clinical  ob¬ 
servation),  the  anterior  and  posterior  vaginal  walls,  normally 
in  contact  with  each  other,  are  triangular  in  shape,  the  base 
being  above,  and  the  apex  below.  The  introduction  of  a 
ring  into  a  loosely  walled  cavity  of  this  shape,  although  it 
may  slightly  alter  its  outline,  will  not  greatly  distort  it.  I 
have  seen  numerous  cases  in  which  patients  have  worn  a 
Meigs’s  ring  for  months,  and  then  have  been  able  to  do 
without  it ;  and  therefore  I  believe  that  this  supposed  in¬ 
jurious  effect  of  the  ring  is  one  which  either  only  exists  in 
imagination,  or  results  from  accidentally  coincident  morbid 
changes,  or  from  badly  fitting  instruments. 

The  real  drawbacks  of  the  Meigs’s  ring  appear  to  me  to  be 
these:  first,  thatitisnotso  efficient  as  Hodge’s  pessary  in  carry¬ 
ing  the  posterior  vaginal  cul-de-sac  upwards  and  backwards  ; 
next,  that  its  posterior  part,  being  flat,  and  not  curved  up¬ 
wards,  presses  on  the  front  of  the  rectum.  If  the  bowels  are 
confined,  and  scybala  have  to  pass,  the  ring  projecting  back¬ 
wards  is  apt  to  obstruct  defeecation.  This  may  easily  be 
avoided  by  keeping  the  bowels  regular ;  when  this  is  attended 
to,  no  trouble  of  the  kind  arises.  There  is  also  the  disad¬ 
vantage  which  attends  every  india-rubber  instrument — that 
when  worn  long  by  inattentive  patients,  they  may  cause 
vaginitis,  with  foetid  discharge.  This  is  to  be  prevented  in 
most  cases  by  telling  the  patients,  while  wearing  the  ring, 
to  syringe  the  vagina  night  and  morning  with  hot  water. 
In  dealing  with  patients  who  are  not  very  intelligent,  it  is 
well  to  be  sure  that  they  have  a  syringe  provided  with  a 
vaginal  nozzle  of  sufficient  length. 

Hodge’s  pessary  cannot  be  more  correctly  described  than  in 
the  words  of  the  inventor  himself.  He  says  :  (d)  “  The  impor¬ 
tant  modification  consists  in  making  a  ring  oblong  instead  of 
circular,  and  curved  so  as  to  correspond  to  the  curvatures  of 
the  vagina  and  rectum.  Great  advantages  result  from  this 
form  :  the  convexity  of  the  curve,  being  in  contact  with  the 
posterior  wall  of  the  vagina,  corresponds  with  more  or  less 
accuracy  to  the  curve  of  the  rectum,  perineum,  and  sacrum. 
Hence,  when  properly  arranged,  there  is  no  pressure  against 
the  rectum.  .  .  .  The  oblong  form  and  the  curvature  are  the 
two  essential  peculiarities  of  the  lever  pessary.” 

Hodge  put  before  the  profession  two  forms — the  open  and 
the  closed  lever.  The  open  lever  has  never,  so  far  as  I  know, 
been  much  used ;  and  therefore  I  speak  only  of  the  closed 
lever — the  one  universally  known  as  Hodge’s  pessary.  Its 


peculiar  advantages  are  these — First,  by  its  oblong  shape, 
it  carries  the  posterior  vaginal  cul-de-sac  further  upwards 
and  backwards  than  the  ring  of  which  it  is  a  modification. 
In  being  not  a  simple  oblong,  but  smaller  at  the  lower  end 
than  the  upper,  and  in  being  slightly  sigmoid  when  looked 
at  from  the  side,  it  corresponds  to  the  shape  of  the  vagina  j 
and,  through  this  exact  adaptation,  it  is  kept  in  position  by 
the  simple  pressure  of  the  anterior  vaginal  wall  against  the 
posterior,  no  spot  being  used  as  a  point  of  support,  and 
therefore  unduly  pressed  on.  Further,  its  oblong  shape 
permits  its  introduction,  when  made  of  a  rigid  material, 
without  excessive  pain  to  the  patient ;  and  this  gives  us  a 
large  range  of  choice  of  fabric.  Thus,  tin,  pewter,  vul¬ 
canite,  xylonite,  aluminium,  have  all  been  used.  The  respec¬ 
tive  merits  of  the  different  materials  I  shall  nob  here  discuss. 

I  would  now  remark  on  the  ordinary  modifications  of 
Hodge’s  pessary.  First,  a  large  posterior  curve  has  been  re¬ 
commended  by  many.  The  explanation  usually  given  of  its 
utility  is  that  it  presses  the  body  of  the  uterus  further  up. 
For  reasons  already  given,  I  think  it  cannot  both  do  this  and 
at  the  same  time  straighten  the  uterus.  Its  real  advantage  I 
judge  to  be  this — that,  by  bulging  out  behind  the  posterior 
vaginal  cul-de-sac,  it  gives  room  for  the  cervix  to  move  back¬ 
wards.  When  the  posterior  vaginal  wall  is  put  on  the 
stretch,  it  of  course  becomes  as  nearly  straight  as  the  instru¬ 
ment  extending  it  will  permit,  and  if  the  portio  vaginalis 
be  long,  the  vaginal  wall,  as  it  approaches  a  straight  line, 
must  press  the  cervix  forward.  This  is  an  effect  directly 
contrary  to  that  of  Hodge’s  pessary  when  acting  with  the 
maximum  of  efficiency ;  for  then,  as  has  been  pointed  out, 
as  the  body  of  the  uterus  falls  forward  the  cervix  moves 
backward.  The  advantage  of  the  large  posterior  curve  is, 
that  it  makes  room  for  this  backward  movement  of  the 
cervix.  Next,  certain  alterations  of  the  posterior  end  have  been 
made,  upon  the  theory  that  the  pessary  presses  directly  upon 
the  uterus.  They  tacitly  recognise  the  fact  that  when  the  in¬ 
strument  does  so  press  upon  a  congested  uterus  the  pressure 
is  painful,  for  they  seek  to  lessen  the  pain  by  distributing  or 
lessening  the  pressure.  On  this  principle,  the  posterior  end 
has  been  made  slightly  concave,  to  correspond  with  the  con¬ 
vexity  of  the  body  of  the  uterus,  so  that  this  convexity  may 
lie  in  the  concavity  of  the  pessary,  instead  of  touching  it  at 
one  point  only,  as  would  be  the  case  were  the  end  of  the  in¬ 
strument  convex.  With  a  similar  aim,  the  posterior  end  has. 
been  greatly  thickened,  in  order  to  diffuse  the  pressure.  It 
has  also  been  capped  with  a  soft  pad.  I  regard  these  modi¬ 
fications  as  suited  only  for  exceptional  cases.  The  pessary 
should  not  press  on  the  uterus  at  all ;  and  if  it  does  not  press 
on  the  uterus,  it  matters  little  what  is  the  shape  of  its  pos¬ 
terior  end.  But  when  a  Hodge  will  not  straighten  the 
uterus,  but  presses  on  it,  and  the  uterus  is  tender,  the  soft 
pad  is  the  one  which  makes  the  pressure  the  least  severe. 
There  are  also  modifications  of  the  lower  end.  One  of  them 
consists  in  making  it  pointed,  the  theory  being,  that  the 
point  shall  fit  in  between  the  rami  of  the  pubes,  and  thus 
the  pessary  be  kept  in  the  antero-posterior  diameter  of  the 
pelvis,  and  prevented  from  shifting  its  position  so  as  to  get 
across  that  diameter.  This  principle  seems  to  me  erroneous, 
because  Hodge’s  pessary  ought  not  to  take  its  support  from 
bony  parts,  or  to  press  upon  bones  at  all ;  it  should  be  held 
in  position  simply  by  the  vaginal  walls.  The  change  is  also, 
I  think,  disadvantageous  in  two  ways — first,  the  point  serves 
as  a  wedge  to  facilitate  its  slipping  out ;  and,  second,  the. 
projection  downwards  of  the  point  makes  it  inconvenient 
for  married  women.  For  these  reasons  I  do  not  regard  this 
modification  as  an  improvement.  Another,  and  most  useful, 
alteration  is  that  which  we  owe  to  the  ingenuity  of  Dr. 
Greenhalgh.  In  this  form  the  anterior  end  is  square,  and 
formed  by  connecting  the  extremities  of  the  lateral  limbs 
by  pliable  india-rubber.  This  form  differs  essentially,  in  the 
mechanism  by  which  it  is  retained,  from  the  original  pessary 
of  Hodge.  Its  especial  utility  is  in  cases  in  which  the  in¬ 
tegrity  of  the  vagina  has  been  so  destroyed  by  parturient 
inj  uries,  its  tone  relaxed,  and  its  lower  orifice  widened,  that 
it  will  not  retain  a  pessary  by  the  mere  coaptation  of  its  walls. 
The  lower  end  of  Greenhalgh’s  instrument  can  be  made  very 
wide,  and  yet  its  sides  can  be  pressed  together  during  its  in¬ 
troduction,  so  that  it  can  be  put  in  without  pain ;  and  when 
in  position,  the  spring  makes  it  regain  its  shape.  It  is  kept 
in  place  by  the  pressure  of  its  two  anterior  corners  against, 
the  sides  of  the  vaginal  orifice,  supported  by  the  rami  of  the, 
pubes.  Its  disadvantages  are  those  common  to  all  india- 


(c)  Op.  cit.,  page  399. 


( 1)  Op.  cit.,  page  413. 


Medical  Times  and  Gazette. 


MEDICAL  AND  SUEGICAL  PEACTICE. 


Nov.  21,  1883.  597 


rubber  pessaries.  A  variety  which  is  retained  by  the  same 
mechanism,  and  which  is  commonly  used  for  uterine  pro¬ 
lapse,  is  that  in  which  the  anterior  of  the  two  curves  which 
give  Hodge’s  invention  its  sigmoid  shape  is  dispensed  with, 
•or  replaced  by  a  curve  in  the  opposite  direction,  so  that  the 
lateral  view  of  the  pessary  resembles  a  C  more  than  an  S. 
The  instrument  is  usually  at  the  same  time  widened.  The 
effect  of  the  change  is  that  the  anterior  end  is  directed  more 
forwards,  and  impinges  on  the  anterior  vaginal  wall  instead 
of  presenting  at  the  vaginal  orifice.  Consequently,  expulsive 
pressure  is  resisted  by  the  sides  of  the  pessary  pressing 
^against  the  sides  of  the  vaginal  orifice.  Under  conditions 
which  make  the  pressure  from  above  greater  than  usual,  this 
instrument,  like  Greenhalgh’s,  presses  on  the  pubic  rami. 


SEQUEL  OF  A  CASE  OF 
FEACTUEED  PATELLA  TEEATED  BY 
MALGAIGNE’S  HOOKS. 

By  H.  EOYES  BELL,  F.E.C.S., 

Surgeon  to  King’s  College  Hospital. 

It  will  not  be  out  of  place  at  the  present  moment  to  draw 
attention  to  several  cases  of  fractured  patella  treated  by 
Malgaigne’s  hooks,  under  the  care  of  the  late  Mr.  Partridge, 
and  reported  in  the  Medical  Times  and  Gazette  as  long  ago 
as  February  15,  1868.(a) 

Case  1. — A  married  woman,  aged  forty-six,  was  admitted 
into  King’s  College  Hospital  on  April  2,  1866,  suffering  from 
a  transverse  fracture  of  her  right  patella,  about  its  middle. 
She  was  seen  immediately  after  the  accident,  when  there 
was  three-quarters  of  an  inch  space  between  the  fragments, 
and  no  effusion.  The  fragments  were  brought  into  apposi¬ 
tion  by  Malgaigne’s  hooks,  which  were  retained  until  May  15, 
when  the  reporter  states  that  the  fragments  had  perfectly 
united  by  bone— at  least,  it  then  appeared  so.  Two  months 
after,  no  trace  of  fracture  could  be  detected. 

“  Case  2  is  of  more  interest,  and  to  it  I  wish  to  call  special 
attention.  Alfred  B.,  aged  thirty-six,  was  admitted  under 
Mr.  Partridge’s  care  on  January  4,  1868,  suffering  from  a 
fracture  of  the  right  patella,  running  transversely,  and  near 
to  the  upper  margin  of  the  bone.  The  fragments  were 
separated  about  two  fingers’  breadth.  There  was  little  or 
no  effusion  into  the  knee-joint.  The  left  patella,  it  was  also 
found,  had  been  broken  transversely  some  six  years  pre¬ 
viously;  the  pieces  were  just  four  inches  asunder.  The 
left  patella  had  been  treated  at  a  neighbouring  hospital 
in  the  usual  way,  and  not  with  ‘  Malgaigne’s  hooks.’  The 
house-surgeon  fastened  the  hooks  into  the  upper  and  lower 
fragments  of  the  right  patella,  and  brought  them  closely  in 
apposition.  The  limb  was  placed  on  a  back-splint,  and  raised 
as  in  the  last  case,  and  evaporating  lotion  applied.  There 
has  been  no  irritation  caused  by  the  apparatus,  nor  has 
there  been  much  effusion  into  the  joint.  The  hooks  have 
not  yet  (February  10)  been  removed,  for  it  is  considered 
always  advisable  to  keep  them  in  for  some  six  weeks,  pro¬ 
vided  that  they  do  not  set  up  irritation ;  but,  to  all  appear¬ 
ance,  bony  union  has,  even  at  this  short  date,  been 
•completed.” 

About  the  final  result  of  the  fii’st  case  I  know  nothing, 
but  the  second  case  has  come  under  observation  several 
times  during  the  last  year  or  two.  The  most  efficient  way, 
next  to  uniting  a  broken  patella  by  means  of  a  wire  suture, 
is  to  bring  the  broken  fragments  together  by  the  use  of 
Malgaigne’s  hooks.  In  the  winter  session  of  1864-65,  when 
House-Surgeon  to  King’s  College  Hospital,  I  applied  them 
to  the  cases  admitted  for  fractured  patella,  and  with  very 
excellent  immediate  results,  with  the  exception  of  one  case 
— that  of  a  woman,  a  playbill-seller  at  Drury-lane  Theatre 
who  was  addicted  to  intemperance.  Unfortunately,  erysi¬ 
pelas  attacked  the  wounds  made  by  the  hooks,  extensive 
cellulitis  of  the  thigh  followed,  and  the  woman  died.  It  is 
advisable  to  avoid  their  use  when  the  patient  is  suspected 
to  be  diseased,  and  if  used  they  might  be  more  safely  applied 
with  antiseptic  precautions.  The  man  alluded  to  above  has 
applied  to  me  several  times,  suffering  from  effusion  into  one 
or  other  of  the  knee-joints,  owing  to  injuries  from  falls. 


The  right  patella  (the  one  treated  by  the  hooks)  is  in  a  better 
condition  than  the  left,  and  has  a  strong  uniting  medium  of 
about  two  inches  of  fibrous  tissue.  The  fragments  of  the 
left  patella  are  separated  for  between  four  and  five  inches, 
and  the  uniting  medium  is  much  thinner  than  that  of  the 
right  patella.  He  is  now  fifty  years  of  age,  and  can  follow 
his  occupation — that  of  an  engineer, —but  is  liable  to  fall  at 
times  and  injure  himself.  A  back-splint  and  the  application 
of  a  lotion  are  all  that  is  found  necessary  to  relieve  him  of 
his  occasional  mishaps.  Like  the  above,  many  of  the  cases 
of  so-called  bony  union  eventually  turn  up  with  ununited 
patella  and  wide  separation  of  the  fragments. 

Queen  Anne-street,  W. 


,  EEPOETS  OF 

HOSPITAL  PRACTICE  IN  MEDICINE 
AND  SURGERY. 

- ♦ - 

ST.  THOMAS’S  HOSPITAL. 

HYDATID  TUMOUE  OF  THE  LIYEE— ANTISEPTIC 
INCISION  INTO  CYST— CUEE. 

(Under  the  care  of  Mr.  CROFT.) 

S.  J.  B.,  a  young  woman  twenty-two  years  of  age,  came  under 
Mr.  Croft’s  care,  from  a  physician’s  ward  in  St.  Thomas’s  Hos¬ 
pital,  on  May  9,  1881.  At  this  time  a  movable  tumour  could 
be  distinguished  in  the  epigastric  region.  On  pressing  the  left 
ribs  when  the  patient  was  recumbent,  the  tumour  was  easily 
passed  into  the  epigastric  region,  and  by  further  pressure  it 
could  be  made  to  glide  as  far  down  as  the  lower  part  of  the 
umbilical  region.  When  all  pressure  was  removed,  the 
tumour  retracted  under  the  left  costal  cartilages.  When 
she  moved  on  to  the  right  side,  the  tumour  shifted  about  two 
inches  and  a  half.  In  the  erect  posture,  gravitation  scarcely 
altered  the  position  of  the  swelling.  The  tumour-dulness 
measured  laterally  about  five  inches,  and  from  above  down¬ 
wards  about  four  inches.  To  the  touch  it  yielded  a  sense  of 
elasticity  and  doubtful  fluctuation.  Manipulation  induced 
nausea  and  a  feeling  of  sickness,  and  she  said  it  was  tender. 
The  liver-dulness  extended  from  half  an  inch  below  the  right 
nipple  to  just  below  the  margin  of  the  ribs,  and  was  con¬ 
tinuous  towards  the  left  with  the  dulness  over  the  tumour. 
She  complained  of  throbbing  in  the  tumour,  but  no  real 
pulsation  existed.  The  abdominal  viscera  were  all  function¬ 
ally  healthy,  and  no  physical  derangement  of  any  of  them 
could  be  detected.  Exploration  of  the  tumour  by  a  trocar 
and  canula  had  been  made  about  a  month  previously,  and 
two  or  three  drops  of  opalescent  fluid  were  drawn  off.  These 
yielded  chlorides,  but  no  albumen  nor  any  cell-growth.  The 
puncture  caused  a  little  pain  and  feeling  of  faintness,  which 
soon  passed  away.  No  change  followed  in  the  tumour. 

Previous  History. — She  had  first  observed  a  swelling 
when  lifting  a  heavy  weight  about  a  year  back.  She  felt  a 
something  rise  in  the  abdomen,  and  since  then  she  had  never 
felt  well.  She  had  experienced  dragging  pains  in  the  left 
side  more  or  less  for  three  years.  She  became  incapable  of 
pursuing  her  occupation  as  a  servant,  being  rendered  sick 
and  faint  by  exertion,  lifting,  standing,  or  walking  for  any 
length  of  time.  The  tumour  had  increased  in  size  notably 
during  the  last  five  months.  Catamenia  had  never  been 
regular.  She  was  a  delicate-looking  woman.  She  had  been 
under  observation  by  various  physicians  since  May,  1880, 
when  she  first  observed  the  tumour.  Her  temperature  had 
been  normal  and  the  kidneys  appeared  healthy. 

On  June  1,  1881,  Mr.  Croft  made  an  exploratory  operation 
with  antiseptic  precautions,  the  patient  being  under  ether. 
An  incision  in  the  median  line  over  the  tumour  soon  dis¬ 
covered  a  pyriform  tumour  of  the  size  of  a  fist  projecting 
from  under  the  front  margin  of  the  liver.  On  the  assumption 
that  it  was  hydatid,  Mr.  Croft  endeavoured  to  extirpate  it, 
but  it  was  so  closely  adherent  to  the  liver,  and  the  parenchyma 
of  the  organ  bled  so  freely,  that  he  abandoned  the  attempt. 
He  next  brought  the  fundus  of  the  tumour  forward  into  the 
wound,  attached  it  by  suture  to  the  edges  of  the  skin,  then 
freely  incised  it  and  turned  out  its  contents.  It  was  densely 
packed  with  hydatids,  but  contained  scarcely  any  fluid. 
Having  completely  emptied  it,  without  having  allowed  any 
of  its  contents  to  escape  into  the  peritoneal  cavity,  he  care- 


(a)  Neale’s  “  Medical  Digest,”  page  (06,  1763-66. 


598 


Medical  Times  and  Gazette. 


PURE  PRACTICE. 


Nov.  24,  1883, 


fully  stitched  the  cut  edges  of  the  cyst  to  the  skin,  cutting 
away  as  much  of  the  cyst- wall  as  could  be  spared.  The  after¬ 
progress  was  perfectly  aseptic  and  satisfactory.  When  the 
edges  of  the  cyst  had  become  safely  united  to  the  abdominal 
wall,  the  full  antiseptic  dressings  were  left  off,  and  suppura¬ 
tion  favoured.  Some  small  pieces  of  the  cyst- wall  necrosed 
and  came  away.  In  September  a  sinus  about  one  inch  and 
a  half  in  length  remained,  and  she  was  allowed  to  go  into 
the  country,  whence  she  had  come.  In  a  few  weeks  the 
sinus  had  closed. 

HYDATID  CYST  IN  THE  THIGH— ANTISEPTIC 
EXTIRPATION — CUKE . 

(Under  the  care  of  Mr.  CROFT.) 

K.  B.,  male,  aged  forty  years,  a  servant  by  occupation  at 
Marlow,  was  admitted  under  Mr.  Croft’s  care  in  St.  Thomas’s 
Hospital  on  June  7,  1880,  recommended  by  Dr.  Gover,  of 
Bishop’s  Stortford. 

The  man  presented  an  obvious  tumour  in  the  inner 
portion  of  the  right  thigh,  in  its  middle  and  upper  thirds. 
It  was  longer  from  above  downwards  than  from  side  to 
side,  the  prominent  part  of  it  measuring  four  inches  in 
length  and  three  in  width.  The  skin  was  not  adherent 
over  it,  and  it  was  quite  movable  among  the  muscles. 
It  was  crossed  by  the  sartorius  and  gracilis  muscles. 
The  internal  saphena  vein  was  dilated  and  thickened, 
and  this  condition  had  not  been  noticed  prior  to  the 
tumour.  The  swelling  was  tense,  elastic,  and  yielded 
fluctuation ;  it  was  free  from  true  pulsation.  He  had 
first  discovered  the  swelling  about  three  years  previously, 
when  it  was  nearly  as  large  as  on  admission.  It  had 
not  caused  him  much  inconvenience  or  any  pain.  The 
neighbouring  glands  were  unaffected.  He  had  enjoyed  good 
health,  led  an  active  life,  and  had  been  in  the  same  service 
for  fifteen  years. 

On  the  16th,  Mr.  Croft  cut  down  upon  the  tumour  after 
Lister’s  antiseptic  method,  and  with  some  difficulty  dissected 
out  the  cyst.  The  fundus  which  presented  in  the  middle  of 
the  thigh  was  prolonged  upwards  beneath  the  adductor 
brevis  muscle,  and  this  necessitated  a  troublesome  dissection . 
The  sheath  of  the  femoral  vessels  was  exposed,  and  some 
adductor  muscular  fibres  were  cut  through.  The  wound 
was  dressed  antiseptically,  and  drainage- tubing  inserted. 
The  cyst,  which  was  flask-shaped,  was  thick -walled  below, 
but  very  thin  above;  it  contained  a  large  quantity  of 
hydatids  and  a  considerable  quantity  of  fluid.  On  the  five 
days  following  the  operation  the  temperature  was  febrile, 
varying  from  100°  to  103°  Fahr.  The  wound  was  dressed 
four  times  (antiseptically)  during  this  period,  and  on  each 
occasion  a  tense  condition  of  the  parts  prevailed.  On  the 
sixth  day  Mr.  Croft  dressed  it,  providing  for  more  free 
drainage,  and  immediately  the  temperature  fell  to  normal. 
The  wound  afterwards  followed  a  perfectly  aseptic  course, 
and  at  the  end  of  three  weeks  the  patient  was  able  to  return 
to  Essex,  cured. 

Remarks  (by  Mr.  Croft). — The  source  of  the  hydatids 
could  not  be  traced  in  either  case.  The  very  small  quantity 
of  fluid  in  the  liver-cyst  is  interesting  so  far  as  it  affected 
the  exploratory  tapping.  The  minute  quantity  of  fluid 
obtained  did  not  yield  sufficiently  positive  indications  with 
regard  to  the  nature  of  the  cyst.  The  special  vibratory 
thrill  of  hydatid  cysts  was  not  obtained  in  either  case. 


Relapse  of  Zona. — Dr.  Fabre  relates  in  the  Gazette 
Medicate,  October  20,  a  case  of  relapse  of  zona,  which  is 
stated  by  all  writers  on  skin  diseases  to  be  of  rare  occur¬ 
rence,  and  which  he  has  only  observed  once  before  in  sixty- 
four  cases  that  he  has  had  in  his  own  practice.  On  the 
first  occasion  of  the  zona  appearing  it  occurred  on  the  right 
leg,  and  sixteen  months  afterwards  it  appeared  on  the  left 
side  of  the  chest.  The  man  who  was  the  subject  of  this 
case  had,  eight  months  before  the  first  appearance  of  the 
zona,  slight  cerebral  haemorrhage,  which  was  followed  by  a 
certain  degree  of  hemiplegia  on  the  right  side ;  and  Drs. 
Duncan  and  Payne  have  each  related  a  case  in  which  zona 
occurred  on  the  same  side  as  a  preceding  hemiplegia.  Dr. 
Barthes  in  1874  published  a  case  in  which  the  zona  was  on 
the  same  side  as  the  hemiplegia,  and  Dr.  Fabre  has  also  met 
with  a  similar  instance.  In  his  present  case,  the  first  attack 
of  zona  occurred  on  the  same  side,  and  the  second  attack  on 
the  opposite  side. 


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♦ 


SATURDAY,  NOVEMBER  24,  1883. 


PURE  PRACTICE. 

The  question  of  the  rights  and  wrongs  of  “  general  prac¬ 
titioners  ”  and  “  consultants  ” — their  relations  to  one  another 
and  to  their  patients — seems  to  rise  ever  and  anon  to  the 
surface,  and  to  be  a  subject  of  perennial  interest,  if  we  may 
judge  from  the  discussion  which  it  evokes,  to  many  members 
of  our  profession.  Quite  recently,  a  paper  read  by  Dr.  Newth 
before  a  branch  of  the  British  Medical  Association  has  drawn 
forth  comments  and  letters  from  various  quarters.  The- 
question  considered  by  Dr.  Newth — that  of  the  possibility 
of  establishing  in  the  profession  a  class  of  “  pure  consul¬ 
tants” — is  one  which  appears  to  us  even  now  to  come* 
scarcely  within  the  field  of  practical  possibilities.  It  would 
be  well,  no  doubt,  for  us  all— for  the  profession  and  for  the 
public — if  a  separate  class  of  consulting  physicians  and 
surgeons  could  exist,  whose  work  should  be  found  ex¬ 
clusively  in  what  is  known  as  “pure  practice”  in  their 
respective  branches.  It  might  be  well  even  if  the 
Royal  Colleges  of  Physicians  and  Surgeons  should  reserve 
their  fellowships  for  those  who  should  thus  take  rank  as  a 
separate  and  leading  grade  in  the  profession  ;  well,  too, 
if  this  grade  of  honour  should  contain  those  only  who,  by 
their  work  as  authors  or  professors,  or  by  the  high  and- 
peculiar  excellence  attained  by  them  while  in  the  lower  or 
general  ranks  of  our  body,  should  have  gained  the  excep¬ 
tional  esteem  and  confidence  of  the  profession  as  a  whole.. 
Such  a  class  of  pure  consultants  would  no  doubt  reflect 
credit  upon  us  all.  Their  talents  and  qualities  would  so 
command  the  respect  of  their  brethren  that  their  advice* 
would  be  gladly  and  confidently  sought.  Their  remunera¬ 
tion  would  be  by  a  scale  of  fees  which,  while  it  should  endue- 
them  with  much  of  the  respect  which  any  article  of  high* 
value  will  command,  should  place  them  beyond  all  sus¬ 
picion  of  competition  with  the  ordinary  practitioners  of  medi¬ 
cine.  All  these,  however,  are  details  of  a  scheme  which  is. 
probably  impossible  of  realisation  ;  and  for  this  reason 
above  all,  that  the  voice  of  the  public  and  their  influence; 


Medical  Times  and  Gazette, 


THE  SODIUM  NITRITE  RESEARCH. 


Nov.  24, 1883.  5  9  9 


could  never  be  enlisted  for  the  establishment  and  main¬ 
tenance  of  such  a  class  as  we  have  indicated.  The  position  of 
consultant  must  ever  be  attained  by  the  action,  combined  or 
separate,  of  three  factors.  First,  the  physician  or  surgeon 
himself.  Any  man,  however  inexperienced,  may,  if  his 
means  allow,  take  up  his  position  as  a  pure  consultant,  and 
refuse  all  work  except  what  comes  under  that  head.  True, 
he  may  find  himself  left  without  work,  and  may  descend, 
after  all,  from  his  lofty  and  self-constituted  ideal.  Secondly, 
tthe  public  may,  and  often  do,  elevate  any  man,  not  always 
the  most  worthy,  from  the  ranks  of  the  general  to  that  of 
the  pure  practitioner.  This  is  a  gradual,  but  in  many  cases 
a  sure  and  permanent  process.  And,  thirdly,  the  profession 
«sn  masse  may,  to  a  great  extent,  make  or  mar  any  consultant 
by  seeking  or  by  neglecting  his  advice.  At  any  rate  it  is  clear 
that,  whilst  freedom  of  action  remains  to  the  profession  and 
to  the  public,  a  popular  consultant  might  arise  and  flourish 
outside  the  special  grade  of  honour  (did  such  a  grade  exist), 
.and  that,  on  the  other  hand,  a  consultant  belonging  to  the 
superior  grade  might  be  driven,  by  absence  of  work,  back 
to  the  lower  rank  from  which  he  had  untimely  sprung. 
Either  eventuality  would  discredit  the  reputation  and 
destroy  the  raison  d’etre  of  the  class  of  pure  consultants. 

This,  then,  being  the  case,  and  consultants  being,  as  they 
are,  not  especially  limited  in  their  practice,  but  free,  like 
other  men,  to  practise  their  profession  to  their  own  best 
advantage,  what  are  the  grounds  of  complaint  alleged 
against  them  by  many  general  practitioners?  That  there  is 
in  many  quarters  a  soreness  or  consciousness  of  wrong,  we 
■must,  from  the  correspondence  elicited  by  the  mere  mention 
of  the  subject,  believe.  It  is  from  the  provinces  that  these 
complaints  are  most  loudly  heard,  and  the  provincial  con¬ 
sultants  whose  position  is  most  frequently  assailed.  Matters 
professional  settle  down,  as  other  matters  do,  with  less 
friction  and  clatter  in  the  great  labour  market  of  the  metro¬ 
polis,  though  here  too  the  same  conditions,  if  sought  for, 
may  be  found  to  exist.  The  grounds  of  complaint,  as  im¬ 
plied  in  reviewing  the  correspondence  on  the  subject,  are 
twofold.  First,  that  those  who  engage  nominally  in  pure 
practice  as  physicians  or  as  surgeons  undertake,  if  occasion 
offers,  the  treatment  of  diseases  foreign  to  the  line  of 
•exclusive  practice  which  they  have  adopted ;  and,  secondly, 
that,  while  calling  themselves  consultants,  they  engage  in 
what  is  practically  general  or  family  practice,  and  work 
thus  for  such  fees  as  place  them  in  direct  competition  with 
the  general  practitioner,  from  whom,  nevertheless,  they 
■expect  support.  As  to  the  first  complaint,  there  is  no 
■doubt  that  it  is  in  some  cases  well  founded.  The  consulting 
physician  or  surgeon,  being  generally  attached,  in  provincial 
towns,  to  the  staff  of  the  local  hospital,  derives  a  certain 
prestige  from  such  a  post,  and,  in  accepting  it,  agrees 
tacitly  or  actually  to  confine  himself  either  to  medicine  or 
to  surgery,  as  the  case  may  be,  and,  by  using  the  hospital 
Avards  as  a  field  of  practice,  so  to  devote  himself  to  the 
perfection  of  a  higher  knowledge  of  that  branch  of  his  art 
•as  to  deserve  the  confidence  and  support  of  the  general 
practitioner.  But  we  should  say  that  this  grievance  is  too 
rare  to  deserve  much  notice.  There  must  be  few  consulting 
physicians  who  will,  in  the  ordinary  course  of  practice,  set 
a  broken  bone,  and  but  few  consulting  surgeons  who  will 
attend  on  a  case  of  pneumonia  or  typhoid  fever.  Where 
-such  cases  do  occur,  it  can  hardly  be  wondered  at  that  a 
withdrawal  of  mutual  confidence  and  a  strained  condition 
■of  the  relations  between  consultant  and  general  practitioner 
are  the  result. 

The  second  accusation  against  the  consulting  body  is  one 
which  we  must  allow  to  be  founded  on  fact.  It  involves, 
however,  a  more  comprehensive  issue,  and  it  has  appeared 
tto  ns,  regarding  the  matter  impartially  from  the  points  of 


view  both  of  the  consultant  and  the  general  practitioner, 
that  the  latter  has,  in  fact,  no  legitimate  ground  of  complaint. 
Nothing,  assuredly,  can  be  gained  by  multiplying  points  of 
etiquette,  and  surrounding  medical  practice  with  such 
artificial  restrictions  and  by-laws  as  can  never  stand  the 
strain  of  actual  work.  We  may  be  sure  at  least  of  one 
thing,  that  the  public,  if  these  barriers  be  in  truth  unreal 
and  artificial,  will,  in  any  emergency,  insist  on  their  being 
set  aside.  The  rights  of  the  general  practitioner  cannot  be 
supreme,  and  this  matter  of  the  absolute  distinction  between 
consultant  and  practitioner  is  one  in  which  the  public  voice 
would  soon  make  itself  heard. 

The  general  practitioner  complains  that  the  consultant 
competes  with  him  in  what  is,  in  effect,  general  practice ; 
but  i3  he  ready  to  forego  all  right  of  competing,  should 
occasion  offer,  with  the  consultant  in  the  higher  field  of 
consulting  practice  ?  We  hardly  think  that  he  will  stand 
the  test.  Let  us  take  the  case  of  a  high-class  general 
practitioner  in  any  of  our  large  provincial  towns.  As  time 
goes  on,  and  as  he  rises,  gradually  but  surely,  in  public 
estimation,  he  will  have  various  opportunities  of  enhancing 
his  fame  and  improving  his  status  by  acting,  on  request,  as 
a  consultant  with  some  brother  practitioner.  Will  he  refuse 
this  opportunity  ?  Will  he  reply  to  these  tempting  offers, 
“  I  am  a  general  practitioner ;  I  cannot  act  as  a  consultant, 
or  receive  fees  as  such”?  Of  course  he  will  do  no  such 
thing,  but  will  visit  the  patient,  consult  with  his  profes¬ 
sional  brother,  and  return,  richer  in  pocket  and  in  reputation 
by  the  process.  He  will  thus,  without  question,  encroach 
upon  the  province  of  the  consulting  physician  or  sur¬ 
geon,  and  must  be  willing,  a  fortiori,  to  recognise  the 
right  of  the  consultant  to  equal  freedom  of  action  in 
his  own  lower  sphere  of  independent  practice.  These 
matters  must,  of  necessity,  be  left  to  find  their  own  level ; 
rules  and  restrictions  must  protect  all  alike,  and  a  one¬ 
sided  etiquette  wall  remain  neglected  and  dishonoured.  A 
pure  practitioner  does  not,  of  necessity,  bind  himself  merely 
to  consulting  practice.  Such  a  course,  in  most  provincial  towns 
at  any  rate,  would  lead  to  his  practice  being  soon  more  select 
than  lucrative,  and  his  skill  itself  might  suffer  from  want 
of  means  of  routine  practice  and  observation.  This  grievance 
is  an  unreal  and  unpractical  one,  and  can  be  entertained 
only  by  those,  we  fear,  in  whose  minds  self-interest  has  out¬ 
weighed  justice  and  common  sense.  The  “consultant”  is, 
we  imagine,  a  man  Avho  is,  or  may  be,  consulted — not  one  who 
works  solely  as  a  consultant.  The  term  “pure  practice”  limits 
the  technical  nature  of  his  practice,  not  the  free  field  of 
public  competition  ;  and  the  general  practitioner  would  only 
lower  his  own  status  by  too  clearly  defining  that  of  his 
superior.  In  this,  as  in  other  walks  of  life,  a  man’s  work  is 
worth  simply  what  it  will  fetch,  and  both  pure  and  general 
practitioners  may  be  safely  left  to  put  their  own  value  on 
their  services.  So  long  as  the  consultant,  keeping  loyally 
to  his  selected  field  of  medicine  or  surgery,  acts  courteously, 
justly,  and  honourably  to  the  general  practitioner,  neither 
giving  his  opinion  without  due  reference  and  respect  to  that 
of  the  latter,  nor  seeking  by  any  means  to  attract  the  patient, 
to  the  exclusion  of  the  ordinary  attendant,  so  long  must  he 
be  held  free  from  all  suspicion  of  blame,  and  free  to  conduct 
his  own  practice  to  his  own  best  advantage. 


THE  SODIUM  NITRITE  RESEARCH. 

No  one  can  regret  more  than  we  do  that  Dr.  Murrell’s  full 
reply  to  the  charges  made  against  him  was  so  long  withheld, 
and  that  he  did  not  at  once  state  the  plain  facts  of  the  case, 
viz.,  that  the  cases  he  reported  were  “  the  first  intimation 
he  had  had  from  any  source  that  nitrite  of  sodium  was  a 
toxic  agent,”  and  that  he  “prescribed  it  only  in  those  cases 


600 


Medical  Times  and  Gaxette. 


THE  SODIUM  NITRITE  RESEARCH. 


Nov.  21, 1883- 


in  which  he  was  convinced  that  it  would  prove  useful.” 
These  corrections  once  made,  no  further  charge  can  be 
brought;  against  Dr.  Murrell  of  making  physiological  experi¬ 
ments  on  his  patients,  or  of  inhumanity.  But,  while  we 
gladly  take  this  opportunity  of  expressing  our  regret  if  any 
of  the  remarks  we  felt  it  our  duty  to  make  have  caused 
pain  to  Dr.  Murrell,  we  still  maintain '  that,  so  long  as  only 
the  original  paper  and  Dr.  Murrell’s  letter  in  the  Standard 
of  the  10th  inst.  (which  contained  neither  of  the  two  above 
statements)  were  before  us,  we  were  perfectly  justified 
in  drawing  the  conclusion  that  we  did.  Our  appreciation  of 
the  facts  then  before  us  was  neither  hasty  nor  incorrect :  for 
a  similar  inference  was  implied  in  the  repudiation  of  the 
investigation  by  the  authorities  of  two  London  hospitals, 
one  of  whom,  at  any  rate,  may  be  assumed  to  have  seen  Dr. 
Murrell’s  first  defence ;  and  similar  conclusions  were  drawn 
not  only  by  one  of  the  most  thoughtful  and  well-informed 
of  the  lay  journals,  but  by  every  single  one  of  the  many 
members  of  the  profession  whose  opinion  on  the  subject  we 
had  the  privilege  of  hearing.  In  fact,  the  inference  was 
irresistible,  and  Dr.  Murrell  has  only  himself  and  his 
advisers  to  thank  if  his  action  was  so  long  left  open  to 
misconstruction. 

It  is,  perhaps,  hardly  necessary  to  further  justify  our 
criticisms  ;  bu  the  following  points  may  be  alluded  to : — 

1.  In  their  paper  the  authors,  no  doubt  inadvertently, 
more  than  imply  that  the  drug  was  used  experimentally; 
for  the  words  “  observations”  and  “experiments”  are  used 
interchangeably.  The  “  experiments  ”  on  cats  are  also 
called  “  observations,”  and  the  authors  proceed  to  say, 

“  in  addition  to  these  experiments  we  have  made  some  ob¬ 
servations  clinically.”  2.  In  the  original  paper  not  the 
slightest  hint  is  given  that  the  toxic  properties  of  pure 
nitrite  of  sodium  were  not  well  known  to  the  authors  at  the 
very  outset  of  the  investigation.  Indeed,  it  was  difficult  to 
avoid  inferring  the  opposite  (though  we  now  know  the 
inference  to  have  been  incorrect),  from  their  own  quota¬ 
tion  of  the  trials  of  the  drug  by  Drs.  Ralfe  and  Ramskill, 
which  were  made  widely  known  to  the  profession  at  a 
meeting  of  the  Royal  Medical  and  Chirurgical  Society  in 
November,  1882,  and  were  published  at  the  time  in  the 
medical  journals.  We  now  learn  for  the  first  time  that 
the  investigation  to  which  so  much  exception  has  been 
taken  was  made  more  than  twelve  months  ago,  and  there¬ 
fore  presumably  before  the  results  obtained  by  Drs.  Ralfe  1 
and  Ramskill  were  made  known.  If  so.  Dr.  Murrell  is  to 
be  excused  for  his  ignorance  of  the  toxic  properties  of 
the  drug,  though  one  might  perhaps  deplore  that  he  did 
not  publish  his  own  experiences  sooner,  especially  as  he 
assures  us  that  he  felt  “  that  to  suppress  them  would  be 
little  less  than  criminal.”  3.  In  Dr.  Murrell’s  paper  the 
experiments  on  cats  appeared  to  have  preceded  the  clinical 
observations,  and  as  that  would  be  the  natural  order  in 
every  exact  scientific  investigation,  we,  in  common  with 
every  other  reader  of  the  paper,  were  forced  to  the  con¬ 
clusion  that  Dr.  Murrell  knew  of  the  fatal  effects  of  the 
drug  on  animals  before  he  administered  it  to  his  patients. 
This  was  another  misconception  which  Dr.  Murrell  should 
have  corrected  at  once.  4.  From  the  wording  of  the 
account  of  the  clinical  observations  it  was  impossible  for  the 
reader  to  draw  any  other  inference  than  that  the  patients 
were  as  nearly  as  possible  physiological  subjects — i.e.,  that 
little  or  nothing  was  the  matter  with  them.  What,  one 
could  not  help  asking,  was  the  object  of  stating  that  one 
patient  was  “  suffering  from  a  little  rheumatism  only,” 
if  not  to  accentuate  the  fact  that  the  case  was  to  be  looked 
on  rather  as  a  physiological  than  as  a  clinical  observation  ? 
As  an  instance  of  the  very  different  character  of  the  original 
statement  from  that  which  we  now  gladly  accept,  we  may 


compare  the  paragraph  in  which  the  above  sentence  occurs 
with  the  account  given  of  the  same  case  in  Dr.  Murrell’s 
explanation  : — 

“  Lancet ,”  November  17, 1883,  p.  880, 
The  second  patient  (who'  re¬ 
turned)  was  a  man  who,  as  it  sub¬ 
sequently  appeared,  suffered  only 
from  a  little  rheumatism,  although 
at  the  time  the  symptoms  resembleds 
closely  those  of  angina  pectoris.  He 
complained  of  the  effects  produced, 
by  the  medicine,  and  said  it  made 
him  “  feel  giddy.”  He  described 
other  symptoms,  but  it  seemed  un¬ 
likely  they  could  have  been  pro¬ 
duced  by  the  drug,  for  it  had  been 
recommended  in  so  much  larger 
doses,  and  I  had.  myself  just  seen 
a  man  who  had  taken  the  very  same 
dose  three  times  a  day  for  a  week 
without  making  any  complaint.  I 
asked  the  patient  how  many  doses 
he  had  taken,  and  he  said  only  one^ 
I  advised  him  to  try  it  again,  but 
he  declined,  adding  jokingly  that 
he  had  “  a  wife  and  family.” 

If  Dr.  Murrell  has  successfully  met  the  charge  of  in¬ 
humanity,  his  defence  has  not  touched — in  fact,  it  has  rather 
given  fresh  force  to — the  charge  of  indiscretion.  For,  in 
the  first  place,  we  now  find  that  he  gave  a  drug,  of  which 
he  knew  next  to  nothing  except  that  it  belonged  to  a  class 
of  powerful  poisons,  to  eighteen  different  patients  in  succes¬ 
sion  in  one  week.  A  careful  observe^  would  have  tried  the 
drug  first  upon  a  single  case,  perhaps  upon  himself,  and. 
would  then  have  patiently  awaited  the  result  before  he  pre¬ 
scribed  it  to  others.  Secondly,  having  found  that  the  drug 
given  in  ten-grain  doses  produced  alarming  symptoms  in 
seventeen  out  of  eighteen  patients,  he  forthwith  prescribed 
it  in  five-grain  doses  to  sixteen  patients,  ten  of  whom,  as  it 
turned  out,  were  unable  to  take  it,  and  in  one  of  whom  the 
symptoms  induced  by  it  were  quite  as  serious  as  in  any  of 
the  previous  series  of  cases.  This  single  case  is  sufficient 
to  establish  the  charge  of  indiscretion,  for  any  careful 
therapeutist,  finding  the  drug  in  ten-grain  doses  so  uni¬ 
versally  toxic  in  its  effects,  would  have  dropped  his  dose 
at  once  to  one  grain,  and  then  cautiously  increased  it  until 
he  obtained  physiological  effects.  On  this  point  we  must 
still  adhere  to  our  assertion,  made  a  fortnight  ago,  that  Dr. 
Murrell’s  mode  of  conducting  out-patient  practice  is  "  alto¬ 
gether  exceptional,  and  would  not  meet  with  the  approval 
of  half  a  dozen  doctors  in  the  metropolis.” 

A  few  remarks,  in  conclusion,  on  the  general  character 
of  the  research,  which  it  would  be  inaccurate  to  term 
scientific.  Everyone  who  has  experience  of  hospital  prac¬ 
tice  knows  that  it  is  impossible  to  obtain  in  the  out-patient 
room  observations  or  data  sufficiently  accurate  to  warrant 
any  scientific  induction  worthy  of  the  name ;  and  the  hasty 
generalisations  made  from  the  unreliable  statements  of 
out-patients,  and  from  carelessly  noted  impressions,  have 
done  more  than  anything  else  to  retard  the  extension 
of  just  views  of  therapeutics.  Books  and  journals  of 
therapeutics  teem  with  assertions  founded  on  evidence 
which  true  scientific  investigators,  such  as  those  who  are 
now  so  successfully  exploring  the  unknown  fields  of  physi¬ 
ology,  clinical  medicine,  and  pathology,  would  not  look 
at.  Dr.  Law  treated  successfully  one  case  of  epilepsy — a 
disease  known  often  to  benefit  for  a  time  under  any  change 
of  treatment — with  an  impure  sample  of  sodium  nitrite ; 
and  this  single  observation  is  extolled  as  “  clinical  expe¬ 
rience  of  the  valuable  uses  of  nitrite  of  sodium  in  epilepsy.’” 
This  kind  of  unconsidered  statement  is  as  little  likely  to 
further  the  cause  of  science  and  humanity  as  the  brilliant 
and  eloquent  special  pleading  of  the  British  Medical  Journal 


“  Lancet ,”  November  3,  18S3,  p.  767. 

One  man,  a  burly,  strong  fellow, 
suffering  from  a  little  rheumatism 
only,  said  that  after  taking  the  first 
dose  he  “  felt  giddy,”  as  if  he  would 
“  go  off  insensible.”  His  lips,  face, 
and  hands  turned  blue,  and  he  had 
to  lie  down  for  an  hour  and  a  half 
before  he  dared  move.  His  heart 
fluttered,  and  he  suffered  from 
throbbing  pains  in  the  head.  He 
was  urged  to  try  another  dose,  but 
declined  on  the  ground  that  he  had 


Sledical  Times  and  Gazette. 


CHRONICLE  OF  THE  WEEK. 


Nov.  24, 18ES.  601 


is  to  further  the  cause  of  Dr.  Murrell.  A  temperate  state¬ 
ment  in  half  a  dozen  lines  of  the  two  facts  which  we  have 
quoted  at  the  beginning  of  this  article,  if  made  as 
'soon  as  the  Standard  published  its  criticisms,  or  indeed  in 
the  course  of  the  previous  week,  would  have  done  more  to 
clear  Dr.  Murrell’s  reputation,  and  to  rehabilitate  that  of 
the  profession,  than  all  this  belated  rhetoric.  But  what 
strikes  us  more  than  anything  in  the  article  we  are  referring 
to,  is  its  entire  inability  to  appreciate  and  give  us  and  others 
of  Dr.  Murrell’s  critics  credit  for  any  honesty  of  purpose 
or  single-hearted  desire  to  clear  the  profession  of  an  un¬ 
deserved  slur.  Indeed,  it  would  appear  that  this  aspect  of 
the  question  is  for  our  contemporary  non-existent.  We  are 
as  anxious  as  the  writer  of  the  article  in  question  that  no 
injustice  should  be  done  to  anyone,  but  it  seems  to  us  a 
higher  object  to  keep  unstained  the  moral  reputation  of  the 
whole,  than  to  secure  immunity  from  criticism  for  any 
single  individual,  especially  when  that  individual  has  laid 
himself  so  open  to  criticism  as  did  Dr.  Murrell.  We  are 
not  alone  in  regretting  the  line  taken  by  the  journal  of 
the  Association,  and  in  thinking  that  in  this  particular 
.instance  the  profession  has  not  been  well  served  by  it. 


CHRONICLE  OP  THE  WEEK. 

- -c - 

The  past  week  has  been  marked  by  a  sad  and,  to  most, 
an  unexpected  event.  There  is  in  life  no  more  pathetic 
•occurrence  than  the  death  of  a  physician  or  surgeon 
at  the  epoch  when  the  hard  and  hopeless  toil  of  youth 
is  over,  and  the  success  of  middle  life,  which  it  has  won,  has 
just  begun.  None  of  his  contemporaries  worked  with  more 
Tpetseverance  and  with  better  results  than  Dr.  Hiitou 
iPagge,  and  none  had  better  promise  of  taking  a  leading 
Iplace  in  the  profession.  Re  wai  a  worthy  pupil  and  She- 
•censor  of  the  men  who  have  made  Guy’s  Hospital  the  chief 
home  in  England  of  clinical  medicine  and  pathology.  His 
work,  whether  at  Guy’s,  at  the  Evelina,  at  the  societies, 
or  on  the  annual  Committee  of  Convocation  of  the  London 
University,  was  admirable.  The  profession,  and  especially 
the  Guy’s  students,  have  suffered  an  irreparable  loss  in  the 
death  of  Hilton  Fagge- 


It  really  seems  more  than  a  pity  that  such  a  paper  as 
■that  which  Mr.  J.  B.  Sutton  communicated  to  the  Patho¬ 
logical  Society  last  Tuesday,  on  Tuberculosis  (so-called) 
in  Birds,  should  have  been  hurried  through  in  so  uncere¬ 
monious  a  manner  at  the  fag-end  of  the  meeting.  That  it 
was  appreciated  by  those  present  was  evidenced  by  the  quite 
unusual  applause  which  followed  its  conclusion,  and  it  is  to 
be  hoped  that,  when  Mr.  Sutton  brings  forward  his  further 
communication  on  the  same  subject,  some  opportunity  will  be 
afforded  to  members  of  the  Society  of  discussing  a  question 
of  such  vast  importance.  It  was,  we  believe,  the  first  attempt 
on  a  large  scale  to  identify  the  tuberculosis  of  birds  as 
synonymous  with  that  of  the  human  species;  and  as 
Dr.  Gibbes  has  ascertained  the  presence  of  tubercle-bacilli 
in  the  various  viscera  submitted  for  his  examination,  there 
•would  seem  to  be  little  room  for  doubt  on  the  subject.  The 
greater  portion  of  the  evening  was  taken  up  with  the  account 
■of  Mr.  Durham’s  very  interesting  cases  of  the  development 
■of  bone-tissue  in  the  midst  of  sarcomatous  growths,  and 
•by  the  discussion  which  ensued  in  reference  to  them.  Dr. 
Hale  White’s  specimen  of  atrophied  pelvis  was  no  doubt 
remarkable,  but  lacked  much  of  the  value  it  otherwise  would 
have  possessed,  for  want  of  a  more  complete  history.  Dr. 
Angel  Money  read  the  notes  of  a  case  of  necrosis  of  the 
superior  maxilla  in  a  boy  at  the  termination  of  an  attack  of 


typhoid  fever ;  and  Mr.  Eve  showed  some  sections  from  an 
unusually  large  pedunculated  adenoma. 


At  the  meeting  of  the  Society  of  Medical  Officers  of 
Health  on  Friday  week,  Brigade-Surgeon  Nicholson  read  a 
paper  “On  the  Water-Supply  of  Troops  in  India,”  which 
proved  much  more  interesting  than  might  have  been  antici¬ 
pated.  Papers  on  which  only  experts  dare  speak  are  usually 
dull,  but  Mr.  Nicholson  treated  his  subject  in  a  fresher  style 
than  experts  ordinarily  employ.  As  to  the  influence  of 
drinking-water  as  a  cause  of  disease,  he  was  sceptical  as  to 
this  mode  of  causation  in  gout  and  calculus,  neutral  in  his 
opinion  as  regards  elephantiasis,  and  emphatically  affirm^ 
five  in  respect  to  diseases  caused  by  parasitic  worms.  In 
the  latter  case,  boiling  was  a  safer  preventive  than  filtering. 
On  the  question  of  the  occurrence  of  true  enteric  fever 
amongst  native  Indians,  as  to  which  many  have  held  a 
negative  opinion,  Mr.  Nicholson  declared  that,  even  in  non- 
malarious  districts,  fever  accounted  for  a  large  proportion 
of  native  mortality.  “  The  question  is  important  in  its  bear¬ 
ings  on  the  health  of  English  troops,  and  it  is  strange  that 
it  has  so  long  remained  unsettled.  Soldiers,  especially  on 
newly  arriving,  are  addicted  to  roaming  about  the  bazaars, 
and,  as  the  inhabitants  of  these  places  live  in  a  particularly 
dirty  way,  the  water  with  which  the  soldiers  quench  their 
thirst  is  so  polluted  that  there  is  no  difficulty  in  accounting 
for  outbreaks  of  fever  among  troops.”  After  alluding  to  the 
manner  in  which  the  disease  could  be  spread  by  the  pollu¬ 
tion  of  drinking-water  on  the  march,  Mr.  Nicholson  said 
that  the  mortality  from  cholera  was  largely  connected  with 
travelling  by  road,  and  the  facility  with  which  the  railways 
carried  the  natives  at  low  fares  appeared  to  have  had  a 
material,  effect  in  checking  the  epidemic  form  of  the  dis¬ 
ease.  The  reading  of  the  paper  was  followed  by  a  fairly 
interesting  discussion. 


In  a  letter  issued  last  week,  the  Education  Department 
administers  a  severe  snubbing  to  the  elementary  teachers 
who  had  complained  that  “  educational  over-pressure  ”  in 
primary  schools  was  due  to  the  excessive  requirements  of 
the  Code.  Mr.  Mundella  admits  that  cases  of  over-pressure 
do  occur,  and  that  in  some  instances  more  is  required  of 
individual  pupils  than  they  are  able  to  accomplish;  he 
also  admits  that  part  of  this  pressure  is  caused  by  irre¬ 
gular  attendance  during  the  children’s  early  years,  which 
necessitates  over-exertion  when  they  do  come  to  school 
But  he  defends  the  impeached  Code,  and  hints  gently 
that  the  fault  is  with  the  teachers.  “Irregularity,”  he 
avers,  “is  one  of  the  marks  of  an  inefficient  school.  A 
good  teacher  is  the  best  attendance  officer  in  the  district.” 
He  further  states  his  belief  that  the  course  of  instruc¬ 
tion  under  the  Code  can  be  easily  mastered  by  a  child  of 
ordinary  health  and  intelligence,  who  attends  school  with 
fair  regularity.  If  a  teacher  fails  to  distribute  the  work 
fairly  over  the  whole  period  of  the  scholar’s  attendance,  or 
to  teach  diligently  throughout  the  school-year,  he  neces¬ 
sarily  resorts  to  a  system  of  special  effort  and  preparation 
during  the  few  weeks  or  months  immediately  preceding  the 
inspector’s  visit.  This  leads  to  his  “  keeping  in  ”  his 
scholars  for  an  unreasonable  length  of  time  in  excess  of  the 
ordinary  school-hours.  This  practice  is  on  many  grounds 
objectionable,  more  especially  in  the  case  of  younger 
children.  As  to  home  lessons,  Mr.  Muridella  holds  that  for 
delicate  or  very  young  children  they  are  plainly  unsuit¬ 
able,  but  in  the  upper  classes  of  good  schools  they  are,  under 
certain  conditions,  open  to  no  practical  objection.  In  con¬ 
clusion,  it  is  maintained  that  the  over- pressure  is  caused 
not  by  the  Code  itself,  which  requires  much  less  than  is 


602 


Medical  Times  and  Gazette. 


CHRONICLE  OF  THE  WEEK. 


Nov.  24,  1883-- 


required  of  foreign  children,  but  by  the  inconsiderate 
manner  in  which  its  provisions  are  used  for  the  purpose 
of  obtaining  high  grants.  Mr.  Mundella  has  not  dealt 
with  the  objections  of  the  medical  critics,  which  were 
directed  not  so  much  to  the  quantity  as  to  the  quality  of 
primary  education.  “  Their  lordships”  are  still  evidently 
possessed  by  the  German  ideal  of  education,  and  ignore  the 
fact  that  “memory,”  which  is  the  only  faculty  that  can 
give  “  results  ”  such  as  an  average  inspector  can  appreciate, 
is  not  the  only  faculty  worth  educating.  The  best  results 
do  not  admit  of  immediate  appraisal.  The  true  “  results  ” 
will  have  to  be  looked  for  years  hence  in  the  records  of 
prisons  and  hospitals. 


“  O  for  a  world  without  germs  !  ”  How  many  an  ardent 
hygienist  and  Listerian  must  have  uttered  that  aspiration 
with  a  sigh  as  he  realised  how  impossible  is  his  ideal.  Pro¬ 
bably  he  does  not  pause  to  consider  whether  the  world 
could  get  on  without  them ;  he  has  not  the  open  mind  of 
the  American  humourist  who  saw  wisdom  even  in  measles. 
The  biologist,  on  the  other  hand,  will  be  inclined  to  make 
much  of  germs ;  they  came  on  the  scene  before  man,  and 
will  probably  outlive  him ;  they  are  necessary  to  the 
balance  of  life  on  the  earth,  and  where  refuse  lies  thick  are 
as  much  in  place  as  dogs  in  an  Eastern  city  or  vultures  in 
the  desert.  Man’s  best  way  of  dealing  with  them  is  not  to 
fight  them  so  much  as  to  starve  them.  Cut  off  their  diet 
and  they  will  disappear. 


Among  the  mountains,  we  are  told  by  Freudenreich,  there 
are  no  germs ;  on  Labe  Thun  there  is  scarcely  one  to  each 
litre  of  air;  in  a  room  in  Thun  Town,  sixty  in  the  same 
amount  of  air.  Contrast  these  figures  with  Miguel’s  results, 
viz.,  at  Montsouris  observatory  760  germs  per  litre  of  air,  and 
in  the  Eue  de  Eivoli  5500.  The  reason  for  this  strange 
difference  is  doubtless  that  up  in  the  mountains  the  germs 
are  starved,  whereas  in  a  town  street  they  increase  and 
multiply  up  to  the  food  limit— the  Malthusian  theory  being, 
no  doubt,  true  of  germs  if  of  nothing  else.  Expose  a  carcase 
on  the  top  of  the  Schilthorn,  and  see  if  the  air  around  it  will 
not  soon  teem  with  germs,  flocking  down  on  it  like  vultures 
out  of  the  blue.  The  converse  of  the  experiment — the 
removal  of  all  food  out  of  the  way  of  germs — is  what  sani¬ 
tarians  are  constantly  attempting  at  lower  levels*  with,  as 
yet,  but  moderate  success. 


But  if  you  cannot  kill  germs  by  starvation,  you  may  do 
it  by  poison.  Unfortunately,  we  have  not  yet  discovered  a 
substance  that  will  attack  them  in  the  air,  which  will  not 
also  impartially  attack  the  lungs  of  any  individual,  be  he 
sick  or  healthy,  who  occupies  the  room  in  which  the  attack 
is  made.  This  much  seemed  to  be  admitted  in  the  dis¬ 
cussion  which  followed  Dr.  Eobert  J.  Lee’s  interesting 
lecture  at  the  Parkes  Museum  on  Thursday  week.  As  an 
executioner  of  germs.  Dr.  Lee  has  made  many  experiments, 
and  he  can  report  clinical  observations  to  which  not  even 
the  absurd  quixotism  of  the  Medical  Times  can  take  ex¬ 
ception.  He  still  holds  to  carbolic  acid,  and,  as  the 
result  of  his  experiments,  considers  that  the  vapour  of  a 
2  per  cent,  solution  of  cai’bolic  acid  will  destroy  germs  in 
the  air.  But  the  practical  point  of  the  lecture  was  to  warn 
people  against  putting  their  trust  in  saucerfuls  of  solution 
of  carbolic  acid  or  Condy  placed  about  a  room.  They  give  a 
false  sense  of  security,  and  are  worse  than  useless.  In  short, 
if  we  want  to  strangle  germs,  we  must  go  after  them. 
They  have  more  sense  than  flies,  and  will  not  come  to  be 
poisoned. 


The  contributions  to  this  week’s  French  journals  are  both 
numerous  and  important.  The  Revue  de  Mddecine  contains 
a  paper  on  Nephritis  determined  by  Compression  of  the 
Ureters  in  the  course  of  Cancer  of  the  Uterus,  and  Conse¬ 
cutive  Hypertrophy  of  the  Heart,  by  M.  G.  Artaud ;  a  case 
of  Primary  Encysted  Cancer  of  the  Liver,  Secondary  Cancer 
of  the  Lymphatic  Glands  of  the  Hilum  and  Vena  Portae,  by 
MM.  Hayem  and  Gilbert ;  a  note  on  a  case  of  Chronic 
Diffuse  Myelitis  complicated  with  Apoplectiform  Seizures, 
followed  by  Death,  by  M.  Girandeau  ;  and  the  continuation 
of  two  papers  which  appeared  in  a  former  number,  viz.,  M. 
Ollivier’s  contribution  to  the  history  of  Typhoid  Orchitis, 
and  the  experimental  researches  on  the  Infectious  Disease 
called  Charbon,  by  MM.  Arloing,  Cornevin,  and  Thomas. 
The  Revue  de  Chirurgie  contains  an  article  on  the  Cancerous 
Taint,  by  M.  Nicaise ;  a  paper  by  M.  Trifaud  on  Gangrene, 
and  a  note  on  the  presence  of  Bacilli  in  Surgical  Lesions, 
by  M.  Bouilly.  In  the  Progres  Medical  we  find  a  continua¬ 
tion  of  M.  Debove’s  lectures  on  Parasitic  Tuberculosis,  and 
a  report  by  M.  Paul  Blocq  on  a  New  Dressing  for  Surgical 
Purposes,  which  goes  by  the  name  of  “  helenol ”  (it  is 
claimed  for  it  that  it  is  an  antiseptic  without  caustic  or 
toxic  properties,  and  without  an  unpleasant  odour)  ;  as  well 
as  brief  notices  of  the  opening  lectures  by  MM.  See,  Potain, 
Cornil,  J.  Simon,  Terrillon,  Budin,  Landouzy,  Blanchard, 
and  Duval.  In  the  Gazette  Hebdomadaire,  M.  E.  Kirmisson 
describes  a  case  of  Cirrhosis  of  the  Liver,  and  M.  J. 
Meneault  records  a  Quintuple  Birth.  The  Concours  Medical 
contains  some  Therapeutic  Indications  for  certain  Diseases 
of  the  Skin,  by  M.  Armand  Eizat;  and  some  notes  by  M- 
Paul  Gerne  on  the  Plan  to  be  adopted  in  a  case  of  Abortion- 


The  Centralblatt  fur  Klinische  Medicin  contains  ab¬ 
stracts  of  papers — by  Sattler,  on  Jequirity  Ophthalmia  ;  by 
Scheube,  on  Filaria  Sanguinis  Hominis ;  by  Veronese  and 
Obersteiner,  respectively,  on  the  Eelation  of  Syphilis  to 
Diseases  of  the  Nervous  System  and  Paralysis.  In  tires 
Centralblatt  fur  die  Medicinischen  Wissenschaften  appears; 
an  original  paper  by  Bikfalvi,  on  the  Employment  of  Gastric' 
Digestion  as  a  means  of  Isolation  (of  cellular  elements  in 
histological  researches)  :  abstracts  of  papers— by  Pfalz,  on 
the  Eeaction  of  Heat  and  Electricity  on  Unstriped  Muscular 
Fibre;  by  Burckhardt,  on  the  Chemistry  and  Physi¬ 
ology  of  the  Serum  of  the  Blood;  by  Schreiber,  on  Intra- 
thoracic  and  Intra-abdominal  Pressure ;  and  by  Onimus, 
on  Electrisation  of  the  Uterus— are  also  published.  The  Cen¬ 
tralblatt  fur  Chirurgie  publishes  abstracts  of  papers — by 
Feoktistow,  Pokrowski,  and  Petersen,  on  the  Treatment  of 
Bubo ;  by  David,  on  Growths  in  the  Naso-Pharynx ;  by 
Albrecht,  on  Hare-Lip ;  by  Clos,  on  Intestinal  Invagination 
produced  by  Tumours.  The  Centralblatt  fur  Gynakologie 
contains  original  papers — on  Ophthalmia  Neonatorum,  by 
Dr.  Haidlen,  of  Stuttgart;  and  on  Inversio  Uteri,  by  Dr. 
Lauenstein,  of  Hamburg :  abstracts  of  papers  by  von 
Nussbaum  and  Eder,  respectively,  on  Ignipuncture,  are  of 
interest.  In  the  Berliner  Klinische  Wochenschrift  is  pub¬ 
lished  an  address  by  Dr.  Kirn  on  Chloral  Psychoses ;  the 
papers  by  Dr.  Semon  on  Laryngeal  Paralysis,  and  by  Dr. 
Bidder  on  the  Eelations  of  Alkali  Foods  to  Tuberculosis, 
are  continued  and  concluded.  Dr.  Karl  Braun  von  Fernwald 
concludes  in  the  Wiener  Medizinische  Wochenschrift  hi3 
account  of  twelve  cases  of  Caesarian  Section  ;  Dr.  Herz  con¬ 
tinues  his  critical  sketch  of  the  Modern  Medication  of 
Diphtheria ;  Dr.  Patzelt,  of  Bucharest,  communicates  a  case- 
of  Gastrotomy. 

The  current  (November)  number  of  the  Archives  Gdndrales 
de  Medecine  is  more  than  usually  interesting  as  to  original  com¬ 
munications.  Dr.  Kirmisson  contributes  an  article  on  the 


Meiical  Times  and  Gazette. 


ANNOTATIONS. 


Nov,  24, 1883.  603 


“  Influence  of  Traumatism  in  the  Development  of  Hydatid 
Cysts.”  After  reviewing  previous  work  on  the  subject,  most 
of  which  seemed  to  indicate  that  there  is  a  pretty  constant 
element  of  traumatism,  he  contributes  a  further  personal 
case  “  of  hydatid  cyst  in  the  liver,  the  evolution  of  which 
was  intimately  associated  with  an  accident  that  had  befallen 
the  patient.”  Contusions  of  the  liver,  or  ruptures  (slight 
or  severe),  can  hardly  take  place  without  some  haemor¬ 
rhage,  and  it  is  argued  that  with  the  blood  escape  also  the 
embryos  of  the  taenia.  It  is  proved  by  experiment  that 
the  fluid  portion  may  be  injected  into  the  veins  of  dogs 
without  leading  to  the  development  of  hydatids,  and,  this 
being  so,  the  explanation  here  offered  seems  both  reason¬ 
able  and  probable.  Dr.  Parinaud  discusses  “Interstitial 
Keratitis  and  Hereditary  Syphilis.”  He  commences  by 
saying  that  “  the  hereditary  syphilitic  origin  of  interstitial 
keratitis,  admitted  by  Hutchinson,  has  been  seriously  dis¬ 
puted,  especially  in  France.  ...”  A  list  of  thirty-two  cases 
with  family  history  follows ;  in  twenty-three  cases  there  is 
an  admission  of  syphilis,  in  seven  others  syphilis  is  probable, 
in  one  it  is  doubtful,  and  in  one  it  is  negatived.  The 
author  thinks  these  statistics  will  settle  the  question  in 
the  future.  After  a  critical  analysis  of  his  cases,  he  con¬ 
cludes  that  this  form  of  keratitis  must  be  considered 
as  the  manifestation  of  syphilis,  attenuated  in  the  parents  ; 
that  it  may  show  itself  fifteen  or  even  twenty  years  after 
birth,  in  subjects  who  have  presented  no  other  specific 
manifestation ;  that  it  is  frequently  associated  with  develop¬ 
mental  troubles  in  the  teeth,  having  a  like  cause  ;  that  it 
is  difficult  to  class  the  disease  among  specific  lesions ;  and, 
finally,  that  it  may  be  due  to  other  than  a  syphilitic  cause. 
Dr.  Netter  has  an  article  on  the  “Irregular  Development  of 
the  Arteries  as  a  Cause  of  various  Morbid  Conditions.”  He 
says,  “  The  affections  of  arteries  play  an  important  part  in 
pathology ;  they  act  less  often  directly  than  by  the  interme¬ 
diary  of  the  organs  to  which  they  are  distributed.”  In  support 
of  his  theory,  he  analyses  the  effects  of  congenital  atresia,  or 
absence  or  modification  in  size  of  the  vessels  on  the  various 
organs  of  the  body,  and  certainly  makes  out  a  primd  facie 
case  in  favour  of  his  thesis.  Dr.  J.  Comby  contributes  the 
first  half  of  a  paper  on  “  Pulsating  Empyemata,”  which  is  of 
great  interest  and  worthy  of  a  more  extended  notice.  This 
we  shall  defer  until  the  article  is  complete. 


THE  HISTORY  OF  MEDICINE. 

The  appearance  of  Dr.  Theodore  Puschmann’s  admirable 
history  of  the  Vienna  School  of  Medicine  coincidently 
with  the  publication  of  Dr.  Payne’s  conscientious  article 
in  the  sixteenth  volume  of  the  “Encyclopedia  Britannica” 
suggests  the  question  why  the  history  of  medicine  has  been 
so  absolutely  neglected.  Other  sciences  have  had  their  his¬ 
torians,  but  until  Dr.  Payne’s  essay  appeared  there  was  no 
single  comprehensive  account  in  the  English  language  of 
the  evolution  of  medicine  as  a  science,  and  almost  the  only 
persons  ever  known  to  study  it  were  inaugural  lectures  at 
their  wits’  end  for  something  to  say.  If  there  is  nothing 
that  can  be  made  so  wearisome  by  a  dull  lecturer  or  a  vapid 
author  as  the  dry  bones  of  medical  history,  it  is  equally 
true  that  in  the  hands  of  an  able  and  sympathetic  author 
there  is  nothing  that  could  be  made  so  interesting.  The  able 
monographs  on  the  history  of  certain  surgical  subjects 
published  some  years  ago  by  Dr.  Albert,  of  Vienna,  were 
a  proof  of  this ;  and  some  day,  no  doubt,  an  author 
will  arise  in  this  country  who  will  carry  us  along  with 
him  while  he  traces  the  development  of  medicine  from 
its  dark  and  questionable  beginnings  up  to  its  present 
honoured  position.  A  worthy  history  of  medicine  would 
not  be  a  history  of  medicine  alone,  for  as  medicine  has  been 


justly  termed  “the  mother  of  the  sciences,”  an  account  of 
its  development  would  show  how  chemistry,  physics,  botany, 
and  even  philosophy,  have  all  received  their  initial  impulse 
from  the  efforts  of  man  to  alleviate  the  sufferings  of  his 
fellows.  There  is  one  explanation  why  so  little  attention  has 
hitherto  been  devoted  to  the  subject,  which  is  a  little  con¬ 
soling.  History  does  not  usually  flourish  in  times  of  great 
activity.  While  discovery  is  progressing,  men  are  looking 
forward  too  intently  to  find  time  for  looking  back.  Flourish¬ 
ing  arts  have  seldom  found  their  historian  till  they  were 
already  beginning  to  decay,  and  possibly  no  great  medical 
historian  will  arise  until  the  progress  of  medicine  has  been 
arrested,  and  men  are  content  to  dwell  rather  on  the 
conquests  of  the  past  than  on  the  achievements  of  the 
future. 


THE  LATE  DIFFICULTIES  AT  ST.  JOHN’S  HOUSE. 

Bather  late  in  the  day,  when  the  heat  of  public  feeling 
has  somewhat  diminished,  and  only  those  immediately  con¬ 
cerned  continue  to  have  the  facts  fresh  in  their  memory,  the 
Council  of  St.  John’s  House  append  to  their  report  for  the 
year  their  version  of  justification  of  their  action  during  the 
summer  months.  It  may  be  questioned  whether  any  justi¬ 
fication  was  needed  further  than  that  already  furnished 
unwittingly  by  the  Sisters  themselves.  The  present  pamphlet 
(much  shorter  than  the  former)  proves  the  correctness  of 
the  deductions  formulated  in  the  article  in  the  Times  last 
August.  It  is  calm  and  dignified  in  tone ;  pathetically 
forgiving  in  some  passages  ;  but  as  a  whole  its  plain  state¬ 
ment  of  facts  can  leave  no  doubt  as  to  the  urgent  need  for 
the  radical  changes  then  effected.  Letters  now  published 
for  the  first  time  show  that  prompt  action  was  the  only 
course  open  last  July.  Efforts  were  being  made  to  tempt 
the  nurses  from  their  duties  by  offers  of  better  clothes  and 
higher  wages,  and  forcible  language  was  not  spared  in  criti¬ 
cising  the  authorities  of  the  institution.  The  Council  of 
St.  John’s  House  is  certainly  to  be  congratulated  on  having 
firmly  maintained  its  principles  without  having  been 
compelled  to  stop  work  even  temporarily. 


AN  UNUSUAL  CASE  OF  TETANUS. 

Mr.  Payne,  the  Southwark  Coroner,  held  an  inquest  on 
Monday  last  on  the  body  of  a  boy,  aged  nine  years,  who 
had  died  in  Huy’s  Hospital  from  tetanus  two  days  after  a 
fall  from  a  ladder.  Mr.  Dendy,  the  House-Surgeon,  in  his 
evidence,  said  that  they  had  been  unable  to  trace  the  least 
scratch  or  wound,  or  even  sign  that  the  deceased  had  had  a 
fall,  except  that  pressure  about  the  neck  appeared  to  give 
him  pain.  Nor  did  the  autopsy  show  any  injury,  either 
local  or  to  the  spinal  cord  or  elsewhere.  The  occurrence  of 
tetanus  without  breach  of  surface  is  very  unusual  in  this 
country.  When  it  does,  however,  take  place,  it  usually  fol¬ 
lows  blows  or  falls  on  the  back  of  the  head  or  on  the  spine- 
The  exact  percentage  of  such  cases  is  not  known.  In  our 
most  reliable  statistics  (those  from  Huy’s  Hospital)  it 
will  be  seen  that  twenty-three  cases  of  tetanus  occurred 
out  of  a  total  of  3668  surgical  lesions,  with  one  case  under 
the  mixed  heading  of  “  Injuries  and  Contusions The 
author  (Mr.  Poland),  however,  says  “  there  is  scarcely  a 
single  lesion  which  may  be  said  to  be  exempt  from  its  attack, 
from  the  simple  bruise  or  graze  to  the  most  severe  compound 
fracture”;  but  he  does  not  further  particularise.  It  is 
therefore  difficult  to  know  whether  to  regard  this  particular 
case  as  idiopathic  or  traumatic  tetanus ;  and,  unfortunately, 
we  get  no  aid  from  the  pathology  of  the  disease,  for  it  is 
considered  by  some  as  due  to  sepsis,  and  by  others  t® 
peripheral  nerve-irritation.  It  would  be  impossible  to  ex¬ 
clude  either  or  both  these  conditions  in  any  given  case,  but 


G04 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Nov.  24, 1883. 


the  latter  doctrine  would  best  fit  with  what  we  at  present 
know  of  this  case.  We  are  not  aware  of  any  points  show¬ 
ing  that  tetanus  is  ever  due  to  direct  lesion  of  the  spinal 
cord.  The  full  report  of  the  case  would  he  of  great  interest. 


INCOMPLETE  FRACTURES  OF  THE  CLAVICLE  AND 
SCAPULA. 

At  the  recent  meeting  of  the  Pathological  Section  of  the 
Irish  Academy  of  Medicine,  Dr.  E.  H.  Bennett  brought 
forward  a  specimen  of  this  rare  result  of  an  accident.  The 
bones  were  taken  from  the  body  of  a  young  man,  aged  nine¬ 
teen,  who  was  killed  by  some  masonry  falling  upon  him. 
The  clavicle  presented  at  its  sternal  end  a  complete  dentate 
fracture,  and  at  its  middle  an  incomplete  fracture  involving 
about  half  the  thickness  of  the  bone.  The  base  of  the  cora¬ 
coid  process  of  the  scapula  presented  a  fracture  of  similar 
character.  Dr.  Bennett  pointed  out  that  his  case  proved 
the  possibility  of  a  green-stick  fracture  occurring  in  the 
clavicle,  which  had  been  denied  by  some  writers  ;  and  it  also 
proved  that  a  green-stick  fracture  was  not  confined  to  child¬ 
hood,  as  had  often  been  asserted. 


THE  FRENCH  CHOLERA  COMMISSION. 

M.  Strauss  has  recently  made  a  preliminary  report  to  the 
Societe  de  Biologie  on  behalf  of  the  French  mission  to  in¬ 
vestigate  the  cholera  in  Egypt.  The  report  includes  the 
study  of  twenty-seven  autopsies  which  were  performed 
within  half  an  hour  of  death,  so  that  putrefaction  may  be 
excluded  as  a  cause  of  any  of  the  changes  which  they  found. 
Examination  of  the  alimentary  canal  gave  the  following 
results : — The  stools  contained  rice-like  bodies,  formed  by 
collections  of  epithelial  cells  affected  with  that  special  form 
of  necrosis  known  as  “  necrosis  of  coagulation  ”;  the  cell- 
contents  were  turbid,  and  the  nuclei  would  not  take  carmine 
or  the  aniline  dyes.  Microscopically,  in  the  contents  of  both 
the  stomach  and  alimentary  canal  were  a  great  many 
microbes.  There  was  superficial  desquamation  of  the 
mucous  membrane  of  the  small  intestine,  most  marked  at 
its  lower  end,  and  the  walls  of  the  intestine  were  found  to 
be  infiltrated  with  microbes,  bacteria,  and  micrococci  of 
various  shapes  and  kinds — some  rather  long,  resembling  the 
microbe  of  charbon ;  others,  in  the  submucous  tissues,  exactly 
like  tubercle-bacilli,  only  rather  smaller.  The  examination 
of  the  liver,  spleen,  kidneys,  and  mesenteric  glands  gave 
negative  results.  The  blood,  however,  was  found  to  be  pro¬ 
foundly  modified;  it  would  not  coagulate,  the  red  corpuscles 
sinking  to  the  bottom,  leaving  a  clear  supernatant  serum. 
Microscopically,  the  leucocytes  were  in  marked  excess,  and 
highly  granular,  the  coloured  corpuscles  being  scattered 
about  instead  of  gathered  into  rouleaux.  Between  them 
were  seen  small,  very  pale,  elongated  bodies,  contracted  in 
the  middle,  extremely  slender,  recalling  the  shape  of  the 
lactic  ferment.  With  the  aid  of  heat  these  bodies  under¬ 
went  proliferation  and  arranged  themselves  in  little  chains. 
The  serum  of  the  blood  was  mostly  found  to  be  extremely 
acid,  and  once  the  fluid  in  the  pericardium  was  noted  to  be 
acid.  Contrasting  the  results  of  the  French  expedition  with 
those  of  the  German,  there  are  two  points  of  difference. 
Koch  could  find  nothing  in  the  blood.  M.  Strauss  found 
small,  badlv-refracting  bodies,  which  did  not  take  the 
colouring  matter  of  the  dyes  well,  and  which  rapidly  multi¬ 
plied  on  the  addition  of  heat,  the  multiplication  taking- 
place  best  in  the  bottom  part  of  the  tube — that  is  to  say,  in 
the  part  least  exposed  to  the  air.  Cultivation  experiments 
with  these  wholly  failed;  still,  taking  into  consideration 
the  general  character  of  cholera,  there  is  a  strong  probability 
that  this  discovery  of  M.  Strauss  and  his  colleagues  is  a  step 
in  the  right  direction.  Koch  described  what  he  believed  to 


be  a  characteristic  microbe  in  the  coats  of  the  intestine. 
The  Frenchmen  have  likewise  seen  this  microbe,  but  com 
sider  it  the  result  of  a  secondary  invasion,  for  they  say  that 
it  does  not  belong  exclusively  to  the  submucous  coat  of  the 
intestines ;  that  its  presence  is  not  constant,  being  only  noted 
in  certain  conditions;  and,  further,  that  it  is  entirely  absent 
in  the  most  malignant  forms  of  cholera,  and  that  it  is  only 
observed  after  the  morbid  process  has  lasted  from  ten  to 
fifteen  days,  and  then  conjointly  with  other  microbes. 
These  reasonings  do  not  appear  to  be  conclusive ;  it  is  clear 
that  further  researches  are  necessary  before  the  point  can 
be  cleared  up.  It  only  remains  to  be  mentioned  that  the 
Frenchmen  have  met  with  no  more  success  than  Koch  did, 
in  their  cultivation  and  inoculation  experiments,  for  they 
have  not  once  succeeded  in  conveying  cholera  to  animals. 


SANITARY  IMPROVEMENTS  IN  NOTTINGHAM. 

The  correspondent  of  a  Nottingham  journal  gives  a  striking 
account  of  the  complete  sanitary  works  which  have  been 
organised  in  the  East  Croft.  Probably  none  is  of  greater 
importance  than  the  efficient  system  adopted  for  dealing 
with  the  contents  of  dry  ashpits,  refuse  from  middens, 
vegetable  market  refuse,  and  rubbish  of  all  kinds,  amount¬ 
ing  to  260  tons  weekly.  This  was  formerly  deposited  in  the 
East  Croft,  but  it  is  now  partly  converted  into  slag  by  the 
heat  of  the  destructor,  and  partly  into  manure  by  the 
machine  described  as  a  “  mortar-mill.”  There  are,  in  addi¬ 
tion,  a  well-arranged  mortuary,  and  every  appliance  for  the 
health  and  comfort  of  the  workmen  engaged.  The  com¬ 
pleteness  of  the  sanitary  works  in  the  East  Croft  is  admitted 
to  be  due  chiefly  to  the  superintendence  of  Dr.  Seaton,  the 
Medical  Officer  of  Health ;  but  the  whole  organisation  is 
under  the  active  supervision  of  the  Sanitary  Authority. 


NEPHRECTOMY  BY  ABDOMINAL  SECTION. 

On  Wednesday,  November  14,  Mr.  Knowsley  Thornton 
performed  nephrectomy  by  Langenbiich’s  incision,  at  the 
Samaritan  Hospital.  The  patient  was  a  young  woman, 
with  a  history  of  seven  years’  renal  trouble.  The  kidney 
(right)  was  much  enlarged,  sacculated,  and  full  of  pus  and 
putty-like  material.  The  bladder  end  of  the  ureter  was 
brought  outside  the  abdomen  and  fastened  in  the  lower  angle 
of  the  wound.  Mr.  Thornton  was  the  first  to  suggest  this 
modification  in  the  operation,  and  thinks  it  of  great  im¬ 
portance  in  avoiding  septic  infection.  The  patient  is  con¬ 
valescing  most  satisfactorily,  without  fever  or  trouble  of 
any  kind,  and  all  the  reflex  urethral  and  bladder  symptoms 
disappeared  immediately  after  the  operation.  This  is  the 
sixth  consecutive  successful  nephrectomy  performed  by  ab¬ 
dominal  section  by  Mr.  Thornton  at  the  Samaritan  Hospital. 


FIRES  IN  HOSPITALS. 

A  short  time  ago  a  fire  occurred  at  St.  Mary’s  Hospital, 
which  would  probably  have  increased  to  a  very  serious 
extent  had  not  the  arrangements  for  the  extinguishing  of 
fire  at  this  institution  been  in  good  working  order.  Smoke 
was  seen  issuing  from  the  floor  over  the  engine-room,  and 
it  was  discovered  that  some  of  the  woodwork  was  on  fire. 
In  various  parts  of  the  building  are  placed  buckets  filled 
with  water,  several  of  which  were  promptly  emptied 
upon  the  smouldering  woodwork,  and  the  fire  was  thus 
extinguished.  Although  a  hospital  or  other  institution 
may  be  well  supplied  with  every  modern  appliance  for 
dealing  with  fires,  and  especially  for  dealing  with  them  in 
their  early  stages,  yet  it  by  no  means  follows  that  such 
appliances  are  kept  in  working  order ;  in  fact,  we  have 
known  such  apparatus  to  be  attached  to  their  places  by 
padlocks,  the  key  being  in  the  possession  of  some  “  respon- 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Nov.  24, 1888.  605 


sible  ”  official.  Such,  a  plan  is,  of  course,  radically  bad. 
Everything— hose,  taps,  etc. — should  be  in  readiness  and 
accessible  for  immediate  use  ;  buckets  should  be  kept  filled 
with  water ;  every  servant  of  the  institution,  and  in  a 
hospital  every  resident  medical  officer  also,  should  know 
how  to  act  in  the  event  of  so  serious  a  calamity  as  the 
occurrence  of  a  fire ;  and  we  strongly  recommend  a  periodical 
“  fire  drill.”  The  importance  of  this  subject  cannot  be 
overrated,  and  it  is  especially  desirable  that  institutions 
where  the  sick,  or  the  crippled,  or  any  other  class  of  more 
or  less  helpless  people  are  housed,  should  be  especially 
protected  from  the  horrible  results  of  fire. 


THE  PARIS  WEEKLY  RETURN. 

The  number  of  deaths  for  the  forty-fifth  week  of  1883, 
terminating  November  6,  was  962  (498  males  and  464 
females),  and  of  these  there  were  from  typhoid  fever  30, 
small-pox  5,  measles  11,  scarlatina  none,  pertussis  6,  diph¬ 
theria  and  croup  34,  erysipelas  2,  and  puerperal  infection  3. 
There  were  also  50  deaths  from  acute  and  tubercular  menin¬ 
gitis,  162  from  phthisis,  38  from  acute  bronchitis,  73  from 
pneumonia,  91  from  infantile  athrepsia  (28  of  the  infants 
having  been  wholly  or  partially  suckled),  and  30  violent 
deaths  (22  males  and  8  females).  Deaths  from  epidemic 
diseases  continue  stationary  and  in  moderate  amount  ; 
while  bronchitis  and  pneumonia,  especially  the  latter,  show 
some  increase,  and  deaths  from  athrepsia  have  risen  from 
69  to  91.  During  the  week  there  were  1233  births,  viz.,  654 
males  (472  legitimate  and  182  illegitimate)  and  579  females 
(414  legitimate  and  165  illegitimate)  :  95  infants  were  either 
born  dead  or  died  within  twenty-four  hours,  viz.,  59  males 
(38  legitimate  and  21  illegitimate)  and  36  females  (26 
legitimate  and  10  illegitimate) . 


DEATHS  FROM  ERYSIPELAS  FOLLOWING  VACCINATION. 

A  protracted  inquiry  was  held  on  the  13th  inst.,  by  the 
Coroner  for  Bury  St.  Edmunds,  at  Great  Cornard,  on  the 
body  of  an  infant  who  became  ill  soon  after  vaccination 
and  died.  Another  child,  who  had  been  vaccinated  with 
the  same  lymph,  had  died  previously.  After  the  death  of 
the  second  child  (the  subject  of  this  inquest),  a  Local 
Government  Board  inquiry  was  solicited,  and  Dr.  Airy  went  to 
Great  Cornard  to  investigate  the  circumstances— an  inquiry 
which  was  not  completed  when  the  inquest  was  held.  Counsel 
appeared  at  the  inquest  for  the  parents  of  the  deceased  child 
(representing,  evidently,  the  Society  for  the  Abolition  of 
Compulsory  Vaccination).  Dr.  Mason,  the  public  vacci¬ 
nator,  deposed  that  the  father  of  the  first  of  the  three  chil¬ 
dren  who  had  died  after  vaccination,  a  man  named  Elliston, 
had  been  suffering  for  some  time  from  a  wound  in  the 
leg,  and  that  subsequently  he  went  into  the  hospital.  The 
lymph  used  for  Elliston’ s  child  was  from  a  child  whose 
parents  are  perfectly  healthy  and  well.  The  same  lymph 
had  been  used  for  other  children  without  any  evil  results. 
The  lymph  used  for  the  child,  the  subject  of  this  inquiry, 
was  taken  from  Elliston’s  child.  Dr.  Mason  visited  the 
deceased  after  vaccination,  hearing  that  it  was  ill,  and 
found  it  suffering  from  decided  erysipelas,  which  spread 
rapidly  and  ended  fatally.  He  had  attended  Elliston  s 
child  after  vaccination,  and  it  had  also  died  from  ery- 
He  was  of  opinion  that  infection  was  present 
in  Elliston’s  child  at  the  time  of  vaccination,  but  he  did 
not  actually  see  it  then  ;  and  that  the  lymph  used  from  the 
child  was  the  means  of  communicating  the  erysipelas  to 
this  deceased  child.  He  thought  the  public  vaccination 
station  was  not  a  suitable  place,  and  it  was  in  an  unsanitary 
condition.  He  x'ecorded  the  cause  of  death  as  erysipelas, 
deeming  reference  to  vaccination  unnecessary.  Dr.  Airy  ob¬ 


served,  with  regard  to  the  tirade  of  counsel  against  the  Local 
Government  Board,  that  they  were  carrying  out  the  provi¬ 
sions  of  an  Act  of  Parliament  expressing  the  will  of  the 
nation.  The  coroner,  in  summing  up,  remarked  that  the 
case  was  not  an  ordinary  one.  The  fact  of  three  children 
dying  from  erysipelas  arising  from  vaccination  made  him 
think  it  was  one  which  ought  to  be  inquired  into,  and  if  the 
Board  of  Guardians  had  provided  a  more  suitable  place  for 
vaccination,  some  good  would  have  been  done.  No  one  was  to 
blame  in  respect  to  the  deaths,  or  guilty  of  negligence.  They 
would  say,  by  their  verdict,  whether  erysipelas  was  caused  as 
pointed  out  by  the  medical  evidence,  or  was  conveyed  by 
vaccination,  or  communicated  to  this  child  by  vaccination 
from  a  child  who  probably  had  it  in  her  system,  and  who  died 
of  the  disease.  The  verdict  was,  “That  the  deceased  died 
from  erysipelas  conveyed  by  vaccination  from  a  person 
suffering  from  erysipelas.”  The  inquiry  was  a  protracted 
one,  and  appears  to  have  been  conducted  by  the  Coroner, 
under  very  trying  circumstances,  with  praiseworthy  firmness 
and  fairness. 


IMPORTANT  ACTION  AGAINST  THE  GOVERNMENT 
IN  IRELAND. 

Medical  circles  in  Dublin  have  this  week  been  much  in¬ 
terested  in  the  action  brought  against  the  Government  by 
Mr.  William  Ireland  Wheeler,  President  of  the  Royal 
College  of  Surgeons  in  Ireland,  to  recover  LI  150  fees  for 
attending  Mr.  Carter,  of  Shaen  Manor,  county  Mayo.  The 
case  was  listed  for  trial  last  Wednesday,  the  21st  inst. 
The  facts  are,  briefly,  that  Mr.  Carter  was  the  victim  of  an 
agrarian  outrage  in  the  spring  of  1881,  and  Mr.  Wheeler 
afterwards  attended  him  according  to  instructions  issued  by 
the  late  Under- Secretary,  Mr.  Thomas  Henry  Burke,  who 
was  assassinated  in  the  Phsenix  Park  on  the  evening  of 
May  6,  1882.  The  suit  is  brought  as  against  the  Queen, 
and  Her  Majesty  has  issued  the  usual  fiat — “  Let  justice  be 
done.”  Mr.  Wheeler  has  secured  a  strong  bar — Messrs. 
Samuel  Walker,  Q.C.,  John  G.  Gibson,  Q.C.,  John  Monroe, 
Q.C.,  and  Hemphill.  The  Government  will  be  represented 
by  the  Attorney-General,  the  Solicitor-General,  and  Mr. 
Dodd  (instructed  by  Mr.  W.  Lane  Joynt,  D.L.,  Crown  and 
Treasury  Solicitor). 


THE  AUTOMATISM  OF  CARDIAC  MUSCLE. 

The  theories  of  cardiac  rhythm  founded  on  the  classical 
experiments  of  Stannius,  that  rhythmic  action  is  in  every 
case  dependent  upon  the  presence  of  ganglion-cells  in  some 
part  of  the  fibre,  have  latterly  undergone  much  modification. 
Evidence  has  been  accumulating,  showing  that  well-fed 
muscular  fibre  has  the  power  of  spontaneous  rhythmic 
action.  For  involuntary  muscle  this  property  must  be  con¬ 
ceded  without  a  doubt.  With  regard  to  cardiac  muscle, 
Gaskell  formulates  the  following  laws  “The  power  of  in¬ 
dependent  rhythmical  contraction  decreases  regularly  as  we 
pass  from  the  sinus  to  the  ventricle”;  and,  “the  rhythmical 
power  of  each  segment  of  the  heart  varies  inversely  as  its 
distance  from  the  sinus.”  Gaskell’s  recent  very  important 
researches  on  the  “  Innervation  of  the  Heart  ”  establish, 
amongst  other  important  points,  that  in  the  tortoise’s  heart 
the  isolated  ventricle  has  much  more  capacity  for  automatic 
rhythm  than  in  that  of  the  frog,  the  extra  chemical,  mechani¬ 
cal,  or  electrical  assistance  required  by  the  latter  to  set  going 
spontaneous  rhythm  not  being  required  in  the  case  of  the 
tortoise.  If  strips  of  ventricle  muscle  be  suspended  in  a 
muscle-chamber,  and  an  induced  current  sent  in  every  ten 
seconds,  just  strong  enough  to  cause  a  contraction,  and  if 
at  intervals  a  very  weak  induced  current  (not  strong  enough 
itself  to  cause  a  contraction)  is  sent  through,  and  the  effect 
observed,  it  is  seen  that  gradually  the  muscle  acquires  the 


606 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Nov.  24,  1S83.- 


power  of  contracting  well,  though  at  first  there  are  evident 
“  blocks  ”  to  the  passage  of  the  contraction- wave,  which, 
consequently,  does  not  reach  all  the  way  down  the  fibre. 
When  contracting  well  the  current  may  be  removed,  and  the 
muscle-strip  will  go  on  spontaneously  for  as  long  as  twenty- 
eight  hours.  The  contractions  are,  therefore,  clearly  “  myo¬ 
genic  and  “  automatic,”  since  there  are  no  nerves  present. 
Electrical  stimulus  is  not  needed  to  set  going  this  automatic 
rhythm,  since  a  strip  of  ventricular  muscle  suspended  in  a 
muscle-chamber  begins  to  contract  of  its  own  accord  after 
a  while  it  may  be  three  or  four  hours — though  the  beats 
are  not  so  regular  as  “  in  the  one  that  has  been  taught.” 
The  importance  of  this  evidence  in  favour  of  “  automatic 
rhythm”  cannot  be  over-estimated. 


THE  LATE  DR.  HILTON  FAGGE. 

A  crowded  meeting  of  students  was  held  on  Tuesday  in 
the  anatomical  theatre  at  Guy’s  Hospital,  and  the  following 
resolution  was  passed : — “  That  this  meeting  of  Guy’s 
students  do  request  the  Senior  House-Surgeon  and  House- 
Physician  to  convey  to  Mrs.  Fagge  their  heartfelt  sympathy 
with  her  in  her  bereavement,  and  desire  to  express  their 
sense  of  the  great  loss  which  they  as  students,  and  the  pro¬ 
fession  generally,  have  sustained  in  the  death  of  one  who 
was  so  eminent  a  physician  and  so  kind  a  teacher.” 


GELSEMIUM  SEMPERVIRENS. 

Is  gelsemium  a  useful  and  practical  remedy  for  neuralgia  ? 
On  this  point  we  think  medical  opinion  would  be  consider¬ 
ably  divided.  Some  claim  to  have  used  it  with  success  ; 
others  have  found  it  constantly  to  fail.  Some  will  speak  of 
■it  as  a  drug  in  whose  efficacy  they  have  much  confidence ; 
others  consider  it  merely  as  one  of  many  such  medicines 
which  may  or  may  not  be  tried,  but  without  any  reasonable 
expectation  of  result.  Now,  apart  from  what  we  know  as 
to  the  physiological  effects  of  the  drug  upon  different  parts 
of  the  nervous  system,  and  setting  aside  the  nature  and 
applicability  of  the  cases  in  which  it  is  prescribed,  we  think 
there  are  two  points  as  to  which  further  information  should 
be  forthcoming.  First,  What  is  the  best  preparation  of  gelse¬ 
mium  ?  It  has  seemed  to  us,  from  experiments  made,  that  much 
of  what  is  sold  as  tinct.  gelsemii  is  without  any  physiological 
action  whatever.  The  drug  is,  of  course,  of  American  origin, 
and,  if  we  may  trust  our  American  confreres,  the  fluid  ex¬ 
tract,  prepared  exclusively  from  the  green  plant,  is  the  only 
reliable  preparation.  Secondly,  as  to  dose.  This,  of  course, 
can  only  be  determined  by  therapeutical  experiments  with 
a  preparation  of  known  and  constant  strength.  It  is  re¬ 
markable  at  present  to  learn  in  what  varying  doses  this 
drug  is  prescribed.  Usually  it  is  given  in  doses  of  five  to  ten 
drops  of  the  tincture,  but  some  will  boldly  give  doses  of  one, 
two,  or  three  drachms,  and,  as  they  profess,  with  good  results. 
An  American  author  in  the  St.  Louis  Courier  of  Medicine 'pre¬ 
scribes  the  fluid  extract  in  one-quarter  to  one-half  drop  doses 
every  half-hour.  It  is  certain,  we  believe,  that  the  drug  must 
have  definite  physiological  effects  before  a  neuralgia  can  be 
relieved.  These  effects  are  exhaustively  described  in  Finger’s 
“  Handbook.”  But  there  is  need  of  further  and  more  care¬ 
ful  clinical  experiments  as  to  the  relative  potency  of  the 
different  preparations  in  the  market,  and  as  to  the  compara¬ 
tive  dose  in  which  each  may  be  safely  and  advantageously 
prescribed. 

A  NOVEL  TREATMENT  OF  TETANUS. 

An  instance  of  recovery  from  tetanus  under  somewhat 
novel  treatment  has  been  recorded  in  the  Philadelphia 
Medical  News.  The  tetanic  symptoms  resulting  from  a 
punctured  wound  of  the  foot  were  most  marked.  Chloral, 


bromide  of  potassium,  and  chloroform  had  been  freely  used, 
without  apparent  beneficial  effect.  Dr.  Ameden  then,  from 
physiological  deductions,  determined  to  try  the  venom  of 
the  rattlesnake.  This  was  injected  subcutaneously  on  two 
occasions ;  the  tetanic  spasms  and  rigidity  ceased,  and  were 
replaced  by  extreme  prostration,  followed,  however,  by  a 
fairly  rapid  recovery. 

ROYAL  MEDICAL  AND  CHIRURGICAL  SOCIETY. 

The  price  of  the  new  Catalogue  of  the  Library,  for  all 
Fellows  elected  since  1879,  has  hitherto  been  12s.  The 
Catalogue  consists  of  three  volumes ;  in  the  first  two  the 
books  are  arranged  according  to  authors,  alphabetically, 
while  in  the  third  volume  they  are  arranged  according  to 
subjects.  It  is  known  that  Mr.  Wheatley  devoted  some 
years  to  the  work.  Not  only  is  it  rich  in  numbers,  but  it 
abounds  also  in  cross  references,  which  are  of  great  service 
to  those  who  may  be  engaged  in  the  study  of  any  particular 
subject.  The  Council,  with  a  view  to  extend  the  utility  of 
their  library,  have  decided  that  in  future  the  price  shall  be 
reduced  to  7s.  6d. 


LATHYRISM  AND  BERIBERI. 

Poisoning  by  the  use  of  the  lathyrus  is  probably  almost 
unknown  in  England,  but  appears  to  be  far  from  uncommon 
in  France.  The  lathyrus  belongs  to  the  order  Leguminosce, 
and  is  used  as  food  both  for  man  and  animals.  The  berry 
is  about  the  same  size  as  a  pea.  The  state  produced  by 
this  has  been  named  lathyrism,  on  the  same  principle  as 
that  produced  by  ergot  is  called  ergotism.  A  recent  writer 
having  stated  that  lathyrism  and  beriberi  were  identical 
diseases,  M.  Pierre  Marie  has  set  himself  the  task  of  proving 
that  such  is  not  the  case  ( Progres  Medical,  No.  43).  In  a 
very  general  way  they  resemble  each  other,  in  that  in  both 
diseases  there  is  paraplegia ;  but  on  comparing  the  symp¬ 
toms  the  contrast  becomes  very  obvious.  Thus,  in  lathyrism 
the  body  of  the  patient  is  inclined  forwards,  the  legs  being 
rigidly  extended,  and  not  flexed  at  the  knee.  The  toes  are 
flexed,  and  are  the  first  to  touch  the  ground  in  walking. 
There  are  convulsive  twitchings  in  the  muscles  of  the  calves. 
The  foot  is  directed  downwards,  and  slightly  rotated  inwards. 
Almost  all  patients  present  excoriations  or  wounds  on  the 
dorsal  aspect  of  their  toes.  The  tendon  reflexes  are  markedly 
exaggerated,  and  the  foot-phenomenon  is  present  in  a  high 
degree.  There  is  no  muscular  wasting,  and  no  apparent 
alteration  in  the  limbs  except  the  sores  above  alluded  to. 
There  are  no  signs  of  altered  nutrition.  In  beriberi,  on 
the  other  hand,  the  legs  are  always  flaccid,  none  of  the 
joints  being  stiff.  In  walking,  the  patient’s  legs  give  under 
him  ;  the  foot  does  not  leave  the  ground  progressively,  as 
in  ordinary  persons,  but  all  at  once,  and  is  put  down  again 
suddenly,  and  quite  flat ;  the  legs  are  separated ;  the  point 
of  the  foot  is  sometimes  turned  in,  and  sometimes  out. 
The  patients  have  much  difficulty  in  keeping  their  shoes  on 
their  feet.  The  knee  reflex  is  generally  absent ;  it  is  never 
exaggerated.  Muscular  wasting  is  always  present.  In  ex¬ 
treme  cases  the  skin  of  the  legs  becomes  atrophied,  dried, 
corrugated,  covered  with  a  branny  desquamation,  and  to  a 
great  extent  loses  its  elasticity.  In  both  disorders  there  are 
urinary  troubles,  such  as  retention  or  incontinence,  and  loss 
of  sexual  function  seems  to  be  tolerably  constant.  Only 
two  points  remain  to  be  noticed,  both  relating  to  beriberi — 
one  is  the  existence  of  muscular  cramps  or  contractions, 
more  or  less  prolonged,  but  nevertheless  temporary,  occur¬ 
ring  in  the  calves,  and  coinciding  with  the  diminution  or 
abolition  of  the  tendon  reflexes  ;  the  other  is  the  muscular 
wasting  which  is  peculiar  to  beriberi,  and  which  is  believed 
to  depend  upon  a  multiple  subacute  neuritis  due  to  the  specific 
poison  rather  than  to  a  spinal-cord  lesion. 


SEedicul  Times  and  Gazette. 


REPORT  OF  THE  ARMY  MEDICAL  DEPARTMENT. 


Nov.  24, 1883.  607 


Trichinosis  has  broken  out  in  another  German  town, 
Thorn,  and  fifty  persons  have  been  attacked  by  it. 


A  military  medical  school  is  to  be  established  in  the 
Chateau  Pharo,  recently  ceded  by  the  ex-Empress  Eugenie 
to  the  town  of  Marseilles. 


The  number  of  deaths  from  cholera  in  Alexandria  during 
the  second  outbreak — that  is  to  say,  from  October  18  to 
November  16 — amounts  to  forty-six  Europeans  and  fifty- 
four  natives. 

The  funeral  of  the  late  Dr.  Fagge,  which  will  be  of  a 
■strictly  private  character,  will  leave  Grosvenor-street  on 
Saturday,  November  24,  at  2.15  p.m.,  to  arrive  at  Norwood 
Cemetery  about  three  o’clock. 


The  Journal  of  the  British  Dental  Association  states  that 
Mr.  T.  F.  Ken  Underwood  is  about  to  resign  the  deanship 
of  the  Dental  Hospital  School,  after  discharging  the  duties 
of  the  office  for  eight  years,  with  great  credit  to  himself 
and  still  greater  benefit  to  the  School. 


On  Monday  last.  Dr.  Alfred  Carpenter  and  Prof.  Corfield, 
■as  part  of  a  deputation  from  the  Council  of  the  Sanitary 
Institute,  attended  a  meeting  of  the  College  of  Physicians 
in  Dublin,  convened  for  the  purpose  of  making  preliminary 
arrangements  for  next  year’s  Sanitary  Congress  and  Ex¬ 
hibition  in  Dublin. 

A  serious  epidemic  of  diphtheria  has  broken  out  at 
Bodfordd,  a  little  village  in  Anglesea.  Eighteen  persons 
have  been  attacked,  of  whom  six  have  already  died.  The 
sanitary  condition  of  Bodfordd  is  said  to  be  deplorable.  An 
•outbreak  of  diphtheria  has  also  occurred  in  the  household 
of  Lord  Richard  Grosvenor,  and  four  of  his  children  and 
four  servants  have  been  attacked. 


The  Field-Marshal  Commanding-in-Chief  has  conveyed 
his  thanks  and  praise  to  the  officers  composing  the  medical 
staff  in  Egypt  for  their  fearless  and  untiring  services  during 
the  late  cholera  outbreak  among  the  British  forces  serving 
in  that  country.  The  success  which  attended  their  ability 
and  zeal,  in  stamping  out  a  disease  which  at  one  time 
threatened  to  reduce  the  battalions  more  than  actual  war¬ 
fare,  has  called  forth  His  Royal  Highness’s  special  admiration 
and  highest  commendation. 

At  the  first  meeting  of  the  Medico-Chirurgical  Society  of 
Edinburgh,  on  November  7,  the  following  gentlemen  were 
unanimously  elected  as  office-bearers  for  the  ensuing  year :  — 
President :  Dr.  Henry  D.  Littlejohn.  Vice-Presidents : 
Prof.  Fraser,  Dr.  David  Wilson,  Dr.  J.  Batty  Tuke.  Coun¬ 
cillors:  Dr.  P.  Heron  Watson,  Dr.  Byrom  Bramwell,  Dr. 
Buist,  Dr.  Ronaldson,  Dr.  Geo.  Hunter,  Dr.  Jas.  Jamieson, 
Dr.  Graham  Brown,  Dr.  J.  M.  Cotterill.  Treasurer :  Mr. 
A.  G.  Miller.  Secretaries :  Dr.  MacGillivray,  Dr.  James. 
Editor  of  Transactions  :  Dr.  William  Craig. 


The  arrangements  for  the  medical  inspection  of  the 
municipal  schools  of  Paris  are  about  to  be  reorganised. 
One  hundred  and  twenty-six  medical  inspectors  are  to  be 
elected  at  a  yearly  stipend  of  800  frs.  each ;  and  every 
school  will  be  visited  twice  a  month,  irrespective  of  special 
visits  in  cases  of  urgency.  After  each  visit  the  inspector 
will  send  a  report  to  the  mayor  of  the  arrondissement,  who 
will,  in  his  turn,  supply  a  summary  to  the  administration 
every  quarter,  and  a  detailed  report  every  half-year.  The 
annual  cost  of  the  inspection  will  be  over  .£4000. 


THE  REPORT  OF  THE  ARMY  MEDICAL 
DEPARTMENT  FOR  1881. 


[Second  Article.] 

The  members  of  the  profession,  whether  military  or  civilian, 
are  by  no  means  likely  to  forget  the  outcry  raised  against  the 
Medical  Department  during  and  at  the  close  of  the  Egyptian 
campaign.  Nor  is  it  likely  that  the  Report  of  the  War  Office 
Committee,  which  investigated  the  complaints,  will  be  com¬ 
pletely  buried  in  oblivion.  But  that  enormous  Blue-book 
is  bewildering  in  its  very  vastness,  and  confusing  in  its 
assertions,  contradictions,  and  insinuations,  so  that  the 
reader  gets  but  a  faint  notion  of  the  gross  injustice  done 
to  the  Medical  Department  by  combatant  officers  who 
were  jealous  of  the  “  position  ”  of  their  medical  brethren, 
and  by  some  war  correspondents  who  listened  to  second¬ 
hand  gossip,  and  found  in  the  cry  against  the  doctors 
an  exciting  theme  to  swell  the  sale  of  the  daily  papers. 
Justice  never  has  been  done  the  Army  Medical  Department, 
although  nothing  is  more  clear  to  all  who  have  studied  the 
report  of  Lord  Morley’s  Committee  than  that  a  most  ample 
apology  was  due  to  it.  The  consideration  of  the  Report 
in  the  House  of  Commons  was  postponed  from  month  to 
month  during  the  past  session,  until  at  last  it  was  declared 
too  late  to  consider  it  at  all ;  and  the  profession  had  to  be 
content  with  the  assurance  of  the  Secretary  of  State  for 
War  and  other  high  authorities  that  the  individual  members 
of  the  Army  Medical  Department  did  their  duty  well.  Next 
year,  indeed,  there  is  to  be  an  opportunity  of  reviewing 
medical  matters  in  the  House.  Happy  are  they  who  have 
faith  and  hope  enough  to  wait  for  it.  We  confess  that  we 
have  not,  and  would  rather  trust  for  the  vindication  of  the 
Department  to  the  Medical  History  of  the  War  in  the 
Appendix  of  the  present  Blue-book.  It  is  more  than  a  plain 
account  of  medical  proceedings ;  it  is  a  complete  vindication 
of  the  Army  Medical  Department.  It  is  also  an  exposition 
of  the  want  of  confidence  shown  by  the  military  authorities 
to  the  doctors  during  the  progress  of  the  war ;  it  is  a  re¬ 
monstrance  against  the  economy  of  the  War  Office,  which 
has  left  the  Medical  Department  in  some  respects  crippled 
and  inefficient ;  and,  in  conclusion,  it  points  out  how  present 
defects  may  and  must  be  remedied,  if  the  care  of  the  sick 
and  wounded  in  the  future  be  really  a  matter  of  interest  to 
the  public,  now  that  the  nation  is  at  peace  and  the  victims 
of  past  wars  have  been  buried  in  oblivion.  Sir  J.  Hanbury 
tells  of  the  preparations  made  for  the  war  by  the  Army 
Medical  Department.  The  staff  of  medical  officers  consisted 
of  163  of  all  ranks,  the  Army  Hospital  Corps  was  820  strong, 
and  in  addition  twenty-four  nurses  were  originally  sent  out 
for  service.  Provision  was  made  by  the  Department  for  the 
various  lines  of  assistance  to  the  sick  and  wounded,  com¬ 
mencing  with  the  bearer  companies  with  mountain  equip¬ 
ment,  and  the  medical  officers  of  corps.  Behind  the  first 
line  were  the  mobile  field-hospitals ;  and  the  third  line 
consisted  of  the  stationary  field-hospitals.  The  base-hos¬ 
pitals  were  never  intended  to  be  formed  on  Egyptian 
soil,  but  dieted  hospitals  were  established  at  Gozo  and 
Cyprus,  while  the  steamship  Carthage  was  intended  for 
the  first  base-hospital  on  the  seaboard.  Transports  were 
held  ready  also  for  the  conveyance  of  the  sick  to  the 
various  base -hospitals,  or,  if  necessary,  to  England. 

The  forethought  of  the  Army  Medical  Department  had 
provided  a  number  of  special  articles  to  meet  the  extra¬ 
ordinary  requirements  to  be  expected  in  a  country  like 
Egypt,  such  as  goggles,  veils,  mosquito-nets,  wire  dish- 
;  covers,  refrigerators,  ice-machines,  etc.,  in  addition  to  all  the 
modern  appliances  for  the  treatment  of  wounds  antisep- 
tically.  Surely  all  these  arrangements  are  not  indicative 
that  the  Department  was  behind  the  age  !  and  one  can  only 
wonder  at  the  unworthy  sneer  of  Lord  Wolseley,  when  he 
implied,  in  his  address  to  the  students  of  Charing-cross 
Hospital,  that  the  medical  affairs  of  the  Army  were  carried 
on  now  according  to  the  old  system  in  existence  during  the 
Peninsular  Wars.  Such  an  assertion  is  as  wild  as  it  is  base¬ 
less.  It  meets  with  its  refutation  in  the  Sanitary  Report 
by  Deputy  Surgeon-General  Marston,  who,  alluding  to  the 
manner  in  which  Egyptian  ophthalmia  was  “  stamped  out,” 
says,  "  If  called  upon  to  furnish  a  practical  illustration  of 


608  Medical  Times  and  Gazette. 


ABSTRACTS  AND  EXTRACTS. 


Not.  24, 1883. 


what  had  been  accomplished  by  the  great  sanitary  changes 
that  have  taken  place  since  the  Crimea,  it  is  probable  that 
no  more  effective  one  could  be  cited  than  that  of  the  preva¬ 
lence  of  ophthalmia  now  and  then/’  He  says  that  anyone 
with  a  knowledge  of  the  British  Army  can  recognise  the 
vast  improvement.  The  exception  proves  the  role,  and  Lord 
Wolseley  appears  to  be  the  exception. 

The  instructions  issued  by  the  Director-  General  and  by 
the  Surgeon- General  were  clear  and  comprehensive,  and 
seemed  calculated  to  provide  for  every  contingency,  with  one 
exception.  We  cannot  find  that  it  was  ever  supposed  pos¬ 
sible  that  medical  officers  should  assert  a  superiority  to  the 
regulations  of  the  Service  by  assuming  a  direct  power  of 
purchase,  and  rendering  themselves  independent  of  the 
established  authorities  when  supplies  fell  short !  We  can 
only  find  that  medical  officers  were  required  to  report  all 
deficiencies  to  the  surgeons-general.  This  is  the  one  point 
which  was  vulnerable  in  the  attack  made  by  Lord  Wolseley 
on  the  Medical  Department  in  his  evidence  given  before 
Lord  Morley’s  Committee.  He  would  have  expected  the 
Department  to  rise  superior  to  the  base  consideration  of 
spending  other  people’s  money,  and  is  sure  the  public  would 
have  pardoned  the  liberty.  All  we  can  say  is — Wait !  The 
War  Office  has  yet  to  frame  new  regulations  based  upon 
the  Report  of  Lord  Morley’s  Committee,  and  we  shall  see 
if  the  power  of  unlimited  purchase  is  one  of  the  rights  and 
privileges  to  be  conceded  to  the  doctors  in  time  of  war  !  We 
are  glad  to  say  that  the  services  of  individual  medical  officers 
have  been  universally  acknowledged.  Few  people  know¬ 
how  hard  the  doctors  worked.  The  Surgeon-General  tells  us, 
with  regard  to  the  illness  of  Brigade-Surgeon  Yeale,  “  The 
extraordinary  mental  anxiety  and  bodily  fatigue  which 
were  incurred  in  the  discharge  of  his  duties  were  un¬ 
doubtedly  the  cause  of  his  health  breaking  down.  Indeed, 
these  remarks  apply  equally  to  the  whole  hospital  staff, 
many  of  whom  were  invalided  from  want  of  sleep  and  over¬ 
work.”  The  men  of  the  Army  Hospital  Corps  appear  to 
have  been  equally  overtaxed,  having  to  perform  incessant 
fatigue  duties,  in  addition  to  their  proper  work  of  attending 
to  the  sick  and  wounded  in  hospital. 

We  have  said  that  Sir  J.  Hanbury’s  Report  exposes  certain 
shortcomings  on  the  part  of  the  General  and  his  staff,  which 
tended  to  embarrass  the  action  of  the  Medical  Department 
in  Egypt.  Directions  were  given  in  General  Orders  which 
it  was  impossible  to  carry  out,  the  system  upon  which  the 
medical  organisation  was  based  not  admitting  of  it.  We 
hear  of  horses  and  mules  which  had  been  "  told  off  ”  to  the 
Medical  Department  being  employed  on  the  line  of  railway. 
This,  no  doubt,  was  unavoidable.  The  fighting  men  and 
their  needs  must  be  the  first  consideration  in  war;  but 
we  cannot  find  an  excuse  for  the  delay  which  only  per¬ 
mitted  the  Medical  Department  at  the  eleventh  hour  to 
become  aware  of  change  of  plans.  We  cannot  understand 
even  now  why  Cyprus  was  abandoned  so  unexpectedly, 
and  the  doctors  informed  at  the  very  last  moment  that 
the  “base”  hospital  must  be  given  up.  We  all  know 
that,  when  the  fighting  was  over,  great  complaints  were 
made  of  the  hospital  establishments  formed  at  Cairo.  We 
may  learn  from  this  Report  what  tremendous  difficulties 
the  doctors  had  to  contend  with  in  that  city.  We  have 
heard  of  the  indignation  of  Lord  Wolseley  at  the  neglect  of 
obvious  precautions,  of  his  sympathy  with  the  complaints  of 
the  patients,  and  of  his  scathing  remarks.  The  curious 
part  of  the  matter  is  that  the  patients  did  not  complain,  and 
not  a  medical  officer  appears  to  have  heard  Lord  Wolseley’s 
observations.  We  can  only  suppose  that  his  feelings  were 
too  deep  for  words.  Sir  J.  Hanbury  says,  with  regard  to 
the  Citadel  Hospital  at  Cairo,  “  I  avail  myself  of  this  oppor¬ 
tunity  of  recording  my  deliberate  opinion  that  no  patient  in 
that  hospital  was  at  any  time  placed  in  an  unfavourable 
position,  as  regards  his  treatment  or  recovery,  from  any 
causes  connected  with  its  equipment  or  general  medical 
arrangements.”  A  great  many  complaints  were  made  by 
combatant  officers  before  Lord  Morley’s  Committee,  and 
particularly  of  their  being  obliged  to  go  to  hotels  when 
sick,  incurring,  of  course,  great  expense  thereby.  We  find, 
to  our  astonishment,  that  Sir  J.  Hanbury  applied  for  leave 
to  establish  an  officers’  hospital,  and  that  the  application  was 
refused !  We  wonder  whether  Lord  Wolseley  had  suddenly 
become  economical,  and  dreaded  the  expense  ?  We  have  said 
that  Sir  J.  Hanbury’s  Report  is  in  some  sort  a  remonstrance. 
He  points  out  fbo  impossibility  of  carrying  out  the  orders  • 


of  the  War  Office  without  the  assistance  of  a  larger  number 
of  subordinates  directly  under  medical  authority.  Witt 
regard  to  sanitary  matters,  he  says  “  that  the  sanitary 
officer  submits  his  opinions,  advice,  and  recommendations 
day  after  day,  but  with  comparatively  little  result,  because 
there  is  no  organised  conservancy  corps  for  executive  work 
in  connexion  with  the  Sanitary  and  Quartermaster-General’s 
Department.”  He  refers  to  the  present  bad  system  by 
which  military  hospitals  are  equipped  by  the  Commissariat 
Department  in  time  of  peace,  and  by  the  Ordnance  Depart¬ 
ment  in  time  of  war.  “  It  is  difficult,”  he  says,  “  to  imagine 
any  arrangement  more  unsatisfactory  than  this  ;  and  so  long: 
as  it  continues,  the  Medical  Department  cannot  be  held 
responsible  for  the  equipment  of  the  hospitals.” 

One  word  more  on  the  great  question  of  the  power  of  the 
purse.  Sir  J.  Hanbury  says — “  There  should  be  on  the  staff 
of  the  Surgeon-General-in-Chief  of  the  field  force  an  expe¬ 
rienced  commissariat  officer,  and  he  should  be  empowered  to’ 
purchase  localhj  whatever  the  Surgeon-General  may  consider 
necessary  for  the  well-being  of  the  ‘sick  and  wounded .”  Surely 
this  suggestion  will  commend  itself  to  the  War  Office  as 
being  infinitely  preferable  to  permitting  medical  officers 
recklessly  to  purchase  all  they  fancy,  in  the  hope  that  a 
generous  British  public  will  condone  all  offences  against 
their  pockets  while  the  sound  of  the  trumpet  is  still  in  their 
ears ! 

We  cannot  doubt  that  the  Medical  History  of  the  Egyptian 
War  will  bear  fruit,  but  we  can  hardly  expect  that  the 
authorities  will  consent  to  make  the  Army  Medical  Establish¬ 
ment  complete.  It  should  doubtless  have  its  separate  trans¬ 
port,  conservancy  corps,  and  commissariat.  But,  as  the 
Duke  of  Cambridge  frequently  remarks  with  regard  to  Army 
reforms,  “  It  is  a  question  of  money,  gentlemen — simply  a 
question  of  money.” 


ABSTRACTS  AND  EXTRACTS. 


Action  of  Compounds  of  Nickel. 

The  salts  of  nickel,  and  more  particularly  the  bromide,, 
have  recently  been  investigated  by  Prof.  Da  Costa,  of  Phila¬ 
delphia  ( Medical  News,  September  29,  1883),  and  his  results, 
given  avowedly  in  an  introductory  form,  may  well  stimulate 
further  research.  Of  the  sulphate  and  chloride  he  does  not 
speak  with  any  degree  of  certainty.  Tolerated  in  small 
doses,  they  cause  giddiness  and  nausea  when  pushed  beyond 
five  grains.  They  appear  to  be  most  serviceable  in  cases  of 
obstinate  diarrhoea.  He  speaks  of  the  sulphate  as  “  some¬ 
thing  of  an  anodyne,”  and  of  the  chloride  having  a  “calming 
influence  ”  on  the  nervous  system.  The  bromide,  however, 
gave  more  satisfactory  results,  doses  of  five  to  seven  grains 
producing  all  the  effects  of  full  doses  of  the  other  bromides. 
This  is  clearly  to  be  ascribed  to  some  special  action  of  nickel 
bromide,  the  proportion  of  bromine  present  being  less  than 
in  the  corresponding  salts  of  potassium  and  sodium.  Prof- 
Da  Costa  regards  the  drug  as  of  probable  utility  in  cases  of 
epilepsy  unaffected  by  the  more  common  bromides. 


Uterine  Milk. 

A  recent  number  of  the  Zeitschrift  fur  Geburtshiilfe  und ' 
Gynakologie  contains  an  article  by  Dr.  G.  von  Hoffmann,  of 
Wiesbaden,  in  support  of  the  doctrine  advocated  by  Ercolani, 
and  to  a  certain  extent  by  Dr.  Braxton  Hicks,  viz.,  that  the- 
foetal  villi  in  the  placenta  do  not  float  naked  in  the  maternal 
blood,  but  are  surrounded  by  cells  whose  function  it  is  to- 
secrete  a  special  fluid  serving  for  the  nutrition  of  the  foetus, 
and  called  uterine  milk.  Dr.  von  Hoffmann  believes  that 
he  has  been  able  to  extract  this  fluid  from  the  human 
placenta.  His  method  is  simply  this — he  takes  a  quite  fresh 
placenta,  which  has  not  been  allowed  to  come  into  contact 
with  water,  and  lays  it  with  its  maternal  side  uppermost. 
A  cotyledon,  the  integrity  of  which  has  not  been  damaged, 
is  then  selected,  and  carefully  dried  with  a  sponge  or  towel, 
so  that  no  blood  adheres  to  it,  and  into  it  a  capillary  tube  is 
then  pressed,  so  that  it  may  penetrate  about  one-third  or 
half  an  inch.  The  tube  thus  used  pushes  the  villi  aside, 
and  lies  in  the  inter-villal  space.  It  is  important  in  insert¬ 
ing  the  instrument  to  see  that  no  bloodvessels  are  injured 
by  it,  lest  blood  be  effused  between  the  villi.  When  a  capil¬ 
lary  tube  is  employed  in  this  manner  it  sucks  up  the  fluid 
from  the  inter-villal  space  ( i.e .,  the  uterine  milk),  which  can 


Medical  Times  and  Gazette. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


then  be  collected  and  examined.  Dr.  von  Hoffmann  has 
examined  the  fluid  from  about  forty  placentae,  some  at  term, 
others  from  cases  of  abortion  at  different  months.  Micro¬ 
scopically,  he  finds  in  it  the  following  constituents : — 
1.  Red  blood-corpuscles  of  different  sizes  and  depth  of  colour, 
often,  especially  in  placentae  of  the  earlier  months,  with 
little  or  no  tendency  to  aggregate  into  rouleaux.  2.  White 
corpuscles.  3.  The  chief  structures  contained  are  what 
the  author  calls  “  uterine  milk-globules,”  peculiar,  clear, 
round  globules,  having  a  very  Thin,  feebly  refracting  wall, 
on  the  average  about  as  large  as  white  corpuscles,  but 
varying  from  a  tenth  of,  to  twice,  their  size.  These  bodies 
precisely  resemble  those  seen  in  “  uterine  milk  ”  obtained 
from  the  placenta  of  the  cow.  4.  Clear  watery  inter¬ 
cellular  fluid.  The  above-described  “  uterine  milk-globules  ” 
are  present  in  such  numbers  that  Dr.  von  Hoffmann  cal¬ 
culates  that  each  cubic  millimetre  of  the  fluid  contains  180,000 
to  200,000  of  them.  5.  There  are  also  found  free  decidual 
cells  and  pigmentary  molecules,  granules,  and  flakes  of 
different  shapes  and  sizes,  which  our  author  regards  as 
products  of  the  disintegration  of  red  blood-corpuscles. 
-Fluid  such  as  this.  Dr.  von  Hoffmann  states,  can  be  extracted 
from  every  healthy  placenta ;  if  it  is  wanting,  the  placenta 
is  not  healthy.  He  believes,  moreover,  that  he  has  traced 
the  mode  of  formation  of  these  "  uterine  milk-globules  ” 
from  decidual  cells,  and  the  production  of  the  large  decidual 
cells  from  the  many  nucleated  “  giant-cells  ”  of  the  decidua. 
Dr.  von  Hoffmann’s  views  as  to  the  physiology  of  foetal 
nutrition  are  summed  up  in  the  following  propositions : — 
1.  The  general  office  of  the  decidua,  both  in  animals  and  in 
man,  is  to  supply  the  foetus  during  its  intra-uterine  life  with 
a  part  of  the  nutritive  material  necessary  for  its  growth. 
To  fulfil  this  function  the  decidua  serotina  becomes  a  special 
milk-secreting  organ,  which,  after  the  birth  of  the  child, 
is  expelled  with,  and  as  an  integral  part  of,  the  placenta. 
:2.  The  secretion  of  this  organ,  the  so-called  uterine  milk, 
is  separated  into  gradually  formed  spaces,  in  which  lie  the 
placental  tufts.  Here  the  uterine  milk  is  mixed  with 
maternal  blood,  which  is  at  the  same  time  extra vasated,  and 
together  with  it  forms  the  material  for  nutrition  of  the 
foetus,  this  material  being  only  suited  for  absorption  by  the 
placental  villi  when  these  changes  have  taken  place. 
•3.  From  the  point  of  view  of  the  comparative  anatomist, 
St  can  no  longer  be  maintained  that  there  is  any  essential 
difference  in  this  respect  between  the  placenta  of  man  and 
the  higher  animals.  Dr.  von  Hoffmann  promises  a  further 
communication  in  which  he  will  elucidate  the  mode  in  which 
this  uterine  milk  is  absorbed  by  the  placental  tufts. 


Application  for  Warts.— Dr.  Cordes,  of  Geneva, 
states  ( Journal  de  Therapeutique,  October  25)  that  he  has 
.always  found  the  following  application  successful: — Iodine 
.six,  crystallised  carbolic  acid  twenty-one,  and  alcohol  two 
parts  and  a  half  by  weight.  After  scraping  the  wart  or 
•cutting  it  down  to  a  level  with  the  skin  (without  causing  it 
To  bleed),  he  touches  the  wart  with  a  few  drops  of  the  above 
.solution.  In  a  minute  it  becomes  soft,  and  allows  of  another 
scraping  and  a  new  application;  and  sometimes  even  a 
third  scraping  and  application  can  be  made  without  causing 
bleeding. 

IIydrobromic  Acid. — Dr.  Dana,  in  a  communication 
to  the  American  Neurological  Association  (Phil.  Med.  Times, 
July  14)  on  the  substitution  of  this  acid  for  the  alkaline 
bromides  in  insomnia,  said  that  it  should  be  given  in  larger 
doses  than  those  usually  employed.  He  had  recorded  very 
satisfactory  results  from  drachm  doses  of  the  officinal  10 
per  cent,  solution.  It  may  be  substituted  in  all  the  milder 
disorders  in  which  the  bromides  are  used,  especially  in  those 
requiring  vascular  and  nervous  sedation.  In  epilepsy  some 
patients  had  markedly  improved  under  drachm  doses  four 
or  five  times  daily,  while  others  had  derived  no  benefit.  In 
chorea  and  alcoholism  it  has  been  used  as  an  adjunct  to 
•other  treatment.  It  is  a  good  solvent  of  quinine,  but  does 
not,  contrary  to  the  usual  belief,  prevent  cinchonism. — Dr. 
Hammond  observed  that,  after  several  years’  trial,  he  had 
abandoned  this  agent  in  consequence  of  its  inferiority  to  the 
bromides ;  but  he  was  satisfied  that  it  really  does  possess 
the  power  of  preventing  the  unpleasant  nervous  effects  of 
quinine. — In  this  last  opinion  Dr.  Eskridge  agreed,  and 
he  also  recommended  the  use  of  the  acid  to  relieve  insomnia 
occurring  in  typhoid  conditions. 


Nov.  24, 1883.  6  0  9 


REVIEWS  AND  NOTICES  OP  BOOKS. 


Insanity:  its  Classification,  Diagnosis,  and  Treatment.  By 

E.  C.  Spitzka,  M.D.  New  York :  Bermingham  and  Co. 

1883.  Demy  Svo,  pp.  400. 

Dr.  Spitzka  is  so  well  and  so  favourably  known  as  a  most 
industrious  and  original  worker  in  the  field  of  alienism, 
his  numerous  monographs  upon  subjects  connected  with 
insanity  have  been  characterised  by  such  thoroughness  of 
investigation  and  independence  of  thought,  that  when  it  was 
known  that  he  was  bringing  out  a  book  upon  insanity,  high 
expectations  were  entertained  as  to  the  character  of  the 
work.  It  must  be  confessed  that  these  expectations  are  not 
quite  realised.  The  merits  of  the  book  are,  it  is  true,  great 
and  conspicuous ;  but  the  same  must  be  said  of  its  defects. 
It  is  an  honest  and  praiseworthy  attempt  to  grapple  with  a 
most  difficult  and  very  imperfectly  known  subject.  The 
author  has  abundant  courage  ;  he  never  shirks  a  difficulty ; 
he  shakes  himself  free  from  the  trammels  of  authority; 
thinks  out  the  problems  for  himself ;  has  plenty  of  sound 
common-sense  ;  rarely  fails  to  arrive  at  a  very  positive  con¬ 
clusion,  which  he  expresses  in  terms  that  are  downright 
and  unhesitating  without  being  actually  dogmatic.  In  fact, 
the  book  is  so  good  as  to  make  us  wonder  that  it  is  not 
better.  Its  faults  are  that  the  author  is  too  certain.  He 
expresses  himself  as  though  every  conclusion  at  which  he 
arrives  were  eternal  and  immutable ;  and  people  who  differ 
from  him  are  often  singled  out  by  name  or  identified  by 
circumstances,  and  treated  with  a  severity  and  even  vitupera¬ 
tion  that  are  unbecoming.  Moreover,  the  book  is  disfigured 
by  its  literary  style,  which  is  careless  and  slovenly  in  a  high 
degree,  and  serves  often  to  effectually  obscure  the  author’s 
meaning  to  his  reader,  and  sometimes,  it  appears,  even  to 
himself. 

Dr.  Spitzka  begins,  of  course,  with  a  definition  of  insanity 
— a  definition  which  extends  to  thirteen  lines  of  rather 
small  print,  and  includes  within  itself  a  baker’s  dozen  of 
exceptions.  When  this  portentous  sentence  is  carefully 
parsed — a  work  of  no  small  difficulty— and  the  exceptions 
duly  deducted,  it  is  found  to  be  tantamount  to  a  statement 
that  insanity  is  insanity.  Dr.  Spitzka  says  that  the  first 
condition  of  a  definition  is  that  it  shall  be  descriptive  of  the 
subject  to  be  defined.  In  this  we  think  he  is  in  error;  but 
whether  it  is  so  or  not,  it  is  certain  that  a  description  should 
convey  a  clearer  notion  of  the  thing  described  than  the  mere 
name  of  the  thing  conveys ;  and  this  is  not  the  case  with 
Dr.  Spitzka’s  definition. 

Following  the  definition  comes,  equally  of  course,  a  new 
classification  of  insanity.  This  subject  has  a  fascination 
that  no  writer  on  insanity  has  yet  been  able  to  resist.  It  is 
not  the  first  time  that  Dr.  Spitzka  himself  has  yielded  to 
the  temptation,  and  we  are  forcibly  reminded  of  that  verse 
of  Stanley’s  old  song  that  runs — 

“  He  that  was  shipwrecked  once  before 
By  such  a  syren’s  call, 

If  he  neglects  to  shun  that  shore, 

Deserves  his  second  fall.” 


A  “  second  fall  ”  Dr.  Spitzka  has  certainly  suffered.  His 
classification  is  even  more  plainly  erroneous  than  many  that 
have  preceded  it.  The  largest  group  is  divided  into  two 
main  sub-groups,  according  as  the  kinds  of  insanity  severally 
included  in  the  latter  are  or  are  not  “  essentially  the  mani¬ 
festation  of  a  constitutional  neurotic  condition.”  Among  the 
former  he  includes  the  insanity  that  is  owing  to  the  inges¬ 
tion  of  alcohol,  opium,  etc. ;  and  among  the  latter  he  places 
the  insanity  of  pubescence.  Another  group  is  divided  ac¬ 
cording  as  its  members  are  or  are  not  associated  with 
demonstrable  organic  changes  in  the  brain  ;  a  very  curious 
division,  seeing  that  no  man  living  is  more  likely  to  shift 
forms  of  insanity  out  of  the  second  of  these  groups  into  the 
first  than  Dr.  Spitzka. 

When  the  author  leaves  the  speculative  ground,  and  comes 
down  to  the  description  of  the  individual  forms  of  insanity  as 
they  are  clinically  observed,  he  is  much  more  at  home,  and 
his  work  is  of  far  greater  value.  Here  every  page  bears  evi¬ 
dence  of  accurate  observation,  extensive  reading,  and  sound 
common-sense  reasoning.  The  various  forms  of  insanity  are 
well  described,  and  the  distinctions  between  them  are  drawn 
with  the  utmost  plainness  ;  in  fact,  they  are  j  great  deal 
too  plain.  While  a  great  many  cases  ^H^s^mtjr, 

T/Tads  orcKj- 


610 


Medical  Times  and  Gazette. 


GENERAL  CORRESPONDENCE. 


Nov.  24,  188 S'. 


referred  with  approximate  certainty  to  one  or  other  of 
the  groups  described  by  Dr.  Spitzka,  there  are  also  a  very 
great  many  cases  that  cannot  with  any  certainty  be  referred 
to  any  of  them,  and  this,  we  think,  should  have  received 
more  prominent  mention.  The  work  is,  it  is  true,  written 
for  a  student’s  manual,  and  this  may  to  some  extent  explain 
its  positive  and  unhesitating  tone  ;  but  it  is  just  those  who 
are  commencing  a  study  who  are  most  apt  to  be  disheartened 
when  they  find,  as  in  this  case  they  must  often  find,  that 
the  cases  they  meet  with  in  practice  cannot  be  classed  in 
any  of  the  divisions  marked  out  for  their  guidance. 

The  sections  on  morbid  anatomy  are,  on  the  whole,  excel¬ 
lent,  excepting  the  woodcuts,  which  are  vile.  On  page  283,  by 
a  curious  oversight,  the  two  engravings  placed  side  by  side  for 
the  purpose  of  comparison  are  both  impressions  of  the  same 
block.  The  treatment  of  the  very  important  subject  of 
heredity  is  poor  and  bald.  No  subject  bearing  on  insanity 
has  been  more  industriously  worked  at  than  this,  but  Dr. 
Spitzka  limits  himself  to  a  few  disjointed  observations,  and 
to  the  quotation  of  the  conclusions  of  Bicharz,  of  whom  Dr. 
Spitzka  is,  we  believe,  the  only  adherent.  “  The  relative 
preponderance  of  maternal  influence  in  hereditary  trans¬ 
mission,”  says  Dr.  Spitzka,  “is  almost  a  dogma  of  natural 
history.”  It  may  be  so,  but  we  are  not  aware  of  any  autho¬ 
rity  who  promulgates  such  a  dogma,  and,  dogma  or  no,  the 
opinion  is  assuredly  erroneous.  The  chapters  on  the  etiology 
of  insanity  are  brief  and  perfunctory — for  an  excellent 
reason  ;  but  those  upon  the  treatment  of  insanity  are  also 
very  imperfect,  and  with  less  excuse.  Bromide  of  potassium 
is  mentioned  as  an  hypnotic  ;  but  no  reference  is  made  to 
its  continuous  use  over  long  periods  of  time  — a  method  of 
administration  which,  whether  advisable  or  not,  is  common 
in  epileptic  and  other  chronic  forms  of  insanity.  No  men¬ 
tion  is  made  of  iodide  of  potassium,  nor  of  the  phosphates 
of  iron,  quinine,  and  strychnia — medicines  that  are  very 
largely  used  in  this  country,  and  that,  rightly  or  wrongly, 
are  credited  with  highly  beneficial  properties.  The  bath 
and  the  cold  pack  are  mentioned,  but  no  instructions,  even 
as  to  duration,  are  given  about  the  latter,  and  no  reference 
is  made  to  the  shower  bath,  Turkish  bath,  douche  or  arrosoir, 
all  of  which  are  powerful  agents  for  good  or  evil,  and  ought 
to  be  treated  of  in  a  work  on  insanity.  The  all-important 
question  of  employment  is  altogether  omitted. 

Still,  with  all  its  defects,  the  book  is  a  good  and  valuable 
one,  and  is  a  welcome  addition  to  the  comparatively  scanty 
bibliography  of  insanity.  If  we  have  laid  more  stress  upon 
its  defects  than  on  its  merits,  it  is  not  because  the  former 
are  not  greatly  outweighed  by  the  latter,  but  rather  because 
the  author  confides  to  us  that  he  has  in  preparation  a  larger 
work  on  the  same  subject,  and  we  would  wish  to  see  him  do 
himself  more  justice  in  his  next  attempt.  His  errors  seem  to 
be  a  too  demonstrative  scorn  of  minds  less  vigorous  than  his 
own;  a  too  positive  conviction  of  the  correctness  of  his  own 
opinions ;  and  an  undue  haste  and  carelessness  in  putting 
his  thoughts  in  a  literary  dress. 


The  American  Journal  of  Neurology  and  Psychiatry. 

August,  1883. 

A  brier  and  cursory  paper  by  Dr.  Kiernan  on  Variola  and 
Insanity  opens  this  number.  Dr.  Kiernan  thinks  it  fair  to 
conclude — first,  that  variola  may  cause  lypemania,  dementia, 
and  probably  moral  imbecility;  second,  that  it  exerts  an 
influence,  sometimes  beneficial,  sometimes  the  reverse,  on 
co-existing  insanity ;  and  third,  that  the  insanity  may 
modify  the  variolous  symptoms.  Incidentally,  Dr.  Kiernan 
speaks  of  “  the  exaggerated  non-restraint  conceptions  too 
prevalent  in  the  United  States  and  in  England.”  We  were 
under  the  impression  that  even  unexaggerated  non-restraint 
practice  was  far  from  being  prevalent  in  the  United  States. 
Dr.  Bluthardt  relates  a  case  of  simulation  of  insanity  by  a 
criminal  lunatic  ;  and  Dr.  Julius  Hoffman  contributes  a  long 
paper  on  Researches  in  the  Normal  and  Pathological  Ana¬ 
tomy  of  the  Grey  Substance,  etc.,  which  contains  virtually 
nothing  that  is  new  except  some  micro-measurements.  Dr. 
Lewis  Mason  writes  upon  Alcoholic  Insanity,  and  Dr.  McBride 
gives  a  case  of  Aphasia  with  Eight  Hemiopia. 


The  Physicians’  and  Surgeons’  Visiting  List  for  1884.  London: 

John  Smith  and  Co.,  Long  Acre. 

A  sample  of  this  excellent  and  familiar  diary  is  again  before 
ns.  It  is  so  well  known  and  so  widely  patronised  in  the  pro¬ 


fession  that  it  is  unnecessary  to  do  more  than  notify  its 
appearance.  We  have  one  or  two  criticisms  to  make  on  the 
arrangement  of  the  latter  part  of  the  book,  suggested  by 
some  years’  very  practical  familiarity  with  it.  The  space 
set  apart  for  obstetric  and  vaccination  engagements  is  out 
of  proportion,  at  any  rate  in  those  editions  which  we  are 
familiar  with,  to  the  number  of  patients  allowed  for  in  the 
visiting  list.  A  general  practitioner  with  a  weekly  visiting 
list  of  fifty  patients  will  hardly  be  likely  to  attend  over  200 
midwifery  cases  in  the  year,  or  to  execute  nearly  250  vac¬ 
cinations.  If  some  of  the  pages  left  for  these  engagements 
were  transferred  to  “  Bills  and  Accounts  asked  for,”  a 
department  at  present  far  too  meagrely  represented,  we 
believe  that  the  requirements  of  the  average  general  prac¬ 
titioner  would  be  far  more  conveniently  met.  Another 
suggestion  which  we  may  make,  in  the  interest  of  the 
general  practitioner,  is  that  in  the  memoranda  of  receipts 
four  pages  instead  of  two  should  be  allotted  to  January,  the 
month  in  which  most  of  the  previous  year’s  bills  are  paid. 
Lastly,  we  have  often  thought  that  a  few  blank  temperature- 
charts  at  the  end  of  the  book  would  be  of  great  advantage 
to  practitioners.  A  special  edition  might  perhaps  be  issued 
for  pure  physicians  and  surgeons,  in  which  the  obstetric  and 
vaccination  pages  should  be  replaced  by  pages  arranged  for 
the  record  of  clinical  facts  of  such  a  character  as  are  likely 
to  escape  the  memory. 


GENERAL  CORRESPONDENCE. 

- «• - 

MESMERISM. 


[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Sib, — I  had  hoped  not  to  have  to  trouble  you  again  ;  but  my 
critic  has  now  made  a  fresh  statement  which,  if  not  contra¬ 
dicted,  would  be  taken  as  admitted.  He  speaks  of  an 
occasion  on  which  Messrs.  Smith  and  Wells  were  “  baffled”' 
by  some  ordinary  precautions,  and  says  that  this  failure 
ought  to  have  been  recorded.  The  occasion  exists  only  in  his 
own  imagination.  The  idea  of  it  probably  arose  from  a  de¬ 
scription  (clearly  a  very  imperfect  one)  of  some  quite  different 
experiments  in  which  Wells  took  no  part,  and  the  failure  of 
which,  with  the  reason  for  it,  is  recorded  in  the  published 
Proceedings  of  our  Society.  I  may  add  that  the  only  experi¬ 
ments  in  ordinary  thought-transference  which  we  have  ever 
represented  as  crucial  are  those  where  the  persons  in  collusion, 
if  they  existed,  must  have  been  ourselves. 

I  am,  &c., 

14,  Dean’s-yard,  S.W.  Edmund  Gurnet. 

[Perhaps  it  is  Mr.  Gurney’s  memory  and  not  our  imagina¬ 
tion  that  is  at  fault.  The  occasion  to  which  we  referred 
was  one  in  the  month  of  April  or  May  last,  when  a  party 
of  scientific  men  attended,  by  invitation,  at  the  rooms  of 
the  Psychical  Research  Society,  to  witness  some  demonstra¬ 
tions  in  thought-transference  by  two  subjects  upon  whom 
the  Society  was  then  experimenting,  and  one  of  whom  was 
named  Smith.  The  demonstrations  consisted  in  the  repro¬ 
duction  by  the  subject,  without  contact,  of  diagrams  which 
had  been  shown  to  the  operator.  The  scientific  witnesses 
of  these  demonstrations  had  no  hesitation  in  arriving 
at  a  very  definite  conclusion  as  to  the  manner  in  which 
such  wretched  results  as  were  submitted  them  were  pro¬ 
cured.  No  further  results  were  obtained  when  they  took 
means  effectually  to  prevent  sight  and  hearing  by  the 
subject ;  and  the  failure  of  the  experiments  from  this 
point  was  attributed  by  the  Psychical  Researchers  present 
(of  whom,  if  we  are  not  misinformed,  Mr.  Gurney  was  one) 
not  to  the  precautions  which  they  adopted,  but  to  the  dis¬ 
turbing  influence  of  their  want  of  faith  and  attitude  of 
determined  antagonism.  No  account  of  these  experiments 
has  appeared  in  the  Proceedings  of  the  Society,  unless 
another  set  of  Proceedings  has  been  issued  beyond  the  two' 
parts  that  have  reached  us.  We  shall  look  forward  to 
the  Society’s  report  of  this  particular  stance  with  muck 
interest. — Ed.  Med.  Times  and  Gaz .] 


Medical  Times  and  Gazette. 


THE  ODONTOLOGICAL  SOCIETY  OF  GREAT  BRITAIN". 


Nov.  24,  1883.  621) 


INFLAMMATION  OF  THE  EAR  AND  TONSIL  IN 
CONNEXION  WITH  RHEUMATISM. 


[To  the  Editor  of  the  Medical  Times  and  Gazette.] 

Silt, — I  have  often  remarked  on  the  frequency  with  which 
chronic  rheumatism  is  associated  with  more  or  less  inflam¬ 
mation  about  the  auditory  meatus.  Those  who  come  to 
consult  the  physician  on  account  of  rheumatic  pains  nearly 
always  have  some  greater  or  less  amount  of  impairment  of 
hearing;  and  when  the  ear  is  examined,  to  see  if  there  be 
any  gouty  deposits  about  it,  the  patient  will  be  found 
wearing  a  plug  of  wool  to  protect  the  organ  from  cold. 
The  rheumatic  irritation  appears  to  affect  the  meatus, 
causing  often  a  hot,  burning  feel  therein,  with  increase 
of  secretion,  and  consequent  blocking  of  the  passage  with 
lumps  of  hard  cerumen.  The  membrana  tympani,  the  in¬ 
ternal  ear,  and  the  Eustachian  tubes  participate  ;  and  often 
these  last  become  obstructed,  so  that  no  air  will  pass  through 
them  into  the  cavity  of  the  tympanum. 

Of  actual  severe  tonsillitis  as  a  precursor  of  acute  rheu¬ 
matism  I  have  quite  recently  had  a  most  marked  example. 
The  efficacy  of  preparations  of  guaiacum  in  curing  some 
forms  of  sorethroat  and  tonsillitis  may  he  taken  as  an 
additional  proof  of  the  rheumatic  nature  of  these  maladies. 
The  ear-trouble  fairly  established  is  obstinate  and  not  soon 
cured.  Hence  the  wisdom  of  the  following  bit  of  advice : — 
“  Enfoncez  bien  votre  bonnet  j usque  sur  vos  oreilles  ;  il  n’y 
a  rien  qui  enrhumetant  que  deprendre  l’air  par  les  oreilles,” 
is  the  advice  of  “  Beline  ”  to  £t  M.  Argan  ”  in  the  Malade 
Imaginaire.  I  am,  &c., 

John  C.  Thorowgood,  M.D.,  F.R.C.P. 

Welbeck- street,  November. 


REPORTS  OE  SOCIETIES. 

- <*> - 

THE  ODONTOLOGICAL  SOCIETY  OF  GREAT 

BRITAIN. 

Monday,  November  5. 

Joseph  Walker,  M.D.,  President,  in  the  Chair. 


Amongst  the  specimens  exhibited  were  two  of  considerable 
antiquarian  interest.  A  partial  denture  worn  by  Queen 
Caroline  during  her  trial  was  sent  by  Mr.  John  Parkinson, 
M.R.C.S.,  of  Porchester-square.  It  consisted  of  five  or  six 
upper  front  teeth,  fastened  to  a  flattened  gold  wire,  and 
secured  by  clasps  at  each  end.  It  could,  of  course,  only  have 
been  intended  for  ornament. 

Mr.  Foran,  of  Southsea,  sent  a  model  of  a  seal  affixed  to 
a  deed  of  the  time  of  Edward  II.,  on  which  was  the  impres¬ 
sion  of  upper  incisor  teeth,  accompanied  by  extracts  from 
standard  works  on  the  subject,  explaining  that,  before  the 
general  use  of  engraved  seals,  it  was  the  custom  to  impress 
the  wax  with  the  teeth.  The  specimen  from  which  this 
model  was  taken  was  a  very  late  example  of  this  practice. 

Mr.  W.  A.  Hunt,  of  Yeovil,  showed  a  first  right  upper 
molar  which  he  had  extracted  on  account  of  periostitis,  etc., 
from  the  mouth  of  a  lad  aged  thirteen.  Projecting  some 
distance  from  the  end  of  the  palatal  root  was  a  piece  of 
elastic  rubber,  such  as  is  found  in  the  webbing  used  for  side¬ 
spring  boots.  How  it  could  have  got  there  was  a  mystery. 
The  apical  foramen  had  became  enlarged  to  exactly  the  size 
and  shape  of  the  rubber,  showing  the  effect  of  even  slight 
pressure  in  producing  absorption. 

The  Relation  between  Dental  Lesions  and  Diseases 

of  the  Eye. 

Mr.  Henry  Power  read  a  paper  on  the  above  subject, 
for  the  abstract  of  which  we  are  indebted  to  the  Journal 
of  the  British  Dental  Association.  The  connexion  between 
dental  diseases  and  affections  of  the  eye  (Mr.  Power  observed) 
was  not  one  which  was  apparent  at  first  sight,  and  it  was 
only  within  the  last  sixty  years  that  it  had  been  noticed  by 
writers  on  ophthalmic  diseases,  and  by  most  of  these  it  was 
only  casually  referred  to.  The  first  writers  he  had  met  with 
who  distinctly  refer  to  this  connexion  were  Travers  and 
Frick,  1824  and  1826,  both  of  whom  mention  difficult  denti¬ 
tion  as  one  of  the  causes  of  strabismus.  After  this  date, 
difficult  dentition  and  dental  disease  are  often  mentioned 
incidentally  amongst  other  causes  of  ophthalmic  disease. 


|  He  would  take  it  for  granted  that  all  present  would  admit? 

I  that  there  was  such  an  affection  as  reflex  sympathetic  oph¬ 
thalmia,  of  the  existence  of  which  ophthalmic  surgeons  were- 
constantly  reminded  by  the  frequent  occurrence  of  cases  in- 
which  injury  to  one  eye,  especially  of  the  ciliary  region,  was 
followed,  after  a  period  of  very  variable  duration,  by  in¬ 
flammation  of  the  uninjured  eye,  of  a  low  but  steadily  pro¬ 
gressive  type,  generally  involving  all  the  tissues  and  leading: 
to  more  or  less  serious  impairment,  or  even  to  complete  loss  of 
vision.  If  the  question  be  put,  How  does  irritation  or  in¬ 
flammation  of  one  eye  come  to  affect  the  other,  by  what  path- 
does  the  irritation  travel  ?  the  reply  given,  both  by  exact  clini¬ 
cal  observation  and  by  pathological  investigation,  is  that,  in, 
the  vast  majority  of  cases,  a  neuritis  travels  along  the  ciliary 
nerves,  or  in  a  few  instances  along  the  optic  nerve;  and  this; 
evidence  of  conduction  of  the  morbid  process  along  the 
sheaths  of  the  nerves  is  of  considerable  importance  in 
enabling  some  explanation  to  be  given  of  the  occurrence  of 
reflex  troubles  where  the  teeth  are  the  seat  of  the  primary 
lesion.  It  is  well  known  that  injuries  affecting  the  branches 
of  the  first  (ophthalmic)  division  of  the  fifth  pair  may  affect- 
the  eye  of  the  same  side.  Thus  a  case  is  recorded  by  M. 
Decaisne,  a  staff-surgeon  in  the  Belgian  army,  in  which  an 
officer  was  struck  on  the  forehead  with  a  piece  of  wood  in 
the  course  of  the  frontal  nerve,  and  complete  blindness 
followed.  That  injuries  to  the  supra-orbital  nerve  may  be- 
occasionally  followed  by  amaurosis  seems  also  to  he  well- 
established,  and  there  are  good  reasons  for  believing  that 
affections  of  other  branches  of  the  fifth  pair  may  be  the 
cause  of  ophthalmic  troubles  (cases  confirming  this  opinion 
were  referred  to  by  Mr.  Power).  The  existence  of  this  con¬ 
nexion  with  reference  to  the  dental  nerves  is  specially 
dwelt  upon  by  M.  Decaisne,  in  the  Gazette  M6dicale,  1871, 
page  369,  who  reports  several  cases  to  prove  that  odontalgia, 
is  often  accompanied  by  lacrimation,  redness  of  the  con¬ 
junctiva,  sudden  darts  of  pain,  and  winking  of  the  lids ;  and 
he  explains  this  by  supposing  that  the  irritation  of  the  dental 
branch  of  the  superior  or  inferior  maxillary  nerve  extends  to¬ 
other  branches  of  the  fifth,  and  especially  to  the  ophthalmic* 
thus  producing  the  phenomena  just  mentioned. 

The  question  as  to  whether  dental  irritation  is  specially 
liable  to  cause  any  particular  affection  of  the  eyes  is  rendered 
difficult  of  solution  by  the  extreme  frequency  of  dental  dis¬ 
ease,  it  being  rare  to  find  a  person,  either  with  or  without, 
eye  disease,  who  has  thoroughly  sound  teeth.  The  fact,, 
however,  that  dental  irritation  may,  under  certain  circum¬ 
stances,  set  up  reflex  irritation  of  the  eye,  cannot  be- 
doubted.  This  may  express  itself  in  any  of  the  follow¬ 
ing  ways : — (1)  By  reflex  irritation  affecting  striated  and 
unstriated  muscle ;  (2)  affecting  the  mucous  membrane 
and  cornea  ;  and  (3)  it  may  affect  the  optic  nerve  and  retina 
and  the  intra-ocular  tissues.  Under  the  first  head  may  be 
mentioned  paralysis  of  the  ciliary  muscle,  of  the  intra¬ 
orbital  muscle,  of  the  muscular  fibres  of  the  iris,  of  any  of 
the  ocular  muscles,  and  of  the  orbicularis  palpebrarum. 
One  of  the  commonest  forms  of  visual  disturbance  induced 
by  dental  disease  is  loss  or  failure  of  the  power  of  accom¬ 
modation,  due  to  paresis  of  the  ciliary  muscle  This  has 
been  particularly  investigated  by  Dr.  Hermann  Schmidt,  of' 
Berlin,  who  found  that  of  ninety-two  patients  suffering  from 
various  forms  of  dental  irritation  there  were  only  nineteen 
in  whom  the  range  of  accommodation  was  normal,  whilst  in 
most  of  the  remaining  seventy-three  cases  the  range  was.- 
considerably  reduced.  This  effect  of  dental  irritation  was,  as. 
might  have  been  expected,  most  marked  in  young  patients, 
in  whom  the  ciliary  muscle  is  strong,  and  the  range  of  ac¬ 
commodation  naturally  most  extensive.  In  patients  over 
thirty  the  impairment  of  the  power  of  accommodation  was 
much  less  frequently  observed.  The  results  of  these  obser¬ 
vations,  in  which  also  the  influence  of  sex,  of  the  particular 
teeth  affected,  and  of  the  nature  of  the  lesion  were  inquired 
into,  were  published  in  Grafe’s  Archiv,  xiv.,  page  107.  Urn 
fortunately,  Schmidt  was  only  able  to  ascertain  the  effect  of 
the  removal  of  the  offending  tooth  or  teeth  in  eight  out  of 
the  ninety-two  cases,  but  in  five  of  these  distinct  improve¬ 
ment  was  observed. 

Mr.  Power  then  proceeded  to  quote  cases  in  which  para,- 
lysis  of  the  iris,  with  consequently  dilated  pupil,  and  exoph¬ 
thalmia,  had  been  produced  by  dental  irritation.  Both  these- 
were  rare  occurrences — indeed,  of  the  latter  there  was  only 
one  case  recorded ;  in  this,  however,  the  connexion  appeared 
to  be  perfectly  clear,  since  all  the  symptoms,  which  had  been. 


<612 


Medical  Times  and  Gazette. 


THE  PATHOLOGICAL  SOCIETY  OF  LOYD  OK 


Nov.  24,  1883. 


'very  marked,  disappeared  within  three  days  of  the  extrac¬ 
tion  of  three  carious  teeth.  That  strabismus  may  be  induced 
by  difficult  dentition  seems  to  be  generally  admitted,  though 
probably  this  is  not  a  very  common  cause  of  the  deformity, 
which,  as  was  pointed  out  byDonders,is  in  the  great  majority 
of  cases  due  to  hypermetropia.  Cases  are  also  on  record  in 
which  paresis  of  the  levator  palpebral,  supplied  by  the  third 
nerve,  and  the  orbicularis  palpebrarum,  supplied  by  the 
seventh,  have  occurred  as  the  result  of  dental  irritation. 
An  affection  that  is  notunfrequently  observed  is  that  known 
as  blepharospasm,  or  incessant  winking  of  the  lids.  This 
is  most  often  associated  with  the  error  of  refraction  known 
as  hypermetropia,  but  that  it  may  also  occasionally  be  ex¬ 
cited  by  reflex  dental  irritation  is  established  by  cases 
recorded  by  von  Grafe  and  Mitchell. 

Passing  on  to  the  consideration  of  the  second  group  of 
phenomena,  viz.,  where  there  was  reflex  irritation  of  the 
mucous  membrane  of  the  eye  and  the  cornea,  Mr.  Power 
•said  he  had  noticed  that  phlyctenular  ophthalmia  (a  common 
disease  amongst  children)  was  very  frequently  associated 
with  carious  teeth,  and  it  was,  he  believed,  often  caused  by 
them  ;  he  had  found,  in  his  own  practice,  that  children  who 
presented  themselves  suffering  from  phlyctenular  ophthal¬ 
mia  invariably  had  carious  teeth.  Severe  conjunctivitis 
might  result  from  the  same  cause,  as  had  been  proved  by 
cases  in  which,  the  inflammation  having  resisted  all  ordinary 
treatment,  the  mouth  had  been  examined  and  a  carious 
tooth  found,  which  had,  however,  given  the  patient  but 
Might  inconvenience ;  this  was  removed,  and  the  conjunc¬ 
tivitis  forthwith  and  spontaneously  disappeared.  Mr.  Power 
.-also  narrated  a  case  which  had  come  under  his  own  observa¬ 
tion,  in  which  abscess  of  the  cornea  seemed  to  be  intimately 
-connected  with  the  presence  of  carious  teeth  on  the  same 
side,  resisting  all  treatment  until  these  were  removed,  when 
the  mischief  gradually  subsided,  though  not  without  leaving 
:great  impairment  of  vision. 

He  then  proceeded  to  the  consideration  of  the  last  class 
of  cases,  quoting  a  case  recorded  by  Sir  William  Lawrence, 
in  which,  after  two  months  of  severe  neuralgia  of  the  left 
side  of  the  face,  loss  of  the  sight  of  the  left  eye  supervened. 

months  later,  symptoms  of  antral  abscess  appeared ;  this 
'discharged  under  the  lower  eyelid.  Finally,  attention  was 
'directed  to  the  left  first  upper  molar,  which  was  carious, 
%ut  which  had  never  given  rise  to  much  apparent  uneasi¬ 
ness  ;  it  was  extracted,  and  a  small  fragment  of  wood,  about 
three  lines  in  length,  was  found  projecting  from  the  apical 
foramen.  A  probe  could  be  passed  through  the  socket  of 
the  tooth  into  the  antrum.  The  remarkable  feature  of  the 
•case  was,  that  not  only  did  the  pain  cease,  but  the  same 
•evening  the  eye  began  to  be  sensible  to  light,  and  vision 
improved  so  rapidly  that  by  the  ninth  day  the  patient 
could  see  as  well  with  the  left  eye  as  with  the  right,  although 
he  had  been  totally  blind  with  that  eye  for  thirteen  months. 
.Somewhat  similar  cases,  though  of  less  striking  character, 
had  been  recorded  by  other  writers.  Thus,  Dr.  De  Witt 
relates,  in  the  American  Journal  of  the  Medical  Sciences,  the 
case  of  a  strong  healthy  man,  aged  thirty,  who  suddenly 
discovered  that  he  had  lost  the  sight  of  the  right  eye. 
There  were  no  local  symptoms  to  account  for  the  blind¬ 
ness.  Two  months  before,  several  teeth  had  been  stopped ; 
one  of  these,  the  right  first  molar,  had  become  painful,  and 
•an  alveolar  abscess  had  formed  in  connexion  with  it.  Dr. 
De  Witt,  suspecting  irritation  of  the  fifth  nerve  from  this 
source,  removed  the  stopping  from  the  inflamed  tooth. 
The  periostitis  then  subsided,  and  the  sight  of  the  right 
eye  began  to  return.  Three  weeks  later,  when  the  distinct¬ 
ness  of  vision  had  greatly  improved,  there  was  a  fresh 
attack  of  inflammation  around  the  tooth,  and  at  the  same 
time  the  sight  became  worse.  The  tooth  was  then  extracted, 
improvement  again  took  place  in  the  eye,  and  it  soon  became 
almost,  though  not  quite,  as  good  as  the  other.  Lastly,  the 
relation  of  dental  irritation  to  glaucoma  was  referred  to, 
the  result  of  various  investigations  on  this  subject  being  to 
the  effect  that,  in  persons  in  whom  the  constitutional  state 
and  the  local  conditions  were  such  as  to  predispose  to  the 
occurrence  of  this  disease,  the  irritation  of  a  carious  tooth 
might  be  a  very  probable  and  active  exciting  cause. 

In  conclusion,  Mr.  Power  said  he  thought  it  might  be 
laid  down  as  a  rule  to  be  generally  observed,  that  in  all 
cases  of  threatening  glaucoma,  especially  when  associated 
■with  ciliary  neuroses  and  obscure  pain  in  the  temporal, 
maxillary,  and  orbital  regions ;  in  all  cases  of  mydriasis. 


and  probably  also  of  myosis,  originating  without  apparent 
cause  ,-  in  all  cases  of  sudden  paralysis  of  any  of  the  orbital 
muscles,  or  of  loss  of  sensation,  in  the  absence  of  cerebral 
symptoms  ;  in  all  cases  of  phlyctenular  disease,  of  conjunc¬ 
tivitis,  and  ulcers  of  the  cornea  resisting  ordinary  treatment ; 
in  all  cases  of  sudden  failure  of  accommodation,  especially 
in  young  persons  ;’and,  finally,  in  cases  of  exophthalmia — the 
condition  of  the  teeth  should  always  be  examined,  and,  if 
faulty  conditions  presented  themselves,  these  should  at  once 
be  rectified ;  and  thus  one  at  least  of  the  possible  causes  of 
these  diseases  would  have  been  removed. 

A  short  discussion  ensued,  in  which  the  President  and 
Messrs.  Charters  White,  Hunt,  Coleman,  and  Thomas  Nunn 
took  part ;  but  a  fuller  discussion  on  the  paper  will  take 
place  at  the  next  meeting  on  December  3. 


THE  PATHOLOGICAL  SOCIETY  OF  LONDON. 
Tuesday,  November  20. 

J.  W.  Hulke,  F.E.S.,  President,  in  the  Chair. 


Ossifying  Chondro-Sarcoma  in  a  Cicatrix. 

Mr.  Durham  observed  that  the  pathology  of  new  growths 
was  always  a  question  of  great  interest.  The  first  case 
he  brought  before  the  Society  that  evening  was  one  of  the 
development  of  bone-tissue  in  a  tumour  arising  from  a  cica¬ 
trix.  The  patient  was  a  man  aged  seventy-three,  who  had 
been  severely  burnt  about  the  lower  part  of  the  abdomen, 
when  twelve  years  old,  by  the  explosion  of  some  squibs  in 
his  pocket.  A  large  scar  formed,  but  created  no  trouble 
until  a  few  months  before  he  came  under  observation ;  then 
a  lump  appeared  in  the  scar,  followed  by  a  sore  place, 
which  gradually  extended.  Portions  of  apparently  bony 
material  were  from  time  to  time  discharged  from  it.  When 
he  came  into  the  hospital  there  was  a  half -fungating  kind  of 
sore  in  the  cicatrix,  just  above  Poupart’s  ligament,  looking 
like  an  epithelioma.  It  was  very  freely  removed.  Some 
parts  were  comparatively  soft,  others  very  hard  and  cut  with 
difficulty;  the  hard  part  was  unlike  mere  calcification,  more 
like  bone.  Microscopically,  there  was  very  distinct  bone- 
formation.  The  growth  was  evidently  a  sarcoma,  which  was 
unusual  in  a  cicatrix  at  such  an  age  ;  it  would  have  been, 
d  priori,  more  likely  to  be  an  epithelioma  or  carcinoma.  The 
tumour  contained  fibrous  tissue  in  various  stages  of  de¬ 
velopment,  well-developed  cartilage-cells, and  well-developed 
myeloid  cells,  besides  the  development  of  true  bone  up  to 
a  certain  point. 

Bony  Tumour  in  the  Breast. 

Mr.  Durham  detailed  the  case  of  a  woman,  aged  twenty- 
seven,  who,  two  years  previously,  had  noticed  pain  in  the 
left  breast,  which  was  followed  by  the  appearance  of  a 
tumour.  This  seemed  to  be  a  case  of  adenoid  tumour, 
though  around  it  was  an  induration,  which  raised  some 
doubt  as  to  its  nature.  It  was  indistinctly  lobulated,  and 
enclosed  in  a  capsule.  On  section  it  was  found  to  be  of 
pinkish-grey  colour ;  some  parts  soft,  some  harder,  some 
friable.  The  principal  part  had  a  plate,  three-eighths  of 
an  inch  across,  of  bony  tissue  embedded  in  it.  Micro¬ 
scopically  there  were  trabeculae  of  osseous  tissue,  with  lacunae 
and  canaliculi.  The  tumour  was  a  very  distinct  and  well- 
characterised  sarcoma ;  there  were  abundant  cartilage-cells 
contained  in  it.  At  the  periphery  there  was  some  glandular 
tissue  with  intracystic  growths. 

Mr.  Hulke  observed  that  both  these  cases  were  of 
great  interest.  In  the  skin,  osteomata  were  not  very  un¬ 
common,  but  quite  small.  In  reference  to  the  development 
of  bone  in  tumours,  he  alluded  to  the  tumours  seen  not  in¬ 
frequently  in  the  muciparous  buccal  glands,  which  were  now 
and  then  found  to  contain  true  bone.  All  these  structures 
belonged  to  the  group  of  connective  tissues.  He  wished  to 
ask  Mr.  Durham  whether,  in  his  first  patient,  the  ulceration 
preceded  the  development  of  bone,  or  not. 

Mr.  Butlin  had  been  much  interested  in  the  President’s 
observations,  as  he  had  thought  that  the  muciparous-gland 
tumours  were  calcareous,  and  not  b  my.  He  then  referred 
to  the  absence  of  the  evidence  of  the  growth  of  bone  in 
carcinomatous  tumours,  except  in  one  French  case  of  tumour 


Medical  Times  and  Gazette. 


THE  PATHOLOGICAL  SOCIETY  OF  LONDON. 


of  the  breast.  Mr.  Durham’s  first  case  had  originated,  he 
believed,  in  the  subcutaneous  tissues  rather  than  in  the 
skin  itself.  He  had  himself  shown  to  the  Society,  about  ten 
years  previously,  an  ossifying  sarcoma  in  the  subcutaneous 
tissues. 

Mr.  Alban  Doran  observed  that  chondrification  and 
ossification  were  very  frequent  in  the  connective  tissue 
which  is  so  abundantly  developed  under  the  skin  found  in 
dermoid  ovarian  cysts.  This  was  not  necessarily  due  to  the 
same  formative  power,  as  it  is  often  called,  which  produced 
skin  and  hair  in  such  cysts.  The  cause  might  lie  within 
the  connective  tissue  itself.  It  was  also  to  be  noted  that 
in  the  same  tissue  sarcomatous  tracts  were  very  frequent, 
and  within  these  tracts  small  round  or  many-sided  pieces  of 
bone  were  not  uncommon.  These  osseous  fragments  were 
quite  different  from  the  flat  plates  of  bone  developed  in 
dermoid  cysts  independently  of  sarcomatous  tissue. 

Dr.  Goodhart  had  brought  a  case  before  the  Society 
where  a  buccal  tumour,  about  three-quarters  of  an  inch 
across,  had  formed  in  the  lower  lip.  He  wished  to  ask 
whether  there  was  any  reason  why  these  tumours  should 
occur  in  the  lip. 

Mr.  Eve  alluded  to  the  paper  brought  before  the  Inter¬ 
national  Medical  Congress  by  Malherbe  on  the  subject  of 
bony  tumours  in  the  skin.  He  (the  speaker)  had  examined 
many  supposed  cases  of  this  kind,  but  had  always  found 
the  deposit  to  be  calcareous,  and  not  true  bone. 

Dr.  Co  upland  mentioned  the  case  of  an  osteoma  removed 
from  the  subcutaneous  tissue  of  the  buttock  of  a  woman. 
He  thought  that  the  definition  of  an  osteoma  was  that  it 
must  be  developed  from  connective  tissue  away  from  bone. 

Mr.  Henry  Morris  mentioned  a  fatty  tumour,  nearly  the 
whole  of  which  had  undergone  ossification ;  and,  referring 
to  the  growth  of  bony  tumours  in  the  muciparous  follicles, 
he  alluded  to  a  man  who  came  under  his  care  suffering  from 
epileptiform  neuralgia,  and  who,  after  going  through  several 
operations,  was  relieved  (apparently  permanently)  by  the 
removal  of  several  minute  bony  tumours  from  the  mucous 
membrane  of  his  cheek. 

Mr.  Hdlke  could  suggest  no  reason  why  bony  tumours 
should  occur  so  frequently  in  the  neighbourhood  of  the 
lip. 

Mr.  Durham,  in  reply  to  one  of  the  questions,  said  that 
the  lump  was  noticed  in  the  cicatrix  before  there  was  any 
ulceration. 

Charcot’s  Joint-Disease. 

Dr.  Hale  White  showed  a  pelvis,  taken  from  a  subject 
who  was  brought  into  the  dissecting-room  of  Guy’s  Hospital 
last  winter,  which  he  thought  was  an  example  of  Charcot’s 
disease.  The  bones  were  extremely  thin  and  light,  the 
spaces  in  the  cancellous  tissue  being  unusually  large.  This 
change  made  the  bones  so  light  that  the  whole  pelvis  only 
weighed  seven  ounces.  The  acetabula  were  much  altered, 
the  walls  being  as  thin  as  paper  in  many  parts.  Owing  to 
this  tenuity  of  the  bone,  the  heads  of  the  femora  had  pressed 
the  bottom  of  the  acetabula  into  the  pelvis,  thus  forming 
two  very  prominent  bosses  on  its  interior,  and  making  the 
transverse  diameter  of  the  brim  three  inches  and  a  quarter. 
All  articular  cartilage  had  disappeared.  This  deepening  of 
the  cavity  made  its  margins  very  prominent,  so  that  the 
anterior  superior  spine  quite  overhung  the  acetabulum  on 
the  right  side.  At  the  back  part  the  deepening  was  so  ex¬ 
treme  that  the  thick  part  of  the  bone  between  the  acetabular 
and  posterior  surface  of  the  ischium  was  almost  worn 
through.  On  both  sides,  especially  the  right,  it  was  seen 
that  the  deepened  cavity  was  divided  into  two  parts  by  a 
vertical  ridge  placed  opposite  the  most  superior  part  of  the 
ischial  tuberosity ;  the  anterior  of  these  two  parts  was  for 
the  lesser  trochanter  to  play  in,  as  the  absorption  of  the 
neck  of  the  femur  was  so  great  that  the  lesser  trochanter 
was  brought  up  to  the  margin  of  the  obturator  foramen. 
The  chief  points  about  the  specimen  were  the  great  atrophy 
of  bone  without  the  formation  of  any  new  bone,  thus  corre¬ 
sponding  exactly  to  Prof.  Charcot’s  description  of  “  con¬ 
siderable  atrophy  without  the  production  of  stalactites.” 

Mr.  Hulke  thought  that  these  changes  of  rarefying 
osteitis  were  due  to  pressure.  He  was  always  rather 
sceptical  about  Charcot’s  joint-disease,  and  he  thought 
that  the  case  brought  before  them  that  evening  differed  in 
some  important  particulars  from  those  which  Charcot  had 
described. 

Mr.  Hutchinson  asked  whether  any  other  joints  were 


Nov.  24, 1883.  6  1  3- 


affected,  and  whether  it  would  be  possible  to  obtain  any 
further  history  of  the  case. 

Dr.  White,  in  reply,  said  that  no  other  joints  were 
affected,  and  he  much  regretted  that  he  had  been  unable: 
to  obtain  any  history. 

Pedunculated  Adeno-Sarcoma  or  Skin. 

Mr.  Eve  showed  some  microscopical  sections  of  this-  case. 
The  patient  was  a  woman,  aged  forty-six,  under  the  care  of 
Mr.  Langton,  with  a  pedunculated  tumour  hanging  from 
the  left  groin,  measuring  five  inches  by  three  inches  and  a 
half.  The  skin  was  adherent  at  the  apex  only.  The  tumour 
was  irregular.  There  was  a  history  of  a  kick  in  the  groin. 
Four  years  after,  an  abscess  formed  there  ;  then,  three  years 
later,  a  small  swelling,  which  recently  had  grown  rapidly. 
The  mass  was  uniformly  fleshy,  and  of  indistinct  fibrous 
structure.  Microscopically,  the  growth  was  a  fibro-sarcoma 
with  scattered  epithelial  cells  of  glandular  type.  Some  of 
these  had  the  appearance  of  alveoli.  The  growth  resembled 
an  adenoma  of  the  skin,  and  was  prob  ably  due  to  hyper¬ 
trophy  of  the  glandular  element  of  the  skin.  It  was  likely 
to  return  locally. 

Necrosis  of  Upper  Jaw  in  Typhoid  Fever. 

Dr.  Angel  Money  read  notes  of  a  case  of  typhoid  fever 
which  supervened  on  rheumatic  fever  in  a  boy  aged  nine 
years.  The  typhoid  fever  set  in  about  six  weeks  (Feb¬ 
ruary  18)  after  the  patient’s  admission  to  hospital,  and  there 
seemed  to  be  no  doubt  that  the  primary  illness  was  of  a 
rheumatic  nature.  Five  weeks  (March  22)  after  the  appa¬ 
rent  onset  of  the  fever,  the  signs  of  necrosis  of  the  upper- 
jaw  on  the  left  side  were  apparent.  Several  teeth  came 
away,  and,  after  a  protracted  course,  the  sequestrum  was- 
removed  without  any  mishap  on  May  30.  The  sequestrum 
consisted  of  a  large  portion  of  the  superior  maxillary  and 
palate  bones — necrosis  of  something  more  than  the  mere 
alveolar  border.  The  patient  made  an  excellent  recovery,, 
and  a  note  on  June  4  says  that  no  fluid  has  returned  through 
the  nose.  It  might  be  remarked  that  the  necrosis  seemed  to- 
come  on  during  the  course  of  typhoid  fever,  but  it  was  much 
more  likely  that  the  specific  fever  had  ended  its  course,  and 
that  the  pyrexia  observed  was  due  to  the  local  mischief 
about  the  jaw. 

Mr.  Parker  was  of  opinion  that  this  case  closely  re¬ 
sembled  cases  of  cancrum  oris  except  in  the  fact  of  recovery. 
He  had  frequently  seen  a  similar  occurrence  after  measles, 
scarlet  fever,  and  typhoid  fever. 

Mr.  Mahomed  had  seen  two  cases  in  which  scarlet  fever  had 
been  followed  by  the  loss  of  a  portion  of  the  maxilla  and  some 
teeth.  Clinically,  Dr.  Money’s  case  bore  no  resemblance  to 
cases  of  cancrum  oris,  for  the  bone  was  affected  rather  than 
the  soft  tissues,  the  process  was  not  a  creeping  one,  and  a 
large  area  was  affected  from  the  first. 

Mr.  Hulke  thought  that  this  was  certainly  not  a  case  of 
cancrum  oris.  The  fact  that  the  patient  recovered  without 
local  treatment  was  in  itself  sufficient  to  prove  this. 

Dr.  Money  replied  that  though  pathologically  there  might 
not  be  much  difference  between  his  case  and  one  of  cancrum 
oris,  yet  that  clinically  they  were  quite  distinct  conditions. 

The  so-called  Tuberculosis  in  Birds. 

Mr.  J.  B.  Sutton  read  a  communication  on  this  subject. 
His  attention  was  first  attracted  to  the  disease  called 
££  tuberculosis  ”  in  birds  in  the  spring  of  1879  by  a  farmer- 
in  the  North  of  Middlesex,  who  sent  him  two  dead  fowls, 
stating  that  disease  had  broken  out  among  his  (the  farmer’s) 
poultry,  and  that  his  stock  of  birds  stood  a  fair  chance  of 
destruction.  By  thoroughly  destroying  the  bodies  of  the 
dead  birds  and  killing  the  sickly  ones  the  disease  seemed  to 
be  arrested  for  a  time.  In  1881  the  disease  again  made  its 
appearance,  and  nearly  all  the  offspring  of  the  stock  of  1879 
died.  Ducks  and  geese  were  not  affected  in  either  epidemic. 
In  the  latter  part  of  that  year  the  author  commenced  work  at 
the  Zoological  Gardens,  where,  in  the  course  of  his  dissec¬ 
tions,  he  found  the  disease  very  prevalent.  After  spending 
more  than  two  years  in  investigating  the  matter,  and  examin¬ 
ing,  from  all  sources,  more  than  a  thousand  birds  of  various 
species,  he  now  proposed  to  put  the  results  of  his  observa¬ 
tions  before  the  Society  under  three  headings  — 1.  The 
anatomy  of  the  disease ;  2.  Its  zoological  distribution 

3.  The  histology  of  the  affected  organs.  (1.)  With  regard  to 
the  first  division  of  the  subject,  the  author  said  that  the 


€14 


Medical  Times  and  Gazette. 


OBITUARY. 


Nov.  24,  1883. 


disease  first  manifested  itself  in  the  alimentary  canal  in  the 
form  of  yellowish-white  nodules,  varying  in  size  from  a 
small  pin’s  head  to  a  mass  as  large  as  a  chestnut.  They 
projected  most  into  the  interior  of  the  bowel,  thus  causing 
■death  by  obstruction,  or  projected  on  the  serous  surface, 
setting  up  peritonitis.  The  liver  next  became  the  seat 
of  caseous  nodules  equally  disseminated  throughout  its  sub¬ 
stance,  at  first  very  minute,  but  soon  attaining  a  con¬ 
siderable  size.  The  spleen  rarely  escaped,  frequently  being 
so  full  of  these  nodules  that  the  capsule  ruptured.  The 
Jymphatic  glands  in  the  neck  were  affected  in  severe  cases. 
The  mesentery  often  contained  nodules  due  to  collection  of 
fhe  morbid  material  in  the  ducts  leading  to  the  recep- 
‘fcaculum  chyli.  The  kidneys,  heart,  etc.,  were  rarely  the 
seat  of  gross  lesions.  Only  once  was  a  deposit  in  the 
lungs  met  with.  Death  was  nearly  always  caused  by  the 
■mechanical  effects  of  the  nodules  in  the  intestines  pro¬ 
ducing  obstruction  or  setting  up  peritonitis.  (2.)  The  birds 
■almost  exclusively  affected  by  this  disease  were  those 
which  lived  on  seed,  grain,  and  fruit  (by  grain  was  meant 
'barley,  maize,  oats,  etc.).  Twice  it  occurred  in  flesh-eaters, 
but  no  case  was  met  with  in  those  subsisting  on  fish.  The 
astruthiones,  particularly  the  rhea  (South  American  ostrich), 
were  very  liable  to  this  affection.  The  birds  most  liable 
were  the  common  fowl,  the  peacock,  grouse,  guinea-fowl, 
tragopan,  pigeon,  and  partridge.  Possibly  the  two  flesh- 
•eating  birds  contracted  the  disease  by  eating  the  flesh  of  birds 
who  had  died  from  it.  (3.)  In  July,  1883,  the  author  commnni- 
■eated  with  Dr.  Gibbes,  who  submitted  specimens  of  the  organs 
■of  rhea,  peacock,  tragopan,  and  golden  pheasant  affected  with 
tuberculosis  to  microscopical  examination  with  the  following 
^result.  Sections  of  the  liver,  when  stained  with  logwood, 
showed  circumscribed  areas  surrounded  by  fibrous  tissue, 
in  which  were  numbers  of  cells  that  appeared  to  be  dis¬ 
integrated.  Among  them  were  numbers  of  small  cells 
which  stained  deeply.  Outside  these  areas  the  liver  ap¬ 
peared  to  be  normal.  On  staining  sections  specially  for 
bacilli,  the  whole  of  the  circumscribed  areas  before  men¬ 
tioned  were  found  to  be  made  up  of  cells,  of  varying  size, 
filled  with  bacilli.  These  bacilli  were  also  arranged  in 
tubular  masses  in  what  appeared  to  be  vessels.  They  had 
the  same  reaction  to  staining  agents  as  the  bacilli  found  in 
tuberculosis  ;  with  a  high  magnifying  power  (  x  4000)  they 
were  indistinguishable  from  them,  and  they  also  contained 
■rounded  bodies  resembling  spores.  Bacilli  were  also  found 
in  the  lung  and  lymphatic  glands  of  the  peacock,  in  the 
lymphatic  glands  and  liver  of  the  tragopan,  and  in  the  lung, 
intestine,  liver,  and  spleen  of  the  golden  pheasant.  The 
question  for  consideration  was — Was  there  any  chance  of  the 
-disease  becoming  transferred  from  man  to  other  animals  ? 
Dn  the  farm  where  the  disease  was  originally  watched  some 
•of  the  pigs  died  from  peritonitis,  the  coils  of  the  intestine 
being  matted  together  by  small  growths.  These  pigs  were 
fed  on  refuse  from  the  kitchen,  including  the  offal  from 
ffhe  poultry.  With  regard  to  this  it  appeared  that  in  the 
Grand  Duchy  of  Baden  the  veterinary  surgeons  reported  on 
■the  frequency  of  tuberculosis  in  pigs  fed  on  the  residue  of 
'the  distillery  and  kitchen  waste,  the  infection  starting  from 
the  alimentary  canal,  and  affecting  the  liver,  spleen,  and 
occasionally  the  kidney  ( Veterinary  Journal,  October,  1883). 
At  the  Zoological  Gardens,  two  carnivorous  animals — an 
oyra  from  Brazil,  and  a  paradoxure  from  India— died  with 
■their  livers  in  the  same  condition  as  tuberculous  birds.  These 
creatures  were  fed  on  small  birds  and  the  offal  of  poultry. 
"Their  livers  were  examined  by  Dr.  Gibbes,  who  found  that  the 
modules  contained  bacilli  giving  the  same  reaction  to  staining 
agents  as  those  found  in  the  nodules  of  the  birds’  viscera. 
The  author  wished  to  state  that  this  was  only  a  prelimi¬ 
nary  paper.  He  was  still  working  actively  at  the  subject, 
hoping  soon  to  bring  further  important  matter  before  the 
Society  ;  but,  having  cleared  the  way  to  the  point  attained 
by  the  investigations  recorded  in  this  paper,  it  was  thought 
•desirable  that  these  facts  should  be  contributed  to  the 
•members. 

Card  Specimens. 

J.  R.  Lttnn. — Fracture  of  Lumbar  Spine. 

F.  S.  Eve  (for  Dr.  Lediard). — Sarcoma  of  Lower  Jaw  of 
Horse. 

F.  S.  Eve. — Hydatid  Cyst  from  Calf  of  Leg. 

R.  E.  Carington. — Ulcerative  Endocarditis. 

Dr.  S.  West. — Stomach  from  a  case  of  Carbolic  Acid 
Poisoning. 


OBITUARY. 

- + - 

CHARLES  HILTON  FAGGE,  M.D.,  F.R.C.P. 

With  feelings  of  the  most  profound  regret  we  have  to 
record  the  death  of  Dr.  C.  Hilton  Fagge,  which  occurred  on 
November  19,  at  76,  Grosvenor-street,  W.  The  fact  that 
his  health  had  become  precarious  was  already  known  to 
many,  but  the  particular  form  of  his  malady  was,  by  his 
own  desire,  only  divulged  to  a  few,  and  the  knowledge 
that  he  had  been  fulfilling  his  duties  as  Examiner  in  Medi¬ 
cine  at  the  University  of  London  during  the  previous  week 
had  dispelled  any  idea  of  immediate  danger.  For  the  last 
eighteen  months  he  had  become  aware  of  some  imperfection 
of  the  aortic  valves,  but  not  until  the  beginning  of  the 
present  year  was  any  suspicion  entertained  of  the  disease 
which  has  now  proved  fatal — viz.,  aneurysm  of  the  arch  of 
the  aorta.  Recognising  only  too  clearly  what  was  before 
him,  he  followed  with  precision  the  advice  of  his  col¬ 
leagues,  Drs.  Wilks  and  Moxon,  and  for  some  time 
made  most  satisfactory  progress.  Relaxing  only  those 
of  his  professional  duties  which  involved  physical  exer¬ 
tion,  he  continued,  with  a  brave  spirit,  in  the  regular 
work  of  his  practice.  Possibly  the  fatigue  attending  the 
M.B.  examination,  just  concluded,  may  have  contributed 
to  the  more  rapid  close  of  a  life  which  must  under  any  cir¬ 
cumstances  have  been  near  its  end.  The  immediate  cause 
of  death  was  syncope,  probably  from  internal  haemorrhage. 

Descended  from  a  race  of  medical  men,  and  nephew 
of  the  late  John  Hilton,  F.R.S.,  Dr.  Fagge  was,  after 
an  early  training  under  private  tuition,  entered  at  Guy’s 
Hospital  at  the  age  of  eighteen,  and  from  that  day  for¬ 
ward  every  medical  honour  and  appointment  which  his 
years  permitted  was  at  his  disposal.  At  his  First  M.B. 
examination  at  the  London  University,  in}  1859,  Dr.  Fagge 
took  first  places  in  anatomy  and  physiology,  chemistry 
(bracketed  equal  with  Dr.  Gee),  botany,  and  in  materia 
medica  and  pharmaceutical  chemistry  ;  at  his  Second 
M.B.,  in  1861,  he  was  first  in  physiology  and  comparative 
anatomy,  in  medicine  (again  bracketed  equal  with  Dr.  Gee), 
and  second  in  surgery  and  in  obstetric  medicine ;  and  in  1862 
he  took  his  M.D.  degree.  His  student-career  is  probably 
the  most  brilliant  in  the  records  of  the  University  of  London, 
and  the  promise  there  shadowed  forth  was  most  amply 
fulfilled. 

Appointed  Demonstrator  of  Anatomy  at  Guy’s  Hospital 
in  1863,  and  Medical  Registrar  in  1866,  he  succeeded  to 
the  Assi3tant-Physicianship  in  1867.  For  several  years  he 
took  charge  of  the  department  of  skin  diseases,  and,  besides 
the  work  of  clinical  teaching,  he  drew  up  a  valuable  cata¬ 
logue  of  the  beautiful  series  of  wax  models  in  the  Guy’s 
museum.  In  1871  he  became  associated  with  Dr.  Moxon 
in  the  pathological  department,  succeeding  in  1873  to  the 
Curatorship  of  the  Pathological  Museum  and  the  Lectureship 
on  Pathology.  In  the  active  work  of  the  post-mortem  room 
he  continued  until  a  year  ago,  and  he  contributed  in  no 
small  degree  to  the  perfection  of  the  present  pathological 
demonstrations  in  the  new  theatre,  by  the  earnest  manner 
in  which  he  urged  upon  the  authorities  of  the  Hospital  the 
necessity  of  providing  a  suitable  building  for  the  work  of 
which  he  so  well  knew  the  importance.  Besides  his  work 
as  Assistant-Physician  at  Guy’s,  he  held  appointments  at 
various  times  as  Lecturer  on  Physics,  on  Materia  Medica, 
and  on  Hygiene,  in  addition  to  the  ordinary  courses  of 
clinical  lectures.  For  several  years  he  held  office  as  Phy- 
.  sician  to  the  Evelina  Hospital  and  to  the  Royal  Hospital  for 
Women  and  Children,  and  officiated  till  the  time  of  his  death 
as  physician  to  three  assurance  societies,  the  London  and 
Westminster  Bank,  etc.  His  distinguished  career  at  the 
University  of  London  naturally  led  him  to  take  a  deep 
interest  in  all  matters  relating  to  it,  and  especially  in  the 
achievements  of  the  students  of  his  own  school  who  in 
successive  years  became  candidates  for  its  degrees  and 
honours,  many  of  whom  owe  a  large  share  of  their  sub¬ 
sequent  success  to  bis  kindly  encouragement  and  brilliant 
example. 

In  succession  to  the  late  Dr.  Murchison,  Dr.  Hilton  Fagge 
was  appointed  an  Examiner  in  Medicine  at  the  University, 
and  held  the  office  till  the  day  of  his  death,  having  been 
engaged  in  looking  over  the  papers  of  the  candidates  for  the 
recent  M.B.  examination  within  a  few  hours  of  the  end.  A 


Medical  Times  and  Gazette. 


MEDICAL  NEWS. 


Nor.  24, 1883.  6 If/ 


striking  similarity  between  the  terminations  of  two  useful 
and  honourable  lives  is  seen  on  comparing  the  case  of  Dr. 
Murchison  with  that  of  Dr.  Fagge.  Distinguished  as 
scholars  and  teachers,  both  working  for  the  same  end,  they 
each  in  turn  were  called  upon  to  face  the  dreadful  certainty 
that  their  lives  were  in  daily  danger.  With  the  true  spirit  of 
bravery  which  animated  them  both,  they  steadfastly  deter¬ 
mined  to  do  their  duty  to  the  last,  and,  dying  in  harness, 
as  both  would  have  desired,  have  left  behind  them  names 
which  will  for  ever  be  remembered  with  the  respect  due  to 
brave  and  honourable  men. 

Dr.  Fagge’s  place  as  Physician  to  Guy’s  Hospital,  which 
he  only  lived  to  enjoy  during  three  years,  may  be  filled 
readily  by  others  ;  but  the  loss  of  his  personal  influence  in 
the  Hospital  and  School  will  be  felt  for  a  long  time  after  the 
immediate  shock  of  bereavement  has  passed  away.  Of  his 
qualities  as  a  scholar,  writer,  and  thinker  in  the  great  de¬ 
partment  of  medical  science,  he  has  left  abundant  evidence 
behind,  scattered  through  transactions,  reports,  and  records 
of  various  societies  and  associations.  A  still  more  powerful 
testimony  has  yet  to  be  given  to  the  world  in  his  work  on 
Medicine,  upon  which,  in  the  intervals  of  active  practice,  and 
lately  under  the  most  trying  circumstances,  he  had  been 
engaged  for  many  years  past ;  but  an  unwritten  record  of 
his  wide  reading,  his  careful  reasoning,  his  painstaking  and 
conscientious  observations,  and  his  truly  scientific  habit  of 
thought,  will  remain  indelibly  impressed  upon  the  minds  of 
all  those  whose  privilege  it  was  to  work  in  association  with 
him. 

In  addition  to  a  well-stored  and  evenly-balanced  mind, 
which  should  be  the  property  of  every  physician.  Dr.  Fagge 
had  that  gift  for  painstaking  and  laborious  observation 
which,  we  fear,  is  less  cultivated  now  than  in  former  days ; 
and  in  the  old-fashioned  requirements  of  diagnosis  and  treat¬ 
ment  he  had  scarcely  an  equal,  certainly  not  a  superior, 
among  his  contemporaries.  He  always  remembered  and 
brought  to  bear  on  a  difficult  case  the  particulars  of  any 
analogous  cases  that  he  might  have  previously  seen,  and  his 
field  for  observation  had  been  as  large  as  it  was  well  worked. 
He  was  an  assiduous  and  careful  pathologist,  and  all  his 
observations  and  writings  fully  attested  the  value  and 
earnestness  of  his  work.  He  was  in  no  way  sanguine  as  to 
the  results  of  theoretical  investigations,  but  was  remarkable 
for  the  orderly  and  masterful  manner  in  which  he  placed 
his  facts  before  his  hearers,  almost  regardless  of  the  in¬ 
ferences  which  he  intended  should  be  formed  from  them. 
He  had  worshipped  at  the  shrine  of  Addison  and  Bright, 
and  was  no  mean  follower  in  their  footsteps.  His  most 
valuable  writings  are,  in  our  opinion,  amongst  his  earliest, 
viz.,  the  articles  on  “  Intestinal  Obstruction  ”  and  “  On  the 
Murmurs  attendant  on  Mitral  Contraction,”  in  the  Guy's 
Hospital  Reports  for  1869  and  1871.  He  was  always  greatly 
devoted  to  Dermatology,  and  published  many  short  memoirs 
thereon.  He  also  edited  and  translated,  for  the  new 
Sydenham  Society,  Hebra’s  classic  work  on  Exanthemata 
and  Diseases  of  the  Skin.  He  was  a  constant  attendant  at 
the  meetings  of  the  Pathological  Society,  and  every  recent 
volume  of  its  Transactions  contains  records  of  cases  and 
post-mortem  examinations  of  extreme  value,  sufficiently 
indicative  of  the  manner  of  work  and  the  character  of  Dr. 
Fagge  as  a  physician.  The  last  public  occasion  in  which 
Dr.  Fagge  took  a  prominent  part  was  in  November,  1880, 
when,  in  his  opening  speech  at  the  debate  on  Rickets — 
probably  the  most  important  discussion  ever  held  at  the 
Pathological  Society, — he  gave  the  conclusions  at  which  he 
had  arrived  from  his  practice  at  the  Evelina  Hospital  for 
Children.  He  was  particularly  quiet  and  unassuming  in 
manner,  beloved  by  all  who  knew  him  well,  and,  in  losing 
him,  we  feel  that  “  a  modest  as  well  as  a  great  clinical 
observer  and  teacher  has  passed  from  amongst  us.” 


LOUIS  BORCHARDT,  M.D. 

After  a  somewhat  brief  illness,  this  well-known  physician 
died  on  November  15,  at  his  residence  near  Manchester,  at 
the  age  of  sixty-seven.  Born  in  East  Prussia,  Dr.  Borchardt 
was  early  entered  as  a  student  at  the-  University  of  Berlin, 
where  he  graduated  as  Doctor  of  Medicine  in  1838.  A  few 
years  later  he  did  some  very  good  work  as  a  Royal  Com¬ 
missioner  in  organising  a  successful  opposition  to  the  ravages 
of  an  epidemic  of  typhus  fever  in  Upper  Silesia.  In  1848 
he  played  a  prominent  part  in  the  agitation  against  the 


Government,  the  ultimate  result  of  which  was  a  term  of 
imprisonment  for  two  years,  and  such  systematic  persecution 
afterwards  that  he  was  obliged  to  give  up  all  thoughts  of 
practising  his  profession  in  his  native  land,  and  came  over 
to  this  country  rather  more  than  thirty  years  ago.  He  soon 
settled  down  in  Manchester,  where  he  early  became  connected; 
with  the  Children’s  Hospital,  holding  the  office  of  Physician 
to  it  for  nearly  a  quarter  of  a  century.  He  soon  gained  an 
extensive  practice,  and  enjoyed  the  confidence  of  his  patientsr. 
in  marked  degree.  He  was  at  one  time  President  of  the 
Manchester  Medical  Society,  and  was  also  President  of  the 
Lancashire  and  Cheshire  Branch  of  the  British  Medical 
Association  ;  and  during  the  International  Medical  Congress 
held  in  London  in  1881  he  was  a  member  of  the  Council  in> 
the  Section  of  Diseases  of  Children. 


INVENTIONS  AND  IMPROVEMENTS. 


RUSPINI’S  ASTRINGENT  TINCTURE,  DENTIFRICE,, 
AND  BALSAMIC  STYPTIC. 

Samples  of  these  old  and  well-known  remedies  are  again 
before  us.  They  have  been  in  use  so  long,  and  have  main¬ 
tained  their  undoubted  excellences  so  well,  that  it  is  un¬ 
necessary  for  us  to  say  much  about  them.  The  tincture  and 
dentifrice  are  specially  useful  in  cases  of  spongy  gums, 
leading  to  loosening  of  the  teeth  ;  they  are  powerfully  and1 
agreeably  astringent,  and  seem  well  adapted  to  the  purposes 
they  serve.  The  styptic,  both  for  internal  and  external  use, 
is  indicated  in  cases  where  haemorrhage  is  going  on,  and  it 
was  used  in  such  cases  by  the  late  Sir  Benjamin  Brodie.  Ik 
is  perhaps  not  generally  known  that  the  original  proprietor 
was  an  Italian  surgeon.  At  his  death  the  recipes  passed  to 
his  eldest  son,  who  was  once  at  school  with  the  First 
Napoleon.  They  have  since  been  handed  down,  and  are* 
now  in  possession  of  a  great  grandson  of  old  Ruspini.  We-, 
do  not  usually  notice  secret  preparations,  but  the  present 
ones  claim  some  exemption  on  account  of  their  antiquity 
and  respectability  of  origin.  They  may  be  obtained  of 
Barclay  and  Sons,  Farringdon-street,  E.C. 


MEDICAL  NEWS. 


University  of  London. — The  following  is  a  list  of  the 
candidates  who  have  passed  the  recent  M.B.  Examination  : — 
First  Division—  Charles  Frederick  Bailey,  St.  Bartholomew’s  Hospital  J 
John  Metcalfe  Beverley,  Owens  College  and  Manchester  Royal  Infirmary; 
Robert  Black,  London  Hospital ;  Edward  Hargrave  Booth,  Guy’s  Hospital 
Frederick  Foord  Caiger,  St.  Thomas’s  Hospital ;  John  Howard  Champ, 
Guy’s  Hospital;  Joseph  Collier,  Owens  College  and  Manchester  Royal 
Infirmary;  Louis  Albert  DunD,  Guy’s  Hospital;  Charles  Reginald  Elgood, 
University  College;  Robert  Forteseue  Fox,  London  Hospital;  William. 
Dobinson  Halliburton,  B.Sc.,  University  College;  Wheelton  Hind,  Guy’s. 
Hospital ;  William  Heaton  Horrocks,  B.Se.,  Owens  College ;  Walter  Hull, 
St.  Thomas’s  Hospital;  Frederick  Knight,  University  College ;  Albert 
Martin,  Guy’s  Hospital;  Sidney  Harris  Cox  Martin,  B.Sc.,  University 
College;  Paul  Frank  Moline,  University  College;  Frederick  John  Paley,. 
St.  Bartholomew’s  Hospital;  Maurice  Parry-Jones,  Guy’s  Hospital; 
George  Victor  Perez,  University  College;  John  Alfred  Parry  Price,  Guy’s 
Hospital;  Samuel  Rabbeth,  King’s  College;  John  Thomas  Rogerson, 
Owens  and  University  Colleges ;  Edmund  Wilkinson  Roughton,  St. 
Bartholomew’s  Hospital ;  Thomas  William  Shore,  B.Sc.,  St.  Bartholomew’s 
Hospital ;  Richard  Sisley,  St.  George’s  Hospital ;  Robert  Henry  Soanes 
Spicer,  B.Sc.,  St.  Mary’s  Hospital;  St.  Clair  Thomson,  King’s  College; 
Clement  Bernard  Voisey,  Owens  College,  Manchester  Royal  Infirmary,  and 
St.  Mary’s  Hospital;  Ernest  William  White,  King’s  College;  Sidney 
Worthington,  Guy’s  Hospital. 

Second  Division.— Harry  Poole  Berry,  Guy’s  Hospital ;  Isaac  Blore,. 
Owens  College  and  Manchester  Royal  Infirmary  ;  Walter  Tyrrell  Brooks, 
King’s  College  ;  Robert  Cuff,  Guy’s  Hospital ;  William  Thomas  Frederick 
Davies,  Guy’s  Hospital ;  William  Dudley,  Queen’s  College,  Birmingham  ; 
Joseph  Langton  Hewer,  St.  Bartholomew’s  Hospital ;  Donald  Templeton- 
Hoskyn,  University  College ;  Charles  Montagu  Handheld  Jones,  St.  Mary’s 
Hospital;  Nicholas  Percy  Marsh,  St.  Bartholomew’s  Hospital;  Charles 
Hartvig  Louw  Meyer,  Guy’s  Hospital ;  Michael  O’Kane,  Guy’s  Hospital ; 
Arthur  Guy  Salmon,  St.  Bartholomew’s  Hospital;  Henry  Shillito,  Bir¬ 
mingham  School  of  Medicine;  Druce  John  Slater,  St.  Bartholomew’s 
Hospital;  James  Henry  Targett,  Guy’s  Hospital;  Emily  Tomlinson., 
London  School  of  Medicine  for  Women;  Edward  Waldemar  von- 
Tunzelmann,  University  College;  Henry  Dunn  Waugh,  B.A.,  B.Sc., 
University  College ;  Edwin  James  Wenyon,  B.A.,  B.So.,  Guy’s  Hospital;. 
Thomas  Wilson,  University  College. 


The  Royal  University  of  Ireland. — The  second 
annual  public  meeting  of  the  University  for  the  conferring 
of  degrees  and  awarding  honours  and  prizes  took  place  in 
the  University  Buildings,  Earlsfort-terrace,  Dublin,  on  the 
afternoon  of  Thursday,  the  25th  ult.  His  Grace  the  Duke 


616 


Medical  Times  and  Gaxett*. 


MEDICAL  NEWS, 


Nov.  24,  1883. 


of  Abercorn,  K.G.,  Chancellor  of  the  University,  presided. 
In  his  opening-  statement  the  Chancellor  observed  that  the 
number  of  candidates  entered  for  examination  in  the  Faculty 
of  Medicine  during  the  past  year  had  been  502,  of  whom 
.237  had  been  successful.  The  following  exhibitions  and 
honours  were  awarded  in  the  Faculty  of  Medicine  : — 

M.D.  Degree  Examination. 

Exhibitions. — First  Class,  £50 :  W.  H.  Thompson,  Queen’s  College,  Gal¬ 
way.  Second  Class,  £25  each:  W.  J.  Moynihan  and  J.  M.  fiheedy, 
■Queen's  College,  Cork. 

Honours. — First  Class  :  W.  H.  Thompson.  Second  Class  :  D.  P. 
Gaussen,  W.  J.  Moynihan,  J.  Sheedy.  Upper  Pass  Division:  W.  Barter, 
H.  C.  Brannigan,  J.  J.  Brownlee,  J.  Cagney,  B.  W.  Henderson,  J.  Meek, 
J.  H.  Swanton,  W.  Watters,  P.  B.  White.  Lower  Pass  Division:  W. 
Atterbury,  R.  A.  Barber,  R.  Barry,  E.  C.  Bigger,  ,T.  W.  Bullen,  W. 
Calwell,  j.  Carroll,  A.  A.  G.  Dickey,  P.  J.  Doyle,  J.  Ellison,  R.  H.  Hall, 
J.  B.  Jackson,  G.  J.  W.  Johnston,  R.  E.  Kelly,  T.D.  Kirk,  J.  Lennox 

A.  Lindsay,  J.  A.  Lynch,  W.  R.  A.  M‘ Alister,  M.  M'Auley,  J.  M‘Caw’ 

R.  M‘Elwaine,  J.  M'Glynn,  J.  MTlroy,  J.  M’Ninch,  J.  A.  M.  Macaulay’ 
J.  M'Mahon,  H.  Massey,  J.  Mitchell,  A.  P.  B.  Moore,  S.  J.  Moore,  A.  E’ 
Morris,  J.  O’Connell,  C.  O’Donel,  D.  O’Mahony,  P.  Quinlivan,  R.  Sayers' 
H.  J.  Taylor,  J.  Taylor,  8.  Wallace,  E.  C.  Ward,  B.  Wilson,  C.  G.  Woods’ 

First  Examination  in  Medicine. 

Exhibitions. — First  Class,  £30 :  E.  J.  M‘ Weeney  (Scholarship!,  Catholic 
University  School  of  Medicine.  Second  Class,  £15  each :  [  J.  Flynn, 
Catholic  University  School  of  Medicine  ;  J.  A.  Keogh  and  W.  MacSweeny, 
Queen’s  College,  Cork  ] 

Honours. — First  Class :  E.  J.  M’Weeney  (Scholarship).  Second  Class: 
JJ.  Flynn,  J.  A.  Keogh,  W.  MacSweeny,]  J.  D.  H.  Smyth.  Upper  Pass 
Division :  A.  F.  Downey,  J.  C.  Harkin,  W.  R.  Jones,  J.  M’Ginness,  W.  K. 
M‘Roberts,  E.  F.  O’Sullivan,  S.  A.  Powell,  S.  Ryan.  Lower  Pass  Division  : 
A.  E.  J.  Birmingham,  J.  J.  Curran,  J.  M.  Fagan,  J.  F.  Fagan.  M.  Fitz¬ 
gerald,  J.  W.  Fogarty,  F.  E.  Gahagan,  H.  J.  Gahagan,  J.  E.  P.  Gannon, 
W.  M.  Hamilton,  E.  F.  Hanrahan,  A.  Henderson,  G.  Hickey,  T.  8.  Hogg, 

A.  M’Grath,  S.  M’Nair,  A.  P.  Mooney,  C.  W.  Morgan,  T.  J.  Mulholland, 
<C.  H.  Murray,  F.  E.  Murray,  W.  Mussen,  R.  Nelson,  C.  V.  H.  Nesbitt, 
L.  O’Clery,  J.  K.  O’Connor,  J.  Orr,  J.  J.  Orr,  W.  S.  P.  Patterson,  N.  H. 
Run  el  man,  W.  C.  N.  Sloane,  W.  C.  Steen,  G.  S.  Thomson,  F.  K.  Tweedie, 

E.  W.  Waters,  W.  Weatherup,  E.  M‘N.  Woods. 

Second  Examination  in  Medicine. 

Exhibitions.—  First  Class,  £40  each  :  J.  Bradley,  Queen’s  College,  Cork; 
W.  B.  M‘Quitty,  Queen’s  College,  Belfast.  Second  Class,  £20  each  : 
<3.  Bradley,  Queen’s  College,  Cork  :  A.  Buchanan,  Queen’s  College,  Belfast. 

Honours.  —First  Class:  J.  Bradley,  W-  B.  M’Quitty.  Second  Class: 
<C.  Bradley,  A.  Buchanan.  Upper  Pass  Division  :  F.  J.  Burns,  H.  A. 
Clarke,  C.  J.  M’Gragh,  R.  W.  Nixon,  T.  D.  Smith,  E.  A.  Starling. 
Lower  Pass  Division  :  J.  Barry,  R.  H.  Brew,  F.  C.  J.  D.  Browne-Webber, 
]E.  J.  Chancellor,  J.  W.  Chapman,  J.  J.  Clarke,  P.  J.  Cleary,  J.  K.  Close, 

S.  R,  Collier,  R.  T.  Condon,  T.  Corkery,  A.  Corry,  T.  B.  Costello,  J.  Cree, 
•C.  F.  Daly,  R.  H.  Dickson,  P.  S.  Donnellan,  M.  P.  Dunlea,  J.  F.  Eagleton, 

B.  Forde,  G.  Fuller,  J.  F.  Gordon,  R.  M.  Griffin,  P.  G.  Griffith,  S.  Horneck, 

C.  J.  Humphries,  J.  W.  Irwin,  D.  T.  Lane,  W.  M.  Lewis,  H.  A.  Logan, 

L.  Lyttle,  N.  M’Bride,  D.  J.  M’Kinny,  M.  M'Swiney,  C.  J.  Macdonald, 
W.  E.  MacFeeters,  J.  B.  Massey,  J.  Menary,  G.  L.  Moore,  S.  Moore, 
James  Nesbitt,  John  Nesbitt,  J.  P.  O’Byrne,  D.  J.  O’Mahonv,  W.  R.  Orr, 
W.  R.  Scott,  A.  J.  Smith,  B.  Sumner,  J.  C.  Thomas,  A.  S.  Thompson,  G. 
Vance,  J.  J.  Walsh,  W.  A.  Whitelegge,  M.  P.  Williams,  J.  D.  Williamson, 
■G.  N.  Wynne. 

The  list  of  those  upon  whom  degrees  in  Medicine  and 
Surgery  and  diplomas  in  Midwifery  were  conferred  has 
already  been  published  in  our  pages.  At  a  meeting  of  the 
Senate  of  the  University,  held  on  Friday,  October  26,  on  the 
motion  of  the  Eight  Hon.  Lord  Emly,  seconded  by  the  Earl 
of  Eosse,  the  following  gentlemen  were  elected  Medical 
Fellows: — In  the  Department  of  Anatomy:  Christopher  J. 
Nixon,  M.B. ;  Joseph  P.  Pye,  M.D.,  M.Ch. ;  Peter  Eedfern, 

M. D.  In  the  Department  of  Physiology :  J.  J.  Charles,  M.D., 
M.Ch.;  Charles  Coppinger,  F.E.C.S. I.  In  the  Department 
-of  Medicine:  Benjamin  G.  M’Dowel,  M.D.,  M.Ch.  In  the 
Department  of  Surgery:  Anthony  H.  Corley,  M.D. ,  M.Ch., 

F. E.C.S. I.;  P.  J.  Hayes,  F.E.C.S.E.  The  Fellowshqos  are 
tenable  for  seven  years,  and  are  each  worth  <£100  a  year. 


King  and  Queen’s  College  of  Physicians  in 
Ireland. — At  the  usual  monthly  examinations  for  the 
Licences  of  the  College,  held  on  Monday,  Tuesday,  Wed¬ 
nesday,  and  Thursday,  November  5,  6,  7,  and  8,  the  under¬ 
mentioned  candidates  were  successful : — 

To  Practise  Medicine.— John  Joseph  Buggey,  Kilkenny;  Arthur  Cole, 
Dublin;  Cecil  Spencer  Cronin,  Cork;  Richard  John  D’Arcy,  Kingstown, 
•co.,  Dublin;  Charles  H.  P.  D.  Graves,  Cookstown,  co.  Tyrone;  Michael 
Joseph  McCartan,  Rostrevor. 

To  Practise  Midwifery.  —  John  Joseph  Buggey;  Arthur  Cole;  Cecil 
Spencer  Cronin;  Richard  John  D’Arcy;  Charles  H.  P.  D.  Graves; 
Michael  Joseph  McCartan;  Jeremiah  MacMahon,  M.D.  R.U.I.,  Cork; 
•James  Meek,  M.D.  R.U.I.,  Belfast;  James  Mitchell,  M.D.  R.U.I.,  Desert- 
martin,  co.  Derry ;  William  Langford  Symes,  L.K.  &  Q.C.P.  Dublin. 

The  following  Licentiates  in  Medicine,  having  complied 
with  the  by-laws  relating  to  Membership,  pursuant  to  the 
Supplemental  Charter  of  1878,  have  been  duly  enrolled 
Members  of  the  Collge : — 

Thomas  George  Kerans,  L.M.  1869,  Northwich,  Cheshire ;  Charles 
William  McCarthy,  L.M.  1872,  Clonmel;  John  William  Kennedy,  L.M. 
1875,  Lisburn;  William  Hall  Owen,  L.M.  1877,  Liverpool. 


Koyal  College  of  Surgeons  of  England. — The 
following  gentlemen  having  undergone  the  necessary  exa¬ 
minations  for  the  diploma,  were  admitted  Members  of  the 
College  at  a  meeting  of  the  Court  of  Examiners  on  the 
15th  inst.,  viz.: — 

Bowker,  R.  S.,  L.R.C.P.  Edin.,  Sydney,  N.S.  Wales,  student  of  the 
Middlesex  Hospital. 

Bowtray,  Albert,  L.S.A.,Calstock,  Cornwall,  of  tbe  Charing-eross  Hospital. 
Busb,  E.  A.  A.,  L.R.C.P.  Edin.,  Old  Kent-road,  of  Guy’s  Hospital. 
Doidge,  M.  J.,  Seaton,  Devon,  of  St.  Mary’s  Hospital. 

Fowler,  Walter,  M.A.  Cantab.,  Old Burlington-street,  of  Guy’s  HospitaL 
Greenhill,  G.  T.,  L.R.C.P.  Edin.,  Chilmington,  near  Ashford,  of  Uni¬ 
versity  College  Hospital. 

Holyoak,  Ralph,  Droitwich,  of  the  London  Hospital. 

Ley,  Herbert,  L.S.  A.,  Westbourne-terrace,  of  St.  Bartholomew’s  Hospital. 
Lyon,  T.  G.,  Peckham,  S.E.,  of  St.  Thomas’s  Hospital. 

Martin,  J.  P.,  Doddington-grove,  S.E.,  of  Guy’s  Hospital. 

Maurice,  W.  J.,  L.R.C.P.  Lond.,  Renfrew-road,  S.E.,  of  St.  Thomas’s 
Hospital. 

Millhouse,  George,  Scarborough,  of  the  Leeds  School. 

Robinson,  Louis,  L.S. A.,  Tyrwhitt-road,  S.E.,  of  St.  Bartholomew’s 
Hospital. 

Ruck,  D.  N.,  Devizes,  of  St.  Bartholomew’s  Hospital. 

Salmon,  L.  E.  A.,  L.R.C.P.  Edin.,  Portishead,  of  the  Middlesex  Hospital. 
Simmons,  E.  W.,  L.S.  A  ,  Warrington,  of  Guy’s  Hospital. 

Waller,  O.  B.,  L.S  A.,  Ipswich,  of  the  Westminster  Hospital. 

Wilson,  W.  E.,  Oldham,  of  the  Manchester  School. 

Eleven  gentlemen  passed  in  Surgery,  and  when  qualified  in 
Medicine  will  be  admitted  Members  of  the  College  ;  and  six 
candidates,  having  failed  to  acquit  themselves  to  the  satis¬ 
faction  of  the  Court  of  Examiners,  were  referred  to  their 
professional  studies  for  six  months,  including  one  who  had 
had  an  additional  three  months.  The  following  gentlemen 
passed  on  the  16th  inst.,  viz. : — 

Bentlif,  P.  B.,  L.S.A..  Salisbury,  student  of  the  Middlesex  Hospital. 
Buckmaster,  G.  A.,  Wandsworth,  of  St.  George’s  Hospital. 

Chadwick,  C.  S.,  L.R.C.P.  Edin.,  Manchester,  of  the  Manchester  School. 
Dovaston,  M.  E.,  Camden  Town,  of  University  College  Hospital. 

Hadley,  W.  J.  A.,  L.S.  A.,  Clapham  Common,  of  the  London  Hospital. 
Herbert,  G.,  L.R.C.P.  Edin.,  Tonbridge,  of  University  College  Hospital. 
Josling,  C.  L.,  L.S.A.,  Gauden- terrace,  S.E.,  of  the  Charing-eross  Hospital. 
Kealy,  J.  W.  G.,  L.S.  A.,  Gosport,  of  King’s  College  Hospital. 

Larking,  A.  E.,  L.S. A.,  St.  Thomas’s-terrace,  S.E.,  of  Guy’s  Hospital. 
Lee,  G.  T.,  Upper  Wimpole-strtet,  of  Univergity  College  Hospital. 
Leeming,  R.  W.,  L.S.  A.,  Kendal,  of  University  College  Hospital. 
Lipscomb,  E.  R.  S.,  L.S. A.,  Woodside  Park,  Fincbley,  of  Guy’s  Hospital. 
London,  J.  E.,  L.S. A.,  Berbice,  British  Guiana,  of  King’s  College  Hospital. 
Mathew,  C.  P.,  L.S. A.,  Heavitree,  Exeter,  of  St.  Bartholomew’s  Hospital. 
Molyneux,  J.  F.,  L.R.C.P.  Edin.,  West  Battersea,  of  the  Charing-eross 
Hospital. 

Moorhouse,  B.  M.,  M.B.  Edin.,  Canterbury,  New  Zealand,  of  the  Earn- 
burgh  School. 

Mumby,  L.  P.,  L.S.  A.,  Gosport,  of  the  Westminster  Hospital. 

Oglesby,  H.  N.,  L.R.C.P.  Edin.,  Melbourne,  Derby,  of  the  Leeds  School. 
Powell,  J.  H.,  L.R.C.P.  Edin.,  Clifton,  of  the  Bristol  School. 

Spencer,  Walter,  L.R.C.P.  Edin.,  Streatham,  of  the  Charing-eross  Hospital. 
Williams,  J.  H.,  L.S.  A.,  Llanidloes,  Mont.,  of  the  London  Hospital. 

Pour  gentlemen  passed  in  Surgery,  and,  when  qualified  in 
Medicine,  will  be  admitted  Members  of  the  College.  Six 
candidates,  having  failed  to  acquit  themselves  to  the  satis¬ 
faction  of  the  Court  of  Examiners,  were  referred  to  their 
professional  studies  for  six  months,  and  two  for  three 
months. 

With  this  meeting  the  Pass  Examinations  were  brought 
to  a  close.  One  hundred  and  twenty-nine  candidates 
were  examined,  as  against  ninety  at  the  corresponding 
period  last  year.  Of  this  number  seven  were  referred  to 
their  professional  studies  for  three  months,  thirty-five  for 
six  months,  and  two  for  the  extended  period  of  nine  months 
— making  a  total  of  forty-four  rejected  candidates  out  of  the 
129  examined. 

The  following  gentlemen  passed  their  Primary  Examina¬ 
tion  for  the  Fellowship  of  the  College  at  a  meeting  of  the 
Board  on  the  19th  inst.,  viz. : — 

Hutchinson,  J.,  student  of  the  London  Hospital. 

Johnson,  G.  L.,  of  St.  Bartholomew’s  Hospital. 

Lake,  R.,  of  St.  Thomas’s  Hospital. 

McCabe,  W.  A.  B.,  of  University  College  Hospital. 

Pearce,  G.,  of  St.  Thomas’s  Hospital. 

Sheild,  A.  M.,  of  St.  George’s  Hospital. 

Ten  candidates  were  referred  to  their  anatomical  and  phy¬ 
siological  studies  for  six  months.  The  following  gentlemen 
passed  on  the  20th  inst.,  viz. : — 

Aekland,  J.  McK.,  student  of  the  Charing-eross  Hospital. 
Barendt,  F.  H.,  of  the  Liverpool  School. 

Damian,  F.  G.  C.,  of  St.  George’s  Hospital. 

Lister,  J.  J.,  of  the  University  of  Cambridge. 

Twelve  candidates  were  rejected.  The  following  gentlemen 
passed  on  the  21st  inst.,  viz. : — 

Brito,  P.  S.,  student  of  tbe  University  of  Aberdeen 
Green,  C.  D.,  of  St.  Thomas’s  Hospital. 

Stiles,  H.  J.,  of  the  University  of  Edinburgh. 

Stonham,  C.,  of  University  College  Hospital. 


Medical  Times  and  Gaz«;te. 


MEDICAL  NEWS, 


Nov.  24, 1883.  6  1  7 


Eight  candidates  were  referred  to  their  anatomical  and 
physiological  studies  for  six  months. 

Forty-four  candidates  presented  themselves  for  this  exa¬ 
mination,  as  compared  with  thirty-six  at  the  corresponding 
period  of  last  year.  Of  this  number  thirty  were  referred., 
against  eleven  last  year. 


Apothecaries’  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday, 
November  15  : — 

Barnett,  Frank  Septimus,  Lancaster-road,  Notting  Hill. 

Barry,  Donald  Moore,  West  Drayton,  Middlesex. 

Brickwell,  Henry  Taylor,  Clapton-square,  E. 

Clegg,  Joseph.  Flixton,  Manchester. 

Higginson,  Alfred,  Vemon-street,  Bolton. 

Jenkins,  Jenkin,  Ancaster,  Grantham. 

Lipscomb,  Edgar  Bichard  Senhouse,  Woodside  Park,  N. 

Mumby.  Langton  Philip,  Spring-gardens,  Gosport. 

Pratt,  William  Sutton,  Torrington-square,  W.C. 

Williams,  George  Forbes  Crawford,  Burton-road,  Brixton. 

Wood,  John  William  Atkinson,  Grosvenor-street,  Chorlton-on- 
Medlock,  Manchester. 


APPOINTMENTS. 

Anderson,  William  Milne,  M.B.,  C.M.  Aber. — House-Surgeon  to  the 
West  London  Hospital,  vice  Mr.  Harold  Hendley,  M.R.C.S.  Eng., 
L.S.A.,  resigned. 

Carter,  Eustace  G.,  M.R.C.S. ,  L.R.C.P.  Edin.  (late  General  Infirmary, 
Leeds). — Dispensary-Surgeon  to  the  Bradford  Infirmary,  vice  — Caine, 
resigned. 

Chaffey,  W.  C.,  M.B.  Lond.— Medical  Registrar  to  the  Hospital  for  Sick 
Children,  Great  Ormond-street,  vice  A.  Money,  M.D.,  resigned. 

Gould,  Alfred  Pearce,  M.B.  Lond.,  F.R.C.S.  Eng.— Surgeon  to  the 
Royal  Hospital  for  Diseases  of  the  Chest,  vice  — Walsham,  resigned. 

Lewis.  C.  J.,  M.D.,  M.R.C.S.,  L.R.C.P.— Assistant-Surgeon  to  the  Ear 
and  Throat  Infirmary,  Birmingham. 

Macdonald,  George  Childs,  L.R.C.P.  and  L.M.  Edin. — Resident  Phy¬ 
sician  to  the  Royal  Infirmary,  Edinburgh. 

Malin.  Henry  G.,  L.R.C.S.— Resident  Medical  Officer  to  Monkstown 
Hospital,  Dublin. 

Owen,  Edmund,  F.R.C.S. — Surgeon  to  the  Hospital  for  Sick  Children, 
Great  Ormond-street,  vice  Thomas  Smith,  F.R.C.S.,  resigned. 

Redwood,  Theophilus,  Ph.D.,  F.C.S.— Public  Analyst  for  the  County  of 
Middlesex. 

Savill,  T.  D.,  M.D.  Lond.,  M.R.C.P.— Registrar  and  Pathologist  to  the 
West  London  Hospital. 

Toulmin,  William  Calvert,  L.R.C.P.  Lond.,  M.R.C.S. — Honorary  Sur¬ 
geon  to  the  Stamford  Hill,  Stoke  Newington,  etc.,  Dispensary,  vice 
—  Hacon,  resigned. 

Voss,  F.  H.  Vivian,  M.R.C.S.,  L.S.A.  Lond.— House-Physician  to  the 
London  Hospital. 


DEATHS. 

Blyth,  Louis  Gwyn,  M.R.C.S.,  late  of  Martley,  Worcestershire,  on 
November  14,  aged  40. 

Borchardt,  Louis,  M.D.,  of  Swinton  House,  Fallowfield,  Manchester,  on 
November  15,  aged  67. 

Davies,  William  Joseph,  F.R.C.S.,  J.P.,  at  Penner  House,  near  . New¬ 
port,  Mon.,  on  November  18,  aged  66. 

Fagge,  W.  C.  Hilton,  M.D. ,  F.R.C.P.,  Physician  to  Guy’s  Hospital,  at 
76,  Grosvenor-street,  W.,  on  November  19,  in  his  46th  year. 

Grindrod,  Ralph  Barnes,  M.D.,  at  Malvern  Wells,  on  November  18,  in 
his  73rd  year. 

Kraussold,  Hermann,  M.D.,  at  Frankfort-on-Main,  on  November  12, 
aged  32. 

Marras,  Ernest  Adrian,  M.R.C.S.,  L.R.C.P.,  of  St.  George’s  Hospital, 
at  10,  Canning-place,  on  November  21,  in  his  30th  year. 

Nelson,  Samuel  Christian,  M.D.,  M.R.C.S.E.,  at  Sydney  Mount, 
Douglas,  Isle  of  Man,  on  November  15. 

Wilkinson,  W.  H.  Beacon,  M.R.C.S.,  at  4,  Devonshire-place,  Brighton, 
on  November  20,  aged  79. 


VACANCIES. 

Addenbrooke’s  Hospital,  Cambridge. — House-Surgeon.  [For particulars 
see  Advertisement.') 

Coton  Hill  Lunatic  Hospital,  Stafford.- — Resident  Medical  Superin¬ 
tendent.  (For  particulars  see  Advertisement.) 

Dental  Hospital  of  London,  Leicester-square,  W. — Dental  Surgeon. 
(For  particulars  see  Advertisement .) 

General  Hospital  for  Sick  Children,  Manchester. — Medical  Officer. 
Salary  £1 80  per  annum,  without  board  and  lodging.  Candidates  must 
be  doubly  qualified  and  on  the  Medical  Register.  Applications,  stating 
age,  with  testimonials,  to  be  sent  to  the  Chairman  of  the  Medical  Board, 
Children’s  Dispensary,  Gartside-street,  on  or  before  November  26. 

General  Infirmary,  Northampton. — Assistant  House-Surgeon.  (For 
particulars  see  Advertisement.) 

Gebto  Hospital,  Edinbane,  Skye. — Resident  Medical  Officer.  Salary 
£276,  with  furnished  house,  fire  and  light,  etc.  Applications,  with 
copies  of  testimonials,  to  be  sent  to  J.  MacLennan,  solicitor,  Portree, 
on  or  before  December  1. 

Hospital  for  Sick  Children,  49,  Great  Ormond-street,  W.C. -Assistant- 
Surgeon.  (For  particulars  see  Advertisement.) 


Liverpool  Dispensaries.— Assistant  House-Surgeon.  Salary  to  com¬ 
mence  at  £108  per  annum,  with  apartments,  fire,  gas,  and  attendance. 
Applications,  stating  age,  with  testimonials  and  registration  Certificates, 
to  be  sent  to  R.  R  Greene,  Secretary,  Leith  Offices,  34,  Moorfields, 
Liverpool,  not  later  than  November  26. 

London  LookHospital  and  Asylum,  Westbourne-green,  Harrow-road, 
W. — House-Surgeon  in  the  Female  Department.  Salary  £100  per  annum. 
Applications,  with  testimonials,  to  be  sent  to  the  Secretary  by  Novem¬ 
ber  24. 

N  orth  London  Hospital  for  Consumption  and  Diseases  of  the 
Chest,  Mount  Vernon,  Hampstead,  N.W.— Resident  Medical  Officer 
and  Registrar.  (For  particulars  see  Advertisement.) 

Queen’s  Hospital,  Birmingham. —  Honorary  Physician.  Candidates 
must  be  graduates  in  medicine  of  a  University,  and  be  Fellows  01* 
Members  of  the  Royal  College  of  Physicians  of  London,  or  Fellows  of 
the  King  and  Queen’s  College  of  Physicians,  Ireland,  or  Fellows  of  the 
Royal  College  of  Physicians,  Edinburgh.  The  successful  candidate  is 
prohibited  from  engaging  in  the  practice  of  midwifery,  pharmacy,  or 
surgery  after  his  appointment.  Applications,  testimonials,  and  certi¬ 
ficate  of  registration  to  be  sent  under  cover  to  the  Secretary  (front 
whom  all  further  information  may  be  obtained)  on  or  before  Nov.  26. 

Royal  Free  Hospital,  Geay’s-inn-road,  W.C. — Assistant-Surgeon. 
(For  particulars  see  Advertisement.) 

Royal  Pimlico  Dispensary,  104,  Buckingham  Palace-road.  S.W.— 
Medical  Officer.  Candidates  must  reside  in  the  district.  Applications 
and  testimonials  to  be  forwarded  on  or  before  December  3. 


Death  under  Chloroform.— A  girl,  aged  eleven* 
died  on  Saturday  last  at  Glasgow  from  the  effects  of  chloro¬ 
form,  administered  preparatory  to  an  operation  for  harelip. 

Violent  Deaths  in  India.— An  official  report  states 
that  the  total  number  of  persons  killed  by  wild  animals  and’ 
snakes  in  India  last  year  was  22,125,  against  21,427  in  the 
previous  year.  Of  these,  2606  were  killed  by  wild  animals 
and  19,519  by  snakes.  Of  the  former,  895  were  caused  by 
tigers,  278  by  wolves,  207  by  leopards,  359  by  jackals,  and 
202  by  alligators. 

Presentation  of  a  Testimonial  to  Mr.  Lund. — 
At  a  conversazione  recently  given  by  the  President  of  the 
Manchester  Medical  Society,  Dr.  D.  J.  Leech,  a  testimonial* 
which  had  been  subscribed  for  by  old  pupils  and  a  few 
friends,  was  presented  to  Mr.  Edward  Lund,  as  an  acknow¬ 
ledgment  of  the  great  benefits  he  had  conferred  upon  the 
cause  of  medical  education  in  Birmingham. 

Admiralty  Appointments. — The  following  appoint¬ 
ments  have  been  made  at  the  Admiralty : — Deputy  Inspector- 
General  Thomas  J.  Breen,  to  Jamaica  Hospital,  vice  Deputy 
Inspector-General  Began ;  Deputy  Inspector-General  Henry 
Fegan,  M.D.,  C.B.,  to  Chatham  Division,  Royal  Marines* 
vice  Deputy  Inspector-General  Breen ;  Deputy  Inspector- 
General  John  Breakey,  M.D.,  to  the  Pembroke,  additional* 
for  temporary  service. 

Anderson’s  College,  Glasgow. — Prof.  Bergius  ia 
to  deliver  in  Anderson’s  College,  during  the  winter,  a  course? 
of  lectures  on  Astronomy.  The  introductory  lecture  to  the 
course  was  delivered  on  Saturday  last.  The  fees,  we  under¬ 
stand,  are  to  be  devoted  to  the  purchase  of  one  or  more  astro¬ 
nomical  instruments,  to  be  given  to  the  gentleman  or  lady 
who  at  the  end  of  the  course  produces  the  best  paper  on 
astronomy  after  a  competitive  examination. 

Munificent  Bequests  to  Aberdeen  Charities.-— 
By  the  will  of  the  late  Mr.  David  Roberts,  who  died  in  1875> 
allocations  have  just  been  made  out  of  the  deceased’s  estate 
to  the  following  institutions  : — Aberdeen  Royal  Infirmary 
(improvements  and  building  extension  fund),  A1000 ;  ditto* 
for  Convalescent  Hospital,  <£200 ;  ditto  for  Samaritan  Fund, 
,£100 ;  Aberdeen  General  Dispensary,  =£100  ;  Hospital  for 
Incurables,  <£200  ;  Hospital  for  Sick  Children,  <£100  ;  Oph¬ 
thalmic  Institution,  ,£25 ;  Cottage  Home  for  Convalescents, 
at  Newhills,  <£50. 

Health  in  the  Tropics. — The  popular  notion  of  the 
unhealthiness  of  life  in  the  tropics  is  not  corroborated  by 
the  report  of  Sir  Anthony  Musgrave,  Governor  of  Jamaica, 
from  the  statistics  given  in  which  it  appears  that  the 
mortality  in  the  island  last  year  was  only  at  the  rate  of 
20  per  1000.  This  indicates  conditions  more  healthy  than 
those  of  London  and  the  environs,  where  the  death-rate  is 
over  21  per  1000.  The  Jamaica  death-rate,  however,  would 
he  much  less  than  it  is  but  for  the  extraordinary  mortality 
of  children  under  five  years,  which  Sir  Anthony  Musgrave 
attributes  to  incompetence  of  native  midwives,  and  ignorance 
and  carelessness  of  mothers.  Of  the  total  deaths  in  a  year* 
38£  per  cent,  are  deaths  of  children  of  this  tender  age. 


618 


Medical  Times  and  Gazette. 


VITAL  STATISTICS. 


Not.  24,  1883. 


Lunatics  in  France. — Of  46,000  lunatics  now  under 
treatment  in  the  various  establishments  in  France,  only 
10,000,  or  22  per  cent.,  are  at  the  exclusive  charge  of  their 
families. — Union  M4d.,  October  27. 

Seamen’s  Hospital. — Nineteen  collecting-boxes  for 
the  funds  of  this  charity  were  placed  in  the  different  courts 
during  the  Fisheries  Exhibition,  with  the  result  that  D38 
was  collected.  As  the  Hospital  has  just  been  obliged  to 
borrow  A 1000  to  meet  current  expenses,  this  sum  is  hardly 
likely  to  materially  diminish  its  difficulties. 

The  Law  respecting  Lunatic  Witnesses. — The 
United  States  Supreme  Court  has  recently  decided,  “A 
lunatic  or  person  affected  with  insanity  is  admissible  as  a 
witness  if  he  has  sufficient  understanding  to  apprehend  the 
obligation  of  an  oath,  and  to  be  capable  of  giving  a  correct 
account  of  the  matters  which  he  has  seen  or  heard  with 
reference  to  the  questions  at  issue ;  and  whether  he  has  that 
understanding  is  a  question  to  be  determined  by  the  Court 
upon  examination  of  the  party  himself  and  any  competent 
witnesses  who  can  speak  to  the  nature  and  extent  of  his 
insanity.” 

Extirpation  of  the  Thyroid. — In  the  Archives 
Gen6rales  for  September,  Dr.  Le  Bee  states  that  of  203  cases 
of  this  operation  which  he  has  collected,  172  were  cured  and 
31  proved  fatal — a  mortality  of  15-6  per  cent.  But  if  the 
cases  of  thyroidectomy  for  cancer  (an  operation  which  should 
never  be  performed)  are  abstracted,  there  remain  25  deaths, 
or  12-3  per  cent.,  for  parenchymatous  or  cystic  goitre. 
Susskind,  in  his  thesis  on  the  operation,  points  out  the  de¬ 
crease  in  the  mortality  since  the  operation  was  first  prac¬ 
tised.  Thus,  before  1850,  he  refers  to  44  operations  with  18 
deaths,  or  the  enormous  mortality  of  40 '9  per  cent. ;  and 
Briere  Yverden,  in  1871,  cites  73  cases  with  23  deaths,  or 
31  per  cent.  Between  1850  and  1877,  Susskind  finds  the  mor¬ 
tality  reached  to  19  -4  per  cent. ;  and  now,  as  stated  above,  it 
is  12-3  per  cent.,  owing  to  the  superiority  of  the  antiseptic 
treatment,  and  the  greater  care  taken  in  selecting  fitting 
cases :  so  that,  well  performed,  and  in  suitable  cases,  thy¬ 
roidectomy  is  not  a  more  dangerous  operation  now  than 
amputation  of  the  thigh  or  hip-joint. 

Health  of  Glasgow. — The  Health  Officer’s  report 
states  that  during  the  fortnight  ending  November  10,  1883, 
there  were  472  deaths  registered,  as  compared  with  469  in 
the  fortnight  preceding — representing  a  death-rate  of  24  per 
1000  living.  The  report  mentions  that  typhus  fever  still 
maintains  the  position  gained  last  fortnight,  and  is  distri¬ 
buted  pretty  uniformly  through  the  various  districts.  A 
remarkable  group  of  cases  was  formed  by  six  persons  who 
were  all  employed  in  a  large  umbrella  factory,  and  in  one 
department,  viz.,  the  “home  frame-making  department/’ 
There  was  no  other  connexion  save  that.  Their  residences 
were  in  various  and  widely  separated  parts  of  the  town,  but 
all  worked  in  one  room  in  the  factory,  and  all  sickened  within 
the  space  of  one  week — four,  indeed,  on  the  same  day.  The 
room  was  capacious,  well  ventilated,  and  not  at  all  crowded. 
The  health  officer  has  not  been  able  to  trace  the  individual 
by  whom  the  infection  was  introduced;  it  is  a  proof,  how¬ 
ever,  of  the  transportation  of  typhus  by  means  of  the  clothing 
of  some  one  who  lived  in  a  typhus-loaded  atmosphere. 
Instances  of  this  are  constantly  observed. 

Raw  Eggs  as  a  Nutritious  Article  of  Diet. — 
While  referring  to  the  successful  trials  of  the  dietetic  power 
of  the  powder  of  dried  beef-blood  made  in  Baris  by  Dr. 
Guerder,  the  New  York  Medical  Record  (September  15)  goes 
on  to  say: — “In  this  connexion  we  may  also  speak  of 
another  article — highly  nutritious,  easily  digested  and  re¬ 
tained,  and  but  little  used — viz.,  raw  eggs.  The  •  only  ob¬ 
jection  to  their  use  is  the  individual  objection  of  the 
patients,  and  this  only  before  the  first  is  taken — for  they 
seldom  object  afterwards.  The  egg  may  be  broken  into  a 
glass,  care  being  taken  that  the  yelk  is  not  broken,  and  a  little 
salt  and  pepper  added  if  desired.  The  patient  has  scarcely 
the  trouble  of  swallowing  it,  for  it  goes  down  of  itself.  We 
have  seen  patients  retain  easily  and  even  relish  a  raw  egg 
who  could  retain  nothing  else — more  than  600  having  been 
taken  in  one  case  within  three  or  four  months.  It  goes 
without  saying  that  the  egg  should  always  be  carefully 
selected ;  and,  indeed,  for  fear  that  one  which  has  seen  its 
best  days  should  disgust  the  patient,  it  were  better  to  prepare 
the  eggs  out  of  his  sight.” 


VITAL  STATISTICS  OF  LONDON. 

Week  ending  Saturday ,  November  17,  1883. 
BIRTHS. 

Births  of  Boys,  3S0;  Girls,  1273;  Total,  2633. 

Corrected  weekly  average  in  the  10  years  1873-82,  2735 ’3. 

DEATHS. 


Males. 

Females. 

Total. 

Deaths  during  the  week . 

882 

799 

1681 

Weekly  average  of  the  ten  years  1873-82, ) 
corrected  to  increased  population  ...  f 

831-4 

876-7 

1758-1 

Deaths  of  people  aged  80  and  upwards 

... 

... 

64 

DEATHS  IN  SUB-DISTRICTS  FROM  EPIDEMICS. 


Enumerated 

Population, 

1881 

(unrevised). 

Small-pox. 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

Whooping- 

cough. 

Typhus. 

Enteric  (or 

Typhoid) 

Fever. 

Simple 

continued 

Fever. 

Diarrhoea. 

West . 

669633 

6 

1 

6 

4 

1 

3 

... 

5 

North  ... 

905947 

. . . 

9 

8 

8 

8 

... 

12 

... 

5 

Central 

282238 

2 

3 

... 

3 

1 

6 

... 

1 

East . 

692738 

... 

15 

28 

1 

6 

... 

5 

2 

2 

South . 

1265927 

... 

15 

17 

10 

12 

10 

... 

6 

Total . 

3816483 

... 

47 

55 

25 

33 

2 

36 

2 

19 

METEOROLOGY. 

From  Observations  at  the  Greenwich  Observatory. 

Mean  height  of  barometer  . .  .  29'727  in. 

Mean  temperature 


Highest  point  of  thermometer 
Lowest  point  of  thermometer 
Mean  dew-point  temperature 
General  direction  of  wind 
Whole  amount  of  rain  in  the  week 


39-4° 

50'S" 

27-8° 

35-2° 

Variable. 
0'31  in. 


BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  the 
Week  ending  Saturday,  Nov.  17,  in  the  following  large  Towns : — 


Cities 

and 

Boroughs. 

Estimated  Population  to 
middle  of  the  year  1883. 

Births  Registered  during 
the  week  ending  Nov.  17. 

1  DeathsRegistered  during 
|  the  week  ending  Nov.  17. 

Annual  Rate  of 
Mortality  per  1000  living, 
from  all  causes. 

1 

Temperature 
of  Air(Fahr.) 

Temp, 
of  Air 
(Cent.) 

Rain 

Fall. 

to 

a 

P  <x> 

<X» 

.S 

to5 

U 

to  i 
p  . 

P  O) 

to  r* 

(D  <D 

<32  1 

S3 

<D  t>» 
CD  '-h 

o 

a  a 

So 

£ 

DQ 

<D 

■3 

A 

a 

M 

QQ 

a> 

+3 

CD 

a 

’■+3 

P 

O) 

O 

*3 

London  . 

3955814 

2633 

1681 

222 

50-9 

27-8 

39-4 

4-11 

0-31 

0-79 

Brighton  . 

111262 

61 

49 

23-0 

51-1 

31-1 

39-9 

4-39 

0-58 

1-47 

Portsmouth 

131478 

94 

61 

24-2 

... 

... 

... 

... 

... 

... 

Norwich  . 

89612 

58 

38 

221 

... 

. . . 

... 

... 

... 

... 

Plymouth  . 

74977 

37 

30 

209 

52 '7 

32  5 

42-0 

556 

1-11 

2-82 

Bristol . 

212779 

123 

89 

2P8 

50-0 

22  5  37-9 

3-28 

0’30 

0-76 

Wolverhampton  . 

77557 

44 

25 

16-8 

45-7 

23-9  34-8 

1-56 

1-29 

3-28 

Birmingham 

414846 

263 

159 

200 

... 

... 

... 

... 

Leicester  ...  ,.. 

129483 

70 

39 

15-7 

46-5 

25-81  38-2 

2-33 

1"25 

3-17 

Nottingham 

199349 

117 

93 

243 

46-4 

21-0 

36-3 

2-39 

0-42 

1-07 

Derby . 

85574 

58 

37 

22-6 

... 

... 

... 

... 

... 

... 

Birkenhead 

88700 

54 

44 

25-9 

... 

... 

... 

... 

Liverpool  . 

566753 

352 

287 

26-4 

48-0 

32-6 

40-0 

4-44 

0-59 

1'50 

Bolton . 

107862 

71 

54 

26-1 

45-1 

28-1 

37-4 

3-00 

1-07 

2-72 

Manchester 

339252 

203 

217 

33-4 

... 

... 

... 

... 

... 

... 

Salford  . 

190465 

126 

102 

27-9 

... 

... 

... 

... 

... 

... 

Oldham  . 

119071 

87 

52 

22-8 

... 

... 

... 

... 

... 

... 

Blackburn . 

108460 

68 

64 

30-8 

... 

... 

... 

... 

... 

Preston  . 

98564 

73 

52 

27-5 

46-0 

29-5 

37  4 

3-00 

0-47 

1-19 

Huddersfield  ... 

84701 

47 

44 

27-1 

... 

... 

... 

... 

Halifax  . 

75591 

38 

33 

228 

... 

... 

... 

... 

Bradford  . 

204807 

111 

78 

19-9 

45-0 

29-2 

37-6 

312 

0-28 

0-71 

Leeds  . 

321611 

187 

162 

26-3 

47-0 

30-0 

39-2,  4-00 

0-35 

0-89 

Sheffield  . 

295497 

215 

129 

22-8 

46-0 

26-0 

38-6 

367 

0-35 

0-89 

Hull  . 

176296 

128 

55 

163 

... 

... 

... 

... 

... 

Sunderland 

121117 

93 

47 

20-2 

... 

... 

... 

... 

... 

... 

Newcastle  . 

149461 

111 

68 

23-7 

... 

... 

... 

... 

... 

... 

Cardiff . 

90033 

59 

39 

22-6 

... 

... 

... 

... 

... 

... 

For  28  towns ... 

8620975 

5581 

3828 

23-2 

52-7 

21-0 

38-2 

344 

0-64 

1-63 

Edinburgh . 

235946 

:  121 

90 

19-9 

46-0 

28-3 

38-0 

3-33 

0-05 

013 

Glasgow  . 

515589 

328 

291 

29-5 

45-2;  23-0 

34-4 

1-33 

0-24 

061 

Dublin . 

1  349685 

159 

169 

25-2 

49-2! 21-2 

!39‘1  3-95 

0-75 

l-90 

At  the  Royal  Observatory,  Greenwich,  the  mean  reading 
of  the  barometer  last  week  was  29'73  in. ;  the  highest  reading 
was  30-03  in.  on  Wednesday  morning,  and  the  lowest  29‘37  in. 
on  Saturday  afternoon. 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES. 


Nov.  24,  1883.  619 


NOTES,  QUERIES,  AND  REPLIES. 

- <> - 

He  tjjat  questioned  mne(r  B^all  learn  mne|r. — Bacon. 


The  Rogebs  Testimonial. 

The  following  is  the  fourth  list  of  subscriptions  Edwin  H.  Roe,  Esq., 
Patricroft,  Manchester,  £1  Is. ;  Dr.  Edwards,  12,  Orchard-street,  Portman- 
square,  £1  Is. ;  Dr.  Welch,  877,  Hackney-road,  £1  Is. ;  Dr.  Brett,  Watford, 
£1  Is. ;  Dr.  Bramwell,  Tynemouth,  £1  Is.;  W.  P.  Mills,  Esq.,  Ipswich, 
10s.  6d. 

The  Hind  Fund. 

The  following  additional  subscriptions  have  been  received  and  paid  to 
the  account  of  the  “Hind  Fund”  at  Messrs.  Coutts’  Bank: — A.  B.  C., 
£1  Is. ;  A.  D.,  10s. ;  Dr.  H.  C.  Andrews,  £1  Is. ;  A.  H.  W.  Ayling,  Esq., 
£1  Is. ;  Wright  Baker,  Esq.,  £1  Is. ;  A.  E.  Barker,  Esq.,  £1  Is. ;  Wm. 
Bird,  Esq.,  J.P.,  £5;  Dr.  R.  L.  Bowles,  £2  2s. ;  Wm.  Bowman,  Esq.,  £5 ; 
Mrs.  Budd,  £1  Is. ;  Major  Childs,  £1  Is. ;  G.  R.  Cooke,  Esq.,  £i  Is. ;  Mrs. 
Cronin,  £2;  Edward  Ellis,  .Esq.,  10s.;  F.  T.,  £1  Is.;  Dr.  Fitzpatrick, 
10s.  6d.  ;  Trevethan  Frampton,  Esq.,  10s.  6d. ;  C.  C.  Fuller,  Esq.,  £2  2s.  ; 
Geo.  H.  Furber,  Esq.,  £1  Is. ;  F.  J.  Gant,  Esq.,  £1  Is. ;  Dr.  John  Harley, 
£1  Is.;  James  Harris,  Esq.,  £1  Is.  ;  Csesar  Hawkins,  Esq  ,  £5  5s.;  Dr. 
H.  Horton,  10s.  6d.;  Dr.  G.  How,  £2  2s.;  Jonathan  Hutchinson,  Esq., 
£5  5s. ;  S.  May  Kendall,  Esq.,  £2  2s. ;  Dr.  Kirby,  £3  3s. ;  Dr.  J.  C. 
Langmore,  £1  Is. ;  H.  Laver,  Esq.,  10s. ;  Dr.  Little,  £2  2s.  ;  J.  B.  Martin, 
Esq.,  £2  2s. ;  J.  W.  Mason,  Esq.,  £1  Is. ;  J.  Merryweather,  Esq.,  £3  3s. ; 
Prof.  Pettigrew,  £1  Is. ;  L.  D.  Powles,  Esq.,  £1  Is. ;  Dr.  Renner,  10s.  6d. ; 
Dr.  Ringer,  £2  2s. ;  Surgeon-Major  Spencer,  £5  ;  Dr.  Tayler,  £2  2s.  ; 
Prof.  Turner,  £5  ;  John  Wiblin,  Esq.,  £2  2s. 

Subscriptions  may  be  paid  to  Dr.  Richardson,  F.R.S.  (chairman), 
25,  Manchester-square ;  John  Tweedy,  Esq.,  F.R.C.S.,  24,  Harley-street, 
hon.  treasurer  ;  A.  J.  Pepper,  Esq.,  F.R.C.S.,  122,  Gower-street,  or  T. 
Wakley,  jun.,  Esq.,  L.R.C.P.,  96,  Redcliffe-gardens,  hon.  secretaries  ;  or 
to  Messrs.  Coutts  and  Co.,  Strand. 

Medical  Bulletins. 

TO  THE  EDITOE  OE  THE  MEDICAL  TIMES  AND  GAZETTE. 

Sib, — The  spirit  of  your  leading  article  on  “  Medical  Bulletins  ”  theo¬ 
retically  is  everything  that  the  highest-minded  practitioners  of  medicine 
could  wish  for ;  and  if  it  could  be  effused  into  the  profession  generally, 
into  the  “big  men”  as  well  as  into  the  “lesser  men,”  doubtless  the 
social  standing  of  the  profession  as  a  whole  would  be  considerably 
enhanced.  I  venture  to  think,  however,  that  the  attainment  of  such  a 
standard  is  hardly  possible  in  such  a  many-sided  profession  as  that  of 
medicine.  Apart  from  the  personal  element  of  medical  men,  there  are 
social  differences  in  the  classes  among  whom  they  labour,  which  utterly 
preclude  a  hard-and-fast  line  of  action.  I  fear  you  will  have  to  discou¬ 
rage  other  forms  of  advertising  as  well  as  the  issuing  of  medical  bulletins 
if  you  are  going  to  be  really  consistent ;  and  I  hope,  if  the  College  of 
Physicians  follows  out  your  suggestion,  that  it  will  legislate  on  broad 
general  principles,  and  not  on  the  narrow  line  of  discouraging  merely  one 
particular  form  of  publicity.  I  never  take  up  a  medical  paper  that  I  do 
not  see  some  one  or  other  of  the  many  forms  which  advertising  nowadays 
assumes.  First  and  foremost  come,  of  course,  direct  advertisements,  of  a 
book,  or  atlas,  or  pamphlet ;  even  reprints  from  the  columns  of  some  of  the 
journals  are  advertised  week  after  week — at  a  ruinous  cost,  if  truth  be 
told — by  men  holding  the  highest  diplomas  which  our  colleges  can  give. 

Our  hospitals  and  their  medical  schools  are  largely  advertised— in  the 
lay  as  well  as  in  the  medical  press, — giving  the  names  and  qualifications 
of  the  staff,  and  repeating  them  over  again,  as  lecturers  on  this  or  demon¬ 
strators  of  that  subject.  Thus  the  medical  student  is,  from  the  very  com¬ 
mencement  of  his  studentship,  or  even  before,  surrounded  by  an  atmos¬ 
phere  of  advertisement,  which  grows  with  his  growth,  and  finally  becomes 
rooted  in  him.  Is  it  any  wonder  that  this  should  show  itself  again  when, 
having  obtained  his  qualifications,  the  student  has  to  get  into  practice  ? 
Can  there  be  so  much  harm,  he  thinks,  in  just  making  his  name  a  little 
known  by  a  friendly  notice  in  a  paper,  seeing  that  he  himself  had  first 
become  acquainted  with  his  teachers  and  hospital  by  means  of  an  adver¬ 
tisement — probably  in  one  of  the  large  daily  papers  1  Or,  having  done 
well  in  practice,  and  being  called  in  to  attend  some  “  big  gun  ”  (a  man, 
perhaps,  whose  life  and  health  are  of  paramount  importance  in  his  own 
county  or  district),  can  there  be  so  very  much  harm  in  signing  a  bulletin 
which  is  eagerly  sought  after  by  a  great  number  of  local  personages,  seeing 
that  in  every  medical  paper,  and  in  not  a  few  lay  papers  also,  the  names 
of  the  most  prominent  teachers  and  leaders  in  the  profession  are  being 
constantly  advertised  in  one  way  or  another  ?  I  think,  sir,  the  desire  to 
be  advertised  must  be  as  strong  in  the  patient  as  in  the  doctor :  and  it  is 
very  probably  part  of  the  same  spirit— a  growing  spirit,  and  characteristic 
of  the  age— to  which  you  alluded,  which  now  induces  the  clergy  to  advertise 
themselves  and  their  churches  ;  which  leads  the  nobility  to  chronicle  their 
dinners  and  their  dances ;  the  legal  profession  to  associate  their  names, 
day  after  day,  with  the  trials  on  which  they  are  engaged ;  and  which 
makes  “  every  petty  celebrity  ”  anxious  to  appear  in  print  in  one  capacity 
or  another.  I  have  just  said  it  is  the  characteristic  spirit  of  the  age,  but 
it  as  doubtless  exists  in  response  to  the  public  demand,  as  any  and  every 
other  marketable  commodity.  If  there  were  no  demand  for  such  infor¬ 
mation  the  supply  would  cease. 

The  question  is,  could  we  get  on  without  advertising  1  I  think  not.  But 
I  think  the  personal  element  might  be  left  out.  Guy’s  or  Bartholomew’s 
School  of  Medicine  could  be  advertised  without  the  personal  element,  and 
the  more  so  as  this  element  is  unnecessary.  To  the  new  students  the 
names  convey  nothing ;  to  those  who  re-join  the  information  is  superfluous  ; 
while  to  the  general  public  it  is  puff  and  advertisement,  pure  and  simple. 
As  regards  books,  these  should  be  advertised  from  time  to  time ;  the 
titles  and  publishers’  names  would  suffice ;  the  addition  of  press  notices 
(many  of  them  distinctly  misleading)  is  low  and  unworthy  of  a  good  man 
as  it  is  unnecessary  for  a  good  book.  The  advertising  of  a  small  pamphlet 
— a  shilling  reprint,  for  instance  -  ought  to  be  condemned  altogether. 

At  Liverpool  the  British  Medical  Association  incidentally  discussed  medi¬ 
cal  advertising,  and,  during  the  discussion,  a  small  handbill  which  had  been 
issued  by  a  doctor  in  some  poor  neighbourhood  was  handed  round ;  it  was 
hooted  and  hissed  by  men  who  were,  to  my  thinking,  just  as  reprehensible 
as  the  weak  brother  himself  who  had  issued  it.  They  who  live  and  practise 
in  the  richer  parts  of  London  should  have  compassion  on  us  who  live 


*  v  1  ■  ■  ■  ■  - 

among  the  poor,  and  should  be  thankful  that  their  lines  are  cast  in 
pleasanter  places.  The  kind  of  advertisement  on  which  the  former  ride  to 
practice  is  doubtless  of  a  different  class  from  the  unfortunate  handbill 
just  alluded  to,  but,  before  they  condemn  it,  let  them  be  quite  sure  that 
their  own  record  is  sans  peur  et  sans  reproche.  To  suppress  advertising 
completely  will  need  the  concurrence  of  the  whole  profession,  but  espe¬ 
cially  of  the  leaders.  Let  them  set  the  example,  let  them  begin  by  adver¬ 
tising  the  schools  with  which  they  are  associated  privately — that  is,  by  the 
publication  of  a  calendar  similar  to  the  calendars  issued  by  Oxford  and 
Cambridge.  These  Universities  each  attract  more  students  than  the 
London  hospitals,  and  that  too  without  the  advertising  which  the  latter 
think  it  necessary  to  adopt.  Let  them  suppress  their  names  on  the  bul¬ 
letins  which  are  issued,  whoever  the  personages  may  be,  etc.  In  other 
words,  let  them  cease  advertising  in  any  and  every  shape.  Lesser  men 
will  not  be  slow  to  follow  their  example.  I  am,  &c.. 

Commercial-road,  E.,  November  10.  East-Endeb. 

[We  admit  that  there  is  much  reason  in  our  correspondent’s  objection,  but 
the  relation  of  a  teacher  to  his  class  or  of  an  author  to  his  readers  stands- 
on  an  entirely  different  footing  from  that  of  a  doctor  to  his  patient. 
Each  relation  may  be  looked  upon  commercially,  but  it  is  a  thousand 
times  more  important  to  keep  the  last-named  free  from  any  taint  of  trade 
than  the  two  former.  An  author  or  a  teacher  sells  his  wares  for  an  equi¬ 
valent  ;  each  is  a  commercial  transaction,  and  though  we  w  ould  not  have- 
it  conducted  on  the  lines  of  ordinary  commercial  morality,  we  see  no 
very  crying  evil  in  the  fact  that  such  wares  are  for  sale  being  made- 
widely  known.  No  doctor,  on  the  other  hand,  would  admit  that  his  re¬ 
lation  to  his  patients  is  purely  commercial.  Everyone  who  has  the- 
interest  of  the  profession  at  heart  is  anxious  rather  to  increase  than  to- 
diminish  the  sanctity  of  that  relationship,  and  to  insure  this  it  is  neces¬ 
sary  that  the  system  of  medical  bulletins  should  be  discountenanced. 
Apart  from  that,  it  seems  to  us  in  quite  as  bad  taste  to  allow  one’s  name- 
to  appear  at  the  bottom  of  a  bulletin  as  it  would  be  to  advertise  in  the- 
papers  that  one  was  the  friend  of  this  or  that  celebrity.  If  the  present 
system  is  carried  to  its  logical  conclusion,  some  day  perhaps  we  may 
expect  to  see  some  such  announcement  as  the  following  : — “  Dr.  A.  B. 
has  been  appointed  private  medical  adviser  to  her  Grace  the  Duchess  of 
E.,  vice  Dr.  X.  Y.,  dismissed  for  incompetence  and  neglect.”— Ed.. 
Med.  Times  and  Gaz.~\ 

Munificent  Bequests.— The  late  Mr.  James  Bain,  of  Helensburgh,  made  the- 
following  bequests  to  certain  charities  in  Glasgow,  which  have  now  been 
paid,  viz.: — Glasgow  Royal  Infirmary,  £500  ;  Glasgow  Western  Infirmary, 
£500 ;  Association  for  the  Relief  of  Incurables  for  Glasgow  and  W est 
of  Scotland,  £103 ;  Glasgow  Blind  Asylum,  £100. 

The  Bradshawe  Lecture. — This  discourse,  founded  by  the  widow  of  Dr.  W» 
Woods  Bradshawe,  F.R.C.S.,  in  memory  of  her  husband,  will  be  de¬ 
livered  in  the  theatre  of  the  Royal  College  of  Surgeons  on  Thursday, 
December  6,  by  Mr.  John  Marshall,  F.R.S. ,  President  of  that  institu¬ 
tion,  who  has  chosen  for  his  subject,  “  Nerve-Stretching  for  the  Relief 
or  Cure  of  Pain.” 

The  Howard  Medal. — The  Howard  Medal  of  1883,  with  £20,  was  presented 
on  November  20  to  Dr.  R.  D.  R.  Sweeting,  Medical  Superintendent  of 
the  Western  District  Fever  Hospital,  Fulham,  for  “  The  best  Exposi¬ 
tion  of  the  Experiences  and  Opinions  of  J ohn  Howard  on  the  Preserva¬ 
tion  and  Improvement  of  the  Health  of  the  Inmates  of  Schools,  Prisons, 
Workhouses,  Hospitals,  and  other  Public  Institutions,  as  far  as  Health- 
is  affected  by  Structural  Arrangements  relating  to  Supplies  of  Air  and 
Water,  Drainage,  etc.” 

The  Howard  Association.— The  last  annual  report  is,  as  usual,  comprehen¬ 
sive  in  the  variety  of  questions  it  deals  with,  and  alike  interesting 
and  instructive.  Touching  the  popular  subject  of  temperance,  the- 
report  contrasts  the  result  of  moral  persuasion  and  law  as  reformatory 
agents,  and  attention  is  directed  to  the  more  effective  operation  of  the- 
law  restricting  licences  to  a  fixed  ratio  of  population,  as  enforced  in 
Holland,  than  that  of  total  prohibition,  as  attempted  in  the  United  States. 
In  the  one  ease,  legislation  had  resulted  in  a  decreased  consumption  and 
less  drunkenness ;  in  the  other,  in  increased  consumption  and  more¬ 
drunkenness. 

University  of  Cambridge. — The  Special  Board  for  Medicine  publish,  for  the- 
guidance  of  students  proceeding  to  medical  and  surgical  degrees,  the- 
following  schedule,  defining  the  range  of  the  examination  in  elementary 
biology  under  the  regulations  which  come  into  effect  on  January  1,  1884  r 
—Elementary  Biology :  The  examination  will  have  reference  to— 1.  The- 
fundamental  facts  and  laws  of  the  morphology,  histology,  physiology, 
and  life-history  of  plants  as  illustrated  by  the  following  types  :  Saccharo- 
myces,  Protococcus,  Mucor,  Spirogyra,  Chara  or  Nitella,  a  fern,  I’inus, 
and  an  angiospermous  flowering  plant.  2.  The  fundamental  facts  and 
laws  of  animal  morphology,  as  illustrated  by  the  following  types  . 
Amoeba,  Paramoecium  or  Vorticella,  Hydra,  Lumbricus,  Astacus, 
Anodon,  Amphioxus,  Scyllium,  Rana,  Lepus.  Under  the  head  of  vege¬ 
table  physiology  the  student  will  not  be  expected  to  deal  with  special 
questions  relating  to  the  more  highly  differentiated  flowering  plants. 
He  will  be  expected  to  show  a  practical  knowledge  of  the  general  struc¬ 
ture  of  each  of  the  animal  types  above  specified,  and  an  elementary 
knowledge  of  the  chief  biological  laws  which  the  structural  phenomena 
illustrate.  He  will  also  be  expected  to  show  an  elementary  knowledge 
of  the  general  developmental  history  of  Amphioxus  and  of  Rana.  He 
will  not  be  expected  to  deal  with  purely  physiological  details. 


620 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES 


Nov.  24,  1883. 


® oyal  College  of  Surgeons. — At  the  half-yearly  Primary  or  Anatomical 
and  Physiological  Examination  for  the  Fellowship  of  the  College  on 
the  16th  inst.,  when  forty-four  candidates  presented  themselves,  the 
following  were  the  questions  on  Physiology  submitted  to  the  candi¬ 
dates,  when  they  were  required  to  answer  at  least  three  out  of 
the  four  questions,  between  nine  and  twelve  o’clock  noon,  viz. : — 
1.  Give  an  account  of  the  development  of  a  long  bone;  describe 
minutely  the  changes  that  occur  in  the  formation  of  the  compact 
-structure.  2.  What  are  the  constituents  of  the  bile  1  Give  an  account  of 
their  origin  and  destination,  and  describe  the  tests  by  which  they  may 
T)e  recognised.  3.  What  are  the  functions  of  the  skin  l  How  is  the 
temperature  of  the  body  governed  by  the  nervous  system  ?  Give  the 
•evidence  on  which  your  statements  rest.  4.  Describe  the  development 
of  the  spinal  cord.  State  what  is  known  of  the  paths  of  conduction  in 
it.  Describe  the  methods  by  which  these  paths  have  been  investigated. 
— The  following  were  the  questions  on  Anatomy,  three  of  which  out  of 
four  were  required  to  be  answered,  between  one  and  four  o’clock,  viz. : — 
1.  Give  the  dissection  required  to  expose  the  chorda  tympani  nerve  from 
its  exit  from  the  canal  of  Huguier  to  its  termination.  2.  Describe  the 
relations  of  the  arch  of  the  aorta  and  its  branches  to  the  neighbouring 
•structures  and  the  walls  of  the  thorax.  Mention  the  chief  peculiarities 
which  havebeen  met  with  in  its  position,  and  in  the  origin  and  number  of 
its  branches.  Illustrate  these  occasional  variations  from  development  and 
from  the  permanent  condition  of  the  arch  and  its  branches  in  the  lower 
vertebrates.  3.  Compare  and  contrast  the  muscles  of  the  human  hand 
and  foot.  4.  Describe  the  dissection  required  to  expose  the  whole  of  the 
posterior  surface  of  the  descending  colon. 

Taking  a  Coroner  to  Task.  — The  Chairman  of  the  Quarter  Sessions  held  at 
Gloucester  last  month  expressed  regret  at  having  again  to  draw  the 
attention  of  the  Court  to  the  inquests  held  by  Dr.  Grace.  It  was  found 
that  the  doctor’s  practice  as  to  holding  inquests  was  not  that  which  was 
•commonly  adopted  by  the  other  coroners.  For  some  reason  Dr.  Grace 
leld  fewer  inquests  than  they  did  in  proportion  to  the  notices  of  death 
sent  by  the  police,  and  this  appeared  in  a  marked  degree.  He  (the 
Chairman)  did  not  say  that  they  could  have  the  same  proportion  of 
inquests  to  notices  sent  in  all  cases.  During  the  quarter  Dr.  Grace 
.had  held  inquests  in  only  sixteen  out  of  thirty-two  cases  reported  to 
him,  and  though  the  Court  had  no  power  to  interfere  if  a  coroner 
■exercised  a  sound  judgment  as  to  holding  an  inquest,  yet  the  Committee 
felt  that  in  five  or  six  of  the  cases  reported  to  Dr.  Grace  an  inquest  was 
-almost  necessary.  After  some  discussion  the  Court  unanimously  agreed 
that  the  doctor  should  be  summoned  to  attend  an  adjourned  session. 
'On  Saturday  last,  Dr.  Grace  attended  the  adjourned  session  to  answer 
the  allegations  preferred  against  him.  The  cases  above  referred  to  were 
■gone  into  at  length,  and  Dr.  Grace  explained  why,  in  the  exercise  of  his 
•discretion,  he  had  not  thought  inquests  necessary.  In  one  case  an  ille¬ 
gitimate  child  had  died  suddenly  while  in  the  custody  of  its  grand¬ 
mother.  Dr.  Grace  said  he  was  satisfied  that  the  child  died  from  atrophy, 
while  the  fact  that  the  child’s  life  was  insured,  and  that  death  took 
place  before  the  insurance  could  be  claimed,  further  tended  to  show 
■there  was  no  suspicion  in  the  case.  In  a  second  case  an  inmate  of  a 
nnion  workhouse  had  complained  that  a  nurse  had  shaken  her,  and  the 
master  of  the  workhouse  asked  for  an  inquest.  Dr.  Grace  said  the 
medical  officer  certified  the  cause  of  death,  and  satisfied  himself  that 
there  had  been  no  ill-treatment.  In  a  third  case  a  child  died  of  scarlet 
fever  after  two  days’  illness,  and  no  doctor  attended.  Dr.  Grace  said 
that  even  if  the  parents  had  been  guilty  of  culpable  neglect  in  not 
getting  medical  attendance  for  the  child,  he  did  not  consider  an  inquest 
would  have  been  of  any  service,  for  the  Peculiar  People,  who  on  prin¬ 
ciple  objected  to  medical  attention,  were  never  convicted  for  their 
neglect.  Other  cases  having  been  explained  away  by  Dr.  Grace,  the 
■County  Chairman  said  the  magistrates  had  modified  the  opinion  which 
-they  had  previously  held,  and  would  let  the  matter  drop  if  Dr.  Grace 
would  in  future  adhere  more  closely  to  the  directions  of  the  Lord 
Chancellor  as  to  the  duties  of  coroners. 

Dr.  Robert  White,  Trinity,  Newfoundland.—  Letter  and  enclosure  received. 


COMMUNICATIONS  have  been  received  from — 

Sir  Andrew  Clark,  Bart.,  M.D..  London;  Dr.  J.  Mitchell  Bruce, 
London ;  Dr.  Herman,  London  ;  Dr.  Thorowgood,  London ;  Dr.  Julius 
Dreschfeld,  Manchester;  The  Secretary  oe  the  Parkes  Museum, 
London;  The  Secretary  of  the  Medico-Chirurgical  Society  of 
Edinburgh  ;  The  Secretary  of  the  Apothecaries’  8ociety,  London ; 
Mr.  T.  H.  Bartleet,  Birmingham ;  Dr.  Tirard,  London ;  Mrs.  Hoggan, 
M.D.,  London  ;  Dr.  Alexander  Harvey,  London ;  Mr.  Noble  Smith, 
London  ;  Dr.  Norman  Kerr,  London ;  Mr.  H.  It.  Bell,  London ;  Dr. 
■J.  Miller.  Southsea;  Mr.  Becher.  London;  The  Editor  of  the 
“Oxford  Times,”  Oxford;  Dr.  J.  W.  Langmore.  London  ;  Mr.  W. 
‘Nicholas,  London  ;  Dr.  B.  G.  Hebb,  London ;  Mr.  T.  M.  Stone, 
'Wimbledon;  Dr.  Clifford  Beale,  London;  The  Director  of  the 
Anthropological  Institute  of  Great  Britain  and  Ireland,  London ; 
The  Editor  of  “  Society,”  London;  Dr.  Sutherland,  London;  Dr. 
Ournow,  London  ;  Dr.  A.  T.  Thomson,  Glasgow;  The  Hon.  Secretary 
of  the  Medical  Society  of  London  ;  Mr.  J.  Chatto,  London  ;  Mr. 
“Wickham  Barnes,  London ;  The  Secretary  of  the  University  of 
London  ;  Mr.  Alban  Doran,  London ;  The  Editor  of  the  “  Sanitary 
-Engineer,”  New  York ;  The  Secretary  of  the  Railway-Passengers’ 
Assurance  Company,  London;  The  House-Surgeon  and  House¬ 
-Physician  of  Guy’s  Hospital,  London;  The  Hon.  Secretary  of  the 
Boyal  Medical  and  Chirurgical  Society,  London ;  The  Secretary 
of  the  Statistical  Society,  London. 


BOOKS,  ETC.,  RECEIVED  - 

On  Infantile  Spasmodic  Paralysis,  by  W.  B.  Hadden,  M.D.,  M.R.C.P.— 
Fallacies,  by  Alfred  Sidgwick — Medical  Diagnosis,  by  J.  Graham  Brown, 
M.D.  — Report  on  the  London  Water-Supply — Address  to  the  Members 
of  the  Anti-Slavery  and  Aborigines’  Protection  Societies  upon  the  Native 
Question  by  the  Transvaal  Deputation — The  Dissector’s  Manual,  by  W. 
Bruce-Clarke,  M.A.,  M.B.,  and  Charles  Barrett  Lockwood,  F.R.C.S. — 
Report  on  the  Sanitary  Condition  of  the  Whitechapel  District  for  the 
Quarter  ended  September  29,  1883 — Der  Torfmoos-Verband,  von  H. 
Leisrink — Surgical  Experiences  in  the  Zulu  and  Transvaal  Wars,  by 
D.  Blair  Brown,  F.R.C.S. — The  Sanitary  State  of  the  British  Troops  in 
Northern  India,  by  Surgeon-General  A.  C.  C.  De  Renzy,  C.  B.—  Manual 
of  Psychological  Medicine  and  Allied  Nervous  Diseases,  by  Edward  C. 
Mann,  M  D. — Compendium  der  Pathologisch-Anatomischen  Diagnostik, 
von  Dr.  Johannes  Orth — Index  Catalogue  of  the  Library  of  the  Surgeon- 
General’s  Office,  United  States  Army,  vol.  iv.— Report  on  the  Sanitary 
Condition  of  the  Wandsworth  District  during  the  Year  1832 — Selections 
from  the  Clinical  Works  of  Dr.  Duchenne,  by  G.  V.  Poore,  M.D. 

PERIODICALS  AND  NEWSPAPERS  RECEIVED — 

Lancet — British  Medical  Journal — Medical  Press  and  Circular — Ber¬ 
liner  Klinische  Wochenschrift— Centralblatt  fiir  Chirurgie — Gazette 
des  Hopitaux— Gazette  Medicale— Revista  de  Medicina— Bulletin  de 
1’AcaddmiedeMddecine— Pharmaceutical  Journal— Wiener  Medicinisehe 
Wochenschrift— Revue  Medicale— Gazette  Hebdomadaire  —  Nature- 
Boston  Medical  and  Surgical  Journal— Louisville  Medical  News — 
Centralblatt  fiir  Gyniikologie — Le  Concours  Medical— Centralblatt  fiir 
die  Medicinischen  Wissenschaften— Centralblatt  fiir  Klinische  Medicin 
— Philadelphia  Medical  News — Le  ProgrSs  Medical — New  York  Medical 
Journal— Edinburgh  Clinical  and  Pathological  Journal --Students’  Jour¬ 
nal  and  Hospital  Gazette— New  York  Medical  Record— Denver  Medical 
Times — West  Sussex  Gazette,  November  8— Manchester  City  News, 
November  10 — Journal  of  the  British  Dental  Association— Canadian 
Practitioner— Manchester  Guardian,  November  18  -Revue  de  Chirurgie 
— Revue  de  Medecine — Weekblad — American  Psychological  Journal— 
Croydon  Advertiser,  November  17— Portsmouth  Times  and  Naval 
Gazette,  November  3  — Inventors’  Record — Alienist  and  Neurologist — 
Le  Scalpel— Canada  Lancet— Ottawa  Sanitary  Journal— Therapeutic 
Gazette —Australian  Medical  Journal. 


APPOINTMENTS  FOR  THE  WEEK. 


November  24.  Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  l  J  p.m. ;  King’s  College,  1J  p.m. ;  Royal 
Free,  2  p.m. ;  Royal  London  Ophthalmic,  11  a.m. ;  Royal  Westminster 
Ophthalmic,  14  p.m.;  St.  Thomas’s,  14  p.m.;  London,  2  p.m. 

26.  Monday. 

Operations  at  the  Metropolitan  Free,  2  p.m.;  St.  Mark’s  Hospital  for 
Diseases  of  the  Rectum, 2  p.m.;  Royal  London  Ophtbalmic.il  a.m.; 
Royal  Westminster  Ophthalmic,  14  p.m.  ;  Hospital  for  Women,  2  p.m. 

Medical  Society  of  London,  84  p.m.  Mr.  Francis  Mason,  “  On  a  Case 
illustrating  the  Treatment  of  the  Premaxillary  Bone  in  Hare-lip” 
(living  specimen).  Mr.  Gay:  Demonstration  of  Veins  connected  with 
the  Hepatic  System.  .Mr.  Spencer  Watson,  “  On  Recent  Improvements 
in  Rhinoscopy  and  the  Treatment  of  Polypus  in  the  Nose.”  Mr.  Startia 
will  show  a  Case  of  Elephantiasis  of  Traumatic  Origin. 


27.  Tuesday. 

Operations  at  Guy’s,  14  p.m. ;  Westminster,  2  p.m. ;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  14  p.m.;  West 
London,  3  p.m. 

Anthropological  Institute  (4,  St.  Martin’s-place,  W.C.),8p.m.  Dr. 
J.  G.  Garson,  “  On  the  Cranial  Characters  of  the  Inhabitants  of  Timor- 
laut.”  Mr.  H.  O.  Forbes,  “  On  some  of  the  Tribes  of  Timor.”  Dr. 
G.  B.  Barron,  “  On  a  Human  Skull  found  near  Southport.” 

Royal  Medical  and  Chirurgical  Society,  84  p.m.  Dr.  Sydney  Ringer 
and  Dr.  H.  Sainsbury,  “  Investigation  into  the  Action  of  the  Digitalis 
Group.”  Mr.  Cowell  will  exhibit  Four  Cases  of  Congenital  Dislocation 
of  both  Femora  (which  will  be  on  view  half  an  hour  before  the  meeting), 
and  he  will  make  some  comments  upon  them  before  its  close. 

28.  Wednesday. 

Operations  at  University  College,  2  p.m. ;  St.  Mary’s,  11  p.m.  ;  Middlesex, 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew’s,  14  p.m. ;  Great  Northern, 

2  p.m. ;  Samaritan,  24  p.m..;  Royal  London  Ophthalmic,  11  a.m. ; 
Royal  Westminster  Ophthalmic,  14  p.m. ;  St.  Thomas’s,  14  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m.;  National  Orthopaedic,  Great 
Portland-street.  10  a.m. 

Bbompton  Hospital  fob  Consumption,  etc.,  4  p.m.  Dr.  John  Tatham, 
“  On  Chronic  Pneumonia  and  Fibroid  Phthisis,”  with  Cases. 

Hunterian  Society,  8  p.m.  Dr.  Bedford  Fenwick,  “  On  some  Common 
Causes  of  Coughs.” 


29.  Thursday. 

Operations  at  St.  George’s,  1  p.m. ;  Central  London  Ophthalmic,  1  p.m. ; 
Royal  Orthopaedic,  2  p.m.;  University  College,  2  p.m. ;  Royal  London 
Ophthalmic, 11a.m. ;  Royal  Westminster  Ophthalmic,  14  p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m. ;  Hospital  for  Women,  2  p.m. ; 
Charing-cross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  24  p.m. 
Abernethian  Society  (St.  Bartholomew’s  Hospital),  8  p.m.  Mr- 
Cresswell,  “  On  Hydatids.” 

Parkes  Museum  of  Hygiene,  8  p.m.  Dr.  Charles  Kelly,  “  On  Diseases 
caused  by  Sanitary  Defects  in  Houses.” 

30.  Friday. 

Operations  at  Central  LondonOphthalmic,  2  p.m.;  Royal  London  Ophthal¬ 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminsttr 
Ophthalmic,  14p.m.;  St.  George’s  (ophthalmic  operations),  11  p.m.; 
Guy’s,  14  p.m. ;  St.  Thomas’s  (ophthalmic  operations) ,  2  p.m. ;  King’s 
College  (by  Mr.  Lister),  2  p.m. 


Medical X  OX  EETEO VERSION  OF  THE  GRAVID  UTERUS.  Dec.i.isss.  621 


CLINICAL  LECTUEES. 

%  J.  MATTHEWS  DUXCAX,  M.D.,  F.R.S., 

Physician- Accoucheur  and  Lecturer  on  Midwifery 
at  St.  Bartholomew’s  Hospital. 

Lecture  I. 

TJETRO  VERSION  OP  THE  GRAVID  UTERUS. 
'Though  retroversion  of  the  gravid  uterus  is  far  from  being 
'common,  we  have  in  “  Martha5’  two  or  three  cases  of  it 
■every  year,  and  quite  recently  there  have  been  three  ;  and 
it  is  necessary  you  should  know  it  well,  for  in  all  such  cases 
.as  come  into  the  hospital  the  disorder  is  grave  and  demands 
immediate  interference.  It  may,  indeed,  have  induced 
■disease  of  the  bladder,  which  may  last  long  and  be  dan¬ 
gerous  to  life,  while  the  original  disorder  has  been  easily 
remedied  by  replacement.  Only  last  month  a  patient  in 
•** Martha”  died  of  sloughing  of  the  bladder,  the  consequence 
-of  treatment  being  too  long  delayed. 

Retroversion  of  the  gravid  uterus  is  a  well-known  condi¬ 
tion  occurring  in  the  third  or  fourth  month  of  pregnancy, 
and  accompanied  by  retention  of  urine — much  commoner  in 
multiparac  than  in  primiparse.  It  is  on  this  that  I  am  to 
lecture,  and  not  on  anything  else  unless  with  a  view  to 
Illustrate  or  explain  this ;  and,  following  my  predecessors,  I 
use  the  word  retroversion  for  all  cases  of  it.  In  most  cases 
there  is  some  flexion,  at  the  internal  os  uteri  or  lower,  but 
I  am  not  to  bother  you  with  this  refinement  because,  so  far 
as  we  at  present  know,  there  is  nothing  important  conse¬ 
quent  on  changes  in  the  point  of  chief  flexion,  whether  it 
he  in  the  neck  of  the  womb  or  in  the  upper  part  of  the 
vagina.  Of  course  there  is  flexion  somewhere,  and  it  is 
here,  as  in  the  unimpregnated  organ,  really  a  matter  of  in¬ 
difference  whether  it  is  the  vagina  that  is  flexed,  or  the 
-cervix  uteri,  or  the  junction  of  the  cervix  and  body,  or  all 
three  in  one  continued  curve. 

It  is  common  to  include  in  retroversion  of  the  gravid 
uterus  rare  and  extraordinary  cases  where  there  are,  in  the 
pelvis,  and  there  only,  conditions  somewhat  like  those  of 
•our  disease,  the  excavation  well  filled,  as  you  see  in  this 
-diagram  of  Oldham’s  case,  the  cervix  high  behind  and  close 
to  the  symphysis ;  the  rest  of  the  uterus  being  naturally 
-developed  in  the  abdomen,  and  pregnancy  advanced  far 
beyond  the  fourth  month,  it  may  be  even  to  the  full  term  ; 
and  the  urine  not  retained.  But  such  cases  have  altogether 
a  different  pathology,  and  should  not  be  classed  with  our 
well- characterised  retroversion  with  retention  of  urine.  In 
these  cases  of  advanced  pregnancy  the  uterus  in  not  really 
retroverted,  but  has  a  peculiar  pouching  of  the  posterior 
wall,  the  pouched  part  protruding  downwards  into  the  pelvic 
excavation,  and  pressing  the  cervix  forwards  and  upwards. 
I  have  recorded  one  case  where  the  cause  was  old  persistent 
perimetric  adhesions  and  parametric  atrophic  induration 
around  the  retroverted  organ,  which,  becoming  pregnant, 
did  not  assume  its  natural  position  and  relations ;  but  its 
lower  posterior  part  swelled  and  grew  inside  the  pelvis,  while 
dhe  examination  of  the  abdomen  generally  revealed  only 
natural  conditions. 

Though  it  is  a  forced  interpolation,  I  may  take  this 
opportunity  of  mentioning  that  in  advanced  pregnancy  we 
Rave  two  kinds  of  anteversion.  Of  these,  one  is  the  common 
pendulous  belly,  the  uterus  falling  through  or  distending 
extremely  the  linea  alba  and  distending  the  peritoneum  and 
,skin.  The  other  is  extremely  rare,  and  I  have  seen  only 
one  case  of  it — in  a  primipara.  In  this  case  the  uterus  was 
■anteflected,  and  could  not  be  replaced  as  in  the  common 
pendulous  belly;  it  was  really  not  displaced  secondarily, 
vbut  grew  into  this  peculiar  shape  and  position. 

As  we  do  not  include  these  cases  of  advanced  pregnancy, 
•so  we  do  not  include  cases  of  early  pregnancy — that  is, 
.before  the  third  month, — nor,  indeed,  cases  of  the  third 
and  fourth  month  if  there  is  no  retention  of  urine. 

When  a  woman  with  a  displaced  uterus  becomes  preg¬ 
nant,  it  may  assume  early  what  is  called  a  normal  position. 
'Or,  a  woman  becoming  pregnant  with  the  womb  in  a  normal 
position,  may  soon  have  it  displaced.  Or,  she  may  become 
pregnant  with  the  uterus  displaced,  the  organ  remaining  so 
•during  the  early  months. 

Vol.  II.  1883.  No.  1744. 


There  may  be  no  symptoms  caused  by  retroversion  in  the 
first  three  months  of  pregnancy,  and  nothing  to  announce 
the  gradual  ascent  of  the  uterus  into  its  ordinary  position 
in  the  abdomen.  But  a  woman,  especially  if  she  is  sensi¬ 
tive,  may  have,  as  a  consequence  of  retroversion  in  the 
earliest  months,  disagreeable  feelings  of  pressure,  of  bear¬ 
ing  down,  or  of  hsemorrhoidal  or  vesical  irritation.  That 
these  feelings  are  due  to  the  displacement  is  shown  by  their 
disappearance  when  the  organ  is  replaced.  Sometimes  such 
replacement  is  maintained  by  a  Hodge  pessary ;  and  if  this 
is  the  case,  and  if  at  the  same  time  disagreeable  symptoms 
are  removed,  the  pessary  should  be  worn  till  the  advance¬ 
ment  of  pregnancy  renders  it  useless.  I  have  seen  several 
cases  where  the  pessary  was  inefficient.  Sometimes  women 
themselves  replace  the  organ,  simply  by  a  few  minutes  of 
the  genu-pectoral  position  with  a  loose  or  bagged  state  of 
the  anterior  abdominal  wall ;  and  this  replacement  is  main¬ 
tained  till  the  woman  resumes  the  erect  position.  When 
the  womb  goes  up,  a  peculiar  feeling  announces  the  change 
of  position  to  the  patient,  and  so  also  when  it  comes  down. 
In  cases  of  this  kind  the  womb  gradually  resumes  its  right 
position  as  pregnancy  advances,  or  it  ceases  to  come  down 
on  the  assumption  of  the  erect  position,  when  its  size  gets 
large  when  compared  with  the  brim  of  the  pelvis,  through, 
which  it  tends  to  prolapse.  The  womb  is  sure  gradually  to 
grow  up  without  causing  disturbance  if  retention  of  urine 
does  not  occur ;  and  if  it  comes  down  retroverted  on  assump¬ 
tion  of  the  erect  position,  it  will  cause  no  great  disturbance 
on  condition  that  retention  of  urine  does  not  occur. 

You  now  can  understand  how  great  is  the  importance  of 
retention  of  urine  in  the  third  and  four  months  of  preg¬ 
nancy.  Were  I  authorised  to  recast  medical  nomenclature, 
I  would  not  speak  to  you  of  retroversion  of  the  gravid 
uterus,  but  of  retention  of  urine,  in  the  third  and  fourth 
months  of  pregnancy.  The  displacement  of  the  womb  is 
not  the  greatest  fact  in  this  matter,  but  the  retention  of 
urine.  It  is  the  overfilling  of  the  bladder  which  causes  the 
grave  symptoms,  increases  the  retroversion,  and  leads  into 
danger  to  life.  Retention  occurring  during  retroversion  in 
the  third  or  fourth  months  of  pregnancy  constitutes  the 
disease ;  and  the  overfilling  of  the  bladder  increases  the 
retroversion,  while  the  increasing  retroversion  renders  spon¬ 
taneous  evacuation  of  the  bladder  more  and  more  difficult. 
Indeed,  though  I  cannot  state  an  observation  in  attestation, 
I  do  not  doubt  that  repletion  of  the  bladder  may  be  not  only 
the  cause  of  the  symptoms  and  danger,  but  also  the  cause 
of  the  retroversion.  Generally  it  is  the  other  way — the 
displacement  causes  the  retention. 

Retroversion  of  the  gravid  uterus,  as  a  grave  disorder,  is 
produced  in  two  ways.  Either  retention  of  urine  occurs  in 
the  course  of  a  pregnancy  in  a  retroverted  uterus,  and  the 
case  is  by  this  occurrence  at  once  rendered  grave,  made  a 
case  of  the  kind;  or,  a  jump  or  fall  suddenly  forces  the 
large  uterus  down  from  the  abdomen  into  the  pelvis,  and 
this  uterine  descent  with  retroversion  causes  retention,  and 
again  you  have  at  once  a  grave  case  of  the  kind. 

Great  curvature  of  the  sacrum  with  projection  of  the  pro¬ 
montory  may  prevent  the  gradual  rising  of  a  retroverted 
uterus,  and  predispose  to  a  case  of  this  kind ;  or  the  same 
shape  of  sacrum  may  prevent  the  spontaneous  replacement 
of  the  uterus  when  suddenly  driven  into  the  pelvis  by  a 
jump  or  fall,  or  such  accident. 

Urine  being  retained,  the  case  is  constituted,  and  sym¬ 
ptoms  develope  themselves.  They  are  ill-defined — pains 
about  the  pelvis,  disturbance  of  defecation  and  of  urination, 
and  the  belly  enlarges. 

The  patient  may  have  very  little  trouble  of  urination,  for 
the  bladder  may  become  extremely  distended  without  much 
suffering ;  but  generally  there  is  at  first  intense  unsatisfied 
desire  to  urinate,  which  soon  decreases  or  passes  off  as  the 
bladder  gets  greatly  distended.  Urination  may  be  quite 
arrested — generally  it  goes  on  more  or  less  copiously,  the 
urine  passing  involuntarily,  or  being  squeezed  out  by 
bearing  down  and  by  pressure  on  the  abdomen.  The  bladder 
gradually  becomes  enormously  large,  and  I  am  sorry  I  can¬ 
not  name  the  extreme  limit  of  its  capacity,  but  it  may  con¬ 
tain  many  pints — in  D.’s  case  there  were  nine  pints ;  it  rises 
to  the  epigastrium,  generally  affecting  the  left  rather  than 
the  right  side  of  the  abdomen ;  it  forms  a  loose  rather  than 
a  tense  sac  when  very  large,  and  the  urine  fluctuates  freely. 
Indeed,  I  have  known  the  distended  bladder  taken  for  a 
unilocular  ovarian  cyst. 


B'ee.  1,  288& 


HARVEY.  OH  APNCEA  OR  ASPHYXIA. 


^  w  Medical  Times  and  Gazette. 

The  urine,  I  have  said,  is  passed  more  or  less  copiously. 
It  is  limpid  and  of  low  specific  gravity  (1010),  and  is 
secreted  in  great  quantity,  often  up  to  200  ounces  in  a  day 
— polyuria.  There  is  enough  to  supply  an  ordinary,  or  even 
greater  than  ordinary,  amount  passed  in  frequent  urinations, 
and,  in  addition,  what  overfills  the  bladder.  The  retention 
is  not  complete.  This  polyuria  persists  for  at  least  several 
days  after  the  bladder  is  regularly  emptied  artificially  or 
spontaneously. 

In  this,  as  in  healthy  states  of  the  bladder,  evacuation  is 
a  result  not  of  contraction,  but  of  collapse ;  the  bladder, 
measured  by  sound  from  orifice  of  urethra  to  its  fundus, 
may  be  eight  inches  before  evacuation,  and  it  is  eight  inches 
after  it ;  and  the  regaining  of  natural  dimensions  of  five  or 
six  inches  is  generally  a  slow  process,  even  if  urination  is 
spontaneous.  The  urine  may  have  to  be  drawn  off  only 
once  or  many  times — it  may  be,  as  in  a  case  in  “  Martha,”  for 
six  weeks. 

I  have  said  that  the  urine  is  limpid,  and  fortunately  it 
generally  is  so.  But,  when  cases  of  retroversion  are  not 
properly  treated,  the  bladder  becomes  inflamed,  the  mucous 
membrane  destroyed  and  separated,  and  the  muscular  tissue 
exposed ;  and  this  evil  begins  at  various  times  in  the  progress 
of  the  case.  Sometimes  it  is  not  till  this  takes  place  that 
the  woman  complains,  and  before  complaining,  as  in  one  of 
our  recent  cases,  there  may  have  been  combined  retention 
and  dribbling  for  many  weeks.  The  urine,  then,  is  not 
limpid,  but  nearly  opaque,  loaded  with  mucus,  pus,  and 
generally  also  with  blood,  the  last  tinting  it  not  pink  or 
bright,  but  brown  and  dark.  This  state  of  urine  is  always 
alarming,  for  it  indicates  the  setting  up  of  inflammation  and 
ulceration  of  the  bladder.  Here  is  a  museum  specimen 
where  the  whole  mucous  membrane  of  the  bladder  has 
separated  and  come  away  as  a  nearly  complete  sac  or  bladder. 
You  can  easily  understand  that,  in  such  inflammation, 
suffering  and  danger  are  both  very  great.  Yet  exceptions 
to  this  occur,  for  we  have  recently  had  a  case,  with  copious 
bloody  urine  loaded  with  pus  and  mucus  discharged  from 
a  bladder  measuring  eight  inches,  in  which  the  woman 
required  for  a  long  time  the  use  of  the  catheter,  yet  she 
had  no  pain,  and  her  pulse  and  temperature  did  not  rise 
above  normal. 

Perimetritis,  with  consequent  adhesions,  is  a  common 
source  of  difficulty  in  cases  which  have  been  neglected  or 
mismanaged.  Instances,  indeed,  are  recorded  where  still 
more  terrible  results  occurred — sloughing  of  the  vagina 
and  posterior  uterine  wall,  and  discharge  of  the  uterine 
contents  in  this  way ;  sloughing  of  the  anterior  wall  of  the 
bladder  and  of  the  anterior  abdominal  wall,  and  discharge 
of  the  urine  in  this  way. 

Examining  per  vaginam,  in  a  case  of  retroversion,  you  find 
the  pelvic  excavation  more  or  less  completely  occupied  by  a 
globular,  hard  tumour  pressed  into  it  from  above.  It  can 
also  be  well  felt  per  rectum,  this  gut  being  expanded  on  it, 
and  lying  between  it  and  the  sacrum.  The  finger,  intro¬ 
duced  per  vaginam,  reaches  the  os  uteri  by  a  passage  which 
is  very  narrow  antero-posteriorly ;  it  has  to  be  pressed 
between  the  globular  mass  occupying  the  pelvis  and  the 
symphysis  pubis,  and  the  cervix  uteri  is  near  the  upper 
margin  of  the  posterior  surface  of  the  symphysis.  Some¬ 
times,  but  rarely,  it  cannot  be  reached. 

The  diagnosis  is  often  to  be  made  only  with  great  care ; 
sometimes  it  is  very  difficult;  and  it  consists  in  making  out 
what  this  globular  mass  is.  If  the  symptoms  of  pregnancy 
are  well  marked,  then  you  have  to  decide  between  retro¬ 
version  and  extra-uterine  pregnancy.  If  the  symptoms  of 
pregnancy  are  not  distinctive,  then  you  may  have  a  retro¬ 
uterine  perimetric  abscess,  or  a  retro-uterine  hsematocele, 
or  a  fibroid.  Other  tumours  are  excessively  rare. 

Occasionally,  feeling  the  tumour  to  be  rounded,  elastic, 
hard,  and  as  if  not  connected  with  the  pelvic  wall,  you  try 
to  replace  with  a  view  to  diagnosis. 

The  grand  source  of  error  in  diagnosis  is  ignorance  or 
forgetfulness  of  two  circumstances :  that  a  woman  with  great 
retention  and  bladder  enormously  distended  may  have  no 
striking  bladder-trouble;  and  that  she  may  be  passing  urine 
in  what  appears  natural  quantity,  or  even  more  than  natural, 
while  retention  persists. 

And  now  for  treatment.  In  principle  it  is  simple,  and 
in  practice  it  is  generally  easy  and  successful.  The  urine 
is  drawn  off,  and  the  uterus  is  replaced.  Often  nothing 
more  is  required ;  and  all  this  may  be  done  in  a  few  minutes. 


But  let  us  suppose  we  have  a  case  of  some  duration,  and  in 
which  there  is  some  difficulty. 

The  woman  is  sent  to  bed ;  the  lower  bowel  is  evacuated  ; 
the  bladder  is  emptied  by  catheter.  Then  the  patient  is 
placed  in  the  genu-pectoral  position,  and  so  as  to  have 
negative  abdominal  pressure,  the  anterior  abdominal  wall 
hanging  loose  or  bagged;  and  this  a  woman  can  do  on 
having  the  matter  explained.  In  the  genu-pectoral  posi¬ 
tion  negative  abdominal  pressure  is  the  natural  condi¬ 
tion,  and  in  this  position  gravity  helps  the  fall  of  the 
uterus  from  the  pelvis  into  the  abdomen.  If  it  do  not 
fall,  pressure  is  applied  to  push  it  into  the  abdomen .  The 
axis  of  the  pelvic  brim  is  nearly  vertical,  and  the  direction 
of  pushing  is  nearly  in  this  axis,  and  it  is  effected  by  two 
fingers  in  the  vagina,  or,  still  better,  in  the  rectum.  You 
are  not  to  expect  the  uterus  to  be  replaced  at  once ;  and 
you  are  not  to  use  great  violence,  for  you  may  perfo¬ 
rate  the  posterior  uterine  wall  by  your  fingers.  You  push 
strongly,  nearly  as  strongly  as  you  can,  by  the  ends  of  your 
fingers,  and  the  womb  gradually  leaves  the  pelvis.  The> 
patient  is  made  to  lie  down  ;  the  uterus  is  now  felt  above 
the  pubes,  and  a  vaginal  examination  discovers  the  pelvis 
empty  and  the  cervix  in  its  natural  situation.  Lest  the 
womb  should  come  down  again,  the  woman  should  lie  quietly 
in  bed  for  some  days.  Care  has  to  be  taken  that  the  bladder 
is  regularly  and  completely  evacuated,  spontaneously  or 
artificially. 

In  cases  where  you  fail  to  replace  you  may  simply  wait, 
beeping  the  bladder  empty,  and  the  uterus  may  ascend 
spontaneously,  as  in  one  of  our  recent  cases. 

If,  on  waiting,  the  case  becomes  worse,  symptoms  of 
strangulation  of  the  uterus  in  the  pelvis  coming  on,  you 
proceed  to  evacuate  the  uterus.  This  I  have  never  had  to 
do.  It  is  effected  in  the  same  way  as  abortion  is,  in  other 
circumstances,  induced,  but  with  difficulty  in  consequence 
of  the  position  of  the  os  uteri,  and  the  narrowness  and 
length  of  the  passage  to  it.  Sometimes  it  is  induced  by- 
withdrawing  the  liquor  amnii  through  the  vagina  and 
posterior  uterine  wall  by  trocar  and  cannula. 


APNCEA  OE  ASPHYXIA. 

ON  SOME  NOTABLE  DISCREPANCIES  OF  STATE¬ 
MENT  IN  RECENT  PHYSIOLOGICAL  WRITINGS 
AS  TO  FUNDAMENTAL  FACTS  IN  THE  PROCESS 
OF  DEATH  BY  SUFFOCATION,  (a) 

By  ALEXANDER  HARYEY,  M.D., 

Consulting  Physician  to  the  Aberdeen  Royal  Infirmary  ; 

Emeritus  Professor  of  Materia  Medica  in  the  University  of  Aberdeen,  and1 
sometime  Lecturer  on  Institutes  of  Medicine  in  that  University. 


Preliminary  Observations. 

The  whole  subject  of  death  from  suffocation  is  one  of  sur¬ 
passing  interest.  Able  physiologists  have  at  different  times 
applied  themselves  to  the  elucidation  of  it, — to  observing 
the  phenomena  that  attend  and  characterise  it ;  the  events 
and  changes  that  take  place  within  the  lungs,  in  the  heart, 
and  in  the  bloodvessels,  from  the  time  that  the  air  is  first 
excluded  from  the  lungs  to  the  final  arrest  of  the  heart’s 
action!  They  have  also  carefully  noted  the  changes  that 
ensue  or  the  events  that  follow  on  the  readmission  of  air 
into  the  lungs  and  the  full  restoration  of  the  heart’s  action 
in  cases  in  which  that  expedient  is  successfully  resorted  to. 
Further,  they  have  made  it  their  business  to  explain  the 
whole  set  of  facts,  phenomena,  and  changes  that  attend 
this  process  from  first  to  last,  as  well  in  cases  that  end 
fatally  as  in  those  in  which  recovery  from  impending  death 
is  successfully  accomplished. 

(a)  For  many  years  past,  physicians,  as  well  in  America  as  in  this 
country,  following  herein  the  advice  of  Sir  Thomas  Watson,  have  desig¬ 
nated  the  mode  of  dying  from  suffocation  by  the  name  of  Apncea— priva¬ 
tion  of  breath.  Of  late  years,  however,  our  physiologists,  disregarding 
this  usage,  have  come  to  apply  and  to  restrict  it  to  undue  insufflation  of 
the  lungs,  or  to  the  breathing  of  pure  oxygen,  leading  to  abnormal 
arterialisation  of  the  blood  and  suspension  of  the  respiratory  process. 
For  reasons  that  will  appear  in  the  sequel,  the  author  of  this  paper  has 
adhered  to  the  name  given  it  by  Sir  Thomas—  Apncea, — except  when 
quoting  from  writers  who  make  use  of  the  older  designation — Asphyxia. 


Medical  Times  and  Gazette. 


HARVEY  OH  APHCEA  OR  ASPHYXIA. 


Dec.  1,  16S3.  623 


It  is  no  part  of  my  present  purpose  to  go  into  the  history 
-of  research,  in  this  field,  highly  interesting  as  that  history 
is.  My  purpose  is  to  call  attention  to  two  notable  (among 
several  minor)  discrepancies  in  recent  physiological  writings 
— discrepancies  bearing  on  the  state  of  the  pulmonic  blood¬ 
vessels  and  of  the  cavities  of  the  heart,  in  respect  of  con¬ 
tained  blood,  at  the  moment  of  death.  These  discrepancies, 
moreover,  relate  to  facts  in  the  history  of  that  process  which 
must  be  regarded  as  fundamental ;  and  they  affect  as  well 
the  theory  of  the  process  as  the  explanation  of  the  beneficial 
action  of  the  artificial  respiration. 

The  first  of  these  discrepancies  relates  to  the  state  of  the 
pulmonic  capillaries  at  the  moment  of  death ;  the  second,  to 
the  state  of  the  left  cavities  of  the  heart  at  the  same  stage 
— the  moment  of  death. 

First,  as  to  the  former  of  these.  1.  It  was  believed  by  Dr. 
Alison,  and  indeed  it  was  the  basis  of  his  theory  of  asphyxia 
— a  belief  acquiesced  in  by  Dr.  John  Eeid — that  after  death 
the  capillaries  of  the  lungs  are  full  of  venous  blood.  And, 
in  keeping  with  this  view.  Dr.  Alison  held  that  the  pulmonic 
veins,  the  left  cavities  of  the  heart,  and  the  systemic  arteries 
are  empty  of  blood,  while  the  pulmonic  artery  and  its 
branches,  the  right  cavities  of  the  heart,  and  the  systemic 
veins  are  full  of  it.  According  to  Dr.  Alison,  the  block  by 
which  the  entire  circulation  is  brought  to  a  standstill  lies  in 
the  capillaries  of  the  lungs,  and  this  from  the  blood  not 
undergoing  there  the  requisite  changes  whereby  it  is  con¬ 
verted  from  venous  into  arterial  blood.  Further,  he  based 
on  this  the  existence  of  a  moving  power  supplementary  to 
that  of  the  heart's  action,  but  essentially  independent  of  it, 
and  capable  when  in  abeyance  of  effectually  counteracting 
that  of  the  heart. 

2.  On  the  other  hand,  and  in  opposition  to  this  view.  Dr. 
George  Johnson,  the  distinguished  Professor  of  Clinical 
Medicine  in  King's  College,  maintains  that  these  capillary 
vessels  are*quite  empty,  or  virtually  quite  empty,  of  blood, 
and  the  lungs  themselves  anaemic  and  collapsed.  His  views 
as  to  this,  and  the  proofs  adduced  by  him  in  support  of 
Them — both  stated  with  singular  clearness  and  relevancy — 
are  fully  brought  out  in  his  Lumleian  Lectures  on  the 
“  Muscular  Arterioles,"  delivered  before  the  Koyal  College 
of  Physicians  in  1877,  and  published  in  the  British  Medical 
Journal  for  that  year ;  the  first  of  these  lectures  being  de¬ 
voted  to  the  subject  of  Apnoea,  in  which,  according  to  him, 
the  muscular  arterioles  play  the  essential  part.  It  may  here 
be  observed  that  Dr.  Johnson  is  supported  in  his  views  by 
no  less  an  authority  than  Prof.  Kutherford,  of  Edinburgh, 
who  performed  the  experiments  described  by  him. 

3.  Again,  to  take  one  of  our  latest  systematic  writers  on 
physiology  — Prof.  McKendrick,  of  Glasgow.  Writing  the 
year  following  the  publication  of  Dr.  Johnson’s  lectures 
(1878),  he  distinctly  affirms,  under  the  head  of  “  Asphyxia,” 
that “  on  examining  the  body,  the  venous  system  generally, 
the  right  cavities  of  the  heart,  and  the  capillaries  of  the  lungs 
are  found  to  be  full  of  blood,  whilst  the  arterial  system  is 
nearly  empty  "  (“Outlines  of  Physiology,"  page  402). 

Now,  as  regards  the  state  of  the  pulmonic  capillaries  in 
apnoea,  we  have  here  a  striking  discrepancy,  and  that  too 
•on  the  part  of  physiologists  of  great  eminence.  It  is  a  dis¬ 
crepancy,  moreover,  as  we  shall  see,  as  to  a  fundamental 
fact  in  the  history  of  that  process. 

Secondly. — So  much,  meanwhile,  for  one  of  the  discre¬ 
pancies  referred  to.  Another  is  to  be  met  with  in  an  essay 
by  Dr.  Fagge,  of  Guy's  Hospital,  headed  “  On  the  Different 
Modes  of  Dying,"  and  published  in  Guy’s  Hospital  Beports 
(third  series,  vol.  xxiv.,  page  349,  1879). 

Dr.  Fagge  there  informs  us  that  at  the  moment  of  death 
in  asphyxia,  as  occurring  in  animals  experimented  on,  “  in 
which  it  is  possible  to  determine  the  state  of  the  heart’s 
-chambers,"  at  that  particular  stage,  “  they  are  seen  to  be 
all  gorged  with  blood — the  left  ones  as  well  as  the  right." 
'This,  in  as  far  as  regards  the  left  chambers,  is  (or  seems  to 
be)  thoroughly  at  variance  with  what  has  heretofore  been 
taught.  But,  deferring  comment  meanwhile,  let  us  see 
what  Dr.  Fagge  says  further.  “  If  in  ordinary  autopsies 
(he  remarks)  in  the  human  subject  the  left  auricle  and 
ventricle  are  found  comparatively  empty,  whereas  the  right 
ones  are  distended,  it  is  because  the  former  unload  them¬ 
selves  during  the  setting-in  of  the  rigor  morti.s” 

But  what  at  the  stage  now  in  view — the  moment  of  death 


— is  the  condition  of  the  pulmonic  capillaries  and  pulmonic 
veins  P  Are  they  also  full  of  blood,  or  are  they,  as  Dr. 
Johnson  affirms,  at  least  as  regards  the  former,  empty  ?  If 
the  left  cavities  are  then  full,  surely  the  vessels  in  question 
must  be  full  also.  Again,  if,  at  the  moment  of  death,  these 
vessels  are  full,  it  is  clear  that  they  must  remain  full  after 
the  rigor  mortis  has  done  its  work — has  emptied  the  left 
cavities.  For  this  tonic  contraction,  designated  rigor 
mortis,  is  of  such  a  nature  as  not  to  admit  of  these  left 
cavities  again  dilating  to  receive  a  further  supply  of  blood 
from  behind.  It  can  only  suffice  to  squeeze  out  the  blood 
that  was  in  them  at  the  moment  of  death. 

As  to  the  state  of  the  vessels  in  question  at  any  stage. 
Dr.  Fagge  says  nothing.  But  how  his  allegation  as  to  the 
state  of  the  left  cavities  at  the  time  of  death  must  affect 
Dr.  Johnson’s  theory  of  apnoea,  will  be  at  once  apparent.  If 
his  allegation  be  true,  the  capillaries  of  the  lungs  will  then 
be  full  of  blood,  and  Dr.  Johnson’s  theory  must  fall  to  the 
ground ;  and  Dr.  Alison’s  also. 

It  will  appear  hereafter  that  Dr.  Fagge’s  affirmation  is 
supported  by  Prof.  M.  Foster,  and  also  by  Dr.  Kirkes,  or  by 
the  editor  of  the  ninth  edition  of  his  “  Handbook  of  Physi¬ 
ology,"  published  in  1876.  But  I  defer  further  comment 
regarding  it  till  I  have  considered  Dr.  Johnson’s  facts  and 
reasonings  on  this  whole  subject  of  Apnoea — his  presenta¬ 
tion  of  which  is  singularly  full,  clear,  and  explicit. 

I.  In  Apncea,  at  the  moment  of  death,  are  the  pulmonic 
capillaries  full  or  empty  of  blood  ? — Dr.  Johnson’s  theory 
of  Apnoea. 

Dr.  Johnson,  as  we  have  seen,  affirms  that,  at  the  moment 
of  death,  the  capillaries  of  the  lungs  are  empty — virtually 
quite  empty  of  blood.  And  his  theory  of  the  process  is 
based  on  the  fact  that  the  minute  arteries  of  the  body, 
pulmonic  and  systemic,  are  furnished  throughout  with  a 
delicate  layer  of  muscular  fibres,  laid  circularly  between  the 
external  investing  and  the  internal  lining  coat ;  and, 
further,  that  these  muscular  fibres  are  under  the  controlling 
agency  of  a  system  of  nerves.  These  minute  arteries  he 
designates  “ muscular  arterioles,”  and  their  nerves  the 
“  vaso-motor.”  At  the  instance  of  these  nerves  the  arte¬ 
rioles  contract,  their  contraction  being  such  as  either  simply 
to  impede  or  altogether  to  arrest  the  flow  of  blood  into  and 
along  the  adjoining  capillaries ;  while,  at  the  same  time, 
this  contraction,  according  to  its  degree,  augments  the 
blood-pressure  behind.  This  contraction  of  the  arterioles 
he  designates  their  “  stopcock  ”  action. 

1 .  Now,  on  occasion  of  the  access  of  air  to  the  lungs  being 
at  once  and  completely  excluded,  the  blood,  albeit  no  longer 
ar  terialised,  continues  to  pass  through  the  lungs  and  is  distri¬ 
buted  to  the  system  at  large.  On  its  reaching  the  small  sys¬ 
temic  arteries,  however,  the  vaso-motor  nerves,  finding  that 
the  blood  is  not  of  the  right  sort,  but  venous,  give  intimation 
of  the  fact  to  the  arterioles.  These  contract — exert  their  stop¬ 
cock  action, — but  to  such  an  extent  as  to  impede  only,  not  to 
arrest  the  passage  of  blood  through  them.  Simultaneously 
with  the  contraction  of  the  arterioles,  the  systemic  blood- 
pressure  is  augmented,  with  the  result  of  causing  the  left 
cavities  of  the  heart  (auricle  and  ventricle)  to  dilate  and 
become  distended  with  blood,  the  distension  being  greater 
and  more  marked  in  the  auricle  because  of  its  being  much 
the  more  distensible  of  the  two  cavities. 

The  venous  blood  holding  on  its  way,  although  impeded 
in  its  course,  returns  to  the  right  side  of  the  heart,  and 
passing  through  it,  reaches  the  small  pulmonic  arteries. 
Here  a  singular  result  follows.  Accustomed  the  pulmonic 
arterioles  are  to  the  presence  of  ordinary  venous  blood:  they 
allow  it  to  pass  freely  through  the  pulmonic  arteries  into 
the  capillaries  of  the  lungs.  Not  so,  it  would  appear,  to 
venous  blood  which,  as  such,  has  once  passed  through  the 
systemic  capillaries.  On  this  kind  of  venous  blood  reaching 
them,  their  vaso-motor  nerves  take  alarm,  advising  the 
arterioles  of  impending  danger.  Whereupon,  the  arterioles, 
exerting  their  stopcock  action,  contract,  yet  not  as  do  their 
systemic  fellows.  Instead  of  merely  impeding  the  onward 
flow  of  blood,  they  gradually,  yet  rapidly,  put  a  complete 
arrest  to  it.  The  passage  of  blood  is  blocked — and  per¬ 
manently  blocked, — none  now  gaining  access  into  the 
pulmonic  capillaries. 

Again,  as  before  with  the  systemic,  on  the  pulmonic 


624 


Medical  Times  and  Gazette. 


HARVEY  ON  APNCEA  OR  ASPHYXIA. 


Dec.  1, 1883. 


arterioles  thus  contracting,  the  pulmonic  blood-pressure  is 
raised,  and  the  right  cavities  of  the  heart  come  to  be  dilated 
and  distended  with  blood,  the  auricle  standing  out  promi¬ 
nently  as  a  large,  tense,  round  ball. 

Concurrently,  or  nearly  so,  with  this  filling  of  the  right 
cavities,  that  of  the  left  subsides ;  and  very  quickly  they 
cease  to  be  distended,  and  assume  their  natural  condition. 

It  may  here  be  observed  that  the  augmentation  of  the 
pulmonic  blood-pressure  very  quickly  follows,  or  follows  in 
the  course  of  a  minute  or  thereby,  that  of  the  systemic ; 
and  that  the  right  cavities  begin  to  dilate  and  become  dis¬ 
tended  while  yet  the  left  cavities  are  full.  It  may  further 
be  observed  that  while  the  systemic  blood-pressure  is  but 
partial,  the  pulmonic  blood-pressure  is  complete  and  abiding 
— permanent. 

It  would  further  appear  that  during  the  whole  process, 
until  the  final  arrest  of  the  circulation  at  the  pulmonic 
arterioles  and  by  reason  of  the  complete  and  persistent 
contraction  of  these,  there  is  but  one  augmentation  of 
the  systemic  blood-pressure,  and  but  one  augmentation  of 
the  pulmonic. 

Dr.  Johnson’s  own  account  of  the  process  is  briefly  as 
follows  ;  the  details  being  filled  in  by  him  here  and  there  in 
his  first  lecture  :  — 

The  access  of  air  to  the  lungs  having  been  cut  off, 
“  immediately  the  colour  of  the  left  auricle  changed  from 
crimson  to  purple,  and  the  kymograph  indicated  a  con¬ 
tinuous  increase  of  pressure  in  the  systemic  arteries.  After 
the  increase  of  pressure  had  continued  for  about  a  minute, 
the  left  cavities  of  the  heart  became  much  distended ;  the 
auricle,  in  particular,  became  expanded  into  a  tense  globular 
ball  with  a  smooth  surface.  In  the  next  period  the  pressure 
on  the  arteries  began  to  fall,  and,  about  the  same  time,  the 
right  cavities  of  the  heart,  which  had  hitherto  remained  of 
the  normal  size  and  form,  began  to  expand,  while  the  dis¬ 
tension  of  the  left  began  rapidly  to  subside.  Meanwhile, 
the  right  cavities  became  more  distended;  and  now  the 
right  auricle  assumed  the  appearance  of  a  round,  tense  ball, 
while  the  left  auricle  had  become  nearly  empty  and  flaccid. 
The  right  ventricle  also  became  so  distended  that  it  pro¬ 
jected  above  the  level  of  the  left.  This  was  the  condition 
of  the  heart’s  cavities  when  the  animal  died  by  the  final 
arrest  of  the  circulation  ”  (the  Lumleian  Lectures  on  the 
“  Muscular  Arterioles,”  etc..  Lecture  I.,  British  Medical 
Journal,  1877). 

It  would  thus  appear  that  while  venous  blood  is  allowed 
to  make  one  circuit  as  such  through  the  lungs,  it  is  not 
allowed  to  make  a  second.  And  this  appears  from  the  cir¬ 
cumstance  recently  adverted  to,  and  seen  when  the  process 
is  witnessed  on  the  opened  chest  and  exposed  heart  of  a 
living  dog,  of  there  being  but  one  augmentation  of  blood- 
pressure,  systemic  and  pulmonic,  from  first  to  last. 

2.  In  connexion  with  the  foregoing,  it  may  be  observed 
that  no  other  agency  is  alleged  by  Dr.  Johnson  to  be  con¬ 
cerned  in  the  arrest  of  the  circulation  in  apnoea  than  that  of 
venous  blood  which,  as  such,  has  once  passed  through  the 
general  system. 

It  is  not  incumbent,  indeed,  on  Dr.  Johnson  to  show  cause 
why  such  venous  blood  should  have  that  effect.  Enough  if 
it  be  the  fact  that  it  has  the  effect  in  question.  Yet,  strange 
enough  one  cannot  but  deem  it.  That  the  systemic  arterioles 
should  demur  to  the  passage  of  venous  blood  through  them 
— used  as  they  are  to  that  of  arterial  blood  only — one  can 
understand.  But  why  the  pulmonic  should  be  so  sensitive 
to  venous  blood  of  the  kind  in  question  is  sufficiently 
remarkable. 

In  passing  from  the  arteries  through  the  systemic  capil¬ 
laries,  venous  blood  cannot,  of  course,  subserve  the  purposes 
of  arterial;  it  cannot  undergo  the  changes  through  the 
interchange  of  materials  between  it  and  the  tissues  which 
arterial  blood  does.  Its  quality  must  in  some  way  or  in 
divers  ways  be  different  from  that  of  ordinary  venous  blood. 
But  wherein  does  it  so  differ  from  such  venous  blood  as  to 
exert  the  effect  it  does  on  the  pulmonic  arterioles  ?  It 
may  fairly  be  questioned  whether  either  chemical  analysis 
or  microscopic  inspection  would  throw  any  light  on  the 
question. 

3.  Let  us  now  consider  the  evidence  adduced  by  Dr. 
Johnson  in  support  of  his  theory  of  apnoea. 


*  Yet  let  us  first  of  all  see  clearly  what  is  the  main  basis  of 
the  theory.  Dr.  Johnson  affirms  that  at  the  moment  of 
death  the  pulmonic  capillaries  are  empty — virtually  quite 
empty — of  blood.  We  shall  hereafter  see  the  physiological 
value  of  this  qualifying  term  virtually.  It  has  no  bearing 
on  the  theory  itself,  but  an  important  bearing  on  the  process 
of  resuscitation.  He  does  not  affirm  that  the  vessels  in 
question  are  absolutely  empty,  but  only  that  they  are  (to 
repeat  the  expression  as  the  best,  as  most  truly  represent¬ 
ing  the  facts  of  the  case)  virtually  empty. 

“  At  the  moment  of  death  ”  is  an  observation  made  once 
and  again  by  Dr.  Johnson;  and  rightly  so.  For  it  is  plain 
that  the  immediate  cause  of  death  in  apnoea  must  be  sought 
for  in  the  state  of  matters  which  then  obtains.  It  may  be 
that  some  hours  after  death  the  state  of  the  lungs  and  of 
their  capillary  vessels  is  not  what  it  was  at  the  moment  of 
death.  Blood  may  gradually  make  its  way  into  them,  after 
the  arterioles  have  become  relaxed,  from  the  distended  parts 
behind,  favoured  by  rigor  mortis  of  the  right  ventricle. 
And  this  may  account  for  the  discrepancies  of  statement 
formerly  adverted  to  as  met  with  in  physiological  writings 
bearing  on  this  process. 

a.  It  may  be  premised  that,  were  the  theory  put  forth  by 
Dr.  Alison,  and  supported  by  Dr.  John  Reid,  the  true  one, 
or  were  the  allegations  made  by  them  and  by  Dr.  McKendrick 
in  conformity  with  the  actual  facts  of  the  case — namely, 
that  the  pulmonic  capillaries  are  full  of  blood  at  the  moment 
of  death, — then,  on  examination  made  directly  after  death, 
the  lungs  should  be  found  distended  and  filling  the  cavity  of 
the  chest,  and  (containing  only  venous  blood)  livid  through¬ 
out.  How  stand  the  facts  ?  Referring  to  the  post-mortem 
examination  of  a  dog  killed  by  simple  apnoea,  Dr.  Johnson 
says: — “  The  lungs  collapsed  to  an  extreme  degree;  they 
were  pale  and  non-crepitant”  (Lect.  I.).  Again,  speaking 
of  the  exact  seat  of  the  impediment  which  arrests  the  flow 
of  blood  into  the  lungs,  he  remarks  that  “  the  extreme 
ancemia  of  the  minute  tissue  of  the  lungs,  when  examined 
immediately  after  death,  in  cases  of  acute  apncea,  is  evidence 
that  the  stoppage  occurs  before  the  blood  has  reached  the 
capillaries.”  Again,  in  reference  to  another  point  presently 
to  be  adverted  to,  he  speaks  of  the  “nearly  bloodless  state 
in  which  the  capillaries  of  the  lungs  are  actually  found  to 
be.”  Again,  referring  to  the  apnoea  produced  by  the  in¬ 
halation  of  the  nitrous  oxide  gas,  and  to  the  result  of  exami¬ 
nation  after  death  in  experiments  he  had  witnessed.  Dr. 
Johnson  says : — “  The  lungs  were  ancemic  and  collapsed 
throughout.” 

b.  The  foregoing  seems  decisive  as  to  the  state  of  the 
lungs  in  respect  of  contained  blood.  They  are  bloodless  and 
ancemic  and  collapsed.  “If  (he  says),  in  accordance  with, 
the  hypothesis  of  Alison  and  Reid,  the  blood  were  attracted 
into  the  capillaries  and  retained  there,  ....  the  capillaries 
would  be  in  a  state  of  engorgement,  and  not  in  the  nearly 
bloodless  state  in  which  they  are  actually  found  to  be.” 

It  must  be  borne  in  mind  that  the  lungs  are  not  and  can¬ 
not  be  absolutely  bloodless.  They  must  contain  all  and 
whole  the  blood  that  lies  pent  up  in  the  branches  of  the 
pulmonary  artery  distributed  through  them.  And  this  must 
amount  to  a  not  inconsiderable  quantity,  albeit,  in  view  of  the 
pulmonic  capillaries  and  the  pulmonic  veins,  and  the  recep¬ 
tive  capacities  of  these,  alleged  to  be  empty,  the  quantity 
will  be  relatively  small.  Accordingly,  while  one  need  not  be 
surprised  at  a  statement  quoted  by  Dr.  Johnson  from  Dr; 
Massey,  of  Nottingham,  regarding  a  man  hanged  there — to> 
wit,  that  “  on  cutting  out  the  lungs,  a  large  quantity  of  black 
blood  flowed,”  and  that  “  the  colour  of  the  lungs  was  of  a 
darker  hue  than  natural,  especially  at  the  base,” — he  will  be 
prepared  to  understand  that  elsewhere  and  for  the  most  part 
they  were  anaemic  ;  and  further,  and  very  particularly,  that 
on  opening  the  chest  “  the  lungs  were  found  to  occupy  a 
very  small  space  at  the  back  part  of  the  chest,  resembling 
the  contents  of  a  feet al  thorax” — a  case  in  which  the  lungs,, 
having  received  neither  air  nor  blood,  are  naturally  in  a  state 
of  collapse  or  compression. 

Yet,  to  advert  now  to  the  qualifying  expression  “virtually,”’ 
formerly  made  use  of — “  virtually  empty,” — it  is  highly  im¬ 
portant  that  note  should  be  taken  of  a  circumstance  bearing 
on  the  condition  of  the  pulmonary  capillaries,  and  this  (a3 
before  observed)  because  of  its  bearing  on  the-  efficacy  of  the 


Medical  Times  and  Gazette.  GAY  ON  VEINS  CONNECTED  WITH  THE  HEPATIC  SYSTEM. 


Dec.  1,  1883.  625 


artificial  respiration.  Empty  as  these  vessels  are  found  to 
‘be  and  the  lungs  themselves  anaemic  at  the  moment  of  death, 
the  capillaries  do  and  must  contain  a  small,  a  very  small 
quantity  of  blood  at  their  origins  or  just  beyond  the  confines 
■of  the  arterioles.  And  it  is  easy  to  understood  how  they 
should.  The  arrest  of  the  blood’s  movement  through  and 
along  these  vessels  is  not  a  sudden  arrest.  The  stopcock 
action  of  the  pulmonic  arterioles,  although  energetic  enough 
and  rapid  enough,  is  yet  gradual ;  and  the  effect  of  it  on 
that  movement  correspondingly  gradual.  The  venous  blood 
at  the  first,  and  for  a  brief  space,  passes  freely  through  the 
pulmonic  capillaries ;  after  a  time,  and  very  shortly  it  is, 
it  begins  to  be  impeded,  and  its  movement  rendered  slower, 
till  the  acme  of  stopcock  action  is  reached.  Altogether,  the 
movement  must  be  in  such  wise  affected  that,  while  the  mass 
of  blood  is  driven  off  from  the  ensemble  of  the  capillaries  and 
these  left  empty,  a  small  quantity  of  blood  will  yet  pass 
through,  and  (the  heart’s  action  now  languishing,  or  else 
the  blood  only  now  trickling  through)  will  lodge  in  that 
part  of  the  capillaries  that  is  adjacent  or  contiguous  to  the 
arterioles,  enough  to  admit  of  the  air  reaching  it  on  its  re¬ 
admission  to  the  lungs,  and  so,  in  favourable  cases,  of  the 
circulation  being  restored,  (b) 

c.  The  evidence  already  adduced  seems  abundantly  suffi¬ 
cient  to  establish  Dr.  Johnson’s  allegation  as  to  the  state  of 
the  lungs  in  respect  of  contained  blood. 

Were  Dr.  Alison’s  theory  the  true  one,  it  is  plain  that  these 
•organs,  being  full  of  venous  blood,  gorged  with  it  instead  of 
being  collapsed  and  so  reduced  in  size  as  to  be  pushed  into 
the  back  part  of  the  chest,  and  for  the  most  part  ancemic, 
would  be  livid  throughout  instead  of  at  the  base  alone,  and 
would  fill  and  distend  the  whole  cavity  of  the  chest.  Ac¬ 
cording  to  Dr.  Alison,  the  obstacle  to  the  exit  of  blood  from 
them  lies  within  the  lungs  themselves,  and  results  from  the 
loss  of  the  auxiliary  moving  power  supposed  by  him  to  be 
•derived  from  the  conversion  of  the  venous  into  arterial 
blood.  The  obstacle  may  in  fact,  in  a  certain  sense,  be 
said  to  lie  at  the  origin  of  the  pulmonic  veins — avowedly 
not  at  the  origin  of  the  pulmonic  capillaries. 

According  to  Dr.  Johnson’s  view,  the  obstacle  lies  at  the 
origin  of  these  capillaries,  in  fact  at  the  terminal  ends  of 
the  pulmonic  arteries ;  and  the  state  of  the  lungs,  as  met 
with  directly  after  death,  harmonises  with  that  view.  The 
lungs  are  collapsed,  shrunken,  reduced  in  size,  and  anaemic 
throughout  except  at  the  base. 

But,  in  connexion  with  this,  there  is  a  piece  of  evidence 
which  might  have  been  made  more  of  by  Dr.  Johnson  than 
has  been  done  by  him.  It  is  the  very  notable  projection  of 
the  right  auricle.  This  fact,  duly  considered,  seems  to  me 
admirably  to  cap  the  other  proofs  adduced  by  him.  It  is  the 
near  proximity  of  the  obstacle  to  the  auricle  that  accounts 
for  that  projection,  and'  specially  it  is  the  inability  of  the 
lungs  to  admit  the  mass  of  blood  that  is  pressing  on  from 
behind  to  flow  into  them  and  so  be  diffused  through  them. 
Were  there  no  obstacle  at  the  beginnings  of  the  capillaries, 
the  receptive  capacity  of  the  lungs  is  such  and  so  great  that 
the  organs  in  question  would  admit  an  enormous  quantity  of 
blood  to  pass  into  them,  and  be  spread  through  them.  In 
this  way  the  whole  mass  of  blood  would  be  diffused  over  a 
very  large  area.  The  pressure  of  it  would  be  laid  on 
equally  over  all  that  area,  and  then  the  projection  in  ques¬ 
tion  could  not  arise.  How  great  that  distension  is.  Dr. 
Johnson  has  himself  taken  note  of.  Yet  it  appears  more 
strikingly  in  a  quotation  he  makes  from  Harvey  in  his 
“  Second  Dissertation  on  the  Circulation  of  the  Blood.” 
Speaking  of  the  inspection,  within  two  hours  after  death, 
•of  the  body  of  a  man  who  had  been  hanged,  Harvey  says 
as  to  the  distension  of  the  right  auricle  of  the  heart,  "  that 
it  was  of  the  size  of  a  large  man’s  fist,  and  so  full  of  blood 
that  it  looked  as  if  it  would  burst  ”  (Sydenham  Society’s 
translation,  page  127). 

4.  Before  leaving  Dr.  Johnson’s  theory  there  is  yet  another 
point  which  seems  to  call  for  a  passing  notice. 

It  is  one  arising  out  of  the  restoration  of  the  circulation 
by  means  of  the  artificial  respiration  in  persons  rescued 
from  impending  death  by  apnoea. 

(b)  The  propriety  of  the  expression  “  virtually,”  in  respect  of  the  state 
of  the  capillaries  as  empty,  will  now,  it  is  hoped,  appear.  To  say  that 
they  are  nearly  empty  would  convey  no  such  idea  of  the  state  of  matters 
as  is  requisite  in  order  to  a  right  understanding  of  the  whole  process. 


Now,  in  view  of  Dr.  Johnson’s  theory,  it  may  occur  ot  some 
to  ask.  How,  agreeably  to  that  theory,  can  the  artificial 
respiration  avail  in  any  case  ?  If  the  capillary  vessels  are 
empty  of  blood,  how  can  the  air  by  any  possibility  reach 
the  blood  pent  up  in  the  small  pulmonic  arteries — arteries 
lying  behind,  lying  beyond  the  range  of  the  air-cells  of  the 
lungs  P  It  is  to  the  capillaries  overspreading  these  air-cells 
and  to  the  blood  contained  in  them  that  the  air  stands  re¬ 
lated.  And  yet  these  capillaries  are  said  to  be  empty  of 
blood.  We  have  already  given  what  we  believe  to  be  a  full 
and  sufficient  answer  to  this  very  natural  question  (supra, 
p.  624).  Although,  as  there  pointed  out,  the  capillaries  are 
empty,  as  a  whole — virtually  quite  empty,— there  is  yet  at 
their  origins,  and  a  little  way  within  these,  enough  of  blood, 
and  this  at  ten  thousand  different  points,  for  the  air  on  its 
readmission  to  act  on  it,  and,  arterialising  it,  to  effect  the 
restoration  of  the  circulation. 

Were  it  otherwise — were  there  absolutely  no  blood  lying 
at  the  points  indicated,  were  it  all  pent  up  behind  the 
arterioles, — it  is  inconceivable  that  the  artificial  respiration 
should  in  any  case  avail  to  the  saving  of  life,  once  the  stop¬ 
cock  action  had  effectually  done  its  work  throughout. 

It  is,  however,  it  must  be  admitted,  a  matter  of  inference 
that  the  state  of  things  is  as  has  here  been  represented. 
The  actual  condition  of  the  vessels  in  respect  of  blood  at 
the  junction  of  the  small  pulmonic  arteries  and  the  pulmonic 
capillaries  has  not  as  yet,  as  far  as  I  am  aware,  been  made 
the  subject  of  special  microscopic  inquiry.  And  it  seems 
desirable  that  such  inquiry  should  be  made.  The  determi¬ 
nation  of  the  assumption  is  not,  indeed,  needed  for  the 
establishing  of  Dr.  Johnson’s  theory.  It  is  needed  only  to 
enable  us  to  understand,  in  conformity  with  that  theory, 
how  the  artificial  respiration  should  avail  as  it  does  to  effect 
resuscitation  in  cases  of  suspended  animation  from  apnoea. 
The  theory  itself,  entirely  due  to  Dr.  Johnson,  and  a  singu¬ 
larly  simple  and  beautiful  one,  is  now,  in  my  opinion,  placed 
beyond  all  challenge  by  the  ample  body  of  evidence  adduced 
by  him  in  support  of  it. 

(To  be  continued.) 


A  DEMONSTRATION  OF  THE 
VEINS  CONNECTED  WITH  THE  HEPATIC 
SYSTEM.(a) 

By  JOHN  GAY,  F.R.C.S., 

Senior  Surgeon  to  the  Great  Northern  Hospital. 


Having  been  invited  to  take  part  in  providing  subjects  for 
thought  and  discussion  during  the  evenings  of  the  season 
on  which  we  have  entered,  I  felt  that,  however  incompetent 
I  might  be,  for  many  reasons,  to  cater  for  your  interest  and 
to  your  advantage,  I  could  not  decline  the  compliment  paid 
to  me.  And,  on  consideration,  I  thought  I  could  not  better 
occupy  your  time  for  half  an  hour,  although  quite  in  con¬ 
travention  of  the  usual  course  of  our  proceedings,  than  by 
drawing  your  attention  to  some  (hitherto,  I  believe,  unknown) 
anatomical  facts  that  bear  upon  doctrines  with  which  we 
have  long  been  familiar,  but  the  foundations  of  which,  being 
laid  during  what  I  may  call  the  transitional  period  of  ana¬ 
tomical  research,  may  very  reasonably  become  subject  to 
modification  if  rightly  transferred  to  some  other  and  more 
substantial  basis. 

In  rooms  that  have  been  supplemented  by  this  splendid 
hall  through  the  energy  and  influence  very  largely  of  our 
distinguished  Fellow,  Mr.  Bryant,  I  delivered,  in  the  season 
1837-38,  some  lectures  (the  Lettsomian)  on  some  special 
diseases  of  the  veins ;  and  from  that  time  I  conceived  such, 
I  might  almost  say,  love  for  the  general  subject  of  the  venous 
system,  that  what  little  time  and  strength  I  have  sirice  had 
at  command  I  have  given  in  great  part  to  its  further  study. 
This  has  been  more  than  repaid  by  the  abstract  enjoyment 
I  have  derived  from  that  source.  Every  little  scintillation 
of  light  that  has  fallen  on  my  mind  has  given  me  indescrib¬ 
able  pleasure,  for  on  these  matters  it  was  almost  a  tabula 

(a)  Communicated  to  the  Medical  Society  of  London  November  26, 1883. 


626 


Medical  Times  and  Gazette. 


GAY  ON  VEINS  CONNECTED  WITH  THE  HEPATIC  SYSTEM. 


Dec.  1, 1883, 


rasa,  so  little  had  I  been  able  to  gather  of  a  practical  cha¬ 
racter  from  books  or  teachings  of  any  kind  relating  to  that 
subject.  I  could  not  pursue  it,  as  I  have  done  by  the  aid  of 
injection  and  the  scalpel,  without  getting  some  little  infor¬ 
mation  that  was  new,  and  it  occurred  to  me  that  I  might 
agreeably  vary  the  course  of  the  inquiries  and  disquisitions 
that  have  usually  made  the  subjects  of  our  evening  work 
here,  if  I  employed  a  part  of  this  in  a  demonstration  of  the 
veins,  which  appears  to  me  a  nearer  approximation  of  the 
relative  anatomy,  especially  of  the  thoracic  and  its  tribu¬ 
tary  vein  system,  than  that  which  has  hitherto  been  accepted. 
I  say  a  “  demonstration,”  for  a  paper  on  such  a  subject 
without  demonstration  would  be  open  to  doubt  and  perhaps 
cavil,  and  be  of  little  or  no  use  in  an  effort  to  render  it 
advantageous  to  science.  The  facts  I  am  about  to  relate  are 
the  results  of  a  series  of  experiments  by  injections,  conducted 
for  a  long  time  past  with  every  effort  to  render  them  exact, 
intelligible,  and  reliable. 

The  conclusions  at  which  I  have  arrived,  and  of  which  I 
can  entertain  no  doubt  or  question,  relate  mainly  to  the  free 
anastomosis  of  veins  of  the  trunk,  even  in  parts  where  valves 
exist  and  might  be  supposed  to  interfere  with  such  freedom 
of  intercourse.  I  began  the  series  in  the  human  subject,  then 
I  took  monkeys,  and  subsequently,  to  satisfy  the  inferences 
they  yielded,  had  again  recourse  to  human  anatomy.  After 
trying  a  variety  of  injections  in  monkeys,  which  failed  of 
their  purpose  on  account  of  their  dying  from  disease  (usually 
phthisis),  I  got  a  macaque  from  the  Zoological  Gardens  that 
died  apparently  without  any  pathological  lesions  that  could 
stand  in  my  way ;  and  Mr.  William  Pearson,  at  the  College 
of  Surgeons,  injected  it  with  wax.  This  he  did  with  a  certain 
amount  of  success,  enough  for  my  purpose,  although  my 
friend  Prof.  Flower  was  good  enough  with  his  critical  eye 
to  see  defects  and  to  draw  my  attention  to  them. 

The  injected  specimen  is  before  you,  but  I  regret  that  I 
have  been  unable  to  procure  a  duplicate  more  fitted  for  my 
purpose.  When  fresh  it  was  a  very  beautiful  object;  Prof. 
Humphry,  Sir  James  Paget,  and  other  anatomists,  including 
Prof.  Flower,  examined  it  carefully,  and  admitted  the  success, 
so  far,  of  the  injections  as  I  have  described  it.  But  it  has 
suffered  from  the  attempts  to  preserve  it ;  still,  I  hope  it 
contains  evidence  of  the  points  I  desire  to  establish. 

Prior  to  and  since  that  injection  I  have  had  opportunities 
of  obtaining  injections  in  the  human  subject  at  Mr.  Cooke’s 
admirably  contrived  and  well-stocked  anatomical  studio,  in 
a  little  burial-ground  near  the  Foundling  Hospital.  To  my 
friend  Mr.  Cooke,  and  the  means  afforded  me  by  the  re¬ 
sources  of  that  interesting  and  comparatively  perfect  retreat, 
I  am  to  a  very  large  extent,  and  indeed  well-nigh  exclusively, 
indebted.  These  were  made,  and  followed  by  sectional  dis¬ 
play  of  the  vessels  and  parts  by  Mr.  Monteille,  recently  of 
Prof.  Humphry’s  School,  and  now  at  the  museum  at  St. 
Thomas’s  Hospital,  to  whom  I  am  much  indebted  for  second¬ 
ing  my  efforts;  as  well  as  to  Mr.  Pearson,  to  whom  I  am 
beholden  for  the  opportunity  of  showing  the  macaque 
before  you. 

The  results  of  these  injections  exactly  correspond,  and 
will,  I  trust,  help  to  lay  the  foundation  in  some  important 
respects  of  the  new  reading  of  vein  anatomy  to  which  I 
have  alluded,  and  to  which  I  will  solicit  your  more  particular 
attention. 

As  it  bears  considerably  on  the  azygoid  and  related 
systems,  I  will  first  offer  a  few  remarks  on  their  historical 
anatomy,  with  the  hope  of  showing  the  excellent  work  done 
on  the  revival  of  learning  in  Europe,  especially  in  Italy  and 
farther  east. 

At  the  end  of  the  second  century  the  learned  physician  of 
Pergamos  founded  anatomy  by  observation,  and  made  it  a 
science.  But  he  imperfectly  understood  the  nature  or  uses 
of  the  azygoid  veins.  It  was  not  until  the  time  of  Eustachius 
that  these  veins  became  known ;  he  published  a  series  of 
plates  on  their  anatomy,  and  was  followed  by  Yolthier 
Goiter,  of  Groningen,  who  improved  our  knowledge  of 
these  veins,  and,  at  the  same  time,  invented  that  much, 
and  in  some  respects  well,  abused  practice  of  vivisection. 
Fabricius  de  Aquapendente  followed  up  the  inquiry,  until  we 
come  to  Canini,  who  more  thoroughly  examined  these  vessels, 
and  first  brought  to  light  the  fact  of  their  having  valves  ;  and 
onwards  to  our  immortal  Harvey,  who  gathered  up  all  the 
fragments  of  knowledge  that  had  been  collected  by  these 
great  masters,  and  landed  them  on  the  terra  firma  of  the 
great  disco^esy  of  the  circulation. 


At  present,  a  latent  suspicion  has  been  awakening  in 
favour  of  abstract  physiological  research  as  the  means  of 
advancing  the  science  of  healing  and  the  practice  of  medicine, 
rather  than  anatomy  or  than  consolidating  its  base  by  elu¬ 
cidation  of  what  is  still  obscure  and  has  been  least  explored’ 
in  our  knowledge  of  anatomy.  To  this  view  I  am  tempted, 
to  demur. 

Both  are  good,  but  perfection  in  anatomical  details  must 
antedate  and  form  the  substratum  of  all  physiological? 
advance. 

The  oscillations  in  the  progress  of  physiological  science;, 
as  well  as  all  rightful  progress  in  the  art  of  medicine,  corre¬ 
spond  very  much  with  the  fluctuation  in  the  advance  of 
anatomical  truth.  It  is  not  my  design — indeed,  I  cannot  add. 
to  or  improve  the  knowledge  we  possess  of  the  anastomotical 
relations  of  the  veins.  This  is  very  perfectly  supplied  by 
the  works  of  Gray  and  Quain,  and  well  known  to  everyone.- 
The  veins  form  together  a  network  of  intercommunication- 
throughout  the  body.  Every  venule  and  vein  contributes  to* 
the  extradition  of  its  blood  from  its  capillary  reservoir,  and 
its  complete  return  and  full  discharge  into  the  systemic- 
veins,  with  a  certain  and  co-ordinate  amount  of  free  oscilla¬ 
tion  in  order  to  provide  against  casual  or  designed  obstruc¬ 
tion.  In  its  way  to  the  heart  this  is  the  course  of  the- 
blood-stream,  and  it  is  marvellously  provided  for  by  t he¬ 
ar  ran  gement  of  the  sinuous  channels  which  conduct  it’. 
Here  I  must  interpose  the  statement  that  all  the  trunk 
veins,  like  the  muscular  or  axial  veins  of  the  extremities,, 
appertain  to  the  systemic  system,  whilst  the  collateral  run 
exclusively  and  without  exception  through  the  cutaneous  or- 
superficial  veins.  If  you  want  to  get  any  communication' 
between  the  most  remote  portions  of  the  systemic  veins  you- 
will  have  to  deligate  the  inferior  cava  at  its  entrance  to  the- 
heart,  and  above  the  hepatic  trunks,  and  trust  to  cutaneous- 
channels  for  its  establishment. 

My  first  statement  bearing  upon  the  fact  related  is,  that 
if  you  inject  a  tributary  vein,  large  or  small,  in  any  part  of 
the  body — as,  for  instance,  of  the  internal  mammary, — in  the 
trunk  or  in  the  limbs,  and  in  any  direction  either  backwards  or~ 
centripetally,  the  injected  fluid  (if  thin  enough  for  permea¬ 
tion)  will  fill  every  vein  throughout  the  body,  and  extend  intu¬ 
its  finest  ramifications.  The  macaque  exhibited  is  the  proof 
to  which  I  have  referred.  You  will  observe  that  there  is  no' 
vein  or  vein-twig  that  is  not  fully  injected,  and  from  that 
one  point,  the  internal  mammary.  This  I  believe  to  be  a- 
new  fact  in  the  vein  circulation.  I  have  put  its  proof  to  the- 
test  by  a  considerable  number  of  experiments,  and  in  no> 
one  instance  have  I  failed,  provided  the  animal  was  healthy.. 

In  order  to  examine  the  communications,  even  where ■ 
these  -are  apparently  exposed  to  valvular  interruption,  as 
in  the  azygoids,  its  vessels  must  be  injected  by  two  distinct 
methods  and  from  different  points  :  first,  forwards  from  am 
iliac,  renal,  or  sacro-lumbar  (a  systemic)  vein ;  and  then, 
after  tying  its  trunk,  in  another  subject,  backwards  or  in  a- 
direction  opposed  to  the  natural  currents,  from  the  orifice? 
of  a  remote  collateral  ( e.g .,  an  internal  mammary  or  in¬ 
ternal  jugular)  vein.  I  have  caused  these  methods  of  inject¬ 
ing  this  department  of  the  vein  system  to  be  adopted  several: 
times.  In  the  first,  the  flow  of  the  injection  will  be  checked.' 
by  the  valves  at  the  junction  of  the  thoracic  with  the  azygoid! 
intercostals.  In  the  second,  it  will  take  a  circuitous  route,, 
but  enter  the  azygoid  trunks  by  these  veins. 

The  next  point  is,  that  the  injection  in  taking  this  course’ 
fills  every  interposing  organised  structure.  It  will  traverse- 
the  lungs,  liver,  kidneys,  and,  as  I  have  every  reason  to» 
believe,  the  spleen,  supra-renal  capsules,  the  thyroid,  and 
other  parenchymatous  structures. 

The  third  is,  that  it  does  not  follow  that  because  one? 
large  organ  such  as  the  liver,  or  even  the  other  parts  of  the- 
body,  are  thus  injected,  all  or  any  parts  or  organs  should  be- 
equally  so  filled. 

In  the  case  of  a  subject  injected  by  Mr.  Monteille  (at 
present  lying  in  Mr.  Cooke’s  studio  for  observation  by- 
anyone  desiring  it),  the  lobules  of  the  liver  were  completely" 
injected  from  the  jugular  and  femoral  veins,  but  no  part  of' 
the  fluid  had  passed  into  it  by  the  portal  vein.  This  vein 
was  empty.  And  this  is  quite  possible,  for  the  course  of 
the  injections  might  be  first  from  the  superior,  which- 
receives  the  trunk  of  the  inferior,  phrenic,  and  their 
conjoined  single  vein  into  the  external  hepatic,  and’ 
thus  into  the  liver  ;  for  the  phrenics  anastomose  freely- 
with  the  lower  intercostals,  and  mammary  blood  flows: 


Medical  Times  and  Gazette. 


MEDICAL  AND  SURGICAL  PRACTICE. 


Deo.  1,  1883.  627 


into  the  heart  through  the  azygoids.  The  spermatic 
vein  on  the  right  side  passes  into  the  superior  cava,  on  the 
left  into  the  renal  as  well  as  into  the  cava.  The  injection 
might  also  fill  the  inferior  hsemorrhoidal.  This  completes 
the  proof  that  the  whole  of  the  vein-blood  from  the  nearest 
To  the  most  remote  parts  of  the  trunk  can  have  free  access 
To  the  hepatic  globules  without  being  dependent  on  the 
portal  veins  for  its  conduct,  so  that  it  would  appear  that 
these  veins  are  not  exclusively  portal  to  that  organ.  By  the 
network  already  alluded  to,  the  liver  is  accessible  to  blood 
■equally  from  all  parts  of  the  vein  system. 

The  bearing  of  this  inquiry  and  its  results  on  physiological 
:seience  is  far  from  being  remote  as  to  its  consequences.  It 
■shows  that  blood  depuration  by  organic  textures  does  nob  ' 
■depend  so  much  upon  the  means  of  access  to  the  liver  and 
■other  excreting  organs  of  the  blood  from  every  part  of  the 
body,  as  upon  the  healthy  performance  of  their  functions. 
Any  interruption  to  either  the  first  or  second  of  these 
mecessary  conditions  will  be  followed  by  marked  local 
■evidence,  such  as  a  sallow  tint  corresponding  with  the  area 
ever  which  they  have  failed  of  being  fulfilled. 


REPORTS  OF 

HOSPITAL  PRACTICE  IN'  MEDICINE 
AND  SURGERY. 


UNIVERSITY  COLLEGE  HOSPITAL. 


'TESTIS  IN  PERINAX) —  TENDERNESS  IN  BOTH 

TESTES  —  SUCCESSFUL  REMOVAL  TO  THE 

SCROTUM. 

(Under  the  care  of  Mr.  MARSHALL.) 

t[For  the  notes  of  this  case  we  are  indebted  to  Mr.  Victor  Horsley,  B.S., 
Surgical  Registrar  to  the  Hospital.  ] 

Robert  B.,  aged  sixteen,  a  cabinet-maker,  was  admitted 
into  University  College  Hospital  on  May  5,  1882,  under  the 
■care  of  Mr.  Marshall. 

Present  State. — The  left  half  of  scrotum  is  of  normal  size, 
and  contains  a  testicle  which  seems  healthy  and  well- 
developed,  but  which  is  very  tender.  The  right  half  of  the 
■scrotum  is  small  and  empty.  The  testicle,  which  is  even 
■more  tender  than  the  left  one,  is  of  fair  size  and  consistence  ; 
■it  generally  lies  a  little  below  the  external  ring,  just  above 
the  entrance  to  the  scrotum  proper.  It  can  be  easily  pressed 
down  lower;  but  it  then  misses  the  scrotum,  and  goes 
almost  into  the  perineum.  The  boy  is  otherwise  well 
developed  and  well  nourished. 

Past  History. — The  boy  gave  the  following  account  of 
himself About  four  years  ago  he  was  running  and  fell 
down.  On  getting  up  he  experienced  difficulty  in  walking 
and  pain  in  the  groin.  This  passed  off  next  day ;  but  ever 
.since  he  has  felt  from  time  to  time  a  similar  pain  when  he 
walks  quickly,  lifts  heavy  weights,  or  coughs.  Occasionally 
his  pain  comes  on  so  severely  that  he  has  to  leave  off  work. 
While  at  work  a  few  days  ago  this  pain  came  on  so  severely 
that  he  came  to  the  hospital  and  was  admitted.  The  pain 
in  the  left  testicle  came  on  yesterday  for  the  first  time. 

May  9. — Operation.— The  patient  being  under  ether,  Mr. 
Marshall  made  an  incision  just  inside  the  inguino-scrotal 
fold,  and  freed  the  testis  from  its  surroundings.  It  was 
then  pressed  towards  the  scrotum,  and  attached  to  it  by 
means  of  a  loop  of  catgut,  passed  into  the  tunica  vaginalis 
through  the  lowest  part  of  the  scrotum,  to  which  it  was  then 
tied.  °The  edges  of  the  wound  were  then  brought  together. 
There  was  very  little  haemorrhage.  Antiseptic  precautions 
and  dressings  were  adopted. 

10th— Temperature  102'6°  Fahr.  The  patient  has  had 
a  rather  restless  night ;  he  has  been  retching  a  good  deal ; 
complains  of  headache.  Wound  was  re-dressed.  There  is 
■considerable  tenderness. 

11th.— Temperature  101-2’  Fahr.  Patient  is  much  better ; 
retching  and  vomiting  have  ceased. 

13th.— Temperature  99-6°  Fahr.  Wound  re-dressed  ;  a 
few  drops  of  dark  blood-clot  were  squeezed  out  of  the  wound. 
'The  testicle  remains  in  its  new  position,  but  continues  very 

-tender.  ,  .  ,  . 

17th. — The  antiseptic  gauze  dressings  were  replaced  by 
horacic  lint.  Testis  continues  in  its  new  situation.  There 
is  little  pain  in  it.  Left  testis,  however,  continues  tender. 


20th. — In  dressing  the  wound  this  morning,  pads  of  lint 
were  adjusted  so  as  to  press  the  testis  down  on  the  scrotum. 

30th. — The  wound  is  gradually  healing  up,  the  testis 
remaining  in  its  new  position.  He  gets  up  every  day,  and 
goes  about  the  ward  in  a  wheel-chair. 

June  7. — He  was  discharged.  The  testes  remained  rather 
tender. 

Remarks  (by  Mr.  Victor  Horsley) . — The  case  above  quoted 
is  of  especial  interest  from  the  rarity  of  the  condition.  The 
testicle  may  be  found  situated  in  the  perineum  from  two 
causes — (1)  congenital  malposition,  and  (2)  dislocation. 
The  present  case  falls  under  the  latter  category,  but  it  is 
worth  while  to  glance  generally  at  the  subject,  especially 
as  up  to  quite  recently  operation  as  a  remedial  agent  has  not 
been  very  successful.  I  have  been  able  to  collect  twenty- 
nine  other  cases  arising  from  one  or  the  other  of  the  above- 
mentioned  causes.  Of  these,  in  seventeen  cases  the  malposi¬ 
tion  occurred  eight  times  on  the  left  side  and  nine  times  on 
the  right,  so  that  there  would  not  appear  to  be  any  special 
tendency  for  the  deformity  to  appear  on  either  side  in 
particular.  The  dislocation  of  the  testicle  backwards 
into  the  perineum  has  occurred  at  varying  ages :  thus, 
in  the  present  case  the  accident  causing  the  deformity 
happened  at  twelve  years  of  age,  while  in  other  cases  it 
has  resulted  from  severe  blows  even  when  the  subject  has 
been  a  full-grown  adult  (9).  The  chief  importance  of  the 
subject  lies  in  the  remediation  of  the  condition,  since  the 
testicle  in  its  unusual  position  is  the  source  of  great  incon¬ 
venience,  and  frequently  of  severe  pain.  In  the  present 
case  this  was  the  prominent  symptom,  and  one  calling 
for  active  interference.  Up  to  1879  (18)  the  attempts  made 
in  this  direction  (5,  9,  15)  were  not  successful,  the  wound 
suppurating,  and  in  two  cases  the  patients  died  in  a  few 
weeks  (5,  15) .  The  sources  of  failure  appeared  to  be  two  in 
number,  viz.,  first,  the  septic  state  of  the  wound,  and, 
secondly,  the  want  of  power  to  retain  the  testis  in  its  new 
position.  These' were  met  successfully  first  by  Annandale 
(18)  in  the  strict  employment  of  Listerian  dressings  and  by 
sewing  the  lower  end  of  the  tunica  vaginalis  to  the  bottom 
of  the  scrotum  with  a  catgut  suture,  as  indeed  had  already 
been  done  by  Adams  (15).  In  the  present  case  this  course 
was  adopted  in  its  entirety,  and  the  result  completely  justified 
the  measures  taken.  Now  that  the  causes  of  failure  are 
thoroughly  understood  and  counteracted  with  perfect  success, 
it  is  not  too  much  to  say  that  all  imperfectly  palliative 
means,  such  as  the  employment  of  trusses,  etc.,  are  archaic, 
and  should  be  replaced  by  an  operation  conducted  under 
strict  antiseptic  precautions,  and  in  which  the  testis  is 
secured  in  its  new  position  by  some  non-irritative  suture. 
As  the  cases  are  scattered  far  and  wide,  I  append  for  the 
convenience  of  subsequent  workers,  in  tabular  form,  all 
the  hitherto  recorded  cases,  together  with  a  reference  to  their 
place  of  publication  : — 

Literature. 


1 

Surgeon. 

Cases. 

Where  published. 

1. 

Hunter  . 

2 

Quoted  by  Curling. 

2. 

Godard  . 

1 

“  Researches  sur 
1866,  PI.  iii. 

les  Monorcbides,  etc.,” 

3. 

Ricord  . 

... 

s.  Le  Dentu ;  also  Provincial  Med.  J  oumal,  1843, 
page  264. 

4. 

Vidal  de  Cassis 

*2 

“Traite  de  Pathologie  Externe,  tome  v., 
page  432,  deuxidme  edition. 

5. 

Curling  . 

8 

“  Diseases  of  the  Testis,  etc.,”  1878. 

6. 

Ledwich ...  ... 

1 

Dublin  Quar.  Jour,  of  Medical  Science,  Feb¬ 
ruary,  1855,  page  76. 

7. 

Zeis  . 

1 

Langenbeck’ s  Archiv  fur  Klin.  Ghirurgie , 
Bd.  ii.,  8.  87. 

8. 

Hutchinson  ... 

2 

Quoted  by  Curling. 

9. 

Partridge 

1 

British  Med.  Jour 

,  1Sd8,  page  519. 

Quoted  by  Kocher,  in 

10. 

Friedinger 

1 

1861. 

Billroth  and  Pitba’s 

11. 

Forster  . 

1 

Jahrb.f.  Kinder 
heilkunde,  18b3 

“  Handbuch  der  Allg. 
ii  Spec.  Chirurgie,”  Bd. 

12. 

Humphry 

1 

Holmes’s  System  of  Surgery,”  first  edition, 
vol.  v.,  page  78. 

13. 

Bryant  . 

1 

Oufs  Hospital  Reports ,  1868,  vol.  xiii. 

“  Anomalies  de  Testicule,”  Paris,  1869 ; 
quotes  one  by  Ricord. 

14. 

Le  Dentu 

2 

15. 

James  Adams 

1 

Lancet,  vol.  i.  1871,  page  710. 

16. 

Owen  . 

1 

Lancet,  vol.  i.  1877,  page  878. 

17. 

Wagstaffe 

1 

Lancet ,  vol.  ii.  1878,  page  42. 

18. 

Annandale  ... 

1 

British  Med.  Jour vol.  i.  1879,  page  7. 

19. 

Marshall . 

1 

Univ.  Coll.  Hospital  Reports,  1882. 

20. 

Baudry  . . 

1 

Progrhs  Medical ,  August  5,  18S2. 

*  la  two  brothers. 


^  /  y 


ORDv 

\  LIBRARY 


Ni 


:rv: 


Medical  Times  and  Gazette. 


THE  HOMES  OF  OUT-PATIENTS. 


Dec.  1,  1883. 


PERINEPHRITIC  ABSCESS —CAUSE  DOUBTFUL  — 

ANTISEPTIC  EXPLORATION— GREAT  RELIEF. 

(Under  the  care  of  Mr.  HEATH.) 

[Eor  the  notes  of  this  case  we  are  indebted  to  Mr.  V.  Horsley,  B.S., 
Surgical  Registrar.] 

Hannah  P.  was  admitted  into  University  College  Hospital 
under  Mr.  Heath  on  April  25,  1882. 

Family  History. — She  is  a  married  woman,  and  has  had 
seven  children,  three  of  whom  died  in  infancy;  the  others 
are  healthy.  Her  father  is  living,  aged  sixty-six,  and 
healthy.  Her  mother  died,  aged  sixty-four,  insane.  She 
has  lost  two  brothers — one  of  “  consumption  one  died 
(insane)  from  the  effects  of  throwing  himself  out  of  a 
window. 

Past  History. — Patient  has  always  had  good  health  until 
her  marriage.  Since  then  she  has  experienced  pains  of  a 
twisting  character  across  the  lower  part  of  the  back.  These 
have  generally  been  worse  at  the  menstrual  periods.  Since 
the  formation  of  the  abscess  the  nature  of  the  pains  has 
changed,  and  are  now  of  a  heavy,  aching  character.  They 
commenced  about  six  months  ago,  and  occupied  the  place 
of  the  present  swelling,  which  was  perceived  for  the  first 
time  about  fourteen  days  ago.  They  are  now  so  very  intense 
that  she  is  unable  to  keep  up.  Since  its  first  appearance 
the  swelling  has  rapidly  increased.  About  fifteen  months 
ago  she  noticed  her  urine  to  be  thick,  and  that  it  deposited 
a  yellowish-white  sediment.  This  continued  for  about  six 
months.  She  has  never  experienced  pain  either  before, 
during,  or  after  micturition.  Bowels  have  always  been 
rather  confined.  Her  menstrual  periods  have  been  regular. 
Her  pains  have  not  been  increased  by  movement. 

Present  State. — Patient  is  thin  and  very  yellow.  On  the 
back  of  the  right  lumbar  region  there  is  a  large  swelling, 
over  which  the  skin  is  hot,  red,  and  tender.  The  surface  is 
rendered  irregular  by  rounded  projections,  where  the  skin 
is  thinner  than  elsewhere.  This  swelling  extends  from  the 
last  rib,  to  well  below  the  iliac  crest,  and  from  the  spine  to 
the  mid-line  of  the  side.  There  is  distinct  fluctuation.  The 
liver  is  found  to  be  far  below  the  ribs,  reaching  almost  to 
the  umbilicus ;  its  edge  can  be  seen  moving  plainly  beneath 
the  thin  abdominal  wall ;  it  is  sharp  and  thin.  The  surface 
of  the  liver  is  smooth.  The  spleen  comes  one  inch  below  the 
ribs;  it  is  smooth,  and  not  tender.  In  the  situation  of  the 
lower  end  of  the  right  kidney,  and  almost  concealed  by  the 
liver-edge  in  inspiration,  but  uncovered  in  expiration,  a 
body  can  be  felt,  having  much  the  shape  of  the  lower  end  of 
the  kidney.  It  is  smooth,  very  firm,  taking  no  impression 
from  the  finger ;  very  slightly  tender,  and  fixed.  There  is 
no  tenderness  or  fulness  in  the  right  iliac  fossa.  The  abdo¬ 
men  is  normal  in  appearance,  and  there  is  no  tenderness 
about  it. 

April  26. — The  House-Surgeon  aspirated  the  abscess, 
removing  twenty  ounces  of  a  thick  purulent  fluid. 

28th.  — Patient  being  under  ether,  Mr.  Heath  made  an 
incision  over  the  abscess  in  the  colotomy  position.  A  large 
quantity  of  thick  purulent  fluid  escaped.  On  inserting  the 
finger  into  the  wound,  and  directing  it  upwards  and  back¬ 
wards,  he  felt  an  aperture,  about  the  size  of  his  finger-end, 
leading  towards  the  kidney.  On  making  pressure,  what 
appeared  to  be  calculi  in  the  kidney  were  felt  to  grate. 
The  incision  was  made  under  Listerian  precautions,  and 
antiseptic  dressings  were  subsequently  applied. 

29th. — Temperature  97-6°  Fahr.  Patient  felt  relieved. 
Dressings,  being  soaked  through,  were  changed. 

May  1. — Urine  was  found  to  contain  carbolic  acid,  also  a 
yellowish  sediment,  amounting  to  about  one-third.  Forty- 
four  ounces  were  passed  in  the  twenty-four  hours.  No 
albumen;  specific  gravity  1025.  Besides  pus-cells,  there 
were  a  few  epithelium  cells,  but  no  crystals. 

2nd. — The  redness  over  the  lumbar  region  was  almost  gone. 

9th. — Urine  less  charged  with  carbolic  acid  this  morning. 
On  passing  the  finger  into  the  wound,  the  opening  towards 
the  kidney  could  not  be  detected. 

June  1. — Wound  has  continued  to  discharge,  but  the 
amount  has  lessened,  and  it  has  remained  quite  sweet. 

3rd. — Listerian  dressings  were  discontinued. 

Remarks. — This  case  appeared  to  be  one  of  perinephritic 
abscess,  the  origin  of  which  still  remains  doubtful.  The 
signs  of  abscess  being  so  unequivocal,  it  was  obviously 
necessary  to  lay  the  sac  open  and  examine  the  source  of 
suppuration.  Calculi  were  thought  to  be  felt  in  the  kidney. 


and  it  is  possible  that  the  whole  abscess  may  have  com¬ 
menced  around  the  posterior  surface  of  the  inflamed  pelyis. 
The  improvement  in  the  condition  of  the  patient  was  so 
great  as  not  to  warrant  immediate  further  surgical  inter¬ 
ference. 


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epical  Curies  anir  defile* 


SATURDAY,  DECEMBER  1,  1883. 

- *■ - 

THE  HOMES  OF  OUT-PATIENTS. 

The  condition  of  the  dwellings  of  the  extreme  poor  of 
London  has  been  recently  receiving  a  great  deal  of  attention- 
in  the  most  varied  quarters  ;  and,  however  much  difference 
of  opinion  there  may  be,  politically  or  theologically,  between 
various  writers  on  this  subject,  there  is,  happily,  no  dif¬ 
ference  whatever  as  to  the  main  points — the  existence  of  the 
evil,  and  the  need  of  a  remedy.  It  seems  almost  ungracious, 
to  say  that  to  the  medical  profession  the  subject  is  by  no 
means  new.  Every  medical  man,  probably,  until  dis¬ 
heartened  by  the  difficulty  of  the  task,  has  tried  to  cleanse 
these  Augean  stables.  Every  medical  student  in  his  third 
year  has  had  practical  experience  of  the  painful  truth  of 
the  pictures  drawn  by  sensational  winters  on  the  subject. 
Medical  opinion  on  the  question  is  apt,  perhaps,  to  be  too 
one-sided  and  materialistic ;  and  as  abstainers  trace  every 
conceivable  ill  affecting  the  lowest  orders  to  the  results :  of' 
indulgence  in  alcohol,  so  most  medical  men  in  the  present 
age  of  physiology  and  sanitary  science  are  tempted  to  look 
to  faulty  hygienic  conditions  as  a  sufficient  cause  for  all  the- 
moral  and  physical  shortcomings  of  the  poor.  However 
that  may  be,  the  medical  view  of  the  subject  is  not  one  that 
can  be  safely  neglected.  Medical  men,  moreover,  have  a 
further  claim  to  speak  on  the  matter.  These  dwellings  are 
the  homes  of  our  out-patients,  and  thus  the  subject  becomes, 
one  of  very  practical  interest  to  us.  With  all  the  agitation, 
in  the  daily  press,  with  the  meetings  in  Southwark  and  in 
Exeter  Hall,  with  energetic  addresses  delivered  with  epis¬ 
copal  authority  or  nonconformist  zeal,  it  is  but  natural  that 
medical  men  should  rouse  themselves  hopefully.  The  time 
seems  reached  when  we  should  say  what  we  know  of  truths 
which  many  of  the  laity  would  prefer  to  consider  merely 


Medical  Times  and  Gazette. 


THE  USE  OF  THE  WORTHLESS. 


Dec.  1,  188?.  629 


■sensational  padding  for  the  dull  season ;  that  we  should 
point  out  the  directions  in  which  work  should  be  carried  on, 
.and  that  we  should  aid  this  work  by  giving  our  word  of 
warning  against  the  danger  of  trop  de  zcle.  Medical  men 
working  in  the  neighbourhoods  from  which  most  striking 
instances  have  been  drawn  must  feel  that  they  have  a  right 
do  be  heard.  They  have  performed  post-mortems  in  these 
homes  ;  they  have  had  long  talks  while  waiting  wearily  for 
the  birth  of  new  heirs  to  human  sorrows  ;  they  have  seen 
the  difficulties  attending  the  lying-in  room  which  serves  as 
sleeping  apartment  of  the  whole  family,  and  storehouse  for 
whatever  articles  the  bread-winner  deals  in ;  and  they 
must  have  been  perplexed  by  restless  questions  with  regard 
to  the  future  of  children  reared  in  such  surroundings. 
Even  an  active  philanthropist  like  Dr.  Barnardo  does  not 
hesitate  to  refer  to  a  “  miserable-looking  babe,  whose  days — 
happily,  as  it  seemed  to  me — were  numbered  ” ;  while  Colonel 
E.  C.  Fitzroy,  speaking  of  the  families  of  young  children 
depending  on  poor  parents,  asks,  “  Why  should  these  exist  ?” 
Fortunately  for  us,  our  duty  is  clear,  for  it  has  never  yet 
been  questioned  that  it  is  the  duty  of  medical  science  to  do 
its  best  to  save  life  even  when  disease  may  render  it  a  weary 
burden.  We  must  ever  look  rather  to  improving  the  con¬ 
ditions  around  him  than  to  improving  the  individual  off  the 
face  of  the  earth. 

We  spoke  last  week  of  the  difficulty  of  obtaining  accurate 
data  from  the  out-patient  room  on  account  of  the  unreliable 
character  of  the  statements  we  receive.  Numberless  other 
•causes  add  to  the  lack  of  satisfaction  attending  out-patient 
practice,  and  tend  to  counteract  possible  benefits  derivable 
from  advice  there  given.  Not  the  least  of  these  is  the  ques¬ 
tion  before  us— the  condition  of  the  homes  of  our  patients. 
We  have  to  deal  not  only  with  disease,  but  also  with  poverty 
and  its  results.  Many  require  nourishment.  In  a  children’s 
hospital  this  may  be  given  in  the  guise  of  cod-liver  oil,  but 
with  adults  we  are  often  reduced  to  ordering  tonics  for  patients 
who  have  no  means  of  meeting  the  appetites  raised  by  them . 
Let  us  remember,  however,  that  among  the  necessaries  of 
life  food  is  but  one  item.  To  aid  recovery  from  any 
severe  illness  a  due  attention  to  sanitary  laws  is  essential. 
It  is  a  truism  now  to  urge  that  sanitary  laws  cannot  be 
broken  with  impunity  ;  that  though  the  results  of  their  vio¬ 
lation  may  not  be  immediately  seen,  they  tell  none  the  less 
on  the  later  life  of  the  individual.  These  facts,  however, 
are  unfortunately  not  yet  grasped  by  the  poor  themselves  ;  the 
word  “  sanitary  ”  is  not  in  their  vocabulary,  and,  until  this 
is  remedied,  little  can  be  done.  We  may  take  it  for  granted 
that  overcrowding  is  at  the  root  of  the  whole  matter.  This 
is  the  truth  dwelt  upon  by  the  Marquis  of  Salisbury,  and 
■supported  by  the  evidence  of  the  great  increase  of  rents — an 
increase  bringing  the  rent,  in  many  cases,  to  a  third  or  half 
the  total  income.  The  question  to  be  solved  is,  How  is 
this  overcrowding  to  be  dealt  with  ?  It  is  not  for  us  to 
decide  where  the  Leader  of  the  Opposition  and  the  President 
of  the  Board  of  Trade  are  yet  uncertain,  and  Sir  Charles 
Dilke  investigates  and  holds  his  peace.  This,  however,  we 
may  say  with  confidence :  that  the  greatest  care  must  be 
exercised  not  to  increase  the  evil  in  efforts  at  improvement. 
Dr.  Bridges,  of  the  Local  Government  Board,  has  done 
good  service  in  drawing  attention  to  the  danger  likely  to 
arise  from  the  unskilled  erection  of  workmen’s  buildings. 
Air  and  light  are  requirements  for  health,  and,  from  the  par¬ 
ticulars  given  in  his  letter  to  the  Pall-mall  Gazette,  it  is 
obvious  that  these  are  too  often  overlooked,  the  houses 
being  commonly  built  too  high  and  too  close  together. 
Workmen’s  buildings,  however,  must  fail  to  reach  the  lowest 
•orders.  A  fair  amount  of  decency  of  life  is  required  in 
them,  and  the  restrictions  enforced  necessarily  exclude 
the  very  poorest  and  the  criminal  classes  who  at  present  t 


inhabit  "  Horrible  London  ”  with  the  working  men.  Their 
condition  is  not  altogether  hopeless.  It  would  be  improved 
by  more  breathing  room  being  left  by  the  removal  of  the 
bees  to  suitable  hives ;  and  perhaps  it  is  not  too  Utopian  to 
imagine  that,  on  Darwinian  principles,  the  drones  might 
change  their  nature,  and  in  future  ages  qualify  for  admission 
to  sanitary  dwellings. 


THE  USE  OF  THE  WORTHLESS. 

The  controversy  which  has  arisen  out  of  a  recently  pub¬ 
lished  research  has  brought  to  light  some  strange  and 
unlooked-for  opinions,  the  exponents  of  which  appear  to  be 
innocently  indifferent  to  conditions  of  time  and  space. 
Longitude  and  chronology  are  to  these  writers  evidently 
matters  of  no  moment,  for,  to  judge  from  their  utterances, 
one  would  think  that  they  had  succeeded  in  putting  back 
the  dial  a  couple  of  centuries,  or  with  a  twirl  of  their  pen 
had  spirited  us  all  away  to  the  meridian  of  Berlin.  The 
freedom  of  the  Press  and  the  equality  of  man  are  clearly,  in 
their  view,  mere  catchwords  of  emotional  politicians,  and  not 
rights  which  have  won  recognition  through  struggle  and 
suffering.  This  country  in  the  sixteenth  century,  and 
Russia  in  the  nineteenth,  are  indubitably  better  suited  to 
their  tone  of  mind  than  Victorian  England.  For  such  writers 
the  Reformation  and  the  French  Revolution  have  happened 
in  vain ;  the  Areopagitiea  is  a  mere  tour  de  force  ;  John 
Wilkes  was  a  fool  to  go  to  prison  ;  and  every  Radical  from 
Luther  to  Stuart  Mill  has  spoken  and  written  mere  words. 
It  is  strange,  it  is  almost  laughable,  to  see  a  medical 
journal,  of  all  journals  iu  the  world,  refurbishing  the  old 
weapons  of  threat  and  abuse,  because  another  journal 
happens,  in  the  course  of  its  duty,  to  utter  honest  criticism 
which  displeases  it.  This  is  a  small  matter,  and  may  be 
briefly  dismissed  with  an  apology  for  having  thought  it 
worth  mentioning.  But  the  other  utterance  to  which 
we  take  exception  introduces  a  question  of  much  more 
vital  importance.  We  allude  to  Dr.  De  Watteville’s  letter 
on  “  The  Uses  of  Hospital  Patients,”  which  appeared  in 
the  Standard  of  Saturday  last.  This  letter  is,  in  effect,  a 
mere  continuation  of  the  correspondence  “  in  corpore  vili  ” 
recently  published  in  that  journal.  It  is  an  honest  and 
courageous,  if  mistaken,  expression  of  opinion,  and,  as 
such,  demands  respectful  criticism.  But  the  assumption 
made  in  the  letter  is  one  which  cannot  be  allowed  to  pass 
unchallenged.  It  may  be  noted  in  passing  that  Dr.  De 
Watteville  contradicts  himself ;  for  if  it  be  right  and 
customary,  as  he  contends,  to  experiment  on  hospital 
patients,  then  the  accusation  made  against  a  certain  prac¬ 
titioner  in  a  previous  letter,  sighed  “  M.D.,”  cannot  con¬ 
sistently  be  held  by  Dr.  De  Watteville  to  be  a  serious 
charge.”  That,  however,  is  a  minor  point.  The  real 
fault  we  find  with  the  letter  is,  that  Dr.  De  Watteville 
claims  in  it  the  right  to  use  hospital  patients  for  other 
pui'poses  than  those  tending  to  their  own  direct  benefit, 
without  their  free  and  full  consent,  and  merely  at  the  dis¬ 
cretion  of  the  doctors.  Such  a  claim  is  an  anachronism. 
Indeed,  the  progress  of  modern  thought  has  robbed  the 
dictum  “Fiat  experimentum  in  corpore  vili”  of  all  meaning. 
Except  in  the  case  of  those  who  have  forfeited  their 
rights  by  crime,  no  enlightened  thinker  can  justifiably 
maintain  that  one  body  is  more  worthless  than  another ; 
and  it  is  strange  to  find  medical  men  familiar  with 
the  republicanism  of  the  post-mortem  table  upholding 
such  a  distinction.  If  it  is  still  allowable  to  make  experi¬ 
ments  on  the  poor  without  their  full  consent,  which  it 
would  not  be  thought  equally  justifiable  to  make  on  the 
rich,  then  all  the  political  struggles  of  the  past  century 
1  have  been  made  in  vain,  so  far  as  regards  any  lesson  which 


630 


Medical  Times  and  Oazetle. 


CHRONICLE  OE  THE  WEEK. 


Dec.  1,  1883- 


those  who  make  such  a  claim  have  derived  from  them. 
Their  claim,  in  fact,  is  one  which  smacks  of  the  dark  ages. 

So  much  for  the  principle  of  the  matter.  Let  us  now 
turn  to  the  practice.  A  poor  patient  goes  into  hospital,  and 
he  admits  by  the  act  that  he  consents  to  become  a  subject 
of  observation  to  a  much  larger  number  of  medical  men 
than  if  he  had  been  treated  at  home.  But  he  does  not 
admit,  nor  is  it  generally  claimed  by  the  medical  profession, 
that  his  treatment  may,  if  his  doctor  wills  it,  be  different  or 
more  experimental  than  would  have  been  the  case  if  he  had 
been  a  rich  man  in  his  own  bed.  All  treatment,  whether  of 
the  rich  or  of  the  poor,  is,  logically  speaking,  an  experi¬ 
ment,  for  it  is  an  interference  with  the  conditions  which 
would  otherwise  obtain.  But  the  whole  course  of  the  late 
controversy  proves  what  we  have  contended  from  the  first — 
that  it  is  not  thought  right  even  by  the  medical  conscience 
to  make  any  experiment  on  any  man  without  his  consent, 
which  shall  not  be  or  promise  to  be  for  his  individual  benefit. 
Even  the  right  of  observation  on  hospital  patients  has  its 
limits,  and  the  conscience  of  medical  men  in  England 
unhesitatingly  condemns  any  examination  of  patients  in  a 
critical  or  moribund  condition  which  is  not  meant  for  their 
immediate  benefit;  and  it  would,  we  are  sure,  be  revolted 
by  a  scientific  procedure  which  we  have  seen  practised 
on  the  Continent,  and  which  is  merely  the  logical  out¬ 
come  of  such  a  claim  as  Dr.  De  Watteville’s— viz.,  the  ex¬ 
cision  of  a  piece  of  diseased  skin  from  a  living  patient  for 
the  purposes  of  histological  research.  Too  much  stress 
cannot  be  laid  on  the  fact  that  the  main  use  of  hospital 
patients  is  one  of  observation,  and  not  of  experiment.  The 
close  and  multiplied  scrutiny  to  which  they  are  subjected, 
the  registration  of  their  symptoms,  and  the  careful  record 
kept  of  the  effects  of  their  treatment,  while  working  for  the 
immediate  benefit  of  the  individual  patient,  are  indispens¬ 
able  as  a  means  of  educating  the  future  practitioner.  But 
while  fully  admitting  the  benefits  to  be  derived  from  such 
extended  observation,  we  cannot  for  a  moment  admit  that 
the  responsibility  of  the  hospital  physician  or  surgeon 
towards  his  poorer  patients  is  any  less  sacred  than  that 
towards  his  paying  patients. 

We  had  already  answered  Dr.  De  Watteville’s  argument 
by  anticipation  in  our  leading  article  of  the  17th  ult.,  but  it 
appears  necessary  to  repeat  the  contention  that  we  then 
laid  down — viz.,  “that  it  is  not  right  for  one  man,  from  any 
motive  whatever,  to  cause  another  to  suffer  without  his 
consent  for  the  good  of  the  greatest  number.”  Dr.  De 
Watteville  claims  that  it  is  a  plain  law  of  nature  that  the 
few  should  suffer  for  the  many,  but  happily  it  is  one  which 
is  overridden  by  a  higher  and  later  gift  of  nature — that 
sympathy  with  one’s  fellows  which  softens  the  crude  struggle 
of  life,  and  aims,  as  far  as  it  can,  at  abolishing  vicarious 
suffering.  Moreover,  according  to  Dr.  De  Watteville’s 
reading  of  the  law,  it  is  the  many —hoipolloi — who  are  to 
be  made  to  suffer  for  the  few.  Such  a  claim,  we  are  sure, 
is  entirely  out  of  harmony  with  modern  thought,  whether 
medical  or  lay,  and  few  will  be  found  to  support  it  in  theory. 
That  it  is  widely  asserted  in  practice,  we  do  not  for  a 
moment  believe.  We  are  convinced  that  an  overwhelming 
majority  of  hospital  physicians  and  surgeons  feel  their 
responsibilities  to  their  poor  patients  quite  as  acutely  as 
they  feel  them  in  the  case  of  their  rich  patients.  That 
some  are  occasionally  led  into  an  opposite  line  of  conduct 
by  the  love  of  science  and  of  fame  is  quite  possible, 
but  the  fact  has  only  to  be  admitted  in  order  to  be 
condemned  and,  if  possible,  prevented.  The  question 
is — How  is  it  to  be  prevented  ?  and  here  we  must  re¬ 
peat  that  the  only  guarantee  against  it  consists  in  the 
right  feeling  and  moral  sense  of  the  practitioner.  The 
public  has  hitherto  implicitly  trusted  that  moral  sense,  and. 


hard  as  are  the  words  that  are  sometimes  used  against 
doctors,  it  has  never  yet  been  said  of  them— as  it  has  often 
been  said  of  lawyers,  for  instance — that  they  use  their  clients 
for  their  own  advantage.  It  is,  above  all  things,  important 
that  this  confidence  of  the  public  should  be  maintained,  and 
the  best  and  only  way  to  maintain  it  is  by  showing  that 
the  moral  conscience  of  the  profession  in  the  matter  is- 
even  more  strict,  if  possible,  than  that  of  the  public.  If  one 
wished  to  destroy  that  confidence,  one  could  hardly  find  a. 
better  way  than  to  admit  such  a  claim  as  Dr.  De  Watteville’s,, 
or  to  submit  to  such  a  bridling  of  free  and  watchful  criticism 
as  certain  medical  organs  are  anxious  to  impose.  Both  are 
revivals  of  dark  and  dead  modes  of  thought,  which  cannot 
live  in  the  fresh  air  of  modern  English  life. 


CHRONICLE  OF  THE  WEEK. 

- ♦ - 

At  the  meeting  of  the  Clinical  Society  on  November  23,  arr 
interesting  debate  took  place  upon  the  subject  of  Myxcedema,, 
in  which  Sir  W.  Gull,  Dr.  Ord,  and  other  observers  whose 
names  have  been  associated  with  our  knowledge  of  the- 
disease,  took  part.  A  valuable  communication  was  made  by 
Dr.  Felix  Semon  of  a  series  of  cases  of  myxcedema  occurring 
after  extirpation  of  the  thyroid  gland,  by  Prof.  Kocher,  of 
Berlin,  who,  not  being  acquainted  with  the  disease  as  such, 
had  described  his  cases  as  a  peculiar  form  of  cachexia  ;  in 
sixteen  instances  of  complete  removal  the  myxoedematous 
changes  had  been  observed,  whilst  in  the  cases  of  partial 
removal  the  results  upon  the  general  health  had  been  satis-  - 
factory.  The  previous  belief  in  the  intimate  connexion 
existing  between  the  loss  of  the  thyroid  gland  and  the- 
development  of  myxcedema  was  undoubtedly  strengthened 
by  the  evidence  which  the  discussion  called  forth,  but  it  was- 
no  less  evident  that  there  are  at  present  no  facts  extant  by 
which  the  nature  of  that  connexion  can  be  determined- 
A  paper  by  Dr.  Thin  on  some  cases  of  thickened  epidermis, 
treated  by  salicylic  plaster  was  also  contributed ;  and  an 
unusually  interesting  series  of  living  specimens  were  shown  : 
a  case  of  myxcedema,  by  Dr.  Drewitt ;  hypertrophy  of  right 
leg,  by  Mr.  Barwell ;  arrest  of  development  of  right  side„ 
with  right  facial  paralysis,  by  Mr.  Barker ;  arteritis  pro¬ 
gressively  affecting  the  vessels  of  the  right  arm,  by  Mr.. 
Gould;  and  thrombosis  of  vena  cava,  by  Mr.  Mansell-Moullin- 


The  successful  treatment  of  certain  cases  of  myxcedema 
by  means  of  diaphoresis,  and  especially  when  induced  by 
jaborandi  and  pilocarpin,  is  noteworthy.  The  experience  of 
different  physicians  with  respect  to  the  effects  produced  by 
the  drug  would  appear  to  be  by  no  means  alike.  The  con¬ 
stant  headache  of  one  patient  contrasts  strangely  with  the- 
freedom  from  discomfort  of  another,  whilst  in  a  third  the- 
action  of  the  pilocarpin  was  found  to  manifest  itself  solely 
upon  the  urinary  excretion.  That  such  uncertainty  should' 
exist  with  respect  to  the  action  of  an  accepted  thera¬ 
peutic  agent,  such  as  pilocarpin  undoubtedly  is,  seems- 
in  the  highest  degree  unsatisfactory.  It  is  greatly  to  be 
desired  that  the  efforts  of  experimental  therapeutists  should' 
be  directed  towards  the  determination  of  the  exact  action 
of  those  drugs  which  we  already  possess.  Precise  knowledge 
of  one  or  two  powerful  agents  for  the  production  of  diapho¬ 
resis  would  be  of  far  greater  scientific  interest  and  practical 
value  than  that  “  little  knowledge  ”  of  a  host  of  drugs 
which  occasionally,  in  unwary  minds,  may  prove  itself  indeed 
a  “  dangerous  thing.” 

Drs.  Ringer  and  Sainsbury  contributed,  on  Tuesday  last, 
to  the  Royal  Medical  and  Chirurgical  Society,  some  interest¬ 
ing  observations  obtained  experimentally  on  tortoises,  on  the 


Medical  Times  and  Gazette. 


CHRONICLE  OF  THE  WEEK. 


Dec.  1,1893.  631 


action  of  digitaline  and  allied  substances  on  the  heart-muscle 
as  well  as  on  the  arterioles.  The  spasm  of  the  heart  has 
long  been  recognised,  but  the  condition  of  the  arterioles 
under  the  influence  of  digitalis  is  not  so  well  recognised. 
The  results  of  the  researches,  while  they  confirm  what  was 
previously  known  concerning  the  heart,  go  to  prove  that  a 
similar  and  direct  action  on  the  bloodvessels  is  produced.  The 
President  congratulated  the  author  on  the  results,  not  less 
than  on  the  mode  in  which  the  experiments  had  been  carried 
on.  Dr.  Brunton  thought  that  the  “  digitalis  group ”  was 
far  too  large  already,  and  that  only  such  drugs  should  be 
grouped  as  tended  to  produce  the  same  sum-total  effects. 
He  did  not  attach  much  value  to  the  action  of  these  sub¬ 
stances  on  the  voluntary  muscles,  because  these  effects 
varied  greatly  not  only  in  different  species,  but  also  among 
different  individuals.  Dr.  John  Harley  considered  the 
results  as  dependent  on  the  dying  condition  of  the  animal 
after  section  of  its  spinal  column.  The  discussion  is  elsewhere 
fully  reported. 


The  Committee  of  the  Westminster  Hospital  have  pub¬ 
lished,  not  a  day  too  soon,  an  ably  reasoned  and  carefully 
drafted  report  on  the  much  discussed  paper  on  sodium 
nitrite,  which  will  be  read  with  satisfaction  by  all  who  have 
taken  our  view  of  the  subject.  It  corroborates  our  con¬ 
tentions  in  every  particular,  and,  while  fully  accepting  Dr. 
Murrell’s  corrections,  is  hardly  less  severe  on  the  original 
paper  than  we  were  ourselves.  It  will  be  said,  of  course, 
that  the  report  is  the  work  of  the  lay  element  of  the  Com¬ 
mittee — the  product  of  prejudice  and  obscurantism.  The 
backs  of  the  lay  members  of  the  Committee  are  no  doubt 
broad  enough  to  bear  such  a  charge  ;  but  it  may  be  said  in 
anticipatory  reply  to  the  objectors —whose  claim  on  behalf 
of  the  profession  of  immunity  from  lay  criticism  is  as 
arrogant  as  any  similar  claim  ever  put  forward  by  an  un¬ 
reasoning  priesthood — that  it  is  lay  opinion  that  we  have  to 
reckon  with.  The  profession  cannot  go  a  step  further  in 
scientific  experiment  than  the  tether  of  the  public  con¬ 
science  will  permit.  That  tether  may  be  lengthened  by 
reasonable  argument,  but  all  attempts  to  break  it  or  to  slip 
out  of  it  will  only  make  it  tighter  and  shorter. 


It  has  been  said  by  some  within  the  profession  that  the 
fault  is  not  in  doing  experiments  which  the  public  will 
object  to,  but  in  publishing  them.  That  is  not  a  position 
with  which  any  self-respecting  practitioner  can  sympathise, 
nor  one  which  the  medical  press  can  advantageously  take  up . 
Is  there  any  profession  which  can  be  safely  withdrawn  from 
public  criticism  ?  Do  we  doctors  sympathise,  say,  with  clergy¬ 
men  who  object  to  their  doings  in  the  confessional  being 
made  the  subject  of  newspaper  articles  ?  It  is  desirable,  of 
course,  as  Sir  W.  Jenner  appears  to  have  maintained  at  the 
College  of  Physicians,  that  comments  which  are  calculated 
to  damage  the  profession  should  not  appear  in  the  public 
press.  But  the  best  way  to  command  such  immunity  from 
criticism  is  to  deserve  it.  We  have  full  confidence  that 
the  Censors’  Board  of  the  College  of  Physicians  -will  as 
thoroughly  confirm  the  line  we  have  taken  on  this  subject 
as  the  Committee  of  the  Westminster  Hospital  have  done. 


We  are  told  that  the  recruiting  for  the  Army  causes 
present  uneasiness,  and  we  can  well  believe  it ;  for,  looking 
back  on  the  past,  we  hardly  remember  the  time  when  re¬ 
cruiting  was  not  a  cause  of  uneasiness.  In  the  good  old 
days  the  temptations  offered  to  “  spirited  young  men  ” 
failed  sometimes  to  fill  the  ranks,  though  the  barrack-room 
was  then  a  home,  and  a  pension  was  certain  at  the  expiration 
of  twenty-one  years’  service.  But  vThen  the  authorities  fell 


back  on  “  short  service,”  to  accommodate  the  growing  intelli¬ 
gence  of  the  age,  it  was  confidently  expected  that  thousands 
would  volunteer  to  serve  Her  Majesty.  So  strong  was  this 
conviction  on  the  part  of  the  authorities,  that  recruits  were 
allowed  to  join  their  regiments  as  free  and  independent 
Britons,  instead  of  being  marched  to  the  barrack-yard  in  the 
custody  of  a  veteran  recruiting-sergeant.  And  now  this  hope 
is  falsified,  and  “  recruiting  is  once  more  a  source  of  uneasi¬ 
ness.”  Judging  from  our  own  experience,  we  should  say 
that  lt  hard  times  ”  are  the  only  seasons  when  soldiering  is 
in  vogue.  An  Irish  famine,  great  commercial  distress,  and 
strikes  in  the  manufacturing  districts,  can  alone  be  relied 
upon  to  tempt  young  men  to  serve  Her  Majesty  in  the  wars. 
It  is  a  curious  fact  that  the  thirst  for  glory  inflames  the 
,  brain  when  hunger  pinches  the  belly.  But  the  authorities 
do  not  look  upon  matters  in  this  light.  We  are  told  “  it  is 
thought  at  headquarters  that  many  who  are  willing  to  join 
the  Army  do  not  know  the  way  to  go  about  it,”  and,  in 
consequence,  it  is  contemplated  to  turn  all  the  post-offices 
in  England  into  recruiting  offices,  and  “bringers”  are  to  be 
selected  by  the  postmasters,  who  wall  be  instructed  to  way¬ 
lay  likely  young  men,  and  tell  them  how  to  go  about  it! 
As  the  “  bringers  ”  will  get  5s.  on  the  approval  of  each 
recruit,  they  will  probably  be  as  eloquent  and  insinuating  as 
the  recruiting-sergeant  of  yore.  We  trust  they  may  be. 


Eeceititing  is  no  particular  business  of  ours,  and  we  should 
not  have  touched  upon  it  at  all  but  for  two  letters  recently 
published  in  the  Standard,  which  are  somewhat  hard  upon 
army  doctors.  We  learn  in  the  first  that  these  gentlemen 
reject  fine  young  recruits  because  they  have  bad  teeth,  and 
in  the  second  we  are  informed  that  strong  young  men  are 
sent  away  from  the  barracks  because  they  cannot  see  dis¬ 
tinctly.  We  cannot  help  suspecting  that  these  letters  are 
concealed  warnings  to  too  officious  army  medical  officers. 
The  public  will  naturally  ask — “  What  have  a  man’s  teeth 
to  do  with  his  fighting  P  British  soldiers  are  not  cannibals  ! 
And,  after  all,  what  difference  can  it  make  whether  a  man 
can  hit  the  target  at  a  thousand  yards  or  not  ?  Give  them 
the  cold  steel !  ”  If  the  doctors  should  insist  upon  teeth  being 
necessary  to  eat  with,  and  point  out  that  men  cannot  fight 
on  empty  stomachs,  the  public  will  doubtless  draw  attention 
to  the  modern  improvements  in  cookery.  With  regard  to 
short  sight,  too,  the  public  will  ask  with  a  sneer  if  army 
doctors  never  heard  of  spectacles,  and  if  they  are  so  ignorant 
as  not  to  know  how  to  adjust  them? 


We  might  be  inclined  to  give  up  the  case  for  the  doctors 
if  it  were  only  a  question  of  such  simple  matters  as  eyes  and 
teeth,  but  there  is  something  else  to  be  considered.  We  see 
by  the  Blue-book  for  1881  that  there  were  not  two,  but  forty, 
classes  of  causes  of  rejection!  Ho  doubt  those  whose  only 
object  it  is  to  fill  the  ranks  will  treat  with  scorn  the  med¬ 
dling  interference  of  the  army  doctors  in  any  of  the  forty 
classes  of  supposed  disqualification.  Take  phthisis  :  there 
is  much  to  be  said  for  abolishing  this.  Surely  a  foreign 
climate  is  the  best  remedy  for  consumptive  patients  ?  Then 
we  have  “  weakness  of  intellect.”  This  is  absurd,  as  the 
very  desire  to  become  a  soldier  proves  the  soundness  of  the 
brain  !  Next,  we  observe  varix  given  as  a  disqualification. 
Surely  a  man’s  legs  may  be  expected  to  last  out  short-service  ! 
We  might  go  through  the  whole  list,  and  find  some  plausible 
reason  for  upsetting  each  cause  of  rejection.  The  writer  of 
one  of  the  letters  alluded  to  suggests  that  the  standard  of 
visual  acuteness  should  be  lowered  for  recruits,  and  that 
when  the  defect  of  sight  is  due  to  a  simple  error  of  refrac¬ 
tion,  and  not  to  disease,  the  standard  should  be  reduced  to  a 
minimum.  We  object  to  this  piecemeal  work.  Have  “a 


632 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Dec.  1,  1883. 


committee  ”  if  you  like,  and  let  the  authorities  consider  the 
question  whether  causes  which  disqualified  in  long-service 
are  equally  objectionable  now.  Make  what  alterations  you 
please,  but  don’t  throw  the  blame  on  the  army  doctors  for 
carrying  out  rigidly  the  regulations  which  now  exist  or 
which  may  be  permitted  to  survive.  We  observe  that  20,522 
cripples  were  rejected  by  the  doctors  in  1SS1.  Would  the  W ar 
Office  or  the  public  feel  less  uneasiness  if  the  cripples  were 
in  the  ranks  ?  If  so,  by  all  means  abolish  the  medical  exa¬ 
mination  of  recruits,  and  let  us  trust  to  the  judgment  of 
the  "  bringers  ”  employed  by  the  postmasters  of  the  United 
Kingdom.  _ 

Dk.  De  Watteville,  to  whose  letter  on  "  The  Uses  of 
Hospital  Patients  ”  we  have  referred  at  length  in  another 
column,  has  found  adherents  to  his  views  in  an  unexpected 
quarter.  An  offer  has  been  made  to  the  Manchester  In¬ 
firmary  by  certain  temperance  advocates  to  contribute  =£1000 
to  the  funds  of  the  institution  “  for  experiments  as  to  the  use 
of  alcohol.”  They  propose  that  a  series  of  patients  should 
be  treated  religiously  without  alcohol,  and  the  results  of 
their  treatment  compared  with  those  obtained  under  the 
use  of  the  drug.  This  proposal  has  wisely  been  declined  by 
the  Committee,  for  the  following  reasons  : — “  First,  the  con¬ 
ditions  necessary  for  arriving  at  a  trustworthy  conclusion  as 
to  the  value  of  alcohol  by  the  proposed  scheme  cannot  pos¬ 
sibly  be  realised,  and  therefore  any  conclusion  arrived  at, 
whether  in  favour  of  or  against  alcohol,  must  lead  to  a 
disastrous  practice,  either  by  an  undue  extension  or  curtail¬ 
ment  of  the  use  of  any  drug.  Secondly,  alcohol  in  its 
various  forms  is  given  in  this  hospital  as  medicine,  and  not 
as  an  article  of  diet.  As  a  medicine  it  is  of  great  value  in 
the  treatment  of  disease,  and  at  times  essential  for  the 
saving  of  life.  This  being  so,  they  can  only  consider  the 
course  suggested  in  the  letter  submitted  to  them  as  an  ex¬ 
periment  winch  involves  the  lives  of  their  fellow-creatures, 
and  cannot,  therefore,  he  countenanced.”  That  is  as  severe 
a  counter-check  quarrelsome  to,  the  would-be  scientific  in¬ 
vestigators,  and  as  timely  a  corroboration  of  the  line  we 
have  recently  taken,  as  need  be  wished  for. 


The  incident  serves  to  draw  attention  to  a  certain  in¬ 
definiteness  which  attaches  to  the  meaning  of  the  word 
“  experiment.”  To  a  logician  it  would  not  be  an  “  experi¬ 
ment  ”  to  leave  a  patient  to  the  course  of  nature,  and,  in  the 
words  of  a  popular  manual,  “  to  sit  by  the  dying  man  and 
observe  the  curious  physiological  phenomena  presented  ”; 
but  to  the  medical  practitioner  such  an  action  would  be  an 
experiment  very  distinctly,  if  he  saw  the  remotest  chance 
of  averting  the  fatal  issue  by  any  therapeutic  expedient. 
As  the  man  who  first -dropped  a  grain  of  wheat  into  the 
ground  was  the  boldest  of  speculators,  so  the  physician  who 
in  times  still  recent  first  left  a  pneumonia  patient  “'un¬ 
blooded  ”  was  the  boldest  of  experimenters.  Against  this 
class  of  experiment,  however,  no  one  can  have  a  word  to 
say — provided  only  it  be  conducted  with  caution.  The  error 
of  the  total-abstinence  enthusiasts  who  have  offered  to 
subsidise  the  Manchester  Infirmary  is  that  they  will  not  be 
satisfied  with  anything  short  of  a  wholesale  experiment. 
They  will  say,  of  course,  that  they  are  so  certain  of  the 
results  that  there  is  nothing  experimental  in  their  proposal. 
We,  with  weaker  faith,  are  less  certain  about  it. 


The  following  are  the  most  important  of  the  contribu¬ 
tions  to  the  leading  French  medical  papers  for  the  current 
week,  viz. : — In  the  Archives  de  Neurologie,  on  Bony  and 
Articular  Lesions  of  the  Foot  in  Tabes  Dorsalis,  by  MM. 
Charcot  and  Fere ;  on  the  Development  of  Speech  in  Chil¬ 
dren,  by  M.  Sikasky ;  and  on  Bilateral  Hallucinations  of 


Different  Character,  according  to  the  Side  affected,  by 
M.  Magnan.  In  the  Pr ogres  Medical,  M.  Troisier  writes 
on  Subcutaneous  Rheumatic  Nodules ;  M.  J.  Simon  has  a 
lecture  on  the  use  of  Mineral  Waters  in  Diseases  of  the 
Nervous  System;  M.  Dubois  writes  on  the  Influence  of 
Alcohol  on  the  Physiological  Action  of  Chloroform  ;  a 
brief  summary  is  also  given  of  the  opening  addresses  of 
MM.  Hardy,  Jaccoud,  Laboulbene,  and  Magnan.  The 
Gazette  Hebdomadaire  contains  an  important  article  based 
on  M.  Fauvel’s  address  on  the  Prophylaxis  of  Cholera.  In 
the  Gazette  Medicate  de  Paris,  M.  Raymond  gives  a  case  of 
Aphasia  where  the  third  left  frontal  convolution  was  healthy, 
but  the  subjacent  white  matter  was  affected.  The  Gazette 
des  Hopitaux  contains  a  case  of  Chronic  Icterus  which  had 
lasted  nineteen  months. 


The  Centralblatt  fur  Klinische  Medicin  contains  an  ori¬ 
ginal  paper  by  Dr.  Menche  on  Kairin  and  its  use  in  Acute 
Rheumatism  :  abstracts  of  papers— by  Cornil  and  Babes,  on 
Contagious  Peripneumonia ;  by  Feletti,  on  the  Causes  of 
the  Percussion-Note  in  the  Thorax ;  by  Bettelheim,  on  the 
production  of  the  Second  Sound  in  the  Carotid;  by  Schech, 
on  the  Etiology  of  Laryngeal  Paralyses.  In  the  Centralblatt 
fur  die  Medicinischen  Wissenschaften,  a  short  paper  by  Dr. 
Andeer  on  Resorcin-Blue  is  followed  by  abstracts  of  several 
papers  of  interest— Dr.  Strasser,  on  the  Functional  Adapta¬ 
tion  of  Voluntary  Muscles  ;  G.  von  Liebig,  on  the  Production 
of  Pulse-Waves ;  Pott,  on  the  Respiration  of  Chicken-Embryos; 
Lemonnier,  on  Psoriasis  Linguae ;  Lewin,  on  the  Function 
of  the  Hypoglossal  Nerve ;  Sahli,  on  Spinal  Localisation. 
In  the  Centralblatt  f  ur  Chirurgie,  Dr.  Landerer  discusses  the 
Treatment  of  Strumous  Disease  with  Arsenic.  Abstracts  of 
papers — by  Bienstock,  on  Bacteria  in  Faeces ;  by  Brigidi  and 
Bianchi,  on  Rabies  ;  by  Bergmann  and  Vigessi,  respectively, 
on  Transfusion  ;  and  by  Wolff,  on  Trophic  Disturbance  in 
Primary  Joint  Affections — are  of  interest.  The  Centralblatt 
fiir  Gynalcologie  contains  an  original  paper  by  Dr.  Zeiss  on 
Pyo-  and  Haemato-Salpinx.  Abstracts  of  papers — by  Ziehl 
(of  Heidelberg),  on  Abdominal  Fistula  after  Tubercular 
Peritonitis;  by  Nunez  (Paris),  on  Malformations  of  the 
Female  Urethra  ;  by  Rovillain  (Amiens),  on  Malformations 
of  Anus  and  Rectum,  and  their  Treatment ;  by  Bar  (Paris), 
on  the  Production  of  Hydramnion — may  also  be  noted.  In 
the  Berliner  Klinische  Wochenschrift  appear  papers  on  the 
Arrest  of  Arterial  Haemorrhage  by  Antiseptic  Tampons,  by 
Prof.  E.  Kiister;  on  the  Staining  of  Tubercle-Bacilli  in 
Sputa,  by  Dr.  Petri  ;  and  Dr.  Semon’s  paper  on  Laryngeal 
Paralysis  is  continued.  The  Wiener  Medicinische  Wochen¬ 
schrift  publishes  a  critical  article  on  a  paper  by  Prof. 
Jacobson,  of  Konigsberg,  on  the  subject  of  Glaucoma. 
Dr.  Herz’s  paper  on  Modern  Medication  of  Diphtheria  is 
continued,  and  a  case  of  Suture  of  the  Ulnar  Nerve  is 
contributed  by  Dr.  Zesas. 


SIR  WILLIAM  MAC  CORMAC  IN  NEW  YORK. 

The  weekly  medical  publications  of  New  York  and  Phila¬ 
delphia,  of  November  3,  print  at  length  an  address  delivered 
at  the  Bellevue  Hospital  Medical  College,  on  October  3,  by 
Sir  William  Mac  Cormac.  The  address  was  in  response  to  a 
special  invitation,  and  the  subject,  “  Gunshot  Wounds,”  was 
one  to  which  the  personal  experiences  of  the  speaker  lent  a 
special  interest,  and  secured  without  difficulty  the  intelli¬ 
gent  appreciation  of  the  audience.  The  lecture  itself  is 
both  interesting  and  instructive,  the  subject  being  treated 
throughout  with  a  masterly  realism  which  is  secured  by 
an  actual  familiarity  with  the  conditions  described.  Sir 
William’s  remarks  on  resections  in  military  surgery — advo¬ 
cating,  as  he  does,  secondary,  in  preference  to  primary. 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Dec.  1,  18«3.  633 


operations  of  this  nature— come  before  us  with  the  im¬ 
press  of  comparative  novelty ;  they  appear,  however,  to 
be  both  cogent  and  well  considered.  The  sound  ad¬ 
vice  as  to  caution  in  probing  gunshot  wounds,  where 
over-zeal  or  exaggerated  surgical  curiosity  has  too  often 
been  the  agent  of  septic  infection  to  the  patient,  will 
be  approved  by  all.  Numerous  examples  are  adduced  in 
which  bullets  have  become  life-long  and  harmless  tenants 
of  lung,  brain,  bone,  or  even  joint-cavities.  In  the  treat¬ 
ment  of  gunshot  wounds  of  the  abdomen.  Sir  William 
endorses  the  advice  of  the  late  Dr.  Marion  Sims,  his  col¬ 
league  and  chief  on  the  Anglo-American  Ambulance  staff. 
The  ride  will  no  doubt  be  established  that  soldiers  so 
suffering  should  not  be  “’simply  left  to  die,”  but  that  an 
attempt  should  be  made  (by  abdominal  section)  to  search 
for,  excise,  suture,  or  appropriately  treat  the  injured  intes¬ 
tine.  In  this,  as  in  all  other  operations  of  military  surgery, 
the  importance  of  antiseptic  precautions  and  dressings  was 
eloquently  described  and  insisted  on.  The  whole  address 
was  at  once  a  valuable  contribution  to  the  science  of  military 
and  true  conservative  surgery,  and  a  graceful  conclusion  to 
a  visit  in  which  the  “lavish  hospitality  and  great  kind¬ 
nesses”  received  are  modestly  attributed,  not  to  any  personal 
merit  of  the  recipient,  but  to  the  goodwill  “  of  the  highly 
cultured  portion  of  the  American  people  to  the  old  country.” 


THE  “  MEDICO -CHIRURGICAL  TRANSACTIONS.” 

The  new  volume  of  Transactions  of  the  Royal  Medical  and 
Chirurgical  Society  quite  maintains  the  high  character  of 
its  predecessors.  It  may  even  be  said  that  in  general 
interest  the  papers  contained  in  it  are  above  the  average ; 
and,  if  read  in  connexion  with  the  discussions  to  which  they 
gave  rise  (and  which  are  now  published  in  the  Society’s 
Proceedings),  additional  interest,  as  well  as  instruction,  is 
imparted.  Nevertheless  we  are  sorry  to  note  that  many 
communications  which  were  read  before  the  Society,  and 
gave  rise  to  interesting  discussions,  are  conspicuous  by  their 
absence  from  the  present  volume,  for  of  thirty-three  com¬ 
munications  received,  only  twenty-one  are  published  in 
detail.  Among  the  innocents  thus  slaughtered  we  note 
papers  the  publication  of  which  would  in  no  way  have  dis¬ 
graced  even  the  present  volume  of  Transactions ;  and 
more  especially  so  as  the  Council  “  deems  it  proper  to 
state  that  the  Society  does  not  hold  itself  in  any  way 
responsible  for  the  statements  set  forth.”  We  venture 
to  specially  mention  three  of  the  twelve  absentee  papers, 
and  to  express  a  regret  that  they  do  not  form  part  of 
the  present  volume — Dr.  Neale’s  paper  on  the  Etiology  of 
Scurvy;  Mr.  Thomas’s  Researches  into  the  Life-History  of 
the  Liver-Fluke;  and,  finally.  Dr.  Rawdon’s  case  of  Nephrec¬ 
tomy  for  Rupture  of  the  Kidney.  Among  the  most  note¬ 
worthy  of  the  papers  which  do  appear  may  be  mentioned 
those  on  Resection  of  Portions  of  Intestine  ;  on  Endemic 
Hsematuria  ;  on  Scurvy-Rickets ;  and  on  Purulent  Pericar¬ 
ditis  treated  with  Free  Incision  and  Drainage.  We  notice, 
too,  rather  more  than  the  average  number  of  errors  and 
mistakes  of  a  more  or  less  clerical  nature,  and  recommend 
more  careful  editing  in  future. 


SUTURE  OF  THE  PATELLA. 

The  Soeiete  de  Chirurgie  of  Paris  was  engaged  last  week  in 
a  discussion  on  suture  of  the  patella.  M.  Verneuil  showed 
a  patella  which  he  had  removed  from  the  body  of  a  patient 
who  had  recently  died  in  the  Hopital  de  la  Pitie.  The 
man  was  a  tubercular  subject,  and  while  in  the  hospital 
had  fallen  and  sustained  a  comminuted  fracture  of  his 
patella.  He  was  at  once  placed  in  a  gouttiere  splint,  and  a 
blister  was  applied.  After  a  few  days  this  splint  was  re-  | 


moved,  and  a  silicate  (fixative)  bandage  substituted.  In 
less  than  three  weeks  there  was  perfect  and  complete 
osseous  union,  as  the  post-mortem  examination  showed. 
Here,  argued  M.  Verneuil,  was  an  instance  of  osseous  union 
obtained  without  suture  of  the  fragments,  and  even  without 
aspiration  of  the  joint.  He  further  remarked  that  during 
the  past  twenty  years  he  had  never  seen  a  case  in  which 
aspiration  under  these  circumstances  was  indicated.  In 
the  discussion  which  followed,  M.  Berger  emphasised  the 
difference  between  these  fractures  and  transverse  ones.  In 
the  former  there  was  seldom  much  separation  of  the  frag¬ 
ments  ;  they  were  also  very  much  less  common,  and  there 
was  not  one  single  case  in  the  Dupuytren  Museum.  He 
rejects  suture  of  the  fragments  in  primary  cases,  and  only 
thinks  it  justifiable  in  those  old  cases  where  progression  is 
impossible.  In  reply  to  M.  Nicaise,  the  author  of  the  paper 
stated  that  there  was  always  sanguineous  exudation  into 
the  knee-joint  in  patellar  fractures.  The  Surgical  Section 
of  the  Academy  of  Medicine,  Ireland,  has  also  recently 
discussed  the  treatment  of  fractured  patella.  The  speakers 
were  by  no  means  unanimous  as  to  whether  bony  union 
was  a  sine  qud  non  of  success,  nor  did  they  agree  as  to  the 
relative  value  of  the  various  forms  of  apparatus  that  have 
been  devised  for  bringing  the  pieces  of  bone  into  apposi¬ 
tion  ;  but  they  were  nearly  unanimous  in  regarding  Lister’s 
method  of  opening  the  joint  and  suturing  the  bones  as  too 
heroic  in  cases  of  recent  fracture,  and  as  only  safe  and 
justifiable  in  the  hands  of  one  thoroughly  versed  in  the 
Listerian  method. 

MILK  ADULTERATION. 

A  letter  appeared  in  the  Times  last  week  from  Mr. 
Wigner,  who  is  President  of  the  Society  of  Public  Analysts, 
upon  the  subject  of  milk  adulteration,  which  again  brings 
before  the  public  the  fact  that  the  milk  which  is  supplied  to 
this  metropolis  is  largely  diluted  with  water.  The  milk  as 
it  arrived  in  London  from  fifty  different  dairies  was  tested, 
and  every  sample  was  found  to  be  good ;  “  not  a  watered  or 
skimmed  sample  was  found,  but  the  average  of  the  whole 
was  7  per  cent,  better  than  the  limit  ”  which  the  public 
analysts  have  to  work  to.  From  300  samples  of  milk  bought 
at  the  same  time  from  retail  dealers,  some  from  every  dis¬ 
trict  of  London,  only  ninety-seven  samples  passed  the  limit, 
while  “203  samples  were  watered,  or  skimmed,  or  both.” 
And  this  adulteration  was  also  very  considerable  in  degree ; 
it  varied  between  3  and  Gl  per  cent. :  forty- five  contained 
between  20  and  30  per  cent,  of  water,  and  forty- five  con¬ 
tained  over  30  per  cent.  Moreover,  fifty-seven  were  skimmed 
as  well  as  watered  ;  and  twenty-one  were  skimmed,  but  not 
watered.  Mr.  Wigner  refers  to  the  monetary  loss  to  the 
consumers,  and  it  is  to  this  point  of  view  that  the  public 
is  most  likely  to  be  attracted.  He  computes  this  loss  at 
<£356,000  annually,  and  he  is  probably  well  within  the  mark 
in  doing  so.  But  there  is  a  much  more  serious  side  to  the 
question  than  that  of  pecuniary  loss,  for  this  wholesale  adul¬ 
teration  no  doubt  has  a  serious  influence  upon  the  health  of 
the  community.  In  the  first  place,  it  is  one  of  the  chief 
causes  why  the  children  of  the  poor  are  often  ill-nourished 
and  rickety,  so  that  they  either  succumb  to  the  common 
illnesses  of  childhood,  or  grow  up  deformed  or  permanently 
debilitated.  And,  in  the  second  place,  the  adulteration  of 
milk  with  impure  water  no  doubt  leads  to  the  dissemination 
of  disease — notably  typhoid  and  scarlet  fevers.  As  a  remedy, 
Mr.  Wigner  advises  that  a  proper  standard  limit  of  quality 
should  be  insisted  upon  ;  and  we  would  add,  that  unless  this 
is  done  by  the  properly  constituted  authorities,  reform  will 
be  either  very  slow  or  will  not  take  place  at  all.  Those  who 
suffer  most  are  unable  or  unwilling  to  protect  themselves 
against  this,  the  most  scandalous  of  adulterations. 


C34 


Medical  Times  an 3  Gazette. 


ANNOTATIONS. 


Dec.  1,  1883. 


CELLULOID  COLLARS 

The  riding  of  a  “  cycle  ”  is  productive  of  cutaneous  transuda¬ 
tion,  and  this  condition  is  inimical  to  starch.  It  has  been 
endeavoured  to  supply  the  want  thus  revealed,  and  to  pro¬ 
vide  a  snowy  yet  rigid  collar  to  the  machine-rider  by  the 
introduction  and  advertisement  of  the  so-called  “  celluloid  ” 
collars  and  cuffs.  It  has  fallen  to  our  lot  to  note  how  ill 
adapted  is  this  material  for  the  purpose  for  which  it  is 
recommended.  The  celluloid  collar,  when  warm,  clings 
closely,  with  a  firm  if  slightly  elastic  pressure  to  the  throat 
of  the  wearer,  producing  in  all  cases  a  redness  of  the  sub¬ 
jacent  skin  and  an  unpleasant  sense  of  fulness  in  the  head. 
In  one  instance  a  zone  of  eczematous  eruption,  and  in 
another  severe  attacks  of  congestive  headache,  causing  utter 
prostration,  and  traced  at  length  to  their  true  cause, 
resulted  from  the  use  of  these  collars.  In  point  of  fact  the 
venous  circulation  from  head  to  body  is  seriously  interfered 
with  during  any  active  exercise  by  such  a  constriction,  and 
we  would  strongly  advise  our  readers  not  to  be  seduced,  by 
any  love  of  neatness  or  decorum,  to  run  the  risk. 


THE  PARIS  WEEKLY  RETURN. 

The  number  of  deaths  for  the  forty-sixth  week  of  1883, 
terminating  November  13,  was  964  (530  males  and  434 
females),  and  of  these  there  were  from  typhoid  fever  38, 
small-pox  3,  measles  1,  scarlatina  none,  pertussis  6,  diph¬ 
theria  and  croup  43,  erysipelas  5,  and  puerperal  infection  1. 
There  were  also  40  deaths  from  tubercular  and  acute  menin¬ 
gitis,  177  from  phthisis,  25  from  acute  bronchitis,  65  from 
pneumonia,  77  from  infantile  athrepsia  (24  of  the  infants 
having  been  wholly  or  partially  suckled),  and  30  violent 
deaths  (25  males  and  5  females).  The  mortality  of  the 
week  remains  low  and  nearly  stationary.  The  figures  of 
small-pox,  measles,  and  pertussis  are  very  low,  while  no 
death  from  scarlatina  has  occurred  in  Paris  during  four 
weeks.  Deaths  from  typhoid  fever  have  increased  by  8,  and 
from  diphtheria  by  9.  During  the  week  there  were  1258  births, 
viz.,  646  males  (478  legitimate  and  168  illegitimate)  and  612 
females  (441  legitimate  and  171  illegitimate)  :  103  infants 
were  either  born  dead  or  died  within  twenty-four  hours, 
viz.,  62  males  (53  legitimate  and  9  illegitimate)  and  41 
females  (26  legitimate  and  15  illegitimate). 


KAIRIN  AS  AN  ANTIPYRETIC. 

That  there  is  still  room  for  a  good  antipyretic,  few  would 
probably  be  inclined  to  dispute,  and  it  is  not  surprising  to 
find  that  kairin,  introduced  about  a  year  since  in  Germany, 
has  lately  been  put  upon  its  trial  in  Boston  by  Drs.  Shattuck 
and  F.  W.  Draper,  the  former  of  whom  gave  it  in  six  cases 
of  typhoid  fever,  and  the  latter  in  two  cases.  Their  cases 
would  seem  to  show  that,  when  administered  in  a  manner  to 
be  alluded  to,  kairin  has  a  definite  and  tolerably  speedy  anti¬ 
pyretic  action,  and  is  a  fairly  safe  drug.  In  some  patients 
it  induced  a  certain  degree  of  collapse,  which  was  overcome 
by  stimulants.  This  may  possibly  have  been  due,  in  some 
degree,  to  individual  susceptibility  ;  its  effect  seemed  to  pass 
off  speedily,  the  temperature  regaining  its  former  height  after 
a  short  cessation  of  the  drug.  The  plan  of  administration 
adopted  by  both  the  above-mentioned  physicians  was  to  give 
an  hourly  dose  of  seven  grains  and  a  half,  commencing  in  the 
evening,  and  continuing  it  for  four,  six,  eight,  or  even  ten 
hours  consecutively,  according  to  the  requirements  of  the  case. 
There  was  usually  free  perspiration  after  the  administration. 
During  the  rise  of  temperature  that  succeeded  the  fall  there 
was  often  a  rigor.  The  symptoms  of  an  overdose  were  feeble 
pulse,  pinched  countenance,  and  cyanosis  of  the  lips  and 
extremities.  The  drug  was  rapidly  eliminated,  the  urine 


becoming  of  a  dark-green  colour  half  an  hour  after  the  first 
dose.  _ 

THE  MICROCOCCUS  OF  CROUPOUS  PNEUMONIA. 

Some  observations  upon  the  micrococcus  of  croupous  pneu¬ 
monia  have  lately  been  presented  to  the  Physiological 
Society  of  Berlin  by  Mr.  Carl  Friedlander  and  Dr. 
Frobenius,  of  that  city.  The  micro-organism  is  character¬ 
ised  and  distinguished  by  the  presence  of  a  peculiar  mucous 
capsule,  which  it  retains  when  re-cultivated  in  gelatine. 
Inoculation  with  this  “  cultivated  ”  material  was  made  into 
the  lung-tissue  of  rabbits,  but  without  effect.  Similar 
injections  into  dogs  and,  with  still  more  constancy,  into 
mice  produced  all  the  phenomena  of  genuine  croupous  lobar 
pneumonia.  In  a  few  cases,  inhalations  of  the  material  in 
pulverised  form  were  equally  successful. 


THE  WEATHER  AND  THE  POOR  IN  GLASGOW. 

Odr  Glasgow  correspondent  writes  : — “  The  severely  cold 
and  foggy  weather  which  has  set  in  with  the  present  month 
has  increased  the  mortality  of  the  city,  and,  unless  a  change 
takes  place  soon,  we  are  sure  to  see  the  death-rate  go  up 
further.  The  several  dispensaries  are  already  besieged  by 
vast  numbers  of  applicants,  many  of  whom,  however,  are 
quite  able,  but  unwilling,  to  pay  for  either  advice  or  medi¬ 
cine  ;  and  this  tendency  seems  to  be  more  common  in  Glasgow 
than  elsewhere.  We  have  no  desire  to  close  the  hand  of 
charity,  or  to  thrust  it  aside,  but  it  must  be  said  that  many 
of  the  charities,  so-called,  are  started  by  a  few  energetic  in¬ 
dividuals  who  have  plenty  of  time  at  their  disposal,  which 
they  apply  to  the  collecting  of  funds,  in  order  to  vie  with 
other  institutions  already  in  existence.  The  result  is,  there 
is  always  a  cry  for  funds  for  generally  hard-up  but  well- 
intentioned  institutions.  At  present,  the  general  tendency 
is  certainly  downwards  ,•  in  fact,  the  populace  are  taught  the 
way  to  become  paupers — which,  however,  we  are  told  is  not 
pauperism,  but  only  a  right  which  they  are  entitled  to  exact. 
At  a  recent  parochial  election,  one  of  the  candidates  (a 
medical  man)  promised,  if  returned,  to  furnish  the  names  of 
individuals  who  were  in  receipt  of  parochial  aid  and,  at  the 
same  time,  earning  good  wages.  When  such  things  are 
allowed  to  go  on  unchecked,  it  may  safely  be  inferred  that 
that  community  is  in  a  very  unsatisfactory  condition.  For  a 
considerable  time  past  the  infirmaries  have  been  unable  to 
supply  applicants  with  beds.  They  overcome  the  difficulty 
by  writing  to  applicants  in  rotation  when  they  can  be 
admitted,  those  before  them  being  sent  to  the  convalescent 
homes.  The  competition  is  keen — the  desire  for  dclat  great. 
While  waiting  for  admission,  attendance  and  medicine  are 
supplied  by  other  charities,  and  in  many  cases  nurses  are 
sent  daily  to  wait  upon  the  sick.  Truly,  the  lines  of  the 
working  class  are  fallen  in  pleasant  places — their  bread  is 
certain  and  their  water  pure.” 


THE  THERAPEUTICS  OF  ADDER' S  POISON. 

Dr.  Bichard  Neale  writes  to  us  "  In  your  paper  of  last 
week,  page  606,  the  value  of  adder’s  poison  in  tetanus 
is  noted  as  novel.  A  glance  at  the  ‘Medical  Digest’ 
(Section  526 :  3)  will  show  that,  in  1874,  the  value  of  in¬ 
oculating  the  venom  of  the  adder  was  apparently  esta¬ 
blished  by  several  experiments  and  observations  on  cases  of 
hydrophobia— a  disease  very  nearly  allied  to  tetanus;  and, 
at  Section  1516  :  4,  a  paper  by  a  nephew  of  the  illustrious 
Baron  Humboldt  is  noted,  in  which  the  inoculation  of 
adder’s  poison,  after  it  had  been  attenuated  by  passing  it 
through  putrid  liver,  was  found  to  be  a  certain  prophylactic 
against  yellow  fever.  Out  of  1438  persons  so  inoculated  only 
seven  took  the  fever,  and  these  recovered.” 


Meiica',  Times  and  Gaastte. 


ANNOTATIONS. 


Dec.  1, 1883.  635 


PILLAGING  LECTURES. 

The  American  medical  journals  contain  an  account  of  the 
result  of  an  appeal  to  the  Philadelphia  Court  of  Common 
Pleas  by  a  Dr.  Samuel  Miller  in  order  to  obtain  a  dissolu¬ 
tion  of  an  injunction  which  had  been  obtained  by  Profs. 
Hayes,  Agnew,  and  Penrose,  restraining  him  from  selling  a 
work  entitled  an  “  Epitome  of  Medicine,  Surgery,  and  Mid¬ 
wifery.”  The  complainants  declared  that  this  work  was 
-entirely  made  up  of  their  lectures.  Miller  only  contributing 
the  summary  of  them  and  the  errors  to  be  found  in  the 
book.  They  never  authorised  the  publication,  and  their 
interests  were  damaged  by  it.  Miller  did  not  deny  the  alle¬ 
gation,  but  maintained  that,  having  been  a  student  at  the 
university  in  which  these  lectures  were  delivered,  and  never 
having  received  notice  that  the  lecturers  reserved  any 
^property  in  them,  he  had  a  full  right  to  the  use  of  what  was, 
in  fact,  a  common  property  of  the  students  who  were  present. 
Counsel  for  the  Professors  replied  that  a  man  had  an  absolute 
xight  of  property  in  the  productions  of  his  own  brain  ;  and 
Chat  Miller  had  no  right  in  law  or  equity  to  publish  a  book 
purporting  to  be  written  by  them,  and  to  enjoy  all  the  profits 
of  the  pretence,  to  the  prejudice  of  the  gentlemen  whose 
names  were  used.  The  Court  concurred  in  this  view,  and 
refused  to  dissolve  the  injunction. 


CALOMEL  IN  ENTERIC  FEVER. 

At  the  first  meeting  of  the  Medical  Section  of  the  Irish 
Academy  of  Medicine,  Dr.  J.  W.  Moore  read  the  notes  of  a 
case  of  typhoid  fever  in  which,  on  three  occasions  at  inter¬ 
vals  of  forty-eight  hours,  he  administered  ten-grain  doses  of 
calomel.  In  the  discussion  which  followed,  this  mode  of 
"treatment  did  not  by  any  means  meet  with  unqualified 
approval.  The  patient  seems  to  have  made  a  good  recovery, 
but  there  is  no  mention  of  the  period  of  the  disease  when 
the'  calomel  was  given.  Notwithstanding  its  alleged  powers 
as  a  germ-killer,  we  cannot  regard  calomel  as  otherwise  than 
a  dangerous  remedy  to  use  in  enteric  fever  after  the  second 
week. 


W e  regret  to  learn  the  death  of  M.  Georges  Homolle,  at 
Paris,  on  November  24.  He  was  a  physician  of  great 
promise.  _ 

The  next  Thursday  evening  lecture  at  the  Parkes 
Museum  will  be  given  by  Dr.  G.  Y.  Poore  on  “  Coffee  and 
Tea.”  The  chair  will  be  taken,  most  appropriately,  by  Sir 
Henry  Thompson.  _ 

The  Royal  College  of  Physicians  has  instituted  a  special 
annual  examination  on  hygiene.  The  certificate  to  be 
awarded  will  be  entitled  “  Certificate  in  Hygiene  of  the 
Eoyal  College  of  Physicians  of  London.” 


Pboe.  Eilhard  Schulze,  of  Gratz,  has  accepted  the  call 
as  Professor  of  Zoology  in  the  Berlin  University,  in  succession 
to  the  late  Prof.  Peters.  He  will  lecture  on  General  Zoology, 
including  Comparative  Anatomy,  which  has  been  removed 
from  the  Medical  to  the  Philosophical  Faculty. 


MM.  Chambrelent  and  Macssous  have  announced,  in  a 
report  to  the  Paris  Academy  of  Sciences,  that  they  have  at 
length  succeeded  in  discovering,  in  the  milk  of  cows  affected 
with  inflammation  of  the  spleen,  the  bacillus  of  that  disease. 
They  have  further  succeeded  in  their  experiments  in  the 
reproduction  of  this  micro-organism  and  in  inoculating 
animals  with  it. 


A  photographic  studio  has  now  been  attached  to  most  of 
the  French  hospitals,  for  photographing  the  sick  persons  at 
different  times.  The  rapid  dry-plate  process  is  employed. 
An  electrically  operated  camera,  devised  by  Prof.  Charcot,  of 
the  Salpetriere,  is  very  useful  in  taking,  in  rapid  succession, 
a  series  of  views. 


The  Broca  Prize  of  1500  fr.,  founded  by  the  widow  of  the 
late  Prof.  Broca,  for  the  best  memoir  on  any  question  in 
human  or  comparative  anatomy  or  physiology  having  a 
bearing  on  anthropological  science,  will  be  adjudged  for  the 
first  time  by  the  Anthropological  Society  of  Paris  in  April, 
1884.  All  memoirs  must  be  sent  in  by  the  end  of  the  month. 


The  interment  of  the  remains  of  the  late  Dr.  Hilton 
Fagge  took  place  on  Saturday,  November  24,  at  Norwood 
Cemetery.  The  funeral  arrangements  throughout  were  of 
a  strictly  private  character,  but  the  attendance  of  a  great 
concourse  of  former  friends,  colleagues,  and  pupils  bore 
silent  but  impressive  testimony  to  the  affection  and  respect 
in  which  the  deceased  physician  was  so  universally  held. 


On  Saturday  last,  M.  Waldeck  Rousseau,  the  French 
Minister  of  the  Interior,  paid  a  lengthy  visit  to  the  hospital 
for  British  subjects,  founded  by  Sir  Richard  Wallace,  at 
Levallois-Perret.  Drs.  Herbert  Rocolaff  and  Hogg  received 
the  Minister,  who  made  a  thorough  inspection  of  the  esta¬ 
blishment,  and  specially  expressed  his  admiration  at  the  way 
in  which  space,  ventilation,  and  light  had  been  provided  for 
the  inmates. 


The  chair  of  Internal  Pathology  at  Paris  having  been 
vacated  by  Prof.  Jaccoud’s  transference  to  the  chair  of 
Clinical  Medicine,  rendered  vacant  by  the  death  of  Prof. 
Lasegue,  the  Paris  Faculty  of  Medicine  has  sent  in  three 
names  to  the  Minister  of  Public  Instruction  in  the  following 
order,  viz.,  MM.  Damaschino,  Dieulafoy,  and  Grancher. 
M.  Pajot,  the  Professor  of  Midwifery,  has  been  appointed  to 
the  chair  of  Clinical  Midwifery,  rendered  vacant  by  the 
death  of  Prof.  Depaul.  _ 

Dr.  Rochard,  Medical  Director  of  the  French  Marine, 
who  some  weeks  since  received  at  the  hands  of  a  lunatic  a 
gunshot  wound  of  the  lung,  which  for  some  time  caused 
grave  apprehensions,  has  since  made  an  uninterrupted 
recovery,  so  that  he  was  enabled  at  the  last  meeting  of  the 
Academie  de  Medecine  to  thank  his  colleagues  personally 
for  the  great  interest  they  had  taken  in  his  progress,  and  to 
inform  them  that  he  had  so  completely  recovered  that  “  all 
that  remained  to  him  of  this  adventure  was  a  small  piece  of 
lead  in  the  right  lung,  and  great  gratitude  in  his  heart.” 


In  the  action  brought  by  the  President  of  the  Royal 
College  of  Surgeons  in  Ireland  against  the  Government, 
which  came  on  for  hearing  in  the  Common  Pleas  Division 
of  the  High  Court  of  Judicature  in  Ireland  on  Wednesday 
and  Thursday,  November  21  and  22,  the  Government  un¬ 
expectedly  surrendered  at  discretion,  and  offered  no  defence. 
When  the  further  hearing  of  the  case  was  resumed  on  Thurs¬ 
day  morning,  the  Attorney- General  for  Ireland  announced 
that  the  Government  were  prepared  to  consent  to  take  a 
verdict  for  the  full  amount  of  Mr.  Wheeler’s  claim.  Mr. 
Justice  Harrison  said  he  was  perfectly  sure  that  there  was  now 
at  the  head  of  the  Irish  Executive  a  nobleman  who  would  be 
only  too  happy  to  do  what  was  right.  A  verdict  was  then 
taken  for  the  petitioner  for  the  sum  mentioned  (,£1147  18s.), 
with  costs. 


636 


Medical  Times  and  Gazette. 


THE:  DISTRIBUTION  OF  TYPHUS  IN  LIVERPOOL. 

3 


Dec.  1,  1883. 


THE  SODIUM  NITRITE  RESEARCH. 


We  have  received  the  following  from  the  Secretary  of  the 
Westminster  Hospital,  with  a  request  for  its  publication  : — 

“The  House-Committee,  having  appointed  a  sub-com¬ 
mittee  to  consider  a  paper  r  On  Nitrite  of  Sodium  as  a 
Toxic  Agent,5  by  S.  Ringer,  M.D.,  and  W.  Murrell,  M.D., 
which  was  published  in  the  Lancet  of  November  3,  together 
with  the  correspondence  and  the  articles  which  have  subse¬ 
quently  appeared  in  the  newspapers  in  relation  thereto,  the 
sub-committee  beg  to  report  as  follows : — 

“  1.  They  have  carefully  considered  the  paper,  the  corre¬ 
spondence,  and  the  articles  in  question,  and  have  received 
such  further  information  from  Dr.  Murrell  as  they  required. 

“  2.  They  are  of  opinion  that  the  paper,  which,  it  is  only 
fair  to  say,  had  not  received  Dr.  Murrell’s  final  revision,  is 
open  to  serious  objections  on  the  grounds  of  .want.of  chrono¬ 
logical  order,  precision,  and  gravity  of  style.  In  the  last  par¬ 
ticular,  they  cannot  at  all  excuse  its  deficiencies — deficiencies 
of  which  Dr.  Murrell  himself  is  now  sufficiently  aware ;  but 
they  think  their  effect  is  lessened  when  the  history  of  the 
experiments  with  the  drug  is  clearly  given,  in  proper  order 
and  connexion. 

“3.  They  find  on  examination  that  Dr.  Murrell’s  attention 
was  first  called  to  the  use  of  nitrite  of  sodium  in  epilepsy 
and  certain  diseases  of  the  chest  by  a  statement  made  by 
Dr.  Law,  in  the  Practitioner,  that  he  had  successfully  em¬ 
ployed  it  in  twenty-grain  doses.  The  whole  of  the  cases 
treated  by  Dr.  Murrell  more  than  twelve  months  ago,  and 
prior  to  his  appointment  in  April  last  as  Assistant-Physician 
to  Westminster  Hospital,  were  expressly  selected  by  him 
from  a  very  large  number  of  out-patients  at  another  hospital 
with  which  he  is  connected,  and  were  all  of  them  suffering 
from  diseases  for  which  this  drug  and  other  allied  drugs 
would  be  suitable. 

“  There  is  no  ground  whatever  for  supposing  that  any 
patient  was  treated  by  way  of  simple  experiment,  without 
reference  to  the  presence  of  specific  disease,  and  without 
bond  fide  belief  that  the  treatment  would  be  beneficial  to  the 
individual  patient. 

“  With  commendable  caution  Dr.  Murrell  began  by  giving 
his  patients  only  half  the  dose  prescribed  by  Dr.  Law,  and 
had  he  then  known  what  Dr.  Law  seems  to  have  discovered 
afterwards,  that  the  drug  used  by  him  was  not  of  a  pure 
quality,  no  doubt  he  would  have  still  further  diminished  the 
dose,  as  indeed  the  symptoms  which  he  observed  in  the  first 
series  of  patients  for  whom  he  prescribed  immediately  led 
him  to  do. 

“  The  experiments  on  lower  animals,  which  conclusively 
revealed  the  toxic  properties  of  the  drug,  followed,  and  did 
not  precede,  as  one  would  gather  from  the  paper,  its  ad¬ 
ministration  to  human  subjects,  and  were  made  in  order  to 
elucidate  the  unexpected  symptoms. 

“  The  sub-committee  have  been  assured  that  none  of 
the  patients  suffered  any  ill  effects  from  the  doses  actually 
taken,  while  many  of  them  received  ultimate  benefit  and 
willingly  continued  under  Dr.  Murrell’s  care  until  they 
ceased  to  be  out-patients.  This  it  is  important  to  notice, 
as  a  proof  that  the  alarm  expressed  by  the  patients  in 
describing  the  effects  of  the  medicine  upon  them  was  not 
so  serious  as  the  terms  employed  by  them  and  quoted  by  Dr. 
MurrelL  would  seem  to  indicate. 

“  It  is  further  to  be  observed  that  ‘  the  literature  on  the 
subject,’  to  which  reference  is  made  in  the  paper,  is  either 
contemporary  with  Dr.  Murrell’s  investigations  or  of  a  later 
date. 

“4.  The  sub-committee,  after  careful  consideration  of 
these  facts,  see  no  reason  why  the  House-Committee  should 
withdraw  from  Dr.  Murrell  their  confidence  in  his  ability 
and  humanity,  and  they  trust  that  the  unfortunate  manner 
in  which  the  paper  was  put  together  will  be  forgotten, 
while  the  value  of  his  experiences  will  remain.  In  this  con¬ 
nexion  the  sub-committee  would  call  attention  to  the  fact 
that  in  consequence  of  this  experience  the  ‘  official  ’  dose  of 
nitrite  of  sodium,  hitherto  appearing  in  the  standard  text¬ 
books  of  therapeutics  as  twenty  grains,  has  since  been  re¬ 
duced  to  two  grains,  and  a  permanent  source  of  danger  has 
thus  been  averted. 

“  5.  The  sub-committee,  while  arriving  at  the  foregoing 
conclusion,  are  far,  from  ^agreeing  with  the  view  of  those 


who  would  ascribe  to  ignorance  or  prejudice  the  public 
attention  directed  towards  Dr.  Murrell’s  paper,  and  the 
adverse  comments  which  it  excited.  They  think,  on  the 
contrary,  that  it  was  a  natural  result  of  its  publication  in 
the  Lancet,  and  was  due  to  the  terms  employed  in  describ¬ 
ing  the  experiences  and  the  conditions  under  which  they 
were  obtained.  Nor  do  they  think  the  medical  profession, 
and  still  less  the  governing  body  of  a  hospital  depending 
upon  the  good  opinion  of  the  public  at  large  for  its  support, 
would  be  disposed  lightly  to  disregard  such  opinion,  or  other¬ 
wise  alienate  the  goodwill  and  confidence  at  present  reposed 
in  them. 

“6.  The  sub-committee  recommend  that  a  copy  of  this 
report  be  sent  to  the  Lancet  and  other  medical  journals  for 
publication,  so  that  the  public  may  be  aware  of  the  strict 
investigation  instituted  by  the  House-Committee.  They  also, 
recommend  that  regulations  be  strictly  enforced,  that,  in  re¬ 
spect  to  the  treatment  of  out-patients,  who  of  necessity  cannot 
be  under  constant  clinical  observation,  no  remedial  agent  the 
properties  and  effects  of  which  are  not  fully  ascertained  shall 
be  administered  by  the  medical  officers  in  charge. 

“  Rutherford  Alcock  (Chairman). 

“Octavius  Sturges,  M.D.  C.  Alfred  Jones. 

George  Cowell,  F.R.C.S.  J.  Troutbeck,  D.D. 

A.  DupRk,  Ph.D.,  F.R.S.  Fra.  Whitaker. 

G.  Helmore.  Lewis  Winckworth. 

“  Westminster  Hospital,  November  24,  1883.” 


THE  DISTRIBUTION  OE  TYPHUS  IN 
LIVERPOOL. 


At  a  well-attended  meeting  of  the  Liverpool  Medical  Society 
on  November  22,  a  very  able  and  important  paper  was  read 
on  this  subject  by  Dr.  Hope,  the  recently  appointed  Assistant 
Medical  Officer  of  Health  for  that  city.  He  estimated  the 
typhus-bearing  population  at  230,000,  of  whom  90,000  dwelt 
in  courts,  15,000  in  lodging-houses  of  different  kinds, 
25,000  in  cellars,  and  100,000  in  street  houses.  During  the 
last  few  months  831  cases  of  typhus  had  come  under  the 
notice  of  the  health  authorities,  and,  strange  to  say,  the 
great  majority  of  these  cases  dwelt  in  street  houses — i.e.,  in 
the  best  constructed  houses  inhabited  by  the  lower  class, 
and  in  those  most  likely  to  be  free  from  fever.  The  cellars 
— abodes  condemned  by  all  sanitarians — were  practically 
free,  and  so  were  the  lodging-houses,  whilst  the  courts  were 
much  less  affected  than  the  street  houses.  The  mortality 
amongst  those  known  to  be  treated  at  home  was  43 
per  cent.,  but  no  doubt  there  were  many  cases  success¬ 
fully  treated  at  home  which  the  health  authorities  did  not 
hear  of.  Dr.  Hope  showed  from  these  figures  that  the  pre¬ 
valence  of  typhus  was  almost  in  an  inverse  ratio  to  the 
structural  defects  of  the  dwellings  of  the  poor  ;  and  this 
was  owing  to  the  fact  that  the  worst  dwellings  were  best 
inspected — hence  the  outbreak  of  fever  was  detected  at  an 
early  period,  and  the  cases  removed  to  hospital,  or  isolation 
secured.  As  regards  the  action  of  sanitary  improvements 
alone  in  dispelling  typhus  from  any  locality,  he  could  point 
to  neighbourhoods  (notably  Fontenoy-street)  where  over 
<£20,000  had  been  spent  on  the  rebuilding  or  improvement 
of  the  houses,  and  where  fever  still  raged  as  vigorously  as 
before.  In  other  places,  demolition  of  insanitary  property 
and  rebuilding  had  dispelled  typhus,  but  these  were  chiefly 
cases  where  a  railway-station  or  a  warehouse  took  the  place 
of  the  insanitary  property,  and  drove  away  the  inhabitants 
as  well  as  the  disease.  In  Dr.  Hope’s  opinion,  the  habits 
and  social  condition  of  the  people  were  the  chief  agents  in 
favouring  or  checking  the  spread  of  typhus.  Constant, 
police  and  sanitary  inspection,  both  by  day  and  night,  would 
be  far  more  effectual  amongst  the  lower  classes,  even  with¬ 
out  better  sanitary  dwellings,  than  the  improvement  of  pro¬ 
perty  alone  would  be  without  a  vigilant  inspection.  Pros¬ 
perity  to  the  inhabitants  of  these  streets  and  courts  meant 
drink  and  crime,  whilst  adversity  emptied  the  gaols  by 
lessening  the  facilities  for  obtaining  drink.  The  proposals 
of  the  medical  men  of  Liverpool  to  carry  out  more  strictly 
the  Dairies  and  Cowsheds  Act  would  not  touch  the  question, 
as  there  was  no  very  close  connexion  between  typhus  and  the 
milk-supply.  The  onus  of  giving  early  information  should 


Madical  Times  and  Gazette. 


MEDICAL  REPOETS  TO  THE  LOCAL  GOVERNMENT  BOARD.  Dec.i,i888.  6  3  7 


be  laid  on  the  medical  attendants  of  these  poor  people,  as  the 
people  themselves  could  not  be  relied  upon.  Certificates 
for  all  children  attending  schools  would  involve  an  enormous 
expense,  as  medical  men  would  require  to  be  paid  for  such 
•certificates.  The  argument  that  the  poor  were  already 
under  the  skilled  guidance  of  their  own  medical  attendants 
he  would  leave  to  be  appreciated  by  the  common  sense  of 
those  of  his  hearers  who  knew  anything  practically  of  these 
matters. 

In  the  discussion  that  ensued.  Dr.  Bailey  protested  against 
the  43  per  cent,  mortality  amongst  patients  treated  at  home 
as  misleading.  The  mortality  at  home  was  less  than  in 
hospital.  Dr.  John  Bligh  described  Fontenoy-street  as  an 
xt  old  clothes  ”  shop,  in  explanation  of  the  persistence  of  typhus 
there  in  spite  of  improvements.  Other  improved  streets, 
such  as  Gerard-street  and  Byrom-street,  were  the  habitat 
•of  tramps,  who  constantly  imported  the  disease.  Drainage, 
■cleanliness,  and  ventilation  were  the  most  potent  factors  in 
the  production  of  typhus.  He  did  not  believe  in  a  paper 
founded  on  the  observation  of  sanitary  inspectors. 

Dr.  Prytherch  said  the  mortality  of  home  patients  would 
be  always  higher  than  that  of  hospital  patients,  because  the 
former  were  in  better  circumstances,  had  a  more  highly 
organised  nervous  system/and  hence  succumbed  more  readily 
to  typhus. 

Dr.  Carter  regretted  very  much  that  at  the  present  junc¬ 
ture,  when  the  people  of  Liverpool  were  roused  to  the 
Insanitary  condition  of  the  dwellings  of  the  poor  in  many 
parts  of  the  town.  Dr.  Hope  should  read  a  paper  that  seemed 
to  prove  that  the  improvement  of  sanitary  property  was 
useless  in  preventing  typhus.  In  his  opinion,  the  opposite 
was  the  case.  In  a  district  to  which  the  late  Dr.  Duncan 
called  attention  many  years  ago,  where  typhus  annually 
carried  off  one  out  of  every  twenty-five  of  the  whole  popu¬ 
lation,  improvements  of  the  dwellings  alone  had  now  almost 
stamped  out  the  disease.  In  another  notorious  typhus  dis¬ 
trict,  sanitary  improvements  had  so  far  succeeded  that  only 
one  death  occurred  there  last  year.  Attention  to  sewerage, 
the  closing  of  cellars,  and  the  opening  up  of  courts  were, 
in  his  opinion,  the  chief  agents  in  preventing  disease.  It 
was  never  intended  that  the  certificates  required  for  school- 
children  should  be  medical  ones;  the  statements  of  the 
parents  were  to  be  accepted. 

Dr.  Roberts  thought  the  high  mortality  amongst  home 
patients  arose  from  the  fact  that  these  cases  were  too  ill, 
when  discovered,  to  be  removed  to  hospital. 

Dr.  Robertson  maintained  that  insanitary  property  was 
mot  the  real  cause  of  typhus  being  endemic,  nor  the  chief 
means  of  its  spread.  The  filthy  habits  of  the  people  had  far 
more  to  do  with  the  disease.  In  America,  typhus  was  in 
many  places  as  prevalent  as  in  Liverpool,  yet  they  had  no 
courts  there.  Compulsory  notification  and  early  removal 
to  hospital  were  the  best  methods  of  controlling  typhus,  and 
this  was  well  shown  by  Dr.  Hope’s  paper. 

Dr.  Barr  said  that  typhus  was  almost  unknown  in  Walton 
Gaol,  and  this  showed  the  effects  of  sanitary  dwellings  upon 
the  poor.  Disinfection  by  the  sanitary  authority  was  gene¬ 
rally  a  farce,  and  he  only  trusted  the  efficacy  of  disinfection 
when  it  was  superintended  by  himself. 

Dr.  Archer  thought  the  geological  formation  of  the  soil 
had  something  to  do  with  the  matter.  He  noticed  from  the 
maps  sent  round  that  typhus  prevailed  most  in  the  low- 
lying  alluvial  districts,  and  vanished  as  the  houses  became 
more  elevated  and  were  built  on  the  red  sandstone.  He 
advocated  compulsory  notification. 

Dr.  Hamilton  thought  compulsory  notification  was  neces¬ 
sary  in  the  localities  mentioned  in  the  paper,  but  this  was 
■quite  different  from  the  notification  desired  by  the  Corpora¬ 
tion  a  year  ago.  Demolition  of  property  was  not  so  much 
to  be  aimed  at  as  improvement  of  the  present  houses. 

Dr.  Whitford  advocated  compulsory  notification  without 
any  reserve,  as  sometimes  shopkeepers  were  most  culpable 
in  spreading  typhus — more  so  than  their  poor  customers, — 
and  it  would  not  be  fair  to  allow  them  to  escape.  He  cited 
two  eases  in  point.  Besides,  he  disapproved  on  principle  of 
making  one  law  for  the  rich  and  another  for  the  poor. 

Dr.  Hope,  in  replying,  disclaimed  any  idea  of  making 
•capital  out  of  the  43  per  cent,  mortality.  It  was  fully  ex¬ 
plained  in  his  paper.  The  observations  on  which  the  paper 
was  founded  were  made  by  himself.  He  would  remind  Dr. 
Garter  that  the  lessened  mortality  in  the  districts  mentioned 
by  him  arose  from  the  cleansing  of  cellars  that  were  in  an 


abominable  condition,  rather  than  from  structural  improve¬ 
ment  of  property.  Typhus  did,  in  fact,  occur,  but  did  not 
spread  on  account  of  the  early  diagnosis  and  isolation.  He 
had  had  five  cases  while  resident  in  Walton  Gaol.  He  was 
afraid  the  statements  of  the  parents  to  the  School  Board 
authorities  would  not  be  of  much  use,  as  the  poor  he  was 
speaking  of  were  not  to  be  relied  on. 


MEDICAL  REPORTS  TO  THE  LOCAL 
GOVERNMENT  BOARD. 

Fever  and  Diphtheria  in  Monmouthshire. 

In  certain  parts  of  the  registration  district  of  Bedwelby, 
Monmouthshire,  enteric  and  scarlet  fevers,  and  diphtheria, 
had  for  the  past  two  years  been  so  prevalent  that  it  was 
considered  advisable  to  ascertain  the  causes  of  such  preva¬ 
lence  ;  and,  in  March  last,  Mr.  J ohn  Spear  was  deputed  by 
the  Local  Government  Board  to  undertake  the  inquiry. 
The  districts  in  question  are  on  the  eastern  limits  of  the 
South  Wales  coal-field,  and  comprise  Abertillery,  Blaina, 
and  Nantyglo,  and  Ebbw  Yale.  The  population  may  be 
said  to  be  entirely  a  cottage  population,  and  its  sanitary 
observances  may  be  gathered  from  the  following  descrip¬ 
tion : — A  practically  universal  prevalence  of  sewage  and 
other  filth  nuisances  prevailed,  and  an  all-pervading  damp¬ 
ness  of  soil  and  habitations,  the  latter  often  squalid  and 
overcrowded;  a  water-supply  in  many  parts  totally  insuffi¬ 
cient  for  either  bodily  or  household  cleanliness ;  a  population 
composed  largely  of  children  of  the  age  most  susceptible  to 
scarlatinal  infection,  and  including  many  individuals  long 
exposed  to  privations  ;  a  population,  moreover,  amongst  the 
younger  members  of  which  measles  had  just  extensively 
prevailed.  Even  with  such  a  state  of  things,  existing, 
scarlet  fever  did  not,  the  report  says,  spread  widely,,  and 
had  any  means  for  the  isolation  of  the  early  sufferers  existed, 
the  best  results  might  have  been  anticipated.  Sporadic 
cases  existed  for  months  at  Abertillery  before  the  disease 
became  epidemic,  and  for  some  weeks  only  two  or  three 
families  were  attacked  at  Blaina,  Nantyglo,  and  Ebbw  A  ale. 
The  sanitary  authorities  were,  however,  wholly  unprepared 
to  take  advantage  of  circumstances  so  favourable  to  their 
action.  No  hospital  was  ready,  and  at  no  time  was  any 
attempt  made  to  provide  such  accommodation.  The  medical 
officers  of  health  reported  that  it  was  impossible  to  isolate 
the  sufferers  at  their  own  homes,  and  at  the  time  of  Mr. 
Spear’s  visit,  after  two  years  of  fatal  experience,  free  inter¬ 
course  between  the  sick  and  healthy  was  still  going  on,  and 
children  in  the  desquamative  stage  were  being  carried  from 
house  to  house  in  neighbourly  visits.  In  one  year  (1882)  it 
is  estimated  that  there  were  2200  sufferers,  and  failure  oi 
the  supply  of  susceptible  individuals  was  apparently  the 
sole  limiting  agency.  Enteric  fever  was,  the  report  adds, 
much  more  limited  in  its  diffusion.  During  the  last  two 
years  three  small  localities  suffered  notably— Victoria,  a 
village  of  the  Ebbw  Vale  district,  and  Garnfach,  Nantyglo, 
in  1881,  and  a  few  streets  and  detached  houses  in  Abertillery 
in  1882.  In  Victoria,  in  1881,  the  disease  spread  almost 
from  house  to  house,  and  altogether  seventy  cases  occurred. 
Sewage  nuisances  abounded  in  the  locality,  excrement  was 
being  thrown  into  the  street  gutters,  and  the  spread  of  the 
fever  was  mainly  ascribed  by  the  medical  officer  of  health 
to  the  resulting  excremental  pollution  of  the  atmosphere. 
Concerning  this  outbreak,  it  should  be  remarked  that  one 
fact  elicited  during  the  inquiry — viz.,  that  the  working-lads 
of  this  community  suffered  disproportionately,  and  were 
unusually  often  the  first  to  be  attacked  in  family  invasions 
— received  no  explanation.  At  Garnfach  between  forty  and 
fifty  persons  are  believed  to  have  suffered ;  and  the  outbreak 
in  Abertillery  resulted  in  sixty-one  well-marked  attacks,  of 
which  number  thirteen  proved  fatal.  Diphtheria  was 
present  in  Blackwood,  a  straggling  village  with  the  worst 
of  sanitary  reputations,  and  in  the  neighbouring  hamlets  of 
the  Newport  Rural  District,  in  the  latter  part  of  1881  and  in 
1882.  About  twenty  cases  occurred  in  Blackwood,  the 
attacks  being  invested  with  a  great  deal  of  obscurity,  though 
apparently  the  village  school  played  some  part  in  the  diffu¬ 
sion  of  the  disease. 


Medical  Time?*  and  Gazett*. 


ABSTRACTS  AND  EXTRACTS. 


Dec.  1, 1S83. 


ABSTRACTS  AND  EXTRACTS. 


Solid  Tumours  of  the  Round  Ligament. 

A  becent  number  of  the  Archiv  fur  Gynakologie  contains 
a  careful  paper  on  this  subject  by  Dr.  M.  Sanger,  of  Leipzig. 
These  tumours  belong  to  the  connective  tissue  group,  their 
structure  being  that  either  of  myoma,  fibroma,  sarcoma,  or 
a  combination  of  these.  The  author  has  collected  twelve 
such  cases,  to  which  he  adds  a  hitherto  unpublished  one 
of  his  own.  In  situation,  he  points  out,  they  may  be  either 
intra-peritoneal ,  that  is,  growing  from  the  part  of  the 
round  ligament  which  is  within  the  peritoneal  cavity ; 
intra-canalicular,  i.e.,  in  the  inguinal  canal;  extra-peri¬ 
toneal,  that  is,  arising  from  the  round  ligament  outside  the 
inguinal  canal ;  or  they  may  grow  from  the  abdominal  wall, 
in  such  proximity  to  the  origin  of  the  round  ligament  that 
their  connexion  with  that  structure  may  be  inferred.  The 
third,  or  extra-peritoneal  variety,  are  the  commonest.  Most 
of  them  are  fibroid  in  structure.  In  eight  out  of  ten  of  Dr. 
Sanger’s  cases  the  tumour  was  on  the  right  side ;  and  he 
asks,  Does  this  arise  from  causes  similar  to  those  which 
cause  a  greater  frequency  of  inguinal  hernia  on  the  right 
side  P  He  cannot  trace  a  predilection  for  any  particular  age. 
All  the  patients  had  borne  children.  The  growth  of  these 
tumours  is  usually  slow ;  during  pregnancy  they  seem  to 
increase  with  greater  rapidity,  and  during  the  lying-in 
period  to  undergo  a  temporary  retrogression  or  involution. 
The  only  exciting  cause  that  Dr.  Sanger  can  find,  and  this 
only  in  one  case,  is  long-continued  or  severe  pressure.  The 
growths  themselves  appear  to  cause  no  symptoms  until  they 
get  large,  and  then  they  may  be  painful  and  tender,  and 
cause  symptoms  by  pressure  or  dragging  on  other  parts, 
such  as  dysuria,  ovarian  pain,  constipation,  abdominal  and 
sacral  pain,  etc.  They  may  thus  deteriorate  the  general 
health.  The  diagnosis  is  extremely  difficult;  and  there 
hardly  seem  to  be  sufficient  grounds  for  formulating  any 
diagnostic  points.  The  only  treatment  of  these  tumours  is 
removal.  This  is  called  for  not  only  on  account  of  the 
symptoms  they  cause,  but  also  because  of  their  liability  to 
accidental  injury  and  inflammation  in  consequence  of  their 
superficial  situation. 


Expebihental  Diphthebia. 

A  sebies  of  valuable  experiments  and  investigations  upon 
the  subject  'of  diphtheria  have  lately  been  published  in 
Leipsic  by  Dr.  0.  Heubner,  and  reviewed  in  the  Centralblatt 
fur  Klinische  Medicin,  No.  43, 1883.  Following  the  lines  pre¬ 
viously  traced  by  Treitz,  Oertel,  Weigert,  and  others,  who 
had  already  succeeded  in  the  artificial  production  of  false 
membranes  upon  mucous  surfaces,  he  made  a  series  of  expe¬ 
riments  with  the  view  of  producing  such  artificial  membranes 
in  a  manner  more  resembling  the  natural  processes  of  disease 
than  had  before  been  attempted.  By  modifying  the  blood- 
supply  of  a  2iortion  of  the  mucous  membrane  of  the  bladder 
he  succeeded  in  producing  a  form  of  epithelial  necrosis  with 
the  formation  of  a  definite  membrane  in  every  way  correspond¬ 
ing  to  that  found  in  diphtheria.  By  occluding  a  large  branch 
of  an  artery  for  several  hours,  and  then  restoring  the  circu¬ 
lation,  he  found  that  the  following  changes  were  induced : — 
Inflammatory  oedema  with  detachment  and  vacuolation  of 
the  epithelial  cells,  the  mucous  membrane  becoming  sur¬ 
rounded  writh  an  albuminous  exudation  which  speedily  co¬ 
agulated.  In  about  ten  hours  parts  of  the  tissue  thus 
affected  showed  signs  of  necrosis  ;  in  forty-eight  hours  these 
parts  became  still  further  decolourised,  and  stood  out  as 
yellowish-white  patches  upon  the  surface  of  the  mucous 
membrane.  On  the  edges  of  these  patches  the  surrounding 
healthy  epithelium  was  observed  to  be  thickly  infiltrated 
with  blood  corpuscles.  This  coagulation-necrosis  advanced 
steadily,  gradually  attacking  the  whole  mucous  membrane 
of  the  bladder,  the  hemorrhagic  infiltration  advancing  with  it. 
It  seems  more  than  probable  that  the  production  of  simple 
membranous  croup  in  the  human  subject  may  be  due  to  a 
similar  temporary  arrest  of  circulation  from  spasmodic  con¬ 
traction  of  vessels.  But  from  Heubner’s  experiments  it  must 
be  concluded  that  the  immediate  cause  of  the  local  affection 
of  the  mucous  membrane  in  diphtheria  must  be  temporary 
arrest  and  subsequent  restoration  of  the  circulation.  This, 
however,  is  only  a  small  part  of  the  pathology  of  the  disease. 


By  injecting  into  the  circulation  portions  of  genuine  diph¬ 
theritic  membrane,  it  was  found  that  the  poison  concentrated 
itself  especially  within  the  artificially-produced  patches  of 
membrane,  and  injections  made  with  this  latter  membrane 
were  found  to  be  far  more  fatal  in  their  results  than  were 
those  made  with  the  first  membrane,  produced  by  the  natural 
processes.  Further,  it  was  found  that  injections  of  apparently 
healthy  membrane  in  the  neighbourhood  produced  no  result 
whatever.  That  an  active  poison  must  be  at  work  in  these 
cases  is  almost  certain ;  but  the  question  of  its  nature, 
remains  still  unsettled.  Whether  it  must  be  ranked  with 
the  class  of  septic  poisons,  of  which  Koch  has  enumerated  a 
series,  or  whether  a  genuine  diphtheritic  poison  exists  dis¬ 
tinct  from  these,  cannot  at  present  be  proved,  although 
Heubner’s  experiments  have  fairly  opened  a  way  which  may 
eventually  lead  to  its  discovery. 


COMPARATIVE  MORTALITY  IN'  THE  FRENCH  MARINE 
Infantry  and  the  Army. — In  France  and  Algeria  the 
mortality  in  the  Army  is  8'65  per  1000  men.  In  the  Marine 
Infantry  it  is — in  France,  18'9  per  1000 ;  in  Martinique,  32-2  ; 
in  Guadaloupe,  34-5  ;  in  Senegal,  146'6  ;  in  Reunion,  209  ;  in 
New  Caledonia,  2ST;  and  in  Cochin-China,  97  per  1000. 
These  figures  are  the  means  of  the  eight  years  1872-80,  in¬ 
clusive  ;  and  according  to  them  the  general  mortality  of  the 
French  Marine  Infantry  is  70'7  per  1000.  For  the  officers 
separately,  while  the  mortality  of'  the  Army  is  6\81,  it  is  i  n 
the  Marine  Infantry  39  per  1000. — Lyon  Med.,  October  14. 

An  Old  Practitioner. — It  is  well  known  that  in 
tables  of  mortality  arranged  according  to  occupations 
medical  practitioners  occupy  a  very  unfavourable  position. 
There  are,  however,  exceptions  to  this  law,  and  more  than 
one  example  of  such  is  to  be  found  amongst  the  members 
of  the  French  academies.  Rarely  indeed,  however,  has  such 
a  limit  been  reached  as  that  attained  by  Dr.  Jackimovicz, 
of  Jarvszinka,  in  the  Government  of  Kiew.  This  worthy 
Russian  confrere  has  died  at  the  age  of  106,  and  almost  tc> 
his  last  days  was  able  to  meet  the  exigencies  of  an  important 
practice. — Gaz.  Med.,  November  24.  [The  population  sta¬ 
tistics  of  Russia  supply  so  large  a  proportion  of  cases  of 
great  longevity  as  to  lead  to  the  conclusion  that  that 
country  is  very  exceptionally  placed  in  this  matter,  or  that 
the  figures  are  not  compiled  with  the  accuracy  deemed 
necessary  in  other  parts  of  Europe.] 

Chinese  Hospital  Beds. — “  Without  going  into  de¬ 
tails  of  the  peculiar  arrangements  of  this  hospital,  it  may 
be  admissible  to  state  that  the  character  of  the  beds  is  one 
of  the  most  curious  of  its  features.  They  are  constructed 
of  large  bricks  set  in  mortar,  having  a  fireplace  beneath 
each,  in  which  straw,  hay,  and  brush  are  burned  for  heating 
the  whole.  Thus,  each  patient  has  his  own  fire  by  which 
all  his  food  is  cooked  in  utensils  furnished  by  himself.  Now, 
when  a  Chinaman  takes  to  one  of  these  beds,  which  might 
with  propriety  be  termed  a  brick  oven,  he  immediately  pro¬ 
ceeds  to  divest  himself  of  all  clothing  to  the  skin,  nothing 
remaining  on  the  body  save,  it  may  be,  a  piece  of  cloth 
around  the  loins.  He  then  places  himself  between  two  thick, 
coarse,  plank- like  quilts,  with  his  neck  on  a  wooden  pillow. 
This  is  the  Chinese  fashion  of  preparing  for  and  going  to 
bed,  and  although  it  has  drawbacks,  yet  it  allows,  certainly, 
of  free  inspection  of  the  individual  at  a  moment’s  notice. 
And  let  it  be  remembered  that  for  nearly  half  the  year  the 
climate  of  Tien-Tain  is  arctic  in  severity,  there  being  no 
artificial  heat  in  the  building  save  that  derived  from  the 
burning  brush  or  straw  in  the  small  fireplaces  beneath  the 
so-called  beds.  It  is  not  uncommon  for  operations  of  mag¬ 
nitude  to  be  performed  in  an  almost  freezing  temperature, 
the  patient  being  nearly  nude— this  fact  illustrating  the 
great  vital  powers  of  this  hardy  people.”  The  above  ex¬ 
tract  is  taken  from  an  account  of  "  Medicine  in  China  ”  fur¬ 
nished  by  a  correspondent  of  the  Philadelphia  Medical  News 
(August  25).  The  hospital  he  alludes  to  is  one  erected  at 
Tien-Tain,  the  port  of  Pekin,  by  the  enlightened  and  pro¬ 
gressive  statesman,  the  Viceroy  Li  Hung  Chau,  in  recogni¬ 
tion  of  the  cure  of  a  prolapsus  uteri  occurring  in  his  chief 
wife  by  the  advice  of  Dr.  Mackenzie,  of  the  London  Mis¬ 
sion,  and  the  immediate  intervention  of  Mrs.  Howard,  an 
American  lady-doctor,  practising  in  Pekin.  In  this  article 
he  states  that  the  Chinese  sick  and  insane  poor  are  left 
in  the  most  deplorable  condition,  utterly  unattended  to,, 
except  in  the  foreign  settlements. 


Medical  Times  and  Gazette. 


REVIEWS  AND  NOTICES  OF  EOOKS. 


Dec.  1, 1883.  6  3  3^ 


REVIEWS  AND  NOTICES  OP  BOOKS. 


The  Filaria  Sanguinis  Hominis,  and  certain  New  Forms  of 

Parasitic  Disease  in  India,  China,  and  Warm  Countries. 

By  Patrick  Manson,  M.D.  London :  H.  K.  Lewis. 

1883.  Pp.  182. 

Dr.  Manson  has  rendered  the  profession  a  real  service  by 
putting  together  the  various  papers  on  the  above  subject 
which  have  from  time  to  time  appeared  from  his  pen,  and 
in  the  monograph  before  us  we  have  a  concise  but  perfectly 
clear  account  of  all  that  is  known  about  the  Filaria  sanguinis 
hominis,  and  the  diseases  associated  with  it.  To  Dr.  Manson 
belongs  the  credit  of  having  been  the  first  to  demonstrate 
that  the  parent  worm  resides  in  the  lymphatics,  which  he 
was  enabled  to  do  by  finding  her  protruding  from  the  cut 
end  of  a  lymphatic  vessel  in  an  amputated  scrotum.  Even 
before  this  conclusive  evidence  was  obtained,  “the  lymphatics 
were  credited  with  being  the  proper  habitat  of  the  animal 
and  in  another  passage  we  read,  “  ova,  however,  have  been 
found  in  the  lymph,  and  the  ovum  being  too  large  to  pass 
from  the  outside  to  the  inside  of  a  lymphatic,  and  having  no 
power  to  work  its  way,  the  parent  that  laid  it  must  have 
communicated  directly  with  the  lymphatics.  Again,  in  not 
a  few  instances,  filaria  embryos  have  been  found  in  the 
lymph  discharges  of  individuals  from  whose  blood  not  a 
single  specimen  could  be  obtained  ;  they  could  not,  there¬ 
fore,  have  come  from  the  bloodvessels.  It  may  be  taken  as 
settled  that  the  parent  worm  lives  in  the  lymphatics.'”  The 
embryos  then  are  discharged  into  the  lymphatic  vessels,  and, 
being  very  minute,  they  pass  through  these,  traverse  the 
lymph-glands  to  reach  the  thoracic  duct,  and  so  make  their 
appearance  in  the  blood.  It  is  thus  that  we  may  explain 
the  presence  of  ova  or  embryos  in  the  blood  of  persons  who 
are  apparently  perfectly  healthy,  for  the  worm  may  reside 
for  years  in  the  lymphatics  without  giving  rise  to  any 
symptoms.  For  an  extremely  interesting  account  of  the 
manner  in  which  the  parasite  is  liberated  from  the  blood, 
and  a  description  of  all  that  is  known  of  its  life-history,  we 
must  refer  our  readers  to  the  work  itself.  So  long  as  the 
embryos  do  not  reach  the  lymphatic  vessels  until  they  are 
fully  developed,  all  goes  well;  they  pass  into  the  blood¬ 
vessels,  and  their  existence  causes-  no  inconvenience  to 
their  host;  but  the  ovum  in  its  original  state  is  more 
or  less  round,  and  a  great  deal  larger  than  a  lymph- 
corpuscle,  and,  should  it  be  expelled  prematurely,  we  read — 
“  It  is  not  too  large  to  pass  along  the  vessels ;  but  when 
the  lymph-stream  has  carried  it  to  the  glands  it  is  imme¬ 
diately  arrested,  for  there  the  afferent  vessel  breaks  up 
into  many  very  minute  branches,  which  end  in  the  solid 
parenchyma  of  the  gland.  The  imprisoned  embryo  has  no 
power  to  aid  its  onward  progress  ;  but  the  egg  lies  like  an 
embolus — passive,  plugging  the  vessels,  and  damming  up 
the  lymph.  There  will  then  be  complete  stasis  of  lymph  in 
this  particular  vessel  as  far  back  as  the  first  anastomosing 
lymphatic.  Along  this  the  current  will  now  pass,  carrying 
with  it  other  ova ;  these  in  their  turn  will  be  arrested  at  the 
first  gland  they  reach.  And  this  process  of  embolism,  stasis 
of  lymph,  diversion  of  current  into  anastomosis,  will  go  on 
until  the  whole  of  the  lymphatic  glands,  directly  or  indirectly 
connected  with  the  vessel  into  which  the  parent  parasite 
ejects  her  ova,  are  rendered  impervious,  provided  the  supply 
of  embolic  ova  is  sufficient,  kept  up  long  enough,  or  renewed 
from  time  to  time.”  If  the  worm  be  seated  in  the  lymphatics 
of  the  leg,  the  ova  in  such  a  case  as  we  are  supposing  will 
be  obstructed  at  the  lymphatic  glands  in  the  groin.  When 
all  these  have  become  obstructed,  they  will  be  carried  by 
deep  anastomoses  to  the  other  leg.  When  all  the  glands  of 
both  legs  have  become  blocked,  a  condition  of  elephantiasis 
of  the  leg  or  legs  will  result,  and  also  of  the  scrotum.  If 
the  parent  worm  is  in  the  pelvic  lymphatics,  then,  when  the 
pelvic  and  lymphatic  glands  have  become  obstructed,  we 
should  get  chyluria.  When  the  lymphatics  of  the  over¬ 
distended  scrotum  give  way,  the  condition  known  as  lymph- 
scrotum  is  produced,  and,  in  the  fluid  that  escapes  from  these, 
ova  or  embryos  may  be  found.  Dr.  Manson  was  the  first  to 
call  attention  to  the  fact  that  the  embryos  are  present  in 
the  blood  in  far  greater  numbers  at  night  than  during  the 
day— a  fact  which  Cobbold  has  pithily  described  as  “  filarial 
periodicity.”  The  causes  of  this  are  still  obsure.  It  has 
been  shown  that  neither  temperature,  atmospheric  pressure. 


nor  light  has  anything  to  do  with  it.  Following  up  Dr.. 
Stephen  Mackenzie’s  ingenious  experiment  of  making  the 
patient  keep  awake  at  night  and  sleep  in  the  day.  Dr. 
Manson  finds  “  that  filarial  periodicity  is  maintained  during 
prolonged  watching  ;  and  also  when  the  hours  of  eating  are 
changed,  so  that  the  middle  meal  is  taken  at  midnight,  and 
not,  as  usual,  at  midday;  also  that  prolonged  sleep  pos¬ 
sibly  disturbs  periodicity,  and  diminishes  the  number  of 
parasites  circulating  at  the  time  of  maximum ;  and  that, 
when  the  usual  allowance  of  eight  hours’  sleep  is  taken  in. 
spells  of  four  hours  at  a  time,  at  intervals  of  eight  hours, 
periodicity  is  disturbed,  and  the  numbers  circulating  at  the- 
time  of  maximum  are  sensibly  diminished.”  That  this- 
periodicity  is  not  due  to  intermittent  reproduction,  as  has:, 
been  suggested,  is  proved  by  the  fact  that  the  embryos  are- 
constantly  present  in  the  lymph,  and  that  their  numbers  do. 
not  vary  much ;  and,  on  the  whole.  Dr.  Manson’s  theory  that 
during  the  day  they  retire  to  some  set  of  vessels  (probably 
the  pulmonary  circulation)  seems  the  most  plausible.  His 
chapter  on  the  parasitic  nature  of  elephantoid  diseases,  and 
that  on  the  clinical  evidence  that  these  diseases  are  due  to» 
plugging  of  the  lymphatics  by  ova,  will  well  repay  perusal. 
The  volume  concludes  with  an  account  of  the  Distoma- 
Ringeri  and  Ligula  Mansoni,  but  we  have,  unfortunately,, 
not  space  to  do  more  than  mention  them.  We  cannot  too- 
highly  express  our  opinion  of  the  value  of  Dr.  Manson’s 
investigations,  conducted,  as  they  were,  single-handed  and. 
under  difficulties  to  which  we  in  this  country  are  strangers . 


Annual  Report  of  the  Sanitary  Condition  of  Nottingham  in- • 
1882  :  comprising  an  Account  of  Ten  Years’  Sanitary  Worfc, 
and  its  Effect  uponthe  Public  Health,  as  shown  by  the  Death- 
Rate.  By  Edward  Seaton,  M.D.  Lond.,  M.E.C.P.,  Medical. 
Officer  of  Health,  etc. 

In  112  well-printed  pages,  many  tables,  and  two  maps,  we 
have  at  once  a  report  and  a  history — a  report  of  the  sanitary 
condition  of  Nottingham  in  1882;  a  history,  nay  almost  an 
itinerary,  of  the  growth,  manufactures,  and  topography  of: 
the  restless  growing  city  on  the  banks  of  Trent. 

We  gather  from  these  chronicles  that  the  town  has  beert 
in  some  directions  a  pioneer  in  sanitary  progress  ;  it  was  the 
first  to  possess  a  hospital  for  the  isolation  of  the  infectious 
sick,  and  the  first  to  establish  a  constant  water-supply.  It 
has  grappled  so  successfully  with  the  sewage  difficulty  that 
this  is  utilised,  not  wasted.  The  pail  system,  replacing  the- 
old  middens,  enables  the  Authority  to  sell  to  farmers  60,000 
tons  a  year  of  night-soil  at  a  profit,  while  an  outfall  sewer 
five  feet  in  diameter,  tunnelled  a  mile  and  three-quarters, 
through  a  hill,  carries  liquid  sewage  far  away  to  a  farm,  to- 
be  dealt  with  by  intermittent  irrigation.  Another  great- 
work — an  intercepting  sewer  eleven  miles  in  length  (with  the, 
outfall) — protects  the  river  Leen  from  pollution. 

An  experiment  of  great  interest  has  been  tried  since 
February  22,  1882,  a  clause  in  the  Nottingham  Health 
Improvement  Act  having  been  put  in  force,  under  which 
the  Authority  has  paid  threepence  for  each  certificate  giving 
notice  of  infectious  disease.  Under  this  system,  sixty-three 
medical  men  gave  information  of  over  1500  cases  of  disease, 
many  of  which,  without  doubt,  would  have  been  formerly 
either  concealed  from,  or  not  known  to,  the  Health  Authority. 

Turning  to  the  vital  statistics  of  Nottingham,  it  still 
maintains  its  unenviable  notoriety  as  a  destroyer  of  infant 
life.  The  high  infant  mortality  is  the  prominent  feature  of 
the  death- returns,  and  colours  the  death-rate.  Of  a  thousand; 
children  born,  only  812  survived  their  first  year.  The  deaths 
of  children  under  five  years  of  age  are  99  per  1000  living, 
as  against  65'7  of  the  English  life-table.  Dr.  Seaton  refers- 
the  excess,  not  to  sanitary  conditions,  but  to  maternal 
neglect — truly  a  sad  explanation.  Subtracting  the  deaths- 
of  children  under  five  years  of  age,  the  rates  of  other  ages 
in  nearly  every  case  are  lower  than  those  of  the  English, 
life-table. 

The  ten  years’  summary  is  full  of  interesting  and  clearly 
expressed  information.  The  outcome  of  the  striving  of  the 
scavenging,  disinfecting ;  of  the  pulling  down  of  disease- 
sodden  tenements,  the  building  of  new ;  of  isolation  of  the- 
infectious  sick — and  of  the  continuous  and  varied  labours  of 
many  years,  is  proved  by  Dr.  Seaton  to  be  a  reduction  in 
mortality  of  no  less  than  one  and  a  half  per  1000.  This 
Report  should  be  studied  by  students  and  health  officers. 


640 


Medical  Times  and  Gazette. 


THE  OBSTETRICAL  SOCIETY  OF  LONDON. 


Dec.  1,  1883. 


Tile  one  will  find  a  complete  epitome  of  the  details  of  sani¬ 
tary  work  ;  the  others,  encouragement.  We  also  trust  that 
copies  will  be  presented  to  most  public  libraries  for  preserva¬ 
tion  and  reference. 


A  Memoir  of  John  Deaton  Heaton ,  M.D.,  of  Leeds.  Edited 
by  T.  Wemyss  Reid.  London :  Longmans,  Green,  and 
Co.  1883. 

After  a  distinguished  career  at  University  College  and  the 
University  of  London,  Dr.  Heaton  determined  to  settle  in 
practice  in  his  native  town — Leeds, — and  soon  after  became 
Lecturer  on  Botany  in  the  Medical  School.  He  remained 
connected  with  the  school  in  one  capacity  or  another  for 
thirty-five  years,  and  on  his  final  retirement  from  it  in  1877 
he  received  a  handsome  testimonial  from  his  old  colleagues. 
But  though  he  had  always  been  held  in  the  highest  esteem 
and  respect  by  his  colleagues  and  pupils,  yet  from  a  pro¬ 
fessional  point  of  view  he  did  not  succeed  :  he  never  enjoyed 
-a  large  or  lucrative  practice ,-  and  of  this  he  was  fully  con¬ 
scious.*  This  was  not  due,  however,  to  any  want  of  medical 
"knowledge  or  skill,  for  those  who  consulted  him  recognised  in 
Mm  an  able  and  painstaking  physician.  But  it  is  on  account 
of  his  public  career  rather  than  his  professional  one  that  Dr. 
Heaton  will  be,  and  deserves  to  be,  remembered  in  Leeds. 
For  several  years  he  was  President  of  the  Philosophical 
and  Literary  Society ;  he  was  one  of  the  members  of  the 
first  School  Board  in  Leeds  ;  and  was  one  of  the  earliest  and 
most  ardent  founders  and  supporters  of  the  Yorkshire 
College  of  Science.  These  and  many  other  public  offices 
which  he  filled  must  have  made  great  demands  upon  his 
time,  but  this  he  gave  ungrudgingly,  and  no  man  could 
have  been  more  punctilious  in  the  discharge  of  his  duties 
than  he  was. 


REPORTS  OF  SOCIETIES. 


THE  OBSTETRICAL  SOCIETY  OF  LONDON. 

Wednesday,  November  7. 

Dr.  Gervis,  President,  in  the  Chair. 

Fibroids  removed  by  Abdominal  Section. 

Dr.  Meadows  exhibited  two  specimens  of  sub-peritoneal 
fibroids,  one  weighing  half  a  pound,  the  other  five  pounds, 
successfully  removed  by  abdominal  section. 

Yentral  Pregnancy  treated  by  Abdominal  Section. 

Dr.  Meadows  also  exhibited  a  foetus  successfully  removed 
by  abdominal  section  from  a  suppurating  extra-uterine  cyst. 
The  pregnancy  had  occurred  about  fifteen  months  previously. 
The  cyst  was  stitched  to  the  abdominal  wall,  and  its  cavity 
washed  out. 

Deformed  Pelvis. 

Mr.  W.  S.  A.  Griffith  showed  an  oblique  rachitic  pelvis, 
■occurring  without  spinal  curvature,  and  due,  he  believed,  to 
unequal  length  of  the  legs. 

Dr.  Robert  Barnes  had  figured  in  an  early  volume  of 
the  Transactions  a  similar  case. 

The  President  called  attention  to  the  fact  that  the  half 
of  the  sacrum  corresponding  to  the  shorter  leg  was  smaller 
than  the  ojther,  although  no  synostosis  of  the  sacro-iliac 
joint  existed. 

Cesarian  Section. 

Dr.  Godson  presented  (for  Dr.  R.  P.  Harris)  a  table  of 
■cases  in  which  Caesarian  section  had  been  performed  twice 
■on  the  same  patient,  and  exhibited  photographs  of  a  patient 
and  her  children. 

Dysmenorrhceal  Membrane. 

Dr.  Wynn  Williams  exhibited  a  fibrinous  cast  of  the 
uterus  (dysmenorrhceal  membrane)  passed  without  pain  by 
a  patient. 

Reports  of  Committees. 

The  reports  of  committees  appointed  to  examine  specimens 
;£hown  at  former  meetings  were  then  read. 

Three  Cases  of  Pyosalpinx. 

This  paper,  by  Mr.  Lawson  Tait,  was  then  read.  The 
author  related  three  cases  of  acute  peritonitis  due  to  pyo¬ 


salpinx  cured  by  abdominal  section,  removal  of  the  diseased 
appendages,  cleansing  and  draining  of  the  peritoneum.  The 
first  case  was  one  of  chronic  pyosalpinx  made  acute  by  a 
stem  pessary.  The  tube  burst,  and  acute  peritonitis  fol¬ 
lowed.  Abdominal  section  was  promptly  performed,  and 
the  patient  saved.  Mr.  Tait  quoted  the  remarks  of  the 
gentleman  who  sent  the  case  to  him,  as  to  the  effect  of  the 
mechanical  treatment  in  causing  the  disease,  the  difficulty 
in  discriminating  the  cases  suitable  for  treatment  by  stem 
pessaries,  and  the  dangers  of  these  instruments.  The 
second  case  had  already  been  published  in  the  British  Medical 
Journal  of  February  17,  1882,  and  was  brought  forward  here 
for  the  purpose  of  recording  the  subsequent  history,  which 
was  that  all  the  symptoms  had  vanished,  and  the  patient 
was  now  perfectly  well.  The  third  case  was  one  of  purulent 
peritonitis  arising  from  rupture  of  a  suppurating  Fallopian 
tube.  The  pyosalpinx  was  due  to  gonorrhoeal  infection. 
The  left  tube  only  was  removed.  The  patient  recovered 
completely.  Mr.  Tait  had  now  operated  on  sixty-five  cases 
of  occlusion  and  distension  of  the  Fallopian  tube  without  a 
death.  In  only  one  had  there  been  failure  to  completely 
relieve  the  patient’s  sufferings.  Six  cases  had  been  lost 
sight  of,  and  two  had  died  since  the  operation,  from  causes 
independent  of  it.  The  author  remarked  that  cases  such  as 
these  could  not  be  relieved  by  anything  short  of  removal 
of  the  diseased  organs ;  and  that  they  existed  in  large 
numbers,  forming  a  large  proportion  of  the  cases  which 
wander  about  from  one  practitioner  to  another,  seeking 
relief.  He  also  complained  of  some  unjust  and  ungenerous 
criticisms  which  were  frequently  repeated  to  him,  and  he 
asked  those  who  expressed  such  views  to  come  and  see  his 
work. 

Dr.  Wynn  Williams  protested  against  the  use  of  a  stem 
pessary  in  such  a  case  as  the  one  related.  If  harm  followed 
the  use  of  a  stem  in  such  a  case,  the  blame  should  be  laid 
on  the  practitioner,  not  on  the  instrument.  He  presumed 
the  pyosalpinx  was  not  attributed  to  the  stem,  as  it  must 
have  been  there  previous  to  the  insertion  of  the  instru¬ 
ment. 

Mr.  Doran  believed  that  suppuration  of  the  Fallopian 
tube  was  sometimes  caused  by  the  introduction  of  a  dirty 
sound  into  the  uterine  cavity,  conveying  septic  matter 
therein,  and  setting  up  a  low  form  of  inflammation. 

Dr.  Robert  Barnes  said  that  Mr.  Lawson  Tait  had  opened 
out  a  new  field  in  abdominal  surgery.  It  was  to  be  expected 
that  there  would  be  opposition  to  his  views.  Everyone  must 
have  seen  cases  like  those  described  by  Mr.  Tait,  and  his 
statistics  proved  that  they  were  amenable  to  surgical 
treatment. 

Dr.  W.  A.  Duncan  asked  Mr.  Tait  whether  in  many  of 
his  cases  the  tubes  were  fixed  by  adhesions,  and,  if  so,  whether 
the  operation  was  made  much  more  difficult  ?  He  had  re¬ 
cently  seen  two  cases  of  pyosalpinx :  in  one,  the  left  tube 
ruptured  into  the  vagina ;  in  the-  other,  a  very  characteristic 
left  pyosalpinx  entirely  disappeared. 

The  President  thought  Mr.  Tait  took  somewhat  too 
gloomy  a  view  of  the  prognosis  in  cases  of  tubal  distension. 
Some  cases,  possibly  of  hydrosalpinx,  certainly  got  better 
without  operation.  He  thought  that  whatever  induced  endo¬ 
metritis  might  lead  to  tubal  inflammation.  He  asked  for 
further  information  as  to  the  diagnosis  of  these  cases.  He 
thought  that  this  operation,  though  the  latest,  was  not  the 
least  important  of  r.ecent  advances  in  abdominal  surgery. 

Dr.  Horrocks  asked  how  it  was  that  these  cases  were  not 
more  often  seen  on  the  post-mortem  tables  of  large  hospitals. 
If  they  were  so  common  as  Mr.  Tait  thought,  was  it  not 
probable  that  most  of  them  got  well  without  operative 
interference  P 

Dr.  Fancourt  Barnes  congratulated  Mr.  Tait.  He  now 
recognised,  by  the  light  thrown  by  Mr.  Tait,  several  cases 
of  pyosalpinx.  He  believed  he  had  such  a  case  now  under 
care. 

Dr.  Graily  Hewitt  thought  the  affection  described  by 
Mr.  Tait  was  not  a  common  one.  Another  cause,  not  men¬ 
tioned,  was  occlusion  of  the  canal  of  the  cervix  uteri.  He 
mentioned  a  case  in  illustration. 

Mr.  Knowsley  Thornton  asked  for  the  respective 
numbers  of  the  cases  of  hydrosalpinx  and  pyosalpinx.  He 
could  not  admit  that  hydrosalpinx  was  a  grave  condition ; 
he  had  met  with  it  often  in  performing  ovariotomy,  and 
believed  that  its  bursting  caused  little  or  no  disturbance, 
and  was  a  common  mode  of  its  natural  cure.  Pyosalpinx 


Medical  Times  and  Gazette. 


THE  CLINICAL  SOCIETY  OF  LONDON. 


Dec.  1,  1883.  641 


was  more  serious,  but  he  believed  it  was  often  cured  by  dis¬ 
charging  into  the  uterus.  The  distinction  between  these 
two  conditions  was  therefore  of  much  importance,  and  he 
asked  for  information  as  to  the  diagnosis  between  them. 
He  had  twice  operated  for  pyosalpinx,  and  in  neither  case 
were  there  more  than  slight  adhesions. 

Hr.  Matthews  Owens  had  seen  some  fifteen  of  these 
operations,  and  could  vouch  for  the  great  good  done  by  them. 
He  believed  that  many  cases  of  so-called  hysteria  would 
now  prove  to  be  due  to  disease  of  the  Fallopian  tube.  He 
mentioned  a  case  in  illustration.  Such  cases  were  not  re¬ 
corded  in  post-mortem  records,  because  they  were  put  down 
as  peritonitis.  The  difficulty  of  diagnosis  of  these  cases  was 
a  drawback.  But  the  risk  of  an  exploratory  incision  was 
nil,  and  the  result,  if  pyosalpinx  were  found,  brilliant. 

Hr.  Galabin  inquired  as  to  the  tube  and  the  fluid  used 
for  drainage  and  washing  out  the  abdomen. 

Hr.  Murray  remarked  on  the  importance  of  diagnosis, 
and  congratulated  Mr.  Tait.  He  thought  the  Lock  Hos¬ 
pital  might  afford  opportunity  for  verifying  the  supposed 
influence  of  gonorrhoea. 

Hr.  Hetwood  Smith  asked  whether,  in  cases  of  hydro¬ 
salpinx,  aspiration  should  not  be  preferred  to  the  major 
operation  ? 

Mr.  Lawson  Tait  said  the  words  condemning  the  stem 
pessary  were  not  his  own.  He  had  known  gonorrhoea  given 
by  a  dirty  speculum,  and  thought  it  might  be  given  by  a 
dirty  sound.  If  he  were  called  to  a  case  of  puerperal  peri¬ 
tonitis  sufficiently  early  to  promise  a  good  result,  he  would 
open  the  abdomen,  wash  out  and  drain  the  cavity;  but 
as  yet  he  had  not  had  a  chance  of  doing  this.  He  had  no 
doubt  that  many  cases  of  hydrosalpinx  and  some  of  pyo¬ 
salpinx  were  cured  by  natural  processes.  In  diagnosis,  he 
depended  largely  on  the  history,  which  started  from  an 
inflammatory  attack.  There  was  more  or  less  constant  pain, 
aggravated  by  movement  and  by  intercourse,  and  menor¬ 
rhagia;  and  there  were  physical  signs  of  pelvic  changes. 
Errors  in  diagnosis  occurred  in  his  practice  about  once  in 
ten  times,  and  were  always  instructive.  He  mentioned 
cases  in  which  he  had  taken  for  pyosalpinx  a  small  dermoid 
cyst.  In  these,  the  initial  point  in  the  history  was  the  only 
thing  wanting.  Cases  of  pyosalpinx  were  not  seen  in  hos¬ 
pital  post-mortem  rooms  because  they  commonly  died  from 
peritonitis  too  quickly  to  come  into  hospital.  They  were, 
however,  exceptionally  seen  in  hospitals.  Hydrosalpinx 
and  pyosalpinx  occurred  in  his  practice,  he  thought,  in 
the  proportion  of  about  three  to  two.  Hydrosalpinx  was  not 
dangerous  to  life,  but  often  caused  intense  suffering,  and 
therefore  he  did  not  hesitate  to  remove  it.  He  did  not  think 
its  rupture  ever  likely  to  prove  fatal.  The  differential 
diagnosis  between  the  two  could  not  be  made.  He  used  a 
glass  drainage-tube  and  washed  out  the  abdomen  with  plain 
water.  He  expressed  his  gratification  at  the  reception  of 
his  paper. 

A  Case  or  Idiopathic  Gangrene  op  the  Uterus. 

This  paper,  by  Mr.  Lawson  Tait,  was  then  read.  The 
patient,  aged  thirty-four,  was  admitted  into  hospital  on 
account  of  vague  pelvic  pain  and  offensive  watery  discharge. 
The  uterus  felt  soft  and  flabby,  the  abdomen  was  swollen, 
and  there  were  feverish  symptoms.  The  patient  died  forty 
days  afterwards,  and  on  post-mortem  the  uterus  was  found 
a  black,  sloughing,  stinking  mass,  having  only  about  a  square 
inch  of  normal  tissue.  No  reason  could  be  discovered  for 
the  gangrene.  No  operative  treatment  was  permitted,  or 
else  it  would  probably  have  been  quite  easy  to  remove  the 
dead  uterus  by  abdominal  section. 

An  Undescribed  Hisease  op  the  Fallopian  Tubes. 

Mr.  Lawson  Tait  also  contributed  the  following  case. 
The  patient,  aged  thirty-six,  suffered  from  constant  pelvic 
pain  aggravated  during  menstruation  and  after  marital 
intercourse,  and  was  much  emaciated  and  haggard.  She 
had  had  much  fruitless  medical  treatment.  There  were  no 
physical  signs  of  pelvic  disease,  except  great  tenderness. 
Mr.  Tait  made  an  exploratory  incision,  and  found  the  fim¬ 
briae  of  the  tubes  adherent  by  curious  little  nodules  like 
millet-seeds.  He  therefore  removed  the  uterine  appendages, 
with  the  result  of  completely  restoring  the  patient  to  health. 
The  nodules  had  been  examined  by  Mr.  F.  S.  Eve,  who 
reported  that  he  could  offer  no  opinion  as  to  their  origin  or 
nature,  but  that  they  were  neither  cartilage  nor  bone. 


THE  CLINICAL  SOCIETY  OF  LONDON. 

Friday,  November  23. 

Sir  Andrew  Clark,  Bart.,  President,  in  the  Chair. 

Cases  of  Thickened  Epidermis  treated  by  Salicylic 

Plaster. 

Hr.  George  Thin  gave  an  account  of  cases  of  thickened 
epidermis  treated  by  salicylic  gutta-percha  plaster.  The 
plaster  which  he  used  was  manufactured  by  Herr  Beiersdorf,. 
of  Hamburg,  at  the  suggestion  of  Hr.  Unna,  who  had  intro¬ 
duced  it  into  practice.  Case  1  was  that  of  an  adult  man,  in 
whom  a  tendency  to  extreme  tylosis  of  the  soles  and  palms 
was  hereditary.  The  palms  and  soles  in  this  man’s  case  were 
covered  with  an  extremely  thick  and  hard  epidermis,  and 
had  been  for  many  years  in  this  condition,  the  affection 
having  resisted  very  varied  methods  of  treatment.  The 
treatment  by  the  plaster  was  in  the  first  instance  recom¬ 
mended  by  Hr.  Unna,  and  the  author  simply  continued  Hr. 
Unna’s  treatment.  Under  the  use  of  the  salicylic  plaster, 
which  was  kept  constantly  applied  by  means  of  bandages, 
and  changed  every  third  or  fourth  day,  the  hard  layer  of 
epidermis  came  off  in  one  mass,  leaving  a  delicate  rose- 
coloured  epidermis  behind  it.  There  was  neither  pain  nor 
inconvenience  connected  with  the  use  of  the  plaster,  and 
the  patient,  a  business  man  actively  employed,  was  able  to- 
follow  his  usual  avocation  without  interruption.  Case  2. — A 
gentleman,  aged  seventy-two,  who  had  always  been  healthy, 
was  unable  to  walk  for  a  period  of  six  or  seven  months  on  ac¬ 
count  of  an  attack  of  sciatica.  When  the  sciatica  was  relieved 
he  somewhat  suddenly  resumed  his  professional  employment 
in  the  City,  which  at  the  time  involved  a  good  deal  of  walking- 
on  the  hard  pavement.  The  result  was  that  the  soles  of 
both  feet  became  hot  and  tender,  and  after  a  few  weeks  the 
skin  of  the  ball  of  each  foot  became  hard  and  horny. 
When  he  consulted  the  author  this  condition  had  lasted  for 
about  seven  years,  and  gave  rise  to  much  pain  and  dis¬ 
comfort.  The  whole  of  the  surface  of  the  ball  of  one  foot 
and  part  of  the  surface  of  the  other  were  covered  with  a 
layer  of  epidermis  of  extreme  hardness.  In  this  hard 
layer  there  were  small  isolated  horny  formations  of  the  - 
nature  of  corns,  which  produced  the  same  sensation  as  if 
the  patient  were  walking  on  shot  or  on  small  hard  stones. 
The  first  treatment  recommended  was  the  application  of 
strong  solutions  of  potash  and  scraping  with  a  sharp  spoon, 
and  wearing  a  horse-hair  pad  in  a  large  boot.  This- 
alleviated  the  condition,  but  the  application  required  to  -be 
frequently  repeated.  The  salicylic  plaster  relieved  the 
condition  for  several  months  at  a  time.  Case  3. — In  a  gentle¬ 
man,  aged  forty-three,  the  palmar  surface  of  the  right  fore¬ 
finger  had  been  covered  for  years  by  a  thick,  hard,  fissured 
epidermis.  This  morbid  formation  had  been  removed  by 
the  salicylic  plaster,  and  the  skin  of  the  finger  had  remained 
normal  when  the  patient  was  seen  by  the  author  nine- 
months  afterwards.  Case  4. — A  gentleman,  aged  forty,  had 
suffered  from  the  condition  of  his  heels  for  about  twenty 
years.  It  had  begun  by  the  skin  being  red,  tender,  and 
scaly,  and  the  hardness  had  gone  on  progressively  increasing. 
The  condition  had  been  on  several  occasions  mistaken  for 
syphilis,  and,  amongst  other  methods  of  treatment  which 
had  been  employed  in  vain,  several  antisyphilitic  courses, 
were  to  be  reckoned.  When  seen  by  the  author  the  skin  of 
both  heels  was  covered  by  thick,  hard,  horny,  uneven  masses,, 
which  rendered  walking  very  painful.  Solutions  of  potash, 
and  a  scraper,  which  were  first  recommended,  had  been  used 
faithfully  for  a  year  almost  daily,  but  with  only  temporary 
alleviation.  When  the  author  became  acquainted  with  the 
specific  action  of  the  salicylic  plaster  it  was  recommended 
to  the  patient.  Although  by  its  use  the  tendency  to  horny 
formation  was  not  removed,  yet  the  hard  masses  had  been 
completely  got  rid  of,  the  patient  could  walk  with  comfort, 
and  with  the  occasional  use  of  the  plaster  the  fresh  forma¬ 
tion  of  hard  masses  was  avoided.  The  author  regarded  the 
condition  of  which  these  cases  were  examples  as  being 
essentially  allied  to  eczema.  The  formative  power  of  the 
epithelium  was  injured  mechanically  or  otherwise,  and  an 
imperfectly  formed  epidermis  resulted.  By  its  solvent  power 
on  horny  epidermis,  salicylic  acid  incorporated  with  gutta¬ 
percha,  as  in  Beiersdorf’s  plaster,  freed  the  skin  from  an 
adherent  irritating  mass,  and  the  deeper  layers  of  the  rete 


THE  CLINICAL  SOCIETY  OF  LONDON. 


Dec.  1, 1883. 


-1  Medical  Times  and  Gazette. 


mucosum  were  placed  in  more  favourable  conditions  for 
(regaining  their  physiological  properties. 

The  President  asked  for  further  particulars  as  to  the 
(structure  of  the  plaster  employed.  Noting  Dr.  Thin’s 
statement  that  different  classes  of  warts  were  differently 
.affected  by  the  treatment*  he  asked  for  further  information 
upon  that  point  also. 

Dr.  Thin  replied  that  the  good  results  were  generally 
■obtained  in  the  case  of  large  ragged  warts,  whether  treated 
by  salicylic  plaster  or,  as  in  some  cases,  by  a  saturated 
solution  of  salicylic  acid  in  alcohol.  The  exact  quantity  of 
-the  acid  contained  in  the  plaster  was  not  known.  These 
plasters  were  peculiar  in  being  spread  upon  gutta-percha, 
which  might  in  itself  be  an  element  in  the  success  of  the 
treatment,  part  of  the  effect  of  the  plaster  being  due  to  the 
■maceration  of  the  tissue  beneath  it. 

Mr.  Butlin,  speaking  partly  on  behalf  of  Mr.  T.  Smith, 
referred  to  the  action  of  salicylic  acid  in  cases  of  carcinoma, 
-and  mentioned  the  success  obtained  by  Mr.  Smith  in  the 
treatment  of  an  obstinate  wart  of  long  standing  by  a 
saturated  alcoholic  solution  of  the  acid.  In  cases  of  ulcerat¬ 
ing  carcinoma  and  rodent  ulcer  he  had  had  equal  success 
subsequently.  Mr.  Butlin  had  not  himself  tried  the  treat¬ 
ment  in  cases  where  the  disease  had  already  attacked  sub¬ 
cutaneous  tissues. 

Mr.  Morrant  Baker  referred  to  a  case  of  non-syphilitic 
warts  in  which  salicylic  cream  (the  acid  rubbed  up  with 
waseline)  had  been  applied  with  far  more  success  than  had 
■attended  other  modes  of  treatment.  A  saturated  solution  of 
the  acid  in  collodion  had  been  used  and  sold  under  the  name 
■of  “  Solvine.” 

Dr.  Thin,  in  reply,  stated  that  he  had  had  no  opportunity 
■of  trying  salicylic  acid  in  cases  of  carcinoma. 

A  Typical  Case  op  Myxcedema. 

Dr.  Drewitt  exhibited  a  case  of  myxcedema  in  a  woman, 
aged  forty-five,  who  had  been  an  out-patient  at  the  West 
London  Hospital  during  the  last  year.  The  disease  was  of 
twelve  years’  standing,  dating  from  a  time  when  the  woman 
lost  her  husband  and  one  of  her  children.  At  that  time 
sshe  was  slightly  built  and  active,  but  since  then  she  had  gra¬ 
dually  become  stout  and  heavy,  slow  and  languid  and  feeble 
in  moving,  slow  and  deliberate  and  indistinct  in  her  speech. 
She  would  now  give  anything  to  be  able  to  move  or  speak  as 
readily  as  she  once  did.  She  was  afraid  of  going  about  alone 
'lest  she  should  be  run  over,  and  she  could  hardly  lift  her  feet 
high  enough  to  get  upstairs.  She  was  always  cold,  even  in 
■summer,  and  never  perspired.  Her  bowels  were  obstinately 
•confined.  There  was  dyspepsia,  and  she  had  partly  lost  the 
-senses  of  taste  and  hearing.  All  the  characteristics  of  the 
disease  were  present— the  generally  swollen  look;  the  round 
•and  fat  face  ;  the  sallow,  translucent,  wax-like  skin,  broad 
■nose,  and  thick,  coarse,  purple  lips  ;  on  the  cheeks  was  the 
same  peculiar  dusky  reddish-purple  colour,  caused  by  dilated 
-capillaries  and  veins.  The  eyelids  were  pendulous  and  trans¬ 
parent  ;  the  tongue,  which  was  pale,  swollen,  smooth,  and 
tooth-marked,  was  too  large  for  the  mouth,  and  more  “  cre- 
itinoid ”  than  the  intellect;  the  soft  palate  was  also  swollen 
nnd  pale.  The  abdomen  was  greatly  enlarged,  as  if  from 
growth  of  fat ;  the  swelling,  in  fact,  was  universal,  but  there 
was  nowhere  pitting  on  pressure.  The  skin  of  hands  and 
•arms  was  rough  and  scaly,  as  in  xeroderma.  The  hands  were 
thick,  and  swollen,  and  could  no  longer  be  clasped ;  the 
wedding-ring  had  become  embedded  in  the  swollen  finger, 
and  had  been  cut  out.  Pulse  76,  feeble.  Heart-sounds  dis¬ 
tant,  feeble  ;  no  murmur.  Temperature  in  axilla  only  95°. 
Urine  :  Specific  gravity  1011 ;  no  albumen  or  sugar.  Dr. 
Drewitt  remarked  that  the  spade-like,  clumsy  hand  had  been 
especially  noticed  by  Sir  William  Gull  in  his  paper  read 
‘before  this  Society,  describing  the  disease  for  the  first 
just  ten  years  ago;  but  he  thought  that  the  most 
striking  physical  peculiarities  were  the  pendulous  eyelids, 
like  alabaster  in  translucency,  and  the  purple,  pouting  lips. 
Tranquillity  was  also,  in  those  few  cases  he  had  seen,  a  most 
marked  characteristic — tranquillity  of  mind,  undisturbed 
by  emotion ;  tranquillity  of  body,  undisturbed  by  change 
«of  expression,  or  by  any  sudden  speech  or  movement. 
Though  painfully  conscious  of  their  own  state,  there  was 
no  irritability.  He  once  travelled  in  an  omnibus  for  some 
miles,  sitting  opposite  to  a  woman  with  this  disease,  and 
though  she  noticed  all  that  was  going  on,  the  face  remained 
like  that  of  a  statue,  absolutely  unaffected  by  any  of  the 


little  changes  of  expression  through  which  the  faces  of  others 
are  continually  going,  in  response  either  to  their  thoughts  or 
to  the  world  around  them.  As  to  the  pathology,  Dr.  Ordhad 
described  the  post-mortem  appearances.  The  whole  connec¬ 
tive  tissue  of  the  body  had  been  found  swollen  and  jelly-like, 
and  oedematous  with  mucin.  This  swelling  seemed  sufficient 
to  account  for  all  the  symptoms.  The  heart  and  arteries 
were  obstructed  by  it,  and  hence  the  feeble  blood-current, 
the  deficient  aeration  of  the  blood,  and  the  purple  of  the 
cheeks  and  lips.  The  tongue  and  palate  were  swollen  with 
it,  the  intestine  choked  by  it,  the  senses  dulled,  the  functions 
of  organs  interfered  with,  and  the  patients  died  with  all 
their  tissues  smothered  by  their  own  padding.  In  treat¬ 
ment  of  this  patient  he  had  found  strychnia  of  the  most 
value,  and  both  muscular  movement  and  speech  had  in¬ 
creased  in  briskness  under  it.  In  the  appearance  of  the 
patient,  however,  there  had  been  no  improvement.  As  to 
the  origin  of  the  disease,  it  had  been  perhaps  rightly 
ascribed  to  nerve  influence.  Great  anxiety  or  mental 
shock  had  occurred  at  the  beginning  of  many  cases.  In 
Dr.  Ord’s  first  case,  as  in  the  one  now  before  the  Society, 
it  followed  upon  the  fatal  illness  of  a  husband.  In  Dr. 
Cavafy’s  first  case  it  followed  a  shock ;  in  his  second,  a  bad 
time  at  childbirth.  Dr.  Duckworth’s  second  patient  men¬ 
tioned  that  it  came  on  after  her  husband  had  kicked  and  ill- 
treated  her.  Dr.  Semon’s  patient  had  fourteen  children  and 
some  miscarriages  in  a  “comparatively  short  time.”  Great 
mental  anxiety  or  distress  profoundly  depressed  vitality. 
The  secretion  of  gastric  juice,  saliva,  bile,  were  all  influenced 
by  emotion  ;  mental  shock  was  given  as  a  cause  of  atrophy  of 
the  liver ;  and  syncope  might  follow  bad  news :  therefore  it 
would  not  be  wonderful  if  it  should  be  shown  that  the  nutri¬ 
tion  of  the  connective  tissues  of  the  body  were  altered  in  that 
way.  Sir  William  Gull,  in  his  paper,  had  alluded  to  the 
changes  in  the  thyroid  in  true  cretins.  It  would  be  interest¬ 
ing  to  know  whether  instances  either  of  atrophy  or  hyper¬ 
trophy  of  the  thyroid  had  been  observed  in  any  of  these 
cretinoid  cases.  Our  knowledge  of  the  whole  subject  was 
still  in  its  infancy,  and  it  was  impossible  not  to  believe,  when 
such  a  definite,  well-marked  disease — the  cases  of  which  were 
so  like  each  other,  and  so  unlike  anything  else — had  existed 
so  long  unrecognised  among  us,  that  there  might  not  be  many 
more  facts  about  it  to  be  discovered,  only  less  important  than 
the  discovery  of  the  disease  itself. 

The  President  suggested  that,  before  a  discussion  com¬ 
menced  upon  the  subject  of  myxcedema,  a  further  communi¬ 
cation  might  with  advantage  be  interpolated,  and  he  called 
upon 

Dr.  Felix  Semon,  who  reminded  the  Society  that  a  paper 
had  lately  been  published  by  Prof.  Koclier  in  Berlin  on  the 
subject  of  “  Extirpation  of  G-oitre  and  its  Consequences,” 
recording  his  experience  of  101  cases  of  such  extirpation. 
In  1874,  Prof.  Kocher’s  attention  had  been  called  to  certain 
peculiar  changes  which  had  been  observed  to  occur  in  one 
of  the  cases  upon  whom  he  had  operated.  Knowing  nothing 
of  the  disease  myxoedema  at  that  time,  he  was  struck  with 
the  cretinoid  condition  produced  in  his  patient,  and  forth¬ 
with  proceeded  to  communicate  as  far  as  it  was  possible 
with  the  other  cases  upon  whom  he  had  operated.  In  some 
of  these  cases  only  a  part  of  the  thyroid  gland  had  been 
removed,  and  of  these  he  was  able  to  find  twenty-eight 
patients  who  had  not  only  experienced  relief  from  their  im¬ 
mediate  trouble  of  dyspnoea,  but  had  continued  in  good 
health  afterwards.  Of  eighteen  cases  in  which  the  gland 
had  been  completely  extirpated,  only  two  patients  had  been 
improved  in  health,  and  of  these,  one  was  found  to  have  had  a 
small  accessory  thyroid  gland  which  had  escaped  observation, 
and  had  undergone  subsequent  hypertrophy ;  the  other,  owing 
to  incompleteness  of  the  operation,  had  still  a  small  portion 
of  the  thyroid  left  intact.  In  the  remaining  cases  Dr.  Kocher 
had  found  that  a  progressive  condition  of  ill-health  had 
been  observed,  the  symptoms  of  which  corresponded  exactly 
with  those  of  myxoedema  as  we  know  it  at  present.  In  some 
of  the  cases,  and  especially  in  the  younger  patients,  mental 
activity  had  not  been  much  retarded,  full  consciousness  being 
retained  of  the  progressive  loss  of  bodily  and  mental  power. 
Anaemia  was  a  very  general  condition,  a  diminution  in  the 
number  of  red  corpuscles  and  slight  augmentation  of  the 
number  of  white  cells  being  occasionally  observed.  The 
occurrence  of  albumen  in  the  urine  was  rare.  The  only 
change  observed  in  the  retina  was  slight  general  narrowing 
of  the  arteries.  One  point  of  difference  in  the  etiology  of 


Medical  Times  and  Gazette. 


THE  CLINICAL  SOCIETY  OF  LONDON. 


Dec.  1,1883.  64$ 


the  disease  in  these  cases,  as  compared  with  others  previously 
recorded,  was  its  occurrence  in  young  children  as  well  as  in 
adults.  Dr.  Kocher  had  called  his  cases  cachexia  after  extir¬ 
pation  of  the  thyroid  gland,  and  had  suggested  the  theory  that 
the  changes  observed  were  due  to  the  absence  of  that  organ. 
Dr.  Semon  then  referred  to  a  case  of  his  own  in  which  the 
thyroid  body  had  been  removed  by  Mr.  Lister  three  years 
ago,  and  in  which  no  other  symptoms  than  swelling  of  eye¬ 
lids  and  general  anaemia  had  yet  shown  themselves.  He 
stated  his  own  belief  that  the  cachexia  after  removal  of  the 
thyroid,  the  cretinoid  condition,  and  myxoedema  were  not 
distinct  diseases,  but  rather  different  phases  of  the  same. 
Although  speculation  as  to  the  causation  of  the  disease  must 
be  regarded  as  premature,  he  threw  out  the  suggestion  that 
the  thyroid  body  had  some  direct  influence  upon  the  proper 
formation  of  the  blood,  and  that,  when  this  influence  is  by 
any  means  withdrawn,  a  tendency  on  the  part  of  the 
tissues  of  the  body  became  manifest  to  form  lowly  organised 
matter,  such  as  that  of  which  myxoedematous  material 
consisted,  instead  of  the  true  physiological  tissue  peculiar 
to  the  part. 

The  President  mentioned  that  in  his  own  cases  of 
myxoedema  he  had  observed  that  the  quantity  of  urea  pre¬ 
sent  in  the  urine  was  liable  to  variation  at  different  periods, 
sometimes  increasing  considerably,  and  at  others  decreasing. 

Sir  W.  Gull,  in  response  to  a  call  from  the  President, 
said  that  he  was  not  able  to  contribute  any  further  informa¬ 
tion  upon  the  disease.  He  considered  that  the  profession 
was  greatly  indebted  to  Dr.  Ord  for  the  light  that  he  had 
thrown  upon  the  pathological  aspect  of  the  affection  ;  but 
with  regard  to  its  mode  of  origin  we  were  still  unable  to 
speak  with  confidence.  If  it  was  of  a  neuropathic  nature, 
was  its  origin  central  or  peripheral  ?  He  pointed  out  that 
the  late  Dr.  Hilton  Fagge,  in  his  paper  on  “  Sporadic 
Cretinism  ”  in  the  Medico-Chirurgical  Transactions  for  1871, 
had  mentioned  the  fact  that  in  most  cretins  the  thyroid 
gland  had  become  atrophied,  and  had  suggested  a  possible 
connexion  between  the  two  conditions.  The  cases  com¬ 
municated  to  the  Society  by  Dr.  Semon  appeared  to  bear 
out  the  truth  of  this  suggestion.  The  question,  however, 
still  remained,  did  the  disease  become  developed  as  a  con¬ 
sequence  of  the  changes  in  the  thyroid,  or  must  the  altera¬ 
tion  of  the  tissues  be  regarded  as  the  primary  manifestation  ? 
That  the  removal  of  a  single  gland  should  produce  such 
definite  changes  was  no  doubt  remarkable,  but  not  more 
remarkable  than  were  the  changes  at  present  observed  to 
result  from  the  removal  of  the  ovary  or  the  testes.  If  a 
simply  nervous  origin  must  be  found  for  the  disease, 
it  would  have  to  be  classed  among  the  tropho-neurotic 
affections. 

Dr.  Ord,  who  had  communicated  with  Dr.  Kocher  after 
the  publication  of  his  paper,  calling  his  attention  to  the 
similarity  between  his  cases  and  those  of  myxoedema,  had 
received  a  reply,  parts  of  which  he  read.  The  writer,  having 
compared  the  cases,  expressed  no  doubt  as  to  the  analogy 
between  them.  The  atrophy  of  the  thyroid  was  a  most  im¬ 
portant  point.  At  first  he  had  been  led  to  believe  that  the 
affection  in  his  own  cases  was  confined  to  children,  but  he 
had  subsequently  met  with  it  in  adults.  The  operation  of 
extirpation  itself  might  possibly  be  held  to  have  some  in¬ 
fluence  in  producing  the  results,  as  it  was  not  unlikely  that 
some  injury  might  be  at  the  same  time  inflicted  upon  the 
fibres  of  the  sympathetic  nerves.  Dr.  Ord  considered  that  the 
outcome  of  Dr.  Kocher’ s  cases  pointed  in  the  same  direction 
as  did  the  previous  observations  of  Sir  W.  Gull,  Mr.  Curling, 
Dr.  Fagge,  and  himself,  viz.,  that  atrophy  of  the  thyroid 
gland  was  directly  associated  with  cretinism.  He  referred 
to  Dr.  Fagge’s  observation  that  people  with  large  goitres 
were  not  cretins.  He  himself  had  found  in  some  cases  of 
myxoedema  the  thyroid  larger  than  normal,  and  in  one  case 
had  observed  a  history  of  exophthalmic  goitre  preceding 
myxoedema.  Possibly  enlargement  of  the  gland  might  be 
accompanied  by  such  alteration  of  function  as  to  render  it 
useless.  With  the  present  evidence  he  considered  that  there 
could  be  no  doubt  that  the  thyroid  body  played  a  chief  part 
in  the  production  of  the  disease,  but  in  what  manner  could 
not  at  present  be  decided.  Having  studied  the  subject  of 
myxoedema  for  twenty  years,  and  examined  a  large  number 
of  cases.  Dr.  Ord  had  become  very  cautious  about  prema¬ 
turely  theorising  as  to  the  possibilities  of  its  mode  of 
production. 

Dr.  Burnet  Yeo  mentioned  a  case  observed  some  years 


ago,  in  which  very  complete  loss  of  hair  and  eyebrows  had 
taken  place.  With  respect  to  the  fluctuations  observed  in 
the  quantity  of  urea  excreted,  he  considered  that  a  wider 
application  must  be  made,  since  such  fluctuations  were  very 
frequently  found  in  conditions  of  ill-health  preceding  the- 
development  of  organic  disease. 

Dr.  Cavafy  asked  for  some  further  information  with) 
respect  to  the  natural  history  of  myxoedema.  He  believed- 
that  there  were  at  times  periods  of  quiescence  with  distinct 
improvement  in  symptoms,  and  mentioned  the  case  of  a 
woman  of  thirty -three,  in  whom,  after  childbirth,  a  marked 
improvement  took  place  during  the  period  of  lactation.  A 
second  case,  with  ascites,  had  experienced  marked  relief 
whilst  the  peritoneal  effusion  had  been  allowed  to  remain. 
Marked  variations  in  symptoms  might  take  place  without  any 
assignable  cause.  In  one  case  he  had  observed  pain  and 
vomiting  to  occur  with  a  severity  resembling  that  of  the- 
crises  gastrigues  of  Charcot. 

Dr.  Radcliffe  Crocker  believed  that  the  estimation  of 
urea  was  often  attended  with  much  fallacy.  In  order  to- 
determine  a  definite  standard  of  daily  excretion  he  had. 
himself  made  observations  upon  dogs,  but  had  been  struck 
with  the  great  variation  in  the  quantity  excreted,  other 
conditions  of  life  being  maintained  exactly  the  same.  As 
great  a  difference  as  between  seventeen  and  twenty-nine- 
grammes  had  been  observed  without  any  discoverable  cause. 
In  cases  of  universal  dermatitis,  too,  he  had  been  equally 
unsuccessful  in  obtaining  satisfactory  results. 

Dr.  Hadden  had  also  made  observations  upon  the  excre¬ 
tion  of  urea  in  myxoedema,  with  equally  varied  results- 
Having  had  the  opportunity  of  examining  the  sympathetic 
nerves  in  cases  of  myxoedema  and  exophthalmic  goitre,  he- 
had  found  no  change  whatever. 

Dr.  Ord,  agreeing  with  Dr.  Cavafy  as  to  the  occurrence 
of  fluctuations  in  the  course  of  the  disease,  thought  that 
the  general  tendency  of  the  cases  was  to  get  worse.  He 
mentioned  a  case  in  the  course  of  which  two  pregnancies 
had  taken  place  without  any  effect  being  produced  on  the 
myxoedema  at  the  time  or  subsequently.  Six  cases  during; 
the  last  three  years,  however,  had  shown  progressive  im¬ 
provement.  Being  struck  with  the  complete  inaction  of 
the  skin,  he  had  given  jaborandi  in  doses  of  thirty  minims^ 
and  upwards  for  three  or  four  months  in  succession,  with- 
excellent  results  in  some  cases.  In  one,  the  patient,  from 
being  helpless,  had  so  far  recovered  as  to  be  able  to  go- 
about  her  work ;  in  another,  the  characteristic  heavy,  puffed 
face  of  myxoedema  had  been  reduced  so  far  that  the  patient’s- 
previous  good  looks  had  been  restored.  Such  results  justi¬ 
fied  the  persistent  use  of  the  drug  for  a  long  time,  especially 
as  no  discomfort  was  produced  by  it. 

Dr.  Whipham  had  used  various  means  of  exciting  the 
action  of  the  skin,  and  had  obtained  some  success  with  hot¬ 
air  baths,  but  he  had  found  that  gradually  increasing  doses 
of  pilocarpin  (one-twelfth  to  a  quarter  of  a  grain)  afforded 
very  marked  relief;  but  relapse  took  place  when  the  drug 
was  discontinued.  Its  use  had  generally  been  attended 
with  headache ;  but  this  was  borne  for  the  sake  of  the  relief 
afforded  to  the  more  serious  symptoms. 

Dr.  Douglas  Powell  inquired  what  had  been  the  results 
produced  by  jaborandi  and  pilocarpin  upon  the  quantity  of 
urine  secreted.  In  his  own  cases  he  had  found  that  the 
kidneys  were  more  freely  acted  upon  than  the  skin. 

The  President  referred  to  a  case  seen  by  him  in  appa¬ 
rently  good  health  two  days  previously,  which  had  been 
regarded  as  hopeless  four  years  ago.  He  had  seen  other 
cases  in  which  continued  improvement  had  taken  place 
without  treatment  of  any  kind. 

Dr.  Duckworth  thought  that  it  would  lead  to  a  better 
knowledge  of  the  disease  if  all  the  surgeons  who  had  per¬ 
formed  extirpation  of  the  thyroid  would  make  inquiry 
into  the  subsequent  history  of  their  cases.  He  was  con¬ 
vinced  that  there  must  be  very  many  surgeons  scattered 
through  the  country  who  had  performed  the  operation  and 
could  supply  the  needed  information. 

The  President  summed  up  the  results  of  the  debate. 
He  thought  that  whilst  it  had  added  to  our  knowledge  of 
myxoedema  it  had  led  us  back  to  the  position  originally 
taken  by  Sir  W.  Gull  as  to  the  nature  of  the  disease.  Our 
present  knowledge  of  its  causation  was  defective,  and  he 
considered  that  the  time  had  now  arrived  when  a  commis¬ 
sion  should  be  appointed  to  institute  closer  inquiries  into 
it.  He  did  not  propose  to  take  any  immediate  action  in  the 


644 


Medical  Times  and  Gazette. 


EOYAL  MEDICAL  AND  CHIRURGICAL  SOCIETY. 


Dec.  1,  1883. 


matter,  but  thought  that  the  subject  should  be  taken  into 
■consideration  by  the  members  of  the  Society. 

Sir  W.  Gull  suggested  that  the  patient  shown  by  Dr. 
Drewitt  should  be  treated  with  jaborandi  for  a  few  months, 
and  the  result  observed. 


Living  specimens  were  shown — by  Mr.  Barwell,  of  Hyper¬ 
trophy  of  the  Bight  Arm  and  Leg  in  a  girl  aged  six ;  by 
Mr.  Barker,  of  Arrested  Development  of  the  Eight  Hajf  of 
the  Body,  with  Paralysis  of  the  Right  Half  of  the  Pace,  in 
an  infant ;  by  Dr.  Drewitt,  of  Myxoedema  in  a  woman ; 
by  Mr.  Mansell-Moullin,  of  Thrombus  of  the  Inferior 
Y ena  Cava ;  by  Mr.  Pearce  Gould,  of  Progressive  Arteritis 
in  a  young  man. 


ROYAL  MEDICAL  AND  CHIRURGICAL 
SOCIETY. 

Tuesday,  November  27. 

John  Marshall,  F.R.S.,  President,  in  the  Chair. 


Investigations  into  the  Action  of  the  Digitalis  Group. 

A  considerable  number  of  Fellows  and  visitors  assembled 
to  hear  read  a  paper  detailing  some  investigations  into  the 
action  of  the  digitalis  group  by  Drs.  Sydney  Ringer  and 
Harrington  Sainsbury.  The  following  is  an  abstract : 
— Digitalis  is  taken  as  the  type  of  a  group  of  drugs 
whose  influence  is  exerted  mainly  on  the  circulatory 
system.  The  facts  of  chief  importance  in  this  action 
are  : — 1.  The  arrest  of  the  heart  in  systole  (if  the  dose 
be  sufficiently  large).  2.  The  raised  blood-pressure  which 
obtains  throughout  till  close  upon  the  final  systolic  arrest. 
Whilst  the  spasm  of  the  heart  is  universally  recognised  as 
the  result  of  the  digitalis  action,  and  as  caused  by  direct 
action  of  the  drug  on  the  cardiac  tissue,  there  is  doubt  both 
as  to  the  condition  of  the  arterioles  under  the  influence  of 
the  drug,  and  as  to  whether  the  influence  be  direct  or  in¬ 
direct.  Digitalis  action  upon  the  heart  may  be  thus 
defined  as  the  'production  of  continuous  spasm  of  the 
heart-muscle  by  direct  action  of  the  drug  on  this  tissue. 
It  is  pointed  out  that  this  spasm  must  not  be  of  the 
nature  of  a  tetanus,  i.e.,  of  a  fusion  of  adjacent  beats; 
and  further,  that  it  may  affect  either  the  whole  heart  or  a 
limited  portion  of  the  same,  according  as  the  drug  is  applied 
to  the  whole  heart  or  to  a  limited  portion.  Thus  defined,  the 
already  very  large  group  of  bodies  classed  by  Schmiedeberg 
under  the  heading  digitalis  becomes  yet  larger,  and  will  in¬ 
clude,  amongst  others,  the  caustic  alkalies  and  barium  salts. 
Experiments  are  recorded  in  which  an  artificial  saline  solu¬ 
tion  was  circulated  through  the  vessels  of  the  hinder  extre¬ 
mities  of  a  tortoise  whose  brain  and  spinal  cord  had  been 
■completely  destroyed.  The  experiments  were  so  arranged 
that  the  rate  of  flow  could  be  measured,  and  so  soon  as  a 
uniform  rate  of  flow  had  been  established  the  drug  was 
added  to  the  circulating  fluid.  The  results  obtained  with 
digitalis  were  both  uniform  and  striking  ;  invariably,  on 
the  addition  of  the  drug,  the  circulation  became  slowed, 
even  to  the  extent  of  almost  complete  stasis.  Similar  ex¬ 
periments  were  made  with  the  following  members  of  the 
digitalis  group  :  strophanthus,  dyak  poison,  con vallamarin, 
and  scillitine.  In  the  case  of  each  of  these  drugs  evidence 
•of  constriction  of  the  vessels  was  obtained  in  the  shape  of  a 
slowed  circulation-rate.  Digitaline,  however,  ranked  as  by 
far  the  most  active  of  the  above.  Similar  experiments  were 
made  with  hydrate  of  potassium,  and  with  the  carbonates  of 
potassium  and  sodium,  and  sodium  bicarbonate,  which,  with 
the  exception  of  the  latter,  gave  like  evidence  of  constriction 
of  the  arterioles.  Experiments  carried  on  simultaneously 
with  the  above  on  the  excised  frog’s  heart  showed,  in  the 
case  of  each  of  the  above  drugs,  the  production  of  more  or 
less  persistent  spasm,  with  the  notable  exception,  however, 
of  sodium  bicarbonate,  which  gave  none.  Experiments  then 
followed,  which  sought  to  determine  whether  the  calibre  of 
the  vessels,  in  addition  to  being  directly  influenced  by  these 
drugs,  could  be  affected  by  them  through  the  nerves.  Digi¬ 
taline  was  alone  experimented  with.  The  results  were  purely 
negative.  Finally,  to  meet  the  suggestion  as  to  the  action 
of  the  drugs  on  the  skeletal  muscles,  experiments  were 
made  with  frogs,  given  quantities  of  solutions  of  digitaline, 
strophanthus,  dyak,  scillitine,  barium  chloride,  and  caustic 


potash  and  soda  being  injected.  The  results  showed  the 
first  five  to  be  notable  muscle-poisons,  the  muscles  rapidly 
dying  and  losing  their  excitability ;  indeed,  even  before 
the  death  of  the  animal  a  very  marked  diminution  of 
muscular  irritability  was  in  several  cases  observed.  Com¬ 
paring  the  actions  among  each  other,  it  was  noted  that 
strophanthus  and  dyak  poisons  acted  much  more  power¬ 
fully  on  the  skeletal  muscles  than  did  digitaline.  To  sum 
up,  the  argument,  briefly  stated,  is  as  follows  : — Starting 
from  the  systolic  digitalis  heart,  which  is  admittedly  a 
result  of  direct  action  of  the  drug  on  the  cardiac  muscle, 
we  have  found: — 1.  That  for  the  other  members  of  the 
digitalis  group  here  examined  a  like  action  obtains.  2.  We 
have  suggested  that  the  local  action  on  the  heart  may 
serve  as  the  definition  of  digitalis  action  ;  this  accepted,  we 
have  pointed  out  that  Schmiedeberg’s  already  large  group 
must  be  still  further  enlarged.  3.  Arguing  from  this  action 
on  the  muscular  tissue  of  the  heart,  we  have  inferred  that 
the  action  on  the  muscular  tissue  of  the  arterioles  will  be 
similar — an  inference  verified  by  actual  experiment.  4.  So 
far  as  our  experiments  go,  we  do  not  find  that  these  drugs 
influence  the  calibre  of  the  vessels  indirectly  through  the 
nervous  system.  5.  We  have  pointed  out  that  many  of  the 
digitalis  group  are  notable  muscle-poisons,  and  that  the 
tissue  of  the  heart,  standing  functionally  midway  between 
the  striped  and  unstriped  muscular  tissues,  may  permit  of 
the  inference  that  a  marked  action  of  the  drug  on  the  tone 
of  the  heart  would  indicate  a  similar  effect  on  the  tone  of 
the  vessels,  whereas  a  marked  action  on  the  cardiac  beat 
would  indicate  like  action  on  the  skeletal  muscles. 

The  President  congratulated  the  authors  on  their  valu¬ 
able  paper.  It  afforded  an  admirable  example  of  the  method 
in  which  experimentation  should  be  carried  on,  by  able  and 
practised  hands,  and  without  waste  of  animal  life.  He 
thought  the  results  obtained  could  hardly  have  been  got 
in  any  other  way,  and  he  invited  discussion  from  those 
specialists  who  were  present. 

Dr.  Lauder  Brunton  had  listened  with  great  pleasure  to 
the  remarks.  He  agreed  with  the  authors  in  most  of  their 
conclusions,  but  differed  in  a  few ;  to  these  he  would  briefly 
advert.  He  disapproved  of  grouping  these  cases  together, 
for  the  substances  so  grouped  were  not  at  all  alike  in  many 
of  their  chief  actions.  If  we  were  to  group  together  all 
those  substances  which  produced  narrowing  of  the  arterioles, 
we  should  have  to  include  half  the  Pharmacopoeia  ;  for — in 
addition  to  barium — strontium,  aluminium,  manganese, 
platinum,  etc.,  all  caused  contraction  of  the  bloodvessels 
(i.e.,  of  the  involuntary  muscular  fibre),  though  not  to  the 
same  extent.  He  thought  rather  that  we  should  group  only 
those  the  sum  total  of  whose  action  was  identical.  As 
regarded  the  action  of  digitaline  on  the  voluntary  muscles 
-it  varied  not  only  with  the  species  or  genus,  but  with  the 
individual  ;  and  we  knew  also  that  the  same  differences 
were  observable  in  our  patients.  He  personally  did  not 
regard  digitaline  as  a  marked  muscular  poison  compared 
with  many  others,  though,  in  some  experiments  which  he 
had  made  years  ago,  he  had  found  distinct  differences  in  dif¬ 
ferent  species  of  animals,  as  also  with  caffeine.  He  did  not 
think  it  wise  to  draw  conclusions  as  to  the  action  of  these 
drugs  on  the  skeletal  muscles  from  their  action  on  the 
involuntary  muscles. 

Dr.  John  Harley  did  not  wish  to  be  hypercritical,  yet 
he  could  not  but  feel  that  a  huge  fallacy  underlay  the  whole 
of  the  experiments.  The  results  were  drawn  from  the  effect 
of  certain  drugs  on  animals  whose  spinal  cord  (and,  conse¬ 
quently,  sympathetic  nerve)  was  cut  off  from  the  parts  ex¬ 
perimented  upon.  The  tables  showed  a  constant  declension 
of  circulatory  power,  such  as  one  would  naturally  expect 
from  an  animal  in  a  slowly  dying  condition ;  and  hence  they 
could  have  no  specific  value  as  to  the  action  of  the  drugs 
which  had  been  used.  Further,  it  was  not  wise  to  argue 
from  these  experiments  that  such-and-such  an  action  would 
follow  on  the  administration  of  these  drugs  to  healthy, 
warm-blooded  animals  under  ordinary  conditions  of  life. 
The  authors,  as  also  Dr.  Brunton,  appeared  to  have  assumed 
that  these  drugs  acted  directly  on  the  muscular  fibres  of  the 
vessels,  but  he  submitted  there  was  no  proof  that  any  drug 
could  so  act.  He  thought  all  such  actions  were  brought 
about  through  the  sympathetic  nervous  system.  A  vast 
amount  of  time,  talent,  and  ingenuity  was  being  wasted 
which  might  be  otherwise  and  usefully  expended. 

Dr.  Broadbent  said  he  was  sophisticated  or  unsophisti- 


Medical  Times  and  Gazette. 


VITAL  STATISTICS. 


Dec.  1, 1888.  645 


cated  enough  to  accept  the  results  of  these  experiments  as 
conclusive  and  of  great  value.  It  was  not  as  if  they  stood 
alone ;  on  the  other  hand,  they  confirmed  and  amplified  many 
others.  He  thought  there  was  now  evidence  enough  that 
the  digitalis  group  did  act  as  the  authors  had  suggested. 
It  was  a  matter  of  first  importance  for  physicians  to  have 
such  results  to  rely  upon.  He  hoped  in  time  that,  as  a 
result  of  careful  work  such  as  this,  the  science  of  thera¬ 
peutics  would  be  placed  on  the  same  level  as  other  sciences. 
He  thought  that  the  organic  remedies  did  not  act  by  simple 
contact  with  the  vessel-wall,  but  that  the  effect  produced 
was  due  to  some  dynamic  action  on  the  part,  and  that  there 
was  a  radical  difference  between  the  action  of  alkalies  and 
salines,  and  such  drugs  as  the  digitalis  group. 

Dr.  Bernard  O’Connor  inquired  as  to  the  part  played 
by  the  ganglia  in  the  heart-muscle  round  about  the  base. 

The  President  asked  for  the  authors’  views  as  to  the 
influence  of  the  muscular  paralysis  (due  to  section  of  the 
cord)  on  the  arteries. 

Dr.  Ringer  replied :  He  quite  agreed  as  to  the  differences 
between  the  various  substances  included  in  their  group,  but 
they  had  themselves  remarked  on  them  in  the  paper.  Of  all 
the  drugs  he  knew,  digitaline  was  one  about  the  action  of 
which  he  thought  there  could  not  be  much  doubt — it 
strengthened  the  heart,  it  slowed  the  action,  it  regulated 
the  beat,  and  it  tightened  the  arteries.  As  regarded  its 
action  on  the  heart-muscle,  it  was  well  known,  he  said,  that 
if  applied  locally  to  a  bit  of  the  muscle  in  which  there  were 
no  ganglia  it  caused  contraction,  thus  showing  that  the 
pneumogastric  nerve  and  ganglia  were  not  concerned. 

Four  Cases  oe  Congenital  Dislocation  of  Hips. 

Mr.  George  Cowell  showed  four  cases  of  so-called  con¬ 
genital  dislocation  of  the  hip,  occurring  in  four  little  girls, 
each  of  whom  presented  the  typical  symptoms  of  this  de¬ 
formity,  now  well  recognised  clinically,  though  its  exact 
pathology  remains  obscure.  He  pointed  out  as  the  main 
symptoms — lordosis,  with  corresponding  prominence  of  the 
abdomen ;  an  altered  relation  in  the  level  of  the  great  tro¬ 
chanter,  which  rose  as  high  as  the  anterior-superior  spine  of 
the  ilium ;  flattening  of  the  nates ;  and  a  peculiar  gait, 
which  in  well-marked  cases  was  a  decided  waddle.  The 
children  had  considerable  power  over  the  limbs,  and  their 
progression  was  little,  if  at  all,  impeded.  It  was  remark¬ 
able  that  the  defect  occurred  in  girls  chiefly,  almost  in  the 
proportion  of  three  to  one.  The  general  health  was  excellent. 

Owing  to  the  lateness  of  the  hour  these  cases  could  not 
be  properly  discussed.  Mr.  William  Adams  and  Mr. 
Barker  spoke. 

The  Society  then  adjourned. 


INVENTIONS  AND  IMPROVEMENTS. 


WALTHAM  BROTHERS’  “S.N.”  STOUT. 
Stout,  as  an  article  of  diet,  as  an  aid  to  digestion,  and  in  a 
certain  degree  as  a  tonic,  is  in  some  cases  distinctly  in¬ 
dicated.  In  other  cases  there  are,  of  course,  contra-indica¬ 
tions  against  its  use  ;  but  it  is  probable  that  the  prejudice 
even  against  the  heavier  malt  liquors  has  of  late  years  been 
somewhat  exaggerated.  Most  practitioners  will,  at  any 
rate,  admit  that  many  nursing  mothers  would  fare  but 
badly  without  the  support  and  nourishment  afforded  by  a 
sound  stout.  Iu  these  and  other  cases  Waltham’s  stout 
would  appear  to  answer  every  requirement.  It  professes  to 
be  brewed  entirely  from  the  finest  malt  and  hops,  and  it  is 
certainly  a  rich,  agreeable,  and  clean-tasting  beverage,  free 
from  the  sickly  flavour  which  occasionally  renders  commoner 
samples  of  stout  unsatisfactory  both  to  the  palate  and  the 
stomach. 


Scarlet  Fever  in  Horses. — Dr.  John  C.  Peters,  of 
New  York,  lecturing  recently  at  the  Columbia  Veterinary 
College  in  that  city,  stated  that  he  had  discovered  the  exist¬ 
ence  of  scarlet  fever  in  horses,  at  the  same  time  adducing 
many  facts  in  support  of  his  theory.  Grooms,  he  said,  rarely 
contracted  the  fever,  because  they  had  almost  invariably 
suffered  from  it  in  a  mild  form  when  young.  Dr.  Peters 
expressed  it  as  his  opinion  therefore  that  the  day  would 
come  when  equine  virus  would  be  used  for  the  inoculation 
of  human  subjects  as  an  antidote  to  that  disease. 


VITAL  STATISTICS  OF  LONDON. 

Week  ending  Saturday,  November  24,  1883. 
BIRTHS. 

Births  of  Boys,  1310;  Girls,  1172;  Total,  2482. 

Corrected  weekly  average  in  the  10  years  1873-82,  2645'3. 

DEATHS. 


Males. 

Females. 

Total.. 

Deaths  during  the  week . 

834 

836 

1670 

Weekly  average  of  the  ten  years  1873-82, 1 

902-5 

873-5 

1776  -O 

64 

corrected  to  increased  population  ...  J 

Deaths  of  people  aged  80  and  upwards 

DEATHS  IN  SUB-DISTRICTS  FROM  EPIDEMICS. 


Enumerated 

Population, 

1881 

(unrevised). 

Small-pox. 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

Whooping- 

cough. 

Typhus. 

Enteric  (or 

Typhoid) 

Fever. 

Simple 

continued 

Fever. 

C£ 

s 

*4 

s 

s 

West . 

669633 

1 

6 

6 

2 

4 

... 

8 

6 

North 

906947 

... 

8 

8 

9 

10 

.  . . 

3 

2 

Central 

282238 

... 

1 

5 

2 

... 

... 

4 

2 

1 

East . . 

692738 

... 

8 

13 

1 

6 

••• 

8 

2. 

South..,  ... 

1265927 

... 

26 

9 

7 

9 

1 

9 

... 

6 

Total . 

3816483 

1 

49 

41 

21 

29 

1 

32 

2 

ir 

METEOROLOGY. 


From  Observations  at  the  Greenwich  Observatory. 


Mean  height  of  barometer  ...  . 

Mean  temperature  . 

Highest  point  of  thermometer 
Lowest  point  of  thermometer 
Mean  dew-point  temperature 
General  direction  of  wind 
Whole  amount  of  rain  in  the  week  . 


29-666  in„ 
43 '9° 

521° 

33-8° 

39-0° 

sw. 

071  in. 


BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  thee 
Week  ending  Saturday,  Nov.  24,  in  the  following  large  Towns : — 


Cities 

and 

Boroughs. 

Estimated  Population  to 
middle  of  the  year  1883. 

Births  Registered  during 
the  week  ending  Nov.  24. 

1  DeathsRegistered  during 
i  the  week  ending  Nov.  24. 

Annual  Rate  of 
Mortality  per  1000  living, 
from  all  causes. 

Temperature 
of  Air(Fahr.) 

Temp, 
of  Air 
(Cent.) 

Rain 

Fall. 

Highestduring 
the  Week. 

Lowestduring 
the  Week. 

WeeklyMeanof 
Daily  MeanValues 

Weekly  Mean  of 
Daily  Mean 
Values. 

In  Inches. 

0Q 

a> 

I 

s 

a 

a 

London 

3955814 

2482 

1670 

22-0 

52-1 

33-8 

439 

6-61 

0-71 

1-80 

Brighton  ... 

fM 

111262 

58 

36 

16-9 

520 

34-0 

44-1 

673 

1-32 

335 

Portsmouth 

... 

131478 

92 

51 

20-2 

... 

... 

... 

... 

... 

... 

Norwich 

•  •• 

89612 

55 

35 

20-4 

... 

... 

... 

... 

... 

... 

Plymouth  ... 

•  . . 

74977 

32 

26 

181 

540 

37  0 

45-9 

772 

113 

2 -87 

Bristol . 

212779 

149 

93 

22-8 

53-0 

35-0 

43-3 

6-28 

2-36 

5-99 

Wolverhampton  . 

77557 

51 

28 

18-8 

47-5 

289 

38-2 

3-44 

0-69 

1-75 

Birmingham 

... 

414846 

287 

162 

204 

... 

... 

... 

... 

Leicester  ... 

»rt 

129483 

76 

51 

20-5 

50-2 

32-5 

40-5 

4-72 

0-62 

1-57 

Nottingham 

,,, 

199349 

164 

85 

222 

493 

30-0 

39-1 

3-95 

1-27 

3-23 

Derby . 

86574 

49 

25 

15-2 

... 

... 

.... 

... 

... 

... 

Birkenhead 

88700 

54 

40 

235 

... 

... 

... 

... 

... 

... 

Liverpool  ... 

566753 

350 

262 

241 

52-1 

37-5 

44-0 

667 

054 

1-37 

Bolton . 

107862 

64 

48 

23-2 

46-8 

326 

39-0 

3-89 

1-09 

2-77 

Manchester 

339262 

236 

206 

31-7 

... 

... 

... 

... 

... 

Salford 

190465 

110 

103 

282 

... 

... 

... 

... 

... 

... 

Oldham 

119071 

57 

57 

25-0 

... 

... 

... 

... 

... 

... 

Blackburn  ... 

103460 

67 

50 

24-1 

... 

... 

... 

... 

... 

Preston 

98564 

72 

47 

249 

46-0 

35-0 

41-2 

511 

0-98 

2-49' 

Huddersfield 

84701 

53 

36 

22-2 

... 

... 

... 

... 

... 

Halifax 

75591 

32 

35 

242 

... 

... 

... 

... 

Bradford  ... 

204807 

103 

71 

18-1 

46-6 

346 

40-7 

4-83 

1-04 

264 

Leeds  . 

321611 

163 

153 

24-8 

49  0 

350 

41-4 

5-22 

0-79 

201 

Sheffield  ... 

295497 

188 

143 

253 

475 

350 

40-7 

4-83 

1-10 

2-79- 

Hull  . 

176296 

118 

69 

20-4 

47-0 

30-0 

38-9 

3-83 

0-40 

1-02- 

Sunderland 

121117 

113 

45 

19-4 

... 

... 

... 

... 

... 

... 

Newcastle  ... 

149464 

95 

77 

269 

... 

... 

... 

... 

... 

•  •• 

Cardiff . 

... 

90033 

68 

44 

255 

... 

... 

... 

... 

... 

... 

For  28  towns 

... 

8620975 

5438 

3748 

22-7 

54-0 

289 

415 

5-23 

1-00 

2'54‘ 

Edinburgh  ... 

235946 

142 

115 

254 

48-2 

327 

38  5 

3-61 

1-45 

3-68 

Glasgow 

515589 

361 

289 

232 

49-5,  29-5 

400 

444 

2-07 

626 

Dublin . 

... 

349385 

160 

221 

33-0 

55-L32-0 

40-9 

4-94 

109 

277 

At  the  Royal  Observatory,  Greenwich,  the  mean  reading 
of  the  barometer  last  week  was  29'67  in. ;  the  highest  reading 
was  29'88  in.  on  Tuesday  evning,  and  the  lowest  29'28  in.  at 
the  end  of  the  week. 


646 


Medical  Times  and  Gazette. 


MEDICAL  NEWS, 


Dec.  1,  1S83. 


MEDICAL  NEWS. 

- o - 

Apothecaries’  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday, 
November  22 : — 

Foley,  Charles  Nicholas,  Denbigh-place,  S.W. 

Hehir,  Patrick,  London-street,  Paddington. 

Smith,  Edward  John,  Charing-cross  Hospital. 

The  following  gentleman  also  on  the  same  day  passed  the 
Primary  Professional  Examination  : — 

Loftus,  Arthur  Smith,  Charing-cross  Hospital. 


APPOINTMENTS. 

Burke,  Hubert  W.,  L.R.C.S.,  L.R.C.P.— Resident  Medical  Officer  at  St. 
George’s  Retreat,  Burgess  Hill,  Sussex. 

■Caiger,  F.  F.,  M.B.,  M.R.C.S. — Assistant  House-Surgeon  to  St.  Thomas’s 
Hospital. 

•Chaffey,  Wayland  C.,  M.B.  Lond.,  L.R.C.P.  Lond.,  M.R.C.S.  Eng. — 
Medical  Registrar  to  the  Hospital  for  Sick  Children,  Great  Ormond- 
street. 

Cooper,  G.  F„  M.R.C.S.,  L.R.C.P.— House-Surgeon  to  St.  Thomas’s 
Hospital. 

Foxwell,  A.,  M.B. ,  L.R.C.P.— House-Physician  to  St.  Thomas’s  Hospital. 

Green,  C.  D.,  M.R.C.S.,  L.R.C.P. — Assistant  House-Physician  to  St. 
Thomas’s  Hospital. 

Jones,  W.  Wansbrough,  M.B. ,  M.R.C.S.—  House-Surgeon  to  St.  Thomas’s 
Hospital. 

Lightfoot,  Charles  Lewis,  M.B.,  C.M. — House-Surgeon  to  the  North 
Riding  Infirmary,  vice  —  Bateman,  resigned. 

Marlow,  F.  W.,  M.R.C.S.,  L.S.A.— Ophthalmic  Assistant  to  St.  Thomas’s 
Hospital. 

Milton,  H.,  M.R.C.S.,  L.S.A.  —  House-Physician  to  St.  Thomas’s 
Hospital. 

Obford,  John,  M.R.C.S.,  L.R.C.P.— Non-Resident  House-Physician  to 
St.  Thomas’s  Hospital. 

■Owen,  Edmund,  M.B.  Lond.,  F.R.C.S.  Eng.— Surgeon  to  the  Hospital  for 
Sick  Children,  Great  Ormond-street. 

Sheppard,  W.  J.,  M.B.,  M.S.,  L.R.C.P. — Resident  Accoucheur  at  St- 
Thomas’s  Hospital. 

Underwood,  Arthur,  M.R.C.S.,  L.D.S.— -  Lecturer  on  Dental  Anatomy 
and  Physiology  in  the  Medical  School  attached  to  the  Dental  Hospital, 
vice  Charles  S.  Tomes,  F.R.S., F.R.C.S.,  resigned. 


DEATHS. 

Grombie,  John  M.,  M.A.,  M.D.,  at  1,  Oakley-square,  N.W.,  on  Novem¬ 
ber  26,  aged  39. 

Greaves,  William  Thomas,  M.R.C.S.,  at  Brighton,  on  November  23,  in 
his  76th  year. 

Hastings,  Richard  Ledsham,  M.R.C.S.,  at  the  Abbey  Green,  Chester,  on 
November  25,  aged  85. 

■Joynt,  Francis  George,  Surgeon- General  I.M.D.  (retired),  at  Eastbum, 
Dawlish-road,  Teignmouth,  Devon,  on  November  24. 

Learmonth. — On  the  28th  inst.,  at  White  Rock,  Hastings,  from  typhoid 
fever,  Eliza  Learmonth,  of  the  North-West  London  Hospital,  Kentish 
Town,  the  beloved  daughter  of  Olivia  and  the  late  William  Learmonth. 
— R.I.P. 

Leslie,  Louis,  M.D.,  at  Amery  House,  Alton,  Hants,  on  November  25, 
aged  61. 

Pearson,  George,  M.D.,  at  Lincoln  House,  St.  John’s  Wood,  on 
November  25. 

Tabral,  Nicolas,  M.D.,  F.R.C.S.,  at  Havre,  France,  on  November  26,  in 
his  73rd  year. 

Williams,  J.,  M.R.C.S.,  late  Madras  Army,  at  Ryde,  I.W.,  on  November 
19,  aged  86. 


VACANCIES. 

Addenbrooke’s  Hospital,  Cambridge. — House-Surgeon.  [For particulars 
see  Advertisement.) 

•City  of  London  Hospital  for  Diseases  of  the  Chest,  Victoria-park, 
E. — Assistant-Physician.  Applications,  with  testimonials,  to  be  for¬ 
warded  to  the  office,  24,  Finsbury-circus,  E.C.,  on  or  before  December  17. 
Further  information  can  be  obtained  from  the  Medical  Officers  or 
Secretary. 

-Clayton  Hospital,  Wakefield,  General  Dispensary.— House-Surgeon. 
Salary  £120  per  annum,  with  residence  at  the  Hospital,  attendance,  coal, 
and  gas.  Candidates  .must  be  duly  registered  in  medicine  and  surgery 
under  the  Medical  Act,  and  unmarried.  Applications,  with  testimonials 
to  be  sent  to  John  Binks,  Honorary  Secretary,  on  or  before  December  3] 

Coton  Hill  Lunatic  Hospital,  Stafford. — Resident  Medical  Superin¬ 
tendent.  ( For  particulars  see  Advertisement.) 

-Gesto  Hospital,  Edinbane,  Skye.— Resident  Medical  Officer.  Salary 
£275,  with  furnished  house,  fire  and  light,  etc.  Applications,  with 
copies  of  testimonials,  to  be  sent  to  J.  MacLennan,  solicitor,  Portree, 
on  or  before  December  1. 

Hospital  for  Sick  Children,  49,  Great  Ormond-street,  W.C.  -Assistant- 
Surgeon.  [For  particulars  see  Advertisement.) 

North  London  Hospital  for  Consumption  and  Diseases  of  the 
Chest,  Mount  Vernon,  Hampstead,  N.W.— Resident  Medical  Officer 
and  Registrar.  [For  particulars  see  Advertisement.) 

Royal  Free  Hospital,  Gray’s-inn-road,  W.C.— Assistant-Surgeon. 
[For  particulars  see  Advertisement.) 


Royal  Pimlico  Dispensary,  104,  Buckingham  Palage-road,  S.W. — 
Medical  Officer.  Candidates  must  reside  in  the  district.  Applications 
and  testimonials  to  he  forwarded  on  or  before  December  3. 

Royal  Portsmouth,  Portsea,  and  Gosport  Hospital.— House-Surgeon. 
Salary  £100  per  annum,  with  board  and  residence.  Candidates  must  be 
graduates  of  a  university,  or  members  of  a  college  of  surgeons  of  the 
United  Kingdom,  registered,  and  unmarried.  Applications,  with  testi¬ 
monials,  etc.,  to  be  addressed  to  the  Chairman  of  the  Committee, 
Vicarage,  Portsmouth*  on  or  before  December  5. 

University  of  Edinburgh  :  Department  of  Medical  Jurisprudence. — 
Examiner  in  Medicine.  [For  particulars  see  Advertisement.) 

Victoria  Hospital  for  Children,  Queen’s-road,  Chelsea,  S.W.  ’’ 
Assistant-Physician.  Candidates  must  be  graduates  in  medicine  of  a 
university  recognised  by  the  Medical  Council,  and  not  practising  phar¬ 
macy.  Applications,  with  copies  of  testimonials,  to  be  sent  to  the 
Secretary,  at  the  Hospital,  on  or  before  December  10. 

Victoria  Hospital  for  Children,  Queen’s-road,  Chelsea,  S.W. — 
House-Surgeon.  An  honorarium  of  £60  per  annum,  with  board  and 
lodging  in  the  Hospital.  Candidates  must  be  Fellows  or  Members  of  the 
Royal  College  of  Surgeons  of  England,  and  Licentiates  of  the  Society  of 
Apothecaries  or  of  the  Royal  College  of  Physicians,  or  graduates  in 
medicine  of  any  university  recognised  by  the  Medical  Council.  Appli¬ 
cations,  with  testimonials,  etc.,  to  he  sent  to  the  Secretary,  at  the 
Hospital,  on  or  before  December  10. 


UNION  AND  PAROCHIAL  MEDICAL  SERVICE. 

***  The  area  of  each  district  is  stated  in  acres.  The  population  is 
computed  according  to  the  census  of  1881. 

RESIGNATIONS. 

Alton  Union.— Mr.  Arthur  Curtis  has  resigned  the  Second  District :  area 
19,888 ;  population  4803 ;  salary  £110  per  annum. 

Daventry  Union. — Mr.  Frederick  Gustavus  Fowke  has  resigned  the  Fifth 
District :  area  11,067  ;  population  1928  ;  salary  £42  10s.  per  annum. 

Halifax.  Union. — The  office  of  Medical  Officer  for  the  Ovenden  District  is 
vacant  by  the  death  of  Mr.  James  Steele  :  area  5170;  population  12,873  ; 
salary  £30  per  annum. 

Halstead  Union. — Mr.  James  Hinds  has  resigned  the  Workhouse  and 
First  Division  of  First  District :  salary  for  Workhouse  £40  per  annum  ; 
area  of  District  9039  ;  population  7575 ;  salary  £50  per  annum. 

Houghton-le- Spring  Union. — The  office  of  Medical  Officer  for  the  Rainton 
District  is  vacant :  area  3622  ;  population  5499  ;  salary  £25  per  annum. 

Hoxne  Union. — Mr.  G.  W.  Pretty  has  resigned  the  Fressingfleld  District : 
area  12,736 ;  population  2999 ;  salary  £80  13s.  per  annum. 

West  Derby  Union. — Mr.  Rowland  Owen  has  resigned  the  office  of 
Assistant  Medical  Officer  at  the  Workhouse  :  salary  £100  per  annum. 

Wolverhampton  Union. — Mr.  J.  W.  Scott  has  resigned  the  Third  District : 
area  1075 ;  population  27,538 ;  salary  £115  per  annum. 

APPOINTMENTS. 

Alton  Union. — Edward  J.  L.  Leslie,  L.R.C.P.  Edin.,  L.R.C.S.  Edin.,  to 
the  First  District. 

Catherington  Union. — Robert  G.  Strong,  L.R.C.P.,  L.R.C.S.  Edin.,  for 
the  Union  and  Workhouse. 

Dore  Union. — Thomas  R.  Atkinson,  M.R.C.S.  Eng.,  L.S.A. ,  to  the 
Madley  District. 

Dorking  Union. — William  Lascelles  Batson,  M.R.C.S.  Eng.  and  L.R.C.P 
Lond.,  to  the  Workhouse  and  the  Middle  District. 

Haverfordwest  Union.—  John  H.  H.  Williams,  M.R.C.S.  Eng.,  L.R.C.P. 
Lond.,  L.S.A.,  to  the  Haverfordwest  District  and  the  Workhouse. 

Hinckley  Union. — Ernest  J.  Pritchard,  M.B.,  C.M.  Glasg.,  L.S.A.,  to  the 
Stoke  Goiding  District. 

Holsworthy  Union.— Henry  H.  Paisloe,  M.R.C.S.  Eng.,  L.R.C.P.  Edin., 
to  the  Second  District. 

Isle  of  Wight  Union.— Alfred  Woodward,  M.R.C.S.  Eng.,  L.S.A.,  to  the 
Ryde  District. 

Nantwich  Union. — James  Atkinson,  M.R.C.S.  Eng.,  L.R.C.P.  Edin.,  to 
the  Crewe  District. 

Pembroke  Union. — Arthur  G.  R.  Harris,  L.R.C.P.  Lond.,  M.R.C.S.  Eng., 
to  the  First  District. 

Saffron  Walden  Union. — Henry  St.  George  Boswell,  M.B  and  C.M.  Edin., 
to  the  Seventh  District. 

Wakefield  Union. — James  Howard,  M.R.C.S.  Eng.,  L.K.&Q.C.P.  Ire., 
to  the  Altofts  District;  William  Roulston,  M.D.,  M.C.  Queen’s Univ.,  Ire. 
to  the  Crofton  District. 


The  French  Hospital. — M.  Waddington  will  pre¬ 
side  at  the  next  annual  dinner,  to  be  held  at  Willis’s  Rooms 
on  February  2,  in  aid  of  tbe  funds  of  the  French  Hospital 
in  London. 

The  Aberdeen  Students  and  Examinations  in 
Pathology. — At  a  meeting  of  the  University  Court,  held 
on  the  20th  nit.,  an  appeal  was  made,  by  medical  students 
attending  the  University,  against  a  decision  of  the  Senatus 
with  reference  to  examination  in  pathology.  The  students 
enrolled  prior  to  the  foundation  of  the  Erasmus  Wilson 
Chair  of  Pathology  objected  to  a  special  examination  in 
pathology  being  forced  upon  them,  and  maintained  that 
they  were  entitled  to  graduate  under  the  system  in  force  at 
the  dates  when  they  severally  began  their  medical  studies 
at  the  University.  Principal  Pirie  moved  that  the  appeal 
be  dismissed  ;  and  an  amendment,  proposed  by  Dr.  Webster, 
that  it  be  sustained,  received  an  equal  number  of  votes — 
namely,  three.  The  casting  vote  of  the  Lord  Rector  was, 
however,  given  in  favour  of  the  amendment,  which  was 
declared  carried.  We  congratulate  the  students  on  the 
success  of  their  rather  short-sighted  policy. 


NOTES,  QUERIES,  AND  REPLIES. 


EDec.  1, 1883.  647 


Medical  Times  and  Gazette. 


Indian  Medical  Service. — The  Queen  has  approved 
the  admission  of  the  undermentioned  surgeons  to  Her 
Majesty’s  Indian  Medical  Service  : — To  be  Surgeons  :  Bengal 
— John  More  Young  and  Granville  Jameson.  Madras — 
Arthur  Owen  Evans.  Bombay — Mackintosh  Alexander 
Thomas  Collie  and  William  Henry  Quicke. 

Small-pox  in  South  Africa. — A  great  difference  of 
opinion  exists  among  the  doctors  at  the  diamond-fields  as  to 
the  nature  of  the  disease  which  has  recently  broken  out 
there,  and  which  has  been  supposed  to  be  small-pox.  It 
appears,  however,  tolerably  certain  now  that  the  disease  is 
not  small-pox,  but  an  aggravated  form  of  varicella,  which 
has  before  given  rise  to  needless  alarms. 

Alleged  Death  from  Overwork  at  School. — At 
a  meeting  of  the  Bacup  Town  Council,  this  week.  Dr. 
Brown,  the  medical  officer,  said  it  had  been  reported  to  him 
that  a  girl,  aged  seven,  had  recently  died  from  inflammation 
of  the  brain,  brought  on  by  overwork  at  school.  The  medical 
officer  strongly  condemned  the  practice  of  making  young 
children  do  home  lessons  at  night.  He  said  it  worried  them 
and  made  them  restless  in  their  sleep.  Education,  he  said, 
was  often  pushed  to  such  an  extent  nowadays  that  childhood 
was  robbed  of  all  its  happiness  and  joyousness.  It  tended 
to  physical  and  mental  deterioration. 

Westminster  Hospital. — The  authorities  of  the 
Westminster  Hospital  are  about  to  issue  a  special  appeal 
for  funds  to  assist  them  in  carrying  out  the  urgently  needed 
improvements  in  the  out-patient  departments,  and  in  erecting 
a  new  medical  school.  A  site  has  been  secured  for  the  latter 
in  Caxton-street ;  and  as  next  year  it  will  be  just  fifty  years 
since  the  school  was  founded,  the  present  is  a  very  auspi¬ 
cious  time  for  making  this  new  effort.  When  the  new  school 
is  built,  the  premises  at  present  occupied  for  teaching  will 
be  available  for  the  improvements  in  the  out-patient  depart¬ 
ments.  It  is  estimated  that  <£12,500  will  be  required  to 
complete  the  whole  scheme. 

Surgeon-Major  Eosenberg. — Surgeon-Major  Kosen- 
berg,  who  formed  one  of  the  unfortunate  staff  of  Hicks 
Pasha,  was  a  Jewish  convert  who  was  educated  at  the 
expense  of  the  Free  Church  in  Scotland  to  take  part  in  the 
foreign  mission  of  that  denomination  to  the  Jews  in  the 
East.  He  studied  medicine  at  the  University  or  Edinburgh, 
was  a  very  expert  anatomist,  and  a  favourite  pupil  of  Mr. 
Joseph  Bell.  On  completing  his  studies  he  resisted  strong 
pressure  to  start  practice  in  this  country,  and  resolved  to 
fulfil  the  engagement  he  had  entered  into  with  the  Free 
Church.  In  due  course  he  went  out  to  the  Jewish  Mission 
of  the  Church  at  Constantinople,  but  ultimately  he  dis¬ 
agreed  with  the  Principal  of  the  Mission,  and  left  it  for 
Egypt. 

Cantor  Lectures. — The  first  course  of  Cantor  Lectures, 
at  the  Society  of  Arts,  will  commence  on  Monday  next,  and 
the  subject  will  be  “  The  Scientific  Basis  of  Cookery,”  by 
W.  Mattieu  Williams,  F.C.S.  The  introductory  lecture  will 
treat  of  modes  of  applying  heat ;  radiation,  conduction,  and 
convection  ;  roasting,  grilling,  baking,  boiling,  and  stewing. 
The  second  lecture  will  deal  with  the  constituents  of  flesh ; 
the  action  of  heat  on  albumen,  gelatine,  fibrin,  etc. ;  exos¬ 
mosis  and  endosmosis  as  operating  in  the  kitchen ;  macera¬ 
tion  ;  caseine  ;  the  cookery  of  cheese  and  its  nutritive  value  ; 
milk,  butter,  and  “  bosch.”  In  the  third  and  concluding 
lecture  will  be  considered  the  nutritive  constituents  of 
vegetables ;  the  changes  effected  by  cookery  on  vegetable 
substances,  etc.  The  lectures  will  be  illustrated  by  a  selected 
exhibition  of  cooking  apparatus  and  appliances. 

“Tinned  ”  Foods.— We  have  received  a  communication 
from  Messrs.  Lazenby  and  Sons,  giving  the  results  of  Prof. 
Attfield’s  analysis  of  sixteen  samples  of  their  “  canned  ” 
foods,  the  main  result  being,  that  salmon,  lobsters,  sardines, 
potted  beef,  potted  tongue,  and  similar  matters  were  free 
from  tin,  while  bloater-paste,  apricots,  pears,  tomatoes,  and 
peaches  contained  minute  quantities  of  tin,  varying  from 
•008  grain  to  ‘028  grain  per  pound.  Such  small  quantities 
could  have  no  influence  on  the  health  of  the  consumer; 
nevertheless,  so  far  as  the  research  goes,  it  is  only  an  ad¬ 
ditional  proof  that  acid  fruits  dissolve  small  but  estimable 
portions  of  tin.  In  a  special  report  to  the  manufacturers 
Dr.  Attfield  goes  so  far  as  to  say  that  “  canned  foods  are  as 
harmless  as  uncanned  foods,  I  can  and  do  professionally 
certify  ” ! 


— :  . —  1  » 

St.  John  Ambulance  Association. — -A  horse  ambu¬ 
lance  carriage  has  just  been  presented  to  the  Association  by 
a  member  of  the  Committee.  This  vehicle  was  designed  by 
Mr.  John  Furley,  deputy  chairman.  It  will  carry  three 
patients  on  stretchers,  and  two  persons  seated  as  well  as  two 
on  the  box.  The  mode  of  putting  the  stretchers  into  the 
carriage  is  entirely  novel.  The  carriage  is  constructed  of 
English  and  American  ash,  with  a  roof  of  the  best  pine,  the 
wheels  being  of  English  oak  and  ash.  It  has  sliding  plate- 
glass  windows,  framed  in  mahogany,  and  set  in  borders  of 
walnut-wood.  The  fittings  are  very  complete,  and  include 
a  small  chest  for  hospital  comforts.  This  carriage  is  intended 
for  use  in  the  streets  of  London. 

The  International  Health  Exhibition. — The  pre¬ 
liminary  arrangements  for  holding  the  International  Health 
Exhibition  are  now  completed.  Her  Majesty  has  consented 
to  be  the  Patron,  and  the  Prince  of  Wales  is  President  and 
Chairman  of  the  General  Committee.  The  Executive  Council 
are  as  follows  : — Chairman:  The  Duke  of  Buckingham  and 
Chandos.  Vice-Chairman  :  Sir  James  Paget,  F.R.S.,  Mr. 
Edward  Birkbeck,  M.P.,  George  Buchanan,  M.D.,  Sir  F. 
Philip  Cunliffe-Owen,  K.C.M.G.,  Sir  Joseph  Fayrer,  K.C.S.I., 
the  Marquis  of  Hamilton,  Mr.  Ernest  Hart,  Sir  John 
Lubbock,  M.P.,  Mr.  Samuel  Morley,  M.P.,  G.  V.  Poore,. 
M.D.,  Sir  John  Rose.  Secretary :  Mr.  Edward  Cunliffe-Owen. 
The  prospectus  sets  forth  as  the  object  of  the  Exhibition  the- 
illustration,  in  as  vivid  and  practical  a  manner  as  possible, 
of  food,  dress,  the  dwelling,  the  school,  and  the  workshop, 
as  affecting  the  conditions  of  healthful  life ;  and  also  the- 
bringing  into  public  notice  the  most  recent  appliances  for 
elementary  school  teaching  and  instruction  in  applied  science, 
art,  and  handicrafts. 


NOTES,  QUERIES,  AND  REPLIES. 

- o - 

H*  tjjat  questioned!  mnejj  sjjall  learn  mnejj. — Bacon . 


The  Hind  Fund. 

The  following  additional  subscriptions  have  been  received  and  paid  to 
the  account  of  the  “Hind  Fund ”  at  Messrs.  Coutts’  Bank  : — G.  P.  Field, 
Esq.,  £1  Is. ;  G.  Gregson,  Esq.,  £1  Is. ;  W.  G.  Marshall,  Esq  ,  £1 ;  Percy 
May,  Esq.,  £1  Is.  ;  Edmund  Owen,  Esq.,  £l  Is. ;  Dr.  Ridsdale,  £1  Is. ; 
8.  Sibley,  Esq.,  £2  2s. 

Subscriptions  may  be  paid  to  Dr.  Richardson,  F.R.S.  (chairman),. 
25,  Manchester-square ;  John  Tweedy,  Esq.,  F.R.C.S.,  24,  Harley-street, 
hon.  treasurer  ;  A.  J.  Pepper,  Esq.,  F.R.C.S.,  122,  Gower-street.  or  T. 
Wakley,  jun.,  Esq  ,  L.R.C.P.,  96,  Redcliffe-gardens,  hon.  secretaries  ;  or 
to  Messrs.  Coutts  and  Co.,  Strand. 

The  Rogers  Testimonial. 

The  following  is  the  fifth  list  of  subscriptions : — Dr.  Gramshaw, 
Gravesend,  £1  Is. ;  Jas.  Crocker,  Esq.,  Budgley,  5s. ;  J.  B.  Bromley,  Esq.,. 
Castle  Headington,  £1  Is. ;  J.  Sadd,  Esq.,  Rugby,  £1  Is.  ;  Dr.  Wood  nouse, 
Hertford,  10s.  6d.  ;  Dr.  Young,  Aldershot,  £1  Is. ;  B.  D.  Taplin,  Esq., 
Market  Rasen,  £l  Is.  ;  T.  Taylor,  Esq.,  Booking,  £1  Is.  :  Dr.  Matcham,. 
Southwark,  £1  Is. ;  G.  Evans,  Esq.,  Bridport,  10s.  6d.  :  W.  Martin,  Esq., 

F. R.C.S.,  Walkden,  10s. ;  R.  Fothergill,  Esq.,  Bedale,  Yorkshire,  10s.  6d. ; 

G.  T.  Willan,  Esq.,  Melton  Mowbray,  10s.  6d. ;  A.  B-  Simpson,  Esq., 
Birmingham,  £1  Is.;  Jas.  Crisp,  Esq.,  Lacock,  10s.  6d.  ;  J.  Odell,  Esq., 
Hertford,  £1  Is  ;  Dr.  Colder,  Enfield,  10s.  6d.  ;  R.  Davison,  Esq.,. 
Newburn-on-Tyne,  £1  Is.;  T.  H.  Steele,  Esq.,  Abergavenny,  10s.;  J. 
Vallance,  Esq.,  Stratford,  Essex,  £1  Is.;  E.  Marshall,  Esq.,  Mitcham, 
£1  Is.;  C.  Macnamara,  Esq.,  Grosvenor-street,  £1  Is.  ;  Dr.  Grove,  St. 
Ives,  10s.;  M.  Balding,  Esq.,  St.  Albans,  10s.  6d. ;  A.  Roper,  Esq., 
Croydon,  £1  Is. ;  Dr.  Woodward,  Worcester,  £1  Is. ;  Dr.  Pitt,  St.  George’s- 
in-the-East,  £1  Is. ;  Dr.  Pearse,  Botesdale,  5s. ;  Dr.  Walford,  Reading,  5s. 
E.  Young,  Esq.,  Steyning,  Sussex,  £t  Is.;  Eairlie  Clarke,  Esq.,  South- 
borough,  £1  Is. ;  H.  E.  Norris,  Esq.,  Sidmouth,  £1  Is. ;  Dr.  Orton,  Crouch 
End,  £1  Is. ;  W.  G.  Marshall,  Esq.,  E.R.C.S.,  Colney  Hatch,  £1 ;  Dr.  J. 
Watson,  Ardwick,  10s.  6d.  ;  H.  Stear,  Esq.,  Saffron  Walden,  10s.  6d. ;  Dr. 
John  Thompson,  Bideford,  £1  Is.;  Francis  Vacher,  Esq.,  F.R.C-S., 
Birkenhead,  £1  Is.;  Dr.  W.  Wyke  Smith,  Wimborne,  10s.;  Lancelot 
Newton,  Esq.,  Alconbury  Hill,  £l  Is. 

Dr.  Newton  Madge,  New  South  Wales.— Letter  and  enclosure  received  with, 
thanks. 

Boyal  College  of  Surgeons.— At  the  half-yearly  examination  for  the 
Fellowship  of  this  institution,  which  has  just  been  brought  to  a  close, 
the  following  were  the  questions  on  Pathology,  Therapeutics,  and 
Surgery  submitted  to  the  candidates  on  Thursday,  the  22nd  ult.,  when 
they  were  required  to  answer  the  four  questions,  between  1.30  and  5.30 
p.m.,  viz. 1.  Describe  the  immediate  and  remote  effects  of  severe 
injuries  of  nerves.  2.  State  what  you  know  of  the  causes  of  venous 
thrombosis.  Describe  the  changes  which  the  clot  may  undergo,  and  the 
consequent  course  of  the  affection.  3.  Enumerate  the  various  forms  of 
loose  bodies  met  with  in  joints.  Describe  their  pathology.  4.  Discuss 
the  differential  diagnosis  of  the  various  forms  of  internal  intestinal 
obstruction,  and  the  treatment  suitable  to  each.  (The  names  of  the 
successful  candidates  cannot  be  published  until  after  the  next  meeting 
of  the  Council.) 


648 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES. 


Dec.  1, 1883. 


Bathing  in  the  River  Avon. — The  Town  Council  of  Warwick  has  decided  to 
serve  notices  under  the  Rivers’  Pollution  Act  upon  the  Local  Board  of 
Kenilworth  and  the  Town  Councils  of  Leamington  and  Coventry  for 
polluting  this  river.  Dr.  Tibbits  reports  that  the  river  was  no  longer 
safe  as  a  bathing-place  owing  to  the  tons  of  refuse  discharged  into  it, 
which  converted  the  bed  of  sand  into  a  bed  of  sewage.  Our  sanitary 
authorities  are  so  frequently  disposed,  from  personal  motives  and 
interests,  to  allow  the  existence  of  sources  of  contamination,  that  it  is 
satisfactory  to  see  the  Rivers’  Pollution  Act  put  in  force. 

.Suburban  Jerry  Buildings. — Kilburn  would  appear  to  be  a  somewhat 
favourite  spot  of  the  speculative  builder’s.  “  Jerry  building”  cases  are  by 
no  means  few  or  far  between,  which  are  brought  thence  to  the  police- 
court.  A  recent  instance  of  the  kind  was  that  of  a  builder,  of  Salus- 
bury-road,  Kilburn,  who  was  prosecuted  for  using  material  contrary  to  the 
requirements  of  the  law.  The  defendant  had  been  cautioned  several 
times  against  using  defective  mortar,  and,  in  consequence,  the  magis¬ 
trate  was  asked  to  strengthen  the  hands  of  the  Local  Board  by  inflict¬ 
ing  such  exemplary  punishment  as  would  be  likely  to  check  “  jerry 
building.”  The  penalty  fixed  for  the  offence  was  £5,  with  power  also 
to  impose  a  fine  of  forty  shillings  per  day  in  addition  when  it  was  shown 
that  the  offence  was  continued  after  service  of  a  notice.  A  fine  of  £5  was 
imposed,  and  a  further  penalty  of  forty  shillings  a  day  for  three  days. 

-Escaping  Vaccination. — It  appears  that  the  proportion  of  children  escaping 
the  operation  of  vaccination  is  very  much  greater  in  the  parish  of 
Chelsea  than  in  other  parishes,  having  due  regard  to  the  relative  size 
und  population.  The  Local  Government  Board  have  exhibited  com¬ 
mendable  vigilance  in  such  cases  as  this,  and  we  are  glad  to  perceive 
■they  have  forwarded  a  complaint  to  the  Board  of  Guardians  on  the 
subject.  The  Clerk  assigns  various  causes  for  the  default,  but  which 
chiefly  arise  from  what  may  be  called  a  “migratory  population.” 
Moreover,  neighbours  were  generally  in  collusion  with  the  persons  who 
■evaded  the  requirements  of  the  law,  and  very  little  information  con¬ 
sequently  was  to  be  obtained  as  to  removals.  The  sending  out  vaccina¬ 
tion  notices  within  one  month  after  registration  of  birth,  instead  of  after 
three  months,  had  resulted  in  a  great  .improvement  in  the  vaccination 
returns — a  system  which  might  be  advantageously  pursued  generally. 

'The  Poison  of  the  Indian  Cobra. — Dr.  Nicholson,  who  writes  in  the  Academy, 
Apropos  of  the  recent  book  by  Dr.  Wall,  thinks  that  the  researches  of 
Indian  medical  officers  on  this  special  subject  have  not  been  of  much 
use,  “  except  so  far  as  one  experimentalist  may  upset  the  results  of 
another,  and  expose  the  worthlessness  of  the  antidote  which  already 
claims  public  gratitude.”  The  writer  further  suggests  that  some  fatali¬ 
ties  said  to  be  due  to  poisonous  snakes  are  really  attributable  to  other 
■causes,  and  that  the  sins  of  mankind  are,  at  times,  conveniently  laid  upon 
"the  “  creeping  things  after  their  kind.”  He  enforces  this  theory  by  the 
fact  that  in  Bengal,  the  province  where  the  mortality  from  snake-bite  is 
the  largest,  more  women  than  men  are  killed.  “It  is  singular,”  he 
adds,  “  that  the  mortality  from  this  cause  should  be  very  largely  in  pro¬ 
portion  to  the  Hinduism  of  the  people— to  the  ascendency  of  caste  in 
the  various  parts  of  India,—  and  that  it  seems  to  be  least  where  venomous 
snakes  swarm  most,  and  where  people  live  under  conditions  of  life  most 
favourable  to  meeting  with  snakes.” 

~J.  Gf.  Kiernan. — We  have  not  at  present  a  correspondent  in  your  city. 

COMMUNICATIONS  have  been  received  from — 

-Mr.  Noble;  Smith,  London;  Messrs.  Letts  and  Son,  London;  Mr. 
Nelson  Haedt,  Dulwich;  Mr.  L.  M.  Griffiths,  Bristol;  The 
Sanitary  Commissioner  for  the  Ponjaub,  Lahore;  The  Secretary 
of  the  Parkes  Museum,  London;  Dr.  W.  Alexander,  Liverpool; 
The  Registrar  of  the  University  of  Cambridoe  ;  Dr.  J.  T.  W. 
Bacot,  Seaton ;  Mr.  T.  J.  Barnardo,  London  ;  The  Secretary  of  the 
Apothecaries’  Society,  London;  Dr.  W.  Blyth,  London  ;  The  Hon. 
Secretary  of  the  Medical  Society  of  Charing-crobs  Hospital, 
London ;  The  Hon.  Secretaries  of  the  Epidemiological  Society, 
London ;  The  Hon.  Secretaries  of  the  Odontological  Society  of 
■’Great  Britain,  London;  Mr.  T.  M.  Stone,  Wimbledon;  Dr.  Kelly, 
Bermondsey;  The  Secretary  of  the  Westminster  Hospital, 
London ;  Dr.  R.  Neale,  London ;  Mr.  E.  C.  Baker,  Brighton  ;  The 
Secretary  of  the  Sanitary  Institute  of  Great  Britain,  London ; 
The  Secretary  of  the  St.  John  Ambulance  Association,  London  ; 
Dr.  J.  W.  Moore,  Dublin  ;  Dr.  Wolfenden,  London  ;  Messrs.  Lazenby 
and  Sons,  London ;  The  Hon.  Secretary  of  the  Medical  Society 
of  London  ;  Mr.  J.  Chatto,  London ;  The  Hon.  Secretary  of  the 
Obstetrical  Society  of  London  ;  The  Hon.  Secretary  of  the 
Pathological  Society  of  London  ;  The  Registrar-General  for 
Scotland,  Edinburgh ;  Mr.  John  Marshall,  F.R.S.,  London;  The 
Secretary"  of  the  Local  Government  Board,  London ;  The  Secre¬ 
tary  of  the  College  of  Practical  Engineering,  London;  The 
Secretary  of  the  Royal  Institution,  London ;  Mr.  Wickham 
Barnes,  London;  Dr.  Julius  Althaus,  London;  The  Editor  of  the 
“Journal  of  Education,”  London;  The  Secretary  of  the  Society 
of  Arts,  London ;  The  Hon.  Secretary  of  the  Bread  Reform 
League,  London. 

BOOKS,  ETC..  RECEIVED - 

Hhe  Essentials  of  Pathology,  by  D.  Tod  Gilliam,  M.D.  —A  Compend  of 
Surgery,  by  Orville  Horwitz,  B.8.,  M.D. — Electro-Therapeutics,  by  Dr. 
Wilhelm  Erb — Diseases  of  Children,  by  Dr.  Edward  Henoch — The 
Roller  Bandage,  by  W.  B.  Hopkins,  M.D. — The  Principles  and  Practice 
of  Surgery,  by  D.  Hayes  Agnew,  M.D.,  LL.D.— Discussion  on  Intestinal 
Obstruction,  by  Rushton  Parker,  B.S.,  E.R.C.S. — On  Chronic  Atrophic 
Spinal  Paralysis  in  Children,  by  A.  H.  Bennett,  M.D.— Our  Eyes  and 
>our  Industries,  by  B.  Joy-Jeffriesj-ArML  M.D.  (Harvard)  — Manchester 


Health  Lectures  for  the  People  :  Breathing,  by  Arthur  Ransome,  M.D., 
M.A.— The  People’s  Guide  to  the  New  Law  of  Bankruptcy,  by  W.  Berry 
Greening,  LL.D. — Tenement  Hospitals,  by  Francis  Vacher — Report  on 
the  Sanitary  Condition  of  the  Borough  of  Birkenhead  for  1882. 

PERIODICALS  AND  NEWSPAPERS  RECEIVED— 

Lancet — British  Medical  Journal— Medical  Press  and  Circular — Ber¬ 
liner  Klinische  Wochenschrift— Centralblatt  fur  Chirurgie— Gazette 
des  Hopitaux — Gazette  Medicale — Revista  de  Medicina — Bulletin  de 
1’  AcadSmie  de  Mcdecine — Pharmaceutical  J  our  nal — Wiener  Medicinische 
Wochenschrift — Revue  MSdicale— Gazette  Hebdomadaire— Nature- 
Boston  Medical  and  Surgical  Journal — Louisville  Medical  News — 
Centralblatt  fur  Gynakologie — Le  Concours  Medical— Centralblatt  fiir 
die  Medicinischen  Wissenschaften — Centralblatt  fiir  Klinische  Medicin 
— Philadelphia  Medical  News — Le  ProgrSs  Medical — New  York  Medical 
J ournal — Edinburgh  Clinical  and  Pathological  Journal — Students’  Jour¬ 
nal  and  Hospital  Gazette— New  York  Medical  Record — Archives  de 
Neurologie — Archivio  Italiano— Western  Medical  Reporter — Grocers’ 
Gazette  —  Mediciniseh-Chirurgisches  Correspondenz-Blatt  —  American 
Journal  of  Obstetrios — Detroit  Lancet — Maryland  Medical  Journal — 
Sanitary  Engineer,  New  York— Boy’s  Own  Paper— Friendly  Greetings— 
Girl’s  Own  Paper — Leisure  Hour — Dublin  Journal  of  Medical  Science — 
Glasgow  Herald,  November  23— Revue  de  Chirurgie. 


APPOINTMENTS  FOR  THE  WEEK. 


December  1.  Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  1J  p.m. ;  King’s  College,  1|  p.m. ;  Royal 
Free,  2  p.m.;  Royal  London  Ophthalmic,  11  a.m. ;  Royal  Westminster 
Ophthalmic,  li  p.m. ;  St.  Thomas’s,  14  p.m.;  London,  2  p.m. 


3.  Monday. 

Operations  at  the  Metropolitan  Free,  2  p.m.;  St.  Mark’s  Hospital  for 
Diseases  of  the  Rectum. 2  p.m.;  Royal  London  Ophthalmic,  11  a.m.; 
Royal  Westminster  Ophthalmic,  14  p.m.  ;  Hospital  for  Women,  2  p.m. 

Royal  Institution,  5  p.m.  General  Monthly  Meeting. 

Odontological  Society  of  Great  Britain,  8  p.m.  Casual  Communi¬ 
cations  from  Messrs.  H.  Weiss,  Bland  Sutton,  Morton  Smale,  and  Dr. 
Elliott.  Discussion  on  Mr.  Henry  Power’s  paper  “  On  the  Relations 
between  Diseases  of  the  Eye  and  Diseases  of  the  Teeth.” 

Medical  Society  of  London  (Council  Meeting,  7J  p.m.),  84  p.m.  Mr. 
Clutton,  “  On  a  Case  of  Fistulee  in  the  Penile  Portion  of  the  Urethra 
successfully  treated  by  a  Plastic  Operation  after  opening  the  Urethra  in 
the  Perineum.”  Mr. (Rose,  “  On  a  Case  of  Recurrent  Femoral  Aneurysm 
after  Ligature  of  the  External  Iliac  Artery ;  Excision  of  the  Entire 
Sac  ;  Recovery”  (living  specimen).  Mr.  RoyesBell,  “  On  a  New  Method 
for  Exposing  the  Knee-Joint  in  order  to  remove  Pulpy  Degeneration  of 
the  Synovial  Membrane.” 

Society  of  Arts,  8  p.m.  Mr.  W.  Mattieu  Williams,  “  On  the  Scientific 
Basis  of  Cookery.”  (Cantor  Lectures— I.) 


4.  Tuesday. 

Operations  at  Guy’s,  1J  p.m. ;  Westminster,  2  p.m. ;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  14  p.m.;  West 
London,  3  p.m. 

Pathological  Society,  84  p.m.  Dr.  Norman  Moore — Three  Cases  of 
Pancreatic  Disease.  Dr.  S.  West— Purulent  Pericarditis.  Mr.  Symonds 
— Aneurysmal  Dilatation  of  Radial  Artery  following  Suppurative 
Arteritis.  Dr.  Mahomed— Cystic  Disease  of  the  Kidney  and  Hydro¬ 
nephrosis.  Dr.  Dawson  Williams,  “  On  the  Etiology  of  Tuberculosis.” 
Mr.  A.  Barker —Tubercular  Ulceration  of  Tongue.  Dr.  Charlewood 
Turner — Encysted  Central  Sequestrum  of  Tibia.  Mr.  Jessett — Medullary 
Sarcoma  of  the  Skull  in  a  Child.  Dr.  Lediard— Caries  of  the  Vertebrae 
in  a  Dog  (card). 


5.  Wednesday. 

Operations  at  University  College,  2  p.m. ;  St.  Mary’s,  lj  p.m. ;  Middlesex, 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew’s,  14  p.m.  ;  Great  Northern, 

2  p.m. ;  Samaritan,  24  p.m. ;  Royal  London  Ophthalmic,  11  a.m. ; 
Royal  Westminster  Ophthalmic,  l£  p.m. ;  St.  Thomas’s,  14  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m. ;  National  Orthopaedic,  Great 
Portland-street,  10  a.m. 

Brompton  Hospital  for  Consumption,  etc.,  4  p.m.  Dr.  Percy  Kiddi 
“  On  Cases  of  Laryngeal  Phthisis.” 

Epidemiological  Society  (Council  Meeting,  74  p.m. ;  Special  General 
Meeting,  7f  p.m.),  8  p.m.  Sir  W.  R.  E.  Smart,  K.C.B.,  M.D.,  R.N., 
“  On  Scurvy  in  its  Bearings  on  Explorations  by  Sea.” 

Obstetrical  Society  of  London,  8  p.m.  Specimens  will  be  shown- 
Dr.  Barnes,  “  On  the  Mechanism  of  Labour,  especially  with  reference 
to  Naegele’s  Obliquity  and  the  Lumbo-Sacral  Curve.”  Dr.  E.  S.  Tait, 
“  Observations  on  Puerperal  Temperatures.” 


6.  Thursday. 

Operations  at  St.  George’s,  1  p.m. ;  Central  London  Ophthalmic,  1  p.m.; 
Royal  Orthopaedic,  2  p.m.;  University  College,  2  p.m.;  Royal  London 
Ophthalmic,  11a.m. ;  Royal  Westminster  Ophthalmic,  14  p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m. ;  Hospital  for  Women,  2  p.m. ; 
Charing-eross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  24  p.m. 
Abernethian  Society  (St.  Bartholomew’s  Hospital),  8  p.m.  Mr. 
Montagu  Smith,  “  On  the  Ethics  of  Vivisection.” 

Parkes  MIiseum  of  Hygiene,  8  p.m.  Dr.  G.  V.  Poore,  “On  Coffee  and 
Tea.” 


7.  Friday. 

Operations  at  Central  LondonOphthalmic ,  2  p.m.;  Royal  London  Ophthal¬ 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminster 
Ophthalmic,  14  p.m.;  St.  George’s  (ophthalmic  operations),  1 j  p.m.; 
Guy’s,  1J  p.m.  ;  St.  Thomas’s  (ophthalmic  operations),  2  p.m.;  King’s 
College  (by  Mr.  Lister),  2  p.m. 

Medical  Society  of  Charing-cross  Hospital,  8  p.m.  Mr.  A.  E. 
Dodson,  “  On  Cremation.” 


APNCEA  OR  ASPHYXIA. 

ON  SOME  NOTABLE  DISCREPANCIES  OF  STATE¬ 
MENT  IN  RECENT  PHYSIOLOGICAL  WRITINGS 
AS  TO  FUNDAMENTAL  FACTS  IN  THE  PROCESS 
OF  DEATH  BY  SUFFOCATION. 

Ey  ALEXANDER  HARVEY,  M.D., 

Consulting  Physician  to  the  Aberdeen  Royal  Infirmary  ; 
Emeritus  Professor  of  Materia  Medica  in  the  II niversit.y  of  Aberdeen,  and 
sometime  Lecturer  on  Institutes  of  Medicine  in  that  University. 


[Concluded  from  page  625. ) 

II.  In  Apncea,  at  the  moment  of  death,  are  the  left 
■cavities  of  the  heart  full  or  empty  of  blood  ? — Dr.  Fagge’s 
allegation  as  to  this  considered. (a) 

In  the  introductory  part  of  this  paper  a  brief  statement 
was  given  of  Dr.  Fagge’s  representation  of  the  state  of 
these  cavities  at  the  time  when  death  actually  occurs  in 
apncea.  It  embraces,  it  will  be  remembered,  two  main 
points.  First,  he  affirms  that  at  the  moment  of  death  the 
ieft  cavities  of  the  heart  are  not  only  full  of  blood,  but 
gorged  with  it,  equally  and  alike  with  the  right  cavities  ; 
and,  secondly,  that  “  if  in  ordinary  autopsies  in  the  human 
subject  the  left  auricle  and  ventricle  are  found  compara¬ 
tively  empty,  whereas  the  right  ones  are  distended,  it  is 
because  the  former  unload  themselves  during  the  setting  in 
of  the  rigor  mortis.” 

Dr.  Fagge  tells  us  nothing  more.  He  makes  no  reference 
to  the  state  of  the  whole  set  of  bloodvessels  intervening 
between  the  right  ventricle  and  the  left  auricle  as  being  full 
or  empty  of  blood.  Like  Dr.  Johnson,  he  takes  matters  as 
they  stand  at  the  moment  of  death.  He  is  right  in  doing 
so,  for  in  respect  of  any  true  theory  of  asphyxia  it  is  on  this 
that  its  validity  must  hinge. 

No  doubt,  in  common  with  Dr.  Johnson  and  other  phy¬ 
siologists,  Dr.  Fagge  would  allow  that  the  whole  set  of 
pulmonary  arteries  are  also  full  of  blood.  But  what  as  to 
the  condition  in  this  respect  of  the  pulmonic  capillaries  and 
the  pulmonic  veins  ?  Dr.  Johnson,  as  we  have  seen,  holds 
that  these  capillaries  are  nearly  empty  of  blood,  and  that 
the  lungs  themselves  are  anaemic  throughout,  except  at  the 
base,  and  collapsed  and  shrunken.  But  if  at  the  moment 
of  death,  the  left  cavities  of  the  heart  are  full  of  blood,  nay, 
gorged  with  it,  as  Dr.  Fagge  alleges,  the  capillaries  in 
question  and  the  pulmonic  veins  must  needs  be  full  also. 
And  if  such  be  the  condition  of  these  vessels,  it  is  plain  that 
Dr.  Johnson’s  theory  must  fall  to  the  ground,  and  Dr. 
Alison’s  also,  and  the  cause  of  the  fatal  event  in  asphyxia 
must  be  sought  for  elsewhere. 

In  his  essay.  Dr.  Fagge  incidentally  remarks  that  in  his 
account  of  the  'phenomena  of  asphyxia  he  has  followed  Prof. 
Foster  almost  word  for  word.  Fancying  that  he  might 
have  thus  followed  that  distinguished  physiologist  in  his 
account  of  other  parts  of  the  process,  I  turned  to  Dr. 
Foster’s  “Text-book  of  Physiology,” — to  the  last  edition 
of  it  (the  fourth),  published  during  the  year  now  current 
<1883).  There  I  find  a  like  absence  of  information  as  to 
the  state  of  the  pulmonary  bloodvessels.  Dr.  Foster  is 
absolutely  silent  regarding  them  as  empty  or  full.  But, 
quite  in  keeping  with  Dr.  Fagge,  he  affirms  that  “if  the 
chest  of  an  animal  be  opened  under  artificial  respiration, 
and  asphyxia  brought  on  by  cessation  of  the  respiration,  it 
will  be  seen  that  the  heart  during  the  second  and  third 
stages  becomes  completely  gorged  with  venous  blood,  all  the 
cavities  as  well  as  the  large  veins  being  distended  to  the 
utmost.”  Again — “If  the  heart  be  watched  to  the  close  of 
the  events,  it  will  be  seen  that  the  feebler  strokes  which 
come  on  towards  the  end  of  the  third  stage  are  quite 
unable  to  empty  its  cavities ;  and  when  the  last  beat  has 
passed  away,  its  parts  are  still  choked  with  blood.”  Again 
— “  When  rigor  mortis  sets  in  after  death  by  asphyxia,  the 

(a)  The  author  desires  to  express  his  sincere  regret  at  the  untimely 
&eath  of  this  distinguished  and  rising  physician — an  event  which  occurred 
while  these  sheets  were  passing  through  the  press.  All  honour  to  his 
memory ! 

Vol.  II.  1833.  No.  1745. 


left  side  of  the  heart  is  more  or  less  emptied  of  its  contents, 
but  not  so  the  right  side.  Hence,  in  an  ordinary  post¬ 
mortem  examination,  in  cases  of  death  by  asphyxia,  while 
the  left  side  is  comparatively  empty,  the  right  appears 
gorged.”  Dr.  Fagge  and  Dr.  Foster  are  clearly  at  one  as 
to  the  state  of  the  left  cavities  at  the  moment  of  death  aid 
some  time  thereafter.  It  is  remarkable  enough,  it  may  here 
be  observed,  that  in  speaking  of  the  heart  and  its  cavities 
Dr.  Foster  seldom  discriminates  between  its  two  sides — 
between  the  right  and  the  left.  He  speaks  of  it  and  of  its 
cavities  as  a  whole.  It  is  only  when  he  comes  to  speak  of 
the  rigor  mortis,  and  the  alleged  effect  of  it,  that  he  specially 
refers  to  the  left. 

Turning  now  to  another  and  much  esteemed  work  on 
physiology — viz..  Dr.  Kirkes’s  Handbook,  and  to  the  ninth 
edition  of  it,  as  edited  in  1876  by  Mr.  Morrant  Baker — for 
further  light  on  the  vexed  question  before  us,  I  must  confess 
to  disappointment.  I  met  with  a  singular  want  of  precision 
in  the  statements  as  to  npt  a  few  points  of  importance. 
Nothing  is  said  as  to  the  condition  of  the  pulmonic  capil¬ 
laries.  Reference  indeed  is  made  to  “  obstruction  to  the 
passage  of  blood  through  the  lungs.”  It  is  said  “  to  be  not 
so  great  as  it  was  once  supposed  to  be,”  and,  such  as  there 
is,  “  to  occur  chiefly  in  the  later  stages  of  asphyxia,”  and 
then,  seemingly,  from  mechanical  “  pressure  made  in¬ 
directly  on  the  lungs,  from  violent  and  convulsive  action  of 
the  respiratory  muscles  ”  (page  260).  As  to  the  effect,  how¬ 
ever,  of  this  obstruction  in  the  way  of  filling  or  emptying 
the  pulmonic  capillaries,  nothing  is  said.  But  as  the  obstruc¬ 
tion  is  said  to  be  not  so  great  as  was  once  supposed,  and  to 
occur  chiefly  in  the  later  stages,  it  is  a  sound  inference  that 
these  capillaries  should  be  fairly  full  of  blood.  Yet  as  to 
one  point  Dr.  Kirkes  or  his  editor  is  explicit  enough.  He 
affirms,  in  common  with  Dr.  Foster  and  Dr.  Fagge,  that,  at 
the  moment  of  death,  “the  left  as  well  as  the  right  cavities 
are  distended  with  blood  ”  (page  261). 

On  inspection,  then,  of  the  left  cavities  of  the  heart  in 
articulo  mortis,  in  what  state  are  they  found  in  respect  of 
blood  ?  One  set  of  physiologists  affirm  that  they  are  empty 
— virtually  quite  empty ;  another  set  that  they  are  full  of 
blood — gorged  with  it.  “  Who  shall  decide  when  doctors 
disagree  ?  ”  And  such  doctors  !  Dr.  Johnson,  Prof.  Ruther¬ 
ford,  and  Prof.  McKendrick  on  the  one  side ;  and  on  the 
other.  Prof.  Foster,  Dr.  Fagge,  Dr.  Kirkes.  And  this  in 
respect  of  a  process  of  such  interest  as  apncea,  and  which 
has  so  often  been  the  subject  of  research,  and  in  respect 
also  of  a  part  of  that  process  so:  little  recondite,  so  open  to 
the  eye ! 

What  is  obviously  called  for  in  the  circumstances  is  a 
renewed  inquiry  into  the  matter.  Meanwhile,  I  would  take 
leave  to  observe  that  no  one  can  carefully  read  the  state¬ 
ments  adduced  by  Dr.  Johnson  without  being  satisfied  that 
the  result  of  any  such  inquiry  will  be  to  confirm  what  he 
has  advanced  under  this  head.  The  allegations  of  the  phy¬ 
siologists,  who  say  that  the  cavities  in  question  are  full  of 
blood  at  the  moment  of  death,  may  be  said  to  be  general 
and  off-hand  ;  while,  as  regards  those  made  by  Dr.  Johnson, 
there  is  a  quality  about  them  which,  in  a  manner,  vouches 
for  their  truth.  They  stand  out  as  the  result  of  actual  and 
very  careful  observation  made  at  the  time  by  himself  and 
others,  and  as  the  result  not  of  one  observation  only,  but 
of  several. 

The  observations  made  in  the  first  division  of  this  paper 
had  reference  to  the  state  of  the  pulmonic  capillaries  and  of 
the  lungs  generally,  in  respect  of  contained  blood  at  the 
time  of  death.  Yet,  while  establishing  fully  Dr.  Johnson’s 
assumptions  in  regard  to  this  point,  they  bore  not  a  few  of 
them  on  the  question  now  before  us,  and  gave  substantial 
support  to  the  view  of  it  taken  by  him. 

Let  us  now  consider  in  detail  the  evidence  adduced  by  Dr. 
Johnson  to  show  that  at  the  moment  of  death  the  left  cavities 
of  the  heart  are  really  empty  of  blood.  He  first  refers  to 
an  experiment  made  in  October,  1S67,  on  a  dog  weighing, 
fourteen  pounds  and  a  quarter.  “  Directly  the  respiratory 
movements  ceased  the  chest  was  opened.  The  right  cavities 
of  the  heart  were  full  and  tense;  the  left,  comparatively 
empty  and  flaccid.  In  particular,  the  two  auricles  presented 
a  marked  contrast.  The  right  auricle  stood  out  in  a  globular 
form,  and  had  a  tense  and  elastic  feel,  like  an  india-rubber 


Medical  Times  and  Gazette. 


HARVEY  OH  APHCEA  OR  ASPHYXIA. 


Dec.  8,  188 3. 


650 


"ball  distended  with  air,  while  the  left  auricle  was  flaccid 
and  its  surface  wrinkled.”  Again,  in  this  case,  “  a  ligature 
having  been  placed  round  the  large  vessels,  the  heart  was 
removed,  and  its  cavities  emptied,  when  two  ounces  of  blood 
gushed  out  of  the  distended  right  cavities,  while  two  drachms 
and  a  half  only  flowed  slowly  from  the  left  side.”  Again, 
in  the  case  of  two  rabbits  experimented  on  in  1876  by  him¬ 
self  and  Mr.  Hamilton  Cartwright,  and  in  which  fatal 
apnoea  was  induced  by  the  inhalation  of  nitrous  oxide  gas, 
the  chest  was  laid  open  immediately  after  death,  but,  while 
the  heart  was  still  found  beating,  “  the  right  cavities  and 
the  systemic  veins  were  greatly  distended  with  blood,  while 
the  left  cavities  and  the  aorta  were  completely  empty  and 
flaccid.” 

Nor  this  alone,  decisive  as  the  evidence  is.  In  another 
set  of  experiments,  made  in  1873,  in  conjunction  with  Prof. 
Eutherford,  the  observations  made  in  respect  of  the  blood- 
pressures — systemic  and  pulmonic — were  quite  in  keeping 
with  Dr.  Johnson’s  allegations  as  to  the  state  of  the  left 
cavities.  The  general  facts  as  to  this  were  fully  stated  in 
the  former  division  of  this  paper.  Let  me  again  adduce 
them  here  somewhat  more  in  detail.  On  the  artificial  res¬ 
piration  being  suspended,  “  immediately  the  colour  of  the 
left  auricle  changed  from  crimson  to  purple,  and  the  kymo¬ 
graph  indicated  a  continuous  increase  of  pressure  in  the 
systemic  arteries.  After  the  increase  of  pressure  had  con¬ 
tinued  for  about  a  minute,  the  left  cavities  of  the  heart 
became  much  distended, — the  auricle,  in  particular,  became 
expanded  into  a  tense  globular  ball  with  a  smooth  surface. 
In  the  next  period  the  pressure  in  the  arteries  began  to 
fall,  and,  about  the  same  time,  the  right  cavities  of  the 
heart,  which  had  hitherto  remained  of  the  normal  size  and 
form,  began  to  expand,  while  the  distension  of  the  left  began 
rapidly  to  subside.  Meanwhile  the  right  cavities  became 
more  and  more  distended,  and  now  the  right  auricle  assumed 
the  appearance  of  a  round,  tense  ball,  while  the  left  auricle 
had  become  nearly  empty  and  flaccid.  The  right  ventricle 
also  became  so  distended  that  it  projected  above  the  level  of 
the  left.” 

Here  is  circumstantial  evidence  of  an  incidental  yet  of 
the  strongest  kind  in  support  of  Dr.  Johnson’s  view  of  the 
state  of  the  left  cavities  at  the  moment  of  death.  And, 
singularly  enough,  it  is  borne  out  unintentionally  by  Dr. 
Foster.  Speaking  of  the  subsidence  of  the  systemic  blood- 
pressure,  which,  according  to  him,  begins  early  in  the  second 
minute  of  the  asphyxial  process.  Dr.  Foster  says,  “  it  falls 
even  more  rapidly  than  its  rise,  repassing  the  normal  and 
becoming  nil  as  death  ensues  ”  (“  Text-book,”  fourth  edition, 
page  378).  No  renewal  of  this  blood- pressure  is  spoken  of, 
such  as  would  be  needed  again  to  fill  the  left  cavities  emptied 
by  the  subsidence  just  referred  to.  Nor  could  there  well  be 
any  renewal  of  it  at  the  time  spoken  of  by  Dr.  Foster — death 
just  ensuing.  It  is  singular  that,  with  this  in  his  eye.  Dr. 
Foster  could  speak  of  these  left  cavities  being  full  of  blood 
— gorged  with  it  at  the  moment  of  death  !  It  was  the  sys¬ 
temic  blood-pressure,  exerted  by  the  presence  of  venous  blood 
in  the  systemic  arteries,  that  led  to  the  filling  and  distension 
of  the  left  cavities  in  the  first  instance ;  it  was  its  subsi¬ 
dence  that  led  to  the  emptying  of  them ;  and,  doubtless, 
had  there  subsequently  been  venous  blood  passing  into  these 
arteries  from  the  left  side  of  the  heart,  the  blood-pressure 
would  again  have  come  into  play,  with  the  effect  of  again 
distending  the  left  cavities.  But  there  is  no  such  renewal 
of  that  pressure — a  fact  implying  that  there  is  now  no  venous 
blood  in  the  cavities  in  question. 

Enough  I  think  appears,  as  well  directly  as  indirectly,  to 
demonstrate  that  Dr.  Fagge,  and  Dr.  Foster,  and  Dr.  Kirkes 
are  somehow  wrong  in  the  assumption  they  make  as  to  the 
state  of  the  left  cavities  of  the  heart  at  the  moment  of 
death  ;  and  enough  to  show  that  Dr.  Johnson  and  Dr. 
Eutherford  are  right  in  theirs.  In  the  circumstances,  how¬ 
ever,  it  seems  desirable  that  a  fresh  inquiry  should  be  insti¬ 
tuted  to  set  the  question  finally  at  rest;  and  this  surely 
could  be  done  by  the  drowning  or  suffocation  of  cats  and  dogs 
without  leave  asked  and  obtained  of  the  Home  Secretary  ? 

Supplementary  Observations. 

I  shall  conclude  this  essay  on  Apnoea  with  some  remarks 
bearing  on  certain  points  in  the  history  of  that  process 
which,  it  seems  to  me,  have  not  received  at  the  hands  of 
physiologists  the  attention  they  deserve ;  and  also  on  some 
others  as  to  which  differences  of  statement  are  to  be  found. 


other  than  those  already  considered,  in  some  of  our  best 
treatises  on  physiology. 

I.  As  to  what  goes  on  in  the  interior  of  the  heart  and  in' 
the  bloodvessels  intervening  between  the  right  and  left 
sides  of  the  heart  during  a  comparatively  large  part  of  the 
process. 

Taking  the  process  as  it  occurs  in  the  dog,  it  appears  that 
the  time  intervening  between  the  exclusion  of  air  from  the 
lungs  and  the  final  arrest  of  the  heart’s  action  is,  on  an 
average,  in  ordinary  cases,  seven  minutes  eleven  seconds. 

Now,  we  learn  from  Dr.  Foster  that  the  first  stage,  or 
that  of  dyspnoea,  passes  into  the  second,  or  that  of  con¬ 
vulsions,  at  the  end  of  the  first  minute,  and  this  into  the 
third  or  final  stage  early  in  the  second  minute ;  and  that 
this  third  stage,  or  that  of  (respiratory)  exhaustion,  con¬ 
sisting  of  lingering  and  long-drawn  inspirations,  lasts  from 
early  in  the  second  minute  to  the  end  of  the  fourth  or  fifth 
minute.  After  this  cessation  of  respiratory  effort,  however, 
the  heart  goes  on  acting  till  the  end  of  seven  minutes  fifteen 
seconds,  or,  on  an  average,  about  three  minutes  after  that 
effort  is  over. 

This  substantially  agrees  with  Dr.  Johnson’s  observations. 
Within  a  few  seconds  from  the  outset,  from  the  exclusion 
of  the  atmospheric  air,  the  pulse  and  the  breathing  are 
quickened ;  in  a  few  seconds  more  the  breathing  becomes  slow 
and  shallow,  and  the  pulse  full  and  firm.  The  latter  indi¬ 
cates  the  rise  of  the  Systemic  blood-pressure.  Then,  in  from 
forty  to  eighty  or  ninety  seconds  from  the  outset,  the  pulse 
suddenly  becomes  almost  or  quite  imperceptible,  indicating- 
the  fall  of  that  pressure  to  “nil.”  As  to  this.  Dr.  Foster 
states  that  “  during  the  first  minute  (or  sixty  seconds)  and. 
a  brief  part  of  the  second  ”  [say  fifteen  seconds,  or,  in  all, 
eighty  seconds],  “the  systemic  blood-pressure  rises  rapidly,., 
attaining  a  height  far  above  the  normal ;  but  that  during: 
the  third  stage,  which  then  begins  ”  [begins  after  seventy- 
five  or  eighty  seconds],  “it  falls  even  more  rapidly,  re¬ 
passing  the  normal  and  becoming  nil  as  death  ensues.” — 
(“Handbook  of  Physiology,”  fourth  edition,  page  378.)  By¬ 
death  is  here  meant  doubtless  apparent  death— i.e.,  cessation 
of  the  breathing. 

Simultaneously  with  the  fall  of  the  systemic  blood-pressure,, 
that  of  the  pulmonic  rises ;  and  then  there  ensues,  accord¬ 
ing  to  Dr.  Johnson,  collapse  of  the  left  cavities  of  the  heart 
and  distension  of  those  of  the  right — that  of  the  latter  going- 
on  rapidly,  and  quickly  reaching  a  height  in  inordinate- 
bulging  of  the  right  auricle. 

Putting  together  the  phenomena  already  described,  and 
the  times  just  indicated,  it  may  fairly  be  assumed  that  the 
bulging  just  referred  to  reaches  its  apparent,  if  not  its 
actual,  consummation  within  one  minute  and  forty-eight 
seconds  from  the  beginning  of  the  process — if  not,  indeed, 
within  a  still  shorter  period :  let  us  say  within  two  minutes. 

Now,  the  extreme  distension  and  bulging  of  the  right 
auricle  denotes  that  the  stopcock  action  of  the  pulmonic 
arterioles  is  in  full  exercise  ;  that  the  pulmonic  arteries  and 
the  right  ventricle  are  full  and  distended  with  blood— the 
obstruction  in  front  of  the  auricle  (i.e.,  at  the  pulmonic 
arterioles)  and  the  pressure  of  the  advancing  current  of 
blood  behind  it  in  the  great  veins  aiding  in  the  distension 
of  it. 

I  presume  that,  according  to  Dr.  Johnson,  this  state  of 
matters  implies  the  virtual  arrest  of  the  circulation.  From 
the  moment  that  the  filling  of  the  right  auricle  begins,  it 
goes  on  rapidly  to  the  full,  and  never  again  subsides.  The 
auricle  cannot  empty  itself,  by  reason  of  the  stopcock  action 
never  again  relaxing.  The  ventricle,  being  already  full  to 
distension,  can  admit  no  more  blood  from  the  auricle,  while 
the  ventricle  cannot  now  empty  itself  into  the  pulmonary 
artery  because  of  the  latter  being  also  full  to  distension. 

And  yet  the  heart  continues  to  act,  and  to  all  appearance 
it  must  do  so,  for  full  five  minutes  after  the  block  has 
occurred, — but  say  four  minutes. 

How,  in  the  circumstances,  does  the  heart  act,  and  what 
is  the  result  of  its  action  P  Four  minutes  is  a  very  notable,, 
in  fact,  at  such  a  juncture,  a  long  time  for  it  to  act.  Dr. 
Johnson  states  that  after  the  right  cavities  had  become 
distended,  the  right  ventricle  continues  to  act  forcibly.  Dr. 
Foster  speaks  of  “  the  heart’s  beats  as  at  first  somewhat 
quickened,  while  at  the  same  time  they  acquire  great  force.” 
Again,  according  to  Dr.  Foster,  “the  heart  continues  to  beat. 


HARVEY  OH  APNCEA  OR  ASPHYXIA. 


Dec.  8,  1883.  651 


Medical  Times  and  Gazette. 

for  some  seconds  after  the  respiratory  movements  have 
ceased,  the  strokes  at  last  rapidly  failing  in  frequency  and 
strength.”  And  again,  "  the  feebler  strokes  which  come  on 
toward  the  end  of  the  third  stage  are  quite  unable  to  empty 
its  cavities”  (page  378). 

There  is  some  want  of  precision  in  these  few  particulars, 
and  yet  one  cannot  but  think  that,  often  as  the  heart  has 
been  seen  acting  in  the  exposed  chest  in  experiments  on 
living  animals,  our  information  might  be  of  a  more  definite 
kind.  Its  action  is  quickened  and  stronger  for  a  time,  then 
after  a  time  it  becomes  slower  and  weaker,  and  in  the  end 
very  feeble.  There  will,  of  course,  be  differences  in  different 
animals  of  the  same  species.  Average  results  are  all  that 
can  be  looked  for,  or  need  be  desired.  Yet  surely,  by  a 
series  of  well-devised  experiments,  the  precise  character  of 
the  heart’s  beats  and  the  times  of  the  several  kinds  of  change 
they  undergo,  might  be  determined  to  minutes  and  seconds. 

Meanwhile,  one  can  only  speculate  on  what  may  or  must 
be  going  on  within  its  cavities  and  inside  the  pulmonic 
bloodvessels  during  the  four  minutes  that  intervene  between 
the  full  stopcock  action  of  the  pulmonic  arterioles  and  the 
final  cessation  of  the  heart’s  action. 

From  all  that  appears  from  sundry  statements  of  Dr. 
Johnson  and  Dr.  Foster,  I  incline  to  think  that  the  strong 
action  of  the  heart  does  not  continue  long  after  the  filling 
and  bulging  of  the  right  auricle.  Dr.  Johnson  indeed  states 
that  after  the  right  cavities  have  become  distended  the 
right  ventricle  continues  to  act  forcibly.  How  long  he  does 
not  say,  but,  according  to  his  theory,  cui  bono  its  action  at 
all  ?  The  right  ventricle  can  expel  little  or  nothing— in  fact, 
nothing.  The  left  ventricle,  according  to  Dr.  Johnson’s 
theory,  has  nothing  in  it  to  expel,  nor  has  it  had  anything 
to  expel  for  full  four  minutes.  Is  its  action,  then,  on 
both  sides,  for  some  minutes,  action  without  result— abor¬ 
tive  action— a  mere  contracting  and  relaxing  of  individual 
fibres  ?  But  how  can  a  hollow  muscle  already  full  to  dis¬ 
tension,  and  without  an  available  outlet,  contract  at  all  ?  (b) 

Dr.  Foster  says  (as>e  have  seen)  that  “  the  feebler  strokes 
which  come  on  toward  the  end  of  the  third  stage  are  quite 
unable  to  empty  its  cavities”  (page  378).  This  stage  ends 
full  three,  if  not  four,  minutes  before  the  heart  finally  ceases 
to  act.  But  how  does  Dr.  Foster  know  that  there  is  here 
any  question  at  all  as  to  the  emptying,  of  the  heart’s  cavities, 
and  that  too  for  some  minutes  ?  Is  it  from  actual  observa¬ 
tion  made  during  the  process,  or  how  P  He  does  not  say, 
and,  according  to  Dr.  Johnson’s  theory,  there  can  be  nothing 
of  the  sort  taking  place.  It  is  conceivable  that  the  stop¬ 
cock  action  of  the  pulmonic  arterioles,  though  sufficiently 
complete  to  keep  the  right  auricle  always  distended,  always 
bulging,  may  yet  be  such  as  to  admit  of  a  few  drops,  or  even 
of  a  tiny  stream,  to  pass  into  the  capillaries.  Very  small, 
however,  the  quantity  must  needs  be,  else  there  could  not 
fail  to  be  a  renewal  or  renewals  of  the  systemic  blood- 
pressure — an  occurrence  never  seen. 

This  whole  matter  is  one  of  no  moment  any  way ;  yet  it 
is  one  which  surely  merits  some  attention  as  a  part  of  the 
physiology  of  the  process. 

II.  Next  as  to  Prof.  Foster’s  theory  of  asphyxia,  and  some 
points  connected  with  it. 

Both  Dr.  Foster  and  Dr.  Kirkes  (or  his  editor)  assume,  it 
will  be  remembered,  in  common  with  Dr.  Fagge,  that  at 
the  moment  of  death  the  left  cavities  of  the  heart  are, 
equally  and  alike  with  the  right,  full  of  blood— nay,  dis¬ 
tended  with  it.  This,  if  true,  necessarily  implies  that  the 
whole  set  of  pulmonary  bloodvessels  intervening  between 
the  two  sides  of  that  organ  are  also  full  of  blood — the  pul¬ 
monic  capillaries  and  the  pulmonic  veins  not  less  than  the 
pulmonic  arteries. 

Dr.  Foster’s  view  seems  to  be  that  the  action  of  the  heart 
fails  simultaneously  on  both  sides,  and  from  like  causes — in 
part  from  over-distension  of  its  cavities  weakening  its  con¬ 
tractile  power,  in  part  from  the  poisonous  agency  of  venous 
blood  on  the  heart,  with  which  its  substance  soon  comes  to 
be  permeated,  and  in  part  from  exhaustion  of  its  nervous 

(b)  We  must  discriminate,  of  course,  between  tbe  right  and  left 
ventricles  -  the  latter  empty,  or  virtually  empty ;  the  former  full  to  dis¬ 
tension,  and  now  without  any  available  outlet.  The  left  may  go  on  flapping 
and  flapping  upon  itself,  albeit  expelling  nothing.  But  how  can  the  right 
possibly  act  when  distended  and  precluded  from  expelling  a  single  drop  ? 
And  there  is  even  more  than  four  minutes  for  the  heart  acting  in  some  way 
before  its  action  finally  ceases.  Surely  it  were  a  matter  of  no  small 
interest  to  know  precisely  the  behaviour  of  the  heart  at  this  stage. 


energy.  This  too  seems  to  be  the  view  taken  of  the  matter 

by  Dr.  Kirkes  or  his  editor.  And  as  to  the  weakening  of  the 
contractile  power  of  the  heart  from  over-distension  of  its 
cavities,  they  both  liken  or  compare  it  to  what  takes  place 
with  the  urinary  bladder  from  a  like  cause.  They  speak 
of  it  as  a  paralysis  of  the  heart. 

Now,  as  to  these  alleged  causes  of  failure  of  the  heart’s 
action,  it  may  well  be  asked.  In  what  way  does  the  readmis¬ 
sion  of  atmospheric  air  affect  them  ?  The  effect  of  the 
re-arterialisation  of  the  venous  blood  is,  in  favourable  cases, 
immediate ,  or  virtually  so.  The  enfeebled,  poisoned,  para¬ 
lysed  heart  at  once  acts  with  wonderful  vigour,  re-establish¬ 
ing  the  suspensed  circulation.  “  More  than  once,”  says  Dr. 
Johnson,  “  when  the  circulation  was  nearly  at  a  standstill, 
artificial  respiration  was  resumed.  The  blood  at  once  passed 
freely  through  the  lungs ;  the  distension  of  the  right  cavi¬ 
ties  of  the  heart  subsided.”  The  experiments  of  Bichat, 
made  with  a  stopcock  affixed  to  the  summit  of  the  trachea, 
and  those  of  others,  exhibited  the  same  result— the  imme¬ 
diate  restoration  of  the  full  action  of  the  heart ;  and  this  of 
the  naturally  weaker  right  ventricle,  which,  moreover,  has 
far  more,  and  for  a  much  longer  time,  had  to  bear  distension, 
and  which  must  be  the  first  of  the  two  ventricles  to  resume 
action,  and  thus  enable  the  left  one  to  act.  Again,  what  a 
contrast  to  the  urinary  bladder — inoperative  for  days  or 
weeks  !  Here  it  is  an  affair  of  seconds,  and,  in  the  nature 
of  things,  must  be  of  seconds  only.  Again,  how  is  the  newly 
made  arterial  blood  to  reach  the  substance  of  the  already 
poisoned  heart  but  through  the  action  of  the  poisoned  heart 
itself? — an  organ  which,  agreeably  to  Dr.  Foster’s  theory, 
has  first  of  all  to  send  on  the  whole  mass  of  venous  blood 
assumed  to  be  lying  in  the  pulmonic  capillaries,  veins,  and 
left  cavities  of  the  heart,  poisoning  it  still  further,  and  thus 
further  enfeebling  it,  before  the  revivifying  arterial  blood 
can  reach  it.  And  how  as  to  the  restoration  of  nervous 

energy?  . 

But  we  have  already  seen  good  reason  for  believing  that 
Dr.  Foster  is  in  error  as  to  the  facts  of  the  case,  and  Dr. 
Johnson  right — the  one  wrong,  the  other  right,  as  to  the 
state  of  the  left  cavities  [and  of  the  pulmonic  capillaries  and 
veins  at  the  moment  of  death.  In  fact,  I  assume  that  there 
can  now  be  no  longer  any  question  as  to  this. 

III.  Another  point  in  the  history  of  apnoea  demands  some 
notice.  It  is  whether  reanimation  is  possible  after  the  heart 
has  ceased  to  act.  Dr.  Alison  states  that  it  is  so.  "  For  some 
minutes,”  he  says,  “  after  the  circulation  has  ceased,,  in  a 
warm-blooded  animal,  it  is  still  possible  to  restore  it  by 
blowing  air  into  the  lungs”  (“  Outlines,”  third  edition,  page 
242).  In  a  footnote  he  refers  to  Koesler,  and  to  Goodwin’s 
reply  to  Bichat,  and  to  both  as  to  be  found  in  the  Edinburgh 
Medical  and  Surgical  Journal,  vols.  xxiii.  and  xxiv. 

Ao-ain,— Sir  Thomas  Watson  makes  the  same  affirmation 
(third  edition,  1848) :  "  In  this  state,  even  after  the  heart 
has  ceased  to  beat,  but  not  long  after,  if  the  cause  which  has 
excluded  the  air  be  withdrawn,  and  fresh  air  readmitted — 
in  other  words,  if  artificial  respiration  be  instituted,  the 
blood  in  the  pulmonary  capillaries  undergoes  the  required 
change,  becomes  arterial,  begins  again  to  pass  onwards,  and 
by  degrees  the  circulation  is  restored,  and  the  patient  saved  ” 
(Lecture  Y.,  vol.  i.,  page  67).  . 

It  appears,  however,  from  the  experiments  ot  the  Com¬ 
mittee  of  the  Medico-Chirurgical  Society  of  London,  ap¬ 
pointed  to  investigate  the  subject  of  suspended  animation, 
that  in  no  case  of  simple  apncea  did  recovery  take  place 
after  the  heart’s  action  had  ceased.  . 

Whether  this  negative  result  of  one  set  of  experiments  be 
decisive  of  the  question,  I  cannot  say,  and  I  am  not  in  cir¬ 
cumstances  to  pursue  the  matter  further.  But  one  would 
think  that  there  must  surely  have  been  facts  of  a  positive 
kind  to  lead  Dr.  Alison  and  Sir  Thomas  Watson  to  make  the 
affirmations  they  do.  And  in  view  of  the  fearfully  appalling 
loss  of  child-life  at  Sunderland,  on  J une  16  last,  when  282 
children  perished  within  a  few  minutes  from  suffocation, 
it  is  to  be  hoped  that,  in  some  cases  at  least,  reanimation 
may  be  possible  even  after  the  heart  has  ceased  its  action, 
albeit  for  only  a  minute  or  two  thereafter. 

IY.  Now  for  a  word  or  two  of  a  practical  kind.  1.  How 
important  it  is  to  have  a  lively  appreciation  of  the  danger 
attaching  to  cases  in  which  death  from  acute  apnoea  is 


652 


Medical  Times  and  Gaiette. 


HARVEY  ON  APNCEA  OR  ASPHYXIA. 


Dec.  8,  1883. 


threatened ;  nor  less  a  like  appreciation  of  the  value  of  the  ] 
only  remedy  that  can  in  such  cases  be  regarded  as  infallible,  I 
to  wit,  tracheotomy.  My  late  revered  friend,  Dr.  P.  M. 
Latham,  of  St.  Bartholomew’s  Hospital,  had  such  an  apprecia¬ 
tion.  '  “  As  I  was  going  round  the  hospital  one  morning,”  he 
tells  us,  “a  dying  woman  was  carried  in  and  laid  upon  a  bed. 
What  a  frightful  picture  she  was !  Cold  and  livid,  and 
pulseless ;  her  eyes  starting  from  their  sockets  ;  her  mouth 
wide  open,  and  lips  and  tongue  and  teeth  black  with  sordes ; 
and  breathing  convulsively,  and  with  a  kind  of  scream. 
With  what  agony  she  struggled  for'  life  !  and  what  force 
she  used  to  preserve  it !  Tossing  about  her  arms,  striking 
aside  all  who  came  near,  for  they  kept  the  air  from  her.  .  .  . 
What  was  to  be  done  ?.  .  .  She  had  been  bled  without  relief. 
■Symptom  after  symptom  arose  rapidly  and  uncontrollably, 
•until  they  reached  their  present  awful  consummation. 

“  This  was  quite  enough  to  know.  I  ordered  her  trachea 
be  opened.  Mr.  Earle  was  at  hand,  and  did  the  opera¬ 
tion  at  once.  The  relief  was  complete,  and  she  -  sank  into  a 
calm  slumber.  ...  In  six  weeks  she  was  discharged  well.  I 
have  twice,”  adds  Dr.  Latham,  “  at  distant  intervals,  met  her 
in  the  street,  and  she  has  recognised  me  with  a  smile.” — 
{“Lectures  on  Subjects  connected  with  Clinical  Medicine,” 
1836,  page  93-4.)  Could  Dickens  or  Thackeray  have  drawn 
a  more  graphic  picture  ? 

2.  Again.  A  hospital  surgeon  in  Paris,  making  his  round 
of  visits  one  morning  in  his  wards,  came  to  the  bedside  of  a 
patient  admitted  a  little  while  before.  The  man  was  suffer¬ 
ing  from  laryngitis.  It  was  well  marked,  but  at  the  time 
of  visit  there  was  nothing  urgent  in  the  symptoms ;  yet 
straightway  the  surgeon  called  for  the  requisite  appliances 
and  laid  open  the  windpipe.  This  done,  he  remarked  to 
the  students  around  him  that  he  had  deemed  it  his  duty  to 
do  what  he  had  done,  his  object  being  to  put  his  patient  in  a 
position  of  assured  safety.  There  was  nothing,  he  said, 
directly  demanding  the  operation,  nor  might  there  have 
been  in  the  future,  but  the  ailment  was  of  such  a  nature 
that  it  might  at  any  moment  become  urgent ;  that  it  might 
be  fatal  in  a  few  minutes,  and  at  a  time  when  there  might 
be  no  help  at  hand.  On  these  grounds  he  did  what  he  did. 
He  acted  well  and  wisely,  I  think.  The  operation,  no  doubt, 
was  a  painful  one ;  but  the  contingency  was  a  vital  one — 
life  was  at  stake  and  in  peril.  It  was  a  life-assurance  at  a 
tolerably  high  rate  of  premium ;  yet  the  assurance  given 
was  worth  the  price.  I  have  always  looked  upon  this  case 
and  Dr.  Latham’s  as  the  finest  illustrations  possible  of 
Cullen’s  “memorable  injunction” — that  of  “  olviating  the 
tendency  to  death.” 

3.  In  his  treatise  “  On  the  Practice  of  Medicine,”  Dr. 
Flint  gives  a  case  the  exact  counterpart  of  that  of  the 
French  surgeon,  with  this  wide  difference :  that  what  ought 
to  have  been  done  at  the  time  it  was  first  seen  was  left 
undone.  Everything,  indeed,  was  got  in  readiness  for  the 
operation  being  performed  “  at  an  instant’s  notice.”  That 
instant  came  too  soon !  Suddenly  the  symptoms  became 
urgent.  “  The  physician  was  in  a  few  moments  at  the 
bedside,  but  too  late  to  save  the  patient.”  Dr.  Flint 
urges  the  importance  of  acting  in  such  cases  on  the 
principle  by  which  the  French  surgeon  was  guided,  ex¬ 
hibiting  at  the  same  time  the  frightful  mortality  that  has 
actually  resulted  from  the  neglect  of  it.  Treating  of  the 
cedema  glottidis,  he  observes  that  “  the  operation  may  be 
advisable  as  a  precautionary  measure,  even  if  life  be  not  at 
the  moment  threatened,  when  the  practitioner  cannot  remain 
with  or  near  the  patient  until  danger  is  past  and,  further, 
that  “  with  a  correct  appreciation  of  the  pathological  con¬ 
dition,  a  prompt  recognition  of  it,  and  timely  surgical  inter¬ 
ference,  many,  if  not  most,  patients  may  be  saved  adding 
that  “  the  large  proportion  of  fatal  cases  heretofore  recorded 
may  fairly  be  ascribed  either  to  an  imperfect  knowledge  of 
the  affection,  delay  in  the  diagnosis,  or  want  of  promptness 
in  resorting  to  efficient  interference.”  The  statistics  given  by 
him  show  a  mortality  of  16  in  17  cases,  of  31  in  40,  and  of  127 
in  168— in  all,  a  mortality  of  174  in  225  cases,  in  respect  of  a 
disease  “in  which  most  patients  maybe  saved”  (“Prin¬ 
ciples  and  Practice  of  Medicine,”  fifth  edition,  pages  303, 
304).  An  apt  illustration  this  mortality  furnishes  of  the 
wisdom  of  a  precept  of  the  late  revered  Dr.  Alison,  to  wit, 
that  “  in  those  diseases  in  which  most  can  be  done  by  art, 
our  practice  .must  always  be  guided  in  part  by  conjecture, 
because  if  we  wait  for  certainty  we  very  often  wait  until 
the  time  for  successful  practice  is  past  ”  (History  of 


Medicine  in  “  Cyclopaedia  of  Practical  Medicine,”  Introduc¬ 
tion,  page  lxxxvii.). 

4.  I  may  perhaps  be  pardoned  for  giving  here  a  case 
under  my  own  care  in  the  Aberdeen  Royal  Infirmary  in 
1847 — a  case  showing  how  one  may  succeed  in  saving  life 
when  all  hope  of  averting  a  fatal  issue  has  been  abandoned, 
against  even  the  patient’s  resolve  to  die  rather  than  submit 
to  the  requisite  operation.  It  was  the  case  of  a  young 
woman,  aged  about  twenty-five,  convalescent  from  typhus, 
then  raging  epidemically  in  the  large  towns  of  Scotland. 
She  had  passed  safely  through  the  fever,  but  during  recovery 
was  seized  with  oedema  of  the  glottis.  A  consultation  of  the 
whole  hospital  staff  was  held.  The  operation  of  tracheotomy 
was  unanimously  pronounced  to  be  urgently  demanded.  On 
the  necessity  for  it  being  intimated  to  her,  she  at  once  re¬ 
fused  to  submit  to  it.  Told  that  she  must  die  if  not  per¬ 
formed,  she  still  refused;  and  all  entreaty  was  unavailing. 

The  staff  retired,  leaving  myself  and  the  House-Surgeon 
alone  with  her.  Ruminating  over  matters  by  the  fireside 
of  the  ward,  a  pan  on  the  hob  beside  us  suggested  to  us  a 
yet  untried  expedient — that  of  moist  heat  to  the  throat  in 
the  way  of  fomentation.  To  this  she  assented.  So,  setting 
the  water  in  the  pan  a-boiling,  we  immersed  in  it  a  goodly 
number  of  strips  of  flannel.  These  ready  for  use,  we,  in 
a  trice,  had  the  whole  neck  all  round  enveloped  with  the 
scalding  bits  of  flannel,  holding  her  down  in  bed  the  while. 
She  struggled  with  all  her  might,  kicked  and  screamed — or, 
rather,  squeaked.  Immediate  vesication  was  our  purpose, 
and  our  hope  was  that  this  would  effectually  take  off  the 
tension  within  the  glottis. 

In  a  brief  space  there  were  agreeable  indications  of  our 
hope  being  realised.  And  realised  it  was.  Gradually  the 
breathing  became  more  and  more  free,  and  the  voice  more 
distinct.  Within  thirty  or  forty  minutes  all  immediate 
danger  had  passed  away,  and  we  left  her,  mollified  towards 
us,  and  well  pleased  with  the  fomentation. 

Unfortunately,  she  died  some  weeks  after  of  bronchitis, 
and  congestion  of  the  lungs. 

Y.  A  word  or  two  in  conclusion  as  to  the  nomenclature 
in  use  to  designate  the  process  of  death  by  suffocation. 

Fifty  years  ago.  Sir  Thomas  Watson  called  attention  in  his 
Lectures  to  the  inappropriateness  of  the  term  long  in  use  to 
designate  it — namely,  asphyxia.  It  signifies,  as  he  observed, 
pulselessness,  or  want  of  pulse,  and  might  therefore  express- 
any  kind  of  death,  or,  if  applied  to  any  particular  mode  of 
dying,  is  specially  appropriate  to  that  beginning  at  the 
heart — to  syncope  or  asthenia — and  specially  inappropriate 
to  that  resulting  from  suffocation.  And  for  this  mode  he 
suggested,  and  intimated  his  own  intention  of  using,  the 
term  apncea,  signifying  privation  or  want  of  breath. 

This  suggestion  was  readily  acquiesced  in,  and  the  term 
apncea  came  to  be  very  generally  adopted  by  writers  on 
pathology  and  practice  of  medicine — by  Dr.  Flint,  Dr- 
Bristowe,  Dr.  Aitken,  Dr.  Johnson,  Dr.  Roberts,  the  reporters 
(expressly)  of  the  Committee  of  the  Medico-Chirurgical 
Society,  and  many  others. 

It  so  happens,  however,  that  long  after  the  general  adop¬ 
tion  by  pathologists  and  physicians  of  the  wise  suggestion 
made  by  Sir  Thomas  Watson,  the  physiologists  stepped  in, 
and,  with  a  singular  unanimity,  filched  that  term  from  its 
legitimate  use  and  from  physicians.  They  came  to  appro¬ 
priate  the  term  not  to  any  condition  ever  met  with  in. 
medical  or  surgical  practice,  but  to  an  incident  attaching 
to  a  physiological  experiment.  It  appears  that  when  in¬ 
sufflation  is  carried  on  too  rapidly  or  unduly,  as  in 
the  artificial  respiration,  or  when  an  animal  is  made  to 
breathe  pure  oxygen,  the  whole  blood  of  the  body  becomes 
arterial ised.  On  this  happening  the  breathing  is  suspended 
— spontaneously  ceases.  It  is  to  this  somewhat  complex 
affair  that  they  apply  the  term,  and  to  which  they  restrict 
it.  This  failure  of  breathing  from  prior  overmuch  breath¬ 
ing,  and  leading  to  undue  arterialisation  of  the  blood,  is  to 
them  apncea.  What,  it  may  fairly  be  asked,  is,  in  their 
own  view,  their  warrant  for  this  use  and  restriction  of  the 
term  ?  Is  it  to  the  cause  of  it— overmuch  breathing,— or  to 
the  effect  of  this  on  the  blood,  or  to  the  suspension  of  the 
breathing  in  the  midst  of  air  abounding  ?  To  none  of  these 
singly  is  the  term  “apnoea”  appropriate.  Is  it  to  the  whole 
jointly  ?  To  this  it  is  equally  inappropriate,  except  after  an 
Irish  fashion— “  Water,  water  everywhere,  and  not  a  drop 
to  drink !”  There  is  no  want  or  privation  of  air  in  the 


Medical  Times  and  Gazette. 


CHEVERS  ON  THE  ORDINARY  DISEASES  OF  INDIA. 


Dee.  8,  1883.  653 


matter  ;  it  is  only  that  no  more  is  needed.  If  it  be  simply 
to  the  suspension  of  the  breathing,  per  se,  then,  while  the 
word  apnoea  does  not  express  this  condition,  it  is  one  that 
Folds  of  an  important  stage  of  the  process  of  suffocation, 
and  one  lasting  in  the  dog  for  full  three  minutes  before  the 
heart  ceases  to  beat.  Sir  Thomas  Watson,  indeed,  named 
it  apnoea  after  its  essential  cause,  “  privation  of  air,” — not 
from  any  one  feature  of  the  process  itself.  But  if  apnoea 
is  to  be  held  want  of  breathing  (which,  as  we  have  said, 
it  does  not  express),  why  should  not  the  physiologists 
have  acquiesced  in  the  extension  of  it  to  the  whole  pro¬ 
cess,  as  already  agreed  on  at  the  instance  of  Sir  Thomas  ? 
Again,  we  have  the  like  occurring  in  cases  of  sudden  syn- 
■cope,  and  lasting  often  for  many  minutes  or  hours  before 
recovery  takes  place  or  life  becomes  extinct.  Is  this  also 
apnoea  ?  If  so,  it  should  be  regarded  as  the  designa¬ 
tion,  not  of  any  one  process,  but  of  a  condition  incidental 
to  several,  namely,  suspended  breathing.  But  to  this, 
;as  already  remarked,  it  is  as  inappropriate  as  it  is  to  any 
other  part  of  the  affair  to  which  the  physiologists  have 
.applied  it.  It  cannot,  in  any  sense  of  the  term,  apply  to  the 
abnormal  arterialisation  of  the  blood.  Altogether,  the 
^physiological  use  and  restriction  of  the  term  “  apnoea  ”  to  a 
matter  so  trumpery,  physiologically,  as  that  of  over-insuffla- 
dion  can  only  be  looked  upon  as  an  unmeaning  play  upon 
words,  to  say  nothing  of  the  morale  of  the  appropriation. 

Anyhow,  in  thus  appropriating  that  word — taking  it  from 
the  physicians  who  had  acquired  a  prescriptive  right  to  it 
of  over  forty  years — the  physiologists  might  have  shown 
some  care  to  devise  for  them  and  for  themselves  some  suit¬ 
able  designation  for  the  important  process  of  suffocation. 
Why  throw  them  and  themselves  back  on  the  rightly  dis¬ 
carded  term  asphyxia — pulselessness  ?  For  this  term 
“asphyxia”  is  appropriate  to  no  part  or  stage  of  it,  pulseless- 
mess  obtaining  only  when  the  heart  ceases  to  act,  i.e.,  when 
life  is  extinct. 

In  strict  propriety,  want  of  breath  means  absence  or 
privation  of  breath.  In  common  parlance  it  means  need  of 
breath.  We  may  thus  have  Apnoea  for  the  cause  of  suffoca¬ 
tion,  Apnoea  for  the  remedy  for  it,  and  Apnoea  for  the  last 
stage — leaving  no  name  for  the  earlier  stages  going  on  unseen 
within  the  chest,  unless  we  take  it  in  Watson’s  way — Apnoea 
for  the  whole.  We  may  thus  play  upon  words  to  any  extent 
we  please,  as,  in  a  way  of  their  own,  the  physiologists  have 
done  with  this  word  Apncea, — a  word  absolutely  needed  accu¬ 
rately  to  designate  the  interesting  and  important  process 
of  death  from  Suffocation. 

16,  Hanover-terrace,  Ladbroke-square,  W. 


PRACTICAL  NOTES  ON 

THE  ORDINARY  DISEASES  OF  INDIA, 

ESPECIALLY  THOSE  PREVALENT  IN  BENGAL. 

By  NORMAN  CHEVERS,  C.I.E.,  M.D., 

President  of  the  Epidemiological  Society. 

( Continued  from  page  483. ) 

MALARIAL  CACHEXIA — Continued  from  page  154. 
Malarial  Hepatic  Disease. — Within  my  bare  recollection 
•enlargement  of  the  liver,  following  repeated  attacks  of 
Intermittent,  occurred  among  the  denizens  of  English 
marshes,  who  were  said  to  be  “liver-grown.”  It  is  to  be 
trusted  that  these  cases  have  become  fewer  since  the  marsh 
people  in  remote  districts  have  supplied  themselves  with 
stocks  of  quinine  and  Gregory’s  powder.  This  state  of  dis¬ 
ease,  which,  commencing  with  enlargement,  has  a  tendency 
to  end  in  kirrhosis,  is  noticed  in  nearly  all  highly  malarious 
districts  in  India.  In  large  development  it  is  far  less  com¬ 
mon  in  Bengal  than  splenic  hypertrophy,  although  the 
liver  is  rarely,  if  ever,  healthy  where  the  spleen  is  extremely 
diseased.  It  is  probable  that  the  ascites,  which  is  common 
in  spleen  cases,  is  largely  due  to  functional  or  organic 
hepatic  obstruction.  I  have  seen  malarious  disease  of 
the  liver  at  various  stages.  It  appears  to  commence 
as  enlargement,  which,  for  a  time,  diminishes  at  the 
end  of  every  attack  of  fever.  Still,  every  succeeding 
paroxysm  gives  increment  to  the  mass.  If  the  fever  be 


completely  got  rid  of,  the  organ  may  recover;  but,  in 
neglected  cases.  Malarious  Cachexia  is  established,  and, 
after  many  alternations  of  enlargement  and  contraction,  an 
extreme  degree  of  kirrhosis  is  established.  The  most  ex¬ 
cessive  development  of  the  hobnail  condition  that  I  ever 
recollect  to  have  seen — not  excepting  the  gin  livers  at  Guy’s 
Hospital — was  in  a  poor  native  woman,  probably  not  a 
drunkard.  A  medical  officer,  of  very  high  character,  having 
been  stationed  at  Akyab,  a  malarious  seaport,  became  the 
subject  of  rapidly  progressing  kirrhosis  of  the  liver.  I  saw 
him  in  London  not  long  before  his  death  from  hydrothorax 
and  other  dropsical  effusions.  He  was  still  an  active  man, 
between  thirty  and  forty  years  of  age,  but  with  the  pinched 
features  and  parchment-like  complexion  often  seen  in  organic 
hepatic  disease. 

An  officer,  who  now  occupies  a  high  post  in  India,  came 
to  Bengal  about  twenty-nine  years  ago.  I  recollect  him, 
on  his  arrival,  a  very  fine  young  man,  apparently  in  perfect 
health.  He  was  sent,  early  in  his  career,  to  a  newly 
occupied  station,  which  was  then  notoriously  malarious, 
where  he  had  a  great  deal  of  fever.  In  the  autumn  of  1855 
I  was  asked  to  see  him  in  Calcutta.  He  was  much  wasted 
and  ansemiated,  his  features  pinched,  drawn,  and  painfully 
anxious,  dusky,  and  pallid.  The  abdomen  was  tumid,  an 
enlarged  liver  extending  from  high  up  in  the  chest  nearly 
to  Poupart’s  ligament  and  to  the  left  beyond  the  navel. 
To  the  touch  the  mass  was  of  even  solidity,  generally 
smooth,  except  where,  below  the  plane  of  the  umbilicus,  a 
defined  hemispherical  nodule,  as  large  as  half  an  orange, 
raised  the  abdominal  walls.  I  happened  to  go  as  far  as 
Madras  in  the  steamer  which  conveyed  him  to  England. 
During  his  first  few  days  on  board  the  rapidity  of  his  im¬ 
provement  was  very  striking.  His  strength  and  appetite 
began  to  return ;  he  was  much  upon  deck ;  and  his  liver 
went  up  a  finger’s  breadth  daily. 

I  apprehend  that,  had  he  remained  in  a  very  malarious 
district,  the  liver  would  not  have  recovered,  but  would, 
eventually,  have  become  kirrhosed  and  much  contracted. 
He  has  always  remained  very  thin,  with  a  pale,  shrunken 
countenance,  and  has  suffered  much  from  neurotic  asthma. 
In  these  cases  long-continued  courses  of  quinine  and  ipe¬ 
cacuanha  and  change  of  climate  are  the  chief  remedies. 
As  mercury  is  not  used  in  India  for  hepatic  disorder,  no 
caution  against  the  employment  of  this  drug,  which  would 
probably  kill,  is  necessary.  I  have  alluded  elsewhere  to  the 
influence  of  malarious  liver-disease  in  the  production  of 
abdominal  dropsy,  and  I  shall  have  to  discuss  hereafter  the 
question,  “  What  influence  has  malarious  cachexia  in  the 
causation  of  hepatic  abscess  P” 

When  contraction  of  the  liver  causes  dropsy,  we  have 
before  us  an  important  clinical  study.  As  we  know  that 
stenosis  of  one  of  the  ostia  of  the  heart  may  advance  to 
such  a  degree  as  scarcely  to  allow  of  the  passage  of  a  goose- 
quill  before  the  walls  of  its  chamber  lose  all  power  of  mus¬ 
cular  contraction,  so  it  is  almost  certain  that  kirrhotic 
contraction  of  the  liver  very  rarely,  if  ever,  goes  on  to  so 
extreme  a  degree  as  absolutely  to  arrest  the  portal  circula¬ 
tion.  At  various  stages  of  confirmed  and  advancing  kirrhotic 
contraction,  the  liver  becomes  congested,  say  in  consequence 
of  an  attack  of  intermittent  fever,  of  a  debauch,  or  of  a 
chill,  or  of  the  establishment  of  one  of  those  states  of  blood- 
impoverishment  which  we  designate  as  “  anaemic.”  Now 
the  portal  circulation  is  impeded,  and,  to  relieve  this, 
ascitic  effusion  occurs.  Here  is  another  of  what  I  have 
termed  “  constitutional  fixes.”  Here  we  may  have  emphy¬ 
sematous,  bronchitic,  or  otherwise  impedimental  lungs,  a 
weak  or  otherwise  obstructive  heart,  kidneys  as  faulty  as 
they  generally  are  in  cases  of  hepatic  kirrhosis,  and  a  history 
of  heematemesis  and  dysentery.  What  are  we  to  do  here  P 
We  can  give  neither  drastics  nor  diuretics.  It  remains  to 
us  only  to  relieve  the  liver  from  all  removable  congestion. 
We  act  here  upon  the  principle  which  guides  us  in  the 
treatment  of  what  is  called  “spasmodic”  stricture,  in  which 
there  is  temporary  congestion  of  a  narrowed  urethra.  We 
endeavour  to  avoid  tapping,  at  least  until  we  have  fairly 
tried  other  means.  We  give  a  course  of  small  doses  of 
ipecacuanha,  apply  large  sinapisms  frequently  over  the 
whole  hepatic  region  and  beyond  it,  keep  the  bowels  regu¬ 
larly  open,  employ  gentle  pressure  by  means  of  a  broad 
flannel  bandage,  cut  off  the  drunkard’s  and  generous  liver’s 
supply  of  hydrocarbons,  and  give  quinine  in  the  malarious 
cases.  Should  the  kidneys  be  sounder  than  they  are  likely 


Medical  Times  and  Gazette. 


654 


CHEVERS  ON  THE  ORDINARY  DISEASES  OF  INDIA.  Dec.s.isss. 


to  be  at  an  advanced  stage  of  hepatic  kirrhosis,  we  may 
cautiously  promote  diuresis.  Thus  we  may  effect  judiciously 
what  the  famous  Dr.  Sermon  did,  coarsely  and  harshly, 
by  use  of  his  “  cathartique  and  diuretique  pill”  in  General 
Monk’s  dropsy. 

While  his  Grace’s  bowels  were  sound  enough  and  his 
:  kidneys  valid  enough,  they  bore  and  obeyed  the  evacuants, 
and  the  dropsy  disappeared.  When  the  hepatic  congestion 
returned,  the  general  health  being  lower,  these  coarse 
evacuants  could  not  be  borne,  only  irritated  and  failed 
signally. 

We  need  not  fear  that,  by  such  a  course  as  I  have  sketched 
above,  we  can,  without  any  strain  upon  the  constitution,  at 
least  partially  relieve  the  liver  of  its  congestion ;  and  then, 
and  not  till  then  (unless  the  upward  pressure  of  the  fluid 
threatens  immediate  danger,  when  we  may  remove  a  few 
quarts  through  a  fine  canula),  we  may  tap  with  a  fair  hope 
of  temporary  success.  I  would  most  earnestly  advise  the 
young  practitioner  never  to  declare  hastily  that  a  kirrhosed 
liver  is  hopelessly  obstructive.  Up  to  almost  the  moment  of 
dissolution,  the  congestions  of  these  contracted  livers  fluc¬ 
tuate  in  degree,  and  are  more  or  less  removable.  I  shall 
recur  to  this  subject  when  speaking  of  anaemic  ascites 
consequent  upon  malarial  cachexia. 

Pneumonia. — Doubtless,  nine-tenths  of  the  cases  of  pneu¬ 
monia  which  occur  are  due,  not  to  external  circumstances, 
but  to  the  presence  of  some  constitutional  fault.  Thus, 
pneumonia  is  likely  to  attack  the  victims  of  paludal  cachexia, 
but  I  have  never  been  able  to  trace  any  relationship  more 
direct  than  this  between  malaria  and  pneumonia.  In  Lower 
Bengal — that  hotbed  of  malaria — I  do  not  think  that,  in 
upwards  of  twenty-seven  years,  I  saw  or  heard  of  half  a 
dozen  cases  of  idiopathic  pneumonia.  I  never  saw  it  in  a 
European,  bpt,i  saw  a  few  cases,  and  heard  of  more,  in 
poor,  ill-fed  natives,  in  whom  the  upper  lobes  are  especially 
liable  to  be  attacked. 

Dr.  Maclean(a)  regards  pneumonia  as  the  most  formidable 
complication  of  intermittent  fever.  He  insists  that  invalids 
returning  from  India  or  from  other  hot  and  malarial  climates 
to  high  latitudes,  unless  they  are  carefully  protected  by  suit¬ 
able  clothing,  are  prone  to  suffer  from  this  disease.  The 
rapidity  with  which  consolidation  of  the  lungs  takes  place 
in  such  cases  is  very  remarkable.  It  is  not  an  uncommon 
thing  to  see  five  or  six  cases  of  this  kind  out  of  one  party  of 
invalids  landed  at  Net  ley  from  India,  if,  on  entering  the 
Channel,  they  have  been  exposed  to  cold  weather.  The 
pneumonia  is  generally  double,  and  recovery  is  rare,  the 
patients  either  sinking  at  once,  or  dying  after  a  longer  or 
shorter  illness  from  pneumonic  phthisis.  So  I  heard  from 
my  father,  who  was  a  naval  surgeon,  that,  about  the  com¬ 
mencement  of  this  century,  a  Russian  squadron  having  run 
in  to  Spithead,  the  commanding  officer  was  so  much  struck 
by  the  neat  appearance  of  our  sailors  in  their  thin  blue 
jackets  and  trousers,  that  he  made  his  own  people  leave  off 
their  heavy  clothing  and  gave  them  a  like  outfit.  The 
weather  was  warm,  but  there  were  fresh  breezes.  The  poor 
Russians  died  in  great  numbers  of  pneumonia,  as  if  by  a 
pestilence.  Here  we  have  a  choice  of  causes  between 
scorbutus  and  the  influence  of  the  Portsea  marshes. 

It  has  been  frequently  noticed  that  catarrh  prevails  ex¬ 
tensively  in  outward-bound  vessels  on  nearing  the  coast  of 
India.  I  do  not  know  that  it  is  so,  but  it  may  be  the  fact, 
that,  in  certain  localities,  malaria  and  pneumonia  exist  in  the 
relationship  of  cause  and  effect.  Thus  malarious  Rome  is 
notorious  for  pneumonia  ;  but  there  the  frequency  of  marked 
atmospheric  transitions  may  be  at  least  equally  to  blame. 
Mr.  Oldham  has  recently  described  the  complication  of  In¬ 
termittent  and  Remittent  Fevers  with  pneumonia  and 
pleurisy  as  very  frequent  and  fatal  on  the  border  of  the 
great  Indian  Desert,  as  at  Bhawulpore.  This  fact  becomes 
clearer  when  he  adds  that,  in  February,  1872,  the  maximum 
daily  reading  in  the  sun  was  107°  Fahr.,  and  the  average 
nightly  minimum  30°  Fahr.,  giving  an  average  variation  of 
77°  in  the  twenty-four  hours.  Still,  the  question  remains, 
“  Seeing  that  Calcutta  and  Chittagong  are  impested  with 
malaria,  and  that  both  places  are  liable  to  sudden  and  very 
great .  changes  of  temperature,  why  are  those  places  singu¬ 
larly  free  from  pneumonia  of  strictly  pronounced  type,  if 
malaria  is  to  be  looked  upon  as  a  principal  cause  of  that 
disease  P  ”  There  is,  however,  one  fact  which  deserves 


(a)  Quain  rage  734. 


further  consideration  and  examination.  I  have:  already- 
noticed  the  great  proclivity  of  native  sick  in  Bengal  to  be 
suddenly  attacked  with  fatal  symptoms  in  the  “  small  hours.” 
Here  there  are  generally  found  what  appear  to  be  little- 
more  than  the  evidences  of  passive  congestion  of  the  lungs. 
Possibly  this  may  be  “pneumonia”  which  never  goes  on  to- 
consolidation,  but  kills  in  three  or  four  hours.  To  me,  how¬ 
ever,  it  appears  to  be  merely  that  hypostatic  pneumonia  of 
the  dying  which  frequently  puts  a  sudden  end  to  gra  ve  cases 
in  all  climates.  ( See  also  Pneumonia  under  the  head  of 
“  Diseases  of  the  Respiratory  System.”) 

Renal  Disease. — Albuminuria  is  often  seen  among  anse- 
miated  Europeans  who  have  frequently  suffered  from 
malarious  fever  in  India.  This  symptom  may  attend  a 
condition  of  apparently  vigorous  health;  and,  as  I  have- 
found  it  where  the  urine  was  free  from  casts  and  had  a 
normal  specific  gravity,  I  believe  that  it  may  be  a  more- 
passive  serous  haemorrhage,  from  spanaemia  unattended  with 
permanent  organic  renal  lesion. 

Dr.  Maclean  (b)  observes  that,  in  malarial  cachexia  “  the- 
urine  is  sometimes  albuminous,  with  oedema  of  the  lower 
extremities — symptoms  suggestive  of  Bright’s  disease,  lead¬ 
ing  to  a  grave  prognosis,  often  ill-founded,  as  the  above¬ 
symptoms  usually  disappear  under  good  climatic  and  thera¬ 
peutic  means.”  I  have,  however,  repeatedly  heard  of  cases; 
of  officers  of  the  highest  character,  who  could  not  be  sus¬ 
pected  of  intemperance,  in  whom  a  long  Indian  career  was 
terminated  by  what  appeared  to  be  Bright’s  disease.  As  the- 
patients  were  not  mine,  I  have  no  precise  knowledge  of  the 
conditions  of  the  kidneys  in  these  cases. 

Dr.  W.  J.  Moore  observes(c)  that  “  if  the  urine  passed- 
during  or  immediately  after  a  fever  paroxysm  is  examined, 
it  will  very  frequently  indeed  show  evidence  of  albumen. 
When  fever  becomes  habitual  or  of  frequent  recurrence, 
albumen  is  more  constantly  present.  In  the  more  severe 
forms  of  malarious  cachexy,  albuminous  urine  is  quite  as. 
often  present  as  absent.” 

Sir  Andrew  Clark  has  recently  stated(d)  the  noteworthy 
fact  that  of  the  young  men  competing  for  places  in  the 
Indian  Civil  Service  examination,  he  has  ascertained,  by 
repeated  personal  examination,  that  more  than  a  tenth 
become  albuminuric.  He  attributes  this  to  “the  strain  of 
prolonged  competitive  examinations.” 

Indian  albuminuria  might  well  engage  the  attention  of 
pathologists  in  that  country,  who  should  begin  by  examining 
the  urine  of  a  great  number  of  Europeans  and  natives  in 
apparently  good  health,  then  in  various  diseases,  and  espe¬ 
cially  in  fever  and  malarial  cachexia.  As  I  have  before 
mentioned,  ordinary  Morbus  Brightii  occurs  in  India ;  but 
far  less  frequently  than  in  England.  Dr.  Morehead  devoted^ 
a  large  section  of  his  work  to  this  disease.  Many  years  ago, 
my  friend,  Dr.  Joseph  Ewart,  published(e)  a  very  interest¬ 
ing  and  suggestive  series  of  cases  of  Granular  or  Hobnail 
Kidney,  which  occurred  in  the  Jail  and  Dispensary  at  Ajmeer. 
The  whole  subject  of  Renal  Disease  in  India  would  amply 
repay  some  years  of  diligent  research. 

I  think  that  this  inquiry  could  be  best  undertaken  in  those 
districts  of  the  Madras  and  Bombay  Presidencies  and  in 
Ceylon  where  Beriberi  is  most  prevalent.  Mr.  J.  L.  Rankin 
observed,  many  years  ago,(f )  that  his  experience  led  him  “  to 
adopt  the  opinion  that  Beriberi  is  primarily  and  essentially 
a  renal  disease.”  I  shall  return  to  this  question  under  the 
heading  of  “  Beriberi.” 

[To  be  continued.) 


Lobsters  as  an  Article  of  Diet. — Dr.  Folson  writes 
to  the  Boston  Medical  and  Surgical  Journal,  that  when  in 
service  at  the  Tainton  Lunatic  Hospital  he  had  charge  of 
the  diet  of  about  450  patients.  During  the  plentiful  season 
all  patients  not  acutely  ill  had  well- boiled  plain  lobster 
once  a  week.  Not  a  single  instance  of  digestive  disturbance 
occurred  in  consequence.  Dr.  Folson  thinks  that  lobsters, 
if  fresh  and  well  boiled,  are  a  wholesome  diet  for  all  without 
a  special  idiosyncrasy  against  them. — New  York  Med.  Record, 
November  10. _ _ _ _ 

Ob)  Quain,  page  916. 

(c)  Indian  Annals  of  Medical  Science ,  No.  22,  page  281,  Masked 
Malarious  Fever.” 

(d)  President’s  Address,  Clinical  Society  of  London,  1833. 

(e)  Indian  Annals  of  Medical  Science,  No.  4  for  1*55,  page  539. 

(f)  Proceedings  of  the  Hyderabad  Medical  and  Physical  Society  .*  P°port 
on  Beriberi. 


Medical  Times  and  Gazette. 


MEDICAL  AND  SURGICAL  PRACTICE. 


Dec.  8,  1883.  655' 


CLINICAL  NOTES  OF 

CASES  OF  HYSTERO-  EPILEPSY  TREATED 
BY  APOMORPHIA. 

By  T.  HAMMOND  WILLIAMS.  L.R.C.P.,  etc.. 

Resident  Medical  Officer  at  the  Infirmary,  Denbigh,  N.  Wales. 


<7ase  1. — M.  K.,  aged  sixteen,  a  domestic  servant.  She 
•was  in  good  health,  and  body  was  well  nourished.  When  I 
first  saw  her,  on  February  5,  1882,  I  was  informed  by  her 
mother  that  she  had  been  seized  by  as  many  as  six  fits 
during  the  day,  each  lasting  about  half  an  hour.  There  was 
no  history  of  convulsions  during  childhood,  and  there  was 
nothing  striking  in  her  family  history.  Menstruation  had 
ceased  two  months  previous  to  the  onset  of  these  attacks, 
and  the  patient  imagined  that  she  was  pregnant,  which, 
however,  proved  to  be  not  so.  Labouring  under  this  false 
belief,  the  moral  shock,  and  the  reproach  of  her  parents,  she 
became  dull,  irritable,  and  latterly  subject  to  convulsions.  On 
the  third  day  after  the  first  series  of  fits,  the  convulsions  re¬ 
appeared.  The  motor  symptoms  were  those  of  a  general  con¬ 
vulsive  seizure,  preceded  by  an  aura  from  the  prcecordial 
region,  which,  however,  was  not  constant.  No  cry  preceded 
the  fit.  The  spasms  were  at  first  clonic  in  character,  face 
pallid,  and  features  distorted,  this  stage  lasting  for  three 
minutes.  Afterwards  the  body  and  limbs  passed  into  a  state 
of  tonic  rigidity,  the  attack  altogether  lasting  from  twenty 
to  thirty  minutes.  The  tongue  was  not  bitten,  nor  were  the 
pupils  dilated.  On  two  occasions  she  struggled  violently, 
threw  her  arms  about,  and  scratched  the  attendant’s  face. 
Sometimes  she  would  tear  her  clothes,  sit  up  in  bed  making 
gestures,  and  the  more  the  attendant  attempted  to  restrain 
her  movements  the  more  resistance  she  offered.  During  the 
attack  the  orbicularis  palpebrarum  was  in  a  state  of  tonic 
spasm,  which  occasionally  was  broken  by  a  quivering  move¬ 
ment.  The  eyeballs  were  turned  upwards,  but  there  was 
no  strabismus.  Reflex  action  was  not  completely  abolished. 
Emotional  activity  revealed  itself  by  gestures  simply;  no 
utterances  of  any  kind  were  present.  On  pricking  the  skin 
no  response  could  be  elicited,  and  no  blood  appeared  after 
the  pin-prick  test.  Pressure  on  the  ovarian  region  was  of 
no  avail,  and  the  cold  douche  produced  no  benefit.  A  pur¬ 
gative  was  frequently  given,  also  a  dose  of  thirty  grains  of 
hydrate  of  chloral  was  administered  thrice  daily,  which 
resulted  in  no  beneficial  effect,  for  the  fits  still  continued  to 
occur  three  or  four  times  in  a  day.  After  these  convulsive 
attacks  had  continued  daily  for  over  a  week,  the  chloral  was 
stopped,  and,  instead,  an  injection  of  one-fifteenth  of  a  grain 
of  apomorphia  was  administered  subcutaneously  immediately 
each  fit  commenced.  The  first  two  injections  produced  no 
emesis,  probably  because  the  hydrate  of  chloral  previously 
given  retarded  its  action.  Afterwards  each  injection  pro¬ 
duced  speedy  vomiting  in  ten  minutes  after  its  administra¬ 
tion.  On  every  occasion  the  patient  complained  of  nausea  and 
severe  frontal  headache,  which  accompanied  and  followed 
the  vomiting.  The  convulsions  ceased  as  soon  as  sickness 
and  vomiting  occurred  ;  so  that  the  duration  of  the  attack 
lasted  only  ten  minutes,  instead  of  from  twenty  to  thirty 
minutes.  The  drug  was  given  on  ten  occasions,  the  seizures 
•occurring  less  frequently  and  being  shorter  in  duration.  The 
effects  of  the  drug  were  well  marked,  for  the  pulse  became 
very  rapid,  the  respirations  accelerated,  and  after  the 
vomiting  stopped  the  patient  became  prostrate,  drowsy,  and 
finally  fell  into  a  deep  sleep.  During  this  period,  purgatives 
were  administered  and  warm  baths  taken  twice  weekly. 
Menstruation  returned  a  week  before  the  fits  ceased,  after 
being  absent  for  three  months.  No  recurrence  took  place, 
and  the  patient’s  health  has  remained  good  since. 

Case  2. — Elizabeth  T.,  aged  seventeen,  had  been  in  a  hos¬ 
pital  ward  for  over  a  year,  suffering  from  hystero-epilepsy. 
By  her  own  statement  it  seemed  that  she  had  suffered  from 
“  fits”  since  she  was  ten  years  of  age,  i.e.,  for  the  last  seven 
years  of  her  life.  Her  body  was  well  nourished,  and  she 
suffered  from  no  organic  disease.  She  was  very  reserved, 
shy,  and  diffident.  She  seldom  entered  into  conversation  with 
anyone,  and  would  laugh  instead  of  responding  to  questions 
asked  of  her.  The  hysterical  dyscrasia  had  always  been 
pronounced  in  this  case.  She  would  frequently  cry  and 
laugh  alternately,  would  pass  large  quantities  of  clear  urine. 


and  be  troubled  with  the  “globus  hystericus.”  On  one' 
occasion  she  retained  her  urine  for  two  days,  until  the 
bladder  was  greatly  distended,  and  submitted  without  com¬ 
punction  or  hesitation  to  the  employment  of  the  catheter. 
Latterly  she  manifested  a  tendency  to  excitement  and 
unruly  conduct,  and  in  a  few  days  became  so  restless  and 
violent  that  she  had  to  be  confined  in  an  asylum.  Her  mind 
was  then  (confused  and  obtuse,  so  that  to  simple  questions 
asked  of  her  she  either  gave  no  answer  or  an  incoherent 
one.  She  imagined  strange  things,  had  peculiar  delusions 
and  deceptions  associated  with  the  excitement,  and  in¬ 
coherency,  which  may  be  characterised  as  hysterical  mania. 
She  was  dangerous  to  others,  but  not  suicidal.  As  the 
maniacal  symptoms  passed  off,  the  convulsions  reappeared 
after  being  absent  throughout  the  period  of  excitement. 
Apomorphia  was  used  as  in  the  previous  case,  and  it  again 
proved  of  great  service  in  diminishing  frequency  and  dura¬ 
tion  of  the  convulsive  seizures. 

Remarks. — Mental  perturbation  was  marked  in  both  cases, 
evidently  existing  in  the  first  as  a  result  of  the  uterine  func¬ 
tion  being  in  abeyance.  Also  in  the  same  case  the  vaso¬ 
motor  system  seemed  to  be  at  fault,  for,  on  pricking  the 
skin,  no  blood  appeared  from  the  cutaneous  arterioles  and 
capillaries.  The  general  nutrition  and  the  condition  of  the 
secretions  were,  however,  consistent  with  health.  The  drug 
no  doubt  produced  emesis  by  being  carried  into  the  circula¬ 
tion,  to  the  great  nervous  centre  in  the  medulla  oblongata, 
where,  by  its  action,  it  excited  vomiting,  besides  causing 
nausea  and  depression  of  the  circulatory  system,  and 
diminishing  the  muscular  and  nervous  power.  It  therefore 
acts  as  a  direct  emetic  upon  the  so-called  vomiting  centre, 
but  as  an  indirect  emetic  in  relation  to  the  stomach.  The 
value  of  apomorphia  as  an  emetic  was  particularly  well 
marked  in  both  cases,  although  the  dose  may  be  considered 
small.  Also,  prostration,  drowsiness,  and- sleep  followed, 
after  the  vomiting  ceased. 


REPORTS  OF 

HOSPITAL  PRACTICE  IN  MEDICINE 
AND  SURGERY. 

— - ♦- - 

ROYAL  WESTMINSTER  OPHTHALMIC 
HOSPITAL. 


MILD  CASE  OF  SYMPATHETIC  OPHTHALMITIS 
FOLLOWING  WOUND  OF  THE  CORNEA  WITH 
PROLAPSE  OF  THE  IRIS  —  IRIDECTOMY  —  RE¬ 
COVERY. 

(Under  the  care  of  Mr.  GUSTAV  US  HARTRIDGE.) 

Percy  C.,  aged  ten,  was  brought  from  Southampton  to  the 
Royal  Westminster  Ophthalmic  Hospital  on  June  30,  1883, 
having,  nine  weeks  previously,  injured  his  right  eye  by  the 
slipping  of  a  knife,  with  which  he  was  cutting  his  boot-lace. 
He  was  immediately  taken  to  a  doctor,  who  kept  it  bandaged 
for  a  week.  The  vision  has  been  impaired  since,  but  the 
eye  remained  comfortable  till  the  last  week,  when  slight 
redness  appeared,  with  pain  and  watering.  He  complains 
now  that  he  does  not  see  so  well  with  his  left  eye  as  formerly. 

Present  Condition. — Right  eye  :  A  cicatrix  about  six  milli¬ 
metres  long  on  the  lower  and  inner  part  of  the  cornea,  ex¬ 
tending  slightly  into  the  sclerotic;  iris  prolapsed  ;  anterior 
chamber  shallow;  pupil  pear-shaped  and  drawn  towards  the 
prolapse ;  some  tenderness,  with  slight  ciliary  redness ;  no 
apparent  iritis;  lens  uninjured;  vision  s6n;  J.  8 ;  Tn.  Left 
eye :  Slight  ciliary  redness ;  good  anterior  chamber  ;  iris 
looks  somewhat  hazy,  but  acts  moderately  to  light ;  vision  |T, 
not  improved  with  glasses.  On  applying  atropine  the  pupil 
dilates  well  with  the  exception  of  one  slight  posterior 
synechia ;  there  are  numerous  very  small  dots  of  lymph  on 
the  posterior  surface  of  the  cornea,  which  are  seen  by  the 
oblique  illumination,  but  better  still  with  the  direct  ophthal¬ 
moscopic  examination ;  with  a  strong  convex  glass  behind 
the  instrument  the  dots  show  up  as  small  black  spots  on 
the  background  of  the  illuminated  fundus.  The  disc  looks 
slightly  hazy. 

The  boy  was  admitted  as  an  in-patient,  and  a  large  iri¬ 
dectomy  done  at  the  seat  of  the  prolapse.  The  iris  was 
divided  on  both  sides  of  it,  but  a  part  was  so  incorporated 
in  the  cicatrix  that  it  could  not  be  removed.  Vaseline 


656 


Medical  Times  and  Gazette. 


THE  HOMES  OF  THE  RICH. 


Dec.  S,  19S3* 


containing  two  grains  of  atropine  to  the  ounce  was  applied, 
together  with  pad  and  bandage.  Treatment  for  left  (the 
sympathising)  eye  was  atropine  and  exclusion  of  light  by 
keeping  the  patient  in  a  dark  room . 

July  2. — Patient  seems  comfortable.  Eight  eye  not  looked 
at.  Left,  pupil  widely  dilated ;  the  synechia  has  given  way. 

6th. — Eight  eye  quiet ;  iridectomy- wound  healed ;  anterior 
chamber  good.  Left  eye,  keratitis  punctata  well  marked  ; 
disc  somewhat  more  hazy. 

13th. — Eight  eye  looks  well ;  vision  |j.  Left  eye,  vision  ^  ; 
all  ciliary  redness  gone ;  keratitis  punctata  disappearing ; 
well-marked  papillo- retinitis.  Atropine  and  exclusion  from 
light  continued. 

20th. — Eight  eye,  vision  |j.  Quite  quiet.  Atropine  and 
bandage  discontinued.  Left  eye,  vision  ;  spots  on  cornea 
almost  gone  ;  papillo -retinitis  about  the  same.  To  be  kept 
shaded,  and  atropine  continued. 

A  few  days  later  he  was  made  an  out-patient. 

August  10. — Eight  eye  well ;  vision  £f.  Left  eye,  vision  T6S ; 
keratitis  punctata  gone ;  no  change  in  papillo-retinitis. 

24th. — Eight  eye,  vision  |j.  Left  eye,  vision  ;  cornea 
quite  clear;  papillo-retinitis  subsiding.  Atropine  discon¬ 
tinued.  To  wear  a  shade  for  a  week  or  two  longer. 

Has  not  been  seen  since  last  note.  His  friends  were  cau¬ 
tioned  to  bring  him  immediately  on  the  slightest  appearance 
of  irritation  in  either  eye. 

Remarks  (by  Mr.  Hartridge). — The  point  of  interest  in  this 
case  was  the  difficulty  of  deciding  whether  enucleation  of 
the  exciting  eye  should  at  once  be  performed,  or  an  attempt 
made  to  save  it  by  a  large  iridectomy.  I  decided  to  adopt 
this  latter  course,  being  influenced  in  my  decision  by  the 
following  reasons  : — First,  that  the  sympathetic  inflamma¬ 
tion  was  of  a  mild  type.  Second,  by  the  opinion  expressed 
by  Mauther  on  this  subject  in  his  work  on  “  Sympathetic 
Diseases  of  the  Eye,”  “  that  iridectomy  on  the  eye  causing 
sympathy  is  only  to  be  done  when  the  iris  has  become  in¬ 
carcerated  in  the  peripheral  wound  in  the  cornea,  for  then 
we  may  succeed  in  saving  both  eyes;  in  any  other  condi¬ 
tion  iridectomy  cannot  be  advantageously  substituted  for 
enucleation.” 


N ORTH-EASTERN  HOSPITAL  FOR  CHILDREN. 


EETSIPELAS  FOLLOWING  THE  USE  OF  CHRYSO¬ 
PHANIC  ACID  FOE  RINGWORM. 

(Under  the  care  of  Mr.  RICKMAN  GODLEE.) 

[For  these  notes  we  are  indebted  to  Mr.  J.  A.  West,  Resident 
Medical  Officer.] 

Elizabeth  M.  G.,  aged  five  years,  attended  the  hospital 
on  September  25,  1883,  with  extensive  tinea  tonsurans. 
Some  ointment  containing chrysophanic  acid  (g?s.  v.  ad  jjj.) 
was  ordered.  She  continued  to  show  herself  once  a  week 
until  October  15,  up  to  which  time  there  appeared  to  be 
some  improvement. 

October  22. — The  patient  was  now  brought  again.  There 
was  a  blush  of  bright  redness,  of  an  erysipelatous  character, 
extending  over  the  forehead,  cheeks,  and  back  of  the  neck. 
She  was  not,  however,  suffering  from  any  of  the  constitu¬ 
tional  symptoms  of  erysipelas  ;  she  had  apparently  no  fever, 
and  had  a  good  appetite.  A  saline  mixture  was  ordered ; 
the  chrysophanic  ointment  was  stopped,  and  zinc  ointment 
substituted. 

25th. — The  blush  was  not  so  bright  as  on  former  visit, 
and  the  erysipelas  was  clearly  not  spreading  ;  the  same 
extent  of  surface  was  affected  as  at  last  visit.  There  was 
slight  desquamation. 

29th. — The  erysipelas  has  disappeared  from  the  forehead, 
and  is  now  only  visible  on  the  cheeks  and  neck.  Desquama¬ 
tion  is  more  pronounced. 

November  5. — The  redness  has  quite  disappeared.  The 
ringworm  remains  in  statu  quo. 

Remarks  (by  Mr.  Godlee). — The  case  is  of  value  as  an 
example  of  an  erythema  starting  from  the  slight  inflamma¬ 
tion  produced  by  an  external  application  without  an  external 
wound.  It  is  also  interesting  to  note  that,  as  in  the  case 
of  some  of  the  erythemata  following  surgical  operations, 
the  constitutional  symptoms  were  either  very  slight  or  alto¬ 
gether  absent.  It  seems  to  be  precisely  similar  to  those 
instances  which  have  long  been  recognised  of  general 
erysipelas  following,  say,  the  local  application  of  arnica 
lotion. 


TEEMS  OF  SUBSCEIPTION  fbom  JANUARY  5,  1884. 

( Free  by  post.) 

British  Islands  .  .  12  Months  £0  19  6;  in  advance  £ 0  17  6 


))  yy  •  • 

The  Colonies,  the  \ 

6 

0 

9 

9 

yy 

0  9 

G 

United  States  of  f 

12 

>9 

i 

2 

0 

yy 

1  0 

0- 

America,  and  Con-  i 
tinerdal  Europe  / 

6 

>> 

0 

11 

0 

yy 

0  10 

& 

India . 

12 

yy 

1 

4 

0 

yy 

1  2 

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0  11 

& 

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final  (times  ;uD  d^etfe. 


SATURDAY,  DECEMBER  8,  1883. 

- ♦ - 

THE  HOMES  OF  THE  RICH. 

Public  attention  is  being  projected  so  forcibly  just  now- 
on  to  the  homes  of  the  poor,  that  intellects  of  the  boomerang 
order,  if  one  may  use  the  expression,  are  apt  to  find  them¬ 
selves  flying  in  exactly  the  reverse  direction,  and  lighting 
upon  the  rooftrees  of  the  rich.  To  be  one  of  a  shoal  all 
swimming  one  way  is  to  some  men  so  intolerable,  that  they 
need  no  pretext  to  start  them  off  towards  the  opposite  point 
of  the  compass.  On  the  present  occasion  Mr.  Alfred  Austin 
has  been  the  first  to  leave  the  shoal;  but,  though  he  entitles 
his  paper  in  the  current  number  of  the  National  Review 
“Rich  Men’s  Dwellings,”  he  is  much  less  concerned  with., 
the  houses  than  with  their  tenants.  And  yet  there  is  much 
to  be  said  worth  saying  about  the  homes  of  the  rich  from 
every  point  of  view.  Nothing  perhaps  can  be  so  perfect,  in 
theory,  as  the  house  of  a  wealthy  man  in  England.  Science- 
and  art  have  given  of  their  best  to  make  it  an  abode  of 
refinement  and  health.  Architects,  hygienists,  artists,  and 
antiquarians  have  all  contributed  from  their  stores  of  know¬ 
ledge  and  taste  to  make  it  possible  for  a  rich  man  to  have, 
if  he  wishes  it,  a  house  in  which  no  critic  could  find  a  flaw. 
This  being  so,  it  is  strange  that,  in  practice,  such  a  large- 
proportion  of  rich  men’s  dwellings  should  fall  so  far  short 
of  the  theoretical  standard  of  excellence.  Their  artistic 
shortcomings  are  a  matter  of  common  remark,  but  their 
sanitary  defects,  though  they  have  been  frequently  pointed 
out,  are  less  generally  admitted.  The  science  of  sanitation 
is  always  so  far  ahead  of  the  practice,  that  to  find  a  house  in 
town  or  country  which  would  entirely  satisfy  a  strict  sani¬ 
tary  critic  may  be  reckoned  an  impossibility.  For  if  a  house 
be  practically  perfect  to-day,  by  to-morrow  science  will  have 
raised  her  standard,  and  will  require  a  higher  perfection, 
still.  But  though  disease  has  a  sharp  eye  for  the  smallest 
loophole  in  sanitary  defences,  it  would  be  foolish  to  dwell  on 
these  minor  defects  in  the  homes  of  the  rich  while  there- 
remain  so  many  glaring  and  dangerous  instances  of  sanitary 
ignorance  and  neglect.  The  chief  wonder  is  that  outbreaks. 


Medical  Times  and  Gazette. 


THE  INTERNATIONAL  HEALTH  EXHIBITION. 


Dec.  8, 1833.  65  7 


of  enteric  fever  are  not  much  more  common  in  the  best  parts 
■of  London  than  they  are.  For,  as  Dr.  Kelly  pointed  out  last 
Tveek  at  the  Parkes  Museum,  it  is  the  best  houses  that  are 
most  liable  to  be  infected  with  this  fever  through  the  medium 
-of  the  drains. 

It  is  only  fair  to  admit  that,  as  the  result  of  persistent 
preaching,  a  large  number  of  rich  men’s  houses  have  been 
put  during  the  last  ten  years  into  as  good  a  sanitary 
state  as  the  conditions  admit,  but  nevertheless  the  pro¬ 
portion  of  unhealthy  houses  in  the  best  parts  of  London 
-still  remains  much  greater  than  is  usually  suspected.  In  the 
older  streets  of  the  West-end  it  is  probable  that  a  perfectly 
sanitary  dwelling  could  only  be  obtained  by  rebuilding  from 
the  basement.  The  old  brick  drains  have  in  many  cases 
been  leaking  for  years,  and  even  where  they  have  been 
replaced  by  earthenware  the  whole  subsoil  still  remains 
permeated  with  the  filth  of  generations.  But,  apart  from 
these  hopeless  houses,  there  are  many  in  which  either  no 
attempt  has  been  made  to  place  them  in  a  healthy  condi¬ 
tion,  or  the  most  laudable  intentions  have  been  frustrated 
by  the  ignorance  and  incompetency  of  the  British  workman. 
In  some  cases,  hundreds  of  pounds  have  been  spent  in  add¬ 
ing  to  the  magnificence  of  the  abode,  and  every  new  fashion 
Las  been  introduced  except  those  alone  which  rest  on  a 
scientific  basis — the  new  fashions  in  drainage,  heating,  and 
water-supply.  A  few  years  ago  there  was  an  exquisite  little 
house  in  Mayfair,  which  has  figured  as  the  “bijou residence” 
of  the  heroine  in  half  a  dozen  novels  of  fashion.  The 
decorator’s  art  had  been  lavished  upon  it.  Its  tiny  wooden 
stairs  had  been  pulled  down  and  replaced  by  marble,  the 
walls  of  its  miniature  rooms  had  been  covered  with  the 
costliest  hangings,  and  the  door-panels  had  been  painted  by 
the  brush  of  a  well-known  artist ;  but  behind  the  marble 
staircase,  and  separated  from  it  only  by  a  flimsy  partition, 
there  was  left  a  leaky  soil-pipe  oozing  with  foulness.  The 
jresult  of  course  was  that  heroine  after  heroine  lapsed  into 
•the  same  interesting  condition  of  delicacy,  and  was  forced 
to  transfer  the  scene  of  her  triumphs  elsewhere,  while  the 
house  once  so  favoured  of  fashion  passed  metaphorically 
into  the  bad  odour  in  which  it  had  so  long  been  literally. 
In  a  fashionable  square  in  another  part  of  the  West-end  it 
is  still  quite  common  to  find  the  water-closet  placed  in 
the  very  centre  of  the  house,  and  ventilating  on  to  the 
stairs.  In  one  of  these  chambers  of  horror  the  pan  was 
found  cracked,  and  beneath  it  was  the  accumulated  leakage 
of  years.  In  another  house  a  few  doors  off,  half  a  year’s 
.rental,  or  .£300,  had  been  spent  on  repairing  the  sanitary 
arrangements,  but  unfortunately  the  builders,  with  crude 
■conceptions  of  the  principles  of  hydrostatics,  had  placed 
the  outlet  of  the  house-drain  below  the  level  of  the  sewer, 
which,  six  months  later,  it  was  found  necessary  to  lower  at 
the  cost  of  another  half  year’s  rental.  In  an  adjoining 
house  a  similar  sum  had  been  spent  on  drainage,  but  case 
after  case  of  diphtheritic  sorethroat  occurred,  until  a  second 
costly  revision  of  the  sanitary  arrangements  became  neces¬ 
sary.  Even  where  the  utmost  has  been  done  to  secure  a 
healthy  home,  and  with  success  so  far  as  the  home  itself  is 
concerned,  the  same  care  has  not  been  extended  to  the  stables, 
and  a  source  of  danger  is  thus  left  beneath  the  very  windows. 
The  mews  in  many  of  the  best  parts  of  London  are,  in  fact, 
still  in  such  a  hopeless  condition  that  nothing  short  of  entire 
rebuilding  would  bring  them  up  to  the  proper  sanitary 
standard.  In  other  cases,  crowded  and  unhealthy  courts  are 
allowed  to  remain  under  the  back  windows  of  princely  houses. 
One  of  the  most  fashionable  sets  of  flats  in  the  West-end 
looks  upon  a  foul  purlieu  in  which  fatal  outbreaks  of 
•diphtheria  periodically  occur. 

These  defects  are  so  glaring  that  one  would  think  that  it 
would  be  only  necessary  to  point  them  out  to  secure  their 


immediate  removal.  But  sanitarians  have  found  that  it 
needs  a  much  sharper  reminder  than  mere  demonstration 
and  advice  to  induce  people  to  spend  money  on  things 
which  make  no  show.  It  is  evident,  from  the  merest  glance 
at  the  rooms  of  many  of  the  most  luxurious  houses,  that  their 
tenants  have  not  even  an  elementary  idea  of  the  conditions 
of  health.  Their  sins  of  commission  are  more  monstrous 
even  than  their  sins  of  omission.  It  is  hardly  too  much  to 
say  that  many  fashionable  drawing-rooms  are  so  assiduously 
converted  by  their  tenants  into  nests  of  disease  that  one 
would  think  that  health  was  to  them  an  object  of  aversion. 
The  thick-piled  carpets,  the  Eastern  rugs,  the  heavy  plush 
curtains  disposed  wherever  it  is  possible  to  fix  them,  the 
piles  of  cushions,  the  dying  plants  in  waterlogged  flower¬ 
pots,  the  bundles  of  pampas-grass,  the  long  trails  of  dirty 
ivy,  the  numberless  pictures  inclining  from  the  walls— all 
constitute  traps  for  catching  dirt  and  holding  it.  In  a  room 
so  furnished  a  healthy  atmosphere  is  impossible,  whatever 
the  efforts  made  to  secure  cleanliness.  But  the  fact  is  that 
in  many  of  these  houses  so  much  is  squandered  on  maintain¬ 
ing  a  show  of  lazy  men-servants,  that  little  is  left  to  spend 
on  those  handmaidens  of  health,  the  housemaids,  and  dust 
is  left  undisturbed  week  after  week  because  there  is  no  one 
to  remove  it.  This  is  not  perhaps  the  case  in  the  houses  of 
the  most  wealthy ;  but  where  the  income  is  insufficient  to 
meet  both  show  and  cleanliness,  it  is  naturally  cleanliness 
that  goes  to  the  wall.  Amongst  the  nouveaux  riches,  many 
of  whom  have  but  lately  emerged  from  a  class  in  which  the 
hatred  of  dirt  is  not  the  instinct  that  it  is  amongst  the  real 
upper  classes,  the  defiance  of  sanitary  laws  is  startling,  and 
it  would  be  well  for  some  of  them  if,  instead  of  hurrying  off 
to  the  East-end  to  join  in  the  fashionable  crusade,  they 
would  stay  at  home,  and  receive  instruction  in  cleanliness 
from  some  of  those  very  poor  whom  they  now  seek  to  in¬ 
struct.  A  sanitary  mission  to  the  West-end  would  be  an 
enterprise  deserving  of  every  support. 


THE  INTERNATIONAL  HEALTH  EXHIBITION. 
The  great  success  of  the  Fisheries  Exhibition  has,  without 
doubt,  sown  the  seeds  of  hope  and  emulation  in  the  breasts 
of  show-promoters  of  all  kinds ;  and  one  of  the  early  blossoms 
promises  to  be  an  International  Health  Exhibition.  The 
Common  Council  has  voted  a  sum  of  money  for  the  purpose, 
the  Prince  of  Wales  gives  it  his  powerful  support;  and  thus, 
fertilised  by  external  gold  and  fostered  by  princes,  there  is 
every  prospect  of  vigorous  growth.  We  will  not  ask,  “  Cui 
bono?”  but  would  emphasise  a  few  points  which  may  not 
strike  the  crowd  standing  before  the  booth,  stunned  and 
confused  it  may  be  by  the  flourish  of  trumpets  and  drums 
•  and  the  loud  voice  of  the  showman.  What  have  health 
exhibitions  and  museums  hitherto  done  to  elevate  and  popu¬ 
larise  the  science  of  hygiene  ?  So  far  as  we  can  see,  they 
have  impressed  the  erroneous  notion  on  the  laity  that  it  is 
mainly  a  science  of  water-closets  and  drain-traps  ;  so  much 
so,  indeed,  that  society  alludes  euphemistically  to  the  con¬ 
duits  and  cloaca  as  “  sanitary  appliances,”  and  associates 
with  hygiene  no  higher  ideas  than  those  connected  with 
slopping,  dusting,  and  scavenging.  Health  Exhibitions  have 
hitherto  been  mainly  huge  advertising  machines;  the  happy 
brooding  ground  of  everyone  who  had  bitters,  biscuits 
scents,  soaps,  sauces,  stoves,  and  a  thousand  other  things  to 
sell,  and  wished  to  allure  the  public  to  buy.  The  time  has 
come  to  put  an  end  to  all  this,  and  it  is  to  be  hoped  that  the 
promoters  of  the  present  Exhibition  will  not  neglect  the 
splendid  opportunity  they  have  of  raising  the  whole  character 
of  such  displays,  and  contributing  to  the  real  advance  of  the 
study  of  hygiene.  The  science  of  health  is  so  interwoven  with 
all  matters  of  civilised  life  and  culture,  that  its  limitations 


658 


Medical  Times  and  Gazette. 


ON  FUNCTIONAL  DISEASE. 


Dec.  8, 1883. 


and  boundaries  are  of  an  extremely  indefinite  character 
There  is  no  article  of  food  or  of  drink,  there  is  no  drug,  there 
is  no  kind  of  clothing,  no  machine,  no  manufacture,  no  trade^ 
occupation,  or  manner  of  living,  which  may  not  be  dragged 
or  forced  into  some  near  or  remote  connexion  with  hygiene. 
It  is  claimed  that  of  the  City  livery  companies  at  least  fifty 
are  connected  with  one  or  other  branch  of  hygiene,  and 
could  appropriately  take  part  in  the  proposed  Exhibition- 
In  fact,  from  the  miscellaneous-store-like  appearance  of 
sanitary  exhibits,  the  conclusion  is  inevitable  that  all  Exhibi¬ 
tions,  from  the  International  of  1851  to  the  Fisheries  of 
1883,  have  been  so  many  shows  of  “hygienic  appliances.” 
And  yet  the  new  health-science  never  has  been  and  never  can 
be  placed  in  a  concrete  form.  The  battle  of  man  and  germ, 
the  subtle  influences  of  soil  and  sky,  the  habits  and  customs 
of  individuals  and  races,  lie  at  the  very  basis  of  preventive 
medicine,  but  are  for  the  most  part  incapable  of  popular 
illustration,  and  decidedly  cannot  be  displayed  in  the  same 
way  as  pickles  and  Banner’s  cowls.  Nevertheless,  we  are 
not  disposed  to  deny  that,  with  great  trouble  a,nd  judgment 
in  the  selection  of  subjects  for  exhibition,  with  ruthless 
pruning  of  the  exuberant  plumbing  and  engineering  ele¬ 
ment,  and  with  absolute  rejection  of  quack  drugs  and 
nostrums  of  unknown  composition,  it  is  possible  to  open  an 
Exhibition  that  shall  be  interesting,  instructive,  and  in 
some  degree  representative  of  the  sanitary  science  of  the 
nineteenth  century. 


THE  PLACE  OF  BOTANY  IN  THE  CUKRICITLUM. 
As  a  consequence  of  the  ever-increasing  expansion  of  the 
medical  curriculum,  the  exact  position  and  scope  of  botani¬ 
cal  teaching  have  been,  for  a  considerable  period,  more  or 
less  undefined,  and  great  difference  of  opinion  has  been 
expressed  on  all  hands  as  to  the  possible  advantages  to  be 
derived  by  the  medical  student  from  the  study  of  this 
branch  of  biology.  On  the  one  hand  it  was  said  to  encourage 
habits  of  accurate  observation,  to  illustrate  and  enforce  the 
principles  of  logical  classification,  to  be  useful  in  the  study 
of  the  materia  medica,  and  to  be  essential  to  the  general 
scientific  culture  of  the  medical  practitioner.  Its  opponents 
looked  on  it,  on  the  other  hand,  rather  as  an  obstacle  to 
the  study  of  other  and  more  important  subjects,  and  would 
have  preferred  to  have  either  expelled  it  altogether  from  the 
medical  course,  or  relegated  it  to  the  period  before  the  com¬ 
mencement  of  medical  studies.  This  science,  indeed,  as  it 
was  presented  to  the  student,  had  many  enemies,  and  but 
few  friends.  For  much  of  this  unpopularity  botanists 
have  themselves  to  blame.  In  former  days,  -we  venture  to 
think,  the  plant  was  too  much  considered  from  the  merely 
sesthetic  point  of  view.  The  flower  had  been  elevated  to 
an  unnatural  and  exaggerated  position.  Its  various  forms 
and  modifications  were  dwelt  on  with  careful  and  tender 
regard,  until  the  whole  subject  became  buried  under  a  mass 
of  uninviting  nomenclature,  and  the  most  essential  elements 
for  the  successful  prosecution  of  this  science  appeared  to  be 
a  good  memory  and  a  smattering  of  Greek.  Just  as  in 
Covent-garden  Market  it  is  the  custom  to  pluck  off  the 
anthers  of  lilies  in  order  that  the  golden-brown  pollen 
may  not  sully  the  pure  whiteness  of  the  perianth,  so,  in 
the  botanical  lecture-theatre,  the  study  of  function  had 
become  almost  entirely  subordinated  to  the  admiration 
of  form.  Of  late,  however,  a  considerable  reaction  against 
this  emasculating  tendency  has  begun  to  make  itself  felt. 
The  physiological  investigations  of  Darwin  have  slowly 
produced  effect,  and  have  permeated  with  their  influence 
the  whole  science  of  botany.  The  various  methods  of  fer¬ 
tilisation,  the  development  of  organs  and  their  adaptation 
to  function — in  short,  the  study  of  the  habits  and  life-history 


of  plants  in  general, — have  gradually  assumed  paramount 
importance.  The  brilliant  light  thrown  on  the  etiology  of 
disease  by  modern  research  in  the  domain  of  the  lowest 
forms  of  vegetable  life  has,  in  addition,  directed  greater- 
attention  to  the  conditions  of  life  and  of  multiplication  of 
these  minute  organisms.  Physiological  botany  has  now 
been  placed  on  a  sound  and  scientific  basis,  and  it  is  on  this 
ground  that  it  must  continue  to  hold  its  own  in  the  general 
teaching  of  medicine.  Plants  must  continue  to  be  studied  as 
illustrations  of  a  special  aspect  of  life,  and  the  study  of  the 
physical  and  physiological  laws  underlying  the  phenomena 
of  plant  nutrition,  of  tension  of  tissues,  and  the  mechanics 
of  growth  will  form  a  valuable  and  most  instructive  section 
of  general  physiological  training.  Many  interesting  analo¬ 
gies  between  the  functions  of  plants  and  animals  at  once 
present  themselves  to  us.  The  researches  of  Dr.  Burdon 
Sanderson  on  the  electric  currents  of  Dioncea,  the  influence 
of  iron  in  the  soil  and  of  light  on  the  formation  of  colouring 
matter,  the  movements  and  processes  of  nutrition  of  plants, 
all  illustrate  points  of  analogy  with  allied  functions  in 
animals,  which  will  in  the  future  go  far  to  elucidate  many 
obscure  problems  in  both  kingdoms.  The  increasing  im¬ 
portance  of  the  study  of  function,  and  of  form  as  modi¬ 
fying  function,  is  well  shown  by  the  more  recent  changes  in 
the  Botany  Syllabus  of  the  Preliminary  Science  Examina¬ 
tion  of  the  University  of  London.  The  physiology  and 
histology  of  plants  are  here  made  of  primary  importance,  and 
certain  special  types  of  plants  are  selected  for  more  detailed 
investigation.  The  microscopic  examination  of  plant  struc¬ 
ture  should  take  its  place  by  the  side  of  the  general  histology 
of  animal  tissues.  Sections  of  the  various  organs  and 
structures  of  plants  are  easily  prepared,  and  can  be  readily 
stained  by  various  aniline  dyes,  thus  producing  most 
beautiful  and  instructive  specimens.  The  structure  of  cells, 
and  the  various  modifications  and  thickenings  of  their  walls, 
the  formation  and  arrangement  of  fibro- vascular  bundles, 
the  structure  of  ovules  and  pollen,  and  many  other  points 
of  extreme  morphological  and  physiological  interest,  may 
thus  be  amply  illustrated.  Physics  and  chemistry  must 
also  be  impressed  into  the  service  of  botany ;  and  this  branch, 
from  being,  as  heretofore,  the  mere  handmaid  of  the  materia 
medica,  will  rise  to  be  one  of  the  widest  and  most  all- 
embracing  subjects  of  the  medical  course.  It  is  along  these 
lines  and  by  such  methods  that  we  may  hope  to  see  botany 
finally  rescued  from  that  cloud  of  oblivion  which  but  lately 
threatened  to  overwhelm  it. 


CLINICAL  PAPERS.-No.  II. 


On  Functional  Disease. 

The  expression  “  functional  disease  ”  has  given  rise  to 
much  confusion  in  medical  science,  and  the  meaning  attached 
to  it  varies  according  to  the  preconceptions  of  individual 
observers.  Everyone  fancies  he  knows  what  is  implied 
by  the  term,  but  finds  it  difficult  to  express  its  exact 
signification  in  words.  There  are  some  who  consider  that 
there  is  a  place  in  nosology  for  such  a  class  of  disorders, 
and  others  who  altogether  deny  its  existence.  As  this  is  a 
subject  of  great  practical  importance,  no  excuse  is  made  for 
directing  attention  to  it,  with  the  view  of  attempting  to  de¬ 
termine  the  significance  of  the  word  “functional”  as  applied 
to  abnormal  states,  to  examine  the  position  it  occupies  in 
the  classification  of  diseases,  and  to  ascertain  the  nature  of 
the  disorders  which  it  includes  as  distinguished  from  other 
maladies. 

If  we  review  the  entire  field  of  pathology,  two  prominent 
classes  of  disorders  may  be  recognised.  First,  there  are  those 
maladies  which  are  the  obvious  result  of  structural  degene- 


Medical  Times  and  Gazette. 


ON  FUNCTIONAL  DISEASE. 


Dec.  8,  1883.  659 


ration.  This  tissue-change  is  visible  and  can  be  demon¬ 
strated,  and  it  bears  a  constant  relation  to  the  abnormal 
conditions  which  accompany  it.  The  symptoms  and  signs 
of  such  maladies  disappear  when  the  alterations  which 
caused  them  no  longer  exist."  In  other  words,  there  is  a 
gross  lesion  in  some  part  of  the  economy,  whose  powers 
of  irritation ’  or  destruction  induce  not  only  those  signs  re¬ 
sulting  from  the  direct  'implication  of  tissue,  but,  as  a 
sequence,  bring  about  increase,  diminution,  or  perversion 
of  the  functions  of  the  nervous  system,  to  the  varied 
phases'  of  which  we  give  the".  name  of  symptoms.  Such 
diseases  are  termed  organic  in  contra-distinction  to  those 
which,  although  they  may  present  exactly  similar  con¬ 
ditions  in  many  respects,  essentially  differ  from  them  in 
others.  These  last  maladies  are  characterised  by  the  ab¬ 
sence  of  any  definite  structural  alteration  to  account  for 
the  abnormal  symptoms,  and  not  only  are  such  changes  im¬ 
possible  to  discover,  but  the  nature,  progress,  and  termina¬ 
tion  of  the  complaint  seem  to  indicate  that  they  are  not  in 
existence.  In  short,  the  only  evidence  of  any  departure 
from  health  is  the  development  of  the  varied  abnormalities 
of  innervation  which  appear  to  have  arisen  independently  of 
any  demonstrable  organic  lesion.  It  is  to  this  class  of  dis¬ 
order  that  the  term  “functional”  has  been  given.  The  two 
forms  of  disease  are  well  recognised  in  practical  medicine, 
and  are  broadly  distinguished  from  one  another  not  only  by 
the  pathological  difference  between*  them,  but  by  the  com¬ 
plete  clinical  picture  of  the  affection.  There  is  no  exact 
line  of  demarcation,  the  one  blending  with  the  other,  and 
both  being  frequently  associated  in  the  same  patient.  The 
first  is  pathologically  definite,  and  the  phenomena  accom¬ 
panying  it  are  comparatively  simple  of  comprehension.  The 
last  is  anatomically  obscure,  and  its  indications  are  more 
difficult  to  explain. 

The  exact  definition  of  functional  disease  is,  then,  impos¬ 
sible,  and  a  distinction  between  the  disorders  belonging  to 
this  class  and  other  affections  is  an  arbitrary  one  without 
definite  limits,  which,  as  our  knowledge  advances,  will  pro¬ 
bably  require  modification.  The  former  may,  however,  for 
all  practical  purposes,  be  generally  described  as  morbid 
states,  usually  apyretic,  in  which  there  is  an  exclusive,  or 
at  least  a  predominant,  modification  of  the  functions  of  the 
nervous  system,  presenting  the  double  peculiarity  of  being 
produced  in  the  absence  of  any  appreciable  lesion,  and  of 
not  by  itself  necessarily  inducing  profound  or  persistent 
structural  change. 

With  regard  to  the  first  part  of  this  definition,  we  may 
assume  that  the  indications  of  functional  disorder  are 
nothing  more  than  simple  perversion  of  innervation  in  a 
variety  of  forms.  Physiology  teaches  us  that  the  nervous 
system,  with  its' physical  and  functional  connexions,  consti¬ 
tutes '.the  basis  of  material  life.  It  is  the  instrument  of  the 
intellectual  faculties,  the  receptacle  and  conductor  of  sensa¬ 
tion  and  motility,  and  on  it  depends  the  performance  of  the 
organic  functions,  including  respiration,  circulation,  secre¬ 
tion,  nutrition,  and  animal  heat.  In  other  words,  on  its 
integrity  depends  that  of  the  entire  organism.  Pathology 
eonfirfns  this  fact,  as  evidenced  by  the  important  role  the 
system  plays  in  the  production  of  divers  morbid  states ;  for 
as'  abnormal  symptoms  are  the  phenomena  which  mainly 
determine  the  existence  of  disease,  it  may  be  stated  that 
these  are  represented  almost  exclusively  by  disturbances 
of  the  function  of  innervation.  All  diseases,  therefore, 
from  whatever  cause  or  of  whatever  kind,  are  intimately 
associated  with  the  nervous  system,  through  the  agency 
of  which’ they  are  made  apparent' to  the  senses.  It  is  upon 
the  perversion  of  intelligence,  sensation,  motility,  and  the 
sympathetic  functions  that  we  rely  for  our  appreciation  and 
knowledge  of  disease.  On  this  reasoning  most  maladies 


would  come  under  the  denomination  of  functional,  and  it 
must  be  admitted  that,  if  all  diseases  do  not  bear  this 
appellation,  the  symptoms  of  most  of  them  may  be  so 
characterised.  ■  0-: 

The  arbitrary  distinction  is  chiefly  to  be  determined  by  the 
consideration  contained  in  the  second  part  of  the  general  de¬ 
finition,  namely,  the  absence  of  a  morbid  lesion.  In  so-called 
functional  complaints  the  minutest  search  fails  to  discover 
any  structural  change  in  the  tissues  of  the  body,  and'  their 
nature  would  not  lead  us  to  expect  that  such  would  exist. 
Symptoms — another  name  for  abnormal  nervous  perturba¬ 
tions— are  simply  the  modification  of  healthy  actions,  an 
increase,  diminution,  or  perversion  of  natural  functions.  An 
ordinary  act,  motion,  or  sensation  is  not  accompanied  by  any 
visible  alteration  of  structure,  although  we  may  hypotheti¬ 
cally  assume  that  it  is  represented  by  molecular  changes 
in  the  nerve-tissues  beyond  our  powers  of  appreciation. 
Should  such  acts,  motions,  or  sensations  become  irregular, 
as  in  the  transport  of  rage,  the  tremor  of  fear,  or  the  palsy 
of  shock,  we  may  conceive  there  would  be  corresponding 
molecular  change,  but  we  could  not  hope  to  demonstrate  such 
a  condition.  Finally,  should  these  modifications  become 
permanent,  as  in  chorea,  old  age,  or  certain  forms  of  para¬ 
lysis,  we  call  the  results  abnormal  symptoms,  but  we  do  not 
and  cannot  expect  to  demonstrate  the  minute  alterations 
representative  of  them.  It  is  to  these  symptoms,  consisting 
of  a  peftersion  of  natural  activity  as  a  result  of  molecular 
movement  which  we  cannot  anatomically  display,  that  we 
give  the  name  of  functional,  in  distinction  from  those  which 
are  obviously  the  result  of  new  formation  or  degenerative 
process. 

From  the  preceding  considerations  it  will  be  apparent 
that  the  symptoms  alone  in  both  classes  of  disease  under 
discussion  may  be  identical.  This  is  readily  understood 
when  it  is  remembered  that  in  reality  both  are  functional 
in  the  strict  sense  of  the  term.  In  the  one  case,  however, 
they  are,  as  it  were,  idiopathic  ;  and  in  the  other,  the  secon¬ 
dary  result  of  a  pre-existing  abnormal  tissue-change.  A 
failure  to  display  a  morbid  lesion  is  not  necessarily  a  con¬ 
clusive  proof  of  functional  disease,  nor  on  this  account  does 
it  militate  against  the  general  principle  already  laid  down. 
The  present  state  of  science  does  not  always  enable  us  to 
anatomically  demonstrate  every  abnormal  state  ;  and  there 
are  certain  maladies  which,  although  as  yet  no  lesion  to 
which  they  may  be  attributed  has  been  discovered,  we 
do  not  place  in  the  category  of  functional  disorders,  be¬ 
cause  their  clinical  course  seems  to  suggest  that  if  our 
powers  of  histological  observation  have  not  met  with  defi¬ 
nite  results,  changes  probably  are  present  which  improved 
methods  of  research  will  subsequently  determine.  Again, 
it  is  unnecessary  to  point  out  that  the  presence  of  organic 
disease  does  not  negative  the  existence  of  functional  dis¬ 
order  ;  on  the  contrary,  the  two  are  frequently  associated, 
and  a  most  common  form  of  the  one  in  a  given  locality  is 
the  presence  of  the  other  at  a  remote  part  of  the  body. 

The  general  definition  between  organic  and  functional 
diseases,  if  difficult  to  express  in  words,  has  been  recognised 
with  tolerable  accuracy  in  practice.  In  the  former  the  gross 
lesion  is  accompanied  by  signs  corresponding  with  its  extent 
and  degree,  and  it  causes  symptoms  which  bear  a  close  re¬ 
lation  to,  and  are  dependent  upon  it.  In  the  latter  the 
conditions  are  those  we  should  expect  to  find  as  the  result 
of  a  simple  perturbation  of  normal  function.  The  syrnp-  . 
toms,  although  they  may  be  the  same  in  appearance,  differ 
in  nature  and  degree,  and  are  characterised  by  being  pro¬ 
duced  by  causes  which  would  not  be  followed  by  gross 
tissue-change,  by  extreme  mobility,  by  their  readiness  to 
undergo  change,  and  by  the  possibility  of  their  sudden  and 
complete  recovery  without  leaving  a  trace  of  their  existence. 

•>***y. 


660 


Medical  Times  and  Gazette. 


CHRONICLE  OF  THE  WEEK. 


Dec.  8,  1883. 


Whether  such  unseen  molecular  alterations  are  capable  of 
ultimately  leading  to  demonstrable  change  of  structure,  we 
do  not  know.  Experience  tells  us  that  such  is  not  neces¬ 
sary,  as  a  person  may  be  invalided  for  years  with  the  most 
violent  of  neuroses,  and  in  the  end  quickly  and  completely 
recover. 

It  is  not  to  be  inferred  from  the  foregoing  observations 
that,  because  the  class  of  functional  diseases  thus  differs  from 
that  of  organic  diseases,  they  are  on  that  account  maladies 
of  no  moment,  and  to  be  placed  low  in  the  estimation  of  the 
physician.  On  the  contrary,  although  it  maybe  admitted 
that  the  latter  are  the  more  dangerous  to  life,  it  must  also  be 
conceded  that  the  former  are  accompanied  by  the  greatest 
amount  of  suffering  and  distress.  Happily,  on  account 
of  their  nature,  functional  disorders  offer  the  most  en¬ 
couraging  prospects  for  treatment,  and  many  of  the 
triumphs  of  medical  skill  have  been  effected  in  this  direc¬ 
tion.  At  the  same  time  it  must  not  be  forgotten  that 
frequently  these  affections  assume  the  most  severe  and 
intractable  forms,  and  defy  all  the  efforts  made  for  their 
relief. 

The  diagnosis  between  the  two  conditions  under  con¬ 
sideration  often  presents  great  difficulties,  due  to  the  fact 
that  the  symptoms  of  functional  disorder  may  in  every 
respect  exactly  simulate  those  of  organic  disease.  A  dis¬ 
tinction  between  them  is  obviously  a  matter  of  the  highest 
practical  importance.  Thousands  of  persons  have  been  in¬ 
carcerated  for  life  as  hopeless  invalids,  who  by  a  little 
energy  and  judgment  might  easily  have  been  cured,  and 
others  have  been  neglected  or  ill-treated  as  suffering  from 
trifling  and  imaginary  complaints,  who  in  reality  were  the 
victims  of  intractable  disease.  Such  errors  can  only  be 
avoided  by  an  advanced  knowledge  of  the  nervous  system. 

A 


CHRONICLE  OP  THE  WEEK. 


The  chief  event  of  Tuesday’s  meeting  of  the  Pathological 
Society  was  one  of  no  small  importance,  for  it  was  nothing 
less  than  a  public  recantation  by  Dr.  Wilson  Fox  of  his 
views  as  to  the  communicability  of  tubercle  by  inoculation. 
Some  sixteen  years  ago,  in  conjunction  with  Dr.  Burdon 
Sanderson,  Dr.  Fox  made  a  series  of  experiments  on  guinea- 
pigs  and  rabbits,  and  succeeded  in  producing  tuberculosis 
by  the  inoculation  of  such  different  materials  as  cotton- 
fibres,  bits  of  wood,  and  portions  of  putrid  muscle.  Until 
the  publication  of  Koch’s  results  the  view  naturally  arising 
out  of  these  experiments — viz.,  that  tubercle  could  be  pro¬ 
duced  by  the  irritation  of  other  substances  than  tubercular 
matter — was  generally  accepted  in  this  country.  After 
Koch’s  discovery,  however.  Dr.  Wilson  Fox  felt  that  it  was 
incumbent  on  him  to  make  some  fresh  inquiries.  Dr.  Dawson 
Williams  accordingly  repeated  all  the  old  experiments,  with 
more  strict  precautions,  perhaps,  as  to  cleanliness,  and  failed 
to  produce  tubercle  except  by  the  introduction  of  tubercular 
matter.  This  being  so.  Dr.  Wilson  Fox  has,  in  a  manner 
which  greatly  redounds  to  his  honour,  lost  no  time  in  making 
public  his  altered  opinion  to  the  effect  that  tubercle  can  only 
be  produced  from  tubercle. 


The  subject  brought  forward  by  Dr.  Samuel  West  at  the 
same  meeting — viz.,  the  treatment  of  suppurative  pericarditis 
by  free  incision — attracted  a  good  deal  of  attention  during 
the  early  part  of  the  year,  when  he  brought  his  case  before 
the  Royal  Medical  and  Chirurgical  Society,  and  we  have  but 
little  doubt  that  practitioners  will  be  less  afraid  in  the  future 
of  taking  active  measures  to  empty  the  pericardium  in  such 


cases  than  they  have  been  heretofore.  Mr.  Symons  made  an 
important  contribution  towards  a  better  understanding  of 
the  causes  of  secondary  haemorrhage,  by  showing  the  changes 
that  had  taken  place  in  some  arteries  after  injury  and 
amputation ;  and  Mr.  Barker  opened  up  the  subject  of 
tubercular  disease  of  the  tongue  by  a  carefully  recorded  case 
with  post-mortem  and  microscopic  examinations.  We  shall 
hope  to  hear  more  upon  the  same  topic  at  the  next  meeting, 
as  the  discussion  was  necessarily  cut  short  owing  to  the 
lateness  of  the  hour.  The  President  opened  the  proceedings 
by  handing  round  a  drawing  of  the  foot  of  a  woman  with 
curious  tumours  on  her  toes,  which  seemed  to  be  in  some 
way  associated  with  the  sweat-glands,  and  possibly  owned 
for  their  cause  a  peripheral  neuritis. 


The  usual  monthly  meeting  of  the  Obstetrical  Society  of 
London  was  held  on  Wednesday  evening  last,  December  5. 
The  time  was  entirely  occupied  in  the  reading  and  discus¬ 
sion  of  an  elaborate  and,  it  is  scarcely  necessary  to  say,  a 
learned  and  able  paper  by  Dr.  Robert  Barnes,  on  the  mechan¬ 
ism  of  labour,  especially  in  reference  to  what  is  known  as 
the  “  Naegele  obliquity,”  i.e.,  the  obliquity  of  the  fostalhead 
on  its  longitudinal  axis,  by  which  the  side  of  the  head 
that  lies  anterior — the  right  side  when  the  head  occupies 
the  first  position — dips  lower  in  the  pelvis  than  the  other. 
This  obliquity,  as  its  name  implies,  was  first  described  by 
Naegele,  and  its  existence  was  for  a  long  time  accepted  as 
an  established  fact  by  obstetricians.  It  is  admitted  now 
by  all  that  this  obliquity  takes  place  in  labour  with 
contraction  of  the  brim,  and  that  it  is  present  after  the  head 
has  entered  the  pelvic  cavity.  But  it  has  been  denied,  by 
Duncan  and  Leishman  in  this  country,  and  by  some  German 
writers,  that  any  such  obliquity  exists  until  the  head  has 
advanced  into  the  pelvic  cavity.  They  maintain  that  in 
natural  labour  the  head  enters  the  brim  perpendicularly  to 
the  plane  of  the  brim,  without  any  inclination  either  to  one 
side  or  the  other.  The  object  of  Dr.  Barnes’s  paper  was  to 
controvert  this  view,  and  to  show  that  the  head  must,  and 
does,  enter  the  brim  with  the  obliquity  which  Naegele 
described.  We  shall  in  due  course  publish  a  report  of 
the  meeting,  from  which  our  readers  will  be  able  to  learn 
the  arguments  advanced  for  and  against  this  thesis. 
The  paper  was  discussed  by  Dr.  Duncan,  who,  however, 
limited  his  remarks  to  a  few  only  of  the  points  raised ;  Dr. 
Galabin,  who,  in  a  paper  read  before  the  Society  some  years 
ago,  showed  the  mechanical  advantages  gained  by  such 
obliquity,  and  who  now  exhibited  some  mathematical  dia¬ 
grams  illustrating  his  views ;  Drs.  Champneys,  G.  Roper, 
and  Wiltshire.  The  President,  after  commenting  upon  the 
paper,  expressed  the  gratification  with  which  the  Society 
again  saw  among  them  Dr.  Wiltshire,  who  had  been  for 
some  time  prevented  by  severe  illness  from  attending  the 
meetings.  In  this  we  are  quite  sure  all  our  readers  will 
heartily  concur. 

Prof.  Huxley,  as  President  of  the  Royal  Society,  delivered 
on  Friday  se’nnight  the  first  of  what  it  is  to  be  hoped  may 
be  a  long  series  of  presidential  addresses.  Amongst  the 
Fellows  who  had  died  in  the  past  year  he  had  to  mention 
“the  venerable  Sir  Thomas  Watson,  the  very  type  of  a 
philosophical  physician.”  Later  on,  in  the  course  of  his 
address,  he  expressed  his  regret  that  the  Government  had 
not  sent  out  a  scientific  mission  during  the  Egyptian  cholera 
epidemic.  “  It  is  assuredly,  in  the  present  state  of  science, 
something  more  than  a  permissible  hypothesis  that  the 
cause  of  cholera  may  be  an  organic  living  materies  morbi, 
and  that  the  discovery  of  the  proper  curative  and  prophy¬ 
lactic  measures  will  follow  upon  the  determination  of  the 
nature  and  conditions  of  existence  of  these  organisms.  If 


CHRONICLE  OF  THE  WEEK. 


Dec.  8, 1883.  661 


Medical  Times  and  Gazette. 

this  reasoning  is  just,  it  is  certainly  to  be  regretted 
that  the  opportunity  of  the  outbreak  of  cholera  in  Egypt 
was  not  utilised  for  the  purposes  of  scientific  investigation 
into  the  cause  of  the  epidemic.  There  are  able,  zealous, 
and  courageous  young  pathologists  in  this  country  who 
would  have  been  willing  enough  to  undertake  the  labour 
and  the  risk;  and  it  seems  a  pity  that  England  should 
leave  to  Germany  and  to  France  an  enterprise  which 
requires  no  less  daring  than  Arctic  or  African  exploration, 
but  which,  if  successful,  would  be  of  a  thousand  times 
more  value  to  mankind  than  the  most  complete  knowledge 
of  the  barren  ice  wastes  of  the  pole  or  of  the  sweltering 
barbarism  of  the  equator.  It  may  be  said  that  inquiries 
into  the  causation  of  cholera  have  been  for  some  years  con¬ 
ducted  in  India  by  the  Government  without  yielding  any 
very  definite  result.  But  this  is,  perhaps,  rather  an  argu¬ 
ment  in  favour  of,  than  against,  setting  fresh  minds  to  work 
upon  the  problem/’  After  the  address  the  medals  were  pre¬ 
sented,  and  the  officers  for  the  year  elected.  The  medical 
profession,  though  it  provides  the  Royal  Society  with  its 
President  and  one  of  its  Secretaries  (Dr.  Michael  Foster),  is 
not  so  well  represented  in  the  Council  as  it  used  to  be.  Sir 
William  Gull  and  Dr.  Lauder  Brunton  being  the  only  medical 
members.  _ _ 

As  to  the  cholera  mission  manque  on  which  so  many  vain 
reports  have  been  expended,  the  Government  is  stated  to 
have  been  much  exercised  by  the  criticisms  which  have  been 
passed  upon  its  remissness  in  that  matter.  But  there  is 
still  time  to  repair  the  neglect.  Dr.  Koch  and  his  assistants 
are  at  work  at  Calcutta,  which  they  have  found  a  more 
promising  centre  for  their  operations  than  Bombay,  and 
they  would  no  doubt  welcome  some  “  fresh  minds  ”  from 
England  to  work  in  friendly  rivalry  side  by  side  with  them. 
There  is  every  argument  for  a  scientific  mission  now  that 
there  was  in  the  autumn — except  one :  that  the  public,  having 
forgotten  their  panic,  would  be  less  inclined  to  pay  for  it. 
But  that,  unfortunately,  is  an  argument  that  tells  very 
strongly  with  a  Government.  The  defeat  of  cholera  might 
mean  the  victory  of  the  Conservatives. 

The  weekly  lecture  at  the  Parkes  Museum  was  delivered 
last  week  by  Dr.  Charles  Kelly,  the  King  s  College  Pro¬ 
fessor  of  Hygiene,  who  chose  for  his  subject  the  connexion 
between  zymotic  disease  and  sanitary  defects  in  houses. 
Dr.  Kelly,  as  is  well  known,  when,  some  years  ago,  he  gave 
up  the  promise  of  a  first-class  consulting  practice  in  London 
to  take  under  his  charge  the  health  of  West  Sussex,  brought 
to  the  study  of  hygiene  a  wider  medical  culture  and  a  higher 
standard  of  ability  than  is  common  amongst  health  officers, 
cultured  and  able  as  many  of  them  are.  Since  then  his 
annual  reports  have  been  valued  as  models  of  sanitary  work, 
and  the  peculiar  nature  of  his  district  has  given  him  a  more 
varied  experience  than  falls  to  the  lot  of  many  of  his  col¬ 
leagues  in  his  special  branch  of  science.  Thus  much  was 
expected  of  him  when  it  was  known  that  he  was  to  lecture 
at  the  Parkes  Museum.  His  address  was  valuable,  no  doubt, 
and  admirably  adapted  to  the  occasion,  but  there  was  little 
of  novelty  about  it.  His  inclination  to  the  belief  that 
enteric  fever  may  develope  de  novo  is  something  of  a  new, 
or  at  any  rate  of  a  revived  departure,  but  it  is  supported 
by  much  practical  experience,  as  well  as  by  the  later  de¬ 
velopments  of  the  germ  theory.  The  practical  result  of 
an  openness  of  mind  on  this  point  is  obvious.  If  the  poison 
may  develope  afresh,  then  it  is  equally,  if  not  more,  impor¬ 
tant  to  remove  the  predisposing  causes  of  such  development 
than  to  disinfect  every  typhoid  stool ;  and  attention  must 
be  paid  quite  as  much  to  what  is  allowed  to  remain  in  the 
sewers  or  in  the  ground  as  to  what  is  discharged  into  them. 


If  sewage  is  allowed  to  remain  and  decompose  in  the  sewers, 
we  may,  on  this  view,  be  liable  at  any  time  to  outbreaks 
of  typhoid,  but  in  a  properly  constructed  sewerage  system 
every  particle  of  faecal  matter  ought  to  have  left  the  sewers 
within  a  few  hours  of  its  entry  into  them.  Thus  the  care 
of  the  sewers — a  hitherto  much-neglected  subject  becomes 
one  of  the  most  pressing  duties  of  the  hygienist.  There  is 
less  need  to  lock  the  stable-door — that  is,  to  trap  your 
house-drain— if  you  cut  off  the  supply  of  thieves. 


The  ceremony  of  presenting  Mr.  Jonathan  Hutchinson 
with  the  testimonial  which  has  been  subscribed  to  by  past 
and  present  students  of  the  London  Hospital  took  place  on 
Thursday,  the  29th  ult.,  at  the  Holborn  Restaurant.  Sir 
Andrew  Clark  officiated  both  as  chairman  at  the  presenta¬ 
tion  dinner,  and  as  representative  of  the  subscribers 
in  handing  to  Mr.  Hutchinson  the  trust-deeds  of  the 
«  Hutchinson  Prize  ”  Fund  and  the  silver  centrepiece  in 
which  the  subscriptions  have  been  invested.  Both  Sir 
Andrew  Clark  in  presenting  the  testimonial,  and  Mr. 
Jonathan  Hutchinson  in  receiving  it,  made  speeches  of 
great  interest.  Both  were  retrospective.  Sir  Andrew  Clark 
dwelt  on  the  early  days  when  Mr.  Hutchinson  was  “an 
earnest,  thoughtful,  fervid  student  in  the  wards  of  the 
Hospital  and  Mr.  Hutchinson  himself  took  a  further  dive 
into  the  past,  and  recalled  his  early  fruitful  study  of  the 
poSts,  his  apprenticeship  to  a  conscientious  practitioner, 
and  his  education  at  the  small  medical  school  at  York,  to 
each  of  which  he  attributed  some  share  in  his  subsequent  de¬ 
velopment.  We  should  have  said  that  it  is  Mr.  Hutchinson’s 
great  and  exceptional  merit  to  be  what  he  is  in  spite  of  these 
unpromising  beginnings.  They  would  have  ruined  most  men. 


The  mild  autumn,  which  has  just  come  to  a  close,  has 
had  a  favourable  influence  on  the  death-rate.  The  average 
mortality  for  the  months  of  October  and  November  was,  in 
1881,  20-8  per  1000,  and  in  1882,  20'5.  This  year  it  has  not 
risen  above  19'9.  Last  week,  though  the  death-rate  was 
21-8,  the  number  of  deaths  from  the  zymotic  and  the  re¬ 
spiratory  class  were  in  each  case  more  than  50  below  the 
corrected  ten  years’  average.  There  were,  nevertheless,  as 
many  as  59  deaths  from  scarlet  fever— a  figure  implying 
an  amount  of  suffering  and  a  loss  to  the  community,  for  the 
diminution  of  which  it  is  surely  time  that  the  State  should 
institute  some  comprehensive  organisation. 


“  Is  the  executioner  right  ?”  This  was  the  rather  sensa¬ 
tional  problem  put  by  a  medical  contemporary  a  week  or 
two  ago,  and  it  has  received  a  speedy  answer  in  the  negative 
under  painful  circumstances.  "We  have  no  desire  to  enter 
into  a  discussion  of  the  scientific  aspects  of  hanging.  The 
poor  culprit  who  was  so  clumsily  hanged  at  Liverpool  on 
Monday  that  his  heart  continued  to  beat  for  eight  minutes 
after  the  drop  fell,  may  have  died  of  strangling,  as  Dr.  Barr 
maintained,  or  he  may  have  been  killed  secundum  avtem  by 
the  stretching  of  his  medulla  oblongata,  and  the  inhibition 
of  his  respiratory  movements.  But  in  either  case  public 
opinion  will  demand  a  reversion  to  Marwood’s  method.  The 
late  executioner  nearly  always  succeeded  in  fracturing  or 
dislocating  the  vertebrae,  which  is  evidently  a  much  more 
effectual  way  of  arresting  respiration  than  the  perhaps  more 
scientific  method  of  stretching  the  medulla.  In  most  cases 
it  was  probably  the  third  cervical  vertebra  that  was  frac¬ 
tured,  for  this  was  found  to  be  the  case  in  four  of  the 
“  Invincibles  ”  hanged  by  Marwood.  The  fact  is  that  hang¬ 
ing  is  not  a  science,  but  an  art,  and  is  better  done  by  rule 
of  thumb  than  by  theory.  We  know  that  the  cleverest  scien¬ 
tific  men  will  sometimes  fail  in  bringing  off  an  experiment 


*66,2 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Dec.  8, 1883. 


before  an  audience  ;  but  though  it  raises  a  smile,  their  failure 
does  not  shake  our  belief  either  in  them  or  in  the  general 
principle  they  intended  to  illustrate.  With  Mr.  Binns  it 
is  different.  In  hanging,  the  success  of  the  experiment  is 
everything. 

The  French  medical  journals  for  the  current  week  have  a 
goodly  array  of  original  communications.  In  the  Archives 
Generates  de  Medecine  we  find  a  case  of  Fibrous  Pseudarthrosis 
of  the  Femur  successfully  treated  by  Eesection  and  Suture  of 
the  Bones,  by  Dr.  E.  Mathieu ;  a  contribution  to  the  study 
of  Acute  Peritonitis  in  the  region  of  the  Umbilicus,  by  Dr. 
Alphonse  Goix  ;  a  communication  on  Peritendinous  Cellulitis 
of  the  Tendo  Achillis,  by  Dr.  Raynal ;  and  the  conclusion  of 
Dr.  Comby’s  paper  on  Pulsating  Empyema.  In  the  Progres 
Medical,  M.  Terrillon  treats  of  the  Differential  Diagnosis  of 
Syphilitic  Gummata  and  Cold  Abscesses ;  M.  Troisier  con¬ 
tinues  his  paper  on  Subcutaneous  Rheumatic  Nodules ;  M. 
Mathieu  has  a  note  on  the  History  of  Strumous  Pseudo- 
Elephantiasis  ;  M.  F ere  contributes  an  article  on  the  Salaam 
Convulsion ;  and  Dr.  Comby  one  on  Xeroderma  Pig¬ 
mentosum.  In  the  Gazette  Hebdomadaire,  M.  Muscarel 
deals  with  the  Treatment  of  Diphtheria.  The  Gazette  des 
Hopitaux  gives  an  article  on  Syphilitic  Stricture  of  the 
Rectum.  The  Revue  Mensuelle  de  Laryngologie,  d’ Otologie 
et  de  Rhinologie  contains  an  article  on  Adenoid  Tumours 
of  the  Naso-Pliaryngeal  Cavities,  by  Dr.  Baratoux.  The 
Concours  Medical  gives  an  article  on  Neuralgia  of  Dental 
Origin,  by  Dr.  Aguilhon  de  Sarran. 


The  Centralblatt  filr  die Medicinischen  Wissenschaften  con¬ 
tains  an  original  communication  from  Dr.  Bouina,  of  Leiden, 
on  the  Staining  of  Cartilage  by  Saffranin.  Abstracts  of 
papers — by  Eckhard,  on  Artificial  Respiration  in  Strychnia 
Tetanus ;  by  Kronecker,  on  the  Formation  of  Hippuric  Acid 
in  Disease;  by  von  Hosslin,  on  Disturbed  Nutrition  from 
Want  of  Iron  in  the  Food;  by  Westphal,  on  a  case  of  Grey 
Degeneration  of  the  Central  Nervous  System,  with  remarks 
on  Nerve-Stretching — are  of  chief  interest.  In  the  Wiener 
Medizinische  Wochensclirift ,  Dr.  Anton  Wolfler  discusses  the 
different  forms  of  Benign  Tumours  of  the  Thyroid;  the 
series  of  papers  by  Dr.  Herz  on  the  Modern  Medication  of 
Diphtheria  is  concluded ;  and  Dr.  Biach,  of  Vienna,  com¬ 
municates  a  paper  on  the  so-called  Idiopathic  Hypertrophy 
of  the  Heart.  The  Berliner  Klinische  Wochenschrift  pub¬ 
lishes  an  interesting  account  of  Delivery  of  a  Rachitic 
Dwarf,  by  Dr.  Lange,  of  Konigsberg;  Dr.  Penzoldt,  of 
Erlangen,  contributes  to  the  same  journal  a  critical  article 
on  the  Diagnostic  Value  of  Ehrlichs’  so-called  Diazo- 
Reaction  ;  and  Dr.  F.  Semon’s  paper  on  Laryngeal  Paralysis 
is  concluded.  In  the  Centralblatt  fur  Klinische  Medicin 
are  published  abstracts  of  papers — by  Adamkiewicz,  on  Intra¬ 
cranial  Pressure;  by  Colucci  and  Tizzoni,  respectively,  on 
Regeneration  of  Liver  Tissue  ;  by  Babes,  on  Micrococci  in 
Yellow  Fever;  by  Knie  (Moscow),  on  three  cases  of  Gas¬ 
trostomy  ;  by  Carl  Schmidt,  on  Empyema.  The  Central¬ 
blatt  fur  Chirurgie  contains  an  original  paper  by  Dr.  Bouma, 
on  a  Reaction  of  Iodoform  :  abstracts  of  papers — by  Bohn, 
on  Skin  Diseases;  by  Englisch,  on  Obliteration  of  Cowper’s 
Glands  ;  by  Peruzzi,  on  400  cases  of  Ovariotomy  in  Italy — 
are  also  of  interest.  Dr.  Kaltenbach  contributes  to  the 
Centralblatt  fur  Gynahologie  an  original  paper  on  Episio- 
kleisis,  with  establishment  of  Recto-Vaginal  Fistula ;  Dr. 
Brennicke  discusses  Vaginal  Extirpation  of  the  Uterus. 
Amongst  the  abstracts  are  found  papers — by  Lorner  (Berlin), 
on  Enucleation  of  Myomata  ;  and  by  Budin  (Paris),  on  the 
Position  of  Twin-Ova,  and  the  symptoms  produced  thereby. 
.  A  report  of  a  late  meeting  of  the  Obstetrical  Society  of 
j  Berlin  is  also  published. 


THE  VOLUNTEER  MEDICAL  DEPARTMENT. 

The  December  number  of  the  Midland  Medical  Miscellany 
contains,  among  other  articles  of  interest,  the  first  part  of  a 
“  Catechism  ”  upon  Army  Medical  Organisation,  by  Surgeon- 
Major  E.  Evatt,  M.D.,  A.M.D.  It  is  intended  apparently 
for  the  use  of  Volunteer  medical  officers,  and’ will  doubtless 
be  appreciated  by  them.  As  the  editor  of  the  '  Midland 
Medical  Miscellany  complacently  observes,  it  is  “  unique  of 
its  kind,”  and  certainly  contains,  in  a  handy  and  pithy  form, 
a  vast  amount  of  ’condensed  information  relative  to  the 
formation,  organisation,  and  duties  of  the  medical  depart¬ 
ment  of  an  army  corps.  That  such  a  catechism  will  supply  a 
want,  we  have,  as  we  have  said,  no 'doubt,  and  we  shall 
await  with  interest  its  further  development.  We  trust, 
too,  that  it  will  be  republished  in  a  pamphlet  *  form, 
and  thus  secure  a  wider  publicity  than  can  be  insured 
by  its  appearance  in  the  Midland  Medical  Miscellany. 
All  interested  in  the  Volunteer  force  must  have  observed 
with  pleasure  the r  growing  tendency  shown  by  its  medical 
department  towards  that  practical  efficiency  which  has  been 
already,  to  a  great  extent,  attained  by  the  combatant  portion 
of  the  force.  The  time  will  soon  arrive,  we  hope,»when 
every  surgeon  of  a  Volunteer  regiment  will  take  pride  in  the 
full  knowledge  of  his  military  duties,  and  in  the  instruction 
of  regimental  bearers  and  others  upon  whose  aid,  in  time  of 
actual  service,  he  would  be  dependent.  Any  Volunteer 
medical  officer  who  is  anxious  for  instruction  on  the  many 
simple,  though  technical,  points  connected  with  military 
medical  organisation  will  find  that  he  cannot  fail  to  rise 
with  a  clear  and  sound  elementary  knowledge  of  the 
subject  from  the  perusal  of  Dr.  Evatt’s  questions  and 
answers. 


AN  APOLOGY  FOR  FOOTBALL. 

The  game  of  football  has  found  an  able  and  spirited  defender 
in  Dr.  C.  W.  Cathcart,  who  devoted  to  it  the  greater  part  of 
the  Health  Lecture  which  he  delivered  at  Edinburgh  on 
Saturday  last.  There  are  two  ways  in  which  the  game  may 
be  defended — by  accentuating  its  good  effects  on  the  physical 
organisation,  and  by  minimising  its  risks.  ’  Dr.  Cathcart 
made  use  of  both  methods.  He  obtained  statistics  as  to 
the  latter  from  forty  head-masters  ,  of  various  schools 
throughout  the  country,  and  from  these  he  found '  that 
during  periods  varying  from  two  to  thirty  years  there  had 
been  recorded  46  fractures  (chiefly  of  the  collar-bone),  93 
dislocations  and  sprains,  and  23  other  injuries. These 
accidents  had  occurred  amongst  a  total  of  3540  boys.  The 
accidents  resulting  from  “  skylarking  ”  for  corresponding 
periods  at  the  same  schools  were— 15  fractures,  47  sprains 
or  dislocations,  and  13  other  injuries.  These  figures,  which 
to  the  medical  mind  are  full  of  significance,  seem  to  show 
that  football,  which  is  played  only  during  the  winter,  is 
out  and  out  more  fatal  to  anatomical  integrity  than  all  the 
forms  of  “  skylarking,”  which  goes  on  from  one  year’s  end 
to  the  other.  But  Dr.  Cathcart  claimed  that  the  regular 
exercise  of  football  prevented  a  much  larger  total  of  injuries 
occurring  from  irregular  games,  included  under  the  com¬ 
prehensive  term  “skylarking.”  Altogether,  Dr.  Cathcart 
thought  that  the  statistics  showed  that  at  schools  the  risk  of 
serious  accidents  from  football  was  really  small,  and  much 
less  than  was  generally  supposed.  He  admitted  that  amongst 
young  men  more  serious  accidents  did  occur,  but  even  then  it 
compared  favourably  with  hunting  and  other  outdoor  sports. 
He  thought  that  “  scragging  ”  and  deliberate  “hacking” 
should  be  stopped.'  Still,  it  should" be  remembered  that 
the  great  beauty  and  attraction  of.  football  was  that  it  was, 
to  a  certain  extent,  rough  and,  within  limits,  even  violent ; 
otherwise  it  would  no  be  the  grand  winter  game  that  it 


Msdical  Times  and  Gaz3tte. 


ANNOTATIONS. 


Dec.  8,  1883.  663 


,  was,  available  in  all  weathers  except  in  frost  and  snow, 
giving  exercise,  short,  sharp,  and  bracing,  and  offering  an 
indescribable  charm  and  fascination  to  old  and  young.  Dr. 
,  Cathcart  will  be  gre  eted  with  a  chorus  of  approval  from 
-all  the  schoolboys  in  the  kingdom. 


FEVER  AT  GLASGOW. 

The  health  officer’s  report  states  that  during  the  fortnight 
ending  November  24  there  were  571  deaths  registered,  as 
compared  with  472  in  the  preceding  fortnight — an  increase 
cf  99,  representing  a  death-rate  of  29,  as  compared  with  24 
of  the  previous  fortnight,  for  a  thousand  living.  The  num¬ 
ber  of  deaths  from  infectious  diseases  of  children  was  56,  in 
place  of  45 — viz.,  36  from  scarlet  fever,  19  from  whooping- 
cough,  and  1  from  measles.  There  have,  says  the  report, 
not  been  so  many  deaths  registered  from  scarlet  fever  since 
the  autumn  of  1880 ;  but  of  the  36  deaths,  16  took  place  in 
the  northern  district.  The  increase  in  fatal  cases  coin¬ 
cided  with  a  diminution  in  the  number  of  the  known  cases 
and  in  the  numbers  removed  to  hospital.  This  arises  from 
the  disease  having  invaded  a  higher  grade  in  society.  A 
suspicion  arose  in  the  minds  of  two  medical  men  indepen- 
•  dently  that  the  spread  of  scarlet  fever  was  associated  with  a 
certain  milk-supplv.  They  reported  their  suspicion  to  the 
health  officer,  and  gave  lists  of  associated  cases.  There 
has,  no  doubt,  been  an  unusual  number  of  cases  not  asso¬ 
ciated  territorially  or  by  schools,  but  agreeing  in  being 
served  with  milk  from  one  dairy.  The  addresses  of  all  farms 
supplying  this  dairy  were  obtained,  and  on  inquiry  it  was 
found  that  no  disease  existed  on  these  farms.  All  the  boys 
and  girls  engaged  in  conveying  milk  fromthis  dairy,  and 
the  servants  employed  about  the  premises,  were  inspected 
and  their  homes  visited,  but  with  equal  want  of  success. 
The  history  of  milk  epidemics  of  scarlet  fever  proves  that 
the  source  of  infection  escapes  detection  oftener  than  in  the 
case  of  enteric  fever — a  circumstance  which  is  not  surprising 
when  we  remember  that  there  are  cases  so  mild  as  to  escape 
notice,  and  that  even  well-marked  cases  are  most  dangerous 
1  as  sources  of  infection  j  ust  when,  according  to  the  general 
practice,  they  cease  to  be  patients  and  are  what  is  called 
“  quite  well.”  Many  cases  of  scarlet  fever,  we  hear,  are  not  re¬ 
ported  because  the  general  public  have  a  very  decided  aversion 
to  sending  their  friends  to  hospital  when  suffering  from  infec¬ 
tious  diseases.  The  result  is  that,  in  many  instances,  medical 
.  aid  is  not  sought  until,  perhaps,  the  patient  is  in  a  hopeless 
condition.  Then  a  doctor  is  called  in,  not  because  he  can  be 
of  any  real  service  to  the  sufferer,  but  simply  to  enable  the 
friends  to  get  a  death-certificate.  In  almost  every  case  the 
sufferer  is  in  some  burial  or  other  society,  or  some  insurance 
society ;  and  it  is  simply  for  the  few  shillings  obtainable 
from  these  that  the  medical  man’s  aid  is  sought.  As  for  the 
mere  registration  of  the  death,  in  Glasgow  at  least,  anyone 
seems  to  be  able  to  do  it  without  a  “  line  ”  from  the  doctor. 
Even  in  the  case  of  sudden  death  the  friends  can  register 
without  any  other  step  being  taken  to  ascertain  the  real  cause 
cf  death.  We  have  even  heard  of  death-certificates  being 
accepted  from  medical  students. 


“DOCKING.” 

We  learn  from  the  Veterinarian  that  the  question  of  docking 
has  been  dealt  with  at  two  of  the  veterinary  societies. 
Prof.  Pritchard  threw  down  the  gauntlet,  boldly  stating 
that  he  looked  on  docking  as  an  act  of  cruelty,  and  invitiDg 
discussion,  although  he  anticipated  that  it  would  be  adverse. 
The  event  proved  that  he  was  correct  in  this  :  all  the 
speakers  defended  the  operation — some  on  the  score  of  the 
accidents  likely  to  happen  from  an  undocked  horse  getting 
its  tail  over  the  reins,  which  they  held  to  constitute  a  suffi¬ 


cient  cause  for  the  practice ;  while  most  spoke  of  it  merely 
as  a  matter  of  pounds,  shillings,  and  pence,  the  pain  being 
considered  slight  if  the  operation  were  properly  performed. 
The  general  feeling  appears  to  have  been  accurately  given 
by  one  speaker,  who  said  “  he  would  be  glad  to  see  horses 
have  the  free  use  of  all  their  members  if  practicable,  and 
would  leave  them  their  tails  if  the  removal  of  them  could 
not  increase  the  animal’s  comfort,  value,  or  power  of  being 
safely  used ;  but  he  would  not  do  anything  to  lessen  the 
value  of  horses  without  good  reason/’  If  commercial 
reasons  such  as  these  are  all  that  can  be  urged,  and  we  are 
to  recommend  the  removal  of  every  structure  that  does  not 
fulfil  the  conditions  of  “  comfort,  value,  or  power  of  being 
safely  used,”  we  may  look  for  a  wholesale  series  of  opera¬ 
tions  in  the  future  for  the  removal  of  appendages  of  no 
value  or  comfort  to  the  possessor. 


THE  PARIS  WEEKLY  RETURN. 

The  number  of  deaths  for  the  forty-seventh  week  of  1883, 
terminating  November  20,  was  985  (515  males  and  470 
females),  and  of  these  there  were  from  typhoid  fever  31. 
small-pox  6,  measles  7,  scarlatina  1,  pertussis  6,  diphtheria 
and  croup  44,  erysipelas  9,  and  puerperal  infection  3. 
There  were  also  51  deaths  from  acute  and  tubercular  menin¬ 
gitis,  189  from  phthisis,  38  from  acute  bronchitis,  65  from 
pneumonia,  69  from  infantile  athrepsia  (21  of  the  infants 
having  been  wholly  or  partially  suckled),  and  27  violent 
deaths  (19  males  and  8  females).  With  the  exception  of  diph¬ 
theria,  epidemic  diseases  remain  stationary ;  but  the  deaths 
from  this  disease  have  gradually  increased  during  the  last 
four  weeks  from  27  to  44 ;  and  during  the  last  week  the 
hospitals  have  received  30  cases  in  place  of  19  the  week 
before.  The  bronchitis  of  young  infants  is  becoming 
gradually  more  fatal  as  winter  approaches,  while  athrepsia 
is  continually  on  the  decrease.  During  the  week  there  were 
1150  births,  viz.,  574  males  (407  legitimate  and  167  ille¬ 
gitimate)  and  576  females  (416  legitimate  and  160  ille¬ 
gitimate)  ;  85  of  the  infants  were  either  born  dead  or  died 
within  twenty-four  hours,  viz.,  37  males  (26  legitimate 
and  11  illegitimate)  and  48  females  (32  legitimate  and  16 
illegitimate) .  _ 

WAXLIKE  DISEASE  OF  THE  HEART. 

The  heart  has  hitherto  had  the  credit  of  escaping,  as  a 
rule,  in  cases  of  lardaceous  disease  ;  such,  at  least,  is  the 
opinion  that  will  be  generally  found  in  our  text-books,  either 
expressed  or  implied.  That  distinction,  however,  it  has  no 
just  title  to,  for  Prof.  Hamilton  states  ( Journal  of  Anatomy 
and  Physiology,  October)  that,  on  examining  cases  of  general 
waxy  disease,  he  has  found  the  heart  to  be  affected  in 
nearly  every  severe  case,  and  sometimes  when  the  affec¬ 
tion]  is  limited  to  a  few  organs.  The  change  is  one  that 
would  be  very  likely  to  escape  detection  by  the  naked  eye, 
a  slight  milkiness  of  the  endocardium  in  patches  being 
the  only  appearance.  The  auricles  are  more  prone  to  be 
affected  than  the  ventricles,  and  the  right  more  than 
the  left.  The  wall  of  the  ventricles  is  of  a  pale  brown 
colour;  it  is  often  atrophied,  and  but  seldom  hypertro¬ 
phied.  All  these  changes  are,  however,  very  slight;  but 
the  addition  of  iodine  brings  out  rounded  or  irregular 
brown  stains  in  the  endocardium,  and  similar  brown  points 
may  sometimes  be  seen  in  the  substance  of  the  heart-wall 
after  the  use  of  iodine.  The  pericardium  is  usually  un¬ 
affected.  Thus  it  appears  that  the  disease  in  the  heart  corre¬ 
sponds  to  that  found  in  the  arteries,  where,  as  is  well  known, 
the  intima  and  middle  coats  are  its  chief  seats.  On  exa¬ 
mination  under  the  microscope,  after  staining  with  methyl- 
aniline,  the  waxy  material  is  found  in  the  endocardium  in 


664 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Dec.  8, 1883. 


irregular  masses ;  it  appears  to  have  infiltrated  the  fibrous 
tissue  of  the  endocardium,  and  to  have  pushed  the  fibres 
aside.  These  eventually  become  surrounded  by  the  waxy 
material,  but  they  do  not  become  converted  into  it.  The 
sub-endothelial  fibrous  tissue  also  contains  many  waxy 
deposits.  In  the  myocardium  also  the  waxy  deposit  occurs 
in  small  patches,  either  within  a  fasciculus  of  muscular 
fibres,  or  around  the  small  arteries  running  in  the  peri¬ 
mysium  externum.  The  waxy  material  is  poured  out 
from  the  capillaries  into  the  spaces  around  these  between 
the  perimysium  internum  and  the  muscular  fibrils.  As 
the  quantity  of  waxy  material  increases,  the  fibrils  be¬ 
come  compressed,  break  down  into  a  granular  mass,  and 
eventually  are  absorbed  ;  in  this  way  the  fibres  gradually 
undergo  atrophy,  the  waxy  matter  growing  more  abundant 
all  the  time.  It  is  to  be  especially  noted  that  the  fibres 
do  not  undergo  any  waxy  degeneration  themselves.  The 
small  arteries  between  the  fasciculi  are  almost  all  waxy ;  the 
small  veins,  too,  frequently  become  waxy  ;  and  many  of  the 
capillaries  are  similarly  affected.  Doubtless,  now  that  atten¬ 
tion  has  been  called  to  the  subject,  the  disease  will  be  readily 
recognised  by  other  observers ;  but  if  it  be  so  frequently 
present  as  Prof.  Hamilton  believes  it  to  be,  it  is  a  little 
remarkable  that  symptoms  of  cardiac  failure  should  not 
form  a  more  prominent  feature  at  the  close  of  life.  It  may 
be  that  more  close  investigation  will  demonstrate  that  such 
really  is  the  case.  At  any  rate.  Prof.  Hamilton  has  done 
good  service  in  calling  attention  to  a  somewhat  overlooked 
subject. 


THE  THIRTY-SEVENTH  REPORT  OF  THE 
COMMISSIONERS  IN  LUNACY. 

From  this  Report  we  learn  that  the  number  of  lunatics  in 
England  and  Wales  increased  during  the  year  1882  by  1923, 
the  average  for  the  previous  ten  years  being  1620,  and  for 
the  last  three  years  1757.  This  augmentation  in  the  rate 
of  increase  of  the  numbers  of  the  insane  is  not,  however, 
due  to  any  increase  in  the  numbers  becoming  insane  year 
by  year,  but  solely  to  the  diminishing  death-rate,  the 
mortality  in  county  and  borough  asylums  throughout 
the  kingdom  having  fallen  1  per  cent.  In  this  way  a 
diminished  rate  of  removal  is,  of  course,  as  efficacious  in 
augmenting  the  number  of  those  under  treatment  for 
insanity  as  an  increased  rate  of  addition  to  their  numbers, 
and  we  may  again  rest  satisfied  that  the  number  of  those 
who  become  insane  is  not  materially  increasing.  Comfort 
may  also  be  drawn  from  the  fact  that  the  recoveries,  as 
compared  with  the  admissions,  were  4041  per  cent.  No 
fewer  than  twelve  suicides  have  occurred  in  county  and 
borough  asylums  during  the  year.  Doubtless  this  does  not 
seem  a  very  large  proportion  of  the  5500  patients  under 
care  in  these  asylums  who  are  known  to  be  suicidally  in¬ 
clined,  and  doubtless  also  it  is  sometimes  practically  impos¬ 
sible  to  prevent  a  suicidal  patient  from  carrying  out  his 
intention,  as  in  the  well-known  case  of  the  man  who  tore 
his  abdomen  open  with  his  naked  hands  without  attracting 
the  notice  of  the  attendant  who  was  sitting  by  his  bedside ; 
but  still  it  appears  evident  that  in  nearly  every  one  of  these 
eleven  cases  there  had  been  contributory  negligence  on  the 
part  of  the  asylum  authorities.  With  regard  to  a  suicidal 
patient  who  is  apparently,  convalescent,  the  medical  officers 
of  asylums  are  placed  between  the  devil  and  the  deep  sea. 
If  they  detain  him  in  an  asylum  they  render  themselves 
liable  to  endless  complaints  on  the  part  of  the  patient,  his 
friends,  and  often  also  of  the  guardians  who  are  liable  for  his 
maintenance  ;  and  they  often  suffer  serious  misgivings  and 
searchings  of  heart  without  these  external  incentives.  On 
the  other  hand,  they  know  from  almost  daily  experience  how 


little  an  improvement  in  cheerfulness  can  be  depended  on  as 
an  indication  of  any  real  diminution  of  the  suicidal  tendency ; 
and  how  ready  the  very  same  people  who  blame  them  for 
detaining  a  patient — that  is,  for  excess  of  vigilance — will  be  to 
blame  them  if  a  relaxation  of  that  vigilance  permits  him  to 
injure  himself.  A  special  feature  in  this  Report  is  the  obser¬ 
vations  made  by  the  Commissioners  on  the  night-watching 
of  the  epileptic  and  suicidal.  For  the  last  ten  years  the  Com¬ 
missioners  have  paid  marked  attention  to  this  matter,  and 
have  again  and  again  drawn  attention  to  the  advisability  of 
a  continuous  supervision  of  these  classes  of  patients  by 
night  as  well  as  by  day ;  and,  in  nearly  all  the  asylums  visited 
by  them, arrangements  for  this  purpose,  more  or  less  efficient, 
have  been  made.  The  only  asylums  which  havenot  yetadopted 
this  most  salutary  and  necessary  change  are  those  for  the 
county  of  Suffolk,  for  the  East  Riding  of  Yorkshire,  and  for 
the  boroughs  of  Hull,  Newcastle,  Norwich,  and  Bristol.  In 
order  to  procure  explicit  information  on  this  head,  and  also 
to  elicit  the  opinion  of  asylum  superintendents  as  to  the 
usefulness  of  the  system,  the  Commissioners  have  recently 
issued  a  circular  to  the  asylums  under  their  jurisdiction,  and 
embody  in  their  Report  the  answers  they  have  received.  The 
testimony  thus  obtained  is,  of  course,  of  the  highest  value, 
and  speaks  very  strongly  indeed  for  the  benefits  that  the 
continuous  night  supervision  confers  both  upon  the  patients 
and  the  officers  in  these  institutions.  Suicidal  attempts  are 
largely  prevented,  and,  when  made,  are  detected  and  frus¬ 
trated,  epileptics  are  saved  from  suffocation,  quarrels  and 
consequent  injuries  to  patients  by  one  another  are  pre¬ 
vented,  and  a  general  feeling  of  security  is  generated 
not  only  among  the  patients,  but  also  among  the  medical 
officers,  who  are  relieved  from  a  great  burden  of  anxiety. 
The  demand  for  asylum  accommodation  continues  to  in¬ 
crease,  as  may  naturally  be  inferred  from  the  increasing 
numbers  of  the  insane  that  we  have  already  mentioned. 
Many  asylums  are  full,  several  are  overcrowded,  and  in  the 
majority  the  margin  between  accommodation  and  occupation 
is  unduly  narrow ;  and  this  in  spite  of  new  asylums,  new 
annexes  to  existing  asylums,  and  extension  in  various  w aye 
of  old  asylum  buildings. 


THE  ETIOLOGY  OF  FUNGOUS  ENDOMETRITIS. 

A  recent  number ^of  the  Archiv  fur  Gynakologie  contains 
a  long,  but  somewhat  theoretical,  paper  by  Dr.  Brennecke 
on  the  etiology  of  fungous  endometritis,  more  especially  of 
the  form  described  by  Olshausen  under  the  name  of  “  chronic 
hyperplastic  endometritis.”  The  weakness  of  this  carefully 
written  paper  is  in  the  small  number  of  cases  upon  which  it 
is  based.  Of  the  disease  described  by  Olshausen,  the  author 
believes  there  are  two  forms — a  glandular,  in  which  over¬ 
growth  of  gland- tissue  is  the  conspicuous  change ;  and  an 
interstitial,  marked  by  hyperplasia  of  the  connective  tissue. 
Between  these  extreme  forms,  other  mixed  or  intermediate 
cases  occur,  in  which  bothjchanges  are  present.  The  inter¬ 
stitial  form  occurs  in  the  younger,  the  glandular  form 
in  the  older  patients.  Dr.  Brennecke  describes  six  cases 
observed  by  himself,  and  refers  to  some  other  published  cases, 
and  upon  this  material  he  builds  his  theory.  He  finds  that 
in  them  all  the  haemorrhage  and  other  symptoms  character¬ 
istic  of  the  disease  were  preceded  by  periods  either  of  com¬ 
plete  amenorrhoea,  or  of  irregular,  infrequent,  and  scanty 
menstruation.  Therefore,  he  says,  the  disease  depends  pri¬ 
marily  upon  a  functional  disturbance  in  the  ovaries,  which, 
as  a  reflex  effect,  causes  chronic  hyper® mia  of  the  uterine 
mucous  membrane,  and  thus  leads  to  hypertrophy  of  that 
structure.  This  reflex  effect  is  produced  through  the  nervous 
mechanism  which  governs  ordinary  menstruation,  and  it 
therefore  affects  the  body  only,  not  the  cervix,  of  the  uterus. 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Dec.  8,  1S?3.  665 


Being  a  disease  due  to  reflex  action,  it  cannot  be  cured  while 
the  cause  of  the  reflex  effect  remains  in  operation.  Hence, 
says  Dr.  Brennecke,  the  frequency  of  relapse  which  is 
observed  in  this  disease.  Our  author  also  adduces  the 
occasional  association  of  abscess  of  the  ovary  with  this 
morbid  condition  in  support  of  his  view.  For  the  treatment 
of  this  form  he  looks  on  the  curette,  used  to  remove  the 
hypertrophied  membrane,  as  the  grand  agent.  This  should 
be  combined  with  tonic  medication  to  alter  the  morbid  action 
which  leads  to  its  formation.  Cauterisation  he  thinks  use¬ 
less,  its  adoption  being  based  on  an  erroneous  view  as  to  the 
pathology  of  the  disease,  viz.,  that  it  is  merely  a  local  change 
in  the  uterine  mucous  membrane.  He  does  not  think 
that  this  malady  ever  passes  into  cancer.  The  form  of 
disease  in  which  there  are  localised  fungous  outgrowths 
in  the  uterine  cavity.  Dr.  Brennecke  in  his  experience  has 
always  found  dependent  on  some  other  disease  of  the  uterus  : 
either  chronic  catarrh  (simple  or  gonorrhoeal),  retroflexion, 
stenosis  of  the  os  internum  or  externum,  interstitial  or  sub¬ 
mucous  fibroids.  This  form  he  therefore  calls  the  local  uterine 
form,  in  contradistinction  to  the  cases  of ■  chronic  hyper¬ 
plastic  endometritis,  which,  in  accordance  with  his  theory, 
he  calls  the  ovarian  form.  He  points  out  these  distinctions  : 
— 1.  In  the  uterine  form  there  is  haemorrhage  from  the  be¬ 
ginning;  in  the  ovarian,  menstruation  is  at  first  deficient  or 
absent.  2.  In  the  uterine  form  there  is  scarcely  any  ten¬ 
dency  to  relapse ;  in  the  ovarian,  a  strong  tendency.  3.  The 
fragments  removed  by  the  curette  are  smaller  in  the  uterine 
form  than  in  the  ovarian.  4.  In  the  ovarian  form  these 
pieces  show  the  structure  simply  of  hypertrophied  mucous 
membrane ;  this  being  seldom  the  case  in  the  uterine  form, 
in  which  the  products  of  catarrh  and  ulceration  are  com¬ 
monly  found.  Lastly,  Dr.  Brennecke  describes  fungous 
endometritis  following  abortion,  which  he  denominates  the 
decidual  form.  These  cases  yield  the  most  satisfactory  re¬ 
sults  to  treatment,  being  commonly  completely  cured  by 
once  using  the  curette.  Dr.  Brennecke  adds  to  his  paper 
an  interesting  novelty  in  the  shape  of  a  plate,  in  which  the 
course  of  some  cases  of  fungous  endometritis  is  shown  in  a 
graphic  form. 

STATISTICS  OF  FRENCH  MEDICAL  PRACTITIONERS. 

The  Progres  Medical  furnishes  the  following  analysis  of  the 
quinquennial  report  which  the  Minister  of  Commerce  has 


■just  published : — 

1S76.  1881. 

Doctors  of  Medicine  .  .  10,743  11,643 

Officiers  de  Sante .  .  .  3,633  3,203 

Pharmaciens  .  .  .  6,232  6,443 

Herbalists  ....  983  982 

Midwives  ....  12,847  13,403 


In  the  Department  of  the  Seine  there  were,  at  the  end 
■of  1881,  555  doctors  of  medicine,  21  officiers  de  sante, 
30  pharmaciens,  and  395  midwives  more  than  in  1876,  while 
there  were  76  fewer  herbalists.  The  number  of  communes 
in  France  is  36,097 ;  and  in  these  3645  doctors  alone  prac¬ 
tise,  in  1914  officiers  de  sante  alone  practise,  in  743  both 
■doctors  and  officiers  practise,  while  in  29,795  there  are 
neither  doctors  nor  officiers. 


THE  EFFECTS  OF  COTTON  SIZING  ON  THE  HEALTH 
OF  THE  OPERATIVES. 

Dr.  J.  H.  Bridges  and  Mr.  E.  Haydon  Osborn,  the  Com¬ 
missioners  appointed  by  the  Home  Office  to  inquire  into  the 
■effects  upon  the  operatives  of  the  process  of  heavy  sizing  in 
cotton  manufacture,  state  in  their  report  that  though  notable 
changes  have  taken  place  during  the  last  ten  years  in  the 
proportion  of  the  various  ingredients  used  in  the  process,  the 
amount  of  dust  in  weaving-sheds  has  not  proportionately 


increased.  There  is  no  doubt  that  the  change  effected  by 
steaming  the  atmosphere  of  weaving-sheds  is  to  create  an 
artificial  climate  of  a  somewhat  tropical  and  relaxing  kind, 
whilst  there  is  great  unwillingness  to  admit  fresh  air  into  the 
weaving-sheds  owing  to  the  artificial  and  unstable  composi¬ 
tion  of  the  warps.  During  frosty  winter  afternoons,  when 
steam- jets  have  been  for  hours  in  full  operation,  and  when 
the  products  of  gas-combustion  have  been  added  to  the 
exhalations  from  the  lungs  of  the  workpeople,  the  atmosphere 
of  a  weaving-shed  must  be  in  a  high  degree  injurious  to  con¬ 
stitutions  predisposed  to  pulmonary  disease  or  dyspepsia.  The 
conditions  of  the  work  are  not  such  as  to  prevent  that  large 
proportion  of  workpeople  whose  constitutions  are  naturally 
vigorous  from  following  their  calling  without  serious  incon¬ 
venience.  But  there  remains  the  proportion,  always  very 
considerable,  who  have  a  constitutional  tendency  to  one 
form  or  other  of  rheumatic,  phthisical,  or  dyspeptic  ail¬ 
ments.  Such  tendencies  cannot  fail  to  be  intensified  by 
working  continuously  in  an  ill- ventilated  atmosphere  per¬ 
vaded  by  mineral  dust  or  rendered  artificially  damp.  The 
remedies  recommended  by  the  Commissioners  are — first,  that 
those  processes  by  which  very  large  quantities  of  size  can  be 
incorporated  with  the  warp  without  necessitating  the  diffusion 
of  dust  or  moisture,  but  which  are  at  present  trade  secrets, 
should  become  generally  known  and  applied.  Secondly, 
that  more  effective  means  of  ventilation  should  be  secured, 
and  that  measures  should  be  taken  to  apply  these  means 
where  they  exist.  In  many  dusty  occupations,  notably  in 
that  of  flax-heckling,  it  is  a  most  important  mitigation  of 
the  evil  that  they  are  carried  on  with  open  windows.  The 
air  of  the  workroom  where  this  is  the  case  is  probably 
changed  more  than  a  score  of  times  during  an  hour.  It 
may  be  doubted  whether  with  the  majority  of  weaving-sheds 
it  is  effectively  changed  once  during  the  working-day.  Thirdly, 
that  as  the  business  of  weaving  has  become  from  various 
causes  one  of  great  complexity,  and  requires  an  amount  of 
skill,  and  even  of  scientific  knowledge,  such  as  appeared  to 
the  Commissioners  to  be  not  unfrequently  wanting,  mea¬ 
sures  should  be  taken  for  diffusing  elementary  information 
with  regard  to  the  qualities  of  the  atmosphere.  In  a  manu¬ 
facturing  process  in  which  the  quality  of  the  atmosphere  is 
so  important,  it  might  have  been  expected  that  means  would 
be  taken  to  ascertain  with  some  precision  facts  capable  of 
such  easy  and  exact  measurement  as  temperature  and  mois¬ 
ture.  Yet  it  is  very  rare  to  find  a  thermometer  in  a  weaving- 
shed  ;  and  a  hygrometer,  simple  though  the  instrument  is, 
appears  to  be  entirely  unknown.  The  diffusion  of  elementary 
information  on  these  two  points,  combined  with  a  recogni¬ 
tion  of  the  paramount  importance  of  ventilation,  would  go 
far  towards  the  provision  of  remedies,  or  at  least  of  effective 
palliatives,  for  the  evils  complained  of. 


A  BATCH  OF  “TRANSACTIONS.” 

The  thirty-fourth  volume  of  the  Pathological  Society’s 
Transactions,  which  has  just  been  issued,  contains,  as  usual, 
a  large  amount  of  valuable  material.  The  chief  feature  of 
the  volume  is  the  considerable  increase  in  number  of  records 
of  pathological  specimens  taken  from  animals  exhibited 
during  the  session — the  firstfruits,  so  to  speak,  of  the  Com¬ 
parative  Pathology  Committee  appointed  at  the  instigation 
of  Mr.  Jonathan  Hutchinson.  It  would  be  invidious,  where 
so  many  papers  are  good,  to  pick  out  any  one  as  of  especial 
merit ;  and  it  is  needless  to  add  that  the  communications  are 
not  all  of  equal  value  in  respect  to  either  the  novelty  or  the 
rarity  of  the  cases  to  which  they  refer.  The  sixteenth 
volume  of  the  Clinical  Society’s  Transactions,  which  has 
just  been  published,  contains  fifty- one  papers,  many  of 
them  referring  to  cases,  of  unusual  interest.  Among  the 


666 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Dec.  8,  1883. 


more  important  of  these  we  may  mention  cases  of  local 
asphyxia  (or  Raynaud’s  disease),  of  scleroderma,  of  sub¬ 
cutaneous  rheumatic  nodules,  cases  of  intussusception  treated 
in  different  ways,  of  nephrectomy  and  nephrolithotomy,  a 
case  of  extirpation  of  a  small  goitre,  and  one  of  subperi¬ 
osteal  amputation  at  the  hip-joint.  The  second  volume  of 
the  new  series  of  the  Transactions  of  the  Medico-Chirurgical 
Society  of  Edinburgh  and  the  first  volume  of  the  Transac¬ 
tions  of  the  Academy  of  Medicine  in  Ireland  are  also  before 
us.  They  differ  considerably  in  size.  The  former,  though 
consisting  of  only  116  pages,  contains,  nevertheless,  some 
elaborate  papers  and  well-reported  discussions.  We  may 
refer  especially  to  Mr.  Bell’s  paper  “On  Loss  of  Memory  occa¬ 
sionally  following  Cranial  Injuries”  ;  to  Or.  John  Duncan’s 
paper  “  On  Germs  and  the  Spray  to  two  papers,  “  On  Ankle- 
Clonus  in  relation  to  the  Height  of  the  Individual,”  and  “  On 
Nutrition  and  Reproduction,”  by  Dr.  Alexander  James  ; 
and  to  Dr.  Allan  Jamieson’s  paper  “  On  the  Treatment 
of  Diphtheritic  Sorethroat,”  and  the  discussion  thereon. 
The  Irish  volume  is  much  more  pretentious,  numbering 
371  pages,  and  containing  several  plates,  photographs,  and 
woodcuts.  The  papers  range  over  a  very  wide  area  indeed, 
as  amongst  them  are  some  read  in  the  Medical  Section, 
others  in  the  Surgical,  Obstetrical,  Pathological,  Public 
Health,  and  Anatomy  and  Physiology  Sections.  Many  of  the 
communications  are  mere  records  of  interesting  or  unusual 
cases  or  specimens,  but  there  are  also  some  papers  deserving 
of  special  allusion :  such  are,  for  instance.  Dr.  Cameron’s  paper 
“On  Consanguineous  MarriagesinRelation  to  Deaf-Mutism”; 
Mr.  Davison’s  paper  “On  the  Influence  of  Fractures  on 
the  Growth  of  Bone  Mr.  Chas.  Coppinger’s,  “  On  Hydatid 
Tumours  of  the  Bones  and  one  by  Dr.  Stack,  “  On  the  Re¬ 
plantation  and  Transplantation  of  Teeth.”  It  is  much  to  be 
hoped  that  the  editor  of  this  volume  in  future  years  will  be 
able  to  see  his  way  to  reporting  the  discussions  whenever 
these  have  been  really  good.  That  it  can  be  done,  and  with 
the  advantage  of  adding  very  considerably  to  the  value 
of  the  Transactions,  is  evident  from  the  example  of  the 
Edinburgh  Society. 


FREE  ASSOCIATES  OF  THE  PARIS  ACADEMY  OF 
MEDICINE. 

Many  persons,  even  in  France,  being  ignorant  of  the  quali¬ 
fications  requisite  in  order  to  become  an  associe  libre  in  the 
Academy,  the  Gazette  des  Hopitaux  explains  that  amidst 
the  numerous  changes  which  the  Academy  has  undergone 
since  its  foundation  in  1820,  the  rule  relating  to  free  asso¬ 
ciates  has  remained  unaltered.  According  to  this,  they  are 
directed  to  be  chosen  from  among  persons  who  have  culti¬ 
vated  with  success  the  sciences  which  are  accessory  to 
medicine,  or  contributed  in  some  way  to  their  progress, 
or  served  with  zeal  and  distinction  in  some  of  the  different 
establishments  devoted  to  the  solace  of  mankind.  Thus 
there  is  a  marked  distinction  between  the  ordinary  mem¬ 
bers  of  the  Academy  who  belong  to  th'e  different  cate¬ 
gories  of  the  art  of  healing,  properly  so  called,  and  these 
associates,  who,  whether  they  have  diplomas  or  not,  are 
occupied  in  the  pursuit  of  science  or  administration.  In 
order  to  inaugurate  this  distinction,  ten  associate  mem¬ 
bers  were  chosen,  whose  names  should  add  lustre  to  the 
Academy,  and  their  enumeration  is  sufficient  to  show  that 
they  did  so — viz.,  those  of  Berthollet,  Chaptal,  Cuvier, 
Desfontaines,  Gay-Lussac,  Etienne  Geoffroy  St.  Hilaire, 
Lacepede,  Ramond,  Rochefoucauld,  and  Thenard.  The  suc¬ 
cessors  of  this  illustrious  body  have  been  Arago,  Chevreul, 
Milne- Edwards,  Davaine,  Littre,  Isidore  Geoffroy  St. 
Hilaire,  Trebuchet,  Lafonde  Ladebat,  Coste,  Atnedee  Latour, 
Peisse,  Payen,  and  Pasteur.  If  they  do  not  possess  all  the 
distinction  of  the  first  series,  these  names  represent  the 


ilite  of  science,  administration,  and  the  medical  press.  At 
some  recent  elections  it  has  been  attempted  to  substitute 
for  names  thus  honoui’ably  characterised  those  of  medical 
men  who,  not  feeling  strong  enough  to  enter  the  Academy , 
through  the  recommendations  of  the  sections  of  the  various 
branches  of  the  medical  art  into  which  the  Academy  is 
divided,  sought  to  gain  admission  through  this  channel; 
but  hitherto  the  attempts,  which,  if  successful,  would  hav  e 
destroyed  the  distinguishing  peculiarity  of  the  associes  libres, 
have  failed,  and  the  election  which  has  just  taken  place  fully 
maintains  the  characteristics  of  the  preceding  nominations. - 
The  vacancy  was  created  by  the  death  of  M.  Amedee  Latour, 
a  distinguished  writer  in  the  medical  press,  and  the  founder 
of  the  Union  Medicate  and  the  French  Medical  Association. 
The  special  committee  appointed  to  propose  candidates  pre¬ 
sented  their  list,  with  Prof.  Quatrefages  on  the  first  line, 
and  on  the  second  line  M.  Durand-Claye,  the  celebrated 
sanitary  engineer  ;  MM.  Foville,  Magitot,  De  Rause  (editor 
of  the  Gazette  Medicate),  and  Worms.  At  the  first  ballot 
Prof.  Quatrefages  received  forty-seven  of  the  votes  of  the 
ninety-three  members  present,  and  M.  Worms  received 
thirty-three.  As  this  did  not  constitute  the  required 
majority,  a  second  ballot  was  taken,  when  the  votes 
were  fifty-nine  for  Prof.  Quatrefages,  and  thirty  for 
M.  Worms.  _ 

FASHION  IN  TREATMENT. 

As  Dr.  Wendell  Holmes  pointed  out  in  his  valuable  ad¬ 
dress,  the  progress  of  our  knowledge  in  respect  of  phy¬ 
siology  and  pathology  has,  thanks  to  improved  methods  of 
study  and  investigation,  been  simply  enormous  during  the 
last  few  decades;  and  it  has  been  steady  progress — slow, 
perhaps,  but  built  up  gradually,  step  by  step,  on  the  sure 
foundation  of  fact.  Speculation  counts  for  very  little  now¬ 
adays,  and  our  text-books  on  anatomy  no  longer  attempt  to' 
determine  the  exact  habitation  of  the  soul,  though  there 
are  hundreds  of  men  living  and  in  practice  now,  who  were 
taught  by  one  of  the  leading  anatomists  of  their  student- 
days  that  the  soul  inhabited  the  pineal  gland,  and  that, 
according  to  the  best  authorities,  it  invested  itself  in  that 
body  between  the  thirty-fifth  and  fortieth  day  of  intra-uterine 
life.  We  are,  then— and  it  is  not  said  in  any  spirit  of  boasting, 
— immeasurably  superior  to  our  predecessors  of  half  a  century 
ago,  both  in  our  knowledge  of  disease-processes  and  our 
means  of  diagnosis.  Upon  this  point  there  can  be  no  manner 
of  doubt;  and  the  natural  question  arises.  Have  our  advances 
in  treatment  been  commensurate  with/or  borne  any  definite 
relation  to,  our  more  thorough  appreciation  of  disease  ?  This, 
after  all,  is  the  practical  point,  and  if  it  cannot  be  answered 
in  the  affirmative,  then  -  surely  we  are  failing  to  fulfil  what 
should  be  the  main  object  of  our  lives,  viz  ,  to  benefit  our 
fellow-men.  The  striking  address  on  “  Good  Remedies — out 
of  Fashion,”  delivered  by  Dr.  Hare  some  months  since,  and 
recently  published  in  a  separate  form,  naturally  suggests 
such  reflections  as  these.  Why,  the  very  title  is  an  accusa¬ 
tion,  not  against  our  honesty  perhaps,  but  certainly  against 
our  common  sense,  and  yet,  unfortunately,  the  truth'  of  it 
cannot  be  denied.  “  Out  of  fashion,”  indeed  !  What  has 
fashion,  or,  rather,  what  ought  it  to  have,  to  do  with  treat¬ 
ment  ?  The  medical  profession  is  supposed  to  consist  of 
fairly  well-educated,  intelligent  human  beings,  and  not  of 
a  flock  of  sheep.  There  are  evidences,  however,  that  the 
men  of  the  present  generation  do  not  intend  to  run  of  ne¬ 
cessity  in  the  same  grooves — some  would  say  ruts — as  their 
predecessors,  and  in  nothing  is  this  more  evident  than  in 
the  use  of  stimulants  in  fevers.  The  statistics  given  by 
Dr.  Hare  show  very  prominently  the  influence  of  Dr.  Todd’s 
views,  in  the  enormous  beer  and  spirit  bills  which  were  run 
up  in  the  various  metropolitan  hospitals  twenty  years  - 


Medical  Times  and  Gazette. 


THE  VIENNA  SCHOOL  OF  MEDICINE.' 


Dee.  8,  1883.  667 


ago ;  and  they  also  show  further  that  that  influence  has 
ceased  practically  to  he  felt,  and  that  the  indications  for 
their  use  are  now  probably  estimated  at  their  true  value. 
That  bleeding  was  formerly  carried  to  excess,  none  can  deny ; 
that  it  might  be  used  more  frequently  with  advantage  at 
the  present  day,  most  would  probably  agree.  The  young 
men  of  the  present  day  would  be  as  little  likely  to  derive 
benefit  from  a  biennial  bleeding  as  they  would  be  likely  to 
finish  a  couple  of  bottles  of  old  port  with  impunity.  Rail¬ 
ways  and  telegraphs,  and  competitive  examinations,  and  a 
host  of  other  modern  improvements,  have  entirely  changed 
our  mode  of  life,  and  have  probably  exercised  a  modifying 
influence  upon  the  constitutions  of  the  rising  generation, 
for  which  corresponding  allowances  must  be  made  in  our 
modes  of  treatment.  But,  after  making  all  due  allowances 
for  the  age  in  which  we  live,  the  fact  remains  that  many 
excellent  remedies  have  quite  undeservedly  fallen  into 
disuse ;  and  if  the  employment  of  some  of  these  should 
henceforth  once  more  become  general.  Dr.  Hare  will  have 
the  satisfaction  of  knowing  that  he  did  not  deliver  his 
address  in  vain. 


THERAPEUTIC  PLAYTHINGS. 

However  useful  playthings  may  be,  they  are  not  often 
seriously  advocated  and  described  as  remedial  agents.  Dr. 
T.  S.  Latimer,  of  Baltimore,  in  a  recent  article  on  infantile 
paralysis,  puts  aside  drugs  and  the  “  much -belauded  elec¬ 
tricity/’  in  favour  of  frictions,  massage,  and  “  judiciously 
selected  playthings,  such  as  encourage  voluntary  efforts  on 
the  part  of  the  child.”  He  considers  that  various  forms  of 
swings,  velocipedes,  and  other  vehicles  which  shall  be  pro¬ 
pelled  by  the  movements  of  the  patient’s  legs  or  arms  are 
of  great  value  in  encouraging  voluntary  efforts. 


We  hear  with  great  pleasure  that  Mr.  Lister  has  been 
offered  and  has  accepted  a  baronetcy. 


The  old  pupils  of  Prof.  Charcot  entertained  him  at  a 
banquet  on  Wednesday  last,  on  the  occasion  of  his  election 
into  the  Academie  des  Sciences  of  the  Institute. 


'  Professor  McKendricjk,  of  Glasgow,  will  deliver  a, 
series  of  five  lectures  at  the  Royal  Institution  “  On  the 
Origin,  Distribution,  and  Regulation  of  Animal  Heat,”  on 
Tuesdays,  March  4  to  April  1. 


A  soiree  was  given  on  Thursday  evening  by  the  Medical 
and  Physical  Society  of  St.  Thomas’s  Hospital,  in  the  central 
hall  of  the  Hospital.  There  was  some  good  music  and  a 
well-selected  show  of  objects  of  interest. 


The  Medical  Officer  of  the  Sheerness  Local  Board  reports 
that  Sheerness  was  the  only  naval  port  in  England  in  which 
the  suspension  of  the  Contagious  Diseases  Act  had  been 
attended  with  a  decrease  in  the  number  of  cases  under  that 
Act.  _ 

It  was  stated  by  one  of  the  speakers  at  the  recent  meeting 
of  the  General  Council  of  St.  Andrews  University  that  Dr. 
B.  W.  Richardson,  the  retiring  Assessor,  would,  at  the  next 
general  Parliamentai’y  election,  contest  Finsbury  in  the 
Radical  interest.  _ 

A  conference  on  the  “Dwellings  of  the  London  Poor” 
will  be  held  at  the  Mansion  House  on  Tuesday  next,  the 
11th  inst.,  at  2.30  p.m.  Several  members  of  Parliament 
and  medical  officers  of  health  are  expected  to  take  part 
in  the  proceedings. 


The  deaths  of  two  medical  practitioners  from  fever  eon-- 
tracted  in  the  discharge  of  their  duties  are  reported.  Dr. 
John  Wall,  the  Medical  Officer  of  the  Cork  Public  Health 
Committee,  died  on  Tuesday  from  typhus;  and  Dr.  John 
Paton,  of  Bo’ness,  Linlithgowshire,  died  on  Sunday  of 
typhoid. 

The  gradually  increasing  number  of  Centralbldtter  has 
lately  been  augmented  by  the  appearance  of  a  new  Central- 
blatt  fur  Zahnheilkunde.  Published  in  Berlin,  under  the 
editorship  of  Dr.  Goltstein,  of  Geneva,  the  new  paper  sup¬ 
plies  a  want  long  felt  among  practitioners  and  students  of 
dental  surgery. 


THE  VIENNA  SCHOOL  OF  MEDICINE. 


For  those  who  have  spent  any  time  there,  the  very  name  of 
Vienna  has  an  undefinable  charm.  To  the  young  doctor, 
fresh  from  hard  reading  or  from  onerous  ward-work,  the  free 
and  careless  life  of  the  Austrian  capital,  the  making  of  new 
friends,  the  plunge  amongst  new  ideas,  the  emancipation 
from  schedules,  and  the  liberty  to  study  what  and  when  he 
pleases,  combine  to  make  his  stay  a  charmed  part  of  his 
life  to  which  he  will  always  look  back  with  feelings  of  grati¬ 
tude  and  delight.  Vienna  is  to  him  what  Rome  is  to  the 
artist,  and  Paris  to  the  good  American.  That  every  branch 
of  medical  science  and  practice  can  be  learned  just  as  well, 
if  not  better,  in  London  nowadays  than  it  can  in  Vienna, 
does  not  destroy  its  merit ;  for  the  chief  value  to  a  doctor  of 
a  final  six  months  or  year  of  study  abroad  has  always  con¬ 
sisted  not  so  much  in  the  opportunity  it  gave  him  to  work 
at  skin  and  throat  and  eyes,  as  in  the  general  widening  of 
his  view  of  life,  in  the  new  friends  and  new  ideas,  and  in. 
the  leisure  for  digesting  his  knowledge  that  it  brought  him. 
Thus  a  “  wander-year,”  the  greater  part  of  which  should  be 
spent  at  Vienna,  may  still  be  cordially  recommended  to  the 
young  practitioner,  though,  if  he  has  duly  availed  himself  of 
all  the  advantages  that  a  good  English  medical  education 
affords,  he  will  probably  find  many  of  the  courses  at  Vienna, 
useless  to  him.  For  as  there  are  generally  some  dozen 
American  students  there  to  one  who  hails  from  the  British 
Isles,  the  courses  have  been  wisely  adapted  rather  to  the 
American  than  the  English  standard.  Still  the  practice  of 
the  best  men  is  well  worth  following,  if  one  can  only  escape 
the  dragooning  into  classes  which  the  high  organisation  of 
the  Vienna  School  as  a  paying  concern  appears  to  render 
necessary. 

A  volume  has  been  sent  us  for  review,  (a)  which  will  have 
a  deep  interest  for  everyone  who  has  ever  studied  at  Vienna, 
and  which  should  be  read  as  a  matter  of  duty  by  all  who 
are  thinking  of  studying  there.  It  is  a  history  of  the  Vienna 
Medical  School  during  thelast  century,  and  has  been  compiled, 
in  preparation  for  the  approaching  centenai-y  of  the  General 
Hospital,  by  Dr.  Puschmann,  the  Professor  of  the  History 
of  Medicine  in  the  University.  Dr.  Puschmann  has  had 
access  to  the  various  ministerial  archives  and  to  the  records 
of  the  Hospital,  and  he  has  succeeded  in  producing  a  work 
which,  while  thoroughly  German  in  its  conscientiousness 
and  precision,  differs  agreeably  from  many  of  the  writings 
of  his  fellow-countrymen  in  being  extremely  easy  and  agree¬ 
able  reading.  The  author  divides  his  subject  into  four  chap¬ 
ters.  The  first,  entitled  “  The  Old  Vienna  Medical  School,” 
begins  with  the  arrival  of  Boerhaave’s  most  celebrated  pupil 
— Van  Swieten — in  Vienna  in  1744,  on  the  invitation  of  the 
Empress  Maria  Theresa ;  describes  the  changes  which  he 
instituted  in  the  Medical  Faculty  of  the  University ;  the 
introduction  by  him  of  clinical  instruction,  with  the  help 
of  another  of  Boerhaave’s  pupils,  Anton  de  Haen  (the  father 
of  medical  thermometry)  ;  the  erection  of  new  university 
buildings;  the  discovery  of  percussion  by  Auenbrugger; 
and  the  introduction  of  scientific  therapeutics  by  Anton 
Storck.  The  method  pursued  by  the  latter  is  thus  de¬ 
scribed  : — “In  making  investigations  on  drugs,  he  first 


(a)  “Die  Medium  in  Wien  wsihrend  der  letzten  100  Jahre.”  Yon  Dr. 
Theodor  Puschmann.  Wien  :  Verlag  von  Moritz  Perles.  1884. 


663 


Madical  Times  and  Gazette. 


MEDICAL  REPORTS  TO  THE  LOCAL  GOVERNMENT  BOARD. 


Dec.  8, 1883. 


administered  them  to  animals,  and  then  made  trials  with 
them  upon  himself,  in  order  to  determine  what  were  their 
effects  on  the  healthy  organism  ;  for  he  saw  that  one  must 
he  acquainted  with  their  physiological  effects  if  one  wished 
to  use  them  to  remove  pathological  conditions.  When  he 
had  instructed  himself  as  to  the  general  mode  of  action  of 
.a  drug,  he  prescribed  it  in  single  cases  of  disease  in  which 
it  appeared  likely  to  produce  a  favourable  effect.” 

The  second  chapter  deals  with  the  reforms  introduced  by 
the  enlightened  and  philanthropic  son  of  Maria  Theresa, 
and  brother  of  the  ill-fated  Marie  Antoinette,  the  Emperor 
Joseph  II.  The  reign  of  this  Emperor  from  1780  to  his 
premature  and  lamented  death  in  1790,  was  a  time  of  im¬ 
mense  activity.  It  was  filled,  says  Dr.  Puschmann,  “  with 
the  spirit  of  humanity  and  enlightenment.  The  foundation 
of  hospitals  and  almshouses,  of  benevolent  institutions  of 
•every  sort,  of  schools  and  educational  establishments,  bears 
testimony  to  the  noble  thoughts  and  enlightened  spirit  of 
this  monarch.”  But  Joseph  II.  was  before  his  time.  His 
efforts  were  obstructed  on  all  sides  by  ignorance  and  preju¬ 
dice  ;  and  though  his  energy  was  such  that  he  succeeded 
during  the  short  period  of  his  reign  in  introducing  reforms 
-which  otherwise  would  have  taken  a  century,  he  had  the 
misfortune  to  see  many  of  his  plans  suffer  shipwreck  even 
during  his  life,  and  on  his  death  men  fell  back  for  the  most 
part  into  the  old  state  of  things.  The  “  Reaction  ” — though  it 
serves  as  the  title  of  Dr.  Puschmann’s  third  chapter — was 
Jess  felt  in  the  Medical  Eaculty  than  in  other  departments, 
and  even  during  the  period  which  followed  the  death  of  the 
enlightened  Emperor  the  Medical  School  of  Vienna  boasts 
•of  many  famous  names.  Of  these  the  most  famous  is  that 
of  Peter  Frank,  Director  of  the  General  Hospital  and  Pro- 
lessor  of  Clinical  Medicine  from  1795  to  1804.  Prank  is  chiefly 
known  as  the  Father  of  State  Medicine,  his  classical  work  on 
"that  subject  being  one  of  the  most  remarkable  and  valuable 
productions  of  the  German  school.  But  he  was  besides  a 
most  successful  clinical  teacher,  and  the  founder  of  the 
Pathological  Museum  at  Vienna.  The  third  chapter  of  Dr. 
Puschmann’s  work  carries  the  history  of  the  Vienna  School 
down  to  the  year  1840,  and  includes,  besides  many  other  in¬ 
teresting  matters,  an  account  of  the  rise  of  mesmerism  and 
phrenology,  both  Mesmer  and  Gall  having  been  practitioners 
in  Vienna. 

The  fourth  chapter,  on  “  The  New  Vienna  School  of  Medi¬ 
cine,  ”  begins  with  the  researches  of  Skoda  and  Rokitansky, 
and  brings  us  down  to  the  present  day.  It  would  hardly  be 
too  much  to  say  that  the  history  of  the  Vienna  School 
during  a  great  part  of  this  time  is  the  history  of  medicine 
in  general.  A  succession  of  great  teachers  arose,  whose 
names  are  familiar  to  all  of  us,  and  whose  efforts  raised  the 
Vienna  School  to  the  height  of  [its  renown.  Dr.  Puschmann 
gives  a  short  sketch  of  each  of  these  teachers— of  Skoda, 
Rokitansky,  Hebra,  Hyrtl,  Oppolzer,  Sigmund,  Arlt,  Billroth, 
Czermak,  Strieker,  and  many  others  ;  and  it  is  to  this 
chapter  that  the  English  reader  will  turn  with  greatest 
interest.  These  men  have  trained  many  able  successors, 
who  will  doubtless  still  uphold  the  reputation  of  their 
^School,  but  it  is  hardly  to  be  expected  that  the  Vienna 
Hospital  will  ever  again  possess  such  an  array  of  clinical 
talent  as  that  which  raised  it  to  the  highest  point  of  emi¬ 
nence  during  the  past  generation.  Dr.  Puschmann’s  work 
is  a  most  instructive  one,  and  we  would  gladly  see  an 
.-abbreviated  edition  of  it  published  in  an  English  dress. 


MEDICAL  REPORTS  TO  THE  LOCAL 
GOVERNMENT  BOARD. 


A  Supplemental  Report  on  Diphtheria  and  Scarlet 
Fever  at  Sutton-in-Ashpield. 

Not  very  long  since  we  published  an  abstract  of  the 
Teport  of  Dr.  Parsons,  presented  to  the  Local  Government 
Board,  embodying  the  result  of  his  inquiries  into  an  undue 
prevalence  of  scarlet  fever  and  diphtheria  in  the  Sutton-in- 
Ashfield  Urban  Sanitary  District.  These  inquiries  were 
undertaken  so  recently  as  May,  1882  ;  but,  in  consequence 
of  the  high  continued  mortality  from  these  diseases  recorded 
in  the  Registrar-General’s  returns.  Dr.  Parsons  was  in¬ 
structed,  in  April  of  the  present  year,  to  revisit  the  district 


in  question  and  make  a  further  investigation  into  the  sub¬ 
ject.  The  existing  conditions  of  the  district  were,  of  course, 
so  similar  to  those  that  had  already  been  described,  that 
Dr.  Parsons  did  not  consider  it  necessary  to  repeat  them. 
He  merely  records  that,  whereas  up  to  May  5,  1882  (the  date 
of  his  previous  inspection),  the  cases  of  diphtheria  reported 
had  been  39  in  30  households,  with  12  deaths,  and  the  cases 
of  scarlet  fever  27  in  18  households,  with  4  deaths, — up  to 
April  14,  1883,  there  had  come  to  his  knowledge,  in  addition 
to  the  foregoing,  87  cases  set  down  as  diphtheria,  occurring 
in  61  households,  with  40  deaths,  and  108  cases  of  scarlet  fever 
in  49  households,  with  24  deaths.  It  is  probable,  however, 
Dr.  Parsons  adds,  that  this  list  is  far  from  complete,  and,  for 
various  reasons,  exact  information  respecting  the  cases,  espe¬ 
cially  in  the  matter  of  dates,  could  not  be  obtained.  It  will  be 
sufficient,  in  noticing  the  present  report,  to  give  a  short  state¬ 
ment  from  it,  of  the  action  taken  by  the  Sanitary  Authority 
in  carrying  out  the  recommendations  presented  to  them  in 
1882.  The  system  of  voluntary  notification  of  infectious  dis¬ 
ease  by  the  medical  practitioners  of  the  district  on  payment 
of  a  fee  of  Is.  for  each  notification  has  been  continued ;  but, 
the  report  says,  there  is  reason  to  believe  that  the  information 
received  by  the  Medical  Officer  of  Health  as  to  the  cases  of 
disease  which  have  occurred,  has  been  by  no  means  complete. 
The  schools  have  not  been  closed,  except  for  the  holidays, 
since  1882,  but  the  school  attendance  officer  has  endeavoured 
to  prevent  children  from  known  infected  households  con¬ 
tinuing  attendance.  At  the  Hardwick-street  schools  several 
of  the  unwholesome  conditions  referred  to  in  the  previous 
report  have  been  rectified.  Infected  houses  have  in  many, 
but  not  in  all,  cases  been  fumigated  with  sulphur.  Dr. 
Parsons  did  not  meet  with  any  instances  in  which  the 
subsequent  recurrence  of  disease  appeared  to  be  due  to  the 
neglect  of  this  precaution.  Nevertheless,  the  sanitary  con¬ 
dition  of  the  town  remains  much  the  same  as  at  the  date  of 
the  previous  report.  Few  improvements  have  been  carried 
out.  One  well  which  was  polluted  is  said  to  have  been 
“  closed,”  but  the  water  is  still  accessible.  Some  privies  in 
Kirkby-lane,  which  were  too  near  to  the  houses  and  wells, 
have  been  pulled  down,  and  rebuilt  at  a  greater  distance, 
but  on  the  old  objectionable  pattern.  Over-full  midden 
privies  were  frequently  observed  during  this  second  inspec¬ 
tion.  The  work  of  inspection  of  nuisances  is  still  negli¬ 
gently  and  unintelligently  performed.  A  committee  has 
been  appointed  by  the  Local  Board  to  consider  the  best 
means  of  providing  a  water-supply,  and  an  engineer’s 
report  has  been  obtained.  The  small  amount  of  sewerage 
improvement  undertaken  is  either  unsatisfactory  or  has 
not  yet  been  completed ;  and  it  is  stated  that  the  Local 
Board,  instead  of  obtaining  a  loan  to  form  a  complete 
system  at  once,  propose  to  sewer  their  district  a  portion  at  a 
time,  out  of  current  expenditure — by  which  proceeding,  time, 
that  may  be  of  great  importance  to  the  public  health,  will 
certainly  be  lost.  The  foregoing  particulars  will,  we  think, 
be  sufficient  to  establish  the  fact  that  the  central  Board’s 
investigations  are,  in  the  majority  of  cases,  only  loss  of  valu¬ 
able  time,  and  must  continue  so  uutil  Parliamentary  powers 
are  obtained  to  compel  the  carrying  out  of  the  sanitary 
improvements  recommended  by  the  inspecting  officials. 


Dr.  Downes’s  Report  on  an  Outbreak  of  Diphtheria 

at  Oaksey. 

The  area  to  which  this  inquiry  relates  is  the  village  and 
vicinity  of  Oaksey,  a  parish  in  the  Malmesbury  Rural  Sani¬ 
tary  District,  1924  acres  in  extent,  with  a  population  in  1881 
of  419  persons.  The  village  is  situated  on  the  crest  of  a 
ridge  about  350  feet  above  Ordnance  datum,  and  in  a  valley 
on  its  south  side  are  broad  meadows,  liable  to  flood,  and 
unprecedentedly  flooded  in  the  autumn  of  1882.  The  popu¬ 
lation  consists  chiefly  of  agricultural  and  railway  labourers, 
housed  in  substantial  cottages  of  excellent  building-stone, 
and  roofed  with  tilestone.  Their  stone-paved  floors,  the 
report  says,  appeared  for  the  most  part  dry ;  but  in  five  or 
six  of  those  invaded  by  diphtheria,  dampness  was  noted, 
occasioned  by  the  floor  being  sunk  below  the  ground-level 
by  retention  of  subsoil  water,  or  by  absence  of  free  exit  for 
roof  and  surface  drainage.  But  little  overcrowding  was 
met  with.  The  water-supply  is  obtained  from  wells,  a  large 
proportion  of  which  stand  close  to  objectionable  privy  cess¬ 
pits,  leaky  drains,  and  refuse-heaps,  and  Dr.  Downes  remarks 
that  they  are,  for  the  most  part,  obviously  unsafe  as  a 


Medical  Times  and  Gazette. 


ABSTRACTS  AND  EXTRACTS. 


Dec.  8, 1883.  669 


source  of  domestic  water-supply.  This  fact  becomes  clearly 
evident  when  Dr.  Downes  states  that  one  cesspit  was 
emptied  in  his  presence,  which  it  was  admitted  had  not  been 
subjected  to  such  a  process  for  a  period  of  twelve  years  ! 
The  diphtheria  outbreak,  which  formed  the  subject  of  the 
present  inquiry,  would  seem  to  have  commenced,  so  far  as 
Oaksey  was  concerned,  in  June,  1882,  and  to  have  continued 
with  irregular  incidence  down  to  March,  1883,  during  which 
period  sixty-five  cases  were  reported,  with  seven  deaths.  A 
consideration  of  his  report  suffices  to  show  that  Dr.  Downes 
instituted  a  most  thorough  investigation  into  the  origin  and 
causes  of  the  outbreak :  it  will  be  sufficient  here  to  record 
that,  as  the  result  of  a  house-to-house  inquiry,  he  discovered 
that  on  May  22,  1882,  a  child  was  brought  from  Cirencester 
to  its  grandparents  at  Oaksey,  suffering  from  throat-illness 
which  was  undoubtedly  diphtheritic ;  and  this  case  was,  in 
his  opinion,  the  initial  cause  of  the  outbreak.  Allowing 
this,  it  would  appear  probable  that  it  was  afterwards  trans¬ 
mitted  by  ordinary  personal  infection,  chiefly  through  the 
schools  ;  and  an  inspection  of  one  school  in  particular  seemed 
to  furnish  a  clue  to  one  very  simple  modus  operandi  of  this 
school  influence,  and  an  explanation,  in  some  part,  of  the 
comparative  intensity  of  its  effects  at  certain  times.  The 
children  were  arranged.  Dr.  Downes  explains,  in  classes,  each 
class  in  a  double  row,  face  to  face  in  close  proximity,  the 
forms  being  only  two  feet  apart.  Singing  formed  an 
invariable  and  large  part  of  the  school  programme ;  and, 
granted  the  presence  of  a  child  with  infectious  throat  secre¬ 
tions,  he  is  of  opinion  that  no  more  certain  arrangement 
could  be  adopted  for  the  emission  and  transmission  of  con¬ 
tagious  particles.  Until  October  and  November,  1882,  cases 
were  few  and  scattered.  This  may  be  explained.  Dr.  Downes 
thinks,  partly  by  the  fact  that  until  October  8  there  is  no 
evidence  of  any  infected  child  attending  school ;  the  con- 
tagium  until  then  had  apparently  been  passed  on  indepen¬ 
dently  of  school  influence,  chiefly  among  adults,  and  with 
difficulty.  Once  in  the  schools,  it  found  a  suitable  soil,  and 
the  transference  of  the  not  easily  diffused  contagium  would 
be  promoted  by  the  school  arrangements  just  described.  The 
recommendations  to  the  local  Sanitary  Authority,  appended 
to  the  report,  as  usual,  refer  to  the  abatement  of  the  different 
nuisances  found  to  exist  in  the  village,  and  to  an  improved 
water-supply  for  the  district. 


ABSTRACTS  AND  EXTRACTS. 

- ♦ - 

Icterus  Neonatorum:. 

A  recent  number  of  the  Zeitschrift  fur  Geburtshulfe  und 
Gyndkologie  contains  an  article  on  the  above  subject  by  Dr. 
M.  Hofmeier,  of  Berlin.  The  writer  first  considers  the 
theories  hitherto  advanced  as  to  the- production  of  this  con¬ 
dition.  It  has  been  suggested,  first,  that  it  is  due  to  changes 
taking  place  in  the  blood,  leading  to  production  and  non¬ 
elimination  of  pigment.  Dr.  Hofmeier  does  not  accept  this 
view,  because  he  finds  no  evidence  of  the  supposed  blood- 
changes,  or  of  the  assumed  deficiency  in  the  emunctory  organs. 
It  has  been  also  said  to  be  due  to  pigmentary  changes  in 
capillary  cutaneous  extravasations  produced  during  labour. 
Three  points,  says  our  author,  tell  against  this — (1)  there  is 
in  this  disease  colouration  of  internal  organs  as  well  as  of 
the  skin;  (2)  it  is  met  with  in  small  and  premature  children, 
as  well  as  in  those  with  whom  labour  has  been  protracted  ; 
(3)  it  is  met  with  in  children  delivered  by  Caesarian  section, 
or  by  laparotomy,  in  cases  of  extra-uterine  pregnancy.  A 
third  theory  is,  that  it  is  due  to  diminution  of  blood-pressure 
generally,  and  therefore  in  the  portal  system,  leading  to 
re-absorption  of  bile.  To  this  Dr.  Hofmeier  objects  (1)  that 
there  is  no  proof  that  lowering  of  the  blood-pressure  does 
lead  to  re-absorption  of  bile ;  (2)  that  if  it  were  so,  in  infants 
in  whom  the  late  ligature  of  the  cord  is  practised,  so  that 
the  blood-pressure  in  their  circulation  is  little  diminished,  or 
even  increased,  jaundice  ought  not  to  be  met  with ;  whereas 
it  occurs  as  commonly  in  them  as  in  others.  Yirchow  sup¬ 
poses,  and  so  does  Kehrer,  that  icterus  neonatorum  is  due 
simply  to  catarrhal  swelling  and  occlusion  of  the  bile-duct. 
Dr.  Hofmeier  accepts  this  as  true  for  a  few  cases,  but  not  for 
all.  The  latest  explanation  is  that  of  Birch-Hirschfeld,  who, 
basing  his  views  on  600  post-mortem  examinations,  attributes 
the  jaundice  to  compression  of  the  bile-ducts  inconsequence 
of  venous  stasis  in  the  liver.  Dr.  Hofmeier  points  out  that  such 


venous  stasis  implies  grave  disturbance  in  circulation  and 
respiration ;  and  while  entirely  accepting  Birch-Hirschfeld’s 
facts,  he  yet  sees  jaundice  so  often  in  children  whose  breath¬ 
ing  and  circulation  are  quite  vigorous,  that  he  thinks  the 
post-mortem  appearances  in  children  who  die  do  not  account 
for  the  jaundice  in  robust  children  who  live.  Finding,, 
thus,  that  none  of  the  explanations  of  icterus  neonatorum 
hitherto  advanced  explain  its  occurrence  in  a  satisfactory 
manner.  Dr.  Hofmeier  ha3  himself  investigated  the  subject 
from  a  clinical  point  of  view.  He  finds  that  with  the- 
jaundice  of  the  new-born  the  following  phenomena  are 
associated  : — During  the  first  few  days  of  life  the  loss  of 
weight  which  occurs  in  all  children  is  in  the  icteric  much 
greater  than  in  others.  There  is  also  during  the  first  nine 
days  a  greatly  increased  excretion  of  urea  and  of  uric  acid ; 
and  there  are  also  appearances  in  the  urine  which  (from  a 
former  investigation)  he  believes  to  indicate  the  presence  of 
uric  acid  infarcts  in  the  kidneys.  Albuminuria  occurs  more 
often  in  the  icteric  than  in  the  non-icteric.  In  the  jaundiced 
a  yellow  pigment  is  invariably  present  in  the  urine,  to  a 
degree  corresponding  to  the  intensity  of  the  jaundice. 
These  things  indicate,  he  thinks,  a  considerable  waste  of 
the  nitrogenous  tissues ;  and  this  inference  leads  to  the 
next  question,  viz.,  as  to  the  cause  of  the  waste.  It  might 
be  due  (1)  to  deficient  quantity  of  nutrition,  (2)  to  defective 
quality,  (3)  to  mal-assimilation.  These  disadvantageous- 
circumstances  would  be  expected  to  more  affect  first-born 
and  premature  children,  and  those  whose  mothers  were 
suffering  from  illness.  Observation  corroborates  theory., 
for  Dr.  Hofmeier  finds  from  statistics  that  among  icteric 
children  there  are  undue  proportions  of  first  children 
and  of  premature  children,  and  that  icterus  is  more 
often  seen  in  lying-in  hospitals  than  in  private  practice. 
Assuming,  then,  that  there  is  an  excessive  waste  of  nitro¬ 
genous  constituents,  the  question  comes — on  what  tissue 
does  this  fall  ?  Dr.  Hofmeier  answers — on  the  blood.  It 
leads,  in  his  view,  to  destruction  of  red  blood-corpuscles ; 
and  it  is  the  pigment  derived  from  this  disintegration  that 
causes  the  j  aundice.  He  points  out  that  many  blood-poisons,. 
— both  chemical,  such  as  phosphorus,  and  vital,  such  as  the 
poison  of  pyaemia — produce  jaundice  as  one  of  their  symp¬ 
toms;  and  some  among  these  ( e.g .,  ether  and  chloroform) 
have  been  experimentally  proved  to  cause  destruction  of 
red  blood-corpuscles.  Dr.  Hofmeier  has  sought  for  direct 
proof  of  his  theory  by  examining  the  blood.  In  the  newly- 
born  he  finds  these  peculiarities  present :  less  tendency  to- 
the  formation  of  rouleaux,  a  greater  resistance  to  the  action, 
of  fluids  which  make  the  corpuscles  swell,  and  a  great  vari¬ 
ability  in  the  number  of  white  corpuscles.  These  changes 
he  finds  more  marked  in  the  icteric  than  in  the  non-icteric 
children.  From  these  facts  Dr.  Hofmeier  draws  the  general 
conclusion  that  icterus  neonatorum  is  intimately  connected, 
with  certain  phenomena  depending  upon  tissue-changes,, 
these  changes  themselves  depending  upon  the  state  of  nutri¬ 
tion  ;  and  further,  that  a  connexion  between  icterus  and 
certain  processes  going  on  in  the  blood  is  unmistakable. 
The  jaundice  he  believes  due  to  the  presence  of  bile  in  the 
blood,  bile-pigment  being  present  in  the  excreta  to  an 
extent  proportionate  to  the  depth  of  the  jaundice.  Bile- 
pigment  he  regards  as  physiologically  an  ultimate  product 
of  the  decomposition  of  blood-pigment.  He  thinks  that 
there  is  an  excessive  production  of  very  highly  pigmented 
bile,  in  consequence  of  the  nutritive  changes  previously 
mentioned,  and  that  the  jaundice  results  from  the  re-absorp¬ 
tion  of  this.  Icterus  neonatorum,  therefore,  according  to- 
Dr.  Hofmeier,  depends  essentially  upon  the  state  of  nutri¬ 
tion  during  the  first  few  days  of  life.  It  is  a  partly  physio¬ 
logical,  partly  pathological  phenomenon;  and  when  it  i& 
observed  to  be  intense  and  of  long  duration,  it  should  be 
regarded  as  an  indication  of  some  radical  fault  in  nutrition,, 
and  the  especial  attention  and  care  of  the  medical  man 
should  be  directed  to  the  discovery  and  removal  of  that 
which  is  exerting  an  unfavourable  influence. 


The  Work  done  by  the  Heart. 

Howelu  and  Donaldson  ( Proceedings  of  the  Royal  Society 
of  London )  conclude  that  the  mean  ratio  of  the  maximum 
weight  of  blood  pumped  out  of  the  left  ventricle  at  each 
systole  to  the  body-weight  is  gj5,  with  a  pulse  beating  180. 
The  pressure  in  the  left  auricle  is  about  16  mm.  mercury  ; 
Goltz  and  Gaule  had  estimated  it  for  the  auricle  of  a  dog- 


670 


Medical  Times  and  Gazette. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


Dec.  S,  1883. 


atl9'6  mm.  mercury.  They  state  that  variations  of  arterial 
pressure  of  from  58  to  147  mm.  mercury  have  no  effect  on 
the  force  of  ventricular  contractions,  and  Within  these  limits, 
therefore,  heightened  blood- pressure  does  not  increase  the 
work  of  the  heart.  The  outflow  from  the  left  ventricle,  and 
consequently  the  work  done,  increases  with  the  venous 
pressure,  but  not  proportionally.  The  most  direct  factor 
influencing  the  amount  of  work  to  be  done  by  the  left 
ventricle  is  the  extent  of  intraventricular  distension  during 
diastole,  which  is  mainly  owing  to  the  auricle,  since  pressure 
in  the  great  veins  seldom  has  any  positive  value,  but  often 
a  negative  one.  Further,  a  diminution  in  the  pulse-rate,  by 
lowering  the  temperature  of  the  blood  flowing  through  the 
heart,  causes  an  increase  in  the  amount  pumped  out  by  the 
ventricle,  and  therefore  increases  the  amount  of  work  done 
by  the  ventricle.  The  changes  in  the  outflow  from  the  ven¬ 
tricle  at  each  systole  are  not,  as  has  been  previously  stated, 
inversely  as  the  pulse-rate.  The  total  outflow  and  the  total 
work  done  by  the  ventricle  during  any  given  period  of  time 
decreases  with  a  diminished  pulse-rate,  and  increases  with 
an  increased  pulse-rate.  These  facts  have  a  definite  bearing 
on  practical  medicine.  The  experiments  were  conducted  on 
dogs.  _ 

Iodoform  as  a  Dressing  in  Wounds. — Dr.  Michael, 
Professor  of  Clinical  Surgery  at  the  University  of  Maryland, 
Baltimore,  sums  up  the  results  of  his  trials  with  this  sub¬ 
stance  as  follows  r — 1.  Iodoform  is  a  most  convenient  and 
valuable  dressing,  possessing  great  antiseptic  power,  and 
being  perfectly  simple  in  its  application.  2.  Its  local  anaes¬ 
thetic  power  adds  to  its  other  advantages.  3.  It  decreases 
secretion  in  wounds,  thereby  making  dry  and  infrequent 
dressing  possible.  4.  It  does  not  prevent  healingper  primam. 
5.  It  is  dangerous,  and  should  be  used  with  great  circumspec¬ 
tion,  especially  in  old  and  debilitated  subjects,  and  those  with 
weak  hearts. — Phil.  Med.  News,  September  8. 

The  Jaundice  of  Pregnancy. — Dr.  Queirel,  Phy¬ 
sician  to  the  Marseilles  Maternite,  in  a  “  Note  on  the  Jaun¬ 
dice  of  Pregnancy/’  read  at  the  Academie  de  Medecine 
(Bulletin,  November  20),  states  that  he  is  of  opinion  that 
we  should  admit  (1)  a  jaundice  at  the  commencement  of 
pregnancy,  connected  with  a  morbid  condition  of  the  alimen¬ 
tary  canal;  (2)  a  jaundice,  which  is  of  very  rare  occurrence, 
occurring  at  the  end  of  pregnancy,  due  to  compression  of 
the  excretory  ducts ;  and  (3)  jaundice  that  may  occur 
at  any  period  of  pregnancy,  due  to  a  disease  of  the  liver 
(the  mature  of  which  he  does  not  specify),  and  which  is 
itself  dependent  upon  the  influence  of  the  condition  of 
pregnancy. 

Non  -  Recurrence  of  Menstruation  after  the 
Hbnopause. — In  a  recent  clinical  lecture  on  malignant 
diseases  of  the  neck  of  the  womb,Dr.  Gaillard Thomas  states 
as  an  axiom  in  gynaecology,  that  if  a  woman  who  has  normally 
ceased  to  menstruate  begins  to  have  uterine  haemorrhage 
one  should  always  suspect  carcinoma.  “  Not  infrequently,” 
he  says,  “  you  will  see  in  the  medical  journals  the  reports  of 
cases  of  women  who,  having  passed  the  change  of  life,  have 
begun  to  menstruate  regularly  again ;  but  such  accounts  are 
altogether  deceptive,  and,  if  these  cases  could  be  followed 
cut,  it  would  be  found,  with  scarcely  a  single  exception,  that 
the  uterine  flow  was  merely  the  indication  of  the  presence  of 
malignant  disease.  In  other  words,  there  is  absolutely  no 
such  thing  as  the  return  of  the  menses  when  a  woman  has 
once  reached  the  normal  menopause. — Boston  Med.  Jour., 
November  8. 

Bacteria,  Forms  of  Fibrin. — “  Dr.  Gregg,  of  Buffalo, 
has  been  conducting  some  experiments  on  bacteria,  and 
publishes  the  following  remarkable  summary  of  his  labours  : 
— By  boiling  a  quantity  of  healthy  blood  he  obtained  all 
the  forms  of  bacteria.  Then,  with  some  pure  fibrin  obtained 
from  a  washed  clot  of  blood,  and  boiling  it,  proving  that  it 
was  the  threads  of  fibrin  broken  up  into  pieces  and  granules 
that  gave  the  bacteria,  the  same  results  were  obtained. 
Next,  some  blood  was  obtained,  and  rotted  under  warmth, 
and  closely  watched  for  two  months ;  and  here  again  the 
same  forms  were  obtained  that  the  fresh-boiled  blood  gave. 
From  these  experiments  Dr.  Gregg  concludes  that  all  the 
bacteria  of  disease  are  forms  of  fibrin,  and,  for  the  general 
good,  requests  all  investigators  to  repeat  his  experimental 
work,  and  report  to  the  public  the  results.” — New  York  Med. 
Record,  September  29. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


The  Field  of  Disease  :  a  Boole  of  Preventive  Medicine.  By 

B.  W.  Richardson,  M.D.,  LL.D.,  F.R.S.  London  : 

Macmillan  and  Co.  1883.  8vo,  pp.  992. 

This  book  is  written,  as  is  stated  in  the  preface,  for  those 
members  of  the  intelligent  reading  public  who  wish  to  know 
the  leading  facts  about  the  diseases  of  the  human  family, 
their  causes  and  prevention.  It  must,  therefore,  be  criti¬ 
cised  from  the  point  of  view  of  its  ostensible  object,  and 
the  effect  it  is  likely  to  produce  on  its  destined  readers. 
That  a  clearer  understanding  of  the  structure  and  func¬ 
tions  of  the  body,  both  in  health  and  disease,  than  at 
present  prevails  is  desirable  for  the  well-being  of  mankind, 
will  be  doubtless  admitted.  A  little  knowledge  is  not  neces¬ 
sarily  dangerous ;  on  the  contrary,  if  it  be  sound,  it  will 
probably  be  useful.  But  a  work  addressed  to  men  for  their 
practical  benefit  and  useful  information  regarding  the  causes 
and  prevention  of  disease  should  rather  consist  of  a  clear 
setting  forth  of  the  leading  facts  of  physiology  and  what 
is  definitely  settled  in  pathology  and  sanitary  science, 
than  appear  in  the  guise  of  an  incomplete  and  not  very 
accurate  dictionary  of  medicine.  Dr.  Richardson  indeed 
entitles  his  work  “  a  Book  of  Preventive  Medicine,”  but 
much  of  it  is  nothing  more  than  a  descriptive  list 
of  diseases,  based  chiefly  on  the  Nomenclature  of  the 
College  of  Physicians,  and  prefaced  by  a  condensed 
account  of  some  general  medical  terms,  such  as  Fever,  In¬ 
flammation,  etc.  It  can  scarcely  be  believed  that  the 
uninitiated  reader  can  derive  any  solid  information  from  a 
few  large-print  pages  on  “  Fever,”  and  less  than  one  on 
“  Functional  Derangement,”  or  benefit  in  any  way  by  de¬ 
scriptions  of  disease  after  disease,  even  of  such  importance 
as  typhoid  fever,  which  occupy  often  but  a  few  lines. 
Such  matter  as  this,  when  given  to  the  public,  is  obviously 
more  calculated  to  alarm  than  to  instruct. 

The  “Physiological  Outline,”  occupying  fifty  pages,  which 
precedes  the  account  of  “Local  Diseases,”  cannot  be  regarded 
as  of  great  explanatory  value,  or  as  giving  this  book  the 
character  that  its  professed  object  would  imply.  A  super¬ 
ficial  and  often  erroneous  treatment  of  the  wide  subject  of 
the  “Field  of  Disease”  is  perhaps  an  inevitable  outcome  of 
the  author’s  method  in  this  work,  which  is  thus  rendered 
liable  to  a  graver  charge  than  that  of  being  merely  one  of 
supererogation.  A  few  instances  will  suffice.  It  cannot  be 
considered,  from  the  preventive  point  of  view,  a  luminous 
manner  of  describing  syphilis  and  gonorrhoea,  to  dispose  of 
these  diseases  in  a  few  lines,  omitting  to  mention,  doubtless 
“for  decency’s  sake,”  that  they  are  usually  conveyed  by 
sexual  intercourse.  Under  the  heading  of  “Pneumonia” 
(the  subject  of  catarrhal  pneumonia  having  been  already 
treated),  the  reader  is  told  that  “  lobular  pneumonia”  is  an 
affection  where  the  disease  is  confined  to  portions  of  the 
lung  structure,  and  “  broncho-pneumonia,”  where  the  pneu¬ 
monia  is  combined  with  bronchial  inflammation ;  and  this 
after  the  author  has  stated  that  “  essentially  the  disease  is 
one.”  Surely  this  very  careless  or  esoteric  use  or  misuse  of 
well-known  terms  is  quite  indefensible.  Under  “Diseases 
of  the  Nervous  System,”  a  section  which,  with  that  on  the 
Circulatory  System,  we  think  of  more  than  doubtful  public 
advantage,  even  were  its  statements  unassailable,  we  find 
the  dictum  that  the  deposition  of  tubercle  in  meningitis 
takes  place,  as  a  rule,  between  the  dura  mater  and  the 
arachnoid.  Again,  we  are  told  that  when  sclerosis  affects 
the  middle-aged  it  causes  “  paralysis  agitans.”  Here  either 
the  pathology  or  the  terminology  of  the  writer  is  rather 
cloudy.  One  of  the  two  commonest  causes  of  sudden  apoplexy 
or  “stroke”  is  furthermore  stated  to  be  obstruction  of  the 
sinuses  of  the  brain  from  coagulated  blood,  and  a  consequent 
effusion  of  “  watery  matter”  from  the  blood  into  the  closed 
cavity !  The  offhand  opinion  is  expressed  that  morbid 
hypertrophy  and  atrophy  of  brain  are  often  produced  by 
mental  activity  or  inactivity.  Such  a  doubtful  and  subtle 
pathological  hypothesis  as  this  should  hardly  be  given  in  a 
dogmatic  form  to  the  non-medical  reader,  whatever  of  truth 
there  may  possibly  be  in  the  suggestion.  Dr.  Richardson’s 
brain,  however,  is  big  with  suggestions ;  and  his  notion  of 
the  alcoholic  substratum  of  disease  meets  our  eyes  at  almost 
every  turn  of  the  page.  Not  satisfied  with  marshalling 
before  us  alcoholic  sunstroke,  phthisis,  sclerosis,  gastritis. 


MedicalTiir.es  and  Gazette. 


OBITUARY. 


Dec.  8, 1883.  671 


calculus,  sterility,  insanity,  etc.,  our  author  is  found  in  the 
act  of  detecting  the  “fumes  of  whisky”  arising  from 'the 
brain  of  a  drunkard  killed  in  a  railway  accident !  The 
attack  on  tobacco  is  less  worthy  of  attention  and  serious 
refutation  than  the  somewhat  misguided  one  on  alcohol ; 
for,  with  smaller  foundation  in  fact,  it  is  far  more  extrava¬ 
gant,  a  diligent  confusion  being  made,  after  the  manner  of  a 
platform  propagandist  rather  than  of  a  candid  teacher, 
between  the  effects  of  minute  and  excessive  quantities  of 
the  drug.  Not  fears,  but  smiles,  will  be  excited  in  most 
smokers  by  the  perusal  of  this  part  of  the  book.  Such 
writing,  for  the  sake  of  the  scientific  dignity  of  the  profes¬ 
sion,  is  greatly  to  be  deprecated.  Epilepsy  is  called,  with¬ 
out  qualification,  hereditary;  and  epileptic  vertigo  a  “  re¬ 
coverable  form  of  the  disease.”  Under  “ Chorea ”  we  are 
told  that  “  it  presents  itself  at  all  ages,  and  that  recovery 
sometimes  occurs  ”;  and  Catalepsy  is  described  as  a  state 
of  relaxation.  Besides  these  and  other  somewhat  impor¬ 
tant  inaccuracies  of  statement,  there  is  frequent  evidence 
of. the  hasty  construction  of  this  book  in  the  occurrence 
of  such  words  as  “dipsomania”  and  “  lanceolating,”  and 
other  faults  of  terminology  and  expression. 

Towards  the  end  of  the  work  are  to  be  found  some 
chapters  which  it  is  much  to  be  regretted  the  author  has 
not  enlarged  and  offered  to  the  reader  in  a  scientific  garb. 
Much  the  best  part  of  the  book  is  the  chapter  on  the  zymotic 
causes  of  disease ;  but  such  an  important  question  as  this  is 
clearly  unfit  at  present  to  be  boiled  down  for  the  public  at 
large,  and  Dr.  Richardson’s  exposition  of  it  is  deserving  of 
a  more  select  audience  than  that  to  which  it  is  addressed. 
The  author  gives  a  very  clear  statement  of  the  present  posi¬ 
tion  of  the  discussion,  and  a  lucid  and  valuable  setting  forth 
of  his  own  speculations  on  the  subject.  No  one  after  care¬ 
fully  reading  this  chapter — much  too  short  though  it  is  for 
the  nature  of  its  contents — is  likely  to  commit  the  fashion¬ 
able  medical  error  of  the  present  day,  and  prematurely  regard 
the  establishment  of  an  exclusive  germ-theory  of  so-called 
zymotic  diseases  as  a  fait  accompli.  The  chapter  on 
“Acquired  Diseases  from  Mental  Agencies”  is  well  worthy 
the  perusal  of  the  practitioner  of  medicine,  and  contains 
many  wise  reflections.  We  wish  we  could  have  spoken  of 
this  book  entirely  as  its  best  parts  and  the  undoubted 
talents  of  its  author  deserve.  But  it  must  be  considered 
to  fail  in  its  professed  object.  It  is  only  in  its  inferior 
aspects  that  it  appeals  to  the  general  public;  and  thereby 
it  will  probably  do  more  harm  than  good,  by  tending  to 
generate  a  nervous  dread  of  illness  rather  than  a  rational 
avoidance  of  its  causes.  Much  of  the  matter  of  this  book 
is  thus  unadapted  to  the  public  to  whom  it  is  addressed; 
much,  too,  that  is  really  valuable  is  misplaced.  Of  making 
many  medical  books  there  is  no  end  ;  and  the  work  before 
us  is  but  an  addition  to  the  list  of  those  which,  from  an 
apparent  confusion  both  of  purpose  and  method,  serve  no 
useful  public  end,  and  add  little  to  the  knowledge  of  the 
profession  or  to  the  welfare  of  mankind. 


Transactions  of  the  College  of  Physicians  of  Philadelphia. 

Third  Series,  Vol.  VI.,  1S83.  Pp.  451. 

A  volume  of  Transactions  extending  from  December,  1881,  to 
Jdly,  1883,  is  somewhat  difficult  to  review,  especially  when 
it  consists  of  no  less  than  thirty-one  articles  on  subjects  as 
varied  as  Meteorology,  Fungosities  of  the  Bladder,  Poisoning 
from  Impure  Water,  Congenital  Irideremia,  Flexible  Gela¬ 
tine,  etc.  The  mere  titles  form  sufficient  evidence  of  the 
wide-spread  energy  of  the  College  of  Physicians  of  Phila¬ 
delphia.  Unfortunately,  many  papers  in  this  volume  come 
to  us  too  late  for  review.  All  that  Dr.  Keating  has  to  say 
on  the  Micrococcus  in  the  Blood  of  Malignant  Measles,  or 
Dr.  Whittaker  on  the  Bacillus  Tuberculosis,  is  already  more 
than  a  year  old  ;  and  one  year  in  the  rapidly  developing 
history  of  these  micro-organisms  makes  them  appear  quite 
antiquated.  One  of  the  most  important  contributions  during 
the  current  year  is  that  on  Albuminuria,  by  Dr.  Meigs.  In 
this  he  dwells  on  the  advisability  of  giving  a  guarded  pro¬ 
gnosis  in  cases  of  chronic  albuminuria,  on  the  frequency  of 
renal  asthma  in  the  increased  mortality  from  Bright’s  disease 
in  recent  times,  and  on  the  occasional  occurrence  in  the 
urine  of  tube-casts  without  albumen,  or  of  albumen  without 
tube-casts.  In  a  very  brief  but  striking  paper.  Dr.  John  B. 
Roberts  for  the  second  time  predicts  that  the  time  may 
possibly  come  when  wounds  of  the  heart  itself  will  be  treated 


by  pericardial  incision  to  allow  extraction  of  clots,  and 
perhaps  to  suture  the  cardiac  muscle.  He  consides  that 
“  there  is  no  reason  to  believe  that  cardiac  surgery  will  stop 
its  march  with  the  demonstration  that,  the  pericardium  can. 
be  treated  as  the  pleura.”  From  such  startling  suggestions 
it  is  pleasant  to  turn  to  the  Treatment  of  Enteric  Fever,  by 
Dr.  Wilson,  even  though  part  of  the  treatment  consists  of 
the  frequent  administration  of  fairly  large  doses  of  calomel 
during  the  first  week.  Dr.  Weir  Mitchell  and  Dr.  Reichert 
give  a  racy  account  of  a  study  of  the  poison  of  Heloderma 
Suspectum,  the  Gila  Monster.  The  need  for  scientific 
investigation  is  evidenced  by  quotations  from  two  letters 
from  Arizona,  one  of  these  describing  the  monster  as  being 
“more  peaceful  and  harmless  than  a  young  missionary,” 
while  the  second  writer  considers  him  “  worse  than  a, 
whole  apothecary-shop.”  From  experiments  on  animals  the 
authors  of  this  paper  conclude  that  the  poison  causes  death 
by  arresting  the  heart’s  action  in  diastole,  and  that,  previous 
to  this  termination,  it  annihilates  the  power  of  the  spinal 
cord  in  a  very  abrupt  manner.  The  final  papers  on  the 
“  Salivary  Digestion  of  Starch  by  Infants,”  and  the  “  Faeces 
of  Starch-fed  Infants,”  are  interesting,  but  can  hardly  be 
regarded  as  conclusive.  It  is  noticeable  that  the  saliva  of 
one  child  (Devine)  is  stated  in  the  first  paper  to  give  well- 
marked  sugar  reaction,  and  in  the  second  to  be  inefficient. 
Other  papers  on  Sewer  Gas  and  on  Arsenical  Paralysis  are 
worthy  of  mention.  The  discussions  reported  might  in 
many  cases  have  been  omitted  with  advantage. 


Nordiskt  Medicinskt  Arkiv.  Fifteenth  Volume,  Second  Part. 
This  periodical  contains  several  papers  of  interest.  Two 
cases  of  intestinal  obstruction,  due  to  congenital  malforma¬ 
tion  of  the  mesentery  and  of  Meckel’s  diverticulum,  respec¬ 
tively,  are  recorded  by  Dr.  E.  Tscherning.  The  ^subject  of 
“  masked  ”  epilepsy  is  discussed  at  considerable  length  by 
Dr.  E.  Hjertstrom.  Under  that  name  he  describes  a  form, 
of  acute  mania,  relapsing,  or  rather  continuing  in  relapses, 
with  several  symptoms  indicating  its  epileptiform  nature,' 
although  the  convulsive  epileptic  fits  are  absent.’  Several 
illustrative  cases  are  given,  in  some  of  which  -  acute  mania 
appeared  to  be  replaced  by  true  epilepsy  at  different  periods. 
The  physiological  condition  associated  with  these  relapses 
of  epileptic  mania  is  stated  to  be  a  “  spasm  of  the  nutritive 
vessels  of  the  cortical  layers,  produced  by  the  irritation  of 
the  vaso-motor  centre.”  The  paper  is  concluded  by  some  ■ 
remarks  on  the  differential  diagnosis  of  the  disease. 


OBITUARY. 


JOHN  MANN  CROMBIE,  M.A.,  M.B.,  C.M. 

Dk.  J.  M.  Crombie,  whose  sad  death  on  the  26th  ult.,  front 
an  overdose  of  morphia  taken  inadvertently  for  pain  and 
want  of  sleep  following  a  surgical  operation,  has  been, 
recorded  in  the  daily  papers,  received  his  education  both  in 
Arts  and  Medicine  at  the  Aberdeen  University.  His  career 
in  both  faculties  was  a  distinguished  one.  He,  took  his  M.  A. 
degree  in  1864,  and  four  years  later  .graduated,  as  M.B.  and 
C.M.  After  a  course  of  study  at  ‘the  Paris  hospitals,  he 
returned  to  Aberdeen  to  engage  in  the  practice  of  his 
profession,  but  in  1872  he  removed  to  the  wider  sphere  of 
London  practice.  He  was  for  some  time  Resident  Medical 
Officer  to  the  Cancer  Hospital,  and  his  experiences  there 
directed  his  attention  to  the  various  means_pf  relieving  pain, 
especially  by  the  self -administration  of  •  anaesthetics.  In 
1873  he  published  a  work  “  On  the  Induction  '  of  Sleep  and 
Insensibility  to  Pain  by  the  Self- Administration  .  of  Anes¬ 
thetics,”  and  three  years  later  he  contributed  a:paper  “  On 
the  Self- Administration  of  Chloroform”  to  the  Practitioner. 
He  invented  a  self- an  aesthetic  administrator,  with- the  view 
of  putting  in  the  hands  of  sufferers  a  safe  and  surq  .-means  of 
relief,  and  in  his  “  hypodermic  suppositories  ’’  he  -  attempted  , 
to  provide  a  simple  method  of  exhibiting ;  morphia  sub¬ 
cutaneously.  He  also  published  other  works  and  contribu¬ 
tions  on  analogous  subjects.  His  death  from  theineautious 
use  of  one  of  the  remedies,  the  self-administration, of  which 
it  had  been  the  aim  of  his  life  to  place  beyond,  the' possibility 
of  accident,  is  another  sad  commentary  on  the  ;dangerous 
contempt  which  familiarity  with  these  .perilous  means  of 
relief  is  apt  to  breed  in  the  medical  mind.  «  U.  cr  :  ; 


THE  PATHOLOGICAL  SOCIETY  OE  LONDON. 


Dec.  8, 1883. 


-1  Medical  Times  and  Gazette. 


REPORTS  OF  SOCIETIES. 


THE  PATHOLOGICAL  SOCIETY  OF  LONDON. 

Tuesday,  December  4. 

J.  W.  Hulke,  F.E.S.,  President,  in  the  Chair. 

Multiple  Tumours  op  the  Foot. 

The  President  showed  a  drawing  of  the  foot  of  a  woman, 
aged  twenty-nine,  married,  and  healthy-looking.  At  the 
nail-root  of  the  great-toe  there  was  a  firm  swelling,  as  broad 
as  the  root  of  the  nail,  reaching  back  to  the  second  joint. 
■On  the  inner  and  outer  sides  of  the  second  toe  were  similar 
but  smaller  swellings  ;  one  of  these  showed  two  small  bluish 
dots.  On  the  dorsum  of  the  third  toe  was  a  similar  swell¬ 
ing  with  small  bluish  dots  on  surface,  bedewed  with  sweat. 
Over  the  outer  end  of  the  foot  was  a  rounded  semi-elastic 
swelling ;  also  another  slightly  lobulated  mass  on  the  inner 
side  of  the  heel,  freely  movable  on  the  deeper  parts.  In 
front  of  this,  below  and  behind  the  internal  malleolus, 
were  two  smaller  swellings.  All  these  nodules  perspired 
more  than  other  portions  of  the  foot;  pressure  over  the 
external  popliteal  nerve  caused  beads  of  sweat  to  appear 
on  them.  The  patient  attributed  them  to  a  blow  six 
months  before.  She  was  a  woman  of  neurotic  tempera¬ 
ment,  and  was  said  to  bleed  more  readily  than  other  people 
after  a  wound.  Her  menstruation  was  normal.  The  swellings 
were  in  the  deepest  parts  of  the  cutis  vera.  The  bluish  dots 
were  probably  small  haemorrhages,  because  they  did  not 
■disappear  on  pressure,  and  on  account  of  her  haemorrhagic 
diathesis.  The  tumours  were  intimately  connected  with 
the  secretory  apparatus  of  perspiration,  and  not  of  the 
nature  of  corns  or  angiomata. 

Purulent  Pericarditis  treated  by  Incision. 

Dr.  Samuel  West  showed  the  heart  of  the  above  case, 
taken  from  the  body  of  a  boy  aged  fourteen  years.  In  con¬ 
sequence  of  a  fall,  the  boy  had  had  an  abscess  form  in  the 
left  shoulder,  which  was  freely  opened.  The  temperature 
rose,  there  was  much  dyspnoea  and  some  cyanosis,  and 
there  were  physical  signs  of  pneumonia  at  the  left  base.  A 
few  days  later  the  left  pleura  was  tapped,  several  ounces  of 
serum  being  removed,  with  considerable  relief.  A  little  later 
n  free  incision  was  made  at  the  site  of  puncture,  but  no  fluid 
was  found.  The  pericardium  was  felt  to  be  full  of  fluid  by 
the  finger  inserted  into  the  wound,  and  was  incised,  twenty- 
four  ounces  of  pus  being  removed.  The  patient  was  relieved 
for  the  time  ;  but  the  dyspnoea  and  cyanosis  continued,  and 
eventually  the  patient  died — nine  weeks  after  the  accident. 
At  the  autopsy  there  was  found  a  large  abscess  in  the  left 
thigh  and  inflammation  of  the  left  ankle-joint.  There  was 
■extensive  thickening  of  the  mediastinal  tissues,  in  the  midst 
of  which  the  great  vessels  were  embedded,  the  veins,  how¬ 
ever,  being  free.  The  right  pleural  cavity  contained  some 
serous  fluid.  The  left  was  divided  into  three  sacs  by  adhe¬ 
sions,  each  containing  serous  fluid.  The  middle  one  only  had 
been  opened,  and  corresponding  with  the  incision  was  the 
opening  in  the  pericardium.  The  pericardium  was  in  great 
part  obliterated,  except  at  the  apex.  There  was  no  obstruc¬ 
tion  in  any  of  the  vessels.  The  case  resembled  those  origi¬ 
nally  described  by  Kussmaul,  in  the  extensive  inflammation 
■of  the  mediastinum,  to  which  condition  he  attributed  the 
pulsus  paradoxus,  which  was  a  marked  feature. of  the  case. 
The  present  was  the  third  instance  in  which  the  pericardium 
had  been  freely  laid  open  for  purulent  pericarditis.  The 
first  was  under  the  care  of  Prof.  Eosenstein,  of  Leiden,  in  a 
boy,  whose  pericardium  was  opened  and  drained  after  it  had 
twice  been  tapped,  and  who  recovered  in  spite  of  secondary 
left  pleurisy.  The  second  case  had  been  under  his  own  care 
at  the  Victoria-park  Hospital,  and  was  published  in  full  in 
the  current  volume  of  the  Transactions  of  the  Royal  Medical 
and  Chirurgical  Society.  It  was  a  case  of  idiopathic  puru¬ 
lent  pericarditis.  A  free  incision  was  made,  and  recovery 
was  complete  in  five  weeks’  time.  Dr.  West  drew  attention 
to  the  fact  that  the  incision  into  the  pericardium  had  given 
great  relief,  that  the  pericardium  had  in  the  short  space  of 
a  fortnight  been  in  great  part  obliterated,  and  that  death  had 
mot  resulted  from  the  pericardial  affection.  He  was  of  opinion 
that  opening  the  pericardium  was  not  a  more  hazardous 
proceeding  than  opening  the  pleura  or  peritoneum. 


A  Note  of  some  Experiments  on  the  Etiology  of 
Tuberculosis. 

Dr.  Dawson  Williams  read  a  paper  on  the  above  subject. 
After  Villemin  had,  in  1865,  firmly  established  the  fact 
of  the  inoculability  of  tuberculosis,  his  experiments  were 
repeated  and  confirmed  by  many  observers,  some  of  whom 
went  further,  and  maintained  that  tuberculosis  followed,  in 
the  rodents,  the  infliction  of  various  injuries,  and  the  in¬ 
jection  of  such  substances  as  quicksilver  and  charcoal  into 
the  jugular  vein  (Lebert  and  Wyss).  Dr.  Wilson  Fox  ob¬ 
tained  like  results  with  putrid  muscle,  the  products  of  acute 
inflammation,  and  vaccine  fluid.  Dr.  Fox  also  found  that  in¬ 
oculation  with  pysemic  pus,  and  the  introduction  of  a  seton, 
were,  with  considerable  frequency,  followed  by  tuberculosis  in 
the  rodents;  and  these  observations  were  confirmed  by  Dr. 
Burdon  Sanderson.  A  number  of  the  observers  had  produced 
tuberculosis  by  the  inoculation  of  various  non -tubercular 
substances.  Among  these  were  Sir  Andrew  Clark,  Messrs. 
Senior,  Page,  Ernpis,  and  Belieu;  quite  recently,  Formad 
and  Eobinson  in  Philadelphia  made  a  very  extensive  series 
of  experiments  with  striking  results.  At  the  request  of  Dr. 
Wilson  Fox  and  Dr.  Sanderson,  Dr.  Williams  had  repeated 
some  of  the  earlier  experiments  with  non-tubercular  mate¬ 
rial.  Care  was  taken  to  avoid  contamination  with  tubercular 
material,  but  no  antiseptics  were  used.  The  repetition  of 
the  experiments  with  putrid  fluids  gave  entirely  negative 
results.  All  the  animals  (guinea-pigs)  which  survived  the 
primary  infective  fever  (when  this  occurred)  recovered  en¬ 
tirely,  and  when  killed,  after  varying  periods,  presented  no 
lesions  of  either  a  tubercular  or  pysemic  character.  In  seven 
guinea-pigs  setons  were  introduced,  but  all  the  animals 
remained  healthy,  and,  when  killed,  were  found  quite  free 
from  disease.  Dr.  Dawson  Williams  referred  to  Mr.  Watson 
Cheyne’s  experiments,  published  while  his  own  were  in  pro¬ 
gress,  and  remarked  that  his  results  entirely  coincided  with 
Mr.  Cheyne’s  on  this  point.  In  Germany,  Salomonsen 
and  Baumgarten  had  made  numerous  experiments  with  the 
products  of  inflammation,  with  tumours,  and  with  fungi  and 
micro-organisms,  with  negative  results.  All  the  experiments 
of  Waldenburg,  Fox,  Sanderson,  and  Cohnheim  had  now 
been  repeated  with  negative  results.  The  evidence,  there¬ 
fore,  was  all  against  the  theory  that  tuberculosis  could  be 
produced  in  any  other  way  than  by  infection  with  tubercular 
material.  Dr.  Dawson  Williams  further  thought  that  the 
observations  on  the  eye  after  inoculation,  recently  published 
by  Baumgarten  and  Arndt,  were  extremely  important,  and 
appeared  to  show  that  the  growth  of  the  bacilli  preceded 
the  characteristic  histological  changes,  which  would  make 
it  appear  that  these  changes  were  the  reaction  of  the  tissues 
under  the  peculiar  stimulus  of  the  growing  bacillus.  The 
all-important  role  now  assigned  to  the  bacillus  was  thought 
to  create  fresh  difficulties ;  and  it  seemed  possible  that  it 
might,  after  all,  be  shown  that  the  activity  of  the  bacillus 
was,  when  a  broad  view  of  the  etiology  of  the  disease  was 
taken,  of  secondary  importance. 

Dr.  Wilson  Fox  referred  to  observations  by  Dr.  Burdon 
Sanderson  and  himself,  and  to  Mr.  Simon’s  communication, 
at  a  previous  meeting  of  the  Society.  Dr.  Koch’s  observa¬ 
tions  had  made  it  necessary  that  his  own  investigations 
should  be  repeated.  This  had  been  taken  in  hand  before  Mr. 
Cheyne’s  work.  He  now  felt  that  there  must  have  been 
some  fallacy  in  conducting  his  own  experiments,  perhaps 
from  want  of  disinfection  of  his  trocar,  or  from  keeping  the 
animals  together  too  much,  though  no  animal  not  operated 
upon  became  tubercular.  In  Dr.  Williams’s  experiments 
no  single  guinea-pig  inoculated  with  non-tubercular  mate¬ 
rial  became  tuberculous.  All  sources  of  fallacy  had  been 
carefully  avoided  in  these  experiments.  He  paid  a  high 
tribute  to  the  inductive  capacity  of  Prof.  Villemin.  He 
would  ask  whether  we  were  dealing  with  an  absolutely 
specific  bacterium,  or  if  it  was  capable  of  evolution  from 
other  bacteria.  There  was,  perhaps,  some  danger  of  phthi- 
siophobia  or  phthisiomania.  During  the  past  thirty  years 
there  had  been  many  changes  in  the  doctrine  of  phthisis. 
Portal  had,  after  patient  observation,  given  up  the  theory 
of  the  infectiousness  of  phthisis.  He  was  unwilling  that 
his  former  observations  should  still  be  quoted  as  opposed  to 
the  doctrines  of  Koch  and  those  who  had  been  more  recently 
working  at  the  subject ;  and  therefore  he  had  felt  bound  to 
come  forward  and  make  known  the  modification  which  his 
views  had  undergone. 


Jtfftdical  Times  and  Gazette. 


•  MEDICAL  NEWS. 


Mr.  Watson  Chetne  spoke  of  the  great  value  of  these 
experiments  of  Dr.  Williams  in  contradicting  former 
erroneous  opinions.  Before  his  own  investigations  were 
undertaken  he  had  made  up’his  mind  on  the  subject,  as  he 
had  never  been  able  to  obtain  tuberculosis  by  the  injection 
of  putrid  materials.  ,  . 

Mr.  Hulke  said  they  were  deeply  indebted  to  Dr.  Williams 
for  his  work,  and  to  Dr.  Wilson  Fox  especially  for  his 
acknowledgment  of  altered  views,  for,  after  all,  scientific 
men  only  aimed  at  learning  the  truth. 

Dr.  Dawson  Williams  explained  that  he  did  not  wish 
to  speak  for  Dr.  Burdon  Sanderson,  as  he  did  not  know  what 
views  he  held. 

Aneurysmal  Dilatation  of  Radial  Artery. 

Mr.  Symons  detailed  the  case  of  a  man  who  met  with 
an  accident,  and  whose  forearm  was  crushed,  but  was  not 
at  once  amputated  ;  this  was  done  on  the  eleventh  day 
owing  to  severe  haemorrhage.  On  examination,  both  bones 
were  found  to  be  comminuted ;  radial  artery  at  two  points 
dilated  into  aneurysmal  pouches ;  upper  half  softened  and 
filled  with  coagula ;  at  one  point  it  was  perforated.  -  The 
ulnar  artery  was  somewhat  dilated  ;  the  microscope  showed 
the  middle  and  external  coats  were-  much  separated ;  outer 
part  of  middle  coat  much  thickened,  partly  by  a  clot  which 
had  formed  in  the  inner  coat ;  elastic  lamina  had  nearly  dis¬ 
appeared.  The  ulnar  artery  showed  similar  changes.  He 
also  showed  another  specimen  of  suppurative  arteritis  taken 
from  a  man  aged  fifty-two  years,  who  died  ' of -  pulmonary 
phthisis.  He  had  elbow-joint  disease,  for  which  amputation 
was  performed.  Suppuration  took  place  in  the  stump.  After 
death  the  lower  end  of  brachial  artery  was  found  much 
softened,  and  just  above  hollowed  out  and  containing  a 
broken-down  blood-clot.  On  section,  the  artery  was  unusually 
thick,  the  inner  coat  raised  up  and  pushed  inwards,  the 
elastic  lamina  destroyed.  These  cases  he  thought  threw 
some  light  on  cases  of  secondary  haemorrhage,  viz.,  that  it 
was  not  due  to  the  non-formation  of  clot,  but  to  giving  way 
of  the  wall. 

•  Dr.  Goodhart  noted  that  the  changes  took  place  in 
different  parts  of  the  artery  in  these  two  cases.  He  believed 
that  this  was  not  uncommon;  it  was  well  known  in  syphilitic 
arteritis,  where  sometimes  the  inner,  sometimes  the  outer 
coat  was  affected.  But  the  chief  interest  for  him  was  the 
question  of  secondary  haemorrhage ;  he  had  for  some  years 
held  that  this  w£ts  not  dependent  on  the  ligature,  but  on 
suppuration  around.  Again,  with  regard  to  the  formation  of 
aneurysm  from  embolism,  or  after  the  application  of  a  liga¬ 
ture,  he  believed  both  were  due  not  to  obstruction,  but  to  an 
acute  inflammation  such  as  had  been  shown  to  exist  in  these 
two  cases. 

Mr.  Symons,  in  reply,  referred  to  a  man  who  had  an 
aneurysm  of  the  femoral  artery  after  amputation  of  thigh, 
due,  he  believed,  to  extension  of  inflammation  up  the  artery. 
Secondary  haemorrhage  was  almost  a  thing  of  the  past. 

Tubercular  Disease  of  the  Tongue. 

Mr.  Barker  read  notes  of  the  case  of  a  man  who,  always 
delicate,  had  been  ailing  a  year ;  he  had  a  sore  on  the  tongue 
from  holding  tacks  in  his  mouth— at  first  only  a  fissure  near 
the  tip  of  his  tongue.  Five  months  previously  he  had  had 
haemoptysis,  and  also  haemorrhoids.  He  got  worse,  and  was 
admitted  into  the  hospital  five  weeks  later.  His  tongue  pre¬ 
sented  a  shallow  ulcer  near  the  tip,  and  a  second  one  further 
back.  There  were  signs  of  phthisis  in  both  lungs,  and  also 
distinct  ulceration  of  rectum.  Anti-syphilitic  treatment  did 
no  good;  the  ulcer  spread,  and  invaded  about  a  third  of 
the  tongue ;  gradual  exhaustion,  and  death.  At  the  post¬ 
mortem,  lungs  and  intestines  typically  tubercular  ;  larynx 
and  trachea  healthy ;  anterior  third  of  tongue  ulcerated  ; 
margins  of  ulcer  abrupt,  surface  uneven,  base  not  indurated  ; 
glands  beneath  jaw  not  enlarged.  Microscopically,  there 
were  collections  of  minute  cells  in  groups  in  the-  base  of 
the  ulcer,  with  some  giant-cells.  The  appearances  were 
similar  in  sections  taken  from  the  intestinal  ulcers.  Tuber¬ 
cular  ulceration  of  the  tongue  appeared  to  be  very  rare  in 
this  country  ;  only  one  case  (that  of  Dr.  Hadden’s,  last  year) 
was  to  be  found  in  the  Transactions  of  the  Society,  and  a 
living  specimen  had  been  shown  by  Mr.  Stanley  Boyd ;  also 
two}  cases  were  recorded  by  Mr.  Bryant  in  Guy  s  Hos¬ 
pital  Reports.  Abroad,  the  subject  had  attracted  much  more 
attention.  The  affection  was  very  important,  owing  to  the 
necessity  for  early  surgical  interference. 


Dec.  8, 1883.  673 


Mr.  Croft  referred  to  the  case  Dr.  Hadden  had  shown, 
who  had  been  a  patient  of  his  own  ;  and  asked  Mr.  Barker 
whether  the  affection  was  secondary « or  -  primary  in  his 
patient,  as  this  was  all-important  in  regard  to  treatment. 
In  his  own  patient  the  tongue  lesion  was  secondary.'  * 

Mr.  Godlee  mentioned  that  a  patient  of  Mr.  Heath’s  was 
in  the  outer  room  with  a  tubercular  ulcer  of  the  tongue.  He 
promised  to  bring  the  subject  forward  at  a  subsequent 
meeting. 

Dr.  Fowler  mentioned  a  case  under  his  care  at  the 
Brompton  Hospital,  where  the  ulceration  of  the  tongue  had 
been  present. 

After  a  few  remarks  from  Dr.  Bernard  O’Connor, 

Mr.  Barker  replied  that  he  could  not  be  certain  which 
had  been  first  in  his  patient,  the  sore  on  the  tongue  or  the 
pulmonary  affection. 

Card  Specimens. 

Dr.  H.  A.  Lediard. — Caries  of  the  Yertebrse  in  a  Dachs¬ 
hund. 

Mr.  Waeen  Tay  showed  an  infant,  eleven  months  old, 
with  typical  Bromide  Hash  on  the  extremities,  which  began 
to  appear  after  the  administration  of  four  grains  and  a 
half  of  bromide  of  potassium  three  times  a  day  for  eight 
days. 


MEDICAL  NEWS. 

•  pr.  i 

- ♦ - 

Apothecaries’  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday, 
November  29 : — 

Agar,  Samuel  Hollingsworth,  Trinity-square,  Borough.  • 
Anderson,  Langford  McEwan.  New  Cross-road,  S.E. 

Caldecott,  Charles,  Church-square,  Basingstoke. 

Hamilton,  Thomas  Theophilus,  Loughgilly,  co.  Armagh,  Ire. 
Kelson,  William  Henry,  London  Hospital. 

Lee,  George  Thomas,  Upper  Wimpole-street,  W. 

The  following  gentlemen  also  on  the  same  day  passed  their 
Primary  Professional  Examination  :  — 

Caswell,  George  William,  University  College  Hospital. 

West,  William  Paynter,  Guy’s  Hospital. 


APPOINTMENTS. 

Anderson,  William  "Milne,  M.B. ,  CM.  Aber. — House-Surgeon,  to  the 
West  London  Hospital,  vice  —  Hendley,  resigned 

Benson,  A.  H.,  M.B.— Ophthalmic  Surgeon  to  the  City  of  Dublin  Hospital, 
Dice. J.  H.  L.  Stoney,  M.D.,  deceased. 

Cboom,  John  Halliday,  M.D.,  F.R.C.P.,  F.R.C.S.  Edin. — Assistant- 
Physician  to  the  Gynaecological  Department  of  the  Royal  infirm. ary, 
Edinburgh. 

Hodges,  R.  W.,  L.R.C.P.  Edin. — Honorary  Medical  Officer  to  the  Fever 
Hospital,  Queenstown,  Cork. 

Johnston,  F.,  M.B. — House-Surgeon’s  Assistant  to  the  Liverpool  Northern 
Hospital,  vice  W.  Horrocks,  M.R.C.8. 

Oliver,  J.,  M  B.— Medical  Officer  and  Registrar  to  the  National  Hospital 
for  the  Paralysed  and  Epileptic,  Bloomsbury,  vice  N.  Rushworth, 
M.R.C.S.,  resigned. 

Parry-Jones,  M.,  M.B.  Lond.,  M.R.C.S. — Resident  Clinical  Assistant  at 
the  City  of  London  Hospital  for  Diseases  of  the  Chest,  Yictoria-park,  B. 

Pitts,  Bernard,  M.B.,  M.C.  Cantab.,  F.R.C.S.— Assistant-Surgeon  to 
the  Hospital  for  Sick  Children,  Great  Ormond-street. 

Rudge,  H.  T.,  M.R.C.S. -Physician’s  Assistant  to  the  Bristol  General 
Hospital,  vice  J.  B.  Woolby,  M.B.,  resigned. 

Savill,  T.D.,  M.D.  Lond.,  M.R.C.P.— Registrar  and  Pathologist  to  the 
West  London  Hospital. 

Taylor.,  G.  H.,  L.R.C.S.— Junior  Assistant  Medical  Officer  to  the  Durham 
County  Asylum,  vice  C.  M.  Campbell,  M.D.,  resigned. 

Vinracb,  E.  Dennis,  M.R.C.S.,  L.S  A— Resident  Medical  Officer  at  the 
Hospital  for  Diseases  of  the  Throat,  in  the  place  of  Dr.  Edward  Law, 
resigned. 

Waugh,  Henry  D.,  M.D.,  B. A. —Resident  Medical  Officer  to  the  Hospital 
for  Consumption  and  Diseases  of  the  Chest,  Brompton,  vice  Dr.  Hicks, 
resigned. 

Young,  John,  M.B.,  C.M.—  House-Surgeon  to  the  Scarborough  Hospital 
and  Dispensary.  _ 

DEATHS. 

Barratt,  Edgar,  M.D.,  at  46,  Grand-parade,  Brighton. 

Harper,  Philip  Henry,  F.R.C.S.,  at  30,  Cambridge  street,  Hyde-park,  on 
November  29,  aged  61. 

Keene,  James,  F.R.C.S.,  M.R.C.P.,  Aural  Surgeon  and  Lecturer  to  the 
Westminster  Hospital,  on  November  27,  in  his  50th  year. 

Madden,  William  Herriks,  M.D.,  F.R.C.P.,  at  Dechmont  House, 
Linlithgowshire,  N  B.,  on  December  3. 

Pearless,  Edward  Montague,  M.R.C.S.,  at  the  Colonial  Hospital,  George 
Town,  Demerara,  aged  25. 

Pearson,  George,  M.D.,  at  Lincoln  House,  St.  John’s  Wood,  on 
November  25. 


674 


M ©dleal  Times  and  Gazette 


MEDICAL  NEWS. 


Dee.  8,  1883. 


VACANCIES. 

Bath  General  or  Mineral-Water  Hospital. — Resident  Medical  Officer. 
[For  particulars  see  Advertisement.') 

Faculty  op  Physicians  and  Surgeons  op  Glasgow. — Faculty  Lecture¬ 
ship.  [For particulars  see  Advertisement.) 

General  Hospital  for  Sick  Children,  Pendlebury,  Manchester. — 
Junior  Besident  Medical  Officer.  Salary  £80  per  annum,  with  board 
and  lodging.  Candidates  must  be  doubly  qualified  and  on  the  Medical 
Register.  Applications,  stating  age,  and  accompanied  by  testimonials 
(not  originals),  to  be  sent  to  the  Chairman  of  the  Medical  Board  on  or 
before  December  12. 

Liverpool  Northern  Hospital. — House-Physician.  Salary  £80  per 
annum,  with  residence  and  maintenance  in  the  Hospital.  Candidates 
must  possess  a  medical  and  surgical  qualification  from  one  or  more  British 
colleges  or  institutions  recognised  under  the  Medical  Act.  Applications 
and  copies  of  testimonials  to  be  addressed  to  the  Chairman  of  the 
Committee  not  later  than  December  14.  The  election  takes  place  on 
December  21. 

'Newton  Abbot  Bural,  and  Dawlish  and  Wolborough  Urban  Sani¬ 
tary  Authorities. — Medical  Officer  of  Health.  [For  particulars  see 
Advertisement.) 

North  London  Hospital  for  Consumption  and  Diseases  of  the 
Chest,  Mount  Vernon,  Hampstead,  N.W. — Besident  Medical  Officer 
and  Begistrar.  [For  particulars  see  Advertisement.) 

Bov  a  i.  Cornwall  Infirmary.— House-Surgeon.  Salary  £120  per  annum, 
with  furnished  apartments,  fire,  light,  and  attendance,  Candidates 
must  be  legally  registered  to  practise  both  in  medicine  and  surgery,  and 
unmarried.  Applications,  stating  age,  with  testimonials,  to  be  sent  to 
the  Secretary,  Boyal  Cornwall  Infirmary,  Truro,  before  December  10. 

Victoria  Hospital  for  Children,  Queen’s-road,  Chelsea,  S.W.— 
Assistant-Physician.  Candidates  must  be  graduates  in  medicine  of  a 
university  recognised  by  the  Medical  Council,  and  not  practising  phar¬ 
macy.  Applications,  with  copies  of  testimonials,  to  be  sent  to  the 
secretary,  at  the  Hospital,  on  or  before  December  10. 

Victoria  Hospital  for  Children,  Queen’s-boad,  Chelsea,  S.W.— 
House-Surgeon.  An  honorarium  of  £50  per  annum,  with  board  and 
loag’iiig  m  the  Hospital.  Candidates  must  be  Fellows  or  Members  of  the 
Boyal  College  of  Surgeons  of  England,  and  Licentiates  of  the  Society  of 
Apothecaries  or  of  the  Boyal  College  of  Physicians,  or  graduates  in 
medicine  of  any  university  recognised  by  the  Medical  Council.  AppU- 
cations,  with  testimonials,  etc.,  to  be  sent  to  the  Secretary,  at"  the 
Hospital,  on  or  before  December  10. 


UNION  AND  PAROCHIAL  MEDICAL  SERVICE. 

***  The  area  of  each  district  is  stated  in  acres.  The  population  is 
•computed  according  to  the  census  of  1881. 


BESIGNATIONS. 

Gosford  Union. — Mr.  Charles  Parker  Mann  has  resigned  the  Boxford 
District :  area  11,189  ;  population  2992  ;  salary  £57  per  annum. 

Gainsborough  Union.— Mr.  Percy  Pope  has  resigned  the  West  Butterwick 
District :  area  7847  ;  population  2501  ;  salary  £26  per  annum. 

Kmgston-on- Thames  Union.— The  office  of  Medical  Officer  for  the  Kingston 
District  is  vacant :  salary  £155  per  annum. 

Woburn  Union.— Ur.  A.  D.  Mahon  has  resigned  the  Aspley  Guise 
District  and  the  Workhouse :  area  7466  ;  population  2943 ;  salary  £70  per 
annum.  Salary  for  Workhouse  £45  per  annum. 


APPOINTMENTS. 

Burton-upon-Trent  Union—  John  W.  Wolfenden,  L.B.C.P. 
L.B.C.S.  Ire.,  to  the  Tutbury  District. 

Redruth  Union.— Arthur  E.  Permewan,  M.B.  Lond.,  M.B.C.S. 
L.S.A.,  to  the  Bedruth  District. 


Edin., 

Eng., 


The  Leeds  Medical  Chabities. — Nearly  £2000  from 
the  balance  accruing  from  the  Leeds  Musical  Festival  is  to 
be  divided  between  the  Infirmary,  the  Dispensary,  and  the 
Hospital  for  Women  and  Children. 

Testimonial. — On  Monday  last  a  testimonial,  con¬ 
sisting  of  an  illuminated  address  signed  by  359  subscribers, 
and  a  purse  containing  nearly  £200,  was  presented  to  Mr. 
■C.  C.  Balding,  of  .Sheff  ord,  who  is  compelled  by  ill-health  to 
retire  from  practice  after  twenty-five  years  of  steady  work. 

Pooe-Law  Confebence.— The  Annual  Central  Con¬ 
ference  of  the  Representatives  of  Poor-Law  Guardians  will 
be  held  at  Exeter  Hall  on  Wednesday,  the  12th  inst.,  when 

Poor-Law  Medical  Relief  ”  will  be  one  of  the  subjects 
discussed. 

Clerical,  Medical,  and  General  Life  Assubance 
Society.— The  fifty-ninth  annual  meeting  of  this  Society 
was  held  on  Friday,  the  30th  ult.,  when  the  directors  pre¬ 
sented  a  very  favourable  report  of  the  financial  progress  of 
the  Society  and  the  development  of  its  business  during  the 
past  year. 

The  Royal  Hospital  pob  Incueables. — At  the 
annual  meeting  of  the  governors  of  the  above  Hospital,  on 
Friday  week,  it  was  stated  that  the  income  of  the  year  had 
not  sufficed  for  the  expenditure,  and  a  loan  of  £3000  had  to 
he  repaid  to  the  bankers.  The  cost  of  the  institution,  how- 
over,  showed,  as  compared  with  last  year,  a  diminution.  The 
number  of  inmates  was  197,  and  pensioners  457,  making  a 
total  on  the  funds  of  the  institution  of  654. 


Action  fob  Slandee. — An  action  for  slander,  which 
has  created  some  excitement  in  Ireland,  was  commenced  on 
the  27th  ult.  by  Dr.  Connolly,  a  medical  practitioner  of  Bruff, 
co.  Limerick,  against  a  man  living  in  the  same  town,  who 
had  accused  the  plaintiff  of  conspiring  to  murder  him.  The 
damages  claimed  amounted  to  £2000,  but  after  a  trial 
extending  over  four  days  the  jury  were  on  Monday  last 
discharged  without  being  able  to  agree  to  a  verdict. 

The  Health  of  Ventnor. — Dr.  Woodford,  the  Medi¬ 
cal  Officer  of  Health,  states,  in  his  report  for  the  quarter 
ending  September  30  last,  that,  excluding  the  deaths  of 
eleven  visitors  who  came  to  Ventnor  with  their  fatal  illness 
upon  them,  the  mortality  for  the  quarter  did  not  exceed 
an  annual  rate  of  12\8  per  1000,  as  compared  with  12-6  in 
1882.  There  was  during  the  three  months  an  entire  absence 
of  any  zymotic  or  epidemic  disease. 

The  Blane  Medal. — This  medal,  founded  by  the 
late  Sir  Gilbert  Blane,  Bart.,  Director-General  of  the 
Medical  Department  of  the  Royal  Navy,  has  just  been 
awarded  to  Staff-Surgeon  George  Maclean,  M.A.,  M.B.,  and 
C.M.  Aber.  1862,  of  H.M.S.  London,  and  {Staff  Surgeon 
Robert  Hall  More,  M.D.  and  C.M.  Aber.,  of  H.M.S.  Swift- 
sure,  for  the  excellence  of  their  journals,  on  the  recommen¬ 
dations  of  the  Presidents  of  the  Royal  Colleges  of  Physicians 
and  of  Surgeons  of  London,  and  of  the  present  Director- 
General  of  the  Medical  Department  of  the  Royal  Navy. 

Glasgow  Maternity  Hospital. — The  annual  report 
of  the  Glasgow  Maternity  Hospital,  read  before  a  meeting 
on  November  27,  showed  that  during  the  year  1542  cases 
had  been  attended  to,  258  in  the  Hospital  and  1284  outside. 
These  figures  indicate  a  continued  advance  in  the  usefulness 
of  the  institution.  Financially  the  report  was  also  favour¬ 
able,  the  income  from  all  sources  being  £2335,  and  the 
expenditure  £2303.  Five  deaths  took  place  in  the  Hospital, 
and  ten  outside.  Only  one  death  from  puerperal  fever 
occurred  during  the  year  in  the  Hospital. 

Ambulance  Training  on  the  “Exmouth.” — A 
gratifying  report  has  been  forwarded  to  the  St.  John  Ambu¬ 
lance  Association  from  Deputy  Inspector -General  Coates, 
on  an  examination  held  on  board  the  Metropolitan  Asylums’ 
training-ship  Exmouth,  when  the  whole  of  the  boys  (sixty- 
five  in  number),  instructed  by  Mr.  S.  Osborn,  R.N.  A.V., 
were  recommended  for  certificates,  the  examiner  reporting 
that  any  one  of  the  candidates  would  be  able  to  render  most 
valuable  assistance  to  a  surgeon  in  the  cockpit  of  a  man-of- 
war,  a  railway  smash,  or  any  similar  emergency. 

The  Alice  Memorial  Hospital. — The  new  Alice 
Memorial  Hospital  atDarmstadtwillbeceremoniouslyopened 
by  the  Grand  Duke  on  the  8th  inst.  (to-day).  This  building, 
which  stands  in  a  commanding  position  on  a  site  granted 
for  the  purpose  by  the  Grand  Duke,  forms  no  unworthy 
memorial  of  the  late  Princess  Alice,  Grand  Duchess  of 
Hesse.  Her  Royal  Highness  founded  and  took  an  active 
part  in  the  management  of  the  old  hospital  and  training- 
school  for  nurses.  The  old  house  was  found,  however,  to  be 
quite  inadequate  to  the  requirements  of  the  nurses  and 
their  patients,  and  this  has  led  to  the  erection  of  the  new 
Memorial  Hospital.  The  trustees  of  the  English  “  Alice 
Memorial  Fund  ”  have  given  a  sum  of  £3400  towards  these 
buildings,  and  the  balance  of  the  amount  required  for  its 
erection  has  been  obtained  from  other  sources. 

Bread  Reform  League. — A  report  of  this  Associa¬ 
tion  for  last  year,  which  has  been  delayed  in  consequence  of 
the  illness  of  the  Secretary,  Miss  Yates,  has  recently  been 
issued.  The  Council  state  that  the  object  for  which  the 
League  was  organised — namely,  the  spread  of  a  knowledge 
of  the  dietetic  advantages  of  wheat-meal  bread— has  met 
with  very  gratifying  success.  The  principal  thing,  they 
say,  that  is  now  required  for  the  complete  success  of  the 
movement  is  an  improved  reliable  supply  of  perfectly  cleaned 
wheat  (whole  or  decorticated),  ground  of  a  uniform  very  fine 
quality,  made  into  palatable  bread,  and  sold  cheaper  than 
white  bread.  The  movement  would,  in  the  opinion  of  the 
Council,  be  greatly  assisted  if  large  commercial  bodies, 
either  as  companies  or  co-operative  associations,  could  he 
formed  for  the  production  of  whole-meal  bread,  as  bakers 
are  not  anxious  to  introduce  it.  The  report  mentions  the 
fact  that  the  London  School  Board  has  included  wheat-meal 
bread  in  its  syllabus  of  instruction  in  cookery. 


Medical  Times  and  Gazette. 


VITAL  STATISTICS. 


Dec.  8, 1883.  6  7  5 


St.  Andrews  University.— At  the  half-yearly  meet¬ 
ing  of  the  General  Council,  on  Friday,  the  30th  ult.,  to  elect 
an  Assessor,  three  candidates  were  proposed,  viz..  Dr. 
Cleghorn,  Dr.  B.  "W.  Richardson  (who  had  held  the  office  for 
twelve  years),  and  Sir  Richard  Cross.  Dr.  Cleghorn  having 
obtained  a  majority  of  votes,  a  poll  was  demanded.  Since 
then.  Dr.  Cleghorn  has  retired  in  favour  of  Sir  R.  Cross, 
and  the  contest  will  therefore  lie  between  the  ex-Home 
Secretary  and  Dr.  Richardson.  The  constituency  numbers 
over  1000. 

Glasgow  Sick  Children’s  Hospital. — When  passing 
through  Glasgow  on  Saturday  last,  the  Duke  and  Duchess 
of  Montrose  showed  the  practical  interest  which  they  take 
in  this  Hospital  by  paying  it  a  visit.  They  were  conducted 
through  the  various  wards,  and  were  much  interested  in 
the  many  improvements  in  the  way  of  nursing  with 
which  the  Hospital  has  been  furnished.  The  Duchess  is 
one  of  the  patronesses,  and  brought  a  number  of  books 
and  toys,  which  were  distributed  among  the  children. 
At  present  there  are  fifty- one  patients  under  treatment 
in  .the  Hospital.  The  visitors  expressed  themselves  as 
being  highly  pleased  with  the  management  and  condition 
of  the  institution. 

Cold  in  the  Treatment  of  Fevers. — Dr.  Cameron, 
M.P.,  read  a  paper  on  the  29th  ult.,  before  the  Glasgow 
Southern  Medical  Society,  on  the  subject  of  “  Cold  in°the 
Treatment  of  Fevers.”  Dr.  Cameron  stated  that  Dr.  Brand, 
of  Stettin,  in  1861,  had  been  the  first  to  introduce  the  treat¬ 
ment  of  typhoid  cases  by  cold  baths,  from  which  wonderful 
results  had  since  been  obtained.  In  the  course  of  the  paper 
many  striking  cases  of  cure  by  means  of  cold  treatment 
were  instanced,  and  the  investigation  of  the  subject  was 
recommended  as  worthy  of  the  attention  of  the  faculty 
in  Glasgow,  who  had  generally  so  much  to  do  with  fever 
outbreaks. 

Glasgow  Western  Infirmary. — The  annual  report 
of  the  managers  of  the  Western  Infirmary  was  submitted  to 
a  meeting  of  subscribers  on  Thursday,  the  29th  ult.  It 
stated  that  during  the  year  ending  October  31,  1883,  there 
were  treated  18,905  outdoor  and  3917  indoor  patients.  The 
average  daily  number  of  patients  in  the  Hospital  was  368, 
and  the  average  residence  of  each  thirty-eight  days.  The 
number  of  deaths  was  296,  or  8  per  cent,  of  all  the  cases 
treated  to  a  termination.  The  financial  statement  showed 
that  the  ordinary  income  was  <£15,153,  and  the  ordinary 
expenditure  <£18,639,  being  a  deficit  of  ,£3486.  The  de¬ 
ficiency  was  due  to  a  falling  off  in  the  donations  for 
maintenance,  and  to  the  large  increase  in  the  number  of 
patients. 

A  Veteran  Army  Surgeon. — Mr.  Moses  Griffith, 
D.L.,  and  J.P.  for  the  county  of  Pembroke,  who  died  on 
the  29  th  ult.,  aged  ninety -five,  served  in  the  Peninsula  as 
army  surgeon  from  January  7,  1810,  to  the  end  of  the  war, 
including  the  battles  of  Busaco,  Fuentes  d’Onor ;  siege  and 
assaults  of  Ciudad  Rodrigo,  January,  1812 ;  siege  and  assault 
of  Badajoz,  April,  1812  ;  battles  of  Salamanca,  Yittoria, 
Pyrenees,  Nivelle,  Nive,  Orthes,  and  Toulouse.  He  was 
wounded  at  the  affair  of  Yich  Bigorre  on  January  19,  1814  ; 
served  in  India,  Arabia,  and  the  Burmese  Empire  from 
May,  1818,  including  the  sieges  of  Asserghur,  Rasel,  Kyma, 
and  Zaia,  the  siege  and  assault  of  Dwarkae,  the  affair  of 
Bemabu  Ali,  the  assault  of  a  fortress  on  the  banks  of  the 
Pegu  River,  the  assault  and  siege  of  Donabew,  and  the  battle 
near  Pyrome. 

The  Housing  of  the  Poor. — The  Local  Government 
Board  is  about  to  address  a  circular  to  the  metropolitan 
vestries,  drawing  their  attention  to  the  powers  that  can  be 
exercised  by  them  under  the  Sanitary  Act  of  1866  in  reference 
to  houses  let  in  lodgings  or  occupied  by  members  of  more 
than  one  family.  The  circular  will  be  accompanied  by  some 
model  regulations  dealing  with  the  following  matters  : — 
The  fixing  of  the  number  of  persons  who  may  occupy  a 
house  let  in  lodgings ;  the  registration  and  inspection  of 
such  houses,  and  the  keeping  of  the  same  in  a  cleanly  and 
wholesome  state ;  the  enforcement  of  the  provisions  of 
accommodation  and  other  appliances  and  means  of  cleanli¬ 
ness  in  proportion  to  the  number  of  lodgings  and  occupiers ; 
the  cleansing  and  ventilation  "of  the  common  passages  and 
staircases ;  and  the  cleansing  and  lime- washing  at  stated 
times  of  such  premises. 


- -  ■  —  — 

VITAL  STATISTICS  OF  LONDON. 

Week  ending  Saturday,  December  1,  1883. 


BIRTHS. 

Births  of  Boys,  1239;  Girls,  1184;  Total,  2423. 

Corrected  weekly  average  in  the  10  years  1873-82,  2637 '2. 


DEATHS. 


Males. 

Females. 

Total. 

Deaths  during  the  week  ... 

839 

816 

1655 

Weekly  average  of  the  ten  years  1873-82, 1 
corrected  to  increased  population  ...  j 

897'6 

891-7 

1789 -S 

Deaths  of  people  aged  80  and  upwards 

... 

... 

76 

DEATHS  IN  SUB-DISTRICTS  FROM  EPIDEMICS. 


|  Enumerate! 

Population, 

1881 

(unrevised), 

Small- pox. 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

Whooping- 

cough. 

Typhus. 

Enteric  (or 

Typhoid) 

Fever. 

Simple 

continued 

Fever. 

OS 

8 

A 

i 

•M 

o 

West . 

669633 

6 

5 

6 

9 

4 

1 

2- 

North 

905947 

5 

3 

8 

7 

3 

13 

Central 

282238 

.. 

2 

3 

1 

3 

3 

East . 

692738 

... 

8 

23 

1 

4 

... 

6 

2 

South . 

1265927 

... 

19 

20 

13 

10 

... 

7 

2 

5 

Total . 

3816483 

5 

38 

59 

28 

29 

... 

33 

3 

9 

METEOROLOGY. 

From  Observations  at  the  Greenwich 

Mean  height  of  barometer  . 

Mean  temperature  . 

Highest  point  of  thermometer  . . 

Lowest  point  of  thermometer  . . 

Mean  dew-point  temperature  . 

General  direction  of  wind  . .  ...  ... 

Whole  amount  of  rain  in  the  week  ...  . 


Observatory. 

.  29'755  in- 

.  463° 

.  56-2° 

.  36 '6° 

.  427° 

.  s.w. 

.  0'83  in. 


BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  the- 
Week  ending  Saturday,  Dec.  1,  in  the  following  large  Towns : — 


Cities 

and 

Boroughs. 

Estimated  Population  to 
middle  of  the  year  1883. 

Births  Registered  during 
the  week  ending  Dec.  1. 

|  Deaths  Registered  during 
|  the  week  ending  Dec.  1. 

Annual  Rate  of 
Mortality  per  1000  living, 
from  all  causes.  i 

Temperature 
of  Air(Fahr.) 

Temp, 
of  Air 
(Cent.) 

Rain 

Fall. 

Highestduring 
the  Week. 

Lowestduring 

theWeek. 

Weekly  Mean  of 
Daily  MeanValues 

Weekly  Mean  of 
Daily  Mean 
Values. 

In  Inches. 

OR 

0> 

43* 

<3X 

a 

a> 

O 

5 

London 

... 

3955814 

2423 

1655 

21-8 

56-2 

30-6 

463 

7-95 

0-83 

2-n 

Brighton  ... 

... 

111262 

60 

40 

18-8 

553 

37'8 

46-6 

8-12 

0-72 

1-83- 

Portsmouth 

... 

131478 

91 

47 

18-7 

... 

Norwich  ... 

89612 

60 

29 

169 

... 

... 

... 

Plymouth  ... 

... 

74977 

38 

27 

18-8 

56- 1 

35  0 

47-7 

872 

064 

1-63 

Bristol . 

... 

212779 

139 

£0 

221 

57-5 

362 

46-0 

7'78 

0  64 

1-37 

Wolverhampton  . 

77557 

64 

34 

22-3 

55-9 

305 

43-4 

6  33 

0'53 

1-35- 

Birmingham 

... 

414846 

249 

187 

23-5 

... 

... 

... 

... 

... 

... 

Leicester  ... 

129483 

84 

60 

24-2 

65'8 

35-5 

45'5 

7  50 

0-58 

PUT 

Nottingham 

... 

199349 

156 

92 

241 

662 

338 

44-6 

7-01 

0-59 

1'50 

Derby . 

... 

85574 

44 

36 

22-0 

... 

... 

Birkenhead 

88700 

56 

31 

18-2 

... 

Liverpool  ... 

... 

566763 

377 

289 

26-6 

68-1 

40-5 

46-8 

823 

0-82 

2-0& 

Bolton . 

**t 

107862 

76 

48 

23-2 

55-1 

34-6 

44-0 

6-67 

0-95 

2-41- 

Manchester 

... 

339252 

220 

191 

29-4 

... 

... 

M 

Salford 

190465 

117 

92 

25-2 

M 

... 

... 

Oldham 

... 

119071 

91 

61 

267 

... 

Blackburn  ... 

108460 

79 

60 

29-9 

... 

... 

Preston 

98564 

62 

38 

20-1 

•  •• 

... 

_  _  _ 

Huddersfield 

84701 

48 

43 

23-5 

... 

Halifax 

75591 

39 

32 

22'1 

... 

Bradford  ... 

204807 

130 

64 

163 

562 

40-0 

46-6 

812 

0-59 

1-60 

Leeds  . 

321611 

181 

160 

26-0 

58-0 

40-0 

47-7 

8-72 

064 

1-63 

Sheffield 

295497 

227 

128 

226 

67-0 

39-0 

462 

7'89 

0-59 

1-50 

Hull  . 

176296 

118 

69 

20-4 

55-0 

35  0 

44-2 

678 

0-81 

2 -06 

Sunderland 

121117 

102 

56 

24-1 

... 

t 

... 

... 

Newcastle  ... 

149464 

108 

84 

293 

•  •• 

•  •• 

... 

Cardiff . 

90033 

70 

49 

284 

... 

... 

... 

... 

... 

... 

For  28  towns 

... 

6620975 

6509 

3792 

23-0 

68-1 

30-5 

458 

7-67 

0-68 

1'7S 

Edinburgh  ... 

235946 

130 

89 

19-7 

57'0 

360 

46  0 

7'78 

0-40 

1-02 

Glasgow 

515589 

388 

260  ‘ 

263 

... 

... 

... 

... 

... 

Dublin . 

... 

349-85 

183 

172 

25-7 

568 

35-1 

46-5 

8-06 

0  29 

074- 

At  the  Royal  Observatory,  Greenwich,  the  mean  reading 
of  the  barometer  last  week  was  29 '76  in. ;  the  lowest  reading 
was  28'90  in.  at  noon  on  Sunday,  and  the  highest  3023  in. 
on  Wednesday  evening. 


NOTES,  QUERIES,  AND  REPLIES. 


Dec.  8,  1S83. 


NOTES,  QUERIES,  AND  REPLIES. 

- - 

He  tfcat  questiotuljj  mtu|}  stjall  learn  mncfr. — Bacon. 


The  Hind  Fund. 

The  following  additional  subscriptions  have  been  received  and  paid  to 
the  account  of  the  “Hind  Fund”  at  Messrs.  Coutts’  Bank:— E.  Bartlett, 
Esq.,  10s. ;  F.  W.  Braine,  Esq.,  £3  3s.  ;  J.  Jackson  Gawith,  Esq..  £1  Is. ; 
John  Hall,  Esq.,  £1  Is. ;  W.  M.,  10s.  6d. :  J.  H.  Parker  Wilson,  Esq.,  £1. 

Subscriptions  may  be  paid  to  Dr.  Bichardson,  F.R.S.  (chairman), 
25,  Manehester-square ;  John  Tweedy,  Esq.,  F.R.C.S.,  21,  Harley-street, 
hon,  treasurer  ;  A.  J.  Pepper,  Esq.,  F.R.C.S.,  122,  Gower-street,  or  T. 
Wakley,  jun.,  Esq.,  L.R.C.R.,  96,  Redcliffe-gardens,  hon.  secretaries  ;  or 
to  Messrs.  Coutts  and  Co.,  Strand. 

The  Rogers  Testimonial. 


l’AcadSmiedeMedecine — Pharmaceutical  Journal — Wiener Medicinische 
Wochenschrift — Revue  M^dicale — Gazette  Hebdomadaire —Nature — 
Boston  Medical  and  Surgical  Journal — Louisville  Medical  News — 
Centralblatt  fiir  Gynakologie — Le  Concours  Medical— Centralblatt  fur 
die  Medicinischen  Wissenschaften — Centralblatt  fiir  Klinische  Medicin 
—Philadelphia  Medical  News— Le  Progres  Medical— New  York  Medical 
Journal — Edinburgh  Clinical  and  Pathological  Journal — Students’  Jour¬ 
nal  and  Hospital  Gazette— New  York  Medical  Record — National  Anti- 
Compulsory  Vaccination  Reporter — Chemiker-Zeitung — Veterinarian — • 
Revue  Mensuelle  de  Laryngologie,  etc. — Archives  Gdndrales  de  Medeeine 
Edinburgh  Medical  Journal— Polyclinic — Weekblad — Glasgow  Medical 
Journal — British  Workman —  Band  of  Hope  Review — Bradford  Observer, 
December  1 — Popular  Science  News  and  Boston  Journal  of  Chemistry — 
Birmingham  Medical  Review — Monthly  Homoeopathic  Review. 


APPOINTMENTS  FOR  THE  WEEK. 


The  following  is  the  sixth  list  of  subscriptions : — Dr.  James  Wakley  and 
T’.  Wakley,  Esq.,  F.R.C  8.,  £10  10s.;  C.  Bader,  Esq.,  Finsbury-circus, 
£1  Is. ;  Lennox  Browne,  Esq.,  36,  Weymouth-street,  £1  Is. ;  Dr.  Morgan, 
Newport.  Monmouth.  £1  Is. ;  Dr.  Milward,  Cardiff,  £1  Is. ;  Dr.  Webb, 
Wirksworth,  £1  Is. ;  Jesse  Newington,  Esq.,  Tenterden,  £1  Is. ;  T.  Cheatle, 
Esq.,  Burford.  Oxon,  £1  Is.;  Dr.  England,  Winchester,  £1  Is.;  C.  F. 
Sutton,  Esq.,  Holmes  Chapel,  £1 ;  John  Elliot,  E=q.,  Kingsbridge,  £1  Is. ; 
F.  C.  G.  Griffin,  Esq.,  M.B.  Oxon.,  Weymouth,  £1  Is. ;  F.  Wacher,  Esq., 
Canterbury,  £l  Is  ;  Dr.  J.  H.  Hughes,  Ombersley,  10s.  6d. ;  H.  Mallins, 
Esq.,  M.B.,  Watton,  Norfolk,  10s.  6d. ;  Dr.  A.  Kirkland,  Chalfont  St. 
Peter,  10s.  6d.  ;  Dr.  H.  M.  Morgan,  Lichfield,  10s.  6d. ;  Joseph  Soane, 
Esq.,  Dock-street,  10s.  6d.  ;  Dr.  Wallis,  Brentwood,  1<K  6d. ;  J.  Selwyn 
Cowley,  Esq.,  Upton-on-Severn,  10s.  6d;  C  Winstanley,  Esq..  Ingatestone, 
10s.  6d.;  James  Hughes,  Esq.,  Middlewich,  5s.;  Dr.  Mackinder,  Gains¬ 
borough,  5s. ;  Dr.  H.  F.  Manley,  Padstow,  5s. ;  T.  H.,  2s.  6d. 

Mr.  31.  B.  By  gent  writes: — “I  should  be  much  obliged  if  any  of  your 
readers  will  inform  me  whether  the  following  work  has  ever  been 
translated  into  English  Bartholinus— ‘  De  Armillis  Veterum  ;  De 


December  8.  Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  14  p.m. ;  King’s  College,  1£  p.m. ;  Royal 
Free,  2  p.m.;  Royal  London  Ophthalmic,  11a.m.;  Royal  Westminster 
Ophthalmic,  14  p.m.;  St.  Thomas’s,  14  p.m.;  London,  2  p.m. 


10.  Monday.' 

Operations  at  the  Metropolitan  Free,  2  p.m.;  St.  Mark’s  Hospital  for 
Diseases  of  the  Rectum, 2  p.m.;  Royal  London  Ophthalmic.il  a.m.; 
Royal  Westminster  Ophthalmic,  1J  p.m.  ;  Hospital  for  Women,  2  p.m. 

Society  or  Arts,  8  p.m.  Mr.  W.  Mattieu  Williams,  “  On  the  Scientific 
Basis  of  Cookery.”  (Cantor  Lectures— II.) 

Medical  Society  of  London,  84  p.m.  Mr.  H.  Royes  Bell,  “  On  a  New 
Method  for  Exposing  the  Knee-joint  in  order  to  remove  Pulpy  Degenera¬ 
tion  of  the  Synovial  Membrane.”  Dr.  Richardson,  “  Opium  Habitues 
and  their  Treatment.” 


Puerpero  Veterum;  Delnauribus  Veterum,  Syntagma.’  Amstelodami, 
3676.” 

Opium-Smokers.— Dr.  Ayres,  the  British  Colonial  Surgeon  at  Hong-kong, 
in  his  report  on  the  prisons  in  that  colony  for  the  year  1882,  says  that 
among  the  prisoners  in  the  gaol  who  are  set  down  as  opium-smokers 
there  have  been  no  deaths,  and  he  has  not  found  among  them  any 
cases  of  disease  which  could  be  attributed  to  this  habit.  The  heaviest 
smoker,  a  man  who  consumed  in  this  way  fifteen  grains  of  opium  a  day, 
and  had  been  a  smoker  for  thirty  years,  weighed  107  lbs.  on  entering 
the  gaol,  and  in  three  weeks  he  gained  3  lbs.,  although  he  underwent 
penal  diet,  that  is  to  say,  for  five  days  out  of  fifteen  he  had  to  subsist 
on  riee  and  water  only.  Dr.  Ayres  declares  the  opium-smoker  suffers 
much  less  from  the  enforced  deprivation  of  the  accustomed  luxury  at 
once  than  the  tobacco-smoker,  and  there  was  no  particular  symptom 
caused  by  the  deprivation.  Many  make  no  complaint  at  all. 

BaUway  Casualties  for  the  Past  Half-year. — The  half-yearly  returns,  ending 
June  last,  of  the  several  railway  companies  to  the  Board  of  Trade,  still 
exhibit  an  appalling  list  of  accidents  and  fatalities,  which  strongly  con¬ 
firms  the  prevailing  opinion  that  precautions  against  accidents  are 
lamentably  deficient.  The  total  number  of  personal  accidents  during 
the  six  months  was  581  killed  and  4021  injured.  But  all  these  casualties 
are  not  due  to  accidents  to  trains.  Of  this  total,  only  17  persons  were 


11.  Tuesday. 

Operations  at  Guy’s,  14  p.m. ;  Westminster,  2  p.m. ;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  14  p.m.;  West 
London,  3  p.m. 

Royal  Medical  and  Chiburgical  Society  (Ballot.  8  p.m.),  8}  p.m.  Mr. 
Jonathan  Hutchinson,  “  On  High  Amputations  for  Senile  Gangrene.” 
Mr.  Frederick  Treves,  “  On  the  Direct  Treatment  of  Spinal  Caries  by 
Operation.” 


12.  Wednesday. 

Operations  at  University  College,  2  p.m. ;  St.  Mary’s,  1}  p.m.  ;  Middlesex, 

1  p.m. ;  London,  2  p.m.;  St.  Bartholomew’s,  14  p.m.  ;  Great  Northern, 

2  p.m.;  Samaritan,  24  p.m.;  Royal  London  Ophthalmic,  11  a.m.; 
Royal  Westminster  Ophthalmic,  14  p.m. ;  St.  Thomas’s,  14  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m. ;  National  Orthopaedic,  Great 
Portland-street,  10  a.m. 

Brompton  Hospital  for  Consumption,  etc.,  4  p.m.  Dr.  Percy  Kidd, 
“  On  Cases  of  Laryngeal  Phthisis.” 

Hunterian  Society  (Council  Meeting,  74  p.m.),  8  p.m.  Mr.  Bryant, 
“  On  some  Peculiarities  in  the  course  of  Strangulated  Hernia.”  Mr. 
Charters  J.  Symonds,  (l)  “On  the  Reliable  Signs  of  Fracture  of  the 
Neck  of  the  Femur”;  (2)  “On  Fallopian  Tubes  and  Ovaries  removed 
for  Relief  of  Uterine  Fibroid.” 

Royal  Microscopical  Society,  8  p.m.  Dr.  J.  H.  F.  Flogel,  “  On  Sections 
of  Diatoms.” 


killed  by  accidents  to  trains,  rolling  stock,  permanent  way,  etc.,  and 
374  injured.  The  numbers  in  the  corresponding  half  of  the  previous  year 
were  14  and  370  respectively.  Far  greater  loss  of  life  and  personal 
injury  are  classified  in  the  returns  under  the  head  of  “Accidents  to 
passengers  from  causes  other  than  accidents  to  trains,  rolling  stock, 
permanent  way,  including  accidents  from  their  own  want  of  caution  or 
misconduct.”  The  returns  give  in  detail  the  various  causes  of  accidents, 
arising  chiefly  from  carelessness,  thoughtless  risk,  or  want  of  necessary 
caution,  a  prominent  feature  being  the  large  number  of  casualties  to 
railway  employes.  These  latter  complain  that  the  accidents  from  which 
they  suffer  continue  to  increase,  and  that  the  companies  fail  to  adopt  the 
more  perfect  appliances  available,  which  would  be  additional  safeguards 
against  accidents  if  put  into  operation. 

COMMUNICATIONS  have  been  received  from — 

Tax  Clbbk  of  the  Local  Board,  Ventnor;  The  Secretary  of  the 
Central  Committee  of  Poor-Law  Reform,  London ;  The  Secre¬ 
tary  of  the  Clerical,  Medical,  and  General  Life  Assurance 
Society,  London;  Mr.  John  Gay,  London;  Dr.  Miller.  Soutbsea; 
The  Secretary  of  the  Apothecaries’  Hall,  London  ;  Dr.  Arthur 
Blomfield,  Exeter  ;  Dr.  Matthews  Duncan,  London  ;  The  Assistant- 
Secbetary  of  the  Royal  Microscopical  Society,  London;  Dr.  W. 
Blyth,  London ;  The  Hon.  Secretaries  of  the  Hutchinson 
Testimonial  Fund,  London  ;  Messrs.  Rudall,  Carte,  and  Co.,  London  ; 
The  Hon.  Secretary  of  the  St.  Pancras  Anti-Compulsory  Vacci¬ 
nation  Society,  London;  Dr.  C.  E.  8helly,  Hertford;  Dr.  H.  C. 
Andrews,  London;  The  Hon.  Secretary  of  the  Medical  Society 
of  London;  Mr.  J.  Chatto,  London;  The  Hon.  Secretary  of  the 
Royal  Medical  and  Chirurgical  Society,  London  ;  The  Registrar- 
General  for  Scotland,  Edinburgh ;  Messrs.  C.  Griffin  and  Co  , 
London:  The  Hon.  Secretary  of  the  Clinical  Society  of  London; 
Dr.  A.  T.  Thomson,  Glasgow;  Mr.  J.  Wickham  Barnes,  London; 
The  Secretary  of  the  Royal  Institution  of  Great  Britain, 
London;  Dr.  Neale,  London  ;  Dr.  W.  C.  McInto-ii,  St.  Andrews. 

PERIODICALS  AND  NEWSPAPERS  RECEIVED  — 
lApcet— British  Medical  Journal— Medical  Press  and  Circular— Ber¬ 
liner  Klinische  Wochenschrift— Centralblatt  fiir  Chirurgie — Gazette 
flee  Hopitaux— Gazette  Medicale— Revista  de  Medicina— Bulletin  de 


13.  Thursday. 

Operations  at  St.  George’s,  1  p.m. ;  Central  London  Ophthalmic,  1  p.m. ; 
Royal  Orthopaedic,  2  p.m.;  University  College,  2  p.m.;  Royal  London 
Ophthalmic,  11a. m. ;  Royal  Westminster  Ophthalmic,  14  p.m.;  Hospital 
for  Diseases  of  the  Throat,  2  p.m. ;  Hospital  for  Women,  2  p.m. ; 
Charing-cross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  24  p.m. 

Abebnethian  Society  (St.  Bartholomew’s  Hospital),  8  p.m.  House- 
Physicians’  Evening. 

Ophthalmological  Society,  ?4  p.m.  Living  Specimens,  etc.,  at  8  p.m. 
Dr.  8.  Mackenzie,  “On  Anaemia  as  a  Cause  of  Retinal  Haemorrhage.” 
Mr.  Nettleship,  "On  a  Case  of  Sympathetic  Iritis  following  Immediate 
Excision  for  Injury.”  Dr.  Brailey,  “On  the  Various  Forms  of  Sympa¬ 
thetic  Ophthalmitis.”  Mr.  Simeon  Snell,  “  On  Two  Cases  of  Retinal. 
Glioma,  in  one  of  which  Shrinking  of  the  Eyeball  occurred  without  Per¬ 
foration.”  Dr.  G.  A.  Brown,  “  On  a  Case  of  Severe  Conjunctivitis,  with 
formation  of  Membrane  on  the  Corneae,  caused  by  Whisky  thrown  in 
the  Eyes.”  Mr.  Priestley  Smith,  0)  “On  Blood  in  Sheath  of  Optic 
Nerve  from  Case  of  Cerebral  Haemorrhage  ”;  (2)  Modpl  Illustrating 
Conjugate  Movements  of  the  Eyes.  Mr.  A.  Stanford  Morton,  “  On 
Congenital  Unilateral  Absence  of  Lacrimation  in  a  Boy.”  Mr.  E. 
Nettleship,  “On  a  Case  of  Sympathetic  Ophthalmitis  where  the  Eye¬ 
lashes  became  White.”  Mr.  W.  J.  Milles,  “  On  an  Improved  Microtome, 
with  a  New  Method  of  Embedding  Eyes.”  Mr.  H.  W.  Pigeon  (for 
W.  A.  Brailey) — Microscopic  Specimens  showing  the  Development  of 
Bacteria  in  Jequirity  Infusions.” 


14.  Friday. 

Operations  at  Central  LondonOpbthalmic,  2  p.m.;  Royal  London  Ophthal¬ 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminsti r 
Ophthalmic,  14  p.m. ;  St.  George’s  (ophthalmic  operations),  l(  r.ra. ; 
Guy’s,  14  p.m.  ;  St.  Thomas’s  (ophthalmic  operations),  2  p.m. ;  King’s 
College  (by  Mr.  Lister),  2  p.m. 

Clinical  Society  of  London,  84  p.m.  Dr.  Cayley,  “  On  Pneumothorax 
occurring  in  the  course  of  Typhoid  Fever.”  Dr.  8.  West,  “  On  a  Case 
of  Complete  Recovery  from  Pneumothorax  without  Effusion  of  Fluid.” 
Mr.  C  J.  Symonds,  “  On  Cases  illustrating  the  Relation  between  Labial 
Herpes  and  Rigor.”  Dr.  J.  K.  Fowler,  “  On  a  Case  of  Subcutaneous 
Nodules  in  an  Adult  Male.”  Livin?  Specimens,  8  p.m. :  Mr.  Clement 
Lucas— A  Case  of  Charcot’s  Joint-Disease  attacking  the  Right  Elbow 
and  Foot. 


ARTERIO-VENOUS  ANEURYSM. 

Delivered  at  St.  George’s  Hospital. 

By  T.  PICKERING  PICK,  F.R.C.S., 

Surgeon  to  the  Hospital. 


Gentlemen, — I  propose  to  draw  your  attention  to-day  to 
the  case  of  the  police-constable  who,  you  will  remember, 
was  shot  in  the  thigh  in  an  encounter  with  a  burglar  in 
August  last.  For  the  notes  of  the  case  which  I  am  about 
to  read  I  am  indebted  to  my  clinical  clerk,  Mr.  Mead. 

Patrick  B.,  aged  twenty-eight  years,  was  admitted  into 
Grosvenor  Ward  on  August  28,  1883. 

History. — He  states  that  he  has  always  been  healthy  and 
never  had  syphilis.  He  had  been  in  the  army  for  nine  years, 
part  of  which  time  he  was  in  India,  where  he  had  an  attack 
•of  ague,  but  was  never  ill  enough  to  lay  up.  After  leaving 
the  army  he  joined  the  police  force,  in  which  he  has  served 
for  the  last  six  months.  Whilst  on  duty  on  the  night  of 
August  27  he  had  an  encounter  with  burglars,  and  was  shot 
in  the  leg.  He  says  he  felt  faint,  but  managed  to  crawl  to 
a,  cottage  a  little  distance  from  where  the  affray  took  place. 
He  was  not  brought  to  the  hospital  until  the  following 
afternoon. 

On  Admission. — He  was  a  fine,  well-made  man,  and  well 
nourished.  He  looked  rather  pale  from  loss  of  blood.  A 
bullet  wound  was  found  in  the  fleshy  part  of  the  right  thigh, 
about  six  inches  below  Poupart’s  ligament,  and  on  the 
inner  side.  The  direction  of  the  wound  was  backwards, 
•outwards,  and  a  little  downwards,  and  appeared  to  cross  the 
line  of  the  femoral  artery.  On  the  back  of  the  outer  side 
of  the  thigh,  at  a  little  lower  level  than  the  anterior  wound, 
was  a  contused  spot,  in  the  centre  of  which  was  a  minute 
opening,  and  here  the  bullet  could  be  felt  lodged  imme¬ 
diately  beneath  the  integument.  There  was  also  a  small 
wound  on  the  little  finger,  and  a  contused  and  lacerated 
wound  on  the  middle  finger  of  the  right  hand,  where  a 
second  bullet  had  grazed  the  tissues.  An  incision  was  made 
over  the  bullet,  and  it  was  extracted.  The  wound  was  care¬ 
fully  syringed  out  with  carbolic  acid,  and  a  drainage-tube 
inserted  into  either  aperture,  but  not  carried  across  from 
the  wound  of  entrance  to  that  of  exit,  for  fear  of  injuring 
the  femoral  vessels  in  the  attempt  to  do  so.  He  was  dressed 
antiseptically. 

August  29. — On  the  following  morning  he  complained  of 
intense  pain,  and  had  an  anxious  and  somewhat  frightened 
expression.  His  temperature  was  100°  Fahr.  He  was  pale, 
and  his  pulse  weak.  R.  Tinct.  opii  Tfl_x.,  spt.  ammon.  arom. 
gss.,  aq.  menth.  pip.  5jss.,  6tis  horis. 

I  need,  not  weary  you  by  reading  Mr.  Mead’s  daily  record 
of  the  case.  It  will  be  sufficient  for  me  to  say  that  the 
patient’s  wound  went  on  remarkably  well.  It  was  dressed 
on  the  third  day,  when  there  was  a  little  redness  about  it, 
but  no  discharge ;  and  at  subsequent  dressings  the  discharge 
was  never  more  than  j  ust  sufficient  to  stain  the  antiseptic 
gauze.  As  regards  his  general  condition,  he  soon  rallied 
from  the  shock  of  the  injury.  The  temperature  was  normal, 
or  almost  normal,  throughout,  and  he  ate  and  slept  well. 
I  will  pass  on  to  the  notes  of  September  18,  when  I  found 
him  up  and  about  the  ward,  with  the  wound  quite  healed. 
Upon  passing  my  hand  over  the  injured  part  as  the  man 
■was  standing  before  me,  I  was  astonished  to  feel  a  peculiar 
sensation  which  at  once  induced  me  to  make  a  careful  exa¬ 
mination.  Upon  requesting  the  patient  to  lie  down,  there 
was  felt  to  be  a  continuous  vibratory  thrill,  most  plainly  to 
be  perceived  over  the  seat  of  the  wound,  but  extending 
upwards  as  high  as  the  groin,  and  downwards  to  the  lower 
level  of  the  popliteal  space  in  the  course  of  the  femoral 
vessels.  This  is  not  inaptly  compared  by  my  clerk  to  the 
“  kind  of  sensation  one  experiences  when  placing  the  hand 
jon  the  chest  of  a  purring  cat.”  Beneath  the  wound,  in  the 
course  of  the  femoral  vessels,  was  an  oblong  swelling,  soft 
and  easily  compressible,  in  which  was  a  distinct  pulsation. 
Along  the  whole  course  of  the  femoral  vein  was  a  continuous, 
rough,  blowing  murmur,  which,  when  heard  with  the  bin¬ 
aural  stethoscope,  was  positively  painful  to  the  ear.  The 
limb  below  the  knee  appeared  to  be  swollen,  and  upon 

Von.  II.  1883.  No.  1746. 


measurement  proved  to  be  actually  slightly  larger  than  the 
one  on  the  opposite  side  ;  the  superficial  veins  were  not, 
however,  enlarged. 

Such,  then,  gentlemen,  is  the  history  of  the  case,  and  the 
first  point  which  we  shall  have  to  consider  is  the  diagnosis — 
what  was  the  nature  of  the  lesion,  and  to  what  result  had 
it  led  ?  It  cannot  be  doubted  from  the  character  of  the 
symptoms,  taken  in  conjunction  with  the  course  of  the  ball 
through  the  limb,  that  there  had  been  some  serious  injury 
to  the  femoral  artery.  What,  then,  was  the  nature  of  this 
injury.  Was  this  a  case  of  traumatic  aneurysm,  or  was  it 
an  arterio-venous  aneurysm  ? 

First,  Was  it  a  traumatic  aneurysm  ?  Might,  in  fact,  the 
following  chain  of  events  have  occurred  ?  That  the  ball  in 
its  passage  through  the  limb  had  bruised,  but  not  cut  the 
artery;  that  the  injured  coat  had  subsequently  sloughed, 
but  before  the  artery  had  given  way  the  parts  around  had 
become  so  condensed  that  the  effused  blood  was  enclosed  in 
a  cavity,  and  surrounded  and  limited  by  a  dense  layer  of 
plastic  matter  forming  a  distinct  circumscribed  sac. 

For  three  reasons  I  am  inclined  to  think  that  this  was  not 
the  case.  1.  Because  in  these  cases  there  is  a  tumour  of 
tolerably  firm  consistence  produced  by  the  inflammatory 
matting  together  of  the  tissues  -;  whereas  here  we  had  a  soft, 
easily  compressible  swelling.  2.  Because  in  the  traumatic 
aneurysms  there  is  a  distensile  pulsation  synchronous  with 
the  beat  of  the  heart;  and  here  we  had  a  tremulous,  jarring 
vibration.  3.  Because  in  these  cases  there  is  a  broken, 
rhythmic  murmur;  whereas  here  the  murmur  was  of  a 
continuous,  swelling  character. 

Secondly,  was  it  an  arterio-venous  aneurysm  P  Clearly, 
if  it  was,  the  bullet  must  have  passed  between  the  artery 
and  vein,  and  some  of  you  might  be  inclined  to  doubt 
whether  such  a  thing  could  occur  without  lacerating  the 
vessels.  Mr.  Hulke,  however,  records  an  instance  in  which 
this  actually  did  happen,  in  the  case  of  a  man  who  was  shot 
in  the  thigh,  and  died  rapidly  of  blood-poisoning.  At  the 
post-mortem  examination  the  bullet  was  found  to  have 
passed  between  the  artery  and  vein,  its  track  being  marked 
by  a  small  ashy-grey  slough  in  their  walls,  the  exfoliation 
of  which  had  begun.  The  surrounding  tissues  were  so  con¬ 
solidated  and  matted  that  any  extravasation  of  blood  would 
probably  have  been  hindered.  Both  vessels  were  unob¬ 
structed.  (a)  Therefore  such  a  thing  is  possible. 

Now,  one  of  the  most  prominent  symptoms  in  our  patient’s 
case  was  the  presence  of  a  peculiar  vibratory  thrill,  which 
is  highly  characteristic,  and  which  results  from  the  impul¬ 
sion  of  arterial  blood  into  a  vein,  and  thus  a  meeting  of  the 
two  currents.  And  it  was  the  presence  of  this  peculiar 
thrill  which  mainly  led  us  to  conclude  that  we  had  to  deal 
with  an  arterio-venous  aneurysm.  But  these  aneurysms,  as 
doubtless  you  are  aware,  are  of  two  kinds,  and  the  next 
point  we  had  to  determine  was  whether  this  was  a  case  of 
aneurysmal  varix — that  is  to  say,  a  direct  communication 
between  the  artery  and  vein, — or  a  varicose  aneurysm,  in 
which  an  aneurysmal  sac  is  developed  between  an  artery 
and  vein,  and  communicates  with  both.  The  history  agrees 
best  with  the  view  that  it  was  the  former  ;  that  the  bullet, 
in  its  passage  through  the  limb,  had  passed  between  the 
two  vessels,  bruising  their  contiguous  surfaces,  but  not 
actually  cutting  them  through ;  that  the  adhesion  of  the 
artery  and  vein  had  taken  place  around  the  site  of  injured 
tissue,  and  subsequently  the  damaged  spot  in  the  vessels 
had  given  way,  and  a  direct  communication  had  been  esta¬ 
blished  between  the  two.  Secondly,  the  appearance  of  the 
tumour  favoured  the  idea  that  the  case  was  one  of  aneu¬ 
rysmal  varix.  It  was  an  oblong,  soft,  and  easily  compressible 
swelling,  and  felt  like  a  dilated  vein,  differing  from  the 
firmer,  harder,  and  more  oval  or  round  enlargement  of 
varicose  aneurysm,  in  which  the  symptoms  partake  more  of 
the  character  of  traumatic  aneurysm.  We  seemed,  there¬ 
fore,  to  be  able  to  come  to  the  conclusion  that  this  was  a 
case  of  aneurysmal  varix. 

These  cases  were  first  described  by  William  Hunter  in 
1761.  He  stated  that  they  always  arose  from  injury — that 
is,  by  the  transfixion  of  an  artery  and  a  vein  lying  in  close 
contact  by  a  sharp  instrument,  and  the  subsequent  adhesion 
of  these  apertures  together  in  such  a  manner  that  the  two 
tubes  communicated,  and  a  mutual  transmission  of  blood 
between  them  was  freely  permitted ;  that  the  cases  in  which 


(a)  Clinical  Society's  Transactions,  vol.  viii.,  page  173. 


678 


Hedical  Times  and  Gazette. 


BARRETT  ON  HYDATID  DISEASE  IN  VICTORIA. 


Dee..  15, 1883. 


the  accident  generally  happened  were  instances  in  which  the 
brachial  artery  was  punctured  in  bleeding  from  the  median 
basilic  vein.  Since  his  time,  other  traumatic  causes,  as  gun¬ 
shot  wounds,  injury  from  fragments  of  comminuted  frac¬ 
ture,  and  even  simple  contusion,  have  been  recorded. 

The  investigations  and  recorded  cases  of  Bransby  Cooper, 
Porter,  and  Perry  have,  however,  proved  that  this  disease 
may  occur,  without  any  injury,  from  thinning  and  giving  way 
of  the  coats  of  the  vessels,  adhesion  having  first  taken  place 
between  them. 

When  I  was  Surgical  Registrar  a  case  occurred  here,  under 
the  care  of  Sir  Prescott  Hewett,  which  induced  me  to  believe 
that  there  was  a  third  cause,  namely,  that  there  might  be  a 
congenital  communication  existing  between  an  artery  and  a 
vein,  leading  to  this  form  of  disease.  The  case  was  that  of 
a  girl,  who  was  admitted  with  the  history  that  ever  since 
birth  the  veins  of  the  right  thigh  had  been  noticed  to  be 
enlarged.  When  admitted,  the  femoral  vein  was  found  to  be 
much  dilated,  and  in  it  could  be  felt  a  very  distinct  vibratory 
thrill,  which  could  be  traced  up  to  the  junction  of  the  two 
iliac  veins  in  the  vena  cava.  A  very  loud  continuous  blow¬ 
ing  sound  could  be  traced  up  the  vein  to  the  same  spot ;  (b) 
and  the  only  conclusion  to  which  I  could  come  was,  that 
there  was  a  congenital  communication  between  the  right 
iliac  artery  and  vein  where  these  vessels  cross  one  another. 

And  now  what  is  the  result  of  this  communication  between 
an  artery  and  vein  upon  the  vessels  themselves  ?  It  is  quite 
clear  that  some  of  the  arterial  blood  must  find  its  way  into 
the  vein  in  consequence  of  the  arterial  current  being  stronger 
than  the  venous,  and  thus  a  meeting  of  the  two  streams 
takes  place.  In  consequence  of  this  the  vein  at  the  seat  of 
communication  becomes  dilated  into  a  fusiform  pouch,  and 
its  coats  thickened.  The  veins  of  the  part  generally  are 
also  enlarged,  nodulated,  and  thickened.  The  artery  below 
the  point  of  communication  becomes  contracted,  because  it 
carries  less  blood  than  normal,  part  of  its  proper  supply 
finding  its  way  into  the  vein,  and,  as  a  consequence,  the 
limb  below  the  aneurysm  is  colder  than  on  the  opposite  side. 
At  the  same  time  the  proximal  end  of  the  artery  becomes 
dilated. 

With  regard  to  the  symptoms  by  which  you  would  recog¬ 
nise  this  condition,  I  need  say  very  little  more  than  has 
already  been  said  in  speaking  of  the  diagnosis  in  our 
patient’s  case.  We  have,  first,  the  vibratory  thrill,  which 
is  produced  by  the  meeting  of  the  currents.  The  tension  of 
the  coats  of  the  artery  produces  a  continuous  flow  of  arterial 
blood  into  the  venous  tumour ;  while  at  the  same  time  the 
wave  of  blood  at  each  beat  of  the  heart  produces  a  corre¬ 
sponding  impulse  in  the  flow  of  blood  through  the  tumour,  and 
so  establishes  the  vibratory  character  of  the  thrill.  Secondly, 
we  have  a  loud,  harsh,  rasping  murmur,  which  is,  moreover, 
continuous,  and  in  this  fact  differs  from  the  broken  and 
rhythmic  murmur  of  an  ordinary  aneurysm,  and  affords,  as 
was  first  pointed  out  by  Nelaton,  an  important  element  in 
our  diagnosis.  The  sound  is  peculiar,  and  has  been  compared 
by  various  authors  to  many  different  things.  Porter  com¬ 
pares  it  to  the  noise  made  by  a  fly  in  a  paper  bag.  To  my 
mind  it  forcibly  resembles  the  noise  made  by  the  engines  of 
a  steamship  when  labouring  in  a  heavy  sea.  Then,  as  a  third 
symptom,  we  have  the  dilated  condition  of  the  veins  and 
their  pulsation,  so  that  they  assume  a  more  or  less  arterial 
character.  This  was  not  noticeable  in  our  patient’s  case, 
for  it  is  a  condition  which  comes  on  slowly ;  but  we  had, 
nevertheless,  the  enlarged  condition  of  the  leg,  which  was 
no  doubt  due  to  venous  engorgement,  that  will  subse¬ 
quently  lead  to  dilatation.  Lastly,  there  is  the  coldness 
of  the  limb  below  the  point  of  communication,  and  in  some 
cases  a  diminution  in  the  force  of  the  pulse  on  the  affected 
side. 

And  now,  in  conclusion,  just  a  word  or  two  about  the 
treatment ;  and  here  we  are  surrounded  by  difficulties.  In 
many  cases,  it  is  true,  nothing  requires  to  be  done,  and  the 
disease  occasions  so  little  inconvenience  and  shows  such  a 
slow  tendency  to  advance  that  no  operative  interference  is 
necessary,  and  the  application  of  an  elastic  bandage  or 
stocking  to  support  the  enlarged  veins  is  all  that  is  requisite. 
In  the  Clinical  Society’s  Transactions  a  case  is  recorded  by 
Mr.  Hulke,  which  in  many  important  particulars  resembles 
the  case  of  our  patient  upstairs.  In  this  instance  the 
aneurysmal  varix,  which  was  the  result  of  a  gunshot  wound 


of  the  thigh,  had  existed  for  three  years.  It  caused  great 
weakness  and  pain,  which  quite  disabled  the  patient  and 
laid  him  aside  from  work.  In  addition  it  had  caused  an 
eczematous  condition  of  the  limb,  and  a  small,  very  painful 
superficial  ulcer  on  the  shin.  After  various  plans  of  treat¬ 
ment  by  pressure  had  been  adopted  without  avail,  he  was 
supplied  with  an  elastic  stocking  reaching  from  the  foot  to 
the  groin,  with  a  small  pad  placed  upon  the  spot  of  inocula¬ 
tion.  With  the  uniform  and  efficient  support  thus  afforded 
he  was  able  to  steadily  follow  his  employment  with  but  little 
inconvenience;  so  that,  as  Mr.  Hulke  writes,  “the  relief 
from  the  stocking  is  so  great  that  the  man  himself  would 
reject,  and  I  should  not  feel  justified  in  advising,  any  direct 
surgical  interference.”  (c) 

But  this  is  not  always  the  case.  Sometimes  the  disease 
may  extend  so  rapidly  as  to  threaten  the  patient’s  life ;  or, 
at  all  events,  entirely  incapacitate  him  from  following  any 
active  employment.  What  then  is  to  be  done  ?  The  ordi¬ 
nary  methods  of  treating  aneurysm,  such  as  pressure  (either 
digital  or  instrumental)  on  the  artery  above,  or  the  Hunterian 
method  of  ligature,  are  not  applicable  to  a  case  of  this 
sort.  Those  measures  aim  at  diminishing  the  flow  of  blood 
through  the  sac,  and  thus  causing  a  fibrinous  deposit  on 
its  internal  surface ;  but  here  there  is  no  defined  sac, 
and  the  constant  flow  of  blood  through  the  dilated 
vein  would  impede  rather  than  favour  this  condition. 
Direct  pressure  and  flexion,  when  applicable,  appear  to 
have  had  no  beneficial  result  in  cases  in  which  they  have 
been  tried,  nor,  indeed,  could  we  expect  that  they  would 
have.  The  cure  of  a  disease  of  this  kind  must  be  effected 
by  the  cutting  off  of  the  communication  between  the  artery 
and  vein ;  and  this  is  not  likely  to  be  achieved  either  by 
direct  pressure  or  by  flexion. 

The  only  operative  procedure  which  appears  to  hold  out 
any  hope  of  success  is  that  of  ligature  of  the  artery  above 
and  below  the  point  of  communication.  We  must  bear  in 
mind,  however,  that  the  risks  of  this  operation  are  con¬ 
siderably  greater  than  those  of  ordinary  ligature  of  the 
femoral  artery,  and  that  it  is  one  not  lightly  to  be  undertaken.. 

What  I  propose  to  do,  therefore,  for  our  patient,  is  to 
apply  well-regulated  and  efficient  support  to  the  whole 
limb  from  the  foot  to  the  groin  by  means  of  a  carefully 
adjusted  “  Martin’s  elastic  bandage,”  and  keep  him  under 
observation.  Should  the  disease  make  but  little  progress 
and  not  cause  him  any  great  amount  of  inconvenience,  so 
that  he  is  able  to  follow  some  light  occupation,  I  shall 
counsel  him  to  leave  matters  alone  and  to 

“  Eatlier  bear  those  ills  he  has 
Than  fly  to  others  that  he  knows  not  of.” 

On  the  other  hand,  if  the  dilatation  of  the  veins  increases 
rapidly,  so  as  to  entirely  incapacitate  him  from  work,  and 
especially  if  the  patient’s  life  is  threatened  from  haemor¬ 
rhage,  I  shall  take  the  opinion  of  my  colleagues  as  to  the 
advisability  of  tying  his  artery  above  and  below  the  point 
of  communication. 


HYDATID  DISEASE  IN  VICTORIA. 

By  JAMES  W.  BARRETT,  M.B.,  Ch.B.  (Melbourne  Univ.).. 


The  great  prevalence  of  hydatid  disease  in  Australia,  and 
the  considerable  mortality  which  it  occasions,  give  medical 
practitioners  in  this  country  an  opportunity  of  studying  it 
which  European  observers  apparently  do  not  possess.  It  is  on 
this  account,  therefore,  that  I  venture  to  draw  the  attention 
of  the  medical  profession  in  Great  Britain  to  a  few  points  of 
interest  connected  with  its  causation,  pathology,  clinical 
characters,  and  treatment.  Its  detailed  anatomical  charac¬ 
ters  are  already  so  well  known  that  no  reference  to  them  is 
necessary.  The  disease  is  very  common  in  Victoria,  espe¬ 
cially  in  the  flat  and  pastoral  districts,  where  both  the 
human  beings  and  the  beasts  inhabiting  the  vast  plains  not 
unfrequently  obtain  their  water  from  common  water-holes,, 
dams,  and  creeks.  The  beasts  include,  for  (he  most  part, 
cattle,  sheep,  horses,  dogs,  and  in  some  places  kangaroos. 

It  has  long  been  known  that  the  hydatid  (echinococcus) 


(b)  See  Lancet,  vol.  i.  1867,  page  146. 


(c)  Clinical  Society’s  Transactions,  vol.  viii.,  page  175. 


Medical  Times  and  Gazette. 


BARRETT  ON  HYDATID  DISEASE  IN  VICTORIA. 


Dec.  15,  1883.  679 


is  produced  by  tbe  ingestion  of  the  ova  of  the  T tenia 
echinococcus,  the  embryos  of  which,  when  liberated  in  the 
stomach  of  a  suitable  host,  make  their  way  as  pro-scolices 
through  its  coats,  and  either  get  deposited  in  the  liver,  or 
else  obtain  an  entrance  into  the  general  blood  circulation, 
whence  they  are  deposited  in  more  distant  organs.  Once 
they  obtain  a  lodgment,  they  become  cystic  and  are  hydatids. 
If  in  this  condition  they  are  swallowed  by  a  suitable  host, 
they  develope  into  the  Taenia  echinococcus  in  the  alimentary 
canal.  Dogs,  and  especially  stray  ones  (scavengers),  are 
very  numerous  in  Victoria,  and  in  the  pastoral  districts 
large  numbers  are  kept  by  shepherds.  Dr.  Thomas,  of 
Adelaide,  examined  a  number  of  dogs  in  Adelaide  and  in 
Melbourne,  and  found  that  in  the  former  city  40  per  cent, 
were  infested  with  the  Tsenia  echinococcus.  In  Victoria  very 
many  dogs  are  so  affected,  but  the  exact  proportion  is  not 
definitely  determined.  This  being  so,  it  is  very  easy  to 
understand  that  many  of  the  ova  (which  are  passed  in 
myriads  with  the  dogs'  faeces)  find  their  way  into  the  water- 
holes  and  into  the  surrounding  pasture. 

Of  the  tens  of  thousands  of  sheep  and  the  large  number 
of  cattle  who  feed  on  these  plains,  and  obtain  their  water 
from  the  common  source,  some  are  sure  to  swallow  the  ova. 
As  a  result,  hydatids  are  frequently  developed  in  their  organs 
(generally  the  liver),  as  everyone  who  has  any  experience  in 
the  matter  knows  too  well.  The  dogs  are  often  fed  on  the 
flesh  of  these  animals,  and  so  in  turn  swallow  the  hydatids, 
which  in  their  alimentary  canal  become  Tsenia  echinococci, 
and  so  the  cycle  of  development  is  complete. 

Dr.  Thomas  attributes  the  great  prevalence  of  Taenia 
echinococcus  in  the  dogs  of  Adelaide  to  the  easy  access 
which  the  dogs  have  to  the  slaughter-houses.  It  seems  that 
they  there  devour  viscera  and  flesh  in  which  these  echinococci 
are  probably  contained. 

Bearing  these  facts  in  mind,  it  at  first  sight  seems  an 
extraordinary  circumstance  that  so  many  human  beings 
living  in  the  pastoral  districts  should  escape  the  disease. 
They  owe  their  immunity  to  their  habit  of  drinking  tea  to 
excess  ;  i.e.,  they  make  tea  almost  their  only  beverage,  and 
by  boiling  the  water  in  its  preparation  destroy  the  hydatid 
embryo.  Of  course  if  echinococci  existed  in  man  alone  they 
would  soon  cease  to  be,  since  dogs  no  longer  being  able  to 
swallow  echinococci,  could  no  longer  suffer  from  Taenia 
echinococcus. 

Victoria'n  medical  practice  furnishes  numerous  examples 
of  hydatid  disease  appearing  as  a  result  of  undue  familiarity 
with  dogs  on  the  part  of  human  beings.  Thus,  children 
have  been  known  to  play  with  them  and  to  crawl  into  their 
kennels,  families  to  make  household  pets  of  them,  and,  as  a 
result,  they  have  suffered  in  many  instances  from  repeated 
attacks  of  hydatid  disease.  I  suppose  the  reason  that  the 
disease  is  not  so  common  in  Europe  is  that  the  water-supply 
is  better  regulated,  and  dogs,  sheep,  and  man  do  not  obtain 
their  water  from  a  common  source.  Even  in  Victoria  the 
disease  is  not  nearly  so  frequent  in  the  cities  as  in  the 
country. 

Pathology . — As  everyone  knows,  the  wall  of  an  hydatid 
cyst  comprises  three  layers.  An  outer  one  (adventitia) 
is  formed  by  the  condensation  of  the  tissues  in  which  the 
animal  is  situated.  This  layer  is  thick,  somewhat  fibroid, 
and  vascular.  The  inner  two  layers  are  proper  to  the 
hydatid,  and  are  not  attached  firmly  to  the  outer  one  except 
during  the  decay  of  the  parasite.  Of  the  two,  the  outer  is 
known  as  the  laminated,  and  the  inner  as  the  germinal  mem¬ 
brane.  Echinococci  therefore  obtain  their  nutriment  by 
imbibition,  and  their  growth  is  limited  by  (1)  failure  of 
developmental  energy ;  (2)  failure  of  nutritive  supply.  Like 
all  other  organised  bodies,  they  have  a  period,  of  growth  and 
reach  a  maximum  size,  then  cease  to  grow,  undergo  retrograde 
changes,  and  diminish  in  size.  Unfortunately,  however,  the 
limit  of  development  is  not  the  same  for  all  individuals,  and 
too  often  the  life  of  the  host  is  destroyed  before  it  is  reached. 

It  is  now  necessary  to  draw  attention  to  a  most  important 
distinction  between  different  kinds  of  hydatid  cysts,  which 
are  divisible  into  two  varieties— (1)  the  unilocular  variety, 
and  (2)  the  multilocular  variety.  The  latter  includes  those 
hydatids  in  which  large  numbers  of  secondary  cysts  are 
formed  in  the  interior  of  the  primary  one.  The  secondary 
(daughter)  cysts,  of  course,  have  only  two  coats,  i.e.,  those 
proper  to  the  echinococcus,  the  germinal  and  the  laminated 
layers.  The  main  cyst  may  be  simply  packed  with  the 
secondary  cysts,  or  may  contain  fluid  as  well. 


After  the  limit  of  growth  is  reached,  hydatid  cysts  may 
either  (1)  degenerate,  (2)  rupture,  or  (3)  suppurate.  They 
may,  however,  rupture  or  suppurate  before  it  is  reached, 
but  if  uninfluenced  by  treatment  their  course  is  tolerably 
uniform. 

I.  Once  the  developmental  process  ceases,  for  either  of 
the  reasons  mentioned  previously,  a  series  of  degenerative 
changes  ensue  in  the  cyst  and  its  contents :  the  walls 
become  thickened  and  the  coats  inseparably  blended;  the 
echinococci  themselves  degenerate  and  become  unrecognis¬ 
able  ;  the  fluid  partly  or  wholly  absorbs|;  and  contraction  of 
the  whole  mass  steadily  progresses. 

(a.)  If  the  cyst  be  unilocular,  it  becomes  converted,  first, 
into  a  thick-walled  cyst  containing  a  little  fluid,  and  ulti¬ 
mately  into  a  solid  fibrous  mass,  which  in  course  of  time 
may  become  calcareous.  In  this  process  of  contraction  it  is 
obvious  that  considerable  traction  may  be  exercised  on  any 
adhesions  which  may  have  formed  during  its  growth.  In 
one  case,  a  patient,  who  was  not  aware  that  she  had  ever  suf¬ 
fered  from  hydatid  disease,  was  admitted  into  the  Melbourne 
Hospital,  exhibiting  symptoms  of  pyloric  obstruction.  She 
became  very  emaciated  and  died.  At  the  autopsy  there  was 
found  to  be  situated  near  the  pylorus  a  solid,  round,  cal¬ 
careous  body,  the  product  of  the  degeneration  of  an  hydatid 
cyst  in  the  small  omentum.  Old  adhesions  extended  on 
every  side,  and  by  traction  on  them  both  the  pylorus  and 
transverse  colon  had  been  constricted  and  totally  obstructed  ; 
hence  the  fatal  result.  Sometimes  calcification  takes  place 
in  the  cyst- wall  during  the  process  of  contraction. 

(6.)  If,  however,  a  cyst  is  multilocular,  the  degenerative 
process  assumes  a  form  of  which  I  can  find  at  present  no 
description.  When  they  reach  their  limit  of  development 
the  cyst-wall  undergoes  exactly  the  same  changes  as  it  does 
in  the  unilocular  cysts.  The  fluid  both  inside  and  outside 
the  secondary  cysts  absorbs ;  and  the  material  left  inside  the 
main  cyst,  consisting  of  echinococci  and  cyst-walls,  becomes 
converted  into  a  soft,  non-homogeneous,  greenish  mass, 
which  shows  traces  of  the  cyst- walls  from  which  it  is  formed. 
To  this  form  of  degeneration,  which  is  peculiar  to  the  multi¬ 
locular  cysts,  I  propose  to  give  the  name  of  gelatinoid 
degeneration.  It  has  only  recently  been  recognised  even  in 
the  Melbourne  Hospital,  where  it  was  forced  under  notice 
by  the  following  case,  which  I  reported  in  the  Australian 
Medical  Journal,  June  15,  1883  :  — 

J.  T.,  aged  twenty-seven,  admitted  May  12,  1882,  under 
the  care  of  Mr.  T.  N.  Fitzgerald.  Four  years  ago  the 
patient  first  noticed  a  small  lump  situated  deeply  in  the  left 
hypochondrium.  It  was  for  a  long  time  painless,  and  grew 
slowly.  Twelve  months  since,  he  was  thrown  from  a  cart, 
and  injured  his  side  ;  and  six  months  after,  noticed  that  the 
tumour  was  rapidly  enlarging,  and  was  causing  him  great 
pain.  It  was  tapped  for  hydatids,  but  no  fluid  obtained. 
When  admitted,  the  patient  was  a  muscular  man,  and  seemed 
to  be  in  good  health.  There  was  bulging  in  the  left  hypo¬ 
chondrium,  where  the  edge  of  an  enlarged  spleen  could  be 
felt.  The  enlargement  of  the  organ  was  considerable ;  by 
percussion  it  could  be  made  out  to  extend  upwards  poste¬ 
riorly,  where  it  encroached  on  the  left  lung ;  upwards  laterally 
to  the  sixth  rib,  and  forwards  to  within  three  inches  of  the 
mid-line.  There  was  an  obscure  feeling  of  fluctuation  in 
the  hypochondrium.  Measurement  of  the  body  showed  that 
the  distance  from  the  umbilicus  to  the  spine  was  two  inches 
greater  on  the  left  than  on  the  right  side.  The  apex-beat  of 
the  heart  was  not  displaced,  but  there  was  an  apical  systolic 
bruit.  A  consultation  was  held  on  June  6,  1882, when  it  was 
decided  that  the  probabilities  were  in  favour  of  the  existence 
of  an  hydatid  cyst  rather  than  that  of  a  simple  enlargement 
of  the  spleen,  because  (1)  of  the  obscure  sense  of  fluctuation, 
and  (2)  of  the  projection  of  the  tumour  upwards  towards 
the  lung.  A  fine  trochar  was  passed  into  its  lower  part,  and 
was  felt  to  enter  a  thick- walled  cavity,  in  which  the  point 
could  be  freely  moved.  No  fluid  came  away,  and  a  whale¬ 
bone  stilette  was  therefore  passed  through  the  canula  into 
the  cavity,  but  without  result.  A  few  days  afterwards  the 
patient  was  seized  with  a  rigor,  followed  by  vomiting,  pain, 
and  a  rise  of  temperature  to  104°.  He  sank  rapidly,  and 
died  of  collapse,  symptoms  of  peritoneal  inflammation  not 
being  marked. 

At  the  autopsy,  made  twelve  hours  after  death,  the  heart 
weighed  three-quarters  of  a  pound.  The  musculi  papillares 
of  the  left  ventricle  were  undergoing  fatty  degeneration  : 
hence  the  bruit.  Both  lungs  were  congested  at  their 


680 


Medical  Times  and  Gasette. 


BARRETT  ON  HYDATID  DISEASE  IN  VICTORIA. 


Dec.  15, 198k. 


dependent  parts,  and  the  pleural  surfaces  were  studded  with 
petechial  ecchymoses.  At  the  lower  edge  there  were  several 
wedge-shaped  patches  of  congestion.  The  spleen  weighed 
seven  pounds  and  a  half,  and  contained  two  hydatid  cysts. 
The  upper  one,  which  was  unilocular  and  large,  contained 
decomposing  fluid.  It  was  pressing  upwards,  and  so  com¬ 
pressing  the  left  lung.  Ulceration  had  so  progressed  that 
only  a  thin  layer  of  diaphragm  intervened  between  the 
hydatid  and  the  left  pleural  cavity.  The  lower  cyst,  which 
had  been  tapped,  was  smaller,  and  had  tough  fibroid  walls  ; 
it  was  full  of  secondary  cysts  undergoing  gelatinoid  degenera¬ 
tion.  At  the  site  of  tapping  there  were  adhesions.  There 
was  no  general  peritonitis,  but  there  was  some  fluid  blood 
in  the  peritoneal  cavity.  Peyer’s  patches  and  the  mesenteric 
glands  were  enlarged,  and  there  were  petechial  ecchymoses 
on  the  small  intestines.  The  blood  in  the  large  veins  was 
frothy  and  decomposing. 

At  the  time  of  tapping,  no  one  could  understand  why  no 
fluid  came  away  from  a  distinct  cyst,  and  why  the  stilette 
was  not  even  moistened.  However,  the  gelatinoid  degenera¬ 
tion  explained  it. 

More  recently,  we  had  another  case  of  multilocular 
hydatids  of  the  liver,  in  which  the  main  cyst  was  of 
enormous  size,  and  contained  hundreds  of  secondary  cysts, 
in  some  of  which  degeneration  had  just  begun.  As  in  the 
unilocular  form,  calcification  may  ensue,  and  the  whole 
hydatid  become  a  calcareous  mass.  Whilst  making  post¬ 
mortem  examinations  of  the  bodies  of  persons  who  have 
died  of  other  diseases,  I  have  seen  very  many  hydatids  in 
various  stages  of  degeneration.  I  have  thus  found  them  in 
many  different  organs,  but  mostly  in  the  liver.  Very  fre¬ 
quently  their  existence  was  not  even  suspected  during  life. 

2.  Rupture  rarely  occurs  spontaneously,  but  has  occurred 
whilst  a  grooved  needle  has  been  introduced  into  a  cyst  or 
during  manipulation.  It  seems  to  be  unattended  with  any 
danger,  provided  no  air  obtains  admission.  It  is  followed  by 
the  appearance  of  the  hydatid  rash,  a  form  of  erythema 
attended  with  great  itching,  which  appears  all  over  the 
body  as  a  result  of  the  absorption  of  some  part  of  the  hydatid 
contents,  and  lasts  a  few  hours  or  days.  So  far,  I  have 
known  of  no  case  where  rupture  has  been  followed  by  a 
fatal  result,  or  by  further  hydatid  development,  at  all  events 
for  some  time. 

3.  Suppuration  does  not  generally  occur  unless  the  hydatid 
has  been  tapped,  but  nevertheless  does  occur  spontaneously 
sometimes.  As  a  result  the  echinococci  are  killed,  and  the 
cyst  becomes  equivalent  to  a  thick-walled  abscess.  It  has 
been  said  that  cancer  (scirrhus  and  medullary)  and  hydatid 
are  related  to  one  another  causally,  because  they  are  not 
infrequently  co-existent. 

The  irritation  of  the  hydatid  probably  determines  the 
cancerous  growth  to  the  organ  in  which  the  hydatid  is 
situated. 

Hydatid  fremitus  is  a  peculiar  vibration  attendant  on  per¬ 
cussion  of  a  hydatid  cyst.  It  is  noticeable  just  after  the 
blow  is  struck  with  the  finger,  and  seems  to  be  most  readily 
perceived  in  multilocular  cysts  in  which  the  main  cyst  is 
tightly  filled  with  secondary  cysts. 

Treatment  of  hydatids  is  almost  purely  surgical,  since  at 
present  there  is  no  remedy  which  materially  influences 
their  growth,  once  they  obtain  a  lodgment.  Remembering 
that  the  parasite  has  a  definite  period  of  growth,  after  which 
it  undergoes  degeneration  and  its  walls  contract,  and  that, 
on  the  other  hand,  its  removal  means  a  surgical  operation, 
with  its  attendant  risks  (which  may  or  may  not  be  slight), 
it  follows  that  an  effort  must  be  made  to  procure  this 
degeneration  and  contraction,  provided  that  the  presence  of 
the  cyst  is  not  incompatible  with  the  preservation  of  health . 

As  already  shown,  their  existence  is  not  necessarily  inju¬ 
rious  to  health  ;  so  that,  in  the  first'instance,  it  must  be  con¬ 
sidered  whether  the  hydatid  is  likely  to  degenerate  if  left 
alone.  If  it  is  large  enough  to  have  caused  the  victim  to 
seek  advice,  it  is  not  likely  that  it  will  be  benefited  thus,  but 
in  some  cases  may  be  left  for  a  little  time.  Delay  in  suit¬ 
able  cases  can  do  no  harm,  and  may  usher  in  the  commence¬ 
ment  of  degeneration  and  contraction. 

The  remaining  cases,  which  require  treatment,  are  divided 
into  two  great  groups— (a)  those  seen  before  suppuration 
has  taken  place  in  the  cyst,  and  ( b )  those  seen  after 
suppuration  has  occurred. 

(a.)  Before  suppuration  has  occurred,  treatment  is  adopted 
with  a  view  of  causing  contraction.  This  may  often  be 


accomplished  by  tapping  them  with  a  capillary  trochar,  and 
removing  a  few  ounces  of  fluid — not  more.  This  withdrawal 
of  a  small  quantity  of  fluid  is  said  to  be  followed  by  an 
exudation  of  albumen  into  the  non-albuminous  hydatid 
fluid,  and  is  often  followed  by  the  death  and  degeneration  of 
the  parasite.  If  it  fail  to  do  so,  the  tapping  may  be  re¬ 
peated.  If,  on  tapping,  no  fluid  is  obtained,  it  follows  that 
the  cyst  is  multilocular,  and  is  either  (1)  full  of  growing 
cysts,  or  (2)  undergoing  gelatinoid  degeneration.  If  the 
wall  is  very  thick  and  tough,  it  is  probably  the  latter. 

Capillary  trochars  may  be  plunged  into  almost  any  part  of 
the  body  without  risk.  I  have  seen  a  physician  try  to  find  a 
hydatid  cyst  in  the  liver  by  plunging  a  capillary  trochar 
into  that  organ  in  half  a  dozen  different  directions.  At  last 
he  found,  apparently,  a  very  large  branch  of  the  portal  vein  j. 
but  no  ultimate  harm  resulted. 

If  this  tapping  fails  to  destroy  the  vitality  of  the  parasite, 
and  the  cyst  continue  to  grow,  if  it  causes  serious  inconveni¬ 
ence,  or  if  it  suppurate,  then  it  must  either  be  (1)  opened*, 
emptied,  and  drained,  or  (2)  removed  by  operation.  It  must 
be  remembered  that  nearly  all  hydatid  cysts  are  met  with  in 
parts  and  organs  formed  from  the  splanchnopleure ;  hence 
to  reach  the  cyst  the  trochar  must  pass  through  one  of  the 
various  subdivisions  of  the  pleuro-peritoneal  space. 

The  description  of  treatment  given  here  is  wholly  directed 
to  cysts  situated  in  these  parts,  since  in  the  brain  they  cannot 
be  accurately  diagnosed,  and  are  beyond  the  reach  of  surgical 
treatment ;  and  in  the  other  parts  formed  from  the  somato- 
pleure  or  its  divisions,  the  treatment  is  conducted  on  the 
same  principles,  but  is  of  course  infinitely  more  simple. 

1.  If  the  cyst  is  to  be  opened  and  drained,  care  must  be 
taken  that  none  of  the  fluid  escapes  into  the  serous  sacs.  To 
prevent  this,  adhesions  must  be  formed  between  the  opposed 
surfaces,  and  the  tumour  tapped  through  them.  Some  ad¬ 
hesions  always  form  naturally  at  the  projecting  part,  but,  as  a 
rule,  they  are  not  very  extensive,  since  an  hydatid  is  not  an 
inflammatory  growth.  With  regard  to  the  pleura,  adhesions 
form  easily.  In  the  peritoneum  they  form  less  easily,  but 
may  be  set  up  by  Mr.  Fitzgerald’s  method : — Tap  the  hydatid 
at  its  most  prominent  part  with  a  fine  trochar,  and  let  fluid 
come  away.  (If  the  canula,  however,  chokes,  let  things  be  for 
a  few  hours.)  Next,  stick  a  number  of  harelip-pins  through 
the  abdominal  wall  into  the  hydatid,  disposing  them  in  a  circle 
round  the  trochar.  Leave  everything  for  a  day  or  two,  and 
then  remove  them.  Adhesions  will  be  formed,  and  the  open¬ 
ing  may  now  be  enlarged  either  with  dilators  (tents,  etc.), 
or  by  cutting  with  a  bistoury.  The  sooner  the  contents  of 
the  cyst,  including  the  inner  two  fine  layers  of  its  wall, 
can  be  removed,  the  more  quickly  will  recovery  ensue.  Many 
surgeons  enlarge  the  opening  by  dilatation  or  cutting,  and 
then  seize  these  two  layers  with  their  fingers  or  with  forceps, 
and  slowly  drag  them  away. 

It  will  be  seen  at  once  that  the  larger  the  opening,  the- 
freer  the  drainage,  and  the  more  perfect  the  antiseptic  pre¬ 
cautions  used,  the  more  rapid  will  be  recovery.  The  adven¬ 
titia  left  will  contract,  and  the  cavity  granulate.  At  the 
same  time  it  will  be  understood  how  easily  decomposition  of 
the  contents  may  occur,  and  septicaemia  result. 

Recently,  my  father.  Dr.  James  Barrett,  of  Albert-park* 
was  called  to  see  a  case  of  suppurating  hydatid  of  the  liver 
which  had  been  tapped.  An  attendant  had,  however,  allowed 
a  probe  to  drop  into  the  cavity.  My  father  dilated  the 
opening  with  tents  until  it  was  very  large  indeed,  then  with 
pharynx  (crocodile-billed)  forceps  he  succeeded  in  extracting 
the  probe  (black  and  oxidised)  from  the  bottom  of  the 
cavity,  which  extended  nearly  to  the  spine.  The  patient 
made  a  good  recovery. 

2.  Sometimes,  from  the  enormous  size  of  a  cyst,  which  if 
opened  would  kill  by  suppuration,  or  from  the  existence  of 
suppuration  in  a  cyst,  it  is  necessary  to  remove  them  by 
operation.  In  the  lungs  no  special  operation  is  necessary,, 
because  they  can  be  removed  by  the  method  just  described- 
From  the  abdominal  viscera  they  must  be  removed  by  abdo¬ 
minal  section  or  some  other  operative  method.  There  is 
nothing  special  to  note  in  the  operations,  which  are  per¬ 
formed  in  the  usual  manner.  As  much  of  the  adventitia 
should  be  removed  as  is  compatible  with  safety,  as  it  is 
apt  to  suppurate  when  left  behind. 

To  recapitulate,  the  treament  of  hydatid  disease  com¬ 
prises — (1)  leaving  the  cysts  to  nature ;  (2)  tapping  with  a 
capillary  trochar,  and  removing  a  little  fluid  ;  (3)  opening 
them  and  draining  the  cavity,  and  removing  the  inner  two 


Medical  Times  and  Gazette. 


CHEVERS  ON  THE  ORDINARY  DISEASES  OF  INDIA. 


Dec.  15,  1883.  681 


layers  of  the  cyst-wall ;  (4)  abdominal  section,  or  other 
operative  measures  adapted  to  remove  them  en  masse. 
Melbourne  Hospital. 


PRACTICAL  NOTES  ON 

THE  ORDINARY  DISEASES  OF  INDIA, 

ESPECIALLY  THOSE  PREVALENT  IN  BENGAL. 

By  NORMAN  CIEVERS,  C.I.E.,  M.D., 

President  of  the  Epidemiological  Society. 

( Continued  from  page.  654.) 

MALARIAL  CACHEXIA — Continued. 

Blood  Diseases  of  Malarious  Origin. 

Medical  men  in  the  East  have  reason  to  be  proud  of  the 
facts  that,  recently.  Dr.  H.  Vandyke  Carter  has  added  con¬ 
siderably  to  our  knowledge  of  the  Spirillum  of  Relapsing 
Fever, (a)  and  that,  Wucherer  having  detected  the  filariee  of 
chylous  urine  in  Bahia  in  1866,  Dr.  T.  R.  Lewis,  A.M.D.,  now 
•of  Netley,  made  the  independent  discovery  of  these  nematodes 
in  lymphuria  in  1870  (I  had  an  early  opportunity  of  seeing 
these  microzoa).  In  1872,  Dr.  Lewis  first  observed  filarise, 
as  hsematozoa,  in  the  blood  of  a  native  patient  in  my  hospital. 
Indian  physicians  have  still,  however,  a  wide  field  of  re¬ 
search  open  to  them  in  investigating  the  Bacillus  Malaria, 
and  in  studying  those  morbid  conditions  of  the  elements  of 
the  blood  itself  which  are  marked  characteristics  of  malarious 
cachexia — Anaemia,  Pernicious  Anaemia,  with  marrow,  etc., 
lesion  (if  there  be  such  a  disease,  apart  from  the  most  ad¬ 
vanced  condition  of  anaemia,  as  Dr.  Andrew  fairly  doubts), 
Leucocythaemia,  Melanaemia,  Blood  Disintegration,  and  con¬ 
sequent  deposit  of  pigment,  etc.  Up  to  the  present  time, 
these  are  only  known  to  differ  in  degree  from  the  corre¬ 
sponding  blood-lesions  in  Europe.  As  I  remarked  in  speak¬ 
ing  of  the  light  which  has  still  to  be  thrown  upon  the 
pathology  of  Indian  renal  disease,  the  most  promising  field 
for  such  research  appears  to  lie  in  those  flat  and  humid 
•districts  of  Madras  and  Bombay,  in  which  Beriberi  and 
Anasarca  are  most  prevalent.  Doubtless,  these  morbid 
states  of  the  blood  are  generally  far  less  developed  in 
Europeans  at  present  than  they  were  during  the  triumphant 
career  of  VS.  and  mercury  in  India,  when  it  was  a  common 
saying  of  considerable  significance  that  we  “  went  to  India 
green,  and  came  back  yellow  ”;  and  when  their  generally 
cadaverous  appearance  led  Theodore  Hook  to  stigmatise 
old  Indians  as  “  Yellow-bellies.”  Now  the  retired  Anglo- 
Indian  usually  appears  to  have  nearly  as  large  a  share  of 
normal  red  corpuscles  as  his  stay-at-home  English  neighbours 
have. 

Mr.  Hare  quotes  from  Sir  Ranald  Martin  a  case  of  mala¬ 
rious  anaemia,  which  must  bring  back  the  remembrance  of 
many  like  it  to  old  Indian  practitioners.  An  originally 
plethoric  officer,  aged  thirty-two,  who  was  treated  for 
Remittent  Fever,  with  bleeding,  leeches,  calomel  to  saliva¬ 
tion,  with  a  continuous  course  of  powerful  purgatives,  the 
diet  consisting  of  sago  and  arrowroot,  is  described  as  being 
in  a  state  of  complete  anaemia,  with  a  pale,  bloated,  lemon- 
coloured  complexion,  and  mossy,  dry,  scanty  hair ;  the 
abdomen  doughy  and  inelastic;  the  skin  dry,  harsh,  and  con¬ 
stricted.  “  This,”  Martin  adds,  “  is  an  example  of  simple 
uncomplicated  anaemia,  resulting  from  Intermittent  and 
Remittent  Fever,  and  their  necessary  treatment  by  blood¬ 
letting,  mercury,  purgatives,  and  low  diet.  The  patient  had 
"been  under  able  and  experienced  medical  treatment,  but 
the  malarious  influences  proved  too  strong  to  be  resisted 
•even  by  his  strong  European  constitution.” 

HcBmorrhages  and  Sanguinolent  Oozings  in  Malarious 
Cachexia. 

We  see,  at  the  instant  of  the  article,  as  the  hue  of  the 
visage  is  changed  by  the  arrest  of  arterial  supply,  that  thick 
mulberry-coloured  streams  of  grumous  cruor  escape  from 
the  nostrils  and  corner  of  the  mouth.  This  form  of  so- 
called  haemorrhage  is  the  type  of  those  spontaneous  oozings 
which  take  place  in  malarious  cachexia,  which  are  rarely, If 
ever,  true  haemorrhage,  but  a  voidance  of  the  debris  of  dis¬ 
organised  blood  no  longer  fit  for  the  uses  of  the  system. 

(a)  “  Spirillum  Fever  ....  as  seen  in  Western  India,”  1882. 


Wherever  there  is  such  dyscrasis  of  the  blood,  haemorrhage 
from  wounds,  post-partum,  and  in  menstruation  is  likely  to 
become  formidable. 

Although,  unquestionably,  Indian  Anaemia  was  in  old 
times  largely  due  to  blood-dyscrasis  directly  resulting  from 
spoliative  treatment,  marsh  poison  certainly  produces  blood- 
disease  in  that  country.  Hare,  who  put  down  the  use  of 
calomel  and  blood-letting  in  Indian  fevers,  writes: — “In 
Burmah,  at  Rangoon,  where  I  witnessed  malaria  in  its  most 
intense  forms,  I  had  young  healthy  patients  so  poisoned 
that  their  blood  became  as  much  decomposed  as  by  the 
poison  of  a  snake-bite,  and  haemorrhage  took  place  from 
the  gums  and  nostrils  ;  and,  in  one  man  with  an  open  bubo, 
there  was  uncontrollable  dark  venous  bleeding.  These  cases 
were  of  frequent  occurrence,  and  the  face  and  lips  had  a 
blue  venous  tinge.”  I  think  that,  in  all  probability,  there 
was  a  scorbutic  taint  in  the  above  cases.  Among  the  many 
specious  reasons  upon  which  the  old  practice  of  blood-letting 
in  fevers  was  based,  was  the  idea  of  getting  rid  of  bad  blood, 
suggested  by  these  spontaneous  oozings  of  sanguinolent 
serum  in  which,  generally,  clots  do  not  form,  which  are,  as  I 
believe.  Nature’s  own  mode  of  clearing  the  system  of  faulty 
blood.  These  spontaneous  discharges  are  frequent  in  India. 
Sir  Ranald  Martin  told  me  that,  being  on  service  in  a  jungly 
district,  he  was  attacked  by  the  fever  which  prevailed  in  the 
force,  and  became  insensible.  He  awakened  from  complete 
unconsciousness,  and  found  himself  drenched  with  blood 
which  had  flowed  from  his  nose.  Certainly  these  spon¬ 
taneous  attacks  of  epistaxis,  where  the  brain  has  been  a  good 
deal  affected,  appear  to  do  far  more  good  than  our  leechings 
do.  In  the  case  of  an  Indian  brother  officer  which  I  saw 
after  my  return  to  England,  violent  epistaxis  occurred  in 
cholsemia  from  gall-stone.  It  was  most  profuse  and  obsti¬ 
nate,  requiring  plugging,  but  it  appeared  to  be  decidedly 
beneficial,  although  the  sick  man  was  more  than  seventy 
years  old.  I  lately  heard  of  a  young  gentleman  whose 
health  had  been  much  tried  in  a  Civil  Service  examination, 
who,  after  the  ordeal  was  over,  had  violent  epistaxis  which 
recurred  for  about  eight-and-forty  hours.  When  his  son-in- 
law  landed  in  England,  James  the  Second,  being  doubtless 
painfully  overworked  in  mind  and  body,  had  several  attacks 
of  bleeding  from  the  nose.  His  death  was  caused,  thirteen 
years  later,  by  apoplexy. 

I  was  a  good  deal  concerned,  many  years  ago,  in  the  case 
of  a  young  officer  in  India  who  was  cashiered  for  drunken¬ 
ness.  The  chief  morbid  result  of  the  chronic  alcoholic 
poisoning  which  he  had  brought  upon  himself  was  almost 
uncontrollable  haemorrhage  from  the  nose  and  from  an  ulcer 
upon  the  prepuce.  I  not  long  since  heard  of  a  poor  boy, 
suffering  from  purpura,  who  is  subject  to  violent  attacks  of 
epistaxis,  which  leave  him  exhausted  and  ansemiated,  but 
he  recovers  colour  and  strength  in  a  few  days.  A  delicate 
and  pale,  but  healthy,  girl  of  twelve,  born  in  India,  but 
taken  home  in  a  few  months,  generally  has  epistaxis  just  as 
a  cold  in  the  head  is  passing  off.  Epistaxis  is  of  very  fre¬ 
quent  occurrence  in  India,  especially  in  spleen  cases.  I 
have  not  seen  that  periodic  epistaxis  curable  by  quinine 
which  has  been  observed  elsewhere. (b)  A  young  and  active 
native  subordinate  (of  European  habits)  of  my  own  in  Cal¬ 
cutta,  used  from  time  to  time  to  get  most  formidable 
haemorrhage  from  the  bowels.  Internal  piles  were  not  the 
cause.  He  always  recovered  perfectly  in  a  day  or  two.  It 
must  be  recollected  that  here,  as  in  menstruation,  Nature 
elects  her  own  portal — some  highly  vascular  surface,  most 
commonly  the  nose  or  intestinal  mucous  membrane — for  col¬ 
lecting  and  voiding  the  offending  blood.  She  does  not  call  in 
the  surgeon,  whose  leeches  and  lancet  do  not  remove  the 
blood  when  and  whence  she  determines  to  eliminate  it.  Con¬ 
sequently,  it  is  not  surprising  that  this  clumsy  withdrawal  of 
good  living  blood,  of  which  the  system  had  less  than  enough, 
often  killed  the  sick  or  left  them  blanched  for  life.  Profuse 
as  these  spontaneous  “  hsemorrhages  ”  often  are,  we  ought, 
with  due  regard  to  the  patient’s  strength,  to  be  usually  dis¬ 
inclined  to  check  them.  Almost  uncontrollable  haemorrhage 
from  leech-bite  was  noticed  by  most  of  the  older  Indian 
writers.  Twining  says  :  “  The  altered  appearance  of  the 
blood  in  many  of  these  fevers,  which  arise  from  exposure 
to  the  malaria  of  the  jungles,  is  very  remarkable,  and 
merits  careful  observation.  Connected  with  this  morbid  con¬ 
dition  of  the  blood,  there  appears  a  disorder  of  the  vascular 

(b)  “  Copland’s  Dictionary ”  (Art.,  “Intermittent  Fever”)  and  Med. 
Zeitung,  No.  33,  1836. 


682 


Medical  Times  and  Gazette. 


CH EVERS  ON  THE  ORDINARY  DISEASES  OE  INDIA. 


Deo.  15,  lgeSt- 


system  which  favours  prolonged  and  profuse  oozing  of  blood 
from  leech -bites.”  Hare  notices  the  frequent  occurrence 
of  hemorrhage  (most  generally  in  fowls,  etc.)  after  the  bite 
of  some  poisonous  snakes.  About  a  year  ago  an  old  friend 
asked  me  what  he  was  to  do  for  dreadful  attacks  of  ague, 
which  commenced  soon  after  his  retirement  in  England. 
More  than  thirty  years  previously  he  had  a  very  dangerous 
attack  of  Jungle  Remittent  at  Chittagong.  I  took  no  blood 
from  him  then.  But,  upon  his  getting  pain  and  swelling  of 
one  testicle,  a  frequent  sequel  of  Bengal  Fever,  I  applied  a 
few  leeches.  He  felt  relieved,  but,  having  gone  to  sleep 
after  I  had  attended  to  the  bites,  he  bled  immoderately. 
Twenty  years  later,  the  state  of  the  testicle  prevented  him 
from  playing  cricket.  He  is  now  a  great  pedestrian  and 
lawn-tennis  player,  but  probably  a  chill  would  bring  on  a 
return  of  Chittagong  Fever,  and  perhaps  of  local  pain.  In 
anaemic  children,  lancing  the  gums  has  occasioned  serious 
loss  of  blood. 

Under  this  head  I  would  place  the  transitory  Hcematuria 
or  Hemoglobinuria,  of  which  I  have  seen  cases  in  anaemic  | 
European  children  in  Bengal.  Mr.  H.  De  Tatham  gives(c) 
a  case  of  Hematuria  in  a  native  suffering  from  Scurvy.  In 
the  August  number  of  the  Practitioner  for  1868,  Dr.  Lionel 
Beale  wrote  upon  “  Periodic  Hematuria,”  remarking  that 
the  disease  is  perhaps,  after  all,  more  closely  allied  to 
ague  than  to  any  affection  of  which  hematuria  is  a  symp¬ 
tom.  The  researches  of  Prof.  Murri,  of  Bologna,  appear  to 
bring  us  still  nearer  to  the  conclusion  that  at  least  some 
cases  of  Hemoglobinuria  are  of  malarious  origin.  A  very 
full  account  of  this  disease,  which  is  now  properly  designated 
by  Lebert  as  Paroxysmal  Hemoglobinuria,  as  the  urine 
does  not  contain  normal  blood-corpuscles,  but  hemoglobin,  is 
given  by  Dr.  Robert  Saundby.  (d)  Dr.  Saundby  mentions  that 
there  has  been  a  previous  history  of  ague  in  several  of  the 
cases,  and  that  there  has  been  splenic  enlargement  in  some 
of  them,  but  he  considers  that  these  states  are  exceptional. 

In  its  typical  form  the  attack  resembles  ague;  and  it  is 
added  that  “  a  few  cases  have  resided  for  a  length  of  time 
in  a  hot  climate.”  “Quinine  has  seemed  of  most  service.” 
He  holds  that  “  the  relation  of  this  disease  to  ague  is  ex¬ 
ceptional  and  not  well  made  out.  As  the  attack  is  gene¬ 
rally  excited  by  exposure  to  cold,  he  recommends  residence 
in  a  tropical  climate  as  a  means  of  warding  off  attacks.  We 
know  that  this  measure  has  been  tried,  but  we  doubt  its 
prudence.  We  have  seen  an  attack  of  this  kind  (I  called  it 
Hsematuria  then)  on  an  unusually  cold  morning  in  Cal¬ 
cutta  ;  and  undoubtedly  there  are  few  tropical  climates  so 
free  from  malaria  as  to  invigorate  the  constitutions  of  those 
in  whom  “the  microscopical  characters  of  the  blood  are 
those  of  slight  anaemia.” 

The  late  Dr.  Robert  Druitt,  having  been  attacked,  with 
“intermittent  hsematuria”  in  1866,  attributed  to  a  severe 
chill  when  he  was  suffering  from  overwork,  went  to  Madras 
in  1873  and  1874,  but  we  are  told(e)  that  his  disease  pro¬ 
gressed  with  unequal  steps,  but  always  downwards  until 
his  death  in  May  last.  I  cannot  think  the  voyages  to  and 
fro,  and  residence  in  such  a  climate  as  that  of  Madras,  at  all 
likely  to  benefit  such  a  case  as  this.  Hemoglobinuria  is 
evidently  one  of  Nature’s  modes  of  clearing  the  system  of 
faulty  blood.  Doubtless,  medical  men  in  India  now  dis¬ 
tinguish  true  spontaneous  haemorrhages  from  discharges  of 
haemoglobin.  My  friend  Dr.  Francis  directed  attention  to 
this  point  in  1868.  (f) 

At  the  International  Congress  of  1881  a  paper  by  Dr. 
Dreschfeld  and  Mr.  Stocks  was  read,  “  On  the  Hemoglo¬ 
binuria  produced  by  Large  Doses  of  Chlorate  of  Potash,”  (g) 
and  a  discussion  followed.  A  woman  having  taken  about 
an  ounce  and  a  half  of  solid  chlorate  of  potash  in  twenty- 
four  hours  for  a  slight  sore-throat,  “  was  suddenly  taken  ill 
with  cyanosis  and  dyspnoea,  and  passed  masses  of  haemo¬ 
globin  both  per  rectum  and  per  vaginam';  the  urine  and 
vomited  matter  also  contained  masses  of  hemoglobin.  On 
the  third  day  she  became  slightly  jaundiced,  while  the 
cyanosis  passed  off.  On  the  fourth  day  she  died.”  Beyond 
an  enlargement  of  the  spleen,  which  was  painful  to  the 
touch,  no  organ  was  found  diseased.  Either  previously 

( c)  Bombay  Medical  and  Physical  Transactions,  1876,  page  276. 

(d)  Medical  Times  and  Gazette,  May  1,  1830,  and  February  4, 1881.  Ibid., 
March  4,  1882. 

(e)  Ibid.,  May  26,  1883. 

(f)  Indian  ; Medical  Gazette,  December  of  that  year:  “Periodic 
Hsematuria.” 

(g)  “  Transactions,”  vol.  i.,  page  398. 


existing  splenic  disease  rendered  the  blood  liable  to  dissolu¬ 
tion,  or  a  poisonous  dose  of  a  potash  salt  caused  the  splenic 
and  sanguineous  lesions.  I  have  always  avoided  the  use  of 
chlorate  of  potash  in  diphtheria,  and  of  large  doses  of  other 
potash  salts  in  every  form  of  ataxic  disease. 

Twice  in  Calcutta  I  noticed  the  occurrence,  with  an  in¬ 
ternal  of  many  years,  of  a  type  of  cholera  in  which  the  rice- 
water  stools  were  tinged  with  blood.  On  the  first  occasion 
a  considerable  number  of  these  cases  did  so  well  that  I 
persuaded  myself  that  this  moderate  loss  of  blood  from  the 
intestinal  surface  was  a  good  symptom.  In  the  second  out¬ 
break  the  disease  was  so  fatal  that  my  favourable  impression: 
was  dispelled.  In  1867,  Mr.  John  F.  Foster  published(h)' 
the  case  of  an  artilleryman  at  Cawnpore  who  had  suffered 
during  the  whole  of  the  previous  year  from  constant  but 
painless  diarrhoea,  and  who  was  brought  to  hospital  after  he 
had  taken  part  in  a  brigade  parade  that  morning.  At 
3  p.m.  his  stools  were  very  frequent  and  in  large  quantity, 
consisting  “  of  clear  fluid  of  a  deep  crimson  colour,  showing 
no  tendency  to  coagulate.”  There  was  no  straining  or 
tenesmus.  The  abdomen  was  hot  and  very  tender.  Pulse 
fast  and  feeble ;  tongue  coated ;  head  hot,  with  clammy 
perspiration  upon  his  brow ;  countenance  extremely  anxious ; 
great  restlessness  and  thirst.  In  an  hour  he  was  collapsed,, 
and  purged  every  ten  or  twelve  minutes.  At  9  p.m.  the 
collapse  was  greater,  extremities  cold,  cramps  in  arms  and 
legs,  abdominal  tenderness  less,  countenance  shrunken,  voice 
feeble,  and  pulse  barely  perceptible.  Constant  yawning  and. 
extreme  restlessness.  No  vomiting  or  sensation  of  sickness. 
The  motions  became  gradually  of  a  lighter  colour,  and  con¬ 
tained  flocculent  particles.  Collapse  increased  until  his 
arms  and  legs  became  blue;  pulse  imperceptible  at  the 
wrist ;  faculties  unimpaired.  He  expired  with  difficult 
breathing  in  twenty-two  hours  from  the  commencement  of 
the  attack.  The  ascending  colon  was  slightly  congested,, 
and  many  of  the  solitary  glands  were  surrounded  by  a  thin 
zone  of  blood  effused  beneath  the  mucous  membrane ;  but 
there  was  no  ulceration  or  breach  of  tissue.  Both  small 
and  large  intestines  were  distended  with  clear  fluid  of  a 
light  yellow  colour,  in  which  floated  numerous  flocculent 
particles  like  those  in  the  rice-water  dejections  of  cholera. 
The  spleen  weighed  one  pound  eight  ounces,  was  slate- 
coloured,  and  of  very  pulpy  consistence.  This  patient  had 
suffered  from  two  attacks  of  hepatitis  and  one  of  splenitis 
but  not  from  dysentery,  diarrhoea,  or  scurvy. 

Similar  as  this  case  was,  in  some  of  its  leading  features, 
to  one  of  haemorrhagic  cholera,  I  quite  coincide  in  the 
opinion  of  Mr.  Foster  and  the  Editor  of  the  Gazette  that  it 
was  one  of  Remittent  Fever ;  I  would  say  a  Pernicious 
form  of  that  disease,  closely  linking  it  with  true  Cholera. 
The  Editor  mentions  that  similar  cases  were,  he  believes,, 
met  with  in  men  of  the  101st  Regiment,  who  were  saturated . 
with  malarious  poison  when  that  corps  was  stationed  at 
Mooltan  a  few  years  previously.  He  adds,  “  The  effect  of 
malaria  in  inducing  a  state  of  the  blood  favourable  to  the 
occurrence  of  haemorrhage  is  too  well  known  at  Peshawur.” 
Two  other  cases,  much  resembling  Mr.  Foster’s,  of  Pernicious 
Malarious  Fever  with  bloody  flux,  are  given  by  Baboo 
Ooday  Chund  Dutt.  I  have  cited  them  in  tracing  the 
close  relationship  which  exists  between  Pernicious  Remit¬ 
tent  Fever  and  Cholera.  I  only  notice  these  cases  here  on. 
account  of  their  markedly  hemorrhagic  character,  although 
the  disease  which  they  characterise  is  no  mere  haemorrhage. 

In  the  above  article  Mr.  Foster  mentions  that  he  has 
notes  of  a  case  of  fever  which  came  under  his  observation, 
which  was  rapidly  fatal  in  consequence  of  passive  hemor¬ 
rhage  from  the  whole  of  the  mucous  membrane  of  the  lungs — 
a  characteristic  occurrence  in  black  death,  sweating  sickness, 
Pali  Plague,  and  Mahamurree. 

In  a  report  published  in  1842,(i)|Mr.  Leith  notices  a  case 
of  “  Intermittent  Menorrhagia  of  tertian  type  in  an  Indo- 
Briton  (half-caste)  wife  of  a  soldier,  which  was  cured  with 
quinine  given  in  repeated  doses  close  on  the  expected  time* 1 
of  return.”  I  have  seen  a  great  deal  of  very  troublesome- 
menorrhagia  in  Bengal ;  but,  perhaps  by  blamable  over¬ 
sight,  never  observed  that  it  assumed  a  periodic  character. 
There  is  generally  amenorrhoea  in  splenic  cachexia. 

Post-partum  '  Hcemorrhage  is  probably  the  greatest  and 
most  frequent  danger  attendant  upon  parturition  in  India. 

I  shall  revert  to  this  subject  in  speaking  of  Puerperal  Fever. 

(h)  Indian  Medical  Gazette  for  December  of  that  year. 

(i)  Indian  Journal  of  Medical  and  Physical  Science ,  yol.  ix.,  page  71(X 


.’Medical  Times  and  Gazette, 


MEDICAL  AND  SUEGICAL  PEACTICE. 


Hcematemesis  is  a  not  very  frequent  occurrence  in  splenic 
•disease,,  but  I  know  of  two  marked  cases  in  officers.  It  was 
observed  by  Dr.  Duncan  Stewart  that  such  hemorrhage 
**<  often  effects  a  salutary  change  in  the  diseased  organ,  and 
conduces  to  its  cure/’  Doubtless,  when  the  haemorrhage  is 
large,  the  size  of  the  spleen  is  temporarily  reduced ;  but,  in 
my  experience,  haematemesis  only  adds  gravely  to  the  sum 
of  splenic  cachexia  and  its  attendant  anaemia. 

Those  practising  in  Bengal  have  abundant  evidence  of  the 
fact  that  the  marsh  poison  and  deficient  food  induce  extreme 
poverty  of  the  blood.  Sir  Ranald  Martin  noticed  that,  in 
operating  at  the  old  Chandney  Hospital  at  Calcutta,  the 
blood  often  looked  like  thin  claret. (k)  I  have  repeatedly 
seen  this,  especially  in  a  poor  fisherman  whose  thigh  I  ampu¬ 
tated  in  consequence  of  a  desperate  crocodile-bite.  After 
.every  visible  artery  had  been  secured,  there  was  oozing  of 
thin  dark  blood  from  the  whole  surface  of  the  stump  until 
he  sank. 

With  these  expressions  of  states  of  blood-disintegration 
must  be  ranged  the  bloody  sweats  of  plague  and  malignant 
fever  described  by  Hodges  and  Huxhatn  ;(1)  the  “haemor¬ 
rhages,”  ecchymoses,  and  cardiac  blood-concretions  of  scor¬ 
butus;  and  also  the  yellow  suffusions,  petechiae,  “flea-bitis,” 
and  black  vomit  of  yellow  fever,  of  the  relapsing  fever  of 
India,  of  the  yellow  plague  of  the  middle  ages,  and  of  certain 
-grave  forms  of  tropical  paludal  remittent. 

The  whole  of  the  Indian  blood-diseases  ought  to  be  care¬ 
fully  re-investigated  in  that  country— a  multitude  of  points, 
such  as  the  following,  being  thoroughly  wrought  out  in 
localities  where  malarial  cachexia  is  most  prevalent  and  of 
“most  extreme  intensity,  in  both  Europeans  and  natives. 
Hertz’s  observations,  on  blood-pigmentation  in  anaemia 
should,  as  Sir  Joseph  Fayrer  indicates,  be  practically  fol¬ 
lowed  out.  Dr.  Growers  found  that  4  per  cent,  of  cases  of 
lymphadenoma  were  related  to  intermittent  fever.  This 
disease  occurred  very  rarely  in  my  Indian  practice.  The 
•condition  of  the  blood  and  viscera  should  be  examined  as  far 
as  possible  in  all  such  cases.  Twenty-five  per  cent,  only  of 
Dr.  Gowers’  cases  of  splenic  leucocythremia  were  found  to 
have  either  suffered  from  intermittent,  or  lived  in  an  ague 
district.  A  complete  series  of  observations  upon  the  red  and 
white  corpuscles  in  Indian  malarious  cachexia  is  needful. 
What  of  progressive  pernicious  anaemia  in  pregnancy,  which 
is  not  considered  to  be  malarious,  in  India  ?  What  also  of 
leukcemia-myelogenica  in  that  country  ? 

In  the  majority  of  cases,  malarious  anaemia  is  distinguish¬ 
able  by  a  single  glance  at  the  patient’s  countenance ;  but  in 
some  cases,  especially  in  young  women,  the  roundness  (in 
reality,  oedematous  puffiness)  of  the  face  is,  just  at  first  sight, 
deceptive.  In  naturally  florid  Europeans,  the  colour  of  the 
lips  and  cheeks  is  sometimes  misleading,  but,  in  all  severe 
•cases,  the  blanched  conjunctiva  of  the  lower  lid  is  distinctive. 
Daily  examination  of  the  eyelid  is  our  guide  in  the  employ¬ 
ment  of  quinine,  iron,  and  nourishing  diet. 

{To  be  continued.) 


Bismuth  as  a  Dressing  in  Operations  for  Cica¬ 
tricial  Contraction. — In  a  communication  to  the  New 
York  Medical  and  Surgical  Society  (New  York  Med.  Record, 
November  10),  Dr.  Post  relates  a  case  in  which  the  line  of 
the  incisions  made  into  cicatricial  tissue  was  filled  with 
bismuth,  sprinkled  by  means  of  a  pepper-box,  the  powder 
adhering  to  the  parts  and  forming  a  kind  of  scab.  At  each 
dressing  another  quantity  was  applied.  This  kept  down 
exuberant  granulations,  while  scarcely  any  inflammation 
took  place,  and  but  a  very  small  amount  of  suppuration 
was  present.  He  had  since  used  the  dressing  in  a  number 
of  cases,  and  with  better  effects  than  could  be  obtained  by 
the  use  of  any  other  application.  He  had  also  found,  in 
•granulating  surfaces  following  burns,  that  bismuth  dimi¬ 
nished  the  amount  of  granulations,  the  contraction  of  which 
:is  the  chief  cause  of  the  deformity.  In  neither  children  nor 
adults  had  the  remedy  caused  any  ill  effect. _ 

(k)  Huxhatn  says,  in  speaking  of  bloody  sweat,  “It  is  observable  that, 
when  this  sort  of  haemorrhage  happens  from  the  nose,  the  matter  is  a  thin 
bloody  ichor,  not  concreting  as  blood  commonly  doth  from  the  nose  of 
persons  in  health,  or  in  an  inflammatory  fever.”  “  Some  chlorotic  girls 
are  vastly  apt  to  bleed  from  the  nose,  and  yet  their  blood  doth  but  j  ust 
•colour  a  linen  cloth.” 

(l)  Huxham  had  a  very  fair  idea  of  embolism  and  pigment  plugging. 
“The  petechice,  vibices,  or  livid  stigmata  that  very  often  attend  these 
Hemorrhages,  show  that  the  Blood-globules  are  dissolved,  or  broken 
flown,  and  enter  into  the  serous  arteries,  vasa  exhalentia,  etc.,  where 
sticking  fast,  they  form  these  appearances.” 


REPORTS  OF 

HOSPITAL  PRACTICE  IN 
AND  SURGERY. 

- -9 - 

DEVON  AND  EXETEE  HOSPITAL. 


THREE  CASES  OF  FATAL  INJURY  TO  THE  SPINE. 

[Reported  by  Arthur  G.  BlomfieldJM.D.,  House-Surgeon.] 

Case  1. — Fracture  of  Fourth  Cervical  Vertebra — Immediate 
Paraplegia — Death. 

(Under  the  care  of  Mr.  CAIRD.) 

William  B.,  labourer,  aged  thirty-five,  was  admitted  into 
the  Exeter  Hospital  on  September  30, 1882.  Three-quarters 
of  an  hour  before  his  admission,  while  working  as  an  ex¬ 
cavator  on  the  South-Western  Railway,  a  quantity  of  loose 
earth  fell,  striking  him  on  the  chest,  and  knocking  him 
backwards,  so  that  the  back  of  his  neck  came  in  violent 
contact  with  the  buffer  of  the  waggon  he  was  loading. 

On  admission  his  extremities  were  warm,  but  he  was  suffer¬ 
ing  severely  from  shock.  His  voice  was  a  mere  whisper,  and  he 
complained  of  pain  in  the  nape  of  the  neck,  but  nowhere  else. 
There  was  tenderness  on  pressure  over  the  cervical  spines, 
but  no  unnatural  mobility,  nor  any  sign  of  fracture  or  dislo¬ 
cation.  The  arms,  chest,  abdomen,  and  lower  extremities 
were  completely  paralysed  both  as  to  motion  and  sensation. 
The  respiration  was  most  shallow  and  gasping,  the  dia¬ 
phragm  alone  acting,  but  very  feebly.  He  remained  in  the 
same  state,  respiration  getting  feebler  and  shallower,  until 
5  p.m.,  when  he  died,  consciousness  remaining  until  the 
last. 

Post-mortem. — On  dissecting  down  to  the  cervical  spine 
there  was  found  effusion  of  blood  into  the  surrounding 
soft  parts.  The  fourth  cervical  vertebra  was  fractured ; 
the  spinous  process  and  laminae  were  broken  and  separated 
from  the  transverse  processes,  so  that  they  were  quite  loose 
and  somewhat  pressing  upon  the  cord.  The  spinal  mem¬ 
branes  were  full  of  extra vasated  blood  at  this  point ;  the 
cord  itself  congested,  bub  not  lacerated.  The  rest  of  the 
body  was  not  examined. 

Case  2. — Fall  from  Steps  while  carrying  a  Sack — Immediate 

Paralysis  of  Chest,  Abdomen,  and  Lower  Extremities — 

Spinal  Haemorrhage — Death. 

(Under  tbe  care  of  Mr.  CAIRD.) 

William  B.,  a  waggoner,  aged  forty,  was  admitted  into 
the  Exeter  Hospital  on  September  3,  1883.  Between  one 
and  two  o’clock  on  the  day  of  his  admission,  while  carrying 
a  sack  of  flour  on  his  back  up  some  steps  into  a  loft,  the 
steps  slipped  and  he  fell.  He  let  go  the  sack  of  flour,  which 
fell  on  to  a  table  and  broke  it,  and  he  fell  to  the  ground 
between  the  steps  and  an  oven.  He  tried  to  rise,  bub  was 
unable  to  do  so.  He  was  admitted  into  the  hospital  about 
5.30  the  same  afternoon.  He  was  quite  conscious,  and  com¬ 
plained  of  numbness  all  over  the  lower  part  of  his  body ;  he 
also  complained  of  some  little  pain  between  the  shoulders. 
There  was  no  external  evidence  of  fracture  or  dislocation 
of  the  spine.  There  was  complete  paralysis  both  of  sensa¬ 
tion  and  motion  of  the  entire  body  from  the  level  of  the 
second  rib  downwards.  The  breathing  was  jerky  and 
entirely  diaphragmatic.  He  lay  quite  powerless  in  bed,  but 
was  able  to  move  the  arms  about,  and  said  he  “  felt  them  all 
right.”  There  was  retention  of  urine  and  erection  of  the 
penis.  He  remained  in  much  the  same  state  until  noon  next 
day,  when  he  began  to  wander  slightly,  and  the  breathing 
became  more  jerky.  Gradually  he  became  unconscious,  with 
symptoms  of  pulmonary  congestion,  and  died  at  5.30  p.m., 
twenty-four  hours  after  his  admission. 

Post-mortem. — Back:  No  external  marks  of  violence.  An 
incision  was  made  over  the  spinous  processes  from  the  sixth 
cervical  vertebra  to  the  lower  dorsal  region.  On  dissecting 
back  the  soft  parts  there  was  seen  some  effusion  of  blood 
into  the  muscles  and  neighbouring  parts.  On  opening  the 
spinal  canal  the  spinal  cord  could  not  be  seen,  and  the  entire 
canal  from  the  level  of  the  sixth  cervical  region  to  low  down 
in  the  dorsal  was  full  of  blood.  On  removing  it  the  spinal 
cord  and  its  membranes  were  seen;  there  was  no  effusion  of 
blood  between  the  membranes  and  the  cord,  or  into  the 
substance  of  the  cord  itself,  which  was  normal  in  colour. 


681 


Medical  T.mes  and  Gazette. 


INTEMPERATE  TEMPERANCE. 


Dec.  15,  18S3. 


appearance,  and  consistence.  The  other  organs  were  not 
examined. 

Case  3. — Fall  from  a  Window — Immediate  Paralysis  of  Chest, 

Abdomen,  and  Lower  Extremities — Comminuted  Fracture 

of  Left  Leg — Death  from  Syncope  on  the  Eighth  Day. 

(Under  the  care  of  Mr.  HARRIS.) 

Richard  W.,  aged  sixty-three,  was  admitted  into  the 
Exeter  Hospital  on  November  5,  1883.  He  was  engaged  on 
the  day  of  the  accident  in  taking  out  some  glass  from  a 
window  about  twelve  feet  from  the  ground,  when  the  sill  on 
which  he  was  sitting  suddenly  gave  way  and  precipitated 
him  to  the  garden  below.  There  was  no  loss  of  conscious¬ 
ness,  and  on  his  admission  it  was  found  that  he  had  sus¬ 
tained  a  comminuted  fracture  of  the  left  tibia  at  its  lower 
third.  There  was  complete  paralysis  both  of  motion  and 
sensation  of  the  entire  body  from  the  level  of  the  second 
rib  downwards.  There  was  very  slight  movement  in  breath¬ 
ing  of  the  top  of  the  chest,  and  the  chest- walls  were  drawn 
in  during  inspiration.  The  breathing  was  almost  entirely 
diaphragmatic,  and  was  attended  by  a  well-marked  down¬ 
ward  jerk  of  the  diaphragm,  which  seemed  to  shake  the  bed 
upon  which  he  was  lying.  The  heart- sounds  were  normal, 
and  the  pulse  small  but  regular.  There  was  retention  of 
urine,  but  no  erection  of  the  penis.  There  were  no  external 
marks  of  violence  about  the  spine,  but  he  complained  of 
soreness  between  the  shoulders,  and  a  few  days  before  his 
death  a  large  bruise  made  its  appearance  over  the  lumbar 
spine.  He  was  suffering  from  chronic  bronchitis.  At  no 
time  was  there  any  return  of  motion  or  sensation  in  the 
parts  paralysed,  though  at  times  he  said  he  felt  “  pins  and 
needles”  in  his  legs.  The  catheter  was  used  regularly, 
and  no  sensation  was  felt  on  passing  it ;  the  urine  remained 
quite  clear  up  to  the  time  of  his  death.  The  intestines 
became  much  distended  with  flatus,  but  this  was  speedily 
relieved  by  a  turpentine  enema.  The  face  remained  quite 
clear,  nor  were  there  any  signs  of  advancing  pulmonary  con¬ 
gestion.  He  died  suddenly  on  the  morning  of  November  12, 
having  survived  exactly  one  week  from  the  date  of  the  acci¬ 
dent.  Unfortunately,  there  was  no  post-mortem  examination; 
but  as  the  symptoms  of  the  case  are  in  most  respects  similar 
to  the  preceding  case,  it  seems  probable  that  they  depended 
upon  haemorrhage  into  the  spinal  canal.  It  is  interesting 
to  note  that  in  this  case  the  immediate  cause  of  death  was 
syncope,  while  in  the  second  case  death  resulted  from 
asphyxia. 


The  Communication  of  Cancer.  —  Dr.  Gaillard 
Thomas  says,  in  answer  to  a  question  by  one  of  his  clinical 
class — “  There  is,  undoubtedly,  great  danger  of  propagating 
cancer  by  sexual  intercourse,  and  repeated  instances  of 
cancer  of  the  penis  contracted'  in  this  way  are  on  record. 
The  slightest  abrasion  of  the  penis  may  be  sufficient  for  the 
absorption  of  virus  from  the  malignant  growth,  and  the 
husbands  of  women  suffering  from  cancer  of  the  uterus 
should,  therefore,  always  be  warned  against  intercourse 
with  their  wives.  This,  as  you  will  see,  is  a  matter  of  very 
considerable  importance,  and  I  am  glad  that  the  point  has 
been  suggested.” — New  York  Med.  Record,  November  10. 

Iodoform  in  Pemphigus Pruriginosus. — Dr.  Garland, 
after  relating  a  case  (Boston  Med.  Jour.,  August  23)  in  which 
iodoform  acted  very  beneficially,  observes: — “This  was  a 
case  of  pemphigus  pruriginosus,  which  Hebra  declares  in¬ 
curable  and  always  fatal.  The  treatment  consisted  of  rest 
(in  the  horizontal  position),  small  doses  of  quinine,  good 
diet,  cleanliness,  carbolic  wash,  and  iodoform-powder.  The 
rapid  improvement  in  the  appearance  of  the  ulcers  after  the 
application  of  the  iodoform  was  noticeable  by  all  who  watched 
the  case.  Moreover,  it  was  noticed  that  new  blisters  ceased 
to  form  after  the  application  of  the  powder,  and,  as  we 
know  that  iodoform  is  readily  absorbed  by  raw  surfaces, 
the  question  arises  as  to  how  far  the  constitutional  effect  of 
the  absorbed  iodoform  contributed  to  this  happy  result. 
About  a  year  after  treating  the  above  case,  I  noticed  a 
similar  one  reported  by  an  English  physician,  which  was 
treated  with  Fowler’s  solution,  and  the  reporter  of  the  case 
claimed  that  this  solution  is  an  infallible  remedy  for  pem¬ 
phigus.  The  success  of  my  own  case  would  indicate  that  we 
also  have  a  very  reliable  remedy  in  iodoform.”  The  patient 
in  this  case  was  seventy-eight  years  of  age,  and  280  ulcers 
and  blisters  appeared  on  his  limbs  and  trunk. 


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Illegal  Ciraes  ani)  §%}ttk 


SATURDAY,  DECEMBER  15,  1S83. 

- ♦ - 

INTEMPERATE  TEMPERANCE. 

The  leading  journal  has  acquired  a  reputation  for  steering’ 
clear  of  emotional  currents,  but  no  utterance  on  its  part  will 
commend  itself  more  to  sensible  men  than  its  recent  remarks 
on  alcohol :  “  Nothing  more  absurd  can  be  imagined  than 
the  demand  for  a  voluntary  abdication  by  mankind  of  the 
right  to  apply  alcohol  as  an  article  of  food.  If  its  uses 
were  now  first  discovered,  the  discoverer  would  doubtless  be 
hailed  as  among  the  greatest  of  human  benefactors.”  To 
the  adherents  of  the  temperance  cause  these  observations 
may  appear  paradoxical,  if  not  worse ;  but  they  will  com¬ 
mend  themselves  to  all  men  who  love  sweet  reasonableness,, 
in  which  category  we  hope  that  we  may,  without  boast¬ 
fulness,  include  ourselves.  We  have  no.  intention,  be  it 
stated  at  once,  to  depreciate  the  efforts  that  have  been 
made  to  lessen  the  evils  of  excess  in  alcohol,  and  to  check 
its  cause:  they  have  our  cordial  sympathy,  and  deserve 
our  ready  and  earnest  aid ;  but  for  these  very  reasons  we- 
are  the  more  anxious  that  the  dual  character  of  the  work 
should  not  be  overlooked,  and  that  its  progress  should  not 
be  smothered  by  misdirected  energy,  or  delayed  by  checks 
which  are  the  natural  outcome  of  intemperate  enthusiasm. 
Medical  men,  who  see  the  effects  of  drink  more  frequently 
and  more  clearly  than  any  other  members  of  the  community,, 
are  not  likely  to  ignore  its  potential  harmfulness  ;  and  they 
have  been  the  first  and  the  most  consistent  in  condemning 
especially  that  pernicious  variety  of  drinking  which  stops 
far  short  of  actual  drunkenness.  They  know  that  the 
causes  of  alcoholism  and  the  effects  of  alcoholism  are  not 
one  and  the  same  ;  and  that  the  remedy  appropriate  for  the- 
first  may  miss,  or  even  intensify,  the  other.  They  recognise 
that  total  abstinence  may  be  the  one  hope  of  salvation  for 
the  victim  of  confirmed  alcoholism ;  but  they  do  not  thence- 
infer  that  complete  abstention  from  all  forms  of  alcohol  is 


Medical TDinres  and  Gazette. 


INTEMPERATE  TEMPERANCE. 


Dec.  15,  1883.  685 


the  only  means  whereby  any  member  of  the  human  race 
can  escape  the  future  of  the  drunkard  and  the  sot,  or  deem 
that  the  evils  entailed  by  the  abuse  of  alcoholic  drinks 
negative  the  possibility  of  their  moderate  and  legitimate 
employment.  And,  strong  in  the  wider  knowledge  which 
they  are  seldom  given  credit  for  by  their  opponents  on 
this  question,  they  do  not  hesitate,  in  appropriate  cases, 
to  prescribe  small  quantities  of  sound  alcoholic  stimu¬ 
lants,  just  as  they  prescribe  other  poisons,  in  therapeutic 
and  dietetic  doses.  But  the  man  who  proclaims  him¬ 
self  a  total  abstainer — meaning  thereby  that  he  eschews 
all  forms  of  alcoholic  beverage — because  he  has  dis¬ 
covered  that  he  is  better,  or  at  least  can  do  as  well, 
without  them,  must  needs  have  all  his  fellow-creatures 
clad  in  the  same  livery,  and  would  banish  from  the  face 
of  the  earth  every  variety  of  a  substance  which  is  often 
useful,  because,  like  everything  else,  it  is  always  harmful 
in  excess.  Of  those  who  range  themselves  under  this 
title,  the  most  ardent  are  the  men  least  able  to  adopt 
its  tenets  with  advantage  either  to  themselves  or  to  others. 
We  make  this  statement  advisedly,  as  the  result  of  dis¬ 
passionate  observation,  and  with  due  reservation  of  those 
apparent  exceptions  which  test  every  rule.  A  weak  and 
imperfectly  balanced  mind  most  readily  seizes,  most  closely 
•clings  to,  and  most  ardently  advocates  the  dogma  which 
affords  it  a  ready  holding-ground  and  an  apparent  refuge 
from  its  own  dimly  realised  vacillation.  No  fanatic  is 
master  of  a  calm  and  evenly  portioned  intellect :  his  fana¬ 
ticism  is  but  the  expression  of  a  mind  which  has  become,  so 
to  say,  lop-sided,  because  it  could  not  trust  itself  not  to  roll. 
But  a  mind  thus  constituted  is  an  index  of  an  unstable 
nervous  system  ;  and  an  unstable  nervous  organisation  (often 
correlated  in  the  educated  man  of  the  present  day  with 
imperfect  physical  development)  is  precisely  the  combina¬ 
tion  of  conditions  which,  while  acutely  sensitive  to  the 
baleful  effects  of  excessive  stimulation  of  any  kind,  is 
•markedly  benefited  by  a  timely  and  judicious  employment 
of  small  quantities  of  alcohol  properly  administered.  The 
Aay  of  six-  and  four-bottle  men  has  passed,  never  to  return. 
The  average  English  gentleman  of  the  present  generation 
is  physically  incapable  of  drinking  what  his  great  grand¬ 
father  was  accustomed  to  take  daily  with  impunity.  But 
••this  modified  condition  of  the  nervous  system,  the  outcome 
•  of  a  more  rapid  rate  of  living,  not  seldom  shows,  in  its 
lack  of  digestive  and  assimilative  vigour,  an  indication  for 
moderate  stimulation. 

The  original  experiments  and  deductions,  which  are  so  fre- 
■-quently  quoted  by  the  total  abstainer  on  the  platform,  have 
been  again  gone  through  of  recent  years,  with  a  care  and  accu¬ 
racy  previously  unattainable,  and  we  now  1 enow  that  a  small 
quantity  of  alcohol,  taken  with  food,  or  towards  the  end  of 
a  meal,  materially  aids  digestion  even  in  the  healthy  animal. 
This  truth  is  at  last  brought  home  to  the  ardent  and  broken- 
down  advocate  of  teetotalism,  and,  “under  medical  direc¬ 
tion,”  he  at  length  consents  to  take  the  stimulant  in  order 
to  regain  something  of  that  health  which  his  own  perversity 
has  jeopardised.  The  most  conspicuous  examples  of  this 
kind  are  naturally  found  amongst  the  younger  clergy  ;  the 
character  of  their  vocation,  their  sympathy  with  all  that 
tends  to  elevate  and  improve  those  with  whom  they  are 
brought  in  contact,  their  desire  to  set  an  example  for  good, 
the  difficulty  and  the  nature  of  their  work,  all  contribute  to 
■•their  taking  on  themselves  a  burden  greater  than  they  can 
bear.  In  a  group  of  five  contiguous  parishes,  taken  at 
random,  three  of  the  incumbents— all  in  more  or  less  delicate 
health — became  “total  abstainers”:  at  the  end  of  three 
months  one  had  become  inaudible  to  the  major  portion  of 
this  congregation,  and  recovered  his  usual  health  only  after 
a  long  .course  cf  tonic  treatment,  with  port  wine,  and  a  six 


weeks’  holiday;  a  little  later  the  second  was  obliged  to 
close  his  church  for  three  Sundays,  and  is  now  able  to  take 
only  occasional  duty ;  the  third  is  still  at  his  post,  but 
suffers  from  attacks  of  syncope.  Out  of  eight  candidates 
for  the  curacy  of  a  moderately  large  church,  five  were  total 
abstainers :  each  of  the  five,  in  turn,  declined  the  post  on 
learning  the  size  of  the  church  ;  and  one,  in  addition,  pro¬ 
fessed  himself  unequal  to  evening  or  night  work.  Examples 
such  as  these  might  be  multiplied  almost  indefinitely,  and, 
while  they  bear  out  the  views  which  we  have  already  ex¬ 
pressed,  they  show  how  strangely  indifferent  the  most 
conscientious  advocate  of  a  good  cause  may  be  to  the  flaws 
in  his  own  line  of  argument  and  practice. 

No  one  denies  that  a  rigid  adhesion  to  the  pledge  of  total 
abstinence  may  be,  in  certain  cases,  the  one  available  safe¬ 
guard  for  the  tempted ;  no  one  denies  that  it  may  be,  in 
certain  cases,  a  wise  and  noble  thing  for  a  man — who,  for 
himself,  needs  no  such  aid  to  temperance — to  take  such  a 
pledge  and  to  keep  it  by  way  of  example  and  encourage¬ 
ment  to  his  weaker  and  more  vacillating  brother.  But  to 
strive  to  bring  all  wills  down  to  this  level  of  bolts  and 
bars  is  to  degrade  the  power  and  value  of  all  moral 
training.  Is  it,  in  effect,  taking  higher  ground  to  say, 
“  A.  and  B.  cannot  trust  themselves  to  keep  their  simple 
word ;  we  will  make  matters  easier  for  them  by  each  of  us 
subscribing  an  oath  similar  to  the  one  they  take,  and  binding 
ourselves  by  the  same  penalties,”  or  to  be  able  to  point  to 
men  of  intelligence  and  education,  and  to  say,  “  Here  are 
men  who  labour  hard  at  work  of  a  kind  which  more  than 
any  other,  possibly,  maybe  thought  likely  to  induce  a  craving 
for  stimulants,  and  who  know  this;  who  are,  however,  not 
so  lacking  in  self-reliance  and  in  moral  strength  as  to  be 
compelled  to  say,  c  I  will  not  touch  nor  taste  this  thing,  lest 
I  come  to  take  too  much  of  it/  but  who  are  able  to  take  at 
the  proper  time,  and  in  the  proper  way,  that  quantity  which 
is  useful,  and  to  stop  short  of  what  would  be  injurious  ”  ? 
Moreover,  there  is  the  counter-argument  of  the  beer  or  spirit 
drinker,  who  says,  with  what  seems  to  him  triumphant  logic, 
“Here  are  gentlemen  who  take  the  pledge  to  give  us  an 
example :  they  have  comfortable  homes,  good  wives,  good 
food,  good  clothes ;  but  they  fail  ill,  and  have  to  take  port 
wine  and  champagne.  Why  should  I  take  the  pledge  ?  I 
don’t  want  to  be  laid  up ;  and,  if  I  were,  I  shouldn’t  get 
port  or  champagne.” 

And  the  matter  is  seldom  put  fairly  before  the  lower 
classes,  who  are  most  frequently  appealed  to,  in  its  full 
bearings.  Too  often  it  seems  to  be  implied  that  the  mere 
giving  up  of  beer  and  spirits  will  at  once  and  of  itself  secure 
them  good  food,  warm  clothing,  a  contented  mind,  and 
healthy,  cheerful  homes.  What  was  the  effect  produced  by 
the  speech  of  a  well-known  temperance  orator,  who,  at  a 
recent  meeting,  after  stating  how  crowded  with  engage¬ 
ments  was  his  working-day,  said  that  when  he  felt  ex¬ 
hausted  in  the  forenoon,  and  in  need  of  a  stimulant,  he 
took,  “not  a  glass  of  wine,  but  a  good  slice  of  roast 
beef  ”  ?  That  must  have  sounded  but  cruel  irony  to  the 
ill-fed,  scantily-clothed  mother  “  who  kept  six  children  on 
four-and-sixpence  a  week.”  The  working  classes  have 
found  out  for  themselves  that  a  certain  amount  of  alcohol 
makes  scanty  food  go  further.  If  the  spirits  which  are 
proffered  them  at  a  temptingly  cheap  rate  are  raw  and  rich 
in  fusel  oil,  and  the  beer  unsound  and  poisonous,  it  is  no 
fault  of  theirs.  And  if  the  working  man  is  to  be  taught  to 
give  up  his  alcohol  or  to  lessen  his  consumption  of  it  per¬ 
manently,  he  must  be  taught  and  aided  to  escape  the  foul 
air,  and  coarse  ill-dressed  food,  and  depressing  surround¬ 
ings,  and  dull  thoughts  which  conspire  to  that  craving  for 
stimulants  which  is,  under  the  circumstances,  inevitable. 
Teach  him  temperance,  not  in  drink  alone— which  is 


686 


Medical  Times  and  Gazette. 


RECENT  ADVANCES  IN  NEURO-PATHOLOGY. 


Dee.  15,  1863. 


■useless,  or  nearly  so,— but  in  all  things;  let  him  realise 
his  capability  for,  and  the  legitimacy  of,  bodily  enjoy¬ 
ment  of  all  kinds  in  moderation.  Teach  him  the  true 
value  of  food  (and  his  wife  how  best  to  cook  it),  of  air,  of 
sunshine,  of  water,  of  recreation,  and  of  sleep ;  and  when 
each  of  these  things  occupies  its  due  share  of  his  atten¬ 
tion,  the  temptations  to  alcoholism — which,  after  all,  are  at 
the  root  of  the  evil  that  none  of  us  dispute — will  be  within 
measurable  distance  of  annihilation.  Total  abstinence  is 
a  cheap  cry  and  a  catching  one.  But  the  landlord  who 
honestly  looks  to  the  sanitary  condition  of  his  labourers’ 
dwellings ;  the  employer  who  establishes  schools  for  cookery, 
reading-rooms  and  baths  for  the  use  of  his  workpeople  ; 
the  public  body  that  opens  parks  and  museums  ;  the  brewer 
who  makes  only  sound  beer;  and  the  schoolmaster  or 
mistress  who  teaches  his  or  her  pupils  how  to  learn  rather 
than  how  much  they  can  be  made  to  repeat — must  be  looked 
to  as  the  real  factors  of  a  permanent  and  national  sobriety. 


RECENT  ADVANCES  IN  NEURO-PATHOLOGY. 

It  is  not  many  years  since  a  definite  and  constant  lesion 
was  recognised  in  the  outer  part  of  the  posterior  columns  of 
the  spinal  cord  in  cases  of  locomotor  ataxy ;  and,  in  conse¬ 
quence  of  the  general  acceptation  of  this  view  as  to  its 
pathology,  the  name  of  tabes  dorsalis  has  been  gradually 
superseding  the  other.  Recent  investigations,  however,  have 
tended  to  raise  doubt  as  to  whether  a  central  lesion  is  the 
one  and  only  cause  of  the  symptoms  in  this  disorder.  Prof. 
Pierret  was  the  first  to  sound  a  note  of  warning  when  he 
demonstrated,  at  the  International  Medical  Congress  in 
1881,  peripheral  in  addition  to  central  lesions  in  a  case  of 
locomotor  ataxy  ;  and  in  a  recent  number  of  a  contemporary 
Mr.  Page  has  asked  point-blank  whether  tabes  dorsalis  may 
not  have  a  peripheral  origin.  The  patient  who  seems  to 
have  been,  so  to  speak,  the  starting-point  of  this  latter 
paper,  was  an  old  soldier,  who  came  under  observation 
suffering  from  locomotor  ataxy  and  arthropathy,  and  who 
had  suffered  previously  on  separate  occasions  from  per¬ 
forating  ulcer  of  each  foot ;  and  Mr.  Page  puts  forward  the 
hypothesis  that  the  corn  which  preceded  the  perforating 
ulcer  set  up  a  peripheral  neuritis  which  ultimately  led  to 
ordinary  locomotor  ataxy.  The  fact,  however,  that  each 
great  toe  was  affected  with  a  perforating  ulcer  is  much 
more  compatible  with  the  theory  of  an  already  existing 
central  affection  than  with  any  other ;  but  even  if  the  per¬ 
forating  ulcer  had  been  unilateral,  it  would  not  have  formed 
a  strong  argument  in  support  of  Mr.  Page’s  plea.  Gastric 
crises  often  precede  the  more  common  symptoms  of  loco¬ 
motor  ataxy  by  a  great  many  years,  but  no  one  would 
seriously  argue  that  the  stomach  formed  the  starting-point 
of  a  neuritis  which  ultimately  led  to  the  development  of 
locomotor  ataxy.  An  affirmative  answer  to  Mr.  Page’s 
question  can  only  be  supplied  by  pathology.  No  amount 
of  clinical  study  can  afford  convincing  proof  on  this  point. 
Two  things  are  necessai’y  for  the  satisfactory  solution  of 
the  problem  :  it  should  be  shown,  first,  that  it  is  possible  for 
peripheral  neuritis  to  occur  spontaneously ;  and  next,  that 
when  it  does  so  originate  it  is  capable  of  giving  rise  to  the 
symptoms  of  locomotor  ataxy. 

A  contribution  towards  the  elucidation  of  the  former 
requirement  has  recently  been  furnished  by  MM.  Pitres  and 
Vaillard,  who,  in  a  series  of  valuable  papers  in  the  Archives 
de  Neurologie ,  have  put  forward  their  views  on  the  nature  of 
peripheral  neuritis  not  due  to  traumatic  lesion.  The  subject 
is,  comparatively  speaking,  a  new  one.  Several  causes  have 
contributed  to  this — one  of  these  being  the  general  belief 
that  a  neuritis  could  not  originate  independently  of  any 
primary  change  in  the  spinal  cord,  or  ganglia  on  the  posterior 


roots ;  another  being  the  imperfect  methods  which,  up  to  a 
very  few  years  ago,  were  employed  in  examining  the  nerves. 
Their  papers  are  based  on  the  careful  study  of  nine  cases  in 
which  peripheral  neuritis  existed,  not  originating  in  an 
injury.  Three  of  these  were  cases  of  cerebral  haemorrhage, 
two  were  cases  of  locomotor  ataxy,  two  of  Pott’s  disease,  one 
of  double  herpes  zoster,  and  one  of  leucocythsemia.  In  none 
of  the  cases  was  any  alteration  in  the  nerves  perceptible  to 
the  naked  eye.  They  were  of  normal  colour,  and  were  neither 
softened,  indurated,  reddened,  nor  oedematous.  The  micro¬ 
scope  alone  enabled  the  authors  to  detect  any  alterations. 
The  changes  closely  resemble  those  found  in  the  peripheral 
portion  of  a  divided  nerve.  In  both  instances  there  is  at  first 
swelling  of  the  nucleus  of  the  nerve-fibres,  and  segmentation, 
of  the  myelin,  advancing  to  complete  destruction  of  the- 
cylinder-axis  and  of  the  path  of  Schwann ;  in  both  instances 
too  the  destroyed  fibres  may  be  regenerated,  or  at  any  rate 
may  be  replaced  by  newly  formed  ones.  But  though  the 
processes  present  these  analogies,  it  must  not  thereby  be 
assumed  that  they  are  identical.  The  form  of  neuritis 
under  consideration  has  not  the  regular,  uniform  evolution 
observed  in  “  Wallerian ”  degeneration;  sometimes  it  runs 
a  very  rapid  course,  at  others  a  very  slow  one.  There  is  aLo 
some  evidence  that  spontaneous  neuritis  may  be  propagated 
towards  the  central  parts,  which  does  not  occur  after  divi¬ 
sion  of  the  nerve.  The  changes  affect  exclusively,  at  the 
onset  at  any  rate,  the  nerve-fibres  themselves,  the  connec¬ 
tive  tissue  remaining  normal  during  a  comparatively  long 
period,  and  only  becoming  thickened  when  the  nerve-tubes 
are  already  deeply  involved.  Even  in  cases  where  the 
neuritis  appeared  to  be  associated  with  primary  changes  in 
the  nerve-centres,  the  authors  did  not  find  the  changes  con¬ 
tinuous  between  the  spinal  cord  and  the  affected  nerves ;  the- 
nerve-trunks  in  the  intervening  portions  often  appeared  to 
be  quite  healthy.  All  peripheral  nerve  inflammations  do 
not  give  rise  to  appreciable  nutritive  or  sensory  disturbances  ; 
these  probably  only  occur  when  the  proportion  of  affected 
fibres  is  somewhat  considerable.  They  vary  in  their  nature 
according  to  the  function  of  the  affected  nerve  and  the 
degree  of  the  change.  Amongst  the  affections  resulting 
from  peripheral  neuritis,  described  in  this  paper,  are  eschars- 
of  rapid  formation,  ulcers  with  no  tendency  to  heal,  vesicular 
herpetic  eruptions  or  pemphigoid  bull®,  perforating  disease 
of  the  foot,  chronic  oedema,  arthropathy,  and  malnutrition 
of  the  nails.  Local  anaesthesia  was  not  constantly  present. 
From  a  pathological  point  of  view  the  authors  make  five 
distinct  types— 1.  Fragmentation  of  the  myelin  into  masses  j 
2.  Fragmentation  of  the  myelin  into  balls ;  3.  Fragmenta¬ 
tion  of  the  myelin  into  fine  granulations  ;  4.  Atrophy  of  the 
tubes,  with  amber-coloured  granulations  in  the  interior  of 
the  path  of  Schwann ;  5.  Complete  atrophy  of  the  nerva- 
tubes. 

The  second  requirement — namely,  that  it  should  be  shown 
that  the  symptoms  of  locomotor  ataxy  can  be  produced 
by  a  peripheral  lesion — has  quite  recently  been  fulfilled  by 
M.  Dejerine,  who,  in  a  short  communication  to  the  Gazette 
Medicate  de  Paris  (No.  44),  gives  an  account  of  two  cases- 
which  during  life  presented  certain  characteristic  symptoms, 
of  locomotor  ataxy — e.g.,  marked  incoordination,  anaesthesia, 
and  analgesia  of  the  legs,  and  loss  of  the  patellar  tendon 
reflex, — and  in  which,  after  death,  the  spinal  cord  was 
found  to  be  perfectly  normal,  whilst  the  peripheral  nerves 
presented  a  high  degree  of  neuritis.  No  indication  is 
oiven  as  to  the  duration  of  the  disease  in  either  of  these 

O 

cases,  and  it  seems  fair  to  suppose  that,  had  the  disease 
lasted  longer,  the  spinal  cord  might  perhaps  have  been 
found  to  be  involved.  This,  however,  is  not  M.  Dejerine’s 
opinion,  as  he  proposes  to  group  his  cases  apart  from  the 
ordinary  disease,  calling  them  peripheral  tabes,  in  opposs- 


Medical  Times  and  Gazette. 


CHRONICLE  OF  THE  WEEK. 


Dec.  15,  1883.  687 


tion  to  the  spinal  disease.  If,  however,  a  differential 
diagnosis  can  only  he  made  by  the  aid  of  the  microscope 
after  elaborate  chemical  processes  have  been  followed  out, 
it  is  a  distinction  that  is  hardly  worth  making,  and  it  will 
be  more  rational  to  admit  that  locomotor  ataxy  may  be  due 
to  a  peripheral  lesion. 


THE  HOMES  OF  THE  POOR  IN  ENGLAND  AND 
ELSEWHERE. 

Seldom  has  a  meeting  convened  for  the  discussion  of  a  ques¬ 
tion  of  national  importance  been  more  thoroughly  repre¬ 
sentative  of  all  classes  of  the  community  and  of  all  parties, 
political  and  religious,  than  that  which  on  Tuesday  assem¬ 
bled  at  the  Mansion  House  to  consider  the  state  of  the 
dwellings  of  the  London  poor.  Public  feeling  has  now 
been  so  thoroughly  aroused  to  the  moral,  social,  and  sanitary 
dangers  of  such  a  state  of  things  in  our  midst,  that  it  is  to 
be  hoped  it  will  not  subside  when  the  novelty  of  the  excite¬ 
ment  has  worn  off,  and  questions  of  party  politics  and  the 
contests  of  a  general  election  again  come  to  the  front- 
But  why  society  should  just  now  have  awoke  from  the  fool’s 
paradise  in  which  it  has  been  living,  when  “  the  bitter  cry 
of  the  outcast  poor  ”  has  been  ringing  in  its  ears  for  years, 
we  are  at  a  loss  to  explain.  Much  credit  is  doubtless  due  to 
those  whose  graphic  descriptions  have  fanned  the  smoulder¬ 
ing  interest  into  a  flame,  but  the  facts  themselves  in  their 
naked  horror  have  long  been  only  too  familiar  to  the  clergy, 
parish  surgeons,  and  others  whose  work  lies  among  the  very 
poor,  and  only  apathy  or  something  worse  has  hitherto  kept 
them  from  the  public  gaze.  One  great  result,  we  venture  to 
hope,  of  the  Mansion  House  Conference  will  be  to  prevent 
the  question  becoming  a  watchword  of  political  parties  or  a 
lever  for  setting  class  against  class.  What  the  causes  may 
be,  and  consequently  what  the  remedies,  we  shall  attempt 
to  point  out,  but  the  first  fact  to  be  insisted  upon  is 
that  the  evil  is  not  confined  to  London  or  to  English  cities, 
but  is  found  wherever  men  are  densely  crowded  together. 
Mr.  Stopford  Brooke  has,  indeed,  asserted  that  nothing  is  to 
be  found  in  the  great  cities  of  other  countries  to  equal  the 
condition  of  the  London  poor.  But  he  speaks  from  an  in¬ 
sufficient  study  of  the  facts.  We  have  before  us  a  fearful 
picture  by  Dr.  Du  Mesnil  of  the  dwellings  of  the  poor  in 
Paris,  and,  bad  as  London  may  be,  we  can  conscientiously 
say  that  in  its  very  worst  quarters  such  scenes  as  he  de¬ 
scribes  would  be  sought  in  vain.  There,  in  the  rear  of 
the  largest  streets,  may  be  found  courts  covered  with 
hutches  containing  only  seven  or  eight  cubic  yards,  built 
of  rotten  planks  and  covered  with  more  rotten  felt,  stand¬ 
ing  on  the  bare  soil  below  the  level  of  the  sodden  path¬ 
way,  reeking  with  solid  and  fluid  filth  and  ordure,  or, 
to  avoid  this,  erected  on  mounds  of  refuse,  where  the 
wretched  occupants  keep  up  all  night  a  struggle  for  pos¬ 
session  with  armies  of  rats;  the  landlord,  a  sleek  bour¬ 
geois,  exacting  his  rents,  and  taking  back  great  part  of 
the  wages  of  his  tenants  and  employes  (in  the  rag  trade) 
in  bad  spirits,  served  at  what  is  at  once  office,  counting- 
house,  and  bar.  Well  may  Dr.  Du  Mesnil  exclaim,  "  It  is 
not  mere  virtue,  it  is  heroism,  if  these  people  do  not 
entertain  a  hatred  of  the  society  which  tolerates  such 
a  state  of  things.”  Dr.  Eklund,  of  Stockholm,  tells  us 
of  eight  or  ten  persons  living  day  and  night  in  “  small 
kennels,”  the  very  boards  rotten  and  saturated  with  filth, 
and  naked  children  lying  in  heaps  of  rags  stinking  with 
urine  and  faeces,  while  drunkenness  and  vice  prevail 
to  an  inconceivable  extent.  From  New  York,  Chicago,  and 
other  great  towns  of  America — where  certainly  entail  and 
primogeniture  cannot  be  made  scapegoats  for  the  sins  of 
the  owners  of  house-property  or  of  the  misery  of  the 
tenants — we  hear  the  same  tale,  and  the  question  of  the 


provision  of  better  accommodation  is  as  eagerly  discussed 
in  the  pages  of  the  Nevj  York  Sanitary  Engineer  and  the 
Tribune  as  in  any  of  our  own  papers.  Wherever  there  is 
over-population,  wherever  there  is  ‘drunkenness,  wherever, 
above  all,  there  is  greed  of  money  (and  where  is  there 
not  ?) — there  the  very  poor  are  in  the  same  state,  whether 
their  poverty  and  helplessness  be  the  result  of  their  own 
improvidence  and  vice,  or  of  circumstances  over  which  they 
have  little  or  no  control.  Greed  is  the  vice  of  those  who 
are  “  making  haste  to  be  rich,”  rather  than  of  men  who 
have  inherited  wide  estates  or  large  fortunes  ;  greed  takes 
advantage  of  the  competition  consequent  on  the  struggle 
for  existence  in  an  overcrowded  population ;  greed  places 
allurements  and  opportunities  to  drunkenness  at  every 
turn  in  the  midst  of  the  depressed  and  degraded  masses ; 
and  greed,  in  the  person  of  the  middleman,  makes  himself 
no  longer  a  convenience,  but  a  necessity  to  employer  and 
employed,  fattening  on  the  labour  of  the  poor,  and  divert¬ 
ing  to  his  own  pocket  all  but  a  tithe  of  the  earnings  of  the 
sweat  of  their  brow.  The  skilled  artisan,  the  man  who  can 
sell  his  services  direct  to  the  capitalist,  may  by  sobriety 
and  providence  hold  his  ground  ;  but  to  talk  of  self-help  to 
the  helpless  is  a  cruel  mockery.  For  them  the  strong  arm 
of  the  law  must  interpose ;  and  how  this  may  best  be  done 
we  will  consider  another  time. 


CHRONICLE  OP  THE  WEEK. 

- -* - 

On  Tuesday  last,  at  the  Royal  Medical  and  Chirurgical 
Society,  Mr.  Hutchinson  raised  a  discussion  on  the  treat¬ 
ment  of  senile  gangrene,  which,  as  the  President  remarked, 
was  interesting  as  indicative  of  the  changes  which  our  views 
are  undergoing  in  consequence  of  general  advances  in  sur¬ 
gical  knowledge.  Mr.  Hutchinson  based  his  conclusions  on 
five  cases  of  gangrene,  which  were  senile  in  their  charac¬ 
teristics,  rather  than  in  the  usual  acceptation  of  that  word, 
for  one  of  his  patients  was  only  forty-eight  years  old,  and 
another  was  suffering  from  frostbite  gangrene.  Such  a 
nomenclature,  however,  is  quite  in  accordance  with  prece¬ 
dent  :  the  late  Sir  Benjamin  Brodie  (to  whose  teaching 
much  of  our  present  knowledge  of  the  minute  pathology  of 
this  disease  is  due)  applied  the  term  to  a  patient  who  was 
even  younger  than  Mr.  Hutchinson’s  youngest  case.  The 
treatment  proposed  is  amputation  above  the  knee ;  in  this 
situation  it  is  argued  that  the  calcareous  condition  of  the 
arteries  which  leads  to  the  gangrene  is  less  likely  to  be 
met  with  than  below  the  knee,  that  there  is  less  danger  of 
secondary  haemorrhage,  and  that  amputations  in  this  part 
heal  more  kindly  than  those  which  are  practised  through 
the  upper  third  of  the  leg. 


These  were  many  speakers,  including  some  of  the  leading 
metropolitan  surgeons.  Under  the  circumstances,  it  was  not 
a  little  surprising  to  find  what  a  paucity  of  material  was  at 
the  disposal  of  the  meeting.  Two  or  three,  at  least,  of  the 
speakers  remarked  that  they  had  no  personal  experience  at 
all.  It  can  only  be  surmised  that  these  cases  remain  as  in¬ 
curables  in  the  workhouse  infirmaries,  and  that  they  do  not 
come  under  the  observation  of  hospital  surgeons.  This  is 
much  to  be  regretted.  Mr.  Hulke  was  not  disposed  to  accept 
the  plan  of  treatment  proposed ;  he  thought ,  the  cases  did 
not  bear  out  the  suggestion.  He  was  almost  sure  that  he 
had  seen  cases  of  gangrene  above  the  ankle  get  well  spon¬ 
taneously.  Mr.  Rivington’s  experience,  as  far  as  it  went, 
corroborated  the  practice.  Mr.  Barwell  had  had  one 
successful  case.  Mr.  Croft  had  no  personal  experience. 
He*  thought  the  use  of  antiseptics  explained  the  success. 

I  Mr.  Godlee  had  had  a  fairly  successful  case.  He  believed 


688 


Medical  Time4?  and  Gazette. 


CHRONICLE  OF  THE  WEEK. 


Dec.  15,  1883. 


that  the  use  of  antiseptics  would  allow  us  to  go  lower  down, 
and  still  obtain  success.  Mr.  Cripps  thought  the  danger  of 
amputating  without  antiseptics  lay  in  the  want  of  repara¬ 
tive  power  in  the  tissues,  which  thus  failed  to  build  up  a 
harrier  to  the  infective  products  of  the  wound.  With  anti¬ 
septics  he  would  be  inclined  to  try  amputation  lower  down. 
Mr.  Savory  thought  the  doctrine  of  amputation  grave  and 
important;  amputation  through  the  thigh  was  for  all 
persons  a  serious  operation,  and  especially  so  for  patients 
the  subjects  of  gangrene.  The  discussion  is  elsewhere 
reported  at  length.  _ 

In  another  column  will  be  found  the  report  of  an  impor¬ 
tant  meeting  held  at  Sir  William  Jenner’s  house  on  Monday, 
to  consider  the  action  of  the  Public  Prosecutor  in  the  case 
of  Messrs.  Bower  and  Keates,  and  to  make  a  recommenda¬ 
tion  to  the  Government  with  the  view  of  avoiding  such  cases 
in  the  future.  In  another  recent  prosecution  of  a  medical 
practitioner  the  Public  Prosecutor  did  act,  we  are  informed, 
on  competent  medical  advice,  but  in  the  case  of  Messrs. 
Bower  and  Keates  he  appears  to  have  acted  on  his  own 
responsibility.  There  cannot  be  two  opinions,  whether 
within  the  profession  or  outside  it,  as  to  the  inadvisability 
of  the  law  being  put  in  action  against  a  medical  practi¬ 
tioner,  on  such  a  delicate  and  difficult  charge  as  that  of 
mala  praxis,  without  the  advice  of  an  unbiassed  medical 
authority,  and  the  question  for  the  Government  to  decide  is 
whether  such  advice  shall  be  given  formally  or  informally. 
If  a  responsible  medical  adviser  to  the  Public  Prosecutor  is 
to  be  appointed,  then  the  same  privilege  may  be  logically 
claimed  by  other  professions,  and  even  by  anyone  who  is 
liable  to  bungle  in  his  business  and  to  be  prosecuted  for  the 
results  of  such  bungling.  This  would  be  to  reduce  the  office 
of  Public  Prosecutor  to  an  absurdity,  and  its  abolition  would 
not  be  long  delayed.  It  would  on  the  whole  be  better  to 
have  an  understanding  that  in  all  charges  of  professional 
misconduct  against  doctors  the  Public  Prosecutor  should  not 
act  without  taking  informally  the  advice  of  a  medical  man 
of  authority  on  the  matter. 


The  discussion  on  outdoor  medical  relief  at  the  Poor-Law 
Guardians’  Conference  on  Wednesday  resulted  in  a  resolu¬ 
tion  to  the  effect  that  boards  of  guardians  should  be  em¬ 
powered  to  administer  medical  relief  by  way  of  loan  at  a 
minimum  fixed  rate.  At  present  relief  may  be  administered 
in  this  way  to  servants,  the  repayment  of  the  loan  being 
made  from  the  wages  in  the  masters’  hands  ;  but  in  other 
cases  it  is  not  allowed  by  the  central  authority.  The  reso¬ 
lution  of  the  guardians’  representatives  will  no  doubt  have 
great  weight  with  the  Local  Government  Board;  but  the 
views  of  the  medical  officers  on  the  subject  have  yet  to  be 
heard.  It  would  be  advantageous,  of  course,  for  all  parties, 
and  not  least  so  for  the  patients  themselves,  if  all  who 
are  not  actually  destitute  could  be  made  to  give  some 
equivalent  for  medical  attendance,  either  by  a  regular 
subscription  to  a  provident  dispensary,  or  by  payment 
of  a  lump  sum  on  requiring  advice,  or  by  undertaking  to 
pay  such  a  sum  in  instalments  after  the  illness.  But 
it  is  obvious  that  any  scheme  for  securing  this  might,  if 
not  very  carefully  worked,  seriously  prejudice  the  interests 
of  the  medical  officer,  by  removing  to  the  provident  class 
patients  who  could  well  afford  to  pay  for  private  attendance, 
and  who  would  have  done  so  but  for  the  adoption  of  the 
loan  system.  With  the  gradual  removal  of  middle-class 
families  into  the  large  towns,  the  country  doctor  is  losing 
many  of  his  best  patients,  and  to  draw  many  away  at  the 
other  end  of  the  social  scale  would,  in  some  cases,  leave  him 
nothing  but  contract  work.  The  country  doctor’s  life  is 
hard  enough  and  his  remuneration  too  modest  as  it  is. 


and  any  scheme  which  threatens  to  place  him  in  a  worse 
position  must  be  jealously  scrutinised. 

On  Thursday  week.  Dr.  G.  Y.  Poore  delivered  a  lecture  at 
the  Parkes  Museum  on  Coffee  and  Tea,  the  chair  being 
occupied  by  Sir  Henry  Thompson.  Coffee  the  lecturer 
declared  to  be  the  better  stimulant ;  but  tea — the  tobacco 
of  women — cloyed  the  palate  less,  and  was  easier  of  diges¬ 
tion,  if  made  so  as  to  exclude  the  astringent  matter  of  the  leaf. 
Coffee  was  a  stimulant  which  would  prove  a  good  substitute 
for  spirits,  and  its  use  should  be  encouraged  by  those  who 
were  trying  to  reclaim  the  drunkard.  Since  1854  the  con¬ 
sumption  of  tea  in  the  United  Kingdom  had  increased 
from  2  lbs.  per  head  to  an  average  of  4  lbs.  9  ozs.;  but 
the  consumption  of  coffee  had  in  the  same  period  de¬ 
creased  from  an  average  of  1  lb.  6  ozs.  to  15  ozs.  each 
person — a  result  due  to  a  mistaken  policy  on  the  part  of  the 
Government  in  allowing  coffee  to  be  adulterated  with  such 
rank  weeds  as  chicory  and  dandelion.  We  cannot  help 
thinking  there  is  some  other  explanation  than  this  for  the 
victory  in  England  of  tea  over  coffee  in  the  struggle  for 
existence.  The  curious  geographical  distribution  of  tea¬ 
drinking  and  coffee-drinking  has  never  been  explained. 
Why  do  Englishmen,  Russians,  Australians,  and  Chinese 
all  drink  tea,  and  Erenchmen,  Germans,  and  Turks  all 
drink  coffee  ?  It  is  a  phenomenon  that  has  yet  to  be 
accounted  for. 

Miss  Eeances  Power  Cobbe  evidently  appreciates  the 
advantage  of  setting  a  “fresh  mind”  to  a  subject  as  much 
as  her  victim,  the  President  of  the  Royal  Society  (see  his 
recent  remarks  on  Cholera),  but  she  does  not  equally  appre¬ 
ciate  the  necessity  of  duly  remunerating  its  work.  She 
selects  a  literary  stripling  whose  mind  is  a  tabula  rasa  as 
regards  the  subject  she  wishes  him  to  deal  with;  sets  him  to 
“  coach  ”  himself  in  anatomy,  medicine,  surgery,  etc. ;  sends 
him  forth  to  attack  vivisection  from  a  scientific  standpoint, 
and  to  do  battle  with  such  opponents  as  Huxley  and  Owen  ; 
and  then,  after  he  has  written  with  “  transcendent  ability  ” 
151  columns  of  “  brilliant  illustration  and  clenching  argu¬ 
ment,”  she  suddenly  objects  to  go  on  paying  for  them. 
There  must  have  been  some  reason,  which  did  not  come  out 
at  the  trial,  for  this  sudden  discovery  of  the  worthlessness  of 
her  champion’s  columns,  at  any  rate  from  a  pecuniary  point 
of  view.  Perhaps  they  were  not  so  fatal  to  “  that  old 
impostor,  Owen”  as  at  one  time  seemed  probable  to  her; 
and  as  Miss  Cobbe  and  other  anti-vivisectionists  seem  much 
more  intent  on  inflicting  suffering  on  their  fellows  than  in 
savins:  animals  from  it,  their  failure  to  make  the  veteran 
palaeontologist  wince  may  have  opened  their  eyes  to  the 
valuelessness  of  their  instruments  of  torture.  Passion  is 
apt  to  grow  cool  and  thrifty  when  its  payments  bring  no 
adequate  return.  Of  course  Miss  Cobbe  will  now  claim 
that  the  151  guineas  she  has  been  obliged  to  pay  for  her 
pleasure  have  succeeded  in  driving  Prof.  Owen  from  the 
honourable  office  he  has  held  at  the  British  Museum  for  over 
a  quarter  of  a  century.  Let  her  persevere.  There  is  still 
the  President  of  the  Royal  Society  to  be  brought  low. 


Mr.  Bowman  is  to  be  a  baronet  as  well  as  Mr.  Lister,  and 
the  expressions  of  disappointment  which  we  have  heard 
during  the  past  week,  at  his  being  presumably  passed  over 
again,  are  justified  as  well  as  allayed.  The  work  by  which 
Mr.  Bowman  gained  his  reputation  was  done  so  long  ago 
that  the  present  generation,  but  for  an  occasional  reminder 
in  the  physiological  text-books,  are  apt  to  forget  that  he 
was  a  world-famed  physiologist  before  he  became  an  eye- 
surgeon.  It  is  more  than  forty  years  since  he  was  awarded 
a  Royal  Medal  by  the  Royal  Society ;  and  men  who  are  now 


Medic*]  Times  and  Gazette. 


CHRONICLE  OF  THE  WEEK. 


Dec.  15, 1683.  689 


thinking  of  retiring  from  practice,  when  they  were  students 
read  no  physiology  but  Todd  and  Bowman’s.  Forty  years  ago 
it  was  quite  probable  that  Mr.  Bowman  would  become  the 
leading  London  surgeon,  and  his  subsequent  retreat  to  a 
specialty,  though  it  was  of  immense  service  to  that  specialty, 
no  doubt  delayed  both  the  development  of  scientific  surgery 
in  this  country  and  the  State  recognition  of  his  own  merits. 
If  Mr.  Bowman  had  remained  a  general  surgeon  he  would 
probably  have  had  his  baronetcy  ten  years  ago ;  and  if  he 
had  been  a  German  he  would  have  obtained  his  “  von  ”  and 
been  a  Geheimrath  at  thirty-five.  Talking  of  Germans,  it  is 
a  curious  coincidence  that  the  two  new  baronets  are,  so  far  as 
we  know,  the  only  two  living  English  medical  practitioners 
whose  names  our  Teutonic  cousins  have  thought  worth  em¬ 
bodying  in  their  vocabulary.  “Die  Bowman’sche  Discs,” 
and  “die  Lister’sche  Behandlung”  we  know,  but  we  have 
not  yet  heard  of  “  die  Spencer  Wells’sche  Behandlung,”  or 
seen  myxoedema  called  “  die  Ord’sche  Krankheit,”  and  we 
have  lost  the  first  describer  of  the  “  Corrigan’scher  Puls.” 


At  the  London  University  M.B.  Honours  Examination, 
Mr.  S.  H.  C.  Martin,  of  University  College,  has  taken  the 
Scholarship  and  Gold  Medal  in  Medicine,  and  Mr.  R.  F. 
Fox,  of  the  London  Hospital,  the  Gold  Medal ;  the  Mid¬ 
wifery  Scholarship  and  Gold  Medal  have  fallen  to  Mr.  S. 
Rabheth,  of  King’s  College,  and  the  Gold  Medal  to  Mr. 
E.  W.  Roughton,  of  St.  Bartholomew’s.  In  Forensic  Medi¬ 
cine  the  Scholarship  and  Gold  Medal  have  been  awarded  to 
Mr.  J.  Collier,  and  the  Gold  Medal  to  Mr.  J.  M.  Beverley, 
both  of  the  Manchester  School.  From  the  double  success 
of  this  school  it  looks  as  if  forensic  medicine  were  better 
taught  there  than  at  the  London  hospitals.  London  men 
have  always  been  apt  to  look  on  the  examination  in  this 
branch  as  of  the  nature  of  a  puzzle  competition.  They 
come  to  it  for  the  most  part  well  up  in  the  book-work,  but 
badly  prepared  for  the  testing.  If,  by  a  happy  inspiration, 
one  happens  to  find  out  what  poison  lies  hidden  in  the  coffee 
or  stout  put  before  him,  he  gets  the  scholarship ;  if  the  poison 
evades  his  researches,  however  excellent  his  paper,  he  gets 
a  third  class.  A  more  practical  knowledge  of  toxicological 
inquiry  would,  no  doubt,  have  removed  this  uncertainty 
long  ago,  but  hitherto  it  has  been  difficult  for  the  student 
to  obtain  it,  and,  what  is  more,  it  is  doubtful  whether  he 
ought  to  be  encouraged  to  obtain  it.  If  he  gives  only  two 
years  to  preparing  for  the  examination,  he  has  quite  enough 
to  do  to  learn  his  medicine,  pathology,  and  obstetric  medi¬ 
cine.  The  Senate  would  do  wisely,  we  think,  to  substitute 
an  honours  examination  in  pathology  for  that  in  forensic 
medicine,  and  to  give  their  honours  for  the  latter  subject 
in  connexion  with  the  examination  in  state  medicine.  The 
M.D.  degree  might  very  well  be  given,  like  the  M.A. 
degree,  in  different  branches,  one  of  which  might  include 
medical  jurisprudence  and  hygiene.  These  subjects  are  now 
falling  so  exclusively  into  the  hands  of  specialists,  and 
requires  such  a  special  training,  that  it  seems  very  unde¬ 
sirable  to  encourage  the  student  to  give  up  to  them  time 
which  ought  to  be  spent  on  clinical  medicine  and  pathology. 


De.  De  Watteville’s  letter  on  the  “Uses  of  Hospital 
Patients  ”  has  not  fallen  from  the  press  so  stillborn  as  we 
had  hoped.  The  Vicar  of  Old  Ford  has  called  the  Lord 
Mayor’s  attention  to  it,  and  the  Lord  Mayor  has  referred 
the  whole  subject  to  the  Council  of  the  Hospital  Sunday 
Fund,  which  will  take  it  into  their  consideration  on  Monday 
next.  Dr.  De  Watteville  meanwhile  has  written  another 
letter  to  the  Standard,  in  which  he  entirely  changes 
his  position.  All  he  claims  now  is  that  medical  men  shall 
be  allowed  to  be  the  only  competent  judges  as  to  whether 


a  given  experiment  is  one  which  conscience,  science,  and 
humanity  justify.  The  general  public,  who  are,  after  all, 
reasonable  beings,  will  doubtless  be  willing  to  admit  this 
claim,  so  long  as  the  profession  shows  that  its  conscience 
is  as  sensitive  and  its  humanity  as  high  as  theirs.  The 
profession,  by  generations  of  humane  and  unselfish  work, 
has  won  the  confidence  of  the  public ;  that  confidence  is  the 
resultant  of  a  million  of  individual  experiences  of  the 
humanity  of  doctors  all  over  the  country,  and  it  is  a  price¬ 
less  possession  not  to  be  trifled  with.  The  country  practi¬ 
tioners,  whom  Dr.  Clifford  Allbutt  eulogised  of  late,  when 
they  turn  out  into  the  snow  and  darkness  without  prospect 
of  pay,  are  earning  immunity  from  public  criticism  for 
hospital  physicians  and  surgeons.  Each  class  earns  for  his 
profession  reputation ;  and  as  the  country  or  private  prac¬ 
titioner  shares  in  and  is  justly  proud  of  the  scientific 
reputation  won  in  public  work,  so  the  hospital  physician 
should  prize  the  moral  reputation  won  by  private  work. 
One  form  of  reputation  is  the  complement  of  the  other,  and 
it  is  the  hospital  physician’s  privilege  to  have  the  means  in 
his  power  of  adding  to  both. 


The  contest  for  the  Assessorship  of  St.  Andrews  Uni¬ 
versity  is  being  waged  with  vigour,  but  we  have  little  doubt 
as  to  the  issue.  The  medical  graduates  will  have  to  do  all 
they  know,  and  more,  if  they  are  to  carry  Dr.  Richardson 
against  such  a  powerful  opponent  as  Sir  Richard  Cross.  The 
characters  of  the  candidates  are  curiously  contrasted.  Dr. 
Richardson  is  a  man  of  enthusiasms  ;  Sir  Richard  Cross  is 
the  embodiment  of  cold  common-sense.  Dr.  Richardson 
has  almost  too  much  imagination  even  for  a  man  of  science ; 
Sir  Richard  Cross  too  little  even  for  a  statesman.  Dr. 
Richardson  has  culture  and  eloquence,  which  no  one  has 
ever  accused  Sir  Richard  Cross  of  possessing  to  any  remark¬ 
able  extent;  but  the  ex-Home-Secretary  has  precision  and 
judgment  in  sufficient  abundance  to  supply  Dr.  Richardson’s 
deficiencies  in  those  qualities.  Throw  all  their  gifts  into 
hotchpot,  and  the  mixture  would  rival  Prof.  Huxley  both 
in  science  and  statesmanship.  If  we  had  a  vote,  we  should 
cast  it  for  Dr.  Richardson,  who,  besides  his  long  and  faithful 
services,  has  the  great  claim  of  not  basing  his  candidature 
on  politics.  _ _ 

The  death-rate  of  London  for  last  week  was  21  •  5,  having 
steadily  declined  during  the  past  month  from  22-2.  The 
deaths,  in  number  1628,  included  207  from  zymotic  disease, 
which  was  47  below  the  corrected  ten  years’  average.  Of 
these,  44  were  from  measles,  53  from  scarlet  fever,  23 
from  diphtheria,  43  from  whooping-cough,  26  from  enteric 
fever,  and  only  2  from  small-pox.  From  the  fever-hospital 
returns,  however,  it  appears  that  while  fever  cases  are  still 
very  heavy,  there  has  been  during  the  last  fortnight  a 
sudden  influx  of  small-pox  cases.  In  the  five  asylums  for 
fever  cases  there  had  been  150  fresh  cases  of  fever  admitted 
during  the  fortnight,  and  657  cases  are  still  under  treat¬ 
ment,  as  against  628  a  fortnight  ago.  Of  these,  465  are 
cases  of  scarlet  fever,  4  are  cases  of  typhus,  and  187  are 
cases  of  enteric  fever.  In  the  small-pox  asylums  a  fortnight 
ago  there  were  49  cases  altogether,  but  in  the  last  fortnight 
37  cases  had  been  admitted,  6  had  died,  and  9  had  been  dis¬ 
charged,  leaving  71  under  treatment— an  increase  of  22  in 
the  fortnight.  The  increase  of  infectious  cases  was  a  subject 
of  comment  at  the  last  meeting  of  the  Metropolitan  Asylums 
Board,  and  a  scheme  was  discussed  for  providing  a  con¬ 
valescent-fever  asylum  outside  London,  as  recommended  by 
the  Royal  Commission  on  Infectious  Hospitals  in  the  Metro¬ 
polis,  with  the  view  of  lessening  the  necessity  for  acute-fever 
asylums  within  the  immediate  area  of  the  metropolis.  The 
General  Purposes  Committee  recommend  the  purchase  of 


69  0 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Dec.  15, 1S83. 


an  estate  at  Winchmore  Hill  for  the  purpose.  The  sooner 
this  convalescent  hospital  is  built,  the  better  will  it  be  for 
the  metropolis.  As  it  is,  scarlet-fever  patients  are  sent  out 
from  one  at  least  of  the  metropolitan  fever  hospitals  a 
great  deal  too  soon.  It  would  be  an  economy  in  the  long 
run  to  keep  every  scarlet-fever  patient  at  least  eight  weeks 
in  hospital. _ 

The  Gazette  Hebdomadaire  for  the  current  week  has  a 
clinical  note  on  a  case  of  Vesicular  Mole.  The  Gazette  des 
Hopitaux  contains  a  communication  from  M.  Richer  on  the 
Neuro-Muscular  Phenomena  of  Hypnotism,  a  note  by  Dr. 
Sorbels  on  Epithelioma  of  the  Clitoris,  an  article  on  two  cases 
of  Atrophic  Cirrhosis  of  the  Liver,  and  one  on  Monoplegia  of 
the  Arm  and  Leg  of  a  hysterical  nature.  The  Gazette 
Mddicale  de  Paris  gives  a  paper  by  MM.  Malassez  and  Yignal 
on  Zooglosic  Tuberculosis,  and  one  entitled  “  Hydatid  Cysts  of 
the  Liver  opening  into  the  Stomach,  with  especial  reference 
to  prognosis,”  by  Dr.  Llandier. 


The  Oentralblatt  fur  Klinische  Medicin  contains  abstracts 
of  papers — by  Cornil  and  Berlioz,  on  Jequirity  Poisoning ; 
by  Petrone,  on  some  Experimental  Observations  in  Thera¬ 
peutics  ;  by  Zimmerlin,  on  Hereditary  Progressive  Muscular 
Atrophy  ;  by  Seitz,  on  a  case  of  Sudden  Death  from  Laryn¬ 
geal  Paralysis.  An  original  paper  by  Dr.  Victor  Babes  on 
the  Structure  of  Sarcoma  appears  in  the  Oentralblatt  fur  die 
Medicinischen  Wissenschaften,  which  also  contains  abstracts 
of  papers — by  Eckhard,  on  Excitation  of  the  Heart  after 
Injury  to  the  Vagus  ;  by  Pouchet,  on  a  New  Form  of  Hydro¬ 
carbon  in  Phthisical  Lung-Tissue;  by  Nieden,  on  a  case  of 
Hemianopsia  after  Injury  to  the  Cerebral  Cortex;  by 
Jendrassik,  on  Tendon-Reflex.  In  the  Oentralblatt  fur 
Ohirurgie  appear  the  following  abstracts,  amongst  others— 
Vivien,  on  Traumatic  Cephalhydrocele  ;  Hack,  on  Reflex 
Affections  in  Nasal  Diseases  and  their  Operative  Treatment; 
Mensing  and  Fiorani,  respectively,  on  Resection  of  the  Knee; 
Courvoisier,  of  Basle,  contributes  an  account  of  a  case  of 
Gastro-Enterostomy.  The  Oentralblatt  f Hr  Gynakologie  pub¬ 
lishes  original  communications  from  Dr.  Brose,  of  Berlin,  on 
Continuous  Suture  in  Ruptured  Perineum  ;  and  from  Dr. 
Opitz,  of  Chemnitz,  on  Disinfection  of  the  Genital  Passages ; 
an  abstract  of  a  paper  by  Ungar  (Bonn)  on  Atelectasis  of 
Lungs,  and  a  report  of  a  late  meeting  of  the  Obstetrical 
Society  of  Leipzig,  are  also  published.  In  the  Berliner 
Klinische  Wochenschrift,  Dr.  Kredel  relates  a  case  of  Pseudo- 
Leukaemia,  with  Perforation  of  Spleen  and  Stomach;  Dr. 
Falk’s  address  on  Inoculated  Tubercle  is  published  in  extenso, 
a  debate  upon  the  same  finding  a  place  among  the  reports 
of  societies;  and  the  first  part  of  an  address  by  Dr.  Korte, 
on  the  Treatment  of  Artificial  Anus,  is  also  communicated. 
Dr.  Heinrich  Auspitz  contributes  to  the  Wiener  Medizinische 
Wochenschrift  some  notes  on  the  Treatment  of  Eczema; 
papers — by  Dr.  Weiss  on  the  Prodromata  of  Paralytic 
Mental  Disturbance,  and  by  Dr.  Biach  on  Idiopathic 
Hypertrophy  of  the  Heart — are  also  of  interest. 


THE  BRADSHAWE  LECTURE. 

The  second  annual  Bradshawe  Lecture  of  the  Royal  College 
of  Surgeons  was  delivered  in  the  theatre  of  the  College,  on 
the  6th  inst.,  by  Prof.  John  Marshall,  F.R.S.,  the  President. 
There  was  a  crowded  audience,  among  whom  were  Sir  James 
Paget,  F.R.S.,  Sir  Spencer  Wells,  Sir  Risdon  Bennett,  Sir 
Henry  Thompson,  Sir  W.  Mac  Cormac,  Mr.  Le  Gros  Clark, 
F.R.S.,  Mr.  Hutchinson,  F.R.S.,  Mr.  Wood,  F.R.S.,  Mr.  Hulke, 
F.R.S.,  Mr.  Timothy  Holmes,  Mr.  C.  Heath,  and  Mr.  Lund, 
of  Manchester.  Mr.  Marshall  said  that  while  Sir  James 
Paget  had  devoted  the  first  of  these  lectures  to  the  con¬ 


sideration  of  some  “  new  diseases,”  he  had  chosen  a  “  new 
operation  ”  for  the  subject  of  the  second,  or  present,  lec¬ 
ture— namely,  “  Nerve-Stretching,”  especially  considered 
in  relation  to  “  the  relief  or  cure  of  pain.”  By  nerve¬ 
stretching  was  understood  a  palpable  and  appreciable  ex¬ 
tension  of.  a  nerve — not  a  mere  lifting  of  a  nerve  up 
from  its  bed.  He  explained  the  result  of  such  stretching 
on  the  physical  properties  of  nerves,  on  their  anatomical 
structure,  and  on  their  functions.  Nerves  were  decidedly, 
though  moderately,  extensible ;  they  retracted  after  re¬ 
moval  of  a  strain ;  and  they  were  remarkably  strong.  The 
small  nerves  of  the  face  could  bear  weights  of  from  six 
pounds  to  twelve  pounds,  while  the  sciatic  nerve  would 
withstand  a  strain  varying  from  eighty  pounds  to  two 
hundred  and  eighty  pounds.  The  effects  of  stretching  on 
the  minute  structure  of  a  nerve  were  fully  explained  by 
the  lecturer,  and  illustrated  by  diagrams  prepared  for  the 
occasion  by  M.  Victor  Horsley.  Passing  from  the  changes 
produced  by  nerve-stretching  on  the  bloodvessels  and  the 
lymphatics  of  the  nerve,  he  described  the  subsequent 
evidences  of  degeneration  in  a  stretched  living  nerve, 
and  its  restoration  and  recovery.  In  regard  to  the  func¬ 
tions  of  nerves,  he  explained  how  these  were  gradually 
injured  by  increasing  degrees  of  strain,  sensibility  suffering 
before  motor  power.  The  irritability  of  conducting  power 
was  first  excited  and  then  depressed.  In  the  second  division 
of  the  lecture  the  therapeutical  effects  of  nerve-stretching 
were  dealt  with,  and  the  great  success  of  the  practice  in 
the  cure  of  neuralgia  was  shown.  In  the  third  division  of 
his  subject  Mr.  Marshall  explained  the  possible  modes  of 
action  of  stretching  diseased  nerves  and  the  nerve-centres, 
especially  in  relation  to  the  cure  of  the  pains  of  neu¬ 
ralgia  and  of  locomotor  ataxy.  The  former  he  assumed 
to  be  very  generally  peripheral  or  in  the  nerves  them¬ 
selves,  and  suggested  that  they  might,  possibly,  frequently 
be  referred  to  sensory  nerves  supplying  the  nerve-sheath 
itself — i.e.,  to  nervi  nervorum, — which,  when  the  sheath 
is  forcibly  tightened,  would  be  paralysed  directly  from 
the  stretching,  and  so  would  no  longer  suffer  pain.  In 
other  cases,  however,  the  neuralgic  pains  might  depend  upon 
a  disordered  state  of  the  component  fibres  of  the  nerve  itself, 
and  these  would  be  alleviated  by  the  stretching  of  those 
fibres,  by  the  disruption  of  their  medullary  sheath,  and  the 
over-elongation  or  possible  rupture  of  the  axis-cylinders. 
Lastly,  in  other  cases  the  nerve-centres  themselves  might  be 
concerned.  In  locomotor  ataxy  it  was  not  the  nerves  outside 
the  spinal  column,  but  the  intra-spinal  nerve-roots  and  the 
white  conducting  columns  in  the  cord  itself,  which  were 
chiefly  affected ;  and  here,  as  well  as  in  central  neuralgias, 
jf  they  existed,  the  effect  of  nerve-stretching,  which  did  not 
reach  mechanically  the  intra-spinal  nerve-roots  or  the  spinal 
cord,  must  be  considered  to  be  due  to  subsequent  nutritive 
changes  dependent  upon  excitation  of  the  vaso-motor  nerves, 
and  perhaps  of  trophic  nerves ;  but  in  regard  to  such  ex¬ 
planations  the  lecturer  did  not  assume  to  dogmatise.  In  the 
concluding  division  of  the  lecture  the  different  modes  of 
nerve-stretching  were  explained. 


RECORDS  OF  FAMILY  FACULTIES. 

The  information  supplied  by  a  medical  contemporary,  in 
reference  to  Mr.  Francis  Galton’s  scheme  for  obtaining  data 
for  a  comprehensive  study  of  hereditary  tendencies,  was 
incorrect.  The  prize  competition  will  not  be  limited  to 
medical  men,  and  Mr.  Galton  is  not  prepared  to  furnish 
schedules  to  all  applicants.  The  following  letter  of  ex¬ 
planation  has  been  addressed  by  Mr.  Galton  to  an  American 
contemporary : — “  The  information  wanted  applies  to  so 
many  different  individuals  in  the  same  family  group,  and 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Dec.  15,  1S?3.  691 


differs  so  much  in  minuteness,  according  to  the  degree  of 
kinship,  and  it  has  to  he  arranged  in  so  special  a  manner, 
tihat  a  copious  explanatory  description  and  numerous  tables 
are  requisite.  There  is  no  real  complexity ;  nevertheless,  I 
feel  assured  that  without  considerable  guidance  endless  mis- 
rtakes  will  arise.  Correspondents  will  send  pages  of  useless 
matter,  and,  on  the  other  hand,  they  will  be  silent  about 
simple  facts,  the  absence  of  which  will  seriously  diminish 
the  value  of  otherwise  copious  returns.  I  therefore  found  it 
.necessary  to  prepare  a  book,  containing  a  full  account  and 
-explanation  of  what  was  wanted  in  order  to  exhibit  the 
various  hereditary  tendencies  that  converge  upon  any  given 
[person,  and  containing  at  the  same  time  all  the  necessary 
•schedules.  This  I  have  done ;  it  is  in  the  press,  and  will  be 
published  about  Christmas  by  Messrs.  Macmillan,  and  will 
l>e  procurable  in  America.  As  regards  the  prize  scheme,  I 
Lound  it  inadvisable  to  restrict  it  to  medical  men,  and  have 
thrown  it  open  to  c  British  subjects  resident  in  the  United 
Kingdom.’  I  could  not  extend  it  further,  owing  to  the  ex¬ 
treme  difficulty  of  verifying  statements  of  facts  alleged  to 
have  occurred  abroad.  My  self-imposed  task  will  be  hard 
-enough  as  it  is.  The  conditions  of  the  prizes  are  fully 
-explained  in  a  fly-leaf  to  the  English  edition.” 


LAST  QUARTER’S  HEALTH  RETURNS. 

According  to  the  report  of  the  English  Registrar- General 
for  the  third  quarter  of  the  present  year,  the  number  of 
hirths  registered  during  that  period  was  214,144,  corre¬ 
sponding  to  an  annual  birth-rate  of  31-7  per  1000.  So  low 
a  birth-rate  has  not  been  recorded  in  the  third  quarter 
of  any  year  since  1849.  Fortunately  the  death-rate  also 
■exhibited  a  falling  off,  the  total  deaths  being  113,118,  and 
"the  rate  16-8  per  1000.  This  mortality  was  2T  below  the 
average  rate  in  the  ten  preceding  corresponding  quarters, 
and  with  two  exceptions— 1879  and  1881— was  lower  than  in 
any  summer  quarter  since  civil  registration  commenced. 
This  signifies  that  the  deaths  during  the  last  quarter  in 
England  and  Wales  were  fewer  by  23,860  than  they  would 
have  been  had  the  rate  of  mortality  equalled  the  average 
rate  in  the  corresponding  pei’iod  of  the  forty-five  preceding- 
years.  This  decline  in  the  death-rate  is  mainly  due  to  a 
■decrease  in  the  fatality  of  the  principal  zymotic  diseases,  the 
.zymotic  death-rate  for  the  quarter  being  only  2-65  as  com¬ 
pared  with  an  average  rate  of  3-78  per  1000  for  the  ten  “  third 
quarters”  immediately  preceding.  In  London  during  the 
quarter  under  notice  the  death-rate  was  18'8  per  1000,  or 
T9  lower  than  the  average  rate  in  the  other  twenty-seven 
large  English  towns.  It  is  satisfactory  to  be  able  to  note 
that  the  proportion  of  uncertified  deaths  showed  a  further 
-decline  from  that  which  prevailed  in  the  three  preceding 
quarters.  In  Ireland  during  this  same  quarter  the  birth-rate 
•was  22-1  in  every  1000  of  the  estimated  population,  and  the 
death-rate  15’3.  The  birth-rate  is  stated  to  be  T9  under  the 
five  years’  average,  and  1*0  under  the  rate  for  the  third 
quarter  of  1882.  On  the  other  hand,  the  death-rate  is  0  9 
above  the  rate  for  the  corresponding  quarter  of  1882,  and 
0-2  over  the  average  for  the  third  quarter  of  the  five  years 
1878-82.  As  regards  the  general  health  of  the  people,  very 
many  of  the  799  registrars  remark  in  their  reports  on  the 
healthy  state  of  their  respective  districts  during  the  quarter 
under  notice,  although  scarlatina  was  very  fatal  in  some 
localities  (chiefly  in  Ulster),  and  whooping-cough  continued 
prevalent  in  several  parts  of  Connaught.  In  Scotland 
during  the  period  under  review  the  birth-rate  was  also  below 
the  average  of  the  past  ten  years,  and  the  death-rate,  too,  was 
-slightly  below  the  average,  and  nearly  identical  with  that 
for  England.  It  varied  considerably  in  the  eight  principal 
towns,  being  returned  as  241  for  every  10,000  inhabitants  in 


Glasgow,  232  in  Paisley,  231  in  Greenock,  174  in  Dundee, 
170  in  Leith,  168  in  Edinburgh,  155  in  Aberdeen,  and  140 
in  Perth. 


THE  M'GILL  MEDICAL  FACULTY,  MONTREAL. 

On  October  1,  last  year,  the  occasion  of  the  semi-centennial 
of  the  above  school,  a  gentleman  offered  $50,000,  if  the 
Faculty  succeeded  in  raising  an  equivalent  sum,  as  a  memo¬ 
rial  fund  to  their  late  Dean,  Dr.  G.  W.  Campbell.  This, 
we  are  glad  to  hear,  they  have  been  able  to  do,  and,  at  the 
opening  of  the  current  session.  Dr.  R.  P.  Howard,  the  Dean, 
was  able  to  make  the  pleasing  announcement  that  the 
$100,000  had  been  secured.  With  part  of  it  the  Faculty 
propose  to  found  a  chair  of  pathology,  human  and  com¬ 
parative.  The  Montreal  General  Hospital  has  also  received 
a  bequest  of  $50,000  from  Mr.  George  Stephen,  for  a  wing 
to  commemorate  the  services  which  the  late  Dr.  Campbell 
rendered  to  the  Hospital  and  to  the  public. 


DUBLIN  LADIES’  SANITARY  ASSOCIATION. 

On  the  afternoon  of  Thursday,  the  5th  inst.,  the  Countess 
Spencer  attended  a  meeting  of  this  most  useful  Association, 
and  conferred  the  certificates  on  the  pupils  who  had  passed 
a  successful  examination  in  hygiene  and  domestic  sanita¬ 
tion,  and  on  the  women  who  had  obtained  prizes  for  clean 
rooms.  From  a  preliminary  statement  made  by  Miss  M. 
O’Shaughnessy,  honorary  secretary,  we  learn  that  the  Asso¬ 
ciation  aims  at  (1)  providing  means  of  instruction  in  sani¬ 
tary  knowledge  for  all  classes,  and  (2)  endeavouring  to 
improve  the  physical  condition  of  the  poor  by  direct  per¬ 
sonal  effort.  Lectures  are  given  annually  in  accordance 
with  the  syllabus  of  the  Association,  which  is  as  follows  : — 

(1)  Lecture  on  breathing,  including  air  and  respiration ; 

(2)  lecture  on  digestion,  including  food  and  cooking  ;  (3)  lec¬ 
ture  on  beverages,  including  water,  the  action,  uses,  and 
abuses  of  tea,  coffee,  and  alcoholic  liquors  ;  (4)  lecture  on 
light,  sleep,  and  exercise ;  (5)  lecture  on  the  house  and  its 
surroundings,-  (6)  lecture  on  the  prevention  of  disease. 
Since  the  work  of  district-visiting  commenced  in  1881,  200 
families  have  competed  for  prizes,  1400  visits  have  been 
paid,  and  thirty-five  women  have  obtained  prizes  varying 
in  value  from  5s.  to  <£1 . 


ROYAL  COLLEGE  OF  PHYSICIANS. 

The  lectures  next  year  will  be  delivered  at  the  College 
on  each  of  the  following  Wednesdays  and  Fridays,  at  five 
o’clock : — Gulstonian  Lectures :  Dr.  Clifford  Allbutt  (March  7, 
12,14) — "  Chapters  on  Visceral  Neuroses.”  Croonian  Lec¬ 
tures  :  Dr.  Hughlings- Jackson  (March  19,  21,  26) — “  Evolu¬ 
tion  and  Dissolution  of  the  Nervous  System.”  Lumleian 
Lectures  :  Dr.  James  Andrew  (March  28,  April  2,  4) — 
<f  iEtiology  of  Phthisis.” 


THE  LONDON  FEVER  HOSPITAL. 

The  new  pavilion  which  it  has  been  found  necessary  to 
erect  in  connexion  with  this  Hospital  is  now  finished,  and 
will  shortly  be  open  to  patients.  Since  the  formation  of 
the  Metropolitan  Asylums  Board  the  benefits  of  the  Hospital 
in  the  Liverpool-road  have  to  a  continually  increasing 
extent  been  limited  to  those  who  can  contribute  some¬ 
thing  towards  the  expenses  of  the  charity  ;  and  as  other 
diseases,  such  as  measles  and  diphtheria,  have  been  thought 
suitable  for  admission  with  a  view  to  their  efficient 
isolation,  it  has  become  necessary  to  erect  additional 
isolation  wards.  These  have  been  provided  in  the  plans 
for  the  new  pavilion,  though  of  the  twelve  wardrooms 
and  two  administrative  rooms,  of  which  it  will  eventually 


692 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Dec.  15, 1888. 


consist,  only  three  rooms  have  so  far  been  erected.  These 
have  been  constructed  from  the  designs  of  Mr.  Keith  Young, 
and,  in  the  belief  of  the  Committee,  their  details  have  been 
so  carefully  thought  out  that  they  stand  unique  in  English 
hospital  construction.  The  size  of  the  wardrooms  is  such 
that  the  patients  will  have  a  floorspace  of  from  150  to  180 
square  feet,  and  about  2000  cubic  feet  each.  Their  walls 
are  faced  with  glazed  bricks  in  different  harmoniously 
arranged  colours,  and  the  flooring  is  constructed  of  oak 
blocks  on  a  basis  of  concrete.  The  sashes  are  specially  made 
with  the  view  of  preventing  the  lodgment  of  dust,  and  the 
glazing  is  of  stout  sheet  glass  in  two  thicknesses,  with  an 
interspace  of  three-quarters  of  an  inch.  The  greatest  atten¬ 
tion  has  been  paid  to  the  heating,  ventilating,  and  “  sani¬ 
tary  ”  arrangements,  and  the  furniture  has  been  specially 
designed.  It  is  to  be  hoped  that  this  sample  of  their  care  for 
their  patients  will  bring  in  such  an  influx  of  funds  that  the 
Committee  will  shortly  be  able  to  complete  the  pavilion. 

✓ 


SYPHILITIC  STENOSIS  OF  THE  (ESOPHAGUS. 

Syphilitic  disease  of  the  oesophagus  is  rare,  or,  at  any  rate, 
very  little  attention  has  been  given  to  it.  In  a  paper  in  the 
Berliner  Klinische  Wochenschrift,~No.  33,  Dr.  Lublinski  relates 
two  cases  which  occurred  in  his  practice.  The  first  occurred 
in  a  man  twenty-nine  years  of  age,  who  came  under  observa" 
tion  in  November,  1880,  complaining  of  difficulty  in  swallow¬ 
ing  solid  food.  This  symptom  had  existed  three  weeks,  and  was 
getting  worse.  There  was  no  history  of  his  having  swallowed 
any  corrosive,  and  there  was  no  evidence  of  pressure  on  the 
oesophagus  from  any  tumour  in  the  neck  or  mediastinum. 
On  the  uvula  there  was  a  scar,  but  otherwise  the  pharynx 
and  the  oesophagus  (so  much  as  was  visible)  were  healthy. 
The  larynx  was  movable,  and  not  diseased.  A  medium¬ 
sized  sound  was  passed  without  difficulty  to  the  level  of 
the  sixth  dorsal  vertebra,  where  it  met  with  an  insuper¬ 
able  obstruction.  A  small- sized  bougie  could  be  passed 
through  the  stricture,  which  communicated  to  the  hand 
a  feeling  of  roughness.  There  was  a  distinct  history  of 
syphilis,  ten  years  before.  The  patient  was  treated  with 
iodide  of  potassium,  and  bougies  were  not  used.  At  the 
end  of  eight  days  there  was  no  improvement,  and  the 
patient  was  suffering  from  palmar  psoriasis.  The  iodide 
was  increased  to  thirty  grains  daily.  At  the  end  of  three 
weeks  there  was  marked  improvement :  the  sound  could 
be  passed,  though  with  some  difficulty;  and  the  patient 
could  swallow  solid  food,  though  he  experienced  a  sensation 
of  soreness  and  pressure  behind  the  sternum  when  the  food 
was  too  solid.  In  the  course  of  some  weeks,  under  treat¬ 
ment  with  iodide,  these  symptoms  quite  disappeared,  and  a 
sound  could  be  passed  without  difficulty.  The  patient  was 
apparently  cured  in  March,  1881.  The  second  case  was  a 
man  aged  fifty-four,  who  came  under  treatment  for  an  affec¬ 
tion  of  the  tongue,  and  pain  in  swallowing,  in  November, 
1881.  For  eight  weeks  he  had  been  unable  to  swallow  any¬ 
thing  but  liquid  and  soft  food,  and  the  latter  gave  him  pain 
between  the  shoulders  and  behind  the  sternum.  On  the  left 
side  of  the  tongue,  near  the  tip,  was  a  hard  ulcerated  tumour 
the  size  of  a  bean;  the  edges  of  the  ulcer  were  sinuous 
and  considerably  thickened,  and  around  the  ulcer  was  a 
red  areola.  The  tumour  was  said  to  have  been  growing 
gradually  and  painlessly  until  fourteen  days  before,  when  it 
began  to  ulcerate.  The  glands  about  the  jaw  were  a  little 
swollen ;  the  pharynx  and  larynx  were  healthy.  At  the 
level  of  the  fifth  cervical  vertebra  the  oesophageal  sound  met 
with  an  obstruction,  which  only  permitted  a  fine  bougie  to 
pass.  The  patient  showed  no  other  signs  of  disease.  He 
had  been  infected  with  syphilis  twenty-two  years  before,  for 


which  he  had  been  treated,  and  during  the  subsequent  years 
he  had  had  occasional  signs  of  the  disease.  Under  treatment 
with  iodide  of  potassium  the  tumour  in  the  tongue  dimi¬ 
nished,  lost  its  hardness,  and  healed,  leaving  a  puckered 
scar.  The  oesophageal  stricture  was  treated  by  the  daily 
passage  of  bougies,  at  first  with  little  benefit ;  but,  as  the 
iodide  was  pushed  up  to  forty-five  grains  daily,  an  improve¬ 
ment  gradually  occurred,  pains  diminished,  and  the  patient 
was  able  to  swallow  solid  food.  The  improvement  con¬ 
tinued,  though  in  July,  1882,  there  was  still  some  obstruction 
to  a  large  sound,  probably  due  to  the  contraction  of  the  scar 
left  by  the  syphilitic  disease.  Besides  these  two  cases, 
Lublinski  mentions  seven  other  cases,  three  reported  by 
West,  of  Birmingham  (two  in  the  Dublin  Quarterly  Journal 
February  and  August,  1860 ;  one  in  the  Lancet,  August  31, 
1872),  two  by  Follin  (in  his  “  Traite  Elementaire  de  Patho- 
logie  Externe,”  1861),  one  by  Robert,  of  Marseilles  (in  his 
,£  Nouveau  Traite  des  Maladies  Veneriennes,”  1861),  one  by 
Clapton  (in  St.  Thomas’s  Hospital  Reports,  1871),  and  one  by 
Morell  Mackenzie  (in  the  Lancet,  May  30, 1874).  Lublinski 
is  of  opinion  that  this  affection  of  the  oesophagus  occurs  in 
the  later  stages  of  syphilis,  years  after  infection,  when  the 
patient  seems  to  be  cured.  Most  of  the  cases  begin  as  & 
gummatous  deposit  in  the  submucous  tissue.  This  deposit 
may  undergo  one  of  two  changes — either,  under  proper  treat¬ 
ment,  it  undergoes  fatty  metamorphosis  and  is  absorbed ;  or 
the  cell-proliferation  continues,  the  intercellular  substance 
softens,  and  becomes  gelatinous,  and  the  mass  becomes  puri- 
forrn,  and  at  length  ulcerates.  The  ulcer,  in  the  process  of 
healing,  forms  a  thick  scar,  which  has  a  further  tendency  to 
contract,  and  narrow  the  canal.  In  some  cases  the  walls  of 
the  oesophagus  may  be  at  last  converted  into  firm  fibrous 
tissue,  which  may  occupy  the  whole  thickness,  and  may 
extend  over  a  greater  part  of  the  surface  of  the  canal. 
When  the  deposit  undergoes  fatty  metamorphosis  and  is. 
absorbed,  no  permanent  stricture  is  produced;  but  when 
ulceration  has  occurred  with  the  formation  of  scars,  the 
stricture  may  improve,  but  will  never  be  cured.  As  to  the 
rarity  of  this  affection,  Lublinski  suggests  that  the  reason 
may  be  in  the  protection  afforded  by  the  thick  stratified 
squamous  epithelium  which  covers  the  mucous  membrane 
of  the  oesophagus,  and  protects  it  from  external  influences  j 
or  that  slight  affections  may  be  frequently  overlooked  both 
in  the  living  patient  and  at  autopsies,  the  symptoms  being 
frequently  so  slight,  and  physical  examination  in  the  living 
almost  impossible,  so  that  the  early  stages  of  this  disease 
may  be  overlooked ;  and  the  disease  may  really  be  more 
common  than  it  is  generally  admitted  to  be. 


COMPULSORY  NOTIFICATION  OF  INFECTIOUS  DISEASES. 

The  Dublin  Sanitary  Association,  accompanied  by  the  Royal 
College  of  Surgeons  in  Ireland,  are  about  to  wait  upon  the 
Chief  Secretary  for  Ireland,  to  press  upon  him  the  necessity 
which  exists  for  the  Government  to  introduce  into  Parlia¬ 
ment,  with  as  little  delay  as  possible,  a  measure  for  the 
notification  of  infectious  diseases  in  Ireland,  based  on  the 
lines  of  the  Bill  introduced  by  Mr.  Charles  Meldon,  M.P., 
in  the  session  of  1882.  It  will  be  remembered  that  Mr. 
Meldon’s  Bill  provided  for  compulsory  notification  by  the 
head  of  the  family  or  the  householder,  while  it  allowed  to- 
the  medical  attendant  the  option  of  himself  notifying 
should  he  think  fit  to  do  so.  This  principle  received  the 
assent  of  the  King  and  Queen's  College  of  Physicians,  the 
Royal  College  of  Surgeons  in  Ireland,  the  Irish  Medical 
Association,  and  the  Dublin  Branch  of  the  British  Associa¬ 
tion,  and  was  generally  accepted  as  a  satisfactory  solution 
of  the  difficulty  attending  notification  by  the  medical 
attendant. 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Dec.  15,  1883.  693 


THE  PARIS  WEEKLY  RETURN. 

The  number  of  deaths  for  the  forty-eighth  week  of  1883, 
terminating  November  27,  was  972  (550  males  and  422 
females),  and  of  these  there  were  from  typhoid  fever  32, 
small-pox  4,  measles  14,  scarlatina  1,  pertussis  9,  diphtheria 
and  croup  43,  dysentery  1,  erysipelas  6,  and  puerperal  in¬ 
fection  5.  There  were  also  54  deaths  from  acute  and 
tubercular  meningitis,  171  from  phthisis,  37  from  acute 
bronchitis,  73  from  pneumonia,  56  from  infantile  athrepsia 
(21  of  the  infants  having  been  wholly  or  partially  suckled), 
and  29  violent  deaths  (20  males  and  9  females).  The  deaths 
from  epidemic  diseases  continue  nearly  stationary.  Typhoid 
fever,  although  not  on  the  increase,  is  more  fatal  than  is 
usual  at  this  time  of  the  year.  Diphtheria  too  continues  to 
be  frequent  (as  is  usual  in  winter),  43  deaths  having  taken 
place  instead  of  the  20  to  25  of  the  summer  months,  while 
the  admissions  also  go  on  increasing  yet  more  rapidly. 
The  deaths  from  the  bronchitis  of  infants  and  from  pneu¬ 
monia  are  also  frequent,  while  those  from  infantile  athrep¬ 
sia  have  been  very  few.  During  the  week  there  were  1174 
births,  viz.,  582  males  (411  legitimate  and  171  illegitimate) 
and  592  females  (417  legitimate  and  175  illegitimate)  :  107 
infants  were  born  dead  or  died  within  twenty-four  hours,  viz., 
<65  males  (39  legitimate  and  26  illegitimate)  and  42  females 
(31  legitimate  and  11  illegitimate). 


ROYAL  COLLEGE  OF  SURGEONS. 

At  a  meeting  of  the  Council  of  the  Royal  College  of  Surgeons 
on  the  13th  inst.,  the  following  Fellows  were  elected  members 
of  the  Board  of  Examiners  in  Anatomy  and  Physiology, 
viz. : — Messrs.  John  Langton  and  Henry  Power,  of  St.  Bar¬ 
tholomew’s  Hospital ;  T.  Pickering  Pick,  of  St.  George’s 
Hospital ;  Edward  Bellamy,  of  the  Charing-cross  Hospital ; 
Henry  G.  Howse,  of  Guy’s  Hospital ;  Edmund  B.  Owen,  of 
St.  Mary’s  Hospital ;  Benjamin  T.  Lowne,  of  the  Middlesex 
Hospital ;  Jeremiah  McCarthy,  of  the  London  Hospital;  and 
Gerald  P.  Yeo,  of  King’s  College  Hospital. 


QUININE  AND  INSANITY. 

At  the  Chicago  Medical  Society  a  paper  was  recently  read 
on  insanity  from  quinine.  It  was  based  on  three  cases  only, 
but  the  evidence  in  each  seems  fairly  conclusive.  In  all 
three  the  quinine  was  employed  on  account  of  malarial 
symptoms.  The  first  man  took  three  doses  of  three  grains 
in  the  course  of  one  day,  and  was  then  seized  by  a  violent 
attack  of  frenzy,  with  hallucinations  of  hearing  and  dim¬ 
ness  of  vision ;  the  second  fell  into  a  state  of  extreme 
dementia  after  only  ten  grains  of  quinine,  and  the  third 
became  destructive  and  violent  after  one  dose  of  twenty 
grains.  In  all  three  cases  there  was  the  strongest  possible 
family  history  of  insanity.  The  medico-legal  importance  of 
such  results  was  dwelt  upon  by  Dr.  Kiernan,  the  reader  of 
the  paper,  and  he  remarked  that  when  the  use  of  quinine 
was  pleaded  as  an  excuse  for  crime  it  would  be  fair  to  ad¬ 
minister  further  doses  to  test  the  validity  of  this  claim— 
rather  bringing  to  memory  the  Judge’s  suggestion  in  Trial 
by  Jury.  _ _ 

“CACHEXIA  STRUMI  PRIVA.” 

De.  Lardy,  writing  to  the  Union  Medicale  (December  6) 
from  Bern,  gives  some  account  of  Prof.  Kocher’s  operations 
for  goitre,  of  which  he  has  performed  a  greater  number 
(about  150)  than  any  other  surgeon.  He  alludes  here,  how¬ 
ever,  chiefly  to  a  secondary  effect  which  Prof.  Kocher 
alleges  sometimes  follows  this  operation,  and  which  he 
terms  cachexia  strumi ,  yriva,  and  which  ensues  in  some 
cases  when  the  whole  thyroid  is  removed.  Until  lately  this 


gland  was  thought  to  be  of  so  little  consequence  that  it  did 
not  much  matter  whether  it  was  removed  in  its  entirety 
even  when  one  lobe  only  was  affected ;  but  Prof.  Kocher 
asserts  that  in  some  of  these  cases  a  considerable  reflex 
action  operates  upon  the  brain,  and  the  patient  becomes 
idiotic.  A  memoir,  in  which  he  stated  this  view,  was 
received  at  the  last  Berlin  Surgical  Congress  with  open 
ridicule;  and  Prof.  Billroth  (who  has  himself  performed 
thyroidectomy  120  times)  entirely  denies  the  accuracy  of 
the  statement.  In  the  meantime,  such  cases.  Dr.  Lardy 
maintains,  are  to  be  met  with  in  considerable  numbers, 
and  he  refers  in  his  letter  to  several  such.  One  remark¬ 
able  feature  is  the  brutalised  countenance  these  unfortunate 
persons  assume,  while  they  become  incapable  of  executing 
any  employment  that  demands  intelligence. 


INSANITARY  PROPERTY  IN  LIVERPOOL. 

At  a  meeting  of  the  Liverpool  Medical  Society  on  the  6th 
inst.,  a  paper  was  read  by  Dr.  Newton  on  the  chief  causes 
of  the  high  death-rate  in  Liverpool.  A  rather  excited  dis¬ 
cussion  ensued,  owing  to  the  contention  of  Dr.  Newton  that 
the  habits  of  the  “  low  Irish  ”  were  the  chief  cause  of  con¬ 
tagious  disease.  The  arguments  used  were  much  the  same 
as  those  already  reported  in  our  issue  of  November  24.  At 
the  close  of  the  meeting  the  following  resolution  was  carried, 
and  directed  to  be  sent  to  the  City  Council : — “  That  this 
institution  views  with  great  satisfaction  the  resolution  of 
the  Liverpool  City  Council  to  apply  to  the  Local  Government 
Board  for  permission  to  borrow  .£200,000  for  the  purpose  of 
improving  the  insanitary  dwellings  of  the  working  classes ; 
and  believes  that  the  expenditure  of  the  money  for  such  a 
purpose  will  be  followed  by  a  great  diminution  in  the  disease 
and  mortality  of  the  city.  It  further  desires  to  express 
the  hope  that  advantage  will  be  taken  of  every  opportunity 
to  acquire  open  spaces  and  to  widen  streets,  so  as  to  afford 
additional  breathing-places  to  the  population.” 


THE  EFFECTS  OF,  TOBACCO. 

In  non-smokers  of  average  constitutions  the  mean  tempera¬ 
ture  of  the  twenty -four  hours  amounts  to  36’76°  C.  (or  about 
98°  Fahr.),  and  the  pulse-rate  to  72-9°.  In  smokers  the  tem¬ 
perature  reaches  37'02:>  C.  (98'6°  Fahr.),  and  the  pulse-rate 
89-9:>.  Tobacco-smoking,  therefore,  raises  the  temperature 
0'263  C.,  and  the  pulse-rate  16°.  In  persons  of  feeble  con¬ 
stitutions  the  temperature  rises  0‘43°  C.,  and  pulse-rate  11-9°. 
Taking  a  mean,  tobacco  may  be  said  to  raise  the  tempera¬ 
ture  0-29°  C.  (nearly  1°  Fahr.),  and  to  increase  the  cardiac 
pulsations  by  12’7°.  Representing  the  normal  temperature 
at  1000  in  non-smokers,  in  moderate  smokers  it  rises  to 
1008 ;  and  whereas  the  pulse  of  the  former  may  be  taken  at 
1000,  that  of  the  smoker  is  1180.  It  is  by  increasing  cardiac 
pulsations  that  tobacco  has  such  an  injurious  effect  on  some 
constitutions,— such,  at  least,  is  the  conclusion  which  Dr. 
Troitski  communicates  to  the  Annales  d’Hygiene. 


PROCRASTINATION  AT  TAUNTON. 

Taunton,  including  the  neighbourhood  around  it,  has  re¬ 
cently  earned  an  unenviable  notoriety  on  account  of  its 
insanitary  condition — so  much  so,  that  the  Local  Govern¬ 
ment  Board  considered  it  necessary  to  despatch  one  of  its 
medical  officers  to  furnish  a  special  report  on  the  subject. 
This  report  we  have  already  reviewed,  and  we  are  bound  to 
admit  that  it  is  very  generally  corroborated  by  the  annual 
returns  for  the  year  1882,  compiled  by  Dr.  Henry  J.  Alford, 
the  Medical  Officer  of  Health  for  the  locality  in  question. 
This  latter  authority  remarks  that  diphtheria  was  epi¬ 
demic  in  the  district  during  the  year  under  notice,  with  a 


694 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Deo.  15, 18S&, 


heavy  mortality ;  in  fact,  in  Taunton  proper  the  deaths  from 
the  zymotic  class  of  diseases  were  at  the  rate  of  3-7  per  1000. 
Nor  can  this  be  wondered  at  when  Dr.  Alford  records  that 
although  for  the  past  ten  years  he  has  been  urging  upon 
the  authorities  the  necessity  of  some  steps  being  taken  to 
ventilate  the  sewers  of  the  town,  nothing  has  as  yet  been 
done.  Twice,  he  says,  the  experiences  of  other  large  towns 
have  been  sought  as  some  guide  in  this  direction,  and  twice 
he  has  very  fully  reported  on  the  matter  to  the  Sanitary 
Board;  on  both  occasions,  however,  his  suggestions  were 
negatived,  and  although  the  subject  is  under  the  consi¬ 
deration  of  a  special  committee,  no  practical  work  has,  up 
to  the  end  of  1882,  been  undertaken.  This  is  a  very  fair 
simple  of  the  difficulties  with  which  medical  officers  of 
health  have  to  contend  in  their  dealings  with  the  powers  by 
whom  they  are  appointed  :  they  are  presumably  responsible 
for  the  sanitary  condition  of  their  districts,  yet  suggestions 
of  vital  importance  made  by  them  are  studiously  ignored. 
In  the  present  instance  Dr.  Alford  can  only  predict  that  so 
long  as  the  sewers  of  Taunton  remain  in  their  present  con¬ 
dition,  so  long  will  its  death-rate  remain  abnormally  high, 
and  the  health  of  the  town  be  deteriorated.  Fortunately 
for  the  district,  the  medical  officer  despatched  by  the  Local 
Government  Board  also  called  attention  to  the  defective  con¬ 
dition  of  the  sewers  ;  and  it  remains  to  be  seen  whether  this 
additional  warning  will  stimulate  the  authorities  into  taking 
action. 


SUBACUTE  AND  CHRONIC  PNEUMONIA. 

E.  Wagner  (Deutsches  Archiv  fur  Klin.  Med.,  1883,  Bd. 
xxxiii.)  describes  four  distinct  forms'of  chronic  or  subacute 
pneumonia,  each  of  which  may  be  subject  to  a  variety  of 
subdivisions.  1.  Cases  which  originate  in  the  delayed  re¬ 
sorption  of  pneumonic  infiltration.  Of  these,  some  become 
completely  healed,  and  others  show  signs  of  temporary  or 
permanent  shrinking  of  the  lung-tissue.  2.  Cases  of  sub¬ 
acute  lobular  [or  broncho-pneumonia,  occurring  either  as  a 
consequence  of  irritation  by  foreign  particles  or  by  chemical 
rritants,  or,  as  sometimes  happens,  in  a  primary  form  in 
old  persons.  3.  Subacute  and  chronic  interstitial  inflam¬ 
mations,  most  of  which  owe  their  origin  to  some  previously 
existing  pulmonary  affection  or  to  some  obstructive  thoracic 
disease  leading  to  prolonged  congestion.  An  important 
indication  of  this  condition  is  the  frequent  occurrence  of 
pinkish  sputa.  4.  Caseous  pneumonia. 


OLEATE  OF  QUINIA. 

There  are  many  patients,  and  some  pathological  conditions, 
in  which,  though  the  administration  of  quinine  is  urgently 
indicated,  the  digestive  tract  rejects,  fails  to  absorb,  or  is 
dangerously  irritated  by  the  alkaloid.  It  is  in  such  cases 
that  the  inunction  of  the  oleate  of  quinia  has  been  recom¬ 
mended  by  some  Transatlantic  authorities,  and  observa¬ 
tions  on  the  subject  were  recently  invited  by  the  North 
Carolina  Medical  Journal.  A  case  appears  in  the  October 
number  of  that  publication,  which  appears  to  show  con¬ 
clusively  that  quinine,  when  thus  epidermically  adminis¬ 
tered,  is  absorbed  into  the  circulation,  may  be  detected  in 
the  urine,  and  produces  fully  marked  constitutional  effects . 
One  to  two  drachms  of  quinia  alkaloid  were  added  to  two 
ounces  of  oleic  acid,  and  the  whole  mass  thus  prepared 
rubbed  patiently  into  the  skin  of  the  thighs,  groins,  and 
abdomen  during  every  eight  hours.  Convalescence  from  a 
sharp  attack  of  malarial  fever  was  established  in  two  weeks. 
Now,  without  taking  into  consideration  the  irksomeness  and 
personal  discomfort  involved  in  this  mode  of  treatment,  it  is 
obvious  that  a  serious  obstacle  to  its  adoption  will  be  found 
in  the  costliness  of  the  pure  quinia  alkaloid  which  must  be 


used  in  the  preparation  of  the  oleate.  A  large  quantity 
must  be  employed  in  the  inunction,  and  the  process,  though 
interesting  as  a  pathological  experiment,  will  probably  be- 
but  seldom  imitated.  Whether  the  oleate  of  quinia  can  be 
advantageously  and  unobjectionably  used  for  purposes  of 
hypodermic  injection,  is  a  point  of  more  practical  interest, 
and  one  on  which  we  await  further  enlightenment  from  our 
confreres  in  North  Carolina.  In  the  opinion  of  the  editor  of 
the  journal  referred  to,  “  it  will  prove  to  be  the  very  thing 
the  profession  has  so  long  desired  ”  for  hypodermic  use. 


It  is  reported  that  there  is  now  more  typhus  and  scarlet 
fever  in  Dublin  than  there  has  been  at  any  time  during  the 
past  three  years.  _ 

The  Princess  Alice  Hospital  at  Darmstadt,  the  principal 
English  memorial  to  the  late  Princess,  was  formally  opened 
by  the  Grand  Duke  of  Hesse  on  Saturday  last. 


Dr.  Dxjtrieux,  whose  report  on  the  cholera  was  so  insult¬ 
ingly  treated  by  the  Board  of  Health,  has  returned  from 
Europe,  and  will  publish  a  second  report  as  soon  as  Dr- 
Hunter’s  final  report  appears. 


At  the  election  at  the  Academie  de  Medecine  in  the 
Section  of  Therapeutics  and  Medical  Natural  History,  in 
order  to  fill  the  vacancy  caused  by  the  death  of  Dr.  Davaine,' 
Dr.  Vidal  received  the  votes  of  fifty-seven  of  the  eighty- 
five  academicians  present.  Dr.  Hayem  following  next  with 
twenty-four  votes.  _ 

Another  Paris  interne  has  fallen  a  victim  to  diphtheria, 
contracted  in  the  performance  of  his  duty.  Three  weeks 
ago  a  child  was  brought  into  hospital  suffering  from  diph¬ 
theria,  and  was  attended  by  M.  Gustave  Bivet,  the  interne 
on  duty.  The  next  day  he  sickened  of  the  disease ;  the 
membrane  invaded  the  larynx,  and  tracheotomy  was  dis¬ 
cussed,  but  M.  Bivet  was  then  too  weak  to  undergo  it.  On 
Monday  last  he  died.  _ 

Dr.  Blot,  in  his  report  on  the  vaccinations  performed  by 
the  Academie  de  Medecine  for  1882,  calls  the  particular 
attention  of  the  Academy  to  the  negligence  of  parents  re¬ 
specting  the  operation,  and  the  need  of  the  intervention  of 
the  law.  On  examining  the  ages  of  the  children,  whether 
vaccinated  at  the  Academy  or  at  the  different  other  esta¬ 
blishments  in  Paris,  he  finds  that  more  than  a  third  of  them 
had  exceeded  the  age  of  a  year. 


Chloroformisation  during  Sleep. — The  New  York 
Medical  Record,  October  27,  closing  an  article  on  Chloroform 
Narcosis  during  Sleep,  in  which  several  publications  on  the 
subject  are  passed  under  review,  observes: — “It  would 
appear,  therefore,  from  the  foregoing  and  other  accumulated 
evidence,  that  it  is  quite  possible  to  bring  a  sleeping  patient 
profoundly  under  the  influence  of  chloroform  without  first 
causing  a  period  of  consciousness.  This  is  more  especially 
true  of  children.  In  adults,  chloroform-narcosis  during  sleep 
is,  apparently,  not  so  easy,  and  in  many  instances  it  probably 
cannot  be  accomplished  at  all.  But  that  in  certain  cases  it 
is  possible,  particularly  where  careful  judgment  and  skill 
are  exercised  in  the  administration  of  the  drug,  we  think 
that  there  can  be  no  doubt.  To  be  successful,  however,  it 
is  necessary  that  the  means  employed,  the  quantity  used, 
etc.,  should  be  selected  with  excellent  judgment,  aud  the- 
drug  given  by  an  experienced  physician  with  great  care- 
and  by  easy  and  gradual  approaches.  But  that  even  this- 
plan,  faithfully  carried  out,  will  not  succeed  in  all  cases,  is 
equally  evident.  In  this  light,  however,  we  cannot  help 
thinking  that  the  possibility  of  this  procedure  would  be 
more  practically  conclusive  were  all  the  successful  attempts 
recorded  side  by  side  with  the  failures.” 


Medical  Times  and  Gasette. 


THE  CASE  OE  MESSRS.  BOWER  AND  KEATES. 


Dec.  15, 18SS.  695 


IMPORTANT  MEETING  AT  SIR  WILLIAM 
JENNER’S. 


The  Case  of  Messes.  Boweb  and  Keates. 

A  drawing- boom  meeting  of  a  large  number  of  the  leading 
consultants  and  practitioners  residing  in  London  was  held  at 
the  residence  of  Sir  William  Jenner,  on  Monday  evening, 
December  10,  to  consider  the  case  of  Messrs.  Bower  and 
Keates,  who,  it  will  be  remembered,  were  recently  charged 
with  the  manslaughter  of  a  child  suffering  from  diphtheria, 
upon  whom  they  had  performed  the  operation  of  tracheotomy 
to  avert  impending  asphyxia.  The  matter  was  taken  up  by 
the  Public  Prosecutor,  who  conducted  the  case  against  the 
defendants.  The  case  was  brought  before  the  College  of 
Physicians  at  the  last  meeting  of  the  Fellows,  on  Novem¬ 
ber  22,  by  Dr.  Moxon,  and  it  was  referred  to  the  Council  to 
consider  what  steps  could  be  taken  to  protect  members  of 
the  profession  from  such  unwarrantable  prosecutions  as  this 
proved  to  be, 

The  meeting  was  opened  by  some  remarks  by  Sir  William 
Jenner,  in  the  course  of  which  he  stated  that  he  had  invited 
the  members  present  to  attend  the  meeting  because  he  felt 
that  the  subject  was  one  of  the  gravest  importance,  and 
one  in  which  every  member  of  the  profession  must  feel  a 
deep  personal  interest ;  for  any  medical  man,  whether  con¬ 
sultant  or  practitioner,  might  be  placed  in  a  similar  position 
at  any  moment. 

Dr.  Moxon  was  then  called  upon  by  Sir  William  Jenner 
to  make  a  statement  of  the  details  of  the  case  to  the  meet¬ 
ing.  From  this  it  appeared  that  two  actions  had  been 
brought  against  the  unfortunate  gentlemen ;  one  a  civil 
action,  brought  by  the  father  of  the  child  to  recover  damages 
from  Messrs.  Bower  and  Keates  because  he  had  been  in¬ 
structed  by  them,  after  the  operation  of  tracheotomy  had  been 
performed,  to  suck  the  tube  which  had  become  obstructed, 
and  thereby  to  save  the  life  of  his  own  child.  The  father  sub¬ 
sequently  had  some  slight  throat  affection,  which,  it  was 
thought,  was  probably  of  a  diphtheritic  nature,  though  it 
was  certainly  not  severe  diphtheria;  and  it  was  to  recover 
damages  for  this  that  he  brought  the  action.  The  first 
trial  terminated  by  the  disagreement  of  the  jury.  A  new 
action  had  been  commenced,  and  this  part  of  the  matter 
was  therefere  sub  judice  and  could  not  be  discussed  at  pre¬ 
sent.  After  the  failure  of  the  civil  action,  although  it  had 
been  given  in  evidence  in  the  course  of  the  trial  that  the 
parents  had  no  complaint  to  make  concerning  the  treat¬ 
ment  of  the  child,  and,  indeed,  were  completely  satisfied 
therewith,  the  mother  proceeded  to  swear  an  allegation 
at  the  Lambeth  Police-court,  stating  that  the  treatment 
of  the  child  had  been  improper,  and  charging  its  medical 
attendants  with  manslaughter.  This  charge  was  taken  up 
by  the  Public  Prosecutor,  who  conducted  the  action  on 
oehalf  of  the  Crown.  It  might  appear  scarcely  credible 
that  this  high  public  functionary  felt  justified  in  under¬ 
taking  the  criminal  prosecution  of  these  gentlemen  for  the 
manslaughter  of  their  patient,  without  one  atom  of  medical 
evidence  before  him  in  support  of  the  charge.  The  result 
of  the  examination  of  the  defendants  before  the  magistrate 
was  the  dismissal  of  the  charge  immediately  after  the  cross- 
examination  of  the  medical  witness  summoned  on  behalf  of 
the  prosecution — the  magistrate  remarking  that  this  was  a 
case  of  “  persecution,”  not  prosecution. 

It  appeared  clear  from  Dr.  Moxon’s  statement  that  the 
united  action  of  the  profession  was  called  for  in  three  distinct 
lines.  First,  to  bring  under  the  notice  of  the  Government 
the  terrible  injury  that  must  be  inflicted  upon  any  medical 
man  against  whom  the  Public  Prosecutor  may  see  fit  to  take 
action  ;  and  to  ask  that  steps  may  be  taken  to  restrain  this 
official  from  taking  action  without  first  obtaining  adequate 
medical  evidence  in  support  of  the  charge.  Secondly,  to 
convey  to  Messrs.  Bower  and  Keates  an  expression  of  the 
deep  feeling  of  sympathy  for  them  in  their  trouble  which  is 
felt  throughout  the  profession.  Thirdly,  to  obtain  subscrip¬ 
tions  to  indemnify  them  for  the  heavy  legal  expenses  which 
they  have  been  compelled  to  incur. 

After  some  discussion  on  the  best  methods  by  which  these 
objects  could  be  attained,  the  following  resolutions  were 
unanimously  adopted  :  — 

1.  Proposed  by  Sir  James  Paget,  and  seconded  by  Dr. 


Moxon — “  That  a  committee  be  formed  for  the  purpose  of 
collecting  subscriptions  to  defray  the  legal  expenses  incurred 
by  Messrs.  Bower  and  Keates  in  their  defence  from  the 
charges  recently  brought  against  them,  and  of  preparing  a 
statement  by  which  subscribers  may  express  their  sympathy 
with  those  gentlemen,  and  their  conviction  that  the  treat¬ 
ment  of  the  case  for  which  they  were  prosecuted  was  right. 
That  the  committee  consist  of  Sir  William  Jennei’,  Sir  James 
Paget,  Dr.  Quain  (treasurer).  Dr.  Wilson  Fox,  Dr.  Moxon* 
Dr.  Glover,  Mr.  Hutchinson,  Mr.  Bryant,  Dr.  Bright  (Forest 
Hill),  Mr.  Jackson  (Highbury-grove),  Mr.  Sidney  Turner 
(Anerley) ;  with  Dr.  Mahomed  and  Dr.  Burnet  as  honorary- 
secretaries.” 

2.  Proposed  by  Sir  James  Paget,  and  seconded  by  Dr. 
Wilson  Fox — “  That  the  Council  of  the  Royal  College  of 
Physicians  and  the  Council  of  the  Royal  College  of  Surgeons, 
be  requested  to  consider  the  propriety  of  representing  to  the- 
Secretary  of  State  for  the  Home  Department  that  it  is  very- 
desirable  that  there  should  be  some  arrangement  by  which 
the  Public  Prosecutor  may  obtain  the  assistance  of  skilled 
advisers  when  he  is  solicited  to  institute  prosecutions  of: 
medical  practitioners.” 

A  vote  of  thanks  to  Sir  William  Jenner  for  summoningr 
the  meeting  to  his  house,  and  for  so  promptly  and  power¬ 
fully  taking  action  in  defence  of  the  profession  in  a  tnatter- 
of  vital  importance  to  every  member  of  it— proposed  by  Dr- 
Glover,  and  seconded  by  Mr.  William  Adams  (of  Regent’s- 
park-road) — was  carried  with  enthusiasm,  and  brought  the- 
meeting  to  a  close. 


Promises  of  subscriptions  which  would  amount  to  upwards-, 
of  ,£200  were  received  on  this  evening  alone  ;  but  the  com¬ 
mittee  will  be  asked  to  consider  at  its  next  meeting  whether 
it  would  not  be  better  to  limit  the  amount  of  each  subscrip¬ 
tion,  as  it  is  felt  that  the  support  of  every  member  of  the 
profession  is  required,  and  that  by  limiting  the  amount  of 
each  subscription  a  large  number  of  gentlemen  will  have- 
the  opportunity  afforded  them  of  expressing  their  sympathy 
with  the  movement. 


A  complete  statement  of  the  case,  with  a  memorial  for 
signature,  is  being  prepared  by  the  committee,  and  it  is 
hoped  that  it  may  be  in  the  hands  of  every  member  of  the- 
profession  in  the  United  Kingdom  by  about  the  end  of  next 
week.  We  have  no  doubt  that  the  response  which  will  be- 
made  to  this  appeal  will  be  unanimous  and  emphatic. 

Appended  is  a  list  of  the  subscriptions'  promised  at  the 


meeting  : — 

£  p. 

Sir  William  Jenner . 25  0 

Dr.  Moxon . 25  0 

Sir  James  Paget  . 2t  0 

Dr.  Quain  ..  10  10 

Dr.  Wilson  Fox  . 10  10 

Dr.  Herbert  Davies .  5  5 

Mr.  Bryant .  5  5 

Mr. William  Adams,  Regent’ s- 

park-road,  N.W .  5  5 

Dr.  Glover,  Compton-terrace, 

N.W .  5  5 

Mr.  J.  T.  Jackson,  Highbury- 

grove,  N .  5  5 

Dr.  H.  J.  Stoker,  Highbury,  N.  5  5 

Dr.  Bright  and  Mr.  Eyre, 

Forest  Hill  .  5  5 

Dr.  F.  T.  Roberts  .  3  3 


£  s>. 

Mr.  J.  Sidney  Turner,  Anerley  3  3= 
Dr.  John  Brockwell,  Gipsy 

Hill . 2  2: 

Dr.  Arthur  Evershed,  Hump- 

Dr.  Forshall,  Highgate  2  2 

Dr.  E.  Baxter  Forman,  Stoke 

Newington-road,  N .  2  2 ■ 

Dr.  John  Hewer,  Highbury 

New-park,  N .  2  55- 

Dr.  Hooper  May,  Tottenham  2  2 
Dr.  Nash,  Lansdowne-rd.,  W.  2  2: 
Mr.  J.  Rand  (paid  to  local 

fund.  Dulwich)  .  2  2-: 

Mr.  Sidney  Parsons,  Kensing- 

ton-park-road  ...-  .  1  1' 

Dr.  Mahomed . 1  l 


The  following  gentlemen,  who  either  attended  the  meet 
ing  or  were  unavoidably  prevented  from  doing  so,  also  pro¬ 
mised  subscriptions;  but  the  sums  were  not  stated:— Sir- 
William  Gull,  Sir  Andrew  Clark,  Sir  Spencer  Wells,  Prof.. 
Lister,  Mr.  J.  Allen  (Alexandra-road,  N.W.),  Mr.  Edgar- 
Barker  (Hy de-park-street,  W.),  Mr.  J.  Blackstone  (Albert- 
terrace,  N.W.),  Dr.  Blades  (Kennington-park-road),  Mr. 
Blasson  (Edgware),  Dr.  J.  Brockwell  (Gipsy  Hill),  Dr. 
Lauder  Brunton,  Mr.  W.  F.  Butt  (Park-street,  W.),  Mr. 
Brudenell  Carter,  Mr.  Arthur  Durham,  Dr.  Easton  (Norfolk- 
crescent),  Dr.  Gibbings  (Dalston),  Dr.  Robert  Harris- 
(Hackney),  Mr.  Christopher  Heath,  Mr.  E.  Reynolds  Ray 
(Dulwich),  Dr.  Russell  Reynolds,  Dr.  H.  Cooper  Rose 
(Hampstead),  Dr.  Sergeant  (Camberwell),  Mr.  Septimus. 
Sibley  (Harley-street),  Dr.  Stocker  (Peckham  Rye). 


Infectious  Diseases  at  Barnsley. — The  whole  of  the 
public  elementary  schools  at  Barnsley  were  on  Saturday 
ordered  by  the  authorities  to  be  closed  for  a  month,  owing  to» 
the  prevalence  of  measles  and  other  infectious  diseases  in 
the  town.  There  are  over  300  cases  of  measles  alone. 


€96  Mid, cal  Times  and  Gazette.  MEDICAL  REPOETS  TO  THE  LOCAL  GOVERNMENT  BOARD. 


Deo.  15,  1883. 


MEDICAL  REPORTS  TO  THE  LOCAL 
GOVERNMENT  BOARD. 


Dk.  Aiey’s  Report  on  Diphtheria,  at  Great  Dunmow. 

In  May  of  the  present  year  a  statement  appeared  in  a 
local  journal,  to  the  effect  that  diphtheria  -was  alarmingly 
prevalent  at  Great  Dunmow,  in  Essex,  and  as  at  about  the 
same  time  private  representations  were  made  to  the  Local 
Government  Board  impugning  the  sanitary  state  of  the 
town.  Dr.  Airy  was  instructed  to  proceed  to  the  locality  and 
institute  an  inquiry.  Dp  to  the  time  of  his  visit  on  May  15 
last,  there  had  been,  as  far  as  could  be  ascertained,  about 
thirty-six  cases  of  diphtheria  in  the  Dunmow  Rural  Sanitary 
District  since  the  beginning  of  the  year,  of  which  no  fewer 
than  twenty  proved  fatal,  including  three  which  were 
registered  as  “  malignant  sore  throat.”  Twenty-three  had 
•occurred  in  the  parish  of  Great  Dunmow  (population  3005) ; 
the  remaining  thirteen  in  neighbouring  parishes.  Of  these 
thirteen  outlying  cases  the  greater  number  showed  no  con¬ 
nexion  with  those  in  Great  Dunmow.  The  first  appearance 
of  undoubted  diphtheria  in  this  outbreak  took  place  at 
Great  Dunmow  in  January  last,  although  it  had  been  noticed 
that  some  of  the  children  had  been  suffering  with  sore- 
throat  for  two  or  three  months  previously.  Fatal  diph¬ 
theria  would  appear,  however,  to  have  been  very  rare  in  the 
town,  since  only  two  deaths  had  been  registered  under  that 
name  in  the  last  ten  years.  The  two  children  in  the  family 
first  attacked  had  not  recently  been  away  from  the  town, 
tnor  had  the  family  been  visited  by  any  friend  who  could 
Rave  been  suspected  of  carrying  diphtheritic  infection ;  they 
had  both,  however,  attended  the  Dunmow  National  School, 
■and,  as  the  subsequent  spread  of  the  infection  took  place,  in 
a  large  measure,  among  the  scholars  of  this  school,  atten¬ 
tion  was  especially  directed  to  its  surroundings  in  seeking 
for  the  origin  of  the  outbreak.  In  the  first  place.  Dr.  Airy 
noted  the  existence  of  a  large  pond  in  its  immediate  vicinity, 
which,  it  was  subsequently  found,  received  some  sewage  at 
the  upper  end ;  this  pond  was  said  often  to  stink,  especially 
in  hot  weather.  But  in  going  carefully  over  the  National 
School  buildings.  Dr.  Airy  discovered  in  one  of  the  boys’ 
^closets  an  unmistakable  smell  of  sewer  air,  and  on  close 
■examination  it  was  found  that  the  earthenware  siphon  of  the 
water-closet  was  broken  through,  about  two  inches  below 
the  level  of  the  trap-roof,  so  that  the  water  sank  below  that 
level,  the  trap  was  unsealed,  and  there  was  free  way  for  the 
sewer  air  to  escape.  Assuming  the  sewer  air  to  contain  that 
which  causes  diphtheria,  this  would  be  sufficient  to  account 
for  diphtheria  attacking  a  susceptible  child  who  had  used 
f  he  closet ;  and  this,  in  Dr.  Airy’s  opinion,  may  be  said  to 
have  caused  the  present  outbreak,  which  was  chiefly  spread 
afterwards  by  close  personal  contact  amongst  the  children 
.attending  the  school,  especially  in  one  particular  class,  and 
among  children  of  the  same  family.  In  conclusion.  Dr. 
Airy  remarks  :  “  The  sanitary  condition  of  Great  Dunmow  is 
far  from  satisfactory.  Sewers  have  been  laid  at  various 
times  to  drain  different  small  sections  of  the  town ;  they 
have  a  comparatively  short  course,  and  discharge  at  conve¬ 
nience  into  the  nearest  ditches  among  the  gardens  and 
•outlying  cottages  on  the  lower  side  of  the  main  street.  The 
ditches  eventually  communicate  with  the  river  Chelmer, 
which  is  visibly  polluted  thereby,  and  the  sewers  are  en¬ 
tirely  without  ventilation.”  Dr.  Airy  recommends  that  the 
Sanitary  Authority  should  take  skilled  engineering  advice 
as  to  the  best  way  of  dealing  with  the  sewage  of  the  town, 
so  as  to  abate  the  nuisances  at  present  existing  in  connexion 
therewith ;  and  also  that  the  nuisance  caused  by  the  large 
pond  near  the  National  School  should  be  at  once  attended  to. 


Mr.  W.  H.  Power’s  Report  on  Diphtheria 
at  Whitstable. 

During  the  past  two  years,  Whitstable,  in  the  Blean  Rural 
Sanitary  District,  has  gained  an  unenviable  notoriety  for 
diphtheria  mortality,  and  the  Local  Government  Board, 
in  December  of  last  year,  requested  the  Rural  Sanitary 
Authority  to  instruct  their  health  officer  to  furnish  a  report 
■on  the  circumstances  which  led  to  the  prevalence  of  the 
disease.  Dr.  Robinson,  the  health  officer,  duly  complied 
with  this  instruction,  and  the  result  of  his  observations  was 


that  diphtheria  was  imported  into  the  district  in  October, 
1880,  and  quickly  extended,  especially  among  children  at¬ 
tending  a  particular  school.  The  Whitstable  schools,  indeed, 
he  regarded  as  having  had  throughout  much  to  do  with  the 
dissemination  not  only  of  diphtheria,  but  of  scarlatina  also, 
which  in  1881  largely  prevailed  concurrently  with  it.  In 
reference  to  the  continued  maintenance  or  frequent  re¬ 
currence  of  diphtheria.  Dr.  Robinson  was  disposed  to  think 
that  insanitary  conditions  (which  he  specified),  in  conjunc¬ 
tion  with  the  careless  habits  of  the  population  and  the 
apathy  of  the  school  managers,  had  had  a  great  deal  to  do 
with  fostering  the  disease  in  the  town.  This  latter  opinion 
induced  the  Local  Government  Board  to  institute  an  inspec¬ 
tion  of  Whitstable,  and  in  May  of  the  present  year  Mr.  W.  H. 
Power  was  despatched  to  undertake  it.  His  first  step  was  to 
endeavour  to  learn  something  definite  as  to  the  localities 
affected  by  diphtheria  and  throat-illness,  and  the  dates  of 
incidence  on  them  of  these  maladies ;  he  speedily  found, 
however,  that  no  such  information  was  to  be  obtained,  as  no 
sufficient  records  had  been  kept  by  the  medical  practitioners 
of  the  town.  In  these  circumstances,  Mr.  Power  frankly 
admits  that  his  report  simply  deals  with  the  facts  as  to 
disease  prevalence  in  Whitstable,  and  the  results  of  his 
observation  of  the  sanitary  state  of  the  place,  without 
attempting  to  assign  to  any  particular  condition  its  share  in 
the  production  of  diphtheria  or  other  disease.  There  can 
be  no  doubt,  he  says,  that  for  a  time — viz.,  from  October, 
18S0,  to  the  end  of  1881— diphtheria  and  scarlatina  were 
concurrent,  and  even  in  particular  instances  attacked  at 
one  time  different  members  of  the  same  family.  Moreover, 
it  is  worthy  of  mention,  Mr.  Power  observes,  that,  during 
the  concurrence  of  these  two  diseases  in  Whitstable,  more 
than  one  practitioner  had  difficulty  in  diagnosing  between 
one  and  the  other  of  them.  Setting  aside  nondescript 
minor  sorethroat,  the  etiological  relations  of  which  might 
only  be  guessed  at,  there  occurred,  it  was  stated,  cases  of 
smart  throat-illness  associated  with  distinct  skin-rash,  and 
altogether  free  from  faucial  false  membrane,  that  at  no 
period  of  their  illness  or  convalescence  betrayed  any  sort 
of  tendency  to  peeling  of  the  skin,  such  as  usually  follows 
scarlatina.  The  sanitary  condition  of  Whitstable,  according 
to  the  present  report,  whilst  leaving  much  to  be  desired, 
is  not  so  bad  as  that  of  many  of  the  country  districts 
necessitating  inquiries  by  the  medical  officers  of  the  central 
Board.  The  worst  feature  has  been  the  water-supply,  up 
to  the  present  time  derived  from  shallow  wells :  but  a  local 
waterworks  company  has  succeeded  in  obtaining  excellent 
water  from  the  chalk  in  ample  quantity  for  the  requirements 
of  the  district ;  and  though  as  yet  only  some  three  hundred 
houses  have  adopted  the  supply,  the  outlook  in  this  direction 
is  more  promising,  especially  as  Mr.  Power  in  his  report  bears 
testimony  to  the  efforts  of  the  Blean  Rural  Sanitary  Autho¬ 
rity  to  carry  out  their  important  duties.  Their  principal 
omission,  he  thinks,  is  in  having  as  yet  neglected  to  provide 
a  properly  equipped  hospital  for  the  isolation  of  cases  of 
infectious  diseases  occurring  in  the  place. 


Dr.  H.  F.  Parsons’  Report  on  Scarlet  Fever  and 
Diphtheria  in  the  Thorne  District. 

In  May  of  the  present  year.  Dr.  Parsons  was  deputed  by 
the  Local  Government  Board  to  institute  an  inquiry  into  a 
recent  prevalence  of  scarlet  fever  and  diphtheria  in  the 
Thorne  Registration  District  and  the  surrounding  neigh¬ 
bourhood.  It  may  be  mentioned  that  the  district  in  question 
is  a  level  fenny  tract,  situated  partly  in  the  South  of  York¬ 
shire,  partly  in  the  North  of  Lincolnshire.  It  was  in  ancient 
times  a  swampy  waste,  foruiing  a  part  of  the  Royal  Forest 
of  Hatfield  Chase,  but  by  the  skill  and  enterprise  of  succes¬ 
sive  generations  of  engineers  and  capitalists  it  has  been 
converted  into  fertile,  mostly  arable  land.  On  examination. 
Dr.  Parsons  found  that  the  proportional  mortality  of  the 
Thorne  District  is  under  that  of  the  kingdom  as  a  whole, 
and,  as  regards  certain  of  the  zymotic  diseases,  bears 
favourable  comparison  with  even  the  healthiest  districts,  but 
is  above  the  average  as  regards  scarlet  fever  and  continued 
fevers.  Scarlet  fever  had  been  prevalent  in  the  district, 
with  a  greater  or  less  mortality,  from  1872  to  1880  ;  it  almost 
disappeared  in  1881,  only  two  deaths  being  attributed  to  it 
in  that  year— one  in  June,  and  the  other  in  September.  The 
present  epidemic,  Dr.  Parsons  observes,  appears  to  have 
commenced  in  the  parish  of  Belton  about  December,  1881  ; 


Medical  Times  and  Gazett  *. 


ABSTRACTS  AND  EXTRACTS. 


Dee.  15. 1883.  697 


the  earliest  cases  were  slight,  and  their  origin  was  not 
ascertained ;  the  first  death  occurred  at  Epworth,  on 
January  3,  1882.  The  fever  first  became  prevalent  at  Carr 
Houses,  a  hamlet  of  Belton,  in  a  low  swampy  situation,  where 
also  it  was  especially  fatal.  One  of  the  earlier  households 
attacked  was  that  of  a  yeoman  who  sold  milk  to  a  few  of  his 
neighbours,  who  came  or  sent  their  children  to  the  house  to 
fetch  it.  Some  of  the  latter  at  once  contracted  the  disease, 
and  the  attention  of  the  medical  officer  of  health  for  the 
district  having  been  called  to  the  circumstance,  the  sale  of 
milk  from  this  house  was  at  once  stopped.  After  a  searching 
inquiry  and  a  thorough  examination  of  the  district,  Dr. 
Parsons  came  to  the  conclusion  that  the  propagation  of  the 
disease  had  been  effected  by  the  intercommunication  of  in¬ 
fected  households  with  those  previously  healthy,  there  being 
much  carelessness  in  this  respect  among  the  inhabitants ;  the 
mingliDg  of  children  of  different  households  at  school  had 
also  a  share  in  spreading  the  disease.  Diphtheria,  too,  was 
found  to  have  prevailed  in  the  district  concurrently  with 
scarlet  fever,  and  the  two  diseases  seemed  to  be  inter¬ 
changeable,  as  if  the  one  had  been  capable  of  giving  rise  to 
the  other  :  several  instances  were  met  with  in  which  persons 
who  had  had  former  attacks  of  scarlet  fever  had  recently 
suffered  from  diphtheria ;  and  it  appeared  to  Dr.  Parsons  that 
scarlet  fever  had  tended  more  to  assume  a  diphtheritic 
character  in  houses  where  there  were  local  insanitary  con¬ 
ditions,  such  as  defective  and  untrapped  drains,  and  foul 
privy  middens.  The  apparent  prevalence  of  “  fever  ”  has 
been  partly  due.  Dr.  Parsons  says,  to  a  mistake  of  the 
registrar,  but  the  mortality  from  it  has,  nevertheless,  been 
above  the  average ;  whilst  recent  outbreaks  of  enteric  fever 
have  been  associated  with  unwholesome  conditions,  such  as 
exposure  to  exhalations  from  defective  drains,  and  the  drink¬ 
ing  of  polluted  water.  The  sanitary  condition  of  both  the 
urban  and  rural  districts  is,  the  report  says,  very  unsatis¬ 
factory,  and  the  action  taken  by  the  respective  sanitary 
authorities  to  prevent  the  spread  of  infectious  disease  very 
incomplete;  whilst  the  arrangement  by  which  the  rural 
district  is  divided  between  a  number  of  medical  officers  of 
health  has  not,  on  the  whole,  worked  well,  and  there  is 
reason  to  believe  that  more  satisfactory  progress  would  be 
made  if  the  Authority  had  the  uniform  skilled  advice  of  a 
competent  officer  acting  for  the  whole  district. 


ABSTRACTS  AND  EXTRACTS. 

- ♦- - - — 

Veronese  on  Syphilis  in  relation  to  Diseases  of 
the  Nervous  System. 

In  the  Wiener  Med.  KliniTc,  Heft  9,  1883,  is  contained  an 
interesting  paper  on  this  subject,  a  concise  review  of  which 
is  published  in  the  Centralblatt  fur  Klin.  Medicin,  No.  46. 
Amongst  the  earliest  symptoms  of  syphilitic  affection  of  the 
brain  are  headache  and  sleeplessness,  which  the  writer 
assumes  to  be  associated  with  hypersemia  of  the  brain  and 
its  membranes,  rather  than  with  the  formation  of  tophi 
or  hyperplastic  forms  of  local  inflammation.  These  latter 
are  more  usually  indicated  by  localised  pain  and  tenderness 
on  pressure.  Extreme  redness  of  the  retina  and  optic  nerve 
has  been  observed.  Another  symptom,  pointing  to  a  modi¬ 
fication  of  the  blood-supply  to  the  central  nervous  system, 
may  be  found  in  the  altered  irritability  of  the  skin  and 
tendon  reflexes,  which  at  first  are  found  to  be  greatly  in¬ 
creased,  and  later  on  become  diminished  even  below  the  normal 
standard.  Conditions  of  maniacal  excitement  and  other 
functional  disturbances  may  ensue.  The  intolerance  which 
such  cases  manifest  for  any  form  of  opiate  is  very  marked. 
Chloral,  however,  is  well  borne.  In  many  of  the  cases  in 
which  syphilis  appears  as  the  cause  of  the  brain  disturbance, 
other  elements,  such  as  abuse  of  alcohol,  etc.,  may  be  present. 
The  syphilitic  affection  of  the  nervous  centres  is  generally 
manifest  before  similar  affections  of  other  viscera  can  be 
discovered ;  it  may  show  itself  at  any  time  during  the  first 
ten  years  after  infection.  It  occurs  most  frequently  in  males, 
and  usually  amongst  persons  of  the  better  classes.  With 
respect  to  its  connexion  with  well-marked  forms  of  disease, 
such  as  progressive  paralysis  and  tabes,  Dr.  Veronese  con¬ 
siders  that  no  direct  influence  can  be  recognised ;  but  he 
thinks  that  while,  on  the  one  hand,  syphilis  may  give  rise  to 
symptoms  which  may  simulate  those  of  special  diseases,  its 
exhaustive  influence  on  the  nerve-centres  may,  on  the  other 


hand,  be  a  directly  exciting  cause  for  the  development  of 
various  affections  for  which  a  predisposition  may  already 
exist. 


The  Frequency  of  Anteflexion. 

A  recent  number  of  the  Centralblatt  f  ur  Gyndkologie  con¬ 
tains  a  report  of  the  meetings  of  the  gynaecological  section 
of  a  German  scientific  association,  held  at  Freiburg,  under 
the  presidency  of  Dr.  Freund,  of  Strasburg.  Among  other 
communications  of  interest,  a  paper  by  Bandl,  of  Vienna, 
occupied  the  attention  of  the  congress,  the  full  title  of  which 
runs,  “  On  the  Normal  Position  and  Normal  Shape  of  the 
Uterus,  and  the  Anatomico-Pathological  Causes  of  Apparent 
Anteflexion.”  Our  readers  will  be  well  aware  that  ante¬ 
flexion  of  the  uterus  is  by  many  regarded  as  a  morbid  con¬ 
dition,  causing  numerous  and  varied  symptoms,  and  seldom 
existing  without  some  disturbance  in  the  functions  of  the 
affected  organ.  This  view  has  lately  been  controverted,  the 
most  elaborate  attacks  being  those  of  Herman  and  of 
Vedeler.  The  chief  ground  of  opposition — Herman’s  maim 
argument,  and  Vedeler ’s  only  one — is  that  they  find  ante¬ 
flexion  very  common,  and  just  as  frequent  in  those  who  are- 
healthy  as  in  those  who  suffer  from  uterine  disturbance  ; 
and  they  therefore  conclude  that  it  is  one  of  the  natural 
shapes  which  the  uterus  may  have.  To  this  question  Band! 
has  directed  his  attention.  He  has  investigated  the  fre¬ 
quency  of  anteflexion  in  three  ways  : — 1.  By  the  examina¬ 
tion  of  patients  simply.  2.  By  the  examination  of  patients 
upon  whom  abdominal  section  was  about  to  be  performed, 
and  in  whom  the  idea  of  the  shape  and  position  of  the 
uterus  gained  by  vaginal  examination  could  afterwards 
be  verified  or  corrected  by  subsequent  examination  from 
within  the  peritoneal  cavity.  3.  By  examination  of  dead 
bodies.  By  the  first  method.  Dr.  Bandl  found  that  appa¬ 
rent  anteflexion  was  exceedingly  common,  but,  as  it  is 
not  stated  that  he  examined  any  women  who  did  not  com¬ 
plain  of  functional  uterine  disturbance,  his  results  do  not 
tell  either  for  or  against  the  views  of  Herman  and  Vedeler.. 
The  cases  in  which  the  conclusion  arrived  at  by  vaginal 
touch  was  checked  by  examination  from  above  after  the- 
abdomen  had  been  opened  were  very  few.  The  author  found 
in  them  the  uterus  slightly  bent  forwards.  His  post-mortem 
researches  were  made  on  200  bodies — of  children,  virgins, 
and  parous  women.  He  found  sometimes  anteflexion  exist¬ 
ing  before  the  uterus  was  removed,  but  that  after  the  uterus 
was  taken  out  of  the  body  it  became  straight.  In  only  four- 
cases  did  he  find  anteflexion  persisting  in  a  uterus  severed, 
from  its  attachments.  Dr.  Bandl  unfortunately  does  not 
give  any  numbers  except  those  we  have  quoted.  This  re¬ 
sult  of  post-mortem  research  is  susceptible  of  several  ex¬ 
planations.  It  may  be  said  that  anteflexion  is  a  condition 
temporarily  produced  by  the  method  of  examination ;  or  that 
it  is  usually  a  result  of  forces  acting  on  the  uterus  during 
life,  and  seldom  a  shape  properly  belonging  to  the  uterus  and 
retained  by  it ;  or  that  its  losing  its  curve  after  removal  (a 
fact  in  which  our  own  experience  accords  with  that  of  Dr. 
Bandl)  is  a  result  of  post-mortem  change.  Whichever  be  the 
explanation  preferred,  it  does  not  seem  to  us  to  affect  the 
argument  based  on  the  identical  frequency  of  anteflexion 
in  health  and  disease,  because,  if  any  objection  founded 
on  it  be  taken  to  the  results  of  examination  of  the  healthy, 
it  applies  equally  to  those  gained  from  the  other  class. 


Diphtheria  in  Russia. — Dr.  Drowsdow,  reporting  to 
the  Kasan  Medical  Society  on  the  epidemic  of  this  dis¬ 
ease  which  occurred  in  1882  in  the  circle  of  Nowouson,  con¬ 
sisting  of  61,400  inhabitants,  stated  that  1644  cases  came 
under  treatment,  but  that  more  than  double  this  number 
were  sufferers.  The  mortality  varied  from  47  to  64  per 
cent.,  according  to  the  time  of  year,  the  maximum  of  deaths 
occurring  in  October.  The  country  practitioner  does  his 
work  at  a  great  disadvantage  on  account  of  the  long  dis¬ 
tances  at  which  patients  are  placed,  so  that  treatment  is 
usually  only  illusory ;  and  the  sanitary  rules  and  precau¬ 
tions  are  generally  left  unobserved  by  the  peasantry,  the 
epidemics  running  their  course  until  they  have  exhausted 
the  supply  of  subjects  for  attack.  Dr.  Drowsdow  points  out 
how  little  is  to  be  expected  in  sanitary  matters  from  a 
population  in  which  a  favourite  maxim  is  that  “a  cow 
costs  more  than  a  child.”— St.  Petersburg  Medizinische 
Wochenschrift,  November  24. 


•698 


Medic&l  Times  and  Gazette. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


Dec.  15,  1883. 


Hot  Milk  as  a  Restorative. — -Milk  that  is  heated 
to  much  above  100°  Fahr.  loses,  for  the  time,  a  degree  of 
its  sweetness  and  density ;  but  no  one  fatigued  by  over¬ 
exertion  of  body  or  mind  who  has  ever  experienced  the 
reviving  influence  of  a  tumbler  of  this  beverage  as  hot  as  it 
•can  be  sipped,  will  willingly  forego  a  resort  to  it  because  of 
its  having  been  rendered  somewhat  less  acceptable  to  the 
palate.  The  promptness  with  which  its  cordial  influence  is 
felt  is  indeed  surprising.  Some  portions  seem  to  be  digested 
and  appropriated  almost  immediately  ;  and  many  who  fancy 
that  they  need  alcoholic  stimulants  when  exhausted  by 
labour  of  brain  or  body,  will  find  in  this  simple  draught  an 
■equivalent  that  will  be  as  abundantly  satisfying  and  more 
enduring  in  its  effects. — Louisville  Med.  News,  November  10. 

Atrophy  of  the  Olfactory  Nerves. — In  relation 
to  a  case  mentioned  at  the  Societe  de  Biologie  by  M.  Lebec, 
in  which,  on  dissecting  the  brain,  he  had  found  that  the 
olfactory  nerves  were  absent,  although  the  sense  of  smell 
was  not  interfered  with,  M.  Duval  observed  that  he  believed 
that  this  contradiction  did  not  really  exist,  and  that  the 
olfactory  nerves  were  really  only  atrophied  and  reduced  to 
some  thick  fibrillse  beneath  the  pia  mater.  Such  fibrillse  he 
has  found  in  the  pituitary,  and  these  would  suffice  for  the 
ordinary  sense  of  smell.  Civilised  man,  in  fact,  possesses, 
M.  Duval  added,  an  olfactory  apparatus  disproportionate  to 
his  needs,  and  nine-tenths  of  it  might  be  destroyed  without 
the  olfactory  power  being  notably  modified.  This  would  not 
be  the  case  with  savage  man,  who  utilises  all  his  olfactory 
fibres.  There  is,  indeed,  reason  to  believe  that  the  atrophy 
observed  in  the  nerves  of  this  brain  is  destined  to  become 
the  rule  in  civilised  races.  It  is  the  same  with  the  teeth,  of 
which  we  have  thirty-two,  while  twenty-eight  are  all  that 
are  necessary ;  and  the  wisdom-teeth  tend  to  disappear,  so 
that  in  the  course  of  some  thousands  of  years  they  will  have 
idone  so  completely. — Gazette  des  Hopitaux,  November  27. 

Chloroform-Water. — This  application,  which  is  much 
employed  in  the  Paris  hospitals,  is  prepared  as  follows, 
according  to  Profs.  Lashgue  and  Regnauld’s  formula  An 
excess  of  chloroform  is  poured  into  a  bottle  three-parts 
filled  with  distilled  water,  and,  after  repeated  shaking,  the 
mixture  is  allowed  to  stand  until  the  extra  chloroform 
is  deposited,  and  the  liquid  quite  clear.  The  transparent 
portion  is  then  to  be  removed  by  a  syphon,  forming  a  satu¬ 
rated  solution  of  ten  grammes  of  chloroform  per  litre.  Ap¬ 
plied  on  compresses,  either  in  its  pure  state,  or  diluted  with 
.a  half  or  its  whole  weight  of  water,  it  is  found  to  relieve 
superficial  pains  ;  but  when  these  are  more  deeply  situated, 
.a  very  hot  linseed-meal  poultice  is  first  applied,  which  is  after¬ 
wards  replaced  by  the  compress  of  chloroform-water.  Active 
revulsion  is  thus  produced,  which  relieves  the  pain.  Asso¬ 
ciated  with  a  weak  solution  of  opium  it  relieves  vague  dental 
pain ;  and  with  syrup  of  morphia  it  is  successfully  given 
internally  for  various  forms  of  malaise  from  indigestion, 
••such  as  gapings,  eructations,  sense  of  weight,  etc.  It  is 
also  useful  as  a  palliative  in  cancer  of  the  stomach. — Union 
Mdd.,  November  22. 

Long  Retention  of  Needles  in  the  Body.— Dr. 
Buist,  of  Charlestown,  relates  in  the  Philadelphia  Medical 
Reporter,  November  10,  an  additional  example  of  this  occur¬ 
rence.  He  removed  a  needle  from  the  left  thigh  of  a  lady, 
twenty-six  years  of  age,  which,  from  positive  evidence,  was 
known  to  have  entered  the  right  arm  when  she  was  two 
years  old.  The  presence  of  the  needle  was  well  known  to 
her  parents,  and,  at  intervals  of  her  life,  sharp  neuralgic 
pains  had  been  complained  of,  extending  over  the  thoracic 
region,  and  latterly  around  the  pelvis.  An  acute  lancinating 
pain  directed  attention  to  the  left  thigh,  and  a  foreign  body 
was  detected  in  the  soft  tissues  of  its  posterior  parts.  This 
proved  to  be  a  needle,  which  was  blackened  and  rough,  and 
required  considerable  force  for  its  extraction — it  proving 
also  to  be  of  a  pattern  not  at  present  manufactured.  As  a 
contrast  to  the  twenty-four  years’  residence  of  this  needle. 
Dr.  Buist  refers  to  another  case,  in  which,  on  an  exploratory 
incision  having  been  made  into  a  tumour  in  the  right  thigh, 
about  a  pint  of  pus,  which  had  been  bound  down  by  the 
fascia  lata,  was  discharged.  On  examination,  a  small  thin 
body  was  found  embedded  in  the  lower  third  of  the  femur, 
which  proved  to  be  part  of  an  ordinary  needle.  This  needle 
had  been  known  to  have  entered  the  thigh  six  months 
previously ;  coming  in  contact  with  the  femur,  it  induced 
nflammation  and  suppuration. 


REVIEWS  AND  NOTICES  OP  BOOKS. 


Les  Microzymes  dans  leurs  Rapports  a,vec  I’Heterogenie, 

VHistogenie,  la  Physiologie  et  la  PoAhologie.  Par  A. 

B^champ.  Paris  :  Bailli&re  et  fils.  1883.  8vo,  pp.  992. 
We  are  told  in  the  preface  that  this  book  contains  a  new 
doctrine  as  to  organisation  and  life,  and  the  early  chapters 
are  occupied  with  a  description  of  the  facts  and  experiments 
which  led  to  the  formation  of  this  doctrine.  The  author’s 
views  as  to  the  role  which  is  played  by  the  microzymes  of 
the  animal  body  must  be  already  familiar  to  those  who  have 
read  his  paper  in  the  “  Transactions  of  the  International 
Medical  Congress,”  1881.  A  physiologically  healthy  organism 
is  defined  as  one  “  of  which  the  microzymes  in  all  the  centres 
of  activity  conform  most  to  an  ideal  type,  having  undergone 
no  morbid  change  or  extra-physiological  influence”;  and 
morbidity  is  said  to  be  “  a  superadded  property,  dependent 
no  doubt  on  some  material  change.”  The  products  of  the 
activity  of  the  microzymes  in  health  are  believed  to  be  so 
balanced  that  they  are  useful  to  the  whole  organism ;  whereas, 
in  the  pathological  state,  they  bring  the  blood  to  a  state  of 
dyscra.sia,  which  produces,  more  or  less,  in  all  the  centres  of 
organic  activity,  a  correlative  dyscrasic  state.  It  is  further 
imagined  that  the  microzymes  differ  according  to  tem¬ 
perament,  constitution,  and  diathesis,  so  that  there  are 
lymphatic,  scrofulous,  cancerous  microzymes,  etc. 

The  author  sees  in  bacteria  the  effect  and  not  the  cause 
of  a  disease,  and  has  no  sympathy  with  those  who  uphold 
the  view  that  specific  organisms  may  be  introduced  into  the 
body  from  without  and  give  rise  to  specific  diseases.  “  There 
are,”  he  says,  “  microscopic  organisms,  from  the  microzyme 
to  the  most  developed  bacterium  which  is  derived  from  it 
by  evolution,  which  are  capable  of  communicating  diseases. 
To  deny  this  is  to  deny  the  evidence.  But  they  are  not  met 
with  in  air,  water,  or  soil,  except  accidentally,  and  then  we 
know  from  whence  they  come.  One  has  never  been  able  to 
demonstrate  that  a  disease,  e.g.,  splenic  fever,  has  been  pro¬ 
duced  by  a  germ  taken  from  some  point  of  the  external  air. 
When  one  has  provoked  the  disease  it  has  been  by  taking 
the  germ  from  soil  where  animals  had  been  buried  which 
had  died  of  splenic  fever.”  Admitting  that  splenic  fever 
maybe  provoked  by  what  he  terms  the  bacteridium  (Bacillus 
anthracis),  the  author  asks  whether  it  is  really  the  parasite 
which  multiplies-,  or  whether  “The  bacteridium  which  is 
introduced  does  not  provoke  a  dyscrasia,  which  becomes  the 
point  of  departure  of  the  corresponding  morbid  evolution  of 
the  microzymes  of  the  affected  animals.”  .Anyone,  we 
should  think,  who  had  examined  suitably  prepared  sections 
of  organs  of  animals  which  have  died  of  splenic  fever  would 
have  no  doubt  as  to  the  multiplication  of  the  bacteridium, 
and  would  not  require  to  seek  the  assistance  of  a  dyscrasia 
to  explain  the  production  of  the  disease.  The  author’s 
views  as  to  the  mode  of  production  of  tuberculosis  are  in 
entire  disaccord  with  those  which  are,  as  the  result  of  recent 
researches,  generally  accepted  at  the  present  time.  He 
says  :  “  Let  us  conclude  that  the  free  tuberculous  microzyme 
comes  from  the  pathological  destruction  of  an  epithelial 
globule  or  cell  of  determined  tissues ;  that  it  is  a  ferment, 
and  that  it  is  capable  of  cultivation,  and  able  to  multiply 
in  suitable  media.  It  does  not  pre-exist  originally  in  the 
air,  it  is  the  product  of  the  diseased  organism.  .  .  .  Phthisis, 
tuberculosis,  is  not  a  parasitic  disease.  No,  no ;  there  is  not 
a  tuberculous  microzyme  originally  created  to  make  men 
and  animals  phthisical.” 

Suppuration,  glanders,  variola,  syphilis,  paludinal  and 
puerperal  fevers,  etc.,  and  even  spirillar  fever,  are  all  ex¬ 
plained  according  to  the  theory  of  microzymes  and  the 
regression  of  cells.  With  regard  to  the  latter  disease,  in 
which,  if  in  any,  the  specific  character  of  the  organism  has, 
after  the  researches  of  Vandyke  Carter,  assuredly  been 
established,  the  author  says,  “  If  it  (the  spirillum)  is  a 
true  parasite  in  the  blood,  one  should  be  able  to  show 
the  place  by  which  it  comes  out  of  it.  If,  on  the  con¬ 
trary,  it  is  only  the  product  of  evolution  of  the  micro¬ 
zymes,  the  notion  of  change  of  function  and  the  history 
of  the  facts  of  regression  explain  all.”  M.  Bechamp  com¬ 
mands  much  more  attention  when  he  speaks  with  the 
authority  of  a  chemist,  than  in  the  capacity  of  patholo¬ 
gist,  and  those  who  are  interested  in  the  subject  of  fer¬ 
mentation  will  find  in  the  early  chapters  much  matter 


Medical  Times  and  Gazette. 


EOYAL  MEDICAL  AND  CHIRURGICAL  SOCIETY. 


which  is  worthy  of  careful  study.  Unfortunately,  the  book 
is  marred  by  a  continuation  of  the  old  struggle  for  priority 
between  the  author  and  M.  Pasteur,  of  whom  he  speaks  in 
bitter  terms,  and  whose  methods  of  experimentation,  deduc¬ 
tions,  and  even  language,  he  repeatedly  condemns.  Whether 
future  generations  will  see  in  Bechamp  or  in  Pasteur  the  pre¬ 
cursor  of  the  antiseptic  system,  we  cannot  foretell,  but  we 
incline  to  the  belief  that  the  theory  of  microzymes,  as  applied 
to  disease,  will  sink  beneath  the  weight  of  evidence  in  favour 
of  specific  organisms. 


A.  Handbook  of  Hygiene  and  Sanitary  Science.  By  George 

Wilson,  M.A.,  M.D.,  F.R.S.E.  Fifth  Edition.  London. 

1883. 

So  familiar  is  this  work  that  the  eye  in  glancing  over  the 
shelves  of  medical  libraries  recognises  at  once  the  green- 
coated  octavo  with  as  much  facility  as  the  back  of  a  friend 
in  a  motley  crowd.  The  chief  improvement  in  the  present 
(fifth)  edition  is  the  chapter  on  vital  statistics,  in  which  are 
clearly  detailed  the  methods  followed  by  the  Itegistrar- 
General  in  the  calculation  of  his  more  important  tables. 
The  chapter  on  dwellings  is  much  to  be  commended  ;  and  a 
study  of  the  new  section,  giving  short  and  explicit  direc¬ 
tions  as  to  the  best  method  of  inspection,  will  be  indis¬ 
pensable  to  all  students  desiring  to  know  the  practical 
details  of  sanitary  work.  One  of  the  weak  points  of  the 
book  is  that  portion  relating  to  the  examination  of  food.  It 
may  be  generally  and  not  unfairly  stated  that  the  directions 
given  to  the  medical  officer  of  health  as  to  his  inspection  of 
milk,  butter,  flour,  and  bread  are  in  point  of  information  a 
quarter  of  a  century  behind  date.  While  large  space  is 
devoted  to  details  as  to  the  chemical  examination  of  air, 
such  simple  processes  as  the  gelatine  test  for  alum,  the  cal¬ 
culation  of  the  "fat”  and  "solids  not  fat”  in  milk  by 
Clausnizer  and  Mayer’s  formula,  and  Koettstorfer’s  method 
of  titrating  butter-fat — none  of  which  require  any  great 
chemical  skill  or  consume  more  than  half  an  hour,  and  all 
of  which  may  be  used  advantageously  by  a  medical  officer 
of  health  — are  passed  over  in  silence.  Notwithstanding  these 
defects  and  the  inferior  literary  style  of  the  historical  com¬ 
position,  the  "  Handbook  ”  has  many  and  conspicuous  merits, 
and  will,  without  doubt,  hold  for  many  years  the  position  it 
has  gained. 


Transactions  of  the  Obstetrical  Society  of  London.  Vol. 

XXIV .,  for  the  Year  1882.  London :  Longmans,  Green,  and 

Co.  1883.  Pp.  339. 

The  contents  of  this  volume  are,  we  need  scarcely  say, 
much  the  same  in  kind  as  in  former  years.  As  a  whole,  we 
think  it  rather  above  the  average  in  point  of  scientific 
merit.  It  consists  partly  of  carefully  worked  out  scientific 
papers ;  partly  of  reports  of  cases — some  instructive,  some 
deserving  record  only  because  uncommon  ;  some  described 
well,  others  imperfectly.  Among  the  papers  we  find  one 
upon  puerperal  diabetes,  by  Ur.  Matthews  Duncan,  in 
which  is  given,  so  far  as  we  know,  the  only  account  of  this 
complication  of  pregnancy  that  has  yet  been  published. 
Like  all  the  writings  of  its  distinguished  author,  it  is  strictly 
scientific  in  tone  and  method,  and  marked  by  fulness  of 
knowledge,  exactness  in  statement,  and  caution  in  inference. 
Dr.  John  Williams  writes  upon  the  natural  history  of  dys- 
menorrhcea,  and  approaches  the  subject  from  an  entirely 
new  standpoint.  Most  of  those  who  have  hitherto  attempted 
to  enlighten  the  profession  upon  this  disorder  have  con¬ 
sidered  it  simply  from  the  point  of  view  of  treatment,  draw¬ 
ing  their  conclusions  as  to  the  nature  of  the  malady  simply 
from  the  apparent  success  or  failure  of  some  particular  reme¬ 
dial  measure.  It  is  plain  that  no  valid  conclusions  can  be 
drawn  from  the  course  of  a  case  subsequent  to  treatment 
unless  we  know  what  is  likely  to  have  been  its  course 
without  treatment ;  but  we  cannot  call  to  mind  any  writer 
who  has  as  yet  taken  the  trouble  to  ascertain  the  history  of 
dysmenorrhoeic  patients  when  not  interfered  with  by  treat¬ 
ment.  This  Dr.  Williams  has  done,  basing  his  conclusions 
on  a  careful  analysis  of  1944  cases.  Dr.  Flayfair  writes  on 
Emmet’s  operation,  but  as  we  commented  on  this  paper  and 
the  discussion  thereon  at  the  time  it  was  read,  it  is  unneces¬ 
sary  now  to  do  more  than  refer  to  it.  The  relation  of  back¬ 
ward  displacements  of  the  uterus  to  painful  menstruation  is 
the  subject  of  a  paper  by  Dr.  Herman,  in  which  he  shows 
reason  against  the  widely  accepted  view  that  dysmenorrhoea 


Dec.  15, 1883.  6  9  9 


accompanying  these  displacements  is  due  to  flexion  of  the 
canal.  The  volume  also  contains  two  able  papers  by  Dr. 
Champneys— one  on  an  obliquely  contracted  pelvis,  the  other- 
on  a  kyphotic  pelvis,  in  which  he  considers  the  mode  of  pro¬ 
duction  of  the  deformities  present  in  each  specimen.  Mr. 
Knowsley  Thornton  describes  a  remarkable  case  of  extra- 
uterine  gestation,  treated  by  abdominal  section,  and  removal’ 
both  of  foetus  and  a  hypertrophied  placenta.  A  case  of  "so- 
called”  imperforate  hymen  is  important  because  it  affords; 
Dr.  Matthews  Duncan  the  opportunity  of  setting  forth  his 
opinions  as  to  the  nature  and  treatment  of  this  malforma¬ 
tion.  There  are  two  papers  by  foreign  authors — one  by  Dr. 
Popow,  of  Pensa,  on  the  corpus  luteum ;  and  one  by  Dr.. 
Chahbazian,  of  Paris,  on  ergotine  in  post-partum  haemor¬ 
rhage.  Although  the  volume  contains,  as  will  thus  be  seen,, 
some  good  work — more  than  in  some  former  years, — yet,  con¬ 
sidered  as  representing  collectively  the  progress  made  by- 
the  scientific  obstetricians  of  the  capital  city  of  the  world, 
there  is  scarcely  as  much  of  it  as  a  stranger  might  expect. 


REPORTS  OF  SOCIETIES. 

- - 

EOYAL  MEDICAL  AND  CHIRURGICAL 
SOCIETY. 

Tuesday,  December  11. 

John  Marshall,  F.R.S.,  President,  in  the  Chair. 


At  the  ordinary  meeting  of  the  Society  on  Tuesday  last,  am 
interesting  discussion  followed  the  reading  of  a  paper  by 
Mr.  Hutchinson  on  amputation  of  the  thigh  for  senile  gan¬ 
grene.  Subsequently  a  communication  from  Dr.  Champneys 
on  mediastinal  emphysema  in  connexion  with  tracheotomy 
was  read.  It  was  ballot  night  also,  and  an  unusually  long, 
list  of  new  Fellows  were  elected  'into  the  Society. 

On  High  Amputations  for  Senile  Gangrene. 

Mr.  Hutchinson  read  a  paper  on  the  above  subject,  which’ 
began  by  the  statement  that  the  author’s  chief  object  was  to 
urge  the  safety  and  expediency  of  amputating  in  senile  gan¬ 
grene  if  the  operation  were  done  at  a  good  distance  from  the- 
disease.  In  the  common  form  of  gangrene  of  the  toes  and 
foot,  the  lower  third  of  the  thigh  was  the  part  suggested,  and 
in  rare  cases  in  which  the  hand  is  affected,  the  middle  of  the* 
upper  arm.  After  remarking  on  the  fact  that  amputations, 
had  hitherto  generally  proved  disappointing  owing  to  return 
of  the  disease,  the  author  urged  that  this  was  from  their 
having  usually  been  done  too  low  down.  The  calcification 
of  the  arteries,  upon  which  in  the  main  the  disease  de¬ 
pended,  was  usually  greatest  near  the  periphery,  and  hence’ 
the  difficulty  as  to  supply  of  blood  for  the  nutrition  of  the- 
flaps.  This  source  of  danger  was  not  encountered  if  the 
amputation  were  done  sufficiently  high.  In  a  series  of  cases; 
in  very  old  patients  the  author  had  not  encountered  the 
recurrence  of  gangrene  excepting  in  one.  In  three  the 
stump  had  healed  well.  In  a  fourth,  in  which  the  patient,, 
although  not  old,  was  prematurely  senile,  and  the  calcification 
of  the  arteries  extreme,  the  recovery  had  also  been  excellent.. 
In  this  instance  the  femoral  artery  was  so  rigid  that  it  stuck 
out  from  the  face  of  the  stump  like  a  small  bone.  One  of' 
the  patients  in  whom  the  stump  had  healed  without  a  draw¬ 
back  was  seventy  years  old.  In  two  of  the  cases  the  other 
foot  had  been  subsequently  threatened  with  gangrene.  As 
to  the  time  to  be  selected,  the  author  thought  that  as  soon  as 
the  patient  was  so  ill  as  to  be  confined  to  bed  and  the  disease 
well  established,  it  was  better  to  do  the  operation.  Spon¬ 
taneous  cure  was,  he  urged,  very  exceptional,  and  a  great 
majority  of  such  cases  ended  in  death  after  a  long  period  of 
much  suffering.  The  thinner  the  patient  the  less  was  the 
probable  risk  of  the  amputation.  In  a  few  cases  in  which, 
the  thigh  was  exceptionally  fat  and  the  tissues  flabby,  it 
might  be  wise  to  hesitate  as  to  recommending  it.  In  all  his; 
cases  Lister’s  precautions  had  been  carefully  used,  and  in 
two  or  three  the  patient  had  never  experienced  the  slightest 
pain  from  the  day  of  the  operation. 

The  President  said  it  was  interesting  to  see  that  our 
views  on  this  subject  were  undergoing  change,  and  that  it 
was  due  to  the  advances  in  surgery  generally  which  were 
being  made.  The  paper  was  calculated  to  teach  us  that. 


700 


Medical  Times  and  Gazette. 


ROYAL  MEDICAL  AND  CHIRURGICAL  SOCIETY. 


Dec.  15, 1883. 


amputation  in  these  cases  was  more  successful  than  was 
generally  believed,  especially  if  done  at  a  distance  from  the 
-disease.  He  saw  many  surgeons  of  eminence  around  him, 
and  invited  an  expression  of  their  opinion. 

Mr.  Eivington  said  his  own  experience,  though  not  an 
extensive  one,  went  to  corroborate  the  views  propounded  by 
Mr.  Hutchinson.  He  had  never  met  with  a  case  of  spon¬ 
taneous  gangrene  which,  having  spread  beyond  the  ankle, 
ever  got  well  alone ;  though  toes  occasionally  came  off,  and 
the  stumps  healed.  Hot  having  referred  to  his  case-books, 
he  was  unable  to  speak  with  absolute  certainty,  but  he  had 
amputated  in  one  or  two  cases  with  success.  In  his  last 
case,  done  about  a  year  ago,  the  gangrene  had  spread  beyond 
the  ankle  ;  the  arteries  were  very  calcareous.  He  had  ampu¬ 
tated  above  the  knee,  using  antiseptic  precautions ;  decom¬ 
position  nevertheless  set  in,  and  although  there  was  some 
slight  superficial  ulceration  of  the  stump,  it  finally  healed, 
and  the  man  had  done  well.  Thus  his  own  experience  was 
•confirmatory  of  the  views  propounded. 

Mr.  Hulke  had  no  personal  experience  of  this  method  of 
preventive  treatment.  In  analysing,  however,  Mr.  Hutchin¬ 
son’s  cases,  he  thought  the  arguments  became  less  cogent 
than  they  were  represented.  The  first  three  cases  could  hardly 
be  considered  as  senile  gangrene,  and  thus  the  practice 
rested  on  the  two  remaining  cases.  Mr.  Eivington  had  said 
that  these  cases  never  recovered  spontaneously ;  he  had, 
however,  seen  such  recoveries  with  exfoliation  of  foot  or 
lower  third  of  the  leg.  He  was  very  averse  to  amputa¬ 
tion,  and  before  giving  his  adhesion  to  such  a  method  of 
treatment  he  should  require  more  conclusive  evidence  in  its 
support,  and  more  especially  so  as  amputation  of  the  thigh 
was  a  severe  and  dangerous  operation.  He  remembered  the 
old  German  maxim  apropos  of  amputations — “  Zollweise 
steigt  die  Gefahr  ”  (the  danger  increases  with  every  inch 
you  go  up). 

Mr.  Barwell  had  not  much  experience  in  this  matter. 
But  in  one  case  he  had  operated  successfully,  although  there 
had  been  some  slight  superficial  sloughing  in  the  flaps.  Mr. 
Hutchinson’s  reason  for  recommending  amputation  above 
the  knee  was  because  of  the  less  likelihood  of  meeting  with 
■calcified  arteries  ;  but,  in  his  own  opinion,  success  depended 
less  on  this  than  on  the  condition  of  the  capillaries  and 
arterioles.  In  one  of  the  cases  related,  diseased  arteries 
were  found  notwithstanding,  and  he  felt  it  was  not  possible 
to  discriminate  in  all  cases  as  to  the  extent  of  the  arterial 
disease. 

Mr.  Croft  said  he  should  like  to  say  a  few  words,  although 
he  had  never  had  such  a  case  to  deal  with  during  the  whole 
course  of  his  hospital  experience.  He  had  been  much  struck 
with  the  title  of  the  paper.  Senile  Gangrene — that  is,  gan¬ 
grene  in  old  people.  But  cases  of  a  different  kind  had  been 
introduced,  and  this  gave  him  also  an  opportunity  of  drawing 
in  other  cases.  The  idea  seemed  to  be  to  get  well  above  the 
local  disease.  Most  of  the  patients,  if  not  all,  died  of  blood- 
poisoning,  more  or  less  well  marked.  In  performing  ampu¬ 
tation  high  up  we  had  a  broad  margin  of  tissues  between 
the  healthy  and  diseased  parts,  and  we  thus  wholly  got  rid 
of  all  local  infection.  In  all  forms  of  septic  inflammation 
it  was  a  sound  principle  to  amputate  at  a  distance  from  the 
infective  centre.  By  using  antiseptic  precautions,  additional 
chances  of  a  favourable  result  were  gained.  He  thought  the 
cases  described  to-night  demonstrated  the  value  of  amputa¬ 
tion  high  up,  not  in  cases  of  gangrene  only,  but  in  all  cases 
-of  septic  inflammation. 

Mr.  Godlee  referred  to  a  case  of  gangrene,  extending 
halfway  up  the  foot,  recently  under  his  care  in  University 
College  Hospital.  There  was  also  a  history  of  syphilis,  but 
this  did  not  seem  to  be  in  any  causal  connexion  with  the 
gangrene.  There  was  no  pulsation  to  be  felt  in  the  affected 
lower  limb.  The  other  limb  was  healthy.  As  there  was  no 
sign  of  spontaneous  recovery,  he  decided  to  amputate  at  the 
knee-joint.  The  man  was  still  alive  ;  and  though  his  con¬ 
dition  was  not  quite  satisfactory,  he  had  benefited  by  the 
operation.  Antiseptic  precautions  were  used.  He  had  had 
no  vessels  to  tie.  There  was  never  any  decomposition  in  the 
wound,  although  some  bone  had  necrosed,  and  pieces  had  to 
be  removed  on  two  occasions.  He  thought  the  bearing  of 
the  antiseptic  treatment  on  these  cases  was  important;  and 
he  believed  antiseptics  would  allow  us  to  amputate  nearer 
the  seat  of  disease.  In  such  cases  the  tissues  could  not  bear 
the  irritation  of  the  decomposition  which  took  place  when 
these  precautions  were  not  adopted.  With  perfect  asepsis 


we  might  go  somewhat  nearer  the  seat  of  disease  than  was 
possible  formerly. 

Mr.  Harrison  Cripps  said  that  he  considered  that  Mr. 
Hutchinson  had  called  attention  to  an  extremely  important 
point  in  practical  surgery.  Our  knowledge  of  both  the 
pathology  and  treatment  of  senile  gangrene  was  chiefly 
owing  to  the  admirable  work  of  Brodie  on  this  subject. 
That  great  surgeon,  speaking  with  wide  experience  of  the 
surgery  of  his  time,  argued  very  strongly  that  amputation 
was  useless,  owing  to  the  almost  certain  recurrence  of  gan¬ 
grene  in  the  stump  ;  on  the  other  hand,  he  had  mentioned  the 
rareness  of  a  spontaneous  cure  when  the  gangrene  had  once 
passed  beyond  the  toes.  The  cases  brought  forward  by  Mr. 
Hutchinson  clearly  demonstrated,  however,  that  an  amputa¬ 
tion  performed  high  up  the  limb,  with  strict  Listerian 
precautions,  was  often  followed  by  most  satisfactory  re¬ 
sults  ;  and  he  attributed  his  success  to  the  amputation 
being  performed  at  such  a  height  as  to  render  the 
nutrition  of  the  stump  more  certain.  Experience  might 
prove  that  this  view  was  correct,  but  he  (the  speaker)  could 
not  agree  with  Mr.  Hutchinson  in  regarding  an  amputa¬ 
tion  in  the  lower  third  of  the  thigh  as  an  operation 
devoid  of  danger,  for  he  still  believed  in  what  he  had 
been  taught — that  every  inch  up  the  limb  added  to  the 
danger  of  the  amputation.  There  could  be  no  question 
that  arterial  disease  was  the  chief  factor  in  these  senile 
gangrenes.  Nevertheless,  he  felt  that  there  must  be 
another  cause  at  work  to  excite  progressive  ulceration  and 
putrefaction.  It  appeared  that  the  tissues  were  so  im¬ 
perfectly  nourished,  from  the  deficient  blood-supply,  that 
they  became  an  easy  prey  to  putrefactive  changes  when 
once  started,  and  that  they  had  no  power  to  build  up  a 
barrier  to  stay  their  advance.  Such  putrefactive  changes 
usually  commenced  through  some  slight  wound  or  excoria¬ 
tion  of  the  skin.  Holding  these  views,  he  suggested  that 
the  protection  of  the  stump  even  for  a  few  days  from 
external  contamination,  so  carefully  carried  out  by  Mr. 
Hutchinson,  was  perhaps  a  more  important  factor  in  the 
prevention  of  the  recurrence  than  the  performance  of  ampu¬ 
tation  nearer  to  the  centre  of  the  circulation.  Might  it 
not  be  well,  therefore,  he  asked,  before  resorting  to  so  com¬ 
paratively  severe  an  operation  as  the  amputation  of  the 
lower  third  of  the  thigh,  to  see[  whether  removal  in  the 
lower  third  of  the  leg  might  not  be  sufficient,  provided  the 
stump  was  carefully  kept  warm,  and  prevented,  by  antiseptic 
treatment,  from  putrefactive  changes  during  the  early  stages 
of  healing  P  He  would  not  have  advocated  such  a  procedure  on 
speculative  grounds  alone,  had  it  not  been  that,  when  Sur¬ 
gical  Registrar  of  St.  Bartholomew’s,  he  recollected  taking 
notes  of  a  case  in  which  Mr.  Holden  amputated  through 
the  lower  third  of  the  leg  for  well-marked  senile  gangrene 
of  the  foot.  In  that  case  antiseptic  precautions  were  taken 
for  the  first  few  days,  and  although  after  awhile  there  was 
some  sloughing  of  the  flap,  resulting  in  exposure  of  the 
bones,  which  were  removed  by  a  subsequent  operation,  the 
patient  left  the  hospital  with  the  wound  healed. 

Mr.  Savory  said  the  paper  raised  grave  and  important 
questions  in  theoretical  and  in  practical  surgery.  Amputa¬ 
tion  of  the  thigh  was  one  of  considerable  risk  in  all  persons, 
but  especially  in  persons  of  advancing  years.  He  inquired 
whether  we  were  not  too  much  inclined  to  divide  gangrene 
into  groups,  as  though  the  cases  were  not,  pathologically 
speaking,  more  or  less  alike.  Bid  such  great  differences 
really  exist  ?  He  well  remembered  Baron  Larrey’s  proposal 
to  operate  in  traumatic  gangrene,  thus  entirely  breaking 
through  the  traditions  current  at  that  time  ;  nevertheless, 
he  carried  out  the  idea  with  considerable  success,  and  this 
doctrine  was  followed  for  some  time  until  Mr.  Vincent 
showed  that  there  were  two  forms  of  traumatic  gangrene, 
and  that  the  purely  local  form  frequently  recovered  quite 
as  well  when  left  alone.  Cases  of  gangrene,  he  said,  were  divi¬ 
sible  into  two  classes,  in  which  there  were  two  factors — first, 
there  was  the  constitutional  element  predisposing  to  the  dis¬ 
ease  ;  and,  secondly,  there  were  local  conditions  of  parts,  of 
the  vessels,  and  states  of  tissue.  Gangrene  only  resulted  when 
the  two  factors  were  both  at  work,  though  one  or  other 
might  predominate.  When  a  waggon  passed  over  a  limb, 
gangrene  resulted  because  of  the  extent  of  the  local  injury. 
On  the  other  hand,  when  a  brewer’s  drayman,  with  diseased 
tissues,  and  soaked  with  alcohol,  received  an  injury,  if  gan¬ 
grene  resulted,  the  cause  was  not  so  much  the  traumatism  as 
the  condition  of  the  man’s  tissues.  In  the  former  case  it 


Medical  Times  and  Ga*ett». 


ROYAL  MEDICAL  AND  CHIRURGICAL  SOCIETY. 


Dec.  15, 1838.  701 


resulted  from  local  changes  ;  in  the  latter  it  was  due  to  con¬ 
stitutional  causes.  The  surgeon  at  the  bedside  should 
always  have  these  factors  present  in  his  mind,  for,  when  he 
had  to  do  with  constitutional  gangrene,  there  was  very  little 
hope  from  any  treatment,  especially  operation.  It  was  neces¬ 
sary  to  determine  whether  the  operation  might  not  do  more 
harm  than  the  disease,  for  there  was  not  only  the  local  effect 
but  also  the  shock  to  the  system  at  large.  Mr.  Hutchinson’s 
cases  were  not  strictly  cases  of  senile  gangrene ;  they  were 
a  mixed  lot  of  cases.  From  that  list  he  thought  we  should 
not  be  warranted  in  advocating  such  an  operation  as 
amputation  through  the  thigh  as  the  usual  surgical  practice 
to  be  followed. 

Mr.  Hutchinson  said  he  would  reply  first  to  the  criticism 
that  his  cases  were  not  all  examples  of  true  senile  gan¬ 
grene.  With  the  exception  of  the  first,  which  he  had 
adduced  simply  in  order  to  prove  the  advantages  of  ampu¬ 
tation  through  the  thigh  over  that  through  the  leg,  he  must 
submit  that  they  were  all  of  the  senile  form.  All  the  patients 
were  between  sixty  and  eighty  excepting  one;  and  although 
in  that  case  the  patient  was  only  forty-eight,  he  was  prema¬ 
turely  senile,  his  arteries  being  calcified  in  an  extreme 
degree.  The  difficulties  of  defining  senile  gangrene  must 
be  admitted  by  all.  The  best  definition  which  he  could  give 
of  it  was  that  which  he  had  ventured  in  the  paper,  viz., 
gangrene  due  to  calcification  of  the  arteries.  This  form  of 
gangrene  always  presented  peculiarities,  and  was  almost 
always  progressive.  He  could  not  admit  Mr.  Savory’s 
description  of  the  type-form  of  senile  gangrene  as  being 
that  in  which  the  limb  dried  up.  In  his  experience,  nine- 
tenths  of  the  most  definite  cases  of  senile  gangrene  were 
moist,  and  not  dry ;  whilst  the  most  typical  examples  of 
mummified  limbs  were  in  association  with  other  causes.  Most 
certainly  senile  gangrene  and  dry  gangrene  were  not  synony¬ 
mous  terms.  Nor  could  he  admit  that  senile  gangrene  was 
always  spontaneous,  for  not  unfrequently  some  slight  injury, 
attended  by  inflammation,  appeared  to  act  as  its  local  and 
exciting  cause.  Although  we  were  accustomed  to  classify 
gangrene  as  traumatic  and  spontaneous,  it  must  never  be 
forgotten  that  in  almost  all  cases  both  constitutional  and 
local  influences  had  their  share.  In  some  cases  the  one 
predominated,  and  in  others  the  other ;  but  it  could  seldom 
or  never  be  said  that  a  gangrene  was  due  wholly  either 
to  local  or  to  constitutional  influences.  He  was  glad  that 
Mr.  Savory  had  so  ably  reminded  them  of  the  important 
step  in  surgical  practice  which  was  taken  when  M.  Larrey 
recommended  amputation  in  traumatic  gangrene  without 
waiting  for  a  line  of  demarcation  ;  he  also  felt  indebted  to 
Mr.  Croft  for  suggesting  that  the  present  discussion  should 
be  widened  so  as  to  include  other  forms  of  gangrene  than 
those  purely  senile.  He  felt  sure  that  the  line  of  practice 
which  he  had  endeavoured  to  recommend  would  be  found 
applicable  to  a  larger  class  than  those  referred  to  in  his 
paper.  Having  regard  to  the  risks  which  all  forms  and 
conditions  of  gangrene  necessarily  entailed,  of  death  from 
septicaemia  when  acute,  and  from  pain  and  exhaustion  when 
chronic,  he  believed  that  the  rule  of  practice  ought  to  be  to 
amputate  early  in  all  cases,  unless  it  was  thought  that  by 
so  doing  more  of  the  limb  would  be  sacrificed  than  was 
necessary.  He  could  think  of  no  other  consideration  which 
would  induce  him  to  delay,  for  unquestionably  the  relief  to 
the  patient’s  pain  and  the  removal  of  the  danger  of  blood- 
poisoning  were  most  definitely  secured  by  amputation.  With 
anaesthetics  the  'deration  caused  no  shock  ;  with  Esmarch’s 
bandage  there  need  be  no  loss  of  ’  blood ;  and  with  Lister’s 
dressings,  or  an  equivalent,  the  wound  ought  to  heal  with¬ 
out  fever  and  without  suppuration.  In  two  of  the  cases 
which  he  had  narrated,  in  both  of  which  the  arteries  were 
most  extensively  diseased  (in  one  the  patient  being  close 
upon  eighty),  the  healing  of  the  stump  had  been  literally 
that  referred  to.  In  one  of  these  the  patient  suffered  from 
diabetes  and  albuminuria  at  the  same  time ;  yet  he  was 
now  alive  and  well— three  years  after  the  amputation  of  his 
thigh.  He  fully  accepted  the  criticism  of  Mr.  Savory  and 
Mr.  Hulke,  that  his  cases  were  not  sufficiently  numerous  to 
warrant  the  formation  of  a  new  rule  of  practice.  Cer¬ 
tainly  we  must  wait  the  result  of  further  experience. 
Since  he  had  written  his  paper,  however,  he  had  succeeded 
in  finding,  after  much  search,  an  important  piece  of  addi¬ 
tional  statistical  information.  It  consisted  of  a  record  by 
Mr.  James,  of  Exeter,  of  no  fewer  than  five  cases  of  gangrene 
of  the  feet  in  old  patients,  in  which  amputation  had  been 


J  performed.  In  some  the  amputation  had  been  through  the 
leg,  and  in  others  through  the  thigh.  Although  it  would 
appear  that  in  nearly  all  the  stump  had  been  for  a  time  in 
an  unhealthy  condition,  all  five  patients  had  ultimately  reco¬ 
vered.  In  two,  both  limbs  had,  with  an  interval,  beenremoved; 
and  in  one  of  these,  Mr.  James  stated,  he  had  himself  seen 
the  patient  walking  about  on  two  wooden  legs.  These  cases 
were  all  done  before  the  introduction  of  antiseptics  and  of 
improved  methods  of  dealing  with  arteries.  Mr.  Dix,  of 
Hull,  had  also  supplied  him  with  the  notes  of  a  case  in  which 
he  had  amputated  close  below  the  knee,  and  the  patient  had 
recovered.  With  regard  to  the  selection  of  the  place  of  am¬ 
putation,  Mr.  Hutchinson  said  that  his  own  experience  would 
lead  him  to  hold  strongly  to  the  opinion  expressed  in  his 
paper,  that  the  lower  third  of  the  thigh  was  the  safest  place. 
He  did  not  believe  that  the  common  dictum  as  to  increase  of 
risk  as  we  ascend  the  limb  was  true.  The  lower  third  of  the 
thigh  offered  several  definite  advantages :  there  was  only  one 
bone  to  cut,  and  often  only  a  single  artery  to  deal  with.  The 
arteries  in  the  upper  third  of  the  leg  were  often  more  or  less 
difficult  to  secure,  and  recurrent  haemorrhage  was  by  no 
means  uncommon.  He  had  often  seen  amputation  in  the 
lower  third  of  the  thigh  heal  absolutely  by  first  intention, 
whilst  he  had  very  seldom  indeed  witnessed  this  result  in 
the  upper  third  of  the  leg.  These  reasons,  added  to  the  yet 
more  weighty  one,  which  had  been  prominently  mentioned 
in  his  paper,  that  the  greater  the  distance  from  the  gangrene 
the  less  was  it  likely  to  recur  in  the  stump,  led  him  to  believe 
that  future  experience  would  demonstrate  the  superiority  of 
the  position  recommended.  In  elderly  persons  the  saving 
of  six  inches  more  or  less  in  the  length  of  the  stump  was  not 
a  matter  of  much  importance ;  and  it  was  certainly  not  worth 
while,  with  that  object  in  view,  to  diminish  the  probability 
of  rapid,  painless  recovery. 

Mediastinal  Emphysema  and  Pneumothorax 
in  connexion  with  Tracheotomy. 

Dr.  Champneys  contributed  this  paper,  as  an  addendum  fo¬ 
lds  third  communication  on  Artificial  Eespiration  in  Stillborn 
Children.  Since  the  publication  of  that  paper  there  had  been 
twenty- eight  cases  in  which  autopsy  was  made  after  trache¬ 
otomy.  Of  these  fourteen  were  males  and  fourteen  were 
females.  In  all  cases  the  examination  was  made  under 
water.  In  sixteen  cases  out  of  the  twenty-eight  (eight 
males  and  eight  females)  emphysema  of  the  mediastinum 
was  found.  In  two  of  these  cases  pneumothorax  was  also 
found.  It  was  found  in  no  case  without  emphysema  of  the 
mediastinum.  The  amount  of  emphysema  of  the  mediastinum 
was  greatest  when  pneumothorax  existed  also.  In  many,  if 
not  all  cases,  artificial  respiration  had  been  performed.  It 
would  be  seen  that  the  occurrence  of  emphysema  was  noted 
in  five  cases,  or  6  per  cent.,  of  those  which  ended  fatally 
after  tracheotomy  in  twenty-one  years  before  the  publica¬ 
tion  of  the  paper  above  referred  to,  and  in  sixteen  cases,  or 
57  per  cent.,  in  the  two  years  following  its  publication. 
Pneumothorax  was  not  noted  in  a  single  one  of  the  eighty- 
two  cases  occurring  in  the  twenty- one  years  previous  to  the 
paper,  but  had  been  noticed  twice  in  twenty-eight  cases 
occurring  in  the  two  years  following  its  publication. 

Dr.  Kingston  Fowler  said  that  for  the  last  two  years 
he  had  noted  carefully  the  condition  of  the  mediastinum  in 
cases  of  death  from  diphtheria  in  the  Middlesex  Hospital ; 
he  had  examined  twenty  cases,  of  which  ten  were  males 
and  ten  females  :  the  average  age  was  four  years  and 
a  half.  In  sixteen  of  these  tracheotomy  had  been  per¬ 
formed.  Of  these  tracheotomies  he  had  found  emphy¬ 
sema  in  six  cases,  that  is  in  375  per  cent.  A  high 
operation  had  been  performed  in  thirteen  cases,  with  em¬ 
physema  in  four,  pneumothorax  in  two ;  in  three  the  low- 
operation  had  been  done,  and  emphysema  was  found  in  two, 
pneumothorax  in  one.  In  three  of  the  cases  of  emphysema 
following  tracheotomy,  artificial  respiration  was  practised, 
while  it  was  not  necessary  or  practised  in  the  remaining  three 
cases.  Artificial  respiration  had  been  done  in  two  cases  of  tra¬ 
cheotomy  in  which  emphysema  was  not  found.  He  thought 
Dr.  Champneys’  explanation  the  correct  one  for  these  cases. 
On  the  other  hand— and  this  was  really  the  chief  of  what  he 
had  to  say — a  similar  emphysematous  condition  had  been, 
found  in  one  case,  independent  both  of  tracheotomy  and  of 
artificial  respiration. 

Dr.  Powell  said  that  in  seven  cases  dying  after  trache¬ 
otomy  in  the  last  two  years,  two  cases  of  emphysema  had 


Medical  Times  and  Gazette. 


MEDICAL  NEWS. 


Deo.  IB,  1883. 


occurred.  In  one  of  the  cases  the  tube  had  not  been  put 
into  the  trachea,  but  along  its  side.  In  another  case,  dying 
some  hours  after  the  operation,  emphysema  with  collapse  of 
lung  was  found.  He  could  not  see  how  we  could  escape  this 
condition  ;  for,  the  natural  passages  being  closed,  air  found 
its  way  more  easily  into  the  mediastinum  than  into  the  lung, 
where,  besides  the  other  impediments,  it  had  to  overcome 
the  natural  elasticity  of  the  lung  It  had  two  important 
bearings  on  surgical  practice — first,  it  suggested  the  high 
operation  because  the  cervical  fascia  was  less  cut  into ;  and, 
secondly,  the  danger  of  forcibly  throwing  back  the  head  in 
order  to  make  the  trachea  more  prominent. 

Dr.  Champneys  replied  that  in  his  paper  he  had  only 
referred  to  emphysema  after  tracheotomy.  He  had  not  left 
to  conjecture  the  route  followed  by  the  air,  but  had  demon¬ 
strated  it  by  the  experiments  detailed  in  his  paper.  Forcing 
the  tube  by  the  side  of  the  trachea,  above  all  other  things, 
tended  to  produce  this  inspiratory  mediastinal  emphysema. 
The  dangerous  period  of  the  operation  was  that  between  the 
division  of  the  deep  cervical  fascia  and  the  efficient  introduc¬ 
tion  of  the  tracheotomy-tube.  Emphysema  without  trache¬ 
otomy  is  no  doubt  expiratory  emphysema,  alluded  to  but 
not  further  discussed  in  his  paper.  On  this  point  he  hoped 
to  lay  a  paper  before  the  Society  in  a  few  days.  The  observa¬ 
tion  of  Dr.  Douglas  Powell,  in  which  the  air  was  auscultated 
in  its  course  down  the  mediastinum,  was  of  the  greatest 
interest. 

The  meeting  then  adjourned. 


MEDICAL  NEWS. 

- - 

University  of  London. — The  following  is  a  list  of  the 
candidates  who  have  passed  the  recent  examinations : — 

M.B.  Examination — Honours. 

MEDICINE. 

First  Class. — Sidney  Harris  Cox  Martin,  B.Sc.  (Scholarship  and  Gold 
Medal),  University  College  ;  Robert  Forteseue  Fox  (Gold  Medal),  London 
Hospital;  William  Dobinson  Halliburton,  B.Sc.,  University  College,  and 
Edward  Waldemar  von  Tunzelmann,  University  College,  equal;  John 
Howard  Champ,  Guy’s  Hospital. 

Second  Class.— Joseph  Collier,  Owens  College  and  Manchester  Royal 
Infirmary ;  Paul  Frank  Moline,  University  College,  and  Sidney  Worthing¬ 
ton,  Guy’s  Hospital,  equal ;  Robert  Henry  Scanes  Spicer,  B.Sc.,  St.  Mary’s 
Hospital ;  Frederick  Foord  Caiger,  St.  Thomas’s  Hospital,  and  William 
Heaton  Horrocks,  B.Sc.,  Owens  College,  equal ;  John  Alfred  Parry  Price, 
•Guv’s  Hospital ;  John  Thomas  Rogerson,  Owens  and  University  Colleges. 

Third  Class.— Walter  Tyrrell  Brooks,  King’s  College  ;  Edmund  Wilkin¬ 
son  Roughton,  St.  Bartholomew’s  Hospital ;  Robert  Black,  London  Hos¬ 
pital;  John  Metcalfe  Beverley,  Owens  College  and  Manchester  Royal 
Infirmary ;  Clement  Bernard  Voisey,  Owens  College,  Manchester  Royal 
Infirmary,  and  St.  Mary’s  Hospital ;  Walter  Hull,  St.  Thomas’s  Hospital, 
Richard  Sisley,  St.  George’s  Hospital,  and  St.  Clair  Thomson,  King’s 
•College,  equal. 

OBSTETRIC  MEDICINE. 

First  Class. — Samuel  Rabbeth  (Scholarship  and  Gold  Medal),  King’s 
College  ;  Edmund  Wilkinson  Roughton  (Gold  Medal),  St.  Bartholomew’s 
Hospital;  John  Howard  Champ,  Guy’s  Hospital. 

Second  Class.— St.  Clair  Thomson,  King’s  College ;  Charles  Montagu 
Handheld  Jones,  St.  Mary’s  Hospital,  and  Richard  Sisley,  St.  George’s 
Hospital,  equal ;  Wheelton  Hind,  Guy’s  Hospital. 

Third  Class. — Charles  Frederic  Bailey,  St.  Bartholomew’s  Hospital,  and 
William  Dobinson  Halliburton,  University  College,  equal ;  Frederick 
Foord  Caiger,  St.  Thomas’s  Hospital;  Thomas  William  Shore,  B.Sc.,  St. 
Bartholomew’s  Hospital ;  Robert  Forteseue  Fox,  London  Hospital. 

FORENSIC  MEDICINE. 

First  Class.— Joseph  Collier  (Scholarship  and  Gold  Medal),  Owens  Col¬ 
lege  and  Manchester  Royal  Infirmary ;  John  Metcalfe  Beverley  (Gold 
Medal),  Owens  College  and  Manchester  Royal  Infirmary;  John  Alfred 
Parry  Price,  Guy’s  Hospital ;  James  Henry  Targett,  Guy’s  Hospital ;  John 
Howard  Champ,  Guy’s  Hospital. 

Second  Class.— Robert  Henry  Scanes  Spicer,  St.  Mary’s  Hospital ;  Sidney 
Worthington,  Guy’s  Hospital ;  Wheelton  Hind,  Guy’s  Hospital. 

Third  Class. — Sidney  Harris  Cox  Martin,  University  College ;  Charles 
Hartvig  Louw  Meyer,  Guy’s  Hospital ;  Emily  Tomlinson,  London  School 
-of  Medicine  and  Royal  Free  Hospital;  Robert  Forteseue  Fox,  London 
Hospital. 

B.S.  Examination — Pass. 

First  Division—  Frederick  Foord  Caiger,  St.  Thomas’s  Hospital ;  Louis 
Albert  Dunn,  Guy’s  Hospital;  Sidney  Harris  Cox  Martin,  B.Sc.,  Univer¬ 
sity  College;  Charles  Hartvig  Louw  Meyer,  Guy’s  Hospital;  Thomas 
Wilson,  University  College. 

Second  Division.—  Gilbert  Harry  Barling,  St.  Bartholomew’s  Hospital 
and  Birmingham  ;  Wheelton  Hind,  Guy’s  Hospital  ;  John  Thomas 
Rogerson,  Owens  and  University  Colleges  ;  Arthur  Guy  8almon,  St.  Bar¬ 
tholomew’s  Hospital ;  Isaac  Scarth,  Owens  College  and  London  Hospital. 


University  of  Durham.— Michaelmas  Term,  1883. 
— At  the  examination  for  degrees  in  Medicine  and  Surgery 
at  the  College  of  Medicine,  Newcastle-upon-Tyne,  the 
following  satisfied  the  examiners  : — 


Degree  of  Doctor  in  Medicine  for  Practitioners  of  Fifteen  Years'  standing. — 

Thomas  Michael  Dolan,  L.R.C.S.,  L.R.C.P.  Edin, ;  Roderick  Macdonald, 

L. R.C.P.,  L.R.C.S.  Edin. 

One  candidate  failed  to  satisfy  the  examiners. 

Degree  of  Doctor  in  Medicine. — Henry  Hinds  Austen,  M.B.,  M.R.C.S. ; 
Frederick  William  East,  M.B.,  L.R.C.P.,  M.R.C.S.,  L.S.A.  ;  Charles 
Green,  M.B.,  M.R.C.S.,  L.S.A. ;  Theodore  Joseph  Hudson,  M.B.,  M.R.C.S. 

One  candidate  failed  to  satisfy1  the  examiners. 

Cold  Medal  for  the  Best  Essay  for  the  Year  1883. — Frederick  William  East. 
Second  Examination  for  the  Degree  of  Bachelor  in  Medicine.— First  Class 
Honours :  None.  Second  Class  Honours  (in  order  of  merit)  :  Walter 
Robert  Awdry,  M.R.C.S. ;  William  Owen  Travis,  M.R.C.S. ;  Henry  Milner 
Hughes ;  Edward  Augustus  Opie ;  Arthur  Tresco  Eranklyn  Brown, 

M. R.C.S.,  L.S.A.;  Simpson  Powell,  M.R.C.S.,  L.S.A.;  Henry  Pottinger 
Keatinge,  M.R.C.S.  Pass  List  (in  alphabetical  order)  :  Thomas  Elisha 
Gordon;  John  Campion  Grinling,  M.R.C.S.;  Robert  Hardie;  Septimus 
Lowes,  L.R.C.S.  Edin.,  L.S.A.  ;  Herbert  Ryding  Mosse,  M.R.C.8.,L.S.A. ; 
William  Augustus  Norry,  M.R.C.S..  L.S.A.  ;  Thomas  H.  Openshaw, 
M.R.C.S. ;  J.  Inglis  Parsons  ;  Alfred  Robinson,  M.R.C.S.,  L.S.A. ;  James 
Matthew  Robson,  B.A. ;  Charles  Yaldwyn  Shuter,  M.R.C.S.,  L.S.A. ;  E. 
Walpole  Simmons;  Frederick  Spicer ;  J.  Henry  Surtees  Sumner,  M.R.C.S., 
L.S.A. ;  Abelardo  Triay ;  Arthur  William  Wheatley,  M.R.C.S.,  L.S.A. 

Two  candidates  were  rejected. 

Degree  of  Master  in  Surgery. — William  Owen  Travis,  M.R.C.S. 

Four  candidates  failed  to  satisfy  the  examiners. 

Boyal  College  of  Surgeons  of  England. — The 
following  Members  of  the  College  having  undergone  the 
necessary  examinations  at  the  half-yearly  meetings  of  the 
Court  of  Examiners  on  the  22nd,  23rd,  and  '  24th  ult.,  were 
reported  to  have  acquitted  themselves  to  the  satisfaction  of 
the  Court,  and  at  a  meeting  of  the  Council  on  the  13th 
inst.  were  admitted  Fellows  of  the  College,  viz.: — 

Marsh,  Frank,  L.S.A.,  Stafford,  diploma  of  Membership  dated  April  24, 
1877,  student  of  King’s  College  Hospital. 

Morrison,  J.  T.  J.,  B.A.  and  M.B.  Cantab.,  Trinity-square,  S.E., 
January  24,  1879,  of  the  University  of  Cambridge. 

Sheild,  A.  M.,  L.R.C.P.  Lond.,  Cambridge,  July  24,  1879,  of  the  Univer¬ 
sity  of  Cambridge. 

Whitehouse,  John,  L.R.C.P.  Edin.,  Smethwick,  July  22,  1879,  of  the 
Galway  School  of  Medicine. 

Platt,  W.  B.,  M.D.  Harvard,  Baltimore,  April  19,  1881,  of  the  University 
of  Harvard. 

Rand,  R.  E.,  M.B.  Edin.,  Constantinople,  of  the  Edinburgh  School. 
Square,  J.  E.,  L.R.C.P.  Lond.,  Plymouth,  November  15,  1881,  of  St. 
Bartholomew’s  Hospital. 

Power,  D’Arcy,  M.A.  and  M.B.  Oxon.,  Great  Cumberland-place,  W., 
January  18,  1882,  of  St.  Bartholomew’s  Hospital. 

At  the  same  meeting,  Mr.  D.  D.  Day,  M.B.  Lond.  (diploma 
of  Membership  dated  May  20,  1880),  Norwich,  of  St.  Bar¬ 
tholomew’s  Hospital,  who  passed  the  examination  in  May 
last,  having  reached  the  legal  age  of  twenty-five  years,  was 
also  admitted  a  Fellow;  and  Mr.  E.  T.  D.  Harrison,  L.S.A., 
of  Clifton,  Bristol,  was  elected  a  Eellow,  his  diploma  of  mem¬ 
bership  bearing  date  July  15,  1842.  One  candidate  passed 
who  will  receive  his  diploma  when  twenty-five  years  of  age ; 
and  eight  candidates  having  failed  to  acquit  themselves  to 
the  satisfaction  of  the  Court,  were  referred  to  their  profes¬ 
sional  studies  for  twelve  months.  With  these  meetings  the 
examinations  for  the  present  year  were  brought  to  a  close. 

Apothecaries’  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday , 
December  6 : — 

Bennett,  Frank  Albert,  Queen’s  College,  Birmingham. 

Griffin,  John  Hubert,  Woburn-place,  W.C. 

Llewellyn,  John,  Mount-place,  London  Hospital,  E. 

Parsons,  Charles  John,  Muxter,  near  Newport,  Salop. 

The  following  gentlemen  also  on  the  same  day  passed  their 
Primary  Professional  Examination  - 

Brooks,  William  Harrison,  London  Hospital. 

Jaynes,  Frederick  John,  Middlesex  Hospital. 

Naghten,  Matthew  Barnwell,  Dublin  School  of  Medicine. 


APPOINTMENTS. 

Clegg,  Joseph,  M.R.C.S.,  L.S.A. — Medical  Officer  of  the  Gartside-street 
Dispensary  of  the  General  Hospital  for  Children,  Pendlebury,  Man¬ 
chester,  vice  T.  C.  Booth,  resigned. 

Cockey,  C.  P.,  M.R.C.S.— House-Surgeon  to  the  Female  Lock  Hospital, 
vice  P.  P.  Whitcomhe,  M.R.C.S.,  L.S.A.,  resigned. 

Eve,  Fredebick  S.,  F.R.C.S.— Assistant-Surgeon  to  the  Royal  Free 
Hospital,  in  the  place  of  the  late  James  Shuter,  F.R.C.S. 

Fox.  W.  H.  P.,  L.R.C.P.,  L.R.C.S.— House-Surgeon  to  the  Wrexham 
Infirmary. 

Hodges,  R.  W.,  L.R.C.P..  L.A.H.  Dub.— Honorary  Medical  Officer  to  the 
Fever  Hospital,  Queenstown,  Cork. 

Jakins,  P.  S.,  M.R.C.S. — Surgeon  to  the  Western  Ophthalmic  Hospital, 
Marylebone-road,  vice  W.  Charnley,  M.B.,  resigned. 

Stokes,  F.  A.,  L.R.C.P.,  M.R.C.S.— Senior  Resident  Medical  Officer  to  the 
Great  Northern  Hospital,  vice  —  Ashwell,  resigned. 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES. 


Dec.  15, 1883.  703- 


DEATHS. 

Johnstone,  T.  B.,  M.D.,  Surgeon- General  H.M.  Indian  Army  (retired), 
at  Ealing,  W.,  on  December  4. 


VACANCIES. 

City  op  London  Hospital  fob  Diseases  of  the  Chest,  Victoria- 
park,  E.— Assistant  Physician.  Applications,  accompanied  by  testi¬ 
monials,  to  be  forwarded  to  the  office,  24,  Finsbury-circus,  E.C.,  on  or 
before  December  17.  Particulars  can  be  obtained  from  the  medical 
officers  or  Secretary. 

Kent  and  Canterbury  Hospital.— Assistant  House-Surgeon  and  Dis¬ 
penser.  Salary  £50  per  annum,  with  board  and  lodging,  etc. ,  in  the 
Hospital.  Candidates  must  be  registered  under  the  Medical  Act  as 
being  legally  qualified  to  practise,  accustomed  to  dispense  medicines, 
unmarried,  and  not  more  than  fifty  years  of  age.  Qualifications  and 
testimonials  to  be  sent  to  the  Secretary  on  or  before  December  21.  The 
election  will  take  place  on  December  28. 

Newton  Abbot  Rural,  and  Dawlish  and  Wolbobougii  Ubban  Sani¬ 
tary  Authorities. — Medical  Officer  of  Health.  ( For  particulars  see 
Advertisement.) 

Royal  Hospital  for  Diseashs  of  the  Chest,  City-road,  E.C. — House- 
Physician.— Salary  at  the  rate  of  £80  per  annum,  with  residence,  etc., 
and  attendance.  Candidates  must  be  registered  under  the  Medical 
Act,  and  must  not  engage  in  private  practice.  The  appointment  is 
tenable  for  six  months.  Applications  and  testimonials  to  be  sent  to 
the  Secretary,  from  whom  further  particulars  may  be  obtained,  by 
December  18. 

Westbourne  Provident  Dispensary  and  Maternity,  29,  Westbourne- 
park-crescent,  Harrow-road,  W.— Surgeon.  Candidates  to  send  their 
applications,  with  testimonials,  to  the  Hon.  Secretary  at  the  Dispensary, 
on  or  before  December  17. 


UNION  AND  PAROCHIAL  MEDICAL  SERVICE. 

***  The  area  of  each  district  is  stated  in  acres.  The  population  is 
computed  according  to  the  census  of  1881. 

RESIGNATIONS. 

Glutton  Union.— The  offices  of  Medical  Officer  for  the  Cam  el  ey  District 
and  the  Workhouse  are  vacant,  by  the  death  of  Mr.  J.  D.  Perrin  :  area 
3438 ;  population  798  ;  salary  £14  per  annum.  Salary  for  Workhouse  £60 
per  annum. 

Ticehurst  Union. — Mr.  T.  W.  Popplewall  has  resigned  the  Wadhurst 
District:  area  10,138  ;  population  3216 ;  salary  £70  per  annum. 

APPOINTMENTS. 

Brackley  Union. — Richard  T.  King,  L.R.C.S.  Ire.,  L.K.&Q.C.P.  Ire.,  to 
the  Second  District. 

Ely  Union.  —  Wilfred  Howard,  M.R.C.S.  Eng.,  L.R.C.P.  Edin.,  to  the 
Littleport  District. 

Hexham  Union.— Robert  James  Foulis,  L.R.C.S.  Edin..  L.R.C.P.  Edin., 
to  the  Eastern  Division  of  the  Seventh  District.  George  McCoull, 
M.R.C.S.  Eng.,  L.R.C.P.  Edin.,  to  the  Western  Division  of  the  Seventh 
District. 

Madeley  Union.— George  D.  Collins,  M.R.C.S.  Eng.,  L.S.A.,  to  the 
Broseley  District. 

Sheffield  Union. — Wm.  Lougbottom,  L.R.C.S.  Edin.,  L.R.C.P.  Edin.,  as 
Resident  Assistant  Medical  Officer  of  the  Workhouse. 

Wangford  Union. — Robert  H.  Johnston,  B.M.,  B.C.  Trim  Coll.  Dub.,  to 
the  Bungay  District. 

Wantage  Union. — Robert  Main,  L.R.C.P.  Edin.,  L.R.C.S.  Edin.,  to  the 
Hsley  District. 

Wolverhampton  Union. — Alfred  Freeman,  M.R.C.S.  Eng.,  L.R.C.P. 
Edin.,  to  the  Third  District. 


Jervis-street  Hospital,  Dublin, — We  understand 
that  Dr.  Christopher  Gunn  is  likely  to  be  appointed  a  Surgeon 
to  this  Hospital,  in  room  of  Mr.  James  Edward  Kelly,  who 
lately  resigned  in  order  to  take  up  his  residence  at  San 
Francisco.  Dr.  Gunn  is  a  graduate  in  medicine,  surgery, 
and  midwifery  of  the  Queen’s  University  in  Ireland,  and 
Assistant-Physician  to  both  the  Mater  Misericordise  and 
Cork-street  Fever  Hospitals.  He  was  formerly  Surgeon  to 
the  Frontier  Police,  Cape  Colony,  and  served  as  Civil  Sur¬ 
geon  during  the  Zulu  campaign  in  1879.  As  a  student  at 
the  Carmichael  College  of  Medicine  he  won  the  Mayne 
Scholarship  and  the  Senior  Prizes  in  Anatomy,  Physiology, 
Medicine,  Surgery,  and  Ophthalmic  Surgery.  The  appoint¬ 
ment  is  likely  to  be  a  very  popular  one. 

The  London  Hospital. — -At  a  special  meeting  of  the 
governors  on  the  5th  inst.,  the  draft  of  the  Bill  proposed  to 
be  introduced  in  the  coming  session  of  Parliament  relative 
to  the  administration  of  the  Hospital  was  unanimously  con¬ 
firmed.  By  it  the  governors  seek  power  to  enable  them  to 
grant  a  building  lease  of  part  of  their  land  to  any  person 
willing  to  erect  buildings  for  the  accommodation  of  the 
hospital  staff  and  students;  to  enable  them  to  receive  a 
limited  number  of  paying  patients ;  and  to  elect  not  more 
than  two  members  of  the  consulting  and  senior  medical  staff 
as  members  of  the  House-Committee  of  the  Hospital.  The 
new  rules  with  regard  to  out-patients  will  come  in  force  at 
the  beginning  of  the  new  year.  Under  these  an  inspector 
will  be  appointed,  whose  duty  it  will  be  to  inquire  into  the 
circumstances  of  persons  applying  for  medical  assistance. 


The  New  Children’s  Hospital  at  Dundee. — This 
Hospital,  which  has  been  erected  in  connexion  with  the 
Dundee  Royal  Infirmary,  was  opened  on  the  4th  inst.  by 
Sir  John  Ogilby.  The  building  is  situated  on  the  ground 
floor  of  the  east  front  of  the  Infirmary,  is  100  ft.  by  20  ft. 
in  dimensions,  and  contains  twenty-seven  cots. 

Birmingham  Children’s  Hospital. — -At  a  meeting  of 
the  Election  Committee  of  this  Hospital,  Dr.  Annie  Clark 
was  elected  to  fill  one  of  the  vacancies  on  the  staff  of  acting 
physicians,  in  opposition  to  eight  of  the  most  eminent  phy¬ 
sicians  of  the  town.  Dr.  Annie  Clark  has  been  for  some 
years  connected  with  hospital  work  in  the  town,  and  was 
elected  by  a  large  majority. 


NOTES,  QUERIES,  AND  REPLIES. 

- - 

$e  tfcat  qntstionelj;  mtu£r  sfeall  learn  mnt^.— Bacon. 


The  Rogers  Testimonial. 

The  following  is  the  seventh  list  of  subscriptions  C.  Sedgwick,  Esq.s- 
Hollingboupe,  £1  Is.;  A.  E.  Boulton,  Esq.,  Horncastle,  £1  Is.;  Dr- 
Tyley  Weamore,  £1  Is.;  Jabez  Hogg,  Esq.,  Bedford-square,  £t  Is.? 
R.  R.,  "Well-Wisher,  £1  Is. ;  Dr.  Dutton,  Sidlesham,  10s.  6d. ;  Dr.  Grove, 
8t.  Ives,  10s.:  Dr.  Jardine,  Capel,  Surrey,  10s.  ;  W.  F.  Brooks,  Esq., 
Fareham,  7s.  6d. ;  W.  E.  Soffe,  Esq.,  East  Harling,  5s.  ;  Dr.  Harday, 
West  Haddon,  os. ;  Dr.  C.  J.  Connon,  Allendale,  5s. 

Medical  Charities. — The  late  Mr.  J.  K.  Ford,  solicitor,  has  just  bequeathed 
£2000  to  the  Royal  Portsmouth,  Portsea,  and  Gosport  Hospital. 

Dr.  A.  C.  Dr  ownless.— The  papers  were  only  delivered  last  Thursday  from 
the  Colonial  Office —therefore  too  late  for  the  election  this  year ;  but  they- 
will  be  laid  before  the  Council  in  January  next. 

London  Charities.— The  income  of  the  metropolitan  charities  1  ast  year 
was  £4,452,902.  This  total  was  made  up,  inter  alia,  as  follows  : — Seven¬ 
teen  general  hospitals,  £274,159;  twenty-seven  special  hospitals,  £109.042  ; 
twenty  hospitals  for  women  and  children,  £64,704 ;  twenty-four  charities 
for  the  blind,  £55,872;  three  institutions  for  idiots,  £55,724;  eight 
convalescent  hospitals,  £53,078  ;  forty-four  convalescent  institutions^ 
£43,139 ;  nine  charities  for  incurables,  £33,447  ;  thirty-three  general- 
dispensaries,  £25,206 ;  eight  charities  for  the  deaf  and  dumb,  £16,692  ; 
five  institutions  for  surgical  appliances,  £14,135;  thirty-two  provident 
dispensaries,  £9916 ;  five  ophthalmic  hospitals,  £9454  ;  sixteen  nursing 
institutions,  £7400 ;  five  lying-in  hospitals,  £7235  ;  three  orthopsedie- 
hospitals,  £5541 ;  four  skin-diseases  hospitals,  £5092  ;  and  two  institu¬ 
tions  for  vaccination,  £2700. 

Short-sightedness.— Dr.  Cohn,  who  has  summarised  various  statistics  on  the 
question  of  hereditary  short-sightedness,  which  have  from  time  to  time- 
been  collected  by  Erisman,  Scheiding,  Pfliiger,  and  other  authorities  on? 
the  subject,  finds  that  the  researches  of  the  last-named  writer  resulted, 
in  the  following  facts  being  elucidated  as  to  the  percentage  of  short¬ 
sighted  pupils  Public  schools— without  predisposition,  8  per  cent. ;  with 
predisposition,  19  per  cent.  Higher  schools — without  predisposition, 
17  percent.;  with  predisposition,  26  per  cent.  The  difference  of  about 
10  per  cent,  in  favour  of  those  children  without  an  hereditary  predis¬ 
position  to  short-sightedness  is,  according  to  Pfliiger’s  opinion,  a  reliable 
basis  of  argument.  At  the  same  time,  he  asserts  that  this  relatively  low- 
figure  is  arrived  at  after  the  necessary  elimination  of  those  cases  where 
the  predisposition  has  remained  latent,  and  where  it  is  of  such  a  nature 
as  only  to  become  the  source  of  ocular  affection  under  circumstances  of" 
an  unfavourable  character. 

Ophthalmic  Hospital  at  Jerusalem. — Mr.  Moore,  Consul  at  Jerusalem,  in 
an  account  of  the  Hospice  and  Ophthalmic  Dispensary  of  the  English- 
Order  of  St.  John  of  Jerusalem  which  has  been  established  in  that  city, 
says  “  A  hospital  for  the  treatment  of  diseases  of  the  eye  meets  one 
of  the  most  urgent  wants  of  Jerusalem  and  the  country  around;  for' 
while  there  happily  exist  several  charitable  institutions  for  the  general 
relief  of  sickness,  to  such  an  extent  are  affections  of  the  eye  prevalent, 
that  a  special  hospital  for  such  cases  has  been  a  long-standing  desi¬ 
deratum,  and  will  prove  an  inestimable  boon  to  the  population.  A  very- 
eligible  plot  of  land  near  the  city,  of  about  six  acres  in  extent,  has  been 
secured.  On  the  land,  moreover,  stands  a  substantial  two-storeyed  house, 
which,  with  some  not  very  considerable  repairs  and  alterations  now  going- 
forward,  will  make  an  admirable  hospital.  The  medical  officers  sent  out 
by  the  Order  commenced  to  receive  and  treat  patients  in  December  last. 
The  work  has  thus  completed  six  months  of  existence.  Dr.  Waddell 
reports  that  during  that  period  the  total  number  of  patients  received 
has  been  1692,  while  the  total  attendance — that  is  to  say,  of  patients- 
who  received  advice  and  medicine— has  been  6318.  On  many  days  the 
attendance  has  reached  the  large  number  of  140,  the  average  daily  appli¬ 
cations  having  been  about  eighty.  Just  at  present,  Dr.  Waddell  states, 
the  results  cannot  be  exactly  shown,  by  reason  that  a  great  many  of 
the  patients  are  still  under  treatment,  but  he  estimates  that  at  least 
1900  cures  have  been  effected.” 


704 


Medical  Times  and  Gazette. 


VITAL  STATISTICS. 


Deo.  15,  1S83. 


r,  r  r 


’  \ 


COMMUNICATIONS  have  been  received  from— 

JDr.  Exchaqttrt,  Bex :  Dr.  Alexander,  Liverpool ;  The  Director  of  the 
Anthropological  Institute,  London;  Dr.  A.  Smart,  London;  The 
■  Secretary  of  the  Apothecaries’  Society,  London  ;  The  Registrar 
•  of  the  University  of  Durham,  Newcastle-on-Tyne  ;  Mr.  E.  Bellamy, 
London  ;  The  Sanitary  Commissioner  for  the  Punjaub,  Lahore  ;  Dr. 
‘George  Johsson,  F.R.S.,  London;  The  Secretary  of  the  Chinese 
Maritime  Customs,  London;  The  Bedell  of  the  Royal  College  of 
Physicians,  London ;  The  Secretary  of  the  London  Fever  Hospital, 
London  ;  Mr.  J.  T.  W.  Bacot,  Seaton,  Devon ;  Dr.  Tirard,  London ; 
Dr.  A.  Harvey,  London;  Mr.  A.  S.  Kenny', London ;  Mr.  T.  M.  Stone, 
Wimbledon ;  Dr.  Oslar,  Montreal,  Canada ;  Mr.  F.  Galton,  London  ; 
Dr.  Maclagan,  London;  Dr.  J.  W.  Moore,  Dublin;  Mr.  J.  Chatto, 
London ;  The  Hon.  Secretary  of  the  Medical  Society  of  London  ; 
The  Hon.  Secretary  of  the  Pathological  Society  of  London;  Dr. 
W.  Blyth,  London;  Dr.  Schwalbe,  Magdeburg;  The  Registrar- 
General  for  Queensland,  Brisbane;  The  Registrar-General  for 
'Scotland,  Edinburgh  :  Mr.  J.  Wickham  Barnes,  London  ;  Dr.  F.  A. 
Mahomed,  London  ;  The  Secretary  of  the  University  of  London  ; 
The  Editor  of  the  “Sanitary  Engineer,”  London ;  Mr.  Jonathan 
Hutchinson,  F.R.S.,  London. 


VITAL  OF  LONDON. 


Week  ending  Saturday,  December  8,  1883. 


BIRTHS. 

Births  of  Boys,  1237;  Girls,  1109;  Total,  2316. 

Corrected  weekly  average  in  the  10  years  1873-82,  2640'2. 


DEATHS. 


Males. 

Females. 

Total. 

Deaths  during  the  week . 

819 

809 

1628 

Weekly  average  of  the  ten  years  1873-82,  ) 
corrected  to  increased  population  ..  j 

932  0 

911'6 

1843'6 

Deaths  of  people  aged  80  and  upwards 

... 

... 

63 

DEATHS  IN  SUB-DISTRICTS  FROM  EPIDEMICS. 


BOOKS,  ETC.,  RECEIVED  - 

On  Photographing  the  Larynx,  by  Thomas  R.  French,  M.D.,  Brooklyn — 
The  Diseases  of  Children,  by  Armand  Semple,  B.A.,  M. B.,  M.R.C.P. — 
Diseases  of  the  Bladder,  etc.,  by  Frederick  James  Gant,  F.RC.S.— 
The  Transactions  of  the  Edinburgh  Obstetrical  Society -Poisons  :  their 
Effects  and  Detection,  by  Alexander  Wynter  Blyth,  M.R.O.S.,  F.C.S., 
etc.— The  Possibility  of  Abnormal  Ocular  Conditions  through  the 
Sympathetic  System  impairing  the  Function  of  the  Uterus,  by  W.  S. 
Little,  A.M.,  M.D.  Philadelphia — The  Life  and  Work  of  St.  Paul,  by 
IF.  W.  Farrar,  D.D.,  part  xxiii. — Notes  on  Books,  by  Messrs.  Longman 
and  Co. — Note  sur  Vingt-deux  Operations  de  Goitre— Report  on  the 
Health,  Sanitary  Condition,  etc  ,  of  Kensington  from  November  4  to 
December  1  — Changes  in  New  England  Population,  by  Nathan  Allen, 
M.D.,LL.D. — The  Law  of  Human  Increase,  by  Nathan  Allen,  M.D. , 
LL.D. 

PERIODICALS  AND  NEWSPAPERS  RECEIVED  — 

ILancet— British  Medical  Journal— Medical  Press  and  Circular — Ber¬ 
liner  Klinische  Wochenschrift— Centralblatt  fiir  Chirurgie — Gazette 
des  Hopitaux— Gazette  Medicale— Revista  de  Medicina— Bulletin  de 
I’Aeademie  deM6decine — Pharmaceutical  Journal — Wiener  Medicinische 
Wochenschrift— Revue  Mddicale — Gazette  Hebdomadaire—  Nature- 
Boston  Medical  and  Surgical  Journal — Louisville  Medical  News — 
Centralblatt  fiir  Gvuiikologie — Le  Concours  Medical— Centralblatt  fiir 
■die  Medicinischen  Wissenschaften — Centralblatt  fiir  Klinische  Medicin 
— Philadelphia  Medical  News — Le  Progrds  Medical — New  York  Medical 
Journal — Edinburgh  Clinical  and  Pathological  Journal— Students’  Jour¬ 
nal  and  Hospital  Gazette— New  York  Medical  Record— Indian  Medical 
Gazette— Australian  Medical  Journal— Ophthalmic  Review — Practitioner 
— Analyst — El  Ensayo  Medico— Revue  Sanitaire— Society. 


Enumerated 

Population, 

1881 

(unrevised). 

Small-pox. 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

1 

Ps  bn 

0  P 

0  0 

rP  O 

Typhus. 

Enteric  (or 

Typhoid) 

Fever. 

Simple 

continued 

Fever . 

OS 

8 

•1-. 

« 

West . 

669633  ... 

•5 

4 

1 

12 

•  •• 

5 

2 

2 

North  ... 

905947)  2 

4 

8 

7 

9 

13 

... 

3 

Central 

282238  ... 

1 

2 

3 

4 

... 

3 

... 

1 

East . 

692738  ... 

5 

23 

1 

5 

... 

4 

... 

3 

South . 

1265927  ... 

29 

16 

11 

13 

... 

1 

... 

5 

Total . 

3816483  2 

44 

53 

23 

43 

... 

26 

2 

14 

METEOROLOGY. 


From  Observations  at  the  Greenwich 

Mean  height  of  barometer  . .  . 

Mean  temperature  . . 

Highest  point  of  thermometer  . 

Lowest  point  of  thermometer  ...  ...  ... 

Mean  dew-point  temperature  . 

General  direction  of  wind  . .  ... 

Whole  amount  of  rain  in  the  week  ... 


Observatory. 

.  29  986  in. 

.  37-8° 

.  53'2° 

...  ...  28'4° 

. 321° 

N.N.W.,N.,&S.W. 
.  O' 05  in. 


BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  the 
Week  ending  Saturday,  Dec.  8,  in  the  following  large  Towns : — 


APPOINTMENTS  FOR  THE  WEEK. 


December  15.  Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  1£  p.m. ;  King’s  College,  1%  p.m. ;  Royal 
Free,  2  p.m.;  Royal  London  Ophthalmic,  11  a.m. ;  Royal  Westminster 
Ophthalmic,  lip.m.;  St.  Thomas’s,  lip.m.;  London,  2  p.m. 

17.  Monday. 

•Operations  at  the  Metropolitan  Free,  2  p.m.;  St.  Mark’s  Hospital  for 
Diseases  of  the  Rectum. 2  p.m.;  Royal  London  ODhthalmic.il  a.m.; 
Royal  Westminster  Ophthalmic,  1?  p.m.  ;  Hospital  for  Women,  2  p.m. 
Society  of  Arts,  8  p.m.  Mr.  W.  Mattieu  Williams,  “  On  the  Scientific 
Basis  of  Cookery.”  (Cantor  Lectures —III.) 

Medical  Society  of  London,  85  p.m.  Sir  Andrew  Clark,  “  On  Catheter- 
Fever.” 


18.  Tuesday. 

Operations  at  Guy’s,  1J  p.m.  ;  Westminster,  2  p.m. ;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  1&  p.m.;  West 
London,  3  p.m. 

Pathological  Society.  8i  p.m.  Dr.  Charlewood  Turner — Quiet  Necrosis. 
Dr.  Wickham  Legg — Melanosis  after  Melanotic  Sarcoma  of  the  Choroid. 
Mr.  Godlee -Three  Cases  of  Tubercular  Disease  of  the  Tongue  (living). 
Mr.  Symonds—  Tubercular  Ulceration  of  the  Tongue.  Mr.  Jessett— 
Tubercular  Ulceration  of  the  Tongue.  Dr.  Goodhart— Tubercular 
Ulcers  of  the  Base  of  the  Epiglottis  (card).  Dr.  Norman  Moore — 
Three  Examples  of  Pancreatic  Disease.  Mr.  Bowlby— Dermoid  Cyst  of 
the  Finger. 

19.  Wednesday. 

Operations  at  University  College,  2  p.m. ;  St.  Mary’s,  11  p.m. ;  Middlesex, 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew’s,  lj  p.m.  ;  Great  Northern, 

2  p.m. ;  Samaritan,  2J  p.m. ;  Royal  London  Ophthalmic,  11  a.m. ; 
Royal  Westminster  Ophthalmic,  ljj  p.m. ;  St.  Thomas’s,  l£  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m. ;  National  Orthopaedic,  Great 
Portland-street.  10  a.m. 


20.  Thursday. 

Operations  at  St.  George’s,  1  p.m. ;  Central  London  Ophthalmic,  1  p.m. ; 
Royal  Orthopaedic,  2  p.m.;  University  College,  2  p.m.;  Royal  London 
Ophthalmic,  11  a.m. ;  Royal  Westminster  Ophthalmic,  14  p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m. ;  Hospital  for  Women,  2  p.m. ; 
Charing-cross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  24  p.m. 

21.  Friday. 

Operations  at  Central  LondonOphthaimic,  2  p.m.;  Royal  London  Ophthal¬ 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminster 
Ophthalmic,  p.m. ;  St.  George’s  (ophthalmic  operations),  If  r.m.; 
Guy’s,  14  p.m. ;  St.  Thomas’s  (ophthalmic  operations),  2  p.m.;  King’s 
College  (by  Mr. Lister),  2  p.m. 


Cities 

and 

Boroughs. 

Estimated  Population  to 
middle  of  the  year  1883. 

1  Births  Registered  during 
!  the  week  ending  Dec.  8. 

I  Deaths  Registered  during 

1  the  week  ending  Dec.  8. 

Annual  Rate  of 
Mortality  per  1000  living, 
from  all  causes. 

Temperature 
of  Air(Fahr.) 

| 

Temp, 
of  Air 
(Cent.) 

Rain 

Fall. 

Highest  during 
the  Week. 

Lowestduring 
the  Week. 

|  Weekly  Mean  of 
|  DailyMeanVaiues 

Weekly  Mean  of 
Daily  Mean 
Values. 

In  Inches. 

In  Centimetres. 

London  . 

3955814 

2346 

1628 

21'5 

45'7 

28'4 

37'8 

3'23 

005 

0'13 

Brighton  . 

111262 

54 

44 

20'6 

52'0 

26'8 

37 '7 

317 

0'34 

0'S6 

Portsmouth 

131478 

88 

42 

16'7 

... 

... 

... 

... 

... 

Norwich  . 

89612 

53 

36 

20'4 

... 

... 

... 

... 

Plymouth  . 

74977 

41 

31 

21'6 

53'9 

28 '0 

41'0 

5'00 

O' 12 

O'SO 

Bristol . 

212779 

130 

SO 

19'6 

53'0 

26'4 

37'7 

3'17 

0  01 

0'C3 

Wolverhampton  . 

77557 

64 

38 

25'6 

51'9 

23'3 

351 

1'73 

0-23 

0'58 

Birmingham 

414846 

269 

173 

21'8 

... 

Leicester  ...  ... 

129483 

90 

53 

21'4 

51'0 

29'2 

36'9 

2'72 

O'  24 

0'61 

Nottingham 

199349 

164 

77 

20'2 

51'8 

28  "2 

37'6 

312 

012 

0'30 

Derby . 

85574 

63 

34 

20'7 

... 

... 

... 

... 

'  ... 

... 

Birkenhead 

88700 

61 

45 

26'5 

... 

... 

Liverpool  . 

566763 

357 

256 

23'6 

49'8 

30'5 

39'7 

4'28 

O' 60 

O'OO 

Bolton . 

107862 

72 

51 

24'7 

490 

25' 2 

36'4 

2'44 

0'86 

218 

Manchester 

339252 

229 

170 

26'1 

... 

... 

... 

... 

... 

Salford  . 

190465 

112 

63 

17'3 

.  .  . 

... 

... 

... 

... 

Oldham  . 

119071 

91 

32 

14  0 

... 

... 

... 

... 

... 

Blackburn . 

108460 

63 

35 

16'8 

... 

... 

... 

... 

... 

... 

Preston  . 

98564 

50 

62 

32 '8 

.  .  . 

... 

... 

... 

... 

Huddersfield 

84701 

66 

39 

240 

... 

... 

... 

... 

... 

... 

Halifax  . 

75591 

35 

38 

26'2 

... 

... 

... 

... 

Bradford  . 

204807 

91 

65 

16'6 

50'0 

29'0 

38'7 

3 '72 

001 

O' 03 

Leeds  . 

321611 

198 

151 

24'5 

50  0 

30'0 

39'5 

4'17 

0'10 

0'25 

Sheffield  . 

295497 

210 

112 

19'8 

51  0 

31'5 

38'6 

3'67 

0T0 

O' 25 

Hull  . 

176296 

126 

68 

20'1 

48'0 

29'0 

36'7 

2 '61 

0'40 

l'C2 

Sunderland 

121117 

89 

50 

2P5 

.  .  . 

..» 

... 

... 

... 

Newcastle  . 

149464 

85 

67 

23'4 

... 

... 

... 

•  •• 

... 

•  .c 

Cardiff . 

90033 

78 

29 

16'8 

... 

... 

... 

... 

... 

... 

For  28  towns ... 

8620975 

5365 

3568 

21'6 

63'9 

23'3 

380 

*  3'33 

0'20 

0'51 

Edinburgh . 

235946  120 

81 

17'9 

46'7 

28'8 

38 '3 

3'50 

O'OO 

O'OO 

Glasgow  . 

515589 

396 

232 

23'5 

53'2 

27'0 

39  7 

4'28 

0'C0 

O'CO 

Dublin . 

349^85 

185 

223 

33'3 

51'9i25'4 

37'4 

3'00 

0'24  0'61 

At  the  Royal  Observatory,  Greenwich,  the  mean  reading 
of  the  barometer  last  week  was  29’99  in. ;  the  lowest  reading 
was  29’42  in.  on  Monday  evening,  and  the  highest  30'38  in. 
on  Friday  evening. 


Medical  Times  and  Gazette. 


CLARK  OK  “  CATHETER  FEVER.” 


Dec.  22, 1883.  705 


SOME  OBSERVATIONS  ON 
“  CATHETER  FEVER.” 

By  SIR  ANDREW  CLARK,  Barb.,  M.D.,  E.R.C.P., 

Physician  to  the  London  Hospital ;  President  of  the  Clinical  Society. 


Somewhere  about  the  year  1850,  one  of  the  medical  officers 
of  Haslar  Hospital,  between  fifty  and  sixty  years  of  age, 
of  a  nervous  constitution,  but  apparently  in  robust  health, 
requested  me  to  examine  his  urine.  Accordingly  I  sub¬ 
mitted  it  to  as  careful  an  examination  as  I  was  then  com¬ 
petent  to  make,  and  all  that  I  could  find  out  against  it 
was  that  it  was  too  great  in  quantity,  too  low  in  density, 
and  too  pale  in  colour.  He  then  informed  me  that  he  had 
trouble  with  his  bladder,  that  he  meant  to  consult  Sir 
Benjamin  Brodie,  and  that  he  wished  me  to  accompany  him 
for  that  purpose  to  London.  Sir  Benjamin  examined  his 
patient,  drew  off  a  rather  large  quantity  of  urine  from  the 
bladder,  told  him  that  he  was  suffering  from  simple  enlarge¬ 
ment  of  the  prostate,  prescribed  the  regular  use  of  a  catheter, 
and,  with  a  few  general  cautions  against  a  careless  diet  and 
exposure  to  cold,  he  quickly  but  kindly  dismissed  us  both. 
We  returned  to  Haslar.  For  about  a  week  the  patient  was 
free  from  local  discomfort,  and  without  complaint  of  bis 
general  health.  Then  he  began  to  feel  and  to  look  ill.  He 
complained  of  malaise,  of  weakness,  of  general  pains.  He 
lost  his  appetite,  was  tormented  by  thirst,  had  nausea, 
became  feverish,  took  to  bed,  got  daily  worse,  and,  notwith¬ 
standing  the  efforts  of  his  colleagues,  who  could  not  agree 
as  to  the  nature  of  his  malady,  he  died  in  three  or  four 
weeks  from  the  beginning  of  his  illness.  Ho  post-mortem 
examination  was  made. 

The  case  here  so  imperfectly  narrated  made  upon  my  mind 
an  impression  which  has  never  been  effaced.  But  until  about 
the  year  1865  I  saw  no  other  exactly  resembling  it.  In  that 
year  I  was  summoned  by  Mr.  Peter  Marshall  to  visit  a 
gentleman  suffering  from  fever.  Certainly  he  was  in  what 
is  vaguely  called  the  typhoid  state.  Between  fifty  and 
sixty  years  of  age,  he  was  lying  on  his  back  in  bed,  appa¬ 
rently  in  a  state  of  great  prostration.  The  face  was  faintly 
yellowish  and  mottled,  the  lips  were  dry,  the  pupils  dilated, 
and  the  breath  foetid.  The  tongue  was  small,  brownish- red, 
dry,  and  tremulous.  There  was  complete  anorexia.  The 
bowels  were  imperfectly  relieved.  The  urine,  habitually 
removed  by  the  catheter,  was  low  in  density  and  acid,  de¬ 
posited  on  standing  a  little  muco-pus,  and  contained  a  small 
quantity  of  albumen.  The  heart’s  action  was  quick  and 
frequent,  the  pulse  small  and  compressible.  The  bases  of 
both  lungs  were  congested.  The  skin,  sub-icteric  and  for  the 
most  part  rough  and  dry,  was  here  and  there,  chiefly  about 
the  hands  and  feet,  bedewed  with  a  watery  sweat.  The 
acuteness  of  all  the  special  senses  was  blunted ;  and  the 
patient,  dull,  heavy,  and  indifferent,  could  yet  be  roused  to 
speak  and  to  answer  questions  put  to  him.  The  tempera¬ 
ture  of  the  body  at  the  time  of  examination  in  the  afternoon 
was  about  103°. 

The  story  of  this  case  resembled  the  story  of  the  first 
case  narrated.  The  patient,  supposed  to  be  healthy,  but 
suffering  from  an  affection  of  the  bladder,  was,  a  few  weeks 
before  my  visit,  placed  upon  the  daily  use  of  the  catheter, 
did  well  for  a  week,  then  became  ill,  and  fell  steadily  down¬ 
wards  into  his  present  condition. 

Neither  Mr.  Marshall  nor  I  ventured  to  form  a  definite 
opinion  of  the  nature  of  the  patient’s  malady  ;  but,  remem¬ 
bering  the  case  at  Haslar,  I  suggested  that  the  fever,  which 
we  agreed  was  not  a  specific  one,  had  originated  out  of  the 
conditions  begotten  by  the  entrance  upon  catheter-life.  I 
saw  the  patient  only  once.  The  remedies  proposed — food, 
alcohol,  quinine,  and  aperients — were  unavailing,  and  he 
died  within  a  week  of  our  consultation. 

Vol.  II.  1883.  No.  1747. 


With  great  difficulty,  permission  was  obtained  to  make  a 
post-mortem  examination;  and,  although  it  was  made  with 
both  care  and  interest,  nothing  definite  was  found  outside 
the  bladder,  and  nothing  in  it  sufficient  to  necessitate  or 
account  for  death.  The  prostate  was  much  enlarged.  The 
bladder  was  dilated  and  thickened ;  viewed  from  the  inside 
it  was  trabecular  and  very  slightly  saccular.  The  mucous 
lining  was  congested,  at  parts  eroded,  and  everywhere 
coated  with  a  greyish-white  stinking  mucus.  There  was 
nothing  to  be  detected  in  the  ureters  and  kidneys  ;  and 
neither  Mr.  Marshall  nor  I  could  say  anything  better  of  the 
cause  of  death  than  that  it  was  due  to  irritative  fever.  1 

The  study  of  this  case  gave  birth  to  the  opinion,  now  a 
firm  belief,  that  the  entrance  upon  catheter-life  occasionally 
gives  rise  to  a  pernicious  fever,  which  in  the  majority  of  in¬ 
stances  destroys  life  without  the  intervention  of  any  sensible 
structural  change  sufficient  to  account  for  death. 

Since  1866  every  year  has  added  to  my  experience  of  such 
cases,  and  for  over  ten  years  at  least  I  have  been  in  the  habit 
of  mentioning  them  to  surgeons  with  whom  I  have  had  the 
privilege  of  consulting.  From  Sir  James  Paget  and  from 
Sir  Henry  Thompson,  whom  I  have  often  met  in  cases  of  the 
kind,  I  have  received  at  various  times  much  important  in¬ 
formation.  But  as  I  have  received  from  neither  of  these 
distinguished  surgeons  explanations  completely  in  harmony 
with  my  own  experience  of  such  cases  as  the  one  j  ust  narrated, 
and  as  fresh  information  might  be  now  in  their  possession, 
or  in  the  possession  of  others,  I  ventured  upon  a  recent 
occasion  at  the  Clinical  Society  to  mention  the  subject  in 
the  way  that  it  occupied  my  thoughts,  and  to  invite  from 
my  surgical  contemporaries  their  latest  experiences  and 
conclusions  concerning  it. 

My  remarks  finding  a  place  in  the  medical  journals,  and 
being  by  them  widely  disseminated,  have  elicited  from  prac¬ 
tical  surgeons  a  variety  of  interesting  and  instructive  com¬ 
munications  concerning  the  nature  and  causes  of  the  fever 
which  occasionally  follows  casual  or  habitual  catheterisation. 
Nevertheless,  as  the  exact  scope  and  character  of  those 
remarks  has  been — doubtless  through  my  own  fault — mis¬ 
apprehended  :  and  as  the  subject  is  of  such  importance  as 
not  only  to  justify,  but  to  require,  that  statements  made 
respecting  it  should  be  clear  as  well  as  accurate  :  I  gladly 
comply  with  the  requests  conveyed  to  me  from  various 
quarters  to  reopen  the  subject. 

Now,  it  is  not  my  intention,  on  the  present  occasion,  to 
narrate  a  series  of  cases  and  build  thereon  a  dissertation  on 
Catheter  Fever.  I  have  not  at  my  command  the  materials 
necessary  for  such  an  undertaking ;  and  if  I  had,  devoid  as 
I  am  of  the  enlightenment  and  strength  which  flow  out  of 
the  surgical  instincts  begotten  of  long  surgical  experience, 
I  would  not  attempt  it.  I  have  seen  many  cases  of  catheter 
fever,  but  I  have  never  had  charge  of  one.  I  have  visited 
my  cases  only  occasionally  in  consultation  with  other  prac¬ 
titioners,  and  almost  always  my  colleagues  have  been  too 
busy  to  keep  and  furnish  me  with  minute  and  continuous 
records.  Indeed,  from  the  present  temper  of  the  public 
mind,  the  fear  which  patients  have  of  being  made  the  sub¬ 
jects  of  experiment,  and  the  demands  thoughtlessly  made 
upon  a  practitioner’s  time,  it  is  becoming  increasingly  diffi¬ 
cult  to  keep  careful  clinical  records  for  oneself ;  and  the 
public,  in  its  vicious  stupidity,  is  thus,  hindering  us  from 
beeping  it  so  well  as  we  might  otherwise  have  the  power 
to  do.  But  although  my  records  of  individual  cases  of 
Catheter  Fever  are  thus  necessarily  incomplete,  I  venture  to 
think  that,  both  by  study  of  their  silent  characteristics  and 
by  the  questioning  of  those  in  charge  of  the  cases,  I  have 
learned  enough  of  their  nature  and  importance  to  justify 
me  in  making  certain  propositions  and  in  asking  certain 
questions  concerning  this  Catheter  Fever. 

The  statements  which  I  propose  making  about  this  fever 
will  be  most  conveniently  embodied  in  a  series  of  proposi¬ 
tions.  But,  before  submitting  them  to  your  consideration 
and  criticism,  it  will  be  necessary,  in  order  to  obtain  a  clear 
and  comprehensive  understanding  of  their  underlying  sub¬ 
ject  to  discover  the  origin  and  follow  the  historical  deve¬ 
lopment  of  those  ideas  which  have  shaped  the  theories  of 
surgeons  and  determined  their  lines  of  practice,  (a) 

(a)  I  have  here  enumerated  only  those  writers  whose  observations  have 
visibly  influenced  the  current  of  theory  and  practice  prevailing  at  the 
time.  A  catena  of  authorities,  prepared  by  Dr.  DelOpine,  to  whose  care 
and  diligence  and  ability  I  owe  the  greater  part  of  my  references,  has  been 
hung  upon  the  wall  at  the  end  of  the  room. 


70G 


Medical  Times  and  Gazette. 


CLARK  OK  “  CATHETER  FEVER.’' 


Dec.  22,  1S83. 


In  1800  it  was  known,  but  not  distinctly  expressed,  that 
surgical  interference  with  the  urethra  and  bladder  was 
sometimes,  in  certain  circumstances,  followed  by  irritative 
fever.  It  was  not,  however,  until  lSlOthat  Moffait,  as  quoted 
by  Velpeau,  described  a  case  of  chronic  stricture  of  the 
urethra  in  which  simple  catheterisation  was  followed  by 
rigors,  irregular  fever,  purulent  arthritis,  and  death. 

In  1832,  ideas  concerning  the  causal  relationship  of  cathe- 
terisrn  to  consecutive  fever  found  form  and  expression  in 
the  writings  and  teachings  of  Brodie,  of  Velpeau,  and  of 
Civiale. 

Brodie  distinctly  and  even  emphatically  mentions  the 
dangers  of  catheterism,  and  describes,  as  occasionally  occur¬ 
ring  in  consequence  of  it,  paroxysms  of  irregular  fever  like 
ague,  leading  sometimes  to  prolonged  debility,  sometimes 
to  a  continued  fever  with  rheumatic  pains,  and  sometimes 
even  to  mania.  He  further  says  that  in  such  cases  death 
may  follow,  but  he  cites  no  case  of  its  actual  occurrence. 

Velpeau  enters  more  minutely  into  the  nature  and  rela¬ 
tions  of  the  fever,  and  contributes  several  new  ideas  to  the 
development  of  the  subject.  He  alleges  that  in  some 
persons  perfectly  healthy,  not  malarious,  and  not  exposed  to 
its  influences,  even  easy  catheterism  may  develope  a  con¬ 
secutive  and  continuous  fever,  and  that  this  fever  has  five 
varieties.  In  the  first  it  consists  of  a  single  paroxysm  oj 
fever,  ending  in  malaise  and  debility,  with  recovery  in  a  few 
days.  The  second  consists  of  recurring  paroxysms,  issuing 
in  continued  fever,  and  often  fatal.  The  third  consists  of 
inflammatory  fever  arising  out  of  nephritis,  phlebitis,  or 
other  local  inflammation.  The  fourth  consists  of  fever 
associated  with  purulent  arthritis.  The  fifth  consists  of  a 
rapid  succession  of  violent  paroxysms  of  fever,  speedily  end¬ 
ing  in  collapse  and  death.  Velpeau  then  points  out  that  in 
the  second  and  fifth  varieties  he  has  never  found  present  at 
the  autopsy  any  adequate  structural  cause  of  death  ;  and  in 
these  cases  he  is  disposed  to  regard  the  origin  of  the  fever 
as  caused  by  the  reabsorption  of  vitiated  urinary  secretions 
or  by  some  fault  in  the  elimination  of  the  urinary  con- 
stituents.(b)  But  on  this  and  on  similar  points  of  patho¬ 
genesis  he  i§  hoth  obscure  and  vague. 

Civiale,  who'se  great  work  is  disfigured  by  passionate 
claims  of  priority  in  this  matter  (of  which  claims  no  proof 
is  given),  and  by  the  satirical  invectives  which  he  launches 
against  the  jiister  and  greater  Velpeau,  gives  a  full  and 
admirable  description  of  this  Catheter  Fever.  But  whilst 
admitting  that  the  fever  is  due  sometimes  to  the  urethra 
and  sometimes  to  the  bladder,  and  asserting  that  the  fever 
of  the  one  differs  essentially  from  the  fever  of  the  other,  he 
almost  angrily  minimises  the  effects  of  surgical  interference, 
and,  it  would  seem,  with  a  judgment  disturbed  by  emotion, 
contends  that  in  most  cases  the  fever  has  existed  before  the 
use  of  the  catheter,  or  that  it  is  due  to  a  nephritis.  But  in 
a  later  part  of  the  work,  marked  by  greater  sobriety  of 
language  and  a  more  judicial  tone  of  argument  (page  612 
of  the  .1860  edition),  he  distinctly  qualifies  these  strong 
assertions,  and  says  that  the  cause  of  the  fever  is  vague  and 
uncertain,  and  that  in  speaking  of  its  nature  one  can  only 
guess. 

In  1858,  M.  Phillips  contributed  some  fresh  ideas  concern¬ 
ing  the  condition  under  which  this  fever  is  developed. 
Describing  the  fever,  and  in  the  main  following  the  classi¬ 
fication  proposed  by  Velpeau,  the  source  whence  almost  all 
subsequent  writers  have  derived  their  inspiration  and 
sometimes  their  ideas,  he  asserts,  first,  that  the  simplest  as 
well  as  the  severest  catheterism,  with  the  largest  or  the 
smallest  instrument,  may  originate  the  fever ;  second,  that 
unless  the  affection  of  the  urinary  passages  lies  behind  the 
bulb  the  fever  does  not  folloiv  ;  and  third,  that  the  predis¬ 
position  to  the  fever  does  not  lie  in  the  state  of  the  nervous 
system,  but  in  the  existence  of  certain  diatheses,  and  in 
chronic  disorders  of  the  general  health. 

In  1859,  Marx,  in  a  monograph  of  remarkable  merit,  re¬ 
views  the  state  of  the  question,  and  contributes  to  its 
elucidation  and  development  certain  important  facts  and 
ideas  expressed  with  clearness  and  used  with  judicial  ability. 
He  adopts  fa  classification  of  the  varieties  of  Catheter 
Fever  similar  to  that  given  by  Velpeau,  recognises  uncompli¬ 
cated  cases  issuing  in  death  without  any  discernible  struc¬ 
tural  lesion  outside  the  bladder,  asserts  that  it  may  occur  in 
persons  in  perfect  health,  and  that  in  them  and  in  others 

(b)  Dr.  Matthews  Duncan  tells  me  that  his  mind  was  seriously 
impressed  with  the  importance  of  this  subject  by  Velpeau’s  lectures. 


not  healthy  if)* may.  follow  upon  any  state  of  the  urinary 
organs  requiring^  the  passage  of  a  catheter.  Finally,  he  de¬ 
clares  the  fever)'  to  be  positively  uraemic,  and  ascribes  its 
origin  to  insufficiency  of  the  kidneys  arising  out  of  functional 
or  structural  disease. 

In  this  work,  perhaps  for  the  first  time,  the  causal  relation¬ 
ship  of  Catheterism  to  Catheter  Fever  is  most  clearly  and 
comprehensively  set  forth,  and  a  logical,  coherent,  and 
ingenious,  if  not  accurate,  theory  of  the  genesis  of  the  fever 
is  propounded. 

In  1867  the  practical  aspects  of  this  subject  were  very 
greatly  advanced  by  the  publication  of  the  now  classical 
work  of  Sir  Henry  Thompson  on  the  Hrinary  Organs.  In 
this  work,  characterised  by  care,  experience,  strength, 
method,  clearness,  and  precision,  he  mentions  the  perils  of 
catheterism,  gives  instructions  for  averting  them,  notices 
the  occurrence  in  a  few  exceptional  cases  of  a  low  irritative 
fever,  and  quotes  Sir  Benjamin  Brodie  to  show  that  in  a 
few  weeks  it  might  terminate  in  death.  Furthermore,  he 
says— and  herein  he  differs  from  every  one  of  his  predecessors 
in  this  line  of  inquiry— that  in  all  such  cases  there  will  be 
found  old-standing  pyelitis  with  dilatation  and  marked  de¬ 
generation  of  the  renal  structures,  and  that  in  no  circum¬ 
stances  could  such  patients  long  survive. 

Looking  at  the  unrivalled  experience  of  this  distinguished 
surgeon,  and  remembering  how  often  I  have  consulted  with 
him  about  cases  such  as  I  am  now  considering,  I  confess  to 
a  feeling  of  disappointment  that  he  has  not  made  time  to 
give  to  the  profession  a  more  serious  and  adequate  account 
of  this  important  question. 

In  1867  also  your  President,  Sir  Joseph  Fayrer,  gave  an 
admirable  account  of  the  varieties  of  Catheter  Fever,  and 
declared  that  in  India  at  least  the  predisposition  lay  either  in 
the  malarious  state  or  in  advanced  disease  of  the  kidneys,  that 
it  began  in  reflex  disorder  of  the  nervous  system,  that  it  was 
not  in  the  ordinary  sense  toxsemic,  that  it  might  destroy 
life  without  the  production  of  visible  structural  change  out¬ 
side  the  urethra  or  bladder,  and  that  catheterism  alone, 
without  injury  or  even  irritation,  was  sufficient  to  set  in 
movement  the  febrile  phenomena. 

In  1868,  Sir  James  Paget  took  notice  of  this  fever,  and 
made  some  very  important  additions  to  our  knowledge  of 
the  conditions  out  of  which  it  is  developed.  He  says  that 
when  the  urine  is  of  low  density  and  abundant,  when  the 
patient  is  gouty,  dyspeptic,  or  otherwise  chronically  dis¬ 
ordered,  when  having  a  stricture  it  becomes  irritable  and 
weakens  the  health,  or  when  being  old  something  has 
happened  to  cause  depression,  catheterism  will  be  dangerous 
and  may  originate  a  fever  ending  in  death.  He  leans  to  the 
opinion  that  renal  degeneration  is  the  cause  of  the  fever,  but 
admits  that  often  the  apparent  cause  is  inadequate.  We 
have  here  mentioned  for  the  first  time,  as  I  think,  in  a 
clear  and  impressive  manner  the  important  fact  also  set 
forth  by  myself,  that  a  low  density  of  urine  (without,  in  my 
opinion,  adequate  increase  of  quantity)  indicates  the  exist¬ 
ence  of  conditions  which  render  surgical  interference  of 
every  kind  and  degree  more  perilous  to  life.  Finally,  this 
distinguished  surgeon  estimates  the  mortality  in  such 
cases  at  from  3  to  4  per  cent.,  and  notices  that  the  conse¬ 
quences  of  death  are  sometimes  aggravated  by  its  unexpected 
occurrence. 

In  1871,  Banks,  of  Liverpool,  described  the  effects  of 
catheterism  under  the  title  of  urethral  fever,  of  which  he 
made  three  varieties.  The  first  consists  of  rigor,  malaise, 
and  speedy  restoration  to  health.  The  second,  of  rigor, 
malaise,  prostration,  followed  in  a  few  days  by  death.  The 
third,  of  rigor  with  shock,  destroying  the  patient  in  the 
course  of  a  single  day.  Admitting  that  renal  disease  pre¬ 
disposes  to  such  attacks,  he  denies  that  they  are  due  to  sup¬ 
pression  of  urine,  and  he  ascribes  them  to  shocks  of  greater 
or  of  less  severity  propagated  through  the  nervous  system . 

In  1873,  Malherbe,  in  his  work  on  the  Fever  of  Diseases  of 
the  Hrinary  Passages,  presents  a  fairly  just  compendium  of 
the  knowledge  of  the  subject  current  at  the  time  of  publica¬ 
tion,  adds  certain  important  cases  of  his  own,  illustrates 
them  by  a  number  of  instructive  temperature-charts,  avert 
that  the  fever  may  arise  without  local  irritation,  describes  is 
as  ursemic,  alleges  that  the  predisposition  to  it  is  renal, 
and,  whilst  admitting  that  in  some  cases  no  structural  lesions 
are  found  after  death,  he  holds  to  the  hypothesis  that  the 
origin  of  the  fever  is  in  some  sort  of  renal  imperfection. 

In  1877,  Mr.  Marcus  Beck  contributed  to  the  further 


Medical  Times  and  Gazette. 


DONKIN  ON  NERVE- STRETCHING  FOR  SCIATICA. 


Dec.  22, 1883.  70  7 


renal  disease.  The  duration  of  fully  developed  Catheter 
Fever  is  at  once  longer  and  shorter  than  that  of  urtemia  : 
longer  than  that  of  acute  uraemia,  and  wanting  its  head¬ 
ache,  its  lesions  of  sensation,  its  changes  in  the  urine,  its 
convulsions,  and  its  speedy  and  complete  coma  :  shorter 
than  that  of  chronic  uraemia,  and  wanting  its  characteristic 
breath,  its  vomitings,  its  attacks  of  dyspnoea  and  palpita¬ 
tion,  its  recurring  headaches,  its  defects  of  sight,  its  neural¬ 
gic  and  rheumatic  pains,  its  painful  nervousness,  its  fleeting 
paralyses,  its  itching  skin,  and  its  low  temperatures ;  some¬ 
times  unaffected  even  by  intercurrent  inflammations.  Fur¬ 
thermore,  the  urine  of  this  variety  of  Catheter  Fever  is 
always  loaded  with  micro-organisms  of  various  forms,  and 
although  its  percentage  of  urea  may  be  lowered,  and 
although  it  may  contain  albumen  in  greater  quantity  than 
can  be  accounted  for  by  the  presence  of  pus,  it  does  not 
necessarily  deposit  tube-casts,  and  it  is  capable  of  complete, 
or  of  almost  complete,  restoration  to  its  normal  state.  Again, 
whilst  chronic  uraemia  invariably  issues  in  death.  Catheter 
Fever  sometimes  issues  in  complete  restoration  to  health. (d) 

Lastly,  if  a  low  density  of  urine  signifies  not  merely  renal 
inadequacy,  which  may  remain  for  an  indefinite  time  com¬ 
patible  with  good  health,  but  also  the  existence  of  a  real 
interstitial  nephritis,  how  comes  it  about  that  patients  re¬ 
covering  from  this  fever  may  remain  well  for  years  ?  and 
why  is  it  that,  when  catheter-life  has  been  entered  and 
satisfactorily  established,  the  peril  of  Catheter  Fever  has 
almost  completely  disappeared  ? 

Such,  then,  are  the  main  conclusions  which  I  have  drawn 
from  my  interrupted  and  fragmentary  studies  of  Catheter 
Fever.  I  know  that  they  are  incomplete,  and  I  fear  that 
they  may  be  inaccurate.  But  however  this  may  be,  I  sub¬ 
mit  them  to  your  consideration,  and  I  console  myself  for  my 
deficiencies  with  the  reflection  that  they  may  call  forth  the 
ripened  experience  of  practical  surgeons,  who  in  this 
matter,  furnished  with  surer  instincts  and  a  more  practised 
judgment,  may  be  able  not  only  to  correct  me  where  I  am  in 
error,  and  to  confirm  me  where  I  have  caught  the  truth,  but 
also  to  supply  us  with  that  fuller  knowledge  which  now  we 
need  and  seek. 


NERVE  -  STRETCHING  FOR 

By  H.  B.  DONKIN,  M.B., 

Physician  to  Westminster 

The  three  cases  subjoined  may  be  of  present  interest,  as 
showing  the  probable  good  results  of  the  modern  treatment 
by  nerve-stretching  in  this  obstinate  malady. 

Case  1. — M.  K.,  a  laundress,  aged  forty-four ;  constantly 
standing  on  wet  floors.  For  five  months  before  admission 
under  my  care  at  Westminster  Hospital  on  June  27,  1883, 
she  had  suffered  from  severe  pain  in  lower  part  of  back, 
right  hip,  and  down  the  right  leg  as  far  as  the  toes.  The 
pain  had  been  constant,  but  worse  at  intervals.  She  was 
treated  for  a  month  with  many  remedies— purgatives,  nar¬ 
cotics,  blistering,  guaiacum,  iodide  of  potassium,  colchicum, 
alkalies,  and  many  other  drugs,  and  numerous  liniments — 
with  no  relief  whatever,  except  when  under  the  full  influ¬ 
ence  of  morphia.  On  July  27  my  colleague,  Mr.  Macnamara, 
at  my  request,  cut  down  on  the  sciatic  nerve,  making  an 
incision  over  four  inches  long,  beginning  at  the  lower  border 
of  the  gluteus  maximus.  The  nerve  was  lifted  up  from  its 
bed,  and  vigorously  pulled  by  Mr.  Macnamara,  myself, 
and  others,  several  times.  The  wound  rapidly  healed  by 
first  intention,  the  temperature  never  rising  to  100h  and, 
with  the  exception  of  a  little  pain  over  the  wound  itself, 
the  patient  made  no  complaint,  going  out  well  at  the  end  of 
August.  Since  that  time  she  has  been  ascertained  to  have 
been  quite  free  from  pain,  and  is  so  now. 

Case  2.— A.  Y.,  also  a  laundress,  aged  forty  seven,  came 
under  my  care  on  July  18,  suffering  from  well-marked  scia¬ 
tica  on  the  left  side,  of  six  months’  duration.  The  pain  in 
this  instance  was  first  noticed  in  the  region  of  the  ankle,  and 
spread  upwards.  This  patient  suffered  as  continuously  as 
Case  1,  though  the  pain  was  perhaps  not  quite  so  severe. 


elucidation  of  this  subject  two  important  papers  bearing 
the  marks  of  practical  knowledge,  accuracy  of  observation, 
and  careful  thought.  Describing  the  fever  in  which  death 
may  occur  in  from  nine  to  forty- eight  hours,  he  holds  that 
the  predisposition  to  it  lies  in  chronic  disorders  of  the 
health,  renal  imperfections,  and  age ;  that  the  exciting 
cause  is  probably  mechanical  irritation  of  the  cerebro¬ 
spinal  and  sympathetic  system  reflected  upon  the  kidney, 
and  bringing  about  structural  or  other  insufficiency  thereof. 
Beck  gives  no  description  of  the  more  prolonged  forms  of 
fever,  but  holds  apparently  to  the  uraemic  origin  of  all  of 
them. 

It  will  be  seen  from  this  rough  historical  retrospect 
that  catheterism  is  occasionally  followed  by  a  fever  which 
has  received  the  names  of  urethral  fever,  urethro-vesical 
fever,  urinary  fever,  catheter  fever,  uraemic  fever,  and  the 
like ;  that  in  some  cases  this  fever  is  dependent  upon  or 
associated  with  “  purulent  arthritis,”  ordinary  pyaemia, 
surgical  kidney,  or  interstitial  nephritis  ;  and  that  on  a 
small  but  notable  percentage  of  cases  no  adequate  struc¬ 
tural  cause  of  death  can  be  found.  Now,  it  was  of  this 
last  variety  of  Catheter  Fever  that  I  spoke  at  the  Clinical 
Society,  and  it  was  of  this  variety  that  I  made,  or  meant 
to  make,  the  following  propositions  : — 

1.  That  about  middle  life,  in  men  apparently  healthy  or 
with  no  discoverable  evidence  of  disease  except  a  low 
density  of  urine,  the  commencement  of  habitual  catheterism 
is  sometimes  followed  by  a  form  of  remittent  fever  which 
often  ends  in  death ;  and  that  for  the  fatal  issue  of  most 
cases  belonging  to  this  variety  of  Catheter  Fever  no  ade¬ 
quate  structural  explanation  can  be  found. 

2.  That  although  it  is  well  known  that  in  persons  affected 
with  renal  disease  or  with  chronic  gout  or  with  general 
textural  degenerations  the  beginning  of  catheter-life  is  from 
the  possible  occurrence  of  secondary  fever  attended  with 
serious  peril  to  life,  the  fact  that  this  fever  may  arise  in 
seemingly  good  health  and,  without  the  mediation  of  any 
visible  structural  lesion,  issue  in  death  is  not  well  known, 
and  has,  as  respects  England,  no  adequate  place  in  the 
surgical  treatment  or  in  the  surgical  teaching  of  the  time. (c) 

3.  That  this  fever  is  neither  distinctly  ursemic  nor  dis¬ 
tinctly  pysemic ;  that,  although  having  some  of  the  characters 
of  each,  it  has  the  essential  characters  of  neither;  that 
probably  it  begins  by  a  reflex  disturbance  of  the  nervous 
system,  affecting  in  the  first  instance  the  general  metabolism, 
and  in  the  second  the  secretory  organs,  beginning  with  the 
kidneys  ;  that  the  effects  upon  the  kidneys  consist  either  in 
such  structural  alterations  as  are  undiseernible  by  any 
known  instruments  of  research,  or,  as  is  much  more  pro¬ 
bable,  in  dynamic  alterations  of  the  condition  of  blood  sup¬ 
plied  to  the  kidneys  and  essential  to  the  elaborative  action 
of  its  secretory  cells ;  and  that  the  effects  of  nervous 
disturbance  are  speedily  reinforced  by  septic  absorption. 

4.  That  there  are  great  grounds  for  believing  that  a  more 
complete  knowledge  of  this  fever,  of  the  conditions  of  its 
origin,  maintenance,  increase,  and  issues,  might  lead  to 
some  material  diminution  of  its  mortality;  and  that  even 
now,  by  treating  as  a  serious  matter  the  entrance  upon 
catheter- life,  by  enforcing  the  precautions  set  forth  by 
Thompson,  by  care  in  the  use  of  food  and  stimulants,  by 
quiet  and  warmth,  by  diaphoretics  and  laxatives,  by  the  free 
admission  of  opium,  and  perhaps  by  the  cautious  use  of 
antiseptic  injections  as  employed  by  Lister  and  Harrison, 
lives  might  be  saved  which  without  such  precautions  are 
lost. 

Of  these  propositions,  the  one  most  open  to  attack,  and 
sure  to  be  assailed,  is  the  third,  wherein  it  is  asserted  that 
this  form  of  Catheter  Fever  is  not  distinctly  and  exclusively 
ursemic  ;  for  it  has  come  to  pass  that  the  ursemic  theory  first 
advanced,  although  imperfectly,  by  Velpeau  and  Civiale,  and 
clearly  enunciated  by  Marx  and  Malherbe,  is  now  accepted 
and  taught,  with  one  distinguished  exception  in  Mr.  Savory, 
by  almost  every  writer  and  teacher  of  the  present  time.  I 
ground  my  main  opposition  to  the  exclusively  ursemic  theory 
of  this  variety  of  Catheter  Fever  upon  the  fact  that  its  phe¬ 
nomena  in  their  appearance,  assemblage,  progression,  and 
issues  are  different  from  those  of  the  uraemia  of  recognised 


(e)  Of  course  this  adequate  knowledge  may  be  found  in  snecial  mono¬ 
graphs  and  papers,  but  these  are  the  luxury  of  the  few,  and  familiar  for 
the  most  part  only  to  specialists.  But  such  knowledge  should  be  fully 
and  clearly  imported  into  our  common  text-books,  that  so  it  may  become 
accessible  and  useful  to  the  whole  body  of  the  profession. 


(d)  Quite  recently  I  attended,  with  my  friend  Mr.  Ransford,  a  case  of 
Catheter  Fever  which  was  also  seen  by  Sir  William  Gull,  Sir  James  Paget, 
Sir  Henry  Thompson,  and  Mr.  Marshall,  and  which  ended  in  complete 
recovery. 


708 


Medical  Times  and  Gazette. 


WILKES’S  CASES  IK  SURGERY. 


Dec.  22,  1883. 


She  was  treated  in  a  similar  manner  at  first,  but  no  relief 
was  obtained.  On  October  3,  Mr.  Macnamara  operated  by- 
incision,  as  in  the  former  case,  and  the  nerve  was  repeatedly 
and  vigorously  stretched.  In  this  case  there  was  suppura¬ 
tion,  and  the  temperature,  at  first  rising  to  103‘8°,  did  not 
reach  the  normal  till  October  25.  Pain  in  the  wound  was 
complained  of  after  the  operation,  but  none  along  the  course 
of  the  nerve.  Three  or  four  days  after  the  operation,  pain 
began  at  the  back  of  the  leg  and  in  the  ankle-joint.  This 
was  apparently  relieved  by  the  application  of  belladonna, 
but  returned,  till  on  October  23  the  wound  burst  open  and 
discharged  two  ounces  of  pus.  Healing  then  gradually  pro¬ 
gressed,  and  no  pain  was  complained  of  except  in  the 
neighbourhood  of  the  ankle-joint.  On  November  24  the 
patient  was  strong  enough  to  walk  about,  and  quite  free 
from  pain;  and  she  left  the  hospital  on  December  1,  perfectly 
well,  remaining  so  up  till  the  present  time.  Prom  the  day 
of  operation  she  had  no  pain  over  the  course  of  the  sciatic 
nerve.  ( 

Case  3. — This  case  was  under  the  care  entirely  of  my 
colleague,  Mr.  Richard  Davy,  who  kindly  permits  me  to 
publish  it  with  mine.  Charles  C.,  a  labourer,  aged  forty- 
one,  much  exposed  to  cold  and  wet,  was  admitted  on 
January  27,  1883,  suffering  from  sciatica  of  three  weeks’ 
duration.  He  had  had  one  previous  attack  lasting  a  few 
days  in  the  summer  of  1882,  which  got  well  without  treat¬ 
ment.  Three  days  after  admission,  Mr.  Davy  performed  a 
similar  operation  to  those  recorded  above,  though  in  this 
case  the  nerve  was  continuously  kept  on  the  stretch  for  two 
or  three  minutes.  For  four  nights  the  patient  complained 
of  much  pain  in  the  wound.  On  February  2  the  sutures 
were  removed,  and  a  large  quantity  of  pus  escaped.  The 
discharge  continued  free  for  some  days.  The  patient  left 
the  hospital  on  February  24,  with  the  wound  healed,  and 
quite  free  from  pain.  He  has  had  no  return  up  to  the 
present  time. 

The  prompt  recourse  to  the  treatment  by  stretching  in 
Case  3  gives  it  perhaps  less  comparative  value  as  illustrat¬ 
ing  the  probable  beneficial  effect  of  this  operation  in  sciatica. 
But  whether  the  explanation  given  by  Prof.  Marshall  in  his 
recent  Bradshawe  Lecture  ,of  the  modus  operandi  of  this 
remedy  be  true  or  not,  or  whatever  the  explanation  may  be, 
it  must  be  admitted  that  the  three  cases  here  recorded  hell) 
to  corroborate  the  belief  that  something  is  to  be  hoped  from 
nerve-stretching  in  sciatica,  and  that  the  operation  need 
not  be  dreaded. 


CASES  IK  SURGERY. 

By  W.  D.  WILKES,  M.E.C.S., 

Surgeon  to  the  Salisbury  Infirmary. 


Case  1. —  Congenital  Malformation — Urethra  opening  into 

Vagina. 

A  private  patient  lately  died  in  her  ninetieth  year ;  she 
had  been  a  widow  forty-two  years,  and  had  never  borne  a 
child. 

Of  late  years  I  ascertained  that  she  had  frequently  diffi¬ 
culty  in  passing  urine.  With  this  exception,  and  an  acci¬ 
dent  in  1880  (broken  ribs  and  contusions  of  face  and  neck), 
she  had  always  been  well.  In  October,  1881,  I  was  con¬ 
sulted  for  cystitis  and  retention  of  urine.  On  examination 
I  found  a  congenital  absence  of  the  orifice  of  the  urethra 
in  front  at  its  usual  place,  and  only  a  very  contracted 
orifice  of  the  vagina,  barely  admitting  a  probe,  through 
which  the  urine  could  pass  at  all. 

Under  chloroform  I  enlarged  this  opening,  and  afterwards 
small  phosphatic  calculi  began  to  pass  at  intervals,  formed 
in  the  bladder,  forced  by  it  into  the  vagina,  and  escaping  from 
it  with  the  urine.  The  calculi  generally  required  removal, 
and  at  times  quite  stopped  the  orifice,  and  had  to  be  broken 
up  before  extraction.  The  urine  always  contained  blood, 
often  in  clots,  and  much  muco- purulent  matter.  No  probing 
of  the  vagina  could  detect  the  opening  of  the  urethra  into 
its  roof,  and  the  bladder  could  not  be  sounded.  Neither 
sponge-tents  nor  drainage-tube  could  be  borne  in  the  vagina, 
and  there  was  a  refusal  to  submit  to  any  kind  of  operation, 
such  as  an  exploratory  lithotomy,  or  introduction  of  a 
drainage-tube  from  the  front,  for  the  cystitis  and  more  easy 
escape  of  urine.  Her  sufferings  when  wanting  to  empty  the 


bladder  were  very  great — every  hour  or  so  during  the  night, 
but  less  often  in  the  daytime.  She  also  refused  all  medicines, 
and  sedatives  had  to  be  given  unknown  to  her. 

I  was  allowed  after  her  death  to  make  a  local  examination. 
The  bladder,  thickened,  contracted,  and  very  vascular,  con¬ 
tained  fragments  of  phosphatic  calculi,  blood-stained  and 
mixed  with  muco-pus.  A  probe  could  be  passed  from  the 
base  of  the  bladder  into  the  vagina,  and  outwards  through 
its  orifice,  showing  a  congenital  vesico- vaginal  urethra.  This 
opened  into  the  upper  wall  of  the  vagina  about  one  inch  and 
a  half  from  its  orifice.  The  uterus  was  atrophied,  and  had 
a  globular  deposit  of  bone  at  the  side  of  its  anterior  wall. 
Two  or  three  similar  deposits  were  forming  at  the  fundus. 
The  vagina  was  much  dilated,  forming  as  it  were  a  second 
bladder ;  its  orifice  was  much  contracted,  and  had  become 
an  organic  stricture,  similar  to  that  in  a  male  urethra. 

I  have  never  been  able  to  meet  with  a  description  of  such 
malformation.  I  suppose  that  until  the  vaginal  orifice  con¬ 
tracted  no  suspicion  of  it  existed,  as  there  had  never  pre¬ 
viously  been  any  examination  of  the  parts.  I  hardly  know 
what  surgery  could  have  done.  It  is  doubtful  whether  it 
would  have  been  possible  to  close  what  was  the  natural 
urethra,  and  establish  an  artificial  one  in  its  usual  place.  The 
bone  pipe  of  an  ounce  ball-syringe  was  passed  daily  or  oftener, 
and  the  vagina  syringed  out.  This  kept  the  orifice  from 
further  contraction,  and  favoured  the  escape  of  the  calculi. 
Had  the  patient  allowed  one,  the  best  treatment  would 
have  been  a  free  dilatation  of  the  orifice  to  admit  the  finger, 
when  the  situation  of  the  urethra  might  have  been  detected, 
and  the  opinion  formed  during  her  life  confirmed;  whilst 
the  urine  would  have  had  an  easy  escape,  and  much  suffering 
been  relieved. 

Case  2. — Fracture  of  Inner  Condyle  of  Femur  and  Vertical 
Dislocation  of  Patella. 

On  October  30,  1882,  an  old  gentleman,  who  said  he  was 
eighty-one,  was  brought  into  the  Salisbury  Infirmary  with 
the  following  accident : — He  fell  off  the  platform  of  the 
Porton  station  of  the  South-Western  Railway,  mistaking 
his  way  in  the  evening. 

There  was  a  bruise  on  the  outer  side  of  the  front  of  the 
right  knee.  The  knee-cap  stuck  out  vertically,  with  its 
anterior  surface  facing  outwards,  and  wedged  tightly  into 
the  interval  of  the  condyles  of  the  femur.  The  outline 
of  the  limb  was  in -kneed,  whilst  the  other  was  straight  and 
well  grown. 

When  he  was  put  under  ether,  I  found  that  the  joint 
could  be  readily  flexed  from  its  partly  bent  position.  There 
was  a  fracture  at  the  lower  end  of  the  femur,  apparently 
through  the  condyles,  as  they  seemed  separated,  and  were 
probably  split  into  the  joint.  No  extension,  flexion,  abduction, 
or  adduction  influenced  the  position  of  the  knee-cap  ;  neither 
did  strong  pressure  on  the  cap  itself  have  any  influence.  So 
I  had  to  content  myself  with  extending  the  knee  to  the 
utmost,  placing  the  limb  on  a  McIntyre’s  splint,  and 
slinging  it  in  a  Salter’s  cradle. 

I  forgot  to  add  that  there  was  no  apparent  effusion  into 
the  joint.  After  a  week  or  so,  the  knee-cap,  of  its  own 
accord,  was  found  in  its  natural  position.  The  joint  did  not 
swell  much,  and  was  kept  covered  with  hot  spirit  lotion, 
which  was  very  grateful  to  the  patient.  He  did  not  have 
much  pain.  Pressure  on  the  knee-cap  gave  a  grating 
sensation,  as'if  that  bone  itself  was  fractured. 

In  about  a  month  the  limb  was  taken  out  of  the  McIntyre, 
and  put  up  in  a  straight  position  with  a  plaster-of -Paris 
bandage,  which  remained  on  for  three  or  four  weeks ;  then 
it  was  taken  off,  and  a  flannel  roller  applied.  The  outer 
condyle  seemed  prominent,  and  the  reason  will  be  explained 
presently. 

He  got  up  for  a  week  or  more,  and  then  a  sore  formed  on 
the  heel,  like  a  broken  chilblain,  ‘and  the  foot  and  leg 
swelled.  He  was  confined  to  bed  again  ;  sloughing  of  the 
heel  followed,  which  separated  after  poulticing,  and  he 
seemed  very  comfortable,  the  swelling  of  the  leg  subsiding. 
He  took  his  food  well,  and  on  the  evening  of  January  7, 
1883,  was  cheery.  During  the  night,  about  4  a.m.  of  the 
8th,  he  died  suddenly,  without  any  pain,  from  failure  of  the 
heart’s  action. 

An  examination  of  the  knee,  on  the  10th,  revealed  a 
healthy  joint,  with  the  internal  condyle  fractured  from  the 
femur  as  if  it  had  been  chopped  off,  from  the  front,  between 
the  condyles ;  fibrous  union  had  taken  place  with  the  shaft 


Medical  Times  and  Gazette.  . 


MEDICAL  AND  SURGICAL  PRACTICE. 


Dec.  22,  1883.  7  09 


of  the  bone,  and  it  was  displaced  about  one-sixth  of  an 
inch  from  the  front  of  the  femur,  giving  an  explanation  of 
the  prominence  of  the  external  condyle,  which  was  con¬ 
tinuous  with  the  shaft  of  the  bone.  The  patella  had  not  been 
fractured,  and  there  was  a  tendency  to  in-knee  from  the 
want  of  support  of  the  internal  lateral  ligament  attached  to 
the  fractured  condyle,  or  rather,  perhaps,  of  the  condyle 
itself. 

The  rare  occurrence  of  this  form  of  dislocation  of  the  knee¬ 
cap  has  induced  me  to  publish  this  case,  the  more  so  as  I  was 
enabled  to  make  a  post-mortem  examination.  It  may  have 
happened  in  this  manner  :  A  sudden  fall  on  a  hard  substance, 
with  a  bent  knee,  and  probably  way  on  the  body  at  the  time, 
may  cause  severe  contusion  only,  or  direct  fracture  of  the 
knee-cap  ;  but  if  this  bone  be  a  strong  one,  it  may  resist 
breaking,  and  communicate  the  impulse  to  the  inner  condyle 
of  the  femur,  and  fracture  it.  I  attended  such  a  case  on 
September  1  last,  where  a  gentlemen,  about  sixty-five, 
turning  round  suddenly  at  the  railway  station,  stepped  on  a 
travelling-bag  which  had  just  been  put  down  without  his 
seeing  it,  and  he  fell  violently  on  the  asphalte.  Visiting 
him  about  an  hour  afterwards,  I  found  the  inner  condyle 
fractured,  with  much  effusion  into  the  joint.  Further,  if 
the  condyle  be  detached,  the  violent  contraction  of  the 
quadriceps  occurring  at  the  time  would  evert  the  bone,  from 
loss  of  the  support,  from  the  inner  condyle  to  the  corre¬ 
sponding  surface  of  the  cap,  and  dislocation  be  the  result.  If 
the  edge  of  the  cap  were  retained  in  the  fissure,  it  would  explain 
the  difficulty  of  reducing  the  dislocation.  Vertical  disloca¬ 
tion  of  the  patella  may  also  occur  without  any  fracture, 
probably  from  an  irregular  contraction  of  the  quadriceps, 
aided  by  the  direction  of  the  injury — as  in  the  case  reported 
by  Dr.  Griffiths  in  the  Lancet  of  May  12  last,  when,  as  soon 
as  the  muscle  relaxed  from  the  patient  being  placed  fully 
under  the  influence  of  ether,  the  dislocation  was  easily 
reduced. 

Case  3. —  Compound  Colles’s  Fracture — Traumatic  Gangrene 
— Amputation  of  Arm,  etc. 

Frederick  S.,  a  ploughboy,  twelve  years  old,  fell  from 
a  tree,  about  twenty-five  feet,  whilst  bird's-nesting  at 
Winterslow,  on  June  17,  1883. 

He  was  brought  to  the  Infirmary  . at  midnight,  suffering 
from  a  compound  Colles’s  fracture  of  the  right  forearm. 
The  radius  had  separated  from  its  epiphysis,  which  re¬ 
mained  attached  to  the  carpus.  The  upper  fractured  end 
protruded  about  three-quarters  of  an  inch  through  the  skin 
by  a  transverse  wound  about  an  inch  and  a  half  in  length : 
the  ulna  was  fractured  about  an  inch  and  a  half  higher  up. 
There  was  no  bleeding.  An  attempt  was  made  to  reduce 
the  fractured  radius,  under  chloroform,  unsuccessfully.  By 
sawing  off  the  projecting  end  of  the  bone  level  with  the  skin, 
the  fracture  was  easily  reduced.  An  outside  splint  was  put 
on,  and  the  wound  treated  with  boracic  lint. 

On  the  18th  the  arm  was  quiet.  The  next  day  he  had 
great  pain,  and  the  bandages,  etc.,  were  removed  and  the 
wound  poulticed. 

On  the  morning  of  the  20th  the  parts  had  become  much 
swollen,  and  traumatic  gangrene  had  set  in.  This 
rapidly  extended  during  the  day,  and  it  was  decided, 
in  consultation  with  my  colleagues,  to  amputate  the  arm. 
The  consent  of  the  boy’s  relations  could  not  be  obtained 
until  5  p.m.-,  and  by  this  time  the  discolouration  and  swell¬ 
ing  of  the  skin  had  extended  up  to  the  shoulder  and  slightly 
on  to  the  chest ;  yet  there  was  a  faint  line  of  demarcation 
about  the  insertion  of  the  deltoid,  and  I  resolved  to  chance 
high  amputation  of  the  arm  by  the  circular  method. 

I  succeeded  in  controlling  the  artery  in  the  axilla  by  a 
screw-pad  tourniquet  with  split  leather  straps.  With  two 
lateral  incisions  in  the  skin  after  the  circle  was  made,  I  was 
enabled  to  turn  back  a  double  square  flap  and  easily  finish 
the  operation.  A  large  drainage-tube  was  placed  across  the 
bottom  of  the  stump  after  all  the  vessels  were  secured  ;  the 
flaps  were  sutured,  dressed  with  carbolised  warm  water, 
and  covered  with  wool.  Ether  was  inhaled  during  the 
operation,  and  the  boy  had  a  beef -tea  and  brandy  enema. 

His  pulse  was  very  thready  for  some  twenty-four  hours. 
He  had  beef-tea  enemata,  port  wine,  champagne,  bark,  and 
ammonia,  and  a  hypodermic  of  morphia. 

He  was  very  restless  for  the  next  day  or  two,  with  occa¬ 
sional  delirium,  but  his  pulse  improved.  He  had  incessant 
craving  for  cold  water,  which  he  was  freely  indulged  in. 


On  the  23rd  the  tube  was  removed,  and  on  the  24th  he 
seemed  out  of  danger;  appetite  had  returned,  the  stump 
looked  wonderfully  well,  and  you  would  not  have  suspected 
that  there  had  been  gangrene  as  the  cause  of  the  ampu¬ 
tation. 

From  this  time  his  progress  was  good.  A  ring  of  bone 
exfoliated.  He  was  made  an  out-patient  on  September  8, 
and  discharged  cured  in  October. 

On  examining  the  limb  after  the  operation,  the  epiphysis 
of  the  radius  was  found  attached  to  the  carpus,  and  a  com¬ 
minuted  fracture  of  the  ulna  an  inch  and  a  half  above  that 
of  the  radius.  The  whole  of  the  flesh  and  integuments  were 
foetid  to  a  degree,  gas  and  serum  freely  escaping,  the  hand 
and  parts  about  the  injury  black,  and  the  muscles  of  the 
forearm  sodden  and  dull  red  in  colour.  The  upper  arm  ex¬ 
hibited  all  the  changing  colours  of  advancing  mortification. 

As  the  lower  epiphysis  of  the  radius  is  united  to  the  shaft 
about  the  twentieth  year,  it  is  more  likely  to  separate  than 
fracture  of  the  radius  to  occur  in  an  accident  which  would 
produce  the  ordinary  Colles’s  fracture  in  an  adult. 

It  has  been  recommended,  in  cases  of  rapidly  extending 
gangrene,  to  amputate  at  the  shoulder- joint  as  a  greater 
measure  of  safety  ;  but  then  it  is  a  more  serious  operation 
than  that  of  the  arm,  and  although  the  skin  may  show  all 
the  signs  of  gangrene,  yet,  if  absolute  death  of  the  integu¬ 
ment  has  not  occurred,  it  has  a  power,  when  the  effusion  can 
freely  drain  away,  of  recovering  itself.  So  it  was  in  this 
boy’s  case.  The  flaps  did  not  slough  at  all,  and  he  recovered 
with  a  useful  stump,  such  as  an  artificial  limb  could  be 
fitted  to,  and  better  than  any  contrivance  could  have  com¬ 
manded  had  the  arm  been  removed  at  the  joint. 


REPORTS  OF 

HOSPITAL  PRACTICE  IN  MEDICINE 
AND  SURGERY. 

- «-■ - 

SAMARITAN  FREE  HOSPITAL  FOR  WOMEN 
AND  CHILDREN. 


DERMOID  OVARIAN  TUMOURS. 

(Under  tlie  care  of  Mr.  KNOWSLEY  THORNTON.) 

( Concluded  from  page  236.) 

Case  11  (No.  201  in  Ovariotomy  Tables — not  yet  published). 

A.  S.,  single,  aged  twenty-one ;  healthy-looking,  and  with 
full  colour.  Increase  of  size  noticed  four  years  ago.  Paternal 
grandmother  died  of  cancer  of  breast,  and  two  aunts  on 
same  side  of  phthisis.  Menstruation  began  at  the  age  of 
fourteen,  and  was  profuse  and  regular.  About  the  time 
that  she  first  noticed  the  tumour,  a  chill  during  menstrua¬ 
tion  stopped  the  catamenia  for  some  months,  and  since  the 
return  the  flow  has  been  scanty. 

Ovariotomy,  July  31,  1880.  A  large  bicystic  tumour  of 
left  ovary,  with  a  multilocular  mass  at  its  base,  and  in  one 
of  the  cysts  of  this  mass  a  quantity  of  hair  and  fat. 

I  noted  the  right  ovary  as  also  rather  large. 

The  patient  left  the  hospital  well  on  the  seventeenth  day. 

Case  12  (No.  219  in  Ovariotomy  Tables— not  yet  published). 

M.  T.,  single,  aged  forty-eight;  very  emaciated;  abdomen 
enormously  distended.  Had  only  noticed  increase  of  size 
for  three  years  and  a  half.  Catamenia  regular  up  to  nine 
months  back,  when  they  ceased  altogether.  Family  history 
unimportant. 

Ovariotomy,  December  8,  1880.  An  enormous  multilocular 
tumour  of  the  left  ovary,  weighing  in  all  seventy  pounds. 
One  of  the  secondary  cysts  was  full  of  bone,  hair,  and  fat. 

The  right  ovary  had  a  thin- walled  cyst  in  it ;  but  it 
was  very  adherent,  and  I  thought  it  better  to  leave  it,  as 
the  patient  was  much  exhausted  with  a  formidable  opera¬ 
tion.  It  has  given  no  trouble  up  to  the  present  time.  The 
patient  made  a  rapid  recovery. 

Case  13  (No.  232  in  Ovariotomy  Tables — not  yet  published). 

A.  H.,  married,  aged  thirty-three ;  mother  of  six  children 
(the  last  four  were  all  born  after  she  was  under  my  obser¬ 
vation  with  ovarian  tumour).  The  tumour  was  first  dia¬ 
gnosed  in  1874 ;  it  never  increased  much,  if  at  all,  in  size, 
and  her  husband  would  not  hear  of  operation.  During 
the  last  pregnancy  she  suffered  very  severely  with  constant 


710 


Medical  Times  and  Gazette. 


MEDICAL  AND  SURGICAL  PRACTICE. 


Dec.  22,  1883. 


pain  in  and  about  tbe  tumour,  and  at  each  montb  bad  a 
sharp  feverish  attack,  and  it  was  determined  that  if  she  got 
safely  through  this  confinement  the  .tumour  should  be 
removed.  She  herself  knew  that  there  was  a  swelling  in 
the  abdomen  when  her  first  child  was  born. 

I  performed  ovariotomy  on  April  2,  1881,  and  found  a 
dermoid  tumour  with  a  false  pedicle  attached  to  the  omen¬ 
tum,  and  a  band  connecting  it  with  the  right  ovary.  On  the 
left  side  of  the  uterus  was  a  stump,  from  which  the  tumour 
had  evidently  twisted  off,  the  Fallopian  tube  between  the 
end  of  the  stump  and  the  uterus  being  cystic.  The  right 
ovary  was  cystic,  and  was  also  removed. 

The  tumour  was  full  of  fat  and  hair.  I  have  no  report 
of  the  right  ovary.  The  patient  made  a  good  recovery. 

Case  14  (No.  235  in  Ovariotomy  Tables — not  yet  published). 

A  little  American  girl  of  seven  years  old.  A  private  case, 
and  published  separately  in  the  British  Medical  Journal. 

Case  15  (No.  267  in  Ovariotomy  Tables — not  yet  published). 

W.  J.  R.,  single,  aged  twenty-one  ;  a  full-coloured  blonde. 
Menstrual  history  unimportant.  Family  history  unimportant. 
First  noticed  pain  in  right  side  in  August,  1880,  and  then 
found  a  small  lump  there ;  it  has  grown  rapidly  since. 

I  performed  ovariotomy  on  December  7,  1881,  and  re-, 
moved  a  very  solid  dermoid  tumour  of  the  right  ovary.  It 
was  completely  bedded  in  adherent  omentum  and  intestines, 
though  there  was  no  history  of  pain  or  of  inflammatory 
attacks.  Every  cyst  that  I  opened  contained  dermoid  struc¬ 
tures,  and  in  some  there  were  large  masses  of  bone,  with 
teeth,  etc. 

The  patient  made  a  good  recovery.  I  have  not  heard  of 
her  since,  but  think  I  should  have  done  so  had  she  not 
remained  well. 

Case  16  (No.  289  in  Ovariotomy  Tables — -not  yet  published). 

A  young  lady,  aged  twenty-seven ;  single.  Not  a  hospital 

case. 

Case  17  (No.  297  in  Ovariotomy  Tables — not  yet  published). 

L.  M.,  single,  aged  forty-one.  Menstruation  is  and  always 
has  been  regular.  Family  history  unimportant.  First 
noticed  a  small  hard  swelling  of  the  size  of  a  duck’s  egg  in 
the  left  iliac  region  about  five  years  ago. 

I  performed  ovariotomy  on  May  3,  1882,  and  removed  a 
dermoid  tumour  from  the  right  side,  which  was  bedded  in 
adhesions  to  uterus,  intestines,  etc.  There  was  no  pedicle, 
the  stump  from  which  the  tumour  had  twisted  off  being 
plainly  visible.  The  left  ovary  was  as  large  as  an  orange, 
and  was  also  removed.  The  right-side  tumour  was  distended 
with  hair  and  thick  putty-like  material ;  the  left  also  con¬ 
tained  hair  and  fat.  The  patient  made  a  good  recovery. 

This  completes  the  dermoid  cases  in  another  (third)  series 
of  one  hundred  ovariotomies.  In  the  former  two  hundred 
there  were  two  malignant  cases  and  ten  simple,  or  6  per 
cent.  In  this  series  there  are  two  malignant  and  seven 
simple,  or  9  per  cent.  This  is  a  very  much  larger  propor¬ 
tion  than  that  found  by  other  operators.  Sir  Spencer  Wells 
only  met  with  twenty-two  dermoid  tumours  in  one  thousand 
operations  ;  and  Peaslee  gives  the  percentage  as  one  and  a 
half  to  two.  I  think  the  apparent  increase  may  be  partly 
due  to  the  fact  that  we  now  operate  on  smaller  tumours, 
and  in  more  doubtful  cases  than  formerly.  To  both  classes 
of  cases  the  dermoid  tumours  decidedly  belong.  They  are 
often  small,  and  of  slow  and  uncertain  growth,  and  they  are 
much  more  liable  to  be  mistaken  for  uterine  tumours. 
Certain  it  is  that  the  larger  percentage  is  fully  maintained 
in  my  fourth  hundred,  now  nearly  complete. 

The  small  size,  slow  growth,  and  greater  comparative 
density  of  the  dermoid  tumours  explain  certain  facts  in 
connexion  with  this  variety  of  the  ovarian  cysts.  1.  They 
are  specially  liable  to  twisting  of  the  pedicle,  even  to  com¬ 
plete  twisting  off,  with  adhesion  to  other  surfaces.  2,  They 
are  specially  liable  to  inflame  and  adhere  to  neighbouring 
organs,  and  to  suppurate  and  form  fistulous  openings  into 
the  bladder  or  intestine,  or  externally. 

In  fully  a  third  of  my  cases  the  second  ovary  was  also 
found  to  contain  a  dermoid  cyst  or  cysts ;  and  I  noted  in 
some  cases  in  which  I  did  not  remove  the  second  ovary  that 
it  was  enlarged,  and  I  think  very  likely  would  also  have 
been  found  to  contain  small  dermoid  cysts.  From  my 
present  experience  I  shall  be  more  inclined  to  remove  the 


second  ovary  in  all  cases  which  show  any  increase  of  its 
size. 

The  single  and  married  are  nearly  of  equal  numbers,  and 
the  majority  of  the  latter  have  been  mothers. 

The  tumours  are  most  commonly  diagnosed  about  the 
middle  period  of  menstrual  life  ,•  i.e.,  when  the  ovaries  are 
in  their  most  robust  reproductive  state.  Tait,  in  his  recent 
work,  puts  the  age  at  from  seventeen  to  twenty-one,  but 
this  is  fully  ten  years  too  early.  He  also  states  that  “  der¬ 
moid  cysts  are  generally  unilocular  ”;  the  exact  reverse  of 
this  is  my  experience, — they  are  nearly  all  multilocular. 
Ritchie  advanced  the  theory  that  the  dermoid  ovarian  cysts 
are  due  to  parthenogenesis  ;  and  Tait  supports  and  amplifies 
this  view,  believing  that  they  all  arise  from  an  ovum,  and 
in  foetal  or  early  infantile  life.  I  think  it  is  possible  that 
they  may  take  their  origin  in  ova  which  do  not  escape  from  the 
follicles,  and  hence  have  a  perverted  nutrition  and  growth ; 
just  as  adenoid,  carcinomatous,  and  sarcomatous  tumours 
have  their  origin  in  perverted  nutrition  and  growth  of  other 
cellular  elements  of  the  ovary.  I  cannot,  however,  find  any 
evidence  to  support  the  theory  that  they  begin  always  in 
foetal  or  infantile  ovaries,  and  usually  remain  quiescent 
till  after  puberty.  The  early  stage  of  disease  so  often 
found  in  the  second  ovary  seems  opposed  to  this  view; 
and  I  have  recently  operated  upon  a  single  woman  of  sixty- 
two,  fifteen  years  after  her  menopause,  whose  whole  men¬ 
strual  history  is  against  such  a  theory.  In  her  case  also  the 
second  ovary  was  multicystic,  and  one  of  the  cysts  contained 
dermoid  structures.  If  these  dermoid  cysts  had  been  present 
all  through  life,  why  should  they  have  waited  fifteen  years 
after  the  menopause,  and  then  developed  so  unequally  in 
the  two  sides  ?  It  seems  to  me  much  more  probable,  from  a 
careful  consideration  of  my  own  cases  and  of  those  recorded 
by  others,  that  the  ova-cells  partake  of  the  stimulus  (what¬ 
ever  it  be)  which  sets  up  tumour- growth;  and  the  varying 
age  at  which  we  find  dermoid  cysts,  from  childhood  to  old 
age,  supports  this  view.  They  are  commonest,  as  I  have 
shown,  during  the  most  active  period  of  a  woman’s  mens¬ 
trual  life,  but  in  this  they  only  follow  the  rule  of  the 
ovarian  tumours.  Dermoid  cysts  are  common  enough  in 
other  parts  of  the  body,  and  also  in  the  male,  where  they 
cannot  originate  from  ova.  It  is  true  that  some  of  those  in 
the  ovary  have  been  found  to  contain  striped  muscle,  brain, 
and  other  structures  not  found  in  dermoid  cysts  in  other 
situations ;  but  if  we  allow  for  these  exceptional  cases  an 
origin  from  the  ovum,  I  see  no  use  in  straining  this  to  make 
it  account  for  all,  when  similar  cysts  are  found  where  such 
an  origin  is  impossible.  One  practical  point  of  much  im¬ 
portance  I  would  urge  with  regard  to  dermoid  ovarian 
tumours  :  let  them,  however  small,  be  removed  directly  they 
are  diagnosed ;  for,  in  spite  of  their  slow  growth  and  periods 
of  apparent  quiescence,  they  are  more  dangerous  to  their 
hosts  than  the  ordinary  tumours,  from  their  proneness  to 
inflame  or  suppurate,  or  twist,  or  cause  perforation  of  the 
walls  of  neighbouring  organs. 

I  shall  hope  to  continue  the  series  at  some  future  time, 
as  it  is  only  by  the  records  of  a  large  number  of  cases  that 
fallacies,  such  as  those  as  to  the  age  of  the  patients  and 
the  unilocular  character  of  the  cysts,  can  be  corrected.  It 
is  easy  from  a  small  experience  to  make  things  fit  a  theory  ; 
much  more  difficult  if  our  experience  is  large. 


Leprosy  in  New  Brunswick. — In  a  communication 
to  the  Canada  Medical  Association,  Dr.  Graham  gave  an 
account  of  a  visit  which  he  had  paid  to  Tracadie,  on  the 
Gulf  of  St.  Lawrence,  where  leprosy  has  prevailed  since  1820,- 
and  where  a  lazaret  has  been  established  for  the  isolation 
and  treatment  of  lepers.  From  the  investigation  which 
he  made  he  came  to  these  conclusions  : — 1.  The  origin  and 
early  spread  of  the  disease  cannot  be  explained  on  the 
theory  of  hereditary  transmission,  although  this  may  in 
part  account  for  its  further  propagation.  2.  Although 
endemic  influences,  such  as  climate,  mode  of  life,  etc.,  may 
be  strong  predisposing  elements,  they  are  in  no  case  the  sole 
cause  of  the  disease.  3.  Leprosy  in  Tracadie  was  imported 
from  without,  and,  finding  there  favourable  conditions,  was 
propagated  from  one  person  to  another  by  contagion. 
4.  Leprosy  may  be  regarded  as  one  of  the  least  contagious 
of  diseases,  and  one  which  only  spreads  under  a  combination 
of  favouring  circumstances  such  as  were  found  in  Tracadie. 
— Canada  Medical  Journal,  October. 


Medical  Times  and  Gazette. 


NERVE  -  STRETCHING. 


Deo.  22,  1SS3.  711 


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SATURDAY,  DECEMBER  22,  1883. 


- -9 - 

NERVE  -  STRETCHING. 

Mr.  Marshall’s  admirable  lecture  at  the  Royal  College  of 
‘Surgeons  has  drawn  very  prominent  attention  to  this  sub¬ 
ject  as  a  surgical  means  of  treating  certain  diseases  of  the 
nervous  system  which  are  not  amenable  to  other  forms  of 
Treatment.  Nerve-stretching,  though  it  dates  back  to  the 
year  1869,  is  still  quite  in  its  infancy  ;  and  if  Mr.  Marshall 
has  not  added  much  to  our  knowledge  of  the  subject,  his 
selection  of  it  for  his  Bradshawe  Lecture  cannot  fail  to 
direct  that  special  attention  to  it,  which,  by  securing  for  it 
a  more  careful  and  systematic  study  than  it  has  hitherto 
received,  will  be  productive  of  great  gain,  and  for  which 
Mr.  Marshall  will  earn  the  thanks  of  the  profession.  In  his 
sketch  of  the  history  and  development  of  nerve-stretching 
as  a  surgical  operation,  it  was  not  a  little  strange  that 
neither  von  Nussbaum’s  nor  Billroth’s  name  was  mentioned, 
and  that  their  now  historical  cases  were  not  even  alluded  to. 
It  is,  however,  well  known  that  nerve-stretching  was  first 
carried  out  with  intent  by  Prof,  von  Nussbaum  in  the  year 
1872.  Billroth,  indeed,  in  the  year  1869  had  laid  bare  the 
sciatic  nerve,  not  with  any  intention  of  stretching  it,  but 
for  the  purpose  of  examining  it.  In  doing  so,  he  detached  it 
from  its  connexions,  and  did  not  hesitate  to  finger  it  freely  in 
his  search  after  some  morbid  condition,  or  for  some  tangible 
mechanical  pressure  which  might  be  interfering  with  its 
function.  But  the  first  application  of  nerve-stretching  as  a 
definite  surgical  operation  is  undoubtedly  due  to  von  Nuss¬ 
baum.  His  first  case  was  a  soldier,  who  had  received  a  blow 
from  the  butt  end  of  a  musket  over  the  region  of  his  brachial 
plexus  at  the  memorable  battle  at  Bazeilles,  on  September  1, 
1870.  This  was  followed  by  extravasation  of  blood,  and  an 
abscess,  which  had  to  be  opened ;  it  discharged,  and  shortly 


healed  up.  Subsequently,  violent  and  painful  spasm  of  the 
upper  limb  of  the  same  side  set  in,  and  resisted  every  kind  of 
treatment  for  many  months.  It  was  thought  possible  that 
cicatricial  thickening  of  the  nerve-sheaths  of  the  four  lower 
cervical  nerves  might  be  the  cause  of  the  affection,  and 
von  Nussbaum  determined  to  cut  down  on  the  nerves, 
thoroughly  expose  them,  and  break  down  any  adhesions 
which  he  might  find.  This  was  accordingly  done.  The 
ulnar  nerve  was  stretched  at  the  elbow,  and  all  the  nerves  as 
they  surround  the  artery  in  the  axilla,  as  well  as  the  main 
trunks  above  the  clavicle.  Yon  Nussbaum  certainly  left 
nothing  to  chance,  for,  besides  attacking  the  nerves  at  the 
three  places  named,  he  followed  them  with  his  finger  up 
to  their  exit  from  the  spinal  column.  The  spasms  never 
returned,  and  from  the  first  the  man  was  able  to  perform 
voluntary  movements  with  the  fingers  and  hand,  such  as 
previously  were  impossible.  The  patient,  in  fact,  recovered 
perfectly,  and  remained  quite  free  from  any  return  of 
spasm  or  pain.  Such  was  the  introduction  of  nerve-stretch¬ 
ing  as  a  surgical  operation. 

The  first  accurate  account  of  the  subject  in  all  its  bear¬ 
ings,  clinical  as  well  as  experimental,  was  written  by  Dr. 
Paul  Vogt,  Professor  of  Surgery  at  Greifswald.  A  full 
analysis  of  this  pamphlet  was  published  in  this  journal  in 
September,  1877,  and  was  the  earliest  account  of  the  sub¬ 
ject  which  appeared  in  this  country.  Mr.  Marshall  would 
have  found  a  great  deal  of  interesting  matter  in  Vogt’s  book, 
together  with  a  fuller  account  of  the  early  cases  than  is  con¬ 
tained  in  Stintzing’s  work,  to  which  the  lecturer  admitted 
that  he  was  largely  indebted,  and  a  study  of  which  he 
recommended  to  his  audience.  Both  authors,  however, 
had  the  advantage  of  having  studied  and  worked  out  their 
subject  under  the  eyes  of  von  Nussbaum  in  the  Munich 
General  Hospital,  and  both  works  are  worthy  of  careful 
study. 

The  operation  has  by  this  time  become  fully  recognised, 
and  has  been  done  for  all  sorts  and  conditions  of  nerve- 
disease.  Fortunately — thanks  largely  to  antiseptics — it  is 
a  most  simple  one,  and  almost  devoid  of  danger.  Von 
Nussbaum’s  patient  quickly  got  over  the  immediate  effects 
of  his  operation,  although  he  was  very  ill  at  the  time  it 
was  undertaken ;  but  he  subsequently  nearly  succumbed  to 
phlegmonous  erysipelas — -a  complication  which  is  hardly 
ever  heard  of  nowadays.  There  is  the  further  advantage 
that  the  proceeding  in  no  way  aggravates  the  disease,  even 
in  the  cases  in  which  it  fails  to  be  of  service.  This  harm- 
lessness  is  a  fortunate  circum stance,  and  serves  to  justify 
the  many  tentative  operations  that  have  been  undertaken. 
Originally,  nerve-stretching  was  tried  only  as  a  last  resource 
in  all-but  hopeless  cases,  and  in  the  full  expectation  that 
some  gross  lesion  would  be  discovered,  which  might  be  re¬ 
movable.  It  now  seems  to  be  done  not  in  hopeless  cases  only, 
but  comparatively  early,  and  in  any  form  of  nerve-disease 
which  is  not  amenable  to  ordinary  therapeutic  treatment. 
It  is  even  done,  occasionally,  in  cases  in  which  the  patho¬ 
logical  anatomy,  being  well  defined,  absolutely  precludes 
any  commensurate  benefit,  as,  for  instance^  in  infantile 
paralysis.  But  in  all  hopeless  cases,  in  which  there  is  no 
recognised  pathological  anatomy,  and  which  have  resisted 
the  usual  therapeutic  measures,  such  an  operation  as  this 
may  be  tried;  for,  as  already  stated,  if  carefully  performed, 
the  operation  entails  no  serious  after-consequences,  either 
local  or  general.  There  are  limits,  however,  beyond  which 
tentative  surgery  should  not  proceed.  A  perusal  of  Mr. 
Marshall’s  lecture  will  suffice  to  show  how  little  we  under¬ 
stand  the  modus  operandi  of  nerve- stretching.  His  sugges¬ 
tion  that  it  acts  in  some  way  on  the  nervi  nervorum  is  pure 
hypothesis.  There  is,  in  the  first  instance,  no  proof  that 
any  such  nerves  exist;  and,  secondly,  no  evidence  was 


712 


Medical  Times  and  Gazette. 


PHYSIOLOGY  m  THE  SCHOOLROOM. 


Dec.  22, 1S83. 


brought  forward  in  support  of  such  a  theory — the  learned 
lecturer  simply  stating  that  he  “imagined  them  to  exist."’ 
It  was  unfortunate  that  Mr.  Marshall  could  not  have 
brought  forward  a  series  of  personally  observed  cases.  He 
would  hardly  have  been  so  enthusiastic  in  his  favourable 
anticipations  of  what  the  operation  may  accomplish.  For 
the  present  our  knowledge  of  the  initial  changes  in  the 
nervous  system  which  lead  to  disease  is  not  sufficiently 
accuratej  neither  is  the  rationale  of  nerve-stretching  suffi¬ 
ciently  definite  to  lead  us  to  look  for  the  brilliant  results 
which  were  once  anticipated  from  it. 


PHYSIOLOGY  IN  THE  SCHOOLROOM. 

Every  doctor  who  is  not  an  educational  Tory  has  probably 
taken  it  as  an  axiom  that  the  best  way  to  make  people  good 
citizens  and  sensible  patients  is  to  give  them  a  knowledge 
of  their  own  bodies  and  of  the  laws  that  govern  them.  So 
much  of  the  difficulty  of  dealing  with  the  laity,  both  rich 
and  poor,  is  traceable  to  their  ignorance  of  the  laws  of  life, 
the  haziness  of  their  notions  as  to  the  true  relation  of 
cause  and  effect,  their  inability  to  distinguish  between  true 
knowledge  and  quack  assumption,  their  credulity,  their 
superstition,  and  their  love  of  mystery,  that  many  of 
us  assume  that  nothing  is  required  but  sound  general 
physiological  teaching  to  make  this  the  best  possible  of 
worlds,  and  to  give  the  doctor  the  place  and  power  in  it 
that  he  deserves.  And  if  this  knowledge  is  to  be  brought 
within  the  range  of  all,  then  it  follows  that  we  cannot 
begin  to  teach  it  at  too  early  an  age ;  for,  amongst  the 
poorer  classes,  if  the  boy  is  not  taught  to  “  know  himself  ” 
in  the  schoolroom,  he  will  infallibly  remain  ignorant  of  that 
interesting  object  of  study  for  the  rest  of  his  mortal  days. 
It  is  on  this  principle  that  we  have  been  going  more  or  less 
{ or  the  last  thirty  years.  In  March,  1853,  the  Privy  Council 
:'s  sued  a  document,  signed  by  sixty-six  of  the  leading  medical 
men  of  the  day,  in  which  it  was  strongly  maintained  that 
‘‘it  would  greatly  tend  to  prevent  sickness,  and  to  promote 
soundness  of  body  and  mind,  were  the  elements  of  Physiology, 
in  its  application  to  the  preservation  of  Health,  made  a  part 
of  general  education.”  And  the  signatories  of  the  circular 
further  stated  that  they  were  “  convinced  that  such  instruc¬ 
tion  could  be  made  most  interesting  to  the  young,  and  might 
be  communicated  to  them  with  the  utmost  facility  and  pro¬ 
priety  in  the  ordinary  schools,  by  properly  instructed  school¬ 
masters.”  Thus  heartily  recommended  by  the  medical 
profession  to  the  public.  Physiology  has  up  to  the  present 
time  assumed  a  constantly  increasing  importance  in  general 
education,  and  has,  in  fact,  been  gladly  welcomed  as  a 
subject  of  teaching  everywhere  except  in  those  strongholds 
of  lost  causes — -the  public  schools.  That  it  has  not  done  all 
that  was  promised  of  it — that,  in  spite  of  all  instruction  in 
the  laws  of  life  and  health,  the  masses  still  overwhelm  us 
with  their  incurable  dirtiness,  stupidity,  and  superstition — 
may  be  readily  admitted ;  but  this  has  been  reasonably  put 
down  to  the  inefficiency  and  limited  extension  of  physio¬ 
logical  teaching.  Considering  the  quality  of  the  physio¬ 
logical  instruction  that  was  until  within  quite  recent  times 
thought  sufficient  for  the  medical  student,  it  was  hardly  to 
be  expected  that  we  could  all  at  once  turn  out  a  legion  of 
schoolmasters  fitted  for  the  difficult  task  of  making  Physi¬ 
ology  intelligible  and  interesting  to  children.  A  century 
would  not  be  too  long  a  period  to  give  to  such  a  revolu¬ 
tionary  experiment  in  our  methods  of  education.  One  was 
perhaps  prepared  to  meet  with  disappointment,  difficulty, 
opposition,  and  revolt  on  the  part  of  the  laity,  who  are 
generally  considered  to  be  prejudiced  against  anyone’s 
prying  into  their  insides ;  but  the  ordinary  medical  mind 
scarcely  expected  to  find  the  first  sign  of  dissent  from  the 


new  doctrine  coming  from  the  physiologists  themselves.  The 
unforeseen,  however,  has  happened,  as  usual,  and  henceforth 
the  directors  of  education  in  this  country  will  have  to  reckon 
with  a  certain  amount  of  incredulity  amongst  physiological 
experts  as  to  their  science  being  a  fit  subject  for  teaching 
“in  the  vulgar  tongue.” 

Early  in  the  present  year.  Hr.  Allchin,  who  has  had  ex¬ 
ceptional  opportunities  of  forming  an  opinion  on  the  subject, 
read  a  paper  before  the  College  of  Preceptors,  in  which  he 
boldly  argued  that  physiology  is  not  an  appropriate  subject 
to  teach  in  elementary  schools.  “  It  is,”  he  contended, 
“  too  uncertain  and  too  extensive,  too  much  involved  in  many 
other  branches  of  science,  to  allow  of  its  being  attempted 
by  a  mind  hitherto  untutored,  and  any  attempt  to  the  con¬ 
trary  can  and  does  only  result  in  cramming  a  mass  of  ill- 
assorted  facts  and  ideas  into  the  mind,  thereby  training 
neither  observation  nor  reasoning.  Even  from  the  point  of 
view  of  the  direct  value  of  the  knowledge  gained,  its 
advantage  is  more  than  questionable,  and  finally  experience 
has  decided  against  it.”  This  bold  and  at  first  sight  para¬ 
doxical  statement  has  not  been  allowed  to  pass  unchallenged, 
and,  at  the  November  meeting  of  the  College  of  Preceptors, 
Mr.  John  Angell,  the  Science  Master  at  the  Manchester 
Grammar  School,  read  a  paper,  in  which  an  attempt  was 
made  to  controvert  Hr.  Allchin’s  arguments.  Hr.  Allchin 
does  not  appear  to  have  been  present  himself  to  answer  his 
opponent ;  but  he  found  an  able  ally  in  Hr.  J.  F.  Payne, 
who  presided  on  the  occasion,  and  stated  that  his  own  expe¬ 
rience  as  an  examiner  had  led  him  to  exactly  the  same  con¬ 
clusions  as  Hr.  Allchin.  For  the  purpose  of  clearness  it  may 
be  well  to  give  a  brief  comparative  summary  of  the  opposed 
views. 


Physiology  is  not  adapted  for  the 
teaching  of  the  young— 

1.  Because  it  involves  a  know¬ 
ledge  of  so  many  other  sciences. 
There  is  scarcely  a  branch  of  ex¬ 
perimental  science  that  is  not  in¬ 
volved  in  the  explanation  of  phy¬ 
siological  problems. 


2.  Because  it  is  an  in  exact  science. 


3.  Because  it  will  result  in  the 
cramming  of  a  mass  of  ill-assorted 
facts  and  ideas  into  the  mind, 
thereby  training  neither  observa¬ 
tion  nor  reasoning. 


4.  Because  its  study  results  in 
cramming  into  the  individual  a 
mass  of  names  and  phrases,  the 
meaning  of  which  he  fails  to  under¬ 
stand,  since  they  are  too  complex 
and  abstruse  ;  and  as  for  its  use  in 
preparing  the  mind  for  sanitary 
truths,  experience  tells  us  that  the 


Physiology  is  adapted  for  the- 
teaching  of  the  young  — 

1.  Because  the  fact  that  it  is  based 
on  all  the  experimental  sciences, 
and  not  on  one  or  two  only,  affords- 
the  strongest  reason  why  it  should 
be  the  best  elementary  science  sub¬ 
ject  for  the  commencement  of  the 
systematic  cultivation  and  develop¬ 
ment  of  the  intelligent  faculties. 
It  is  an  error  to  assume  that  there 
are  a  number  of  sciences.  There  is 
but  one  science— Natural  Science. 

2.  It  is  not  inexact  in  relation  to 
that  with  which  it  has  to  deal,  and 
its  study,  by  teaching  the  general 
conformity  to  law  in  all  that  is 
comprised  within  our  living  and 
acting  world,  tends  to  general  exact¬ 
ness  of  thought  in  things  mental  and 
moral  as  well  as  physical.  Quanti¬ 
tatively,  it  may  be  inexact,  but  the 
love  of  quantitative  subjects  is  a 
late  development. 

3.  There  is  no  Science  subject  in 
which  the  teaching  of  youth  can  be 
made  more  sound  and  real.  Ask  a 
boy  the  why  and  wherefore  of  his 
sensations  and  experiences — why 
he  gets  out  of  breath,  for  instance, 
if  he  runs  fast, — and  he  immedi¬ 
ately  becomes  interested.  This, 
on  the  part  of  the  pupil,  means 
roused  intellect,  quickened  obser¬ 
vation,  quickened  attention,  greater 
reasoning  power,  greater  concentra¬ 
tion,  and  more  retentive  memory. 

4.  The  terms  of  Physiology— a 
comparatively  modem  science— are 
built  of  definite  roots,  have  a  defi¬ 
nite  meaning,  and  are  profitable  for 
a  boy  to  learn ;  and  as  for  its  prac¬ 
tical  usefulness,  the  experience  of 
the  Manchester  Sanitary  Associa¬ 
tion  is  that  the  chief  difficulty  in 


Medical  Times  and  Gazette. 


GEESHAM  COLLEGE. 


Dec.  22, 1883.  713 


the  way  of  extending  sanitary  im¬ 
provements  into  the  houses  of  the 
lower  class  lies  in  their  present 
state  of  ignorance,  which  the  Asso¬ 
ciation  is  trying  to  overcome  by 
instituting  lectures  on  physiological 
and  sanitary  subjects. 

5.  It  is  not  more  rapidly  pro¬ 
gressing  than  chemistry,  electricity, 
or  magnetism. 

6.  The  greater  part  of  Science  has 
been  built  up  of  provisional  theories, 
and  it  is  an  error  to  think  that  such 
cannot  be  used  for  educational 
purposes. 

In  the  above  summary  we  do  not  profess  to  have  given 
more  than  the  merest  skeleton  of  the  arguments,  and  we 
must  refer  those  who  wish  for  further  information  to  Mr. 
AngelTs  able  paper,  published  in  the  Educational  Times  for 
December  1.  In  such  a  discussion,  of  course,  the  opinion  of 
a  physiological  expert  deserves  every  respect,  but  we  are 
inclined  to  think  that  experts,  as  a  class,  are  very  often  apt 
to  attach  too  much  importance  to  a  full  knowledge  of  their 
special  subject,  and  too  little  importance  to  a  superficial 
knowledge  of  it.  But,  as  one  of  the  speakers  at  the  discus¬ 
sion  pointed  out,  it  is  impossible  to  give  a  perfect  knowledge 
in  any  subject  to  children,  and  he  might  have  extended  his 
dictum  to  many  grown-up  people.  Few  medical  men, 
probably,  have  a  knowledge  of  physiology  that  would  come 
up  to  Dr.  Allchin’s  standard,  but  he  would  hardly  argue 
that  they  would,  like  his  patients,  do  better  without  it.  It 
has  even  been  said  that  the  teaching  of  Physiology  to 
medical  students  has  been  overdone  of  late,  and  that  where 
taught  by  experts,  who  are  removed  from  its  practical 
application  to  Medicine,  it  is  less  usefully  taught  than 
where  the  lecturer  is  a  practising  physician.  That  con¬ 
sideration,  however,  though  it  would  tell  as  a  strong 
argument  against  the  proposed  federation  of  medical  schools, 
has  but  a  remote  connexion  with  the  present  question. 
But  there  is  another  point  which  might  with  advantage 
tiave  been  brought  into  greater  prominence  in  the  dis¬ 
cussion  of  Dr.  Allchin’s  views,  and  that  is  the  much 
greater  opportunity  of  training  the  observation  offered 
by  Physiology  than  by  most  other  sciences.  The  material 
of  elementary  physiological  instruction  is  always  at  hand, 
and  it  lends  itself .  admirably  to  observation  and  description 
by  the  pupil.  It  is  organised,  and  therefore  more  complex 
than  minerals  or  electrical  apparatus  or  geometrical  figures, 
and  it  thus  appeals  to  a  larger  range  of  sense-perceptions. 
Faulty  observation  is  at  the  root  of  most  fallacies,  and  we 
contend  that  a  boy  would  cultivate  his  faculties  much  more 
usefully  by  looking  at  his  tongue  in  a  mirror  and  describing 
it  in  words,  than  by  learning  the  dates  of  all  the- kings  that 
ever  lived.  Compared  with  the  history  and  geography  that 
have  hitherto  formed  the  staple  of  elementary  education, 
the  broad  outlines  of  physiology  can  hardly  be  called 
complex;  and,  if  properly  taught,  could,  we  believe,  be 
made  to  interest  children  more  than  the  most  thrilling  and 
best-remembered  facts  in  the  history-primer.  The  king 
who  died  of  eating  lampreys  owes  his  immortality  to  his 
physiological  and  not  to  his  historical  associations. 


GEESHAM  COLLEGE. 

Geesham  College  from  its  foundation  has  been  insecure. 
It  has  been  submitted  to  the  test  of  a  Eoyal  Commission, 
and  found  wanting.  The  end  is  delayed,  but  only  for  the 
time  being.  Excesses  in  its  prime  and  decay  of  nature 
render  its  continuance  in  its  present  form  futile.  The 
change  to  a  larger,  better  sphere  of  work  must  come ;  and 
while  awaiting  this  change  with  some  impatience,  it  may 
be  of  interest  to  review  its  life  now,  since  there  is  no  know¬ 


ing  for  how  long  a  true  obituary  notice  might  be  deferred. 
Gresham  College,  in  the  present  and  in  the  past,  has  many 
points  in  common  with  the  “  Heathen  Chinee.”  The  lectures 
may  fairly  be  termed  “  bland,”  the  modern  observance  of 
some  niceties  of  ancient  ritual  is  “  childlike,”  and  the  history 
of  the  institution  affords  ample  illustration  of  “  ways  that 
are  dark.”  Sir  Thomas  Gresham’s  objects  were  clear 
enough.  Having  no  son,  he  desired  to  perpetuate  his  name 
honourably  in  the  cause  of  education — education  for  the 
great  city  from  which  he  had  largely  derived  his  wealth. 
He  ignored  all  promises  previously  made  to  Cambridge  Uni¬ 
versity,  and  shortly  before  his  death  drew  up  a  will  leaving 
his  house,  which  occupied  a  large  area  opening  on  to 
Bishopsgate-street,  as  the  residence  for  seven  lecturers. 
They  were  to  be  paid  <£50  a  year  each  out  of  revenues 
derived  from  rents  in  the  Eoyal  Exchange.  They  were  ta 
be  graduates,  unmarried  or  widowers,  and  the  subjects  of 
their  lectures  were  broadly  defined.  As  Prof.  Eay  Lankester 
recently  reminded  us,  Gresham  did  his  best  to  preserve  his- 
foundation  by  solemnly  cursing  those  of  his  trustees  who 
might  divert  his  property  from  his  original  intentions. 
B  usin ess-man  as  he  was,  he  lost  sight  of  much  in  framing 
this  will.  He  overlooked  the  fact  that  in  the  coming 
materialistic  age  a  posthumous  curse  would  not  count 
for  much  when  weighed  against  present  pecuniary  bene¬ 
fits.  He  did  not  take  into  account  the  possibility  of  his 
bequest  increasing  in  value  so  largely  as  almost  to  invite 
legal  spoliation.  He  simply  left  it  all  to  be  held  in  trust  by 
his  widow,  and  to  be  applied  as  above  stated,  on  her 
demise,  by  the  Corporation  of  the  City  of  London  and  the 
Mercers’  Company. 

Some  forms  of  philanthropy  excite  opposition,  especially 
from  those  who  deem  their  private  interests  attacked  for  the 
good  of  the  greater  number.  Lady  Gresham,  after  her 
husband’s  death  in  1579,  made  repeated  attempts  to  alter 
the  terms  of  the  will.  She  had  disputes  with  Sir  Henry 
bTevill,  necessitating  “an  Act  for  the  stablishynge  of  an 
agrement  betwene  them.”  In  1592  she  made  another  peti¬ 
tion  to  Parliament ;  and,  in  a  document  opposing  this  success¬ 
fully,  we  find  the  Lord  Mayor  and  Aldermen  so  confident  of 
their  own  honesty  of  purpose  that  they  hopefully  state  that 
they  “  do  assuredly  persuade  themselves  that  there  shall  not 
at  any  time  be  any  cause  given  of  their  parts  to  complain 
against  them,”  and  accordingly  we  find  that  when  the  pro¬ 
perty  came  into  their  hands  they  procured  a  patent  from  the 
Crown  in  1614  to  hold  for  ever  the  Eoyal  Exchange  and  Sir 
Thomas  Gresham’s  “  mansion  house  ”  upon  the  terms  ex¬ 
pressed  in  the  will  of  the  donor.  In  1596  they  had  appealed 
to  the  Universities  for  advice,  and  had  elected  three  pro¬ 
fessors  from  each  University,  Queen  Elizabeth  herself 
nominating  as  the  seventh  professor  a  graduate  of  both 
Universities.  In  January,  1597,  a  memorandum  was  drawn 
up,  defining  the  duties  of  the  several  professors,  and  esta¬ 
blishing  the  rule  that  for  “  more  order  and  comeliness  sake 
the  said  lecturers  shall  read  their  lectures  in  their  hoods, 
according  to  their  degrees  in  the  Universities.”  The  great 
bell  which  summoned  merchants  to  ’Change  was  to  be  rung 
to  give  notice  of  the  lecture.  The  lecture  was  to  be  de¬ 
livered  in  Latin  for  the  benefit  of  the  “  diverse  strangers 
of  foreign  countries,”  but  since  the  greatest  part  of  the 
“auditorie”  would  probably  consist  of  “such  citizens  and 
other,  as  have  small  knowledge  or  none  at  all  of  the  Latine. 
tongue,”  the  substance  of  the  lecture  was  to  be  repeated 
later  in  the  day  in  English.  The  English  version  of  the 
Divinity  lecture  was  to  be  a  “  revised  version,”  as  we  find 
that  “the  rest  is  to  be  referred  to  the  discretion  of  the 
reader,  who  is  of  small  judgment  if  he  cannot  discerne  what 
is  meet  to  be  omitted  and  delivered  openly  in  his  English 
lectures.”  The  lecturer  on  Physic  was  directed  to  read 


best  patients  are  those  who  do  as 
they  are  told  without  question. 


B.  It  is  a  rapidly  progressing 
science., 

6.  Its  facts  are  relatively  few,  its 
hypotheses  many. 


714 


Medical  Times  and  Gazette. 


CHRONICLE  OF  THE  WEEK. 


Dec.  22,  18S3. 


“  first  physiologic,  then  pathologie,  and  lastly,  therapeutice, 
whereby  the  body  of  the  said  art  may  be  better  imprinted 
by  good  method  in  the  studious  auditors.” 

For  some  sixty  years  from  its  foundation  all  went  well, 
the  College  forming  a  focus  of  philosophic  and  scientific 
meetings.  Then  came  troubles.  Soldiers  were  quartered 
in  the  College,  and  the  professors  were  scattered.  They 
reassembled  in  1660,  but  only  shortly  after  to  have  their 
work  again  interrupted  by  the  plague  and  the  great  fire. 
The  next  disturbance  came  from  the  trustees.  The 
value  of  the  large  area  on  which  the  College  stood  had 
increased  very  much,  the  building  itself  had  become 
dilapidated,  so  that  in  1701  the  trustees  applied  for  powers 
to  “  make  some  improvement  of  Sir  Thomas  Gresham’s 
gifts,  the  better  to  enable  them  to  pay  his  uses.” 
Sixteen  years  later,  a  similar  but  less  circumstantial 
petition  was  put  forward;  and  finally,  in  1760,  they  boldly 
sought  to  pass  an  Act  to  empower  them  to  pull  down  the 
College  and  almshouses,  merely  undertaking  to  “  erect  and 
provide  a  proper  and  convenient  room  ”  for  the  public  read¬ 
ing  of  the  lectures.  The  final  death-blow  to  Gresham’s 
wishes  was  given  in  1768,  when  the  trustees  obtained 
an  Act  to  enable  them  to  make  over  to  the  Crown  the 
ground  on  which  the  College  stood  for  a  perpetual  rent  of 
£500  per  annum.  To  quiet  opposition,  the  lecturers  were 
now  allowed  to  marry,  their  remuneration  was  raised  from 
,£50  to  £100,  and  the  lectures  were  delivered  in  an  out-of- 
the-way  corner  of  the  Royal  Exchange.  From  Burgon’s 
book  (to  which  we  are  indebted  for  many  of  the  above  facts) 
we  learn  that  the  “City  and  Mercers’  Company  further 
agreed  to  pay  conjointly,  out  of  their  respective  shares  of 
the  Gresham  Estate,  £1800  to  the  Commissioners  of  His 
Majesty’s  Excise,  towards  the  charge  of  pulling  down  the 
College  and  building  an  Excise  office.”  And  yet,  only  eight 
years  before,  they  had  gravely  calculated  that  their  losses 
by  Sir  Thomas  Gresham’s  gift  amounted  to  the  curiously 
exact  sum  of  £201,318  17s.  8jd.  ! 

The  past,  then,  was  chequered  ;  and  in  the  present  what 
can  be  said  P  The  present  value  of  the  original  endowment 
should  be  something  like  three  millions  sterling,  but  only  a 
small  portion  of  this  remains  available.  In  small  matters  the 
authorities  directing  the  College  appear  to  have  great  regard 
for  the  founder’s  wishes.  The  subjects  of  the  lectures  nomi¬ 
nally  remain.  The  regulations  as  to  hood  and  gown  are 
observed,  and  the  doors  are  thrown  open  to  all  “  citizens  and 
other.”  Dealing  only  with  the  lectures  on  Physic,  it  has  been 
deemed  advisable  to  discard  all  thought  of  physiology,  path¬ 
ology,  and  therapeutics.  Purely  medical  lectures  seem  to 
have  failed  in  the  heart  of  the  City,  so  that  they  have 
given  place  to  a  more  popular  course  on  N ursing.  The  well- 
filled  character  of  the  hall  recently  gave  evidence  of  the 
lecturer’s  wisdom.  The  audience  was  as  “mixed”  as  it 
could  possibly  be;  a  glance  around  sufficed  to  show  that 
scientific  research  in  medicine  would  not  be  appreciated. 
There  is  no  doubt,  however,  that  many  present  were  inte¬ 
rested.  They  were  clearly  on  good  terms  with  the  lec¬ 
turer,  and  greeted  many  of  his  “points”  with  discrimi¬ 
nating  applause.  They  were  eager  for  anything  in  the 
way  of  an  experiment,  even  when  it  was  only  taking 
the  temperature  of  a  bowl  of  hot  water ;  they  delighted 
in  learning  how  to  make  a  linseed-poultice,  and  were  in¬ 
terested  in  the  Listerian  method.  They  certainly  left  feel¬ 
ing  that  they  had  learnt  much  as  to  poultices,  fomentations, 
blisters,  and  the  administration  of  food  and  medicine.  If 
we  consider  the  prime  duty  of  a  lecturer  to  be  to  interest  his 
audience,  to  distribute  such  knowledge  as  they  are  able  to 
appreciate,  and  to  fill  a  room  which  has  a  reputation  of  being 
commonly  empty,  then  indeed  we  may  congratulate  him  on 
having  succeeded.  When  we  remember,  however,  that,  so 


far  as  Medicine  is  concerned  in  the  present  course,  these  four 
lectures  on  Nursing  represent  all  we  have  to  show  for  our 
share  of  three  millions  which  should  be  devoted  to  research, 
we  can  only  hope  that  the  day  may  not  be  far  distant  when 
the  modern  representatives  of  the  corporations  who  perverted 
Gresham’s  trust  may  be  induced,  either  by  uneasy  consciences 
or  by  Act  of  Parliament,  to  restore  this  splendid  endowment 
to  its  proper  uses.  It  certainly  looks  like  the  beginning  of 
the  end  when  Physic  is  displaced  in  favour  of  Nursing. 


CHRONICLE  OF  THE  WEEK. 

- - 

Sib  Andrew  Clark,  before  a  crowded  meeting,  including 
many  provincial  surgeons,  raised  a  most  important  discus¬ 
sion  at  the  Medical  Society,  on  Monday  last,  on  Catheter- 
Life  and  its  Attendant  Dangers.  The  paper  on  which  the 
discussion  arose — as  will  be  seen  by  reference  to  it  in  another 
part  of  this  journal — dealt  with  a  class  of  cases  apart,  viz., 
such  as  were  not  associated  with  appreciable  or  manifest 
pathological  changes  in  the  urinary  organs.  The  discussion- 
turned  for  the  most  part  on  the  cases  in  which  a  very  mani¬ 
fest  lesion  was  to  be  found  either  in  the  bladder,  or  ureters, 
or  kidneys,  or  in  all  three ;  and  in  this  sense,  therefore,  it 
(the  discussion)  was  wide  of  the  mark.  Sir  Andrew’s  pro¬ 
positions  may  be  summed  up  as  follows  : — About  middle 
life,  in  men  apparently  healthy,  or  with  no  discoverable 
disease  except  a  low  density  of  urine,  the  commencement  of 
habitual  catheterisation  is  sometimes  followed  by  a  form  of 
remittent  fever,  which  is  often  fatal.  This  danger  is  well 
recognised  for  persons  vnth  kidney  disease,  but  not  for 
apparently  healthy  persons,  and  the  doctrine  is  not  found 
in  surgical  text-books.  The  fever  is  neither  distinctly 
ureemic  nor  pysemic,  but  begins  as  a  reflex  disturbance  of 
the  nervous  system  of  the  urinary  organs.  There  are  good 
reasons  to  think  that  the  mortality  may  be  avoided  or 
lessened  by  recognising  the  nature  of  the  disease  and  by 
suitable  treatment. 


Sir  Henry  Thompson  opened  the  discussion.  He  objected 
in  limine  to  the  title  of  the  paper.  He  much  preferred  the- 
term  “  urinary  fever,”  because  it  pertained  to  the  urinary 
organs,  and  not  essentially  to  the  use  of  catheters.  He- 
recognised  three  distinct  forms  of  this  fever — 1.  An  acute 
transient  attack,  following  the  use  of  the  catheter,  which 
rapidly  passed  off  and  left  no  trace  behind;  2.  An  acute 
recurrent  form,  often  associated  with  stricture  of  the- 
urethra  and  lowered  health— a  not  uncommon  form,  and 
not  fatal ;  3.  A  chronic  urinary  fever,  coming  on  insi¬ 
diously  in  old  men,  without  rigors,  soon  after  taking  to- 
the  catheter.  The  cases  which  die  very  rapidly,  clearly 
die  of  shock  to  the  nervous  system.  In  his  own  experi¬ 
ence  the  chronic  class  of  cases  which  were  fatal  always- 
had  advanced  renal  disease.  Mr.  B.  Hill  had  examined 
the  records  of  University  College  Hospital.  He  had 
never  seen  Sir  Andrew  Clark’s  class  of  cases  without- 
finding  kidney  disease  sufficient  to  account  for  death.  Of 
thirteen  fatal  cases  in  University  College  Hospital  during 
the  past  few  years,  eleven  had  died  with  chronic  nephritis. 
Mr.  Savory  thought  the  subject  was  well-worn,  but  had 
lately  been  overlooked  in  the  multiplicity  of  new  subjects 
which  had  cropped  up.  The  immense  frequency  with  which 
the  catheter  was  used  for  all  sorts  of  conditions,  and  at  all 
ages,  stood  in  marked  contrast  with  the  rarity  of  a  fatal  results 
and  this  fact-  suggested  to  his  mind  that  it  was  a  peculiar 
condition,  unassociated  directly  with  the  catheter.  There 
were  cases  in  which  the  kidney  was  not  manifestly  affected. 
For  his  own  part,  he  was  in  the  habit  of  having  the  urine  exa¬ 
mined  as  to  its  urea  contents,  as  the  most  reliable  evidence  oL 


Medical  Times  and  Gazette. 


CHRONICLE  OF  THE  WEEK. 


Bee.  22,  1883.  7  1  5 


unimpaired  function.  The  occurrence  of  rigors  after  cathe¬ 
terisation,  the  long-continued  reflex  irritability  even  under 
chloroform,  the  rigors  which  not  infrequently  followed  on 
amputation  of  the  penis,  all  suggested  some  special  associa¬ 
tion  of  the  organs  with  the  nervous  system  ;  and,  in  his 
mind,  those  cases  in  which  there  was  no  pathological  lesion 
of  the  kidneys  died  of  shock.  Mr.  Reginald  Harrison  thought 
that  something  was  due  to  the  altered  condition  in  the 
bladder — from  over-distension  to  one  of  emptiness.  He 
treated  his  cases  by  substituting  for  the  urine,  which  was 
foul,  some  warm  fluid  which  was  aseptic.  Mr.  Bennett  May 
thought  that  death  resulted  from  septic  causes.  The  Presi¬ 
dent  was  familiar  with  these  cases.  In  India,  such  deaths 
would  have  been  attributed  to  malarial  influences. 


At  the  meeting  of  the  Clinical  Society  on  Friday  week, 
papers  were  read  by  Dr.  Cayley  on  pneumothorax  occurring 
in  the  course  of  typhoid  fever,  and  by  Dr.  Samuel  West 
on  a  case  of  complete  recovery  from  pneumothorax  without 
effusion.  Mr.  C.  J.  Symonds  read  notes  of  cases  illustrating 
the  relation  between  labial  herpes  and  rigor,  one  of  which, 
being  in  every  sense  of  the  word  a  personal  observation, 
was  followed  with  much  interest.  All  the  papers  gave  rise 
to  lively  discussion.  Living  specimens  of  Charcot’s  joint- 
disease,  and  of  successful  union  of  fractured  patella  without 
operation,  were  also  exhibited.  The  treatment  of  pneumo¬ 
thorax  proved  an  interesting  subject  of  debate.  A  large  pre¬ 
ponderance  of  opinion  was  found  to  be  in  favour  of  non-inter¬ 
ference  in  all  except  the  cases  of  rapid  and  severe  dyspnoea 
The  absolute  necessity  of  tapping  the  chest  under  these  cir¬ 
cumstances  was  made  very  clear  by  the  cases  recorded,  and  it 
is  worthy  of  note  that  in  almost  all  these  no  ill-effects  followed 
the  operation  itself.  While  the  simple  treatment  of  expec¬ 
tancy  was  advocated  by  some  speakers,  others  would  agree  to 
postpone  operative  interference  until  late ;  but  no  suggestion 
was  made  as  to  any  evil  results  likely  to  follow  from  tapping, 
whether  undertaken  early  or  late.  Looking  to  the  fact  that 
the  lung,  when  compressed  by  air,  tends  to  expand  at  once 
on  the  pressure  being  removed,  it  seems  somewhat  illogical 
to  refrain  from  so  simple  a  procedure  as  the  evacuation  of 
the  air  through  capillary  needles. 


The  suggestion  thrown  out  by  the  President  of  the 
Clinical  Society  at  the  close  of  the  debate  on  November  23 
has  been  carried  into  effect,  by  the  appointment  of  a  com¬ 
mittee  of  investigation  upon  the  subject  of  myxoedema  and 
its  relations  to  disease  and  removal  of  the  thyroid  gland. 
The  work  hitherto  undertaken  in  this  country  has  from  the 
first  been  brought  forward  under  the  auspices  of  the  Clinical 
Society ;  and  the  appointment  of  this  committee,  selected 
from  its  members,  will  still  further  identify  it  with  the 
advance  of  our  knowledge  of  this  paradoxical  disease.  A 
glance  at  the  names  of  which  the  committee  is  composed 
will  sufficiently  guarantee  that  the  work  will  be  carried  out 
in  a  thoroughly  scientific  spirit. 


At  the  meeting  of  the  Pathological  Society  on  Tuesday 
evening  last  the  proceedings  commenced  with  a  specimen  of 
a  somewhat  rare  form  of  central  necrosis  of  the  tibia,  ex¬ 
hibited  by  Dr.  Turner,  as  to  the  exact  nature  of  which  the 
surgeons  were  not  quite  unanimous.  Dr.  Wickham  Legg 
then  narrated  a  case  of  wide-spread  pigmentation  of  the 
skin  in  a  patient  the  subject  of  multiple  melanotic  sarco¬ 
mata,  and  without  disease  of  the  supra-renal  bodies.  The 
rest  of  the  evening  was  devoted  to  some  papers  on  tubercu¬ 
lar  ulceration  of  the  tongue,  and  the  discussion  arising 
therefrom.  The  subject  is  one  to  which  we  alluded  a  fort¬ 
night  ago,  when  Mr.  Barker  introduced  it  at  the  last  meet¬ 


ing  of  this  Society.  The  existence  of  such  an  affection, 
though  hitherto  ignored,  must  henceforth  be  acknowledged 
to  be  proved  beyond  all  doubt,  although  we  have  still  much 
to  learn  about  it— its  mode  of  onset,  for  instance;  does  it 
always  begin  as  an  ulcer,  or  may  this  be  preceded  by  a  sort 
of  gummous  change,  which  ulcerates  by  sloughing  ?  Mr. 
Godlee’s  second  case  and  Mr.  Symonds’  case  would  seem  to 
support  this  theory  of  the  onset.  Then,  may  it  precede 
the  development  of  the  lung  affection,  or  does  the  deposit 
of  tubercle  occur  simultaneously  in  both  places  ?  This  is  a 
question  of  immense  practical  importance,  of  which  the 
cases  brought  forward  did  not  afford  any  definite  solution. 
One  interesting  point  may  be  noted  incidentally,  viz.,  the 
greater  preponderance  of  male  patients  affected.  Mr.  Barker 
had  collected  fifteen  recorded  cases.  Of  these  eleven  were 
males,  and  all  the  cases  described  last  Tuesday  were  males. 
The  debate  came  to  a  somewhat  abortive  termination,  as  no 
one  was  willing  to  second  a  motion  to  prolong  the  meeting 
beyond  10  p.m.,  to  the  undisguised  joy  (at  least,  it  appeared 
so)  of  those  at  the  reporters’  table. 


The  Ophthalmologists,  or,  as  our  American  cousins  would 
say,  the  “  ophthalmists,”  had  a  busy  time  at  their  second 
meeting,  last  Thursday  week.  The  most  important  paper 
of  the  evening  was  one  by  Dr.  Brailey  on  sympathetic 
ophthalmia.  He  regarded  a  certain  amount  of  cell-infiltra¬ 
tion  into  the  substance  of  the  iris  as  a  constant  lesion,  and 
exudation  on  its  posterior  surface  as  almost  invariably 
present.  Collections  of  newly  formed  cells  were  also  com¬ 
monly  present  on  the  posterior  aspect  of  the  cornea  and 
the  internal  aspect  of  the  pars  ciliaris  retinae ;  inflam¬ 
matory  cells  were  also  frequently  seen  in  the  layers  of  the 
choroid.  Amongst  the  less  common  forms  of  sympathetic 
inflammation  he  recognised  keratitis  punctata,  simple  kera¬ 
titis,  and  simple  papillitis.  As  regarded  the  outbreak  of 
sympathetic  inflammation  after  removal  of  the  exciting  eye, 
his  explanation  was  that  the  nutrition  of  the  second  eye 
might  be  so  altered  at  the  time  by  sympathetic  irritation 
that  the  eye  would  afterwards  be  liable  to  spontaneous  in¬ 
flammation,  even  after  excision  of  the  damaged  eye.  He 
suggested  that  glaucoma,  being  a  neurosis  of  the  secretory 
nerves  of  the  eyeball,  might  be  produced  sympathetically 
by  the  occurrence  of  glaucoma  in  the  other  eye. 


Db.  Stephen  Mackenzie  was  quite  at  home  when  dealing 
with  anaemia  as  a  cause  of  retinal  haemorrhage — a  subject  at 
which  he  has  already  done  much  good  work.  The  cases  he 
adduced  on  this  occasion  certainly  tend  to  show,  as  he 
meant  they  should,  that  when  the  corpuscular  richness  of 
the  blood  falls  below  50  per  cent,  we  may  look  out  for 
squalls,  i.e.,  haemorrhages  in  the  retina.  Mr.  Waren  Tay 
showed  two  very  interesting  cases — one,  a  man  with  atrophy 
of  one  disc  after  fractui .  if  the  base  of  his  cranium ;  the 
other,  a  man  with  facial  paralysis  after  an  attack  of  herpes 
zoster.  We  ought  also  not  to  omit  to  notice  Mr.  Priestley 
Smith’s  very  simple,  and  yet  exceedingly  ingenious,  appa¬ 
ratus  for  demonstrating  the  conjugate  movements  of  the 
eyes.  A  miniature  of  it  ought  to  be  in  evei-y  medical  out¬ 
patient  room  where  students  congregate. 


The  charge  brought  by  the  Public  Prosecutor  against 
the  late  Mr.  Haffenden  and  his  patient  came  before  the 
Central  Criminal  Court  on  Friday,  the  14th  inst.,  and,  after 
a  trial  lasting  the  whole  day,  a  verdict  of  acquittal  was  de¬ 
clared  amidst  loud  applause.  The  chief  witness  for  the 
prosecution  broke  down  in  cross-examination,  and  that, 
combined  with  the  entire  openness  of  Mr.  Haffenden’s  pro¬ 
ceedings  and  the  evidence  of  Dr.  Robert  Barnes,  the  only 

* 


716 


Medical  Times  and  Gazette. 


CHKONICLE  OF  THE  WEEK. 


Dec.  22, 1883. 


medical  witness  called  for  the  defence,  left  no  doubt  in  the 
minds  of  the  jury  that  the  charge  could  not  be  upheld.  It  is 
to  be  deplored  that  the  prosecution  was  ever  instituted,  and 
it  is  a  still  greater  matter  for  regret  that  Mr.  Haffenden 
did  not  abide  in  life  to  see  his  reputation  vindicated. 
The  case,  though  reported  so  meagrely  in  the  journals 
as  to  be  useless  for  medico-legal  purposes,  will  serve  as 
a  timely  reminder— first,  to  the  Public  Prosecutor  and  his 
advisers  never  to  bring  such  another  charge  against 
a  medical  practitioner  without  an  overwhelming  mass  of 
proof ;  secondly,  to  pregnant  women  that  it  is  something 
more  than  a  peccadillo  to  destroy  the  fruit  within  their 
womb  ;  and  thirdly,  to  medical  practitioners  to  be  more 
wary  in  the  use  of  the  uterine  sound.  Ladies  have  been 
known  to  go  to  gynaecologists  so  well  coached  up  in  the 
symptoms  of  displacement  that  the  sound  has  been  intro¬ 
duced  as  a  matter  of  course,  and  the  doctor  has  not  found 
out  till  afterwards  that  he  has  been  made  the  subject  of 
a  plant. 

Instances  of  “  science  run  riot  ”  are  not  far  to  seek  in 
this  ingenious  age,  but  we  have  never  met  with  a  more 
striking  one  than  that  which  is  described  in  the  following 
cutting  from  a  Scotch  paper: — “At  Stow,  on  Wednesday, 
the  12th  inst.,  Dr.  Carter  Moffat,  of  Motherwell,  gave  a 
lecture  ‘  On  the  Applications  of  Chemical  Science  to  the 
Improvement  of  Vocal  Tone.’  Mr.  John  Anderson,  with  a 
choir,  gave  a  selection  of  sacred  and  secular  pieces  during 
the  evening,  with  harmonium  accompaniments.  The  lecture 
embraced  the  results  of  many  years’  study  at  home  and  in 
Italy  of  the  action  of  chemical  agents  on  the  vocal  cords. 
The  discovery  of  peroxide  of  hydrogen  in  the  atmosphere 
of  the  plains  and  valleys  of  Italy  led  Dr.  Moffat  to  conclude 
that  that  agent  was  the  cause  of  the  beauty  of  the  Italian 
tone,  as  well  as  of  the  invigorating  tendencies  of  that  country 
to  invalids.  Experiments  were  made  by  the  lecturer  to 
demonstrate  the  effect  of  peroxide  of  hydrogen  and  con¬ 
densed  ammonia  on  vocal  tone.  These  chemicals  were  in¬ 
haled  by  the  members  of  the  choir,  and  seemed  to  have  the 
effect  of  enriching  the  voice.”  The  lozenges  and  com¬ 
pressed  tablets  which  have  hitherto  been  recommended 
with  such  insistence  as  “  good  for  the  voice  ”  to  the  members 
of  the  stage,  the  legislature,  and  the  bar,  have  evidently  had 
their  day,  and  ere  long  the  gas-bag  will  no  doubt  become  an 
indispensable  article  of  furniture  at  all  "  places  where  they 
sing.”  To  found  an  establishment  where  those  who  are 
intending  to  live  by  their  voice  could  take  a  course  of  daily 
inhalations,  would  be  an  enterprise  of  some  pith  and 
moment. 


The  cold  weather  has  sent  up  the  mortality  of  the  metro¬ 
polis  a  point  (from  21 -5  to  22'7),  but  the  deaths  from  dis¬ 
eases  of  the  respiratory  organs  last  week  were  still  95  below 
the  corrected  average,  and  the  total  deaths  as  many  as  179  less 
than  the  usual  tale  in  this  week  of  the  year.  Zymotic  disease 
also  caused  62  fewer  deaths  in  the  week  than  the  experience 
of  the  last  ten  years  might  have  led  one  to  expect ;  but  the 
statement  that  53  deaths  were  caused  by  measles,  40  by 
scarlet  fever,  24  by  diphtheria,  and  25  by  enteric  fever,  is 
sufficiently  serious.  What  a  wail  throughout  the  country 
there  would  have  been  if  as  many  lives  had  been  lost  in  a 
colliery  explosion  or  a  battle !  It  may  be  said  that  the 
deaths  from  zymotic  disease  are  deaths  of  children,  and  that 
plenty  more  are  on  the  way  to  supply  their  place.  That  is 
true  ;  but  then  these  children  have  done  nothing  to  repay  the 
cost  of  their  keep  till  death  seized  them,— they  are  so  much 
sunk  capital :  whereas  the  collier  and  the  soldier,  who  die 
at  the  post  of  duty,  have  at  least  repaid  in  work  some  of 
the  money  spent  on  them.  Some  day  we— or  our  descen¬ 


dants— will  wonder  that  zymotic  disease  was  borne  with  so 
long. 

The  profession  in  Ireland  is  considerably  excited  about  a 
letter  which  has  been  addressed  to  the  governor  of  each 
convict  and  local  prison  in  Ireland,  by  the  Dublin  Prisons 
Board,  with  reference  to  autopsies  on  prisoners.  The  letter* 
which  was  read  on  Tuesday  last  at  the  inquest  on  the  Seville- 
place  murderer,  Poole,  bears  date  September  29,  1883,  and 
states  that  “  in  the  case  of  an  inquest  being  held  as  to  the 
cause  of  death  of  an  inmate  of  a  prison,  it  is  the  desire  of 
his  Excellency  the  Lord  Lieutenant  that,  in  the  event  of  a 
post-mortem  examination  being  ordered  by  the  coroner,  such 
examination  shall  not  be  held  by  the  medical  officer  of  the 
prison,  but  by  an  independent  medical  authority.”  The 
Coroner  stated  his  opinion  that  the  circular  contravened  an 
Act  of  Parliament,  and  was  an  act  of  great  discourtesy  to  an 
honourable  profession.  The  order  was  probably  not  meant  to 
apply  to  executed  criminals,  but,  in  any  case,  Earl  Spencer 
and  his  advisers  are  ahead  of  their  times.  The  hour  of  the 
pathological  expert  ”  has  not  yet  come. 


“  Oh,  mickle  is  the  powerful  grace  that  lies  in  herbs  !  ” 
That  is  a  motto  which  may  be  seriously  recommended  to 
Mr.  Holloway,  to  have  written  in  gold  above  the  portals  of 
the  imposing  buildings  which  he  has  erected  at  Egham, 
and  which  will  be  opened  in  the  course  of  the  ensuing  year. 
Mr.  Holloway  has  made  his  fortune  out  of  the  middle  classes, 
and  it  was  a  happy  inspiration  of  his  to  devote  his  riches  to 
their  benefit.  The  sanatorium,  a  very  large  and  handsome 
building  close  to  the  Virginia  Water  Station,  is  to  afford 
persons  of  both  sexes  in  the  middle  rank  of  life,  who  are 
afflicted  with  mental  disorders,  medical  restoration  and  all 
the  comforts  of  a  home,  and  such  social  enjoyment  as  may 
be  possible,  with  the  ulterior  view  of  forming  a  valuable 
and  profitable  school  for  the  special  study  of  mental  ailments. 
The  College  for  Women,  on  the  outskirts  of  Windsor  Forest, 
eclipses  in  magnificence  all  that  Tennyson  dreamt  of  in  “  The 
Princess.”  It  will  afford  accommodation  for  250  lady- 
students  preparing  for  university  examinations;  but  the 
founder  hopes  that,  in  course  of  time,  it  will  be  empowered 
to  confer  its  own  degrees.  If  these  institutions  are  suc¬ 
cessful — and  even  medical  practitioners  cannot  desire  them 
to  be  otherwise — they  will  play  no  small  part  in  the  edu¬ 
cation  of  the  future.  Future  generations  will  extol  the 
munificence  of  their  founder,  and  never  cease  to  marvel  at 
the  strange  predilections  and  adamantine  viscera  of  his 
contemporaries. 

The  following  are  amongst  the  most  interesting  of  the 
communications  to  this  week’s  French  journals,  viz. :  a  paper 
on  the  Doctrine  of  Acetonsemia  Apropos  of  a  case  of  Diabetic 
Coma,  by  MM.  Cornillon  and  Mallat,  in  the  Progres  Medical ; 
a  note  on  the  Pathological  Anatomy  and  on  the  Nature  of 
Psoriasis  of  the  Tongue  by  M.  Leloir,  and  an  article  on  the 
Micrococcus  of  Pneumonia  by  M.  Bricon — both  in  that 
journal.  In  the  Gazette  Hebdomadaire  there  is  a  paper  by 
M.  F.  Widal  on  Rheumatic  Nodules  of  Long  Duration.  In 
the  Gazette  des  Hopitaux  is  a  lecture  by  M.  Trelat  on  the 
Surgical  Aspects  of  Tuberculosis,  as  well  as  articles  on 
Anomalous  Measles,  Pulmonary  Emphysema,  and  Acute 
Cystitis. 

Among  the  abstracts  in  the  Centralblatt  fur  Klinische  Medi- 
cin  may  be  noted  those  byEummo,  on  Iodoform ;  by  Baumann 
and  Schotten,  on  Icthyol ;  by  J ubineau,  on  Tabes  Spasmodica 
(from  its  negative  interest) ;  and  by  Journez,  on  an  Epi¬ 
demic  of  Typhoid  Fever  at  Liege.  Prof.  Lugiani,  of  Florence, 
contributes  an  original  article  to  the  Centralblatt  f  ur  die 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Dec.  22,  1883.  717 


Medicinischen  Wissenschaften  on  Mechanical  Irritation  of 
the  Cerebral  Cortex.  The  abstracts  are  of  unusual  number 
and  interest ;  those  by  Kronecker  and  Nicolaides,  Henocque 
and  Eloy,  and  Erb  and  Desplats,  upon  Cerebro-Spinal  Patho¬ 
logy  and  Physiology,  may  be  especially  mentioned.  In  the 
Centralblatt  fur  Chirurgie  is  published  an  original  paper  by 
Dr.  Bako,  of  Pesth,  on  Suture  of  the  Abdominal  Wall.  Ab¬ 
stracts  of  papers  by  Ch.  Nelaton  on  Tubercle  in  Surgical 
Affections,  and  by  Arnaud  on  Tubercular  Inflammation  of 
Joints,  are  also  of  interest.  The  Centralblatt  fur  Gyna- 
Icologie  is  largely  occupied  by  a  critical  article  by  Dr.  Kehrer, 
of  Heidelberg,  on  Dr.  MermanAs  “  Aphorisms.”  An  ab¬ 
stract  of  a  paper  by  Straus  and  Cumberland  on  the  Convey¬ 
ance  of  Infectious  Disease,  especially  Splenic  Fever,  from 
Mother  to  Foetus  in  Utero,  is  of  considerable  importance. 
The  chief  contributions  to  the  Berliner  Klinische  Wochen- 
schrift  are — by  Dr.  Zeller,  on  an  Operation  for  Radical  Cure 
of  Congenital  Inguinal  Hernia ;  by  Dr.  Aufrecht,  of  Magde¬ 
burg,  on  the  Treatment  of  Acute  Nephritis ;  and  by  Dr. 
Korte,  the  conclusion  of  his  paper  on  Treatment  of  Artificial 
Anus.  Dr.  Mikulicz,  of  Cracow,  records  two  cases  of  Osteo¬ 
plastic  Eesection  of  the  Foot  in  the  Wiener  Medixinische 
Wochenschrift,  which  also  publishes  the  conclusion  of  the 
papers  by  Dr.  Weiss  on  the  Prodromata  of  Paralytic  Mental 
Disturbance,  and  by  Dr.  Biach  on  Idiopathic  Hypertrophy  of 
the  Heart. 


AN  APPEAL. 

Mb.  Walter  Whitehead,  of  Manchester,  writes  to  us  in 
connexion  with  an  appeal  which  is  being  made  on  behalf  of 
the  widow  and  children  of  a  young  surgeon,  Mr.  E.  B. 
Carruthers,  who  has  died  from  injuries  received  while 
attending  a  patient  during  the  gale  on  the  night  of 
Tuesday  week.  On  that  night  Mr.  Carruthers  went  to 
attend  a  patient  who  had  sustained  a  compound  fracture  of 
the  leg  from  the  fall  of  a  chimney-stack,  and  while  he  was 
by  her  side  another  chimney-stack  was  blown  down.  Mr. 
Carruthers  became  wedged  in  the  debris,  and  a  considerable 
time  elapsed  before  he  could  be  got  out  and  taken  to  the  Eoyal 
Infirmary,  where  not  long  ago  he  was  a  constant  attendant 
as  a  medical  student.  At  the  Infirmary  it  was  found  that 
he  had  sustained  a  compound  double  fracture  of  the  right 
leg,  injuries  to  his  back,  and  several  minor  contusions. 
The  question  of  amputation  of  the  injured  leg  could  never 
be  entertained.  Mortification  set  in  on  Saturday  morning, 
made  rapid  progress,  and  terminated  fatally  on  Sunday. 
The  deceased  was  under  the  immediate  care  of  Mr.  White- 
head,  who  visited  him  frequently  each  day,  and  he  also 
had  the  benefit  of  the  advice  of  Dr.  Simpson,  Mr.  Lund, 
and  Mr.  Heath.  Mr.  Carruthers  leaves  a  widow  and  three 
children,  who  are,  we  have  been  informed,  comparatively 
unprovided  for.  A  representative  committee  has  been  formed 
to  raise  a  fund  for  their  benefit,  including  the  names  of  the 
Mayor  and  the  Bishop  of  Manchester ;  Dr.  Greenwood, 
Vice-Chancellor  of  the  Victoria  University ;  Profs.  Eoscoe, 
Gamgee,  Eoberts,  Leech,  Dreschfeld,  and  Lund ;  Dr. 
Simpson,  and  Mr.  H.  B.  Jackson.  Mr.  Walter  Whitehead 
is  acting  at  present  as  honorary  secretary  to  the  committee, 
and  Mr.  F.  Ashton  Heath,  of  Portland-street,  as  treasurer. 
The  appeal  will  doubtless  meet  with  a  favourable  response 
from  the  medical  profession  throughout  the  country. 


VESTRIES  AND  MEDICAL  OFFICERS  OF  HEALTH. 

The  daily  journalist,  safe  beneath  his  impenetrable  mask, 
seldom  wearies  in  making  accusations  of  a  general  kind. 
One  of  the  latest  instances  may  be  found  in  an  article  by  a 
contemporary  commenting  on  the  relations  of  metropolitan 
officers  of  health  and  vestries.  It  is  asserted  that  on  account 


of  the  present  position  of  the  metropolitan  medical  officers 
of  health,  most  of  them  eking  out  their  salaries  by  private 
practice,  and  all  dependent  on  the  vestries  for  the  length  of 
their  tenure  of  office,  they  fail  in  duty ;  that  in  cases  where 
vestrymen  are  concerned  they  have  eyes  that  see  not,  noses 
that  do  not  smell.  We  quite  admit  that  it  would  be  better  for 
medical  officers  of  health  to  devote  their  whole  time  to  public 
duties,  and  not  to  hold  their  office  at  the  pleasure  of  an  elec- 
tivebody.  An  ill  windis  that  which  wafts  no  shipto  port;  and, 
from  recent  authoritative  utterances,  the  position  of  medical 
officers  in  this  and  in  other  respects  is  likely  to  be  improved 
under  any  new  distribution  of  London  local  government. 
That,  however,  the  medical  officers  of  health  have  been  kept 
in  check  or  awed  by  their  employers  is  not  in  any  way  sup¬ 
ported  by  facts.  Where  is  the  single  instance  of  a  medical 
officer  of  health  being  even  censured  for  his  zeal  by  the 
sanitary  authority  ?  Sanitary  committees  may  have  been 
meddlesome  ;  leniency  and  laxity  may  also  be  brought  home 
to  a  few,  a  very  few,  of  the  local  bodies;  but,  as  a  rule,  the 
metropolitan  medical  officers  of  health  have  done  their 
duty  well  and  fearlessly.  We  know  instances  are  con¬ 
stantly  occurring  of  the  ordinary  notices  being  not  only 
served  on  vestrymen,  but  enforced.  It  is  difficult  to  be¬ 
lieve  that  any  local  governing  body  exists  in  the  metro¬ 
polis  that  would  take  the  side  of  the  vestrymen  in  resisting 
the  requirements  of  a  health  officer,  still  less  in  oppressing 
him  for  his  independent  action.  The  present  overcrowded 
and  insanitary  state  of  the  poor  is  not  produced  by  the 
sins  of  omission  or  commission  on  the  part  of  vestries,  but 
is  attributable  to  causes  which  it  has  not  suited  the  poli¬ 
tician  at  the  moment  to  refer  to — the  enormous  price  of  the 
London  land ;  poverty  ;  and  the  personal  habits  of  the  in¬ 
sanitary  degraded  English,  of  the  Irish,  and  of  the  Italian 
immigrants,  colonising  the  slums  and  alleys. 


DR.  CARPENTER  ON  THE  MODIFIABILITY  OF  GERMS. 

In  a  leading  article  on  “  Bacteria  and  Disease,”  in  our 
issue  of  November  3,  we  upheld  what  we  have  since  heard 
called  the  very  heterodox  hypothesis  that  certain  species 
of  pathogenic  bacteria  may  have  a  free-living  phase  in 
which  they  are  entirely  harmless.  A  somewhat  similar 
theory  was  stated  by  Dr.  W.  B.  Carpenter  in  a  paper  read 
at  the  meeting  of  the  British  Association  at  Southport,  and 
has  since  been  re-stated  by  him  in  an  interesting  letter 
which  he  has  addressed  to  the  President  of  the  Carlisle 
Microscopical  Society,  on  being  elected  an  honorary  vice- 
president  of  that  active  club.  “  I  need  scarcely  point  out 
to  a  body  including  many  medical  men,”  he  writes,  “  what 
a  wide  field  there  now  is  in  the  study  of  disease-germs.  As 
a  qualification  for  that  study,  I  should  suggest  the  deter¬ 
mination  of  the  life-history  of  the  yeast-plant.  For  there 
is  a  strong  reason  to  believe  that  what  we  know  under  this 
form  is  only  an  aberrant  stage  in  the  life  of  an  ordinary 
mucor;  its  cell-germs  developing  themselves  in  a  very  dif¬ 
ferent  mode,  in  a  saccharo-albuminous  liquid,  from  that  in 
which  they  vegetate  on  an  ordinary  mould-producing  sur¬ 
face.  And  while,  on  the  one  hand,  it  was  long  since  ob¬ 
served  by  Mr.  Berkeley  that  a  mucor  may  develope  itself  in 
a  confervoid  form  in  ordinary  water,  it  is  still  an  open 
question  whether,  if  growing  in  an  organic  fluid,  the  same 
mucor  may  not  become  the  f  vinegar-plant/  I  have  always, 
myself,  been  a  believer  in  the  great  polymorphism  of  the 
f  saprophytic 5  fungi ;  and  I  recently  argued  that  the  exten¬ 
sion  of  the  same  idea  to  disease-germs  will  account  for  many 
clinical  facts  observed  by  able  practitioners  of  medicine, 
which  have  hitherto  received,  in  my  opinion,  far  too  little 
attention — I  mean,  the  occurrence  of  what  have  been  called 
hybrid  varieties  of  exanthemata,  or  of  forms  of  fever  inter- 


718 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Dec.  22,1883. 


mediate  between  typhus  and  typhoid,  or  the  conversion  of 
an  endemic  malarious  remittent  into  a  contagious  fever.” 


“ABDUCTOR”  PARALYSIS  OF  THE  LARYNX. 

The  study  of  laryngology,  which  is  steadily  advancing  to 
its  proper  place  in  the  ranks  of  the  medical  sciences,  will  be 
still  further  stimulated  in  its  progress  by  a  valuable,  and 
in  part  original,  contribution  to  some  recent  numbers  of  the 
Berliner  Klinische  WocTienschrift  by  Dr.  Felix  Semon.  The 
subject  is  one  with  which  his  name  has  been  for  some  time 
associated — viz.,  the  proclivity  which  certain  fibres  of  the 
recurrent  laryngeal  nerve  show  to  become  affected  ,by  any 
common  cause  of  paralysis  before  any  of  the  other  fibres  of 
which  the  nerve  is  composed.  The  fact  that  paralysis  of 
the  abductor  muscles  of  the  larynx  was  the  most  frequent 
lesion  found  in  cases  of  pressure  of  tumours  upon  the  trunk 
of  the  nerve  had  long  been  known,  but  the  clue  to  the  correct 
explanation  of  this  frequency  had  never  been  found.  The 
credit  of  the  discovery,  that  in  all  cases  of  such  paralysis 
the  abductor  muscles  are  the  first  to  be  affected,  un¬ 
doubtedly  rests  with  Dr.  Semon.  In  his  recently  published 
paper  he  brings  forward  a  series  of  cases,  observed 
and  recorded  with  a  scientific  precision  that  renders 
them  of  the  highest  value,  showing  that  not  only  in 
cases  of  peripheral  but  also  of  central  paralysing  lesions 
the  abductor  muscles  have  been  invariably  the  first,  if  not 
the  only,  set  of  muscles  to  become  paralysed.  The  im¬ 
portance  of  this  observation  is  great,  whether  regarded 
from  a  scientific  or  practical  standpoint.  It  is  more  than 
probable  that  the  earliest  signs  of  developing  tumours,  or 
even  of  central  brain-disease,  may  be  given  by  the  larynx, 
if  its  indications  be  rightly  interpreted.  Such  severe  con¬ 
ditions  as  bilateral  paralysis  of  the  abductor  muscles  give 
rise,  of  necessity,  to  symptoms  of  s'uch  gravity  that,  even 
without  the  use  of  the  laryngoscope,  no  doubt  can  exist  of  the 
obstruction  which  they  produce.  But  probably  few  persons 
are  aware  how  complete  may  be  an  abductor  paralysis  on 
one  side  of  the  larynx  without  the  production  of  any  notice¬ 
able  symptom.  The  vocal  cord,  drawn  to  the  middle  line 
by  the  uncounteracted  traction  of  the  healthy  adductor 
muscles,  may  still  be  capable  of  function  so  far  as  to  pro¬ 
duce  unaltered  vocal  tones,  and  the  glottic  chink  is  still 
wide  enough  to  give  passage  to  all  the  air  required  for 
quiet  respiration.  That  such  a  condition  is  too  often  left 
unrecognised  for  want  of  thorough  examination  is  as  certain 
as  it  is  unsatisfactory.  The  routine  use  of  the  ophthalmo¬ 
scope  is  now  established  in  all  cases  where  central  or  peri¬ 
pheral  nerve-lesions  are  suspected,  and  the  most  enthusiastic 
ophthalmoscopist  would  hardly  claim  that  its  revelations 
are  invariably  diagnostic.  Might  not  the  routine  use  of 
the  laryngoscope  lead  to  an  earlier  diagnosis  of  commencing 
aortic  aneurysm  with  at  least  equal  frequency  to  that  of  the 
ophthalmoscope  in  the  diagnosis  of  commencing  tubercle  of 
the  meninges  ? 

THE  PARIS  WEEKLY  RETURN. 

The  number  of  deaths  for  the  forty-ninth  week  of  1883, 
terminating  December  4,  was  1025  (519  males  and  476 
females),  and  of  these  there  were  from  typhoid  fever  34, 
small-pox  2,  measles  18,  scarlatina  1,  pertussis  8,  diphtheria 
and  croup  50,  erysipelas  2,  and  puerperal  infection  4. 
There  were  also  52  deaths  from  acute  and  tubercular 
meningitis,  172  from  phthisis,  47  from  acute  bronchitis, 
63  from  pneumonia,  68  from  infantile  athrepsia  (26  of  the 
infants  having  been  wholly  or  partially  suckled),  and  30 
violent  deaths  (23  males  and  7  females).  The  mortality  of  this 
week  has  considerably  increased  upon  that  of  the  preceding 
week  (972),  although  the  deaths  from  epidemics  remain  sta¬ 


tionary,  with  the  exception  of  those  from  measles  and  diph¬ 
theria,  which  have  increased  in  a  slight  degree.  During 
the  week  there  were  1163  births,  viz.,  600  males  (441  legiti¬ 
mate  and  159  illegitimate)  and  563  females  (401  legitimate 
and  162  illegitimate)  :  82  infants  were  born  dead  or  died 
within  twenty-four  hours,  viz.,  3S  males  (25  legitimate  and 
13  illegitimate)  and  44  females  (30  legitimate  and  14 
illegitimate). 


INSTRUCTION  IN  HYGIENE. 

We  have  received  from  |Dr.  Corfield  the  prospectus  of  the 
active  Department  of  Hygiene  and  Public  Health  at  Uni¬ 
versity  College.  The  time  will  come  when  instruction  in 
sanitary  science  will  form  an  essential  part  of  every  medical 
curriculum,  and  the  subject  will  be  practically  taught  at 
every  hospital.  But  at  present  those  who  direct  the  course 
of  medical  studies  seem  almost  as  far  from  filling  up  this 
gap  in  general  medical  education  as  they  were  a  century 
ago,  when  the  publication  of  the  third  volume  of  Frank’s 
great  work  on  State  Medicine  first  called  attention  to  the 
prevention  of  disease.  It  is  a  strange  commentary  on  the 
unsatisfactory  state  of  medical  education  in  this  country, 
that  from  the  time  when  the  student  enters  at  a  hospital 
to  the  moment  when  he  receives  his  diploma  he  hears  not 
a  word  about  the  prevention  of  disease,  it  being  entirely 
ignored  except  in  the  higher  examinations.  But  there  can 
be  no  doubt  that  the  science  of  hygiene  has  a  great 
future  before  it  ;  and  when  other  hospitals  wake  up  to 
their  responsibilities,  and  decide  on  instituting  instruc¬ 
tion  in  hygiene,  it  is  to  the  courses  of  Prof.  Corfield  at 
University  College,  and  of  Prof.  Kelly  at  King’s  College 
that  they  will  go  for  their  models.  At  present,  no  doubt, 
the  University  College  course  is  the  only  really  complete 
one  from  both  the  scientific  and  the  practical  point  of  view, 
and  it  has  in  effect  a  monopoly  of  this  branch  of  instruc¬ 
tion.  Practitioners  come  from  all  quarters  of  the  world  to 
share  in  its  advantages,  and  the  list  of  honours  and  public 
appointments  gained  by  them  is  a  testimony  to  the  valuable 
work  done  by  the  department.  We  are  sorry  not  to  see 
more  candidates  competing  at  the  London  University  for 
the  sanitary  certificate.  Only  one  has  obtained  it  this  year 
— Dr.  Louis  Parkes,  who  was  one  of  Dr.  Corfield’s  pupils. 
The  title  of  the  diploma  is  unsatisfactory.  Surely  the 
subject  is  worthy  of  more  than  a  certificate ! 


THE  LATEST  IRISH  CONJOINT  EXAMINATION  SCHEME. 

An  ad  interim  report  has  been  submitted  to  the  King  and 
Queen’s  College  of  Physicians  and  to  the  Koyal  College  of 
Surgeons  in  Ireland  by  a  combined  committee,  consisting  of 
representatives  of  both  Collleges,  appointed  for  the  purpose 
of  suggesting  and  reporting  upon  a  scheme  for  the  giving 
conjointly  of  diplomas  in  medicine,  surgery  and  midwifery 
The  report  includes  the  following  six  resolutions  : — 1.  “  That 
it  is  desirable  that,  under  certain  conditions,  the  King  and 
Queen’s  College  of  Physicians  and  the  Koyal  College  of 
Surgeons  in  Ireland  should  combine  so  as  to  give  a  com¬ 
plete  examination  in  medicine,  surgery,  and  midwifery.” 
2.  “  That  candidates  who  pass  the  combined  examinations 
shall  be  entitled  to  receive  the  licences  of  the  Colleges  in 
medicine,  surgery,  and  midwifery.”  3.  “  That  the  Colleges 
do  bind  themselves  not  to  grant  separate  diplomas  except  to 
candidates  who  already  hold,  in  the  case  of  the  College  of 
Physicians  a  surgical  diploma,  and  in  the  case  of  the  College 
of  Surgeons  a  medical  diploma.  (The  surgical  and  medical 
diplomas  referred  to  in  this  resolution  are  to  be  approved  by 
both  Colleges.)”  4.  “  That  the  fee  to  be  paid  by  each  suc¬ 
cessful  candidate  shall  be  thirty  guineas  for  the  diplomas  in 
medicine,  surgery,  and  midwifery.”  5.  “  That  the  expenses 


Medical  Times  and  Gazette. 


ANNOTATION'S. 


Dec.  22,  1883.  7  1  9 


of  the  professional  examination  shall  be  defrayed  in  equal 
shares  by  the  two  Colleges,  and  that  the  surplus  thereafter  re¬ 
maining  shall  be  divided  between  the  College  of  Physicians 
and  the  College  of  Surgeons  in  the  proportion  of  three  to 
five  respectively.”  6.  “  That  in  the  opinion  of  this  Com¬ 
bined  Examination  Committee  the  proposed  scheme  should 
be  based  upon  the  principle  of  sessional  professional  exa¬ 
minations.”  The  foregoing  report  has,  we  understand,  been 
under  consideration  separately  by  the  President  and  Fellows 
of  the  College  of  Physicians  and  by  the  Council  of  the  Eoyal 
College  of  Surgeons,  but  no  conclusion  or  compromise  has 
yet  been  arrived  at. 


COOMBE  LYING-IN  HOSPITAL,  DUBLIN. 

On  Thursday,  December  IB,  Dr.  Samuel  Roberts  Mason  was 
elected  Master  of  this  institution,  in  succession  to  Dr.  G-eorge 
Hugh  Kidd,  whose  septennial  period  of  office  had  lately  ex¬ 
pired.  Dr.  Mason  is  a  graduate  in  Arts  and  Medicine  of 
the  University  of  Dublin,  and  a  Fellow  (1874)  of  the  Royal 
College  of  Surgeons  in  Ireland.  He  served  as  Assistant- 
Master  at  the  Coombe  Lying-in  Hospital,  and  has  for  some 
time  filled  the  post  of  Lecturer  on  Midwifery  and  Diseases 
of  Women  in  the  Ledwich  School  of  Medicine,  Peter- street, 
Dublin. 


METROPOLITAN  HOSPITAL  SUNDAY  FUND. 

On  Monday  afternoon  the  annual  general  meeting  of  the 
clergymen  and  laymen  representing  the  congregations  who 
have  contributed  to  this  fund  was  held  at  the  Mansion 
House,  the  Lord  Mayor,  M.P.,  and  afterwards  Sir  J.  Risdon 
Bennett,  presiding.  The  Lord  Mayor  having,  in  opening 
the  proceedings,  expressed  his  willingness  to  render  the  fund 
any  assistance  in  his  power  during  his  year  of  office,  the 
report  of  the  Council  was  submitted.  It  stated  that  the 
eleventh  year  of  the  existence  of  the  fund  disclosed  the 
satisfactory  increase  of  seventy-seven  in  the  number  of 
contributing  congregations  as  compared  with  the  number 
for  the  previous  year.  The  total  amount  realised  was 
<£33,935,  as  against  ,£34,146  in  1882,  ,£31,856  in  1881, 
and  ,£27,700  in  1873  (the  year  when  the  fund  was  started) . 
The  contributing  congregations  had  increased  from  1072  in 
1873  to  1414  last  year.  The  fund  was  distributed  among 
148  institutions,  of  which  a  list  has  already  been  given. 
Four  per  cent,  of  the  total  amount  of  the  collections — 
viz.,  <£1400 — had  been  set  aside  for  the  purchase  of  surgi¬ 
cal  appliances.  The  total  amount  available  for  distribution 
was  ,£32,24.3,  of  which  £29,664  was  given  to  ninety-seven 
hospitals,  and  £2579  to  fifty-one  dispensaries.  The  working 
expenses  had  been  £1149,  or  a  little  over  3  per  cent,  of  the 
gross  receipts.  The  report  having  been  received  and  ap¬ 
proved,  Mr.  Few  moved,  and  the  Rev.  J.  F.  Kitto  seconded, 
the  continuation  of  the  existing  laws  of  the  Society,  with  a 
trifling  alteration.  The  Rev.  J.  W.  Bennett  proposed,  and 
the  Rev.  N.  Loraine  seconded,  an  amendment  suspending, 
in  favour  of  the  Royal  Hospital  for  Incurables,  a  regulation 
by  which  no  institution,  to  the  benefits  of  which  admission 
could  only  be  gained  by  selection  from  the  general  body  of 
subscribers,  should  be  eligible  for  grants  from  the  fund ;  and 
directing  that  that  institution  should  be  admitted  to  a  share 
of  the  fund  in  respect  of  its  hospital  work,  and  exclusive  of 
its  pension-list.  The  subject  gave  rise  to  a  long  debate,  and 
it  was  finally  agreed  that  the  question  should  be  adjourned, 
and  that  a  special  meeting  should  be  called  before  the  next 
collection,  to  determine  whether  or  not  any  alteration  should 
be  made  in  the  constitution  of  the  fund.  The  Council  having 
been  reappointed  with  a  few  changes,  June  15  next  was  fixed 
as  Hospital  Sunday  for  1884 ;  and  votes  of  thanks  having 
been  accorded  to  the  Lord  Mayor  and  Sir  J.  Risdon  Bennett, 
the  proceedings  terminated. 


THE  DIAGNOSTIC  VALUE  OF  THE  BACILLUS 
TUBERCULOSIS. 

Db.  Austin  Flint  stated,  at  a  recent  meeting  of  the 
New  York  Medical  and  Surgical  Society,  that  he  had  lately 
made  this  question  a  subject  of  clinical  study  ;  and,  so  far 
as  his  experience  had  gone,  it  confirmed  the  value  of  the 
presence  of  the  bacilli  in  the  sputa  as  positive  proof  of 
phthisis,  their  absence  being  of  more  or  less  value  in  the  ex¬ 
clusion  of  that  disease,  and  the  importance  of  their  compara¬ 
tive  abundance  or  scarcity  as  bearing  on  the  question  as  to 
whether  the  disease  was  or  was  not  actively  progressing. 


“THE  BOWER  AND  KEATES  CASE.” 


At  a  meeting  of  the  Committee,  held  on  Wednesday  evening, 
December  19  (Sir  William  Jenner,  Bart.,  in  the  chair),  it 
was  agreed — (1)  that  a  copy  of  the  appeal  should  be  sent 
to  every  member  of  the  profession  in  the  United  Kingdom 
whose  name  appears  in  Messrs.  Churchill’s  “  Directory  and 
(2)  that  the  hon.  secretaries  be  requested  to  communicate 
with  the  hon.  secretaries  of  the  various  branches  of  the 


British  Medical  Association,  with  a  view  to  obtain  their 
valuable  co-operation  in  this  matter.  The  following  sub¬ 
scriptions  to  the  indemnity  fund  have  been  received  or 
promised  in  addition  to  those  already  announced  : — 


&  a. 


Sir  William  Gull,  Bart . 10  10 

Mr.  John  Marshall,  F  R.S.  ..  10  10 
Mr.  Jonathan  Hutchinson, 


F.R.S . 

10 

10 

Dr.  Russell  Reynolds,  F.R.S. 

10  10 

Dr.  C.  T.  Williams . 

5 

5 

Mr.  J.  W.  Hulke  . 

Messrs.  Merriman,  Kensing¬ 

5 

5 

ton  . .  . 

5 

5 

Mr.  W.  Pitt  Palmer  . 

5 

5 

Dr.  R.  Barnes . 

5 

5 

Dr.  Gervis . 

5 

5 

Dr.  Kershaw,  Surbiton . 

5 

5 

Mr.  J.  T.  Jackson,  Highbury  5  5 
Dr.  Matthews  Duncan .  3  3 


£.  s. 

Dr.  Gibbings,  Dalston .  3  3 

Mr.  Lumsden  Propert  .  2  2 

Mr.  James  Adams .  2  2 

Dr.  Philpot  .  1  1 

Mr.  Spencer  Watson  .  1  1 

Dr.  Heywood,  East  Dulwich..  1  1 

Mr.  C.  Ballance  .  1  1 

Dr.  Corbett  Blades,  Kenning- 

ton .  1  1 

Mr.  Laurence  Bead,  Kensing¬ 
ton  .  1  1 

Dr.  H.  G.  Swan  .  1  1 

Dr.  Garskill  .  1  1 

Dr.  R.  W.  Burnet .  1  1 

Dr.  Stanley  Haynes,  Malvern  1  1 


THE  PARIS  FACULTY  OF  MEDICINE. 

At  the  last  meeting  of  the  Conseil  Academique  de  Paris, 
it  was  stated  [Gaz.  des  Hop.,  December  11)  that  the  number 
of  medical  students  on  October  1,  1883,  was  4207  (only  two 
less  than  in  October,  1882),  of  whom  108  were  foreigners. 
The  “Egyptian  Mission,”  which  formerly  attended  the  courses 
of  lectures  delivered  at  the  Paris  Faculty,  has,  since  recent 
events,  been  transferred  to  England.  Among  the  medical 
students  of  the  present  session  there  have  been  forty-five 
ladies  (six  more  than  in  1882),  for  the  most  part  Russians. 
Among  the  6076  examinations  which  were  undergone  during 
the  academic  year  1882-83,  the  proportion  of  ajournements 
was  24  per  cent. — the  candidates  having  been  generally  weak 
in  physics,  chemistry,  and  the  natural  sciences. 


THE  TYNEMOUTH  RURAL  SANITARY  DISTRICT. 

Db.  F.  W.  Babby  has  recently  been  employed  for  a  con¬ 
siderable  period,  on  behalf  of  the  Local  Government  Board, 
in  inquiring  into  the  sanitary  condition  of  Tynemouth  and 
its  neighbourhood,  and  his  report  upon  the  Tynemouth 
Rural  Sanitary  District  has  just  been  published.  This 
district  has  fourteen  contributory  places,  divided  into  north 
and  south,  under  two  medical  officers  of  health,  and  from 
Dr.  Barry’s  most  comprehensive  report  it  is  to  be  gathered 
that,  since  the  establishment  of  the  Rural  Authority  under 
the  Public  Health  Act  of  1872,  sanitary  administration  has 
in  several  important  respects  been  efficiently  carried  out. 
Previous  to  that  period  it  is  reported  that  there  was  an 
almost  entire  absence  of  sanitary  arrangements :  drainage 
was  imperfect,  or  entirely  wanting;  privy  accommodation 
there  was  none ;  whilst  the  water-supply  was  very  deficient 
and  inferior  in  quality.  Since  that  time  nearly  all  the  villages 


720 


Medical  Times  and  Gazette. 


SANITARY  WORK  IN  INDIA. 


Deo.  22, 1883. 


have  been  efficiently  drained,  and  the  sewage  dealt  with 
effectually  at  its  outfall ;  the  water-supply  has  been  much 
improved ;  whilst,  with  few  exceptions,  the  dwellings  have 
been  provided  with  means  for  the  storage  of  filth.  Never¬ 
theless,  Dr.  Barry  points  out  that  the  water-supply  is,  as 
yet,  far  from  satisfactory,  the  outbreaks  of  fever  of  the 
enteric  type  which  have  from  time  to  time  occurred  being 
in  nearly  every  instance  traceable  to  polluted  water,  whilst 
the  provision  of  suitable  hospital  accommodation  is  of  the 
first  importance  to  enable  the  Sanitary  Authority  to  cope 
successfully  with  outbreaks  of  infectious  disease. 


Me.  T.  K.  Undekwood  having  resigned  the  position  of 
Dean  of  the  School  in  connexion  with  the  Dental  Hospital 
of  London,  Mr.  Morton  Smale,  M.E.C.S.,  L.D.S.,  has  been 
elected  to  the  post.  Mr.  Smale  has  been  Medical  Tutor  at 
the  institution  for  several  years. 

The  Council  of  the  Ophthalmological  Society  are  desirous 
of  founding  a  library  and  museum  in  connexion  with  the 
Society,  and  with  that  object  in  view  they  have  appointed  a 
small  committee,  who  will  be  glad  to  receive  any  gifts  of 
books,  instruments,  appliances,  or  drawings  relating  to 
ophthalmic  medicine  or  surgery.  Communications  should 
be  addressed  to  either  of  the  Hon.  Secretaries,  viz..  Dr. 
Abercrombie,  39,  Welbeck-street,  or  Dr.  Brailey,  16,  Orchard- 
street,  Portman-square,  W. 


SANITARY  WORK  IN  INDIA. 


The  ignorance  and  want  of  curiosity  shown  by  most 
Englishmen  as  to  the  affairs  of  their  great  Imperial  depen¬ 
dency  has  become  proverbial.  Only  when  a  war,  or  a  great 
pestilence,  or  a  famine,  or  flood,  or  other  disturbance  of 
natural  progress  bursts  upon  the  country  is  their  interest  at 
all  excited.  The  medical  profession,  cultured  as  it  is,  is  not 
exempt  from  the  general  want  of  knowledge  and  curiosity, 
and  though  the  experiments  in  disease  that  Nature  makes 
in  India,  and  the  experiments  in  prevention  that  man  is 
opposing  to  her,  are  both  on  a  scale  which  dwarfs  our  largest 
efforts  at  home,  all  is  allowed  to  pass  without  notice  or 
comment  here.  This  is  not  fair  either  to  ourselves  or  to  the 
hundreds  of  brother  workers  who  are  doing  such  good 
service  amongst  the  difficulties  and  trials  of  an  Indian 
life.  The  fault,  perhaps,  is  in  great  measure  due  to  the 
unattractive  form  in  which  information  on  the  subject  is 
presented.  For  the  man  who  wishes  to  ‘study  sanita¬ 
tion  in  the  East,  nothing  can  be  more  satisfactory  than 
the  Reports  of  the  Sanitary  Commissioners  of  India,  with 
their  long  and  well-arranged  array  of  figures  and  tabular 
statements  ;  but  for  the  man  who  only  reads,  and  who  has  no 
turn  for  statistics,  these  reports  are,  to  say  the  least,  un¬ 
inviting.  Some  day  in  the  future,  it  is  to  be  hoped,  a  writer 
with  the  historian’s  gift  will  take  these  figures  in  hand, 
and  weave  for  us  out  of  them  a  story  which  will  excite  our 
interest  in  spite  of  ourselves. 

The  whole  sanitary  work  of  India  was.  reorganised  by  the 
Government  some  seven  years  ago,  and  since  then  much 
valuable  work  has  been  done.  In  the  presidency  towns,  Cal¬ 
cutta,  Madras,  and  Bombay,  sanitation  is  placed  under  the 
supervision  and  direction  of  special  health-officers  appointed 
and  paid  by  the  respective  municipalities.  Their  position 
and  duties  are  exactly  analogous  to  those  of  urban  medical 
officers  of  health  at  home,  except  that  they  are  much  less 
hampered  in  the  discharge  of  their  duties  by  the  conflict  of 
vested  interests.  In  rural  India  the  sanitary  arrangements 
are  considerably  different.  Each  presidency  is  placed  under  a 
sanitary  commissioner,  who  ranks  as  a  deputy  surgeon-  general 
but  is  independent  of  the  head  of  the  Medical  Department. 
For  registration  purposes,  each  presidency  is  divided  into 
a  certain  number  of  districts,  varying  in  area  and  popula¬ 
tion,  for  each  of  which  there  is  a  medical  officer  designated 
a  deputy  sanitary  commissioner.  It  is  these  officials  who 


have  the  sanitary  welfare  of  India  in  their  hands.  Their 
duties  are  onerous,  but  varied  and  interesting.  They  in¬ 
clude  the  compilation  of  the  vital  statistics  of  the  district, 
the  superintendence  of  vaccination,  and  the  supervision  of 
the  sanitary  condition  of  towns  and  villages,  more  especially 
the  latter.  All  this  entails  constant,  careful  supervision, 
and  a  large  and  yearly  increasing  amount  of  clerical  labour, 
the  establishment  for  each  office  at  present  sometimes  being 
four  clerks.  The  birth  and  death  registers  are  made  up  by 
the  revenue  officers  in  the  vernacular,  and  are  sent  monthly 
to  the  office  of  the  deputy  sanitary  commissioner,  where 
they  are  transferred  to  English  forms  before  being  submitted 
to  the  sanitary  commissioner.  The  registers  are  not  so 
accurate  as  could  be  wished,  but  this  is  not  the  fault  of  the 
Sanitary  Department. 

Vaccination  is  compulsory  in  a  few  of  the  large  towns 
only ;  Bombay,  faithful  to  its  motto,  “  Primus  in  Indis,” 
having  been  the  first  to  set  a  praiseworthy  example  in  this 
respect.  Animal  vaccination  is  practised  probably  on  a 
larger  scale  in  Bombay  than  in  any  other  part  of  the  globe 
— a  fact  which  greatly  redounds  to  the  liberal  spirit  of  its 
municipality.  In  the  districts  arm-to-arm  vaccination  is 
the  practice,  lymph  being  changed  as  occasion  requires  by 
supplies  from  England  in  the  cold  season,  when  the  vaccine 
germ  is  more  active,  and  yields  more  satisfactory  results. 
The  variolous  poison  also  appears  to  acquire  greater  strength 
in  the  winter,  if  one  may  judge  from  the  prevalence  of 
small-pox  in  the  plains  of  India  —  a  fact  possibly  due  to  the 
lower  temperature  of  the  atmosphere  causing  increased 
gaseous  tension.  Small-pox  is  undoubtedly  spread  by  hill- 
tribes,  who  are,  as  a  rule,  very  dirty  people  clad  in  woollen 
tatters  seldom  washed.  The  disease  is  also  propagated  by 
inoculation,  which  is  still  practised  in  native  States,  and  is 
periodically  imported  into  British  territory,  especially  in 
the  cold  season,  when  communication  with  hilly  countries 
is  more  general ;  in  the  hot  season  in  the  plains  the 
disease  invariably  declines.  This  may  be  partly  owing 
to  the  increased  activity  of  the  skin,  and  partly  due  to 
the  fact  that  bathing  is  also  more  frequently  practised  on 
account  of  the  heat  and  from  water  being  more  plentiful  in 
canals  and  tanks ;  and,  lastly,  the  attenuated  state  of  the 
air  may  be  an  important  factor  in  'diluting  the  poison. 
Wherever  small-pox  breaks  out,  the  vaccinator  promptly 
operates  on  all  unprotected  persons  within  his  reach.  The 
inspector  and  an  additional  vaccinator  are  also  detailed  for 
duty  in  the  affected  district,  should  their  services  be  neces¬ 
sary,  and  revaccination  is  largely  carried  on.  The  deputy 
sanitary  commissioner  personally  renders  all  possible  aid  as 
regards  treatment,  isolation,  and  disinfection,  and  reports  to 
his  immediate  superior,  the  sanitary  commissioner,  on  the 
origin,  source,  and  type  of  the  disease.  Any  reported  death 
from  small-pox  after  vaccination  is  specially  inquired  into, 
and  it  is  needless  to  add  that  such  cases  invariably  prove 
not  to  have  well-marked  cicatrices. 

The  blessings  of  J enner’s  discovery  are  fully  appreciated 
by  the  more  intelligent  classes,  who  take  a  pardonable  pride 
in  exhibiting  three  or  four  typical  scars  on  one  or  both  arms 
of  their  swarthy  little  ones  ;  for  it  is  customary  in  India  to 
vaccinate  on  both  arms  at  once,  and  with  the  most  successful 
issue.  There  is  some  difficulty  experienced  in  vaccinating 
females  of  the  higher  class,  who  dare  not  show  their  faces 
to  a  strange  male,  or  indeed  to  anyone  outside  the  harem. 
In  some  instances  midwives  have  been  taught  how  to  vac¬ 
cinate,  but  the  result  of  their  work  could  not  be  satisfac¬ 
torily  verified.  We  would  invite  the  attention  of  our  female 
confreres  who  are  about  to  embark  on  an  Indian  career  to 
this  important  sphere  of  labour  and  usefulness  among  their 
less  favoured  sisters. 

Deputy  sanitary  commissioners  are  travelling  through 
their  districts  during  eight  months  of  the  year,  when  they 
come  into  personal  contact  with  people  of  all  classes,  their 
presence  and  precepts  exercising  the  most  beneficial  in¬ 
fluence  in  regard  to  preventable  diseases.  The  water- 
supply  of  each  town  and  village  is  examined,  and  the  con¬ 
dition  of  wells,  tanks,  and  canals  noted ;  any  source  of 
contamination  is  pointed  out,  and  suggestions  and  recom¬ 
mendations  are  made  to  remedy  existing  defects.  Meat  and 
fish  markets  are  inspected,  and  precautions  adopted  with 
regard  to  the  sale  of  unwholesome  food.  Slaughter-houses 
are  established  at  a  distance  from  human  habitations,  and 
the  necessary  supervision  is  exercised.  Surface  cleanliness 
and  conservancy  are  attended  to  by  a  staff  of  scavengers  of  a 


Medical  Times  and  Gazette.  MEDICAL  REPORTS  TO  THE  LOCAL  GOVERNMENT  BOARD.  Dec.  22,  1888.  721 


strength  proportionate  to  the  population  of  the  town,  canton¬ 
ment,  or  village.  The  night-soil  is  removed  from  the  privies 
to  depots  conveniently  situated,  from  which  it  is  carted 
off  to  some  distance  to  be  converted  into  “  poudrette,” 
burned,  or  buried  in  pits.  When  buried  in  trenches  it 
becomes  converted,  after  nine  months  or  a  year,  into  a  rich 
black  mould,  which  is  sold  for  manure  whenever  there 
happens  to  be  a  sufficient  demand.  The  dry-earth  system 
is  carried  out  to  perfection  in  those  of  the  Indian  gaols  which 
are  favourably  situated  as  regards  arable  land.  The  soil  is 
applied  to  the  ground  in  a  fresh  state  in  gardens  where 
luxuriant  crops  of  vegetables  are  grown  for  the  use  of  the 
prisoners  or  for  sale  in  the  bazaars,  the  sums  realised  being 
credited  to  Government.  In  the  smaller  outlying  villages 
special  plots  of  ground  and  patches  of  jungle  are  set  apart 
for  natural  purposes,  care  being  taken  that  they  are  distant 
from  the  drinking-water  source,  and,  if  possible,  not  in  the 
direction  of  the  prevailing  winds.  To  prevent  the  pollution 
of  the  water-supply,  special  stations  are  appointed  for  the 
use  of  washermen  and  watering  animals.  In  conclusion,  it 
may  be  stated  that  there  is  not  the  least  doubt  that  the 
sanitary  condition  of  many  Indian  villages  would  compare 
favourably  with  that  of  villages  at  home,  and  it  is  question¬ 
able  whether  any  nuisance  exists  in  the  East  as  aggravating 
as  that  caused  by  a  London  dustcart  on  a  windy  day.  As 
these  receptacles  are  uncovered  and  heaped  high  with 
sweepings,  a  cloud  of  dust  is  blown  from  them  as  they  are 
driven  along  the  thoroughfares.  Such  an  arrangement  is 
scandalous  and  discreditable  to  the  richest  municipality  in 
the  world,  and  it  should  be  forcibly  brought  to  the  notice  of 
the  sanitary  authorities,  as  in  all  probability  many  diseases 
are  propagated  by  this  means. 


MEDICAL  REPORTS  TO  THE  LOCAL 
GOVERNMENT  BOARD. 


Fever  Prevalence  in  Liverpool. 

Dr.  J.  Stopford  Taylor,  Medical  Officer  of  Health  for  the 
City  and  Port  of  Liverpool,  in  his  report  on  the  sanitary 
condition  of  the  locality  for  the  year  1882,  refers  to  the 
remarks  which  he  made  when  commenting  on  the  history  of 
the  previous  year,  with  regard  to  the  increase  of  fever 
(chiefly  typhus)  in  his  district  among  the  poorer  population. 
The  apprehensions  of  its  increase  then  entertained  have,  he 
says,  been  unfortunately  realised,  since  the  number  of 
deaths  during  the  past  year  has  been  593,  against  292  in 
1881,  and  the  number  of  cases  coming  under  the  notice  of 
the  medical  officer  of  health  has  been  2643,  or  1436  more 
than  in  the  previous  year.  The  prevalence  of  fever  is.  Dr. 
Taylor  observes,  generally  associated  with  insanitary  pro¬ 
perty  and  crowded  courts  and  alleys  ;  but  in  the  early  part 
of  the  year  under  notice  there  was  an  outbreak  in  the  West 
Derby  district,  just  outside  the  municipal  boundaries,  where 
the  houses  are  comparatively  new,  and  the  situation  elevated, 
open,  and  healthy ;  but  some  of  the  houses  were  occupied 
by  a  class  similar  to  those  dwelling  in  the  lowest  parts  of 
the  city,  and  when  fever  got  amongst  them  it  spread  rapidly. 
From  January  to  April  twenty-nine  cases  were  sent  to  the 
Brownlow  Hill  hospital  from  this  district  alone,  eight  of 
which  terminated  fatally.  The  necessity  for  a  system  of 
compulsory  notification  of  infectious  diseases  is.  Dr.  Taylor 
thinks,  becoming  more  generally  felt  as  the  very  first  step 
in  preventive  treatment ;  the  subject,  he  says,  has  been  dis¬ 
cussed  both  in  the  Council  and  by  the  Health  Committee,  but 
nothing  definite  has  resulted  beyond  affirming  the  principle. 
Meanwhile,  the  report  observes,  it  is  futile  to  expect  that  a 
sanitary  authority  which  only  receives  information  of  the 
dying  and  the  dead  will  be  able  to  cope  with  infectious 
disease  whilst  it  is  being  secretly  spread  and  scattered 
broadcast  by  the  affected  as  well  as  by  their  visitors  and 
attendants.  However  desirous  many  persons  may  be  to 
nurse  the  sick  at  their  homes,  it  is  utterly  impossible  to  so 
isolate  cases  of  fever  in  small  or  even  ordinary- sized  houses, 
as  to  secure .  the  other  members  of  the  family,  and  the 
public  from  the  danger  of  infection  ;  whilst  by  the  early 
removal  of  the  sufferers  to  clean,  airy  wards,  with  skilled 
and  trained  nurses  to  attend  upon  them,  they  have  a  much 
better  chance  of  recovery  than  if  left  at  home  to  the  kind 
but  inexperienced  management  of  relatives  and  friends. 


The  Work  of  the  Medical  Officer  of  Health 
for  the  Port  of  London. 

The  half-yearly  report  of  Dr.  Collingridge,  to  June  30  last, 
in  his  capacity  of  Medical  Officer  of  Health  for  the  Port  of 
London,  has  recently  been  made  public.  In  the  outset  the 
report  calls  attention  to  the  increased  duties  imposed  upon 
the  staff,  consequent  upon  the  extension  of  the  Committee’s 
jurisdiction  below  Gravesend;  also  to  the  fact  that  such 
extension  necessitates  increased  hospital  accommodation, 
since,  in  the  event  of  cases  of  infectious  disease  being  met 
with  in  vessels  lower  down,  while  it  would  obviously  be  out 
of  the  question  to  allow  them  to  remain  on  board,  it  would 
be  equally  impossible  to  remove  them  twenty  or  thirty  miles 
to  the  hospital-ship  at  Gravesend.  To  meet  this  difficulty. 
Dr.  Collingridge  suggests  that,  as  there  is  a  small  hospital 
at  Eochford  for  infectious  diseases,  under  the  control  of  the 
Eochford  Union,  arrangements  should  be  made  with  that 
authority  to  receive  any  cases  that  might  occur  within  a 
reasonable  distance  of  it ;  and  this  suggestion  is  being  con¬ 
sidered  by  the  Committee  of  the  Corporation.  It  would 
also  appear  that  the  old  hospital-ship  Rhin,  which  has  for 
so  long  a  time  been  stationed  off  Gravesend,  is  to  be  super¬ 
seded  by  a  hospital  built  on  shore  on  a  piece  of  land  acquired 
outside  that  town.  This,  Dr.  Collingridge  thinks,  is  a  very 
wise  decision :  the  Rhin  has  undoubtedly  been  of  great 
service,  but  she  was  most  unfitted  for  a  hospital,  being  too 
large,  and  absolutely  without  proper  arrangements  for  venti¬ 
lation  ;  her  timbers,  also,  were  so  rotten  as  to  be  absolutely 
unsafe,  while  the  whole  structure  was  just  in  a  condition  to 
retain  infection. 

With  the  exception  of  small-pox,  the  Port,  during  the 
six  months  under  notice,  has  been  exceptionally  free  from 
infectious  disease,  and,  happily,  those  cases  which  have 
occurred  have  all  been  quickly  discovered,  and  every  pre¬ 
caution  taken  to  prevent  the  spread  of  the  disease.  In  the 
case  of  a  vessel  hailing  from  Seaham,  from  which  a  man  was 
removed  with  semi-confluent  small-pox,  although  the  vessel 
was  duly  fumigated,  on  her  leaving  the  Thames  notice  was 
sent  to  the  Medical  Officer  for  the  Port  of  Seaham,  in  order 
that  special  attention  might  be  paid  to  her.  The  system  of 
intercommunication  between  medical  officers  of  different 
ports  has.  Dr.  Collingridge  explains,  now  become  a  settled 
thing,  and,  as  might  be  expected,  has  been  productive  of 
extremely  good  results.  Thus,  the  fact  of  a  vessel  leaving 
one  port  for  another  by  no  means  frees  her  from  sanitary 
inspection,  as  notice  reaches  the  port  of  destination  before 
she  can.  Four  of  the  school-ships  stationed  on  the  river 
were  visited  by  either  typhoid  or  scarlet  fever  during  the 
six  months.  In  at  least  two  instances  the  infection  was  im¬ 
ported  by  lads  returning  from  a  holiday  on  shore.  On  May  3 
last  a  large  number  of  boys  on  board  the  Cornwall  were 
.attacked  with  curiously  vague  and  indefinite  symptoms. 
Two  cases  were  diagnosed  as  enteric  fever,  and  seven  as 
scarlet  fever — in  most  of  the  latter  there  being  no  eruption. 
The  remaining  cases — fifty-four  in  all, — though  they  could 
scarcely  be  classed  as  any  definite  disease,  presented  well- 
marked  and  similar  symptoms.  There  was,  the  report  says, 
in  most  cases  a  distinct  rise  of  temperature  for  a  few  days 
only,  followed  frequently  by  a  temperature  much  below 
normal,  and  almost  invariably  accompanied  by  diarrhoea, 
whilst  sorethroat  was  a  marked  feature  with  most.  Dr. 
Collingridge  bears  testimony  to  the  thorough  arrangements 
which  were  made  on  board  the  ship  for  checking  the  out¬ 
break  ;  but,  although  he  undertook  a  careful  investigation 
and  thorough  examination  of  the  vessel,  he  was  reluctantly 
compelled  to  come  to  the  conclusion  that  the  cause  of  the 
outbreak  was  not  to  be  discovered. 


Diminution  of  Blindness. — The  authors  of  the  recent 
Census  note  the  encouraging  facts  that  the  proportion  of 
the  blind  to  the  population  has  not  only  decreased  with  each 
successive  enumeration  since  1851  (in  which  year  account  of 
them  was  taken  for  the  first  time),  but  the  decrease  in  the 
decade  ending  in  1881  was  much  greater  than  in  either  of 
the  preceding  decennial  intervals.  The  number  of  cases 
returned  on  this  latter  occasion  was  22,832 — equal  to  one 
blind  person  in  every  1138.  This  decrease  is  considered  to 
be  fairly  attributable  to  the  progressive  improvement  in 
the  surgical  treatment  of  affections  of  the  eyes,  and  to  the 
diminished  prevalence  among  children  of  such  diseases  as 
'  small-pox. 


722 


Medical  Times  and  Gazette. 


ABSTRACTS  AND  EXTRACTS. 


Dec.  22, 1883. 


ABSTRACTS  AND  EXTRACTS. 


Salicylate  of  Soditjm. — Dr.  Kennedy,  in  the  Pliil. 
Med.  Reporter,  November  24,  recommends  the  following 
formula  for  rendering  the  salicylate  of  sodium  pleasant 
to  the  taste:  —  R.  Sod.  bicarb.  5 ij .  ;  acid,  salicyl. 
glycerinae,  aquse,  5a  gij.  :  a  teaspoonful  every  four  hours. 
The  carbonic  acid  gas  is  set  free,  and  the  sodium  uniting 
with  the  salicylic  acid,  forms  a  salicylate,  which  is  held  in 
suspension  by  the  glycerine. 

Foreign  Bodies  in  the  Ear. — Dr.  Chisolm,  of  Bal¬ 
timore,  in  a  paper  read  at  the  Medical  Society  of  Virginia, 
stated  that  little  bony  projections  at  the  outside  of  the 
membrana  tynipani  are  often  taken  for  foreign  bodies,  and 
the  attempt  to  extract  them  has  produced  disease  and  per¬ 
manentdeafness.  In  proof  of  this  statement,  he  cited  several 
cases  which  had  come  under  his  own  notice.  He  believes 
that  there  are  numerous  cases  of  individuals  living  many 
years  with  foreign  bodies  in  the  ear  without  a  knowledge  of 
the  fact,  and  stated  that  most  instances  of  inflammation  of 
the  ear  were  due  more  to  injudicious  attempts  at  removal 
than  to  the  presence  of  the  body  itself.  He  had  never  seen, 
in  all  his  experience  as  a  specialist,  a  case  of  foreign  body  in 
the  ear,  not  interfered  with  by  another  person,  which  he 
was  unable  to  remove  by  the  careful  use  of  a  syringe  and 
warm  water.  In  all  instances  of  leguminous  or  other  foreign 
bodies  that  increase  in  size  by  the  absorption  of  water  in 
the  ear,  he  recommends  the  filling  the  meatus  with  pure 
alcohol,  to  produce  shrinkage,  before  using  the  syringe. — 
New  York  Med.  Record,  September  15. 

The  Mixture  of  Chloroform  and  Air  as  an  Anaes¬ 
thetic.— Prof.  Paul  Bert  read  to  the  Societe  de  Biologie  a 
note  from  M.  Peyraud,  of  Libourne,  in  which  he  stated  that 
his  employment  of  a  mixture  of  air  with  chloroform  in 
surgical  anaesthesia  had  furnished  him  with  the  same  results 
as  those  obtained  by  Prof.  Bert  in  his  experiments  on  the 
dog.  By  this  procedure,  which  consists  in  pouring  out  a 
drop  of  chloroform  at  each  inspiration,  M.  Peyraud  succeeds 
in  obtaining  anaesthesia  with  very  small  quantities  of  chloro¬ 
form,  and  without  inducing  a  period  of  agitation.  Thus, 
a  young  woman  was  anaesthetised  with  six  grammes  in  seven 
minutes,  while  a  child  of  four  years  of  age  required  only 
three  grammes.  A  woman  also,  suffering  from  cancer  of 
the  breast,  who  had  been  twice  given  up  in  despair  by 
surgeons  in  consequence  of  her  unprecedented  resistance  to 
the  effects  of  chloroform,  was  rendered  by  this  procedure 
completely  insensible  by  means  of  twenty-five  grammes, 
although  the  operation  lasted  an  hour.  M.  Peyraud 
employs  a  mixture  consisting  of  twelve  grammes  of  chlo¬ 
roform  to  100  litres  of  air,  while  Prof.  Bert  in  his  experi¬ 
ments  has  employed  ten  grammes. — Gazette  des  Hopitaux, 
December  4. 

Tuberculosis  and  the  German  Army. — The  Berlin 
correspondent  of  the  Phil.  Med.  News,  August  25,  states 
that  a  circular  has  been  issued  from  the  Medical  Depart¬ 
ment  of  the  Ministry  of  War,  urging  upon  the  army  medical 
officers  to  give  their  earnest  attention  to  commencing  tuber¬ 
culosis  amongst  recruits,  and,  as  far  as  possible,  not  to  enrol 
suspected  individuals  at  all,  or,  if  enrolled,  to  dismiss  them 
from  the  service  in  the  earliest  stages  of  the  disease.  Hos¬ 
pital  patients  suffering  from  unquestionable  tuberculosis 
are  to  be  isolated,  and  their  sputa  are  to  be  disinfected.  It 
is  firmly  hoped  that  the  death-rate  from  tuberculosis — al¬ 
ready  diminished  to  3  "8  per  1000  by  the  sanitary  improve¬ 
ment  of  barracks  and  hospitals — may  thus  be  reduced  to  its 
lowest  possible  degree.  In  relation  to  this  question,  the 
microscopic  examination  of  the  sputa  lately  has  become  of 
the  greatest  importance,  and,  therefore,  first-rate  micro¬ 
scopes  were  recently  distributed  among  all  the  larger 
garrison  hospitals,  in  order  to  facilitate  an  early  diagnosis. 
Prof.  Fraentzel,  who  is  also  an  army  medical  officer, 
in  a  paper  read  at  the  Berlin  Military  Medical  Society, 
warmly  approved  of  this  step  taken  by  the  War  Depart¬ 
ment.  He  said  he  felt  a  pride  in  having  been  the  first 
among  German  clinical  teachers  who  had  adopted  the  germ- 
theory  of  tuberculosis,  and  scrupulously  applied  its  logical 
deductions  to  clinical  practice.  Continued  experience,  now 
comprising  upwards  of  500  cases,  served  to  confirm  his 
former  views  as  to  the  diagnostic  and  prognostic  value  of 
the  tubercle-bacilli  found  in  the  sputa. 


REVIEWS. 

- - 

A  System  of  Surgery,  Theoretical  and  Practical.  In  Treatises 
by  Various  Authors.  Edited  by  T.  Holmes,  M.A.  Cantab., 
and  J.  W.  Hulke,  F.B.S.  Third  Edition,  in  three 
volumes,  with  illustrations.  London :  Longmans,  Green, 
and  Co.  1883.  Pp.  1109,  964,  and  942. 

[First  Notice.] 

The  editors  of  the  present  edition  of  the  “  System  ”  are, 
on  the  whole,  to  be  congratulated  on  the  completion,  no  less 
than  on  the  result,  of  their  labours.  They  "  plead  the  extreme 
difficulty  of  their  task  as  an  excuse  for  the  many  shortcomings 
of  which  they  are  conscious  in  its  execution,”  and  thus,  in 
part,  they  disarm  much  of  the  criticism  which  would  other - 
wisehavetobe  made .  In  the  co  m  pilat  ion  of  all  s  uch  "  systems  ” 
as  this  before  us,  there  are  sure  to  be  inequalities  in  the 
style  and  treatment  of  the  subjects  ;  and  this  is  all  the  more 
likely  to  occur  when  new  authors  have  to  be  introduced  either 
to  re-edit,  re-write,  replace,  modify,  or  supplement  the  old 
essays  ;  for  it  is  through  one  or  other  of  these  processes,  we 
find,  that  the  old  essays  have  passed  before  being  presented 
to  us  in  the  new  edition.  Better  were  it,  by  far,  for  all 
parties,  including  the  readers,  if  when  an  author  for 
some  reason  or  other  no  longer  edits  his  own  essay,  an 
entirely  new  article  were  substituted,  and  its  treatmant 
left  altogether  to  the  discretion  of  the  newly  selected 
author.  Our  contention  will  readily  be  granted,  we  think, 
by  anyone  who  will  contrast  one  of  the  new  articles  in  the 
present  edition  with  one  from  the  old  edition  which  has 
only  been  <c  modified  ”  or  “  re-edited  ”  or  supplemented.” 
It  is  stated  that  the  same  general  arrangement  has  been 
followed  as  in  the  two  former  editions ;  and  that  all  the 
treatises  have  been  carefully  revised  either  by  the  original 
authors  or  “  by  surgeons  of  known  authority  on  the  topics 
in  question.”  Doubtless  this  is  correct  in  a  great  many 
instances,  but  it  appears  to  us  that  there  are  some  notable 
exceptions.  Let  us  glance  at  a  few  of  the  most  striking. 
Speaking  of  certain  very  special  advances  which  have  been 
made  in  surgery,  the  editors  say  that  they  have  ‘c  evidently 
coincided  with  the  introduction  of  what  is  known  as 
Antiseptic  Surgery  ”;  and  yet,  in  this  ,r  faithful  mirror  of 
the  teaching  and  practice  of  surgery  in  England  at  the 
present  day,”  there  is  no  detailed  description  of  the  most 
approved  mode  of  applying  antiseptic  or  Listerian  precau¬ 
tions,  for  Mr.  Croft’s  brief  remarks  in  Vol.  I.  can  hardly  be 
regarded  in  this  light.  In  any  other  country  the  great 
master  himself — Professor  Lister — would  doubtless  have 
been  solicited  to  supply  such  a  chapter  as  that  on  the  mode 
of  treating  wounds  which  bears  his  name;  failing  him 
one  would  like  to  have  seen  the  chapter  written  by  one 
of  his  pupils :  for  there  is  no  more  important  chapter 
in  the  whole  book  than  this.  Surely  Mr.  Watson  Cheyne 
might  have  been  more  usefully  employed  in  writing  a 
chapter  on  antiseptics  than  one  on  artificial  limbs,  although, 
as  regards  the  latter  subject,  from  the  editor’s  point  of 
view,  Mr.  Cheyne  is  no  doubt  a  surgeon  “  of  known  autho¬ 
rity  on  the  topics  in  question.”  It  is  not  a  little  curious 
that  in  this  country  there  is  no  short  authoritative  expo¬ 
sition  of  the  antiseptic  method  of  dressing  wounds,  so  that 
those  who  have  not  had  the  benefit  of  being  Mr.  Lister’s 
pupils  have  no  means  of  learning  it  otherwise  than  piece¬ 
meal.  By  a  curious  editorial  arrangement.  Professor  Lister 
contributes  the  article  on  Anaesthetics.  He  is  no  doubt  an 
“  authority  on  the  topic  in  question,”  and  one  far  too  high 
to  suffer  in  any  way  from  an  expression  of  regret  on  our  part 
that  this  very  specialised  subject  was  not  placed  in  the 
hands  of  a  man  who  devotes  himself  entirely  to  this  branch 
i  of  operative  surgery. 

The  editors  say,  “  Among  the  most  important  of  the 
practical  changes  we  may  note  the  immense  progress 
which  has  been  made  in  the  operative  treatment  of  tumours 
and  other  affections  of  the  abdominal  cavity.”  We  ac¬ 
cordingly  turn  to  the  chapters  on  these  subjects,  again  to 
find,  truly,  writers  “  of  known  authority  on  the  topics  in 
question,”  but  not  surgeons  specially  devoting  themselves 
to  the  practice  and  study  of  abdominal  surgery.  The 
writers  are  of  such  celebrity,  however,  that  we  may  safely 
repeat  the  spirit  of  our  criticism  on  antiseptics.  And 
firstly  as  regards  Ovariotomy,  the  author  of  this  article 
admits  “  that  no  impression  can  be  more  false  than  that 


Medical  Times  and  Gazette. 


REVIEWS. 


Dec.  22, 1883.  7  2  3 


the  extirpation  of  an  ovarian  tumour  is  a  procedure  re¬ 
quiring  but  little  surgical  skill  or  forethought,  and  making 
demands  only  upon  the  surgeon’s  courage  ”;  that,  on  the 
contrary,  “  there  is,  perhaps,  no  operation  in  surgery  pre¬ 
senting  greater  scope  for  ingenuity,  and  requiring  more 
prompt  attention  to  numerous  details  in  its  performance. 
Hence  the  remarkable  success  which  has  attended  the  ope¬ 
ration  in  the  hands  of  specialists  as  compared  with  that  of 
other  surgeons.”  Surely  in  the  country  where  ovariotomy 
has  practically  been  worked  out  and  reduced  to  a  system 
largely  by  the  genius  and  perseverance  of  one  man — Sir 
Spencer  Wells — it  might  have  been  expected  that  the  chapter 
upon  it  would  have  been  written  either  by  him  or  by  one  of 
his  immediate  pupils.  Secondly,  as  regards  “  Renal  Calculus 
and  operations  for  its  removal.”  This  equally  special  sub¬ 
ject  is  discussed  briefly  (in  three  pages)  under  diseases  of  the 
urinary  organs.  In  this  case  too  the  author  is  a  distinguished 
surgeon ;  but  he  does  not  speak  on  renal  surgery  with  any¬ 
thing  like  the  same  weight  as  on  calculus  in  certain  other 
organs.  It  is  to  the  abdominal  surgeons  in  great  part  that  we 
owe  present  advances  in  this  department,  and  it  would  have 
been  by  them  that  these  subjects  could  have  been  most 
usefully  treated. 

We  may  also  allude  in  the  same  sense  to  the  chapter  on 
Osteotomy.  Although  specially  mentioned  in  the  preface,  as 
among  the  most  important  of  the  practical  changes  made  in 
this  new  edition,  yet  the  whole  subject,  as  applied  “at  the 
hip,  knee,  leg  bones,  and  radius,”  is  summed  up  in  four 
pages.  These  are  written  not  by  a  surgeon,  but  by  a  Fellow 
of  the  Royal  College  of  Physicians— a  gentleman  whose 
name  has  long  been  honourably  associated  with  orthopaedic 
surgery,  but  who  can  scarcely  be  regarded  as  “  of  known 
authority  ”  in  this  special  department  of  practice.  Again, 
the  chapter  on  Injuries  and  Diseases  of  Nerves  has,  curiously 
enough,  been  entrusted  to  a  foreigner,  and,  what  is  more 
remarkable,  to  an  author  whose  views  on  some  of  the  most 
important  of  the  cerebral  functions  are  considered  heterodox, 
whose  views,  at  any  rate,  differ  from  those  held  by  most  dis¬ 
tinguished  English  neurologists — a  poor  compliment,  we 
hold,  to  Englishmen,  whose  reputation  in  this  department 
of  professional  work,  whether  as  original  workers  or  sound 
thinkers,  stands  second  to  none  in  the  world. 

We  need  not  enlarge  further  on  the  selection  of  the  authors 
of  the  various  treatises.  Enough  has  been  said,  we  think, 
to  justify  the  expression  of  our  opinion  that  the  “  System  ” 
can  hardly  claim  to  be  as  perfect  an  exposition  of  the  theory 
and  practice  of  the  English  school  of  surgery  as  it  might 
have  been.  We  regret  to  find  that  neither  Edinburgh 
nor  Dublin  nor  any  of  the  great  provincial  schools  is 
represented  amongst  the  authors;  London  alone  has  been 
thought  worthy  of  this  honour,  and  even  there  the  dis¬ 
tribution  of  work  among  the  different  hospitals  is  curiously 
unequal.  Thus,  St.  George’s  Hospital  contributes  twenty- 
two  articles — one  more  than  Guy’s,  St.  Thomas’s,  and  Uni¬ 
versity  Hospitals,  all  combined ;  St.  Bartholomew’s  con¬ 
tributes  seven;  King’s,  four;  the  London,  two;  and  the 
Middlesex,  nine  articles. 

With  these  preliminary  and  general  remarks  on  the 
editorial  arrangement  of  the  work  as  a  whole,  we  will  pass 
on  to  a  less  invidious  task — to  the  consideration  of  the  in¬ 
dividual  volumes  ;  confining  ourselves  in  the  present  notice 
to  volume  the  first.  This  volume  opens  with  an  article 
on  Inflammation;  or  it  would  perhaps  be  more  correct  to 
say,  with  two  articles  on  this  subject — one  by  Mr.  Simon, 
the  other  by  Dr.  Burdon-Sanderson.  Mr.  Holmes,  though 
he  edits  the  former,  has  left  “the  general  article  practically 
untouched,”  thinking  that  “  it  will  not  be  without  its  use 
to  the  student  of  pathology  to  compare  the  doctrines  of 
to-day  with  those  of  a  previous  though  still  recent  period. 
.  .  .  .”  Doubtless  such  study  would  be  interesting,  and 
edifying  too,  not  only  as  regards  this  subject,  but  many 
others  also;  but  it  would  have  been  more  in  accordance  with 
custom,  and  better  suited  to  the  limited  space  at  the  disposal  of 
the  editors,  to  have  referred  readers  to  previous  editions  of 
the  work,  where  the  articles  might  have  been  read  fresh  from 
the  pen  of  the  writer,  and  without  annotation  of  any  kind. 
These  articles,  as  they  stand  at  present,  are  in  many  re¬ 
spects  contradictory  rather  than  supplemental  of  each 
other,  though,  as  Dr.  Sanderson  does  not  enter  into  the 
subject  of  treatment,  on  that  head  our  remark  does  not 
apply.  Thus,  Mr.  Simon  refers  to  “  agents  which, 
when  in  the  blood,  exert  specific  powers  of  textural 


change,  ....  acting  after  the  manner  of  ferments.” 
Speaking  of  their  action,  as  contrasted  with  the  effects  of 
traumatism  (which  latter  are  believed  to  be  due  to  the 
traumatism,  pure  and  simple),  he  says — “But  between  the 
two  cases  there  is  this  difference :  in  order  that  a  stab  or 
bruise  or  burn  shall  cause  inflammation,  no  bodily  pre¬ 
disposition  (except  the  fact  of  being  alive)  is  necessary ;  but 
in  all  living  persons  alike,  on  a  certain  quantity  of  the  hurt, 
inflammation  assuredly  results  ;  whereas,  on  the  other  hand,, 
the  morbid  poisons  are  inoperative  as  exciting  causes  of 
inflammation,  except  where  there  is  a  definite  bodily  pre¬ 
disposition.  .  .  .  ”  Dr.  Sanderson,  on  the  other  hand, 
founds  his  etiology  purely  on  the  results  of  experimental 
investigation;  he  says — “We  must  take  as  the  basis  of 
our  inquiries  what  we  have  learnt  by  experiment  and 
observation  as  to  the  way  in  which  it  begins  when  it  is 
produced  intentionally  or  accidentally  by  inj  uries  of  which 
.  we  can  measure  and  limit  the  action.”  And  elsewhere,  in 
summarising  the  results  obtained  from  certain  experimental 
investigations,  he  says  that  “very  severe  injuries  may  be 
inflicted  ....  without  producing  any  pathological  effects 
in  adjoining  parts  not  destroyed  by  the  direct  action  of  the 
noxa,  provided  that  the  blood  circulating  in  such  parts  is 
not  contaminated,”  while  “  if  septic  products  in  sufficient 
quantity  are  present  in  the  blood,  injuries  of  much  less 
intensity  may  lead  to  inflammation.”  Thus  we  see  how 
these  authors’  statements  disagree  ;  in  other  words,  how 
the  present  doctrines  of  inflammation  contradict  “  those  of 
a  previous,  though  still  recent,  period,”  and  how,  as  a 
natural  consequence,  the  subject  of  treatment  equally 
requires  a  thorough  revision.  Mr.  Simon’s  article  is  never¬ 
theless  a  very  interesting  one,  and  has  a  distinct  merit  of 
its  own,  though  it  is  hardly  fair  to  place  it  in  this  new 
edition,  especially  as  Mr.  Holmes’s  additions  only  make  its 
rather  antiquated  views  the  more  palpable. 

Mr.  Cripps’s  article  on  Abscess  follows  the  lines  of  former 
editions.  Reference  is  of  course  made  to  the  presence  of 
bacteria  and  allied  organisms  in  pus.  Acute  inflammatory 
oedema  of  the  neck — “  angina  Ludovici,”  as  it  should  ;be 
called— is  included  in  this  article;  but  it  would  have  been 
better  to  have  kept  such  a  specialised  form  of  disease  quite 
separate  from  abscess,  and  to  have  entered  more  fully  into 
its  etiology  and  clinical  history  in  a  separate  chapter. 
Gangrene  appears  to  have  been  completely  re-written  by 
Mr.  Cripps.  A  very  elaborate  and  well-considered  article  is 
the  result.  The  author  begins  by  classifying  the  varieties 
of  gangrene  very  minutely,  arguing  that  otherwise  there 
can  be  no  scientific  basis  for  treatment.  Thus  we  get  four 
chief  classes— idiopathic,  frost-bite,  traumatic,  and  specific 
septic  gangrene.  ,  Each  class  has  several  varieties  or  sub¬ 
classes.  There  is  no  fault  to  be  found  with  such  an  arrange¬ 
ment,  though  we  are  inclined  to  think  that  the  varieties  run 
so  nearly  one  into  the  other  that  the  author  will  himself 
oftentimes  be  troubled  to  say  in  which  class  a  given  case 
should  be  placed.  We  think  that  noma  vulvse— a  disease 
closely  allied  to,  if  not  identical  with,  cancrum  oris — should 
have  been  included  in  Class  IY. 

The  chapter  on  Ulcers  remains  very  much  as  it  was  in  the 
former  edition ;  and,  considering  that  it  was  Sir  James 
Paget  who  originally  framed  this  article,  we  need  hardly 
wonder  that  Mr.  Butlin  should  have  done  little  else  but  edit 
it.  Nevertheless,  with  the  advances  made  on  all  sides,  there 
is  much  room  for  modification,  not  only  in  the  arrangement 
of  the  different  forms  of  xflcers,  but  in  their  pathology  also. 
We  feel  a  little  doubtful  as  to  the  propriety  of  speaking  of 
a  “  common,  simple,  or  healthy  ulcer,  such  an  one  as  is  left 
after  the  separation  of  an  accidental  slough  in  a  healthy 
person”;  for  this  is  essentially  a  process  of  repair,  while 
“  ulceration  has  very  near  affinity  to  gangrene  neither 
does  it  at  all  resemble  a  senile  ulcer,  or  the  chronic  ulceration, 
seen  in  the  lower  limbs  of  an  old  overworked  washerwoman. 
Perhaps  strumous  ulcers  and  syphilitic  ulcers  would  be 
better  left  out,  and  treated  under  their  respective  patho¬ 
logical  causes.  The  old  nomenclature  is  preserved;  thus, 
among  other  varieties,  the  varicose  ulcer,  or,  as  it  is  here 
called,  the  haemorrhagic  ulcer,  is  mentioned,  but  we  do  not 
find  the  pathological  description  which  shows  what  connexion 
there  is  between  varicose  veins  and  the  ulcerative  process. 
Ulcers,  and  very  troublesome  ones,  often  occur  in  asso¬ 
ciation  with  varicose  veins,  but  the  exact  pathological  con¬ 
nexion  has  never,  to  our  knowledge,  been  worked  out.  If 
Mr.  Butlin’s  knowledge  of  minute  pathology  had  been 


724 


Medical  Times  and  Gazette. 


THE  OPHTHALMOLOGICAL  SOCIETY. 


Dec.  22, 1886. 


brought,  to  bear  on  the  subject,  it  is  very  possible  that  a  I 
more  instructive  classification  and  description  of  the  process 
would  have  resulted. 

The  late  Mr.  Campbell  de  Morgan’s  article  on  Erysipelas 
is  edited  by  Mr.  Holmes,  who,  in  classifying  the  disease 
according  to  its  causes,  speaks  of  symptomatic  erysipelas, 

4C  the  expression  of  some  pre-existing  constitutional  dis¬ 
turbance.”  We  could  have  wished  for  some  adequate  ex¬ 
planation  of  this  peculiar  condition ;  we  fail  to  recognise  it, 
and  should  be  at  a  loss  to  account  for  the  contagiousness  of 
symptomatic  erysipelas  if  the  disease  depended  only  or 
primarily  on  constitutional  disturbance.  Mr.  Clutton  deals 
with  Pyaemia  and  Septicaemia  in  a  brief  but  carefully  written 
article.  Fortunately,  these  diseases  are  becoming  rarer  each 
year,  and  will,  we  hope,  soon  be  erased  from  onr  surgical 
diseases. 

The  article  on  Tumours,  originally  written  by  Sir  James 
Paget,  and  edited  by  the  late  Mr.  Moore  in  the  second 
edition,  is  re-written  by  Mr.  Butlin  in  this  the  third  edition. 
No  department  of  scientific  work  has  undergone  greater 
changes,  as  the  alterations  which  appear  in  this  article 
amply  testify.  In  the  classification  of  tumours,  Mr.  Butlin 
adopts  the  anatomical  basis,  because,  “  apart  from  any 
graver  reason,”  the  old  clinical  classification  has  gradually 
become  more  and  more  impossible,  and  the  anatomical 
appears  likely  to  lead  to  a  more  accurate  knowledge  not  of 
the  structure  only,  but  of  the  life-history  of  tumours.  The 
difficulties  of  this  classification  are  referred  to,  and  will  be 
fully  appreciated  by  those  who  have  tried  to  reconcile  all  j 
the  facts.  Time  and  study,  however,  may  show  that  the  I 
anatomical  basis  is  difficult  to  apply  in  all  cases,  simply 
because  our  knowledge  of  anatomy,  especially  of  embryonic 
anatomy,  is  defective.  It  is  chiefly  in  tumour-growth  in¬ 
vading  the  generative  apparatus  that  the  anatomical  diffi¬ 
culties  present  themselves,  and  it  is  especially  with  regard 
to  the  embryology  of  these  same  organs  that  our  anatomical 
knowledge  is  most  hazy.  There  are  many  drawings  by  the 
author,  which  are  executed  with  the  skill  he  is  well  known 
to  possess,  and  which  help  to  elucidate  this  especially  difficult 
part  of  pathological  surgery. 

The  articles  on  Tetanus,  Scrofula,  Traumatic  Fever,  are 
all  interesting,  but  want  of  space  prevents  our  entering 
into  details.  Chapters  on  Contusions,  Wounds,  Wounds  of 
Vessels,  are  included  with  the  foregoing  under  “  General 
Pathology,”  instead  of  being  arranged  under  14  Local  In¬ 
juries,”  which  constitute  Part  2  of  this  volume.  We  are  a 
little  at  a  loss  to  understand  this  arrangement,  unless  it  is 
accidental.  We  must  leave  this  part  of  the  work  to  speak 
for  itself.  It  is  largely  clinical,  and  each  chapter  is  written 
by  a  distinguished  surgeon,  and  represents  the  experience 
of  a  large  hospital. 


The  International  Health  Exhibition.  —  The 
Executive  Council  is  now  meeting  regularly  twice  a  week, 
and  a  large  general  committee  is  also  in  course  of  formation. 
From  among  the  members  of  the  general  committee  the 
following  sub-committees  have  been  appointed  : — 1.  The 
Dwelling;  2.  Workshop  and  Factory  Sanitation ;  3.  Food 
(raw  materials)  ;  4.  Food  and  Cookery ;  5.  Heat;  6.  School 
and  Education;  7.  Ambulance;  8.  India;  9.  Colonial. 
They  will  meet  for  the  present  at  the  rooms  of  the  Society 
of  Arts,  and  will  have  under  their  superintendence  the 
arrangements  necessary  for  securing  the  efficient  repre¬ 
sentation  of  the  objects  of  the  various  sections  of  the 
Exhibition. 

Hospital  Saturday  Fund. — At  a  meeting  of  the 
board  of  delegates  of  this  fund,  held  on  the  13th  inst.,  it 
was  reported  by  the  Secretary  (Mr.  It.  Frewer)  that  twenty- 
three  of  the  London  medical  charities  had  agreed  to  receive 
life  governors  appointed  by  the  board,  and  admit  them  to 
a  share  in  the  management  of  the  institutions.  On  the 
motion  of  Mr.  N.  Hamilton  Hoare,  the  hon.  treasurer,  it  was 
decided  that  in  no  case  should  the  fund  be  represented  at 
any  hospital  or  dispensary  to  which  it  contributed  by  more 
than  three  life  governors,  unless  with  the  consent  of  the 
authorities  of  the  institutions.  It  was  resolved  to  distribute 
.£3250,  or  £1000  more  than  the  fund  was  enabled  to  dis¬ 
burse  last  year,  to  sixty-eight  hospitals,  thirty-eight  dis¬ 
pensaries,  five  cottage  hospitals,  eleven  convalescent  and 
other  homes,  and  two  surgical  aid  and  appliance  societies. 


REPORTS  OF  SOCIETIES. 

- ♦ - 

THE  OPHTHALMOLOGICAL  SOCIETY. 

Thursday,  December  13. 

Jonathan  Hutchinson,  F.R.S.,  President,  in  the  Chair. 


A  New  Method  of  Mounting  and  Cutting  Eyes. 
Mr.  W.  Jennings  Milles  described  the  method  of  em¬ 
bedding  eyes  in  celloidin  without  opening  them ;  they  were 
then  cut  with  Katsch’s  microtome.  The  chief  advantage  of 
the  new  method  was  that  sections  of  the  whole  eye  could  be 
made  without  disturbance  of  the  mutual  relations  of  its 
various  structures. 

Orbital  Tumour. 

Dr.  A.  Emrys-Jones  showed  a  woman,  aged  fifty,  from 
whose  right  orbit  he  had  removed  a  small  round-celled 
growth.  It  had  recurred  two  months  later,  and  again  been 
removed,  but  the  patient  was  now  becoming  cachectic. 

Papilloma  of  the  Conjunctiva. 

Messrs.  G.  A.  Critchett  and  H.  E.  Juler  exhibited  a 
girl,  aged  fourteen,  with  a  small  reddish  mass  on  the  con¬ 
junctiva,  near  the  inner  canthus  of  the  right  eye.  It  had 
been  noticed  for  about  five  years. 

Peculiar  Affection  of  Conjunctiva. 

Messrs.  Critchett  and  Juler  also  showed  a  woman,  aged 
thirty,  in  whose  rig-ht  eye  the  ocular  conjunctiva  was 
markedly  thickened,  the  thickening  encroaching  on  the 
cornea.  Both  cul-de-sacs  were  obliterated.  It  was  attri¬ 
buted  to  a  “  cold  in  the  eyes  ”  nine  months  previously.  The 
left  eye  showed  an  earlier  stage  of  the  same  condition. 

Herpes  Zoster  and  Facial  Paralysis. 

Mr.  Waken  Tay  exhibited  this  patient.  About  three 
weeks  previously  the  man  had  had  swelling  of  the  right 
side  of  his  face,  followed  the  next  day  by  an  eruption  on 
the  cheek.  This  occupied  the  area  supplied  by  the  second 
division  of  the  fifth  nerve,  and  partly  that  supplied  by  the 
first  division.  There  was  ulceration  of  the  cornea.  There 
was  also  right  facial  paralysis.  There  was  slight  diminu¬ 
tion  of  sensibility  over  the  area  of  the  second  division  of  the 
fifth  nerve,  but  the  faradic  contractility  was  preserved. 

Dr.  Stephen  Mackenzie  thought  that  the  ulceration  of 
the  cornea  in  this  case  could  not  he  due  to  exposure,  as  it 
came  on  at  the  same  time  as  the  spots.  Herpes  zoster 
occurring  with  facial  paralysis  was  rare,  and  the  increase  in 
the  faradic  irritability  was  noteworthy. 

The  President  said  he  had  been  much  interested  in  the 
coincidence  of  herpes  and  facial  paralysis  ;  he  had  observed 
that  occasionally  motor  as  well  as  sensory  areas  were  affected 
after  herpes  zoster. 

Blindness  of  Left  Eye  and  Deafness  with  Eight  Ear 
after  a  Fall. 

Mr.  Waren  Tay  showed  a  patient  who,  seven  weeks 
earlier,  had  fallen  down  a  ship’s  hold  on  to  his  head.  He 
was  picked  up  unconscious.  On  admission  shortly  after¬ 
wards,  he  was  conscious.  Blood  was  oozing  from  the  left 
nostril  and  right  ear ;  the  left  pupil  was  insensitive  to  light ; 
there  was  no  paralysis  of  the  facial  or  any  other  nerve.  There 
was  fracture  of  the  right  lower  jaw,  and  a  laceration  of  the 
soft  parts  in  the  left  fronto-temporal  region.  There  was  no 
subconjunctival  haemorrhage,  and  no  serous  discharge.  Two 
days  later  it  was  ascertained  that  he  could  not  see  the  light 
of  a  lamp  with  the  left  eye.  On  the  eighteenth  day  after 
the  injury  the  left  optic  disc  was  thought  to  be  paler  than 
the  right.  On  the  twenty-fourth  day  the  left  optic  disc  was 
certainly  pale.  At  the  time  of  the  meeting  (seven  weeks 
after  the  injury)  the  left  disc  was  uniformly  white  from 
commencing  atrophy.  He  was  markedly  deaf  on  the  right 
side.  Mr.  Tay  proceeded  to  observe  that  statistics  pub¬ 
lished  by  Holder  showed  that  injury  to  the  optic  nerve  was 
very  common  iu  fracture  of  the  base  of  the  skull.  Out  of 
eighty-eight  cases,  the  roof  of  the  orbit  was  fractured  in 
eighty  cases,  the  optic  foramen  was  injured  in  fifty- four 
cases,  and  blood  was  effused  in  the  sheath  in  forty-two  cases. 


Medical  Times  and  Gazette. 


THE  OPHTHALMOLOGICAL  SOCIETY. 


Dec.  22,1853.  725 


The  mode  of  production  of  the  nerve-atrophy  was,  as  yet,  by 
no  means  well  understood,  since  the  statistics  just  quoted 
could  not  be  considered  as  throwing  much  light  on  this  part 
of,  the  question. 

Bacilli  in  Jequirity  Infusions. 

Dr.  Brailey  described  the  results  of  his  observations  in 
conjunction  with  Mr.  Pidgeon.-  They  found  that  bacilli 
began  to  develope  about  twenty-four  hours  after  the  infusion 
was  made,  and  their  presence  could  be  recognised  up  to  the 
fifteenth  day. 

Extreme  Tortuosity  of  Retinal  Vessels. 

Dr.  Stephen  Mackenzie  showed  a  girl,  aged  twelve,  with 
this  condition  especially  well  marked  in  the  left  eye.  The 
patient  had  suffered  from  headache  for  about  five  years,  but 
he  would  not  express  an  opinion  as  to  the  connexion,  if  any, 
between  this  and  the  tortuous  vessels. 

Anaemia  as  a  Cause  of  Retinal  Haemorrhage. 

Dr.  Stephen  Mackenzie  commenced  a  paper  on  this 
subject  by  narrating  the  following  series  of  cases  : — Case  1. 
— A  female,  aged  twenty-nine,  suffered  from  marked  anasmia, 
due  to  repeated  profuse  hasmatemesis,  caused  by  ulcer  of 
stomach.  Corpuscular  richness  fell  to  42 '9  per  cent.  Haemor¬ 
rhages  were  seen  in  the  retina,  disappearing  with  improve¬ 
ment  in  the  quality  of  the  blood.  Case  2. — A  female,  aged 
thirty-six,  also  suffering  from  ulcer  of  stomach.  Severe 
haematemesis,  resulting  in  marked  anaemia,  occurred,  and 
corpuscular  richness  fell  to  44  per  cent.  Linear  and  flame¬ 
shaped  haemorrhages  with  white  patches  were  seen  in  both 
retinae,  disappearing  with  the  subsidence  of  anaemia.  Case  3. 
— A  female,  aged  twenty-nine,  also  the  subject  of  ulcer  of 
stomach,  which  caused  severe  and  repeated  haematemesis, 
and  extreme  anaemia.  The  corpuscular  richness  fell  to 
302  per  cent.,  and  the  haemoglobin  to  23  per  cent.  Several 
haemorrhages  were  seen  in  the  left  retina,  and  a  white  patch, 
possibly  due  to  haemorrhage,  in  the  right.  The  haemorrhages 
disappeared  with  the  subsidence  of  the  anaemia.  Case  4. — A 
male,  aged  thirty-five,  suffering  from  cancer  of  the  stomach 
and  progressive  anaemia.  No  haematemesis  occurred,  but  the 
corpuscular  richness  fell  to  20  and  30  per  cent.,  and  the  haemo¬ 
globin  to  30  and  15  per  cent.  Haemorrhages  occurred  in  both 
retinae,  and  the  man  died.  Case  5. — A  female,  aged  sixty-one, 
the  subject  of  abdominal  cancer.  Profound  anaemia  super¬ 
vened,  and  the  corpuscular  richness  fell  to  46  and  28  per 
cent.,  the  haemoglobin  to  30  and  20  per  cent.  Haemorrhages 
were  seen  in  both  retinae.  Case  6. — A  male  suffering  from 
scurvy.  Marked  anaemia  supervened,  and  the  corpuscular 
richness  fell  to  40' 5  per  cent.,  the  haemoglobin  to  20  per 
cent.  Recovery  from  the  scurvy  and  anaemia  was  followed 
by  disappearance  of  the  retinal  haemorrhage. — The  author 
thought  that  this  series  of  cases  justified  the  conclusion 
that  the  tendency  to  retinal  haemorrhage  occurred  when 
the  corpuscular  richness  fell  below  50  per  cent.,  whatever 
was  the  cause  of  the  anaemia.  The  fact  that  retinal  haemor¬ 
rhage  was  so  frequent  in  the  form  of  anaemia  designated  by 
Addison  “ idiopathic,”  and  which  others  called  “progressive 
pernicious  anaemia,”  was  due,  in  his  opinion,  to  the  high 
degree  of  anaemia  present  in  such  cases  (always  below  50 
per  cent.),  and  not  to  its  kind.  The  corpuscular  richness 
might  fall  below  50  per  cent,  without  retinal  haemorrhage 
taking  place,  but  when  this  point  was  reached  there 
occurred  the  tendency  to  haemorrhages. 

Dr.  Angel  Money  briefly  referred  to  a  case  of  anaemia 
that  had  come  under  his  observation,  where  at  the  post¬ 
mortem  he  had  found  retinal  haemorrhages. 

Two  Cases  of  Sympathetic  Inflammation. 

Mr.  Nettleship  read  notes  of  a  case  of  iritis,  probably 
sympathetic,  coming  on  about  a  month  after  immediate 
excision  of  the  other  eye.  The  patient,  a  man  aged  forty- 
one,  received  severe  contused  wounds  of  the  right  eye  and 
orbital  parts  in  a  railway  accident.  The  injured  eyeball  was 
removed  within  forty- eight  hours  by  Dr.  C.  W.  Philpot.  A 
good  deal  of  suppuration  occurred  in  the  orbit  afterwards. 
About  a  month  later  the  remaining  eye  inflamed  and  became 
dim  ;  and  when  the  patient  was  seen  by  Mr.  Nettleship,  six 
months  after  the  accident,  there  was  moderately  severe 
plastic  iritis  with  much  membrane.  A  month  later  the  eye 
was  much  better,  and  the  man  was  then  lost  sight  of.  He  (the 
speaker)  thought  it  most  probable  that  the  iritis  was  sympa¬ 


thetic,  but  that  it  was  excited  by  the  inflammation  of  the 
damaged  orbital  tissues  rather  than  by  the  wounded  eyeball 
itself.  Mr.  Nettleship  also  read  notes  of  a  case  of  destruc¬ 
tive  sympathetic  inflammation,  in  which  all  the  eyelashes  of 
the  sympathising  eye  became  white,  those  of  the  exciting 
eye  not  being  altered.  The  patient,  a  woman  aged  twenty- 
three  years,  ruptured  the  right  eye  by  a  fall ;  it  was  excised 
three  months  later.  The  other  eye  passed  into  a  severe 
subacute  condition  of  irido-choroiditis,  ending  in  softening 
and  almost  complete  blindness.  All  the  lashes  of  both  its 
lids  became  white.  The  exact  date  of  onset  in  relation  to 
the  excision  of  the  other  eye  could  not  be  determined.  The 
author  compared  the  case  with  one  which  Mr.  Hutchinson 
had  described,  where  both  eyes  were  lost  by  spontaneous 
irido-choroiditis,  and  many  of  the  lashes  became  white.  He 
thought  that  the  cases  favoured  the  theory — of  late  some¬ 
what  discredited — that  the  fifth  nerve,  or  at  least  the  ciliary 
nerves,  formed  the  channel  for  communication  of  sympathetic 
inflammation  from  one  eye  to  the  other. 

The  President  always  regarded  this  blanching  as  of  a 
neurotic  origin,  and  mentioned  a  drawing  he  had  in  which  a 
patch  in  each  eyebrow  was  blanched.  He  also  alluded  ta 
the  case  of  a  child,  in  whom,  a's  the  result  of  severe  illness, 
probably  of  the  nature  of  pityriasis  rubra,  the  whole  of  the 
hair  of  the  head  had  become  white  as  well  as  a  patch  in 
each  eyelid. 

Mr.  Adams  Frost  alluded  to  a  similar  instance  recorded 
by  Jacobi. 

Sympathetic  Ophthalmia. 

Dr.  Brailey  read  a  paper  on  the  various,  sympathetic 
affections  of  the  eye,  and  their  bearing  on  the  mode  of 
transmission  of  sympathetic  inflammation  from  one  eye' to 
the  other.  He  defined  the  microscopic  characters  of  sympa¬ 
thetic  inflammation  of  the  iris,  ciliary  body,  and  choroid, 
the  first  being  involved,  he  believed,  in  every  case,  either 
alone  or  in  association  with  one  or  both  of  the  others.  In 
the  iris  there  were  either  clusters  of  cells  in  its  middle 
layers,  or  a  continuous  infiltration  of  its  thickened  sub¬ 
stance  with  cell-elements.  There  was  also,  in  all  but  the 
milder  cases,  a  thick  exudation  over  all  its  posterior  surface. 
Cells  were  formed  also,  either  in  clusters  or  in  a  continuous 
layer,  on  the  lower  part  of  the  posterior  surface  of  the 
cornea.  The  affection  of  the  ciliary  body  and  choroid  was 
similar,  only  there  was  no  exudation  on  the  surface  of  the 
latter,  while  in  the  former  it  occurred  on  the  internal 
aspect  of  the  pars  ciliaris  retinge.  The  inflammatory  cells 
were  situated  in  the  middle  choroidal  layers,  and  in  the 
connective-tissue  layer  of  the  ciliary  body  internal  to  the 
ciliary  muscle.  There  were  also  cells  round  the  blood¬ 
vessels  of  the  papilla,  extending  thence  along  the  central 
vessels  of  the  optic  nerve.  He  recognised  also  a  pure 
sympathetic  keratitis,  and  a  pure  sympathetic  papillitis, 
both  these  being  not  uncommon,  though  difficult  to  identify. 
He  also  attributed  certain  uncomplicated  cases  of  atrophy 
of  the  disc,  of  vitreous  opacities,  and  even  of  retinal  detach¬ 
ments,  to  sympathetic  disease.  He  found  the  same  diversity 
in  the  first  eye.  For,  whereas  the  uveal  affection  was  a 
pure  iritis  or  irido-cyclitis,  or  irido-cyclo-choroiditis,  in  more 
than  half  the  cases,  it  was  a  kerato-iritis  in  about  20  per 
cent.,  and  a  distinct  iritis,  with  keratitis  punctata,  in  about 
30  per  cent.  He  thought  that  this  last  form  was  really  more 
common  than  these  figures  would  indicate,  as  dots  were  in 
some  cases  found  early,  but  not  later,  and,  conversely, 
sometimes  at  the  later  stages  only  of  the  inflammation. 
The  exciting  condition  might  be  also  an  eye  shrunken  after 
panophthalmitis,  or  even  a  choroidal  sarcoma.  Perforating 
wounds  produced  it  in  about  80  per  cent,  of  the  cases, 
and  spontaneous  inflammations  in  about  15  per  cent.  He 
found  no  relationship  as  regards  the  precise  position  of  the 
disease  in  the  two  eyes,  and  argued  from  that,  as  well  as 
from  numerous  cases  in  which  the  outbreak  had  been  delayed 
even  for  one  year  after  excision,  against  the  theory  of  direct 
transmission,  either  by  the  optic  nerve-sheath,  or  by  the 
optic  or  ciliary  nerves  themselves.  He  thought  that  sym¬ 
pathetic  irritation,  whether  producing  pain  or  congestion 
only,  might,  owing  to  the  unique  relationship  between  the 
two  eyes,  so  alter  the  nutrition  of  the  second  eye  as  to  render 
it  liable  to  spontaneous  inflammations  of  any  kind,  and  that 
such  liability  persisted  after  excision  of  the  first  eye,  whether 
through  the  state  of  the  sympathising  eye  itself,  or  of  the 
centre  of  the  fifth  nerve.  He  thought  that  glaucoma  could 
be  produced  sympathetically  by  glaucoma  in  the  first  eye. 


726 


Medical  Times  and  Gazette. 


THE  CLINICAL  SOCIETY  OF  LONDON 


Dec.  22,  1883. 


and  that  it  was  a  neurosis  of  the  secretory  nerves  of  the 
eyeball.  He  drew  attention  to  the  similarity  between  the 
pathological  changes  he  had  previously  pointed  out  in  this 
disease,  and  those  found  in  Lewaschew  in  the  lower  limbs  of 
animals  after  long-continued  irritation  of  the  sciatic  nerve. 

After  a  few  remarks  from  Mr.  G.  A.  Critchett,  further’ 
discussion  on  this  subject  was  postponed  owing  to  the  late¬ 
ness  of  the  hour. 

Cerebral  Hemorrhage  with  Passage  of  Blood 
into  both  Optic  Nerves. 

Mr.  Priestley  Smith  said  that  he  was  indebted  to  Dr. 
Leslie  Phillips  for  the  opportunity  of  recording  this  case. 
Dr.  Phillips  had  had  charge  of  the  patient  during  life,  and 
had  made  the  post-mortem  examination.  A  man,  aged 
thirty-eight,  had  a  fall  on  March  8 ;  the  next  day  he  had  a 
fit,  but  showed  no  decisive  symptoms  until  March  18,  when 
headache  began.  On  March  20  he  vomited,  his  mind  became 
clouded,  and  he  was  brought  to  the  hospital  with  symptoms 
of  intracranial  pressure  ;  the  optic  discs  were  examined  with 
the  ophthalmoscope,  and  found  healthy.  Insensibility  in¬ 
creased,  and  at  4  a.m.  on  March  21  he  had  a  fit  and  died. 
Post-mortem  examination  showed  a  large  quantity  of  blood 
beneath  the  dura  mater  on  the  left  side,  proceeding  from  a 
recent  haemorrhagic  cavity  in  the  left  frontal  lobe,  opening 
through  a  clean  rupture  of  the  cortex  in  the  inferior  frontal 
convolution.  The  optic  nerves  were  distended:  one  was 
opened  at  once,  and  found  to  contain  blood ;  the  other  was 
hardened  in  Muller’s  fluid.  On  longitudinal  section,  it  was 
found  to  contain  a  blood-clot,  the  situation  of  which  ap¬ 
peared  to  demonstrate  the  existence  of  two  distinct  spaces 
around  the  nerve — a  subdural  and  a  subarachnoidal — as 
described  by  Schwalbe.  The  blood  lay  entirely  in  the  sub¬ 
dural  space— the  space  which,  from  its  situation  beneath  the 
dura  mater,  it  would  naturally  enter.  The  subarachnoidal 
space  of  the  nerve  was  distended  with  colourless  fluid,  pro¬ 
bably  cerebro- spinal  fluid  forced  into  it  from  the  subarach¬ 
noidal  space  of  the  meninges  by  the  increased  pressure  within 
the  skull.  The  case,  unfortunately,  gave  no  evidence  as  to 
the  ophthalmoscopic  changes  and  visual  impairments  which 
might  be  caused  by  hsemorrhage  into  the  nerve-sheath.  The 
discs  were  examined  eighteen  hours  before  death,  and  then 
appeared  healthy,  but  it  was  by  no  means  certain  whether 
the  blood  had,  at  that  time,  found  its  way  into  the  nerves. 
One  half  of  the  nerve  in  longitudinal  section,  together  with 
an  enlarged  drawing  of  the  same,  were  exhibited. 

Model  illustrating  Conjugate  Movements  oe  the  Eyes. 

In  this  model,  designed  by  Mr.  Priestley  Smith,  the  eyes 
were  represented  by  two  discs  of  wood,  covered  with  paper, 
and  painted  so  as  to  represent  horizontal  sections  of  the 
globe  ;  these  rotated  about  their  centres  upon  screws  fixed 
into  a  black  board.  The  motor  apparatus,  so  far  as  hori¬ 
zontal  movements  of  the  eyes  were  concerned,  was  repre¬ 
sented  by  silk  threads  attached  to  the  sides  of  the  wooden 
discs,  like  the  tendons  of  the  recti  to  the  eyeballs ;  these 
passed  backwards,  as  the  nerves  pass  to  the  brain,  each  of 
the  four  nerve-trunks  being  represented  by  a  double  thread. 
Each  thread  then  separated  from  the  other  thread  of  its 
own  nerve,  so  as  to  represent  the  co-ordination  in  the  brain, 
by  means  of  which  all  motor  impulses  to  the  eyes  were  made 
bilateral.  The  brain-centres  were  represented  by  four  brass 
weights  hung  upon  the  threads  :  one  of  these  combined  the 
threads  coming  from  the  two  third  nerves,  and  produced 
movements  of  convergence ;  another  combined  the  threads 
coming  from  the  two  sixth  nerves,  and  produced  movements 
of  divergence ;  the  two  others  combined,  in  each  case,  a 
thread  from  the  third  nerve  of  one  eye  with  a  thread  from 
the  sixth  nerve  of  the  other  eye,  and  produced  conjugate 
movements  to  the  right  and  to  the  left  respectively.  The 
model  being  placed  in  a  vertical  position,  it  was  easy,  by 
pressing  upon  one  or  other  weight,  or  upon  two  simul¬ 
taneously,  to  imitate  any  compound  movement  of  the  eyes 
in  the  horizontal  plane.  Mr.  Priestley  Smith  said  that  the 
model  had  been  found  useful  in  class -demonstration.  It 
served  to  explain  the  occurrence  of  conjugate  deviations  in 
hemiplegia.  It  showed  how  one  and  the  same  muscle  might 
be  paralysed  for  conjugate  lateral  movement,  and  at  the 
same  time  active  for  convergence,  or  vice  vers 6 .  It  illus¬ 
trated  how  it  was  that  an  ordinary  convergent  squint,  though 
a  bilateral  affection,  was  transferred  at  will  from  one  eye  to 
the  other,  and  thus  manifested  in  one  eye  only  at  a  time. 


THE  CLINICAL  SOCIETY  OF  LONDON. 

Friday,  December  14. 

Sir  Andrew  Clark,  Bart.,  President,  in  the  Chair.  * 


The  President  referred  to  a  suggestion,  made  .by  himself 
at  the  previous  meeting  of  the  Society,  that  a  committee 
should  be  formed  to  investigate  the  subject  of  Myxoedema, 
and  more  especially  its  pathological  connexion  with  disease 
or  removal  of  the  thyroid  gland.  The  Clinical  Society  had 
been  the  first  to  work  upon,  the  subject,  and  he  considered 
that  it  should  maintain  its  hold  at  the  present  time,  with 
which  object  he  nominated  the  following  physicians  and 
surgeons  to  form  a  committee  of  investigation: — Sir  W. 
Gull ;  Drs.  Ord,  Semon,  Cavafy,  Goodhart,  Mahomed,  and 
Hadden;  Messrs.  Godlee,  Durham,  Haward,  Sydney  Jones, 
and  Pugin  Thornton. 

Pneumothorax  occurring  during  Typhoid  Fever. 

Dr.  Cayley  read  the  above  paper.  The  patient,  a  girl, 
aged  fourteen,  was  admitted  into  the  London  Fever  Hospital 
April  26,  on  the  eighth  day  of  a  severe  attack  of  typhoid 
fever,  characterised  by  great  prostration,  muttering  delirium, 
muscular  twitchings,  pulmonary  congestion,  and  severe 
diarrhoea.  She  was  treated  by  cold  baths  and  occasional 
large  doses  of  quinine.  On  May  9,  when  apparently  con¬ 
valescing,  signs  of  pleurisy  of  the  right  side  appeared,  and 
on  May  13,  pneumothorax  with  very  severe  dyspnoea  and 
symptoms  of  collapse.  The  chest  was  twice  punctured,  and 
air  escaped  with  a  hissing  sound.  The  second  time  a  few 
drops  of  pus  also  came  through  the  trocar.  She  gradually 
improved,  and  by  June  20  the  signs  of  pneumothorax  had 
disappeared.  The  author  mentioned  a  case  which  had  been 
reported  by  Dr.  Gairdner,  and  said  that  the  probable  cause 
was  the  breaking  down  of  an  embolism  of  the  lung. 

o  o 

Case  oe  Complete  Recovery  erom  Idiopathic  Pneumo¬ 
thorax,  WITHOUT  Effusion  OE  FLUID. 

Dr.  Samuel  West,  at  the  desire  of  the  President,  read  a 
paper  on  the  above  subject.  A.  B.,  male,  aged  twenty-four, 
had  right  pneumothorax,  probably  due  to  rupture  of  a  small 
phthisical  cavity.  He  was  aspirated  and  relieved.  Amphoric 
breathing  and  bell-sounds  were  audible  over  the  whole  side, 
but  slowly  disappeared,  the  bell-sound  going  first ;  and  the 
patient  recovered.  In  one  month  the  bell-sound  had  dis¬ 
appeared,  and  in  six  weeks  all  trace  of  amphoric  breathing. 
Healthy  respiratory  sounds  were  audible  over  the  whole 
side,  and  the  patient  was  discharged  well.  He  has  continued 
well  for  a  ■year  since.  Points  of  interest  were  discussed  :  — 
1.  The  question  whether  the  orifice  was  patent  for  some  time 
or  not.  2.  The  cause.  3.  The  occurrence  of  subcutaneous 
emphysema  after  paracentesis.  Why  does  pneumothorax 
not  occur  often  after  fractured  rib  ?  4.  Records  of  twenty- 

four  other  cases  of  complete  recovery,  with  short  analysis 
of  them. 

The  President  asked  whether  any  effect  had  been  pro¬ 
duced  upon  the  subsequent  course  of  the  disease  in  the 
lung  ?  He  referred  to  two  cases,  both  females,  in  which 
the  occurrence  of  pneumothorax  in  the  course  of  phthisis 
had  checked  the  progress  of  the  latter  disease. 

Dr.  S.  West  inquired  whether  any  signs  of  phthisis  had 
been  present  in  Dr.  Cayley’s  case.  In  his  own  case  the 
presence  of  phthisis  could  only  be  inferred,  and  thus  the 
effects  of  the  pneumothorax  upon  it  were  doubtful. 

Dr.  Cayley  replied  in  the  negative. 

Dr.  Mahomed,  referring  to  the  pathology  of  these  cases, 
stated  that  he  had  frequently  seen  lungs  in  typhoid  fever 
apparently  on  the  brink  of  rupturing,  and  so  setting  up 
pneumothorax.  The  appearance  of  these  lungs  was  charac¬ 
teristic.  Prolonged  restand  imperfect  expansion  of  the  bases 
of  the  lungs  led  to  a  condition  of  splenisation,  only  occur¬ 
ring  in  cases  of  long-continued  fever,  and  in  some  instances 
accompanied  by  dilatation  and  inflammatory  softening  of 
the  walls  of  the  tubes.  These  softened  points,  often  con¬ 
taining  pus,  might  sometimes  be  seen  through  an  almost 
transparent  pleura,  so  closely  were  they  situated  to  the  sur¬ 
face  of  the  lung.  A  cough  or  other  simple  strain  might 
at  any  moment  cause  their  rupture.  In  Dr.  Cayley’s  case, 
which  had  been  for  a  time  under  his  own  care,  there  was 
severe  bronchitis  ;  but  the  recovery  from  the  pneumothorax 
was  complete.  The  rapidity  of  recovery  in  such  cases,  as 


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THE  CLINICAL  SOCIETY-  OF  LONDON. 


Dec.  22, 1833.  727 


compared  with  those  of  fluid  effusion  in  the  pleura,  was 
probably  to  be  attributed  to  the  freedom  from  adhesions 
binding  the  lung  down,  and  also  to  the  shorter  time 
during  which  the  lung  underwent  compression.  The  dis¬ 
placement  of  the  heart  he  considered  to  indicate  increased 
intrathoracic  pressure.  In  cases  of  fluid  effusion  he  believed 
that  a  pressure  equivalent  to  seventy  millimetres  of  mer¬ 
cury  was  necessary  for  such  displacement,  and  probably  a 
somewhat  similar  amount  was  required  in  pneumothorax. 
Treatment  by  tapping  was  in  such  cases  most  important, 
complete  recovery  often  resulting  from  the  relief  afforded. 

Mr.  Jonathan  Hutchinson,  looking  at  the  subject  from 
a  surgical  point  of  view,  considered  that  pneumothorax  as  a 
result  of  fracture  of  ribs  was  not  so  rare  as  had  been  sup¬ 
posed.  He  had  himself  seen  a  considerable  number  of  cases 
in  which  the  question  of  tapping  had  arisen.  In  two 
instances  life  had  been  saved  by  prompt  withdrawal  of 
the  air.  Usually  he  had  not  advised  it  until  considerable 
dyspnoea  wras  present ;  in  many  cases  absorption  was  slow, 
but  it  was  usually  satisfactory  in  the  end.  He  would  prefer 
to  postpone  tapping  until  late,  unless  urgently  called  for, 
believing  that  the  cases  generally  did  well  without  operation. 

Mr.  Herbert  Page,  whilst  agreeing  with  Mr.  Hutchinson, 
mentioned  a  case  of  extreme  dyspnoea  and  collapse  due  to 
pneumothorax  from  fractured  rib,  which  obtained  the  most 
marked  relief  from  the  removal  of  the  air  four  hours  after 
the  injury.  In  this  case  the  re-expansion  of  the  lung  and 
the  return  of  the  heart  to  its  normal  limits  could  be  clearly 
made  out  during  the  operation.  The  evacuation  of  air 
having  been  incomplete  at  first,  two  subsequent  tappings 
were  performed.  No  harm,  except  slight  bleeding,  appeared 
to  result,  and  recovery  was  absolute. 

Mr.  Pearce  Gould  gave  details  of  a  case  under  his  care, 
in  which  rupture  of  the  lung  had  taken  place  from  violence, 
without  any  fracture  of  ribs.  Tapping  with  a  plain  trocar 
was  performed  for  the  relief  of  the  extreme  dyspnoea  :  the 
lung  at  once  expanded,  and  complete  recovery  followed,  no 
sign  of  pneumothorax  being  discoverable. 

Dr.  Maclagan  related  a  case  similar  to  the  last.  A 
gentleman,  aged  twenty-three,  was  thrown  violently  against 
the  trunk  of  a  tree  whilst  hunting.  No  fracture  of  ribs  took 
place,  but  the  left  pleura  was  filled  with  air  from  rupture 
of  the  lung.  Tapping  was  suggested,  but  not  performed,  and 
the  patient  recovered  completely  in  two  months.  He  was  a 
man  with  a  very  broad  chest ;  and  Dr.  Maclagan  was  of 
opinion  that  the  severity  of  these  cases  was  generally  com¬ 
mensurate  with  the  capacity  of  the  chest,  many  persons 
being  provided  with  a  much  larger  lung-area  than  is  really 
essential  to  healthy  respiration. 

Mr.  S tmonds  mentioned  the  case  of  a  man  of  cachectic 
appearance  and  intemperate  habits,  admitted  a  few  years 
ago  into  Guy’s  Hospital  for  some  trivial  surgical  affection, 
in  whom  a  sudden  attack  of  dyspnoea,  due  to  right- sided 
pneumothorax,  had  threatened  life.  Immediate  evacuation 
of  the  air  from  the  pleura  by  means  of  a  simple  trocar  gave 
instant  relief.  The  air  in  this  case  rushed  out  with  great 
force  through  the  canula.  The  patient  subsequently  died, 
and  no  cause  could  be  found  for  the  previous  pneumo¬ 
thorax,  except  on  the  supposition  of  the  rupture  of  an 
emphysematous  vesicle. 

Dr.  .T.  K.  Fowler  took  exception  to  some  of  Dr. 
Mahomed’s  remarks  on  the  increased  pressure  within  the 
pleura  in  these  cases,  and  mentioned  that  Dr.  Douglas 
Powell  had  shown  that  the  displacement  of  the  heart  was 
.due  rather  to  the  dragging  action  of  the  other  lung  than  to 
active  pressure  from  its  own  side  of  the  chest. 

Dr.  Mahomed  explained  that  the  increased  tension  of 
which  he  bad  spoken  was  present  in  a  large  number  of 
cases,  though  not  in  all.  He  considered  that  the  forcible 
discharge  of  the  released  air  through  the  canula,  to  which 
several  speakers  had  referred,  proved  the  truth  of  this. 

Dr.  F.  Taylor  asked  for  information  as  to  the  occurrence 
•of  pneumothorax  in  acute  pneumonia.  He  referred  to  the 
case  of  a  young  man  in  whom  the  signs  and  symptoms  of 
acute  pneumonia  were  followed  by  those  of  pneumothorax. 
Absorption  of  the  air  took  place  after  a  few  days,  and  the 
symptoms  due  to  its  effusion  subsided.  A  year  later 
haemoptysis  occurred,  and  tubercular  disease  showed  itself. 
There  was  no  doubt,  however,  that  the  starting-point  had 
been  a  genuine  pneumonic  attack. 

Mr.  E.  J.  Godlee  thought  that  the  question  of  the  time 
for  operative  interference  was  of  importance.  How  long 


should  w;e  wait  ?  In  cases  due  to  injury  it  was  probable 
that  the  wound  of  the  lung  became  very  rapidly  closed,  and 
he  thought  that  the  best  course  was  to  evacuate  the  air 
immediately  after  allowing  reasonable  time  for  the  closure 
to  take  place.  It  was  important  to  avoid  long-continued 
pressure  upon  the  lung.  In  some  cases,  as  in  Dr.  Cayley’s, 
pus  was  absorbed  at  the  same  time  as  the  air,  and,  although 
this  might  take  place  frequently  in  children,  it  did  so  far 
less  often  in  adults.  , 

Dr.  Angel  Money,  referring  to  Dr.  Taylor’s  question, 
mentioned  a  case  in  which  tympanitic  resonance  had 
accompanied  acute  pneumonia  without  being  due  to 
pneumothorax. 

The  President  stated  that,  in  his  own  experience,  a  tym¬ 
panitic  note  was  almost  always  present  at  the  upper  part 
of  the  chest  in  cases  where  rapid  and  excessive  exudation 
had  taken  place. 

Dr.  F.  Taylor  added  that  the  bell-sound  had  been  present 
in  his  case,  and  several  other  symptoms  had  rendered  the 
diagnosis  of  pneumothorax  certain.  He  was  perfectly 
familiar  with  the  class  of  cases  referred  to  by  the  President 
and  Dr.  Money. 

The  President,  in  response  to  a  request  by  Dr.  Felix 
Semon,  related  the  particulars  of  a  case  under  his  care,  in 
which  the  symptoms  of  phthisis  had  undergone  marked 
relief  for  eighteen  months  in  consequence  of  the  occurrence 
of  pneumothorax.  The  chest  having  been  tapped,  against 
his  wishes,  and  the  pleura  emptied  of  air,  the  symptoms  of 
phthisis  again  increased,  and  the  disease  steadily  progressed 
to  a  fatal  termination. 

Dr.  Cayley,  in  reply,  thought  that  Dr.  Mahomed’s  ex¬ 
planation  of  the  mode  of  occurrence  of  pneumothorax  in 
tpphoid  was  correct. 

Dr.  Samuel  West,  in  reply,  maintained  the  view  that  he 
had  expressed,  that  pneumothorax  in  consequence  of  injury 
to  ribs  was  comparatively  y  if  not  positively,  rare.  Such 
cases  were  but  few  in  surgical  literature,  and  he  would  ask 
Mr.  Hutchinson  what,  in  his  experience,  was  their  propor¬ 
tional  frequency.  In  fevers  it  was  difficult  to  rely  upon 
other  signs  than  those  of  displacement  of  organs.  Hyper¬ 
resonance  might  be  common  to  several  conditions.  With 
respect  to  the  degree  of  tension  within  the  pleura,  he  thought 
that  far  less  than  that  of  seventy  millimetres  of  mercury 
would  be  sufficient  to  displace  organs.  The  retraction  of 
the  lung  was  the  chief  factor,  and  it  had  been  shown  by 
Donders  that  seven  millimetres  of  mercury  sufficed  in  such 
cases.  The  operation  of  tapping  must  sometimes  be  under¬ 
taken  in  order  to  save  life,  but  usually  the  cases  did  well 
after  the  first  shock.  Pneumothorax  might  occur  as  an 
accident  in  the  course  of  phthisis,  and,  from  the  point  of 
view  of  treatment,  might  often  be  disregarded.  In  reply  to 
the  President,  he  said  that  while  having  no  objection  to 
urge  against  the  use  of  a  fine  needle  for  evacuation  of  air, 
he  thought  that  unless  an  operation  were  necessary  it  had 
better  not  be  performed. 

The  President,  replying  to  Dr.  Taylor,  said  that  in 
cases  of  the  discontinuous  form  of  caseous  pneumonia, 
pneumothorax  was  occasionally  set  up  by  the  melting  of 
caseous  deposits  very  close  to  the  surface  of  the  lung. 

Cases  illustrating  the  K  elation  between  Labial 
Herpes  and  Kigor. 

Mr.  Charters  J.  Symonds  read  notes  of  cases  illustrating 
the  relation  between  labial  herpes  and  rigor.  His  attention 
was  first  called  to  the  connexion  between  the  phenomena  by 
a  personal  experience  in  1880.  After  unusual  exercise  in  the 
open  air,  a  severe  rigor  lasting  five  hours,  followed  by  profuse 
sweating,  ensued.  The  temperature  reached  105°  Fahr.  The 
next  day  no  ill  effects  were  experienced,  and  the  health  was 
as  good  as  usual.  Two  days  after  the  attack  an  abundant 
crop  of  herpes  appeared  on  the  lips  and  tongue,  unaccom¬ 
panied  by  any  other  symptom.  The  factors  considered  to  be 
acting  in  producing  this  attack  were — fatigue,  exposure  to 
the  sun  (the  air,  however,  being  only  moderately  warm),  a 
sensation  of  dread  experienced  when  about  to  plunge  into 
the  water  from  a  boat,  followed  by  undue  chilliness.  Other 
cases  in  which  a  rigor  preceded  herpes  were  given,  viz., 
ague,  operations  on  the  urethra,  erysipelas —  i.e.,  to  show 
that  there  was  nothing  peculiar  to  the  form  of  dis¬ 
ease,  and  that  therefore  the  eruption  had  no  special 
connexion,  as  seemed  to  be  thought,  with  pneumonia, 
but  indicated  that  this  disease  had  come  on  suddenly 


728 


Medical  Times  and  Gazette. 


THE  PATHOLOGICAL  SOCIETY  OF  LONDON. 


Dec.  22j  1883. 


and  severely  with  a  rigor.  Prom  these  facts  it  was  con-  ] 
sidered  that  labial  herpes  was  directly  due  to  the  rigor.  It  I 
was  also  pointed  out  that  the  accompanying  pyrexia  was 
not  alone  sufficient  to  produce  the  herpes.,  as  the  latter  was 
absent  in  many  well-known  febrile  affections.  Again,  herpes 
did  not  appear  after  every  rigor.  Some  other  factor,  there¬ 
fore,  appeared  to  exist,  but  what  this  was  remained  in  doubt. 

It  seemed  equally  difficult  to  explain  why  the  second  and 
third  divisions  of  the  fifth  nerve  should  be  specially  selected, 
its  occurrence  over  the  distribution  of  the  first  being  rare. 
It  was  pointed  out  that  with  a  common  “  cold  sore”  there  was 
always  some  chilliness,  and  that  perhaps,  in  those  cases  where 
the  herpes  exists  without  catarrh,  some  unrecognised  cause, 
such  as  fatigue,  may  have  acted ;  or  that  this  eruption  may  be 
a  disease  of  itself,  attended  with  its  own  fever  and  rigor. 
Verneuil  was  referred  to  as  describing  a  traumatic  herpes. 
It  was  suggested,  in  conclusion,  that  a  rigor  is  a  necessary 
precursor  of  labial  herpes,  but  that  some  factor  other  than 
pyrexia  is  associated  with  it.  The  author  also  inquired  as  to 
how  far  simple  fatigue  might  be  considered  to  be  a  cause  of 
rigor,  or  of- more  severe  affections. 

Dr.  Longhurst  referred  to  the  dietetic  causes  of  herpes, 
and  inquired  if  the  food  taken  could  in  any  way  account  for 
it  in  the  present  case.  • 

Dr.  Hale  White  pointed  out  that  physiologists  had  de¬ 
termined  the  existence  of  a  cortical  controlling  centre  for 
heat-production  on  the  anterior  surface  of  the  brain,  and 
this  must  be  regarded  as  a  trophic  centre.  The  lesion  in 
Mr.  Symonds’s  case  was  essentially  of  a  trophic  nature,  and 
he  suggested  that  a  central  cause  might  be  found  for  it. 

Dr.  Kadct.iffe  Crocker  had  had  abundant  opportunity 
of  observing  and  teaching  the  connexion  between  herpes  and 
rigor.  But  herpes  might  occur  in  other  conditions  also,  as 
at  the  close  of  fevers,  or  in  acute  gastritis.  In  pneumonia 
it  was  generally  present  in  the  most  acute  and  rapid  cases. 
It  might  appear  elsewhere  than  on  the  lips.  As  a  concomi¬ 
tant  of  general  catarrh  it  might  be  due  to  the  direct  influence 
of  cold  upon  the  fifth  nerve. 

Dr.  Felix  Semon,  having  had  exceptional  opportunities 
of  studying  the  phenomena  of  relapsing  fever  during  an 
epidemic  in  Berlin,  had  observed  160  cases,  in  each  of  which 
from  three  to  five  relapses  had  taken  place,  making  thus  at 
least  320  rigors.  In  only  ten  or  twelve  of  these  cases  had 
any  herpes  been  present. 

Dr.  Frederick  Taylor  had  observed  the  occurrence  of 
herpes  in  a  few  cases  of  relapsing  fever. 

The  President  observed  that  the  influence  of  the  nervous 
system  had  been  rather  left  out  of  sight  in  the  discussion. 
Other  forms  of  skin  eruption  were  well  known  to  be  asso¬ 
ciated  with  emotional  states,  and  possibly  the  phenomena  in 
Mr.  Symonds’s  case  might  also  be  thus  accounted  for. 

Dr.  Maclagan  remarked  that  rigor  also  might  arise  from 
very  slight  emotional  causes,  especially  in  children.  It  was 
probable  that  in  the  present  case  the  nervous  system  was 
very  much  depressed. 

Mr.  Jonathan  Hutchinson,  whilst  acknowledging  the 
value  of  the  careful  observations  made  by  the  author,  main¬ 
tained  that  the  connexion  between  rigor  and  herpes  had  been 
fully  recognised  and  taught  for  twenty  years.  The  theory 
of  causation  of  rigor  itself  was  less  clearly  proved ;  it  had 
usually  been  attributed  to  a  condition  of  general  arterial 
spasm.  Surgeons  had  more  practical  experience  of  it, 
perhaps,  than  physicians.  The  rigors,  at  times  of  dangerous 
severity,  which  followed  the  use  of  catheters  were  often 
accompanied  by  herpes,  and  the  latter  was  generally  pro¬ 
portionate  in  its  extent  to  the  intensity  of  the  rigor.  Herpes 
was  symptomatic  of  several  conditions,  but  its  connexion 
with  rigor  was  undoubted. 

The  President  remarked  that  thetheoryof  rigor  mentioned 
by  Mr.  Hutchinson  had  been  first  propounded  by  Dr.  Cullen. 

Mr.  Symonds,  in  reply,  stated  that  he  had  not  brought 
the  subject  forward  as  something  new,  but  rather  with  the 
hope  of  obtaining  information  on  the  relation  of  rigors  and 
herpes  to  conditions  of  fatigue.  He  could  not  state  what 
dietetic  influence  might  have  been  at  work  in  his  own  case. 

Living  Specimens  of  Charcot’s  Joint-Disease  of  Elbow  and 
Ankle,  by  Mr.  Clement  Lucas  ;  and  of  Fractured  Patella, 
treated  by  the  immediate  application  of  plaster-of-Paris 
bandage,  which  was  removed  after  twelve  weeks,  by  Mr. 
Christopher  Heath — were  shown  before  the  meeting. 

Dr.  Finlay  and  Mr.  Pearce  Glould  were  appointed  auditors. 


THE  PATHOLOGICAL  SOCIETY  OF  LONDON. 

Tuesday,  December  18. 

J.  W.  Hulke,  F.R.S.,  President,  in  the  Chair. 


Quiet  Necrosis. 

Dr.  F.  C.  Turner  showed  a  greatly  enlarged  tibia  of  a 
woman,  aged  sixty-seven,  in  longitudinal  section.  In  the  upper 
part  of  the  bone,  where  the  enlargement  was  greatest,  there 
was  a  central  sequestrum  in  a  smooth-walled  cavity,  at  the 
lower  end  of  which  was  an  opening  communicating  with  the 
surface  of  the  bone,  on  its  inner  side.  This  channel  was  not 
visible  until  the  periosteum  was  removed.  There  were  no 
adhesions  between  the  bone  and  the  skin  at  this  part,  and 
no  scar  was  seen.  The  bone  consisted  almost  wholly  of 
cancellous  tissue,  and  was  bowed  forwards  by  a  backward 
bend  just  above  the  middle  of  the  shaft.  There  were  bony 
outgrowths  from  the  surface  of  the  shaft  at  the  upper  part 
and  along  its  internal  aspect.  The  specimen  was  regarded 
as  one  of  latent  necrosis  without  inflammation  of  external 
parts,  described  by  Sir  James  Paget  in  the  Transactions  of 
the  Clinical  Society,  vol.  iii.,  and  as  illustrating  the  views  of 
Mr.  Morrant  Baker,  in  the  Medico-Chirurgical  Transactions , 
vol.  lx.,  as  to  the  occurrence  of  necrosis  without  suppura¬ 
tion,  consecutively  to  ost-eo-sclerosis  in  bones  enlarged  by  a- 
general  osteitis. 

Mr.  Bowlby  referred  to  a  case  of  osteitis  deformans- 
that  he  had  shown  last  year,  in  which  there  was  a  single 
sequestrum.  He  thought  it  was  unusual  for  sequestra  to- 
form  at  the  age  of  this  patient.  The  disease  was  of  some 
standing ;  could  not  have  been  recent.  Periosteum  was  not 
adherent,  nor  was  it  in  osteitis  deformans.  The  thickening 
was  seen  to  be  over  a  greater  length  of  bone  than  in  osteitis. 
He  did  not  think  that  the  bone  had  been  in  this  condition  a 
very  long  time.  He  suggested  maceration  of  one  half  of  the 
specimen. 

Mr.  Morris  thought  that  cases  of  central  necrosis  were 
not  very  rare.  The  absence* of  an  external  sinus  was  ex¬ 
plained  by  the  absence  of  active  symptoms,  though  pain 
might  have  existed  a  long  time.  In  such  cases,  on  operation, 
a  little  deep-seated  pus  was  often  found. 

Mr.  Symonds  said  this  was  certainly  not  osteitis  de¬ 
formans.  The  bone  was  not  uniformly  enlarged ;  he  would 
call  it  a  “  condensing  osteitis.”  He  thought  it  was  of  very 
long  standing  ;  it  was  a  form  that  did  not  lead  to  suppura¬ 
tion.  The  cancellation  was  due  to  a  natural  moulding  of 
the  bone. 

Mr.  Silcock  asked  if  there  was  any  syphilis. 

The  President  considered  that  this  was  quite,  distinct 
from  osteitis  deformans.  He  asked  if  the  sclerosis  of  bone 
was  due  to  a  cutting  off  of  the  blood-supply. 

Dr.  F.  C.  Turner  said  it  was  an  essentially  atrophic- 
condition,  and,  as  in  osteoporosis,  due  to  defective  blood- 
supply.  He  had  no  history  of  the  case  whatever. 

Melanotic  Sarcomata  op  Skin. 

Dr.  J.  Wickham  Legg  showed  a  drawing  of  the  skin  of  a 
man  who  had  had  sarcoma  of  choroid,  for  which  the  eye 
had  been  removed.  The  face  was  noticed  to  be  dark  six 
months  before  death — not  patchy,  quite  uniform  ;  mucous 
membrane  not  affected ;  chiefly  of  the  face,  neck,  and  hands  j 
resembling  nitrate  of  silver  staining,  but  no  history  of  this 
could  be  obtained ;  and  this  was  confirmed  by  Mr.  Taynton, 
his  ordinary  medical  attendant.  Sections  of  the  rete  mucosum 
showed  pigmentation  of  young  cells  in  the  lower  part — in 
patches,  not  universal.  He  regarded  it  as  a  rare  occurrence. 
He  supposed  the  cause  of  this  was  the  same  as  the  pigmenta¬ 
tion  of  the  nodules.  White  blood-corpuscles  were  in  decided 
excess,  red  blood-discs  large  and  pale,  and  intermediary 
corpuscles  were  present ;  no  granules  were  found  in  the 
blood,  urine,  or  vomit.  Supra-renal  bodies  natural. 

The  President  had  never  seen  anything  like  this  in 
melanotic  sarcoma.  He  remarked  that  in  these  cases  there 
was  often  defect  of  pigment  in  parts  where  pigment  was 
normally  seen. 

Mr.  Butlin  suggested  that  the  pigment  was  taken  up  by 
skin  instead  of  passing  into  the  blood,  urine,  faeces,  and 
vomit,  as  had  usually  been  found  to  take  place  in  previously 
observed  cases. 

Dr.  S.  Mackenzie  referred  to  a  case  of  his  own — a  man 


Medical  Times  and  Gazette. 


THE  PATHOLOGICAL  SOCIETY  OF  LONDON. 


Deo.  22, 1883.  729 


very  dark-complexioned.  Every  organ  of  the  body  was 
studded  with  little  ink-like  spots.  Pigment  was  deposited  in 
those  parts  in  which  it  naturally  accumulated. 

Three  Cases  of  Tubercular  Disease  of  the  Tongue. 

Mr.  B.  J.  Godlee  read  the  notes  of  these  cases.  1.  Man, 
aged  thirty-eight ;  delicate,  tubercular  aspect ;  had  had 
fistula  in  ano,  and  was  subject  to  asthma  and  also  to 
pleurisy.  Both  testicles  were  tubercular.  He  had  a  round 
ulcer  at  the  tip  of  his  tongue,  with  raised  hard  edges  and 
a  grey  surface,  very  painful,  and  much  irritated  by  the 
teeth.  The  teeth  were  first  attended  to,  and  then  iodo¬ 
form  and  stimulating  lotions  were  applied  to  the  ulcer. 
Nitrate  of  silver  was  applied  once  a  week  with  good  result. 
The  patient  went  to  New  Zealand,  and  returned  with 
the  ulcer  healed  and  the  asthma  gone.  Soon  after  his 
return  the  ulcer  broke  out  again,  and  became  worse  than 
before.  Death  occurred  from  pneumonic  phthisis  eighteen 
months  from  onset.  No  suspicion  of  syphilis,  and  no  sign 
of  consolidation  of  lungs  was  detected  at  first.  2.  Man, 
aged  thirty-three,  who  had  had  phthisis  for  two  years  ad¬ 
vanced,  also  some  affection  of  right  sacro-iliac  articulation. 
The  tongue  was  much  swollen  in  anterior  half  of  right  side, 
the  swelling  being  elastic  and  soft,  and  the  surface  of  the 
swollen  part  covered  with  a  superficial  ulceration.  No 
history  of  syphilis;  but  antisyphilitic  remedies  were  tried, 
without  avail,  except  salivation.  The  tongue  was  punc¬ 
tured,  and  afterwards  a  free  incision  was  made  into  the  mass, 
but  led  to  no  result.  The  wound  healed,  but  the  man  died 
soon  afterwards.  There  was  found  recent  pneumonia,  and 
suppuration  of  the  sacro-iliac  joint.  The  nodule  in  the 
tongue  was  quite  diffuse,  and  seemed  made  up  of  pale  and 
thickened  tongue -tissue.  Microscopically,  distinct  tubercles 
were  found,  and  bacilli  in  large  numbers  near  the  surface. 
3.  Man,  aged  twenty- two,  who  had  had  a  cough  four  or  five 
years,  and  slight  attacks  of  haemoptysis.  In  February, 
1882,  he  had  an  ulcer  of  the  tongue,  and  consulted  Mr. 
Heath.  At  first  there  was  a  pimple,  and  then  a  crack ; 
these  ran  together,  and  began  to  be  irritated  by  the  teeth. 
A  gutta-percha  shield  was  applied  to  the  teeth.  Chromic 
acid  and  nitrate  of  silver  were  employed.  The  condition 
of  things  had  much  improved,  but  the  ulceration  had 
destroyed  the  tip  of  the  tongue.  He  was  in  fairly  good 
health,  and  there  was  no  mischief  in  the  lungs  at  the  pre¬ 
sent  time.  The  tubercular  affection  of  the  tongue  had 
probably  until  recently  been  taken  for  syphilitic  lesion. 
— The  cases  described  illustrated  two  conditions  :  an  infil¬ 
tration  amongst  the  muscular  fibres  of  the  organ,  accom¬ 
panied  by  more  or  less  ulceration  ;  and  an  ulcer  of  the 
tongue,  accompanied  by  a  slighter  amount  of  underlying 
infiltration.  It  was  probable  that  these  did  not  complete 
the  tubercular  diseases  of  the  tongue,  for  others  presenting 
a  good  many  differences  as  to  site  and  appearances  had  been 
enumerated.  Possibly  the  extensive  ulceration  about  the 
soft  palate  and  the  back  of  the  tongue  in  strumous  children 
would  have  to  be  included  in  the  category.  For  the  present 
our  duty  seemed,  he  said,  to  be  to  record  carefully  all  cases 
coming  under  observation,  giving  as  far  as  possible  the 
evidence  for  the  tubercular  nature  of  the  disease,  and 
leaving  any  wide  generalisation  until  a  larger  mass  of  facts 
was  available. 

Mr.  Charters  Stmonds  related  a  case  (and  exhibited  a 
specimen  and  sections)  of  tubercular  ulcer  of  the  tongue. 
It  occurred  in  a  man  aged  fifty,  the  father  of  seven  healthy 
children,  who  had  been  in  good  health  up  to  nine  weeks 
before  he  was  first  seen.  Then  he  caught  cold,  and  since 
had  been  ailing.  He  complained  chiefly  of  difficulty  in 
swallowing,  having  for  some  weeks  been  unable  to  take 
solids.  He  had  lost  flesh  to  the  amount  of  two  stone.  The 
ulcer  was  situated  in  the  centre  of  the  left  half  of  the  tongue. 
In  shape  it  resembled  a  leech-bite,  being-  composed  of  three 
fissures  running  from  a  central  point.  The  edges  were  sharp, 
and  but  slightly  hard  ;  the  sides  vertical  and  deep.  On  sepa¬ 
rating  the  edges  a  considerable  cavity  was  exposed,  with 
undermining  of  the  sides.  The  colour  was  grey.  It  was 
not  painful.  No  induration  existed  around  the  ulcer,  and 
no  glandular  enlargement.  He  was  placed  upon  an  abun¬ 
dant  fluid  diet,  and  given  iodide  of  potassium.  The  epi¬ 
glottis,  by  means  of  the  laryngoscope,  was  found  healthy,  as 
well  as  the  vocal  cords,  though  his  voice  was  deep,  and  had 
changed  to  this  tone  of  late  only.  A  bougie  could  be  passed 
into  the  stomach  also,  encountering  a  slight  obstruction 


half-way  down.  He  improved  at  once  in  appearance,  and 
felt  stronger,  although  his  weight  remained  the  same.  He 
was  able  in  a  week  to  eat  chicken  finely  minced,  and  in  a 
fortnight  to  take  solids  in  the  ordinary  way.  A  cough, 
which  had  been  causing  him  trouble,  now  became  serious, 
and  grave  symptoms  appeared,  gradually  getting  worse  till 
September  8  (one  month  after  admission),  when  he  was 
drowsy  and  had  difficulty  in  breathing.  The  temperature 
rose  to  103 '4°,  and  pulse  to  132,  while  mucous  rales  were 
heard  over  the  left  base.  The  signs  and  symptoms  of  acute 
pulmonary  disease  gradually  increased,  and  he  died  on  the 
10th,  having  been  seriously  ill  only  a  few  days.  At  the 
autopsy,  acute  tuberculosis  of  the  lungs  was  found  to  be  the 
cause  of  death.  The  oesophagus  was  pouched  and  dilated,  but 
not  strictured.  The  larynx  also  was  healthy.  The  appear¬ 
ance  of  the  ulcer  was  recognised  as  peculiar,  and  belonging 
neither  to  the  syphilitic  nor  epitheliomatous.  Mr.  Bryant, 
however,  who  saw  the  case  early,  called  it  tubercular  at 
once.  The  oesophageal  obstruction,  taken  in  connexion  with 
the  tongue-affection,  supported  the  syphilitic  view,  as  did  the 
rapid  improvement  in  swallowing  which  followed  the  ad¬ 
ministration  of  antisyphilitic  remedies.  The  ulcer,  however, 
underwent  no  improvement,  nor  did  the  man  increase  in 
weight,  though  he  was  able  to  take  large  quantities  of  food. 
The  ulcer  probably  preceded  the  pulmonary  affection  by  two 
or  three  weeks,  for  the  man  says  that  when  first  noticed  the 
place  would  admit  his  thumb.  This  he  noticed  a  week  after 
he  caught  cold.  Microscopical  examination  of  the  ulcer 
showed  its  tubercular  nature.  Many  nodules  of  small  cells 
were  scattered  round  the  ulcer,  the  compressed  and  wasted 
muscle  forming  a  definite  boundary.  The  cells  showed  the 
appearances  usually  seen  in  tubercle.  Giant-cells  were  pre¬ 
sent,  but  were  scarce.  The  microscopical  appearances  indi¬ 
cated  rapid  growth  and  early  caseation,  and  in  these  respects 
j  differed  from  those  seen  in  the  case  published  by  Mr.  Bryant 
in  the  Guy’s  Reports  for  1882. 

Mr.  Jessett  showed  a  man,  aged  fifty-four,  who  had  an 
ulcer  of  the  tongue.  Family  history  good.  History  of 
syphilis  twenty  years  previously.  His  children,  however, 
were  all  healthy.  He  had  been  ailing  with  a  cough  since 
November,  I8S2.  In  March,  18S3,  he  noticed  a  sore  on  left 
side  of  tongue,  due  (?)  to  irritation  of  pipe;  he  had  had 
similar  sores  before,  which  got  well  with  nitrate  of  silver. 
He  came  under  observation  with  an  ulcer  three-quarters  of 
an  inch  by  half  an  inch  on  left  side  of  tongue,  and  some 
signs  of  early  phthisis  in  lungs.  He  had  not  improved 
under  antisyphilitic  treatment.  No  enlargement  of  the 
glands. 

Dr.  Thin  had  examined  sections  of  Mr.  Barker’s  specimen 
of  ulcer  of  the  tongue.  Bacilli  were  plentiful  near  the  free 
surface;  they  were  crowded  together  in  certain  localised 
parts,  not  deep  seated.  This  was  not  due  to  any  staining 
changes.  They  were  contained  in  small  cells,  white  blood- 
corpuscles;  others  in  epithelioid  cells.  Numbers  appeared 
to  be  free,  but  he  was  not  certain  that  they  were  not  really 
in  cells.  They  were  grouped  near  the  free  surface  of  the 
ulcer.  In  his  view  a  giant-cell  was  a  bloodvessel  with 
j  thickened  walls  and  granular  matter  in  the  centre.  He 
I  had  found  bacilli  in  two  of  these,  deeply  seated ;  they, 
j  in  fact,  formed  a  soil  in  which  these  bacilli  could  grow, 
j  Scrapings  of  an  ulcer  ought  to  yield  bacilli  if  the  affection 
were  tubercular,  and  would  therefore  be  valuable  in  a 
diagnostic  point  of  view. 

Mr.  Bowlby  showed  two  specimens  of  ulceration  of  the 
tongue.  1.  Boy,  aged  nineteen  ;  had  suffei-ed  for  two  years. 
Dorsum  of  tongue  showed  a  large,  ragged,  irregular  ulcer; 
edges  overhanging;  it  spread  to  soft  palate  and  arytseno-epi- 
glottidean  folds.  Signs  of  phthisis  in  lungs.  Tonsils  natural. 
Death  two  months  later.  Cavities  in  right  lung  ;  tubercles 
in  both  lungs  ;  glands  under  jaw  considerably  enlarged  and 
painful.  2.  Man,  aged  thirty-seven;  ulcer  of  tongue  for  eight 
months.  Death  from  phthisis.  At  first  there  was  a  tendency 
to  heal.  He  alluded  to  two  cases  published  by  Billroth. 
Both  patients  died  of  tuberculosis,  though  there  was  some 
tendency  of  the  ulcer  to  heal. 

The  President  observed  that  no  doubt  these  cases  must 
have  been  seen,  but  not  recognised.  There  appeared  to  be 
two  forms— one  gummous  thickening,  followed  by  ulcer ; 
the  other,  ulceration  from  the  first.  One  of  these  ulcers 
was  in  a  sloughing  condition.  Extreme  chronicity  was  the 
most  important  diagnostic  feature.  The  bacilli  were  near 
the  surface  of  the  ulcer,  and  therefore  might  have  crept  in 


Medical  Times  and  Ga2ette. 


MEDICAL  NEWS. 


Deo.  22,  188?. 


from  without;  then  they  were  seen  in  leucocytes — a  point 
of  some  importance. 

Dr.  Ormerod,  referring  to  Mr.  Bowlby’s  first  case,  said  the 
ulcer  was  far  back  and  Y-shaped.  No  definite  physical  sign 
in  lungs  at  that  time. 

Mr.  Butlin  also  recollected  this  case.  It  was  not  difficult 
to  diagnose.  Syphilis  or  cancerous  disease  was  clearly  out  of 
the  question.  He  believed  that  Mr.  Godlee  had  under-esti¬ 
mated  the  difficulties  of  diagnosis.  Dr.  Thin’s  remarks  had 
interested  him  very  much,  especially  as  he  had  often  scraped 
ulcers  in  epitheliomatous  affections,  and  been  thereby  enabled 
to  make  a  diagnosis. 

Mr.  Barker,  at  the  last  meeting  of  the  Society,  had  re¬ 
ferred  to  all  the  recorded  cases — fifteen  in  number.  Eleven 
were  males;  half  were  above  the  age  of  forty-seven,  none 
at  a  very  early  age,  eighteen  being  the  earliest.  In  four, 
perhaps  five,  cases  no  disease  of  the  lungs  could  be  recog¬ 
nised  when  the  tongue  was  affected;  in  two  of  these  the 
tongue  was  excised,  and  the  patients  recovered.  He  sug¬ 
gested  that  the  ulcers  might  take  up  the  bacilli  from  the 
sputa,  and  begin  simply  from  irritation  of  a  tooth. 


MEDICAL  NEWS. 

- ®. - 

University  oe  London. — The  following  is  a  list  of  the 
candidates  who  have  passed  the  recent  examinations : — 

M.D.  Examination. 

Entire,  Examination. — Edwin  Leonard  Adeney  (Gold  Medal),  Guy’s 
Hospital ;  George  Frederick  Barnes,  St.  Bartholomew’s  Hospital ;  Dudley 
Wilmot  Buxton,  B.S.,  University  College ;  William  Chisholm,  B.A. 
Sydney,  University  College  ;  David  Collingwood,  B.S.,  University  College ; 
William  Radford  Dakin,  B.S.,  Guy’s  Hospital ;  Edward  Alfred  Dingley, 
University  College;  John  Thomas  Faulkner,  Owens  College  and  Man¬ 
chester  Royal  Infirmary;  William  Eckett  Fielden,  Guy’s  Hospital ;  James 
Harper,  St.  Bartholomew’s  Hospital ;  Thomas  Harris,  Owens  College  and 
Manchester  Royal  Infirmary  ;  John  Davey  Hayward,  University  College  ; 
John  Edward  Hine,  University  College  ;  Robert  Jones,  St.  Bartholomew’s 
Hospital;  Henry  Maudsley,  B.S.,  University  College;  William  Henry 
Neale,  B.S.,  University  College;  Arthur  Edward  Permewan,  University 
College ;  William  Sellers,  University  of  Edinburgh  and  London  Hospital ; 
Lauriston  Elgie  Shaw,  Guy’s  Hospital ;  Samuel  Walter  Sutton,  B.S.,  St. 
Thomas’s  Hospital;  Harold  Gilbertson  Taylor,  King's  College;  Robert 
Spencer Wainewright,  Guy’s  Hospital;  Frederick Rufenacht Walters, B.S. , 
St.  Thomas’s  Hospital;  Alfred  Ernest  Wells  (obtained  the  number  of 
marks  qualifying  for  the  Medal),  St.  Thomas’s  Hospital. 

Logie  and  Psychology  only. — David  Samuel  Davies,  St.  Thomas’s  Hos¬ 
pital  ;  Henry  Hoole,  Charing-eross  Hospital ;  Hubert  Montagu  Murray, 
University  College ;  Reginald  Pratt,  University  College ;  Tom  Henry 
Sawtell,  St.  Bartholomew’s  Hospital ;  Henry  Smith,  St.  Bartholomew’s 
Hospital. 

M.S.  Examination. 

William  Arbuthnot  Lane,  Guy’s  Hospital. 

Examination  in  Subjects  relating  to  Public  Health. 

Louis  Coltman  Parkes,  M.D.,  University  College. 


King  and  Queen’s  College  of  Physicians  in 
Ireland. — At  a  special  examination  for  the  Licence  in 
Midwifery,  held  on  Monday,  December  3,  1883,  the  following 
candidate  was  successful :  — 

Richard  Henry  Dowse,  M.B.  Univ,  Dub.,  Enniscorthy. 

At  the  usual  monthly  examinations  for  the  Licences  of 
the  College,  held  on  Monday,  Tuesday,  Wednesday,  and 
Thursday,  December  10,  11,  12,  and  13,  the  following 
candidates  were  successful : — 

To  Practise  Medicine.  —  John  Charles  Aldred,  Sheffield;  Fred.  William 
Allwright,  Sydney-parade,  Dublin  ;  John  Bernal,  Limerick  ;  Henry  Joseph 
Butler,  Dublin;  Henry  Wilkinson  Carr,  Kilburn,  London;  Robert 
Hampden  Clement,  Glenageary,  co.  Dublin;  Cornelius  Daly,  Charleville, 
co.  Cork;  Quintin  Richard  Darling.  Kinsale,  co.  Cork;  Patrick  Thomas 
Dillon,  Listowel,  co.  Kerry;  John  Greenhalgh,  Northenden,  Manchester; 
William  Byron  Hanbidge,  Ogdensburg,  New  York ;  John  M.  Prior 
Kennedy,  Dublin;  William  Nolan,  Dublin;  William  Hewes  Oliphant, 
Toronto,  Ontario,  Canada;  Francis  Helen  Prideaux,  London;  William 
Swanson  Sprent,  Gargrave,  near  Skipton,  Yorks. 

To  Practise  Midwifery. — John  Charles  Aldred;  John  Bernal;  Edward 
Coey  Bigger,  M.D.  R.U. I.,  Belfast;  HeDry  J.  Butler:  William  Calwell, 
M.D.  R.U.I.,  Belfast:  Henry  Wilkinson  Carr  ;  Robert  Hampden  Clement; 
William  Courtney,  M.D.  R.U.I.,  Killane,  co.  Clare;  Quintin  Richard 
Darling  ;  Archibald  Alexander  George  Dickey,  M.D.  R.U. I.,  Raphoe,  co. 
Donegal ;  David  Peter  Gaussen,  M.D.  R.U.I.,  Holywood,  co.  Down ;  John 
Greenhalgh;  John  Murray  Prior  Kennedy;  William  Nolan;  William 
Swanson  Sprent ;  Arthur  Jalland  Stiles,  M.B.  Edin..  Spalding,  Lincoln¬ 
shire  ;  Edward  Copley  Ward,  M.D.  R.U.I.,  Charleville,  co.  Cork. 

The  following  Licentiates  in  Medicine  of  the  College, 
having  complied  with  the  by-laws  relating  to  Membership, 
pursuant  to  the  provisions  of  the  Supplemental  Charter  of 
December  12,  1878,  have  been  duly  enrolled  Members  of  the 
College : — 

Robert  Francis  Buchanan,  L.M.  1864,  Surgeon-Major  A. M.D. ;  Richard 
James  Sweetnam,  L.M.  1864,  Staff-Surgeon  R.N. 


granted  the  Licence  as  a  Midwife  and  Nurse-tender  :  — 

Sarah  Anne  Hemming?,  Steevens’  Hospital,  Dublin. 


University  oe  Dublin. — School  of  Physic  in 
Ireland. — At  the  Michaelmas  Term  Examination  for  the- 
degree  of  Bachelor  of  Medicine  (M.B.),  held  on  Monday, 
December  3,  and  subsequent  days,  the  successful  candidates 
were  arranged  in  the  following  order  of  merit,  viz. : — 

Charles  Herbert  Thompson,  Harloe  Henry  Fleming,  Richard  Miller, 
Charles  C.  de  Burgh  Daly,  Randolph  Kilkelly,  [William  Nedham  Denning, 
Glascott  Hardy  Symes— equal],  Victor  Edwin  Smith,  Richard  Nunn. 

At  the  Michaelmas  Term  Examination  for  the  degree  of 
Bachelor  in  Surgery  (B.Ch.),  held  on  Monday,  December  10, 
and  subsequent  days,  the  candidates  passed  in  the  following- 
order  of  merit,  viz. :  — 

Arthur  F.  Geoghegan,  Richard  Miller,  [George  M.  Dobson,  William] 
Fenton,  Glascott  Symes — equal],  Charles  C.  de  Burgh  Daly,  Richard  Nunn, 
Henry  McQuade,  William  Nedham  Denning,  Robert  H.  Fleming,  Robert 
E.  Sproule,  Henry  E.  Blandford. 


Apothecaries’  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday, 
December  13 : — 

Bradbrook,  William,  Green-street,  E. 

Walton,  Francis  Fielder,  Mason-street,  Hull. 

The  following  gentlemen  also  on  the  same  day  passed  their 
Primary  Professional  Examination  :  — 

Bennett,  Edwin  Alfred,  Cornwall-road,  Bayswater. 

Ward,  John  Smallwood,  Lisburn. 


APPOINTMENTS. 

Audland,  W.  E.,  L.R.C.P.,  M.R.C.S.— Assistant  House-Surgeon  to  the 
Northampton  General  Infirmary,  vice  —  Smith,  resigned. 

Ciiubton,  T.,  M.D. — Consulting  Physician  to  the  Batley  and  District 
Cottage  Hospital. 

Clarke,  W.  Bruce,  M.B.  Oxon.,  F.B.C.S.— Assistant-Surgeon  to  Sf- 
Bartholomew’s  Hospital,  vice  James  Shuter,  F.R.C.S.,  deceased. 

Evans,  William  George,  M.R.C.S.,  L.R.C.P.— Samhrooke  Surgical 
Registrar  at  King’s  College  Hospital. 

Eve,  Frederick  S.,  E.R.C.S.—  Assistant-Surgeon  to  the  Royal  Free, 
Hospital,  vice  James  Shuter,  F.R.C.S.,  deceased.  Also,  Surgical 
Registrar  to  the  London  Hospital. 

Giddings,  R.  R.,  M.B.  and  C.M.  Edin.,  M.R.C.S.— Junior  Surgeon  to  the 
Nottingham  Dispensary. 

Johnston,  F. ,  M.B. — House-Surgeon’s  Assistant  to  the  Liverpool  Northern 
Hospital,  vice  —  Horrocks. 

Mason,  Samuel  R.,  M.D.,  F.R.C.S. I.—  Master  of  the  Coombe  Lying-in 
Hospital,  vice  G.  H.  Kidd,  M.D.,  F.R.C.S. I. 

Mivart,  F.  St.  George,  M.R.C.S. -Surgeon  to  the  Western  General 
Dispensary,  vice  G.  8.  Hames,  E.R.C.S,,  resigned. 

Pryce,  T.  Davies,  M.R.C.S.,  L.S. A. —Junior  Surgeon  to  the  Nottingham 
Dispensary. 

Richards,  Thomas,  M.B. —Extra  Acting-Physician  to  the  Children’s 
Hospital,  Birmingham. 

Robson,  A.  W.  M.,  E.R.C.S.— Consulting  Surgeon  to  the  Batley  and 
District  Cottage  Hospital. 

Scott,  J.  H.,  M. B. -Assistant-Surgeon  to  the  Dublin  Throat  and  Ear 
Hospital. 

Silk,  John  Frederick  William,  M.B.— Samhrooke  Medical  Registrar  at 
King’s  College  Hospital. 

Vinrace,  E.  D.,  M.R.C.S. -Resident  Medical  Officer  to  the  Throat 
Hospital,  Golden-square,  W. 

Wilson,  J.  Grant,  M.R.C.S.,  L.S. A.—  Senior  Resident  Surgeon  to  the 
Nottingham  Dispensary. 


DEATHS. 

Abhburner,  Henry  John,  M.R.C.S.,  at  Horsham,  on  December  II, 
aged  5a. 

Ashton,  Thomas,  M.D.,  at  Norwood,  Altrincham,  Cheshire,  on  December 
15,  aged  83. 

Buchan,  Charles  Forbes,  M.A.,  M.B.,  at  Camberwell,  on  December  10. 
Pretty,  George  Willson,  M.R.C.S.,  etc.,  at  Fressingfield,  Suffolk,  on 
December  16,  aged  65. 


VACANCIES. 

Birmingham  General  Dispensary. — Resident  Surgeon.  Salary  £150  per 
annum  (with  an  allowance  of  t30  per  annum  for  cab  hire) ,  with  fur¬ 
nished  rooms,  fire,  light,  and  attendance.  Candidates  must  be  registered 
and  possess  both  a  medical  and  a  surgical  qualification.  Applications, 
with  original  testimonials  and  certificate  of  .registration,  to  be  forwarded 
to  the  Secretary,  on  or  before  January  15. 

Chorlton-upon-Medlock  Dispensary. -House-Surgeon.  Salary  £120  per 
annum,  with  apartments,  etc.  Applications  to  be  sent  to  the  Hon. 
Secretary  at  the  institution. 

Dental  Hospital  oe  London,  Leicester-square,  W. — Assistant  Dental 
Surgeon.  ( For  particulars  see  Advertisement.) 


730 


The  undermentioned  candidate  was,  after  examination. 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES. 


Dec.  22, 1883.  731 


Metropolitan  Asylums  Board  :  Darenth  Imbecile  Schools,  near 
Dartfobd,  Kent. — Assistant  Medical  Officer.  (For  particulars  see 
Advertisement.) 

York  Dispensary. — Resident  Medical  Officer.  Salary  £130  per  annum, 
•with  furnished  apartments,  coals,  and  gas.  Candidates  must  be  duly 
qualified  and  unmarried.  Applications  and  testimonials  to  be  sent  to 
S.  W.  North,  Esq.,  84,  Mieklegate,  York,  on  or  before  December  28. 


UNION  AND  PAROCHIAL  MEDICAL  SERVICE. 

***  The  area  of  each  district  is  stated  in  acres.  The  population  is 
computed  according  to  the  census  of  1881. 

RESIGNATIONS. 

East  Ward  Union. — The  offices  of  Medical  Officer  for  the  Kirkby  Stephen 
District  and  the  Workhouse  are  vacant  by  the  death  of  Mr.  Thomas  Sayer  : 
area  19,163;  population  2493  ;  salary  £'20  per  annum;  salary  for  Workhouse 
£30  per  annum. 

Sunderland  Union. — Dr.  A.  B.  Low,  Medical  Officer  for  the  Workhouse, 
has  resigned ;  salary  £275  per  annum,  proposed. 

APPOINTMENTS. 

Hoxne  Union. — William  H.  Anderson,  M.B.,  C.M.,  to  the  Bessingfield 
District. 

St.  Saviour's  Union. — John  P.  Williams,  M.R.C.S.  Eng.,  L.S.A.,  as 
Assistant  Medical  Officer  and  Dispenser  at  the  Infirmary. 


The  Cholera  at  Mecca. — Mecca  is  at  length  re¬ 
ported  to  be  free  from  cholera,  and  the  sanitary  condition  of 
the  caravans  returning  from  that  place  is  now  excellent. 

Shop  Assistants. — -A  Bill,  which  is  virtually  an  ex¬ 
tension  of  the  Factory  and  Workshops  Act,  1878,  has  been 
framed  under  the  auspices  of  the  Shop-Hours  League,  with 
the  view  of  obtaining  reasonable  hours  for  shop  assistants 
of  both  sexes.  It  is  expected  that  it  will  be  introduced  into 
Parliament  next  session,  and  it  is  to  be  hoped  that  time  will 
be  found  to  pass  a  measure  affecting  the  health  of  such  a 
large  class  of  the  population. 

The  late  Sir  Wyville  Thomson. — On  Saturday 
last  a  bust  of  the  late  Professor  of  Natural  History  was 
presented  to  the  University  of  Edinburgh  on  behalf  of  the 
subscribers  by  Mr.  Murray,  of  the  Challenger  Expedition, 
who,  in  making  the  presentation,  said  that  it  had  been  a 
project  of  Sir  Wyville  Thomson’s  to  establish  large  marine 
laboratories  on  the  Firth  of  Forth.  The  bust  is  by  Mr.  John 
Hutchison,  of  Edinburgh,  and  is  said  to  be  a  good  likeness.- 
The  Homes  of  the  Poor  in  Vienna.- — The  ques¬ 
tion  of  the  housing  of  the  poor  has  been  raised  in  the 
Austrian  Parliament  by  a  motion  to  exempt  from  the  heavy 
house-tax  lodgings  of  which  the  rent  is  under  <£14,  and 
to  give  State  facilities  to  societies  formed  for  the  erection 
of  healthy  artisans’  dwellings.  Vienna,  like  all  large  towns, 
has  slums  and  rookeries,  in  some  cases  worse  than  any  in 
London,  but  improvement  seems  impossible  owing  to  the 
enormous  house-tax,  which  is  over  35  per  cent,  on  the  rent. 

Prosecution  under  the  Apothecaries  Act. — Mr. 
J.  M.  Rhodes,  of  Yeadon,  Leeds,  who  appears  in  the 
“  Medical  Directory”  as  a  Licentiate  of  the  Apothecaries’ 
Society,  has  been  sued  by  that  Society  for  £20  penalties  for 
practising  as  an  apothecary  without  being  duly  qualified. 
The  defendant  had  been  fined  a  similar  amount  early  in 
the  year  for  the  same  offence,  and  though  it  was  stated  that 
he  had  since  then  always  had  a  properly  qualified  practi¬ 
tioner  in  charge  of  his  practice,  the  judge  considered  the 
case  proved,  and  gave  a  verdict  for  the  full  penalty. 

Classification  of  Diseases. — In  a  recently  pub¬ 
lished  report,  Surgeon-General  Wales,  Chief  of  the  United 
States  Naval  Bureau  of  Medicine  and  Surgery,  recommends 
that  the  medical  departments  of  the  great  naval  powers  be 
invited  to  a  conference  with  a  view  to  the  adoption  of  a 
uniform  nomenclature,  classification,  and  tabulation  of 
-diseases,  as  well  as  of  a  system  of  interchange  of  periodical 
reports  of  the  movement  of  disease,  from  which  inter¬ 
national  reports  of  sanitary  conditions  all  over  the  world 
may  be  published  at  intervals. 

Bequests  to  Hospitals.  —  The  late  Mr.  Samuel 
Lancaster,  of  Walthamstow,  has  bequeathed  <£500  to  each 
-of  the  following  charities  : — The  Seamen’s  Hospital,  Wan- 
stead;  the  City  of  London  Hospital  for  Diseases  of  the 
'Chest,  Victoria-park ;  the  Royal  Hospital  for  Consumption, 
Ventnor ;  the  Royal  Hospital  for  Incurables,  Putney  ;  the 
Royal  Hospital  for  Diseases  of  the  Chest,  City-road ;  the 
Earlswood  Idiot  Asylum ;  the  London  Hospital ;  the  Throat 
Hospital,  Golden-square  ;  the  Truss  Society,  Finsbury  ;  and 
the  General  Throat  Society,  Gray’s-inn. 


Health  Lectures.— On  the  12th  inst.,  Dr.  Andrew 
Wilson  delivered,  at  Burntisland,  the  last  of  a  series  of  eight 
popular  lectures  on  “  Physiology  in  its  Relation  to  Health,” 
which  he  has  been  giving  in  connexion  with  the  Combe  Trust. 
A  prize  competition  will  be  held  on  the  subject  of  the 
lectures,  and  the  local  medical  men,  Drs.  Spence  and  Orr, 
have  consented  to  act  as  adjudicators. 

Gresham  Lectures. — The  lectures  founded  by  Sir 
Thomas  Gresham  will  be  read  to  the  public  on  the  following 
days,  at  6  o’clock  p.m.,  in  the  theatre  of  Gresham  College, 
Basinghall-street,  in  the  following  order : — Divinity  (Dean 
Burgon),  January  8,  9,  10,  and  11 ;  Rhetoric  (Mr.  Nixon), 
January  15, 16, 17,  and  18  ;  Geometry  (Dean  Cowie),  January 
22,  23,  24,  and  25;  Law  (Dr.  Abdy),  January  29,  30,  and  31, 
and  February  1 ;  Astronomy  (Rev.  E.  Ledger),  February  5, 
6,  7,  and  8;  Physic  (Dr.  Symes  Thompson),  February  12,13, 
14,  and  15  ;  and  Music  (Dr.  Henry  Wylde),  February  19,  20, 
21,  and  22. 

The  late  Surgeon- General  Johnstone. — Surgeon- 
General  T.  B.  Johnstone,  M.D.,  who  recently  died  at  Ealing 
in  the  sixty-sixth  year  of  his  age,  graduated  at  Edinburgh 
in  1842,  and  shortly  after  proceeded  to  India  as  an  Assistant- 
Surgeon  upon  the  Bombay  establishment.  He  served  with 
the  2nd  Bengal  Regiment  with  the  troops  under  Sir  Charles 
Napier,  G.C.B.,  in  the  campaign  against  the  mountain  tribes 
in  Kutch  in  1844-45,  and  also  with  the  Camel  corps  in  Scinde. 
On  returning  to  India  after  his  furlough.  Dr.  Johnstone  held 
various  civil  appointments,  including  that  of  Secretary  to  the 
Inspector-General,  in  which  office  he  remained  until  he  be¬ 
came  a  Deputy  Surgeon-General,  when,  upon  his  retirement 
from  the  service  in  1877,  he  obtained  the  rank  of  Surgeon- 
General. 

The  Convalescence  of  Scurvy. — Dr.  Richberg  calls 
attention  to  the  necessity  of  absolute  and  resolute  main¬ 
tenance  of  the  horizontal  posture  until  recovery  is  pretty 
well  advanced.  Patients  who  seemed  to  be  in  the  best  of 
spirits,  and  in  a  fair  way  of  recovery,  have  died  instantly 
on  making  a  sudden  exertion.  The  transfer  from  a  vessel 
to  a  hospital  in  the  harbour,  the  endeavour  to  leave  the  room, 
or  the  effort  to  sit  up  in  bed,  have  all  been  attended  with 
the  direst  results.  The  fatal  termination  in  these  cases  is 
undoubtedly  due  to  syncope,  occasioned  either  by  the  dimi¬ 
nished  power  of  the  heart  (reduced  as  this  organ  sometimes 
is  to  one-third  of  its  usual  size),  or,  as  suggested  by  Aitken, 
to  embolism  from  an  altered  state  of  the  fibrin. — Phil.  Med. 
Reporter,  November  24. 


NOTES,  QUERIES,  AND  REPLIES. 

- o - 

He  t^rat  questioned  mutjj  sjjall  learn  much. — Bacon. 


The  Rogers  Testimonial. 

The  following  is  the  eighth  list  of  subscriptions  Dr.  Farquharson, 
M.P.,  Aboyne,  £1  Is. :  Well-Wisher,  Camberwell,  £1  Is. ;  James  Somers, 
Esq.,  Broadclyst, Devon,  £1  Is. ;  C.  D.  Waite,  Esq.,  M.B.,  Old  Burlington- 
street,  £1  Is.  ;  John  Storr,  Esq.,  King-street,  Covent-garden,  £1  Is. ;  H. 
Taylor,  Esq.,  F.R.C.S.,  Guildford,  £1  Is.;  Messrs.  Haynes,  Evesham, 
£1  Is.  ;  H.  G.  Sadler,  Esq.,  Canterbury,  £1  Is.;  Dr.  Bain,  Blackwall, 
10s.  6d.  ;  J.  W.  Hayward,  Esq.,  Whitstable,  10s.  6d. ;  R.  Jeffreys,  Esq., 
Chesterfield,  10s.  6d. ;  W.  D.  James,  Esq. ,  Sheffield,  10s.  6d. ;  John  Wood, 
Esq.,  Tarrington,  10s. ;  S.  J.  Erwin,  Esq.,  Openshaw,  5s. ;  H.  A.  Lawton, 
Esq.,  Poole,  5s. ;  R.  Hickman,  Esq.,  Newbury,  5s. 

The  Hind  Fund. 

The  following  additional  subscriptions  have  been  received  and  paid  to 
the  account  of  the  “Hind  Fund”  at  Messrs.  Coutts’  Bank:— W.  Cadge, 
Esq.,  £1  Is.;  L.  Cattermole,  Esq.,  fills.;  E.  W.  Coleman,  Esq.,  £1 ; 
Dr.  E.  O.  Hopwood,  £1  Is. ;  W.  J.  King,  Esq.,  £1  Is. ;  G.  E.  Mineard, 
Esq.,  £1  Is. ;  T.  D’O.  Partridge,  Esq.,  £1  Is. ;  W.  E.  Soffe,  Esq.,  £1  Is. 

Subscriptions  may  be  paid  to  Dr.  Richardson,  F.R.S.  (chairman', 
25,  Manchester-square  ;  John  Tweedy,  Esq.,  F.R.C.S.,  24,  Harley-street, 
hon.  treasurer  ;  A.  J.  Pepper,  Esq.,  F.R.C.S.,  122,  Gower-street,  or  T. 
Wakley,  jun.,  Esq.,  L.R.C.P.,  96,  Redcliffe-gardens,  hon.  secretaries  ;  or 
to  Messrs.  Coutts  and  Co.,  Strand. 

Dr.  Henry  Sorley,  Wanganui ,  New  Zealand. — Letter  and  enclosure  received 
with  thanks. 

Dr.  Exchaquet,  Bex,  Suisse. — We  have  already  noticed  the  pamphlet,  and 
cited  the  cases  you  mention.  See  issue  of  November  3,  page  528. 

Dr.  Harris.—  There  is  a  vacancy  in  the  Council  of  the  College  of  Surgeons, 
caused  by  the  resignation  of  Mr.  John  Gay,  who  was  re-elected  a  member 
of  the  Council  in  1878,  with  Mr.  Edward  Lund,  of  Manchester.  The 
vacant  chair  cannot  be  filled  up  until  the  annual  meeting  of  Fellows, 
the  first  Thursday  in  J uly  next. 


VITAL  STATISTICS. 


Dec.  22, 1883. 


I  Medical  Times  and  Gazette. 


A  Competitor. — Essays  for  the  Jacksonian  Prize  of  the  Royal  College  of 
Surgeons  must  be  sent  to  the  Secretary  of  that  institution  on  or  before 
Monday,  the  31st  inst.,  and  before  four  o’clock. 

COMMUNICATIONS  have  been  received  from— 

Dr.  S.  Wicks,  P  R.S.,  London;  The  Secretary  of  the  Chelsea  Hos¬ 
pital  for  Women,  London;  L'Editeur  de  la  “  Revue  Sanitaip.e,” 
Bordeaux;  Mr.  E.  Owen,  London ;  Dr.  G.  E.  Herman,  London;  Mr. 
A.  Knight,  London  ;  Mr.  George  Donilevski,  St.  Petersburg  ;  Mr.  S. 
Hall,  Carlisle ;  Dr.  J.  Mortimer  Granville,  London ;  The  Secretary 
of  the  Apothecaries’  Society,  London ;  The  Secretary  of  the 
Local  Government  Board,  London ;  Dr.  Norman  Chevers,  London  ; 
The  Registrar  of  the  University  of  London  ;  Mr.  T.  M.  Stone, 
Wimbledon;  Dr.  J.  W.  Moore.  Dublin;  The  Secretary  of  the 
Native  Guano  Company  (Limited),  London  ;  The  Secretary  of  the 
International  Health  Exhibition,  London ;  Mr.  Becher.  London ; 
Mr.  M.  Smale,  London;  Dr.  W.  H.  Corfield,  London;  Mr.  J. Chatto, 
London ;  Mr.  E.  Atkinson,  Leeds. 

BOOKS,  ETC.,  RECEIVED  - 

The  Effects  of  Unhealthy  Occupations,  etc.,  by  Andrew  Smart,  M.D., 
F.R.C.P. — Some  Debatable  Questions  and  how  to  Solve  them,  by 
Sampson  Gamgee,  F.R.S.E. — China  Imperial  Maritime  Customs  Medical 
Reports  for  the  Half-Year  ended  March  31,  1883 -Transactions  of  the 
Pathological  Society  of  London,  vol.  xxxiv.— Transactions  of  the 
Clinical  Society,  vol.  xvi. — How  to  Arrest  Infectious  Diseases,  by  E.  G. 
Barnes,  M.D. — Annals  of  Cholera,  by  John  Macpherson,  M.D.— Religio 
Medici,  by  Sir  Thomas  Browne— Evolution  of  Morbid  Germs,  by  K.  W. 
Mdlican,  B.A.,  M.R.C.8.— Relation  of  Eye  and  Spinal  Diseases,  by  A. 
Friedenwald,  M.D. —On  Baldness  and  Greyness,  by  T.  Robinson,  M.D. 
Transactions  of  the  American  Gynecological  Society  for  1882— The 
Pathology  and  Treatment  of  Venereal  Diseases,  by  F.  J.  Bumstead, 
M.D.,  and  Robert  W.  Taylor,  A.M.,  M.D. — On  Wasting  Diseases  of 
Infants  and  Children,  by  Eustace  Smith,  M.D.  Lond. — A  Compendium 
of  Modern  Pharmacy  and  Druggists’  Formulary,  by  W.  B.  Kilner — The 
Electro-Osteotome,  by  Dr.  Milton  Josiah  Roberts — Annual  Report  of 
the  Supervising  Surgeon-General  of  the  Marine  Hospital  Service  of  the 
United  States  for  1883 — Illustrated  Catalogue  of  the  Publications  issued 
by  Cassell  and  Co.  (Limited) — Malignant  Disease  of  the  Larynx,  by 
H.  T.  Butlin,  F.R.C.S.— Sterility  in  Woman,  by  J.  Matthews  Duncan, 
M.D.,  LL.D.,  etc. — Mental  Diseases,  by  T.  S.  Clouston,  M.D.,  F.R.C.P. 
— Influence  of  the  Mind  upon  the  Body,  vols.  i.  and  ii.,  by  D.  H.  Tuke, 
M.D.,  F.R.C.P.  — Rupture  of  the  Urinary  Bladder,  by  Walter  Rivington, 
F.R.C.S.— Report  of  the  London  Water-Supply. 

PERIODICALS  AND  NEWSPAPERS  RECEIVED— 

Lancet— British  Medical  Journal— Medical  Press  and  Circular — Ber¬ 
liner  Klinische  Wochenschrift — Centralblatt  fiir  Chirurgie — Gazette 
des  Hopitaux— Gazette  Medicale— Revista  de  Medicina— Bulletin  de 
1’ Academie  de  Medecine— Pharmaceutical  J ournal — W iener  Medicinische 
Wochenschrift— Revue  Mfidicale— Gazette  Hebdomadaire— Nature- 
Boston  Medical  and  Surgical  Journal— Louisville  Medical  News— 
Centralblatt  fiir  Gynakologie — Le  Concours  Medical— Centralblatt  fur 
die  Medicinischen  Wissenschaften— Centralblatt  fiir  Klinische  Medicin 
—Philadelphia  Medical  News— Le  Progres  Mddical — New  York  Medical 
Journal — Edinburgh  Clinical  and  Pathological  Journal — Students’  Jour¬ 
nal  and  Hospital  Gazette— New  York  Medical  Record— Philadelphia 
Medical  Times -Maryland  Medical  Journal — Arztlichen  Polytechnik — 
Revue  des  Sciences  Mgdicales — Journal  of  the  Vigilance  Association— 
AnEphemeris  of  Materia  Medica,  etc. — Canada  Lancet— Australasian 
Medical  Gazette — Wharfedale  and  Airedale  Observer,  December  14 — 
Toronto  Sanitary  J  ournal— Therapeutic  Gazette— Canadian  Practitioner. 


APPOINTMENTS  FOR  THE  WEEK. 


December  22.  Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  1 J  p.m. ;  King’s  College,  1J  p.m. ;  Royal 
Free,  2  p.m. ;  Royal  London  Ophthalmic,  11  a.m. ;  Royal  Westminster 
Ophthalmic,  lip.m.;  St.  Thomas’s,  ljp.m.;  London,  2  p.m. 

24.  Monday. 

Operations  at  the  Metropolitan  Free,  2  p.m.;  St.  Mark’s  Hospital  for 
Diseases  of  the  Rectum. 2  p.m.;  Royal  London  Ophthalmic,  11  a.m.; 
Royal  Westminster  Ophthalmic,  l.j  p.m. ;  Hospital  for  Women,  2  p.m. 


25.  Tuesday. 

Operations  at  Guy’s,  1J  p.m. ;  Westminster,  2  p.m. ;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  1 5  p.m.;  West 
London,  3  p.m. 


26.  Wednesday. 

Operations  at  University  College,  2  p.m. ;  St.  Mary’s,  If  p.m. ;  Middlesex, 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew’s,  1J  p.m. ;  Great  Northern, 

2  p.m. ;  Samaritan,  2J  p.m. ;  Royal  London  Ophthalmic,  11  a.m. ; 
Royal  Westminster  Ophthalmic,  lj  p.m. ;  St.  Thomas’s,  1£  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m. ;  National  Orthopaedic,  Great 
Portland-street,  10  a.m. 


27.  Thursday. 

Operations  at  St.  George’s,  1  p.m. ;  Central  London  Ophthalmic,  1  p.m. ; 
Royal  Orthopaedic,  2  p.m.;  University  College,  2  p.m. ;  Royal  London 
Ophthalmic,  11  a.m. ;  Royal  Westminster  Ophthalmic,  1J  p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m. ;  Hospital  for  Women,  2  p.m. ; 
Charing-cross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  2f  p.m. 

28.  Friday. 

Operations  at  Central  LondonOphthalmic,  2  p.m.;  Royal  London  Ophthal¬ 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminster 
Ophthalmic,  ljp.m.;  St.  George’s  (ophthalmic  operations),  If  p.m.; 
Guy  s,  If  p.m.  ;  St.  Thomas’s  (ophthalmic  operations),  2  p.m. ;  King’s 
College  (by  Mr.  Lister),  2  p.m. 


VITAL  STATISTICS  OF  LONDON. 


Week  ending  Saturday,  December  15,  1883. 


BIRTHS. 

Births  of  Boys,  1257;  Girls,  1283;  Total,  2540. 

Corrected  weekly  average  in  the  10  years  1873-82,  2673'0. 


DEATHS. 


Males. 

Females. 

Total. 

Deaths  during  the  week . 

833 

889 

1722 

Weekly  average  of  the  ten  years  1873-82,  j 

965-7 

935-5 

1901-2 

76 

corrected  to  increased  population  ...  j 

Deaths  of  people  aged  80  and  upwards 

DEATHS  IN  SUB-DISTRICTS  FROM  EPIDEMICS. 


Enumerated 

Population, 

1881 

(unrevised). 

Small-pox. 

Measles. 

Scarlet 

Fever. 

Diphtheria. 

Whooping- 

cough. 

Typhus. 

Enteric  (or 

Typhoid) 

Fever. 

Simple 

continued 

Fever. 

Diarrhoea. 

West  ... 

669833  ... 

11 

3 

9 

•  •• 

3 

5 

North  ... 

905947  6 

9 

8 

10 

4 

•  •• 

5 

2 

4 

Central 

282238  ... 

1 

2 

,,, 

3 

... 

3 

... 

East . 

692738;  ... 

8 

16 

1 

12 

2 

1 

... 

... 

South . 

1265927  1 

24 

14 

10 

14 

... 

13 

... 

3 

Total . 

3816483  7 

53 

40 

24 

42 

2 

25 

2 

12 

METEOROLOGY. 


From  Observations  at  the  Greenwich  Observatory . 


Mean  height  of  barometer . 

Mean  temperature  . 

Highest  point  of  thermometer 
Lowest  point  of  thermometer  ... 
Mean  dew-point  temperature 

General  direction  of  wind  . 

Whole  amount  of  rain  in  the  week  ... 


29’691  in. 
44-0° 

54-2° 

32-9° 

38-0° 

S.W. 

0'63  in. 


BIRTHS  and  DEATHS  Registered  and  METEOROLOGY  during  the 
Week  ending  Saturday,  Dec.  16,  in  the  following  large  Towns: — 


Cities 

and 

Boroughs. 

Estimated  Population  to 
middle  of  the  year  1883. 

|  Births  Registered  during 
j  the  week  ending  Dec.  15. 

|  DeathsRegistered  during 

1  the  week  ending  Dec.  15. 

Annual  Rate  of 
Mortality  per  1000  living, 
from  all  causes. 

Temperature 
of  Air  (Fahr.) 

Temp, 
of  Air 
(Cent.) 

Rain 

Fall. 

Highestduring 
the  Week. 

Lowest  during 
the  Week. 

|  Weekly  Mean  of 
j  Daily MeanValues 

Weekly  Mean  of 
Daily  Mean 
Values. 

In  Inches. 

In  Centimetres, 

London 

3955814 

2540 

1722 

22-7 

54-2 

32-9 

44-0 

6-67 

053 

1-35 

Brighton  ... 

... 

111262 

66 

48 

225 

51-2 

31-3 

42-1 

5-62 

074 

1-88 

Portsmouth 

... 

131478 

96 

35 

13-9 

... 

... 

... 

... 

... 

Norwich  ... 

896(2 

53 

35 

20-4 

... 

... 

... 

... 

... 

... 

Plymouth  ... 

74977 

32 

29 

20-2 

54-0 

312 

45'5 

7-50 

0-46 

117 

Bristol . 

212779 

119 

63 

154 

53-0 

335 

45-0 

7-22 

052 

1-32 

Wolverhampton  . 

77557 

42 

24 

16-2 

54-0 

28-8 

414 

5-22 

0-64 

1-63 

Birmingham 

... 

414846 

27S 

193 

24-3 

... 

... 

... 

... 

Leicester  ... 

f  *• 

129483 

88 

51 

20-5 

... 

... 

Nottingham 

199349 

15S 

90 

236 

53-9 

330 

42-4 

5-78 

0-50 

1-27 

Derby . 

... 

85574 

52 

40 

24-4 

... 

... 

... 

... 

... 

... 

Birkenhead 

88700 

63 

38 

22-4 

... 

... 

... 

Liverpool  ... 

566753 

368 

275 

253 

55-0 

37-5 

45' 1 

7-28 

1-04 

2-64 

Bolton . 

107S62 

65 

46 

22-3 

51  1 

30-6 

41-0 

5-C0 

3-30 

8-38 

Manchester 

339252 

211 

190 

29-2 

... 

... 

... 

... 

... 

... 

Salford 

190465 

130 

98 

26-8 

... 

... 

... 

... 

... 

Oldham 

119071 

76 

46 

202 

... 

... 

... 

... 

Blackburn  ... 

108460 

68 

50 

24-1 

... 

... 

... 

... 

... 

... 

Preston 

98564 

71 

52 

27-5 

... 

... 

... 

... 

... 

Huddersfield 

84701 

44 

39 

24-0 

... 

... 

... 

... 

... 

... 

Halifax 

75591 

42 

26 

17-9 

... 

... 

... 

... 

Bradford  ... 

204807 

116 

63 

161 

54-0 

32-0 

42-6 

5'90 

1-12 

2-84 

Leeds  .  ... 

321611 

205 

155 

25-1 

... 

...  , 

... 

Sheffield 

295497 

224 

119 

21-0 

55-0 

33-0 

42-3 

5-73 

1*51 

3-S4 

Hull  . 

176296 

99 

59 

17-5 

53-0 

32-0 

40-9 

4-94 

0-60 

1-52 

Sunderland 

121117 

99 

48 

20-7 

... 

... 

... 

Newcastle  ... 

149464 

96 

65 

22-7 

... 

... 

... 

•  •• 

... 

... 

Cardiff . 

... 

90033 

60 

36 

20-9 

... 

... 

... 

... 

... 

... 

For  28  towns 

... 

8620975 

5562 

3735 

22-6 

55-0 

28-8 

42-9 

6-06 

1-00 

2-54 

Edinburgh  ... 

235946 

133 

94 

20-8 

52-3 

33-8 

42-0 

5-56 

0-53 

1-35 

Glasgow 

515589 

357 

260 

26-3 

... 

... 

Dublin . 

349885 

152 

215 

32-1 

53-7 

30-7 

43-3 

6-28 

1  15 

2-92 

At  the  Royal  Observatory,  Greenwich,  the  mean  reading 
of  the  barometer  last  week  was  29’69  in. ;  the  highest  reading 
was  30-23  in.  at  the  beginning  of  the  week,  and  the  lowest 
29-25  in.  on  Tuesday  morning. 


DUNCAN  ON  RETENTION  OF  MENSES. 


Bee.  29,  1883.  733 


Medical  Times  and  Gazette. 


CLINICAL  LECTURES. 

By  J.  MATTHEWS  DUNCAN,  M.D.,  F.R.S., 

C  Physician-Accoucheur  and  Lecturer  on  Midwifery 
at  St.  Bartholomew’s  Hospital. 


Lecture  II. — RETENTION  OF  MENSES. 

This  morbid  condition  has  been  classed  under  amenorrhcea, 
and  this  will  give  you  some  idea  how  superficial  and  erro¬ 
neous  prevalent  views  may  be.  Menstruation  was  looked 
upon  as  mainly  a  bloody  discharge  from  the  vagina,  and  in 
this  disease  there  was  none ;  hence  it  was  an  amenorrhcea. 
But  you  know  that  the  blood  is  discharged,  though  not  from 
the  vagina,  not  on  the  clothes  of  the  woman  or  the  diaper 
she  wears,  but  into  the  genital  passages.  There  it  is  re¬ 
tained,  the  natural  exit  for  it  being  closed ;  there  it  accu¬ 
mulates  ;  and  so  the  disease  is  constituted.  There  is  not 
amenorrhcea,  but  menorrhcea  into  the  passages,  not  farther. 

It  is  a  rare  condition.  Lately  we  have  had  three  charac¬ 
teristic  cases  in  “  Martha,”  and,  using  only  these  and  others 
that  I  have  seen,  I  will  describe  it  to  you.  I  have  not  met 
with  a  case  where  menses  were  retained  by  closure  of  the 
internal  or  external  os  uteri.  I  have  seen  closure  of  the 
internal  os  uteri  and  consequent  pyometra  in  an  old 
woman;  closure  of  the  external  os  uteri  in  a  pregnant 
syphilitic  woman  I  have  seen ;  but  these  are  not  cases  of 
retained  menses.  Sometimes  the  vagina  becomes  closed  by 
the  healing  of  sores,  the  result  of  sloughing  from  pressure 
during  parturition,  or  the  result  of  syphilitic  infection..  But 
though  cases  of  stricture  more  or  less  tight,  and  having  a 
small  lumen,  from  these  causes  are  not  uncommon,  I  have 
not  seen  one  of  complete  closure  (atresia)  with  retention 
and  accumulation. 

When  a  passage  has  no  perforation  or  hole,  or  is  really 
not  a  passage,  it  is  said  to  be  in  a  state  of  atresia.  It  is 
atresia  of  the  vagina  (not  of  the  hymen)  that  generally 
eauses  retention  of  menses.  The  atresia  is  generally  at  the 
external  orifice  of  the  vagina  or  very  near  it,  and  it  is  con¬ 
genital.  Cases  occur  where  the  atresia  is  produced  by  ab¬ 
sence  of  more  or  less  of  the  lower  parts  of  the  vagina,  not 
by  mere  closure  inferiorly,  that  passage  being  then  only  a 
limited  cavity,  potential  or  distended,  at  first  high  in  the 
pelvis,  into  which  the  canal  of  the  cervix  uteri  opens. 
Lately  I  saw  a  case  wherein  the  atresia  affected  only  the 
middle  of  the  vagina,  about  an  inch  and  a  half  of  passage 
existing  below,  and  a  largely  dilated  upper  portion  above,  the 
atresia.  In  this  case  it  was  not  such  a  closure  by  a  diaphragm 
or  hymen-like  membranous  dissepiment  as  has  been  de- 
scribed,  but  a  closure  by  apparent  absence  of  part  of  the 
vagina,  its  place  being  taken  by  a  cord-like  mass  of  dense 
tissue. 

The  amount  of  lower  vagina  absent  is  a  very  important 
point  in  regulating  practice,  as  you  will  soon  understand. 
Generally  there  appears  to  be  no  absence  of  any  part  of  the 
vao-ina,  no  atresia  of  it,  but  only  of  the  hymen  ;  and  con¬ 
sequently,  cases  of  retention  of  menses  are  ordinarily 
described,  or  spoken  of,  as  cases  of  imperforate  hymen. 
When  a  considerable  part  of  the  lower  vagina  is  absent, 
then,  on  examination,  with  a  finger  in  the  rectum  and  a 
bougie  in  the  urethra,  you  find  no  intervening  tissues, 
nothing  to  represent  the  vagina  there;  but  higher  up  it  is 
felt  as  a  distended  sac.  f Though  the  lower  part  of  the 
vagina  is  absent,  you  may  find  a  distinct  hymen.J 

I  have  said  there  appears  to  be  no  absence  of  any  part  of 
the  vagina,  only  an  imperforate  hymen — appears  to  be  but  it 
is,  at  least  often,  a  delusive  appearance,  the  vagina  being 
really  closed  inferiorly;  and  the  hymen,  not  imperforate, 
being  found  in  its  usual  situation :  the  so-called  and  appa¬ 
rently  closed  hymen  being  the  distended  and  expanded 
fossa  navicularis,  or  mucous  membrane  between  the  posterior 

margin  of  the  hymen  and  the  fourchette. 

Into  this  atresic  vagina  the  menstrual  fluid,  chiefly  blood, 
is  poured,  in  successive  monthly  flows.  It  is  retained  and 
accumulates.  The  mucus  of  the  passages  poured  into  the 
same  cavity  for  years  previously  is  retained  but  does  not 
accumulate— an  important  and  curious  fact.  It  is  retained 
and  is  somehow  or  other  disposed  of,  probably  is  in  some 
sense  decomposed  and  absorbed.  The  retained  menstrual 

Vol.  II.  1883.  No.  1748. 


fluid  becomes  denser,  the  liquor  being  mostly  absorbed  ;  and 
at  last  it  is  a  viscid,  treacly,  or  tar-like  mass,  lighter  or 
darker  brown  in  colour,  having  a  faint  faded  smell  or  none 
at  all.  As  a  result  of  decomposition  its  elements  are  altered 
chemically  and  microscopically,  but  it  is  not  putrid.  If  air 
is  admitted  into  the  vagina,  putrid  decomposition  rapidly 
ensues.  The  quantity  of  accumulated  fluid  varies  greatly, 
forty  or  even  fifty  ounces  being  reached.  In  my  own  prac¬ 
tice  I  remember  no  case  where  I  measured  and  found  more 
than  about  fifty  ounces,  but  I  have  heard,  and  recently,  ot 
larger  quantities,  even  105  ounces  in  a  well-authenticated 
C£lS0. 

This  fluid  is  gradually  accumulated  and  retained  long,  it 
may  be  for  years  ;  and  on  these  accounts  it  is  not  the  same 
as  that  found  in  hsematoceles.  No  doubt  the  blood  of  an 
old  hcematocele  becomes  treacly  or  tarry  in  appearance  and 
consistence,  and  that  uniformly ;  but  this  is  rarely  seen 
because  it  is  generally  absorbed  and  disappears,  not  decaying 
or  getting  old.  The  blood  of  a  lisematocele  is  sometimes 
putrid,  germs  having  somehow  reached  it..  The  blood  of  a 
recent  hsematocele  is  clotted,  its  liquor  is  absorbed ;  the 
clots  become  partially  decolourised,  brick-coloured,  if  they 
remain  long  enough  and  yet  have  not  had  time  to  dissolve 
into  the  treacly  fluid  of  an  old  hsematocele.  The  fluid  of  a 
lisematocele  varies  greatly  in  amount.  I  have  recorded  a 
case  where  115  ounces  were  discharged  from  one. 

The  accumulating  fluid  opens  up  and  fills  the  vagina,,  or 
what  of  that  passage  may  be  left.  The  replete  vagina 
distends  and  fills  the  pelvis.  It  is  felt  to,  as  it  were,  flatten 
the  rectum  against  the  sacrum,  but  I  have  Dever  seen  any¬ 
thing-  like  complete  obstruction  of  faeces.  At  last,  in. cases 
of  so-called  imperforate  hymen,  it  causes  bulging,  like  a 
large  abscess,  between  the  labia  majora;  and. if  here  the 
distended  membrane  of  the  fossa  navicularis  is  thin,  the 
bulging  part  is  livid  or  bluish.  As  in  retro-uterine  hsemato- 
celes,  the  degree  of  descent  into  the  pelvic  excavation  varies, 
and  in  one  of  our  cases  in  “Martha”  this  was  exemplified. 
The  bag  was  enormous,  containing  forty  ounces ;  it  was 
easily  felt  per  rectum,  but  was  far  from  pressing  strongly  on 
the  perineum  or  against  the  pelvic  floor,  and.  it  was  far  from, 
tight  or  highly  distended  ;  it  was  also  easily  felt  between  the 
labia,  but  it  did  not  protrude  between  them  or  bulge,  them, 
like  an  abscess  ready  to  burst.  As  felt  per  hypogastrium  it 
was  prominent,  hard,  and  rounded,  like  other  masses  of  the 
same  kind  in  other  cases.  The  fluid  seemed  to  be  drawn  up 
rather  than  pushed  down.  When  the  blood  is  accumulated 
in  the  vagina,  the  commonest  case,  it  is  called  hsematokolpos. 

After  more  or  less  completely  distending  the  vagina, 
which,  in  cases  of  long  standing,  becomes  thickened  or 
hypertrophied  around  its  contents,  the  increasing  fluid  dis¬ 
tends  the  cervix  uteri,  which  is  also  hypertrophied ;  and 
here,  I  believe,  in  most  cases,  distension  ends.  We  have  no 
term  for  this — hsematauchen,  or  some  such,  and  we  ought 
to  have ;  for  the  cervix  uteri  gets  widely  opened  up  and  helps 
largely  to  form  the  containing  cavity. 

After  the  neck  of  the  womb  the  body  sometimes  gets  tilled 
— hsemotometra, — but  this  is,  I  believe,  rare.  It  is  difficult 
to  get  this  point  settled ;  for,  during  life,  e  xamination  does 
not  give  results  to  be  fully  confided  in,  and  post-mortem 
examinations  are  rare.  The  cervix  is  a  diff  erent  organ  from 
the  body  of  the  womb,  and  is  easily  dilated.  The  body 
generally  resists  the  dilating  forces ;  and,  as  in  two  of  oui 
recent  cases,  it  is  felt,  per  hypogastrium,  of  nearly  natural 
size  and  projecting  from  the  smooth  globe  of  the  general 

mass.  i 

Then,  in  some  cases,  a  tube  or  both  tubes  become  replete 
— haematosalpinx, — and  this  is  held  to  be  the  case  when  the 
tumour  felt  per  hypogastrium  is  irregular  in  shape,  more 
or  less  in  correspondence  with  what  one  would  expect  if  the 
tubes  were  filled  and  lying  at  the  sides,  of  the  great  and 
nearly  central  mass.  Of  course  it  is  possible  the  tubes  may 
be  dilated  without  the  uterine  body  being  so,  for  they  some¬ 
times  excrete  menstrual  fluid ;  but  it  is  naturally  held,  in 
default  of  post-mortem  investigations  to  settle  the  point, 
that  if  the  uterine  body  is  not  expanded  the  tubes  also  will 
not  be  dilated. 

Not  unnaturally  you  might  expect  that  this  retention, 
accumulation,  distension,  would  soon  cause  symptoms  locally 
and  general  constitutional  disturbance.  Now,  that  is  gene¬ 
rally  not  the  case.  I  heard  the  other  day  of  a  case^  where 
the  "first  and  only  symptom  was  retention  of  urine.  We  have 
a  remarkable  case  of  the  same  kind  now  in  ‘  Martha, 


734 


Medical  Times  and  Gazette. 


DUNCAN  ON  RETENTION  OF  MENSES. 


Dec.  29,  1883. 


where  the  first  and  only  symptom  was  retention  of  urine. 
If  retention  of  urine  does  not  occur,  you  will  probably  not 
have  symptoms  till  you  have  tension  caused  by  accumula¬ 
tion.  Our  case  of  L.  P.,  at  present  in  “  Martha,”  is  remark¬ 
able  on  account  of  the  youth  of  the  girl  (thirteen),  but  it  is 
plain  that  she  is  developed  in  a  womanly  way  beyond  her 
years.  In  this  case  the  retention  of  urine  occurred  very  early, 
the  bladder  being  seven  inches  long ;  and  its  loss  of  power 
could  scarcely  be  ascribed  to  pressure,  for  the  vagina  was 
not  tense,  the  bulging  between  the  labia  slight,  and  only 
seventeen  ounces  accumulated. 

In  two  recent  cases  of  great  accumulation  we  may  well 
say  there  were  no  symptoms  and  no  constitutional  disturb¬ 
ance.  Certainly,  even  at  last,  there  was  no  constitutional 
disturbance  in  either  of  them.  In  one,  S.  P.,  aged  twenty- 
one,  a  florid  girl,  beaming  health  and  vigour,  it  was  only 
eight  months  before  coming  into  hospital  that  she  knew  she 
had  a  lump  in  the  lower  belly ;  it  was  discovered  accidentally 
by  her  doctor,  who  happened  to  examine  her  in  bed  for  a 
passing  illness ;  and  she  had  no  symptoms  till  the  doctor 
told  her  she  had  this  lump.  Then  she  began  to  find  out  that 
she  had  irregular  achings  for  about  the  half  of  each  month, 
probably  suggested,  or  what  are  called  imaginary  symptoms. 

Here  I  would  make  a  digression  to  call  your  attention  to 
two  points  exemplified  in  the  case  of  S.  P.  There  were  no 
symptoms  during  the  development  of  this  great  tumour  or 
bag ;  therefore  this  disease  has  no  essential  symptoms.  Pain 
is  an  essential  symptom  or  part  of  many  diseases.  Here  is 
a  growing  disease  without  any  pain  or  any  other  symptom, 
as  distinguished  from  sign.  In  the  case  of  all  diseases,  you 
should  consider  what  symptoms  are  essential  and  what  signs 
are  essential  or  invariable,  what  symptoms  and  signs  are 
very  frequent  or  frequent,  and  so  on.  The  second  point  to 
which  I  would  call  your  attention  is  equally  important :  it 
is  the  suggestion  of  symptoms.  A  woman  has  a  disease,  or 
fancies  she  has  one ;  she  soon  imagines  or  finds  a  suitable 
symptom,  or  constructs  a  group  of  symptoms,  which  are  in 
a  sense  not  real  but  imaginary,  and  it  is  often  impossible  to 
distinguish  these  imaginary  from  real  symptoms.  When  we 
call  these  symptoms  imaginary,  you  must  not  suppose  they 
are  false  or  humbug — far  from  it ;  such  pains  are  as  grievous 
and  real  as  any  other.  The  pain  of  an  imagined  cancer 
may  be  as  severe  as,  or  severer  than,  that  of  a  real  one.  In 
our  case  of  S.  P.  there  were  no  aches  or  symptoms  of  any 
kind  till  she  was  told  she  had  this  lump ;  and  the  pains  or 
aches  when  they  did  come  were  not  accompanied  by  any 
failure  of  health,  loss  of  good  looks,  want  of  appetite,  or 
inability  to  do  with  alacrity  all  her  hard  work.  For  these 
two  reasons  I  believe  they  were  imaginary  in  her  case.  I 
have  said  that  you  may  not  be  able  to  distinguish  real  from 
imaginary  pain,  but  often  you  can  do  so.  A  case  will  show 
this  and  illustrate  it — a  case  often  alluded  to  in  my  lectures. 
A  lady  of  high  character  and  well-regulated  mind  was  long 
under  uterine  treatment,  and  believed  she  had  cancer.  She 
did  not  dare  to  ask  whether  she  had  cancer  or  not,  desiring 
to  avoid  receiving  the  expected  painful  assurance  from  her 
physician.  She  had  intense  nocturnal  uterine  pain,  so 
severe  as  to  cause  much  family  distress  and  disturbance. 
This  went  on  for  two  years,  and  then  her  physician  died. 
She  consulted  me  in  the  greatest  anxiety ;  and,  fortunately, 
giving  her  my  opinion,  I  added  that  she  had  no  trace  or 
indication  of  cancer.  Immediately  she  was  cured ;  and  no 
doubt,  as  she  herself  asserted,  it  was  this  assurance  as  to 
“no  cancer”  that  alone  blew  away  all  her  dark  cloud  of 
symptoms  and  bad  health. 

In  cases  of  this  kind,  however,  symptoms  are  at  least 
frequently  present.  Most  of  them  may  be,  in  a  word, 
described  as  the  symptoms  often,  not  always,  observed  in 
early  pregnancy.  Peculiar  uneasy  feelings  in  the  pelvis, 
disturbance  of  urination  and  defsecation,  sickness  or  other 
derangement  of  stomach,  pains  in  the  mammas,  some  de¬ 
velopment  of  the  areolae.  When  you  consider  that  these 
symptoms  accompany  a  rounded  tumour  in  the  lower  belly, 
you  will  not  be  astonished  that  such  a  case  is  often  mistaken 
for  pregnancy. 

The  great  symptom  is  pain  or  pains,  present  only  occa¬ 
sionally,  and  sometimes  recurring  with  such  four-week 
periodicity  as  to  suggest  that  they  come  on  at  the  monthly 
times.  To  the  best  of  my  judgment,  these  pains  are  like 
to,  if  not  identical  with,  the  pains  of  dysmenorrhoea  or  of 
after-pains — pains  of  recurring  uterine  spasms.  They  are 
occasionally  very  severe,  and  accompanied  with  some  uterine 


tenderness.  Like  other  pains,  when  very  severe,  they  bring 
on  sickness,  vomiting,  and  general  prostration.  I  have  no 
sure  ground  for  my  impression  that  these  pains  are  present 
chiefly,  if  not  exclusively,  when  the  body  of  the  womb  is 
dilated  and  when  the  tubes  are  so.  Certainly  this  was  my 
judgment  in  the  severest  case  of  recurring  spasmodic  pains 
that  I  have  observed. 

Tension  accounts  for  the  appearance  and  continuance  of 
pain  which  may  be  very  severe,  and  the  delay  of  symptoms 
probably  arises  from  delay  of  tension.  Numerous  cases  lead 
me  to  believe  that,  as  a  rule,  your  advice  is  not  asked  till 
tension  comes,  and  that  tension  does  not  begin  to  urge  till 
two  pints  or  more  are  accumulated,  in  a  woman  with  so-called 
imperforate  hymen  and  otherwise  well-made. 

I  have  little  to  say  of  the  tumour.  It  and  the  malforma¬ 
tion  are  the  two  great  signs  of  the  disease,  and  generally 
these  two  suffice  for  diagnosis.  The  tumour  is  rounded,  dull 
on  percussion,  dumb,  slightly  displaceable,  somewhat  sensi¬ 
tive  ;  rising,  when  at  its  largest,  as  high  as  half-way  from 
the  symphysis  to  the  navel,  or  somewhat  higher.  Generally 
it  has  a  regular  rounded  form,  and  often  upon  it  can  be  felt 
a  little  lump  of  the  size  and  shape  of  the  body  of  the 
uterus.  Other  irregularities  in  shape  are  attributed  to  dila¬ 
tation  of  the  body  of  the  uterus  and  of  one  or  of  both 
tubes. 

All  I  have  hitherto  told  you  of  this  morbid  condition  takes- 
for  granted  that  the  malformation  consists  only  in  atresia 
of  a  passage  otherwise  naturally  developed  ;  but  other  mal¬ 
formations  occur  with  atresia  and  retention.  I  cannot  de¬ 
scribe  them  in  a  clinical  lecture,  for  I  have  seen  only  one  case, 
and  regarding  it  have  not  sufficient  assurance  as  to  its  real 
nature.  I  simply  state  that  a  woman  may  have  one  tube  closed 
internally  and  distended,  or  a  tube  and  half  of  a  double 
uterus  may  be  distended :  these  are  possible  occurrences- 
There  may  be  distension  of  an  undeveloped  uterine  horn. 
But  there  have  now  been  put  on  record  several  cases  of 
double  uterus  and  vagina,  with  atresia  on  one  side,  and  con¬ 
sequent  retention  and  accumulation ;  and  generally  there 
’  has  been  absence  of  the  lower  half  of  the  closed  or  atresic 
vagina,  just  as  is  often  seen  in  ordinary  or  simple  reten¬ 
tion.  These  remarkable  cases  with  duplicity  of  organs 
'  constitute  unilateral  retention.  You  may  have,  then,  uni- 
i  lateral  hsematokolpos,  hsematauchen,  hsematometra,  hsemato- 
■  salpinx  ;  and  in  a  puzzling  case  it  is  necessary  to  keep  this 
in  mind,  with  a  view  to  diagnosis.  I  do  not  remember  any 
case  where  the  disease  was  double  or  bilateral ;  yet  this  is 
possible. 

The  natural  termination  of  a  case  of  this  kind  I  have  not 
observed.  The  retained  fluid  may  find  vent  through  a  tube 
into  the  peritoneal  cavity,  and  there  it  may  accumulate,  or,, 
what  is  more  probable,  excite  dangerous  diffuse  peritonitis ; 
or  it  may  find  vent  through  the  bladder  or  rectum.  In  cases 
of  imperforate  hymen,  real  or  so-called,  the  fluid  will  pro¬ 
bably  make  its  way  through  the  distended  pouch  projecting 
between  the  labia  majora. 

Treatment  consists  in  making  artificially  an  opening  in 
the  retaining  cyst  large  enough  to  give  free  exit  to  the  pent- 
up  fluid,  and  in  maintaining  this  opening  so  that  in  future 
the  menses  may  flow  unobstructedly  through  it. 

When  the  rectum  and  urethra  adjoin  one  another,  the- 
opening  should  be  made  through  the  former,  and  it  may  be 
done  by  a  guarded  knife  or  by  a  Pouteau’s  trocar.  When 
the  tarry  fluid  ceases  to  flow,  the  opening  should  be  main¬ 
tained  till  the  wound  is  healed  ;  and  this  is  done  by  daily,  or 
every  two  or  three  days,  pushing  the  finger  or  a  bougie 
through  the  artificial  aperture. 

In  such  cases  adventurous  surgeons  often  try  to  make,  or 
succeed  in  making,  a  new  vagina,  or  rather  a  new  piece  of 
vagina,  to  form  a  passage  from  the  vulva  to  the  upper  part 
of  the  vagina,  or  real  vagina,  the  vaginal  sac  into  which  the 
cervix  uteri  opens.  This  is  effected  by  cutting  or  otherwise 
tunnelling  in  the  scanty  tissues  between  the  urethra  and 
rectum  ;  and  this  part  of  the  operation  is  quite  feasible,  and 
suffices  for  the  exit  of  the  retained  fluid.  But  the  whole 
proceeding  is  most  unsatisfactory,  for  the  wound  persists  in 
closing  or  so  contracting  as  to  be  a  most  disappointing  kind 
of  passage — ever  requiring  dilatation,  and  at  its  best  forming 
a  hard,  inconvenient  meatus  ;  never  a  real  mucous  channel, 
but  a  cicatricial  indurated  passage.  These  operations  should, 
indeed,  be  discommended,  as,  at  best,  only  vanity  and  vexa¬ 
tion  of  spirit.  They  are  done  with  the  view  of  restoring  to 
the  female  full  sexual  womanhood  ;  and  this-  would  be,  of 


Medical  Times  and  Gazette. 


CHEVERS  ON  THE  ORDINARY  DISEASES  OF  INDIA. 


Dec.  29, 1883,  735 


course,  a  great  gain  to  the  woman,  naturally  much  desired 
and  highly  appreciated.  But  it  is  not  to  he  doubted  that  it 
is  inexpedient  that  a  gravely  malformed  woman  should  con¬ 
tinue  the  species,  and  it  is  imprudent  to  aid  and  abet  this 
course.  Besides,  as  already  hinted,  the  attempts  to  make 
a  new  vagina  result  in  a  ti  onblesome  and  most  imperfect 
imitation  of  nature — as  bad,  indeed,  as  the  new  noses  that 
surgeons  amuse  themselves  by  making. 

Fortunately,  the  commonest  cases  are  those  where  the 
vagina  comes  down  to  the  vulva,  and,  indeed,  when  replete, 
protrudes  between  the  labia.  Then,  the  rectum  and  urethra 
do  not  mutually  adjoin,  and  operation  is  simple  and  efficient. 
The  malformation  is  comparatively  slight,  and  the  surgical 
procedure  necessary  for  its  relief  does  at  the  same  time 
restore  to  the  woman  full  sexual  capability.  In  the  case  of 
I.  P.,  the  young  girl  of  thirteen  now  in  “  Martha,”  the 
rectum  and  urethra  were  not  adjacent,  but  we  had  to  cut 
through  half  an  inch  of  wall  to  reach  the  treacly  fluid. 
Probably,  had  the  accumulation  increased  this  would  have 
lost  thickness. 

The  patient  is  placed  in  the  lithotomy  position,  and  an 
incision  an  inch  long  is  made  in  the  region  of  the  hymen  in 
a  sagittal  direction ;  and  it  is  not  necessary  to  make  it  crucial. 
The  incision  was  made,  and  I  think  advantageously,  with  a 
view  to  avoiding  septicaemia,  in  our  last  three  cases  by 
Paquelin’s  knife-cautery.  By  this  you  cut  through  layer 
after  layer,  and  make  a  large  opening.  The  viscid  contents 
now  flow,  accelerated  by  each  inspiration,  and  gushing '  if 
an  attempt  at  vomiting  occurs.  When  it  has  ceased  to 
flow  copiously,  lint  soaked  in  carbolic  oil  is  placed  over  the 
pudendum ;  arrangements  are  then  made  to  receive  further 
discharge, fand  the  woman  is  put  to  rest. 

Chocolate-coloured  discharge  comes  for  a  few  days ;  and 
the  next  coloured  discharge  is  brighter,  and  probably  the 
duly  recurring  monthly  flow.  The  finger  occasionally  exa¬ 
mining  keeps  the  wound  in  the  vestibule  widely  open  until 
it  heals,  in  a  week  or  ten  days.  The  woman  should  all  this 
time,  and,  indeed,  for  three  or  four  weeks,  remain  in  bed, 
that  the  restoration  of  the  vagina  and  uterus  to  a  natural 
state  may  meet  with  no  interruption.  At  first  the  vaginal 
cavity  is  felt  to  be  large,  and  its  walls  thick  and  hard ;  the 
cervix  uteri,  difficult  to  reach,  is  in  a  like  state  ;  and  these 
parts  very  slowly  resume  a  natural  state,  after  a  long  pro¬ 
cess  of  involution  and  retraction.  In  the  case  of  the  young 
girl  with  only  seventeen  ounces  retained,  there  was  no 
thickening  and  hypertrophy  of  the  vagina. 

You  will  observe  that  I  have  not  directed  you  to  squeeze 
out  by  hypogastric  pressure  nor  to  wash  out  by  syringe  and 
water;  and  I  do  this  deliberately.  These  processes,  when 
resorted  to,  cause  irritation,  and  lead  to  putrefaction  of  the 
contents  if  any  is  allowed  to  remain.  Nothing  could  have 
done  better  than  our  last  three  cases  treated  by  Paquelin’s 
cautery  incision,  and  otherwise  let  alone  ;  we  had  no 
putridity  of  discharge,  no  rise  of  temperature,  or  other 
sign  of  irritation  or  inflammation. 

I  have  not  spoken  of  any  dangers  attending  this  disease 
or  the  operation  for  its  relief ;  and  I  know  by  experience 
only  of  dangers  attending  the  operation.  In  all  my  earlier 
cases  I  have  had,  only  occasionally,  trouble  from  sapraemia 
caused  by  putrid  discharge,  and  in  one  case  a  sharp  attack 
of  peritonitis.  But  it  is  well  known  that  this  operation, 
even  in  simple  cases  of  so-called  imperforate  hymen,  is  not 
rarely  fatal,  and  the  ordinary  cause  of  death  is  septicaemia, 
generally  with  peritonitis.  Another  cause  of  death  is  reflux 
of  fluid  into  the  peritoneal  cavity,  inducing  pernicious 
peritonitis.  This  is  a  curious  occurrence  if  you  regard  its 
cause,  and  I  conclude  this  lecture  with  a  few  words  on  it. 
It  is  certainly  not  to  be  accounted  for  in  all  cases  by  inju¬ 
dicious  hypogastric  squeezing  ;  and,  if  this  is  not  the  cause, 
what  is  it  ?  You  make  a  free  opening  for  the  tightly  pent- 
up  fluid ;  it  flows  copiously ;  and  now,  when  it  is  not  under 
tension,  flow  per  vaginam  being  unobstructed,  it  cruelly 
passes  into  the  peritoneal  cavity  through  a  tube.  I  cannot 
account  for  this  satisfactorily ;  and  the  only  hypothesis  I 
can  frame,  in  explanation,  is  that,  while  the  abdominal 
contents  are  being  rapidly  considerably  reduced  in  bulk  by 
the  flow  of  retained  fluid,  some  movement  by  the  woman 
produces  negative  abdominal  pressure,  and  hence  the  retro- 
flux  through  a  tube.  This  retroflux  sometimes  occurs  before 
the  operation ;  and  that  is  quite  another  matter,  easily  ex¬ 
plained  by  the  increased  tension  of  increased  accumulation, 
and  by  its  gradually  produced  results. 


PRACTICAL  NOTES  ON 

THE  ORDINARY  DISEASES  OF  INDIA, 

ESPECIALLY  THOSE  PREVALENT  IN  BENGAL. 

By  NOEMAN  CHEVEES,  C.I.E.,  M.D., 

President  of  the  Epidemiological  Society. 

[Oontinued  from  page  683.) 

MALAEIAL  CACHEXIA — Continued. 

Among  the  diseased  conditions  consequent  upon  Malarial 
Cachexia  are  (Edema,  Ascites,  and  Hydrocele.  Each  of  these 
demands  separate  notice. 

(Edema. — More  or  less  puffiness  of  the  face,  ankles,  and 
•ometimes  of  the  hands,  is  characteristic  of  severe  Indian 
malarial  anaemia.  Some  oedema  of  the  ankles  is  very  fre¬ 
quently  seen  among  old  Indians.  I  (in  common,  I  believe 
with  many  other  medical  men)  long  regarded  this  condition 
of  the  ankles  as  being,  in  all  cases,  a  very  grave  evidence  of 
a  broken  constitution.  Hr.  John  Radcliffe’s  brutal  remark 
to  William  the  Third — “I  would  not  take  your  Majesty’s 
two  legs  for  your  three  kingdoms  !  ”  has,  doubtless,  ever 
since,  rankled  in  many  minds.  I,  for  one,  did  not  give 
sufficient  weight  to  the  common  facts  that  unseasoned  female 
nurses  and  shopwomen,  and  sailors  who  have  become  a  little 
scorbutic  on  long  voyages,  get  oedema  of  the  lower  extre¬ 
mities  ;  and  that  there  ts  always  more  or  less  swelling  of  the 
feet,  suggesting  slippers,  after  a  long  walk.  We  all  know 
what  is  the  true  significance  of  this  symptom  in  fixed 
organic  disease,  cardiac,  pulmonary,  renal,  etc. ;  and,  in  hos¬ 
pital  practice,  the  student,  observing  the  almost  constant 
attendance  of  this  symptom  upon  deadly  chronic  maladies, 
naturally  imagines  that  it  is  always  a  harbinger  of  death. 
A  sensible  writer  has  said  that  a  large  proportion  of  our 
worst  hospital  cases  only  seek  admission  when  oedema  has 
become  so  great  as  to  prevent  them  from  wearing  their  hoots, 
otherwise  they  would  go  about  their  business  until  they 
sank  from  debility.  Men  in  private  practice  in  England  and 
in  India  see  a  great  deal  of  oedema  of  the  ankles,  unattended 
with  serious  organic  disease.  Many  ruddy  and  active  old 
Indians  are  subject  to  this  condition.  Some  time  ago,  I  was 
making  a  few  calls  among  my  Indian  friends,  and  saw  a 
brother  officer,  in  whom  oedema  of  the  lower  limbs  was  really 
a  symptom  of  advanced  organic  disease.  In  thinking  over 
his  case,  I  recollected  that  I  had  chanced  to  see,  on  that 
day,  six  other  fairly  healthy  people  from  India,  whom  I 
knew  to  be  then,  or  to  have  been  at  some  time  or  other, 
subject  to  this  condition.  Doubtless  this  oedema  arises 
from  a  variety  of  causes  in  different  subjects  ;  and  it  is 
probably  a  graver  symptom  in  some  cases  than  in  others. 
In  all,  anaemia  appears  to  be  present  while  the  oedema  lasts, 
and  is  evidently  diminished  when  that  symptom  disappears. 
Considering  that  I  know  of  persons  now  living,  in  by  no 
means  very  weak  health,  who  became  subject  to  oedema  of 
the  lower  limbs  in  India,  twelve,  fourteen,  twenty  years  ago, 
it  is  evident  that  this  condition  is  not  always  attended  with 
great  danger.  Since  the  above  was  written,  I  have  seen  the 
report  of  the  death  of  a  senior  brother  officer,  the  statement 
of  whose  case  I,  as  Secretary  to  the  Medical  Board,  saw  in 
1857.  He  had  undergone  considerable  hardship  in  the  siege 
of  Saugor,  was  probably  rather  scorbutic,  and  was  de¬ 
scribed^  being  dropsical  and  oedematous.  He  subsequently 
resided  at  Cheltenham  for  a  quarter  of  a  century,  dying  in 
February  last  at  the  age  of  seventy-eight. 

Ascites,  quite  independent  of  any  discoverable  disease  of 
other  organs,  is  very  common  among  natives  of  India  suffer¬ 
ing  from  enlarged  spleen  and  malarious  cachexia.  At  first 
I  tapped  some  of  these  poor  creatures,(a)  but  I  had  very 
bad  success  in  most  of  my  cases  of  paracentesis,  and  latterly, 
for  several  years,  found  that,  by  treating  the  cachexia  and 

(a)  In  many  cases  they  are  not  brought  to  us  until  the  distension  is  so 
extreme  that  we  are  compelled  to  relieve  the  upward  pressure  of  the 
diaphragm  upon  the  lungs  by  drawing  off  fluid.  I  asked  one  poor 
woman,  on  admission,  how  long  she  had  suffered  from  dropsy.  She 
replied,  “  Two  years.”  She  was  so  weak  that,  although  the  distension 
threatened  suffocation,  she  was  obliged  to  lie  without  a  pillow,  evi¬ 
dently  that  sufficient  blood  might  reach  the  brain.  I  asked  my  colleague. 
Dr.  Edward  Goodeve,  who  was  passing  my  ward,  to  look  at  her,  saying 
that  I  hated  tapping,  and  knew  that  if  I  tapped  her  she  would  certainly 
die,  and  that  if  I  did  not  she  must  inevitably  die.  “  Then,”  said  my 
friend,  “  give  her  the  benefit  of  going  out  of  the  world  secundum  artem,” 
and  he  lent  me  a  very  delicate  trocar,  with  which  I  let  out  only  sufficient 
fluid  to  relieve  the  diaphragm.  She  sank  in  two  days. 


or* 

°  u  Medical  Times  and  Gazette. 


CHEYERS  ON  THE  ORDINARY  DISEASES  OF  INDIA. 


Dee.  29,  1883. 


by  carefully  bandaging  tbe  abdomen,  nearly  all  cases  of 
merely  anaemic  ascites,  not  admitted  moribund,  did  well, 
the  fluid  disappearing  more  or  less  readily  without  the  use 
of  diuretics,  cathartics,  or  other  evacuants. 

Unquestionably,  hepatic  obstruction,  temporary  or  per¬ 
manent,  generally  has  much  to  do  with  the  causation  of 
ascites  in  spleen  cases.  I  have  met  with  cases  which 
afforded  me  assurance  that,  when  the  system  is  lowered  by 
paludal  cachexia,  a  state  of  liver  disease  which  is  tem¬ 
porarily  obstructive  to  the  circulation,  but  which  has  not 
reached  the  condition  of  permanent  kirrhosis,  may  lead  to 
abdominal  dropsy,  which  may  be  relieved  by  change  of 
climate,  by  steady  counter-irritation  over  the  hepatic  region, 
and  by  a  course  of  ipecacuanha  in  small  doses,  combined 
with  all  those  means  by  which  we  treat  malarious  ansemia. 
It  is  needful  to  examine  the  state  of  the  liver  most  carefully 
in  all  these  cases. 

Here  it  may  be  noticed  that  a  deteriorated  condition  of  the 
blood  is  more  operative  than  mechanical  obstruction  is  in 
the  causation  of  dropsy  in  “  obstructive ”  disease  of  the 
heart  and  liver  ;  thus — 

A.  and  B.  suffer,  at  the  same  age,  from  the  same  degree 
of  rheumatic  stenosis  of  the  aortic  valves. 

A.  lives  for  many  years,  and  dies,  probably  suddenly, 
without  dropsy. 

B.  dies  in  a  few  years  with  chronic  dropsy.  Here  many 
causes  of  death  are  at  work,  but  the  main  causation  is 
that — 

A.  lives  in  such  a  manner  that  his  blood  does  not  become 
deteriorated,  breathes  good  air,  avoids  fatigue,  has  the  best 
food,  and  only  dies  when  arctation  of  the  aortic  ostium,  and 
consequent  dilatation  of  the  left  ventricle,  have  proceeded  to 
the  utmost. 

B.  is  obliged  to  work  hard  in  a  malarious  place,  has  bad 
food,  is  ill-clad;  he,  being  inadequately  nourished,  becomes 
in  a  degree  scorbutic  or  arnemic ;  the  life  of  his  blood  is 
deteriorated,  the  muscular  power  of  the  left  ventricle  rapidly 
fails,  and  dropsy  occurs  under  a  very  moderate  amount 
of  cardiac  obstruction.  Consequently,  one  of  the  leading 
therapeutic  indications  in  these  cases  is  to  keep  the  blood  in 
good  condition. 

Hydrocele  is  a  disease  of  very  great  prevalence  among  the 
natives  of  Bengal,  chiefly  the  poor,  but  many  of  the  rich 
suffering.  Sir  Joseph  Payrer  has  published(b)  an  important 
paper  in  which  he  holds  that  this  “  is  one  of  the  many  forms 
in  which  the  influence  called  ‘  Malaria 5  expresses  itself.” 
This  is  undoubtedly  the  case.  As  Secretary  to  the  Medical 
Board  I  saw  nearly  all  the  officers  who  were  sent  down  to 
Calcutta  sick  during  the  Great  Mutiny  of ’57 ;  many  who 
had  undergone  great  fatigue,  exposure,  and  privation,  espe¬ 
cially  during  the  siege  of  Lucknow,  suffered  from  hydrocele, 
which  I  attributed,  in  part,  to  scorbutus. 

In  malarious  blood-disease  various  Embolic  Conditions, 
such  as  vessel-plugging.  Phlegmasia  Dolens,  and  Gangrene 
of  the  extremities,  are  very  liable  to  occur.  Both  arterial 
and  venous  embolism  are  not  infrequently  observed  as  com¬ 
plications  of  paludal  cachexia  in  temperate  climates  ;  these 
lesions  are  probably  more  frequent  in  India. 

Venous  Plugging. — Dr.  J.  Mouat,  H.M.  13th  Dragoons,  pub¬ 
lished  (c)  the  cases  of  two  dragoons  suffering  respectively 
from  malarious  fever  and  from  dysentery,  who  were  both 
attacked,  while  under  treatment  in  the  notoriously  unhealthy 
hospital  at  Bangalore,  with  extensive  plugging  of  the  veins 
of  the  lower  limbs,  as  in  phlegmasia  dolens,  and  who  appear 
to  have  died  from  pulmonary  embolism. 

Mr.  Greig  records(d)  the  case  of  a  European  who,  having 
been  bled  for  continued  fever,  died  from  phlebitis. 

In  his  remarks(e)  upon  the  case  of  a  European  soldier 
suffering  from  dysentery,  who  died  of  phlebitis  consequent 
upon  VS.,  Dr.  Macgregor  says  “  During  the  latter  part  of 
July  scarcely  a  man  was  bled  without  the  risk  of  producing 
inflammation  of  the  vein.”  He  appears  to  attribute  this  to 
the  impurity  of  the  hospital  air.(f) 

(b)  “  Clinical  and  Pathological  Observations  in  India,”  page  513. 

(c)  Bengal  Medical  and  Physical  Transactions,  vol.  viii.,  part  i.,  page  28. 

(d)  I  hid.,  vol.  v.,  page  101. 

(e)  Op.  cit.,  Appendix,  page  cxiv. 

(f )  During  his  eleven  days  in  hospital  this  poor  man  lost  two  pounds  of 
blood  by  V8.  twice,  and  was  again  bled  to  syncope,  and  had  twenty  leeches 
applied  in  the  course  of  the  inflamed  vein.  On  post-mortem  examination 
“  there  was  only  a  slight  blush  in  the  colon,  showing  that  active  inflamma¬ 
tion  had  existed  and  was  subdued  by  the  repeated  use  of  the  lancet.”  In 
tbe  present  day  one  large  dose  of  ipecacuanha  would  probably  have  saved 
all  this  trouble. 


At  Chittagong  a  portion  of  one  of  my  external  thoraci 
veins  became  plugged,  without  pain  or  any  sign  of  active 
inflammation.  An  old  man,  one  of  my  table  servants,  came 
to  me  with  a  corded  state  of  the  saphena  vein  at  the  middle 
of  the  thigh.  An  abscess  formed  externally  and  was  opened. 
There  were  no  other  bad  symptoms. 

Phlegmasia  Bolens  after  delivery  is  a  rather  frequent 
occurrence  in  women  who  have  suffered  from  Malarious 
Fever  in  Bengal. 

Arterial  Plugging. — When  a  student  at  Guy’s,  I  had  the 
case  of  an  ansemiated  lad,  one  of  whose  hands  went  quite 
spontaneously  into  a  state  of  dry  gangrene  from  arterial 
plugging.  Dr.  Carter  narrates  the  case(g)  of  a  Mussulman 
Beggar  of  Bombay,  aged  thirty-two,  who  was  an  opium- 
eater,  and  who  had  suffered  from  great  exposure  in  stormy 
weather,  who  died  from  gangrene  of  the  feet  consequent 
upon  plugging  of  the  abdominal  aorta.  Sir  Joseph  Fayrer 
has  given  a  very  interesting  set  of  cases  of  natives  suffering 
from  gangrene  of  the  extremities  caused  by  arterial  plugging 
of  distinctly  malarious  origin.  In  one  year  I  saw  more  of 
these  cases  at  the  Calcutta  Medical  College  Hospital  than  I 
did  in  all  the  rest  of  my  Indian  experience.  There  was 
evidently  something  peculiar  in  the  endemic  constitution  of 
that  year.  At  this  time  I  saw,  with  my  friend  Dr.  Robert 
Bird,  of  Howrah,  a  Jewish  girl  of  seventeen,  the  child  of 
rich  parents,  whom  I  had  attended  before  for  congenital 
heart-disease,  dying  from  arterial  gangrene  of  both  lower 
limbs.  Some  years  previously  I  was  consulted  in  Calcutta 
in  the  case  of  a  European  uncovenanted  judge,  whose  femoral 
became  plugged  high  up,  with  the  remarkable  and  most 
painful  result  of  causing  sloughing  of  the  whole  integument 
of  the  lower  extremity,  producing  an  enormous  expanse  of 
ulcer  which  refused  to  heal.  Sir  Joseph  Fayrer  notices  that 
anthrax  and  boils  and  abscesses,  so  common  in  India,  are 
attributed  to  capillary  obstruction  by  pigment — the  d4bris 
of  broken-down  blood  corpuscles ;  he  would  rather  attribute 
them  and  other  consequences  of  obstruction  to  fibrinosis. 
During  a  long  course  of  years.  Sir  J.  Fayrer  obseiwed,  in 
India,  the  occurrence  of  ante-mortem  coagula  in  the  right 
heart  as  a  cause  of  death  after  surgical  operations  and 
accidental  injuries,  in  cholera,  and  in  various  forms  of 
malarious  cachexia.  The  result  is  communicated  at  page  94 
of  his  Clinical  and  Pathological  Observations.”  Hertz(h) 
describes  Gangrene  in  Pernicious  Fever,  affecting  the  leg  and 
the  female  genitals  [was  not  this  Malarious  Phagedsena  P  ] . 
A  girl’s  hands,  first  one  and  then  the  other,  became 
gangrenous  after  a  few  days  of  intermittent  fever,  (i) 

Sloughing  of  the  Cornea  and  Spontaneous  Gangrene  of  the 
Scrotum  and  Perineum  are,  in  some  years,  frequent  sequelae- 
of  Malai’ious  Fever  and  Cholera  among  the  ill-fed  poor  of 
Bengal.  This  mischief,  occurring'in  the  perineum,  has  not, as 
far  as  I  am  aware,  been  commented  upon  as  occurring  else¬ 
where.  Most  of  the  cases  which  I  saw  were  in  native  prisoners. 
One’s  attention  is  called  by  the  native  doctor  to  a  man  with 
extravasation  of  urine,  but  there  is  no  evidence  that  sudden 
rupture  of  the  urethra  has  occurred.  Upon  making  free 
incision  it  is  found  that  the  whole  perineum  is  occupied  by 
a  huge  gangrenous  abscess,  which  in  some  cases  does,  and 
in  others  does  not,  communicate  with  the  urethra.  In  these 
cases  I  used  to  say  that  the  man  had  begun  to  die  at  the 
perineum.  A  distinguished  officer  died  in  this  manner  in 
Bengal  some  years  ago.  I  believe  that,  elsewhere,  extravasa¬ 
tion  of  urine  in  old  stricture  cases  generally  results  from  the 
formation  of  abscess  outside  that  portion  of  the  urethra 
which  gives  way.  When  at.  Howrah  I  was  called  to  see  an 
elderly  native  who  was  famed  as  the  wealthiest  man  in 
Calcutta.  He  had,  after  suffering  from  fever,  begun  to  die 
at  the  scrotum,  and  expired  in  a  few  hours  after  my  visit.. 
As  far  as  I  am  aware,  these  forms  of  gangrene  of  the  peri¬ 
neum  and  scrotum  are  always  speedily  fatal.  Many  of  those 
who  suffer  from  sloughing  of  the  cornece  (which,  in  its 
causation,  appears  to  resemble  that  sloughing  of  the  cornea' 

(g)  Bombay  Medical  and  Physical  Transactions  for  1 880. 

(h)  In  Ziemssen. 

(i)  Dry  gangrene,  due  to  other  than  a  malarious  cause,  may,  of  course, 
occur  in  India.  Dr.  Campbell  saw  a  case  [Bengal  Medical  and  Physical 
Transactions,  vol.  i.,  page  287)  in  which  it  may  have  been  due  to  eating 
diseased  grain.  My  friend  Dr.  Theodore  Dukarecords  the  case  of  a  young 
Madrassee  woman,  aged  fifteen  years  and  a  half,  in  the  eighth  month  of 
her  first  pregnancy,  which  occurred  at  Simla.  There  was  dry  gangrene  of 
both  legs  to  within  three  inches  of  the  knee-joints.  Amputation  was 
performed ;  no  bleeding  vessel  had  to  be  secured.  The  patient  had  an 
easy  recovery,  and  gave  birth  to  a  well-formed  full-grown  child.  No 

;  enlargement  of  the  spleen  or  liver  could  be  detected. 


Helical  Times  and  Gazette. 


BELLAMY  ON  FIBROCYSTIC  BRONCHO CELE. 


Dec.  29, 1883.  73  7 


which  Magendie  produced  in  dogs  by  feeding  them  exclu¬ 
sively  on  bread)  sink — death  commencing  at  the  corneas. 
But,  in  a  long  course  of  years,  a  good  many  of  my  patients 
recovered.  I,  at  first,  adopted  the  treatment  much  employed 
by  my  friend  Mr.  Samuel  Browne,  of  Belfast— the  applica¬ 
tion  of  a  saturated  solution  of  nitrate  of  silver.  With  this 
I  obtained  some  success.  But,  latterly,  at  the  recommenda¬ 
tion  of  Mr.  C.  Macnamara,  I  merely  closed  the  eyes  with 
fine  cotton-wadding,  due  attention  being  paid  to  cleanliness. 
Under  this  treatment  a  considerable  proportion  of  cases 
recovered,  especially  where  they  were  taken  early,  and  when 
■only  one  eye  was  affected.  We  always  looked  for  this  slough¬ 
ing  in  every  low  case.  The  first  sign  is  a  generally  sunken 
appearance  of  the  cornea,  such  as  is  seen  after  death,  with  a 
cloud  of  milky  opacity  of  a  segment  of  its  lower  edge,  as  if 
its  attachment  to  the  sclerotic  had  been  slightly  separated 
with  a  cornea  knife.  Of  course,  quinine,  wine,  and  the  best 
nourishment  are  indispensable  in  these  cases. 

Malarious  Phagedcena  ( Cancrum  Oris),  although  occurring 
in  the  same  class  of  cases  of  malarious  cachexia,  especially 
in  advanced  splenic  disease,  is  not  attributable  to  the  same 
immediate  cause  as  the  gangrenes  above  described  are,  the 
plugging  of  afferent  or  efferent  bloodvessels.  It  is  not 
simple  gangrene,  but  is  a  true  sloughing  phagedsena.  In 
many  of  these  cases  the  patients  are  brought  to  us  death- 
stricken,  and  expire  in  a  few  hours  without  separation  of 
the  slough.  This  looks  like  simple  gangrene,  but  it  is  not. 
When  we  can  get  the  slough  to  separate  and  to  put  on 
healing  action,  we  notice  that,  while  the  ulcer  may  be  heal¬ 
ing  at  two-thirds  of  its  circumference,  the  edge  of  the 
remaining  segment  is  being  eaten  away  by  phagedaenic  ulce¬ 
ration,  and  that  the  sore  is  rapidly  extending  at  that  part.  I 
have  seen  cancrum  oris  (only  in  young  children)  in  England, 
before  I  went  to  India  and  since  my  retirement.  The  disease 
appears  to  be  nearly  the  same  in  this  country  and  in  India. 
There,  in  old  times,  it  used  frequently  to  be  caused  by  the 
use  of  mercury  in  our  hospitals.  Three  grains  of  calomel 
would  set  it  up  in  a  cachectic  subject.  Now,  cases  are 
brought  to  us  where  it  is  attributable  to  mercury  given  by 
Kobirajes.  But  we  often  observe  its  appearance  in  our  own 
wards  in  patients  who  have  not  taken  mercury.  It  generally 
occurs  in  cases  of  splenic  cachexia,  after  repeated  attacks  of 
malarious  fever.  Soon  after  I  joined  I  was  surprised  to  see 
the  disease  in  a  middle-aged  native  man  in  my  Jail  Hospital 
at  Chittagong.  In  1834  the  editor  of  the  Indian  Journal  of 
Medical  Science  mentioned  the  case  of  a  young  sepoy  who 
had  taken  five  grains  of  calomel  in  two  pills  on  account  of  a 
slight  attack  of  fever.  In  about  thirty  hours  his  face  began 
to  swell.  There  was  no  salivation ;  the  left  cheek  “completely 
sphacelated  away,  and  the  poor  fellow  sank.”  Dr.  Macgregor 
gives(k)  the  fatal  case  of  a  European  soldier,  aetat  twenty- 
one,  who  had  suffered  from  Dysentery,  Dropsy,  and  Fever; 
•and  a  second,  the  report  of  whose  case  is  headed,  “Dysen¬ 
tery  and  Dry  Gangrene  succeeding  the  accumulation  of 
Calomel  in  the  system.”  A  case  occurring  in  a  European 
soldier,  setat  twenty-two,  with  enlarged  spleen,  got  at 
Roorkee,  has  lately  been  published  by  Mr.  P.  W.  O’Gorman. (1) 
In  1836,  Dr.  Corbyn  mentioned(m)  that,  some  years  pre¬ 
viously,  in  Arracan,  he  had  seen  a  great  deal  of  phagedenic 
affections  which  resisted  every  application  employed,  although 
many  of  these  had  proved  efficacious  in  checking  similar 
disease  elsewhere.  Phagedosna  invariably  supervened  when 
the  constitution  had  been  previously  debilitated  by  repeated 
attacks  of  the  Arracan  Remittent  Fever,  in  which  disease 
the  spleen  was  always  more  or  less  affected.  A  great  number 
of  patients  were  sent  to  a  hospital  formed  at  Barrackpore 
for  their  reception,  but  the  failure  of  every  means  adopted 
was  the  lamentable  result.  I  think  that,  upon  reviewing  the 
history  of  this  disease,  in  cases  not  attributable  to  mercu- 
rialisation,  and  of  venereal  noma  pudendi  of  the  very  poorest 
girls,  and  of  “  black  lion  ’  ’  in  soldiers  in  trying  campaigns  and 
in  sailors  just  come  in  from  long  voyages,  it  will  be  found 
that  scorbutus  is  almost  always  a  factor  in  the  causation  of 
sloughing  phagedsena.  Three  forms  of  this  disease  are 
common  in  paludal  cases  in  Bengal.  They  commence  as 
follows  : — either  (1)  as  a  swelling  of  the  cheek,  with  a  slight 
vascular  blush,  in  the  European,  commencing  on  one  side  at 
the  commissure  of  the  lips,  and  going  on  to  commit  almost 
unlimited  destruction  of  soft  parts  and  bone.  This  form 


k)  Op.  cit.,  pages  ix.  and  Ixii. 

l)  Indian  Medical  Gazette  for  January,  1882. 

(m)  Indian  Journal  of  Medical  and  Physical  Science,  vol.  iii.,  page  545. 


has  always  been  fatal  in  my  observation  ;  although,  in  a  few 
cases,  tile  progress  of  ulceration  has  been  tardy.  (2)  On 
turning  down  the  lower  lip  a  sloughing  ulcer  is  seen  in  the 
mesian  line  where  the  mucous  membrane  of  the  lip  is  re¬ 
flected  upon  the  gum  of  the  incisors.  Here  ulceration  may 
go  on  to  destroy  the  lip,  alveolus,  and  more.  (3)  Opening 
the  mouth  widely,  a  portion  of  the  ascending  ramus  of  the 
lower  jaw,  about  the  size  of  a  finger-nail,  is  seen,  white  like 
a  piece  of  toothbrush  handle,  and  quite  denuded  of  mucous 
membrane  and  periosteum.  When  the  second  and  third 
lesions  occurred  in  patients  under  treatment  in  my  beds, 
and  I  was  able  to  act  early,  I  now  and  then  succeeded  in 
bringing  them  through  by  means  of  quinine,  support,  and 
the  daily  application  of  the  Compound  Tincture  of  Benzoin 
to  the  diseased  surface.  Some  use  Nitric  Acid ;  but,  where 
there  was  so  little  vitality,  I  preferred  the  above  stimulant. 

In  1836,  Mr.  Egerton  described(n)  an  outbreak  of  noma 
pudendi  which  had  lately  occurred  in  the  Lower  Orphan 
School  of  Calcutta,  which  was  crowded.  Children  came  in 
with  fever ;  head  hot,  countenance  sunk.  They  continued 
in  a  state  of  low  fever  from  ten  to  fifteen  or  twenty  days  ; 
when,  in  one  case  especially,  sloughing  supervened  ;  an 
ulcer  first  appeared  on  the  clitoris,  spreading  to  the  mons 
veneris  and  labia,  which  sloughed  off.  The  girl  recovered. 
Preparation  549  in  the  Calcutta  Medical  College  Museum  is 
“  Enlargement  of  the  spleen,  taken  from  a  girl  who  had 
been  a  sufferer  from  sloughing  ulceration  of  the  labia  and 
the  soft  parts  over  the  pubes.” 

In  some  cases,  especially  when  we  can  give  quinine  and 
support  early,  the  ulceration  becomes  chronic.  I  had  a 
native  lad  with  large  spleen  in  whom  the  disease  assumed 
the  first  form,  commencing  at  the  cheek.  After  great  part 
of  the  cheek  had  come  away,  what  would,  in  a  dog,  have 
been  one  of  the  intermaxillary  bones,  separated,  and  was 
drawn  out,  and  was  made  a  preparation  in  our  museum. 
The  whole  of  the  inner  portion  of  the  upper  jaw,  with  two 
incisors  and  a  canine  tooth,  and  the  palatine  and  nasal  pro¬ 
cesses,  are  there.  He  improved  in  health;  took  his  food, 
wine,  and  quinine  well ;  the  raw  edges  being  quite  clean. 
He  kept  a  little  hand-glass,  in  which  he  used  to  examine  his 
face  ;  and  we  became  so  hopeful  that  we  might  save  him, 
that  I  consulted  my  friend  Dr.  Phin  Smith,  who  thought 
that  he  could  supply  the  loss  by  an  apparatus  of  silver  and 
gutta-percha.  At  length  the  whole  of  the  integumentary 
edge  would  appear  to  be  cicatrised,  but,  upon  carefully  exa¬ 
mining  this  all  round,  it  would  be  found  that,  somewhere  or 
other,  ulceration  was  undermining  the  margin  and  eating  it 
away,  as  a  spark  extends  on  touch-paper.  He  died  after  he 
had  been  with  me  for  several  weeks. 

At  Chittagong,  my  assistant  Babao  Ramkinoo  Dutt 
showed  me  a  native  boy  with  spleen,  in  whom  the  applica¬ 
tion,  by  a  Kobiraj,  of  a  gool,  as  an  issue,  had  caused  destruc¬ 
tion  of  all  the  soft  parts,  integument,  and  extensor  muscles 
of  the  whole  of  the  back  of  one  forearm,  so  that  the  shafts 
of  the  radius  and  ulna  lay  exposed  throughout  their  course 
from  elbow  to  wrist.  Most  careful  dressing  was  being 
rewarded  by  the  appearance  of  a  clean  surface  and  a  few 
granulations. 

[To  he  continued.) 


NOTE  ON  THE  TREATMENT  OF  A  CASE  OF 
FIBRO-CYSTIC  BRONCHOCELE  (GOtTRE). 

By  EDWARD  BELLAMY,  F.R.C.S., 

Fellow  of  King’s  College ;  Surgeon  to  Charing-cross  Hospital. 


A  lady,  about  forty-five  years  of  age,  was  recommended 
to  me  for  operative  interference  in  a  case  of  an  enormous 
trilobed  goitre,  which  she  affirmed  had  first  appeared  during 
her  early  confinements.  She  came  from  New  Zealand  in  very 
weak  health  to  have  the  growth  removed ;  but  this  was  ob¬ 
viously  impossible,  and  the  dyspnoea  caused  by  it  gave  rise 
to  such  severe  symptoms  that  it  was  surprising  how  she  had 
survived  her  voyage. 

The  growth,  involving  the  left  lobe  of  the  thyroid  body, 
was  about  twice  the  size  of  a  cricket-ball,  apparently  firmly 
fixed  below,  and  on  palpation  showing  one  or  two  softish 

(n)  Ibid.,  vol.  iii.,  page  545. 


738 


Medical  Times  and  Gazette. 


MEDICAL  AND  SURGICAL  PEACTICE. 


Dec.  29, 18S8V 


spots,  evidently  portions  of  cyst-walls.  The  isthmus  was  so 
enlarged  that  the  trachea  was  completely  covered  by  it,  and 
I  did  not  look  forward  to  the  almost  inevitable  tracheotomy 
without  uneasiness. 

I  punctured  several  of  the  cysts  with  great  difficulty,  as 
the  walls  were  so  thick,  and  injected  a  little  iodine  in  the 
usual  way,  and  placed  her  under  the  treatment  generally 
adopted — with  no  result  beyond  perhaps  slightly  lessening 
the  great  pressure  on  the  trachea  and  recurrent  nerves. 

I  next  went  a  little  more  boldly  to  work,  and,  although  I 
could  not  actually  make  out  the  position  of  the  great  vessels, 
I  aspirated,  fortunately,  one  very  large  cyst,  and  injected  it 
Avith  a  saturated  solution  of  tannic  acid  (1 :  2),  and  applied 
poultices.  Suppuration  shortly  followed,  but  without  any 
marked  rise  of  temperature,  and  I  passed  in  a  fine  drainage- 
tube  into  the  body  of  the  growth  through  two  apertures  of 
pointing,  and  proceeded  in  a  like  manner  with  other  portions 
of  the  mass,  which  I  could  now  the  more  readily  attack. 

The  immediate  result  was  great  relief  of  the  urgent 
symptoms,  and  in  about  two  months’  time  a  general  slough¬ 
ing  of  the  entire  mass  of  the  left  side,  which  I  pulled  out 
after  incising  the  integument  with  much  care,  as  I  felt  sure 
I  was  very  near  the  great  veins,  and  any  tearing  might 
have  been  serious.  The  mass  was  about  as  large  as  an 
average-sized  potato,  and  on  the  base  of  its  bed  the  in¬ 
ternal  jugular  could  be  easily  seen.  The  wound  was  plugged 
Avith  carbolised  lint,  and  allowed  to  granulate.  The  other 
portions  of  the  growth  were  not  interfered  with,  and  the 
patient  returned  at  any  rate  greatly  relieved.  She  never 
lay  up  in  any  way,  and  went  about  her  usual  visiting 
without  the  slightest  inconvenience. 

Wimpole- street,  W. 


REPORTS  OF 

HOSPITAL  PRACTICE  IN  MEDICINE 
AND  SURGERY. 

- o-- - 

LIYEEPOOL  EOYAL  INFIEMAEY. 


SEEIES  OF  BONE  AND  JOINT  CASES. 
(Under  the  care  of  Mr.  RUSHTON  PARKER.) 

LConcluded  from  page  346.) 

Five  Cases  or  Deformity  of  Lower  Limb,  Treated 
by  Simple  Fracture  of  the  Femur. 

Case  8. — Incurvation  of  Right  Thigh,  laming  the  Patient — 
Fracture  of  the  Femur,  permitting  the  Hip,  Knee,  and 
Ankle  to  he  in  the  same  Straight  Line — Perfect  Cure  after 
Union. 

Sarah  A.  E.,  aged  fourteen  and  a  half  years,  visited  the 
Royal  Infirmary  in  May,  1878,  to  show  the  completion  of 
her  cure,  which  Avas  effected,  however,  in  the  Stanley  Hos¬ 
pital,  where  she  had  been  admitted  early  in  October,  1877. 
She  was  fairly  stout  generally,  being  also  well  built -and  of 
moderate  size  as  to  her  arms  and  trunk,  but  of  short 
stature  owing  to  the  stunted  length  of  the  lower  limbs. 
The  tibiae  were  flattened  laterally,  and  bent  with  the  con¬ 
vexity  forwards— the  right  rather  more  so  than  the  left. 
The  bones  were  quite  strong,  and  the  left  limb  altogether 
was  quite  useful,  but  the  patient  complained  of  weakness  in 
the  right  knee.  This  complaint  was  at  first  but  little 
heeded  by  Mr.  Parker,  as  no  obvious  reason  for  it  was 
recognised  on  examination  in  the  standing  posture  at  her 
earlier  visits.  After  repeated  and  persistent  complaint, 
and  the  assurance  of  her  mother  that  the  girl’s  disablement 
was  authentic,  her  right  limb  was  examined  more  closely  as 
she  lay  down.  On  placing  the  upper  part  of  the  thigh 
in  a  position  of  normal  symmetry,  it  was  found  that  the  leg 
lay  across  and  in  front  of  its  fellow,  instead  of  parallel  Avith 
it.  This  was  found  to  be  due  to  a  curve  in  the  femur  rather 
beloAv  the  middle,  the  convexity  being  outwards,  and  to  a 
rotation  of  the  lower  end  of  the  bone,  causing  the  back  of 
the  condyles  to  look  obliquely  inwards.  The  effect  of  this 
was  that  one  of  the  three  joints  was  always  out  of  the  line 
of  the  other  two ;  and  although  the  bones,  joints,  and 
muscles  were  all  strong  enough,  the  attempt  to  use  the  limb 
as  a  prop  to  the  body  could  only  be  made  at  a  strain  upon 
the  knee-joint  (of  which  she  most  complained),  that  was 
noAv  comprehensible  enough.  Sbe  was  put  up  in  a  Thomas’s 


knee-splint,  the  limb  being  fully  extended  with  the  aid  of 
stirrup-strapping  to  the  leg,  and  lateral  bandaging  being 
brought  to  bear,  by  pressure  and  counter-pressure,  on  the 
knee  and  femur,  in  the  hope  that  the  bone  might  be  induced 
to  grow  into  the  desired  position.  But  it  soon  became 
evident  that  the  time  for  any  such  process  was  now  past  in 
this  case,  and  that  the  bones  were  far  too  short  and  too 
strong  to  be  influenced  in  that  way.  After  a  month,  there¬ 
fore,  further  trial  Avas  abandoned,  and  fracture  of  the  femur 
determined  on  if  practicable.  This  was  done  under  ether 
on  November  16,  1877.  The  knee-joint  was  first  fixed 
straight  in  a  series  of  padded  splints  of  sheet-iron,  envelop¬ 
ing  the  upper  half  of  the  leg  and  the  lower  third  of  the 
thigh,  and  tightly  bandaged  on  so  that  that  part  of  the  limb 
below  the  femoral  curve  became  stiff  enough  to  serve  as  a 
suitable  lever.  The  thigh  was  laid  on  its  outer  side,  the 
upper  part  being  held  forcibly  down  on  the  table,  the  con¬ 
vexity  of  the  curve  lying  on  the  edge  of  the  table,  and  the 
rest  of  the  limb  projecting  beyond  the  edge,  being  held  by 
the  operator.  It  was  then  found  not  difficult  with  such 
powerful  leverage  to  break  the  thigh  at  the  spot  desired. 
When  the  crack  occurred,  after  a  short  effort,  the  limb  was 
easily  straightened  until  all  the  three  joints  were  in  the 
same  straight  line,  without  entirely  separating  the  frag¬ 
ments  on  the  previously  convex  side.  The  splints  around 
the  knee  being  removed,  Thomas’s  knee-splint  was  then 
replaced,  and  four  sheet-iron  splints,  padded  with  boiler- 
felt,  surrounding  the  femur,  put  on  in  addition,  for  due 
fixation  of  the  fracture,  somewhat  in  the  manner  referred  te 
in  Cases  6  and  7  (September  22).  One  of  these  splints,  a 
little  longer  than  the  others,  supported  the  back  of  the 
thigh  and  knee-joint,  swung  between  the  bars  of  the 
Thomas’s  splint. 

Three  days  later,  the  thigh  was  found  free  from  pain  and 
tenderness,  the  uppermost  short  splints  having  been  lifted 
off  for  inspection  and  then  replaced.  A  little  fulness  and 
elasticity  also  were  perceived  in  the  knee-joint  from  effusion1 
of  fluid.  The  patient  Avas  permitted  to  sit  out  on  a  chair. 

After  five  days  (November  21)  the  effusion  into  the  joint, 
having  increased,  was  drawn  off  by  aspiration  through  a. 
needle  the  size  of  a  No.  2  catheter.  The  fluid  was  two  ounces 
of  bright  liquid  blood  or  bloody  serum  (see  Case  3— July  14). 
At  the  end  of  a  week  she  was  up,  and  occasionally  moving 
about  the  Avard,  the  apparatus  being  a  “  walking  splint,”' 
and  permitting  this.  At  the  end  of  a  fortnight  she  went 
home — wearing  the  splints,  of  course. 

On  December  19,  five  weeks  after  fracture,  she  called,, 
and  had  the  sheet-iron  splints  removed,  the  walking  knee- 
splint,  however,  being  retained. 

On  January  9,  1878,  after  eight  Aveeks,  she  could  bear  a 
good  part  of  her  weight  on  the  limb  without  the  splint1, 
which  she  then  wore  part  of  each  day  only  for  rest. 

In  the  end  of  May,  1878,  she  called  at  the  Infirmary  to 
show  herself.  Having  to  come  about  three  miles,  she  wore 
the  splint  for  that  occasion  only,  but  she  had  discontinued 
its  general  use  for  some  months  previously.  The  limb  was 
in  every  respect  useful,  and  has  continued  so  ever  since, 
the  three  joints  being  suitably  in  line,  though  the  bones 
are,  as  they  have  all  along  been,  deformed  by  rickety  curves. 
These  last,  however,  are  not  a  source  of  mechanical  incon¬ 
venience,  and  therefore  require  no  interference. 

Remarks. — It  may  appear  astonishing  that  this  patient 
should  have  been  allowed  to  get  up  a  week  after  fracture  of 
the  femur.  But  the  fracture  was  not  a  complete  one,  and 
therefore  Avas  particularly  easy  to  manage  after  once  being 
set.  Added  to  that,  but  apart  from  it  in  relation  to  other  cases, 
the  apparatus  used  secures  a  degree  of  immobility  hardly 
attainable  by  other  means,  and  one  that  Avould  permit  safe 
transport  in  almost  any  case,  if  that  should  happen  to  be 
required ;  and,  in  the  case  of  small  children,  allows  their 
easy,  safe,  and  therefore  justifiable  treatment  as  out-patients 
— a  matter  of  great  convenience,  sometimes,  to  all  concerned. 
The  effusion  into  the  knee-joint  is  not  to  be  wondered  at, 
considering  that  in  making  the  fracture  the  articulation 
must  have  been  submitted  to  a  severe  sprain,  in  spite  of  the 
protecting  splints  around  it.  Effusion  into  the  knee-joint,, 
or  around  it,  or  both,  is,  in  cases  of  fractured  shaft  of  the 
femur,  a  common  attendant  feature  that  seems  to  be  hardly 
ever  alluded  to.  The  fact  was  first  made  known  to  the 
Avriter  during  a  clinical  lecture  at  the  Charite  Hospital  in 
Paris,  April,  1870,  by  M.  Qosselin,  who  showed  a  femur, 
recently  fractured,  from  a  case  otherwise  speedily  fatal. 


Medical  Times  and  Gasctto. 


MEDICAL  AXD  SURGICAL  PRACTICE. 


Bee.  2S,  'S8'k  73  J 


d  prop  os  of  which  he  said  that  he  had  often  found  cases  of 
fractured  femur  followed  in  a  few  days  by  effusion  into  the 
knee-joint  of  the  same  side.  Mr.  Parker  can  confirm 
entirely  the  observation  of  M.  Gosselin,  having  found  the 
effusion  in  almost  every  case  of  fracture  of  the  shaft  of  the 
femur  that  he  has  subsequently  seen,  and  also  occasionally 
in  fracture  of  the  upper  part  of  the  leg. 

■Case  9. — Twist  of  Lower  Limb,  corrected  by  Fracture  of  Femur 

and  Rotation  of  Lower  Fragment  with  the  attached  Leg. 

James  V.,  aged  ten,  under  treatment  since  January,  1878, 
for  the  correction  of  double  knock-knee  of  an  extreme  kind. 
The  left  limb  had  already  been  straightened  by  gradual 
extension  and  lateral  compression  with  bandages  on  a 
Thomas’s  knee-splint ;  the  right  was  also  straight ;  and  both 
limbs  were  now  in  calliper  knee-splints  with  boots  attached, 
but  the  front  of  the  right  knee-joint  was  turned  outwards, 
and  the  inner  condyle  looking  forwards.  Both  tibise  were 
compressed  laterally  and  curved  in  a  rickety  fashion,  but 
the  right  was  flexible,  while  the  left  was  rigid.  It  was 
thought  that  fracture  of  the  femur  would  permit  the  knee- 
joint  to  be  turned  round  to  its  proper  attitude,  while  the 
softness  of  the  tibia  would  permit  this  to  be  done  without 
twisting  the  foot  inwards  or  even  breaking  the  tibia.  The 
knee  was  accordingly  fixed  with  sheet-iron  padded  splints, 
as  in  Case  8,  and  the  patient  put  under  the  influence  of 
ether  on  January  24, 1880.  The  femur  was  without  difficulty 
broken,  a  little  below  its  middle,  across  the  edge  of  the 
operating-table,  and  the  lower  fragment  forcibly  twisted 
inwards  rather  more  than  was  absolutely  required,  until 
the  knee-joint  occupied,  without  elastic  recoil,  its  proper 
position,  with  the  patella  forwards.  The  foot  was  mean¬ 
while  easily  maintained  in  its  former  proper  position,  owing 
to  the  flexibility  and  thinness  of  the  lower  third  of  the 
tibia.  The  limb  was  put  up  in  Thomas’s  longer  knee  bed- 
splint,  with  side  plasters,  short  splints  of  sheet-iron,  etc., 
as  in  the  preceding  cases  of  fractured  thigh. 

An  excellent  union,  without  noticeable  incident,  had  re¬ 
sulted  by  March  15  of  the  same  year,  when  a  calliper  splint, 
made  of  full  length  so  as  to  take  a  portion  of  the  weight 
of  the  body,  was  replaced. 

‘Case  10. — Double  Bandy-Leg,  treaded  by  Antiseptic  Osteotomy 

of  both  Tibice;  afterwards  by  Simple  Fracture  of  one  Femur. 

Emma  J.,  aged  seven,  was  admitted  in  January,  1882, 
having  rather  conspicuous  bandy-legs,  owing  to  rickety 
curve  of  the  tibiee  with  the  concavity  inwards.  Simple  frac¬ 
ture  of  each  leg  under  ether,  February  1,  1882,  was  first 
attempted,  with  the  hands  pulling  the  patient’s  limb  across 
the  knee  of  the  operator — a  method  that  easily  succeeds  in 
some  cases.  But  the  bones  were  too  short  and  too  strong 
for  this ;  so  osteotomy  with  a  narrow  saw,  introduced 
through  a  small  incision,  was  at  once  performed  under  car¬ 
bolic  acid  spray.  After  sawing  through  part  of  the  thickness, 
the  fracture  of  the  tibia  was  completed  by  hand,  a  Lister 
gauze  dressing  put  around  the  leg,  and  a  couple  of  sheet- 
iron  lateral  splints  outside,  with  a  bandage  over  all.  In  each 
case  a  simple,  uncomplicated  healing  resulted,  with  a  de- 
•eided  diminution  of  the  leg-curve.  But  when  she  recovered 
the  strength  of  her  limbs,  it  became  evident  that  her  condi¬ 
tion  of  bandy-leg  still  remained.  On  laying  her  down  and 
placing  the  upper  halves  of  the  thighs  in  a  position  of  normal 
symmetry  and  parallelism,  the  cause  of  the  bandy-leg  de¬ 
formity  was  discovered  (as  in  Case  8)  to  be  due  to  distortion 
of  the  femur  on  both  sides.  Here,  however,  the  lower  ends 
of  those  bones  were  rotated  in,  so  that  the  inner  condyles  stood 
forwards  and  the  outer  condyles  backwards  nearly  a  quarter 
©f  a  turn  in  the  attitude  in  which  she  lay.  The  legs  in  this 
.attitude  crossed  each  other— the  ankles,  knees,  and  hips  not 
lying  in  the  same  straight  line.  Accordingly,  in  the  month 
of  June,  1882,  under  the  influence  of  an  anaesthetic,  the  right 
femur  was  broken  across  the  edge  of  the  operating-table, 
the  knee-joint  having  been  previously  fixed,  as  in  Cases  8 
and  9.  The  lower  fragment  carrying  the  leg  was  rotated 
inwards,  and  the  limb  set  in  Thomas’s  bed-splint,  as  in  the 
other  cases. 

The  bone  quickly  united,  and  the  patient  was  allowed  to 
go  home  at  the  end  of  July,  by  which  time  she  could  stand 
upon  the  limb,  the  lightness  of  her  weight  and  the  strength 
©f  her  bones  permitting  this  without  further  precaution. 

As  the  child  had  become  rather  anaemic  during  her  stay 
in  hospital,  she  was  sent  to  get  esh  air  until  after  the 


vacation.  The  shape  of  the  limb  was  now  entirely  satis¬ 
factory  as  regards  general  symmetry  and  the  line  of  the 
joints,  the  only  drawback  being  the  slight  tibial  curve  still 
remaining — a  defect  of  no  mechanical  consequence,  only 
visually  recognisable,  and  not  further  remediable. 

The  other  limb  has  not  yet  been  put  right,  owing  to  a 
prolonged  absence  of  the  child  in  a  distant  part  of  the 
country.  It  is  still,  however,  in  contemplation.  She  was 
last  seen  several  months  after  her  discharge,  the  limb 
retaining  all  the  essentials  of  strength  and  efficiency. 

Case  11. — Double  Knock-Knee,  due  to  Incurvation  of  both 
Femora,  corrected  by  Simple  Fracture  of  each  Bone. 

Fred  W.,  aged  eleven  or  twelve,  half-brother  to  the  pre¬ 
ceding  case,  was  admitted  in  April,  1883,  to  have  his  legs 
straightened  by  such  means  as  might  seem  best  suited  to 
his  state,  and  was  examined  several  times.  It  gradually 
appeared  that  in  his  case  the  deformity  was  owing  chiefly  to 
incurvation  with  twist  of  the  femora.  On  April  27  the 
right  thigh  was  broken  and  reset,  as  in  the  other  cases,  the 
limb  being,  after  sound  union,  placed  in  Thomas’s  calliper 
splint  with  boot  attached.  On  June  22  the  left  limb  was 
broken,  and  the  lower  fragment  with  the  leg  thoroughly 
twisted  into  position.  A  similar  after-treatment  was 
adopted,  the  patient  being  sent  home  at  the  end  of  July, 
walking  with  a  calliper  knee-splint  on  each  limb.  The 
result  was  perfect  on  the  left  side,  where  a  much  more 
thorough  twist  was  adopted  after  fracturing  the  bone. 

About  September  he  was  seen  again,  the  left  limb  being 
perfectly  efficient  without  splint.  In  the  case  of  the  right 
the  benefit  was  much  less,  owing  to  the  defective  employ¬ 
ment,  it  is  believed,  of  the  twist  manoeuvre.  A  refracture 
was  advised,  but  the  patient  declined  it.  Under  the  circum¬ 
stances,  he  was  told  to  continue  wearing  the  splint,  keep¬ 
ing  the  knee-joint  in  line  with  leather  bandages  attached. 
He  has  not  been  seen  since. 

Case  12. — Fracture  of  Left  Femur,  with  Twist]  of  Lower 
Fragment,  to  correct  Genu  Valgum. 

Herbert  B.,  aged  five,  was  similarly  treated  on  July  27, 
1883,  the  fracture  being  made  at  or  slightly  below  the  middle 
of  the  bone.  A  simple  and  (after  the  first  day)  painless 
recovery  was  made,  with  restoration  of  the  proper  line  of 
the  limb.  He  was  discharged  within  a  month  of  operation. 
The  case  was  one  of  rickety  bend  of  the  tibias,  the  con¬ 
vexity  forwards,  with  genu  valgum,  pronounced  on  the  left 
side,  but  slight  on  the  right.  The  tibial  bends  are  not  a 
source,  apparently,  of  mechanical  inconvenience. 

When  seen  on  December  14  he  was  very  vigorous,  active, 
and  well  able  to  walk  and  run.  There  was  a  very  slight 
degree  of  double  genu  valgum,  which  it  is  believed  he  will 
grow  out  of  with  the  use  of  boots  having  sloping  heels,  the 
inner  sides  being  high.  He  is  still  under  treatment  with 
that  object. 

j Remarks. — Among  the  various  forms  and  degrees  of  knock- 
knee,  bandy-leg,  and  other  deformities  of  the  lower  limbs, 
there  is  some  scope  for  selection  in  the  method  of  treatment. 
In  childhood  much  can  be  done  with  the  aid  of  splint  and 
bandages  alone,  without  operative  interference  at  all,  to 
favour  the  resumption  of  proper  line  by  natural  growth,  as 
has  been  well  said  by  Mr.  Edmund  Owen  in  the  British 
Medical  Journal  of  February  21,  1880.  The  force  that 
distorts  young  limbs  is  apparently  not  great  when  the 
bones  are  abnormally  soft,  or  the  ligaments  weak  or  over¬ 
strained.  Similarly,  the  force  required  to  train  such  limbs 
back  to  the  proper  line  is  frequently  but  slight  when  dili¬ 
gently  and  carefully  employed.  But  there  are  cases  in 
which,  even  at  a  very  early  age,  the  bones  have  become 
too  hard,  and  the  curves  have  become  too  abrupt,  to  permit 
of  successful  mechanical  training  in  aid  of  natural  growth. 
Simple  fracture  of  a  bone,  whether  tibia  or  femur,  is,  in 
certain  instances,  effectual  in  permitting  replacement  of  the 
joints  of  the  limb  in  suitable  line  one  with  another.  The 
mere  shape  of  the  bones  is  often  of  no  moment  in  determin¬ 
ing  the  efficient  strength  of  a  limb  ;  and,  as  a  general  rule, 
the  present  writer  is  now  more  particular  about  the  relative 
position  of  the  joints  in  one  and  the  same  straight  line  than 
about  the  exact  shape  of  the  bones.  The  latter  may  be 
obviously  deformed  without  interfering  with  the  mechanical 
efficiency  of  the  limb,  provided  the  joints  be  in  line ;  whereas, 
a3  some  of,  the  above  oases  show  but  slight  deformity  of 


Medical  Times  and  Gazette. 


THE  MEDICAL  HISTORY  OF  THE  YEAR. 


3>ee.  ‘29,  1883. 


bone  may  lead  to  conspicuous  weakness  and  deformity  of  limb. 
These  cases  illustrate  a  single  item  in  the  wide  domain  of 
treatment,  and  do  not  interfere  with  the  useful  fact  that 
antiseptic  osteotomy  effects  the  correction  of  similar  de¬ 
formities  in  cases  to  which  simple  fracture  or  mechanical 
training  are  not  applicable. 


TERMS  OF  SUBSCRIPTION  from  JANUARY  5,  1884. 

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SATURDAY,  DECEMBER  29,  1883. 


- ❖ - 

THE  MEDICAL  HISTORY  OF  THE  YEAR. 

I.— POLITICS. 

The  Parliamentary  Session  of  this  dying  year,  1883,  was, 
to  use  some  of  the  favourite  epithets  of  the  day,  of  pheno¬ 
menal  length,  but  was  anything  but  epoch-making,  Yery 
few  Government  measures  of  primary  importance  were 
carried,  and,  as  regards  medical  legislation,  the  session  was 
worse  than  barren.  Parliament  met  for  business  on  Feb¬ 
ruary  15,  but,  to  the  surprise  and  disappointment  of  the 
profession,  the  Speech  from  the  Throne  contained  no  men¬ 
tion  of  any  medical  or  sanitary  measures.  In  the  following 
week,  however,  it  was  officially  announced  in  both  the  Rouses 
of  Legislature  that  a  Government  Bill  for  the  amendment 
of  the  Medical  Acts  would  be  introduced  in  the  House  of 
Lords;  and  the  measure  was  brought  in  by  the  Lord  Presi¬ 
dent  of  the  Council,  Lord  Carlingford,  on  March  19.  ,  It  is 
a  very  important,  large,  and  lengthy  measure,  intituled 
“An  Act  for  the  Consolidation  and  Amendment  of  the  Law 
relating  to  Medical  Practitioners,”  and  framed  on  the  lines 
of  the  recommendations  of  the  Royal  Commission  on  the 
Medical  Acts.  The  Bill- — for  it  is  still  only  a  Bill— has  been 
dealt  with  so  fully  and  in  such  detail  in  our  first  volume 
for  the  year  that  we  need  not  here  allude  to  more  than  its 
principal  provisions.  It  proposes  to  abolish  the  existing 
Medical  Council,  and  to  appoint  in  place  thereof  a  new  ope, 
consisting  of  eighteen  members  only ;  and  this  new  Council 
is  to  contain  four  members  elected  by  the  votes  of  the  re¬ 
gistered  medical  practitioners  of  the  United  Kingdom — 
the  so-called  direct  representatives  of  the  profession ;  two  for 
England,  one  for  Scotland,  and  one  for  Ireland.  Further, 
individual  representation  of  the  medical  authorities— the 
universities  and  corporations — on  the  Council  is  to  be  super¬ 
seded  by  representation  through  the  Medical  Boards;  the 
English  Board  electing  four,  and  the  Scottish  and  Irish 
each  two,  members.  And,  lastly,  the  new  Council  is' to, have 


supervision  and  control  over  the  Medical  Boards..  The  Bill! 
provides  for  the  establishment  in  each  of  the  three  divisions 
of  the  United  Kingdom  of  a  Medical  Board,  to  be  constituted 
of  members  chosen  by  the  medical  authorities  of  that  divi¬ 
sion  of  the  kingdom  to  which  each  Board  belongs.  The 
duties  to  be  imposed  on  these  Boards  are  of  great  import¬ 
ance  :  they  include  the  preparation  of  schemes  for  the  final 
examinations ;  the  appointment  of  examiners  for,  and  the 
direction  of  the  nature  and  conduct  of,  such  examinations. 
The  question  whether  the  preponderance  of  power,  or  at 
least  of  representation,  on  each  Board  should  be  given  to 
the  universities  or  to  the  corporations  in  each  part  of  the 
kingdom,  excited  great  interest  and  contention.  It  became 
the  main  point  upon  which  opposition  to  the  MB  was 
concentrated,  and  was  the  determining  cause  of  its  failure 
to  pass  into  law.  When  the  measure  was  introduced, 
the  Board  for  England  consisted  of  fifteen  members — 
two  to  be  chosen  by  each  of  the  Universities  of  Ox¬ 
ford,  Cambridge,  and  London,  one  by  the  University  of 
Durham,  and  one  by  the  Victoria  University,  Manchester; 
three  by  the  Royal  College  of  Physicians,  three  by  the 
Royal  College  of  Surgeons,  and  one  by  the  Apothecaries5 
Society.  The  Board  for  Scotland  was  given  eleven  members 
— three  to  be  elected  by  the  University  of  Edinburgh,  two 
each  by  the  U niversities  of  Glasgow  and  Aberdeen  respec¬ 
tively,  and  one  by  the  University  of  St.  Andrews  ;  and  one 
each  by  the  College  of  Physicians  of  Edinburgh,  the  College 
of  Surgeons  of  Edinburgh,  and  the  Faculty  of  Physicians 
and  Surgeons  of  Glasgow,  respectively.  And  the  Board 
for  Ireland  had  eleven  members — two  to  be  elected  by  the 
University  of  Dublin,  two  by  the  Royal  University  of 
Ireland ;  three  each  by  the  King  and  Queen’s  College  of 
Physicians  and  by  the  Royal  College  of  Surgeons  respec¬ 
tively,  and  one  by  the  Apothecaries’  Hall.  But,  as  finally 
amended  in  the  House  of  Lords,  the  representation  of  the 
Apothecaries’  Halls  was  dropped,  and  the  proportions  of  the 
representation  of  the  universities  and  the  corporations  was 
changed  as  regards  the  Boards  for  England  and  Ireland. 
On  the  former  of  these  two  Boards  an  additional  represen¬ 
tative  was  given  to  each  of  the  Royal  Colleges,  and  on  the 
latter  an  additional  representative  was  given  to  each  of  the 
universities,  and  one  was  taken  away  from  the  King  and 
Queen’s  College.  The  constitution  of  the  Board  for  Scot¬ 
land  rema  ined  unaltered.  These  amendments  were  gene¬ 
rally  approved;  but  met  with  determined  hostility  from 
the  corporations  in  Scotland  and  Ireland,  and  decided  oppo¬ 
sition  from  the  Apothecaries’  Society  of  London.  Some 
other  important  amendments  were  also  accepted  during  the 
passage  of  the  Bill  through  the  Upper  House ;  such  as  the 
omission  of  the  proposal  for  an  annual  fee  for  registration, 
the  abandonment  of  a  provision  that  every  person  passing  the 
final  examination  of  a  Medical  Board  should  be  entitled  to 
use  and  to  register  the  title  of  Licentiate  of  the  Medical  Coun¬ 
cil  in  Medicine,  Surgery,  and  Midwifery,  and  the  addition 
of  words  permitting  the  registration  of  all  diplomas  granted 
by  the  medical  authorities.  The  amended  measure  was. 
brought  forward  and  read  a  first  time  in  the  House  of 
Commons  without  delay;  was  put  down  for  a  second  reading 
on  May  10;  was  promptly  blocked;  and,  without  having 
been  carried  a  stage  further,  was  at  last,  abandoned  by  the 
Government  a  few  days  before  the  close  of  the  session. 
Such  a  result,  after  all  the  time,  patience,  and  labour  be¬ 
stowed  on  the  measure  by  Lord  Carlingford  and  Mr. 
Mundella,  was  very  disappointing-.  In  the  House  of  Lords 
the  Bill  had  been  so  much  improved  that  all  parties  con¬ 
cerned  might  well  have  been  content,  to  say  the  least,  to, 
accept  it,  in  order  to  put  an  end  to  the  agitation  and  uncer¬ 
tainty  that  have  for  so  long  hindered  ;  the  work  of  the- 
I  Medical  Council,  and  kept  medical  students,  the  schools 


Medical  Times  and  Gazette. 


THE  MEDICAL  HISTORY  OF  THE  YEAR. 


Dec.  29,  1883.  741 


and  the  examining  bodies  in  a  state  of  troublesome  and 
mischievous  uncertainty  and  worry.  Should  the  Bill  be 
introduced  again  next  year,  the  Government  must  make  it 
a  measure  of  primary  importance,  to  be  pressed  forward 
with  all  possible  weight,  insistence,  and  persistence,  or 
there  will  be  no  chance  of  its  being  carried.  Experience  has 
amply  proved  that  a  very  little  steady,  stolid  hostility  may 
suffice  to  wreck  a  measure.  A  practicable  alternative  would 
be  the  introduction  of  a  very  short  Bill,  dealing  simply  with 
the  requirements  for  registration  and  the  re-organisation 
of  the  Medical  Council ;  but  it  is  not  probable  that  either 
the  Government  or  the  British  Medical  Association  would 
see  fit  to  support  such  a  measure  as  that. 

In  April  the  House  of  Commons,  by  a  vote  of  182  to  110, 
agreed  to  Mr.  Stansfeld’s  motion,  “That  this  House  dis¬ 
approves  of  the  compulsory  examination  of  women  under 
the  Contagious  Diseases  Acts.”  The  resolution  was  arrived 
at  in  the  teeth  of  the  evidence  given  before  the  Select  Com¬ 
mittee  on  the  Acts,  and  in  spite  of  the  very  decided  and 
weighty  opinions  in  support  of  them  given  by  those 
members  of  the  House  and  of  the  Government  who  had  had 
the  best  opportunities  of  becoming  well  acquainted  with 
their  working.  The  Ministry  were  divided  on  the  subject, 
and  therefore  the  House  was  left  without  any  g'uidance 
from  the  Government,  as  such,  in  the  matter;  but  the  Prime 
Minister,  nevertheless,  insisted  that  Government  was  com¬ 
pelled  to  carry  the  resolution  of  the  House  into  action  with¬ 
out  delay.  The  result  has  already  been  a  disastrous  increase 
of  the  diseases  which  Mr.  Stansfeld  and  his  colleagues  have 

O 

taken  under  their  special  protection  in  the  towns  to  which 
the  Acts  were  applied;  and  that  increase  will  gradually 
affect  the  population  at  large.  The  success  of  the  Anti-Con- 
tagious  Diseases  Acts  party  encouraged  the  Anti-Vaccina¬ 
tionists  ;  and  Mr.  P.  A.  Taylor  brought  forward  a  motion  for 
the  repeal  of  the  compulsory  clauses  of  the  Acts  ;  but,  owing 
largely,  no  doubt,  to  the  effect  produced  by  the  masterly 
•speech  of  Sir  Lyon  Playfair,  and  the  very  able  support  given 
him  by  Dr.  Cameron  and  Sir  Charles  Dilke,  the  motion  was 
rejected  by  286  votes  against  16.  Two  Bills  to  provide 
for  the  Compulsory  Notification  of  Infectious  Disease  were 
introduced;  but  neither  of  them  made  much  progress. 
Several  provincial  corporations,  however,  succeeded  in 
getting  their  local  Bills  passed ;  and  four  towns— Burnley, 
Hartlepool,  Heywood,  and  Portsmouth — obtained  powers  for 
the  compulsory  notification  of  infectious  disease.  The  time 
has  surely  come  for  Government  to  take  this  subject  into  its 
own  hands.  It  is  a  grave  scandal  that  legislation  on  a 
matter  of  such  vast  import  to  the  public  weal  has  been  left 
to  be  nibbled  at  by  provincial  corporations  and  vestries. 

The  report  of  the  Committee  appointed  to  inquire  into 
Hospital  Management  and  Nursing  in  the  Field,  and  the 
evidence  laid  before  them,  most  fully  and  amply  vindicated 
the  conduct  and  management  of  the  medical  officers  of  the 
army  in  Egypt.  It  was  proved  to  demonstration  that  the 
very  grave  faults  and  shortcomings  of  which  they  had  been 
accused  were  either  absolutely  without  any  foundation  what¬ 
ever,  or  were  most  grossly  exaggerated.  The  report  and  the 
evidence  have  been  so  fully  dealt  with  in  our  pages  that  it  is 
enough  now  to  state  that  it  was  admitted  by  Ministers  in 
both  Houses  of  Parliament  that  never  had  any  campaign 
been  carried  on  with  greater  success,  as  far  as  regards 
the  services  of  the  Army  Medical  Department,  than  the 
campaign  in  Egypt.  The  only  faults  and  shortcomings 
that  were  clearly  known  to  have  existed  were  due  either  to 
•the  false  and  petty  economy  exercised  in  the  organisation 
and  training  of  the  Hospital  Corps,  or  to  the  exigencies  of 
the  military  conduct  of.  the  campaign.  The  highest  praise 
•was  due  to  the  management  and  behaviour  of  the  medical 
-officers  throughout.  _  It  is  much  to  be  regretted  that  Lord 


Wolseley  did  not  see  fit  to  avail  himself  of  the  opportunity 
afforded  him,  by  the  discussion  in  the  House  of  Lords  on  the 
matter,  to  explain  his  evidence  before  Lord  Morley’s  Com¬ 
mittee  ;  and  that  Lord  Hartington  was  not  able  to  redeem 
his  promise  that  ample  opportunity  should  be  given  to 
vindicate  the  conduct  of  the  medical  officers  when  the  vote 
for  the  medical  establishments  and  services  of  the  army  was 
brought  forward  in  the  House  of  Commons. 


II. — SCIENCE. 

The  year  which  is  now  rapidly  drawing  to  a  close  will  not 
occupy  so  marked  a  position  in  the  calendar  of  the  history 
of  Medicine  as  either  of  its  immediate  predecessors.  We 
do  not  have,  nor  desire  to  have,  an  International  Medical 
Congress  here  every  year,  nor  can  such  a  discovery  as  that  of 
the  tubercle-bacillus  be  an  annual  occurrence.  The  chief 
medical  event  of  1883  has  been  the  outbreak  of  cholera  in 
Egypt,  which  not  unnaturally  caused  alarm  throughout 
Europe,  and  led  to  a  sanitary  activity,  in  our  own  country 
at  any  rate/which  cannot  have  been  otherwise  than  beneficial. 
Many  comments  have  been  passed  on  the  way  in  which  the 
three  great  countries  of  Europe  acted  on  receipt  of  the 
news  of  the  outbreak.  England,  practical  as  usual  rather 
than  theoretical,  and  as  in  duty  bound,  took  immediate 
steps  to  check  its  spread,  and  for  that  purpose  despatched 
a  dozen  young  medical  men  to  Egypt  under  Surgeon- 
General  Hunter.  Within  a  month  of  their  arrival  the 
epidemic  was  at  an  end — post  hoc  certainly,  but  whether 
entirely  propter  hoc  it  would  be  hard  to  say.  It  may,  how¬ 
ever,  be  fairly  claimed  that  the  arduous  and  responsible 
labours  of  our  professional  brethren  out  there  played  a 
very  important  part  in  bringing  about  the  speedy  termina¬ 
tion  of  the  outbreak.  France  and  Germany  availed  them¬ 
selves  of  the  opportunity  afforded  to  make  a  scientific  in¬ 
vestigation  into  the  nature  of  the  disease,  the  latter  sending 
out  a  commission  under  the  personal  guidance  of  Koch,  the 
former  one  under  the  auspices  of  Pasteur.  Koch's  report, 
which  was  the  first  to  come  out,  told  us  of  the  discovery, 
as  a  constant  appearance  in  cases  that  had  died  directly 
from  cholera,  of  rod-shaped  bacteria  in  the  follicular  glands 
of  the  mucous  membrane  of  the  alimentary  canal,  and  their 
penetration  in  severe  cases  beyond  the  glands  into  the 
various  tissues  in  the  immediate  neighbourhood.  Koch  re¬ 
gards  these  bacilli  as  characteristic  of  cholera  ;  but,  having 
failed  to  induce  the  disease  by  inoculation  in  animals,  he  has 
Obtained  permission  to  proceed  to  the  banks  of  the  Hooghly, 
where  he  hopes,  with  better  opportunities,  to  meet  with  better 
success.  The  French  Commission  did  not  think  much  of  this 
intestinal  bacillus  of  Koch's,  which  they  averred  was  not 
present  in  the  most  malignant  cases  ;  but  they  laid  great 
stress  upon  the  existence  in  the  blood  of  small,  pale,  badly 
refracting  bodies,  and  stated  that  the  blood,  moreover,  was 
profoundly  modified  in  its  chemical  character.  They  were 
not,  however,  more  successful  than  the  Germans  in  their 
inoculation  experiments.  Surgeon- General  Hunter  did  not 
deal  with  any  such  minute  scientific  investigations.  It  was 
his  business,  first,  to  stamp  out  the  epidemic,  and,  secondly, 
to  determine  a  practical  point  which  was  of  immense  im¬ 
portance  from  a  commercial  point  of  view.  He  had  to 
decide  whether  the  epidemic  was  endogenous  or  exogenous. 
After  a  long  and  cateful  investigation  he  came  to  the  conclu¬ 
sion  that  cholera  had  been  endemic  in  Damietta  for  some 
time  previous  to  the  outbreak.  We  have  at  present  only 
his  statement  to  this  effect,  his  third  report,  containing  the 
voluminous  evidence  on  which  he  founded  his  opinion,  being 
yet  in  process  of  preparation. 

Mr.  Watson  Cheyne’s  report  in  the  early  part  of  the 
year  to  the  Association  for  the  Advancement  of  Medicine 


742 


Mrd  ca*  Times  a*d 


THE  MEDICAL  HISTORY  OF  THE  YEAR. 


Dec.  29. 1S83. 


by  Research  confirmed  in  every  detail  Koch’s  statements 
about  the  tubercle-bacillus.  His  experiments  were  per¬ 
formed  with  every  antiseptic  precaution,  and  he  failed  to 
induce  tuberculosis  by  inoculation,  except  with  the  tubercle- 
bacillus.  A  similar  result  has  quite  recently  been  recorded 
by  Dr.  Dawson  Williams,  who  repeated  the  original  experi¬ 
ments  of  Drs.  Wilson  Fox  and  Burdon  Sanderson,  at  the 
wish  and  under  the  direction  of  the  former  gentleman. 
He  did  not  use  full  antiseptic  precautions,  but  observed 
strict  cleanliness  as  to  his  instruments  and  apparatus  in  all 
his  experiments,  and  took  care  that  the  animals  experi¬ 
mented  upon  were  not  exposed  to  the  contagion  of  phthisis. 
He  too  could  only  induce  tuberculosis  by  the  inoculation 
of  tuberculous  material.  The  publication  of  these  results  at 
a  meeting  of  the  Pathological  Society  was  followed  by  the 
admission  of  Dr.  Wilson  Fox  that  his  former  doctrines  on 
the  causation  of  tubercle  were  no  longer  tenable. 

Our  Societies  have  all  been  busy  during  the  past  year,  as 
is  evidenced  by  the  bulky  volumes  they  have  so  lately 
issued.  The  Pathological  Society  had  a  discussion  in  the 
spring  on  Diabetes,  the  outcome  of  which  was  a  general 
admission  that  we  do  not  as  yet  know  much  about  it.  At 
the  Ophthalmological  Society,  Dr.  Gowers  opened  a  dis¬ 
cussion  on  Eye  Symptoms  in  Diseases  of  the  Spinal  Cord ; 
and  the  Fellows  of  the  Medical  Society  had  a  couple  of 
field-nights  with  Tubercle-Bacilli.  On  the  whole,  the  out¬ 
look,  so  far  as  Medicine  is  concerned,  is  encouraging ;  the 
number  of  able,  earnest  men  ever  alert  to  probe  deeper  into 
the  mysteries  of  disease  is  constantly  on  the  increase,  and 
their  labours  cannot  fail  eventually  to  meet  with  success. 

Though  Surgery  has  not  by  any  means  been  at  a  stand¬ 
still,  yet  the  past  year  has  not  been  characterised  by  any 
startling  novelties  either  as  regards  doctrine  orpractice.  Anti¬ 
septic  surgery,  after  much  opposition  and  controversy,  has 
thoroughly  settled  down  into  an  everyday  affair,  and  its 
founderandpromulgator  has  at  last  received  that  recognition 
from  the  State  which  his  overwhelming  services  to  science, 
and  through  it  to  humanity  at  large,  have  so  well  merited. 
It  is  not  too  much  to  say  that  the  introduction  of  aseptic 
surgery  has  revolutionised  the  practice  and  the  teaching 
of  every  medical  school  and  hospital  in  the  world.  The 
triumphs  of  surgery  which  have  been  chronicled  in  this 
place  at  the  close  of  the  year  have  for  many  years  past 
depended  upon,  and  gone  pari  passu  with,  what  is  briefly 
called  Listerism.  The  present  year  began,  continued,  and 
has  ended  with  discussion  on  urethral  and  bladder  surgery. 
Sir  Henry  Thompson,  at  the  Royal  Medical  and  Chirurgical 
Society  in  January  and  June,  read  papers  on  the  treatment 
of  tumours  in  the  bladder  and  on  a  method  for  exploring  the 
bladder  by  perineal  section.  This  operation,  which  is  prac-' 
tically  the  same  as  “Cock’s  operation,”  is  proposed,  how¬ 
ever,  for  a  new  and  important  purpose.  Sir  Henry  contends 
that  by  means  of  a  urethrotomy— through  the  mem¬ 
branous  portion,  and  without  injury  to  either  bladder  or 
prostate — the  bladder  can  be  fully  explored,  and  tumours 
or  stone,  etc.,  removed.  Several  cases  bearing  on  this 
subject  have  been  published  during  the  year,  noteworthy 
among  which  are  some  by  Mr.  Henry  Morris.  At  Liver¬ 
pool,  again,  bladder-surgery  formed  the  subject  of  the 
Address  in  Surgery  at  the  annual  meeting  of  the  British 
Medical  Association,  when  Mr.  Reginald  Harrison  gave  a 
good  retrospect  of  recent  advances  in  this  branch  of  sur¬ 
gery,  in  which  he  himself  has  figured  not  inconspicuously. 
Finally,  Sir  Andrew  Clark  has  drawn  further  attention  to 
the  subject  quite  recently.  Surgeons  in  discussing  these 
iews  (which  were  fully  set  forth  in  our  issue  last  week) 
seemed  to  doubt  whether  cases  of  “  catheter  fever”  ever 
occurred  without  kidney  disease,  thus  directly  joining 
issue  with  Sir  Andrew.  The  post-mortem  evidence  whicY 


was  brought  forward  in  support  of  the  paper  was  certainly 
not  large,  though  it  appeared  to  be  conclusive.  Over  and 
above  this,  however,  there  is  the  accurate  and  well-deve¬ 
loped  clinical  instinct,  which  must  be  allowed  its  full  value 
in  such  a  subject.  We  expect  before  another  year  closes  that 
many  new  facts  of  importance  will  be  at  our  disposal.  Mr. 
Treves  has  made  a  valuable  and  suggestive  communication 
on  resection  of  portions  of  intestine.  To  Dr.  West — a 
physician — belongs  the  honour  of  recording  the  first  suc¬ 
cessful  operation  of  pericardiotomy  practised  in  this  country. 
May  we  hope  that  the  surgeon,  when  his  turn  comes  to 
perform  this  operation,  will  meet  with  the  same  success¬ 
or.  Rawdon,  of  Liverpool,  has  recorded  a  unique  case  of 
diagnosis  and  removal  of  a  ruptured  kidney.  Mr.  R.  W. 
Parker  brought  forward  a  case  of  inguinal  aneurysm  in  a 
boy  aged  twelve,  with  ligature  of  the  external  iliac  artery. 
Some  thirteen  or  fourteen  cases  of  external  aneurysms  in 
persons  under  twenty  years  of  age  are  the  only  others  re¬ 
corded.  An  important  paper  on  removal  of  the  thyroid 
gland  has  been  published  by  Prof.  Kocher,  of  Berne.  One 
of  the  chief  points  of  interest  is  the  alleged  onset  in  a 
few  cases  of  a  condition  resembling  myxoedema  or  the 
“  cretinoid  condition  ”  in  adults.  Mr.  Godlee  has  added 
one  more  to  the  list  of  successful  abdominal  sections  prac¬ 
tised  for  intussusception ;  the  patient  was  an  infant  aged 
nine  months.  Dr.  Frederick  Taylor  has  recently  advocated* 
and  successfully  practised,  inflation  for  this  disease. 


III.— ETHICS. 

From  the  ethical  point  of  view,  using  the  term  in  its  widest 
sense,  the  year  has  not  been  a  happy  one.  To  be  ethically 
fortunate,  a  profession  should  have  no  annals,  and  that  cannot 
be  said  of  the  medical  profession  in  1883.  The  year  began, 
with  the  inquest  on  Dr.  Edsvardesof  Hounslow,  and  it  closed 
with  the  judicial  inquiry  into  the  charges  against  Mr.. 
Haffenden.  In  both  cases  a  respected  practitioner  was. 
accused  of  a  serious  offence,  in  both  cases  he  quailed  before 
the  threatened  infamy  and  put  an  end  to  his  own  life,  and 
in  both  cases  a  tardy  justice  declared  the  dead  man  innocent 
of  the  charge.  Besides  the  pain  which  such  a  tragedy  in. 
the  career  of  a  fellow-practitioner  must  inevitably  cause  to 
all  of  us,  the  profession  have  had  a  further  reason  for 
emotion  in  respect  to  these  two  cases.  For  there  is  scarcely 
one  of  us  who  might  not  conceivably  be  placed  in  the  same 
position,  and  there  must  be  many  who  cannot  help  feeling 
that  in  such  a  calamity  their  tenacity  of  mind  and  of 
life  would  be  scarcely  greater  than  that  of  Edwardes  or 
Haffenden.  There  is,  indeed,  no  profession  the  members, 
of  which  are  more  sensitive  as  to  their  reputation  than  that 
of  Medicine.  Accustomed  to  finding  their  best  reward  in 
private  and  often  silent  approbation,  and  their  worst  penalty 
in  an  equally  silent  neglect, — not  used  ,  like  lawyers,  or  poli¬ 
ticians,  or  authors,  to  have  their  work  and  character  made 
the  subject  of  outspoken  criticism  and  abuse, — medical  prac¬ 
titioners  are  very  apt  to  attach  undue  weight  to  every  form, 
of  publicity,  to  exaggerate  the  honourableness  of  public, 
honours  and  the  infamy  of  public  censure.  This  sensitive¬ 
ness  to  praise  or  blame  has  its  weak  points  as  well  as  its, 
strong  ones.  It  is  that,  and  that  alone,  which  enables  the 
profession  generally  to  maintain  such  a  high  standard  of 
honour,  untainted  by  the  commercial  atmosphere  of  the  day.. 
But  it  is  also  that  same  sensitiveness  which  makes  doctors 
sink  heart-broken  under  public  opprobrium,  and  wrangle 
as  they  have  done  especially  during  the  past  year,  over 
baronetcies  and  knighthoods.  No  one  can  question  that 
both  Edwardes  and  Haffenden  would  have  shown  a  more- 
admirable  strength  of  mind  if  they  had  been  able  to  wait, 
in  patience  till  they  were  cleared  of  their  accusations,  and. 


Dec.  2°,  18S3.  743 


SYPHILIS,  RICKETS,  AND  STRUMA. 


Medical  Times  and  Gazette. 

reinstated  in  public  confidence.  The  ideal  man  is  still,  as  in 
Horace’s  day,  the  man  of  uprightness  and  tenacity,  whose 
equanimity  no  imaginable  calamity  can  shake  ;  and,  in  spite 
of  the  clamour  about  titles,  we  all  of  us  have,  nevertheless, 
a  sneaking  regard  for  the  man  who  refuses  them,  and  in  our 
saner  moments  agree  with  Sir  Thomas  Browne  that  “to  be 
destitute  of  fortune  doth  not  any  way  deject  the  spirit  of 
wiser  judgments,  who,  being  enriched  with  higher  donatives, 
cast  a  more  careless  eye  on  the  vulgar  parts  of  felicity.”  If 
there  are  professions  to  whom  we  could  give  lessons  in  honour, 
there  are  also  professions  from  whom  we  could  appropriately 
take  instruction  in  repose  of  mind. 

In  the  third  cause  celebre  of  the  year — that  of  Messrs. 
Bower  and  Keates — it  is  fortunately  left  open  to  us  to 
evince  our  sympathy  otherwise  than  by  vain  regrets.  The 
full  particulars  of  this  scandalous  case  are  in  the  hands  of 
the  members  of  the  profession,  and  it  remains  for  them  to 
give  that  support  to  their  leaders,  whereby  Messrs.  Bower 
and  Keates  may  be  in  some  measure  indemnified  for  the 
damage  done  to  their  reputation,  their  pockets,  and  their 
peace  of  mind  ;  and  assurances  may  be  demanded  that  such 
unfounded  charges,  if  made  in  the  future,  shall  be  a  matter 
of  private  and  not  of  official  prosecution. 

Medical  advertising,  in  its  different  forms,  has  during  the 
year  received— or  rather  compelled — a  good  deal  of  attention. 
Last  year,  it  will  be  remembered,  the  College  of  Physicians 
passed  a  resolution  strongly  condemning  the  extensive  adver¬ 
tising  of  medical  books,  and  the  profession  was  therefore 
considerably  startled  when,  quite  early  in  the  present  year,  a 
long  advertisement  of  a  well-known  medical  book  appeared 
in  the  Times,  and  some  of  the  best  honoured  names  in  the 
profession  were  found  cheek  by  jowl  with  quack  announce¬ 
ments.  The  episode  was  an  unfortunate  one,  but  it  was 
quickly  explained  and  put  an  end  to.  The  publishers  alone 
were  declared  to  be  at  fault,  and  it  was  heard  with  relief 
that  it  was  no  one  within  the  profession  who  had  thus 
flouted  the  sacred  College.  But  the  College,  having  been 
thus  successful  in  its  crusade  against  the  advertising  of 
books  in  the  lay  press,  has  another  herculean  labour  before 
it — to  prevent  the  advertising  of  names  by  the  same  channel ; 
in  other  words,  the  publication  of  medical  bulletins.  The 
College  has  not,  so  far  as  we  know,  as  yet  come  to  any  resolu¬ 
tion  on  the  subject;  but  within  the  last  year  or  two  the  custom 
has  so  grown  both  in  frequency  and  vulgarity  that  some 
action  will  shortly  be  demanded  by  the  almost  unanimous 
voice  of  the  profession.  It  may  be  readily  admitted  that, 
in  an  individual  case  of  illness,  the  folly  of  friends,  the 
curiosity  of  the  public,  and  the  competition  of  journalists 
may  render  it  difficult  for  the  medical  attendant  to  keep  his 
name  out  of  the  public  prints  ;  but  that  is  only  the  greater 
argument  for  an  authoritative  expression  of  opinion  on  the 
subject  by  the  leaders  of  the  profession.  It  is  difficult  to 
believe  that  if  the  reasons  for  condemning  this  specious 
form  of  advertisement  were  candidly  explained,  the  public 
and  the  press  would  not  give  their  aid  towards  suppressing 
it.  The  subject  is  ripe  for  decision,  and  before  another  year 
is  over  we  hope  to  be  able  to  announce  that  it  has  been 
decided  in  the  sense  we  advocate. 

The  discussion  on  the  uses  of  out-patients  is  of  such  recent 
date  that  it  may  be  dismissed  in  a  few  words.  It  caused 
considerable  excitement  amongst  the  class  of  people  who 
support  the  hospitals,  and  has  driven  many  of  them  into  the 
arms  of  the  homoeopathists.  That  was  foolish  of  them,  of 
course :  for  homoeopathy  claims  to  be  based  on  experiments 
on  the  physiological  action  of  drugs,  and  its  followers,  believ¬ 
ing  as  they  do  in  a  remedy  for  every  complaint,  would  be 
false  to  their  faith  if  they  were  not  constantly  on  the  scent 
of  new  specifics.  They  claim  too  that  they  have  known 
nitrite  of  sodium  to  be  a  dangerous  drug  for  years — a  know¬ 


ledge  which  could  only  be  derived  from  experiment.  The 
public,  however,  invariably  connects  homoeopathy  with 
infinitesimal  doses  administered  on  principles  settled  once 
for  all  a  couple  of  generations  ago.  It  will  be  said,  of  course, 
by  those  who  can  afford  to  disregard  public  opinion,  that  to 
draw  attention  to  the  pecuniary  loss  which  would  result  to 
the  profession  if  it  took  up  an  unpopular  position  in  this 
question  is  to  treat  it  on  selfish  grounds.  But  an  argument 
of  this  sort  will  appeal  to  minds  which  are  not  open  to  other 
reasoning ;  and  if  the  public  will  is  a  good  argument  to  excuse 
medical  bulletins,  it  is  an  equally  valid  one  for  discounte¬ 
nancing  the  claim  to  regard  hospital  patients  as  material 
for  experiments. 


SYPHILIS,  RICKETS,  AND  STRUMA. 

The  connexion  between  congenital  syphilis  and  rickets  has 
long  been  a  fertile  subject  of  discussion,  and  although 
authors  are  still  at  variance  as  to  their  exact  etiological 
relations,  there  are  few  who  do  not  feel  that  a  vanishing 
syphilitic  taint  may  be  a  factor  in  the  causation  of  rickets. 
On  the  other  hand,  the  connexion  between  congenital 
syphilis  and  struma  is  not  yet  so  clearly  defined;  at  all 
events,  it  is  not  so  frequently  alluded  to  nor  so  generally 
acknowledged.  In  tracing  this  'connexion,  if  any,  one  may 
also  ask  whether  there  is  any  connexion  between  rickets 
and  struma.  The  first  point  to  be  determined  in  seeking  a 
solution  to  these  problems,  is  whether  congenital  syphilis  is 
a  specific  disease  in  the  same  sense  as  acquired  syphilis  P 
The  answer  to  this  question  is  not  so  simple  a  one  as  at 
first  sight  appears.  It  is  well  known  that  if  a  healthy 
wet-nurse  suckles  a  syphilitic  infant,  she  may,  and  pro¬ 
bably  will,  contract  a  typical  hard  chancre  on  her  nipple, 
and  subsequently  develope  all  the  symptoms  of  secondary 
disease.  It  is,  however,  not  so  well  known  how  long 
such  an  infant  is  liable  to  communicate  the  disease, 
nor  whether  even  it  communicates  the  disease  under 
all  circumstances.  If  there  be  sores  in  the  child’s  mouth, 
contagion  is  almost  certain;  but  if  not,  contagion  is 
quite  uncertain.  And  that  the  liability  to  spread  the 
disease  becomes  less  and  less  as  the  child  grows,  is 
also  a  matter  of  daily  observation.  For  instance,  we 
seldom  meet  with  chancres  in  children  under  any  circum¬ 
stances ;  and  when  we  do  they  are  still  more  rarely  the 
result  of  inoculation  from  a  congenitally  syphilitic  infant 
or  child.  Yet  among  the  poorer  classes  the  practice  of 
“  minding  the  baby  ”  while  its  mother  is  away  is  ex¬ 
ceedingly  common.  Even  in  a  somewhat  higher  social 
scale,  where  syphilitic  infants  are  still  common  enough, 
how  often  do  we  meet  with  cases  of  syphilis  in  the  girls  em¬ 
ployed  as  nurses,  who,  though  they  do  not  suckle  the  chil¬ 
dren,  at  least  kiss  them  numberless  times  a  day?  In  this 
station  of  life,  where  several  families  occupy  the  same  house, 
the  children  so  freely  intermix,  that  if  congenital  syphilis 
were  as  contagious  as  ordinary  syphilis,  there  would  be  no 
lack  of  cases  for  clinical  observation.  In  truth,  however, 
syphilis  acquired  in  this  manner  is  a  great  rarity,  and  this 
would  seem  to  depend  on  the  fact  that  congenital  syphilis 
differs  materially  from  ordinary  syphilis,  in  that  it  rapidly 
loses  its  specific  characters,  one  of  the  chief  of  which  is  the 
power  of  reproducing  itself.  Even  vaccino-syphilis  is  ex¬ 
tremely  rare,  notwithstanding  an  immense  amount  of  mani¬ 
fest  infantile  syphilis  at  the  period  of  life  when  vaccina¬ 
tion  is  usually  practised,  and  when  congenital  syphilis  is 
thought  to  be  most  infective  and  the  constitution  most 
receptive.  Going  still  further  ahead,  it  is  well  known  that 
parents,  the  subjects  of  congenital  syphilis,  may  beget  and 
bear  perfectly  healthy  children. 

The  question  thus  arises.  What  becomes  of  the  specificity 


744 


Medical  Times  and  Gazette. 


CHRONICLE  OF  THE  WEEK. 


Dec.  29,  1883. 


of  the  original  poison  ?  The  danger  of  begetting  syphilitic 
children  seems  to  decrease  with  the  lapse  of  time.  Further¬ 
more,  the  dose  of  syphilis  in  various  members  of  a  family 
is  not  at  all  equally  distributed,  and  it  is  not  always  the 
early  children  of  a  marriage  who  suffer  most.  And  if  this 
diminution  of  intensity  is  possible  in  the  parents,  to  what 
degree  of  attenuation  may  not  the  virus  attain  in  the  next 
generation  P  What  becomes,  then,  of  the  specificity  of  the 
virus?  Unfortunately  for  us,  no  investigator  has  yet  found 
out  its  intimate  nature,  and  until  this  is  definitely  settled 
our  answer  can  be  little  better  than  guesswork.  To  believe 
that  the  disease  is  due  to  a  micro-organism,  the  presence  of 
which  in  the  blood  gives  rise  to  a  process  of  fermentation, 
after  which  the  organism  dies  and  becomes  inert,  is  a  most 
seductive  doctrine,  and  one  which  appears  to  answer  many 
of  the  questions  that  arise ;  but  how  does  such  an  organism 
get  into  the  foetus  which  is  being  carried  by  a  non-syphilitic 
mother  ?  and  how  does  the  mother  in  so  many  cases  herself 
escape  ?  Are  there  any  facts  either  for  or  against  the  view 
that  rickets  or  struma  represents  this  attenuated  form  of 
congenital  syphilis  ?  In  other  words,  are  rickets  and 
struma  manifestations  of  congenital  syphilis  deprived  of 
its  specificity  ? 

In  the  sense  of  being  “  specific,”  congenital  syphilis  pre¬ 
sents  a  great  contrast  with  both  rickets  and  struma,  neither 
of  which  at  any  period  shows  any  such  tendency,  as  far  as 
we  know.  Though  this  character,  as  we  have  said,  soon 
vanishes,  yet  the  disease  still  retains  certain  other  special 
features.  The  three  diseases  may  all  be  more  or  less  severe 
in  type ;  they  may  be  localised  in  a  single  system,  or  may 
he  multiple  and  occur  in  several  systems.  Thus,  syphilis 
may  attack  one  bone  or  many,  the  muscles,  or  the  nerves. 
Eickets  may  be  chiefly  present  in  the  legs,  while  the  rest  of 
the  body  appears  healthy j  or,  the  legs  being  unaffected,  the 
intestinal  tract  may  suffer,— and  so  on.  While,  as  regards 
struma,  although  the  lymphatic  glands  are  its  favourite 
3eat,  strumous  caries  or  synovial  disease  is  almost  as  often 
present,  and  each  of  them  when  present  is  equally  typical 
of  the  affection.  We  have  thus  certain  characters  which 
are  common  to  the  three  diseases.  No  one,  however,  would 
mistake  a  rickety  curve  in  the  tibia  for  a  syphilitic  hyper¬ 
ostosis,  nor  vice  versa.  Not  less  typical  also  is  a  strumous 
caries ]  it  is  distinguishable  from  a  syphilitic  caries  almost 
at  first  sight.  In  what  relation,  then,  are  syphilis,  rickets, 
and  struma  to  he  regarded  ?  Are  they  stages  of  one  dis¬ 
ease  j  are  they  in  any  sense  allied  to  each  other ;  or  are  they 
distinct  manifestations  of  separate  constitutional  states  ? 

We  can  only  answer  this  last  question  by  asking  whether 
any  two  of  these  diseases  occur  in  the  same  subject]  we 
might  even  ask  whether  all  three  diseases  may  not  occur  in 
one  subject.  The  first  question  can  be  answered  in  the 
affirmative  without  any  hesitation.  We  frequently  see  cases 
of  syphilo-struma,  and  almost  as  frequently  cases  of  syphilis 
and  rickets  combined.  Not  infrequently,  also,  do  we  see  a 
combination  of  rickets,  syphilis,  and  struma,  though  such 
cases  are,  of  course,  much  less  common.  In  the  combina¬ 
tions,  one  or  other  of  the  diseases  may  be  predominant,  but 
they  each  keep  their  individual  characters.  A  case  of 
syphilo-struma  in  a  young  child  recently  came  under  obser¬ 
vation.  She  had  pegged  teeth,  slight  remains  of  keratitis, 
and  some  periosteal  thickening  just  below  the  tubercle  of 
the  tibia  on  one  side.  Antisyphilitic  remedies  were  used 
for  some  weeks,  without  any  improvement  taking  place ;  the 
periosteal  thickening  began  to  redden  and  inflame,  some  of 
the  nearest  lymphatic  glands  became  swollen,  and  finally 
3howed  signs  of  suppuration  ;  the  general  health  failed,  and 
anaemia  became  pronounced.  Mercurial  treatment  was  Sus¬ 
pended,  cod-liver  oil  and  iron  being  substituted ;  this  was 
followed  by  great  improvement  in  the  general  health,  but  the 


local  symptoms  remained  in  statu  quo.  It  was  now  decided  to 
combine  a  mercurial  treatment  with  the  cod-liver  oil,  and 
shortly  the  patient  commenced  rapidly  to  mend.  The  peri¬ 
osteal  thickening  began  to  disappear,  the  redness  and  sense 
of  fluctuation  passed  away,  and  soon  no  traces  of  the  con¬ 
dition  remained.  Cases  of  syphilis  and  rickets  combined  are 
not  less  exacting  in  their  treatment.  Due  regard  must  be 
paid  to  the  duality  of  the  cachexia,  and  the  treatment  must  be 
in  accordance.  It  has  been  argued  that  congenital  syphilis 
brings  about  a  condition  of  malnutrition,  which  favours  the 
development  of  rickets  or  struma,  or  even  both.  But  before 
accepting  such  a  doctrine  it  must  be  shown  that,  on  the  one 
hand,  syphilis  is  no  longer  present  as  such,  and,  on  the  other 
hand,  that  other  factors  which  usually  produce  rickets  or 
struma  have  not  been  present.  Such  proof,  of  course,  is  not 
attainable  ;  and  for  the  present,  therefore,  we  must  continue 
to  accept  the  doctrine  of  separate  but  associated  diseases, 
rather  than  seek  to  explain  that  which  is  admittedly  obscure 
by  the  substitution  of  that  which,  to  say  the  least,  is 
doubtful. 


CHRONICLE  OP  THE  WEEK. 

- <>. - 

The  Society  of  Medical  Officers  of  Health  assembled  on 
Friday,  the  20th  inst.,  in  considerable  strength  to  hear 
papers  on  the  question  of  the  day  by  Dr.  Tripe  and  Mr. 
Wynter  Blyth,  the  former  of  whom  pointed  out  the  more 
serious  defects  in  the  Artisans’  and  Labourers’  Dwellings 
Acts,  and  made  suggestions  for  their  improvement]  while 
the  latter  gave  an  account  of  the  work  actually  performed 
under  these  Acts  by  the  Yestry  of  Marylebone  during  the 
four  years  he  had  been  in  office.  A  brisk  discussion  followed, 
in  which  several  of  the  visitors — vestry  clerks  and  surveyors 
— took  part,  but  all  agreed  in  condemning  the  dual  autho¬ 
rity  created  by  these  Acts  ;  the  cost  and  unreasonable  delay 
of  proceedings ;  the  lightness  of  the  penalties  under  the 
Nuisance  Removal  Acts,  and  the  facilities  afforded  by  the  law 
for  their  evasion  ;  and,  lastly,  the  fact  that  the  action  of  the 
Metropolitan  Board  of  Works  only  aggravated  the  distress 
of  the  really  poor,  while  all  improvements,  whether  on 
a  large  or  small  scale,  were  paid  for  in  the  end  by  the  poor, 
and  not  by  those  who  were  culpably  responsible  for  their 
necessity. 

It  is  understood  that  the  Local  Government  Board  are 
about  to  take  immediate  action  in  the  matter,  and  to  make 
a  serious  attempt  to  find  out  how  far  the  sanitary  condition 
of  the  homes  of  the  London  poor  can  be  improved  by 
putting  into  force  the  provisions  of  existing  laws.  The 
Acts  in  question  are  the  Sanitary  Act  of  1866,  Section  35  j 
and  the  Amendment  Act  of  1874.  By  the  former  it  is 
provided  that  the  Local  Government  may,  on  application 
by  the  Nuisance  Authority  of  a  district,  insert  a  notice  in 
the  Gazette,  empowering  the  Local  Authority  to  make 
regulations — 1.  For  fixing  the  number  of  persons  who 
may  occupy  a  house,  or  part  of  a  house,  which  is  let  in 
lodgings,  or  occupied  by  members  of  more  than  one  family. 

2.  For  the  registration  of  the  houses  so  let  or  occupied. 

3.  For  the  inspection  of  such  houses  and  the  beeping  of 
the  same  in  a  cleanly  and  wholesome  state.  4.  For 
enforcing  the  provision  of  privy  accommodation  and  other 
appliances  and  means  of  cleanliness  in  proportion  to  the 
number  of  lodgers  and  occupiers,  and  for  the  cleansing 
and  ventilation  of  the  common  passages  and  staircases. 
5.  For  the  cleansing  and  lime-washing  at  stated  times  of 
such  premises.  By  the  Amendment  Act  the  Local  Govern¬ 
ment  Board  may  itself  take  the  initiative  without  any 
■application  froth  the  Local  District  Authority  j  and  the 


Medical  Times  and  Gazette. 


ANNOTATIONS. 


Dec.  29,  18S3.  745 


same  Act  further  provides  means  for  enforcing  the  proper 
ventilation  of  rooms,  the  separation  of  the  sexes,  and  efficient 
paving  and  drainage. 


The  powers  at  the  disposal  of  the  Board  are  to  be  applied 
to  nineteen  of  the  metropolitan  parishes  and  districts— viz., 
Marylebone,  St.  Pancras,  Paddington,  St.  Mary  (Newington), 
Camberwell,  Clerkenwell,  St.  Leonard’s  (Shoreditch),  Ber¬ 
mondsey,  St.  George’s,  St.  Martin-in-the-Fields,  Hampstead, 
Greenwich,  Wandsworth,  Holborn,  Fulham,  St.  Saviour’s, 
Plumstead,  Lewisham,  and  St.  Olave’s.  It  is  believed  to  be 
the  intention  of  the  Board  to  require  regulations  to  be  made 
in  all  these  places,  and  also  fresh  regulations  in  the  remain¬ 
ing  districts.  The  Local  Board  authorities  maintain  that 
the  statements  made  as  to  the  condition  of  the  homes  of 
the  poor  in  London  are  much  exaggerated ;  but  even  if  these 
dwellings  are  no  worse  than  official  optimism  would  have  us 
believe,  there  is  still  crying  need  for  improvement,  and  Sir 
Charles  Dilke’s  resolution  to  do  what  he  can  with  his  avail¬ 
able  means,  without  -waiting  for  a  Eoyal  Commission  and 
Parliamentary  action,  with  all  its  certainties  of  obstruction 
and  delay,  will  meet  with  universal  commendation. 


Dr.  Clotjston,  of  the  Morningside  Asylum,  gave  a  lecture 
at  Edinburgh  last  week  on  the  effects  of  the  excessive  use 
of  alcohol  on  the  functions  of  the  brain.  One  of  its  most 
unquestioned  effects,  he  maintained,  was  the  production  of 
absolute  insanity.  As  a  statistical  fact,  it  was  found  that 
from  15  to  20  per  cent,  of  the  actual  insanity  of  the  country 
was  produced  by  alcohol ;  and,  as  one  person  in  every  300 
of  the  population  was  insane,  it  followed  that  about  one 
person  in  every  2000  of  the  population  was  deprived  of 
reason,  of  the  power  of  action,  of  the  power  of  enjoyment, 
and  of  personal  liberty,  from  the  excessive  use  of  alcohol. 
This  gave  about  17,500  persons  at  any  one  time  in  the 
British  Empire  who  were  incapacitated  from  this  cause. 
They  must  also  remember  that  these  were  merely  the  regis¬ 
tered  persons  who  had  become  insane  through  the  agency  of 
alcohol ;  and  he  had  no  doubt  that  for  every  one  who  thus 
became  insane  there  were  a  large  number  who  had  become 
partially  affected,  and  required  to  be  deprived  of  their  liberty. 
He  had  himself  little  doubt  that  out  of  the  1600  suicides 
that  took  place  every  year  in  England,  probably  half  were 
due  to  the  beginning  of  alcoholic  insanity.  Dr.  Clouston 
does  not  appear  to  have  said  anything  about  the  converse  of 
his  thesis — a  subject  which  his  large  experience  would  have 
enabled  him  to  treat  with  authority.  Ere  he  holds  forth 
again,  he  might  advantageously  inform  us  how  many  people 
drink  alcohol  to  excess  because  they  are  insane  from  other 
causes. 


Amongst  the  papers  in  the  last  issue  of  the  French 
medical  journals  we  may  note  the  following  : — In  the  Pr ogres 
Medical  there  is  the  abstract  of  a  lecture  by  M.  Terrillon 
on  Lymphadenoma  of  the  Neck;  the  article  by  MM. 
Cornillon  and  Mallat  on  the  Doctrine  of  Acetonsemia  in 
reference  to  a  Case  of  Diabetic  Coma;  a  note  by  M-  Talamon 
on  the  Lance- shaped  Organism  of  Fibrinous  Lobar  Pneu¬ 
monia  ;  and  a  general  review  by  M.  Bricon  on  Coto,  Cotoine, 
and  Paraeotoine.  The  Gazette  Hebdomadairc  contains  the 
record  of  some  fresh  cases  of  Subclavicular  Lipoma,  by  M. 
L.  H.  Petit.  The  Gazette  des  Hopitaux  contains  articles  on 
the  “  Bruit  de  Flot  ”  of  the  Stomach  as  a  Sign  of  Dilatation 
of  the  Stomach  ;  and  on  Perforating  Disease  of  both  Feet, 
due  to  a  Spinal  Affection.  The  Concours  Medical  contains 
a  note  on  the  Articular  Manifestations  of  Mumps,  by  Dr. 
Edmond  Chaumier ;  and  an  article  on  Practical  Obstetrics,, 
by  Dr.  Langlais. 


THE  RADICAL  CURE  OF  HERNIA. 

The  radical  cure  of  hernia  has,  until  within  the  last  few 
years,  been  a  comparatively  rare  operation.  Five  years  ago 
Wood’s  operation  was  occasionally  performed,  and  Wutzcr’s 
operation  only  served  to  test  the  knowledge  of  the  student. 
In  the  Liverpool  Medical  Society,  on  December  20,  a  discus¬ 
sion  which  arose  on  a  paper  on  this  subject  by  Mr.  G.  G. 
Hamilton  elicited  the  fact  that  within  the  last  three  or  four 
years  about  a  hundred  and  fifty  radical  cures  have  been, 
performed  by  the  surgeons  of  that  city.  Mr.  Banks  has 
performed  between  fifty  and  sixty.  Dr.  Alexander  about 
thirty,  Mr.  Hushton  Parker  twenty-eight,  the  Surgeons  of 
the  Northern  Hospital  fourteen,  whilst  Messrs.  Pughe, 
Eawdon,  and  others  have  operated  on  smaller  numbers. 
The  mortality  has  been  nil,  and  the  successes  highly  satis¬ 
factory  to  all  as  far  as  time  has  enabled  them  to  judge.  The 
operation  consists  in  tying  the  neck  of  the  sac,  and  severing 
the  neck  thus  tied  from  the  rest  of  the  sac.  Mr.  Bushton 
Parker  stops  here,  and  has  had  a  success  quite  satisfactory 
to  himself.  Dr.  Alexander  adopted  that  method  for  a  time, 
but  he  now  joins  all  the  other  surgeons  in  dissecting  out 
the  severed  sac,  because  it  makes  the  cicatrix  firmer  and 
gives  a  better  support  to  the  ligatured  neck.  In  inguinal 
hernia  especially,  and  to  a  certain  extent  in  every  variety,  all 
the  surgeons  Avho  spoke,  with  the  exception  of  Mr.  Parker, 
bring  together  by  suture  the  fascial  boundaries  of  the 
opening,  which  in  inguinal  hernia  are  formed  by  the  pillars 
of  the  ring.  Mr.  Parker  would  only  do  this  in  exceptional 
cases.  As  to  the  material  to  be  used  for  tying  the  neck  of 
the  sac  and  suturing  the  pillars  of  the  ring,  there  was  wide 
diversity  of  practice.  In  the  Northern  Hospital  cases  which 
were  performed  by  Mr.  Manifold,  Mr.  Puzey,  Dr.  Macfie 
Campbell,  and  Mr.  Darner  Harrisson,  chromic  catgut 
was  generally  used  for  both  purposes.  Mr.  Banks  ties 
the  neck  of  the  sac  with  chromic  gut,  and  brings  the 
pillars  of  the  ring  together  with  silver- wire  sutures,  which 
are  to  be  retained  indefinitely.  If  the  sutures  irritate,  all 
the  better,  as  they  can  then  be  removed.  If  they  do  not 
irritate,  it  is  still  well,  as  they  will  always  maintain  their 
hold.  Dr.  Alexander  uses  catgut  for  the  neck  of  the  sac,  and 
silver-wire  sutures  for  the  pillars  of  the  ring.  He  removes 
these  sutures  before  the  wound  closes,  and  looks  with  favour 
on  healing  by  granulation.  Mr.  G.  G.  Hamilton  recom¬ 
mended  fishing  gut  or  sulphurous  gut  for  both  purposes; 
and  Mr.  Bhinallt  Pughe  spoke  highly  of  the  latter  as  being 
pliable  and  making  a  firm  knot.  It  was  therefore  evident 
I  that  good  results  could  be  obtained  by  any  of  these  methods, 
and  that  the  kind  of  suture  .was  not  essential.  This  method 
of  I’adical  cure  is  capable  of  being  performed  in  all  kinds 
of  hernia,  reducible  or  irreducible.  In  all  cases,  the 
sac,  having  been  dissected  out  from  its  surroundings,  and 
especially  from  the  cord  in  male  inguinal  hernia,  is  opened, 
and,  if  irreducible,  the  contents  explored,  the  adhesions 
severed,  and  omentum  removed  if  necessary.  Mr.  Banks 
and  Dr.  Alexander  have  successfully  removed  great  masses 
of  adherent  omentum  in  this  manner.  In  reducible  hernia 
the  sac  is  always  opened,  to  see  that  the  hernia  is  completely, 
reduced.  This  free  opening  of  the  sac  is  not,  therefore,  new 
in  Liverpool,  although  Mr.  Lawson  Tait,  in  the  last  number 
of  the  Birmingham  Medical  Review,  puts  it  forward  as,  at 
new  practice  in  that  town.  Mr.  Banks  described  in  great, 
detail  the  cases  suitable  for  operation.  It  need  nqt  be  per-, 
formed  in  young  children  except  under  exceptional  circum¬ 
stances,  as  a  truss  generally  cured  such  cases  before  puberty 
was  reached.  The  exceptional  circumstances'  were  a  very 
wide  opening,,  or  the  presence  of  the  disease  debarring  an 
orphan  from  a  charity  school,  or  inability  or  dislike  te, 
wearing  a  truss.  In  adults  it  should  only  be  performed  in 


K  e  lical  Times  and  Gazette. 


ANNOTATIONS. 


Dee.  29,  1883. 


i  1 

I  ID 

omental  liernia  and  in  hernia  complicated  with  undescended 
testis,  on  account  of  the  exceptional  danger  of  such  cases. 
In  ordinary  cases  of  reducible  hernia  he  would  not  operate 
unless  life  was  rendered  miserable  by  the  disease,  or  the 
patient  was  thereby  unfitted  for  work.  When  a  well-fitting 
iruss  completely  relieved  the  patient,  he  would  not  recom¬ 
mend  an  operation.  As  to  the  after-treatment,  all  agreed 
upon  the  advantages  of  a  prolonged  rest  in  bed  for  at  least 
three  weeks.  Some  of  Mr.  Parker’s  cases  were  up  in  ten  days, 
and  others  in  fourteen  days,  and  he  now  believes  that  these 
periods  were  too  short.  In  most  of  the  cases  no  appliance  was 
used  afterwards.  Mr.  Banks,  however,  recommends  a  light 
truss  to  be  always  worn  after  operation.  He  does  not  believe 
in  a  radical  cure  of  hernia  in  the  sense  of  the  patient  being 
as  strong  in  the  region  operated  on  as  a  perfectly  healthy 
man  would  be.  The  wearing  of  the  truss  is  no  discredit  to 
the  benefits  of  the  operation,  and  is  an  additional  security  to 
the  patient.  The  results  at  the  Northern  Hospital  were,  up 
to  the  present  time,  ten  cures  and  two  failures.  Tn  two  cases 
the  interval  was  under  six  months,  and  therefore  the  ques¬ 
tion  of  cure  could  not  be  entertained ;  they  had  not  failed. 
The  dressing  varied  as  much  as  the  kinds  of  ligature  and 
suture.  Mr.  Eushton  Parker  first  introduced  the  operation 
into  Liverpool,  and  thought  the  idea  was  new  to  others  as  it 
was  original  with  himself.  He  afterwards  found  that  it 
had  been  performed  by  Dr.  Macleod,  of  Calcutta,  by  Drs. 
Annandale  and  Buchanan,  and  by  some  others.  In  the 
successful  and  frequent  application  of  the  operation  it  will 
be  seen  that  Liverpool  occupies  an  exceptional  place. 
According  to  some  writers  in  the  medical  journals,  the 
operation  is  almost  unknown  in  many  places. 


THE  PARIS  WEEKLY  RETURN. 

The  number  of  deaths  for  the  fiftieth  week  of  1883,  ter¬ 
minating  December  11,  was  1065  (583  males  and  682 
females),  and  of  these  there  were  from  typhoid  fever  23, 
small-pox  1,  measles  7,  scarlatina  5,  pertussis  11,  diphtheria 
and  croup  54,  erysipelas  7,  and  puerperal  infection  5. 
There  were  also  42  deaths  from  acute  and  tubercular 
meningitis,  201  from  phthisis,  45  from  acute  bronchitis, 
70  from  pneumonia,  73  from  infantile  athrepsia  (29  of  the 
infants  having  been  wholly  or  partially  suckled),  and  29 
violent  deaths  (20  males  and  9  females).  All  the  epidemic 
diseases  have  remained  stationary  or  have  diminished,  with 
the  exception  of  diphtheria.  The  deaths  from  typhoid  fever 
and  measles  are  notably  fewer,  but  those  from  diphtheria 
have  been  progressively  increasing  for  several  weeks  past. 
During  the  week  there  have  been  1237  births,  viz.,  635  males 
(485  legitimate  and  170  illegitimate)  and  602  females  (433 
legitimate  and  169  illegitimate)  :  88  infants  were  either 
born  dead  or  died  within  twenty-four  hours,  viz  ,  49  males 
(36  legitimate  and  13  illegitimate)  and  39  females  (26 
legitimate  and  13  illegitimate). 


THE  McGILL  MEDICAL  FACULTY,  MONTREAL, 

We  have  before  us  the  interesting  address  delivered  at  the 
opening  of  the  fifty-first  session  of  the  above  Faculty  by 
Dr.  Joseph  Workman,  of  Toronto,  who  is  one  of  its  oldest 
surviving  graduates.  It  is  entitled  “  Past,  Present,  and 
Future,”  but,  as  might  be  expected  of  an  octogenarian, 
is  taken  up  principally  with  retrospect,  which,  interesting 
as  it  is  to  us  who  are  necessarily  unfamiliar  with  the  history 
of  McGill  College,  must  have  been  far  more  interesting  to 
his  hearers.  But  the  address  also  contains  some  excellent 
advice  to  students,  from  which  we  may  cull  the  following. 
Speaking  of  the  tendency  of  young  medical  practitioners  in 
rude  rural  districts  to  fall  into  habits  of  idleness,  intel¬ 
lectual  and  moral  torpor,  and  ultimately  confirmed  dissipa¬ 


tion — a  tendency  not  confined  to  Canada,  we  may  add, — Dr. 
Workman  says  that  not  the  least  potent  of  the  causes  of  this 
tendency  is  “  the  persistent  mental  overstrain  undergone 
by  some  students  of  feeble  enduring  powers  in  their  college 
courses.  Having  applied  themselves  too  intently  and  too 
hurriedly  to  the  proper  subjects  of  their  training,  they 
become  at  the  end  utterly  tired  out,  and,  once  liberated 
from  their  drudgery,  they  revolt  against  any  resumption 
whatever  of  their  past  studies,  despite  the  fact  that  on 
graduation  day  they  may  have  been  told  by  their  zealous  and 
well-wishing  dean  that  they  must  ever  continue  students,  or, 
indeed,  that  they  must  consider  their  real  studies  as  only  then 
beginning.  All  this  is  very  good  and  beautifully  sentimental, 
but,  somehow  or  other,  jaded  brains,  as  well  as  tired  limbs, 
ache  for  rest,  and  weakened  mental  stomachs  call,  at  the 
least,  for  some  change  of  diet.  Change  of  mental  aliment 
might,  in  these  cases,  work  admirably,  but  how  or  where  is 
it  to  be  had  ?  The  libraries  of  young  practitioners  are  not 
redundantly  stored  with  volumes  of  classic  literature,  nor 
even  with  those  on  scientific  subjects  in  affinity  with  their 
own ;  and  rural  libraries,  where  such  really  exist,  present 
but  a  meagre  number  outside  the  run  of  sensational  novels, 
distensively  padded  biographies,  and  wonder-filled  travels. 
As  to  congenial,  improving,  intellectual  society,  any  such 
hypothesis,  in  the  villages  and  bush  settlements  of  Canada, 
or  even  in  the  richer  agricultural  parts,  would  be  too  ridi¬ 
culous  a  delusion  to  be  indulged  in  by  anyone  outside  of 
Bedlam.”  The  true  prophylaxis,  Dr.  Workman  thinks, 
consists  in  contracting  a  love  for  one  of  the  kindred  sciences 
— botany,  zoology,  or  geology, — the  study  of  which  will 
always  keep  the  mind  interested,  and  in  cultivating  a  taste 
for  good  literature. 

THE  SANITARY  CONDITION  OF  BIRMINGHAM. 

In  presenting  his  tenth  annual  report  on  the  health  of 
the  borough  of  Birmingham  for  the  year  1882,  Dr.  Alfred 
Hill,  the  Medical  Officer  of  Health,  congratulates  the  autho¬ 
rities  on  the  fact  that  the  sanitary  condition  of  the  town 
during  the  past  year  maintains,  within  a  fractional  varia¬ 
tion,  the  highest  position  which  it  has  occupied  during  the 
whole  of  the  preceding  decade.  This  variation,  as  measured 
by  the  death-rate,  is  0’9  per  1000  of  the  popmlation  in  excess 
of  that  of  the  preceding  year,  and  only  01  in  excess  of  that 
of  the  year  1880.  Dr.  Hill  shows  that  on  his  appointment 
as  Medical  Officer  of  Health,  in  1873,  the  death-rate  was 
24'8 ;  in  1874  it  was  26'8 ;  and  in  1875,  263.  From  that 
time,  with  the  exception  of  the  year  1878,  when  the  figures 
were  25-2,  the  rate  has  steadily  decreased.  The  high  rates  of 
1874  and  1878,  and  the  slight  rise  in  1882,  are  to  be  accounted 
for  on  each  occasion  by  an  epidemic  of  scarlet  fever — a  disease, 
the  report  says,  which  is  found  to  recur  with  more  or  less  regu¬ 
larity  every  four  years ;  and  in  1874  there  was  also  an  epidemic 
of  small-pox  conjoined  with  it.  “  Such  a  result  of  ten  years’ 
sanitation,”  Dr.  Hill  says,  “  seems  clearly  to  establish  the 
value  of  preventive  medicine,  and  enables  some  idea  to  be 
formed  of  the  enormous  advantage  to  be  gained  by  the 
development  of  a  branch  of  medical  science,  which  at 
present  is  only  in  its  infancy  as  far  as  its  application  goes, 
and  is  under  the  disadvantage  of  having  to  contend  with 
incomplete  legislation,  prejudice,  ignorance,  and  other 
retarding  influences.  Surely  the  future,  with  advancing 
education  and  juster  views  of  individual  and  social  duty, 
may  be  reasonably  expected  to  present  a  prospect  of  still 
greater  sanitary  advancement.” 

FLATTERING  COMPARISONS. 

The  generally  received  idea  that  c‘  comparisons  are  odious  ’’ 
can  scarcely  be  said  to  hold  good  when  we  set  to  work  to  • 
compare  the  health  of  our  own  country  with  that  of  foreign 


Medical  Times  and  Oasstte. 


ANNOTATION'S. 


Dec.  29,  1883.  74  7 


places.  Taking  as  our  authority  the  English  Registrar- 
General,  we  find  that  the  average  annual  death-rate  during 
the  last  September  quarter  in  twenty-nine  colonial  and 
foreign  cities,  having  an  aggregate  population  of  rather 
more  than  fourteen  millions  of  persons,  was  27-5  per  1000. 
In  the  twenty-two  European  cities  the  average  rate  was  26‘9 
per  1000,  against  19-9  in  twenty-eight  of  the  largest  English 
owns.  The  lowest  death-rates  abroad  were  18-0  in  Christi¬ 
ania,  19  2  in  Rotterdam,  19-7  in  Geneva,  and  2T0  in  Copen¬ 
hagen  ;  the  highest  were  34’9  in  Munich,  35‘4  in  Breslau, 
371  in  Berlin,  and  41T  in  Madras.  With  regard  to  specific 
diseases,  it  appears  that  the  deaths  referred  to  small-pox  in 
Paris,  which  in  three  preceding  quarters  had  been  101,  154, 
and  181,  declined  during  the  September  quarter  to  78.  The 
fatal  cases  of  measles  and  diphtheria  also  showed  a  marked 
decline  from  those  returned  in  the  two  previous  quarters  of 
the  year ;  whilst  the  deaths  from  typhoid  fever,  which  in  the 
two  preceding  quarters  had  been  582  and  523,  were  in  this 
quarter  524 — equal  to  an  annual  rate  of  0  94  per  1000,  against 
a  London  return  of  022  for  the  same  period.  The  fatal 
cases  of  small-pox  in  St.  Petersburg,  which  had  been  232 
and  129  in  the  two  previous  quarters,  further  declined  to  41. 
This  latter  disease  was  epidemic  during  the  quarter  referred 
to  in  Madras,  Brussels,  and  Prague.  Measles  caused  392 
deaths  in  Berlin,  227  in  Paris,  and  137  in  Munich.  Diph¬ 
theria  showed  increased  prevalence  in  Amsterdam,  Berlin, 
Dresden,  and  Prague.  The  deaths  referred  to  typhus  and 
typhoid  fever  in  St.  Petersburg,  which  had  been  321  and  356 
in  the  two  preceding  quarters  of  the  year,  declined  to  224 
during  this  quarter,  but  were  equal  to  a  rate  of  097  per  1000, 
against  one  of  023  from  the  same  disease  in  London.  Diar- 
rhoeal  diseases  showed  excessive  fatality  in  many  of  the 
continental  cities.  The  annual  death-rates  from  these  dis¬ 
eases,  which  averaged  only  2'1  per  1000  in  the  twenty-eight 
large  English  towns,  were  equal  to  8 '2  in  Breslau,  8'4  in 
Munich,  8-7  in  Brooklyn,  and  11*3  in  Berlin. 


SEWER- SMELLS. 

Some  people  boast  that  they  have  such  delicate  sensibilities 
that  they  can  tell  whether  the  wind  has  changed  before 
they  get  out  of  bed  in  the  morning;  others  are  proud  of 
their  entire  indifference  to  the  weathercock  and  barometer. 
But,  whether  one’s  nerves  be  sensitive  or  not,  in  the 
streets  of  most  towns  there  is  one  sign  of  a  change  of 
wind  or  of  a  variation  in  barometric  pressure  which  one 
cannot  ignore.  Whenever  there  is  a  rise  or  fall  of  the 
mercury — if  not  indeed  at  other  times— the  ventilators 
and  manholes  of  all  but  the  best-laid  sewers  always  give 
off  a  sickening  stench.  Many  expedients  have  been  tried 
in  different  towns  to  prevent  or  to  conceal  these  exhala¬ 
tions  from  the  nether  world,  but,  if  the  sewers  have  been 
imperfectly  constructed,  invariably  without  success.  Trays 
of  charcoal  have  been  fixed  in  the  openings,  but  the  char¬ 
coal  becomes  rapidly  moist  in  the  damp  air  of  the  sewer, 
and  soon  gets  choked  with  fine  dust  from  the  roadway, 
so  that  unless  the  trays  are  daily  replenished,  at  a  ruinous 
expense,  they  do  more  harm  than  good,  by  preventing 
the  ready  ingress  and  egress  of  air  which  is  necessary 
for  the  proper  ventilation  of  the  sewer.  Moreover,  even  if 
charcoal  is  successful  in  deodorising  the  sewer-air — as  to 
which  the  evidence  is  very  contradictory, — it  probably  has 
little,  if  any,  destructive  influence  on  the  germs  which 
that  air  may  contain.  In  many  places,  shafts  have  been 
utilised,  with  or  without  an  artificially  produced  current. 
In  either  case  they  ventilate  the  sewers  more  efficiently 
than  openings  flush  with  the  ground;  but  they  are  very 
unsightly,  and  as,  if  they  are  to  be  of  any  use,  they  must 
exist  at  short  intervals,  it  is  difficult  to  find  situations  in 


which  they  will  not  discharge  their  current  in  quite  a 
dangerous  proximity  to  dwelling-houses  as  the  street 
gratings.  At  best  they  are  but  a  palliative  of  an  evil 
which  ought  not  to  exist.  The  plain  truth  is,  that  if  a 
sewer  is  well  laid,  well  kept,  and  well  flushed,  the  air  in  it 
should  not  be  offensive.  It  is  only  when  sewage  is  allowed 
to  remain  and  decompose  in  it,  owing  to  the  sewer  having 
an  insufficient  fall,  or  being  unevenly  constructed,  or 
too  large  for  the  amount  of  sewage  passing  through 
it,  that  the  air  emitted  by  the  ventilators  is  really 
offensive.  Of  course,  if  the  sewage  is  already  decom¬ 
posing  when  it  enters  the  sewer,  as  is  the  case  where 
the  latter  receives  the  overflow  from  foul  cesspools,  or 
decomposing  blood  from  slaughter-house  cesspits,  or  even 
fresh  blood,  which  coagulates  and  adheres  to  the  sides  of 
the  sewer,  the  ventilators  will  smell,  however  well  con¬ 
structed  the  sewer  may  be.  But,  in  a  properly  arranged 
drainage  system,  nothing  but  fresh  sewage  should  be  sent 
into  the  sewers,  and  that  should  leave  them  before  it  has 
time  to  decompose.  Another  most  important  point  in  the 
management  of  sewers  is  to  keep  them  clear  of  roadsand, 
which,  if  it  gains  admission  to  them,  will  form  deposits, 
impede  the  flow  of  sewage,  and,  becoming  impregnated  with 
decomposing  matter,  will  emit  a  most  offensive  odour.  This 
exclusion  is  only  to  be  attained  by  efficient  road-making  and 
scavenging,  and  by  the  use  of  proper  road-gullies,  so  con¬ 
structed  as  to  intercept  sand  and  mud,  and  only  to  allow 
surface  water  to  enter  the  sewer.  In  semi-rural  districts  a 
separate  surface-water  system  may  be  required.  As  to 
manholes,  they  ought  never  to  notify  their  existence  to  the 
nostrils  of  the  passer-by,  if  they  are  properly  constructed. 
But  often  the  bottom  of  the  manhole  is  lower  than  the  level 
of  the  sewer ;  in  which  case  sewage  is  allowed  to  accumulate 
in  it,  and  the  whole  becomes  little  better  than  an  open  cess¬ 
pool.  It  should  always  be  borne  in  mind  that,  whether  they 
smell  or  not,  street  ventilators  are  a  safeguard ;  it  is  better 
that  the  sewers  should  discharge  their  offensive  gases  into 
the  free  air  of  the  street  than  into  the  close  air  of  our 
houses,  for  few  houses  even  in  the  richest  quarters  of  towns 
are  so  well  constructed  as  never  to  admit  an  invasion  of 
sewer-air.  But  we  ought  not  to  be  satisfied  until  a  drain- 
smell  is  as  much  unknown  in  our  streets  as  in  our  houses. 
Wherever  they  exist  they  may  bring  with  them  disease 
and  doctors’  bills  ;  cf.  Shakespeare  :  “  ‘  These  exhalations, 
what  think  you  they  portend  f  ’  ‘  Hot  livers  and  cold 
purses.’  ” 

FORENSIC  MEDICINE  IN  THE  UNITED  STATES. 

Determined  to  give  due  prominence  to  the  working  of  the 
medical  examiner  system,  the  last  few  numbers  of  the  Boston 
Medical  and  Surgical  Journal  have  had  original  articles  on 
cases  of  difficulty  or  peculiarity  which  have  been  recently  in¬ 
vestigated.  Dr.  W.  H.  Taylor  describes  a  caseof  delayedputre- 
faction  in  a  body  exhumed  thirty-seven  days  after  its  burial 
in  loose  gravelly  loam,  free  from  frost.  The  body  appeared 
perfectly  fresh,  with  no  colour  or  odour  of  decomposition 
about  it.  The  integument,  however,  presented  a  hard,  tallowy 
feel,  indenting  on  firm  pressure.  Under  the  heading  of  a 
“  Strange  Case,”  Dr.  O.  T.  Howe  discusses  the  medico-legal 
points  which  arose  in  connexion  with  a  death  from  numerous 
injuries  on  the  head,  giving  his  grounds  for  deciding  that 
the  death  resulted  from  suicide  rather  than  murder.  Dr. 
A.  Elliot  Paine  narrates  a  simple  case  of  murder  in  which 
the  interest  lies  in  the  proof  of  the  continuance  of  vitality 
and  power  of  voluntary  movements  for  a  considerable  period 
after  the  skull  had  received  a  compound  comminuted  frac¬ 
ture.  The  publication  of  these  and  similar  eases  in  scien¬ 
tific  journals  will  go  far  towards  promoting  the  rapid  growth 
of  forensic  skill  amongst  the  members  of  the  profession. 


ANNOTATIONS. 


Dec.  29, 1883. 


748 


Medical  Times  and  Gazette. 


AN  OBSCURE  FEVER  OUTBREAK. 

Some  outbreaks  of  continued  fever  which,  occurred  in  the 
Thornbury  Rural  Sanitary  District  were  considered  by  Dr. 
Francis  Bond  (Medical  Officer  of  Health  for  the  Gloucester¬ 
shire  Combined  Sanitary  District)  to  be  so  important  and 
interesting,  both  on  account  of  the  circumstances  under 
which  they  occurred  and  the  obscurity  attaching  to  their 
precise  origin,  that  in  his  annual  report  for  the  year  1882 
he  gives  a  history  of  them.  The  sufferers  were,  for  the  most 
part,  men  employed  in  the  construction  of  the  Severn 
Tunnel  works,  residing  in  the  neighbourhood  of  New 
Passage  ;  the  first  evidence  of  the  fever  presenting  itself  in 
the  form  of  a  few  sporadic  cases  amongst  workmen  who  had 
returned  home  ill.  At  that  time  the  only  water  available 
for  drinking  at  the  works  was  that  laid  on  from  the 
neighbouring  rhine,  and  many  of  the  men  had  to  walk 
some  miles  to  and  from  their  daily  labour.  Subse¬ 
quently  the  contractor  had  water  daily  carried  to  the  works 
for  drinking  purposes  from  an  adjacent  spring,  and  he 
also  erected  wooden  huts  in  the  neighbourhood  of  New 
Passage  for  the  accommodation  of  the  men.  From  October 
to  December  of  1882  some  twenty  cases  of  fever  occurred 
in  the  Thornbury  District,  principally  in  these  wooden  huts. 
With  reference  to  the  origin  of  the  outbreaks.  Dr.  Bond  is  by 
no  means  satisfied  that  all  the  cases  were  genuine  cases  of 
enteric  fever  ;  in  many  of  them  he  suspected  that  there 
was  a  certain  amount  of  initial  pulmonary  complication, 
which  made  their  real  pathology  rather  obscure.  Again,  he 
was  not  able  to  connect  them,  as  a  whole,  with  any  single 
intelligible  cause.  It  was  not  possible  to  attribute  them  to 
any  common  source  of  contaminated  water  ;  whilst  milk  had 
even  less  to  do  with  the  illness.  It  was  not  attributable  in 
the  larger  number  of  cases  to  any  structural  defects  in 
drainage  or  closet  accommodation,  though  Dr.  Bond  had 
little  doubt  that  some  of  the  cases  which  occurred  in 
the  huts  originated  in  this  way;  nor  was  it  produced 
in  all  cases  by  overcrowding,  though  this  agency,  he 
says,  in  all  probability  exercised  a  potent  influence  in 
the  dissemination  of  the  infection.  As  a  fact,  there 
was  no  single  condition  common  to  all,  or  even  to  the 
majority  of  the  cases,  except  the  circumstance  that  the  men 
were  employed  at  the  tunnel  works,  and  even  in  this 
respect  the  conditions  of  their  employment  were  by  no 
means  identical,  as  some  worked  in  the  tunnel,  and  others 
above  ground.  It  is  the  more  remarkable.  Dr.  Bond  observes, 
that  these  outbreaks  of  fever  occurred  only,  so  far  as  he  was 
able  to  learn,  at  the  New  Passage  end  of  the  tunnel,  the 
cases  of  fever  at  the  Portskewett  end  having  been  very 
few  in  number. 


TUBERCLE  AND  ITS  RESISTANCE  TO  ANTISEPTICS. 

Ik  a  previous  number  of  this  journal  (vol.  ii.  1882,  page  669), 
a  brief  notice  will  be  found  of  a  paper  which  appeared  in 
the  Revue  de  Mddecine,  by  M.  H.  Martin,  demonstrating  the 
extraordinary  power  of  resistance  enjoyed  by  the  tubercu¬ 
lous  virus  against  high  temperatures  and  the  effects  of 
alcohol.  In  the  October  number  of  the  same  periodical 
there  is  a  further  communication  from  the  same  author,  in 
conjunction  with  his  deceased  teacher,  M.  Parrot,  detailing 
the  results  of  experiments  with  salicylic  acid,  sulphate  of 
quinine,  corrosive  sublimate,  carbolic  acid,  creasote,  bromine 
solution,  and  oxygenated  water.  The  plan  adopted  was  to 
take  a  portion  of  the  tuberculous  viscera  of  an  animal  that 
had  just  died  of  tuberculosis,  and  place  it  in  the  solution 
to  be  tried.  After  it  had  been  left  a  varying  length  of  time 
in  such  solution,  inoculation-experiments  in  fresh  animals 
were  made,  to  see  if  it  would  induce  tuberculosis.  The 
solutions  used  varied  in  strength  from  one  in  5000  to  one  in 


500,  and  it  may  be  said  that  none  of  the  above  reagents 
succeeded  in  destroying  the  infective  property  of  the  tuber¬ 
culous  material  with  anything  approaching  constancy. 
The  authors  conclude  their  paper  with  the  following 
practical  remarks  : — "  It  is  thus  clearly  proved  that  the 
vitality  of  the  tuberculous  virus  is  considerable.  In  thera¬ 
peutic  doses  the  antiseptic  agents  actually  in  use  are 
powerless  to  destroy  it,  and  the  daily  failures  in  practice 
seem,  so  to  speak,  borne  out  by  what  has  already  been 
shown.  Again,  it  is  perfectly  clear  from  our  experiments 
that  the  antiseptics  in  daily  use  are  powerless  against  it. 
We  wash  instruments  in  alcohol  or  in  a  solution  of  carbolic 
acid  (1  or,  at  most,  2  per  cent.) ;  we  moisten  the  walls  or 
the  floors  of  our  hospitals  with  the  same  solution ;  and  are 
quite  willing  to  believe  that,  in  consequence  of  this,  all  germs, 
including  those  of  tuberculosis,  are  rendered  inert.  It  is 
easy  to  understand  that  such  an  illusion  may  bring  about 
grave  consequences.  Even  the  sulphurous  vapours  advised 
by  M.  Vallin,  even  the  vapour  of  bromine,  which  is  still 
more  caustic,  can  only  act  when  tolerably  concentrated 
and  after  some  length  of  time,  and  in  this  case  their 
employment  becomes  dangerous  and  difficult.  The  only 
agent  which  germs,  be  they  what  they  may,  cannot 
resist  for  a  single  moment  is  fire.  Now,  we  know  that 
at  100°  the  tubercle  loses  its  infectious  property  in  a  very 
little  while ;  and  a  temperature,  even  dry,  of  120°  to  125° 
destroys  this  power  almost  instantly.  We  must  conclude 
that  a  heated  stove  is  the  only  certain  and  practical  purifier 
of  instruments  for  surgical  or  experimental  operations,  for 
clothing,  linen,  and  dressings  ;  in  short,  for  all  objects  whose 
shape  and  size  admit  of  their  being  introduced  into  it.  As 
regards  the  walls,  floors,  etc.,  of  private  rooms  or  hospital 
wards,  it  would  be  possible,  it  seems  to  us,  from  time  to  time 
to  submit  them  to  the  action  of  a  current  of  air  heated  to 
about  125°,  which,  being  brought  by  means  of  suitable 
portable  tubes,  and  distributed  just  as  one  directs  a  jet  of 
water  from  a  pump,  would  dry  and  calcine  the  infectious 
germs  hanging  about  the  plaster,  pictures,  or  woodwork, 
without  sensibly  damaging  them.”  Such  are  the  precau¬ 
tionary  hygienic  measures  the  authors  recommend  for 
adoption  against  the  contagion  of  tuberculosis. 


BOLTON  AND  THE  COMPULSORY  NOTIFICATION  OF 
INFECTIOUS  DISEASES. 

The  annual  reports  of  Mr.  Edward  Sergeant,  Medical 
Officer  of  Health  for  the  borough  of  Bolton,  have  for  the 
past  few  years  possessed  additional  interest,  since  there 
was  a  general  desire  to  ascertain  whether  the  arrangement 
for  the  compulsory  notification  of  infectious  diseases  was 
likely  to  prove  as  successful  as  its  promoters  prognosticated. 
So  far  as  the  town  of  Bolton  is  concerned,  the  success 
achieved  would  appear  to  have  been  satisfactory ;  Mr. 
Sergeant,  commenting  on  the  subject  in  his  review  for  the 
year  1882 — the  fifth  complete  year,  by  the  way,  since  the 
system  of  notification  of  infectious  disease  came  into 
operation  in  Bolton, — gives  the  number  of  infectious  cases 
reported  during  that  period  as  655.  The  cases  reported 
were  more  numerous  than  during  the  preceding  year,  but 
the  excess  is  admitted  to  be  chiefly  due  to  the  unusual 
prevalence  of  small-pox  in  the  locality.  The  proportion  of 
deaths  from  the  infectious  diseases  for  which  reports  were 
received  was  equal  to  11-14  per  cent,  of  the  total  cases, 
against  13  per  cent,  for  the  year  1881.  The  advantage  of 
notification,  Mr.  Sergeant  says,  was  exemplified  during  the 
recent  epidemic  of  small-pox  in  Bolton ;  since,  although  the 
sanitary  authorities  were  unable  to  stop  the  spread  of  the 
disease  at  the  commencement  of  the  outbreak,  the  prompt 
notification  of  the  cases  as  they  occurred  enabled  them,  by 


Medical  Time*  and  Gazette. 


ANNOTATIONS. 


Dec.  29, 1883.  749 


means  of  isolation  and  other  precautionary  measures,  to 
limit  as  much  as  possible  the  extension  of  the  disease ; 
whilst  at  any  time  the  exact  condition  of  the  town  with 
regard  to  small-pox  could  be  accurately  gauged.  The 
system  of  notification  of  infectious  diseases,  which  was  first 
granted  to  Bolton  in  1877,  has  continued,  Mr.  Sergeant 
claims,  to  find  favour  in  the  eyes  of  the  public,  since  at  the 
present  time  there  are  no  fewer  than  thirty-one  cities  and 
towns  in  Great  Britain  possessed  of  legal  power  for  insuring 
compulsory  notification.  But,  with  all  due  respect  for  Mr. 
Sergeant’s  opinions,  we  feel  bound  to  remark  that  the  success 
of  the  system  depends  in  a  much  greater  degree  upon  the 
profession  than  upon  the  public,  and  if  its  promoters  had 
been  content  to  throw  the  responsibility  of  notification  upon 
the  householder  instead  of  upon  the  medical  attendant,  it 
would  long  before  this  have  been  made  compulsory  for  the 
whole  of  the  kingdom. 


CAUSE  AND  MECHANISM  OF  FLAT-FOOT. 

Dr.  Hermann  von  Meter,  Professor  of  Anatomy  in  Zurich, 
after  a  careful  examination  of  the  normal  and  of  the  flat 
foot,  anatomical  as  well  as  clinical,  comes  to  the  following 
conclusions,  which,  as  will  be  seen,  are  somewhat  at  variance 
with  the  generally  accepted  views : — Flat- foot  does  not  depend 
on  destruction  of  the  arch  of  the  foot,  but  on  a  valgous 
position  of  the  foot,  and  chiefly  of  the  os  calcis,  with  regard 
to  the  astragalus,  together  with,  as  a  complemental  and 
secondary  condition,  version  upwards  and  outwards  of  the 
fore  part  of  the  foot.  The  deformity  is  not  due  to  relaxa¬ 
tion  of  the  plantar  ligaments,  but  depends  rather  on  exag¬ 
gerated  rotation  inwards  of  the  astragalus,  and  on  subsequent 
changes  in  the  conditions  of  the  plantar  bones  due  to  the 
atrophy  resulting  from  mutual  pressure.  The  present  bro¬ 
chure  (“  Studien  fiber  den  Mechanismus  des  Fusses,”  part  i., 
published  at  Jena)  is  the  first  of  three  in  which  the  normal 
and  pathological  conditions  of  the  foot  are  to  be  discussed. 
We  shall  look  forward  to  the  others  with  some  interest  ; 
the  second  will  deal  with  the  normal  mechanism  of  the  foot, 
and  the  last  will  complete  the  subject  by  discussing  the 
various  forms  of  club-foot. 


CHLORAL-PSYCHOSIS. 

The  evil  results  of  the  excessive  use  of  chloral,  whether 
brought  into  prominent  relief  by  the  occurrence  of  a  sudden 
catastrophe,  or  less  clearly  indicated  by  the  production 
of  skin  eruptions,  chronic  dyspepsia,  etc.,  are  sufficiently 
well  recognised  by  professional,  if  not  by  lay,  consumers  of 
the  drug.  Cases  of  chronic  poisoning  by  hydrate  of  chloral 
are  not,  however,  recorded  in  any  great  number,  and  the 
following  instance,  reported  by  Prof.  Kirn  ( Berliner  Klinische 
Wochenschrift ,  No.  47,  1883),  forms  an  interesting  addition 
to  the  series.  A  man,  aged  thirty-five,  with  a  strongly 
marked  neurotic  family  history,  himself  of  very  excitable 
temperament,  suffered  severely  from  asthmatic  attacks  for 
three  years,  during  which  period  he  had  been  in  the  habit 
of  taking  hydrate  of  chloral  with  morphia  at  intervals. 
With  the  increase  of  his  asthmatic  troubles  he  increased 
his  dose,  until,  from  a  chronic  state  of  chloral  stupor, 
he  began  to  show  symptoms  of  chronic  intoxication — loss 
of  appetite,  diarrhoea,  wasting,  strangury,  pains  in  back 
and  limbs,  sleeplessness,  complete  demoralisation,  and  ex¬ 
citement.  Being  removed  to  hospital  to  insure  isola¬ 
tion,  the  use  of  chloral  hydrate  was  stopped,  the  patient 
being  only  allowed  a  small  subcutaneous  injection  of  morphia. 
In  a  short  time  lively  hallucinations  set  in,  but  hallucina¬ 
tions  of  hearing  only.  Voices  were  constantly  heard  utter¬ 
ing  frightful  threats  and  giving  orders  for  the  torture  and 
punishment  of  the  victim.  These  voices,  however,  were  only 


heard  by  day ;  notwithstanding  his  complete  sleeplessness 
and  excitement,  the  patient  was  free  from  the  hallucinations 
by  night.  For  about  a  month  the  symptoms  of  intoxication 
and  the  psychic  disturbance  showed  but  little  improvement, 
but  after  that  period  all  the  indications  began  to  be  less 
marked.  Strangury,  however,  persisted,  but  without  polyuria. 
The  urine  was  found  to  be  free  from  albumen  and  sugar. 
At  intervals  the  hallucinations  returned,  but  lasted  only  for 
short  periods.  After  two  months  all  the  symptoms  were 
relieved  j  but  with  the  improvement  in  general  health  the 
attacks  of  asthma,  which  had  been  absent  during  the 
period  of  intoxication,  recurred  as  severely  as  before.  The 
history  of  the  case  bears  a  strong  resemblance  to  that  of 
the  more  familiar  cases  of  chronic  alcoholic  intoxication. 
Prof.  Kirn  regards  the  chronic  impairment  of  nutrition  of 
the  cerebrum,  due  to  the  constant  vaso-paresis  induced  by 
the  chloral,  as  the  most  probable  explanation  of  the  physio¬ 
logical  condition  present  in  such  cases.  The  slow  recovery 
after  complete  withdrawal  of  the  drug  corresponds  to  the 
gradual  restitution  to  the  normal  of  the  altered  brain- 
substance. 


RETROGRADE  DIVULSION  OF  THE  (ESOPHAGUS  AND 

PYLORUS. 

Under  this  title  is  furnished,  in  the  Gazzetta  Med.  Lom¬ 
bardia  of  November  24,  a  short  account  of  a  new  operation 
executed  on  October  24  by  Prof.  Loreta  at  the  Surgical 
Clinic  of  Bologna.  The  case  was  one  of  stricture  of  the 
oesophagus  at  its  lower  third,  produced  by  swallowing  caustic 
potash.  No  history  of  the  case  is  given  at  present,  but  it  is 
stated  that  the  patient  was  so  reduced  by  inability  to 
swallow  food  that  surgical  interference  had  become  urgently 
needful.  The  seat,  nature,  and  degree  of  the  contraction 
rendered  all  operative  proceedings  by  the  mouth  out  of  the 
question,  and  Prof.  Loreta  resolved  to  attack  the  stenosis 
from  the  stomach,  in  order  to  obtain  sufficient  space  for  the 
introduction  of  the  dilating  instrument  and  its  passage 
through  the  cardiac  orifice  into  the  cesophagus.  Gastrostomy 
was  accordingly  performed.  The  operation,  although  difficult, 
did  not  occupy  more  than  half  an  hour,  and  its  efficacy  was 
proved  by  the  fact  that  the  patient  was  able  to  swallow  food 
with  ease  on  the  first  day.  The  wound  healed  by  the  first 
intention,  no  peritonitis  occurred,  and  the  patient  was  re¬ 
garded  as  cured  by  the  fourteenth  day — a  bougie  being 
ordered  to  be  introduced  periodically,  in  order  to  maintain  the 
dilatation.  It  is  also  stated  that  Dr.  Loreta  has  performed 
another  similar  operation  with  like  success. 


A  so-called  epidemic  of  chorea  is  said  to  have  broken 
out  in  a  girls’  school  at  Moscow,  and  to  have  manifested 
itself  simultaneously  in  eighteen  different  houses  in  which 
the  schoolgirls  reside.  ______ 

At  the  election  of  Assessor  to  the  Council  of  St.  Andrews 
University,  Sir  Richard  Cross  received  727  votes,  against 
341  cast  for  Dr.  Richardson.  The  total  available  votes 
numbered  1562,  and  1095  voted. 


It  has  been  decided  to  devote  part  of  the  Montefiore 
Commemoration  Fund  to  the  establishment  and  endow¬ 
ment  of  a  convalescent  home  at  Ramsgate,  open  to  patients, 
irrespective  of  creed,  on  the  recommendation  of  the 
governing  bodies  of  hospitals. 

In  consequence  of  the  increase  of  small-pox  in  the  Clapton 
district  of  the  Hackney  Union,  the  guardians  have  requested 
the  vaccination  officers  to  make  a  house-to-house  visitation 
in  that  district  with  the  view  of  impressing  on  the  inhabit¬ 
ants  the  expediency  of  vaccination  or  re  vaccination. 


DIARY  OF  THE  YEAR. 


Dec.  29, 1883. 


750 


Medical  Times  and  Gazette. 


A  stained  glass  window  to  the  memory  of  Dr.  Robert 
Druitt  is  about  to  be  fixed  in  the  Minster  of  Wimborne,  in 
the  diocese  of  Salisbury. 

We  are  requested  to  state  that  the  absence  of  the  name 
of  the  President  of  the  Royal  College  of  Surgeons  from  the 
Committee  appointed  to  carry  out  the  measures  deemed  fit 
in  regard  to  the  case  of  Messrs.  Bower  and  Keates  is  due 
entirely  to  his  not  having  been  made  aware  of  the  intention 
to  hold  a  meeting  upon  the  subject.  Hence  he,  as  President 
of  the  College,  has  been  unable  to  add  the  sanction  of  his 
authority  to  a  movement  which  has  his  entire  sympathy  and 
approval. 


DIARY  OF  THE  YEAR. 


Januaby  8. — Dr.  Sansom’s  First  Lettsomian  Lecture  on 
Valvular  Diseases  of  the  Heart. 

11.  — Annual  Meeting  of  British  Medical  Benevolent  Fund. 

12.  — Annual  Meeting  of  the  Clinical  Society.  Dr.  Andrew 

Clark  elected  President. 

13.  — President’s  Reception  on  Reopening  of  the  Museum  of 

the  Royal  College  of  Surgeons. 

14.  — Death  of  Mr.  Walter  Ottley,  M.B.,  F.R.C.S.,  set.  33. 

17. — Meeting  of  the  Metropolitan  Counties  Branch  of  the 

British  Medical  Association.  Addresses  on  the  Collec¬ 
tive  Investigation  of  Disease  by  Sir  William  Gull  and 
Sir  James  Paget. 

18  — Harveian  Society’s  Conversazione. 

Verdict  of  Coroner’s  Inquest  on  the  Death  of  Dr.  Edwardes, 
of  Hounslow. 

26.  — Dr.  Andrew  Clark’s  Address  to  the  Clinical  Society. 

29. — Discussion  at  the  Medical  Society  on  Tuberculosis  and 

Bacilli . 

February  1. — Presentation  to  the  Association  for  the  Ad¬ 
vancement  of  Medicine  by  Research  of  Mr.  Watson 
Cheyne’s  Report  on  “  The  Relation  of  Micro-Organisms 
to  Tuberculosis.” 

2. — Prof.  Parker’s  First  Lecture  at  the  Royal  College  of 
Surgeons  on  “  The  Metamorphosis  of  Suctorial  Fishes 
and  Batrachia.” 

5. — Presentation  of  Prizes  at  ISTetley  Hospital  by  Sir  Ralph 
Thompson. 

7. — Annual  meeting  of  Obstetrical  Society.  Address  by 
Dr.  Matthews  Duncan.  Dr.  Gervis  elected  President. 

11.  — Death  of  Mr.  Watkin  Williams,  F.R.C.S.,of  Birming¬ 

ham,  set.  67. 

12.  — Resumed  Discussion  at  the  Medical  Society  on  Tuber¬ 

culosis  and  Bacilli. 

14.  — Hunterian  Oration  at  the  Royal  College  of  Surgeons 

by  Mr.  Spencer  Wells. 

15.  — Dr.  Andrew  Clark’s  Address  on  “  Renal  Inadequacy.” 

16. — Dr.  Matthews  Duncan’s  First  Gulstonian  Lecture  on 

“  Sterility  in  Woman.” 

27.  — Discussion  at  the  Royal  Medical  and  Chirurgical 

Society  on  Scurvy  in  Arctic  Expeditions. 

Mr.  Flower’s  First  Lecture  at  the  Royal  College  of  Surgeons 
on  “  The  Anatomy  of  the  Horse  and  its  Allies.” 

28.  — Dr.  J.  E.  Pollock’s  First  Croonian  Lecture  on  “Modern 

Theories  and  Treatment  of  Phthisis.” 

March  1. — Annual  Meeting  of  the  Royal  Medical  and  Chi¬ 
rurgical  Society.  Mr.  Marshall  re-elected  President. 

5. — General  Meeting  of  the  Medical  Society.  Sir  J.  Fayrer 
elected  President. 

7.  — Dr.  Gervis’s  Address  to  Obstetrical  Society. 

8.  — Medical  Act  Amendment  Bill  introduced  in  the  House 

of  Lords  by  Lord  Carlingford. 

9.  — Dr.  A.  B.  Garrod’s  First  Lumleian  Lecture  on  “Uric 

Acid  in  its  Relation  to  Renal  Calculi  and  Gravel.” 

12. — Extraordinary  Meeting  of  Royal  College  of  Physicians. 
Adoption  of  Report  of  Committee  on  Conjoint  Examina¬ 
tions. 

19.— Meeting  at  Royal  College  of  Physicians.  Re-election 
of  Sir  W.  Jenner  as  President. 

20 — Death  of  Prof.  Lasegue,  of  Paris,  set.  66. 

Supplementary  Charter  signed,  enabling  the  Victoria 
University,  Manchester',  to  grant  Degrees  in  Medicine 
and  Surgery. 


24. — Death  of  Mr.  Paul  Swain,  F.R.C.S.,  J.P.,  aet.  74. 

28.  — Public  Meeting  at  Edinburgh  for  the  Extension  of  the 

Buildings  of  the  University. 

April  3. — Debate  on  Diabetes  at  the  Pathological  Society. 
The  Council  of  the  College  of  Surgeons  resolved  to  Peti¬ 
tion  the  House  of  Lords  against  the  Medical  Act 
Amendment  Bill. 

Opening  Lecture  at  the  Royal  Institution  of  Dr.  McKen- 
drick’s  Course  on  “  Physiological  Discovery.” 

4.  — Mr.  Lyon  Playfair’s  Speech  in  House  of  Commons  against 

the  Second  Reading  of  the  Bill  for  the  Total  Abolition 
of  Vivisection.  Debate  adjourned. 

5.  — Second  Reading  of  Medical  Act  Amendment  Bill  in 

House  of  Lords  :  Speeches  of  Lords  Carlingford,  Aber¬ 
deen,  Milltown,  Cairns,  Cranbrook,  Balfour  of  Burley, 
and  Camperdown. 

10. — Death  of  Dr.  Palfrey,  set.  45. 

Presentation  of  Portrait  to  Mr.  Ernest  Hart. 

12.  — Meeting  of  Royal  College  of  Physicians.  Report  of 

Committee  on  Medical  Act  Amendment  Bill. 
Complimentary  Dinner  to  Dr.  Wendell  Holmes  at  New 
York. 

Jacksonian  Prize  of  Royal  College  of  Surgeons  awarded 
to  Mr.  A.  A.  Bowlby  for  his  Essay  on  “Injuries  of 
Nerves.” 

14.  — Death  of  Dr.  W.  Farr,  C.B.,  set.  75. 

17.  — The  Metropolitan  Counties  Branch  of  the  British  Medi¬ 

cal  Association  resolved  to  petition  against  the  Bill  for 
the  Compulsory  Notification  of  Infectious  Diseases. 

18.  — Sir  James  Paget  elected  Vice-Chancellor  of  the  London 

University,  vice  Sir  G.  Jessel,  deceased. 

19.  — The  Medical  Act  Amendment  Bill  passed  through  Com¬ 

mittee  in  the  House  of  Lords. 

Meeting  of  General  Medical  Council. 

Death  of  Surgeon- General  Holloway,  Principal  Medical 
Officer  at  Netley  Hospital,  set.  57. 

20.  — Resolution  passed  in  House  of  Commons  (by  182  votes 

to  100)  disapproving  of  Compulsory  Examination  of 
Women  under  Contagious  Diseases  Acts. 

21.  — Dr.  Matthews  Duncan  took  his  seat  on  the  General 

Medical  Council  in  succession  to  Sir  W.  Gull. 

26.  — Report  of  Amendments  to  the  Medical  Act  Amend¬ 

ment  Bill  agreed  to  by  the  House  of  Lords. 

Discussion  in  the  General  Medical  Council  on  the  Amended 
Medical  Bill. 

Election  of  Fellows  by  the  Royal  College  of  Physicians, 
and  Resolution  to  institute  an  Examination  in  Hygiene. 

27.  — Third  Reading  of  Medical  Act  Amendment  Bill  in  the 

House  of  Lords. 

29.  — Death  of  Mr.  B.  W.  Richardson,  of  Dublin. 

May  1. — Resumed  Discussion  on  Diabetes  at  the  Pathological 
Society. 

2.— First  Reading  of  the  Medical  Act  Amendment  Bill  in 
the  House  of  Commons. 

10. — The  Council  of  the  Royal  College  of  Surgeons  passed  a 
Resolution  approving  the  Medical  Bill  as  amended. 

15.  — Death  of  Dr.  Robert  Druitt,  set.  68. 

19. — Publication  of  the  Report  of  Lord  Morley’s  Committee 
on  the  Army  Medical  Department. 

22.  — Royal  Medical  and  Chirurgical  Society :  Communica¬ 

tions  on  Renal  Surgery. 

26. — Reopening  of  the  Parkes  Museum  by  H.R.H.  the  Duke 
of  Albany. 

30.  — Mr.  Henry  Power’s  First  Lecture  at  the  Royal  College 

of  Surgeons  on  the  “  Lacrimal  Apparatus  and  Accessory 
Organs  of  the  Eye.” 

June  1. — Dr.  De  Chaumont’s  Inaugural  Address  at  the 
Parkes  Museum. 

2. — Mr.  Wheeler  elected  President  of  the  Royal  College  of 
Surgeons  of  Ireland. 

6.  — Mr.  Frederic  Eve’s  First  Lecture  at  the  Royal  College 

of  Surgeons  on  “  Cysts.” 

7.  — Ophthalmological  Society :  Discussion  on  Eye  Symp¬ 

toms  in  Spinal  Disease. 

8.  — Resolution  in  the  House  of  Commons  to  refer  the 

Grievances  of  Militia  Surgeons  to  a  Committee  lost  by 
61  votes  to  48. 

10.— Hospital  Sunday:  ,£33,935  collected. 

13.  — Mr.  Jonathan  Hutchinson’s  First  Lecture  at  the  Royal 

College  of  Surgeons  “  On  certain  Diseases  of  the 
Tongue.” 


Medical  Times  and  Gazette. 


THE  BOWER  AND  KEATES  CASE. 


Dec.  29, 1883.  751 


13.  — Death  of  Mr.  Benjamin  Bell,  of  Edinburgh,  set.  73. 

19.  — Discussion  on  Vaccination  in  the  House  of  Commons — 

Compulsory  Vaccination  upheld  by  majority  of  286 
to  16. 

20.  — President’s  Conversazione  at  the  Royal  College  of 

Surgeons. 

23.  — Outbreak  of  Cholera  at  Damietta. 

Distribution  of  Prizes  at  St.  Thomas’s  Hospital  by  H.R.H. 
the  Duke  of  Connaught. 

27. — Mr.  Hastings  moved  the  Second  Reading  of  his  Bill  for 
the  Compulsory  Notification  of  Infectious  Diseases. 

Dr.  Habershon  gave  the  Harveian  Oration  at  the  Royal 
College  of  Physicians. 

July  2. — Conversazione  at  the  Medical  Society,  attended  by 
H.R.H.  the  Prince  of  Wales. 

4.  — Conversazione  at  the  Royal  College  of  Physicians. 

5.  — Messrs.  Cooper  Forster  and  Sydney  Jones  and  Sir  W. 

Mac  Cormac  elected  on  the  Council  of  the  Royal  College 
of  Surgeons. 

Distribution  of  Prizes  at  Charing-cross  Hospital  by  Lord 
Wolseley. 

6.  — Annual  Meeting  of  the  Ophthalmological  Society.  Mr. 

Jonathan  Hutchinson  elected  President. 

7.  — Outbreak  of  Enteric  Fever  in  St.  Pancras. 

10.  — Chelsea  Hospital  for  Women  opened  by  H.R.H.  the 

Duchess  of  Albany. 

11.  — Annual  Meeting  of  Metropolitan  Counties  Branch  of 

British  Medical  Association.  Dr.  Hare’s  Address  on 
“  Good  Remedies  out  of  Fashion.” 

12.  — Mr.  John  Marshall  elected  President  of  the  Royal 

College  of  Surgeons. 

Anniversary  Meeting  of  Sanitary  Institute. 

16.  — Appearance  of  Cholera  at  Cairo. 

17.  — Death  of  Dr.  A.  P.  Stewart,  set.  70. 

20. — Discussion  in  the  House  of  Lords  on  Lord  Morley’s 
Report. 

Departure  of  Surgeon- General  Hunter  for  Egypt. 

25. — Departure  of  English  Medical  Men  for  Egypt.  ■ 

27. — Annual  Meeting  of  Medico- Psychological  Association : 

Address  by  the  President,  Dr.  Orange. 

31. — Fifty-first  Annual  Meeting  of  the  British  Medical 
Association  at  Liverpool  :  First  General  Meeting ;  Dr. 
W.  Strange’s  Presidential  Address. 

August  1. — British  Medical  Association  :  Second  General 
Meeting  ;  Address  in  Surgery  by  Mr.  Reginald 
Harrison. 

Annual  Meeting  of  Association  of  Fellows  of  the  Royal 
College  of  Surgeons  of  England. 

2.  — British  Medical  Association  :  Third  General  Meeting; 

Public  Dinner. 

3.  — British  Medical  Association  :  Fourth  General  Meeting; 

Address  in  Pathology  by  Dr.  Creighton. 

5.  — Death  of  Prof.  Parrot,  of  Paris,  set.  54. 

6.  — Distribution  of  Prizes  at  Netley  Hospital  by  Sir 

Galbraith  Logan. 

14.  — Fatal  Fire  at  Southall  Park  Lunatic  Asylum  :  Death  of 

Dr.  Robert  Boyd,  set.  70. 

15.  — Arrival  of  the  Pasteur  Mission  at  Alexandria. 

16.  — Departure  of  Dr.  Koch’s  Mission  from  Berlin,  to  inquire 

into  the  Outbreak  of  Cholera  in  Egypt. 

18.  — Dr.  Wickham  Legg’s  Bradshawe  Lecture  on  “  Cardiac 

Aneurysms  ”  at  the  Royal  College  of  Physicians. 
Withdrawal  of  the  Superior  and  Sisters  from  St.John’s 
House. 

22. — Withdrawal  by  the  Government  of  the  Medical  Act 
Amendment  Bill. 

September  1. — Gradual  Subsidence  of  Cholera  in  Lower 
Egypt. 

6. — Opening  of  the  Intercolonial  Medical  Congress  at 
Amsterdam. 

8.  — Hospital  Saturday. 

18.— Meeting  of  British  Association  at  Southport. 

20. — Death  of  Dr.  Thuillier  from  Cholera  at  Alexandria, 
set.  27. 

24.  — Congress  of  Sanitary  Institute  at  Glasgow  :  Prof. 

Humphry’s  Inaugural  Address. 

25.  — Sanitary  Congress :  Address  by  Prof.  Gairdner. 

October  1. — Introductory  Addresses  at  the  London  Hos¬ 
pitals. 

3. — Social  Science  Congress  at  Huddersfield. 


3.  — Dr.  Michael  Foster’s  Address  to  Pharmaceutical 

Students. 

4.  — The  Walthamstow  Murderer  respited. 

Social  Science  Congress :  Discussion  on  Educational  Over¬ 
pressure. 

5.  — Social  Science  Congress  :  Discussion  on  the  Spread  of 

Disease  by  Milk. 

6.  — Social  Science  Congress :  Mr.  Teale’s  Presidential 

Address  to  the  Health  Section. 

8.  — Address  on  Recreation  by  Sir  James  Paget  at  the 

Working  Men’s  College. 

9.  — Prof.  Huxley’s  Address  at  the  London  Hospital  on  State 

Intervention  in  Medical  Affairs. 

Mr.  Haffenden  arrested  at  Kensington. 

11. — Ophthalmological  Society:  Mr.  J.  Hutchinson’s  Address. 

13. — Publication  of  Dr.  Koch’s  Report  on  Cholera  in  Egypt. 1 

18.  — Entombment  of  Harvey’s  Remains  at  Hampstead  by 

the  Royal  College  of  Physicians. 

19. — Society  of  Medical  Officers  of  Health:  Dr.  Dudfield’s 

Inaugural  Address. 

23.  — Dr.  Ferrier  delivered  the  Marshall  Hall  Prize  Oration 

at  the  Royal  Medical  and  Chirurgical  Society. 

Suicide  of  Mr.  Haffenden. 

24.  — Presentation  of  Testimonial  to  Prof.  Bentley  at  King’s 

College. 

29. — Medical  Society  :  Prof.  Lister  on  “  Treatment  of  Frac¬ 
tured  Patella.” 

November  1. — Messrs.  Bower  and  Keates  charged  at 
Lambeth  Police-comrt :  Charge  dismissed. 

3.— Death  of  Mr.  James  Shuter,  F.R.C.S. 

5.  — Medical  Society :  Discussion  on  Prof.  Lister’s  Treat¬ 

ment  of  Fractured  Patella. 

7.  — Dr.  Norman  Chevers’s  Inaugural  Address  at  the  Epi¬ 

demiological  Society. 

8.  — Adoption  by  Royal  College  of  Surgeons  of  Principle  of 

Non-personal  Voting  at  Election  of  Members  of  Council. 

9.  — Clinical  Society :  Discussion  on  Treatment  of  Fractured 

Patella  by  Suture. 

13.  — Death  of  Dr.  Marion  Sims,  set.  70. 

18. — Death  of  Dr.  Hilton  Fagge. 

23. — Clinical  Society  :  Discussion  on  Myxcedema. 

29 .  — Presentation  of  Testimonial  to  Mr .  J onathan  Hutchinson . 

30.  — Royal  Society :  Prof.  Huxley’s  Presidential  Address. 

December  5. — Obstetrical  Society:  Dr.  Robert  Barnes  on 
“  The  Mechanism  of  Labour.” 

Dr.  C.  S.  Roy,  Professor  at  the  Brown  Institution,  gave 
his  First  Lecture  on  “  Inoculation  for  the  purpose  of 
preventing  Zymotic  Disease.” 

6.  — Prof.  Marshall’s  Bradshawe  Lecture  “  On  Nerve- 

Stretching  ”  at  the  Royal  College  of  Surgeons. 

8. — Opening  of  the  Princess  Alice  Memorial  Hospital  at 
Darmstadt. 

10.  — Meeting  at  Sir  W.  Jenner’s  to  consider  the  Case  of 

Messrs.  Bower  and  Keates. 

11.  — Conference  at  Mansion  House  on  the  Dwellings  of  the 

London  Poor. 

12.  — Conference  of  Poor-Law  Guardians  :  Discussion  on  Out¬ 

door  Medical  Relief. 

14.  — Charge  against  the  late  Mr.  Haffenden  tried  at  the 

Central  Criminal  Court :  Verdict  of  Acquittal. 

17. — Medical  Society  :  Sir  Andrew  Clark  on  “  Catheter- Life.” 
22. — St.  Andrews  University :  Sir  Richard  Cross  elected 
Assessor. 


THE  BOWER  AND  KEATES  CASE. 


In  the  letter  recently  addressed  to  the  profession,  the  name 
of  Prof.  John  Marshall,  F.R.S.,  President  of  the  Royal 
College  of  Surgeons  of  England,  was  accidentally  omitted 
from  the  list  of  the  Committee,  of  which  he  is  a  member. 
From  the  number  of  letters  received  by  the  Committee 
indicating  a  wish  that  some  steps  may  be  taken  to  protect 
the  profession  from  such  ill-advised  prosecutions  in  future, 
it  seems  desirable  to  mention  that  a  resolution  was  passed 
at  the  meeting  held  at  Sir  William  Jenner’s  residence  on 
December  10,  asking  the  Council  of  the  Royal  College  of 
Physicians  and  the  Council  of  the  Royal  College  of  Surgeons 


Medical  Times  and  Gazette. 


SPECIALISM— A  DISCUSSION-. 


Dec.  29,  1883. 


“  to  consider  the  propriety  of  representing  to  the  Secretary 
of  State  for  the  Home  Department  that  it  is  very  desirable 
that  there  should  be  some  arrangement  by  which  the  Public 
Prosecutor  may  obtain  the  assistance  of  skilled  advisers 
when  he  is  solicited  to  institute  prosecutions  of  medical  prac¬ 
titioners.’5  It  may  be  added  that  the  Councils  of  both 
Colleges  have  already  the  matter  under  their  consideration 
with  a  view  to  combined  action.  The  memorial,  if  signed 
by  the  whole  profession,  will  greatly  strengthen  any  repre¬ 
sentation  made  to  the  Government  by  the  two  Colleges. 
It  may  also  be  stated,  in  reply  to  other  letters,  that,  although 
the  memorial  which  members  are  asked  to  sign  refers  only 
to  the  criminal  prosecution  for  the  alleged  manslaughter  of 
the  child  in  which  the  Public  Prosecutor  was  concerned,  it 
is  thought  by  the  Committee  that  the  profession  will  wish 
to  defray  the  whole  legal  expenses  incurred  by  Dr.  Bower 
and  Mr.  Keates  in  connexion  with  the  matter,  and  these 
include  the  expenses  of  their  defence  in  the  civil  action  as 
well  as  in  the  criminal  one.  Any  gentlemen  who  have  not 
received  the  letter  and  memorial  issued  by  the  Committee 
are  requested  to  communicate  with  the  honorary  secretaries. 
The  appeal  was  posted  on  Saturday,  December  22,  at  mid¬ 
day  ;  by  five  o’clock  p.m.  on  the  following  Monday  208  replies 
were  received  at  the  College  of  Physicians.  A  very  large 
number  of  replies  have  since  been  received,  but  it  has  been 
found  impossible  to  acknowledge  them  in  the  present  issue. 
The  following  contributions  to  the  indemnity  fund  (third 
list)  were  received  before  five  o’clock  p.m.  on  Monday, 
December  24 : — 


Sir  Joseph  Lister,  Bart.,  F.R.S . £10  10  0 

J.  Uugblings-Jackson,  M.D.,  F.R.S.  . .  10  10  0 

William  Wood,  M.D . 10  10  0 

R.  Quain,  F.R.S . 10  5  0 

J.  Blackstone,  Esq .  5  5  0 

W.  Adams,  Esq .  5  5  0 

J.  Cooper  Forster,  F.R.C.S.  .  5  5  0 

Sydney  Ringer,  M.D.  .  5  5  0 

W.  C.  Begley,  M.D .  5  0  0 

W.  Cadge,  F.R.C.S .  3  0  0 

J.  Sidney  Turner,  Esq .  3  0  0 

Thomas  Annandale,  F.R.C.S.,  Edinburgh  ...  2  2  6 


The  following  have  sent  two  guineas  each  : — Walter  Bryant,  M.R.C.P. ; 
W.  Allingham,  F.R.C.S.;  Vincent  Ambler,  Surg.-Maj. ;  C.  A.  Aikin, 
F.R.C.S.;  W.  Bruce  Clarke,  M.D.  ;  Sir  Oscar  Clayton,  F.R  C.S.  ;  G. 
Anderson  Critchett,  F.R.C.S.  ;  John  Easton,  M.D. ;  Berkeley  Hill,  M.B., 
F.R.C.S. ;  Samuel  Gee,  M.D.  ;  F.  W.  Jowers,  Esq. ;  Robert Liveing,  M.D. ; 
Stephen  Mackenzie,  M.D. ;  E.  Nash,  M.D. ;  W.  M.  Ord,  M.D.  ;  R.  J. 
Spitta,  M.D. ;  Sigismund  Sutro,  M.D.  ;  J.  Thornton,  Esq.  ;  H.  M. 
Tuckwell,  M.D. 

William  Fuller,  Esq.,  £2. 

The  following  have  sent  one  guinea  each: — Edward  Ablett,  M.D. ,  White¬ 
haven  ;  C.  H.  Allfrey,  M.D.,  St.  Mary  Cray ;  Julius  Althaus,  M.D. ;  J. 
A.  Ball,  M.B.,  Stockport ;  Edgar  Barker,  Esq.  ;  Lionel  W.  Beale,  F.R.S.; 
Charles  E.  Beevor,  M.D.  ;  Henry  Belcher,  Esq.,  Brighton  ;  T.  M.  Briggs, 
Esq.;  John  Birkett,  F.R.C.S.;  W.  F.  Blakes,  Esq.;  G.  Fielding Blandford, 
M.B.;  Byrom  Bramwell,  M.D. ,  Edinburgh  ;  J.  W.  Bramwell,  M.D. ,  Tyne¬ 
mouth  ;  J.  Brisbane,  M.D.;  Augustus  Brown,  M.D.;  H.  Langley  Browne, 
F.R.C.S.,  West  Bromwich  ;  Walter  Buchanan,  Esq.,  Chatham  :  Kyran 
T.  Buggy,  Esq.,  Framlingham ;  F.  C.  Bullmore,  Esq.,  Falmouth ; 
Henry  T.  Butlln,  F.R.C.S.;  Thomas  Buzzard,  M.D. ;  Jabez  Carter, 
Esq.,  Bedford;  A.  W.  M.  Caudle,  Esq.,  Henfield  ;  W.  Cock,  Esq.  ; 
J.  A.  Cooksey,  Esq.,  Malvern;  Sidney  Coupland,  M.D. ;  W.  H.  Crosse, 
Esq. ;  Henry  Curling,  F.R.C.S. ;  Henry  Dayman,  F.R.C.S  ,  Southampton; 
Benjamin  Duke,  Esq.  ;  Clement  Dukes,  M.D.,  Rugby ;  W.  J.  Bafley 
Eadon,  Bristol ;  W.  Eddowes,  Esq.,  Shrewsbury;  Alex.  Forsyth,  M.D., 
Greenwich;  Robert  Fowler,  M.D. ;  John  H.  Galton,  M.D. ;  James  F. 
Goodhart,  M.D. ;  Francis  Goolden,  Esq.,  Maidenhead;  Edward  B.  Gray, 
M.D. ,  Oxford;  George  Fox  Grosvenor,  M.D. ;  Fred.  B.  Hallowes,  Esq., 
Redhill;  George  Harley,  M.D.  ;  Robert  Harris,  M.B. ;  William  Harris, 
F.R.C.S.,  Hellesdon;  Wilmot  Parker  Herringham,  M.B.  ;  Constantine 
Holman,  M.D.,  Reigate;  George  E.  Jeaffreson,  Esq.,  Framlingham; 
George  Johnson,  M.D.  ;  W.  E.  Ledgard,  Esq.,  Kirkby  Lonsdale;  R.  T. 
Leeming,  F.R.C.S.,  Kendal;  W.  Liddon,  M.B.,  Taunton  ;  W.  Withers 
Moore,  M.D.,  Brighton;  Edward  J.  Nix,  M.D. ;  George  Oliver,  M.D. , 
Harrogate  ;  George  Rice  Ord,  M.D. ;  William  B.  Page,  F.R.C.S.,  Car¬ 
lisle;  G.  E.  Paget,  M.D.,  Cambridge;  Sidney  Parsons,  Esq.;  C.  J. 
Pinching,  Esq.,  Gravesend  ;  Joseph  Francis  Porter,  M.D. ;  William  Price 
Jones,  M.D.,  Surbiton;  R.  Prosser,  Esq.,  Bromsgrove;  Smith  Richards, 
Esq. ;  E.  Cuthbert  King,  Esq.  ;  T.  Morley  Rooke,  Esq.,  Cheltenham  ; 
Mathias  Roth,  M.D.  ;  James  Russell,  M.D.,  Edgbaston,  Birmingham; 
Joseph  Harvey  Sutcliff,  Esq.,  Ripley,  Surrey  ;  Felix  Semon,  M.D.  ; 
Malim  Sharman,  Esq. ,  Birmingham;  Thomas  Sheldon,  M.D.  ;  Ernest 
Barrett  Smith,  M.B.,  Twickenham  ;  William  H.  Spencer,  M.D..  Bristol; 
Henry  Stilwell,  M.D.,  Hillingdon;  Horatio  P.  Symonds,  F.R.C.S., 
Oxford;  James  Taylor,  F.R.C.S.,  Chester  ;  Thomas  Taylor,  Esq.,  Brain¬ 
tree,  Essex  ;  T.  Pridgin  Teale,  F.R.C.S.,  Leeds;  Frederic  Thorne,  Esq., 
Leamington;  John  Topham,  M.D. ;  J.  J.  Tweed,  F.R.C.S.;  John  Under¬ 
wood,  M.D.,  Hastings;  A.  Law  Wade,  M.D.,  Wells;  Thomas  James 
Walker,  M.D.,  Peterborough;  Hermann  Weber,  M.D. ;  Walter  Whitehead, 
F.R.S,,  Manchester ;  G.  Friend  Whiteley,  Esq.,  J.P.,  Twickenham ; 
Pugin  Thornton,  Esq.;  George  May,  Esq.,  Reading;  Handheld  Jones, 
M.B. ;  Battershell  Gill,  M.D.  ;  Abernethy  Kingdon,  Esq. 

W.  Corbin  Finch,  M.D.,  Salisbury,  £1. 

The  following  have  sent  half  a  guinea  each  W.  H.  Barr,  Esq.,  Bury ; 
John  Beddoe,  M.D.,  Bristol;  Cornelius  Biddle,  Esq.,  Merthyr  Tydfil; 
C.  H.  Bloxsome,  Esq.,  Fairford;  Henry  J.  Buck,  Esq. ;  James  Cornwall, 
F.R.C.S.,  Fairford;  John  Gill,  Esq.,  Welshpool;  Joseph  Harper,  Esq., 
Barnstaple;  Henry  Jackson,  Esq.,  Barnstaple;  Albert  Kisch,  Esq.;  J. 


Mulvaney,  Esq. ;  Geo.  Robinson,  Esq.,  Bedford;  F.  W.  Salzmann,  Esq., 
Brighton;  F.  H.  Spooner,  M.D. ;  E.  Symes  Thompson,  M.D. ;  J.  N. 
Winter,  Esq.,  Brighton;  James  A.  Rigby.  M.D., Preston;  Charles  Rigby, 
M.B.,  Preston ;  John  H.  Wraith,  Esq.,  Darwen;  Otho  F.  Wyer,  M.D., 
Leamington. 

The  following  have  sent  ten  shillings  each:— E.  Adams,  Esq.,  Liver¬ 
pool;  James  Adams,  M.D.,  Barnes  ;  J.  M.  Appleton,  Esq. ;  Robert  Bruce, 
Esq. ;  O.  E.  P.  Chard,  M.B. ;  Edwd.  D.  Doughty,  Esq. ;  D.  Duke,  Esq., 
Leicester;  R.  C.  D.  Durden,  Esq.,  Leicester;  R.  S.  Fowler,  F.R.C.S., 
Bath;  B.  Lawrence  Hawkins,  Esq.,  Woburn;  W.  B.  Hunter,  M.D., 
Matlock;  Talfourd  Jones,  M. B.,  Brecon;  W.  Y.  Veitch,  Esq.,  Middles- 
boro’ ;  Leonard  Williams,  M.B.,  Wheatley  ;  W.  J.  Qualtrough,  Esq. 

The  following  have  sent  five  shillings  each  : — H.  M.  Baker,  M.B., 
Leicester  Asylum ;  R.  W.  F.  Carter,  Esq.,  Dulverton  ;  J.  Christian,  Esq., 
Dulverton ;  F.  W.  Clarke,  Esq.,  Bury  St.  Edmunds;  W.  Soltan  Eccles, 
Esq. ;  W.  Moorman,  Esq.,  St.  Columb;  Edmund  Palmer,  M.B.,  Thanet; 
D.  W.  Parsons,  Esq.,  Liverpool;  Frank  Smith,  Esq.,  Plumstead;  E.  A. 
Snell,  M.B. ;  Edward  T.  Tibbits,  M.D. ,  Bradford. 

•  Other  smaller  sums Thomas  Warner,  Esq.,  Cirencester,  4s.  2d.;  A. 
Haslewood,  Esq.,  Buxton,  2s.  6d.;  T.  Law  Webb,  Esq.,  Ironbridge,  2s.  6d.; 
A.  Kebbell,  Esq.,  Flaxton,  2s. ;  H.  T.  Wharton,  M.A.,  Is.  6d. ;  from  a 
Poor  Man,  Is.  4d. 

Errata. — In  last  week’s  list  for  Dr.  Garskill  read  “  Gaitskell”;  for  Dr. 
Hey  wood  read  “Heyward.” 

F.  A^  Mahomed, -)H  g 
E.  W.  Burnet,  j 

Eoyal  College  of  Physicians,  Pall-mall  East,  S.W. 


SPECIALISM— A  DISCUSSION. 


There  is  probably  no  subject  more  often  discussed  in 
medical  circles  than  that  of  Specialism,  and  there  is  cer¬ 
tainly  none  which  is  more  thorny  or  more  difficult.  It  may 
be  looked  upon  from  so  many  different  points  of  view,  and 
one’s  opinions  on  it  are  so  apt  to  be  insensibly  bound  up 
with  one’s  interests,  that  the  most  opposite  standpoints 
may  no  doubt  be  honestly  held.  The  public  at  large  is 
certainly  in  favour  of  immoderate  specialism  :  the  profes¬ 
sion  at  large,  with  equal  certainty,  is  opposed  to  it :  and 
the  problem  is  far  from  settlement  either  on  the  one  side 
or  on  the  other ;  though  we  hear  from  the  one  camp  that 
specialism  is  in  full  retreat,  and  from  the  other  that  it  has 
won  all  along  the  line,  and  the  campaign  is  at  an  end. 
It  is  very  important  to  realise  whether  there  is  a  real  and 
radical  difference  of  opinion  on  the  subject,  or  whether  the 
two  sides  are  not  in  effect  only  looking  at  different  surfaces 
of  the  same  shield. 

The  general  practitioner,  and  those  amongst  the  consult¬ 
ants  who  sympathise  with  his  view,  will  tell  you  that  the  very 
term  Specialism  is  comparatively  new,  and  that  the  immense 
variety  of  mental  bent  and  occupation  which  it  may  now 
denote  is  altogether  without  parallel  in  the  past  history  of  our 
profession.  In  time  past,  not  to  go  back  by  any  means  to  the 
dark  or  early  ages  of  our  history,  the  consulting  or  hospital 
physician  or  surgeon  was  the  only  further  or  higher  authority 
than  the  general  or  family  practitioner.  Other  resort  there 
was  none.  A  great  operator  for  a  surgical  emergency,  or  a 
consulting  physician  for  a  grave  medical  dilemma — these 
were  the  safeguards  and  luxuries  of  the  rich ;  and  the  ex¬ 
ceptional  occasion  which  called  for  this  resort  was  such  that 
the  prestige  of  both  consultant  and  practitioner  was  en¬ 
hanced  by  the  gravity  and  rarity  of  the  crisis  so  contended 
with.  Then  came  a  period  when  the  eye,  the  ear,  and  perhaps 
some  special  surgical  procedure,  had  each  its  chief  and 
chosen  votary.  But  now  Specialism  has  so  increased  and 
developed  that  nearly  every  disease,  medical,  surgical,  or 
gynaecological — every  condition,  organ,  or  function  of  the 
body — has  its  coterie  of  special  professors,  who  influence  and 
attract  the  public  mind  more  and  more,  impressing  the  belief 
that  each  subdivision  of  our  art,  so  created,  should  be  the  sole 
and  exclusive  study  of  a  special  and  master  intellect. 

It  is  hopeless  to  expect  that  ordinary  medical  men,  be 
they  as  little  jealous  and  self-seeking  as  they  may,  will 
look  with  complacence  upon  this  state  of  things.  “  What,” 
they  ask,  “  is  the  effect  upon  us  the  mass  of  the  profession, 
upon  us  the  general  practitioners  in  town  and  country,  of 
this  exaggerated  specialism  among  the  upper,  or  consulting, 
members  of  our  body  P  How  does  it  affect  our  own  work 
and  status,  and  the  opinions  of  our  patients  ?  Why,  we  say 
without  hesitation,  that  the  effect  is  opposed  both  to  our 
interests  and  our  self-respect.  Every  disease  and  organ  has 
its  special  exponent.  Each  patient  who  can  afford  the 
luxury  becomes  anxious  to  corroborate  the  opinion  of  his 
ordinary  medical  attendant  by  the  dictum  of  the  specialist. 
A  spirit  of  restlessness  and  impatience  takes  the  place 


Medical  Times  and  Gazette. 


SPECIALISM— A  DISCUSSION. 


Dec.  29, 1883.  75  3 


of  the  loyal  dependence  upon  the  trusted  adviser.  ‘It 
is  impossible/  says  the  specialist,  ‘that  one  man  can 
have  every  branch  of  medical  and  surgical  science  at  his 
fingers’  ends.’  And  the  patients  are  too  prone  to  believe 
him  ;  and  the  consultation  which  was  once,  when  sought  in 
case  of  doubt  or  danger,  the  strength  and  comfort  of  the 
practitioner,  becomes  a  source  of  anxiety  and  annoyance 
when  obtained  (often  without  his  desire  or  co-operation)  by 
the  timid  and  credulous  patient.  ‘A.  is  the  best  man  for 
this  organ,’  or  ‘B.  the  great  opinion  for  that  complaint,’ 
says  the  world  of  sympathising  friends.  And  to  A.  or  to  B. 
accordingly  the  patient  will  go,  though  his  own  medical 
adviser,  who  deserves  the  full  trust  and  confidence  of  the 
invalid,  feels  himself  in  no  doubt,  and  well  able  to  cope  with 
the  disease  in  question.” 

That  is  what  the  general  practitioners  are  saying,  and 
they  have  every  excuse  for  taking  that  line.  But  is  not 
their  view  based,  perhaps  unconsciously,  upon  their  own 
feelings  and  interests,  rather  than  upon  that  deep  sym¬ 
pathy  for  the  crying  needs  of  their  patients,  upon  the 
necessity  of  which  Dr.  Allbutt  has  of  late  so  eloquently 
insisted  ?  If  the  general  practitioner  had  the  misfortune 
to  be  seized  with  a  special  complaint,  would  he  not  be  the 
first  to  fly  to  the  specialist  for  relief  ?  It  is  to  his  interest, 
as  well  as  to  that  of  his  patients,  that  he  should  carefully 
weigh  the  arguments  of  the  other  side  before  illness  in  his 
own  person  converts  him  to  them.  “  Specialism,”  he  will 
hear,  “  is  nothing  new,  nothing  strange  or  foreign.  The 
very  existence  of  medicine  as  a  separate  profession  is  itself 
a  specialism.  To  the  general  public,  immersed  in  multi¬ 
farious  occupations,  the  medical  practitioner  is  a  specialist 
who  has  devoted  himself  to  the  science  and  art  of  healing. 
To  the  general  practitioner  the  pure  physician,  the  pure 
surgeon,  the  obstetrician,  and  the  alienist  are  specialists 
in  their  respective  departments.  What  rule  of  reason  or 
ethics  demands  that  the  process  of  division  should  stop  at 
this  point  ?  On  the  contrary,  is  it  not  manifest  that  the 
process  must  and  ought  to  continue  P  The  days  of  the 
cyclopsedists  are  over.  Nevermore  can  one  man  say,  ‘I  take 
all  knowledge  to  my  province.’  As  with  the  whole  of  medi¬ 
cine,  so  with  each  great  branch  of  it,  and  afterwards  with 
minor  and  secondary  branches,  the  time  at  length  arrives 
when  the  accumulation  of  knowledge  and  the  varieties  of 
skill  demanded  for  its  practice  are  greater  than  can  be 
acquired  by  any  single  man.  When  this  time  arrives  what 
Is  to  be  done  ?  If  every  man  is  to  distribute  over  the  whole 
of  medical  science  and  art  that  time  and  attention  which 
are  only  sufficient  to  thoroughly  master  one  branch  of  it, 
it  is  manifest  that  the  profession  will  sink  to  a  dead  level 
of  mediocrity.  If,  on  the  other  hand,  a  man  works  at  one 
branch  until  he  has  mastered  it,  and  finds  that  his  whole 
energies  are  required  in  order  to  retain  his  proficiency 
and  advance  his  knowledge  in  that  one  subject, — and  if  he 
does  devote  himself  to  it  accordingly, — then  he  is  a 
specialist.” 

“  The  specialisation  of  the  functions  of  the  social  organism, 
like  the  specialisation  of  the  functions  of  the  individual 
organism,  must  be  pushed  further  as  the  organism  becomes 
more  highly  developed — as  it  increases  in  size  and  complexity. 
The  same  natural  law  which  necessitates  that  in  a  savage 
community  one  man  shall  be  a  hunter,  another  a  fisher,  and 
a  third  a  maker  of  weapons,  necessitates  that  in  a  civilised 
community  some  medical  men  shall  turn  their  hands  to  the 
section  of  tendons,  others  shall  study  diseases  of  the  brain, 
and  yet  others  perfect  themselves  in  the  performance  of 
ovariotomy.  Those  who  have  studied  the  principles  of  physi¬ 
ology  should  be  the  first  to  admit  that  as  every  man  is  born 
with  physical  features  in  which  he  differs  from  his  fellows, 
so  he  is  born  with  special  qualities  and  aptitudes  in  which 
no  two  men  are  alike.  These  qualities  and  aptitudes  will 
fit  him  to  do  certain  things  better  than  he  does  others ;  and 
since  good  work  is  more  remunerative  than  bad  work,  he  will 
do  most  what  he  does  best ;  and  since  qualities  are  developed 
and  perfected  by  exercise,  that  in  which  he  excels  he  will 
tend  more  and  more  to  excel  in  ;  and  since  the  more  he  excels 
in  one  kind  of  work  the  more  remunerative  it  becomes,  he 
will  tend  more  and  more  to  confine  himself  to  it.  The 
justification  of  specialism  is  deep  down  in  the  foundation  of 
human  nature,  and  they  who  fight  against  it  have  engaged 
in  a  hopeless  struggle.” 

‘‘Well,  we  will  admit  all  that,”  return  the  general 
practitioners,  “but  how  is  the  division  of  labour  to  con¬ 


tinue  ?  Surely  it  cannot  be  right  that  there  should  be  prac¬ 
titioners  confining  their  attention  to  diseases  of  the  thumb¬ 
nail?”  “We  answer  you  in  Lord  Melbourne’s  words,” 
reply  the  other  side ;  “  Let  the  thing  alone.  It  will  go  on 
whether  you  meddle  with  it  or  no,  and  its  limitation,  like 
its  progress,  is  subject  to  natural  laws,  and  will  yield  to 
them  only.  The  aim  of  a  man  who  takes  up  a  specialty  is 
to  make  a  living,  or  a  reputation,  or  both.  If  the  specialty 
be  too  narrow  he  will  find  himself  unable  to  live  by  it,  and 
he  must  widen  it  or  starve.  If  he  is  independent,  but  takes 
too  narrow  a  specialty,  he  will  never  attain  influence,  and 
his  example  will  not  be  followed.” 

“  But  is  there  no  danger  of  specialism  becoming  narrow¬ 
ness  ?  ”  “Of  course  ;  any  function  may  become  morbid, 
but  we  do  not  seek  on  that  account  to  abolish  the  function. 
We  try  to  maintain  it  in  health ;  and  this  is  the  right  course 
to  pursue  with  a  special  social  function  as  with  a  special 
bodily  function.  Specialism  is  one  thing,  narrowness 
another.  Specialism  is  a  thirsty  plant,  and  must  throw  out 
roots  far  and  wide  into  neighbouring  tracts  of  knowledge, 
or  it  will  droop  and  die.  Take,  for  instance,  the  gyne¬ 
cologist  who  confines  himself  mainly  to  the  subject  of 
ovarian  tumours — a  somewhat  limited  specialty — a  branch 
of  a  branch  of  general  medicine.  He  must  know,  of  course, 
all  that  is  known  of  ovarian  tumours.  He  must  know  all 
their  varieties,  and  the  natural  history  of  each  variety. 
He  must  know  where  each  kind  begins,  when,  and  how,  in 
what  direction,  and  with  what  speed  it  tends  to  grow ;  its 
physical  characters,  its  microscopic  structure,  its  modes  of 
degeneration — in  short,  its  whole  biology.  Then  he  must 
know  the  physical  relations  of  each  variety  of  tumour 
to  surrounding  structures — which  structures  it  displaces, 
which  it  destroys,  which  it  incorporates.  He  must  know 
how  each  such  tumour  will  affect  the  structures  and  the 
functions  of  the  other  pelvic  organs  with  which  he  has  to 
deal.  And  when  he  has  learnt  all  this  his  acquirements 
have  but  begun.  He  must  now  study  the  life-history  and  all 
the  corresponding  particulars  of  every  possible  tumour  that 
can  grow  in  surrounding  organs,  together  with  all  their 
concomitants  and  results,  so  as  to  be  able  to  effect  a 
diagnosis.  Thus  the  whole  of  gynaecology  and  a  large 
province  of  general  splanchnology  becomes  incorporated 
with  his  specialty.  But  his  knowledge  is  yet  far  from 
sufficient.  He  must  be  acquainted  with  the  special  reactions 
that  each  disease  of  each  of  these  organs  has  upon  the 
general  condition  of  the  body  at  large ;  and  unless  his  special 
knowledge  has  a  broad  foundation  on  general  pathology  it 
is  not  merely  incomplete  and  useless — it  is,  or  may  very 
easily  be,  positively  noxious.  Pathology  cannot,  of  course,  be 
known  without  a  previous  knowledge  of  physiology,  which, 
again,  necessitates  sound  anatomical  and  histological  know¬ 
ledge.  The  requirements  of  our  specialist  are  not  yet  all 
enumerated.  He  must  be  a  surgeon  as  well  as  a  physician. 
He  must  be  prepared  to  undertake  the  greatest  operation 
known  to  modern  surgery;  and  thus  the  whole  theory  of 
the  healing  of  wounds,  with  all  its  ramifications,  becomes 
an  essential  and  intimate  portion  of  his  intellectual  furni¬ 
ture,  and  the  manual  dexterity  and  microscopic  vigilance  of 
the  operating  surgeon  are  added  to  the  accomplishments 
that  are  required  of  him.  A  department  of  medicine  in 
itself  so  large,  and  resting  upon  so  extensive  a  foundation 
as  this,  is  certainly  not  open  to  the  reproach  of  narrowness  ; 
and  the  only  condition  requisite  to  preserve  it  from  any 
stain  of  this  character  is  one  whose  absence  would  degrade 
any  calling,  special  or  general,  and  that  is — honesty  of 
purpose.” 

“  Ah,  if  that  is  specialism,”  exclaims  the  general  practi¬ 
tioner,  “  I  have  nothing  further  to  say.  We  are  agreed  after 
all ;  but,  as  so  often  happens  in  the  warmest  discussions,  we 
have  been  thinking  and  talking,  all  along,  each  with  a 
different  connotation  of  the  term  in  his  mind.  One  question 
more,  however.  What  about  the  student  ?  What  practical 
effect  will  this  tendency  to  subdivision  and  specialism  in 
medical  science  have  upon  him  ?  Surely  to  him  it  must  be 
obviously  a  source  of  danger.”  “  True;  there  we  shall  agree 
again.  Nothing  should  be  more  carefully  guarded  against 
or  more  ruthlessly  suppressed,  by  teachers  and  professors, 
than  any  tendency  of  the  student,  either  in  the  earlier  or 
later  years  of  his  curriculum,  to  imitate  the  specialism  which 
he  sees  prevailing  among  his  leaders  and  seniors.  We  would 
by  no  means  encourage  him  to  devote  himself  to  any  special 
branch  of  our  art  or  science  before  he  has  so  occupied  him- 


754  „«ac.,TM,.anda™,,.,  MEDICAL  REPOETS  TO  THE  LOCAL  GOVERNMENT  BOARD.  Dee.  29,1893. 


gelf,  and  formed  his  mind  and  judgment  by  a  study  of  all 
which  his  course  embraces,  as  to  receive  the  stamp  of  at 
least  average  merit  in  the  complete  series  of  his  professional 
requirements.  You  may  he  sure  that  the  very  minds  which 
are  so  easily  fascinated  by  the  prospect  of  a  short  cut  by 
specialism  to  early  fame  and  distinction,  are  those  upon 
which  the  rigour  and  routine  of  an  uncompromising  course 
of  study,  in  subjects  perhaps  less  attractive  than  those 
naturally  chosen,  will  have  the  most  healthful  and  lasting 
effect.  You  may  be  sure  enough  that  the  spark  of  special 
talent,  the  individuality  and  originality  of  mind,  if  it  he 
present,  will  shine  forth  in  due  course  when  time  and 
opportunity  allow.  And  with  the  greater  brilliancy  will  it 
flash  out,  from  its  repression  till  that  due  and  later  time 
shall  have  come.  For  the  mind  so  formed  by  the  study 
of  exact  and  perhaps  uncongenial  sciences  will  be  rendered 
more  robust  and  capable  of  the  pursuit  of  its  own  special 
bent,  which  must  be  the  ornament,  not  the  essential,  the 
pinnacle,  not  the  foundation,  of  the  true  medical  training.” 


MEDICAL  REPORTS  TO  THE  LOCAL 
GOVERNMENT  BOARD. 


The  Work  of  the  South-Eastern  District  Hospital 
of  the  Metropolitan  Asylums  Board  during  the 
Year  1882. 

The  report  of  Dr.  McCombie,  the  indefatigable  Medical 
Superintendent  of  the  South-Eastern  District  Hospital,  for 
the  year  1882  has  been  issued,  as  usual,  as  one  of  the  Me¬ 
tropolitan  Asylums  Board  publications.  Presumably,  want 
of  time  has  compelled  Dr.  McCombie  to  confine  himself  to  a 
strictly  statistical  account  of  the  year’s  doings,  and  from 
this  we  learn  that  on  the  small-pox  side  947  acute  cases  of 
that  disease  were  admitted,  894  were  discharged  recovered, 
and  162  diefl— the  mortality  being  at  the  rate  of  16-2  per 
cent.  Thirty-seven  cases  of  other  disease  were  admitted,  of 
which  one  died.  Ninety  convalescents  were  transferred  to 
Darenth  in  the  beginning  of  the  year,  and  98  were  received 
from  the  Homerton  Hospital.  Of  the  admissions,  720  were 
vaccinated,  83  were  doubtfully  vaccinated,  and  144  were  un¬ 
vaccinated.  In  patients  with  good  vaccination  the  mortality 
was — in  males  3-7  per  cent.,  and  in  females  3-9  per  cent. ; 
in  patients  with  imperfect  vaccination  the  mortality  was — 
in  males  16-3  per  cent.,  and  in  females  8‘2  per  cent.  On 
the  fever  side  of  the  Hospital  there  were  admitted  365  acute 
cases.  Of  these  309  were  discharged  recovered,  or  trans¬ 
ferred  to  other  hospitals  under  the  Board,  and  55  died ;  the 
mortality  being  at  the  rate  of  15T  per  cent.  Of  these 
latter  admissions  243  were  cases  of  scarlet  fever,  84  were 
cases  of  enteric  fever,  11  were  cases  of  typhus  fever,  and  27 
were  cases  of  other  disease.  The  percentage  mortality  was 
— in  scarlet  fever,  11 ;  in  enteric  fever,  24'2 ;  in  typhus 
fever,  222;  and  in  other  diseases,  22‘2.  Owing  to  the 
pressure  of  small-pox  during  the  year,  the  fever  wards  were 
closed  against  the  admission  of  fever  patients  in  Feb¬ 
ruary,  and  were  not  reopened  for  fever  cases  until  the  fol¬ 
lowing  August.  The  health  of  the  staff  of  the  Hospital  was 
generally  good  throughout  the  year,  both  on  the  fever  and 
small-pox  sides ;  but  one  nurse  and  one  assistant-nurse — 
both  on  duty  in  the  enteric  wards — and  one  laundrymaid 
contracted  enteric  fever;  two  assistant-nurses  contracted 
scarlet  fever;  and  one  ward-servant,  whose  re  vaccination 
had  been  overlooked,  contracted  small-pox.  All  these  cases, 
however,  happily  recovered. 


The  Sanitary  Condition  of  Hackney  during  the 
Year  1882. 

The  annual  reports  of  Dr.  J.  W.  Tripe  on  the  sanitary  con¬ 
dition  of  the  Hackney  district  are  always  interesting,  on  ac¬ 
count  of  the  information  they  contain  ;  and  that  for  the  year 
1882  is  no  exception  to  the  rule.  We  gather  from  it  that  the 
death-rate  for  the  period  was  singularly  low,  having  been  only 
17  9  per  1000,  against  21-4  for  London  generally,  and  is  the 
smallest  recorded  by  Dr.  Tripe  since  his  appointment  to  the 
post  of  medical  officer  of  health.  The  next  lowest,  18-3  per 
1000,  occurred  in  1880.  These  figures  are,  the  report  points 


out,  the  more  satisfactory  as  they  happened  in  the  year  before 
and  the  year  after  the  census  of  1881,  so  that  the  calculated 
population  could  not  be  far  wrong  in  either  year.  The  num¬ 
ber  of  small-pox  cases  reported  to  Dr.  Tripe  during  1882  was 
very  small  as  compared  with  1881,  there  having  been  only 
seventy-nine  in  the  former,  against  1146  in  the  latter  year. 
Of  the  seventy-nine  cases,  fifty  occurred  in  small  houses,  and 
twenty-nine  in  better-class  houses — to  a  great  extentamongst 
servants  and  other  emploijes.  The  report  records  the  particu¬ 
lars  of  a  severe  outbreak  of  diarrhoea  which  oocurred  in 
November,  1882,  at  Clapton  Common  and  the  upper  part  of 
Stam ford-hill,  the  disease  attacking  the  inmates  of  most  of 
the  houses  (which  are  of  a  good  class),  between  the  3rd  and  6th 
of  that  month.  The  outbreak  was  so  sudden  and  so  general 
that  it  clearly  arose  from  some  sudden  cause — either  polluted 
milk  or  water— or  from  sewer-gas.  The  time  of  the  year 
and  the  absence  of  smell  from  the  sewers  were  against  the 
latter  supposition,  and  it  was  found  that  the  milk  was  ob¬ 
tained  from  various  dealers,  who  received  it  from  totally 
different  sources.  As  the  water  was  suspected,  the  East 
London  Company  were  requested  to  have  the  Clapton  main 
scoured  out,  and  this  was  done  in  less  than  twenty-four 
hours  ;  but  several  fresh  cases  occurring  the  day  after  the 
main  was  scoured,  the  Company  were  requested  to  flush  it  a 
second  time,  which  was  done,  when  the  outbreak  ceased  as 
rapidly  as  it  had  begun.  The  persons  attacked  were  those 
who  drank  unboiled  water,  and  several  visitors  who  partook 
of  luncheon  at  Clapton  on  November  3,  and  drank  water, 
were  attacked  with  the  disease  on  their  return  home  ;  whilst 
two  visitors  who  drank  sherry  at  luncheon  on  the  same  day 
escaped  an  attack.  Chemical  analysis  of  the  water  failed  to 
account  for  the  outbreak  ;  and  this  shows.  Dr.  Tripe  thinks, 
that  too  much  reliance  ought  not  to  be  placed  on  a  chemical 
examination,  but  that  in  all  cases  microscopical  examination 
should  also  be  made. 


ABSTRACTS  AND  EXTRACTS. 


Subnitrate  of  Bismuth  as  a  Preventative  of 
Cicatricial  Contraction. 

Dr.  A.  C.  Post  extols  the  external  use  of  this  agent  em¬ 
ployed  as  a  dressing  both  in  cases  of  recent  burns  and  in 
remedial  operations.  When  deformity  or  limited  motion  is 
due  to  the  presence  of  cicatricial  bands,  he  divides  the  ad¬ 
hesions  in  the  usual  manner  by  multiple  parallel  adhesions, 
dressing  the  parts  first  with  carbolised  oil  or  va  seline,  and  at 
subsequent  dressings  sprinkling  them  freely  with  the  sub¬ 
nitrate  of  bismuth,  so  as  to  completely  fill  up  all  interstices 
between  the  incisions.  The  granulations  are  thus  kept  down, 
and  the  wounds  are  maintained  in  a  remarkably  healthy  con¬ 
dition,  with  very  little  suppuration.  When  used  as  a  dressing 
to  granulating  surfaces  following  burns,  it  lessens  the 
amount  of  granulations,  the  contraction  of  which,  when  they 
are  allowed  to  develope  exuberantly,  is  the  chief  source  of 
deformity.  In  neither  children  nor  adults  has  this  dressing 
been  observed  to  produce  any  toxic  effects. 


The  Development  of  Language  in  Children. 

In  an  article  on  this  subject  in  the  Archives  de  Neurologie 
for  November  last,  M.  Sikorosky  concludes  that  in  the 
infant’s  first  cry — the  first  manifestation  on  its  part  of 
general  sensibility — are  contained  movements  of  all  parts  of 
the  articulating  mechanism  (the  tongue,  lips,  etc.),  whence 
there  gradually  arise  two  categories  of  the  movements  of 
articulation,  the  one  labial,  the  other  lingual,  the  acquisition 
of  which  is  almost  simultaneous,  and  which,  proportionately 
to  their  gradual  development,  enter  into  the  most  varied 
combinations  with  the  expiratory  and  vocal  movements 
necessary  to  form  the  different  sounds  of  language.  In  his 
view  there  are  two  types  of  language  in  infants,  arrived  at 
in  different  ways.  Some  children  make  a  minute  study  of 
the  sounds  of  a  word,  and  succeed  in  reproducing  with  fair 
accuracy  the  various  component  sounds,  but  cannot  combine 
these  into  syllables ;  others,  on  the  contrary,  pay  most 
attention  to  the  syllabic  structure  of  the  word,  and  do  not 
trouble  themselves  about  the  constituent  sounds  thereof. 
To  one  or  other  of  these  classes  all  the  defects  of  children’s 
speech  may  be  attributed. 


Madioal  Timci=  and  Gazett  •• 


ABSTRACTS  AND  EXTRACTS. 


Dec.  29,  1883.  755 


The  Kidney  Disease  of  Pregnancy  and  Labour. 

1  recent  number  of  the  Zeitschrift  fur  Geburtshiilfe  und 
Gyndkologie  contains  an  article  on  this  subject  by  Dr. 
.Flaischlen,  of  Berlin.  He  gives  first  some  interesting  figures 
-from  his  own  observations,  showing  the  frequency  of  albu¬ 
minuria  in  (a)  pregnancy  and  (6)  labour.  He  examined  the 
■urine  of  (a)  ^  1000  pregnant  women,  in  most  cases  several 
'times.  In  2G  he  found  albumen  present.  Of  these  5  were 
■suffering  from  cystitis,  and  2  from  pronounced  chronic 
Bright’s  disease.  Deducting  these,  there  remain  19  in  which 
he  considers  the  albuminuria  was  due  to  pregnancy.  In  13 
•of  these  the  urine  was  again  examined  after  delivery,  and 
at  was  found  that  in  3  of  them  the  albuminuria  had  then 
•disappeared.  In  6  others  the  disease  was  only  slight,  the 
quantity  of  albumen  being  small,  there  being  no  casts,  and 
■symptoms  of  kidney  disease  being  absent.  In  most  of  these 
the  albumen  disappeared  a  few  days  after  delivery.  In  the 
[remaining  4,  eclamptic  seizures  supervened,  and  in  3  labour 
•came  on  prematurely.  There  was  in  all  more  or  less  oedema 
of  dependent  parts  ;  in  none  general  anasarca.  The  urine 
was  scanty,  of  high  specific  gravity  (reaching  in  one  case 
1045),  and  containing  hyaline  and  epithelial  casts,  the 
latter  showing  extensive  fatty  degeneration ;  but  little 
•cr  no  blood  or  blood-casts.  These  appearances,  in  Dr. 
Flaischlen’ s  opinion,  are  characteristic  of  ancemia  of  the 
kidneys.  Some  further  cases  are  given,  illustrative  of  par¬ 
ticular  points  in  the  subject  under  consideration.  One 
■case  exemplifies  the  rare  occurrenqe  of  general  anasarca 
without  albuminuria,  and  without  eclampsia  or  other  sign 
•ef  kidney  disease.  The  dropsy  subsided  eight  days  after 
•delivery.  Another  case  is  given,  in  which,  on  autopsy,  the 
part  of  the  right  ureter  above  the  pelvic- brim,  and  the 
pelvis  of  the  corresponding  kidney,  were  found  greatly 
-dilated,  the  condition  being  attributed  by  Dr.  Flaischlen  to 
•compression  of  the  ureter  between  the  brim  of  the  pelvis 
and  the  gravid  uterus.  A  case  of  puerperal  eclampsia  is  also 
•described,  in  which,  contrary  to  rule,  the  symptoms  and  con¬ 
dition  of  the  kidneys  were  those  of  ordinary  acute  nephritis. 
■Our  author  considers  that  in  the  differential  diagnosis  be¬ 
tween  chronic  interstitial  nephritis  and  renal  disease  due 
.simply  to  pregnancy,  the  chief  guide  is  the  condition  of  the 
urine.  In  chronic  nephritis  the  urine  is  abundant  and  its  j 
specific  gravity  low  ;  in  albuminuria  due  to  pregnancy  the 
secretion  is  scanty  and  its  density  high.  In  addition  to  this, 
there  is  the  cardiac  hypertrophy  and  the  pulse  of  high  ten¬ 
sion  which  accompany  kidney  disease.  He  finds  no  evidence 
that  the  kidney-changes  set  up  by  pregnancy  at  all  tend  to 
pass  into  chronic  interstitial  nephritis.  ( b )  Out  of  the 
1000  pregnant  women  already  mentioned,  in  537  Dr. 
Flaischlen  examined  the  urine  during  labour ;  of  these  395 
were  primiparse,  242  multiparse.  In  93  cases  (73  primiparse 
•and  20  multipart)  he  found  albumen  present  in  the  urine. 
The  greater  frequency  of  albuminuria  in  first  labours  he 
■attributes  to  the  greater  length  of  such  labours.  In 
•order  to  test  the  theory  that  the  albuminuria  of  pregnancy 
is  due  to  venous  congestion  of  the  kidneys  from  aug¬ 
mented  intra-abdominal  pressure,  and  consequent  obstruc¬ 
tion  to  the  return  of  blood,  our  author  examined  the 
urine  of  28  patients  suffering  from  abdominal  tumours,  but 
found  albuminuria  in  only  3  of  them,  in  2  of  which  casts  j 
were  also  present.  The  theory  recently  advocated  by  j 
Halbertsma,  that  it  is  due  to  compression  of  the  ureters. 
Dr.  Flaischlen  rejects  as  a  general  explanation,  although 
he  admits  its  occasional  occurrence,  as  evidenced  by  the  j 
case  already  described.  The  final  conclusion  to  which  our  j 
author  comes  as  to  the  pathology  of  the  albuminuria  of  \ 
pregnancy,  is  that  it  is  due  to  a  reflex  amemia  of  the 
kidneys  excited  by  the  gravid  uterus.  This  anaemia  leads 
to  degenerative  changes  of  the  epithelium  in  the  renal 
tubules.  In  consequence  of  these  changes  the  excretion  of 
urea  becomes  deficient.  In  some  cases  these  changes  come 
on  during  the  latter  half  of  pregnancy,  and  their  evil  con¬ 
sequences  are  then  best  averted  by  the  induction  of  prema¬ 
ture  labour.  Sometimes,  on  the  other  hand,  they  are 
produced  by  the  uterine  contractions  of  the  process  of 
labour  itself. 


Fracture  of  the  Cervix  Femoris  in  the  Aged. 

Dr.  Allis,  Surgeon  to  the  Jefferson  Medical  College  Hos¬ 
pital,  read  at  the  Philadelphia  County  Medical  Society  j 
(Phil.  Med.  Times,  August 25)  a  paper  entitled,  “Some  Re-  I 


marks  upon  the  Diagnosis  and  Treatment  of  Fracture  of  the 
Heck  of  the  Femur  in  Elderly  Subjects.”  His  observations 
are  entirely  confined  to  persons  of  advanced  age — that  is, 

■  of  seventy  and  upwards.  Seeing  that  in  such  persons  the 
j  accident  may  be  accompanied  by  severe  or  even  fatal  shock, 
j  the  surgeon  has  to  ask  himself  whether  for  the  purposes  of 
j  diagnosis  he  should  be  satisfied  with  such  signs  as  can  be 
attained  without  risking  an  increase  of  the  shock,  or  whether 
i  anaesthetics  or  manipulation  should  be  employed  so  as  to 
elicit  the  distinctive  crepitus.  One  important  sign  which 
can  be  observed  without  adding  to  the  patient’s  danger  is 
diminished  tension. 

“  By  comparing  the  limbs,  the  integument  and  muscles  of 
the  injured  thigh  will  be  perceptibly  softer  than  those  of  its 
;  fellow,  and  if  an  effort  is  made  to  define  the  great  trochanter 
j  it  will  be  readily  done  on  the  injured  side,  but  not  so  on 
I  the  sound  side.  This  symptom— the  relaxation  of  the  fascia 
lata — is  of  great  importance.  One  of  its  principal  functions 
is  to  enable  man  to  stand  at  rest.  From  the  crest  of  the 
ilium  to  the  oubfr  surface  of  the  external  tuberosity  of  the 
tibia  a  band  of  fascia  lata  passes — the  thickest,  longest, 
strongest  band  of  fascia  in  the  body.  When  the  thigh  is 
broken  in  any  part,  this  fascia  is  relaxed,  and  becomes  a 
valuable  auxiliary  to  other  symptoms  in  this  injury.  The 
injured  limb  lies  its  entire  length  upon  the  bed,  without 
producing  any  arching  of  the  spine. 

“  Upon  these  points — age  seventy  or  over  (at  which  time 
of  life  there  are  not,  probably,  five  recorded  cases  of  disloca¬ 
tion  of  the  head  of  the  femur),  sudden  loss  of  power  in 
locomotion  due  to  an  inj  ury,  with  pain  on  the  slightest  motion, 
shortening  and  eversion,  with  diminished  tension  and  supine¬ 
ness— I  would  not  feel  justified  in  pushing  my  inquiries 
further:  first,  because  the  only  remaining  symptom,  viz., 
crepitus,  may  not  be  elicited,  even  on  the  most  unrestricted 
examination ;  second,  because  the  absence  or  inability  to 
elicit  crepitus  is  no  proof  that  the  injury  is  not  fracture ; 
third,  because,  as  there  is  not  a  single  symptom  of  disloca¬ 
tion  present,  one  is  not  justified  in  prejudicing  the  case  by 
manipulation,  either  with  or  without  ether.  The  adminis¬ 
tration  of  ether  or  chloroform  at  this  advanced  age  is  always 
attended  with  risk,  and  to  be  avoided  if  possible ;  while 
the  flexion  and  extension,  the  circumduction  and  rotation, 
necessary  to  produce  crepitus — all  of  which  must  be  re¬ 
peated  by  everyone  professionally  connected  with  the  case — 
is  an  ordeal  even  for  the  robust,  and  not  to  be  unnecessarily 
superadded  to  shock  occurring  in  old  age.” 

With  respect  to  treatment.  Dr.  Allis  observes  that  it  must 
always  be  remembered  that  the  patient  is  aged,  and  will  not 
bear  long  confinement  in  one  position  without  bed-sores 
being  produced,  which  may  often  cause  death  when  otherwise 
recovery  might  have  taken  place. 

“  In  my  treatment  of  this  class  of  cases  I  regard  but  two 
stages— tliatof  shock  and  that  of  convalescence.  From  first  to 
last  I  make  the  patient  my  first  care,  and  regard  the  fracture 
as  of  secondary  importance.  During  shock  I  keep  him  re¬ 
cumbent,  shifting  his  position  as  it  affords  him  relief,  and 
placing  pillows  or  some  extempore  contrivance  about  the 
limb  for  its  support.  If  care  is  taken  to  shift  the  patient 
from  side  to  side  on  the  bed,  to  change  bedding  and  cloth¬ 
ing  whenever  they  are  wet,  no  matter  how  often ;  if  the 
patient  is  placed  on  his  right  side,  his  back,  and  left 
side,  there  will  be  no  danger  of  bed-sores  until  he  has  suffi¬ 
ciently  recovered  from  the  shock — and  this  may  be  in  a  week 
or  less,  according  to  the  strength  and  condition  of  the 
patient.  I  am  in  the  habit  of  ordering  a  movable  platform, 
upon  which  I  can  fix  securely  an  easy  rocking-chair.  This 
I  roll  to  the  bedside,  and  with  very  little  difficulty  my 
patient  is  helped  to  the  chair  and  rolled  to  a  pleasant  part 
of  the  room  while  his  bed  is  being  made.  The  first  attempts 
to  get  him  up  are  attended  with  pain,  but  this  is  in  a  great 
measure  due  to  fear  and  uncertainty  of  movements.  After 
a  few  trials  the  patient  will  so  far  help  himself  as  to  require 
little  additional  assistance.  At  first  he  sits  up  an  hour  or 
more;  but  soon  he  will  spend  the  entire  day  in  his  chair. 
....  But  it  will  be  urged  by  some.  What  excuse  have  you 
to  offer  for  thus  leaving  a  fracture  of  the  neck  wholly  to 
nature  for  repair  ?  To  this  I  say,  I  never  abandon  my  patient 
as  those  do  who  insist  upon  treating  the  fracture  and  mag¬ 
nify  its  importance.  These,  I  say,  do  abandon  the  patient, 
making  his  very  existence  secondary  to  the  accident.  But 
experience  shows  that  the  seeming  neglect  of  the  fracture  is 
only  apparent  [some  cases  are  cited  by  Dr.  Allis  in  which  re- 


756 


Medical  Time*  and  Gazette. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


Dec.  29, 1883. 


covery  was  quite  satisfactory].  Still  the  question  may  arise. 
Would  not  these  have  done  better  with  special  treatment  ? 
Are  they  not  exceptional  cases  ?  I  say.  No  ;  I  do  not 
believe  that  the  results  in  the  treatment  of  fracture  of 
the  neck  are  brought  about  by  splints,  apparatus,  inclined 
chairs,  or  fancy  beds.  I  believe  that  they  are  determined 
by  the  character  of  the  fracture  the  instant  that  it  occurs. 
I  make  this  statement  after  examining  morbid  specimens  of 
recent  and  remote  injuries,  a  study  of  which  must  convince 
any  unprejudiced  mind  that  in  some  cases  nature  has  no 
resources  that  avail  the  patient.  Against  the  practice  that  I 
have  advocated  it  will  be  stated  that  daily  shiftings  in  bed, 
and  from  bed  to  chair,  will  interfere  with  union,  since  by 
such  a  course  the  fragments  will  be  disturbed,  and  efforts  at 
repair  frustrated.  Even  were  this  conclusion  a  just  one,  I 
would  say.  Better  imperfect  repair  than  a  headstone.  But 
it  is  an  assertion,  and  nothing  else,  to  say  that  carefully 
getting  the  patient  up  even  daily  will  produce  a  separation 
of  the  fragments/’ 

Convinced  as  he  is  of  the  superiority  of  the  mode  of 
treatment  described  above.  Dr.  Allis  admits  that  it  has  its 
serious  aspect  for  the  practitioner  in  relation  to  the  law 
courts,  into  which  ingratitude  or  discontent  on  the  part  of 
the  patient  might  drag  him,  where  he  would  be  exposed  to 
the  charge  of  unorthodox  treatment  by  able  counsel,  not 
infrequently  aided,  we  may  add,  by  the  evidence  of  medical 
rivals — his  judges  being  an  ignorant  jury. 


Cuvier’s  Cranium  and  Brain. — In  a  recent  commu¬ 
nication  to  the  Societe  d’Anthropologie,  Dr.  Georges  Herve 
quoted  some  details  from  a  report  on  the  illness  and  autopsy 
of  Cuvier,  which  was  addressed  to  the  Societe  de  Medecine 
Pratique  by  EmmanuelRousseau,  and  inserted  in  th eLancette 
Franchise  for  May  26,  1832.  According  to  this  report,  the 
weight  of  the  encephalon  was  found  to  be  3  lbs.  11  ozs.  and 
4  drachms,  or  1861-20  grammes;  while  the  official  proces- 
verbal  of  the  autopsy,  signed  by  A.  Berard,  fixes  it  at  1882-96 
grammes.  The  cerebellum  weighed  191-40  grammes.  The 
dimensions  of  the  cranium  were  taken  prior  to  the  autopsy, 
and  are  as  follow  (the  hair  having  been  previously  shaved 
off) : — (1)  The  great  horizontal  circumference  65-45  centi¬ 
metres  ;  (2)  the  median  ineo-frontal  curve,  36 "69  centimetres  ; 
(3)  the  transverse  supra-auricular  curve,  40’60  centimetres. 
The  examination  of  the  brain  revealed,  besides  a  truly 
extraordinary  abundance  of  the  cortical  substance,  a  great 
amplitude  of  the  lateral  ventricles,  which  contained  a  small 
quantity  of  slightly  turbid  fluid,  their  walls  seeming  of  a 
mucous  nature.  This  fact,  joined  to  the  enormous  dimen¬ 
sions  of  the  cephalic  extremity  and  the  thinness  of  the  walls 
of  the  cranium,  would  lead  to  the  supposition  that  Cuvier 
had  been — as  indeed  it  was  stated  that  he  had — the  subject  of 
hydrocephalus  in  his  childhood. — Revue  de  Therap.,  Dec.  1. 

A  Curious  Propensity.  —  The  feuilletonist  of  the 
Union  MSdicale  for  December  8  states  that  a  large  manufac¬ 
turer  of  gloves,  who  sends  out  great  quantities  to  the 
different  retail  establishments,  received  lately  from  num¬ 
bers  of  his  customers  loud  complaints  of  the  quality  of  the 
articles  furnished.  On  a  close  examination,  he  found,  amidst 
the  merchandise  ready  to  be  despatched  to  the  shops,  hun¬ 
dreds  of  pairs  of  gloves  which  had  undergone  most  singular 
mutilations.  They  seemed  all-right  outside,  but  on  examin¬ 
ing  their  lining  it  was  found  to  be  torn  into  shreds  so  that 
the  gloves  were  absolutely  lost  for  selling  purposes.  This 
extraordinary  procedure,  which  could  benefit  no  one,  could 
not  have  been  perpetrated  within  the  establishment,  and  a 
rigorous  search  was  made  among  the  numerous  workwomen 
who  were  employed  at  their  own  homes,  and  the  culprit  was 
at  last  found  to  be  a  young  girl,  whose  work  consisted  simply 
in  the  embroidering,  by  means  of  a  machine,  the  three  lines 
corresponding  to  the  back  of  the  hand.  For  this  purpose 
she  had  not  even  to  expose  the  inside  of  the  glove,  as  the 
punctures  did  not  extend  through  all  the  thickness  of  the 
glove — so  that  the  insides  of  the  several  dozen  pairs  of  gloves 
which  were  consigned  to  her  daily  were  never  examined. 
However,  pressed  with  questions,  she  confessed  that  she  had 
done  all  the  mischief,  impelled  by  an  irresistible  impulse  to 
tear  the  insides  of  the  gloves,  sometimes  with  scissors  and 
sometimes  with  her  teeth  ;  and  she  had  swallowed  the  frag¬ 
ments  so  detached,  notwithstanding  that  these  particular 
gloves  were  made  of  coarse  sheepskjn,  impregnated  with 
nauseous  oils.  The  same  manufacturer  stated  that  he  had 


also  received  so  many  applications  from  ladies  complaining 
of  an  incurable  propensity  their  daughters  had  acquired  of 
gnawing  the  ends  of  their  gloves,  that  he  had  been  induced 
to  introduce  nauseous  substances  during  their  manufacture, 
in  order  to  arrest  what,  from  its  obstinacy  in  some  young 
girls,  had  become  a  true  neurosis. 


REVIEWS  AND  NOTICES  OF  BOOKS. 


The  Electro-Magnet  and  its  Employment  in  Ophthalmic 

Surgery  ;  ivith  Special  Reference  to  the  Detection  and  Re¬ 
moval  of  Fragments  of  Steel  or  Iron  from  the  Interior  of 

the  Eye.  By  Simeon  Snell.  London  :  J.  and  A.  Churchill. 

1883.  Pp.  94. 

As  long  ago  as  1646  the  employment  of  a  magnet  for  the 
extraction  of  foreign  bodies  from  the  eye  was  advocated  by 
Fabricius  Hildanus,  but  it  is  only  since  the  introduction  of 
the  electro-magnet  for  this  purpose  in  1877  that  this  mode 
of  treatment  has  received  much  attention  from  ophthalmic 
surgeons. 

The  possible  usefulness  of  the  electro-magnet  is  distinctly 
limited.  For  the  extraction  of  pieces  of  steel  or  iron 
situated  in  the  eyelids  or  in  the  external  coats  of  the  globe 
its  employment  will  seldom  be  found  necessary.  It  is  in 
cases  where  the  foreign  body  lies  within  the  eyeball  (viz.,, 
in  the  aqueous  or  vitreous  chambers,  in  the  lens  or  retina} 
that  this  instrument  is  likely  to  be  of  more  service  than  the 
methods  of  treatment  hitherto  in  vogue — methods  which 
must  still  be  used  in  the  large  number  of  cases  where  the 
foreign  body  is  of  brass,  copper,  stone,  glass,  etc.  When  the 
fragment  lies  in  the  aqueous  chamber,  it  is  usual  to  make 
an  incision  through  that  part  of  the  periphery  of  the  cornea 
corresponding  to  the  position  of  the  foreign  body.  Should 
the  latter  not  escape  with  the  gush  of  aqueous,  it  will  be 
necessary  then  to  remove  a  piece  of  iris  and  the. fragment 
lying  on  or  attached  to  it.  A  coloboma  is  therefore  fre¬ 
quently  the  result,  and,  unless  this  be  situated  above,  the 
eye,  although  safe,  will  remain  with  vision  impaired.  The 
avoidance  of  this  iridectomy  would  therefore  be  a  great 
advantage.  Mr.  Snell  gives  an  account  of  eighteen  cases  in 
which  the  bar  or  electro-magnet  was  used  to  extract  foreign 
bodies  from  the  anterior  chamber.  In  eleven  of  these  the- 
foreign  body  was  successfully  removed  without  iridectomy. 
Here  we  think  this  method  of  treatment  promises  to  be  of 
decided  service. 

For  foreign  bodies  embedded  in  the  lens  the  magnet  has 
been  used  ten  or  eleven  times.  In  every  case  the  cataractousr 
lens  was  removed  either  at  once  or  after  a  short  interval.  Its 
employment  certainly  gives  us  a  security  against  the  possi¬ 
bility  of  the  foreign  body  being  left  behind  on  extraction 
of  the  lens — an  accident  that  has  occasionally  taken  place. 
The  only  recorded  case  of  removal  of  a  foreign  body  from 
the  retina  was  remarkably  successful.  But  as  there  are  now 
several  cases  known  of  the  existence  of  a  fragment  of  iron 
in  the  retina  or  optic  nerve,  without  any  bad  effects  hitherto, 
it  would  hardly  be  advisable  in  ordinary  cases  to  resort  to 
this  method  of  removal. 

Our  author  is  of  opinion  that  it  is  where  “  fragments  are 
situated  in  the  vitreous  chamber  that  the  electro-magnet 
evinces  particularly  its  superiority  over  the  older  methods.” 
This  we  would  certainly  expect,  as  the  usual  fate  of  an  eye- 
in  which  such  an  accident  lias  occurred  is  excision.  Of  the 
fifty-one  cases  in  which  the  electro-magnet  has  been  em¬ 
ployed  for  the  removal  of  foreign  bodies  from  the  vitreous., 
fifteen  have  proved  failures — i.e.,  the  magnet  was  not  power¬ 
ful  enough  to  disentangle  the  piece  of  metal  from  the  coats 
of  the  eyeball.  In  one  of  these  the  fragment  was  removed 
afterwards  by  forceps  and  scissors,  in  eleven  enucleation  was 
necessary,  in  one  excision  was  not  required,  and  in  two  the 
after-treatment  is  not  stated.  Of  the  remaining  thirty-six 
cases,  where  the  foreign  body  was  successfully  removed,  the 
result  was  very  good  (about  normal  vision)  in  six  cases  5 
good  (  V  =  about  :\)  in  six  cases  ;  bare  perception  of  light  or 
exact  result  not  stated  in  ten  cases.  In  the  other  fourteen 
cases  the  eye  was  left  blind ;  in  six  of  them  there  was  sub¬ 
sequent  shrinking,  and  in  four  suppuration,  while  excision 
is  mentioned  as  having  been  found  necessary  in  six  cases. 
Of  these  fifty-one  cases,  then,  the  result  may  be  called 
satisfactory  in  twelve,  which  is  only  moderately  encouraging. 

This  volume  of  Mr.  Snell’s  brings  our  knowledge  of  the 


Medical  Times  and  Gazette. 


THE  OBSTETRICAL  SOCIETY  OF  LONDON. 


Deo.  29,  1883.  757 


subject  well  up  to  date,  and  the  author  deserves  credit  for 
the  care  he  has  bestowed  on  collecting  all  the  cases  hitherto 
published. 


Practical  Pathology  :  a  Manual  for  Students  and  Prac¬ 
titioners.  By  G.  S.  Woodhead,  M.D.,  F.R.C.P.E.  With 
13(3  coloured  plates.  Edinburgh  :  Y.  J.  Pentland. 

On  a  superficial  or  cursory  examination,  this  work  appears 
to  be  very  striking.  Its  title,  appealing  to  the  student  and 
practitioner,  is  sympathetic.  It  is  called  a  practical  treatise, 
is  exceedingly  well  got  up,  and  adorned  with  brilliantly 
coloured  illustrations  inserted  in  the  text.  Starting  at  the 
very  beginning  of  pathological  inquiry,  it  gives  minute 
•directions  (chiefly  Virchow’s)  for  post-mortem  examinations ; 
it  then  discourses  on  reagents  and  staining  fluids,  of  which 
latter  picrocarmine  receives  the  premium.  After  this 
commences  the  descriptive  portion,  which  in  the  various 
chapters  is  composed  of  methods  for  hardening,  cutting,  and 
staining  the  tissues  in  question,  together  with  illustrations 
of  sections  for  the  most  part  coloured  by  picrocarmine. 
Occasionally  some  morbid  anatomy  is  thrown  in,  and  the 
volume  terminates  with  a  chapter  on  micro-organisms. 

A  very  slight  scrutiny,  however,  reveals  unevenness  and 
inconsistency.  For  example,  out  of  399  pages  no  less 
than  106  (more  than  one-fourth  of  the  descriptive  part) 
are  devoted  to  the  liver  and  kidney ;  while,  on  the  other 
hand,  the  eye  is  dismissed  in  a  single  paragraph  of  eleven 
lines,  and  of  the  skin,  bladder,  male  and  female  repro¬ 
ductive  organs  no  mention  is  made,  although  these  organs 
are  of  considerable  importance.  Moreover,  why  should 
the  alimentary  canal,  the  bones  and  joints,  and  nervous 
system  be  deprived  of  the  privilege  of  an  account  of 
their  normal  structure,  when  this  same  privilege  is  ac¬ 
corded  to  the  liver,  kidney,  etc.  P  We  have  referred  to 
the  author’s  partiality  for  picrocarmine,  and  several 
plates  bear  evidence  to  the  effective  results  of  this  stain ; 
yet  the  uncertainty  of  its  vaunted  power  of  selection  is 
shown  in  such  illustrations  as  Figs.  112  and  129,  the  former 
of  which  is  a  pallid  and  the  latter  a  bright  brick-red  blaze. 
After  describing  three  forms  of  scarlet-fever  kidney,  a 
fourth  section  is  devoted  to  subacute  interstitial  nephritis, 
on  the  ground  that  “the  student  will  be  in  a  position  to 
understand  the  more  chronic  forms  of  nephritis.”  Con¬ 
trast  this  wealth  of  renal  histology  with  the  poverty  of 
the  nervous  diseases,  for  the  description  of  which  we  are 
apologetically  referred  to  “  the  systematic  text-books.”  We 
fancy  we  should  prefer  a  systematic  to  a  practical  treatise. 
Perhaps  these  few  instances  will  be  sufficient  to  point  out 
the  kind  of  defect  by  which  this  book  is  handicapped ;  and 
in  taking  leave  of  it  we  congratulate  the  author  on  the  ex¬ 
cellence  of  his  euphemistic  paraphrase  for  compilation,  and 
on  the  fulness  of  his  gratitude  to  Profs.  Sanders,  Hamilton, 
■and  Grenfield  for  two  courses  of  lectures  on  which  “the 
work  is  based.”  Yet,  notwithstanding  the  many)deficiencies 
and  discrepancies,  we  are  disposed  to  think  that,  seeing 
these  faults  are  those  of  haste  rather  than  of  incompetence, 
future  editions  may  improve  upon  the  present,  for  the  work 
is  based  upon  a  logical  plan,  and  has  the  additional  merit 
of  introducing  certain  new  features. 


Note-Book  for  Post-mortem  Examinations.  By  Byrok 

Beamweli,  M.D.  Edinburgh:  Maclachlan  and  Stewart. 

18S3. 

This  consists  of  a  series  of  outlines  to  be  filled  in  at  the 
time  of  making  the  post-mortem  •  some  of  them  provide  only 
for  partial  post-mortems,  others  for  inspection  of  the  whole 
body.  The  absence  of  any  provision  for  recording  the  state 
of  the  internal  ear  strikes  us  as  an  omission  which  would 
not  be  likely  to  Be  made  in  so  exhaustive  an  examination  as 
is  in  other  respects  arranged  for.  We  assume  that  the  line 
•devoted  to  the  external  organs  of  generation  is  intended  to 
include  a  description  of  the  state  of  the  testes  as  well  as  the 
penis.  With  these  exceptions  we  readily  grant-  that  each 
outline  is  so  full  that  any  record  taken  by  its  aid  should 
leave  little  to  be  desired  in  the  way  of  completeness.  The 
book  almost  necessitates  the  presence  of  a  second  person  at 
the  post-mortem  examination,  which  will  restrict  its  use  in 
great  measure  to  hospital  practice  ;  and,  indeed,  to  fill  in 
all  the  details  that  it  asks  for  would  require  more  leisure 
than  most  practitioners  could  spare  to  a  post-mortem  in 
private. 


REPORTS  OF  SOCIETIES. 

- ♦ - 

THE  OBSTETRICAL  SOCIETY  OF  LONDON. 

Wednesday,  December  5. 

Dr.  Gervis,  President,  in  the  Chair. 

The  Effect  of  the  Forces  and  Resistances  of  Labour 
in  producing  Lateral  Flexion  of  the  Foetal  Head. 
Dr.  Galabin  showed  three  diagrams  to  illustrate  the  view 
as  to  this  subject,  which  he  had  formerly  brought  before 
the  Society,  viz.,  that  whenever  the  head  was  so  shaped,  by 
prominence  of  the  parietal  tubera,  that  the  biparietal 
diameter  was  greater  than  oblique  diameters  slightly  in¬ 
clined  to  it,  so  that  a  lateral  obliquity  secured  a  mechanical 
advantage  by  bringing  into  any  diameter  of  the  pelvis 
opposed  to  the  head  a  smaller  diameter  than  the  biparietal, 
and  when  also  there  was  any  notable  pressure  upon  the  head 
at  the  ends  of  its  transverse  diameters,  then  the  effect  of 
this  pressure  upon  the  head  was  to  promote  lateral  obliquity 
up  to  the  point  at  which  mechanical  advantage  was  gained, 
and  beyond  that  point  to  counteract  it.  Diagram  1  showed 
a  head  engaged  in  the  pelvis,  with  a  lateral  obliquity  of 
about  seven  degrees.  Here  it  was  shown  that  both  pres¬ 
sures  and  propelling  force  tended  to  increase  the  obliquity. 
Diagram  2  showed  a  head  engaged  in  the  pelvic  cavity,  with  a 
lateral  obliquity  of  about  fifteen  degrees.  Here  it  was  shown 
that  the  pressures  tended  to  diminish  the  displacement,  but 
the  propelling  force  to  increase  it.  Diagram  3  showed  a 
head  arrested  above  the  brim,  with  a  lateral  obliquity  of 
about  fifteen  degrees.  Here  it  was  shown  that  both  resist 
ances  and  propelling  force  tended  to  increase  the  obliquity. 
The  mechanism  producing  this  lateral  obliquity  was  ana¬ 
logous  to  that  which  produced  chin-flexion. 

The  Mechanism  of  Labour,  more  especially  with 
reference  to  Naegel^’s  Obliquity  and  the  Influence 
of  the  Lumbo-Sacral  Curve. 

This  paper,  by  Dr.  Robert  Barnes,  was  then  read.  The 
author  quoted  Naegele’s  description  of  the  obliquity  of  the 
head  as  it  presents  at  the  pelvic  brim.  He  next  examined 
the  theory  of  those  who  hold  that  the  axes  of  the  pelvic 
brim,  uterus,  and  foetus  coincide.  He  showed  that  while 
Naegele  held  the  same  view  as  his  opponents  as  to  the  in¬ 
clination  of  the  pelvis  to  the  horizon,  he  did  not  deduce 
from  it  that  the  uterus  and  foetus  presented  with  their 
axes  coincident  with  that  of  the  pelvic  brim.  The  author 
examined  this  view,  and,  appealing  to  the  frozen  sections 
of  Braune  and  Chiara,  showed  that  the  uterine  axis  forms 
a  considerable  angle  with  the  axis  of  the  pelvic  brim. 
He  demonstrated  the  difference  between  the  heart-shaped 
brim  of  the  pelvis  and  the  circular  cavity  of  greater  capacity 
than  the  brim,  and  therefore  that  the  head  passing  the  brim 
must,  under  the  law  of  accommodation,  and  of  movement  in 
the  direction  of  least  resistance,  rotate  under  the  promontory. 
He  then  described  the  lumbo-sacral  curve,  the  influence  of 
which  upon  labour  had  received  inadequate  attention.  This 
curve  was  represented  by  a  line  drawn  from  the  promontory 
as  a  centre,  with  a  radius  intersecting  the  middle  of  the  plane 
of  the  brim.  This  he  proposed  to  call  Barnes’s  curve.  It  is 
the  counterpart  for  the  brim  of  Carus’s  curve  for  the  outlet. 
The  resultant  of  the  two  forms  a  sigmoid  curve  beginning  at 
the  fundus  of  the  uterus  and  ending  at  the  outlet  of  the 
pelvis.  He  called  it  the  parturient  curve.  He  showed  that 
the  driving  force  acts  in  a  line  forming  an  angle  behind  the 
axis  of  the  brim,  and  that  therefore,  under  the  combined 
action  of  the  convex  lumbo-sacral  curve,  and  of  the  rela¬ 
tion  of  the  uterine  and  foetal  axes  by  an  angle  behind 
the  brim  axis,  the  head  cannot  enter  synclitically — 
that  is,  with  its  base  or  transverse  section  parallel  with 
the  brim  plane.  He  showed  that,  from  the  curve  of 
the  parturient  canal,  the  irregular  shape  of  the  head, 
and  the  non-coincidence  of  the  three  axes,  all  the  conditions 
of  true  synclitism  are  wanting.  He  then  referred  to  the 
part  borne  by  the  planes  of  the  uterus.  The  first,  resting  on 
the  lumbo-sacral  curve,  helps  to  guide  the  head  to  the  brim 
in  obliquity;  the  second  guides  the  head  backwards  into  the 
sacral  cavity  and  under  the  promontory,  completing  the 
lower  course  of  Barnes’s  curve  ;  the  third,  or  perineal  plane, 
throws  the  head  forwards  to  the-  outlet  in  Carus’3  curves 


758 


Medical  Times  and  Gaiette. 


ACADEMY  OF  MEDICINE  IN  IRELAND. 


Dec.  29, 1888- 


He  next  demonstrated,  from  Galabin’s  and  his  own  measure-  ] 
ments,  that  there  is  a  distinct  gain  in  presenting  the  I 
oblique  diameter  instead  of  the  biparietal  to  the  brim,  the  ■ 
point  especially  insisted  upon  by  Naegele.  He  illustrated 
the  theory  of  normal  obliquity  by  comparison  with  that  of 
labour  with  brim-contraction,  showing  that  the  importance 
of  the  lumbo-sacral  curve  increases  with  the  degree  of  con¬ 
traction,  but  that  the  same  law  prevails  throughout  all 
labours.  He  concluded  by  submitting  that  the  objections 
urged  against  Naegele’s  obliquity  are  vitiated  by  erroneous 
assumptions ;  that  there  is  an  adequate  reason  for  this  obli¬ 
quity,  and  an  adequate  mechanism  to  produce  it ;  and  that 
it  is  a  real  and  necessary  result  of  the  combined  action  of 
the  factors  working  in  the  mechanism  of  labour.  The 
memoir  was  illustrated  by  several  diagrams. 

The  President  thanked  Dr.  Barnes  for  his  erudite  and 
interesting  paper.  He  (the  President)  had,  in  his  earlier 
years,  influenced  much  by  Dr.  Tyler  Smith,  accepted 
Naegele’s  view  as  to  the  brim  obliquity.  Subsequently,  the 
writings  of  Duncan  and  others  had  led  him  to  doubt  it. 
After  studying  Dr.  Galabin’s  paper  on  the  subject,  he  had 
come  to  the  conclusion  that  while,  in  the  case  of  a  well-formed 
pelvis  and  head  of  average  size,  the  head  entered  the  brim 
perpendicularly  to  the  brim  plane,  yet  that  when  the  brim 
was  even  slightly  contracted,  new  conditions  prevailed,  and 
there  was  a  gain  in  the  obliquity  of  Naegele.  He  expressed 
the  gratification  of  the  Fellows  present  in  seeing  Dr. 
Wiltshire  again  among  them. 

Dr.  Matthews  Duncan  said  that  the  mechanism  of  natural 
and  unnatural  labour  had  very  little  in  common  with  a 
view  to  Naegele’s  obliquity.  The  “curve  of  the  false  pro¬ 
montory,”  or  “  Barnes’s  curve,”  had  no  importance  in 
natural  parturition.  In  the  flat  pelvis  the  head  followed  this 
curve.  The  question  could  not  be  settled  with  mathematical  J 
exactness.  It  was  one  for  simple  observation,  not  for  in¬ 
genious  argument.  As  a  matter  of  fact,  he  did  not  find  the  j 
right  parietal  bone  enter  the  pelvis  first ;  nor  did  he  find  the 
caput  succedaneum  of  early  labour  form  upon  that  bone,  but 
upon  the  vertex.  It  was  only  in  late  labour  that  it  was 
formed  on  the  right  parietal  bone.  He  held  that  the  axes 
of  the  pelvis,  uterus,  and  foetus  were  practically  coincident. 
The  frozen  sections  appealed  to  by  Dr.  Barnes  were  not 
faithful  representations  of  the  state  during  life.  The  uterus 
during  the  contractions  of  labour  erected  itself,  bringing  its 
axis  into  coincidence  with  that  of  the  brim.  It  was  not 
pushed  back  towards  the  spine,  but  became  more  prominent. 
In  the  “bearing-down”  action  accompanying  labour  the 
recti  muscles  were  not  the  only  ones  which  acted  :  the  dia¬ 
phragm  and  its  crura  acted  as  well,  forming  a  dome,  which 
supported  and  assisted  the  uterus. 

Dr.  Galabin  had  frequently  observed  Naegele’s  obliquity, 
not  in  easy  labours,  but  in  cases  in  which  there  was  no  de¬ 
formity,  but  the  head  met  with  considerable  resistance.  He 
ascribed  it  chiefly  to  the  lateral  pressures  on  the  head  in  the 
pelvis,  as  shown  in  the  diagrams  he  had  exhibited.  A  head 
with  a  large  biparietal  diameter  thrown  directly  across  the 
canal  was  in  a  position  of  unstable  equilibrium,  like  a  head  in 
a  position  of  brow-presentation.  He  could  not  understand 
how  Dr.  Barnes  considered  that  the  posterior  obliquity  of  the 
uterus  helped  to  produce  Naegele’s  obliquity.  Such  uterine 
obliquity  would,  until  the  resistance  came  into  play,  tend  to 
produce  the  opposite  of  Naegele’s  obliquity.  But  he  did  not 
think  that  posterior  obliquity  of  the  uterus  -was  nearly  so 
great  as  might  appear  from  frozen  sections.  He  could  not 
accept  Dr.  Barnes’s  account  of  the  action  of  the  anterior 
uterine  valve,  for  he  did  not  think  that  displacement  of  the 
os  uteri  backwards  was  a  regular  occurrence.  The  effect  of 
uterine  obliquity  in  producing  obliquity  of  the  head  was  only 
in  operation  while  the  force  was  transmitted  through  the 
condyles.  While  the  liquor  amnii  was  retained,  the  force 
acted  in  the  axis  of  the  pelvis,  and  had  no  tendency  to 
produce  obliquity. 

Dr.  Champneys  agreed  with  Dr.  Galabin,  that  the  first 
effect  of  posterior  obliquity  of  the  uterus  would  be  to  pro¬ 
duce  the  opposite  of  Naegele’s  obliquity.  He  pointed  out  that 
the  condition  known  as  “  pendulous  belly  ”  was  generally 
recognised  as  a  cause  of  exaggerated  Naegele’s  obliquity. 
How  could  these  two  opposite  conditions  (anterior  and  pos¬ 
terior  deflection  of  the  uterus)  produce  the  same  effect,  viz., 
Naegele’s  obliquity  ? 

Dr.  Roper  remarked  that  although  a  slight  advantage 
was  gained  by  the  Naegele  obliquity,  yet  its  practical  im¬ 


portance,  even  in  contracted  pelvis,  was  very  small.  The 
other  obliquities — e.g.,  flexion  and  extension — were  of  in¬ 
finitely  greater  importance. 

Dr.  Barnes  held  that  the  curve  of  the  promontory  was 
important  both  in  natural  and  unnatural  labour,  the  differ¬ 
ence  being  simply  one  of  degree.  It  was  necessary,  for 
synclitism,  that  the  axes  of  the  uterus,  foetus,  and  pelvic 
brim  should  be  absolutely,  not  merely  practically,  coinci¬ 
dent,  for  the  slightest  deviation  would  be  enough  to  cause- 
obliquity  of  the  head.  He  thought  that  the  frozen  sections 
were  essentially  true  representations  of  nature.  There  was 
no  evidence  that  the  crura  of  the  diaphragm  contracted  in 
such  a  way  as,  or  that  the  diaphragm  had  the  power,  to  drive 
the  uterus  forward  against  the  abdominal  muscles.  If 
during  turning  the  direction  of  the  force  were  observed,  it 
would  be  found  to  lie  behind  the  axis  of  the  pelvic  brim. 
He  had  observed  cases  of  labour  very  carefully,  and  had' 
observed  the  presence  of  the  Naegele  obliquity  from  the 
beginning  of  labour. 


ACADEMY  OF  MEDICINE  IN  IRELAND. 

Pathological  Section. — Friday,  November  30. 

A.  H.  Corley,  F.R.C.S. I., President  of  Section,  in  the  Chair- 


Pseudoglioma. 

Mr.  John  B.  Story  exhibited  an  eyeball  removed  from  a 
boy,  aged  eight  months,  for  puroplastic  inflammation  in  the1 
interior  of  the  globe.  Numerous  microscopic  preparations 
were  shown,  demonstrating  the  pathological  distinctions; 
between  this  disease  and  glioma  retinae,  of  which  three  un¬ 
doubted  specimens  were  exhibited  for  purposes  of  com¬ 
parison.  Mr.  Story  agreed  with  most  authorities  in  holding" 
that  in  some  cases  the  diagnosis  was  so  difficult  that  it  had 
to  remain,  for  a  time  at  least,  uncertain. 

Mr.  Swanzy  said  that,  as  he  understood  the  case,  it  seemed 
to  be  one  of  the  spontaneous  formation  of  pus  in  the  interior 
of  the  eyeball — a  purulent  infiltration  of  the  interior  of  the- 
eyeball,  starting  probably  from  the  choroid.  That  being  so*, 
the  specimen  was  rather  a  rare  one;  for,  according  to  general 
experience,  such  an  occurrence  was  connected  in  some  way" 
with  septic  disease  the  direct  result  of  a  wound  or  injury  to 
the  eyeball,  or  with  septic  blood-disease.  They  knew  that 
this  purulent  choroiditis  might  occur  in  cases  of  metria,, 
or  of  septicaemia  after  surgical  operations,  and  from  other 
causes.  It  also  occurred  in  cerebro-spinal  meningitis.  He- 
was  not  aware  of  any  instance  in  which  it  had  occurred 
spontaneously;  it  was  hard  to  understand  how  it  should- 
He  had  never  seen  a  case  of  purulent  choroiditis  Nin  con¬ 
nexion  with  vaccination  after  inflammation,  but  he  had  seen 
affected  eyes  that  seemed  to  be  the  result  of  purulent  infil¬ 
tration  of  the  choroid,  and  in  cases  in  which  he  learned  that 
there  had  been  inflammation  of  the  arm  after  vaccination- 
It  was  easy  to  understand  septic  matter  being  carried  from 
the  arm  to  the  vascular  coat  of  the  eyeball. 

Dr.  Arthur  Benson  said  there  had  been  great  difficulty 
in  making  an  exact  diagnosis.  Before  the  eyeball  was  ex- 
tractedthere  was  so  much  inflammation  that  he  was  of  opinion 
it  was  not  true  glioma.  On  enucleating  the  eyeball  it  was- 
found  that  the  inflammation  had  extended  to  the  orbit,  and 
that  there  was  further  disease  all  round,  so  that  it  seemed 
as  if  the  case  was  one  for  more  or  less  dissection  ;  but  it 
turned  out  that  there  was  only  a  thickening  of  the  tissues- 
and  no  protrusion  of  anything  through  the  sclerotic. 

Mr.  Story,  in  reply,  said  that  the  occurrence  of  sponta¬ 
neous  suppurative  hyalitis  or  choroiditis  was  very  rare,  bub 
he  did  not  see  why  it  should  be  impossible  for  pus  to  origi¬ 
nate  in  the  eye  any  more  than  elsewhere.  Spontaneous- 
suppuration  had  occurred  in  other  places  in  the  same  child,, 
and  there  were  spots  on  the  skin.  The  occurrence  of  spon¬ 
taneous  suppurative  hyalitis  was  not,  however,  a  thing  un¬ 
known  :  for,  in  a  paper  published  in  the  last  number  of  the-. 
Transactions  of  the  Ophthalmol ogical  Society,  Mr.  Nettleship. 
recorded  several  cases  of  pseudoglioma;  and  Dr.  Brailey,  in 
Guy’s  Hospital  Reports,  recorded  the  occurrence  of  sponta¬ 
neous  suppurative  hyalitis  and  spontaneous  diffused  morbid 
changes  of  the  eyeball.  One  of  the  reasons  for  enucleation 
in  the  case  in  question  was  the  fear  lest  the  second  eye  should 
become  implicated. 


Medical  Times  and  Gazette. 


MEDICAL  NEWS. 


Dec.  29,  1883.  759 


Pebviotjs  Urachus  with  Remarkable  Disease  of 
Bladder. 

Dr.  C.  B.  Ball  exhibited  specimens  taken  from  a  patient 
aged  ten  years.  Twenty  months  previously  to  his  death 
the  patient  was  admitted  into  Sir  Patrick  Dun’s  Hospital, 
suffering  from  incontinence  of  urine.  He  had  frequent 
attacks  of  hsematuria.  The  water  was  alkaline,  and  con¬ 
tained  considerable  quantities  of  pus.  Sounding  gave  nega¬ 
tive  results.  These  symptoms  subsided  under  the  treatment, 
and  he  was  discharged,  but  was  readmitted  January  13, 1883, 
with  urine  flowing  from  the  umbilicus — none  coming  by  the 
urethra.  His  mother  stated  that  three  weeks  before  his 
readmission  a  small  gathering  had  formed  at  the  umbilicus, 
which  broke,  and  since  then  all  the  urine  had  come  by  the 
abnormal  opening.  Attempts  to  pass  any  instrument  by 
the  urethra  into  the  bladder  having  failed,  a  laminaria  tent 
was  placed  in  the  umbilical  opening.  This  was  followed  by 
dribbling  of  urine  from  the  urethra  in  three  hours — the  first 
that  had  passed  naturally  for  seven  weeks.  A  catheter  could 
now  be  passed  without  difficulty,  but  not  retained  in  the 
bladder  Cauterisation  of  the  umbilical  cicatrix,  with  a  sub¬ 
cutaneous  ligature  passed  round  the  umbilicus  when  granu¬ 
lation  was  established,  closed  the  opening  for  ten  days,  but 
fresh  suppuration  supervening,  the  fistula  re-opened.  A 
further  and  more  extended  cauterisation  was’again  followed 
by  closure.  The  bladder  now  to  a  certain  extent  regained 
the  power  of  holding  water,  it  being  noticed  on  one  occasion 
that  he  retained  his  urine  for  two  hours.  Three  weeks  sub¬ 
sequently,  without  apparent  stoppage  of  the  urethra,  the 
umbilical  orifice  again  opened,  urine  now  flowing  by  both 
channels.  A  plastic  operation  was  performed,  and  a  gradual 
closure  of  the  abdominal  opening  took  place.  He  improved 
for  a  time,  but  ultimately  died  from  peritonitis.  A  post¬ 
mortem  examination  was  held.  Upon  opening  the  abdomen 
a  small  quantity  of  fluid  was  found  in  the  peritoneal  cavity, 
with  abundance  of  recent  lymph.  The  omentum  was  ad¬ 
herent  to  the  front  abdominal  wall,  apparently  as  the  result 
of  old-standing  peritonitis.  The  bladder  was  much  con¬ 
tracted  and  the  walls  increased  in  thickness.  Springing 
from  the  fundus  was  an  elongated  tongue-shaped  cavity, 
reaching  up  to  a  level  with  the  umbilicus,  measuring  two 
inches  and  a  half  by  one  inch  and  a  half.  Upon 
opening  the  bladder  a  number  of  new  growths  were 
found,  resembling  in  appearance  the  columns!  carnese 
of  the  heart.  Some  were  attached  by  one  extremity  only ; 
others  by  both  ends,  a  space  being  left  between  the  side  and 
the  wall  of  the  bladder ;  they  also  frequently  intersected. 
The  microscopic  examination  of  these  growths  showed 
them  to  be  composed  of  fibrous  tissue  covered  with  mucous 
membrane.  There  was  no  evidence  of  true  papillary  struc¬ 
ture.  The  obstruction  to  the  urethra  was  caused  by  a 
septum  attached  posteriorly,  immediately  below  the  openings 
of  the  ureters,  and  stretching  to  the  front  wall.  This  was 
divided  in  opening  the  bladder.  Springing  from  the  fundus, 
the  cavity  before  mentioned  communicated  with  the  bladder 
by  a  large  opening,  and  its  walls  contrasted  markedly  with 
the  bladder-walls,  being  exceedingly  thin  and  smooth  on  the 
surface.  In  the  front  of  this,  two  openings  communicated 
with  the  peritoneal  cavity,  by  means  of  which  the  fatal 
extravasation  took  place.  A  microscopic  examination  of 
the  wall  of  this  cavity  showed  it  to  be  lined  with  mucous 
membrane,  thus  demonstrating  the  fact  that  this  was  a 
case  of  dilated  urachus.  The  ureters  and  kidneys  presented 
appearances  of  long-standing  bladder-destruction. 

The  President  said  he  saw  the  case  while  the  patient 
was  in  hospital,  and,  seeing  now  the  result  of  the  post-mortem, 
he  did  not  quite  agree  in  the  opinion  that  the  urachus  was 
completely  obliterated.  Obstructions  in  either  the  bladder 
or  the  urethra  had  such  a  degree  of  force  that  they  would 
enlarge  an  unobliterated  urachus. 

Dr.  Benson  said  Dr.  Ball’s  case  reminded  him  of  one  of  a 
man  in  the  City  of  Dublin  Hospital,  who  came  there  for  a 
chest  affection.  Whilst  at  hospital  he  directed  attention  to 
a  small  lump  about  an  inch  below  the  umbilicus.  It  got 
larger,  grew  soft,  and  was  opened.  The  man  died  of  chest 
disease  and  kidney  disease  combined ;  and  they  traced  an 
abscess  backwards  into  the  cavity  of  the  abdomen,  and  found 
that  it  originated  in  the  apex  of  the  wall  of  the  bladder. 
The  abscess  had  evidently  commenced  in  a  posterior  part  of 
the  wall  of  the  bladder.  He  was  doubtful  at  the  time 
whether  it  could  be  ascribed  to  the  urachus  or  not.  He 


searched  for  the  urachus  at  the  time,  but  found  no  trace- 
of  it. 

Dr.  Bennett  observed  that  this  case  had  a  greater  surgical, 
than  pathological  interest ;  but  the  Section  was  of  course 
limited  to  the  latter  view.  The  difficulty  of  diagnosis  in 
such  cases  was  extreme.  He  had  seen  the  case  with  his 
colleague  from  the  beginning,  and  he  could  not  arrive  at 
anything  like  a  satisfactory  diagnosis  of  it.  The  extreme 
freedom  with  which  a  probe  passed  in  the  first  instance 
suggested  the  possibility  of  a  pervious  urachus.  The? 
great  practical  point  was,  that  notwithstanding  in  other 
respects  the  boy  was  in  comparatively  good  health,  yet, 
whether  surgical  interference  was  resorted  to  or  not,  his  life 
hung  on  a  thread.  Although  trifling  external  conditions 
were  presented,  the  case  might  have  become  disastrous  at 
any  moment  by  rupture. 

Mr.  Story  thought  Dr.  Ball  had  laid  too  much  stress  on 
the  supposed  existence  of  a  membranous  diaphragm  in  the- 
bladder.  He  said  that  in  the  early  part  of  the  case  he  co  uld 
pass  a  probe  through  the  umbilicus  and  a  catheter  through 
the  urethra.  If  a  membranous  diaphragm  had  been  there 
he  could  not  have  done  so.  Possibly  the  membranous  dia¬ 
phragm  was  only  of  partial  extent. 

Dr.  Ball,  in  reply,  said  that  where  an  obliteration  repre¬ 
sented  the  urachus  there  was  some  trace  of  a  mucous 
membrane  to  be  found  in  the  middle  of  it.  He  did  not 
mean  to  convey  that  that  was  pervious.  The  first  time  the 
boy  was  brought  to  the  hospital  great  difficulty  was  found 
in  passing  the  sound,  his  first  attempt  to  do  so  being  a 
failure;  but  Dr.  Bennett  succeeded  in  passing  a  sound  by 
depressing  the  handle.  Afterwards  he  passed  a  catheter 
through  the  urethra,  and  a  probe  through  the  urachus,  and 
made  them  touch. 


The  rest  of  the  meeting  was  occupied  by  a  discussion  on 
a  specimen  of  Cystic  Sarcoma  of  the  Breast  which  was 
exhibited  by  Dr.  Bennett,  and  a  case  of  Tumour  of  the 
Dura  Mater  brought  forward  by  Dr.  Walter  Beatty. 


MEDICAL  NEWS. 

- - 

TJ jvi ve rsit Y  of  Dublin. — -At  the  Winter  Commence¬ 
ments,  held  at  the  close  of  Michaelmas  Term,  on  Wednesday,. 
December  19,  18S3,  in  the  Examination  Hall  of  Trinity 
College,  the  following  degrees  in  Medicine  and  Surgery  were 
conferred  by  the  University  Caput,  viz.  :  — 

Baccalaurei  in  Ohirurgid.  —Alexander  Ambrose  [stip.  cond.),  Henricus 
Edmundus  Blandford,'  Carolus  Calthorpe  de  Burgh  Daly,  Gulielmus 
Nedham  Denniag,  Georgius  Magill  Dobsou,  Gulielmus  Gualterus  Fenton, 
Robertus  Howard  Fleming,  Arturus  Fredericus  Gulielmus  Geoghegan,. 
Jacobus  Sullivan  Green,  Henricus  M‘Q,uade,  Ricardus  Miller,  Ricardus 
Nunn,  Glascott  Hardy  Symes,  Robertus  Edvardus  Sproule. 

Baccalaurei  in  Medicind.—  Alexander  Ambrose,  Carolus  Calthorpe  de 
Burgh  Daly,  Gulielmus  Nedham  Denning,  Harloe  Henricus  Fleming, 
Arturus  Fredericus  Gulielmus  Geoghegan,  Jacobus  Sullivan  Green,  CaroBus 
Randolph  Kilkelly,  Ricardus  Miller,  Ricardus  Nunn,  Glascott  Hardy 
Svmes. 

Doctores  in  Medicind.— Alexander  Ambrose,  Thomas  Donelly,  Georgius 
Chadwick  Kingsbury  (stip.  cond.),  Thomas  Waite  Lewis,  Andreas  Murray,, 
David  Chadwick  Smith,  David  Tucker. 


Royal  College  of  Surgeons  in  Ireland.— At  a 
meeting  of  the  Court  of  Examiners,  held  on  December  10 
and  following  days,  the  undernamed  gentlemen,  having 
passed  their  several  examinations  for  the  Letters  Testi¬ 
monial,  and  taken  the  declaration  and  signed  the  roll,  were 
admitted  Licentiates  of  the  College,  viz.  : — 

Edward  S.  Aherne.  Henry  Osborne  Beattie,  Henry  Bullen  Beattie, 
James  J.  Bolger,  William  Boude,  Henry  J.  Butler,  John  F.  B.  Campbell 
Godfrey  O.  Cuppage,  Edward  B.  Denny,  George  A.  Dreaper,  Thomas  G. 
Drake,  George  B.  A.  Flanagan,  Charles  H.  P.  D.  Graves,  James  W 
Greene,  John  H.  Griffin,  Robert  F.  Herron,  John  Keys,  John  P.  M’Craith, 
Edward  J.  Rvan  MacMahon,  Matthew  M  icnarn  ara,  Francis  J.  Maguire, 
Francis  B.  Manning,  Francis  J.  Maunsell,  Thomas  G.  Miderick,  Andrew 
Murphy,  Wilson  M.  Nugent,  Thomas  O’Donnell,  Edward  G.  Peters, 
Thomas  J.  G.  8heehan,  Charles  N.  Simons,  Henry  W.  Smartt,  Fredetick 
J.  W.  Stoney,  Whitley  Stokes.  Francis  W.  Sullivan,  William  G.  Leman,.. 
Thomas  H.  Torney,  John  J.  Walsh,  Henry  Whitby,  and  Geo.  R.  Williams. 


Apothecaries’  Hall,  London. — The  following  gentle¬ 
men  passed  their  examination  in  the  Science  and  Practice  of 
Medicine,  and  received  certificates  to  practise,  on  Thursday* 
December  20 :  — 

Bean,  Charles  Edward,  Brooklyn  House,  Shepherd’s  Bush,  W. 
Bower,  Edward  Igaatius,  Actou-street,  Gray’s-inn-road,  W.C. 


760 


Medical  Times  and  Gazette. 


NOTES,  QUERIES,  AND  REPLIES. 


Dec.  29, 1883. 


Carvell,  John  Maclean,  East  India-road,  E. 

Ferguson,  Geo.  Henry  Fletcher,  Cly de-road,  Croydon. 

Foot,  Ernest  George,  Bigbury,  near  Kingsbridge,  Devon. 
Hartzhorne,  Bernard  Frederic,  Chichester-road,  Bayswater,  W. 
Harvey,  Frank,  Endsleigh-plaee,  Plymouth. 

Ogg,  George,  St.  Anthony’s,  Newcastle-on-Tyne. 

Bring.  Frederick  Arthur,  Northlands,  Exeter. 

Roe,  Montagu  Walter,  Newland-street,  W. 

Sumpter,  Walter  John  Erneley,  Cley-next-the-Sea,  Norfolk. 
Thirkell,  Joseph,  Aberford,  Leeds. 

The  following  gentleman  also  on  the  same  day  passed  the 
IPrimary  Professional  Examination  : — 

Muspratt,  Ernest  Lambert  Chambers,  King’s  College. 


APPOINTMENTS. 

Bateman,  Alfred  George,  M.B.,  M.Ch.,  L.S.A. — Honorary  Medical 
Officer  to  the  Holloway  and  North  Islington  Dispensary,  vice  J.  Grey 
Glover,  M.D.,  resigned. 

Brown,  John,  L.R.C.P.,  L.S.A. — Re-appointed  Medical  Officer  of  Health 
to  the  Bacup  Sanitary  District. 

Canton,  Frederick,  M.R.C.S.,  L.R.C.P.,  etc. — Dental  Surgeon  to  the 
Dental  Hospital  of  London,  Leicester-square,  vice  A.  Hill,  resigned. 

Chaffey,  W.  C.,  M.B. — Medical  Registrar  to  the  Children’s  Hospital, 
Great  Ormond-street,  vice  Angel  Money,  M.D.,  resigned. 

■Collins,  G.  D.,  M.R.C.S.,  L.S.A.— Medical  Officer  to  the  Broseley  District 
of  the  Madeley  Union. 

Downie,  J.  Walker,  M.B. — Surgeon  to  the  Throat  Department, 
Anderson’s  College  Dispensary,  Glasgow. 

Line,  W.  H.,  B.A.,  M.D.,  etc.  -  Resident  Medical  Superintendent  to  the 
Borough  Hospital  Sor  Infectious  Diseases,  Birmingham. 

'McIntyre,  J.,  M.B. —Surgeon  to  the  Throat  Department,  Anderson’s 
College  Dispensary,  Glasgow. 

'Mayo,  F.  H.,  L.R.C.P.,  M.R.C.S.  —Senior  Resident  Medical  Officer  to  the 
Hospital  for  Sick  Children,  Pendlebury,  Manchester,  vice  W.  C.  Chaffey, 
M.B.,  resigned. 

Oakes,  Arthur,  M.D.,  L.R.C.P.- Honorary  Physician  to  the  Kilburn, 
Maida  Vale,  and  St.  John’s  Wood  General  Dispensary. 

Warner,  E.  H.,  M.B.  and  C.M.  Edin. — Honorary  Assistant-Surgeon  to 
the  Eye  Infirmary,  Newcastle-on-Tyne. 

Young,  John,  M.B.  and  C.M.  Glasg.— Honse-Surgeon  to  the  Scarborough 
Hospital  and  Dispensary. 


DEATH. 

Wheeler,  Thomas  Rivington,  F.R.C.S.,  at  5,  Albion-terrace,  St.  Law- 
rence-on-Sea,  on  December  19,  aged  65. 


VACANCIES. 

Birmingham  General  Dispensary. — Resident  Surgeon.  Salary  £150  per 
annum  (with  au  allowance  of  £30  per  annum  for  cab  hire),  with  fur¬ 
nished  rooms,  fire,  light,  and  attendance.  Candidates  must  be  registered 
and  possess  both  a  medical  and  a  surgical  qualification.  Applications, 
with  original  testimonials  and  certificate  of  registration,  to  be  forwarded 
to  the  Secretary,  on  or  before  January  15. 

33elgrave  Hospital  for  Children,  79,  Gloucester-street,  Pimlico, 
S.W. — Assistant-Surgeon.  (For  particulars  see  Advertisement .) 

Plymouth  Public  Dispensary. — Physician’s  Assistant.  ( For  particulars 
see  Advertisement .) 


UNION  AND  PAROCHIAL  MEDICAL  SERVICE. 

APPOINTMENT. 

Downham  Union. — Donald  Reid,  M.B.,  C.M.  Aber.,  to  the  Wiggenhall 
District. 


NOTES,  QUERIES,  AND  REPLIES. 

- « - 

t^at  qucstianet^  mncjj  s(jall  learn  nutcfj.— Bacon. 


Testimonial  to  Dr.  Rogers. 

The  following  is  the  ninth  list  of  subscriptions  : — Dr.  Eyton  Jones, 
Wrexham,  £1  Is. ;  Dr.  A.  Leachman,  Petersfleld,  £1  Is. ;  Dr.  Grime, 
Blackburn,  £1 ;  W.  Powell,  Esq.,  Cheltenham,  10s.  ;  A.  J.  Moore,  Esq., 
Reading,  10s. ;  E.  R.  Denton,  Esq.,  Leicester,  5s. ;  M.  R.  Behrendt, 
Burrington,  5s. ;  Dr.  B.  Laverick,  Staithes,  5s.,:  Ignotus,  5s. 

A.  E.— Full  directions  for  preparing  the  so-called  artificial  human  milk 
are  to  be  found  in  Playfair’s  “  Midwifery.” 

F>r.  Taylor. — A  brief  resume  of  the  Government  Medical  Bill  appears  in 
one  of  the  leading  articles  in  the  present  issue. 

BOOKS,  ETC..  RECEIVED - 

The  Contagious  Diseases  Acts,  by  C.  B.  Taylor,  M.D.,  etc.— New  Operation 
for  Rupture  of  the  Perineum,  by  J.  Collins  Warren,  M.D. — Transac¬ 
tions  of  the  American  Dermatological  Association— Medical  and  other 
Uses  of  Carbolic  Acid — Coffee  and  Tea,  by  G.  V.  Poore,  M.D.,  etc.— In¬ 
troductory  Addj-ess  to  the  Course  of  Clinical  Lectures  at  the  Hospital  for 
Women,  by  Protheroe  Smith,  M.D. — The  Extra  Pharmacopoeia,  by  W. 
Martindale,  F.C.8. 


COMMUNICATIONS  have  been  received  from — 

Dr.  J.  Matthews  Duncan,  F.R.S.,  London;  Dr.  Mahomed,  London; 
The  Dean  of  King’s  College,  London  ;  Dr.  F.  Warner,  London ;  Mr- 
Wynter  Blyth,  London:  Dr.  Norman  Ciievers,  London ;  Mr.  Mark 
H.  Judge,  London;  The  Editor  of  the  “Sanitary  Engineer,” 
London ;  Dr.  J.  Russell,  Birmingham ;  The  Hon.  Secretary  of  the 
Society  of  Medical  Officers  of  Health,  London  ;  Tiie  Secretary 
of  the  Royal  Institution  of  Great  Britain,  London ;  Dr.  R.  W. 
Burnet,  London ;  Mr.  W.  Whitehead,  Manchester ;  The  Secretary 
of  the  Poor-Law  Medical  Officers’  Association,  London ;  Mr.  J. 
Chatto,  London ;  The  Hon.  Secretary  of  the  Pathological 
Society  of  London  :  The  Secretary  of  the  Hospitals ’Association, 
London;  Messrs.  Saxon  Snell  and  Co.,  London;  Mr.  E.  Cresswell 
Baber,  Brighton;  Messrs.  C.  Mitchell  and  Co.,  London;  Messrs. 
Domeier  and  Co.,  London;  Dr.  Alexander,  Liverpool;  The  Editor 
of  the  “British  Medical  Journal.”  London;  Dr.  Shelly,  Hert¬ 
ford;  Mr.  J.  T.  W.  Bacot,  Seaton;  Dr.  Protheroe  Smith,  London; 
The  Secretary  of  the  South  London  8ciiool  of  Pharmacy,  London; 
The  Hon.  Secretary  of  the  Royal  Institution,  London  ;  Dr.  J.  W. 
Moore,  Dublin ;  Dr.  Thomson,  Glasgow  ;  Mr.  J.  Wickham  Barnes, 
London;  The  Secretary  of  the  Apothecaries’  Hall,  London. 

PERIODICALS  AND  NEWSPAPERS  RECEIVED— 

Lancet— British  Medical  Journal— Medical  Press  and  Circular— Ber¬ 
liner  Klinische  Wochenschrift — Centralblatt  fiir  Chirurgie — Gazett- 
des  Hopitaux — Gazette  Medicale — Revista  de  Medicina— Bulletin  de 
1’  Academie  de  Medecine— Pharmaceutical  J  our  nal — W  iener  Medicinische 
Wochenschrift — Revue  Medicale— Gazette  Hebdomadaire— Nature — 
Boston  Medical  and  Surgical  Journal— Louisville  Medical  News— 
Centralblatt  fiir  Gyniikologie— Le  Concours  Medical— Centralblatt  fiir 
die  Medicinisehen  Wissenschaften — Centralblatt  fur  Klinische  Medicin 
— Philadelphia  Medical  News— Le  ProgrSs  Medical — New  York  Medical 
Journal — Edinburgh  Clinical  and  Pathological  Journal— Students’  Jour¬ 
nal  and  Hospital  Gazette— New  York  Medical  Record— Philadelphia 
Medical  Times —Maryland  Medical  Journal— Journal  of  Cutaneous  and 
Venereal  Diseases — North  Carolina  Medical  Journal— The  Bristol 
Medico-Chirurgical  Journal -Night  and  Day — Revue  d’HygiSne— The 
Detroit  Lancet  —  Correspondenz-Blatt  —  Boy’s )  O  wn  Paper  —  Friendly 
Greetings— Leisure  Hour— Sunday  at  Home -Girl’s  Own  Paper— Revue 
Sanitaire— Journal  of  the  British  Dental  Association— El  Ensayo 
Medico. 


APPOINTMENTS  POP  THE  WEEK, 


December  29.  Saturday  ( this  day). 

Operations  at  St.  Bartholomew’s,  1 J  p.m. ;  King’s  College,  1J  p.m. ;  Royal 
Free,  2  p.m. ;  Royal  London  Ophthalmic,  11  a.m. ;  Royal  Westminster 
Ophthalmic,  14  p.m.;  St.  Thomas’s,  lip.m.;  London,  2  p.m. 

31.  Monday. 

Operations  at  the  Metropolitan  Free,  2  p.m.;  St.  Mark’s  Hospital  for 
Diseases  of  the  Rectum. 2  p.m.;  Royal  London  Ophthalmic,  11  a.m.; 
Royal  Westminster  Ophthalmic,  14  p.m.  ;  Hospital  for  Women,  2  p.m. 


January  1,  1884.  Tuesday. 

Operations  at  Guy’s,  14  p.m. ;  Westminster,  2  p  .m. ;  Royal  London  Oph¬ 
thalmic,  11  a.m.;  Royal  Westminster  Ophthalmic,  14  p.m.;  West 
London,  3  p.m. 


2.  Wednesday. 

Operations  at  University  College,  2  p.m. ;  St.  Mary’s,  1{  p.m. ;  Middlesex, 

1  p.m. ;  London,  2  p.m. ;  St.  Bartholomew’s,  14  p.m. ;  Great  Northern, 

2  p.m. ;  Samaritan,  24  p.m. ;  Royal  London  Ophthalmic,  11  a.m. ; 
Royal  Westminster  Ophthalmic,  14  p.m. ;  St.  Thomas’s,  14  p.m. ;  St. 
Peter’s  Hospital  for  Stone,  2  p.m. ;  National  Orthopaedic,  Great 
Portland-street,  10  a.m. 


3.  Thursday. 

Operations  at  St.  George’s,  1  p.m. ;  Central  London  Ophthalmic,  1  p.m.; 
Royal  Orthopaedic,  2  p.m.;  University  College,  2  p.m.;  Royal  London 
Ophthalmic, 11a.m. ;  Royal  Westminster  Ophthalmic,  14  p.m. ;  Hospital 
for  Diseases  of  the  Throat,  2  p.m. ;  Hospital  for  Women,  2  R.m. ; 
Charing-cross,  2  p.m. ;  London,  2  p.m. ;  North-West  London,  24  p.m. 

4.  Friday. 

Operations  at  Central  LondonOphthalmic,  2  p.m.;  Royal  London  Ophthal¬ 
mic,  11  a.m. ;  South  London  Ophthalmic,  2  p.m. ;  Royal  Westminster 
Ophthalmic,  14  p.m.;  St.  George’s  (ophthalmic  operations),  it  p.m.; 
Guy’s,  14  p.m.  ;  St.  Thomas’s  (ophthalmic  operations),  2  p.m. ;  King’s 
College  (by  Sir  J.  Lister),  2  p.m. 

Pathological  Society,  84  p.m.  Annual  General  Meeting  for  Election  of 
Officers,  Report  of  the  Council,  etc.  The  following  preparations  will  be 
shown  : — Dr.  Norman  Moore — Three  Examples  of  Pancreatic  Disease. 
Dr.  Savage  and  Dr.  Hale  White— Further  Specimens  of  Yacuolation  of 
the  Liver.  Dr.  Heneage  Gibbes— Entozoon  in  the  Lungs  of  an  Animal. 
Mr.  Bowlby- Epithelioma  of  the  Ear.  Mr.  Jessett -Medullary  Sarcoma 
of  the  Skull  of  a  Child. 


TERMS  FOR  ADVERTISEMENTS. 


Seven  lines  . 

Each  additional  line . 
Half-column,  or  quarter-page  . 
Whole  column,  or  half -page 
Whole  page  . 


,£0  3  6 
0  0  6 
12  6 
2  5  0 
4  10  0 


The  Medical  Times  is  published  on  Friday  morning :  Ad¬ 
vertisements  must  therefore  reach  the  Publishing  Office 
not  later  than  One  o’clock  on  Thursday. 


Medical  Times  and  Gazette. 


INDEX. 


Dec.  29,  1883.  761 


INDEX. 


A 

Aberdeen  University,  pass-lists  of  the,  251 
regulations  of  the,  294 
opening  of  the  medical  session  of  the,  520 
Academy  of  Medicine  of  Paris,  associate  members 
of  the,  666 

in  Ireland,  meeting  of  the,  23 
Acland,  Dr.  address  of,  at  King’s  College,  "31 
Acne  rosacea,  Yleminckx’s  solution  in,  228 
Acorns,  estimate  of  the  utility  of,  492 
Adam,  Dr.  John  Mitchell,  death  of,  443 
Airy,  Dr.  on  diphtheria  at  Coggeshall,  439 
at  Great  Dunmow,  696 

Alexander,  Dr.  W.,  Mineral  Waters  of  Scar¬ 
borough,  notice,  108 

Alimentation,  artificial,  powdered  blood  in,  22 
Alkali  works,  Dr.  Angus  Smith’s  report  on,  268 
Allbutt,  Dr.  Clifford,  address  of,  to  the  Leeds 
students,  importance  of  the,  425 
Allchin,  Dr.  on  teaching  physiology  in  schools, 
712 

Allen,  Dr. Harrison,  System  of  Human  Anatomy, 
review,  247 

Allis,  Dr.  on  the  treatment  of  fracture  of  the 
cervix  femoris  in  the  aged,  755 
Althaus,  Dr.  case  of  syphilitic  tumours  of  mem¬ 
branes  of  brain,  631,  559 

Ambulance  Association  (St.  John),  report  of  the, 
433  . 

Amputation,  double,  of  the  arms,  Mr.  Godlee’s 
case  of,  374 

for  senile  gangrene,  Mr.  Hutchinson  on,  at 
the  joints,  699 

sponge-dressing  after,  Dr.  McClellan  on,  498 
Amsterdam  Medical  Congress,  Drs.  Duckworth 
and  Ewart’s  report  on  the,  611 
Anaemia  as  a  cause  of  retinal  haemorrhage,  725 
progressive,  arsenic  in,  Dr.  Warfvinge  on,  128 
Anaesthesia  and  Anaesthetics,  Dr.  Lyman  on, 
review,  277 

Anaesthetic,  ether  as  an,  Dr.  Phillips  on,  261 
Anderson,  Dr.  McCall,  diagnosis  of  diseases  of 
the  skin,  229 

Andrews  (St.),  University  of,  regulations  of  the, 

291 

Aneurysmal  dilatation  of  the  radial,  673 
Aneurysm,  arterio-venous,  Mr.  Pick  on  a  case  of, 
677 

spontaneous  inguinal.  Mr.  Turner’s  case  of, 
with  discussion,  573,  5S6 
abdominal,  rupture  of  an,  Dr.  Coupland’s 
case  of,  65 

cardiac,  Dr.  Legg  on,  19  ,  214 
in  the  corpus  striatum,  Dr.  Bastian’s  case  of, 
530 

vide  Aorta 

Angina  pectoris,  varieties  of.  Dr.  Huchard  on 
the,  72 

Antiseptic  dressing,  sugar  as  an,  360 
Antiseptics,  Prof.  Lister  on  the  rigid  rules  for,  575 
Anthropometric  Committee,  report  of  the,  as 
regards  Britain,  460 
Anus,  fissure  of  the,  iodoform  in,  80 
Aorta,  aneurysm  of  the  abdominal,  rupture  into 
the  duodenum,  case  of,  65 
aneurysm  of  the,  in  China,  Dr.  Manson’s  re¬ 
port  on, 274 

Aphasia,  word-blindness  in,  Prof.  Charcot  on,  45 
Apnoea  or  asphyxia,  Dr.  A  H  <rvey  on,  622,  649 
Apoplexy  in  a  boy,  Dr.  Bastian' s  case  of,  530 
Apothecaries’  Society,  pass-fists  of  the,  26,  55,  84, 
112,  142,  196,  225,  252,  280,  .319,  359,  388, 
415,  443,  475,  604  ,  533,  569,  590,  617,  646, 
673,  702,;730,  759 
regulations  of  the,  v99 
Hall,  Ireland,  regulations  of  the,  303 
Arbutin,  properties  of,  43 

Archambault,  Dr.  (of  Paris),  obituary  notice  of, 
101 

Armies,  hygiene  of,  in  the  field,  Mr.  Eawlingson 
on,  4 

sanitation  of,  Mr.  Chadwi ck  on,  5 
Army,  hospital  accommodate  ou  for  officers  of  the, 
465 


Army  medical  officers,  Lord  Wolseley  on,  6 

medical  organisation,  Surgeon-Major  Evatt 
on,  662 

doctors,  past,  present,  and  future,  8 

“A  Surgeon-General”  on  distinctions  con¬ 
ferred  on,  162 

Medical  Department,  report  of  the,  analysis 
of,  580,  607 

successful  candidates  for  the,  217 
regulations  and  payments  in  the,  332 
alleged  shortcomings  of  the,  in  Egypt, 
vide  Egypt 

recommendations  of  Lord  Morley’s  Com¬ 
mittee  on  the,  38 
Viscount  Bury  on  the,  102 
observations  on  the,  212 
Medical  School,  marks  of  surgeons  on  proba¬ 
tion  at  tfie,  161 

distribution  of  prizes  at  the,  166 
the  French,  and  the  Marine,  mortality  of,  63S 
the  German,  tuberculosis  in,  722 
Arsenic  of  wall-papers,  etc.,  report  of  the  Com¬ 
mittee  on,  49 

hydrated  oxide  of  iron  as  an  antidote  to,  682 
Ashburner,  Mr.  Henry  John,  death  of,  730 
Ashby,  Dr.  and  Mr.  Hehner  on  sewage  contami¬ 
nation  of  water,  67 
Ashton,  Dr.  Thomas,  death  of,  730 
Asphyxia,  Dr.  A.  Harvey  on,  623,  649 
Association,  the  British  Medical,  fifty-first  meet¬ 
ing  of,  report  of  the,  135,  163 
address  of  the  President,  115,  127 
Mr.  Reginald  Harrison’s  address  in  Sur¬ 
gery,  119, 156 

Dr.  Creighton’s  address  in  Pathology,  145, 
157 

Dr.  Mercier  on  the.  177 
Dr.  Graily  Hewitt’s  address  to  the  Obste¬ 
trical  Section  of  the,  152 
Dr.  Gee’s  address  to  the  Section  of 
Diseases  of  Children,  173 
Dr.  Schafer’s  address  to  the  Section  of 
Physiology,  2C4 

Social  Science,  proceedings  of  the,  429 
Atkinson,  Mr.  John  Ismay  (of  Wylam-on-Tyne), 
.  obituary  notice  of,  250 

Attfield,  Prof,  address  of,  at  the  Pharmaceutical 
Conference,  352 

Austin,  Mr.  Alfred,  article  of,  on  “Homes  of  the 
Rich,”  criticised,  656 

Australia,  hydatid  disease  in,  Dr.  Barrett  on,  678 
Ayrton,  Mrs".  Chaplin,  M.D.  obituary  notice  of,  195 

B 

Bacillus  tuberculosis,  vide  Tuberculosis 
Bacteria  in  relation  to  disease,  615 
as  forms  of  fibrin,  670 
Dr.  Bechamp  on,  as  effects  of  disease,  698 
Baker,  Mr.  on  epiphysial  necrosis,  165 
Balding,  Mr.  James,  death  of,  388 
Ball,  Dr.  on  a  pervious  urachus,  769 
Barker,  Dr.  case  of  tubercular  disease  of  the 
tongue,  673 

Barnes,  Dr.,  Synoptical  Guide  to  the  Study  of 
Obstetrics,  notice,  22 
on  the  mechanism  of  labour,  660,  757 
Baronets,  medical,  and  surgical,  506,  683 
Barratt,  Dr.  Edgar,  death  of,  673 
Barrett,  Dr.  on  picric  acid  as  a  test  for  sugar, 
469 

Dr.  James,  on  hydatid  disease  in  Vifctoria,  678 
Barrow,  Mr.  B.  address  of,  at  the  Westminster 
Hospital,  409 

Barrow-on-Soar,  sanitary  state  of,  497 
Bartholomew’s  (St. )  Hospital  Reports,  vol.  xviii. 
notice,  194 

cases  treated  at,  514,  643 
Medical  School,  scholarships  and  prizes  of 
the,  303 

Bartlett,  Mr,  Joseph  James  Henry,  death  of,  252 
Barton,  Mr.  on  excision  of  the  hip-joint,  23 
Bastian,  Dr.  on  a  case  of  cerebro-sninal  sclerosis, 

451 


Bastian,  Dr.  on  a  ease  of  apoplexy  in  a  boy> 
530 

case  of  aneurysm  in  the  corpus  striatum,  530 
Bayer,  Dr.  on  rhabdomyoma  of  the  orbit,  101 
Bechamp,  Dr.  Les  Microzymes ,  review,  698 
Beddoe,  Dr.  on  educational  over-pressure,  469 
Beds,  Chinese  hospital,  638 

Bell,  Mr.  James,, Analysis  and  Adulteration  of 
Foods,  review,  53 

Dr.  Joseph,  Manual  of  Operations,  notice,  557 
Surgeon-Major  Dr.  George  Coates,  death  of, 
562 

Mr.  Royes,  case  of  fractured  patella,  597 
Belladonna,  ingestion  of,  by  a  child,  373 
Bellamy,  Mr.  case  of  removal  of  the  jaws,  453 
case  of  fibro-cystic  bronchocele,  737 
Bennet,  Dr.  Henry,  on  the  os  uteri  internum,  469- 
Bennett,  Mr.  W.  H.  address  of,  at  St.  George’s- 
Hospital,  408 
criticism  on  the,  426 
Dr.  Hughes,  on  spastic  paralysis,  507 
Bentley,  Prof,  testimonial  to,  488 
Beriberi,  Dr.  Marie  on,  606 
Berlin,  as  compared  with  London,  282 
hospital  returns  of,  for  1882,  14 
Bert,  Prof.  Paul,  on  administering  chloroform 
with  air,  722 

Berthier,  Dr.  F.  (of  Aix-Ies-Bains),  death  of,  359 
obituary  notice  of,  464 

Bile,  influence  of  alkalies  on  the  composition  of, 
73 

Bird,  Mir.  Golding,  case  of  dislocation  of  the  jaw,. 
633 

Birds,  tuberculosis  in,  Mr.  Sutton  on,  601,  613 
Birmingham,  sanitary  state  of,  in  1882,  746 
Blache,  Dr.  on  the  cephalalgia  of  adolescence,  191 
Bladder,  exploration  of  the,  by  median  urethro¬ 
tomy,  Mr.  Morris  on,  98 
tumours  of  the,  improvements  in  treating,. 

Mr.  R.  Harrison  on  the,  121 
disease  of  the,  with  pervious  urachus,  759 
seirrhus  of  the,  specimen  of,  473 
rupture  of  the,  without  external  sign,  476 
Blanc,  Dr.  L6on,  Mineral  Waters  of  Aix-les- 
Bains,  notice,  108 

Blaxall,Dr.  report  of,  on  typhoid  fever  at  Weston- 
super-Mare,  219 

Blind,  condition  of  the,  in  Japan,  177 

diminution  in  the  number  of,  in  England,  721 
Blood,  powdered,  in  artificial  alimentation,  Dr. 
Guerder  on,  22 

Blyth,  Mr.  Louis  Gwyn,  death  of,  617 
Bond,  Prof.  Henry  John  Hayles,  death  of,  280 
Dr.  Francis,  on  scarlatinoid  diseases,  578 
Bone,  chronic  inflammation  in,  Mr.  Symonds  onr 
165 

disease  of,  in  monkeys,  Mr.  Sutton  on,  474 
Books,  reviews  and  notices  of,  21,  51,  80,  107,. 
192,  247,  275, 356, 385, 468,  499,  527,  557,  683, 
609,  639,  670,  698,  722,  756 
Borchardt,  Dr.  Louis  (of  Manchester),  obituary 
notice  of,  615 

Botany,  place  of ,  in  the  curriculum,  658 
Bourneville  and  Bricon,  Manuel  des  Injections 
sous-cutanees,  notice,  358 

Bower  and  Keates,  Messrs,  and  the  Public  Prose¬ 
cutor,  meeting  at  Sir  William  Jennex’s 
respecting,  696,  747  . 

Boyd,  Dr.  R.  fatal  fire  in  the  lunatic  asylum  of, 
188,  267,349 
obituary  notice  of,  249 

Bradford,  Surgeon-Major  Henry,  death  of,  142 
Bradshawe  lecture,  by  Dr.  Legg,  199,  214 
by  Mr.  Marshall,  690,  711 
Brailey,  Dr.  on  sympathetic  ophthalmia,  725 
Brain,  localisation  of  the  functions  of,  Dr.  Ferrier’s- 
address  on  the,  502 
gauge,  observations  on  the,  493 
of  TurgC-nieff,  weight  of  the,  680 
lesions  of  motor  areas  of  the,  Prof.  Charcot 
on,  270 

cortex  of  the,  localisations  in  the,  Prof.  Charco- 
ob,  491 

contusions  of  the,  Dr.  Liddell  on,  ie6 
melanotic  sarcoma  of  the,  473 


”6-  Medical  Times  and  Gazette. 


Brain,  rupture  of  aneurysm  in  the,  Dr.  Bastian’s 
case  of,  530 

syphilis  or  tubercle  of  the,  521 
syphilitic  tumours  of  the  membranes  of  the. 
Dr.  Althaus’  case  of,  531,  559 
vide  Encephalitis 

'Bramwell,  Dr.,  Note-Book  for  Post-mortems, 
notice,  767 

Breast,  cancer  of,  removal  of  axillary  glands  in, 
discussion  on,  at  Berlin,  414 
bony  tumour  in  the,  Dr.  Durham’s  case  of,  612 
Brennecke,  Dr.  on  fungous  endometritis,  684 
Breus,  Dr.  Carl,  on  puerperal  convulsions,  493 
Bright’s  disease,  deafness  and  tinnitus  in,  Dr. 
Turnbull  on,  36 

Bristol,  good  sanitary  state  of,  460 

School  of  Medicine,  scholarships  and  prizes  of 
the,  310 

Bristowe,  Dr.  observations  on  purpura,  87 
British  Medical  Association,  vide  Association 
Brodhurst,  Mr.,  Curvatures  and  Disease  of  the 
Spine,  review,  51 

Broesicke,  Dr.  case  of  chlorate  of  potash  poison¬ 
ing,  526 

Bromide  of  sodium,  superiority  of,  Dr.  Field  on,  91 
Bromides,  improved  administration  of,  Dr.  Seguin 
on,  234 

Bronchitis,  Pathology  of,  Dr.  Hamilton  on,  re¬ 
view,  51 

Bronchocele,  operations  for,  discussion  on,  at 
Berlin,  273 

cachexia  supervening  on.  Prof.  Kocher  on,  693 
at  Tubingen,  Prof.  P.  Bruns  on,  499 
Dr.  L.  Reverdin’s  cases  of,  527 
Dr.  Le  Bee  on,  618 
Mr.  Bellamy  on  a  case  of,  737 
Broomall,  Dr.  Anna,  on  an  improved  Ceesarian 
section,  527 

Brown,  Prof.  Crum,  address  of,  at  Edinburgh,  525 
Dr.  Charles  Robert,  death  of,  590 
Brown-Sequard,  Prof,  the  theory  of  shock  of,  578 
Browne,  Mr.  Charles  Frederick,  death  of,  359 
Bruen,  Dr.  Pocket-Book  of  Physical  Diagnosis, 
notice,  558 

Bruns,  Prof.  P.  on  operations  for  bronchocele,  499 
Buchan,  Dr.  Charles  Forbes,  death  of,  730 
Buchanan,  Dr.  memoranda  on  cholera,  3 
Bufatini  prize-question  for  1884,  280 
Bull,  Dr.  on  operations  in  disease  of  the  lungs,  45 
Bulletins,  medical,  observations  on,  544 
“East-Ender  ”  on,  619 
examples  of  American,  576 
Buret,  Dr.  on  ectopia  of  the  kidney,  357 

C 

Caesarian  section,  Dr.  Anna  Broomall’s  “im¬ 
proved,”  527 

Cambridge  University,  regulations  of,  for  degrees 
_  in  medicine,  287,  619 
list  of  sanitary  science  certificates  at,  443 
Cameron,  Dr.  on  a  standard  of  porter,  242 
Cancer,  statistics  of,  in  Berlin,  484 

development  of,  from  non-malignant  disease, 
1C9 

as  an  infection.  Dr.  Creighton  on,  145 
communicability  of,  684 
vide  Bladder,  Breast,  Prostate 
Cantlie,  Mr.  on  the  cholera  in  Egypt,  521 
Cappie,  Dr.,  Causation  of  Sleep,  review,  22 
Carbolic  acid,  poisoning  by,  case  of,  66 
Cardiac  aneurysm,  Dr.  Legg  on,  119,  214 
muscle,  automatism  of  the,  605 
Carotid  arteries,  thrombosis  of,  case  of,  401 
Carpenter,  Dr.  A.  ideas  of,  on  medical  peerages, 
criticised,  129 

Dr.  W.  B.  on  the  modifiability  of  germs,  717 
Carruthers,  Mr.  R.  B.  appeal  for  the  family  of,  717 
Castor-oil  with  glycerine,  106 
Cathartics  (saline),  Dr.  Hay  on  the  action  of,  241 
Catheter  fever,  Sir  A.  Clark  on,  and  discussion, 
705,  714 

Cathcart,  Dr.  defence  of  football,  662 
Cell,  structure  of  the  animal,  Prof.  Schafer  on, 
204 

Celluloid  collars,  dangers  of,  634 
Cerebro-spinal  sclerosis,  Dr.  Bastian’s  case  of,  451 
Chadwick,  Mr.  on  army  sanitation,  5 
Chambord,  the  Count  of,  illness  and  death  of, 
Prof.  Yulpian  on  the,  355 
Ciiampneys,  Dr.  on  emphysema  and  pneumo¬ 
thorax  after  tracheotomy,  701 
on  the  kyphotic  pelvis,  81 
Charcot,  Prof,  on  word-blindness,  45 

Lectures  on  the  Localisation  of  Cerebral  and 
Spinal  Diseases,  notice,  500 
and  Dr.  Fere  on  the  tabetic  gout,  219 
and  Dr.  Pitrds  on  lesions  of  motor  areas  of 
the  brain,  270 

on  cortical  cerebral  localisations,  491 
Charing-cross  Hospital,  cases  treated  at  the,  452 
Medical  School,  Lord  Wolseley’s  address  at 
the,  6 

scholarships,  medals,  and  prizes  of  the, 
304 

Charpentier,  Prof.  Train  Pratique  des  Accouche- 
vients,  review,  275 


INDEX. 


Chevers,  Dr.  Norman,  practical  notes  on  the  ordi¬ 
nary  diseases  of  India.  63,  90,  153,  208,  232, 
260,  342,  369,  481,  653,  681,  735 
on  urethral  fever,  501 

on  medico-topographical  and  health  histories 
for  districts  and  towns,  537 
Chevreul,  Prof,  remarkable  career  of,  353 
Chiari  and  Riehl,  Drs.  on  lupus  of  the  larynx,  557 
Children,  diseases  of,  Dr.  Gee  on  the  literature  of, 
175 

the  faeces  of  starch-fed.  Dr.  Randolph  on,  262 
need  of  sufficient  water, by,  38S 
development  of  language  in,  754 
vide  Belladonna,  Eczema,  Foods,  Hip-joint, 
Leucorrhoea,  Peritoneal,  Pleurisy,  Sclerosis 
East  London  Hospital  for,  cases  treated  at 
the,  180,  262,  373 

North-Eastern  Hospital  for,  cases  treated  at 
the,  484,  666 

Chinese  hospital-beds,  638 
Chisolm,  Dr.  on  foreign  bodies  in  the  ear,  722 
Chloral,  poisoning  by,  Prof.  Da  Costa  on,  168 
Chloral-psychosis,  749 

Chlorate  of  potash,  poisoning  by,  case  of,  526 
Chloroform,  reminiscences  about,  by  Surgeon- 
General  Francis,  36 
administered  mixed  with  air,  722 
water,  utility  of,  698 
pomade,  417 

Chloroformisation  during  sleep,  question  of,  694 
Cholera,  contagiousness  of,  discussion  on,  at  the 
Amsterdam  Congress,  511 
memoranda  concerning,  Dr.  Buchanan’s,  3 
production  and  prevention  of,  40 
in  relation  to  quarantine,  10,  47 
intraperitoneal  injections  in,  Dr.  Richardson 
on,  124, 180 

feeding  by  the  veins  in,  Dr.  Richardson  on, 
155, 179 

treatment  of,  during  first  stage  and  reaction , 
Dr.  Richardson  on  the,  210 
progress  of.  in  Egypt,  47,  73,  98,  103,  132, 160, 
186,  215.  248,  267,  489 
Dr.  Hunter’s  reports  on  the,  236,  377 
Dr.  Koch’s  report  on  the,  447,  455 
Mr.  Cantlie  on  the,  52 1 
Dr.  Strauss’s  report  on  the,  604 
precautions  concerning,  in  the  metropolis,  97, 
268 

in  the  port  of  London,  134 
in  Dublin,  48,  108 

in  India,  Dr.  Chevers  on,  208,  232,  260,  342, 
369,  481 

Surgeon-General  Cuningham  on  the  epi¬ 
demics  of,  35 
sanitary  lesson  from,  59 
Inspector-General  Lawson  on,  J.38,  169 
Chorea,  relation  of,  to  rheumatism,  429 
Choreic  cough,  Dr.  Granville  on,  584 
Chrysophanic  acid,  erysipelas  following  the  use 
of,  656 

Cinchona,  cultivation  of,  in  India,  Dr.  King's 
report  on  the,  434 

Cicatrices,  bismuth  as  a  dressing  for,  683 

as  a  preventivd  of  contraction  of,  754 
Cicatrix,  ossifying  chondrosarcoma  in  a,  Mr. 
Durham  on,  612 

Civilisation  as  the  result  of  intellectual  progress, 
Dr.  Pettigrew  on,  576 

Clark,  Dr.  Alonzo,  on  oxygen  in  gas-poisoning, 

362 

Mr.  Le  Gros.  address  of,  at  St.  Thomas’s,  409 
on  compensation  after  railway  accidents, 
529 

Sir  Andrew,  on  catheter  fever,  and  discussion, 
705,  713 

Clavicle  and  scapula,  incomplete  fractures  of  the, 
604 

Clinical  papers,  546,  659 

Clinical  Society,  reports  of  meetings  of  the,  471, 
530,  58 1,  640,  716,  726 

Clouston,  Dr.  Charles  Stewart,  death  of,  359 
Club-foot,  pathology  of,  Messrs.  Parker  and 
Shattock  on  the,  560 
Mr.  Croft’s  cases  of.  669 

Cobb,  Dr.  Frederick  (of  the  London  Hospital), 
obituary  notice  of,  279 
Cocoanut  as  an  article  of  food,  464 
Cody,  Surgeon-Major  (Bombay  Army),  obituary 
notice  of,  111 

Cohen,  Dr.  on  operations  on  the  larynx,  366 
Cohn,  Dr.  statistics  of  short  sight,  703 
Collective  investigation  of  disease  in  Germany, 
162 

Congress,  Intercolonial  Medical,  at  Amsterdam, 
Drs.  Duckworth  and  Ewart’s  report  on  the, 
511 

Conjoint  examination  scheme  for  Ireland,  718 
Consultation  practice,  observations  on,  598 
Contagious  Diseases  Acts,  questions  on  the,  in 
Parliament,  137 

ill  effects  of  the  changes  in  the,  185 
Convallaria,  Savory  and  Moore’s  preparation  of, 
83 

Convulsions,  puerperal,  vide  Puerperal 
Corfield,  Dr.  on  compulsory  notification  of  infec¬ 
tious  diseases,  192 
Corns,  formula  for,  82 


Dec.  29  1883. 


Coronary  arteries,  anastomosis  of  the,  Dr.  West 
on, 559 

Coroners,  substitutes  for,  at  Boston,  460 

inquests,  Mr.  Hussey  on  amendment  of,  568 
Corpus  striatum,  rupture  of  an  aneurysm  in  the, 
Dr.  Bastian  on,  530 
Coryza,  atropia  in,  388 
Cotton-wool  tissue,  absorbent,  279 
Cotton-sizing,  effects  of,  on  health  of  operatives, 
665 

Cough,  choreic,  Dr.  Granville  on.  584 
Coupland,  Dr.  case  of  abdominal  aneurysm,  63 
Cousins,  Dr.  Ward,  on  a  new  needle  and  thread, 
387 

Cowell,  Mr.  on  a  case  of  strangulated  femoral 
hernia,  173 

Lectures  on  Cataract,  notice,  248 
cases  of  cougenital  dislocation  of  the  hip,  645 
Crede,  Prof,  prevention  of  ophthalmia  neona¬ 
torum  by,  498 

Creighton,  Dr.  autonomous  life  of  specific  infec¬ 
tions,  145, 156 

Dr.  Mercier  on  the  address  of,  177 
Cripps,  Mr.  on  a  case  of  strangulated  hernia  and 
osteotomy,  543 

Croft,  Mr.  cases  of  club-foot,  568 
cases  of  hydatid  cysts,  597 
Croker,  Mr.  John  Rees,  death  of,  84 
Crombie,  Dr.  John  Mann,  obituary  notice  of,  671 
Crushing  injury,  a  curious,  332 
Cullingworth,  Dr.  Manual  of  Nursing,  notice,  2t 
Cuningham.  Surgeon-General  Dr.  sanitary  lessons 
of  Indian  epidemics,  35,  69 
criticisms  on  views  of,  67,  138,  169 
Cupriss,  Mr.  Francis  P.  death  of,  26 
Cuvier,  Baron,  the  cranium  and  brain  of,  756 
Cystitis,  median  urethrotomy  in,  Mr.  Morris  on, 

89 

D 

Da  Costa,  Prof,  on  chloral  poisoning,  168 
on  compounds  of  nickel,  608 
Dana,  Dr.  on  hydrobromie  acid,  609 
Davies,  Mr.  William  Joseph,  death  of,  617 
Death-rate,  influence  of  social  position  on  the,  44 
Decaisne,  Dr.  effects  of  tobacco-smoking  on  chil¬ 
dren,  114 

Decapitation,  observations  after,  by  Dr.  Holm¬ 
gren,  25 

Deformities,  fracture  of  the  femur  for  the  cure  of, 
738 

Delivery,  position  in,  Dr.  McCraith  on,  483 
vide  Genu-pectoral 

Dengue,  Dr.  McCall  Anderson  on.  232 
Dental  surgery,  regulations  for  the  diploma  in, 
324 

Depaul,  Prof,  (of  Paris),  obituary  notice  of,  561 
Diabetes,  reparation  of  fractures  in  the  subjects 
of,  Prof.  Verneuil  on,  125 
Diary  of  the  year,  750 

Digitalis  group,  action  of  the,  Drs.  Ringer  and 
Sainsbury  on,  644 

Dignat,  Dr.  on  the  non-paralysed  limbs  in  hemi¬ 
plegia,  498 

Diphtheria,  heart-failure  in,  Dr.  B.  Johnson  on, 

90 

paralysis  in,  treated  by  strychnia,  16 
in  relation  to  the  “hoarding  out”  of  conva¬ 
lescents,  407 

experimental,  Dr.  Heubner  on,  638 
in  Russia,  697 

outbreaks  of,  Dr.  Parsons’  reports  on,  18,  19, 
668,  696 

Mr.  Power’s  reports  on,  245,  246,  407,  696 
Dr.  Airy’s  reports  on,  439,  696 
Mr.  Spear’s  reports  on,  245,  637 
Disease,  collective  investigation  of,  in  Germany, 
162 

functional,  nature  and  definition  of,  658 
fashion  in  the  treatment  of,  666 
Dislocations,  Dr.  Schreiber’s  Atlas  of,  notice,  468 
vide  Femur,  Jaw,  Patella 
Dispensatory  of  the  United  States,  notice,  529 
Donkin,  Dr.  II.  on  a  case  of  pleurisy  in  a  child, 
262 

address  on  popular  and  rational  therapeutics, 
398 

“A  Practitioner  of  FiftyYears'  Standing  ” 
on  the,  415 
reply  to,  412 

on  nerve-stretching  for  sciatica,  707 
Doses,  “  maximum,”  M.  Vigier  on,  582 
Downes,  Dr.  on  an  outbreak  of  diphtheria,  668 
Dress  as  a  cause  of  scrof  ulosis.  Dr.  Paulson  on,  237 
Drewett,  Dr.  on  myxoedema,  642 
Drighton,  Mr.  John,  death  of,  562 
Drink,  an  ideal,  461,  492 
Dublin,  opening  of  the  medical  session  in,  551 
University  School  of  Physic,  regulations  for 
degrees  at  the,  294 
prizes  of  the,  317 
pass-lists  of  the,  25,  730,  769 
Duckworth  and  Ewart,  Drs.  report  on  Amsterdam 
Intercolonial  Congress,  511 
Dudfield,  Dr.  on  metropolitan  sanitary  adminis¬ 
tration,  479 

observations  on  the  paper  of,  487 


Medical  Times  and  Gazette. 


INDEX. 


Dee.  29,  1863.  7  63 


Duhring,  Dr.  on  Paget’s  disease  of  the  nipple,  189 
Du  Mesnil,  Dr.  on  the  homes  of  the  poor  in  Paris, 
687 

Dunbar,  Dr.  Henry,  death  of,  431 
Duncan,  Dr.  Matthews,  Clinical  Lectures  on 
Diseases  of  Women,  review,  583 
on  retroversion  of  the  gravid  uterus,  621 
on  retention  of  the  menses,  733 
Durham,  Mr.  on  ossifying  chondrosarcoma  in  a 
cicatrix,  602 

case  of  bony  tumours  in  the  breast,  612 
Durham  University  College  of  Medicine,  regula- 
■  tions  for  degrees  of  the,  289 
scholarships  of  the,  310 
pass-lists  of  the,  533,  702 
Dysmenorrhoea.  flexions  of  the  uterus  in  relation 
to,  Drs.  Yedeler  and  Herman  on,  96,  404 
mechanical,  404 

E 

Ear,  affections  of  the,  in  relation  to  rheumatism, 
578 

effects  of  quinine  on  the,  Dr.  Green  on  the,  20 
effects  of  noise  on  the  healthy  and  diseased, 
Dr.  St.  John  Roosa  on  the,  181 
removal  of  foreign  bodies  from  the,  Dr. 
Chisolm  on,  722 
Earache,  chloroform  in,  211 
atropia  in,  74 

Eczema,  treatment  of,  Prof.  Pick  on  the,  439 
applications  in,  Dr.  Draper  on,  151 
of  the  scalp  in  infants,  formula  for,  274 
Edinburgh,  opening  of  the  medical  session  at,  519, 
624 

University  Medical  Eaculty,  pass-lists  of  the, 
224,  589 

regulations  for  degrees  at  the,  291 
fellowships,  scholarships,  and  bur¬ 
saries  of  the,  314 
the  tercentenary  of,  459 
Education,  medical,  vide  Medical 
Educational  over-pressure,  question  of,  427 
Lord  Stanley  on,  74 
as  a  cause  of  lunacy,  94,  167,  160 
Dr.  Beddoe  on,  469 
Mr.  Mundella  on,  601 
Eggs,  raw,  as  an  article  of  diet,  618 
Egypt,  Army  Medical  Service  in,  debate  in  the 
House  of  Lords  on  the,  93, 108,  249,  352 
census  of,  105 
letter  from,  249 
cholera  in,  vide  Cholera 
filaria  sanguinis  in,  vide  Filaria 
Embolism  of  the  middle  cerebral  artery,  case  of, 
401 

Empyema,  Mayer  and  Meltzer’s  drainage-tubes 
in,  381 

Encephalitis,  congenital,  Prof  .Virchow  on,  576, 581 
Endometritis,  fungous,  Dr.  Brennecke  on,  664 
Endowment  of  research,  Prof.  Lankester  on,  376 
Epidemic  Diseases,  Haeser’s  History  of, review,  357 
Epidemiological  Society,  Dr.  Chevers’  address  at 
the,  537 

Epidermis,  thickened,  salicylic  plaster  in,  Dr. 
Thin  on,  641 

Epiphyses,  necrosis  of  the,  Mr.  Baker  on,  165 
Epilepsy,  treatment  of,  Dr.  Hammond  on  the,  75 
Erb,  Prof,  on  the  etiology  of  tabes,  236 
Ernst,  Dr.  on  the  bacillus  of  tubercle,  444 
Erysipelas  following  the  use  of  chrysophanic  acid, 
656 

Ether-narcosis,  Dr.  Leslie  Phillips  on,  261 
Evans,  Dr.  George  Henry,  obituary  notice  of,  442 
Mr.  Thomas,  death  of,  475 
Evatt,  Surgeon-Major,  catechism  of,  on  army 
medical  organisation,  662 
Everitt,  Mr.  Herbert,  death  of,  443 
Euonymin  as  a  biliary  stimulant,  6 
Ewart,  Dr.  Joseph,  on  the  contagiousness  of 
cholera,  512 

“Experimental  medication,”  571,  632 

“A  Practitioner  of  Pifty  Years’  Standing” 
on,  691 

Eye,  protective  and  lacrimal  apparatus  of  the, 
Mr.  Power  on  the,  335,  363,  419,  508,  540 
foreign  body  in  fundus  of  the,  case  of,  110 
every-day  therapeutics  in  diseases  of  the,  Mr. 
Hutchinson  on,  450 

dental  lesions  in  relation  to  diseases  of  the, 
Mr.  Power  on,  611 
vide  Ophthalmia 

Eyeball,  excision  of.  Mr.  Godlee’s  case  of,  484 
pseudoglioma  of  the,  768 
Eyes,  conjugate  movements  of  the,  model  illus¬ 
trating  the,  726 

F 

Fabre,  Dr.  case  of  relapse  of  zona,  598 
Faeces  of  starch-fed  infants,  Dr.  Randolph  on 
the,  261 

Fagge,  Dr.  Hilton,  obituary  notice  of,  601,  614 
“Fall  of  the  leaf”  and  prevalence  of  disease, 
522 

Fallopian  tubes,  Mr.  Tait  on  an  undescribed 
disease  of  the,  641 

Family  medical  registers,  Mr.  Galton  on,  130,  690 


Fashion  in  the  treatment  of  disease,  666 
Fasken,  Deputy  Inspector-General  Dr.  William, 
death  of,  475 

Fats,  action  of  mammary  ferment  on,  Dr.  Tidy 
on  the,  243 

Feet,  foetidity  of,  bismuth  in,  124 
Femur,  fracture  of  the  cervix  of  the,  pathogno¬ 
monic  sign  of,  168 

in  the  aged,  Dr.  Allis  on,  755 
fracture  of  the,  for  the  cure  of  deformities, 
Mr.  R.  Parker’s  cases  of,  738 
fracture  of  inner  condyle  of  the,  case  of,  708 
congenital  dislocations  of  the,  Mr.  Cowell’s 
cases  of,  645 

Ferment,  a  mammary.  Dr.  Tidy  on,  243 
Ferrier,  Dr.,  Marshall  Hall  oration  of,  502 
Fever,  pernicious  form  of  remittent,  in  India,  Dr. 
Chevers  on  the,  63 

Dr.  Bond  on  an  obscure  outbreak  of,  748 
the  Mediterranean,  Brigade-Surgeon  Fuller 
on,  561 

vide  Malarial,  Typhoid,  Typhus,  Yellow 
Fibula,  fracture  of  the  lower  end  of  the,  frequency 
of,  246 

Field,  Dr.  on  superiority  of  bromide  of  sodium, 
91 

Filaria  sanguinis  parasitism  in  Egypt,  Prof. 
Sonsino  on,  340.  367,  421 

Filaria  Sanguinis  Hominis,  Dr.-  Manson  on, 
review,  639 

Finch,  Dr.  Henry,  death  of,  3S8 
Fingers,  movements  of  the,  cerebral  centre  for, 
Dr.  Lepine  on  the,  217 
Fish  as  a  dietary  at  the  Bristol  Infirmary,  358 
observations  on,  379 
Flat-foot,  cure  and  mechanism  of,  749 
Flint,  Dr.  on  the  bacillus  tuberculosis,  719 
Foetus,  prolonged  retention  of,  Prof.  Sappey  on 
a  case  of,  385 

flexion  of  the  head  of  the,  Dr.  Galabin  on, 
757 

Foods,  Analysis  and  Adulterations  of, Mr.  Bell  on, 
review,  53 

in  relation  to  obstetrical  medicine,  Dr.  Hewitt 
on,  152 

of  infants,  Dr.  Leeds  on,  220 

starchy  digestion  of,  by  infants,  Dr. 

Keating  on,  177 

the  faeces  from,  Dr.  Randolph  on,  262 
Foot,  the  tabetic,  Prof.  Charcot  on  the,  219 
multiple  tumours  of  the,  case  of,  672 
Football,  Dr.  Cathcart’s  defence  of,  632 
Footman,  Dr.  John,  death  of,  359 
Foroeps,  Dr.  E.  Richardson  on  the  employment 
of,  222 

Fothergill,  Dr.,  Gout  in  its  Protean  Aspects, 
notice,  80 

Fox,  Dr.  Dacre,  on  infantile  mortality,  57 
Fracture,  multiple,  Mr.  Rushton  Parker’s  case  of, 
345 

vide  Clavicle,  Diabetes,  Femur,  Fibula, 
Patella,  Pelvis 

Fraentzel,  Dr.  on  the  bacillus  of  tubercle,  453 
Frampton,  Mr.  Thomas,  death  of,  562 
France,  mortality  of  the  army  and  marines  in, 
638 

the  hospitals  of,  in  1883,  240,  552 
lunatics  in,  in  1883,  618 
medical  practitioners  of,  statistics  of  the,  665 
the  law  on  rabid  animals  in,  652 
Francis,  Surgeon-General,  reminiscences  about 
chloroform,  36 

on  the  uncovenanted  medical  service  in  India, 
383 

Fraser,  Prof,  address  of,  at  Edinburgh,  526 
Friedlander  and  Frobenius,  Drs.  on  the  micro¬ 
coccus  of  pneumonia,  634 
Friere,  Dr.  researches  of,  on  yellow  fever,  143,  576 
Frommel,  Dr.  on  contractions  of  the  uterus,  626 
Fuller,  Brigade-Surgeon,  on  Mediterranean  fever, 
651 

Functional  disease,  nature  and  definition  of,  658 
Fiirst,  Dr.  on  puerperal  inversion  of  the  uterus, 
461 

G 

Galabin,  Dr.  on  flexion  of  the  foetal  head,  757 
Galen,  Dr.  Habershon  on,  30 
Galton,  Mr.  Francis,  views  of,  on  medical  family 
registers,  130,  690 

Gamgee,  Mr.  S.,  Treatment  of  Wounds  and  Frac¬ 
tures,  notice,  2t 

Gangrene,  senile,  amputation  in,  Mr.  Hutchinson 
on,  and  discussion,  687,  699 
Gartner’s  ducts  in  women,  Dr.  Kocks  on,  459 
Gas-poisoning,  inhalations  of  oxygen  in,  362 
Gastric  ulcer,  vide  Stomach 
Gaultheria  in  rheumatism,  Dr.  Flint  on,  106 
Gay,  Mr.  on  the  veins  connected  with  the  hepatic 
system,  625 

Gee,  Dr.  on  the  literature  of  diseases  of  childhood, 
173 

Gelsemium  sempervirens,  properties  of,  606 
Genu-pectoral  position,  “The  Bare-Faced”  on, 

281 

“  Theophilus  Philologus  ”  on  the,  387 


Genu-pectoral  position,  “  Topsy-Turvy  ”  on  the, 
477 

George’s  (St.)  Hospital  Medical  School,  exhibi¬ 
tions  and  prizes  of  the,  305 
Mr.  Bennett’s  address  at,  408 
Germs,  modifiability  of,  Dr.  Carpenter  on  the,  717 
and  germicides,  602 
of  disease,  mode  of  action  of,  548 
Gibbon,  Dr.  on  prevalence  of  syphilis  in  London, 
492 

Gillies,  Surgeon  Walter,  death  of,  504 
Glasgow,  sanitary  condition  of,  in  1833,  82,  188, 
271,  436,  618,  634 
hospital  accommodation  of,  186 
prevalence  of  fever  at,  663 
Town’s  Hospital,  cases  treated  at  the,  211 
University  (Medical  Faculty  of  the),  pass- 
lists  of  the,  195 

regulations  for  degrees  at  the,  293 
Glycerine,  utility  of,  in  fevers,  Dr.  Semnola  on,  582 
“  God’s  gifts  to  man,”  “  A  Practitioner”  on,  415 
Godlee,  Mr.  on  a  case  of  double  amputation  of 
the  arms,  374 

on  a  case  of  strangulated  undescended  testis, 
425 

on  a  case  of  excision  of  the  eyeball,  484 
on  a  case  of  erysipelas  following  the  use  of 
chrysophanic  acid,  656 
on  cases  of  tubercle  of  the  tongue,  728 
Goodhart,  Dr.  cases  of  peritoneal  abscess  in- 
children,  471 

Gould,  Mr.  Pearce,  address  of,  at  the  Middlesex! 

Hospital  Medical  School,  409 
Govan  combination  fever  hospital,  account  of  the, 
46 1 

Grant,  Surgeon  Peter  Macpherson,  obituary  notice- 
of,  250 

Granville,  Dr.  Mortimer,  on  choreic  cough,  581 
Greaves,  Mr.  William  Thomas,  death  of,  646 
Green,  Dr.  Orme,  on  the  effects  of  quinine  on  the- 
ear,  20 

Greenfield,  Prof,  address  of,  at  Edinburgh.  525 
Gregg,  Dr.  on  bacteria  as  forms  of  fibrin,  670 
Gresham  College,  past  and  present  state  of,  713 
Griffith,  Dr.  Moses,  obituary  notice  of,  675 
Grindrod,  Dr.  Ralph  Barnes,  death  of,  617 
Gross,  Prof,  on  early  operations  for  morbid 
growths,  274 

Guerder,  Dr.  on  powdered  blood  for  artificial 
alimentation,  22 

Gunshot  wounds,  Sir  William  Mac  Cormac  on.  63£ 
Gurney  and  Myers  (Messrs.),  comments  on  their 
article  on  mesmerism,  437,  495 
Mr.  letters  of,  in  reply,  601,  556,  610 
Guttmann,  Dr.  on  the  efficacy  of  kairin,  162 
Guy’s  Hospital,  cases  treated  at,  401 
Reports,  vol.  xli.  notice,  278 
Medical  School,  scholarships  and  prizes  of  the,. 
305 

Gynecological  practice,  food  in  relation  to,  Dr, 
Hewitt  on,  152 

H 

Hahershon,  Dr.  the  Harveian  Oration,  30 
Hackney,  sanitary  state  of,  Dr.  Tripe’s  report*  oa 
the,  754 

Hadden,  Dr.  cases  of  rupture  of  the  heart,  560 
Hsemoglobinaemia,  Prof.  Ponfick  on,  183 
Haemorrhoids,  structure  of,  Mr.  Roeckel  on  the, 
561 

Haeser,  Dr.  Oeschichte  der  epidemischen  Krankheiten , 

review,  857 

Haffenden,  Mr.  Dalton  Adolphus,  death  of,  533 
Hamilton,  Dr.  D.  J.  on  the  Pathology  of  Bron¬ 
chitis,  review,  61 

Dr.  Frank,  aphorisms  of  health,  474 
Prof,  on  wax-like  disease  of  the  heart,  663 
Hammond,  Dr.  on  the  treatment  of  epilepsy,  75 
on  Sexual  Impotence  in  the  Male,  notice,  553 
Mr.  Henry  Samuel,  death  of,  112 
Hanging,  observations  on  the  best  mode  of,  661 
Hand  and  fingers,  Dr.  Warner’s  apparatus  for 
measuring  movements  of  the,  557 
Hardy,  Dr.  Frederick,  death  of,  358 
Harper,  Mr.  Philip  Henry,  death  of,  673 
Harrison,  Mr.  Reginald,  on  recent  advances  in 
the  surgery  of  the  urinary  organs,  119, 157 
Mr.  Henry,  death  of,  196 
Harveian  Oration  by  Dr.  Habershon,  30 
Harvey,  Dr.  Alexander,  on  apnoaa  and  asphyxia, 
623.  649 

Harvey,  William,  translation  of  the  remains  of,  488- 
Hastings,  Mr.  Richard  Ledsham,  death  of,  646 
Hay,  Dr.  on  iodoform  in  fissure  of  the  anus,  80 
Dr.  Matthew,  on  action  of  saline  cathartics, 
241 

Headache  of  adolescents,  Dr.  Blache  on,  191 
Health  aphorisms.  Dr.  Hamilton’s,  474 
Health-resorts,  zymotic  diseases  of,  218 
Health-histories  of  towns,  Dr.  Chevers  on,  637 
Health  Exhibition,  observations  on  the  proposed, 
657 

Health  (Public) ,  regulations  for  degrees  in  science 
in,  825 

Heart,  muscular  automatism  of  the,  605 

work  done  by  the,  Messrs.  Howell  and 
Donaldson  on  the,  669 


764 


Medical  Times  and  Gazette. 


INDEX. 


Dec.  29,  1883. 


Heart,  ectopia  of  the,  Prof.  Tarnier’s  cases  of,  191, 
524 

aneurysm  of  the,  Dr.  Degg  on,  199,  214 
congenital  malformation  of  the,  specimen  of, 
473 

rupture  of  the,  Mr.  Hadden’s  cases  of,  560 
wax-like  disease  of  the,  Prof.  Hamilton  on, 
663 

Hemiachromatopsia,  Mr.  Swanzy’s  case  of,  109 
Hemianopia,  homonymous,  Mr.  Nettleship’s  case 
of,  470 

Dr.  Sharkey  on,  471 

Hemiatrophia,  Dr.  Henschen’s  case  of,  134 
Hemiplegia,  the  non-paralysed  limbs  in,  Dr. 
Dignat  on,  498 

Henschen,  Dr.  case  of  hemiatrophia,  134 
Hepatic  system,  the  veins  connected  with  the, 
Mr.  Gay  on,  685 

Herman,  Dr.  on  flexion  of  the  uterus  and  dys- 
menorrhoea,  95 

on  a  case  of  prolapsus  uteri,  211 
on  Hodge’s  pessary,  567,  595 
Hernia,  operations  for,  and  antiseptic  treatment, 
discussion  on,  385 

femoral,  Mr.  Cowell  on  a  case  of  strangulated, 
173 

inguinal  strangulated,  in  an  aged  man,  543 
radical  cure  of,  observations  on  the,  745 
Herpes  labialis  with  rigor,  Mr.  Symonds  on,  with 
discussion,  727 

Mertwig,  Prof,  on  symbiosis,  550 
Heubner,  Dr.  on  experimental  diphtheria,  638 
Hewan,  Dr.  Archibald,  death  of,  388 
Hewitt,  Dr.  Graily,  on  food  in  obstetric  and  gynae¬ 
cological  practice,  152 
Hewson,  Dr.  John  Dale,  death  of,  590 
Hiccough,  arrest  of,  by  compression,  155,  257 
Higgins,  Mr.  Andrew  Henry,  death  of,  533 
Highmore,  Dr.  William,  death  of,  280 
Hilbers,  Dr.  George  James,  death  of,  562 
Hip- joint,  excision  of  the,  Mr.  Barton’s  cases  of, 
with  discussion,  23 
double,  Dr.  Byrd’s  case  of,  35 
lardaceous  disease  of  the,  Mr.  Parker’s  case 
of,  in  a  child,  180 

Histology,  pathological,  Dr.  Sharkey  on,  593 
Hodge,  Mr.  Benjamin  Terry,  death  of,  388 
Hodgson,  Mr.  Freeth  Foster,  death  of,  358 
Hoffmann,  Dr.  G.  on  uterine  milk,  608 
Hofmeier,  Dr.  on  icterus  neonatorum,  669 
Holman,  Deputy  Inspector-General  J.  R.  death 
of,  388 

Holmes,  Mr.  T.  on  internal  urethrotomy,  29 

and  Mr.  Hulke,  System  of  Surgery,  review, 
722 

Dr.  Oliver  Wendell,  address  of,  at  Harvard 
College,  547 

a  century’s  progress  in  medicine,  554 
Holmgren,  Dr.  observations  after  decapitation,  25 
■“  Homes  of  out-patients,”  628 
Homes  of  the  rich,”  656 

Homes  of  the  poor  in  England  and  elsewhere, 
687 

insanitary,  and  zymotic  diseases,  Dr.  Kelly 
on,  661 

Hope,  Dr.  on  distribution  of  typhus  in  Liverpool, 
636 

Horner’s  muscle,  Mr.  Power  on,  421 
Horses,  docking  the  tails  of,  663 
Horsley,  Mr.  on  a  case  of  testis  in  perineo,  627 
Hospital  administration,  conference  on,  41 

patients,  uses  of,  Dr.  De  Watteville  on  the, 
629,  6S9 

out-patients,  the  homes  of,  628 
Sunday  Fund,  distribution  of  the,  133,  719 
Hospitals  of  Paris,  enlargement  of  the,  110 
consumption  of  stimulants  in,  435 
of  France,  number  of,  in  1883,  240 
statistics  of  the,  552 

Hospitals,  vide  Bartholomew’s  (St.),  Berlin, 
Charing-cross,  Children,  Devon,  Glasgow, 
Guy’s,  Liverpool,  London,  Melbourne, 
Middlesex,  Samaritan,  Thomas’s  (St.), 
University  College,  Westminster  Ophthal¬ 
mic 

Houston,  Dr.  Patrick  Cruikshank,  death  of,  84 
Howell  and  Donaldson,  Messrs,  on  work  done  by 
the  heart,  669 

Huchard,  Dr.  on  the  varieties  of  angina  pectoris, 
72 

Hughes,  Dr.  James  Sheridan,  death  of,  475 
Hunt,  Dr.  Benjamin,  death  of,  280 
Hunter,  Dr.  reports  on  cholera  in  Egypt,  286,  377 
Hunterian  Society,  Mr.  Rivington’s  address  at 
the,  227,  258 

Husemann,  Prof.  Handhuch  der  gesammten  Arznei- 
mittellehre,  review,  276 

Hussey,  Mr.  on  amendment  of  the  law  of  coroners’ 
inquests,  568 

Hutchinson,  Mr.  address  of,  at  the  Ophthalmolo- 
gical  Society,  448 

on  amputation  in  senile  gangrene,  687,  699 
presentation  of  a  testimonial  to,  661 
Huxley,  Prof,  on  State  interference  in  medical 
affairs,  428 

address  of,  at  the  London  Hospital  Medical 
School,  436 

to  the  Royal  Society,  660 


Hydatid  cysts  treated  by  incision,  Mr.  Croft’s 
cases  of,  597 

influence  of  traumatism  on,  Dr.  Kirmisson 
on,  602 

disease  in  Victoria,  Dr.  Barrett  on,  678 
Hyde,  Dr.,  Treatise  on  Diseases  of  the  Skin,  re¬ 
view,  107 

Hydrobromic  acid,  properties  of,  Dr.  Dana  on 
the,  609 

Hydrophobia  in  Paris  in  1881,  484 
Hygiene  and  public  health,  instruction  in,  718 
Hygiene  of  schools,  Dr.  Ralfe  on,  101 
Hypodermic  syringes,  keeping  in  order  of,  345 
Hystero-epilepsy  treated  by  apomorphia,  Dr.  T. 
H.  Williams’s  cases  of,  655 


I 

Ichthyosis  in  tabes,  MM.  Ballet  and  Dutil  on,  16 
Icterus  neonatorum,  Dr.  Hofmeier  on,  669 
lies,  Dr.  Francis  Henry  Wilson,  death  of,  358 
Ince,  Mr.,  Latin  Grammar  of  Pharmacy,  notice, 
109 

India,  sanitary  lessons  from  the  epidemics  of, 
Surgeon-General  Cuningham  on,  35,  59 
criticism  on  the,  67 

Inspector-General  Lawson  on,  138,  169 
account  of  the  sanitary  work  in,  721 
Dr.  Chevers’  practical  notes  on  ordinary 
diseases  of,  vide  Chevers 
water-supply  for  troops  in.  Dr.  Nicholson 
on,  601 

deaths  from  wild  animals  in,  617 
Indian  Medical  Service,  rate  of  payments  in  the, 
132 

successful  candidates  for  the,  264,  242 
regulations  for  candidates  for  the,  332 
the  uneovenanted,  Surgeon-General  Francis 
on, 383 

Industrial  schools,  a  radical  fault  in,  405 
Infections,  the  autonomous  life  of  specific,  Dr. 
Creighton  on,  145,  156 

Infectious  diseases,  heart-failure  in  acute,  90 

destruction  of  carcases  of  animals  dying 
from,  131 

compulsory  notification  of,  Dr.  Corfield 
on  the,  192 

the  question  of,  at  Liverpool,  412 
movement  in  Dublin  respecting,  692 
trial  of,  at  Bolton,  748 

Inflammation,  bleeding  in  local,  Dr.  Nanereae  on, 
273 

Insanity,  its  Causes  and  Prevention,  Dr.  Stearns 
on,  notice,  52 

its  Classification,  Diagnosis,  and  Treatment, 
Dr.  Spitzka  on,  review,  609 
effects  of  school  overwork  on  the  increase  of, 
94,  167,  190 

definition,  classification,  and  causes  of,  Dr. 
Sutherland  on,  255 

simple,  and  its  subdivisions,  Dr.  Sutherland 
on,  565 

puerperal,  Dr.  Sutherland  on,  566 
the  uses  of  seclusion  in,  10 

the  American  Psychological  J ournal  on,  266 
increase  of,  in  New  York,  351 
alleged  production  of,  by  quinine,  693 
the  plea  of,  Dr.  Mercier  on,  372 
Colonel  Corkhill  on,  84 
in  the  Walthamstow  murder,  34 S,  374 
in  the  case  of  Cole,  485,  618 
vide  Lunatics 

“  Intemperate  temperance,”  684 
Intestinal  absorption,  Dr.  Zawarykin  on,  70 
Intestine,  lympho-sarcoma  of  the,  472 
Intestines,  diverticula  of  the  small,  discussion  on, 
559 

Introductory  addresses  of  1883-84,  criticisms  on, 
403,  408 

Iodine,  improved  administration  of,  Dr.  Seguin 
on  the,  234 

Iodoform,  counteracting  the  odour  of,  79 
as  employed  in  Prof.  Billroth’s  clinic,  556 
as  a  dressing  for  wounds,  670 
Ireland,  Academy  of  Medicine  in,  meetings  of  the, 
23,  758 

Royal  University  of,  pass-lists  of  the,  55,  111 
475,  615  ’ 

regulations  for  degrees  of  medicine  of  the, 
296 

the  proposed  conjoint  scheme  for,  718 
Iron,  hydrated  oxide  of,  preparation  of  the,  582 
Irrigator  and  enema  apparatus,  Allen’s,  388 


J 

Jamaica,  slight  mortality  in,  617 
James,  Dr.  W.  on  the  functions  of  the  semicircular 
canals,  499 

Jaundice  of  pregnancy,  Dr.  Qneirel  on,  670 
of  infants,  Dr.  Hofmeier  on,  669 
Jaw,  dislocation  of  the,  Mr.  G.  Bird’s  case  of,  532 
necrosis  of,  in  typhoid  fever,  Dr.  Money’s  case 
of,  613 

recovery  from,  Mr.  Tay’s  case  of,  560 
Jaws,  removal  of  the,  Mr.  Bellamy’s  case  of,  452 


Jenner,  Sir  William,  meeting  at  the  house  of,  695 
Jequirity  in  granular  lids,  106,  189 
Jervis,  Dr.  Thomas,  obituary  notice  of,  503 
Jewsbury,  Mr.  Charles  Frederick,  death  of,  55 
Johnson,  Dr.  Beverley,  on  heart-failure  in  infec¬ 
tious  disease,  90 

Dr.  E.  G.  on  suture  and  transplantation  of 
nerves,  271 

Johnstone,  Surgeon-General  Dr.  T.  B.  obituary 
notice  of,  703. 731 

Joints,  amputation  at  the,  sponge-dressingin,  Dr. 
McClellan  on,  49S 

diseases  of  the,  trophic  troubles  in,  Dr.  J. 
Wolff  on,  100 

Charcot’s  disease  of  the,  specimen  of,  613 
Jones,  Dr.  Handfield,  address  of,  at  St.  Mary’s,  408 
Joynt,  Surgeon- General  Francis  George,  death  of, 
646 

K 


Kain,  Mr.  William,  death  of,  590 
Kairin,  therapeutical  employment  of,  Dr.  Gutt- 
mann  on,  162 
as  an  antiseptic,  634 

Keating,  Dr.  digestion  of  starch  by  infants,  177 
Keene,  Mr.  James,  death  of,  673 
Kelly,  Dr.  report  on  West  Sussex  for  1882,  20,  522 
on  the  relation  of  insanitary  homes  to  zymotic 
diseases,  661 

Kidd,  Dr.  case  of  nephrectomy,  268 
Kidney,  surgery  of  the,  Mr.  R.  Harrison  on  the, 
120 

discussion  on  the,  164 
ectopia  of  the,  Dr.  Buret  on,  357 
changes  in  the,  through  pregnancy,  755 
vide  Nephrectomy,  Perinephritic  abscess 
King,  Mr.  Louis,  Principles  of  Health,  review,  52 
King,  Dr.  report  on  cultivation  of  cinchona,  434 
King’s  College  Hospital  and  St.  John’s  House,  168 
Medical  School,  scholarships  aud  prizes  at,  305 
Dr.  Acland’s  address  at,  391 
Kirmisson,  Dr.  influence  of  traumatism  on  hydatid 
cysts,  603 

Knee-joint,  synovitis  of  the,  Mr.R.  Parker’s  cases 
of,  36 

Knights,  medical,  535 

Kobner,  Dr.  on  communicability  of  syphilis  to 
animals,  160 

Koch,  Dr.  Robert  (of  Berlin),  account  of,  136 
on  bacterioscopic  examination  of  water,  271 
report  on  cholera  in  Egypt,  447,  455 
Kocher,  Prof,  on  extirpation  of  the  thyroid  gland, 
273 

on  cachexia  strumi  priva,  693 
Kocks,  Dr.  on  Gartner’s  ducts  in  women,  459 
Kraussold,  Dr.  Hermann,  death  of,  617 
Kiister,  Dr.  removal  of  axillary  glands  in  cancer 
of  breast,  414 

Krukenberg,  Dr.  case  of  breaking  down  of  uterine 
fibroid,  522 

L 

Laache,  Dr.  on  molluscum  contagiosum  gigan- 
teum,  161 

Laborde,  Dr.  on  effects  of  napelline,  26 
Labour,  induced  premature,  statistics  of,  492 
duration  of,  Dr.  Lumpe  on  the,  523 
mechanism  of,  Dr.  Barnes  on  the,  660,  757 
genu-pectoral  position  in,  vide  Genu-pectoral 
Lacrimal  apparatus,  comparative  anatomy  of  the, 
Mr.  Power  on  the,  338,  363,  420,  509,  540 
Landis,  Dr.,  Compend  of  Obstetrics,  notice,  22 
Lankester,  Prof,  on  endowment  of  research,  378 
Larynx,  extirpation  of  the,  Dr.  Macleod’s  case  of, 
35 

Dr.  Cohen  on  the  results  of,  366 
lupus  of  the,  Drs.  Chiari  and  Riehl  on,  557 
abductor,  paralysis  of  the,  Dr.  8emon  on,  718 
Lathyrism  and  beriberi,  Dr.  Marie  on,  606 
Lawson,  Inspector-General,  on  the  sanitary  les¬ 
sons  from  Indian  epidemics,  138,  169 
observations  on  the  views  of,  140 
Lead  (white),  workers  in,  sanitary  state  of,  213 
Lead-poisoning,  pathological  anatomy  of,  269 
Le  Bee,  Dr.  on  extirpation  of  the  thyroid,  618 
Lectures,  decision  as  to  the  right  of  publishing, 
635 

“Leeds  School  of  Medicine,  scholarships  and  prizes 
of  the,  312 

Dr.  Clifford  Allbutt’s  address  at  the,  im¬ 
portance  of,  427 

Leeds,  Dr.  on  infants’  foods,  220 
Legg,  Dr.,  Bradsha we  Lecture  on  cardiac  aneu¬ 
rysms,  199,  214 

case  of  melanotic  sarcoma,  728 
Lemoine,  Dr.  De  la  Rachialgie,  notice,  583 
Leney,  Mr.  George,  death  of,  475 
Lepine,  Dr.  on  a  cerebral  centre  of  movements  of 
the  fingers.  217 

Leprosy  in  New  Brunswick,  710 
Leslie,  Dr.  Louis,  death  of,  646 
Leucorrhoea,  infantile,  Prof.  Thomas  on,  75 
Lewaschew  and  Klikowitsch,  Drs.  on  the  influence 
of  alkalies  on  bile,  73 
on  trophic  nerves  and  nerve-centres,  184 


/ 


Medical  Times  and  Gazette 


Lewis,  Surgeon-Major  T.  R.  on  the  contagious¬ 
ness  of  cholera,  511 
Surgeon  Charles  Blake,  death  of,  142 
Liddell,  Dr.  on  contusion  of  the  brain,  166 
“  Light— whence  1  leading -whither  1  ”  425 
Litmus  paper,  Dr.  Squibb’s,  1C3 
Littler,  Surgeon-Major  Dr.  John  Harry,  death 
of,  504 

Liver,  veins  connected  with  the,  Mr.  Gay  on  the, 
625 

hydatid  tumour  of  the,  treated  by  incision, 
Mr.  Croft’s  case  of,  597 

Liverpool,  distribution  of  typhus  in,  Dr.  Hope’s 
report  on  the,  636 
Dr.  Taylor  on  the,  721 

Royal  Infirmary,  cases  treated  at  the,  36,  345, 
73S 

Medical  Society,  notice  of  meeting  of  the,  458 
University  College,  Catalogue  of  the  Patholo¬ 
gical  Museum  of,  notice,  108 
School  of  Medicine,  scholarships  and 
prizes  of,  311 

Lizards,  the  poison  of,  Dr.  Mitchell  on,  234 
Lobsters  as  an  article  of  diet,  654 
Local  Government  Board,  reports  of  medical  in¬ 
spectors  of  the,  18,  245,  466,  497,  637,  668, 
696,  721 

Locomotor  ataxy,  relation  of,  to  syphilis,  424 
peripheric  origin  of,  686 
vide  Tabes 

London,  vital  statistics  of,  27,  56,  85,  113,  143, 160, 
171,  166, 197,  223,253,  281,  334,  351,  361,  389, 
417,  430,  445,  476,  489,  £05,  548,  583,  591,  618, 
645,  175,  689,  704,  732 
sanitary  state  of  the  Port  of,  721 
sanitary  administration  of,  Dr.  Dudfield  on 
the,  479,  487 

observations  on,  487 
as  compared  with  Berlin,  282 
Hospital,  cases  treated  at  the,  211 

Medical  School,  scholarships  and  prizes 
of  the,  308 

Prof.  Huxley’s  address  at  the,  436 
Medical  Society,  notices  of  meetings  of  the, 
519,  547 

University,  pass-lists  of  the,  170,  251,  615, 
702,  730 

rules  and  regulations  for  degrees  at  the, 
288 

the  honours  examination  at  the,  689 
Longevity,  alleged  Russian,  638 
Longstreth,  Dr.,  Rheumatism  and  Gout,  review, 
248 

Loreta,  Prof,  operation  by,  for  stricture  of  the, 
oesophagus,  749 

Lublinski,  Dr.  cases  of  syphilitic  stenosis  of  the 
oesophagus,  692 
Lumbago,  relief  of,  194 

Lumbar  abscess  treated  by  free  incision,  Mr. 

Thomas  Smith’s  cases  of,  514 
Lumpe,  Dr.  on  the  duration  of  labour,  623 
Lunacy,  Commissioners  in,  Thirty- seventh  Report 
of,  notice,  664 

recent  appointment  of  a  Commissioner  in, 
“  Medico-Psychologicus  ”  on,  169 
report  of  Commissioners  in  Scotland,  435 
report  of  Inspectors  in  Ireland,  545 
laws,  observations  on  reform  in  the,  182 
Bill  for  reform  of  the,  186 
vide  Insanity 

Lunatic  asylum,  the  fire  in  a.'at  Southall,  188,  267 
question  of  blame  in,  349 
asylums,  fires  in,  observations  on,  354 
Lunatics  as  witnesses,  law  in  the  United  States 
as  to,  353,  618 
rumination  in,  373 
in  Prance,  in  1833,  618 
in  Spain,  treatment  of,  463 
Lungs,  disease  of  the,  operations  for,  Dr.  Bull  on, 
45 

Lupus — is  it  tuberculosis  1  44 

erythematosus,  Dr.  Duhringon  the  treatment 
of,  582 

Lyman,  Dr.,  Artificial  Anaesthesia  and  Anaes¬ 
thetics,  review,  277 

Lympbo-sarcoma  of  the  intestine,  specimen  of, 
472 


M 


McClellan,  Dr.  on  sponge-dressing  after  amputa¬ 
tion.  4S8 

McClelland,  Dr.  John,  death  of,  170 
Mac  Cormao,  Sir  W.  on  gunshot  wounds,  632 
McCraith,  Dr.  on  position  in  midwifery  practice, 
483 

McDonald,  Dr.  John  Alexander,  death  of,  225 
Dr.  J.  D.,  Guide 'to  Microscopical  Examina¬ 
tion  of  Water,  notice,  557 
Mackenzie,  Dr.  Stephen,  on  purpura,  164 

on  retinal  haemorrhage  from  anaemia,  725 
Dr.  John,  on  the  reflex  area  of  the  nose,  582 
Maeleod,  Dr.  case  of  extirpation  of  the  larynx, 
35 

Macnaughf,  Dr.  John,  death  of,  562 
McO-car,  Dr.  John,  death  of,  196 
Madden,  Dr.  William  Herries,  death  of,  673 


INDEX. 


Maier,  Dr.  on  the  pathological  anatomy  of  lead¬ 
poisoning,  269 

Malarial  cachexia  in  India,  Dr.  Chevers  on,  64, 
90,  153,  653,  681.  735 

Mallet,  Dr.  Formulaire  des  Maladies  des  Voies 
Urinaires,  notice,  387 

Malt-jelly,  Allen  and  Hanburys’,  532 
Mammary  ferment,  Dr.  Tidy  on  a,  243 
Mania,  Dr.  Sutherland  on,  565 
Manson,  Dr.  on  aneurysm  of  the  aorta  in  China, 
274 

Pilaria  Sanguinis  Hominis,  review,  639 
Marcet,  Dr.,  Southern  and  Swiss  Health-Resorts, 
review,  358 

Marey,  Prof,  on  a  case  of  ectopia  of  the  heart, 
191,  524 

Marie,  Dr.  on  disseminated  sclerosis  in  children, 
381 

on  lathyrism  and  beriberi,  606 
Marras,  Mr.  Ernest  Adrian,  death  of,  617 
Marshall,  Mr.  on  nerve-stretching,  690,  711 
Martin,  Dr,  H.  A.  on  heifer- vaccination,  66 

Dr.  H.  on  the  resistance  of  tubercle  to  anti¬ 
septics,  748 

Mr.  John,  death  of.  358 

Mary’s  (St.)  Hospital  Medical  School,  scholar¬ 
ships  and  prizes  of  the,  307 
Dr.  Handfield  Jones’s  address  at,  408 
Master,  Mr.  Alfred,  death  of,  280 
Masturbation,  excessive,  excision  of  the  vas 
deferens  in,  559 

Maudsley,  Dr.,  Body  and  Will,  review,  440 
Meals,  before  and  after,  medicines  in  regard  to, 
244 

Measles  and  German  measles,  Dr.  McCall 
Anderson  on.  230 
Medical  history  of  the  year,  740 

affairs,  question  of  State  intervention  in,  428 
baronets,  £06,  68S 
bulletins,  vide  Bulletins 
and  Chirurgical  Society  (the  Royal),  reports 
of  meetings  of  the,  502,  586,  644,  699 
Medical  education,  rules  and  regulations  for,  284 
observations  on,  263,  322 
family  registers,  Mr.  Galton  on,  180,  690 
practitioners  in  Prance,  statistics  of,  665 
profession,  Mr.  Gladstone  on  honours  con¬ 
ferred  on  the,  168 

schools,  criticism  of  the  introductories  of  the, 
403,  408 

question  of  a  federation  of,  451 
proposed  preparatory,  576 
societies,  vide  Societies 
students,  registration  of,  283 

advice  to,  vide  Medical  education 
of  Germany  and  Switzerland,  in  1883,  222 
Medicine,  present  aspects  and  future  prospects  of, 
Dr.  Waters  on,  115,  126 
a  century's  progress  in,  Dr.  Oliver  Wendell 
Holmes  on,  554 

Medicines,  question  of  taking,  before  and  after 
meals,  244 

Mediterranean  fever,  Brigade-Surgeon  Puller  on, 
551 

Mein,  Dr.  Archibald,  death  of,  14 
Melanotic  sarcoma  of  the  skin,  case  of,  728 
Melbourne  Hospital,  cases  treated  at  the,  7 
Meniere,  Dr.  on  inflammation  of  the  membrana 
tympani  preceding  rheumatism,  678 
Menopause,  nou-recurrence  of  menstruation  after 
the,  Dr.  Thomas  on,  670 

Menses,  retention  of,  Dr.  Matthews  Duncan  on, 
733 

Mercier,  Dr.  on  metaphysics  in  pathology,  177,358 
Mr.  Mill! can’s  note  to,  223 
on  responsibility  in  law.  372 
Merry,  Mr.  Robert  Rosier,  death  of,  358 
“  Mesmerismus  chronicus,”  and  Messrs.  Gurney 
and  Myers,  437.  495,  553 
Mr.  Gurney’s  replies  to  criticisms,  501, 556,  610 
Metropolitan  Asylums  Board,  notices  of  meetings 
of  the,  100,  164 

Dr.  McCombie’s  report  on  the  South- 
Eastern  Hospital  ofjthe,  754 
Micro-biology  in  relation  to  medicine,  517 
Middlesex  Hospital,  cases  treated  at  the,  65,93, 126 
Medical  School,  scholarships  and  prizes  of  the, 
£07 

address  of  Mr.  Pearse  Gould  at  the,  409 
Midwifery,  Prof.  Charpentier’s  Treatise  on,  re¬ 
view,  275 

Mikulicz,  Prof,  on  resection  of  the  pylorus,  490 
Milt,  extraordinary  secretion  of,  581 
hot,  as  a  restorative,  698 
epidemic  of  typhoid  from,  vide  Typhoid  fever 
in  relation  to  tubercle,  550 
adulteration  of,  Mr.  Wigner  on  the,  633 
uterine.  Dr.  Hoffmann  on,  60S 
Millican,  Mr.  on  evolution  applied  to  pathology, 
223 

metaphysics  in  pathology,  415,  477 
Mineral  Waters  of  Europe,  Dr.  Titchborne  on  the, 
review,  356 

of  France,  Dr.  Vintras  on,  notice,  557 
Mitchell,  Dr.  Weir,  on  lesions  of  peripheral  nerve- 
trunks,  353 

Molluscum  eontagiosum  giganteum,  Dr.  Laache 
on, 161 


Dec.  29, 188?.  765 


Moore,  Dr.  James  (of  Belfast),  obituary  notice  of, 
561 

Morbid  growths,  early  operations  for,  Prof.  Gross 
on.  274 

Morris,  Mr.  on  exploration  of  the  bladder  by 
urethrotomy,  S3 

cases  of  median  urethrotomy,  92,  126 
“  Mors  in  olla,”  455 
Moss  as  a  dressing  for  wounds,  246 
Mouth,  zona  of  the,  case  of,  280 
Mundella,  Mr.  on  educational  over-pressure,  601 
Murder  and  madness,  vide  Insanity,  plea  of 
Murphy,  Mr.  report  on  an  epidemic  of  typhoid, 
455 

note  on  the,  535 

Murrell,  Dr.  and  Prof.  Ringer’s  experiments  with 
sodium  nitrite,  vide  Sodium  nitrite 
Myxoedema,  Dr.  Drewitt  on,  and  discussion,  642 


N 

Nsevus,  facial,  conjunctival,  and  retinal.  Dr. 
Horrocks’s  case  of,  110 

Nancrede,  Dr.  on  bleeding  in  local  inflammation, 
273 

Napelline,  Dr.  Laborde  on,  26 
Nasal  duct,  Mr.  Power  on  the,  503 
Naval  Medical  Service,  successful  candidates  for- 
the,  240 

regulations  for  candidates  for  the,  333 
Neale,  Dr.  on  adder-poison  in  tetanus,  634 
Necrosis,  quiet,  Dr.  Turner’s  case  of,  728 
Needle  and  thread,  Dr.  Cousins  on  a  new,  387 
Needles,  prolonged  retention  of,  698 
Nelson,  Dr.  Samuel  Christian,  death  of,  617 
Nephrectomy,  unsuccessful  case  of,  259 
Dr.  Kidd’s  case  of,  268 
Mr.  Thornton’s  case  of,  604 
vide  Kidney 

Nerves,  suture  and  transplantation  of,  Dr.  E.  G. 
Johnson  on,  271 
and  nerve-centres,  trophic,  183 
Nerve-stretching,  Mr.  Marshall  on,  690,  711 
in  sciatica,  Dr.  Donkin  on,  707 
Nerve-trunks,  peripheral,  Dr.  Mitchell  on  lesions 
of,  353 

Nervous  diseases,  recent  advances  in  the  pathology 
of,  686 

iodide  of  potassium  in  non-syphilitic,. 

Dr.  Seguin  on,  222 
syphilitic,  Dr.  Veronese  on,  697 
Neuritis,  peripheral,  686 
Neuro-fibroma,  ease  of,  7 
Neuro-pathology,  recent  advances  in,  685 
Newcastle-on-Tyne,  sanitary  reports  on,  for  18S2r 
186 

New  York,  increase  of  physicians  in,  17 
number  of  practitioners  in,  90 
Nicholson,  Deputy  Inspector-General,  on  the  use 
of  turpentine,  234,  543 
on  water-supply  for  troops  in  India,  601 
Nickel,  compounds  of,  Prof.  Da  Costa  on,  608 
Nipples,  sore,  application  for,  142 

Paget’s  disease  of  the,  Dr.  Duhring  on,  189 
Nose,  reflex  area  of  the,  Dr.  J.  Mackenzie  on  a, 
582 

Nottingham,  sanitary  state  of,  Dr.  Seaton’s  report 
on,  639 

O 

Obituary  Notices 

Archambault,  Dr.  (of  Paris),  101 
Atkinson,  Mr.  John  Ismay  (of  Wylam-on- 
Tyne),  250 

Ayrton,  Mrs.  Chaplin,  M.D.  195 
Berthier,  Dr.  F.  (of  Aix-les-Bains) ,  464 
Borchardt,  Dr.  Louis,  of  Manchester),  615 
Boyd,  Dr.  R.  (of  Southall),  249 
Cobb,  Dr.  Frederick  (of  the  London  Hospital), 
279 

Cody,  Surgeon-Major  (Bombay  Army),  111 
Crombie,  Dr.  John  Mann  (of  Aberdeen),  671 
Depaul,  Prof,  (of  Paris),  561 
Evans,  Dr.  George  Henry  (of  London),  442 
Pagge,  Dr.  Hilton.  601,  614 
Grant,  Surgeon  Peter  Macpherson  (of  the 
Indian  Medical  Service),  260 
Griffith,  Dr.  Moses  (of  the  Army  Medical 
Service),  675 

Jervis,  Dr.  Thomas  (of  Connaught-square) ,, 
603 

Johnstone,  Surgeon-General  Dr.  T.  B.  731 
Moore,  Dr.  James  (of  Belfast),  56t 
Orlebar,  Dr.  Hotham  George,  581 
Parrot,  Prof.  (Paris),  223 
Rosenberg,  Surgeon-Major  (in  Egypt),  646 
Schofield,  Dr.  Robert  Harold  Ainsworth  (of 
the  China  Inland  Mission),  431 
Sliuter,  Mr.  James,  520 
Sims,  Dr.  Marion  (of  New  York),  578 
Stewart,  Dr.  Alexander  Patrick,  72,  140 
Stoney,  Dr.  John  Henry  Loftie  (of  Dublin), 
2£0 

Sullivan,  Dr.  John,  474 
Twining,  Dr.  Prank  Theed,  431,  443 
Valentin,  Prof.  Gustav,  15 


Medical  Times  and  Gazette. 


INDEX. 


Dec.  29, 1833. 


Obstetrical  Society,  reports  of  meetings  of  the,  81, 
469,  640 

Obstetrical  practice,  food  in,  Dr.  Graily  Hewitt 


on,  162 

Odontologicall 


ociety,  notices  of  meetings  of  the. 


611,767 

^Esophagus,  syphilitic  stenosis  of  the,  Dr.  Lub- 
linski’s  cases  of,  692 

stricture  of  the,  Prof.  Loreta’s  operation  for, 


749 


Olfactory  nerves,  atrophy  of,  698 
Ophthalmia,  sympathetic,  Mr.  Snell’s  case  of,  100 
Mr.  Brailey  on,  726 
iridectomy  in,  case  of,  655 
granular,  jequirity  in,  106,  189 
catarrhal,  ointment  in,  476 
Egyptian,  “  Caution”  on,  195 
■  strumous,  Dr.  Wadsworth  on,  467 
neonatorum,  prevention  of,  Prof,  von  CredS 
on  the,  498 

Ophthalmic  Surgery,  the  Electro-Magnet  in,  Mr. 
Snell  on,  review,  758 

Ophthalmological  Society,  reports  of  meetings  of 
the.  71,  109,  470,  715,  724 
Mr.  Hutchinson’s  address  at  the,  448 
Opium-smoking,  innocuity  of,  Dr.  Ayres  on,  676 
Optic  nerves,  passage  of  blood  into  the,  726 
O’Reilly,  Dr.  John,  death  of,  504 
Orlebar,  Dr.  Hotham  George,  obituary  notice  of, 


561 


Orbit,  congenital  tumour  of  the,  specimen  of,  473 
Orme,  Mr.  Campbell,  death  of,  590 
Osborn,  Dr.  John,  death  of,  475 
Osteotomy,  Mr.  Cripps’s  case  of,  543 
Oswald,  Mr.  case  of  early  carcinoma  of  the  pros¬ 
tate,  423 

Out-patients,  the  homes  of,  628 
Ovarian  tumour,  cases  of  dermoid,  by  Mr.  Thorn¬ 
ton,  235 ,  709 

Oxford  University,  regulations  relating  to  degrees 
of  medicine  at  the,  287 


P 

Page,  Mr.  H.  W.,  Injuries  of  the  Spine,  review,  499 
Dr.  reports  on  scarlatina,  467 
Taladini,  Dr.  case  of  hypodermic  transfusion  of 
blood,  467 

Paraldehyde,  nature  and  properties  of,  373 
Paralysis,  spastic,  Dr.  H.  Bennett  on,  507 
Paris,  weekly  returns  of,  13,  44,  72,  100,  134, 161, 
187,  217,  241,  270,  362,380,  412,  434,  462,  492, 
523,  552,  577,  605,  634,  663,  693,  718,  746 
typhoid  fever  in,  during  1865-82,  353 
night-service  of,  88,  623 
homes  of  the  poor  in,  687 
medical  census  of,  in  1883,  220 
hospitals  of,  vide  Hospitals 
hydrophobia  in,  in  1881,  484 
Parker,  Mr.  Rushton,  bone  and  joint  cases,  36, 
345,  738 

Surgical  Cases  and  Essays,  notice,  500 
Mr.  R.  W.  on  a  caBe  of  lardaceous  disease  of 
the  hip,  181 

and  Mr.  Shattock  on  the  pathology  of 
club-foot,  560 

on  spontaneous  inguinal  aneurysm  in  a 
boy,  586 

Parliament,  medical  matters  in,  17,  47,  73,  102, 
137,  167,  220,  244 

Parrot,  Prof,  (of  Paris),  obituary  notice  of,  223 
Parsons,  Dr.  reports  of,  on  diphtheria,  18, 19, 668, 
696 

Surgeon-Major,  on  volunteer  medical  organi¬ 
sation,  163 

Patella,  fracture  of  the,  treated  by  Malgaigne’s 
hooks,  case  of,  697 

discussion  on  Prof.  Lister’s  operation  for, 
547,  573 

discussion  on,  at  the  Socidtd  de  Chirurgie, 
633 

dislocation  of  the,  Mr.  Wilkes’  case  of,  708  18 
ununited  fracture  of  the,  Mr.  Turner’s  case, 
and  discussion,  685 

Pathological  Society,  reports  of  meetings  of  the, 
472,  559,  612,  672,  715,  728 
Pathology,  Dr.  Creighton’s  address  on,  145, 157 
metaphysics  in.  Dr.  Mercier  on,  177,  858 
Dr.  Saundby  on,  387,  442 
evolution  applied  in,  Mr.  Millican  on,  223, 
415.  477 

Paulsen,  Dr.  on  dress  as  a  cause  of  scrofulosis,  237 
Pearless,  Mr.  Edward  Montague,  death  of,  673 
Pearse,  Dr.  pocket  emergency-case,  82 
Pearson,  Dr.  George,  death  of,  646 
Peerages  (medical),  Dr.  A.  Carpenter’s  views  on, 
criticised,  129 

Pelvis,  the  kyphotic.  Dr.  Champneys  on,  81 
fracture  of,  Mr.  Parker’s  case  of,  346 
Pemphigus  pruriginosus,  iodoform  in,  684 
Pepsin,  physiological  production  of,  682 
Peptonised  foods,  Benger’s,  279 
Pericarditis,  purulent,  Dr.  West  on  incision  in, 
660,  672 

Perinephritic  abscess,  Mr.  Heath’s  case  of,  628 
Peritoneal  abscess  in  children,  Dr.  Goodhart’s 
cases  of,  471 


Peritoneum,  enormously  thickened,  case  of,  4S4 
Peritonitis,  case  of  operation  for,  48 
Pessary  (Hodge’s),  Dr.  Herman  on,  567,  595 
Pettigrew,  Dr.  on  civilisation  as  the  result  of 
intellectual  progress,  567 
Phagedsena  after  fever,  turpentine  in,  Dr. 
Nicholson  on,  234 

Phillips,  Mr.  Richard,  death  of,  112 

Dr.  Leslie,  notes  on  ether-narcosis,  261 
Phthisis,  germicide  treatment  of,  Dr.  Hurd  on, 
463 

Physicians  (Royal  College  of)  of  London,  rules 
and  regulations  of  the,  296 
admission  of  Fellows  to  the,  25 
pass-lists  of  the,  141,  533 
Physicians  and  Surgeons  (Royal  College  of)  of 
Edinburgh,  rules  and  regulations  of  the, 
301,  589 

Physicians  (Royal  College  of)  of  Edinburgh,  pass- 
lists  of  the,  196 

Physicians  (King  and  Queen’s  College  of)  in 
Ireland,  regulations  of  the,  301 
pass-lists  of  the,  111,  196, 416, 475,  616,  730 
Physiology  in  the  schoolroom,  712 
Pick,  Prof,  treatment  of  eczema,  439 

Mr.  Pickering,  clinical  lecture  on  arterio¬ 
venous  aneurysm,  677 

Picric  acid  as  a  test  for  sugar,  Dr.  Barrett  on, 
469 

Piscidia  erythina  as  a  hypnotic,  380 
Pitres  and  Vaillard,  Drs.  on  peripheric  neuritis, 
686 

Placenta  prsevia,  the  tampon  in,  Dr.  Curtis 
Smith  on,  169 

Plantar  arch,  wound  of  the,  Mr.  Turner’s  case  of 
584 

Pleurisy  in  a  child,  Dr.  Donkin  on  a  case  of,  262 
Pneumonia,  croupous,  the  micrococcus  of,  634 
subacute  and  chronic,  Dr.  Wagner  on,  694 
Pneumothorax,  idiopathic,  Dr.  West  on,  with 
discussion,  726 

Poisoning,  accidental  case  of,  187 

vide  Carbolic  acid,  Chloral,  Chlorate  of  potash, 
Gas,  Lead,  Snake 

Ponfick,  Prof,  on  hcemoglobinaemia,  183 
Porter,  a  standard  for,  Dr.  Cameron  on,  242 
Portsmouth,  sanitary  state  of,  in  1892,  192 
Position  in  midwifery  practice,  Dr.  McCraith  on, 
483 

vide  Genu-pectoral 

Power,  Mr.  W.  H.  report  on  epidemics  of  diph¬ 
theria,  245,  246,  696 
on  enteric  fever  at  Hitchin,  497 
Mr.  Henry,  lectures  on  protective  and  lacri¬ 
mal  apparatus  of  the  eye,  335,  363,  420,  508, 
640 

on  the  relation  of  dental  lesions  to  diseases 
of  the  eye,  611 

Practice,  “pure,”  observations  on,  598 
Pratt,  Dr.  Charles,  death  of,  55 

Assistant-Surgeon  Edward,  death  of,  65 
Pregnancy,  changes  in  the  kidney  during,  755 
Pretty,  Mr.  George  Willson,  death  of,  730 
Propensity,  instance  of  a  curious,  756 
Prostate,  diseases  of  the,  improvements  in  the 
treatment  of,  Mr.  R.  Harrison  on,  122 
enlarged,  median  urethrotomy  in,  Mr.  Morris’s 
cases  of,  126 

carcinoma  of  the,  at  an  early  age,  Mr. 
Oswald’s  case  of,  423 

Public  Prosecutor,  mischievous  action  of  the.  in 
the  case  of  Messrs.  Bower  and  Keates,  695 
Puerperal  convulsions,  treated  by  diaphoresis,  Dr. 
Carl  Breus  on,  493 
insanity,  Dr.  Sutherland  on,  566 
eclampsia,  case  of,  212 
“  Pure  practice,”  693 
Purpura,  Dr.  Stephen  Mackenzie  on,  164 

with'cerebral  haemorrhage,  Dr.  Bristowe  on, 87 
Pusehmann,  Dr.  Die  Medicin  in  Wien,  notice,  667 
Pylorus,  resection  of  the,  Prof.  Mikulicz  on,  490 
Pyosalpinx,  Mr.  Lawson  Tait’s  cases  of,  640 


Q 

Quackery,  enthusiasm  in  relation  to,  348 
Quarantine,  discussion  on,  at  the  Amsterdam 
Congress,  511 

Quassine  and  amorphous  quassia,  M.  Vigier  on, 
126 

Queirel,  Dr.  on  the  jaundice  of  pregnancy,  070 
Quinia  oleate,  external  employment  of,  694 
Quinine,  effects  of,  on  the  ear,  Dr.  Green  on,  20 
alleged  production  of  insanity  by,  693 


E 

Rabid  animals,  the  law  respecting,  in  France,  662 

Rachialgia,  Dr.  Lemoine  on.  notice,  582 

Radial  artery,  aneurysmal  dilatation  of  the,  case 
of,  673 

Radius,  compound  fracture  of,  Mr.  Wilkes’  case 
of,  709 

Railway  accidents,  question  of  compensation 
after,  486 

Mr.  Le  Gros  Clark  on,  529 


Railway-carriage,  how  to  sleep  in  a,  252 
Ralfe,  Dr.  on  school  hygiene,  101 
Randolph,  Dr.  on  the  faeces  of  starch-fed  infants, 
262 

Rawlingson,  Mr.  hygiene  of  armies  in  the  field,  4 
Recruiting  for  the  army,  observations  on,  631 
Reformatories  and  industrial  schools,  a  radical 
defect  in,  405 

Registers,  medical  family,  Mr.  Galton  on,  130,690 
Registrar-General  for  England  and  Wales’  Forty- 
fourth  Report,  analysis  of  the,  465 
Registration  reports  for  Scotland  in  1883,  42,  72, 
215,  242,  267,  379,  381,  412 
for  England  and  Wales  in  1883,  238,  269,  691 
for  Ireland  in  1883,  272 

for  foreign  and  colonial  cities  in  1883, 241,  746 
Responsibility  in  law,  Dr.  Mercier  on,  372 
Retina,  haemorrhage  into  the,  from  anaemia,  725 
Reverdin,  Dr.  L.  Note  sur  Vingt-deux  Operations 
de  Goitre,  review,  527 

Rhabdomyoma  of  the  orbit,  Dr.  Bayer  on,  101 
Rheumatism  and  Gout,  Dr.  Longstreth  on,  re* 
view,  248  a 

Rheumatism,  gaultheria  in,  Dr.  Flint  on,  106 
relation  of,  to  chorea,  429 
inflammation  of  the  membrana  tympani  as  a 
precursor  of,  578 
Dr.  Thorowgood  on,  611 

Rich,  homes  of  the,  observations  on  Mr.  Austin’s 
article  on  the,  656 

Richardson,  Dr.  B.  W.  on  the  treatment  of  the 
collapse  of  cholera,  124,  155,  179 
treatment  of  first  stage  and  reaction  in 
cholera,  210 

on  temperance  statistics,  457 
the  Field  of  Disease,  review,  670 
Dr.  Elliot,  on  employment  of  the  forceps,  222 
Rickets,  relation  of,  to  syphilis,  743] 

Ridout,  Staff-Surgeon  Charles  Lyon,  death  of,  359 
Ringer  and  Murrell,  Drs.  vide  Sodium  nitrite 
Ringer  and  Sainsbury,  Drs.  on  the  digitalis  group, 
644 

Ringworm  of  the  scalp,  Dr.  van  Harlingen  on,  49 
Rivington,  Mr.  address  at  the  Hunterian  Society, 
227,  258  * 

Robinson,  Mr.  Henry,  Sewage  Disposal,  notice, 
528 

Rochard,  Dr.  attempted  assassination  of,  by  a 
lunatic,  462,  635 

Roeckel,  Mr.  on  structure  of  haemorrhoids,  561 
Rohrschneider,  Dr.  on  tuberculosa  dolorosa,  371 
Roosa,  Dr.  St.  John,  effects  of  noise  on  the  ears, 

181 

Rosenberg,  Surgeon-Major,  obituary  notice  of, 
646 

Ross,  Dr.,  Diseases  of  the  Nervous  System, 
review,  395 

Dr.  John  (of  Inverness),  death  of,  533 
Round  ligament,  solid  tumours  of  the,  Dr. 
Sanger  on,  638 

Rubeola,  Dr.  McCall  Anderson  on,  230 
Rumination  in  lunatics,  373 
Rumpe,  Dr.  statistics  of  induction  of  premature 
labour,  492 

Ruspini’s  tincture,  dentifrice,  and  styptic,  615 
Russell.  Dr.  James,  case  of  dilatation  of  the 
stomach,  99 

Rutherford,  Prof,  opening  address  of,  524 


S 


Salicylate  of  sodium,  formula  for,  722 
Salt  and  Sons’  Daily  Clinical  Charts,  notice,  80 
Samaritan  Hospital,  cases  treated  at  the,  235,  709 
Sanger,  Dr.  on  solid  tumours  of  the  round  liga¬ 
ment,  638 

Sanitary  Institute,  annual  meeting  of  the,  411 
improvements,  urban  and  rural,  282 
metropolitan  administration.  Dr.  Dudfield 
on,  479,  487 

co-operation,  advantages  of,  435 
science,  regulations  for  degrees  in,  325 
defects  and  zymotic  diseases,  Dr.  Kelly  on, 
661 

rose-powder,  Woolley’s,  530 
Sansom,  Dr.,  Lettsomian  Lectures,  notice,  500 
Sappey,  Prof,  on  a  prolonged  retention  of  a 
foetus,  385 

Satchell,  Mr.  William  Carrol,  death  of,  359 
Saundby,  Dr.  on  metaphysics  in  pathology,  387, 
443 

Scarlatina,  Dr.  McCall  Anderson  on,  230 
Dr.  Parsons  on  an  outbreak  of,  696 
Dr.  Page’s  reports  on  outbreaks  of,  466 
local  application  of  vaseline  in,  582 
in  horses,  Dr.  Peters  on,  646 
Scarlatinoid  disease,  Dr.  Bond  on,  578 
Scatliff,  Dr.  John  Parr,  death  of,  690 
Sciatica,  nerve-stretching  in,  Dr.  Donkin  on,  707 
Schafer,  Prof,  on  the  structure  of  the  cell,  204 
Schofield,  Dr.  Robert  Harold  Ainsworth,  obituary 
notice  of,  431 

Schools,  overwork  in,  vide  Educational  over¬ 
pressure 

hygiene  of,  Dr.  Ralfe  on,  101 
teaching  physiology  in,  712 


Medical  Times  and  Gazette. 


INDEX, 


Dee.  29,  1883.  767 


Schreiber,  Dr.  Zar  Lehre  von  den  Complicirten 
Luxationen,  notice,  468 
Sclerosis,  disseminated,  in  children,  381 

cerebro-spinal,  Dr.  Bastian’s  case  of*,  451 
Scriven,  Dr.  Samuel  Swain,  death  of,  26 
Scrofulosis,  dress  as  a  cause  of,  Dr.  Paulsen  on, 
237 

Scurvy,  caution  during  convalescence  of,  731 
Seaton,  Dr.,  Report  on  the  Sanitary  Condition  of 
Nottingham,  notice,  639 
Sebaceous  cysts  on  the  ring-finger,  473 
Seguin,  Dr.  on  iodide  of  potassium  in  non-syphi¬ 
litic  nervous  disease,  222 

Semicircular  canals,  function  of.  Dr.  James  on 
the,  499 

Semnola,  Dr.  on  glycerine  in  fevers,  582 
Semon,  Dr.  on  Prof.  Kocher’s  investigations  on 
bronchocele,  630,  641 
on  abductor  paralysis  of  the  larynx,  718 
Sewage,  disposal  of,  at  Berlin,  265 
Sewer,  a  new  form  of  closed,  by  Mr.  Reeves,  246 
Sewer-smells,  observations  on,  747 
Sharkey,  Dr.  on  homonymous  hemianopia,  471 
on  pathological  histology,  593 
Shock,  Dr.  Brown-Sequard’s  theory  of,  678 
Short  sight,  Dr.  Cohn’s. statistics  of,  703 
Shuter,  Mr.  James,  obituary  notice  of,  520 
Shuttleworth,  Mr.  Robert,  death  of,  504 
Sims,  Dr.  Marion  (of  New  York),  obituary  notice 
of,  678 

Skin,  Diseases  of,  Dr.  Hyde’s  Practical  Treatise 
on,  review,  107 

diagnosis  of  the,  Dr.  McCall  Anderson  on, 
229 

external  use  of  perchloride  of  iron  in,  155 
Skinner.  Dr.,  Homoeopathy  in  relation  to  Diseases 
of  Females,  notice,  277 

Sleep,  Causation  of,  Dr.  Cappie  on  the,  review,  22 
Small-pox  as  an  autonomous  infection,  148 

as  an  eruptive  fever,  Dr.  McCall  Anderson 
on,  231 

statistics  of,  in  Islington,  462 
Smith,  Dr.  Curtis,  on  the  tampon  in  placenta 
prsevia,  169 

Dr.  Eustace,  on  a  case  of  ingestion  of  bella¬ 
donna,  373 

Dr.  John  Alexander,  death  of,  225 
Dr.  Lewis,  on  early  tuberculosis  in  infants,  243 
Mr.  Thomas,  cases  of  lumbar  abscess,  514 
Snake-Poisons  in  India,  Dr.  Wall  on,  notice,  46S 
Dr.  Nicholson’s  observations  on,  648 
Snell,  Mr.  case  of  sympathetic  ophthalmia,  109 
The  Electro-Magnet  in  Ophthalmic  Surgery, 
review,  756 

Societies,  medical,  vide  Clinical,  Epidemiological, 
Liverpool,  London,  Medical  and  Chirurgical 
(the  Royal),  Obstetrical,  Odontological, 
Ophthalmological,  Pathological 
Sodium  nitrite.  Prof.  Ringer  and  Dr.  Murrell’s  ex¬ 
periments  with,  criticisms  on,  549,  571,  599 
report  of  the  Committee  of  Westminster 
Hospital  on,  631,  636 

Sonsino,  Prof,  on  filaria  sanguinis  parasitism  in 
Egypt,  340,  367,  421 
Southam,  Mr.  Thomas,  death  of,  170 
Southby,  Dr.  Anthony,  death  of,  196 
Spear,  Mr.  reports  on  diphtheria  and  fever,  18, 
245,  637 

report  on  wool-sorters’  disease,  76 
“  Specialism” — a  discussion,  752 
“  Speech-day,”  403 
Spilsbury,  Mr.  Thomas,  death  of,  476 
Spinal  dura  mater,  gumma  of  the,  specimen  of, 
473 

Spine,  Injuries  to  the,  Mr.  Page’s  Treatise  on, 
review,  499 
fatal  cases  of,  683 

Spitzka,  Dr., Insanity,  its  Classification,  Diagnosis, 
and  Treatment,  review,  609 
Spleen,  abscess  of  the,  in  India,  Dr.  Chevers  on,  90 
Square,  Dr.  J.  E.  on  the  Camden  Town  epidemic, 
601 

Stack,  Dr.  on  transplantation  of  teeth,  24 
Starchy  food,  digestion  of,  vide  Foods 
State  medicine,  regulations  for  degrees  in,  325 
Steams,  Dr.,  Insanity,  its  Causes  and  Prevention, 
review,  51 

Stein,  Dr.  S.  T.  Die  allgemeine  Elektrisation  des 
Korpers,  review*  247 

Stewart,  Dr.  Alexander  Patrick,  obituary  notice 
of,  72, 140 

Prof.  Grainger,  address  of,  at  Edinburgh,  525 
Stomach,  dilatation  of  the,  Dr.  Russell’s  case  of,  99 
ulcer  of  the,  the  less  obvious  symptoms  of,  546 
vide  Pylorus,  resection  of  the 
Stoney,  Dr.  John  Henry  Loftie  (of  Dublin), 
obituary  notice  of,  260 
Strauss,  Dr.  report  on  cholera  in  Egypt,  604 
Strickland,  Mr.,  Sick-Room  Charts,  notice,  80 
“  Success,”  431 

Suffocation,  death  by.  Dr.  A.  Harvey  on  dis¬ 
crepancies  of  opinion  on,  622,  649 
Sugar,  picric  acid  for  the  detection  of,  Dr. 
Barrett  on,  469 

Sullivan,  Dr.  John,  obituary  notice  of,  474 
Surgeons  (Royal  College  of)  of  England,  collection 
of  drawings  in  the,  Sir  James  Paget  on  the 
formation  of  a,  48 


Surgeons  (Royal  College  of)  of  England,  question 
of  election  by  proxy  into  the  Council  of  the, 
66,  571 

regulations  of  the.  297 

statistics  of  the  results  of  examinations  at 
the,  in  1882-83,  105 

primary  examination  at  the,  pass-lists  of  the, 
25,  55,  83,  562,  589 

questions  for  the,  26,  564 
diploma  of  the,  pass- lists  for  the,  83,  111,  142, 
589,  616 

questions  for  the,  83,  592 
primary  fellowship  of  the,  pass-list  for  the, 
616 

questions  for  the,  620 

fellowship  of  the,  final  pass-list  for  the,  702 

questions  for  the,  647 

licence  in  dental  surgery  of  the,  pass-lists 
of  the,  504 

questions  for  the,  504 

Surgeons  (Royal  College  of)  of  Edinburgh,  pass- 
lists  of  the,  196,  589 

Surgeons  (Royal  College  of)  in  Ireland,  honorary 
fellowships  conferred  by  the,  106 
regulations  of  the,  302 
pass-lists  of  the,  196,  769 
Surgical  operations  in  relation  to  race,  Dr.  Van 
Brinton  on,  71 

early,  for  morbid  growths,  Prof.  Gross  on, 
274 

Sussex  (West),  Dr.  Kelly’s  report  on,  for  1882,  20, 
621 

Sutherland,  Dr.  Henry,  Lectures  on  Insanity,  256, 
565 

Sutton,  Mr.  on  tuberculosis  in  birds,  601,  613 
Swaine,  Dr.  case  of  gangrene  during  pregnancy, 
469 

Swanzy,  Mr.  case  of  hemiachromatopsia,  109 
Symbiosis,  Prof.  Hertwig  on,  550 
Symonds,  Mr.  on  chronic  inflammation  of  bone, 
165 

case  of  dilatation  of  the  radial  artery,  673 
on  herpes  labialis  with  rigor,  727 
Syphilis,  communicability  of,  to  animals.  Dr. 
Kobner  on,  160 

of  the  nervous  system.  Dr.  Veronese  on,  697 
of  the  membranes  of  the  brain,  Dr.  Althaus’ 
case  of,  531,  558 

stenosis  of  the  oesophagus  from,  Dr.  Lub- 
linski’s  cases  of,  692 
rickets,  and  struma,  743 
in  the  metropolis,  Dr.  Gibbon  on,  493 
as  treated  at  Vienna,  104 
the  formidad  of  mercury  in.  Prof.  Zeissl  on, 
20 

turpentine  in  secondary,  Dr.  Nicholson  on, 
234 

T 

Tabes,  ichthyosis  in,  MM.  Ballet  and  Dutil  on,  16 
lesions  of  the  foot  in,  Profs.  Charcot  and  F6r6 
on,  219 

etiology  of,  Prof.  Erb  on  the,  236 
vide  Locomotor  ataxy 
Tabral,  Dr.  Nicholas,  death  of,  646 
Tait,  Mr.  Lawson,  on  uterine  myoma,  81 
on  cases  of  pyosalpinx,  640 
case  of  gangrene  of  the  uterus,  641 
Tarnier,  Prof,  case  of  ectopia  of  the  heart,  191, 524 
Taylor,  Dr.  F.  on  a  case  of  thrombosis  and  em¬ 
bolism,  402 

Dr.  A.  Swaine,  Medical  Jurisprudence,  notice, 
528 

Dr.  S.  on  fever  in  Liverpool,  721 
Teale,  Mr.  address  of,  at  the  Social  Science  Asso¬ 
ciation,  430 

Tears,  Mr.  Power  on  the,  540 
Teeth,  replantation  and  transplantation  of,  Dr. 
Stack  on,  with  discussion,  24 
affections  of  the,  in  relation  to  diseases  of  the 
eye,  Mr.  Power  on,  611 
Telegraphy,  effects  of,  on  the  health,  212 
Terai  fever,  Dr.  Chevers  on  the  treatment  of,  63 
Testamentary  capacity,  curious  decision  concern¬ 
ing,  39 

recognition  of,  during  life,  proposed,  112 
Testis,  strangulated  undescended,  Mr.  Godlee’s 
case  of,  424 

in  perineo,  Mr.  Horsley  on  a  case  of,  627 
Tetanus  from  contusion,  case  of,  603 

treated  by  venom  of  rattlesnake,  606 
adder-poison  in,  Dr.  Neale  on,  634 
Tetany,  Dr.  Weiss  on,  42 

Therapeutics,  popular  and  rational,  Dr.  Donkin 
on,  398 

Thermometers  (clinical),  how  to  carry,  262 
Thin,  Dr.  on  salicylic  plaster  in  thickened  epi¬ 
dermis,  641 

Thomas,  Prof.  Gaillard,  on  infantile  leucorrhoea, 
75 

on  non-recurrence  of  menstruation  after  the 
menopause,  670 

on  communicability  of  cancer,  684 
Thomas’s  (St.)  Hospital,  reports  of  cases  treated 
at,  569,  597 

Medical  School,  prizes  and  appointments  of, 
307 


Thomas’s  (St.)  Hospital  Medical  School,  Mr. 

Le  Gros  Clark’s  address  at,  409 
Thomson,  Dr.  Spencer,  Dictionary  of  Domestic 
Medicine,  notice,  248 

Surgeon  S.  J.,  Sanitary  Principles,  notice,  683 
Thornton,  Mr.  Knowsley,  on  surgical  treatment 
of  fibro-myoma  of  the  uterus,  1 
cases  of  dermoid  ovarian  tumours,  235,  709 
case  of  nephrectomy.  604 
Thorowgood,  Dr.  on  affections  of  the  ear  and 
tonsil  in  connexion  with  rheumatism,  611 
Thrombosis  of  the  carotids,  case  of,  401 
Thurston,  Mr.  George  James,  death  of,  84 
Thyroidectomy,  vide  Bronchocele 
Tinned  provisions,  a  danger  of,  368 
poisoning  by,  574,  647 
tin  in,  scientific  proof  of,  496 
Titchborne,  Dr.,  Mineral  Waters  of  Europe? 
review,  356 

Tobacco-smoking,  effects  of,  on  children,  Dr. 
Decaisne  on  the,  114 

effects  of,  on  the  temperature  and  pulse,  693 
Tongue,  sweeping  the  pharynx  with  the.  35 

enlargement  of  the,  treated  by  Paquelin’s 
cautery,  310 

tubercular  disease  of  the,  Mr.  Barker’s  case 
of,  673 

Mr.  Godlee’s  cases  of,  with  discussion,  729 
Torquay,  sanitary  condition  of,  in  1882,  459 
Towns,  medico-topographical  and  health  histories 
of,  Dr.  Chevers  on,  637 

Tracheotomy,  mediastinal  emphysema  and  pneu¬ 
mothorax  after,  Dr.  Champneys  on,  701 
Transfusion  (hypodermic)  of  blood,  Dr.  Paladini’s 
case  of,  467 

Trophic  nerves  and  nerve-centres,  183 
Tubercle,  resistance  of,  to  antiseptics,  Dr.  H. 
Martin  on,  748 

Tuberculosa  dolorosa,  Dr.  Rohrschneider  on,  371 
Tuberculosis  as  an  infection,  Dr.  Creighton  on, 
146 

bovine,  147,  550 

early,  in  infants,  Dr.  L.  Smith  on,  243 
the  bacillus  of,  Dr.  Ernst  on,  444 
Prof.  Fraentzel  on,  453 
Dr.  Austin  Flint  on,  719 
etiology  of,  Dr.  D.  Williams’s  experiments 
on  the,  672 

in  the  German  Army.  722 
inoculation  of.  Dr.  Wilson  Fox  on  the,  672 
in  birds,  Mr.  Sutton  on,  601,  613 
Turnbull,  Dr.  on  deafness  and  tinnitus  in  Bright’^ 
disease,  35 

Turner,  Mr.  G.  E.  ease  of  wound  of  the  plantar 
arch,  684 

case  of  ununited  fra  cture  of  the  patella, 
585 

Dr.  F.  C.  case  of  necrosis,  728 
Turpentine  in  secondary  syphilis,  Dr.  Nicholson 
on,  234 

on  a  third  use  of,  543 

Tweedy,  Mr.  address  of,  at  University  College, 
395,  408 

Twining,  Dr.  Frank  Theed,  obituary  notice  of? 
431,  443 

Tympani  (membrana),  effects  of  explosions  on 
the,  550 

inflammation  of  the,  as  a  precursor  of  rheu¬ 
matism,  478 

Tynemouth,  sanitary  reports  on,  for  1882, 414, 719 
Typhoid  fever,  heart-failure  in,  Dr.  B.  Johnson 
on,  90 

as  an  eruptive  fever,  Dr.  Anderson  on,  229 
pneumothorax  during,  Dr.  Cayley’s  case  of, 
726 

question  of  calomel  treatment  of,  635 
necrosis  of  the  jaw  in,  Dr.  A.  Money’s  case 
of,  613 

epidemic  of,  at  Hitchin,  Mr.  Power  on  an,  497 
epidemic  through  milk  in  St.  Pancras,  455, 
532,  564 

Dr.  Squire  on  the,  501 
in  Dundee,  494,  564 

epidemic  outbreaks  of,  at  Southborough  and 
St.  Helen’s,  Mr.  Spear  on,  18 
in  the  Holbeach  district.  Dr.  Parsons  on, 
19 

at  Weston-super-Mare,  Dr.  Blaxall  on, 
219 

in  Paris,  in  1866-82,  353 
Typhus,  outbreak  of,  in  Skye,  189 

distribution  of,  in  Liverpool,  Dr.  Hope’s 
report  on  the,  636 

u 

University  College  Hospital, cases  treated  at,  374, 
425,  627 

Medical  School,  scholarships  and  exhibitions 
of,  308 

Mr.  Tweedy’s  address  at,  395,  408 
Department  of  Public  Health  and  Hygiene 
of,  718 

Urachus,  pervious,  Dr.  Ball’s  case  of,  759 
Urethra  opening  into  the  vagina,  case  of,  7C8 
Urethral  fever.  Dr.  Chevers  on,  601 
Urethrotomy,  internal,  Mr.  Holmes  on,  29 


768 


Medical  Times  and  Gazette. 


INDEX. 


Dec.  2P,  1883 


Urethrotomy,  internal,  Mr.  E.  Harrison  on,  123 
median,  for  exploration  of  the  bladder,  Mr. 
Morris  on,  89 

cases  of,  by  Mr.  Morris,  92,  126 
Urinary  organs,  improvements  in  treating  dis¬ 
eases  of  the.  Mr.  E.  Harrison  on,  119 
test-papers,  Wilson’s,  279 
Uterine  milk,  Dr.  Hoffmann  on,  609 
Uterus,  puerperal  inversion  of  the,  Dr.  Fiirst  on, 
461 

the  os  internum  of  the,  Dr.  H.  Bennet  on,  469 
absence  of  the,  340 

■contractions  of  the,  Dr.  Frommel  on,  526 
Diseases  of  the,  Prof.  Courty  on,  review,  193 
prolapsus  of  the,  and  elytrorrhaphy,  Dr. 
Herman’s  case  of,  211 

retroversion  of  the  gravid,  Dr.  Duncan  on, 
621 

fibroids  of  the,  breaking  down  during  preg¬ 
nancy,  522 

fibro-myoma  of  the,  Mr.  Thornton  on  the 
surgical  treatment  of,  1 
myoma  of  the,  Mr.  Lawson  Tait  on,  81 
gangrene  of  the,  Mr.  Lawson  Tait  on,  641 
anteflexion  of  the,  discussion  on.  697 
flexion  of  the,  in  relation  to  dysmenorrhcea, 
Dr.  Vedeler  on,  96,  404 
displacements  of  the,  notes  on,  281,  369, 415, 
477 

vide  Endometritis 

V 

Vaccination,  neglect  of  early,  in  Paris,  694 

in  the  army,  Parliamentary  queries  concern¬ 
ing,  220 

deaths  from  erysipelas  following,  605 
heifer,  Dr.  Martin  on,  66 
educational  stations  for,  328 
Vaccine  virus,  the  Government  supply  of,  167 
the  origin  of,  Dr.  Warlomont  on,  582 
Vaginitis  in  aged  women,  346 

thrombosis  of  the  carotids  following,  case  of, 
401 

Valentin,  Prof.  Gustav,  obituary  notice  of,  15 
Van  Harlingen,  Dr.  on  ringworm  of  the  scalp,  49 
Vaporiser,  the  vapo-cresolene,  532 
Varicella,  Dr.  McCall  Anderson  on,  231 
Vedeler, Dr.  on  uterine  flexions  and  dysmenorrhcea, 
96,  404 

Veins,  feeding  by  the,  in  the  collapse  of  cholera, 
Dr.  Eiehardson  on,  125,  179 
connected  with  the  hepatic  system,  Mr.  Gay 
on,  625 

Verneuil,  Prof,  on  reparation  of  fracture  in  the 
diabetic,  125 


Veronese,  Dr.  on  syphilis  in  relation  to  the  ner-  j 
vous  system,  697 

Vienna,  surgical  eases  at,  582 

the  School  of  Medicine  at,  Dr.  Puschmann 
on,  667 

Vintras,  Dr.,  Mineral  Waters  of  Erance,  notice, 
657 

Virchow,  Prof,  and  the  “  Swiss  pill,”  359 
on  congenital  encephalitis,  576,  581 

Volunteer  medical  organisation,  Surgeon-Major 
Parsons  on,  163 

Vulpian,  Prof,  on  the  illness  and  death  of  the 
Comte  de  Chambord,  355 


W 


Wadsworth,  Dr.  on  phlyctenular  diseases  of  the 
eye,  467 

Wagner,  Dr.  on  subacute  and  chronic  pneumonia, 
694 

Wall.  Dr.,  Indian  Snake-Poisons,  notice,  468 
Walthamstow  murder,  vide  Insanity,  plea  of 
Wandsworth,  sanitary  condition  of,  356 
Warfvinge,  Dr.  on  arsenic  in  progressive  anaemia, 
128 

Warlomont,  Dr.  on  the  origin  of  vaccine  virus,  582 
Warner,  Dr.  apparatus  of,  for  measuring  move¬ 
ments  of  the  hand,  567 
Warts,  application  for,  609 
Warwick,  Dr.  Eichard  Archer,  death  of,  504 
Water  for  infants,  need  of,  388 

bacterioscopic  examination  of,  Dr.  Koch  on 
the,  270 

sewage  contamination  of,  67 
supply,  the  metropolitan,  monthly  reports  on, 
13,  189,  216,  270 

quality  of,  Dr.  Erankland  on  the,  190 
Watercress,  properties  of  the,  discussion  on  the, 
124 

Waters,  Dr.  on  the  aspects  and  prospects  of 
medicine,  115,  127 

Watteville,  Dr.  de,  ’‘Uses  of  Hospital-Patients,” 
criticism  on,  629,  689 
Weiss,  Dr.  on  tetany,  42 
Wellings,  Mr.  Eichard,  death  of,  280 
West,  Dr.  8.  on  anastomosis  of  the  coronary 
arteries,  559 

on  incision  in  purulent  pericarditis,  660,  672 
on  idiopathic  pneumothorax,  727 
West  London  Hospital,  preparatory  school  of 
medicine  and  natural  science  at  the,  576 
Westminster  Hospital,  report  of  the  Committee 
of.  on  Dr.  Murrell’s  experiments,  631,  636 
Medical  School,  prizes  of  the,  309 
Mr.  Barron’s  address  at  the,  409 


END  OF  VOLUME  II.  1883. 


* 


Westminster  Eoyal  Ophthalmic  Hospital,  cases 
treated  at  the,  655 

Weston-super-Mare,  typhoid  fever  at,  219 
Wheeler,  Mr.  Thomas  Eivington,  death  of,  760 
White,  Mr.,  The  Knapsack  Handbook,  notice,  109 
Mr.  William  Todd,  death  of,  2k0 
Wilkes,  Mr.  saving  life  after  craniotomy,  691 
cases  in  surgery,  708 
Wilkinson,  Mr.  W.  H.  death  of,  617 
Williams,  Dr.  Dawson,  on  the  etiology  of  tuber¬ 
culosis,  672 
Dr.  Y.  death  of,  646 

Mr.  T.  Hammond,  cases  of  hystero-epilepsy, 
655 

Wilson,  Mr.  George,  Handbook  of  Hygiene, 
notice,  699 

Wolf,  Dr.  Julius,  on  trophic  troubles  in  joint- 
disease,  100 

Wolseley,  General  Lord,  address  of,  at  the 
Charing-cross  Hospital,  6 
Women,  danger  of  examining,  when  alone,  378 
London  School  of  Medicine  for,  Dr.  Donkin’s 
address  at  the,  393 

Woodhead,  Dr.,  Practical  Pathology,  notise,  757 
Wool-sorters’  disease,  Mr.  Spear  on,  76 
Word-blindness,  Prof.  Charcot  on,  45 
“  Worthless,  the  use  of  the,”  629 
Wrist,  synovitis  of  the,  with  rice-like  bodies,  179 
Writer’s  cramp,  Nussbaum’s  bracelet  for,  82 

Y 

Yarde,  Staff-Surgeon  Dr.  William,  death  of,  388 
Yellow  fever,  Dr.  Freire’s  researches  in,  143,  577 
Dr.  Creighton  on,  as  an  autonomous  infec¬ 
tion,  149 

alleged  parasite  of,  379,  398 
ravages  of,  in  Mexico,  403 

Z 

Zawarykin,  Dr.  on  intestinal  absorption,  70 
Zeissl,  Prof,  on  the  formidad  of  mercury  in 
syphilis,  20 

Zona,  relapse  of,  case  of,  593 

of  the  mouth.  Dr.  Deshayes’  case  of,  280 


LIST  OF  ILLUSTRATIONS. 

1.  Professor  Nussbaum’s  Bracelet  for  Writer’s 

Cramp,  82 

2.  Dr.  Pearse’s  Pocket  Medical  Emergency  Case, 

82 

3.  Mayer  and  Meltzer’s  Double  Drainage-Tube 

for  Empyema,  387 

4.  Allen’s  Irrigator  and  Enema  Apparatus,  333 

5.  Mr.  Croft’s  Cases  of  Club-Eoot,  589 


LONDON:  PRINTED  BY  PARDON  AND  SONS,  LOVELL’S  COURT,  PATERNOSTER  ROW. 


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